diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/11s-necX1t0.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/11s-necX1t0.srt
new file mode 100644
index 0000000000000000000000000000000000000000..c92ef7cabb2c8bc38d86e67cadd5055fd6d80bfa
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/11s-necX1t0.srt
@@ -0,0 +1,1402 @@
+1
+00:00:21,240 --> 00:00:23,520
+بسم الله الرحمن الرحيم نكمل إن شاء الله اليوم ال
+
+2
+00:00:23,520 --> 00:00:27,160
+lab diagnosis of Helicobacter pylori
+
+3
+00:00:28,910 --> 00:00:32,570
+شبه اتفاقنا أنه من أكثر الميكروبات التي تم
+
+4
+00:00:32,570 --> 00:00:39,250
+الاهتمام بها بالعقدين السابقين وتم إنتاج لها عدد
+
+5
+00:00:39,250 --> 00:00:42,750
+كبير من الفحوصات سنحاول مع بعض اليوم إن شاء الله
+
+6
+00:00:42,750 --> 00:00:47,410
+نتطرق للّي هو الـ diagnostic tests used for
+
+7
+00:00:47,410 --> 00:00:52,830
+this organism فسنعمل عملية مقارنة ما بين نوعين أو
+
+8
+00:00:52,830 --> 00:01:03,740
+صنفين سميناهما invasive و non-invasive الآن بالنسبة
+
+9
+00:01:03,740 --> 00:01:14,160
+للـ invasive  قلنا ندخل وناخذ بيوبسي أو
+
+10
+00:01:14,160 --> 00:01:24,600
+blood sample نبدأ في الـ biopsy الـ biopsy فيه عندي
+
+11
+00:01:24,600 --> 00:01:28,240
+staining
+
+12
+00:01:31,870 --> 00:01:36,730
+ناخذ الـ Staining ونشوف مع بعض ماذا ممكن نصبغ أو
+
+13
+00:01:36,730 --> 00:01:41,570
+كيف ممكن نصبغ اللي هو الـ Biopsy أول حاجة  أتحدث عن
+
+14
+00:01:41,570 --> 00:01:45,840
+simple stain  الذي يسمى Methylene blue
+
+15
+00:01:45,840 --> 00:01:52,420
+blue very simple stain just place
+
+16
+00:01:52,420 --> 00:01:56,820
+the biopsy in between two slides and squeeze يعني
+
+17
+00:01:56,820 --> 00:01:59,780
+نحط الـ biopsy على الشريحتين ونضغطهما، نفصلها عن
+
+18
+00:01:59,780 --> 00:02:03,280
+بعض فيصبح فيه عندي imprint طبعة هنا وطبعة هنا من
+
+19
+00:02:03,280 --> 00:02:06,720
+الشريحة نجففها، نعمل لها fixation، نلونها بـ
+
+20
+00:02:06,720 --> 00:02:10,380
+methylene blue وسنرى البكتيريا  ما شكلها Spiral أو Curved فيه عندي حالة تسمى
+
+21
+00:02:10,380 --> 00:02:16,200
+أي شكلها Spiral أو Curved  فيه عندي حالة تسمى
+
+22
+00:02:16,200 --> 00:02:23,640
+Silver Stain
+
+23
+00:02:23,640 --> 00:02:27,960
+Stain ليس مثل الـ Stain الذي تعملونه أنتم يعني خلينا
+
+24
+00:02:27,960 --> 00:02:33,280
+نقول في تقنية نوعا ما مختلفة قليلا لكن في الآخر هو
+
+25
+00:02:33,280 --> 00:02:39,160
+عبارة عن Simple Staining Procedures  ممكن أتحدث عن
+
+26
+00:02:39,160 --> 00:02:40,660
+الـ Gram Stain نفسه
+
+27
+00:02:44,750 --> 00:02:48,090
+يبقى فيه عندي  أكمل stain أصبح عندي simple stain مثل
+
+28
+00:02:48,090 --> 00:02:51,050
+الـ blue أصبح عندي silver stain أصبح عندي gram stain
+
+29
+00:02:51,050 --> 00:02:56,590
+أيها المفضل فيهم؟ الذي يعني معظم المراجع تقول أنه
+
+30
+00:02:56,590 --> 00:03:02,340
+الأفضل هو silver stain لكن أنا شخصيا عملت على الـ
+
+31
+00:03:02,340 --> 00:03:04,840
+Helicobacter pylori من البيوبسيس وعملت على الـ
+
+32
+00:03:04,840 --> 00:03:07,380
+methylene blue ووجدت أن methylene blue  very
+
+33
+00:03:07,380 --> 00:03:11,560
+simple وas effective as silver stain and other
+
+34
+00:03:11,560 --> 00:03:15,240
+techniques وبالتالي خلينا نقول أن أي من هذه
+
+35
+00:03:15,240 --> 00:03:19,980
+الفحوصات المتوفرة  can do  طيب قلنا الـ staining
+
+36
+00:03:19,980 --> 00:03:23,320
+methylene blue silver stain gram stain  ما فيه
+
+37
+00:03:23,320 --> 00:03:28,700
+غير الـ staining؟ فيه الـ culture إنها بكتيريا
+
+38
+00:03:28,700 --> 00:03:32,000
+micro-aerophilic  يعني تحتاج ٧٪ أو
+
+39
+00:03:32,000 --> 00:03:35,060
+٥٪ أكسجين تمام؟ يعني ممكن نزرعها أيضا،
+
+40
+00:03:35,060 --> 00:03:43,380
+ما الـ culture  التي نستخدمها؟  كانت بيئة
+
+41
+00:03:43,380 --> 00:03:43,860
+بيئة
+
+42
+00:03:46,660 --> 00:03:48,940
+التي تحدثنا عنها المرة الماضية، بيئة بلانت
+
+43
+00:03:48,940 --> 00:03:51,920
+أجر بليت التي أضفنا إليها الـ Vancomycin وأضفنا إليها
+
+44
+00:03:51,920 --> 00:03:55,480
+Trimethoprim  مظبوط؟ يبقى فيه عندي culture
+
+45
+00:03:55,480 --> 00:03:59,020
+لكن يجب أن نذكر أن هذه الـ culture  تحت
+
+46
+00:04:01,300 --> 00:04:07,000
+CO2 و ٥٪  O2 إذا نقطة مهمة جدا يجب أن
+
+47
+00:04:07,000 --> 00:04:10,040
+نعرفها  أن هذه الـ culture ليست culture عادية  خذوا
+
+48
+00:04:10,040 --> 00:04:14,560
+بالكم إذا جئنا نحن  نقارن أي تقنية في العالم في الـ
+
+49
+00:04:14,560 --> 00:04:18,620
+microbiology نقارنها بـ من؟ بـ الـ culture لذلك
+
+50
+00:04:18,620 --> 00:04:23,820
+تعتبر الـ culture شيئا نسميه  golden standard
+
+51
+00:04:25,730 --> 00:04:29,470
+أي المعيار الذهبي لأي فحوصات أخرى، مثلا طورنا
+
+52
+00:04:29,470 --> 00:04:33,750
+تقنية جديدة لنقول أن هذه التقنية جيدة أو غير
+
+53
+00:04:33,750 --> 00:04:36,810
+جيدة، نقارنها بمن؟ بـ الـ culture نقول as
+
+54
+00:04:36,810 --> 00:04:40,730
+sensitive as the culture as specific as the
+
+55
+00:04:40,730 --> 00:04:43,330
+culture إذن الـ culture غالبا ما هو الـ
+
+56
+00:04:43,330 --> 00:04:47,790
+golden standard  لكن تذكروا أنني أتحدث عن من؟ عن الـ
+
+57
+00:04:47,790 --> 00:04:52,430
+biopsy  الـ biopsy  كيف نأخذها؟ عملية معقدة
+
+58
+00:04:52,430 --> 00:04:57,170
+ندخل إلى المريض عبر منظار، هذه عملية ليست
+
+59
+00:04:57,170 --> 00:05:01,450
+محببة للمرضى، عملية ليست محببة للمرضى على الرغم من
+
+60
+00:05:01,450 --> 00:05:05,430
+دقة التقنية وأنها حساسة، لو one bacteria could
+
+61
+00:05:05,430 --> 00:05:10,750
+be isolated إلا أنها تقنية صعبة، ننتقل من
+
+62
+00:05:10,750 --> 00:05:13,290
+الـ culture ننتقل الآن  أريد أن أشرح الـ .. الـ ..
+
+63
+00:05:13,290 --> 00:05:15,990
+نتحدث عن من حتى الآن؟  عن الـ invasive
+
+64
+00:05:24,770 --> 00:05:31,050
+الآن الـ biopsy  نفسه، أنا ممكن أعمل له test كيف
+
+65
+00:05:31,050 --> 00:05:35,030
+يعني؟  الـ biopsy  قطعة صغيرة، قطعة
+
+66
+00:05:35,030 --> 00:05:39,210
+صغيرة يأخذها الجراح الذي يعمل المناظير، يأخذها هو
+
+67
+00:05:39,210 --> 00:05:44,950
+في أثناء جولة  في المعدة، يجد منطقة inflamed  حمرة،
+
+68
+00:05:44,950 --> 00:05:48,840
+وبالتالي يأخذ عينة منها  ويخرج بها، أنا أحضرت
+
+69
+00:05:48,840 --> 00:05:55,160
+أنبوبة فيها ten percent urea وفيها indicator أو
+
+70
+00:05:55,160 --> 00:06:01,700
+indicators  عفوا مثل phenol red،  ووضع الـ biopsy داخل
+
+71
+00:06:01,700 --> 00:06:06,810
+الأنبوبة within one minute،  إذا الـ ..
+
+72
+00:06:06,810 --> 00:06:10,050
+الـ biopsy فيه Helicobacter pylori يعني فيه
+
+73
+00:06:10,050 --> 00:06:13,430
+يورياز، وتذكرون كلمة يورياز؟  له يورياز،
+
+74
+00:06:13,430 --> 00:06:15,970
+له strong يورياز producer
+
+75
+00:06:15,970 --> 00:06:20,950
+within one minute it will turn this into different
+
+76
+00:06:20,950 --> 00:06:25,090
+color وبالتالي الفحص  إيجابي، إذا within one minute
+
+77
+00:06:25,090 --> 00:06:28,430
+لم يطرأ أي تغيير في اللون يكون الفحص سلبي
+
+78
+00:06:28,430 --> 00:06:34,470
+وهذا يسمى ultra rapid urease test  أنه ultra
+
+79
+00:06:34,470 --> 00:06:40,390
+مثل super أكثر من super  يعني ultra rapid rapid
+
+80
+00:06:40,390 --> 00:06:45,010
+معناه سريع urease test هذا أين ينفع هذا الفحص؟
+
+81
+00:06:45,010 --> 00:06:49,860
+في المختبرات؟ أم في عيادة الأطباء؟ في بعض الأحيان
+
+82
+00:06:49,860 --> 00:06:53,640
+الطبيب يأخذ العينة مباشرة بالفعل حضرنا
+
+83
+00:06:53,640 --> 00:06:56,580
+لبعض الزملاء والأصدقاء على سبيل التجربة من الأطباء
+
+84
+00:06:56,580 --> 00:07:01,400
+حضرنا لهم هذه الـ media  التي لا تكلف الفحص الواحد
+
+85
+00:07:01,400 --> 00:07:06,160
+نصف قيمة الفحص الواحد، هذه الأنبوبة الواحدة  تكلف
+
+86
+00:07:06,160 --> 00:07:11,200
+لكن في الآخر تذكروا  بيوبسي،  البيوبسي يدخل إلى داخل
+
+87
+00:07:11,200 --> 00:07:16,380
+المعدة  ونأخذ عينة منها إذن هذا الفحص أيضا  كثير
+
+88
+00:07:16,380 --> 00:07:26,370
+مشهور، اسمه ultra rapid urease test  فضلا عن
+
+89
+00:07:26,370 --> 00:07:32,090
+وفيه
+
+90
+00:07:32,090 --> 00:07:37,050
+.. وفيه أدوات لجمع العينات مثل الكباش، تمام
+
+91
+00:07:37,050 --> 00:07:41,670
+يلتقط فيها العينة،  يعني يخدم غرضين: غرض  أن يشاهد
+
+92
+00:07:41,670 --> 00:07:43,170
+وفي نفس الوقت غرض أن يأخذ عينة
+
+93
+00:07:46,900 --> 00:07:56,080
+طيب ننتقل معا إلى  يورياز test  ننتقل إلى PCR
+
+94
+00:07:58,690 --> 00:08:00,830
+الآن الـ PCR هو عبارة عن molecular technique،
+
+95
+00:08:00,830 --> 00:08:04,170
+molecular technique  ليس فحصا سهلا، هو عبارة عن
+
+96
+00:08:04,170 --> 00:08:08,210
+.. عبارة عن amplification، amplification بمعنى أنه
+
+97
+00:08:08,210 --> 00:08:11,490
+يكبر لي قطعة معينة  أبحث عنها، التي
+
+98
+00:08:11,490 --> 00:08:14,550
+تسمى الـ unique sequence  التي نراها في الـ
+
+99
+00:08:14,550 --> 00:08:18,230
+Helicobacter pylori  طبعا أصبحت اليوم التقنية يعني
+
+100
+00:08:18,230 --> 00:08:23,750
+أسهل من أن نتحدث عنها،  فين لدي  مجهر فلوري؟
+
+101
+00:08:25,590 --> 00:08:29,110
+ولنفترض لا يوجد فلوريسنت  in situ
+
+102
+00:08:29,110 --> 00:08:38,290
+hybridization يعني ندخل إلى داخل الخلية ونصبغ ونعمل
+
+103
+00:08:38,290 --> 00:08:42,310
+florescent staining داخل الخلية، داخل الخلية
+
+104
+00:08:42,310 --> 00:08:46,470
+florescent in situ hybridization  تقنية رائعة جدا
+
+105
+00:08:46,470 --> 00:08:49,970
+تعالوا نشوف كيف نستخدمها،  تعرفون الـ biopsy
+
+106
+00:08:49,970 --> 00:08:53,930
+التي تحدثنا عنها، القطعة الصغيرة،  لا نعمل بها
+
+107
+00:08:53,930 --> 00:09:01,470
+شيئا هنا،  نضعها في Formalin  حتى
+
+108
+00:09:01,470 --> 00:09:04,610
+يستخدم Formalin نحن في علم الأنسجة، صحيح؟
+
+109
+00:09:04,610 --> 00:09:08,350
+نوديها على علم الأنسجة  ونقول لهم أعدوا لنا
+
+110
+00:09:08,350 --> 00:09:09,370
+شرائح
+
+111
+00:09:12,000 --> 00:09:17,160
+Tissue section يعني يضعونها في .. دلسوها
+
+112
+00:09:17,160 --> 00:09:20,920
+في علم الأنسجة  لا تقلقوا ..  كيف نصنع شريحة من
+
+113
+00:09:20,920 --> 00:09:26,240
+نسيج، ليس مزرعة أنسجة،  عملنا fixation  بالفورمالين
+
+114
+00:09:26,240 --> 00:09:30,840
+تمام؟ وبعدين  عملنا لها embedding  بالشموع، وبعد الشمع
+
+115
+00:09:30,840 --> 00:09:34,440
+القطعة أصبحت موجودة أين؟ في قلب الشمع وبعدين
+
+116
+00:09:34,440 --> 00:09:37,840
+نأخذها ونعمل لها sectioning، sectioning  يعني
+
+117
+00:09:37,840 --> 00:09:41,420
+نقطعها شرائح دقيقة جدا، ١ ميكرون، ١.٥
+
+118
+00:09:41,420 --> 00:09:44,480
+ميكرون، ونأخذ جزء من الـ ..  طبعا لأنها تكون
+
+119
+00:09:44,480 --> 00:09:46,940
+موجودة في الشمع  نستطيع أن نتعامل .. نمسكها بملقط  نستطيع
+
+120
+00:09:46,940 --> 00:09:53,890
+أن نعمل بها  أي طريقة ونضعها على الشريحة تمام؟ الآن الـ
+
+121
+00:09:53,890 --> 00:09:59,130
+tissue  موجودة على الشريحة، نفترض أن الـ tissue فيه
+
+122
+00:09:59,130 --> 00:10:04,230
+Helicobacter pylori واستخدمنا أنا كلمة ماذا؟
+
+123
+00:10:04,230 --> 00:10:09,990
+ماذا  probe؟ complementary RNA complementary  لـ DNA
+
+124
+00:10:09,990 --> 00:10:15,030
+أي RNA complementary لـ DNA؟  يعني sequence موجود
+
+125
+00:10:15,030 --> 00:10:19,170
+له complementary في من؟ في البكتيريا نفسها،  نعمل
+
+126
+00:10:19,170 --> 00:10:22,360
+عملية denaturation،  ماذا تعني؟ تعرفون الـ
+
+127
+00:10:22,360 --> 00:10:26,100
+denaturation؟ التي هي فصل أو فك الـ .. الـ .. الـ
+
+128
+00:10:26,100 --> 00:10:29,140
+strands عن بعضها ونضيف الـ reaction  تبعنا فيصبح re
+
+129
+00:10:29,140 --> 00:10:32,660
+annealing، إذا الـ .. إذا البكتيريا موجودة our
+
+130
+00:10:32,660 --> 00:10:36,100
+probe  الذي هو fluorescent labelled  سيرتبط داخل
+
+131
+00:10:36,100 --> 00:10:40,020
+البكتيريا تمام؟ يبقى لما أنظر تحت الـ fluorescent
+
+132
+00:10:40,020 --> 00:10:43,340
+microscope  على الشريحة سأرى  الـ fluorescent
+
+133
+00:10:43,340 --> 00:10:46,940
+سأرى البكتيريا وهي تضيء لأننا قمنا بـ labeling
+
+134
+00:10:46,940 --> 00:10:51,130
+قمنا بـ labeling  ميزة في الموضوع أن هذا الـ labeling
+
+135
+00:10:51,130 --> 00:10:55,210
+could be with different colors يعني يعطينا أخضر
+
+136
+00:10:55,210 --> 00:10:59,030
+أصفر أحمر  labeling أنا ممكن أبحث ليس فقط عن
+
+137
+00:10:59,030 --> 00:11:04,010
+البكتيريا،  ممكن أبحث عن جينات معينة في البكتيريا
+
+138
+00:11:04,010 --> 00:11:07,810
+مثل clarithromycin resistant التي بحثنا عنها
+
+139
+00:11:11,050 --> 00:11:15,910
+mycine-resistant genes في غزة بحثنا عن الـ
+
+140
+00:11:15,910 --> 00:11:21,010
+bacteria  في البيوبسيات من المرضى، بالإضافة إلى ذلك
+
+141
+00:11:21,010 --> 00:11:24,390
+نريد أن نرى مدى مقاومتها لمن؟  للـ mycine-resistant
+
+142
+00:11:24,390 --> 00:11:27,690
+genes  بحثنا عن الجين المسؤول عن المقاومة
+
+143
+00:11:27,690 --> 00:11:30,710
+بـ probes  وبالفعل نجحنا ووجدنا أن هناك نسبة
+
+144
+00:11:30,710 --> 00:11:36,290
+معينة من  البحث صحيح،  أصبح عمره خمس سنوات لكن لم
+
+145
+00:11:36,290 --> 00:11:42,910
+ننشره، في مواعيد جديدة لنشر البحث، لكن الـ FISH
+
+146
+00:11:42,910 --> 00:11:46,670
+أعطاني معلومة إضافية: البكتيريا موجودة أو غير موجودة
+
+147
+00:11:46,670 --> 00:11:50,150
+وإذا كانت موجودة ممكن أبحث عن صفات أخرى مثل الـ
+
+148
+00:11:50,150 --> 00:11:55,250
+resistant gene لماذا هذه التقنية مهمة؟  إنها مكلفة
+
+149
+00:11:55,250 --> 00:12:02,610
+وتستغرق وقتا طويلا،  وهي مشتقة من ماذا؟  من الـ
+
+150
+00:12:02,610 --> 00:12:05,450
+culture  تعالوا  نرى في غزة  من يقوم بـ culture  كم
+
+151
+00:12:05,450 --> 00:12:13,530
+مختبر يقوم بها؟ صفر،  طبعا الآن الكثير من
+
+152
+00:12:13,530 --> 00:12:16,210
+المختبرات أصبحت لديها molecular techniques  وأصبحت
+
+153
+00:12:16,210 --> 00:12:18,890
+لديها fluorescent microscope وبالتالي الـ
+
+154
+00:12:18,890 --> 00:12:22,030
+fluorescent microscope موجود، موجود الآن بدلا من
+
+155
+00:12:22,030 --> 00:12:24,830
+أن أعمل culture بدلا من أن أعمل culture وأعمل
+
+156
+00:12:24,830 --> 00:12:29,630
+sensitivity أنا الآن أعمل FISH  لشخص واحد
+
+157
+00:12:29,630 --> 00:12:32,590
+وأعرف هل هي مقاومة للمضاد الحيوي الذي أريد
+
+158
+00:12:32,590 --> 00:12:39,170
+أن أعطيها أم لا، هذه أيضا نقطة مهمة، إذن
+
+159
+00:12:39,170 --> 00:12:43,450
+أصبح لدينا كم تقنية الآن في الـ .. في الـ invasive
+
+160
+00:12:43,450 --> 00:12:49,410
+Staining, Culture, Urease Test و PCR و FISH  قلنا
+
+161
+00:12:49,410 --> 00:12:55,810
+فيه غير الـ biopsy  الذي هو من؟ الـ blood الـ
+
+162
+00:12:55,810 --> 00:13:02,210
+sample وأخرى تسمى الـ serum الـ serum أول شيء
+
+163
+00:13:02,210 --> 00:13:06,170
+فعلناه، بحثنا عن الـ antibody الـ IgG  بحثنا عن الـ
+
+164
+00:13:06,170 --> 00:13:10,960
+IgG  قلت لكم بالأمس في المحاضرة أن ٥٠٪ من سكان
+
+165
+00:13:10,960 --> 00:13:15,810
+العالم نجد أنهم  positive  عندما نظرنا إلى الـ
+
+166
+00:13:15,810 --> 00:13:20,090
+pathogenesis  للبكتيريا، وجدنا أن most of
+
+167
+00:13:20,090 --> 00:13:25,370
+patients will tolerate  يتحملونه  و they will resist  و
+
+168
+00:13:25,370 --> 00:13:28,510
+they will recover spontaneously وبالتالي ليس كل
+
+169
+00:13:28,510 --> 00:13:34,630
+شخص لديه IgG  يعني أنه لديه active infection  ليس
+
+170
+00:13:34,630 --> 00:13:36,430
+ضروريا أن يكون لديه active infection  ربما أصيب
+
+171
+00:13:36,430 --> 00:13:40,470
+في وقت سابق  ولا يزال لديه مناعة،  إذن هذا الفحص علامة
+
+172
+00:13:40,470 --> 00:13:46,310
+استفهام،  نبحث عن IgM نبحث عن IgM
+
+173
+00:13:46,310 --> 00:13:50,710
+وأنتم جميعا تعلمون أن IgM  مؤشر على أن
+
+174
+00:13:50,710 --> 00:13:55,230
+recent infection هذا جيد، فيه أيضا  kit أو
+
+175
+00:13:55,230 --> 00:14:00,950
+فحص يستخدم IgA  أقول لكم لأن الجسم إذا كون IgA
+
+176
+00:14:00,950 --> 00:14:05,290
+يعني أيضا أن هناك active infection لأن IgA
+
+177
+00:14:05,290 --> 00:14:08,870
+تحمي  mucous membrane تحمي الـ mucous membrane
+
+178
+00:14:08,870 --> 00:14:12,230
+إذا كم فحص  متوفر الآن في فحوصات IgG
+
+179
+00:14:12,230 --> 00:14:15,150
+ممكن نستخدم IgG لمن؟  لـ screening  أي نرى
+
+180
+00:14:15,150 --> 00:14:19,470
+من  population  ما
+
+223
+00:17:40,460 --> 00:17:45,040
+الـ carbon 14 في هذه الحالة كثير في نفس المريض
+
+224
+00:17:45,040 --> 00:17:50,700
+above a محدد level وبخلال carbon 14 measurement
+
+225
+00:17:50,700 --> 00:17:53,900
+بنعرف إذا كان المريض عنده Helicobacter pylori أم لا
+
+226
+00:17:53,900 --> 00:17:58,460
+ماعندهش Helicobacter pylori وصلت النتيجة أم لا، أكيد؟
+
+227
+00:17:58,460 --> 00:18:03,750
+مرة أخرى، بيقول إن المريض شرب يوريا
+
+228
+00:18:03,750 --> 00:18:08,430
+يوريا، و الـ carbon تبعها أربعة، لأنها radioactive
+
+229
+00:18:09,140 --> 00:18:12,460
+دخلت إلى المعدة قابلة للهليكوبكتر بايلوري
+
+230
+00:18:12,460 --> 00:18:15,500
+الهليكوبكتر بايلوري عندها إنزيم بالفطرة تنتجه
+
+231
+00:18:15,500 --> 00:18:19,940
+يسموه Constitutive enzyme، يعني سواء كان الأمر لازم
+
+232
+00:18:19,940 --> 00:18:24,560
+أو مش لازم، بتنتجه، وبتنتجه بكميات كبيرة، اليورياز
+
+233
+00:18:24,560 --> 00:18:29,700
+يُحوّل اليوريا إلى أمونيا و CO2، الـ C أتذكر الـ C
+
+234
+00:18:29,700 --> 00:18:36,360
+العادي 12، اللي شربه المريض، إذا اتكسر هيطلع
+
+235
+00:18:36,360 --> 00:18:41,600
+أين؟ مع الـ ... مع الزفير، احنا
+
+236
+00:18:41,600 --> 00:18:45,280
+اللي خدناها، العينة اللي خدناها، عينة زفير، هواء، حطيناها
+
+237
+00:18:45,280 --> 00:18:51,180
+في الجهاز، ليقيس الـ radio activity، إذا وجد radio
+
+238
+00:18:51,180 --> 00:18:57,580
+activity، معناه  ... ماذا يعني؟ لأنه carbon 14،
+
+239
+00:18:57,580 --> 00:19:00,740
+carbon 14 من أين جاء؟ من تكسير اليوريا، من تكسير
+
+240
+00:19:00,740 --> 00:19:05,360
+اليوريا، هذه النقطة المهمة، هذا الفحص رائع جداً، و
+
+241
+00:19:05,360 --> 00:19:08,700
+الحساسية تبعته، و الـ sensitivity، أو عفواً، الـ
+
+242
+00:19:08,700 --> 00:19:13,740
+specificity، توازي الـ culture، يعني لو قلنا من هو
+
+243
+00:19:13,740 --> 00:19:17,380
+الـ golden standard في الـ non invasive، في الـ non
+
+244
+00:19:17,380 --> 00:19:23,380
+invasive، هذا هو، في الـ invasive الـ culture.  في  الـ non
+
+245
+00:19:23,380 --> 00:19:28,640
+invasive، غير الـ urea breath test،  يوجد أيضاً  stool antigen
+
+246
+00:19:28,640 --> 00:19:35,870
+stool antigen، بمعنى تعالوا نتخيل البكتيريا
+
+247
+00:19:35,870 --> 00:19:41,590
+البكتيريا عاملة قرحة في المعدة و تتكاثر، ومع طحن
+
+248
+00:19:41,590 --> 00:19:45,130
+الطعام و الشراب، ينزل أجزاء من الخلايا الميتة اللي
+
+249
+00:19:45,130 --> 00:19:48,270
+فيها Helicobacter pylori، تروح على الـ intestine، و
+
+250
+00:19:48,270 --> 00:19:51,430
+في الآخر تطلع في البراز، يبقى البراز بيحتوي على
+
+251
+00:19:51,430 --> 00:19:54,950
+البكتيريا، أو على الأقل على
+
+252
+00:19:54,950 --> 00:19:59,050
+بقايا البكتيريا، وبقايا البكتيريا، ماذا نسميها نحن؟
+
+253
+00:19:59,050 --> 00:20:01,970
+Antigens، أليس كذلك؟ ما هي إلا fragments من البكتيريا
+
+254
+00:20:01,970 --> 00:20:06,520
+فهي Antigens، فهي Antigens، في الـ stool detection
+
+255
+00:20:06,520 --> 00:20:09,900
+أعتقد أيضاً، مرة أخرى، يعني هذا الفحص، أو هذا
+
+256
+00:20:09,900 --> 00:20:15,080
+الفحص، يعني فحوصات رائعة، وما في أيّ مشكلة، لماذا؟ لأنه
+
+257
+00:20:15,080 --> 00:20:19,920
+غير invasive، أخذ عينة براز، أخذ عينة هواء، العملية ليست
+
+258
+00:20:19,920 --> 00:20:24,220
+عملية معقدة، تتم عملية extraction بطريقة معينة، و
+
+259
+00:20:24,220 --> 00:20:26,240
+بعدين فحص serology،  يُنتج الجسم، إذا وجد
+
+260
+00:20:26,240 --> 00:20:28,520
+agglutination، بسيط، ما في agglutination، بيكون الفحص
+
+261
+00:20:28,520 --> 00:20:33,440
+negative، هذا الفحص متوفر في غزة، بينما هذا الفحص
+
+262
+00:20:33,440 --> 00:20:39,140
+للأسف، حتى الآن، غير متوفر في قطاع غزة، لأن صار لنا
+
+263
+00:20:39,140 --> 00:20:44,820
+صورة، نقدر نقول شبه كاملة، لكن صورة، يعني
+
+264
+00:20:44,820 --> 00:20:49,160
+نوعاً ما موسعة، عن الطرق المتنوعة أو المختلفة للـ
+
+265
+00:20:49,160 --> 00:20:57,100
+diagnosis، وهو الـ Helicobacter pylori، بالنسبة
+
+266
+00:20:57,100 --> 00:21:01,660
+له، اليوريا breath test، عينة الهواء اللي قلت لكم
+
+267
+00:21:01,660 --> 00:21:02,000
+عنها
+
+268
+00:21:04,880 --> 00:21:07,520
+بالنسبة للعلاج، تبقى Helicobacter pylori تُعالج
+
+269
+00:21:07,520 --> 00:21:11,260
+بأن نعطي ثلاثة أو أربعة مضادات حيوية، يسمى
+
+270
+00:21:11,260 --> 00:21:14,560
+triple therapy أو quadruple therapy، يعني يا علاج
+
+271
+00:21:14,560 --> 00:21:19,340
+ثلاثي، يا علاج رباعي، عشان تكونوا في الصورة، لو احنا
+
+272
+00:21:19,340 --> 00:21:22,300
+طلعنا على المثال اللي يكون على السبورة، عندنا من
+
+273
+00:21:22,300 --> 00:21:27,590
+triple therapy، مترونيدازول، زائد Clarithromycin أو
+
+274
+00:21:27,590 --> 00:21:31,710
+amoxicillin، واحد من الاثنين، زائد
+
+275
+00:21:31,710 --> 00:21:35,670
+أوميبرازول، هذا الأوميبرازول ليس مضاد حيوي، وإنما proton
+
+276
+00:21:35,670 --> 00:21:39,710
+pump inhibitor
+
+277
+00:21:43,000 --> 00:21:49,020
+يعني يقلل من إفراز الحامض في المعدة، لكن برضه في
+
+278
+00:21:49,020 --> 00:21:52,180
+اعتقاد أنه له Antimicrobial Activity، لكن استخدامه
+
+279
+00:21:52,180 --> 00:21:55,280
+الأساسي كـ proton pump inhibitor، أنا قلت جاب شوية
+
+280
+00:21:55,280 --> 00:21:59,000
+إنْ جئنا في غزة، الاريثروميسين مقاوم، طب هذا الـ
+
+281
+00:21:59,000 --> 00:22:03,320
+antibiotic أصلاً، يعني بتقدر تقولوا إنه استخدامه في
+
+282
+00:22:03,320 --> 00:22:06,960
+قطاع غزة أسوأ استخدام على وجه الأرض، هذا الـ ... الـ
+
+283
+00:22:06,960 --> 00:22:10,160
+amoxicillin، فبالتالي احتمال مقاومة الكلاريثروميسين
+
+284
+00:22:10,160 --> 00:22:13,880
+والـ amoxicillin، الاثنين، المقاومة، وطبعاً ليس فقط
+
+285
+00:22:13,880 --> 00:22:16,800
+في بلدنا، في بلدان أخرى، في استخدام مفرط
+
+286
+00:22:16,800 --> 00:22:20,380
+للمضادات الحيوية، لذلك نلجأ إلى ... كل فترة، يا
+
+287
+00:22:20,380 --> 00:22:22,860
+شباب، بيصير فيه review للـ protocol، ماذا يعني review
+
+288
+00:22:22,860 --> 00:22:27,200
+للـ protocol؟ مراجعة للـ protocol العلاجي، بمعنى أنه
+
+289
+00:22:27,200 --> 00:22:29,880
+إذا وجدنا نسبة كبيرة من المقاومة لهذا
+
+290
+00:22:29,880 --> 00:22:34,300
+الـ antibiotic، نغيره، لكن لاحظوا أن الـ key
+
+291
+00:22:34,300 --> 00:22:39,380
+component في العلاج هو المترونيدازول، وهو المستخدم
+
+292
+00:22:39,380 --> 00:22:45,880
+للبكتيريا اللاهوائية، هذا معروف عنه، هذا الشيء
+
+293
+00:22:45,880 --> 00:22:46,860
+الخاص به، فجيل
+
+294
+00:22:50,070 --> 00:22:53,630
+أكثر استخدام له، للانتاميبة الهستولتيكا، الجيارديا
+
+295
+00:22:53,630 --> 00:22:57,450
+لامبليا، يعني الجيارديا لامبليا، والانتاميبة الهستولتيكا
+
+296
+00:22:57,450 --> 00:23:02,290
+لامبليا، لكن بالإضافة للجيارديا والانتاميبة، نستخدمه
+
+297
+00:23:02,290 --> 00:23:06,190
+للبكتيريا اللاهوائية، طب هذه بكتيريا لاهوائية؟ لا،
+
+298
+00:23:06,190 --> 00:23:09,270
+لكن وجد أن له تأثير قوي جداً على هذه البكتيريا
+
+299
+00:23:09,270 --> 00:23:13,390
+إذا الـ key component هو المترونيدازول، هذا أيضاً
+
+300
+00:23:13,390 --> 00:23:17,170
+key component، طلع هذين الجميلين، المتغير اللي
+
+301
+00:23:17,170 --> 00:23:22,970
+بنلعب فيه غالباً، اللي هو الـ antibiotics العادية، عصب
+
+302
+00:23:22,970 --> 00:23:25,190
+الردوسيين، اللي هما الـ clarithromycin أو الـ
+
+303
+00:23:25,190 --> 00:23:30,790
+اللي هو ...  ممكن الـ vaccine، لازم ...  يجب أن ...
+
+304
+00:23:30,790 --> 00:23:33,510
+يجب أن العالم يحاول أن ينتج vaccine، لأنه ينتج
+
+305
+00:23:33,510 --> 00:23:37,110
+vaccine فعال، يمكن أن يكون هو الحل الأمثل، مثل هذا الـ
+
+306
+00:23:37,110 --> 00:23:41,130
+microbe المنتشر بشكل كبير، طيب، هكذا يمكن أن نختم
+
+307
+00:23:41,130 --> 00:23:44,450
+المحاضرة، لكن أنا الصحيح كنت حابب أُعرِض لكم
+
+308
+00:23:44,450 --> 00:23:46,990
+software عملناه
+
+309
+00:23:49,230 --> 00:23:52,870
+أحدهم، واحد من الطلاب في الجامعة الإسلامية، وهو صمم
+
+310
+00:23:52,870 --> 00:23:55,010
+خصيصاً لطلبة التخصصات الطبية الصحية، ومع أنه
+
+311
+00:23:55,010 --> 00:23:58,710
+عمله طالب من كلية الطب، فلنُطلع معاً على
+
+312
+00:23:58,710 --> 00:24:03,510
+مواصفاته، وكيفية استخدام هذا البرنامج، أولاً، نُنسب
+
+313
+00:24:03,510 --> 00:24:08,690
+الفضل لأهله، اللي عمل البرنامج، طالب اسمه
+
+314
+00:24:08,690 --> 00:24:15,550
+عبد الكريم زهير صادق، و ذكي اليازجي همام، هذان
+
+315
+00:24:15,550 --> 00:24:18,790
+الطالبان، كانا طالبين مميزين في كلية الطب، صحيح
+
+316
+00:24:18,790 --> 00:24:23,150
+وعملا هذا المشروع الناجح، فلازم ننسب لهم الفضل
+
+317
+00:24:23,150 --> 00:24:27,230
+لأنهما عملا هذا المشروع
+
+318
+00:24:27,230 --> 00:24:31,310
+فيه
+
+319
+00:24:31,310 --> 00:24:35,540
+هناك حالة، اسمها ... أو خياران في بداية البرنامج، Go to
+
+320
+00:24:35,540 --> 00:24:40,080
+consecutive test، فحوصات متتابعة، تذكرون نحن ذُكرنا
+
+321
+00:24:40,080 --> 00:24:44,760
+في تعريف الميكروبات، إما نستخدم قائمة متوازية
+
+322
+00:24:44,760 --> 00:24:49,060
+بالتوازي، نعمل indoor و indoor، مثل الـ ABI، أو نجئ
+
+323
+00:24:49,060 --> 00:24:53,510
+نفكر بطريقة مختلفة، اللي طلعت Ureas test، نعملها
+
+324
+00:24:53,510 --> 00:24:58,210
+فحص، هكذا، صح؟ هذا الكلام يأخذ وقتاً طويلاً، لكن هو
+
+325
+00:24:58,210 --> 00:25:02,210
+عملية تدريب فقط، ليست عملية تعريف على الـ micro
+
+326
+00:25:02,210 --> 00:25:04,990
+organism، نأخذ الخيار الأول، وبعدين نرجع للخيار
+
+327
+00:25:04,990 --> 00:25:11,310
+الثاني، أول فحص بدأنا به بشكل عام، هو خاصية الـ
+
+328
+00:25:11,310 --> 00:25:13,530
+gram stain، تعالوا نختار ... احنا لماذا ... علشان
+
+329
+00:25:13,530 --> 00:25:15,090
+تعرفوا أنتم عن الـ gram، انظروا، اللي gram negative
+
+330
+00:25:15,090 --> 00:25:17,690
+تعرفونه أنتم، اللي أنتم خلصتوه، gram negative، هذه gram
+
+331
+00:25:17,690 --> 00:25:20,570
+negative، بس اللي هو الكوكساي، حتى اللي أنتم
+
+332
+00:25:20,570 --> 00:25:23,370
+تعرفونه، بس اللي هو ...  الهوائية، أم اللاهوائية؟
+
+333
+00:25:23,370 --> 00:25:26,270
+تعرفون الاثنين؟ تعرفون الاثنين؟ يعني الفاكولت ...
+
+334
+00:25:27,370 --> 00:25:33,170
+خلّيني أقول، هل البكتيريا نمت هوائياً أم لا؟
+
+335
+00:25:33,170 --> 00:25:36,330
+هوائياً، إذا هوائياً، ممكن تكون Facultative anaerobic
+
+336
+00:25:36,330 --> 00:25:41,090
+أيضاً، أم لا، فأتعلق، أنا نمت هوائياً، خذوا بالكم
+
+337
+00:25:41,090 --> 00:25:45,110
+وأنا جائع أشتغل، وأنا جائع أشتغل وأختار، يكتب لي تحت
+
+338
+00:25:45,110 --> 00:25:49,750
+أنك اخترت، يذكرك، gram negative، لكنها هوائية
+
+339
+00:25:49,750 --> 00:25:53,230
+bacteria، صح أم لا؟ هي اللي اخترتها، طيب
+
+340
+00:25:53,230 --> 00:25:55,950
+البكتيريا، fastidious أم non fastidious؟
+
+341
+00:25:55,950 --> 00:26:00,190
+نفترض أنها non fastidious، طيب، البكتيريا oxidase
+
+342
+00:26:00,190 --> 00:26:05,370
+positive أم negative؟ نختار negative، طيب، الـ next
+
+343
+00:26:05,370 --> 00:26:08,070
+step you must do is، oxidation fermentation test، أذكرني، الـ oxidation
+
+344
+00:26:08,070 --> 00:26:10,850
+fermentation test، the bacterium is
+
+345
+00:26:10,850 --> 00:26:14,130
+oxidative أم fermentative؟  ماهي؟ أخذت الكوكينة
+
+346
+00:26:14,130 --> 00:26:18,470
+oxidase negative، غالباً ستكون هنا،  ممكن أن تكون
+
+347
+00:26:18,470 --> 00:26:21,390
+fermentative، طيب، lactose و non-lactose،  انظروا
+
+348
+00:26:21,390 --> 00:26:25,740
+شوية non-lactose fermenter، خذوا بالكم، في القائمة اللي
+
+349
+00:26:25,740 --> 00:26:31,180
+تحت، كل شيء أنت اخترته، سجل لك إياه، تمام؟ بألوان
+
+350
+00:26:31,180 --> 00:26:34,220
+جميلة، أليس كذلك؟ بألوان جميلة، وماذا أيضاً؟ ومعلومات
+
+351
+00:26:34,220 --> 00:26:38,800
+أيضاً جيدة،  لأ، حقيقة برنامج رائع، ولِمَ نصل نحن
+
+352
+00:26:38,800 --> 00:26:42,960
+للروعة، لأن الروعة ليست فقط التعرف على البكتيريا،  بل أيضاً
+
+353
+00:26:42,960 --> 00:26:47,560
+أن نرى صورها، ونرى بعض المعلومات عنها، البكتيريا هذه
+
+354
+00:26:47,560 --> 00:26:55,940
+الـ negative، نختار نحن
+
+355
+00:26:55,940 --> 00:27:01,220
+من؟ سالمونيلا، لأن عندما جلّت البكتيريا تبعتنا سالمونيلا
+
+356
+00:27:01,220 --> 00:27:05,600
+تمام، ضغطنا على السالمونيلا، أعطاني صورها
+
+357
+00:27:06,160 --> 00:27:08,680
+gram negative، بس، الله، ليس ... ليس ضروري الصورة
+
+358
+00:27:08,680 --> 00:27:12,480
+السالمونيلا، لأ، أعطاني في كل فحص أنا اخترته، أعطاني
+
+359
+00:27:12,480 --> 00:27:15,740
+صورة عنه، هي oxidase negative، gram negative، بس
+
+360
+00:27:15,740 --> 00:27:18,280
+الله، أنا هوائية، بكتيريا هوائية، المفروض اللي
+
+361
+00:27:18,280 --> 00:27:21,080
+الـ ... الـ ... هذه الصورة عاملها لكل non fastidious
+
+362
+00:27:21,080 --> 00:27:24,440
+بكتيريا، معلق، أي حاجة عندي non lactose fermenter
+
+363
+00:27:24,440 --> 00:27:29,220
+لونها المكونكي colorless، glucose fermenter، صورة
+
+364
+00:27:29,220 --> 00:27:33,560
+معبرة عن الفحوصات اللي استخدمناها،  هيفندي الـ
+
+365
+00:27:33,560 --> 00:27:36,160
+H2S، والـ motility، will your risk test negative،
+
+366
+00:27:36,160 --> 00:27:38,900
+الآن، في هذه النقطة اللي نحكي عنها، الـ clinical
+
+367
+00:27:38,900 --> 00:27:43,140
+details، عاملين عن كل ميكروب من الميكروبات اللي
+
+368
+00:27:43,140 --> 00:27:47,740
+موجودين في السلسلة، عاملين نحن، حارس، إنها summary
+
+369
+00:27:47,740 --> 00:27:51,440
+of clinical details، اللي جاي نقول، سلام الله، ليس
+
+370
+00:27:51,440 --> 00:27:54,720
+يسير، ليس هين علينا أن نكتبها كلها في إطار واحد، فـ
+
+371
+00:27:54,720 --> 00:27:57,080
+هكذا، بسم الله،  فيه Enterocolitis، أخذنا سنة و
+
+372
+00:27:57,080 --> 00:28:00,180
+نهار طويل، أعطانا الـ disease characteristic، العَرَضيات،
+
+373
+00:28:00,180 --> 00:28:02,400
+habitat and transmission،  بعض genesis، laboratory
+
+374
+00:28:02,400 --> 00:28:07,200
+diagnosis، treatment and prevention، برنامج يعني
+
+375
+00:28:07,200 --> 00:28:14,000
+خلينا نقول مفيد جداً للطالب، بدل ما يضيع وقته على ...
+
+376
+00:28:14,000 --> 00:28:16,960
+لأ، ليس على الفيسبوك فقط،  أنا ... أنا ... أنا أيضاً
+
+377
+00:28:16,960 --> 00:28:19,360
+أحياناً أبدأ ... أنا ... أنا أتنبه، يعني ... يعني إن شاء
+
+378
+00:28:19,360 --> 00:28:24,940
+الله يكون فيه منفعة، الإنسان من طبعه يمل من
+
+379
+00:28:24,940 --> 00:28:30,560
+الأشياء التي يجد عليها وقتاً، فأنا أقول، الإنسان المجتهد، لما
+
+380
+00:28:30,560 --> 00:28:36,820
+يمل من شكل من أشكال الدراسة، لو جَرّب نوعاً آخر من
+
+381
+00:28:36,820 --> 00:28:41,520
+أنواع الدراسة، هذا أيضاً يقتل الملل، ويعني استغلال
+
+382
+00:28:41,520 --> 00:28:45,700
+الوقت بشكل جيد، فبدل ما يقرأ من الكتاب العادي، أو
+
+383
+00:28:45,700 --> 00:28:49,380
+الكتاب الإلكتروني، يعمل تحدياً مع الحاسوب على سبيل
+
+384
+00:28:49,380 --> 00:28:53,780
+المثال، في هذا الوضع، ويحاول يتعرف على الميكروبات
+
+385
+00:28:53,780 --> 00:28:57,400
+بهذه الطريقة، وفي نفس الوقت، يعمل revision بطريقة
+
+386
+00:28:57,400 --> 00:29:00,600
+interactive، يعني فيها نوع من الـ ... الـ ... الـ
+
+387
+00:29:00,600 --> 00:29:04,820
+خذوا نقول الحوار بينك وبين الجهاز، ليس ... طبعاً الـ
+
+388
+00:29:04,820 --> 00:29:10,160
+الـ ... البرنامج أيضاً يعطيني الخيار أن أختار من
+
+389
+00:29:10,160 --> 00:29:17,720
+قائمة كبيرة من البكتيريا، تمام؟ وأرى الـ clinical
+
+390
+00:29:17,720 --> 00:29:24,440
+أو الـ symptoms التي تبعها، كلها، هذا يرجعني بالسهم للـ last
+
+391
+00:29:24,440 --> 00:29:30,450
+step، طبعاً هذه القائمة اللي بنحرك فيها، اللي هي
+
+392
+00:29:30,450 --> 00:29:33,250
+القائمة، هي الـ Helicobacter pylori، اللي كنا نشرح
+
+393
+00:29:33,250 --> 00
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/11s-necX1t0_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/11s-necX1t0_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..9e0939df9909facddbdf7668de99139c772c2e2c
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/11s-necX1t0_raw.srt
@@ -0,0 +1,1656 @@
+1
+00:00:21,240 --> 00:00:23,520
+بسم الله الرحمن الرحيم نكمل ان شاء الله اليوم ال
+
+2
+00:00:23,520 --> 00:00:27,160
+lab diagnosis of helicobacter pylori
+
+3
+00:00:28,910 --> 00:00:32,570
+شبه اتفاقنا انه من اكثر الميكروبات اللى تم
+
+4
+00:00:32,570 --> 00:00:39,250
+الاهتمام بيها بالعقدين السابقين و تم انتاج لهم عدد
+
+5
+00:00:39,250 --> 00:00:42,750
+كبير من الفحوصات هنحاول مع بعض اليوم ان شاء الله
+
+6
+00:00:42,750 --> 00:00:47,410
+نتطرق لليه اللي هو ال diagnostic tests used for
+
+7
+00:00:47,410 --> 00:00:52,830
+this organism فهنعمل عملية مقارنة ما بين نوعين او
+
+8
+00:00:52,830 --> 00:01:03,740
+صنفين سمناهم invasive و noneinvasive الان بالنسبة
+
+9
+00:01:03,740 --> 00:01:14,160
+لل invasive احنا قلنا ندخل و ناخد بيوبسي او
+
+10
+00:01:14,160 --> 00:01:24,600
+blood sample نبدأ في ال biopsy ال biopsy في عندي
+
+11
+00:01:24,600 --> 00:01:28,240
+staining
+
+12
+00:01:31,870 --> 00:01:36,730
+ناخد الـ Staining و نشوف مع بعض إيش ممكن نصبغ أو
+
+13
+00:01:36,730 --> 00:01:41,570
+كيف ممكن نصبغ اللي هو ال Biopsy أول حاجة اتلحقوا
+
+14
+00:01:41,570 --> 00:01:45,840
+simple stain اللي اسمه Methylene Bluemethylene
+
+15
+00:01:45,840 --> 00:01:52,420
+blue very simple stain just place
+
+16
+00:01:52,420 --> 00:01:56,820
+the biopsy in between two slides and squeeze يعني
+
+17
+00:01:56,820 --> 00:01:59,780
+بنحط ال biopsy على الشريحتين و بنضغطهم بنفكهم عن
+
+18
+00:01:59,780 --> 00:02:03,280
+بعض بصير في عندي imprint طبعة هنا و طبعة هنا من
+
+19
+00:02:03,280 --> 00:02:06,720
+الشريحة بنجففهم بنعملهم fixation بنسبقهم ب
+
+20
+00:02:06,720 --> 00:02:10,380
+methylene blue و هنشوف البكتيريا اللي هي جنعانها
+
+21
+00:02:10,380 --> 00:02:16,200
+ايش شكلهاSpiral أو Curved في عندي حالة اسمها
+
+22
+00:02:16,200 --> 00:02:23,640
+Silver Stain Silver
+
+23
+00:02:23,640 --> 00:02:27,960
+Stain مش زي ال Stain اللي بتعمله انتوا يعني خلينا
+
+24
+00:02:27,960 --> 00:02:33,280
+نقول في تقنية نوعا ما مختلفة شوية لكن في الآخر هو
+
+25
+00:02:33,280 --> 00:02:39,160
+عبارة عن Simple Staining Procedures ممكن اتكلم على
+
+26
+00:02:39,160 --> 00:02:40,660
+ال Gram Stain نفسه
+
+27
+00:02:44,750 --> 00:02:48,090
+يبقى في عندي أكمل stain صار عندي simple stain مثل
+
+28
+00:02:48,090 --> 00:02:51,050
+ال blue صار عندي silver stain صار عندي gram stain
+
+29
+00:02:51,050 --> 00:02:56,590
+مين المفضل فيهم اللي يعني معظم المراجع بتقول ان هو
+
+30
+00:02:56,590 --> 00:03:02,340
+الأفضل ال silver stain؟لكن انا شخصيا اشتغلت على ال
+
+31
+00:03:02,340 --> 00:03:04,840
+helicobacter pylori من البيوبسيس و اشتغلت على ال
+
+32
+00:03:04,840 --> 00:03:07,380
+methane ال blue و وردت ان ال methane ال blue very
+
+33
+00:03:07,380 --> 00:03:11,560
+simple و as effective as silver stain and other
+
+34
+00:03:11,560 --> 00:03:15,240
+techniques وبالتالي خلينا نقول ان اي من هذه
+
+35
+00:03:15,240 --> 00:03:19,980
+الفحوصات المتوفرة can do طيب احنا قلنا ال staining
+
+36
+00:03:19,980 --> 00:03:23,320
+methane ال blue silver stain gram stain ايش فيه
+
+37
+00:03:23,320 --> 00:03:28,700
+غير ال staining في عند ال cultureمش هي بكتيريا وجن
+
+38
+00:03:28,700 --> 00:03:32,000
+عنها micro-aerophilic يعني بدها سبعة في المية أو
+
+39
+00:03:32,000 --> 00:03:35,060
+خمسة في المية اكسجين تمام؟ يعني ممكن نزرعها برضه،
+
+40
+00:03:35,060 --> 00:03:43,380
+ايش ال culture بيتها تبعتها؟ كانت شرق البلد او كان
+
+41
+00:03:43,380 --> 00:03:43,860
+بيباب
+
+42
+00:03:46,660 --> 00:03:48,940
+اللي حكينا عنها المرة الماضية اللي كان بي بلد أجر
+
+43
+00:03:48,940 --> 00:03:51,920
+بليت اللي ضفنا عليها ال Vancomycin وضفنا عليها
+
+44
+00:03:51,920 --> 00:03:55,480
+Trimethoprim مظبوط ولا لأ؟ يبقى في عندي culture
+
+45
+00:03:55,480 --> 00:03:59,020
+لكن بدنا نذكر أن ال culture هذه كلها under
+
+46
+00:04:01,300 --> 00:04:07,000
+CO2 و5% اللي هو O2 إذا نقطة كتير مهمة نبقى
+
+47
+00:04:07,000 --> 00:04:10,040
+عارفينها إنه ال culture هنا مش culture عادية خدوا
+
+48
+00:04:10,040 --> 00:04:14,560
+بالكم لو جينا احنا نقارن أي تقنية في العالم في ال
+
+49
+00:04:14,560 --> 00:04:18,620
+microbiology بنقارنها في مين؟ في ال culture لذلك
+
+50
+00:04:18,620 --> 00:04:23,820
+تعتبر ال culture حاجة بنسميها golden standard
+
+51
+00:04:25,730 --> 00:04:29,470
+يعني المعيار الذهبي لأي فحوصات أخرى مثلا طورنا
+
+52
+00:04:29,470 --> 00:04:33,750
+تقنية جديدة عشان نقول أن التقنية هذه جيدة أو غير
+
+53
+00:04:33,750 --> 00:04:36,810
+جيدة بنقررنا في من؟ في ال culture بنقول as
+
+54
+00:04:36,810 --> 00:04:40,730
+sensitive as the culture as specific as the
+
+55
+00:04:40,730 --> 00:04:43,330
+culture فإذن ال culture غالبا هنا إيش ليها ال
+
+56
+00:04:43,330 --> 00:04:47,790
+golden standard لكن تذكروا أنا بتكلم عن مين؟ عن ال
+
+57
+00:04:47,790 --> 00:04:52,430
+biopsy ال biopsy بيقول كيف أخدناها دخلنا إلى معقدة
+
+58
+00:04:52,430 --> 00:04:57,170
+المريض دخلنا عن طريق منظركمان مرة هذه عملية ليست
+
+59
+00:04:57,170 --> 00:05:01,450
+محببة للمرضى عملية ليست محببة للمرضى على الرغم من
+
+60
+00:05:01,450 --> 00:05:05,430
+دقة التقنية ومن انها حساسة لو one bacteria could
+
+61
+00:05:05,430 --> 00:05:10,750
+be isolated الا انه يعني بتضال تقنية صعبة خلاصنا
+
+62
+00:05:10,750 --> 00:05:13,290
+من ال culture نيجي الآن ماعرفش نمسح ال .. ال ..
+
+63
+00:05:13,290 --> 00:05:15,990
+احنا بتتكلم عن مين لحد الآن من ال invasive
+
+64
+00:05:24,770 --> 00:05:31,050
+الان ال biopsy نفسها انا ممكن اعملها test كيف
+
+65
+00:05:31,050 --> 00:05:35,030
+يعني؟ بتعرفيش ال biopsy يبقى عن قطعة صغيرة، قطعة
+
+66
+00:05:35,030 --> 00:05:39,210
+صغيرة بياخدها الجراح اللي بيعمل مناضير، بياخدها هو
+
+67
+00:05:39,210 --> 00:05:44,950
+جاعت بتطلع في المعدة، بيلاقي منطقة inflamed، حمرة،
+
+68
+00:05:44,950 --> 00:05:48,840
+وبالتالي بياخد يزور منها و بطلع فيهلو انا جيبت
+
+69
+00:05:48,840 --> 00:05:55,160
+انبوبة فيها ten percent urea وفيها indicators او
+
+70
+00:05:55,160 --> 00:06:01,700
+indicators عفوا زي الفينار red وحطت ال biopsy داخل
+
+71
+00:06:01,700 --> 00:06:06,810
+الانبوبةwithin one minute .. one minute إذا ال ..
+
+72
+00:06:06,810 --> 00:06:10,050
+ال biopsy فيها helicobacter pylori يعني فيها
+
+73
+00:06:10,050 --> 00:06:13,430
+يورياز وفاكرين كلمة يورياز؟ ماجونها يورياز وخلاص،
+
+74
+00:06:13,430 --> 00:06:15,970
+ماجونها strong .. ماجونها strong يورياز producer
+
+75
+00:06:15,970 --> 00:06:20,950
+within one minute it will turn this into different
+
+76
+00:06:20,950 --> 00:06:25,090
+color وبالتالي الفحصبصتف اذا within one minute
+
+77
+00:06:25,090 --> 00:06:28,430
+ماصار اي change في ال color بيكون الفحص negative
+
+78
+00:06:28,430 --> 00:06:34,470
+وهذا بيسموه ultra rapid urease test اش انه ultra
+
+79
+00:06:34,470 --> 00:06:40,390
+زي super اكتر من super يعني ultra rapid .. rapid
+
+80
+00:06:40,390 --> 00:06:45,010
+معناها سريع urease test هذا وان بينفع الفحص؟ انه
+
+81
+00:06:45,010 --> 00:06:49,860
+في المختبرات؟ ولا بينفع في ايادة الأطباء؟في أوقات
+
+82
+00:06:49,860 --> 00:06:53,640
+الطبي بياخد العينة على طول مباشرة وبالفعل حضرنا
+
+83
+00:06:53,640 --> 00:06:56,580
+لبعض الزملاء الأصدقاء على سبيل تجربة من الأطباء
+
+84
+00:06:56,580 --> 00:07:01,400
+حضرنا لهم هاد ال media اللي لن تكلف الفحص الواحد
+
+85
+00:07:01,400 --> 00:07:06,160
+نصف شكل الفحص الواحد هاد الأنبوبة الواحدة تتكلف
+
+86
+00:07:06,160 --> 00:07:11,200
+لكن في الآخر تذكروا بيوبسي بيوبسي بتدخل جوا
+
+87
+00:07:11,200 --> 00:07:16,380
+الماعدة وناخد عينها فيها إذن هذا الفحص كمان كتير
+
+88
+00:07:16,380 --> 00:07:26,370
+مشهورايش اسمه ultra rapid urease test فضل
+
+89
+00:07:26,370 --> 00:07:32,090
+وفيها
+
+90
+00:07:32,090 --> 00:07:37,050
+.. وفيها أدوات كمال لجمع العينا زي كبشات تمام
+
+91
+00:07:37,050 --> 00:07:41,670
+بيلتقط فيها العين يعني بيخدم غرضين غرض انه يشوف و
+
+92
+00:07:41,670 --> 00:07:43,170
+في نفس الوقت غرض انه ياخد عين
+
+93
+00:07:46,900 --> 00:07:56,080
+طيب نصفط هين مع بعض جونانا يورياز test نيجي لل PCR
+
+94
+00:07:58,690 --> 00:08:00,830
+الان ال PCR هو عبارة عن molecular technique،
+
+95
+00:08:00,830 --> 00:08:04,170
+molecular technique هو مش فحص الصحي، هو عبارة عن
+
+96
+00:08:04,170 --> 00:08:08,210
+.. عبارة عن amplification، amplification بمعنى انه
+
+97
+00:08:08,210 --> 00:08:11,490
+بي .. بيكبرلي قطعة معينة انا بدور عليها اللي هو
+
+98
+00:08:11,490 --> 00:08:14,550
+بيسموها ال unique sequence اللي احنا بنشوفه في ال
+
+99
+00:08:14,550 --> 00:08:18,230
+helicobacter pylori طبعا صارت اليوم التقنية يعني
+
+100
+00:08:18,230 --> 00:08:23,750
+اسهل من انه نتكلم فيها، فين دي حارس مجورنا fish؟
+
+101
+00:08:25,590 --> 00:08:29,110
+واختار لايش فيش هنا florescent in-sito
+
+102
+00:08:29,110 --> 00:08:38,290
+hybridization يعني احنا بندخل جوا الخلية و بنصبغ و
+
+103
+00:08:38,290 --> 00:08:42,310
+بنعمل florescent staining جوا الخلية داخل الخلية
+
+104
+00:08:42,310 --> 00:08:46,470
+florescent in-sito hybridization تقنية رائعة جدا
+
+105
+00:08:46,470 --> 00:08:49,970
+تعالوا نشوف كيف ممكن نستخدمهاتعرفوا الـ biopsy
+
+106
+00:08:49,970 --> 00:08:53,930
+اللي حكينا عنها القطعة المرة ها دي بنشتغلش فيها
+
+107
+00:08:53,930 --> 00:09:01,470
+الشغل منها هنا بنحطها في Formalin لمن
+
+108
+00:09:01,470 --> 00:09:04,610
+يستخدم ال Formalin احنا ده الهيستوباتولوجي صح؟
+
+109
+00:09:04,610 --> 00:09:08,350
+فبنوديها على الهيستوباتولوجي بنقولهم جيبونا منها
+
+110
+00:09:08,350 --> 00:09:09,370
+شرائح
+
+111
+00:09:12,000 --> 00:09:17,160
+Tissue section يعني بيحطوها في .. دلسوا
+
+112
+00:09:17,160 --> 00:09:20,920
+الهيستبوتولوجيا ما دلسوش .. يعني كيف نعمل شريحة من
+
+113
+00:09:20,920 --> 00:09:26,240
+نسيجلأ مش مزارع انسجة عملنا fixation بالفورمالين
+
+114
+00:09:26,240 --> 00:09:30,840
+تمام؟ وبعدين عملنا لها embedding بالشمق وبعد الشمق
+
+115
+00:09:30,840 --> 00:09:34,440
+القطعة صارت موجودة في وين؟ في قلب الشمق وبعدين
+
+116
+00:09:34,440 --> 00:09:37,840
+بناخدها و بنعملها sectioning sectioning يعني
+
+117
+00:09:37,840 --> 00:09:41,420
+بنجطعها شرايح دقيقة جدا واحد مايكرون واحد و نص
+
+118
+00:09:41,420 --> 00:09:44,480
+مايكرون و بناخد جزء من ال .. طبعا لأنها بتكون
+
+119
+00:09:44,480 --> 00:09:46,940
+موجودة في الشمق نقدر نتعامل .. نمسكها بملقة نقدر
+
+120
+00:09:46,940 --> 00:09:53,890
+نعملها بأي طريقة و بنحطها على الشريحة تمام؟الان ال
+
+121
+00:09:53,890 --> 00:09:59,130
+tissue موجودة على الشريحة نفترض ان ال tissue فيه
+
+122
+00:09:59,130 --> 00:10:04,230
+helicobacter pylori و استخدمت انا prop كلمة ايش
+
+123
+00:10:04,230 --> 00:10:09,990
+مات prop؟ complementary RNA complementary ل DNA
+
+124
+00:10:09,990 --> 00:10:15,030
+ايش RNA complementary ل DNA؟ يعني sequence موجود
+
+125
+00:10:15,030 --> 00:10:19,170
+له complementary في مين؟ في البكتيرى نفسه بنعمل
+
+126
+00:10:19,170 --> 00:10:22,360
+عمليةdenaturation ايش يعني؟ عارفين الـ
+
+127
+00:10:22,360 --> 00:10:26,100
+denaturation؟ اللي هي فصل او فك ال .. ال .. ال
+
+128
+00:10:26,100 --> 00:10:29,140
+strands عن بعضها و بنضيف ال reaction تبعنا بصير re
+
+129
+00:10:29,140 --> 00:10:32,660
+annealing فإذا ال .. إذا البكتيريا موجودة our
+
+130
+00:10:32,660 --> 00:10:36,100
+probe اللي هو fluorescent labelled هيرتبط جوا
+
+131
+00:10:36,100 --> 00:10:40,020
+البكتيريا تمام؟ يبقى لما أطلع تحت ال fluorescent
+
+132
+00:10:40,020 --> 00:10:43,340
+microscope على الشريحة هشوف اللي هو ال fluorescent
+
+133
+00:10:43,340 --> 00:10:46,940
+هشوف البكتيريا و هي بتضوء لأنه عملها labeling
+
+134
+00:10:46,940 --> 00:10:51,130
+عملها labeling حلو في الموضوعإن ال labeling هنا
+
+135
+00:10:51,130 --> 00:10:55,210
+could be with different colors يعني بيعطينا أخضر
+
+136
+00:10:55,210 --> 00:10:59,030
+أصفر أحمر labeling فانا ممكن أدور مش بس على
+
+137
+00:10:59,030 --> 00:11:04,010
+البكتيريا ممكن أدور على genes معينة في البكتيريا
+
+138
+00:11:04,010 --> 00:11:07,810
+زي ال clarithromycin resistant اللي دورنا عليه
+
+139
+00:11:11,050 --> 00:11:15,910
+mycine-resistant genes في غزة دورنا على ال
+
+140
+00:11:15,910 --> 00:11:21,010
+bacteria في ال biopsies من المرضى بالاضافة لذلك
+
+141
+00:11:21,010 --> 00:11:24,390
+بدنا نشوف مدى مقومتها لمين لل mycine-resistant
+
+142
+00:11:24,390 --> 00:11:27,690
+genes فدورنا على ال gene المسئول عن ال resistance
+
+143
+00:11:27,690 --> 00:11:30,710
+بال probes و بالفعل نجحنا و لجينا انه فيه نسبة
+
+144
+00:11:30,710 --> 00:11:36,290
+معينة من البحث الصحيح صاروا خمس سنوات بس لسه
+
+145
+00:11:36,290 --> 00:11:42,910
+مانشرنهوشفي مساء جديدة لنشر البحث لكن ال fish
+
+146
+00:11:42,910 --> 00:11:46,670
+عطاني شغل تان ان البكتيريا موجودة او غير موجودة
+
+147
+00:11:46,670 --> 00:11:50,150
+وإذا موجودة ممكن أبحث عن صفات أخرى زي مثلا ال
+
+148
+00:11:50,150 --> 00:11:55,250
+resistant gene ليش هذه التقنية مهمة؟ أنا أخد بالك
+
+149
+00:11:55,250 --> 00:12:02,610
+expensive وبتطول وكمان جاية من وين؟ من بيفز ال
+
+150
+00:12:02,610 --> 00:12:05,450
+culture تعالوا نطلع في غزة مين بيعمل culture ريكو
+
+151
+00:12:05,450 --> 00:12:13,530
+بكتر بالوريه؟ Zeroفيش طبعا الان الكثير من
+
+152
+00:12:13,530 --> 00:12:16,210
+المختبرات صار عندها molecular techniques وصار
+
+153
+00:12:16,210 --> 00:12:18,890
+عندها fluorescent microscope وبالتالي ال
+
+154
+00:12:18,890 --> 00:12:22,030
+fluorescent microscope موجود موجود الان بدل ما
+
+155
+00:12:22,030 --> 00:12:24,830
+اعمل culture بدل ما اعمل culture و اعمل
+
+156
+00:12:24,830 --> 00:12:29,630
+sensitivity انا الان بعمل fish لمرة واحدة بشخص و
+
+157
+00:12:29,630 --> 00:12:32,590
+بعرف هل هي مقاومة للمضاد الحيوي اللي انا بده
+
+158
+00:12:32,590 --> 00:12:39,170
+اعطيها ولا مش مقاومة فهذه كمان برضه نقطة مهمةإذن
+
+159
+00:12:39,170 --> 00:12:43,450
+صار عندنا كام تقنية الآن في ال .. في ال invasive
+
+160
+00:12:43,450 --> 00:12:49,410
+Staining, Culture, Urease Test و PCR و Fish قلنا
+
+161
+00:12:49,410 --> 00:12:55,810
+في عندنا غير ال biopsy اللي هو مين ال blood ال
+
+162
+00:12:55,810 --> 00:13:02,210
+sample و بالأخرى اسمها ال serum ال serum أول حاجة
+
+163
+00:13:02,210 --> 00:13:06,170
+عملناها دورنا على ال antibody ال IgG دورنا على ال
+
+164
+00:13:06,170 --> 00:13:10,960
+IgGأنا قلتلكم بارح في المحاضرة ان 50% من سكان
+
+165
+00:13:10,960 --> 00:13:15,810
+العالم بنلاقيهم positiveهل و لما طلعنا على ال
+
+166
+00:13:15,810 --> 00:13:20,090
+pathogenesis تبع البكتيريا لجينا انه most of
+
+167
+00:13:20,090 --> 00:13:25,370
+patient will tolerate هيتحمله و they will resist و
+
+168
+00:13:25,370 --> 00:13:28,510
+they will recover spontaneously وبالتالي مش كل
+
+169
+00:13:28,510 --> 00:13:34,630
+واحد عنده IGG معناها انه عنده active infection مش
+
+170
+00:13:34,630 --> 00:13:36,430
+ضروري يكون عنده active infection يمكن انصاب فيها
+
+171
+00:13:36,430 --> 00:13:40,470
+زمان و ضال عنده منع فإذا هذا الفحص ضال علي علامة
+
+172
+00:13:40,470 --> 00:13:46,310
+استفهامجاله ولا لأ بنعمل IGMاندوى على ال IGM
+
+173
+00:13:46,310 --> 00:13:50,710
+وانتوا كلكوا بتعرفوا انه ال IGM مؤشر على انه
+
+174
+00:13:50,710 --> 00:13:55,230
+recent infection فهذا okay فيه كمان طلعوا kit او
+
+175
+00:13:55,230 --> 00:14:00,950
+فحص بيستخدم ال IGA اقولك لإن الجسم إذا كون IGA
+
+176
+00:14:00,950 --> 00:14:05,290
+معناه الحكي برضه انه active infection لإنه ال IGA
+
+177
+00:14:05,290 --> 00:14:08,870
+بتحمي ال mucous membrane بتحمي ال mucous membrane
+
+178
+00:14:08,870 --> 00:14:12,230
+إذا في عندي كام واحد available الآن في فحصات IGG
+
+179
+00:14:12,230 --> 00:14:15,150
+ممكن نستخدم هذه ال IGG لمين؟لـ screening يعني شوف
+
+180
+00:14:15,150 --> 00:14:19,470
+كده من ال population كان عنده prevalence rate بشكل
+
+181
+00:14:19,470 --> 00:14:24,350
+عام للبكتيريا في مجتمع ما باستخدام ال IgG ال IgM
+
+182
+00:14:24,350 --> 00:14:27,970
+وال IgA اي من هما قد يستخدم لعمليات التشخيص اعتقد
+
+183
+00:14:27,970 --> 00:14:32,050
+انه عينة الدم مش زي عينة بيوبسي برضه كمان هذه يعني
+
+184
+00:14:32,050 --> 00:14:36,950
+بدنا نعطيها قيمة لأبقى سابعة فكده مرة انا نقشت
+
+185
+00:14:36,950 --> 00:14:39,810
+معاكم كلمة الفحص الأفضل هي عندنا خيار من الفحصات
+
+186
+00:14:39,810 --> 00:14:44,340
+مين الفحص الأفضل؟مش مش .. احنا قُلنا اتفاق انه
+
+187
+00:14:44,340 --> 00:14:49,160
+الأفضل هو .. هو شئ نسب .. شئ نسبي .. شئ نسبي من
+
+188
+00:14:49,160 --> 00:14:53,020
+خلاله فيه مجموعة من المعايير انا بوزنها و بقرر في
+
+189
+00:14:53,020 --> 00:14:57,520
+الآخر مين أفضل إلي ك patient أو مين أفضل إلي ك
+
+190
+00:14:57,520 --> 00:15:02,580
+hospital أو مين أفضل إلي كسياسة عامة كما ذكرنا ال
+
+191
+00:15:02,580 --> 00:15:08,420
+culture هي الأدق لكن time consuming هيفيلها عيب
+
+192
+00:15:08,420 --> 00:15:13,680
+رقم اتنين برضه فيه أننا قلنا biopsyاندي ال PCR
+
+193
+00:15:13,680 --> 00:15:17,380
+very rapid within 24 hours اشوف 24 hours within
+
+194
+00:15:17,380 --> 00:15:20,900
+hours لما ما بتاخد النتيجة تبعتك مابدوش أربع أيام
+
+195
+00:15:20,900 --> 00:15:27,320
+و خمس أيام لكن برضه لحظة بيوبسي لأ ال blood sample
+
+196
+00:15:27,320 --> 00:15:33,540
+سيرم سيرم سيرم لأ هذا نوع .. هذا نوع و هذا نوع
+
+197
+00:15:33,540 --> 00:15:36,080
+اتنين كلهم بينتهوا لمين قلنا لل invasive
+
+198
+00:15:36,080 --> 00:15:41,210
+procedures لل invasive proceduresطيب خلصنا ال
+
+199
+00:15:41,210 --> 00:15:44,550
+invasive او اخدنا فكرة عن ال invasive تمام ناخد
+
+200
+00:15:44,550 --> 00:15:49,270
+فكرة عن ال non-invasive test و هذا الحلوين برضه مش
+
+201
+00:15:49,270 --> 00:15:53,250
+عاطلين يعني هعجبوكم لإن خاصة انهم قلنا عنهم non
+
+202
+00:15:53,250 --> 00:16:04,430
+-invasive non
+
+203
+00:16:04,430 --> 00:16:09,220
+-invasive في نديها اسمها Eurea Breath Testيوريا
+
+204
+00:16:09,220 --> 00:16:15,540
+breath test بنعطي المريض يوريا يشربها بطعم
+
+205
+00:16:15,540 --> 00:16:20,220
+البرتقال او بطعم فاكهة معينة عشان انتشرت طعمها
+
+206
+00:16:20,220 --> 00:16:23,800
+مقبول يوريا ده اليوريا مش مقبولة يعنى فبيعطوها
+
+207
+00:16:23,800 --> 00:16:27,820
+flavoring حتى تكون مقبولة هذه اليوريا مش يوريا
+
+208
+00:16:27,820 --> 00:16:32,060
+عادية ال level ال carbon تبقى carbon fourteen عظيم
+
+209
+00:16:32,060 --> 00:16:36,880
+ان ال carbon قدرش الوزن الداري تبقى اتناشراحنا
+
+210
+00:16:36,880 --> 00:16:42,160
+بستخدم isotope 14 يعني radioactive .. radioactive
+
+211
+00:16:42,160 --> 00:16:45,420
+إذا الكربون المستخدم في تصنيع اليوريا هذه
+
+212
+00:16:45,420 --> 00:16:53,520
+radioactive .. radioactive carbon الآن
+
+213
+00:16:53,520 --> 00:16:58,060
+بنقول للمريض اعطينا .. بنعطيه كيس، كيس ينفخ فيه،
+
+214
+00:16:58,060 --> 00:17:03,210
+هذا عينة هوة رقم 1وبعدين بنعطيه اليوريا وبعد نصف
+
+215
+00:17:03,210 --> 00:17:07,430
+ساعة بناخد منه كمان عينة هوا عينة هوا قبل وعينة
+
+216
+00:17:07,430 --> 00:17:11,190
+هوا بعد وبندخلهم في جهاز لقياس ال radio activity
+
+217
+00:17:11,190 --> 00:17:15,650
+شوفوا الآن اليوريا دخلت المعيدة نفترض ان في
+
+218
+00:17:15,650 --> 00:17:19,970
+helicobacter pylori helicobacter pylori اليوريا
+
+219
+00:17:19,970 --> 00:17:27,150
+هتتكسر بفعل اليوريز الى CO2 صح؟هو أمونيا، أحنا من
+
+220
+00:17:27,150 --> 00:17:30,050
+.. الأمونيا اللي هي ال nitrogen صح أو لا؟ احنا من
+
+221
+00:17:30,050 --> 00:17:33,590
+ده العالمين قاعدين؟ لأن احنا بنتكلم عن carbon 14
+
+222
+00:17:34,600 --> 00:17:40,460
+الـ CO2 كيف بيصيله طرح مش عبر التنفس وبالتالي حلاج
+
+223
+00:17:40,460 --> 00:17:45,040
+ال carbon 14 في هذه الحالة كتير في نفس المريض
+
+224
+00:17:45,040 --> 00:17:50,700
+above a level محدد وبنخلال carbon 14 measurement
+
+225
+00:17:50,700 --> 00:17:53,900
+بنعرف إذا المريض عنده helicobacter pylori ولا
+
+226
+00:17:53,900 --> 00:17:58,460
+ماعندهش helicobacter pylori وصلت ولا ماوصلت أكيد؟
+
+227
+00:17:58,460 --> 00:18:03,750
+كمان مرة حاضركمان مرة بيقول إن المريض شرب يوريا
+
+228
+00:18:03,750 --> 00:18:08,430
+يوريا ها دي ال carbon تبعها اربعة عشان radioactive
+
+229
+00:18:09,140 --> 00:18:12,460
+دخلت إلى المعدة قابلة الهيليكوبكتر بايلوري
+
+230
+00:18:12,460 --> 00:18:15,500
+الهيليكوبكتر بايلوري عندها انزايم بالفطرة تنتجه
+
+231
+00:18:15,500 --> 00:18:19,940
+يسموه Constitutive enzyme يعني سواء كان لازم الأمر
+
+232
+00:18:19,940 --> 00:18:24,560
+أو مش لازم بتنتجه وبتنتجه بكميات كبيرة اليورياز
+
+233
+00:18:24,560 --> 00:18:29,700
+هيكسل اليوريا إلى أمونيا و CO2 ال C اتذكر ال C
+
+234
+00:18:29,700 --> 00:18:36,360
+العادي 12 احنا اللي شربناه المريضإذا اتكسر هيطلع
+
+235
+00:18:36,360 --> 00:18:41,600
+وين؟ في ال .. مع ال .. ال .. التنفس مع الزفير احنا
+
+236
+00:18:41,600 --> 00:18:45,280
+اللي خدناها العينة خدناها عينة زفير، هواء حطناها
+
+237
+00:18:45,280 --> 00:18:51,180
+في الجهاز يجيسمين لل radio activity إذا في radio
+
+238
+00:18:51,180 --> 00:18:57,580
+activity معناه الحكي .. إيش يعني؟ لأنه carbon 14،
+
+239
+00:18:57,580 --> 00:19:00,740
+carbon 14 من وين إيجاه؟ من تكسير اليوريا، من تكسير
+
+240
+00:19:00,740 --> 00:19:05,360
+اليوريا، هذه النقطة المهمةهذا الفحص رائع جدا و
+
+241
+00:19:05,360 --> 00:19:08,700
+الحساسية تبعته و ال sensitivity او عفوا ال
+
+242
+00:19:08,700 --> 00:19:13,740
+specificity توازي ال culture يعني لو قلنا مين هو
+
+243
+00:19:13,740 --> 00:19:17,380
+ال golden standard في ال non invasive في ال non
+
+244
+00:19:17,380 --> 00:19:23,380
+invasive هذا هو في ال invasive ال culture في ان دي
+
+245
+00:19:23,380 --> 00:19:28,640
+غير ال urea breath test فيها اسمها stool antigen
+
+246
+00:19:28,640 --> 00:19:35,870
+stool antigenبمعنى تعالوا نتخيل البكتيريا
+
+247
+00:19:35,870 --> 00:19:41,590
+البكتيريا عاملة قرحة في الميدا و بتتكاثر و مع طحن
+
+248
+00:19:41,590 --> 00:19:45,130
+الطعام و الشراب بينزل أجزاء من الخلايا الميتة اللي
+
+249
+00:19:45,130 --> 00:19:48,270
+فيها helicobacter pylori بتروح على ال intestine و
+
+250
+00:19:48,270 --> 00:19:51,430
+في الآخر تطلع في البوراز يبقى البوراز بيحتوي على
+
+251
+00:19:51,430 --> 00:19:54,950
+البكتيريا مش بيحتوي على البكتيريا أو على الأقل على
+
+252
+00:19:54,950 --> 00:19:59,050
+بقايا البكتيرياوبقايا البكتيرا إيش بنسميها إحنا؟
+
+253
+00:19:59,050 --> 00:20:01,970
+Antigenات برضه ولا لأ ما هي fragments من البكتيرا
+
+254
+00:20:01,970 --> 00:20:06,520
+فهي Antigenات فهي Antigenاتففي ال stool detection
+
+255
+00:20:06,520 --> 00:20:09,900
+اعتقد كمان بقى كمان مرة يعني هذا الفحص او هذا
+
+256
+00:20:09,900 --> 00:20:15,080
+الفحص يعني فحصات رائعة ومافي اي اشكالية ليش؟ لأنه
+
+257
+00:20:15,080 --> 00:20:19,920
+مش invasive خد عينة stool خد عينة هوا العملية مش
+
+258
+00:20:19,920 --> 00:20:24,220
+عملية معقدة بيتم عملية extraction بطريقة معينة و
+
+259
+00:20:24,220 --> 00:20:26,240
+بعدين فحص serology انتج انتج body اذا في
+
+260
+00:20:26,240 --> 00:20:28,520
+agglutination بسط مافي agglutination بيكون الفحص
+
+261
+00:20:28,520 --> 00:20:33,440
+negative هذا الفحص متوفر في غزةبينما دا الفحص
+
+262
+00:20:33,440 --> 00:20:39,140
+للأسف لحد دلان مش متوفر في القطاع غزن لأن صار لنا
+
+263
+00:20:39,140 --> 00:20:44,820
+صورة نقدر نقول شبه نقدر نقول كاملة لكن صورة يعني
+
+264
+00:20:44,820 --> 00:20:49,160
+نوعا ما موسعة عن الطرق المتنوعة او المختلفة لل
+
+265
+00:20:49,160 --> 00:20:57,100
+diagnosis اللي هو ال helicobacter pylori بالنسبة
+
+266
+00:20:57,100 --> 00:21:01,660
+لهياليوريا breath test عينة الهواء اللي قلتلكم
+
+267
+00:21:01,660 --> 00:21:02,000
+عنها
+
+268
+00:21:04,880 --> 00:21:07,520
+بالنسبة للعلاج تبقى ال helicobacter pylori بتلخص
+
+269
+00:21:07,520 --> 00:21:11,260
+بإن احنا بنعطي three أو four antibiotics فبسمو
+
+270
+00:21:11,260 --> 00:21:14,560
+triple therapy او quadruple therapy يعني يا علاج
+
+271
+00:21:14,560 --> 00:21:19,340
+تلاتي يا علاج رباعي عشان تكونوا في الصورة لو احنا
+
+272
+00:21:19,340 --> 00:21:22,300
+طلعنا على المثال اللي بتكون على الصبورة عنا من
+
+273
+00:21:22,300 --> 00:21:27,590
+triple therapy متروندازول زائدClarithromycin or
+
+274
+00:21:27,590 --> 00:21:31,710
+amoxicillin واحد من التنين واحد من التنين زائد
+
+275
+00:21:31,710 --> 00:21:35,670
+امبرازول هذا الامبرازول مش antibiotic وانما proton
+
+276
+00:21:35,670 --> 00:21:39,710
+pump inhibitor
+
+277
+00:21:43,000 --> 00:21:49,020
+يعني بيقلل من إفراز الحامض في المعيدة لكن برضه في
+
+278
+00:21:49,020 --> 00:21:52,180
+اعتقاد انه Antimicrobial Activity لكن استخدامه
+
+279
+00:21:52,180 --> 00:21:55,280
+الأساسي ك proton pump inhibitor انا قولت جابي شوية
+
+280
+00:21:55,280 --> 00:21:59,000
+ان لجينا في غزك الارتروميسين resistance طب هذا ال
+
+281
+00:21:59,000 --> 00:22:03,320
+antibiotic أصلايعني بتقدر تقولوا إنه استخدم في
+
+282
+00:22:03,320 --> 00:22:06,960
+قطاع غزة أسوأ استخدام على وجه الأرض، هذا ال .. ال
+
+283
+00:22:06,960 --> 00:22:10,160
+amoxicillin فبالتالي احتمال اللاجئ الكلاريثروميسين
+
+284
+00:22:10,160 --> 00:22:13,880
+وال amoxicillin التنين ال resistance وطبعا مش بس
+
+285
+00:22:13,880 --> 00:22:16,800
+في بلدنا، في بلدان أخرى في استخدام مفرط
+
+286
+00:22:16,800 --> 00:22:20,380
+للAntibiotic، لذلك بنلاجئ إنه ..كل فترة و فترة يا
+
+287
+00:22:20,380 --> 00:22:22,860
+شباب بيصير فيه review لل protocol ايش يعني review
+
+288
+00:22:22,860 --> 00:22:27,200
+لل protocol مراجعة لل protocol العلاجي بمعنى انه
+
+289
+00:22:27,200 --> 00:22:29,880
+والله إذا لجينا نسبة كبيرة من النصرة المقاومة لهذا
+
+290
+00:22:29,880 --> 00:22:34,300
+ال antibiotic بنغيره لكن لاحظوا ان ال key
+
+291
+00:22:34,300 --> 00:22:39,380
+component في العلاج هو ال metronasol وهو المستخدم
+
+292
+00:22:39,380 --> 00:22:45,880
+للبكتيريا الهوائية هذا معروف عنه ان هو هذا الاسم
+
+293
+00:22:45,880 --> 00:22:46,860
+الشيعة تبعه فلجيل
+
+294
+00:22:50,070 --> 00:22:53,630
+أكتر استخدام له للانتميبة استروتيكا دلبرازايتز
+
+295
+00:22:53,630 --> 00:22:57,450
+يعني دلبروترزوهوا الانتميبة استروتيكا والجارديا
+
+296
+00:22:57,450 --> 00:23:02,290
+لامبليا لكن بالإضافة للجارديا والانتميبة بنستخدمه
+
+297
+00:23:02,290 --> 00:23:06,190
+للبكتيريا اللاهوائية طب هذي بكتيريا لاهوائية؟ لأ
+
+298
+00:23:06,190 --> 00:23:09,270
+لكن لجوا أنه له تأثير قوي جدا على هذه البكتيريا
+
+299
+00:23:09,270 --> 00:23:13,390
+إذا ال key component من الميترونالازول هذا كمان
+
+300
+00:23:13,390 --> 00:23:17,170
+key component طلعوا هاتينين الجميل المتغير اللي
+
+301
+00:23:17,170 --> 00:23:22,970
+بنلعب فيه غالبااللي هو ال antibiotics العادية عصب
+
+302
+00:23:22,970 --> 00:23:25,190
+الردوسيين اللي دالي ال clarithromycin او ال اول
+
+303
+00:23:25,190 --> 00:23:30,790
+اللي هو اللي انا مكسله ال vaccine لازم يعني او
+
+304
+00:23:30,790 --> 00:23:33,510
+لازم العالم بيحاول انه ينتج vaccine لانه انتج
+
+305
+00:23:33,510 --> 00:23:37,110
+vaccine فعال يمكن يكون هو الحل الأنثالي مثل هذا ال
+
+306
+00:23:37,110 --> 00:23:41,130
+microbe المتشر بشكل كبير طيب احنا هيك بممكن ختمنا
+
+307
+00:23:41,130 --> 00:23:44,450
+المحاضرة لكن انا الصحيح كنت حابب ألعجب معاكم
+
+308
+00:23:44,450 --> 00:23:46,990
+software عملناها
+
+309
+00:23:49,230 --> 00:23:52,870
+احنا واحد الطلاب في الجامعة الإسلامية وهو صمم
+
+310
+00:23:52,870 --> 00:23:55,010
+خصيصا لطلبة التحيات الطبية الصحية ومع أنه اللي
+
+311
+00:23:55,010 --> 00:23:58,710
+عمله طالب من كلية الطب فخليني نتطلع مع بعض على
+
+312
+00:23:58,710 --> 00:24:03,510
+مواصفاته وكيفية استخدام هذا البرنامج أول حاجة ننسب
+
+313
+00:24:03,510 --> 00:24:08,690
+الفضل لأهل الفضل اللي عمل البرنامج طالب اسمه
+
+314
+00:24:08,690 --> 00:24:15,550
+عبدالكريم زهيرصادق و ذكى اليازجى همام هدول
+
+315
+00:24:15,550 --> 00:24:18,790
+الطالبين كانوا طلبة مميزين في كوليو الطب الصحيح
+
+316
+00:24:18,790 --> 00:24:23,150
+وعملوا هذا المشروع الناجح فلازم ننسب لهم الفضل
+
+317
+00:24:23,150 --> 00:24:27,230
+انهم عملوا هذا المشروع
+
+318
+00:24:27,230 --> 00:24:31,310
+في
+
+319
+00:24:31,310 --> 00:24:35,540
+اندي حالة اسمها او خيارين في بداية البرنامجGo to
+
+320
+00:24:35,540 --> 00:24:40,080
+consecutive test فحصات متتابعة فاكرين احنا جوننا
+
+321
+00:24:40,080 --> 00:24:44,760
+في تعريف الميكروبات اما بنستخدم قائمة متوازية
+
+322
+00:24:44,760 --> 00:24:49,060
+بالتوازي بنعمل indoor و indoor مثل ال ABI او بجينا
+
+323
+00:24:49,060 --> 00:24:53,510
+نفكر بطريقة مختلفةاللي طلعت Ureas Bustef نعملها
+
+324
+00:24:53,510 --> 00:24:58,210
+فحص كده صح؟ هذا الكلام بياخد معانا وقت طويل لكن هو
+
+325
+00:24:58,210 --> 00:25:02,210
+عملية تدريب فقط لغير عملية تعرف على ال micro
+
+326
+00:25:02,210 --> 00:25:04,990
+organism ناخد الخيار الأول و بعدين نرجع للخيار
+
+327
+00:25:04,990 --> 00:25:11,310
+التانيأول فحص بدأنا فيه احنا بشكل عام هو خاصية ال
+
+328
+00:25:11,310 --> 00:25:13,530
+gramestين تعالوا نختار .. احنا ليه ال .. علشان
+
+329
+00:25:13,530 --> 00:25:15,090
+تعرفوا انتوا عن ال gram بصوا اللي gram negative
+
+330
+00:25:15,090 --> 00:25:17,690
+تعرفوه انتوا اللي خلصتواه gram negative، هاي gram
+
+331
+00:25:17,690 --> 00:25:20,570
+negative بس اللي هو الكوكساي، اللي حتى اللي انتوا
+
+332
+00:25:20,570 --> 00:25:23,370
+تعرفوه بس اللي بس اللاس، aerobic ولا anaerobic؟
+
+333
+00:25:23,370 --> 00:25:26,270
+بتعرفوا تنتين؟ بتعرفوا تنين؟ يعني الفاكولت ..
+
+334
+00:25:27,370 --> 00:25:33,170
+خلّيني أقول إنه هل البكتيرا نمت هوائيا ولا لا
+
+335
+00:25:33,170 --> 00:25:36,330
+هوائيا، إذا هوائيا ممكن تكون faculty في أنايروب
+
+336
+00:25:36,330 --> 00:25:41,090
+برضه ولا لا فبتعلق ان انا نمت هوائيا خدوا بالك
+
+337
+00:25:41,090 --> 00:25:45,110
+وانا جاعت بشتغل وانا جاعت بشتغل وبختار، بكتبلي تحت
+
+338
+00:25:45,110 --> 00:25:49,750
+ان انت اخترت، بذكركgram negative بس لاي و aerobic
+
+339
+00:25:49,750 --> 00:25:53,230
+bacteria صح ولا لأ هى اللى اخترته منها طيب
+
+340
+00:25:53,230 --> 00:25:55,950
+البكتيريا تبعت non fastidious ولا non fastidious
+
+341
+00:25:55,950 --> 00:26:00,190
+نفترض انها non fastidious طيب البكتيريا اكسيدايز
+
+342
+00:26:00,190 --> 00:26:05,370
+positive ولا negative نختار نيجاتيف طيب the next
+
+343
+00:26:05,370 --> 00:26:08,070
+step you must do is off test فاكريني ال off اللى
+
+344
+00:26:08,070 --> 00:26:10,850
+oxidation fermentation test the bacterium is
+
+345
+00:26:10,850 --> 00:26:14,130
+oxidative ولا fermentative ماهى اخده بقى الكوكينة
+
+346
+00:26:14,130 --> 00:26:18,470
+اكسيدايزex negative غالبا هتكون هنا ممكن تكون
+
+347
+00:26:18,470 --> 00:26:21,390
+fermentative طيب lactose و non-lactose انعقدها
+
+348
+00:26:21,390 --> 00:26:25,740
+شوية non-lactose fermenterخد بالك في القايمة اللي
+
+349
+00:26:25,740 --> 00:26:31,180
+تحت كل إشي أنت اخترته سجل لك إياه تمام؟ بطل ألوانه
+
+350
+00:26:31,180 --> 00:26:34,220
+حلوة أه؟ بطل ألوانه حلوة و إيش كمان؟ و معلوماته
+
+351
+00:26:34,220 --> 00:26:38,800
+كمان جيدة لأ حقيقة برنامج رائع و لسه ماوصلناش نحن
+
+352
+00:26:38,800 --> 00:26:42,960
+للروعة لإن الروعة مش بس نتعرف على البكتيريا كمان و
+
+353
+00:26:42,960 --> 00:26:47,560
+نشوف صورها و نشوف بعض المعلومات عنهاالبكتيريا هذه
+
+354
+00:26:47,560 --> 00:26:55,940
+نعجبها الـ negative نختار احنا
+
+355
+00:26:55,940 --> 00:27:01,220
+مين سلمونيلا لان لما جل البكتيريا تبعتنا سلمونيلا
+
+356
+00:27:01,220 --> 00:27:05,600
+تمام ضغطنا على السلمونيلا راح اعطاني الصور تبعتها
+
+357
+00:27:06,160 --> 00:27:08,680
+gram negative بس الله مش مش مش مش ضروري الصورة
+
+358
+00:27:08,680 --> 00:27:12,480
+السلمونية لأ اعطاني في كل فحص انا اختارته اعطاني
+
+359
+00:27:12,480 --> 00:27:15,740
+صورة عنه هي oxidized negative gram negative بس
+
+360
+00:27:15,740 --> 00:27:18,280
+الله انا aerobic بكتيريا ولا aerobic المفروض اللي
+
+361
+00:27:18,280 --> 00:27:21,080
+ال .. ال .. هذا الصورة عاملها لكل non fastidia
+
+362
+00:27:21,080 --> 00:27:24,440
+سنتان معلق اي حاجة عندي non lactose fermenter
+
+363
+00:27:24,440 --> 00:27:29,220
+لونها المكونكي colorless glucose fermenter صورة
+
+364
+00:27:29,220 --> 00:27:33,560
+معبرة عن الفحوصات اللي احنا استخدمناهاهيفندي الـ
+
+365
+00:27:33,560 --> 00:27:36,160
+H2S و الـ motility will your risk test negative
+
+366
+00:27:36,160 --> 00:27:38,900
+الان في هذا النقطة اللى بنحكي عنها ال clinical
+
+367
+00:27:38,900 --> 00:27:43,140
+details عاملين عن كل ميكروب من الميكروبات اللى
+
+368
+00:27:43,140 --> 00:27:47,740
+موجودين فى السلسلة عاملين احنا حارس انها summary
+
+369
+00:27:47,740 --> 00:27:51,440
+of clinical details اللى جاي نقول سلام الله مش
+
+370
+00:27:51,440 --> 00:27:54,720
+كاين مش هاين عليه ان نكتبها كلها فى اطار و احد فا
+
+371
+00:27:54,720 --> 00:27:57,080
+كده بسلام الله تعالى فيهو Enteroditis أخدنا سنة و
+
+372
+00:27:57,080 --> 00:28:00,180
+نهار طيفي أعطانا ال disease characteristic عسرية
+
+373
+00:28:00,180 --> 00:28:02,400
+habitat and transmission بعض genesis laboratory
+
+374
+00:28:02,400 --> 00:28:07,200
+diagnosis treatment and prevention برنامج يعني
+
+375
+00:28:07,200 --> 00:28:14,000
+خلينا نقول مفيد جدا للطالب بدل ما يجضي وقته على ..
+
+376
+00:28:14,000 --> 00:28:16,960
+لأ مش على الفيسبوك بس يعني انا .. انا .. انا كمان
+
+377
+00:28:16,960 --> 00:28:19,360
+مرة ابدأ .. انا .. انا بتنبيه يعني .. يعني ان شاء
+
+378
+00:28:19,360 --> 00:28:24,940
+الله يكون في منه فايدةالإنسان من طبعه بيمل من
+
+379
+00:28:24,940 --> 00:28:30,560
+أشياء بيجد عليها وقتفانا بقول الإنسان المجتهد لما
+
+380
+00:28:30,560 --> 00:28:36,820
+بمل من شكل من أشكال الدراسة لو جرب نوع آخر من
+
+381
+00:28:36,820 --> 00:28:41,520
+أنواع الدراسة هذا برضه قتل الملل و يعني استغلال
+
+382
+00:28:41,520 --> 00:28:45,700
+الوقت بشكل جيد فبدل ما بيقرأ من الكتاب العادي أو
+
+383
+00:28:45,700 --> 00:28:49,380
+الكتاب الإلكتروني بيعمل تحدي مع الحاسوب على سبيل
+
+384
+00:28:49,380 --> 00:28:53,780
+المثال في هذا الوضع و بيحاول يتعرف على الميكروبات
+
+385
+00:28:53,780 --> 00:28:57,400
+بهذه الطريقةو في نفس الوقت بعمل revision بطريقة
+
+386
+00:28:57,400 --> 00:29:00,600
+interactive يعني فيها نوع من ال .. ال .. ال ..
+
+387
+00:29:00,600 --> 00:29:04,820
+خدنا نقول الحوار بينك وبين الجهاز مش .. طبعا ال ..
+
+388
+00:29:04,820 --> 00:29:10,160
+ال .. البرنامج كمان بعطيني الخيار ان انا اختار من
+
+389
+00:29:10,160 --> 00:29:17,720
+قائمة كبيرة من البكتيريا تمام؟ و اشوف ال clinical
+
+390
+00:29:17,720 --> 00:29:24,440
+او السهم اللي تبعها كلها هذا برجعني بالسهم لل last
+
+391
+00:29:24,440 --> 00:29:30,450
+stepطبعا هذه القائمة اللي بنحرك فيها اللي هي
+
+392
+00:29:30,450 --> 00:29:33,250
+القوام هي ال helicopter pilot تبعتنا اللي كنا نشرح
+
+393
+00:29:33,250 --> 00:29:33,730
+فيها اليوم
+
+394
+00:29:36,560 --> 00:29:41,520
+فكرة بسيطة يعني خدنا نقول يعني digest تذكير
+
+395
+00:29:41,520 --> 00:29:46,100
+بالعناوين مش تفاصيل كبيرة مملة لأ تذكير بالعناوين
+
+396
+00:29:46,100 --> 00:29:49,660
+اعتقد ان هو ده البرنامج الكل ان شاء الله يكون الكل
+
+397
+00:29:49,660 --> 00:29:51,740
+ينزله عن ال facebook انا وضعته على صفحة ال
+
+398
+00:29:51,740 --> 00:29:57,700
+diagnostic ويحاول ان يطلع فيه الفكرة تبعته العنوان
+
+399
+00:29:57,700 --> 00:30:00,700
+تبعته اسمه identification of bacteria by
+
+400
+00:30:00,700 --> 00:30:03,420
+consecutive
+
+401
+00:30:03,930 --> 00:30:07,870
+biochemical test كلمة consecutive كنا مرة تتابع
+
+402
+00:30:07,870 --> 00:30:11,650
+لكن احنا مش هي الطريقة الحقيقية اللي بنكون فيها في
+
+403
+00:30:11,650 --> 00:30:17,030
+التعرف لكن نفترض نفترض معناه ABI وطلعت نتائجه ال
+
+404
+00:30:17,030 --> 00:30:23,830
+20 فحص مين فيكوا هيحفظ جدول 200 بكتيريا ضرب 20
+
+405
+00:30:23,830 --> 00:30:28,860
+positive negative ولا واحدمظبوط ولا مش مظبوط؟ لكن
+
+406
+00:30:28,860 --> 00:30:31,520
+كلكوا حفظته ان الاشريشة كولاي indole positive
+
+407
+00:30:31,520 --> 00:30:34,460
+سيطرة negative صح ولا مش صح؟ كلكوا عارفين الكلام
+
+408
+00:30:34,460 --> 00:30:38,460
+هذا فلما ألاجي indole positive بستثنى كل ال indole
+
+409
+00:30:38,460 --> 00:30:40,840
+negative اللي بعرفهم فبالتالي أنا بدور على
+
+410
+00:30:40,840 --> 00:30:43,760
+بالطريقة هذه مين indole positive؟ مين سيطرة
+
+411
+00:30:43,760 --> 00:30:46,540
+positive؟ مين gelatin liquefaction positive؟ هذا
+
+412
+00:30:46,540 --> 00:30:50,080
+ال dead world او هذا البرنامج بمرني او بعملي ميران
+
+413
+00:30:50,080 --> 00:30:53,560
+على هذا الكلام ان شاء الله واعتقد ان مافيش أسئلة
+
+414
+00:30:53,560 --> 00:30:55,320
+اليوم بيكفي هذه المحاضرة
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/316CJubl8XM.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/316CJubl8XM.srt
new file mode 100644
index 0000000000000000000000000000000000000000..13b06e9b46a145321cf30163576168991ead84b3
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/316CJubl8XM.srt
@@ -0,0 +1,1931 @@
+1
+00:00:20,230 --> 00:00:26,370
+بسم الله الرحمن الرحيم اليوم موضوع جديد بنناقش فيه
+
+2
+00:00:26,370 --> 00:00:29,410
+الجزء الثاني من العنوان الرئيس: gram-positive bacilli
+
+3
+00:00:29,410 --> 00:00:32,690
+العنوان الأول كان: gram-positive bacilli in the spore
+
+4
+00:00:32,690 --> 00:00:35,110
+-forming. اليوم الجزء الثاني: non-spore-
+
+5
+00:00:35,110 --> 00:00:37,650
+forming. ويمكن أشهر مايكروب في السلسلة اللي
+
+6
+00:00:37,650 --> 00:00:40,610
+هنناقشه اللي هو كوريني بكتيريوم أو كورينو بكتيريم
+
+7
+00:00:40,610 --> 00:00:45,420
+على حسب الألفاظ المختلفة. هناك ثلاث أسماء مهمة جدا
+
+8
+00:00:45,420 --> 00:00:48,740
+بالنسبة لنا، كوريني بكتيريوم دفتيريا، كوريني
+
+9
+00:00:48,740 --> 00:00:52,860
+بكتيريوم ألسيرانس، وواضح من الاسم ألسيرانس أنه
+
+10
+00:00:52,860 --> 00:00:56,360
+بتعمل قرح، وكوريني بكتيريوم أوبس أو pseudo
+
+11
+00:00:56,360 --> 00:00:59,040
+tuberculosis. ومن الاسم pseudo tuberculosis يعني
+
+12
+00:00:59,040 --> 00:01:05,180
+بتعمل زي داء السل الزائف، وأوبس في الأبقار غالبا
+
+13
+00:01:05,180 --> 00:01:09,420
+يعني ممكن تنتقل إلى الإنسان، لكن نسبة حدوثها قليلة.
+
+14
+00:01:09,420 --> 00:01:14,480
+جدامكم، الثلاثه اللي أمامكم على اللوحة الآن،
+
+15
+00:01:14,480 --> 00:01:18,480
+الأهم على الاطلاق هي رقم واحد، وكانت في يوم من
+
+16
+00:01:18,480 --> 00:01:22,240
+الأيام من أهم مسببات الأمراض (pathogens) المسببة للوفيات عند
+
+17
+00:01:22,240 --> 00:01:27,000
+الأطفال، وسميت باللغة العربية الخناق، الخناق لأنها
+
+18
+00:01:27,000 --> 00:01:31,220
+كانت تخنق، تخنق الطفل فيموت الطفل، ولونه ازرق
+
+19
+00:01:31,220 --> 00:01:35,120
+وكان اسموه برضه blue babies، يعني الأطفال الزرق.
+
+20
+00:01:35,880 --> 00:01:40,580
+والسبب في الخنق هو قدرة البكتيريا على تكوين
+
+21
+00:01:40,580 --> 00:01:44,280
+ما يسمى بالـpseudomembrane، مكون من البكتيريا
+
+22
+00:01:44,280 --> 00:01:47,240
+نفسها، من الخلايا الميتة، وفضلات
+
+23
+00:01:49,890 --> 00:01:53,350
+قد يمتد ليغطي القصبة الهوائية (التراكية)، إذا غطى التراكية عند
+
+24
+00:01:53,350 --> 00:01:56,630
+الأطفال الرضع اللي ما بيعرفوا يتكلموا ولا يعبروا عن
+
+25
+00:01:56,630 --> 00:02:00,710
+أنفسهم، فغالبا هيموتوا من الاختناق (suffocation) أو من نقص في
+
+26
+00:02:00,710 --> 00:02:05,370
+الأكسجين (oxygen). لكن الحمد لله رب العالمين، بعد إدخال الـ
+
+27
+00:02:05,370 --> 00:02:10,430
+لقاح (vaccination)، يعني من سنوات عديدة لم نسمع بأي حالة
+
+28
+00:02:10,430 --> 00:02:15,250
+من الدفتيريا في قطاع غزة. الـClinical Manifestation
+
+29
+00:02:15,250 --> 00:02:18,970
+للـDiphtheria هي عبارة عن Local Lesion in the
+
+30
+00:02:18,970 --> 00:02:23,010
+Nose and Throat. كمان مرة، it is a Local Infection
+
+31
+00:02:23,010 --> 00:02:26,730
+بتذكرنا بإن الكلستريديوم تيتاني لما قلنا إن
+
+32
+00:02:26,730 --> 00:02:31,580
+الكلستريديوم تيتاني برضه بتعمل Local Infection. كلاهما
+
+33
+00:02:31,580 --> 00:02:35,560
+السموم (Toxin) تبعهم بينتقل من مكان الانتاج إلى
+
+34
+00:02:35,560 --> 00:02:40,760
+أماكن متنوعة في جسم الإنسان. وبالتالي، إذا بتقرأوا
+
+35
+00:02:40,760 --> 00:02:45,080
+اخر جملة في اللوحة، هتلاقوا إن الـDeath is usually
+
+36
+00:02:45,080 --> 00:02:49,990
+resulting from heart failure. إذا الـToxin can reach
+
+37
+00:02:49,990 --> 00:02:53,370
+distant organs، can affect many organs، والسموم
+
+38
+00:02:53,370 --> 00:02:56,550
+احنا درسناه، أول سم درسناه في الـExotoxins
+
+39
+00:02:56,550 --> 00:03:01,090
+كنموذج على البروتين اللي عامل AB model، وإنه بيعمل
+
+40
+00:03:01,090 --> 00:03:05,230
+protein synthesis inhibition عن طريق اللي هو الـ
+
+41
+00:03:05,230 --> 00:03:07,470
+interference أو الـinactivation للـelongation
+
+42
+00:03:07,470 --> 00:03:11,550
+factor 2 (EF2) عن طريق طبعا إضافة ADP ribose اللي
+
+43
+00:03:11,550 --> 00:03:16,770
+يقولنا عنها ADP ribosylation. إيقاف نشاط elongation
+
+44
+00:03:16,770 --> 00:03:19,930
+factor 2 بيوقف تصنيع البروتين، تصنيع البروتين، إذا
+
+45
+00:03:19,930 --> 00:03:24,130
+وقف الخلية، اتفقنا من زمان ان الخلية دي doomed
+
+46
+00:03:24,130 --> 00:03:32,600
+to death، محكم عليها بالموت. إذا خلايا ميتة، بقايا الطعام،
+
+47
+00:03:32,600 --> 00:03:36,660
+البكتيريا نفسها can aggregate، بتتجمع مع بعضها، و
+
+48
+00:03:36,660 --> 00:03:39,000
+بتكون اللي ما يسمى بالـpseudomembrane اللي قلنا
+
+49
+00:03:39,000 --> 00:03:42,640
+عنه، can extend to cover up the trachea. وفي الغالب
+
+50
+00:03:42,640 --> 00:03:45,320
+المريض (patient) will die of suffocation، suffocation هو
+
+51
+00:03:45,320 --> 00:03:50,440
+الاختناق. هذه الصورة بتوضح أن الغشاء (membrane) اللي
+
+52
+00:03:50,440 --> 00:03:54,840
+متكون وممتد إلى to cover the tonsils، مغطي الـ
+
+53
+00:03:54,840 --> 00:04:00,960
+لوزتين (tonsils). لحظة، الفتحة المتبقية، والمريض فاتح فمه، يعني
+
+54
+00:04:00,960 --> 00:04:07,900
+يعني مسافة ضيقة جدا. لو امتدت هذه المسافة، أو الـ
+
+55
+00:04:07,900 --> 00:04:11,800
+الـmembrane، حجمه زاد، هيغلق الـ
+
+56
+00:04:11,800 --> 00:04:17,360
+المجرى الهوائي (airway)، وبالتالي بيصير بالفعل في أنه يختنق. الـsigns
+
+57
+00:04:17,360 --> 00:04:20,220
+and symptoms للـdisease، بيقولنا الـrespiratory
+
+58
+00:04:20,220 --> 00:04:23,120
+form has an incubation period of two to five days،
+
+59
+00:04:23,120 --> 00:04:26,870
+اتنين لخمس أيام. The onset of disease is usually
+
+60
+00:04:26,870 --> 00:04:30,350
+gradual، يعني ما بتكونش صدمة، بتكون تدريجية، الأعراض
+
+61
+00:04:30,350 --> 00:04:33,890
+تبدأ. Symptoms include fatigue، fever، mild sore
+
+62
+00:04:33,890 --> 00:04:38,690
+throat، مصطلح ذكرناه لما كلمنا عن الـgroup A
+
+63
+00:04:38,690 --> 00:04:41,350
+streptococci، اللي الـstreptococcus، الـgenes
+
+64
+00:04:41,350 --> 00:04:43,650
+اللي موجودة في التهاب اللوزتين (tonsillitis) والتهاب البلعوم (pharyngitis)، كلهم
+
+65
+00:04:43,650 --> 00:04:46,610
+collectively، يقولنا بيطلق عليهم بالعامية sore
+
+66
+00:04:46,610 --> 00:04:49,910
+throat، التهابات الحلق، بنسمي التهابات الحلق
+
+67
+00:04:50,810 --> 00:04:53,330
+difficulty in swallowing، maybe evidence برضه، يعني
+
+68
+00:04:53,330 --> 00:04:58,410
+ممكن تظهر علامات صعوبة في اللي هو البلع. الـ
+
+69
+00:04:58,410 --> 00:05:02,970
+children غالبا بيظهروا علامات إضافية، من ضمنها اللي
+
+70
+00:05:02,970 --> 00:05:08,330
+هو الغثيان (nausea) والقيء (vomiting) والقشعريرة (chills) والحمى العالية (high fever). وأحد
+
+71
+00:05:08,330 --> 00:05:13,330
+الإشكاليات أن بعض أو نسبة من الأطفال لا يظهروا أي
+
+72
+00:05:13,330 --> 00:05:18,420
+من هذه الأعراض، وبالتالي بيكون المرض (disease) silent،
+
+73
+00:05:18,420 --> 00:05:22,820
+يعني، يعني بيتطور، it progresses بدون ظهور أعراض
+
+74
+00:05:22,820 --> 00:05:27,640
+كثيرة. هاي طبعا بتقدر يكون فيه sudden onset of
+
+75
+00:05:27,640 --> 00:05:31,200
+the disease، يعني هو طبيعته تدريجية (gradual)، لكن في دول
+
+76
+00:05:31,200 --> 00:05:35,760
+الأطفال غالبا بيعطينا sudden onset. في كمان نقطة
+
+77
+00:05:35,760 --> 00:05:40,070
+كتير مهمة لازم نعرفها. في نسبة من المرضى (patients) بتمثل
+
+78
+00:05:40,070 --> 00:05:43,190
+حوالي عشرة بالمائة (10%) من المرضى (patients)،
+
+79
+00:05:43,190 --> 00:05:47,610
+هؤلاء بيصير عندهم انتفاخ في الرقبة، وكل كتير اللي
+
+80
+00:05:47,610 --> 00:05:50,990
+بيسموهم bull neck أو رقبة الثور، لأنه بيصير فيه
+
+81
+00:05:50,990 --> 00:05:55,830
+انتفاخ في الرقبة. الآن هؤلاء الناس اللي عندهم
+
+82
+00:05:55,830 --> 00:06:02,570
+الانتفاخ في الرقبة هم الأكثر عرضة للوفيات، يعني اللي
+
+83
+00:06:02,570 --> 00:06:07,850
+بيطور هذا العرض (symptom)، هذا bad prognosis، يعني نتنبأ
+
+84
+00:06:07,850 --> 00:06:12,970
+بأن تطور المرض (progression of disease) هيكون أسوأ (worse)، يعني
+
+85
+00:06:12,970 --> 00:06:15,650
+هيكون أسوأ، وممكن يؤدي إلى الوفاة.
+
+86
+00:06:18,000 --> 00:06:20,640
+من اللي هو، الحياة السابقة عرفنا حاجة واحدة مهمة
+
+87
+00:06:20,640 --> 00:06:23,140
+جدا لكم، في علم الأحياء الدقيقة التشخيصي (diagnostic microbiology)، من وين العينة
+
+88
+00:06:23,140 --> 00:06:27,840
+بناخدها؟ من الأذن؟ ولا من الشعر؟ ولا من وين؟ من الـ
+
+89
+00:06:27,840 --> 00:06:30,260
+الحلق (throat) ومن مسحة البلعوم الأنفي (nasal pharyngeal swab)، nasal pharyngeal
+
+90
+00:06:30,260 --> 00:06:35,400
+أو throat swab هي العينة الأساسية للبكتيريا. الآن
+
+91
+00:06:35,400 --> 00:06:37,680
+الخصائص (characteristics) دي لازم نعرفها عشان نقدر نتعرف
+
+92
+00:06:37,680 --> 00:06:39,520
+على البكتيريا. البكتيريا، احنا عنواننا gram
+
+93
+00:06:39,520 --> 00:06:43,700
+positive bacilli، وعنواننا كمان non-spore-forming. هذه
+
+94
+00:06:43,700 --> 00:06:49,640
+نقطة مهمة جدا. Polymorphic، متعددة الأشكال والأحجام،
+
+95
+00:06:49,640 --> 00:06:53,380
+مش متجانسة الأشكال (polymorphic). أشكال وأحجام طويلة،
+
+96
+00:06:53,380 --> 00:06:58,400
+قصيرة، منتفخة، على شكل حرف L، على شكل حرف V، يعني فيه أكثر من
+
+97
+00:06:58,400 --> 00:07:07,140
+شكل لها. Non-motile، Non-acid-fast، and aerobic. الآن
+
+98
+00:07:07,140 --> 00:07:12,240
+Non-acid-fast، ايش يعني هذه المعلومة؟ احنا بنعرف
+
+99
+00:07:12,240 --> 00:07:15,850
+إنه مين الـacid-fast بس في الدنيا؟ داء السل (tuberculosis)
+
+100
+00:07:15,850 --> 00:07:19,370
+الجنس (genus) تبعها هو الـmycobacteria، الـ
+
+101
+00:07:19,370 --> 00:07:24,670
+mycobacteria وفي النوكارديا، مظبوط؟ في النوكارديا،
+
+102
+00:07:24,670 --> 00:07:28,890
+برضه acid-fast، الآن النوكارديا تصنف على أنها gram
+
+103
+00:07:28,890 --> 00:07:33,870
+positive. وهذه البكتيريا جرام بوزتف، بس، إذن
+
+104
+00:07:33,870 --> 00:07:37,910
+الاثنتين بينتموا لنفس الشكل، الاثنتين جرام بوزتف
+
+105
+00:07:37,910 --> 00:07:42,010
+بس، وبالتالي بحاجة نحن إلى أي معلومة تساعدنا في
+
+106
+00:07:42,010 --> 00:07:45,770
+عملية التصنيف. انها acid-fast لكن هذه non-
+
+107
+00:07:45,770 --> 00:07:51,910
+acid-fast. طيب aerobic بتساعدنا في أنه هنعرف أن
+
+108
+00:07:51,910 --> 00:07:57,300
+كلها catalase positive، صح؟ Catalase positive. Club-shaped
+
+109
+00:07:57,300 --> 00:08:02,000
+form، swelled end أو swelled end. فاكرين الكلستريديوم
+
+110
+00:08:02,000 --> 00:08:06,040
+تيتاني؟ كان فيه على الطرف النهائي (terminal) البصلي كان فيه
+
+111
+00:08:06,040 --> 00:08:11,040
+جراثيم (spore) فسميناها drum stick، عصا، وقُدّامها
+
+112
+00:08:11,040 --> 00:08:17,020
+فيه كرة. تمام؟ هذه بتشبهها إلى حد ما، لأن الطرف
+
+113
+00:08:17,020 --> 00:08:21,750
+تبعها برضه منتفخ، لكن الانتفاخ ليس ناتج عن مين؟ عن
+
+114
+00:08:21,750 --> 00:08:24,770
+الجراثيم (spore). احنا اتفقنا أنه non-spore-forming. طب
+
+115
+00:08:24,770 --> 00:08:27,510
+الانتفاخ ناتج عن ايش؟ الانتفاخ ناتج عن أن
+
+116
+00:08:27,510 --> 00:08:33,130
+البكتيريا هذه بتنتج حبيبات ميتاكروماتيكية (metachromatic granules)، لها الـ
+
+117
+00:08:33,130 --> 00:08:39,190
+storage granules، وبتتخزن في أماكن متنوعة، لكن أكثر
+
+118
+00:08:39,190 --> 00:08:43,370
+مكان تتخزن فيه مين؟ الطرف. كيف لو بدنا نميز الاثنين
+
+119
+00:08:44,020 --> 00:08:46,960
+عن بعض، الكلستريديوم تيتاني والكوريني بكتيريوم
+
+120
+00:08:46,960 --> 00:08:56,060
+دفتيريا؟  تنقلهم مدببة على الحافة أو أحد الطرفين. لو
+
+121
+00:08:56,060 --> 00:08:59,020
+عملنا جرام ستين، ايش هنشوف في الكلستريديوم
+
+122
+00:08:59,020 --> 00:09:02,700
+تيتاني؟ هنشوف هذة البنية (structure) على الطرف، لأن الجراثيم (spore)
+
+123
+00:09:02,700 --> 00:09:06,700
+لم تسبق، لم تسبق. بينما الكوريني بكتيريوم دفتيريا
+
+124
+00:09:06,700 --> 00:09:10,460
+هنشوف حاجة ملساء (مسمطة)، ملساء (مسمطة) يعني ملساء تماما، لانها مش
+
+125
+00:09:10,460 --> 00:09:15,700
+جراثيم (spore). هي التمييز بين الاثنين. إحدى النقاط المهمة جدا
+
+126
+00:09:15,700 --> 00:09:19,680
+كمان في هيئة (arrangement) البكتيريا وهي، وهي بنسميها hallmark،
+
+127
+00:09:19,680 --> 00:09:21,960
+أو distinguishing characteristics، اللي هو الـ
+
+128
+00:09:21,960 --> 00:09:24,440
+شكل (appearance) وترتيب (arrangement) الخلايا. فاكرين في
+
+129
+00:09:24,440 --> 00:09:28,120
+الجرام بوزتف كوكساى (gram-positive cocci) كنا نقول streptococci أو
+
+130
+00:09:28,120 --> 00:09:32,160
+عناقيد عنبية الشكل (grape-like clusters). هنا في شكل بيسموه
+
+131
+00:09:32,160 --> 00:09:34,400
+Chinese letter characters، Chinese letter
+
+132
+00:09:34,400 --> 00:09:37,320
+characters زي الأحرف الصينية. اللي أنا شباب فيه عندي
+
+133
+00:09:37,320 --> 00:09:40,160
+عندي حرف الـV وحرف الـL. يقول إن هدول
+
+134
+00:09:40,160 --> 00:09:43,160
+شكلين من الأشكال اللي بتميز فيها البكتيريا. لو
+
+135
+00:09:43,160 --> 00:09:49,320
+تخيلنا مجموعة حروف V ومجموعة حروف L وراميناهم على بعض هيتشكل لدينا حرف الـL
+
+136
+00:09:49,320 --> 00:09:54,820
+هيك، بدنا نرسمها. وراميناهم على بعض، هيتشكل لدينا حرف الـL.
+
+137
+00:09:54,820 --> 00:10:00,640
+هنرسم رسمة هذه.
+
+138
+00:10:00,640 --> 00:10:10,680
+L
+
+139
+00:10:10,680 --> 00:10:22,080
+وهذه بالمقلوب، وهذه V، تمام؟ وهذه كمان V. في الآخر صار
+
+140
+00:10:22,080 --> 00:10:27,500
+عندي ايش؟ حرف صيني. فغالبا بتعطينا الـappearance هذا
+
+141
+00:10:27,500 --> 00:10:31,520
+أو الشعور بأنك أنت بتتفرج على حروف صينية، ناتجة عن
+
+142
+00:10:31,520 --> 00:10:35,100
+مين؟ قلنا كده مرة عن الـarrangement بتاعتها، الـL والـV
+
+143
+00:10:35,100 --> 00:10:35,640
+shape.
+
+144
+00:10:38,940 --> 00:10:41,660
+إذن بدنا نربط معلومة الـChinese letter characters
+
+145
+00:10:41,660 --> 00:10:46,260
+بالـكوريني بكتيريوم بشكل عام. كمان في نقطة كتير
+
+146
+00:10:46,260 --> 00:10:50,420
+مهمة، شباب، مقدرة البكتيريا على النمو في وسط بيحتوي
+
+147
+00:10:50,420 --> 00:10:53,340
+على تيلوريت البوتاسيوم (potassium tellurite). مش كتير من البكتيريا عندها
+
+148
+00:10:53,340 --> 00:10:56,220
+المقدرة هذه، وبالتالي بنعتبر هذه البكتيريا أو
+
+149
+00:10:56,220 --> 00:11:00,600
+بنعتبر هذه الميزة برضه ميزة جيدة لها، وبتعطينا
+
+150
+00:11:00,600 --> 00:11:03,720
+اللون الأسود، بتعطينا اللون الأسود، الناتج عن
+
+151
+00:11:03,720 --> 00:11:08,420
+اختزال التيلوريت. الـSpecimen collection زي ما
+
+152
+00:11:08,420 --> 00:11:14,440
+حكينا، بنحتاج إلى throat or nasopharyngeal swab.
+
+153
+00:11:14,440 --> 00:11:19,320
+وإذا وجد واحد من أفراد العائلة،
+
+154
+00:11:25,080 --> 00:11:30,220
+أو في الحضانة، أو في المدرسة، كل المخالطين (contacts) يجب أن
+
+155
+00:11:30,220 --> 00:11:33,340
+يأخذ منهم برضه throat and nasopharyngeal swab.
+
+156
+00:11:33,340 --> 00:11:38,560
+لماذا؟ لأنه مادام احتكوا ببعضهم يمكن يكونوا نقلوا
+
+157
+00:11:38,560 --> 00:11:41,480
+العدوى، وبالتالي احنا بدنا نحمي المريض ونحمي الـ
+
+158
+00:11:41,480 --> 00:11:41,920
+contacts.
+
+159
+00:11:44,780 --> 00:11:48,020
+مش هشرح الـmedia لكن بدي أمر عليها مرة سريعة. الـ
+
+160
+00:11:48,020 --> 00:11:51,660
+media، في عندي حاجة اسمها بيضة وسط (pie media)، pie media يحتوي
+
+161
+00:11:51,660 --> 00:11:56,640
+على بيض كامل متجانس (homogenized whole egg)، بيض كامل، تمام؟ ومحتوي على
+
+162
+00:11:56,640 --> 00:12:02,270
+جلسرين (glycerol) وجلوكوز (glucose). تينسدال ميديوم يحتوي على
+
+163
+00:12:02,270 --> 00:12:05,390
+الكلام اللي حكيناه، أو غني نوعا ما، لكن مضاف إليه
+
+164
+00:12:05,390 --> 00:12:08,370
+مادة مضافة (supplement). الـsupplement هذه فيها صوديوم
+
+165
+00:12:08,370 --> 00:12:11,350
+ثيوكبريتات (thiosulfate) وتيلوريت البوتاسيوم (potassium tellurite)، اللي هو
+
+166
+00:12:11,350 --> 00:12:14,210
+مقدرة البكتيريا على النمو في وسط يحتوي على تيلوريت البوتاسيوم
+
+167
+00:12:14,210 --> 00:12:18,290
+(potassium tellurite). ليش شباب في الـmedia بنضيف supplement؟
+
+168
+00:12:18,290 --> 00:12:22,570
+media و supplement؟ ليش ما كلهم مع بعض، خلطة واحدة؟
+
+169
+00:12:22,600 --> 00:12:26,140
+لأنه غالبا اللي حطيناه في الـsupplement بتتأثر
+
+223
+00:15:56,290 --> 00:16:00,610
+لكن اللون تبعها بيكون أغمق، كيف لنا أن نميز
+
+224
+00:16:00,610 --> 00:16:04,490
+بين Gravis و بين التنتين البجيين؟ والـ Gravis على
+
+225
+00:16:04,490 --> 00:16:08,440
+فكرة هي الأهم، Gravis بيعمل hydrolysis للـ
+
+226
+00:16:08,440 --> 00:16:11,920
+starch والجليكوجين، while meatus and intermediates
+
+227
+00:16:11,920 --> 00:16:15,300
+do not يفجر في عندي فحص اللي هو الـ starch
+
+228
+00:16:15,300 --> 00:16:18,420
+hydrolysis أو الجليكوجين hydrolysis بيميزلي لـ
+
+229
+00:16:18,420 --> 00:16:22,680
+Gravis عن التلتين الأخرين، فده الـ diagram اللي
+
+230
+00:16:22,680 --> 00:16:27,000
+هو هيكون محور المحاضرة تبعتنا اليوم إن شاء الله للـ
+
+231
+00:16:27,000 --> 00:16:31,080
+isolation and identification of اللي هي الـ
+
+232
+00:16:31,080 --> 00:16:33,960
+Cornebacterium diphtheria طلعولي على العينة، إيش
+
+233
+00:16:33,960 --> 00:16:38,650
+كانت العينة؟ Collect more than one swab، غالبًا
+
+234
+00:16:38,650 --> 00:16:42,970
+بنعمل جملة three swabs، three swabs، واحد في
+
+235
+00:16:42,970 --> 00:16:45,830
+النصر، إيش بنعمل فيه يا شباب؟ نزرع على cigarette
+
+236
+00:16:45,830 --> 00:16:50,910
+agar أو blood agar، لأي غرض؟ إحنا بنعرف إن الـ most
+
+237
+00:16:50,910 --> 00:16:56,690
+common cause of bacterial sore throat هو مين؟
+
+238
+00:16:56,690 --> 00:16:58,810
+مين؟
+
+239
+00:17:02,660 --> 00:17:06,080
+الـ Streptococcus pyogenes اللي هي group A، group A
+
+240
+00:17:06,080 --> 00:17:08,860
+Streptococcus، وبالتالي أنا بدي أستثنى .. بدي
+
+241
+00:17:08,860 --> 00:17:11,540
+أستثنى هذه الاحتمالية من اللي سوافها زرعتها على
+
+242
+00:17:11,540 --> 00:17:15,160
+blood agar أو على chocolate agar to examine for
+
+243
+00:17:15,160 --> 00:17:19,640
+beta hemolytic streptococci، الآن على الطرف هذا
+
+244
+00:17:19,640 --> 00:17:22,640
+زرعت على Loeffler أو  Blood agar، واحنا جدنا على الطرف هذا
+
+245
+00:17:22,640 --> 00:17:26,640
+هي بمثابة enrichment، وعلى الطرف التاني زرعنا على
+
+246
+00:17:26,640 --> 00:17:31,920
+Tellurite agar بمثابة selective،و للتأكيد لما
+
+247
+00:17:31,920 --> 00:17:35,020
+زرعنا على الـ Loeffler ما استنانا على الـ Loeffler و
+
+248
+00:17:35,020 --> 00:17:38,920
+انتهى الموضوع بعد ساعتين لثمان ساعات، أخدنا و
+
+249
+00:17:38,920 --> 00:17:42,920
+زرعنا على مين؟ على Tellurite agar زي ما عملنا
+
+250
+00:17:42,920 --> 00:17:46,980
+بالظبط في السالمونيلا فاكرين؟ stool على
+
+251
+00:17:46,980 --> 00:17:51,020
+Selanite F ومن السيلانايت F زرعنا على SSA أو XLD
+
+252
+00:17:51,020 --> 00:17:55,890
+صح ولا؟ نفس الخطوة هذه، لكن هنا في خطوة زيادة بعد
+
+253
+00:17:55,890 --> 00:17:58,790
+ساعتين لثمان ساعات إحنا زرعنا صحيح على تلويرات
+
+254
+00:17:58,790 --> 00:18:02,630
+أجار، بس عملنا حالة اسمها Methylene Blue Staining
+
+255
+00:18:04,370 --> 00:18:07,070
+لحظة ما قلناش جرام stain، بيقولنا ميثيلين بلو
+
+256
+00:18:07,070 --> 00:18:10,590
+لماذا ميثيلين بلو؟ ميثيلين بلو اللي هو simple
+
+257
+00:18:10,590 --> 00:18:13,910
+stain is the best for  Cornebacterium diphtheria، ده
+
+258
+00:18:13,910 --> 00:18:17,810
+الرقم واحد، و ليش هو best أصلاً؟ best لإنه بيعمل لي
+
+259
+00:18:17,810 --> 00:18:21,150
+demonstration للـ metachromatic granules اللي كنا
+
+260
+00:18:21,150 --> 00:18:23,490
+إحنا هنجيبها شوية، مش كنا قلنا إن هذه البكتيريا بتنتج
+
+261
+00:18:23,490 --> 00:18:26,870
+metachromatic granules، فالميثيلين بلو بيعمل لي
+
+262
+00:18:26,870 --> 00:18:32,690
+staining أنقلها بشكل جيد، طيب تيلورايت أجار selective
+
+263
+00:18:32,690 --> 00:18:36,470
+و تيلورايت أجار بعد subculture، أي مستعمرة
+
+264
+00:18:36,470 --> 00:18:39,850
+resembling  Cornebacterium diphtheriae، إيش شكلها؟
+
+265
+00:18:39,850 --> 00:18:48,100
+إيش لونها؟ أسود، من أين الـ Methylene blue؟ اللون تبعها على
+
+266
+00:18:48,100 --> 00:18:52,800
+الطبق كان لون مستعمراتها أسود، وبالتالي المستعمرات
+
+267
+00:18:52,800 --> 00:18:55,420
+السوداء هي الـ suspect colonies، الآن الـ suspect
+
+268
+00:18:55,420 --> 00:18:58,620
+colonies إيش بنعمل فيها؟ بناخدها ونزرعها على
+
+269
+00:18:58,620 --> 00:19:03,100
+مجموعة من الأوساط، بنعرف كل وسط زرعنا ليه زرعنا
+
+270
+00:19:03,100 --> 00:19:07,240
+عليه، مثلاً زرعنا على الـ Loeffler أو Blood agar كم
+
+271
+00:19:07,240 --> 00:19:10,520
+مرة؟ الـ Loeffler و الـ Blood agar مرتين، مرة فوق ومرة
+
+272
+00:19:10,520 --> 00:19:14,800
+تحت، اللي فوق غير عن التحت، الآن الغرض من اللي فوق
+
+273
+00:19:14,800 --> 00:19:18,160
+غير اللي تحت، الغرض من اللي فوق كان enrichment،
+
+274
+00:19:18,160 --> 00:19:22,720
+إغناء، تنمية البكتيريا بأقصى ما يكون، بس كان فيه
+
+275
+00:19:22,720 --> 00:19:26,120
+بكتيريا ثانية معاها، أنا أخدت throat swab ما أخدتش
+
+276
+00:19:26,120 --> 00:19:29,120
+pure culture، فبالتالي ممكن يكون في other organisms
+
+277
+00:19:29,120 --> 00:19:32,820
+موجودين في الـ .. لكن لما أنا أخدت هنا، أخدت مستعمرة
+
+278
+00:19:32,820 --> 00:19:35,520
+واحدة وزرعتها على Loeffler، فهذه الحالة لازم تكون
+
+279
+00:19:35,520 --> 00:19:38,240
+المستعمرة اللي هنا pure، يبقى يا إما
+
+280
+00:19:38,240 --> 00:19:40,220
+Cornebacterium diphtheriae، يا إما مش
+
+281
+00:19:40,220 --> 00:19:44,520
+Cornebacterium، لكن نوع واحد، زرعته على الـ Loeffler
+
+282
+00:19:44,520 --> 00:19:47,820
+لغرضين، عشان أعمل staining كمان مرة وميثيلين بلو،
+
+283
+00:19:47,820 --> 00:19:50,680
+وعشان أعمل biochemical tests، أنا قلت لكم الـ
+
+284
+00:19:50,680 --> 00:19:54,880
+biochemical tests اهتمامنا فيها مش عالي، لكن عشان
+
+285
+00:19:54,880 --> 00:19:57,780
+نميز التلاتة عن بعضهم، الـ ulcerans والـ diphtheriae
+
+286
+00:19:57,780 --> 00:20:03,060
+والـ ovis، محتاجين بعض الـ biochemical tests، بنزرع الـ
+
+287
+00:20:03,060 --> 00:20:06,880
+suspect colony على أجار medium for in vitro
+
+288
+00:20:06,880 --> 00:20:10,920
+toxigenicity assay، فاكرين الـ in vitro؟ لما جيبنا
+
+289
+00:20:10,920 --> 00:20:15,160
+filter paper، رسمناها على الرسام في المحاضرة، جبنا
+
+290
+00:20:15,160 --> 00:20:18,320
+نجيبنا filter paper وزرعنا الـ positive control والـ
+
+291
+00:20:18,320 --> 00:20:22,020
+الـ negative control والـ test perpendicular على الـ
+
+292
+00:20:22,020 --> 00:20:27,040
+filter paper المغمور بـ antitoxin وعملنا
+
+293
+00:20:27,040 --> 00:20:32,080
+لهم incubation، إذا البكتيريا بتنتج toxin هيصير لها
+
+294
+00:20:32,080 --> 00:20:34,680
+diffusion، وطبعاً فيه diffusion لمين الآن؟ للـ
+
+295
+00:20:34,680 --> 00:20:37,420
+antitoxin، إذا التقى التوكسين مع الـ antitoxin
+
+296
+00:20:37,420 --> 00:20:41,500
+هيكون في ما نقوله precipitate أو line of precipitate
+
+297
+00:20:41,500 --> 00:20:46,040
+ناتجة عن الـ complex تبع الـ antigen antibody اللي
+
+298
+00:20:46,040 --> 00:20:50,360
+هو الـ toxin antitoxin reaction
+
+299
+00:20:52,160 --> 00:20:55,740
+وبنزرع كمان على broth media for in vivo
+
+300
+00:20:55,740 --> 00:20:59,140
+toxigenicity test، طبعاً الـ in vivo اللي هو الفار
+
+301
+00:20:59,140 --> 00:21:03,400
+فاكرين برضه، الفارين اللي حقننا
+
+302
+00:21:03,400 --> 00:21:07,740
+واحد منهم بالـ antitoxin وبعد نصف ساعة حقنهم بالـ
+
+303
+00:21:07,740 --> 00:21:12,640
+extract تبع الـ .. الـ .. الـ .. الـ .. لما شرحنا الـ
+
+304
+00:21:12,640 --> 00:21:17,000
+Clostridium perfringens، الـ toxigenic assay مظبوط؟
+
+305
+00:21:17,000 --> 00:21:19,060
+طيب لما .. لما .. لما نشوفوا الآن الصورة اللي
+
+306
+00:21:19,060 --> 00:21:23,070
+هتذكروا، بس قبل ما نروح على الصور ونطلع على الـ
+
+307
+00:21:23,070 --> 00:21:27,690
+assay بدنا نذكر الـ toxin والـ structure تبعه، الـ
+
+308
+00:21:27,690 --> 00:21:32,590
+toxin عبارة عن heat labile polypeptide، الجرعة
+
+309
+00:21:32,590 --> 00:21:36,930
+القاتلة منه هي 0.1 microgram لكل kilogram
+
+310
+00:21:36,930 --> 00:21:39,950
+ما عرفش مرة عليكم مصطلح per kilogram هذا، وده لأ في
+
+311
+00:21:39,950 --> 00:21:44,710
+الجرعات، بس أنا هأوضحه لكم، يعني زمان الصيدلة كانت
+
+312
+00:21:44,710 --> 00:21:48,670
+بتعطي جرعات على حسب السن، تقول الطفل اللي من عمره
+
+313
+00:21:48,670 --> 00:21:52,600
+كده كده، أعطوه جرعة كده كده، لكن مع طور الطب صار في
+
+314
+00:21:52,600 --> 00:21:56,540
+فكرة ثانية، يقولك الطفل في أطفال بيكون وزنه خمسين
+
+315
+00:21:56,540 --> 00:22:02,360
+كيلو وهو عمره سبع سنين، طيب هل ممكن الجرعة اللي
+
+316
+00:22:02,360 --> 00:22:05,660
+بيعطيها طفل وزنه عشرة كيلو تكون نفس الجرعة اللي
+
+317
+00:22:05,660 --> 00:22:08,740
+بيعطيها واحد خمسين كيلو؟ أكيد لأ، مش هتوزع بالجسم
+
+318
+00:22:08,740 --> 00:22:13,670
+بنفس التركيز، منطقي يعني،صار في مدرسة أخرى تنادي
+
+319
+00:22:13,670 --> 00:22:18,370
+بإنه لأ، الجرعات هي تبقى تكون حسب الوزن وليس حسب
+
+320
+00:22:18,370 --> 00:22:22,490
+العمر، مع أنه في اختلاف صحيح، وفي ناس بدأت تتسكر
+
+321
+00:22:22,490 --> 00:22:25,530
+بطريقة جدية إنه ندمجوا الاثنين مع بعض، العمر والوزن،
+
+322
+00:22:25,530 --> 00:22:30,170
+لأنه الطفل برضه يعني في بعض الـ systems من جسمه
+
+323
+00:22:30,170 --> 00:22:32,890
+ممكن ما تكونش كاملة، وبالتالي، حتى لو كان وزنه كبير، ممكن
+
+324
+00:22:32,890 --> 00:22:37,500
+يتحمل جرعة كبيرة per kilogram، لكن في النهاية قد
+
+325
+00:22:37,500 --> 00:22:42,520
+يتم حساب .. قد يتم حساب الجرعات سواء كانت دوائية
+
+326
+00:22:42,520 --> 00:22:48,240
+أو الجرعات السامة، تمام؟ للإنسان أو للحيوان، على
+
+327
+00:22:48,240 --> 00:22:52,600
+الوزن، per kilogram body weight، تمام؟ يعني بنقول
+
+328
+00:22:52,600 --> 00:22:56,180
+الجرعة القاتلة 0.1 microgram لكل kilogram
+
+329
+00:22:56,180 --> 00:23:01,030
+body weight، الآن الـ .. الـ .. الـ .. التوكسين تبعه
+
+330
+00:23:01,030 --> 00:23:03,710
+إحنا كنا متفقين عليه إنه .. إنه fragment A و
+
+331
+00:23:03,710 --> 00:23:06,390
+fragment B، فاكرين؟ كنا قلنا إنه الـ A بيعمل أول
+
+332
+00:23:06,390 --> 00:23:09,730
+واحد،  أخضرصناها، فلو جيبنا الـ disulfide bond وجزأنا
+
+333
+00:23:09,730 --> 00:23:14,150
+جزأناها، هيكون عندي قطعتين، B has no
+
+334
+00:23:14,150 --> 00:23:19,300
+independent action، ما لوش أي تأثير سام مستقل، هي
+
+335
+00:23:19,300 --> 00:23:24,200
+بالفعل للـ binding فقط، بينما A هي الـ toxic
+
+336
+00:23:24,200 --> 00:23:27,580
+والميكانيزم اللي قدامكم بيقولنا إنه it inhibits
+
+337
+00:23:27,580 --> 00:23:31,780
+polypeptide chain elongation by inactivating
+
+338
+00:23:31,780 --> 00:23:38,160
+elongation factor 2 أو EF2، هذا الـ factor وظيفته إنه
+
+339
+00:23:38,160 --> 00:23:41,820
+بيعمل عملية translocation للـ peptidyl tRNA
+
+340
+00:23:41,820 --> 00:23:45,360
+أو tRNA from the receptor site to the
+
+341
+00:23:45,360 --> 00:23:49,740
+donor site، وبالتالي هكذا إحنا وجدنا مين؟ وجدنا
+
+342
+00:23:49,740 --> 00:23:53,520
+عملية إطالة السلسلة بتاعة البوليبتيد توقفت لـ
+
+343
+00:23:53,520 --> 00:23:59,050
+protein synthesis، واتفقنا منذ زمن بعيد، Protein is
+
+344
+00:23:59,050 --> 00:24:03,670
+doomed to death، محكومة عليها بالموت، تمام؟ وبالتالي
+
+345
+00:24:03,670 --> 00:24:07,310
+الخلايا في النهاية هتموت، الآن هذا الشكل اللي
+
+346
+00:24:07,310 --> 00:24:10,170
+قدامكم شفناه قبل كده، هو نفس الشكل اللي شرحناه
+
+347
+00:24:10,170 --> 00:24:15,130
+أول مرة، وفيه له كمان يعني لوحة أخرى بتوضح إنها نفس
+
+348
+00:24:15,130 --> 00:24:21,980
+اللي هو الفكرة، نجي للـ biochemical tests، إحنا اتفقنا
+
+349
+00:24:21,980 --> 00:24:24,620
+أنه في البكتيريا هذه الـ biochemical tests لا تشكل
+
+350
+00:24:24,620 --> 00:24:26,800
+أهمية كبرى في التعرف على الكورني
+
+351
+00:24:26,800 --> 00:24:30,000
+البكتيريا، كعنوان، الـ staining مهم،
+
+352
+00:24:30,000 --> 00:24:35,260
+الميثيلين بلو staining مهم، التيلورايت أجار مهم،
+
+353
+00:24:35,260 --> 00:24:39,060
+لكن هناك بعض الصفات اللي بنستخدمها يا شباب لتمييز
+
+354
+00:24:39,060 --> 00:24:43,340
+بين الـ species، طلعوا على الجدول هذا، Diphtheria،
+
+355
+00:24:43,740 --> 00:24:48,440
+Ulcerans و Ovis، كان دي تلات فحوصات أنا حاططهم
+
+356
+00:24:48,440 --> 00:24:55,040
+مع بعضهم بلون رمادي، الوحيدة اللي positive للنترات
+
+357
+00:24:55,040 --> 00:25:01,160
+هي الـ Ulcerans، الوحيدة اللي positive للجيلاتين هي
+
+358
+00:25:01,160 --> 00:25:06,580
+برضه الـ Ulcerans، الوحيدة اللي negative لليوريا هي
+
+359
+00:25:06,580 --> 00:25:13,680
+الـ Diphtheria، صح؟ يبقى من التلات فحوصات هدول، هل
+
+360
+00:25:13,680 --> 00:25:20,160
+بنقدر نعمل diagram نميزهم؟ بكل سهولة، بنقول إذا
+
+361
+00:25:20,160 --> 00:25:22,080
+كانت البكتيريا كورني بكتيريا، نعمل test of urea،
+
+362
+00:25:22,080 --> 00:25:23,120
+إذا كانت البكتيريا كورني بكتيريا نعمل test of
+
+363
+00:25:23,120 --> 00:25:23,580
+urea، إذا كانت البكتيريا كورني بكتيريا نعمل test
+
+364
+00:25:23,580 --> 00:25:23,600
+of urea، إذا كانت البكتيريا كورني بكتيريا نعمل
+
+365
+00:25:23,600 --> 00:25:24,440
+test of urea، إذا كانت البكتيريا كورني بكتيريا
+
+366
+00:25:24,440 --> 00:25:25,560
+فعمل test of urea، إذا كانت البكتيريا كورني
+
+367
+00:25:25,560 --> 00:25:29,080
+بكتيريا نعمل test of urea، إذا كانت البكتيريا
+
+368
+00:25:29,080 --> 00:25:31,040
+كورني بكتيريا نعمل test of urea، إذا كانت
+
+369
+00:25:31,040 --> 00:25:32,600
+البكتيريا كورني بكتيريا نعمل test of urea، إذا
+
+370
+00:25:32,600 --> 00:25:36,260
+كانت البكتير
+
+371
+00:25:36,720 --> 00:25:40,840
+الـ Toxigenicity Assay اللي قلنا عنهم in vivo وin
+
+372
+00:25:40,840 --> 00:25:43,860
+vitro، هذا اللي قدامكم إيه، إيش هيكون؟ in vivo،
+
+373
+00:25:43,860 --> 00:25:51,110
+حقننا الـ control بيه اللي هو الـ antitoxin والـ
+
+374
+00:25:51,110 --> 00:25:57,650
+test ما حقنناها بأي شيء، وبعد نصف ساعة حقننا الاثنين
+
+375
+00:25:57,650 --> 00:26:01,990
+بالـ filtrate تبع البكتيريا اللي نمناها في الـ broth
+
+376
+00:26:01,990 --> 00:26:05,610
+media، من الـ diagram اللي جبناه قبل شوية لما كنا بنزرع
+
+377
+00:26:05,610 --> 00:26:09,250
+الـ suspect colony على solid للـ in vitro وعلى
+
+378
+00:26:09,250 --> 00:26:13,790
+liquid أو broth للـ in vivo، حقنناهم الاثنين بالـ
+
+379
+00:26:13,790 --> 00:26:19,630
+liquid أو broth، بعد فترة زمنية محددة بنقرأ
+
+380
+00:26:19,630 --> 00:26:24,170
+النتائج، النتائج عشان أنا أقول إن هي  Cornebacterium
+
+381
+00:26:24,170 --> 00:26:28,690
+Diphtheriae لازم مين اللي يموت؟ الـ test ولازم مين اللي يبقى حي؟ الـ control،اللي حقنها
+
+382
+00:26:28,690 --> 00:26:33,420
+بالضبط، الـ antitoxin، إذا الاثنين ماتوا، فمعناه الحكي
+
+383
+00:26:33,420 --> 00:26:36,460
+أن البكتيريا ليست  Cornebacterium diphtheriae، إذا الاثنين
+
+384
+00:26:36,460 --> 00:26:41,560
+عاشوا فهي non-toxigenic، non-toxigenic، بنقول إذا
+
+385
+00:26:41,560 --> 00:26:45,460
+الـ test عاش والـ control مات، بنقول الفحص لا يُعتد به،
+
+386
+00:26:45,460 --> 00:26:50,320
+الفحص يعني لا يعتمد عليه، ولا يقرر، بيسموه invalid،
+
+387
+00:26:50,320 --> 00:26:54,440
+invalid، هي الشكل اللي .. اللي جاي عنه اللي ممكن
+
+388
+00:26:54,440 --> 00:26:59,530
+يعطينا انطباع إنه بتكلم عن حروف صينية من التبديل
+
+389
+00:26:59,530 --> 00:27:03,530
+أو من الـ .. من الـ grouping للبكتيريا مع بعضها
+
+390
+00:27:07,050 --> 00:27:14,030
+البعض، الـ in vitro toxicity test، شرحنا ده، الـ .. هي
+
+391
+00:27:14,030 --> 00:27:20,430
+الـ filter paper تمام؟ وهي البكتيريا زي ما رأيناها بهذا
+
+392
+00:27:20,430 --> 00:27:22,570
+الشكل هذا negative control وهذا positive control
+
+393
+00:27:22,570 --> 00:27:26,390
+هذا الـ test اللي قدامكم، طبعاً الصورة فيها خطأ شنيع
+
+394
+00:27:26,390 --> 00:27:29,870
+اللي هو الخطأ هذا، الـ line of precipitation لازم
+
+395
+00:27:29,870 --> 0
+
+445
+00:31:10,660 --> 00:31:14,460
+نجاتيف ما معناه agustin،
+
+446
+00:31:14,460 --> 00:31:21,520
+goal، أكيد، فش عنده أيش؟ فش عنده antibody
+
+447
+00:31:24,460 --> 00:31:28,540
+النجاتيف نجاتيف، ليش صار نجاتيف يا شباب؟ لأنه الـ
+
+448
+00:31:28,540 --> 00:31:31,640
+antitoxin تفاعل مع التوكسين وعمل نتراليزيش، فما
+
+449
+00:31:31,640 --> 00:31:34,860
+أثر التوكسين، فعشان هيك عندنا نجاتيف، وصلت ولا
+
+450
+00:31:34,860 --> 00:31:38,980
+ما وصلت، الـ antibody عمل neutralization للتوكسين
+
+451
+00:31:38,980 --> 00:31:44,070
+وبالتالي لم يستطع التوكسين أن يقوم بأي عمل. لكن لو
+
+452
+00:31:44,070 --> 00:31:48,290
+صار حمرار معناه لحق التوكسين قتل الخلايا أو صار فيه
+
+453
+00:31:48,290 --> 00:31:50,670
+inflammation. طب إذا صار فيه inflammation معناه
+
+454
+00:31:50,670 --> 00:31:55,010
+لحقه أنه مافيه antibody. طيب الآن باختصار شديد جدا
+
+455
+00:31:55,010 --> 00:31:59,610
+واحد طلع عنده الفحص positive يعني ماعندهوش
+
+456
+00:31:59,610 --> 00:32:04,650
+antibody، وفي النوبة بنعطيه vaccine، لو ماعطوهش
+
+457
+00:32:04,650 --> 00:32:10,730
+vaccine، بنعطيه vaccine. لكن واحد طلع عنده الفحص
+
+458
+00:32:10,730 --> 00:32:15,090
+negative، يعني عنده antibody، هل نعطيه vaccine؟
+
+459
+00:32:15,090 --> 00:32:19,870
+لازموش، صح؟ وبالتالي هذا الفحص is to evaluate the
+
+460
+00:32:19,870 --> 00:32:23,530
+susceptibility، هل أنت معرض للإصابة ولا غير معرض
+
+461
+00:32:23,530 --> 00:32:27,430
+للإصابة، وصلت الصورة؟ مش diagnostic، مش diagnostic
+
+462
+00:32:28,960 --> 00:32:33,500
+يعني بنقدر نقول كمان عبارة أخرى إنه هذا الفحص to
+
+463
+00:32:33,500 --> 00:32:38,520
+check your... خلّيني أقول immunity to diphtheria،
+
+464
+00:32:38,520 --> 00:32:41,460
+ماشي الحلقة، ماشي الحق، إنه أنت محصّن ولا غير
+
+465
+00:32:41,460 --> 00:32:42,800
+محصّن للـ diphtheria
+
+466
+00:32:45,290 --> 00:32:49,270
+فيه إنّها حاجة اسمها treatment و control، الـ control
+
+467
+00:32:49,270 --> 00:32:51,090
+نبدأ في الـ control لأن هو الـ control الأسهل، أنا
+
+468
+00:32:51,090 --> 00:32:53,350
+بقول لكم لأن treatment مافيش حالات أصلا نعملها
+
+469
+00:32:53,350 --> 00:32:56,710
+treatment غالبا لأن المرض تقريبا zero في فلسطين
+
+470
+00:32:56,710 --> 00:33:01,480
+لأن الـ coverage للـ vaccine hundred percent، عشان
+
+471
+00:33:01,480 --> 00:33:05,800
+hundred percent يعني كل الأطفال في، على الأقل في
+
+472
+00:33:05,800 --> 00:33:10,420
+قطاع غزة بيتعرضوا للـ DPT اللي احنا عرفنا جزء منه
+
+473
+00:33:10,420 --> 00:33:14,760
+تيتانوس لما درسنا تيتانوس، الـ DPT واللي أنا متكلم
+
+474
+00:33:14,760 --> 00:33:17,280
+عنه، الشق الثاني اللي هو الـ diphtheria. إذا صار عندي
+
+475
+00:33:17,280 --> 00:33:20,840
+diphtheria وصار عندي تيتانوس، طلعنا من الـ pertussis
+
+476
+00:33:20,840 --> 00:33:24,900
+متكلم عنه لاحقا إن شاء الله. إذا الـ immunization by
+
+477
+00:33:24,900 --> 00:33:28,360
+the inactivated or attenuated toxin of toxigenic
+
+478
+00:33:28,360 --> 00:33:32,360
+Corynebacterium diphtheriae. إذا هذا هو الـ control الأساسي للـ
+
+479
+00:33:32,360 --> 00:33:38,370
+disease. بينما الـ treatment زي أي gram-positive exotoxin producer درسناها، درسناها كم واحدة احنا
+
+480
+00:33:38,370 --> 00:33:41,870
+Clostridium tetani و Clostridium perfringens بتنتج
+
+481
+00:33:41,870 --> 00:33:47,330
+توكسين خارجي، و درسنا البوتولينيوم، لكن البوتولينيوم ما
+
+482
+00:33:47,330 --> 00:33:54,530
+عالجناهاش، بقى إنتَ بتتكلم لأن مشكلتنا معاها ما كانتش infection، كانت مشكلتنا معاها poisoning، صح؟ مشكلتنا
+
+483
+00:33:54,530 --> 00:33:58,430
+كانت معاها poisoning، بينما الـ Clostridium tetani و
+
+484
+00:33:58,430 --> 00:34:02,770
+Clostridium perfringens كانت مشكلتنا معاهم infection
+
+485
+00:34:02,770 --> 00:34:07,410
+وبتنتج توكسين، فاضطرينا نعالجهم بشغلتين: بـ antibiotic
+
+486
+00:34:07,410 --> 00:34:12,830
+للقضاء على البكتيريا، وبـ antitoxin to neutralize
+
+487
+00:34:12,830 --> 00:34:16,250
+unbound toxin. وهذه النقطة بنكررها في الـ corynebacterium
+
+488
+00:34:16,250 --> 00:34:20,050
+diphtheriae. إذا عندي الدفتيريا، بنستخدم
+
+489
+00:34:20,050 --> 00:34:23,610
+العلاج البنسالين أو الإريثروميسين to eradicate the
+
+490
+00:34:23,610 --> 00:34:27,470
+organism، and we use antitoxin to neutralize the
+
+491
+00:34:27,470 --> 00:34:31,750
+effect of diphtheria toxin. في عندي ميكروب بيلوثريكس
+
+492
+00:34:31,750 --> 00:34:38,040
+روسوباتيا، مرّ معنا في أحد الميكروبات الـ disease
+
+493
+00:34:38,040 --> 00:34:42,420
+اسمه erysipelas. Erysipelothrix معناها red skin... red
+
+494
+00:34:42,420 --> 00:34:47,920
+skin. هذا الـ disease تبعه اسمه erysipeloid...
+
+495
+00:34:47,920 --> 00:34:55,280
+erysipeloid. دائما احنا... إذا بتتذكروا بعض
+
+496
+00:34:55,280 --> 00:34:59,720
+المصطلحات: metal... metalloid... metal الفلزات و...
+
+497
+00:34:59,720 --> 00:35:03,460
+و... و metalloid، أشبه الفلزات... toxin toxoid...
+
+498
+00:35:03,460 --> 00:35:08,780
+طبعا ف أنا هنا الآن: إرسبلس وإرسبيلويد، يعني شبيه مين؟
+
+499
+00:35:08,780 --> 00:35:12,400
+الإرسبلس برضه بيكون الـ disease: red skin، ويمكن هذه
+
+500
+00:35:12,400 --> 00:35:16,420
+الصورة بتوضح لنا إن الإصبع هذا very red، هو و
+
+501
+00:35:16,420 --> 00:35:19,720
+المنطقة الحمراء اللي موجودة. بقول عموما هو الـ
+
+502
+00:35:19,720 --> 00:35:22,920
+disease بتكون من الـ three clinical entities. واحد
+
+503
+00:35:22,920 --> 00:35:26,300
+إرسبيلويد، وهو عبارة عن localized، يعني localized في
+
+504
+00:35:26,300 --> 00:35:30,180
+منطقة محددة. Cutaneous infection usually on the
+
+505
+00:35:30,180 --> 00:35:33,000
+fingers and the hand. Generalized cutaneous
+
+506
+00:35:33,000 --> 00:35:35,840
+infection. ممكن هذا شكل تاني إنه يعطينا بدل ما هو
+
+507
+00:35:35,840 --> 00:35:39,860
+local يعطينا generalized. تلاتة: إذا المريض غالبا
+
+508
+00:35:39,860 --> 00:35:43,640
+وضعه سيء للغاية من ناحية المناعة، ممكن تصل لمرحلة
+
+509
+00:35:43,640 --> 00:35:47,310
+اللي هو septic. البكتيريا اسمها كمان مرة
+
+510
+00:35:47,310 --> 00:35:51,450
+Erysipelothrix rhusiopathiae. It is a gram-positive but
+
+511
+00:35:51,450 --> 00:35:56,510
+a little non-motile, non-spore forming, facultative
+
+512
+00:35:56,510 --> 00:36:00,800
+anaerobic. تتذكروا الدفتيريا إيش كان وضعها؟ كانت
+
+513
+00:36:00,800 --> 00:36:04,480
+aerobic، كانت aerobic. واحنا يمكن لو
+
+514
+00:36:04,480 --> 00:36:08,680
+رجعنا برجعوها للجدول، ما أكدناش احنا يعني انغمسنا في
+
+515
+00:36:08,680 --> 00:36:12,420
+إنّه كيف نميزهم مع بعض، لكن غفلنا عن ذكر اللي هو
+
+516
+00:36:12,420 --> 00:36:17,400
+catalase. كلهم إذا بتلاحظوا positive، لأنها أكدنا على
+
+517
+00:36:17,400 --> 00:36:20,240
+الحقيقة ده لأنهم هي aerobic bacteria. نرجع برجعوها
+
+518
+00:36:20,240 --> 00:36:20,380
+دلوقت
+
+519
+00:36:23,510 --> 00:36:26,470
+فقلت إن أنا aerobic كمان مرة، non-spore former، non-
+
+520
+00:36:26,470 --> 00:36:30,150
+motile، و gram-positive. بس، على specimen and
+
+521
+00:36:30,150 --> 00:36:34,430
+media. عرفنا diseases: skin localized، skin
+
+522
+00:36:34,430 --> 00:36:38,910
+generalized، أو تسمى، بتصير يا إما skin biopsy يا
+
+523
+00:36:38,910 --> 00:36:43,530
+إما عينات blood. تمام؟ الآن بقولنا إن الـ culture
+
+524
+00:36:43,530 --> 00:36:47,050
+media بتحتوي على one percent glucose، growth and
+
+525
+00:36:47,050 --> 00:36:50,560
+blood agar. واحد من اثنين بيمشي الحالة. Gram
+
+526
+00:36:50,560 --> 00:36:52,680
+staining of the organism from clinical specimen
+
+527
+00:36:52,680 --> 00:36:57,080
+and the growth on blood agar. يعني احنا بقولنا إنه
+
+528
+00:36:57,080 --> 00:36:59,240
+لو... لو... لو احنا أخذنا من الـ skin مباشرة و
+
+529
+00:36:59,240 --> 00:37:02,940
+عملنا gram stain، أو أخذنا من الطبق اللي زرعنا عليه
+
+530
+00:37:02,940 --> 00:37:05,700
+الـ blood agar وعملنا gram stain، هذا برضه بيساعدنا
+
+531
+00:37:05,700 --> 00:37:10,100
+في التعرف على البكتيريا، كيف إنها gram-positive. بس
+
+532
+00:37:10,100 --> 00:37:13,560
+الله يقوم ويقولنا في الـ skin هذا مؤشر قوي إن
+
+533
+00:37:13,560 --> 00:37:19,260
+البكتيريا هي herciproteric ratio above. فيه مميزات
+
+534
+00:37:19,260 --> 00:37:23,880
+رائعة لهذه البكتيريا. من المميزات الرائعة اللي هي
+
+535
+00:37:23,880 --> 00:37:28,300
+test-tube brush appearance in gelatin stabs. مرّ
+
+536
+00:37:28,300 --> 00:37:33,940
+معانا بكتيريا بوصف محدد في الـ gelatin stab
+
+537
+00:37:37,630 --> 00:37:42,170
+Bacillus anthracis. سُمِّيها inverted bovine
+
+538
+00:37:42,170 --> 00:37:45,830
+زي شُرَارة الـ... الـ... الـ... العين أو السرقة اللي هي
+
+539
+00:37:45,830 --> 00:37:50,030
+المقلوبة، هنا بتطلع على الـ tube بتلاقي تعرف test
+
+540
+00:37:50,030 --> 00:37:52,810
+tube brush. عارفين اللي بنغسل فيها القنابيب كيب
+
+541
+00:37:52,810 --> 00:37:56,890
+بتكون على اطرافها. فبقولنا الشكل تبعها بيكون عامل زي
+
+542
+00:37:56,890 --> 00:38:01,910
+test-tube brush. هذا واحد. رقم اثنين: it produces H2S.
+
+543
+00:38:01,910 --> 00:38:04,810
+هذا كمان نقطة مهمة. بس مش في الجلاتين... مش في
+
+544
+00:38:04,810 --> 00:38:10,230
+الـ gelatin stabs. هذا ما بتعملوش إنت الفحص إمّا triple
+
+545
+00:38:10,230 --> 00:38:16,250
+sugar iron agar أو فحص يعني بيكشف عن الـ H2S في الـ
+
+546
+00:38:16,250 --> 00:38:18,430
+H... في الـ... في الـ triple sugar iron agar، بتعمل
+
+547
+00:38:18,430 --> 00:38:21,310
+اللي هو acidification of the slant and butt، بت...
+
+548
+00:38:21,310 --> 00:38:26,830
+يعني بتعمل A على A، plus A على A. الآن to
+
+549
+00:38:26,830 --> 00:38:30,370
+differentiate it from the streptococcus genes.
+
+550
+00:38:30,370 --> 00:38:36,410
+Perform the catalase test. الليستيريا بنعرفها احنا،
+
+551
+00:38:36,410 --> 00:38:39,490
+بنعرفها ومرّت معنا أكثر من مرة، حتى وين ما درسناهاش
+
+552
+00:38:39,490 --> 00:38:43,530
+لما ميزناها عن beta-hemolytic streptococci،
+
+553
+00:38:43,530 --> 00:38:46,530
+ميزناها بفحص الكاتاليز، بيقولنا الـ streptococci
+
+554
+00:38:46,530 --> 00:38:50,630
+catalase negative، وواجه الشبه بين الـ streptococci
+
+555
+00:38:50,630 --> 00:38:54,310
+وبين الليستيريا، ما فيش وجه شبه، هذي cocci وهذي
+
+556
+00:38:54,310 --> 00:38:57,530
+bacilli، فلماذا ميزناهم عن بعض؟ إيش وجه الشبه كان
+
+557
+00:38:57,530 --> 00:39:02,090
+بينهم؟ على الـ blood، لا، على الـ blood agar they both
+
+558
+00:39:02,090 --> 00:39:07,210
+produce small colonies surrounded by large zone of
+
+559
+00:39:07,210 --> 00:39:10,210
+beta-hemolysis. كان الـ hemolysis الـ characteristic
+
+560
+00:39:10,210 --> 00:39:13,650
+colony على الـ blood agar هو اللي خلانا in shock
+
+561
+00:39:13,650 --> 00:39:16,730
+إنّه هذي Listeria أو... أو... أو Streptococcus
+
+562
+00:39:16,730 --> 00:39:18,930
+pyogenes. وبتاع اللي ميزناهم بفحص اللي هو الـ
+
+563
+00:39:18,930 --> 00:39:23,630
+catalase. ما أقصده من كلامي هذا إنه الأصل إن احنا
+
+564
+00:39:23,630 --> 00:39:26,590
+بنعرف إن البكتيريا اللي اسمها Listeria هي عبارة عن
+
+565
+00:39:26,590 --> 00:39:30,090
+catalase positive، وبالتالي إذا بدي أقول إن البكتيريا
+
+566
+00:39:30,090 --> 00:39:33,910
+هذي بيميزها عن الـ... الـ... الـ... Erysipelothrix
+
+567
+00:39:33,910 --> 00:39:37,790
+rhusiopathiae، فالـ Erysipelothrix حتكون إيش؟ catalase
+
+568
+00:39:37,790 --> 00:39:39,990
+negative، catalase negative. طب هي facultative anaerobic،
+
+569
+00:39:39,990 --> 00:39:43,670
+طب أنتم كل... أنتم كل... أنتم بتعرفوا إن
+
+570
+00:39:43,670 --> 00:39:46,630
+الـ facultative anaerobic ممكن تكون أو معظمها بتكون
+
+571
+00:39:46,630 --> 00:39:50,450
+catalase... catalase positive. ليش هذي... هذي... إيش ممكن
+
+572
+00:39:50,450 --> 00:39:55,130
+ت... كيف تتحمل وجود الأكسجين هذي؟ كيف تتحمل و...
+
+573
+00:39:55,130 --> 00:39:58,930
+احنا بنعرف إن الكاتاليز خلقة في هذه المخلوقات أو
+
+574
+00:39:58,930 --> 00:40:03,510
+وضعة في هذه المخلوقات لمكافحة سمية الـ oxygen. طب
+
+575
+00:40:03,510 --> 00:40:07,810
+هذه البكتيريا بتنمو في الهواء، فكيف لها؟ أنتم عاد
+
+576
+00:40:07,810 --> 00:40:12,290
+... خلاص، بتجفلوا الدماغ على جزئية واحدة، إنه catalase
+
+577
+00:40:12,290 --> 00:40:14,930
+و... و... و... catalase و تاني إيش اسمه؟ الـ super
+
+578
+00:40:14,930 --> 00:40:18,470
+oxide dismutase. في system تاني يا شباب، في system
+
+579
+00:40:18,470 --> 00:40:24,450
+آخر لمكافحة الـ oxygen اسمه peroxidase. Peroxidase لا
+
+580
+00:40:24,450 --> 00:40:28,210
+ينتج عنه، لا ينتج عنه molecular oxygen، عشان هي في
+
+581
+00:40:28,210 --> 00:40:31,410
+الفحص negative للكاتاليز لأن ما بيطلعش عنها bubbles
+
+582
+00:40:31,410 --> 00:40:35,750
+لأنه أصلا الـ peroxidase ما بيطلعش molecular oxygen. طيب
+
+583
+00:40:35,750 --> 00:40:40,030
+الـ treatment: penicillin is the drug of choice.
+
+584
+00:40:40,030 --> 00:40:44,070
+المرة اللي جاية إن شاء الله بنكمل الموضوع بالـ
+
+585
+00:40:44,070 --> 00:40:45,490
+streptococcus
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/316CJubl8XM_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/316CJubl8XM_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..1f2dcf314da1149a2b64c596e3b4004c5a13a602
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/316CJubl8XM_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 4329, "start": 20.23, "end": 43.29, "text": "بسم الله الرحمن الرحيم اليوم موضوع جديد بنناقش فيه الجزء الثاني من العنوان الرئيس gram-bustefbacilli العنوان الأول كان gram-bustefbacilli in the spore-forming اليوم الجزء الثاني non-in-the-spore-forming ويمكن أشهر مايكروب في السلسلة اللي هنناقشه اللي هو كوريني بكتيريم أو كورينو بكتيريم على حسب الألفاظ المختلفة", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 45595, 20498, 3714, 2407, 11242, 45367, 10874, 16254, 3215, 44945, 8315, 4587, 8592, 8978, 3224, 25724, 11622, 38207, 6024, 104, 7649, 1829, 9154, 18863, 1863, 2407, 7649, 34892, 19986, 1829, 3794, 21353, 12, 65, 381, 5666, 65, 326, 31922, 18863, 1863, 2407, 7649, 16247, 12610, 25961, 21353, 12, 65, 381, 5666, 65, 326, 31922, 294, 264, 637, 418, 12, 48610, 45595, 20498, 25724, 11622, 38207, 6024, 104, 7649, 1829, 2107, 12, 259, 12, 3322, 12, 4952, 418, 12, 48610, 4032, 32640, 19452, 5551, 8592, 3224, 2288, 19446, 1829, 4117, 32887, 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"word": " انتوا", "probability": 0.9459635416666666}, {"start": 2407.53, "end": 2407.81, "word": " عاد", "probability": 0.788818359375}, {"start": 2407.81, "end": 2408.11, "word": " ..", "probability": 0.87841796875}, {"start": 2408.11, "end": 2408.81, "word": " خلاص", "probability": 0.9720052083333334}, {"start": 2408.81, "end": 2409.57, "word": " بتجفلوا", "probability": 0.8513671875}, {"start": 2409.57, "end": 2410.01, "word": " الدماغ", "probability": 0.9515380859375}, {"start": 2410.01, "end": 2410.35, "word": " على", "probability": 0.7861328125}, {"start": 2410.35, "end": 2410.93, "word": " جزئية", "probability": 0.8553466796875}, {"start": 2410.93, "end": 2411.39, "word": " واحدة", "probability": 0.9861653645833334}, {"start": 2411.39, "end": 2411.89, "word": " انه", "probability": 0.752685546875}, {"start": 2411.89, "end": 2412.29, "word": " كتاليز", "probability": 0.867919921875}, {"start": 2412.29, "end": 2412.43, "word": " و", "probability": 0.662109375}, {"start": 2412.43, "end": 2412.65, "word": " ..", "probability": 0.60595703125}, {"start": 2412.65, "end": 2413.01, "word": " و", "probability": 0.72705078125}, {"start": 2413.01, "end": 2413.31, "word": " ..", "probability": 0.68408203125}, {"start": 2413.31, "end": 2413.55, "word": " و", "probability": 0.59375}, {"start": 2413.55, "end": 2413.55, "word": " ..", "probability": 0.52197265625}, {"start": 2413.55, "end": 2413.87, "word": " كتاليز", "probability": 0.92880859375}, {"start": 2413.87, "end": 2413.99, "word": " و", "probability": 0.4296875}, {"start": 2413.99, "end": 2414.11, "word": " تاني", "probability": 0.7245279947916666}, {"start": 2414.11, "end": 2414.19, "word": " اش", "probability": 0.619140625}, {"start": 2414.19, "end": 2414.57, "word": " اسمه", "probability": 0.9117838541666666}, {"start": 2414.57, "end": 2414.79, "word": " ال", "probability": 0.417724609375}, {"start": 2414.79, "end": 2414.93, "word": " super", "probability": 0.86767578125}, {"start": 2414.93, "end": 2415.33, "word": " oxide", "probability": 0.54345703125}, {"start": 2415.33, "end": 2415.91, "word": " سيموتايز", "probability": 0.59820556640625}, {"start": 2415.91, "end": 2416.83, "word": " في", "probability": 0.54638671875}, {"start": 2416.83, "end": 2417.21, "word": " system", "probability": 0.869140625}, {"start": 2417.21, "end": 2417.53, "word": " تاني", "probability": 0.9700520833333334}, {"start": 2417.53, "end": 2417.63, "word": " يا", "probability": 0.958984375}, {"start": 2417.63, "end": 2417.83, "word": " شباب", "probability": 0.9837239583333334}, {"start": 2417.83, "end": 2418.03, "word": " في", "probability": 0.7216796875}, {"start": 2418.03, "end": 2418.47, "word": " system", "probability": 0.98291015625}, {"start": 2418.47, "end": 2419.03, "word": " اخر", "probability": 0.770263671875}, {"start": 2419.03, "end": 2420.29, "word": " لمكافحة", "probability": 0.9900390625}, {"start": 2420.29, "end": 2420.61, "word": " ال", "probability": 0.96826171875}, {"start": 2420.61, "end": 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"word": " ينتج", "probability": 0.9832356770833334}, {"start": 2426.17, "end": 2426.49, "word": " عنه", "probability": 0.938232421875}, {"start": 2426.49, "end": 2427.05, "word": " موليكلار", "probability": 0.6555989583333334}, {"start": 2427.05, "end": 2427.33, "word": " أكسجين", "probability": 0.8943359375}, {"start": 2427.33, "end": 2427.69, "word": " عشان", "probability": 0.8163248697916666}, {"start": 2427.69, "end": 2427.75, "word": " هي", "probability": 0.7509765625}, {"start": 2427.75, "end": 2428.21, "word": " في", "probability": 0.314453125}, {"start": 2428.21, "end": 2428.59, "word": " الفحص", "probability": 0.9694010416666666}, {"start": 2428.59, "end": 2429.53, "word": " نيجاتف", "probability": 0.63095703125}, {"start": 2429.53, "end": 2430.05, "word": " للكتاليزة", "probability": 0.666015625}, {"start": 2430.05, "end": 2430.21, "word": " لإنه", "probability": 0.68280029296875}, {"start": 2430.21, "end": 2430.53, "word": " مابيطلعش", "probability": 0.7413504464285714}, 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/316CJubl8XM_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/316CJubl8XM_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..d0cea8a12c046654cd9b2e13a054d32de5686d3e
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/316CJubl8XM_raw.srt
@@ -0,0 +1,2348 @@
+1
+00:00:20,230 --> 00:00:26,370
+بسم الله الرحمن الرحيم اليوم موضوع جديد بنناقش فيه
+
+2
+00:00:26,370 --> 00:00:29,410
+الجزء الثاني من العنوان الرئيس gram-bustefbacilli
+
+3
+00:00:29,410 --> 00:00:32,690
+العنوان الأول كان gram-bustefbacilli in the spore
+
+4
+00:00:32,690 --> 00:00:35,110
+-forming اليوم الجزء الثاني non-in-the-spore
+
+5
+00:00:35,110 --> 00:00:37,650
+-forming ويمكن أشهر مايكروب في السلسلة اللي
+
+6
+00:00:37,650 --> 00:00:40,610
+هنناقشه اللي هو كوريني بكتيريم أو كورينو بكتيريم
+
+7
+00:00:40,610 --> 00:00:45,420
+على حسب الألفاظ المختلفةهناك تلات أسماء مهمة جدا
+
+8
+00:00:45,420 --> 00:00:48,740
+بالنسبة إنا احنا كوريني بكتيريوم ديثيريا كوريني
+
+9
+00:00:48,740 --> 00:00:52,860
+بكتيريوم ألسيرانس و واضح من الإسم ألسيرانس إنه
+
+10
+00:00:52,860 --> 00:00:56,360
+بتعمل ألسر و كوريني بكتيريوم أوبس أو pseudo
+
+11
+00:00:56,360 --> 00:00:59,040
+tuberculosis و من الإسم pseudo tuberculosis يعني
+
+12
+00:00:59,040 --> 00:01:05,180
+بتعمل زي tuberculosis زائف و أوبس في الأبقار غالبا
+
+13
+00:01:05,180 --> 00:01:09,420
+يعني ممكن تنتقل إلى الإنسان لكن نسبة حدوثها قليلة
+
+14
+00:01:09,420 --> 00:01:14,480
+جدامن التلاتة اللي أسمعهم أمامكم على اللوحة الآن
+
+15
+00:01:14,480 --> 00:01:18,480
+الأهم على الإطلاق هي رقم واحد وكانت في يوم من
+
+16
+00:01:18,480 --> 00:01:22,240
+الأيام من أهم ال pathogens المسببة للوفيات عند
+
+17
+00:01:22,240 --> 00:01:27,000
+الأطفال وسميت باللغة العربية الخنّاق خنّاق لأنها
+
+18
+00:01:27,000 --> 00:01:31,220
+كانت تخنق .. تخنق الطفل فيموت الطفل ولونه أزرق
+
+19
+00:01:31,220 --> 00:01:35,120
+وكان اسموه برضه blue babies يعني الأطفال الزرق
+
+20
+00:01:35,880 --> 00:01:40,580
+والسبب الخنق هو تكون أو قدرة البكتيريا على تكوين
+
+21
+00:01:40,580 --> 00:01:44,280
+ما يسمى بالـpseudomembrane مكوّن من البكتيريا
+
+22
+00:01:44,280 --> 00:01:47,240
+نفسها، من الخلايا الميتة بفيلترات
+
+23
+00:01:49,890 --> 00:01:53,350
+قد يمتد ليغطي التراكية، إذا غطي التراكية عند
+
+24
+00:01:53,350 --> 00:01:56,630
+الأطفال الرضّع اللي مابيعرف يتكلم و لايعبروا عن
+
+25
+00:01:56,630 --> 00:02:00,710
+أنفسهم فغالبا هيموتوا من suffocation أو من نقص في
+
+26
+00:02:00,710 --> 00:02:05,370
+ال oxygen لكن الحمد لله رب العالمين بعد إدخال ال
+
+27
+00:02:05,370 --> 00:02:10,430
+vaccination يعني من سنوات عديدة لم نسمع بأي حالة
+
+28
+00:02:10,430 --> 00:02:15,250
+من الدفتيريا في قطاع غزةالـ Clinical Manifestation
+
+29
+00:02:15,250 --> 00:02:18,970
+للـ Diphtheria هي عبارة عن Local Lesion in the
+
+30
+00:02:18,970 --> 00:02:23,010
+Nose and Throat كمان مرة it is Local Infection
+
+31
+00:02:23,010 --> 00:02:26,730
+بتذكرنا بإن الكلسترديوم تيتاني لما قلنا إن
+
+32
+00:02:26,730 --> 00:02:31,580
+الكلسترديوم تيتاني برضه بتعمل Local Infectionكلا
+
+33
+00:02:31,580 --> 00:02:35,560
+هما الـToxin تبعهم بينتقل من مكان الإنتاج إلى
+
+34
+00:02:35,560 --> 00:02:40,760
+أماكن متنوعة في جسم الإنسان وبالتالي إذا بتقرأوا
+
+35
+00:02:40,760 --> 00:02:45,080
+أخر جملة في اللوحة هتلاقوا إن الـDeath is usually
+
+36
+00:02:45,080 --> 00:02:49,990
+resulting from heart fireإذا الـToxin can reach
+
+37
+00:02:49,990 --> 00:02:53,370
+distant organs، can affect many organs، والتكسين
+
+38
+00:02:53,370 --> 00:02:56,550
+احنا درسناه، أول تكسين درسناه في الـExotoxins
+
+39
+00:02:56,550 --> 00:03:01,090
+كنموذج على البروتين اللي عامل AB model وإنه بيعمل
+
+40
+00:03:01,090 --> 00:03:05,230
+protein synthesis inhibition عن طريق اللي هو ال
+
+41
+00:03:05,230 --> 00:03:07,470
+interference أو ال inactivation لل elongation
+
+42
+00:03:07,470 --> 00:03:11,550
+factor 2 ال EF2 عن طريق طبعا إضافة ADP ribose اللي
+
+43
+00:03:11,550 --> 00:03:16,770
+يقولنا عنها ADP ribosylationإيقاف نشاط elongation
+
+44
+00:03:16,770 --> 00:03:19,930
+factor 2 بيوقف تصنيع البروتين تصنيع البروتين إذا
+
+45
+00:03:19,930 --> 00:03:24,130
+وقف الخلية اتفقنا من منذ زمان ان الخلية دي doomed
+
+46
+00:03:24,130 --> 00:03:32,600
+death محكم عليها بالموت إذا خلايا ميتةبقاية طعام
+
+47
+00:03:32,600 --> 00:03:36,660
+البكتيرا نفسها can aggregate بتتجمع مع بعضها و
+
+48
+00:03:36,660 --> 00:03:39,000
+بتكون اللي ما يسمى بال pseudo membrane اللي قولنا
+
+49
+00:03:39,000 --> 00:03:42,640
+عنه can extend to cover up the trachea و في الغالب
+
+50
+00:03:42,640 --> 00:03:45,320
+ال patient will die of suffocation، suffocation هو
+
+51
+00:03:45,320 --> 00:03:50,440
+الاختناق هذه الصورة بتوضح أن ال membrane اللي
+
+52
+00:03:50,440 --> 00:03:54,840
+متكون و ممتد إلى to cover the tonsils، مغطي ال
+
+53
+00:03:54,840 --> 00:04:00,960
+tonsils لحظة الفتحة المتبقية و المريض فاتح فمهيعني
+
+54
+00:04:00,960 --> 00:04:07,900
+.. يعني مسافة ضيقة خالص لو امتدت هذه المسافة او ال
+
+55
+00:04:07,900 --> 00:04:11,800
+.. ال .. ال membrane حجمه زاد هيغلق ال .. ال .. ال
+
+56
+00:04:11,800 --> 00:04:17,360
+airway وبالتالي بيصير بالفعل في أنه يختنع ال signs
+
+57
+00:04:17,360 --> 00:04:20,220
+and symptoms لال disease بيقولنا ال respiratory
+
+58
+00:04:20,220 --> 00:04:23,120
+form has an incubation period of two to five days
+
+59
+00:04:23,120 --> 00:04:26,870
+اتنين لخمس أيامThe onset of disease is usually
+
+60
+00:04:26,870 --> 00:04:30,350
+gradual يعني ما بتكونش صدم، بتكون بتدريجي، العراض
+
+61
+00:04:30,350 --> 00:04:33,890
+تبدأ. Symptoms include fatigue, fever, mild sore
+
+62
+00:04:33,890 --> 00:04:38,690
+throat مصطلح ذكرناه لما كلمنا عن ال group A
+
+63
+00:04:38,690 --> 00:04:41,350
+streptococci اللي الـ streptococcus، ال bio genes
+
+64
+00:04:41,350 --> 00:04:43,650
+اللي موجودة تانسولايتس وفيرنجايتس كلهم
+
+65
+00:04:43,650 --> 00:04:46,610
+collectively يقولنا بيطلق عليهم بالعامية sore
+
+66
+00:04:46,610 --> 00:04:49,910
+throat التهابات الحلق، بنسمي التهابات الحلق
+
+67
+00:04:50,810 --> 00:04:53,330
+difficulty in swallowing maybe evidence برضه يعني
+
+68
+00:04:53,330 --> 00:04:58,410
+ممكن تظهر علامات صعوبة في اللي هو البلاء ال
+
+69
+00:04:58,410 --> 00:05:02,970
+children غالبا بيظهروا علامات إضافية من ضمنها اللي
+
+70
+00:05:02,970 --> 00:05:08,330
+هو nausea و vomiting و chills و high fever و أحد
+
+71
+00:05:08,330 --> 00:05:13,330
+الإشكاليات أن بعض أو نسبة من الأطفال لا يظهروا أي
+
+72
+00:05:13,330 --> 00:05:18,420
+من هذه الأعراضوبالتالي بيكون ال disease silent
+
+73
+00:05:18,420 --> 00:05:22,820
+يعني .. يعني بيتطور it progresses بدون ظهور أعراض
+
+74
+00:05:22,820 --> 00:05:27,640
+كثيرة هاي طبعا بتقدر يكون في اندي sudden onset of
+
+75
+00:05:27,640 --> 00:05:31,200
+the disease يعني هو طبيعته gradual لكن في دول
+
+76
+00:05:31,200 --> 00:05:35,760
+الأطفال غالبا بيعطينا sudden onset في كمان نقطة
+
+77
+00:05:35,760 --> 00:05:40,070
+كتير مهمة لازم نعرفهافي نسبة من ال patients بتمثل
+
+78
+00:05:40,070 --> 00:05:43,190
+حوالي عشرة بالمائة عشرة في المائة من ال patients
+
+79
+00:05:43,190 --> 00:05:47,610
+هدولة بيصير عندهم انتفاخ في الرقبة وكل كتير اللي
+
+80
+00:05:47,610 --> 00:05:50,990
+بيسموهم بولز نك أو رقبة الثورة لإنه بيصير فيه
+
+81
+00:05:50,990 --> 00:05:55,830
+انتفاخ في الرقبة الآن هدولة الناس اللي عندهم
+
+82
+00:05:55,830 --> 00:06:02,570
+الانتفاخ في الرقبة هم الأكثر عرضة للوفياتيعني اللي
+
+83
+00:06:02,570 --> 00:06:07,850
+بيطور هذا ال symptom هذا bad prognosis، يعني نتنبأ
+
+84
+00:06:07,850 --> 00:06:12,970
+بإنه ال progression of disease هيكون worse، يعني
+
+85
+00:06:12,970 --> 00:06:15,650
+هيكون أسوأ، وممكن يقدي للوفاة
+
+86
+00:06:18,000 --> 00:06:20,640
+من اللي هو الحياة السابقة عرفنا حاجة واحدة مهمة
+
+87
+00:06:20,640 --> 00:06:23,140
+جدا لكوا ال diagnostic microbiology من وين العينا
+
+88
+00:06:23,140 --> 00:06:27,840
+بناخدها؟ من الودن ولا من الشعر ولا من وين؟ من ال
+
+89
+00:06:27,840 --> 00:06:30,260
+throat و من nasal pharyngeal swab nasal pharyngeal
+
+90
+00:06:30,260 --> 00:06:35,400
+أو throat swab هي العينا الأساسية للبكتيريا الآن
+
+91
+00:06:35,400 --> 00:06:37,680
+ال characteristics دي لازم نعرفها عشان نقدر نتعرف
+
+92
+00:06:37,680 --> 00:06:39,520
+علي البكتيريا البكتيريا احنا عنواننا gram
+
+93
+00:06:39,520 --> 00:06:43,700
+-bostefbacilli و عنواننا كمان non-sparformic هذه
+
+94
+00:06:43,700 --> 00:06:49,640
+نقطة كتير مهمةPolymorphic متعددة الأشكال والأحجام
+
+95
+00:06:49,640 --> 00:06:53,380
+مش polymorphic، polymorphic أشكال وأحجام طويلة
+
+96
+00:06:53,380 --> 00:06:58,400
+جسيرة منتفخة L-shaped V-shaped يعني فيه أكتر من
+
+97
+00:06:58,400 --> 00:07:07,140
+شكل إلها non-motile non-acid fast and aerobic الآن
+
+98
+00:07:07,140 --> 00:07:12,240
+non-acid fast إيش يعني دلالة المعلومة؟ احنا بناعرف
+
+99
+00:07:12,240 --> 00:07:15,850
+أنه مين ال acid fast بس في الدنيا؟لأ بستوبركلوسيس
+
+100
+00:07:15,850 --> 00:07:19,370
+ال genus لأ ال genus تبعها هو ال mycobacteria ال
+
+101
+00:07:19,370 --> 00:07:24,670
+mycobacteria وفي النوكارديا، مظبوط؟ في النوكارديا،
+
+102
+00:07:24,670 --> 00:07:28,890
+برضه acid fast، الان النوكارديا تصنف علينها gram
+
+103
+00:07:28,890 --> 00:07:33,870
+-boostedوهذه البكتيريا جرام بوستف بس الله، إذن
+
+104
+00:07:33,870 --> 00:07:37,910
+التنتين بينتموا إلى نفس الشكل التنتين جرام بوستف
+
+105
+00:07:37,910 --> 00:07:42,010
+بس الله وبتالي بحاجة نحن إلى أي معلومة تساعدنا في
+
+106
+00:07:42,010 --> 00:07:45,770
+عملية التصنيف إنه cardio acid fast لكن هذي non
+
+107
+00:07:45,770 --> 00:07:51,910
+acid fast طيب aerobic بتساعدنا في أنه هنعرف أن
+
+108
+00:07:51,910 --> 00:07:57,300
+كلها كتاليز بوستف، صح؟ كتاليز بوستفClub-shaped
+
+109
+00:07:57,300 --> 00:08:02,000
+form swelled end او swelled end فاكرين الكلستردوم
+
+110
+00:08:02,000 --> 00:08:06,040
+تتانية كان فيه على ال terminal تبع البصلاي كان فيه
+
+111
+00:08:06,040 --> 00:08:11,040
+sport فسميناها drum stick عصاء تطبل عصاء و قدامها
+
+112
+00:08:11,040 --> 00:08:17,020
+فيه كورة تمام هذه بتشبهها إلى حد ما لأن الطرف
+
+113
+00:08:17,020 --> 00:08:21,750
+تبعها برضه منتفخ لكنالانتفاخ ليس ناتج عن مين؟ عن
+
+114
+00:08:21,750 --> 00:08:24,770
+ال sport احنا اتفقنا انه non sport formal طب
+
+115
+00:08:24,770 --> 00:08:27,510
+الانتفاخ ناتج عن ايش؟ الانتفاخ ناتج عن ان
+
+116
+00:08:27,510 --> 00:08:33,130
+البكتيريا هذه بتنتج metachromatic granules ليها ال
+
+117
+00:08:33,130 --> 00:08:39,190
+storage granules و بتتخزن في اماكن متنوعة لكن اكثر
+
+118
+00:08:39,190 --> 00:08:43,370
+مكان تتخزن فيه مين؟ الطرف كيف لو بدنا نميز اتنتين
+
+119
+00:08:44,020 --> 00:08:46,960
+عن بعض الكوليستيروديوم تتانى والكوريني بكتيروم
+
+120
+00:08:46,960 --> 00:08:56,060
+دفتيريا وتنقلهم مدببة على الحافة أو أحد الطرفين لو
+
+121
+00:08:56,060 --> 00:08:59,020
+عملنا من جرامز تانى ايش هنشوف في الكوليستيروديوم
+
+122
+00:08:59,020 --> 00:09:02,700
+تتانى هنشوف هلو structure على الطرف لأن ال sport
+
+123
+00:09:02,700 --> 00:09:06,700
+لم تسبق لم تسبق بينما الكوريني بكتيروم دفتيريا
+
+124
+00:09:06,700 --> 00:09:10,460
+هنشوف حاجة مسمطة مسمطة يعني مسبوقة كاملا لانها مش
+
+125
+00:09:10,460 --> 00:09:15,700
+sport هي التمييز بين اتانىأحد النقاط المهمة جدا
+
+126
+00:09:15,700 --> 00:09:19,680
+كمان في يد البكتيريا و هي .. و هي بنسميها hallmark
+
+127
+00:09:19,680 --> 00:09:21,960
+أو distinguishing characteristics اللي هو ال
+
+128
+00:09:21,960 --> 00:09:24,440
+appearance تبع الarrangement تبع الخلايا فاكرين في
+
+129
+00:09:24,440 --> 00:09:28,120
+ال gram-boston في كوكسايا كنا نقول streptococci او
+
+130
+00:09:28,120 --> 00:09:32,160
+cluster grape-like clusters هنا في شكل بيسموه
+
+131
+00:09:32,160 --> 00:09:34,400
+Chinese letter characters Chinese letter
+
+132
+00:09:34,400 --> 00:09:37,320
+characters زي الأحرف الصيني اللي أنا شباب فيه عندي
+
+133
+00:09:37,320 --> 00:09:40,160
+.. أنا فيه عندي حرف ال V و حرف ال L يقول إن هدول
+
+134
+00:09:40,160 --> 00:09:43,160
+شكلين من الأشكال اللي بتميز فيهم البكتيريالو
+
+135
+00:09:43,160 --> 00:09:49,320
+تخيلنا مجموعة حروف V ومجموعة حروف L ومساكنهم هيك
+
+136
+00:09:49,320 --> 00:09:54,820
+بيدنا مسك وراميناهم على بعض هيتشكل لدينا حرف ال L
+
+137
+00:09:54,820 --> 00:10:00,640
+هنرسم رسمة هاي
+
+138
+00:10:00,640 --> 00:10:10,680
+L
+
+139
+00:10:10,680 --> 00:10:22,080
+وهيال بالمجلوب وهي V تمام وهي كمان V بالاخر صار
+
+140
+00:10:22,080 --> 00:10:27,500
+عندي ايش حرف صيني فغالبا بتعطينا ال appearance هذا
+
+141
+00:10:27,500 --> 00:10:31,520
+او الشعور بانك انت بتتفرج على حروف صينية ناتجة عن
+
+142
+00:10:31,520 --> 00:10:35,100
+مين قلنا كده مرة عن ال arrange بتبعتها ال L و ال V
+
+143
+00:10:35,100 --> 00:10:35,640
+shape
+
+144
+00:10:38,940 --> 00:10:41,660
+إذن بدنا نربط معلومة ال chinese letter characters
+
+145
+00:10:41,660 --> 00:10:46,260
+بال كورين البكتيريوم بشكل عام كمان في نقطة كتير
+
+146
+00:10:46,260 --> 00:10:50,420
+مهمة شباب مقدرة البكتيريا على النمو في وسط بيحتوي
+
+147
+00:10:50,420 --> 00:10:53,340
+على بوتاسيوم تليوريد مش كتير من البكتيريا عندها
+
+148
+00:10:53,340 --> 00:10:56,220
+المقدرة هذه وبالتالي بنعتبر هذه البكتيريا أو
+
+149
+00:10:56,220 --> 00:11:00,600
+بنعتبر هذه الميزة برضه ميزة جيدة لها وبتعطينا
+
+150
+00:11:00,600 --> 00:11:03,720
+اللون الأسود بتعطينا اللون الأسود النتج عن
+
+151
+00:11:03,720 --> 00:11:08,420
+الاختزال للتليوريدالـ specimen collection زي ما
+
+152
+00:11:08,420 --> 00:11:14,440
+حكينا بنحتاج إلى throat or nasopharyngeal swab
+
+153
+00:11:14,440 --> 00:11:19,320
+وإذا وجد واحد من أفراد العائلة
+
+154
+00:11:25,080 --> 00:11:30,220
+أو في الحضانة أو في المدرسة كل ال contacts يجب أن
+
+155
+00:11:30,220 --> 00:11:33,340
+يأخذ منهم برضه throat and nasopharyngeal swab
+
+156
+00:11:33,340 --> 00:11:38,560
+لماذا؟ لأنه مادام احتكفي من أدمين يمكن يكون نقلهم
+
+157
+00:11:38,560 --> 00:11:41,480
+العدوة وبالتالي احنا بدا نحمي المريض ونحمي ال
+
+158
+00:11:41,480 --> 00:11:41,920
+contacts
+
+159
+00:11:44,780 --> 00:11:48,020
+مش هشرح ال media لكن بدي أمر عليها مره سريع ال
+
+160
+00:11:48,020 --> 00:11:51,660
+media في عندى حاجة اسمها pie media pie media محتوي
+
+161
+00:11:51,660 --> 00:11:56,640
+على homogenized whole egg بيض كامل تمام ومحتوي على
+
+162
+00:11:56,640 --> 00:12:02,270
+glycerol و glucoseالتنزدالي ميديوم محتوي على
+
+163
+00:12:02,270 --> 00:12:05,390
+الكلام اللي حاكيناه أو غنيه نوعا ما لكن مضاف إليها
+
+164
+00:12:05,390 --> 00:12:08,370
+supplement ال supplement هذه فيها Sodium
+
+165
+00:12:08,370 --> 00:12:11,350
+Thiosulphate and Potassium Telluride اللي هو
+
+166
+00:12:11,350 --> 00:12:14,210
+المقدرة البكتيريا على النمو في وين بالبوتاسيوم
+
+167
+00:12:14,210 --> 00:12:18,290
+تليورايت ليش الشباب في ال media بنضيف supplement
+
+168
+00:12:18,290 --> 00:12:22,570
+media و supplement ليش ما كلهم مع بعض خلطة واحدة؟
+
+169
+00:12:22,600 --> 00:12:26,140
+لأنه غالبا اللي حطناه في ال supplement بتحمسش ال
+
+170
+00:12:26,140 --> 00:12:28,800
+autoclaving وبالتالي لو أنا حطته مباشرة مع ال
+
+171
+00:12:28,800 --> 00:12:33,680
+media سيتدمر ومش هيكون له أي قيمة فبنعقمه عبر ال
+
+172
+00:12:33,680 --> 00:12:37,720
+filtration أو وسيلة أخرى تمام؟ وبعدين لما نعقم ال
+
+173
+00:12:37,720 --> 00:12:39,340
+media اللي بيسميها ال base اللي هذا الجزء اللي
+
+174
+00:12:39,340 --> 00:12:43,060
+الآن مش بيصير base ال media وهذا ال supplement
+
+175
+00:12:43,060 --> 00:12:48,360
+اتنين مع بعض بشكله ال media بشكله ال mediaهي اللون
+
+176
+00:12:48,360 --> 00:12:50,380
+الأسود اللي حكينالكوا عنه اللي بنشوفه لـ
+
+177
+00:12:50,380 --> 00:12:54,560
+Cornebacterium Diphtheria عندما تزرع على وسط اللي
+
+178
+00:12:54,560 --> 00:12:57,640
+بيحتوي على بوتاسيوم تليوريد، هذا كتير كتير اللون
+
+179
+00:12:57,640 --> 00:13:00,220
+لإنه .. هذه كرامبوستر بس الله يعني
+
+180
+00:13:03,170 --> 00:13:06,450
+مثيلاتها مش كثر وبالتالي أنا بلجأش لل biochemical
+
+181
+00:13:06,450 --> 00:13:11,190
+test بشكل كبير جدا بلجأ لل selective media و لل
+
+182
+00:13:11,190 --> 00:13:14,370
+colony morphology عشان أقدر أتحقق منها بعمل
+
+183
+00:13:14,370 --> 00:13:17,290
+biochemical test لكن مش زي ما بعمل لل
+
+184
+00:13:17,290 --> 00:13:21,510
+enterobacterias على سبيل المثالLoffler Medium باي
+
+185
+00:13:21,510 --> 00:13:25,890
+تنسدالي و Loffler تلعبوني لوفلر اش مالو بيف سيرام
+
+186
+00:13:25,890 --> 00:13:30,370
+ايج درايد برضه فيه ايج صح؟ وده برضه كان فيه
+
+187
+00:13:30,370 --> 00:13:34,910
+الاولان ايج heart muscle solid from infusions
+
+188
+00:13:34,910 --> 00:13:38,750
+glucose بيبتيك دايتستو بانيمالتيشيو صدمكلورايد
+
+189
+00:13:38,750 --> 00:13:43,970
+يعني وسط غني جدا لكن ليس مضاف الو بوتاسيوم
+
+190
+00:13:43,970 --> 00:13:48,290
+تليورايددي بيجي مش selective، دي بيجي مش
+
+191
+00:13:48,290 --> 00:13:52,350
+selective، وده ال-bi selective، إذا ال-bi و ال
+
+192
+00:13:52,350 --> 00:13:55,730
+-lofler ليه يعتبروا إيه؟ selective، فقط تلك اللي
+
+193
+00:13:55,730 --> 00:13:58,570
+تحتوي على ال potassium telluride، اللي جينا من
+
+194
+00:13:58,570 --> 00:14:01,630
+ضمنها ال-tensedal وهي .. هذه التانية ال-high،
+
+195
+00:14:01,630 --> 00:14:05,150
+medium، لاحظوا ال-sublimate مش بحتوي علشان على
+
+196
+00:14:05,150 --> 00:14:08,590
+potassium telluride، ليه هذه؟ potassium telluride
+
+197
+00:14:09,590 --> 00:14:13,930
+بالتالة الفيان دي supplement، يدان هايل و تنزدال
+
+198
+00:14:13,930 --> 00:14:16,890
+بيحتوي على ال potassium telluride بينما باي و
+
+199
+00:14:16,890 --> 00:14:20,570
+لوفلار بيحتويش على ال potassium tellurideعاملًا
+
+200
+00:14:20,570 --> 00:14:23,390
+الـ Pie and Loeffler Medium Provide Good Growth
+
+201
+00:14:23,390 --> 00:14:26,310
+بمعنى .. هيا هنشوف ال diagram اللي هنشوفه يا شباب
+
+202
+00:14:26,310 --> 00:14:30,050
+هنشوف إنه بالفعل ال pie و ال loafler بيمثلوا إن ال
+
+203
+00:14:30,050 --> 00:14:33,230
+enrichment media زي ال diagram اللي كنا ناخده في
+
+204
+00:14:33,230 --> 00:14:36,430
+السلمونيلا و الشيجيلا أو في ال vibrio مش كان فيه
+
+205
+00:14:36,430 --> 00:14:39,570
+على طرف enrichment و على طرف selective media هنشوف
+
+206
+00:14:39,570 --> 00:14:42,890
+diagram شبيه بهذا الكلام إذن ال loafler أو ال pie
+
+207
+00:14:42,890 --> 00:14:46,510
+مش التانين مع بعض واحد من التانين استخدم واحد بصدر
+
+208
+00:14:46,510 --> 00:14:51,700
+التانيبيستخدمه ت provide good growth للبكتيريا و
+
+209
+00:14:51,700 --> 00:14:55,960
+أي stain سمير بنعمله من هذه ال media غالبا بيعطينا
+
+210
+00:14:55,960 --> 00:14:59,100
+الشكل اللي احنا قلنا عنه قبل شوية شكل مميز اللي هو
+
+211
+00:14:59,100 --> 00:15:02,920
+chinese letter characters في تلت أشكال من
+
+212
+00:15:02,920 --> 00:15:06,900
+المستعمرات ممكن نشوفها على telluride agar واحد
+
+213
+00:15:06,900 --> 00:15:10,680
+بنسميه Gravis، التاني Metis، والتالت Intermedias
+
+214
+00:15:13,140 --> 00:15:17,860
+هو المستعمرات الأضخم هي المستعمرات الأضخم ال
+
+215
+00:15:17,860 --> 00:15:22,480
+intermediates هي المستعمرات الأصغر يبجى الأولى هي
+
+216
+00:15:22,480 --> 00:15:29,060
+الأكبر والأخيرة هي الأصغر الان ال metis تتميز بإن
+
+217
+00:15:29,060 --> 00:15:34,160
+اللون تبعها أغمق من ال grav-spain من اللي هو ال
+
+218
+00:15:34,160 --> 00:15:40,830
+intermediates هل التلت أسماء هذه الغريبةهي أسماء
+
+219
+00:15:40,830 --> 00:15:45,150
+لبكتيريا مختلفة وده اسم واحد هي كورين لبكتيريوم ..
+
+220
+00:15:45,150 --> 00:15:48,070
+هي كورين لبكتيريوم دفتيريا different strains ..
+
+221
+00:15:48,070 --> 00:15:51,790
+different strains إذن هي سلالات بتعطي .. سلالة
+
+222
+00:15:51,790 --> 00:15:56,290
+بتعطي حجم كبير، حجم صغير، حجم متوسط اللي هي الـ
+
+223
+00:15:56,290 --> 00:16:00,610
+Metis لكن اللون تبعها بيكون أغمق كيف لنا أن نميز
+
+224
+00:16:00,610 --> 00:16:04,490
+بين Gravis و بين التنتين البجيين؟ والـ Gravis على
+
+225
+00:16:04,490 --> 00:16:08,440
+فكرة هي الأهمGravestrain بيعمل hydrolysis للـ
+
+226
+00:16:08,440 --> 00:16:11,920
+starch والجليكوجين while meatus and intermediates
+
+227
+00:16:11,920 --> 00:16:15,300
+do not يفجر في عندي فحص اللي هو الـ starch
+
+228
+00:16:15,300 --> 00:16:18,420
+hydrolysis أو الجليكوجين hydrolysis بيميزلي لـ
+
+229
+00:16:18,420 --> 00:16:22,680
+Gravestrain عن التلتين الأخرين فده ال diagram اللي
+
+230
+00:16:22,680 --> 00:16:27,000
+هو هيكون محور المحاضرة تبعتنا اليوم ان شاء الله لل
+
+231
+00:16:27,000 --> 00:16:31,080
+isolation and identification of اللي هي ال
+
+232
+00:16:31,080 --> 00:16:33,960
+-coronabacterium diphtheria طلعولي على العينة، إيش
+
+233
+00:16:33,960 --> 00:16:38,650
+كانت العينة؟Collect more than one swab، غالبًا
+
+234
+00:16:38,650 --> 00:16:42,970
+بنعمل جملة three swabs، three swabs، واحد في
+
+235
+00:16:42,970 --> 00:16:45,830
+النصر، إيش بنعمل فيه يا شباب؟ نزرع على cigarette
+
+236
+00:16:45,830 --> 00:16:50,910
+agar أو blood agar، لأي غرض، إحنا بنعرف إن ال most
+
+237
+00:16:50,910 --> 00:16:56,690
+common cause of bacterial sore throat هو مين؟
+
+238
+00:16:56,690 --> 00:16:58,810
+المين؟
+
+239
+00:17:02,660 --> 00:17:06,080
+الـ streptococcus biodeins اللي هي group A group A
+
+240
+00:17:06,080 --> 00:17:08,860
+streptococcus وبالتالي أنا بدي أستثنى .. بدي
+
+241
+00:17:08,860 --> 00:17:11,540
+أستثنى هذه الاحتمالية من اللي سوافها زرعتها على
+
+242
+00:17:11,540 --> 00:17:15,160
+blood agar أو على chocolate agar to examine for
+
+243
+00:17:15,160 --> 00:17:19,640
+beta hemolytic streptococci الان على الطرف هذا
+
+244
+00:17:19,640 --> 00:17:22,640
+زرعت على loafler or pie واحنا جدنا على الطرف هذا
+
+245
+00:17:22,640 --> 00:17:26,640
+هي بمثابة enrichment وعلى الطرف التاني زرعنا على
+
+246
+00:17:26,640 --> 00:17:31,920
+telluride agar بمثابة ايه selectedو للتأكيد لما
+
+247
+00:17:31,920 --> 00:17:35,020
+زرعنا على ال loafler ما استنانا على ال loafler و
+
+248
+00:17:35,020 --> 00:17:38,920
+انتهى الموضوع بعد ساعتين ل تمان ساعات اخدنا و
+
+249
+00:17:38,920 --> 00:17:42,920
+زرعنا على مين؟ على teluride agar زي ما عملنا
+
+250
+00:17:42,920 --> 00:17:46,980
+بالظبط في السيل المونيلا فاكرين؟ stool على
+
+251
+00:17:46,980 --> 00:17:51,020
+سيلانايت F و من السيلانايت F زرعنا على SSA او XLD
+
+252
+00:17:51,020 --> 00:17:55,890
+صح ولا؟ نفس الجثة هذه لكن هنا في خطوة زيادةبعد
+
+253
+00:17:55,890 --> 00:17:58,790
+ساعتين ل تمان ساعات احنا زرعنا صحيح على تلويرات
+
+254
+00:17:58,790 --> 00:18:02,630
+أجار بس عملنا حالة اسمها Methylene Blue Staining
+
+255
+00:18:04,370 --> 00:18:07,070
+لحظة ماقلناش جرام stain، بيقولنا مثلين ال blue
+
+256
+00:18:07,070 --> 00:18:10,590
+لماذا مثلين ال blue؟ مثلين ال blue اللي هو simple
+
+257
+00:18:10,590 --> 00:18:13,910
+stain is the best for cornebacterium diphtheria ده
+
+258
+00:18:13,910 --> 00:18:17,810
+الرقم واحد و ليش هو best أصلا؟ best لإنه بيعمللي
+
+259
+00:18:17,810 --> 00:18:21,150
+demonstration لل metachromatic granules اللي كنا
+
+260
+00:18:21,150 --> 00:18:23,490
+احنا هجابش شوية مش كنا ان هذه البكتيريا بتنتج
+
+261
+00:18:23,490 --> 00:18:26,870
+metachromatic granules فالمثلين ال blue بيعمللي
+
+262
+00:18:26,870 --> 00:18:32,690
+stain انقلها بشكل جيدطيب تليو رايت أجار selective
+
+263
+00:18:32,690 --> 00:18:36,470
+و تليو رايت أجار بعد subculture أي مستعمرة
+
+264
+00:18:36,470 --> 00:18:39,850
+resembling corneal bacterium دفتيريا إيش شكلها؟
+
+265
+00:18:39,850 --> 00:18:48,100
+إيش لونها؟ أسوأ من أين ال blue؟اللون تبعها على
+
+266
+00:18:48,100 --> 00:18:52,800
+الطبق كان لون مصطمعاتها أسود وبالتالي المستعمرات
+
+267
+00:18:52,800 --> 00:18:55,420
+السوداء هي ال suspect colonies الآن ال suspect
+
+268
+00:18:55,420 --> 00:18:58,620
+colonies إيه بنعمل فيها؟ بناخدها ونزرعها على
+
+269
+00:18:58,620 --> 00:19:03,100
+مجموعة من الأوساط بنعرف كل وسط زرعنا ليش زرعنا
+
+270
+00:19:03,100 --> 00:19:07,240
+عليه مثلا زرعنا على ال loafler or pice land أكام
+
+271
+00:19:07,240 --> 00:19:10,520
+مرة ال loafler و ال pice land مرتين مرة فوق و مرة
+
+272
+00:19:10,520 --> 00:19:14,800
+تحت اللي فوق غير عن التحت الآنأو الغرض من اللي فوق
+
+273
+00:19:14,800 --> 00:19:18,160
+غير اللي تحت الغرض من اللي فوق كان enrichment
+
+274
+00:19:18,160 --> 00:19:22,720
+اغناء تنمية البكتيريا بأقصى ما يكون بس كان فيه
+
+275
+00:19:22,720 --> 00:19:26,120
+بكتيريا تانية معاها انا أخدت throat swab ما أخدتش
+
+276
+00:19:26,120 --> 00:19:29,120
+pure culture فبالتالي ممكن يكون في other organism
+
+277
+00:19:29,120 --> 00:19:32,820
+موجودين في ال .. لكن لما أنا أخدت هنا أخدت مستعمرة
+
+278
+00:19:32,820 --> 00:19:35,520
+واحدة وزرعتها على لفلة فهذه الحالة لازم تكون
+
+279
+00:19:35,520 --> 00:19:38,240
+المستعمرة اللي هون pure يبقى يا إما
+
+280
+00:19:38,240 --> 00:19:40,220
+كورينيباكتريوم، diphtheria، يا إما مش
+
+281
+00:19:40,220 --> 00:19:44,520
+كورينيباكتريوم، لكن نوع واحدزرعته على ال Loeffler
+
+282
+00:19:44,520 --> 00:19:47,820
+لغرضين عشان أعمل Staining كمان مرة ومثلين ال blue
+
+283
+00:19:47,820 --> 00:19:50,680
+وعشان أعمل biochemical test انا قولتلكوا ال
+
+284
+00:19:50,680 --> 00:19:54,880
+biochemical test اهتمامنا فيها مش عالي لكن عشان
+
+285
+00:19:54,880 --> 00:19:57,780
+نميز التلاتة عن بعضهم ال ulcerans و ال diphtheria
+
+286
+00:19:57,780 --> 00:20:03,060
+و ال ovus محتاجين بعض ال biochemical test بنزرع ال
+
+287
+00:20:03,060 --> 00:20:06,880
+suspect colony على أجار medium for in vitro
+
+288
+00:20:06,880 --> 00:20:10,920
+toxigenicity assay فاكرين ال in vitro؟لما جيبنا
+
+289
+00:20:10,920 --> 00:20:15,160
+filter paper، رسمناها على الرسام في المحاضرة، جبنا
+
+290
+00:20:15,160 --> 00:20:18,320
+نجيبنا filter paper و زرعنا ال positive control و
+
+291
+00:20:18,320 --> 00:20:22,020
+ال negative control و ال test perpendicular على ال
+
+292
+00:20:22,020 --> 00:20:27,040
+filter paper المغمور ب ash بال anti-toxin و عملنا
+
+293
+00:20:27,040 --> 00:20:32,080
+لهم incubation، إذا البكتيريا بتنتج toxinهيصيرله
+
+294
+00:20:32,080 --> 00:20:34,680
+diffusion و طبعا فيه diffusion لمين الآن؟ للـ
+
+295
+00:20:34,680 --> 00:20:37,420
+antitoxin إذا التقى التوكسين مع ال antitoxin
+
+296
+00:20:37,420 --> 00:20:41,500
+هيكونه قولنا precipitate أو line of precipitate
+
+297
+00:20:41,500 --> 00:20:46,040
+ناتجة عن ال complex تبع ال antigen antibody اللي
+
+298
+00:20:46,040 --> 00:20:50,360
+هو ال toxin antitoxin reaction
+
+299
+00:20:52,160 --> 00:20:55,740
+و بنزرع كمان على broth media for in vivo
+
+300
+00:20:55,740 --> 00:20:59,140
+toxigenicity test طبعا ال in vivo اللي هو الفران
+
+301
+00:20:59,140 --> 00:21:03,400
+فاكرين برضه حسن و حسن الجرد و الجرد اللي حقننا
+
+302
+00:21:03,400 --> 00:21:07,740
+واحد منهم بال antitoxin و بعد نصف ساعة حقنهم بال
+
+303
+00:21:07,740 --> 00:21:12,640
+extract تبع ال .. ال .. ال .. ال .. لما شرحنا ال
+
+304
+00:21:12,640 --> 00:21:17,000
+clostridium perifringens ال toxigenic assay مظبوط؟
+
+305
+00:21:17,000 --> 00:21:19,060
+طيب لما .. لما .. لما نشوفوا الآن الصورة اللي
+
+306
+00:21:19,060 --> 00:21:23,070
+هتذكروابس قبل ما نروح على الصور و نطلع على ال
+
+307
+00:21:23,070 --> 00:21:27,690
+assay بدنا نذكر ال toxin و ال structure تبعه ال
+
+308
+00:21:27,690 --> 00:21:32,590
+toxin عبارة عن heat labile polypeptide الجرعة
+
+309
+00:21:32,590 --> 00:21:36,930
+المميتة منه هي point one micro gram لكل kilogram
+
+310
+00:21:36,930 --> 00:21:39,950
+ماعرفش مرة عليكم مصطلح per kilogram هذا و ده لأ في
+
+311
+00:21:39,950 --> 00:21:44,710
+الجرعات بس انا هحضه هالكوا يعنى زمان الصيدلة كانت
+
+312
+00:21:44,710 --> 00:21:48,670
+بتعطي جرعات على حسب السن تقول الطفل اللي من عمره
+
+313
+00:21:48,670 --> 00:21:52,600
+كده لكده عطو جرعة كده كدهلكن مع طور الطب صار في
+
+314
+00:21:52,600 --> 00:21:56,540
+فكرة تانية، يقولك الطفل في أطفال بيكون مزنه خمسين
+
+315
+00:21:56,540 --> 00:22:02,360
+كيلو و هو عمره سبع سنين، طيب هل ممكن الجرعة اللي
+
+316
+00:22:02,360 --> 00:22:05,660
+بيعطيها الطفل أبوه عشرة كيلو يكون نفس الجرعة اللي
+
+317
+00:22:05,660 --> 00:22:08,740
+بيعطيها واحد خمسين كيلو؟ أكيد لأ، مش هتوزع بالجسم
+
+318
+00:22:08,740 --> 00:22:13,670
+بنفس التركيز، منطقي يعنيفصار في مدرسة أخرى تنادي
+
+319
+00:22:13,670 --> 00:22:18,370
+بإنه لأ الجرعات هي تبقى تكون بحسب الوزن وليس بحسب
+
+320
+00:22:18,370 --> 00:22:22,490
+الأمر، مع أنه في اختلاف الصحيح وفي ناس بدأت تتسكر
+
+321
+00:22:22,490 --> 00:22:25,530
+بطريقة جدية إنه ندمجوا تنتين مع بعض، الأمر والوزن،
+
+322
+00:22:25,530 --> 00:22:30,170
+لأنه الطفل برضه يعني في بعض ال systems من جسمه
+
+323
+00:22:30,170 --> 00:22:32,890
+ممكنش مكتمله وبتالي، حتى لو كان وزنه كبير، ممكن
+
+324
+00:22:32,890 --> 00:22:37,500
+يتحمل الجرعة كبيرة per kilogram، لكن في النهايةقد
+
+325
+00:22:37,500 --> 00:22:42,520
+يتم حساب .. قد يتم حساب الجرعات سواء كانت دوائية
+
+326
+00:22:42,520 --> 00:22:48,240
+او الجرعات السامة، تمام؟ للانسان او للحيوان على
+
+327
+00:22:48,240 --> 00:22:52,600
+الوزن، per kilogram body weight، تمام؟ يعني بنقول
+
+328
+00:22:52,600 --> 00:22:56,180
+الجرعة القاتلة point واحد microgram لكل kilogram
+
+329
+00:22:56,180 --> 00:23:01,030
+body weightالان ال .. ال .. ال .. التوكسين تبعا
+
+330
+00:23:01,030 --> 00:23:03,710
+احنا كنا عنه متفقين انه .. انه fragment A و
+
+331
+00:23:03,710 --> 00:23:06,390
+fragment B فاكرين؟ كنا ان هو ال A بيه model أول
+
+332
+00:23:06,390 --> 00:23:09,730
+واحد أخدرصناها فلو جيبنا ال di-sulfide في بيرجي و
+
+333
+00:23:09,730 --> 00:23:14,150
+جسناهم .. جسناها هتكون عندي قطعتين B has no
+
+334
+00:23:14,150 --> 00:23:19,300
+independent action مالاش أي تأثير سام مستقلهي
+
+335
+00:23:19,300 --> 00:23:24,200
+بالفعل لل binding فقط بينما A هي ال toxic
+
+336
+00:23:24,200 --> 00:23:27,580
+والميكانيزم اللي قدامكوا بيقولنا انه it inhibits
+
+337
+00:23:27,580 --> 00:23:31,780
+polypeptide chain elongation by inactivating
+
+338
+00:23:31,780 --> 00:23:38,160
+elongation factor 2 او EF2هذا الفكتور الوظيفة انه
+
+339
+00:23:38,160 --> 00:23:41,820
+بيعمل عملية Translocation للبوليبتديل Transfer RNA
+
+340
+00:23:41,820 --> 00:23:45,360
+أو Transfer RNA from the receptor site to the
+
+341
+00:23:45,360 --> 00:23:49,740
+donor site وبالتالي هيك احنا وجفنا مين؟ وجفنا
+
+342
+00:23:49,740 --> 00:23:53,520
+عملية اطالة السلسلة بتاعة البوليبتيد توقف ل
+
+343
+00:23:53,520 --> 00:23:59,050
+protein synthesis واتفقنا منذ زمن بعيدProtein is
+
+344
+00:23:59,050 --> 00:24:03,670
+doomed to death محكم عليها بالإعداد تمام؟ وبتالي
+
+345
+00:24:03,670 --> 00:24:07,310
+الخلايا في النهاية هتموت.الان هذا الشكل اللي
+
+346
+00:24:07,310 --> 00:24:10,170
+قدامكوا شفناه قبل هيكد هو نفس الشكل اللي شرحناه
+
+347
+00:24:10,170 --> 00:24:15,130
+أول مرة وفيه له كمان يعني لوحة أخرى بتوضح أنها نفس
+
+348
+00:24:15,130 --> 00:24:21,980
+اللي هو الفكرة نجي لل biochemical testsأحنا اتفقنا
+
+349
+00:24:21,980 --> 00:24:24,620
+أنه في البكتيريا هذه ال biochemical test لاتشكل
+
+350
+00:24:24,620 --> 00:24:26,800
+أهمية كبرى في العاملية التعرف على الكورين
+
+351
+00:24:26,800 --> 00:24:30,000
+البكتيريا ككورين البكتيريا كعنوان ال staining مهم
+
+352
+00:24:30,000 --> 00:24:35,260
+الميثينين ال blue staining مهم التنزدال أجار مهم
+
+353
+00:24:35,260 --> 00:24:39,060
+لكن هناك بعض الصفات اللي بمستخدمها الشباب لتمييز
+
+354
+00:24:39,060 --> 00:24:43,340
+بين ال species طلعوا على جدول هذاDiphtheria,
+
+355
+00:24:43,740 --> 00:24:48,440
+Ulcerance and Obesity كان دي تلت فحوصات انا حاطهم
+
+356
+00:24:48,440 --> 00:24:55,040
+مهشرهم بلون رمادي الوحيدة اللي positive للنيتريت
+
+357
+00:24:55,040 --> 00:25:01,160
+هي ال ulcerance الوحيدة اللي positive للجيلاتين هي
+
+358
+00:25:01,160 --> 00:25:06,580
+برضه ال ulcerance الوحيدة اللي negative لليوريا هي
+
+359
+00:25:06,580 --> 00:25:13,680
+ال diphtheria صح؟ يبقى من التلت فحوصات هدولةهل
+
+360
+00:25:13,680 --> 00:25:20,160
+بنقدر نعمل diagram نميزهم؟ بكل سهولة، بنقول إذا
+
+361
+00:25:20,160 --> 00:25:22,080
+كانت البكتيريا كورين البكتيريا فعمل test of urea
+
+362
+00:25:22,080 --> 00:25:23,120
+إذا كانت البكتيريا كورين البكتيريا فعمل test of
+
+363
+00:25:23,120 --> 00:25:23,580
+urea إذا كانت البكتيريا كورين البكتيريا فعمل test
+
+364
+00:25:23,580 --> 00:25:23,600
+of urea إذا كانت البكتيريا كورين البكتيريا فعمل
+
+365
+00:25:23,600 --> 00:25:24,440
+test of urea إذا كانت البكتيريا كورين البكتيريا
+
+366
+00:25:24,440 --> 00:25:25,560
+فعمل test of urea إذا كانت البكتيريا كورين
+
+367
+00:25:25,560 --> 00:25:29,080
+البكتيريا فعمل test of urea إذا كانت البكتيريا
+
+368
+00:25:29,080 --> 00:25:31,040
+كورين البكتيريا فعمل test of urea إذا كانت
+
+369
+00:25:31,040 --> 00:25:32,600
+البكتيريا كورين البكتيريا فعمل test of urea إذا
+
+370
+00:25:32,600 --> 00:25:36,260
+كانت البكتير
+
+371
+00:25:36,720 --> 00:25:40,840
+الـ Toxinist Assay اللي قلنا عنهم in vivo و in
+
+372
+00:25:40,840 --> 00:25:43,860
+vitro، هذا اللي قدامكوا أيه، إيش هيكون؟ in vivo،
+
+373
+00:25:43,860 --> 00:25:51,110
+حققنا ال control بيه اللي هو ال ..الانتوكسين وال
+
+374
+00:25:51,110 --> 00:25:57,650
+test ما حقنناها بأي شيء وبعد نصف ساعة حقننا اتنين
+
+375
+00:25:57,650 --> 00:26:01,990
+بال filtrate تبع البكتيريا اللى نمناها فى ال broth
+
+376
+00:26:01,990 --> 00:26:05,610
+media من ال diagram اللى جابله بشوية لما كنا بنزرع
+
+377
+00:26:05,610 --> 00:26:09,250
+ال suspect colony على solid لل in vitro وعلى
+
+378
+00:26:09,250 --> 00:26:13,790
+liquid او broth لل in vivo حقنناهم اتنين بال
+
+379
+00:26:13,790 --> 00:26:19,630
+liquid او broth بعدفترة زمانية محددة بنقرأ
+
+380
+00:26:19,630 --> 00:26:24,170
+النتائج، النتائج عشان انا اقول ان هي Corne
+
+381
+00:26:24,170 --> 00:26:28,690
+Bacterium Diphtheria لازم مين اللي موت ال test و
+
+382
+00:26:28,690 --> 00:26:33,420
+لازم مين اللي يبقى حقيقيا ال controlاللي حقنها
+
+383
+00:26:33,420 --> 00:26:36,460
+بالظبط، الانتوكسين، إذا التنين ماتوا، فمعناه الحكي
+
+384
+00:26:36,460 --> 00:26:41,560
+أن البكتيريا ليست كورنيبكتيريوم دفترية، إذا التنين
+
+385
+00:26:41,560 --> 00:26:45,460
+عاشوا فهي non-toxigenic، non-toxigenic، بقولنا إذا
+
+386
+00:26:45,460 --> 00:26:50,320
+ال test عاش و ال control مات، بقولنا الفحص لغي،
+
+387
+00:26:50,320 --> 00:26:54,440
+الفحص يعني لا يعتد به ولا يقرع، بيسموه invalid،
+
+388
+00:26:54,440 --> 00:26:59,530
+invalidهى الشكل اللى .. اللى جونى عنه اللى ممكن
+
+389
+00:26:59,530 --> 00:27:03,530
+يعطينا انطباع انه بتكلم عن حروف صينية من التبديل
+
+390
+00:27:03,530 --> 00:27:07,050
+او من ال .. من ال grouping للبكتيريا مع بعضها
+
+391
+00:27:07,050 --> 00:27:14,030
+البعض ال in vitro toxicity test شرحنا ده ال .. هى
+
+392
+00:27:14,030 --> 00:27:20,430
+ال filter paper تمام؟ وهى البكتيريازي رأيناها بهذا
+
+393
+00:27:20,430 --> 00:27:22,570
+الشكل هذا negative control وهذا positive control
+
+394
+00:27:22,570 --> 00:27:26,390
+هذا ال test اللي قدامكوا طبعا الصورة فيها خطأ شنيع
+
+395
+00:27:26,390 --> 00:27:29,870
+اللي هو الخطأ هذا ال line of reciprocation لازم
+
+396
+00:27:29,870 --> 00:27:34,390
+يظهر من وين؟ لازم يظهر من طرف ال strip وليس من
+
+397
+00:27:34,390 --> 00:27:36,690
+منتصف ال strip يعني هذا المفروض كل الزاوية تكون
+
+398
+00:27:36,690 --> 00:27:40,390
+موجودة في المنطقة هذه نفس الشيء هنا تبني تكون
+
+399
+00:27:40,390 --> 00:27:43,920
+موجودة بهذا الشكلطبعا الخط هذا اللي .. اللي ..
+
+400
+00:27:43,920 --> 00:27:46,420
+اللي قدامكوا اللي ظهر ناتج عن مين قلنا كمان مرة
+
+401
+00:27:46,420 --> 00:27:52,980
+ناتج عن ارتباط التوكسين والانتيتوكسين الفحص معروف
+
+402
+00:27:52,980 --> 00:27:57,940
+مشهور باسم elix .. elix test تمام؟ فال .. يعني
+
+403
+00:27:57,940 --> 00:28:02,320
+يارتنا نبجي عارفين انه ال in vitro toxicity assay
+
+404
+00:28:02,320 --> 00:28:07,360
+تعرف باسم elix testفحص تاريخ عمروناش دراسناه ولا
+
+405
+00:28:07,360 --> 00:28:11,740
+شرحناه ولا اتكلمنا عنه البتة بس الان بنفهمه بشكل
+
+406
+00:28:11,740 --> 00:28:14,760
+جيد اسمه skin test يعني ما شرحناه ولا جابلك ولا
+
+407
+00:28:14,760 --> 00:28:19,100
+skin test هذا اول skin test نشرحه والاصل ان معظم
+
+408
+00:28:19,100 --> 00:28:22,720
+ال skin test تستخدم لل diagnosis يعني بنعرف ان انت
+
+409
+00:28:22,720 --> 00:28:26,040
+مريض او مش مريض او مصاب او غير مصاب لكن هذا الفحص
+
+410
+00:28:26,040 --> 00:28:30,040
+لا يستخدم لهذا الغرض وانما يستخدم لمعرفة ما إذا
+
+411
+00:28:30,040 --> 00:28:34,400
+كنت تمتلك أجسام مضادةللبكتيريا الاسمة
+
+412
+00:28:34,400 --> 00:28:38,060
+cornbacterium diphtheria أم لا تمتلك؟ كيف نعمل
+
+413
+00:28:38,060 --> 00:28:42,900
+الفحص؟ تركزوا معايا الله أرضى عليكم دقيقتين هنفهم
+
+414
+00:28:42,900 --> 00:28:47,720
+الموضوع We have to use both hands ال left و ال
+
+415
+00:28:47,720 --> 00:28:52,760
+right في ال left بنحقن inactivated diphtheria
+
+416
+00:28:52,760 --> 00:28:59,340
+toxin intradermally إيش انترا ديرمالي؟ لأ في الجلد
+
+417
+00:28:59,690 --> 00:29:03,710
+intradermal يعني داخل الجلد بينما subcutaneous هي
+
+418
+00:29:03,710 --> 00:29:06,890
+تحت الجلب وبينميز بين اتنين وهناك فرق كبير بين
+
+419
+00:29:06,890 --> 00:29:11,110
+اتنين بين في الجلد وتحت الجلد إذا هي عبارة عن
+
+420
+00:29:11,110 --> 00:29:15,990
+intra dermal injection الان ال intra dermal
+
+421
+00:29:15,990 --> 00:29:21,310
+injection جونا بنحقنها في منطقة محددة كويسة في ال
+
+422
+00:29:21,310 --> 00:29:27,750
+left arm على سبيل المثال وال right arm بنحقنToxin
+
+423
+00:29:27,750 --> 00:29:32,650
+diluted مخفف تمام في ال .. في الإيدة التانية لكن
+
+424
+00:29:32,650 --> 00:29:35,570
+مش inactivated هذا اللي زرعناها .. اللي حقرناها
+
+425
+00:29:35,570 --> 00:29:39,170
+انها inactivated وبعد اربعة و عشرين لتانية و ربعين
+
+426
+00:29:39,170 --> 00:29:45,390
+ساعة بنقلع النتيجة ايش تفسيراتنا للنتيجة هتكون؟
+
+427
+00:29:45,390 --> 00:29:49,970
+الآن في الإيدة هذه احنا ليش حقرنا inactivated
+
+428
+00:29:49,970 --> 00:29:55,370
+toxinعشان نشوف هل ال patient يمكن يكون عنده حساسية
+
+429
+00:29:55,370 --> 00:29:59,850
+أصلا لل proteins و ال toxin عبارة عن protein
+
+430
+00:29:59,850 --> 00:30:05,370
+فحققنا فقط to eliminate the possibility of having
+
+431
+00:30:05,370 --> 00:30:09,790
+hypersensitivity to proteins تمام؟ يبقى المفروض
+
+432
+00:30:09,790 --> 00:30:12,890
+أنه مستشفى لحالة إذا ما عندهش حساسية المفروض أنه
+
+433
+00:30:12,890 --> 00:30:16,590
+يكون هدايش طبيعي ماصار أي reaction في المنطقة هذه
+
+434
+00:30:17,670 --> 00:30:23,430
+هنا إذا ماعندوش antibody إيش اللي هيصير؟ التكسين
+
+435
+00:30:23,430 --> 00:30:29,850
+هيبدأ يموت الخلايا موت الخلايا هيعمل inflammation
+
+436
+00:30:29,850 --> 00:30:34,910
+فهيصير عندي redness احمرار ممكن الصورة مبينة هنا
+
+437
+00:30:34,910 --> 00:30:36,270
+في المنطقة هذه شايفينها؟
+
+438
+00:30:39,910 --> 00:30:43,990
+في احمرار في المنطقة و التاني هنا مافيش اي احمرار
+
+439
+00:30:43,990 --> 00:30:47,850
+هذا ال control هنا ال test الان احمرار و
+
+440
+00:30:47,850 --> 00:30:51,950
+induration سموه تصلب يعني بيصير الجلد او المنطقة
+
+441
+00:30:51,950 --> 00:30:56,170
+اللي عملنا فيها injection صلبة يبقى في احمرار
+
+442
+00:30:56,170 --> 00:31:00,730
+readiness and induration اذا في عندي احمرار و
+
+443
+00:31:00,730 --> 00:31:05,010
+induration مامعنى النتيجة positive نتيجة positive
+
+444
+00:31:06,240 --> 00:31:10,660
+إن مافيش أحمرار يبقى يفحص نجاتيف، لكن ما معناه
+
+445
+00:31:10,660 --> 00:31:14,460
+نجاتيف ما معناه agustin،
+
+446
+00:31:14,460 --> 00:31:21,520
+goal، أكيد، فش عنده أيش؟ فش عنده antibody
+
+447
+00:31:24,460 --> 00:31:28,540
+النجاتف نجاتف، ليش صار نجاتف يا شباب؟ لأنه الـ
+
+448
+00:31:28,540 --> 00:31:31,640
+Antitoxin تفاعل مع التوكسين وعمل نتراليزيش، فما
+
+449
+00:31:31,640 --> 00:31:34,860
+أثرش التوكسين، فعشان اتصال عندياش نجاتف، وصلت ولا
+
+450
+00:31:34,860 --> 00:31:38,980
+ماوصلت، ال Antibody عمل neutralization للتوكسين
+
+451
+00:31:38,980 --> 00:31:44,070
+وبالتالي لم يستطع التوكسين أن يقوم بأي عمللكن لو
+
+452
+00:31:44,070 --> 00:31:48,290
+صار حمرار معناه لحق التكسين قتل الخلايا أو صار فيه
+
+453
+00:31:48,290 --> 00:31:50,670
+inflammation طب إذا صار فيه inflammation معناه
+
+454
+00:31:50,670 --> 00:31:55,010
+لحقه أنه مافيه antibody طيب الآن باختصار شديد جدا
+
+455
+00:31:55,010 --> 00:31:59,610
+واحد طلع عنده الفحص positive يعني ماعندهوش
+
+456
+00:31:59,610 --> 00:32:04,650
+antibody وفي النوبة بنعطيه vaccine لو ماعطوهش
+
+457
+00:32:04,650 --> 00:32:10,730
+vaccine بنعطيه vaccine لكن واحدطلع عنده الفحص
+
+458
+00:32:10,730 --> 00:32:15,090
+negative، يعني عنده antibody، هل نعطيه vaccine؟
+
+459
+00:32:15,090 --> 00:32:19,870
+لازموش، صح؟ وبتالي هذا الفحص is to evaluate the
+
+460
+00:32:19,870 --> 00:32:23,530
+susceptibility، هل أنت معرض للإصابة ولا غير معرض
+
+461
+00:32:23,530 --> 00:32:27,430
+للإصابة، وصلت صورة مش diagnostic، مش diagnostic
+
+462
+00:32:28,960 --> 00:32:33,500
+يعني بنقدر نقول كمان عبارة أخرى إنه هذا الفحص to
+
+463
+00:32:33,500 --> 00:32:38,520
+check your .. خلّيني أنقول immunity to diphtheria،
+
+464
+00:32:38,520 --> 00:32:41,460
+مامشي الحلقة، مامشي الحق، إنه أنت محاصن ولا غير
+
+465
+00:32:41,460 --> 00:32:42,800
+محاصن للـ diphtheria
+
+466
+00:32:45,290 --> 00:32:49,270
+في انها حاجة اسمها treatment و control، ال control
+
+467
+00:32:49,270 --> 00:32:51,090
+نبدأ في ال control لإن هو ال control الأسهل أنا
+
+468
+00:32:51,090 --> 00:32:53,350
+بتقولكوا لإن treatment مافيش حالات أصلا نعملها
+
+469
+00:32:53,350 --> 00:32:56,710
+treatment غالبا لإن المرض تقريبا zero في فلسطين
+
+470
+00:32:56,710 --> 00:33:01,480
+لإن ال coverage لل vaccine hundred percentعشان
+
+471
+00:33:01,480 --> 00:33:05,800
+hundred percent يعني كل الأطفال في على الأقل في
+
+472
+00:33:05,800 --> 00:33:10,420
+قطاع غزة بيتعرضوا لل DBT اللي احنا عرفنا جزء منه
+
+473
+00:33:10,420 --> 00:33:14,760
+تيتانوس لما دراسنا تيتانوس ال DBT واللي انا متكلم
+
+474
+00:33:14,760 --> 00:33:17,280
+عنه الشق التاني اللي هو ال diphtheria اذا صار عندي
+
+475
+00:33:17,280 --> 00:33:20,840
+diphtheria وصار عندي تيتانوس طلعنا من ال pertosis
+
+476
+00:33:20,840 --> 00:33:24,900
+متكلم عنه لاحقا ان شاء الله اذا ال immunization by
+
+477
+00:33:24,900 --> 00:33:28,360
+the inactivated or atinimated toxin of toxigenic
+
+478
+00:33:28,360 --> 00:33:32,360
+chlorine bacteriumإذا هذا هو ال control الأساسي لل
+
+479
+00:33:32,360 --> 00:33:38,370
+disease بينما ال treatment زي أيground positive X
+
+480
+00:33:38,370 --> 00:33:41,870
+-toxin producer درسناها درسناها كام واحدة احنا
+
+481
+00:33:41,870 --> 00:33:47,330
+Clostridium Tetani و Clostridium Perifringens بنتج
+
+482
+00:33:47,330 --> 00:33:51,930
+تكسين خارجي و درسنا البوتلونيوم لكن البوتلونيوم ما
+
+483
+00:33:51,930 --> 00:33:54,530
+علجنهاش بقى انت بيتك لان مشكلتنا معاها ماكانتش
+
+484
+00:33:54,530 --> 00:33:58,430
+infection كانت مشكلتنا معاها poisoning صح مشكلتنا
+
+485
+00:33:58,430 --> 00:34:02,770
+كانت معاها poisoning بينما ال Clostridium Tetani و
+
+486
+00:34:02,770 --> 00:34:07,410
+Clostridium Perifringens كانت مشكلتنا معاهمانفكشن
+
+487
+00:34:07,410 --> 00:34:12,830
+وبينتج تكسين فاضطرينا نعالجهم شغلتين بـ Antibiotic
+
+488
+00:34:12,830 --> 00:34:16,250
+للقضاء على البكتيريا و بـ Antitoxin to neutralize
+
+489
+00:34:16,250 --> 00:34:20,050
+unbound toxin وهذه النقطة بنكررها في الكورين
+
+490
+00:34:20,050 --> 00:34:23,610
+البكتيريوم دفتيريا إذا عندي الدفتيريا بنستخدم
+
+491
+00:34:23,610 --> 00:34:27,470
+العلاج البنسالين أو الارتروميسين to eradicate the
+
+492
+00:34:27,470 --> 00:34:31,750
+organism and we use antitoxin to neutralize the
+
+493
+00:34:31,750 --> 00:34:38,040
+effect of diphtheria toxinفي اندي ميكروب بيلوثريكس
+
+494
+00:34:38,040 --> 00:34:42,420
+روسيوباتيا مار معانا في احد الميكروبات ال disease
+
+495
+00:34:42,420 --> 00:34:47,920
+اسمه ersepilasArecipillus معناها red skin .. red
+
+496
+00:34:47,920 --> 00:34:52,000
+skin هذا ال disease تبعه اسمه arecipilloid ..
+
+497
+00:34:52,000 --> 00:34:55,280
+arecipilloid دايما احنا .. اذا بتتذكروا بعض
+
+498
+00:34:55,280 --> 00:34:59,720
+المصطلحات metal .. metalloid .. metal الفلزات و ..
+
+499
+00:34:59,720 --> 00:35:03,460
+و .. و metalloid أشبه الفلزات .. toxin toxoid ..
+
+500
+00:35:03,460 --> 00:35:08,780
+طبعا فانا هنا الآنإرسبلس و إرسبلويد يعني شبيه مين
+
+501
+00:35:08,780 --> 00:35:12,400
+الارسبلس برضه هكون ال disease red skin ويمكن هذه
+
+502
+00:35:12,400 --> 00:35:16,420
+الصورة بتوضح لنا إن الإصبع هذا very red هو و
+
+503
+00:35:16,420 --> 00:35:19,720
+المنطقة الحمراء اللي موجودة بقول عموما هو ال
+
+504
+00:35:19,720 --> 00:35:22,920
+disease بتكون من ال three clinical entities واحد
+
+505
+00:35:22,920 --> 00:35:26,300
+إرسبلويد وهو عبارة عن localized يعني localized في
+
+506
+00:35:26,300 --> 00:35:30,180
+منطقة محددةCatanius infection usually on the
+
+507
+00:35:30,180 --> 00:35:33,000
+fingers and the hand.Generalized catanius
+
+508
+00:35:33,000 --> 00:35:35,840
+infection ممكن هذا شكل تاني انه يعطينا بدل ما هو
+
+509
+00:35:35,840 --> 00:35:39,860
+local يعطينا generalized تلاتة اذا المريض غالبا
+
+510
+00:35:39,860 --> 00:35:43,640
+وضعه سيء للغاية من ناحية المناعة ممكن تصل لمرحلة
+
+511
+00:35:43,640 --> 00:35:47,310
+اللي هو septicالبكتيريا اسمها كمان مرة
+
+512
+00:35:47,310 --> 00:35:51,450
+ersepiloxyrosiopathia it is a ground positive but
+
+513
+00:35:51,450 --> 00:35:56,510
+a lie non motile non sport forming facultative
+
+514
+00:35:56,510 --> 00:36:00,800
+anaerobic تتذكروا الدفتير ايش كان وضعها؟كانت
+
+515
+00:36:00,800 --> 00:36:04,480
+aerobic كانت aerobic كانت aerobic و احنا يمكن لو
+
+516
+00:36:04,480 --> 00:36:08,680
+رجعنا برجوها للجدول مأكدناش احنا يعني انغمسنا في
+
+517
+00:36:08,680 --> 00:36:12,420
+انه كيف نميزهم مع بعض لكن غفلنا عن ذكر اللي هو
+
+518
+00:36:12,420 --> 00:36:17,400
+catalase كلهم اذا بتلاحظوا بوستف لإنها اكدنا على
+
+519
+00:36:17,400 --> 00:36:20,240
+الحقيقة ده لإنهم هي aerobic bacteria نرجع برجوها
+
+520
+00:36:20,240 --> 00:36:20,380
+دلوقت
+
+521
+00:36:23,510 --> 00:36:26,470
+فقلت ان انا ايروب كمان مرة نان سبور فورمر نان
+
+522
+00:36:26,470 --> 00:36:30,150
+موتايل و ground positive بس الله specimen and
+
+523
+00:36:30,150 --> 00:36:34,430
+media عرفنا diseases skin localized skin
+
+524
+00:36:34,430 --> 00:36:38,910
+generalized او تسمى تسمى يبجى يا اما skin بيوبس يا
+
+525
+00:36:38,910 --> 00:36:43,530
+اما عيانات blood تمام؟الان بقولنا ان ال culture
+
+526
+00:36:43,530 --> 00:36:47,050
+media بتحتوي على one percent glucose growth and
+
+527
+00:36:47,050 --> 00:36:50,560
+blood أجارة واحد من اتنين بيمشي الحالةGram
+
+528
+00:36:50,560 --> 00:36:52,680
+Staining of the organism from clinical specimen
+
+529
+00:36:52,680 --> 00:36:57,080
+and the growth on blood agar يعني إحنا بقولنا إنه
+
+530
+00:36:57,080 --> 00:36:59,240
+لو .. لو .. لو أحنا أخدنا من ال skin مباشرة و
+
+531
+00:36:59,240 --> 00:37:02,940
+عملنا gram stain أو أخدنا من الطبق اللي زرعنا عليه
+
+532
+00:37:02,940 --> 00:37:05,700
+ال blood agar و عملنا gram stain هذا برضه بيساعدنا
+
+533
+00:37:05,700 --> 00:37:10,100
+في التعرف على البكتيريا كيف إنها gram positive بس
+
+534
+00:37:10,100 --> 00:37:13,560
+الله يقوم و يقولنا في ال skin هذا مؤشر قوي إن
+
+535
+00:37:13,560 --> 00:37:19,260
+البكتيريا هي herciproteric ratio aboveفيه مميزات
+
+536
+00:37:19,260 --> 00:37:23,880
+رائعة لهذه البكتيريا من المميزات الرائعة اللي هي
+
+537
+00:37:23,880 --> 00:37:28,300
+test tube brush appearance in gelatin steps مر
+
+538
+00:37:28,300 --> 00:37:33,940
+معانا بكتيريا بوصف محدد في ال gelatin step
+
+539
+00:37:37,630 --> 00:37:42,170
+Bacillus Bacillus anthracis سمنها inverted bovine
+
+540
+00:37:42,170 --> 00:37:45,830
+زي شررة ال .. ال .. ال .. البعين أو السرق اللي هي
+
+541
+00:37:45,830 --> 00:37:50,030
+المجلوبة هنا اتطلع على ال tube بتلاقي تعرف test
+
+542
+00:37:50,030 --> 00:37:52,810
+tube brush عارفين اللي بنغسل فيها القنابيب كيب
+
+543
+00:37:52,810 --> 00:37:56,890
+بتكون على اطراف فبقولنا الشكل تبعها بيكون عامل زي
+
+544
+00:37:56,890 --> 00:38:01,910
+test tube brush هذا واحد رقم اتنين it produces H2S
+
+545
+00:38:01,910 --> 00:38:04,810
+هذا كمان نقطة مهمةبس مش في الجلاتين .. مش في
+
+546
+00:38:04,810 --> 00:38:10,230
+الجلاتين steps هذا ما تعملها انت الفحص اما triple
+
+547
+00:38:10,230 --> 00:38:16,250
+sugar iron agar او فحص يعني بيكشف عن ال H2S في ال
+
+548
+00:38:16,250 --> 00:38:18,430
+H .. في ال .. في ال triple sugar iron agar بتعمل
+
+549
+00:38:18,430 --> 00:38:21,310
+اللي هو acidification of the slant and butt بت ..
+
+550
+00:38:21,310 --> 00:38:26,830
+يعني بتعمل A على A plus A على A plus الان to
+
+551
+00:38:26,830 --> 00:38:30,370
+differentiate it from the stereo monocyte genes
+
+552
+00:38:30,370 --> 00:38:36,410
+perform the catalase testالاستيريا بنعرفها احنا،
+
+553
+00:38:36,410 --> 00:38:39,490
+بنعرفها و مرت معانا اكتر و مرة حتى وين ما درسناهاش
+
+554
+00:38:39,490 --> 00:38:43,530
+لما ميزناها عن beta-hemolytic streptococci،
+
+555
+00:38:43,530 --> 00:38:46,530
+ميزناها بفحص الكتاليزي، بيقولنا الـ streptococci
+
+556
+00:38:46,530 --> 00:38:50,630
+كتاليزي negative وواجه الشبه بين الـ streptococci
+
+557
+00:38:50,630 --> 00:38:54,310
+و بين الاستيريا، مافيش وجه شبه، هذي كوكساي و هذي
+
+558
+00:38:54,310 --> 00:38:57,530
+بسلاي، فلماذا ميزناهم عن بعض؟ ايش وجه الشبه كان
+
+559
+00:38:57,530 --> 00:39:02,090
+بينهم؟على ال blood لأ على ال blood agar they both
+
+560
+00:39:02,090 --> 00:39:07,210
+produce small colonies surrounded by large zone of
+
+561
+00:39:07,210 --> 00:39:10,210
+beta hemolysis كان ال hemolysis ال characteristic
+
+562
+00:39:10,210 --> 00:39:13,650
+colony على ال blood agar هو اللي خلانا in shock
+
+563
+00:39:13,650 --> 00:39:16,730
+انه هدى listeria او .. او .. او streptococcus
+
+564
+00:39:16,730 --> 00:39:18,930
+pyogenes وبتاع اللي ميزناهم بفحص اللي هو ال
+
+565
+00:39:18,930 --> 00:39:23,630
+catalase ما اقصده من كلامي هذا انه الاصل ان احنا
+
+566
+00:39:23,630 --> 00:39:26,590
+بنعرف ان البكتيريا اللي اسمها listeria هي عبارة عن
+
+567
+00:39:26,590 --> 00:39:30,090
+catalaseبسطة، وبالتالي إذا بدي أقول إن البكتيريا
+
+568
+00:39:30,090 --> 00:39:33,910
+هذي بيميزها عن ال .. ال .. ال .. الerciprolithrix
+
+569
+00:39:33,910 --> 00:39:37,790
+روستيوباتيا فالerciprolithrix هتكون إيش؟ كتاليز
+
+570
+00:39:37,790 --> 00:39:39,990
+نيجاتيف، كتاليز نيجاتيف، طب هي فكولتات في أنا
+
+571
+00:39:39,990 --> 00:39:43,670
+إيروب، طب أنتوا كل .. أنتوا كل .. أنتوا بتعرفوا إن
+
+572
+00:39:43,670 --> 00:39:46,630
+الفكولتات في أنا إيروب ممكن تكون أو معظمها بتكون
+
+573
+00:39:46,630 --> 00:39:50,450
+كتاليز .. كتاليز بسطة، ليش هذي .. هذي .. إيش ممكن
+
+574
+00:39:50,450 --> 00:39:55,130
+ت .. كيف تتحمل ولد الوكسجين هذي؟كيف يتحمل و ..
+
+575
+00:39:55,130 --> 00:39:58,930
+احنا بنعرف ان الكتاليز خلقة في هذه المخلوقات أو
+
+576
+00:39:58,930 --> 00:40:03,510
+وضعة في هذه المخلوقات لمكافحة سمية ال oxygen طب
+
+577
+00:40:03,510 --> 00:40:07,810
+هذه البكتيرا بتنمو في الهواء فكيف لها؟ انتوا عاد
+
+578
+00:40:07,810 --> 00:40:12,290
+.. خلاص بتجفلوا الدماغ على جزئية واحدة انه كتاليز
+
+579
+00:40:12,290 --> 00:40:14,930
+و .. و .. و .. كتاليز و تاني اش اسمه ال super
+
+580
+00:40:14,930 --> 00:40:18,470
+oxide سيموتايز في system تاني يا شباب في system
+
+581
+00:40:18,470 --> 00:40:24,450
+اخر لمكافحة ال oxygen اسمه peroxidasePeroxidase لا
+
+582
+00:40:24,450 --> 00:40:28,210
+ينتج عنه لا ينتج عنه موليكلار أكسجين عشان هي في
+
+583
+00:40:28,210 --> 00:40:31,410
+الفحص نيجاتف للكتاليزة لإنه مابيطلعش عنها bubbles
+
+584
+00:40:31,410 --> 00:40:35,750
+لإنه أصلا البروكسديز مابيطلعش موليكلار أكسجين طيب
+
+585
+00:40:35,750 --> 00:40:40,030
+ال treatment ال penicillin is the drug of choice
+
+586
+00:40:40,030 --> 00:40:44,070
+المرة اللي جاي ان شاء الله بنكمل الموضوع بال
+
+587
+00:40:44,070 --> 00:40:45,490
+stereo mono cytogenes
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/5w4owWd7qLs_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/5w4owWd7qLs_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..8b2d5c0ac463865d80107541d71a1d7d090c3a7d
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/5w4owWd7qLs_postprocess.srt
@@ -0,0 +1,1860 @@
+1
+00:00:21,080 --> 00:00:23,840
+بسم الله الرحمن الرحيم اليوم موضوعنا ان شاء الله
+
+2
+00:00:23,840 --> 00:00:28,300
+Francisella tolerances بس قبل ما نبدأ بالموضوع
+
+3
+00:00:28,300 --> 00:00:32,800
+بدنا نأكد على مجموعة من الحقائق اللي بدأنا فيها في
+
+4
+00:00:32,800 --> 00:00:36,920
+أول الفصل على أساس انه نبرر لماذا فصلنا هذه
+
+5
+00:00:36,920 --> 00:00:40,160
+المجموعة او هذه البكتيريا عن مجموعات الأصل انها
+
+6
+00:00:40,160 --> 00:00:44,400
+تلحق بيهااحنا لما درسنا المجموعات درسناها بناء على
+
+7
+00:00:44,400 --> 00:00:47,940
+شغل تان الشغل الأولى ال gram stain هل هي gram
+
+8
+00:00:47,940 --> 00:00:50,020
+positive و gram negative و هل هي بس الله و لا
+
+9
+00:00:50,020 --> 00:00:53,040
+كوكساية و قسمناها من أربع مجموعات و الصحيح أننا
+
+10
+00:00:53,040 --> 00:00:56,220
+المفروض أنه انتهينا من ال gram negative بس الله و
+
+11
+00:00:56,220 --> 00:01:00,660
+انتهينا من كل المجموعات و بدأنا بمناقشة مجموعة ال
+
+12
+00:01:00,660 --> 00:01:03,100
+mycobacteria اللي مالاش علاقة خالص بال gram stain
+
+13
+00:01:03,100 --> 00:01:07,360
+ال acid fast bacteria لماذا عودنا اليوم لنتحدث عن
+
+14
+00:01:07,360 --> 00:01:10,140
+Francilla tolerances وهي gram negative بس الله
+
+15
+00:01:11,870 --> 00:01:16,430
+المجموع اللى هتحدث عنها اليوم لفرانسيسيلا وغدا او
+
+16
+00:01:16,430 --> 00:01:19,850
+المحاضرة القادمة ان شاء الله هيكون عن الهموفلس و
+
+17
+00:01:19,850 --> 00:01:23,990
+بعديها عن لبروسيلا هدولة التلت مجموعات او تلت
+
+18
+00:01:23,990 --> 00:01:27,490
+اسماء هي عبارة عن gram negative بس ال lie لكن
+
+19
+00:01:27,490 --> 00:01:30,970
+لماذا فصلناهم عن المجموعة الاولانية اكيد فيهم
+
+20
+00:01:30,970 --> 00:01:34,590
+خصوصية ايه الخصوصية دى انهم التلت مجموعات are
+
+21
+00:01:34,590 --> 00:01:38,640
+fastidiousيعني إليهم طلبات غذائية they are slow
+
+22
+00:01:38,640 --> 00:01:42,720
+growing bacteria البعض منهم بده يومين أو أربع أيام
+
+23
+00:01:42,720 --> 00:01:46,200
+البعض الآخر بده ستة أسابيع يا شباب البروسيلا بده
+
+24
+00:01:46,200 --> 00:01:49,000
+ستة أسابيع فخديني أتعرف اليوم ان شاء الله على أول
+
+25
+00:01:49,000 --> 00:01:52,140
+مايكروب في السلسلة من ثلاث مايكروبات كمان مرة
+
+26
+00:01:52,140 --> 00:01:56,200
+فرنسسيلا هيموفلاس وفي عندنا اللي هو البروسيلا
+
+27
+00:01:58,360 --> 00:02:02,640
+البكتيريا عبارة عن gram-bacilli لكن بتظهر لنا
+
+28
+00:02:02,640 --> 00:02:06,480
+أشكال و ألوان مختلفة يعني بمعنى أخر قد تتخذ شكل
+
+29
+00:02:06,480 --> 00:02:11,080
+cocoa bacilli و قد تصل بيها يعني إلى شكل كوكساي
+
+30
+00:02:11,080 --> 00:02:14,170
+كامة الاستدارة روحنا نشوف صورة كامة شويةإن
+
+31
+00:02:14,170 --> 00:02:17,550
+البكتيريا بالفعل ماخدة بيزار forms أشكال غريبة
+
+32
+00:02:17,550 --> 00:02:21,070
+ومتنوعة البكتيريا هو إيه إجبارية؟ هي كان ميكروبيا
+
+33
+00:02:21,070 --> 00:02:25,570
+عرفته إجباري لحد اليوم Sodomonas aeruginosa أخدتوا
+
+34
+00:02:25,570 --> 00:02:28,810
+ال mycobacterium tuberculosis، هذي obligate وهي
+
+35
+00:02:28,810 --> 00:02:32,050
+كمان اللي هي strict aerobic اللي هي لـFrancis Hill
+
+36
+00:02:33,430 --> 00:02:39,010
+البكتيريا نعم البصيلاس كان منها aerobic ومنها
+
+37
+00:02:39,010 --> 00:02:43,030
+facultative انا aerobic البكتيريا requires
+
+38
+00:02:43,030 --> 00:02:46,510
+enriched medium وهذا كلام تأكيد على ما ذكرناه في
+
+39
+00:02:46,510 --> 00:02:50,650
+بداية المحاضرة ان هي fastidious تحتاج إلى وسط
+
+40
+00:02:50,650 --> 00:02:54,950
+blood agar محتوى على cysteine زائد جلوكوز ولذلك
+
+41
+00:02:54,950 --> 00:02:59,030
+سمي الوسط cysteine glucose blood agar او CGPA
+
+42
+00:03:00,120 --> 00:03:04,200
+البكتيريا non-motile تستطيع البكتيريا البقاء حية
+
+43
+00:03:04,200 --> 00:03:09,160
+في ال environment وحنشوف أكتر مصدر للبكتيريا اللي
+
+44
+00:03:09,160 --> 00:03:12,960
+هو ال natural water و ال soils highly infectious
+
+45
+00:03:12,960 --> 00:03:18,180
+إذا كنا بنتعامل مع عينة أو مع culture أو مع حيوان
+
+46
+00:03:18,180 --> 00:03:21,980
+حتى مصاب أو إنسان مصاب بالتلوريميا الأصل أنه احنا
+
+47
+00:03:21,980 --> 00:03:26,800
+نكون very cautious لإنه البكتيريا highly
+
+48
+00:03:26,800 --> 00:03:27,520
+infectious
+
+49
+00:03:30,600 --> 00:03:33,440
+هذه الصورة اللي حكيتلكوا عنها انه قدامنا gram
+
+50
+00:03:33,440 --> 00:03:36,760
+stain غالبا في ال gram stain بنشوف حاجة واضحة اما
+
+51
+00:03:36,760 --> 00:03:39,700
+بصلاي او كوكساي لكن في هذه الصورة الحقيقة انه ما
+
+52
+00:03:39,700 --> 00:03:43,880
+بنشوف حاجة واضحة نعم لكن شايفين لون احمر يعني مؤشر
+
+53
+00:03:43,880 --> 00:03:47,700
+على انه gram negative بكتير ال size دي بقى نوعا ما
+
+54
+00:03:47,700 --> 00:03:52,500
+small ال clinical manifestation او ال disease اللي
+
+55
+00:03:52,500 --> 00:03:55,600
+caused by this organism بيعتمد على تلت عناصر مهمة
+
+56
+00:03:55,600 --> 00:04:01,080
+جدا رقم واحدRoot of infection من وين دخل الميكروب
+
+57
+00:04:01,080 --> 00:04:04,200
+وحنشوف الآن مجموعة من ال roots المختلفة اللى ممكن
+
+58
+00:04:04,200 --> 00:04:08,120
+ننتقل من خلالها هذا الميكروب رقم اتنين ال
+
+59
+00:04:08,120 --> 00:04:12,380
+infecting dose مجدش عدد البكتيريا اللى دخل الى هذا
+
+60
+00:04:12,380 --> 00:04:16,410
+المكان رقم تلاتةtype of organism هو كم type يعني
+
+61
+00:04:16,410 --> 00:04:19,810
+احنا هي اسم البكتيريا الفرنسية tolerances لكن في
+
+62
+00:04:19,810 --> 00:04:23,970
+منها subspecies subspecies type A وtype B either
+
+63
+00:04:23,970 --> 00:04:27,750
+from A and B وبيختلفوا عن بعض الحقيقة في ال
+
+64
+00:04:27,750 --> 00:04:31,510
+virulence فtype A is more virulent type B غالبا
+
+65
+00:04:31,510 --> 00:04:34,310
+تنتجلي ما يسمى subclinical infection ايش يعني
+
+66
+00:04:34,310 --> 00:04:38,810
+subclinical يعني الأعراض تبع المرض بتكون غير ظاهرة
+
+67
+00:04:38,810 --> 00:04:43,800
+بنسميها mild أو subclinical infectionأيضا اتفقنا
+
+68
+00:04:43,800 --> 00:04:46,760
+على انه فيه تلت عناصر بيحددوا مصار ال clinical
+
+69
+00:04:46,760 --> 00:04:51,060
+manifestation مكان دخول البكتيريا ال infecting
+
+70
+00:04:51,060 --> 00:04:55,200
+dose نفسها تلاتة نوع البكتيريا هل هي من type A و
+
+71
+00:04:55,200 --> 00:05:00,020
+لا type B الان كيف ينتقل المرض للإنسان يعني
+
+72
+00:05:00,020 --> 00:05:04,080
+البكتيريا كيف مسارات الانتقال تبعتها بقولنا either
+
+73
+00:05:04,080 --> 00:05:06,980
+through the skin or the mucous membrane كلكم
+
+74
+00:05:06,980 --> 00:05:11,610
+بتعرفوا ان ال skinالـ normal skin is impenetrable
+
+75
+00:05:11,610 --> 00:05:14,650
+by microorganism البكتيريا بيكون غير قادرة على
+
+76
+00:05:14,650 --> 00:05:19,890
+اختلاقه، لكن خلال جروح، خدوش، حبوب أصلا موجودة قد
+
+77
+00:05:19,890 --> 00:05:26,750
+ينتقل من الجلد، بتكلم عن broken skin محروج، مجروح،
+
+78
+00:05:26,750 --> 00:05:30,330
+مخدوش، في آفة، في infection أساسي، مصدرها غير
+
+79
+00:05:30,330 --> 00:05:34,570
+البكتيريا اللي بتكلم عنها، كلها قد تؤهل لدخول
+
+80
+00:05:34,570 --> 00:05:38,860
+البكتيريا رقم اتنين لـ mucous membraneماذا يوجد في
+
+81
+00:05:38,860 --> 00:05:43,780
+ميوكاس من برينج الظاهر لنا؟ ال conjunctiva تبقى
+
+82
+00:05:43,780 --> 00:05:44,100
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+83
+00:05:44,100 --> 00:05:46,380
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+84
+00:05:46,380 --> 00:05:47,300
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+85
+00:05:47,300 --> 00:05:47,520
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+86
+00:05:47,520 --> 00:05:51,680
+تبقى تبقى تبقى تبقى
+
+87
+00:05:51,680 --> 00:06:00,500
+تبقى تبقى تبقى تبقىلأنه .. لأنه .. كمان مرة أذكركم
+
+88
+00:06:00,500 --> 00:06:03,320
+بالحقيقة اللي احنا ميرانا و اتكرانا اللي بنقول أنه
+
+89
+00:06:03,320 --> 00:06:07,440
+الأصابع هي الأداة الأكتر استخداما على وجه الأرض من
+
+90
+00:06:07,440 --> 00:06:11,480
+قبل البشر بنستخدمها في كل حاجة حتى لما بنطبع و
+
+91
+00:06:11,480 --> 00:06:14,520
+بنقول أنها حاسيب حتى لما بنمسك ال mouse حتى لو
+
+92
+00:06:14,520 --> 00:06:18,520
+كانت ال wireless ال mouse بنستخدم الأصابع تبعتنا
+
+93
+00:06:18,520 --> 00:06:22,260
+بندفع فلوس، بناخد فلوس، أكم واحد مسكها، بنسلم عن
+
+94
+00:06:22,260 --> 00:06:26,780
+ناس، بنمسك أسطح، وبالتاليطالما هي الأداة الأكثر
+
+95
+00:06:26,780 --> 00:06:30,120
+استخداما يبقى هي الأداة الأكثر أوضر التلوث ومدام
+
+96
+00:06:30,120 --> 00:06:32,840
+هي الأكثر أوضر التلوث يبقى هي برضه كمان من الأدوات
+
+97
+00:06:32,840 --> 00:06:36,400
+المهمة جدا في نقل العدوى من الأشياء اللي احنا
+
+98
+00:06:36,400 --> 00:06:40,080
+بنركز عليها الـ mucous membrane بنقولك انه ال
+
+99
+00:06:40,080 --> 00:06:44,060
+influenza قد تنتقل مش respiratory عبر ال
+
+100
+00:06:44,060 --> 00:06:46,500
+conjunctiva يعني لو انت لمست أسطح عليها فيروس
+
+101
+00:06:46,500 --> 00:06:50,200
+influenza وحكيت عينك ووصلت الأصابع ل ال
+
+102
+00:06:50,200 --> 00:06:53,180
+conjunctiva ممكن تنتقل ال influenza و الرشح وأمراض
+
+103
+00:06:53,180 --> 00:06:57,510
+كثيرة جداالميوكاس ميمبراين أخدنا مثال عليها مين
+
+104
+00:06:57,510 --> 00:07:01,530
+including the conjunctiva through the bite of
+
+105
+00:07:01,530 --> 00:07:05,270
+infective ticks تكس اللي هم القراد حشرة من الحشرات
+
+106
+00:07:05,270 --> 00:07:08,450
+اللي بيسموها blood sucking arthropods يعني بتتغذع
+
+107
+00:07:08,450 --> 00:07:12,590
+الحيوانات أو بتتغذع الإنسان بتاخد منه وشبة دم إذا
+
+108
+00:07:12,590 --> 00:07:15,950
+في عندي skin في عندي ميوكاس ميمبراين في عندي blood
+
+109
+00:07:15,950 --> 00:07:20,100
+sucking arthropods في كمان لسهtransmission may
+
+110
+00:07:20,100 --> 00:07:24,220
+also occur through the respiratory tract كيف؟ عن
+
+111
+00:07:24,220 --> 00:07:28,520
+طريق ال inhalation ل aerosols .. aerosols اللي هم
+
+112
+00:07:28,520 --> 00:07:30,940
+الرذاذ المحتوي على الميكروب
+
+113
+00:07:34,980 --> 00:07:39,380
+اللوحة السابقة قلنا ان ال bacteria can survive for
+
+114
+00:07:39,380 --> 00:07:43,100
+long periods في ال environment و من ضمن ال
+
+115
+00:07:43,100 --> 00:07:46,460
+environment اللي هو ال water و ال water الأساسي
+
+116
+00:07:46,460 --> 00:07:49,420
+اللي ناقل مش ال ground water ال surface water
+
+117
+00:07:49,980 --> 00:07:52,220
+عارفينش ما هي surface water؟ اللي هي ال .. ال ..
+
+118
+00:07:52,220 --> 00:07:55,100
+ال .. الوديان و الأنهار و ال .. يعني المجاري
+
+119
+00:07:55,100 --> 00:07:58,660
+المائية، المجاري المائية لما يكون في مجرة مائي و
+
+120
+00:07:58,660 --> 00:08:02,820
+بينزل منحدر كيف الماء بيسقط؟ مش بيسقط بشكل شلال و
+
+121
+00:08:02,820 --> 00:08:06,340
+بيعملنا إيه؟ رذاذ فلو كان الماء هذا محتوى على
+
+122
+00:08:06,340 --> 00:08:10,600
+الميكروب و عمل رذاذ قد الناس تنشق و احنا و نصاب
+
+123
+00:08:10,600 --> 00:08:14,850
+بال disease رقم اتنينthrough the gastrointestinal
+
+124
+00:08:14,850 --> 00:08:20,370
+tract، يعني الإنسان بدى يتناول لحوم لحيوانات
+
+125
+00:08:20,370 --> 00:08:23,970
+مصابة، هذه اللحوم لم تكن مطهية بشكل جيد، و أنا
+
+126
+00:08:23,970 --> 00:08:28,670
+قلتلكوا إنه قد نقوم بشوي بعض اللحوم ولا تصل
+
+127
+00:08:28,670 --> 00:08:32,610
+الحرارة إلى داخلها بشكل جيد لقتل ال micro organism
+
+128
+00:08:33,220 --> 00:08:37,860
+أنا نسيت أحكي شغل أنه Toleremia هو ال disease اللي
+
+129
+00:08:37,860 --> 00:08:40,760
+بتسببه in France ال tolerances أو rabbit fever
+
+130
+00:08:40,760 --> 00:08:45,360
+حُمّى الأرانب مين فيكوا عمره شاف أرنب بري أو مسك
+
+131
+00:08:45,360 --> 00:08:53,200
+أرنب بري؟ كيف مخالبه؟ ولا مايله مخالب؟ بيكون مجزج
+
+132
+00:08:53,200 --> 00:08:57,820
+أضافر وجهي على ال .. أه؟ الأرنب البري عشانه بري
+
+133
+00:08:58,820 --> 00:09:01,940
+غالباً لما بيجيوا في الشبكة و بيصيدوا بالشبك هم في
+
+134
+00:09:01,940 --> 00:09:06,660
+غزة انا بيصيدوا بالشبك اللي بيجيه بيخلصه بيحاول هو
+
+135
+00:09:06,660 --> 00:09:12,010
+انه يتملص فبمحاولة ممكن يخدشفإذا كان الأرنب هذا
+
+136
+00:09:12,010 --> 00:09:16,210
+مصاب بالتلوريميا أو حامل التلوريميا ممكن ينقل ال
+
+137
+00:09:16,210 --> 00:09:21,150
+disease أو لما نذبح الأرنب و ننظفه تمام؟ إذا كان
+
+138
+00:09:21,150 --> 00:09:24,410
+برضه مصاب و عندنا جروحة احنا و احنا بننظف فيه لذلك
+
+139
+00:09:24,410 --> 00:09:28,450
+أكتر ناس بيصابوا بالتلوريميا هم الناس اللي بتعامله
+
+140
+00:09:28,450 --> 00:09:32,430
+مع الحيوانات المصابة بيسموهم ال carcasses الذبائح
+
+141
+00:09:32,430 --> 00:09:37,920
+الذبيحة carcassإذا في عندي هنالان انا مجموعة من
+
+142
+00:09:37,920 --> 00:09:42,200
+الطرق اللي من خلالها بيتم انتقال البكتيريا عشان
+
+143
+00:09:42,200 --> 00:09:45,960
+اتجهنا دروت of infection مهمة اتجهنا انه قد تنتقل
+
+144
+00:09:45,960 --> 00:09:49,900
+عن طريق ال skin قد تنتقل عن طريق ال ال membrane ال
+
+145
+00:09:49,900 --> 00:09:52,920
+ميوكاسب قد تنتقل عن طريق ال blood sucking earth
+
+146
+00:09:52,920 --> 00:09:56,120
+robot قد تنتقل عن طريق ال respiratory route قد
+
+147
+00:09:56,120 --> 00:10:00,880
+تنتقل عن طريق ال ingestion او تناول اللي هو ال
+
+148
+00:10:00,880 --> 00:10:05,150
+meat of infected animalالان نبدأ للأشكال تبع ال
+
+149
+00:10:05,150 --> 00:10:09,710
+disease بننظر للروحة رقم أو الاسم الأول والتاني
+
+150
+00:10:09,710 --> 00:10:15,370
+نفس النظرة فان دي هاسمة ulceroglandular والتانية
+
+151
+00:10:15,370 --> 00:10:20,290
+oculoglandular الان ال ulceroglandular هو skin
+
+152
+00:10:20,290 --> 00:10:26,150
+والتاني eye لان ocular معناها eyeالاتنين نفس ال
+
+153
+00:10:26,150 --> 00:10:30,130
+disease لكن مكانين مختلفين واحد في الجلد واحد في
+
+154
+00:10:30,130 --> 00:10:35,850
+العين ليش في العين لأننا كنا contaminated fingers
+
+155
+00:10:35,850 --> 00:10:39,970
+الأولاني هو ال most common form of all tularemia
+
+156
+00:10:39,970 --> 00:10:43,930
+أكتر شكل منتشر وشائع من الناس اللي هو ال
+
+157
+00:10:43,930 --> 00:10:49,370
+ulceroglandial وإيش شكله بينتج بينتج لما يسمى ب
+
+158
+00:10:49,370 --> 00:10:56,100
+slowly healing ulcer يعني تقرح أو قرحةالشفاء تبعها
+
+159
+00:10:56,100 --> 00:11:00,880
+بيتم ببطء شديد جدا كمان شغل تاني مهم جدا ان ال
+
+160
+00:11:00,880 --> 00:11:03,880
+lymph node اللي في المنطقة بيصير لها inflammation
+
+161
+00:11:03,880 --> 00:11:07,820
+وقد ترتفع يعني مثلا لو كانت في المنطقة هذه المنطقة
+
+162
+00:11:07,820 --> 00:11:12,040
+دي هسير فيها ايه انتفاخ بتذكرنا بمين باليارسينيا
+
+163
+00:11:12,040 --> 00:11:16,440
+بيستس لما عملت الببو لإن وجهنا اللي لها ال ال ال
+
+164
+00:11:16,440 --> 00:11:19,140
+ال ال ال regional lymph node بيصير لها
+
+165
+00:11:19,140 --> 00:11:23,520
+inflammation وبالتالي بيصير فيها انتفاخ و بتبيننفس
+
+166
+00:11:23,520 --> 00:11:25,900
+الفكرة زى ما حكينا هدا قولنا لكوا ممكن نتقل عن
+
+167
+00:11:25,900 --> 00:11:28,180
+طريق اللى هو الجروح أو عن طريق ال blood sucking
+
+168
+00:11:28,180 --> 00:11:31,800
+earth robots زى ال ticks and flies flies اللى هى
+
+169
+00:11:31,800 --> 00:11:36,950
+الذبابOculoglandular حكيناه كنا نفس الفكرة لكن
+
+170
+00:11:36,950 --> 00:11:38,990
+بصيب العين وعن طريق اللي هو ال contaminated
+
+171
+00:11:38,990 --> 00:11:41,990
+fingers الشكل التالت اللي هو البلموناري or
+
+172
+00:11:41,990 --> 00:11:47,130
+pneumonic وهو شكل من أشكال الخطيرة لل disease صحيح
+
+173
+00:11:47,130 --> 00:11:52,650
+أقل انتشارا أقل انتشارا لكن هو شكل خطير وبينتقل
+
+174
+00:11:52,650 --> 00:11:57,970
+عبر الرذاذ تبع اللي هو المياه اللي infected with
+
+175
+00:11:57,970 --> 00:12:02,440
+this organismالاخير أو الشكل الأخير له تايفايدل
+
+176
+00:12:02,440 --> 00:12:06,220
+تايفايدل طبعا أكيد سمنها تايفايدل على غرار تايفايد
+
+177
+00:12:06,220 --> 00:12:09,660
+ليش لأن هو اللي بينتج عن تناول و أظن التايفايدل
+
+178
+00:12:09,660 --> 00:12:12,680
+كنا نقول ingestion of salmonella إذا بنتج عن تناول
+
+179
+00:12:12,680 --> 00:12:16,200
+اللي هو ال contaminated food symptoms begins as a
+
+180
+00:12:16,200 --> 00:12:18,240
+flu-like associated with vomiting flu-like كنا
+
+181
+00:12:18,240 --> 00:12:21,060
+قلنا زي ال influenza بعدين بيصاحبها اللي هو ال
+
+182
+00:12:21,060 --> 00:12:25,140
+vomiting headache, fever, prostration وممكن دياريا
+
+183
+00:12:25,140 --> 00:12:28,720
+could accompany these symptoms يعني بيصير في الآخر
+
+184
+00:12:28,720 --> 00:12:33,260
+كمان برضه السرإذا كم شكل من الأشكال سارانا؟ أربع
+
+185
+00:12:33,260 --> 00:12:37,960
+نعدهم كمان مرة أوكيلوغلانديلر أولسيروغلانديلر أفضل
+
+186
+00:12:37,960 --> 00:12:40,040
+أولسيروغلانديلر بالأول لأن هو ال most common
+
+187
+00:12:40,040 --> 00:12:43,880
+أوكيلوغلانديلر بلموناري أو ال pneumonia و الرابع
+
+188
+00:12:43,880 --> 00:12:46,980
+اللي هو الtyphoidal أو ال gastrointestinal أو ال
+
+189
+00:12:46,980 --> 00:12:50,920
+oropharyngeal typeذاكرنا احنا في بداية المحاضرة
+
+190
+00:12:50,920 --> 00:12:53,800
+انه في صنثين type A و type B كيف نميز بين التاني
+
+191
+00:12:53,800 --> 00:13:02,080
+فرنسية لورنسا type A و فرنسية لورنسا type B بقولنا
+
+192
+00:13:02,080 --> 00:13:06,840
+الاولى is more virulent thanthe second والدليل على
+
+193
+00:13:06,840 --> 00:13:10,920
+ذلك انه ال mortality rate او ال fatality rate قد
+
+194
+00:13:10,920 --> 00:13:15,480
+تصل الى خمسة لسبعة في المية اذا لم يعالج المرضى
+
+195
+00:13:15,480 --> 00:13:18,940
+لكن لو طلعنا على الجزء السفلي هنا في المحاضرة او
+
+196
+00:13:18,940 --> 00:13:24,520
+في الشريحة هلاجي انه البكتيريا بتسبب ما يسمى mild
+
+197
+00:13:24,520 --> 00:13:28,220
+او subclinical infection يبتدى مافيش انها fatality
+
+198
+00:13:28,220 --> 00:13:33,870
+rate لكن تعالوا نطلع على حاجة مميزةيسمى هذا النوع
+
+199
+00:13:33,870 --> 00:13:39,650
+اسم آخر غير type A تك دير فلاي شيب type ليش سموه
+
+200
+00:13:39,650 --> 00:13:43,490
+.. او هذا ال tick عبارة عن حشرة و ال deer fly برضه
+
+201
+00:13:43,490 --> 00:13:46,550
+عبارة عن حشرة و ال sheep ليها الخرافة ليش سموه
+
+202
+00:13:46,550 --> 00:13:50,250
+بهذا الاسم لأنه في ال nature it cycles between
+
+203
+00:13:50,250 --> 00:13:54,490
+these creatures بين هذه المخلوقات من ال tick لل
+
+204
+00:13:54,490 --> 00:13:58,570
+sheep من ال deer fly لل sheep وبالتالي هي ال cycle
+
+205
+00:13:58,570 --> 00:14:03,100
+تبعته بالاضافة لل environmentلكن type B إيه الاسم
+
+206
+00:14:03,100 --> 00:14:07,220
+تاني؟ بيفر؟ ماعرفش بتعرفوش يعني بيفر ولا بتعرفوش
+
+207
+00:14:07,220 --> 00:14:12,020
+بيفر معناها بالعرب القندس والقندس عبارة عن حيوان
+
+208
+00:14:12,020 --> 00:14:18,280
+مائي كبير نوعا ما بهذا الحجم ويطلق عليه لقب مهندس
+
+209
+00:14:18,280 --> 00:14:25,260
+المياه ليش بيسموه مهندس المياه؟بسوي جسور بالأحرى
+
+210
+00:14:25,260 --> 00:14:31,100
+جسور عشان يعيش فيها لما يعني يخرج من الماء و عنده
+
+211
+00:14:31,100 --> 00:14:35,660
+مهارة كبيرة في قطع النباتات وتحويلها لجسور
+
+212
+00:14:35,660 --> 00:14:41,040
+الموسكرات الموسكرات هذا بسموه جرذ المسك او فقر
+
+213
+00:14:41,040 --> 00:14:45,340
+المسك ايضا حيوان مائي لاحظ حيوان مائي و حيوان مائي
+
+214
+00:14:45,340 --> 00:14:52,180
+واش كمان قلنا في الآخر كمان waterبيفر وموسكرة يبقى
+
+215
+00:14:52,180 --> 00:14:55,960
+ال micro organism يلف في البيئة بين البيفر
+
+216
+00:14:55,960 --> 00:15:01,970
+والموسكرة ومين و ال water وبالتالي هذا ال type Bزي
+
+217
+00:15:01,970 --> 00:15:05,890
+ما حكينا it produces mild infection او subclinical
+
+218
+00:15:05,890 --> 00:15:08,970
+infection الان لو انا في يوم من الأيام و انا
+
+219
+00:15:08,970 --> 00:15:12,370
+استبعد ان يكون هنا في فلسطين اصلا فرنسية لا
+
+220
+00:15:12,370 --> 00:15:16,470
+tolerances ليش باستبعد؟ لا الموسكرات موجود ولا ال
+
+221
+00:15:16,470 --> 00:15:19,630
+beaver موجود ولا ال surface water موجود احنا we
+
+222
+00:15:19,630 --> 00:15:23,310
+totally dependent على مين؟ على اللي هو ال ground
+
+223
+00:15:23,310 --> 00:15:27,190
+water بالمناسبة مرة من المرات ابصر كيف ايجي عندنا
+
+224
+00:15:27,190 --> 00:15:30,090
+beaver على غزة هنا ايجي ال beaver هنا و صدوا على
+
+225
+00:15:30,090 --> 00:15:33,280
+طول و جابونيه على الجامعةهنطول الشباب في الأحياء
+
+226
+00:15:33,280 --> 00:15:39,400
+بس بتاعي راح مع القصف طيب to differentiate between
+
+227
+00:15:39,400 --> 00:15:43,520
+type A and type B فى فحص بسيط جدا احنا مش فاكرين
+
+228
+00:15:43,520 --> 00:15:48,170
+ان احنا خدنا 16 glucose blood agar تمام؟بنجيب واحد
+
+229
+00:15:48,170 --> 00:15:51,690
+في المية glycerol وبنضيفه على الوسط وبنضيف
+
+230
+00:15:51,690 --> 00:15:56,530
+بالاضافة لل glycerol اللي هو bromethymol blue
+
+231
+00:15:56,530 --> 00:15:59,870
+indicator مارمع على ال bromethymol blue indicators
+
+232
+00:15:59,870 --> 00:16:05,110
+في ال test في ال TCBS في ال TCBS اذكركوا بس باللون
+
+233
+00:16:05,110 --> 00:16:10,640
+تبعهكان على ال neutral أو nearly alkaline بيكون أو
+
+234
+00:16:10,640 --> 00:16:13,900
+slightly alkaline بيكون أخضر على alkaline عالي
+
+235
+00:16:13,900 --> 00:16:18,980
+أزرق على acid بيكون لونه أصفر في ال TCBS لما عملنا
+
+236
+00:16:18,980 --> 00:16:22,380
+fermentation للستاكروز حوله للون أصفر في ال
+
+237
+00:16:22,380 --> 00:16:26,690
+citrate test لما اتحولإلى ال alkaline تحول لللون
+
+238
+00:16:26,690 --> 00:16:31,070
+اللي هو الأزرق إذا بتوقع إذا البكتيريا بتعمل
+
+239
+00:16:31,070 --> 00:16:34,970
+fermentation للجليسرول أو utilization للجليسرول و
+
+240
+00:16:34,970 --> 00:16:39,290
+بتنتج منه acid انه يتحول لللون الأصفر فيندي type A
+
+241
+00:16:39,290 --> 00:16:44,030
+و type B type A بيعمل utilization للجليسرول و
+
+242
+00:16:44,030 --> 00:16:48,910
+بيحولوا لللون الأصفر بينما type B بيضل عنده زي ما
+
+243
+00:16:48,910 --> 00:16:51,910
+هو dark blue أو بتحول إلى alkaline
+
+244
+00:16:55,790 --> 00:16:59,610
+شوفنا صحيح أشكال متنوعة من ال disease سواء كان في
+
+245
+00:16:59,610 --> 00:17:03,750
+الإنسان أو في الحيوان فما هي ال specimens اللي
+
+246
+00:17:03,750 --> 00:17:08,970
+احنا ممكن نحصل عليها من هذا ال microbe exudates
+
+247
+00:17:08,970 --> 00:17:11,710
+from catanase or mycosal ulcers or lymph node
+
+248
+00:17:11,710 --> 00:17:14,970
+aspirate اعتقد انه احنا درسنا في الورسينية انه
+
+249
+00:17:14,970 --> 00:17:19,290
+بناخد aspirate من الببواللي هو العيش اللي ببقى و
+
+250
+00:17:19,290 --> 00:17:22,890
+كنا، inflamed lymph nodes، مظبوط ولا لأ؟ وبالتالي
+
+251
+00:17:22,890 --> 00:17:27,230
+ممكن ناخد احنا lymph node، aspirate أو ناخد swaps
+
+252
+00:17:27,230 --> 00:17:30,410
+إذا كان فيه exudates، exudates يعني إفرازات،
+
+253
+00:17:30,410 --> 00:17:33,930
+إفرازات صدرية مثلا من الكتانس أو الـmyocosal
+
+254
+00:17:33,930 --> 00:17:40,160
+ulcersممكن ناخد blood or sputum for pulmonary
+
+255
+00:17:40,160 --> 00:17:45,800
+infection لحظة لما قلنا pulmonary أخدنا واحدة من
+
+256
+00:17:45,800 --> 00:17:49,000
+التنتين او التنتين blood or sputum ده ليه علاش
+
+257
+00:17:49,000 --> 00:17:52,860
+علشان في ال pulmonary infection فيه septicemia
+
+258
+00:17:53,380 --> 00:17:57,580
+بيكون فيه septicemia و لا كيف .. كيف العينة
+
+259
+00:17:57,580 --> 00:18:01,340
+المعبرة عن ال pneumonia هي ال sputum و ليس ال
+
+260
+00:18:01,340 --> 00:18:05,080
+blood لكن لأنه always associated with septicemia
+
+261
+00:18:05,080 --> 00:18:09,240
+فممكن نعبر عنها برضه بعينة من؟ بعينة blood ممكن
+
+262
+00:18:09,240 --> 00:18:12,360
+ناخد عينة blood for serology نكشف عن ال antibody
+
+263
+00:18:12,360 --> 00:18:14,880
+هل في عنده antibody للمريض و ليه ماعندهوش antibody
+
+264
+00:18:14,880 --> 00:18:19,660
+رقم أربعة specimens زي ال biopsy from enlarged
+
+265
+00:18:19,660 --> 00:18:23,040
+liver or spleen كمان برضه هذه ممكن تكون عينة
+
+266
+00:18:24,550 --> 00:18:27,390
+diagnostic procedures أول حاجة بنتكلم عن ال gram
+
+267
+00:18:27,390 --> 00:18:30,810
+أو ال microscopic appearance البكتيريا عبارة عن ال
+
+268
+00:18:30,810 --> 00:18:35,450
+gram ال negative non motile bacilli وحكينا عن ال
+
+269
+00:18:35,450 --> 00:18:39,530
+size تبعها إنها small و can assume different
+
+270
+00:18:39,530 --> 00:18:43,010
+shapes منها coco bacilli أو كوكساي و can assume
+
+271
+00:18:43,010 --> 00:18:48,170
+شكل كتير مهم جدا اللي هو زي ال yersinia bestis و
+
+272
+00:18:48,170 --> 00:18:52,200
+كيف ال yersinia bestis كان شكلها؟Cocopasol-I باي
+
+273
+00:18:52,200 --> 00:18:56,760
+بولارلي ستيند هي تالت مايكروب نعرفه باي بولارلي
+
+274
+00:18:56,760 --> 00:19:00,840
+ستيند مين هو التلاتة؟ اليرسينيا والبستوريلا وهي
+
+275
+00:19:00,840 --> 00:19:05,040
+هذه البكتيريا البستوريلا ما درسناش بعد لكن مرة ما
+
+276
+00:19:05,040 --> 00:19:09,700
+اتكلمنا عن اليرسينيازي ما حكينا morphologically
+
+277
+00:19:09,700 --> 00:19:12,380
+maybe similar to your senior spaces and shows
+
+278
+00:19:12,380 --> 00:19:15,920
+bipolar reaction cultural characteristics هذه
+
+279
+00:19:15,920 --> 00:19:18,960
+النقطة المحورية والمفصلية اللي لازم احنا نفهمها
+
+280
+00:19:18,960 --> 00:19:22,860
+كويس البكتيريا قلنا عنها fastidious يعني slow
+
+281
+00:19:22,860 --> 00:19:26,840
+growing بكتيريا slow growing بكتيريالو كانت العينة
+
+282
+00:19:26,840 --> 00:19:29,880
+contaminated with normal microbiota او other
+
+283
+00:19:29,880 --> 00:19:34,060
+microorganisms usually this organism will overgrow
+
+284
+00:19:34,060 --> 00:19:40,780
+و ال overgrow يعني هينمو في شكل اكبر عن الفرنسي
+
+285
+00:19:40,780 --> 00:19:44,240
+اللي هو بتاعلي استهلكوا كمية الغدا او فيه كمان شئ
+
+286
+00:19:44,240 --> 00:19:48,400
+سبب تاني او مشكلة تانية ان هم بينمو البكتيريا
+
+287
+00:19:48,400 --> 00:19:51,760
+الأخرى مش بيطلعوا .. بيطلعوا metabolite من ضمن ال
+
+288
+00:19:51,760 --> 00:19:56,200
+metabolite ايش بيطلعوا؟ acidالاسد بيحول ال pH
+
+289
+00:19:56,200 --> 00:20:02,060
+بيخفضه في الميديا لدرجة قد لا تكون ملائمة لمن؟
+
+290
+00:20:02,060 --> 00:20:06,800
+لنمو اللي هو لفرنسا لتولرنسا لذلك يجب ان تطلعوا
+
+291
+00:20:06,800 --> 00:20:10,540
+هنا يقولون ان ال isolation from a specimen may be
+
+292
+00:20:10,540 --> 00:20:14,560
+difficultلو سألناك السؤال هذا في الامتحان لماذا ال
+
+293
+00:20:14,560 --> 00:20:18,820
+primary isolation is difficult لواحد من اتنين ال
+
+294
+00:20:18,820 --> 00:20:23,100
+contaminated organism may over grow the bacteria
+
+295
+00:20:23,100 --> 00:20:29,860
+رقم اتنين they may produce او reduce the pH نرجع
+
+296
+00:20:29,860 --> 00:20:30,240
+برجع
+
+297
+00:20:39,010 --> 00:20:42,610
+الان احنا بنقول انه .. هنشوف كمان في اللوحة
+
+298
+00:20:42,610 --> 00:20:45,650
+التانية ان ال biochemical test of little value او
+
+299
+00:20:45,650 --> 00:20:49,530
+of no value in identifying the bacteria مالهاش اي
+
+300
+00:20:49,530 --> 00:20:53,630
+فايدة كبيرة في التعرف على البكتيريا فما العمل؟
+
+301
+00:20:53,630 --> 00:20:58,190
+يمكن اكتر شغل بدنا ندجج عليها هو ال cultural
+
+302
+00:20:58,190 --> 00:21:02,450
+characteristics الشكل على الأطباق شكل على الأطباق
+
+303
+00:21:02,450 --> 00:21:07,690
+كيف تبدو هذه المستعمرات؟ طلع عليفكل ما قلتلكوا أنا
+
+304
+00:21:07,690 --> 00:21:12,330
+بنمسك الطبق و بنحركه إلى الأعلى و إلى الأسفل عشان
+
+305
+00:21:12,330 --> 00:21:17,030
+نشوف بطريقتين بطريقة transmitted light و بطريقة
+
+306
+00:21:17,030 --> 00:21:20,670
+اللي هو ال reflected light يعني طريقة الضوء
+
+307
+00:21:20,670 --> 00:21:25,510
+المنعكس و الضوء المار تمام المنبعث الآن في كمان
+
+308
+00:21:25,510 --> 00:21:28,930
+شغل مهم في ال testing لما بطلع على الطبق أنا
+
+309
+00:21:28,930 --> 00:21:33,330
+بمستوى العين و بشوف المستعمرات معظم المستعمرات
+
+310
+00:21:33,330 --> 00:21:39,300
+بتكون flatflat يعني موازية للطبق أو slightly ..
+
+311
+00:21:39,300 --> 00:21:43,160
+slightly convex يعني بتكون محدبة قليلا هذه
+
+312
+00:21:43,160 --> 00:21:50,710
+البكتيريا resembles medium sizemercury droplets
+
+313
+00:21:50,710 --> 00:21:54,650
+كلكوا شوفتوا زئبق كيف قطرات الزئبق كيف تنتشر على
+
+314
+00:21:54,650 --> 00:21:58,910
+الأسطح كيف بتدوب ولا بيبقوا واقفة كورات كورات
+
+315
+00:21:58,910 --> 00:22:02,370
+بتكون واقفة فبالتالي لو اطلعت على مستوى الكورة في
+
+316
+00:22:02,370 --> 00:22:06,130
+الطبق هلاجيها مرتفعة ولا مقفضة مرتفعة فعشانك
+
+317
+00:22:06,130 --> 00:22:09,570
+بيقولوا أن شكل المستعمرات هنا is a distinguishing
+
+318
+00:22:09,570 --> 00:22:17,020
+character يعني صورة مميزة للبكتيريا كمان مرةmedium
+
+319
+00:22:17,020 --> 00:22:22,200
+-sized mercury droplets surrounded by a small zone
+
+320
+00:22:22,200 --> 00:22:26,540
+of partial hemolysis يعني هذه الصفات مهمة جدا لإن
+
+321
+00:22:26,540 --> 00:22:29,200
+الوسط اللي احنا بتكلم عنه هو عبارة عن blood agar
+
+322
+00:22:29,200 --> 00:22:34,320
+مضاف اله سيستين زائد اللي هو جليكوز لكن متى الكلام
+
+323
+00:22:34,320 --> 00:22:40,010
+هذا يا شباب؟بعد اتنين الى اربع أيام يعني ال
+
+324
+00:22:40,010 --> 00:22:44,970
+bacteria will not grow after 24 hours minimum بدها
+
+325
+00:22:44,970 --> 00:22:48,830
+يومين الى اربع أيام وجدش تاخد دمية تبعها واحد
+
+326
+00:22:48,830 --> 00:22:53,090
+millimeter فبدنا نزود ال incubation عشان نزيد
+
+327
+00:22:53,090 --> 00:22:56,650
+الحجم المستوى صغير هذا واحد millimeterفكده لما كنا
+
+328
+00:22:56,650 --> 00:23:00,410
+لو موصفنا ال stephococcus وصفناها كنا large
+
+329
+00:23:00,410 --> 00:23:03,290
+colonies من اتنين لاربعة ملي متر بينما ال small
+
+330
+00:23:03,290 --> 00:23:05,710
+colonies تبعت ال stepped coccus كانت من واحد الى
+
+331
+00:23:05,710 --> 00:23:11,280
+اتنين ملي مترinculation of the specimen زي ما
+
+332
+00:23:11,280 --> 00:23:14,600
+حكيتلكوا انا و قولتلكوا انه قد يكون من الصعوبة بما
+
+333
+00:23:14,600 --> 00:23:19,300
+كان انه نزرع او او نعزل البكتيريا حتى لو كانت
+
+334
+00:23:19,300 --> 00:23:22,380
+موجودة بعدد كبير لإن الcontaminating microorganism
+
+335
+00:23:22,380 --> 00:23:27,100
+بتكون أسرع منها فإنه قد تسيق إلى البكتيريا من
+
+336
+00:23:27,100 --> 00:23:30,340
+ناحية ايه؟ من ناحية انها بتخفض ال pH عن طريق
+
+337
+00:23:30,340 --> 00:23:35,150
+الميتابولزم ده للجليكوزالوسط اللي قلنا عنه 16
+
+338
+00:23:35,150 --> 00:23:38,610
+جليكوز blood agar هو الوسط المستخدم في الزراعة،
+
+339
+00:23:38,610 --> 00:23:40,910
+الان هذا .. هذا الوسط commercially available، ايش
+
+340
+00:23:40,910 --> 00:23:43,430
+يعني commercially available؟ يعني احنا زي .. زي ما
+
+341
+00:23:43,430 --> 00:23:46,890
+بنشتري مكونكي و blood agar، بنقدر نشتريه، لكن لو
+
+342
+00:23:46,890 --> 00:23:50,930
+كان غير ممتاح، يمكن ايضا تحضيره في المعمل عن طريق
+
+343
+00:23:50,930 --> 00:23:54,810
+إضافة 16 جليكوز على ال blood agar اللي انتوا
+
+344
+00:23:54,810 --> 00:23:59,250
+بتعرفواال biochemical identification ذكرناها عبارة
+
+345
+00:23:59,250 --> 00:24:03,890
+انه little value يبقى بيظل عندنا مين الآن ال
+
+346
+00:24:03,890 --> 00:24:08,210
+serology بنقدر نستخدم tube agglutination او slight
+
+347
+00:24:08,210 --> 00:24:11,230
+agglutination test طبعا ال tube agglutination او
+
+348
+00:24:11,230 --> 00:24:14,110
+slight agglutination من جسميهم هدول ايش antibody
+
+349
+00:24:14,110 --> 00:24:18,130
+فاكرين احنا كنا من ضمن العينات بناخد blood for
+
+350
+00:24:18,130 --> 00:24:23,040
+serologyفي فحص مشهور جدا اسمه ال precipitate test
+
+351
+00:24:23,040 --> 00:24:27,980
+احنا حاولنا ما نشرحوش يعني بس نتكلم عن الغرض تبعه
+
+352
+00:24:27,980 --> 00:24:34,080
+ال precipitate test هو فحص ده مارعينا كتير انه
+
+353
+00:24:34,080 --> 00:24:38,000
+soluble antigen بتفاعل مع soluble antibody لما
+
+354
+00:24:38,000 --> 00:24:40,800
+بتفاعلوا مع بعض برتبته مع بعض بيكونوا insoluble
+
+355
+00:24:41,370 --> 00:24:43,710
+كمباوند وبتاعلي بيصير ال precipitate وعشانك سمينا
+
+356
+00:24:43,710 --> 00:24:47,590
+الفحص اللي هو ال precipitate test لكن مين اللي
+
+357
+00:24:47,590 --> 00:24:51,210
+بيعمل ال precipitate؟ antigen specific لمين؟ ال
+
+358
+00:24:51,210 --> 00:24:53,810
+antibody او العكس antibody specific ل antigen
+
+359
+00:24:53,810 --> 00:24:58,430
+وبتاعلي ممكن نستخدم هذا الفحص للكشف عن اما مستوى
+
+360
+00:24:58,430 --> 00:25:02,290
+ال antibodies او الكشف عن وجود ال antigen وهذا
+
+361
+00:25:02,290 --> 00:25:08,050
+الفحص يصلحللكشف عن الانتيجينات حتى في الحيوانات
+
+362
+00:25:08,050 --> 00:25:12,070
+النافقة اللي من فترة طويلة نافقت يعني دهبت يعني مش
+
+363
+00:25:12,070 --> 00:25:15,730
+ضال منها عضم وجلد ممكن ناخد الجلد و العضم هذا و
+
+364
+00:25:15,730 --> 00:25:19,350
+نطحنه و نستخلص منه الانتيجينات بطريقة معينة و
+
+365
+00:25:19,350 --> 00:25:23,910
+نعمله فحص ال precipitate test و انا هنا بقول ان
+
+366
+00:25:23,910 --> 00:25:28,910
+هذا مين بيعمل الفحص غالبا اللي بيعمله monitoring
+
+367
+00:25:28,910 --> 00:25:34,520
+لل disease ايش يعني monitoring لل diseaseلازم نأكد
+
+368
+00:25:34,520 --> 00:25:38,760
+على مفهوم monitoring في موضوع الأمراض الموعدية و
+
+369
+00:25:38,760 --> 00:25:43,840
+أهميته في الدنيا و احنا هنا ايش مواجبنا في
+
+370
+00:25:43,840 --> 00:25:48,580
+المستقبل لتطوير هذا الجانب اللي احنا نفتقر اليه او
+
+371
+00:25:48,580 --> 00:25:52,760
+نفتقده بدا اوضح المفهوم بعيدا عن المحاضرة يعني
+
+372
+00:25:52,760 --> 00:25:59,140
+عشان .. عشان انه الفكرة تصل ان شاء الله قبل
+
+373
+00:25:59,140 --> 00:26:05,380
+أقل من سنتينأنا مشترك في موقع انترنت اسمه bromid
+
+374
+00:26:05,380 --> 00:26:09,160
+برومد ده مؤسسة بتعمل monitoring لل infectious
+
+375
+00:26:09,160 --> 00:26:11,640
+disease في الحيوانة و في الإنسان و في النبات على
+
+376
+00:26:11,640 --> 00:26:18,620
+كل العالم لو سمعوا خبرحتى و لو صحفي بمعنى واحد كتب
+
+377
+00:26:18,620 --> 00:26:24,140
+مقالة في جريدة في مجلة معروفة في الأردن في فلسطين
+
+378
+00:26:24,140 --> 00:26:27,460
+في الكويت في بوركينا فاسو في اي دولة في العالم
+
+379
+00:26:27,460 --> 00:26:32,060
+بياخدوا التقرير هذا و بيترجموه و بياخدوا منه
+
+380
+00:26:32,060 --> 00:26:34,960
+معلومات ايه علاقة بالinfectious disease و ببعتوها
+
+381
+00:26:34,960 --> 00:26:38,440
+لمين و بحطوها على موقعهم و ببعتوها لكل المشتركين
+
+382
+00:26:38,440 --> 00:26:43,780
+فانا كل يوم بصني تقريبا عشر الى خمستاشر email من
+
+383
+00:26:43,780 --> 00:26:48,930
+هذه المؤسسةهدول عشان عاملين monitoring براقب
+
+384
+00:26:48,930 --> 00:26:52,030
+الأمراض المقاعدة في كل العالم، الآن واجبي في
+
+385
+00:26:52,030 --> 00:26:57,190
+فلسطين أن أكون جزء من ال monitoring هذالأن أنا
+
+386
+00:26:57,190 --> 00:27:01,750
+الأمن تبعي الأمن الصحي من الأمراض المعضلة أو
+
+387
+00:27:01,750 --> 00:27:05,390
+الوباء ايه لا يبدأ عند مصر وعند الكائن الصهيوني
+
+388
+00:27:05,390 --> 00:27:10,010
+وإنما يبدأ وين ما بعدهم يعني لو اقترب الخطر في
+
+389
+00:27:10,010 --> 00:27:13,950
+ليبيا ما هي حدود مصر لو كان المرض في ليبيا انا بدي
+
+390
+00:27:13,950 --> 00:27:17,090
+أسير افكر من الآن ان مدينة مصر ليبيا ممكن يصلها
+
+391
+00:27:17,090 --> 00:27:22,240
+مصر اذا وصلت السودان ممكن يصل مصر وهكذافوصل
+
+392
+00:27:22,240 --> 00:27:24,580
+الأخبار عن ال foot and mouth disease اللي بيسموها
+
+393
+00:27:24,580 --> 00:27:27,120
+الحمّة القلعية باللغة العربية إن مولودة في الكائن
+
+394
+00:27:27,120 --> 00:27:30,540
+الصهيوني مولودة في مصر واحنا في غزة مافي عندنا أي
+
+395
+00:27:30,540 --> 00:27:34,240
+حركة مافي عندنا أي حركة ولا حد تحدث الموضوع هذا
+
+396
+00:27:36,160 --> 00:27:39,820
+وبالتالي أنا شخصيا قمت بالاتصال ببعض الناس و يعني
+
+397
+00:27:39,820 --> 00:27:42,240
+اتفلغوا المسئولين في الموضوع و صار بالفعل نوع من
+
+398
+00:27:42,240 --> 00:27:46,180
+الحراك و جابوا vaccines و أصدروا نشرات توعية و
+
+399
+00:27:46,180 --> 00:27:49,100
+أخدوا بعض العينات و فحصوها في الخارج يعني صار في
+
+400
+00:27:49,100 --> 00:27:55,480
+نوع من الحراك لكن لو كان في عناmonitoring programs
+
+401
+00:27:55,480 --> 00:28:00,320
+برامج مراقبة كمان مرة برامج مراقبة دائمة و ليست
+
+402
+00:28:00,320 --> 00:28:03,480
+موسمية بمعنى انها تكون استراتيجية من استراتيجياتنا
+
+403
+00:28:03,480 --> 00:28:07,940
+احنا هيك بنكون أخدنا فرصة انه عملنا early
+
+404
+00:28:07,940 --> 00:28:12,500
+detection early detection كشف مبكر والكشف المبكر
+
+405
+00:28:12,500 --> 00:28:16,240
+يا شباب بيسهل عيني عملية التدخلزي أي مرض حتى لما
+
+406
+00:28:16,240 --> 00:28:21,120
+لقى سرطان لما نكتشفه مبكرا بيكون سهل علاجه
+
+407
+00:28:21,120 --> 00:28:25,780
+والأمراض الماضية كذلك الأمر بيكون سهل السيطرة
+
+408
+00:28:25,780 --> 00:28:29,420
+عليها، إذا كلمة monitoring بنفهمها في موضوع السياق
+
+409
+00:28:29,420 --> 00:28:34,740
+أن هي عملية مستمرة من خلالها بقدر أنا أكشف مبكرا
+
+410
+00:28:34,740 --> 00:28:39,630
+أو أتنبأوالتنبؤ برضه كمان بعطيني انا فرصة او
+
+411
+00:28:39,630 --> 00:28:43,870
+أسبقية انه انا اتصرف قبل حدوث الحدث زي ما صار
+
+412
+00:28:43,870 --> 00:28:46,930
+عندنا مثلا في .. في .. في أمراض ال influenza
+
+413
+00:28:46,930 --> 00:28:52,030
+للخنازير والطيور انه الأمة او العالم لأول مرة في
+
+414
+00:28:52,030 --> 00:28:58,590
+حياته يمتلك فرصة انه يجهز حاله قبل حدوث الوباء فال
+
+415
+00:28:58,590 --> 00:29:01,970
+monitoring عملية مهمة جدا جدا وبدا اخد اقعد مثال
+
+416
+00:29:01,970 --> 00:29:07,870
+تاني عشان حتى يعني نشاركوا بالاهاميةشاطئ البحر
+
+417
+00:29:07,870 --> 00:29:11,570
+عندنا في قطاع غزة شاطئ ممتد حوالي خمسة واربعين
+
+418
+00:29:11,570 --> 00:29:15,510
+كيلومتر من رفح إلى بيت حنون هذا اللي .. اللي احنا
+
+419
+00:29:15,510 --> 00:29:22,310
+الان بنقدر مسمحونا نجرب عليه تمام؟ والشاطئ هذا هو
+
+420
+00:29:22,310 --> 00:29:27,650
+المتنفس الوحيد لسكان قطاع غزة في فصل الصيف للتنزه
+
+421
+00:29:29,140 --> 00:29:32,480
+لكن للأسف مش احنا الوحيدين اللي بنروح عليه تسبقنا
+
+422
+00:29:32,480 --> 00:29:35,700
+المجال يتبعتنا عليه منها ما هو معالج و منها غير
+
+423
+00:29:35,700 --> 00:29:39,700
+معالج و للأسف في تغيير في كمية الضخم و في كمية
+
+424
+00:29:39,700 --> 00:29:42,620
+المعالج بحسب هل في كهرب فيش كهرب يعني في ظروف
+
+425
+00:29:42,620 --> 00:29:48,330
+معينة فلو انا عندي مراقبة مستمرة للشاطرمش انا بكون
+
+426
+00:29:48,330 --> 00:29:51,990
+عندى دايما أسبقية للناس اقولهم ان المنطقة دى
+
+427
+00:29:51,990 --> 00:29:54,870
+ممنوعة او المنطقة دى مسموحة على الأقل انابه
+
+428
+00:29:54,870 --> 00:29:59,890
+الجمهور انه مايدخل فيها مناطق فيها نوع من .. هذا
+
+429
+00:29:59,890 --> 00:30:02,390
+برضه كمان ندعى عن مين؟ عن ال monitoring فال
+
+430
+00:30:02,390 --> 00:30:07,050
+monitoring يا شباب قضية مهمة يجب عليكم التفكير بها
+
+431
+00:30:07,050 --> 00:30:10,660
+بشكل جيد فالناس اللى بيعملوا ال monitoringالناس
+
+432
+00:30:10,660 --> 00:30:14,640
+اللي بيعملوا monitoring غالبا بيكتشفوا أشياء و
+
+433
+00:30:14,640 --> 00:30:18,900
+بيطوروا فحوصات أو بيطوروا آليات لتسهيل عملية اللي
+
+434
+00:30:18,900 --> 00:30:24,040
+هو ال monitoring فضلا برومد بحطلكوا الموقع تبعها
+
+435
+00:30:24,040 --> 00:30:28,040
+انا اظن وضعته حتى في بداية الفصل على الفيسبوك لكن
+
+436
+00:30:28,040 --> 00:30:33,000
+بضعكواها مرة تانية ان شاء الله طيبرقم اربع من
+
+437
+00:30:33,000 --> 00:30:35,900
+الفحوصات في هندي hemagglutination and complement
+
+438
+00:30:35,900 --> 00:30:40,100
+fixation test of limited use يعني فيه فحوصات
+
+439
+00:30:40,100 --> 00:30:43,360
+معتمدة على ال principle تبع ال hemagglutination او
+
+440
+00:30:43,360 --> 00:30:46,360
+على ال complement fixation لكن استخدامها الصحيح
+
+441
+00:30:46,360 --> 00:30:52,720
+يعني محدود خامسة skin test الآن مين عنده اي معلومة
+
+442
+00:30:52,720 --> 00:30:56,570
+عن البكتيريا في قطاع غزة ولا حدالو اجى واحد وقال
+
+443
+00:30:56,570 --> 00:31:00,470
+والله يا عم الظروف اللى كانت مش متوفرة صارت متوفرة
+
+444
+00:31:00,470 --> 00:31:06,590
+تمام بدنا نعمل نشوف ال prevalence rate لل disease
+
+445
+00:31:06,590 --> 00:31:10,730
+بدناش نشوف الناس اللى لان مصابين مين انصاب في
+
+446
+00:31:10,730 --> 00:31:15,650
+السابق ممكن نعملهم مين skin test والسؤال اللى بيجي
+
+447
+00:31:15,650 --> 00:31:25,070
+في الامتحان أكم skin test بتعرف يلا شعت هى واحد
+
+448
+00:31:27,920 --> 00:31:31,540
+المحاضرة الماضية لسه مانسيا نقشت اتنين اخدنا
+
+449
+00:31:31,540 --> 00:31:35,900
+التبركولين واخدنا الليبرومين والمحاضرة اللي جابلها
+
+450
+00:31:35,900 --> 00:31:39,480
+اخدنا ال death theory فهيصل اندي انا عايش اربعة
+
+451
+00:31:39,480 --> 00:31:45,070
+skin testTreatment and Antibiotic Sensitivity
+
+452
+00:31:45,070 --> 00:31:48,870
+البكتيريا هي still بكتيريا can be treated with
+
+453
+00:31:48,870 --> 00:31:52,430
+antibiotics يمكن الستربتوميسين و الchloramphenicol
+
+454
+00:31:52,430 --> 00:31:55,650
+و الترساكلينز بيستخدموه لكن الchloramphenicol كلكم
+
+455
+00:31:55,650 --> 00:31:59,290
+عارفين انه الان هذا X فبيضل ان الستربتوميسين و
+
+456
+00:31:59,290 --> 00:32:02,090
+الستربتوميسين برضه سميته عالية إذا استخدم لفترات
+
+457
+00:32:02,090 --> 00:32:05,990
+طويلة فممكن يستخدم بالجنتوميسين أو الاميكاسين لكن
+
+458
+00:32:05,990 --> 00:32:09,550
+هذه ال antibiotics اللي ممكن تستخدمهاانا طبعا هيك
+
+459
+00:32:09,550 --> 00:32:12,310
+بكون انتهت المحاضرة لكن في بعض الصور بتوريكوا
+
+460
+00:32:12,310 --> 00:32:16,930
+إياها اللي هي ال .. ال all's اللي شايفينها هذي شكل
+
+461
+00:32:16,930 --> 00:32:20,310
+من أشكال اللي هو ال slow healing على الصرفي كمان
+
+462
+00:32:20,310 --> 00:32:24,990
+صورة أخرى على الإصبع هنا هذا غالبا بينتج من تعامل
+
+463
+00:32:24,990 --> 00:32:28,910
+مع حيوانات زي ما حكينالكوا حيوانات مصابة ب ال
+
+464
+00:32:28,910 --> 00:32:32,250
+Francis de Lawrence المرة الجاية ان شاء الله نكمل
+
+465
+00:32:32,250 --> 00:32:35,390
+في المحاضرة في ال hemophilus influenza بإذن الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/5w4owWd7qLs_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/5w4owWd7qLs_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..dd86300a81db1fe17ebf11c349142e515a5e6ec2
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/5w4owWd7qLs_raw.json
@@ -0,0 +1 @@
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totally dependent على مين؟ على اللي هو ال ground water بالمناسبة مرة من المرات ابصر كيف ايجي عندنا beaver على غزة هنا ايجي ال beaver هنا و صدوا على طول و جابونيه على الجامعة", "tokens": [11622, 1829, 19446, 11331, 4117, 1829, 8315, 309, 14725, 15154, 11764, 1975, 2407, 1422, 3474, 259, 804, 11764, 2423, 7649, 45164, 1975, 8315, 8978, 7251, 20498, 9154, 16247, 1829, 10943, 4032, 1975, 8315, 44713, 3555, 22488, 16472, 7251, 30544, 34105, 8978, 6156, 1211, 3794, 9566, 9957, 1975, 9381, 15040, 6156, 2288, 1863, 3794, 10632, 20193, 11125, 2676, 32239, 8592, 4724, 995, 14851, 3555, 22488, 22807, 20193, 9673, 41779, 37983, 9307, 3714, 29245, 23328, 49429, 2423, 312, 20655, 3714, 29245, 23328, 49429, 2423, 3753, 1281, 3714, 29245, 23328, 1975, 5016, 8315, 321, 3879, 12334, 15844, 3714, 9957, 22807, 15844, 13672, 1829, 31439, 2423, 2727, 1281, 20666, 2304, 8315, 35457, 3660, 3714, 25720, 9154, 9673, 2288, 9307, 48127, 9381, 2288, 9122, 33911, 1975, 1829, 7435, 1829, 43242, 8315, 312, 20655, 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احنا مش فاكرين ان احنا خدنا 16 glucose blood agar تمام؟", "tokens": [3224, 1863, 9566, 12610, 25124, 3555, 16758, 8978, 16247, 5016, 1829, 16606, 4724, 3794, 39894, 45761, 1829, 12602, 39319, 20449, 25062, 9381, 5172, 23032, 1829, 3555, 281, 23203, 1296, 2010, 316, 293, 2010, 363, 6156, 7578, 6156, 5016, 9381, 4724, 3794, 1829, 9566, 10874, 28259, 1975, 5016, 8315, 37893, 6156, 995, 37983, 9957, 16472, 1975, 5016, 8315, 16490, 3215, 8315, 3165, 23997, 3390, 623, 289, 46811, 10943, 22807], "avg_logprob": -0.25135870774586994, "compression_ratio": 1.3064516129032258, "no_speech_prob": 0.0, "words": [{"start": 931.9200000000001, "end": 932.6, "word": "هنطول", "probability": 0.672271728515625}, {"start": 932.6, "end": 932.96, "word": " الشباب", "probability": 0.8831380208333334}, {"start": 932.96, "end": 933.06, "word": " في", "probability": 0.88427734375}, {"start": 933.06, "end": 933.28, "word": " الأحياء", "probability": 0.806884765625}, {"start": 933.28, "end": 933.5, "word": " بس", 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اكتر شغل بدنا ندجج عليها هو ال cultural characteristics الشكل على الأطباق شكل على الأطباق كيف تبدو هذه المستعمرات؟ طلع علي", "tokens": [6027, 7649, 1975, 5016, 8315, 44945, 39648, 16472, 3224, 4386, 8032, 1863, 8592, 38688, 9122, 2304, 7649, 8978, 13672, 2407, 5016, 3660, 16712, 7649, 10632, 16472, 2423, 12198, 34114, 1500, 295, 707, 2158, 1975, 2407, 295, 572, 2158, 294, 16696, 264, 11763, 3714, 6027, 3224, 33599, 1975, 1829, 6156, 995, 25708, 3660, 9122, 3555, 48923, 8978, 16712, 3615, 28480, 15844, 29739, 4117, 2655, 13546, 25528, 6156, 15042, 18863, 42213, 22807, 7251, 43020, 1975, 4117, 2655, 2288, 13412, 17082, 1211, 47525, 8315, 8717, 3215, 7435, 7435, 25894, 11296, 31439, 2423, 6988, 10891, 25124, 28820, 15844, 16247, 9566, 3555, 995, 4587, 13412, 28820, 15844, 16247, 9566, 3555, 995, 4587, 9122, 33911, 6055, 44510, 2407, 29538, 9673, 14851, 25957, 2288, 9307, 22807, 23032, 1211, 3615, 25894], "avg_logprob": -0.15536794318787514, "compression_ratio": 1.6632996632996633, 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"probability": 0.65576171875}, {"start": 1248.05, "end": 1248.51, "word": " bacteria", "probability": 0.91162109375}, {"start": 1248.51, "end": 1249.17, "word": " مالهاش", "probability": 0.765380859375}, {"start": 1249.17, "end": 1249.53, "word": " اي", "probability": 0.7421875}, {"start": 1249.53, "end": 1250.19, "word": " فايدة", "probability": 0.8575439453125}, {"start": 1250.19, "end": 1250.59, "word": " كبيرة", "probability": 0.9874674479166666}, {"start": 1250.59, "end": 1251.01, "word": " في", "probability": 0.71533203125}, {"start": 1251.01, "end": 1251.41, "word": " التعرف", "probability": 0.9718424479166666}, {"start": 1251.41, "end": 1251.59, "word": " على", "probability": 0.76708984375}, {"start": 1251.59, "end": 1252.13, "word": " البكتيريا", "probability": 0.8984375}, {"start": 1252.13, "end": 1252.61, "word": " فما", "probability": 0.79638671875}, {"start": 1252.61, "end": 1253.63, "word": " العمل؟", "probability": 0.8024088541666666}, {"start": 1253.63, "end": 1254.05, "word": " يمكن", "probability": 0.971923828125}, {"start": 1254.05, "end": 1254.81, "word": " اكتر", "probability": 0.9276123046875}, {"start": 1254.81, "end": 1255.83, "word": " شغل", "probability": 0.9392903645833334}, {"start": 1255.83, "end": 1256.33, "word": " بدنا", "probability": 0.959228515625}, {"start": 1256.33, "end": 1256.85, "word": " ندجج", "probability": 0.8712158203125}, {"start": 1256.85, "end": 1257.29, "word": " عليها", "probability": 0.90283203125}, {"start": 1257.29, "end": 1257.73, "word": " هو", "probability": 0.9619140625}, {"start": 1257.73, "end": 1257.85, "word": " ال", "probability": 0.93896484375}, {"start": 1257.85, "end": 1258.19, "word": " cultural", "probability": 0.79638671875}, {"start": 1258.19, "end": 1259.01, "word": " characteristics", "probability": 0.8759765625}, {"start": 1259.01, "end": 1259.55, "word": " الشكل", "probability": 0.89306640625}, {"start": 1259.55, "end": 1260.29, "word": " على", "probability": 0.8701171875}, {"start": 1260.29, 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بطريقتين بطريقة transmitted light و بطريقة اللي هو ال reflected light يعني طريقة الضوء المنعكس و الضوء المار تمام المنبعث الآن في كمان شغل مهم في ال testing لما بطلع على الطبق أنا بمستوى العين و بشوف المستعمرات معظم المستعمرات بتكون flat", "tokens": [5172, 28820, 19446, 12174, 1211, 2655, 23275, 14407, 41850, 44945, 2304, 3794, 4117, 41950, 3555, 4587, 4032, 44945, 5016, 31747, 3224, 30731, 16247, 3615, 23942, 4032, 30731, 16247, 3794, 5172, 1211, 6225, 8592, 7649, 8717, 8592, 38688, 4724, 9566, 16572, 38149, 9957, 4724, 9566, 16572, 28671, 25355, 1442, 4032, 4724, 9566, 16572, 28671, 13672, 1829, 31439, 2423, 15502, 1442, 37495, 22653, 23032, 16572, 28671, 6024, 114, 2407, 38207, 9673, 1863, 3615, 4117, 3794, 4032, 6024, 114, 2407, 38207, 9673, 9640, 46811, 10943, 9673, 1863, 3555, 3615, 12984, 6024, 48506, 8978, 9122, 2304, 7649, 13412, 17082, 1211, 3714, 16095, 8978, 2423, 4997, 5296, 15042, 4724, 9566, 1211, 3615, 15844, 41950, 3555, 4587, 41850, 4724, 2304, 14851, 2407, 7578, 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يعني هذه الصفات مهمة جدا لإن الوسط اللي احنا بتكلم عنه هو عبارة عن blood agar مضاف اله سيستين زائد اللي هو جليكوز لكن متى الكلام هذا يا شباب؟", "tokens": [1912, 2197, 12, 20614, 33307, 41573, 13221, 538, 257, 1359, 6668, 295, 14641, 415, 3280, 356, 17122, 37495, 22653, 29538, 31767, 5172, 9307, 3714, 16095, 3660, 10874, 28259, 5296, 28814, 1863, 2423, 41779, 9566, 13672, 1829, 1975, 5016, 8315, 39894, 4117, 19528, 18871, 3224, 31439, 6225, 3555, 9640, 3660, 18871, 3390, 623, 289, 3714, 11242, 31845, 2423, 3224, 8608, 1829, 14851, 9957, 30767, 16373, 3215, 13672, 1829, 31439, 10874, 20292, 4117, 2407, 11622, 44381, 44650, 7578, 2423, 28820, 10943, 23758, 35186, 13412, 3555, 16758, 22807], "avg_logprob": -0.19840116937493169, "compression_ratio": 1.3922413793103448, "no_speech_prob": 0.0, "words": [{"start": 1336.48, "end": 1337.02, "word": "medium", "probability": 0.59716796875}, {"start": 1337.02, "end": 1337.48, "word": "-sized", "probability": 0.601806640625}, {"start": 1337.48, 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commercially available؟ يعني احنا زي .. زي ما بنشتري مكونكي و blood agar، بنقدر نشتريه، لكن لو كان غير ممتاح، يمكن ايضا تحضيره في المعمل عن طريق إضافة 16 جليكوز على ال blood agar اللي انتوا بتعرفوا", "tokens": [6027, 41779, 9566, 13672, 1829, 12174, 1211, 8315, 18871, 3224, 3165, 10874, 20292, 4117, 2407, 11622, 3390, 623, 289, 31439, 2423, 41779, 9566, 9673, 14851, 9778, 40448, 8978, 6024, 110, 23557, 27884, 12399, 2423, 7649, 23758, 4386, 23758, 2423, 41779, 9566, 41751, 2435, 12399, 1975, 1829, 8592, 37495, 22653, 41751, 2435, 22807, 37495, 22653, 1975, 5016, 8315, 30767, 1829, 4386, 30767, 1829, 19446, 44945, 8592, 2655, 16572, 3714, 30544, 4117, 1829, 4032, 3390, 623, 289, 12399, 44945, 28543, 2288, 8717, 8592, 2655, 16572, 3224, 12399, 44381, 45164, 25961, 32771, 13546, 3714, 2304, 2655, 39319, 12399, 7251, 43020, 1975, 1829, 11242, 995, 6055, 5016, 11242, 13546, 3224, 8978, 9673, 25957, 1211, 18871, 23032, 16572, 4587, 11933, 11242, 31845, 3660, 3165, 10874, 20292, 4117, 2407, 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0.865234375}, {"start": 1906.39, "end": 1906.69, "word": " هي", "probability": 0.501953125}, {"start": 1906.69, "end": 1907.13, "word": " still", "probability": 0.468017578125}, {"start": 1907.13, "end": 1907.71, "word": " بكتيريا", "probability": 0.95615234375}, {"start": 1907.71, "end": 1908.15, "word": " can", "probability": 0.355712890625}, {"start": 1908.15, "end": 1908.37, "word": " be", "probability": 0.9462890625}, {"start": 1908.37, "end": 1908.69, "word": " treated", "probability": 0.83251953125}, {"start": 1908.69, "end": 1908.87, "word": " with", "probability": 0.904296875}, {"start": 1908.87, "end": 1909.53, "word": " antibiotics", "probability": 0.81298828125}, {"start": 1909.53, "end": 1910.27, "word": " يمكن", "probability": 0.915771484375}, {"start": 1910.27, "end": 1911.21, "word": " الستربتوميسين", "probability": 0.561126708984375}, {"start": 1911.21, "end": 1911.69, "word": " و", "probability": 0.53271484375}, {"start": 1911.69, "end": 1912.43, "word": " الchloramphenicol", "probability": 0.7222726004464286}, {"start": 1912.43, "end": 1912.53, "word": " و", "probability": 0.927734375}, {"start": 1912.53, "end": 1913.31, "word": " الترساكلينز", "probability": 0.6535295758928571}, {"start": 1913.31, "end": 1914.45, "word": " بيستخدموه", "probability": 0.8423200334821429}, {"start": 1914.45, "end": 1914.79, "word": " لكن", "probability": 0.79248046875}, {"start": 1914.79, "end": 1915.45, "word": " الchloramphenicol", "probability": 0.9141322544642857}, {"start": 1915.45, "end": 1915.65, "word": " كلكم", "probability": 0.7002766927083334}, {"start": 1915.65, "end": 1915.97, "word": " عارفين", "probability": 0.973388671875}, {"start": 1915.97, "end": 1916.15, "word": " انه", "probability": 0.708984375}, {"start": 1916.15, "end": 1916.47, "word": " الان", "probability": 0.59344482421875}, {"start": 1916.47, "end": 1916.87, "word": " هذا", "probability": 0.62451171875}, {"start": 1916.87, "end": 1917.63, "word": " X", "probability": 0.708984375}, {"start": 1917.63, "end": 1917.99, "word": " فبيضل", "probability": 0.57373046875}, {"start": 1917.99, "end": 1918.13, "word": " ان", "probability": 0.81103515625}, {"start": 1918.13, "end": 1919.21, "word": " الستربتوميسين", "probability": 0.92022705078125}, {"start": 1919.21, "end": 1919.29, "word": " و", "probability": 0.482421875}, {"start": 1919.29, "end": 1919.79, "word": " الستربتوميسين", "probability": 0.90362548828125}, {"start": 1919.79, "end": 1920.01, "word": " برضه", "probability": 0.9498697916666666}, {"start": 1920.01, "end": 1920.39, "word": " سميته", "probability": 0.81353759765625}, {"start": 1920.39, "end": 1920.77, "word": " عالية", "probability": 0.9728190104166666}, {"start": 1920.77, "end": 1921.41, "word": " إذا", "probability": 0.765380859375}, {"start": 1921.41, "end": 1921.73, "word": " استخدم", "probability": 0.9729817708333334}, {"start": 1921.73, "end": 1922.09, "word": " لفترات", "probability": 0.9123046875}, {"start": 1922.09, "end": 1922.53, "word": " طويلة", "probability": 0.957763671875}, {"start": 1922.53, "end": 1923.07, "word": " فممكن", "probability": 0.9002278645833334}, {"start": 1923.07, "end": 1923.43, "word": " يستخدم", "probability": 0.8953857421875}, {"start": 1923.43, "end": 1924.33, "word": " بالجنتوميسين", "probability": 0.7133440290178571}, {"start": 1924.33, "end": 1924.53, "word": " أو", "probability": 0.66943359375}, {"start": 1924.53, "end": 1925.21, "word": " الاميكاسين", "probability": 0.87841796875}, {"start": 1925.21, "end": 1925.99, "word": " لكن", "probability": 0.91455078125}, {"start": 1925.99, "end": 1926.67, "word": " هذه", "probability": 0.7333984375}, {"start": 1926.67, "end": 1926.89, "word": " ال", "probability": 0.8779296875}, {"start": 1926.89, "end": 1927.35, "word": " antibiotics", "probability": 0.693359375}, {"start": 1927.35, "end": 1927.77, "word": " اللي", "probability": 0.911865234375}, {"start": 1927.77, "end": 1928.41, "word": " ممكن", "probability": 0.990234375}, {"start": 1928.41, "end": 1928.99, "word": " تستخدمها", "probability": 0.9353515625}], "temperature": 1.0}, {"id": 85, "seek": 195539, "start": 1929.03, "end": 1955.39, "text": "انا طبعا هيك بكون انتهت المحاضرة لكن في بعض الصور بتوريكوا إياها اللي هي ال .. ال all's اللي شايفينها هذي شكل من أشكال اللي هو ال slow healing على الصرفي كمان صورة أخرى على الإصبع هنا هذا غالبا بينتج من تعامل مع حيوانات زي ما حكينالكوا حيوانات مصابة ب ال Francis de Lawrence المرة الجاية ان شاء الله نكمل في المحاضرة في ال hemophilus influenza بإذن الله", "tokens": [7649, 995, 23032, 3555, 3615, 995, 39896, 4117, 4724, 30544, 16472, 47395, 2655, 9673, 5016, 46958, 25720, 44381, 8978, 45030, 11242, 31767, 13063, 39894, 13063, 1829, 4117, 14407, 11933, 25528, 11296, 13672, 1829, 39896, 2423, 4386, 2423, 439, 311, 13672, 1829, 13412, 995, 33911, 9957, 11296, 8032, 8848, 1829, 13412, 28820, 9154, 5551, 8592, 4117, 6027, 13672, 1829, 31439, 2423, 2964, 9745, 15844, 2423, 9381, 28480, 1829, 9122, 2304, 7649, 20328, 13063, 3660, 5551, 34740, 7578, 15844, 33688, 9381, 3555, 3615, 34105, 23758, 32771, 6027, 3555, 995, 4724, 9957, 2655, 7435, 9154, 37279, 10943, 1211, 20449, 11331, 1829, 2407, 7649, 9307, 30767, 1829, 19446, 11331, 4117, 1829, 8315, 23275, 14407, 11331, 1829, 2407, 7649, 9307, 3714, 9381, 16758, 3660, 4724, 2423, 19648, 368, 22787, 9673, 25720, 25724, 995, 10632, 16472, 13412, 16606, 21984, 8717, 24793, 1211, 8978, 9673, 5016, 46958, 25720, 8978, 2423, 8636, 5317, 388, 301, 36408, 4724, 28814, 8848, 1863, 21984], "avg_logprob": -0.21611201676068367, "compression_ratio": 1.8224299065420562, "no_speech_prob": 0.0, "words": [{"start": 1929.03, "end": 1929.29, "word": "انا", "probability": 0.65478515625}, {"start": 1929.29, "end": 1929.41, "word": " طبعا", "probability": 0.9813232421875}, {"start": 1929.41, "end": 1929.55, "word": " هيك", "probability": 0.83447265625}, {"start": 1929.55, "end": 1929.79, "word": " بكون", "probability": 0.586181640625}, {"start": 1929.79, "end": 1930.51, "word": " انتهت", "probability": 0.94384765625}, {"start": 1930.51, "end": 1930.81, "word": " المحاضرة", "probability": 0.9818115234375}, {"start": 1930.81, "end": 1930.95, "word": " لكن", "probability": 0.8154296875}, {"start": 1930.95, "end": 1931.09, "word": " في", "probability": 0.90185546875}, {"start": 1931.09, "end": 1931.25, "word": " بعض", "probability": 0.970947265625}, {"start": 1931.25, "end": 1931.59, "word": " الصور", "probability": 0.98828125}, {"start": 1931.59, "end": 1932.31, "word": " بتوريكوا", "probability": 0.74228515625}, {"start": 1932.31, "end": 1932.87, "word": " إياها", "probability": 0.8025716145833334}, {"start": 1932.87, "end": 1933.47, "word": " اللي", "probability": 0.920166015625}, {"start": 1933.47, "end": 1933.67, "word": " هي", "probability": 0.8525390625}, {"start": 1933.67, "end": 1934.17, "word": " ال", "probability": 0.98388671875}, {"start": 1934.17, "end": 1934.35, "word": " ..", "probability": 0.19873046875}, {"start": 1934.35, "end": 1934.63, "word": " ال", "probability": 0.92578125}, {"start": 1934.63, "end": 1934.85, "word": " all's", "probability": 0.2657470703125}, {"start": 1934.85, "end": 1934.91, "word": " اللي", "probability": 0.912353515625}, {"start": 1934.91, "end": 1935.43, "word": " شايفينها", "probability": 0.9087890625}, {"start": 1935.43, "end": 1936.43, "word": " هذي", "probability": 0.5613606770833334}, {"start": 1936.43, "end": 1936.93, "word": " شكل", "probability": 0.98388671875}, {"start": 1936.93, "end": 1937.05, "word": " من", "probability": 0.9794921875}, {"start": 1937.05, "end": 1937.69, "word": " أشكال", "probability": 0.8609619140625}, {"start": 1937.69, "end": 1937.87, "word": " اللي", "probability": 0.967529296875}, {"start": 1937.87, "end": 1938.07, "word": " هو", "probability": 0.98095703125}, {"start": 1938.07, "end": 1938.31, "word": " ال", "probability": 0.5966796875}, {"start": 1938.31, "end": 1938.75, "word": " slow", "probability": 0.96435546875}, {"start": 1938.75, "end": 1939.25, "word": " healing", "probability": 0.92041015625}, {"start": 1939.25, "end": 1939.69, "word": " على", "probability": 0.11962890625}, {"start": 1939.69, "end": 1940.03, "word": " الصرفي", "probability": 0.61676025390625}, {"start": 1940.03, "end": 1940.31, "word": " كمان", "probability": 0.9388020833333334}, {"start": 1940.31, "end": 1940.91, "word": " صورة", "probability": 0.98046875}, {"start": 1940.91, "end": 1941.53, "word": " أخرى", "probability": 0.9739583333333334}, {"start": 1941.53, "end": 1941.83, "word": " على", "probability": 0.78125}, {"start": 1941.83, "end": 1942.23, "word": " الإصبع", "probability": 0.916748046875}, {"start": 1942.23, "end": 1942.55, "word": " هنا", "probability": 0.87451171875}, {"start": 1942.55, "end": 1943.27, "word": " هذا", "probability": 0.740234375}, {"start": 1943.27, "end": 1943.77, "word": " غالبا", "probability": 0.96923828125}, {"start": 1943.77, "end": 1944.23, "word": " بينتج", "probability": 0.906494140625}, {"start": 1944.23, "end": 1944.47, "word": " من", "probability": 0.98779296875}, {"start": 1944.47, "end": 1944.99, "word": " تعامل", "probability": 0.962890625}, {"start": 1944.99, "end": 1945.19, "word": " مع", "probability": 0.98828125}, {"start": 1945.19, "end": 1945.69, "word": " حيوانات", "probability": 0.98916015625}, {"start": 1945.69, "end": 1945.81, "word": " زي", "probability": 0.78564453125}, {"start": 1945.81, "end": 1945.85, "word": " ما", "probability": 0.96533203125}, {"start": 1945.85, "end": 1946.33, "word": " حكينالكوا", "probability": 0.9391276041666666}, {"start": 1946.33, "end": 1946.99, "word": " حيوانات", "probability": 0.98359375}, {"start": 1946.99, "end": 1947.89, "word": " مصابة", "probability": 0.9708251953125}, {"start": 1947.89, "end": 1948.67, "word": " ب", "probability": 0.595703125}, {"start": 1948.67, "end": 1948.91, "word": " ال", "probability": 0.40087890625}, {"start": 1948.91, "end": 1949.23, "word": " Francis", "probability": 0.45166015625}, {"start": 1949.23, "end": 1949.69, "word": " de", "probability": 0.4658203125}, {"start": 1949.69, "end": 1950.21, "word": " Lawrence", "probability": 0.10302734375}, {"start": 1950.21, "end": 1950.49, "word": " المرة", "probability": 0.9169921875}, {"start": 1950.49, "end": 1950.71, "word": " الجاية", "probability": 0.6663411458333334}, {"start": 1950.71, "end": 1950.83, "word": " ان", "probability": 0.68701171875}, {"start": 1950.83, "end": 1951.03, "word": " شاء", "probability": 0.984619140625}, {"start": 1951.03, "end": 1951.31, "word": " الله", "probability": 0.96435546875}, {"start": 1951.31, "end": 1952.25, "word": " نكمل", "probability": 0.9921875}, {"start": 1952.25, "end": 1953.09, "word": " في", "probability": 0.95751953125}, {"start": 1953.09, "end": 1953.53, "word": " المحاضرة", "probability": 0.9722900390625}, {"start": 1953.53, "end": 1954.03, "word": " في", "probability": 0.57763671875}, {"start": 1954.03, "end": 1954.15, "word": " ال", "probability": 0.93505859375}, {"start": 1954.15, "end": 1954.57, "word": " hemophilus", "probability": 0.70501708984375}, {"start": 1954.57, "end": 1954.97, "word": " influenza", "probability": 0.94140625}, {"start": 1954.97, "end": 1955.27, "word": " بإذن", "probability": 0.82012939453125}, {"start": 1955.27, "end": 1955.39, "word": " الله", "probability": 0.96240234375}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1956.4205, "duration_after_vad": 1871.0568749999961}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/5w4owWd7qLs_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/5w4owWd7qLs_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..8b2d5c0ac463865d80107541d71a1d7d090c3a7d
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/5w4owWd7qLs_raw.srt
@@ -0,0 +1,1860 @@
+1
+00:00:21,080 --> 00:00:23,840
+بسم الله الرحمن الرحيم اليوم موضوعنا ان شاء الله
+
+2
+00:00:23,840 --> 00:00:28,300
+Francisella tolerances بس قبل ما نبدأ بالموضوع
+
+3
+00:00:28,300 --> 00:00:32,800
+بدنا نأكد على مجموعة من الحقائق اللي بدأنا فيها في
+
+4
+00:00:32,800 --> 00:00:36,920
+أول الفصل على أساس انه نبرر لماذا فصلنا هذه
+
+5
+00:00:36,920 --> 00:00:40,160
+المجموعة او هذه البكتيريا عن مجموعات الأصل انها
+
+6
+00:00:40,160 --> 00:00:44,400
+تلحق بيهااحنا لما درسنا المجموعات درسناها بناء على
+
+7
+00:00:44,400 --> 00:00:47,940
+شغل تان الشغل الأولى ال gram stain هل هي gram
+
+8
+00:00:47,940 --> 00:00:50,020
+positive و gram negative و هل هي بس الله و لا
+
+9
+00:00:50,020 --> 00:00:53,040
+كوكساية و قسمناها من أربع مجموعات و الصحيح أننا
+
+10
+00:00:53,040 --> 00:00:56,220
+المفروض أنه انتهينا من ال gram negative بس الله و
+
+11
+00:00:56,220 --> 00:01:00,660
+انتهينا من كل المجموعات و بدأنا بمناقشة مجموعة ال
+
+12
+00:01:00,660 --> 00:01:03,100
+mycobacteria اللي مالاش علاقة خالص بال gram stain
+
+13
+00:01:03,100 --> 00:01:07,360
+ال acid fast bacteria لماذا عودنا اليوم لنتحدث عن
+
+14
+00:01:07,360 --> 00:01:10,140
+Francilla tolerances وهي gram negative بس الله
+
+15
+00:01:11,870 --> 00:01:16,430
+المجموع اللى هتحدث عنها اليوم لفرانسيسيلا وغدا او
+
+16
+00:01:16,430 --> 00:01:19,850
+المحاضرة القادمة ان شاء الله هيكون عن الهموفلس و
+
+17
+00:01:19,850 --> 00:01:23,990
+بعديها عن لبروسيلا هدولة التلت مجموعات او تلت
+
+18
+00:01:23,990 --> 00:01:27,490
+اسماء هي عبارة عن gram negative بس ال lie لكن
+
+19
+00:01:27,490 --> 00:01:30,970
+لماذا فصلناهم عن المجموعة الاولانية اكيد فيهم
+
+20
+00:01:30,970 --> 00:01:34,590
+خصوصية ايه الخصوصية دى انهم التلت مجموعات are
+
+21
+00:01:34,590 --> 00:01:38,640
+fastidiousيعني إليهم طلبات غذائية they are slow
+
+22
+00:01:38,640 --> 00:01:42,720
+growing bacteria البعض منهم بده يومين أو أربع أيام
+
+23
+00:01:42,720 --> 00:01:46,200
+البعض الآخر بده ستة أسابيع يا شباب البروسيلا بده
+
+24
+00:01:46,200 --> 00:01:49,000
+ستة أسابيع فخديني أتعرف اليوم ان شاء الله على أول
+
+25
+00:01:49,000 --> 00:01:52,140
+مايكروب في السلسلة من ثلاث مايكروبات كمان مرة
+
+26
+00:01:52,140 --> 00:01:56,200
+فرنسسيلا هيموفلاس وفي عندنا اللي هو البروسيلا
+
+27
+00:01:58,360 --> 00:02:02,640
+البكتيريا عبارة عن gram-bacilli لكن بتظهر لنا
+
+28
+00:02:02,640 --> 00:02:06,480
+أشكال و ألوان مختلفة يعني بمعنى أخر قد تتخذ شكل
+
+29
+00:02:06,480 --> 00:02:11,080
+cocoa bacilli و قد تصل بيها يعني إلى شكل كوكساي
+
+30
+00:02:11,080 --> 00:02:14,170
+كامة الاستدارة روحنا نشوف صورة كامة شويةإن
+
+31
+00:02:14,170 --> 00:02:17,550
+البكتيريا بالفعل ماخدة بيزار forms أشكال غريبة
+
+32
+00:02:17,550 --> 00:02:21,070
+ومتنوعة البكتيريا هو إيه إجبارية؟ هي كان ميكروبيا
+
+33
+00:02:21,070 --> 00:02:25,570
+عرفته إجباري لحد اليوم Sodomonas aeruginosa أخدتوا
+
+34
+00:02:25,570 --> 00:02:28,810
+ال mycobacterium tuberculosis، هذي obligate وهي
+
+35
+00:02:28,810 --> 00:02:32,050
+كمان اللي هي strict aerobic اللي هي لـFrancis Hill
+
+36
+00:02:33,430 --> 00:02:39,010
+البكتيريا نعم البصيلاس كان منها aerobic ومنها
+
+37
+00:02:39,010 --> 00:02:43,030
+facultative انا aerobic البكتيريا requires
+
+38
+00:02:43,030 --> 00:02:46,510
+enriched medium وهذا كلام تأكيد على ما ذكرناه في
+
+39
+00:02:46,510 --> 00:02:50,650
+بداية المحاضرة ان هي fastidious تحتاج إلى وسط
+
+40
+00:02:50,650 --> 00:02:54,950
+blood agar محتوى على cysteine زائد جلوكوز ولذلك
+
+41
+00:02:54,950 --> 00:02:59,030
+سمي الوسط cysteine glucose blood agar او CGPA
+
+42
+00:03:00,120 --> 00:03:04,200
+البكتيريا non-motile تستطيع البكتيريا البقاء حية
+
+43
+00:03:04,200 --> 00:03:09,160
+في ال environment وحنشوف أكتر مصدر للبكتيريا اللي
+
+44
+00:03:09,160 --> 00:03:12,960
+هو ال natural water و ال soils highly infectious
+
+45
+00:03:12,960 --> 00:03:18,180
+إذا كنا بنتعامل مع عينة أو مع culture أو مع حيوان
+
+46
+00:03:18,180 --> 00:03:21,980
+حتى مصاب أو إنسان مصاب بالتلوريميا الأصل أنه احنا
+
+47
+00:03:21,980 --> 00:03:26,800
+نكون very cautious لإنه البكتيريا highly
+
+48
+00:03:26,800 --> 00:03:27,520
+infectious
+
+49
+00:03:30,600 --> 00:03:33,440
+هذه الصورة اللي حكيتلكوا عنها انه قدامنا gram
+
+50
+00:03:33,440 --> 00:03:36,760
+stain غالبا في ال gram stain بنشوف حاجة واضحة اما
+
+51
+00:03:36,760 --> 00:03:39,700
+بصلاي او كوكساي لكن في هذه الصورة الحقيقة انه ما
+
+52
+00:03:39,700 --> 00:03:43,880
+بنشوف حاجة واضحة نعم لكن شايفين لون احمر يعني مؤشر
+
+53
+00:03:43,880 --> 00:03:47,700
+على انه gram negative بكتير ال size دي بقى نوعا ما
+
+54
+00:03:47,700 --> 00:03:52,500
+small ال clinical manifestation او ال disease اللي
+
+55
+00:03:52,500 --> 00:03:55,600
+caused by this organism بيعتمد على تلت عناصر مهمة
+
+56
+00:03:55,600 --> 00:04:01,080
+جدا رقم واحدRoot of infection من وين دخل الميكروب
+
+57
+00:04:01,080 --> 00:04:04,200
+وحنشوف الآن مجموعة من ال roots المختلفة اللى ممكن
+
+58
+00:04:04,200 --> 00:04:08,120
+ننتقل من خلالها هذا الميكروب رقم اتنين ال
+
+59
+00:04:08,120 --> 00:04:12,380
+infecting dose مجدش عدد البكتيريا اللى دخل الى هذا
+
+60
+00:04:12,380 --> 00:04:16,410
+المكان رقم تلاتةtype of organism هو كم type يعني
+
+61
+00:04:16,410 --> 00:04:19,810
+احنا هي اسم البكتيريا الفرنسية tolerances لكن في
+
+62
+00:04:19,810 --> 00:04:23,970
+منها subspecies subspecies type A وtype B either
+
+63
+00:04:23,970 --> 00:04:27,750
+from A and B وبيختلفوا عن بعض الحقيقة في ال
+
+64
+00:04:27,750 --> 00:04:31,510
+virulence فtype A is more virulent type B غالبا
+
+65
+00:04:31,510 --> 00:04:34,310
+تنتجلي ما يسمى subclinical infection ايش يعني
+
+66
+00:04:34,310 --> 00:04:38,810
+subclinical يعني الأعراض تبع المرض بتكون غير ظاهرة
+
+67
+00:04:38,810 --> 00:04:43,800
+بنسميها mild أو subclinical infectionأيضا اتفقنا
+
+68
+00:04:43,800 --> 00:04:46,760
+على انه فيه تلت عناصر بيحددوا مصار ال clinical
+
+69
+00:04:46,760 --> 00:04:51,060
+manifestation مكان دخول البكتيريا ال infecting
+
+70
+00:04:51,060 --> 00:04:55,200
+dose نفسها تلاتة نوع البكتيريا هل هي من type A و
+
+71
+00:04:55,200 --> 00:05:00,020
+لا type B الان كيف ينتقل المرض للإنسان يعني
+
+72
+00:05:00,020 --> 00:05:04,080
+البكتيريا كيف مسارات الانتقال تبعتها بقولنا either
+
+73
+00:05:04,080 --> 00:05:06,980
+through the skin or the mucous membrane كلكم
+
+74
+00:05:06,980 --> 00:05:11,610
+بتعرفوا ان ال skinالـ normal skin is impenetrable
+
+75
+00:05:11,610 --> 00:05:14,650
+by microorganism البكتيريا بيكون غير قادرة على
+
+76
+00:05:14,650 --> 00:05:19,890
+اختلاقه، لكن خلال جروح، خدوش، حبوب أصلا موجودة قد
+
+77
+00:05:19,890 --> 00:05:26,750
+ينتقل من الجلد، بتكلم عن broken skin محروج، مجروح،
+
+78
+00:05:26,750 --> 00:05:30,330
+مخدوش، في آفة، في infection أساسي، مصدرها غير
+
+79
+00:05:30,330 --> 00:05:34,570
+البكتيريا اللي بتكلم عنها، كلها قد تؤهل لدخول
+
+80
+00:05:34,570 --> 00:05:38,860
+البكتيريا رقم اتنين لـ mucous membraneماذا يوجد في
+
+81
+00:05:38,860 --> 00:05:43,780
+ميوكاس من برينج الظاهر لنا؟ ال conjunctiva تبقى
+
+82
+00:05:43,780 --> 00:05:44,100
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+83
+00:05:44,100 --> 00:05:46,380
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+84
+00:05:46,380 --> 00:05:47,300
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+85
+00:05:47,300 --> 00:05:47,520
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+86
+00:05:47,520 --> 00:05:51,680
+تبقى تبقى تبقى تبقى
+
+87
+00:05:51,680 --> 00:06:00,500
+تبقى تبقى تبقى تبقىلأنه .. لأنه .. كمان مرة أذكركم
+
+88
+00:06:00,500 --> 00:06:03,320
+بالحقيقة اللي احنا ميرانا و اتكرانا اللي بنقول أنه
+
+89
+00:06:03,320 --> 00:06:07,440
+الأصابع هي الأداة الأكتر استخداما على وجه الأرض من
+
+90
+00:06:07,440 --> 00:06:11,480
+قبل البشر بنستخدمها في كل حاجة حتى لما بنطبع و
+
+91
+00:06:11,480 --> 00:06:14,520
+بنقول أنها حاسيب حتى لما بنمسك ال mouse حتى لو
+
+92
+00:06:14,520 --> 00:06:18,520
+كانت ال wireless ال mouse بنستخدم الأصابع تبعتنا
+
+93
+00:06:18,520 --> 00:06:22,260
+بندفع فلوس، بناخد فلوس، أكم واحد مسكها، بنسلم عن
+
+94
+00:06:22,260 --> 00:06:26,780
+ناس، بنمسك أسطح، وبالتاليطالما هي الأداة الأكثر
+
+95
+00:06:26,780 --> 00:06:30,120
+استخداما يبقى هي الأداة الأكثر أوضر التلوث ومدام
+
+96
+00:06:30,120 --> 00:06:32,840
+هي الأكثر أوضر التلوث يبقى هي برضه كمان من الأدوات
+
+97
+00:06:32,840 --> 00:06:36,400
+المهمة جدا في نقل العدوى من الأشياء اللي احنا
+
+98
+00:06:36,400 --> 00:06:40,080
+بنركز عليها الـ mucous membrane بنقولك انه ال
+
+99
+00:06:40,080 --> 00:06:44,060
+influenza قد تنتقل مش respiratory عبر ال
+
+100
+00:06:44,060 --> 00:06:46,500
+conjunctiva يعني لو انت لمست أسطح عليها فيروس
+
+101
+00:06:46,500 --> 00:06:50,200
+influenza وحكيت عينك ووصلت الأصابع ل ال
+
+102
+00:06:50,200 --> 00:06:53,180
+conjunctiva ممكن تنتقل ال influenza و الرشح وأمراض
+
+103
+00:06:53,180 --> 00:06:57,510
+كثيرة جداالميوكاس ميمبراين أخدنا مثال عليها مين
+
+104
+00:06:57,510 --> 00:07:01,530
+including the conjunctiva through the bite of
+
+105
+00:07:01,530 --> 00:07:05,270
+infective ticks تكس اللي هم القراد حشرة من الحشرات
+
+106
+00:07:05,270 --> 00:07:08,450
+اللي بيسموها blood sucking arthropods يعني بتتغذع
+
+107
+00:07:08,450 --> 00:07:12,590
+الحيوانات أو بتتغذع الإنسان بتاخد منه وشبة دم إذا
+
+108
+00:07:12,590 --> 00:07:15,950
+في عندي skin في عندي ميوكاس ميمبراين في عندي blood
+
+109
+00:07:15,950 --> 00:07:20,100
+sucking arthropods في كمان لسهtransmission may
+
+110
+00:07:20,100 --> 00:07:24,220
+also occur through the respiratory tract كيف؟ عن
+
+111
+00:07:24,220 --> 00:07:28,520
+طريق ال inhalation ل aerosols .. aerosols اللي هم
+
+112
+00:07:28,520 --> 00:07:30,940
+الرذاذ المحتوي على الميكروب
+
+113
+00:07:34,980 --> 00:07:39,380
+اللوحة السابقة قلنا ان ال bacteria can survive for
+
+114
+00:07:39,380 --> 00:07:43,100
+long periods في ال environment و من ضمن ال
+
+115
+00:07:43,100 --> 00:07:46,460
+environment اللي هو ال water و ال water الأساسي
+
+116
+00:07:46,460 --> 00:07:49,420
+اللي ناقل مش ال ground water ال surface water
+
+117
+00:07:49,980 --> 00:07:52,220
+عارفينش ما هي surface water؟ اللي هي ال .. ال ..
+
+118
+00:07:52,220 --> 00:07:55,100
+ال .. الوديان و الأنهار و ال .. يعني المجاري
+
+119
+00:07:55,100 --> 00:07:58,660
+المائية، المجاري المائية لما يكون في مجرة مائي و
+
+120
+00:07:58,660 --> 00:08:02,820
+بينزل منحدر كيف الماء بيسقط؟ مش بيسقط بشكل شلال و
+
+121
+00:08:02,820 --> 00:08:06,340
+بيعملنا إيه؟ رذاذ فلو كان الماء هذا محتوى على
+
+122
+00:08:06,340 --> 00:08:10,600
+الميكروب و عمل رذاذ قد الناس تنشق و احنا و نصاب
+
+123
+00:08:10,600 --> 00:08:14,850
+بال disease رقم اتنينthrough the gastrointestinal
+
+124
+00:08:14,850 --> 00:08:20,370
+tract، يعني الإنسان بدى يتناول لحوم لحيوانات
+
+125
+00:08:20,370 --> 00:08:23,970
+مصابة، هذه اللحوم لم تكن مطهية بشكل جيد، و أنا
+
+126
+00:08:23,970 --> 00:08:28,670
+قلتلكوا إنه قد نقوم بشوي بعض اللحوم ولا تصل
+
+127
+00:08:28,670 --> 00:08:32,610
+الحرارة إلى داخلها بشكل جيد لقتل ال micro organism
+
+128
+00:08:33,220 --> 00:08:37,860
+أنا نسيت أحكي شغل أنه Toleremia هو ال disease اللي
+
+129
+00:08:37,860 --> 00:08:40,760
+بتسببه in France ال tolerances أو rabbit fever
+
+130
+00:08:40,760 --> 00:08:45,360
+حُمّى الأرانب مين فيكوا عمره شاف أرنب بري أو مسك
+
+131
+00:08:45,360 --> 00:08:53,200
+أرنب بري؟ كيف مخالبه؟ ولا مايله مخالب؟ بيكون مجزج
+
+132
+00:08:53,200 --> 00:08:57,820
+أضافر وجهي على ال .. أه؟ الأرنب البري عشانه بري
+
+133
+00:08:58,820 --> 00:09:01,940
+غالباً لما بيجيوا في الشبكة و بيصيدوا بالشبك هم في
+
+134
+00:09:01,940 --> 00:09:06,660
+غزة انا بيصيدوا بالشبك اللي بيجيه بيخلصه بيحاول هو
+
+135
+00:09:06,660 --> 00:09:12,010
+انه يتملص فبمحاولة ممكن يخدشفإذا كان الأرنب هذا
+
+136
+00:09:12,010 --> 00:09:16,210
+مصاب بالتلوريميا أو حامل التلوريميا ممكن ينقل ال
+
+137
+00:09:16,210 --> 00:09:21,150
+disease أو لما نذبح الأرنب و ننظفه تمام؟ إذا كان
+
+138
+00:09:21,150 --> 00:09:24,410
+برضه مصاب و عندنا جروحة احنا و احنا بننظف فيه لذلك
+
+139
+00:09:24,410 --> 00:09:28,450
+أكتر ناس بيصابوا بالتلوريميا هم الناس اللي بتعامله
+
+140
+00:09:28,450 --> 00:09:32,430
+مع الحيوانات المصابة بيسموهم ال carcasses الذبائح
+
+141
+00:09:32,430 --> 00:09:37,920
+الذبيحة carcassإذا في عندي هنالان انا مجموعة من
+
+142
+00:09:37,920 --> 00:09:42,200
+الطرق اللي من خلالها بيتم انتقال البكتيريا عشان
+
+143
+00:09:42,200 --> 00:09:45,960
+اتجهنا دروت of infection مهمة اتجهنا انه قد تنتقل
+
+144
+00:09:45,960 --> 00:09:49,900
+عن طريق ال skin قد تنتقل عن طريق ال ال membrane ال
+
+145
+00:09:49,900 --> 00:09:52,920
+ميوكاسب قد تنتقل عن طريق ال blood sucking earth
+
+146
+00:09:52,920 --> 00:09:56,120
+robot قد تنتقل عن طريق ال respiratory route قد
+
+147
+00:09:56,120 --> 00:10:00,880
+تنتقل عن طريق ال ingestion او تناول اللي هو ال
+
+148
+00:10:00,880 --> 00:10:05,150
+meat of infected animalالان نبدأ للأشكال تبع ال
+
+149
+00:10:05,150 --> 00:10:09,710
+disease بننظر للروحة رقم أو الاسم الأول والتاني
+
+150
+00:10:09,710 --> 00:10:15,370
+نفس النظرة فان دي هاسمة ulceroglandular والتانية
+
+151
+00:10:15,370 --> 00:10:20,290
+oculoglandular الان ال ulceroglandular هو skin
+
+152
+00:10:20,290 --> 00:10:26,150
+والتاني eye لان ocular معناها eyeالاتنين نفس ال
+
+153
+00:10:26,150 --> 00:10:30,130
+disease لكن مكانين مختلفين واحد في الجلد واحد في
+
+154
+00:10:30,130 --> 00:10:35,850
+العين ليش في العين لأننا كنا contaminated fingers
+
+155
+00:10:35,850 --> 00:10:39,970
+الأولاني هو ال most common form of all tularemia
+
+156
+00:10:39,970 --> 00:10:43,930
+أكتر شكل منتشر وشائع من الناس اللي هو ال
+
+157
+00:10:43,930 --> 00:10:49,370
+ulceroglandial وإيش شكله بينتج بينتج لما يسمى ب
+
+158
+00:10:49,370 --> 00:10:56,100
+slowly healing ulcer يعني تقرح أو قرحةالشفاء تبعها
+
+159
+00:10:56,100 --> 00:11:00,880
+بيتم ببطء شديد جدا كمان شغل تاني مهم جدا ان ال
+
+160
+00:11:00,880 --> 00:11:03,880
+lymph node اللي في المنطقة بيصير لها inflammation
+
+161
+00:11:03,880 --> 00:11:07,820
+وقد ترتفع يعني مثلا لو كانت في المنطقة هذه المنطقة
+
+162
+00:11:07,820 --> 00:11:12,040
+دي هسير فيها ايه انتفاخ بتذكرنا بمين باليارسينيا
+
+163
+00:11:12,040 --> 00:11:16,440
+بيستس لما عملت الببو لإن وجهنا اللي لها ال ال ال
+
+164
+00:11:16,440 --> 00:11:19,140
+ال ال ال regional lymph node بيصير لها
+
+165
+00:11:19,140 --> 00:11:23,520
+inflammation وبالتالي بيصير فيها انتفاخ و بتبيننفس
+
+166
+00:11:23,520 --> 00:11:25,900
+الفكرة زى ما حكينا هدا قولنا لكوا ممكن نتقل عن
+
+167
+00:11:25,900 --> 00:11:28,180
+طريق اللى هو الجروح أو عن طريق ال blood sucking
+
+168
+00:11:28,180 --> 00:11:31,800
+earth robots زى ال ticks and flies flies اللى هى
+
+169
+00:11:31,800 --> 00:11:36,950
+الذبابOculoglandular حكيناه كنا نفس الفكرة لكن
+
+170
+00:11:36,950 --> 00:11:38,990
+بصيب العين وعن طريق اللي هو ال contaminated
+
+171
+00:11:38,990 --> 00:11:41,990
+fingers الشكل التالت اللي هو البلموناري or
+
+172
+00:11:41,990 --> 00:11:47,130
+pneumonic وهو شكل من أشكال الخطيرة لل disease صحيح
+
+173
+00:11:47,130 --> 00:11:52,650
+أقل انتشارا أقل انتشارا لكن هو شكل خطير وبينتقل
+
+174
+00:11:52,650 --> 00:11:57,970
+عبر الرذاذ تبع اللي هو المياه اللي infected with
+
+175
+00:11:57,970 --> 00:12:02,440
+this organismالاخير أو الشكل الأخير له تايفايدل
+
+176
+00:12:02,440 --> 00:12:06,220
+تايفايدل طبعا أكيد سمنها تايفايدل على غرار تايفايد
+
+177
+00:12:06,220 --> 00:12:09,660
+ليش لأن هو اللي بينتج عن تناول و أظن التايفايدل
+
+178
+00:12:09,660 --> 00:12:12,680
+كنا نقول ingestion of salmonella إذا بنتج عن تناول
+
+179
+00:12:12,680 --> 00:12:16,200
+اللي هو ال contaminated food symptoms begins as a
+
+180
+00:12:16,200 --> 00:12:18,240
+flu-like associated with vomiting flu-like كنا
+
+181
+00:12:18,240 --> 00:12:21,060
+قلنا زي ال influenza بعدين بيصاحبها اللي هو ال
+
+182
+00:12:21,060 --> 00:12:25,140
+vomiting headache, fever, prostration وممكن دياريا
+
+183
+00:12:25,140 --> 00:12:28,720
+could accompany these symptoms يعني بيصير في الآخر
+
+184
+00:12:28,720 --> 00:12:33,260
+كمان برضه السرإذا كم شكل من الأشكال سارانا؟ أربع
+
+185
+00:12:33,260 --> 00:12:37,960
+نعدهم كمان مرة أوكيلوغلانديلر أولسيروغلانديلر أفضل
+
+186
+00:12:37,960 --> 00:12:40,040
+أولسيروغلانديلر بالأول لأن هو ال most common
+
+187
+00:12:40,040 --> 00:12:43,880
+أوكيلوغلانديلر بلموناري أو ال pneumonia و الرابع
+
+188
+00:12:43,880 --> 00:12:46,980
+اللي هو الtyphoidal أو ال gastrointestinal أو ال
+
+189
+00:12:46,980 --> 00:12:50,920
+oropharyngeal typeذاكرنا احنا في بداية المحاضرة
+
+190
+00:12:50,920 --> 00:12:53,800
+انه في صنثين type A و type B كيف نميز بين التاني
+
+191
+00:12:53,800 --> 00:13:02,080
+فرنسية لورنسا type A و فرنسية لورنسا type B بقولنا
+
+192
+00:13:02,080 --> 00:13:06,840
+الاولى is more virulent thanthe second والدليل على
+
+193
+00:13:06,840 --> 00:13:10,920
+ذلك انه ال mortality rate او ال fatality rate قد
+
+194
+00:13:10,920 --> 00:13:15,480
+تصل الى خمسة لسبعة في المية اذا لم يعالج المرضى
+
+195
+00:13:15,480 --> 00:13:18,940
+لكن لو طلعنا على الجزء السفلي هنا في المحاضرة او
+
+196
+00:13:18,940 --> 00:13:24,520
+في الشريحة هلاجي انه البكتيريا بتسبب ما يسمى mild
+
+197
+00:13:24,520 --> 00:13:28,220
+او subclinical infection يبتدى مافيش انها fatality
+
+198
+00:13:28,220 --> 00:13:33,870
+rate لكن تعالوا نطلع على حاجة مميزةيسمى هذا النوع
+
+199
+00:13:33,870 --> 00:13:39,650
+اسم آخر غير type A تك دير فلاي شيب type ليش سموه
+
+200
+00:13:39,650 --> 00:13:43,490
+.. او هذا ال tick عبارة عن حشرة و ال deer fly برضه
+
+201
+00:13:43,490 --> 00:13:46,550
+عبارة عن حشرة و ال sheep ليها الخرافة ليش سموه
+
+202
+00:13:46,550 --> 00:13:50,250
+بهذا الاسم لأنه في ال nature it cycles between
+
+203
+00:13:50,250 --> 00:13:54,490
+these creatures بين هذه المخلوقات من ال tick لل
+
+204
+00:13:54,490 --> 00:13:58,570
+sheep من ال deer fly لل sheep وبالتالي هي ال cycle
+
+205
+00:13:58,570 --> 00:14:03,100
+تبعته بالاضافة لل environmentلكن type B إيه الاسم
+
+206
+00:14:03,100 --> 00:14:07,220
+تاني؟ بيفر؟ ماعرفش بتعرفوش يعني بيفر ولا بتعرفوش
+
+207
+00:14:07,220 --> 00:14:12,020
+بيفر معناها بالعرب القندس والقندس عبارة عن حيوان
+
+208
+00:14:12,020 --> 00:14:18,280
+مائي كبير نوعا ما بهذا الحجم ويطلق عليه لقب مهندس
+
+209
+00:14:18,280 --> 00:14:25,260
+المياه ليش بيسموه مهندس المياه؟بسوي جسور بالأحرى
+
+210
+00:14:25,260 --> 00:14:31,100
+جسور عشان يعيش فيها لما يعني يخرج من الماء و عنده
+
+211
+00:14:31,100 --> 00:14:35,660
+مهارة كبيرة في قطع النباتات وتحويلها لجسور
+
+212
+00:14:35,660 --> 00:14:41,040
+الموسكرات الموسكرات هذا بسموه جرذ المسك او فقر
+
+213
+00:14:41,040 --> 00:14:45,340
+المسك ايضا حيوان مائي لاحظ حيوان مائي و حيوان مائي
+
+214
+00:14:45,340 --> 00:14:52,180
+واش كمان قلنا في الآخر كمان waterبيفر وموسكرة يبقى
+
+215
+00:14:52,180 --> 00:14:55,960
+ال micro organism يلف في البيئة بين البيفر
+
+216
+00:14:55,960 --> 00:15:01,970
+والموسكرة ومين و ال water وبالتالي هذا ال type Bزي
+
+217
+00:15:01,970 --> 00:15:05,890
+ما حكينا it produces mild infection او subclinical
+
+218
+00:15:05,890 --> 00:15:08,970
+infection الان لو انا في يوم من الأيام و انا
+
+219
+00:15:08,970 --> 00:15:12,370
+استبعد ان يكون هنا في فلسطين اصلا فرنسية لا
+
+220
+00:15:12,370 --> 00:15:16,470
+tolerances ليش باستبعد؟ لا الموسكرات موجود ولا ال
+
+221
+00:15:16,470 --> 00:15:19,630
+beaver موجود ولا ال surface water موجود احنا we
+
+222
+00:15:19,630 --> 00:15:23,310
+totally dependent على مين؟ على اللي هو ال ground
+
+223
+00:15:23,310 --> 00:15:27,190
+water بالمناسبة مرة من المرات ابصر كيف ايجي عندنا
+
+224
+00:15:27,190 --> 00:15:30,090
+beaver على غزة هنا ايجي ال beaver هنا و صدوا على
+
+225
+00:15:30,090 --> 00:15:33,280
+طول و جابونيه على الجامعةهنطول الشباب في الأحياء
+
+226
+00:15:33,280 --> 00:15:39,400
+بس بتاعي راح مع القصف طيب to differentiate between
+
+227
+00:15:39,400 --> 00:15:43,520
+type A and type B فى فحص بسيط جدا احنا مش فاكرين
+
+228
+00:15:43,520 --> 00:15:48,170
+ان احنا خدنا 16 glucose blood agar تمام؟بنجيب واحد
+
+229
+00:15:48,170 --> 00:15:51,690
+في المية glycerol وبنضيفه على الوسط وبنضيف
+
+230
+00:15:51,690 --> 00:15:56,530
+بالاضافة لل glycerol اللي هو bromethymol blue
+
+231
+00:15:56,530 --> 00:15:59,870
+indicator مارمع على ال bromethymol blue indicators
+
+232
+00:15:59,870 --> 00:16:05,110
+في ال test في ال TCBS في ال TCBS اذكركوا بس باللون
+
+233
+00:16:05,110 --> 00:16:10,640
+تبعهكان على ال neutral أو nearly alkaline بيكون أو
+
+234
+00:16:10,640 --> 00:16:13,900
+slightly alkaline بيكون أخضر على alkaline عالي
+
+235
+00:16:13,900 --> 00:16:18,980
+أزرق على acid بيكون لونه أصفر في ال TCBS لما عملنا
+
+236
+00:16:18,980 --> 00:16:22,380
+fermentation للستاكروز حوله للون أصفر في ال
+
+237
+00:16:22,380 --> 00:16:26,690
+citrate test لما اتحولإلى ال alkaline تحول لللون
+
+238
+00:16:26,690 --> 00:16:31,070
+اللي هو الأزرق إذا بتوقع إذا البكتيريا بتعمل
+
+239
+00:16:31,070 --> 00:16:34,970
+fermentation للجليسرول أو utilization للجليسرول و
+
+240
+00:16:34,970 --> 00:16:39,290
+بتنتج منه acid انه يتحول لللون الأصفر فيندي type A
+
+241
+00:16:39,290 --> 00:16:44,030
+و type B type A بيعمل utilization للجليسرول و
+
+242
+00:16:44,030 --> 00:16:48,910
+بيحولوا لللون الأصفر بينما type B بيضل عنده زي ما
+
+243
+00:16:48,910 --> 00:16:51,910
+هو dark blue أو بتحول إلى alkaline
+
+244
+00:16:55,790 --> 00:16:59,610
+شوفنا صحيح أشكال متنوعة من ال disease سواء كان في
+
+245
+00:16:59,610 --> 00:17:03,750
+الإنسان أو في الحيوان فما هي ال specimens اللي
+
+246
+00:17:03,750 --> 00:17:08,970
+احنا ممكن نحصل عليها من هذا ال microbe exudates
+
+247
+00:17:08,970 --> 00:17:11,710
+from catanase or mycosal ulcers or lymph node
+
+248
+00:17:11,710 --> 00:17:14,970
+aspirate اعتقد انه احنا درسنا في الورسينية انه
+
+249
+00:17:14,970 --> 00:17:19,290
+بناخد aspirate من الببواللي هو العيش اللي ببقى و
+
+250
+00:17:19,290 --> 00:17:22,890
+كنا، inflamed lymph nodes، مظبوط ولا لأ؟ وبالتالي
+
+251
+00:17:22,890 --> 00:17:27,230
+ممكن ناخد احنا lymph node، aspirate أو ناخد swaps
+
+252
+00:17:27,230 --> 00:17:30,410
+إذا كان فيه exudates، exudates يعني إفرازات،
+
+253
+00:17:30,410 --> 00:17:33,930
+إفرازات صدرية مثلا من الكتانس أو الـmyocosal
+
+254
+00:17:33,930 --> 00:17:40,160
+ulcersممكن ناخد blood or sputum for pulmonary
+
+255
+00:17:40,160 --> 00:17:45,800
+infection لحظة لما قلنا pulmonary أخدنا واحدة من
+
+256
+00:17:45,800 --> 00:17:49,000
+التنتين او التنتين blood or sputum ده ليه علاش
+
+257
+00:17:49,000 --> 00:17:52,860
+علشان في ال pulmonary infection فيه septicemia
+
+258
+00:17:53,380 --> 00:17:57,580
+بيكون فيه septicemia و لا كيف .. كيف العينة
+
+259
+00:17:57,580 --> 00:18:01,340
+المعبرة عن ال pneumonia هي ال sputum و ليس ال
+
+260
+00:18:01,340 --> 00:18:05,080
+blood لكن لأنه always associated with septicemia
+
+261
+00:18:05,080 --> 00:18:09,240
+فممكن نعبر عنها برضه بعينة من؟ بعينة blood ممكن
+
+262
+00:18:09,240 --> 00:18:12,360
+ناخد عينة blood for serology نكشف عن ال antibody
+
+263
+00:18:12,360 --> 00:18:14,880
+هل في عنده antibody للمريض و ليه ماعندهوش antibody
+
+264
+00:18:14,880 --> 00:18:19,660
+رقم أربعة specimens زي ال biopsy from enlarged
+
+265
+00:18:19,660 --> 00:18:23,040
+liver or spleen كمان برضه هذه ممكن تكون عينة
+
+266
+00:18:24,550 --> 00:18:27,390
+diagnostic procedures أول حاجة بنتكلم عن ال gram
+
+267
+00:18:27,390 --> 00:18:30,810
+أو ال microscopic appearance البكتيريا عبارة عن ال
+
+268
+00:18:30,810 --> 00:18:35,450
+gram ال negative non motile bacilli وحكينا عن ال
+
+269
+00:18:35,450 --> 00:18:39,530
+size تبعها إنها small و can assume different
+
+270
+00:18:39,530 --> 00:18:43,010
+shapes منها coco bacilli أو كوكساي و can assume
+
+271
+00:18:43,010 --> 00:18:48,170
+شكل كتير مهم جدا اللي هو زي ال yersinia bestis و
+
+272
+00:18:48,170 --> 00:18:52,200
+كيف ال yersinia bestis كان شكلها؟Cocopasol-I باي
+
+273
+00:18:52,200 --> 00:18:56,760
+بولارلي ستيند هي تالت مايكروب نعرفه باي بولارلي
+
+274
+00:18:56,760 --> 00:19:00,840
+ستيند مين هو التلاتة؟ اليرسينيا والبستوريلا وهي
+
+275
+00:19:00,840 --> 00:19:05,040
+هذه البكتيريا البستوريلا ما درسناش بعد لكن مرة ما
+
+276
+00:19:05,040 --> 00:19:09,700
+اتكلمنا عن اليرسينيازي ما حكينا morphologically
+
+277
+00:19:09,700 --> 00:19:12,380
+maybe similar to your senior spaces and shows
+
+278
+00:19:12,380 --> 00:19:15,920
+bipolar reaction cultural characteristics هذه
+
+279
+00:19:15,920 --> 00:19:18,960
+النقطة المحورية والمفصلية اللي لازم احنا نفهمها
+
+280
+00:19:18,960 --> 00:19:22,860
+كويس البكتيريا قلنا عنها fastidious يعني slow
+
+281
+00:19:22,860 --> 00:19:26,840
+growing بكتيريا slow growing بكتيريالو كانت العينة
+
+282
+00:19:26,840 --> 00:19:29,880
+contaminated with normal microbiota او other
+
+283
+00:19:29,880 --> 00:19:34,060
+microorganisms usually this organism will overgrow
+
+284
+00:19:34,060 --> 00:19:40,780
+و ال overgrow يعني هينمو في شكل اكبر عن الفرنسي
+
+285
+00:19:40,780 --> 00:19:44,240
+اللي هو بتاعلي استهلكوا كمية الغدا او فيه كمان شئ
+
+286
+00:19:44,240 --> 00:19:48,400
+سبب تاني او مشكلة تانية ان هم بينمو البكتيريا
+
+287
+00:19:48,400 --> 00:19:51,760
+الأخرى مش بيطلعوا .. بيطلعوا metabolite من ضمن ال
+
+288
+00:19:51,760 --> 00:19:56,200
+metabolite ايش بيطلعوا؟ acidالاسد بيحول ال pH
+
+289
+00:19:56,200 --> 00:20:02,060
+بيخفضه في الميديا لدرجة قد لا تكون ملائمة لمن؟
+
+290
+00:20:02,060 --> 00:20:06,800
+لنمو اللي هو لفرنسا لتولرنسا لذلك يجب ان تطلعوا
+
+291
+00:20:06,800 --> 00:20:10,540
+هنا يقولون ان ال isolation from a specimen may be
+
+292
+00:20:10,540 --> 00:20:14,560
+difficultلو سألناك السؤال هذا في الامتحان لماذا ال
+
+293
+00:20:14,560 --> 00:20:18,820
+primary isolation is difficult لواحد من اتنين ال
+
+294
+00:20:18,820 --> 00:20:23,100
+contaminated organism may over grow the bacteria
+
+295
+00:20:23,100 --> 00:20:29,860
+رقم اتنين they may produce او reduce the pH نرجع
+
+296
+00:20:29,860 --> 00:20:30,240
+برجع
+
+297
+00:20:39,010 --> 00:20:42,610
+الان احنا بنقول انه .. هنشوف كمان في اللوحة
+
+298
+00:20:42,610 --> 00:20:45,650
+التانية ان ال biochemical test of little value او
+
+299
+00:20:45,650 --> 00:20:49,530
+of no value in identifying the bacteria مالهاش اي
+
+300
+00:20:49,530 --> 00:20:53,630
+فايدة كبيرة في التعرف على البكتيريا فما العمل؟
+
+301
+00:20:53,630 --> 00:20:58,190
+يمكن اكتر شغل بدنا ندجج عليها هو ال cultural
+
+302
+00:20:58,190 --> 00:21:02,450
+characteristics الشكل على الأطباق شكل على الأطباق
+
+303
+00:21:02,450 --> 00:21:07,690
+كيف تبدو هذه المستعمرات؟ طلع عليفكل ما قلتلكوا أنا
+
+304
+00:21:07,690 --> 00:21:12,330
+بنمسك الطبق و بنحركه إلى الأعلى و إلى الأسفل عشان
+
+305
+00:21:12,330 --> 00:21:17,030
+نشوف بطريقتين بطريقة transmitted light و بطريقة
+
+306
+00:21:17,030 --> 00:21:20,670
+اللي هو ال reflected light يعني طريقة الضوء
+
+307
+00:21:20,670 --> 00:21:25,510
+المنعكس و الضوء المار تمام المنبعث الآن في كمان
+
+308
+00:21:25,510 --> 00:21:28,930
+شغل مهم في ال testing لما بطلع على الطبق أنا
+
+309
+00:21:28,930 --> 00:21:33,330
+بمستوى العين و بشوف المستعمرات معظم المستعمرات
+
+310
+00:21:33,330 --> 00:21:39,300
+بتكون flatflat يعني موازية للطبق أو slightly ..
+
+311
+00:21:39,300 --> 00:21:43,160
+slightly convex يعني بتكون محدبة قليلا هذه
+
+312
+00:21:43,160 --> 00:21:50,710
+البكتيريا resembles medium sizemercury droplets
+
+313
+00:21:50,710 --> 00:21:54,650
+كلكوا شوفتوا زئبق كيف قطرات الزئبق كيف تنتشر على
+
+314
+00:21:54,650 --> 00:21:58,910
+الأسطح كيف بتدوب ولا بيبقوا واقفة كورات كورات
+
+315
+00:21:58,910 --> 00:22:02,370
+بتكون واقفة فبالتالي لو اطلعت على مستوى الكورة في
+
+316
+00:22:02,370 --> 00:22:06,130
+الطبق هلاجيها مرتفعة ولا مقفضة مرتفعة فعشانك
+
+317
+00:22:06,130 --> 00:22:09,570
+بيقولوا أن شكل المستعمرات هنا is a distinguishing
+
+318
+00:22:09,570 --> 00:22:17,020
+character يعني صورة مميزة للبكتيريا كمان مرةmedium
+
+319
+00:22:17,020 --> 00:22:22,200
+-sized mercury droplets surrounded by a small zone
+
+320
+00:22:22,200 --> 00:22:26,540
+of partial hemolysis يعني هذه الصفات مهمة جدا لإن
+
+321
+00:22:26,540 --> 00:22:29,200
+الوسط اللي احنا بتكلم عنه هو عبارة عن blood agar
+
+322
+00:22:29,200 --> 00:22:34,320
+مضاف اله سيستين زائد اللي هو جليكوز لكن متى الكلام
+
+323
+00:22:34,320 --> 00:22:40,010
+هذا يا شباب؟بعد اتنين الى اربع أيام يعني ال
+
+324
+00:22:40,010 --> 00:22:44,970
+bacteria will not grow after 24 hours minimum بدها
+
+325
+00:22:44,970 --> 00:22:48,830
+يومين الى اربع أيام وجدش تاخد دمية تبعها واحد
+
+326
+00:22:48,830 --> 00:22:53,090
+millimeter فبدنا نزود ال incubation عشان نزيد
+
+327
+00:22:53,090 --> 00:22:56,650
+الحجم المستوى صغير هذا واحد millimeterفكده لما كنا
+
+328
+00:22:56,650 --> 00:23:00,410
+لو موصفنا ال stephococcus وصفناها كنا large
+
+329
+00:23:00,410 --> 00:23:03,290
+colonies من اتنين لاربعة ملي متر بينما ال small
+
+330
+00:23:03,290 --> 00:23:05,710
+colonies تبعت ال stepped coccus كانت من واحد الى
+
+331
+00:23:05,710 --> 00:23:11,280
+اتنين ملي مترinculation of the specimen زي ما
+
+332
+00:23:11,280 --> 00:23:14,600
+حكيتلكوا انا و قولتلكوا انه قد يكون من الصعوبة بما
+
+333
+00:23:14,600 --> 00:23:19,300
+كان انه نزرع او او نعزل البكتيريا حتى لو كانت
+
+334
+00:23:19,300 --> 00:23:22,380
+موجودة بعدد كبير لإن الcontaminating microorganism
+
+335
+00:23:22,380 --> 00:23:27,100
+بتكون أسرع منها فإنه قد تسيق إلى البكتيريا من
+
+336
+00:23:27,100 --> 00:23:30,340
+ناحية ايه؟ من ناحية انها بتخفض ال pH عن طريق
+
+337
+00:23:30,340 --> 00:23:35,150
+الميتابولزم ده للجليكوزالوسط اللي قلنا عنه 16
+
+338
+00:23:35,150 --> 00:23:38,610
+جليكوز blood agar هو الوسط المستخدم في الزراعة،
+
+339
+00:23:38,610 --> 00:23:40,910
+الان هذا .. هذا الوسط commercially available، ايش
+
+340
+00:23:40,910 --> 00:23:43,430
+يعني commercially available؟ يعني احنا زي .. زي ما
+
+341
+00:23:43,430 --> 00:23:46,890
+بنشتري مكونكي و blood agar، بنقدر نشتريه، لكن لو
+
+342
+00:23:46,890 --> 00:23:50,930
+كان غير ممتاح، يمكن ايضا تحضيره في المعمل عن طريق
+
+343
+00:23:50,930 --> 00:23:54,810
+إضافة 16 جليكوز على ال blood agar اللي انتوا
+
+344
+00:23:54,810 --> 00:23:59,250
+بتعرفواال biochemical identification ذكرناها عبارة
+
+345
+00:23:59,250 --> 00:24:03,890
+انه little value يبقى بيظل عندنا مين الآن ال
+
+346
+00:24:03,890 --> 00:24:08,210
+serology بنقدر نستخدم tube agglutination او slight
+
+347
+00:24:08,210 --> 00:24:11,230
+agglutination test طبعا ال tube agglutination او
+
+348
+00:24:11,230 --> 00:24:14,110
+slight agglutination من جسميهم هدول ايش antibody
+
+349
+00:24:14,110 --> 00:24:18,130
+فاكرين احنا كنا من ضمن العينات بناخد blood for
+
+350
+00:24:18,130 --> 00:24:23,040
+serologyفي فحص مشهور جدا اسمه ال precipitate test
+
+351
+00:24:23,040 --> 00:24:27,980
+احنا حاولنا ما نشرحوش يعني بس نتكلم عن الغرض تبعه
+
+352
+00:24:27,980 --> 00:24:34,080
+ال precipitate test هو فحص ده مارعينا كتير انه
+
+353
+00:24:34,080 --> 00:24:38,000
+soluble antigen بتفاعل مع soluble antibody لما
+
+354
+00:24:38,000 --> 00:24:40,800
+بتفاعلوا مع بعض برتبته مع بعض بيكونوا insoluble
+
+355
+00:24:41,370 --> 00:24:43,710
+كمباوند وبتاعلي بيصير ال precipitate وعشانك سمينا
+
+356
+00:24:43,710 --> 00:24:47,590
+الفحص اللي هو ال precipitate test لكن مين اللي
+
+357
+00:24:47,590 --> 00:24:51,210
+بيعمل ال precipitate؟ antigen specific لمين؟ ال
+
+358
+00:24:51,210 --> 00:24:53,810
+antibody او العكس antibody specific ل antigen
+
+359
+00:24:53,810 --> 00:24:58,430
+وبتاعلي ممكن نستخدم هذا الفحص للكشف عن اما مستوى
+
+360
+00:24:58,430 --> 00:25:02,290
+ال antibodies او الكشف عن وجود ال antigen وهذا
+
+361
+00:25:02,290 --> 00:25:08,050
+الفحص يصلحللكشف عن الانتيجينات حتى في الحيوانات
+
+362
+00:25:08,050 --> 00:25:12,070
+النافقة اللي من فترة طويلة نافقت يعني دهبت يعني مش
+
+363
+00:25:12,070 --> 00:25:15,730
+ضال منها عضم وجلد ممكن ناخد الجلد و العضم هذا و
+
+364
+00:25:15,730 --> 00:25:19,350
+نطحنه و نستخلص منه الانتيجينات بطريقة معينة و
+
+365
+00:25:19,350 --> 00:25:23,910
+نعمله فحص ال precipitate test و انا هنا بقول ان
+
+366
+00:25:23,910 --> 00:25:28,910
+هذا مين بيعمل الفحص غالبا اللي بيعمله monitoring
+
+367
+00:25:28,910 --> 00:25:34,520
+لل disease ايش يعني monitoring لل diseaseلازم نأكد
+
+368
+00:25:34,520 --> 00:25:38,760
+على مفهوم monitoring في موضوع الأمراض الموعدية و
+
+369
+00:25:38,760 --> 00:25:43,840
+أهميته في الدنيا و احنا هنا ايش مواجبنا في
+
+370
+00:25:43,840 --> 00:25:48,580
+المستقبل لتطوير هذا الجانب اللي احنا نفتقر اليه او
+
+371
+00:25:48,580 --> 00:25:52,760
+نفتقده بدا اوضح المفهوم بعيدا عن المحاضرة يعني
+
+372
+00:25:52,760 --> 00:25:59,140
+عشان .. عشان انه الفكرة تصل ان شاء الله قبل
+
+373
+00:25:59,140 --> 00:26:05,380
+أقل من سنتينأنا مشترك في موقع انترنت اسمه bromid
+
+374
+00:26:05,380 --> 00:26:09,160
+برومد ده مؤسسة بتعمل monitoring لل infectious
+
+375
+00:26:09,160 --> 00:26:11,640
+disease في الحيوانة و في الإنسان و في النبات على
+
+376
+00:26:11,640 --> 00:26:18,620
+كل العالم لو سمعوا خبرحتى و لو صحفي بمعنى واحد كتب
+
+377
+00:26:18,620 --> 00:26:24,140
+مقالة في جريدة في مجلة معروفة في الأردن في فلسطين
+
+378
+00:26:24,140 --> 00:26:27,460
+في الكويت في بوركينا فاسو في اي دولة في العالم
+
+379
+00:26:27,460 --> 00:26:32,060
+بياخدوا التقرير هذا و بيترجموه و بياخدوا منه
+
+380
+00:26:32,060 --> 00:26:34,960
+معلومات ايه علاقة بالinfectious disease و ببعتوها
+
+381
+00:26:34,960 --> 00:26:38,440
+لمين و بحطوها على موقعهم و ببعتوها لكل المشتركين
+
+382
+00:26:38,440 --> 00:26:43,780
+فانا كل يوم بصني تقريبا عشر الى خمستاشر email من
+
+383
+00:26:43,780 --> 00:26:48,930
+هذه المؤسسةهدول عشان عاملين monitoring براقب
+
+384
+00:26:48,930 --> 00:26:52,030
+الأمراض المقاعدة في كل العالم، الآن واجبي في
+
+385
+00:26:52,030 --> 00:26:57,190
+فلسطين أن أكون جزء من ال monitoring هذالأن أنا
+
+386
+00:26:57,190 --> 00:27:01,750
+الأمن تبعي الأمن الصحي من الأمراض المعضلة أو
+
+387
+00:27:01,750 --> 00:27:05,390
+الوباء ايه لا يبدأ عند مصر وعند الكائن الصهيوني
+
+388
+00:27:05,390 --> 00:27:10,010
+وإنما يبدأ وين ما بعدهم يعني لو اقترب الخطر في
+
+389
+00:27:10,010 --> 00:27:13,950
+ليبيا ما هي حدود مصر لو كان المرض في ليبيا انا بدي
+
+390
+00:27:13,950 --> 00:27:17,090
+أسير افكر من الآن ان مدينة مصر ليبيا ممكن يصلها
+
+391
+00:27:17,090 --> 00:27:22,240
+مصر اذا وصلت السودان ممكن يصل مصر وهكذافوصل
+
+392
+00:27:22,240 --> 00:27:24,580
+الأخبار عن ال foot and mouth disease اللي بيسموها
+
+393
+00:27:24,580 --> 00:27:27,120
+الحمّة القلعية باللغة العربية إن مولودة في الكائن
+
+394
+00:27:27,120 --> 00:27:30,540
+الصهيوني مولودة في مصر واحنا في غزة مافي عندنا أي
+
+395
+00:27:30,540 --> 00:27:34,240
+حركة مافي عندنا أي حركة ولا حد تحدث الموضوع هذا
+
+396
+00:27:36,160 --> 00:27:39,820
+وبالتالي أنا شخصيا قمت بالاتصال ببعض الناس و يعني
+
+397
+00:27:39,820 --> 00:27:42,240
+اتفلغوا المسئولين في الموضوع و صار بالفعل نوع من
+
+398
+00:27:42,240 --> 00:27:46,180
+الحراك و جابوا vaccines و أصدروا نشرات توعية و
+
+399
+00:27:46,180 --> 00:27:49,100
+أخدوا بعض العينات و فحصوها في الخارج يعني صار في
+
+400
+00:27:49,100 --> 00:27:55,480
+نوع من الحراك لكن لو كان في عناmonitoring programs
+
+401
+00:27:55,480 --> 00:28:00,320
+برامج مراقبة كمان مرة برامج مراقبة دائمة و ليست
+
+402
+00:28:00,320 --> 00:28:03,480
+موسمية بمعنى انها تكون استراتيجية من استراتيجياتنا
+
+403
+00:28:03,480 --> 00:28:07,940
+احنا هيك بنكون أخدنا فرصة انه عملنا early
+
+404
+00:28:07,940 --> 00:28:12,500
+detection early detection كشف مبكر والكشف المبكر
+
+405
+00:28:12,500 --> 00:28:16,240
+يا شباب بيسهل عيني عملية التدخلزي أي مرض حتى لما
+
+406
+00:28:16,240 --> 00:28:21,120
+لقى سرطان لما نكتشفه مبكرا بيكون سهل علاجه
+
+407
+00:28:21,120 --> 00:28:25,780
+والأمراض الماضية كذلك الأمر بيكون سهل السيطرة
+
+408
+00:28:25,780 --> 00:28:29,420
+عليها، إذا كلمة monitoring بنفهمها في موضوع السياق
+
+409
+00:28:29,420 --> 00:28:34,740
+أن هي عملية مستمرة من خلالها بقدر أنا أكشف مبكرا
+
+410
+00:28:34,740 --> 00:28:39,630
+أو أتنبأوالتنبؤ برضه كمان بعطيني انا فرصة او
+
+411
+00:28:39,630 --> 00:28:43,870
+أسبقية انه انا اتصرف قبل حدوث الحدث زي ما صار
+
+412
+00:28:43,870 --> 00:28:46,930
+عندنا مثلا في .. في .. في أمراض ال influenza
+
+413
+00:28:46,930 --> 00:28:52,030
+للخنازير والطيور انه الأمة او العالم لأول مرة في
+
+414
+00:28:52,030 --> 00:28:58,590
+حياته يمتلك فرصة انه يجهز حاله قبل حدوث الوباء فال
+
+415
+00:28:58,590 --> 00:29:01,970
+monitoring عملية مهمة جدا جدا وبدا اخد اقعد مثال
+
+416
+00:29:01,970 --> 00:29:07,870
+تاني عشان حتى يعني نشاركوا بالاهاميةشاطئ البحر
+
+417
+00:29:07,870 --> 00:29:11,570
+عندنا في قطاع غزة شاطئ ممتد حوالي خمسة واربعين
+
+418
+00:29:11,570 --> 00:29:15,510
+كيلومتر من رفح إلى بيت حنون هذا اللي .. اللي احنا
+
+419
+00:29:15,510 --> 00:29:22,310
+الان بنقدر مسمحونا نجرب عليه تمام؟ والشاطئ هذا هو
+
+420
+00:29:22,310 --> 00:29:27,650
+المتنفس الوحيد لسكان قطاع غزة في فصل الصيف للتنزه
+
+421
+00:29:29,140 --> 00:29:32,480
+لكن للأسف مش احنا الوحيدين اللي بنروح عليه تسبقنا
+
+422
+00:29:32,480 --> 00:29:35,700
+المجال يتبعتنا عليه منها ما هو معالج و منها غير
+
+423
+00:29:35,700 --> 00:29:39,700
+معالج و للأسف في تغيير في كمية الضخم و في كمية
+
+424
+00:29:39,700 --> 00:29:42,620
+المعالج بحسب هل في كهرب فيش كهرب يعني في ظروف
+
+425
+00:29:42,620 --> 00:29:48,330
+معينة فلو انا عندي مراقبة مستمرة للشاطرمش انا بكون
+
+426
+00:29:48,330 --> 00:29:51,990
+عندى دايما أسبقية للناس اقولهم ان المنطقة دى
+
+427
+00:29:51,990 --> 00:29:54,870
+ممنوعة او المنطقة دى مسموحة على الأقل انابه
+
+428
+00:29:54,870 --> 00:29:59,890
+الجمهور انه مايدخل فيها مناطق فيها نوع من .. هذا
+
+429
+00:29:59,890 --> 00:30:02,390
+برضه كمان ندعى عن مين؟ عن ال monitoring فال
+
+430
+00:30:02,390 --> 00:30:07,050
+monitoring يا شباب قضية مهمة يجب عليكم التفكير بها
+
+431
+00:30:07,050 --> 00:30:10,660
+بشكل جيد فالناس اللى بيعملوا ال monitoringالناس
+
+432
+00:30:10,660 --> 00:30:14,640
+اللي بيعملوا monitoring غالبا بيكتشفوا أشياء و
+
+433
+00:30:14,640 --> 00:30:18,900
+بيطوروا فحوصات أو بيطوروا آليات لتسهيل عملية اللي
+
+434
+00:30:18,900 --> 00:30:24,040
+هو ال monitoring فضلا برومد بحطلكوا الموقع تبعها
+
+435
+00:30:24,040 --> 00:30:28,040
+انا اظن وضعته حتى في بداية الفصل على الفيسبوك لكن
+
+436
+00:30:28,040 --> 00:30:33,000
+بضعكواها مرة تانية ان شاء الله طيبرقم اربع من
+
+437
+00:30:33,000 --> 00:30:35,900
+الفحوصات في هندي hemagglutination and complement
+
+438
+00:30:35,900 --> 00:30:40,100
+fixation test of limited use يعني فيه فحوصات
+
+439
+00:30:40,100 --> 00:30:43,360
+معتمدة على ال principle تبع ال hemagglutination او
+
+440
+00:30:43,360 --> 00:30:46,360
+على ال complement fixation لكن استخدامها الصحيح
+
+441
+00:30:46,360 --> 00:30:52,720
+يعني محدود خامسة skin test الآن مين عنده اي معلومة
+
+442
+00:30:52,720 --> 00:30:56,570
+عن البكتيريا في قطاع غزة ولا حدالو اجى واحد وقال
+
+443
+00:30:56,570 --> 00:31:00,470
+والله يا عم الظروف اللى كانت مش متوفرة صارت متوفرة
+
+444
+00:31:00,470 --> 00:31:06,590
+تمام بدنا نعمل نشوف ال prevalence rate لل disease
+
+445
+00:31:06,590 --> 00:31:10,730
+بدناش نشوف الناس اللى لان مصابين مين انصاب في
+
+446
+00:31:10,730 --> 00:31:15,650
+السابق ممكن نعملهم مين skin test والسؤال اللى بيجي
+
+447
+00:31:15,650 --> 00:31:25,070
+في الامتحان أكم skin test بتعرف يلا شعت هى واحد
+
+448
+00:31:27,920 --> 00:31:31,540
+المحاضرة الماضية لسه مانسيا نقشت اتنين اخدنا
+
+449
+00:31:31,540 --> 00:31:35,900
+التبركولين واخدنا الليبرومين والمحاضرة اللي جابلها
+
+450
+00:31:35,900 --> 00:31:39,480
+اخدنا ال death theory فهيصل اندي انا عايش اربعة
+
+451
+00:31:39,480 --> 00:31:45,070
+skin testTreatment and Antibiotic Sensitivity
+
+452
+00:31:45,070 --> 00:31:48,870
+البكتيريا هي still بكتيريا can be treated with
+
+453
+00:31:48,870 --> 00:31:52,430
+antibiotics يمكن الستربتوميسين و الchloramphenicol
+
+454
+00:31:52,430 --> 00:31:55,650
+و الترساكلينز بيستخدموه لكن الchloramphenicol كلكم
+
+455
+00:31:55,650 --> 00:31:59,290
+عارفين انه الان هذا X فبيضل ان الستربتوميسين و
+
+456
+00:31:59,290 --> 00:32:02,090
+الستربتوميسين برضه سميته عالية إذا استخدم لفترات
+
+457
+00:32:02,090 --> 00:32:05,990
+طويلة فممكن يستخدم بالجنتوميسين أو الاميكاسين لكن
+
+458
+00:32:05,990 --> 00:32:09,550
+هذه ال antibiotics اللي ممكن تستخدمهاانا طبعا هيك
+
+459
+00:32:09,550 --> 00:32:12,310
+بكون انتهت المحاضرة لكن في بعض الصور بتوريكوا
+
+460
+00:32:12,310 --> 00:32:16,930
+إياها اللي هي ال .. ال all's اللي شايفينها هذي شكل
+
+461
+00:32:16,930 --> 00:32:20,310
+من أشكال اللي هو ال slow healing على الصرفي كمان
+
+462
+00:32:20,310 --> 00:32:24,990
+صورة أخرى على الإصبع هنا هذا غالبا بينتج من تعامل
+
+463
+00:32:24,990 --> 00:32:28,910
+مع حيوانات زي ما حكينالكوا حيوانات مصابة ب ال
+
+464
+00:32:28,910 --> 00:32:32,250
+Francis de Lawrence المرة الجاية ان شاء الله نكمل
+
+465
+00:32:32,250 --> 00:32:35,390
+في المحاضرة في ال hemophilus influenza بإذن الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8CQvThXrWvw_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8CQvThXrWvw_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..cb2abc133ead20ab9645dc0d8826ebcc2b465690
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8CQvThXrWvw_raw.srt
@@ -0,0 +1,2564 @@
+1
+00:00:20,320 --> 00:00:23,720
+بسم الله الرحمن الرحيم موضوع المحاضرة تبعتنا اليوم
+
+2
+00:00:23,720 --> 00:00:28,140
+اللي هو ال gram-negative bacilli enterobacteriasi
+
+3
+00:00:28,140 --> 00:00:31,940
+المجموعة الأضخم على الإطلاق في ال diagnostic
+
+4
+00:00:31,940 --> 00:00:35,800
+microbiology من الأربع مجموعات اللي ذكرناهم سابقا
+
+5
+00:00:35,800 --> 00:00:39,460
+هي ال gram-negative bacilli لذلك هنبدأ ان شاء الله
+
+6
+00:00:39,460 --> 00:00:43,940
+التعرف على أهم المجموعات اللي في ال gram-negative
+
+7
+00:00:43,940 --> 00:00:48,320
+وكيف نصل لل enterobacteriasiبتلاحظوا على اللوحة
+
+8
+00:00:48,320 --> 00:00:52,340
+اللي أمامكم في انديا دياجرام بيقسم ال gram
+
+9
+00:00:52,340 --> 00:00:55,580
+negative بس ال lie إلى أربع مجموعات من خلال فحصين
+
+10
+00:00:55,580 --> 00:00:59,160
+أساسيين الفحص الأول Oxidase test و الفحص التاني
+
+11
+00:00:59,160 --> 00:01:03,580
+Glucose fermentation البكتيريا أما بتكون Oxidase
+
+12
+00:01:03,580 --> 00:01:06,240
+positive أو بتكون Oxidase negative إذا كانت
+
+13
+00:01:06,240 --> 00:01:08,560
+Oxidase positive و أعملنا لها Glucose fermentation
+
+14
+00:01:08,560 --> 00:01:13,280
+و طلعت positive فهي Vibrio إذا كانت Oxidase
+
+15
+00:01:13,280 --> 00:01:19,560
+positiveو إجلوكوز نيجاتيف فهي Sodomonas إذا كانت
+
+16
+00:01:19,560 --> 00:01:22,380
+Oxidase نيجاتيف و إجلوكوز نيجاتيف فهي
+
+17
+00:01:22,380 --> 00:01:26,400
+Acinetobacter إذا كانت Oxidase نيجاتيف و إجلوكوز
+
+18
+00:01:26,400 --> 00:01:29,460
+بسطف فهي Enterobacteraceae يعني البقية الـ
+
+19
+00:01:29,460 --> 00:01:32,180
+Enterobacteraceae سبعتنا يعرفنا تلت معلومات عنها
+
+20
+00:01:32,180 --> 00:01:36,300
+الآن من اللوحة هذه تلت معلومات Gram negative بس
+
+21
+00:01:36,300 --> 00:01:40,820
+الله، Oxidase negative، إجلوكوز fermenter وهذه
+
+22
+00:01:40,820 --> 00:01:46,540
+التلتصفات تميزها عن باقي أنواع البكتيريا اللى احنا
+
+23
+00:01:46,540 --> 00:01:51,100
+ممكن نتشابه من خلالها زى مثلا Sodomonas بتشبهها
+
+24
+00:01:51,100 --> 00:01:53,540
+إلها حد كبير Grand Negative بس اللي هو إلا كام
+
+25
+00:01:53,540 --> 00:01:56,140
+نميزهم عن بعض كذا كالأول بالنسبة لل Vibrio و
+
+26
+00:01:56,140 --> 00:02:01,610
+Asinito و من بعض أكترما يميز هذه المجموعة أنه
+
+27
+00:02:01,610 --> 00:02:07,510
+بتحمل أسماء عديدة ومتنوعة فمضطرين يعني نمارسها
+
+28
+00:02:07,510 --> 00:02:12,270
+لغويا وشفاويا نحكيها مرارا ومتكرارا حتى تكون سهلة
+
+29
+00:02:12,270 --> 00:02:15,290
+بالنسبة لنا ان شاء الله Escherichia,
+
+30
+00:02:16,670 --> 00:02:22,210
+Shigella, Proteus, Salmonella في بعض الأسماء طبعا
+
+31
+00:02:22,210 --> 00:02:24,730
+منها مارعليك وأسماء أخرى هتكون جديدة ان شاء الله
+
+32
+00:02:25,560 --> 00:02:30,980
+كلب سلة، يرسينيا، سيراتياEnterobacter,
+
+33
+00:02:31,660 --> 00:02:36,240
+Citrobacter, Hafnia, Providentia و Edward Sella
+
+34
+00:02:36,240 --> 00:02:41,520
+هدولة اتناشر اسم والحقيقة ان هناك اكتر من ثلاثين
+
+35
+00:02:41,520 --> 00:02:45,780
+genera موجودين في ال enterobacteriasi لكن في اربع
+
+36
+00:02:45,780 --> 00:02:51,420
+اتاش مشهورين عن الاخرين وبالتالي هتعامل فقط احنا
+
+37
+00:02:51,420 --> 00:02:56,520
+مع تلك الاربعتاشر genera اللي احنا جون عنهم more
+
+38
+00:02:56,520 --> 00:02:56,940
+common
+
+39
+00:02:59,700 --> 00:03:02,460
+ال family enterobacteriaceae جينا .. يعني ياردت
+
+40
+00:03:02,460 --> 00:03:05,980
+نركز مع بعض في ده الجملة لإنه احنا جينا تلت صفات
+
+41
+00:03:05,980 --> 00:03:13,100
+رئيسية، إيش هم .. large glucose ضيفوا عليهم كمان
+
+42
+00:03:13,100 --> 00:03:17,120
+صفة تانية، they are all facultative in Europe، هذه
+
+43
+00:03:17,120 --> 00:03:21,800
+صفة كتير مهمةالصفة الخامسة انه they can reduce
+
+44
+00:03:21,800 --> 00:03:26,720
+nitrate to nitrite يعني بيحوضوا ال NO3 الى NO2 و
+
+45
+00:03:26,720 --> 00:03:30,520
+هذه كمان صفة بتميزه فيها كمجموعة هناك صفات أخرى
+
+46
+00:03:30,520 --> 00:03:37,540
+شباب لكن مش صفات تنطبق على كل المجموعة مثل ال
+
+47
+00:03:37,540 --> 00:03:42,380
+motilityهناك بعض أنواع أو أصناف من الـ
+
+48
+00:03:42,380 --> 00:03:45,600
+Enterobacteraceae motile والبعض الآخر non-motile
+
+49
+00:03:45,600 --> 00:03:50,710
+لكن الصفة المشتركة هي في الـ motileكل ال motile
+
+50
+00:03:50,710 --> 00:03:54,890
+انترو بكترياسي are motile by peritricous flagella
+
+51
+00:03:54,890 --> 00:03:58,190
+اعتقد انكوا عرفتوا ايش يعني peritricous flagella؟
+
+52
+00:03:58,190 --> 00:04:03,170
+توزيع الفلاجلة على البكتيريا بيكون all around the
+
+53
+00:04:03,170 --> 00:04:07,130
+cell بعكس اللي هو بعض أنواع البكتيريا بتكون فقط
+
+54
+00:04:07,130 --> 00:04:11,610
+مثلا polar أو بتكون على الجهة التانية أيضا، لكن
+
+55
+00:04:11,610 --> 00:04:15,150
+الانترو بكترياسي كلها بتميز ان هي جونها
+
+56
+00:04:15,150 --> 00:04:20,480
+peritricous flagellaفي عندي على اللوحة أمامكوا فحص
+
+57
+00:04:20,480 --> 00:04:24,680
+ال catalase positive لكن يا شباب ليس له قيمة
+
+58
+00:04:24,680 --> 00:04:29,000
+تشخيصية لأنه برضه ال .. ال .. ال Sodomonas
+
+59
+00:04:29,000 --> 00:04:34,420
+catalase positive فبالتالي مالوش أي صفة أو قيمة
+
+60
+00:04:34,420 --> 00:04:38,740
+تشخيصية وبالتالي useless أنه نعمله في المختبر مخسر
+
+61
+00:04:38,740 --> 00:04:48,470
+فلوس عالفاضي يعني تبذير بدون داعيحكينا احنا الصفة
+
+62
+00:04:48,470 --> 00:04:51,190
+الرئيسية للانتيلوباكتلاسي من البداية انها أكسيدايز
+
+63
+00:04:51,190 --> 00:04:54,230
+نيجاتيف وتلك الصفة تميزها عن مجموعة أخرى من
+
+64
+00:04:54,230 --> 00:04:59,250
+الميكروبات زي الـPseudomonas من أفضل الميكروبات
+
+65
+00:04:59,250 --> 00:05:03,330
+المعروفة لدينا في هذه العائلة اللي هي الشريشيا
+
+66
+00:05:03,330 --> 00:05:08,010
+كولاي طبعا الشريشيا كولاي تميزت لدى العلماء
+
+67
+00:05:08,010 --> 00:05:13,980
+بمجموعة منهم ميزات بنحاول نذكر بعض منهاإنها very
+
+68
+00:05:13,980 --> 00:05:18,460
+common in nature موجودة في أمعاء الانتستين أو في
+
+69
+00:05:18,460 --> 00:05:23,420
+الانتستين تبع الإنسان والحيوان رقم اتنين او تلاتة
+
+70
+00:05:23,420 --> 00:05:27,670
+it is easy to cultivate من السهل يدون تنميتهاال
+
+71
+00:05:27,670 --> 00:05:30,910
+doubling time تبعها لا تجاوز عشرين دقيقة يعني زمن
+
+72
+00:05:30,910 --> 00:05:33,850
+الانقسام فقط عشرين دقيقة يعني عارفين إيش أنا عشرين
+
+73
+00:05:33,850 --> 00:05:38,270
+دقيقة؟ في اليوم الواحد أربع عشرين ساعة جدش بيكون
+
+74
+00:05:38,270 --> 00:05:42,770
+عندي ال ال ال ال ال generations في الساعة الواحدة
+
+75
+00:05:42,770 --> 00:05:46,290
+تلت تلتة في الأربع عشرين ساعة ضرب تلتة جدش بيطلعوا
+
+76
+00:05:46,290 --> 00:05:49,570
+اتنين وسبعين اتنين وسبعين اتنين وسبعين يعني اتنين
+
+77
+00:05:49,570 --> 00:05:51,670
+اص اتنين وسبعين مرة
+
+78
+00:05:54,680 --> 00:05:57,220
+اتنين اصر اتنين وسبعين عارف ايش بعناها يعني
+
+79
+00:05:57,220 --> 00:06:02,500
+billions .. billions of cells من خلية واحدة will
+
+80
+00:06:02,500 --> 00:06:05,980
+be produced within one hour طبعا هذا كنز ان انا
+
+81
+00:06:05,980 --> 00:06:11,720
+احصل على generations مختلفة ومتنوعة في فترة قصيرة
+
+82
+00:06:11,720 --> 00:06:16,180
+جداكمان شغلة كانت مهمة انهم they are normal
+
+83
+00:06:16,180 --> 00:06:19,820
+microbiota normal microbiota ايش يعني normal
+
+84
+00:06:19,820 --> 00:06:22,720
+microbiota؟ يعني they do not cause disease في ال
+
+85
+00:06:22,720 --> 00:06:26,920
+intestinal tract لكن they are pathogens outside
+
+86
+00:06:26,920 --> 00:06:29,220
+وكنا مبارح في المحاضرة طبعا مبارح اول اللي جابلها
+
+87
+00:06:29,220 --> 00:06:32,540
+انه number one cause number one cause of urinary
+
+88
+00:06:32,540 --> 00:06:37,080
+tract infection اشريشيا كولايبالاضافة الى اكتشافنا
+
+89
+00:06:37,080 --> 00:06:40,760
+الحديث اللى هو من عشر سنوات او من عشرين سنة وجاى
+
+90
+00:06:40,760 --> 00:06:45,400
+انه هناك بعض السلالات قد تسبب اصلا intestinal
+
+91
+00:06:45,400 --> 00:06:48,760
+infection يعني بطلت بريئة تماما فى ال intestinal
+
+92
+00:06:48,760 --> 00:06:51,480
+tract البعض منها بيعمل وشوفنا فى ال toxins
+
+93
+00:06:51,480 --> 00:06:54,840
+enterotoxicinichorrhiza coli وشوفنا فى ال toxins
+
+94
+00:06:54,840 --> 00:06:59,400
+enterohemorrhagicichorrhiza coli يبقى بطلت بريئة
+
+95
+00:06:59,400 --> 00:07:04,610
+تمامايعني باختصار الاشريشيا كولاي لها مجموعة من
+
+96
+00:07:04,610 --> 00:07:09,210
+المواصفات جعلتها مشهورة عن أخريات في ال
+
+97
+00:07:09,210 --> 00:07:15,670
+enterobacteriasis من الميكروبات اللي قريبة من هذا
+
+98
+00:07:15,670 --> 00:07:19,010
+الgenus السلمونيلا والشيجيلا اللي مشهورين انهم
+
+99
+00:07:19,010 --> 00:07:21,770
+بيعملوا intestinal infection بتعرف السلمونيلا
+
+100
+00:07:21,770 --> 00:07:25,870
+والشيجيلا بيعملوا intestinal infectionكمان في
+
+101
+00:07:25,870 --> 00:07:30,310
+مجموعة شوية يعني ليست بدرجة قراءة بتستخدامولا
+
+102
+00:07:30,310 --> 00:07:35,150
+والشجلة زي ال protease و السيراتيا طبعا بدا اتكلم
+
+103
+00:07:35,150 --> 00:07:40,170
+عن السيراتيا كلمة يعني مربطها بمعلومة مهمة
+
+104
+00:07:40,170 --> 00:07:44,550
+السيراتيا شباب من الميكروبات اللي هي pigmented
+
+105
+00:07:48,090 --> 00:07:53,710
+pigmented يعني بتنتج color بتنتج color الآن ال
+
+106
+00:07:53,710 --> 00:07:57,130
+color هذا فيه منه نوعية خدوا بالك مش لل .. لل ..
+
+107
+00:07:57,130 --> 00:08:00,630
+للسيراتيا بشكل عام اي بكتيره بتنتج pigment فهي
+
+108
+00:08:00,630 --> 00:08:07,970
+واحد من اتنين يا اما water soluble يا
+
+109
+00:08:07,970 --> 00:08:11,150
+اما water insoluble
+
+110
+00:08:14,550 --> 00:08:18,510
+كيف بميز انا وانا مش خبير كيميا كيف بدي اميز بين
+
+111
+00:08:18,510 --> 00:08:24,100
+التنتين؟إذا لو وجدت اللون مركز فقط في المستعمرة
+
+112
+00:08:24,100 --> 00:08:29,000
+اعرف انه water insoluble أما إذا كان اللون diffuse
+
+113
+00:08:29,000 --> 00:08:33,100
+في الوسط يجب أن نلحق انه water soluble مين بتعرف
+
+114
+00:08:33,100 --> 00:08:35,200
+ان البكتيريا بينتج water soluble pigment
+
+115
+00:08:35,200 --> 00:08:39,420
+الـPseudomonas aeruginosa بتلاقي الطبق كله أصفر أو
+
+116
+00:08:39,420 --> 00:08:44,340
+أخضر أو أزرق بينما البكتيريا السيراتيا اللون تبعها
+
+117
+00:08:44,340 --> 00:08:50,140
+أحمر ومتركز فقط على المستعمرة نفسهاطيب نيجي
+
+118
+00:08:50,140 --> 00:08:53,260
+للميكروبط التاني اللي هو ال protease ناخد برضه
+
+119
+00:08:53,260 --> 00:08:59,080
+فكرة عن ال protease في ظاهرة بدنا نربطها احنا
+
+120
+00:08:59,080 --> 00:09:02,800
+رابطنا الآن ال red pigment بالسيراتيا بدنا نربط
+
+121
+00:09:02,800 --> 00:09:06,760
+ظاهرة اسمها swarming
+
+122
+00:09:06,760 --> 00:09:16,060
+بال protease لو
+
+123
+00:09:16,060 --> 00:09:16,540
+زرعنا
+
+124
+00:09:19,290 --> 00:09:25,190
+لو ضررنا ال proteins في منتصف الطبق هلاجي ان
+
+125
+00:09:25,190 --> 00:09:29,990
+البكتيريا لم تكون مستعمرة و خلاص هلاجيها تاني يوم
+
+126
+00:09:29,990 --> 00:09:35,670
+عاملة دوائر
+
+127
+00:09:35,670 --> 00:09:40,590
+بهذا الشكل ومافيش مستعمرة واضحة المعالم زي
+
+128
+00:09:40,590 --> 00:09:44,790
+البكتيريا الأخرى ايش السر هنا؟ هذه البكتيريا
+
+129
+00:09:44,790 --> 00:09:50,890
+متحركةلكن الحركة تبعت البكتيريا مش ماشية وانما
+
+130
+00:09:50,890 --> 00:09:57,190
+سباحة والأجار مش وسط للسباحة الأجار وسط للماشي
+
+131
+00:09:57,190 --> 00:10:01,310
+لإنه solid صح ولا لأ فإيش بتعمل البكتيريا عندما
+
+132
+00:10:01,310 --> 00:10:05,850
+تنتهي من تناول الغذاء اللي مولود في منطقتها اللي
+
+133
+00:10:05,850 --> 00:10:15,310
+وجعت فيها فتنتج كمية من الماء كل خلية إلها حصةالآن
+
+134
+00:10:15,310 --> 00:10:18,270
+بتكون قطرة من الماء هذه القطرة بتسبح فيها
+
+135
+00:10:18,270 --> 00:10:22,530
+البكتيريا في الاتجاهات المختلفة فتسبح فيها فتنتقل
+
+136
+00:10:22,530 --> 00:10:27,290
+من مكانها الأصلي لماكن أخرى الآن الأجار بطبيعته
+
+137
+00:10:27,290 --> 00:10:31,310
+hydrophilic بحب المي بحب الماء فبيشفط الماء إلى
+
+138
+00:10:31,310 --> 00:10:36,330
+الأسفل فالبكتيريا بتجف في مكان لكن على مساحة ايش
+
+139
+00:10:36,330 --> 00:10:43,010
+أوسعةصارت .. لأن هي بجت في نقطة صغيرة صارت في نقطة
+
+140
+00:10:43,010 --> 00:10:47,150
+أوسى حتت كاثر وحتى الملنوفي الأن عندي أنا غذاء
+
+141
+00:10:47,150 --> 00:10:52,110
+جديد وهكذا بتكرر العملية فبنلاقيها تاني يوم أصبحت
+
+142
+00:10:52,110 --> 00:10:55,530
+عاملة زي الحقول بهذا الشكل الظاهرة سمينها قلنا
+
+143
+00:10:55,530 --> 00:11:00,690
+إيه؟ swarming في كمان ملاحظة لازم نعرفها عن ال
+
+144
+00:11:00,690 --> 00:11:05,370
+proteins من الأن قدرتها المهولة على إنتاج إنزيم
+
+145
+00:11:05,370 --> 00:11:14,420
+لبروتيز أفوان الوريزلو دخلنا دورات حمامات ذات
+
+146
+00:11:14,420 --> 00:11:19,900
+رائحة نفاذة يعني دورة مش مفتوحة من فترة لو دخلناها
+
+147
+00:11:19,900 --> 00:11:23,240
+بنلاقي ان في ريحة أمونيا فيها غالبا الأمونيا هادى
+
+148
+00:11:23,240 --> 00:11:26,040
+جاية من وين من تحلل اليوريا اللى مولود في ال urine
+
+149
+00:11:26,900 --> 00:11:31,520
+اليوريا موجودة بشكل طبيعي في ال urine البكتيريا
+
+150
+00:11:31,520 --> 00:11:34,280
+إذا كانت موجودة في الدورات، يعني الدورات مش نظيفة،
+
+151
+00:11:34,280 --> 00:11:37,880
+تمام؟ بتكسر اليوريا، بتطلع لنا أمونية، بتطلع لنا
+
+152
+00:11:37,880 --> 00:11:42,100
+الرائحة النفاثة المشهورة، إذا من الميزات اللي
+
+153
+00:11:42,100 --> 00:11:46,500
+بتتميز فيها ال Protaseaceae مقدرتها المهولة على
+
+154
+00:11:46,500 --> 00:11:50,260
+إنتاج ال enzymes يوريا بيسموها rapid urine
+
+155
+00:11:50,260 --> 00:11:54,100
+swarming rapid urea hydrolyzer
+
+156
+00:11:57,150 --> 00:11:59,750
+وانتوا دراستوا في الفصل الماضي في ال essential في
+
+157
+00:11:59,750 --> 00:12:02,810
+المعمل دراستوا ال urease test كيف تعملوا فحص ال
+
+158
+00:12:02,810 --> 00:12:07,330
+urease بيكون slant تزرعوا عليه بيكون colorless أو
+
+159
+00:12:07,330 --> 00:12:12,250
+yellow تقريبا و بيصير pink نتيجة عايشة ال pink هذا
+
+160
+00:12:12,250 --> 00:12:19,630
+من تغير ال indicator من ال neutral إلى اللي هو ال
+
+161
+00:12:19,630 --> 00:12:25,870
+alkaline نتيجة من ال ammoniaفحص لو زرعتنا protease
+
+162
+00:12:25,870 --> 00:12:29,210
+على هذا الفحص خلال أربع ساعات بيطلع positive لو
+
+163
+00:12:29,210 --> 00:12:34,590
+زرعت clipzilla بدها 24 ساعة فتنتهن positive تنتهن
+
+164
+00:12:34,590 --> 00:12:39,350
+positive لكن هذه أسرع فاسمها rapid urea hydrolyzer
+
+165
+00:12:39,350 --> 00:12:46,170
+تمام هناك بعض الميكروبات الأخرى زي مثلا القروينيا
+
+166
+00:12:46,170 --> 00:12:49,610
+هذه القروينيا مافيه علاقة صحيح بالأمراض تبعها
+
+167
+00:12:49,610 --> 00:12:53,530
+الإنسان وإلا علاقة بأمراض النباتاتفي مجموعة أخرى
+
+168
+00:12:53,530 --> 00:12:58,050
+مشهورة جدا اللي هي اليرسينيوم كلكم سمعتم بمرض
+
+169
+00:12:58,050 --> 00:13:05,110
+الطعون مرض الطعون ذكر في الأناجيل وذكر في السيرة
+
+170
+00:13:05,110 --> 00:13:10,810
+النبوية وأن في فلسطين طعون عمواس مشهور مات فيه أبو
+
+171
+00:13:10,810 --> 00:13:15,790
+عبيد عامر بن الجراحالرسول صلى الله عليه و سلم اعطى
+
+172
+00:13:15,790 --> 00:13:19,890
+يعني وصف شهيد لمن مات مطعونا، مطعونا مش بالسكين،
+
+173
+00:13:19,890 --> 00:13:24,590
+مطعونا بالطعون، مطعونا بالطعون و أرسى أول قواعد
+
+174
+00:13:24,590 --> 00:13:30,170
+الحجر الصحي قبل 1400 سنة عندما أخبرنا بإنه إذا
+
+175
+00:13:30,170 --> 00:13:33,450
+ذهبتم إلى أرض بها طعون فلا تدخلوها، سمعتم بأرض بها
+
+176
+00:13:33,450 --> 00:13:39,210
+طعون لا تدخلوها، وإذا كنتم بها فلا تخرجوا منهاهذا
+
+177
+00:13:39,210 --> 00:13:43,870
+قهد حاجة صحي يعني في الطب الحديث معروف ان انت
+
+178
+00:13:43,870 --> 00:13:48,570
+بتأذي الناس عشان انت اتحد من انتشار اللي هو المرض
+
+179
+00:13:48,570 --> 00:13:53,730
+اذا اليارسينيا اللي هي بتسبب مرض الطاعون اللي قتل
+
+180
+00:13:53,730 --> 00:13:57,430
+نصف سكان أوروبا مرة من المرات نصف سكان أوروبا
+
+181
+00:13:57,430 --> 00:14:02,670
+ناتوا من الطاعون تنتمي إلى مين؟البكتيريا دي
+
+182
+00:14:02,670 --> 00:14:06,910
+الانتيرو بكتيريازي يعني زي هزامين زي الاشريشيا
+
+183
+00:14:06,910 --> 00:14:11,430
+كولا هل الطعون موجود لحد الآن نعم موجود لكن بكل
+
+184
+00:14:11,430 --> 00:14:14,470
+سهولة و يصير اليوم نقدر نتعامل معاه بالمضادات
+
+185
+00:14:14,470 --> 00:14:17,470
+الحيوية أبسط Antibiotic لواتترا سايكلين يعني
+
+186
+00:14:17,470 --> 00:14:22,450
+يستخدم لعلاجه بكل فعالية و كفاة و يمكن قبل خمساشر
+
+187
+00:14:22,450 --> 00:14:28,350
+سنة كان فيه انتشار للطعون في الهند لكن سيطر عليه
+
+188
+00:14:28,350 --> 00:14:31,510
+بطريقة سريعة لا تجاوز يمكن الأسابيع
+
+189
+00:14:34,480 --> 00:14:38,060
+كمان مرة عندي ال family انترو بكترياسي بنقدر
+
+190
+00:14:38,060 --> 00:14:42,520
+نجسمها إلى قبائل اربع اخمس قبائل إشريشيه وكليبسليه
+
+191
+00:14:42,520 --> 00:14:46,180
+وبروتيه ويرسينيه وإروينيه إروينيه ده بتلاحظوا مش
+
+192
+00:14:46,180 --> 00:14:50,960
+فيها غير الإروينيه ويرسينيه فقط اليرسينيه بينما
+
+193
+00:14:50,960 --> 00:14:54,480
+البروتيه فيها تلت مجموعات اللي هم البروتيه و
+
+194
+00:14:54,480 --> 00:14:57,780
+البروفيدنشيه و ال مورجانيله هذا الاسم ما مرش عليكم
+
+195
+00:14:57,780 --> 00:15:02,660
+في اللوحة السابقة مورجانيله التلاتةprotease و
+
+196
+00:15:02,660 --> 00:15:06,760
+Morganella و Providentia بنسميهم Protease group
+
+197
+00:15:06,760 --> 00:15:10,380
+بيتشابهوا مع بعض في كتير من الصفات لكن برضه في
+
+198
+00:15:10,380 --> 00:15:14,780
+صفات بتميز مع بعض وإلا لو ما أعطيناهم أسماء مختلفة
+
+199
+00:15:14,780 --> 00:15:18,580
+ال Eclipse ليه؟ طبعا ال Eclipsella ال Enterobacter
+
+200
+00:15:18,580 --> 00:15:22,040
+ال Hafnia و السيراتيا السيراتيا اللي صرتوا عارفين
+
+201
+00:15:22,040 --> 00:15:26,060
+إن هي pigmented إنها pigmented ال Enterobacter هذه
+
+202
+00:15:26,060 --> 00:15:30,130
+مخدة لقب مين؟الانترو بكترياسي لما نقول انترو بو
+
+203
+00:15:30,130 --> 00:15:34,110
+أكتر من انترو بكترياسي مش معناه الحق إنه أشهر، لأ
+
+204
+00:15:34,110 --> 00:15:38,110
+الأشهر الحقيقة اللي هي الإشريشيا الإشريشيا
+
+205
+00:15:38,110 --> 00:15:42,470
+الإدواردسيلا والسترو بو أكتر والسلمونيلا وإشريجيا،
+
+206
+00:15:42,470 --> 00:15:45,330
+لو لاحظوا السلمونيلا وإشريجيا قريبين من مين؟ من
+
+207
+00:15:45,330 --> 00:15:51,210
+اللي هو الإشريشيااحنا بنحب التصنيف وبنحب التجسيم
+
+208
+00:15:51,210 --> 00:15:55,890
+والتجزيق بغرض تسهيل عملية ايه التعرف على
+
+209
+00:15:55,890 --> 00:15:58,950
+الميكروبات لما جولنا gram positive و gram negative
+
+210
+00:15:58,950 --> 00:16:04,550
+لما جولنا بسلاي ولا كوكساي الان وصلنا لمرحلة ان
+
+211
+00:16:04,550 --> 00:16:08,190
+البكتيريا عرفناها انها انترو بكترياسي وايه تبقى ان
+
+212
+00:16:08,190 --> 00:16:11,350
+تكون قادرا على معرفة ان البكتيريا هي عبارة عن ايه
+
+213
+00:16:11,350 --> 00:16:15,690
+انترو بكترياسي كيف واحد جولنا كمان مرة gram
+
+214
+00:16:15,690 --> 00:16:19,640
+negative بسلاي رقم اتنينOxidized negative تلاتة
+
+215
+00:16:19,640 --> 00:16:25,040
+جلوكوز fermenter أربعة facultative anaerobic خمسة
+
+216
+00:16:25,040 --> 00:16:29,340
+produces nitrate to nitrate هذه الخمس صفات أساسية
+
+217
+00:16:29,340 --> 00:16:32,380
+كل اللي ذكرناهم من البكتيريا أو هدول البكتيريا
+
+218
+00:16:32,380 --> 00:16:35,520
+اللي أمامكوا الآن يمتلكوا الخمس صفات وبالتالي أي
+
+219
+00:16:35,520 --> 00:16:39,550
+انترو بكترياسي لازم تمتلك هذه الخمس صفاتيعني لو
+
+220
+00:16:39,550 --> 00:16:42,870
+سألتك في امتحان اعطتك quiz بكرة و قولتلك ماذا تعرف
+
+221
+00:16:42,870 --> 00:16:45,790
+عن اي شيريشيا كولاي تقول ولا مدرسنهاش لسه لأ
+
+222
+00:16:45,790 --> 00:16:52,630
+درستها و بتعرف عنها على الأقل خمس معلومات قسمنا
+
+223
+00:16:52,630 --> 00:16:56,030
+لكتوز fermenter، non-lactose fermenter و delayed
+
+224
+00:16:56,030 --> 00:17:00,010
+lactose fermenter خدوا بالكوا هدولة محفظين من أول
+
+225
+00:17:00,010 --> 00:17:04,030
+صح؟ عارفين هم انت هدولة شيريشيا انتروباكتر
+
+226
+00:17:04,030 --> 00:17:08,060
+كليبسيلا وسيتروباكتراللي مش عارفهم او ماكانش
+
+227
+00:17:08,060 --> 00:17:11,500
+عارفهم يعرفهم الآن ويحفظهم الآن هدول الأربعة هم ال
+
+228
+00:17:11,500 --> 00:17:16,240
+true lactose fermenter ع المكونكي هلاجيهم بشكل
+
+229
+00:17:16,240 --> 00:17:20,900
+مختلف تماما عن باقي أنواع البكتيريا السلمونيلا
+
+230
+00:17:20,900 --> 00:17:25,400
+والشيجيلا والبروتياس واليرسينيا are true non
+
+231
+00:17:25,400 --> 00:17:29,200
+-lactose fermenter ايش يعني true؟ يعني لو تركناهم
+
+232
+00:17:29,200 --> 00:17:35,780
+يوم ويومين وتلاتة لن يستطيعوا تخمير اللاكتوزالعمود
+
+233
+00:17:35,780 --> 00:17:39,440
+الأخير اللي بيحتوي على باقي الميكروبات بنسميه
+
+234
+00:17:39,440 --> 00:17:41,600
+delayed lactose fermenter إيش معناه delayed
+
+235
+00:17:41,600 --> 00:17:45,520
+lactose fermenter؟ إنه إحنا بنحكم على ال
+
+236
+00:17:45,520 --> 00:17:50,820
+fermentation خلال 24 ساعة بعد 48 ساعة أو 72 ساعة
+
+237
+00:17:50,820 --> 00:17:55,260
+بعض الميكروبات بتقدر تخمر اللاكتوز بس في 24 ساعة
+
+238
+00:17:55,260 --> 00:18:00,240
+بتقدرش إيش بنسميها؟ delayed lactose fermenter طيب
+
+239
+00:18:00,240 --> 00:18:04,260
+هذا على فكرة هتعقدلنا المسألة في المعملfor
+
+240
+00:18:04,260 --> 00:18:08,820
+practical reasons we classify these bacteria into
+
+241
+00:18:08,820 --> 00:18:12,420
+lactose and non-lactose fermenter يعني هدولة و
+
+242
+00:18:12,420 --> 00:18:16,800
+هدولة مع بعض بنسميهم non-lactose fermenter ليش؟
+
+243
+00:18:16,800 --> 00:18:20,340
+لإن لما بقرأ الطبق أنا بقرأ و وقتاش بعد 24 ساعة
+
+244
+00:18:20,340 --> 00:18:24,360
+وبالتالي ياما بتعطيني لون ياما بتعطانيش لون فياما
+
+245
+00:18:24,360 --> 00:18:27,840
+lactose ياما non-lactose fermenter وصل الصورة طيب
+
+246
+00:18:27,840 --> 00:18:30,340
+كيف بستفيد من المعلومة أن هذه delayed lactose
+
+247
+00:18:30,340 --> 00:18:34,190
+fermenter انتوا خدتوا فحص ال ABI في المعمل لسه؟طيب
+
+248
+00:18:34,190 --> 00:18:42,070
+في أول فحص في ال ABI فحص اسمه ONBG ONBG فحص بنجيس
+
+249
+00:18:42,070 --> 00:18:46,870
+في صفة Beta Galactosidase البكتيريا اللي عندها
+
+250
+00:18:46,870 --> 00:18:49,770
+قدرة على ال lactose و اللي عندها قدرة على delayed
+
+251
+00:18:49,770 --> 00:18:53,130
+lactose بتطلع positive بينما ال non lactose بتطلع
+
+252
+00:18:53,130 --> 00:19:00,010
+نيجد فانا بقدر اعرف ال delayed من ال nonمن اللكتوز
+
+253
+00:19:00,010 --> 00:19:04,970
+بفحصين بزراعتهم على المكونكي تمام اجار و بفحص اللي
+
+254
+00:19:04,970 --> 00:19:12,190
+هو ال ONBG نجي لجزء المهم جدا في ال
+
+255
+00:19:12,190 --> 00:19:15,090
+enterobacteriasis حدث سموه antigenic properties of
+
+256
+00:19:15,090 --> 00:19:22,710
+enterobacteriasis كلنا بيعلمان ال gram negative
+
+257
+00:19:22,710 --> 00:19:26,150
+بكتيريا بتحتوي على الليبو بولي ساكرايت و الليبو
+
+258
+00:19:26,150 --> 00:19:30,770
+بولي ساكرايت في جزء اتان الجزء الاول lipid A و ال
+
+259
+00:19:30,770 --> 00:19:34,350
+O انتجين مهمين بالنسبة لنا ال core مش كتير مهم
+
+260
+00:19:34,350 --> 00:19:36,430
+بالنسبة لنا الليبو بولي ساكرايت الليبو بولي
+
+261
+00:19:36,430 --> 00:19:36,810
+ساكرايت الليبو بولي ساكرايت الليبو بولي ساكرايت
+
+262
+00:19:36,810 --> 00:19:38,190
+الليبو بولي ساكرايت الليبو بولي ساكرايت الليبو
+
+263
+00:19:38,190 --> 00:19:39,750
+بولي ساكرايت الليبو بولي ساكرايت الليبو بولي
+
+264
+00:19:39,750 --> 00:19:39,750
+ساكرايت الليبو بولي ساكرايت الليبو بولي ساكرايت
+
+265
+00:19:39,750 --> 00:19:43,950
+الليبو بولي ساالان يا شباب o-antigen معناها انه
+
+266
+00:19:43,950 --> 00:19:47,650
+انا من خلال هذا الـantigen بتتعرف على البكتيريا
+
+267
+00:19:47,650 --> 00:19:55,630
+وإلا كيف تفسرون E.coli O157H7 الـ O اللي بتسمعوها
+
+268
+00:19:55,630 --> 00:19:59,230
+في الـ O157 هي عبارة عن إيش هي الآن؟ عن O-antigen
+
+269
+00:19:59,230 --> 00:20:04,550
+للإيجريشيا E.coli لماذا لجأت إلى التعرف على
+
+270
+00:20:04,550 --> 00:20:08,540
+البكتيريامن خلال الـ serology مش بس من خلال الـ
+
+271
+00:20:08,540 --> 00:20:13,300
+genus والسبيسي الاشريشية genus و ال coli species و
+
+272
+00:20:13,300 --> 00:20:18,760
+ال O و ال H عبارة عن Serotyping Serotyping لماذا
+
+273
+00:20:18,760 --> 00:20:23,460
+لجأت إلى هذا التعريف لماذا لم أكتفي بال genus
+
+274
+00:20:23,460 --> 00:20:32,020
+والسبيسي لا مش زيادة في التأكيد طيب انا اعطيكوا
+
+275
+00:20:32,020 --> 00:20:38,340
+وضع حقيقي ومثل حقيقيجبنا مزرعة استول لحضراتكم و
+
+276
+00:20:38,340 --> 00:20:42,420
+روحت أنت عازل منها E.coli و كتبت في تقريرك E.coli
+
+277
+00:20:42,420 --> 00:20:47,140
+و بعثتها للطبيب الطبيب مش هيكون موقفه، هيضحك،
+
+278
+00:20:47,140 --> 00:20:50,780
+مقولنا لنا مين ماعنوش أصلا E.coli؟ كنا عندنا E
+
+279
+00:20:50,780 --> 00:20:54,280
+.coli في الاستول، صح ولا لأ؟ لكن لو كتبتله E.coli
+
+280
+00:20:54,280 --> 00:20:59,480
+O157H7 تفرج معه، هيعرف إنها إيه؟ إنها pathogenic
+
+281
+00:20:59,480 --> 00:21:02,060
+يبقى أنا في هذه الحالة ميزت بين pathogenic و none
+
+282
+00:21:02,060 --> 00:21:06,750
+pathogenic مثال تانيفي ال Epidemiology اللى احنا
+
+283
+00:21:06,750 --> 00:21:10,510
+شرحناه للمحاضرة السابقة، كنا من المهم نعرف مصادر
+
+284
+00:21:10,510 --> 00:21:15,930
+العدوى، مصادر العدوى Vibrocholera Epidemic صار انه
+
+285
+00:21:15,930 --> 00:21:19,390
+وباء لل Vibrocholera وحضراتكم المحققين في هذا
+
+286
+00:21:19,390 --> 00:21:24,390
+الوباء عزلتم من المرضى Vibrocholeraورحت أدوره على
+
+287
+00:21:24,390 --> 00:21:27,810
+مصادر من وين ممكن يكون المصدر الأساسي فروحتوا على
+
+288
+00:21:27,810 --> 00:21:31,690
+البحر، روحتوا على ودي غزة، روحتوا على مياه الشرب،
+
+289
+00:21:31,690 --> 00:21:34,950
+على بعض الخضروات، على بعض الفواكه، أخدتوا منها
+
+290
+00:21:34,950 --> 00:21:38,650
+وعملتوا فحوصات ولجأتوا في البعض منها vibrochlera
+
+291
+00:21:38,650 --> 00:21:42,710
+كيف لكم أن تربطوا ما بين ال vibrochlera التي عُزلت
+
+292
+00:21:42,710 --> 00:21:47,350
+من المريضوهتلك اللتي عُزِلت من مصادر مختلفة لازم
+
+293
+00:21:47,350 --> 00:21:51,130
+يكون الـ Serotype تبعهم identical لازم يكون ال O
+
+294
+00:21:51,130 --> 00:21:55,230
+-antigen تبعهم identical عشان أقول هذه أصلها من
+
+295
+00:21:55,230 --> 00:21:59,170
+هذا المصدر وصل الصورة فبعض الأحيان اللي نحتاج أن
+
+296
+00:21:59,170 --> 00:22:03,810
+نتعرف على البكتيريا serologically زيادة في التعرف
+
+297
+00:22:03,810 --> 00:22:06,410
+على هويتها إما لتحديد إنها pathogenic أو non
+
+298
+00:22:06,410 --> 00:22:13,350
+pathogenic أو لربطها بمصدر معين عمومامن ميزات ال o
+
+299
+00:22:13,350 --> 00:22:17,250
+-antigen انه heat stable انتجين وهذا الكلام تعرفه
+
+300
+00:22:17,250 --> 00:22:19,670
+انتوا كويس لما درسنا الفرق بين ال endotoxin و ال
+
+301
+00:22:19,670 --> 00:22:24,230
+exotoxin كان ال exotoxin غالبا heat labile مع ده
+
+302
+00:22:24,230 --> 00:22:27,190
+واحد اللي هو الاستفاليو كوكاس اوريس بينما ال
+
+303
+00:22:27,190 --> 00:22:32,330
+endotoxin كلهم heat stableالـ O-Antigens are
+
+304
+00:22:32,330 --> 00:22:34,570
+lipopolysaccharides and are found in the cell wall
+
+305
+00:22:34,570 --> 00:22:37,350
+of the most granulated bacteria معلمة بتعرفها with
+
+306
+00:22:37,350 --> 00:22:40,970
+sera containing anti-O antibodies. Anti-O
+
+307
+00:22:40,970 --> 00:22:44,870
+antibodies يعني أجسام مضادة موجهة ضد الـ O
+
+308
+00:22:44,870 --> 00:22:48,850
+-Antigen. Antigen agglutinates slowly in granular
+
+309
+00:22:48,850 --> 00:22:53,320
+masses. هذه على فكرة معلومة كتير مهمةطالما ان انا
+
+310
+00:22:53,320 --> 00:22:56,680
+بتعمل agglutination يبجي انا لو انا استخدمت في
+
+311
+00:22:56,680 --> 00:23:02,160
+المعمل antibodies معلومة ضد بكتيريا مجهولة وصار ال
+
+312
+00:23:02,160 --> 00:23:06,640
+reaction و ال reaction على شكل ايشaggregation او
+
+313
+00:23:06,640 --> 00:23:09,980
+granular masses يبقى طالما ان ال antibody معروف
+
+314
+00:23:09,980 --> 00:23:12,820
+وارتبط مع بكتيريا مجهولة يبقى سهر ال antigen برضه
+
+315
+00:23:12,820 --> 00:23:18,160
+معروف فانا بقدر استغل هذه العملية وهذا واقع مهم
+
+316
+00:23:18,160 --> 00:23:21,380
+جدا في التشخيص في ال diagnostic microbiology اننا
+
+317
+00:23:21,380 --> 00:23:25,240
+نستخدم antibody للتعرف على البكتيريا من خلال مين؟
+
+318
+00:23:25,240 --> 00:23:30,100
+ال O انتجين تبعها غالبا ال antibodies اللي بيفرزها
+
+319
+00:23:30,100 --> 00:23:32,720
+الدسم ضد هذا ال microbe او ضد هذا عفوا ال antigen
+
+320
+00:23:32,720 --> 00:23:38,790
+هو منه IGNالنوع التاني من الانتيجينات اللي هو ال H
+
+321
+00:23:38,790 --> 00:23:42,390
+انتيجين ال H انتيجين و ال H انتيجين اللي في
+
+322
+00:23:42,390 --> 00:23:45,870
+الكابسولر الفلاجلر انتيجين الفلاجلر يعني اللي هو
+
+323
+00:23:45,870 --> 00:23:49,150
+الفلاجلر الخاص بالفلاجلر هذا يا شباب بسمع له ميزة
+
+324
+00:23:49,150 --> 00:23:54,510
+اللي أولا نقول عنه stable صح؟ تاني لأ مش .. مش ..
+
+325
+00:23:54,510 --> 00:23:59,050
+مش stable هذا inactivated by heating over 6 degree
+
+326
+00:23:59,050 --> 00:24:02,170
+centigrade يعني لو سخلنا فوق 30 درجة معوية بيصير
+
+327
+00:24:02,170 --> 00:24:07,500
+له inactivation بس مش هاد الميزةالميزة ان في بعض
+
+328
+00:24:07,500 --> 00:24:12,000
+الميكروبات اللي بتمتلك ال H-antigen و تذكروا انا
+
+329
+00:24:12,000 --> 00:24:15,780
+قلت ال enterobacteriasi البعض منها يحتوي على
+
+330
+00:24:15,780 --> 00:24:19,420
+flagella يعني motile والبعض الآخر non motile يعني
+
+331
+00:24:19,420 --> 00:24:23,580
+لا يحتوي على flagella وبالتالي بنعرف .. بنعرف ان
+
+332
+00:24:23,580 --> 00:24:33,560
+مش كل ال enterobacteriasi فيها H-antigen طيب
+
+333
+00:24:34,500 --> 00:24:37,740
+الـ .. برضه لحد الآن مش هو الفكرة اللي بنتحكي عنها
+
+334
+00:24:37,740 --> 00:24:41,760
+تخيلوا الآن هي الـ flagella والاسم الإنسان كوّن
+
+335
+00:24:41,760 --> 00:24:46,220
+أجسام مضادة إلها .. كوّن أجسام مضادة إلها الآن
+
+336
+00:24:46,220 --> 00:24:53,220
+البكتيريا ممكن تعمل عملية phase variation اتفك هذا
+
+337
+00:24:53,220 --> 00:24:58,980
+الجزء وترميهوتظهر جزء اخر من الانتيجين ما كان مرئي
+
+338
+00:24:58,980 --> 00:25:01,880
+فالان ال antibody اللي اتكون هل بقدر يرتبط مع
+
+339
+00:25:01,880 --> 00:25:06,820
+الانتيجين هذا؟ بقدرش يرتبط معاه يبقى عواجنا عملية
+
+340
+00:25:06,820 --> 00:25:10,800
+او البكتيريا عاملة استراتيجية عاقة تأثير ال
+
+341
+00:25:10,800 --> 00:25:14,400
+antibodies اللي يمكن ينتجها الجسم هذه العملية
+
+342
+00:25:14,400 --> 00:25:20,740
+بيسموها phase variation تباين الأطوارانتقلت من طور
+
+343
+00:25:20,740 --> 00:25:25,740
+الف تمام اللي هو هذا الطور الى طور ده اللي هو هذا
+
+344
+00:25:25,740 --> 00:25:31,120
+الطور كمان مارعيش فايته هذا بيعيق عملية فعالية ال
+
+345
+00:25:31,120 --> 00:25:35,740
+antibody في مكافحة ال infection معظم ال antibodies
+
+346
+00:25:35,740 --> 00:25:39,700
+اللي بتطلع لهذا النوع من ال antigenات اللي هو ال H
+
+347
+00:25:39,700 --> 00:25:45,340
+-antigen من نوع IgG نجي
+
+348
+00:25:45,340 --> 00:25:54,030
+لتالت اللي هو ال V-I antigenو ال V.I. Antigen أطلق
+
+349
+00:25:54,030 --> 00:25:56,850
+أو أول حرفين هدول مأخوذين من كلمة virulence
+
+350
+00:25:56,850 --> 00:26:02,390
+virulence شراسة طيب شراسة يعني ربطنا الكابسول
+
+351
+00:26:02,390 --> 00:26:07,270
+ربطنا الكابسول دون ان عن كل ال other virulence
+
+352
+00:26:07,270 --> 00:26:12,330
+factors بكلمة V.I. لماذا؟ لأن الشباب كانوا متعارف
+
+353
+00:26:12,330 --> 00:26:17,090
+في نموذج مشهور جدا في ال microbiology بكتير اسمها
+
+354
+00:26:17,090 --> 00:26:20,560
+streptococcus pneumoniaفي منها صنفين او two
+
+355
+00:26:20,560 --> 00:26:24,620
+varieties واحدة capsulated واحدة non-capsulated
+
+356
+00:26:24,620 --> 00:26:28,360
+لما حقنناهم التنتين واحدة في فار واحدة في فار تاني
+
+357
+00:26:28,360 --> 00:26:33,300
+هذا الفار مات والتاني ما مات فجالوا ان ال
+
+358
+00:26:33,300 --> 00:26:37,660
+capsulated virulent بينما ال non-capsulated a
+
+359
+00:26:37,660 --> 00:26:40,980
+virulent فصار في رابط ما بين الكابسول وما بين ال
+
+360
+00:26:40,980 --> 00:26:45,640
+virulence تبع البكتير عموما الكابسول ما الموجود
+
+361
+00:26:45,640 --> 00:26:49,640
+للكابسول جوا البكتير ولا برا البكتير؟يعنى بالظبط
+
+362
+00:26:49,640 --> 00:26:57,740
+يعنى لو احنا رسمنا البكتيريا على شكل مستطيل
+
+363
+00:26:57,740 --> 00:27:07,600
+هذا ال O انتجن صح وهذا ال H انتجن وهذا ال K انتجن
+
+364
+00:27:07,600 --> 00:27:12,620
+طيب لو انا عندي antibodies antibodies وبدى افعلها
+
+365
+00:27:12,620 --> 00:27:14,800
+مع ال O انتجن وضفتها هنا
+
+366
+00:27:19,640 --> 00:27:24,260
+لن تستطيع اختراق الكابسول والارتباط مع الـ O
+
+367
+00:27:24,260 --> 00:27:29,320
+-antigenوبالتالي إذا أردت التعرف على ال o-antigen
+
+368
+00:27:29,320 --> 00:27:32,560
+اللي البكتيريا إلها كابسول يجب أن أقوم بإزالة
+
+369
+00:27:32,560 --> 00:27:38,340
+الكابسول كيف هيتم ذلك؟ عن طريق تسخين البكتيريا إلى
+
+370
+00:27:38,340 --> 00:27:43,200
+ستين درجة مقوية لمدة ساعة هذا كفيل بإزالة .. طبعا
+
+371
+00:27:43,200 --> 00:27:47,000
+هيقوللي أحدا البكتيريا هيك بتموت أنا مش معنى كتير
+
+372
+00:27:47,000 --> 00:27:50,400
+أن البكتيريا تبقى حية للفحص يعني أنا بدي أفحصها
+
+373
+00:27:50,400 --> 00:27:55,760
+حتى لو كانت ميتة ال antigen بيظله موجود فيهاطيب،
+
+374
+00:27:55,760 --> 00:28:04,800
+إذا كم .. كم antigen سنعرفين؟ ثلاثة O و H و K الان
+
+375
+00:28:04,800 --> 00:28:11,540
+K او V I و نقلنا K او V I و يوعب ع مين قلنا؟ عن
+
+376
+00:28:11,540 --> 00:28:16,100
+الكابسولار الان تعالى نشوف بكتيريا كاملة مسمة
+
+377
+00:28:16,100 --> 00:28:21,100
+كامل، designation كامل سلمونيلا
+
+378
+00:28:21,100 --> 00:28:27,330
+الطائفي O 1 و 2و بين جثين vi if present ايش يعني
+
+379
+00:28:27,330 --> 00:28:31,010
+if present يعني اذا موجود ال vi بنحطه بين جثين
+
+380
+00:28:31,010 --> 00:28:36,130
+وبعدين نجوطين فوق بعض و ذكرنا حرف و بعدين رقم
+
+381
+00:28:36,130 --> 00:28:40,470
+عارفين اللي بعد النجوطين هم هدول ال H-antigen
+
+382
+00:28:40,470 --> 00:28:44,530
+فاكرين لما قلت ال H-antigen انه كان exist in two
+
+383
+00:28:44,530 --> 00:28:47,570
+phases phase one و phase two لما قلنا phase
+
+384
+00:28:47,570 --> 00:28:52,760
+variation القطاع اللي مشهدناهاهذا بيأشر إنه على
+
+385
+00:28:52,760 --> 00:28:58,160
+إيش؟ على إنه ال bacteria اللي قدامي هذه can have
+
+386
+00:28:58,160 --> 00:29:01,500
+phase
+
+387
+00:29:01,500 --> 00:29:05,920
+variation لإن في عندها حرف و في عندها رقم الحرف
+
+388
+00:29:05,920 --> 00:29:09,140
+بنعطيه ل phase one و الرقم بنعطيه لمين ل phase two
+
+389
+00:29:09,140 --> 00:29:14,340
+كمان مرة one and two are O-antigen تخيلوا بكتيريا
+
+390
+00:29:14,340 --> 00:29:20,040
+واحدة صنف واحد تمام وفيها مش O واحد فيها أكتر من O
+
+391
+00:29:20,900 --> 00:29:25,300
+هذا يبقى أمر طبيعي صح؟ أن يكون فيها أكتر من O رقم
+
+392
+00:29:25,300 --> 00:29:34,380
+اتنين A phase one H-antigen و one phase two H
+
+393
+00:29:34,380 --> 00:29:39,240
+-antigen ليش لجأنا كمان مرة للstereology؟ مين
+
+394
+00:29:39,240 --> 00:29:39,940
+يذكرني؟
+
+395
+00:29:43,500 --> 00:29:50,680
+أو اختصارا اختصارا اختصارا اختصارا
+
+396
+00:29:50,680 --> 00:29:56,680
+اختصارا اختصارا اختصارا اختصارا اختصارا اختصارا
+
+397
+00:29:56,680 --> 00:29:57,140
+اختصارا اختصارا اختصارا اختصارا اختصارا اختصارا
+
+398
+00:29:57,140 --> 00:29:57,180
+اختصارا اختصارا اختصارا اختصارا اختصارا اختصارا
+
+399
+00:29:57,180 --> 00:29:57,800
+اختصارا اختصارا اختصارا اختصارا اختصارا اختصارا
+
+400
+00:29:57,800 --> 00:29:57,800
+اختصارا اختصارا اختصارا اختصارا اختصارا اختصارا
+
+401
+00:29:57,800 --> 00:29:58,400
+اختصارا اختصارا اختصارا اختصارا اختصارا اختصارا
+
+402
+00:29:58,400 --> 00:30:08,020
+اختصارا اختصارا اختصارا اختصارا
+
+403
+00:30:08,020 --> 00:30:12,780
+اختأشوف ال strings .. إيش عن ال strings؟ السلالات
+
+404
+00:30:12,780 --> 00:30:15,860
+اللي بتلف في البلد .. إيش اللي بتلف؟ اللي بتسبب
+
+405
+00:30:15,860 --> 00:30:18,720
+أمراض في البلد فبروح أنا مدور على استيتو كوكاس
+
+406
+00:30:18,720 --> 00:30:22,400
+نيمونيا و أعزلها في كل قطاع غزة من كل المرضى تمام؟
+
+407
+00:30:22,400 --> 00:30:25,860
+اللي عندهم استيتو كوكاس نيمونيا بنعزلها و بنتعرف
+
+408
+00:30:25,860 --> 00:30:28,820
+على طبيعة ال antigenات اللي فيها بغرض إيش اللي أنا
+
+409
+00:30:28,820 --> 00:30:32,300
+هتعرفنا على ال antigenات؟ عشان نعرف مين أكتر
+
+410
+00:30:32,300 --> 00:30:37,080
+مايكروبات موجودة في قطاع غزة عشان نعملها vaccine
+
+411
+00:30:38,010 --> 00:30:42,810
+فبعض الأحيان مضطرين نعرف الـ zero types أعطيكم
+
+412
+00:30:42,810 --> 00:30:47,370
+مثال تالت أو رابع مشهور جدا اليوم اللي هو ال
+
+413
+00:30:47,370 --> 00:30:50,370
+influenza الخنازير أو ال influenza بشكل عام كل سنة
+
+414
+00:30:50,370 --> 00:30:55,450
+يا شباب بيجمعوا السلالات تبع السنة الماضية و
+
+415
+00:30:55,450 --> 00:30:59,070
+بيعملوا منها vaccine للسنة الجاية تمام؟ هذه
+
+416
+00:30:59,070 --> 00:31:02,650
+السلالات كمان مرة كيف بتعرفوا عليها؟ برضه zero
+
+417
+00:31:02,650 --> 00:31:08,130
+types يعني بتعرفوا على الـ serology تبعهاهذا رسم
+
+418
+00:31:08,130 --> 00:31:17,570
+بس يعني توضيحي ل الفكرة أندي الفلاجلة
+
+419
+00:31:17,570 --> 00:31:20,010
+اللي شايفينها من هنا طالعة من ال cell من ال brain
+
+420
+00:31:20,010 --> 00:31:23,790
+و الفلاجلة اللي لاعيش antigen عند الكابسول هي ال
+
+421
+00:31:23,790 --> 00:31:27,170
+outer most في الآخر وعندي ال lipopolysaccharide
+
+422
+00:31:27,170 --> 00:31:30,410
+اللي هو مولود من جزء من مين؟ جزء من ال cell wall و
+
+423
+00:31:30,410 --> 00:31:34,170
+ال lipopolysaccharide lipid A core polysaccharide
+
+424
+00:31:34,170 --> 00:31:35,710
+OO side H
+
+425
+00:31:46,940 --> 00:31:50,560
+حكينا إن انترو بكترياسي فيها ال general
+
+426
+00:31:50,560 --> 00:31:53,700
+characteristics نستذكرها مع بعض عشان الأن ندخل في
+
+427
+00:31:53,700 --> 00:31:56,760
+شوية تفاصيل they are gram negative بس ال life
+
+428
+00:31:56,760 --> 00:31:59,980
+facultative and aerobic they can grow with or
+
+429
+00:31:59,980 --> 00:32:02,980
+without oxygen, glucose fermenter, oxidase
+
+430
+00:32:02,980 --> 00:32:07,220
+negative, nitrate positiveتعالوا نتطلع مع بعض
+
+431
+00:32:07,220 --> 00:32:14,160
+عمليا كيف ممكن نحدد هوية ميكروب على انه انت رو
+
+432
+00:32:14,160 --> 00:32:17,140
+باكترياسي في المعمل بالمعلومات اللي انتوا
+
+433
+00:32:17,140 --> 00:32:22,100
+امتلكتوها لفصل الماضي في المعمل واحد انا عندي طبق
+
+434
+00:32:22,100 --> 00:32:28,120
+جبل طبق مكونكي صح؟ في المكونكي البكتيري نمت growth
+
+435
+00:32:28,120 --> 00:32:34,160
+ال assumption ايش هي ال assumption الافتراض انها
+
+436
+00:32:34,160 --> 00:32:39,350
+جرامنجاتف بكتيريا لكن جرام نجاتف إيش مش عارفين صح
+
+437
+00:32:39,350 --> 00:32:44,710
+ولا لأ يبقى الخطوة الأولى اللي بنعمل جرام stain
+
+438
+00:32:44,710 --> 00:32:52,770
+طلعت البكتيريا جرام نجاتف بسلان كيف؟
+
+439
+00:32:57,290 --> 00:33:01,130
+كمان مرة انا جولت الافتراض انها gram negative
+
+440
+00:33:01,130 --> 00:33:04,910
+bacteria و هذا الافتراض مش دقيق 100% هتعلم الفصل
+
+441
+00:33:04,910 --> 00:33:09,710
+هذا ان هناك بعض الميكروبات منه اجرام بوستف قد تنمو
+
+442
+00:33:09,710 --> 00:33:13,450
+في المكونكي منها الـ Staphylococcus aureus و منها
+
+443
+00:33:13,450 --> 00:33:16,970
+ال enterococcus و احنا صغار الفصل الماضي كانوا
+
+444
+00:33:16,970 --> 00:33:21,050
+يقولونا انه absolutely selective لجرام negative
+
+445
+00:33:21,050 --> 00:33:24,370
+bacteria و حتى لو افترضنا ان هذا ال assumption
+
+446
+00:33:24,370 --> 00:33:30,050
+صحيحهل هي gram نيجاتف بس الله و لا gram نيجاتف
+
+447
+00:33:30,050 --> 00:33:34,270
+كوكسايل مابندهش نعرف تمام فال gram is 10 و أنا
+
+448
+00:33:34,270 --> 00:33:37,490
+كمان مرة و أكد لكم بدأ أمسح هذه المعلومات اللي على
+
+449
+00:33:37,490 --> 00:33:43,630
+السطورة و أبدأ عنواني من gram نيجاتف
+
+450
+00:33:43,630 --> 00:33:48,270
+بس الله كما بدأت محاضرتي ب gram نيجاتف بس الله و
+
+451
+00:33:48,270 --> 00:33:50,390
+بدأ أبدأ عنواني ب gram نيجاتف بس الله هذا العنوان
+
+452
+00:33:50,390 --> 00:33:55,420
+المهم بالنسبة ليتعرفوا حاجة اسمها triple sugar
+
+453
+00:33:55,420 --> 00:34:04,040
+iron agar؟ كيف شكلها هذا؟ عبارة عن slant و butt ال
+
+454
+00:34:04,040 --> 00:34:08,660
+butt اللي هو الجزء السفلي و ال slant جزء الألوى
+
+455
+00:34:08,660 --> 00:34:16,240
+مما يتكون هذا الفحص three sugars أذكركم فيهم point
+
+456
+00:34:16,240 --> 00:34:25,280
+واحد في المية جلوكوزو 1% lactose و 1% sucrose
+
+457
+00:34:25,280 --> 00:34:33,120
+مظبوط؟ مين أقل كمية؟ الجلوكوز فإذا كانت البكتيريا
+
+458
+00:34:33,120 --> 00:34:37,960
+قادرة على تخمير الجلوكوز فقط فإنها ستنتج كمية
+
+459
+00:34:37,960 --> 00:34:44,180
+ضائلة من ال acid لن يكون كافي هذا ال acid إلا
+
+460
+00:34:44,180 --> 00:34:50,360
+لتغيير لون الجزء السفلي اللي هو الشرملة البطبينما
+
+461
+00:34:50,360 --> 00:34:55,200
+لو البكتيريا قادرة على تخمير الجلوكوز و أحد
+
+462
+00:34:55,200 --> 00:34:59,220
+السكرين أو كلاهما أحد السكرين اللي هم اللاكتوز أو
+
+463
+00:34:59,220 --> 00:35:02,980
+الساكروز و لاحظوا كمية هم إيه الشباب؟ عالية إذا
+
+464
+00:35:02,980 --> 00:35:06,280
+كان عنده المقدرة إنه يخمر الجلوكوز و أحد السكرين
+
+465
+00:35:06,280 --> 00:35:10,680
+أو كلاهما فستكون كمية ال acid كافية لتغيير لون كل
+
+466
+00:35:10,680 --> 00:35:21,070
+من البطء إسلان إذا كان مين؟إذا كان بيخمر اتنين لكن
+
+467
+00:35:21,070 --> 00:35:25,550
+إذا بيخمر واحد فقط K على A يبقى الـ
+
+468
+00:35:25,550 --> 00:35:32,170
+Enterobacteriasi تعال نشيل الشغل تبعنا هذا و ناخد
+
+469
+00:35:32,170 --> 00:35:37,770
+استنتاج هاي
+
+470
+00:35:37,770 --> 00:35:40,750
+ال triple sugar iron agar مرة أخرى ال
+
+471
+00:35:40,750 --> 00:35:45,640
+Enterobacteriasiإيش اللي هتجنب أنك تبعتها؟ يا إما
+
+472
+00:35:45,640 --> 00:35:57,800
+a على a أو k على a لكن مستحيل تكونK على K مستحيل
+
+473
+00:35:57,800 --> 00:36:01,880
+هذا ليش؟ لأن أحد الشروط اللي حكيناها ال انترو
+
+474
+00:36:01,880 --> 00:36:05,980
+باكترياسي انها على أقل جلوكوز fermenter وشفته في
+
+475
+00:36:05,980 --> 00:36:10,520
+التصنيفة السابقة ان البعض منها لا يكتفي بأنه
+
+476
+00:36:10,520 --> 00:36:16,100
+جلوكوز كمان هو lactose fermenter فيا إما A على A
+
+477
+00:36:16,100 --> 00:36:20,300
+يا إما K على E إذا البط على الأقل لازم تكون صفرة
+
+478
+00:36:20,300 --> 00:36:24,610
+دلالة على إيش؟ على جلوكوز fermentation طيبعرفنا
+
+479
+00:36:24,610 --> 00:36:30,130
+المعلومة هذه من ال triple sugar iron agar الان
+
+480
+00:36:30,130 --> 00:36:33,430
+في ايش في عندي على triple sugar iron agar قولنا في
+
+481
+00:36:33,430 --> 00:36:38,570
+عندي هنا slant صح؟ لو أخدت أنا من ال slant و عملت
+
+482
+00:36:38,570 --> 00:36:43,610
+فحص ال oxidase عارفين ال filter paper disk اللي
+
+483
+00:36:43,610 --> 00:36:48,910
+عملنا wrapping ده البكتيريا و within 10 seconds
+
+484
+00:36:48,910 --> 00:36:52,130
+اتكون عندي purple color ال purple color المؤشر على
+
+485
+00:36:52,130 --> 00:36:57,940
+انه positive oxidaseإذا بصت في oxidase هل هي انترو
+
+486
+00:36:57,940 --> 00:37:05,520
+بكتيريا سي؟ اتفقنا it should be negative فانا بقول
+
+487
+00:37:05,520 --> 00:37:10,120
+اتطلع جديش هذا الفحص و هذا الفحص مع بعض اللي هم
+
+488
+00:37:10,120 --> 00:37:10,580
+قيمة
+
+489
+00:37:13,250 --> 00:37:18,430
+ماذا بيعمل؟ بتفرج بين الانتيرو بكترياسي لأ مش بس
+
+490
+00:37:18,430 --> 00:37:24,770
+بالانتيرو بكترياسي بدا أقول جملة لوصفهم they are
+
+491
+00:37:24,770 --> 00:37:28,950
+very useful in the initial differentiation of gram
+
+492
+00:37:28,950 --> 00:37:33,250
+negative bacteria كل gram negative بكتيريا مش فقط
+
+493
+00:37:33,250 --> 00:37:37,940
+الانتيرو بكترياسيThey are also useful in the
+
+494
+00:37:37,940 --> 00:37:40,100
+identification of enterobacteriasis لأنه في
+
+495
+00:37:40,100 --> 00:37:46,200
+انديكامان صفات تانية زي مثلا ال H2S صح؟ مش برضه
+
+496
+00:37:46,200 --> 00:37:51,370
+هذا بيكشف عن ال H2S و بيكشف لأمن كمان على الجازإذا
+
+497
+00:37:51,370 --> 00:37:54,930
+ال triple sugar iron agar مع ال oxidase they are
+
+498
+00:37:54,930 --> 00:37:58,570
+very valuable test in the laboratory for the
+
+499
+00:37:58,570 --> 00:38:01,810
+initial differentiation of gram negative bacilli
+
+500
+00:38:01,810 --> 00:38:05,810
+and for the identification of enterobacteriasة
+
+501
+00:38:05,810 --> 00:38:11,730
+أعطيكم مثال بسيط جدا على بعض الأسماء وصفاتها على
+
+502
+00:38:11,730 --> 00:38:13,090
+triple sugar iron agar
+
+503
+00:38:16,670 --> 00:38:19,930
+بس انا بدي مشاركة منكم ال equalize ايش لازم تكون
+
+504
+00:38:19,930 --> 00:38:27,230
+ال triple sugar اجارة تبعها ال
+
+505
+00:38:27,230 --> 00:38:28,790
+equalize ال eclipse اللي
+
+506
+00:38:33,950 --> 00:38:38,190
+ليش قلت ا على ا؟ لأنه lactose ferment لأربعة
+
+507
+00:38:38,190 --> 00:38:40,770
+lactose ferment اللي انتروباكتر والستروباكتر
+
+508
+00:38:40,770 --> 00:38:44,410
+والاشريشيا طيب لو .. لو .. لو واحد فيكوا بيعرف
+
+509
+00:38:44,410 --> 00:38:48,910
+خصائص الستروباكتر وقلتله ايش ال reaction تبع
+
+510
+00:38:48,910 --> 00:38:52,490
+الستروباكتر على triple sugar انا هقول ايه؟ ايه؟
+
+511
+00:38:52,490 --> 00:38:54,330
+ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟
+
+512
+00:38:54,330 --> 00:38:56,910
+ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟
+
+513
+00:38:56,910 --> 00:39:00,600
+ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايه؟ ايهK على A
+
+514
+00:39:00,600 --> 00:39:08,440
+plus الشجلة K على A باختصار ال triple sugar iron
+
+515
+00:39:08,440 --> 00:39:12,580
+agar one of the most valuable test for the initial
+
+516
+00:39:12,580 --> 00:39:16,680
+differentiation of enterobacteria كده نقطة كتير
+
+517
+00:39:16,680 --> 00:39:17,080
+مهمة
+
+518
+00:39:21,110 --> 00:39:25,310
+بالنسبة للشكل يا شباب تحت ال microscope يعني مهما
+
+519
+00:39:25,310 --> 00:39:31,110
+بلغت من خبرة مهما بلغت من مقدرة على رؤية مرارا
+
+520
+00:39:31,110 --> 00:39:35,570
+وتكرارا لعينات لن تستطيع بأي حال من الأحوال أن
+
+521
+00:39:35,570 --> 00:39:40,150
+تقول أن هذه البكتيريا isiacholide just by the look
+
+522
+00:39:40,150 --> 00:39:45,640
+under the microscope لازم ايش تعمل؟يعني المعلومة
+
+523
+00:39:45,640 --> 00:39:50,160
+الوحيدة اللي بتاخدها من الميكروسكوب بسللاي أو
+
+524
+00:39:50,160 --> 00:39:55,300
+كوكساي بسللاي أو كوكساي غير هيكد ماتحولش كتير في
+
+525
+00:39:55,300 --> 00:39:58,520
+بعض الميكروبات اللي لها صفات مميزة لكن هي نادي
+
+526
+00:39:58,520 --> 00:40:01,520
+راوة قليلة أما بالنسبة للـGram Negative دي are
+
+527
+00:40:01,520 --> 00:40:06,240
+just بسللاي شحتة صغيرة حمرة تمام؟ هذه اللي نسبيت
+
+528
+00:40:06,240 --> 00:40:11,620
+منهم كلهم كلهملا يمتلكوا المقدرة على تكوين ال
+
+529
+00:40:11,620 --> 00:40:15,760
+sport هذه قاعدة عامة لجرام negative bacteria أو
+
+530
+00:40:15,760 --> 00:40:19,980
+لجرام negative bacilli و لجرام negative cocci و
+
+531
+00:40:19,980 --> 00:40:23,820
+لجرام positive cocci لا يمتلكوا المقدرة على إنتاج
+
+532
+00:40:23,820 --> 00:40:28,920
+ال sport تمام؟ مالوم مش مين اللي بيمتلك بعض لجرام
+
+533
+00:40:28,920 --> 00:40:36,140
+positive bacilli اللي هو مين؟ ال bacillus زاد ال
+
+534
+00:40:36,140 --> 00:40:40,610
+cholesterolهدولا ال two genuses الوحيدين اللي
+
+535
+00:40:40,610 --> 00:40:45,330
+بيمتلكوا المقدرة على إنتاج ال sports والباقي مايله
+
+536
+00:40:45,330 --> 00:40:57,150
+هذا المقدر محددات
+
+537
+00:40:57,150 --> 00:41:00,790
+الإمراض أو ما يسمى بال viralness factors أحد
+
+538
+00:41:00,790 --> 00:41:04,470
+محددات الإمراض أنها ال endotoxinوأعتقد الاندوكسين
+
+539
+00:41:04,470 --> 00:41:10,010
+شباب يعني تحدثنا عنه في المحاضرات السابقة وشوفنا
+
+540
+00:41:10,010 --> 00:41:14,090
+تأثيراته المتنوعة ذاكرين احنا بعض التأثيرات هنا
+
+541
+00:41:14,090 --> 00:41:17,990
+مثلا fever و lethal shock ودياريا و abortion فى
+
+542
+00:41:17,990 --> 00:41:22,130
+كمان تأثير لازم انا اذكره ماذكرتوش اللى هو ال DIC
+
+543
+00:41:22,130 --> 00:41:29,490
+DIC او disseminated intravascular coagulation
+
+544
+00:41:33,040 --> 00:41:37,380
+فاكرين مرة قولنا ان ال .. ال .. ال endotoxin بيعمل
+
+545
+00:41:37,380 --> 00:41:42,600
+activation ل ال compliment؟ طب كمان ال endotoxin
+
+546
+00:41:42,600 --> 00:41:45,580
+بيعمل activation ل ال clotting cascade ال clotting
+
+547
+00:41:45,580 --> 00:41:47,560
+cascade اللي هو ال trigger .. اللي بيعمل ال
+
+548
+00:41:47,560 --> 00:41:53,340
+trigger لتجلط فتخيل تجلط في الدم و مش تجلط في مكان
+
+549
+00:41:53,340 --> 00:41:57,460
+disseminated .. ايش انا disseminated؟ منتشر في كل
+
+550
+00:41:57,460 --> 00:42:01,930
+الجسمفإذا الـ Clot هذه سكّرت Capillary يعني سكّرت
+
+551
+00:42:01,930 --> 00:42:05,190
+العضو أو الأعضاء أو الأماكن اللي بيصلها الدم
+
+552
+00:42:05,190 --> 00:42:08,330
+وبالتالي ممكن يسميها Multiple Organ Failure
+
+553
+00:42:08,330 --> 00:42:13,170
+Multiple Organ أو Circulatory Collapse كمان يعني
+
+554
+00:42:13,170 --> 00:42:17,470
+فشل في الدورة الدموية إذن بنقدر نقول إن ال
+
+555
+00:42:17,470 --> 00:42:21,970
+Endotoxin أحد أهم ال viral factors اللي موجودة في
+
+556
+00:42:21,970 --> 00:42:26,810
+ال gram negative enterobacteriasome في واحد تاني
+
+557
+00:42:26,810 --> 00:42:27,590
+اسمه
+
+558
+00:42:29,940 --> 00:42:35,180
+الكلشيسين الكلشيسين عبارة عن antibiotic like
+
+559
+00:42:35,180 --> 00:42:39,660
+substance كيف؟
+
+560
+00:42:39,660 --> 00:42:44,640
+بكتيريوستاتين antibiotic like substance بتذكركوا
+
+561
+00:42:44,640 --> 00:42:48,980
+بص مصطلح حكيناه في مقدماتنا مش اليوم في محاضرة
+
+562
+00:42:48,980 --> 00:42:54,340
+سابقة مصطلح حدثنا فيه عن ال competition المنافسة
+
+563
+00:42:54,900 --> 00:42:59,020
+لما قلنا وجود ميكروب قد يمنع ميكروب اخر من النمو
+
+564
+00:42:59,020 --> 00:43:04,700
+لما احنا قلنا انه هذه العملية بتتم باسلحة مهتنوعة
+
+565
+00:43:04,700 --> 00:43:07,880
+من ضمن الاسلحة هدمين ال colchicine فاللي ابننا
+
+566
+00:43:07,880 --> 00:43:11,800
+افترض جدلا انه ميكروب يمتلك ال colchicine وميكروب
+
+567
+00:43:11,800 --> 00:43:16,700
+اخر لايمتلك واتلقوا في مكان بدهم يتنافسوا على ال
+
+568
+00:43:16,700 --> 00:43:22,030
+space و الغذاءواحد اللي بيمتلك الو advantage فوجف
+
+569
+00:43:22,030 --> 00:43:26,590
+نشاط التاني واستخدم الغذاء لما بيستخدم الغذاء احنا
+
+570
+00:43:26,590 --> 00:43:30,630
+قلنا انوا شباب ال number of bacteria ال number of
+
+571
+00:43:30,630 --> 00:43:34,870
+bacteria is essential for the decision to produce
+
+572
+00:43:34,870 --> 00:43:38,110
+toxin or not to produce toxin لما اتكلمنا عن
+
+573
+00:43:38,110 --> 00:43:42,280
+الكورم sensing صح؟وان البكتيريا بتستشعر عددها
+
+574
+00:43:42,280 --> 00:43:47,740
+بتستشعر عددها وبالتالي بتقرر بناء على عدد تبعها
+
+575
+00:43:47,740 --> 00:43:51,600
+تنتج تكسين او ما تنتج تكسين فبالتالي هذا بيعطيها
+
+576
+00:43:51,600 --> 00:43:56,280
+الصحيح advantage
+
+577
+00:43:56,280 --> 00:44:03,240
+شغل تاني ان بعض البكتيريا لو entered ممكن اتموت
+
+578
+00:44:03,240 --> 00:44:07,900
+البكتيريا التانيةالبكتيريا التانية لما تموت هيتحلل
+
+579
+00:44:07,900 --> 00:44:12,340
+لما هيتحلل هيتطلق من اللي هو السموم تبعتها فهذا
+
+580
+00:44:12,340 --> 00:44:15,360
+الكلام إذا كان في الجسم هيؤدي إلى أن الجسم يتأثر
+
+581
+00:44:15,360 --> 00:44:22,940
+بالاندوتوكسين للبكتيريا اللي ماتت ال cultivation,
+
+582
+00:44:23,360 --> 00:44:25,960
+isolation and differentiation of entero bacterias
+
+583
+00:44:25,960 --> 00:44:30,420
+في هنا وسط مشهور جدا شباب اسمه Eosin Methylene
+
+584
+00:44:30,420 --> 00:44:37,370
+Blue ال Eosin Methylene Blue أو EMBوسط مشهور جدا
+
+585
+00:44:37,370 --> 00:44:41,630
+كان يسبق المكونكي انتوا طبعا ال .. ال .. ال ..
+
+586
+00:44:41,630 --> 00:44:45,150
+الوسط اللي درستوه في المعمل هو مين؟ المكونكي على
+
+587
+00:44:45,150 --> 00:44:49,270
+أيامنا احنا كان ال EMB هو المشهور اجى ال .. اجى
+
+588
+00:44:49,270 --> 00:44:54,430
+المكونكي و أزاح ال EMB على جهة و بدلوه ليش أزاح و
+
+589
+00:44:54,430 --> 00:44:58,670
+بدلوه؟ هم لنفس الغلط كانوا اتنين لتنمية ال gram
+
+590
+00:44:58,670 --> 00:45:01,850
+negative بكتير يعني selective media for gram
+
+591
+00:45:01,850 --> 00:45:05,560
+negativeوردوا ان المكونكي بيعطيني differentiation
+
+592
+00:45:05,560 --> 00:45:10,760
+أوضح بين ال lactose و ال non-lactose fermenter
+
+593
+00:45:10,760 --> 00:45:15,180
+فالمكونكي شاعر لكن اتنين بيستخدموا نفس الغرض
+
+594
+00:45:15,180 --> 00:45:20,740
+بالعكس ال EMB الو ميزة عن المكونكي اذا زرعت علي
+
+595
+00:45:20,740 --> 00:45:30,580
+الاشريشيا كولاي تعطيك لون green metallic sheen
+
+596
+00:45:30,580 --> 00:45:36,250
+شفت الصورة اللي انايمكن بدأت فيها ال .. ال .. هذه
+
+597
+00:45:36,250 --> 00:45:41,810
+ها؟ لأ هذه مش واضحة ال green ولا فيها؟ واضح؟ لأ
+
+598
+00:45:41,810 --> 00:45:46,990
+عموما اللون ممكن نحضرلكوا في المعمل بيكون أخضر
+
+599
+00:45:46,990 --> 00:45:50,470
+المعدن لامة خاص بال Escherichia coli فال
+
+600
+00:45:50,470 --> 00:45:51,550
+Escherichia coli
+
+601
+00:45:54,190 --> 00:45:58,190
+بتعطينا التمييز على هذا الوسط وبالتالي ال EMB
+
+602
+00:45:58,190 --> 00:46:02,910
+حولوه وطوروه لوسط اسمه M-Endo Agar والان بيستخدموه
+
+603
+00:46:02,910 --> 00:46:05,570
+في ال water analysis للكشف عنه اللي هو ال
+
+604
+00:46:05,570 --> 00:46:08,970
+Escherichia coli فيها اسمها Hectin and Trig وهي ال
+
+605
+00:46:08,970 --> 00:46:11,010
+Endo Agar اللي حكيتكوا عنه ال Endo Agar اللي هو
+
+606
+00:46:11,010 --> 00:46:15,450
+modification من مين؟ من اليوزين مثلين قبلهالكليجلر
+
+607
+00:46:15,450 --> 00:46:18,110
+ايرون اجار و ال triple sugar ايرون اجار اعتقد ان
+
+608
+00:46:18,110 --> 00:46:19,990
+ال triple sugar ايرون اجار احنا شرحناه قبل شوية
+
+609
+00:46:19,990 --> 00:46:23,170
+لما اتكلمنا عن الصفتين الرئيسيتين اللي هم ال
+
+610
+00:46:23,170 --> 00:46:27,470
+glucose fermentation و ال oxidase لكن ايش الفرق
+
+611
+00:46:27,470 --> 00:46:30,630
+بين التانيين دولة؟ هذا فقط في سكرين يا شباب
+
+612
+00:46:30,630 --> 00:46:34,690
+الكليجلر ايرون في سكرين و هذا في تلت سكرين اما
+
+613
+00:46:34,690 --> 00:46:36,430
+بعضه نفسه اللي هو المعلومة
+
+614
+00:46:41,460 --> 00:46:45,520
+هذا الفكرة او ال principle تبع ال triple sugar
+
+615
+00:46:45,520 --> 00:46:50,900
+iron agar لا بأس انه نعيد تذكير فيه هو عبارة عن
+
+616
+00:46:50,900 --> 00:46:55,080
+primary differentiation media وهذه ال primary
+
+617
+00:46:55,080 --> 00:46:58,820
+differentiation من ان احنا بنزرع المستعمرة على ال
+
+618
+00:46:58,820 --> 00:47:03,980
+triple sugar iron agar تكسير السكريات والانتاج
+
+619
+00:47:03,980 --> 00:47:07,320
+للحمض او ال acid المصاحب لتكسير السكريات او ال
+
+620
+00:47:07,320 --> 00:47:10,920
+fermentation لهاcan be detection by a pH indicator
+
+621
+00:47:10,920 --> 00:47:13,980
+ال pH indicator فاكر أن اللون الأصلي للميديا كان
+
+622
+00:47:13,980 --> 00:47:18,880
+Salmon Pink إذا انخفض ال pH بتحول لللون الأصفر إذا
+
+623
+00:47:18,880 --> 00:47:22,400
+ارتفع ال pH يعني صار alkaline بتحول لللون الأحمر
+
+624
+00:47:22,400 --> 00:47:26,640
+وبالتالي بنقدر نعرف إنه acidic أو alkaline by the
+
+625
+00:47:26,640 --> 00:47:31,580
+change of color إذا كان acid يلو وإذا كان pink أو
+
+626
+00:47:31,580 --> 00:47:37,780
+red اللي هو بيكون alkalineيضاف لهذا الوسط اللي هو
+
+627
+00:47:37,780 --> 00:47:41,740
+الثيو سلفات والثيو سلفات طبعا بصير لها reduction
+
+628
+00:47:41,740 --> 00:47:47,040
+بال H2S اللي هو أصلا غاز عديم اللون مالوش لون ال
+
+629
+00:47:47,040 --> 00:47:51,300
+H2S لكن لو ارتبط بال .. بال .. بالثيو سلفات بصير
+
+630
+00:47:51,300 --> 00:47:55,060
+فعلا اللي هو black كده اللي بنشوفه في الميديا
+
+631
+00:47:55,060 --> 00:48:00,320
+البعض بيقول طيب لو أنا شفت مبوبة الجزء السفلي كلها
+
+632
+00:48:00,320 --> 00:48:06,760
+blackكي بده اقرأها بالنسبة ل .. ال .. ال .. و انا
+
+633
+00:48:06,760 --> 00:48:15,700
+مثلا احمر فهتكون كي على اش ليش ايه قلت طيب ما هي
+
+634
+00:48:15,700 --> 00:48:18,960
+اللون الأسود ال اي أصفر مظبوط؟
+
+635
+00:48:21,990 --> 00:48:25,490
+استنتاج يعني مش بنقول .. بنقول لو لإنه صار في
+
+636
+00:48:25,490 --> 00:48:30,650
+fermentation للجلوكوز لما صار إنتاج أصلا لل H2S
+
+637
+00:48:30,650 --> 00:48:34,330
+وبالتالي هذه صفراء اللون غطى عليها اللون وبالتالي
+
+638
+00:48:34,330 --> 00:48:38,910
+K على A اللى هو plus ال plus طبعا مؤشر ل .. قولنا
+
+639
+00:48:38,910 --> 00:48:46,210
+ال .. ال H2S طيب
+
+640
+00:48:46,210 --> 00:48:48,550
+نجحى في عند هذه اللوحة ان شاء الله اللى الاشريشيا
+
+641
+00:48:48,550 --> 00:48:51,030
+والمرة الجاية بنكمل الموضوع
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8qYMbROMJ7Y_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8qYMbROMJ7Y_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..508e214bf68d44f0072d1df30df7776ca7a46373
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8qYMbROMJ7Y_postprocess.srt
@@ -0,0 +1,2544 @@
+1
+00:00:20,650 --> 00:00:23,730
+بسم الله الرحمن الرحيم اليوم هنبدأ موضوع الـ
+
+2
+00:00:23,730 --> 00:00:25,830
+streptococci احنا بدأنا بمقدمة المحاضرة الماضية
+
+3
+00:00:25,830 --> 00:00:28,910
+لكن لبقص أنه نمر عليها مرور سريع ال streptococci
+
+4
+00:00:28,910 --> 00:00:32,710
+كما ذكرتوا لكم المرة الماضية هي ال genus الأكثر
+
+5
+00:00:32,710 --> 00:00:37,490
+إحداثا لأنواع مختلفة من الأمراض يعني نسبة إحداثه
+
+6
+00:00:37,490 --> 00:00:41,310
+لأمراض متنوعة عالية جدا الأسماء اللي ذكرناها ذكرنا
+
+7
+00:00:41,310 --> 00:00:45,990
+streptococcus biogenes agalactia fecalis pneumonia
+
+8
+00:00:45,990 --> 00:00:49,360
+واتكلمنا عن ال viridians groupاتكلمنا عن ال
+
+9
+00:00:49,360 --> 00:00:52,280
+general characteristics للبكتيريا وقلنا انه يجرم
+
+10
+00:00:52,280 --> 00:00:56,640
+بسطف كوكساي arranged in chains والchains هذه قد
+
+11
+00:00:56,640 --> 00:01:01,040
+تتكون من two or more يعني لحد الأدنى اللي هو تنتين
+
+12
+00:01:01,040 --> 00:01:04,400
+ال corners قلنا عنهم are small usually one to two
+
+13
+00:01:04,400 --> 00:01:07,960
+millimeter in diameter gray to white in color
+
+14
+00:01:07,960 --> 00:01:11,800
+اتكلمنا عن ال classification of streptococci قلنا
+
+15
+00:01:11,800 --> 00:01:15,000
+there are two systems of classificationNumber one
+
+16
+00:01:15,000 --> 00:01:20,280
+is based on hemolytic activity into beta complete
+
+17
+00:01:20,280 --> 00:01:24,180
+hemolysis, alpha incomplete hemolysis, gamma no
+
+18
+00:01:24,180 --> 00:01:28,380
+hemolysis واخدنا مثلها على كل صنف من هذه الأصناف
+
+19
+00:01:29,440 --> 00:01:33,120
+وتحدثنا ايضا عن Landsfeld classification وقلنا انه
+
+20
+00:01:33,120 --> 00:01:36,240
+based on the C polysaccharide found in the cell
+
+21
+00:01:36,240 --> 00:01:40,640
+wall of gram-boosted streptococci groups A, B and
+
+22
+00:01:40,640 --> 00:01:43,760
+D contains the most important pathogen of
+
+23
+00:01:43,760 --> 00:01:47,060
+streptococci واخدنا مثل على group A streptococcus
+
+24
+00:01:47,060 --> 00:01:51,300
+biogenes, B a galactia و group D الينتيرو cocci
+
+25
+00:01:53,300 --> 00:01:59,140
+طبعا ال .. ال .. ال beta-hemolytic يعني سهل انه ..
+
+26
+00:01:59,140 --> 00:02:03,520
+انه .. ان .. انفرقهم cellologically
+
+27
+00:02:05,270 --> 00:02:09,930
+انتوا نعم بمعنى انه group A الوحيدة اللي فيهم beta
+
+28
+00:02:09,930 --> 00:02:12,210
+hemolytic هي الـ streptococcus pyogenes فلو انا في
+
+29
+00:02:12,210 --> 00:02:14,650
+يوم من الأيام لجيت group A و لجيتها في نفس اللي
+
+30
+00:02:14,650 --> 00:02:17,050
+لجيت beta hemolytic فهي الـ streptococcus pyogenes
+
+31
+00:02:17,050 --> 00:02:21,350
+والصحيح انه الـ streptococcus pyogenes هي is the
+
+32
+00:02:21,350 --> 00:02:24,650
+only pathogen في ال group A فبالتالي احنا بنكون
+
+33
+00:02:24,650 --> 00:02:28,590
+محظوظين لو لجينا الصفة بهذه الطريقة group A زاد
+
+34
+00:02:28,590 --> 00:02:32,770
+انه beta hemolyticو ذكرنا أننا نستخدم مزيج من
+
+35
+00:02:32,770 --> 00:02:36,030
+النظامين و على غرار المعلومة اللي تكلمنا فيها الآن
+
+36
+00:02:36,030 --> 00:02:40,950
+اللي هي المعلومة اللي بتقول group A Beta-Hermetic
+
+37
+00:02:40,950 --> 00:02:46,290
+Striptococci وتشير إلى Striptococcus Violinsوبدأنا
+
+38
+00:02:46,290 --> 00:02:49,490
+بالحديث عن ايضا الستيبتوكوكاس بيورينز وقلنا انه
+
+39
+00:02:49,490 --> 00:02:55,170
+this bacteria causes a wide range of diseases منها
+
+40
+00:02:55,170 --> 00:02:59,410
+التونسولايتس منها الارسيبلس او ال red skin حكينا
+
+41
+00:02:59,410 --> 00:03:04,930
+عنه ذكرنا اتايتس ميديا ذكرنا سيبتسيميا ذكرنا
+
+42
+00:03:04,930 --> 00:03:08,930
+مينينجايتس مجموعة ضخمة من الأمراض هذكركم فيها بس
+
+43
+00:03:08,930 --> 00:03:14,580
+عالسريعParsipilas Gonorrhea Red Skin Otitis Media
+
+44
+00:03:14,580 --> 00:03:17,220
+Peripheral Fever أو Peripheral Sepsis اللي هي
+
+45
+00:03:17,220 --> 00:03:20,320
+الحمّة .. الحمّة النفاس و الحمّة النفاس هي اللي
+
+46
+00:03:20,320 --> 00:03:23,600
+بتصيب ال .. ال .. ال .. الأمهات اللي ب .. ب .. بعد
+
+47
+00:03:23,600 --> 00:03:28,360
+الولادة غالبا بتلات أيام وهذه تعتبر مؤشر على تقدم
+
+48
+00:03:28,360 --> 00:03:32,960
+النظام الصحي في البلدان أو على تخلفيه يعني جديش
+
+49
+00:03:32,960 --> 00:03:37,800
+نسبة الوفيات من الأمهات في .. بعد عميلة الولادة
+
+50
+00:03:37,800 --> 00:03:42,260
+تعتبر مؤشر على كمان مرةتطور أو تخلف النظام الصحيح
+
+51
+00:03:42,260 --> 00:03:44,360
+احنا في الفلسطين الحمد لله رب العالمين يعني هذه
+
+52
+00:03:44,360 --> 00:03:48,140
+النسبة يعني تضاهي مثلتها في أوروبا وولايات المتحدة
+
+53
+00:03:48,140 --> 00:03:51,580
+الحمد لله نسبة جيدة كذلك الأمر بالنسبة للوفيات في
+
+54
+00:03:51,580 --> 00:03:56,650
+الموليد برضه كمان عنه نسبة مدنية جداطبعا دايما
+
+55
+00:03:56,650 --> 00:04:03,510
+احنا في اي نظام صحي بيسعى انه يكون النسب Zero لكن
+
+56
+00:04:03,510 --> 00:04:07,450
+هذا الكلام مستحيل من ناحية العملية لكن السعي له
+
+57
+00:04:07,450 --> 00:04:09,330
+يطور النظام الصحي
+
+58
+00:04:26,120 --> 00:04:29,960
+and rheumatic fever وذكرنا إذا بتذكروا وجودنا رقم
+
+59
+00:04:29,960 --> 00:04:33,420
+11 و12 اللي هم ال acute glomerul nephritis و
+
+60
+00:04:33,420 --> 00:04:37,160
+rheumatic fever ذكرنا إنهم عبارة عن immunologic
+
+61
+00:04:37,160 --> 00:04:42,340
+reactions لإن البكتيريا بتنتج أو الجسم بينتج
+
+62
+00:04:42,340 --> 00:04:47,260
+antibodies للبكتيرياهذه الأنتيبوديز ستتعامل مع
+
+63
+00:04:47,260 --> 00:04:51,840
+تجاربنا وبتهاجم البكتيريا وبتهاجم أنسجتنا وبالتالي
+
+64
+00:04:51,840 --> 00:04:55,680
+لا تعتقدوا ان simple tonsillitis is really a
+
+65
+00:04:55,680 --> 00:05:00,100
+simple disease لأ هي مرض خطير ويجب مراقبته وعلاجه
+
+66
+00:05:00,100 --> 00:05:05,040
+فورا وتكراره يجب أن يمنع باستخدام على سبيل المثال
+
+67
+00:05:05,040 --> 00:05:07,860
+ال long acting penicillins اللي حكينا عنه المرة
+
+68
+00:05:07,860 --> 00:05:11,450
+الماضية نرجع برجوعالصورة اللى كنا بناها دى كانت
+
+69
+00:05:11,450 --> 00:05:15,170
+عبارة عن تلخيص لمين لل ال viral factors بشكل ال
+
+70
+00:05:15,170 --> 00:05:18,130
+structures لللوحة السابقة زى ال peptidase,
+
+71
+00:05:18,350 --> 00:05:21,150
+streptodoranase, hyaluronidase, streptokinase
+
+72
+00:05:21,150 --> 00:05:22,830
+وحاكينا على ال streptokinase المرة الماضية كنا
+
+73
+00:05:22,830 --> 00:05:27,750
+يستخدم في تفكيك الجلطات في تفكيك الجلطات عشان لو
+
+74
+00:05:27,750 --> 00:05:31,550
+صار فينا جروح والتهب ب streptococcus biogenes ال
+
+75
+00:05:31,550 --> 00:05:35,970
+LTM تبقى الجروح يطول لماذا يطول؟ لماذا اتمنى ان
+
+76
+00:05:35,970 --> 00:05:40,220
+يطول؟البكتيريا تتكثر و تنهي بشكل جيد تحدثنا عن الـ
+
+77
+00:05:40,220 --> 00:05:43,820
+streptomycin O وتكلمنا عن مين في هذا السياق تكلمنا
+
+78
+00:05:43,820 --> 00:05:47,920
+عن antstreptomycin O اللي هو الفحص المستخدم لقياس
+
+79
+00:05:47,920 --> 00:05:55,480
+مدى وجود هذا ال antibody لهذا ال antigenهدس اللوحة
+
+80
+00:05:55,480 --> 00:05:59,940
+يعني لوحة برضه جيدة بتوضحنا ال .. ال .. ال .. ال
+
+81
+00:05:59,940 --> 00:06:03,860
+entry و ال portal of exit طبعا لاحظوا هنا entry
+
+82
+00:06:03,860 --> 00:06:07,900
+and exit ايش entry and exit يعني مكان الدخول و
+
+83
+00:06:07,900 --> 00:06:11,160
+مكان الخروج للميكروب طبعا النقاط الأخرى اللي
+
+84
+00:06:11,160 --> 00:06:15,110
+موجودة قدامكوا هذه هي الأماكناللي بيعمل فيها
+
+85
+00:06:15,110 --> 00:06:19,230
+infection لـ streptococcus اعتقد انه احنا شايفين
+
+86
+00:06:19,230 --> 00:06:23,910
+كل الدسم شايفين كل الدسم عشان اقولنالكوا wide
+
+87
+00:06:23,910 --> 00:06:28,390
+variety of diseases are caused by streptococcus
+
+88
+00:06:28,390 --> 00:06:32,850
+virus طبعا الصورة هادى لإن احنا قولنالكوا انه
+
+89
+00:06:32,850 --> 00:06:35,910
+tonsillitis استغربنا من أحد الإخوة اللى جاية أنا
+
+90
+00:06:35,910 --> 00:06:38,890
+لم أصاب بالـ tonsillitis زي وسعيد الآن يمكن بكرا
+
+91
+00:06:38,890 --> 00:06:43,070
+او بعده يغيب عشان الـ tonsillitis لكن
+
+92
+00:06:45,370 --> 00:06:48,970
+Tonsillitis is a very common وبالتالي هتواجهكوا
+
+93
+00:06:48,970 --> 00:06:52,650
+انتوا كطلاب تحاليل طبية قد يطلب منكوا جمع عينات
+
+94
+00:06:52,650 --> 00:06:55,630
+لكن احنا بنفضلش انه ال medical technologist هو
+
+95
+00:06:55,630 --> 00:06:58,910
+اللي يجمع العينات دايما او ابدا بنفضل اما الطبيب
+
+96
+00:06:58,910 --> 00:07:02,230
+او experienced nurse انه يجمع العينات حتى blood
+
+97
+00:07:02,230 --> 00:07:05,870
+collection غالبا we prefer physician
+
+98
+00:07:08,300 --> 00:07:10,880
+هذه الصورة اللي انا حكيتلكوا المرة الماضية عن ال
+
+99
+00:07:10,880 --> 00:07:14,120
+.. البكتيريا اللي هي أكلة اللحم flesh eating
+
+100
+00:07:14,120 --> 00:07:18,280
+بكتيريا بيسموها necrotizing fasciitis لاحظوا كيف
+
+101
+00:07:18,280 --> 00:07:22,940
+التأكل في ال .. ال .. اليد هي الصورة مزعجة و
+
+102
+00:07:22,940 --> 00:07:27,380
+disturbing لكن مضطرين نشوفها هذه أخف صور قد
+
+103
+00:07:27,380 --> 00:07:30,420
+تراونها على ال internet ل necrotizing fasciitis
+
+104
+00:07:30,420 --> 00:07:34,300
+ادخله لحالكوا و sweet dreams بعدها
+
+105
+00:07:36,540 --> 00:07:41,240
+Okay Scarlet fever اللي هو الحمق القرمزية غالبا
+
+106
+00:07:41,240 --> 00:07:44,680
+بينتج عن سلالة .. عن الإصابة بسلالة من
+
+107
+00:07:44,680 --> 00:07:49,540
+erythrogenic toxin هذه السلالة مش منتشرة بشكل كبير
+
+108
+00:07:49,540 --> 00:07:53,460
+بمعنى ان مش كل واحد بينصاب with septicemia, with
+
+109
+00:07:53,460 --> 00:07:56,140
+streptococcus, with bio genes بيصير عنده scarlet
+
+110
+00:07:56,140 --> 00:07:59,780
+fever لازم يكون ال strain بيمتلك ال erythrogenic
+
+111
+00:07:59,780 --> 00:08:04,500
+toxin اللي بيتكلم عنهفاكرين ال toxic shock
+
+112
+00:08:04,500 --> 00:08:08,800
+syndrome تكسين؟ لمين كان هداك؟ للاستفيلو كوكاس
+
+113
+00:08:08,800 --> 00:08:13,800
+الاستريبتو كوكاس بتنتج تكسين برضه شبيه و بيعمل
+
+114
+00:08:13,800 --> 00:08:17,380
+toxic shock syndrome و بيشتغل بنفس القلية، إيش
+
+115
+00:08:17,380 --> 00:08:21,260
+القلية كانت اللي بيشتغل فيها هداك؟ super .. super
+
+116
+00:08:21,260 --> 00:08:24,560
+.. super antigen إيش معناه super antigen كمان مرة
+
+117
+00:08:24,560 --> 00:08:29,880
+أذكركوا؟بيرتبط في الـ T-lymphocytes مع الـ
+
+118
+00:08:29,880 --> 00:08:32,320
+macrophage non-specifically وبالتالي بيعمل
+
+119
+00:08:32,320 --> 00:08:35,420
+activation .. بظبط بيعمل .. بيعمل non-specific
+
+120
+00:08:35,420 --> 00:08:42,010
+activation للـ T-cells okaySome of the antibodies
+
+121
+00:08:42,010 --> 00:08:45,510
+produced during the above infection cross react
+
+122
+00:08:45,510 --> 00:08:49,450
+with certain host tissue.الكلام اللي حكيته انه ال
+
+123
+00:08:49,450 --> 00:08:52,370
+antibodies اللي بينتجها الدسم ضد البكتيريا will
+
+124
+00:08:52,370 --> 00:08:55,730
+cross react with some of the tissues in the body
+
+125
+00:08:55,730 --> 00:09:00,830
+طبعا هذا بطريقة نعم بطريقة غير مباشرة بيعمل
+
+126
+00:09:00,830 --> 00:09:05,120
+destruction و damage لل host tissueحتى بعد ما يصير
+
+127
+00:09:05,120 --> 00:09:08,100
+clearance للميكروعجنز يعني لو اتخلصنا من الميكروب
+
+128
+00:09:08,100 --> 00:09:12,440
+إما من جهاز المناعة أو باستخدام ال antibiotics
+
+129
+00:09:12,440 --> 00:09:16,480
+بيظل الدرر شغال لإن ال antibodies are still there
+
+130
+00:09:16,480 --> 00:09:19,560
+these
+
+131
+00:09:19,560 --> 00:09:22,300
+pathological events begin one to three weeks after
+
+132
+00:09:22,300 --> 00:09:24,620
+an acute streptococcal illness هذه كمان نقطة كتير
+
+133
+00:09:24,620 --> 00:09:29,680
+مهمة إنه إذا صارت الأحداث غالبا تنتج بعد واحد لتلت
+
+134
+00:09:29,680 --> 00:09:34,250
+أسابيع من ال acute infectionو ال acute infection
+
+135
+00:09:34,250 --> 00:09:39,330
+غالبا اما بتكون tonsillitis زي ما حكينا او
+
+136
+00:09:39,330 --> 00:09:42,030
+streptococcal sore throat او ممكن تكون wound
+
+137
+00:09:42,030 --> 00:09:45,430
+infection يا شبابوالسيكولا او ال .. ال
+
+138
+00:09:45,430 --> 00:09:49,970
+complication قد تختلف باختلاف مكان ال primary
+
+139
+00:09:49,970 --> 00:09:53,890
+infection اذا كانت tonsillitis ففي الغالب .. في
+
+140
+00:09:53,890 --> 00:09:58,370
+الغالب بتكون rheumatic fever .. rheumatic fever
+
+141
+00:09:58,370 --> 00:10:02,190
+اذا كانت wound infection تؤدي الى acute glomeral
+
+142
+00:10:02,190 --> 00:10:05,330
+nephritis تمام؟ ففي ارتباط ما بين مكان ال
+
+143
+00:10:05,330 --> 00:10:10,990
+infection و ال complication تبعتهاهذه راشز لظهر
+
+144
+00:10:10,990 --> 00:10:15,110
+مريض بتبين عنده scar اللي بتسميها لو هم قرمزية أو
+
+145
+00:10:15,110 --> 00:10:19,470
+يمكن اللون القرمزي لللسان والشفتين والجلد اللي هو
+
+146
+00:10:19,470 --> 00:10:26,470
+اللي اعطى الاسم للبكتير أو للمرض طيب تعلمنا مجموعة
+
+147
+00:10:26,470 --> 00:10:29,830
+من ال .. ال .. من الأمراض اللي بتسميها الـ
+
+148
+00:10:29,830 --> 00:10:34,950
+streptococcus بيوجين نتكلم الآن عن ال specimens و
+
+149
+00:10:34,950 --> 00:10:38,450
+ال specimen collection كمان مرة أؤكد لكمإنه
+
+150
+00:10:38,450 --> 00:10:43,350
+whenever a physician is available he is
+
+151
+00:10:43,350 --> 00:10:47,030
+responsible for specimen collection يعني هو أكتر
+
+152
+00:10:47,030 --> 00:10:53,610
+experience منك ك medical technologist عنده المقدرة
+
+153
+00:10:53,610 --> 00:10:57,010
+على أنه يختار ال location تبع جامعة العينة أفضل
+
+154
+00:10:57,010 --> 00:11:01,430
+برضه منك لإن هو عنده clinical experience انت
+
+155
+00:11:01,430 --> 00:11:03,190
+ماعندك clinical experience انت عندك laboratory
+
+156
+00:11:03,190 --> 00:11:07,110
+experienceوأفضل شي في الدنيا أن كل واحد يشوف
+
+157
+00:11:07,110 --> 00:11:10,470
+المهام تبعته ويشتغل فيها على أكمل وجهة إذا الطبيب
+
+158
+00:11:10,470 --> 00:11:14,430
+جامع العينة واشترطنا إذا .. إذا بدنا نحصل على
+
+159
+00:11:14,430 --> 00:11:18,890
+أتائج جيدة بدنا عينها جيدة وبالتالي يفضل أنه well
+
+160
+00:11:18,890 --> 00:11:24,190
+experienced و well trained تمام؟ يقولنا physician
+
+161
+00:11:24,190 --> 00:11:29,250
+أو nurse to collect the specimen throat swabis
+
+162
+00:11:29,250 --> 00:11:32,270
+collected through the use of tongue depressor
+
+163
+00:11:32,270 --> 00:11:36,990
+بتعرفوا خافض اللسان؟ أوه ده، تمام؟ بنضغط خشب،
+
+164
+00:11:36,990 --> 00:11:40,970
+بنضغط فيها على اللسان، ليش بنضغط فيها على اللسان؟
+
+165
+00:11:40,970 --> 00:11:41,950
+مش بس
+
+166
+00:11:45,390 --> 00:11:50,490
+جربوا حد يدخل حد straight لل back throat هتلاقي
+
+167
+00:11:50,490 --> 00:11:55,630
+اللسان طلع فوق تلقائي احنا بدنا ندخل swap لمؤخرة
+
+168
+00:11:55,630 --> 00:11:58,870
+الفم، مظبوط؟ فإذا دخلنا ل swap تلقائي اللسان
+
+169
+00:11:58,870 --> 00:12:03,170
+بيرتفع، فبيضغط عليه بيمنع دخوله، فانا بدأ أضطر
+
+170
+00:12:03,170 --> 00:12:08,590
+أمسكله اللسان و أدخل لغرضين، أشوف و في نفس الوجهة
+
+171
+00:12:08,590 --> 00:12:13,360
+أجمع عينا، خد بالكواالمستوى تبع الرأس تبع المريض
+
+172
+00:12:13,360 --> 00:12:16,580
+لازم يكون نفس المستوى تبعك انت لا تخليه يرفع فوق
+
+173
+00:12:16,580 --> 00:12:21,640
+ولا تخليه ينزل تحت المستوى الموازي اليك تمام بيقلل
+
+174
+00:12:21,640 --> 00:12:25,560
+من عملية اللي هو ال vomiting reflux تعرفين لما
+
+175
+00:12:25,560 --> 00:12:28,960
+بدخلنا حاجة برضه يصير فينا شعور بال vomiting تمام
+
+176
+00:12:28,960 --> 00:12:32,300
+فانت بدك تاخد منه عينة ولا بدك تاخد منه vomit تمام
+
+177
+00:12:32,300 --> 00:12:36,430
+بدك عينةفي طبعا ال .. ال .. ال .. في .. في بعض
+
+178
+00:12:36,430 --> 00:12:42,070
+المستشفيات بيرشوا مخدر على ال back throat فال ..
+
+179
+00:12:42,070 --> 00:12:45,670
+ال .. ال vomiting mechanism بتروح من ال .. من
+
+180
+00:12:45,670 --> 00:12:50,940
+المريض عموماtongue depressor و ال illumination
+
+181
+00:12:50,940 --> 00:12:55,820
+إضاءة جيدة للفم عبر إما ضوء متحرك من وجهه لفم
+
+182
+00:12:55,820 --> 00:13:00,000
+المريض tongue depressor go inside do not touch
+
+183
+00:13:00,000 --> 00:13:03,420
+anything except the site where you want to collect
+
+184
+00:13:03,420 --> 00:13:06,780
+the sample لا تلمس الخد من جوا ولا اللسان من الطرف
+
+185
+00:13:06,780 --> 00:13:10,780
+ولا أي مكان آخر go directly to the inflamed area
+
+186
+00:13:10,780 --> 00:13:18,100
+إيش ال inflamed area إما area of red color تمام؟أو
+
+187
+00:13:18,100 --> 00:13:23,120
+area of white color white هذه أفضل عيلة تاخد من ال
+
+188
+00:13:23,120 --> 00:13:26,860
+white إذا وجدت حاجة white خد منها ليش white؟
+
+189
+00:13:26,860 --> 00:13:29,600
+المستعمرات البكتيرية بتكون نامية على التونس اللي
+
+190
+00:13:29,600 --> 00:13:33,900
+هو عاملة المستعمرات فانت بتاخد colony تاخد colony
+
+191
+00:13:33,900 --> 00:13:38,990
+لما تكون white طب مافيش مافيش whiteإيش بتعمل؟
+
+192
+00:13:38,990 --> 00:13:42,910
+بتعمل ال press لما تدخل بال swap بتعمل ال press
+
+193
+00:13:42,910 --> 00:13:46,610
+ضغط على ال tonsil و بتعمل ال roll رول يعني بتلف ال
+
+194
+00:13:46,610 --> 00:13:50,910
+swap الحركة دي يتبقى لتستغل أكثر من عشر ثواني ضغط
+
+195
+00:13:50,910 --> 00:13:54,650
+فبنوع من الممارسة و steady hand يعني مش إيد بترجف
+
+196
+00:13:54,650 --> 00:14:00,340
+نزل ال swap اللي هو من الأنفطبعا نزل ال swap بيتم
+
+197
+00:14:00,340 --> 00:14:05,100
+عن طريق اللي هو برضه swap و بيدخل الانف few
+
+198
+00:14:05,100 --> 00:14:07,980
+centimeter و بعدين بيسحب one to two centimeter بس
+
+199
+00:14:07,980 --> 00:14:11,580
+خدوا بالكوا في نزل فرنجل نزل فرنجل هذا احنا نعرفش
+
+200
+00:14:11,580 --> 00:14:15,180
+ناخده بمعنى اخر انتوا بتعرفوش تاخدوه بده طبيب امام
+
+201
+00:14:15,180 --> 00:14:20,860
+و بيستخدموا فيه swap اليد تبعت ال swap او ال
+
+202
+00:14:20,860 --> 00:14:27,020
+handle تبعته مش خشب غالبا wireو elastic wire بمعنى
+
+203
+00:14:27,020 --> 00:14:31,880
+إنه مرن لو صدم في حاجز ممكن تحركه زي الستثة اللي
+
+204
+00:14:31,880 --> 00:14:35,800
+بندخل فيها الأسلاك في النهر فبيكون فيه نوع من إيه؟
+
+205
+00:14:35,800 --> 00:14:41,200
+من المرونة و بندخله عميقا حتى ناخد عينة معبرة على
+
+206
+00:14:41,200 --> 00:14:42,000
+ال nasopharyngeal
+
+207
+00:14:45,020 --> 00:14:48,360
+ال Sputum كنا عينا من العينات درسناها .. وين
+
+208
+00:14:48,360 --> 00:14:53,000
+درسناها ال Sputum؟ في الطعون اظنى لما درسنا الطعون
+
+209
+00:14:53,000 --> 00:14:56,960
+لما درسنا ال .. ال pneumonic plague كنالكوا انه
+
+210
+00:14:56,960 --> 00:15:01,020
+واحدة من اكثر العينات frustration ليش؟ لأنه صحيح
+
+211
+00:15:01,020 --> 00:15:04,180
+هي معبرة عن ال lungs و جاي من ال lungs لكن بتمر
+
+212
+00:15:04,180 --> 00:15:07,360
+عبر الفم و الفم محتوي على ال saliva و ال saliva
+
+213
+00:15:07,360 --> 00:15:10,900
+contaminated with normal flora فانت بدك Sputum
+
+214
+00:15:10,900 --> 00:15:13,930
+true Sputumوبالتالي بدا تعطي المريض instructions
+
+215
+00:15:13,930 --> 00:15:18,850
+on how to collect a proper specimen by gargling
+
+216
+00:15:18,850 --> 00:15:21,970
+two to three times taking deep breath تعطيه
+
+217
+00:15:21,970 --> 00:15:24,710
+container wide mouth container تعمله instruction
+
+218
+00:15:24,710 --> 00:15:28,150
+انه يكح مباشرة في ال container مايمسكش اللي هو ال
+
+219
+00:15:28,150 --> 00:15:31,370
+.. ال .. ال sputum بين أسنانه و في ال .. ال lips
+
+220
+00:15:31,370 --> 00:15:35,110
+early morning sputum ممكن يكون كويس و في المعمل ..
+
+221
+00:15:35,110 --> 00:15:38,210
+في المعمل انت كمان بتقرر ان هذا .. هذا sputum ولا
+
+222
+00:15:38,210 --> 00:15:42,320
+مش sputum عن طريق ايش؟ عن طريق ال number ofbus
+
+223
+00:15:42,320 --> 00:15:47,740
+cells إذا كان فيه bus cells عالي و few ابيثيليال
+
+224
+00:15:47,740 --> 00:15:51,980
+بيكون مقبول لكن لو كان العكس لو كان ابيثيليال كتير
+
+225
+00:15:51,980 --> 00:15:55,880
+و bus قليل بيعتبروها saliva و بيعملوها rejection
+
+226
+00:15:55,880 --> 00:16:00,400
+rejection يعني بإن محتاجين عينة أخرى غير هذا العين
+
+227
+00:16:00,400 --> 00:16:03,720
+ال blood ده أعتقد أتعلمنا كيف .. وصلتوا في المعمل
+
+228
+00:16:03,720 --> 00:16:08,800
+لل blood ولا لسه؟ لل blood cultureفانتوا كيف ..
+
+229
+00:16:08,800 --> 00:16:10,640
+كيف .. ايش نظام .. ايش نظام ال .. المعمل عندكوا
+
+230
+00:16:10,640 --> 00:16:14,260
+الآن الفصل هذا بتاخدوا group بت لل micro organism
+
+231
+00:16:14,260 --> 00:16:22,220
+ولا specimens عيناد؟ لأ لأ مش قصدي لسه بتكلموا عن
+
+232
+00:16:22,220 --> 00:16:27,080
+البكتيريا ولا .. اه مش .. مش على ال specimens لسه
+
+233
+00:16:27,080 --> 00:16:31,830
+okayفينا جزء متعلق بال specimen ال collection و ال
+
+234
+00:16:31,830 --> 00:16:35,090
+processing تبع كل specimen من ال specimen هذه فال
+
+235
+00:16:35,090 --> 00:16:37,970
+blood culture احنا اظن مرة عملنا زي demonstration
+
+236
+00:16:37,970 --> 00:16:41,970
+في المحاضرة هنا ان كيف بنعمل عملية disinfection لل
+
+237
+00:16:41,970 --> 00:16:46,810
+skin بالكحول و بعدين بالايودين و بعدين بالكحول حتى
+
+238
+00:16:46,810 --> 00:16:51,750
+نمنع اي traces اي اثار متبقية للايودين و في نفس
+
+239
+00:16:51,750 --> 00:16:53,950
+الوقت نعمل good disinfection لل skin
+
+240
+00:16:56,400 --> 00:17:00,280
+Diagnostic procedures للـ streptococcus كان دي ال
+
+241
+00:17:00,280 --> 00:17:04,140
+gram stain و ال gram stain أذكركم بس بالصورة
+
+242
+00:17:04,140 --> 00:17:09,780
+عالسرير أن نرجع برجوع هاد الصورة لما قلتلكوا أن
+
+243
+00:17:09,780 --> 00:17:13,740
+هاد عينة أو صورة عينة حقيقية من .. من boss .. لأن
+
+244
+00:17:13,740 --> 00:17:17,800
+فيها boss cells و البكتيريا عاملة long chains هاد
+
+245
+00:17:17,800 --> 00:17:20,460
+الصورة اللي أمامكم هل ممكن نخطأها و نقول
+
+246
+00:17:20,460 --> 00:17:24,930
+Staphylococcus مستحيلبالظبط لأن هذه long chain
+
+247
+00:17:24,930 --> 00:17:29,130
+فبالتالي بيقولنا انه directly from .. from a
+
+248
+00:17:29,130 --> 00:17:32,030
+clinical specimen البكتيريا اللي اسمها
+
+249
+00:17:32,030 --> 00:17:34,830
+Styrtococcus biogenes could be easily
+
+250
+00:17:34,830 --> 00:17:38,810
+distinguished from other bacteria لكن كمان مرة
+
+251
+00:17:38,810 --> 00:17:43,070
+القاعدة العامة you cannot identify اقولكوا احنا
+
+252
+00:17:43,070 --> 00:17:45,730
+بعض الأحيان بنشوف gram negative diplokokai في
+
+253
+00:17:45,730 --> 00:17:50,190
+عينات CSF مين gram negative diplokokai بتعرفها في
+
+254
+00:17:50,190 --> 00:17:54,580
+ال CSF ان هي Serial meningitisأحنا بنكتف في
+
+255
+00:17:54,580 --> 00:17:57,340
+التقرير بتاعنا في ال Gram Stain Gram Negative
+
+256
+00:17:57,340 --> 00:18:01,860
+Diplococcal وبنبعتها للطبيب الطيب لما بيقرأها إيش
+
+257
+00:18:01,860 --> 00:18:04,700
+بيفسرها نيسيريا من انجيطايتس
+
+258
+00:18:07,140 --> 00:18:11,900
+مافسرتاش انا كانت وظيفتي to describe what I see
+
+259
+00:18:11,900 --> 00:18:15,180
+under the microscope وانا عمل description جيد قولت
+
+260
+00:18:15,180 --> 00:18:19,360
+gram negative diplococci ممكن اوصفله جداش فيها
+
+261
+00:18:19,360 --> 00:18:23,520
+intracellular جداش extracellular هل في بص كتير هل
+
+262
+00:18:23,520 --> 00:18:27,880
+في بص قليل لكن لم أستطع القول ولا الفتوى بأن
+
+263
+00:18:27,880 --> 00:18:32,840
+البكتيريا دي هينيسيريا مينويتايدس إذا نجرى نقول
+
+264
+00:18:32,840 --> 00:18:35,600
+إنه could be distinguished quickly but could not
+
+265
+00:18:35,600 --> 00:18:38,280
+be confirmed ال confirmation بده يكون بمين؟ بال
+
+266
+00:18:38,280 --> 00:18:46,540
+culture طيب
+
+267
+00:18:46,540 --> 00:18:52,720
+و أين بيلاجي البكتيريا هذه؟ بيلاجيها في ال blood؟
+
+268
+00:18:52,720 --> 00:18:55,660
+يا ما أسهل عينة ال blood إن نزرعها على blood
+
+269
+00:18:55,660 --> 00:19:00,790
+cultureبنلاجيها في ال CSF منزلها على بلد أجار
+
+270
+00:19:00,790 --> 00:19:03,810
+وعشان كده أجار مافي اي مشكلة عندنا لكن لو أخدناها
+
+271
+00:19:03,810 --> 00:19:09,510
+من الفم oral cavity من ال tonsils هو أنا أخدتها
+
+272
+00:19:09,510 --> 00:19:12,930
+صحيح من ال tonsil ولمستش أي مكان آخر لكن ال tonsil
+
+273
+00:19:12,930 --> 00:19:18,070
+نفسهامش احنا بنبلع الطعام و بنبلع اللعاب تبعنا
+
+274
+00:19:18,070 --> 00:19:21,370
+عليها أدر بكتيريا فبالتالي في هذه الحالة هل العين
+
+275
+00:19:21,370 --> 00:19:26,170
+اللي أخدتها هي single ولا mixed؟ طب أنا بدي أعززل
+
+276
+00:19:26,170 --> 00:19:29,130
+فقط من؟ بدي أستخدم بالظبط selected media في هذه
+
+277
+00:19:29,130 --> 00:19:33,570
+الحالةفي ال .. في ال .. في العينات اللي .. اللي
+
+278
+00:19:33,570 --> 00:19:36,290
+normally sterile بستخدم blood agar بدون أي
+
+279
+00:19:36,290 --> 00:19:39,810
+additives، لكن إذا كانت العينة مختلطة أو يعتقد
+
+280
+00:19:39,810 --> 00:19:43,410
+إنها مختلطة بال .. ال .. ال antibiotic ب .. بother
+
+281
+00:19:43,410 --> 00:19:45,570
+microorganism، أنا محتاج في هذا الحالة أعملها
+
+282
+00:19:45,570 --> 00:19:49,230
+selective mediaمن الـ selective media المعتمدة
+
+283
+00:19:49,230 --> 00:19:52,490
+عبارة عن blood agar محتوى على three antibiotics زي
+
+284
+00:19:52,490 --> 00:19:55,950
+الـgentamicin والكوليستين و الnerodixic acid
+
+285
+00:19:55,950 --> 00:20:00,010
+والصحيح انهم التلاتة هدولة موجهين ضد لجرام
+
+286
+00:20:00,010 --> 00:20:05,490
+negative bacteria طبعا ولا واحد منهم بيقضي على كل
+
+287
+00:20:05,490 --> 00:20:10,130
+جرام negative تمام فبتالي عملنا خلطة combination
+
+288
+00:20:10,130 --> 00:20:14,850
+تعطينا range واسع من القتل لجرام negative bacteria
+
+289
+00:20:18,910 --> 00:20:21,910
+شكل المستعمرات بيقول إن على ال blood is not a
+
+290
+00:20:21,910 --> 00:20:24,610
+distinguishing characteristic طيب أنا معلش يعني
+
+291
+00:20:24,610 --> 00:20:28,490
+أرجع برجع على كلمة selective media عشان أنصح
+
+292
+00:20:28,490 --> 00:20:32,950
+المفهوم لما قلت أنا إضافة ال antibiotic على ال
+
+293
+00:20:32,950 --> 00:20:39,760
+blood agar جعلها selective absolutely selectiveبدأ
+
+294
+00:20:39,760 --> 00:20:43,200
+أكدلكوا الحقيقة هذه مرارا و تكرارا حتى لا ننسى حتى
+
+295
+00:20:43,200 --> 00:20:47,440
+لا ننسى ان المستعمرة اللي بتنمو نعم هي suspected
+
+296
+00:20:47,440 --> 00:20:50,660
+انها تكون البكتيريا اللي بدياها لكن I have to do
+
+297
+00:20:50,660 --> 00:20:55,220
+some test to confirm the identity لو أنا واثقت
+
+298
+00:20:55,220 --> 00:20:58,120
+بإنه absolute selective ما أنا حاكي ماكانش فيه
+
+299
+00:20:58,120 --> 00:21:01,900
+داعي انه نعمل اي confirmation test وصل الصورة
+
+300
+00:21:01,900 --> 00:21:06,060
+وللأسف احنا كل مرة بنعزل مايكروب من selective
+
+301
+00:21:06,060 --> 00:21:10,210
+media لازم نعملهconfirmation حتى في ال food
+
+302
+00:21:10,210 --> 00:21:14,170
+microbiology يا شباب مش هاخدته MSA واخدته مثلا
+
+303
+00:21:14,170 --> 00:21:19,730
+TCPS لل Vibrochloria لو لجينا البكتيريا اللي نامية
+
+304
+00:21:19,730 --> 00:21:22,890
+و typical colonies مانا باخد تنتين او تلاتة و
+
+305
+00:21:22,890 --> 00:21:30,230
+بعملهم confirmation عشان حقيقة مش لازم تكون غائبة
+
+306
+00:21:30,230 --> 00:21:33,310
+عن أذهنكم احنا اللي بنعرفه ان البكتيريا يا شباب لا
+
+307
+00:21:33,310 --> 00:21:36,550
+يساوي واحد في المية من البكتيريا المعروفة المتوقعة
+
+308
+00:21:36,550 --> 00:21:41,380
+في العالمفيمكن يكون في أنواع من البكتيريا أنا ما
+
+309
+00:21:41,380 --> 00:21:47,280
+بعرفهاش تشبه البكتيريا اللي أنا بعرفها مثلا أنا
+
+310
+00:21:47,280 --> 00:21:49,400
+بدوّع على Staphylococcus aureus على الـ Manitoba
+
+311
+00:21:49,400 --> 00:21:52,500
+salt agar يمكن يكون في بكتيريا مجهولة بتعطيني نفس
+
+312
+00:21:52,500 --> 00:21:55,240
+ال characteristics و أنا ما بعرفهاش وبالتالي يجب
+
+313
+00:21:55,240 --> 00:21:58,240
+أن أتأكد من ال suspect كورنيا عن طريق من
+
+314
+00:21:58,240 --> 00:22:04,740
+confirmatory tests أحد أهم الفحوصات اللي بنستخدمها
+
+315
+00:22:04,740 --> 00:22:09,090
+اسمها Basteracin sensitivity testingدرستوها في
+
+316
+00:22:09,090 --> 00:22:11,510
+المعمل هذه انتوا على فكرة خلصتوا ال strip to cocci
+
+317
+00:22:11,510 --> 00:22:17,930
+تمام البستراسين هو يبقى عن فحص رائع جدا لتمييز ال
+
+318
+00:22:17,930 --> 00:22:22,150
+beta hemolytic strip to cocci الان انا قلت عندي
+
+319
+00:22:22,150 --> 00:22:25,450
+مجموعة او مجموعة من البكتيريا بتعطينا beta
+
+320
+00:22:25,450 --> 00:22:31,050
+hemolysis لكن خدوا بالكم ال Staphylococcus aureus
+
+321
+00:22:31,050 --> 00:22:34,290
+بتعمل beta hemolysis صح بعملها test بستراسين
+
+322
+00:22:38,980 --> 00:22:43,960
+ليش ماعملتلهاش طيب أنا بسترسين تست؟ لأنها كانت
+
+323
+00:22:43,960 --> 00:22:47,880
+ليست .. لأنه لا .. كانت ليست لأنه أنا استثنتها من
+
+324
+00:22:47,880 --> 00:22:51,860
+البداية وبتالي الآن هي مش موضوع خلاف بين و بين
+
+325
+00:22:51,860 --> 00:22:55,480
+أحصان أبيض و أحصان أسود، ذاكرين المثال؟ مش موضوع
+
+326
+00:22:55,480 --> 00:22:59,740
+اتهام بإنها تكون من ضمن المجموعة، استثننها من زمان
+
+327
+00:23:00,810 --> 00:23:05,910
+إذا طلعت عند البكتيريا كتاليز نيجاتيف الان بينطبق
+
+328
+00:23:05,910 --> 00:23:11,370
+عليها بستراسينتس عشان نميز من عن من، نميز عن ..
+
+329
+00:23:11,370 --> 00:23:14,770
+نميز اللي هي ال .. ال .. ال .. الستربتوكوكس
+
+330
+00:23:14,770 --> 00:23:18,410
+بيودينز عن الستربتوكوكس أجلاكتي أو عن ال other
+
+331
+00:23:18,410 --> 00:23:19,570
+streptococci
+
+332
+00:23:23,090 --> 00:23:26,550
+كيف الفحص بنعمل؟ blood agar بنعمله striking
+
+333
+00:23:26,550 --> 00:23:29,850
+للبكتيريا وبنحط القرص عليه وincubation، تفتوا
+
+334
+00:23:29,850 --> 00:23:32,570
+الفحص عملناه؟ وين الفحص؟ على blood agar،
+
+335
+00:23:32,570 --> 00:23:35,310
+ماعملناهوش على nutrient ولا على molar junta، لأن
+
+336
+00:23:35,310 --> 00:23:40,040
+البكتيريا هتجه لنا عنها fastidiousإذا البكتيريا
+
+337
+00:23:40,040 --> 00:23:45,780
+عملت zone of inhibition أكتر من خمسة millimeter
+
+338
+00:23:45,780 --> 00:23:51,640
+على حوالين القرص فبيكون الفحص sensitive والبكتيريا
+
+339
+00:23:51,640 --> 00:23:55,600
+biogenes إذا كان أقل من ذلك أو لا يوجد أصلا zone
+
+340
+00:23:55,600 --> 00:23:59,500
+من أساسه فهي resistant طبعا ال sensitive الوحيدة
+
+341
+00:23:59,500 --> 00:24:03,680
+اللي قلناها هي ال biogenes الأجلاكتيا وال other
+
+342
+00:24:03,680 --> 00:24:05,580
+beta-harmonic التنتين resistance
+
+343
+00:24:08,430 --> 00:24:11,310
+الـ Resistance، أه خلاص، احنا ال .. دايما الأرقام
+
+344
+00:24:11,310 --> 00:24:14,970
+اللي عندنا هي الـ Faisal هل .. زي .. زي في ال
+
+345
+00:24:14,970 --> 00:24:16,610
+sensitivity مرات بيكون ال zone of inhibition
+
+346
+00:24:16,610 --> 00:24:19,890
+تبانية و عشرين، تبانية و عشرين millimeter very
+
+347
+00:24:19,890 --> 00:24:23,210
+large zone، تمام؟ و بنقول resistant، عارفين ليش؟
+
+348
+00:24:23,210 --> 00:24:26,270
+لأن ال chart بتاعة ال antibiotic بتقول إن ال
+
+349
+00:24:26,270 --> 00:24:29,330
+sensitivity تسعة و عشرين، تسعة و عشرين و أعلى
+
+350
+00:24:29,330 --> 00:24:32,570
+sensitive، تبانية و عشرين و أقل لأحد ال
+
+351
+00:24:32,570 --> 00:24:34,670
+antibiotic، مش لكل ال antibiotic، بعض الأحيان
+
+352
+00:24:34,670 --> 00:24:38,510
+بتكون ال zone سبعتاش و sensitiveبحسب نوع ال
+
+353
+00:24:38,510 --> 00:24:41,870
+antibiotic نوع البكتيري فلما انا اقول five
+
+354
+00:24:41,870 --> 00:24:45,510
+millimeter or greater يبقى بده you have to stick
+
+355
+00:24:45,510 --> 00:24:52,170
+to this piece of information طيب قلنا step 2
+
+356
+00:24:52,170 --> 00:24:54,790
+coccus biodeins is sensitive to Pastel Racine ممكن
+
+357
+00:24:54,790 --> 00:24:59,650
+نعمل biochemical test أخرى catalase test negative
+
+358
+00:24:59,650 --> 00:25:01,830
+و oxidase test برضه هي negative
+
+359
+00:25:05,200 --> 00:25:09,900
+أعتقد الصورة اللي أمامناها دي بتوضح إنها ال beta
+
+360
+00:25:09,900 --> 00:25:14,610
+hemolysis تبعت البكتيريا أعتقد واضحة جداو بيقولنا
+
+361
+00:25:14,610 --> 00:25:17,890
+انه small size المستعمرات لكن ال hemolysis تبعها
+
+362
+00:25:17,890 --> 00:25:24,330
+large تمام؟ الطبق التاني هذا في عندي القرص زي ما
+
+363
+00:25:24,330 --> 00:25:27,590
+تشوفين في حواليه zone of inhibition تمام؟ فهذه
+
+364
+00:25:27,590 --> 00:25:31,170
+sensitive وهذه مافيش اي zone بالمرة ف resistant و
+
+365
+00:25:31,170 --> 00:25:34,690
+بيقولنا هذه group A وهذه اللي هو ال .. طبعا إذا
+
+366
+00:25:34,690 --> 00:25:39,790
+بتلاحظوا هذا كله hemolysisهذا مش بكتيريا، هذا
+
+367
+00:25:39,790 --> 00:25:43,350
+Hemolysis، اختفاء اللون هنا Hemolysis، لكن المنطقة
+
+368
+00:25:43,350 --> 00:25:46,790
+المحيطة بالقرص مافيش Hemolysis، ليش؟ مافيش
+
+369
+00:25:46,790 --> 00:25:51,690
+بكتيريا، مافيش بكتيريا، نامي، بينما هنا .. طبعا
+
+370
+00:25:51,690 --> 00:25:53,910
+بلاد أجار، طبعا هنقول .. اتفقنا إنه لازم أكون على
+
+371
+00:25:53,910 --> 00:25:54,430
+بلاد أجار
+
+372
+00:25:58,050 --> 00:26:00,650
+الـ Serological Test و أنا المرة الماضية قدمت لهذا
+
+373
+00:26:00,650 --> 00:26:03,730
+الفحص اللي هو الـ ASOT اللي هو الـ Antibody اللي
+
+374
+00:26:03,730 --> 00:26:08,450
+بينتجه جسم الإنسان ك response للـ streptomycin O و
+
+375
+00:26:08,450 --> 00:26:13,230
+كنا حاطينا حرف ال T في الآخر كتابة تركم مقياس عشان
+
+376
+00:26:13,230 --> 00:26:16,850
+معظمنا أصيب وبالتالي معظمنا جسمه بيحتوي على
+
+377
+00:26:16,850 --> 00:26:20,430
+antibodies أو على level معين من ال antibodies
+
+378
+00:26:20,430 --> 00:26:23,470
+فعشان نميز بين recent infection و previous
+
+379
+00:26:23,470 --> 00:26:28,180
+infectionجسدنا التركيز إذا لاجيناه أكتر من 200
+
+380
+00:26:28,180 --> 00:26:32,580
+international unit بيكون
+
+381
+00:26:32,580 --> 00:26:37,460
+حديثا نعم recent infection بينما إذا كان أقل من
+
+382
+00:26:37,460 --> 00:26:41,180
+200 international unit بيكون الإصابة قديمة طبعا
+
+383
+00:26:41,180 --> 00:26:44,060
+الفحص كان كتير مشهور يا شباب في المختبرات عندنا في
+
+384
+00:26:44,060 --> 00:26:47,940
+فلسطين لإنه نسبة كبيرة من أطفالنا يصابوا به اللي
+
+385
+00:26:47,940 --> 00:26:48,400
+هو ال
+
+386
+00:26:51,930 --> 00:26:56,950
+في سنة من السنوات كان فيه debate، debate يعني جدل
+
+387
+00:26:56,950 --> 00:27:00,970
+محتدم لماذا ال Staphylococcus aureus بتكون
+
+388
+00:27:00,970 --> 00:27:04,590
+resistance بشكل مهول و اظن ان احنا لزوم المحاضرة
+
+389
+00:27:04,590 --> 00:27:08,290
+السابقة او اللي جابلها نصف المحاضرة اتحدثنا فيها
+
+390
+00:27:08,290 --> 00:27:10,650
+عن ال history تبع ال resistance تبع ال
+
+391
+00:27:10,650 --> 00:27:14,560
+Staphylococcus aureusكانت sensitive و resistant و
+
+392
+00:27:14,560 --> 00:27:18,200
+بعدين صارت resistant للبنسالين و لمشتقاته و لأحدث
+
+393
+00:27:18,200 --> 00:27:21,540
+مشتقاته اللي هو ال متسيلين قلنا و بعدين صار لنا
+
+394
+00:27:21,540 --> 00:27:25,800
+resistant لل vancomycin فكانوا يقولوا إيش معنى ال
+
+395
+00:27:25,800 --> 00:27:29,060
+staphylococcus بتكون resistant و ال streptococcus
+
+396
+00:27:29,060 --> 00:27:35,180
+مابتكونش resistance لأن فترة طويلة بالفعل و ال
+
+397
+00:27:35,180 --> 00:27:39,600
+streptococcus دلت sensitive للبنسالين الأم اللي هو
+
+398
+00:27:39,600 --> 00:27:44,020
+ال penicillin geneلكن في السنوات الأخيرة مع الحكي
+
+399
+00:27:44,020 --> 00:27:47,840
+الكتير هذا والنج على البكتيريا قررت ان هي انها
+
+400
+00:27:47,840 --> 00:27:51,860
+برضه هي كمان اتكون resistance لكن هذا يعتقد انه
+
+401
+00:27:51,860 --> 00:27:57,720
+نتج عن تطوير البكتيريا القالية لاستقبال مادة
+
+402
+00:27:57,720 --> 00:28:02,900
+وراثية من ال exterior تبعها فأصبح ان للأسف يعني
+
+403
+00:28:02,900 --> 00:28:07,920
+نسبة لا بأس بها من الستراتوكوكس بيودينز مقاومة لل
+
+404
+00:28:07,920 --> 00:28:11,870
+Penicillinلكن whenever sensitive penicillin D is
+
+405
+00:28:11,870 --> 00:28:16,490
+the drug of choice إذا كانت البكتيريا السترتوكوكاس
+
+406
+00:28:16,490 --> 00:28:18,930
+بيودينز حساسة ده البنسالين في ال sensitivity
+
+407
+00:28:18,930 --> 00:28:22,290
+testing فالpenicillin فالpenicillin is still the
+
+408
+00:28:22,290 --> 00:28:26,130
+drug of choice second line ممكن نستخدم ال
+
+409
+00:28:26,130 --> 00:28:29,830
+erythromycin إيش ينبغي نقوله هنا إيش ينبغي نقوله
+
+410
+00:28:29,830 --> 00:28:33,990
+هنا in penicillin sensitive patient أنت بتعرفه أنه
+
+411
+00:28:33,990 --> 00:28:39,080
+ال penicillin واحد من أقمنالمضادات الحيوية اللي
+
+412
+00:28:39,080 --> 00:28:43,360
+اكشفها الإنسان آمن جدا إلا من حالة واحدة اسمها
+
+413
+00:28:43,360 --> 00:28:48,480
+Penicillin Hypersensitivity يعني حساسية مفرطة لمن؟
+
+414
+00:28:48,480 --> 00:28:52,920
+للبنسالين واحد أخد إبرة مات ليش؟ لأنه صار عنده
+
+415
+00:28:52,920 --> 00:28:57,100
+immediate type hypersensitivity انفلاكتك شك صدمة
+
+416
+00:28:57,100 --> 00:29:00,720
+صدمة حساسية فورية بعد ربع ساعة أو تلت ساعة من
+
+417
+00:29:00,720 --> 00:29:04,660
+تناول ال injection بدأت تطلع عليه علامات ال
+
+418
+00:29:04,660 --> 00:29:08,720
+hypersensitivityطبعا حاليا الجثة هتبقاش بأن أي
+
+419
+00:29:08,720 --> 00:29:13,160
+واحد .. بالظبط أي واحد بدي أخد بنسالين بنعمله فحص
+
+420
+00:29:13,160 --> 00:29:17,080
+sensitivity، واحد بقول .. واحد بقول أنه أنا أول
+
+421
+00:29:17,080 --> 00:29:20,140
+مرة أخد بنسالين فعملولي فحص sensitivity، فلاجوني
+
+422
+00:29:20,140 --> 00:29:23,960
+مش sensitive اعطوني بنسالينتاني مرة روحت على عيادة
+
+423
+00:29:23,960 --> 00:29:27,700
+لمرض معين برضه جالولي عندك حساسية ل بنسالين
+
+424
+00:29:27,700 --> 00:29:30,240
+قولتلهم لأ لإن أنا عملت المرة الماضية فحص
+
+425
+00:29:30,240 --> 00:29:35,780
+فماعملوليش فحص فماعملوليش فحص و أعطوني إبرة و كنت
+
+426
+00:29:35,780 --> 00:29:41,320
+بدأ أموت لإنه صار عندي حساسية كل مرة بدك تاخد إبرة
+
+427
+00:29:41,320 --> 00:29:45,240
+بنسالين بدك تعمل حساسية لإنه أصلا المرة الأولى
+
+428
+00:29:45,240 --> 00:29:48,160
+اللي بتاخد فيها أنت بنسالين مستبعد إنه صير عندك
+
+429
+00:29:48,160 --> 00:29:53,000
+حساسية أصلاإنما هي بعد مين؟ بعد ال first exposure،
+
+430
+00:29:53,000 --> 00:29:55,920
+بعد ال first exposure الممكن يصير عندك sensitivity
+
+431
+00:29:55,920 --> 00:29:59,500
+فكل مرة بدك تعمل ال .. ال .. ال .. او تاخد
+
+432
+00:29:59,500 --> 00:30:02,740
+injection للبنسالين، بدك تعمل sensitivity test
+
+433
+00:30:02,740 --> 00:30:07,160
+المهم إن هذا النوع من ال reactions في بعض الناس
+
+434
+00:30:07,160 --> 00:30:09,820
+عندهم reaction للبنسالين، فهذه الحالة بنعطيهم
+
+435
+00:30:09,820 --> 00:30:10,880
+electromycin
+
+436
+00:30:14,230 --> 00:30:15,950
+الميكروبط التاني في السلسلة اللي هو الـ
+
+437
+00:30:15,950 --> 00:30:21,070
+Streptococcus Agalactica وهي يتبع لمجموعة B Group
+
+438
+00:30:21,070 --> 00:30:24,650
+B Beta Hemolytic Streptococcus In fact هو الممثل
+
+439
+00:30:24,650 --> 00:30:26,330
+الوحيد ل group B
+
+440
+00:30:31,070 --> 00:30:33,890
+انسوا اللوحات اللي على الصبورة و خدنا نتكلم مع بعض
+
+441
+00:30:33,890 --> 00:30:37,970
+ببعض المعلومات المهمة جدا لهذا الميكروب المهم
+
+442
+00:30:37,970 --> 00:30:44,470
+والمهمل مهمل يعني بحاجة إلى من يعيد الاهتمام او
+
+443
+00:30:44,470 --> 00:30:51,130
+يثير نقاط الاهتمام هذا الميكروب موجود normal flora
+
+444
+00:30:51,130 --> 00:30:55,370
+في ال oral و ال vagina flora oral and vagina flora
+
+445
+00:30:56,280 --> 00:31:00,280
+approximately 5-15% of the healthy population
+
+446
+00:31:00,280 --> 00:31:03,120
+carry streptococcus biogenes and streptococcus
+
+447
+00:31:03,120 --> 00:31:07,640
+agalactia in the nasopharynx خمسة لخمساشف المية من
+
+448
+00:31:07,640 --> 00:31:11,920
+الناس العاديين اللي زينا healthy بيحملوا في أنوفهم
+
+449
+00:31:11,920 --> 00:31:17,570
+تمام biogenes و agalactiait can be found in the
+
+450
+00:31:17,570 --> 00:31:21,550
+pharynx, vagina, gastrointestinal tract in
+
+451
+00:31:21,550 --> 00:31:24,530
+addition in the newborn it could be present in
+
+452
+00:31:24,530 --> 00:31:27,810
+various sites هذه النقطة اللي بدنا ننطلق منها في
+
+453
+00:31:27,810 --> 00:31:34,130
+النقاش الـ newborn الموليد الجدد لو أخدنا مسحات من
+
+454
+00:31:34,130 --> 00:31:36,910
+أماكن متنوعة من أجسام محلجة فيها عندهم
+
+455
+00:31:36,910 --> 00:31:42,130
+Steptococcus Agilectis السبب انه normal flora في
+
+456
+00:31:42,130 --> 00:31:46,050
+ال vagina of the female طبعا مش كل ال femalesقد
+
+457
+00:31:46,050 --> 00:31:50,390
+تصل في بعض البلدان الى 30% من ال females وقد تصل
+
+458
+00:31:50,390 --> 00:31:53,650
+الى اقل من ذلك او اكتر من ذلك السؤال اللى بتطرح
+
+459
+00:31:53,650 --> 00:31:58,610
+نفسه هل احنا في قطعنا الحبيب نقوم بالبحث عن هذا ال
+
+460
+00:31:58,610 --> 00:32:03,170
+microbe الجواب لأ الجواب لأ ايش اهمية البحث عن هذا
+
+461
+00:32:03,170 --> 00:32:07,890
+ال microbe بالاساس الجبنة الأخيرة ان الأطفال حدثي
+
+462
+00:32:07,890 --> 00:32:11,650
+الولادة تمام ممكن نلاقي على اجسامهم في اماكن
+
+463
+00:32:11,650 --> 00:32:16,220
+متنوعةإيش ممكن تعمل الأطفال حدثي الولادة هذه
+
+464
+00:32:16,220 --> 00:32:19,980
+البكتيريا؟ ممكن تعمل three conditions pneumonia,
+
+465
+00:32:21,000 --> 00:32:27,000
+septicemia and meningitis أمراض خطيرة جدا سواء
+
+466
+00:32:27,000 --> 00:32:29,560
+كانت ال pneumonia ولا ال septicemia ولا ال
+
+467
+00:32:29,560 --> 00:32:34,160
+meningitis طبعا هذا قد يؤدي إلى وفاة الطفل هذا
+
+468
+00:32:34,160 --> 00:32:40,330
+جانب جانب التاني الأم اللي ولدت ال newbornإذا
+
+469
+00:32:40,330 --> 00:32:44,090
+ماكانش good aseptic تقنيك واستخدام antibiotics بعد
+
+470
+00:32:44,090 --> 00:32:48,790
+الولادة قد تصاب هي ب pure blood sepsis لكن النظام
+
+471
+00:32:48,790 --> 00:32:52,230
+الصحي الفلسطيني الستات غالبا بياخده antibiotic بعد
+
+472
+00:32:52,230 --> 00:32:55,210
+الولادة فبالتالي الأم غالبا protected مين اللي
+
+473
+00:32:55,210 --> 00:33:00,150
+بيبقى عنده مشكلة ال newborn طيب إيش الحل في مثل
+
+474
+00:33:00,150 --> 00:33:04,690
+هذا النوع من المشاكل هو ال normal flora في الفيميل
+
+475
+00:33:04,690 --> 00:33:13,060
+يعني وجودها لا يعني شيء لكنالخشية عند الولادة ف ..
+
+476
+00:33:13,060 --> 00:33:20,560
+في مراكز رعاية .. رعاية الأمومة والطفولة بي
+
+477
+00:33:20,560 --> 00:33:24,700
+عندهم policy في الشهر السادس بياخدوا مسحة vaginal
+
+478
+00:33:24,700 --> 00:33:28,480
+.. vaginal swab .. vaginal swab وبيعملوا culture،
+
+479
+00:33:28,480 --> 00:33:32,340
+بيدوروا على مين؟ على Structococcus Agalactica إذا
+
+480
+00:33:32,340 --> 00:33:35,840
+positive، بس بيسجلوا في البطاقة تبعة الـM إنها
+
+481
+00:33:35,840 --> 00:33:39,630
+positiveإيه ده negative؟ بيحطوا برضه negative
+
+482
+00:33:39,630 --> 00:33:44,690
+البُسط في عند الولادة بيعملوها معاملة غير during
+
+483
+00:33:44,690 --> 00:33:47,750
+delivery intrapartum يعني خلال عملية الولادة
+
+484
+00:33:47,750 --> 00:33:52,950
+بيعملوا administration لل antibiotics ال
+
+485
+00:33:52,950 --> 00:33:57,090
+antibiotics خلال عملية الولادة بتحمي كل من مين؟ من
+
+486
+00:33:57,090 --> 00:34:01,630
+الأم و ال .. و ال .. و ال newborn يبقى فإحنا بنعمل
+
+487
+00:34:01,630 --> 00:34:05,750
+culture و مابنعملش أي action عليها متى ال action
+
+488
+00:34:05,750 --> 00:34:09,580
+بتتم؟عند الولادة، عند الولادة، للأسف هذا الكلام ..
+
+489
+00:34:09,580 --> 00:34:12,380
+هذا الكلام غير مطبق عندنا وبالتالي group B
+
+490
+00:34:12,380 --> 00:34:18,040
+streptococci لن تواجهوها إلا إذا اتغيرت السياسة في
+
+491
+00:34:18,040 --> 00:34:25,160
+.. في .. في موضوع الرعاية للأمومة والطفل ممكن يطلع
+
+492
+00:34:25,160 --> 00:34:28,220
+injection بال .. بال IV يعني خلال الولادة، مش قبل
+
+493
+00:34:28,220 --> 00:34:32,150
+الولادة، خلال الولادة، أي ولادةباسم الأجلات هنا
+
+494
+00:34:32,150 --> 00:34:34,150
+ميكون موجود في ال .. في ال .. في ال .. في ال .. في
+
+495
+00:34:34,150 --> 00:34:35,110
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+496
+00:34:35,110 --> 00:34:35,150
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+497
+00:34:35,150 --> 00:34:35,210
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+498
+00:34:35,210 --> 00:34:35,270
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+499
+00:34:35,270 --> 00:34:35,330
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+500
+00:34:35,330 --> 00:34:35,390
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+501
+00:34:35,390 --> 00:34:35,750
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+502
+00:34:35,750 --> 00:34:35,770
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+503
+00:34:35,770 --> 00:34:36,270
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+504
+00:34:36,270 --> 00:34:36,290
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+505
+00:34:36,290 --> 00:34:40,070
+.. في ال .. في ال .. في ال ..
+
+506
+00:34:40,620 --> 00:34:44,640
+ممكن صحيح، ما هو احنا بيقولنا انه احد أهم المشاكل
+
+507
+00:34:44,640 --> 00:34:47,920
+اللي في المستشفيات .. ان احنا في المستشفيات، في
+
+508
+00:34:47,920 --> 00:34:51,560
+المجتمع ممكن كل يوم ننقل بعض ميكروبات، لكن كونها
+
+509
+00:34:51,560 --> 00:34:54,560
+immunocompetent، يعني ال immune system تبعنا كويس،
+
+510
+00:34:54,560 --> 00:34:57,620
+ولا ات affected، لكن لما ننقلها .. شوفوا يا شباب،
+
+511
+00:34:57,620 --> 00:35:03,280
+تركزوا شغل ليش المستشفى بيقى يعني غير صديقة؟أول
+
+512
+00:35:03,280 --> 00:35:05,940
+حاجة قلنا إن استخدام الـ Antibiotic فيها استخدام
+
+513
+00:35:05,940 --> 00:35:09,280
+مفرط كتير Antibiotic بنستخدم وبالتالي الميكروبات
+
+514
+00:35:09,280 --> 00:35:14,000
+اللي في المستشفى اتعرضت أكتر، عندها experience
+
+515
+00:35:14,000 --> 00:35:17,800
+أكتر وبالتالي ال resistance لها أعلى، هذا مفروض
+
+516
+00:35:17,800 --> 00:35:23,380
+منهم من هم النزلاء المستشفيات؟ إما كبار السن، إما
+
+517
+00:35:23,380 --> 00:35:27,000
+كبار السن وانتوا عارفين كبار السن، الآن مع تقدم
+
+518
+00:35:27,000 --> 00:35:33,230
+الطب كثرهبمعنى احنا زمان لما كان مافيش تقدم طبي
+
+519
+00:35:33,230 --> 00:35:39,290
+كان السن الخمسين خلاص هذا مات يعني انه مافيش رعاية
+
+520
+00:35:39,290 --> 00:35:41,810
+طبية كويسة بس الراعية الطبية صار ال .. ال .. ال
+
+521
+00:35:41,810 --> 00:35:45,790
+average age سبعين او اكتر في بعض البلدان نعم في
+
+522
+00:35:45,790 --> 00:35:48,810
+اليابان جرب على خمس و تمانين ال .. ال average age
+
+523
+00:35:48,810 --> 00:35:54,580
+عند اليابانينفكل ما زادت فئة الكبار السن أمراضهم
+
+524
+00:35:54,580 --> 00:35:57,200
+بتزيد ملاعقهم بتجل وبالتالي بيكونوا برضه في
+
+525
+00:35:57,200 --> 00:36:01,000
+المستشفيات أو في دور الرعاية فالمستشفى بيقى مناسبة
+
+526
+00:36:01,000 --> 00:36:06,040
+لانتقال الأمراض انا healthy تمام احمل مايكروبات قد
+
+527
+00:36:06,040 --> 00:36:09,400
+لا تضرر المجتمع لكن قد تضرر هؤلاء الناس لذلك
+
+528
+00:36:09,400 --> 00:36:14,500
+تقولنا انه في سياسات في المستشفيات او او ايش
+
+529
+00:36:14,500 --> 00:36:19,540
+بيسموها committees لل infection controlأنا لأ أنكر
+
+530
+00:36:19,540 --> 00:36:21,680
+ولودها في غزة، مولودة في غزة ال infection control
+
+531
+00:36:21,680 --> 00:36:25,400
+أنا شخصيا عمل training courses يمكن مرتين أو تلاتة
+
+532
+00:36:25,400 --> 00:36:29,700
+لطواقم المستشفيات في موضوع ال infection control
+
+533
+00:36:29,700 --> 00:36:34,560
+لكن ما زلنا نحبه، نحبه يعني .. يعني لم نصل لمرحلة
+
+534
+00:36:34,560 --> 00:36:39,760
+متطورة بتلاقي أنه في أنشطة موسمية، أنشطة غير يعني
+
+535
+00:36:39,760 --> 00:36:44,700
+خلينا نقول مش ممنهجة وانماهي وليدة .. وليدة النشاط
+
+536
+00:36:44,700 --> 00:36:49,700
+الفجائي وتوفر المواد وليس ضمن خطة ومنهجة لمكافحة
+
+537
+00:36:49,700 --> 00:36:53,920
+العدوى في المستشفى general characteristics
+
+538
+00:36:53,920 --> 00:36:57,160
+للبكتيريا ال hemolysis on sheep blood agar is
+
+539
+00:36:57,160 --> 00:37:03,100
+mostly beta hemolytic ولمّا نقول mostly يعني مش
+
+540
+00:37:03,100 --> 00:37:05,860
+absolutely كمان، مظبوط ولا لأ؟ فبالتالي فيه
+
+541
+00:37:05,860 --> 00:37:09,020
+إمكانية إنه نلاقي group B stepped cocaine مش beta
+
+542
+00:37:09,020 --> 00:37:13,320
+hemolytic، مش .. لأ مش beta hemolyticthis group
+
+543
+00:37:13,320 --> 00:37:17,020
+antigen is a cell wall polysaccharide composed of
+
+544
+00:37:17,020 --> 00:37:20,320
+N-acetylglucoseamine, galactose and rhaminose على
+
+545
+00:37:20,320 --> 00:37:23,580
+فكرة هذه المركبات N-acetylglucoseamine و galactose
+
+546
+00:37:23,580 --> 00:37:28,500
+و rhaminose ك .. ك .. ك polysaccharide موجودة أيضا
+
+547
+00:37:28,500 --> 00:37:33,980
+ضمن دراستوها ضمن عارفين مين؟ تكوين ال .. جول لأ
+
+548
+00:37:33,980 --> 00:37:39,300
+تكوين ال antigen تبقى من مين؟ في ال .. ال ABO في
+
+549
+00:37:39,300 --> 00:37:43,000
+ال ABO systemفي ال A B O system عشانك مرض بعض
+
+550
+00:37:43,000 --> 00:37:47,480
+الأحيان بيسأله سؤال هل ممكن انه ال blood grouping
+
+551
+00:37:47,480 --> 00:37:52,120
+يتغير لمريض يعني بمعنى اخر انه انا بعمل test
+
+552
+00:37:52,120 --> 00:37:58,080
+للمريض يكون هو A ل G A B مثلا زي A B C S و Bombay
+
+553
+00:37:58,080 --> 00:38:01,600
+Bombay أحد ال factors أحد ال factors اللي ممكن
+
+554
+00:38:01,600 --> 00:38:05,540
+تساهم في الإجابة على هذا السؤال هو الإصابة ببعض ال
+
+555
+00:38:05,540 --> 00:38:07,160
+bacteria ال infection اللي من ضمنها group B
+
+556
+00:38:07,160 --> 00:38:08,200
+streptococcus
+
+557
+00:38:10,530 --> 00:38:14,830
+الان احد اهم الصفات البيو كيميائية لهذا الميكروب
+
+558
+00:38:14,830 --> 00:38:18,430
+اللى هتميزها عن ميكروبات اخرى اللى هو قدرة
+
+559
+00:38:18,430 --> 00:38:21,690
+البكتيريا على انها تحلل الـHepurate الى Benzoic
+
+560
+00:38:21,690 --> 00:38:25,290
+Acid وGlycine طبعا الـGlycine عبارة عن Amino Acid
+
+561
+00:38:25,290 --> 00:38:31,880
+لما نستخدمmedia خالية من أي amino acid تمام وبعد
+
+562
+00:38:31,880 --> 00:38:38,400
+انمو البكتيريا على الـhypurate انرش 9-hydrine الـ9
+
+563
+00:38:38,400 --> 00:38:41,340
+-hydrine الـreagent اللي بنكشف عن ال amino acid من
+
+564
+00:38:41,340 --> 00:38:45,840
+خلاله إذا تغير اللون بنقول انه بوستر بس بدك تتأكد
+
+565
+00:38:45,840 --> 00:38:51,540
+ان ال media أساسا amino acid من أولا okay it is
+
+566
+00:38:51,540 --> 00:38:56,040
+the resistance to bestracin هذا كده hypurate
+
+567
+00:38:56,040 --> 00:39:01,610
+hydrolysis busterهتفقنا انه من ال .. البكتيرا
+
+568
+00:39:01,610 --> 00:39:04,410
+الماضية البكتيرا الماضية اللي هي الstriptococcus
+
+569
+00:39:04,410 --> 00:39:07,730
+biogenes انها sensitive للبستراسين بينما هذه
+
+570
+00:39:07,730 --> 00:39:11,910
+resistant للبستراسين يعني يا شباب لو احنا عملنا
+
+571
+00:39:11,910 --> 00:39:15,150
+لجينا بيتا hemolytic و عملنا لها بستراسين لجيناها
+
+572
+00:39:15,150 --> 00:39:19,170
+resistant يفجر مش .. مش biogenes هنروح اتجاه مين؟
+
+573
+00:39:19,170 --> 00:39:23,250
+اجلكتيا الان what is the .. the best test to
+
+574
+00:39:23,250 --> 00:39:27,390
+confirm striptococcus aglactica فحص اسمه كام بقى
+
+575
+00:39:27,390 --> 00:39:27,890
+test
+
+576
+00:39:30,520 --> 00:39:33,000
+الأروهيد فيروميشن، أهم الوضع، مش بالك أن نشوف صورة
+
+577
+00:39:33,000 --> 00:39:37,000
+إيه له، بس بعد ال .. مانتكلمش ولا على الأمراض و
+
+578
+00:39:37,000 --> 00:39:39,400
+هنا peripheral sepsis في الأم، اندوكارديتس،
+
+579
+00:39:39,400 --> 00:39:41,940
+نيمونيا، نيونيطال انفكشن، نيمونيا، سفسيميا and
+
+580
+00:39:41,940 --> 00:39:47,040
+مينيجايتس، خمسة بوفاين مستايتس هذي التهابث هذي عند
+
+581
+00:39:47,040 --> 00:39:53,400
+الأبقار، عند الأبقار طبعا بتضرن بإيش هذي؟ إن
+
+582
+00:39:53,400 --> 00:39:56,100
+الحليب المنتج بكون .. contaminated with this
+
+583
+00:39:56,100 --> 00:39:58,320
+bacteria ممكن ينتقل إلى الإنسان
+
+584
+00:40:02,760 --> 00:40:08,020
+يصير عندهم اضحاب شديد بعد ولادة في التدريب يعني؟
+
+585
+00:40:08,020 --> 00:40:11,440
+انا .. انا غالبا .. غالبا استفيد الكوكاس hours،
+
+586
+00:40:11,440 --> 00:40:12,700
+استفيد الكوكاس hours
+
+587
+00:40:16,520 --> 00:40:20,860
+هو ال .. المشكلة هنا بتصير انه في ان عدد خاطئ اول
+
+588
+00:40:20,860 --> 00:40:26,860
+شي واحدة من عدد الخاطئ انهم بيجبروا ال .. الام هذه
+
+589
+00:40:26,860 --> 00:40:31,880
+المصابة ان ترد الولد او ترد الطفل على الرغم من
+
+590
+00:40:31,880 --> 00:40:35,340
+الألم الشديد طبعا ال .. اول حاجة الطفل بياخد
+
+591
+00:40:35,340 --> 00:40:39,580
+البكتيريا مع صديد من الام هو بيريحها بالفعل يعني
+
+592
+00:40:39,580 --> 00:40:43,600
+هي ترتاح الام بعد الرضاعة okay في ألم في الرضاعة
+
+593
+00:40:43,600 --> 00:40:49,580
+لأنه في عملية ضغط علىالانتفاخ اللى هو ضغط على ال
+
+594
+00:40:49,580 --> 00:40:53,100
+nerves تمام فبتشهر بالألم لكن هو بيرضع هو بياخد
+
+595
+00:40:53,100 --> 00:40:56,880
+حقيقة بياخد مش حليب بياخد صديد وبالتالي صديد مليء
+
+596
+00:40:56,880 --> 00:41:00,320
+بمين بالبكتيريا فممكن الام تشفع والولد اه او
+
+597
+00:41:00,320 --> 00:41:04,840
+المولود يصاب بال infection فالمفروض ان هذا يعني
+
+598
+00:41:04,840 --> 00:41:11,380
+يعني تعالج بطريقة عن طريق شفط صناعي للحليبب .. ب
+
+599
+00:41:11,380 --> 00:41:15,980
+.. ب .. انه يزال ال .. ال .. ال bus تمام ممكن
+
+600
+00:41:15,980 --> 00:41:20,200
+يستخدمو ال topical cream antibiotics تمام لل ..
+
+601
+00:41:20,200 --> 00:41:24,960
+للتخلص لكن بالطريقة التقليدية ده احنا في خوف على
+
+602
+00:41:24,960 --> 00:41:30,440
+اللي هو الراضي يعنيطيب الصورة اللي قدامكوا اظن ان
+
+603
+00:41:30,440 --> 00:41:34,780
+صورة مكررة برضه beta hemolytic رائعة جدا نقطة
+
+604
+00:41:34,780 --> 00:41:40,160
+صغيرة نشوف النقطة وبعدين بندور على ال zone of
+
+605
+00:41:40,160 --> 00:41:43,640
+hemolysis اللي هي برضه very large zone of
+
+606
+00:41:43,640 --> 00:41:48,900
+hemolysis تشبه طبعا في الحجم والشكل ال group A
+
+607
+00:41:48,900 --> 00:41:49,980
+streptococcus
+
+608
+00:41:52,150 --> 00:41:55,490
+They produced larger colonies and يعني أكبر شوية
+
+609
+00:41:55,490 --> 00:42:00,990
+من مين من الـ Streptococcus بيوجينز And more
+
+610
+00:42:00,990 --> 00:42:03,170
+translucent to opaque colonies surrounded by a
+
+611
+00:42:03,170 --> 00:42:06,770
+zone of beta hemolysis طبعا على الـ selective
+
+612
+00:42:06,770 --> 00:42:09,230
+media و الـ selective media مستخدمة التنتين
+
+613
+00:42:09,230 --> 00:42:13,710
+للبيوجينز ولا الجالاكتيا احنا الأولى جونا فيها
+
+614
+00:42:13,710 --> 00:42:17,050
+Narcissic acid و فيها كلستين و فيها Gentamicinفي
+
+615
+00:42:17,050 --> 00:42:19,930
+كمان selective media بيسموها Striptococcal
+
+616
+00:42:19,930 --> 00:42:25,410
+Selective
+
+617
+00:42:25,410 --> 00:42:28,850
+Agar بيحتوي على crystal violet in low
+
+618
+00:42:28,850 --> 00:42:31,870
+concentration، كوليستين، and trimethoprim
+
+619
+00:42:31,870 --> 00:42:35,090
+-sulfamethexazole، ويضعف له five percent sheep
+
+620
+00:42:35,090 --> 00:42:38,470
+bloodكده اللي أنا فيها عندى الآن two selective
+
+621
+00:42:38,470 --> 00:42:44,350
+media for streptococcus بشكل عام واحد احتوى على
+
+622
+00:42:44,350 --> 00:42:47,950
+التانى المشترك بينهم blood agar لكن الخلطات
+
+623
+00:42:47,950 --> 00:42:51,270
+المضاعفة مختلفة الأولى three antibiotics سميناهم
+
+624
+00:42:51,270 --> 00:42:55,030
+جنتاميسين كوليستين and radixic acid التانية حطينا
+
+625
+00:42:55,030 --> 00:42:59,410
+low concentration of crystal violet بعدين كوليستين
+
+626
+00:42:59,410 --> 00:43:00,550
+بعدين trimethoprim
+
+627
+00:43:05,320 --> 00:43:12,040
+بارضه Selected Media for Steptococcus بشكل عام ال
+
+628
+00:43:12,040 --> 00:43:13,700
+laboratory diagnosis جونا land field
+
+629
+00:43:13,700 --> 00:43:16,920
+classification او grouping و هي group B هي group
+
+630
+00:43:16,920 --> 00:43:21,100
+بيهيبريت هيدروليسيا شفناها جاب شوية ال camp test
+
+631
+00:43:21,100 --> 00:43:26,710
+بوستفالبيل اسكلين نيجاتيف البكتيريا دي بيل اسكلين
+
+632
+00:43:26,710 --> 00:43:30,030
+إيه نيجاتيف لاتكس أجلوتينيشن وطبعا لاتكس
+
+633
+00:43:30,030 --> 00:43:34,210
+أجلوتينيشن هيبقى عن إيه؟ هيبقى عن antibody مرتبطة
+
+634
+00:43:34,210 --> 00:43:39,950
+ب لاتكس particles مستخدمة للبحث نعم صحيح المرة
+
+635
+00:43:39,950 --> 00:43:42,310
+اللي جاي ان شاء الله بناخد تفاصيل أكتر لالفحوصات
+
+636
+00:43:42,310 --> 00:43:44,650
+ونكمل مع بعض باقى الستريبتو وكذا
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8qYMbROMJ7Y_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8qYMbROMJ7Y_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..443d96808839f3462da8812647a98256e2a0173b
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8qYMbROMJ7Y_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 4771, "start": 20.65, "end": 47.71, "text": "بسم الله الرحمن الرحيم اليوم هنبدأ موضوع الـ streptococci احنا بدأنا بمقدمة المحاضرة الماضية لكن لبقص أنه نمر عليها مرور سريع ال streptococci كما ذكرتوا لكم المرة الماضية هي ال genus الأكثر إحداثا لأنواع مختلفة من الأمراض يعني نسبة إحداثه لأمراض متنوعة عالية جدا الأسماء اللي ذكرناها ذكرنا streptococcus biogenes agalactia fecalis pneumonia واتكلمنا عن ال viridians group", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 45595, 20498, 8032, 1863, 44510, 10721, 3714, 2407, 11242, 45367, 2423, 39184, 2242, 662, 905, 905, 537, 1975, 5016, 8315, 47525, 10721, 8315, 4724, 2304, 28543, 46007, 9673, 5016, 46958, 25720, 9673, 46958, 10632, 44381, 5296, 3555, 4587, 9381, 14739, 3224, 8717, 29973, 25894, 11296, 3714, 2288, 13063, 8608, 16572, 3615, 2423, 2242, 662, 905, 905, 537, 9122, 15042, 29910, 37983, 2655, 14407, 5296, 24793, 9673, 25720, 9673, 46958, 10632, 39896, 2423, 1049, 301, 16247, 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"end": 82.9, "word": " hemolysis,", "probability": 0.9449462890625}, {"start": 83.26, "end": 83.6, "word": " gamma", "probability": 0.798828125}, {"start": 83.6, "end": 84.18, "word": " no", "probability": 0.783203125}, {"start": 84.18, "end": 84.92, "word": " hemolysis", "probability": 0.9476318359375}, {"start": 84.92, "end": 85.34, "word": " واخدنا", "probability": 0.8250732421875}, {"start": 85.34, "end": 85.84, "word": " مثلها", "probability": 0.59716796875}, {"start": 85.84, "end": 86.06, "word": " على", "probability": 0.9345703125}, {"start": 86.06, "end": 86.4, "word": " كل", "probability": 0.9873046875}, {"start": 86.4, "end": 87.0, "word": " صنف", "probability": 0.7532552083333334}, {"start": 87.0, "end": 87.12, "word": " من", "probability": 0.96826171875}, {"start": 87.12, "end": 87.42, "word": " هذه", "probability": 0.93115234375}, {"start": 87.42, "end": 88.38, "word": " الأصناف", "probability": 0.98193359375}], "temperature": 1.0}, {"id": 4, "seek": 11130, "start": 89.44, "end": 111.3, "text": "وتحدثنا ايضا عن Landsfeld classification وقلنا انه based on the C polysaccharide found in the cell wall of gram-boosted streptococci groups A, B and D contains the most important pathogen of streptococci واخدنا مثل على group A streptococcus biogenes, B a galactia و group D الينتيرو cocci", "tokens": [35473, 24401, 12984, 8315, 1975, 1829, 11242, 995, 18871, 30527, 25115, 21538, 4032, 4587, 1211, 8315, 16472, 3224, 2361, 322, 264, 383, 6754, 82, 326, 7374, 482, 1352, 294, 264, 2815, 2929, 295, 21353, 12, 1763, 555, 292, 2242, 662, 905, 905, 537, 3935, 316, 11, 363, 293, 413, 8306, 264, 881, 1021, 3100, 8799, 295, 2242, 662, 905, 905, 537, 4032, 47283, 3215, 8315, 50113, 1211, 15844, 1594, 316, 2242, 662, 905, 905, 1149, 3228, 8799, 279, 11, 363, 257, 7660, 578, 654, 4032, 1594, 413, 2423, 9957, 2655, 13546, 2407, 21047, 537], "avg_logprob": -0.2781249861968191, "compression_ratio": 1.4042553191489362, "no_speech_prob": 0.0, "words": [{"start": 89.44, "end": 90.08, "word": "وتحدثنا", "probability": 0.8468017578125}, {"start": 90.08, "end": 90.32, "word": " ايضا", "probability": 0.83905029296875}, {"start": 90.32, "end": 90.6, "word": " عن", "probability": 0.98974609375}, {"start": 90.6, "end": 91.28, "word": " Landsfeld", "probability": 0.396728515625}, {"start": 91.28, "end": 92.12, "word": " classification", "probability": 0.6533203125}, {"start": 92.12, "end": 92.7, "word": " وقلنا", "probability": 0.6949462890625}, {"start": 92.7, "end": 93.12, "word": " انه", "probability": 0.918212890625}, {"start": 93.12, "end": 93.44, "word": " based", "probability": 0.74169921875}, {"start": 93.44, "end": 93.64, "word": " on", "probability": 0.9453125}, {"start": 93.64, "end": 93.76, "word": " the", "probability": 0.67529296875}, {"start": 93.76, "end": 93.9, "word": " C", "probability": 0.82666015625}, {"start": 93.9, "end": 94.74, "word": " polysaccharide", "probability": 0.81796875}, {"start": 94.74, "end": 95.72, "word": " found", "probability": 0.830078125}, {"start": 95.72, "end": 95.94, "word": " in", "probability": 0.96728515625}, {"start": 95.94, "end": 96.08, "word": " the", "probability": 0.76904296875}, {"start": 96.08, "end": 96.24, "word": " cell", "probability": 0.94140625}, {"start": 96.24, "end": 96.48, "word": " wall", "probability": 0.88232421875}, {"start": 96.48, "end": 96.66, "word": " of", "probability": 0.970703125}, {"start": 96.66, "end": 96.96, "word": " gram", "probability": 0.484619140625}, {"start": 96.96, "end": 97.4, "word": "-boosted", "probability": 0.7913818359375}, {"start": 97.4, "end": 98.24, "word": " streptococci", "probability": 0.95341796875}, {"start": 98.24, "end": 99.34, "word": " groups", "probability": 0.29443359375}, {"start": 99.34, "end": 99.78, "word": " A,", "probability": 0.78955078125}, {"start": 100.1, "end": 100.32, "word": " B", "probability": 0.61572265625}, {"start": 100.32, "end": 100.64, "word": " and", "probability": 0.5361328125}, {"start": 100.64, "end": 100.9, "word": " D", "probability": 0.98974609375}, {"start": 100.9, "end": 101.52, "word": " contains", "probability": 0.56298828125}, {"start": 101.52, "end": 101.78, "word": " the", "probability": 0.92919921875}, {"start": 101.78, "end": 102.0, "word": " most", "probability": 0.89794921875}, {"start": 102.0, "end": 102.62, "word": " important", "probability": 0.9072265625}, {"start": 102.62, "end": 103.26, "word": " pathogen", "probability": 0.9091796875}, {"start": 103.26, "end": 103.76, "word": " of", "probability": 0.962890625}, {"start": 103.76, "end": 104.6, "word": " streptococci", "probability": 0.97412109375}, {"start": 104.6, "end": 105.38, "word": " واخدنا", "probability": 0.857177734375}, {"start": 105.38, "end": 105.64, "word": " مثل", "probability": 0.6796875}, {"start": 105.64, "end": 105.88, "word": " على", "probability": 0.87841796875}, {"start": 105.88, "end": 106.3, "word": " group", "probability": 0.65771484375}, {"start": 106.3, "end": 106.52, "word": " A", "probability": 0.94091796875}, {"start": 106.52, "end": 107.06, "word": " streptococcus", "probability": 0.9013671875}, {"start": 107.06, "end": 107.76, "word": " biogenes,", "probability": 0.8001302083333334}, {"start": 107.88, "end": 108.08, "word": " B", "probability": 0.8408203125}, {"start": 108.08, "end": 108.3, "word": " a", "probability": 0.73779296875}, {"start": 108.3, "end": 108.88, "word": " galactia", "probability": 0.7218424479166666}, {"start": 108.88, "end": 109.36, "word": " و", "probability": 0.810546875}, {"start": 109.36, "end": 109.68, "word": " group", "probability": 0.50341796875}, {"start": 109.68, "end": 109.98, "word": " D", "probability": 0.97021484375}, {"start": 109.98, "end": 110.82, "word": " الينتيرو", "probability": 0.650244140625}, {"start": 110.82, "end": 111.3, "word": " cocci", "probability": 0.43450927734375}], "temperature": 1.0}, {"id": 5, "seek": 12352, "start": 113.3, "end": 123.52, "text": "طبعا ال .. ال .. ال beta-hemolytic يعني سهل انه .. انه .. ان .. انفرقهم cellologically", "tokens": [9566, 3555, 3615, 995, 2423, 4386, 2423, 4386, 2423, 9861, 12, 28005, 16453, 40907, 37495, 22653, 8608, 3224, 1211, 16472, 3224, 4386, 16472, 3224, 4386, 16472, 4386, 16472, 5172, 2288, 4587, 16095, 2815, 17157], "avg_logprob": -0.18504464200564794, "compression_ratio": 1.2826086956521738, "no_speech_prob": 0.0, "words": [{"start": 113.3, "end": 114.34, "word": "طبعا", "probability": 0.958740234375}, {"start": 114.34, "end": 114.56, "word": " ال", "probability": 0.98779296875}, {"start": 114.56, "end": 114.58, "word": " ..", "probability": 0.79638671875}, {"start": 114.58, "end": 115.14, "word": " ال", "probability": 0.9912109375}, {"start": 115.14, "end": 115.14, "word": " ..", "probability": 0.89208984375}, {"start": 115.14, "end": 116.36, "word": " ال", "probability": 0.9921875}, {"start": 116.36, "end": 116.62, "word": " beta", "probability": 0.64599609375}, {"start": 116.62, "end": 117.24, "word": "-hemolytic", "probability": 0.69744873046875}, {"start": 117.24, "end": 117.94, "word": " يعني", "probability": 0.89990234375}, {"start": 117.94, "end": 118.76, "word": " سهل", "probability": 0.8805338541666666}, {"start": 118.76, "end": 119.04, "word": " انه", "probability": 0.746337890625}, {"start": 119.04, "end": 119.14, "word": " ..", "probability": 0.9375}, {"start": 119.14, "end": 119.64, "word": " انه", "probability": 0.910888671875}, {"start": 119.64, "end": 120.08, "word": " ..", "probability": 0.544921875}, {"start": 120.08, "end": 120.1, "word": " ان", "probability": 0.90966796875}, {"start": 120.1, "end": 121.16, "word": " ..", "probability": 0.634765625}, {"start": 121.16, "end": 122.12, "word": " انفرقهم", "probability": 0.91083984375}, {"start": 122.12, "end": 123.52, "word": " cellologically", "probability": 0.780029296875}], "temperature": 1.0}, {"id": 6, "seek": 15019, "start": 125.27, "end": 150.19, "text": "انتوا نعم بمعنى انه group A الوحيدة اللي فيهم beta hemolytic هي الـ streptococcus pyogenes فلو انا في يوم من الأيام لجيت group A و لجيتها في نفس اللي لجيت beta hemolytic فهي الـ streptococcus pyogenes والصحيح انه الـ streptococcus pyogenes هي is the only pathogen في ال group A فبالتالي احنا بنكون محظوظين لو لجينا الصفة بهذه الطريقة group A زاد انه beta hemolytic", "tokens": [7649, 2655, 14407, 8717, 25957, 4724, 2304, 3615, 1863, 7578, 16472, 3224, 1594, 316, 2423, 2407, 5016, 25708, 3660, 13672, 1829, 8978, 16095, 9861, 415, 3280, 356, 40907, 39896, 2423, 39184, 2242, 662, 905, 905, 1149, 10664, 8799, 279, 6156, 1211, 2407, 1975, 8315, 8978, 7251, 20498, 9154, 16247, 1829, 10943, 5296, 7435, 36081, 1594, 316, 4032, 5296, 7435, 36081, 11296, 8978, 8717, 36178, 13672, 1829, 5296, 7435, 36081, 9861, 415, 3280, 356, 40907, 6156, 3224, 1829, 2423, 39184, 2242, 662, 905, 905, 1149, 10664, 8799, 279, 16070, 9381, 5016, 1829, 5016, 16472, 3224, 2423, 39184, 2242, 662, 905, 905, 1149, 10664, 8799, 279, 39896, 307, 264, 787, 3100, 8799, 8978, 2423, 1594, 316, 6156, 3555, 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0.801513671875}, {"start": 129.37, "end": 129.65, "word": " فيهم", "probability": 0.984619140625}, {"start": 129.65, "end": 129.93, "word": " beta", "probability": 0.388427734375}, {"start": 129.93, "end": 130.39, "word": " hemolytic", "probability": 0.79107666015625}, {"start": 130.39, "end": 130.55, "word": " هي", "probability": 0.88134765625}, {"start": 130.55, "end": 130.71, "word": " الـ", "probability": 0.58056640625}, {"start": 130.71, "end": 131.19, "word": " streptococcus", "probability": 0.862646484375}, {"start": 131.19, "end": 131.67, "word": " pyogenes", "probability": 0.6142171223958334}, {"start": 131.67, "end": 131.93, "word": " فلو", "probability": 0.9680989583333334}, {"start": 131.93, "end": 132.09, "word": " انا", "probability": 0.84326171875}, {"start": 132.09, "end": 132.21, "word": " في", "probability": 0.9755859375}, {"start": 132.21, "end": 132.33, "word": " يوم", "probability": 0.6116943359375}, {"start": 132.33, "end": 132.45, "word": " من", "probability": 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135.37, "end": 135.57, "word": " فهي", "probability": 0.9716796875}, {"start": 135.57, "end": 135.71, "word": " الـ", "probability": 0.54736328125}, {"start": 135.71, "end": 136.33, "word": " streptococcus", "probability": 0.9607421875}, {"start": 136.33, "end": 137.05, "word": " pyogenes", "probability": 0.9503580729166666}, {"start": 137.05, "end": 138.05, "word": " والصحيح", "probability": 0.92470703125}, {"start": 138.05, "end": 138.55, "word": " انه", "probability": 0.83544921875}, {"start": 138.55, "end": 139.37, "word": " الـ", "probability": 0.6456298828125}, {"start": 139.37, "end": 140.05, "word": " streptococcus", "probability": 0.97587890625}, {"start": 140.05, "end": 140.57, "word": " pyogenes", "probability": 0.9606119791666666}, {"start": 140.57, "end": 140.81, "word": " هي", "probability": 0.65673828125}, {"start": 140.81, "end": 141.15, "word": " is", "probability": 0.65771484375}, {"start": 141.15, "end": 141.35, "word": " the", "probability": 0.90625}, {"start": 141.35, "end": 141.73, "word": " only", "probability": 0.9189453125}, {"start": 141.73, "end": 142.41, "word": " pathogen", "probability": 0.889404296875}, {"start": 142.41, "end": 142.63, "word": " في", "probability": 0.849609375}, {"start": 142.63, "end": 142.73, "word": " ال", "probability": 0.7236328125}, {"start": 142.73, "end": 142.95, "word": " group", "probability": 0.87158203125}, {"start": 142.95, "end": 143.17, "word": " A", "probability": 0.96728515625}, {"start": 143.17, "end": 143.71, "word": " فبالتالي", "probability": 0.8672688802083334}, {"start": 143.71, "end": 144.29, "word": " احنا", "probability": 0.9791666666666666}, {"start": 144.29, "end": 144.65, "word": " بنكون", "probability": 0.892822265625}, {"start": 144.65, "end": 145.19, "word": " محظوظين", "probability": 0.9903971354166666}, {"start": 145.19, "end": 145.35, "word": " لو", "probability": 0.966796875}, {"start": 145.35, "end": 145.63, "word": " لجينا", "probability": 0.9644775390625}, {"start": 145.63, "end": 146.67, "word": " الصفة", "probability": 0.8528645833333334}, {"start": 146.67, "end": 147.13, "word": " بهذه", "probability": 0.683837890625}, {"start": 147.13, "end": 147.51, "word": " الطريقة", "probability": 0.9900716145833334}, {"start": 147.51, "end": 147.83, "word": " group", "probability": 0.89208984375}, {"start": 147.83, "end": 148.11, "word": " A", "probability": 0.94482421875}, {"start": 148.11, "end": 148.59, "word": " زاد", "probability": 0.572265625}, {"start": 148.59, "end": 149.15, "word": " انه", "probability": 0.875}, {"start": 149.15, "end": 149.45, "word": " beta", "probability": 0.80224609375}, {"start": 149.45, "end": 150.19, "word": " hemolytic", "probability": 0.9329833984375}], "temperature": 1.0}, {"id": 7, "seek": 16505, "start": 150.71, "end": 165.05, "text": "و ذكرنا أننا نستخدم مزيج من النظامين و على غرار المعلومة اللي تكلمنا فيها الآن اللي هي المعلومة اللي بتقول group A Beta-Hermetic Striptococci وتشير إلى Striptococcus Violins", "tokens": [2407, 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depressor", "probability": 0.795654296875}, {"start": 692.27, "end": 692.57, "word": " بتعرفوا", "probability": 0.6995849609375}, {"start": 692.57, "end": 692.91, "word": " خافض", "probability": 0.9376627604166666}, {"start": 692.91, "end": 694.09, "word": " اللسان؟", "probability": 0.857177734375}, {"start": 694.09, "end": 694.77, "word": " أوه", "probability": 0.719970703125}, {"start": 694.77, "end": 695.53, "word": " ده،", "probability": 0.7814127604166666}, {"start": 695.53, "end": 696.11, "word": " تمام؟", "probability": 0.85009765625}, {"start": 696.11, "end": 696.59, "word": " بنضغط", "probability": 0.95458984375}, {"start": 696.59, "end": 696.99, "word": " خشب،", "probability": 0.947998046875}, {"start": 696.99, "end": 697.29, "word": " بنضغط", "probability": 0.951904296875}, {"start": 697.29, "end": 697.51, "word": " فيها", "probability": 0.804443359375}, {"start": 697.51, "end": 697.67, "word": " على", "probability": 0.8349609375}, {"start": 697.67, "end": 698.95, "word": " 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media عشان أنصح المفهوم لما قلت أنا إضافة ال antibiotic على ال blood agar جعلها selective absolutely selective", "tokens": [8592, 28820, 9673, 14851, 25957, 2288, 9307, 4724, 1829, 39648, 36145, 15844, 2423, 3390, 307, 406, 257, 11365, 3807, 16282, 23032, 1829, 3555, 41850, 20449, 1211, 8592, 37495, 22653, 5551, 47341, 3615, 4724, 47341, 3615, 15844, 9122, 19528, 3660, 33930, 3021, 6225, 8592, 7649, 14739, 9381, 5016, 9673, 5172, 3224, 20498, 5296, 15042, 12174, 1211, 2655, 41850, 11933, 11242, 31845, 3660, 2423, 37828, 15844, 2423, 3390, 623, 289, 10874, 30241, 11296, 33930, 3122, 33930], "avg_logprob": -0.2143749944368998, "compression_ratio": 1.5255813953488373, "no_speech_prob": 0.0, "words": [{"start": 1218.91, "end": 1219.25, "word": "شكل", "probability": 0.857177734375}, {"start": 1219.25, "end": 1219.85, "word": " المستعمرات", "probability": 0.8482421875}, {"start": 1219.85, "end": 1220.03, "word": " بيقول", "probability": 0.7548828125}, {"start": 1220.03, "end": 1220.13, 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"probability": 0.771240234375}, {"start": 2569.71, "end": 2570.13, "word": " three", "probability": 0.76513671875}, {"start": 2570.13, "end": 2570.73, "word": " antibiotics", "probability": 0.5908203125}, {"start": 2570.73, "end": 2571.27, "word": " سميناهم", "probability": 0.8255859375}, {"start": 2571.27, "end": 2571.83, "word": " جنتاميسين", "probability": 0.5420735677083334}, {"start": 2571.83, "end": 2572.31, "word": " كوليستين", "probability": 0.8150390625}, {"start": 2572.31, "end": 2572.47, "word": " and", "probability": 0.86279296875}, {"start": 2572.47, "end": 2572.87, "word": " radixic", "probability": 0.7501627604166666}, {"start": 2572.87, "end": 2573.15, "word": " acid", "probability": 0.92041015625}, {"start": 2573.15, "end": 2574.15, "word": " التانية", "probability": 0.8810221354166666}, {"start": 2574.15, "end": 2575.03, "word": " حطينا", "probability": 0.9052734375}, {"start": 2575.03, "end": 2575.41, "word": " low", "probability": 0.97802734375}, {"start": 2575.41, "end": 2576.13, "word": " concentration", "probability": 0.88427734375}, {"start": 2576.13, "end": 2576.65, "word": " of", "probability": 0.9736328125}, {"start": 2576.65, "end": 2577.43, "word": " crystal", "probability": 0.64990234375}, {"start": 2577.43, "end": 2577.89, "word": " violet", "probability": 0.8740234375}, {"start": 2577.89, "end": 2578.61, "word": " بعدين", "probability": 0.827880859375}, {"start": 2578.61, "end": 2579.41, "word": " كوليستين", "probability": 0.95654296875}, {"start": 2579.41, "end": 2579.75, "word": " بعدين", "probability": 0.885009765625}, {"start": 2579.75, "end": 2580.55, "word": " trimethoprim", "probability": 0.870849609375}], "temperature": 1.0}, {"id": 108, "seek": 260171, "start": 2585.32, "end": 2601.72, "text": "بارضه Selected Media for Steptococcus بشكل عام ال laboratory diagnosis جونا land field classification او grouping و هي group B هي group بيهيبريت هيدروليسيا شفناها جاب شوية ال camp test بوستف", "tokens": [3555, 9640, 11242, 3224, 13638, 292, 14741, 337, 745, 5250, 905, 905, 1149, 4724, 8592, 28820, 6225, 10943, 2423, 16523, 15217, 10874, 2407, 8315, 2117, 2519, 21538, 1975, 2407, 40149, 4032, 39896, 1594, 363, 39896, 1594, 4724, 1829, 3224, 1829, 26890, 36081, 8032, 25708, 2288, 12610, 1829, 3794, 25528, 13412, 5172, 8315, 11296, 10874, 16758, 13412, 2407, 10632, 2423, 2255, 1500, 4724, 2407, 14851, 5172], "avg_logprob": -0.5364583252054272, "compression_ratio": 1.3177083333333333, "no_speech_prob": 0.0, "words": [{"start": 2585.3199999999997, "end": 2586.08, "word": "بارضه", "probability": 0.562744140625}, {"start": 2586.08, "end": 2586.62, "word": " Selected", "probability": 0.526611328125}, {"start": 2586.62, "end": 2586.9, "word": " Media", "probability": 0.72265625}, {"start": 2586.9, "end": 2587.12, "word": " for", "probability": 0.451416015625}, {"start": 2587.12, "end": 2587.94, "word": " Steptococcus", "probability": 0.7392578125}, {"start": 2587.94, "end": 2589.26, "word": " بشكل", "probability": 0.96337890625}, {"start": 2589.26, "end": 2589.54, "word": " عام", "probability": 0.9580078125}, {"start": 2589.54, "end": 2592.04, "word": " ال", "probability": 0.448974609375}, {"start": 2592.04, "end": 2592.3, "word": " laboratory", "probability": 0.4541015625}, {"start": 2592.3, "end": 2592.88, "word": " diagnosis", "probability": 0.81494140625}, {"start": 2592.88, "end": 2593.08, "word": " جونا", "probability": 0.4860026041666667}, {"start": 2593.08, "end": 2593.32, "word": " land", "probability": 0.20068359375}, {"start": 2593.32, "end": 2593.7, "word": " field", "probability": 0.78369140625}, {"start": 2593.7, "end": 2594.52, "word": " classification", "probability": 0.87158203125}, {"start": 2594.52, "end": 2594.82, "word": " او", "probability": 0.747802734375}, {"start": 2594.82, "end": 2595.28, "word": " grouping", "probability": 0.59423828125}, {"start": 2595.28, "end": 2595.54, "word": " و", "probability": 0.270751953125}, {"start": 2595.54, "end": 2595.58, "word": " هي", "probability": 0.869140625}, {"start": 2595.58, "end": 2595.9, "word": " group", "probability": 0.8984375}, {"start": 2595.9, "end": 2596.22, "word": " B", "probability": 0.78173828125}, {"start": 2596.22, "end": 2596.5, "word": " هي", "probability": 0.31005859375}, {"start": 2596.5, "end": 2596.92, "word": " group", "probability": 0.9140625}, {"start": 2596.92, "end": 2598.44, "word": " بيهيبريت", "probability": 0.435302734375}, {"start": 2598.44, "end": 2598.9, "word": " هيدروليسيا", "probability": 0.6335797991071429}, {"start": 2598.9, "end": 2599.16, "word": " شفناها", "probability": 0.8521728515625}, {"start": 2599.16, "end": 2599.3, "word": " جاب", "probability": 0.79736328125}, {"start": 2599.3, "end": 2599.72, "word": " شوية", "probability": 0.7173665364583334}, {"start": 2599.72, "end": 2600.42, "word": " ال", "probability": 0.88916015625}, {"start": 2600.42, "end": 2600.66, "word": " camp", "probability": 0.259521484375}, {"start": 2600.66, "end": 2601.1, "word": " test", 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8qYMbROMJ7Y_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8qYMbROMJ7Y_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..8278a87ebe2546a5ee8ef0a57733d281c75ac4e7
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/8qYMbROMJ7Y_raw.srt
@@ -0,0 +1,2548 @@
+1
+00:00:20,650 --> 00:00:23,730
+بسم الله الرحمن الرحيم اليوم هنبدأ موضوع الـ
+
+2
+00:00:23,730 --> 00:00:25,830
+streptococci احنا بدأنا بمقدمة المحاضرة الماضية
+
+3
+00:00:25,830 --> 00:00:28,910
+لكن لبقص أنه نمر عليها مرور سريع ال streptococci
+
+4
+00:00:28,910 --> 00:00:32,710
+كما ذكرتوا لكم المرة الماضية هي ال genus الأكثر
+
+5
+00:00:32,710 --> 00:00:37,490
+إحداثا لأنواع مختلفة من الأمراض يعني نسبة إحداثه
+
+6
+00:00:37,490 --> 00:00:41,310
+لأمراض متنوعة عالية جدا الأسماء اللي ذكرناها ذكرنا
+
+7
+00:00:41,310 --> 00:00:45,990
+streptococcus biogenes agalactia fecalis pneumonia
+
+8
+00:00:45,990 --> 00:00:49,360
+واتكلمنا عن ال viridians groupاتكلمنا عن ال
+
+9
+00:00:49,360 --> 00:00:52,280
+general characteristics للبكتيريا وقلنا انه يجرم
+
+10
+00:00:52,280 --> 00:00:56,640
+بسطف كوكساي arranged in chains والchains هذه قد
+
+11
+00:00:56,640 --> 00:01:01,040
+تتكون من two or more يعني لحد الأدنى اللي هو تنتين
+
+12
+00:01:01,040 --> 00:01:04,400
+ال corners قلنا عنهم are small usually one to two
+
+13
+00:01:04,400 --> 00:01:07,960
+millimeter in diameter gray to white in color
+
+14
+00:01:07,960 --> 00:01:11,800
+اتكلمنا عن ال classification of streptococci قلنا
+
+15
+00:01:11,800 --> 00:01:15,000
+there are two systems of classificationNumber one
+
+16
+00:01:15,000 --> 00:01:20,280
+is based on hemolytic activity into beta complete
+
+17
+00:01:20,280 --> 00:01:24,180
+hemolysis, alpha incomplete hemolysis, gamma no
+
+18
+00:01:24,180 --> 00:01:28,380
+hemolysis واخدنا مثلها على كل صنف من هذه الأصناف
+
+19
+00:01:29,440 --> 00:01:33,120
+وتحدثنا ايضا عن Landsfeld classification وقلنا انه
+
+20
+00:01:33,120 --> 00:01:36,240
+based on the C polysaccharide found in the cell
+
+21
+00:01:36,240 --> 00:01:40,640
+wall of gram-boosted streptococci groups A, B and
+
+22
+00:01:40,640 --> 00:01:43,760
+D contains the most important pathogen of
+
+23
+00:01:43,760 --> 00:01:47,060
+streptococci واخدنا مثل على group A streptococcus
+
+24
+00:01:47,060 --> 00:01:51,300
+biogenes, B a galactia و group D الينتيرو cocci
+
+25
+00:01:53,300 --> 00:01:59,140
+طبعا ال .. ال .. ال beta-hemolytic يعني سهل انه ..
+
+26
+00:01:59,140 --> 00:02:03,520
+انه .. ان .. انفرقهم cellologically
+
+27
+00:02:05,270 --> 00:02:09,930
+انتوا نعم بمعنى انه group A الوحيدة اللي فيهم beta
+
+28
+00:02:09,930 --> 00:02:12,210
+hemolytic هي الـ streptococcus pyogenes فلو انا في
+
+29
+00:02:12,210 --> 00:02:14,650
+يوم من الأيام لجيت group A و لجيتها في نفس اللي
+
+30
+00:02:14,650 --> 00:02:17,050
+لجيت beta hemolytic فهي الـ streptococcus pyogenes
+
+31
+00:02:17,050 --> 00:02:21,350
+والصحيح انه الـ streptococcus pyogenes هي is the
+
+32
+00:02:21,350 --> 00:02:24,650
+only pathogen في ال group A فبالتالي احنا بنكون
+
+33
+00:02:24,650 --> 00:02:28,590
+محظوظين لو لجينا الصفة بهذه الطريقة group A زاد
+
+34
+00:02:28,590 --> 00:02:32,770
+انه beta hemolyticو ذكرنا أننا نستخدم مزيج من
+
+35
+00:02:32,770 --> 00:02:36,030
+النظامين و على غرار المعلومة اللي تكلمنا فيها الآن
+
+36
+00:02:36,030 --> 00:02:40,950
+اللي هي المعلومة اللي بتقول group A Beta-Hermetic
+
+37
+00:02:40,950 --> 00:02:46,290
+Striptococci وتشير إلى Striptococcus Violinsوبدأنا
+
+38
+00:02:46,290 --> 00:02:49,490
+بالحديث عن ايضا الستيبتوكوكاس بيورينز وقلنا انه
+
+39
+00:02:49,490 --> 00:02:55,170
+this bacteria causes a wide range of diseases منها
+
+40
+00:02:55,170 --> 00:02:59,410
+التونسولايتس منها الارسيبلس او ال red skin حكينا
+
+41
+00:02:59,410 --> 00:03:04,930
+عنه ذكرنا اتايتس ميديا ذكرنا سيبتسيميا ذكرنا
+
+42
+00:03:04,930 --> 00:03:08,930
+مينينجايتس مجموعة ضخمة من الأمراض هذكركم فيها بس
+
+43
+00:03:08,930 --> 00:03:14,580
+عالسريعParsipilas Gonorrhea Red Skin Otitis Media
+
+44
+00:03:14,580 --> 00:03:17,220
+Peripheral Fever أو Peripheral Sepsis اللي هي
+
+45
+00:03:17,220 --> 00:03:20,320
+الحمّة .. الحمّة النفاس و الحمّة النفاس هي اللي
+
+46
+00:03:20,320 --> 00:03:23,600
+بتصيب ال .. ال .. ال .. الأمهات اللي ب .. ب .. بعد
+
+47
+00:03:23,600 --> 00:03:28,360
+الولادة غالبا بتلات أيام وهذه تعتبر مؤشر على تقدم
+
+48
+00:03:28,360 --> 00:03:32,960
+النظام الصحي في البلدان أو على تخلفيه يعني جديش
+
+49
+00:03:32,960 --> 00:03:37,800
+نسبة الوفيات من الأمهات في .. بعد عميلة الولادة
+
+50
+00:03:37,800 --> 00:03:42,260
+تعتبر مؤشر على كمان مرةتطور أو تخلف النظام الصحيح
+
+51
+00:03:42,260 --> 00:03:44,360
+احنا في الفلسطين الحمد لله رب العالمين يعني هذه
+
+52
+00:03:44,360 --> 00:03:48,140
+النسبة يعني تضاهي مثلتها في أوروبا وولايات المتحدة
+
+53
+00:03:48,140 --> 00:03:51,580
+الحمد لله نسبة جيدة كذلك الأمر بالنسبة للوفيات في
+
+54
+00:03:51,580 --> 00:03:56,650
+الموليد برضه كمان عنه نسبة مدنية جداطبعا دايما
+
+55
+00:03:56,650 --> 00:04:03,510
+احنا في اي نظام صحي بيسعى انه يكون النسب Zero لكن
+
+56
+00:04:03,510 --> 00:04:07,450
+هذا الكلام مستحيل من ناحية العملية لكن السعي له
+
+57
+00:04:07,450 --> 00:04:09,330
+يطور النظام الصحي
+
+58
+00:04:26,120 --> 00:04:29,960
+and rheumatic fever وذكرنا إذا بتذكروا وجودنا رقم
+
+59
+00:04:29,960 --> 00:04:33,420
+11 و12 اللي هم ال acute glomerul nephritis و
+
+60
+00:04:33,420 --> 00:04:37,160
+rheumatic fever ذكرنا إنهم عبارة عن immunologic
+
+61
+00:04:37,160 --> 00:04:42,340
+reactions لإن البكتيريا بتنتج أو الجسم بينتج
+
+62
+00:04:42,340 --> 00:04:47,260
+antibodies للبكتيرياهذه الأنتيبوديز ستتعامل مع
+
+63
+00:04:47,260 --> 00:04:51,840
+تجاربنا وبتهاجم البكتيريا وبتهاجم أنسجتنا وبالتالي
+
+64
+00:04:51,840 --> 00:04:55,680
+لا تعتقدوا ان simple tonsillitis is really a
+
+65
+00:04:55,680 --> 00:05:00,100
+simple disease لأ هي مرض خطير ويجب مراقبته وعلاجه
+
+66
+00:05:00,100 --> 00:05:05,040
+فورا وتكراره يجب أن يمنع باستخدام على سبيل المثال
+
+67
+00:05:05,040 --> 00:05:07,860
+ال long acting penicillins اللي حكينا عنه المرة
+
+68
+00:05:07,860 --> 00:05:11,450
+الماضية نرجع برجوعالصورة اللى كنا بناها دى كانت
+
+69
+00:05:11,450 --> 00:05:15,170
+عبارة عن تلخيص لمين لل ال viral factors بشكل ال
+
+70
+00:05:15,170 --> 00:05:18,130
+structures لللوحة السابقة زى ال peptidase,
+
+71
+00:05:18,350 --> 00:05:21,150
+streptodoranase, hyaluronidase, streptokinase
+
+72
+00:05:21,150 --> 00:05:22,830
+وحاكينا على ال streptokinase المرة الماضية كنا
+
+73
+00:05:22,830 --> 00:05:27,750
+يستخدم في تفكيك الجلطات في تفكيك الجلطات عشان لو
+
+74
+00:05:27,750 --> 00:05:31,550
+صار فينا جروح والتهب ب streptococcus biogenes ال
+
+75
+00:05:31,550 --> 00:05:35,970
+LTM تبقى الجروح يطول لماذا يطول؟ لماذا اتمنى ان
+
+76
+00:05:35,970 --> 00:05:40,220
+يطول؟البكتيريا تتكثر و تنهي بشكل جيد تحدثنا عن الـ
+
+77
+00:05:40,220 --> 00:05:43,820
+streptomycin O وتكلمنا عن مين في هذا السياق تكلمنا
+
+78
+00:05:43,820 --> 00:05:47,920
+عن antstreptomycin O اللي هو الفحص المستخدم لقياس
+
+79
+00:05:47,920 --> 00:05:55,480
+مدى وجود هذا ال antibody لهذا ال antigenهدس اللوحة
+
+80
+00:05:55,480 --> 00:05:59,940
+يعني لوحة برضه جيدة بتوضحنا ال .. ال .. ال .. ال
+
+81
+00:05:59,940 --> 00:06:03,860
+entry و ال portal of exit طبعا لاحظوا هنا entry
+
+82
+00:06:03,860 --> 00:06:07,900
+and exit ايش entry and exit يعني مكان الدخول و
+
+83
+00:06:07,900 --> 00:06:11,160
+مكان الخروج للميكروب طبعا النقاط الأخرى اللي
+
+84
+00:06:11,160 --> 00:06:15,110
+موجودة قدامكوا هذه هي الأماكناللي بيعمل فيها
+
+85
+00:06:15,110 --> 00:06:19,230
+infection لـ streptococcus اعتقد انه احنا شايفين
+
+86
+00:06:19,230 --> 00:06:23,910
+كل الدسم شايفين كل الدسم عشان اقولنالكوا wide
+
+87
+00:06:23,910 --> 00:06:28,390
+variety of diseases are caused by streptococcus
+
+88
+00:06:28,390 --> 00:06:32,850
+virus طبعا الصورة هادى لإن احنا قولنالكوا انه
+
+89
+00:06:32,850 --> 00:06:35,910
+tonsillitis استغربنا من أحد الإخوة اللى جاية أنا
+
+90
+00:06:35,910 --> 00:06:38,890
+لم أصاب بالـ tonsillitis زي وسعيد الآن يمكن بكرا
+
+91
+00:06:38,890 --> 00:06:43,070
+او بعده يغيب عشان الـ tonsillitis لكن
+
+92
+00:06:45,370 --> 00:06:48,970
+Tonsillitis is a very common وبالتالي هتواجهكوا
+
+93
+00:06:48,970 --> 00:06:52,650
+انتوا كطلاب تحاليل طبية قد يطلب منكوا جمع عينات
+
+94
+00:06:52,650 --> 00:06:55,630
+لكن احنا بنفضلش انه ال medical technologist هو
+
+95
+00:06:55,630 --> 00:06:58,910
+اللي يجمع العينات دايما او ابدا بنفضل اما الطبيب
+
+96
+00:06:58,910 --> 00:07:02,230
+او experienced nurse انه يجمع العينات حتى blood
+
+97
+00:07:02,230 --> 00:07:05,870
+collection غالبا we prefer physician
+
+98
+00:07:08,300 --> 00:07:10,880
+هذه الصورة اللي انا حكيتلكوا المرة الماضية عن ال
+
+99
+00:07:10,880 --> 00:07:14,120
+.. البكتيريا اللي هي أكلة اللحم flesh eating
+
+100
+00:07:14,120 --> 00:07:18,280
+بكتيريا بيسموها necrotizing fasciitis لاحظوا كيف
+
+101
+00:07:18,280 --> 00:07:22,940
+التأكل في ال .. ال .. اليد هي الصورة مزعجة و
+
+102
+00:07:22,940 --> 00:07:27,380
+disturbing لكن مضطرين نشوفها هذه أخف صور قد
+
+103
+00:07:27,380 --> 00:07:30,420
+تراونها على ال internet ل necrotizing fasciitis
+
+104
+00:07:30,420 --> 00:07:34,300
+ادخله لحالكوا و sweet dreams بعدها
+
+105
+00:07:36,540 --> 00:07:41,240
+Okay Scarlet fever اللي هو الحمق القرمزية غالبا
+
+106
+00:07:41,240 --> 00:07:44,680
+بينتج عن سلالة .. عن الإصابة بسلالة من
+
+107
+00:07:44,680 --> 00:07:49,540
+erythrogenic toxin هذه السلالة مش منتشرة بشكل كبير
+
+108
+00:07:49,540 --> 00:07:53,460
+بمعنى ان مش كل واحد بينصاب with septicemia, with
+
+109
+00:07:53,460 --> 00:07:56,140
+streptococcus, with bio genes بيصير عنده scarlet
+
+110
+00:07:56,140 --> 00:07:59,780
+fever لازم يكون ال strain بيمتلك ال erythrogenic
+
+111
+00:07:59,780 --> 00:08:04,500
+toxin اللي بيتكلم عنهفاكرين ال toxic shock
+
+112
+00:08:04,500 --> 00:08:08,800
+syndrome تكسين؟ لمين كان هداك؟ للاستفيلو كوكاس
+
+113
+00:08:08,800 --> 00:08:13,800
+الاستريبتو كوكاس بتنتج تكسين برضه شبيه و بيعمل
+
+114
+00:08:13,800 --> 00:08:17,380
+toxic shock syndrome و بيشتغل بنفس القلية، إيش
+
+115
+00:08:17,380 --> 00:08:21,260
+القلية كانت اللي بيشتغل فيها هداك؟ super .. super
+
+116
+00:08:21,260 --> 00:08:24,560
+.. super antigen إيش معناه super antigen كمان مرة
+
+117
+00:08:24,560 --> 00:08:29,880
+أذكركوا؟بيرتبط في الـ T-lymphocytes مع الـ
+
+118
+00:08:29,880 --> 00:08:32,320
+macrophage non-specifically وبالتالي بيعمل
+
+119
+00:08:32,320 --> 00:08:35,420
+activation .. بظبط بيعمل .. بيعمل non-specific
+
+120
+00:08:35,420 --> 00:08:42,010
+activation للـ T-cells okaySome of the antibodies
+
+121
+00:08:42,010 --> 00:08:45,510
+produced during the above infection cross react
+
+122
+00:08:45,510 --> 00:08:49,450
+with certain host tissue.الكلام اللي حكيته انه ال
+
+123
+00:08:49,450 --> 00:08:52,370
+antibodies اللي بينتجها الدسم ضد البكتيريا will
+
+124
+00:08:52,370 --> 00:08:55,730
+cross react with some of the tissues in the body
+
+125
+00:08:55,730 --> 00:09:00,830
+طبعا هذا بطريقة نعم بطريقة غير مباشرة بيعمل
+
+126
+00:09:00,830 --> 00:09:05,120
+destruction و damage لل host tissueحتى بعد ما يصير
+
+127
+00:09:05,120 --> 00:09:08,100
+clearance للميكروعجنز يعني لو اتخلصنا من الميكروب
+
+128
+00:09:08,100 --> 00:09:12,440
+إما من جهاز المناعة أو باستخدام ال antibiotics
+
+129
+00:09:12,440 --> 00:09:16,480
+بيظل الدرر شغال لإن ال antibodies are still there
+
+130
+00:09:16,480 --> 00:09:19,560
+these
+
+131
+00:09:19,560 --> 00:09:22,300
+pathological events begin one to three weeks after
+
+132
+00:09:22,300 --> 00:09:24,620
+an acute streptococcal illness هذه كمان نقطة كتير
+
+133
+00:09:24,620 --> 00:09:29,680
+مهمة إنه إذا صارت الأحداث غالبا تنتج بعد واحد لتلت
+
+134
+00:09:29,680 --> 00:09:34,250
+أسابيع من ال acute infectionو ال acute infection
+
+135
+00:09:34,250 --> 00:09:39,330
+غالبا اما بتكون tonsillitis زي ما حكينا او
+
+136
+00:09:39,330 --> 00:09:42,030
+streptococcal sore throat او ممكن تكون wound
+
+137
+00:09:42,030 --> 00:09:45,430
+infection يا شبابوالسيكولا او ال .. ال
+
+138
+00:09:45,430 --> 00:09:49,970
+complication قد تختلف باختلاف مكان ال primary
+
+139
+00:09:49,970 --> 00:09:53,890
+infection اذا كانت tonsillitis ففي الغالب .. في
+
+140
+00:09:53,890 --> 00:09:58,370
+الغالب بتكون rheumatic fever .. rheumatic fever
+
+141
+00:09:58,370 --> 00:10:02,190
+اذا كانت wound infection تؤدي الى acute glomeral
+
+142
+00:10:02,190 --> 00:10:05,330
+nephritis تمام؟ ففي ارتباط ما بين مكان ال
+
+143
+00:10:05,330 --> 00:10:10,990
+infection و ال complication تبعتهاهذه راشز لظهر
+
+144
+00:10:10,990 --> 00:10:15,110
+مريض بتبين عنده scar اللي بتسميها لو هم قرمزية أو
+
+145
+00:10:15,110 --> 00:10:19,470
+يمكن اللون القرمزي لللسان والشفتين والجلد اللي هو
+
+146
+00:10:19,470 --> 00:10:26,470
+اللي اعطى الاسم للبكتير أو للمرض طيب تعلمنا مجموعة
+
+147
+00:10:26,470 --> 00:10:29,830
+من ال .. ال .. من الأمراض اللي بتسميها الـ
+
+148
+00:10:29,830 --> 00:10:34,950
+streptococcus بيوجين نتكلم الآن عن ال specimens و
+
+149
+00:10:34,950 --> 00:10:38,450
+ال specimen collection كمان مرة أؤكد لكمإنه
+
+150
+00:10:38,450 --> 00:10:43,350
+whenever a physician is available he is
+
+151
+00:10:43,350 --> 00:10:47,030
+responsible for specimen collection يعني هو أكتر
+
+152
+00:10:47,030 --> 00:10:53,610
+experience منك ك medical technologist عنده المقدرة
+
+153
+00:10:53,610 --> 00:10:57,010
+على أنه يختار ال location تبع جامعة العينة أفضل
+
+154
+00:10:57,010 --> 00:11:01,430
+برضه منك لإن هو عنده clinical experience انت
+
+155
+00:11:01,430 --> 00:11:03,190
+ماعندك clinical experience انت عندك laboratory
+
+156
+00:11:03,190 --> 00:11:07,110
+experienceوأفضل شي في الدنيا أن كل واحد يشوف
+
+157
+00:11:07,110 --> 00:11:10,470
+المهام تبعته ويشتغل فيها على أكمل وجهة إذا الطبيب
+
+158
+00:11:10,470 --> 00:11:14,430
+جامع العينة واشترطنا إذا .. إذا بدنا نحصل على
+
+159
+00:11:14,430 --> 00:11:18,890
+أتائج جيدة بدنا عينها جيدة وبالتالي يفضل أنه well
+
+160
+00:11:18,890 --> 00:11:24,190
+experienced و well trained تمام؟ يقولنا physician
+
+161
+00:11:24,190 --> 00:11:29,250
+أو nurse to collect the specimen throat swabis
+
+162
+00:11:29,250 --> 00:11:32,270
+collected through the use of tongue depressor
+
+163
+00:11:32,270 --> 00:11:36,990
+بتعرفوا خافض اللسان؟ أوه ده، تمام؟ بنضغط خشب،
+
+164
+00:11:36,990 --> 00:11:40,970
+بنضغط فيها على اللسان، ليش بنضغط فيها على اللسان؟
+
+165
+00:11:40,970 --> 00:11:41,950
+مش بس
+
+166
+00:11:45,390 --> 00:11:50,490
+جربوا حد يدخل حد straight لل back throat هتلاقي
+
+167
+00:11:50,490 --> 00:11:55,630
+اللسان طلع فوق تلقائي احنا بدنا ندخل swap لمؤخرة
+
+168
+00:11:55,630 --> 00:11:58,870
+الفم، مظبوط؟ فإذا دخلنا ل swap تلقائي اللسان
+
+169
+00:11:58,870 --> 00:12:03,170
+بيرتفع، فبيضغط عليه بيمنع دخوله، فانا بدأ أضطر
+
+170
+00:12:03,170 --> 00:12:08,590
+أمسكله اللسان و أدخل لغرضين، أشوف و في نفس الوجهة
+
+171
+00:12:08,590 --> 00:12:13,360
+أجمع عينا، خد بالكواالمستوى تبع الرأس تبع المريض
+
+172
+00:12:13,360 --> 00:12:16,580
+لازم يكون نفس المستوى تبعك انت لا تخليه يرفع فوق
+
+173
+00:12:16,580 --> 00:12:21,640
+ولا تخليه ينزل تحت المستوى الموازي اليك تمام بيقلل
+
+174
+00:12:21,640 --> 00:12:25,560
+من عملية اللي هو ال vomiting reflux تعرفين لما
+
+175
+00:12:25,560 --> 00:12:28,960
+بدخلنا حاجة برضه يصير فينا شعور بال vomiting تمام
+
+176
+00:12:28,960 --> 00:12:32,300
+فانت بدك تاخد منه عينة ولا بدك تاخد منه vomit تمام
+
+177
+00:12:32,300 --> 00:12:36,430
+بدك عينةفي طبعا ال .. ال .. ال .. في .. في بعض
+
+178
+00:12:36,430 --> 00:12:42,070
+المستشفيات بيرشوا مخدر على ال back throat فال ..
+
+179
+00:12:42,070 --> 00:12:45,670
+ال .. ال vomiting mechanism بتروح من ال .. من
+
+180
+00:12:45,670 --> 00:12:50,940
+المريض عموماtongue depressor و ال illumination
+
+181
+00:12:50,940 --> 00:12:55,820
+إضاءة جيدة للفم عبر إما ضوء متحرك من وجهه لفم
+
+182
+00:12:55,820 --> 00:13:00,000
+المريض tongue depressor go inside do not touch
+
+183
+00:13:00,000 --> 00:13:03,420
+anything except the site where you want to collect
+
+184
+00:13:03,420 --> 00:13:06,780
+the sample لا تلمس الخد من جوا ولا اللسان من الطرف
+
+185
+00:13:06,780 --> 00:13:10,780
+ولا أي مكان آخر go directly to the inflamed area
+
+186
+00:13:10,780 --> 00:13:18,100
+إيش ال inflamed area إما area of red color تمام؟أو
+
+187
+00:13:18,100 --> 00:13:23,120
+area of white color white هذه أفضل عيلة تاخد من ال
+
+188
+00:13:23,120 --> 00:13:26,860
+white إذا وجدت حاجة white خد منها ليش white؟
+
+189
+00:13:26,860 --> 00:13:29,600
+المستعمرات البكتيرية بتكون نامية على التونس اللي
+
+190
+00:13:29,600 --> 00:13:33,900
+هو عاملة المستعمرات فانت بتاخد colony تاخد colony
+
+191
+00:13:33,900 --> 00:13:38,990
+لما تكون white طب مافيش مافيش whiteإيش بتعمل؟
+
+192
+00:13:38,990 --> 00:13:42,910
+بتعمل ال press لما تدخل بال swap بتعمل ال press
+
+193
+00:13:42,910 --> 00:13:46,610
+ضغط على ال tonsil و بتعمل ال roll رول يعني بتلف ال
+
+194
+00:13:46,610 --> 00:13:50,910
+swap الحركة دي يتبقى لتستغل أكثر من عشر ثواني ضغط
+
+195
+00:13:50,910 --> 00:13:54,650
+فبنوع من الممارسة و steady hand يعني مش إيد بترجف
+
+196
+00:13:54,650 --> 00:14:00,340
+نزل ال swap اللي هو من الأنفطبعا نزل ال swap بيتم
+
+197
+00:14:00,340 --> 00:14:05,100
+عن طريق اللي هو برضه swap و بيدخل الانف few
+
+198
+00:14:05,100 --> 00:14:07,980
+centimeter و بعدين بيسحب one to two centimeter بس
+
+199
+00:14:07,980 --> 00:14:11,580
+خدوا بالكوا في نزل فرنجل نزل فرنجل هذا احنا نعرفش
+
+200
+00:14:11,580 --> 00:14:15,180
+ناخده بمعنى اخر انتوا بتعرفوش تاخدوه بده طبيب امام
+
+201
+00:14:15,180 --> 00:14:20,860
+و بيستخدموا فيه swap اليد تبعت ال swap او ال
+
+202
+00:14:20,860 --> 00:14:27,020
+handle تبعته مش خشب غالبا wireو elastic wire بمعنى
+
+203
+00:14:27,020 --> 00:14:31,880
+إنه مرن لو صدم في حاجز ممكن تحركه زي الستثة اللي
+
+204
+00:14:31,880 --> 00:14:35,800
+بندخل فيها الأسلاك في النهر فبيكون فيه نوع من إيه؟
+
+205
+00:14:35,800 --> 00:14:41,200
+من المرونة و بندخله عميقا حتى ناخد عينة معبرة على
+
+206
+00:14:41,200 --> 00:14:42,000
+ال nasopharyngeal
+
+207
+00:14:45,020 --> 00:14:48,360
+ال Sputum كنا عينا من العينات درسناها .. وين
+
+208
+00:14:48,360 --> 00:14:53,000
+درسناها ال Sputum؟ في الطعون اظنى لما درسنا الطعون
+
+209
+00:14:53,000 --> 00:14:56,960
+لما درسنا ال .. ال pneumonic plague كنالكوا انه
+
+210
+00:14:56,960 --> 00:15:01,020
+واحدة من اكثر العينات frustration ليش؟ لأنه صحيح
+
+211
+00:15:01,020 --> 00:15:04,180
+هي معبرة عن ال lungs و جاي من ال lungs لكن بتمر
+
+212
+00:15:04,180 --> 00:15:07,360
+عبر الفم و الفم محتوي على ال saliva و ال saliva
+
+213
+00:15:07,360 --> 00:15:10,900
+contaminated with normal flora فانت بدك Sputum
+
+214
+00:15:10,900 --> 00:15:13,930
+true Sputumوبالتالي بدا تعطي المريض instructions
+
+215
+00:15:13,930 --> 00:15:18,850
+on how to collect a proper specimen by gargling
+
+216
+00:15:18,850 --> 00:15:21,970
+two to three times taking deep breath تعطيه
+
+217
+00:15:21,970 --> 00:15:24,710
+container wide mouth container تعمله instruction
+
+218
+00:15:24,710 --> 00:15:28,150
+انه يكح مباشرة في ال container مايمسكش اللي هو ال
+
+219
+00:15:28,150 --> 00:15:31,370
+.. ال .. ال sputum بين أسنانه و في ال .. ال lips
+
+220
+00:15:31,370 --> 00:15:35,110
+early morning sputum ممكن يكون كويس و في المعمل ..
+
+221
+00:15:35,110 --> 00:15:38,210
+في المعمل انت كمان بتقرر ان هذا .. هذا sputum ولا
+
+222
+00:15:38,210 --> 00:15:42,320
+مش sputum عن طريق ايش؟ عن طريق ال number ofbus
+
+223
+00:15:42,320 --> 00:15:47,740
+cells إذا كان فيه bus cells عالي و few ابيثيليال
+
+224
+00:15:47,740 --> 00:15:51,980
+بيكون مقبول لكن لو كان العكس لو كان ابيثيليال كتير
+
+225
+00:15:51,980 --> 00:15:55,880
+و bus قليل بيعتبروها saliva و بيعملوها rejection
+
+226
+00:15:55,880 --> 00:16:00,400
+rejection يعني بإن محتاجين عينة أخرى غير هذا العين
+
+227
+00:16:00,400 --> 00:16:03,720
+ال blood ده أعتقد أتعلمنا كيف .. وصلتوا في المعمل
+
+228
+00:16:03,720 --> 00:16:08,800
+لل blood ولا لسه؟ لل blood cultureفانتوا كيف ..
+
+229
+00:16:08,800 --> 00:16:10,640
+كيف .. ايش نظام .. ايش نظام ال .. المعمل عندكوا
+
+230
+00:16:10,640 --> 00:16:14,260
+الآن الفصل هذا بتاخدوا group بت لل micro organism
+
+231
+00:16:14,260 --> 00:16:22,220
+ولا specimens عيناد؟ لأ لأ مش قصدي لسه بتكلموا عن
+
+232
+00:16:22,220 --> 00:16:27,080
+البكتيريا ولا .. اه مش .. مش على ال specimens لسه
+
+233
+00:16:27,080 --> 00:16:31,830
+okayفينا جزء متعلق بال specimen ال collection و ال
+
+234
+00:16:31,830 --> 00:16:35,090
+processing تبع كل specimen من ال specimen هذه فال
+
+235
+00:16:35,090 --> 00:16:37,970
+blood culture احنا اظن مرة عملنا زي demonstration
+
+236
+00:16:37,970 --> 00:16:41,970
+في المحاضرة هنا ان كيف بنعمل عملية disinfection لل
+
+237
+00:16:41,970 --> 00:16:46,810
+skin بالكحول و بعدين بالايودين و بعدين بالكحول حتى
+
+238
+00:16:46,810 --> 00:16:51,750
+نمنع اي traces اي اثار متبقية للايودين و في نفس
+
+239
+00:16:51,750 --> 00:16:53,950
+الوقت نعمل good disinfection لل skin
+
+240
+00:16:56,400 --> 00:17:00,280
+Diagnostic procedures للـ streptococcus كان دي ال
+
+241
+00:17:00,280 --> 00:17:04,140
+gram stain و ال gram stain أذكركم بس بالصورة
+
+242
+00:17:04,140 --> 00:17:09,780
+عالسرير أن نرجع برجوع هاد الصورة لما قلتلكوا أن
+
+243
+00:17:09,780 --> 00:17:13,740
+هاد عينة أو صورة عينة حقيقية من .. من boss .. لأن
+
+244
+00:17:13,740 --> 00:17:17,800
+فيها boss cells و البكتيريا عاملة long chains هاد
+
+245
+00:17:17,800 --> 00:17:20,460
+الصورة اللي أمامكم هل ممكن نخطأها و نقول
+
+246
+00:17:20,460 --> 00:17:24,930
+Staphylococcus مستحيلبالظبط لأن هذه long chain
+
+247
+00:17:24,930 --> 00:17:29,130
+فبالتالي بيقولنا انه directly from .. from a
+
+248
+00:17:29,130 --> 00:17:32,030
+clinical specimen البكتيريا اللي اسمها
+
+249
+00:17:32,030 --> 00:17:34,830
+Styrtococcus biogenes could be easily
+
+250
+00:17:34,830 --> 00:17:38,810
+distinguished from other bacteria لكن كمان مرة
+
+251
+00:17:38,810 --> 00:17:43,070
+القاعدة العامة you cannot identify اقولكوا احنا
+
+252
+00:17:43,070 --> 00:17:45,730
+بعض الأحيان بنشوف gram negative diplokokai في
+
+253
+00:17:45,730 --> 00:17:50,190
+عينات CSF مين gram negative diplokokai بتعرفها في
+
+254
+00:17:50,190 --> 00:17:54,580
+ال CSF ان هي Serial meningitisأحنا بنكتف في
+
+255
+00:17:54,580 --> 00:17:57,340
+التقرير بتاعنا في ال Gram Stain Gram Negative
+
+256
+00:17:57,340 --> 00:18:01,860
+Diplococcal وبنبعتها للطبيب الطيب لما بيقرأها إيش
+
+257
+00:18:01,860 --> 00:18:04,700
+بيفسرها نيسيريا من انجيطايتس
+
+258
+00:18:07,140 --> 00:18:11,900
+مافسرتاش انا كانت وظيفتي to describe what I see
+
+259
+00:18:11,900 --> 00:18:15,180
+under the microscope وانا عمل description جيد قولت
+
+260
+00:18:15,180 --> 00:18:19,360
+gram negative diplococci ممكن اوصفله جداش فيها
+
+261
+00:18:19,360 --> 00:18:23,520
+intracellular جداش extracellular هل في بص كتير هل
+
+262
+00:18:23,520 --> 00:18:27,880
+في بص قليل لكن لم أستطع القول ولا الفتوى بأن
+
+263
+00:18:27,880 --> 00:18:32,840
+البكتيريا دي هينيسيريا مينويتايدس إذا نجرى نقول
+
+264
+00:18:32,840 --> 00:18:35,600
+إنه could be distinguished quickly but could not
+
+265
+00:18:35,600 --> 00:18:38,280
+be confirmed ال confirmation بده يكون بمين؟ بال
+
+266
+00:18:38,280 --> 00:18:46,540
+culture طيب
+
+267
+00:18:46,540 --> 00:18:52,720
+و أين بيلاجي البكتيريا هذه؟ بيلاجيها في ال blood؟
+
+268
+00:18:52,720 --> 00:18:55,660
+يا ما أسهل عينة ال blood إن نزرعها على blood
+
+269
+00:18:55,660 --> 00:19:00,790
+cultureبنلاجيها في ال CSF منزلها على بلد أجار
+
+270
+00:19:00,790 --> 00:19:03,810
+وعشان كده أجار مافي اي مشكلة عندنا لكن لو أخدناها
+
+271
+00:19:03,810 --> 00:19:09,510
+من الفم oral cavity من ال tonsils هو أنا أخدتها
+
+272
+00:19:09,510 --> 00:19:12,930
+صحيح من ال tonsil ولمستش أي مكان آخر لكن ال tonsil
+
+273
+00:19:12,930 --> 00:19:18,070
+نفسهامش احنا بنبلع الطعام و بنبلع اللعاب تبعنا
+
+274
+00:19:18,070 --> 00:19:21,370
+عليها أدر بكتيريا فبالتالي في هذه الحالة هل العين
+
+275
+00:19:21,370 --> 00:19:26,170
+اللي أخدتها هي single ولا mixed؟ طب أنا بدي أعززل
+
+276
+00:19:26,170 --> 00:19:29,130
+فقط من؟ بدي أستخدم بالظبط selected media في هذه
+
+277
+00:19:29,130 --> 00:19:33,570
+الحالةفي ال .. في ال .. في العينات اللي .. اللي
+
+278
+00:19:33,570 --> 00:19:36,290
+normally sterile بستخدم blood agar بدون أي
+
+279
+00:19:36,290 --> 00:19:39,810
+additives، لكن إذا كانت العينة مختلطة أو يعتقد
+
+280
+00:19:39,810 --> 00:19:43,410
+إنها مختلطة بال .. ال .. ال antibiotic ب .. بother
+
+281
+00:19:43,410 --> 00:19:45,570
+microorganism، أنا محتاج في هذا الحالة أعملها
+
+282
+00:19:45,570 --> 00:19:49,230
+selective mediaمن الـ selective media المعتمدة
+
+283
+00:19:49,230 --> 00:19:52,490
+عبارة عن blood agar محتوى على three antibiotics زي
+
+284
+00:19:52,490 --> 00:19:55,950
+الـgentamicin والكوليستين و الnerodixic acid
+
+285
+00:19:55,950 --> 00:20:00,010
+والصحيح انهم التلاتة هدولة موجهين ضد لجرام
+
+286
+00:20:00,010 --> 00:20:05,490
+negative bacteria طبعا ولا واحد منهم بيقضي على كل
+
+287
+00:20:05,490 --> 00:20:10,130
+جرام negative تمام فبتالي عملنا خلطة combination
+
+288
+00:20:10,130 --> 00:20:14,850
+تعطينا range واسع من القتل لجرام negative bacteria
+
+289
+00:20:18,910 --> 00:20:21,910
+شكل المستعمرات بيقول إن على ال blood is not a
+
+290
+00:20:21,910 --> 00:20:24,610
+distinguishing characteristic طيب أنا معلش يعني
+
+291
+00:20:24,610 --> 00:20:28,490
+أرجع برجع على كلمة selective media عشان أنصح
+
+292
+00:20:28,490 --> 00:20:32,950
+المفهوم لما قلت أنا إضافة ال antibiotic على ال
+
+293
+00:20:32,950 --> 00:20:39,760
+blood agar جعلها selective absolutely selectiveبدأ
+
+294
+00:20:39,760 --> 00:20:43,200
+أكدلكوا الحقيقة هذه مرارا و تكرارا حتى لا ننسى حتى
+
+295
+00:20:43,200 --> 00:20:47,440
+لا ننسى ان المستعمرة اللي بتنمو نعم هي suspected
+
+296
+00:20:47,440 --> 00:20:50,660
+انها تكون البكتيريا اللي بدياها لكن I have to do
+
+297
+00:20:50,660 --> 00:20:55,220
+some test to confirm the identity لو أنا واثقت
+
+298
+00:20:55,220 --> 00:20:58,120
+بإنه absolute selective ما أنا حاكي ماكانش فيه
+
+299
+00:20:58,120 --> 00:21:01,900
+داعي انه نعمل اي confirmation test وصل الصورة
+
+300
+00:21:01,900 --> 00:21:06,060
+وللأسف احنا كل مرة بنعزل مايكروب من selective
+
+301
+00:21:06,060 --> 00:21:10,210
+media لازم نعملهconfirmation حتى في ال food
+
+302
+00:21:10,210 --> 00:21:14,170
+microbiology يا شباب مش هاخدته MSA واخدته مثلا
+
+303
+00:21:14,170 --> 00:21:19,730
+TCPS لل Vibrochloria لو لجينا البكتيريا اللي نامية
+
+304
+00:21:19,730 --> 00:21:22,890
+و typical colonies مانا باخد تنتين او تلاتة و
+
+305
+00:21:22,890 --> 00:21:30,230
+بعملهم confirmation عشان حقيقة مش لازم تكون غائبة
+
+306
+00:21:30,230 --> 00:21:33,310
+عن أذهنكم احنا اللي بنعرفه ان البكتيريا يا شباب لا
+
+307
+00:21:33,310 --> 00:21:36,550
+يساوي واحد في المية من البكتيريا المعروفة المتوقعة
+
+308
+00:21:36,550 --> 00:21:41,380
+في العالمفيمكن يكون في أنواع من البكتيريا أنا ما
+
+309
+00:21:41,380 --> 00:21:47,280
+بعرفهاش تشبه البكتيريا اللي أنا بعرفها مثلا أنا
+
+310
+00:21:47,280 --> 00:21:49,400
+بدوّع على Staphylococcus aureus على الـ Manitoba
+
+311
+00:21:49,400 --> 00:21:52,500
+salt agar يمكن يكون في بكتيريا مجهولة بتعطيني نفس
+
+312
+00:21:52,500 --> 00:21:55,240
+ال characteristics و أنا ما بعرفهاش وبالتالي يجب
+
+313
+00:21:55,240 --> 00:21:58,240
+أن أتأكد من ال suspect كورنيا عن طريق من
+
+314
+00:21:58,240 --> 00:22:04,740
+confirmatory tests أحد أهم الفحوصات اللي بنستخدمها
+
+315
+00:22:04,740 --> 00:22:09,090
+اسمها Basteracin sensitivity testingدرستوها في
+
+316
+00:22:09,090 --> 00:22:11,510
+المعمل هذه انتوا على فكرة خلصتوا ال strip to cocci
+
+317
+00:22:11,510 --> 00:22:17,930
+تمام البستراسين هو يبقى عن فحص رائع جدا لتمييز ال
+
+318
+00:22:17,930 --> 00:22:22,150
+beta hemolytic strip to cocci الان انا قلت عندي
+
+319
+00:22:22,150 --> 00:22:25,450
+مجموعة او مجموعة من البكتيريا بتعطينا beta
+
+320
+00:22:25,450 --> 00:22:31,050
+hemolysis لكن خدوا بالكم ال Staphylococcus aureus
+
+321
+00:22:31,050 --> 00:22:34,290
+بتعمل beta hemolysis صح بعملها test بستراسين
+
+322
+00:22:38,980 --> 00:22:43,960
+ليش ماعملتلهاش طيب أنا بسترسين تست؟ لأنها كانت
+
+323
+00:22:43,960 --> 00:22:47,880
+ليست .. لأنه لا .. كانت ليست لأنه أنا استثنتها من
+
+324
+00:22:47,880 --> 00:22:51,860
+البداية وبتالي الآن هي مش موضوع خلاف بين و بين
+
+325
+00:22:51,860 --> 00:22:55,480
+أحصان أبيض و أحصان أسود، ذاكرين المثال؟ مش موضوع
+
+326
+00:22:55,480 --> 00:22:59,740
+اتهام بإنها تكون من ضمن المجموعة، استثننها من زمان
+
+327
+00:23:00,810 --> 00:23:05,910
+إذا طلعت عند البكتيريا كتاليز نيجاتيف الان بينطبق
+
+328
+00:23:05,910 --> 00:23:11,370
+عليها بستراسينتس عشان نميز من عن من، نميز عن ..
+
+329
+00:23:11,370 --> 00:23:14,770
+نميز اللي هي ال .. ال .. ال .. الستربتوكوكس
+
+330
+00:23:14,770 --> 00:23:18,410
+بيودينز عن الستربتوكوكس أجلاكتي أو عن ال other
+
+331
+00:23:18,410 --> 00:23:19,570
+streptococci
+
+332
+00:23:23,090 --> 00:23:26,550
+كيف الفحص بنعمل؟ blood agar بنعمله striking
+
+333
+00:23:26,550 --> 00:23:29,850
+للبكتيريا وبنحط القرص عليه وincubation، تفتوا
+
+334
+00:23:29,850 --> 00:23:32,570
+الفحص عملناه؟ وين الفحص؟ على blood agar،
+
+335
+00:23:32,570 --> 00:23:35,310
+ماعملناهوش على nutrient ولا على molar junta، لأن
+
+336
+00:23:35,310 --> 00:23:40,040
+البكتيريا هتجه لنا عنها fastidiousإذا البكتيريا
+
+337
+00:23:40,040 --> 00:23:45,780
+عملت zone of inhibition أكتر من خمسة millimeter
+
+338
+00:23:45,780 --> 00:23:51,640
+على حوالين القرص فبيكون الفحص sensitive والبكتيريا
+
+339
+00:23:51,640 --> 00:23:55,600
+biogenes إذا كان أقل من ذلك أو لا يوجد أصلا zone
+
+340
+00:23:55,600 --> 00:23:59,500
+من أساسه فهي resistant طبعا ال sensitive الوحيدة
+
+341
+00:23:59,500 --> 00:24:03,680
+اللي قلناها هي ال biogenes الأجلاكتيا وال other
+
+342
+00:24:03,680 --> 00:24:05,580
+beta-harmonic التنتين resistance
+
+343
+00:24:08,430 --> 00:24:11,310
+الـ Resistance، أه خلاص، احنا ال .. دايما الأرقام
+
+344
+00:24:11,310 --> 00:24:14,970
+اللي عندنا هي الـ Faisal هل .. زي .. زي في ال
+
+345
+00:24:14,970 --> 00:24:16,610
+sensitivity مرات بيكون ال zone of inhibition
+
+346
+00:24:16,610 --> 00:24:19,890
+تبانية و عشرين، تبانية و عشرين millimeter very
+
+347
+00:24:19,890 --> 00:24:23,210
+large zone، تمام؟ و بنقول resistant، عارفين ليش؟
+
+348
+00:24:23,210 --> 00:24:26,270
+لأن ال chart بتاعة ال antibiotic بتقول إن ال
+
+349
+00:24:26,270 --> 00:24:29,330
+sensitivity تسعة و عشرين، تسعة و عشرين و أعلى
+
+350
+00:24:29,330 --> 00:24:32,570
+sensitive، تبانية و عشرين و أقل لأحد ال
+
+351
+00:24:32,570 --> 00:24:34,670
+antibiotic، مش لكل ال antibiotic، بعض الأحيان
+
+352
+00:24:34,670 --> 00:24:38,510
+بتكون ال zone سبعتاش و sensitiveبحسب نوع ال
+
+353
+00:24:38,510 --> 00:24:41,870
+antibiotic نوع البكتيري فلما انا اقول five
+
+354
+00:24:41,870 --> 00:24:45,510
+millimeter or greater يبقى بده you have to stick
+
+355
+00:24:45,510 --> 00:24:52,170
+to this piece of information طيب قلنا step 2
+
+356
+00:24:52,170 --> 00:24:54,790
+coccus biodeins is sensitive to Pastel Racine ممكن
+
+357
+00:24:54,790 --> 00:24:59,650
+نعمل biochemical test أخرى catalase test negative
+
+358
+00:24:59,650 --> 00:25:01,830
+و oxidase test برضه هي negative
+
+359
+00:25:05,200 --> 00:25:09,900
+أعتقد الصورة اللي أمامناها دي بتوضح إنها ال beta
+
+360
+00:25:09,900 --> 00:25:14,610
+hemolysis تبعت البكتيريا أعتقد واضحة جداو بيقولنا
+
+361
+00:25:14,610 --> 00:25:17,890
+انه small size المستعمرات لكن ال hemolysis تبعها
+
+362
+00:25:17,890 --> 00:25:24,330
+large تمام؟ الطبق التاني هذا في عندي القرص زي ما
+
+363
+00:25:24,330 --> 00:25:27,590
+تشوفين في حواليه zone of inhibition تمام؟ فهذه
+
+364
+00:25:27,590 --> 00:25:31,170
+sensitive وهذه مافيش اي zone بالمرة ف resistant و
+
+365
+00:25:31,170 --> 00:25:34,690
+بيقولنا هذه group A وهذه اللي هو ال .. طبعا إذا
+
+366
+00:25:34,690 --> 00:25:39,790
+بتلاحظوا هذا كله hemolysisهذا مش بكتيريا، هذا
+
+367
+00:25:39,790 --> 00:25:43,350
+Hemolysis، اختفاء اللون هنا Hemolysis، لكن المنطقة
+
+368
+00:25:43,350 --> 00:25:46,790
+المحيطة بالقرص مافيش Hemolysis، ليش؟ مافيش
+
+369
+00:25:46,790 --> 00:25:51,690
+بكتيريا، مافيش بكتيريا، نامي، بينما هنا .. طبعا
+
+370
+00:25:51,690 --> 00:25:53,910
+بلاد أجار، طبعا هنقول .. اتفقنا إنه لازم أكون على
+
+371
+00:25:53,910 --> 00:25:54,430
+بلاد أجار
+
+372
+00:25:58,050 --> 00:26:00,650
+الـ Serological Test و أنا المرة الماضية قدمت لهذا
+
+373
+00:26:00,650 --> 00:26:03,730
+الفحص اللي هو الـ ASOT اللي هو الـ Antibody اللي
+
+374
+00:26:03,730 --> 00:26:08,450
+بينتجه جسم الإنسان ك response للـ streptomycin O و
+
+375
+00:26:08,450 --> 00:26:13,230
+كنا حاطينا حرف ال T في الآخر كتابة تركم مقياس عشان
+
+376
+00:26:13,230 --> 00:26:16,850
+معظمنا أصيب وبالتالي معظمنا جسمه بيحتوي على
+
+377
+00:26:16,850 --> 00:26:20,430
+antibodies أو على level معين من ال antibodies
+
+378
+00:26:20,430 --> 00:26:23,470
+فعشان نميز بين recent infection و previous
+
+379
+00:26:23,470 --> 00:26:28,180
+infectionجسدنا التركيز إذا لاجيناه أكتر من 200
+
+380
+00:26:28,180 --> 00:26:32,580
+international unit بيكون
+
+381
+00:26:32,580 --> 00:26:37,460
+حديثا نعم recent infection بينما إذا كان أقل من
+
+382
+00:26:37,460 --> 00:26:41,180
+200 international unit بيكون الإصابة قديمة طبعا
+
+383
+00:26:41,180 --> 00:26:44,060
+الفحص كان كتير مشهور يا شباب في المختبرات عندنا في
+
+384
+00:26:44,060 --> 00:26:47,940
+فلسطين لإنه نسبة كبيرة من أطفالنا يصابوا به اللي
+
+385
+00:26:47,940 --> 00:26:48,400
+هو ال
+
+386
+00:26:51,930 --> 00:26:56,950
+في سنة من السنوات كان فيه debate، debate يعني جدل
+
+387
+00:26:56,950 --> 00:27:00,970
+محتدم لماذا ال Staphylococcus aureus بتكون
+
+388
+00:27:00,970 --> 00:27:04,590
+resistance بشكل مهول و اظن ان احنا لزوم المحاضرة
+
+389
+00:27:04,590 --> 00:27:08,290
+السابقة او اللي جابلها نصف المحاضرة اتحدثنا فيها
+
+390
+00:27:08,290 --> 00:27:10,650
+عن ال history تبع ال resistance تبع ال
+
+391
+00:27:10,650 --> 00:27:14,560
+Staphylococcus aureusكانت sensitive و resistant و
+
+392
+00:27:14,560 --> 00:27:18,200
+بعدين صارت resistant للبنسالين و لمشتقاته و لأحدث
+
+393
+00:27:18,200 --> 00:27:21,540
+مشتقاته اللي هو ال متسيلين قلنا و بعدين صار لنا
+
+394
+00:27:21,540 --> 00:27:25,800
+resistant لل vancomycin فكانوا يقولوا إيش معنى ال
+
+395
+00:27:25,800 --> 00:27:29,060
+staphylococcus بتكون resistant و ال streptococcus
+
+396
+00:27:29,060 --> 00:27:35,180
+مابتكونش resistance لأن فترة طويلة بالفعل و ال
+
+397
+00:27:35,180 --> 00:27:39,600
+streptococcus دلت sensitive للبنسالين الأم اللي هو
+
+398
+00:27:39,600 --> 00:27:44,020
+ال penicillin geneلكن في السنوات الأخيرة مع الحكي
+
+399
+00:27:44,020 --> 00:27:47,840
+الكتير هذا والنج على البكتيريا قررت ان هي انها
+
+400
+00:27:47,840 --> 00:27:51,860
+برضه هي كمان اتكون resistance لكن هذا يعتقد انه
+
+401
+00:27:51,860 --> 00:27:57,720
+نتج عن تطوير البكتيريا القالية لاستقبال مادة
+
+402
+00:27:57,720 --> 00:28:02,900
+وراثية من ال exterior تبعها فأصبح ان للأسف يعني
+
+403
+00:28:02,900 --> 00:28:07,920
+نسبة لا بأس بها من الستراتوكوكس بيودينز مقاومة لل
+
+404
+00:28:07,920 --> 00:28:11,870
+Penicillinلكن whenever sensitive penicillin D is
+
+405
+00:28:11,870 --> 00:28:16,490
+the drug of choice إذا كانت البكتيريا السترتوكوكاس
+
+406
+00:28:16,490 --> 00:28:18,930
+بيودينز حساسة ده البنسالين في ال sensitivity
+
+407
+00:28:18,930 --> 00:28:22,290
+testing فالpenicillin فالpenicillin is still the
+
+408
+00:28:22,290 --> 00:28:26,130
+drug of choice second line ممكن نستخدم ال
+
+409
+00:28:26,130 --> 00:28:29,830
+erythromycin إيش ينبغي نقوله هنا إيش ينبغي نقوله
+
+410
+00:28:29,830 --> 00:28:33,990
+هنا in penicillin sensitive patient أنت بتعرفه أنه
+
+411
+00:28:33,990 --> 00:28:39,080
+ال penicillin واحد من أقمنالمضادات الحيوية اللي
+
+412
+00:28:39,080 --> 00:28:43,360
+اكشفها الإنسان آمن جدا إلا من حالة واحدة اسمها
+
+413
+00:28:43,360 --> 00:28:48,480
+Penicillin Hypersensitivity يعني حساسية مفرطة لمن؟
+
+414
+00:28:48,480 --> 00:28:52,920
+للبنسالين واحد أخد إبرة مات ليش؟ لأنه صار عنده
+
+415
+00:28:52,920 --> 00:28:57,100
+immediate type hypersensitivity انفلاكتك شك صدمة
+
+416
+00:28:57,100 --> 00:29:00,720
+صدمة حساسية فورية بعد ربع ساعة أو تلت ساعة من
+
+417
+00:29:00,720 --> 00:29:04,660
+تناول ال injection بدأت تطلع عليه علامات ال
+
+418
+00:29:04,660 --> 00:29:08,720
+hypersensitivityطبعا حاليا الجثة هتبقاش بأن أي
+
+419
+00:29:08,720 --> 00:29:13,160
+واحد .. بالظبط أي واحد بدي أخد بنسالين بنعمله فحص
+
+420
+00:29:13,160 --> 00:29:17,080
+sensitivity، واحد بقول .. واحد بقول أنه أنا أول
+
+421
+00:29:17,080 --> 00:29:20,140
+مرة أخد بنسالين فعملولي فحص sensitivity، فلاجوني
+
+422
+00:29:20,140 --> 00:29:23,960
+مش sensitive اعطوني بنسالينتاني مرة روحت على عيادة
+
+423
+00:29:23,960 --> 00:29:27,700
+لمرض معين برضه جالولي عندك حساسية ل بنسالين
+
+424
+00:29:27,700 --> 00:29:30,240
+قولتلهم لأ لإن أنا عملت المرة الماضية فحص
+
+425
+00:29:30,240 --> 00:29:35,780
+فماعملوليش فحص فماعملوليش فحص و أعطوني إبرة و كنت
+
+426
+00:29:35,780 --> 00:29:41,320
+بدأ أموت لإنه صار عندي حساسية كل مرة بدك تاخد إبرة
+
+427
+00:29:41,320 --> 00:29:45,240
+بنسالين بدك تعمل حساسية لإنه أصلا المرة الأولى
+
+428
+00:29:45,240 --> 00:29:48,160
+اللي بتاخد فيها أنت بنسالين مستبعد إنه صير عندك
+
+429
+00:29:48,160 --> 00:29:53,000
+حساسية أصلاإنما هي بعد مين؟ بعد ال first exposure،
+
+430
+00:29:53,000 --> 00:29:55,920
+بعد ال first exposure الممكن يصير عندك sensitivity
+
+431
+00:29:55,920 --> 00:29:59,500
+فكل مرة بدك تعمل ال .. ال .. ال .. او تاخد
+
+432
+00:29:59,500 --> 00:30:02,740
+injection للبنسالين، بدك تعمل sensitivity test
+
+433
+00:30:02,740 --> 00:30:07,160
+المهم إن هذا النوع من ال reactions في بعض الناس
+
+434
+00:30:07,160 --> 00:30:09,820
+عندهم reaction للبنسالين، فهذه الحالة بنعطيهم
+
+435
+00:30:09,820 --> 00:30:10,880
+electromycin
+
+436
+00:30:14,230 --> 00:30:15,950
+الميكروبط التاني في السلسلة اللي هو الـ
+
+437
+00:30:15,950 --> 00:30:21,070
+Streptococcus Agalactica وهي يتبع لمجموعة B Group
+
+438
+00:30:21,070 --> 00:30:24,650
+B Beta Hemolytic Streptococcus In fact هو الممثل
+
+439
+00:30:24,650 --> 00:30:26,330
+الوحيد ل group B
+
+440
+00:30:31,070 --> 00:30:33,890
+انسوا اللوحات اللي على الصبورة و خدنا نتكلم مع بعض
+
+441
+00:30:33,890 --> 00:30:37,970
+ببعض المعلومات المهمة جدا لهذا الميكروب المهم
+
+442
+00:30:37,970 --> 00:30:44,470
+والمهمل مهمل يعني بحاجة إلى من يعيد الاهتمام او
+
+443
+00:30:44,470 --> 00:30:51,130
+يثير نقاط الاهتمام هذا الميكروب موجود normal flora
+
+444
+00:30:51,130 --> 00:30:55,370
+في ال oral و ال vagina flora oral and vagina flora
+
+445
+00:30:56,280 --> 00:31:00,280
+approximately 5-15% of the healthy population
+
+446
+00:31:00,280 --> 00:31:03,120
+carry streptococcus biogenes and streptococcus
+
+447
+00:31:03,120 --> 00:31:07,640
+agalactia in the nasopharynx خمسة لخمساشف المية من
+
+448
+00:31:07,640 --> 00:31:11,920
+الناس العاديين اللي زينا healthy بيحملوا في أنوفهم
+
+449
+00:31:11,920 --> 00:31:17,570
+تمام biogenes و agalactiait can be found in the
+
+450
+00:31:17,570 --> 00:31:21,550
+pharynx, vagina, gastrointestinal tract in
+
+451
+00:31:21,550 --> 00:31:24,530
+addition in the newborn it could be present in
+
+452
+00:31:24,530 --> 00:31:27,810
+various sites هذه النقطة اللي بدنا ننطلق منها في
+
+453
+00:31:27,810 --> 00:31:34,130
+النقاش الـ newborn الموليد الجدد لو أخدنا مسحات من
+
+454
+00:31:34,130 --> 00:31:36,910
+أماكن متنوعة من أجسام محلجة فيها عندهم
+
+455
+00:31:36,910 --> 00:31:42,130
+Steptococcus Agilectis السبب انه normal flora في
+
+456
+00:31:42,130 --> 00:31:46,050
+ال vagina of the female طبعا مش كل ال femalesقد
+
+457
+00:31:46,050 --> 00:31:50,390
+تصل في بعض البلدان الى 30% من ال females وقد تصل
+
+458
+00:31:50,390 --> 00:31:53,650
+الى اقل من ذلك او اكتر من ذلك السؤال اللى بتطرح
+
+459
+00:31:53,650 --> 00:31:58,610
+نفسه هل احنا في قطعنا الحبيب نقوم بالبحث عن هذا ال
+
+460
+00:31:58,610 --> 00:32:03,170
+microbe الجواب لأ الجواب لأ ايش اهمية البحث عن هذا
+
+461
+00:32:03,170 --> 00:32:07,890
+ال microbe بالاساس الجبنة الأخيرة ان الأطفال حدثي
+
+462
+00:32:07,890 --> 00:32:11,650
+الولادة تمام ممكن نلاقي على اجسامهم في اماكن
+
+463
+00:32:11,650 --> 00:32:16,220
+متنوعةإيش ممكن تعمل الأطفال حدثي الولادة هذه
+
+464
+00:32:16,220 --> 00:32:19,980
+البكتيريا؟ ممكن تعمل three conditions pneumonia,
+
+465
+00:32:21,000 --> 00:32:27,000
+septicemia and meningitis أمراض خطيرة جدا سواء
+
+466
+00:32:27,000 --> 00:32:29,560
+كانت ال pneumonia ولا ال septicemia ولا ال
+
+467
+00:32:29,560 --> 00:32:34,160
+meningitis طبعا هذا قد يؤدي إلى وفاة الطفل هذا
+
+468
+00:32:34,160 --> 00:32:40,330
+جانب جانب التاني الأم اللي ولدت ال newbornإذا
+
+469
+00:32:40,330 --> 00:32:44,090
+ماكانش good aseptic تقنيك واستخدام antibiotics بعد
+
+470
+00:32:44,090 --> 00:32:48,790
+الولادة قد تصاب هي ب pure blood sepsis لكن النظام
+
+471
+00:32:48,790 --> 00:32:52,230
+الصحي الفلسطيني الستات غالبا بياخده antibiotic بعد
+
+472
+00:32:52,230 --> 00:32:55,210
+الولادة فبالتالي الأم غالبا protected مين اللي
+
+473
+00:32:55,210 --> 00:33:00,150
+بيبقى عنده مشكلة ال newborn طيب إيش الحل في مثل
+
+474
+00:33:00,150 --> 00:33:04,690
+هذا النوع من المشاكل هو ال normal flora في الفيميل
+
+475
+00:33:04,690 --> 00:33:13,060
+يعني وجودها لا يعني شيء لكنالخشية عند الولادة ف ..
+
+476
+00:33:13,060 --> 00:33:20,560
+في مراكز رعاية .. رعاية الأمومة والطفولة بي
+
+477
+00:33:20,560 --> 00:33:24,700
+عندهم policy في الشهر السادس بياخدوا مسحة vaginal
+
+478
+00:33:24,700 --> 00:33:28,480
+.. vaginal swab .. vaginal swab وبيعملوا culture،
+
+479
+00:33:28,480 --> 00:33:32,340
+بيدوروا على مين؟ على Structococcus Agalactica إذا
+
+480
+00:33:32,340 --> 00:33:35,840
+positive، بس بيسجلوا في البطاقة تبعة الـM إنها
+
+481
+00:33:35,840 --> 00:33:39,630
+positiveإيه ده negative؟ بيحطوا برضه negative
+
+482
+00:33:39,630 --> 00:33:44,690
+البُسط في عند الولادة بيعملوها معاملة غير during
+
+483
+00:33:44,690 --> 00:33:47,750
+delivery intrapartum يعني خلال عملية الولادة
+
+484
+00:33:47,750 --> 00:33:52,950
+بيعملوا administration لل antibiotics ال
+
+485
+00:33:52,950 --> 00:33:57,090
+antibiotics خلال عملية الولادة بتحمي كل من مين؟ من
+
+486
+00:33:57,090 --> 00:34:01,630
+الأم و ال .. و ال .. و ال newborn يبقى فإحنا بنعمل
+
+487
+00:34:01,630 --> 00:34:05,750
+culture و مابنعملش أي action عليها متى ال action
+
+488
+00:34:05,750 --> 00:34:09,580
+بتتم؟عند الولادة، عند الولادة، للأسف هذا الكلام ..
+
+489
+00:34:09,580 --> 00:34:12,380
+هذا الكلام غير مطبق عندنا وبالتالي group B
+
+490
+00:34:12,380 --> 00:34:18,040
+streptococci لن تواجهوها إلا إذا اتغيرت السياسة في
+
+491
+00:34:18,040 --> 00:34:25,160
+.. في .. في موضوع الرعاية للأمومة والطفل ممكن يطلع
+
+492
+00:34:25,160 --> 00:34:28,220
+injection بال .. بال IV يعني خلال الولادة، مش قبل
+
+493
+00:34:28,220 --> 00:34:32,150
+الولادة، خلال الولادة، أي ولادةباسم الأجلات هنا
+
+494
+00:34:32,150 --> 00:34:34,150
+ميكون موجود في ال .. في ال .. في ال .. في ال .. في
+
+495
+00:34:34,150 --> 00:34:35,110
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+496
+00:34:35,110 --> 00:34:35,150
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+497
+00:34:35,150 --> 00:34:35,210
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+498
+00:34:35,210 --> 00:34:35,270
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+499
+00:34:35,270 --> 00:34:35,330
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+500
+00:34:35,330 --> 00:34:35,390
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+501
+00:34:35,390 --> 00:34:35,750
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+502
+00:34:35,750 --> 00:34:35,770
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+503
+00:34:35,770 --> 00:34:36,270
+.. في ال .. في ال .. في ال .. في ال .. في ال .. في
+
+504
+00:34:36,270 --> 00:34:36,290
+ال .. في ال .. في ال .. في ال .. في ال .. في ال ..
+
+505
+00:34:36,290 --> 00:34:36,290
+في ال .. في ال .. في ال .. في ال .. في ال .. في ال
+
+506
+00:34:36,290 --> 00:34:40,070
+.. في ال .. في ال .. في ال ..
+
+507
+00:34:40,620 --> 00:34:44,640
+ممكن صحيح، ما هو احنا بيقولنا انه احد أهم المشاكل
+
+508
+00:34:44,640 --> 00:34:47,920
+اللي في المستشفيات .. ان احنا في المستشفيات، في
+
+509
+00:34:47,920 --> 00:34:51,560
+المجتمع ممكن كل يوم ننقل بعض ميكروبات، لكن كونها
+
+510
+00:34:51,560 --> 00:34:54,560
+immunocompetent، يعني ال immune system تبعنا كويس،
+
+511
+00:34:54,560 --> 00:34:57,620
+ولا ات affected، لكن لما ننقلها .. شوفوا يا شباب،
+
+512
+00:34:57,620 --> 00:35:03,280
+تركزوا شغل ليش المستشفى بيقى يعني غير صديقة؟أول
+
+513
+00:35:03,280 --> 00:35:05,940
+حاجة قلنا إن استخدام الـ Antibiotic فيها استخدام
+
+514
+00:35:05,940 --> 00:35:09,280
+مفرط كتير Antibiotic بنستخدم وبالتالي الميكروبات
+
+515
+00:35:09,280 --> 00:35:14,000
+اللي في المستشفى اتعرضت أكتر، عندها experience
+
+516
+00:35:14,000 --> 00:35:17,800
+أكتر وبالتالي ال resistance لها أعلى، هذا مفروض
+
+517
+00:35:17,800 --> 00:35:23,380
+منهم من هم النزلاء المستشفيات؟ إما كبار السن، إما
+
+518
+00:35:23,380 --> 00:35:27,000
+كبار السن وانتوا عارفين كبار السن، الآن مع تقدم
+
+519
+00:35:27,000 --> 00:35:33,230
+الطب كثرهبمعنى احنا زمان لما كان مافيش تقدم طبي
+
+520
+00:35:33,230 --> 00:35:39,290
+كان السن الخمسين خلاص هذا مات يعني انه مافيش رعاية
+
+521
+00:35:39,290 --> 00:35:41,810
+طبية كويسة بس الراعية الطبية صار ال .. ال .. ال
+
+522
+00:35:41,810 --> 00:35:45,790
+average age سبعين او اكتر في بعض البلدان نعم في
+
+523
+00:35:45,790 --> 00:35:48,810
+اليابان جرب على خمس و تمانين ال .. ال average age
+
+524
+00:35:48,810 --> 00:35:54,580
+عند اليابانينفكل ما زادت فئة الكبار السن أمراضهم
+
+525
+00:35:54,580 --> 00:35:57,200
+بتزيد ملاعقهم بتجل وبالتالي بيكونوا برضه في
+
+526
+00:35:57,200 --> 00:36:01,000
+المستشفيات أو في دور الرعاية فالمستشفى بيقى مناسبة
+
+527
+00:36:01,000 --> 00:36:06,040
+لانتقال الأمراض انا healthy تمام احمل مايكروبات قد
+
+528
+00:36:06,040 --> 00:36:09,400
+لا تضرر المجتمع لكن قد تضرر هؤلاء الناس لذلك
+
+529
+00:36:09,400 --> 00:36:14,500
+تقولنا انه في سياسات في المستشفيات او او ايش
+
+530
+00:36:14,500 --> 00:36:19,540
+بيسموها committees لل infection controlأنا لأ أنكر
+
+531
+00:36:19,540 --> 00:36:21,680
+ولودها في غزة، مولودة في غزة ال infection control
+
+532
+00:36:21,680 --> 00:36:25,400
+أنا شخصيا عمل training courses يمكن مرتين أو تلاتة
+
+533
+00:36:25,400 --> 00:36:29,700
+لطواقم المستشفيات في موضوع ال infection control
+
+534
+00:36:29,700 --> 00:36:34,560
+لكن ما زلنا نحبه، نحبه يعني .. يعني لم نصل لمرحلة
+
+535
+00:36:34,560 --> 00:36:39,760
+متطورة بتلاقي أنه في أنشطة موسمية، أنشطة غير يعني
+
+536
+00:36:39,760 --> 00:36:44,700
+خلينا نقول مش ممنهجة وانماهي وليدة .. وليدة النشاط
+
+537
+00:36:44,700 --> 00:36:49,700
+الفجائي وتوفر المواد وليس ضمن خطة ومنهجة لمكافحة
+
+538
+00:36:49,700 --> 00:36:53,920
+العدوى في المستشفى general characteristics
+
+539
+00:36:53,920 --> 00:36:57,160
+للبكتيريا ال hemolysis on sheep blood agar is
+
+540
+00:36:57,160 --> 00:37:03,100
+mostly beta hemolytic ولمّا نقول mostly يعني مش
+
+541
+00:37:03,100 --> 00:37:05,860
+absolutely كمان، مظبوط ولا لأ؟ فبالتالي فيه
+
+542
+00:37:05,860 --> 00:37:09,020
+إمكانية إنه نلاقي group B stepped cocaine مش beta
+
+543
+00:37:09,020 --> 00:37:13,320
+hemolytic، مش .. لأ مش beta hemolyticthis group
+
+544
+00:37:13,320 --> 00:37:17,020
+antigen is a cell wall polysaccharide composed of
+
+545
+00:37:17,020 --> 00:37:20,320
+N-acetylglucoseamine, galactose and rhaminose على
+
+546
+00:37:20,320 --> 00:37:23,580
+فكرة هذه المركبات N-acetylglucoseamine و galactose
+
+547
+00:37:23,580 --> 00:37:28,500
+و rhaminose ك .. ك .. ك polysaccharide موجودة أيضا
+
+548
+00:37:28,500 --> 00:37:33,980
+ضمن دراستوها ضمن عارفين مين؟ تكوين ال .. جول لأ
+
+549
+00:37:33,980 --> 00:37:39,300
+تكوين ال antigen تبقى من مين؟ في ال .. ال ABO في
+
+550
+00:37:39,300 --> 00:37:43,000
+ال ABO systemفي ال A B O system عشانك مرض بعض
+
+551
+00:37:43,000 --> 00:37:47,480
+الأحيان بيسأله سؤال هل ممكن انه ال blood grouping
+
+552
+00:37:47,480 --> 00:37:52,120
+يتغير لمريض يعني بمعنى اخر انه انا بعمل test
+
+553
+00:37:52,120 --> 00:37:58,080
+للمريض يكون هو A ل G A B مثلا زي A B C S و Bombay
+
+554
+00:37:58,080 --> 00:38:01,600
+Bombay أحد ال factors أحد ال factors اللي ممكن
+
+555
+00:38:01,600 --> 00:38:05,540
+تساهم في الإجابة على هذا السؤال هو الإصابة ببعض ال
+
+556
+00:38:05,540 --> 00:38:07,160
+bacteria ال infection اللي من ضمنها group B
+
+557
+00:38:07,160 --> 00:38:08,200
+streptococcus
+
+558
+00:38:10,530 --> 00:38:14,830
+الان احد اهم الصفات البيو كيميائية لهذا الميكروب
+
+559
+00:38:14,830 --> 00:38:18,430
+اللى هتميزها عن ميكروبات اخرى اللى هو قدرة
+
+560
+00:38:18,430 --> 00:38:21,690
+البكتيريا على انها تحلل الـHepurate الى Benzoic
+
+561
+00:38:21,690 --> 00:38:25,290
+Acid وGlycine طبعا الـGlycine عبارة عن Amino Acid
+
+562
+00:38:25,290 --> 00:38:31,880
+لما نستخدمmedia خالية من أي amino acid تمام وبعد
+
+563
+00:38:31,880 --> 00:38:38,400
+انمو البكتيريا على الـhypurate انرش 9-hydrine الـ9
+
+564
+00:38:38,400 --> 00:38:41,340
+-hydrine الـreagent اللي بنكشف عن ال amino acid من
+
+565
+00:38:41,340 --> 00:38:45,840
+خلاله إذا تغير اللون بنقول انه بوستر بس بدك تتأكد
+
+566
+00:38:45,840 --> 00:38:51,540
+ان ال media أساسا amino acid من أولا okay it is
+
+567
+00:38:51,540 --> 00:38:56,040
+the resistance to bestracin هذا كده hypurate
+
+568
+00:38:56,040 --> 00:39:01,610
+hydrolysis busterهتفقنا انه من ال .. البكتيرا
+
+569
+00:39:01,610 --> 00:39:04,410
+الماضية البكتيرا الماضية اللي هي الstriptococcus
+
+570
+00:39:04,410 --> 00:39:07,730
+biogenes انها sensitive للبستراسين بينما هذه
+
+571
+00:39:07,730 --> 00:39:11,910
+resistant للبستراسين يعني يا شباب لو احنا عملنا
+
+572
+00:39:11,910 --> 00:39:15,150
+لجينا بيتا hemolytic و عملنا لها بستراسين لجيناها
+
+573
+00:39:15,150 --> 00:39:19,170
+resistant يفجر مش .. مش biogenes هنروح اتجاه مين؟
+
+574
+00:39:19,170 --> 00:39:23,250
+اجلكتيا الان what is the .. the best test to
+
+575
+00:39:23,250 --> 00:39:27,390
+confirm striptococcus aglactica فحص اسمه كام بقى
+
+576
+00:39:27,390 --> 00:39:27,890
+test
+
+577
+00:39:30,520 --> 00:39:33,000
+الأروهيد فيروميشن، أهم الوضع، مش بالك أن نشوف صورة
+
+578
+00:39:33,000 --> 00:39:37,000
+إيه له، بس بعد ال .. مانتكلمش ولا على الأمراض و
+
+579
+00:39:37,000 --> 00:39:39,400
+هنا peripheral sepsis في الأم، اندوكارديتس،
+
+580
+00:39:39,400 --> 00:39:41,940
+نيمونيا، نيونيطال انفكشن، نيمونيا، سفسيميا and
+
+581
+00:39:41,940 --> 00:39:47,040
+مينيجايتس، خمسة بوفاين مستايتس هذي التهابث هذي عند
+
+582
+00:39:47,040 --> 00:39:53,400
+الأبقار، عند الأبقار طبعا بتضرن بإيش هذي؟ إن
+
+583
+00:39:53,400 --> 00:39:56,100
+الحليب المنتج بكون .. contaminated with this
+
+584
+00:39:56,100 --> 00:39:58,320
+bacteria ممكن ينتقل إلى الإنسان
+
+585
+00:40:02,760 --> 00:40:08,020
+يصير عندهم اضحاب شديد بعد ولادة في التدريب يعني؟
+
+586
+00:40:08,020 --> 00:40:11,440
+انا .. انا غالبا .. غالبا استفيد الكوكاس hours،
+
+587
+00:40:11,440 --> 00:40:12,700
+استفيد الكوكاس hours
+
+588
+00:40:16,520 --> 00:40:20,860
+هو ال .. المشكلة هنا بتصير انه في ان عدد خاطئ اول
+
+589
+00:40:20,860 --> 00:40:26,860
+شي واحدة من عدد الخاطئ انهم بيجبروا ال .. الام هذه
+
+590
+00:40:26,860 --> 00:40:31,880
+المصابة ان ترد الولد او ترد الطفل على الرغم من
+
+591
+00:40:31,880 --> 00:40:35,340
+الألم الشديد طبعا ال .. اول حاجة الطفل بياخد
+
+592
+00:40:35,340 --> 00:40:39,580
+البكتيريا مع صديد من الام هو بيريحها بالفعل يعني
+
+593
+00:40:39,580 --> 00:40:43,600
+هي ترتاح الام بعد الرضاعة okay في ألم في الرضاعة
+
+594
+00:40:43,600 --> 00:40:49,580
+لأنه في عملية ضغط علىالانتفاخ اللى هو ضغط على ال
+
+595
+00:40:49,580 --> 00:40:53,100
+nerves تمام فبتشهر بالألم لكن هو بيرضع هو بياخد
+
+596
+00:40:53,100 --> 00:40:56,880
+حقيقة بياخد مش حليب بياخد صديد وبالتالي صديد مليء
+
+597
+00:40:56,880 --> 00:41:00,320
+بمين بالبكتيريا فممكن الام تشفع والولد اه او
+
+598
+00:41:00,320 --> 00:41:04,840
+المولود يصاب بال infection فالمفروض ان هذا يعني
+
+599
+00:41:04,840 --> 00:41:11,380
+يعني تعالج بطريقة عن طريق شفط صناعي للحليبب .. ب
+
+600
+00:41:11,380 --> 00:41:15,980
+.. ب .. انه يزال ال .. ال .. ال bus تمام ممكن
+
+601
+00:41:15,980 --> 00:41:20,200
+يستخدمو ال topical cream antibiotics تمام لل ..
+
+602
+00:41:20,200 --> 00:41:24,960
+للتخلص لكن بالطريقة التقليدية ده احنا في خوف على
+
+603
+00:41:24,960 --> 00:41:30,440
+اللي هو الراضي يعنيطيب الصورة اللي قدامكوا اظن ان
+
+604
+00:41:30,440 --> 00:41:34,780
+صورة مكررة برضه beta hemolytic رائعة جدا نقطة
+
+605
+00:41:34,780 --> 00:41:40,160
+صغيرة نشوف النقطة وبعدين بندور على ال zone of
+
+606
+00:41:40,160 --> 00:41:43,640
+hemolysis اللي هي برضه very large zone of
+
+607
+00:41:43,640 --> 00:41:48,900
+hemolysis تشبه طبعا في الحجم والشكل ال group A
+
+608
+00:41:48,900 --> 00:41:49,980
+streptococcus
+
+609
+00:41:52,150 --> 00:41:55,490
+They produced larger colonies and يعني أكبر شوية
+
+610
+00:41:55,490 --> 00:42:00,990
+من مين من الـ Streptococcus بيوجينز And more
+
+611
+00:42:00,990 --> 00:42:03,170
+translucent to opaque colonies surrounded by a
+
+612
+00:42:03,170 --> 00:42:06,770
+zone of beta hemolysis طبعا على الـ selective
+
+613
+00:42:06,770 --> 00:42:09,230
+media و الـ selective media مستخدمة التنتين
+
+614
+00:42:09,230 --> 00:42:13,710
+للبيوجينز ولا الجالاكتيا احنا الأولى جونا فيها
+
+615
+00:42:13,710 --> 00:42:17,050
+Narcissic acid و فيها كلستين و فيها Gentamicinفي
+
+616
+00:42:17,050 --> 00:42:19,930
+كمان selective media بيسموها Striptococcal
+
+617
+00:42:19,930 --> 00:42:25,410
+Selective
+
+618
+00:42:25,410 --> 00:42:28,850
+Agar بيحتوي على crystal violet in low
+
+619
+00:42:28,850 --> 00:42:31,870
+concentration، كوليستين، and trimethoprim
+
+620
+00:42:31,870 --> 00:42:35,090
+-sulfamethexazole، ويضعف له five percent sheep
+
+621
+00:42:35,090 --> 00:42:38,470
+bloodكده اللي أنا فيها عندى الآن two selective
+
+622
+00:42:38,470 --> 00:42:44,350
+media for streptococcus بشكل عام واحد احتوى على
+
+623
+00:42:44,350 --> 00:42:47,950
+التانى المشترك بينهم blood agar لكن الخلطات
+
+624
+00:42:47,950 --> 00:42:51,270
+المضاعفة مختلفة الأولى three antibiotics سميناهم
+
+625
+00:42:51,270 --> 00:42:55,030
+جنتاميسين كوليستين and radixic acid التانية حطينا
+
+626
+00:42:55,030 --> 00:42:59,410
+low concentration of crystal violet بعدين كوليستين
+
+627
+00:42:59,410 --> 00:43:00,550
+بعدين trimethoprim
+
+628
+00:43:05,320 --> 00:43:12,040
+بارضه Selected Media for Steptococcus بشكل عام ال
+
+629
+00:43:12,040 --> 00:43:13,700
+laboratory diagnosis جونا land field
+
+630
+00:43:13,700 --> 00:43:16,920
+classification او grouping و هي group B هي group
+
+631
+00:43:16,920 --> 00:43:21,100
+بيهيبريت هيدروليسيا شفناها جاب شوية ال camp test
+
+632
+00:43:21,100 --> 00:43:26,710
+بوستفالبيل اسكلين نيجاتيف البكتيريا دي بيل اسكلين
+
+633
+00:43:26,710 --> 00:43:30,030
+إيه نيجاتيف لاتكس أجلوتينيشن وطبعا لاتكس
+
+634
+00:43:30,030 --> 00:43:34,210
+أجلوتينيشن هيبقى عن إيه؟ هيبقى عن antibody مرتبطة
+
+635
+00:43:34,210 --> 00:43:39,950
+ب لاتكس particles مستخدمة للبحث نعم صحيح المرة
+
+636
+00:43:39,950 --> 00:43:42,310
+اللي جاي ان شاء الله بناخد تفاصيل أكتر لالفحوصات
+
+637
+00:43:42,310 --> 00:43:44,650
+ونكمل مع بعض باقى الستريبتو وكذا
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo.srt
new file mode 100644
index 0000000000000000000000000000000000000000..2919306e1dbbb32a457f7a336bc46de6c7349e6a
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo.srt
@@ -0,0 +1,1604 @@
+1
+00:00:20,200 --> 00:00:24,500
+طيب بسم الله الرحمن الرحيم احنا بدأنا المحاضرة
+
+2
+00:00:24,500 --> 00:00:27,180
+السابقة في موضوع الـ chlamydia و الـ micro plasma و
+
+3
+00:00:27,180 --> 00:00:30,600
+الـ rickettsia لكن حتى ننطلق إن شاء الله في هذا
+
+4
+00:00:30,600 --> 00:00:35,040
+الجزء بدنا نعمل revision سريع لجزء اللي شرحناه
+
+5
+00:00:35,040 --> 00:00:38,960
+المرة الماضية اللي هو الـ chlamydia، الكليميديا كنا
+
+6
+00:00:38,960 --> 00:00:42,320
+عبارة عن obligate intracellular بكتيريا، و بتمتلك
+
+7
+00:00:42,320 --> 00:00:46,520
+ريبوزومات زي أي بكتيريا أخرى، طبعا هذه الجملة زي ما
+
+8
+00:00:46,520 --> 00:00:50,000
+ذكرنا عشان نأكد على حق أنها ليس لها علاقة
+
+9
+00:00:50,000 --> 00:00:52,620
+بالفيروسات، are metabolically deficient، و عندها
+
+10
+00:00:52,620 --> 00:00:55,880
+مشكلة في الـ ATP production، و كنا البعض يسميها
+
+11
+00:00:55,880 --> 00:01:00,700
+energy parasite، يعني تتطفل من أجل الطاقة، و ليس من
+
+12
+00:01:00,700 --> 00:01:05,440
+أجل أشياء أخرى، morphology، البكتيريا small round
+
+13
+00:01:05,440 --> 00:01:08,760
+microorganism، تنقسم بالانقسام التنائي البسيط زيها
+
+14
+00:01:08,760 --> 00:01:12,620
+زي أي بكتيريا أخرى، لكن الـ cell wall بتاعها بيشبه
+
+15
+00:01:12,620 --> 00:01:17,060
+إلى حد كبير لـ gram negative، بدون بيبتيدوغليكان
+
+16
+00:01:17,060 --> 00:01:21,250
+حقيقي، الـ species اللي ذكرناهم ثلاثة كانوا هما، و
+
+17
+00:01:21,250 --> 00:01:24,370
+الترتيب كما ذكرت المرة الماضية، هو ليس للأهمية
+
+18
+00:01:24,370 --> 00:01:27,870
+بمعنى أن الـ chlamydia trachomatis is the most
+
+19
+00:01:27,870 --> 00:01:30,830
+important، يليها pneumonia، و بعدين cetaceae، لكن
+
+20
+00:01:30,830 --> 00:01:34,070
+مرتبين الآن قدامنا chlamydia cetaceae، chlamydia
+
+21
+00:01:34,070 --> 00:01:39,010
+pneumonia، chlamydia trachomatis، طبعا كونها
+
+22
+00:01:39,010 --> 00:01:42,130
+obligate intracellular parasite، فمستحيل تنمو على الـ
+
+23
+00:01:42,130 --> 00:01:44,090
+culture media العادي اللي بتعرفوه، وبالتالي بدها
+
+24
+00:01:44,090 --> 00:01:47,050
+إما cell culture، tissue culture، زي ما هي على الـ HeLa cells
+
+25
+00:01:47,050 --> 00:01:50,310
+أو على الـ chicken embryo، و هو غالبا بنحكي أنها في
+
+26
+00:01:50,310 --> 00:01:54,490
+الـ yolk sac تبع الـ chicken embryo، الـ pathogenesis
+
+27
+00:01:54,490 --> 00:01:58,750
+غالبا البكتيريا عندها المقدرة على الارتباط بالـ
+
+28
+00:01:58,750 --> 00:02:01,910
+epithelial cells و الـ mucous membrane، وعندها
+
+29
+00:02:01,910 --> 00:02:05,050
+المقدرة على أنها تعمل infection لخلايا الـ lungs
+
+30
+00:02:06,880 --> 00:02:09,560
+وحكينا عن الـ viral inhibitors، بتذكروا؟ وقلنا عندها
+
+31
+00:02:09,560 --> 00:02:14,800
+مقدرة على الـ resistance للـ phagocytic killing by
+
+32
+00:02:14,800 --> 00:02:18,860
+inhibition of lysozyme أو lysozyme binding to
+
+33
+00:02:18,860 --> 00:02:23,140
+phagolysosome، يعني عملية تكوين الفاغوليزوزوم بتتمش
+
+34
+00:02:23,140 --> 00:02:27,030
+وبتتوقف، البكتيريا بتصير free داخل الخلية، بتنتج
+
+35
+00:02:27,030 --> 00:02:30,450
+endotoxins، وبتعمل competition بينها و بين
+
+36
+00:02:30,450 --> 00:02:33,790
+الخلايا على الـ nutrient، وهي successful competitor
+
+37
+00:02:33,790 --> 00:02:38,010
+يعني منافس جيد، تاخد الـ nutrient، وبالتالي بتأثر على
+
+38
+00:02:38,010 --> 00:02:44,790
+النمو تبع اللي هو الـ host cell، كمان قضية كتير مهمة
+
+39
+00:02:44,790 --> 00:02:50,150
+تطرقنا لها، كان أن معظم الـ destruction الناتج عن
+
+40
+00:02:50,150 --> 00:02:53,470
+الـ chlamydia infection بيكون ناجم عن الـ immune
+
+41
+00:02:53,470 --> 00:02:56,330
+response و الـ inflammation اللي بينتجها الجسم
+
+42
+00:02:57,960 --> 00:03:02,200
+وحكينا، الـ diagram هذا شرحناه، وقلنا أنه اللي أول
+
+43
+00:03:02,200 --> 00:03:05,900
+مرة بنتطرق لحاجة اسمها bacterial life cycle، يعني
+
+44
+00:03:05,900 --> 00:03:08,860
+زي ما ذكرنا simple life cycle، لكن فيها two forms،
+
+45
+00:03:08,860 --> 00:03:11,900
+elementary body و reticulate body، وقلنا الـ
+
+46
+00:03:11,900 --> 00:03:15,240
+elementary body هو الـ infectious form، تمام؟ هو الـ
+
+47
+00:03:15,240 --> 00:03:18,300
+infectious form، بينما الـ reticulate body هو اللي
+
+48
+00:03:18,300 --> 00:03:22,150
+بيعمل replication داخل الخلية، الآن خدوا بالكم
+
+49
+00:03:22,150 --> 00:03:26,550
+النقطة هي خلية whole cell، وفيها reticulate body، لو
+
+50
+00:03:26,550 --> 00:03:29,710
+أنا في لحظة من اللحظات أخذت هذه الخلية وعملت لها
+
+51
+00:03:29,710 --> 00:03:33,270
+صبغة، لاحظوا كده، كبير الحجم
+
+52
+00:03:36,290 --> 00:03:38,630
+بناخد جزء من الخلية، الـ epithelial cells، الصح هذا
+
+53
+00:03:38,630 --> 00:03:42,350
+لأ، وبالتالي بقدر أشوف حاجة بنسميها inclusion
+
+54
+00:03:42,350 --> 00:03:47,010
+bodies، inclusion bodies، وهذه على فكرة تستخدم في الـ
+
+55
+00:03:47,010 --> 00:03:50,890
+diagnosis للبكتيريا، زي ما البعض ممكن درس فيروسات،
+
+56
+00:03:50,890 --> 00:03:55,920
+ممكن؟ مين درس فيروسات فيكم؟ أخذتو cytomegalovirus،
+
+57
+00:03:55,920 --> 00:04:02,180
+CMV؟ مش معقول درستوا فيروسات وماأخذتوش CMV، لكن
+
+58
+00:04:02,180 --> 00:04:06,700
+ذاكرتكم طبعا، الـ memory بتعملها كل مرة format، و
+
+59
+00:04:06,700 --> 00:04:12,280
+بالتالي ما فيش ذاكرة مستقرة، الـ cytomegalovirus أحد أهم
+
+60
+00:04:12,920 --> 00:04:15,780
+الـ distinguishing characteristics له، أنه بيعمل
+
+61
+00:04:15,780 --> 00:04:19,340
+inclusion body، بيسموها owl's eye، زي عينان البومة
+
+62
+00:04:19,340 --> 00:04:22,840
+عينان البومة، بيكون فيه two inclusion bodies غالبا
+
+63
+00:04:22,840 --> 00:04:26,400
+قريبين من بعض، بيعطونا إحساس بأننا بنشوف عينان
+
+64
+00:04:26,400 --> 00:04:30,020
+بومة، فبيسموه owl's eye، إذا الـ inclusion body بتاعة
+
+65
+00:04:30,020 --> 00:04:32,980
+الكلاميديا، كما سنرى لاحقا إن شاء الله، هي
+
+66
+00:04:32,980 --> 00:04:38,070
+diagnostic، أو تستخدم في الـ diagnosis، الكلاميديا
+
+67
+00:04:38,070 --> 00:04:42,030
+psittaci، اتفقنا أن هي zoonotic respiratory
+
+68
+00:04:42,030 --> 00:04:46,570
+disease، و الـ natural habitat بتاعتها في الطيور، و
+
+69
+00:04:46,570 --> 00:04:49,190
+حكينا أن كانت الطيور المنزلية اللي بنربيها إحنا
+
+70
+00:04:49,190 --> 00:04:54,190
+كالألّيفة زي الببغاوات، ممكن تكون أحد أهم مصادر الـ
+
+71
+00:04:54,190 --> 00:04:56,530
+infection، طبعا
+
+72
+00:04:57,770 --> 00:05:02,390
+تنتج عن انتقال الميكروب لنا عبر الـ respiratory
+
+73
+00:05:02,390 --> 00:05:06,690
+tract من خلال الـ dust المحتوي، أو الـ secretions
+
+74
+00:05:06,690 --> 00:05:12,090
+المحتوي على الميكروب، organism، وقلنا أنها very common
+
+75
+00:05:12,090 --> 00:05:16,050
+in poultry workers، اللي هو عمال تربية الدواجن
+
+76
+00:05:16,050 --> 00:05:20,450
+اللي بيربوا الدواجن، والدواجن مش دجاج بس، آه يعني في
+
+77
+00:05:20,450 --> 00:05:27,820
+الوز وفي البط، يعني برضه في مزارع لهم، صح يعني، الـ
+
+78
+00:05:27,820 --> 00:05:31,400
+chlamydia pneumonia، أو psittacosis، الـ diagnosis عبارة عن عزل
+
+79
+00:05:31,400 --> 00:05:35,480
+للبكتيريا من الـ sputum من خلال الـ tissue culture
+
+80
+00:05:35,480 --> 00:05:39,360
+أو عن طريق اللي هو detection of antibody باستخدام
+
+81
+00:05:39,360 --> 00:05:42,900
+الـ complement fixation test، و الـ treatment ذكرنا
+
+82
+00:05:42,900 --> 00:05:46,360
+أنه هيتكرر الـ treatment، رجاء هذا اللي قدامكم في
+
+83
+00:05:46,360 --> 00:05:50,820
+معظم أنواع اللي هو الكلاميديا والركتسيا، أكثر
+
+84
+00:05:50,820 --> 00:05:56,140
+tetracycline للـ adults، و erythromycin في الأطفال، ليش
+
+85
+00:05:56,140 --> 00:06:00,560
+tetracycline بس في الـ adults مش في الأطفال؟ لأنه لا
+
+86
+00:06:00,560 --> 00:06:02,660
+يؤثر في الـ pregnancy ولا في الـ lactating women
+
+87
+00:06:02,660 --> 00:06:05,780
+اللي هي المرأه المرضعة، ولا في الأطفال لأنه بيؤثر على
+
+88
+00:06:05,780 --> 00:06:09,880
+تكوين الكالسيوم و… بالضبط، فنمو الأسنان و
+
+89
+00:06:09,880 --> 00:06:14,380
+إيه اللي هو الإعظام، الـ chlamydia pneumonia
+
+90
+00:06:14,380 --> 00:06:19,430
+بيسموها TWAR، و TWAR جاية من أو… TWAR strain، TWAR جاية
+
+91
+00:06:19,430 --> 00:06:24,830
+من كلمة تايوان، تايوان دولة، تمام؟ و AR جاية من acute
+
+92
+00:06:24,830 --> 00:06:28,530
+respiratory، فهي عبارة عن acute respiratory
+
+93
+00:06:28,530 --> 00:06:32,490
+infection، تم تشخيص الحالة بتاعتها في تايوان،
+
+94
+00:06:32,490 --> 00:06:36,470
+وبالتالي سميت بهذا الاسم، بعدين أطلق عليها اسم
+
+95
+00:06:36,470 --> 00:06:41,790
+chlamydia pneumonia، وهي تشبه الـ pneumonia اللي
+
+96
+00:06:41,790 --> 00:06:47,770
+بتنتجها الـ mycoplasma pneumonia، الـ treatment كمان
+
+97
+00:06:47,770 --> 00:06:51,210
+مرة زي… زي الأولانية، tetracycline في الـ adults،
+
+98
+00:06:51,210 --> 00:06:55,280
+و erythromycin في الـ babies، الميكروب الثالث في
+
+99
+00:06:55,280 --> 00:06:57,180
+السلسلة اللي قلناه هو الأكثر أهمية على الإطلاق، وإحنا
+
+100
+00:06:57,180 --> 00:07:01,480
+بحاجة إلى بالفعل أن نناقش هذا الموضوع الآن بتوسع
+
+101
+00:07:01,480 --> 00:07:07,900
+أكثر، لأنه الميكروب is number one cause of STD in
+
+102
+00:07:07,900 --> 00:07:11,060
+the western hemisphere، في العالم الغربي، أو نصف
+
+103
+00:07:11,060 --> 00:07:16,000
+الكرة الأرضية الغربي، كان زمان السيلان هي number one
+
+104
+00:07:16,000 --> 00:07:20,820
+cause of STD، Gonorrhea is number two، second to
+
+105
+00:07:20,820 --> 00:07:27,620
+what؟ To Chlamydia، إذا لما نقول إنه أشهر مرض STD،
+
+106
+00:07:27,620 --> 00:07:31,740
+يبقى لازم يكون له أهمية خاصة، هذا واحد، رقم اثنين،
+
+107
+00:07:31,740 --> 00:07:37,100
+هذا المرض معروف منذ زمن بعيد أنه أحد أهم أسباب
+
+108
+00:07:37,100 --> 00:07:43,120
+فقدان البصر في الدول الفقيرة ذات المناخ الحار،
+
+109
+00:07:43,120 --> 00:07:50,580
+والجاف، يبقى نتكلم عن فقدان للبصر بشكل كبير عند
+
+110
+00:07:50,580 --> 00:07:55,280
+المصابين في تلك البلدان، يبقى مهم لما نتكلم عن STD،
+
+111
+00:07:55,280 --> 00:08:01,080
+نتكلم كمان عن، في مخاوف أن الأم المصابة تنقل عبر
+
+112
+00:08:01,080 --> 00:08:05,780
+قناة الولادة للطفل بتاعها، وبرضه يصاب بالـ blindness،
+
+113
+00:08:05,780 --> 00:08:09,700
+إذا في مجموعة من المخاوف، مجموعة من المخاطر،
+
+114
+00:08:09,700 --> 00:08:14,500
+بدنا نطلع عليها في الـ chlamydia trachomatis، أمامنا
+
+115
+00:08:14,500 --> 00:08:20,760
+هي fifteen serotypes، بيسموهم A إلى L، A, B, C… إلى L،
+
+116
+00:08:20,760 --> 00:08:24,500
+الـ transmission ممكن عبر الـ sexual زي ما حكينا،
+
+117
+00:08:24,500 --> 00:08:27,800
+أو عبر الـ passage through birth canal، مرور عبر
+
+118
+00:08:27,800 --> 00:08:31,960
+قناة الولادة، أو finger to eye، يعني واحد لمس
+
+119
+00:08:31,960 --> 00:08:36,740
+البكتيريا تمام، ومن ثم، فاكرين اللي قلنا الإصبع و
+
+120
+00:08:36,740 --> 00:08:40,000
+حكاية الـ conjunctiva membrane، هذه اللي موجودة في الـ eye،
+
+121
+00:08:41,980 --> 00:08:44,460
+وكلمة trachoma باللغة العربية مقابلها trachoma، على
+
+122
+00:08:44,460 --> 00:08:48,720
+فكرة أعتقد أن المصطلح الانجليزي هذا مؤخذ من
+
+123
+00:08:48,720 --> 00:08:54,020
+المصطلح العربي في الأساس، trachoma disease، الـ
+
+124
+00:08:54,020 --> 00:08:58,580
+trachoma، قلنا caused by serotypes A, B, Ba, C،
+
+125
+00:08:58,580 --> 00:09:02,360
+يعني في أربعة serotypes بيسببوها، اللي هو الـ trachoma،
+
+126
+00:09:03,780 --> 00:09:07,220
+بيقولوا one of the leading causes of blindness in
+
+127
+00:09:07,220 --> 00:09:09,880
+developing countries with dry and hot weather، زي
+
+128
+00:09:09,880 --> 00:09:13,440
+ما حكينا، البلدان اللي فيها درجة حرارة مرتفعة،
+
+129
+00:09:13,440 --> 00:09:18,460
+والطقس جاف، إحنا لدينا طقس جاف في غزة ولا إيش؟
+
+130
+00:09:18,460 --> 00:09:21,160
+لدينا رطوبة جيدة، إحنا من منطقة ساحلية، في الحالة،
+
+131
+00:09:21,160 --> 00:09:24,900
+لدينا رطوبة، لا، يبقى سابق، chronic، وبعدين إحنا لماذا
+
+132
+00:09:24,900 --> 00:09:27,360
+نعتبر من الدول ذات المناخ الحار، إحنا من الدول
+
+133
+00:09:27,360 --> 00:09:31,760
+ذات المناخ المعتدل، chronic conjunctivitis leads to
+
+134
+00:09:31,760 --> 00:09:35,910
+scarring، هنا النقطة، الآن أنا في عندي infection في
+
+135
+00:09:35,910 --> 00:09:41,090
+العين، وبتعمل cicatricial scar، ندبة، لما تعمل ندبة في
+
+136
+00:09:41,090 --> 00:09:45,930
+القرنية بتعيق من الجسم، خلاص، القرنية بطلت تعمل
+
+137
+00:09:45,930 --> 00:09:49,990
+الوظيفة بتاعتها، فقدان البصر، تمام؟ إذا هذه المشكلة
+
+138
+00:09:49,990 --> 00:09:53,110
+الأساسية في هذا الـ disease اللي إحنا سميناه trachoma،
+
+139
+00:09:53,110 --> 00:10:00,470
+لكن هناك أيضا الـ STD، الآن في عندي مصطلح أنا أول
+
+140
+00:10:00,470 --> 00:10:04,350
+مرة مر معانا non-gonococcal urethritis، ليش الـ non-
+
+141
+00:10:04,350 --> 00:10:06,190
+gonococcal urethritis؟ لأن فيها اسمها الـ
+
+142
+00:10:06,190 --> 00:10:09,830
+gonococcal urethritis، النيسرية السيلانية، لما درسناها
+
+143
+00:10:09,830 --> 00:10:12,570
+إحنا في الصيف، ذكرنا من الأمراض اللي بتسببها الـ
+
+144
+00:10:12,570 --> 00:10:17,420
+urethritis، اللي هي السيلان نفسها، الآن ما عداها
+
+145
+00:10:17,420 --> 00:10:20,900
+سميت من مسببات الـ urethritis، الـ non-gonococcal
+
+146
+00:10:20,900 --> 00:10:24,800
+urethritis، لأن في السابق كانت معلوماتنا بتقول أن
+
+147
+00:10:24,800 --> 00:10:28,260
+النيسرية السيلانية هي number one cause، هي الأكثر شيء
+
+148
+00:10:28,260 --> 00:10:31,940
+شيوعا، لكن بعد ما تطورت تقنياتنا، وصلنا نعرف نعمل
+
+149
+00:10:31,940 --> 00:10:35,420
+cell culture، ونعمل PCR، ونعمل… وصلنا نعرف أو
+
+150
+00:10:35,420 --> 00:10:39,900
+وصلنا نعرف أن في مسببات أخرى، لكن اليوم عرفنا أن
+
+151
+00:10:39,900 --> 00:10:43,800
+المسببات الأخرى أكثر شيوعا أصلا من مين؟ من النيسرية
+
+152
+00:10:43,800 --> 00:10:48,680
+السيلانية، urethritis و non-gonococcal urethritis،
+
+153
+00:10:48,680 --> 00:10:55,360
+وتختصر بـ NGU، عشان الأخوة اللي في الطب يبقوا
+
+154
+00:10:55,360 --> 00:10:58,960
+عارفين الاختصارات، الـ NGU معناها non-gonococcal urethritis،
+
+155
+00:10:58,960 --> 00:11:05,280
+إذن هي a common cause of non-gonococcal
+
+156
+00:11:05,280 --> 00:11:10,680
+urethritis، وبتعطينا characteristic ما يسمى بـ muco-
+
+157
+00:11:10,680 --> 00:11:12,940
+purulent discharge، إيش يعني muco-purulent
+
+158
+00:11:12,940 --> 00:11:16,060
+discharge؟ purulent معناها فيه صديد، muco يعني
+
+159
+00:11:16,060 --> 00:11:20,960
+مخاطي، discharge اللي هي الإفرازات، طبعا الـ disease
+
+160
+00:11:20,960 --> 00:11:26,740
+أحد مخاطره أنه قد يتطور إلى epididymitis and
+
+161
+00:11:26,740 --> 00:11:29,540
+orchitis، orchitis اللي هي التهاب الخصية، طبعا
+
+162
+00:11:29,540 --> 00:11:34,660
+وبالتالي طبعا هنتكلم عن هذا اللي في الذكور، في
+
+163
+00:11:34,660 --> 00:11:38,260
+الإناث، cervicitis and vaginitis and pelvic
+
+164
+00:11:38,260 --> 00:11:41,860
+inflammatory disease، pelvic inflammatory disease،
+
+165
+00:11:41,860 --> 00:11:46,660
+سواء كان orchitis أو epididymitis أو cervicitis أو
+
+166
+00:11:46,660 --> 00:11:50,260
+vaginitis، may lead to infertility، يعني هذا الـ
+
+167
+00:11:50,260 --> 00:11:53,600
+disease can cause infertility، اللي هي إيش بتقول لنا
+
+168
+00:11:53,600 --> 00:11:58,180
+عنها؟ اللي هي… لأ مش عقيمة، هذه الـ sterility،
+
+169
+00:11:58,180 --> 00:12:01,740
+اللي أقرب لـ infertility، قلة الإخصاب يعني، أو ما فيش
+
+170
+00:12:01,740 --> 00:12:07,340
+إخصاب، خصوبة… ل… ل… يعني مصطلح أقل حدة من الـ
+
+171
+00:12:07,340 --> 00:12:12,840
+sterility، يعني في إمكانية للحمل، لكن الفرص أقل من
+
+172
+00:12:12,840 --> 00:12:14,540
+اللي هو normal،
+
+173
+00:12:17,150 --> 00:12:22,290
+طيب إحنا تكلمنا عن… جلّنا التركيز وبعدين جلّنا
+
+174
+00:12:22,290 --> 00:12:25,710
+الـ STD، لأن هنتكلم عن مين؟ عن الـ neonatal infection،
+
+175
+00:12:25,710 --> 00:12:28,530
+لحظة، نفس الـ strains، نرجع نراجع
+
+176
+00:12:31,170 --> 00:12:33,390
+الـ strains أو ال
+
+223
+00:16:12,170 --> 00:16:17,150
+اللي قدامكوا بيرتبط بخلايا الإحليل والمثانة
+
+224
+00:16:17,670 --> 00:16:20,310
+وبالتالي إيش الأعراض اللي هتكون عنده؟
+
+225
+00:16:20,310 --> 00:16:24,770
+إريثرايتس زائد يوريثرايتس، يعني عنده UTI
+
+226
+00:16:24,770 --> 00:16:30,070
+وكان عنده UTI لأن الإحليل ملتهب نتيجة اللي هو
+
+227
+00:16:30,070 --> 00:16:33,230
+ارتباط الـ antibody ومهاجمته، وكلنا بنعرف أن
+
+228
+00:16:33,230 --> 00:16:36,500
+الـ antibody لما بيرتبط بالخلية، الأنتيبودي بيعمل
+
+229
+00:16:36,500 --> 00:16:38,280
+activation للـ complement، والـ complement بيعمل
+
+230
+00:16:38,280 --> 00:16:41,860
+destruction للأنسجة، وبالتالي بيصير فيه التهاب بالفعل
+
+231
+00:16:41,860 --> 00:16:45,540
+inflammation في المنطقة، وبصير فيه ألم والشعور
+
+232
+00:16:45,540 --> 00:16:50,040
+الآن، هو عنده UTI، لكن لو عملنا مزرعة، هتكون
+
+233
+00:16:52,090 --> 00:16:57,110
+سالبة، ما عندوش أي ميكروب، الـ destruction ناتجة
+
+234
+00:16:57,110 --> 00:17:00,770
+على مين؟ لأ لأ، حتى لو .. حتى لو بنعمل .. لو .. لو
+
+235
+00:17:00,770 --> 00:17:03,610
+.. لو افترضنا أن البكتيريا من النوع اللي بنقدر ننميه
+
+236
+00:17:03,610 --> 00:17:07,310
+أو نمينا عينة البول على cell culture، لن تنمو،
+
+237
+00:17:07,310 --> 00:17:11,170
+لأن أنا ما عنديش بكتيريا، أنا عندي antigen-antibody
+
+238
+00:17:11,170 --> 00:17:16,660
+reaction فقط، متفقين؟ الآن، إيش الأمراض الخامسة اللي
+
+239
+00:17:16,660 --> 00:17:20,640
+إحنا ذكرناها على الـ diseases كمان مرة؟ Trachoma رقم
+
+240
+00:17:20,640 --> 00:17:25,340
+اثنين، STD، رقم ثلاثة، Neonatal، رقم أربعة، Lymph
+
+241
+00:17:25,340 --> 00:17:28,160
+Granuloma inguinale، وهي رقم خمسة اللي هي autoimmune
+
+242
+00:17:28,160 --> 00:17:33,230
+disease، نسميها Reiter Syndrome، طبعًا لأن الـ
+
+243
+00:17:33,230 --> 00:17:37,910
+culture صعبة، وبتحتاج cell culture زي ما أنتم
+
+244
+00:17:37,910 --> 00:17:42,450
+شايفينها في اللوحة، تمام؟ فيه عندي اللي هو الـ
+
+245
+00:17:42,450 --> 00:17:45,570
+microscopy، والـ microscopy كده، بندور فيه على
+
+246
+00:17:45,570 --> 00:17:49,830
+inclusion body، شفتوا لما تكلمنا عن الـ life cycle
+
+247
+00:17:49,830 --> 00:17:52,450
+مش بيقول لنا فيه elementary body وفيه reticulate
+
+248
+00:17:52,450 --> 00:17:57,230
+body، الـ reticulate body بيكون باين جوه اللي هو الـ
+
+249
+00:17:57,230 --> 00:18:02,750
+cytoplasm تبع الخلية المصابة، العينات طبعًا بتختلف من
+
+250
+00:18:02,750 --> 00:18:05,990
+حسب الأمراض اللي إحنا ذكرناها، ممكن نعمل Giemsa
+
+251
+00:18:05,990 --> 00:18:09,530
+Staining يا شباب، ومن خلاله نشوف فيه اللي هو الـ
+
+252
+00:18:09,530 --> 00:18:13,650
+.. اللي قلنا عليه، الـ inclusion body، الـ fluorescent
+
+253
+00:18:13,650 --> 00:18:16,730
+antibody staining رائع جدًا، بنكشف فيه البكتيريا
+
+254
+00:18:16,730 --> 00:18:22,310
+مباشرة، الـ PCR تقنية صارت سهلة وميسرة للموضوع الـ
+
+255
+00:18:22,310 --> 00:18:25,250
+cell culture، بتظل هي الـ golden standard، لكن هي
+
+256
+00:18:25,250 --> 00:18:30,030
+الأكثر تكلفة، الـ serodiagnosis، والـ serodiagnosis
+
+257
+00:18:30,030 --> 00:18:33,950
+يمكن هو الوحيد المتبع في قطاع واسع، أقل من هذا الموضوع
+
+258
+00:18:35,030 --> 00:18:38,210
+وبنقدر نشتغل فيه بطريقتين يا شباب، نكشف عن
+
+259
+00:18:38,210 --> 00:18:43,250
+الأنيتجينات، نكشف عن الأنتيجينات مباشرة، يعني لو
+
+260
+00:18:43,250 --> 00:18:46,830
+واحد عنده Trachoma، يعني إحنا قلنا بتعمل infection
+
+261
+00:18:46,830 --> 00:18:50,410
+في الـ eyelid دي، في الجفن تبع العين من جوه، لو
+
+262
+00:18:50,410 --> 00:18:55,130
+أخذنا مسحة، تمام؟ هذا antigen، فيه بكتيريا، وكشفنا
+
+263
+00:18:55,130 --> 00:18:59,390
+باستخدام antibody، تمام؟ نكشف عنه، وبنقدر، صح؟ هذا
+
+264
+00:18:59,390 --> 00:19:03,970
+واحد، خيار ثاني، نجيب الـ swab، urethral discharge
+
+265
+00:19:03,970 --> 00:19:08,390
+تمام؟ أو مسحة برضه، ممكن نكشف عنه عن الأنتيجينات، وممكن
+
+266
+00:19:08,390 --> 00:19:12,420
+نكشف عن مين؟ عن الـ Antibody من الـ patient serum، إذن فيه
+
+267
+00:19:12,420 --> 00:19:15,780
+أننا نعمل serodiagnosis، ومولود، لكن يا شباب، كمان مرة
+
+268
+00:19:15,780 --> 00:19:19,180
+الـ detection of antigen is conclusive، conclusive،
+
+269
+00:19:19,180 --> 00:19:23,000
+يعني حاسم، بينما الـ detection of antibodies، خاصة
+
+270
+00:19:23,000 --> 00:19:27,500
+لما نتكلم عن IgG، بيكونش حاسم، إذن بدنا نعرف شو
+
+271
+00:19:27,500 --> 00:19:31,260
+الطرق، الطرق اللي ممكن نوظفها إحنا، واتذكروا أن
+
+272
+00:19:31,260 --> 00:19:36,400
+إحنا ذكرنا هنا في إمكانية للإصابة بالبكتيريا
+
+273
+00:19:36,400 --> 00:19:42,500
+بالبكتيريا، والبكتيريا قد تسبب العقم، infertility،
+
+274
+00:19:42,500 --> 00:19:47,540
+infertility، فهي أحد الميكروبات اللي لازم نبحث عنها
+
+275
+00:19:47,540 --> 00:19:51,080
+في حال اللي هو موضوع الـ infertility treatment، نفس
+
+276
+00:19:51,080 --> 00:19:53,800
+الشيء، بتتعالج في الكبار erythromycin أو
+
+277
+00:19:53,800 --> 00:19:56,840
+azithromycin، والتانية بتنتمي لنفس الفصيلة اللي هم
+
+278
+00:19:56,840 --> 00:20:02,850
+الـ macrolides، في اسم بكتيريا جميل وحلو كلماته،
+
+279
+00:20:02,850 --> 00:20:07,630
+بكتيريوم جرانيلوماتيس، ولو أنه كبير لكن سهل كلماته،
+
+280
+00:20:07,630 --> 00:20:11,730
+بكتيريوم جرانيلوماتيس، وبيسبب مرض اسمه جرانيلوما
+
+281
+00:20:11,730 --> 00:20:16,610
+إنجوينالي، جرانيلوما إنجوينالي، وجرانيلوما فيها يعني
+
+282
+00:20:16,610 --> 00:20:20,370
+ورم حبيبي، وإنجوينال في منطقة اللي هو العانة، منطقة
+
+283
+00:20:20,370 --> 00:20:25,800
+العانة، يعني في الحوض، البكتيريا كان اسمها زمان
+
+284
+00:20:25,800 --> 00:20:28,700
+Donovan bodies، لأنهم ما كانوش عارفين اسمها،
+
+285
+00:20:28,700 --> 00:20:32,320
+فسموها على اسم الطبيب اللي شافها تحت الميكروسكوب،
+
+286
+00:20:32,320 --> 00:20:35,620
+فسموها أجسام دونوفان، البكتيريا Gram negative، بس
+
+287
+00:20:35,620 --> 00:20:41,880
+الله، Gram negative، بس طبعًا، دونوفان bodies، فالـ
+
+288
+00:20:41,880 --> 00:20:45,460
+disease، إيه اللي سماه دونوفانوسيس، فإذن،
+
+289
+00:20:45,460 --> 00:20:50,700
+بتعرف باسم lymphogranuloma inguinale أو دونوفانوسيس،
+
+290
+00:20:50,700 --> 00:20:55,000
+وصلت الصورة؟ الآن، الـ incubation period من الـ first
+
+291
+00:20:55,000 --> 00:20:59,680
+contact مع البكتيريا، قد تمتد من عشرة لأربعين يوم،
+
+292
+00:20:59,680 --> 00:21:06,940
+إذن فيه ten to forty days، خلينا نقول incubation
+
+293
+00:21:06,940 --> 00:21:11,140
+period، وبيظهر بعد ذلك اللي هو الـ genital lesion،
+
+294
+00:21:11,140 --> 00:21:16,920
+وهو عبارة عن small و painless، ولحظوا كمان مرة، معظم
+
+295
+00:21:17,490 --> 00:21:22,690
+الـ .. الـ .. الـ infections اللي سميناها STD، كانت
+
+296
+00:21:22,690 --> 00:21:26,950
+البثور أو الحبوب أو الـ lesions اللي بتطلع كانت
+
+297
+00:21:26,950 --> 00:21:34,870
+إيش؟ painless، غير مؤلمة، لكن بعد فترة بتبين وجهها
+
+298
+00:21:34,870 --> 00:21:42,720
+القبيح، بتنفجر، وبيصير فيها فتحات، تمام؟ وبتبدأ
+
+299
+00:21:42,720 --> 00:21:46,040
+بالظهور بشكل fleshy، fleshy، اللي هو يعني بتعرف
+
+300
+00:21:46,040 --> 00:21:49,980
+اللحم لما يتعرض، يعني ينجرح، كيف بيكون شكله؟ له شكل
+
+301
+00:21:49,980 --> 00:21:54,900
+معين، اللون بتاعه مظبوط، واللمس بتاعه بيختلف عن الـ
+
+302
+00:21:54,900 --> 00:21:59,120
+skin، فالآن هي بتعطينا appearance أن هي fleshy،
+
+303
+00:21:59,120 --> 00:22:05,970
+oozing، يعني بتترسب سوائل، يعني بتطلع كمان سوائل، الـ
+
+304
+00:22:05,970 --> 00:22:07,790
+General Characteristics، البكتيريا عبارة عن
+
+305
+00:22:07,790 --> 00:22:13,710
+Capsulated Gram Negative Bacilli، وهي STD كمان مرة،
+
+306
+00:22:13,710 --> 00:22:17,010
+Sexual Transmitted Disease with Higher Incidence
+
+307
+00:22:17,010 --> 00:22:21,630
+in Homosexuals، Homosexuals يعني المثليين، يعني
+
+308
+00:22:21,630 --> 00:22:25,910
+الرجال اللي هم مثليون، تمام؟ المثليين، وهم منتشرون
+
+309
+00:22:25,910 --> 00:22:29,850
+في العالم الغربي، على الرغم من أن العلم أثبت لهم
+
+310
+00:22:30,690 --> 00:22:34,130
+بدون أدنى شك أن هؤلاء الناس اللي كمان مرة بيقولهم
+
+311
+00:22:34,130 --> 00:22:39,190
+ناس، أن هؤلاء الناس أحد أكبر المصائب اللي حلت على
+
+312
+00:22:39,190 --> 00:22:44,170
+البشر في القرون الماضية، ليش؟ لأنه ساهموا في نشر
+
+313
+00:22:44,170 --> 00:22:48,890
+الأمراض بطريقة غريبة عجيبة، من ضمنها الـ HIV، والـ HIV
+
+314
+00:22:48,890 --> 00:22:53,690
+معروف عنه انتشاره في الـ homosexuals أعلى بكثير من
+
+315
+00:22:53,690 --> 00:22:57,400
+الـ heterosexuals، وكذلك الأمراض، نفس الأمراض اللي هي
+
+316
+00:22:57,400 --> 00:23:02,960
+الأخرى، يعني للأسف ساهموا في نشرها بشكل كبير، طبعًا هم
+
+317
+00:23:02,960 --> 00:23:06,620
+بنتكلم هذا الكلام دائمًا، وبنكرره، وبنقول الحمد
+
+318
+00:23:06,620 --> 00:23:12,440
+لله ربنا، يعني أننا خلقنا مسلمين، ما بنعانيش من مثل هذه
+
+319
+00:23:12,440 --> 00:23:19,400
+القضايا بشكل كبير، لكن، لكن بدنا نكون واعين ومدركين
+
+320
+00:23:19,400 --> 00:23:24,300
+أن هذه الفئة عرضة للإصابة بأمراض خطيرة من هذا النوع،
+
+321
+00:23:24,300 --> 00:23:29,320
+وقد يحدث .. يحدث فيهم حتى طفرات للفيروسات، و
+
+322
+00:23:29,320 --> 00:23:32,420
+أعتقد أنه .. يعني إحنا بنعرف الـ HIV الآن، فيه HIV 1،
+
+323
+00:23:32,420 --> 00:23:36,060
+وHIV 2، الـ .. الـ .. الـ .. الـ mutations والـ
+
+324
+00:23:36,060 --> 00:23:39,260
+resistance للأدوية، غالبًا بينتج أو .. أو .. أو
+
+325
+00:23:39,260 --> 00:23:43,060
+بيحدث في هؤلاء، من البشر عمومًا، هذا الـ ..
+
+326
+00:23:43,060 --> 00:23:45,940
+الـ .. الـ micro، بينتقل عن طريق الجينات، لكن كمان
+
+327
+00:23:45,940 --> 00:23:48,700
+ممكن ينتقل عن طريق اللمس، وبعض الأحيان بيسموه
+
+328
+00:23:48,700 --> 00:23:52,780
+kissing ulcers، يعني .. يعني مجرد الاحتكاك الجسدي،
+
+329
+00:23:52,780 --> 00:23:56,820
+ممكن ينقل هذا الـ .. الـ .. الـ micro، برضه، الـ
+
+330
+00:23:56,820 --> 00:23:59,080
+treatment بتاعه بالـ tetracycline،
+
+331
+00:24:02,840 --> 00:24:05,600
+يبقى بنقدر نقول إحنا أنهينا الجزء المتعلق
+
+332
+00:24:05,600 --> 00:24:11,380
+بمين؟ بالـ Chlamydia، اليوم فيه أنه ميكروب إحنا بنعرف
+
+333
+00:24:11,380 --> 00:24:16,180
+معلومات عنه مسبقًا، بأنه أصغر free living، the
+
+334
+00:24:16,180 --> 00:24:20,540
+smallest free living ميكروب، أو بكتيريا بالأحرى، وهو
+
+335
+00:24:20,540 --> 00:24:25,920
+يوازي في حجمه أكبر حجم للفيروس، بتعرفوا الـ smallpox،
+
+336
+00:24:25,920 --> 00:24:30,670
+اللي هو فيروس الجدري،small pox، هذا معروف عنه أن
+
+337
+00:24:30,670 --> 00:24:34,130
+هو الفيروس الأكبر، تمام؟ فبقول أن الـ micro plasma
+
+338
+00:24:34,130 --> 00:24:38,150
+تقريبًا بحجم اللي هو الـ small pox، فأصغر بكتيريا
+
+339
+00:24:38,150 --> 00:24:42,810
+مساوية لأكبر فيروس، الـ general characteristics، it
+
+340
+00:24:42,810 --> 00:24:46,750
+is the smallest free living bacteria، فاكرين لما
+
+341
+00:24:46,750 --> 00:24:49,940
+اتكلمت عن الـ campylobacter، كان بالترشيح أكتر، مش كنا
+
+342
+00:24:49,940 --> 00:24:54,120
+بنعملها ترشيح إحنا، وكنا خايفين أن الـ micro
+
+343
+00:24:54,120 --> 00:24:59,800
+plasma هي الوحيدة، لأن حجمها قريب، فتنزل، لكن
+
+344
+00:24:59,800 --> 00:25:06,000
+ما خوفنا من النتيجة، أن قلنا لكم أنه بطيء النمو،
+
+345
+00:25:06,000 --> 00:25:10,800
+أجار، هذا الـ slow growing، required at least one
+
+346
+00:25:10,800 --> 00:25:14,120
+week، one week for growth، بينما الـ Campylobacter
+
+347
+00:25:14,120 --> 00:25:18,200
+كانت بتحتاج 48 ساعة لنمو، فما كانش فيه خوف في هذا
+
+348
+00:25:18,200 --> 00:25:23,220
+المجال، لكن الحقيقة تبقى أن هذه مش obligate
+
+349
+00:25:23,220 --> 00:25:26,600
+intracellular parasites، أنا قلت عنها the smallest
+
+350
+00:25:26,600 --> 00:25:29,760
+free living، يعني تستطيع أن، تستطيع أن ننميها على
+
+351
+00:25:29,760 --> 00:25:34,000
+artificial media، لكن بتحتاج بالفعل rich media، السؤال
+
+352
+00:25:34,000 --> 00:25:40,760
+الثاني، بكتيريا بدون جدار خلوي، كيف لها أن تعيش في
+
+353
+00:25:40,760 --> 00:25:45,900
+هذا العالم الخشن، العالم المليء بالـ fluctuation في
+
+354
+00:25:45,900 --> 00:25:49,720
+الـ osmotic environment، يعني مرة بتدخل بمية مالحة،
+
+355
+00:25:49,720 --> 00:25:54,860
+مرة بتدخل بمية حلوة، مرة تدخل في مربى في مواد
+
+356
+00:25:54,860 --> 00:25:58,980
+كيميائية، فكيف لها؟ وإحنا بنعرف أن الـ cell wall هو
+
+357
+00:25:58,980 --> 00:26:02,940
+أحد الـ components المسؤول عن شكل البكتيريا، ومسؤول
+
+358
+00:26:02,940 --> 00:26:07,180
+عن حمايتها من الـ Osmotic Lysis، لو واجهت فيه يعني
+
+359
+00:26:07,180 --> 00:26:11,060
+محلول، أو في بيئات الضغط الأسموزي تبقى غير مناسبة
+
+360
+00:26:11,060 --> 00:26:15,820
+للبكتيريا، بالظبط، وجود ستيرول في الـ cell membrane
+
+361
+00:26:15,820 --> 00:26:19,040
+بيعطيها هذه الـ capability، بيعطيها هذه الـ
+
+362
+00:26:19,040 --> 00:26:25,140
+capability، الـ micro plasma بطبيعتها مالهاش
+
+363
+00:26:25,140 --> 00:26:29,340
+cell wall، وبالتالي هي resistant، resistant to مين؟
+
+364
+00:26:30,450 --> 00:26:34,510
+to cell wall inhibitors، زي الـ penicillins and
+
+365
+00:26:34,510 --> 00:26:39,050
+cephalosporins، لأن مالهاش cell wall، كمان إحنا
+
+366
+00:26:39,050 --> 00:26:44,210
+بنعرف أن الـ Gram stain أصلًا، يعني بيصبغ البكتيريا
+
+367
+00:26:44,210 --> 00:26:46,590
+ويميز الـ Gram positive عن الـ Gram negative، بين
+
+368
+00:26:46,590 --> 00:26:49,390
+العالمين، على الـ cell wall structure، طب هذه مالهاش
+
+369
+00:26:49,390 --> 00:26:53,070
+cell wall، عشان كده it is poorly stained with اللي
+
+370
+00:26:53,070 --> 00:26:55,030
+هو Gram stain،
+
+371
+00:26:57,730 --> 00:26:59,890
+البكتيريا دي، عنها بطيئة النمو في artificial
+
+372
+00:26:59,890 --> 00:27:03,830
+media، فيه كمان ميزة مميزة صح؟ إنها مستعمراتها
+
+373
+00:27:03,830 --> 00:27:08,470
+بتشبه البيض المقلي، بيسموها fried egg appearance
+
+374
+00:27:08,470 --> 00:27:13,370
+colonies، خاصة .. خاصة يا شباب، الـ old culture،
+
+375
+00:27:13,370 --> 00:27:19,170
+يعني المزرعة لما بيكون عمرها طويل، أعتقد هذه الصورة
+
+376
+00:27:19,170 --> 00:27:23,930
+بتبين أن، اللي فوق، بتبين الشكل اللي إحنا بنقول
+
+377
+00:27:23,930 --> 00:27:26,710
+عليه fried egg appearance، بتلاحظوا في المنتصف فيه زي
+
+378
+00:27:26,710 --> 00:27:32,100
+عين، المنتصف المستعمرة مثلًا زي هذه، تمام؟ طبعًا بعد
+
+379
+00:27:32,100 --> 00:27:36,800
+فترة ممكن يصير فيه نوع من الـ irregular edges هنا،
+
+380
+00:27:36,800 --> 00:27:41,220
+فبيدي الشكل الأوضح للـ fried egg appearance هذا،
+
+381
+00:27:41,220 --> 00:27:45,060
+الوسط اللي .. اللي بيستخدموه لـ .. الـ .. سموّه PPLO
+
+382
+00:27:45,060 --> 00:27:49,040
+أجار، P-P-L-O، طبعًا P-P-L-O مش Palestinian
+
+383
+00:27:49,040 --> 00:27:53,400
+Liberation Organization، الـ P-P-L-O هو عبارة عن اسم
+
+384
+00:27:53,400 --> 00:27:57,930
+اختصار لـ pleuropneumonia-like organisms، وهذا الاسم
+
+385
+00:27:57,930 --> 00:28:00,970
+القديم للـ Mycoplasma، كان بيسموها pleuropneumonia-
+
+386
+00:28:00,970 --> 00:28:03,470
+like microorganism، والتالي، الوسط دلوقت بنفس اللي
+
+387
+00:28:03,470 --> 00:28:08,970
+هو المسمى، بس واضح أنه طبعًا الوسط يعني غني جدًا،
+
+388
+00:28:08,970 --> 00:28:13,530
+بيحتوي على Beef Heart و Infusion وBeptone Sodium
+
+389
+00:28:13,530 --> 00:28:18,820
+Chloride، ففي الأسماء المشهورة، أو الاسم المشهور
+
+390
+00:28:18,820 --> 00:28:21,220
+الحقيقة في الـ microplasma، أكثر اسم مشهور اللي هو
+
+391
+00:28:21,220 --> 00:28:25,820
+microplasma نيومونيا، وبيسبب primary atypical
+
+392
+00:28:25,820 --> 00:28:29,760
+pneumonia، أعتقد أن إحنا قلنا قبل شوية الـ chlamydia
+
+393
+00
+
+445
+00:32:14,960 --> 00:32:18,620
+الـ Urea Plasma Urealyticum تابعة لـ Mycoplasma
+
+446
+00:32:18,620 --> 00:32:21,620
+كان اسمها زمان Mycoplasma Urealyticum لكن لها
+
+447
+00:32:21,620 --> 00:32:25,780
+اسمها Urea Plasma واضح من اسمها يعني احنا مركزين
+
+448
+00:32:25,780 --> 00:32:30,080
+على Urea Plasma Urealyticum  الاثنين Urea Urea
+
+449
+00:32:30,080 --> 00:32:37,410
+وبالتالي أكيد عندها كمية الـ Urea عالية. أن جي يو
+
+450
+00:32:37,410 --> 00:32:45,990
+نان جونو كوكال نان كلميديا يوريثريتس ان من شفتوها
+
+451
+00:32:46,980 --> 00:32:50,880
+Diseases non-gonococcal, non-chlamydial، لكن تصنف
+
+452
+00:32:50,880 --> 00:32:55,380
+مع من طبعا؟ تصنف مع NGU، non-gonococcal
+
+453
+00:32:55,380 --> 00:32:59,740
+urethritis. طبعا الـ differentiation بينها وبين الـ
+
+454
+00:32:59,740 --> 00:33:03,920
+Mycoplasma مبني أساسا على اليوريز enzyme
+
+455
+00:33:03,920 --> 00:33:07,800
+production.  زي الـ ... و ... و ... و ... تتشابه مع الـ
+
+456
+00:33:07,800 --> 00:33:10,340
+Mycoplasma، لأن احنا قلنا كوكاريسيا زمان ايه؟
+
+457
+00:33:10,340 --> 00:33:13,920
+Mycoplasma لكن التشابه مع الـ Mycoplasma في أنه
+
+458
+00:33:13,920 --> 00:33:16,600
+بتعطينا نفس الشكل تبقى المستعمرات اللي هو fried
+
+459
+00:33:16,600 --> 00:33:20,680
+egg appearance. اذا وجه التشابه انه الاثنين
+
+460
+00:33:20,680 --> 00:33:23,380
+بكتيريا الاثنين بيعطينا نفس الـ appearance تبقى
+
+461
+00:33:23,380 --> 00:33:27,360
+المستعمرات. لكن الاختلاف أو التمييز بينهم مبني على
+
+462
+00:33:27,360 --> 00:33:31,620
+إنتاج اليوريز أو عدم إنتاج اليوريز. وكما ذكرنا اللي
+
+463
+00:33:31,620 --> 00:33:33,980
+هو الـ non-gonococcal non-chlamydia urethritis in
+
+464
+00:33:33,980 --> 00:33:38,680
+men. Postpartum fever in women. ما معنى Postpartum
+
+465
+00:33:38,680 --> 00:33:42,340
+fever in women؟ الـ Postpartum اللي هي ما بعد
+
+466
+00:33:42,340 --> 00:33:45,540
+الولادة، fever يعني معناه الحُمّى. ماحنا ماروا
+
+467
+00:33:45,540 --> 00:33:49,240
+معانا كتير Postpartum و دلها اللي هو اللي سميناهم
+
+468
+00:33:49,240 --> 00:33:53,400
+peripheral sepsis. هم النفاذ. والـ Transmission بيكون
+
+469
+00:33:53,400 --> 00:33:56,980
+عبر الـ sexual contact. لأسف كان فينا دراسة في غزة
+
+470
+00:33:56,980 --> 00:34:01,800
+وأظهرت نسبة، يعني أو نسب، مخيفة من الـ Urea plasma
+
+471
+00:34:01,800 --> 00:34:07,700
+Urealyticum among women in Gaza. و هذا STD. STD بمعنى
+
+472
+00:34:07,700 --> 00:34:10,640
+أنه بينتقل عن طريق الجنس. و انتقال عن طريق الجنس
+
+473
+00:34:10,640 --> 00:34:14,640
+معناه الحاجة أنه احنا في بلد مش محافظ. و هذا الكلام
+
+474
+00:34:14,640 --> 00:34:19,100
+مصيب صحيح. فكان يمكن تفسيراتنا للنتيجة العالية أنه
+
+475
+00:34:19,100 --> 00:34:23,340
+خلال جمع العينة من السيدات تمام، بيستخدم محل اسمها
+
+476
+00:34:23,340 --> 00:34:26,880
+speculum. قدالي فاتح اللي هو الـ vagina حتى يقدر
+
+477
+00:34:26,880 --> 00:34:31,020
+ياخد عينة من عنق الرحم. فلو كانت ست واحدة مصابة
+
+478
+00:34:31,020 --> 00:34:34,520
+وما كانش فيه تعقيم جيد، فنقل العدوى. وكانت التقنية
+
+479
+00:34:34,520 --> 00:34:39,080
+المستخدمة في الدراسة كانت تستخدم الـ PCR. والـ PCR
+
+480
+00:34:39,080 --> 00:34:44,230
+بتعمل detection. بتعمل detection. انتهى الموضوع. بيعمل لنا
+
+481
+00:34:44,230 --> 00:34:48,390
+detection لأنه عنده high sensitivity و results.
+
+482
+00:34:49,750 --> 00:34:52,930
+الانتقال by sexual contact. كمان مرة. الـ Mycro
+
+483
+00:34:52,930 --> 00:34:55,490
+plasma and Ureoplasma. Lab diagnosis. الـ culture زي
+
+484
+00:34:55,490 --> 00:34:59,690
+ما حكينا في fried egg appearance. وعلى وسط خاص
+
+485
+00:34:59,690 --> 00:35:02,530
+اللي هو الـ PPLO اللي هو الـ pure pneumonia like
+
+486
+00:35:02,530 --> 00:35:07,090
+organism media. أو في حاجة اسمها called agglutination
+
+487
+00:35:07,090 --> 00:35:12,570
+detection. عبارة عن فحص antibody detection. ادلاجينا
+
+488
+00:35:12,570 --> 00:35:16,490
+الـ titre واحد على 128. مش واحد على 
+
+489
+00:35:16,490 --> 00:35:23,630
+ثمانية وعشرين. مش مية وثلاثين. مش 126. كيف التخفيف
+
+490
+00:35:23,630 --> 00:35:28,650
+بتم؟ لو عملتوا مضاعفات اثنين، اثنين أربعة، ثمانية، ستة عشر، اثنين وثلاثين، أربعة وستين، مية
+
+491
+00:35:28,650 --> 00:35:34,210
+وثمانية وعشرين. فنعمل Serial Dilution. Serial Dilution.
+
+492
+00:35:34,210 --> 00:35:38,850
+طبعا إذا طلع عندي الفحص positive عند واحد على 128 أو
+
+493
+00:35:38,850 --> 00:35:44,850
+أعلى من ذلك، واحد على، إيش؟ ضعف 256. طبعا ومضاعفاتها
+
+494
+00:35:44,850 --> 00:35:51,630
+فبيتطبع الفحص الآن أن المريض عنده Mycoplasma أو
+
+495
+00:35:51,630 --> 00:35:56,090
+Urea Plasma. الـ treatment نفس الشيء تتراسك ليه لكن
+
+496
+00:35:56,090 --> 00:35:59,630
+هنا الخيار الثاني اللي هو الـ Spectinomycin. المرة
+
+497
+00:35:59,630 --> 00:36:03,130
+الجاية إن شاء الله بنكمل المحاضرة.
+
+498
+00:36:03,130 --> 00:36:05,330
+انتهى
+
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..be8bce84e5fb8b7487bbc34f24ef1be6ce4fa8f0
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo_postprocess.srt
@@ -0,0 +1,1992 @@
+1
+00:00:20,200 --> 00:00:24,500
+طيب بسم الله الرحمن الرحيم احنا بدأنا المحاضرة
+
+2
+00:00:24,500 --> 00:00:27,180
+السابقة في موضوع ال chlamydia و ال micro plasma و
+
+3
+00:00:27,180 --> 00:00:30,600
+ال rickettsia لكن حتى ننطلق ان شاء الله في هذا
+
+4
+00:00:30,600 --> 00:00:35,040
+الجزء بدنا نعمل revision سريع لجزء اللي اشرحناه
+
+5
+00:00:35,040 --> 00:00:38,960
+المرة الماضية اللي هو ال chlamydiaالكليميديا كنا
+
+6
+00:00:38,960 --> 00:00:42,320
+عبارة عن obligate intracellular بكتيريا و بتمتلك
+
+7
+00:00:42,320 --> 00:00:46,520
+ريبوزومات زي أي بكتيريا أخرى طبعا هذه الجملة زي ما
+
+8
+00:00:46,520 --> 00:00:50,000
+ذكرنا عشان نأكد على حق أنها ليس لها علاقة
+
+9
+00:00:50,000 --> 00:00:52,620
+بالفيروسات are metabolically deficient و عندها
+
+10
+00:00:52,620 --> 00:00:55,880
+مشكلة في ال ATP production و كنا البعض بسميها
+
+11
+00:00:55,880 --> 00:01:00,700
+energy parasite يعني تتطفل من أجل الطاقة و ليس من
+
+12
+00:01:00,700 --> 00:01:05,440
+أجل أشياء أخرىmorphology البكتيريا small round
+
+13
+00:01:05,440 --> 00:01:08,760
+microorganism تنقسم بالانقسام التنائي البسيط زيها
+
+14
+00:01:08,760 --> 00:01:12,620
+زي أي بكتيريا أخرى لكن ال cell wall بتاعها بيشبه
+
+15
+00:01:12,620 --> 00:01:17,060
+إلى حد كبير ل gram negative بدون بيبتيده إجلايكان
+
+16
+00:01:17,060 --> 00:01:21,250
+حقيقيال species اللي ذكرناهم تلاتة كان هما و
+
+17
+00:01:21,250 --> 00:01:24,370
+الترتيب كما ذكرت المرة الماضية هو ليس للأهمية
+
+18
+00:01:24,370 --> 00:01:27,870
+بمعنى انه ال chlamydia trachomatis is the most
+
+19
+00:01:27,870 --> 00:01:30,830
+important بيليها pneumonia و بعدين cetaceae لكن
+
+20
+00:01:30,830 --> 00:01:34,070
+مرتبين الآن قدامنا chlamydia cetaceae, chlamydia
+
+21
+00:01:34,070 --> 00:01:39,010
+pneumonia, chlamydia trachomatisطبعا كونها
+
+22
+00:01:39,010 --> 00:01:42,130
+obligate intracellular برازايد فمستحيل تنمو على ال
+
+23
+00:01:42,130 --> 00:01:44,090
+culture الميدى العادى اللى بتعرفوها وبالتالي بدها
+
+24
+00:01:44,090 --> 00:01:47,050
+اما cell culture tissue culture زى ما coil cells
+
+25
+00:01:47,050 --> 00:01:50,310
+او على ال chicken embryo و هو غالبا بنحكي انها في
+
+26
+00:01:50,310 --> 00:01:54,490
+ال yolk sac تبع ال chicken embryo ال pathogenesis
+
+27
+00:01:54,490 --> 00:01:58,750
+غالبا البكتيريا عندها المقدرة على الارتباط بال
+
+28
+00:01:58,750 --> 00:02:01,910
+epithelial cells و ال mucous membrane و عندها
+
+29
+00:02:01,910 --> 00:02:05,050
+المقدرة على انها تعمل infection لخلايا ال lungs
+
+30
+00:02:06,880 --> 00:02:09,560
+وحكينا عن ال viral instructors بتذكر وقولنا عندها
+
+31
+00:02:09,560 --> 00:02:14,800
+مقدرة على ال resistance لل phagocytic killing by
+
+32
+00:02:14,800 --> 00:02:18,860
+inhibition of lysozyme أو lysozyme binding to
+
+33
+00:02:18,860 --> 00:02:23,140
+phagozyme يعني بيعملية تكوين الفاجو ليزوزوم بتتمش
+
+34
+00:02:23,140 --> 00:02:27,030
+وبتتر البكتيريا بتصير free داخل البكتيريابتنتج
+
+35
+00:02:27,030 --> 00:02:30,450
+هتلا بيوتوكسين وبتعمل competition بينها و بين
+
+36
+00:02:30,450 --> 00:02:33,790
+العائلة على ال nutrient وهي successful competitor
+
+37
+00:02:33,790 --> 00:02:38,010
+يعني منافس جيد تاخد ال nutrient وبالتالي بتأثر على
+
+38
+00:02:38,010 --> 00:02:44,790
+النمو تبع اللي هو ال host cell كمان قضية كتير مهمة
+
+39
+00:02:44,790 --> 00:02:50,150
+تطرقنا إلها كان أن معظم ال destruction الناتج عن
+
+40
+00:02:50,150 --> 00:02:53,470
+ال chlamydia infection بيكون ناجم عن ال immune
+
+41
+00:02:53,470 --> 00:02:56,330
+response و ال inflammation اللي بينتجها الجسم
+
+42
+00:02:57,960 --> 00:03:02,200
+وحكينا ال diagram هذا شرحناه وقلنا انه اللي أول
+
+43
+00:03:02,200 --> 00:03:05,900
+مرة بنتطرق لحاجة اسمها bacterial life cycle يعني
+
+44
+00:03:05,900 --> 00:03:08,860
+زي ما ذكرنا simple life cycle لكن فيها two forms
+
+45
+00:03:08,860 --> 00:03:11,900
+elementary body وreticulate body وقلنا ال
+
+46
+00:03:11,900 --> 00:03:15,240
+elementary body هو ال infectious form تمام هو ال
+
+47
+00:03:15,240 --> 00:03:18,300
+infectious form بينما ال reticulate body هو اللي
+
+48
+00:03:18,300 --> 00:03:22,150
+بيعمل replication داخل الخليةالان خدوا بالكم
+
+49
+00:03:22,150 --> 00:03:26,550
+النقطة هي خلية whole cell وفيها reticulate body لو
+
+50
+00:03:26,550 --> 00:03:29,710
+انا في لحظة من اللحظات اخدت هذه الخلية وعملت لها
+
+51
+00:03:29,710 --> 00:03:33,270
+صباغة لاحظوا كده كبير الحجم
+
+52
+00:03:36,290 --> 00:03:38,630
+بناخد نص الخلية ال .. ال .. ال epithelia الصح هذا
+
+53
+00:03:38,630 --> 00:03:42,350
+لأ وبالتالي بقدر اشوف حاجة بنسميها inclusion
+
+54
+00:03:42,350 --> 00:03:47,010
+bodies inclusion bodies وهذه على فكرة تستخدم في ال
+
+55
+00:03:47,010 --> 00:03:50,890
+diagnosis للبكتيريا زي ما البعض ممكن درس فيروسات
+
+56
+00:03:50,890 --> 00:03:55,920
+ممكن؟ مين درس فيروسات فيكم؟أخدتوا cytomegalovirus
+
+57
+00:03:55,920 --> 00:04:02,180
+CMV مش معقول درستوا فيروسات ومااخدتوش CMV لكن
+
+58
+00:04:02,180 --> 00:04:06,700
+ذاكرتكوا طبعا ال memory بتعملها كل مرة فورمات و
+
+59
+00:04:06,700 --> 00:04:12,280
+تالي مافيش ذاكرة مستقرة ال cytomegalovirus أحد أهم
+
+60
+00:04:12,920 --> 00:04:15,780
+الـ distinguishing characteristics له انه بيعمل
+
+61
+00:04:15,780 --> 00:04:19,340
+inclusion body بيسموها owl's eye زي عينان البوم
+
+62
+00:04:19,340 --> 00:04:22,840
+عينان البوم بيكون فيه two inclusion bodies غالبا
+
+63
+00:04:22,840 --> 00:04:26,400
+قريبين من بعض بيعطونا اي حق بين احنا بنشوف عينان
+
+64
+00:04:26,400 --> 00:04:30,020
+بوم فبيسموه owl's eye إذا ال inclusion body بتاعة
+
+65
+00:04:30,020 --> 00:04:32,980
+الليكلاميديا كما هنرى لاحقا ان شاء الله هي
+
+66
+00:04:32,980 --> 00:04:38,070
+diagnostic او تستخدم في ال diagnosisالقلميدا
+
+67
+00:04:38,070 --> 00:04:42,030
+سيتاسي اتفقنا على انه هي zoonotic respiratory
+
+68
+00:04:42,030 --> 00:04:46,570
+disease و ال natural habit اتباعتها في الطيور و
+
+69
+00:04:46,570 --> 00:04:49,190
+حكينا ان كانت الطيور المنزلية اللي بنربيها احنا
+
+70
+00:04:49,190 --> 00:04:54,190
+كلزينة زي الببغوات ممكن تكون احد اهم مصادر ال
+
+71
+00:04:54,190 --> 00:04:56,530
+infection طبعا
+
+72
+00:04:57,770 --> 00:05:02,390
+تنتج عن انتقال الميكروب لنا عبر ال respiratory
+
+73
+00:05:02,390 --> 00:05:06,690
+tract من خلال ال dust المحتوي او ال secretions
+
+74
+00:05:06,690 --> 00:05:12,090
+المحتوي على الميكرو Organism ابونا انه very common
+
+75
+00:05:12,090 --> 00:05:16,050
+in poultry workers اللي هو معمال تربية الدواجن
+
+76
+00:05:16,050 --> 00:05:20,450
+اللي بيربوا الدواجن والدواجن مش دجاج بس اه يعني في
+
+77
+00:05:20,450 --> 00:05:27,820
+الوز وفي البط يعني برضه في مزارة لهم صح يعنيالدزيز
+
+78
+00:05:27,820 --> 00:05:31,400
+نيومونيا او سيتاكوسز ال diagnosis عبارة عن عزل
+
+79
+00:05:31,400 --> 00:05:35,480
+للبكتيريا من ال sputum من خلال ال tissue culture
+
+80
+00:05:35,480 --> 00:05:39,360
+او عن طريق اللي هو detection of antibody باستخدام
+
+81
+00:05:39,360 --> 00:05:42,900
+ال complement fixation test و ال treatment ذكرنا
+
+82
+00:05:42,900 --> 00:05:46,360
+انه هيتكرر ال treatment رجمن هذا اللي قدامكوا في
+
+83
+00:05:46,360 --> 00:05:50,820
+معظم أنواع اللي هو الكلاميديا و الركتسيا كتر
+
+84
+00:05:50,820 --> 00:05:56,140
+ساكلين لل adults و erythromycin في الأطفالليش
+
+85
+00:05:56,140 --> 00:06:00,560
+ترساكلين بس في ال adults مش في الأطفال؟ لأنه لا
+
+86
+00:06:00,560 --> 00:06:02,660
+يقطع في ال pregnancy ولا في ال lactating woman
+
+87
+00:06:02,660 --> 00:06:05,780
+اللي هي المردعات ولا في الأطفال لأنه بيأثر على
+
+88
+00:06:05,780 --> 00:06:09,880
+جنمين على ال calcium و .. بالضبط فنمو الأسنان و
+
+89
+00:06:09,880 --> 00:06:14,380
+إيه اللي هو الإعظام. ال chlamydia pneumonia
+
+90
+00:06:14,380 --> 00:06:19,430
+بيسموها Tuarوطوار جاية من أو طوار strain طوار جاية
+
+91
+00:06:19,430 --> 00:06:24,830
+من كلمة تايوان تايوان دولة تمام وAR جاية من acute
+
+92
+00:06:24,830 --> 00:06:28,530
+respiratory فهي عبارة عن acute respiratory
+
+93
+00:06:28,530 --> 00:06:32,490
+infection تم تشخيص الحالة تبعتها في تايوان
+
+94
+00:06:32,490 --> 00:06:36,470
+وبالتالي سميت بهذا الإسم بعدين أطلق عليها اسم
+
+95
+00:06:36,470 --> 00:06:41,790
+Eclamydia pneumonia وهي تشبه ال pneumonia اللي
+
+96
+00:06:41,790 --> 00:06:47,770
+بتنتجها ال micro plasma pneumoniaال treatment كمان
+
+97
+00:06:47,770 --> 00:06:51,210
+مرة زي .. زي الأولانية تترسكلين في ال adults
+
+98
+00:06:51,210 --> 00:06:55,280
+والارترمايسين في ال babiesالميكروب التالت في
+
+99
+00:06:55,280 --> 00:06:57,180
+السلسلة اللي قلناه هو الأهم على الإطلاق واحنا
+
+100
+00:06:57,180 --> 00:07:01,480
+بحاجة إلى بالفعل أنه النقش هذا الموضوع الآن بتوسع
+
+101
+00:07:01,480 --> 00:07:07,900
+أكتر لأنه الميكروب is number one cause of STD in
+
+102
+00:07:07,900 --> 00:07:11,060
+the western hemisphere في العالم الغربي أو نصف
+
+103
+00:07:11,060 --> 00:07:16,000
+الكورة الغربي كان زمان الجنورية هي number one
+
+104
+00:07:16,000 --> 00:07:20,820
+cause of STDGonorrhea is number two، second to
+
+105
+00:07:20,820 --> 00:07:27,620
+what؟ To Chlamydia، إذاً لما نقول إنه أشهر مرض STD
+
+106
+00:07:27,620 --> 00:07:31,740
+يبقى لازم يكون له أهمية خاصة، هذا واحد، رقم اتنين،
+
+107
+00:07:31,740 --> 00:07:37,100
+هذا المرض معروف منذ زمن بعيد إنه أحد أهم أسباب
+
+108
+00:07:37,100 --> 00:07:43,120
+فقدان البصر في الدول الفقيرة ذات المناخ الحار
+
+109
+00:07:43,120 --> 00:07:50,580
+والجاف، يبقى نتكلم عن فقدان للبصربشكل كبير عند
+
+110
+00:07:50,580 --> 00:07:55,280
+المصابين في تلك البلدان يبقى مهم لما نتكلم عن STD
+
+111
+00:07:55,280 --> 00:08:01,080
+متكلم كمان عن في مخاوف انه الأم المصابة تنقل عبر
+
+112
+00:08:01,080 --> 00:08:05,780
+قناة الولادة للطفل تبعها و برضه يصاب بال blindness
+
+113
+00:08:05,780 --> 00:08:09,700
+اذا في انها مجموعة من المخاوف مجموعة من المخاطر
+
+114
+00:08:09,700 --> 00:08:14,500
+بدنا نطلع اليها في ال chlamydia trachomatisأماما
+
+115
+00:08:14,500 --> 00:08:20,760
+هي fifteen stereotypes بيسموهم A to L ABC الاخرى ل
+
+116
+00:08:20,760 --> 00:08:24,500
+L ال transmission ممكن عبر ال sexual زي ما حكينا
+
+117
+00:08:24,500 --> 00:08:27,800
+أو عبر ال passage through birth canal مرور عبر
+
+118
+00:08:27,800 --> 00:08:31,960
+قناة الولادة أو finger to eye يعني واحد لمس
+
+119
+00:08:31,960 --> 00:08:36,740
+البكتيريا تمام و من ثم فاكرين اللي قولنا الإصبع و
+
+120
+00:08:36,740 --> 00:08:40,000
+حكة ال limicus membrane هذه اللي موجودة في ال eye
+
+121
+00:08:41,980 --> 00:08:44,460
+وكلمة Trachoma باللغة العربية مقابلها Trachoma على
+
+122
+00:08:44,460 --> 00:08:48,720
+فكرة اعتقد ان المصطلح الانجليزي هذا مؤخذ من
+
+123
+00:08:48,720 --> 00:08:54,020
+المصطلح العربي بالاساس Trachoma disease ال
+
+124
+00:08:54,020 --> 00:08:58,580
+Trachoma قولنا caused by serotypes A,B,B,A,N,C
+
+125
+00:08:58,580 --> 00:09:02,360
+يعني في اربع serotypes بسببونها اللي هو ب Trachoma
+
+126
+00:09:03,780 --> 00:09:07,220
+بقولنا one of the leading causes of blindness in
+
+127
+00:09:07,220 --> 00:09:09,880
+developing countries with dry and hot weather زي
+
+128
+00:09:09,880 --> 00:09:13,440
+ما حكينا البلدان اللي فيها درجة حرارة مرتفعة
+
+129
+00:09:13,440 --> 00:09:18,460
+والطقس جاف احنا لدينا طقس جاف في غزة ولا إيش؟
+
+130
+00:09:18,460 --> 00:09:21,160
+لدينا رطوبة جيدة، احنا من منطقة ساحلية في ابتالي،
+
+131
+00:09:21,160 --> 00:09:24,900
+لدينا رطوبة لا بقى سابقة chronic وبعدين احنا لانا
+
+132
+00:09:24,900 --> 00:09:27,360
+اعتبر من الدول ذات المناخ الحارة، احنا من الدول
+
+133
+00:09:27,360 --> 00:09:31,760
+المناخ المعتدلة chronic conjunctivitis leads to
+
+134
+00:09:31,760 --> 00:09:35,910
+scarring، هنا النقطةالان انا في اندي infection في
+
+135
+00:09:35,910 --> 00:09:41,090
+العين وبتعمل Asian scar نضبة لما تعمل نضبة في
+
+136
+00:09:41,090 --> 00:09:45,930
+الكورنيا بتهيأنا من الجسم خلاص ال كورنيا بطلت جنب
+
+137
+00:09:45,930 --> 00:09:49,990
+الوظيفة تبعتها فقد البصرة تمام؟ اذا هذا المشكلة
+
+138
+00:09:49,990 --> 00:09:53,110
+الأساسية في هذا ال disease اللي احنا سمينا Trauma
+
+139
+00:09:53,110 --> 00:10:00,470
+لكن هناك ايضا ال STD الان في اندي مصطلح انا اول
+
+140
+00:10:00,470 --> 00:10:04,350
+مرة مر معانا non-gonococcal urethritisليش الـ non
+
+141
+00:10:04,350 --> 00:10:06,190
+-gonococcal urethritis؟ لأن فيها اسمها الـ
+
+142
+00:10:06,190 --> 00:10:09,830
+gonococcal urethritis نيسيريا جونورية لما درسناها
+
+143
+00:10:09,830 --> 00:10:12,570
+احنا في الصيف جنا من الأمراض اللي بتسببها الـ
+
+144
+00:10:12,570 --> 00:10:17,420
+urethritis، اللي هي الجونورية نفسهاالان ما عداها
+
+145
+00:10:17,420 --> 00:10:20,900
+سمية من مسببات الـ urethritis الـ non-gonococcal
+
+146
+00:10:20,900 --> 00:10:24,800
+urethritis لأن في السابق كانت معلوماتنا بتقول ان
+
+147
+00:10:24,800 --> 00:10:28,260
+نيسيريا جنورية هي number one cause هي الأكتر شيء
+
+148
+00:10:28,260 --> 00:10:31,940
+عنها لكن بعد ما اتطورت تقنياتنا وصلنا نعرف نعمل
+
+149
+00:10:31,940 --> 00:10:35,420
+cell culture و نعمل PCR و نعمل .. صلنا نعرف او
+
+150
+00:10:35,420 --> 00:10:39,900
+صلنا نعرف ان في مسببات أخرىلكن اليوم عرفنا ان
+
+151
+00:10:39,900 --> 00:10:43,800
+المسببات الأخرى أكتر شيوعا أصلا من مين من نيسيريا
+
+152
+00:10:43,800 --> 00:10:48,680
+جونوكوكل يوريث رايتس ونان جونوكوكل يوريث رايتس
+
+153
+00:10:48,680 --> 00:10:55,360
+وتختصر ب NGU عشان أن الأخوة اللي في الناد يبقوا
+
+154
+00:10:55,360 --> 00:10:58,960
+عارفين الاختصالات ال NGU معناها نان جونوكوكل يوريث
+
+155
+00:10:58,960 --> 00:11:05,280
+رايتسإذن هي a common cause of non-gonococcal
+
+156
+00:11:05,280 --> 00:11:10,680
+urethritis وبتعطينا characteristic ما يسمى بميوكو
+
+157
+00:11:10,680 --> 00:11:12,940
+-purulent discharge ايش يعني ميوكو-purulent
+
+158
+00:11:12,940 --> 00:11:16,060
+discharge؟ purulent معناها في صديد ميوكو يعني
+
+159
+00:11:16,060 --> 00:11:20,960
+مخاطر، discharge اللي هي الإفرازاتطبعا ال disease
+
+160
+00:11:20,960 --> 00:11:26,740
+احد مخاطره انه قد يتطور الى Epidermitis and
+
+161
+00:11:26,740 --> 00:11:29,540
+Orchitis Orchitis اللي هي التهيأة بالتستس طبعا
+
+162
+00:11:29,540 --> 00:11:34,660
+وبالتالي طبعا هتكلم عن هذا اللي في الذكور في
+
+163
+00:11:34,660 --> 00:11:38,260
+القناة cervicitis and vaginitis and pelvic
+
+164
+00:11:38,260 --> 00:11:41,860
+inflammatory disease pelvic inflammatory disease
+
+165
+00:11:41,860 --> 00:11:46,660
+سواء كان Orchitis او Epidermitis او cervicitis او
+
+166
+00:11:46,660 --> 00:11:50,260
+vaginitis may lead to ato infertility يعني هذا ال
+
+167
+00:11:50,260 --> 00:11:53,600
+disease can cause infertility اللي هي ايش بتقولنا
+
+168
+00:11:53,600 --> 00:11:58,180
+عنها؟ اللي هي .. لأ مش أقم تم هذه ال sterility
+
+169
+00:11:58,180 --> 00:12:01,740
+اللي أقم infertility قلة الإخصاب يعني او مافيش
+
+170
+00:12:01,740 --> 00:12:07,340
+إخصاب خصوبة ل .. ل .. ل .. يعني مصطلح أقل حد من ال
+
+171
+00:12:07,340 --> 00:12:12,840
+sterility يعني في إمكانية لحمل لكن الفرص أقل من
+
+172
+00:12:12,840 --> 00:12:14,540
+اللي هو normal
+
+173
+00:12:17,150 --> 00:12:22,290
+طيب احنا تكلمنا عن .. جُلنا التركامة وبعدين جُلنا
+
+174
+00:12:22,290 --> 00:12:25,710
+ال STD لإن اتكلم عن مين؟ عن الـ Neonatal Infection
+
+175
+00:12:25,710 --> 00:12:28,530
+لحظة نفس ال strings نرجع برجوع
+
+176
+00:12:31,170 --> 00:12:33,390
+الـ Strains أو الـ Stereotypes أو الجنس للإنفكشن
+
+177
+00:12:33,390 --> 00:12:41,350
+من D ل K و النينة للإنفكشن من D ل K مؤشر على إن
+
+178
+00:12:41,350 --> 00:12:46,210
+الأمهات المصابات بالأسطي هم اللي بينقلوا اللي هو
+
+179
+00:12:46,210 --> 00:12:50,690
+الـ Strains هذه لأطفال و كما حكيتلكوا قد تؤثر أو
+
+180
+00:12:50,690 --> 00:12:54,630
+تقدي إلى inclusion conjunctivitis يعني التهفل
+
+181
+00:12:54,630 --> 00:12:59,510
+العينو ممكن تعمل ميوكو
+
+182
+00:12:59,510 --> 00:13:03,010
+بيرولانت ديشارج seven to twelve days after birth
+
+183
+00:13:03,010 --> 00:13:06,570
+يعني لو ظهر التهابات في العين من سبع الى اتناشر
+
+184
+00:13:06,570 --> 00:13:10,790
+يوم مع افرازات صددية من العين هذا مؤشر قوي على ان
+
+185
+00:13:10,790 --> 00:13:15,930
+الطفل مصاب بالكلاميديا طبعا كمان ممكن الطفل يصاب ب
+
+186
+00:13:15,930 --> 00:13:21,940
+انيومونيا نتيجة عن اللي هو كلاميديا تراكوماتسخيار
+
+187
+00:13:21,940 --> 00:13:25,060
+الرابع وهو برضه STD لكن مميز لأن الـ Strain المسبب
+
+188
+00:13:25,060 --> 00:13:30,060
+تبعه مميز اسمه lymphogranuloma venereum أو LGV
+
+189
+00:13:30,060 --> 00:13:34,800
+lymphogranuloma venereum واضح من اسم venereum من
+
+190
+00:13:34,800 --> 00:13:40,040
+venereal و venereal STD يعني sexually transmitted
+
+191
+00:13:40,040 --> 00:13:44,640
+disease إذن في عندنا Strain خاص بسبب
+
+192
+00:13:44,640 --> 00:13:49,140
+lymphogranuloma venereum اللي هو L1 لL3 L1 و L2
+
+193
+00:13:49,140 --> 00:13:54,370
+لL3وهو عبارة عن STD قلنا with lesions on genitalia
+
+194
+00:13:54,370 --> 00:13:58,510
+وفيه lymph node enlargement شباب يعني فيه انتفاخ
+
+195
+00:13:58,510 --> 00:14:03,440
+بوبوز تتكون برضه ناتجة عن ال infectionإذا المتفقين
+
+196
+00:14:03,440 --> 00:14:09,560
+الآن إنه فينا أربع أشكال أربع أشكال رئيسية من مين؟
+
+197
+00:14:09,560 --> 00:14:12,900
+من الـ Chlamydia Trachomatis Infection واحدة
+
+198
+00:14:12,900 --> 00:14:17,460
+تراكوما Primarily بتبصي بالعين STD Neonatal
+
+199
+00:14:17,460 --> 00:14:22,060
+Infection و الينفجرانيلومافنيريومكيف؟ على أي أساس
+
+200
+00:14:22,060 --> 00:14:26,400
+ميزناهم؟ ميزناهم إما على مكان الإصابة والـ strain
+
+201
+00:14:26,400 --> 00:14:31,840
+تمام أو على ال age لأن الأطفال مثلا أو ال neonate
+
+202
+00:14:31,840 --> 00:14:36,000
+عفوا و الأمهات أخدوا نفس ال strains لكن الأمر تبقى
+
+203
+00:14:36,000 --> 00:14:41,240
+هم أكيد مختلف الأمهات .. طيب في condition خامس وهو
+
+204
+00:14:41,240 --> 00:14:47,470
+ليس له علاقة مباشرةبال bacterial infection وإنما
+
+205
+00:14:47,470 --> 00:14:50,350
+إيه له علاقة بال immune response اللي هو ال writer
+
+206
+00:14:50,350 --> 00:14:56,750
+disease ويعتبر autoimmune disease الآن فاكرين
+
+207
+00:14:56,750 --> 00:15:02,470
+درسنا بكتيريا اسمها streptococcus biogenes أحد أهم
+
+208
+00:15:02,470 --> 00:15:06,570
+ال complications rheumatic fever كان لها ولمّا
+
+209
+00:15:06,570 --> 00:15:10,430
+شرحنا rheumatic fever قلنا هو عبارة عنالـ
+
+210
+00:15:10,430 --> 00:15:13,910
+Antibodies اللي نشأت للأنتيجينات تبع الـ
+
+211
+00:15:13,910 --> 00:15:17,070
+streptococcus biodein لم تهاجم لـ streptococcus
+
+212
+00:15:17,070 --> 00:15:20,670
+biodein فحسب بل هاجمت عضلة القلب و بعض ال أنتيجيات
+
+213
+00:15:20,670 --> 00:15:26,770
+الأخرى، ليش؟ لأن هناك تشابه بين أنتيجينات عضلة
+
+214
+00:15:26,770 --> 00:15:30,810
+القلب و أنتيجينات الـ streptococcus biodein إيش
+
+215
+00:15:30,810 --> 00:15:36,700
+بنسمي الظاهرة هذه؟ Antigenic Mimicryمن كلمة mimic،
+
+216
+00:15:36,700 --> 00:15:43,240
+محاكات، شوفوا الآن الحكمة من الموضوع هذا، بدنا
+
+217
+00:15:43,240 --> 00:15:45,500
+نميزها عن الـantigenic variation الـantigenic
+
+218
+00:15:45,500 --> 00:15:48,540
+variation، البكتيريا بتغير كل .. أو الفيروس بيغير
+
+219
+00:15:48,540 --> 00:15:54,180
+انتجناته، بس هنا في محاكاة أو شبه بين انتجنات
+
+220
+00:15:54,180 --> 00:16:02,250
+البكتيريا وكمان مرة شبه وليس تطابقلكن عندما ينتج
+
+221
+00:16:02,250 --> 00:16:07,950
+الانتجين من خلايا الخلايا الخاصة ليست عالية
+
+222
+00:16:07,950 --> 00:16:12,170
+فبيرتبط بالبكتيريا و بخلايا أخرى في هذه الحالة
+
+223
+00:16:12,170 --> 00:16:17,150
+اللي قدامكوا بيرتبط بخلايا الوريثرة و جوينتز
+
+224
+00:16:17,670 --> 00:16:20,310
+وبالتالي ايش ال symptoms اللي هتكون عنده؟
+
+225
+00:16:20,310 --> 00:16:24,770
+أريثرايتس زائد يوريثرايتس حتى كان، يعني عنده UTI
+
+226
+00:16:24,770 --> 00:16:30,070
+وكان عنده UTI لإن الوريثرا inflamed نتيجة اللي هو
+
+227
+00:16:30,070 --> 00:16:33,230
+ارتباط ال antibody ومهاجمته وكل كنت تعرف ان ال
+
+228
+00:16:33,230 --> 00:16:36,500
+antibody لما بيرتبط بالخليةالأنتيبودي بيعمل
+
+229
+00:16:36,500 --> 00:16:38,280
+activation لل complement والcomplement بيعمل
+
+230
+00:16:38,280 --> 00:16:41,860
+destruction للأنسجة وبالتالي بيصير فيه ان بالفعل
+
+231
+00:16:41,860 --> 00:16:45,540
+inflammation في المنطقة هبصير فيه pain فالشعور
+
+232
+00:16:45,540 --> 00:16:50,040
+الآن انه عنده UTI لكن لو عملنا لمزرعة عيش هتكون
+
+233
+00:16:52,090 --> 00:16:57,110
+negative، ماعندوش أي microbe، ال destruction ناتجة
+
+234
+00:16:57,110 --> 00:17:00,770
+على مين؟ لأ لأ، حتى لو .. حتى لو بنعمل .. لو .. لو
+
+235
+00:17:00,770 --> 00:17:03,610
+.. لو افترض أن البكتيريا من النوع اللي بنقدر ننميه
+
+236
+00:17:03,610 --> 00:17:07,310
+أو نمينا عينة اليوران على cell culture، لن تنمو،
+
+237
+00:17:07,310 --> 00:17:11,170
+لأن أنا ماعنديش بكتيريا، أنا عندي antigen-antibody
+
+238
+00:17:11,170 --> 00:17:16,660
+reaction فقطمتفقين الآن إيش الأضواء الخامسة اللي
+
+239
+00:17:16,660 --> 00:17:20,640
+إحنا القناها على ال diseases كمان مرة Trachoma رقم
+
+240
+00:17:20,640 --> 00:17:25,340
+اتنين STD رقم تلاتة Neonatal رقم أربعة Lymph
+
+241
+00:17:25,340 --> 00:17:28,160
+Granulovirium و هي رقم خامسة اللي هي autoimmune
+
+242
+00:17:28,160 --> 00:17:33,230
+disease يسميناها Reiter Syndromeطبعا لأنه ال
+
+243
+00:17:33,230 --> 00:17:37,910
+culture صعبة و بدها cell culture زي ما انتوا
+
+244
+00:17:37,910 --> 00:17:42,450
+شايفينها في اللوحة تمام ففي عندي اللي هو ال
+
+245
+00:17:42,450 --> 00:17:45,570
+microscopy و ال microscopy كده بتدور فيه على
+
+246
+00:17:45,570 --> 00:17:49,830
+inclusion body شوفتوا لما اتكلمنا عن ال life cycle
+
+247
+00:17:49,830 --> 00:17:52,450
+مش بيقولنا فيه elementary body و فيه reticulate
+
+248
+00:17:52,450 --> 00:17:57,230
+body ال reticulate body بيكون مبين جوا اللي هو ال
+
+249
+00:17:57,230 --> 00:18:02,750
+cytoplasm تبع الخلية المصابةالعينات طبعا varies من
+
+250
+00:18:02,750 --> 00:18:05,990
+حسب الأمراض اللي احنا ذكرناها، ممكن نعمل Jamesa
+
+251
+00:18:05,990 --> 00:18:09,530
+Staining يا شباب، و من خلاله نشوف فيها اللي هو ال
+
+252
+00:18:09,530 --> 00:18:13,650
+.. اللي قلنا ال inclusion body، ال fluorescent
+
+253
+00:18:13,650 --> 00:18:16,730
+antibody staining رائع جدا، نكشف فيها البكيرة
+
+254
+00:18:16,730 --> 00:18:22,310
+مباشرةال PCR تقنية صارت سهلة وميسرة للموضوع ال
+
+255
+00:18:22,310 --> 00:18:25,250
+cell culture بتظل هي ال golden standard لكن هي
+
+256
+00:18:25,250 --> 00:18:30,030
+الأكتر تكلفة ال serodiagnosis و ال serodiagnosis
+
+257
+00:18:30,030 --> 00:18:33,950
+يمكن هو الوحيد المتبع في قطاع غزن أقل الموضوع هذا
+
+258
+00:18:35,030 --> 00:18:38,210
+وبنقدر نشتغل فيه بطريقتين يا شباب، نكشف عن
+
+259
+00:18:38,210 --> 00:18:43,250
+الانتجينات، نكشف عن الانتجينات مباشرة، يعني لو
+
+260
+00:18:43,250 --> 00:18:46,830
+واحد عنده Trachoma، يعني انا قولنا بتعمل infection
+
+261
+00:18:46,830 --> 00:18:50,410
+في ال eye lid دي، في الجفن تبع العين من جوا، لو
+
+262
+00:18:50,410 --> 00:18:55,130
+أخدنا swap تمام، هذا antigen، فيه بكتيرياوكشفنا
+
+263
+00:18:55,130 --> 00:18:59,390
+باستخدام antibody تمام نكشف عنه و بنقدر صح هذا
+
+264
+00:18:59,390 --> 00:19:03,970
+واحد خيار تاني بجاين ال swap urethral discharge
+
+265
+00:19:03,970 --> 00:19:08,390
+تمام او swap برضه ممكن نكشف عنه عن انتجينات و ممكن
+
+266
+00:19:08,390 --> 00:19:12,420
+نكشف عن مينعن Antibody من ال patient serum، إذن فى
+
+267
+00:19:12,420 --> 00:19:15,780
+أننا Zero diagnosis و مولود لكن يا شباب كمان مرة
+
+268
+00:19:15,780 --> 00:19:19,180
+ال detection of antigen is conclusive، conclusive
+
+269
+00:19:19,180 --> 00:19:23,000
+يعني حاسم بينما ال detection of antibodies خاصة
+
+270
+00:19:23,000 --> 00:19:27,500
+لما نتكلم عن IGG بكونش حاسم، إذن بدنا نعرف شو
+
+271
+00:19:27,500 --> 00:19:31,260
+الطرق، الطرق اللي ممكن نوظفها احناو اتذكروا ان
+
+272
+00:19:31,260 --> 00:19:36,400
+احنا جونا هنا في امكانية للاصابة بالبكتيريا
+
+273
+00:19:36,400 --> 00:19:42,500
+بالبكتيريا والبكتيريا قد قد تسبب infertility
+
+274
+00:19:42,500 --> 00:19:47,540
+infertility فهي احد الميكروبات اللي لازم نبحث عنها
+
+275
+00:19:47,540 --> 00:19:51,080
+في حال اللي هو موضوع ال infertility treatment نفس
+
+276
+00:19:51,080 --> 00:19:53,800
+الشيء تترسكل في ال adults erythromycin او
+
+277
+00:19:53,800 --> 00:19:56,840
+azithromycin والتاني بيتبعوا نفس الفصيلة اللي هم
+
+278
+00:19:56,840 --> 00:20:02,850
+ال macro lightsفي اسم بكتيريا جميل وحلو كلماته
+
+279
+00:20:02,850 --> 00:20:07,630
+بكتيريوم جرانيلوميتاس ولو انه كبير لكن سهل كلماته
+
+280
+00:20:07,630 --> 00:20:11,730
+بكتيريوم جرانيلوميتاس وبسبب مرض اسمه جرانيلومة
+
+281
+00:20:11,730 --> 00:20:16,610
+انجوينالي جرانيلومة انجوينالي وجرانيلومة فيها يعني
+
+282
+00:20:16,610 --> 00:20:20,370
+ورم حبيبي وانجوينال في منطقة اللي هو العنى منطقة
+
+283
+00:20:20,370 --> 00:20:25,800
+العنى يعني في الحوضالبكتيريا كان اسمها زمان
+
+284
+00:20:25,800 --> 00:20:28,700
+دونوفان bodies لأن هم ماكانوا مش عارفين اسمها
+
+285
+00:20:28,700 --> 00:20:32,320
+فسموها على اسم الطبيب اللي شافها تحت الميكروسكوب
+
+286
+00:20:32,320 --> 00:20:35,620
+فسموه اجسام دونوفان البكتيريا gram negative بس
+
+287
+00:20:35,620 --> 00:20:41,880
+الله gram negative بس الله طبعا دونوفان bodies فال
+
+288
+00:20:41,880 --> 00:20:45,460
+disease ايه اللي مسموه disease دونوفانوسس فإذا
+
+289
+00:20:45,460 --> 00:20:50,700
+تعرف باسم lymphogranuloma inguinal أو دونوفانوسس
+
+290
+00:20:50,700 --> 00:20:55,000
+وصل الصورةالان ال incubation period من ال first
+
+291
+00:20:55,000 --> 00:20:59,680
+contact مع البكتيريا قد تمتد من عشرة الاربعين يوم،
+
+292
+00:20:59,680 --> 00:21:06,940
+إذا في ten to forty days خلينا نقول incubation
+
+293
+00:21:06,940 --> 00:21:11,140
+period وبيظهر بعد ذلك اللي هو ال genital lesion
+
+294
+00:21:11,140 --> 00:21:16,920
+وهو عبارة عن small و painless ولحظوا كمان مرة معظم
+
+295
+00:21:17,490 --> 00:21:22,690
+ال .. ال .. ال infections اللي سمناها STD كانت
+
+296
+00:21:22,690 --> 00:21:26,950
+البثارات أو الحبوب أو ال legions اللي طلع كانت
+
+297
+00:21:26,950 --> 00:21:34,870
+ايش؟ painless غير مؤلمة لكن بعد فترة بتبين وجهها
+
+298
+00:21:34,870 --> 00:21:42,720
+القبيحتنفجر و بيصير فيها مفتوحة تمام و بتبدأ
+
+299
+00:21:42,720 --> 00:21:46,040
+بالظهور بشكل fleshy fleshy اللي هو يعني بتعرف
+
+300
+00:21:46,040 --> 00:21:49,980
+اللحم لما يتعرض يعني انجرح كيف بيكون شكله له شكل
+
+301
+00:21:49,980 --> 00:21:54,900
+معين اللون تبعه مظبوط و ال بالمس تبعه بيختلف عن ال
+
+302
+00:21:54,900 --> 00:21:59,120
+skin فالان هي بتعطينا appearance انها fleshy
+
+303
+00:21:59,120 --> 00:22:05,970
+oozing يعني بتترسب سوائل يعني بتطلع كمان سوائلالـ
+
+304
+00:22:05,970 --> 00:22:07,790
+General Characteristics البكتيريا عبارة عن
+
+305
+00:22:07,790 --> 00:22:13,710
+Capsulated Gram Negative Bacilli وهي STD كمان مرة
+
+306
+00:22:13,710 --> 00:22:17,010
+Sexual Transmitted Disease with Higher Incidence
+
+307
+00:22:17,010 --> 00:22:21,630
+in Homosexuals Homosexuals يعني المثليين يعني
+
+308
+00:22:21,630 --> 00:22:25,910
+الرجال اللي هم مش رجال تمام المثليين وهم منتشرون
+
+309
+00:22:25,910 --> 00:22:29,850
+في العالم الغربي على الرغم من أن العلم أثبت لهم
+
+310
+00:22:30,690 --> 00:22:34,130
+بدون أدنى شك ان هدول الناس اللى كمان مرة بيقولهم
+
+311
+00:22:34,130 --> 00:22:39,190
+ناس ان هدول الناس أحد أكبر المصائب اللى حلت على
+
+312
+00:22:39,190 --> 00:22:44,170
+البشر في القرون الماضية ليش لأنه ساهموا في نشر
+
+313
+00:22:44,170 --> 00:22:48,890
+الأمراض بطريقة غريبة عجيبة من ضمنها ال HIV وال HIV
+
+314
+00:22:48,890 --> 00:22:53,690
+معروف عنه انتشاره في ال homosexuals أعلى بكتير من
+
+315
+00:22:53,690 --> 00:22:57,400
+ال heterosexualsفكذلك الأمراض نفس الأمراض اللي هي
+
+316
+00:22:57,400 --> 00:23:02,960
+الأخرى يعني للأسف ساهم بناشرها بشكل كبير طبعا هم
+
+317
+00:23:02,960 --> 00:23:06,620
+بنتكلم هذا الكلام دائما و بنكرره و بنقول أن الحمد
+
+318
+00:23:06,620 --> 00:23:12,440
+لله ربنا يعني أننا خلقنا مسلمين لانعاني من مثل هذه
+
+319
+00:23:12,440 --> 00:23:19,400
+القضايا بشكل كبير لكن لكنبدنا نكون وعيين ومدركين
+
+320
+00:23:19,400 --> 00:23:24,300
+ان هذه الفئة عرضة لإصابة بأمراض خطيرة من هذا النوع
+
+321
+00:23:24,300 --> 00:23:29,320
+وقد يحدث .. يحدث فيهم حتى mutation للفيروسات و
+
+322
+00:23:29,320 --> 00:23:32,420
+اعتقد انه .. يعني احنا بتعرف ال HIV الآن في HIV 1
+
+323
+00:23:32,420 --> 00:23:36,060
+و HIV 2ال .. ال .. ال .. ال mutations و ال
+
+324
+00:23:36,060 --> 00:23:39,260
+resistance لل drugs غالبا بينتج او .. او .. او
+
+325
+00:23:39,260 --> 00:23:43,060
+بيحدث في هؤلاء اللي فيها من البشر عموما هذا ال ..
+
+326
+00:23:43,060 --> 00:23:45,940
+ال .. ال micro بنتقل عن طريق ال genes لكن كمان
+
+327
+00:23:45,940 --> 00:23:48,700
+ممكن ينتقل عن طريق اللمس و بعض الأحيان بيسمو
+
+328
+00:23:48,700 --> 00:23:52,780
+kissing ulcers يعني .. يعني مجرد الاحتكاك الجسدي
+
+329
+00:23:52,780 --> 00:23:56,820
+ممكن ينقل هذا ال .. ال .. ال micro برضه ال
+
+330
+00:23:56,820 --> 00:23:59,080
+treatment بعته بال tetracycle
+
+331
+00:24:02,840 --> 00:24:05,600
+يبقى بنقدر نقول احنا ناكل أنهينا الجزء المتعلق
+
+332
+00:24:05,600 --> 00:24:11,380
+بمين بالـChlamydia اليوم فيه أنه ميكروب احنا بنعرف
+
+333
+00:24:11,380 --> 00:24:16,180
+معلومات عنه مسبقا بأنه أصغر free living the
+
+334
+00:24:16,180 --> 00:24:20,540
+smallest free living ميكروب أو بكتيريا بالأحرى وهو
+
+335
+00:24:20,540 --> 00:24:25,920
+يوازي في حجمه أكبر حجم للفيروس بتعرف ال smallpox
+
+336
+00:24:25,920 --> 00:24:30,670
+اللي هو الفيروس الجدريsmall box هذا معروف عنه ان
+
+337
+00:24:30,670 --> 00:24:34,130
+هو الويروس الأكبر تمام فبقول ان ال micro plasma
+
+338
+00:24:34,130 --> 00:24:38,150
+تقريبا بحجم اللي هو ال small box فأصغر بكتيريا
+
+339
+00:24:38,150 --> 00:24:42,810
+مساوية لأكبر ويروس ال general characteristics it
+
+340
+00:24:42,810 --> 00:24:46,750
+is the smallest free living bacteria فاكريني لما
+
+341
+00:24:46,750 --> 00:24:49,940
+اتكلمت مع ال campylobactaكان بالوبا اكتر مش كنا
+
+342
+00:24:49,940 --> 00:24:54,120
+بنعملها filtration احنا و كنا خايفين انه ال micro
+
+343
+00:24:54,120 --> 00:24:59,800
+plasma هي الوحيدة لانه حجمها قريب فتنزل لكن
+
+344
+00:24:59,800 --> 00:25:06,000
+ماخوفنا من النتيجة انه قلنالكوا انهزمان عاد شكلة
+
+345
+00:25:06,000 --> 00:25:10,800
+أجار هذا الـ slow growing required at least one
+
+346
+00:25:10,800 --> 00:25:14,120
+week one week for growth بينما ال Campylobacter
+
+347
+00:25:14,120 --> 00:25:18,200
+كان بدها 48 ساعة لنمو فماكانش فيه خوف في هذا
+
+348
+00:25:18,200 --> 00:25:23,220
+المجال لكن الحقيقة بالتبقى أن هذه مش obligate
+
+349
+00:25:23,220 --> 00:25:26,600
+intracellular parasites أنا قلت عنها the smallest
+
+350
+00:25:26,600 --> 00:25:29,760
+free living يعني تستطيع أنه تستطيع أن نميها على
+
+351
+00:25:29,760 --> 00:25:34,000
+artificial media لكن بدها بالفعل rich media السؤال
+
+352
+00:25:34,000 --> 00:25:40,760
+التانيبكتيريا بدون cell wall كيف لها أن تعيش في
+
+353
+00:25:40,760 --> 00:25:45,900
+هذا العالم الخشن العالم المليء بالـ fluctuation في
+
+354
+00:25:45,900 --> 00:25:49,720
+الـ osmotic environment يعني مرة بتدخل بمية مالحة
+
+355
+00:25:49,720 --> 00:25:54,860
+مرة بتدخل بمية حلوة مرة تدخل في مرتبان في مواد
+
+356
+00:25:54,860 --> 00:25:58,980
+كيموية فكيف لها و احنا بنعرف ان ال cell wall هو
+
+357
+00:25:58,980 --> 00:26:02,940
+احد ال components المسؤول عن شكل البكتيرياومسؤول
+
+358
+00:26:02,940 --> 00:26:07,180
+عن حمايتها من الـ Osmotic Lyses لو وجعت فيه يعني
+
+359
+00:26:07,180 --> 00:26:11,060
+محليل أو في بيئات الدغط الأسموذي تبقى غير مناسب
+
+360
+00:26:11,060 --> 00:26:15,820
+للبكتيريا بالظبط وجود استرال في ال cell membrane
+
+361
+00:26:15,820 --> 00:26:19,040
+بيعطيها هذه ال capability بيعطيها هذه ال
+
+362
+00:26:19,040 --> 00:26:25,140
+capability ال micro plasma بطبيعتها جونه مالهاش
+
+363
+00:26:25,140 --> 00:26:29,340
+cell wall وبالتالي هي resistant resistant to مين؟
+
+364
+00:26:30,450 --> 00:26:34,510
+to cell wall inhibitors زي ال penicillins and
+
+365
+00:26:34,510 --> 00:26:39,050
+cephalosporins لأنه مالهاش cell wall كمان احنا
+
+366
+00:26:39,050 --> 00:26:44,210
+بنعرف ان ال gram stain اصلا يعني بيصبغ البكتيريا
+
+367
+00:26:44,210 --> 00:26:46,590
+وميزنا ال gram positive عن ال gram negative بين
+
+368
+00:26:46,590 --> 00:26:49,390
+العالمين على ال cell wall structure طب هذه مالهاش
+
+369
+00:26:49,390 --> 00:26:53,070
+cell wall عشان كده it is poorly stained with اللي
+
+370
+00:26:53,070 --> 00:26:55,030
+هو gram stain
+
+371
+00:26:57,730 --> 00:26:59,890
+البكتيريا جون عنها slow growing في artificial
+
+372
+00:26:59,890 --> 00:27:03,830
+media، في كمان ميزة مميزة صحيلها أن مستعمراتها
+
+373
+00:27:03,830 --> 00:27:08,470
+بتشبه البيض المقلي، بيسموها fried egg appearance
+
+374
+00:27:08,470 --> 00:27:13,370
+colonies، خاصة .. خاصة يا شباب ال old culture،
+
+375
+00:27:13,370 --> 00:27:19,170
+يعني المزرعة لما بيصير عمرها طويلأعتقد هذه الصورة
+
+376
+00:27:19,170 --> 00:27:23,930
+بتبين أن اللي فوق بتبين أن الشكل اللي احنا نقول
+
+377
+00:27:23,930 --> 00:27:26,710
+عنه fried egg appearance بتلاحظه في المنتصف فيه زي
+
+378
+00:27:26,710 --> 00:27:32,100
+العين، المنتصف المستعمر مثلا زي هذه، تمام؟طبعا بعد
+
+379
+00:27:32,100 --> 00:27:36,800
+فترة ممكن تصير فيه نوع من ال irregular edges هنا
+
+380
+00:27:36,800 --> 00:27:41,220
+فبعطينا الشكل الأوضح لل fried egg appearance هذا
+
+381
+00:27:41,220 --> 00:27:45,060
+الوسط اللي .. اللي بيستخدموه ل .. ال .. سموه PPLO
+
+382
+00:27:45,060 --> 00:27:49,040
+أجار P-P-L-O طبعا P-P-L-O مش palestinian
+
+383
+00:27:49,040 --> 00:27:53,400
+liberation organization ال P-P-L-O هو عبارة عن اسم
+
+384
+00:27:53,400 --> 00:27:57,930
+اختصار ل plural pneumonia like organismsوهذا الاسم
+
+385
+00:27:57,930 --> 00:28:00,970
+القديم للـ Mycoplasma كان سموها Blue pneumonia
+
+386
+00:28:00,970 --> 00:28:03,470
+-like microorganism و التالي، الوسط دلوا بنفس اللي
+
+387
+00:28:03,470 --> 00:28:08,970
+هو المسمى، بس واضح أنه طبعا الوسط يعني غني جدا،
+
+388
+00:28:08,970 --> 00:28:13,530
+بيحتوي على Beef Heart و Infusion وBeptone Sodium
+
+389
+00:28:13,530 --> 00:28:18,820
+Chlorideفينا الأسماء المشهورة أو الاسم المشهور
+
+390
+00:28:18,820 --> 00:28:21,220
+حقيقة في ال microplasma أكتر اسم مشهور اللي هو
+
+391
+00:28:21,220 --> 00:28:25,820
+microplasma نيومونيا وبسبب انه primary atypical
+
+392
+00:28:25,820 --> 00:28:29,760
+pneumonia اعتقد ان احنا قلنا قبل شويه ال chlamydia
+
+393
+00:28:29,760 --> 00:28:34,040
+pneumonia بتعمل atypical pneumonia شبيه بمين؟ بال
+
+394
+00:28:34,040 --> 00:28:38,280
+microplasma النيومونيا common in summer and late
+
+395
+00:28:38,280 --> 00:28:41,100
+autumn طبعا هذا في بعض البلدان إذا بتلاحظوا في ال
+
+396
+00:28:41,100 --> 00:28:42,980
+.. اخر جملة هنا
+
+397
+00:28:46,340 --> 00:28:50,260
+common incidence in winter فيبدو انه نقطة لازم
+
+398
+00:28:50,260 --> 00:28:53,580
+نناقشها موضوع ما يسمى بال seasonality of diseases
+
+399
+00:28:53,580 --> 00:28:58,960
+هذه نقطة كتير مهمة للاستيعاب الفروقات وللتخطيط
+
+400
+00:28:58,960 --> 00:29:03,760
+للقضاء على ال infectious diseases احساس عام عند
+
+401
+00:29:03,760 --> 00:29:10,700
+الناس انه فيروس الرشح و ال influenza متى بتكون في
+
+402
+00:29:10,700 --> 00:29:16,870
+فصل الشتاء اكتر صح؟يبقى ال low temperature ال
+
+403
+00:29:16,870 --> 00:29:20,950
+humidity ممكن تكون بعض ال practices بعض ال
+
+404
+00:29:20,950 --> 00:29:23,930
+practices الناس في الصيف بتميل إلى أنه تبعد عن بعض
+
+405
+00:29:23,930 --> 00:29:29,460
+شوب حرفي شتاء بتميل انها تكون ايه؟ قريبة من بعض
+
+406
+00:29:29,460 --> 00:29:33,440
+فربما يكون المسافة فقط هي العامل فانا اللي بتقوله
+
+407
+00:29:33,440 --> 00:29:38,240
+انه لما احنا نعرف انه في اختلافات لل Epidemiology
+
+408
+00:29:38,240 --> 00:29:42,200
+يعني ال incidence لل disease من فصل لفصل بتحاول
+
+409
+00:29:42,200 --> 00:29:47,040
+نقدر نفسر لماذا هذه الاختلافات قد يكون الأمر متعلق
+
+410
+00:29:47,040 --> 00:29:50,180
+بال temperature قد يكون الأمر متعلق كمان مرة
+
+411
+00:29:50,180 --> 00:29:54,580
+بالسلوك تبعنا انه ناجم عن ال temperature مش عن ال
+
+412
+00:29:54,580 --> 00:29:57,420
+temperature نفسهايعني الفيروس ماهوش علاقة بالصيف
+
+413
+00:29:57,420 --> 00:30:00,380
+والشتاء جد ما هو اللي هو علاقة بسلوكنا احنا في
+
+414
+00:30:00,380 --> 00:30:05,940
+الصيف والشتاء تمام؟ هذه كتير نقطة مهمة طيب common
+
+415
+00:30:05,940 --> 00:30:09,580
+in late summer and early autumn بينتقل عن طريق ال
+
+416
+00:30:09,580 --> 00:30:13,080
+droplets يعني ايش معنى الحكي؟ respiratory tract او
+
+417
+00:30:13,080 --> 00:30:16,100
+respiratory route البكتيريا بتعمل adherence
+
+418
+00:30:16,100 --> 00:30:19,560
+للrespiratory epithelium وبتعمل inhibition لل cell
+
+419
+00:30:19,560 --> 00:30:24,880
+reaction بذكركم مين؟Inhibition للـ Ciliary Action
+
+420
+00:30:24,880 --> 00:30:28,720
+أو Interference مع الـ Ciliary Actionتحدثنا عن
+
+421
+00:30:28,720 --> 00:30:31,700
+ميكروب عنده المقدرة على الـ interference مع الـ
+
+422
+00:30:31,700 --> 00:30:35,480
+cilia reaction الـ cilia reaction اللي .. اللي
+
+423
+00:30:35,480 --> 00:30:41,840
+بيترد لـ sputum وقلنا عنه انه احد اسباب البروجرسم
+
+424
+00:30:41,840 --> 00:30:47,260
+اللي هو ال .. النوبة تبت السعال الديكي انه ناتج عن
+
+425
+00:30:47,260 --> 00:30:50,140
+الارتباط تبع البكتيريا بالسيلية فلما نعمل cilia
+
+426
+00:30:50,140 --> 00:30:54,640
+reaction inhibition بصير في accumulationللـ sputum
+
+427
+00:30:54,640 --> 00:30:57,060
+وبالتالي اللي بيحصل فيه اللي هي ال cuffing
+
+428
+00:30:57,060 --> 00:31:00,540
+mechanism بسبب دمج للابيثليام للابيثليام
+
+429
+00:31:00,540 --> 00:31:05,560
+والبكتيريا او اكتر بتكون common في ال children and
+
+430
+00:31:05,560 --> 00:31:11,600
+young adults ال clinical feature ممكن يحصل في ال
+
+431
+00:31:11,600 --> 00:31:15,580
+sore throat ال fever و ال headache طبعا كلمة sore
+
+432
+00:31:15,580 --> 00:31:18,820
+throat معناها التهابات في الحلق بشكل عام التهابات
+
+433
+00:31:18,820 --> 00:31:22,950
+في الحلقممكن فيانا يصير الـ Cough with small
+
+434
+00:31:22,950 --> 00:31:29,110
+amount of whitish nonpurulent sputum يعني مافيش
+
+435
+00:31:29,110 --> 00:31:32,510
+فيه صديد يعني لو احنا أخدنا ال sputum فقط بيكون
+
+436
+00:31:32,510 --> 00:31:37,250
+ميوكاس مافيش فيه أي صديد some extra pulmonary
+
+437
+00:31:37,250 --> 00:31:40,460
+symptoms ايش يعني extra pulmonary symptoms؟يعني مش
+
+438
+00:31:40,460 --> 00:31:45,040
+بس متعلقة بال lungs ممكن يكون متعلقة باماكن اخرى
+
+439
+00:31:45,040 --> 00:31:49,080
+opacity on chest x-ray opacity يعني عتامة في ال x
+
+440
+00:31:49,080 --> 00:31:53,640
+-ray تبعت اللي هو الصدر كلمة immunity incomplete
+
+441
+00:31:53,640 --> 00:31:59,260
+معناه الحكي انه لو أصيب الشخص بالبكتيريا و شفية
+
+442
+00:31:59,260 --> 00:32:04,020
+منها بعد فترة وجيزة اتعرض إلها أمام ممكن تصيرها
+
+443
+00:32:04,020 --> 00:32:08,800
+معناه الحكي ان ال immunity بتاعمش lasting يعني ..
+
+444
+00:32:08,800 --> 00:32:14,960
+يعني بالفعل قصيرة أو incomplete عشان
+
+445
+00:32:14,960 --> 00:32:18,620
+الـ Urea Plasma Urealyticum تابعة لـ Mycoplasma
+
+446
+00:32:18,620 --> 00:32:21,620
+كان اسمها زمان Mycoplasma Urealyticum لكن لهم
+
+447
+00:32:21,620 --> 00:32:25,780
+اسمها Urea Plasma واضح من اسمها يعني احنا مركزين
+
+448
+00:32:25,780 --> 00:32:30,080
+على Urea Plasma Urealyticum التنتين Urea Urea
+
+449
+00:32:30,080 --> 00:32:37,410
+وبالتالي اكيد عندها كمية الـ Urea's عاليةأن جي يو
+
+450
+00:32:37,410 --> 00:32:45,990
+نان جونو كوكل نان كلميديال يوريثريتس ان من شفتوها
+
+451
+00:32:46,980 --> 00:32:50,880
+Diseases non-gonococcal, non-chlamydial، لكن تصنف
+
+452
+00:32:50,880 --> 00:32:55,380
+مع مين طبعا؟ تصنف مع NGU، non-gonococcal
+
+453
+00:32:55,380 --> 00:32:59,740
+urethritis طبعا ال differentiation بينها وبين ال
+
+454
+00:32:59,740 --> 00:33:03,920
+microplasma مبني أساسا على اليوريز enzyme
+
+455
+00:33:03,920 --> 00:33:07,800
+production زي ال .. و .. و .. و .. تتشبه مع ال
+
+456
+00:33:07,800 --> 00:33:10,340
+microplasma، لأن احنا قلنا كوكاريسيا زمان ايه؟
+
+457
+00:33:10,340 --> 00:33:13,920
+microplasmaلكن التشابه مع ال micro plasma في أنه
+
+458
+00:33:13,920 --> 00:33:16,600
+بتعطينا نفس الشكل تبقى المستعمرات اللي هو fried
+
+459
+00:33:16,600 --> 00:33:20,680
+egg appearance اذا وجه التشابه انه تنتين wallace
+
+460
+00:33:20,680 --> 00:33:23,380
+بكتيريا التنتين بيعطينا نفس ال appearance تبقى
+
+461
+00:33:23,380 --> 00:33:27,360
+المستعمرات لكن الاختلاف او التمييز بينهم مبني على
+
+462
+00:33:27,360 --> 00:33:31,620
+إنتاج اليوريز أو عدم إنتاج اليوريز وكما ذكرنا اللي
+
+463
+00:33:31,620 --> 00:33:33,980
+هو ال non-gonococcal non-chlamydia urethritis in
+
+464
+00:33:33,980 --> 00:33:38,680
+men postpartum fever in women ما معنى postpartum
+
+465
+00:33:38,680 --> 00:33:42,340
+fever in womenالـ postpartum اللي هي ما بعد
+
+466
+00:33:42,340 --> 00:33:45,540
+الولادة، fever يعني معناه الحاكي .. ماحنا ماروا
+
+467
+00:33:45,540 --> 00:33:49,240
+معانا كتير postpartum و دلها اللي هو اللي سميناهم
+
+468
+00:33:49,240 --> 00:33:53,400
+peripheral sepsis هم النفاذوالـ Transmission بيكون
+
+469
+00:33:53,400 --> 00:33:56,980
+عبر الـ sexual contact لأسف كان فينا دراسة في غزة
+
+470
+00:33:56,980 --> 00:34:01,800
+و أظهرت نسبة يعني أو نساب مخيفة من الـ urea plasma
+
+471
+00:34:01,800 --> 00:34:07,700
+erraticum among women in Gaza و هذا STD STD بمعنى
+
+472
+00:34:07,700 --> 00:34:10,640
+أنه بينتقل عن طريق الجنس و انتقال عن طريق الجنس
+
+473
+00:34:10,640 --> 00:34:14,640
+معناه الحاجة أنه احنا في بلد مش محافظ و هذا الكلام
+
+474
+00:34:14,640 --> 00:34:19,100
+مص صحيحفكان يمكن تفسيراتنا للنتيجة العالية انه
+
+475
+00:34:19,100 --> 00:34:23,340
+خلال جمع العينة من السيدات تمام بيستخدم محل اسمها
+
+476
+00:34:23,340 --> 00:34:26,880
+spiculum قدالي فاتح اللي هو ال vagina حتى يقدر
+
+477
+00:34:26,880 --> 00:34:31,020
+ياخد عينة من أنقر رحم فلو كانت ست واحدة موصبة
+
+478
+00:34:31,020 --> 00:34:34,520
+وماكنش فيه تعقيم جيد فنقل لله وكانت التقنية
+
+479
+00:34:34,520 --> 00:34:39,080
+المستخدمة في الدراسة كانت مستخدمة ال PCR وال PCR
+
+480
+00:34:39,080 --> 00:34:44,230
+بتعرفينخلّي واحد خلّي تان اه انتهى الموضوع بيعملنا
+
+481
+00:34:44,230 --> 00:34:48,390
+detection لأنه عنده high sensitivity results
+
+482
+00:34:49,750 --> 00:34:52,930
+الانتقال by sexual contact كمان مرة ال micro
+
+483
+00:34:52,930 --> 00:34:55,490
+plasma and ureoplasma lab diagnosis ال culture زى
+
+484
+00:34:55,490 --> 00:34:59,690
+ما حكينا في ride egg appearance و على خاص وسط خاص
+
+485
+00:34:59,690 --> 00:35:02,530
+اللى هو ال PPLO اللى هو ال pure pneumonia like
+
+486
+00:35:02,530 --> 00:35:07,090
+organism media او في حاجة اسمها called agglutinine
+
+487
+00:35:07,090 --> 00:35:12,570
+detection عبارة عن فحص antibody detection ادلاجينا
+
+488
+00:35:12,570 --> 00:35:16,490
+ال title واحد لمية و تمانية و عشرين مش من المية و
+
+489
+00:35:16,490 --> 00:35:23,630
+تمانية و عشرين مش مية و تلاتينمش 126 كيف التخييف
+
+490
+00:35:23,630 --> 00:35:28,650
+بتم؟ لو عملتوا مضاعفات اتنين تنفسدوا مضاعفات اتنين
+
+491
+00:35:28,650 --> 00:35:34,210
+اربعة تمانية ستاشر اتنين تلاتين اربع ستين مية
+
+492
+00:35:34,210 --> 00:35:38,850
+تمانية عشرينفهنعمل Serial Dilution Serial Dilution
+
+493
+00:35:38,850 --> 00:35:44,850
+طبعا إذا طلع عندي الفحص positive عند واحد ل 128 أو
+
+494
+00:35:44,850 --> 00:35:51,630
+أعلى من ذلك واحد ل إيش ضعف 256 طبعا ومضاعفتها
+
+495
+00:35:51,630 --> 00:35:56,090
+فبيتطبع الفحص الآن أن المريض عنده Mycoplasma أو
+
+496
+00:35:56,090 --> 00:35:59,630
+Urea Plasma ال treatment نفس الشي تترسك ليه لكن
+
+497
+00:35:59,630 --> 00:36:03,130
+هنا الخيار التاني اللي هو ال Spectinomycin المرة
+
+498
+00:36:03,130 --> 00:36:05,330
+الجاية ان شاء الله بنكمل المحاولة
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..7227743fb4db17a2a31ddc866215729a11303fcd
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 3688, "start": 20.2, "end": 36.88, "text": "طيب بسم الله الرحمن الرحيم احنا بدأنا المحاضرة السابقة في موضوع ال chlamydia و ال micro plasma و ال rickettsia لكن حتى ننطلق ان شاء الله في هذا الجزء بدنا نعمل revision سريع لجزء اللي اشرحناه المرة الماضية اللي هو ال chlamydia", "tokens": [9566, 1829, 3555, 4724, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 1975, 5016, 8315, 47525, 10721, 8315, 9673, 5016, 46958, 25720, 21136, 16758, 28671, 8978, 3714, 2407, 11242, 45367, 2423, 417, 4326, 37622, 4032, 2423, 4532, 22564, 4032, 2423, 367, 618, 18498, 654, 44381, 11331, 49975, 8717, 1863, 9566, 1211, 4587, 16472, 13412, 16606, 21984, 8978, 23758, 25724, 11622, 38207, 47525, 8315, 8717, 25957, 1211, 34218, 8608, 16572, 3615, 5296, 7435, 11622, 38207, 13672, 1829, 1975, 46309, 5016, 8315, 3224, 9673, 25720, 9673, 46958, 10632, 13672, 1829, 31439, 2423, 417, 4326, 37622], "avg_logprob": -0.16481050294130406, "compression_ratio": 1.7169811320754718, 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727.76, "word": " sterility", "probability": 0.885009765625}, {"start": 727.76, "end": 728.02, "word": " يعني", "probability": 0.939697265625}, {"start": 728.02, "end": 728.56, "word": " في", "probability": 0.89990234375}, {"start": 728.56, "end": 729.2, "word": " إمكانية", "probability": 0.85693359375}, {"start": 729.2, "end": 730.9, "word": " لحمل", "probability": 0.6985677083333334}, {"start": 730.9, "end": 731.22, "word": " لكن", "probability": 0.93798828125}, {"start": 731.22, "end": 732.18, "word": " الفرص", "probability": 0.978515625}, {"start": 732.18, "end": 732.6, "word": " أقل", "probability": 0.9666341145833334}, {"start": 732.6, "end": 732.84, "word": " من", "probability": 0.98681640625}, {"start": 732.84, "end": 733.06, "word": " اللي", "probability": 0.9794921875}, {"start": 733.06, "end": 733.34, "word": " هو", "probability": 0.99072265625}, {"start": 733.34, "end": 734.54, "word": " normal", "probability": 0.50732421875}], "temperature": 1.0}, {"id": 32, "seek": 74853, "start": 737.15, "end": 748.53, "text": "طيب احنا تكلمنا عن .. جُلنا التركامة وبعدين جُلنا ال STD لإن اتكلم عن مين؟ عن الـ Neonatal Infection لحظة نفس ال strings نرجع برجوع", "tokens": [9566, 1829, 3555, 1975, 5016, 8315, 6055, 4117, 19528, 8315, 18871, 4386, 10874, 10859, 1211, 8315, 16712, 31747, 10943, 3660, 46599, 22488, 9957, 10874, 10859, 1211, 8315, 2423, 4904, 35, 5296, 28814, 1863, 1975, 2655, 4117, 19528, 18871, 3714, 9957, 22807, 18871, 2423, 39184, 1734, 266, 40478, 682, 1836, 313, 5296, 5016, 19913, 3660, 8717, 36178, 2423, 13985, 8717, 47341, 3615, 4724, 47341, 45367], "avg_logprob": -0.3473557692307692, "compression_ratio": 1.3227848101265822, "no_speech_prob": 0.0, "words": [{"start": 737.15, "end": 737.59, "word": "طيب", "probability": 0.6667073567708334}, {"start": 737.59, "end": 737.79, "word": " احنا", "probability": 0.9060872395833334}, {"start": 737.79, "end": 738.37, "word": " تكلمنا", "probability": 0.8631591796875}, {"start": 738.37, "end": 738.71, "word": " عن", "probability": 0.986328125}, {"start": 738.71, "end": 738.97, "word": " ..", "probability": 0.1082763671875}, {"start": 738.97, "end": 740.83, "word": " جُلنا", "probability": 0.593414306640625}, {"start": 740.83, "end": 741.79, "word": " التركامة", "probability": 0.6444091796875}, {"start": 741.79, "end": 742.09, "word": " وبعدين", "probability": 0.7291666666666666}, {"start": 742.09, "end": 742.29, "word": " جُلنا", "probability": 0.875732421875}, {"start": 742.29, "end": 742.37, "word": " ال", "probability": 0.94677734375}, {"start": 742.37, "end": 742.95, "word": " STD", "probability": 0.7259521484375}, {"start": 742.95, "end": 743.27, "word": " لإن", "probability": 0.5826009114583334}, {"start": 743.27, "end": 743.49, "word": " اتكلم", "probability": 0.8978271484375}, {"start": 743.49, "end": 743.67, "word": " عن", "probability": 0.95654296875}, {"start": 743.67, "end": 744.25, "word": " مين؟", "probability": 0.890625}, {"start": 744.25, "end": 744.47, "word": " عن", "probability": 0.9140625}, {"start": 744.47, "end": 744.69, "word": " الـ", "probability": 0.70263671875}, {"start": 744.69, "end": 745.15, "word": " Neonatal", "probability": 0.83056640625}, {"start": 745.15, "end": 745.71, "word": " Infection", "probability": 0.8522135416666666}, {"start": 745.71, "end": 746.39, "word": " لحظة", "probability": 0.73760986328125}, {"start": 746.39, "end": 747.11, "word": " نفس", "probability": 0.962646484375}, {"start": 747.11, "end": 747.25, "word": " ال", "probability": 0.92626953125}, {"start": 747.25, "end": 747.73, "word": " strings", "probability": 0.354736328125}, {"start": 747.73, "end": 748.07, "word": " نرجع", "probability": 0.85986328125}, {"start": 748.07, "end": 748.53, "word": " برجوع", "probability": 0.6343587239583334}], "temperature": 1.0}, {"id": 33, "seek": 77489, "start": 751.17, "end": 774.89, "text": "الـ Strains أو الـ Stereotypes أو الجنس للإنفكشن من D ل K و النينة للإنفكشن من D ل K مؤشر على إن الأمهات المصابات بالأسطي هم اللي بينقلوا اللي هو الـ Strains هذه لأطفال و كما حكيتلكوا قد تؤثر أو تقدي إلى inclusion conjunctivitis يعني التهفل العين", "tokens": [6027, 39184, 8251, 2315, 34051, 2423, 39184, 745, 323, 19477, 34051, 25724, 1863, 3794, 24976, 28814, 1863, 5172, 4117, 8592, 1863, 9154, 413, 5296, 591, 4032, 28239, 9957, 3660, 24976, 28814, 1863, 5172, 4117, 8592, 1863, 9154, 413, 5296, 591, 3714, 33604, 46309, 15844, 36145, 16247, 2304, 3224, 9307, 9673, 9381, 16758, 9307, 20666, 10721, 3794, 9566, 1829, 8032, 2304, 13672, 1829, 4724, 9957, 4587, 1211, 14407, 13672, 1829, 31439, 2423, 39184, 8251, 2315, 29538, 5296, 10721, 9566, 5172, 6027, 4032, 9122, 15042, 11331, 4117, 36081, 23275, 14407, 12174, 3215, 6055, 33604, 49115, 34051, 6055, 4587, 16254, 30731, 15874, 18244, 349, 592, 16074, 37495, 22653, 16712, 3224, 5172, 1211, 18863, 9957], "avg_logprob": -0.3194754442998341, "compression_ratio": 1.6694915254237288, "no_speech_prob": 0.0, "words": [{"start": 751.17, "end": 751.47, "word": "الـ", 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{"start": 764.01, "end": 764.63, "word": " هم", "probability": 0.58642578125}, {"start": 764.63, "end": 764.79, "word": " اللي", "probability": 0.961669921875}, {"start": 764.79, "end": 765.53, "word": " بينقلوا", "probability": 0.78447265625}, {"start": 765.53, "end": 765.99, "word": " اللي", "probability": 0.672607421875}, {"start": 765.99, "end": 766.21, "word": " هو", "probability": 0.9052734375}, {"start": 766.21, "end": 766.71, "word": " الـ", "probability": 0.6961669921875}, {"start": 766.71, "end": 767.05, "word": " Strains", "probability": 0.6629638671875}, {"start": 767.05, "end": 767.31, "word": " هذه", "probability": 0.75390625}, {"start": 767.31, "end": 768.27, "word": " لأطفال", "probability": 0.7943359375}, {"start": 768.27, "end": 768.37, "word": " و", "probability": 0.556640625}, {"start": 768.37, "end": 768.49, "word": " كما", "probability": 0.606201171875}, {"start": 768.49, "end": 769.07, "word": " حكيتلكوا", "probability": 0.82041015625}, {"start": 769.07, "end": 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اتناشر يوم مع افرازات صددية من العين هذا مؤشر قوي على ان الطفل مصاب بالكلاميديا طبعا كمان ممكن الطفل يصاب ب انيومونيا نتيجة عن اللي هو كلاميديا تراكوماتس", "tokens": [2407, 3714, 43020, 6055, 25957, 1211, 3714, 1829, 2407, 4117, 2407, 4724, 13546, 12610, 7649, 2655, 11778, 1829, 8592, 9640, 7435, 3407, 281, 14390, 1708, 934, 3965, 37495, 22653, 45164, 1357, 116, 3224, 2288, 16712, 11296, 3555, 9307, 8978, 18863, 9957, 9154, 8608, 3555, 3615, 2423, 7578, 1975, 2655, 1863, 33599, 2288, 7251, 20498, 20449, 1975, 5172, 2288, 31377, 9307, 20328, 3215, 3215, 10632, 9154, 18863, 9957, 23758, 3714, 33604, 46309, 12174, 45865, 15844, 16472, 41950, 5172, 1211, 3714, 9381, 16758, 20666, 4117, 37440, 1829, 16254, 995, 23032, 3555, 3615, 995, 9122, 2304, 7649, 3714, 43020, 41950, 5172, 1211, 7251, 9381, 16758, 4724, 16472, 1829, 20498, 11536, 25528, 8717, 31371, 7435, 3660, 18871, 13672, 1829, 31439, 9122, 37440, 1829, 16254, 995, 6055, 23557, 4117, 20498, 9307, 3794], "avg_logprob": 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..be8bce84e5fb8b7487bbc34f24ef1be6ce4fa8f0
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9a8xjpruoFo_raw.srt
@@ -0,0 +1,1992 @@
+1
+00:00:20,200 --> 00:00:24,500
+طيب بسم الله الرحمن الرحيم احنا بدأنا المحاضرة
+
+2
+00:00:24,500 --> 00:00:27,180
+السابقة في موضوع ال chlamydia و ال micro plasma و
+
+3
+00:00:27,180 --> 00:00:30,600
+ال rickettsia لكن حتى ننطلق ان شاء الله في هذا
+
+4
+00:00:30,600 --> 00:00:35,040
+الجزء بدنا نعمل revision سريع لجزء اللي اشرحناه
+
+5
+00:00:35,040 --> 00:00:38,960
+المرة الماضية اللي هو ال chlamydiaالكليميديا كنا
+
+6
+00:00:38,960 --> 00:00:42,320
+عبارة عن obligate intracellular بكتيريا و بتمتلك
+
+7
+00:00:42,320 --> 00:00:46,520
+ريبوزومات زي أي بكتيريا أخرى طبعا هذه الجملة زي ما
+
+8
+00:00:46,520 --> 00:00:50,000
+ذكرنا عشان نأكد على حق أنها ليس لها علاقة
+
+9
+00:00:50,000 --> 00:00:52,620
+بالفيروسات are metabolically deficient و عندها
+
+10
+00:00:52,620 --> 00:00:55,880
+مشكلة في ال ATP production و كنا البعض بسميها
+
+11
+00:00:55,880 --> 00:01:00,700
+energy parasite يعني تتطفل من أجل الطاقة و ليس من
+
+12
+00:01:00,700 --> 00:01:05,440
+أجل أشياء أخرىmorphology البكتيريا small round
+
+13
+00:01:05,440 --> 00:01:08,760
+microorganism تنقسم بالانقسام التنائي البسيط زيها
+
+14
+00:01:08,760 --> 00:01:12,620
+زي أي بكتيريا أخرى لكن ال cell wall بتاعها بيشبه
+
+15
+00:01:12,620 --> 00:01:17,060
+إلى حد كبير ل gram negative بدون بيبتيده إجلايكان
+
+16
+00:01:17,060 --> 00:01:21,250
+حقيقيال species اللي ذكرناهم تلاتة كان هما و
+
+17
+00:01:21,250 --> 00:01:24,370
+الترتيب كما ذكرت المرة الماضية هو ليس للأهمية
+
+18
+00:01:24,370 --> 00:01:27,870
+بمعنى انه ال chlamydia trachomatis is the most
+
+19
+00:01:27,870 --> 00:01:30,830
+important بيليها pneumonia و بعدين cetaceae لكن
+
+20
+00:01:30,830 --> 00:01:34,070
+مرتبين الآن قدامنا chlamydia cetaceae, chlamydia
+
+21
+00:01:34,070 --> 00:01:39,010
+pneumonia, chlamydia trachomatisطبعا كونها
+
+22
+00:01:39,010 --> 00:01:42,130
+obligate intracellular برازايد فمستحيل تنمو على ال
+
+23
+00:01:42,130 --> 00:01:44,090
+culture الميدى العادى اللى بتعرفوها وبالتالي بدها
+
+24
+00:01:44,090 --> 00:01:47,050
+اما cell culture tissue culture زى ما coil cells
+
+25
+00:01:47,050 --> 00:01:50,310
+او على ال chicken embryo و هو غالبا بنحكي انها في
+
+26
+00:01:50,310 --> 00:01:54,490
+ال yolk sac تبع ال chicken embryo ال pathogenesis
+
+27
+00:01:54,490 --> 00:01:58,750
+غالبا البكتيريا عندها المقدرة على الارتباط بال
+
+28
+00:01:58,750 --> 00:02:01,910
+epithelial cells و ال mucous membrane و عندها
+
+29
+00:02:01,910 --> 00:02:05,050
+المقدرة على انها تعمل infection لخلايا ال lungs
+
+30
+00:02:06,880 --> 00:02:09,560
+وحكينا عن ال viral instructors بتذكر وقولنا عندها
+
+31
+00:02:09,560 --> 00:02:14,800
+مقدرة على ال resistance لل phagocytic killing by
+
+32
+00:02:14,800 --> 00:02:18,860
+inhibition of lysozyme أو lysozyme binding to
+
+33
+00:02:18,860 --> 00:02:23,140
+phagozyme يعني بيعملية تكوين الفاجو ليزوزوم بتتمش
+
+34
+00:02:23,140 --> 00:02:27,030
+وبتتر البكتيريا بتصير free داخل البكتيريابتنتج
+
+35
+00:02:27,030 --> 00:02:30,450
+هتلا بيوتوكسين وبتعمل competition بينها و بين
+
+36
+00:02:30,450 --> 00:02:33,790
+العائلة على ال nutrient وهي successful competitor
+
+37
+00:02:33,790 --> 00:02:38,010
+يعني منافس جيد تاخد ال nutrient وبالتالي بتأثر على
+
+38
+00:02:38,010 --> 00:02:44,790
+النمو تبع اللي هو ال host cell كمان قضية كتير مهمة
+
+39
+00:02:44,790 --> 00:02:50,150
+تطرقنا إلها كان أن معظم ال destruction الناتج عن
+
+40
+00:02:50,150 --> 00:02:53,470
+ال chlamydia infection بيكون ناجم عن ال immune
+
+41
+00:02:53,470 --> 00:02:56,330
+response و ال inflammation اللي بينتجها الجسم
+
+42
+00:02:57,960 --> 00:03:02,200
+وحكينا ال diagram هذا شرحناه وقلنا انه اللي أول
+
+43
+00:03:02,200 --> 00:03:05,900
+مرة بنتطرق لحاجة اسمها bacterial life cycle يعني
+
+44
+00:03:05,900 --> 00:03:08,860
+زي ما ذكرنا simple life cycle لكن فيها two forms
+
+45
+00:03:08,860 --> 00:03:11,900
+elementary body وreticulate body وقلنا ال
+
+46
+00:03:11,900 --> 00:03:15,240
+elementary body هو ال infectious form تمام هو ال
+
+47
+00:03:15,240 --> 00:03:18,300
+infectious form بينما ال reticulate body هو اللي
+
+48
+00:03:18,300 --> 00:03:22,150
+بيعمل replication داخل الخليةالان خدوا بالكم
+
+49
+00:03:22,150 --> 00:03:26,550
+النقطة هي خلية whole cell وفيها reticulate body لو
+
+50
+00:03:26,550 --> 00:03:29,710
+انا في لحظة من اللحظات اخدت هذه الخلية وعملت لها
+
+51
+00:03:29,710 --> 00:03:33,270
+صباغة لاحظوا كده كبير الحجم
+
+52
+00:03:36,290 --> 00:03:38,630
+بناخد نص الخلية ال .. ال .. ال epithelia الصح هذا
+
+53
+00:03:38,630 --> 00:03:42,350
+لأ وبالتالي بقدر اشوف حاجة بنسميها inclusion
+
+54
+00:03:42,350 --> 00:03:47,010
+bodies inclusion bodies وهذه على فكرة تستخدم في ال
+
+55
+00:03:47,010 --> 00:03:50,890
+diagnosis للبكتيريا زي ما البعض ممكن درس فيروسات
+
+56
+00:03:50,890 --> 00:03:55,920
+ممكن؟ مين درس فيروسات فيكم؟أخدتوا cytomegalovirus
+
+57
+00:03:55,920 --> 00:04:02,180
+CMV مش معقول درستوا فيروسات ومااخدتوش CMV لكن
+
+58
+00:04:02,180 --> 00:04:06,700
+ذاكرتكوا طبعا ال memory بتعملها كل مرة فورمات و
+
+59
+00:04:06,700 --> 00:04:12,280
+تالي مافيش ذاكرة مستقرة ال cytomegalovirus أحد أهم
+
+60
+00:04:12,920 --> 00:04:15,780
+الـ distinguishing characteristics له انه بيعمل
+
+61
+00:04:15,780 --> 00:04:19,340
+inclusion body بيسموها owl's eye زي عينان البوم
+
+62
+00:04:19,340 --> 00:04:22,840
+عينان البوم بيكون فيه two inclusion bodies غالبا
+
+63
+00:04:22,840 --> 00:04:26,400
+قريبين من بعض بيعطونا اي حق بين احنا بنشوف عينان
+
+64
+00:04:26,400 --> 00:04:30,020
+بوم فبيسموه owl's eye إذا ال inclusion body بتاعة
+
+65
+00:04:30,020 --> 00:04:32,980
+الليكلاميديا كما هنرى لاحقا ان شاء الله هي
+
+66
+00:04:32,980 --> 00:04:38,070
+diagnostic او تستخدم في ال diagnosisالقلميدا
+
+67
+00:04:38,070 --> 00:04:42,030
+سيتاسي اتفقنا على انه هي zoonotic respiratory
+
+68
+00:04:42,030 --> 00:04:46,570
+disease و ال natural habit اتباعتها في الطيور و
+
+69
+00:04:46,570 --> 00:04:49,190
+حكينا ان كانت الطيور المنزلية اللي بنربيها احنا
+
+70
+00:04:49,190 --> 00:04:54,190
+كلزينة زي الببغوات ممكن تكون احد اهم مصادر ال
+
+71
+00:04:54,190 --> 00:04:56,530
+infection طبعا
+
+72
+00:04:57,770 --> 00:05:02,390
+تنتج عن انتقال الميكروب لنا عبر ال respiratory
+
+73
+00:05:02,390 --> 00:05:06,690
+tract من خلال ال dust المحتوي او ال secretions
+
+74
+00:05:06,690 --> 00:05:12,090
+المحتوي على الميكرو Organism ابونا انه very common
+
+75
+00:05:12,090 --> 00:05:16,050
+in poultry workers اللي هو معمال تربية الدواجن
+
+76
+00:05:16,050 --> 00:05:20,450
+اللي بيربوا الدواجن والدواجن مش دجاج بس اه يعني في
+
+77
+00:05:20,450 --> 00:05:27,820
+الوز وفي البط يعني برضه في مزارة لهم صح يعنيالدزيز
+
+78
+00:05:27,820 --> 00:05:31,400
+نيومونيا او سيتاكوسز ال diagnosis عبارة عن عزل
+
+79
+00:05:31,400 --> 00:05:35,480
+للبكتيريا من ال sputum من خلال ال tissue culture
+
+80
+00:05:35,480 --> 00:05:39,360
+او عن طريق اللي هو detection of antibody باستخدام
+
+81
+00:05:39,360 --> 00:05:42,900
+ال complement fixation test و ال treatment ذكرنا
+
+82
+00:05:42,900 --> 00:05:46,360
+انه هيتكرر ال treatment رجمن هذا اللي قدامكوا في
+
+83
+00:05:46,360 --> 00:05:50,820
+معظم أنواع اللي هو الكلاميديا و الركتسيا كتر
+
+84
+00:05:50,820 --> 00:05:56,140
+ساكلين لل adults و erythromycin في الأطفالليش
+
+85
+00:05:56,140 --> 00:06:00,560
+ترساكلين بس في ال adults مش في الأطفال؟ لأنه لا
+
+86
+00:06:00,560 --> 00:06:02,660
+يقطع في ال pregnancy ولا في ال lactating woman
+
+87
+00:06:02,660 --> 00:06:05,780
+اللي هي المردعات ولا في الأطفال لأنه بيأثر على
+
+88
+00:06:05,780 --> 00:06:09,880
+جنمين على ال calcium و .. بالضبط فنمو الأسنان و
+
+89
+00:06:09,880 --> 00:06:14,380
+إيه اللي هو الإعظام. ال chlamydia pneumonia
+
+90
+00:06:14,380 --> 00:06:19,430
+بيسموها Tuarوطوار جاية من أو طوار strain طوار جاية
+
+91
+00:06:19,430 --> 00:06:24,830
+من كلمة تايوان تايوان دولة تمام وAR جاية من acute
+
+92
+00:06:24,830 --> 00:06:28,530
+respiratory فهي عبارة عن acute respiratory
+
+93
+00:06:28,530 --> 00:06:32,490
+infection تم تشخيص الحالة تبعتها في تايوان
+
+94
+00:06:32,490 --> 00:06:36,470
+وبالتالي سميت بهذا الإسم بعدين أطلق عليها اسم
+
+95
+00:06:36,470 --> 00:06:41,790
+Eclamydia pneumonia وهي تشبه ال pneumonia اللي
+
+96
+00:06:41,790 --> 00:06:47,770
+بتنتجها ال micro plasma pneumoniaال treatment كمان
+
+97
+00:06:47,770 --> 00:06:51,210
+مرة زي .. زي الأولانية تترسكلين في ال adults
+
+98
+00:06:51,210 --> 00:06:55,280
+والارترمايسين في ال babiesالميكروب التالت في
+
+99
+00:06:55,280 --> 00:06:57,180
+السلسلة اللي قلناه هو الأهم على الإطلاق واحنا
+
+100
+00:06:57,180 --> 00:07:01,480
+بحاجة إلى بالفعل أنه النقش هذا الموضوع الآن بتوسع
+
+101
+00:07:01,480 --> 00:07:07,900
+أكتر لأنه الميكروب is number one cause of STD in
+
+102
+00:07:07,900 --> 00:07:11,060
+the western hemisphere في العالم الغربي أو نصف
+
+103
+00:07:11,060 --> 00:07:16,000
+الكورة الغربي كان زمان الجنورية هي number one
+
+104
+00:07:16,000 --> 00:07:20,820
+cause of STDGonorrhea is number two، second to
+
+105
+00:07:20,820 --> 00:07:27,620
+what؟ To Chlamydia، إذاً لما نقول إنه أشهر مرض STD
+
+106
+00:07:27,620 --> 00:07:31,740
+يبقى لازم يكون له أهمية خاصة، هذا واحد، رقم اتنين،
+
+107
+00:07:31,740 --> 00:07:37,100
+هذا المرض معروف منذ زمن بعيد إنه أحد أهم أسباب
+
+108
+00:07:37,100 --> 00:07:43,120
+فقدان البصر في الدول الفقيرة ذات المناخ الحار
+
+109
+00:07:43,120 --> 00:07:50,580
+والجاف، يبقى نتكلم عن فقدان للبصربشكل كبير عند
+
+110
+00:07:50,580 --> 00:07:55,280
+المصابين في تلك البلدان يبقى مهم لما نتكلم عن STD
+
+111
+00:07:55,280 --> 00:08:01,080
+متكلم كمان عن في مخاوف انه الأم المصابة تنقل عبر
+
+112
+00:08:01,080 --> 00:08:05,780
+قناة الولادة للطفل تبعها و برضه يصاب بال blindness
+
+113
+00:08:05,780 --> 00:08:09,700
+اذا في انها مجموعة من المخاوف مجموعة من المخاطر
+
+114
+00:08:09,700 --> 00:08:14,500
+بدنا نطلع اليها في ال chlamydia trachomatisأماما
+
+115
+00:08:14,500 --> 00:08:20,760
+هي fifteen stereotypes بيسموهم A to L ABC الاخرى ل
+
+116
+00:08:20,760 --> 00:08:24,500
+L ال transmission ممكن عبر ال sexual زي ما حكينا
+
+117
+00:08:24,500 --> 00:08:27,800
+أو عبر ال passage through birth canal مرور عبر
+
+118
+00:08:27,800 --> 00:08:31,960
+قناة الولادة أو finger to eye يعني واحد لمس
+
+119
+00:08:31,960 --> 00:08:36,740
+البكتيريا تمام و من ثم فاكرين اللي قولنا الإصبع و
+
+120
+00:08:36,740 --> 00:08:40,000
+حكة ال limicus membrane هذه اللي موجودة في ال eye
+
+121
+00:08:41,980 --> 00:08:44,460
+وكلمة Trachoma باللغة العربية مقابلها Trachoma على
+
+122
+00:08:44,460 --> 00:08:48,720
+فكرة اعتقد ان المصطلح الانجليزي هذا مؤخذ من
+
+123
+00:08:48,720 --> 00:08:54,020
+المصطلح العربي بالاساس Trachoma disease ال
+
+124
+00:08:54,020 --> 00:08:58,580
+Trachoma قولنا caused by serotypes A,B,B,A,N,C
+
+125
+00:08:58,580 --> 00:09:02,360
+يعني في اربع serotypes بسببونها اللي هو ب Trachoma
+
+126
+00:09:03,780 --> 00:09:07,220
+بقولنا one of the leading causes of blindness in
+
+127
+00:09:07,220 --> 00:09:09,880
+developing countries with dry and hot weather زي
+
+128
+00:09:09,880 --> 00:09:13,440
+ما حكينا البلدان اللي فيها درجة حرارة مرتفعة
+
+129
+00:09:13,440 --> 00:09:18,460
+والطقس جاف احنا لدينا طقس جاف في غزة ولا إيش؟
+
+130
+00:09:18,460 --> 00:09:21,160
+لدينا رطوبة جيدة، احنا من منطقة ساحلية في ابتالي،
+
+131
+00:09:21,160 --> 00:09:24,900
+لدينا رطوبة لا بقى سابقة chronic وبعدين احنا لانا
+
+132
+00:09:24,900 --> 00:09:27,360
+اعتبر من الدول ذات المناخ الحارة، احنا من الدول
+
+133
+00:09:27,360 --> 00:09:31,760
+المناخ المعتدلة chronic conjunctivitis leads to
+
+134
+00:09:31,760 --> 00:09:35,910
+scarring، هنا النقطةالان انا في اندي infection في
+
+135
+00:09:35,910 --> 00:09:41,090
+العين وبتعمل Asian scar نضبة لما تعمل نضبة في
+
+136
+00:09:41,090 --> 00:09:45,930
+الكورنيا بتهيأنا من الجسم خلاص ال كورنيا بطلت جنب
+
+137
+00:09:45,930 --> 00:09:49,990
+الوظيفة تبعتها فقد البصرة تمام؟ اذا هذا المشكلة
+
+138
+00:09:49,990 --> 00:09:53,110
+الأساسية في هذا ال disease اللي احنا سمينا Trauma
+
+139
+00:09:53,110 --> 00:10:00,470
+لكن هناك ايضا ال STD الان في اندي مصطلح انا اول
+
+140
+00:10:00,470 --> 00:10:04,350
+مرة مر معانا non-gonococcal urethritisليش الـ non
+
+141
+00:10:04,350 --> 00:10:06,190
+-gonococcal urethritis؟ لأن فيها اسمها الـ
+
+142
+00:10:06,190 --> 00:10:09,830
+gonococcal urethritis نيسيريا جونورية لما درسناها
+
+143
+00:10:09,830 --> 00:10:12,570
+احنا في الصيف جنا من الأمراض اللي بتسببها الـ
+
+144
+00:10:12,570 --> 00:10:17,420
+urethritis، اللي هي الجونورية نفسهاالان ما عداها
+
+145
+00:10:17,420 --> 00:10:20,900
+سمية من مسببات الـ urethritis الـ non-gonococcal
+
+146
+00:10:20,900 --> 00:10:24,800
+urethritis لأن في السابق كانت معلوماتنا بتقول ان
+
+147
+00:10:24,800 --> 00:10:28,260
+نيسيريا جنورية هي number one cause هي الأكتر شيء
+
+148
+00:10:28,260 --> 00:10:31,940
+عنها لكن بعد ما اتطورت تقنياتنا وصلنا نعرف نعمل
+
+149
+00:10:31,940 --> 00:10:35,420
+cell culture و نعمل PCR و نعمل .. صلنا نعرف او
+
+150
+00:10:35,420 --> 00:10:39,900
+صلنا نعرف ان في مسببات أخرىلكن اليوم عرفنا ان
+
+151
+00:10:39,900 --> 00:10:43,800
+المسببات الأخرى أكتر شيوعا أصلا من مين من نيسيريا
+
+152
+00:10:43,800 --> 00:10:48,680
+جونوكوكل يوريث رايتس ونان جونوكوكل يوريث رايتس
+
+153
+00:10:48,680 --> 00:10:55,360
+وتختصر ب NGU عشان أن الأخوة اللي في الناد يبقوا
+
+154
+00:10:55,360 --> 00:10:58,960
+عارفين الاختصالات ال NGU معناها نان جونوكوكل يوريث
+
+155
+00:10:58,960 --> 00:11:05,280
+رايتسإذن هي a common cause of non-gonococcal
+
+156
+00:11:05,280 --> 00:11:10,680
+urethritis وبتعطينا characteristic ما يسمى بميوكو
+
+157
+00:11:10,680 --> 00:11:12,940
+-purulent discharge ايش يعني ميوكو-purulent
+
+158
+00:11:12,940 --> 00:11:16,060
+discharge؟ purulent معناها في صديد ميوكو يعني
+
+159
+00:11:16,060 --> 00:11:20,960
+مخاطر، discharge اللي هي الإفرازاتطبعا ال disease
+
+160
+00:11:20,960 --> 00:11:26,740
+احد مخاطره انه قد يتطور الى Epidermitis and
+
+161
+00:11:26,740 --> 00:11:29,540
+Orchitis Orchitis اللي هي التهيأة بالتستس طبعا
+
+162
+00:11:29,540 --> 00:11:34,660
+وبالتالي طبعا هتكلم عن هذا اللي في الذكور في
+
+163
+00:11:34,660 --> 00:11:38,260
+القناة cervicitis and vaginitis and pelvic
+
+164
+00:11:38,260 --> 00:11:41,860
+inflammatory disease pelvic inflammatory disease
+
+165
+00:11:41,860 --> 00:11:46,660
+سواء كان Orchitis او Epidermitis او cervicitis او
+
+166
+00:11:46,660 --> 00:11:50,260
+vaginitis may lead to ato infertility يعني هذا ال
+
+167
+00:11:50,260 --> 00:11:53,600
+disease can cause infertility اللي هي ايش بتقولنا
+
+168
+00:11:53,600 --> 00:11:58,180
+عنها؟ اللي هي .. لأ مش أقم تم هذه ال sterility
+
+169
+00:11:58,180 --> 00:12:01,740
+اللي أقم infertility قلة الإخصاب يعني او مافيش
+
+170
+00:12:01,740 --> 00:12:07,340
+إخصاب خصوبة ل .. ل .. ل .. يعني مصطلح أقل حد من ال
+
+171
+00:12:07,340 --> 00:12:12,840
+sterility يعني في إمكانية لحمل لكن الفرص أقل من
+
+172
+00:12:12,840 --> 00:12:14,540
+اللي هو normal
+
+173
+00:12:17,150 --> 00:12:22,290
+طيب احنا تكلمنا عن .. جُلنا التركامة وبعدين جُلنا
+
+174
+00:12:22,290 --> 00:12:25,710
+ال STD لإن اتكلم عن مين؟ عن الـ Neonatal Infection
+
+175
+00:12:25,710 --> 00:12:28,530
+لحظة نفس ال strings نرجع برجوع
+
+176
+00:12:31,170 --> 00:12:33,390
+الـ Strains أو الـ Stereotypes أو الجنس للإنفكشن
+
+177
+00:12:33,390 --> 00:12:41,350
+من D ل K و النينة للإنفكشن من D ل K مؤشر على إن
+
+178
+00:12:41,350 --> 00:12:46,210
+الأمهات المصابات بالأسطي هم اللي بينقلوا اللي هو
+
+179
+00:12:46,210 --> 00:12:50,690
+الـ Strains هذه لأطفال و كما حكيتلكوا قد تؤثر أو
+
+180
+00:12:50,690 --> 00:12:54,630
+تقدي إلى inclusion conjunctivitis يعني التهفل
+
+181
+00:12:54,630 --> 00:12:59,510
+العينو ممكن تعمل ميوكو
+
+182
+00:12:59,510 --> 00:13:03,010
+بيرولانت ديشارج seven to twelve days after birth
+
+183
+00:13:03,010 --> 00:13:06,570
+يعني لو ظهر التهابات في العين من سبع الى اتناشر
+
+184
+00:13:06,570 --> 00:13:10,790
+يوم مع افرازات صددية من العين هذا مؤشر قوي على ان
+
+185
+00:13:10,790 --> 00:13:15,930
+الطفل مصاب بالكلاميديا طبعا كمان ممكن الطفل يصاب ب
+
+186
+00:13:15,930 --> 00:13:21,940
+انيومونيا نتيجة عن اللي هو كلاميديا تراكوماتسخيار
+
+187
+00:13:21,940 --> 00:13:25,060
+الرابع وهو برضه STD لكن مميز لأن الـ Strain المسبب
+
+188
+00:13:25,060 --> 00:13:30,060
+تبعه مميز اسمه lymphogranuloma venereum أو LGV
+
+189
+00:13:30,060 --> 00:13:34,800
+lymphogranuloma venereum واضح من اسم venereum من
+
+190
+00:13:34,800 --> 00:13:40,040
+venereal و venereal STD يعني sexually transmitted
+
+191
+00:13:40,040 --> 00:13:44,640
+disease إذن في عندنا Strain خاص بسبب
+
+192
+00:13:44,640 --> 00:13:49,140
+lymphogranuloma venereum اللي هو L1 لL3 L1 و L2
+
+193
+00:13:49,140 --> 00:13:54,370
+لL3وهو عبارة عن STD قلنا with lesions on genitalia
+
+194
+00:13:54,370 --> 00:13:58,510
+وفيه lymph node enlargement شباب يعني فيه انتفاخ
+
+195
+00:13:58,510 --> 00:14:03,440
+بوبوز تتكون برضه ناتجة عن ال infectionإذا المتفقين
+
+196
+00:14:03,440 --> 00:14:09,560
+الآن إنه فينا أربع أشكال أربع أشكال رئيسية من مين؟
+
+197
+00:14:09,560 --> 00:14:12,900
+من الـ Chlamydia Trachomatis Infection واحدة
+
+198
+00:14:12,900 --> 00:14:17,460
+تراكوما Primarily بتبصي بالعين STD Neonatal
+
+199
+00:14:17,460 --> 00:14:22,060
+Infection و الينفجرانيلومافنيريومكيف؟ على أي أساس
+
+200
+00:14:22,060 --> 00:14:26,400
+ميزناهم؟ ميزناهم إما على مكان الإصابة والـ strain
+
+201
+00:14:26,400 --> 00:14:31,840
+تمام أو على ال age لأن الأطفال مثلا أو ال neonate
+
+202
+00:14:31,840 --> 00:14:36,000
+عفوا و الأمهات أخدوا نفس ال strains لكن الأمر تبقى
+
+203
+00:14:36,000 --> 00:14:41,240
+هم أكيد مختلف الأمهات .. طيب في condition خامس وهو
+
+204
+00:14:41,240 --> 00:14:47,470
+ليس له علاقة مباشرةبال bacterial infection وإنما
+
+205
+00:14:47,470 --> 00:14:50,350
+إيه له علاقة بال immune response اللي هو ال writer
+
+206
+00:14:50,350 --> 00:14:56,750
+disease ويعتبر autoimmune disease الآن فاكرين
+
+207
+00:14:56,750 --> 00:15:02,470
+درسنا بكتيريا اسمها streptococcus biogenes أحد أهم
+
+208
+00:15:02,470 --> 00:15:06,570
+ال complications rheumatic fever كان لها ولمّا
+
+209
+00:15:06,570 --> 00:15:10,430
+شرحنا rheumatic fever قلنا هو عبارة عنالـ
+
+210
+00:15:10,430 --> 00:15:13,910
+Antibodies اللي نشأت للأنتيجينات تبع الـ
+
+211
+00:15:13,910 --> 00:15:17,070
+streptococcus biodein لم تهاجم لـ streptococcus
+
+212
+00:15:17,070 --> 00:15:20,670
+biodein فحسب بل هاجمت عضلة القلب و بعض ال أنتيجيات
+
+213
+00:15:20,670 --> 00:15:26,770
+الأخرى، ليش؟ لأن هناك تشابه بين أنتيجينات عضلة
+
+214
+00:15:26,770 --> 00:15:30,810
+القلب و أنتيجينات الـ streptococcus biodein إيش
+
+215
+00:15:30,810 --> 00:15:36,700
+بنسمي الظاهرة هذه؟ Antigenic Mimicryمن كلمة mimic،
+
+216
+00:15:36,700 --> 00:15:43,240
+محاكات، شوفوا الآن الحكمة من الموضوع هذا، بدنا
+
+217
+00:15:43,240 --> 00:15:45,500
+نميزها عن الـantigenic variation الـantigenic
+
+218
+00:15:45,500 --> 00:15:48,540
+variation، البكتيريا بتغير كل .. أو الفيروس بيغير
+
+219
+00:15:48,540 --> 00:15:54,180
+انتجناته، بس هنا في محاكاة أو شبه بين انتجنات
+
+220
+00:15:54,180 --> 00:16:02,250
+البكتيريا وكمان مرة شبه وليس تطابقلكن عندما ينتج
+
+221
+00:16:02,250 --> 00:16:07,950
+الانتجين من خلايا الخلايا الخاصة ليست عالية
+
+222
+00:16:07,950 --> 00:16:12,170
+فبيرتبط بالبكتيريا و بخلايا أخرى في هذه الحالة
+
+223
+00:16:12,170 --> 00:16:17,150
+اللي قدامكوا بيرتبط بخلايا الوريثرة و جوينتز
+
+224
+00:16:17,670 --> 00:16:20,310
+وبالتالي ايش ال symptoms اللي هتكون عنده؟
+
+225
+00:16:20,310 --> 00:16:24,770
+أريثرايتس زائد يوريثرايتس حتى كان، يعني عنده UTI
+
+226
+00:16:24,770 --> 00:16:30,070
+وكان عنده UTI لإن الوريثرا inflamed نتيجة اللي هو
+
+227
+00:16:30,070 --> 00:16:33,230
+ارتباط ال antibody ومهاجمته وكل كنت تعرف ان ال
+
+228
+00:16:33,230 --> 00:16:36,500
+antibody لما بيرتبط بالخليةالأنتيبودي بيعمل
+
+229
+00:16:36,500 --> 00:16:38,280
+activation لل complement والcomplement بيعمل
+
+230
+00:16:38,280 --> 00:16:41,860
+destruction للأنسجة وبالتالي بيصير فيه ان بالفعل
+
+231
+00:16:41,860 --> 00:16:45,540
+inflammation في المنطقة هبصير فيه pain فالشعور
+
+232
+00:16:45,540 --> 00:16:50,040
+الآن انه عنده UTI لكن لو عملنا لمزرعة عيش هتكون
+
+233
+00:16:52,090 --> 00:16:57,110
+negative، ماعندوش أي microbe، ال destruction ناتجة
+
+234
+00:16:57,110 --> 00:17:00,770
+على مين؟ لأ لأ، حتى لو .. حتى لو بنعمل .. لو .. لو
+
+235
+00:17:00,770 --> 00:17:03,610
+.. لو افترض أن البكتيريا من النوع اللي بنقدر ننميه
+
+236
+00:17:03,610 --> 00:17:07,310
+أو نمينا عينة اليوران على cell culture، لن تنمو،
+
+237
+00:17:07,310 --> 00:17:11,170
+لأن أنا ماعنديش بكتيريا، أنا عندي antigen-antibody
+
+238
+00:17:11,170 --> 00:17:16,660
+reaction فقطمتفقين الآن إيش الأضواء الخامسة اللي
+
+239
+00:17:16,660 --> 00:17:20,640
+إحنا القناها على ال diseases كمان مرة Trachoma رقم
+
+240
+00:17:20,640 --> 00:17:25,340
+اتنين STD رقم تلاتة Neonatal رقم أربعة Lymph
+
+241
+00:17:25,340 --> 00:17:28,160
+Granulovirium و هي رقم خامسة اللي هي autoimmune
+
+242
+00:17:28,160 --> 00:17:33,230
+disease يسميناها Reiter Syndromeطبعا لأنه ال
+
+243
+00:17:33,230 --> 00:17:37,910
+culture صعبة و بدها cell culture زي ما انتوا
+
+244
+00:17:37,910 --> 00:17:42,450
+شايفينها في اللوحة تمام ففي عندي اللي هو ال
+
+245
+00:17:42,450 --> 00:17:45,570
+microscopy و ال microscopy كده بتدور فيه على
+
+246
+00:17:45,570 --> 00:17:49,830
+inclusion body شوفتوا لما اتكلمنا عن ال life cycle
+
+247
+00:17:49,830 --> 00:17:52,450
+مش بيقولنا فيه elementary body و فيه reticulate
+
+248
+00:17:52,450 --> 00:17:57,230
+body ال reticulate body بيكون مبين جوا اللي هو ال
+
+249
+00:17:57,230 --> 00:18:02,750
+cytoplasm تبع الخلية المصابةالعينات طبعا varies من
+
+250
+00:18:02,750 --> 00:18:05,990
+حسب الأمراض اللي احنا ذكرناها، ممكن نعمل Jamesa
+
+251
+00:18:05,990 --> 00:18:09,530
+Staining يا شباب، و من خلاله نشوف فيها اللي هو ال
+
+252
+00:18:09,530 --> 00:18:13,650
+.. اللي قلنا ال inclusion body، ال fluorescent
+
+253
+00:18:13,650 --> 00:18:16,730
+antibody staining رائع جدا، نكشف فيها البكيرة
+
+254
+00:18:16,730 --> 00:18:22,310
+مباشرةال PCR تقنية صارت سهلة وميسرة للموضوع ال
+
+255
+00:18:22,310 --> 00:18:25,250
+cell culture بتظل هي ال golden standard لكن هي
+
+256
+00:18:25,250 --> 00:18:30,030
+الأكتر تكلفة ال serodiagnosis و ال serodiagnosis
+
+257
+00:18:30,030 --> 00:18:33,950
+يمكن هو الوحيد المتبع في قطاع غزن أقل الموضوع هذا
+
+258
+00:18:35,030 --> 00:18:38,210
+وبنقدر نشتغل فيه بطريقتين يا شباب، نكشف عن
+
+259
+00:18:38,210 --> 00:18:43,250
+الانتجينات، نكشف عن الانتجينات مباشرة، يعني لو
+
+260
+00:18:43,250 --> 00:18:46,830
+واحد عنده Trachoma، يعني انا قولنا بتعمل infection
+
+261
+00:18:46,830 --> 00:18:50,410
+في ال eye lid دي، في الجفن تبع العين من جوا، لو
+
+262
+00:18:50,410 --> 00:18:55,130
+أخدنا swap تمام، هذا antigen، فيه بكتيرياوكشفنا
+
+263
+00:18:55,130 --> 00:18:59,390
+باستخدام antibody تمام نكشف عنه و بنقدر صح هذا
+
+264
+00:18:59,390 --> 00:19:03,970
+واحد خيار تاني بجاين ال swap urethral discharge
+
+265
+00:19:03,970 --> 00:19:08,390
+تمام او swap برضه ممكن نكشف عنه عن انتجينات و ممكن
+
+266
+00:19:08,390 --> 00:19:12,420
+نكشف عن مينعن Antibody من ال patient serum، إذن فى
+
+267
+00:19:12,420 --> 00:19:15,780
+أننا Zero diagnosis و مولود لكن يا شباب كمان مرة
+
+268
+00:19:15,780 --> 00:19:19,180
+ال detection of antigen is conclusive، conclusive
+
+269
+00:19:19,180 --> 00:19:23,000
+يعني حاسم بينما ال detection of antibodies خاصة
+
+270
+00:19:23,000 --> 00:19:27,500
+لما نتكلم عن IGG بكونش حاسم، إذن بدنا نعرف شو
+
+271
+00:19:27,500 --> 00:19:31,260
+الطرق، الطرق اللي ممكن نوظفها احناو اتذكروا ان
+
+272
+00:19:31,260 --> 00:19:36,400
+احنا جونا هنا في امكانية للاصابة بالبكتيريا
+
+273
+00:19:36,400 --> 00:19:42,500
+بالبكتيريا والبكتيريا قد قد تسبب infertility
+
+274
+00:19:42,500 --> 00:19:47,540
+infertility فهي احد الميكروبات اللي لازم نبحث عنها
+
+275
+00:19:47,540 --> 00:19:51,080
+في حال اللي هو موضوع ال infertility treatment نفس
+
+276
+00:19:51,080 --> 00:19:53,800
+الشيء تترسكل في ال adults erythromycin او
+
+277
+00:19:53,800 --> 00:19:56,840
+azithromycin والتاني بيتبعوا نفس الفصيلة اللي هم
+
+278
+00:19:56,840 --> 00:20:02,850
+ال macro lightsفي اسم بكتيريا جميل وحلو كلماته
+
+279
+00:20:02,850 --> 00:20:07,630
+بكتيريوم جرانيلوميتاس ولو انه كبير لكن سهل كلماته
+
+280
+00:20:07,630 --> 00:20:11,730
+بكتيريوم جرانيلوميتاس وبسبب مرض اسمه جرانيلومة
+
+281
+00:20:11,730 --> 00:20:16,610
+انجوينالي جرانيلومة انجوينالي وجرانيلومة فيها يعني
+
+282
+00:20:16,610 --> 00:20:20,370
+ورم حبيبي وانجوينال في منطقة اللي هو العنى منطقة
+
+283
+00:20:20,370 --> 00:20:25,800
+العنى يعني في الحوضالبكتيريا كان اسمها زمان
+
+284
+00:20:25,800 --> 00:20:28,700
+دونوفان bodies لأن هم ماكانوا مش عارفين اسمها
+
+285
+00:20:28,700 --> 00:20:32,320
+فسموها على اسم الطبيب اللي شافها تحت الميكروسكوب
+
+286
+00:20:32,320 --> 00:20:35,620
+فسموه اجسام دونوفان البكتيريا gram negative بس
+
+287
+00:20:35,620 --> 00:20:41,880
+الله gram negative بس الله طبعا دونوفان bodies فال
+
+288
+00:20:41,880 --> 00:20:45,460
+disease ايه اللي مسموه disease دونوفانوسس فإذا
+
+289
+00:20:45,460 --> 00:20:50,700
+تعرف باسم lymphogranuloma inguinal أو دونوفانوسس
+
+290
+00:20:50,700 --> 00:20:55,000
+وصل الصورةالان ال incubation period من ال first
+
+291
+00:20:55,000 --> 00:20:59,680
+contact مع البكتيريا قد تمتد من عشرة الاربعين يوم،
+
+292
+00:20:59,680 --> 00:21:06,940
+إذا في ten to forty days خلينا نقول incubation
+
+293
+00:21:06,940 --> 00:21:11,140
+period وبيظهر بعد ذلك اللي هو ال genital lesion
+
+294
+00:21:11,140 --> 00:21:16,920
+وهو عبارة عن small و painless ولحظوا كمان مرة معظم
+
+295
+00:21:17,490 --> 00:21:22,690
+ال .. ال .. ال infections اللي سمناها STD كانت
+
+296
+00:21:22,690 --> 00:21:26,950
+البثارات أو الحبوب أو ال legions اللي طلع كانت
+
+297
+00:21:26,950 --> 00:21:34,870
+ايش؟ painless غير مؤلمة لكن بعد فترة بتبين وجهها
+
+298
+00:21:34,870 --> 00:21:42,720
+القبيحتنفجر و بيصير فيها مفتوحة تمام و بتبدأ
+
+299
+00:21:42,720 --> 00:21:46,040
+بالظهور بشكل fleshy fleshy اللي هو يعني بتعرف
+
+300
+00:21:46,040 --> 00:21:49,980
+اللحم لما يتعرض يعني انجرح كيف بيكون شكله له شكل
+
+301
+00:21:49,980 --> 00:21:54,900
+معين اللون تبعه مظبوط و ال بالمس تبعه بيختلف عن ال
+
+302
+00:21:54,900 --> 00:21:59,120
+skin فالان هي بتعطينا appearance انها fleshy
+
+303
+00:21:59,120 --> 00:22:05,970
+oozing يعني بتترسب سوائل يعني بتطلع كمان سوائلالـ
+
+304
+00:22:05,970 --> 00:22:07,790
+General Characteristics البكتيريا عبارة عن
+
+305
+00:22:07,790 --> 00:22:13,710
+Capsulated Gram Negative Bacilli وهي STD كمان مرة
+
+306
+00:22:13,710 --> 00:22:17,010
+Sexual Transmitted Disease with Higher Incidence
+
+307
+00:22:17,010 --> 00:22:21,630
+in Homosexuals Homosexuals يعني المثليين يعني
+
+308
+00:22:21,630 --> 00:22:25,910
+الرجال اللي هم مش رجال تمام المثليين وهم منتشرون
+
+309
+00:22:25,910 --> 00:22:29,850
+في العالم الغربي على الرغم من أن العلم أثبت لهم
+
+310
+00:22:30,690 --> 00:22:34,130
+بدون أدنى شك ان هدول الناس اللى كمان مرة بيقولهم
+
+311
+00:22:34,130 --> 00:22:39,190
+ناس ان هدول الناس أحد أكبر المصائب اللى حلت على
+
+312
+00:22:39,190 --> 00:22:44,170
+البشر في القرون الماضية ليش لأنه ساهموا في نشر
+
+313
+00:22:44,170 --> 00:22:48,890
+الأمراض بطريقة غريبة عجيبة من ضمنها ال HIV وال HIV
+
+314
+00:22:48,890 --> 00:22:53,690
+معروف عنه انتشاره في ال homosexuals أعلى بكتير من
+
+315
+00:22:53,690 --> 00:22:57,400
+ال heterosexualsفكذلك الأمراض نفس الأمراض اللي هي
+
+316
+00:22:57,400 --> 00:23:02,960
+الأخرى يعني للأسف ساهم بناشرها بشكل كبير طبعا هم
+
+317
+00:23:02,960 --> 00:23:06,620
+بنتكلم هذا الكلام دائما و بنكرره و بنقول أن الحمد
+
+318
+00:23:06,620 --> 00:23:12,440
+لله ربنا يعني أننا خلقنا مسلمين لانعاني من مثل هذه
+
+319
+00:23:12,440 --> 00:23:19,400
+القضايا بشكل كبير لكن لكنبدنا نكون وعيين ومدركين
+
+320
+00:23:19,400 --> 00:23:24,300
+ان هذه الفئة عرضة لإصابة بأمراض خطيرة من هذا النوع
+
+321
+00:23:24,300 --> 00:23:29,320
+وقد يحدث .. يحدث فيهم حتى mutation للفيروسات و
+
+322
+00:23:29,320 --> 00:23:32,420
+اعتقد انه .. يعني احنا بتعرف ال HIV الآن في HIV 1
+
+323
+00:23:32,420 --> 00:23:36,060
+و HIV 2ال .. ال .. ال .. ال mutations و ال
+
+324
+00:23:36,060 --> 00:23:39,260
+resistance لل drugs غالبا بينتج او .. او .. او
+
+325
+00:23:39,260 --> 00:23:43,060
+بيحدث في هؤلاء اللي فيها من البشر عموما هذا ال ..
+
+326
+00:23:43,060 --> 00:23:45,940
+ال .. ال micro بنتقل عن طريق ال genes لكن كمان
+
+327
+00:23:45,940 --> 00:23:48,700
+ممكن ينتقل عن طريق اللمس و بعض الأحيان بيسمو
+
+328
+00:23:48,700 --> 00:23:52,780
+kissing ulcers يعني .. يعني مجرد الاحتكاك الجسدي
+
+329
+00:23:52,780 --> 00:23:56,820
+ممكن ينقل هذا ال .. ال .. ال micro برضه ال
+
+330
+00:23:56,820 --> 00:23:59,080
+treatment بعته بال tetracycle
+
+331
+00:24:02,840 --> 00:24:05,600
+يبقى بنقدر نقول احنا ناكل أنهينا الجزء المتعلق
+
+332
+00:24:05,600 --> 00:24:11,380
+بمين بالـChlamydia اليوم فيه أنه ميكروب احنا بنعرف
+
+333
+00:24:11,380 --> 00:24:16,180
+معلومات عنه مسبقا بأنه أصغر free living the
+
+334
+00:24:16,180 --> 00:24:20,540
+smallest free living ميكروب أو بكتيريا بالأحرى وهو
+
+335
+00:24:20,540 --> 00:24:25,920
+يوازي في حجمه أكبر حجم للفيروس بتعرف ال smallpox
+
+336
+00:24:25,920 --> 00:24:30,670
+اللي هو الفيروس الجدريsmall box هذا معروف عنه ان
+
+337
+00:24:30,670 --> 00:24:34,130
+هو الويروس الأكبر تمام فبقول ان ال micro plasma
+
+338
+00:24:34,130 --> 00:24:38,150
+تقريبا بحجم اللي هو ال small box فأصغر بكتيريا
+
+339
+00:24:38,150 --> 00:24:42,810
+مساوية لأكبر ويروس ال general characteristics it
+
+340
+00:24:42,810 --> 00:24:46,750
+is the smallest free living bacteria فاكريني لما
+
+341
+00:24:46,750 --> 00:24:49,940
+اتكلمت مع ال campylobactaكان بالوبا اكتر مش كنا
+
+342
+00:24:49,940 --> 00:24:54,120
+بنعملها filtration احنا و كنا خايفين انه ال micro
+
+343
+00:24:54,120 --> 00:24:59,800
+plasma هي الوحيدة لانه حجمها قريب فتنزل لكن
+
+344
+00:24:59,800 --> 00:25:06,000
+ماخوفنا من النتيجة انه قلنالكوا انهزمان عاد شكلة
+
+345
+00:25:06,000 --> 00:25:10,800
+أجار هذا الـ slow growing required at least one
+
+346
+00:25:10,800 --> 00:25:14,120
+week one week for growth بينما ال Campylobacter
+
+347
+00:25:14,120 --> 00:25:18,200
+كان بدها 48 ساعة لنمو فماكانش فيه خوف في هذا
+
+348
+00:25:18,200 --> 00:25:23,220
+المجال لكن الحقيقة بالتبقى أن هذه مش obligate
+
+349
+00:25:23,220 --> 00:25:26,600
+intracellular parasites أنا قلت عنها the smallest
+
+350
+00:25:26,600 --> 00:25:29,760
+free living يعني تستطيع أنه تستطيع أن نميها على
+
+351
+00:25:29,760 --> 00:25:34,000
+artificial media لكن بدها بالفعل rich media السؤال
+
+352
+00:25:34,000 --> 00:25:40,760
+التانيبكتيريا بدون cell wall كيف لها أن تعيش في
+
+353
+00:25:40,760 --> 00:25:45,900
+هذا العالم الخشن العالم المليء بالـ fluctuation في
+
+354
+00:25:45,900 --> 00:25:49,720
+الـ osmotic environment يعني مرة بتدخل بمية مالحة
+
+355
+00:25:49,720 --> 00:25:54,860
+مرة بتدخل بمية حلوة مرة تدخل في مرتبان في مواد
+
+356
+00:25:54,860 --> 00:25:58,980
+كيموية فكيف لها و احنا بنعرف ان ال cell wall هو
+
+357
+00:25:58,980 --> 00:26:02,940
+احد ال components المسؤول عن شكل البكتيرياومسؤول
+
+358
+00:26:02,940 --> 00:26:07,180
+عن حمايتها من الـ Osmotic Lyses لو وجعت فيه يعني
+
+359
+00:26:07,180 --> 00:26:11,060
+محليل أو في بيئات الدغط الأسموذي تبقى غير مناسب
+
+360
+00:26:11,060 --> 00:26:15,820
+للبكتيريا بالظبط وجود استرال في ال cell membrane
+
+361
+00:26:15,820 --> 00:26:19,040
+بيعطيها هذه ال capability بيعطيها هذه ال
+
+362
+00:26:19,040 --> 00:26:25,140
+capability ال micro plasma بطبيعتها جونه مالهاش
+
+363
+00:26:25,140 --> 00:26:29,340
+cell wall وبالتالي هي resistant resistant to مين؟
+
+364
+00:26:30,450 --> 00:26:34,510
+to cell wall inhibitors زي ال penicillins and
+
+365
+00:26:34,510 --> 00:26:39,050
+cephalosporins لأنه مالهاش cell wall كمان احنا
+
+366
+00:26:39,050 --> 00:26:44,210
+بنعرف ان ال gram stain اصلا يعني بيصبغ البكتيريا
+
+367
+00:26:44,210 --> 00:26:46,590
+وميزنا ال gram positive عن ال gram negative بين
+
+368
+00:26:46,590 --> 00:26:49,390
+العالمين على ال cell wall structure طب هذه مالهاش
+
+369
+00:26:49,390 --> 00:26:53,070
+cell wall عشان كده it is poorly stained with اللي
+
+370
+00:26:53,070 --> 00:26:55,030
+هو gram stain
+
+371
+00:26:57,730 --> 00:26:59,890
+البكتيريا جون عنها slow growing في artificial
+
+372
+00:26:59,890 --> 00:27:03,830
+media، في كمان ميزة مميزة صحيلها أن مستعمراتها
+
+373
+00:27:03,830 --> 00:27:08,470
+بتشبه البيض المقلي، بيسموها fried egg appearance
+
+374
+00:27:08,470 --> 00:27:13,370
+colonies، خاصة .. خاصة يا شباب ال old culture،
+
+375
+00:27:13,370 --> 00:27:19,170
+يعني المزرعة لما بيصير عمرها طويلأعتقد هذه الصورة
+
+376
+00:27:19,170 --> 00:27:23,930
+بتبين أن اللي فوق بتبين أن الشكل اللي احنا نقول
+
+377
+00:27:23,930 --> 00:27:26,710
+عنه fried egg appearance بتلاحظه في المنتصف فيه زي
+
+378
+00:27:26,710 --> 00:27:32,100
+العين، المنتصف المستعمر مثلا زي هذه، تمام؟طبعا بعد
+
+379
+00:27:32,100 --> 00:27:36,800
+فترة ممكن تصير فيه نوع من ال irregular edges هنا
+
+380
+00:27:36,800 --> 00:27:41,220
+فبعطينا الشكل الأوضح لل fried egg appearance هذا
+
+381
+00:27:41,220 --> 00:27:45,060
+الوسط اللي .. اللي بيستخدموه ل .. ال .. سموه PPLO
+
+382
+00:27:45,060 --> 00:27:49,040
+أجار P-P-L-O طبعا P-P-L-O مش palestinian
+
+383
+00:27:49,040 --> 00:27:53,400
+liberation organization ال P-P-L-O هو عبارة عن اسم
+
+384
+00:27:53,400 --> 00:27:57,930
+اختصار ل plural pneumonia like organismsوهذا الاسم
+
+385
+00:27:57,930 --> 00:28:00,970
+القديم للـ Mycoplasma كان سموها Blue pneumonia
+
+386
+00:28:00,970 --> 00:28:03,470
+-like microorganism و التالي، الوسط دلوا بنفس اللي
+
+387
+00:28:03,470 --> 00:28:08,970
+هو المسمى، بس واضح أنه طبعا الوسط يعني غني جدا،
+
+388
+00:28:08,970 --> 00:28:13,530
+بيحتوي على Beef Heart و Infusion وBeptone Sodium
+
+389
+00:28:13,530 --> 00:28:18,820
+Chlorideفينا الأسماء المشهورة أو الاسم المشهور
+
+390
+00:28:18,820 --> 00:28:21,220
+حقيقة في ال microplasma أكتر اسم مشهور اللي هو
+
+391
+00:28:21,220 --> 00:28:25,820
+microplasma نيومونيا وبسبب انه primary atypical
+
+392
+00:28:25,820 --> 00:28:29,760
+pneumonia اعتقد ان احنا قلنا قبل شويه ال chlamydia
+
+393
+00:28:29,760 --> 00:28:34,040
+pneumonia بتعمل atypical pneumonia شبيه بمين؟ بال
+
+394
+00:28:34,040 --> 00:28:38,280
+microplasma النيومونيا common in summer and late
+
+395
+00:28:38,280 --> 00:28:41,100
+autumn طبعا هذا في بعض البلدان إذا بتلاحظوا في ال
+
+396
+00:28:41,100 --> 00:28:42,980
+.. اخر جملة هنا
+
+397
+00:28:46,340 --> 00:28:50,260
+common incidence in winter فيبدو انه نقطة لازم
+
+398
+00:28:50,260 --> 00:28:53,580
+نناقشها موضوع ما يسمى بال seasonality of diseases
+
+399
+00:28:53,580 --> 00:28:58,960
+هذه نقطة كتير مهمة للاستيعاب الفروقات وللتخطيط
+
+400
+00:28:58,960 --> 00:29:03,760
+للقضاء على ال infectious diseases احساس عام عند
+
+401
+00:29:03,760 --> 00:29:10,700
+الناس انه فيروس الرشح و ال influenza متى بتكون في
+
+402
+00:29:10,700 --> 00:29:16,870
+فصل الشتاء اكتر صح؟يبقى ال low temperature ال
+
+403
+00:29:16,870 --> 00:29:20,950
+humidity ممكن تكون بعض ال practices بعض ال
+
+404
+00:29:20,950 --> 00:29:23,930
+practices الناس في الصيف بتميل إلى أنه تبعد عن بعض
+
+405
+00:29:23,930 --> 00:29:29,460
+شوب حرفي شتاء بتميل انها تكون ايه؟ قريبة من بعض
+
+406
+00:29:29,460 --> 00:29:33,440
+فربما يكون المسافة فقط هي العامل فانا اللي بتقوله
+
+407
+00:29:33,440 --> 00:29:38,240
+انه لما احنا نعرف انه في اختلافات لل Epidemiology
+
+408
+00:29:38,240 --> 00:29:42,200
+يعني ال incidence لل disease من فصل لفصل بتحاول
+
+409
+00:29:42,200 --> 00:29:47,040
+نقدر نفسر لماذا هذه الاختلافات قد يكون الأمر متعلق
+
+410
+00:29:47,040 --> 00:29:50,180
+بال temperature قد يكون الأمر متعلق كمان مرة
+
+411
+00:29:50,180 --> 00:29:54,580
+بالسلوك تبعنا انه ناجم عن ال temperature مش عن ال
+
+412
+00:29:54,580 --> 00:29:57,420
+temperature نفسهايعني الفيروس ماهوش علاقة بالصيف
+
+413
+00:29:57,420 --> 00:30:00,380
+والشتاء جد ما هو اللي هو علاقة بسلوكنا احنا في
+
+414
+00:30:00,380 --> 00:30:05,940
+الصيف والشتاء تمام؟ هذه كتير نقطة مهمة طيب common
+
+415
+00:30:05,940 --> 00:30:09,580
+in late summer and early autumn بينتقل عن طريق ال
+
+416
+00:30:09,580 --> 00:30:13,080
+droplets يعني ايش معنى الحكي؟ respiratory tract او
+
+417
+00:30:13,080 --> 00:30:16,100
+respiratory route البكتيريا بتعمل adherence
+
+418
+00:30:16,100 --> 00:30:19,560
+للrespiratory epithelium وبتعمل inhibition لل cell
+
+419
+00:30:19,560 --> 00:30:24,880
+reaction بذكركم مين؟Inhibition للـ Ciliary Action
+
+420
+00:30:24,880 --> 00:30:28,720
+أو Interference مع الـ Ciliary Actionتحدثنا عن
+
+421
+00:30:28,720 --> 00:30:31,700
+ميكروب عنده المقدرة على الـ interference مع الـ
+
+422
+00:30:31,700 --> 00:30:35,480
+cilia reaction الـ cilia reaction اللي .. اللي
+
+423
+00:30:35,480 --> 00:30:41,840
+بيترد لـ sputum وقلنا عنه انه احد اسباب البروجرسم
+
+424
+00:30:41,840 --> 00:30:47,260
+اللي هو ال .. النوبة تبت السعال الديكي انه ناتج عن
+
+425
+00:30:47,260 --> 00:30:50,140
+الارتباط تبع البكتيريا بالسيلية فلما نعمل cilia
+
+426
+00:30:50,140 --> 00:30:54,640
+reaction inhibition بصير في accumulationللـ sputum
+
+427
+00:30:54,640 --> 00:30:57,060
+وبالتالي اللي بيحصل فيه اللي هي ال cuffing
+
+428
+00:30:57,060 --> 00:31:00,540
+mechanism بسبب دمج للابيثليام للابيثليام
+
+429
+00:31:00,540 --> 00:31:05,560
+والبكتيريا او اكتر بتكون common في ال children and
+
+430
+00:31:05,560 --> 00:31:11,600
+young adults ال clinical feature ممكن يحصل في ال
+
+431
+00:31:11,600 --> 00:31:15,580
+sore throat ال fever و ال headache طبعا كلمة sore
+
+432
+00:31:15,580 --> 00:31:18,820
+throat معناها التهابات في الحلق بشكل عام التهابات
+
+433
+00:31:18,820 --> 00:31:22,950
+في الحلقممكن فيانا يصير الـ Cough with small
+
+434
+00:31:22,950 --> 00:31:29,110
+amount of whitish nonpurulent sputum يعني مافيش
+
+435
+00:31:29,110 --> 00:31:32,510
+فيه صديد يعني لو احنا أخدنا ال sputum فقط بيكون
+
+436
+00:31:32,510 --> 00:31:37,250
+ميوكاس مافيش فيه أي صديد some extra pulmonary
+
+437
+00:31:37,250 --> 00:31:40,460
+symptoms ايش يعني extra pulmonary symptoms؟يعني مش
+
+438
+00:31:40,460 --> 00:31:45,040
+بس متعلقة بال lungs ممكن يكون متعلقة باماكن اخرى
+
+439
+00:31:45,040 --> 00:31:49,080
+opacity on chest x-ray opacity يعني عتامة في ال x
+
+440
+00:31:49,080 --> 00:31:53,640
+-ray تبعت اللي هو الصدر كلمة immunity incomplete
+
+441
+00:31:53,640 --> 00:31:59,260
+معناه الحكي انه لو أصيب الشخص بالبكتيريا و شفية
+
+442
+00:31:59,260 --> 00:32:04,020
+منها بعد فترة وجيزة اتعرض إلها أمام ممكن تصيرها
+
+443
+00:32:04,020 --> 00:32:08,800
+معناه الحكي ان ال immunity بتاعمش lasting يعني ..
+
+444
+00:32:08,800 --> 00:32:14,960
+يعني بالفعل قصيرة أو incomplete عشان
+
+445
+00:32:14,960 --> 00:32:18,620
+الـ Urea Plasma Urealyticum تابعة لـ Mycoplasma
+
+446
+00:32:18,620 --> 00:32:21,620
+كان اسمها زمان Mycoplasma Urealyticum لكن لهم
+
+447
+00:32:21,620 --> 00:32:25,780
+اسمها Urea Plasma واضح من اسمها يعني احنا مركزين
+
+448
+00:32:25,780 --> 00:32:30,080
+على Urea Plasma Urealyticum التنتين Urea Urea
+
+449
+00:32:30,080 --> 00:32:37,410
+وبالتالي اكيد عندها كمية الـ Urea's عاليةأن جي يو
+
+450
+00:32:37,410 --> 00:32:45,990
+نان جونو كوكل نان كلميديال يوريثريتس ان من شفتوها
+
+451
+00:32:46,980 --> 00:32:50,880
+Diseases non-gonococcal, non-chlamydial، لكن تصنف
+
+452
+00:32:50,880 --> 00:32:55,380
+مع مين طبعا؟ تصنف مع NGU، non-gonococcal
+
+453
+00:32:55,380 --> 00:32:59,740
+urethritis طبعا ال differentiation بينها وبين ال
+
+454
+00:32:59,740 --> 00:33:03,920
+microplasma مبني أساسا على اليوريز enzyme
+
+455
+00:33:03,920 --> 00:33:07,800
+production زي ال .. و .. و .. و .. تتشبه مع ال
+
+456
+00:33:07,800 --> 00:33:10,340
+microplasma، لأن احنا قلنا كوكاريسيا زمان ايه؟
+
+457
+00:33:10,340 --> 00:33:13,920
+microplasmaلكن التشابه مع ال micro plasma في أنه
+
+458
+00:33:13,920 --> 00:33:16,600
+بتعطينا نفس الشكل تبقى المستعمرات اللي هو fried
+
+459
+00:33:16,600 --> 00:33:20,680
+egg appearance اذا وجه التشابه انه تنتين wallace
+
+460
+00:33:20,680 --> 00:33:23,380
+بكتيريا التنتين بيعطينا نفس ال appearance تبقى
+
+461
+00:33:23,380 --> 00:33:27,360
+المستعمرات لكن الاختلاف او التمييز بينهم مبني على
+
+462
+00:33:27,360 --> 00:33:31,620
+إنتاج اليوريز أو عدم إنتاج اليوريز وكما ذكرنا اللي
+
+463
+00:33:31,620 --> 00:33:33,980
+هو ال non-gonococcal non-chlamydia urethritis in
+
+464
+00:33:33,980 --> 00:33:38,680
+men postpartum fever in women ما معنى postpartum
+
+465
+00:33:38,680 --> 00:33:42,340
+fever in womenالـ postpartum اللي هي ما بعد
+
+466
+00:33:42,340 --> 00:33:45,540
+الولادة، fever يعني معناه الحاكي .. ماحنا ماروا
+
+467
+00:33:45,540 --> 00:33:49,240
+معانا كتير postpartum و دلها اللي هو اللي سميناهم
+
+468
+00:33:49,240 --> 00:33:53,400
+peripheral sepsis هم النفاذوالـ Transmission بيكون
+
+469
+00:33:53,400 --> 00:33:56,980
+عبر الـ sexual contact لأسف كان فينا دراسة في غزة
+
+470
+00:33:56,980 --> 00:34:01,800
+و أظهرت نسبة يعني أو نساب مخيفة من الـ urea plasma
+
+471
+00:34:01,800 --> 00:34:07,700
+erraticum among women in Gaza و هذا STD STD بمعنى
+
+472
+00:34:07,700 --> 00:34:10,640
+أنه بينتقل عن طريق الجنس و انتقال عن طريق الجنس
+
+473
+00:34:10,640 --> 00:34:14,640
+معناه الحاجة أنه احنا في بلد مش محافظ و هذا الكلام
+
+474
+00:34:14,640 --> 00:34:19,100
+مص صحيحفكان يمكن تفسيراتنا للنتيجة العالية انه
+
+475
+00:34:19,100 --> 00:34:23,340
+خلال جمع العينة من السيدات تمام بيستخدم محل اسمها
+
+476
+00:34:23,340 --> 00:34:26,880
+spiculum قدالي فاتح اللي هو ال vagina حتى يقدر
+
+477
+00:34:26,880 --> 00:34:31,020
+ياخد عينة من أنقر رحم فلو كانت ست واحدة موصبة
+
+478
+00:34:31,020 --> 00:34:34,520
+وماكنش فيه تعقيم جيد فنقل لله وكانت التقنية
+
+479
+00:34:34,520 --> 00:34:39,080
+المستخدمة في الدراسة كانت مستخدمة ال PCR وال PCR
+
+480
+00:34:39,080 --> 00:34:44,230
+بتعرفينخلّي واحد خلّي تان اه انتهى الموضوع بيعملنا
+
+481
+00:34:44,230 --> 00:34:48,390
+detection لأنه عنده high sensitivity results
+
+482
+00:34:49,750 --> 00:34:52,930
+الانتقال by sexual contact كمان مرة ال micro
+
+483
+00:34:52,930 --> 00:34:55,490
+plasma and ureoplasma lab diagnosis ال culture زى
+
+484
+00:34:55,490 --> 00:34:59,690
+ما حكينا في ride egg appearance و على خاص وسط خاص
+
+485
+00:34:59,690 --> 00:35:02,530
+اللى هو ال PPLO اللى هو ال pure pneumonia like
+
+486
+00:35:02,530 --> 00:35:07,090
+organism media او في حاجة اسمها called agglutinine
+
+487
+00:35:07,090 --> 00:35:12,570
+detection عبارة عن فحص antibody detection ادلاجينا
+
+488
+00:35:12,570 --> 00:35:16,490
+ال title واحد لمية و تمانية و عشرين مش من المية و
+
+489
+00:35:16,490 --> 00:35:23,630
+تمانية و عشرين مش مية و تلاتينمش 126 كيف التخييف
+
+490
+00:35:23,630 --> 00:35:28,650
+بتم؟ لو عملتوا مضاعفات اتنين تنفسدوا مضاعفات اتنين
+
+491
+00:35:28,650 --> 00:35:34,210
+اربعة تمانية ستاشر اتنين تلاتين اربع ستين مية
+
+492
+00:35:34,210 --> 00:35:38,850
+تمانية عشرينفهنعمل Serial Dilution Serial Dilution
+
+493
+00:35:38,850 --> 00:35:44,850
+طبعا إذا طلع عندي الفحص positive عند واحد ل 128 أو
+
+494
+00:35:44,850 --> 00:35:51,630
+أعلى من ذلك واحد ل إيش ضعف 256 طبعا ومضاعفتها
+
+495
+00:35:51,630 --> 00:35:56,090
+فبيتطبع الفحص الآن أن المريض عنده Mycoplasma أو
+
+496
+00:35:56,090 --> 00:35:59,630
+Urea Plasma ال treatment نفس الشي تترسك ليه لكن
+
+497
+00:35:59,630 --> 00:36:03,130
+هنا الخيار التاني اللي هو ال Spectinomycin المرة
+
+498
+00:36:03,130 --> 00:36:05,330
+الجاية ان شاء الله بنكمل المحاولة
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9umZ2bwpUc8.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9umZ2bwpUc8.srt
new file mode 100644
index 0000000000000000000000000000000000000000..d5dba7d459fa84c99e5dd99c9a5b5e446437c2e0
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9umZ2bwpUc8.srt
@@ -0,0 +1,1396 @@
+1
+00:00:20,250 --> 00:00:24,910
+بسم الله الرحمن الرحيم الجزء الأخير من الموضوع
+
+2
+00:00:24,910 --> 00:00:27,870
+الذي بدأناه، وهو الـ chlamydia والـ mycoplasma و
+
+3
+00:00:27,870 --> 00:00:30,170
+الـ Rickettsia، سنكمله اليوم إن شاء الله، ستكون
+
+4
+00:00:30,170 --> 00:00:35,350
+محاضرة أقصر من المحاضرات المعتادة، الـ Rickettsia
+
+5
+00:00:35,350 --> 00:00:39,150
+فيها اسمين مشهورين: Rickettsia و Coxiella، وعشان نكون
+
+6
+00:00:39,150 --> 00:00:44,550
+قادَرين على إيصال فكرة جيدة، حاولنا أن
+
+7
+00:00:44,550 --> 00:00:49,550
+نصنف الأمراض التي تسببها
+
+8
+00:00:49,550 --> 00:00:52,930
+الركيزيا إلى ثلاث مجموعات، مجموعة سميناها typhus
+
+9
+00:00:52,930 --> 00:00:55,930
+group، وكلمة typhus مرت معكم عندما
+
+10
+00:00:55,930 --> 00:01:00,420
+تكلّمنا عن الـ Ox-19 التي تذكّركم بـ spotted
+
+11
+00:01:00,420 --> 00:01:06,240
+fever أو الحمّى التي فيها بقع، يعني فيها نزف،
+
+12
+00:01:06,240 --> 00:01:10,560
+والمجموعة الثالثة، التي سميناها others،
+
+13
+00:01:10,560 --> 00:01:14,140
+يعني لا تنتمي إلى أي من المجموعتين، فلدينا ثلاث
+
+14
+00:01:14,140 --> 00:01:19,220
+مجموعات، تعالوا لنطّلع على كل مجموعة وخصائصها.
+
+15
+00:01:19,220 --> 00:01:26,620
+هناك حشرات مرسومة: bugs، lice، و fleas، هذا مؤشر على ماذا؟
+
+16
+00:01:26,620 --> 00:01:31,740
+مؤشر على أن كل هذه الأمراض التي ذكرناها في
+
+17
+00:01:31,740 --> 00:01:35,460
+المجموعة الأولى، تبع typhus أو spotted fever،
+
+18
+00:01:35,460 --> 00:01:41,180
+الاثنتان تنتقلان عبر الحشرات، والحشرات تشكّل هنا
+
+19
+00:01:41,180 --> 00:01:47,100
+واحداً من ثلاثة أشياء، تشكّل vector، mechanical carrier،
+
+20
+00:01:47,100 --> 00:01:50,280
+mechanical carrier، يعني ناقل ميكانيكي، تذكرون
+
+21
+00:01:50,280 --> 00:01:53,600
+الذباب، كيف ينقل الأمراض؟ بـ
+
+22
+00:01:53,600 --> 00:01:57,160
+بياخذ، أو على جسمه يأخذ من قاذورات، ينقلها، هذا
+
+23
+00:01:57,160 --> 00:02:00,620
+يسمّى mechanical، لكن البعوض يسمّى biological،
+
+24
+00:02:00,620 --> 00:02:05,280
+لماذا؟ لأنه نفسه، و لنقل microbe، يتكاثر داخل جسم الحشرة، يعني
+
+25
+00:02:05,280 --> 00:02:08,840
+الحشرة تلعب دوراً، يبقى جونا mechanical أو
+
+26
+00:02:08,840 --> 00:02:11,640
+biological، وفيها شيء اسمه reservoir، الحشرة
+
+27
+00:02:11,640 --> 00:02:14,800
+نفسها تشكّل reservoir للـ infection، مخزن للـ
+
+28
+00:02:14,800 --> 00:02:19,120
+infection، ففي عندي epidemic typhus، endemic typhus،
+
+29
+00:02:19,120 --> 00:02:22,840
+و scrub typhus، في الـ spotted fever، في عندي rocky
+
+30
+00:02:22,840 --> 00:02:26,380
+mountain spotted fever، وفيها اسمها Rickettsial
+
+31
+00:02:26,380 --> 00:02:29,360
+pox، الأخير في تصنيف ثالث، وهو اسمه others، فيه
+
+32
+00:02:29,360 --> 00:02:35,180
+بكتيريا واحدة اسمها Coxiella burnetii، والـ Coxiella
+
+33
+00:02:35,180 --> 00:02:38,420
+burnetii، سنبدأ الآن بالتكلّم عنها، تسبب
+
+34
+00:02:38,420 --> 00:02:41,700
+شيئاً اسمه Q fever،
+
+35
+00:02:41,700 --> 00:02:42,780
+Q fever،
+
+36
+00:02:45,810 --> 00:02:49,430
+لما صار مرة من المرات fever of unknown etiology،
+
+37
+00:02:49,430 --> 00:02:54,010
+أسباب غير معروفة، فحطّوا fever under query fever،
+
+38
+00:02:54,010 --> 00:02:58,250
+under query، ماذا يعني query؟  معناه أن fever تحت
+
+39
+00:02:58,250 --> 00:03:01,370
+التحقيق، نحن لا نعرف المسبب، لا نعرف
+
+40
+00:03:01,370 --> 00:03:06,510
+المسبب، بعد فترة من الزمن، من الـ investigation، صار
+
+41
+00:03:06,510 --> 00:03:13,220
+اسمه Q fever، Q fever، حتى بعد أن علمنا، حتى بعد أن
+
+42
+00:03:13,220 --> 00:03:17,400
+علمنا ما هو المسبب، بقي اسمه Q fever، هذه نقطة أيضاً
+
+43
+00:03:17,400 --> 00:03:21,480
+يجب أن نعرفها، نحن لا نرسم بجانبها حشرات، ولا
+
+44
+00:03:21,480 --> 00:03:25,600
+نرى حشرات، دلالة أيضاً على أن هذا
+
+45
+00:03:25,600 --> 00:03:29,820
+هو الوحيد من المجموعة كلها الذي لا ينتقل عبر
+
+46
+00:03:29,820 --> 00:03:33,660
+الحشرات، إنما ينتقل عبر الـ aerosols الملوثة،
+
+47
+00:03:33,660 --> 00:03:37,260
+وهي الرذاذ المحتوي على الـ microorganism، إذاً
+
+48
+00:03:37,260 --> 00:03:41,170
+مرة أخرى، الـ typhus group والـ spotted group، كلاهما
+
+49
+00:03:41,170 --> 00:03:45,290
+ينتقلان عبر الحشرات، بينما الـ Q fever أو
+
+50
+00:03:45,290 --> 00:03:48,750
+الـ Coxiella burnetii، المسببة، لا تنتقل عبر هذا
+
+51
+00:03:48,750 --> 00:03:50,890
+الطريق.
+
+52
+00:03:52,770 --> 00:03:56,450
+طيب، دخلنا مباشرةً على تصنيف الأمراض، ولم نتعرف
+
+53
+00:03:56,450 --> 00:04:00,570
+أصلاً على البكتيريا، أذكّركم بأن هذه البكتيريا
+
+54
+00:04:00,570 --> 00:04:03,970
+الثانية في مجموعة الـ Obligate Intracellular
+
+55
+00:04:03,970 --> 00:04:08,450
+Parasites، يعني هي الوحيدة مع الكلاميديا التي
+
+56
+00:04:08,450 --> 00:04:12,240
+تنتمي إلى هذه المجموعة، كيف نميّز الكلاميديا عن
+
+57
+00:04:12,240 --> 00:04:16,280
+الركيزيا؟ لاحظوا التمييز الذي ذكرناه على الحشرات،
+
+58
+00:04:16,280 --> 00:04:19,400
+هذا جزء مهم من التمييز، الجزء الثاني في صالح
+
+59
+00:04:19,400 --> 00:04:27,640
+الكلاميديا، الكلاميديا كانت تمر خلال
+
+60
+00:04:27,640 --> 00:04:30,300
+الـ replication  تبعها، في life cycle، وهي الوحيدة التي
+
+61
+00:04:30,300 --> 00:04:33,340
+درسناها في البكتيريا، تمر بـ life cycle، كان لدينا
+
+62
+00:04:33,340 --> 00:04:37,340
+الـ reticulate body، وقلنا لكم الـ
+
+63
+00:04:37,340 --> 00:04:41,570
+elementary body، الـ resistance تبعه أعلى من الـ
+
+64
+00:04:41,570 --> 00:04:44,630
+reticulate body، فبالتالي الـ survival تبعه في الـ
+
+65
+00:04:44,630 --> 00:04:48,670
+environment نوعاً ما عالي، ولو أردنا عمل analogy،
+
+66
+00:04:48,670 --> 00:04:52,110
+مقارنة، نقول في البكتيريا، مثل الباسيلس
+
+67
+00:04:52,110 --> 00:04:55,590
+والكلستريديا، كان لدينا vegetative cell وكان لدينا
+
+68
+00:04:55,590 --> 00:05:00,620
+spores، أكثر مقاومة، الـ spore، فممكن نقول كـ
+
+69
+00:05:00,620 --> 00:05:04,540
+analogy، أن الـ elementary body هو الـ spore تبع
+
+70
+00:05:04,540 --> 00:05:07,340
+الـ chlamydia، لكنه ليس spore، لكن لديه
+
+71
+00:05:07,340 --> 00:05:11,420
+قدرة على التحمل أعلى من reticulate body، إذاً الـ
+
+72
+00:05:11,420 --> 00:05:14,420
+chlamydia في الـ environment، نتوقع أن الـ survival
+
+73
+00:05:14,420 --> 00:05:17,540
+تبعها سيكون أفضل من الـ rickettsia، لأن الـ
+
+74
+00:05:17,540 --> 00:05:21,420
+rickettsia هنا لها stage واحد فقط، فبالتالي
+
+75
+00:05:21,420 --> 00:05:24,420
+they do not survive for long in the environment.
+
+76
+00:05:25,730 --> 00:05:31,030
+البكتيريا هي small rod shape، يعني عصوية، round to
+
+77
+00:05:31,030 --> 00:05:34,250
+polymorphic، ممكن تأخذ أشكالاً أخرى غير الـ rods،
+
+78
+00:05:34,250 --> 00:05:36,950
+وممكن تكون polymorphic، معناها متعددة الأشكال، لكن تصنف تحت ماذا؟ طبعاً التصنيف
+
+79
+00:05:36,950 --> 00:05:42,750
+لا ينطبق عليها عادةً، لكن الـ cell wall يبقى
+
+80
+00:05:42,750 --> 00:05:46,930
+بُنيته الأقرب إلى الـ gram أو أقرب إلى الـ
+
+81
+00:05:46,930 --> 00:05:51,310
+gram negative من الـ gram positive، بصمتها، تظهر gram، small
+
+82
+00:05:51,310 --> 00:05:57,950
+rod shape، round to pleomorphic، يعني تأخذ أشكالاً
+
+83
+00:05:57,950 --> 00:06:02,410
+متنوعة، وليس فقط،  أكرر، أنا أتكلّم
+
+84
+00:06:02,410 --> 00:06:05,490
+مرة أخرى عن الـ cell wall، أنه هي أقرب في الشبه إلى الـ
+
+85
+00:06:05,490 --> 00:06:09,470
+gram negative من الـ gram positive.  العبارة
+
+86
+00:06:09,470 --> 00:06:13,870
+التالية مفهومة، لأننا نتكلم عن
+
+87
+00:06:13,870 --> 00:06:18,130
+obligate intracellular parasites، فهي فقط
+
+88
+00:06:18,130 --> 00:06:20,310
+cultivable only in living tissue، فقط تنمو في داخل
+
+89
+00:06:20,310 --> 00:06:24,950
+الأنسجة، لأنها obligate intracellular parasites،
+
+90
+00:06:24,950 --> 00:06:28,570
+transmitted by arthropods، يعني الحشرات هي الناقل
+
+91
+00:06:28,570 --> 00:06:34,650
+الرئيسي لهذه البكتيريا، they cause disease in humans
+
+92
+00:06:34,650 --> 00:06:38,210
+and domestic animals، معنى هذا أنها zoonotic
+
+93
+00:06:38,210 --> 00:06:41,790
+disease، zoonotic disease، يعني تنتقل من هنا إلى
+
+94
+00:06:41,790 --> 00:06:44,610
+هنا أو العكس، but are also found in the cytoplasm
+
+95
+00:06:48,630 --> 00:06:51,690
+وهنا نقطة مهمة جداً، they are found in the
+
+96
+00:06:51,690 --> 00:06:57,670
+cytoplasm of tissue cells of lice, fleas, ticks
+
+97
+00:06:57,670 --> 00:07:03,970
+and mites، دلالة على ماذا؟ نقول إن الحشرات ليست فقط
+
+98
+00:07:03,970 --> 00:07:10,820
+ناقل بيولوجي، وإنما أيضاً reservoir، ناقل، نجدها في
+
+99
+00:07:10,820 --> 00:07:13,480
+الـ salivary gland، نجدها في الـ
+
+100
+00:07:13,480 --> 00:07:16,740
+guts، لكن ليس بالضرورة نجدها في الـ
+
+101
+00:07:16,740 --> 00:07:19,620
+cytoplasm، داخل الخلايا الموجودة في الـ
+
+102
+00:07:19,620 --> 00:07:24,940
+insect، إذاً نفهم أن الحشرة can act as a
+
+103
+00:07:24,940 --> 00:07:27,940
+biological vector and can act as a reservoir،
+
+104
+00:07:27,940 --> 00:07:32,080
+نقطة مهمة جداً، أي transmission في الدنيا
+
+105
+00:07:32,080 --> 00:07:34,880
+ممكن يكون biological أو يكون mechanical، كما
+
+106
+00:07:34,880 --> 00:07:37,660
+ذكرنا، biological، ticks، و sucking lice، وهي
+
+107
+00:07:37,660 --> 00:07:41,860
+القمل الذي يمتص الدم، طبعاً الـ
+
+108
+00:07:41,860 --> 00:07:47,160
+bacteria can survive in insects for months، وهنا
+
+109
+00:07:47,160 --> 00:07:50,940
+يجب أن نتطرق لقضية مهمة، تمثل
+
+110
+00:07:50,940 --> 00:07:57,110
+نظرية التطوّر، يفترض أن المؤمنين بـ
+
+111
+00:07:57,110 --> 00:08:01,850
+نظرية التطور، كما ذكرها داروين، أن الإنسان
+
+112
+00:08:01,850 --> 00:08:06,310
+على سلم الهرم في النظرية، ونحن
+
+113
+00:08:06,310 --> 00:08:10,610
+كمسلمين، نقول إن الله كرم الإنسان، وسخر له
+
+114
+00:08:10,610 --> 00:08:16,350
+كل المخلوقات الأخرى في هذا الكون، لكن داروين
+
+115
+00:08:16,350 --> 00:08:23,460
+يقول إن البقاء للأصلح، البقاء للأصلح، طيب لو
+
+116
+00:08:23,460 --> 00:08:29,640
+جئنا لنحسب من هو الأكثر عدداً على كوكب الأرض؟ النمل أم
+
+117
+00:08:29,640 --> 00:08:35,160
+البشر؟ النمل، سأقول لكم حقيقة مذهلة، وزن النمل على
+
+118
+00:08:35,160 --> 00:08:38,500
+كوكب الأرض يساوي وزن البشر، معنى هذا أن عدد النمل
+
+119
+00:08:38,500 --> 00:08:43,020
+لو أردنا مقارنته بالبشر، يكون مئات الآلاف من الأضعاف
+
+120
+00:08:43,020 --> 00:08:47,660
+من البشر، لأن حجمه صغير، لكن الـ survival رائع
+
+121
+00:08:47,660 --> 00:08:51,520
+جداً، الحشرات بشكل عام، الـ survival رائع، طيب
+
+122
+00:08:51,520 --> 00:08:55,580
+تعالوا لنأخذ مثالاً آخر، من هو أكثر المخلوقات عدداً على
+
+123
+00:08:55,580 --> 00:09:00,440
+كوكب الأرض؟  أقلها تطوراً،
+
+124
+00:09:00,440 --> 00:09:03,900
+وهي الفيروسات، تليها البكتيريا،
+
+125
+00:09:03,900 --> 00:09:07,120
+تليها البكتيريا، التي في التطوّر يفترض أنها
+
+126
+00:09:07,120 --> 00:09:10,560
+مرحلة بعد الفيروسات، إذاً الهرم مقلوب،
+
+127
+00:09:10,560 --> 00:09:14,510
+الهرم مقلوب، وهذا ينسف نظرية التطوّر، أن البقاء
+
+128
+00:09:14,510 --> 00:09:18,330
+للأصلح، لا، البقاء ليس للأصلح، البقاء يعني
+
+129
+00:09:18,330 --> 00:09:24,210
+لمخلوقات أخرى، بمفهوم الأصلح، الإنسان القوي،  أو الديناصور،
+
+130
+00:09:24,210 --> 00:09:27,290
+الديناصور هو
+
+131
+00:09:27,290 --> 00:09:30,730
+الذي سيطر على كوكب الأرض، وليس نحن، طيب،
+
+132
+00:09:30,730 --> 00:09:35,910
+mechanical، سأُمثّل عليها بأدوات، عندنا
+
+133
+00:09:35,910 --> 00:09:39,750
+blood transfusion، نقل الدم، سأُخبركم بـ
+
+134
+00:09:39,750 --> 00:09:45,910
+طريقة أخرى للـ mechanical، تخيّلوا حشرة تأخذ عينة دم من
+
+135
+00:09:45,910 --> 00:09:47,450
+الإنسان،  وليس عينة دم، وضعتها
+
+136
+00:09:47,450 --> 00:09:50,650
+للمختبر، تريد أن تتغذّى على دم، دم، وليس عينة
+
+137
+00:09:50,650 --> 00:09:57,150
+دم، تمام؟ خلال عملية التغذية، قد تتبرز الحشرة على
+
+138
+00:09:57,150 --> 00:10:02,410
+جلد المريض أو الشخص، يعني بعد أن تنتهي
+
+139
+00:10:02,410 --> 00:10:06,890
+من غذائها، المخدر ينتهي مفعوله،  وهي تحقنه مع
+
+140
+00:10:06,890 --> 00:10:12,540
+مع الـ sucking apparatus تبعها، وبالتالي
+
+141
+00:10:12,540 --> 00:10:16,500
+يتغرّض المريض، يشعر بألم في مكان الجروح التي
+
+142
+00:10:16,500 --> 00:10:20,620
+سببتها، يذهب للطبيب، يأخذ البراز، وهذا
+
+143
+00:10:20,620 --> 00:10:23,860
+mechanical transmission، وليس biological transmission،
+
+144
+00:10:23,860 --> 00:10:27,040
+وسنرى مثلاً آخر بعد قليل في الطفيليات،  سيذكر
+
+145
+00:10:27,040 --> 00:10:30,060
+الدكتور عدنان شيئاً اسمه  red-eyed bug، ويسمّى
+
+146
+00:10:30,060 --> 00:10:35,260
+kissing bug، لأنها تأخذ وجبة الدم من
+
+147
+00:10:35,260 --> 00:10:40,760
+المنطقة حول الشفاه، طيب، pathogenesis، insect
+
+148
+00:10:40,760 --> 00:10:44,100
+vectors for human transmission are arthropods such
+
+149
+00:10:44,100 --> 00:10:47,680
+as fleas, ticks, mites and lice، كل هذه الحشرات ممكن
+
+150
+00:10:47,680 --> 00:10:50,160
+أن تكون ناقلة، وفي نوع من الـ specificity، يعني كل
+
+151
+00:10:50,160 --> 00:10:55,500
+disease له الحشرة الخاصة به، القوارض،
+
+152
+00:10:55,500 --> 00:11:00,680
+الإنسان، والحشرات can act as a reservoir، من هو
+
+153
+00:11:00,680 --> 00:11:05,180
+الإنسان؟ الإنسان المصاب بالـ disease هو مخزن،
+
+154
+00:11:05,180 --> 00:11:09,960
+مصدر للحشرات، تأخذ منه وجبة الدم، وتنقلها إلى
+
+155
+00:11:09,960 --> 00:11:14,360
+الآخرين، في نقطة مهمة أيضاً، يجب مناقشتها
+
+156
+00:11:14,360 --> 00:11:20,400
+الآن، الحشرة تبيض، و الـ bite تبعها يفقس، وينتج
+
+157
+00:11:20,400 --> 00:11:25,940
+عنه صغار، الآن، من الممكن أن الصغار يولدوا معقّمين،
+
+158
+00:11:25,940 --> 00:11:29,780
+sterile، بمعنى أن ليس لديهم بكتيريا، ولكي يصيروا
+
+159
+00:11:29,780 --> 00:11:34,000
+لديهم بكتيريا، يجب أن يأخذوا وجبة دم من حيوان أو من
+
+160
+00:11:34,000 --> 00:11:41,020
+إنسان مصاب، وفي خيار آخر، أن الأم تنقل للبيض مباشرةً
+
+161
+00:11:41,020 --> 00:11:45,580
+بعملية تسمّى Trans-ovarian transmission، يعني المبيض
+
+162
+00:11:45,580 --> 00:11:49,900
+عبر المبيض، Trans-ovarian transmission، وصلت الصورة؟
+
+163
+00:11:50,430 --> 00:11:54,350
+ففي إمكانية أن الحشرات تولد أو تفقس
+
+164
+00:11:54,350 --> 00:11:59,030
+بالبكتيريا أو بدون البكتيريا، بحسب نوع الـ
+
+165
+00:11:59,030 --> 00:12:02,550
+insect vector أو الـ vector،
+
+166
+00:12:02,550 --> 00:12:06,390
+multiply in salivary gland، أين تتكاثر
+
+167
+00:12:06,390 --> 00:12:10,570
+البكتيريا؟ تتكاثر في salivary gland أو الـ guts، بحسب
+
+168
+00:12:10,570 --> 00:12:13,390
+من، الـ ticks في salivary gland، و الـ
+
+169
+00:12:13,390 --> 00:12:19,180
+lice في الـ gut، متى تتكاثر؟ عندما تأخذ
+
+170
+00:12:19,180 --> 00:12:24,480
+وجبة دم من حيوان أو إنسان مصاب، التكاثر يتم بعد
+
+171
+00:12:24,480 --> 00:12:29,170
+أن تأخذ وجبة دم،  كلمة تكاثر مهمة،
+
+172
+00:12:29,170 --> 00:12:33,970
+مهمة جداً، لأن التكاثر يزيد عدد البكتيريا،
+
+173
+00:12:33,970 --> 00:12:39,210
+ويخلق ما يسمّى بالجرعة المعدية، تذكرون الـ infective
+
+174
+00:12:39,210 --> 00:12:42,650
+dose؟  لا يكفي إدخال عدد قليل من البكتيريا،
+
+175
+00:12:42,650 --> 00:12:45,590
+ممكن ألا تكون كافية لإحداث
+
+176
+00:12:45,590 --> 00:12:51,300
+infection،  غالباً نحتاج إلى infective dose، حيثما
+
+177
+00:12:51,300 --> 00:12:54,640
+كانت عضة الحشرة، غالباً يكون ما يسمّى بـ
+
+178
+00:12:54,640 --> 00:12:59,640
+scar، و الـ scar عبارة عن encrusted ulcer، ويحدث
+
+
+223
+00:16:06,290 --> 00:16:11,670
+الحَكْ إِله فَبِصِير لَهُ إِدخال للجسم بينتج عنه high fever
+
+224
+00:16:11,670 --> 00:16:15,750
+و chills و rash طبعاً possible الـ rash يعني مِش حاجة
+
+225
+00:16:15,750 --> 00:16:21,350
+مؤكدة، وإنما احتمال وجودها يعني موجودة غالباً في المرض
+
+226
+00:16:21,350 --> 00:16:28,130
+بيستمر إلى حوالي أسبوعين، ويكون أكثر حدة في كبار
+
+227
+00:16:28,130 --> 00:16:32,890
+السن، severe in the elderly من complications تَبَعته
+
+228
+00:16:32,890 --> 00:16:35,730
+central nervous system complication/dysfunction
+
+229
+00:16:35,730 --> 00:16:38,170
+يعني بيصير فيه مشاكل فيه، وممكن يكون عندنا
+
+230
+00:16:38,170 --> 00:16:39,290
+myocarditis
+
+231
+00:16:41,820 --> 00:16:49,200
+خليني أوضح الفكرة: كيف بيطلع الـ rash as a result
+
+232
+00:16:49,200 --> 00:16:55,220
+of rickettsial infection. أنا عندي البكتيريا عاملة
+
+233
+00:16:55,220 --> 00:16:58,080
+infection للـ vascular endothelium. إيش الـ vascular
+
+234
+00:16:58,080 --> 00:17:02,500
+endothelium؟ هو الغشاء المبطّن أوالانسجة المبطّنة
+
+235
+00:17:02,500 --> 00:17:08,090
+للـ blood vessels. الآن دخلت البكتيريا بالـ
+
+236
+00:17:08,090 --> 00:17:10,750
+endocytosis، وأنا برجع بشوية إما phagocytosis أو
+
+237
+00:17:10,750 --> 00:17:14,850
+endocytosis، it multiply within the cells. الـ
+
+238
+00:17:14,850 --> 00:17:18,790
+multiplication في الآخر ultimately هيؤدي إلى تحلل
+
+239
+00:17:18,790 --> 00:17:23,000
+الـ host cell. اتحللت الـ host، الأشراب هيصير فيه دي
+
+240
+00:17:23,000 --> 00:17:27,900
+increase الـ number، و release للبكتيريا، they will
+
+241
+00:17:27,900 --> 00:17:34,920
+infect more cells. في الآخر الـ tissue المبطّن للـ
+
+242
+00:17:34,920 --> 00:17:41,330
+vessel، أجزاء منه بتصير مُخترقة، يعني بتدوب من موت
+
+243
+00:17:41,330 --> 00:17:45,570
+الخلايا، فبيصير release لمين؟ للـ blood، من اللي هو الـ
+
+244
+00:17:45,570 --> 00:17:48,010
+vessels دي. بيفهّمنا من هنا أن أسباب الـ rash من أن
+
+245
+00:17:48,010 --> 00:17:51,090
+البكتيريا عندها المقدرة على أن تعمل... تعمل
+
+246
+00:17:51,090 --> 00:17:55,110
+infection للـ endothelial، و destruction لهذا
+
+247
+00:17:55,110 --> 00:17:57,870
+الخلايا، وبالتالي اللي بيصير فيه إنّها rupturing للـ
+
+248
+00:17:57,870 --> 00:18:04,640
+... اللي هو الـ blood vessels. قدّمنا مثالاً أولاً على الـ
+
+249
+00:18:04,640 --> 00:18:09,560
+... الـ... الـ... الـ Taifas group، وأخذنا الـ epidemic
+
+250
+00:18:09,560 --> 00:18:13,260
+Taifas اللي بتسببها Rickettsia prowazekii، واللي اتفقنا
+
+251
+00:18:13,260 --> 00:18:16,000
+أنه بِنتقل عن طريق مين جاه؟ عن طريق اللي هو القمل
+
+252
+00:18:16,000 --> 00:18:21,380
+القمل من الجسم. نعم، نجي الآن لِمثال ثاني، واحد من
+
+253
+00:18:21,380 --> 00:18:24,780
+مجموعة اللي هو الـ spotted fever، وأشهر واحد اللي
+
+254
+00:18:24,780 --> 00:18:27,280
+هو rocky mountain spotted fever، وهو أشهر واحد في
+
+255
+00:18:27,280 --> 00:18:31,070
+أمريكا. rocky mountain spotted fever، واللي بتسببه
+
+256
+00:18:31,070 --> 00:18:34,290
+بكتيريا سهل النطق تبعها Rickettsia rickettsii
+
+257
+00:18:34,290 --> 00:18:37,930
+لأنه جاي من نفس الـ genus، والـ reservoir تبعه
+
+258
+00:18:37,930 --> 00:18:41,530
+غالباً بيكون الـ rodents زي الـ mice والـ rats. الـ
+
+259
+00:18:41,530 --> 00:18:46,090
+vector غالباً اللي هو، أو بينتقل عن طريق القراد، والقراد
+
+260
+00:18:46,090 --> 00:18:49,510
+هتقولوا حشرة برضه ماصة ليه؟ اللي هو الدم
+
+261
+00:18:49,510 --> 00:18:53,110
+ويفترض أنه في course الطفيليات هتأخذوا رزق من
+
+262
+00:18:53,110 --> 00:18:58,150
+الحشرات هذه بتفصيل أكبر، لأنها تعتبر ectoparasites
+
+263
+00:18:58,150 --> 00:19:00,650
+ectoparasites، ومن ضمن اللي هو الطفيليات اللي
+
+264
+00:19:00,650 --> 00:19:04,370
+بيدرسوها.الريكيتسيا بتكون في الـ saliva of the tick
+
+265
+00:19:04,370 --> 00:19:09,330
+عشان هي كده ممكن تنتقل مباشرة مع الدم الأولاني
+
+266
+00:19:09,330 --> 00:19:12,650
+كانت الـ multiplication في الـ gut اللي ياللاوز،
+
+267
+00:19:12,650 --> 00:19:17,240
+وبالتالي طلعت مع الـ feces تبع الحشرة. high fever
+
+268
+00:19:17,240 --> 00:19:20,900
+malaise then rash initially but becomes particular
+
+269
+00:19:20,900 --> 00:19:23,700
+or hemorrhage. وين بيبدأ الـ rash؟ بيبدأ على الـ
+
+270
+00:19:23,700 --> 00:19:27,060
+extremities، على الأطراف، وبعدين بدخل inward على
+
+271
+00:19:27,060 --> 00:19:31,220
+باقي الجسم. في أمراض الـ rash بيبدأ في المنتصف، و
+
+272
+00:19:31,220 --> 00:19:35,280
+بينتقل إلى الأطراف. هذا لأ، هذا بيبدأ في الأطراف، و
+
+273
+00:19:35,280 --> 00:19:40,150
+كمان مرة عايش بيعمل، بيروح على اللي هو الجسم. Rashes
+
+274
+00:19:40,150 --> 00:19:43,950
+زي ما كنا start on extremities then rapidly spread
+
+275
+00:19:43,950 --> 00:19:47,370
+to the entire body. و إيش بيحصل في الـ untreated
+
+276
+00:19:47,370 --> 00:19:51,690
+cases؟ بقولنا vascular disturbances with myocardial
+
+277
+00:19:51,690 --> 00:19:55,170
+or renal failure possible. شفنا غدّ myocardial
+
+278
+00:19:55,170 --> 00:19:58,870
+myocarditis، و central nervous system dysfunction
+
+279
+00:19:58,870 --> 00:20:02,070
+complications. وشفنا هنا كمان مرة renal failure
+
+280
+00:20:02,070 --> 00:20:06,920
+يعني الـ rickettsial disease يا شباب، if untreated they
+
+281
+00:20:06,920 --> 00:20:11,920
+may يعني cause serious complications اللي قد تؤدي
+
+282
+00:20:11,920 --> 00:20:16,440
+إلى الوفاة if undiagnosed early، و untreated earlier
+
+283
+00:20:16,440 --> 00:20:20,920
+الميكروب يمكن الأخير في السلسلة اللي معانا، إحنا
+
+284
+00:20:20,920 --> 00:20:24,260
+أخذنا تلت مجموعات مظبوط: مجموعة الـ typhus، وأخذنا مثال
+
+285
+00:20:24,260 --> 00:20:30,680
+عليها، ومجموعة الـ... الـ... spotted fever، والآن
+
+286
+00:20:30,680 --> 00:20:35,000
+مجموعة الـ others، اللي هي من ضمنها Coxiella burnetii
+
+287
+00:20:35,000 --> 00:20:38,640
+هي الـ etiological agent للمرض اللي سمّيناها
+
+288
+00:20:38,640 --> 00:20:42,380
+Q fever، وأنا اتفقت معاكم في بداية المحاضرة، إيش
+
+289
+00:20:42,380 --> 00:20:46,080
+معناه Q؟ معناها جاي من كلمة query، و query معناها
+
+290
+00:20:46,080 --> 00:20:49,640
+يعني under investigation. under investigation
+
+291
+00:20:49,640 --> 00:20:55,180
+reservoir: المخازن: cattle، sheep، rodents، ticks
+
+292
+00:20:55,180 --> 00:20:59,020
+شوفوا كلمة reservoir، خلينا نربطها بواقعنا، اسمها
+
+293
+00:20:59,020 --> 00:21:02,420
+في مصر في بعض الحالات لـ coronavirus. طبعاً هذا المرض
+
+294
+00:21:02,420 --> 00:21:06,420
+صار له فترة في الخليج، صار له يمكن سنة بِيلفلف في
+
+295
+00:21:06,420 --> 00:21:08,740
+الإمارات، حالتين في الـ... مش عارف، في السعودية
+
+296
+00:21:08,740 --> 00:21:14,040
+أربعين، خمسين حالة، وبيجينا باستمرار تقارير عن ما
+
+297
+00:21:14,040 --> 00:21:17,700
+زال انتشاره. الآن كان أحد الأشياء المُحيرة في هذا
+
+298
+00:21:17,700 --> 00:21:21,940
+الموضوع: مين الـ reservoir؟ والآن القُراد هي المتهمة،
+
+299
+00:21:21,940 --> 00:21:26,900
+القُراد هي المتهمة بأنها reservoir لـ... الـ... الـ... الـ
+
+300
+00:21:26,900 --> 00:21:30,380
+... وطبعاً كلمة متهمة يعني لسة مش hundred percent
+
+301
+00:21:30,380 --> 00:21:33,800
+proven، أنها... يعني حتى في ناس بعض... خرج بعض
+
+302
+00:21:33,800 --> 00:21:38,100
+الأطباء اللي لهم في المجال، ونفوا أن يكون القراد له
+
+303
+00:21:38,100 --> 00:21:43,080
+دخل في هذا الموضوع، لكن مرة أخرى، معرفة الـ reservoir مهمة،
+
+304
+00:21:43,080 --> 00:21:47,090
+ليش مهم معرفة الـ reservoir؟ لما أنا أعرف الـ Reservoir،
+
+305
+00:21:47,090 --> 00:21:50,070
+إما بعزله عن البنادم، أو بعزل البنادم عنه، مظبوط؟
+
+306
+00:21:50,070 --> 00:21:53,610
+ولا لأ؟ إذا كان reservoir يمكن التخلص منه زي
+
+307
+00:21:53,610 --> 00:21:57,250
+الحشرات، زي القوارض، برضه بنعمل برنامج مكافحة
+
+308
+00:21:57,250 --> 00:22:03,810
+للتخلص من هذه الـ reservoir. لكن بنفهم إن معرفة
+
+309
+00:22:03,810 --> 00:22:08,130
+تفاصيل كيفية الانتقال من الـ reservoir هذه عملية
+
+310
+00:22:08,130 --> 00:22:12,130
+مهمة جداً في أي control procedure لأي micro
+
+311
+00:22:14,840 --> 00:22:19,260
+contaminated aerosols. كمان مرة هي الرذاذ، مرة عينة
+
+312
+00:22:19,260 --> 00:22:24,160
+ميكروب يا شباب، برضه بيجيب الانتقال تبعه سابقاً مار
+
+313
+00:22:24,160 --> 00:22:27,100
+معنا، بينتقل برضه عبر الـ aerosols، وأنا متأكد إن
+
+314
+00:22:27,100 --> 00:22:32,950
+ولا واحد ذاكر الموضوع، ويارت حد يخيب ظني.اللي
+
+315
+00:22:32,950 --> 00:22:36,230
+جونيلا نيومونيا اللي قلنا مش person to
+
+316
+00:22:36,230 --> 00:22:39,870
+person transmission، لازم تروح على environmental
+
+317
+00:22:39,870 --> 00:22:44,170
+water، والـ water يسيله aerosolized، الـ water، ومن
+
+318
+00:22:44,170 --> 00:22:49,350
+ثم ينتقل إلى الناس الأخرى. عموماً، اتفقنا إن الـ
+
+319
+00:22:49,350 --> 00:22:54,150
+pathogen اسمه Coxiella burnetii. الـ reservoir: cattle،
+
+320
+00:22:54,150 --> 00:22:57,070
+sheep، rodents، and ticks. vector: contaminated
+
+321
+00:22:57,070 --> 00:22:59,910
+aerosols. Coxiella burnetii enters the body via
+
+322
+00:22:59,910 --> 00:23:03,530
+mucous membrane inhalation and GIT via consumption
+
+323
+00:23:03,530 --> 00:23:05,510
+of milk of infected animals.
+
+324
+00:23:19,490 --> 00:23:24,650
+الانعصاب بسبب أن الحيوانات تقوم باتصال مع الحيوانات
+
+325
+00:23:24,650 --> 00:23:31,140
+والإنسان.  برا كان في عندي program في الـ... في
+
+326
+00:23:31,140 --> 00:23:33,800
+التلفزيون عن الـ zoonotic diseases، عن الأمراض
+
+327
+00:23:33,800 --> 00:23:37,460
+المشتركة. طبعاً ما... يعني إحنا كنا بنخاطب فيها عامة
+
+328
+00:23:37,460 --> 00:23:41,740
+الشعب. بالتالي كان الكلام برضه بعموميات، لكن يعني كان أحد
+
+329
+00:23:41,740 --> 00:23:46,100
+الأسئلة اللي سُئلت: إن ما هي أشهر الأمراض اللي
+
+330
+00:23:46,100 --> 00:23:48,520
+موجودة في غزة من الـ zoonotic diseases؟ وكان جوابي
+
+331
+00:23:48,520 --> 00:23:54,950
+برضه كمان جواب عام، إنه لا يوجد لدينا مؤسسة رصد
+
+332
+00:23:54,950 --> 00:24:00,190
+للأمراض، يعني بمعنى آخر، لا أحد يستطيع أن يجيب بدقة
+
+333
+00:24:00,190 --> 00:24:07,830
+على هذا السؤال، لأنه ما عندناش امكان، أو خلينا نقول مركز
+
+334
+00:24:07,830 --> 00:24:11,650
+رصد للأمراض المشتركة، أو حتى للأمراض الوبائية. يعني
+
+335
+00:24:11,650 --> 00:24:18,070
+بشيء متواضع، بيتم عن طريق الـ reports تبع الأطباء
+
+336
+00:24:18,070 --> 00:24:21,830
+والمستشفيات، وهم بينقلوا هذه الـ reports، بيعدّلوها في
+
+337
+00:24:21,830 --> 00:24:24,590
+جداول اللي ببعتوها إلينا، لكن واقع الأمر، ما عندناش لا
+
+338
+00:24:24,590 --> 00:24:29,270
+research ولا epidemiological centers للرصد الوبائي،
+
+339
+00:24:29,270 --> 00:24:32,960
+أو بتالي اللي بالفعل فيه مشكلة في هذا المجال.أنا
+
+340
+00:24:32,960 --> 00:24:34,720
+اللي خالاني أتكلم، أتكلم هذه كلمة zoonotic
+
+341
+00:24:34,720 --> 00:24:38,760
+diseases، إنه zoonotic diseases، لكن ما بنعرف إيش هي
+
+342
+00:24:38,760 --> 00:24:43,200
+الـ zoonotic diseases. ممكن يا شباب، أحد الـ
+
+343
+00:24:43,200 --> 00:24:46,560
+complications السيئة، إنه يصير فينا hepatitis أو
+
+344
+00:24:46,560 --> 00:24:51,420
+myocarditis، أو encephalitis، إذا فينا يعني برضه
+
+345
+00:24:51,420 --> 00:24:57,550
+حتى الكوكسيلا لها impact سيء على الصحة الـ... الـ...
+
+346
+00:24:57,550 --> 00:25:02,630
+المرضى، وممكن تؤدي ونا إلى الـ... ما يسمى بالـ
+
+347
+00:25:02,630 --> 00:25:06,620
+scarring of heart valves. ليه صمامات القلب؟ إيش
+
+348
+00:25:06,620 --> 00:25:10,340
+scarring يعني؟ يصير فيها تضّوب، عارفين لما يصير فيه
+
+349
+00:25:10,340 --> 00:25:15,340
+تضّوب في الأنسجة الداخلية، بتصير خشنة، وكلمة خشنة قد
+
+350
+00:25:15,340 --> 00:25:20,280
+تساهم في تكسير الـ platelets، تمام؟ قد تساهم في الـ
+
+351
+00:25:20,280 --> 00:25:22,880
+attachment تبع البكتيريا، لو صار في بكتيريا أخرى
+
+352
+00:25:22,880 --> 00:25:25,620
+بكتيريا، الـ infection بتسهل عليها عملية الـ
+
+353
+00:25:25,620 --> 00:25:30,420
+attachment، لأن في دي سطح خشن، سطح خشن نتج عن مين؟
+
+354
+00:25:30,420 --> 00:25:34,040
+عن الـ scarring اللي ناجم عن الإصابة بهذه البكتيريا
+
+355
+00:25:36,330 --> 00:25:39,070
+Growth characteristics: grow only in eukaryotic
+
+356
+00:25:39,070 --> 00:25:42,050
+cells like tissue culture or in brains
+
+357
+00:26:06,840 --> 00:26:09,440
+مهم جداً إحنا بالنسبة لي، إننا نكون  diagnosis، كوننا
+
+358
+00:26:09,440 --> 00:26:12,540
+إحنا اللي هو الـ medical technologies. بس بالمناسبة،
+
+359
+00:26:12,540 --> 00:26:15,580
+اليوم كان برضه في لقاء الطالبات، واتحدثنا...
+
+360
+00:26:15,580 --> 00:26:19,760
+توسّعنا في جزئية اللي بنتكلم فيها إياكم، أن تظنّوا
+
+361
+00:26:19,760 --> 00:26:24,560
+أنه أنتم the master of diagnosis. إحنا الـ master
+
+362
+00:26:24,560 --> 00:26:27,620
+of diagnosis. هو في النهاية في العملية التشخيصية هو
+
+363
+00:26:27,620 --> 00:26:31,740
+الطبيب. إحنا بنساعد الطبيب، بس في ناس كمان آخرين
+
+364
+00:26:31,740 --> 00:26:34,960
+بيساعدوا الطبيب في الـ diagnosis. عارفين من هم؟ الـ
+
+365
+00:26:34,960 --> 00:26:39,520
+radiologists تبعون الأشعة، والـ ultrasound، والـ...
+
+366
+00:26:39,520 --> 00:26:41,700
+اللي بيستخدموا الـ radiological techniques في الـ
+
+367
+00:26:41,700 --> 00:26:45,480
+diagnosis، اللي هم في MRI، وفي CT scan، وغير الـ X-
+
+368
+00:26:45,480 --> 00:26:50,030
+ray التقليدية كمان. واليوم كمان في يعني diagnostic
+
+369
+00:26:50,030 --> 00:26:55,870
+متطورة جداً، وفي treatment صارت بالـ... بالـ
+
+370
+00:26:55,870 --> 00:26:58,450
+radiology، لكن ما علينا، بس فحابة أؤكد الحقيقة
+
+371
+00:26:58,450 --> 00:27:01,750
+هذه، إن مش إحنا الوحيدين في مجال الـ diagnosis، إحنا
+
+372
+00:27:01,750 --> 00:27:08,140
+جزء من العمل. serology. أنا مش قادر أزرعها بطريقة
+
+373
+00:27:08,140 --> 00:27:11,960
+سهلة، مظبوط، وفاكرين لما اتكلمنا عن الـ... الـ Ox-
+
+374
+00:27:11,960 --> 00:27:17,140
+19؟ الـ Ox-19 لتشخيص مين؟ الـ Rickettsia. استبدلنا
+
+375
+00:27:17,140 --> 00:27:19,900
+... استبدلنا الـ Rickettsia بمين؟ بالـ Proteus، عشان
+
+376
+00:27:19,900 --> 00:27:23,120
+هذه صعبة التنمية، وهذا كان أحد الأسباب اللي بررنا
+
+377
+00:27:23,120 --> 00:27:26,790
+فيها. الـ P طبعاً هنا.  epidemiology هي الـ Ox-19 اللي
+
+378
+00:27:26,790 --> 00:27:30,710
+بتكلم عنه. الـ PCR، والـ tissue culture. طبعاً لو جينا
+
+379
+00:27:30,710 --> 00:27:34,530
+مثلاً على قطاع غزة، للأسف لحد الآن تقنية الـ tissue
+
+380
+00:27:34,530 --> 00:27:39,130
+culture مش common، بمعنى أنه موجودة فقط لأغراض
+
+381
+00:27:39,130 --> 00:27:42,610
+الدراسة والأبحاث، لكن ليست شائعة للاستخدام الـ
+
+382
+00:27:42,610 --> 00:27:46,130
+routine فيه. فبالتالي ما عندناش tissue culture. الـ
+
+383
+00:27:46,130 --> 00:27:49,270
+Weil-Felix reaction هو اللي إحنا شرحناه اللي هو
+
+384
+00:27:49,270 --> 00:27:52,900
+الـ Ox-19، هو نفسه هو الـ Weil-Felix reaction. طبعاً
+
+385
+00:27:52,900 --> 00:27:56,520
+حكينا عن الـ... هاي الأصناف: الـ Ox-2، و Ox-19، و Ox-K
+
+386
+00:27:56,520 --> 00:27:59,260
+هاد الـ... هاد الـ... الـ Proteus strains اللي
+
+387
+00:27:59,260 --> 00:28:03,140
+اشتركت في antigenes تبعها مع الـ Rickettsial species، و
+
+388
+00:28:03,140 --> 00:28:06,700
+استخدمناها كبديل للكشف عن الـ antibodies. طبعاً قلنا
+
+389
+00:28:06,700 --> 00:28:09,260
+هي الـ Proteus Antigen. بالنسبة لي الـ treatment:
+
+390
+00:28:09,260 --> 00:28:13,220
+Tetracycline and Chloramphenicol. وكلكم متفقين إن
+
+391
+00:28:13,220 --> 00:28:16,280
+Chloramphenicol is no longer used. المرة الجاية إن
+
+392
+00:28:16,280 --> 00:28:20,920
+شاء الله، بنبدأ في جزئية اللي هو الفطريات، إن شاء
+
+393
+00:28:20,920 --> 00:28:21,020
+الله
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9umZ2bwpUc8_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9umZ2bwpUc8_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..0c656e45469ca6559a7b85b10c1919fbba2e5c6e
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9umZ2bwpUc8_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 3783, "start": 20.25, "end": 37.83, "text": "بسم الله الرحمن الرحيم الجزء الأخير من الموضوع اللى بدأناه اللى هو ال chlamydia و ال mycoplasma و ال Rickettsia هنكمله اليوم ان شاء الله هتكون محاضرة اقصر من المحاضرات المعتادة ال Rickettsia فيها اسمين مشهورين Rickettsia و Coxella", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 25724, 11622, 38207, 16247, 9778, 13546, 9154, 9673, 2407, 11242, 45367, 13672, 7578, 47525, 10721, 8315, 3224, 13672, 7578, 31439, 2423, 417, 4326, 37622, 4032, 2423, 452, 13084, 7743, 1696, 4032, 2423, 11224, 18498, 654, 8032, 1863, 24793, 1211, 3224, 45595, 20498, 16472, 13412, 16606, 21984, 8032, 2655, 30544, 3714, 5016, 46958, 25720, 1975, 4587, 9381, 2288, 9154, 9673, 5016, 46958, 2288, 9307, 9673, 34268, 18513, 3660, 2423, 11224, 18498, 654, 8978, 11296, 24525, 2304, 9957, 37893, 3224, 13063, 9957, 11224, 18498, 654, 4032, 41576, 9885], "avg_logprob": -0.15144856801877418, "compression_ratio": 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"probability": 0.76220703125}, {"start": 25.75, "end": 26.35, "word": " ال", "probability": 0.87060546875}, {"start": 26.35, "end": 26.85, "word": " chlamydia", "probability": 0.677490234375}, {"start": 26.85, "end": 27.05, "word": " و", "probability": 0.7978515625}, {"start": 27.05, "end": 27.11, "word": " ال", "probability": 0.876953125}, {"start": 27.11, "end": 27.71, "word": " mycoplasma", "probability": 0.84466552734375}, {"start": 27.71, "end": 27.87, "word": " و", "probability": 0.9814453125}, {"start": 27.87, "end": 27.89, "word": " ال", "probability": 0.666015625}, {"start": 27.89, "end": 28.29, "word": " Rickettsia", "probability": 0.6746826171875}, {"start": 28.29, "end": 29.31, "word": " هنكمله", "probability": 0.82353515625}, {"start": 29.31, "end": 29.51, "word": " اليوم", "probability": 0.885986328125}, {"start": 29.51, "end": 29.63, "word": " ان", "probability": 0.7109375}, {"start": 29.63, "end": 29.81, "word": " شاء", "probability": 0.9921875}, {"start": 29.81, "end": 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"end": 1682.76, "word": " Species", "probability": 0.698974609375}, {"start": 1682.76, "end": 1683.14, "word": " و", "probability": 0.75927734375}, {"start": 1683.14, "end": 1683.86, "word": " استخدمناها", "probability": 0.92890625}, {"start": 1683.86, "end": 1684.32, "word": " كبديل", "probability": 0.765625}, {"start": 1684.32, "end": 1684.74, "word": " الكشف", "probability": 0.78515625}, {"start": 1684.74, "end": 1684.94, "word": " عن", "probability": 0.99853515625}, {"start": 1684.94, "end": 1685.32, "word": " ال", "probability": 0.97900390625}, {"start": 1685.32, "end": 1686.12, "word": " antibodies", "probability": 0.5205078125}, {"start": 1686.12, "end": 1686.52, "word": " طبعا", "probability": 0.9683837890625}, {"start": 1686.52, "end": 1686.7, "word": " قلنا", "probability": 0.7593587239583334}, {"start": 1686.7, "end": 1686.86, "word": " هي", "probability": 0.6796875}, {"start": 1686.86, "end": 1687.0, "word": " ال", "probability": 0.90185546875}, {"start": 1687.0, "end": 1687.42, "word": " Protease", "probability": 0.91015625}, {"start": 1687.42, "end": 1687.8, "word": " Antigen", "probability": 0.845458984375}, {"start": 1687.8, "end": 1688.68, "word": " بالنسبالي", "probability": 0.74482421875}, {"start": 1688.68, "end": 1688.84, "word": " ال", "probability": 0.76171875}, {"start": 1688.84, "end": 1689.26, "word": " treatment", "probability": 0.935546875}, {"start": 1689.26, "end": 1691.22, "word": " Tetrasyclin", "probability": 0.59072265625}, {"start": 1691.22, "end": 1691.58, "word": " and", "probability": 0.90576171875}, {"start": 1691.58, "end": 1692.34, "word": " Chloramphenicol", "probability": 0.7988688151041666}, {"start": 1692.34, "end": 1692.48, "word": " و", "probability": 0.8828125}, {"start": 1692.48, "end": 1692.72, "word": " كلكم", "probability": 0.73486328125}, {"start": 1692.72, "end": 1693.14, "word": " متفقين", "probability": 0.9027099609375}, {"start": 1693.14, "end": 1693.22, "word": " ان", "probability": 0.71630859375}, {"start": 1693.22, "end": 1694.08, "word": " Chloramphenicol", "probability": 0.88525390625}, {"start": 1694.08, "end": 1694.44, "word": " is", "probability": 0.83642578125}, {"start": 1694.44, "end": 1694.62, "word": " no", "probability": 0.8759765625}, {"start": 1694.62, "end": 1695.04, "word": " longer", "probability": 0.95068359375}, {"start": 1695.04, "end": 1695.64, "word": " used", "probability": 0.9150390625}, {"start": 1695.64, "end": 1695.94, "word": " المرة", "probability": 0.945556640625}, {"start": 1695.94, "end": 1696.16, "word": " الجاية", "probability": 0.7994791666666666}, {"start": 1696.16, "end": 1696.28, "word": " ان", "probability": 0.7431640625}, {"start": 1696.28, "end": 1696.42, "word": " شاء", "probability": 0.96240234375}, {"start": 1696.42, "end": 1696.42, "word": " الله", "probability": 0.96240234375}, {"start": 1696.42, "end": 1696.76, "word": " بنبدأ", "probability": 0.9620768229166666}, {"start": 1696.76, "end": 1697.02, "word": " في", "probability": 0.96826171875}, {"start": 1697.02, "end": 1697.76, "word": " جزئية", "probability": 0.9566650390625}, {"start": 1697.76, "end": 1697.94, "word": " اللي", "probability": 0.9638671875}, {"start": 1697.94, "end": 1698.12, "word": " هو", "probability": 0.98974609375}, {"start": 1698.12, "end": 1698.98, "word": " الفطريات", "probability": 0.967041015625}, {"start": 1698.98, "end": 1700.74, "word": " ان", "probability": 0.81787109375}, {"start": 1700.74, "end": 1700.92, "word": " شاء", "probability": 0.994140625}, {"start": 1700.92, "end": 1701.02, "word": " الله", "probability": 0.91064453125}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1702.1155, "duration_after_vad": 1645.9831249999984}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9umZ2bwpUc8_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9umZ2bwpUc8_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..7d1987e14237979d3e243dbc39a906d9848c7c17
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/9umZ2bwpUc8_raw.srt
@@ -0,0 +1,1572 @@
+1
+00:00:20,250 --> 00:00:24,910
+بسم الله الرحمن الرحيم الجزء الأخير من الموضوع
+
+2
+00:00:24,910 --> 00:00:27,870
+اللى بدأناه اللى هو ال chlamydia و ال mycoplasma و
+
+3
+00:00:27,870 --> 00:00:30,170
+ال Rickettsia هنكمله اليوم ان شاء الله هتكون
+
+4
+00:00:30,170 --> 00:00:35,350
+محاضرة اقصر من المحاضرات المعتادة ال Rickettsia
+
+5
+00:00:35,350 --> 00:00:39,150
+فيها اسمين مشهورين Rickettsia و Coxellaوعشان احنا
+
+6
+00:00:39,150 --> 00:00:44,550
+يعني نكون قادرين على إيصال فكرة جيدة حاولنا إنه
+
+7
+00:00:44,550 --> 00:00:49,550
+نصنف الأمراض اللي بت .. اللي .. اللي بتسببها
+
+8
+00:00:49,550 --> 00:00:52,930
+الركيزيا إلى ثلاث مجموعات، مجموعة سميناها typhus
+
+9
+00:00:52,930 --> 00:00:55,930
+group وكلمة typhus مرت معاكوا جابا لها كده لما
+
+10
+00:00:55,930 --> 00:01:00,420
+اتكلمنا عن ال Ox-19 اللي بتذكرهو ال .. ال spotted
+
+11
+00:01:00,420 --> 00:01:06,240
+fever أو الحمّة اللي فيها بُقع يعني فيها نزف و
+
+12
+00:01:06,240 --> 00:01:10,560
+المجموعة التالتة اللي هي اللي سموها others others
+
+13
+00:01:10,560 --> 00:01:14,140
+يعني لا تنتمي إلى أي من المجموعتين فإذا اننا تلت
+
+14
+00:01:14,140 --> 00:01:19,220
+مجموعات تعالوا تطلع على كل مجموعة هلاجة على جبالها
+
+15
+00:01:19,220 --> 00:01:26,620
+فيه حشرات مرسومة bugs و lice و fleasهذا مؤشر علاش؟
+
+16
+00:01:26,620 --> 00:01:31,740
+مؤشر على انه كل هذه الأمراض اللي احنا ذاكرينها في
+
+17
+00:01:31,740 --> 00:01:35,460
+المجموعة الأولى تبع ال typhus او ال spotted fever
+
+18
+00:01:35,460 --> 00:01:41,180
+التنتين بينتقلوا عبر الحشرات والحشرات بتشكل هنا
+
+19
+00:01:41,180 --> 00:01:47,100
+واحد من تلت أشياء بتشكل vectormechanical carrier
+
+20
+00:01:47,100 --> 00:01:50,280
+mechanical carrier يعني ناقل ميكانيكي فاكرين
+
+21
+00:01:50,280 --> 00:01:53,600
+الذباب الذباب كيف بينقل أمراض بي .. ب .. ب .. بظبط
+
+22
+00:01:53,600 --> 00:01:57,160
+بياخد أو على جسمه بياخد من قادرات بينقلها هذا
+
+23
+00:01:57,160 --> 00:02:00,620
+بيسموه mechanical لكن البعوض بيسموه biological
+
+24
+00:02:00,620 --> 00:02:05,280
+ليش؟ لأنه نفسه بي .. و خلينا نقول الطفل أو ال
+
+25
+00:02:05,280 --> 00:02:08,840
+microbe بيتكاثر داخل جسم الحشرة يعني بيلعب ..
+
+26
+00:02:08,840 --> 00:02:11,640
+الحشرة بتلعب دور يبقى جونا mechanical أو
+
+27
+00:02:11,640 --> 00:02:14,800
+biologicalو فيها إننا حاجة اسمها reservoir الحشرة
+
+28
+00:02:14,800 --> 00:02:19,120
+نفسها بتشكل reservoir لل infection بالظبط مخزن لل
+
+29
+00:02:19,120 --> 00:02:22,840
+infection ففي عندي epidemic typhus, endemic typhus
+
+30
+00:02:22,840 --> 00:02:26,380
+و scrub typhus في ال spotted fever في عندي rocky
+
+31
+00:02:26,380 --> 00:02:29,360
+mountain spotted fever و فيها اسمها Rickettsial
+
+32
+00:02:29,360 --> 00:02:35,180
+boxالاخير في تصنيف تالت اللي هو اسمه others فيه
+
+33
+00:02:35,180 --> 00:02:38,420
+بكتيريا واحدة اسمها Coxella Bernata وال Coxella
+
+34
+00:02:38,420 --> 00:02:41,700
+Bernata بدنا نبدأ فيها من الآن نتكلم عنها بتسبب
+
+35
+00:02:41,700 --> 00:02:42,780
+حاجة اسمها Q fever
+
+36
+00:02:45,810 --> 00:02:49,430
+لما صار مرة من المرات fever of a non-eteology
+
+37
+00:02:49,430 --> 00:02:54,010
+أسباب غير معروفة فحطوا fever under ال query fever
+
+38
+00:02:54,010 --> 00:02:58,250
+under query ايش معناه query معناها انه fever تحت
+
+39
+00:02:58,250 --> 00:03:01,370
+التحقيق احنا مش عارفين شو المسبب تبعه مش عارفين شو
+
+40
+00:03:01,370 --> 00:03:06,510
+المسبب بعد فترة من الزمن من ال investigation صار
+
+41
+00:03:06,510 --> 00:03:13,220
+اسمه Q feverQ fever حتى بعد أن علمنا .. حتى بعد أن
+
+42
+00:03:13,220 --> 00:03:17,400
+علمنا ايه المسبب دل اسمه Q fever فهذه نقطة كمان
+
+43
+00:03:17,400 --> 00:03:21,480
+بدنا نكون عارفين احنا مش راسمين جنبه حشرات ولا
+
+44
+00:03:21,480 --> 00:03:25,600
+شفته في حشرات؟ مافيش حشرات دلالة ايضا على ان هذا
+
+45
+00:03:25,600 --> 00:03:29,820
+هو الوحيد من المجموعة كلها اللذي لا ينتقل عبر
+
+46
+00:03:29,820 --> 00:03:33,660
+الحشرات انما بينتقل عبر ال .. ال aerosols الملوثة
+
+47
+00:03:33,660 --> 00:03:37,260
+اللي هي الرذاذ المحتوي على ال micro organism اذا
+
+48
+00:03:37,260 --> 00:03:41,170
+كمان مرةالـ typhus group و ال spotted group كلا
+
+49
+00:03:41,170 --> 00:03:45,290
+هما بينتقل عبر الحشرات بينما ال .. ال cue fever أو
+
+50
+00:03:45,290 --> 00:03:48,750
+الكوكسيلا بيرناتي اللي المسببة لا تنتقل عبر اللي
+
+51
+00:03:48,750 --> 00:03:50,890
+هو هذا الطريق
+
+52
+00:03:52,770 --> 00:03:56,450
+طيب احنا دخلنا مباشرة على تصنيف الأوراض ولم نتعرف
+
+53
+00:03:56,450 --> 00:04:00,570
+أصلا على البكتيريا أذكركم بأن هذه البكتيريا
+
+54
+00:04:00,570 --> 00:04:03,970
+الثانية في مجموعة الـ Obligate Intracellular
+
+55
+00:04:03,970 --> 00:04:08,450
+Parasites يعني هي الوحيدة مع الكلاميديا اللي
+
+56
+00:04:08,450 --> 00:04:12,240
+بينتموا لهذه المجموعةكيف هنميز الكلاميديا عن
+
+57
+00:04:12,240 --> 00:04:16,280
+الركيزيا؟ لاحظوا التمييز اللي حكيناه على الحشرات،
+
+58
+00:04:16,280 --> 00:04:19,400
+هذا جزء مهم من التمييز الجزء التاني في صالح
+
+59
+00:04:19,400 --> 00:04:27,640
+الكلاميديا، الكلاميديا كانت بتمر في خلال ال
+
+60
+00:04:27,640 --> 00:04:30,300
+replication تبعها ب life cycle وهي الوحيدة اللي
+
+61
+00:04:30,300 --> 00:04:33,340
+درسناها في البكتيريا بتمر ب life cycle، كان فينا
+
+62
+00:04:33,340 --> 00:04:37,340
+ال .. ال .. ال .. reticulate body وقلنالكوا ال
+
+63
+00:04:37,340 --> 00:04:41,570
+elementary bodyالـ resistance تبعه أعلى من ال
+
+64
+00:04:41,570 --> 00:04:44,630
+reticulate body فبالتالي ال survival تبعه في ال
+
+65
+00:04:44,630 --> 00:04:48,670
+environment نوعا ما عالي، ولو حبينا نعمل analogy،
+
+66
+00:04:48,670 --> 00:04:52,110
+مقارنة، بنقول في البكتيريا زي مثلا البصيلاس
+
+67
+00:04:52,110 --> 00:04:55,590
+والكلسترديوم، كان فينا vegetative cell و فينا
+
+68
+00:04:55,590 --> 00:05:00,620
+sporesمن اكتر مقاومة ل ال sport فممكن احنا ك
+
+69
+00:05:00,620 --> 00:05:04,540
+analogy نقول ان ال body elementary هو ال sport تبع
+
+70
+00:05:04,540 --> 00:05:07,340
+ال chlamydia لكن هو وقع الأمر مش sport لكن في
+
+71
+00:05:07,340 --> 00:05:11,420
+قدرته على التحمل اعلى من body reticulate اذا ال
+
+72
+00:05:11,420 --> 00:05:14,420
+chlamydia في ال environment بتوقع ان ال survival
+
+73
+00:05:14,420 --> 00:05:17,540
+تبع هيكون احسن من مين من ال rickettsia لان ال
+
+74
+00:05:17,540 --> 00:05:21,420
+rickettsia هنا هي stage واحد مافي غيره فبالتالي
+
+75
+00:05:21,420 --> 00:05:24,420
+they do not survive for long in the environment
+
+76
+00:05:25,730 --> 00:05:31,030
+البكتيريا هي small rod shape يعني بصلاي round to
+
+77
+00:05:31,030 --> 00:05:34,250
+polymorphic ممكن تتاخد أشكال أخرى غير ال rods
+
+78
+00:05:34,250 --> 00:05:36,950
+وممكن تكون polymorphic معناها متعددة اللي هو
+
+79
+00:05:36,950 --> 00:05:42,750
+الأشكال لكن تصنف تحت مين؟ طبعا التصنيف يا شباب لا
+
+80
+00:05:42,750 --> 00:05:46,930
+ينطبق عليها typically لكن ال cell wall تبقى ك
+
+81
+00:05:46,930 --> 00:05:51,310
+structure هو الأقرب إلى ال gram أو أقرب إلى ال
+
+82
+00:05:51,310 --> 00:05:57,950
+gram negative من ال gram بصيمه تبطلع ال gram small
+
+83
+00:05:57,950 --> 00:06:02,410
+رود شيب مابي راوند توبيليو مورفك يعني تتاخد أشكال
+
+84
+00:06:02,410 --> 00:06:05,490
+متنوعة و ليس فقط اللي هو بس الله أنا بتكلم دقن
+
+85
+00:06:05,490 --> 00:06:09,470
+كمان مرة عن ال cell wall أنه هي أقرب في شبه إلى ال
+
+86
+00:06:09,470 --> 00:06:13,870
+gram negative من ال gram positiveيعظم الجملة
+
+87
+00:06:13,870 --> 00:06:18,130
+التالية هي by default مفهومة لإن احنا بنتكلم عن
+
+88
+00:06:18,130 --> 00:06:20,310
+obligate intracellular parasites فهي فقط
+
+89
+00:06:20,310 --> 00:06:24,950
+cultivable only in living tissue، فقط تنمو في داخل
+
+90
+00:06:24,950 --> 00:06:28,570
+الأنسجة لإنها obligate intracellular parasites،
+
+91
+00:06:28,570 --> 00:06:34,650
+transmitted by lysticsيعني الحشرات هي الناقل
+
+92
+00:06:34,650 --> 00:06:38,210
+الرئيسي لهذه البكتيريا they cause disease in human
+
+93
+00:06:38,210 --> 00:06:41,790
+and domestic animals معنى الحكي أنه هي zoonetic
+
+94
+00:06:41,790 --> 00:06:44,610
+disease، zoonetic disease يعني بتنتقل من هنا إلى
+
+95
+00:06:44,610 --> 00:06:48,630
+هنا أو العكسbut are also found in the cytoplasm
+
+96
+00:06:48,630 --> 00:06:51,690
+وهنا نقطة كتير كتير مهمة they are found in the
+
+97
+00:06:51,690 --> 00:06:57,670
+cytoplasm of tissue cells of lice, fleas, ticks
+
+98
+00:06:57,670 --> 00:07:03,970
+and mites دلالة على إيش؟ بقولنا إن الحشرات مش فقط
+
+99
+00:07:03,970 --> 00:07:10,820
+ناقل بيولوجيا وإنما أيضا رزروارلو ناقل كان
+
+100
+00:07:10,820 --> 00:07:13,480
+بنلاقيها في ال salivary gland، بنلاقيها في ال
+
+101
+00:07:13,480 --> 00:07:16,740
+guts، لكن مش بالضرورة نلاقيها في مين، في ال
+
+102
+00:07:16,740 --> 00:07:19,620
+cytoplasm داخل الخلايا اللي موجودة في وين، في ال
+
+103
+00:07:19,620 --> 00:07:24,940
+ansia، إذا بنفهم إن الحشرة هنا can act as a
+
+104
+00:07:24,940 --> 00:07:27,940
+biological vector and can act as بناقلة و
+
+105
+00:07:27,940 --> 00:07:32,080
+reservoir، نقطة كتير مهمةأي transmission في الدنيا
+
+106
+00:07:32,080 --> 00:07:34,880
+ممكن يكون biological أو يكون mechanical زي ما
+
+107
+00:07:34,880 --> 00:07:37,660
+ذكرنا ال biological ticks و ال sucking lice اللي
+
+108
+00:07:37,660 --> 00:07:41,860
+هو القمل اللي بيمطس الدم طبعا ال .. ال .. ال
+
+109
+00:07:41,860 --> 00:07:47,160
+bacteria can survive in insects for months و هنا
+
+110
+00:07:47,160 --> 00:07:50,940
+لابد أن .. أن نوّل لقضية مهمة يا شباب قضية بتمث
+
+111
+00:07:50,940 --> 00:07:57,110
+نظرية التطوريُفترض إنه النظرية المؤمنين ..
+
+112
+00:07:57,110 --> 00:08:01,850
+المؤمنين بنظرية التطور كما ذكرها داروين إن الإنسان
+
+113
+00:08:01,850 --> 00:08:06,310
+على سلم .. على سلم ال .. الهرم في النظرية واحنا
+
+114
+00:08:06,310 --> 00:08:10,610
+كمسلمين نقول إن الإنسان ربنا كرمه وهو بالفعل سخر
+
+115
+00:08:10,610 --> 00:08:16,350
+له كل المخلوقات الأخرى في هذا الكون لكن داروين
+
+116
+00:08:16,350 --> 00:08:23,460
+بيقول إنه البقاء للأصلح .. البقاء للأصلحطيب لو
+
+117
+00:08:23,460 --> 00:08:29,640
+جينا نحسب مين أكتر عددا على كوكب الأرض؟النمل ولا
+
+118
+00:08:29,640 --> 00:08:35,160
+البني أدمين النمل اقولك حقيقة مذهلة وزن النمل على
+
+119
+00:08:35,160 --> 00:08:38,500
+كوكب الأرض يساوي وزن البشر معناه الحكي عدد النمل
+
+120
+00:08:38,500 --> 00:08:43,020
+لو بدنا نقارنه بالبشر بيكون مئات الألاف من الأضعاف
+
+121
+00:08:43,020 --> 00:08:47,660
+من البشر لإن حجمه صغير لكن ال survival تبقى رائع
+
+122
+00:08:47,660 --> 00:08:51,520
+جدا الحشرات بشكل عام ال survival تبقى رائع طب
+
+123
+00:08:51,520 --> 00:08:55,580
+تعالوا ناخد مثال تاني مين أكثر المخلوقات عدن على
+
+124
+00:08:55,580 --> 00:09:00,440
+كوكب الأرض؟اللي هي اقلها .. اللي هي اقلها تطورا
+
+125
+00:09:00,440 --> 00:09:03,900
+وهي الفيروسات وهي الفيروسات تليها البكتيريا ..
+
+126
+00:09:03,900 --> 00:09:07,120
+تليها البكتيريا اللي هي في التطور المفروض انه
+
+127
+00:09:07,120 --> 00:09:10,560
+مرحلة بعد من بعد الفيروسات، إذا الهرام مجلوب،
+
+128
+00:09:10,560 --> 00:09:14,510
+الهرام مجلوب، وهذا بينسب نظرية التطورإنه البقاء
+
+129
+00:09:14,510 --> 00:09:18,330
+للأصلح لأ البقاء مش للأصلح لأ البقاء يعني قد يكون
+
+130
+00:09:18,330 --> 00:09:24,210
+لمخلوقات أخرى طبعا بمفهوم الأصلح ال .. ال ..
+
+131
+00:09:24,210 --> 00:09:27,290
+الإنسان القوي و لا كان ال dinosaur ال dinosaur هو
+
+132
+00:09:27,290 --> 00:09:30,730
+اللي ساعد الكوكب بالأرض مش احنا كمان طيب
+
+133
+00:09:30,730 --> 00:09:35,910
+mechanical فاني أمثل عليها instruments أدوات عندنا
+
+134
+00:09:35,910 --> 00:09:39,750
+blood transfusion ممكن نقل دم بدي أقولكوا على كمان
+
+135
+00:09:39,750 --> 00:09:45,910
+طريقة لل mechanical تخيلوا حشرةأدت تاخد عينة دم من
+
+136
+00:09:45,910 --> 00:09:47,450
+الإنسان، ما مش عينة دم من أصحاب اللي وضعتها
+
+137
+00:09:47,450 --> 00:09:50,650
+للمختبر، بدها تتغذى على وشبة دم، وشبة دم، مش عينة
+
+138
+00:09:50,650 --> 00:09:57,150
+دم، تمام؟ خلال عملية التخدية قد تتبرز الحشرة على
+
+139
+00:09:57,150 --> 00:10:02,410
+الجلد تبع المريض أو الشخص يعني فبعد ما بتخلص
+
+140
+00:10:02,410 --> 00:10:06,890
+وشبتها، المخدر بينتهي مفعوله اللي هي بتحقنه مع ال
+
+141
+00:10:06,890 --> 00:10:12,540
+.. مع ال .. ال sucking apparatus تبعهافبالتالي و
+
+142
+00:10:12,540 --> 00:10:16,500
+بيتغادر فالمريض بيشعر بالحق كمكان الجروح اللي
+
+143
+00:10:16,500 --> 00:10:20,620
+سببته فبيروح بحق فبياخد البراز و بدخله هذا
+
+144
+00:10:20,620 --> 00:10:23,860
+mechanical transmission مش biological transmission
+
+145
+00:10:23,860 --> 00:10:27,040
+و هنشوف واحد زيه كمان شوية في الطفليات حدر صمع
+
+146
+00:10:27,040 --> 00:10:30,060
+الدكتور عدنان حاجة اسمها read of it bug و بيسموها
+
+147
+00:10:30,060 --> 00:10:35,260
+kissing bug لأنها بتيجي بتاخد واجبة الدم من
+
+148
+00:10:35,260 --> 00:10:40,760
+المنطقات اللي هو ال lipsطيب ال pathogenesis insect
+
+149
+00:10:40,760 --> 00:10:44,100
+vectors for human transmission earth robots such
+
+150
+00:10:44,100 --> 00:10:47,680
+as fleas, ticks, mites and lice كل هذه حشرات ممكن
+
+151
+00:10:47,680 --> 00:10:50,160
+تكون ناقلة و في نوع من ال specificity يعني كل
+
+152
+00:10:50,160 --> 00:10:55,500
+disease له الحشرة الخاصة فيه القوارض القوارض و
+
+153
+00:10:55,500 --> 00:11:00,680
+الإنسان و الحشراتcan act as a reservoir، مين
+
+154
+00:11:00,680 --> 00:11:05,180
+الإنسان؟ الإنسان المصاب بال disease هو بيكون مخزن،
+
+155
+00:11:05,180 --> 00:11:09,960
+مصدر للحشرات إنها تاخد منه وشبه الدم و تنقل لمين؟
+
+156
+00:11:09,960 --> 00:11:14,360
+للآخرين في نقطة كتير كمان مهمة ممكن لازم نناقشها،
+
+157
+00:11:14,360 --> 00:11:20,400
+الآن الحشرة بتبيض و ال bite تبعها بيفقس و بينتج
+
+158
+00:11:20,400 --> 00:11:25,940
+عنه صغارالان في انتاليجين ان الصغار يولدوا معقمين
+
+159
+00:11:25,940 --> 00:11:29,780
+استرايل بمعناه ان مافيش فيهم بكتيريا وعشان يصيلا
+
+160
+00:11:29,780 --> 00:11:34,000
+عندهم بكتيريا لازم ياخدوا وشبه دم من حيوان او من
+
+161
+00:11:34,000 --> 00:11:41,020
+انسان مصاب وفي خيار تاني ان الأم تنقل للبيض مباشرة
+
+162
+00:11:41,020 --> 00:11:45,580
+بعملية بنسميها Trans-ovarian Ovarian يعني المبيض
+
+163
+00:11:45,580 --> 00:11:49,900
+عبر المبيض Trans-ovarian transmission وصل الصورة
+
+164
+00:11:50,430 --> 00:11:54,350
+ففيه إمكاني إن الحشرات تولد أو تفقس تمام
+
+165
+00:11:54,350 --> 00:11:59,030
+بالبكتيريا أو بدون البكتيريا بحسب النوع اللي هو ال
+
+166
+00:11:59,030 --> 00:12:02,550
+.. ال .. ال .. ال insect vector أو ال vector
+
+167
+00:12:02,550 --> 00:12:06,390
+multiply in salivary gland يبقى .. وين بتتكاثر
+
+168
+00:12:06,390 --> 00:12:10,570
+البكتيريا؟ بتكاثر في salivary gland أو ال guts طب
+
+169
+00:12:10,570 --> 00:12:13,390
+بحسب مين ال ticks في salivary gland و ال
+
+170
+00:12:13,390 --> 00:12:19,180
+lyosolivaly في ال gut متى تتكاثر؟لما هي تاخد عينة
+
+171
+00:12:19,180 --> 00:12:24,480
+دم من حيوان أو من إنسان مصاب يبقى التكاثر بتتم بعد
+
+172
+00:12:24,480 --> 00:12:29,170
+ما تاخد ليها واجبة الدمهى بتصير و كلمة تكاثر مهمة،
+
+173
+00:12:29,170 --> 00:12:33,970
+مالاش مهم شباب، لإنه التكاثر بيزيد عدل البكتيريا و
+
+174
+00:12:33,970 --> 00:12:39,210
+بيخلي ما يسمى بالجرعة المعدية، فاكرين ال infective
+
+175
+00:12:39,210 --> 00:12:42,650
+dose؟ يعني ما بنفعش أنه ندخل حبة بكتيريا لبعض ..
+
+176
+00:12:42,650 --> 00:12:45,590
+لبعض نوع من البكتيريا، ممكن ما تكونش كافية انها
+
+177
+00:12:45,590 --> 00:12:51,300
+تعمل infection، فغالبا بدنا infective doseوين ما
+
+178
+00:12:51,300 --> 00:12:54,640
+كان العضة بتاعة الحشرة بيغالبا بتكون ما يسمى بال
+
+179
+00:12:54,640 --> 00:12:59,640
+scar و ال scar عبارة عن encrusted ulcer و بيصير
+
+180
+00:12:59,640 --> 00:13:02,220
+فيها necrosis و بعد فترة هنشوف أن ال necrosis
+
+181
+00:13:02,220 --> 00:13:06,420
+بتحول إلى اللون الأسود و أنتوا عارفين موت الخلايا
+
+182
+00:13:06,420 --> 00:13:11,010
+زي ما شوفنا فاهمينشوفنا مرة في بكتيريا ال Basillus
+
+183
+00:13:11,010 --> 00:13:15,390
+anthracis مرض الانثراكس الجامرة الخبيثة لما وصفنا
+
+184
+00:13:15,390 --> 00:13:18,970
+الجامرة الخبيثة وصفناها انه زي الجامرة انه في ال
+
+185
+00:13:18,970 --> 00:13:23,430
+center تبعها بيكون أسود و اللي حواليها بيكون أحمر
+
+186
+00:13:23,430 --> 00:13:27,170
+لكن هنا بنتكلم عن انه as a result of necrosis
+
+187
+00:13:27,170 --> 00:13:34,570
+بيصير في blackening لال ال ulcer ال
+
+188
+00:13:34,570 --> 00:13:39,950
+hustle هنا ال hustleالتكاثر تبع البكتيريا احنا
+
+189
+00:13:39,950 --> 00:13:43,170
+مثلا في الفيروسات وانتوا درستوا فيروسات او بعض
+
+190
+00:13:43,170 --> 00:13:45,910
+منكوا درست فيروسات بيعرف ان ال multiplication
+
+191
+00:13:45,910 --> 00:13:49,690
+للفيروس ياما في الcytoplasm ياما في ال nucleus
+
+192
+00:13:49,690 --> 00:13:55,610
+وبنصنف اصلا الفيروسات على هذه القالية ان they
+
+193
+00:13:55,610 --> 00:13:58,750
+multiply in cytoplasm او multiply in nucleus بس مش
+
+194
+00:13:58,750 --> 00:14:01,810
+التانين لكن هنا البكتيريا قادرة على تعمل
+
+195
+00:14:01,810 --> 00:14:05,310
+multiplication في ال nucleus و multiplication في
+
+196
+00:14:05,310 --> 00:14:10,470
+الcytoplasmك .. ك .. ك obligate intracellular
+
+197
+00:14:10,470 --> 00:14:16,150
+parasite و صارلها فاجو cytosis او endocytosis هادي
+
+198
+00:14:16,150 --> 00:14:21,370
+او هادي، هل في خطورة على البكتيريا؟Indocytosis او
+
+199
+00:14:21,370 --> 00:14:24,090
+Phagocytosis كلكوا بتعرفوا في immunology الفاجو
+
+200
+00:14:24,090 --> 00:14:29,170
+سايتوسس اصلا مصمم لقتل البكتيريا لكن بكتيريا اسمها
+
+201
+00:14:29,170 --> 00:14:32,870
+او وصفها انها obligate intracellular parasite هل
+
+202
+00:14:32,870 --> 00:14:38,190
+ستتأثر؟ لن تتأثر بالتأكيد عندها المقدرة على ان
+
+203
+00:14:38,190 --> 00:14:43,230
+تتهرب من الفاجو سايتك killing وهي جوا بتمنع ال
+
+204
+00:14:43,230 --> 00:14:47,730
+fusion تبع جن ال lyosome مع الفاجوزوم وبتاليcan
+
+205
+00:14:47,730 --> 00:14:51,190
+escape the process or the killing by phagocytosis
+
+206
+00:14:51,190 --> 00:14:55,810
+نبدأ هذا الكلام لان ممكن ما .. مالاجوش معاكم في ال
+
+207
+00:14:55,810 --> 00:14:58,030
+.. في ال text فتاخدوه .. تاخدوه من ال bar point ان
+
+208
+00:14:58,030 --> 00:15:01,830
+شاء الله فين ال typhus group ال typhus group بدنا
+
+209
+00:15:01,830 --> 00:15:06,470
+ناخد عليها مثال واحد اللي هو ال epidemic typhus و
+
+210
+00:15:06,470 --> 00:15:11,630
+ال epidemic typhus يا شباب له اسم تاني اللي هو ال
+
+211
+00:15:11,630 --> 00:15:15,830
+laws born يعني منقول عبر اللي هو القمل منقول عبر
+
+212
+00:15:15,830 --> 00:15:20,460
+القمل لذا عرفنامن اسمه انه بينتقل عبر القمل يعني
+
+213
+00:15:20,460 --> 00:15:23,960
+ال vector فيه قمل الوصف التاني اللي هو ال epidemic
+
+214
+00:15:23,960 --> 00:15:28,680
+البكتيريا المسببة اسمها ريكيزيا بروازاكي ريكيزيا
+
+215
+00:15:28,680 --> 00:15:34,100
+بروازاكي ال transmission بينتقل بونا من شخص لشخص
+
+216
+00:15:34,100 --> 00:15:41,120
+عبر ال body laws مش ال head laws مش قمل الرأس قمل
+
+217
+00:15:41,120 --> 00:15:46,390
+الجسم في قمل الرأس و قمل الجسم تمام؟طبعا في هذا
+
+218
+00:15:46,390 --> 00:15:50,190
+الحالة مين اللي هنتقلهم؟ الناس اللي عندهم بالفعل
+
+219
+00:15:50,190 --> 00:15:53,330
+poor hygienic practices خالص
+
+220
+00:15:56,810 --> 00:16:00,050
+والفكرة اللى حكيتلكوا إياها إنه ال louse بينتج ال
+
+221
+00:16:00,050 --> 00:16:02,850
+.. ال .. البراز و البراز بيكون في ال .. ال .. ال
+
+222
+00:16:02,850 --> 00:16:06,290
+microbe بيكون في البراز و بتم عملية scratching أو
+
+223
+00:16:06,290 --> 00:16:11,670
+الحك إله فبصيرله إدخال للجسم بينتج عنه high fever
+
+224
+00:16:11,670 --> 00:16:15,750
+و chills و rash طبعا possible ال rash يعني مش حاجة
+
+225
+00:16:15,750 --> 00:16:21,350
+مؤكدة وإنما احتمالة وجودها يعني موجودةغالبا المرض
+
+226
+00:16:21,350 --> 00:16:28,130
+بيستمر إلى حوالي أسبوعين و بيكون أكتر حدة في كبار
+
+227
+00:16:28,130 --> 00:16:32,890
+السن severe in elderly من complications تبعته
+
+228
+00:16:32,890 --> 00:16:35,730
+central nervous system complication dysfunction
+
+229
+00:16:35,730 --> 00:16:38,170
+يعني بيصير فيه مشاكل فيه و ممكن يكون عندنا
+
+230
+00:16:38,170 --> 00:16:39,290
+myocarditis
+
+231
+00:16:41,820 --> 00:16:49,200
+خلّيني اوضح الفكرة كيف بيطلع ال rash as a result
+
+232
+00:16:49,200 --> 00:16:55,220
+of rickettsial infection انا عندي البكتيريا عاملة
+
+233
+00:16:55,220 --> 00:16:58,080
+infection لل vascular endothelium ايش ال vascular
+
+234
+00:16:58,080 --> 00:17:02,500
+endothelium؟ هو الغشاء المبطن او الانسجار المبطنة
+
+235
+00:17:02,500 --> 00:17:08,090
+لل blood vesselsالان دخلت البكتيريا بال
+
+236
+00:17:08,090 --> 00:17:10,750
+endocytosis و انا بترجع بشوية اما phagocytosis او
+
+237
+00:17:10,750 --> 00:17:14,850
+endocytosis it multiply within the cells ال
+
+238
+00:17:14,850 --> 00:17:18,790
+multiplication في الآخر ultimately هيأدى الى تحلل
+
+239
+00:17:18,790 --> 00:17:23,000
+ال horse cellاتحللت ال host الاشرباب هيصير فين دي
+
+240
+00:17:23,000 --> 00:17:27,900
+increase ال number و release للبكتيريا they will
+
+241
+00:17:27,900 --> 00:17:34,920
+infect more cells في الآخر ال tissue المبطن لل
+
+242
+00:17:34,920 --> 00:17:41,330
+vessel أجزاء منه بتصير مخترقةيعني بتدوب من موت
+
+243
+00:17:41,330 --> 00:17:45,570
+الخلايا فبصير release لمن؟ لل blood من اللي هو ال
+
+244
+00:17:45,570 --> 00:17:48,010
+visits دي بيفهمنا من وان اجال ال rash من ان
+
+245
+00:17:48,010 --> 00:17:51,090
+البكتيريا عندها المقدرة علينا تعمل .. تعمل
+
+246
+00:17:51,090 --> 00:17:55,110
+infection لل endothelial و destruction لهذا
+
+247
+00:17:55,110 --> 00:17:57,870
+الخلايا وبالتالي اللي بيصير فيه انها rupturing ل
+
+248
+00:17:57,870 --> 00:18:04,640
+.. اللي هو ال blood visits قدنا المثال الأولعلى ال
+
+249
+00:18:04,640 --> 00:18:09,560
+.. ال .. ال .. ال Taifas group واخدنا ال epidemic
+
+250
+00:18:09,560 --> 00:18:13,260
+Taifas اللي بتسبب بركيزيا بروازاكي و اللي اتفقنا
+
+251
+00:18:13,260 --> 00:18:16,000
+انه بنتقل عن طريق مين جناه؟ عن طريق اللي هو القلب
+
+252
+00:18:16,000 --> 00:18:21,380
+القلب من الجسم نعم نجي الآن لمثال تاني واحد من
+
+253
+00:18:21,380 --> 00:18:24,780
+مجموعة اللي هو ال spotted fever و أشهر واحد اللي
+
+254
+00:18:24,780 --> 00:18:27,280
+هو rocky mountain spotted fever و هو أشهر واحد في
+
+255
+00:18:27,280 --> 00:18:31,070
+أمريكا rocky mountain spotted feverواللي بتسببه
+
+256
+00:18:31,070 --> 00:18:34,290
+بوباكتيريا سهل اللافظ تبعها Rickettsia Rickettsii
+
+257
+00:18:34,290 --> 00:18:37,930
+لإنه يجاية من نفس ال genus و ال reservoir تبعه
+
+258
+00:18:37,930 --> 00:18:41,530
+غالبا بيكون ال rodents زي ال mice و ال rats ال
+
+259
+00:18:41,530 --> 00:18:46,090
+vector غالبا اللي هو أو بينتقل عن طريق القرادو
+
+260
+00:18:46,090 --> 00:18:49,510
+القرار هتقولكوا حشرة برضه ماصة ليه اللي هو الدماء
+
+261
+00:18:49,510 --> 00:18:53,110
+و يفترض انه في course الطفليات هتاخد رزق من
+
+262
+00:18:53,110 --> 00:18:58,150
+الحشرات هذه بتفصيل أكبر لإنها تعتبر اكتو بارازايتس
+
+263
+00:18:58,150 --> 00:19:00,650
+اكتو بارازايتس و من ضمن اللي هو الطفليات اللي
+
+264
+00:19:00,650 --> 00:19:04,370
+بيدرسوهاالريكيتسيا بتكون في ال saliva of the tick
+
+265
+00:19:04,370 --> 00:19:09,330
+عشان هي كده ممكن تنتقل مباشرة مع الدم الأولانية
+
+266
+00:19:09,330 --> 00:19:12,650
+كانت ال multiplication في ال gut اللي يالاوز
+
+267
+00:19:12,650 --> 00:19:17,240
+وبتالي طلعت مع ال thesis تبع الحشرةhigh fever
+
+268
+00:19:17,240 --> 00:19:20,900
+malaise than rash initially but becomes particular
+
+269
+00:19:20,900 --> 00:19:23,700
+or hemorrhage وين بيبدأ ال rash؟ بيبدأ على ال
+
+270
+00:19:23,700 --> 00:19:27,060
+extremities على الأطراف و بعدين بدخل inward على
+
+271
+00:19:27,060 --> 00:19:31,220
+باقي الجسم في أمراض ال rash بيبدأ في المنتصف و
+
+272
+00:19:31,220 --> 00:19:35,280
+بينتقل إلى الأطراف هذا لأ هذا بيبدأ في الأطراف و
+
+273
+00:19:35,280 --> 00:19:40,150
+كمان مرة عايش بيعمل بيروح على اللي هو الجسمRashes
+
+274
+00:19:40,150 --> 00:19:43,950
+زي ما كنا start on extremities then rapidly spread
+
+275
+00:19:43,950 --> 00:19:47,370
+to the entire body and ايش بيحصل في ال untreated
+
+276
+00:19:47,370 --> 00:19:51,690
+cases بقولنا vascular disturbances with myocardial
+
+277
+00:19:51,690 --> 00:19:55,170
+or renal failure possible شوفنا غد myocardial
+
+278
+00:19:55,170 --> 00:19:58,870
+myocarditis و central nervous system dysfunction
+
+279
+00:19:58,870 --> 00:20:02,070
+complications وشوفنا هنا كمان مرة renal failure
+
+280
+00:20:02,070 --> 00:20:06,920
+يعني الريكتسيا ال disease الشبابif untreated they
+
+281
+00:20:06,920 --> 00:20:11,920
+may يعني cause serious complication اللي قد تؤدي
+
+282
+00:20:11,920 --> 00:20:16,440
+الى الوفا if undiagnosed early و untreated earlier
+
+283
+00:20:16,440 --> 00:20:20,920
+الميكروب يمكن الأخير في السلسلة اللى معاه احنا
+
+284
+00:20:20,920 --> 00:20:24,260
+اخدنا تلت مجموعة مظبوط مجموعة الـtyphus واخدنا مثل
+
+285
+00:20:24,260 --> 00:20:30,680
+عليها ومجموعة ال .. ال ..Spotted Fever والان
+
+286
+00:20:30,680 --> 00:20:35,000
+مجموعة ال others اللي هي من ضمنها كوكسيلا كوكسيلا
+
+287
+00:20:35,000 --> 00:20:38,640
+برناتي هي ال ideological agent للمرض اللي سميناها
+
+288
+00:20:38,640 --> 00:20:42,380
+Q fever وانا اتفقت معاكم في بداية المحاضرة ايش
+
+289
+00:20:42,380 --> 00:20:46,080
+معناه Q معناها جاي من كلمة query و query معناها
+
+290
+00:20:46,080 --> 00:20:49,640
+يعني under investigation under investigation
+
+291
+00:20:49,640 --> 00:20:55,180
+reservoir المخازنان الكتل sheep rodents ticks
+
+292
+00:20:55,180 --> 00:20:59,020
+شوفوا الكلمة reservoir خدنا نربطها بواقعنا اسمها
+
+293
+00:20:59,020 --> 00:21:02,420
+في مصر في بعض الحالات ل coronavirus طبعا هذا المرض
+
+294
+00:21:02,420 --> 00:21:06,420
+صار له فترة في الخليج صار له يمكن سنة بلفلف في
+
+295
+00:21:06,420 --> 00:21:08,740
+الإمارات حالتين في ال .. مش عارف في السعودية
+
+296
+00:21:08,740 --> 00:21:14,040
+اربعين خمسين حالة وبيجينا باستمرار تقارير عن ما
+
+297
+00:21:14,040 --> 00:21:17,700
+زال انتشاره الان كان احد الأشياء المحيرة في هذا
+
+298
+00:21:17,700 --> 00:21:21,940
+الموضوع مين ال reservoirوالان القبل هي المتهمة،
+
+299
+00:21:21,940 --> 00:21:26,900
+القبل هي المتهمة بإنها ريزروار ل .. ال .. ال .. ال
+
+300
+00:21:26,900 --> 00:21:30,380
+.. وطبعا كلمة متهمة يعني لسه مش hundred percent
+
+301
+00:21:30,380 --> 00:21:33,800
+proven انها .. يعني حتى في ناس بعض .. خرج بعض
+
+302
+00:21:33,800 --> 00:21:38,100
+الأطباء اللي لهم في المجال ونفوا أن يكون القبل لها
+
+303
+00:21:38,100 --> 00:21:43,080
+في هذا الموضوع، لكن مرة أخرى معرفة الريزروار مهمة،
+
+304
+00:21:43,080 --> 00:21:47,090
+ليش مهم معرفة الريزروار؟لما انا عرف الـ Reservoir
+
+305
+00:21:47,090 --> 00:21:50,070
+اما بعزله عن البنادمين او بعز البنادمين عنه، مظبوط
+
+306
+00:21:50,070 --> 00:21:53,610
+ولا لا؟ اذا كان Reservoir يمكن التخلص منه زي
+
+307
+00:21:53,610 --> 00:21:57,250
+الحشرات، زي القوارض، برضه بنعمل برنامج مكافحة
+
+308
+00:21:57,250 --> 00:22:03,810
+للتخلص من هذه الـ Reservoir لكن بنفهم ان معرفة
+
+309
+00:22:03,810 --> 00:22:08,130
+تفاصيل كيفية الانتقال من الـ Reservoir هذه عملية
+
+310
+00:22:08,130 --> 00:22:12,130
+مهمة جدا في اي control procedure لأي micro
+
+311
+00:22:14,840 --> 00:22:19,260
+contaminated aerosols كمان مرة هي الرذاذ مرة عينة
+
+312
+00:22:19,260 --> 00:22:24,160
+مايكروبة شباب برضه بيجيب الانتقال تبعه سابقا مار
+
+313
+00:22:24,160 --> 00:22:27,100
+معانا بينتقل برضه عبر ال aerosols و أنا متأكد ان
+
+314
+00:22:27,100 --> 00:22:32,950
+ولا واحد ذاكر الموضوع و يارت حد يخيب ظنىاللي
+
+315
+00:22:32,950 --> 00:22:36,230
+جونيلا نيوموفيلا اللي قولنا مش personal to
+
+316
+00:22:36,230 --> 00:22:39,870
+personal transmission لازم تروح على environmental
+
+317
+00:22:39,870 --> 00:22:44,170
+water و ال water يسيله aerosolized ال water و من
+
+318
+00:22:44,170 --> 00:22:49,350
+ثم ينتقل الى الناس الأخرى عموماتفقنا ان ال
+
+319
+00:22:49,350 --> 00:22:54,150
+pathogen اسمه coaxella pernate ال reservoir cattle
+
+320
+00:22:54,150 --> 00:22:57,070
+sheep rodents and ticks vector contaminated
+
+321
+00:22:57,070 --> 00:22:59,910
+aerosols coaxella pernate enters the body via
+
+322
+00:22:59,910 --> 00:23:03,530
+mucous membrane aberration and GIT via consumption
+
+323
+00:23:03,530 --> 00:23:05,510
+of milk of infected animal
+
+324
+00:23:19,490 --> 00:23:24,650
+الانعصاب بسبب أن الحيوانات تقوم بإتصال الحيوانات
+
+325
+00:23:24,650 --> 00:23:31,140
+بالإنسانبرا كان في عندي program في ال .. في
+
+326
+00:23:31,140 --> 00:23:33,800
+التلفزيون عن ال zoonotic diseases عن الأمراض
+
+327
+00:23:33,800 --> 00:23:37,460
+المشتركة طبعا ما .. يعني احنا كنا بنخاطب فيها عامة
+
+328
+00:23:37,460 --> 00:23:41,740
+فبتالي كان الكلام برضه بعموميات لكن يعني كان أحد
+
+329
+00:23:41,740 --> 00:23:46,100
+الأسئلة اللي سؤلت ان ما هي أشهر الأمراض اللي
+
+330
+00:23:46,100 --> 00:23:48,520
+موجودة في غزة من ال zoonotic disease وكان جوابي
+
+331
+00:23:48,520 --> 00:23:54,950
+برضه كمان جواب عام انه لا يوجد لدينامؤسسة رصد
+
+332
+00:23:54,950 --> 00:24:00,190
+للأمراض يعني بمعنى أخر لا أحد يستطيع أن يجيب بدقة
+
+333
+00:24:00,190 --> 00:24:07,830
+على هذا السؤال لأنه ماعناش امكن او خلينا نقول مركز
+
+334
+00:24:07,830 --> 00:24:11,650
+رصد للأمراض المشتركة أو حتى للأمراض الوبائية يعني
+
+335
+00:24:11,650 --> 00:24:18,070
+بشيء متواضع بيتم عن طريق ال reports تبع الأطباء
+
+336
+00:24:18,070 --> 00:24:21,830
+والمستشفياتوهم بينقلوا هذه ال reports بيعدلوها في
+
+337
+00:24:21,830 --> 00:24:24,590
+جداول اللي ببعتونا إياها، لكن واقع الأمر ماعناش لا
+
+338
+00:24:24,590 --> 00:24:29,270
+research ولا epidemiological centers للرصد الأوبي
+
+339
+00:24:29,270 --> 00:24:32,960
+أو بتالي اللي بالفعل فيه مشكلة في هذا المجالانا
+
+340
+00:24:32,960 --> 00:24:34,720
+اللي خاللي انا اتكلم اتكلم هذا كلمة zoonotic
+
+341
+00:24:34,720 --> 00:24:38,760
+disease انه zoonotic diseases لكن مابنعرف ايش هي
+
+342
+00:24:38,760 --> 00:24:43,200
+ال zoonotic disease ممكن يا شباب احد ال
+
+343
+00:24:43,200 --> 00:24:46,560
+complications السيئة انه يصير فينا hepatitis او
+
+344
+00:24:46,560 --> 00:24:51,420
+myocarditis او encephalitis اذا فيانا يعني برضه
+
+345
+00:24:51,420 --> 00:24:57,550
+حتى الكوكسيلةالها impact سيء على الصحة ال .. ال ..
+
+346
+00:24:57,550 --> 00:25:02,630
+المرضى و ممكن تؤدي ونا الى ال .. ما يسمى بال
+
+347
+00:25:02,630 --> 00:25:06,620
+scarring of heart valvesليه صممات القلب؟ إيش
+
+348
+00:25:06,620 --> 00:25:10,340
+scarring يعني؟ يصير فيها نضوب عارفين لما يصير فيه
+
+349
+00:25:10,340 --> 00:25:15,340
+نضوب في الأنسجة الداخلية بتصير خشنة وكلمة خشنة قد
+
+350
+00:25:15,340 --> 00:25:20,280
+تساهم في تكسير ال platelets تمام؟ قد تساهم في ال
+
+351
+00:25:20,280 --> 00:25:22,880
+attachment تبع البكتيريا لو صار في بكتيريا أخرى
+
+352
+00:25:22,880 --> 00:25:25,620
+بكتيريا ال infection بتسهل عليها عملية ال
+
+353
+00:25:25,620 --> 00:25:30,420
+attachment لأن في دي سطح خشن سطح خشن نتج عن مين؟
+
+354
+00:25:30,420 --> 00:25:34,040
+عن ال scarring اللي ناجم عن الإصابة بهذه البكتيريا
+
+355
+00:25:36,330 --> 00:25:39,070
+Growth characteristics grow only in eukaryotic
+
+356
+00:25:39,070 --> 00:25:42,050
+cells like tissue culture or in brains
+
+357
+00:26:06,840 --> 00:26:09,440
+مهم جدا احنا بالنسبالي اننا love diagnosis كوننا
+
+358
+00:26:09,440 --> 00:26:12,540
+احنا اللي هو ال medical technologies بس بالمناسبة
+
+359
+00:26:12,540 --> 00:26:15,580
+اليوم كان برضه في لقاء الطالبات و اتحدثنا ..
+
+360
+00:26:15,580 --> 00:26:19,760
+توسعنا في جزئية اللي بنتكلم فيها اياكم ان تظنوا
+
+361
+00:26:19,760 --> 00:26:24,560
+انه انتوا the master of diagnosis احنا ال master
+
+362
+00:26:24,560 --> 00:26:27,620
+of diagnosis هو في النهاية في العملية التشخيصية هو
+
+363
+00:26:27,620 --> 00:26:31,740
+الطبيباحنا بنساعد الطبيب بس في ناس كمان آخرين
+
+364
+00:26:31,740 --> 00:26:34,960
+بيساعدوا الطبيب في ال diagnosis عارفين من هم ال
+
+365
+00:26:34,960 --> 00:26:39,520
+radiologists تبعون الأشعة و ال ultrasound و ال ..
+
+366
+00:26:39,520 --> 00:26:41,700
+اللي بيستخدموا ال radiological techniques في ال
+
+367
+00:26:41,700 --> 00:26:45,480
+diagnosis اللي هم في MRI و في CT scan و غير ال X
+
+368
+00:26:45,480 --> 00:26:50,030
+-ray التقليدية كمانو اليوم كمان في يعني diagnostic
+
+369
+00:26:50,030 --> 00:26:55,870
+متطورة جدا و في treatment صارت بال .. بال
+
+370
+00:26:55,870 --> 00:26:58,450
+radiology، لكن ما علينا، بس فحابين أؤكد الحقيقة
+
+371
+00:26:58,450 --> 00:27:01,750
+هدى إن مش احنا الواحدين في مجال ال diagnosis، احنا
+
+372
+00:27:01,750 --> 00:27:08,140
+جزء من العمل، serologyأنا مش قادر أزرعها بطريقة
+
+373
+00:27:08,140 --> 00:27:11,960
+سهلة، مظبوط، و فاكرين لما اتكلمنا عن ال .. ال Ox
+
+374
+00:27:11,960 --> 00:27:17,140
+-19؟ ال Ox-19 لتشخيص مين؟ ال Rickettsia استبدلنا
+
+375
+00:27:17,140 --> 00:27:19,900
+.. استبدلنا ال Rickettsia بمين؟ بالبروتياس، عشان
+
+376
+00:27:19,900 --> 00:27:23,120
+هذه صعبة التنمية، و هذا كان أحد الأسباب اللي بررنا
+
+377
+00:27:23,120 --> 00:27:26,790
+فيهاالـ P طبعا هنا Epigastrology هي ال Ox-19 اللي
+
+378
+00:27:26,790 --> 00:27:30,710
+بتكلم عنه ال PCR و ال tissue culture طبعا لو جينا
+
+379
+00:27:30,710 --> 00:27:34,530
+مثلا على قطاع غزة للأسف لحد الآن تقنية ال tissue
+
+380
+00:27:34,530 --> 00:27:39,130
+culture مش common بمعنى أنه موجودة فقط لأغراض
+
+381
+00:27:39,130 --> 00:27:42,610
+الدراسة و الأبحاث لكن ليست شائعة للاستخدام ال
+
+382
+00:27:42,610 --> 00:27:46,130
+routine فيه فبالتالي ما نعناش tissue culture ال
+
+383
+00:27:46,130 --> 00:27:49,270
+wheel Felix reaction هو اللي احنا شرحناه اللي هو
+
+384
+00:27:49,270 --> 00:27:52,900
+ال Ox-19 هو نفسه هو ال wheel Felix reactionطبعا
+
+385
+00:27:52,900 --> 00:27:56,520
+حاكينا عن ال .. هاي الأصناف ال Ox-2 و Ox-19 و Ox-K
+
+386
+00:27:56,520 --> 00:27:59,260
+هاد ال .. هاد ال .. ال Protease strains اللي
+
+387
+00:27:59,260 --> 00:28:03,140
+اشتركت في أنتيجيناتها مع ال Rickettsial Species و
+
+388
+00:28:03,140 --> 00:28:06,700
+استخدمناها كبديل الكشف عن ال antibodies طبعا قلنا
+
+389
+00:28:06,700 --> 00:28:09,260
+هي ال Protease Antigen بالنسبالي ال treatment
+
+390
+00:28:09,260 --> 00:28:13,220
+Tetrasyclin and Chloramphenicol و كلكم متفقين ان
+
+391
+00:28:13,220 --> 00:28:16,280
+Chloramphenicol is no longer used المرة الجاية ان
+
+392
+00:28:16,280 --> 00:28:20,920
+شاء الله بنبدأ في جزئية اللي هو الفطريات ان شاء
+
+393
+00:28:20,920 --> 00:28:21,020
+الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/DbTwRll785g_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/DbTwRll785g_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..c9dca0190d57c59c8911ae0caae5d6085086602f
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/DbTwRll785g_postprocess.srt
@@ -0,0 +1,2088 @@
+1
+00:00:20,420 --> 00:00:23,960
+بسم الله الرحمن الرحيم، اليوم هنستكمل موضوعنا عن
+
+2
+00:00:23,960 --> 00:00:26,520
+ال micro bacterium، لكن منفعش نبدأ الموضوع من محيث
+
+3
+00:00:26,520 --> 00:00:29,660
+انتهينا، بنحاول نمرمروه سريع على الجزيئات اللي
+
+4
+00:00:29,660 --> 00:00:32,380
+اتطلقنا إليها، قلنا أنواع محاضرتنا كانت ال micro
+
+5
+00:00:32,380 --> 00:00:35,600
+bacteria واتفقنا على تقسيمة معينة في ال micro
+
+6
+00:00:35,600 --> 00:00:37,480
+bacteria، اتكلمنا عن ال complex تبع ال micro
+
+7
+00:00:37,480 --> 00:00:39,600
+bacterium tuberculosis اللي بتكون من three species
+
+8
+00:00:40,360 --> 00:00:42,860
+Tuberculosis والبوفس والافريكانو متكلمنا عن ال non
+
+9
+00:00:42,860 --> 00:00:45,660
+tuberculosis mycobacterium اللي هي ال NTM و
+
+10
+00:00:45,660 --> 00:00:48,780
+جسمناها لجسمين الجسم الأول سمناه atypical
+
+11
+00:00:48,780 --> 00:00:51,560
+mycobacterium والتاني non cultivated هبقول non
+
+12
+00:00:51,560 --> 00:00:54,340
+cultivated هبقول شمل اللي هم ال mycobacterium
+
+13
+00:00:54,340 --> 00:00:57,480
+libri وحنا الصحيح أهم two microbes هدرسهم في هذه
+
+14
+00:00:57,480 --> 00:01:00,020
+المحاضرة اللي هم ال mycobacterium tuberculosis و
+
+15
+00:01:00,020 --> 00:01:03,380
+ال mycobacterium libri وبدرج أقل من ال atypical
+
+16
+00:01:03,380 --> 00:01:05,940
+mycobacterium هتكلم شوية عن mycobacterium avium
+
+17
+00:01:06,130 --> 00:01:10,830
+Intracellular اللي قلنا ارتبط اسمها بال HIV اكتر
+
+18
+00:01:10,830 --> 00:01:14,120
+شيءبعدين بدنا بحديث عن ال general characteristics
+
+19
+00:01:14,120 --> 00:01:19,480
+و تحدثنا عن صفة مهمة جدا بتميزها عن باقى نوع
+
+20
+00:01:19,480 --> 00:01:23,060
+البكتيريا اللى هى وجود ال mycolic acid و ال acid
+
+21
+00:01:23,060 --> 00:01:26,760
+fastness لهذه البكتيريا كنا هى acid fast لإن فى
+
+22
+00:01:26,760 --> 00:01:31,260
+كمية كبيرة من ال waxy lipids اللى بتجعل منصبغتها
+
+23
+00:01:31,260 --> 00:01:36,020
+صعبة ولكن انصبغت تجعل من إزالة اللون منها ايضا
+
+24
+00:01:36,020 --> 00:01:40,520
+صعبة حتى فى وجود حامض زى ما كنا اللى هو او ال
+
+25
+00:01:40,520 --> 00:01:43,510
+mixture من ال acid alcoholالبكتيريا اتفقنا انها
+
+26
+00:01:43,510 --> 00:01:46,390
+aerobic و ال doubling time تباعها قد يتروح من 12
+
+27
+00:01:46,390 --> 00:01:49,630
+ساعة إلى 20 ساعة بحسب الوسط الزراعي اللي هي بتنمو
+
+28
+00:01:49,630 --> 00:01:54,210
+فيه لكن اتفقنا انها بتحب ال CO2 اتحدثنا عن ال
+
+29
+00:01:54,210 --> 00:01:57,310
+disease و جونا ال palmonary tuberculosis أحد أهم
+
+30
+00:01:57,310 --> 00:02:00,530
+أشهر الأمراض اللي بتسيبها البكتيريا و اتحدثنا عن
+
+31
+00:02:00,530 --> 00:02:03,810
+مجموعة من ال legions او two types of legions اللي
+
+32
+00:02:03,810 --> 00:02:06,250
+هم ال excretive type و ال productive type و جون ال
+
+33
+00:02:06,250 --> 00:02:09,950
+productive type هو المهم لأنه هو اللي غالبا بيكون
+
+34
+00:02:09,950 --> 00:02:14,760
+diagnostic للبكتيرياوتحدثنا عن أيضًا مجموعة كبيرة
+
+35
+00:02:14,760 --> 00:02:19,380
+من الأعراض اللي قد تكون مصاحبة للإصابة بال
+
+36
+00:02:19,380 --> 00:02:23,860
+بالبلموناري tuberculosis أهمها قلنا اللي هو ال
+
+37
+00:02:23,860 --> 00:02:27,540
+fever و ال night sweat و ال weight loss و قلنا
+
+38
+00:02:27,540 --> 00:02:32,810
+اللي هو loss of appetiteاعتقد ان احنا بدنا بالحديث
+
+39
+00:02:32,810 --> 00:02:36,290
+عن ال specimen المرة الماضية و اتكلمنا عن ان احنا
+
+40
+00:02:36,290 --> 00:02:41,070
+كان لازم نعمل شغل مهم جدا من خلالها انفكفك
+
+41
+00:02:41,070 --> 00:02:43,330
+البكتيريا اللي هي ال mycobacterium اللي احنا بدنا
+
+42
+00:02:43,330 --> 00:02:46,670
+إياها من ال sputum و في نفس الوجه نقضي على ال
+
+43
+00:02:46,670 --> 00:02:50,050
+contaminants اللي موجودة لإن لو عملنا مقارنة بين
+
+44
+00:02:50,050 --> 00:02:52,410
+ال doubling time لل normal flora او normal
+
+45
+00:02:52,410 --> 00:02:55,130
+microbiota اللي في الفم و بين ال mycobacteria
+
+46
+00:02:55,130 --> 00:02:58,770
+هلاجي انه الفرق شاسة لو اتنين حاطناهم على نفس ال
+
+47
+00:02:58,770 --> 00:03:03,750
+mediaاللي هي بتنمي الاتنين حلاجة انه النمو لصالح
+
+48
+00:03:03,750 --> 00:03:08,090
+مين؟ ال normal microbiota وبالتالي بتستهلك الغذاء
+
+49
+00:03:08,090 --> 00:03:12,610
+من الوسط و بتبنع نموفبالتالي كان من الضروري قتل ال
+
+50
+00:03:12,610 --> 00:03:16,530
+normal microbiota فلجأنا ل ال NAOH treatment اللي
+
+51
+00:03:16,530 --> 00:03:19,750
+احنا حكينا عنها المرة الماضية وهي عبارة عن equal
+
+52
+00:03:19,750 --> 00:03:25,650
+volume من ال Sputum و من 4% Sodium Hydroxide عملنا
+
+53
+00:03:25,650 --> 00:03:29,170
+لهم mixing بعدين عملنا لهم centrifugation بعدين
+
+54
+00:03:29,170 --> 00:03:32,190
+شيلنا ال supernatant و أخدنا sediment و بعدين
+
+55
+00:03:32,190 --> 00:03:37,660
+أضفنا اللي هو ال pH indicator و أضفنا twonormal
+
+56
+00:03:37,660 --> 00:03:42,340
+HCL to a definite endpoint عشان نخل الوسط neutral
+
+57
+00:03:42,340 --> 00:03:48,180
+مرة أخرى وبعدين ال sediment هذه المعادلة أخدناها
+
+58
+00:03:48,180 --> 00:03:52,800
+وعملنا منها شغل تاني عملنا حاجتين sediment زرعنا
+
+59
+00:03:52,800 --> 00:03:58,700
+على slants أو slopes للوسط ال selective اللي اسمه
+
+60
+00:03:58,700 --> 00:04:04,070
+Leinstein جنس الأجار two slants two slopesو زرعنا
+
+61
+00:04:04,070 --> 00:04:07,430
+او مش زرعنا بالاخرى عملنا acid fast stain جيبجا ال
+
+62
+00:04:07,430 --> 00:04:12,090
+sediments اللي حصلنا عليها حصلنا عليها و قمنا
+
+63
+00:04:12,090 --> 00:04:16,030
+بعمليتين ب culture and staining ال culture مداش
+
+64
+00:04:16,030 --> 00:04:21,310
+كلمة بتقولنا لونشتاين جنسن slopes مش plates why
+
+65
+00:04:21,310 --> 00:04:29,050
+not plates ليش tubes؟انها بالعكس ال .. ال .. ال ..
+
+66
+00:04:29,050 --> 00:04:32,710
+ال plates لإن فيها surface area تمام واسعة فبتالي
+
+67
+00:04:32,710 --> 00:04:37,070
+هتكون أسرع solid
+
+68
+00:04:37,070 --> 00:04:39,590
+media slope مش liquid
+
+69
+00:04:43,090 --> 00:04:46,910
+طيب نرجع للفترة الزمنية اللازمة لل incubation كام
+
+70
+00:04:46,910 --> 00:04:50,190
+.. كام الفترة الزمنية؟ six to eight weeks من ست
+
+71
+00:04:50,190 --> 00:04:53,490
+لثمان أسابيع لو وضعنا أطباق في ال incubator على
+
+72
+00:04:53,490 --> 00:04:56,550
+سبعة و ثلاثين درجة مأوية يا شباب وضعناها لمدة أربع
+
+73
+00:04:56,550 --> 00:05:01,960
+أيام بس، إيش حصل في الأطباق؟ حجف تماماليش؟ لأن ال
+
+74
+00:05:01,960 --> 00:05:05,520
+surface area تبعتها واسعة جدا وبالتالي حصير
+
+75
+00:05:05,520 --> 00:05:10,260
+evaporation وإذا جفت ال media معناه الحاجة انه no
+
+76
+00:05:10,260 --> 00:05:13,380
+water activity واحنا قلنالكوا أحد أهم عوامل اللي
+
+77
+00:05:13,380 --> 00:05:17,640
+بتأثر عن نمو هو ال water activity وبالتالي اضطررنا
+
+78
+00:05:17,640 --> 00:05:21,060
+لأن ال incubation period طويلة فاضطررنا نعملهم في
+
+79
+00:05:21,060 --> 00:05:24,380
+مين؟ في أنابيب ويكونوا well screw-capped يعني حتى
+
+80
+00:05:24,380 --> 00:05:31,410
+محكمة الإغلاق بشكل جيدإذا اتفقنا إن ال period هي
+
+81
+00:05:31,410 --> 00:05:37,330
+الجداش6-8 أسابيع الان كلمة 6-8 أسابيع مافيش عندي
+
+82
+00:05:37,330 --> 00:05:40,730
+حاجة اسمها 6-8 أسابيع في ال actual practice في
+
+83
+00:05:40,730 --> 00:05:46,630
+الممارسة الحقيقية في رقم بتقوللي انه بعد 6 أسابيع
+
+84
+00:05:46,630 --> 00:05:50,230
+بعد 7 أسابيع بعد 8 أسابيع مافيش range مافيش range
+
+85
+00:05:50,230 --> 00:05:53,450
+ال range اللي انا بحكيه هنا في اختلافات ما بين
+
+86
+00:05:53,450 --> 00:05:57,550
+مختبر و مختبر مستشفى و مستشفى لكن واقع الأعمال
+
+87
+00:05:57,550 --> 00:06:02,130
+المستشفى له رقم 1 مثلا بعد 8 أسابيعقد يكون بسط في
+
+88
+00:06:02,130 --> 00:06:05,630
+الأسبوع الرابع، في الخامس، في السادس، في السابع،
+
+89
+00:06:05,630 --> 00:06:09,690
+لكن لا أستطيع أن أقول negative إلا بعد مرور الفترة
+
+90
+00:06:09,690 --> 00:06:13,450
+الزمنية ال maximum، اللي هي مثلا تمان أسابيع في
+
+91
+00:06:13,450 --> 00:06:16,630
+هذه الحلقةفي وسط تانية شباب غير الـ Leinstein
+
+92
+00:06:16,630 --> 00:06:21,330
+-Jensen Medium اسمه Middlebrook Agar لاحظوا الفترة
+
+93
+00:06:21,330 --> 00:06:25,830
+الزمنية لازمة للنمو البكتيريا على الطبقين أو على
+
+94
+00:06:25,830 --> 00:06:29,870
+العفوة الوسطين في الأولى four to six weeks التانية
+
+95
+00:06:29,870 --> 00:06:33,610
+two to three weeks اعتقد ان في good reduction
+
+96
+00:06:33,610 --> 00:06:40,860
+للزمن لأن ال middlebrook هيحل محل منلونشتاين و
+
+97
+00:06:40,860 --> 00:06:44,720
+بالتأكيد هو حل محل لونشتاين جنسا أجار في كثير من
+
+98
+00:06:44,720 --> 00:06:50,680
+البلدان والمستشفى لكن في الآخر اتنين موجودين طيب
+
+99
+00:06:50,680 --> 00:06:55,560
+انا ادعيت ادعاء قبل قليل بالانفندو انا قلت ان ال
+
+100
+00:06:55,560 --> 00:06:59,820
+NAOH treatment للعينة عملت شغل تاني قتلت ال
+
+101
+00:06:59,820 --> 00:07:04,160
+contaminant وش عملت؟ عملت concentration للبكتيريا
+
+102
+00:07:04,160 --> 00:07:08,350
+انها حررت البكتيريا من ال mucusهذا الإدعاء
+
+103
+00:07:08,350 --> 00:07:11,790
+الأولاني قتلت كل الcontinent هل هو صحيح مائة
+
+104
+00:07:11,790 --> 00:07:15,530
+بالمائة absolute لو absolute كان مالي ذنب الأمر
+
+105
+00:07:15,530 --> 00:07:19,710
+إنه نظرة على selective mediaبينما ال launch time
+
+106
+00:07:19,710 --> 00:07:23,150
+جنس الأجار هو بالفعل selective media ومضاف إليه يا
+
+107
+00:07:23,150 --> 00:07:26,750
+شباب اللي هو ال malachite green الصبغة اللي
+
+108
+00:07:26,750 --> 00:07:30,930
+استخدمتوها في ال sports training فاكرينها؟ ال
+
+109
+00:07:30,930 --> 00:07:35,350
+malachite green مضافة إلهانة لهذا الوسط ليس بغرض
+
+110
+00:07:35,350 --> 00:07:39,610
+الصباغة وعندما بغرض to inhibit the growthof non
+
+111
+00:07:39,610 --> 00:07:43,370
+-mycobacteria إذن بالفعل أنا ماقدرش أفترض افتراض
+
+112
+00:07:43,370 --> 00:07:46,570
+absolute إن ال sediments اللي أنا حصلت عليها من ال
+
+113
+00:07:46,570 --> 00:07:49,890
+treatment بتبعت ال NMH إنها completely استيراك وصل
+
+114
+00:07:49,890 --> 00:07:53,190
+الصورة طبعا نقول إن أحنا البكتيريا كابنوفيليك و بت
+
+115
+00:07:53,190 --> 00:07:55,470
+require ال CO2 وبتالي ال incubation تبعها بتكون
+
+116
+00:07:55,470 --> 00:08:02,920
+under CO2 incubation طيبالان البكتيريا بعد أربع
+
+117
+00:08:02,920 --> 00:08:08,660
+أسابيع خمس أسابيع نمت البكتيريا تمام وظهر مستعمرات
+
+118
+00:08:08,660 --> 00:08:11,400
+طبعا شكل المستعمرات تبعت ال micro bacterium
+
+119
+00:08:11,400 --> 00:08:15,140
+tuberculosis يشبه إلى حد كبير ما يسمى بال bread
+
+120
+00:08:15,140 --> 00:08:20,290
+crumbs اللي هي فتاة الخبز فتاة الخبزو لو انت عملت
+
+121
+00:08:20,290 --> 00:08:23,530
+simple search على ال .. ال .. ال google هتلاقي
+
+122
+00:08:23,530 --> 00:08:28,030
+برضه كتير .. كتير صور لمستعمرات على ال Leunstein
+
+123
+00:08:28,030 --> 00:08:32,490
+جنس الأجار بالفعل بتعطيك انطباع بأن هذه فتاعة خبز
+
+124
+00:08:32,490 --> 00:08:36,030
+من أشهر الفحوصات اللي لازم نربطها بالmycobacterium
+
+125
+00:08:36,030 --> 00:08:40,290
+tuberculosis فحص اسمه نياسين test نياسين test كيف
+
+126
+00:08:40,290 --> 00:08:45,510
+الفحص بينعمل؟ بطريقة بسيطة جدا هذا ال slant أو ال
+
+127
+00:08:45,510 --> 00:08:48,490
+slopeاللي نامي الفيه البكتيريا طبعا انتوا عارفين
+
+128
+00:08:48,490 --> 00:08:51,570
+كيف ال slope بيكون زي ال triple sugar iron agar او
+
+129
+00:08:51,570 --> 00:08:55,410
+بالأحرى زي ال citrate لإن احنا بلزمناش but بلزمناش
+
+130
+00:08:55,410 --> 00:09:01,130
+but بنضيف واحد milli sterile distilled water و
+
+131
+00:09:01,130 --> 00:09:05,170
+بنميّر القنبوبة بحيث ان الماء يصير ملامس لمين
+
+132
+00:09:05,170 --> 00:09:10,290
+للسطح تبع المستعمرات بتاعت البكتيريا الانياسين هو
+
+133
+00:09:10,290 --> 00:09:10,750
+compound
+
+134
+00:09:16,470 --> 00:09:22,090
+الماء اللى تركناه في الأنبوبة ملامس للسطح فى الماء
+
+135
+00:09:22,090 --> 00:09:22,830
+اللى تركناه في الأنبوبة ملامس للسطح فى الماء اللى
+
+136
+00:09:22,830 --> 00:09:25,130
+تركناه في الأنبوبة ملامس للسطح فى الماء اللى
+
+137
+00:09:25,130 --> 00:09:25,770
+تركناه ملامس للسطح فى الماء اللى تركناه ملامس
+
+138
+00:09:25,770 --> 00:09:25,830
+للسطح فى الماء اللى تركناه ملامس للسطح فى الماء
+
+139
+00:09:25,830 --> 00:09:26,810
+اللى تركناه ملامس للسطح فى الماء اللى تركناه ملامس
+
+140
+00:09:26,810 --> 00:09:27,070
+للسطح فى الماء اللى تركناه ملامس للسطح فى الماء
+
+141
+00:09:27,070 --> 00:09:28,600
+للسطح فى الماء اللى تركناه ملامس للسطح فى الماءبعد
+
+142
+00:09:28,600 --> 00:09:31,580
+ربع ساعة بناخد جزء من الماء، احنا حاطينا واحد مل،
+
+143
+00:09:31,580 --> 00:09:35,140
+خد نص ملي يا سيدي، خد نص ملي من الماء، وحطه في
+
+144
+00:09:35,140 --> 00:09:39,820
+قنبوبة جديدة، نظيفة، مغلقة، مغلقة، خلصنا؟ هي الأن
+
+145
+00:09:39,820 --> 00:09:42,940
+القنبوبة الجديدة، إيش في القنبوبة الجديدة هذه؟
+
+146
+00:09:42,940 --> 00:09:48,020
+point five ml من مين؟من ال water اللى يفترض ان
+
+147
+00:09:48,020 --> 00:09:52,500
+يكون فيه ناسين او مايكونش فيه ناسين كيف بنعمل
+
+148
+00:09:52,500 --> 00:09:56,860
+detection؟ بنضيف two compounds one اللى هو بنحط
+
+149
+00:09:56,860 --> 00:10:01,160
+طبعا الكميات point five ml of four percent aniline
+
+150
+00:10:01,160 --> 00:10:05,340
+و point five ml of ten percent cyanogen bromide
+
+151
+00:10:06,540 --> 00:10:10,540
+your indicator for the presence or absence of اللي
+
+152
+00:10:10,540 --> 00:10:13,300
+هو النايسين اللي هو كلمة مرة أنيالين داي أربع في
+
+153
+00:10:13,300 --> 00:10:16,820
+المية زائد سيانوجين رومايد اللي هو عشرة في المية
+
+154
+00:10:16,820 --> 00:10:22,460
+إذا تحول الوسط فورا within يعني seconds تمام إلى
+
+155
+00:10:22,460 --> 00:10:27,140
+اللون الأصفر للون الأصفر فالنايسين is there يعني
+
+156
+00:10:27,140 --> 00:10:30,240
+الفحص posted إذا ما اتحول للون الأصفر فالفحص
+
+157
+00:10:30,240 --> 00:10:33,810
+negative ليش هذا الفحص أنا بقول بويقع أنه مهم؟لأن
+
+158
+00:10:33,810 --> 00:10:37,530
+من كل ال mycobacteria only two produces niacin
+
+159
+00:10:37,530 --> 00:10:40,450
+test positive mycobacterium tuberculosis and
+
+160
+00:10:40,450 --> 00:10:44,990
+mycobacterium semiae ممر معانا أذكرها في القائمة
+
+161
+00:10:44,990 --> 00:10:48,730
+لكن هي من الموقع ال mycobacterium كيف نتميز بين
+
+162
+00:10:48,730 --> 00:10:55,670
+التنتين بكل سهولة ويسرأصلا مافيش داعي لشبه بينهم،
+
+163
+00:10:55,670 --> 00:10:59,790
+ليش؟ لأن واحدة منهم pigmented ملونة والتانية غير
+
+164
+00:10:59,790 --> 00:11:02,570
+ملونة، مين ال pigmented؟ السمية، بينما ال
+
+165
+00:11:02,570 --> 00:11:04,930
+mycobacterium tuberculosis اللي احنا بصددها non
+
+166
+00:11:04,930 --> 00:11:09,050
+-pigmented فإذا أنا عملت نياسين test ل pigmented
+
+167
+00:11:09,050 --> 00:11:13,330
+test ل pigmented mycobacteria فبتكون سمية، إذا
+
+168
+00:11:13,330 --> 00:11:17,750
+عملت نياسين test ل non-pigmented وطلع positive فهي
+
+169
+00:11:17,750 --> 00:11:21,780
+mycobacterium tuberculosisبالإضافة لأنها scene
+
+170
+00:11:21,780 --> 00:11:24,120
+test اللي قلنا عنه أساسي في مجموعة أخرى من
+
+171
+00:11:24,120 --> 00:11:26,580
+الفحوصات يعني من الممكن أنها مرسلية مافيش داعي أن
+
+172
+00:11:26,580 --> 00:11:32,600
+نفصلها لأنها غالبا يعني ما تستخدم بطريقة مختلفة عن
+
+173
+00:11:32,600 --> 00:11:36,260
+الفحوصات الأخرى، ليش؟ لأن أنا بتكلم عن slow
+
+174
+00:11:36,260 --> 00:11:38,480
+growing bacteria، إذا بدى أعمل ال test بدي أخد
+
+175
+00:11:38,480 --> 00:11:41,280
+وقت، فال biochemical test في هذا الحالة بتاخد وقت
+
+176
+00:11:41,280 --> 00:11:45,140
+طويلTrait reduction test, Urease test, Teluride
+
+177
+00:11:45,140 --> 00:11:49,080
+test, Sodium chloride test, Tolerance test يعني
+
+178
+00:11:49,080 --> 00:11:52,740
+قدرة تحمل البكتيريا على انه مو في تركيز مختلفة من
+
+179
+00:11:52,740 --> 00:11:55,920
+ال Sodium chloride pigment production test ما احنا
+
+180
+00:11:55,920 --> 00:11:59,020
+شوفناها اجابه شوي انها negative الكتاليز بده احكي
+
+181
+00:11:59,020 --> 00:12:03,580
+عنه شوي هنا لانه مش كتاليز عادي خصوصا لازم نعرف ان
+
+182
+00:12:03,580 --> 00:12:06,560
+كل مايكوبكتيريا اصلا كتاليز positive كل
+
+183
+00:12:06,560 --> 00:12:09,200
+مايكوبكتيريا كتاليز positive لانها obligate
+
+184
+00:12:09,200 --> 00:12:14,020
+aerobesنجي لأمبوبة بس المبوبة المرة دي مدرجة
+
+185
+00:12:14,020 --> 00:12:17,880
+امبوبة مدرجة يعني فيها اشارة واحد اتنين تلاتة اربع
+
+186
+00:12:17,880 --> 00:12:21,700
+خمسة الاخر وضعنا فيها كمية hydrogen peroxide محددة
+
+187
+00:12:21,700 --> 00:12:27,540
+وضفنا عليها لوب من البكتيريا بدلا من كتلاس بصتي مش
+
+188
+00:12:27,540 --> 00:12:34,480
+هتعمل bubbles الان ال bubbles بحسبلأن كمية ال H2O2
+
+189
+00:12:34,480 --> 00:12:38,760
+مستقل و تقريبا عد البكتيريا مستقل ناخد لوب احنا
+
+190
+00:12:38,760 --> 00:12:42,480
+فالاصل انه كل مرة بعمل الفحص نفس البكتيريا هيعطيني
+
+191
+00:12:42,480 --> 00:12:47,480
+مستوى معين من مين من ال bubbles لكن لأنه مش دقيقي
+
+192
+00:12:47,860 --> 00:12:51,440
+تماما انا بتكلم عن loop اللي ممكن تاخد نص ممكن
+
+193
+00:12:51,440 --> 00:12:56,300
+تاخد ربع ممكن تاخد مستعمرة كبيرة فبالتالي مش خلينا
+
+194
+00:12:56,300 --> 00:13:00,640
+نقول fixed بسموه semi quantitative catalase ليش
+
+195
+00:13:00,640 --> 00:13:02,900
+semi quantitative لإنه مش accurate لإنه مش
+
+196
+00:13:02,900 --> 00:13:06,000
+accurate لكن في الآخر بعطينا أرقام كمان فبالتالي
+
+197
+00:13:06,000 --> 00:13:09,480
+quantitative لكن لإنه مش accurate سميناها semi
+
+198
+00:13:09,480 --> 00:13:13,370
+quantitativeفمستوى ال bubbles قد يصل إلى سبعة، قد
+
+199
+00:13:13,370 --> 00:13:15,930
+يصل إلى ستة، قد يصل إلى خمسة، حسب نوع من ال
+
+200
+00:13:15,930 --> 00:13:19,550
+mycobacterium فبتالي هنا ليس في ال positive و ال
+
+201
+00:13:19,550 --> 00:13:22,390
+negative و إنما كمان مرة في semi quantitative test
+
+202
+00:13:22,390 --> 00:13:24,970
+في حد اسمها rice sulfatease test و فيه ان دي
+
+203
+00:13:24,970 --> 00:13:28,810
+المقدلة على النمو على المكنكيهال للmycobacterium
+
+204
+00:13:28,810 --> 00:13:33,770
+tuberculosis مقدلة؟ بالتأكيد لأنيجي للفحص المهم
+
+205
+00:13:33,770 --> 00:13:36,570
+الآخر اللي هو ال skin test احنا قبل محاضرة او
+
+206
+00:13:36,570 --> 00:13:39,330
+محاضرتين درسنا ال cornebacterium diphtheria
+
+207
+00:13:39,330 --> 00:13:42,350
+فاكرينها؟ و بقولنا اننا بنعمل skin test بس ال skin
+
+208
+00:13:42,350 --> 00:13:44,730
+test بتبقى ال cornebacterium diphtheria كان لأي
+
+209
+00:13:44,730 --> 00:13:54,100
+غرض يا شاعت؟ كان لأي غرض؟ الحساسية و التعرفيعني هل
+
+210
+00:13:54,100 --> 00:13:57,540
+نعطيك vaccine و لا مانعطيكاش vaccine هل انت
+
+211
+00:13:57,540 --> 00:14:00,860
+immunized و لا مش immunized بس هنا it is
+
+212
+00:14:00,860 --> 00:14:03,780
+diagnostic يعني لانعرف ان عندك tuberculosis و لا
+
+213
+00:14:03,780 --> 00:14:07,740
+ماعندكاش tuberculosis ليس بالبساطة هذه لكن على
+
+214
+00:14:07,740 --> 00:14:11,820
+الأقل هو محاولة او خلينا نقول وسيلة من وسائل
+
+215
+00:14:11,820 --> 00:14:16,380
+التعرف على او ال diagnostic tools للبكتيري كمان
+
+216
+00:14:16,380 --> 00:14:20,500
+مرةالفحص هو عبارة عن intra dermal في الجلد
+
+217
+00:14:20,500 --> 00:14:27,340
+injection لإيش؟ لواحد من المركبين المركب الأول
+
+218
+00:14:27,340 --> 00:14:31,540
+بيسموه old tuberculin والتاني بيسموه purified
+
+219
+00:14:31,540 --> 00:14:38,770
+protein derivative اتنى نفس الشيءمحسن عن الأولاني
+
+220
+00:14:38,770 --> 00:14:42,630
+ال all tuberculin اللي طوره روبرت كوخ وهو عبارة عن
+
+221
+00:14:42,630 --> 00:14:46,610
+crude extract ايش يعني crude؟ خام يعني مش .. مش
+
+222
+00:14:46,610 --> 00:14:50,510
+منقة بينما ال purified protein derivative هي
+
+223
+00:14:50,510 --> 00:14:53,550
+مركبات منقة برضه من ال micro bacterium
+
+224
+00:14:53,550 --> 00:14:59,570
+tuberculosis اذا عرفنا ما هي مكونات الحجنةاللي
+
+225
+00:14:59,570 --> 00:15:02,830
+بنعملها intra-dermal injection يا old توبركولين و
+
+226
+00:15:02,830 --> 00:15:05,390
+أنا قلتلكوا عليه خلصنا منه اللي في الغالب اللي
+
+227
+00:15:05,390 --> 00:15:08,670
+هيكون عنه مين ال PPD ال purified protein
+
+228
+00:15:08,670 --> 00:15:09,270
+derivative
+
+229
+00:15:13,580 --> 00:15:18,360
+الحقنة دي اللي قلنا عنها intra dermal طبعا بنحقن
+
+230
+00:15:18,360 --> 00:15:25,540
+بكمية محددة معروفة غالبا five tuberculin units are
+
+231
+00:15:25,540 --> 00:15:29,700
+the usual dose إذا الفحص negative ممكن يزيد الجرعة
+
+232
+00:15:29,700 --> 00:15:34,580
+إلى 250 tuberculin units إذا الجرعة محددة طبعا
+
+233
+00:15:34,580 --> 00:15:39,840
+وبنحقن قلنا كمان مره وانبعد تمانية و اربعين لاتنين
+
+234
+00:15:39,840 --> 00:15:43,160
+و سبعين ساعة من الحقنا بنقول المريض تعالى بنشوف
+
+235
+00:15:43,160 --> 00:15:47,350
+ايش صار عندك ايه التقاسر عنده؟هي ال injection لحظه
+
+236
+00:15:47,350 --> 00:15:54,550
+بنيدل رفيع جدا عشان ماتعملش subcutaneous هدا واحد
+
+237
+00:15:54,550 --> 00:15:57,830
+ويتحكم فيها أسهل في عملية اللي هو الحقن في الجلب
+
+238
+00:15:57,830 --> 00:16:01,610
+تانيوم مش مبين الصورة بالأسف هنا في الشكل اللي
+
+239
+00:16:01,610 --> 00:16:05,610
+قدامكوا هنا لكن عبارة عن احمرار و enduration زي
+
+240
+00:16:05,610 --> 00:16:10,750
+نفس الفكرة اللي حكينا عنها لشك تيست كورنباكتريوم
+
+241
+00:16:11,930 --> 00:16:15,470
+لكن بنجيس ال zone بنجيس ال zone اتباعت مش ال
+
+242
+00:16:15,470 --> 00:16:18,210
+inhibition انها بتاعة ال antibiotics انما اللي هي
+
+243
+00:16:18,210 --> 00:16:23,310
+ال induration and redness وبنشوف تفسير للنتائج
+
+244
+00:16:23,310 --> 00:16:29,850
+تفسير للنتائج بقولنا تصلب induration يساوي او اكتر
+
+245
+00:16:29,850 --> 00:16:32,530
+من عشرة millimeter with erythemia هذا غالبا
+
+246
+00:16:32,530 --> 00:16:36,610
+positive هذا غالبا positive لكن من خمسة لتسعة
+
+247
+00:16:37,510 --> 00:16:41,190
+Inconclusive، إيش يعني inconclusive؟ غير حاسم، ليش
+
+248
+00:16:41,190 --> 00:16:43,990
+غير حاسم؟ بقول إنه ممكن يكون low-level
+
+249
+00:16:43,990 --> 00:16:48,010
+sensitization with tuberculosis بسلاي or cross
+
+250
+00:16:48,010 --> 00:16:50,470
+-reacting mycobacteria إيش cross-reacting
+
+251
+00:16:50,470 --> 00:16:53,610
+mycobacteria؟ يعني واحد انصاب بmycobacteria أخرى
+
+252
+00:16:53,610 --> 00:16:55,710
+غير mycobacterium tuberculosis لكن عاملة cross
+
+253
+00:16:55,710 --> 00:17:00,430
+-reaction لحظولي الآن الجملة الأخيرة دي in AIDS
+
+254
+00:17:00,430 --> 00:17:06,130
+patient خمسة millimeter in duration تعتبر positive
+
+255
+00:17:06,130 --> 00:17:10,110
+testطبعا هنا عاملا بنقول خمسة لتسعة في المنادمين
+
+256
+00:17:10,110 --> 00:17:15,130
+العاديين مش حاسن في ال aids خمسة اعتبرناها poster
+
+257
+00:17:15,130 --> 00:17:21,010
+عارفين ليش؟ لأن هو immunocompromised فكونه كوّن
+
+258
+00:17:21,010 --> 00:17:23,870
+خمسة millimeter هذا يعتبر انه يعني لو عنده مناعة
+
+259
+00:17:23,870 --> 00:17:26,930
+عادية كان يمكن كوّن تلاتين millimeter بس ماعندهش
+
+260
+00:17:26,930 --> 00:17:29,630
+مناعة عادية عنده مناعة منخفضة فاعتبرناها في هذه
+
+261
+00:17:29,630 --> 00:17:35,220
+الحالة posterهذه تفسيرات للـ tuberculosis test
+
+262
+00:17:35,220 --> 00:17:39,480
+خدنا ناخد على ال postive test و خلينا نستغل الموقف
+
+263
+00:17:39,480 --> 00:17:46,400
+اليوم و نعطي معلومة عامة عن اي postive serological
+
+264
+00:17:46,400 --> 00:17:51,880
+test اي postive serological test لل antibody ايش
+
+265
+00:17:51,880 --> 00:17:55,060
+يعني ال antibody؟ يعني انا بستهدف في وجود ال
+
+266
+00:17:55,060 --> 00:18:00,240
+antibody ماذا يعني postive test لو وجود antibody
+
+267
+00:18:00,240 --> 00:18:05,950
+في الواحد من اربع او واحد من خمس ايش هم الخمس
+
+268
+00:18:05,950 --> 00:18:09,730
+احتمالات ان يكون بالفعل عنده disease الان؟ هذا
+
+269
+00:18:09,730 --> 00:18:14,530
+احتمال صح؟الاحتمال التاني اصيب فيه سابقا الاحتمال
+
+270
+00:18:14,530 --> 00:18:19,490
+التالت انه vaccinated انه كان هو متطعن الاحتمال
+
+271
+00:18:19,490 --> 00:18:25,010
+الرابع تمام انه يكون career للمرض حامل للميكروب
+
+272
+00:18:25,010 --> 00:18:31,050
+الاحتمال الخامس ذكرناه somewhere هنا انه يكون عنده
+
+273
+00:18:31,050 --> 00:18:36,170
+cross reaction لميكروب تانييبقى تخيلوا positive
+
+274
+00:18:36,170 --> 00:18:42,050
+serological test بطل بيعطينا معلومة مؤكدة ان
+
+275
+00:18:42,050 --> 00:18:46,190
+المريض مصاب الآن قد يكون مصاب الآن قد يكون مصاب
+
+276
+00:18:46,190 --> 00:18:50,350
+سابقا قد يكون مصاب قد يكون vaccinated الاحتمالات
+
+277
+00:18:50,350 --> 00:18:53,430
+الخمسة اللي احنا ذكرناهم خدوا بالكم هدول الخمسة
+
+278
+00:18:53,430 --> 00:18:56,530
+احتمالة تخليهم دايما في دماغك خليهم دايما في دماغك
+
+279
+00:18:56,530 --> 00:19:01,830
+لكن تفسير نتائج الفحوصات لازم يكون في السياق
+
+280
+00:19:01,830 --> 00:19:07,150
+السياق ايش؟أنا أصلا كطبيب لماذا قمت بطلب الفحص؟
+
+281
+00:19:07,150 --> 00:19:09,950
+أنا ليش طلبت skin test لل tuberculosis؟ لأن في
+
+282
+00:19:09,950 --> 00:19:15,210
+عندي واحدة من تنتين، يا أما أنت جيتني بأعراض أو أن
+
+283
+00:19:15,210 --> 00:19:21,730
+أنت جيتني مصاحب لعائلة فيها شخص .. فيها شخص مصاحب
+
+284
+00:19:21,730 --> 00:19:23,780
+بال tuberculosisوانتوا عارفين ان عندنا .. عندنا
+
+285
+00:19:23,780 --> 00:19:27,760
+النظام لو واحد اتشخص tuberculosis تمام كل عائلته
+
+286
+00:19:27,760 --> 00:19:31,800
+بتنجاب وبينعملهم فحوصات وبينعطيه prophylaxis كمان
+
+287
+00:19:31,800 --> 00:19:36,300
+حتى نمنع زي أمراض أخرى زي ال .. ال nyseria من
+
+288
+00:19:36,300 --> 00:19:40,810
+الجدايتوصل الصورة إذا هاي الأرقام .. هاي .. هاي
+
+289
+00:19:40,810 --> 00:19:43,370
+التفسيرات بتاعة اللي هو ال boast of skin test
+
+290
+00:19:43,370 --> 00:19:48,270
+حكيناها بشكل عام لأي test بيستهدف ال antibody خدوا
+
+291
+00:19:48,270 --> 00:19:51,310
+بالكوا، أنا بأكد على كلامي اللي بيستهدف ال
+
+292
+00:19:51,310 --> 00:19:54,450
+antibody، ال antigen غير ال antigen موجوده في
+
+293
+00:19:54,450 --> 00:19:57,310
+الدسم، معناه الحاجة إنه ال microbe، الآن موجود،
+
+294
+00:19:57,310 --> 00:20:02,240
+الآن موجود، هذا اللي بيبقى شكل الاختلافchild خدوا
+
+295
+00:20:02,240 --> 00:20:06,400
+بالكوا اللى عمره أقل من خمس سنوات إذا ماكانش
+
+296
+00:20:06,400 --> 00:20:11,320
+vaccinated تمام فالتفسير الوحيد انه عنده ايش
+
+297
+00:20:11,320 --> 00:20:16,600
+active disease ليش استثنائنا استثنائنا ال
+
+298
+00:20:16,600 --> 00:20:20,120
+immunization تمام عمره صغير من قبل previous
+
+299
+00:20:20,120 --> 00:20:24,820
+infection فبالتالي كل الاحتمالات الأخرى انشالت
+
+300
+00:20:24,820 --> 00:20:29,580
+غالبا بيكون هنا active disease negative testno
+
+301
+00:20:29,580 --> 00:20:33,540
+enduration او اقل من قداش من خمسة مليمتر شفتوا في
+
+302
+00:20:33,540 --> 00:20:38,560
+ال aids اعتبرناها خمسة مليمتر ايه اعتبرناها بسطىan
+
+303
+00:20:38,560 --> 00:20:42,240
+unhealthy individual not infected with MTB غالبا
+
+304
+00:20:42,240 --> 00:20:45,440
+بنشوف هذا ال reaction في أولى الزيكو ماعندهم مش ..
+
+305
+00:20:45,440 --> 00:20:49,540
+اللي هو mycobacterium tuberculosis أو في مرضى لسه
+
+306
+00:20:49,540 --> 00:20:53,360
+.. لسه مكونوش hypersensitivity لل tuberculosis
+
+307
+00:20:53,360 --> 00:20:56,700
+يعني في مراحلهم الأولى و هنشوف هذا الكلام في ال
+
+308
+00:20:56,700 --> 00:20:58,920
+false negative لإن هو هذا بيعتبر إيش الآن negative
+
+309
+00:20:58,920 --> 00:21:01,980
+لكن negative مش negative حقيقي و انما false
+
+310
+00:21:01,980 --> 00:21:07,140
+negative early TBنفس دولة ال pre-hypersensitivity
+
+311
+00:21:07,140 --> 00:21:10,580
+immunosuppression انا قولت قبل شويه ان مرضى ال
+
+312
+00:21:10,580 --> 00:21:14,560
+aids اللي كونوا خمسة مليمتر اعتبرناهم positive طيب
+
+313
+00:21:14,560 --> 00:21:16,820
+ايش رأيكوا انه ممكن يكون مصاب بال tuberculosis
+
+314
+00:21:16,820 --> 00:21:20,120
+ومايعطنش اي hypersensitivity او مايعطنش اي
+
+315
+00:21:20,120 --> 00:21:23,940
+induration ماعندوش immunity to respond to this
+
+316
+00:21:23,940 --> 00:21:28,760
+test او الناس اللي عندهم steroid ترابي اللي برضه
+
+317
+00:21:28,760 --> 00:21:32,060
+كمان ال steroid ترابي بيخفط جهاز اللي هو المناع
+
+318
+00:21:33,260 --> 00:21:36,300
+Treatment الميكروب جونا .. تفكرين المحاضرة
+
+319
+00:21:36,300 --> 00:21:40,020
+السابقة؟ جونا جوا شباب من الميكروبات الخطيرة سمينا
+
+320
+00:21:40,020 --> 00:21:42,820
+MDR Multiple Drug Resistant و بعدين ضفنا عليها
+
+321
+00:21:42,820 --> 00:21:47,320
+مصطلح تاني اسمه XDR Extended Drug Resistant يعني
+
+322
+00:21:47,320 --> 00:21:51,790
+البكتيريا بالفعل أنها مشكلة بتواجهناوكانت الفترة
+
+323
+00:21:51,790 --> 00:21:56,370
+الزمنية المستخدمة او ال .. ال .. ال .. المتوقعة ل
+
+324
+00:21:56,370 --> 00:22:02,510
+full recovery لاتقل عن تلت سنوات تخيل علاج مريض ب
+
+325
+00:22:02,510 --> 00:22:06,770
+drugs ب antibiotics لمدة تلت سنوات confined to a
+
+326
+00:22:06,770 --> 00:22:10,090
+containment او .. او .. يعني خدنا نقول hospital
+
+327
+00:22:10,090 --> 00:22:15,270
+environment لمدة تلت سنوات هذا ب .. أمر مرهق جدا
+
+328
+00:22:15,270 --> 00:22:21,080
+للمريض و لأهل المريض و للمستشفى و للدولة لكنأقصر
+
+329
+00:22:21,080 --> 00:22:25,220
+فترة زمانية حصلنا عليها هي ستة أشهر six-month
+
+330
+00:22:25,220 --> 00:22:29,440
+course therapy مكون من ال antibiotics اللي معلمين
+
+331
+00:22:29,440 --> 00:22:32,640
+بالأصفر قدام كوهانا الايزونيازايت اللي بيختصرون I
+
+332
+00:22:32,640 --> 00:22:36,840
+and H, Rifampicin او Rifamycin, Ethambutol and
+
+333
+00:22:36,840 --> 00:22:39,460
+Pyrazinamide طبعا هدول ال antibiotics الأخرى
+
+334
+00:22:39,460 --> 00:22:42,500
+بيستخدموا لكن ببنستخدموا .. الآن بستخدمهم مش في
+
+335
+00:22:42,500 --> 00:22:46,290
+هذا ال course في حال فشلال course اللي احنا
+
+336
+00:22:46,290 --> 00:22:50,210
+بنستخدمه هذا قد نلجأ الى بعض هذه الانتباه لكن اللي
+
+337
+00:22:50,210 --> 00:22:53,610
+بنستخدمه فقط يعني ايزونايزايد ريفامايسين
+
+338
+00:22:53,610 --> 00:22:57,430
+اثامبياتولو بايريزوناماي for 6 month هل كلهم
+
+339
+00:22:57,430 --> 00:23:02,570
+بنستخدمهم for 6 month لأ طلع عليهم ال ايزونايزايد
+
+340
+00:23:02,570 --> 00:23:06,130
+1 و 2 هدولة ببدأوا من اليوم الأول و بننتهي فيهم
+
+341
+00:23:06,130 --> 00:23:10,450
+بعد 6 شهوربينما ال Ethan-bietol و ال Pyrazinamide
+
+342
+00:23:10,450 --> 00:23:14,910
+بنبدأ فيهم من اليوم الأول و بنوقفهم بعد مرور شهرين
+
+343
+00:23:14,910 --> 00:23:20,290
+يعني بعد مرور شهرين من العلاج تمام بنستمر في مين؟
+
+344
+00:23:23,190 --> 00:23:28,210
+أول شهرين بناخد أربع انتيباتك، بعد شهرين بنستمر
+
+345
+00:23:28,210 --> 00:23:31,830
+باتنين انتيباتك لكمان أربع شهور أخرى، إذن هذه هي
+
+346
+00:23:31,830 --> 00:23:35,770
+ال treatment أو ال course therapy المعمول بيه
+
+347
+00:23:35,770 --> 00:23:38,770
+حاليا لmicrobacterium tuberculosis و very
+
+348
+00:23:38,770 --> 00:23:43,740
+effective يا شبابلكن في بلدان جنوب شرق أسيا زي
+
+349
+00:23:43,740 --> 00:23:49,120
+الفلبين و ماليزيا و أندونيسيا و بانجلديش هناك
+
+350
+00:23:49,120 --> 00:23:54,520
+سلالات مقاومة للرفانبسين و سلالات مقاومة لل INH
+
+351
+00:23:54,520 --> 00:24:00,580
+وهذه كنا نسميها XDR وللأسف علاجها بالفعل هيتطلب
+
+352
+00:24:00,580 --> 00:24:04,940
+منها تغيير كبير في السياسات و في النظام اللي موجود
+
+353
+00:24:04,940 --> 00:24:09,760
+حالياايه typical Mycobacteria احنا قولنا وعدناكوا
+
+354
+00:24:09,760 --> 00:24:11,980
+انه نتكلم عن بكتيريا واحدة فقط اللي هي
+
+355
+00:24:11,980 --> 00:24:16,380
+Mycobacterium Avium Intracellular Complex وهي
+
+356
+00:24:16,380 --> 00:24:20,260
+worldwide distribution لأن ال source تبعها غالبا
+
+357
+00:24:20,260 --> 00:24:24,420
+ال natural waters ال natural disease اللي بتسببه
+
+358
+00:24:24,420 --> 00:24:28,920
+tuberculosis of birds واخدوا بقى كلمة avium دي من
+
+359
+00:24:28,920 --> 00:24:33,660
+avian او من avium اللي هي birds تسمعوا avian
+
+360
+00:24:33,660 --> 00:24:38,630
+influenza طيور صح ف avian معناها طيورلكن تعمل برضه
+
+361
+00:24:38,630 --> 00:24:42,730
+في الأطفال حاجة بيسميها cervical lymphadenitis في
+
+362
+00:24:42,730 --> 00:24:46,050
+الأطفال وممكن تعمل disseminated tuberculosis في
+
+363
+00:24:46,050 --> 00:24:49,170
+مرضى ال HIV وانا قولتلكوا لم نكن نسمع بها هذه
+
+364
+00:24:49,170 --> 00:24:55,190
+البكتيريا إلا بعد ظهور مرض ال HIVالفروقات اللي
+
+365
+00:24:55,190 --> 00:24:59,290
+مابين ال typical و ال atypical ال colonial
+
+366
+00:24:59,290 --> 00:25:02,530
+morphology شكلهم بيختلف عن بعض في المستعمرات ال
+
+367
+00:25:02,530 --> 00:25:07,690
+نياسين تست ال atypical negative هذه البكتيريا ال
+
+368
+00:25:07,690 --> 00:25:11,510
+avium intrasolary are more resistant to
+
+369
+00:25:11,510 --> 00:25:14,350
+antituberculosis drugs than mycobacterium
+
+370
+00:25:14,350 --> 00:25:17,930
+tuberculosis itself عارفين ليش كمان؟ بتوقع انا
+
+371
+00:25:19,150 --> 00:25:22,310
+المريض ال aids أكتر مريض في الدنيا بياخد
+
+372
+00:25:22,310 --> 00:25:25,550
+antibiotics عارفين ليش طبعا لأنه دائما عنده
+
+373
+00:25:25,550 --> 00:25:30,010
+infections أو to prevent infection فبيعطوياها كنوع
+
+374
+00:25:30,010 --> 00:25:34,050
+من إيه؟ من ال ال proflaxes فبالتالي الميكروبات
+
+375
+00:25:34,050 --> 00:25:37,890
+اللي بتعمله infection غالبا بتكون محتكة أو احتكت
+
+376
+00:25:37,890 --> 00:25:41,850
+بكل أنواع ال antibiotic ففرص إنها تكون resistance
+
+377
+00:25:41,850 --> 00:25:47,550
+بتكون فرص عالية جدالسة acid fastness يعني لو جينا
+
+378
+00:25:47,550 --> 00:25:49,550
+نقارنها بال .. بال micro bacterium tuberculosis
+
+379
+00:25:49,550 --> 00:25:51,630
+هلاجى ان ال micro bacterium tuberculosis أكتر
+
+380
+00:25:51,630 --> 00:25:55,110
+fastness للacid من ال .. ال .. عارفين كيف بنقارنها
+
+381
+00:25:55,110 --> 00:25:59,390
+هذه الشغلة؟ بالفترة الزمنية اللي بيزول فيها الصفغة
+
+382
+00:25:59,390 --> 00:26:04,650
+مش هنجونا في تحدي انه ال decolarization بنظيفها
+
+383
+00:26:04,650 --> 00:26:10,960
+لمدة دقيقتين صح؟ دقيقتينacid alcohol طب لو خدنا
+
+384
+00:26:10,960 --> 00:26:14,600
+ثلاث دقائق طب لو خدنا أربع دقائق لو خدنا خمس دقائق
+
+385
+00:26:14,600 --> 00:26:18,020
+بنقدر نقارن بين الميكروبات وبعضها وبنقدر نشوف مين
+
+386
+00:26:18,020 --> 00:26:21,260
+أكتر resistant من الأخرى فال micro bacterium
+
+387
+00:26:21,260 --> 00:26:25,340
+tuberculosis is more acid fast than اللي هو ال
+
+388
+00:26:25,340 --> 00:26:28,860
+typical mix disease is less invasive في ال normal
+
+389
+00:26:28,860 --> 00:26:35,420
+individuals غالبا أقل invasion الميكروب التالت في
+
+390
+00:26:35,420 --> 00:26:38,240
+السلسلة تبعتنا اللي هو ال micro bacterium liver
+
+391
+00:26:39,190 --> 00:26:47,810
+Disease Librosi رسولنا الكريم لا عدوة ولا طيرة ولا
+
+392
+00:26:47,810 --> 00:26:55,170
+هامة ولا سفر وفر من المجذومي فرارك من الأسد سمعتوا
+
+393
+00:26:55,170 --> 00:26:59,750
+فيه الحديث عن جبل هيكل؟ ماسمتهوش لا عدوة مش عدوة
+
+394
+00:26:59,750 --> 00:27:04,870
+طبعا العلماء الغرب بيقولك تلع نبيهم رسولهم بيقولهم
+
+395
+00:27:04,870 --> 00:27:09,470
+مش عدوةولتقعون اللغة العربية بيقولك يا عم طب اول
+
+396
+00:27:09,470 --> 00:27:14,130
+حديث في ظاهره بتناقض مع اخر حديث لا عدوى و فره من
+
+397
+00:27:14,130 --> 00:27:17,130
+المجذومي المجذوم اللي هو المصاب بالجذام اللي هو
+
+398
+00:27:17,130 --> 00:27:21,810
+الموضوع المحاضرة تبعتنا فره من المجذومي فرارك من
+
+399
+00:27:21,810 --> 00:27:25,730
+الأسد فكيف بيقولنا لا عدوى و بيقولنا فره من
+
+400
+00:27:25,730 --> 00:27:31,470
+المجذومي فرارك من الأسد تفسير يا شباب والله أعلم
+
+401
+00:27:31,470 --> 00:27:35,950
+بحسب معلوماتنا المتواضعة في ال micro biologyلا
+
+402
+00:27:35,950 --> 00:27:40,950
+ينتقل المرض .. لا ينتقل المرض بالضرورة بانتقال
+
+403
+00:27:40,950 --> 00:27:48,170
+العامل المسبب صح الجملة دي ولا مش صح؟ ليس
+
+404
+00:27:48,170 --> 00:27:51,990
+بالضرورة ان ينتقل اليك المرض بانتقال العامل المسبب
+
+405
+00:27:51,990 --> 00:27:57,390
+اليك مثلا واحد عطس و عنده influenza تمام؟ و بيوزع
+
+406
+00:27:57,390 --> 00:28:02,370
+على الموجودين الفيروس المعظم بيستنشق هل الكل بيصاب
+
+407
+00:28:02,370 --> 00:28:06,280
+بالمرض؟طبعا احنا بتكلم الآن على حسب ال immune
+
+408
+00:28:06,280 --> 00:28:10,840
+system فهذا بيقول انه يعني ليس بالضرورة انتقال
+
+409
+00:28:10,840 --> 00:28:17,120
+المرض تمام؟ لأن في تاكمرة لحديث فأحد العرب بيسأل
+
+410
+00:28:17,120 --> 00:28:18,740
+الرسول صلى الله عليه و سلم بيقول فما باله الجمال
+
+411
+00:28:18,740 --> 00:28:23,540
+تكون كالظبأ الجمال من شكلها وجلدها حلو بتكون شكلها
+
+412
+00:28:23,540 --> 00:28:29,620
+زي الظبأ فيدخل الجمل الأجرب بينها فيجربها كلهافإيش
+
+413
+00:28:29,620 --> 00:28:31,820
+رد عليه الرسول صلى الله عليه وسلم؟ قال له فمن قعد
+
+414
+00:28:31,820 --> 00:28:37,040
+الأول؟ يعني الأول من وين قدرت العدوى؟ففي إنكار
+
+415
+00:28:37,040 --> 00:28:42,120
+لإطلاق العدوى بالكامل لكن ليس إن نفي تم لإن
+
+416
+00:28:42,120 --> 00:28:45,720
+إمكانية انتقال المرض بيه من شخص إلى آخر وبالدليل
+
+417
+00:28:45,720 --> 00:28:50,240
+فر من المجذوم فرارك من الأسد يبقى أقر حقيقة
+
+418
+00:28:50,240 --> 00:28:54,340
+بالبداية أنه مش بالضرورة أنه انت تصعب إذا انت
+
+419
+00:28:54,340 --> 00:29:00,000
+اتعرضت للمرض لكن يجب أن تأخذ حذرك يجب أن تأخذ حذرك
+
+420
+00:29:00,000 --> 00:29:07,450
+إذا الجذام مرض جذام مرضيعني على الأقل هي مر قبل
+
+421
+00:29:07,450 --> 00:29:16,580
+1435الان الان طبعا المرض معروف قبل ذلك كمان يعني
+
+422
+00:29:16,580 --> 00:29:20,960
+بيسموه biblical disease يعني مرض موجود في الانجيل
+
+423
+00:29:20,960 --> 00:29:27,980
+طبعا لكن اللي بنفهمه هنا ان هذا disease is very
+
+424
+00:29:27,980 --> 00:29:34,580
+dangerous disease بيفقد المرضى إحساسهم في الأطراف
+
+425
+00:29:35,380 --> 00:29:39,000
+وفقدان الإنسان الإحساس في الأطراف يعرضه لمخاطر
+
+426
+00:29:39,000 --> 00:29:43,820
+كثيرة، يعني مثلًا أنت تمسك كأس من الشاي الساخن،
+
+427
+00:29:43,820 --> 00:29:48,060
+بتحسه ساخن كتير، تشعر بالألم بالحرارة، بتنزله، هو
+
+428
+00:29:48,060 --> 00:29:51,640
+مش هيشعر بهذا الكلام، فهتحترق إيدي حتى لو مسك فحم
+
+429
+00:29:52,710 --> 00:29:58,850
+مشتعل مش هيشعر فيه وبالتالي أكتر يرضى منك أنت
+
+430
+00:29:58,850 --> 00:30:02,750
+للحوادث لأنه فقد الإحساس في الأطراف، يعني أنت لما
+
+431
+00:30:02,750 --> 00:30:05,530
+تسكري الباب و الباب بدي تسكري على إيدك، على طول
+
+432
+00:30:05,530 --> 00:30:09,170
+بتحس بتسحب إيدك، بتوجه الحركة، هو مابيشعرش بهذا
+
+433
+00:30:09,170 --> 00:30:11,650
+الكلام وبالتالي حوادثه كتير، هو ممكن يضرب إيده
+
+434
+00:30:11,650 --> 00:30:16,540
+بالشكوش، مايشعرشوبالتالي عنده secondary infection
+
+435
+00:30:16,540 --> 00:30:20,360
+باستمرار بالاضافة إلى ان ال nature لل disease
+
+436
+00:30:20,360 --> 00:30:24,720
+بيصير في infiltration لل lymph .. عفوا لل nerve
+
+437
+00:30:24,720 --> 00:30:28,200
+تمام؟ و thickening لل nerve، إذا في destruction
+
+438
+00:30:28,200 --> 00:30:32,420
+وين بصيب ال disease؟ غالبا بصيب ال cooler parts of
+
+439
+00:30:32,420 --> 00:30:35,510
+the bodyوين ال cooler parts of the body؟ فى فصل
+
+440
+00:30:35,510 --> 00:30:39,190
+الشتاء أكتر حاجة بيكون بردنين احنا فيها أطرافنا
+
+441
+00:30:39,190 --> 00:30:43,190
+اللى هم أصابعنا و أصابع القدمان ان الأنف الأذنين و
+
+442
+00:30:43,190 --> 00:30:49,050
+الشفتين تمام؟ هدولة أكتر مناطق هو بيفضل الإصابة
+
+443
+00:30:49,140 --> 00:30:52,120
+فيهم هذا الميكروب هذا الميكروب فاكرين محاضرة
+
+444
+00:30:52,120 --> 00:30:55,620
+السابقة قولنا ومحاضرة هذه قولنا has never been
+
+445
+00:30:55,620 --> 00:30:59,460
+cultivated in artificial media اذا عرفنا كيف عرفنا
+
+446
+00:30:59,460 --> 00:31:03,900
+فقط أخدنا scrapping من المرضى وشفناهم تحت
+
+447
+00:31:03,900 --> 00:31:08,240
+الميكروسكوب لجناهم acid fast stain زي ال micro
+
+448
+00:31:08,240 --> 00:31:12,380
+bacterium tuberculosis اذا ال diagnosis الأساسي
+
+449
+00:31:12,380 --> 00:31:16,260
+لهذا الميكروب خالي من ال culture مافيش culture فيه
+
+450
+00:31:19,600 --> 00:31:23,840
+طيب هناك شكلان .. هناك شكلان من ال .. ال .. ال
+
+451
+00:31:23,840 --> 00:31:28,300
+Librosy واحد بيسموه Tuberculoid Librosy والاخر
+
+452
+00:31:28,300 --> 00:31:34,320
+بيسموه Libromatous Librosy ال Libromatous Librosy
+
+453
+00:31:34,320 --> 00:31:40,700
+is very contagious فاكرين كلمة contagious؟ شديد
+
+454
+00:31:40,700 --> 00:31:45,480
+العدوى مش هنقول عن infectious اه و في contagious
+
+455
+00:31:45,480 --> 00:31:50,750
+contagious شديد العدوىبينما التبركولويد أقل العدوى
+
+456
+00:31:50,750 --> 00:31:54,650
+طبعا هنعرف الكلام ده ليش هذا مؤدي كتير وهذا مؤدي
+
+457
+00:31:54,650 --> 00:31:59,290
+بدرجة أقل أو درجة العدوى المختلفة بينهم ال course
+
+458
+00:31:59,290 --> 00:32:03,930
+is progressive يعني المرض بتطور بشكل سريعwith
+
+459
+00:32:03,930 --> 00:32:07,990
+nodular skin lesions في عندي symmetric nerve
+
+460
+00:32:07,990 --> 00:32:13,770
+involvement و بشوف في هذا النوع من ال disease بشوف
+
+461
+00:32:13,770 --> 00:32:16,410
+كمية كبيرة من مين من ال tuberculosis بصلى الله
+
+462
+00:32:16,410 --> 00:32:22,000
+يعني عفوا من ال liprocy بصلى اللهمدان بشوف في هذا
+
+463
+00:32:22,000 --> 00:32:25,400
+النوع من ال lesions كميات كبيرة من البكتيريا، إيش
+
+464
+00:32:25,400 --> 00:32:28,980
+معنى الحكاية؟ إن هذه البكتيريا ممكن تنتقل للآخرين،
+
+465
+00:32:28,980 --> 00:32:34,280
+بعكس من ال tuberculosis، literacy، هذا more slow،
+
+466
+00:32:34,280 --> 00:32:37,600
+the course is non-progressive، هدا إيش يعني أنها؟
+
+467
+00:32:37,600 --> 00:32:41,380
+progressivewith macular skin lesions, severe
+
+468
+00:32:41,380 --> 00:32:45,400
+asymmetric nerve involvement of certain with few
+
+469
+00:32:45,400 --> 00:32:48,940
+bacilli present in the lesion يعني عادل بسلعي اللي
+
+470
+00:32:48,940 --> 00:32:53,400
+موجودة في ال lesion قليل جدا بينما هنا كثير جدا
+
+471
+00:32:53,870 --> 00:32:58,010
+شوفوا كمان فى شغل هنا ما ذكرناهاش الفحص الليبرومين
+
+472
+00:32:58,010 --> 00:33:01,310
+اللى هو على غرار التوبركولين فاكرين ال skin test
+
+473
+00:33:01,310 --> 00:33:03,730
+اللى جابه شوية تاعت tuberculosis هذا سمينا
+
+474
+00:33:03,730 --> 00:33:07,970
+tuberculin test هذا بيسميه لبرومين test لو المريض
+
+475
+00:33:07,970 --> 00:33:11,310
+عنده لبروماتوس لبروسي بيكون الليبرومين test تبعه
+
+476
+00:33:11,310 --> 00:33:16,000
+negative ليش negative؟ذكروا ان ال course
+
+477
+00:33:16,000 --> 00:33:19,320
+progressive ليش progressive؟ لأنه ماعندوش اصلا
+
+478
+00:33:19,320 --> 00:33:22,420
+immune ال immune تبقى .. ال system تبقى راح
+
+479
+00:33:22,420 --> 00:33:27,060
+وبالتالي لن يكون هناك اي reaction من الجسم يبقى
+
+480
+00:33:27,060 --> 00:33:31,400
+تشخيص هذا ال disease خالي من ال culture خالي من ال
+
+481
+00:33:31,400 --> 00:33:37,010
+skin test، ايش دلوقتي يا شباب؟أسد فاستستان بينما
+
+482
+00:33:37,010 --> 00:33:41,170
+هنا ماعنديش أسد فاستستان الكمية كبيرة يبقى الفحص
+
+483
+00:33:41,170 --> 00:33:44,990
+اللي انا بقدر اشتغله هنا هو الليبرومين test إذا
+
+484
+00:33:44,990 --> 00:33:48,370
+الليبرومين test ممكن يفيد في مين ما تخلطوش عشان
+
+485
+00:33:48,370 --> 00:33:51,430
+اسمه هاد الليبروماتوس الليبرومين مفيد في ال
+
+486
+00:33:51,430 --> 00:33:55,270
+tuberculoid غير مفيد في الليبروماتوس الليبروسي
+
+487
+00:33:55,270 --> 00:33:59,050
+والأسد فاست مفيد في الليبروماتوس مش كتير مفيد في
+
+488
+00:33:59,050 --> 00:34:02,210
+مين؟ في ال tuberculoid الليبروسي وال scrapping
+
+489
+00:34:02,210 --> 00:34:05,150
+بتلخظها ماحكتلكوا حاجة من تنتين ال diagnosis
+
+490
+00:34:05,900 --> 00:34:08,340
+بتلخصوا حاجة من تان تان، ناخد الـ Scrapping و نعمل
+
+491
+00:34:08,340 --> 00:34:11,020
+منها أسطس فاصل تان أو نعمل اللي هو البرومين تست، و
+
+492
+00:34:11,020 --> 00:34:13,620
+البرومين تست كمان مرة عبارة عن ايه كمان مرة شباب،
+
+493
+00:34:13,620 --> 00:34:18,120
+Skin Test، نفس فكرة الـ Tuberculin Test، العلاج
+
+494
+00:34:18,120 --> 00:34:22,400
+تبعنا بتكون من Dapsin، عارفها Mycene and
+
+495
+00:34:23,350 --> 00:34:28,310
+Clofazamine لن تسمعوا بـ Clofazamine ولا بالـ
+
+496
+00:34:28,310 --> 00:34:32,270
+Dapsin ولا بالـ INH ولا بالـ Pyrazinamide اللي
+
+497
+00:34:32,270 --> 00:34:37,570
+سمعتوهم في الـ tuberculosis وسمعتوهم في الليبروسي
+
+498
+00:34:37,570 --> 00:34:40,710
+إلا في الميكو بكتيريا عشانك بيسموهم
+
+499
+00:34:40,710 --> 00:34:45,760
+antimicrobacterial drugsAntimic .. بدل .. بدل ما
+
+500
+00:34:45,760 --> 00:34:47,980
+بنقول antibiotic بشكل عام سنسميهم
+
+501
+00:34:47,980 --> 00:34:51,560
+antimicrobacterial drugs طبعا الارفاهم بيسيان
+
+502
+00:34:51,560 --> 00:34:54,920
+exception او الارفاهم بيسيان هذا exception لأن هذا
+
+503
+00:34:54,920 --> 00:34:58,280
+antibiotic مشهور على ال broad spectrum لكن
+
+504
+00:34:58,280 --> 00:35:03,820
+استخدامه الآن مقصور فقط لمين؟ لل tuberculosis
+
+505
+00:35:03,820 --> 00:35:07,460
+بيسموه reserved drug يعني ممنوع تستخدمه يا عالم في
+
+506
+00:35:07,460 --> 00:35:10,440
+أشياء أخرى حتى ما يتكوّله resistance بدنايا
+
+507
+00:35:10,440 --> 00:35:12,760
+نستخدمه فقط في هذه البكتيريا
+
+508
+00:35:15,890 --> 00:35:19,730
+هذه بعض الصور اللى اللى للأسف بتعطيك ال nodular
+
+509
+00:35:19,730 --> 00:35:24,470
+lesions للبروسي على سواء على ال skin أو على ال
+
+510
+00:35:24,470 --> 00:35:29,390
+face و لاحظوا طبعا الأنف و ممكن الشفاتين يتأثروا
+
+511
+00:35:29,390 --> 00:35:34,170
+بشكل كبير، هنشوف صورة الآن، هذا الشكل اللى قدامكوا
+
+512
+00:35:34,840 --> 00:35:39,680
+بتكون appearance .. بتكون appearance للمريض ب ..
+
+513
+00:35:39,680 --> 00:35:44,920
+بنسميه احنا lion face .. lion face يعني يبدو وجهك
+
+514
+00:35:44,920 --> 00:35:49,620
+للواحدة الأولى كوجه الأشد طبعا ليش الكلام هذا؟بصير
+
+515
+00:35:49,620 --> 00:35:54,520
+فيه thickening لل lips لل upper lips تنتفخ بصير
+
+516
+00:35:54,520 --> 00:35:58,140
+فيه thickening لل skin في المنطقة في ال cheeks هنا
+
+517
+00:35:58,140 --> 00:36:01,980
+فبيرتفع فالأنف بيصير زي الأفطس نوعا ما بالمقارنة
+
+518
+00:36:01,980 --> 00:36:05,780
+مع هذا في ارتفاع و هذا في ارتفاع و الأنف كما هو و
+
+519
+00:36:05,780 --> 00:36:11,020
+مجعت فبيعطيك الانطباع ان هذا الشخص بيشبهواجهه وجه
+
+520
+00:36:11,020 --> 00:36:15,600
+اللي هو الأسد و اعتقد ان اليوم بيكفي بمحاضرة احنا
+
+521
+00:36:15,600 --> 00:36:18,960
+هندقناها المرة الجاية في بكتير اسمها Franzella
+
+522
+00:36:18,960 --> 00:36:23,200
+Tolerances وهي مسببة لمرض حمى القران
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/DbTwRll785g_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/DbTwRll785g_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..f99273545b747b8a31c3f6981c9b2ece03afece3
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/DbTwRll785g_raw.json
@@ -0,0 +1 @@
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"end": 2148.02, "text": "بتكون appearance .. بتكون appearance للمريض ب .. بنسميه احنا lion face .. lion face يعني يبدو وجهك للواحدة الأولى كوجه الأشد طبعا ليش الكلام هذا؟", "tokens": [3555, 2655, 30544, 8967, 4386, 39894, 30544, 8967, 5296, 19528, 16572, 11242, 4724, 4386, 4724, 1863, 38251, 1829, 3224, 1975, 5016, 8315, 17226, 1851, 4386, 17226, 1851, 37495, 22653, 7251, 44510, 2407, 49610, 3224, 4117, 24976, 14407, 24401, 3660, 16247, 12610, 7578, 9122, 29245, 3224, 16247, 8592, 3215, 23032, 3555, 3615, 995, 32239, 8592, 2423, 28820, 10943, 23758, 22807], "avg_logprob": -0.17877604464689892, "compression_ratio": 1.457516339869281, "no_speech_prob": 0.0, "words": [{"start": 2134.84, "end": 2135.76, "word": "بتكون", "probability": 0.8299153645833334}, {"start": 2135.76, "end": 2137.06, "word": " appearance", "probability": 0.8056640625}, {"start": 2137.06, "end": 2137.26, "word": " ..", "probability": 0.489013671875}, {"start": 2137.26, "end": 2137.72, "word": " بتكون", "probability": 0.7666015625}, {"start": 2137.72, "end": 2138.28, "word": " appearance", "probability": 0.8798828125}, {"start": 2138.28, "end": 2139.34, "word": " للمريض", "probability": 0.9591064453125}, {"start": 2139.34, "end": 2139.56, "word": " ب", "probability": 0.5888671875}, {"start": 2139.56, "end": 2139.68, "word": " ..", "probability": 0.43798828125}, {"start": 2139.68, "end": 2140.26, "word": " بنسميه", "probability": 0.78828125}, {"start": 2140.26, "end": 2140.66, "word": " احنا", "probability": 0.978515625}, {"start": 2140.66, "end": 2141.42, "word": " lion", "probability": 0.841796875}, {"start": 2141.42, "end": 2142.32, "word": " face", "probability": 0.8369140625}, {"start": 2142.32, "end": 2142.58, "word": " ..", "probability": 0.458984375}, {"start": 2142.58, "end": 2142.84, "word": " lion", "probability": 0.93212890625}, {"start": 2142.84, "end": 2143.52, "word": " face", "probability": 0.8984375}, {"start": 2143.52, "end": 2144.14, "word": " يعني", "probability": 0.890380859375}, {"start": 2144.14, "end": 2144.5, "word": " يبدو", "probability": 0.9630533854166666}, {"start": 2144.5, "end": 2144.92, "word": " وجهك", "probability": 0.9742838541666666}, {"start": 2144.92, "end": 2145.42, "word": " للواحدة", "probability": 0.87548828125}, {"start": 2145.42, "end": 2146.16, "word": " الأولى", "probability": 0.8343098958333334}, {"start": 2146.16, "end": 2146.52, "word": " كوجه", "probability": 0.9501953125}, {"start": 2146.52, "end": 2146.8, "word": " الأشد", "probability": 0.62255859375}, {"start": 2146.8, "end": 2147.08, "word": " طبعا", "probability": 0.925048828125}, {"start": 2147.08, "end": 2147.24, "word": " ليش", "probability": 0.9716796875}, {"start": 2147.24, "end": 2147.56, "word": " الكلام", "probability": 0.9287109375}, {"start": 2147.56, "end": 2148.02, "word": " هذا؟", "probability": 0.95556640625}], "temperature": 1.0}, {"id": 99, "seek": 216998, "start": 2149.22, "end": 2169.98, "text": "بصير فيه thickening لل lips لل upper lips تنتفخ بصير فيه thickening لل skin في المنطقة في ال cheeks هنا فبيرتفع فالأنف بيصير زي الأفطس نوعا ما بالمقارنة مع هذا في ارتفاع و هذا في ارتفاع و الأنف كما هو و مجعت فبيعطيك الانطباع ان هذا الشخص بيشبه", "tokens": [3555, 9381, 13546, 8978, 3224, 33821, 278, 24976, 10118, 24976, 6597, 10118, 6055, 29399, 5172, 9778, 4724, 9381, 13546, 8978, 3224, 33821, 278, 24976, 3178, 8978, 9673, 1863, 9566, 28671, 8978, 2423, 24135, 34105, 6156, 21292, 43500, 5172, 3615, 6156, 6027, 33456, 5172, 4724, 1829, 9381, 13546, 30767, 1829, 16247, 5172, 9566, 3794, 8717, 45367, 995, 19446, 20666, 2304, 4587, 9640, 1863, 3660, 20449, 23758, 8978, 1975, 43500, 5172, 45761, 4032, 23758, 8978, 1975, 43500, 5172, 45761, 4032, 16247, 1863, 5172, 9122, 15042, 31439, 4032, 3714, 7435, 34268, 6156, 21292, 3615, 9566, 1829, 4117, 2423, 7649, 9566, 3555, 45761, 16472, 23758, 25124, 9778, 9381, 4724, 1829, 8592, 3555, 3224], "avg_logprob": -0.11995738622817126, "compression_ratio": 1.9411764705882353, "no_speech_prob": 0.0, "words": [{"start": 2149.22, "end": 2149.62, "word": "بصير", "probability": 0.7955729166666666}, {"start": 2149.62, "end": 2149.82, "word": " فيه", "probability": 0.62548828125}, {"start": 2149.82, "end": 2150.5, "word": " thickening", "probability": 0.9208984375}, {"start": 2150.5, "end": 2150.78, "word": " لل", "probability": 0.87353515625}, {"start": 2150.78, "end": 2151.1, "word": " lips", "probability": 0.94091796875}, {"start": 2151.1, "end": 2151.26, "word": " لل", "probability": 0.73876953125}, {"start": 2151.26, "end": 2151.5, "word": " upper", "probability": 0.81298828125}, {"start": 2151.5, "end": 2151.94, "word": " lips", "probability": 0.89306640625}, {"start": 2151.94, "end": 2152.76, "word": " تنتفخ", "probability": 0.8917236328125}, {"start": 2152.76, "end": 2154.52, "word": " بصير", "probability": 0.8136393229166666}, {"start": 2154.52, "end": 2155.08, "word": " فيه", "probability": 0.8720703125}, {"start": 2155.08, "end": 2155.64, "word": " thickening", "probability": 0.922119140625}, {"start": 2155.64, "end": 2155.76, "word": " لل", "probability": 0.734375}, {"start": 2155.76, "end": 2156.16, "word": " skin", "probability": 0.904296875}, {"start": 2156.16, "end": 2156.42, "word": " في", "probability": 0.89404296875}, {"start": 2156.42, "end": 2157.08, "word": " المنطقة", "probability": 0.982177734375}, {"start": 2157.08, "end": 2157.38, "word": " في", "probability": 0.88916015625}, {"start": 2157.38, "end": 2157.48, "word": " ال", "probability": 0.95703125}, {"start": 2157.48, "end": 2157.78, "word": " cheeks", "probability": 0.89453125}, {"start": 2157.78, "end": 2158.14, "word": " هنا", "probability": 0.94189453125}, {"start": 2158.14, "end": 2159.18, "word": " فبيرتفع", "probability": 0.92001953125}, {"start": 2159.18, "end": 2159.66, "word": " فالأنف", "probability": 0.94921875}, {"start": 2159.66, "end": 2159.94, "word": " بيصير", "probability": 0.900634765625}, {"start": 2159.94, "end": 2160.08, "word": " زي", "probability": 0.9609375}, {"start": 2160.08, "end": 2160.5, "word": " الأفطس", "probability": 0.8551025390625}, {"start": 2160.5, "end": 2160.86, "word": " نوعا", "probability": 0.9637044270833334}, {"start": 2160.86, "end": 2161.06, "word": " ما", "probability": 0.8935546875}, {"start": 2161.06, "end": 2161.98, "word": " بالمقارنة", "probability": 0.96923828125}, {"start": 2161.98, "end": 2162.12, "word": " مع", "probability": 0.95556640625}, {"start": 2162.12, "end": 2162.56, "word": " هذا", "probability": 0.80322265625}, {"start": 2162.56, "end": 2162.7, "word": " في", "probability": 0.98974609375}, {"start": 2162.7, "end": 2163.24, "word": " ارتفاع", "probability": 0.9781494140625}, {"start": 2163.24, "end": 2163.58, "word": " و", "probability": 0.67138671875}, {"start": 2163.58, "end": 2163.7, "word": " هذا", "probability": 0.91650390625}, {"start": 2163.7, "end": 2163.86, "word": " في", "probability": 0.978515625}, {"start": 2163.86, "end": 2164.34, "word": " ارتفاع", "probability": 0.98583984375}, {"start": 2164.34, "end": 2164.54, "word": " و", "probability": 0.7998046875}, {"start": 2164.54, "end": 2165.02, "word": " الأنف", "probability": 0.8048502604166666}, {"start": 2165.02, "end": 2165.44, "word": " كما", "probability": 0.90625}, {"start": 2165.44, "end": 2165.64, "word": " هو", "probability": 0.994140625}, {"start": 2165.64, "end": 2165.78, "word": " و", "probability": 0.90234375}, {"start": 2165.78, "end": 2166.24, "word": " مجعت", "probability": 0.7091471354166666}, {"start": 2166.24, "end": 2167.4, "word": " فبيعطيك", "probability": 0.955078125}, {"start": 2167.4, "end": 2168.22, "word": " الانطباع", "probability": 0.93408203125}, {"start": 2168.22, "end": 2168.7, "word": " ان", "probability": 0.56494140625}, {"start": 2168.7, "end": 2168.96, "word": " هذا", "probability": 0.90771484375}, {"start": 2168.96, "end": 2169.32, "word": " الشخص", "probability": 0.9886067708333334}, {"start": 2169.32, "end": 2169.98, "word": " بيشبه", "probability": 0.97783203125}], "temperature": 1.0}, {"id": 100, "seek": 218319, "start": 2170.16, "end": 2183.2, "text": "واجهه وجه اللي هو الأسد و اعتقد ان اليوم بيكفي بمحاضرة احنا هندقناها المرة الجاية في بكتير اسمها Franzella Tolerances وهي مسببة لمرض حمى القران", "tokens": [2407, 26108, 3224, 3224, 49610, 3224, 13672, 1829, 31439, 16247, 3794, 3215, 4032, 1975, 34268, 28543, 16472, 45595, 20498, 4724, 1829, 4117, 41185, 4724, 2304, 5016, 46958, 25720, 1975, 5016, 8315, 8032, 41260, 4587, 8315, 11296, 9673, 25720, 25724, 995, 10632, 8978, 4724, 4117, 2655, 13546, 24525, 2304, 11296, 33084, 9885, 21402, 260, 2676, 37037, 1829, 3714, 35457, 49401, 32767, 43042, 11331, 2304, 7578, 25062, 2288, 7649], "avg_logprob": -0.3014706009451081, "compression_ratio": 1.4727272727272727, "no_speech_prob": 0.0, "words": [{"start": 2170.16, "end": 2170.66, "word": "واجهه", "probability": 0.774169921875}, {"start": 2170.66, "end": 2171.02, "word": " وجه", "probability": 0.8505859375}, {"start": 2171.02, "end": 2171.2, "word": " اللي", "probability": 0.770263671875}, {"start": 2171.2, "end": 2171.48, "word": " هو", "probability": 0.9892578125}, {"start": 2171.48, "end": 2172.44, "word": " الأسد", "probability": 0.8557942708333334}, {"start": 2172.44, "end": 2173.14, "word": " و", "probability": 0.66748046875}, {"start": 2173.14, "end": 2173.74, "word": " اعتقد", "probability": 0.76171875}, {"start": 2173.74, "end": 2173.84, "word": " ان", "probability": 0.75830078125}, {"start": 2173.84, "end": 2174.16, "word": " اليوم", "probability": 0.97314453125}, {"start": 2174.16, "end": 2174.78, "word": " بيكفي", "probability": 0.9599609375}, {"start": 2174.78, "end": 2175.36, "word": " بمحاضرة", "probability": 0.830517578125}, {"start": 2175.36, "end": 2175.6, "word": " احنا", "probability": 0.6536458333333334}, {"start": 2175.6, "end": 2176.26, "word": " هندقناها", "probability": 0.526416015625}, {"start": 2176.26, "end": 2176.46, "word": " المرة", "probability": 0.9052734375}, {"start": 2176.46, "end": 2176.86, "word": " الجاية", "probability": 0.888671875}, {"start": 2176.86, "end": 2177.12, "word": " في", "probability": 0.76904296875}, {"start": 2177.12, "end": 2177.88, "word": " بكتير", "probability": 0.971435546875}, {"start": 2177.88, "end": 2178.18, "word": " اسمها", "probability": 0.9715169270833334}, {"start": 2178.18, "end": 2178.96, "word": " Franzella", "probability": 0.435791015625}, {"start": 2178.96, "end": 2179.94, "word": " Tolerances", "probability": 0.6075032552083334}, {"start": 2179.94, "end": 2181.16, "word": " وهي", "probability": 0.791748046875}, {"start": 2181.16, "end": 2181.94, "word": " مسببة", "probability": 0.8624674479166666}, {"start": 2181.94, "end": 2182.28, "word": " لمرض", "probability": 0.872314453125}, {"start": 2182.28, "end": 2182.8, "word": " حمى", "probability": 0.6806640625}, {"start": 2182.8, "end": 2183.2, "word": " القران", "probability": 0.6726888020833334}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2183.88325, "duration_after_vad": 2110.186249999995}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/DbTwRll785g_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/DbTwRll785g_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..d87ef6faf4bcefc54d6ee89085d4fa6d0c3e3d37
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/DbTwRll785g_raw.srt
@@ -0,0 +1,2092 @@
+1
+00:00:20,420 --> 00:00:23,960
+بسم الله الرحمن الرحيم، اليوم هنستكمل موضوعنا عن
+
+2
+00:00:23,960 --> 00:00:26,520
+ال micro bacterium، لكن منفعش نبدأ الموضوع من محيث
+
+3
+00:00:26,520 --> 00:00:29,660
+انتهينا، بنحاول نمرمروه سريع على الجزيئات اللي
+
+4
+00:00:29,660 --> 00:00:32,380
+اتطلقنا إليها، قلنا أنواع محاضرتنا كانت ال micro
+
+5
+00:00:32,380 --> 00:00:35,600
+bacteria واتفقنا على تقسيمة معينة في ال micro
+
+6
+00:00:35,600 --> 00:00:37,480
+bacteria، اتكلمنا عن ال complex تبع ال micro
+
+7
+00:00:37,480 --> 00:00:39,600
+bacterium tuberculosis اللي بتكون من three species
+
+8
+00:00:40,360 --> 00:00:42,860
+Tuberculosis والبوفس والافريكانو متكلمنا عن ال non
+
+9
+00:00:42,860 --> 00:00:45,660
+tuberculosis mycobacterium اللي هي ال NTM و
+
+10
+00:00:45,660 --> 00:00:48,780
+جسمناها لجسمين الجسم الأول سمناه atypical
+
+11
+00:00:48,780 --> 00:00:51,560
+mycobacterium والتاني non cultivated هبقول non
+
+12
+00:00:51,560 --> 00:00:54,340
+cultivated هبقول شمل اللي هم ال mycobacterium
+
+13
+00:00:54,340 --> 00:00:57,480
+libri وحنا الصحيح أهم two microbes هدرسهم في هذه
+
+14
+00:00:57,480 --> 00:01:00,020
+المحاضرة اللي هم ال mycobacterium tuberculosis و
+
+15
+00:01:00,020 --> 00:01:03,380
+ال mycobacterium libri وبدرج أقل من ال atypical
+
+16
+00:01:03,380 --> 00:01:05,940
+mycobacterium هتكلم شوية عن mycobacterium avium
+
+17
+00:01:06,130 --> 00:01:10,830
+Intracellular اللي قلنا ارتبط اسمها بال HIV اكتر
+
+18
+00:01:10,830 --> 00:01:14,120
+شيءبعدين بدنا بحديث عن ال general characteristics
+
+19
+00:01:14,120 --> 00:01:19,480
+و تحدثنا عن صفة مهمة جدا بتميزها عن باقى نوع
+
+20
+00:01:19,480 --> 00:01:23,060
+البكتيريا اللى هى وجود ال mycolic acid و ال acid
+
+21
+00:01:23,060 --> 00:01:26,760
+fastness لهذه البكتيريا كنا هى acid fast لإن فى
+
+22
+00:01:26,760 --> 00:01:31,260
+كمية كبيرة من ال waxy lipids اللى بتجعل منصبغتها
+
+23
+00:01:31,260 --> 00:01:36,020
+صعبة ولكن انصبغت تجعل من إزالة اللون منها ايضا
+
+24
+00:01:36,020 --> 00:01:40,520
+صعبة حتى فى وجود حامض زى ما كنا اللى هو او ال
+
+25
+00:01:40,520 --> 00:01:43,510
+mixture من ال acid alcoholالبكتيريا اتفقنا انها
+
+26
+00:01:43,510 --> 00:01:46,390
+aerobic و ال doubling time تباعها قد يتروح من 12
+
+27
+00:01:46,390 --> 00:01:49,630
+ساعة إلى 20 ساعة بحسب الوسط الزراعي اللي هي بتنمو
+
+28
+00:01:49,630 --> 00:01:54,210
+فيه لكن اتفقنا انها بتحب ال CO2 اتحدثنا عن ال
+
+29
+00:01:54,210 --> 00:01:57,310
+disease و جونا ال palmonary tuberculosis أحد أهم
+
+30
+00:01:57,310 --> 00:02:00,530
+أشهر الأمراض اللي بتسيبها البكتيريا و اتحدثنا عن
+
+31
+00:02:00,530 --> 00:02:03,810
+مجموعة من ال legions او two types of legions اللي
+
+32
+00:02:03,810 --> 00:02:06,250
+هم ال excretive type و ال productive type و جون ال
+
+33
+00:02:06,250 --> 00:02:09,950
+productive type هو المهم لأنه هو اللي غالبا بيكون
+
+34
+00:02:09,950 --> 00:02:14,760
+diagnostic للبكتيرياوتحدثنا عن أيضًا مجموعة كبيرة
+
+35
+00:02:14,760 --> 00:02:19,380
+من الأعراض اللي قد تكون مصاحبة للإصابة بال
+
+36
+00:02:19,380 --> 00:02:23,860
+بالبلموناري tuberculosis أهمها قلنا اللي هو ال
+
+37
+00:02:23,860 --> 00:02:27,540
+fever و ال night sweat و ال weight loss و قلنا
+
+38
+00:02:27,540 --> 00:02:32,810
+اللي هو loss of appetiteاعتقد ان احنا بدنا بالحديث
+
+39
+00:02:32,810 --> 00:02:36,290
+عن ال specimen المرة الماضية و اتكلمنا عن ان احنا
+
+40
+00:02:36,290 --> 00:02:41,070
+كان لازم نعمل شغل مهم جدا من خلالها انفكفك
+
+41
+00:02:41,070 --> 00:02:43,330
+البكتيريا اللي هي ال mycobacterium اللي احنا بدنا
+
+42
+00:02:43,330 --> 00:02:46,670
+إياها من ال sputum و في نفس الوجه نقضي على ال
+
+43
+00:02:46,670 --> 00:02:50,050
+contaminants اللي موجودة لإن لو عملنا مقارنة بين
+
+44
+00:02:50,050 --> 00:02:52,410
+ال doubling time لل normal flora او normal
+
+45
+00:02:52,410 --> 00:02:55,130
+microbiota اللي في الفم و بين ال mycobacteria
+
+46
+00:02:55,130 --> 00:02:58,770
+هلاجي انه الفرق شاسة لو اتنين حاطناهم على نفس ال
+
+47
+00:02:58,770 --> 00:03:03,750
+mediaاللي هي بتنمي الاتنين حلاجة انه النمو لصالح
+
+48
+00:03:03,750 --> 00:03:08,090
+مين؟ ال normal microbiota وبالتالي بتستهلك الغذاء
+
+49
+00:03:08,090 --> 00:03:12,610
+من الوسط و بتبنع نموفبالتالي كان من الضروري قتل ال
+
+50
+00:03:12,610 --> 00:03:16,530
+normal microbiota فلجأنا ل ال NAOH treatment اللي
+
+51
+00:03:16,530 --> 00:03:19,750
+احنا حكينا عنها المرة الماضية وهي عبارة عن equal
+
+52
+00:03:19,750 --> 00:03:25,650
+volume من ال Sputum و من 4% Sodium Hydroxide عملنا
+
+53
+00:03:25,650 --> 00:03:29,170
+لهم mixing بعدين عملنا لهم centrifugation بعدين
+
+54
+00:03:29,170 --> 00:03:32,190
+شيلنا ال supernatant و أخدنا sediment و بعدين
+
+55
+00:03:32,190 --> 00:03:37,660
+أضفنا اللي هو ال pH indicator و أضفنا twonormal
+
+56
+00:03:37,660 --> 00:03:42,340
+HCL to a definite endpoint عشان نخل الوسط neutral
+
+57
+00:03:42,340 --> 00:03:48,180
+مرة أخرى وبعدين ال sediment هذه المعادلة أخدناها
+
+58
+00:03:48,180 --> 00:03:52,800
+وعملنا منها شغل تاني عملنا حاجتين sediment زرعنا
+
+59
+00:03:52,800 --> 00:03:58,700
+على slants أو slopes للوسط ال selective اللي اسمه
+
+60
+00:03:58,700 --> 00:04:04,070
+Leinstein جنس الأجار two slants two slopesو زرعنا
+
+61
+00:04:04,070 --> 00:04:07,430
+او مش زرعنا بالاخرى عملنا acid fast stain جيبجا ال
+
+62
+00:04:07,430 --> 00:04:12,090
+sediments اللي حصلنا عليها حصلنا عليها و قمنا
+
+63
+00:04:12,090 --> 00:04:16,030
+بعمليتين ب culture and staining ال culture مداش
+
+64
+00:04:16,030 --> 00:04:21,310
+كلمة بتقولنا لونشتاين جنسن slopes مش plates why
+
+65
+00:04:21,310 --> 00:04:29,050
+not plates ليش tubes؟انها بالعكس ال .. ال .. ال ..
+
+66
+00:04:29,050 --> 00:04:32,710
+ال plates لإن فيها surface area تمام واسعة فبتالي
+
+67
+00:04:32,710 --> 00:04:37,070
+هتكون أسرع solid
+
+68
+00:04:37,070 --> 00:04:39,590
+media slope مش liquid
+
+69
+00:04:43,090 --> 00:04:46,910
+طيب نرجع للفترة الزمنية اللازمة لل incubation كام
+
+70
+00:04:46,910 --> 00:04:50,190
+.. كام الفترة الزمنية؟ six to eight weeks من ست
+
+71
+00:04:50,190 --> 00:04:53,490
+لثمان أسابيع لو وضعنا أطباق في ال incubator على
+
+72
+00:04:53,490 --> 00:04:56,550
+سبعة و ثلاثين درجة مأوية يا شباب وضعناها لمدة أربع
+
+73
+00:04:56,550 --> 00:05:01,960
+أيام بس، إيش حصل في الأطباق؟ حجف تماماليش؟ لأن ال
+
+74
+00:05:01,960 --> 00:05:05,520
+surface area تبعتها واسعة جدا وبالتالي حصير
+
+75
+00:05:05,520 --> 00:05:10,260
+evaporation وإذا جفت ال media معناه الحاجة انه no
+
+76
+00:05:10,260 --> 00:05:13,380
+water activity واحنا قلنالكوا أحد أهم عوامل اللي
+
+77
+00:05:13,380 --> 00:05:17,640
+بتأثر عن نمو هو ال water activity وبالتالي اضطررنا
+
+78
+00:05:17,640 --> 00:05:21,060
+لأن ال incubation period طويلة فاضطررنا نعملهم في
+
+79
+00:05:21,060 --> 00:05:24,380
+مين؟ في أنابيب ويكونوا well screw-capped يعني حتى
+
+80
+00:05:24,380 --> 00:05:31,410
+محكمة الإغلاق بشكل جيدإذا اتفقنا إن ال period هي
+
+81
+00:05:31,410 --> 00:05:37,330
+الجداش6-8 أسابيع الان كلمة 6-8 أسابيع مافيش عندي
+
+82
+00:05:37,330 --> 00:05:40,730
+حاجة اسمها 6-8 أسابيع في ال actual practice في
+
+83
+00:05:40,730 --> 00:05:46,630
+الممارسة الحقيقية في رقم بتقوللي انه بعد 6 أسابيع
+
+84
+00:05:46,630 --> 00:05:50,230
+بعد 7 أسابيع بعد 8 أسابيع مافيش range مافيش range
+
+85
+00:05:50,230 --> 00:05:53,450
+ال range اللي انا بحكيه هنا في اختلافات ما بين
+
+86
+00:05:53,450 --> 00:05:57,550
+مختبر و مختبر مستشفى و مستشفى لكن واقع الأعمال
+
+87
+00:05:57,550 --> 00:06:02,130
+المستشفى له رقم 1 مثلا بعد 8 أسابيعقد يكون بسط في
+
+88
+00:06:02,130 --> 00:06:05,630
+الأسبوع الرابع، في الخامس، في السادس، في السابع،
+
+89
+00:06:05,630 --> 00:06:09,690
+لكن لا أستطيع أن أقول negative إلا بعد مرور الفترة
+
+90
+00:06:09,690 --> 00:06:13,450
+الزمنية ال maximum، اللي هي مثلا تمان أسابيع في
+
+91
+00:06:13,450 --> 00:06:16,630
+هذه الحلقةفي وسط تانية شباب غير الـ Leinstein
+
+92
+00:06:16,630 --> 00:06:21,330
+-Jensen Medium اسمه Middlebrook Agar لاحظوا الفترة
+
+93
+00:06:21,330 --> 00:06:25,830
+الزمنية لازمة للنمو البكتيريا على الطبقين أو على
+
+94
+00:06:25,830 --> 00:06:29,870
+العفوة الوسطين في الأولى four to six weeks التانية
+
+95
+00:06:29,870 --> 00:06:33,610
+two to three weeks اعتقد ان في good reduction
+
+96
+00:06:33,610 --> 00:06:40,860
+للزمن لأن ال middlebrook هيحل محل منلونشتاين و
+
+97
+00:06:40,860 --> 00:06:44,720
+بالتأكيد هو حل محل لونشتاين جنسا أجار في كثير من
+
+98
+00:06:44,720 --> 00:06:50,680
+البلدان والمستشفى لكن في الآخر اتنين موجودين طيب
+
+99
+00:06:50,680 --> 00:06:55,560
+انا ادعيت ادعاء قبل قليل بالانفندو انا قلت ان ال
+
+100
+00:06:55,560 --> 00:06:59,820
+NAOH treatment للعينة عملت شغل تاني قتلت ال
+
+101
+00:06:59,820 --> 00:07:04,160
+contaminant وش عملت؟ عملت concentration للبكتيريا
+
+102
+00:07:04,160 --> 00:07:08,350
+انها حررت البكتيريا من ال mucusهذا الإدعاء
+
+103
+00:07:08,350 --> 00:07:11,790
+الأولاني قتلت كل الcontinent هل هو صحيح مائة
+
+104
+00:07:11,790 --> 00:07:15,530
+بالمائة absolute لو absolute كان مالي ذنب الأمر
+
+105
+00:07:15,530 --> 00:07:19,710
+إنه نظرة على selective mediaبينما ال launch time
+
+106
+00:07:19,710 --> 00:07:23,150
+جنس الأجار هو بالفعل selective media ومضاف إليه يا
+
+107
+00:07:23,150 --> 00:07:26,750
+شباب اللي هو ال malachite green الصبغة اللي
+
+108
+00:07:26,750 --> 00:07:30,930
+استخدمتوها في ال sports training فاكرينها؟ ال
+
+109
+00:07:30,930 --> 00:07:35,350
+malachite green مضافة إلهانة لهذا الوسط ليس بغرض
+
+110
+00:07:35,350 --> 00:07:39,610
+الصباغة وعندما بغرض to inhibit the growthof non
+
+111
+00:07:39,610 --> 00:07:43,370
+-mycobacteria إذن بالفعل أنا ماقدرش أفترض افتراض
+
+112
+00:07:43,370 --> 00:07:46,570
+absolute إن ال sediments اللي أنا حصلت عليها من ال
+
+113
+00:07:46,570 --> 00:07:49,890
+treatment بتبعت ال NMH إنها completely استيراك وصل
+
+114
+00:07:49,890 --> 00:07:53,190
+الصورة طبعا نقول إن أحنا البكتيريا كابنوفيليك و بت
+
+115
+00:07:53,190 --> 00:07:55,470
+require ال CO2 وبتالي ال incubation تبعها بتكون
+
+116
+00:07:55,470 --> 00:08:02,920
+under CO2 incubation طيبالان البكتيريا بعد أربع
+
+117
+00:08:02,920 --> 00:08:08,660
+أسابيع خمس أسابيع نمت البكتيريا تمام وظهر مستعمرات
+
+118
+00:08:08,660 --> 00:08:11,400
+طبعا شكل المستعمرات تبعت ال micro bacterium
+
+119
+00:08:11,400 --> 00:08:15,140
+tuberculosis يشبه إلى حد كبير ما يسمى بال bread
+
+120
+00:08:15,140 --> 00:08:20,290
+crumbs اللي هي فتاة الخبز فتاة الخبزو لو انت عملت
+
+121
+00:08:20,290 --> 00:08:23,530
+simple search على ال .. ال .. ال google هتلاقي
+
+122
+00:08:23,530 --> 00:08:28,030
+برضه كتير .. كتير صور لمستعمرات على ال Leunstein
+
+123
+00:08:28,030 --> 00:08:32,490
+جنس الأجار بالفعل بتعطيك انطباع بأن هذه فتاعة خبز
+
+124
+00:08:32,490 --> 00:08:36,030
+من أشهر الفحوصات اللي لازم نربطها بالmycobacterium
+
+125
+00:08:36,030 --> 00:08:40,290
+tuberculosis فحص اسمه نياسين test نياسين test كيف
+
+126
+00:08:40,290 --> 00:08:45,510
+الفحص بينعمل؟ بطريقة بسيطة جدا هذا ال slant أو ال
+
+127
+00:08:45,510 --> 00:08:48,490
+slopeاللي نامي الفيه البكتيريا طبعا انتوا عارفين
+
+128
+00:08:48,490 --> 00:08:51,570
+كيف ال slope بيكون زي ال triple sugar iron agar او
+
+129
+00:08:51,570 --> 00:08:55,410
+بالأحرى زي ال citrate لإن احنا بلزمناش but بلزمناش
+
+130
+00:08:55,410 --> 00:09:01,130
+but بنضيف واحد milli sterile distilled water و
+
+131
+00:09:01,130 --> 00:09:05,170
+بنميّر القنبوبة بحيث ان الماء يصير ملامس لمين
+
+132
+00:09:05,170 --> 00:09:10,290
+للسطح تبع المستعمرات بتاعت البكتيريا الانياسين هو
+
+133
+00:09:10,290 --> 00:09:10,750
+compound
+
+134
+00:09:16,470 --> 00:09:22,090
+الماء اللى تركناه في الأنبوبة ملامس للسطح فى الماء
+
+135
+00:09:22,090 --> 00:09:22,830
+اللى تركناه في الأنبوبة ملامس للسطح فى الماء اللى
+
+136
+00:09:22,830 --> 00:09:25,130
+تركناه في الأنبوبة ملامس للسطح فى الماء اللى
+
+137
+00:09:25,130 --> 00:09:25,770
+تركناه ملامس للسطح فى الماء اللى تركناه ملامس
+
+138
+00:09:25,770 --> 00:09:25,830
+للسطح فى الماء اللى تركناه ملامس للسطح فى الماء
+
+139
+00:09:25,830 --> 00:09:26,810
+اللى تركناه ملامس للسطح فى الماء اللى تركناه ملامس
+
+140
+00:09:26,810 --> 00:09:27,070
+للسطح فى الماء اللى تركناه ملامس للسطح فى الماء
+
+141
+00:09:27,070 --> 00:09:27,070
+اللى تركناه ملامس للسطح فى الماء اللى تركناه ملامس
+
+142
+00:09:27,070 --> 00:09:28,600
+للسطح فى الماء اللى تركناه ملامس للسطح فى الماءبعد
+
+143
+00:09:28,600 --> 00:09:31,580
+ربع ساعة بناخد جزء من الماء، احنا حاطينا واحد مل،
+
+144
+00:09:31,580 --> 00:09:35,140
+خد نص ملي يا سيدي، خد نص ملي من الماء، وحطه في
+
+145
+00:09:35,140 --> 00:09:39,820
+قنبوبة جديدة، نظيفة، مغلقة، مغلقة، خلصنا؟ هي الأن
+
+146
+00:09:39,820 --> 00:09:42,940
+القنبوبة الجديدة، إيش في القنبوبة الجديدة هذه؟
+
+147
+00:09:42,940 --> 00:09:48,020
+point five ml من مين؟من ال water اللى يفترض ان
+
+148
+00:09:48,020 --> 00:09:52,500
+يكون فيه ناسين او مايكونش فيه ناسين كيف بنعمل
+
+149
+00:09:52,500 --> 00:09:56,860
+detection؟ بنضيف two compounds one اللى هو بنحط
+
+150
+00:09:56,860 --> 00:10:01,160
+طبعا الكميات point five ml of four percent aniline
+
+151
+00:10:01,160 --> 00:10:05,340
+و point five ml of ten percent cyanogen bromide
+
+152
+00:10:06,540 --> 00:10:10,540
+your indicator for the presence or absence of اللي
+
+153
+00:10:10,540 --> 00:10:13,300
+هو النايسين اللي هو كلمة مرة أنيالين داي أربع في
+
+154
+00:10:13,300 --> 00:10:16,820
+المية زائد سيانوجين رومايد اللي هو عشرة في المية
+
+155
+00:10:16,820 --> 00:10:22,460
+إذا تحول الوسط فورا within يعني seconds تمام إلى
+
+156
+00:10:22,460 --> 00:10:27,140
+اللون الأصفر للون الأصفر فالنايسين is there يعني
+
+157
+00:10:27,140 --> 00:10:30,240
+الفحص posted إذا ما اتحول للون الأصفر فالفحص
+
+158
+00:10:30,240 --> 00:10:33,810
+negative ليش هذا الفحص أنا بقول بويقع أنه مهم؟لأن
+
+159
+00:10:33,810 --> 00:10:37,530
+من كل ال mycobacteria only two produces niacin
+
+160
+00:10:37,530 --> 00:10:40,450
+test positive mycobacterium tuberculosis and
+
+161
+00:10:40,450 --> 00:10:44,990
+mycobacterium semiae ممر معانا أذكرها في القائمة
+
+162
+00:10:44,990 --> 00:10:48,730
+لكن هي من الموقع ال mycobacterium كيف نتميز بين
+
+163
+00:10:48,730 --> 00:10:55,670
+التنتين بكل سهولة ويسرأصلا مافيش داعي لشبه بينهم،
+
+164
+00:10:55,670 --> 00:10:59,790
+ليش؟ لأن واحدة منهم pigmented ملونة والتانية غير
+
+165
+00:10:59,790 --> 00:11:02,570
+ملونة، مين ال pigmented؟ السمية، بينما ال
+
+166
+00:11:02,570 --> 00:11:04,930
+mycobacterium tuberculosis اللي احنا بصددها non
+
+167
+00:11:04,930 --> 00:11:09,050
+-pigmented فإذا أنا عملت نياسين test ل pigmented
+
+168
+00:11:09,050 --> 00:11:13,330
+test ل pigmented mycobacteria فبتكون سمية، إذا
+
+169
+00:11:13,330 --> 00:11:17,750
+عملت نياسين test ل non-pigmented وطلع positive فهي
+
+170
+00:11:17,750 --> 00:11:21,780
+mycobacterium tuberculosisبالإضافة لأنها scene
+
+171
+00:11:21,780 --> 00:11:24,120
+test اللي قلنا عنه أساسي في مجموعة أخرى من
+
+172
+00:11:24,120 --> 00:11:26,580
+الفحوصات يعني من الممكن أنها مرسلية مافيش داعي أن
+
+173
+00:11:26,580 --> 00:11:32,600
+نفصلها لأنها غالبا يعني ما تستخدم بطريقة مختلفة عن
+
+174
+00:11:32,600 --> 00:11:36,260
+الفحوصات الأخرى، ليش؟ لأن أنا بتكلم عن slow
+
+175
+00:11:36,260 --> 00:11:38,480
+growing bacteria، إذا بدى أعمل ال test بدي أخد
+
+176
+00:11:38,480 --> 00:11:41,280
+وقت، فال biochemical test في هذا الحالة بتاخد وقت
+
+177
+00:11:41,280 --> 00:11:45,140
+طويلTrait reduction test, Urease test, Teluride
+
+178
+00:11:45,140 --> 00:11:49,080
+test, Sodium chloride test, Tolerance test يعني
+
+179
+00:11:49,080 --> 00:11:52,740
+قدرة تحمل البكتيريا على انه مو في تركيز مختلفة من
+
+180
+00:11:52,740 --> 00:11:55,920
+ال Sodium chloride pigment production test ما احنا
+
+181
+00:11:55,920 --> 00:11:59,020
+شوفناها اجابه شوي انها negative الكتاليز بده احكي
+
+182
+00:11:59,020 --> 00:12:03,580
+عنه شوي هنا لانه مش كتاليز عادي خصوصا لازم نعرف ان
+
+183
+00:12:03,580 --> 00:12:06,560
+كل مايكوبكتيريا اصلا كتاليز positive كل
+
+184
+00:12:06,560 --> 00:12:09,200
+مايكوبكتيريا كتاليز positive لانها obligate
+
+185
+00:12:09,200 --> 00:12:14,020
+aerobesنجي لأمبوبة بس المبوبة المرة دي مدرجة
+
+186
+00:12:14,020 --> 00:12:17,880
+امبوبة مدرجة يعني فيها اشارة واحد اتنين تلاتة اربع
+
+187
+00:12:17,880 --> 00:12:21,700
+خمسة الاخر وضعنا فيها كمية hydrogen peroxide محددة
+
+188
+00:12:21,700 --> 00:12:27,540
+وضفنا عليها لوب من البكتيريا بدلا من كتلاس بصتي مش
+
+189
+00:12:27,540 --> 00:12:34,480
+هتعمل bubbles الان ال bubbles بحسبلأن كمية ال H2O2
+
+190
+00:12:34,480 --> 00:12:38,760
+مستقل و تقريبا عد البكتيريا مستقل ناخد لوب احنا
+
+191
+00:12:38,760 --> 00:12:42,480
+فالاصل انه كل مرة بعمل الفحص نفس البكتيريا هيعطيني
+
+192
+00:12:42,480 --> 00:12:47,480
+مستوى معين من مين من ال bubbles لكن لأنه مش دقيقي
+
+193
+00:12:47,860 --> 00:12:51,440
+تماما انا بتكلم عن loop اللي ممكن تاخد نص ممكن
+
+194
+00:12:51,440 --> 00:12:56,300
+تاخد ربع ممكن تاخد مستعمرة كبيرة فبالتالي مش خلينا
+
+195
+00:12:56,300 --> 00:13:00,640
+نقول fixed بسموه semi quantitative catalase ليش
+
+196
+00:13:00,640 --> 00:13:02,900
+semi quantitative لإنه مش accurate لإنه مش
+
+197
+00:13:02,900 --> 00:13:06,000
+accurate لكن في الآخر بعطينا أرقام كمان فبالتالي
+
+198
+00:13:06,000 --> 00:13:09,480
+quantitative لكن لإنه مش accurate سميناها semi
+
+199
+00:13:09,480 --> 00:13:13,370
+quantitativeفمستوى ال bubbles قد يصل إلى سبعة، قد
+
+200
+00:13:13,370 --> 00:13:15,930
+يصل إلى ستة، قد يصل إلى خمسة، حسب نوع من ال
+
+201
+00:13:15,930 --> 00:13:19,550
+mycobacterium فبتالي هنا ليس في ال positive و ال
+
+202
+00:13:19,550 --> 00:13:22,390
+negative و إنما كمان مرة في semi quantitative test
+
+203
+00:13:22,390 --> 00:13:24,970
+في حد اسمها rice sulfatease test و فيه ان دي
+
+204
+00:13:24,970 --> 00:13:28,810
+المقدلة على النمو على المكنكيهال للmycobacterium
+
+205
+00:13:28,810 --> 00:13:33,770
+tuberculosis مقدلة؟ بالتأكيد لأنيجي للفحص المهم
+
+206
+00:13:33,770 --> 00:13:36,570
+الآخر اللي هو ال skin test احنا قبل محاضرة او
+
+207
+00:13:36,570 --> 00:13:39,330
+محاضرتين درسنا ال cornebacterium diphtheria
+
+208
+00:13:39,330 --> 00:13:42,350
+فاكرينها؟ و بقولنا اننا بنعمل skin test بس ال skin
+
+209
+00:13:42,350 --> 00:13:44,730
+test بتبقى ال cornebacterium diphtheria كان لأي
+
+210
+00:13:44,730 --> 00:13:54,100
+غرض يا شاعت؟ كان لأي غرض؟ الحساسية و التعرفيعني هل
+
+211
+00:13:54,100 --> 00:13:57,540
+نعطيك vaccine و لا مانعطيكاش vaccine هل انت
+
+212
+00:13:57,540 --> 00:14:00,860
+immunized و لا مش immunized بس هنا it is
+
+213
+00:14:00,860 --> 00:14:03,780
+diagnostic يعني لانعرف ان عندك tuberculosis و لا
+
+214
+00:14:03,780 --> 00:14:07,740
+ماعندكاش tuberculosis ليس بالبساطة هذه لكن على
+
+215
+00:14:07,740 --> 00:14:11,820
+الأقل هو محاولة او خلينا نقول وسيلة من وسائل
+
+216
+00:14:11,820 --> 00:14:16,380
+التعرف على او ال diagnostic tools للبكتيري كمان
+
+217
+00:14:16,380 --> 00:14:20,500
+مرةالفحص هو عبارة عن intra dermal في الجلد
+
+218
+00:14:20,500 --> 00:14:27,340
+injection لإيش؟ لواحد من المركبين المركب الأول
+
+219
+00:14:27,340 --> 00:14:31,540
+بيسموه old tuberculin والتاني بيسموه purified
+
+220
+00:14:31,540 --> 00:14:38,770
+protein derivative اتنى نفس الشيءمحسن عن الأولاني
+
+221
+00:14:38,770 --> 00:14:42,630
+ال all tuberculin اللي طوره روبرت كوخ وهو عبارة عن
+
+222
+00:14:42,630 --> 00:14:46,610
+crude extract ايش يعني crude؟ خام يعني مش .. مش
+
+223
+00:14:46,610 --> 00:14:50,510
+منقة بينما ال purified protein derivative هي
+
+224
+00:14:50,510 --> 00:14:53,550
+مركبات منقة برضه من ال micro bacterium
+
+225
+00:14:53,550 --> 00:14:59,570
+tuberculosis اذا عرفنا ما هي مكونات الحجنةاللي
+
+226
+00:14:59,570 --> 00:15:02,830
+بنعملها intra-dermal injection يا old توبركولين و
+
+227
+00:15:02,830 --> 00:15:05,390
+أنا قلتلكوا عليه خلصنا منه اللي في الغالب اللي
+
+228
+00:15:05,390 --> 00:15:08,670
+هيكون عنه مين ال PPD ال purified protein
+
+229
+00:15:08,670 --> 00:15:09,270
+derivative
+
+230
+00:15:13,580 --> 00:15:18,360
+الحقنة دي اللي قلنا عنها intra dermal طبعا بنحقن
+
+231
+00:15:18,360 --> 00:15:25,540
+بكمية محددة معروفة غالبا five tuberculin units are
+
+232
+00:15:25,540 --> 00:15:29,700
+the usual dose إذا الفحص negative ممكن يزيد الجرعة
+
+233
+00:15:29,700 --> 00:15:34,580
+إلى 250 tuberculin units إذا الجرعة محددة طبعا
+
+234
+00:15:34,580 --> 00:15:39,840
+وبنحقن قلنا كمان مره وانبعد تمانية و اربعين لاتنين
+
+235
+00:15:39,840 --> 00:15:43,160
+و سبعين ساعة من الحقنا بنقول المريض تعالى بنشوف
+
+236
+00:15:43,160 --> 00:15:47,350
+ايش صار عندك ايه التقاسر عنده؟هي ال injection لحظه
+
+237
+00:15:47,350 --> 00:15:54,550
+بنيدل رفيع جدا عشان ماتعملش subcutaneous هدا واحد
+
+238
+00:15:54,550 --> 00:15:57,830
+ويتحكم فيها أسهل في عملية اللي هو الحقن في الجلب
+
+239
+00:15:57,830 --> 00:16:01,610
+تانيوم مش مبين الصورة بالأسف هنا في الشكل اللي
+
+240
+00:16:01,610 --> 00:16:05,610
+قدامكوا هنا لكن عبارة عن احمرار و enduration زي
+
+241
+00:16:05,610 --> 00:16:10,750
+نفس الفكرة اللي حكينا عنها لشك تيست كورنباكتريوم
+
+242
+00:16:11,930 --> 00:16:15,470
+لكن بنجيس ال zone بنجيس ال zone اتباعت مش ال
+
+243
+00:16:15,470 --> 00:16:18,210
+inhibition انها بتاعة ال antibiotics انما اللي هي
+
+244
+00:16:18,210 --> 00:16:23,310
+ال induration and redness وبنشوف تفسير للنتائج
+
+245
+00:16:23,310 --> 00:16:29,850
+تفسير للنتائج بقولنا تصلب induration يساوي او اكتر
+
+246
+00:16:29,850 --> 00:16:32,530
+من عشرة millimeter with erythemia هذا غالبا
+
+247
+00:16:32,530 --> 00:16:36,610
+positive هذا غالبا positive لكن من خمسة لتسعة
+
+248
+00:16:37,510 --> 00:16:41,190
+Inconclusive، إيش يعني inconclusive؟ غير حاسم، ليش
+
+249
+00:16:41,190 --> 00:16:43,990
+غير حاسم؟ بقول إنه ممكن يكون low-level
+
+250
+00:16:43,990 --> 00:16:48,010
+sensitization with tuberculosis بسلاي or cross
+
+251
+00:16:48,010 --> 00:16:50,470
+-reacting mycobacteria إيش cross-reacting
+
+252
+00:16:50,470 --> 00:16:53,610
+mycobacteria؟ يعني واحد انصاب بmycobacteria أخرى
+
+253
+00:16:53,610 --> 00:16:55,710
+غير mycobacterium tuberculosis لكن عاملة cross
+
+254
+00:16:55,710 --> 00:17:00,430
+-reaction لحظولي الآن الجملة الأخيرة دي in AIDS
+
+255
+00:17:00,430 --> 00:17:06,130
+patient خمسة millimeter in duration تعتبر positive
+
+256
+00:17:06,130 --> 00:17:10,110
+testطبعا هنا عاملا بنقول خمسة لتسعة في المنادمين
+
+257
+00:17:10,110 --> 00:17:15,130
+العاديين مش حاسن في ال aids خمسة اعتبرناها poster
+
+258
+00:17:15,130 --> 00:17:21,010
+عارفين ليش؟ لأن هو immunocompromised فكونه كوّن
+
+259
+00:17:21,010 --> 00:17:23,870
+خمسة millimeter هذا يعتبر انه يعني لو عنده مناعة
+
+260
+00:17:23,870 --> 00:17:26,930
+عادية كان يمكن كوّن تلاتين millimeter بس ماعندهش
+
+261
+00:17:26,930 --> 00:17:29,630
+مناعة عادية عنده مناعة منخفضة فاعتبرناها في هذه
+
+262
+00:17:29,630 --> 00:17:35,220
+الحالة posterهذه تفسيرات للـ tuberculosis test
+
+263
+00:17:35,220 --> 00:17:39,480
+خدنا ناخد على ال postive test و خلينا نستغل الموقف
+
+264
+00:17:39,480 --> 00:17:46,400
+اليوم و نعطي معلومة عامة عن اي postive serological
+
+265
+00:17:46,400 --> 00:17:51,880
+test اي postive serological test لل antibody ايش
+
+266
+00:17:51,880 --> 00:17:55,060
+يعني ال antibody؟ يعني انا بستهدف في وجود ال
+
+267
+00:17:55,060 --> 00:18:00,240
+antibody ماذا يعني postive test لو وجود antibody
+
+268
+00:18:00,240 --> 00:18:05,950
+في الواحد من اربع او واحد من خمس ايش هم الخمس
+
+269
+00:18:05,950 --> 00:18:09,730
+احتمالات ان يكون بالفعل عنده disease الان؟ هذا
+
+270
+00:18:09,730 --> 00:18:14,530
+احتمال صح؟الاحتمال التاني اصيب فيه سابقا الاحتمال
+
+271
+00:18:14,530 --> 00:18:19,490
+التالت انه vaccinated انه كان هو متطعن الاحتمال
+
+272
+00:18:19,490 --> 00:18:25,010
+الرابع تمام انه يكون career للمرض حامل للميكروب
+
+273
+00:18:25,010 --> 00:18:31,050
+الاحتمال الخامس ذكرناه somewhere هنا انه يكون عنده
+
+274
+00:18:31,050 --> 00:18:36,170
+cross reaction لميكروب تانييبقى تخيلوا positive
+
+275
+00:18:36,170 --> 00:18:42,050
+serological test بطل بيعطينا معلومة مؤكدة ان
+
+276
+00:18:42,050 --> 00:18:46,190
+المريض مصاب الآن قد يكون مصاب الآن قد يكون مصاب
+
+277
+00:18:46,190 --> 00:18:50,350
+سابقا قد يكون مصاب قد يكون vaccinated الاحتمالات
+
+278
+00:18:50,350 --> 00:18:53,430
+الخمسة اللي احنا ذكرناهم خدوا بالكم هدول الخمسة
+
+279
+00:18:53,430 --> 00:18:56,530
+احتمالة تخليهم دايما في دماغك خليهم دايما في دماغك
+
+280
+00:18:56,530 --> 00:19:01,830
+لكن تفسير نتائج الفحوصات لازم يكون في السياق
+
+281
+00:19:01,830 --> 00:19:07,150
+السياق ايش؟أنا أصلا كطبيب لماذا قمت بطلب الفحص؟
+
+282
+00:19:07,150 --> 00:19:09,950
+أنا ليش طلبت skin test لل tuberculosis؟ لأن في
+
+283
+00:19:09,950 --> 00:19:15,210
+عندي واحدة من تنتين، يا أما أنت جيتني بأعراض أو أن
+
+284
+00:19:15,210 --> 00:19:21,730
+أنت جيتني مصاحب لعائلة فيها شخص .. فيها شخص مصاحب
+
+285
+00:19:21,730 --> 00:19:23,780
+بال tuberculosisوانتوا عارفين ان عندنا .. عندنا
+
+286
+00:19:23,780 --> 00:19:27,760
+النظام لو واحد اتشخص tuberculosis تمام كل عائلته
+
+287
+00:19:27,760 --> 00:19:31,800
+بتنجاب وبينعملهم فحوصات وبينعطيه prophylaxis كمان
+
+288
+00:19:31,800 --> 00:19:36,300
+حتى نمنع زي أمراض أخرى زي ال .. ال nyseria من
+
+289
+00:19:36,300 --> 00:19:40,810
+الجدايتوصل الصورة إذا هاي الأرقام .. هاي .. هاي
+
+290
+00:19:40,810 --> 00:19:43,370
+التفسيرات بتاعة اللي هو ال boast of skin test
+
+291
+00:19:43,370 --> 00:19:48,270
+حكيناها بشكل عام لأي test بيستهدف ال antibody خدوا
+
+292
+00:19:48,270 --> 00:19:51,310
+بالكوا، أنا بأكد على كلامي اللي بيستهدف ال
+
+293
+00:19:51,310 --> 00:19:54,450
+antibody، ال antigen غير ال antigen موجوده في
+
+294
+00:19:54,450 --> 00:19:57,310
+الدسم، معناه الحاجة إنه ال microbe، الآن موجود،
+
+295
+00:19:57,310 --> 00:20:02,240
+الآن موجود، هذا اللي بيبقى شكل الاختلافchild خدوا
+
+296
+00:20:02,240 --> 00:20:06,400
+بالكوا اللى عمره أقل من خمس سنوات إذا ماكانش
+
+297
+00:20:06,400 --> 00:20:11,320
+vaccinated تمام فالتفسير الوحيد انه عنده ايش
+
+298
+00:20:11,320 --> 00:20:16,600
+active disease ليش استثنائنا استثنائنا ال
+
+299
+00:20:16,600 --> 00:20:20,120
+immunization تمام عمره صغير من قبل previous
+
+300
+00:20:20,120 --> 00:20:24,820
+infection فبالتالي كل الاحتمالات الأخرى انشالت
+
+301
+00:20:24,820 --> 00:20:29,580
+غالبا بيكون هنا active disease negative testno
+
+302
+00:20:29,580 --> 00:20:33,540
+enduration او اقل من قداش من خمسة مليمتر شفتوا في
+
+303
+00:20:33,540 --> 00:20:38,560
+ال aids اعتبرناها خمسة مليمتر ايه اعتبرناها بسطىan
+
+304
+00:20:38,560 --> 00:20:42,240
+unhealthy individual not infected with MTB غالبا
+
+305
+00:20:42,240 --> 00:20:45,440
+بنشوف هذا ال reaction في أولى الزيكو ماعندهم مش ..
+
+306
+00:20:45,440 --> 00:20:49,540
+اللي هو mycobacterium tuberculosis أو في مرضى لسه
+
+307
+00:20:49,540 --> 00:20:53,360
+.. لسه مكونوش hypersensitivity لل tuberculosis
+
+308
+00:20:53,360 --> 00:20:56,700
+يعني في مراحلهم الأولى و هنشوف هذا الكلام في ال
+
+309
+00:20:56,700 --> 00:20:58,920
+false negative لإن هو هذا بيعتبر إيش الآن negative
+
+310
+00:20:58,920 --> 00:21:01,980
+لكن negative مش negative حقيقي و انما false
+
+311
+00:21:01,980 --> 00:21:07,140
+negative early TBنفس دولة ال pre-hypersensitivity
+
+312
+00:21:07,140 --> 00:21:10,580
+immunosuppression انا قولت قبل شويه ان مرضى ال
+
+313
+00:21:10,580 --> 00:21:14,560
+aids اللي كونوا خمسة مليمتر اعتبرناهم positive طيب
+
+314
+00:21:14,560 --> 00:21:16,820
+ايش رأيكوا انه ممكن يكون مصاب بال tuberculosis
+
+315
+00:21:16,820 --> 00:21:20,120
+ومايعطنش اي hypersensitivity او مايعطنش اي
+
+316
+00:21:20,120 --> 00:21:23,940
+induration ماعندوش immunity to respond to this
+
+317
+00:21:23,940 --> 00:21:28,760
+test او الناس اللي عندهم steroid ترابي اللي برضه
+
+318
+00:21:28,760 --> 00:21:32,060
+كمان ال steroid ترابي بيخفط جهاز اللي هو المناع
+
+319
+00:21:33,260 --> 00:21:36,300
+Treatment الميكروب جونا .. تفكرين المحاضرة
+
+320
+00:21:36,300 --> 00:21:40,020
+السابقة؟ جونا جوا شباب من الميكروبات الخطيرة سمينا
+
+321
+00:21:40,020 --> 00:21:42,820
+MDR Multiple Drug Resistant و بعدين ضفنا عليها
+
+322
+00:21:42,820 --> 00:21:47,320
+مصطلح تاني اسمه XDR Extended Drug Resistant يعني
+
+323
+00:21:47,320 --> 00:21:51,790
+البكتيريا بالفعل أنها مشكلة بتواجهناوكانت الفترة
+
+324
+00:21:51,790 --> 00:21:56,370
+الزمنية المستخدمة او ال .. ال .. ال .. المتوقعة ل
+
+325
+00:21:56,370 --> 00:22:02,510
+full recovery لاتقل عن تلت سنوات تخيل علاج مريض ب
+
+326
+00:22:02,510 --> 00:22:06,770
+drugs ب antibiotics لمدة تلت سنوات confined to a
+
+327
+00:22:06,770 --> 00:22:10,090
+containment او .. او .. يعني خدنا نقول hospital
+
+328
+00:22:10,090 --> 00:22:15,270
+environment لمدة تلت سنوات هذا ب .. أمر مرهق جدا
+
+329
+00:22:15,270 --> 00:22:21,080
+للمريض و لأهل المريض و للمستشفى و للدولة لكنأقصر
+
+330
+00:22:21,080 --> 00:22:25,220
+فترة زمانية حصلنا عليها هي ستة أشهر six-month
+
+331
+00:22:25,220 --> 00:22:29,440
+course therapy مكون من ال antibiotics اللي معلمين
+
+332
+00:22:29,440 --> 00:22:32,640
+بالأصفر قدام كوهانا الايزونيازايت اللي بيختصرون I
+
+333
+00:22:32,640 --> 00:22:36,840
+and H, Rifampicin او Rifamycin, Ethambutol and
+
+334
+00:22:36,840 --> 00:22:39,460
+Pyrazinamide طبعا هدول ال antibiotics الأخرى
+
+335
+00:22:39,460 --> 00:22:42,500
+بيستخدموا لكن ببنستخدموا .. الآن بستخدمهم مش في
+
+336
+00:22:42,500 --> 00:22:46,290
+هذا ال course في حال فشلال course اللي احنا
+
+337
+00:22:46,290 --> 00:22:50,210
+بنستخدمه هذا قد نلجأ الى بعض هذه الانتباه لكن اللي
+
+338
+00:22:50,210 --> 00:22:53,610
+بنستخدمه فقط يعني ايزونايزايد ريفامايسين
+
+339
+00:22:53,610 --> 00:22:57,430
+اثامبياتولو بايريزوناماي for 6 month هل كلهم
+
+340
+00:22:57,430 --> 00:23:02,570
+بنستخدمهم for 6 month لأ طلع عليهم ال ايزونايزايد
+
+341
+00:23:02,570 --> 00:23:06,130
+1 و 2 هدولة ببدأوا من اليوم الأول و بننتهي فيهم
+
+342
+00:23:06,130 --> 00:23:10,450
+بعد 6 شهوربينما ال Ethan-bietol و ال Pyrazinamide
+
+343
+00:23:10,450 --> 00:23:14,910
+بنبدأ فيهم من اليوم الأول و بنوقفهم بعد مرور شهرين
+
+344
+00:23:14,910 --> 00:23:20,290
+يعني بعد مرور شهرين من العلاج تمام بنستمر في مين؟
+
+345
+00:23:23,190 --> 00:23:28,210
+أول شهرين بناخد أربع انتيباتك، بعد شهرين بنستمر
+
+346
+00:23:28,210 --> 00:23:31,830
+باتنين انتيباتك لكمان أربع شهور أخرى، إذن هذه هي
+
+347
+00:23:31,830 --> 00:23:35,770
+ال treatment أو ال course therapy المعمول بيه
+
+348
+00:23:35,770 --> 00:23:38,770
+حاليا لmicrobacterium tuberculosis و very
+
+349
+00:23:38,770 --> 00:23:43,740
+effective يا شبابلكن في بلدان جنوب شرق أسيا زي
+
+350
+00:23:43,740 --> 00:23:49,120
+الفلبين و ماليزيا و أندونيسيا و بانجلديش هناك
+
+351
+00:23:49,120 --> 00:23:54,520
+سلالات مقاومة للرفانبسين و سلالات مقاومة لل INH
+
+352
+00:23:54,520 --> 00:24:00,580
+وهذه كنا نسميها XDR وللأسف علاجها بالفعل هيتطلب
+
+353
+00:24:00,580 --> 00:24:04,940
+منها تغيير كبير في السياسات و في النظام اللي موجود
+
+354
+00:24:04,940 --> 00:24:09,760
+حالياايه typical Mycobacteria احنا قولنا وعدناكوا
+
+355
+00:24:09,760 --> 00:24:11,980
+انه نتكلم عن بكتيريا واحدة فقط اللي هي
+
+356
+00:24:11,980 --> 00:24:16,380
+Mycobacterium Avium Intracellular Complex وهي
+
+357
+00:24:16,380 --> 00:24:20,260
+worldwide distribution لأن ال source تبعها غالبا
+
+358
+00:24:20,260 --> 00:24:24,420
+ال natural waters ال natural disease اللي بتسببه
+
+359
+00:24:24,420 --> 00:24:28,920
+tuberculosis of birds واخدوا بقى كلمة avium دي من
+
+360
+00:24:28,920 --> 00:24:33,660
+avian او من avium اللي هي birds تسمعوا avian
+
+361
+00:24:33,660 --> 00:24:38,630
+influenza طيور صح ف avian معناها طيورلكن تعمل برضه
+
+362
+00:24:38,630 --> 00:24:42,730
+في الأطفال حاجة بيسميها cervical lymphadenitis في
+
+363
+00:24:42,730 --> 00:24:46,050
+الأطفال وممكن تعمل disseminated tuberculosis في
+
+364
+00:24:46,050 --> 00:24:49,170
+مرضى ال HIV وانا قولتلكوا لم نكن نسمع بها هذه
+
+365
+00:24:49,170 --> 00:24:55,190
+البكتيريا إلا بعد ظهور مرض ال HIVالفروقات اللي
+
+366
+00:24:55,190 --> 00:24:59,290
+مابين ال typical و ال atypical ال colonial
+
+367
+00:24:59,290 --> 00:25:02,530
+morphology شكلهم بيختلف عن بعض في المستعمرات ال
+
+368
+00:25:02,530 --> 00:25:07,690
+نياسين تست ال atypical negative هذه البكتيريا ال
+
+369
+00:25:07,690 --> 00:25:11,510
+avium intrasolary are more resistant to
+
+370
+00:25:11,510 --> 00:25:14,350
+antituberculosis drugs than mycobacterium
+
+371
+00:25:14,350 --> 00:25:17,930
+tuberculosis itself عارفين ليش كمان؟ بتوقع انا
+
+372
+00:25:19,150 --> 00:25:22,310
+المريض ال aids أكتر مريض في الدنيا بياخد
+
+373
+00:25:22,310 --> 00:25:25,550
+antibiotics عارفين ليش طبعا لأنه دائما عنده
+
+374
+00:25:25,550 --> 00:25:30,010
+infections أو to prevent infection فبيعطوياها كنوع
+
+375
+00:25:30,010 --> 00:25:34,050
+من إيه؟ من ال ال proflaxes فبالتالي الميكروبات
+
+376
+00:25:34,050 --> 00:25:37,890
+اللي بتعمله infection غالبا بتكون محتكة أو احتكت
+
+377
+00:25:37,890 --> 00:25:41,850
+بكل أنواع ال antibiotic ففرص إنها تكون resistance
+
+378
+00:25:41,850 --> 00:25:47,550
+بتكون فرص عالية جدالسة acid fastness يعني لو جينا
+
+379
+00:25:47,550 --> 00:25:49,550
+نقارنها بال .. بال micro bacterium tuberculosis
+
+380
+00:25:49,550 --> 00:25:51,630
+هلاجى ان ال micro bacterium tuberculosis أكتر
+
+381
+00:25:51,630 --> 00:25:55,110
+fastness للacid من ال .. ال .. عارفين كيف بنقارنها
+
+382
+00:25:55,110 --> 00:25:59,390
+هذه الشغلة؟ بالفترة الزمنية اللي بيزول فيها الصفغة
+
+383
+00:25:59,390 --> 00:26:04,650
+مش هنجونا في تحدي انه ال decolarization بنظيفها
+
+384
+00:26:04,650 --> 00:26:10,960
+لمدة دقيقتين صح؟ دقيقتينacid alcohol طب لو خدنا
+
+385
+00:26:10,960 --> 00:26:14,600
+ثلاث دقائق طب لو خدنا أربع دقائق لو خدنا خمس دقائق
+
+386
+00:26:14,600 --> 00:26:18,020
+بنقدر نقارن بين الميكروبات وبعضها وبنقدر نشوف مين
+
+387
+00:26:18,020 --> 00:26:21,260
+أكتر resistant من الأخرى فال micro bacterium
+
+388
+00:26:21,260 --> 00:26:25,340
+tuberculosis is more acid fast than اللي هو ال
+
+389
+00:26:25,340 --> 00:26:28,860
+typical mix disease is less invasive في ال normal
+
+390
+00:26:28,860 --> 00:26:35,420
+individuals غالبا أقل invasion الميكروب التالت في
+
+391
+00:26:35,420 --> 00:26:38,240
+السلسلة تبعتنا اللي هو ال micro bacterium liver
+
+392
+00:26:39,190 --> 00:26:47,810
+Disease Librosi رسولنا الكريم لا عدوة ولا طيرة ولا
+
+393
+00:26:47,810 --> 00:26:55,170
+هامة ولا سفر وفر من المجذومي فرارك من الأسد سمعتوا
+
+394
+00:26:55,170 --> 00:26:59,750
+فيه الحديث عن جبل هيكل؟ ماسمتهوش لا عدوة مش عدوة
+
+395
+00:26:59,750 --> 00:27:04,870
+طبعا العلماء الغرب بيقولك تلع نبيهم رسولهم بيقولهم
+
+396
+00:27:04,870 --> 00:27:09,470
+مش عدوةولتقعون اللغة العربية بيقولك يا عم طب اول
+
+397
+00:27:09,470 --> 00:27:14,130
+حديث في ظاهره بتناقض مع اخر حديث لا عدوى و فره من
+
+398
+00:27:14,130 --> 00:27:17,130
+المجذومي المجذوم اللي هو المصاب بالجذام اللي هو
+
+399
+00:27:17,130 --> 00:27:21,810
+الموضوع المحاضرة تبعتنا فره من المجذومي فرارك من
+
+400
+00:27:21,810 --> 00:27:25,730
+الأسد فكيف بيقولنا لا عدوى و بيقولنا فره من
+
+401
+00:27:25,730 --> 00:27:31,470
+المجذومي فرارك من الأسد تفسير يا شباب والله أعلم
+
+402
+00:27:31,470 --> 00:27:35,950
+بحسب معلوماتنا المتواضعة في ال micro biologyلا
+
+403
+00:27:35,950 --> 00:27:40,950
+ينتقل المرض .. لا ينتقل المرض بالضرورة بانتقال
+
+404
+00:27:40,950 --> 00:27:48,170
+العامل المسبب صح الجملة دي ولا مش صح؟ ليس
+
+405
+00:27:48,170 --> 00:27:51,990
+بالضرورة ان ينتقل اليك المرض بانتقال العامل المسبب
+
+406
+00:27:51,990 --> 00:27:57,390
+اليك مثلا واحد عطس و عنده influenza تمام؟ و بيوزع
+
+407
+00:27:57,390 --> 00:28:02,370
+على الموجودين الفيروس المعظم بيستنشق هل الكل بيصاب
+
+408
+00:28:02,370 --> 00:28:06,280
+بالمرض؟طبعا احنا بتكلم الآن على حسب ال immune
+
+409
+00:28:06,280 --> 00:28:10,840
+system فهذا بيقول انه يعني ليس بالضرورة انتقال
+
+410
+00:28:10,840 --> 00:28:17,120
+المرض تمام؟ لأن في تاكمرة لحديث فأحد العرب بيسأل
+
+411
+00:28:17,120 --> 00:28:18,740
+الرسول صلى الله عليه و سلم بيقول فما باله الجمال
+
+412
+00:28:18,740 --> 00:28:23,540
+تكون كالظبأ الجمال من شكلها وجلدها حلو بتكون شكلها
+
+413
+00:28:23,540 --> 00:28:29,620
+زي الظبأ فيدخل الجمل الأجرب بينها فيجربها كلهافإيش
+
+414
+00:28:29,620 --> 00:28:31,820
+رد عليه الرسول صلى الله عليه وسلم؟ قال له فمن قعد
+
+415
+00:28:31,820 --> 00:28:37,040
+الأول؟ يعني الأول من وين قدرت العدوى؟ففي إنكار
+
+416
+00:28:37,040 --> 00:28:42,120
+لإطلاق العدوى بالكامل لكن ليس إن نفي تم لإن
+
+417
+00:28:42,120 --> 00:28:45,720
+إمكانية انتقال المرض بيه من شخص إلى آخر وبالدليل
+
+418
+00:28:45,720 --> 00:28:50,240
+فر من المجذوم فرارك من الأسد يبقى أقر حقيقة
+
+419
+00:28:50,240 --> 00:28:54,340
+بالبداية أنه مش بالضرورة أنه انت تصعب إذا انت
+
+420
+00:28:54,340 --> 00:29:00,000
+اتعرضت للمرض لكن يجب أن تأخذ حذرك يجب أن تأخذ حذرك
+
+421
+00:29:00,000 --> 00:29:07,450
+إذا الجذام مرض جذام مرضيعني على الأقل هي مر قبل
+
+422
+00:29:07,450 --> 00:29:16,580
+1435الان الان طبعا المرض معروف قبل ذلك كمان يعني
+
+423
+00:29:16,580 --> 00:29:20,960
+بيسموه biblical disease يعني مرض موجود في الانجيل
+
+424
+00:29:20,960 --> 00:29:27,980
+طبعا لكن اللي بنفهمه هنا ان هذا disease is very
+
+425
+00:29:27,980 --> 00:29:34,580
+dangerous disease بيفقد المرضى إحساسهم في الأطراف
+
+426
+00:29:35,380 --> 00:29:39,000
+وفقدان الإنسان الإحساس في الأطراف يعرضه لمخاطر
+
+427
+00:29:39,000 --> 00:29:43,820
+كثيرة، يعني مثلًا أنت تمسك كأس من الشاي الساخن،
+
+428
+00:29:43,820 --> 00:29:48,060
+بتحسه ساخن كتير، تشعر بالألم بالحرارة، بتنزله، هو
+
+429
+00:29:48,060 --> 00:29:51,640
+مش هيشعر بهذا الكلام، فهتحترق إيدي حتى لو مسك فحم
+
+430
+00:29:52,710 --> 00:29:58,850
+مشتعل مش هيشعر فيه وبالتالي أكتر يرضى منك أنت
+
+431
+00:29:58,850 --> 00:30:02,750
+للحوادث لأنه فقد الإحساس في الأطراف، يعني أنت لما
+
+432
+00:30:02,750 --> 00:30:05,530
+تسكري الباب و الباب بدي تسكري على إيدك، على طول
+
+433
+00:30:05,530 --> 00:30:09,170
+بتحس بتسحب إيدك، بتوجه الحركة، هو مابيشعرش بهذا
+
+434
+00:30:09,170 --> 00:30:11,650
+الكلام وبالتالي حوادثه كتير، هو ممكن يضرب إيده
+
+435
+00:30:11,650 --> 00:30:16,540
+بالشكوش، مايشعرشوبالتالي عنده secondary infection
+
+436
+00:30:16,540 --> 00:30:20,360
+باستمرار بالاضافة إلى ان ال nature لل disease
+
+437
+00:30:20,360 --> 00:30:24,720
+بيصير في infiltration لل lymph .. عفوا لل nerve
+
+438
+00:30:24,720 --> 00:30:28,200
+تمام؟ و thickening لل nerve، إذا في destruction
+
+439
+00:30:28,200 --> 00:30:32,420
+وين بصيب ال disease؟ غالبا بصيب ال cooler parts of
+
+440
+00:30:32,420 --> 00:30:35,510
+the bodyوين ال cooler parts of the body؟ فى فصل
+
+441
+00:30:35,510 --> 00:30:39,190
+الشتاء أكتر حاجة بيكون بردنين احنا فيها أطرافنا
+
+442
+00:30:39,190 --> 00:30:43,190
+اللى هم أصابعنا و أصابع القدمان ان الأنف الأذنين و
+
+443
+00:30:43,190 --> 00:30:49,050
+الشفتين تمام؟ هدولة أكتر مناطق هو بيفضل الإصابة
+
+444
+00:30:49,140 --> 00:30:52,120
+فيهم هذا الميكروب هذا الميكروب فاكرين محاضرة
+
+445
+00:30:52,120 --> 00:30:55,620
+السابقة قولنا ومحاضرة هذه قولنا has never been
+
+446
+00:30:55,620 --> 00:30:59,460
+cultivated in artificial media اذا عرفنا كيف عرفنا
+
+447
+00:30:59,460 --> 00:31:03,900
+فقط أخدنا scrapping من المرضى وشفناهم تحت
+
+448
+00:31:03,900 --> 00:31:08,240
+الميكروسكوب لجناهم acid fast stain زي ال micro
+
+449
+00:31:08,240 --> 00:31:12,380
+bacterium tuberculosis اذا ال diagnosis الأساسي
+
+450
+00:31:12,380 --> 00:31:16,260
+لهذا الميكروب خالي من ال culture مافيش culture فيه
+
+451
+00:31:19,600 --> 00:31:23,840
+طيب هناك شكلان .. هناك شكلان من ال .. ال .. ال
+
+452
+00:31:23,840 --> 00:31:28,300
+Librosy واحد بيسموه Tuberculoid Librosy والاخر
+
+453
+00:31:28,300 --> 00:31:34,320
+بيسموه Libromatous Librosy ال Libromatous Librosy
+
+454
+00:31:34,320 --> 00:31:40,700
+is very contagious فاكرين كلمة contagious؟ شديد
+
+455
+00:31:40,700 --> 00:31:45,480
+العدوى مش هنقول عن infectious اه و في contagious
+
+456
+00:31:45,480 --> 00:31:50,750
+contagious شديد العدوىبينما التبركولويد أقل العدوى
+
+457
+00:31:50,750 --> 00:31:54,650
+طبعا هنعرف الكلام ده ليش هذا مؤدي كتير وهذا مؤدي
+
+458
+00:31:54,650 --> 00:31:59,290
+بدرجة أقل أو درجة العدوى المختلفة بينهم ال course
+
+459
+00:31:59,290 --> 00:32:03,930
+is progressive يعني المرض بتطور بشكل سريعwith
+
+460
+00:32:03,930 --> 00:32:07,990
+nodular skin lesions في عندي symmetric nerve
+
+461
+00:32:07,990 --> 00:32:13,770
+involvement و بشوف في هذا النوع من ال disease بشوف
+
+462
+00:32:13,770 --> 00:32:16,410
+كمية كبيرة من مين من ال tuberculosis بصلى الله
+
+463
+00:32:16,410 --> 00:32:22,000
+يعني عفوا من ال liprocy بصلى اللهمدان بشوف في هذا
+
+464
+00:32:22,000 --> 00:32:25,400
+النوع من ال lesions كميات كبيرة من البكتيريا، إيش
+
+465
+00:32:25,400 --> 00:32:28,980
+معنى الحكاية؟ إن هذه البكتيريا ممكن تنتقل للآخرين،
+
+466
+00:32:28,980 --> 00:32:34,280
+بعكس من ال tuberculosis، literacy، هذا more slow،
+
+467
+00:32:34,280 --> 00:32:37,600
+the course is non-progressive، هدا إيش يعني أنها؟
+
+468
+00:32:37,600 --> 00:32:41,380
+progressivewith macular skin lesions, severe
+
+469
+00:32:41,380 --> 00:32:45,400
+asymmetric nerve involvement of certain with few
+
+470
+00:32:45,400 --> 00:32:48,940
+bacilli present in the lesion يعني عادل بسلعي اللي
+
+471
+00:32:48,940 --> 00:32:53,400
+موجودة في ال lesion قليل جدا بينما هنا كثير جدا
+
+472
+00:32:53,870 --> 00:32:58,010
+شوفوا كمان فى شغل هنا ما ذكرناهاش الفحص الليبرومين
+
+473
+00:32:58,010 --> 00:33:01,310
+اللى هو على غرار التوبركولين فاكرين ال skin test
+
+474
+00:33:01,310 --> 00:33:03,730
+اللى جابه شوية تاعت tuberculosis هذا سمينا
+
+475
+00:33:03,730 --> 00:33:07,970
+tuberculin test هذا بيسميه لبرومين test لو المريض
+
+476
+00:33:07,970 --> 00:33:11,310
+عنده لبروماتوس لبروسي بيكون الليبرومين test تبعه
+
+477
+00:33:11,310 --> 00:33:16,000
+negative ليش negative؟ذكروا ان ال course
+
+478
+00:33:16,000 --> 00:33:19,320
+progressive ليش progressive؟ لأنه ماعندوش اصلا
+
+479
+00:33:19,320 --> 00:33:22,420
+immune ال immune تبقى .. ال system تبقى راح
+
+480
+00:33:22,420 --> 00:33:27,060
+وبالتالي لن يكون هناك اي reaction من الجسم يبقى
+
+481
+00:33:27,060 --> 00:33:31,400
+تشخيص هذا ال disease خالي من ال culture خالي من ال
+
+482
+00:33:31,400 --> 00:33:37,010
+skin test، ايش دلوقتي يا شباب؟أسد فاستستان بينما
+
+483
+00:33:37,010 --> 00:33:41,170
+هنا ماعنديش أسد فاستستان الكمية كبيرة يبقى الفحص
+
+484
+00:33:41,170 --> 00:33:44,990
+اللي انا بقدر اشتغله هنا هو الليبرومين test إذا
+
+485
+00:33:44,990 --> 00:33:48,370
+الليبرومين test ممكن يفيد في مين ما تخلطوش عشان
+
+486
+00:33:48,370 --> 00:33:51,430
+اسمه هاد الليبروماتوس الليبرومين مفيد في ال
+
+487
+00:33:51,430 --> 00:33:55,270
+tuberculoid غير مفيد في الليبروماتوس الليبروسي
+
+488
+00:33:55,270 --> 00:33:59,050
+والأسد فاست مفيد في الليبروماتوس مش كتير مفيد في
+
+489
+00:33:59,050 --> 00:34:02,210
+مين؟ في ال tuberculoid الليبروسي وال scrapping
+
+490
+00:34:02,210 --> 00:34:05,150
+بتلخظها ماحكتلكوا حاجة من تنتين ال diagnosis
+
+491
+00:34:05,900 --> 00:34:08,340
+بتلخصوا حاجة من تان تان، ناخد الـ Scrapping و نعمل
+
+492
+00:34:08,340 --> 00:34:11,020
+منها أسطس فاصل تان أو نعمل اللي هو البرومين تست، و
+
+493
+00:34:11,020 --> 00:34:13,620
+البرومين تست كمان مرة عبارة عن ايه كمان مرة شباب،
+
+494
+00:34:13,620 --> 00:34:18,120
+Skin Test، نفس فكرة الـ Tuberculin Test، العلاج
+
+495
+00:34:18,120 --> 00:34:22,400
+تبعنا بتكون من Dapsin، عارفها Mycene and
+
+496
+00:34:23,350 --> 00:34:28,310
+Clofazamine لن تسمعوا بـ Clofazamine ولا بالـ
+
+497
+00:34:28,310 --> 00:34:32,270
+Dapsin ولا بالـ INH ولا بالـ Pyrazinamide اللي
+
+498
+00:34:32,270 --> 00:34:37,570
+سمعتوهم في الـ tuberculosis وسمعتوهم في الليبروسي
+
+499
+00:34:37,570 --> 00:34:40,710
+إلا في الميكو بكتيريا عشانك بيسموهم
+
+500
+00:34:40,710 --> 00:34:45,760
+antimicrobacterial drugsAntimic .. بدل .. بدل ما
+
+501
+00:34:45,760 --> 00:34:47,980
+بنقول antibiotic بشكل عام سنسميهم
+
+502
+00:34:47,980 --> 00:34:51,560
+antimicrobacterial drugs طبعا الارفاهم بيسيان
+
+503
+00:34:51,560 --> 00:34:54,920
+exception او الارفاهم بيسيان هذا exception لأن هذا
+
+504
+00:34:54,920 --> 00:34:58,280
+antibiotic مشهور على ال broad spectrum لكن
+
+505
+00:34:58,280 --> 00:35:03,820
+استخدامه الآن مقصور فقط لمين؟ لل tuberculosis
+
+506
+00:35:03,820 --> 00:35:07,460
+بيسموه reserved drug يعني ممنوع تستخدمه يا عالم في
+
+507
+00:35:07,460 --> 00:35:10,440
+أشياء أخرى حتى ما يتكوّله resistance بدنايا
+
+508
+00:35:10,440 --> 00:35:12,760
+نستخدمه فقط في هذه البكتيريا
+
+509
+00:35:15,890 --> 00:35:19,730
+هذه بعض الصور اللى اللى للأسف بتعطيك ال nodular
+
+510
+00:35:19,730 --> 00:35:24,470
+lesions للبروسي على سواء على ال skin أو على ال
+
+511
+00:35:24,470 --> 00:35:29,390
+face و لاحظوا طبعا الأنف و ممكن الشفاتين يتأثروا
+
+512
+00:35:29,390 --> 00:35:34,170
+بشكل كبير، هنشوف صورة الآن، هذا الشكل اللى قدامكوا
+
+513
+00:35:34,840 --> 00:35:39,680
+بتكون appearance .. بتكون appearance للمريض ب ..
+
+514
+00:35:39,680 --> 00:35:44,920
+بنسميه احنا lion face .. lion face يعني يبدو وجهك
+
+515
+00:35:44,920 --> 00:35:49,620
+للواحدة الأولى كوجه الأشد طبعا ليش الكلام هذا؟بصير
+
+516
+00:35:49,620 --> 00:35:54,520
+فيه thickening لل lips لل upper lips تنتفخ بصير
+
+517
+00:35:54,520 --> 00:35:58,140
+فيه thickening لل skin في المنطقة في ال cheeks هنا
+
+518
+00:35:58,140 --> 00:36:01,980
+فبيرتفع فالأنف بيصير زي الأفطس نوعا ما بالمقارنة
+
+519
+00:36:01,980 --> 00:36:05,780
+مع هذا في ارتفاع و هذا في ارتفاع و الأنف كما هو و
+
+520
+00:36:05,780 --> 00:36:11,020
+مجعت فبيعطيك الانطباع ان هذا الشخص بيشبهواجهه وجه
+
+521
+00:36:11,020 --> 00:36:15,600
+اللي هو الأسد و اعتقد ان اليوم بيكفي بمحاضرة احنا
+
+522
+00:36:15,600 --> 00:36:18,960
+هندقناها المرة الجاية في بكتير اسمها Franzella
+
+523
+00:36:18,960 --> 00:36:23,200
+Tolerances وهي مسببة لمرض حمى القران
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/HewR0byEM3M.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/HewR0byEM3M.srt
new file mode 100644
index 0000000000000000000000000000000000000000..d898607ba345c1e4b1e6c754d5928410102ad308
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/HewR0byEM3M.srt
@@ -0,0 +1,1980 @@
+1
+00:00:20,650 --> 00:00:25,210
+بسم الله الرحمن الرحيم عنوان جديد، موضوع جديد، وهو
+
+2
+00:00:25,210 --> 00:00:29,150
+المكمل للأجزاء الأربعة، يعني هو الجزء الرابع من
+
+3
+00:00:29,150 --> 00:00:32,150
+أربعة أجزاء في ال diagnostic microbiology. الجزء
+
+4
+00:00:32,150 --> 00:00:35,090
+الأول كان ال gram-bacilli. الجزء الثاني كان gram
+
+5
+00:00:35,090 --> 00:00:39,050
+-positive cocci. الجزء الثالث gram-positive cocci. الجزء الرابع
+
+6
+00:00:39,050 --> 00:00:42,290
+اليوم اللي هو gram-positive bacilli. gram-positive
+
+7
+00:00:42,290 --> 00:00:46,890
+-bacilli. موضوع إن شاء الله يكون سهل ومش معقد، وعشان
+
+8
+00:00:46,890 --> 00:00:51,260
+نسهل أكثر قسمنا البكتيريا اللي فيه إلى قسمين: قسم
+
+9
+00:00:51,260 --> 00:00:55,800
+spore forming وقسم non spore forming. هنتناول كل
+
+10
+00:00:55,800 --> 00:01:00,450
+موضوع منهم على حدة. لا أقصد بسهل أنهم مش مهمين، هو
+
+11
+00:01:00,450 --> 00:01:05,590
+من أهم أنواع الميكروبات ولهم أهمية خاصة لأنهم على
+
+12
+00:01:05,590 --> 00:01:09,370
+ سبيل المثال، ال spore former لما نسمع باسم Bacillus
+
+13
+00:01:09,370 --> 00:01:13,450
+anthracis، المسبب لمرض anthrax أو الجمرة الخبيثة.
+
+14
+00:01:13,450 --> 00:01:17,790
+تلك البكتيريا المستخدمة في الحرب البيولوجية، تلك
+
+15
+00:01:17,790 --> 00:01:21,190
+البكتيريا التي استخدمت كدعاية لحرب على
+
+16
+00:01:21,190 --> 00:01:27,160
+العراق من قبل الأمريكيين. تلك البكتيريا التي وضعت في
+
+17
+00:01:27,160 --> 00:01:31,640
+مجلات وبريد، وأرسلت لبعض الشخصيات المهمة، وعندما
+
+18
+00:01:31,640 --> 00:01:36,100
+يقوم بفتحها يستنشق بودرة موجودة في ال... وبالتالي
+
+19
+00:01:36,100 --> 00:01:41,120
+قد يقتل الإنسان الذي يستنشقها. فبكتيريا لها تأثير
+
+20
+00:01:41,120 --> 00:01:45,500
+واسع، على الرغم من أن... يعني إحداثها للمرض بشكل
+
+21
+00:01:45,500 --> 00:01:51,000
+طبيعي عدد قليل من الحالات، لكن متوقع أن تستخدم في
+
+22
+00:01:51,000 --> 00:01:55,460
+الإرهاب البيولوجي أو الحرب البيولوجية كما يسميها
+
+23
+00:01:55,460 --> 00:02:00,820
+البعض. الدياجرام اللي أمامنا بيقسم ال gram
+
+24
+00:02:00,820 --> 00:02:03,680
+positive، بس اللي إلى spore negative و spore
+
+25
+00:02:03,680 --> 00:02:06,660
+positive. لما أتكلم على ال spore positive فهي عندي
+
+26
+00:02:06,660 --> 00:02:10,020
+ال aerobic بكتيريا اللي هي الباسيلس، وال anaerobic
+
+27
+00:02:10,020 --> 00:02:13,360
+بكتيريا اللي هي ال clostridium. دي إذا لما أنا أبدأ أبدأ
+
+28
+00:02:13,360 --> 00:02:17,400
+بموضوع الباسيلس فأنا بكون عرفت أن البكتيريا aerobic
+
+29
+00:02:17,400 --> 00:02:21,150
+و spore forming، gram positive. بس اللي على
+
+30
+00:02:21,150 --> 00:02:25,130
+الجهة المقابلة، ال spore negative بكتيريا بنقسمها
+
+31
+00:02:25,130 --> 00:02:29,970
+إلى قسمين بفحص الكاتاليز. الكاتاليز negative بعدها
+
+32
+00:02:29,970 --> 00:02:33,370
+بنعمل H2S. إذا كانت H2S negative فهي Lactobacillus.
+
+33
+00:02:33,370 --> 00:02:37,830
+إذا كانت H2S positive فهي Erysipelothrix rhusiopathiae.
+
+34
+00:02:43,650 --> 00:02:46,410
+على الجهة المقابلة، في عندي catalase positive.
+
+35
+00:02:46,410 --> 00:02:50,350
+ال catalase positive بنميزه مع بعض بثلاث فحوصات أو ثلاث
+
+36
+00:02:50,350 --> 00:02:54,390
+صفات: ال nitrate، وال salicin، وال hemolysis. مهم جدًا
+
+37
+00:02:54,390 --> 00:02:57,970
+كلمة hemolysis هنا لأننا في عندنا بكتيريا ذكرناها
+
+38
+00:02:57,970 --> 00:03:02,570
+قبل هيك أو مرة ذكرناها معانا لما اتكلمنا عن group A
+
+39
+00:03:04,570 --> 00:03:07,610
+Streptococci. مين يقولوا بإيه Streptococci؟
+
+40
+00:03:07,610 --> 00:03:10,950
+Streptococcus pyogenes. قلنا لكم بتبين نقطة و
+
+41
+00:03:10,950 --> 00:03:15,370
+حواليها zone of inhibition، عفواً zone of hemolysis،
+
+42
+00:03:15,370 --> 00:03:20,150
+beta hemolysis. يشبه شكل المستعمرة و ال hemolysis ال
+
+43
+00:03:20,150 --> 00:03:23,510
+Streptococcus agalactiae مع أن هذه البكتيريا إيش
+
+44
+00:03:23,510 --> 00:03:27,870
+قلنا؟  بس الله، وهذه البكتيريا كوكساي، لكن على
+
+45
+00:03:27,870 --> 00:03:32,720
+الطبق they look similar. في الجهة المقابلة، في عندي
+
+46
+00:03:32,720 --> 00:03:35,440
+إذا كانت ال hemolysis negative، والسالسين negative،
+
+47
+00:03:35,440 --> 00:03:39,000
+بينما ال nitrate positive فهي Corynebacterium species.
+
+48
+00:03:39,000 --> 00:03:42,360
+إذا في عندي مجموعة من الأسماء، نرجعهم مع بعض:
+
+49
+00:03:42,360 --> 00:03:46,600
+Listeria monocytogenes، Erysipelothrix rhusiopathiae،
+
+50
+00:03:46,600 --> 00:03:52,140
+Lactobacillus، في عندي اللي هو ال Clostridium، وفي عندي
+
+51
+00:03:52,140 --> 00:03:59,720
+ال Bacillus، Bacillus، Clostridium، Listeria، Coryne
+
+52
+00:03:59,720 --> 00:04:00,380
+bacterium.
+
+53
+00:04:03,000 --> 00:04:06,580
+Erysipelothrix  and Lactobacillus. هذه الأسماء اللي
+
+54
+00:04:06,580 --> 00:04:10,940
+متوقع أن ندرسها في مجموعة ال gram positive bacilli، لكن
+
+55
+00:04:10,940 --> 00:04:13,520
+احنا هنبدأ في اللي قلنا فيه في ال spore forming، و
+
+56
+00:04:13,520 --> 00:04:15,800
+هنبدأ فيه اللي هو ال Bacillus.
+
+57
+00:04:27,990 --> 00:04:32,190
+هناك أكثر من 48 specie في الباسيلس. ال general
+
+58
+00:04:32,190 --> 00:04:35,850
+characteristics بتاعتهم: gram-positive bacilli, spore
+
+59
+00:04:35,850 --> 00:04:39,310
+-former, aerobic and facultative anaerobic. نقطة هنا
+
+60
+00:04:39,310 --> 00:04:45,050
+لازم نوضحها: ال 48 species يا إما بتكون aerobic
+
+61
+00:04:45,050 --> 00:04:48,670
+بكتيريا يا إما بتكون facultative anaerobic، لكن
+
+62
+00:04:48,670 --> 00:04:52,790
+مافيش فيها obligate anaerobic، فقط aerobic and
+
+63
+00:04:52,790 --> 00:04:55,960
+facultative anaerobic. أشهر pathogens في المجموعة
+
+64
+00:04:55,960 --> 00:04:58,580
+هنا ال Bacillus anthracis اللي كنا نتكلم بصددها الآن،
+
+65
+00:04:58,580 --> 00:05:02,360
+وبكتيريا أخرى اللي سميناها Bacillus cereus،
+
+66
+00:05:02,360 --> 00:05:05,580
+وال Bacillus cereus اللي بتوع ال food microbiology،
+
+67
+00:05:05,580 --> 00:05:09,380
+هذه بتسبب food poisoning.
+
+68
+00:05:12,290 --> 00:05:16,670
+و عندما يذكر في أي امتحان بتقابله أو بتواجهه سؤال
+
+69
+00:05:16,670 --> 00:05:20,450
+اثنين، ثلاثة، أربعة راحوا على مطعم صيني، تمام؟ وبعد
+
+70
+00:05:20,450 --> 00:05:24,430
+ساعتين أو ثلاث ساعات من الأكل صار عندهم stomach
+
+71
+00:05:24,430 --> 00:05:28,890
+ache، صار عندهم vomiting، تمام؟ what would be the
+
+72
+00:05:28,890 --> 00:05:32,130
+possible أو the most possible cause of food
+
+73
+00:05:32,130 --> 00:05:35,450
+poisoning؟ هبص للسيريوس لأنه بيتكلم عن مطعم صيني، عن
+
+74
+00:05:35,450 --> 00:05:39,110
+رز، rice، تمام؟ اللي هو السيريوس، اللي هو التالي هي
+
+75
+00:05:39,110 --> 00:05:42,830
+مرتبطة بال food poisoning، لكن مش... مش دي أهميتها
+
+76
+00:05:42,830 --> 00:05:47,770
+الكبيرة زي مين؟ زي ال Bacillus anthracis. نبدأ
+
+77
+00:05:47,770 --> 00:05:51,790
+بال Bacillus anthracis ونشوف بعض الصفات المهمة
+
+78
+00:05:51,790 --> 00:05:55,110
+جداً. قبل ما أبدأ في الموضوع، بدي أحكيلكم قصة صغيرة
+
+79
+00:05:55,110 --> 00:06:00,330
+عن أن الإنسان بالفعل كان يستشعر بوجود الميكروبات
+
+80
+00:06:00,330 --> 00:06:04,750
+قبل علم ال microbiology وقبل رؤية البكتيريا وقبل
+
+81
+00:06:04,750 --> 00:06:08,630
+بمئات وآلاف السنين من وجود اللي هو العلم المسمى
+
+82
+00:06:08,630 --> 00:06:16,460
+بال microbiology. عندما كانت تموت بقرة أو ثور أو ماعز
+
+83
+00:06:16,460 --> 00:06:20,020
+بال anthrax اللي هو الجمرة الخبيثة، المرض معروف.
+
+84
+00:06:20,020 --> 00:06:25,460
+هناك أغنام سليمة وأغنام مريضة، اللي بتمرض بأعراض كل
+
+85
+00:06:25,460 --> 00:06:29,960
+مرض مختلف، تمام؟ فمن ملاحظات الإنسان بيعرف هذا المرض
+
+86
+00:06:29,960 --> 00:06:34,860
+اسمه الجمرة الخبيثة. فكان البعض إيش يعمل؟ ياخد
+
+87
+00:06:34,860 --> 00:06:37,360
+شوكة، بتعرفوا الشوكة اللي بيكون مثلاً شوكة صبر ولا
+
+88
+00:06:37,360 --> 00:06:44,000
+شوكة نبات، ويغمسها في جثة الحيوان المصاب أو الميت،
+
+89
+00:06:44,000 --> 00:06:48,980
+ويروح ويحطها في السرج أو في المكان اللي بيكون يقعد
+
+90
+00:06:48,980 --> 00:06:54,930
+فيه الشخص المراد قتله. فبيجي بيجلس الشخص على الفرس
+
+91
+00:06:54,930 --> 00:07:00,330
+على الكرسي أو المكان اللي بيجلس فيه، بتغرز الشوكة،
+
+92
+00:07:00,330 --> 00:07:02,690
+بتدخل الجراثيم، طبعاً هو مش بعرف... ما عرفوش إن فيه
+
+93
+00:07:02,690 --> 00:07:07,090
+جراثيم، لكن خلاص المفهوم. فاستخدموا anthrax
+
+94
+00:07:07,090 --> 00:07:11,450
+للاغتيالات قبل مئات السنين، بآلاف السنين من معرفة
+
+95
+00:07:11,450 --> 00:07:14,770
+الإنسان ال microbiological. كمان في كمان ظاهرة
+
+96
+00:07:14,770 --> 00:07:20,430
+شبيهة: استخدموا الطاعون، الطاعون اللي هو ال يرسينيا بيستيس.
+
+97
+00:07:20,430 --> 00:07:26,890
+كان يقذفها بالمنجنيق، جثث الناس المصابين أو المتوفين
+
+98
+00:07:26,890 --> 00:07:31,490
+بالطاعون إلى الحصون حتى ينتشر مرض الطاعون في
+
+99
+00:07:31,490 --> 00:07:36,950
+الأخرين. يبقى كان في نوع من استغلال للميكروبات في
+
+100
+00:07:36,950 --> 00:07:40,530
+الحروب، في القتل، كما كان هناك أيضاً استغلال
+
+101
+00:07:40,530 --> 00:07:44,570
+للميكروبات في عمليات تصنيع الأغذية، في كان تصنيع
+
+102
+00:07:44,570 --> 00:07:49,730
+الخبز، تصنيع اللبن، الأجبان، هذه كلها برضه توظيف
+
+103
+00:07:49,730 --> 00:07:54,050
+لمين؟ للميكروبات، قبل ما حتى الإنسان يبقى يعرف إيش
+
+104
+00:07:54,050 --> 00:08:00,360
+يعني ميكروبات. نرجع، بالرجوع للباسيلس anthracis، it
+
+105
+00:08:00,360 --> 00:08:04,000
+is a large gram-positive bacillus، وأنا أول مرة بقول
+
+106
+00:08:04,000 --> 00:08:08,160
+large وبأكد على كلمة large لأن ال large هنا بتفرق
+
+107
+00:08:08,160 --> 00:08:11,520
+معانا، الباسيلس اللي كنا بنشوفها تحت الميكروسكوب
+
+108
+00:08:11,520 --> 00:08:14,160
+كإشريكية كولاي أو سودوموناس، بيها حجم تحت
+
+109
+00:08:14,160 --> 00:08:17,300
+الميكروسكوب، لو بدنا نقارنها بالباسيلس، الباسيلس هيك
+
+110
+00:08:18,570 --> 00:08:22,090
+أظن أن هذه بالفعل مجرد أنها large بالمقارنة مع
+
+111
+00:08:22,090 --> 00:08:26,030
+هذه. ال bacillus non motile، ولا أقصد أنه عمم كل
+
+112
+00:08:26,030 --> 00:08:28,190
+ال bacillus non motile ولا كل ال gram
+
+113
+00:08:28,190 --> 00:08:31,030
+positive bacilli non motile. ما أقدرش أعمم، يبقى هذه
+
+114
+00:08:31,030 --> 00:08:34,450
+البكتيريا non motile، ويبقى في others بتكون motile.
+
+115
+00:08:34,450 --> 00:08:39,190
+found singly, in pairs, or in chains. إذا كانت singly،
+
+116
+00:08:39,190 --> 00:08:43,790
+زي هيك، إذا كانت in pairs بتكون زي هيك، إذا كانت in
+
+117
+00:08:43,790 --> 00:08:50,630
+chains بتكون عاملة يا شباب زي ال bamboo tree، بتعرفوا
+
+118
+00:08:50,630 --> 00:08:59,450
+ال bamboo tree اللي هو الخيزران أو زي الجصب
+
+119
+00:08:59,450 --> 00:09:03,390
+الجصب السكري. طبعاً ليش الفراغ هذا؟ بيان لإنه
+
+120
+00:09:03,390 --> 00:09:08,670
+البكتيريا من أطرافها بتكون concave، فلما بيرتبطوا مع
+
+121
+00:09:08,670 --> 00:09:14,510
+بعض بيبين كأنه في فراغ بين الاثنين. طبعاً ممكن تكون
+
+122
+00:09:14,510 --> 00:09:18,390
+long chain. الآن، أحد مميزات البكتيريا كانت هنا
+
+123
+00:09:18,390 --> 00:09:24,410
+Spore former. طيب Spore former، وين مكان ال Spore؟
+
+124
+00:09:24,410 --> 00:09:29,230
+هذه البكتيريا، نكبر شوية، احتمال وجود ال Spore وين
+
+125
+00:09:29,230 --> 00:09:32,530
+ممكن تكون؟ يا إما central يا إما sub terminal يا
+
+126
+00:09:32,530 --> 00:09:37,900
+إما terminal. هذه موجودة central، بالإضافة إلى الشكل
+
+127
+00:09:37,900 --> 00:09:41,940
+تبعها أنه oval. يبقى في شكلين هنا في ال spore، يا
+
+128
+00:09:41,940 --> 00:09:45,720
+إما spherical يا إما oval، وبالنسبة لل location يا
+
+129
+00:09:45,720 --> 00:09:48,660
+إما central يا إما sub terminal يا إما terminal.
+
+130
+00:09:48,660 --> 00:09:53,220
+لكن الباسيلس anthracis centrally located و oval
+
+131
+00:09:53,220 --> 00:10:00,700
+shape. بقول لنا هنا أن ال spores could be found only
+
+132
+00:10:00,700 --> 00:10:06,020
+in culture outside the animal. بينما ال capsule could
+
+133
+00:10:06,020 --> 00:10:12,180
+be only found in the animal. معلومتان عكس بعض، ال
+
+134
+00:10:12,180 --> 00:10:17,200
+spore بنلاقيها في ال culture برا الحيوان أو
+
+135
+00:10:17,200 --> 00:10:20,920
+برا الإنسان المصاب، بينما ال capsule اللي بيشوفها دي
+
+136
+00:10:20,920 --> 00:10:23,320
+هو في ال infected animal. تعالوا نطلع على النقطة
+
+137
+00:10:23,320 --> 00:10:27,150
+الأولى، الأولانية اللي هي ال spore. لماذا تكون
+
+138
+00:10:27,150 --> 00:10:31,270
+البكتيريا أصلاً spore لما تكون ظروفها صعبة؟ طيب هي
+
+139
+00:10:31,270 --> 00:10:36,090
+بتدخل الجسم وبتعمل infection للإنسان وبتتكاثر، و
+
+140
+00:10:36,090 --> 00:10:39,470
+خذوا بالكم من ال number اللي هحكيلكم إياه، هي ال number
+
+141
+00:10:39,470 --> 00:10:43,190
+في الدم قد يصل إلى أعداد أكبر من ال blood cells.
+
+142
+00:10:44,760 --> 00:10:48,360
+يعني لو أخذت قطرة من الدم من ال venous blood أو
+
+143
+00:10:48,360 --> 00:10:51,460
+من ال peripheral blood بال puncture وحطيتها تحت
+
+144
+00:10:51,460 --> 00:10:55,720
+الميكروسكوب قد ترى البكتيريا مع ال red blood cells.  
+
+145
+00:10:55,720 --> 00:10:59,140
+منع الحكي أنه fulminant growth، growth، heavy
+
+146
+00:10:59,140 --> 00:11:04,740
+growth، very severe infection في الدم. إذا في عندي
+
+147
+00:11:04,740 --> 00:11:09,700
+ظروف ملائمة، البكتيريا بتنمو بشكل جيد، لماذا تكون
+
+148
+00:11:09,700 --> 00:11:15,140
+spore؟ السؤال الثاني: ليش بتكون capsule جوا وبتكونش
+
+149
+00:11:15,140 --> 00:11:19,840
+capsule برا؟ هي ممكن تكون capsule برا إذا أنا وفرت
+
+150
+00:11:19,840 --> 00:11:23,200
+لها ال media التي تحتوي على ال calcium carbonate.
+
+151
+00:11:23,200 --> 00:11:26,560
+ال media اللي بنميه عليها غالباً ما فيهاش
+
+152
+00:11:26,560 --> 00:11:30,820
+calcium carbonate، وتكوين ال capsule بيحتاج لمن؟
+
+153
+00:11:30,820 --> 00:11:35,440
+ل calcium carbonate. إذا البيئة داخل الجسم بتساعدها
+
+154
+00:11:35,440 --> 00:11:38,860
+عليها تكون capsule بينما في ال culture مابتساعدهاش
+
+155
+00:11:38,860 --> 00:11:42,520
+عليها تكون capsule إلا إذا أنا زودت ال media بال
+
+156
+00:11:42,520 --> 00:11:46,590
+calcium carbonate. حكينا عن ال spores are oval and
+
+157
+00:11:46,590 --> 00:11:50,610
+centrally located. شوفوا يا شباب بعض المعلومات عن ال
+
+158
+00:11:50,610 --> 00:11:56,250
+survival تبع ال spore في التربة. أحد العلماء حط
+
+159
+00:11:56,250 --> 00:12:01,510
+البكتيريا في تربة، تربة معينة، وكل سنة بياخد عينة و
+
+160
+00:12:01,510 --> 00:12:04,810
+بيفحص البكتيريا حية باقية ولا مش حية، لقيها حية
+
+161
+00:12:04,810 --> 00:12:09,650
+لِجَدَاش لأكثر من أربعين سنة، وبعدين العالم مات، يعني
+
+162
+00:12:09,650 --> 00:12:15,260
+البكتيريا عاشت أكثر من أربعين سنة survived في التربة.
+
+163
+00:12:15,260 --> 00:12:19,780
+ولو بدنا نكمل التجربة لسنوات أكثر قد نتوقع إحنا
+
+164
+00:12:19,780 --> 00:12:24,140
+لأن spore forming بتطول، قد تطول نظرياً إلى مئات
+
+165
+00:12:24,140 --> 00:12:31,700
+السنين. فال survival  في التربة عالي جدًا، فضل
+
+166
+00:12:36,770 --> 00:12:40,890
+بس لما يكون فيه دم، الانفكشاف، الانمو يعني أي شكل دم،
+
+167
+00:12:40,890 --> 00:12:44,110
+الانفكشاف، الانمو كالسوم؟ لأ، دول ممكن... عفواً، بنميز
+
+168
+00:12:44,110 --> 00:12:47,430
+هنا بين ال... إن إحنا هنا في شكلين في الخلية،
+
+169
+00:12:47,430 --> 00:12:50,410
+الخلية الخضرية اللي بيسموها vegetative cell،
+
+170
+00:12:50,410 --> 00:12:54,710
+vegetative cell، خلية نشطة وبتتغذى، تمام؟ الشكل
+
+171
+00:12:54,710 --> 00:13:01,040
+الثاني مين؟  ال spore. متى بتتحول هذه الخلية ال
+
+172
+00:13:01,040 --> 00:13:05,160
+vegetative cell إلى ال spore cell؟ لما تكون الظروف
+
+173
+00:13:05,160 --> 00:13:09,680
+سيئة. فإحنا بنقول، إحنا بنقول أنه في جسم الإنسان لا
+
+174
+00:13:09,680 --> 00:13:12,060
+يوجد ظروف سيئة أو في جسم الحيوان، وبالتالي البكتيريا
+
+175
+00:13:12,060 --> 00:13:15,200
+بتبقى vegetative cell ما فيهاش spore. لما
+
+17
+
+223
+00:17:11,180 --> 00:17:15,060
+نقطة كتير مهمة بدنا نعرفها هنا أن البكتيريا تبعتنا
+
+224
+00:17:15,060 --> 00:17:20,550
+non-hemolytic، بنؤكد على المعلومة هذه، لماذا نؤكد
+
+225
+00:17:20,550 --> 00:17:25,350
+على المعلومة هذه؟ لأن باقي الـBacillus species
+
+226
+00:17:25,350 --> 00:17:29,630
+are mostly hemolytic أو Beta-hemolytic، فلما يطلع
+
+227
+00:17:29,630 --> 00:17:33,970
+عندي Bacillus، وكل مواصفات الـBacillus فيها، وnon-
+
+228
+00:17:33,970 --> 00:17:37,310
+hemolytic فهي أقرب ما تكون إلى أن تكون Bacillus
+
+229
+00:17:37,310 --> 00:17:42,410
+anthracis، بتكونوا تعرفوا أنه فينا during specimen
+
+230
+00:17:42,410 --> 00:17:47,310
+collection، فينا caution أو تحذير مهم جدا يجب عليكم
+
+231
+00:17:47,310 --> 00:17:51,110
+اتخاذ كل إجراءات السلامة والأمان والوقاية عند
+
+232
+00:17:51,110 --> 00:17:54,990
+التعامل مع أي عينة يشتبه أن يكون فيها Bacillus
+
+233
+00:17:54,990 --> 00:18:01,310
+anthracis، ليش؟ بتحكي لكم عن مرض بتسببه هذه البكتيريا،
+
+234
+00:18:01,310 --> 00:18:06,110
+وأنتم تخيلوا كيف ينتقل هذا المرض، أو ما هو أكثر شكل مشهور
+
+235
+00:18:06,110 --> 00:18:10,250
+من أشكال الأنثراكس، شيء يسمى cutaneous anthrax
+
+236
+00:18:10,250 --> 00:18:13,290
+جلدي، cutaneous،  مش يعني إيه؟ جلدي وهو عبارة عن احتكاك جروح
+
+237
+00:18:13,900 --> 00:18:19,500
+بمواد ملوثة بالبكتيريا، المرض الثاني يسمى
+
+238
+00:18:19,500 --> 00:18:24,460
+pulmonary anthrax، وله اسم بالعربي مرض الصوافّين أو
+
+239
+00:18:24,460 --> 00:18:34,120
+wool sorter's disease
+
+240
+00:18:34,120 --> 00:18:39,060
+اللي هم الـsorters اللي
+
+241
+00:18:42,420 --> 00:18:47,460
+بيفصلوا الصوف، كيف يفصلون الصوف؟ أنتم كل ما رأيتم
+
+242
+00:18:47,460 --> 00:18:51,480
+الأغنام والخرفان كيف يكون شكلها وهي ماشية في
+
+243
+00:18:51,480 --> 00:18:56,600
+الشوارع، تلتقط أشواكًا وقاذورات، بعضها لا يزول
+
+244
+00:18:56,600 --> 00:19:01,080
+بالغسيل، فالصوف هذا بعد ما يحصلوا عليه بدون أن
+
+245
+00:19:01,080 --> 00:19:05,940
+ينظفوه، الأشياء اللي غير قابلة للتنظيف بالماء
+
+246
+00:19:05,940 --> 00:19:09,230
+يشيلوها ناس وهم بيحركوا وينفضوا في الصوف،
+
+247
+00:19:09,230 --> 00:19:12,470
+بيشدوه من هنا ومن هنا، بيطلع الغبار منهم، لما يكون
+
+248
+00:19:12,470 --> 00:19:16,930
+الصوف مأخوذ من حيوان مصاب بالـanthrax، فبيكون مليان
+
+249
+00:19:16,930 --> 00:19:20,830
+بالـspores تبع الـanthrax، وبالتالي يستنشقها مين؟
+
+250
+00:19:20,830 --> 00:19:25,270
+الشخص اللي بيشتغل بالصوف، بيصير عنده التهاب في
+
+251
+00:19:25,270 --> 00:19:28,830
+الرئتين، يسمى pulmonary anthrax
+
+252
+00:19:28,830 --> 00:19:31,770
+pulmonary anthrax
+
+253
+00:19:36,340 --> 00:19:40,360
+لأن الحيوان في بعض الحالات، الاستنتاجات بتبقى
+
+254
+00:19:40,360 --> 00:19:45,280
+متكومة ولا فيها  منطق، هذا الحيوان، هذه الـskin
+
+255
+00:19:45,280 --> 00:19:50,020
+تبعه، هذا الصوف تبع هذا الحيوان، تمام؟ هذا الجرح
+
+256
+00:19:50,020 --> 00:19:54,720
+تبعه، البكتيريا الآن لما تروح على الصوف من الجرح،
+
+257
+00:19:54,720 --> 00:20:00,810
+بتضل في الجسم... مش بيصير في أكل وشرب
+
+258
+00:20:00,810 --> 00:20:04,470
+لها، يبقى إيش؟ تتحول من خلية vegetative إلى
+
+259
+00:20:04,470 --> 00:20:08,790
+spores، فإيش احنا... تمام؟ أقول لكم حتى وإحنا بناخد
+
+260
+00:20:08,790 --> 00:20:12,650
+من الحيوان الصوف، لو أخذنا البكتيريا وهي لسة non-
+
+261
+00:20:12,650 --> 00:20:15,750
+spore-forming، وصار ضمن الصوف بعد فترة قصيرة، الآن إيش؟
+
+262
+00:20:15,750 --> 00:20:19,290
+spores، وبالتالي ينتقل بالاستنشاق بشكل spores
+
+263
+00:20:21,230 --> 00:20:24,770
+عشان هيك على فكرة، المفروض الصوف المستورد حتى
+
+264
+00:20:24,770 --> 00:20:31,550
+يمر عبر فحوصات ويمر عبر عملية sterilization كافية
+
+265
+00:20:31,550 --> 00:20:34,910
+لقتل الـspores، بقى اللي هو البكتيريا، الآن يبقى
+
+266
+00:20:34,910 --> 00:20:39,370
+cutaneous، pulmonary، وفي
+
+267
+00:20:39,370 --> 00:20:43,430
+gastrointestinal، عبر التناول، صعب نتناول البكتيريا
+
+268
+00:20:43,430 --> 00:20:47,730
+من الطبق، لكن ممكن نلمس جلدنا، ممكن نستنشق البكتيريا
+
+269
+00:20:47,730 --> 00:20:51,700
+صح ولا لأ؟ وبالتالي لازم ناخد إجراءات الأمان لحماية
+
+270
+00:20:51,700 --> 00:20:55,180
+أنفسنا، ولحمايتنا أو لحماية البيئة من انتشار هذه
+
+271
+00:20:55,180 --> 00:21:00,920
+البكتيريا في البيئة، شوفوا المستعمرة شكلها اللذيذ، لما
+
+272
+00:21:00,920 --> 00:21:04,500
+واحد بياخذها، بياخذ جزء منها، وبتضل واقفة،
+
+273
+00:21:04,500 --> 00:21:10,240
+دلالة على أن القوام تبعها واكسي زي الشمع، القوام
+
+274
+00:21:10,240 --> 00:21:11,300
+تبعها زي الشمع
+
+275
+00:21:18,090 --> 00:21:21,370
+Samples collected depending on the site affected.
+
+276
+00:21:21,370 --> 00:21:28,690
+إحنا قلنا كم site فيه affected skin صح؟ وإيش
+
+277
+00:21:28,690 --> 00:21:34,890
+كمان؟ pulmonary و gastrointestinal
+
+278
+00:21:34,890 --> 00:21:38,850
+طبعا gastrointestinal إيش بناخذ منها؟ stool أو
+
+279
+00:21:38,850 --> 00:21:43,530
+gastric washing، pulmonary
+
+280
+00:21:45,870 --> 00:21:52,370
+sputum، والـskin هناخد swab صح؟ هذه العينات مع كل
+
+281
+00:21:52,370 --> 00:21:55,510
+واحد من هذول التلاتة بيجوز ناخد sample blood
+
+282
+00:21:55,510 --> 00:22:02,310
+culture، ليش؟
+
+283
+00:22:02,900 --> 00:22:08,140
+لأنه على الرغم من أن skin... أو skin infection، الـ
+
+284
+00:22:08,140 --> 00:22:11,560
+ultimate destination للبكتيريا مش الـskin، وإنما
+
+285
+00:22:11,560 --> 00:22:15,400
+مين؟ الـblood، على الرغم أنه موجود في الـpulmonary، الـ
+
+286
+00:22:15,400 --> 00:22:18,400
+ultimate destination كمان مرة... كده بقول لكم أنه
+
+287
+00:22:18,400 --> 00:22:23,600
+بتنمو داخل الدم بكميات ضخمة جدا، إذا الدم هو الـ
+
+288
+00:22:23,600 --> 00:22:27,980
+target site، فبالتالي ممكن ناخد swab و blood، ناخد
+
+289
+00:22:27,980 --> 00:22:32,310
+sputum، زائد blood، ناخد stool، زائد اللي هو blood، طبعا
+
+290
+00:22:32,310 --> 00:22:35,630
+لما نتكلم عن stool مشكلة، لكن إذا اتكلمنا عن
+
+291
+00:22:35,630 --> 00:22:41,750
+blood culture، عينة الدم بنزرعها في البطل، وإيش بيطلع
+
+292
+00:22:41,750 --> 00:22:45,250
+معنا؟ that's it، لأن الدم أصلا استوائي، بس الـstool
+
+293
+00:22:45,250 --> 00:22:49,830
+مش استوائي، يبقى كيف بنعزل البكتيريا من الـstool؟
+
+294
+00:22:49,830 --> 00:22:55,350
+طب كيف بنعملها selective؟ فكروا، هل اقترحوا طريقة... هل
+
+295
+00:22:55,350 --> 00:22:59,570
+جاءتكم طريقة مثلا معينة، أو معلومة معينة بتسهل لكم أو
+
+296
+00:22:59,570 --> 00:23:03,950
+بتساعدكم أن تعزلها selectively؟ من يفكر؟ يلا، الـ
+
+297
+00:23:03,950 --> 00:23:07,790
+calcium
+
+298
+00:23:07,790 --> 00:23:12,150
+carbonate، هذا للكبسول، الكبسول...
+
+299
+00:23:12,150 --> 00:23:13,090
+(repeated "الكبسول" many times)
+
+305
+00:23:24,500 --> 00:23:30,180
+كيف؟ كيف؟ طب لو أنا جبت عينة stool، عينة stool، وحطيتها في
+
+306
+00:23:30,180 --> 00:23:35,460
+saline، saline، تمام؟ وسخنتها لـ80 درجة،
+
+307
+00:23:35,460 --> 00:23:41,880
+بتقتل كل البكتيريا... كل البكتيريا اللي ما بتكونش
+
+308
+00:23:41,880 --> 00:23:45,640
+endospore، يبقى مين بيطلع منها؟ الـspore
+
+309
+00:23:45,640 --> 00:23:49,980
+forming، هل بس الـBacillus anthracis اللي بتكون؟ لكن
+
+310
+00:23:49,980 --> 00:23:52,680
+على الأقل عندي صنفين Bacillus
+
+311
+00:23:55,710 --> 00:23:58,810
+و الـClostridium، الـClostridium أحسن حاجة فيها
+
+312
+00:23:58,810 --> 00:24:02,430
+هنا anaerobic، يبقى اللي هيكون باقي على الطبق بعد
+
+313
+00:24:02,430 --> 00:24:07,850
+ذلك فقط الباسيلوس، بس مش الباسيلوس anthracis طبعا، أي basillus
+
+314
+00:24:07,850 --> 00:24:11,770
+لكن على الأقل تخلص من أكبر قدر ممكن من... يبقى نعمل heat treatment، هذا الـenrichment تبعتنا، heat
+
+315
+00:24:11,770 --> 00:24:15,870
+treatment، في كمان طريقة ثانية غير
+
+316
+00:24:15,870 --> 00:24:23,210
+التسخين،
+
+317
+00:24:23,210 --> 00:24:23,670
+تسخين
+
+318
+00:24:27,210 --> 00:24:31,730
+الحالة اسمها alcohol treatment
+
+319
+00:24:31,730 --> 00:24:35,870
+نفس الكلام، equal amount، بس المرة دي بنحط على fifty
+
+320
+00:24:35,870 --> 00:24:41,750
+percent ethanol، وبنعمل mixing، ونتركهم لمدة نصف
+
+321
+00:24:41,750 --> 00:24:47,250
+ساعة، نصف ساعة، لما تركيز الكحول إيش؟ خمسين
+
+322
+00:24:47,250 --> 00:24:50,510
+في المئة، عارفين لو ارتفع لسبعين في المئة بيكون
+
+323
+00:24:50,510 --> 00:24:54,070
+تأثير أحسن، بس بنخاف لو رفعنا لسبعين في المئة نعمل
+
+324
+00:24:54,070 --> 00:24:57,290
+shock، نقتل فيه مين؟ نعمل shock، إحنا بدنا نعطي
+
+325
+00:24:57,290 --> 00:25:02,430
+concentration مؤذي للـbacillus، بحاجة أنها تاخد فرصة
+
+326
+00:25:02,430 --> 00:25:05,530
+وتكون عندها spore، بينما الأخريات ما عندهمش الفرصة
+
+327
+00:25:05,530 --> 00:25:08,190
+تكون عندها spore، وبالتالي بيموتوا، وبناخدها، بنزرعها، وبرده نفس الفكرة، بيضل فقط مين؟ الـspore
+
+328
+00:25:08,190 --> 00:25:11,650
+forming bacteria، نصف ساعة تقريبا...
+
+329
+00:25:11,650 --> 00:25:17,810
+نصف ساعة تقريبا...
+
+330
+00:25:17,810 --> 00:25:24,130
+(repeated "نصف ساعة تقريبا" many times)
+
+338
+00:25:47,540 --> 00:25:52,900
+أنت لو فكرت... لو أنت صرت مدرس في المعمل السنة
+
+339
+00:25:52,900 --> 00:25:56,980
+اللي جاية معانا في الجامعة، وبدك... توري
+
+340
+00:25:56,980 --> 00:26:01,900
+طلابك spore-forming bacteria، ودور في التراب... فيه
+
+341
+00:26:01,900 --> 00:26:04,000
+... فيه، ما عندكش spore-forming bacteria، وبدك تعزل
+
+342
+00:26:04,000 --> 00:26:06,300
+اللي هم spore-forming، بتروح على التربة اللي... وين
+
+343
+00:26:06,300 --> 00:26:10,240
+بتقعدوا؟ أمام المبنى؟ جيب علبة، وخد معلقة، وخد
+
+344
+00:26:10,240 --> 00:26:13,020
+شوية تربة، وروح على المختبر، سخنها ثمانين درجة
+
+345
+00:26:13,020 --> 00:26:16,720
+مئوية، تمام؟ وبعد... خليها لمدة خمس دقائق، وبعد ما
+
+346
+00:26:16,720 --> 00:26:19,800
+تبرد، خد منها loop، وزرعها في الطبق، اللي هيتطلع معاك هيتطلع
+
+347
+00:26:19,800 --> 00:26:23,180
+معاك spore-forming bacteria، مش ضروري Bacillus anthracis،
+
+348
+00:26:23,180 --> 00:26:27,890
+بس هيتطلع معاك Bacillus، هيتطلع معاك Bacillus، إذا بدنا... بدنا
+
+349
+00:26:27,890 --> 00:26:30,590
+...إحنا قلنا لكم إنه لما... لما نشرح لكم الـ
+
+350
+00:26:30,590 --> 00:26:34,760
+concept بتاع الـenrichment، بنشرح لكم إيه؟ عشان نزرع
+
+351
+00:26:34,760 --> 00:26:41,040
+فيكم فكر معين، وهو ما هي الصفة التي يمكن
+
+352
+00:26:41,040 --> 00:26:44,260
+استغلالها لفصل هذا الميكروب دون أن تؤثر على الميكروبات
+
+353
+00:26:44,260 --> 00:26:47,840
+الأخرى، زي ما قلنا الـVibrio cholerae، alkaline pH،
+
+354
+00:26:47,840 --> 00:26:50,940
+الـYersinia enterocolitica loves cold temperature،
+
+355
+00:26:50,940 --> 00:26:54,700
+صح؟ هذه البكتيريا can survive heat treatment،
+
+356
+00:26:54,700 --> 00:26:58,500
+can survive alcohol treatment، في عندنا يعني... خليني
+
+357
+00:26:58,500 --> 00:27:02,580
+أقول مجموعة من الصفات قد نستطيع... إيه اتعرفنا عليها
+
+358
+00:27:02,580 --> 00:27:05,580
+إن ننقذ البكتيريا تبعتنا الـ... الـ... الـ
+
+359
+00:27:05,580 --> 00:27:08,400
+Campylobacter عن طريق الـsmall size، فاكرين لما
+
+360
+00:27:08,400 --> 00:27:11,380
+عملناها filtration، عن طريق الـsmall size، إذا بدنا
+
+361
+00:27:11,380 --> 00:27:15,260
+دائما لو في يوم من الأيام اضطرينا، بدنا ننقذ الحالة
+
+362
+00:27:15,260 --> 00:27:20,770
+selectively، بدنا ندرس خصائصها بشكل جيد، swab
+
+363
+00:27:20,770 --> 00:27:24,290
+samples, sputum and blood from pulmonary anthrax,
+
+364
+00:27:24,670 --> 00:27:28,730
+gastric aspirate, feces and stool, and blood for
+
+365
+00:27:28,730 --> 00:27:29,450
+enteric anthrax
+
+366
+00:27:33,700 --> 00:27:37,700
+مظبوط، يبقى العينة بالإضافة إلى الـblood culture،
+
+367
+00:27:37,700 --> 00:27:42,820
+طبعا الـGram stain، ممكن نشوف إحنا من العينة وبنشوف
+
+368
+00:27:42,820 --> 00:27:45,740
+البكتيريا، tree-like appearance، وللمقارنة الـGram stain
+
+369
+00:27:45,740 --> 00:27:49,980
+ولو إنه بسبوخ، الـspore، لأنه الـspore هتبين كيف
+
+370
+00:27:49,980 --> 00:27:54,960
+هتبين
+
+371
+00:27:54,960 --> 00:28:00,040
+أنها شيء مش مسبوخ، فراغ، وبالتالي نقدر نشوفها بشكل
+
+372
+00:28:00,040 --> 00:28:00,300
+جيد
+
+373
+00:28:03,060 --> 00:28:07,240
+الـGiemsa stain، الـGiemsa stain، اسمه بيعطينا purple،
+
+374
+00:28:07,240 --> 00:28:10,660
+بس الـlie with red capsule، يعني بنشوف الـGram positive،
+
+375
+00:28:10,660 --> 00:28:13,520
+أو بنشوف البكتيريا بشكل purple، والكبسولة اللي
+
+376
+00:28:13,520 --> 00:28:16,360
+باعتها بشكل red، عن طريق الـGiemsa stain، ليش بنعمل
+
+377
+00:28:16,360 --> 00:28:19,540
+Giemsa stain؟ لأن أنا قلت لكم أن البكتيريا بتكون
+
+378
+00:28:19,540 --> 00:28:23,760
+متواجدة وين؟ في الدم، و بكميات كبيرة، ولو أخذنا
+
+379
+00:28:23,760 --> 00:28:27,080
+إحنا عينة الدم، وعملناها blood film، وكده... إيش
+
+380
+00:28:27,080 --> 00:28:30,120
+... بنصبغ الـblood film إحنا؟ Giemsa stain أو
+
+381
+00:28:30,120 --> 00:28:34,970
+Giemsa stain، Animal Inoculation، لو في عندنا في
+
+382
+00:28:34,970 --> 00:28:39,690
+المختبر facility للحيوانات للتجارب، ممكن ناخد اما
+
+383
+00:28:39,690 --> 00:28:45,590
+الـculture، أو ناخد العينة ونعملها injection في الـ
+
+384
+00:28:45,590 --> 00:28:50,210
+animal intraperitoneally، في منطقة البطن، by a
+
+385
+00:28:50,210 --> 00:28:53,830
+suspension of the test organism، suspected Bacillus
+
+386
+00:28:53,830 --> 00:28:58,210
+anthracis culture، اللي هي العينة المشتبه أن تكون
+
+387
+00:28:58,210 --> 00:29:03,690
+Bacillus anthracis، the animal dies within 48 to 96
+
+388
+00:29:03,690 --> 00:29:09,170
+hours، يعني موت سريع للحيوان خلال 48 إلى 96 ساعة، due
+
+389
+00:29:09,170 --> 00:29:15,210
+to respiratory failure، طبعا بعد ما يموت الحيوان أو
+
+390
+00:29:15,210 --> 00:29:19,390
+خلال حياته لو أخذنا منه عينة دم بنلاقي large
+
+391
+00:29:19,390 --> 00:29:23,110
+number of bacterial cells في الـblood، لأنه بتعرفوا أن الـ
+
+392
+00:29:23,110 --> 00:29:26,350
+bacteria، الـultimate site تبعها هو الدم
+
+393
+00:29:28,990 --> 00:29:33,170
+هذه الصورة، يمكن من أوائل الصور اللي انتشرت يعني
+
+394
+00:29:33,170 --> 00:29:36,470
+بشكل واسع، بتبين إيش؟ طول السلسلة، لأن البكتيريا هنا
+
+395
+00:29:36,470 --> 00:29:40,970
+نامية في broth، نامية في broth، هنا في عينة حقيقية،
+
+396
+00:29:40,970 --> 00:29:45,670
+هذا Bacillus صح؟ وهذا طالع بشكل بصيلات، ممكن تكون
+
+397
+00:29:45,670 --> 00:29:50,490
+دبلة واحدة، اثنتان، لكن في الآخر هي large
+
+398
+00:29:50,490 --> 00:29:54,210
+بصيلات، فاكرين الصورة اللي إحنا المحاضرة الماضية
+
+399
+00:29:54,210 --> 00:29:58,130
+شرحناها؟ كانت الـBacillus زي هيك، هي... هي... هي الـ
+
+400
+00:29:58,130 --> 00:30:02,110
+...الـ... النواة، والدبلوكوكاي، مليون واحدة جوا
+
+401
+00:30:02,110 --> 00:30:06,850
+صح؟ لكن تطلع هنا كده، إيش طولها؟ طول اثنتين هذول
+
+402
+00:30:06,850 --> 00:30:11,130
+يمكن تقريبا اثنتين، قريبة من إيش؟ من الـ... من الـ...
+
+403
+00:30:11,130 --> 00:30:14,970
+الـ... الـ... الـBacillus، حجمها كبير، حجمها كبير
+
+404
+00:30:18,940 --> 00:30:22,000
+هذه الصورة اللي أمامكم بتبين لنا اللون الأخضر اللي
+
+405
+00:30:22,000 --> 00:30:25,260
+شايفينه هنا، اللي هو الأصفر، موجود، هذه اللي هي اللون
+
+406
+00:30:25,260 --> 00:30:28,540
+الأخضر، لـspores، أو لـfree spores، من spore
+
+407
+00:30:28,540 --> 00
+
+445
+00:33:09,200 --> 00:33:13,120
+Voskosproskauer test positive sensitivity to
+
+446
+00:33:13,120 --> 00:33:17,440
+penicillin it is sensitive. هذا الرقم 17 يعني يمكن
+
+447
+00:33:17,440 --> 00:33:20,780
+هذا الفحص هو الأفضل على الإطلاق ويعتبر
+
+448
+00:33:20,780 --> 00:33:25,550
+confirmatory test. فاكرين مصطلح phage typing؟ لمن
+
+449
+00:33:25,550 --> 00:33:28,710
+استخدمناها؟
+
+450
+00:33:28,710 --> 00:33:33,630
+لستافيلوكوكاس يالا فيه افتراض يعني تنتين
+
+451
+00:33:33,630 --> 00:33:37,510
+تلاتة ممكن لستافيلوكوكاس استخدمنا phage typing
+
+452
+00:33:37,510 --> 00:33:42,010
+وقلنا أنه لكل سلالة لكل strain فيه phage type معين
+
+453
+00:33:42,010 --> 00:33:47,550
+هنا فيه phage اسمه gamma phage هذا خصيصا لحضرة مين
+
+454
+00:33:47,550 --> 00:33:51,130
+الـBacillus anthracis. فلو أنا كان عندي causative agent
+
+455
+00:33:51,130 --> 00:33:52,550
+وكان عندي suspected
+
+456
+00:33:56,140 --> 00:33:59,980
+وكلمة suspected مش أي واحدة suspected، ليش لازم
+
+457
+00:33:59,980 --> 00:34:03,560
+يكونوا أصفاتها suspected؟ واحد، gram positive بس
+
+458
+00:34:03,560 --> 00:34:10,820
+الله، اتنين، spore forming، تلاتة، non-hemolytic،
+
+459
+00:34:10,820 --> 00:34:14,100
+أربع، non-motile، إيه، تخفروا الأربع صفات هدول
+
+460
+00:34:14,100 --> 00:34:19,410
+عندي، بعملها مين؟ Gamma phage وكيف أعمل الفحص نفس
+
+461
+00:34:19,410 --> 00:34:23,370
+اللي عملته لـ Staphylococcus؟ بنجيب يا شباب swab
+
+462
+00:34:23,370 --> 00:34:29,590
+بناخد البكتيريا بنمسحها مسح تماما تماما، وهذا الفحص
+
+463
+00:34:29,590 --> 00:34:31,670
+مش ضروري على blood agar، ليش؟ لأن البكتيريا بتنمو على
+
+464
+00:34:31,670 --> 00:34:36,210
+nutrient agar. بتنمو على nutrient agar. حطينا الـ
+
+465
+00:34:36,210 --> 00:34:42,030
+gamma phage disk على المنطقة هذه. إذا لجينا zone of
+
+466
+00:34:42,030 --> 00:34:47,330
+clearance، zone of clearance as a result of phage
+
+467
+00:34:55,860 --> 00:34:59,840
+فالـ... الـ... البكتيريا بتكون sensitive للفاج وما
+
+468
+00:34:59,840 --> 00:35:02,800
+أن الفاج أنا عارفه gamma phage، يبقى البكتيريا هي
+
+469
+00:35:02,800 --> 00:35:06,020
+Bacillus anthracis. بيبقى Bacillus anthracis. يبقى
+
+470
+00:35:06,020 --> 00:35:11,700
+الـ gamma phage هو الـ confirmatory test الرائع والمؤكد
+
+471
+00:35:11,700 --> 00:35:14,540
+لهوية اللي هو Bacillus anthracis.
+
+472
+00:35:17,090 --> 00:35:20,610
+هيها تلعبها دي شوفوا الـ black اللي صارت هنا يا شباب
+
+473
+00:35:20,610 --> 00:35:26,170
+على الصورة اللي قدامكوا. هذه الصورة بتوضح لي أنه فيه
+
+474
+00:35:26,170 --> 00:35:30,310
+صار lysis، وين اختفت البكتيريا؟ وين راحت البكتيريا؟
+
+475
+00:35:30,310 --> 00:35:33,410
+اتحللت من قبل مين؟ من قبل ال phage اللي
+
+476
+00:35:33,410 --> 00:35:37,510
+وضعته في هذه المنطقة. هذا واضح، أنه نحطه بشكل قطرة، مش
+
+477
+00:35:37,510 --> 00:35:43,590
+بشكل disk، يعني بشكل drop. شوفوا
+
+478
+00:35:43,590 --> 00:35:48,560
+الـ size تبع البكتيريا، size، الحجم تبعها على blood
+
+479
+00:35:48,560 --> 00:35:52,520
+agar، نمو مخيف، ودلها حجم المستعمرات ضخم، يعني الـ
+
+480
+00:35:52,520 --> 00:35:56,140
+bacteria can be cultivated easily، ما بدهاش أي
+
+481
+00:35:56,140 --> 00:36:00,400
+صعوبات، لذلك لما بتكلموا العالم الغربي عن الحرب
+
+482
+00:36:00,400 --> 00:36:04,460
+البيولوجية وعن الإرهاب البيولوجي، طبعا المصطلح هو
+
+483
+00:36:04,460 --> 00:36:10,980
+حرب بيولوجية، تم توظيف الـ Bacillus anthracis فيها،
+
+484
+00:36:10,980 --> 00:36:15,860
+اللي هي عملية المراسلة بالـ anthrax، اللي هي إرسال
+
+485
+00:36:15,860 --> 00:36:20,510
+رسائل ملغمة بالـ anthrax. موطنها زؤام يعني لما نتكلم عن
+
+486
+00:36:20,510 --> 00:36:24,410
+جمرة خبيثة، سميت العرب لما بيسموا الأشياء بيسموها
+
+487
+00:36:24,410 --> 00:36:31,410
+بدقة، سميت جمرة لأنه أنا قلت لكوا 98% من المرض بشكل
+
+488
+00:36:31,410 --> 00:36:37,990
+طبيعي قبل الحروب البيولوجية هو skin disease، العرب سمته
+
+489
+00:36:37,990 --> 00:36:43,870
+جمرة لأنه بيكون في هذه القرحة بيكون في المنتصف
+
+490
+00:36:43,870 --> 00:36:51,630
+أسود، والحواف حمراء، أحمر من إيش أحمر؟ أحمر من الـ
+
+491
+00:36:51,630 --> 00:36:55,570
+flesh، اللحم، الـ... الـ... الـ... نسيج تبعنا والـ
+
+492
+00:36:55,570 --> 00:36:58,750
+المنتصف فيه necrosis، والـ necrosis بكل لونه أسود،
+
+493
+00:36:58,750 --> 00:37:02,650
+تمام؟ وإذا أنت نظرت للجمرة، هتلاقي الجمرة سوداء
+
+494
+00:37:02,650 --> 00:37:08,060
+في المنتصف وحمراء على الطرف، المتوكسة، تمام؟ وسميت
+
+495
+00:37:08,060 --> 00:37:13,160
+خبيثة لأنه إذا ظهرت عند الإنسان تقتله بعد يومين،
+
+496
+00:37:13,160 --> 00:37:15,740
+فتقولوا يسموها الجمرة الخبيثة، إذا الـ disease
+
+497
+00:37:15,740 --> 00:37:21,080
+قاتل، وإذا المرض قاتل، واستخدامه ضد المدنيين أو ضد
+
+498
+00:37:21,080 --> 00:37:25,820
+الإنسان بشكل عام، يتبع جريمة كبرى. و one tube... one
+
+499
+00:37:25,820 --> 00:37:30,220
+tube of Bacillus anthracis لشخص يمتلك التكنولوجيا
+
+500
+00:37:30,220 --> 00:37:33,520
+قد ينتج مئات الآلاف من الأطنان خلال فترة وجيزة
+
+501
+00:37:33,520 --> 00:37:37,120
+الـ table اللي قدامكوا هنا بيظهر بعض الفروقات الأساسية
+
+502
+00:37:37,120 --> 00:37:39,280
+ما بين الـ Bacillus anthracis وما بين الـ other
+
+503
+00:37:39,280 --> 00:37:43,480
+Bacilli. ياريت تركزوا فيهم كويس، لأنه نحفظ... بس
+
+504
+00:37:43,480 --> 00:37:45,940
+نحفظ الـ characteristics ونحفظ أن الـ Bacillus
+
+505
+00:37:45,940 --> 00:37:48,940
+anthracis كلها هي negative، بينما الـ other
+
+506
+00:37:48,940 --> 00:37:51,740
+Bacillus، اللي من ضمنها Bacillus cereus بتكون
+
+507
+00:37:51,740 --> 00:37:56,300
+positive. Growth on PEA، والـ PEA هو عبارة عن phenylethyl
+
+508
+00:37:56,300 --> 00:38:00,620
+alcohol زي الـ brain heart infusion agar، طبق
+
+509
+00:38:00,860 --> 00:38:03,560
+من الـ brain-heart infusion agar مضيف له phenylethyl
+
+510
+00:38:03,560 --> 00:38:06,360
+alcohol. البكتيريا دي ما بتقدر تنمو عليه
+
+511
+00:38:06,360 --> 00:38:09,960
+بينما الـ Bacillus cereus بتقدر تنمو عليه. سالسين
+
+512
+00:38:09,960 --> 00:38:13,600
+fermentation أحد الكربوهيدرات negative، والباقي
+
+513
+00:38:13,600 --> 00:38:18,040
+positive. Motility negative، والـ others positive.
+
+514
+00:38:18,040 --> 00:38:21,840
+Hemolysis on sheep blood agar negative، وهذا كده
+
+515
+00:38:21,840 --> 00:38:25,200
+positive. إذا في عندي مجموعة من الصفات الأربعة دول
+
+516
+00:38:25,200 --> 00:38:32,410
+اللي اتشكّلت وما عنديش الـ... الـ gamma
+
+517
+00:38:32,410 --> 00:38:35,630
+phage، بقدر أعمل presumptive diagnosis، بقدر أعمل
+
+518
+00:38:35,630 --> 00:38:39,190
+presumptive diagnosis أنه البكتيريا اللي أمامنا هي
+
+519
+00:38:39,190 --> 00:38:44,350
+Bacillus anthracis. أنا قلت تلت أشكال من المرض
+
+520
+00:38:44,350 --> 00:38:48,510
+حكيناهم: Cutaneous، وenteric اللي هو الـ intestinal، و
+
+521
+00:38:48,510 --> 00:38:52,050
+الـ intestinal غالبا بيكون ناتج عن أو ناجم عن، ناجم
+
+522
+00:38:52,050 --> 00:38:59,390
+عن تناول طعام... تناول طعام غير ناضج، تمام؟ وهذا
+
+523
+00:38:59,390 --> 00:39:03,390
+الطعام ملوث بالـ spores، يعني لحم لحيوانات مصابة
+
+524
+00:39:03,390 --> 00:39:09,090
+بالـ anthrax، وهو مرض نادر لكن fatal، fatal يعني
+
+525
+00:39:09,090 --> 00:39:14,300
+قاتل، هم كلهم fatal، كلهم fatal. الـ cutaneous anthrax
+
+526
+00:39:14,300 --> 00:39:19,220
+لها تجادش، النسبة الطبيعية 98% من الحالات هي
+
+527
+00:39:19,220 --> 00:39:23,200
+cutaneous anthrax وبتنتج عن احتكاك الجروح تبع
+
+528
+00:39:23,200 --> 00:39:28,180
+الإنسان بحيوانات مصابة أو مصدر، طبعا غالبا الجمرة
+
+529
+00:39:28,180 --> 00:39:34,090
+اللي ذكرتها دي painless، يعني غير مصاحبة بألم، وهنا
+
+530
+00:39:34,090 --> 00:39:39,070
+يظهر الخَبَث مرة أخرى غير مؤلمة وتقتل صاحبها بعد عدة
+
+531
+00:39:39,070 --> 00:39:41,930
+أيام. الأخير اللي هو الـ pulmonary anthrax اللي قلنا
+
+532
+00:39:41,930 --> 00:39:44,630
+عنه wool sorter's disease.
+
+533
+00:39:49,680 --> 00:39:55,580
+هذه مثلا مثال على جمرة، تمام؟ البثور، طبعا المنتصف
+
+534
+00:39:55,580 --> 00:39:59,060
+كان مرة أسود والطرف اللي حوالها بيكون إيه؟ pink أو
+
+535
+00:39:59,060 --> 00:40:08,480
+red، اللي هو اللون اللي في الـ... هذه.
+
+536
+00:40:08,480 --> 00:40:12,020
+بيورينا صورة على الـ bacilli اللي موجودة في الـ lung
+
+537
+00:40:12,020 --> 00:40:15,220
+tissue. بتكلم عن اللي هو الـ pulmonary anthrax.
+
+538
+00:40:19,720 --> 00:40:24,200
+لأ، إذا بتذكروا التوكسين تبع الـ anthrax، إذا... إذا
+
+539
+00:40:24,200 --> 00:40:27,560
+فاكرين من الدروس الأولانية وأنا كل مرة بقول إنه
+
+540
+00:40:27,560 --> 00:40:31,140
+عدم وجود امتحان قريب هو اللي بيخلينا نسأل هذا السؤال
+
+541
+00:40:31,140 --> 00:40:35,280
+هذه. في عندي أنا كان التوكسين مكون من ثلاث... من
+
+542
+00:40:35,280 --> 00:40:39,240
+ثلاث قطع، إذا فاكرين الـ protective antigen والـ
+
+543
+00:40:39,240 --> 00:40:43,520
+edema factor، صح؟ والـ lethal
+
+544
+00:40:47,820 --> 00:40:51,860
+lethal factor. هذا سميناه احنا الـ protective
+
+545
+00:40:51,860 --> 00:40:55,600
+antigen، وقلنا عنه، اعتبره الـ P-fragment اللي تم الـ
+
+546
+00:40:55,600 --> 00:40:59,880
+binding. فلو ارتبط الـ lethal factor بالـ P، من كلمة
+
+547
+00:40:59,880 --> 00:41:02,860
+اسمه lethal. أو الـ edema factor دخل هام
+
+548
+00:41:02,860 --> 00:41:06,380
+الـ edema. الميكانيزم ناتجة عن exotoxin مش عن
+
+549
+00:41:06,380 --> 00:41:07,320
+endotoxin.
+
+550
+00:41:11,290 --> 00:41:14,570
+هذا بيورينا برضه إنّا كنا اللي هو infected meat أو
+
+551
+00:41:14,570 --> 00:41:18,750
+meat، يعني كُلْت meat من حيوان، والـ... والـ... الـ
+
+552
+00:41:18,750 --> 00:41:21,630
+...الـ... الـ meat لم تتعرض لحرارة كافية لقتل
+
+553
+00:41:21,630 --> 00:41:24,430
+الميكروبات، قد يحدث لنا gastrointestinal anthrax.
+
+554
+00:41:24,430 --> 00:41:33,210
+البكتيريا تحتوي على... وأول بكتيريا بندرسها تحتوي
+
+555
+00:41:33,210 --> 00:41:36,810
+على كبسولة. أول بكتيريا درسناها تحتوي على كبسولة ولا
+
+556
+00:41:36,810 --> 00:41:41,450
+درسنا غيرها. طب هذه أول بكتيريا بتقيلها كبسولة من
+
+557
+00:41:41,450 --> 00:41:45,190
+نوع خاص، من حقّي أقول هيك، من حقّي أقول هيك، أما درسنا
+
+558
+00:41:45,190 --> 00:41:48,750
+قبل هيك احنا بكتيريا بكبسولة، إيش النوع الخاص؟ إن
+
+559
+00:41:48,750 --> 00:41:51,910
+الكبسولة تبعها مش مكونة من polysaccharide، مكونة
+
+560
+00:41:51,910 --> 00:41:57,510
+من polypeptide. هذه أول بكتيريا اللي بنتكلم عنها
+
+561
+00:41:57,510 --> 00:42:04,490
+إنها بتكون polypeptide capsule. عندها
+
+562
+00:42:04,490 --> 00:42:07,610
+polysaccharide somatic antigen وعندها complex
+
+563
+00:42:07,610 --> 00:42:10,490
+protein-toxin اللي حكينا عنه، اللي هو اللي مكون من
+
+564
+00:42:10,490 --> 00:42:15,670
+PA. وفي الـ treatment بنتكلم عن penicillin is a drug
+
+565
+00:42:15,670 --> 00:42:20,530
+of choice. بس خدوا بالكم في العصر الحديث اللي احنا
+
+566
+00:42:20,530 --> 00:42:25,570
+فيه الآن هذا استبدل... استبدل كل هذه الـ drugs
+
+567
+00:42:25,570 --> 00:42:28,970
+بـ ciprofloxacin.
+
+568
+00:42:30,310 --> 00:42:32,690
+طبعا مثلا هو step دي اللي احنا هنضيفها، إضافة
+
+569
+00:42:32,690 --> 00:42:36,890
+ciprofloxacin. كالآن modern drug used for this
+
+570
+00:42:36,890 --> 00:42:44,210
+organism. لأ، في الامتحان هي الـ drug of choice، بس
+
+571
+00:42:44,210 --> 00:42:46,850
+يكون اللي ما بيعرف انه الآن كبديل بيستخدموا
+
+572
+00:42:46,850 --> 00:42:50,330
+معانا ciprofloxacin عشان ما يصيرش بس confusion
+
+573
+00:42:50,330 --> 00:42:56,110
+يِطلع لي.
+
+574
+00:42:56,110 --> 00:42:59,170
+على اللوحة دي هختم فيها المحاضرة اللي هي، إن شاء الله
+
+575
+00:43:01,110 --> 00:43:03,810
+هي عندي الـ protective antigen اللي حكينا عنه، وقلنا
+
+576
+00:43:03,810 --> 00:43:08,750
+فيه أنه إمكانية يجي لمين؟ لـ two mechanisms أنه
+
+577
+00:43:08,750 --> 00:43:11,350
+يرتبط بالـ edema factor أو يرتبط لمين؟ بالـ lethal
+
+578
+00:43:11,350 --> 00:43:16,430
+factor. طبعا بتوقع أنه مدام التوكسين منتج وفيه اتنين
+
+579
+00:43:16,430 --> 00:43:20,570
+يبقى مرة هيدخل معاه edema factor ومرة يدخل معاه
+
+580
+00:43:20,570 --> 00:43:24,690
+lethal factor، وفي الحالتين هيقدي الـ effect تبعه.
+
+581
+00:43:24,690 --> 00:43:27,570
+وأعتقد كلكوا بتعرفوا adenylate cyclase enzyme
+
+582
+00:43:27,570 --> 00:43:32,510
+cycle. cAMP هيعمل لنا اللي هو الـ edema factor. هذه
+
+583
+00:43:32,510 --> 00:43:36,890
+الصورة بتوضح لكوا أنه
+
+584
+00:43:36,890 --> 00:43:41,210
+لما بتتعاملوا مع anthrax attack، شوفوا الـ safety اللي
+
+585
+00:43:41,210 --> 00:43:46,110
+احنا، الـ level اللي احنا بنتابعه هو الـ maximum
+
+586
+00:43:46,110 --> 00:43:48,870
+level of biological safety. الـ maximum level هو
+
+587
+00:43:48,870 --> 00:43:52,970
+الأعلى، المستوى اللي بنمارسه في الحماية والوقاية
+
+588
+00:43:52,970 --> 00:43:54,670
+من اللي هو الـ anthrax.
+
+589
+00:43:57,780 --> 00:44:00,340
+المرة اللي جاية إن شاء الله بنكمل وبنتكلم عن
+
+590
+00:44:00,340 --> 00:44:04,400
+الـ Bacillus cereus وبنبدأ بالـ... بنبدأ بالـ... الـ...
+
+591
+00:44:04,400 --> 00:44:05,600
+الـ... الـ Clostridium إن شاء الله.
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/HewR0byEM3M_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/HewR0byEM3M_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..cc36e2a35e4d0e5d2a81a733331b60e9b282ed5e
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/HewR0byEM3M_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 5049, "start": 20.65, "end": 50.49, "text": "بسم الله الرحمن الرحيم عنوان جديد، موضوع جديد، وهو المكمل للأجزاء الأربعة، يعني هو الجزء الرابع من أربعة أجزاء في ال diagnostic microbiology الجزء الأول كان ال gram-bacilli الجزء التاني كان gram-bostev-cocci ثالث gram-bostev-cocci الجزء الرابع اليوم اللي هو gram-bostev-bacilli gram-bostev-bacilli موضوع ان شاء الله يكون سهل ومش معقد وعشان نسهل أكتر قسمنا البكتير اللي فيه إلى قسمين", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 18871, 2407, 7649, 10874, 16254, 3215, 12399, 3714, 2407, 11242, 45367, 10874, 16254, 3215, 12399, 37037, 2407, 9673, 24793, 1211, 24976, 10721, 7435, 11622, 16606, 16247, 25513, 27884, 12399, 37495, 22653, 31439, 25724, 11622, 38207, 34892, 16758, 3615, 9154, 5551, 25513, 27884, 5551, 7435, 11622, 16606, 8978, 2423, 27897, 33234, 1793, 25724, 11622, 38207, 16247, 12610, 25961, 2423, 21353, 12, 65, 326, 31922, 25724, 11622, 38207, 16712, 7649, 1829, 25961, 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0.939697265625}, {"start": 2617.17, "end": 2617.79, "word": " بتتعامل", "probability": 0.95859375}, {"start": 2617.79, "end": 2618.13, "word": " مع", "probability": 0.8994140625}, {"start": 2618.13, "end": 2618.79, "word": " anthrax", "probability": 0.798583984375}, {"start": 2618.79, "end": 2619.35, "word": " attack", "probability": 0.97607421875}, {"start": 2619.35, "end": 2620.13, "word": " شوف", "probability": 0.792724609375}, {"start": 2620.13, "end": 2620.29, "word": " ال", "probability": 0.93212890625}, {"start": 2620.29, "end": 2620.79, "word": " safety", "probability": 0.7841796875}, {"start": 2620.79, "end": 2621.21, "word": " اللي", "probability": 0.740234375}, {"start": 2621.21, "end": 2621.59, "word": " احنا", "probability": 0.9290364583333334}, {"start": 2621.59, "end": 2622.19, "word": " ال", "probability": 0.412353515625}, {"start": 2622.19, "end": 2622.43, "word": " level", "probability": 0.9697265625}, {"start": 2622.43, "end": 2622.59, "word": " اللي", "probability": 0.978271484375}, {"start": 2622.59, "end": 2623.33, "word": " احنا", "probability": 0.9490559895833334}, {"start": 2623.33, "end": 2624.93, "word": " بنتابعه", "probability": 0.84892578125}, {"start": 2624.93, "end": 2625.39, "word": " هو", "probability": 0.96728515625}, {"start": 2625.39, "end": 2625.67, "word": " ال", "probability": 0.861328125}, {"start": 2625.67, "end": 2626.11, "word": " maximum", "probability": 0.97705078125}, {"start": 2626.11, "end": 2626.77, "word": " level", "probability": 0.98388671875}, {"start": 2626.77, "end": 2627.01, "word": " of", "probability": 0.962890625}, {"start": 2627.01, "end": 2627.53, "word": " biological", "probability": 0.98583984375}, {"start": 2627.53, "end": 2628.09, "word": " safety", "probability": 0.96728515625}, {"start": 2628.09, "end": 2628.21, "word": " ال", "probability": 0.364013671875}, {"start": 2628.21, "end": 2628.49, "word": " maximum", "probability": 0.986328125}, {"start": 2628.49, "end": 2628.73, "word": " level", "probability": 0.98779296875}, {"start": 2628.73, "end": 2628.87, "word": " هو", "probability": 0.96630859375}, {"start": 2628.87, "end": 2629.23, "word": " الأعلى", "probability": 0.8411458333333334}, {"start": 2629.23, "end": 2629.87, "word": " المستوى", "probability": 0.95703125}, {"start": 2629.87, "end": 2630.45, "word": " اللي", "probability": 0.929443359375}, {"start": 2630.45, "end": 2631.03, "word": " بنمارسه", "probability": 0.80517578125}, {"start": 2631.03, "end": 2631.27, "word": " في", "probability": 0.9794921875}, {"start": 2631.27, "end": 2632.29, "word": " الحماية", "probability": 0.97607421875}, {"start": 2632.29, "end": 2632.41, "word": " و", "probability": 0.37939453125}, {"start": 2632.41, "end": 2632.97, "word": " الوقاية", "probability": 0.886474609375}, {"start": 2632.97, "end": 2633.31, "word": " من", "probability": 0.9765625}, {"start": 2633.31, "end": 2633.55, "word": " اللي", "probability": 0.986328125}, {"start": 2633.55, "end": 2633.79, "word": " هو", "probability": 0.984375}, {"start": 2633.79, "end": 2634.17, "word": " ال", "probability": 0.9072265625}, {"start": 2634.17, "end": 2634.67, "word": " anthrax", "probability": 0.9440104166666666}], "temperature": 1.0}, {"id": 110, "seek": 264560, "start": 2637.78, "end": 2645.6, "text": "المرة اللي جاي ان شاء الله بنكمل و بنتكلم عن البصيلة serious و بنبدأ بال .. بنبدأ بال .. ال .. ال .. ال closism ان شاء الله", "tokens": [45340, 25720, 13672, 1829, 10874, 47302, 16472, 13412, 16606, 21984, 44945, 24793, 1211, 4032, 44945, 2655, 4117, 19528, 18871, 29739, 9381, 26895, 3660, 3156, 4032, 44945, 44510, 10721, 20666, 4386, 44945, 44510, 10721, 20666, 4386, 2423, 4386, 2423, 4386, 2423, 2611, 1434, 16472, 13412, 16606, 21984], "avg_logprob": -0.32795877405937685, "compression_ratio": 1.6416666666666666, "no_speech_prob": 0.0, "words": [{"start": 2637.78, "end": 2638.26, "word": "المرة", "probability": 0.905029296875}, {"start": 2638.26, "end": 2638.38, "word": " اللي", "probability": 0.458740234375}, {"start": 2638.38, "end": 2638.48, "word": " جاي", "probability": 0.84228515625}, {"start": 2638.48, "end": 2638.56, "word": " ان", "probability": 0.763671875}, {"start": 2638.56, "end": 2638.74, "word": " شاء", "probability": 0.962646484375}, {"start": 2638.74, "end": 2638.8, "word": " الله", "probability": 0.96435546875}, {"start": 2638.8, "end": 2639.5, "word": " بنكمل", "probability": 0.96728515625}, {"start": 2639.5, "end": 2639.7, "word": " و", "probability": 0.86572265625}, {"start": 2639.7, "end": 2640.16, "word": " بنتكلم", "probability": 0.85504150390625}, {"start": 2640.16, "end": 2640.34, "word": " عن", "probability": 0.9794921875}, {"start": 2640.34, "end": 2640.86, "word": " البصيلة", "probability": 0.5904541015625}, {"start": 2640.86, "end": 2641.62, "word": " serious", "probability": 0.779296875}, {"start": 2641.62, "end": 2641.96, "word": " و", "probability": 0.8525390625}, {"start": 2641.96, "end": 2642.62, "word": " بنبدأ", "probability": 0.78076171875}, {"start": 2642.62, "end": 2642.82, "word": " بال", "probability": 0.462158203125}, {"start": 2642.82, "end": 2643.18, "word": " ..", "probability": 0.84033203125}, {"start": 2643.18, "end": 2643.82, "word": " بنبدأ", "probability": 0.90087890625}, {"start": 2643.82, "end": 2644.16, "word": " بال", "probability": 0.830078125}, {"start": 2644.16, "end": 2644.16, "word": " ..", "probability": 0.72119140625}, {"start": 2644.16, "end": 2644.4, "word": " ال", "probability": 0.810546875}, {"start": 2644.4, "end": 2644.4, "word": " ..", "probability": 0.7041015625}, {"start": 2644.4, "end": 2644.74, "word": " ال", "probability": 0.95263671875}, {"start": 2644.74, "end": 2644.84, "word": " ..", "probability": 0.3603515625}, {"start": 2644.84, "end": 2644.84, "word": " ال", "probability": 0.70458984375}, {"start": 2644.84, "end": 2645.14, "word": " closism", "probability": 0.194671630859375}, {"start": 2645.14, "end": 2645.3, "word": " ان", "probability": 0.74072265625}, {"start": 2645.3, "end": 2645.48, "word": " شاء", "probability": 0.992431640625}, {"start": 2645.48, "end": 2645.6, "word": " الله", "probability": 0.93701171875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2646.37825, "duration_after_vad": 2482.1643749999944}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/HewR0byEM3M_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/HewR0byEM3M_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..a581f6a15e743d24d0375fb2a3714271357f8db7
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/HewR0byEM3M_raw.srt
@@ -0,0 +1,2376 @@
+1
+00:00:20,650 --> 00:00:25,210
+بسم الله الرحمن الرحيم عنوان جديد، موضوع جديد، وهو
+
+2
+00:00:25,210 --> 00:00:29,150
+المكمل للأجزاء الأربعة، يعني هو الجزء الرابع من
+
+3
+00:00:29,150 --> 00:00:32,150
+أربعة أجزاء في ال diagnostic microbiology الجزء
+
+4
+00:00:32,150 --> 00:00:35,090
+الأول كان ال gram-bacilli الجزء التاني كان gram
+
+5
+00:00:35,090 --> 00:00:39,050
+-bostev-cocci ثالث gram-bostev-cocci الجزء الرابع
+
+6
+00:00:39,050 --> 00:00:42,290
+اليوم اللي هو gram-bostev-bacilli gram-bostev
+
+7
+00:00:42,290 --> 00:00:46,890
+-bacilli موضوع ان شاء الله يكون سهل ومش معقد وعشان
+
+8
+00:00:46,890 --> 00:00:51,260
+نسهل أكتر قسمنا البكتير اللي فيه إلى قسمينقسم
+
+9
+00:00:51,260 --> 00:00:55,800
+sport forming وقسم non sport forming هنتناول كل
+
+10
+00:00:55,800 --> 00:01:00,450
+موضوع منهم على واحدةلا اقصد بسهل انهم مش مهمين هو
+
+11
+00:01:00,450 --> 00:01:05,590
+من اهم انواع الميكروبات والهم اهمية خاصة لانهم على
+
+12
+00:01:05,590 --> 00:01:09,370
+سبيل المثال ال sport former لما نسمع باسم Bacillus
+
+13
+00:01:09,370 --> 00:01:13,450
+anthracis المسبب لمرض ال anthrax او الجمرة الخبيثة
+
+14
+00:01:13,450 --> 00:01:17,790
+تلك البكتيريا المستخدمة في الحرب البيولوجية تلك
+
+15
+00:01:17,790 --> 00:01:21,190
+البكتيريا اللتي استخدمت كدريعة لشان الحرب على
+
+16
+00:01:21,190 --> 00:01:27,160
+العراق من قبل الأمريكانتلك البكتيريا اللتي وضعت في
+
+17
+00:01:27,160 --> 00:01:31,640
+مجلات و بريد و أرسلت لبعض الشخصيات المهمة عندما
+
+18
+00:01:31,640 --> 00:01:36,100
+يقوم بفتحها يستنشق بودرة موجودة في ال .. وبالتالي
+
+19
+00:01:36,100 --> 00:01:41,120
+قد يقتل الإنسان اللي بيستنشقها فبكتيريا لها سيط
+
+20
+00:01:41,120 --> 00:01:45,500
+واسع على الرغم من انت ..يعني إحداثها للمرض بشكل
+
+21
+00:01:45,500 --> 00:01:51,000
+natural عدد قليل من الحالات لكن متوقع أن تستخدم في
+
+22
+00:01:51,000 --> 00:01:55,460
+الإرهاب البيولوجي أو الحرب البيولوجية كما يسميها
+
+23
+00:01:55,460 --> 00:02:00,820
+البعضالدياجرام اللى أمامنا بيقسم الـ ground
+
+24
+00:02:00,820 --> 00:02:03,680
+positive بس الـ lie إلى sport negative و sport
+
+25
+00:02:03,680 --> 00:02:06,660
+positive لما اتكلم على ال sport positive فهي عندي
+
+26
+00:02:06,660 --> 00:02:10,020
+ال aerobic بكتيريا اللى هى البسلس و ال anaerobic
+
+27
+00:02:10,020 --> 00:02:13,360
+بكتيريا اللى هى ال cluster دي اذا لما انا بدأ ابدأ
+
+28
+00:02:13,360 --> 00:02:17,400
+بموضوع البسلس فانا بكون عرفت ان البكتيريا aerobic
+
+29
+00:02:17,400 --> 00:02:21,150
+و sport farming ال ground positive بس ال lieعلى
+
+30
+00:02:21,150 --> 00:02:25,130
+الجهة المقابلة ال sport negative بكتيريا بنقسمها
+
+31
+00:02:25,130 --> 00:02:29,970
+إلى قسمين بفحص الكتاليز الكتاليز ال negative بعدها
+
+32
+00:02:29,970 --> 00:02:33,370
+بنعمل H2S إذا كانت H2S negative فهي lactobacillus
+
+33
+00:02:33,370 --> 00:02:37,830
+إذا كانت H2S positive فهي ercipilothrixrhizopathia
+
+34
+00:02:43,650 --> 00:02:46,410
+على الجهة المقابلة في اندي كتاليز positive
+
+35
+00:02:46,410 --> 00:02:50,350
+الكتاليز positive بنميزه مع بعض بتلت فحوصات أو تلت
+
+36
+00:02:50,350 --> 00:02:54,390
+صفات ال Nitrate والساليسين وال Hemolysis مهم جدا
+
+37
+00:02:54,390 --> 00:02:57,970
+كلمة Hemolysis هنا لإننا في اندي بكتيريا ضلصناها
+
+38
+00:02:57,970 --> 00:03:02,570
+قبل هيك أو مرة ذكرها معانا لما اتكلمنا عن group A
+
+39
+00:03:04,570 --> 00:03:07,610
+Striptococci مين يقولوا بإيه Striptococci؟
+
+40
+00:03:07,610 --> 00:03:10,950
+Striptococcus biogenes قولنا لكوا بتبين نقطة و
+
+41
+00:03:10,950 --> 00:03:15,370
+حواليها zone of inhibition عفوا zone of hemolysis
+
+42
+00:03:15,370 --> 00:03:20,150
+Beta hemolysis يشبه شكل المستعمرة و ال hemolysis
+
+43
+00:03:20,150 --> 00:03:23,510
+ال stereo mono cytogenes مع أن هذه البكتيريا إيش
+
+44
+00:03:23,510 --> 00:03:27,870
+قولنا؟ بس الله و هذه البكتيريا كوكسايل لكن على
+
+45
+00:03:27,870 --> 00:03:32,720
+الطبق they look similarفي الجهة المقابلة في عندي
+
+46
+00:03:32,720 --> 00:03:35,440
+إذا كانت الـ Hemolysis نيجاتيف والسلسيل نيجاتيف
+
+47
+00:03:35,440 --> 00:03:39,000
+بينما الهيترات بُسطف فهي كورين البكتيريوم species
+
+48
+00:03:39,000 --> 00:03:42,360
+إذا في عندي مجموعة من الأسماء نرجعهم مع بعض
+
+49
+00:03:42,360 --> 00:03:46,600
+لستيريا مونو سايتوجين ارسي بيلو تريكس روسيو باتيا
+
+50
+00:03:46,600 --> 00:03:52,140
+لاكتو باسيلاس في عندي اللي هو الكلسترديوم وفي عندي
+
+51
+00:03:52,140 --> 00:03:59,720
+الباسيلاس باسيلاس كلسترديوم لستيريا كورين
+
+52
+00:03:59,720 --> 00:04:00,380
+البكتيريوم
+
+53
+00:04:03,000 --> 00:04:06,580
+Erythropoethics and Lactobacillus هذي الأسماء اللي
+
+54
+00:04:06,580 --> 00:04:10,940
+متوقع أن ندرسها في مجموعة ل ground boosting بسيلاي
+
+55
+00:04:10,940 --> 00:04:13,520
+لكن احنا هنبدأ فيه اللي قلنا في ال sport forming و
+
+56
+00:04:13,520 --> 00:04:15,800
+هنبدأ فيه اللي هو البسلس
+
+57
+00:04:27,990 --> 00:04:32,190
+هناك اكثر من 48 سبيسي في البصيلة ال general
+
+58
+00:04:32,190 --> 00:04:35,850
+characteristics بتاعتهم gram-boosted bacilli spore
+
+59
+00:04:35,850 --> 00:04:39,310
+-former aerobic and facultative anaerobic نقطة هنا
+
+60
+00:04:39,310 --> 00:04:45,050
+لازم نوضحها ال 48 species يا ما بتكون aerobic
+
+61
+00:04:45,050 --> 00:04:48,670
+البكتيريا يا ما بتكون facultative anaerobic لكن
+
+62
+00:04:48,670 --> 00:04:52,790
+مافيش فيها obligate anaerobic فقط aerobic and
+
+63
+00:04:52,790 --> 00:04:55,960
+facultative anaerobicأشهر pathogenes في المجموعة
+
+64
+00:04:55,960 --> 00:04:58,580
+هنا الباسيلاس أنتراسيس اللي كنا نتكلم بصدادها الآن
+
+65
+00:04:58,580 --> 00:05:02,360
+وبكتيريا أخرى اللي سمناها باسيلاس سيرياس
+
+66
+00:05:02,360 --> 00:05:05,580
+والباسيلاس سيرياس اللي بتوع ال food microbiology
+
+67
+00:05:05,580 --> 00:05:09,380
+هذه بتسبب food poisoning
+
+68
+00:05:12,290 --> 00:05:16,670
+و عندما يذكر في أي امتحان بتقابله او بتواجهه سؤال
+
+69
+00:05:16,670 --> 00:05:20,450
+اتنين، تلاتة، اربعة راحوا على مطعم صيني تمام و بعد
+
+70
+00:05:20,450 --> 00:05:24,430
+ساعتين او تلات ساعات من الأكل صار عندهم stomach
+
+71
+00:05:24,430 --> 00:05:28,890
+ache صار عندهم vomiting تمام what would be the
+
+72
+00:05:28,890 --> 00:05:32,130
+possible او the most possible cause of food
+
+73
+00:05:32,130 --> 00:05:35,450
+poisoning هبصي للسيريس لأنه بتكلم عن مطعم صيني عن
+
+74
+00:05:35,450 --> 00:05:39,110
+رز rice تمام اللي هو السيريس اللي هو التالي هي
+
+75
+00:05:39,110 --> 00:05:42,830
+مرتبطة بال food poisoningلكن مش .. مش ده اهمية
+
+76
+00:05:42,830 --> 00:05:47,770
+كبيرة زي مين زي الـBacillus anthracis نبدأ
+
+77
+00:05:47,770 --> 00:05:51,790
+بالـBacillus anthracis و نشوف بعض الصفات المهمة
+
+78
+00:05:51,790 --> 00:05:55,110
+جدا قبل ما أبدأ في الموضوع بدأ أحكيلكوا قصة صغيرة
+
+79
+00:05:55,110 --> 00:06:00,330
+عن إن الإنسان بالفعل كان يستشعر بوجود الميكروبات
+
+80
+00:06:00,330 --> 00:06:04,750
+قبل علم الـmicrobiology و قبل رؤية البكتيريا و قبل
+
+81
+00:06:04,750 --> 00:06:08,630
+بمئات و ألاف السنين من وجود اللي هو العلم المسمى
+
+82
+00:06:08,630 --> 00:06:16,460
+بالـmicrobiologyعندما كانت تموت بقرة أو شا أو ماعز
+
+83
+00:06:16,460 --> 00:06:20,020
+بالانتراكس اللي هو الجامرة الخبيطة المرض معروف
+
+84
+00:06:20,020 --> 00:06:25,460
+هناك أغنام سليمة وأغنام مريضة اللي بتمرض أعراض كل
+
+85
+00:06:25,460 --> 00:06:29,960
+مرض مختلف تمام فمن ملاحظات الإنسان بيعرف هذا المرض
+
+86
+00:06:29,960 --> 00:06:34,860
+اسمه الجامرة الخبيطةفكان البعض إيش يعمل؟ ياخد
+
+87
+00:06:34,860 --> 00:06:37,360
+شوكة، بتعرف الشوكة اللي بيكون مثلا شوكة صبر ولا
+
+88
+00:06:37,360 --> 00:06:44,000
+شوكة نبات ويغمسها في جثة الحيوان المصاب أو الميت
+
+89
+00:06:44,000 --> 00:06:48,980
+ويروح ويحطها في السرج أو في المكان اللي بديه يقعد
+
+90
+00:06:48,980 --> 00:06:54,930
+فيه الشخص المرادخ ديالهفبيجي بيجلس الشخص على الفرس
+
+91
+00:06:54,930 --> 00:07:00,330
+على الكرسي أو المكان اللي بيجلس فيه بتغز الشوكة
+
+92
+00:07:00,330 --> 00:07:02,690
+تدخل الجراتين طبعا هو مش بعرف .. ماعرفوش إن فيه
+
+93
+00:07:02,690 --> 00:07:07,090
+جراتين لكن خلاص مفهوم فاستخدموا الانتراكس
+
+94
+00:07:07,090 --> 00:07:11,450
+للاغتيالات قبل مئات السنين بألاف السنين من معرفة
+
+95
+00:07:11,450 --> 00:07:14,770
+الإنسان ال micro biological كمان في كمان ظاهرة
+
+96
+00:07:14,770 --> 00:07:20,430
+شبيهة استخدموا الطعونالطعون اللي هو الهرسينابستس
+
+97
+00:07:20,430 --> 00:07:26,890
+كان يقذفه بالمنجنيق جثث الناس المصابين أو المتوفين
+
+98
+00:07:26,890 --> 00:07:31,490
+بالطعون إلى الحصون حتى ينتشر مرض الطعون في
+
+99
+00:07:31,490 --> 00:07:36,950
+الأخرين، يبقى كان في نوع من استغلال للميكروباتفي
+
+100
+00:07:36,950 --> 00:07:40,530
+الحروب، في القتل، كما كان هناك أيضًا استغلال
+
+101
+00:07:40,530 --> 00:07:44,570
+للميكروبات في عمليات تصنيع الأغذية، في كان تصنيع
+
+102
+00:07:44,570 --> 00:07:49,730
+الخبز، تصنيع اللبن، الأجبان، هذه كلها برضه توظيف
+
+103
+00:07:49,730 --> 00:07:54,050
+لمين؟ للميكروبات، قبل ما حتى الإنسان يبقى يعرف إيش
+
+104
+00:07:54,050 --> 00:08:00,360
+يعنيه ميكروباتنرجع، برجوع للبصيلاس anthracis، it
+
+105
+00:08:00,360 --> 00:08:04,000
+is large ground-posted بصيلاي و أنا أول مرة بقول
+
+106
+00:08:04,000 --> 00:08:08,160
+large و بأكد على كلمة large لإن ال large هنا بتفرج
+
+107
+00:08:08,160 --> 00:08:11,520
+معانا، البصيلاي اللي كنا نشوفها تحت الميكروسكوب
+
+108
+00:08:11,520 --> 00:08:14,160
+كإشريشيا كولاي أو تدوموناس بيها الحجم تحت
+
+109
+00:08:14,160 --> 00:08:17,300
+الميكروسكوب لو بدنا نقارنها بالبصيلاس البصيلاس هيك
+
+110
+00:08:18,570 --> 00:08:22,090
+أظن أن هذه بالفعل مجرد ما أنها large بالمقارنة مع
+
+111
+00:08:22,090 --> 00:08:26,030
+هذه الـbacillus none motile ولا أقصد أنه عمّم كل
+
+112
+00:08:26,030 --> 00:08:28,190
+الـbacillus non motile ولا كل الجرام بوسط
+
+113
+00:08:28,190 --> 00:08:31,030
+الـbacilli non motile ماقدرش عمّم يبقى هذه
+
+114
+00:08:31,030 --> 00:08:34,450
+البكتيريا non motile ويبقى في others بتكون motile
+
+115
+00:08:34,450 --> 00:08:39,190
+found singly in pairs or in chain إذا كانت singly
+
+116
+00:08:39,190 --> 00:08:43,790
+زي هيك إذا كانت in pairs بتكون زي هيك إذا كانت in
+
+117
+00:08:43,790 --> 00:08:50,630
+chains بتكون عاملة يا شبابزي ال bamboo tree بتعرف
+
+118
+00:08:50,630 --> 00:08:59,450
+ال bamboo tree اللي هو البوس خيرزان أو زي الجصب
+
+119
+00:08:59,450 --> 00:09:03,390
+الجصب السكر طبعا ليش الفراغ هذا بيان لإنه
+
+120
+00:09:03,390 --> 00:09:08,670
+البكتيريا من انطرفها بتكون concave فلما بيرتقوا مع
+
+121
+00:09:08,670 --> 00:09:14,510
+بعض بيبين كأنه في فراغ بين التنتينوطبعا ممكن تكون
+
+122
+00:09:14,510 --> 00:09:18,390
+long chain الان احد ميادات البكتيريا كانت هنا
+
+123
+00:09:18,390 --> 00:09:24,410
+Spore Former طب Spore Former وين مكان ال Spore؟
+
+124
+00:09:24,410 --> 00:09:29,230
+هذه البكتيريا نكبر شوية احتمالية وجود ال Spore وين
+
+125
+00:09:29,230 --> 00:09:32,530
+ممكن تكون؟ يا اما Central يا اما Sub Terminal يا
+
+126
+00:09:32,530 --> 00:09:37,900
+اما Terminal هذه موجودةcentral بالاضافة الى الشكل
+
+127
+00:09:37,900 --> 00:09:41,940
+تبعها انه oval يبقى في شكلين هنا في ال sport يا
+
+128
+00:09:41,940 --> 00:09:45,720
+اما spherical يا اما oval وبالنسبة لل location يا
+
+129
+00:09:45,720 --> 00:09:48,660
+اما central يا اما sub terminal يا اما terminal
+
+130
+00:09:48,660 --> 00:09:53,220
+لكن البصيلاس and راسيس centrally located و oval
+
+131
+00:09:53,220 --> 00:10:00,700
+shape بقولنا هنا ان ال sports could be found only
+
+132
+00:10:00,700 --> 00:10:06,020
+in culture outside the animalبينما الكابسول could
+
+133
+00:10:06,020 --> 00:10:12,180
+be only found in the animal معلومتان عكس بعض ال
+
+134
+00:10:12,180 --> 00:10:17,200
+sport جون بيلاجيها في ال culture برا الحيوان أو
+
+135
+00:10:17,200 --> 00:10:20,920
+برا الإنسان المصاب بينما الكابسول اللي بيشوفها دي
+
+136
+00:10:20,920 --> 00:10:23,320
+هو ال infected animal تعالوا نطلع على التانية
+
+137
+00:10:23,320 --> 00:10:27,150
+الأولى الأولانية اللي هي ال sportلماذا تكون
+
+138
+00:10:27,150 --> 00:10:31,270
+البكتيريا أصلا sport لما تكون ظروفها صعبة؟ طب هي
+
+139
+00:10:31,270 --> 00:10:36,090
+الانجو والجسم وعملة infection للإنسان و بتتكاثر و
+
+140
+00:10:36,090 --> 00:10:39,470
+خدوا بالكم من ال number اللي حكيلكوا هي ال number
+
+141
+00:10:39,470 --> 00:10:43,190
+في الدم قد يصل إلى أعداد أكبر من ال blood cells
+
+142
+00:10:44,760 --> 00:10:48,360
+يعني لو أخدت قطرة من الدم من الـ venous blood أو
+
+143
+00:10:48,360 --> 00:10:51,460
+من ال peripheral blood بال puncture و حطيتها تحت
+
+144
+00:10:51,460 --> 00:10:55,720
+الميكروسكوب قد ترى البكتيريا مع ال red blood cell
+
+145
+00:10:55,720 --> 00:10:59,140
+مانع الحكي أنه Falminant Growth، Growth، Heavy
+
+146
+00:10:59,140 --> 00:11:04,740
+Growth، Very Severe Infection في الدم، إذا في عندي
+
+147
+00:11:04,740 --> 00:11:09,700
+ظروف ملائمة البكتيريا اتنو بشكل جيد لماذا تكون
+
+148
+00:11:09,700 --> 00:11:15,140
+Spore؟السؤال التاني ليش بتكون كابسول جوا و بتكونش
+
+149
+00:11:15,140 --> 00:11:19,840
+كابسول برا؟هي ممكن تكون كابسول برا إذا أنا وفّرت
+
+150
+00:11:19,840 --> 00:11:23,200
+لها ال media التي تحتوي على ال calcium carbonate
+
+151
+00:11:23,200 --> 00:11:26,560
+ال media اللي بنميها عليها غالبا مافيش فيها
+
+152
+00:11:26,560 --> 00:11:30,820
+calcium carbonate وتكوين الكابسول بتحتاج فيه لمن؟
+
+153
+00:11:30,820 --> 00:11:35,440
+ل calcium carbonate إذا البيئة داخل الجسم بتساعدها
+
+154
+00:11:35,440 --> 00:11:38,860
+عليها تكون capsule بينما في ال culture مابتساعدهاش
+
+155
+00:11:38,860 --> 00:11:42,520
+عليها تكون capsule إلا إذا أنا زوّدت ال media بال
+
+156
+00:11:42,520 --> 00:11:46,590
+calcium carbonateحكينا عن ال sports are oval and
+
+157
+00:11:46,590 --> 00:11:50,610
+centrally located شوفوا شباب بعض المعلومات عن ال
+
+158
+00:11:50,610 --> 00:11:56,250
+survival تبع ال sport في التربة أحد العلماء حط
+
+159
+00:11:56,250 --> 00:12:01,510
+البكتيريا في تربة تربة معينة و كل سنة بياخد عينة و
+
+160
+00:12:01,510 --> 00:12:04,810
+بيفحص البكتيريا حية ضايلة ولا مش حية لجها حية
+
+161
+00:12:04,810 --> 00:12:09,650
+لجداش لأكتر من أربعين سنة و بعدين العالم مات يعني
+
+162
+00:12:09,650 --> 00:12:15,260
+البكتيرياجت اكتر من اربعين سنة survived في التربة
+
+163
+00:12:15,260 --> 00:12:19,780
+ولو بدنا نكمل التجربة لسنوات اكتر قد نتوقع احنا
+
+164
+00:12:19,780 --> 00:12:24,140
+لان sport forming بتطول قد تطول نظريا الى مئات
+
+165
+00:12:24,140 --> 00:12:31,700
+السنين فال survival سباحة في التربة عالي جدا فضل
+
+166
+00:12:36,770 --> 00:12:40,890
+بس لما يكون فيه دم الانفكاط الانمو يعني اي شكل دم
+
+167
+00:12:40,890 --> 00:12:44,110
+الانفكاط الانمو كالسوم؟ لأ دول ممكن .. عفوا، بنميز
+
+168
+00:12:44,110 --> 00:12:47,430
+هنا بين ال .. ان احنا هنا في شكلين في الخلية،
+
+169
+00:12:47,430 --> 00:12:50,410
+الخلية الخضرية اللي بيسموها vegetative cell،
+
+170
+00:12:50,410 --> 00:12:54,710
+vegetative cell، خلية نشيطة و بتغذى، تمام؟ الشكل
+
+171
+00:12:54,710 --> 00:13:01,040
+التاني مين؟الان متى بتتحول هذه الخلية ال
+
+172
+00:13:01,040 --> 00:13:05,160
+vegetative cell الى ال sport cell لما تكون الظروف
+
+173
+00:13:05,160 --> 00:13:09,680
+سيئة فانا بنقول احنا بنقول انه في رسم الإنسان لا
+
+174
+00:13:09,680 --> 00:13:12,060
+يوجد ظروف سيئة او رسم الحيوانة وبالتالي الباكيد
+
+175
+00:13:12,060 --> 00:13:15,200
+ابقالها vegetative cell مافيش فيها sport لما
+
+176
+00:13:15,200 --> 00:13:20,360
+تدخلوا الى الخارج احنا بننميها على الطبقالان الطبق
+
+177
+00:13:20,360 --> 00:13:24,880
+okay فيه ميديا ميحة وغذاء كويس البكتيريا بتنمو لكن
+
+178
+00:13:24,880 --> 00:13:28,920
+بعد عدة ساعات من النمو بتبدأ الميديا و نوترين
+
+179
+00:13:28,920 --> 00:13:34,180
+تتجيل وبالتالي الظروف بتسوق على البكتيريا و بتكون
+
+180
+00:13:34,180 --> 00:13:37,680
+endospore هاي الفرق بين التان تان الان مداش نعمل
+
+181
+00:13:37,680 --> 00:13:42,140
+confusion ما بين اللي هو ال capsule و ال endospore
+
+182
+00:13:42,140 --> 00:13:46,800
+ال capsule structure يتوفر للبكتيريا المواد
+
+183
+00:13:46,800 --> 00:13:52,530
+الملائمة تنتجهماتوفرش مابتنتجوش في رسم الإنسان
+
+184
+00:13:52,530 --> 00:13:58,090
+تتوفر هذه المواد وبتكون capsule في الطبق العادي
+
+185
+00:13:58,090 --> 00:14:02,290
+اللي احنا بننام عليه لاتتوفر لكن إذا وفرناها هتكون
+
+186
+00:14:02,290 --> 00:14:08,290
+برضه capsule البكتيريا
+
+187
+00:14:08,290 --> 00:14:12,880
+الشباب ده مش مطلبات خاصةمش زي ال نيسيريا ولا زي ال
+
+188
+00:14:12,880 --> 00:14:16,000
+hemophilus influenza البكتيريا ممكن تنمو على
+
+189
+00:14:16,000 --> 00:14:19,660
+نوترينت أجار ممكن تنمو على بلد أجار طب هتنمو على
+
+190
+00:14:19,660 --> 00:14:22,360
+نوترينت أجار هتنمو على مين؟ على بلد أجار هل ممكن
+
+191
+00:14:22,360 --> 00:14:24,840
+بكتيريا تنمو على نوترينت أجار وما تنموش على بلد
+
+192
+00:14:24,840 --> 00:14:30,060
+أجار؟ إيش رايكم؟ هل ممكن تنمو البكتيريا على
+
+193
+00:14:30,060 --> 00:14:35,040
+نوترينت أجار وما تنموش على بلد أجار؟ مش سؤال خادع
+
+194
+00:14:35,040 --> 00:14:39,300
+يا شباب سؤال واضح ليش لأ؟
+
+195
+00:14:43,660 --> 00:14:46,700
+و بال blood agar في ايش؟ في زيادة من الحرف طيب لو
+
+196
+00:14:46,700 --> 00:14:49,480
+قلتلك انا ممكن ان ال blood يحتوي على مواد
+
+197
+00:14:49,480 --> 00:14:53,980
+inhibitory للبكتيريا مش احنا في عنا في الدم تبعنا
+
+198
+00:14:53,980 --> 00:14:57,340
+toxic material بتمر على الكيليا بتخلص منها هذه
+
+199
+00:14:57,340 --> 00:15:00,820
+المواد اللي انا أخدتها تمام موجودة في الدم فقد
+
+200
+00:15:00,820 --> 00:15:04,740
+تتأثر بعض الأنواع من البكتيريا الحساسة جدا فقد
+
+201
+00:15:04,740 --> 00:15:07,440
+تنمو على ال .. على نوترد اجاري ولا تنمو على مين؟
+
+202
+00:15:07,440 --> 00:15:09,880
+على ال blood agar طيب
+
+203
+00:15:11,380 --> 00:15:15,540
+البكتيريا مابدهاش كمان incubation خاص على سبعة و
+
+204
+00:15:15,540 --> 00:15:20,720
+تلاتين درجة مقاوية لمدة اربع و عشرين ساعة و على
+
+205
+00:15:20,720 --> 00:15:24,640
+بلد اجار مستعمراتها واضحة كيف مستعمراتها بتكون
+
+206
+00:15:24,640 --> 00:15:30,160
+تسمع بحاجة اسمها ميدوزا تسمع
+
+207
+00:15:30,160 --> 00:15:34,500
+بحاجة اسمها ميدوزا ميدوزا هذه في الأساطير
+
+208
+00:15:34,500 --> 00:15:40,890
+اليونانية أنثى بيطلع من رأسها حيية تعابيناه أحنا
+
+209
+00:15:40,890 --> 00:15:49,270
+السؤال عارفينها ميدوزا هد
+
+210
+00:15:49,270 --> 00:16:05,010
+عشان
+
+211
+00:16:05,010 --> 00:16:11,450
+انا مش عارف دي الصور أصلا كمان لا و شكله ..أو من
+
+212
+00:16:11,450 --> 00:16:15,790
+هال .. هال .. هالشكل ال .. زي الثعابين بيطلعوا من
+
+213
+00:16:15,790 --> 00:16:19,690
+ال .. من الرأس وبتاع المستعمرة نفسها بتعطيك حق
+
+214
+00:16:19,690 --> 00:16:29,510
+بهذا الكلام انه زي ميدوزا هد يعني ممكن
+
+215
+00:16:29,510 --> 00:16:35,430
+تكون أقرب ما يكون .. اه ده الشغل هدي او هد .. هد
+
+216
+00:16:35,430 --> 00:16:39,150
+ممكن الأقرب، تمام؟ ده الشكل ميدوزا هد
+
+217
+00:16:46,580 --> 00:16:51,600
+أو قد تبدو المستعمرات بشكل آخر بيسموه comet tail
+
+218
+00:16:51,600 --> 00:16:54,520
+comet tail بتاع ال comet معناها الشهوب لو تخيرنا
+
+219
+00:16:54,520 --> 00:16:57,260
+واحد معاه كرة كرة من النار و قذفها كيف هيكون
+
+220
+00:16:57,260 --> 00:17:02,500
+شكلها؟ هتكون كرة و بيتبعها ذيل من النار فهذا
+
+221
+00:17:02,500 --> 00:17:05,560
+بيسموه comet tail فالمستعمرات هي ما بتكون ميدوزا
+
+222
+00:17:05,560 --> 00:17:11,180
+هيد أو comet tail في
+
+223
+00:17:11,180 --> 00:17:15,060
+نقطة كتير مهمة بدنا نعرفها هنا ان البكتيريا تبعتنا
+
+224
+00:17:15,060 --> 00:17:20,550
+noneHemolytic، بنأكد على المعلومة هذه، لماذا بنأكد
+
+225
+00:17:20,550 --> 00:17:25,350
+على المعلومة هذه؟ لأن باقي الـBacillus الـspecies
+
+226
+00:17:25,350 --> 00:17:29,630
+are mostly hemolytic أو Beta-hemolytic فلما يطلع
+
+227
+00:17:29,630 --> 00:17:33,970
+عندي Bacillus، كل مواصفات الـBacillus فيها وnon
+
+228
+00:17:33,970 --> 00:17:37,310
+-hemolytics فهي أقرب ما تكون إلينا تكون Bacillus
+
+229
+00:17:37,310 --> 00:17:42,410
+anthracisبتكون تعرفوا أنه فينا during specimen
+
+230
+00:17:42,410 --> 00:17:47,310
+collection فينا caution أو تحذير مهم جدا يجب عليك
+
+231
+00:17:47,310 --> 00:17:51,110
+اتخاذ كل إجراءات السلام والأمان والوقاية عند
+
+232
+00:17:51,110 --> 00:17:54,990
+التعامل مع أي عينة يشتبأ أن يكون فيها بصلص
+
+233
+00:17:54,990 --> 00:18:01,310
+أنتراسيزم، ليش؟بتحكيلكوا عن مرض بتسبب البكتيريا دي
+
+234
+00:18:01,310 --> 00:18:06,110
+وانتوا تخيلوا ليش احنا بنقول كلنا هذا او كيف تم
+
+235
+00:18:06,110 --> 00:18:10,250
+الانتقال تبع المرض او حاجة في عنا اكتر شكل مشهور
+
+236
+00:18:10,250 --> 00:18:13,290
+من اشكال الانتراكس حاجة بيسموها catanius anthrax
+
+237
+00:18:13,900 --> 00:18:19,500
+كتاني مش يعني إيه؟ جلدي وهو عبارة عن احتكاك جروح
+
+238
+00:18:19,500 --> 00:18:24,460
+تمام بمواد ملوثة بالبكتيريا المرض التاني بيسموه
+
+239
+00:18:24,460 --> 00:18:34,120
+palmonary anthrax ويله اسم بالعربي مرض الصوافين أو
+
+240
+00:18:34,120 --> 00:18:39,060
+wool sorter disease
+
+241
+00:18:42,420 --> 00:18:47,460
+اللي هم ال sorting اللي
+
+242
+00:18:47,460 --> 00:18:51,480
+بيفصل الصوف كيف بيفصل الصوف؟ انت كل ما شفتوا
+
+243
+00:18:51,480 --> 00:18:56,600
+الأغنام و الخرفان كيف بيكون شكلها و هي ماشية في
+
+244
+00:18:56,600 --> 00:19:01,080
+الشوارع بتلتقط أشواك و قاضورات البعض منها لا يزول
+
+245
+00:19:01,080 --> 00:19:05,940
+بالغسيل فالصوف هذا بعد ما بيحصلوا عليه بدون أن
+
+246
+00:19:05,940 --> 00:19:09,230
+نظفوهالاشياء اللي غير قابلة للتنظيف بالماء
+
+247
+00:19:09,230 --> 00:19:12,470
+بيشيلوها ناس و هم بيحركوا و بينادفوا في الصوف
+
+248
+00:19:12,470 --> 00:19:16,930
+بيشدوه من هنا و من هنا بيطلع الغبار منهم لما يكون
+
+249
+00:19:16,930 --> 00:19:20,830
+الصوف مأخوذ من حيوان مصاب بال anthrax فهيكون مليان
+
+250
+00:19:20,830 --> 00:19:25,270
+بال spores تبع ال anthrax وبالتالي بيستنشقها مين؟
+
+251
+00:19:25,270 --> 00:19:28,830
+الشخص اللي بيشتغل بالصوف هبصير عنده التهاب في
+
+252
+00:19:28,830 --> 00:19:31,770
+الرقى بيسموه pulmonary anthrax
+
+253
+00:19:36,340 --> 00:19:40,360
+لأن هاي الحيوان في بعض الحالات الاستنتاجات بتبقى
+
+254
+00:19:40,360 --> 00:19:45,280
+اتكومش ولا فيها جنس المنطق هاي الحيوان هاي ال skin
+
+255
+00:19:45,280 --> 00:19:50,020
+تبعه هاي الصوف تبعه هاي الحيوان هنا تمام هاي الجرح
+
+256
+00:19:50,020 --> 00:19:54,720
+تبعه البكتيريا الآن لما تروح على الصوف من الجرح
+
+257
+00:19:54,720 --> 00:20:00,810
+بتضلها في الجسم بتضل .. مش بيصير الآنفي أكل و شرب
+
+258
+00:20:00,810 --> 00:20:04,470
+إلها، يبقى إيش هتتحول من خلية vegetative إلى
+
+259
+00:20:04,470 --> 00:20:08,790
+spores، فجداش احنا .. تمام؟ أقولك حتى و احنا بناخد
+
+260
+00:20:08,790 --> 00:20:12,650
+للحيوان الصوف، لو أخدنا البكتيريا و هي لسه non
+
+261
+00:20:12,650 --> 00:20:15,750
+-spore-formة و صارت ضمن الصوف بعد فترة حصيره الآن
+
+262
+00:20:15,750 --> 00:20:19,290
+إيه؟ Spores، وبتالي أدلة بسنشقة بسنشقة بشكل Spores
+
+263
+00:20:21,230 --> 00:20:24,770
+عشان هيك على فكرة المفروض من الصوف المستورد حتى
+
+264
+00:20:24,770 --> 00:20:31,550
+يمر عبر فحوصات ويمر عبر عملية sterilization كافية
+
+265
+00:20:31,550 --> 00:20:34,910
+لقتل ال sports بقى اللي هو البكتيريا الان يبقى
+
+266
+00:20:34,910 --> 00:20:39,370
+skin كتانيس بالموناري بالموناري وفيه
+
+267
+00:20:39,370 --> 00:20:43,430
+gastrointestinal عبر التناول صعب نتناول البكتيريا
+
+268
+00:20:43,430 --> 00:20:47,730
+من الطبق لكن ممكن نتمس جلبنا ممكن نستنشق البكتيريا
+
+269
+00:20:47,730 --> 00:20:51,700
+صح ولا لأ وبالتالي لازم ناخد إجراءات الأمانلحماية
+
+270
+00:20:51,700 --> 00:20:55,180
+أنفسنا ولحمايةنا أو لحماية البيئة من انتشار هذه
+
+271
+00:20:55,180 --> 00:21:00,920
+البكتيريا في البيئة شوف المستعمر شكله اللذيذ لما
+
+272
+00:21:00,920 --> 00:21:04,500
+واحد بيدي بياخدها بياخد جزء منها و بضلها واقفة
+
+273
+00:21:04,500 --> 00:21:10,240
+دلالة على أن القوام تبعها واكسي زي الشمع القوام
+
+274
+00:21:10,240 --> 00:21:11,300
+تبعها زي الشمع
+
+275
+00:21:18,090 --> 00:21:21,370
+samples collected depending on the site affected
+
+276
+00:21:21,370 --> 00:21:28,690
+احنا قولنا كم site فيه affected skin صح؟ و إيش
+
+277
+00:21:28,690 --> 00:21:34,890
+كمان؟ palmonary و gastrointestinal
+
+278
+00:21:34,890 --> 00:21:38,850
+طبعا gastrointestinal إيش بناخدها؟ stool أو
+
+279
+00:21:38,850 --> 00:21:43,530
+gastric washing palmonary
+
+280
+00:21:45,870 --> 00:21:52,370
+Sputum والسكن هناخد سواب صح؟ هاي العينات مع كل
+
+281
+00:21:52,370 --> 00:21:55,510
+واحد من هدول التلاتة بيجوز ناخدي شباب blood
+
+282
+00:21:55,510 --> 00:22:02,310
+culture ليش؟
+
+283
+00:22:02,900 --> 00:22:08,140
+لأنه على الرغم من انه skin .. او skin infection ال
+
+284
+00:22:08,140 --> 00:22:11,560
+ultimate destination للبكتيريا مش ال skin وانما
+
+285
+00:22:11,560 --> 00:22:15,400
+مين؟ ال blood على الرغم انه موجود في البلموناري ال
+
+286
+00:22:15,400 --> 00:22:18,400
+ultimate destination كمان مرة .. كده بقولكوا انه
+
+287
+00:22:18,400 --> 00:22:23,600
+بتنمو داخل الدم بكميات ضخمة جدا إذا الدم هو ال
+
+288
+00:22:23,600 --> 00:22:27,980
+target site فبالتالي ممكن ناخد swab و blood ناخد
+
+289
+00:22:27,980 --> 00:22:32,310
+sputum زاد blood ناخد stool زاد اللي هو bloodطبعا
+
+290
+00:22:32,310 --> 00:22:35,630
+لما اتكلم معانا stool مشكلة لكن اذا اتكلم على
+
+291
+00:22:35,630 --> 00:22:41,750
+blood culture عينا الدم بنزرعها في البطل واش بيطلع
+
+292
+00:22:41,750 --> 00:22:45,250
+معانا that's it لإن الدم أصلا استرائحي بس ال stool
+
+293
+00:22:45,250 --> 00:22:49,830
+مش استرائحي يبقى كيف بنعزل البكتيريا من ال stool
+
+294
+00:22:49,830 --> 00:22:55,350
+طب كيف بنبقاش selective فكر هل اقفلها طريقة .. هل
+
+295
+00:22:55,350 --> 00:22:59,570
+جيتلها طريقة مثلا معينة او معلومة معينة بتقهلها او
+
+296
+00:22:59,570 --> 00:23:03,950
+بتقهل ان اعزلها selectivelyمين يفكر؟ يلّا الـ
+
+297
+00:23:03,950 --> 00:23:07,790
+calcium
+
+298
+00:23:07,790 --> 00:23:12,150
+carbonate هذا للكابسول الكبسول الكبسول الكبسول
+
+299
+00:23:12,150 --> 00:23:13,090
+الكبسول الكبسول الكبسول الكبسول الكبسول الكبسول
+
+300
+00:23:13,090 --> 00:23:13,390
+الكبسول الكبسول الكبسول الكبسول الكبسول الكبسول
+
+301
+00:23:13,390 --> 00:23:13,990
+الكبسول الكبسول الكبسول الكبسول الكبسول الكبسول
+
+302
+00:23:13,990 --> 00:23:14,830
+الكبسول الكبسول الكبسول الكبسول الكبسول الكبسول
+
+303
+00:23:14,830 --> 00:23:18,570
+الكبسول الكبسول الكبسول الكبسول الكبسول الكبسول
+
+304
+00:23:18,570 --> 00:23:18,570
+الكبسول الكبسول الكبسول الكبسول الكبسول الكبسول
+
+305
+00:23:18,570 --> 00:23:18,570
+الكبسول الكبسول الكبسول الكبسول الكبسول الكبسول
+
+306
+00:23:18,570 --> 00:23:21,290
+الكبسول الكبسول الكبسول الكبسول الكبسول الكبس
+
+307
+00:23:24,500 --> 00:23:30,180
+كيف؟ كيف؟ طب لو انا جيبت عينة ستول عينة ستول و
+
+308
+00:23:30,180 --> 00:23:35,460
+حطيتها في saline saline تمام؟ و سخنت ل 80 درجة
+
+309
+00:23:35,460 --> 00:23:41,880
+مقاوية كل البكتيريا .. كل البكتيريا اللي بتكونش
+
+310
+00:23:41,880 --> 00:23:45,640
+اندو سبور حصر فيها مين بيطلع انها؟ ال sport
+
+311
+00:23:45,640 --> 00:23:49,980
+forming هل بس ال .. البسلص أنتراس اللي بتكون؟ لكن
+
+312
+00:23:49,980 --> 00:23:52,680
+على الأقل عندي صنفين بسلص
+
+313
+00:23:55,710 --> 00:23:58,810
+و ال Eclostridium ال Eclostridium أحسن حاجة فيها
+
+314
+00:23:58,810 --> 00:24:02,430
+هنا Anaerobic يبقى الحيان المؤندي على الطبق بعد
+
+315
+00:24:02,430 --> 00:24:07,850
+ذلك فقط البسلس بس مش البسلس أنفاسي طبعا اي بسلس
+
+316
+00:24:07,850 --> 00:24:11,770
+لكن على الأقل تخلص من مين من أكبر قدر ممكن من يبقى
+
+317
+00:24:11,770 --> 00:24:15,870
+نعمل heat treatment هذا ال enrichment تبعتنا heat
+
+318
+00:24:15,870 --> 00:24:23,210
+treatment في كمان طريقة عطوان غير
+
+319
+00:24:23,210 --> 00:24:23,670
+تسخين
+
+320
+00:24:27,210 --> 00:24:31,730
+الحالة اسمها Alcohol Treatment
+
+321
+00:24:31,730 --> 00:24:35,870
+نفس الكلام equal amount بس المرة بنحط على fifty
+
+322
+00:24:35,870 --> 00:24:41,750
+percent Ethanol وبنعمل mixing ونتركهم لمدة نصف
+
+323
+00:24:41,750 --> 00:24:47,250
+ساعة نصف ساعةنصف ساعة لما تركيز الكهول ايه؟ خمسين
+
+324
+00:24:47,250 --> 00:24:50,510
+في المية عارفين لو ارتفع لسبعين في المية بكون
+
+325
+00:24:50,510 --> 00:24:54,070
+تأثير أحسن بس بنخاف لو رفعنا سبعين في المية نعمل
+
+326
+00:24:54,070 --> 00:24:57,290
+shock نقتل فيه مين نعمل shock احنا بدنا نعطي
+
+327
+00:24:57,290 --> 00:25:02,430
+concentration مؤذي للbacillus بحاجة انها تاخد فرصة
+
+328
+00:25:02,430 --> 00:25:05,530
+و تكون عنده spore بينما الأخرات ماعندهم مش الفرصة
+
+329
+00:25:05,530 --> 00:25:08,190
+تكون عنده spore وبتالي بيموتوا و بناخد يزق و
+
+330
+00:25:08,190 --> 00:25:11,650
+بنزرعه و برضه نفس الفكرة بضل انها فقط مين ال spore
+
+331
+00:25:11,650 --> 00:25:17,810
+forming bacteriaنص ساعة تقريبا نص ساعة تقريبا نص
+
+332
+00:25:17,810 --> 00:25:24,130
+ساعة تقريبا
+
+333
+00:25:24,130 --> 00:25:25,550
+نص ساعة تقريبا نص ساعة تقريبا نص ساعة تقريبا نص
+
+334
+00:25:25,550 --> 00:25:25,690
+ساعة تقريبا نص ساعة تقريبا نص ساعة تقريبا نص ساعة
+
+335
+00:25:25,690 --> 00:25:28,290
+تقريبا نص ساعة تقريبا نص ساعة تقريبا نص ساعة
+
+336
+00:25:28,290 --> 00:25:30,030
+تقريبا نص ساعة تقريبا نص ساعة تقريبا نص ساعة
+
+337
+00:25:30,030 --> 00:25:30,030
+تقريبا نص ساعة تقريبا نص ساعة تقريبا نص ساعة
+
+338
+00:25:30,030 --> 00:25:34,210
+تقريبا نص ساعة تقريبا نص ساعة تقريبا
+
+339
+00:25:34,210 --> 00:25:39,150
+نص ساعة
+
+340
+00:25:39,150 --> 00:25:42,910
+تقريبا نص سا
+
+341
+00:25:47,540 --> 00:25:52,900
+انت لو فكرت .. لو انت صرت مدرس في المعمل السنة
+
+342
+00:25:52,900 --> 00:25:56,980
+اللي جاية معانا في الجامعة و بدك ت .. ت .. توري
+
+343
+00:25:56,980 --> 00:26:01,900
+طلابك sport farming bacterialو دور فى التلارى فىش
+
+344
+00:26:01,900 --> 00:26:04,000
+.. فىش عندك sport forming bacteria و بدك تعززل
+
+345
+00:26:04,000 --> 00:26:06,300
+اللى هم sport forming بتروح على التربة اللى .. وين
+
+346
+00:26:06,300 --> 00:26:10,240
+بتقعدوا؟ أمام المبنى؟ جيب علبة و خدلك معلجة و خد
+
+347
+00:26:10,240 --> 00:26:13,020
+شوية تربة و روح على المختبر سخنها تمانين درجه
+
+348
+00:26:13,020 --> 00:26:16,720
+مقوية تمام و بعد .. خلها مدت خمس دقاق و بعد ما
+
+349
+00:26:16,720 --> 00:26:19,800
+تبرد خد منها لوب و زرع الطبق اللى هيتلع معاك هيتلع
+
+350
+00:26:19,800 --> 00:26:23,180
+معاك sport forming bacteria مش ضرورى بثلث أنفراسيس
+
+351
+00:26:23,180 --> 00:26:27,890
+بس هيتلع معاك بثلث هيتلع معاك بثلثإذا بدنا .. بدنا
+
+352
+00:26:27,890 --> 00:26:30,590
+.. احنا قولنالكوا إنه لما .. لما نشرحلكوا ال
+
+353
+00:26:30,590 --> 00:26:34,760
+concept بتبع ال enrichmentبنشرحلكم ايه عشان نزرع
+
+354
+00:26:34,760 --> 00:26:41,040
+فيكوا تفكير معين اللى وهو ما هي الصفة اللى يمكن
+
+355
+00:26:41,040 --> 00:26:44,260
+استغلالها لفصل هذا الميكروبط دون ان على الميكروباط
+
+356
+00:26:44,260 --> 00:26:47,840
+الأخرى زى ما قلنا الـvibrio cholera alkaline pH
+
+357
+00:26:47,840 --> 00:26:50,940
+اللى يرسينى enterocolitica love's cold temperature
+
+358
+00:26:50,940 --> 00:26:54,700
+صح هذا لأ هذه البكتيريا can survive heat treatment
+
+359
+00:26:54,700 --> 00:26:58,500
+can survive alcohol treatmentفي عندنا يعني خلّيني
+
+360
+00:26:58,500 --> 00:27:02,580
+نقول مجموعة من الصفات قد نستطيع إيه اتعرفنا عليها
+
+361
+00:27:02,580 --> 00:27:05,580
+إنه ننقذ البكتيريا تبعتنا ال .. ال .. ال
+
+362
+00:27:05,580 --> 00:27:08,400
+Campylobacter عن طريق ال small size فاكريني اما
+
+363
+00:27:08,400 --> 00:27:11,380
+عملناها filtration عن طريق ال small size إذا بدنا
+
+364
+00:27:11,380 --> 00:27:15,260
+دائما لو في يوم من الأيام اضطرنا بدنا نقذ الحالة
+
+365
+00:27:15,260 --> 00:27:20,770
+selectively بدنا ندرس خصائصها بشكل جيدswab
+
+366
+00:27:20,770 --> 00:27:24,290
+samples, sputum and blood from pulmonary anthrax,
+
+367
+00:27:24,670 --> 00:27:28,730
+gastric aspirate, feces and stool, and blood for
+
+368
+00:27:28,730 --> 00:27:29,450
+enteric anthrax
+
+369
+00:27:33,700 --> 00:27:37,700
+مظبوط يبقى العينة بالاضافة إلى ال blood culture
+
+370
+00:27:37,700 --> 00:27:42,820
+طبعا ال gram stain ممكن نشوف احنا من العينة و بشرة
+
+371
+00:27:42,820 --> 00:27:45,740
+البامبو tree like appearance و لألمك ال gram stain
+
+372
+00:27:45,740 --> 00:27:49,980
+ولو انه بسبوخش ال sport لأنه ال sport هتبين كيف
+
+373
+00:27:49,980 --> 00:27:54,960
+هتبين
+
+374
+00:27:54,960 --> 00:28:00,040
+انها شئ مش مسبوخ فراغ وبالتالي نقدر نشوفها بشكل
+
+375
+00:28:00,040 --> 00:28:00,300
+جيد
+
+376
+00:28:03,060 --> 00:28:07,240
+الجيمزا ستاين الجيمزا ستاين اسمه بيبعطينا purple
+
+377
+00:28:07,240 --> 00:28:10,660
+بس ال lie with red capsule يعني بنشوف ال gram بستف
+
+378
+00:28:10,660 --> 00:28:13,520
+او بنشوف البكتيريا بشكل purple و ال capsule اللي
+
+379
+00:28:13,520 --> 00:28:16,360
+بعتها بشكل red عن طريق الجيمزا ستاين ليش بنعمل
+
+380
+00:28:16,360 --> 00:28:19,540
+جيمزا ستاين؟ لإن انا قلتلكوا ان البكتيريا بتكون
+
+381
+00:28:19,540 --> 00:28:23,760
+مولدة وين؟ في الدم و بكميات كبيرة و بتاع لو أخدنا
+
+382
+00:28:23,760 --> 00:28:27,080
+احنا عينة الدم و عملناها blood film و كده .. ايش
+
+383
+00:28:27,080 --> 00:28:30,120
+.. بيش بنسبقوا blood film احنا؟ جيمزا ستاين او
+
+384
+00:28:30,120 --> 00:28:34,970
+جيمزا ستاينAnimal Inoculation لو في عندنا في
+
+385
+00:28:34,970 --> 00:28:39,690
+المختبر facility للحيوانات التجارب ممكن ناخد اما
+
+386
+00:28:39,690 --> 00:28:45,590
+ال culture او ناخد العينة و نعملها injection في ال
+
+387
+00:28:45,590 --> 00:28:50,210
+animalwhen intraperitoneally في منطقة البطن by a
+
+388
+00:28:50,210 --> 00:28:53,830
+suspension of the test organism suspected bacillus
+
+389
+00:28:53,830 --> 00:28:58,210
+anthracis culture اللي هي العينة المشتبه أن تكون
+
+390
+00:28:58,210 --> 00:29:03,690
+bacillus anthracis the animal dies within 48 to 96
+
+391
+00:29:03,690 --> 00:29:09,170
+hours يعني موت محتر للفقر خلال 48 إلى 96 ساعة due
+
+392
+00:29:09,170 --> 00:29:15,210
+to respiratory failureطبعا بعد ما يموت الحيوان او
+
+393
+00:29:15,210 --> 00:29:19,390
+خلال حياته لو أخدنا منه عينة دم بنلاقي large
+
+394
+00:29:19,390 --> 00:29:23,110
+number of cell life في ال blood لانه بتلكوا انه ال
+
+395
+00:29:23,110 --> 00:29:26,350
+bacteria ال ultimate site تبعها هو الدم
+
+396
+00:29:28,990 --> 00:29:33,170
+هذا الشكل يمكن من أوائل الصور اللي انتشرت يعني
+
+397
+00:29:33,170 --> 00:29:36,470
+بشكل واسع بتبين لجداش طول السلسة لإن البكتيريا هنا
+
+398
+00:29:36,470 --> 00:29:40,970
+نامية في broth نامية في broth هنا في عينة حقيقية
+
+399
+00:29:40,970 --> 00:29:45,670
+هذا بصل صحيح؟ وهذا طالع لحظه البصلاي ممكن تكون
+
+400
+00:29:45,670 --> 00:29:50,490
+دبله واحد اتان وواحد اتان لكن في الآخر هي large
+
+401
+00:29:50,490 --> 00:29:54,210
+بصلايفاكرين الصورة اللي احنا المحاضرة الماضي
+
+402
+00:29:54,210 --> 00:29:58,130
+شرحناها كانت ال bus سلز زي هيك هي .. هي .. هي ال
+
+403
+00:29:58,130 --> 00:30:02,110
+.. ال .. النواة و الدبلو كوكايك مليون واحدة جوا
+
+404
+00:30:02,110 --> 00:30:06,850
+صح؟ لكي تطلع هنا كداش الحجب طولها طول تنتين هدول
+
+405
+00:30:06,850 --> 00:30:11,130
+يمكن تقريبا تنتين جريب من ايه؟ من ال .. من ال ..
+
+406
+00:30:11,130 --> 00:30:14,970
+ال .. ال .. ال bus سلز حجمها كبير حجمها كبير
+
+407
+00:30:18,940 --> 00:30:22,000
+هذه الصورة اللي أمامكم بتبين لنا اللون الأخضر اللي
+
+408
+00:30:22,000 --> 00:30:25,260
+شايفينه هنا اللي هو الأصبع موجود هذه اللي هي اللون
+
+409
+00:30:25,260 --> 00:30:28,540
+الأخضر لـ Spores أو لـ Free Spores من من Spore
+
+410
+00:30:28,540 --> 00:30:33,180
+Staining Film نفس الشيء هنا في عندي Mixture طبعا
+
+411
+00:30:33,180 --> 00:30:35,800
+لاحظوا ان الخلايا الماخدة باللون الأحمر اللون
+
+412
+00:30:35,800 --> 00:30:38,440
+الأحمر لأنه فاكرين إيش ال .. ال .. ال Spore Stain
+
+413
+00:30:38,440 --> 00:30:41,940
+كان Malachite Green وفي الآخر إيش ال Counter Stain
+
+414
+00:30:41,940 --> 00:30:47,210
+كان؟ بال .. بال ..Carb of Oxygen أو سفرانين، مظبوط
+
+415
+00:30:47,210 --> 00:30:51,230
+او لا؟ سفرانين، يبقى كان عندي اللي هو ال sport
+
+416
+00:30:51,230 --> 00:30:54,890
+تسبق باللون الأخضر والخلايا تسبق باللون اللي هو
+
+417
+00:30:54,890 --> 00:30:57,690
+الأحمر وهي في عندي انهانة واضحة أن في عندي لون
+
+418
+00:30:57,690 --> 00:31:02,090
+أخضر وفي عندي اللون الأحمر غالب على الجسم تبع
+
+419
+00:31:02,090 --> 00:31:02,590
+الخليب
+
+420
+00:31:05,390 --> 00:31:08,250
+هل هناك صعوبة في التعرف علي البكتيريا ولا يمكن
+
+421
+00:31:08,250 --> 00:31:11,730
+التعرف عليها بسهولة؟ انا بقولكوا ان الباصيلوس
+
+422
+00:31:11,730 --> 00:31:14,750
+أنتراسيز زيها زي اي بكتيريا اخرى صحيح خطيرة
+
+423
+00:31:14,750 --> 00:31:20,630
+وسمعتها سيئة وشُنّت حروب نعم شُنّت حروب من أجلها
+
+424
+00:31:20,630 --> 00:31:25,590
+او بحجتها اللي ان البكتيريا زيها زي اي مايكروب من
+
+425
+00:31:25,590 --> 00:31:28,850
+اللي درستهم سابقا بل أسهل من الكثير من المايكروبات
+
+426
+00:31:28,850 --> 00:31:31,810
+انها بتنموا على نوترن الأجار تنموا على ال blood
+
+427
+00:31:31,810 --> 00:31:43,230
+agarنان موتار البكتيريا نان هيموليتك كنان
+
+428
+00:31:43,230 --> 00:31:45,430
+هيموليتك فكان دي كمان اللي فحص ال gelatin
+
+429
+00:31:45,430 --> 00:31:50,550
+liquefaction test فكان ال tube method مش اللي
+
+430
+00:31:50,550 --> 00:31:53,610
+عملته في ال AVI تلاتين يوم negative after seven
+
+431
+00:31:53,610 --> 00:31:59,810
+days negative after seven daysالان إليها شكل مميز
+
+432
+00:31:59,810 --> 00:32:02,850
+فيه تيوب يعني لو اتطلعت على تيوب نامية فيها
+
+433
+00:32:02,850 --> 00:32:06,010
+البكتيرى اللي اسمها Bacillus anthracis هتلاقي فيها
+
+434
+00:32:06,010 --> 00:32:10,950
+.. هرسمها inverted pine tree إيش هال inverted pine
+
+435
+00:32:10,950 --> 00:32:15,230
+tree؟ عندي هاي ال تيوب و هاي ال gelatin dips احنا
+
+436
+00:32:15,230 --> 00:32:21,510
+زرعناها بهذا الشكل stop تمام؟ الان لو بعد سبع أيام
+
+437
+00:32:21,510 --> 00:32:24,650
+اتطلعنا عليها هلاجيها ال gelatin ال liquefaction
+
+438
+00:32:24,650 --> 00:32:29,900
+تبعها negativeيعني مش .. مش سائل لكن شكل البكتيريا
+
+439
+00:32:29,900 --> 00:32:34,120
+عامل زي هيك في
+
+440
+00:32:34,120 --> 00:32:38,940
+النمو بذكركوا بإيش هدى أنا لو برسم شجرة pine
+
+441
+00:32:38,940 --> 00:32:44,620
+برسمها زي هيك إيش هدى؟ شجرة صروب pine tree هداش
+
+442
+00:32:44,620 --> 00:32:50,000
+مالها مجلوبة بسميها inverted pine tree هدى
+
+443
+00:32:50,000 --> 00:32:52,880
+characteristic من ال characteristics المهم جدا في
+
+444
+00:32:52,880 --> 00:32:57,240
+ال identificationNitrate reduction test positive,
+
+445
+00:32:57,380 --> 00:33:00,400
+starch hydrolysis test positive لكن هذا الصفة لـ
+
+446
+00:33:00,400 --> 00:33:05,960
+starch hydrolysis معظم أنواع البصيلاس can produce
+
+447
+00:33:05,960 --> 00:33:09,200
+starch hydrolysis test يعني مش صفة خاصة فيها
+
+448
+00:33:09,200 --> 00:33:13,120
+Voskosproskauer test positive sensitivity to
+
+449
+00:33:13,120 --> 00:33:17,440
+penicillin it is sensitive هذا الرقم 17 يعني يمكن
+
+450
+00:33:17,440 --> 00:33:20,780
+هذا الفحص هو الأفضل على الإطلاق ويعتبر
+
+451
+00:33:20,780 --> 00:33:25,550
+confirmatory test فاكرين مصطلح فهيش typing؟لمن
+
+452
+00:33:25,550 --> 00:33:28,710
+استخدمناها؟
+
+453
+00:33:28,710 --> 00:33:33,630
+حزر استفيل الكوكاس يالا فيه افتراض يعني تنتين
+
+454
+00:33:33,630 --> 00:33:37,510
+تلاتة ممكن لستفيل الكوكاس استخدمنا فاش typing
+
+455
+00:33:37,510 --> 00:33:42,010
+وقلنا انه لكل سلالة لكل string فيه فاش type معين
+
+456
+00:33:42,010 --> 00:33:47,550
+هنا فيه فاش اسمه gamma fash هذا خصيصا لحضرة مين
+
+457
+00:33:47,550 --> 00:33:51,130
+البصيلة's anthracis فلو انا كان عندي career agent
+
+458
+00:33:51,130 --> 00:33:52,550
+وكان عندي suspected
+
+459
+00:33:56,140 --> 00:33:59,980
+وكلمة suspected مش اي واحدة suspected، ليش لازم
+
+460
+00:33:59,980 --> 00:34:03,560
+يكونوا أصفاتها suspected؟ واحد, ground posted بس
+
+461
+00:34:03,560 --> 00:34:10,820
+الله، اتنين, sport, forming، تلاتة, non-hemolytic،
+
+462
+00:34:10,820 --> 00:34:14,100
+أربع, non-motile، إيه تخفروا الأربع أصفات هدول
+
+463
+00:34:14,100 --> 00:34:19,410
+عندي، بعملها مين؟Gamma Fage وكيف أعمل الفحص نفس
+
+464
+00:34:19,410 --> 00:34:23,370
+اللي عملته لـ Staphylococcus بنجيب يا شباب swap
+
+465
+00:34:23,370 --> 00:34:29,590
+بناخد البكتيريا بنمسحها مسح تماما تماما وهذا الفحص
+
+466
+00:34:29,590 --> 00:34:31,670
+مش ضروري على بلد أجار ليش لأن البكتيريا بتنمو على
+
+467
+00:34:31,670 --> 00:34:36,210
+nutrient أجار بتنمو على nutrient أجار حطينا ال
+
+468
+00:34:36,210 --> 00:34:42,030
+gamma fage disk على المنطقة هذه إذا لجينا zone of
+
+469
+00:34:42,030 --> 00:34:47,330
+clearanceZone of clearance as a result of Fage
+
+470
+00:34:55,860 --> 00:34:59,840
+فال .. ال .. البكتيريا بتكون sensitive للفاج وما
+
+471
+00:34:59,840 --> 00:35:02,800
+ان الفاج انا عارفه جامعه فاج يبقى البكتيريا هي
+
+472
+00:35:02,800 --> 00:35:06,020
+Bacillus anthracis بيبقى Bacillus anthracis يبقى
+
+473
+00:35:06,020 --> 00:35:11,700
+الجامعه فاج هو ال confirmatory test الرائع والمؤكد
+
+474
+00:35:11,700 --> 00:35:14,540
+لهوية اللي هو Bacillus anthracis
+
+475
+00:35:17,090 --> 00:35:20,610
+هيها تلعبها دي شوفوا ال black اللي صارت هنا شباب
+
+476
+00:35:20,610 --> 00:35:26,170
+على الصورة اللي قدامكوا هذه الصورة بتوضحلي انه فيه
+
+477
+00:35:26,170 --> 00:35:30,310
+صار lysis وين اختفت البكتيريا وين راحت البكتيريا
+
+478
+00:35:30,310 --> 00:35:33,410
+اتحللت من قبل مين من قبل البكتيريا الفاجلة اللي
+
+479
+00:35:33,410 --> 00:35:37,510
+وضعته في هذه المنطقة هذا واضح انه نحط بشكل قطرة مش
+
+480
+00:35:37,510 --> 00:35:43,590
+بشكل disk يعني بشكل drop شوفوا
+
+481
+00:35:43,590 --> 00:35:48,560
+ال size تبع البكتيرياSize، الحجم تباعها على بلد
+
+482
+00:35:48,560 --> 00:35:52,520
+أجار، نمو مخيف، ودلها حجم المستمرات ضخم، يعني ال
+
+483
+00:35:52,520 --> 00:35:56,140
+bacteria can be cultivated easily، مابدهاش أي
+
+484
+00:35:56,140 --> 00:36:00,400
+صعوبات، لذلكلما بتكلموا العالم الغربي عن الحرب
+
+485
+00:36:00,400 --> 00:36:04,460
+البيولوجية وعن الإرهاب البيولوجي، طبعا المصطلح هو
+
+486
+00:36:04,460 --> 00:36:10,980
+حرب بيولوجية، تم توظيف البصيلة الانتراكس فيها،
+
+487
+00:36:10,980 --> 00:36:15,860
+اللي هي عملية المراسلة بالانتراكس، اللي هي إرسال
+
+488
+00:36:15,860 --> 00:36:20,510
+رسائل ملغمة بالانتراكسموطن زؤام يعني لما نتكلم عن
+
+489
+00:36:20,510 --> 00:36:24,410
+جمرة خبيتها سميت العرب لما بيسموه الأشياء بيسموها
+
+490
+00:36:24,410 --> 00:36:31,410
+بدقة سميت جمرة لإنه انا قلتلكوا 98% من المرض بشكل
+
+491
+00:36:31,410 --> 00:36:37,990
+طبيعي قبل الحرقالوجية هو skin disease العرب سمته
+
+492
+00:36:37,990 --> 00:36:43,870
+جمرة لإنه بيكون في هذه القافة بيكون في المنتصف
+
+493
+00:36:43,870 --> 00:36:51,630
+أسود وع الحوافأحمر .. أحمر من إيش أحمر؟ أحمر من ال
+
+494
+00:36:51,630 --> 00:36:55,570
+flesh، اللحم، ال .. ال .. ال .. نسيش تبعنا و
+
+495
+00:36:55,570 --> 00:36:58,750
+المنتصف فيه necrosis و ال necrosis بكل لونه أسود،
+
+496
+00:36:58,750 --> 00:37:02,650
+تمام؟ و إذا أنت نظرت للجمرة، هتلاقي الجمرة سوداء
+
+497
+00:37:02,650 --> 00:37:08,060
+في المنتصف و حمراء على الطرف، المتوكشة، تمام؟وسميت
+
+498
+00:37:08,060 --> 00:37:13,160
+خبيثة لأنه إذا ظهرت عند الإنسان تقتله بعد يومين،
+
+499
+00:37:13,160 --> 00:37:15,740
+فتقولوا يسموها الجامرة الخبيثة، إذا ال disease
+
+500
+00:37:15,740 --> 00:37:21,080
+قاتل، وإذا المرض قاتل، واستخدامه ضد المدنيين أو ضد
+
+501
+00:37:21,080 --> 00:37:25,820
+الإنسان بشكل عام يتبع جريمة كبرىو one tube .. one
+
+502
+00:37:25,820 --> 00:37:30,220
+tube of Bacillus anthracis لشخص يمتلك التكنولوجيا
+
+503
+00:37:30,220 --> 00:37:33,520
+قد ينتج مئات الألاف من الأطمان خلال الفترة و جيزة
+
+504
+00:37:33,520 --> 00:37:37,120
+تاب اللي قدامكوا هنا بيظهر بعض الفروقات الأساسية
+
+505
+00:37:37,120 --> 00:37:39,280
+ما بين ال Bacillus anthracis وما بين ال other
+
+506
+00:37:39,280 --> 00:37:43,480
+Bacilli يارى تتركزوا فيهم كويس لأنه احفظنا .. بس
+
+507
+00:37:43,480 --> 00:37:45,940
+نحفظ ال characteristics و نحفظ أن ال Bacillus
+
+508
+00:37:45,940 --> 00:37:48,940
+anthracis كلها هي negatives بينما ال other
+
+509
+00:37:48,940 --> 00:37:51,740
+Bacillus اللي من ضمنها Bacillus serious بتكون
+
+510
+00:37:51,740 --> 00:37:56,300
+positiveGrowth on PEA والـ PEA هو عبارة عن فينال
+
+511
+00:37:56,300 --> 00:38:00,620
+إيثايل ألكوهول زي ال brain heart infusion أجار طبق
+
+512
+00:38:00,860 --> 00:38:03,560
+من ال brain-heart infusion أجار مضاعف إله فينال
+
+513
+00:38:03,560 --> 00:38:06,360
+إيثال ألكهول البكتيريا دي ماعرف تجار تنمو عليه
+
+514
+00:38:06,360 --> 00:38:09,960
+بينما القدر بس الله تتجار تنمو عليه سالسين
+
+515
+00:38:09,960 --> 00:38:13,600
+فيرمينتيشن أحد الكاربوهايدريت نيجاتيف والباقي
+
+516
+00:38:13,600 --> 00:38:18,040
+بوستيف موتيلتي نيجاتيف و usual الأخرين مين بوستيف
+
+517
+00:38:18,040 --> 00:38:21,840
+hemolysis on sheep blood أجار نيجاتيف وهذا كده
+
+518
+00:38:21,840 --> 00:38:25,200
+بوستيف إذا في عندي مجموعة من الصفات الأربعة دول
+
+519
+00:38:25,200 --> 00:38:32,410
+اللي هتشكلت وماعنديش أنااللي هو ال .. ال gamma
+
+520
+00:38:32,410 --> 00:38:35,630
+phage بقدر أعمل presumptive diagnosis بقدر أعمل
+
+521
+00:38:35,630 --> 00:38:39,190
+presumptive diagnosis انه البكتيريا اللي أمامنا هي
+
+522
+00:38:39,190 --> 00:38:44,350
+Bacillus anthracis انا قولت تلت أشكال من المرض
+
+523
+00:38:44,350 --> 00:38:48,510
+حكيناهم كتانيوس و enteric اللي هو ال intestinal و
+
+524
+00:38:48,510 --> 00:38:52,050
+ال intestinal غالبا بيكون ناتج عن أو ناجم عن ناجم
+
+525
+00:38:52,050 --> 00:38:59,390
+عنتناول طعام .. تناول طعام غير ناضج، تمام؟ وهذا
+
+526
+00:38:59,390 --> 00:39:03,390
+الطعام ملوث بالـ spores، يعني لحم لحيوانات مصابة
+
+527
+00:39:03,390 --> 00:39:09,090
+بالـ anthrax وهو مرض نادر لكن fatal، fatal يعني
+
+528
+00:39:09,090 --> 00:39:14,300
+قاتل، هم كلهم fatal، كلهم fatalالكتانيوس أنتراكس
+
+529
+00:39:14,300 --> 00:39:19,220
+لها تجادش للنسبة الطبيعية 98% من الحالات هي
+
+530
+00:39:19,220 --> 00:39:23,200
+كتانيوس أنتراكس وبتنتج عن احتكاك الجروح تبع
+
+531
+00:39:23,200 --> 00:39:28,180
+الانسان بحيوانات مصابة او مصدر طبعا غالبا الجامعة
+
+532
+00:39:28,180 --> 00:39:34,090
+اللى دكرتها دىpainless يعني غير مصاحبة بألم وهنا
+
+533
+00:39:34,090 --> 00:39:39,070
+يظهر الخبث مرة أخرى غير مؤلمة وتقتل صاحبة بعد عدة
+
+534
+00:39:39,070 --> 00:39:41,930
+أيام الأخير اللي هو ال palmonary anthrax اللي قلنا
+
+535
+00:39:41,930 --> 00:39:44,630
+عنه wool sorter disease
+
+536
+00:39:49,680 --> 00:39:55,580
+هذه مثلا مثال على جامرة تمام بستول طبعا المنتصف
+
+537
+00:39:55,580 --> 00:39:59,060
+كان مرة أسود و الطرف اللي حوالها بيكون ايه pink او
+
+538
+00:39:59,060 --> 00:40:08,480
+red اللي هو اللون اللي في الاشي هذا
+
+539
+00:40:08,480 --> 00:40:12,020
+بيورينا صورة على البصلاي اللي موجودة فيه ال lung
+
+540
+00:40:12,020 --> 00:40:15,220
+tissue بتكلم عن اللي هو ال palmonary anthrax
+
+541
+00:40:19,720 --> 00:40:24,200
+لأ إذا بتذكر التوكسين تبقى ال anthrax إذا .. إذا
+
+542
+00:40:24,200 --> 00:40:27,560
+فاكروا من الدروس الأولانية و أنا كل مرة بقول إنه
+
+543
+00:40:27,560 --> 00:40:31,140
+عدم وجود امتحان قريب هو اللي بيخدنا نسأله السؤال
+
+544
+00:40:31,140 --> 00:40:35,280
+هذه في عندي أنا كان التوكسين مكون من ثلاث .. من
+
+545
+00:40:35,280 --> 00:40:39,240
+ثلاث قطع إذا فاكرين ال protective antigen و ال
+
+546
+00:40:39,240 --> 00:40:43,520
+edema factor صح؟ و ال lethal
+
+547
+00:40:47,820 --> 00:40:51,860
+Lethal factor هذا سميناه احنا ال protective
+
+548
+00:40:51,860 --> 00:40:55,600
+antigen وقلنا عنه اعتبره ال P-fragment اللي تم ال
+
+549
+00:40:55,600 --> 00:40:59,880
+binding فلو ارتبط ال lethal factor بال P من كلمته
+
+550
+00:40:59,880 --> 00:41:02,860
+اسمه lethal او التان الاديمة factor دخل هام
+
+551
+00:41:02,860 --> 00:41:06,380
+الاديمة فالميكانيزم ناتجة عن اكزوتوكسين مش عن
+
+552
+00:41:06,380 --> 00:41:07,320
+اندوتوكسين
+
+553
+00:41:11,290 --> 00:41:14,570
+هذا بيورينا برضه اننا كنا اللي هو infected meat او
+
+554
+00:41:14,570 --> 00:41:18,750
+meat يعني كنت مات meat من حيوان و ال .. و ال .. ال
+
+555
+00:41:18,750 --> 00:41:21,630
+.. ال .. ال meat لم تتعرض لحرارة كافية لقتل
+
+556
+00:41:21,630 --> 00:41:24,430
+الميكروبات قد يحدث لنا gastro intestinal anthrax
+
+557
+00:41:24,430 --> 00:41:33,210
+البكتيريا تحتوي على .. و أول بكتيريا بندرسها تحتوي
+
+558
+00:41:33,210 --> 00:41:36,810
+على كابسول أول بكتيريا مجورة تحتوي على كابسول ولا
+
+559
+00:41:36,810 --> 00:41:41,450
+درسنا غيرهاطب هذه أول بكتيريا بتقيلها كابسول من
+
+560
+00:41:41,450 --> 00:41:45,190
+نوع خاص، منفع القول هيك، منفع نقول هيك، أما دراسنا
+
+561
+00:41:45,190 --> 00:41:48,750
+قبل هيك احنا بكتيريا بكابسول، إيش النوع الخاص؟ إن
+
+562
+00:41:48,750 --> 00:41:51,910
+الكابسول تبعتها مش مكونة من polysaccharide، مكونة
+
+563
+00:41:51,910 --> 00:41:57,510
+من polypeptide، هذه أول بكتيريا اللي بنتكلم عنها
+
+564
+00:41:57,510 --> 00:42:04,490
+إنها بتكون polypeptide capsuleعندها
+
+565
+00:42:04,490 --> 00:42:07,610
+polysaccharides somatic antigen وعندها complex
+
+566
+00:42:07,610 --> 00:42:10,490
+protein-toxin اللي حكينا عنه اللي هو اللي مكون من
+
+567
+00:42:10,490 --> 00:42:15,670
+PA وفي ال treatment بنتكلم عن penicillin is a drug
+
+568
+00:42:15,670 --> 00:42:20,530
+of choice بس خدوا بالكم في العصر الحديث اللي احنا
+
+569
+00:42:20,530 --> 00:42:25,570
+فيه الآن هذا استبدل .. استبدل كل هذه ال drugs
+
+570
+00:42:25,570 --> 00:42:28,970
+بيسبروفلوكسا
+
+571
+00:42:30,310 --> 00:42:32,690
+طبعا مثلا هو step دي اللي احنا هضيفوه إضافة
+
+572
+00:42:32,690 --> 00:42:36,890
+Siprofloxacin كالآن modern drug used for this
+
+573
+00:42:36,890 --> 00:42:44,210
+organism لأ في الامتحان هي ال drug of choice بس
+
+574
+00:42:44,210 --> 00:42:46,850
+يكون اللي مالديكا معرفه انه الآن كبديل بيستخدموا
+
+575
+00:42:46,850 --> 00:42:50,330
+معانا Siprofloxacin عشان مايصيرش بس confusion
+
+576
+00:42:50,330 --> 00:42:56,110
+طلعلي
+
+577
+00:42:56,110 --> 00:42:59,170
+على اللوحة دي هختم فيها محاضرة اللي هي من شاء الله
+
+578
+00:43:01,110 --> 00:43:03,810
+هي عندى ال protective antigen اللى حكينا عنه وقلنا
+
+579
+00:43:03,810 --> 00:43:08,750
+فيه انه إمكانى يجي لمين لتو لتو mechanisms انه
+
+580
+00:43:08,750 --> 00:43:11,350
+يرتبط بال edema factor او يرتبط لمين بال lethal
+
+581
+00:43:11,350 --> 00:43:16,430
+factor طبعا بتوقع انه مدام التكسين منتج وفيه اتنين
+
+582
+00:43:16,430 --> 00:43:20,570
+يبقى مرة هيدخل معاه edema factor ومرة يدخل معاه
+
+583
+00:43:20,570 --> 00:43:24,690
+lethal factor وفي الحالتين هيقدى ال effect تبعه
+
+584
+00:43:24,690 --> 00:43:27,570
+وأعتقد كلكوا بتعرفوا adenylate cyclase enzyme
+
+585
+00:43:27,570 --> 00:43:32,510
+cycle KMP هيعملنا اللى هو ال edema factorهذه
+
+586
+00:43:32,510 --> 00:43:36,890
+الصورة بتوضحلكوا انه
+
+587
+00:43:36,890 --> 00:43:41,210
+لما بتتعامل مع anthrax attack شوف ال safety اللي
+
+588
+00:43:41,210 --> 00:43:46,110
+احنا ال level اللي احنا بنتابعه هو ال maximum
+
+589
+00:43:46,110 --> 00:43:48,870
+level of biological safety ال maximum level هو
+
+590
+00:43:48,870 --> 00:43:52,970
+الأعلى المستوى اللي بنمارسه في الحماية و الوقاية
+
+591
+00:43:52,970 --> 00:43:54,670
+من اللي هو ال anthrax
+
+592
+00:43:57,780 --> 00:44:00,340
+المرة اللي جاي ان شاء الله بنكمل و بنتكلم عن
+
+593
+00:44:00,340 --> 00:44:04,400
+البصيلة serious و بنبدأ بال .. بنبدأ بال .. ال ..
+
+594
+00:44:04,400 --> 00:44:05,600
+ال .. ال closism ان شاء الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/SOGT4PUCJGQ.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/SOGT4PUCJGQ.srt
new file mode 100644
index 0000000000000000000000000000000000000000..688a0f8ac00e1ba1d01e91476540b8e53e310050
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/SOGT4PUCJGQ.srt
@@ -0,0 +1,1385 @@
+1
+00:00:22,460 --> 00:00:25,620
+بسم الله الرحمن الرحيم، استثمارًا، ويمكن اليوم
+
+2
+00:00:25,620 --> 00:00:27,660
+المحاضرة، تكون المحاضرة الأخيرة في الموضوع
+
+3
+00:00:27,660 --> 00:00:32,380
+Clostridium، هنكمل اسمين أو ثلاثة أسماء جديدة في الـ
+
+4
+00:00:32,380 --> 00:00:35,640
+Clostridium، الـ Clostridium septicum، و من البداية
+
+5
+00:00:35,640 --> 00:00:40,280
+احنا لما رحنا، لسه كنا نبيّض بقى إلحاد كبير اللي هو
+
+6
+00:00:40,280 --> 00:00:44,260
+الـ Clostridium perfringens، و لو أخرنا الـ disease الـ
+
+7
+00:00:44,260 --> 00:00:47,920
+disease هو  حد اللي هو Clostridium myonecrosis، ولو
+
+8
+00:00:47,920 --> 00:00:51,400
+ترجعكم لرقصيكم في الفيلم اللي سحبناه كمهمها Gas,
+
+9
+00:00:51,500 --> 00:00:54,280
+Gangrene و Gas وSin، ما يوضحوا أنها نفس اللي هو
+
+10
+00:00:54,280 --> 00:00:59,000
+المعنى، أو نفس الـ terminology الباثولوجية هنا، أنه نخر
+
+11
+00:00:59,000 --> 00:01:02,920
+روح الأنسجة، ووصول إلى الذنب، ومتاريها، وتأكد من
+
+12
+00:01:02,920 --> 00:01:06,820
+اللوحة، ومتاريها، الـ generalized ده، الـ generalized
+
+13
+00:01:06,820 --> 00:01:10,020
+infections دي، مجموعة من المرضى نادرة، من الـ endocarditis
+
+14
+00:01:10,020 --> 00:01:13,980
+الـ endocarditis اللي عندهم treatment transplant
+
+15
+00:01:13,980 --> 00:01:17,520
+وبيأخذوا، على سبيل المثال، immunosuppression treatment أو
+
+16
+00:01:17,520 --> 00:01:20,800
+عندهم cancer، أو immunotherapy، هذان الحالتان
+
+17
+00:01:20,800 --> 00:01:23,980
+الثلاثة، أو أي حالة فيها الـ insulin بيكون depressed
+
+18
+00:01:23,980 --> 00:01:27,060
+غير أن البكتيريا تعمل، وأنها generalize
+
+19
+00:01:27,060 --> 00:01:30,400
+الـ infection، الـ Clostridium difficile، أنا بدأت فيها
+
+20
+00:01:30,400 --> 00:01:34,280
+المحاضرة تبع الـ Clostridium بشكل مفصل، وقلت إن هذه
+
+21
+00:01:34,280 --> 00:01:38,780
+البكتيريا هي مثال رائع جدًا على nosocomial
+
+22
+00:01:38,780 --> 00:01:40,680
+infection
+
+23
+00:01:45,690 --> 00:01:49,830
+على الـ Antibiotic-induced diseases، يعني أمراض
+
+24
+00:01:49,830 --> 00:01:53,450
+تنتج عن تناول المضادات الحيوية، المضادات الحيوية يُفترض أنه
+
+25
+00:01:53,450 --> 00:01:57,270
+يُعالج الأمراض، لكن هناك بعض الأمراض تنتج عن تناول
+
+26
+00:01:57,270 --> 00:02:01,410
+المضادات الحيوية، منها اللي هو pseudomembranous colitis، هو
+
+27
+00:02:01,410 --> 00:02:05,850
+سميت antibiotic-induced pseudomembranous colitis
+
+28
+00:02:05,850 --> 00:02:12,290
+لماذا؟ لأن سبب حدوث المرض هو استخدام إما for a
+
+29
+00:02:12,290 --> 00:02:15,280
+long period، أو استخدام broad growth spectrum
+
+30
+00:02:15,280 --> 00:02:19,360
+antibiotic، كـ treatment، أقل من البكتيريا اللي
+
+31
+00:02:19,360 --> 00:02:21,860
+هو من الميكروبيوم، البكتيريا دي صارت كانتها
+
+32
+00:02:21,860 --> 00:02:25,580
+proliferation from sensing antitoxin A و antitoxin
+
+33
+00:02:25,580 --> 00:02:29,240
+B، وعملت الـ disease تبعها، فمن هنا سميت antibiotic
+
+34
+00:02:29,240 --> 00:02:34,860
+-induced pseudomembranous colitis، Clostridium
+
+35
+00:02:34,860 --> 00:02:38,240
+difficile جونا هي عبارة عن normal flora of the
+
+36
+00:02:38,240 --> 00:02:44,340
+gastrointestinal tract، البكتيريا موجودة في حوالي
+
+37
+00:02:44,340 --> 00:02:47,660
+يمكن خمسة إلى عشرة في المئة، وتزداد نسبتها في
+
+38
+00:02:47,660 --> 00:02:51,700
+المستشفيات، بمعنى، يعني لو روحنا وعملنا survey في
+
+39
+00:02:51,700 --> 00:02:54,020
+الناس اللي نايمين في المستشفيات، هتلاقي النسبة قد
+
+40
+00:02:54,020 --> 00:02:57,500
+تصل إلى ثلاثين في المئة، كـ normal microbiota، لكن
+
+41
+00:02:59,130 --> 00:03:03,110
+احنا بنذكر الميكروب ده كمثال على شغلتين رئيسيتين،
+
+42
+00:03:03,110 --> 00:03:07,330
+cause of nosocomial diarrhea، رقم اثنين، antibiotic
+
+43
+00:03:07,330 --> 00:03:12,570
+-produced induced pseudomembranous colitis، يعني كان
+
+44
+00:03:12,570 --> 00:03:15,690
+سببها، أو كان سبب حدوثها هو استخدام، كنا الـ
+
+45
+00:03:15,690 --> 00:03:21,380
+antibiotics، على سبيل المثال، في الـ Clindamycin
+
+46
+00:03:21,380 --> 00:03:24,400
+antibiotic، مشهور جدًا، هذا الـ antibiotic، أنه إذا
+
+47
+00:03:24,400 --> 00:03:28,260
+تناوله الإنسان، احتمالية إصابته بـ pseudomembranous
+
+48
+00:03:28,260 --> 00:03:31,940
+colitis بتكون عالية جدًا، لكن بعد هذا الاكتشاف
+
+49
+00:03:31,940 --> 00:03:35,720
+وجدنا أن معظم أنواع الـ antibiotic، إذا أعطيت لفترات
+
+50
+00:03:35,720 --> 00:03:38,540
+طويلة، قد تسبب نفس الإشكالية
+
+51
+00:03:41,060 --> 00:03:43,600
+بتنتج two types of toxins، toxin A هو عبارة عن
+
+52
+00:03:43,600 --> 00:03:45,500
+enterotoxin، كلكم بتعرفوا أن enterotoxin يعني
+
+53
+00:03:45,500 --> 00:03:49,140
+بيؤثر على اللي هو الـ .. الـ .. الـ intestinal tract،
+
+54
+00:03:49,140 --> 00:03:52,660
+toxin B عبارة عن cytotoxin، والـ cytotoxin هذا
+
+55
+00:03:52,660 --> 00:03:56,360
+بيعمل tissue damage، أو cell damage، الـ disease
+
+56
+00:03:56,360 --> 00:04:00,360
+occurs if the organism proliferates to a number،
+
+57
+00:04:00,360 --> 00:04:02,720
+فاكرين الـ .. الـ كلمة اللي قلنا عنها، quorum
+
+58
+00:04:02,720 --> 00:04:05,760
+sensing، إن الـ number تبعها، غالبًا الـ quorum
+
+59
+00:04:05,760 --> 00:04:10,610
+sensing تبعها عشرة أس خمس لكل جرام، فإذا وصل رقمها
+
+60
+00:04:10,610 --> 00:04:15,130
+لهذا الرقم، تبدأ تنتج toxin A و toxin B، لذلك أحد الـ
+
+61
+00:04:15,130 --> 00:04:18,890
+detection methods للبكتيريا، إذا عزلتها
+
+62
+00:04:18,890 --> 00:04:22,680
+من الـ stool تبع المريض، هل يعني ذلك شيئًا؟ طب هي
+
+63
+00:04:22,680 --> 00:04:26,740
+normal flora، لكن لو وجدت toxins في الـ stool، هذا يعني
+
+64
+00:04:26,740 --> 00:04:30,240
+شيئًا، معناه أنها وصلت في الـ stool إلى large
+
+65
+00:04:30,240 --> 00:04:34,060
+numbers، إلى large numbers، وبالتالي أنا أقدر
+
+66
+00:04:34,060 --> 00:04:37,900
+أقول لكم أنه بكل أمانة ودقة، نستطيع أن نشخص المرضى
+
+67
+00:04:37,900 --> 00:04:40,900
+المصابين بـ antibiotic-induced pseudomembranous
+
+68
+00:04:40,900 --> 00:04:44,600
+colitis، عن طريق الـ detection للـ toxin A و toxin B
+
+69
+00:04:44,600 --> 00:04:48,260
+ومتوفّر هذا الفحص في العالم، لكن في غزة للأسف مش
+
+70
+00:04:48,260 --> 00:04:52,040
+متوفر، اللي في .. لغرض الـ research، يعني أجرينا بعض
+
+71
+00:04:52,040 --> 00:04:56,700
+الدراسات البحثية، لكن cytotoxin test مش متوفر على
+
+72
+00:04:56,700 --> 00:04:59,680
+الرغم أنه كمان مرة بيقول هي الـ bacteria number one
+
+73
+00:04:59,680 --> 00:05:02,100
+cause of nosocomial diarrhea، فالأصل أنه يكون
+
+74
+00:05:02,100 --> 00:05:04,320
+بالفعل، يعني cytotoxin test
+
+75
+00:05:07,170 --> 00:05:10,790
+Clostridium novyi A و B، جُن عنهم برضه بيشبهوا الـ
+
+76
+00:05:10,790 --> 00:05:14,970
+Clostridium septicum، وكلاهما بيشبهوا الـ
+
+77
+00:05:14,970 --> 00:05:18,630
+Clostridium perfringens، ولم يُعزل من حالات إلا
+
+78
+00:05:18,630 --> 00:05:21,310
+حالة واحدة، اللي هي myonecrosis، اللي جُن عنها غاز
+
+79
+00:05:21,310 --> 00:05:25,690
+gangrene type B، لم يُعزل من الإنسان، وغالبًا مصاحب
+
+80
+00:05:25,690 --> 00:05:29,430
+للخراف، يعني animal disease وليس human disease
+
+81
+00:05:29,430 --> 00:05:33,070
+بينما type A يُعزل فقط من حالات كمان مرة
+
+82
+00:05:33,070 --> 00:05:34,690
+myonecrosis
+
+83
+00:05:36,840 --> 00:05:41,520
+نيجي لجزء مهم جدًا في المحاضرة بشكل عام، اللي هو
+
+84
+00:05:41,520 --> 00:05:44,940
+الـ isolation and identification of Clostridium، كيف
+
+85
+00:05:44,940 --> 00:05:50,720
+يتم عزل الـ Clostridium، وكيف يتم التعرف عليه، نرجع
+
+86
+00:05:50,720 --> 00:05:54,320
+للقصة القديمة الحديثة، أننا نقسم العينات في رسم
+
+87
+00:05:54,320 --> 00:05:58,620
+الإنسان إلى sterile و non-sterile، إذا كانت العينة
+
+88
+00:05:58,620 --> 00:06:02,080
+اللي بنعزل منها sterile، فهي بسيطة وسهلة، زي مثلًا
+
+89
+00:06:02,080 --> 00:06:05,520
+blood culture، بنزرعها على blood culture bottle
+
+90
+00:06:05,520 --> 00:06:10,660
+under CO2، تحت ظروف لاهوائية، وفي نفس الوقت بنعملها
+
+91
+00:06:10,660 --> 00:06:14,480
+subculture، بعد 24 ساعة أو 48 ساعة، و repeatedly
+
+92
+00:06:14,480 --> 00:06:17,980
+until it produces positive or negative results
+
+93
+00:06:18,660 --> 00:06:21,200
+بنزرعها على إيش؟ الـ subculture على blood agar
+
+94
+00:06:21,200 --> 00:06:24,280
+plates، والـ blood agar plates بنزرعها أو بنحضنها
+
+95
+00:06:24,280 --> 00:06:28,720
+على إيش كمان؟ على ظروف لاهوائية، والمستعمرات اللي
+
+96
+00:06:28,720 --> 00:06:33,120
+بتطلع، بنبدأ نتعرف عليها، مين ممكن يطلع على blood
+
+97
+00:06:33,120 --> 00:06:37,260
+agar under anaerobic condition؟ كتير من البكتيريا
+
+98
+00:06:37,260 --> 00:06:41,020
+.. كتير من البكتيريا، لكن لما نتكلم احنا على
+
+99
+00:06:41,020 --> 00:06:46,080
+sterile source، هيطلع عندنا في الغالب أنه واحد، مش
+
+100
+00:06:46,080 --> 00:06:50,200
+ضروري كلسترديوم، أنه واحد، كيف سنتعرف عليه؟ هذا
+
+101
+00:06:50,200 --> 00:06:53,580
+الـ أمر، رقم اثنين من العينات، اللي هم الـ non
+
+102
+00:06:53,580 --> 00:06:56,620
+-sterile، non-sterile specimen، زي الـ wounds أو الـ
+
+103
+00:06:56,620 --> 00:07:00,820
+tissue اللي هي مصابة، أو الـ stool، whatsoever، هذه مش
+
+104
+00:07:00,820 --> 00:07:05,090
+sterile، كيف يتم عزلها؟ ذكرنا هذا الكلام اللي بنحكيه
+
+105
+00:07:05,090 --> 00:07:09,390
+الآن على أساس two techniques، الـ heat treatment
+
+106
+00:07:09,390 --> 00:07:13,050
+technique، والـ alcohol treatment technique، الـ heat
+
+107
+00:07:13,050 --> 00:07:18,310
+treatment، بنسخّن العينة لـ 80 درجة مئوية لمدة 10
+
+108
+00:07:18,310 --> 00:07:21,970
+دقائق، ستموت جميع أنواع البكتيريا ما عدا الـ spore
+
+109
+00:07:21,970 --> 00:07:26,540
+forming bacteria، مظبوط؟ وبالتالي لما بأخذ الـ .. الـ
+
+110
+00:07:26,540 --> 00:07:29,140
+.. الـ .. الـ end product بعد التسخين، وبأزرعه على
+
+111
+00:07:29,140 --> 00:07:32,400
+blood agar، وبعمله incubation لاهوائي، إيش الحاجات
+
+112
+00:07:32,400 --> 00:07:36,920
+المتوقعة عندي؟ مش بالضرورة Bacillus، اللي هي
+
+113
+00:07:36,920 --> 00:07:40,660
+الـ facultative anaerobe بالظبط، وبالتالي أول حاجة بدي
+
+114
+00:07:40,660 --> 00:07:44,600
+أعملها، بدي أعمل عملية اللي هو differentiation بين
+
+115
+00:07:44,600 --> 00:07:47,920
+الـ Bacillus وبين الـ Clostridium، وبـ simple test
+
+116
+00:07:47,920 --> 00:07:51,100
+اللي هو فحص الكاتلاز، test اللي احنا اتفقنا عليه
+
+117
+00:07:51,100 --> 00:07:55,260
+سابقا، لأن الـ alcohol treatment اتفقنا على أنه
+
+118
+00:07:55,260 --> 00:08:02,580
+استخدامنا للكحول مش بـ 70%، إنما بـ 50%، والمدة
+
+119
+00:08:02,580 --> 00:08:07,280
+الزمنية اللي بنستخدمها، بنستخدم لمدة ساعة، يعني 50%
+
+120
+00:08:07,280 --> 00:08:13,240
+لمدة ساعة كاملة، إيش بيعمل الـ 50%? بيقتل جميع أنواع
+
+121
+00:08:13,240 --> 00:08:18,060
+البكتيريا أيضًا ما عدا الـ spore forming، البعض يفضل
+
+122
+00:08:18,060 --> 00:08:20,220
+الـ heat treatment، والآخر يفضل الـ alcohol
+
+123
+00:08:20,220 --> 00:08:24,800
+treatment، لكل منها مزاياها، هذه في الغالب بتعطي
+
+124
+00:08:24,800 --> 00:08:28,120
+فرصة للبكتيريا اللي من نوع Clostridium، إن حتى لو
+
+125
+00:08:28,120 --> 00:08:32,770
+ما كانش فيه spore، إنها تعمل spore formation، يعني
+
+126
+00:08:32,770 --> 00:08:37,770
+التركيز الخفيف من الكحول، تمام، لو البكتيريا كانت
+
+127
+00:08:37,770 --> 00:08:42,650
+vegetative cell، والتقت مع الكحول، بتبدأ تكون spore
+
+128
+00:08:42,650 --> 00:08:48,040
+فهذا بيوفر لها، بينما الحرارة قد تشكّل صدمة للبكتيريا
+
+129
+00:08:48,040 --> 00:08:52,100
+تقتلها قبل ما تكون spore، فمين اللي بينجو؟ فقط الـ
+
+130
+00:08:52,100 --> 00:08:56,480
+spores اللي مكونة أصلًا في العينة؟ عمومًا، الاثنتان
+
+131
+00:08:56,480 --> 00:08:59,460
+متّبعتان، ومستخدَمتان، وبالتالي لا نستطيع أن نقول إن
+
+132
+00:08:59,460 --> 00:09:02,720
+واحدة أفضل من الأخرى، المتوفرة اللي بتيجي تتعملها
+
+133
+00:09:02,720 --> 00:09:06,030
+هي اللي كويسة، من الأوساط الزراعية المستخدمة كـ
+
+134
+00:09:06,030 --> 00:09:08,930
+selective media للكلستريديا، وسط مشهور جدًا اسمه
+
+135
+00:09:08,930 --> 00:09:12,370
+neomycin egg yolk agar، الـ egg yolk اللي هو صفار
+
+136
+00:09:12,370 --> 00:09:16,750
+البيض، يعني من ضمن المكونات تبع الوسط، أضفناها
+
+137
+00:09:16,750 --> 00:09:20,630
+صفار البيض، وهو مادة تحتوي على phospholipids، وتحتوي
+
+138
+00:09:20,630 --> 00:09:25,000
+على proteins بشكل جيد، وvitamins، ويُضاف إليه الـ
+
+139
+00:09:25,000 --> 00:09:29,380
+antibiotic neomycin ليجعله selective، يبقى الـ egg
+
+140
+00:09:29,380 --> 00:09:34,660
+yolk أضيف حتى يجعل الوسط غني بالـ lipids أو الـ
+
+141
+00:09:34,660 --> 00:09:37,740
+phospholipids، بالإضافة إلى vitamins و other
+
+142
+00:09:37,740 --> 00:09:44,220
+compounds، والـ neomycin أضيف حتى يوفر .. يوفر إيش؟
+
+143
+00:09:44,220 --> 00:09:49,340
+selective environment للبكتيريا، وإن إذا أردنا ..
+
+144
+00:09:49,340 --> 00:09:52,000
+وهناك بعض أنواع من الـ Clostridium للأسف بتعمل الـ
+
+145
+00:09:52,000 --> 00:09:54,680
+swarming، والـ swarming صفة لم نذكرها إلا لبكتيريا
+
+146
+00:09:54,680 --> 00:09:59,540
+واحدة سابقًا، لـ Proteus، الآن فينا كمان microbe آخر
+
+147
+00:09:59,540 --> 00:10:02,960
+ممكن يعمل الـ swarming، اللي هو الـ Clostridia، إذا
+
+148
+00:10:02,960 --> 00:10:07,660
+أردنا أن نمنع الـ swarming، فلنقم بزيادة نسبة
+
+149
+00:10:07,660 --> 00:10:10,120
+الأجار في الوسط، من .. من .. ماجدتش نسبة طبيعية
+
+150
+00:10:10,120 --> 00:10:13,670
+أصلًا، واحد ونصف في المئة .. واحد ونصف في المئة ..
+
+151
+00:10:13,670 --> 00:10:17,430
+لحظة، جيدًا، بننصحنا نزيد هنا أربعة إلى ستة في المئة
+
+152
+00:10:17,430 --> 00:10:21,450
+percent agar، إيه السبب؟ وكيف .. ليش .. ليش
+
+153
+00:10:21,450 --> 00:10:24,770
+الزيادة هذه بتقلل من نسبة الـ swarming، هذه نقطة
+
+154
+00:10:24,770 --> 00:10:28,510
+كتير مهمة، أنتم بتعرفوا الـ swarming هو عملية
+
+155
+00:10:28,510 --> 00:10:33,570
+إنتاج، لمين؟ للماء .. للماء .. H2O .. و
+
+156
+00:10:33,570 --> 00:10:39,270
+السباحة في هذا الماء، الآن الأجار معروف عنه بيسموه
+
+157
+00:10:39,270 --> 00:10:42,610
+hygroscopic، hygroscopic يعني محب للماء، فبيمتصّ
+
+158
+00:10:42,610 --> 00:10:47,110
+الماء، فلما تزيد أنتم نسبة الأجار في الوسط 4 إلى 6%
+
+159
+00:10:47,110 --> 00:10:50,850
+كل ما البكتيريا تنتج جزيء من الماء، بيمتصّه
+
+160
+00:10:50,850 --> 00:10:54,250
+بسهولة، فبالتالي بيعطيها فرصة أنها تنتشر على الوسط،
+
+161
+00:10:54,250 --> 00:10:57,790
+إذن هذه فكرة زيادة نسبة الأجار في الوسط
+
+162
+00:11:00,470 --> 00:11:04,410
+بقول لكم أن احنا مش عملنا تقنيات مختلفة، وزرعنا، أو
+
+163
+00:11:04,410 --> 00:11:08,070
+عملنا selective treatment زي heat treatment، وزي
+
+164
+00:11:08,070 --> 00:11:11,230
+alcohol treatment، وزرعنا على selective media، على
+
+165
+00:11:11,230 --> 00:11:15,350
+أي من هذه الأوساط، إذا نمت البكتيريا، فقم بعمل
+
+166
+00:11:15,350 --> 00:11:20,730
+الفحوصات التالية، أو بأخرى، زرع الأوساط الزراعية
+
+167
+00:11:20,730 --> 00:11:25,510
+التالية، إيش هي الأوساط الزراعية؟ كده مرة، egg yolk agar،
+
+168
+00:11:26,070 --> 00:11:29,130
+كمان مرة، sheep blood agar، ولكل واحد بيكون تعرف
+
+169
+00:11:29,130 --> 00:11:34,590
+الجدول، وتعرف الغرض من الأجار أو الـ media، الـ egg
+
+170
+00:11:34,590 --> 00:11:39,290
+yolk agar بنستخدمه للكشف عن صفة الـ lecithinase و
+
+171
+00:11:39,290 --> 00:11:44,050
+lipase production، وهي صفتان مهمتان جدًا في التفريق
+
+172
+00:11:44,050 --> 00:11:46,830
+بين أنواع الكلستريديا، قدرتها على إنتاج الـ
+
+173
+00:11:46,830 --> 00:11:50,070
+lecithinase، وين ما رأينا معانا الـ lecithinase؟ لما
+
+174
+00:11:50,070 --> 00:11:53,710
+اتكلمنا عن الكلستريديوم perfringens، واتكلمنا عن
+
+175
+00:11:53,710 --> 00:11:58,160
+الـ toxins تبعها، ذكرنا حاجة اسمها alpha toxin، الـ
+
+176
+00:11:
+
+223
+00:15:01,680 --> 00:15:05,540
+هنا شي الأن نيجاتيف يبقي أنا أستطيع من خلال هذا
+
+224
+00:15:05,540 --> 00:15:09,500
+الجدول، وهذا الأن ما هو مطلوب منكم المرة القادمة
+
+225
+00:15:09,500 --> 00:15:12,900
+مش واجب إلي، وواجب إليكم أنكم تفرغوا هذا
+
+226
+00:15:12,900 --> 00:15:17,050
+الجدول على شكل مين؟ شكل chart، كل واحد يعمل chart
+
+227
+00:15:17,050 --> 00:15:20,370
+his own chart to differentiate between the species
+
+228
+00:15:20,370 --> 00:15:23,810
+found in this table. لأول مرة يمر معنا حرف الـ D
+
+229
+00:15:23,810 --> 00:15:27,370
+كان معكم قبل ذلك حرف الـ V اللي هو الـ variable، ها
+
+230
+00:15:27,370 --> 00:15:31,950
+دي نقصد فيها digestion، تمام؟  يعني مش بوزيتيف
+
+231
+00:15:31,950 --> 00:15:33,490
+كده نقول milk digester
+
+232
+00:15:39,820 --> 00:15:42,440
+فيه هنا نقطة كتير مهمة كمان في موضوع الـ
+
+233
+00:15:42,440 --> 00:15:48,000
+toxigenicity assay. الآن، احنا قلنا لكم أنَّ كتير من
+
+234
+00:15:48,000 --> 00:15:54,720
+البكتيريا اللي بتنتج توكسين، بتنتج التوكسين مش لأنَّ
+
+235
+00:15:54,720 --> 00:15:57,640
+هو مولود في الـ chromosome تبعها أو مولود في الـ
+
+236
+00:15:57,640 --> 00:16:01,900
+plasmid تبعها، وإنما ناتج عن إصابة بـ bacteriophage
+
+237
+00:16:01,900 --> 00:16:05,000
+يعني الـ bacteriophage هو اللي خلى البكتيريا تنتج
+
+238
+00:16:05,280 --> 00:16:09,520
+إذا هناك strains مصابة ببكتيروفاج، و strains مش
+
+239
+00:16:09,520 --> 00:16:13,940
+مصابة، وبالتالي واحدة توكسجينك، وواحدة مش توكسجينك
+
+240
+00:16:13,940 --> 00:16:17,860
+إذا، إذا عطلت كلسترديوم، وأنا بدي أعرف إنها
+
+241
+00:16:17,860 --> 00:16:20,220
+توكسيجينك ولا نون توكسجينك، بقدر أعرفها بالـ
+
+242
+00:16:20,220 --> 00:16:24,820
+biochemical test. للأسف لأ، الاتنين بيتشابهوا تمامًا في
+
+243
+00:16:24,820 --> 00:16:28,720
+الـ biochemical test. فكيف بدي أميزهم؟ في فحص اسمه
+
+244
+00:16:28,720 --> 00:16:31,460
+toxicity acid، تمام؟
+
+245
+00:16:36,800 --> 00:16:41,820
+هذا عبارة عن Petri dish. بناخد قطعة مستطيلة من
+
+246
+00:16:41,820 --> 00:16:45,480
+filter paper. هذا الـ filter paper بيكون مغمور بالـ
+
+247
+00:16:45,480 --> 00:16:52,760
+antitoxin. الآن ممكن نزرع بكتيريا
+
+248
+00:16:54,350 --> 00:16:58,410
+بنسميها positive control، وبكتيريا negative control
+
+249
+00:16:58,410 --> 00:17:00,430
+طبعًا تعرفوا يعني إيه negative control؟ يعني بتنتجش
+
+250
+00:17:00,430 --> 00:17:03,670
+توكسين، والـ positive control بتنتج توكسين. الـ test
+
+251
+00:17:03,670 --> 00:17:11,050
+organism نزرعه في المنتصف، وبنخلي
+
+252
+00:17:11,050 --> 00:17:14,610
+الطبق كله في الـ incubation under an aerobic
+
+253
+00:17:14,610 --> 00:17:18,570
+condition. البكتيريا هتنمو، وهتنتج توكسين إذا بتنتج
+
+254
+00:17:18,570 --> 00:17:23,840
+توكسين. الآن الـ Antitoxin فين موجود؟ في الـ filter
+
+255
+00:17:23,840 --> 00:17:28,000
+paper، صح مظبوط؟ الـ filter paper هذا هيعطيني
+
+256
+00:17:28,000 --> 00:17:31,180
+diffusion للـ Antitoxin في كل الطبق، في كل المناطق
+
+257
+00:17:31,180 --> 00:17:34,100
+البكتيريا اللي هتنتج توكسين برضه هيحصل له diffusion
+
+258
+00:17:34,100 --> 00:17:38,360
+إذا صار diffusion من الـ Antitoxin والتوكسين، التقاء
+
+259
+00:17:38,360 --> 00:17:42,240
+مع الـ Antitoxin، اتنين insoluble، هيكون إيه الآن؟
+
+260
+00:17:42,240 --> 00:17:46,060
+هيكون insoluble line of precipitate. احنا ممكن
+
+261
+00:17:46,060 --> 00:17:48,920
+نشوفه، يعني بتوقع أشوف جنب الخط هذا
+
+262
+00:17:53,400 --> 00:17:57,040
+هشوف خط بهذا الشكل، وهشوف خط بهذا الشكل، هدول
+
+263
+00:17:57,040 --> 00:18:00,080
+الخطين عبارة عن إيه دول؟ هدول عبارة عن الـ
+
+264
+00:18:00,080 --> 00:18:03,540
+precipitate الناجم عن التقاء التوكسين مع الـ
+
+265
+00:18:03,540 --> 00:18:05,980
+antitoxin، طبعًا على الجهة الثانية، هذا negative
+
+266
+00:18:05,980 --> 00:18:09,240
+control، معروف أنها ماتنتجش توكسين، مش لازم يتكون
+
+267
+00:18:09,240 --> 00:18:13,590
+خطوط. إذا تكون خطوط عندي هنا أنا على الـ test
+
+268
+00:18:13,590 --> 00:18:17,510
+organism، يبقى الفحص إيه الآن؟ إيه هنا positive؟
+
+269
+00:18:17,510 --> 00:18:22,790
+يعني بتنتج toxin، يعني toxigenic، متفقين على
+
+270
+00:18:22,790 --> 00:18:27,010
+النقطة هذه؟ الآن هذا بنسميه in vitro. ليه in vitro؟
+
+271
+00:18:27,010 --> 00:18:29,790
+لأن عملناها في الطبق، عملناها في الطبق، في عندنا
+
+272
+00:18:29,790 --> 00:18:31,630
+طريقة تانية بنسميها in vivo
+
+273
+00:18:41,290 --> 00:18:51,190
+الـ in vivo، تعرفوا
+
+274
+00:18:51,190 --> 00:18:51,930
+هذا إيه هو؟
+
+275
+00:19:10,940 --> 00:19:17,020
+آه ده فار، وآه ده فار، تمام؟ الآن هدول الفارين، حقنَّا
+
+276
+00:19:17,020 --> 00:19:21,220
+واحد منهم بالـ Antitoxin، شباب، حقنَّاه بالـ
+
+277
+00:19:21,220 --> 00:19:24,100
+Antitoxin تبع الـ Clostridium Perfringens، let's
+
+278
+00:19:24,100 --> 00:19:30,340
+say، والتاني ما حقنَّاهش، وبعد نصف ساعة حقنَّا الاتنين
+
+279
+00:19:30,340 --> 00:19:33,920
+بالبكتيريا، أو بمستخلص البكتيريا اللي احنا بدنا
+
+280
+00:19:33,920 --> 00:19:38,400
+نفحصها، هل هي توكسوجينيك ولا نون توكسوجينيك؟ يفترض إيه
+
+281
+00:19:38,400 --> 00:19:43,210
+اللي يصير؟ احنا حقنَّا Antitoxin، وحقنَّا البكتيريا بنفس
+
+282
+00:19:43,210 --> 00:19:47,510
+التوكسين، هل هيتأثر الفار؟
+
+283
+00:19:47,510 --> 00:19:51,550
+مش هيتأثر، بينما الفار التاني، الفار التاني حصل
+
+284
+00:19:51,550 --> 00:19:56,750
+فيه إيه؟ هيموت. إذا تعالوا نعمل conclusion، خلاصة، أنا
+
+285
+00:19:56,750 --> 00:20:01,910
+حقنت الفار هذا بالـ Antitoxin، وحقنته بالتوكسين وما
+
+286
+00:20:01,910 --> 00:20:06,010
+مات، إيه بنقول؟ أن الـ Antitoxin عمل الـ
+
+287
+00:20:06,010 --> 00:20:10,790
+neutralization لمين؟ للتوكسين، يبقى مين لازم يموت؟
+
+288
+00:20:10,790 --> 00:20:16,050
+هذا الفار. فالآن النتيجة، إذا هذا الفار مات وهذا
+
+289
+00:20:16,050 --> 00:20:22,170
+عاش، يبقى البكتيريا toxigenic، بينما إذا الاتنين
+
+290
+00:20:22,170 --> 00:20:27,230
+ماتوا، إذا الاتنين ماتوا يبقى بكتيريا أخرى، بكتيريا
+
+291
+00:20:27,230 --> 00:20:32,290
+أخرى. إذا الاتنين عاشوا يبقى non-toxigenic. السؤال
+
+292
+00:20:32,290 --> 00:20:37,270
+المحير قعد الآن هنا فين؟ لو هذا مات وهذا بقى
+
+293
+00:20:37,270 --> 00:20:43,010
+حية، إيه بيكون الإجابة؟ قضاء وقدر، وبالتالي
+
+294
+00:20:43,010 --> 00:20:46,190
+الفحص لغي، ليس له أي معنى، ليس له أي معنى، إذا
+
+295
+00:20:46,190 --> 00:20:50,010
+المعنى الحقيقي الـ positive والـ negative إن هذا
+
+296
+00:20:50,010 --> 00:20:54,100
+يبقى حي، وهذا يموت. نعود إلى
+
+297
+00:20:59,750 --> 00:21:03,030
+خلصنا الـ ... الـ ... الـ ... الـ ... الـ in vitro والـ
+
+298
+00:21:03,030 --> 00:21:05,630
+in vivo الـ toxigenicity assay، اللي بيشبهوا مين؟
+
+299
+00:21:05,630 --> 00:21:07,450
+بيشبهوا الـ diphtheria، يعني اللي شرحناهم اليوم
+
+300
+00:21:07,450 --> 00:21:11,470
+هدول مخصصين لمين؟ لبكتيريا الـ diphtheria. بقولنا
+
+301
+00:21:11,470 --> 00:21:15,110
+إذا أردت أن تبحث عن الـ Clostridium Perfringens
+
+302
+00:21:15,110 --> 00:21:18,590
+بعينها، بمعنى آخر، مطلوب منك تبحث عن هذه البكتيريا
+
+303
+00:21:18,590 --> 00:21:22,170
+فقط، فـ ... فقم بتحضير البكتيريا على أربع وأربعين
+
+304
+00:21:22,170 --> 00:21:24,590
+لسه وأربعين درجة مئوية، مؤشر علشان ... علشان
+
+305
+00:21:24,590 --> 00:21:30,230
+البكتيريا محبة للحرارة المرتفعة، وهذا بيرجعنا للـ
+
+306
+00:21:30,230 --> 00:21:33,730
+food poisoning، لما قلنا إن إذا الأغذية حفظت على
+
+307
+00:21:33,730 --> 00:21:36,690
+هذه الـ temperature المرتفعة، قد تنمو البكتيريا
+
+308
+00:21:36,690 --> 00:21:40,790
+وتعمل لنا food poisoning. نيجي للـ treatment، وهو الجزء
+
+309
+00:21:40,790 --> 00:21:45,150
+الأخير من محاضرتنا. الـ treatment للتيتانوس على سبيل
+
+310
+00:21:45,150 --> 00:21:49,250
+المثال، قلنا بيتلخص في كام واحدة؟ شغلتين: إعطاء
+
+311
+00:21:49,750 --> 00:21:51,950
+Antibiotic، اللي هو البنسلين اللي قضى على
+
+312
+00:21:51,950 --> 00:21:56,310
+البكتيريا، و administration of antitoxin، اللي قلنا
+
+313
+00:21:56,310 --> 00:22:00,990
+عليه، قد يستغرق الشفاء أكثر من 6 أسابيع، إذا بتذكروا
+
+314
+00:22:00,990 --> 00:22:06,540
+وكمية كبيرة من الـ antitoxin، لكن كونه العلاج صعب، قد
+
+315
+00:22:06,540 --> 00:22:11,780
+لا ينجح نجاحًا تامًّا، وقد لا يعيد المريض لحالته السابقة
+
+316
+00:22:11,780 --> 00:22:15,100
+فاحنا اتفقنا على أنَّ prevention is all important
+
+317
+00:22:15,100 --> 00:22:18,140
+والـ prevention بيتلخص فيه مجموعة من العناصر
+
+318
+00:22:18,140 --> 00:22:22,360
+active immunization with toxoids، بمعنى أنت بتعطيه
+
+319
+00:22:22,360 --> 00:22:25,520
+الـ toxoid تبع التيتانوس ضمن الـ vaccine اللي سمينا
+
+320
+00:22:25,520 --> 00:22:31,400
+منه DPT. DPT. proper care of wounds، اهتمام جيد
+
+321
+00:22:31,400 --> 00:22:34,440
+بالجروح. اللي اهتمينا بها. رقم تلاتة: prophylactic use
+
+322
+00:22:34,440 --> 00:22:37,660
+of antitoxin. وهذا الكلام كنا بنعمله في قطعتنا
+
+323
+00:22:37,660 --> 00:22:41,100
+الحبيبة. أي واحد يغزّه مسمار ملوث بأي حاجة بيقول له
+
+324
+00:22:41,100 --> 00:22:44,580
+خد لك قبل التيتانوس، تمام؟ أربع administration of
+
+325
+00:22:44,580 --> 00:22:48,140
+penicillin. فالشخص اللي ... الشخص اللي بيتعرض للجروح
+
+326
+00:22:48,140 --> 00:22:52,710
+بياخد proper care of wound، بنعمل له prophylactic
+
+327
+00:22:52,710 --> 00:22:56,350
+antitoxin administration، وبنعطيه antibiotic اللي
+
+328
+00:22:56,350 --> 00:22:59,530
+هو الـ penicillin، لكن هذه بناخدها احنا بشكل روتيني
+
+329
+00:22:59,530 --> 00:23:00,510
+بشكل روتيني، فضل
+
+330
+00:23:08,470 --> 00:23:10,610
+أنت كنت ... أيامك ... أيامك ما كنت غايب وما حضرتش
+
+331
+00:23:10,610 --> 00:23:12,890
+المحاضرة اللي كنت غايب فيها، شرحنا الكلام هذا،
+
+332
+00:23:12,890 --> 00:23:15,750
+قلنا هذه من أسوأ ... من أسوأ العادات اللي ممكن
+
+333
+00:23:15,750 --> 00:23:20,010
+يتخيلها الإنسان، لأنها لن تؤثر ... لن تؤثر على
+
+334
+00:23:20,010 --> 00:23:22,830
+البكتيريا بأي حال من الأحوال، درجة الحرارة هذه،
+
+335
+00:23:22,830 --> 00:23:26,490
+هتحرق الجلد وتموته زيادة، فهتوفر الظروف لها، هوّي
+
+336
+00:23:26,490 --> 00:23:28,990
+أفضل للـ ... فهذا practice سيء للغاية
+
+337
+00:23:32,100 --> 00:23:35,460
+البوتوليزم مايله حل يا شباب، البوتوليزم حله حل واحد
+
+338
+00:23:35,460 --> 00:23:39,540
+إنه يتم تشخيصه، ويعطى المريض الـ Trivalent Antitoxin
+
+339
+00:23:39,540 --> 00:23:41,920
+فاكرين احنا قلنا فيه 8 أنواع من التوكسين، تمانية؟
+
+340
+00:23:41,920 --> 00:23:46,940
+جاتش بتطلعوا هيك، تمانية، أربعة منهم للـ human، واحد
+
+341
+00:23:46,940 --> 00:23:52,060
+منهم نادر الحدوث وموجود في الدنمارك غالبًا، فتلتهم A
+
+342
+00:23:52,060 --> 00:23:57,520
+B وE، فكوّنوا لهم trivalent antitoxin، Anti-A، Anti-B
+
+343
+00:23:57,520 --> 00:24:00,960
+وAnti-E. هدول بنعطيهم للمريض في حالة اللي هو
+
+344
+00:24:00,960 --> 00:24:04,520
+التيتانوس، الـ gas ... عفواً في حالة الـ ... الـ botulism
+
+345
+00:24:04,520 --> 00:24:08,360
+الـ gas gangrene، لأ فيه مشكلة كـ ... أنتو عارفين
+
+346
+00:24:08,360 --> 00:24:12,420
+بيقول لنا أنَّ أحد أهم النقاط في العلاج هو الـ removal
+
+347
+00:24:12,420 --> 00:24:15,220
+أو الـ surgical removal of devitalized tissue
+
+348
+00:24:15,220 --> 00:24:18,220
+الأنسجة الميتة، الحية، وهذا تعبير ودعلكوا لطيف عن
+
+349
+00:24:18,220 --> 00:24:21,620
+عملية الـ butter أو القطع. رقم اتنين اللي هو الـ
+
+350
+00:24:21,620 --> 00:24:23,700
+administration of penicillin لقضاء البكتيريا، أو
+
+351
+00:24:23,700 --> 00:24:26,780
+محاولة لقضاء البكتيريا. رقم تلاتة: administration of
+
+352
+00:24:26,780 --> 00:24:31,380
+antitoxin، إعطاء المريض اللي هو الـ antitoxin. الـ
+
+353
+00:24:31,380 --> 00:24:34,040
+infection due to Clostridium Septicum Anovi
+
+354
+00:24:34,040 --> 00:24:37,780
+similar to gas gangrene، هم نفس المرض، وابتداءً
+
+355
+00:24:37,780 --> 00:24:41,120
+هتتعامل معاهم بنفس اللي هو الطريقة. الخامسة اللي هي
+
+356
+00:24:41,120 --> 00:24:44,360
+pseudomonas colitis، جودنالكو، سببها استخدام
+
+357
+00:24:44,360 --> 00:24:48,600
+antibiotic، لكن برضه علاج بالـ antibiotic، بننزل عددها
+
+358
+00:24:48,600 --> 00:24:53,260
+فبنعطيها vancomycin oral. خد بالك، الـ vancomycin لا
+
+359
+00:24:53,260 --> 00:24:56,840
+يُعطى في الطبيعة oral، بنعطيه injection، لأنه لا
+
+360
+00:24:56,840 --> 00:25:00,700
+يمتص أصلاً في الأمعاء، فليه عطينا oral؟ لأن البكتيريا
+
+361
+00:25:00,700 --> 00:25:04,770
+في الأمعاء، وبدنا تركيزه يكون عالي فين؟ في الأمعاء،
+
+362
+00:25:04,770 --> 00:25:09,210
+وبالتالي أعطينا oral vancomycin. إذا الـ vancomycin
+
+363
+00:25:09,210 --> 00:25:12,970
+لا يُعطى بشكل طبيعي oral، أعطيناها فقط لأنَّ
+
+364
+00:25:12,970 --> 00:25:15,150
+البكتيريا موجودة فين؟ في الأمعاء، وبالتالي بدنا
+
+365
+00:25:15,150 --> 00:25:17,830
+نتخلص منها، وفي حل ثاني مش مذكور عنه هنا، يالا
+
+366
+00:25:17,830 --> 00:25:20,990
+تكتبوه، اللي هو metronidazole، اللي هو الفلاجيل أيضًا،
+
+367
+00:25:20,990 --> 00:25:22,990
+يعني خيار ثاني غير الـ ... غير الـ vancomycin اللي
+
+368
+00:25:22,990 --> 00:25:23,910
+بنعطيه الفلاجيل
+
+369
+00:25:27,640 --> 00:25:32,440
+هذه اللوحة الأخيرة، اللوحة الأخيرة في محاضرتنا، حاجة
+
+370
+00:25:32,440 --> 00:25:35,360
+اسمها Nagler reaction، للأكلستروديوم perfringens
+
+371
+00:25:35,360 --> 00:25:38,320
+ركزوا معايا، الله يرضى عليكم، عشان بس نمضح الفكرة
+
+372
+00:25:38,320 --> 00:25:42,820
+تبع الفحص هذا. الطبق مقسوم من نصين، النص العلوي
+
+373
+00:25:42,820 --> 00:25:48,560
+مسحناه بسواب باستخدام antitoxin، والنص السفلي غير
+
+374
+00:25:48,560 --> 00:25:52,010
+ممسوح بالـ antitoxin، يعني الـ antitoxin ما موجود فوق
+
+375
+00:25:52,010 --> 00:25:54,950
+لما زرعنا البكتيريا، زرعناها بشكل perpendicular على
+
+376
+00:25:54,950 --> 00:25:59,850
+الخط، عمودي، وزرعنا معاها negative control. لحظوا لي
+
+377
+00:25:59,850 --> 00:26:02,930
+في الـ test organism. الجزء السفلي صار فيه نوع من الـ
+
+378
+00:26:02,930 --> 00:26:09,730
+opacity، opacity يعني عتامة أو غبش، تمام؟ الآن بسبب
+
+379
+00:26:09,730 --> 00:26:14,430
+الظبط، هنا مافيش عندي عتامة أو غبش، ليه؟ فوق لأنَّ الـ
+
+380
+00:26:14,430 --> 00:26:18,310
+antitoxin عمل neutralization للتوكسين، بينما هنا
+
+381
+00:26:18,310 --> 00:26:20,390
+مافيش antitoxin عمل neutralization، وبالتالي
+
+382
+00:26:20,390 --> 00:26:24,010
+التوكسين قام بتحويل بعض المركبات، وخلاها
+
+383
+00:26:24,010 --> 00:26:26,870
+diglyceride، الـ diglyceride هذا بيبان على شكل
+
+384
+00:26:26,870 --> 00:26:30,070
+إيه؟ عتامة. إذن هذه نقطة كتير مهمة، سموها الفحص
+
+385
+00:26:30,070 --> 00:26:34,440
+Nagler reaction to Clostridium Perfringens. المرة
+
+386
+00:26:34,440 --> 00:26:36,500
+الجاية إن شاء الله بيكون موضوع جديد. هي سؤال حقيقي
+
+387
+00:26:36,500 --> 00:26:40,680
+عن اللي هو الـ ... الـ Nagler reaction، والمرة الجاية
+
+388
+00:26:40,680 --> 00:26:43,100
+إن شاء الله بيكون فيه موضوع جديد بإذن الله، طبعًا
+
+389
+00:26:43,100 --> 00:26:46,800
+امتحانكم يوم السبت أعتقد؟ متفقين، يوم السبت بنيجي اللي
+
+390
+00:26:46,800 --> 00:26:50,040
+هيكون فيه مراجعة على الساعة تسعة، هيكون فيه مراجعة إن
+
+391
+00:26:50,040 --> 00:26:53,140
+شاء الله للامتحان، تمام؟ فبتكونوا جاهزين أنتم
+
+392
+00:26:53,140 --> 00:26:57,100
+يعني بـ ... بـ ... نعم، جاهزين، واحنا بنجاوب على أسئلتكم
+
+393
+00:26:
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/SOGT4PUCJGQ_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/SOGT4PUCJGQ_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..47329e16114838ce7ed86a1da891520ff4d2adbc
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/SOGT4PUCJGQ_raw.json
@@ -0,0 +1 @@
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"probability": 0.7529296875}, {"start": 713.11, "end": 713.61, "word": " اتكلمنا", "probability": 0.90654296875}, {"start": 713.61, "end": 713.71, "word": " عن", "probability": 0.98828125}, {"start": 713.71, "end": 713.81, "word": " ال", "probability": 0.5576171875}, {"start": 713.81, "end": 714.15, "word": " toxins", "probability": 0.75048828125}, {"start": 714.15, "end": 715.19, "word": " تبعتها،", "probability": 0.77529296875}, {"start": 715.19, "end": 715.61, "word": " ذكرنا", "probability": 0.9495442708333334}, {"start": 715.61, "end": 715.85, "word": " حاجة", "probability": 0.8736979166666666}, {"start": 715.85, "end": 716.09, "word": " اسمها", "probability": 0.8439127604166666}, {"start": 716.09, "end": 716.41, "word": " alpha", "probability": 0.4140625}, {"start": 716.41, "end": 716.93, "word": " toxin", "probability": 0.845703125}], "temperature": 1.0}, {"id": 32, "seek": 73980, "start": 717.76, "end": 739.8, "text": "الـ Alpha-Toxin أسماء أخرى له Phospholipase-C أو لسيثنايز يبقى الليسيثنايز هو الـ Alpha-Toxin فانا بقدر أكشف من خلال الـ Egg Yolk Agar على الليسيثنايز و الليسيثنايز Chopped Meat Broth أو مرق اللحم المقطع بنستخدمه لنشوف هل مقدرة البكتيريا على الـ Digestion ومقدرتها على الIndoor Production لاحظوا شغلة", "tokens": [6027, 39184, 20588, 12, 51, 5230, 259, 5551, 38251, 16606, 5551, 34740, 7578, 46740, 2623, 16378, 401, 647, 651, 12, 34, 34051, 5296, 3794, 1829, 12984, 8315, 1829, 11622, 7251, 3555, 4587, 7578, 13672, 1829, 3794, 1829, 12984, 8315, 1829, 11622, 31439, 2423, 39184, 20588, 12, 51, 5230, 259, 6156, 7649, 995, 4724, 28543, 2288, 5551, 4117, 8592, 5172, 9154, 16490, 1211, 6027, 2423, 39184, 16960, 398, 401, 74, 2725, 289, 15844, 13672, 1829, 3794, 1829, 12984, 8315, 1829, 11622, 4032, 13672, 1829, 3794, 1829, 12984, 8315, 1829, 11622, 761, 17158, 292, 30502, 1603, 900, 34051, 3714, 2288, 4587, 13672, 35571, 9673, 47432, 3615, 44945, 14851, 9778, 40448, 3224, 5296, 1863, 8592, 38688, 8032, 1211, 3714, 28543, 25720, 29739, 4117, 2655, 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"probability": 0.6513671875}, {"start": 731.46, "end": 732.16, "word": " مرق", "probability": 0.966796875}, {"start": 732.16, "end": 732.48, "word": " اللحم", "probability": 0.980712890625}, {"start": 732.48, "end": 733.14, "word": " المقطع", "probability": 0.9739583333333334}, {"start": 733.14, "end": 734.12, "word": " بنستخدمه", "probability": 0.872412109375}, {"start": 734.12, "end": 734.96, "word": " لنشوف", "probability": 0.85107421875}, {"start": 734.96, "end": 735.2, "word": " هل", "probability": 0.8212890625}, {"start": 735.2, "end": 735.52, "word": " مقدرة", "probability": 0.8927408854166666}, {"start": 735.52, "end": 735.96, "word": " البكتيريا", "probability": 0.8939453125}, {"start": 735.96, "end": 736.1, "word": " على", "probability": 0.884765625}, {"start": 736.1, "end": 736.24, "word": " الـ", "probability": 0.59161376953125}, {"start": 736.24, "end": 736.76, "word": " Digestion", "probability": 0.773681640625}, {"start": 736.76, "end": 737.76, "word": " ومقدرتها", 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/SOGT4PUCJGQ_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/SOGT4PUCJGQ_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..6b0353eb6ea466d0176da2506ac85372817817dc
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/SOGT4PUCJGQ_raw.srt
@@ -0,0 +1,1572 @@
+1
+00:00:22,460 --> 00:00:25,620
+بسم الله الرحمن الرحيم استثمارا و يمكن اليوم
+
+2
+00:00:25,620 --> 00:00:27,660
+المحاضرة تكون المحاضرة الأختمية في الموضوع ال
+
+3
+00:00:27,660 --> 00:00:32,380
+prostridium هنكمل اسمين أو تلات اسمات جديدة في ال
+
+4
+00:00:32,380 --> 00:00:35,640
+prostridium ال prostridium septicum و من البداية
+
+5
+00:00:35,640 --> 00:00:40,280
+احنا لما راحنا لسه كنا نبيش بقى إلحاد كبير اللي هو
+
+6
+00:00:40,280 --> 00:00:44,260
+ال prostridium perpendrum و لو أخرنا ال disease ال
+
+7
+00:00:44,260 --> 00:00:47,920
+disease هو حد اللي هو prostridium myocardiumولو
+
+8
+00:00:47,920 --> 00:00:51,400
+ترجعكوا لرقصيكم في الفيلم اللي اسحبناه كمهمها Gas,
+
+9
+00:00:51,500 --> 00:00:54,280
+Cangreen وBang وSin ما يوضحوا أنها نفس اللي هو
+
+10
+00:00:54,280 --> 00:00:59,000
+المعنى أو نفس ال terminology الباتية هنا أنه نقرع
+
+11
+00:00:59,000 --> 00:01:02,920
+روح الأنسجة ووصول إلى الذنب ومتاريها وتأكد من
+
+12
+00:01:02,920 --> 00:01:06,820
+اللوحة ومتاريها ال generalized ده ال generalized
+
+13
+00:01:06,820 --> 00:01:10,020
+infections دي مجموعة من المرضى نادرة من الدوكينيا
+
+14
+00:01:10,020 --> 00:01:13,980
+الاندوكينيا اللي عندهم treatment transplant
+
+15
+00:01:13,980 --> 00:01:17,520
+وبياخته على سبيل المثال immunosuppression talentأو
+
+16
+00:01:17,520 --> 00:01:20,800
+عندهم cancer of the immunotherapy، هذان الحلقات
+
+17
+00:01:20,800 --> 00:01:23,980
+التلاتة أو أي حالة فيها الinsulin بيكون depressed
+
+18
+00:01:23,980 --> 00:01:27,060
+غير أن البكتيريا تعمل و انها generalize
+
+19
+00:01:27,060 --> 00:01:30,400
+الinfection الbistridium difficile أنا بدأت فيها
+
+20
+00:01:30,400 --> 00:01:34,280
+المحاضرة تبع الbistridium بشكل مفصل، و قلت إن هذه
+
+21
+00:01:34,280 --> 00:01:38,780
+البكتيريا هي الميثال رائع جدا على nosocomial
+
+22
+00:01:38,780 --> 00:01:40,680
+infection
+
+23
+00:01:45,690 --> 00:01:49,830
+على الـ Antibiotic-induced diseases يعني أمراض
+
+24
+00:01:49,830 --> 00:01:53,450
+تنتج عن تناول الانتبايدس الانتبايدس يُفترض إنه
+
+25
+00:01:53,450 --> 00:01:57,270
+يعارف الأمراض لكن هناك بعض الأمراض تنتج عن تناول
+
+26
+00:01:57,270 --> 00:02:01,410
+الانتبايدس منها اللي هو pseudomebrania colitis هو
+
+27
+00:02:01,410 --> 00:02:05,850
+سميت antibiotic-induced pseudomebrania colitis
+
+28
+00:02:05,850 --> 00:02:12,290
+لماذا؟ لأن بسبب حدوث المرض هو استخدام إما for the
+
+29
+00:02:12,290 --> 00:02:15,280
+long periodأو استخدام broad growth spectrum
+
+30
+00:02:15,280 --> 00:02:19,360
+antibiotic كإنتجة treatment أقل من البكتيريا اللي
+
+31
+00:02:19,360 --> 00:02:21,860
+هو من الميكروبيوتر البكتيريا دي صارت كانتها
+
+32
+00:02:21,860 --> 00:02:25,580
+proliferation from sensing antitoxin A و Antitoxin
+
+33
+00:02:25,580 --> 00:02:29,240
+B وعملت ال disease تبعها، فمن هنا همارة antibiotic
+
+34
+00:02:29,240 --> 00:02:34,860
+-induced pseudoviraneous proteins Clostridium
+
+35
+00:02:34,860 --> 00:02:38,240
+difficile جونا هي عبارة عن normal flora of the
+
+36
+00:02:38,240 --> 00:02:44,340
+gastrointestinal tractالبكتيريا موجودة في حوالي
+
+37
+00:02:44,340 --> 00:02:47,660
+يمكن خمسة لعشرة في المية وتزداد نسبتها في
+
+38
+00:02:47,660 --> 00:02:51,700
+المستشفيات بمعنى يعني لو روحنا وعملنا survey في
+
+39
+00:02:51,700 --> 00:02:54,020
+الناس اللي نايمين في المستشفيات هلاجي النسبة قد
+
+40
+00:02:54,020 --> 00:02:57,500
+تصلي الى تلاتين في المية ك normal microbiota لكن
+
+41
+00:02:59,130 --> 00:03:03,110
+احنا بنذكر الميكروبه ده كمثال على شغلتين رئيسيتين،
+
+42
+00:03:03,110 --> 00:03:07,330
+cause of nosocomial diarrhea رقم اتنين antibiotic
+
+43
+00:03:07,330 --> 00:03:12,570
+produced induced pseudomonas colitis يعني كان
+
+44
+00:03:12,570 --> 00:03:15,690
+سببها او كان سبب حدوثها هو استخدام كنا ال
+
+45
+00:03:15,690 --> 00:03:21,380
+antibioticsعلى سبب المثال في Clindamycin
+
+46
+00:03:21,380 --> 00:03:24,400
+Antibiotic مشهور جدا هذا ال antibiotic أنه إذا
+
+47
+00:03:24,400 --> 00:03:28,260
+تناقل الإنسان احتمالية إصابته ب Sodium
+
+48
+00:03:28,260 --> 00:03:31,940
+Brionucleitis بتكون عالية جدا لكن بعد هذا الاكتشاف
+
+49
+00:03:31,940 --> 00:03:35,720
+وجدنا أن معظم أنواع ال antibiotic إذا أعطيت لفترات
+
+50
+00:03:35,720 --> 00:03:38,540
+طويلة قد تسبب نفس الإشكالي
+
+51
+00:03:41,060 --> 00:03:43,600
+بتنتج two types of toxin، toxin A هو عبارة عن
+
+52
+00:03:43,600 --> 00:03:45,500
+enterotoxin، كلكم بتعرفوا أن enterotoxin يعني
+
+53
+00:03:45,500 --> 00:03:49,140
+بيأثر على اللي هو ال .. ال .. ال intestinal tract،
+
+54
+00:03:49,140 --> 00:03:52,660
+toxin B عبارة عن cytotoxin، و ال cytotoxin هذا
+
+55
+00:03:52,660 --> 00:03:56,360
+بيعمل tissue damage أو cell damage ال disease
+
+56
+00:03:56,360 --> 00:04:00,360
+occurs if the organism proliferates to a number،
+
+57
+00:04:00,360 --> 00:04:02,720
+فاكرين ال .. ال كلمة اللي قلنا عنها، quorum
+
+58
+00:04:02,720 --> 00:04:05,760
+sensing، إن ال number تبعها، غالباً ال quorum
+
+59
+00:04:05,760 --> 00:04:10,610
+sensing تبعها عشرة أقص خمس لكل gramفإذا وصل رقمها
+
+60
+00:04:10,610 --> 00:04:15,130
+لهذا الرقم تبدأ تنتج تكسين A و تكسين B لذلك أحد ال
+
+61
+00:04:15,130 --> 00:04:18,890
+detection method الشباب لهذه البكتيريا إذا عزلتها
+
+62
+00:04:18,890 --> 00:04:22,680
+من ال stool تبع المريض هل يعني ذلك شيئا؟طب هي
+
+63
+00:04:22,680 --> 00:04:26,740
+normal flora لكن لو لجأت تكسين في الستول هذا يعني
+
+64
+00:04:26,740 --> 00:04:30,240
+شيئا مع الحاجة انه وصلت في الستول الى large
+
+65
+00:04:30,240 --> 00:04:34,060
+numbers الى large numbers وبالتالي انا مقدر
+
+66
+00:04:34,060 --> 00:04:37,900
+اقولكوا انه بكل امانة ودقة نستطيع انه نشخص المرضى
+
+67
+00:04:37,900 --> 00:04:40,900
+المصابين ب antibiotic induced pseudo brain
+
+68
+00:04:40,900 --> 00:04:44,600
+scolitis عن طريق ال detection لتكسين A و تكسين B
+
+69
+00:04:44,600 --> 00:04:48,260
+ومتوفر هذا الفحص في العالم لكن في غزة للأسف مش
+
+70
+00:04:48,260 --> 00:04:52,040
+متوفراللي في .. لغلط ال research يعني أجرينا بعض
+
+71
+00:04:52,040 --> 00:04:56,700
+الدراسات البحثية لكن carotene test مش متوفر على
+
+72
+00:04:56,700 --> 00:04:59,680
+الرغم إنه كمان مرة بيقول هي ال bacteria number one
+
+73
+00:04:59,680 --> 00:05:02,100
+cause of nosocomial diarrhea فالأصل إنه يكون
+
+74
+00:05:02,100 --> 00:05:04,320
+بالفعل يعني carotene test
+
+75
+00:05:07,170 --> 00:05:10,790
+Eclostridium novi A وB جُن عنهم برضه بيشبهوا ال
+
+76
+00:05:10,790 --> 00:05:14,970
+Eclostridium septicum وكلا هما بيشبهوا ال
+
+77
+00:05:14,970 --> 00:05:18,630
+Eclostridium perifringens ولم تعزل من حالات إلا
+
+78
+00:05:18,630 --> 00:05:21,310
+حالة واحدة اللي هي myonecrosis اللي جُن عنها جاز
+
+79
+00:05:21,310 --> 00:05:25,690
+جانجرين type B لم يعزل من الإنسان وغالبا مصاحب
+
+80
+00:05:25,690 --> 00:05:29,430
+الخراف يعني animal disease وليس human disease
+
+81
+00:05:29,430 --> 00:05:33,070
+بينما type A يعزل فقط من حالات كمان مرة
+
+82
+00:05:33,070 --> 00:05:34,690
+myonecrosis
+
+83
+00:05:36,840 --> 00:05:41,520
+نيجي لجزء المهم جدا في المحاضرة بشكل عام اللي هو
+
+84
+00:05:41,520 --> 00:05:44,940
+ال isolation and identification of clostridium كيف
+
+85
+00:05:44,940 --> 00:05:50,720
+يتم عزل ال clostridium و كيف يتم التعرف عليهانرجع
+
+86
+00:05:50,720 --> 00:05:54,320
+للقصة القديمة الحديثة أننا بنقسم العينات في رسم
+
+87
+00:05:54,320 --> 00:05:58,620
+الإنسان إلى sterile وnon-sterile إذا كانت العينة
+
+88
+00:05:58,620 --> 00:06:02,080
+اللي بنعزل منها sterile فهي بسيطة وسهلة زي مثلا
+
+89
+00:06:02,080 --> 00:06:05,520
+blood culture بنزرعها على blood culture bottle
+
+90
+00:06:05,520 --> 00:06:10,660
+under CO2 تحت ظروف الهوائية وفي نفس الوقت بنعملها
+
+91
+00:06:10,660 --> 00:06:14,480
+subculture بعد 24 ساعة أو 48 ساعة و repeatedly
+
+92
+00:06:14,480 --> 00:06:17,980
+until it produces positive or negative results
+
+93
+00:06:18,660 --> 00:06:21,200
+بنزرعها على إيش ال subculture على blood agar
+
+94
+00:06:21,200 --> 00:06:24,280
+plates و ال blood agar plates بنزرعها أو بنحضنها
+
+95
+00:06:24,280 --> 00:06:28,720
+على إيش كمان على ظروف لها هوائية و المستعمرات اللي
+
+96
+00:06:28,720 --> 00:06:33,120
+بتطلع بنبدأ نتعرف عليها مين ممكن يطلع على blood
+
+97
+00:06:33,120 --> 00:06:37,260
+agar under anaerobic condition كتير من البكتيريا
+
+98
+00:06:37,260 --> 00:06:41,020
+.. كتير من البكتيريا لكن لما بنتكلم احنا على
+
+99
+00:06:41,020 --> 00:06:46,080
+sterile source هيطلع عندنا في الغالب ان هو واحدمش
+
+100
+00:06:46,080 --> 00:06:50,200
+ضروري كلسترديوم ان هو واحد كيف سنتعرف عليه هذا
+
+101
+00:06:50,200 --> 00:06:53,580
+امرتعب رقم اتنين من العينات في ان اللي هم ال non
+
+102
+00:06:53,580 --> 00:06:56,620
+-sterile non-sterile specimen زي ال wounds او ال
+
+103
+00:06:56,620 --> 00:07:00,820
+tissue اللي هي مصابة او ال stool whatsoever هذه مش
+
+104
+00:07:00,820 --> 00:07:05,090
+sterileكيف يتم عزلة؟ ذكرنا هذا الكلام اللي بنحكيه
+
+105
+00:07:05,090 --> 00:07:09,390
+الآن على البصلص two techniques ال heat treatment
+
+106
+00:07:09,390 --> 00:07:13,050
+technique وال alcohol treatment technique ال heat
+
+107
+00:07:13,050 --> 00:07:18,310
+treatment بنسخن العينة ل 80 درجة مئوية لمدة 10
+
+108
+00:07:18,310 --> 00:07:21,970
+دقايق ستموت جميع أنواع البكتيريا ما عدا ال spore
+
+109
+00:07:21,970 --> 00:07:26,540
+forming بكتيريا، مظبوط؟وبالتالي لما باخد ال .. ال
+
+110
+00:07:26,540 --> 00:07:29,140
+.. ال .. ال end product بعد التسخين و بأزرعه على
+
+111
+00:07:29,140 --> 00:07:32,400
+بلد أجار و بعمله incubation لهوائي ايش الحاجات
+
+112
+00:07:32,400 --> 00:07:36,920
+المتوجهة عندي؟ مش بالضرورة او Bacillus اللي هي
+
+113
+00:07:36,920 --> 00:07:40,660
+الفكولتية في أنايروب بالظبط وبالتالي أول حاجة بدي
+
+114
+00:07:40,660 --> 00:07:44,600
+اعملها بدي اعمل عملية اللي هو differentiation بين
+
+115
+00:07:44,600 --> 00:07:47,920
+ال Bacillus و بين ال Eclostridium و ب simple test
+
+116
+00:07:47,920 --> 00:07:51,100
+اللي هو فحص الكتاليز test اللي احنا اتفقنا عليه
+
+117
+00:07:51,100 --> 00:07:55,260
+سابقالأن ال alcohol treatment اتفقنا على انه
+
+118
+00:07:55,260 --> 00:08:02,580
+استخدامنا للكحول مش ب 70% انما لمين ل 50% و المدة
+
+119
+00:08:02,580 --> 00:08:07,280
+الزمنية اللى بنستخدمها بنستخدم لمدة ساعة يعني 50%
+
+120
+00:08:07,280 --> 00:08:13,240
+لمدة ساعة كاملةإيش بيعمل ال 50%؟ بيقتل جميع أنواع
+
+121
+00:08:13,240 --> 00:08:18,060
+البكتيريا أيضا ما عدا ال Spore Formة البعض بيفضل
+
+122
+00:08:18,060 --> 00:08:20,220
+ال Heat Treatment والآخر بيفضل ال Alcohol
+
+123
+00:08:20,220 --> 00:08:24,800
+Treatment لكل منها مزاياها هذه في الغالب بتعطي
+
+124
+00:08:24,800 --> 00:08:28,120
+فرصة للبكتيريا اللي من نوع Clostridium إن حتى لو
+
+125
+00:08:28,120 --> 00:08:32,770
+ماكانش فيه Spore إنها تعمل Spore Relationيعني
+
+126
+00:08:32,770 --> 00:08:37,770
+التركيز الخفيف من الكحول تمام لو البكتيريا كانت
+
+127
+00:08:37,770 --> 00:08:42,650
+vegetative cell والتقت مع الكحول بتبدأ تكون sport
+
+128
+00:08:42,650 --> 00:08:48,040
+فهذا بيوفرلها بينما الحرارة قد تشكل صدمةللبكتيريا
+
+129
+00:08:48,040 --> 00:08:52,100
+تقتلها قبل ما تكون sport فمين اللي بينجو فقط ال
+
+130
+00:08:52,100 --> 00:08:56,480
+sports اللي مكونة أصلا في العين؟ عموما التنتين
+
+131
+00:08:56,480 --> 00:08:59,460
+متبعات ومستخدمات وبالتالي لا نستطيع أن نقول إن
+
+132
+00:08:59,460 --> 00:09:02,720
+واحدة أحسن من الأخرى، المتوفرة اللي بتيجي تتعملها
+
+133
+00:09:02,720 --> 00:09:06,030
+هي اللي كويسةمن الأوساط الزراعية المستخدمة ك
+
+134
+00:09:06,030 --> 00:09:08,930
+selective media للإكلاستردية واسط مشهور جدا اسمه
+
+135
+00:09:08,930 --> 00:09:12,370
+Neomycin egg yolk agar ال egg yolk اللي هو صفار
+
+136
+00:09:12,370 --> 00:09:16,750
+البيض يعني من ضمن المكونات تبعت الوسط أضافناها
+
+137
+00:09:16,750 --> 00:09:20,630
+صفار البيض وهو مادة تحتوي على phospholipid وتحتوي
+
+138
+00:09:20,630 --> 00:09:25,000
+على proteins بشكل جيد و vitaminsو يضاف إليه ال
+
+139
+00:09:25,000 --> 00:09:29,380
+antibiotic neomycin ليجعله selective يبقى ال egg
+
+140
+00:09:29,380 --> 00:09:34,660
+yolk أضيف حتى يجعل الوسط غني بال lipids أو ال
+
+141
+00:09:34,660 --> 00:09:37,740
+phospholipids بالإضافة إلى vitamins و other
+
+142
+00:09:37,740 --> 00:09:44,220
+compounds و ال neomycin أضيف حتى يوفر .. يوفر ايش؟
+
+143
+00:09:44,220 --> 00:09:49,340
+selective environment ل البكتيرياوإن إذا أردنا ..
+
+144
+00:09:49,340 --> 00:09:52,000
+وهناك بعض أنواع من الـ Clostridium للأسف بتعمل الـ
+
+145
+00:09:52,000 --> 00:09:54,680
+Swarming والـ Swarming صفة لم نذكرها إلا لبكتيريا
+
+146
+00:09:54,680 --> 00:09:59,540
+واحدة سابقا لـ Protis هالآن فينا كمان Microbe آخر
+
+147
+00:09:59,540 --> 00:10:02,960
+ممكن يعمل الـ Swarming اللي هو الـ Clostridia إذا
+
+148
+00:10:02,960 --> 00:10:07,660
+أردنا أن نمنع الـ Swarming فلنقوم بزيادة نسبة
+
+149
+00:10:07,660 --> 00:10:10,120
+الأجارة في الوسط من .. من .. ماجدتش نسبة طبيعية
+
+150
+00:10:10,120 --> 00:10:13,670
+أصلاواحد و نص في المية .. واحد و نص في المية ..
+
+151
+00:10:13,670 --> 00:10:17,430
+لحظة جديش بينصحنا نزيد هنا اربعة الى ستة في المية
+
+152
+00:10:17,430 --> 00:10:21,450
+percent agar .. ايه السبب و كيف .. ليش .. ليش
+
+153
+00:10:21,450 --> 00:10:24,770
+الزيادة هذه بتقلل من نسبة ال swarming .. هذه نقطة
+
+154
+00:10:24,770 --> 00:10:28,510
+كتير مهمة .. انتوا بتعرفوا ال swarming هو عملية
+
+155
+00:10:28,510 --> 00:10:33,570
+إنتاج لمين .. للميه .. لل water .. H2O .. و
+
+156
+00:10:33,570 --> 00:10:39,270
+السباحة في هذا الماءالان الأجار معروف عنه بيسموه
+
+157
+00:10:39,270 --> 00:10:42,610
+Hygroscopic Hygroscopic يعني محبل الماء فبيمطص
+
+158
+00:10:42,610 --> 00:10:47,110
+الماء فلما تزيد انت نسبة الأجار في الوسط 4 على 6%
+
+159
+00:10:47,110 --> 00:10:50,850
+كل ما البكتيريا تنتج موليكيول من الميه بيمطص
+
+160
+00:10:50,850 --> 00:10:54,250
+بسهولة فبالتالي بيعطيها فرصة انها تنتشر على الوسط،
+
+161
+00:10:54,250 --> 00:10:57,790
+اذا هاي الفكرة من زيادة نسبة الواه الأجار في الميه
+
+162
+00:11:00,470 --> 00:11:04,410
+بقولنا ان احنا مش عملنا تقنيات مختلفة و زرعنا او
+
+163
+00:11:04,410 --> 00:11:08,070
+عملنا selective treatment زي heat treatment و زي
+
+164
+00:11:08,070 --> 00:11:11,230
+alcohol treatment و زرعنا على selective media على
+
+165
+00:11:11,230 --> 00:11:15,350
+اي من هذه الأوساط اذا نمت البكتيريا فقم بعمل
+
+166
+00:11:15,350 --> 00:11:20,730
+الفحوصات التالية او بالاخرى ازرع الأوساط الزراعية
+
+167
+00:11:20,730 --> 00:11:25,510
+التالية ايش هي الأوساط الزراعية كده مرة اجيوك اجار
+
+168
+00:11:26,070 --> 00:11:29,130
+كمان مرة تشيبت 100 أجار و لكل واحد بيكون تعرف
+
+169
+00:11:29,130 --> 00:11:34,590
+الجدول وتعرفه الغرض من الأجار أو ال mediaال إيج
+
+170
+00:11:34,590 --> 00:11:39,290
+يوك أجار بنستخدمه للكشف عن صفة ال lycetinase و
+
+171
+00:11:39,290 --> 00:11:44,050
+lypase production وهي صفتين مهمين جدا في التفريق
+
+172
+00:11:44,050 --> 00:11:46,830
+بين أنواع الكلوستردية قدرتها على إنتاج ال
+
+173
+00:11:46,830 --> 00:11:50,070
+lycetinase، وين ماروا معانا ال lycetinase؟ لما
+
+174
+00:11:50,070 --> 00:11:53,710
+اتكلمنا عن الكلوسترديوم perifringens و اتكلمنا عن
+
+175
+00:11:53,710 --> 00:11:58,160
+ال toxins تبعتها، ذكرنا حاجة اسمها alpha toxinالـ
+
+176
+00:11:58,160 --> 00:12:01,680
+Alpha-Toxin أسماء أخرى له Phospholipase-C أو
+
+177
+00:12:01,680 --> 00:12:05,220
+لسيثنايز يبقى الليسيثنايز هو الـ Alpha-Toxin فانا
+
+178
+00:12:05,220 --> 00:12:07,800
+بقدر أكشف من خلال الـ Egg Yolk Agar على
+
+179
+00:12:07,800 --> 00:12:11,460
+الليسيثنايز و الليسيثنايز Chopped Meat Broth أو
+
+180
+00:12:11,460 --> 00:12:15,960
+مرق اللحم المقطع بنستخدمه لنشوف هل مقدرة البكتيريا
+
+181
+00:12:15,960 --> 00:12:18,800
+على الـ Digestion ومقدرتها على الIndoor Production
+
+182
+00:12:18,800 --> 00:12:23,990
+لاحظوا شغلةالاندول مار معانا في ال gram negative
+
+183
+00:12:23,990 --> 00:12:29,170
+بسلاي لم نتطرق له في ال gram positive كوكساي ولا
+
+184
+00:12:29,170 --> 00:12:32,190
+في ال gram negative كوكساي وهين اتطرقناله في ال
+
+185
+00:12:32,190 --> 00:12:37,010
+gram positive بسلاي اذا في ال بسلاي ل gram
+
+186
+00:12:37,010 --> 00:12:40,770
+negative و في ال بسلاي ل gram positive مهم جدا هذا
+
+187
+00:12:40,770 --> 00:12:44,390
+الفحص لان الوحيدة من الكلستردية اللى درسناها
+
+188
+00:12:44,390 --> 00:12:48,530
+positive اللى درسناها الكلستردية تتانى وهذه ميزة
+
+189
+00:12:48,530 --> 00:12:54,010
+جيدةالملك أجار digestion يعني بنشوف هل البكتيرى
+
+190
+00:12:54,010 --> 00:12:55,850
+عندها المقتل عندها تعمل digestion للملك و لا
+
+191
+00:12:55,850 --> 00:12:58,730
+ماعندهاش جيلاتين أجار و أنت بتعرفوا الجيلاتين لل
+
+192
+00:12:58,730 --> 00:13:02,290
+liquefaction و الباقي من خمسة لعشرة عبارة عن
+
+193
+00:13:02,290 --> 00:13:06,010
+carbohydrate fermentation test and sometimes gas
+
+194
+00:13:06,010 --> 00:13:10,310
+production يعني هل تخمر هذا السكر و هل تنتج غاز من
+
+195
+00:13:10,310 --> 00:13:17,780
+هذا السكر ام لا ال identification لليكلسترديةبغض
+
+196
+00:13:17,780 --> 00:13:20,880
+النظر عن إيش ال media، إيش العينة اللي أنا
+
+197
+00:13:20,880 --> 00:13:24,540
+استخدمتها، طلعت عندي بكتيريا، وطلعت عندي ground
+
+198
+00:13:24,540 --> 00:13:27,740
+positive بس الله، و under anaerobic condition،
+
+199
+00:13:27,740 --> 00:13:31,420
+مشكلة المحصلة النهائية تبعتنا، anaerobic
+
+200
+00:13:31,420 --> 00:13:35,290
+condition، ground positive، بس اللهأول خطوة بدي
+
+201
+00:13:35,290 --> 00:13:39,050
+أعملها بتأكد أنها Clostridia مش بصلص، هعملها فحص
+
+202
+00:13:39,050 --> 00:13:42,770
+من؟ الكتاليز، يبقى فحص الكتاليز رقم واحد، وهذا
+
+203
+00:13:42,770 --> 00:13:47,290
+كتير نقطة مهمة و بتأكدلك و جداش أهمية فحص الكتاليز
+
+204
+00:13:47,290 --> 00:13:51,680
+في الـDifferential Microbiomeالخطوة التانية، أحد
+
+205
+00:13:51,680 --> 00:13:55,360
+الأشياء المشهورة فيها الـ Clostridium Perifringens
+
+206
+00:13:55,360 --> 00:13:57,440
+اللي هي الـ Phospholipase C اللي يكون عنه الـ
+
+207
+00:13:57,440 --> 00:14:00,580
+Cetanase اللي يكون عنه الـ Alpha-Toxin اللي could
+
+208
+00:14:00,580 --> 00:14:06,120
+be detected by إيش؟ By egg yolk agar، الطبق
+
+209
+00:14:06,120 --> 00:14:09,360
+الأولاني، دعنا نطلع على الجدول و نريح .. و نريحكم
+
+210
+00:14:09,360 --> 00:14:14,090
+من هذا الإثارة و ال suspense اللي ممكن تنتجعندي ال
+
+211
+00:14:14,090 --> 00:14:16,670
+species كمان مرة طالع على ال species Clostridium
+
+212
+00:14:16,670 --> 00:14:20,050
+titanium, Perfringens, Botulonium, Septicum,
+
+213
+00:14:20,270 --> 00:14:25,550
+Difficile and Novi A عندي الفحوصات milk لسيثينيز
+
+214
+00:14:25,550 --> 00:14:29,730
+مالش يعني الجدول مش كافي لسيثينيز ليبايز جيلاتين
+
+215
+00:14:29,730 --> 00:14:34,870
+اندولج لكوز مالتوسا كروز سالسين ومانيتل طلعولي على
+
+216
+00:14:34,870 --> 00:14:39,710
+ال .. ال hatch .. ال hatched areas اللي هي المضلة
+
+217
+00:14:39,710 --> 00:14:43,110
+دههتلاقوا انه هذه الأشياء المظلة اللي هي ال
+
+218
+00:14:43,110 --> 00:14:46,430
+distinguishing characteristics مثال الكليستوديوم
+
+219
+00:14:46,430 --> 00:14:48,430
+تتانى مين ال distinguishing characteristics
+
+220
+00:14:48,430 --> 00:14:53,170
+تبعتها؟ في غيرها؟ مافيش غيرها الكليستوديوم
+
+221
+00:14:53,170 --> 00:14:56,830
+perifringens اللي سيثين بس اه في عندى النوبي فيها
+
+222
+00:14:57,620 --> 00:15:01,680
+بس بالاضافة ده الليستين النوفي بتعمل مين؟ ليبايز و
+
+223
+00:15:01,680 --> 00:15:05,540
+هناشي الأن نيجاتيب يبجي أنا أستطيع من خلال هذا
+
+224
+00:15:05,540 --> 00:15:09,500
+الجدول و هذا الأن ما هو مطلوب منكم المرة القادمة
+
+225
+00:15:09,500 --> 00:15:12,900
+مش واجب إلي و واجب إلكوا أنتوا أنكوا تفرغوا هذا
+
+226
+00:15:12,900 --> 00:15:17,050
+الجدول على شكل مين؟شكل chart كل واحد يعمل chart
+
+227
+00:15:17,050 --> 00:15:20,370
+his own chart to differentiate between the species
+
+228
+00:15:20,370 --> 00:15:23,810
+found in this table لأول مرة يمر معانا حرف ال D
+
+229
+00:15:23,810 --> 00:15:27,370
+كان معاكم قبل ذلك حرف ال V اللي هو ال variable هان
+
+230
+00:15:27,370 --> 00:15:31,950
+دي نقصد فيها digestion تمام؟ ميه يعني مش بوستفوري
+
+231
+00:15:31,950 --> 00:15:33,490
+كده نقول milk digester
+
+232
+00:15:39,820 --> 00:15:42,440
+في هنا نقطة كتير مهمة كمان في موضوع الـ
+
+233
+00:15:42,440 --> 00:15:48,000
+toxigenicity assay الآن احنا قلنالكوا انه كتير من
+
+234
+00:15:48,000 --> 00:15:54,720
+البكتيريا اللي بتنتج توكسين بتنتج التوكسين مش لأن
+
+235
+00:15:54,720 --> 00:15:57,640
+هو مولود في ال chromosome تبعها او مولود في ال
+
+236
+00:15:57,640 --> 00:16:01,900
+plasmid تبعتها وانما ناتج عن إصابة ب bacteriophage
+
+237
+00:16:01,900 --> 00:16:05,000
+يعني ال bacteriophage هو اللي خلى البكتيريا تنتج
+
+238
+00:16:05,280 --> 00:16:09,520
+إذا هناك strains مصابة ببكتيروفاج و strains مش
+
+239
+00:16:09,520 --> 00:16:13,940
+مصابة وبالتالي واحدة تكسيجينك واحدة مش تكسيجينك
+
+240
+00:16:13,940 --> 00:16:17,860
+إذا إذا عطلت كلسترديوم أنا و بدي أعرف إنها
+
+241
+00:16:17,860 --> 00:16:20,220
+تكسيجينك ولا نون تكسيجينك بقدر أعرفها بال
+
+242
+00:16:20,220 --> 00:16:24,820
+biochemical test للأسف لأ التنتين بيتشابه تماما في
+
+243
+00:16:24,820 --> 00:16:28,720
+ال biochemical test فكيف بدي أميزهم في فحص اسمه
+
+244
+00:16:28,720 --> 00:16:31,460
+toxicity acid تمام؟
+
+245
+00:16:36,800 --> 00:16:41,820
+هذا عبارة عن petri dish بناخد قطعة مستطيلة من
+
+246
+00:16:41,820 --> 00:16:45,480
+filter paper هذا ال filter paper بيكون مغمور بال
+
+247
+00:16:45,480 --> 00:16:52,760
+antitoxin الان ممكن نزرع بكتيريا
+
+248
+00:16:54,350 --> 00:16:58,410
+بنسميها positive control وبكتيريا negative control
+
+249
+00:16:58,410 --> 00:17:00,430
+طبعا تعرفينش يعني negative control يعني بتنتجش
+
+250
+00:17:00,430 --> 00:17:03,670
+تكسين وال positive control بتنتج تكسين ال test
+
+251
+00:17:03,670 --> 00:17:11,050
+organism نزرعه في المنتصف وبنخلي
+
+252
+00:17:11,050 --> 00:17:14,610
+الطبق كله في ال incubation under an aerobic
+
+253
+00:17:14,610 --> 00:17:18,570
+condition البكتيريا هتنمو و هتنتج تكسين إذا بتنتج
+
+254
+00:17:18,570 --> 00:17:23,840
+تكسينالان الـ Antitoxin وين موجود؟ في ال filter
+
+255
+00:17:23,840 --> 00:17:28,000
+paper صح مظبوط؟ ال filter paper هذا هيعطيني
+
+256
+00:17:28,000 --> 00:17:31,180
+diffusion لل Antitoxin في كل الطبق، في كل المناطق
+
+257
+00:17:31,180 --> 00:17:34,100
+البكتيريا اللي هتنتج تكسين برضه هحصله diffusion
+
+258
+00:17:34,100 --> 00:17:38,360
+إذا صار diffusion من ال Antitoxin والتكسين التقع
+
+259
+00:17:38,360 --> 00:17:42,240
+مع ال Antitoxin اتنت انسليبل، هيكونه ايش الآن؟
+
+260
+00:17:42,240 --> 00:17:46,060
+هيكونه insoluble line of precipitate احنا ممكن
+
+261
+00:17:46,060 --> 00:17:48,920
+نشوفه، يعني بتوقع اشوف جنب الخط هذا
+
+262
+00:17:53,400 --> 00:17:57,040
+هشوف خط بهذا الشكل و هشوف خط بهذا الشكل، هدول
+
+263
+00:17:57,040 --> 00:18:00,080
+الخطين عبارة عن إيش دولة؟ هدول عبارة عن الـ
+
+264
+00:18:00,080 --> 00:18:03,540
+precipitate الناجم عن التقاء التكسين مع الـ
+
+265
+00:18:03,540 --> 00:18:05,980
+antitoxin، طبعا على الجهة التانية، هذا negative
+
+266
+00:18:05,980 --> 00:18:09,240
+control، معروف أنها ماتنتجش تكسين، مش لازم يتكون
+
+267
+00:18:09,240 --> 00:18:13,590
+خطوطإذا تكون خطوط عندي هنا أنا على ال test
+
+268
+00:18:13,590 --> 00:18:17,510
+organism يبقى الفحص إيش الآن؟ إيش هنا positive؟
+
+269
+00:18:17,510 --> 00:18:22,790
+يعني بتنتج toxin يعني toxigenic acid متفقين على
+
+270
+00:18:22,790 --> 00:18:27,010
+النقطة هذه؟ الآن هذا بنسميه in vitro ليش in vitro؟
+
+271
+00:18:27,010 --> 00:18:29,790
+لأنه عملناها في الطبق، عملناها في الطبق، في عندنا
+
+272
+00:18:29,790 --> 00:18:31,630
+طريقة تانية بنسميها in vivo
+
+273
+00:18:41,290 --> 00:18:51,190
+ال in vivo بتعرفوا
+
+274
+00:18:51,190 --> 00:18:51,930
+هذا إيش هو؟
+
+275
+00:19:10,940 --> 00:19:17,020
+أه ده فار و أه ده فار تمام؟ الآن هدول الفرين حقننا
+
+276
+00:19:17,020 --> 00:19:21,220
+واحد منهم بالـ Antitoxin شباب حقنناه بالـ
+
+277
+00:19:21,220 --> 00:19:24,100
+Antitoxin تبع الـ Clostridium Perifringens let's
+
+278
+00:19:24,100 --> 00:19:30,340
+say والتاني ماحقنهوش و بعد نصف ساعة حقننا التنين
+
+279
+00:19:30,340 --> 00:19:33,920
+بالبكتيريا أو بمستخلص البكتيريا اللي احنا بدنا
+
+280
+00:19:33,920 --> 00:19:38,400
+نفحصها هل هي تكسوجينيك ولا non تكسوجينيك يفترض ايش
+
+281
+00:19:38,400 --> 00:19:43,210
+اللي صير؟احنا فينا Antitoxin وحقنت البكتيريا بنفس
+
+282
+00:19:43,210 --> 00:19:47,510
+التوكسين، هل هيتأثر الفار؟
+
+283
+00:19:47,510 --> 00:19:51,550
+مش هيتأثر، بينما الفار التاني، الفار التاني حصل
+
+284
+00:19:51,550 --> 00:19:56,750
+فيه؟ هيموت، إذا تعالوا نعمل conclusion، خلاصة، أنا
+
+285
+00:19:56,750 --> 00:20:01,910
+حقنت الفار هذا بال Antitoxinوحقنتوا بالتوكسين وما
+
+286
+00:20:01,910 --> 00:20:06,010
+مات، إيش بنقول؟ إن الـ Antitoxin عمل ال
+
+287
+00:20:06,010 --> 00:20:10,790
+neutralization لمين؟ للتوكسين، يبقى مين لازم يموت؟
+
+288
+00:20:10,790 --> 00:20:16,050
+هذا الفار، فالآن النتيجة إذا هذا الفار مات و هذا
+
+289
+00:20:16,050 --> 00:20:22,170
+عاش، يبقى البكتيريا toxigenic، بينما إذا التنين
+
+290
+00:20:22,170 --> 00:20:27,230
+ماتواإذا الاتنين ماتوا يبقى بكتيريا أخرى بكتيريا
+
+291
+00:20:27,230 --> 00:20:32,290
+أخرى إذا الاتنين عاشوا يبقى non-toxigenic السؤال
+
+292
+00:20:32,290 --> 00:20:37,270
+المحير قعدت الآن هنا وين؟ لو هذا مات و هذا بقي
+
+293
+00:20:37,270 --> 00:20:43,010
+حقيقيا، إيش بيكون الإجابة؟ قضاء و قدر وبالتالي
+
+294
+00:20:43,010 --> 00:20:46,190
+الفحص لغي، ليس له أي معنى، ليس له أي معنى، إذا
+
+295
+00:20:46,190 --> 00:20:50,010
+المعنى الحقيقي ال positive و ال negative إن هذا
+
+296
+00:20:50,010 --> 00:20:54,100
+يبقى حقيقيا و هذا اموتنعود إلى
+
+297
+00:20:59,750 --> 00:21:03,030
+خلصنا ال .. ال .. ال .. ال .. ال .. in vitro و ال
+
+298
+00:21:03,030 --> 00:21:05,630
+in vivo الـ toxigenist assay اللي بيشبهوا مين؟
+
+299
+00:21:05,630 --> 00:21:07,450
+بيشبهوا الـ diphtheria يعني اللي شرحناهم اليوم
+
+300
+00:21:07,450 --> 00:21:11,470
+هدولة مخصصين لمين؟ لبكتيريا الـ diphtheria بقولنا
+
+301
+00:21:11,470 --> 00:21:15,110
+إذا أردت أن تبحث عن ال eclostridium peripheragens
+
+302
+00:21:15,110 --> 00:21:18,590
+بعينها بمعنى أخر مطلوب منك تبحث عن هذه البكتيريا
+
+303
+00:21:18,590 --> 00:21:22,170
+فقط ف .. فقم بتحضير البكتيريا على أربع و أربعين
+
+304
+00:21:22,170 --> 00:21:24,590
+لست و أربعين درجة مئوية مؤشر علشان .. علشان
+
+305
+00:21:24,590 --> 00:21:30,230
+البكتيريامحبة للحرارة المرتفعة وهذا بيرجعنا لل
+
+306
+00:21:30,230 --> 00:21:33,730
+food poisoning لما قلنا إن إذا الأغذية حفظت على
+
+307
+00:21:33,730 --> 00:21:36,690
+هذه ال temperature المرتفعة قد تنمو البكتيريا
+
+308
+00:21:36,690 --> 00:21:40,790
+وتعملنا food poisoning نيجي لل treatment وهو الجزء
+
+309
+00:21:40,790 --> 00:21:45,150
+الأخير من محاضرتنا ال treatment للتتانوس على سبيل
+
+310
+00:21:45,150 --> 00:21:49,250
+المثال قلنا بيتلخص في كام واحدة شغلتان اعطاء
+
+311
+00:21:49,750 --> 00:21:51,950
+Antibiotic اللى هو البنسالين اللى قضى على
+
+312
+00:21:51,950 --> 00:21:56,310
+البكتيريا و administration of antitoxin اللى قلنا
+
+313
+00:21:56,310 --> 00:22:00,990
+عنه قد يستغرق الشفاء اكتر من 6 أسابيع اذا بتذكروا
+
+314
+00:22:00,990 --> 00:22:06,540
+وكمية كبيرة من ال antitoxin لكن كونه العلاج صعبوقد
+
+315
+00:22:06,540 --> 00:22:11,780
+لا ينجح نجاح تم وقد لا يعيد المريض لحالته السابقة
+
+316
+00:22:11,780 --> 00:22:15,100
+فاحنا اتفقنا على ان ال prevention is all important
+
+317
+00:22:15,100 --> 00:22:18,140
+و ال prevention بيتلخص فيه مجموعة من العناصر
+
+318
+00:22:18,140 --> 00:22:22,360
+active immunization with toxoids بمعنىانت بتعطيه
+
+319
+00:22:22,360 --> 00:22:25,520
+الـ toxoid تبع التيتانوس ضمن ال vaccine اللي سمنا
+
+320
+00:22:25,520 --> 00:22:31,400
+من DPT DPT proper care of wounds اهتمام جيد
+
+321
+00:22:31,400 --> 00:22:34,440
+بالجروح اللي اهتمنا بها رقم تلاتة prophylactic use
+
+322
+00:22:34,440 --> 00:22:37,660
+of antitoxin و هذا الكلام كنا بنعمله في قطعنا
+
+323
+00:22:37,660 --> 00:22:41,100
+الحبيب اي واحد بغزه مصمار ملوث بأي حاجة بيقوله
+
+324
+00:22:41,100 --> 00:22:44,580
+خدلك قبل التيتانوس تمام اربع administration of
+
+325
+00:22:44,580 --> 00:22:48,140
+penicillin فالشخص اللي .. الشخص اللي بتعرض للجروح
+
+326
+00:22:48,140 --> 00:22:52,710
+بياخد proper care of woundبيعملوله prophylactic
+
+327
+00:22:52,710 --> 00:22:56,350
+antitoxin administration وبعتوله antibiotic اللي
+
+328
+00:22:56,350 --> 00:22:59,530
+هو ال penicillin لكن هذه بناخدها احنا بشكل روتيني
+
+329
+00:22:59,530 --> 00:23:00,510
+بشكل روتيني فضل
+
+330
+00:23:08,470 --> 00:23:10,610
+انت كنت .. انت أيامك .. أيامك ماكنت غايب وماحضرتش
+
+331
+00:23:10,610 --> 00:23:12,890
+المحاضرة اللي كنت غايب فيها شرحنا الكلام هذا،
+
+332
+00:23:12,890 --> 00:23:15,750
+قولنا هذه من أسوأ .. من أسوأ العادة اللي ممكن
+
+333
+00:23:15,750 --> 00:23:20,010
+يتخيلها الإنسان لإنه لن تؤثر .. لن تؤثر على
+
+334
+00:23:20,010 --> 00:23:22,830
+البكتيريا بأي حال من الأحوال درجة الحرارة هذه،
+
+335
+00:23:22,830 --> 00:23:26,490
+هتحرج الجلد وتموته بزيادة، فهتوفر الظروف لها هوي
+
+336
+00:23:26,490 --> 00:23:28,990
+أفضل لل .. فهذا practice سيء للغاية
+
+337
+00:23:32,100 --> 00:23:35,460
+البوتوليزم مايله حل يا شباب البوتوليزم حله حل واحد
+
+338
+00:23:35,460 --> 00:23:39,540
+انه تم تشخيصه ويعطى المريض الـ Trivalent Antitoxin
+
+339
+00:23:39,540 --> 00:23:41,920
+فاكرين احنا قولنا فيه 8 أنواع من التوكسين تمانية؟
+
+340
+00:23:41,920 --> 00:23:46,940
+جاتش بتطلعوا هيك تمانية أربعة منهم لل humanواحد
+
+341
+00:23:46,940 --> 00:23:52,060
+منهم نادر الحدوث وموجود في الدنمارك غالبا فتلتهم A
+
+342
+00:23:52,060 --> 00:23:57,520
+B وE فكوّرولهم trivalent antitoxin Anti-A Anti-B
+
+343
+00:23:57,520 --> 00:24:00,960
+وAnti-E هدولة بنعطيهم للمريض في حالة اللي هو
+
+344
+00:24:00,960 --> 00:24:04,520
+التيتانوسال gas .. عفوا في حالة ال .. ال botulism
+
+345
+00:24:04,520 --> 00:24:08,360
+ال gas gangrene لأ فيه مشكلة ك .. انتوا عارفين
+
+346
+00:24:08,360 --> 00:24:12,420
+بيقولنا انه احد اهم النقاط في العلاج هو ال removal
+
+347
+00:24:12,420 --> 00:24:15,220
+او ال surgical removal of debitalized tissue
+
+348
+00:24:15,220 --> 00:24:18,220
+الأنسجة الميتة الحية وهذا تعبير و دالكوا لطيف عن
+
+349
+00:24:18,220 --> 00:24:21,620
+عملية ال butter او القطع رقم اتنين اللي هو ال
+
+350
+00:24:21,620 --> 00:24:23,700
+administration of penicillin لقضاء البكتيريا او
+
+351
+00:24:23,700 --> 00:24:26,780
+محاولة لقضاء البكتيريا رقم تلاتة administration of
+
+352
+00:24:26,780 --> 00:24:31,380
+antitoxin اعطاء المريض اللي هو ال antitoxinال
+
+353
+00:24:31,380 --> 00:24:34,040
+infection due to Clostridium Septicum Anovi
+
+354
+00:24:34,040 --> 00:24:37,780
+similar to gas gangrene هم نفس المرض و ابتدا
+
+355
+00:24:37,780 --> 00:24:41,120
+هتتعامل معاهم بنفس اللي هو الطريقة الخامسة اللي هي
+
+356
+00:24:41,120 --> 00:24:44,360
+pseudomonas colitis جودنالكو سببها استخدام
+
+357
+00:24:44,360 --> 00:24:48,600
+antibiotic لكن برضه علاج بال antibioticبننزل عددها
+
+358
+00:24:48,600 --> 00:24:53,260
+فبنعطيها vancomycin oral خد بالك ال vancomycin لا
+
+359
+00:24:53,260 --> 00:24:56,840
+يُعطى في الطبيعة oral بنعطيه injection لإنه لا
+
+360
+00:24:56,840 --> 00:25:00,700
+يمتص أصلا في الأمعاء فليش عطنا oral لإن البكتيرى
+
+361
+00:25:00,700 --> 00:25:04,770
+في الأمعاء و بدنا تركيزه يكون عالي وين؟في الأمعاوة
+
+362
+00:25:04,770 --> 00:25:09,210
+بالتالي أعطينا oral vancomycin، إذا ال vancomycin
+
+363
+00:25:09,210 --> 00:25:12,970
+لا يُعطى بشكل طبيعي oral، أعطيناها فقط لأن
+
+364
+00:25:12,970 --> 00:25:15,150
+البكتيريا موجودة في وين، في الأمعاوة، بالتالي بدنا
+
+365
+00:25:15,150 --> 00:25:17,830
+نتخلص منها، وفي حل تاني مش مذكور عنه هنا يالا
+
+366
+00:25:17,830 --> 00:25:20,990
+تكتبوه اللي هو metrodazole اللي هو الفلاجيل أيضا،
+
+367
+00:25:20,990 --> 00:25:22,990
+يعني خيار تاني غير ال .. غير ال vancomycin اللي
+
+368
+00:25:22,990 --> 00:25:23,910
+بنعطيه الفلاجيل
+
+369
+00:25:27,640 --> 00:25:32,440
+هذه اللوحة الأخيرة اللوحة الأخيرة في محاضرتنا حاجة
+
+370
+00:25:32,440 --> 00:25:35,360
+اسمها Nagler reaction للأكلستروديوم paraparingens
+
+371
+00:25:35,360 --> 00:25:38,320
+تركزوا معايا الله رضي عليكم عشان بس نمضح الفكرة
+
+372
+00:25:38,320 --> 00:25:42,820
+تبع الفحص هذا الطبق مجسوم من نصين النص العلوي
+
+373
+00:25:42,820 --> 00:25:48,560
+مسحناه بسواب باستخدام antitoxin والنص السفلي غير
+
+374
+00:25:48,560 --> 00:25:52,010
+ممسوح بال antitoxin يعني ال antitoxin ما موجودفوق
+
+375
+00:25:52,010 --> 00:25:54,950
+لما زلعنا البكتيرا زلعناها بشكل perpendicular على
+
+376
+00:25:54,950 --> 00:25:59,850
+الخط عمودي و زلعنا معاها negative control لحظولي
+
+377
+00:25:59,850 --> 00:26:02,930
+في ال test organism الدزء السفلي صار فيه نوع من ال
+
+378
+00:26:02,930 --> 00:26:09,730
+opacity opacity يعني عتامة أو غبش تمام؟ الآن بسبب
+
+379
+00:26:09,730 --> 00:26:14,430
+الظبط هنا مافيش عندي عتامة أو غبش ليش؟ فوقلأن الـ
+
+380
+00:26:14,430 --> 00:26:18,310
+antitoxin عمل neutralization للتوكسين، بينما هنا
+
+381
+00:26:18,310 --> 00:26:20,390
+مافيش antitoxin عمل neutralization، وبتالي
+
+382
+00:26:20,390 --> 00:26:24,010
+التوكسين جام بيتحويل بعض المركبات وخلّها
+
+383
+00:26:24,010 --> 00:26:26,870
+diglyceride، الـ diglyceride هذا بيبين على شكل
+
+384
+00:26:26,870 --> 00:26:30,070
+إيه؟ عتامة، إذن هذه نقطة كتير وهم سموها الفحص
+
+385
+00:26:30,070 --> 00:26:34,440
+Nagler reaction to Clostridium Peripheritisالمرة
+
+386
+00:26:34,440 --> 00:26:36,500
+الجاية ان شاء الله بيكون موضوع جديد هي سؤال حقيقية
+
+387
+00:26:36,500 --> 00:26:40,680
+عن اللي هو ال .. ال nagler reaction و المرة الجاية
+
+388
+00:26:40,680 --> 00:26:43,100
+ان شاء الله بيكون في موضوع جديد بإذن الله طبعا
+
+389
+00:26:43,100 --> 00:26:46,800
+امتحانك يوم السبت أعتقد؟ متفق يوم السبت بنيجي اللي
+
+390
+00:26:46,800 --> 00:26:50,040
+هيكون فيه مراجعة ع الساعة تسعة هيكون فيه مراجعة ان
+
+391
+00:26:50,040 --> 00:26:53,140
+شاء الله ليه الامتحان تمام؟ فبتكونوا جاهزين انتوا
+
+392
+00:26:53,140 --> 00:26:57,100
+يعني ب .. ب .. نعم جاهزين و احنا بنجيب على أسئلتكم
+
+393
+00:26:57,100 --> 00:26:57,460
+ان شاء الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vshf1KAA7wk.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vshf1KAA7wk.srt
new file mode 100644
index 0000000000000000000000000000000000000000..fad2a95e2329e92cb1bb2cfec312e20eef85d6cf
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vshf1KAA7wk.srt
@@ -0,0 +1,1897 @@
+1
+00:00:20,520 --> 00:00:23,260
+بسم الله الرحمن الرحيم اليوم إن شاء الله موضوعنا
+
+2
+00:00:23,260 --> 00:00:27,500
+هيكون عن اللي هو الـ gram-negative diplococci في الـ
+
+3
+00:00:27,500 --> 00:00:31,420
+gram-negative diplococci هنسمع اسمين أو two
+
+4
+00:00:31,420 --> 00:00:35,880
+genera نيسيريا وبرانهاميلا فقط لا غير عندنا
+
+5
+00:00:35,880 --> 00:00:39,660
+مجموعة من الأسماء بنطلع عليهم نيسيريا جنورية
+
+6
+00:00:39,660 --> 00:00:43,940
+نيسيريا ميننغايديس أو meningitis ولاحظوا فيها حرف
+
+7
+00:00:43,940 --> 00:00:47,700
+الـ D بينما المرض meningitis لا يحتوي على حرف الـ
+
+8
+00:00:47,700 --> 00:00:52,390
+D وإنما T فقط. رقم واحد ورقم اثنين are the only
+
+9
+00:00:52,390 --> 00:00:56,510
+true pathogens والباقيين غالباً normal microbiota
+
+10
+00:00:56,510 --> 00:00:59,770
+زي نيسيريا كاتيراليس أو Branhamella catarralis اسمها
+
+11
+00:00:59,770 --> 00:01:03,410
+الآن يبقى هذين الاسمين نيسيريا وBranhamella هنشوفه
+
+12
+00:01:03,410 --> 00:01:06,130
+في الأحد إن شاء الله. كلمة Branhamella نيسيريا سيكا
+
+13
+00:01:06,130 --> 00:01:11,390
+نيسيريا فلافيسنس نيسيريا فلافا نيسيريا ميوكوزا و
+
+14
+00:01:11,390 --> 00:01:14,790
+نيسيريا لاكتاميكا. إذن عندي مجموعة من الأسماء
+
+15
+00:01:14,790 --> 00:01:20,390
+في نيسيريا بنحاول نطلع فيهم كمان مرة ونقرأهم كمان
+
+16
+00:01:20,390 --> 00:01:22,450
+مرة عشان نصير familiar إن شاء الله. نيسيريا
+
+17
+00:01:22,450 --> 00:01:26,510
+جونورية، نيسيريا ميننغايديس، نيسيريا كاتيراليس،
+
+18
+00:01:26,510 --> 00:01:31,630
+كمان مرة. الاسم برانهاميلا كاتيراليس، نيسيريا سيكا،
+
+19
+00:01:31,630 --> 00:01:35,930
+نيسيريا فلافيسنس، نيسيريا فلافا، نيسيريا ميكوزا،
+
+20
+00:01:35,930 --> 00:01:42,330
+نيسيريا لاكتاميكا. الدكتور نايسر الذي على اسمه سميت
+
+21
+00:01:42,330 --> 00:01:46,910
+نايسيريا. مافهمش
+
+22
+00:01:46,910 --> 00:01:51,410
+عليك اسم
+
+23
+00:01:51,410 --> 00:01:54,370
+تسمية جديدة. يعني تفكر أن احنا كتير من الميكروبات
+
+24
+00:01:54,370 --> 00:01:58,490
+اللي درسناهم سابقاً  بقولوا كان نعم، تغيرت، تغيرت
+
+25
+00:01:58,490 --> 00:02:01,370
+الأسماء وتغير الأسماء كمان مرة أو مرة لألف
+
+26
+00:02:01,370 --> 00:02:06,260
+بنقول لكم اللي سبب التغير هو أن تقنياتنا بتتطور
+
+27
+00:02:06,260 --> 00:02:10,020
+فمعلوماتنا بتزداد وبالتالي بنقدر نعرف أن هذا
+
+28
+00:02:10,020 --> 00:02:14,340
+الميكروب لا ينتمي إلى، وخاصة لما عملوا تحليل بالـ GC
+
+29
+00:02:14,340 --> 00:02:17,400
+content. الـ GC content اللي هو الـ guanine cytosine
+
+30
+00:02:17,400 --> 00:02:21,720
+DNA analysis. تمام؟  لجينا أن هذا الـ species بتختلف
+
+31
+00:02:21,720 --> 00:02:24,420
+اختلاف كبير، وعلى فكرة اتغير اسمه أكثر من مرة و
+
+32
+00:02:24,420 --> 00:02:29,500
+هنشوفه كمان إن شاء الله. نعم. Branhamella نيسيريا
+
+33
+00:02:29,500 --> 00:02:36,500
+جونورية. ديبلوكوكاي رائعة جداً مليئة بالـ pili وأحد
+
+34
+00:02:36,500 --> 00:02:40,620
+مكونات الـ virulence تبعها الأساسية هو الـ pili
+
+35
+00:02:40,620 --> 00:02:45,100
+وقدرتها على الـ attachment هي اللي بتخلينا نقول أنه
+
+36
+00:02:45,100 --> 00:02:49,420
+هي قادرة على إحداث disease في منطقة يفترض أن فيها
+
+37
+00:02:49,420 --> 00:02:53,360
+سوائل. السوائل هذه تم الـ wash out للبكتيريا لكن
+
+38
+00:02:53,360 --> 00:02:55,920
+قدرتها على الـ attachment هي اللي بتأهلها للـ
+
+39
+00:02:55,920 --> 00:03:01,910
+infection. الاسم gonorrhea معروف من.. يمكن من سنة
+
+40
+00:03:01,910 --> 00:03:05,990
+مئتين وثلاثين ميلادية. بوسط أحد الأشخاص اسمه جالن
+
+41
+00:03:05,990 --> 00:03:11,410
+لكن الاسم الحقيقي والعلمي أخذ أو أُعطي على اسم
+
+42
+00:03:11,410 --> 00:03:13,950
+العالم اللي اكتشفه، اللي هو نايسر في 1870
+
+43
+00:03:13,950 --> 00:03:20,410
+والتي وصفه، وصفه بمعنى اكتشفه gram-negative
+
+44
+00:03:20,410 --> 00:03:25,820
+diplococci في الصديد المأخوذ من.. المأخوذ من من؟ من
+
+45
+00:03:25,820 --> 00:03:31,880
+الـ purulent discharge لمرضى مصابين بالسيلان. واسم
+
+46
+00:03:31,880 --> 00:03:35,480
+الـ disease gonorrhea باللغة العربية هو السيلان. سمي
+
+47
+00:03:35,480 --> 00:03:40,920
+سيلان لأنه في سائل بيفرز تلقائياً دون تحكم دون
+
+48
+00:03:40,920 --> 00:03:45,240
+سيطرة، وهذا السائل عبارة عن صديد مليء بالبكتيريا
+
+49
+00:03:45,240 --> 00:03:49,320
+فلما أخذ هذا الصديد اللي هو من الـ vaginal أو من
+
+50
+00:03:49,320 --> 00:03:53,160
+الـ urethral أو حتى من الـ conjunctiva تبع الأطفال
+
+51
+00:03:53,160 --> 00:03:57,480
+حديثي الولادة الذين يولدون لأمهات مصابات بمن
+
+52
+00:03:57,480 --> 00:04:01,420
+بالنيسيريا جونورية لَجَد جرام negative diplococci
+
+53
+00:04:01,440 --> 00:04:06,260
+فتكريماً له سميت البكتيريا بعد ذلك على اسمه نيسيريا
+
+54
+00:04:06,260 --> 00:04:14,060
+لكن كلمة جونورية كمرض قديمة جداً. الآن هنا في
+
+55
+00:04:14,060 --> 00:04:18,680
+الجملة الثانية أو الثالثة مكتوب جونورية is the most
+
+56
+00:04:19,570 --> 00:04:22,250
+prevalent venereal disease. إيش يعني the most
+
+57
+00:04:22,250 --> 00:04:25,830
+prevalent؟ هي الأكثر انتشاراً، بس هي المعلومة مش
+
+58
+00:04:25,830 --> 00:04:29,310
+حقيقية الآن، هي رقم اثنين الآن، بدل ما رقم واحد
+
+59
+00:04:29,310 --> 00:04:33,310
+أصبحت، صارت رقم إيه؟ رقم اثنين. برضه مش معنى الحكي
+
+60
+00:04:33,310 --> 00:04:36,210
+أنه صار فيه تغيير في الـ epidemiology. معلوماتنا
+
+61
+00:04:36,210 --> 00:04:40,110
+زادت، قدرتنا على الكشف عن الميكروب الأولاني
+
+62
+00:04:40,110 --> 00:04:44,320
+تحسنت، اللي هو الـ Chlamydia. الكلاميديا فاكرين هي
+
+63
+00:04:44,320 --> 00:04:48,760
+obligate intracellular parasites. وزراعة أو زراعة الـ
+
+64
+00:04:48,760 --> 00:04:51,660
+obligate intracellular parasites أمر ليس بالسهل
+
+65
+00:04:51,660 --> 00:04:56,540
+وبالتالي لما تطورت قدرتنا على الـ detection لجينا
+
+66
+00:04:56,540 --> 00:05:00,100
+لأ، لجينا أن الكلاميديا هي number one والنيسيريا هي
+
+67
+00:05:00,100 --> 00:05:05,490
+number two. عادةً، حتى رقم اثنين لما نتكلم عن نسبة
+
+68
+00:05:05,490 --> 00:05:09,630
+الانتشار تبعها globally في العالم، هلاقيها ضخمة جداً
+
+69
+00:05:09,630 --> 00:05:14,230
+نتكلم عن ملايين بل بلايين الأشخاص مصابين سنوياً
+
+70
+00:05:14,230 --> 00:05:21,150
+بهذا الـ microbe، الـ Chlamydia؟ لأ، الـ Chlamydia حاجة
+
+71
+00:05:21,150 --> 00:05:25,310
+ثانية خالص يا ابني. أنا قلت الـ Chlamydia اللي هي
+
+72
+00:05:25,310 --> 00:05:28,110
+obligate intracellular parasites. اتخذناها هي والـ
+
+73
+00:05:28,110 --> 00:05:31,500
+Rickettsia. الـ Chlamydia في أول فصل. Gonorrhea جُنّا
+
+74
+00:05:31,500 --> 00:05:34,800
+is the most لكنها الآن عدّلت، المعلومة عدّلت أنها
+
+75
+00:05:34,800 --> 00:05:38,300
+the second most، the second most مش the first most
+
+76
+00:05:38,300 --> 00:05:41,200
+the primary infection with Neisseria gonorrhoeae
+
+77
+00:05:41,200 --> 00:05:43,840
+although uncomfortable. وهذه النقطة بدنا نفهمها
+
+78
+00:05:43,840 --> 00:05:49,180
+كويس. كلمة uncomfortable يعني بتعطيك شعور بعدم
+
+79
+00:05:49,180 --> 00:05:53,580
+الراحة. إيش يعني عدم الشعور أو الشعور بعدم
+
+80
+00:05:53,580 --> 00:05:59,350
+الراحة؟ يعني مضايق. هل الإنسان اللي عنده ضيق يعني
+
+81
+00:05:59,350 --> 00:06:02,870
+زي واحد، أكرمكم الله، لابس حذاء شد على رجله شوية
+
+82
+00:06:02,870 --> 00:06:07,570
+جديد أو لابس بنطلون ضيق أو مش مرتاح في جلسته
+
+83
+00:06:07,570 --> 00:06:11,650
+تبعته كويس، مش مرتاح. هل هي مدعاة للذهاب للطبيب؟
+
+84
+00:06:11,650 --> 00:06:15,810
+مش مدعاة للذهاب للطبيب وبالتالي الـ symptoms مش
+
+85
+00:06:15,810 --> 00:06:20,850
+severe ولا painful، ولا painful. وبالتالي المريض
+
+86
+00:06:20,850 --> 00:06:28,180
+غالباً ما يزور، ما يزور الطبيب إلا طبعاً لما
+
+87
+00:06:28,180 --> 00:06:30,500
+يصير complications، لما يصير فيه عنده complications
+
+88
+00:06:30,500 --> 00:06:34,960
+الآن في الفترة اللي كان فيها الـ symptoms بسيطة
+
+89
+00:06:34,960 --> 00:06:39,640
+بيمارس حياته الطبيعية وبالتالي هو مصدر مهم جداً
+
+90
+00:06:39,640 --> 00:06:44,480
+لنقل العدوى للآخرين. بينقل لأنه STD. مع من يمارس
+
+91
+00:06:44,480 --> 00:06:47,800
+الجنس بينقل لهم هؤولاء الميكروبات، وإذا كان الآخرين
+
+92
+00:06:47,800 --> 00:06:50,900
+يمارسون الجنس مع أشخاص آخرين أيضاً، كمان بتنتقل لهم
+
+93
+00:06:50,900 --> 00:06:54,760
+الميكروبات. ودلعلم، ومعرفش أنا، ممكن ناقشنا الموضوع
+
+94
+00:06:54,760 --> 00:06:59,960
+حاجة اللي هي كده. إن موضوع الشخص الواحد بيعمل لو
+
+95
+00:06:59,960 --> 00:07:03,380
+عمل متوسط خمس علاقات في السنة، وكل واحد من هؤولاء
+
+96
+00:07:03,380 --> 00:07:07,260
+الخمس عمل كمان خمس علاقات. مدى الحكي، شبكة network
+
+97
+00:07:07,260 --> 00:07:11,660
+لو واحد منهم مصاب ممكن ينقل لكل هؤلاء الناس. إذا
+
+98
+00:07:11,660 --> 00:07:15,060
+عشان هيك بيقول أن الـ STD في العالم الغربي منتشر
+
+99
+00:07:15,060 --> 00:07:19,380
+جداً بينما في العالم الإسلامي والحمد لله limited
+
+100
+00:07:19,380 --> 00:07:26,040
+very limited. طيب يبقى اتفقنا أن عدم وجود severity
+
+101
+00:07:26,040 --> 00:07:31,000
+للـ disease مدعاة لعدم الذهاب للطبيب، مدعاة لعدم
+
+102
+00:07:31,000 --> 00:07:36,640
+التشخيص. كمان حسابها في ضمن الأعداد قد يقل لذلك
+
+103
+00:07:36,640 --> 00:07:40,980
+ما بنعطيهاش الرقم الحقيقي. يعني لو نقول نسبة الإصابة
+
+104
+00:07:40,980 --> 00:07:46,760
+بالنيسيريا جونورية هذا العام مليون إصابة. مليون هؤولاء
+
+105
+00:07:46,760 --> 00:07:50,140
+اللي راحوا وعملوا لهم diagnosis بس في جدهم ممكن أو
+
+106
+00:07:50,140 --> 00:07:54,640
+أكثر ما راحوا. يبقى احنا بنقدر نقول أن الـ numbers
+
+107
+00:07:54,640 --> 00:07:59,080
+المعلنة are underestimated. يعني تقدير أقل
+
+108
+00:07:59,080 --> 00:08:03,460
+مما هو متوقع أو حقيقي. جملة الأخيرة برح نفهم الغلط
+
+109
+00:08:03,460 --> 00:08:07,660
+Man is the only known host for the organism. ما
+
+110
+00:08:07,660 --> 00:08:10,640
+المقصود فيه أنا مين؟ الإنسان. يعني البشر هم
+
+111
+00:08:10,640 --> 00:08:14,100
+الوحيدين اللي بيصابوا. عشان هيك احنا دائماً بنقول أن
+
+112
+00:08:14,100 --> 00:08:16,980
+sexual transmitted diseases are specifically
+
+113
+00:08:16,980 --> 00:08:20,620
+designed for those who are committing the crime of
+
+114
+00:08:20,620 --> 00:08:24,860
+sexual activity outside marriage relation. خارج
+
+115
+00:08:24,860 --> 00:08:29,940
+العلاقة، الإطار الشرعي للعلاقة الجنسية. من يرتكبها
+
+116
+00:08:29,940 --> 00:08:33,880
+هذه الميكروبات المصممة، اللي هم حتى يعني تستطيع
+
+117
+00:08:33,880 --> 00:08:39,840
+أن تقول. يعني البعض كان يثير نقاط: هل يمكن لشخص مصاب
+
+118
+00:08:39,840 --> 00:08:44,620
+بالنيسيريا جونورية يدخل بركة سباحة واحنا دخلنا
+
+119
+00:08:44,620 --> 00:08:48,560
+معه بركة سباحة أو بعدين؟ هل ممكن أن تنتقل منه
+
+120
+00:08:48,560 --> 00:08:56,920
+للاخرين؟ لأ. لو دخلنا حمام استخدمه شخص مصاب
+
+121
+00:08:56,920 --> 00:09:00,640
+بالنيسيريا جونورية واستخدمنا الحمام هذا بعده، هل
+
+122
+00:09:00,640 --> 00:09:07,130
+يمكن أن نصاب؟ غالباً لأ. المؤشر ليش؟ على أنه sexually
+
+123
+00:09:07,130 --> 00:09:12,330
+transmitted فقط. sexually transmitted والدليل على
+
+124
+00:09:12,330 --> 00:09:16,590
+ذلك لما نجي نتكلم عن جمع العينات. البكتيريا توصف على
+
+125
+00:09:16,590 --> 00:09:19,990
+أنها fragile. إيش يعني fragile؟ هشة أو بيقولوا عنها
+
+126
+00:09:19,990 --> 00:09:23,750
+delicate. delicate يعني رقيقة. إذا تعرضت لأي
+
+127
+00:09:23,750 --> 00:09:29,290
+condition. لو، لو، للـ trace. كلمة trace مايعني trace؟
+
+128
+00:09:30,390 --> 00:09:35,390
+آثار متبقية قليلة. من أي disinfectant ممكن تموت لو
+
+129
+00:09:35,390 --> 00:09:39,290
+تعرضت للجفاف، ممكن تموت شوية حرارة 37 درجة ماء ممكن تموت. إذا الـ bacteria
+
+130
+00:09:39,290 --> 00:09:43,450
+37 درجة ماء ممكن تموت. إذا البكتيريا
+
+131
+00:09:43,450 --> 00:09:49,010
+specifically designed for this purpose. ورسول الله
+
+132
+00:09:49,010 --> 00:09:54,470
+الكريم أخبرنا يعني بهذا الكلام منذ زمن بعيد، أكثر
+
+133
+00:09:54,470 --> 00:09:58,230
+من 1440 سنة لما أخبرنا أنه
+
+134
+00:09:58,230 --> 00:10:03,090
+بمعنى الحديث. إذا ظهرت الفاحشة في قوم، ما ظهرت الفاحشة
+
+135
+00:10:03,090 --> 00:10:07,750
+في قوم قط حتى يعلنوا بها. وكلمة يعلنوا بها يعني أن
+
+136
+00:10:07,750 --> 00:10:12,630
+تكون واضحة للعيان في الشوارع، في الطرقات، في الحدائق
+
+137
+00:10:12,630 --> 00:10:16,370
+زي ما بيصير في الغرب، إلا وظهرت فيهم أمراض لم تكن
+
+138
+00:10:16,370 --> 00:10:22,740
+فيه سابقاً. هل الشرط تحقق يبقى النتيجة حتمية. إذا
+
+139
+00:10:22,740 --> 00:10:26,080
+الشرط تحقق فالنتيجة حتمية. ما ظهرت الفاحشة في قوم
+
+140
+00:10:26,080 --> 00:10:29,820
+قط حتى يعلنوا بها إلا وظهرت فيهم أو كما قال
+
+141
+00:10:29,820 --> 00:10:30,480
+صلى الله عليه وسلم
+
+142
+00:10:37,180 --> 00:10:39,300
+المعلومات كلها بتشير،  الأدلة الأجنبية أنها
+
+143
+00:10:39,300 --> 00:10:43,400
+specifically designed as.. it is gram-negative
+
+144
+00:10:43,400 --> 00:10:47,300
+diplococci oxidase. وهذه نقطة أساسية في الـ
+
+145
+00:10:47,300 --> 00:10:51,080
+diagnosis. إذا لَجَدْت gram-negative diplococci you
+
+146
+00:10:51,080 --> 00:10:55,920
+should do oxidase test. طب أنت خائف من من؟ خائف من من؟
+
+147
+00:10:55,920 --> 00:10:59,780
+إذا اكتشف عن مين؟ عمال ما فيش عين دي gram-negative
+
+148
+00:10:59,780 --> 00:11:01,720
+.. هي gram-negative diplococci
+
+149
+00:11:08,060 --> 00:11:13,960
+الأسينيتوباكتر may mimic
+
+150
+00:11:13,960 --> 00:11:18,760
+نيسيريا
+
+151
+00:11:18,760 --> 00:11:22,480
+جونورية. لذلك الفرق الأساسي بينهم هو الـ oxidase
+
+152
+00:11:22,480 --> 00:11:25,740
+test. نيسيريا is oxidase positive while this
+
+153
+00:11:25,740 --> 00:11:31,390
+bacteria is oxidase negative. كمان نقطة كثيرة مهمة
+
+154
+00:11:31,390 --> 00:11:35,150
+رقم ثلاثة. جملة رقم ثلاثة. احنا بنعمل three
+
+155
+00:11:35,150 --> 00:11:38,670
+carbohydrate oxidation test عشان نميز النيسيريا
+
+156
+00:11:38,670 --> 00:11:45,290
+عن بعض. تمام؟ بنعمل جلوكوز ومالتوز وسكروز
+
+157
+00:11:45,290 --> 00:11:49,010
+هذول الثلاثة سكريات. بنعملهم. النيسيريا جونورية is
+
+158
+00:11:49,010 --> 00:11:52,450
+positive only for جلوكوز اللي هو الـ glucose، but
+
+159
+00:11:52,450 --> 00:11:59,070
+negative for مالتوز and سكروز. طب نميزها عن
+
+160
+00:11:59,070 --> 00:12:03,590
+إيش؟ وبإيش؟ نميزها عن النيسيريا مننجايديس
+
+161
+00:12:03,590 --> 00:12:07,170
+النيسيريا مننجايديس. إيش مواصفاتها؟ Gram
+
+162
+00:12:07,170 --> 00:12:11,610
+negative diplococci وOxidase positive وجلوكوز positive
+
+163
+00:12:11,610 --> 00:12:16,910
+وزائد مالتوز positive. بما أن نيسيريا جونورية مالتوز إيش؟
+
+164
+00:12:16,910 --> 00:12:20,090
+يبقى هذه من الآن نبقى عارفين.. نبقى عارفين هذه
+
+165
+00:12:20,090 --> 00:12:21,670
+الجزء حاضر
+
+166
+00:12:24,620 --> 00:12:28,420
+بنقول نيسيريا جونورية في الكربوهيدرات الثلاثة فقط
+
+167
+00:12:28,420 --> 00:12:31,800
+positive لمن؟ للجلوكوز. بينما النيسيريا مننجايديس
+
+168
+00:12:31,800 --> 00:12:34,660
+positive للجلوكوز زائد مالتوز. هذه
+
+169
+00:12:34,660 --> 00:12:38,700
+differentiation، صح؟ في كمان نقطة كثيرة مهمة أن
+
+170
+00:12:38,700 --> 00:12:41,940
+النيسيريا جونورية والنيسيريا مننجايديس can
+
+171
+00:12:41,940 --> 00:12:45,680
+grow on blood agar، on blood agar، on chocolate
+
+172
+00:12:45,680 --> 00:12:50,350
+agar، but not nutrient agar. طب هذه النقطة كيف
+
+173
+00:12:50,350 --> 00:12:55,670
+نستغلها؟ كل الـ non-pathogenic Neisseria بينمو على
+
+174
+00:12:55,670 --> 00:12:58,590
+blood agar وبينمو على chocolate agar بس بينمو
+
+175
+00:12:58,590 --> 00:13:01,730
+كمان  على الـ nutrient agar. يبقى الـ pathogens
+
+176
+00:13:01,730 --> 00:13:05,9
+
+223
+00:16:07,020 --> 00:16:12,180
+يمكن في بداية الفصل  لأ هذا .. هذا .. هذا شيء يعني
+
+224
+00:16:12,180 --> 00:16:16,680
+كان بتميز في بعض الميكروبات زي السلمونيلا لكن ال
+
+225
+00:16:16,680 --> 00:16:23,060
+antigenic variation قد
+
+226
+00:16:23,060 --> 00:16:25,760
+تكون ناتجة عن pre-programmed
+
+227
+00:16:28,860 --> 00:16:32,560
+ماذا يعني pre-programmed؟ يعني المادة الوراثية
+
+228
+00:16:32,560 --> 00:16:39,520
+بتقول أن كل فترة وفترة بيصير فيه rearrangement هاي
+
+229
+00:16:39,520 --> 00:16:44,780
+جينات تمام مسئولة عن إنتاج  بلاي بدل الجين هذا
+
+230
+00:16:44,780 --> 00:16:50,480
+ما يكون هنا موقعه ثلاثة بنخليه أربعة و بنخليه أربعة
+
+231
+00:16:50,480 --> 00:16:58,670
+موقعه ثلاثة فالمنتج هيطلع بلاي لكن .. لكن مش زي ال
+
+232
+00:16:58,670 --> 00:17:01,710
+بلاي اللي كانت تنتج لما كان أربعة هو ثلاثة وثلاثة
+
+233
+00:17:01,710 --> 00:17:05,750
+كان هو أربعة فده إيش اسمه Antigenic Valency هذه
+
+234
+00:17:05,750 --> 00:17:10,390
+ظاهرة تحدث في كثير من البكتيريا ومن ضمنها النيسيريا
+
+235
+00:17:10,390 --> 00:17:15,990
+و .. okay؟ يعني مش كل مرة بتطلع برا و بتغير .. لأ
+
+236
+00:17:15,990 --> 00:17:20,550
+هذه شغلة مستمرة قد تستطيع بعض البكتيريا أن تغير
+
+237
+00:17:20,550 --> 00:17:21,970
+الـAntigenات هويتها داخل الجسم
+
+238
+00:17:26,400 --> 00:17:30,580
+يعني لكن مفهومين مختلفين هذا واحد للـ antibodies و
+
+239
+00:17:30,580 --> 00:17:36,360
+واحد للـ antibiotics طيب من ضمن المواصفات اللي تميز
+
+240
+00:17:36,360 --> 00:17:39,860
+فيها البكتيريا هذه coffee bean shape، زي
+
+241
+00:17:39,860 --> 00:17:43,340
+الجهة وحبات القهوة، وحبات القهوة كيف تكون عملة زي
+
+242
+00:17:43,340 --> 00:17:48,740
+حرف الـ D، الأوجه المتقابلة flattened، flattened يعني
+
+243
+00:17:48,740 --> 00:17:53,800
+مسطحة، وبعض الأحيان بنشوفها عملة زي حبات الفصوليا
+
+244
+00:17:56,660 --> 00:18:00,460
+هو بيسموها الـ bean اللي هي الفصوليا، الـ coffee أو
+
+245
+00:18:00,460 --> 00:18:02,480
+الـ bean، الـ bean فصوليا، والـ coffee قلنا اللي هو
+
+246
+00:18:02,480 --> 00:18:06,700
+القهوة shape، أو kidney bean shape، kidney عارفين الـ
+
+247
+00:18:06,700 --> 00:18:09,660
+kidney، كلية برضه، أعتقد أنه زي حبة الفصوليا برضه
+
+248
+00:18:09,660 --> 00:18:17,040
+طبعاً الآن هناك نقطة بدنا نتكلم فيها مهمة، احنا قلنا
+
+249
+00:18:17,040 --> 00:18:20,500
+الـ only host is man، وman مقصود فيها قلنا هنا إيه؟
+
+250
+00:18:20,500 --> 00:18:25,190
+الإنسان، مش الرجل، نُتكلم الآن عن الذكر والأنثى في
+
+251
+00:18:25,190 --> 00:18:30,410
+هذا الموضوع، مهمين جداً، احنا ذكرنا مجموعة species
+
+252
+00:18:30,410 --> 00:18:35,750
+قلنا تنتمي منهم infectious أو virulent، والباقي
+
+253
+00:18:35,750 --> 00:18:39,790
+normal microbiota، واحدة الآن نتكلم عن واحدة منهم
+
+254
+00:18:39,790 --> 00:18:44,930
+فقط، النيسيريا جونورية، الـ نيسيريا جونورية is
+
+255
+00:18:44,930 --> 00:18:48,650
+pathogenic، مش  من ضمن الفلورا لكن السيكا
+
+256
+00:18:48,650 --> 00:18:52,490
+واللاكتاميكا والفلافا والفلافيسنس، هدول normal
+
+257
+00:18:52,490 --> 00:18:56,990
+flora، وين موجودين؟ موجودين للأسف normal flora of
+
+258
+00:18:56,990 --> 00:19:00,490
+the female vagina، يعني لو .. وبعض الأحيان بنجيهم
+
+259
+00:19:00,490 --> 00:19:06,150
+في الـ oral flora، oral flora، الآن لو أخدنا swab من
+
+260
+00:19:06,150 --> 00:19:11,050
+urethral discharge من female، يعني أنتَ و
+
+261
+00:19:11,050 --> 00:19:13,350
+عملناها لـ gram stain، ولجينا gram negative double
+
+262
+00:19:13,350 --> 00:19:15,750
+cocci، هل تعني شيء؟
+
+263
+00:19:17,840 --> 00:19:21,840
+الجرام نيجاتيف دبلو كوكاي بشكل عام قد تكون نيسيريا
+
+264
+00:19:21,840 --> 00:19:26,560
+جونورية أو قد تكون other نيسيريا، ما حكمناش لكن لا
+
+265
+00:19:26,560 --> 00:19:32,100
+نستطيع أن نقول أن وجودها غريب لأنها موجودة بشكل
+
+266
+00:19:32,100 --> 00:19:37,360
+normal ميكروبيوتا لكن لو أخبرتكُم أن الـ urethra بتاعة
+
+267
+00:19:37,360 --> 00:19:43,240
+الذكر لا يولد بها normal flora، وقمت أنا بعمل gram
+
+268
+00:19:43,240 --> 00:19:48,380
+stain للذكر اللي جيت عنده، جرام نيجاتيف دبلو كوكاي، هنا
+
+269
+00:19:48,380 --> 00:19:52,540
+الآن إيه؟ بتكون كاشفة عن مين؟ عن أن المريض هذا
+
+270
+00:19:52,540 --> 00:19:57,500
+احتمالية أنه يكون مصاب بالنيسيريا جونورية، احتمالية
+
+271
+00:19:57,500 --> 00:20:01,240
+إيه؟ عالية، وبيفرضوها على أنها presumative
+
+272
+00:20:01,240 --> 00:20:04,320
+diagnosis، إيش يعني presumative diagnosis؟ يعني
+
+273
+00:20:04,320 --> 00:20:07,600
+diagnosis افتراضي أو diagnosis أولي أن المريض عنده
+
+274
+00:20:07,600 --> 00:20:13,610
+نيسيريا جونورية لكن عند ذلك .. ممكن تكون ..
+
+275
+00:20:13,610 --> 00:20:17,190
+كمان مرة ما بتقدرش تحكم أنها normal flora ولا
+
+276
+00:20:17,190 --> 00:20:21,810
+باعتباط، لذلك حتى بعض المختبرات، شباب، بترفض تستقبل
+
+277
+00:20:21,810 --> 00:20:29,290
+urethral discharge، يعني لو اجاك request form، تمام؟
+
+278
+00:20:29,290 --> 00:20:33,090
+هاي الاسم، هاي الأمر، ومكتوب هنا female، تمام؟
+
+279
+00:20:33,090 --> 00:20:38,930
+الجنس، gender، تمام؟ ومطلوب منا urethral
+
+280
+00:20:40,010 --> 00:20:45,130
+discharge، ومطلوبش الآن gram stain، بيقول التكنسين
+
+281
+00:20:45,130 --> 00:20:51,810
+بتطلع آه female، يبقى rejected، مرفوض، لو جالي
+
+282
+00:20:51,810 --> 00:21:00,110
+culture، مقبول، ما فهمش ليش، العقوى، لسه أنا قاعد بقول
+
+283
+00:21:00,110 --> 00:21:03,270
+أنه أنا قاعد بقول أنه لو أنا عملت gram stain و أنا
+
+284
+00:21:03,270 --> 00:21:05,970
+جاتي gram negative و أنا جاتي cocci، ماذا يعني ذلك؟
+
+285
+00:21:05,970 --> 00:21:11,090
+nothing، صح؟ وذلك كمان مرة ما تقولش normal، لأنه ممكن
+
+286
+00:21:11,090 --> 00:21:14,510
+تكون نيسيريا جونورية، ليش أنا قلت موافق؟ أنا بقول
+
+287
+00:21:14,510 --> 00:21:18,990
+بوافق لو كان السؤال أو المطلوب culture، في الـ
+
+288
+00:21:18,990 --> 00:21:24,070
+culture بقدر أميز بين normal microbiota وبين
+
+289
+00:21:24,070 --> 00:21:30,420
+pathogenic نيسيريا جونورية، هو يعني كان Gram Stain
+
+290
+00:21:30,420 --> 00:21:34,580
+يعني useless، يعني مالوش قيمة هنا، هنا مالوش قيمة
+
+291
+00:21:34,580 --> 00:21:37,640
+هو طلب يعني أنه يجيب لك بس أنه Gram Stain، ماهي اللي
+
+292
+00:21:37,640 --> 00:21:40,660
+بحكيلك إيه؟ أنا Gram Stain for urethral discharge
+
+293
+00:21:40,660 --> 00:21:43,060
+وبالتالي rejected، لو كان هنا male
+
+294
+00:21:46,920 --> 00:21:53,060
+احنا جايين بنقول لك أن hospital policy أنه قد يسمح
+
+295
+00:21:53,060 --> 00:21:57,840
+بعمل Gram stain لكن لن يكون له فائدة، بينما لما
+
+296
+00:21:57,840 --> 00:22:00,200
+يكون male بيكون له فائدة في هذا الحال
+
+297
+00:22:03,030 --> 00:22:06,110
+إذا صرنا متفقين .. صرنا متفقين أن الـ gram stain
+
+298
+00:22:06,110 --> 00:22:10,490
+من الـ urethral discharge للـ female is of no value،
+
+299
+00:22:10,490 --> 00:22:14,930
+لكن للـ male بيكون بعطي presumptive diagnosis، هلأ
+
+300
+00:22:14,930 --> 00:22:17,690
+أنا بقول للطبيب أنه أنا شوفت نيسيريا جونورية؟ و ليش
+
+301
+00:22:17,690 --> 00:22:23,400
+بقول له؟ بقول له شفت gram negative diplococci، مش بس
+
+302
+00:22:23,400 --> 00:22:28,280
+هيك بقول له شفت gram negative diplococci وشفت هل هي
+
+303
+00:22:28,280 --> 00:22:31,900
+intracellular ولا extracellular، إيش يعني
+
+304
+00:22:31,900 --> 00:22:34,180
+intracellular و extracellular، دعوني أشوف مع بعض مع
+
+305
+00:22:34,180 --> 00:22:35,920
+صورة، مانعش متأخر شوية
+
+306
+00:22:46,870 --> 00:22:52,870
+ناخد الصورة على الجهة هذه، الجهة البعيدة هذه
+
+307
+00:22:52,870 --> 00:22:56,930
+عبارة عن blood cells، white blood cells، لاحظوا لي
+
+308
+00:22:56,930 --> 00:23:02,910
+الـكوريات الصغيرة الموجودة داخلها هذه عبارة عن دبلو
+
+309
+00:23:02,910 --> 00:23:07,450
+كوكاي، دبلو كوكاي، دبلو كوكاي، دبلو كوكاي، دبلو كوكاي
+
+310
+00:23:07,450 --> 00:23:10,050
+كوكاي، دبلو كوكاي، دبلو كوكاي، دبلو كوكاي، دبلو كوكاي
+
+311
+00:23:10,050 --> 00:23:11,270
+دبلو كوكاي، دبلو كوكاي، دبلو كوكاي، دبلو كوكاي، دبلو
+
+312
+00:23:11,270 --> 00:23:16,230
+كوكاي، دبلو كوكاي، دبلو كوكاي، اللي بدأ أوصفه ورا تحت
+
+313
+00:23:16,230 --> 00:23:19,650
+الـ microscope هنا أنه فيه pus cells ولا فيش pus
+
+314
+00:23:19,650 --> 00:23:23,810
+cells، وأن الـ pus cells عددها بالـ high power
+
+315
+00:23:23,810 --> 00:23:27,670
+field، على سبيل المثال، عشرة، خمسة عشر، عشرين، يعني بوصف
+
+316
+00:23:27,670 --> 00:23:31,690
+أو بالـ oil immersion، بوصف عدد الـ pus cells، وبوصف
+
+317
+00:23:31,690 --> 00:23:36,870
+عدد الخلايا من الـ pus cells المحتوية على النيسيريا
+
+318
+00:23:36,870 --> 00:23:41,810
+جونورية، أو على الـ gram positive دبلو كوكاي، وبأوصف
+
+319
+00:23:41,810 --> 00:23:45,710
+وجودها، هل هو intracellular، وهذا الحال ليش؟ يعني
+
+320
+00:23:45,710 --> 00:23:51,430
+وجود intracellular أكثر من مين؟ من الـ extracellular
+
+321
+00:23:51,430 --> 00:23:55,130
+طب هل هناك فايدة من هذا الكلام؟ أول حاجة أنا ذكرت
+
+322
+00:23:55,130 --> 00:23:59,450
+لكم سابقاً مراراً وتكراراً بأن احنا في الـ gram
+
+323
+00:23:59,450 --> 00:24:03,510
+staining أو في أي staining ما بنتعرف على البكتيريا
+
+324
+00:24:03,510 --> 00:24:08,090
+إلا في حالات الـ staining with specific antibody زي
+
+325
+00:24:08,090 --> 00:24:12,040
+الـ fluorescent، بينما في الـ gram staining في الأغلب
+
+326
+00:24:12,040 --> 00:24:17,540
+الأمر staining، we just describe، بنوصف ما نرى بدقة
+
+327
+00:24:17,540 --> 00:24:21,740
+فبنقول هنا gram negative diplokokai that are found
+
+328
+00:24:21,740 --> 00:24:27,980
+mostly intracellularly، إيش اللي بيفهم منها الطبيب؟
+
+329
+00:24:27,980 --> 00:24:31,920
+بيفهم منها أنها نيسيريا جونورية وأنها acute stage
+
+330
+00:24:32,460 --> 00:24:36,800
+acute stage، لو أنا أشوف اسمير غير هذا الاسمير و
+
+331
+00:24:36,800 --> 00:24:40,660
+مكتوب فيه أو التقرير بيقول gram negative
+
+332
+00:24:40,660 --> 00:24:46,680
+diplococci mostly found extracellularly، بيفهم منها
+
+333
+00:24:46,680 --> 00:24:53,700
+نيسيريا جونورية chronic، جونورية chronic، واحدة
+
+334
+00:24:53,700 --> 00:24:57,820
+acute، واحدة chronic، إيش الفرق بينهم؟ واحدة كانت
+
+335
+00:24:57,820 --> 00:25:02,720
+intracellular، واحدة كانت extracellular، إذا I just
+
+336
+00:25:02,720 --> 00:25:05,600
+describe what I see، الصورة دي اللي قدامكُم هي
+
+337
+00:25:05,600 --> 00:25:08,360
+عبارة عن دبلو كوكاي مكبرة أكثر من الصورة
+
+338
+00:25:08,360 --> 00:25:12,600
+الأولانية لكن مش مأخوذة من smear، مأخوذة من طبق
+
+339
+00:25:13,370 --> 00:25:15,890
+يعني من culture، تمام؟ من الـ chocolate agar
+
+340
+00:25:15,890 --> 00:25:18,990
+وبالتالي شايفين pus cells أنتم في المنطقة؟ ما فيش
+
+341
+00:25:18,990 --> 00:25:21,450
+pus cells، وبالتالي هي pure culture of gram
+
+342
+00:25:21,450 --> 00:25:32,570
+negative diplococam، تفضل كل الأسماء
+
+343
+00:25:32,570 --> 00:25:34,890
+اللي ذكرتها عدا الثلاثة الأوائل
+
+344
+00:25:39,000 --> 00:25:42,840
+الناس من النجار كانوا يقولوا كل نيسيريا ما بنعملهاش، و
+
+345
+00:25:42,840 --> 00:25:45,440
+لا، بس هي بتتعامل؟ أنا لو .. لو .. لو كلها
+
+346
+00:25:45,440 --> 00:25:48,780
+بتنمو عليه كان احنا ما حكينا المعلومة بهذه
+
+347
+00:25:48,780 --> 00:25:52,840
+الطريقة، يعني النجار اللي أنا ذكرته .. النجار اللي
+
+348
+00:25:52,840 --> 00:25:57,460
+أنا ذكرته كـ differential character، الـ pathogen
+
+349
+00:25:57,460 --> 00:26:02,100
+negative والـ non .. قبل مرة ذكرت لكم عن كل الـ
+
+350
+00:26:02,100 --> 00:26:05,520
+pathogen، بتكلم عن مين؟ عن الـ البعضية نيسيريا أو عن
+
+351
+00:26:05,520 --> 00:26:06,160
+الـ نيسيريا
+
+352
+00:26:09,740 --> 00:26:13,560
+الـ pathogens، الـ pathogens لا ينمو negative، بينما
+
+353
+00:26:13,560 --> 00:26:22,940
+الـ none pathogen positive للـ growth، فأنا
+
+354
+00:26:22,940 --> 00:26:27,100
+استخدمته كصفة للتمييز ما بين نيسيريا جونورية و
+
+355
+00:26:27,100 --> 00:26:30,620
+meningitidis على جهة والأخريات على جهة ثانية
+
+356
+00:26:36,770 --> 00:26:40,730
+فيها يعني بعض الـ evidence أنها يعني قد تحدث بعض الـ
+
+357
+00:26:40,730 --> 00:26:44,530
+infection خاصة في الـ ear والـ oral cavity، بس
+
+358
+00:26:44,530 --> 00:26:46,750
+الأولين تاني هم الـ major pathogens، بقى احنا قلنا
+
+359
+00:26:46,750 --> 00:26:49,630
+.. بعدين احنا قلنا أن الـ .. الـ Neisseria catarrhalis
+
+360
+00:26:49,630 --> 00:26:53,750
+اللي معناه شلناها و شيلناها من مين؟ من الـ Neisseria
+
+361
+00:26:53,750 --> 00:26:56,750
+من أساسه، فأنتَ ما تناقش .. ما تناقشهاش أصلاً من ضمن أن
+
+362
+00:26:56,750 --> 00:26:58,550
+الـ Neisseria، خلاص حطيناها اسم جزيرة
+
+363
+00:27:03,090 --> 00:27:06,970
+من الأشياء المهمة جداً يعرفها عن النيسيريا جونورية
+
+364
+00:27:06,970 --> 00:27:11,150
+أنه they cannot survive، they will survive only for
+
+365
+00:27:11,150 --> 00:27:14,770
+brief periods outside the body، يعني قدرتهم على
+
+366
+00:27:14,770 --> 00:27:20,430
+البقاء خارج الجسم هي قدرة محدودة، لذلك عندما تقوم
+
+367
+00:27:20,430 --> 00:27:26,520
+بجمع العينة، عندما تقوم بجمع العينة، لا تستخدم أي
+
+368
+00:27:26,520 --> 00:27:29,400
+disinfectant، أنا هقول أن أي traces من أي
+
+369
+00:27:29,400 --> 00:27:34,380
+disinfectant ممكن تقتلها، هاي إيش نستخدم؟ نمسح العضو
+
+370
+00:27:34,380 --> 00:27:39,440
+المراد جمع العينة منه بـ warm، warm يعني دافئ
+
+371
+00:27:39,440 --> 00:27:45,600
+sterile saline، warm sterile saline، ولما تجمع
+
+372
+00:27:45,600 --> 00:27:50,100
+العينة، تجمعهاش على swab عادي، لازم تستخدم الـ
+
+373
+00:27:50,100 --> 00:27:51,920
+transport media، transport
+
+374
+00:27:57,070 --> 00:28:02,470
+اسمه Transgrow الـ
+
+375
+00:28:02,470 --> 00:28:09,450
+transport media، عبارة عن swab عادي لكن
+
+376
+00:28:09,450 --> 00:28:16,930
+فيه هنا بعض المكونات gel-like components
+
+377
+00:28:16,930 --> 00:28:22,140
+الغرض منها لما أنا بأخذ الـ swab وبروح، وأنا بعد ما
+
+378
+00:28:22,140 --> 00:28:25,460
+أخذه بضغطه بداخله، وين؟ جوا الـ gel-like structure
+
+379
+00:28:25,460 --> 00:28:29,600
+هنا، لغرض منه مش عشان نمّل بكتيريا، عشان أحمل
+
+380
+00:28:29,600 --> 00:28:31,760
+الـ bacteria، يعني اللي صح بيشعسل الآن في المنطقة
+
+381
+00:28:31,760 --> 00:28:34,940
+هذه،
+
+382
+00:28:34,940 --> 00:28:39,140
+هي الـ bacteria هنا أو العينة، تمام؟ والجزء
+
+383
+00:28:39,140 --> 00:28:41,860
+العلوي هنا عند الـ هنا، واصل في عندي اللي هو
+
+384
+00:28:41,860 --> 00:28:46,040
+الـ gel-like structure to protect the bacteria from
+
+385
+00:28:46,040 --> 00:28:51,690
+drying، فقط لحمايتها من مين؟ من الجفاف، طيب احنا
+
+386
+00:28:51,690 --> 00:28:54,450
+قاعدين بنقول أن البكتيريا very fragile، very
+
+387
+00:28:54,450 --> 00:28:57,770
+fragile، very delicate، cannot survive for long
+
+388
+00:28:57,770 --> 00:29:01,110
+period outside the body، لذلك حتى في الـ transport
+
+389
+00:29:01,110 --> 00:29:03,990
+media، مش معناه أن الحاجة أنك حطيتها، تحطها
+
+390
+00:29:03,990 --> 00:29:08,650
+ساعتين ثلاثة، transport as soon as possible، ما فيش
+
+391
+00:29:08,650 --> 00:29:11,930
+أنه وقت طويل نضيعه، لأن البكتيريا حتى في هذه
+
+392
+00:29:11,930 --> 00:29:17,560
+الظروف ممكن تموت، إذا كمان مرة بنقول أن نيسيريا
+
+393
+00:29:17,560 --> 00:29:20,660
+جونورية should be collected in a way، in a way to
+
+394
+00:29:20,660 --> 00:29:24,600
+avoid contact with any disinfectant، it should be
+
+395
+00:29:24,600 --> 00:29:28,800
+placed in a transport أو special transport media
+
+396
+00:29:28,800 --> 00:29:31,840
+and it should be transported to the laboratory as
+
+397
+00:29:31,840 --> 00:29:35,580
+soon as possible، يعني في أقصر فترة زمنية ممكنة
+
+398
+00
+
+445
+00:33:29,500 --> 00:33:35,760
+sex أو الـناتج عن الـ oral sex، وكلاهما منتشران
+
+446
+00:33:35,760 --> 00:33:41,480
+كشذوذ في العالم الغربي، لأن رقم اثنين من الـdiseases
+
+447
+00:33:41,480 --> 00:33:46,840
+الأولان، هذا كله جنورية وما له وما عليه، رقم
+
+448
+00:33:46,840 --> 00:33:49,360
+اثنين في أنديها اسمها ophthalmia neonatorum
+
+449
+00:33:53,130 --> 00:33:56,170
+وإن هي الـinfection التي تصيب الـconjunctiva
+
+450
+00:33:56,170 --> 00:34:01,610
+بتاعة الأطفال الذين ولِدوا لأمهات مصابات بالسيلان
+
+451
+00:34:01,610 --> 00:34:05,490
+جنورية خلال مرورهم عبر قناة الولادة، يأخذون الـ
+
+452
+00:34:05,490 --> 00:34:10,070
+microorganism، فيصيبنا infection، والـinfection
+
+453
+00:34:10,070 --> 00:34:14,950
+قد تؤدي إلى الـblindness if untreated. blindness
+
+454
+00:34:14,950 --> 00:34:21,600
+يعني فقدان البصر، لكن لأن المرض منتشر كثيراً، ويعني
+
+455
+00:34:21,600 --> 00:34:27,720
+قلنا عنه أنه the second most prevalent disease في
+
+456
+00:34:27,720 --> 00:34:35,160
+العالم الغربي، فبالتالي كان فيه سياسة، كل أم تلتقط
+
+457
+00:34:35,160 --> 00:34:40,940
+طفلها، يوضع في عينيه قطرة من 2% silver nitrate
+
+458
+00:34:40,940 --> 00:34:48,070
+percent silver nitrate كإجراء وقائي، وطبعاً الطب
+
+459
+00:34:48,070 --> 00:34:51,870
+الحديث استبدل silver nitrate بـantibiotics، يعني
+
+460
+00:34:51,870 --> 00:34:53,750
+بدنا نعالجه بـantibiotics بدل silver
+
+461
+00:34:53,750 --> 00:34:57,550
+nitrate، لأن silver nitrate ثبت أنها قد تؤذي عيني
+
+462
+00:34:57,550 --> 00:35:04,230
+الطفل ولو شيئاً قليلاً، إذن، للحماية أو للوقاية من الـ
+
+463
+00:35:04,230 --> 00:35:07,790
+Ophthalmia Neonatorum، احنا مضطرين نستخدم إيش؟ منها
+
+464
+00:35:07,790 --> 00:35:12,630
+أو البديل عنه، وهو Antibiotic Solution.  فندخل
+
+465
+00:35:12,630 --> 00:35:16,810
+الرقم ثلاثة، وهو الـPID أو Pelvic Inflammatory
+
+466
+00:35:16,810 --> 00:35:20,790
+Disease، وهذا أيضاً عبارة عن complication.. عبارة
+
+467
+00:35:20,790 --> 00:35:25,450
+عن complication تحدث
+
+468
+00:35:25,450 --> 00:35:27,650
+في مرضى الذين هم الـ...
+
+469
+00:35:30,820 --> 00:35:35,940
+هذه الآن الصور توضح أن الـ... طبعاً لحظة، في أن هذه
+
+470
+00:35:35,940 --> 00:35:39,620
+حاجة اسمها Arthritis، ما ذكرناهاش خالص، لكن الـ
+
+471
+00:35:39,620 --> 00:35:43,380
+arthritis هذه ناتجة أيضاً عن القصة التي حكينا فيها
+
+472
+00:35:43,380 --> 00:35:46,460
+زمان، وهو الـdeposition للـ antigen-antibody
+
+473
+00:35:46,460 --> 00:35:49,790
+complexes في أماكن مختلفة في الجسم، وبالتالي
+
+474
+00:35:49,790 --> 00:35:53,270
+activation للـcomplement، وبالتالي أيضاً
+
+475
+00:35:53,270 --> 00:36:00,030
+activation للـattack على الأنسجة  تبعنا، وهذا
+
+476
+00:36:00,030 --> 00:36:05,430
+الأسف، هذه حالة purely in discharge من من؟ من نيون
+
+477
+00:36:05,430 --> 00:36:09,590
+نيّت، الذي هو قد تؤدي إلى الـblindness
+
+478
+00:36:12,250 --> 00:36:15,530
+بالنسبة للـdiagnosis، احنا في معرض حديثنا، تحدثنا
+
+479
+00:36:15,530 --> 00:36:18,310
+شوياً عن الـdiagnosis لما قلنا urethral discharge
+
+480
+00:36:18,310 --> 00:36:22,750
+Gram stain، تمام؟ Gram stain، لكن قلنا فقط لـGram
+
+481
+00:36:22,750 --> 00:36:26,450
+stain من من؟ من الـmale وليس من الـfemale، لكن الـ
+
+482
+00:36:26,450 --> 00:36:31,590
+golden standard تبعنا، الذي هو الـculture، الآن الـ
+
+483
+00:36:31,590 --> 00:36:35,230
+culture للبكتيريا، احنا قلنا عنها ممكن تنمو على
+
+484
+00:36:35,230 --> 00:36:38,930
+blood agar، لكن نميها أو نفضل نميها على شوكولاتة
+
+485
+00:36:38,930 --> 00:36:45,810
+أجار، ليش على شوكولاتة أجار؟ عشان الفاكولات
+
+486
+00:36:45,810 --> 00:36:49,230
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+487
+00:36:49,230 --> 00:36:49,790
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+488
+00:36:49,790 --> 00:36:50,330
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+489
+00:36:50,330 --> 00:36:57,050
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+490
+00:36:57,050 --> 00:36:59,110
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+491
+00:36:59,110 --> 00:37:02,250
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+492
+00:37:02,250 --> 00:37:05,630
+الفاك...
+
+493
+00:37:07,980 --> 00:37:10,940
+فبنفضل الدم الذي مسخّن، ليش؟ مش مش حاجة لـchocolate
+
+494
+00:37:10,940 --> 00:37:13,860
+agar، هو نفسه blood agar، بس هو أساس تسخينه تبقى على
+
+495
+00:37:13,860 --> 00:37:18,020
+ثمانين درجة مئوية، الآن التسخين على ثمانين درجة
+
+496
+00:37:18,020 --> 00:37:20,800
+مئوية قد يقضي على كثير من الـtoxic material
+
+497
+00:37:20,800 --> 00:37:24,560
+الموجود في الدم، في الدم، فبنفضل أن البكتيريا تنمو
+
+498
+00:37:24,560 --> 00:37:27,380
+عليه، مش على... على الـchocolate agar، مش على blood
+
+499
+00:37:27,380 --> 00:37:32,520
+agar. هذا رقم واحد، رقم اثنين، البكتيريا بدها بدها
+
+500
+00:37:32,520 --> 00:37:35,020
+إيش؟ بدها CO2
+
+501
+00:37:38,300 --> 00:37:43,700
+مش بيقولوا أنا capnophilic، مين بده CO2 من البكتيريا؟
+
+502
+00:37:43,700 --> 00:37:49,080
+عرفته؟
+
+503
+00:37:49,080 --> 00:38:01,880
+هيستعملوا
+
+504
+00:38:01,880 --> 00:38:06,790
+أربعة ميكروبات تعرفوهم: Haemophilus influenzae، Neisseria
+
+505
+00:38:06,790 --> 00:38:14,270
+meningitidis، وNeisseria gonorrhoeae، وكلّهم مش بس بدهم CO2، و
+
+506
+00:38:14,270 --> 00:38:17,650
+كلهم ممكن يتمّ زراعتهم على شوكولاتة أجار، فإذاً وإن
+
+507
+00:38:17,650 --> 00:38:21,610
+شوكولاتة أجار can... and under CO2 can provide
+
+508
+00:38:21,610 --> 00:38:25,110
+growth for these fastidious أو delicate
+
+509
+00:38:25,110 --> 00:38:29,020
+microorganisms. الـtemperature، اللحظة التي مكتوب
+
+510
+00:38:29,020 --> 00:38:32,300
+هناك كده، كل الميكروبات التي ذكرناها في السابق كانت
+
+511
+00:38:32,300 --> 00:38:34,680
+على سبعة وثلاثين، هذه خاصة نص الكتاب الذي كتبناه
+
+512
+00:38:34,680 --> 00:38:38,800
+العالميين، على خمسة وثلاثين، سبعة وثلاثين، قد تقتل
+
+513
+00:38:38,800 --> 00:38:41,940
+البكتيريا، سبعة وثلاثين قد تقتل... عشان أنا جددت لكم
+
+514
+00:38:41,940 --> 00:38:45,460
+...عشان أنا جددت لكم أنه صار تغيير في تفكير
+
+515
+00:38:45,460 --> 00:38:48,800
+العاملين في مجال الـmicrobiology، وأصبحنا نعمل...
+
+516
+00:38:48,800 --> 00:38:53,920
+نعمل الـincubation بشكل عام على خمسة وثلاثين درجة
+
+517
+00:38:53,920 --> 00:38:58,080
+مئوية، طبعاً الـbacteria oxidase الـreaction تبعها
+
+518
+00:38:58,080 --> 00:39:01,560
+هو عبارة عن oxidase test، وهنقول إن هذا قودا
+
+519
+00:39:01,560 --> 00:39:07,300
+واحداً، هو القوض الفصل في أنها نيسيريا أو نيسيريا أو
+
+520
+00:39:07,300 --> 00:39:11,680
+أخرى، لأن هما هي تنتهي بتشابهها مع بعضهم
+
+521
+00:39:11,680 --> 00:39:16,050
+البعض، ففي دي هارسمها fluorescent antibody tagging
+
+522
+00:39:16,050 --> 00:39:19,810
+test، وهو عبارة عن staining باستخدام الذي هو الـ
+
+523
+00:39:19,810 --> 00:39:22,490
+antibody الـspecific، وهذا الـstaining مش عادي،
+
+524
+00:39:22,490 --> 00:39:27,270
+fluorescent label، وتحت الميكروسكوب ممكن نشوفه، فين؟
+
+525
+00:39:27,270 --> 00:39:30,890
+دي الـCTA، والـCTA فاكرين لما قلت لكم أول محاضرة
+
+526
+00:39:30,890 --> 00:39:36,510
+قلت لكم جلوكوز بوزتف نيسيريا جونورية، بينما النيسيريا
+
+527
+00:39:36,510 --> 00:39:41,770
+ميننغايتس جلوكوز نجاتف، مالتوز بوزتف، هذا الفحص للبكتيريا
+
+528
+00:39:41,770 --> 00:39:46,410
+العادية، البكتيريا العادية، كنا نستخدم لها on media
+
+529
+00:39:46,410 --> 00:39:49,830
+صح، oxidation fermentation media، هذه البكتيريا
+
+530
+00:39:49,830 --> 00:39:54,360
+ما بنقدرش نستخدم لها الـon، لأنها fastidious، وبالتالي
+
+531
+00:39:54,360 --> 00:39:58,920
+صممنا له أطباق اسمه 16 triptycase agar، واحد ضفنا
+
+532
+00:39:58,920 --> 00:40:02,220
+عليه الجلوكوز، وواحد ضفنا عليه مالتوز، وواحد ضفنا
+
+533
+00:40:02,220 --> 00:40:06,600
+عليه الذي هو السكروز، النيسيريا جونورية فقط بتصيب
+
+534
+00:40:06,600 --> 00:40:10,700
+لمين؟ للجلوكوز، بينما نيسيريا مننغايتس بتصيب
+
+535
+00:40:10,700 --> 00:40:12,320
+للمالتوز و للـجلوكوز، good
+
+536
+00:40:19,100 --> 00:40:22,180
+لأ، احنا... احنا... شباب، في... في... في بعض الناس
+
+537
+00:40:22,180 --> 00:40:27,460
+يعني بتأخر عليهم وصول المعلومة بشكل واضح، فبدنا
+
+538
+00:40:27,460 --> 00:40:31,840
+نؤكد على حقيقة، احنا لما بنشرح بنشرح بالـ
+
+539
+00:40:31,840 --> 00:40:37,020
+consecutive، فحص طلوة الفحص، لكن واقعياً...
+
+540
+00:40:37,020 --> 00:40:41,900
+الواقع العملي ليس فحص طلوة الفحص، وإنما فحصات جنباً
+
+541
+00:40:41,900 --> 00:40:47,340
+إلى جنب، لأن الفحص طلوة الفحص بده يوم ويوم ويوم، لكن
+
+542
+00:40:47,340 --> 00:40:51,600
+لما بتكلم عن مع بعض، ثلاثة، نعملهم في يوم واحد، غير
+
+543
+00:40:51,600 --> 00:40:54,800
+أن احنا نعملهم بعد ثلاثة أيام، فاحنا للتدريب، و
+
+544
+00:40:54,800 --> 00:40:58,700
+للتفريق، بنستخدم الـconsecutive test، التي هي واحد
+
+545
+00:40:58,700 --> 00:41:02,920
+بعد واحد، بينما في الواقع بنستخدم الـparallel test
+
+546
+00:41:02,920 --> 00:41:06,960
+هذه المستعمرات التي على الـchocolate agar أو البلد
+
+547
+00:41:06,960 --> 00:41:11,820
+أجار، البكتيريا واضحة أنها glistening، لامعة، يعني
+
+548
+00:41:11,820 --> 00:41:13,040
+فيها بريق
+
+549
+00:41:20,170 --> 00:41:23,470
+في مكان ثاني، احنا قلنا نيسيريا جونورية، من أين
+
+550
+00:41:23,470 --> 00:41:26,310
+بناخدها؟ بناخدها من الـurethral discharge، طب، و
+
+551
+00:41:26,310 --> 00:41:28,730
+الـurethra سواء كانت male ولا female، مافيها
+
+552
+00:41:28,730 --> 00:41:35,140
+normal microbiota، بس الصعوبة في الـfemale أنه أكثر
+
+553
+00:41:35,140 --> 00:41:37,800
+الـnormal microbiota أكثر، ومن ضمنها نيسيريا other
+
+554
+00:41:37,800 --> 00:41:41,840
+than نيسيريا جونوريا، فإذا أنا بدي أعزل نيسيريا من
+
+555
+00:41:41,840 --> 00:41:44,280
+community من الميكروبات، بدي selective media ولا
+
+556
+00:41:44,280 --> 00:41:47,200
+ما بديش selective media، الـselective media تبعي اسمه
+
+557
+00:41:47,200 --> 00:41:50,500
+thiamartin medium، إيش هو thiamartin medium؟ هو
+
+558
+00:41:50,500 --> 00:41:55,380
+عبارة عن very similar to chocolate agar، لكن مضاف
+
+559
+00:41:55,380 --> 00:41:58,080
+له antibiotics بيسموهم
+
+560
+00:42:03,250 --> 00:42:10,910
+بنزلسين، كولستين، نيساتين، كمان مرة، بنزلسين
+
+561
+00:42:10,910 --> 00:42:15,470
+كوليستين
+
+562
+00:42:15,470 --> 00:42:18,790
+نيستاتين
+
+563
+00:42:18,790 --> 00:42:23,090
+البنسلين
+
+564
+00:42:23,090 --> 00:42:24,970
+كلّكم عرفتوا أنه هو الـGram-positive بكتيريا،
+
+565
+00:42:24,970 --> 00:42:28,730
+والكوليستين الـGram-negative بكتيريا، النيستاتين
+
+566
+00:42:28,730 --> 00:42:29,470
+للفطريات
+
+567
+00:42:36,180 --> 00:42:37,600
+تمام؟ وبنكمل المرة القادمة إن شاء الله
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vshf1KAA7wk_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vshf1KAA7wk_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..2110985b312e3f706d0df9bc2fded37619b1abe9
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vshf1KAA7wk_postprocess.srt
@@ -0,0 +1,2268 @@
+1
+00:00:20,520 --> 00:00:23,260
+بسم الله الرحمن الرحيم اليوم ان شاء الله موضوعنا
+
+2
+00:00:23,260 --> 00:00:27,500
+هيكون عن اللي هو ال gram-negative-diplokokai في ال
+
+3
+00:00:27,500 --> 00:00:31,420
+gram-negative-diplokokai هنسمع اسمين او two
+
+4
+00:00:31,420 --> 00:00:35,880
+genesis نيسيريا و برانهاميلا فقط لا غير عندنا
+
+5
+00:00:35,880 --> 00:00:39,660
+مجموعة من الأسماء بننطلع عليهم نيسيريا جنورية
+
+6
+00:00:39,660 --> 00:00:43,940
+نيسيريا مينينجيديس او meningitis و لاحظوا فيها حرف
+
+7
+00:00:43,940 --> 00:00:47,700
+ال D بينما المرض ال meningitis لا يحتوي على حرف ال
+
+8
+00:00:47,700 --> 00:00:52,390
+D و انما T فقطرقم واحد ورقم اتنين are the only
+
+9
+00:00:52,390 --> 00:00:56,510
+true pathogens والباقيين غالبا normal microbiota
+
+10
+00:00:56,510 --> 00:00:59,770
+زي نيسيريا كاتراليس او Brahamela kateralis اسمها
+
+11
+00:00:59,770 --> 00:01:03,410
+الان يبقى هاي الاسمين نيسيريا و Brahamela هنشوفه
+
+12
+00:01:03,410 --> 00:01:06,130
+في الأحد ان شاء الله كلمة Brahamela نيسيريا سيكا
+
+13
+00:01:06,130 --> 00:01:11,390
+نيسيريا فلافيسنس نيسيريا فلافا نيسيريا ميوكوزا و
+
+14
+00:01:11,390 --> 00:01:14,790
+نيسيريا لاكتاميكاإذا فاني عندى مجموعة من الأسماء
+
+15
+00:01:14,790 --> 00:01:20,390
+في نيسيريا بنحاول نطلع فيهم كمان مرة و نقرأهم كمان
+
+16
+00:01:20,390 --> 00:01:22,450
+مرة عشان نصيروا familiar ان شاء الله نيسيريا
+
+17
+00:01:22,450 --> 00:01:26,510
+جونوريا، نيسيريا مينيرديدس، نيسيريا كاتيراليس،
+
+18
+00:01:26,510 --> 00:01:31,630
+كمان مرة الاسم برانهاميلا كاتيراليس، نيسيريا سيكا،
+
+19
+00:01:31,630 --> 00:01:35,930
+نيسيريا فلافاسنز، نيسيريا فلافا، نيسيريا ميكوزا،
+
+20
+00:01:35,930 --> 00:01:42,330
+نيسيريا لكتاميكاالدكتور نايسر اللى على اسمه سميت
+
+21
+00:01:42,330 --> 00:01:46,910
+نايسيريا مافهمش
+
+22
+00:01:46,910 --> 00:01:51,410
+عليك اسم
+
+23
+00:01:51,410 --> 00:01:54,370
+تسمية جديدة يعني تفكر ان احنا كتير من الميكروبات
+
+24
+00:01:54,370 --> 00:01:58,490
+اللى درسناهم سابقا بقولنا كان نعم تغيرت تغيرت
+
+25
+00:01:58,490 --> 00:02:01,370
+الأسماء وتغير الأسماء كمان مرة أو مرة لألف
+
+26
+00:02:01,370 --> 00:02:06,260
+بنقولكوا اللى سبب التغير هو انهتقنياتنا بتتطور
+
+27
+00:02:06,260 --> 00:02:10,020
+فمعلوماتنا بتزداد وبالتالي بنقدر نعرف أن هذا
+
+28
+00:02:10,020 --> 00:02:14,340
+الميكروب لا ينتمي إلى وخاصة لما عملوا تحليل بال GC
+
+29
+00:02:14,340 --> 00:02:17,400
+content ال GC content اللي هو ال guanine cytosine
+
+30
+00:02:17,400 --> 00:02:21,720
+DNA analysis تمام؟ لجينا أن هذا ال species بتختلف
+
+31
+00:02:21,720 --> 00:02:24,420
+اختلاف كبير وعلى فكرة اتغير اسمه اكتر من مرة و
+
+32
+00:02:24,420 --> 00:02:29,500
+هنشوفه كمان ان شاء الله نعم بلان هاملالنسيريا
+
+33
+00:02:29,500 --> 00:02:36,500
+جونورية ذبلو كوكاي رائعة جدا مليئة بال بالاي و أحد
+
+34
+00:02:36,500 --> 00:02:40,620
+مكونات ال viralness تبعها الأساسية هو ال بالاي
+
+35
+00:02:40,620 --> 00:02:45,100
+مقدرتها على ال attachment هي اللي بتخلينا نقول انه
+
+36
+00:02:45,100 --> 00:02:49,420
+هي قادرة على احداث disease في منطقة يفترض ان فيها
+
+37
+00:02:49,420 --> 00:02:53,360
+سوائل السوائل هذه تم ال wash out للبكتيريا لكن
+
+38
+00:02:53,360 --> 00:02:55,920
+قدرتها على ال attachment هي اللي بتأهلها لل
+
+39
+00:02:55,920 --> 00:03:01,910
+infectionالاسم gonorrhea معروف من .. يمكن من سنة
+
+40
+00:03:01,910 --> 00:03:05,990
+مية و ثلاثين ميلادية بوسط أحد الأشخاص اسمه جالن
+
+41
+00:03:05,990 --> 00:03:11,410
+لكن الاسم الحقيقي والعلمي أخذ أو أعطيه على اسم
+
+42
+00:03:11,410 --> 00:03:13,950
+العلم اللي اكتشفه اللي هو نايسر في الف و تمانية و
+
+43
+00:03:13,950 --> 00:03:20,410
+سبعين والذي وصفه وصفه بمعنى اكتشفه gram negative
+
+44
+00:03:20,410 --> 00:03:25,820
+diplokai في الصديد المأخوذ منالمأخوذ من مين؟ من
+
+45
+00:03:25,820 --> 00:03:31,880
+الـ Purulent Discharge لمرضى مصابين بالسيالانواسم
+
+46
+00:03:31,880 --> 00:03:35,480
+ال disease جونورية باللغة العربية هو السائلان سميه
+
+47
+00:03:35,480 --> 00:03:40,920
+سائلان لإنه في سائل بيفرز تلقائي دون تحكم دون
+
+48
+00:03:40,920 --> 00:03:45,240
+سيطرة وهذا السائل عبارة عن صديد مليء بالبكتيريا
+
+49
+00:03:45,240 --> 00:03:49,320
+فلمّا أخذ هذا الصديد اللي هو من ال vaginal أو من
+
+50
+00:03:49,320 --> 00:03:53,160
+ال urethral أو حتى من ال conjunctiva تبعت الأطفال
+
+51
+00:03:53,160 --> 00:03:57,480
+حدثي الولادة الذين يولدون لأمهات مصابات بمين
+
+52
+00:03:57,480 --> 00:04:01,420
+بالنسيريا جونورية لجل جرام negative diplococaine
+
+53
+00:04:01,440 --> 00:04:06,260
+فتكريما له صمت البكتيريا بعد ذلك على اسمه ناشيريا
+
+54
+00:04:06,260 --> 00:04:14,060
+لكن كلمة جونورية كمرض قديمة قدام الزمن الآن هنا في
+
+55
+00:04:14,060 --> 00:04:18,680
+الجملة التانية او تالتة مكتوب جونورية is the most
+
+56
+00:04:19,570 --> 00:04:22,250
+prevalent venereal disease، إيش يعني the most
+
+57
+00:04:22,250 --> 00:04:25,830
+prevalent؟ هي الأكثر انتشارا، بس هي المعلومة مش
+
+58
+00:04:25,830 --> 00:04:29,310
+حقيقية الآن، هي رقم اتنين الآن، بدل ما رقم واحد
+
+59
+00:04:29,310 --> 00:04:33,310
+بجت، صارت رقم إيه؟ رقم اتنين، برضه مش معنى الحكي
+
+60
+00:04:33,310 --> 00:04:36,210
+إنه صار فيه تغيير في ال Epidemiology، معلوماتنا
+
+61
+00:04:36,210 --> 00:04:40,110
+زادت، قدرتنا على الكشف عن الميكروب الأولاني
+
+62
+00:04:40,110 --> 00:04:44,320
+اتحسنت، اللي هو ال Clamydiaالكلاميديا فاكرين هي
+
+63
+00:04:44,320 --> 00:04:48,760
+obligate intracellular parasites وزراع أو زراعة ال
+
+64
+00:04:48,760 --> 00:04:51,660
+obligate intracellular parasites أمر ليس بالسهل
+
+65
+00:04:51,660 --> 00:04:56,540
+وبالتالي لما اتطورت قدرتنا على ال detection لجينا
+
+66
+00:04:56,540 --> 00:05:00,100
+لأ لجينا ان الكلاميديا هي number one و النسيريا هي
+
+67
+00:05:00,100 --> 00:05:05,490
+number two عادة لأحتى رقم اتنين لما نتكلم عن نسبة
+
+68
+00:05:05,490 --> 00:05:09,630
+الصعوبة تبعتها globally في العالم هلاجيها ضخمة جدا
+
+69
+00:05:09,630 --> 00:05:14,230
+نتكلم عن ملايين بل بلايين الأشخاص مصابين سنويا
+
+70
+00:05:14,230 --> 00:05:21,150
+بهذا ال micro ال chlamydia؟ لأ ال chlamydia حاجة
+
+71
+00:05:21,150 --> 00:05:25,310
+تانية خالص يا ابني أنا قلنا ال chlamydia اللي هي
+
+72
+00:05:25,310 --> 00:05:28,110
+obligate intracellular parasites اتخذناها هي و ال
+
+73
+00:05:28,110 --> 00:05:31,500
+rickettsia ال chlamydia في أول فصلGonorrhea جُنّا
+
+74
+00:05:31,500 --> 00:05:34,800
+is the most لكنها الأن عدّانا المعلومة جُنّا أنها
+
+75
+00:05:34,800 --> 00:05:38,300
+the second most the second most مش the first most
+
+76
+00:05:38,300 --> 00:05:41,200
+the primary infection with Neisseria Gonorrhea
+
+77
+00:05:41,200 --> 00:05:43,840
+although uncomfortable وهذه النقطة بدنا نفهمها
+
+78
+00:05:43,840 --> 00:05:49,180
+كويس كلمة uncomfortable يعني بتعطيك شعور بعدم
+
+79
+00:05:49,180 --> 00:05:53,580
+الارتياح ايش يعني عدم الشعور أو الشعور بعدم
+
+80
+00:05:53,580 --> 00:05:59,350
+الارتياح؟ يعني مضايق هل الإنسان اللي عنده ضيقيعني
+
+81
+00:05:59,350 --> 00:06:02,870
+زي واحد أكرمكم الله لابس حذاء شد على رجله شويه
+
+82
+00:06:02,870 --> 00:06:07,570
+جديد أو لابس بانطلون ضيق أو مش مرتاح في الجعدة
+
+83
+00:06:07,570 --> 00:06:11,650
+تبعته كويس مش مرتاح هل هي مدعال الذهاب إلى الطبيب؟
+
+84
+00:06:11,650 --> 00:06:15,810
+مش مدعال الذهاب إلى الطبيب وبالتالي ال symptoms مش
+
+85
+00:06:15,810 --> 00:06:20,850
+severe ولا painful ولا painful وبالتالي المريض
+
+86
+00:06:20,850 --> 00:06:28,180
+غالبا ما بيزور ما بيزور الطبيبإلا ماتا طبعا لما
+
+87
+00:06:28,180 --> 00:06:30,500
+يصير complications لما يصير في عنده complications
+
+88
+00:06:30,500 --> 00:06:34,960
+الآن في الفترة اللي كان فيها ال symptoms بسيطة
+
+89
+00:06:34,960 --> 00:06:39,640
+بيمارس حياته الطبيعية وبالتالي هو مصدر مهم جدا
+
+90
+00:06:39,640 --> 00:06:44,480
+لنقل العدوى للآخرين بينقل لإنه STD مع مين بيمارس
+
+91
+00:06:44,480 --> 00:06:47,800
+الجنس بينقل لهم هدول الميكروبات وإذا كان الآخرين
+
+92
+00:06:47,800 --> 00:06:50,900
+بيمارسوا الجنس مع أشخاص آخرين أيضا كمان بتنتقل لهم
+
+93
+00:06:50,900 --> 00:06:54,760
+الميكروبات ودلعلم ومعرفش أنا ممكن نقشت الموضوع
+
+94
+00:06:54,760 --> 00:06:59,960
+حاجاب اللي هي كدهإن موضوع الشخص الواحد بيعمل لو
+
+95
+00:06:59,960 --> 00:07:03,380
+عمل متوسط خمس علاقات في السنة وكل واحد من هدول
+
+96
+00:07:03,380 --> 00:07:07,260
+الخمس عمل كمان خمس علاقات مدى الحكي شبكة network
+
+97
+00:07:07,260 --> 00:07:11,660
+لو واحد منهم مصاب ممكن ينقل لكل هؤلاء الناس اذا
+
+98
+00:07:11,660 --> 00:07:15,060
+عشان هيك بيقول ان ال STD في العالم الغربي منتشر
+
+99
+00:07:15,060 --> 00:07:19,380
+جدا بينما في العالم الإسلامي و الحمد لله limited
+
+100
+00:07:19,380 --> 00:07:26,040
+very limitedطيب يبقى اتفقنا انه عدم وجود severity
+
+101
+00:07:26,040 --> 00:07:31,000
+لل disease مدعاة لعدم الذهاب إلى الطبيب مدعاة لعدم
+
+102
+00:07:31,000 --> 00:07:36,640
+التشخيص كمان حسابها في ضمن الأعداد قد يقل لذلك
+
+103
+00:07:36,640 --> 00:07:40,980
+مابنعطيهاش الرقم الحقيقي يعني لو نقول نسبة الإصابة
+
+104
+00:07:40,980 --> 00:07:46,760
+بالناسيريا جونورية هذا العاممليون إصابة مليون هدول
+
+105
+00:07:46,760 --> 00:07:50,140
+اللي راحوا و عملوهم diagnosis بس في جدهم ممكن أو
+
+106
+00:07:50,140 --> 00:07:54,640
+أكثر مراحوش يبجي احنا بنقدر نقول ان ال numbers
+
+107
+00:07:54,640 --> 00:07:59,080
+المعلنة are underestimated يعني مقدرة تقدير أقل
+
+108
+00:07:59,080 --> 00:08:03,460
+مما هو متوقع أو حقيقي جملة الأخيرة برح نفهم الغلط
+
+109
+00:08:03,460 --> 00:08:07,660
+man is the only known host for the organismما
+
+110
+00:08:07,660 --> 00:08:10,640
+المقصود فيه أنا مين؟ الإنسان يعني البشر هم
+
+111
+00:08:10,640 --> 00:08:14,100
+الوحيدين اللي بيصابوا عشانك احنا دايما بنقول ان
+
+112
+00:08:14,100 --> 00:08:16,980
+sexual transmitted diseases are specifically
+
+113
+00:08:16,980 --> 00:08:20,620
+designed for those who are committing the crime of
+
+114
+00:08:20,620 --> 00:08:24,860
+sexual activity outside marriage relation خارج
+
+115
+00:08:24,860 --> 00:08:29,940
+العلاقة الإطار الشرعي للعلاقة الجنسية من يرتكبها
+
+116
+00:08:29,940 --> 00:08:33,880
+هذه الميكروبات المصاممة اللي هم حتى يعني تستطيع
+
+117
+00:08:33,880 --> 00:08:39,840
+انك تقوليعني البعض كان يثير نقاط هل يمكن لشخص مصاب
+
+118
+00:08:39,840 --> 00:08:44,620
+بالناسيريا جونورية دخل بركة أسباحة و احنا دخلنا
+
+119
+00:08:44,620 --> 00:08:48,560
+معاه بركة أسباحة او بعدين هل ممكن أن تنتقل منه
+
+120
+00:08:48,560 --> 00:08:56,920
+للاخرين؟ لأ لو دخلنا حمام استخدمه شخص مصاب
+
+121
+00:08:56,920 --> 00:09:00,640
+بالناسيريا جونورية و استخدمنا الحمام هذا بعده هل
+
+122
+00:09:00,640 --> 00:09:07,130
+يمكن أن نصاب؟ غالبا لأمؤشرة ليش؟ على انه sexually
+
+123
+00:09:07,130 --> 00:09:12,330
+transmitted فقط sexually transmitted والدليل على
+
+124
+00:09:12,330 --> 00:09:16,590
+ذلك لما نيجي نتكلم عن جمع العين البكتيريا توصف على
+
+125
+00:09:16,590 --> 00:09:19,990
+انها fragile ايش انها fragile؟ هشة او بيقولوا عنها
+
+126
+00:09:19,990 --> 00:09:23,750
+delicate delicate يعني رقيقة اذا تعرضت لأي
+
+127
+00:09:23,750 --> 00:09:29,290
+condition لو لو لل trace كلمة trace مايعني trace؟
+
+128
+00:09:30,390 --> 00:09:35,390
+أثار متبقية قليلة من اي disinfectant ممكن تموت لو
+
+129
+00:09:35,390 --> 00:09:39,290
+تعرضت للجفاف ممكن تموت شوية حرارة سبعة وتلاتين
+
+130
+00:09:39,290 --> 00:09:43,450
+تلاتين درجة موية ممكن تموت اذا ال bacteria
+
+131
+00:09:43,450 --> 00:09:49,010
+specifically designed for this purpose ورسول الله
+
+132
+00:09:49,010 --> 00:09:54,470
+الكريم أخبرنا يعني بهذا الكلام منذ زمن بعيد أكتر
+
+133
+00:09:54,470 --> 00:09:58,230
+من ألف و أربعمائة و أربعين سنة لما أخبرنا انه
+
+134
+00:09:58,230 --> 00:10:03,090
+بمعنى الحديثإذا ظهرت الفحشة في قوم ما ظهرت الفحشة
+
+135
+00:10:03,090 --> 00:10:07,750
+في قوم قط حتى يعلنوا بها وكلمة يعلنوا بها يعني أن
+
+136
+00:10:07,750 --> 00:10:12,630
+تكون واضحة للعيال في الشوارع في الطرقات في الجناين
+
+137
+00:10:12,630 --> 00:10:16,370
+زي ما بيصير في الغرب إلا وظهرت فيهم أمراض لن تكن
+
+138
+00:10:16,370 --> 00:10:22,740
+فيه سابقينهل الشرط تحقق يبقى النتيجة حتمية، إذا
+
+139
+00:10:22,740 --> 00:10:26,080
+الشرط تحقق فالنتيجة حتمية، ما ظهرت الفحشة في قوم
+
+140
+00:10:26,080 --> 00:10:29,820
+القطب حتى يعلنوا بها إلا وظهرت فيهم أو كما بقال
+
+141
+00:10:29,820 --> 00:10:30,480
+صلى الله عليه وسلم
+
+142
+00:10:37,180 --> 00:10:39,300
+المعلومات كلها بتشير الفنانسية الاجانبية انها
+
+143
+00:10:39,300 --> 00:10:43,400
+specifically designed as ت .. it is gram-negative
+
+144
+00:10:43,400 --> 00:10:47,300
+-diplokokai oxidase وهذه نقطة أساسية في ال
+
+145
+00:10:47,300 --> 00:10:51,080
+diagnosis إذا جلجت gram-negative-diplokokai you
+
+146
+00:10:51,080 --> 00:10:55,920
+should do oxidase طب انت خايف من مين؟ خايف من مين؟
+
+147
+00:10:55,920 --> 00:10:59,780
+اذا اكتشف عن مين؟ عمال مافيش عين دي gram-negative
+
+148
+00:10:59,780 --> 00:11:01,720
+.. هي gram-negative-diplokokai
+
+149
+00:11:08,060 --> 00:11:13,960
+الأسينيتوباكتر may mimic
+
+150
+00:11:13,960 --> 00:11:18,760
+نيسيريا
+
+151
+00:11:18,760 --> 00:11:22,480
+جونورية لذلك الفرق الأساسي بينهم هو ال oxidase
+
+152
+00:11:22,480 --> 00:11:25,740
+test نيسيريا is oxidase positive while this
+
+153
+00:11:25,740 --> 00:11:31,390
+bacteria is oxidase negativeكمان نقطة كتير مهمة
+
+154
+00:11:31,390 --> 00:11:35,150
+رقم تلاتة جملة رقم تلاتة احنا بنعمل three
+
+155
+00:11:35,150 --> 00:11:38,670
+carbohydrate oxidation test عشان نميز ال نيسيريا
+
+156
+00:11:38,670 --> 00:11:45,290
+عن بعض، تمام؟ بنعمل دكستروز و مالتوز و ساكروز،
+
+157
+00:11:45,290 --> 00:11:49,010
+هدول التلت سكريات، بنعملهم النيسيريا جنورية is
+
+158
+00:11:49,010 --> 00:11:52,450
+positive only for دكستروز اللي هو الوشلكوز، but
+
+159
+00:11:52,450 --> 00:11:59,070
+negative forMeltose and Saccharose طب بنميزها عن
+
+160
+00:11:59,070 --> 00:12:03,590
+إيش وبإيش؟ بنميزها عن النيسيريا من النجدايدس
+
+161
+00:12:03,590 --> 00:12:07,170
+النيسيريا من النجدايدس إيش بمواصفاتها؟ Gram
+
+162
+00:12:07,170 --> 00:12:11,610
+Negative Diplococci و Oxidase بُسطف وجلوكوز بُسطف
+
+163
+00:12:11,610 --> 00:12:16,910
+زائد ملتوز بُسطف بما أن نيسيريا جنورية ملتوز إيش؟
+
+164
+00:12:16,910 --> 00:12:20,090
+يبجي هذه من الآن نبجي عارفين .. نبجي عارفين هذه
+
+165
+00:12:20,090 --> 00:12:21,670
+الجزء حاضر
+
+166
+00:12:24,620 --> 00:12:28,420
+بنقول نيسيريا جونورية في الكربوهيدرات التلاتة فقط
+
+167
+00:12:28,420 --> 00:12:31,800
+positive لمن؟ لرجل الوكوز بينما النيسيريا من
+
+168
+00:12:31,800 --> 00:12:34,660
+الريضايتس positive لرجل الوكوز زاد مالتهوز هاي
+
+169
+00:12:34,660 --> 00:12:38,700
+differentiation، صح؟ في كمان نقطة كتير مهمة أن
+
+170
+00:12:38,700 --> 00:12:41,940
+النيسيريا جونورية و النيسيريا من الريضايتس can
+
+171
+00:12:41,940 --> 00:12:45,680
+grow on blood agar، on blood agar، on chocolate
+
+172
+00:12:45,680 --> 00:12:50,350
+agar، but not nutrient agarطب هذا النقطة كيف
+
+173
+00:12:50,350 --> 00:12:55,670
+نستغلها؟ كل ال non-pathogenic Neisseria بينمو على
+
+174
+00:12:55,670 --> 00:12:58,590
+blood agar و بينمو على chocolate agar بس بينمو
+
+175
+00:12:58,590 --> 00:13:01,730
+كمان عالمين على ال nutrient agar يبقى ال pathogens
+
+176
+00:13:01,730 --> 00:13:05,970
+مابينموش .. من المجموعة ال Neisseria مابينموش على
+
+177
+00:13:05,970 --> 00:13:08,770
+ال nutrient agar، إذن هذه برضه كمان صفة نستطيع أن
+
+178
+00:13:08,770 --> 00:13:11,390
+نستخدمها في التعرف أو في التمييز ما بين ال other
+
+179
+00:13:11,390 --> 00:13:16,800
+Neisseriaوين بتعمل infection؟ بقولنا بتفضل انها
+
+180
+00:13:16,800 --> 00:13:19,740
+تصيب ال culinary epithelial cells اللي موجود في ال
+
+181
+00:13:19,740 --> 00:13:22,440
+endocervix، في ال urethra، في ال anogenital،
+
+182
+00:13:22,440 --> 00:13:26,340
+anogenital، في الأعنص يعني، و ال genital tract،
+
+183
+00:13:26,340 --> 00:13:29,960
+oropharyngeal تمام؟ ميوكاس ميمبرينز، و ممكن كمان
+
+184
+00:13:29,960 --> 00:13:33,140
+تعمل في ال conjective أنا قلت قبل شوية إذا الأم
+
+185
+00:13:33,140 --> 00:13:39,140
+وصابة الجنين بيولد، بيمور عبر قناة الولادةهذا
+
+186
+00:13:39,140 --> 00:13:42,060
+الكلام شفناه في مين؟ في .. في .. في ال group B
+
+187
+00:13:42,060 --> 00:13:45,880
+streptococci انه برضه الام لما تكون مصابة، مظبوط،
+
+188
+00:13:45,880 --> 00:13:50,380
+الطفل بياخد و بيلاجي البكتيريا على كل جسمه، لكن مش
+
+189
+00:13:50,380 --> 00:13:54,740
+كل جسمه بنصاب بالبكتيريا، أكتر مكان حساس للنيسيديا
+
+190
+00:13:54,740 --> 00:13:57,320
+غنرية عند ال neonates هو ال conjunctive تبعات
+
+191
+00:13:57,320 --> 00:14:00,850
+العينوبالتالت disease بينشأ اسمه Ophthalmia
+
+192
+00:14:00,850 --> 00:14:06,710
+Neonatrum نيو ناتروم نيو نيت نيو نيت و .. و .. و
+
+193
+00:14:06,710 --> 00:14:08,350
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+194
+00:14:08,350 --> 00:14:08,970
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+195
+00:14:08,970 --> 00:14:09,470
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+196
+00:14:09,470 --> 00:14:09,670
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+197
+00:14:09,670 --> 00:14:09,790
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+198
+00:14:09,790 --> 00:14:18,550
+.. و .. و .. و .. و .. و .. و .. و .. و ..
+
+199
+00:14:18,550 --> 00:14:25,110
+و .. و .. والان عندى ال PLI اللى هى قولنا عامل
+
+200
+00:14:25,110 --> 00:14:28,570
+أساسى فى ال virulence factor عامل أساسى فى ال
+
+201
+00:14:28,570 --> 00:14:33,510
+virulence factor ليش عامل أساسى؟ لأنه هى المسؤولة
+
+202
+00:14:33,510 --> 00:14:36,290
+عن ال attachment و بدون attachment مافيش عندي
+
+203
+00:14:36,290 --> 00:14:38,890
+colonization و بدون colonization مافيش عندي
+
+204
+00:14:38,890 --> 00:14:43,550
+infection و بدون infection ماعنديش disease كمان
+
+205
+00:14:43,550 --> 00:14:46,510
+مرة شهد هدى proof على أنه specifically designed
+
+206
+00:14:46,510 --> 00:14:52,660
+for STDs ان اتوا معدنابمعنى يفترض أنه لو جسمنا
+
+207
+00:14:52,660 --> 00:14:58,300
+كوّن أجسام مضادة ضد ال TLA وعمل IGA و ال IGA لأنه
+
+208
+00:14:58,300 --> 00:15:00,960
+موجود على ميوكاس ميمبراين و دخلت مرة تانية
+
+209
+00:15:00,960 --> 00:15:04,840
+البكتيريا مفترض أنه يحمينا من مين؟ من البكتيريا
+
+210
+00:15:04,840 --> 00:15:11,090
+لأنه في عندي antibodiesالانش اللي بيصير بيصير انه
+
+211
+00:15:11,090 --> 00:15:15,310
+ال .. البكتيريا عندها المقدرة انها تعمل variation
+
+212
+00:15:15,310 --> 00:15:22,390
+في ال بالاي فكل مرة بتدخل الرسم تدخل ب بالاي ب
+
+213
+00:15:22,390 --> 00:15:25,430
+بالاي جديدة ال antibody is not suited for that
+
+214
+00:15:25,430 --> 00:15:30,830
+يعني الإنسان يعني يصاب مرارا وتكرارا على فرض انه
+
+215
+00:15:30,830 --> 00:15:36,620
+تعرض لهذا ال micro organism في كمان شغل كتير مهمهي
+
+216
+00:15:36,620 --> 00:15:43,040
+بتستخدمها البكتيريا لمين؟ بتستخدمها للهروب
+
+217
+00:15:43,040 --> 00:15:46,740
+من الجهاز المناع و احنا بنستخدمها لل molecular ..
+
+218
+00:15:46,740 --> 00:15:50,180
+molecular أو خلينا نقول الـ Epidemiological
+
+219
+00:15:50,180 --> 00:15:52,980
+Characterization للتعرف عليها و على السلالات
+
+220
+00:15:52,980 --> 00:15:57,020
+المنتشرة في المنطقة،
+
+221
+00:15:57,020 --> 00:16:03,100
+فضلصحيح مش كل مرة بدخل هو عملية ال antigenic
+
+222
+00:16:03,100 --> 00:16:07,020
+variation ظاهرة موجودة في البكتيريا يعني حكيناها
+
+223
+00:16:07,020 --> 00:16:12,180
+يمكن في بداية الفصل لأ هذا .. هذا .. هذا شيء يعني
+
+224
+00:16:12,180 --> 00:16:16,680
+كان بتميز في بعض الميكروبات زي السلمونيلا لكن ال
+
+225
+00:16:16,680 --> 00:16:23,060
+antigenic variation قد
+
+226
+00:16:23,060 --> 00:16:25,760
+تكون ناتجة عن pre-programmed
+
+227
+00:16:28,860 --> 00:16:32,560
+ماذا يعني pre-programmed؟ يعني المادة الوراثية
+
+228
+00:16:32,560 --> 00:16:39,520
+بتقول ان كل فترة وفترة بيصير فيه rearrangement هاي
+
+229
+00:16:39,520 --> 00:16:44,780
+جينات تمام مسئولة عن إنتاج بلاي بدل الجين هذا
+
+230
+00:16:44,780 --> 00:16:50,480
+مايكون هنا موقعه تلاتة بنخليه أربعة و بنخليه أربعة
+
+231
+00:16:50,480 --> 00:16:58,670
+موقعه تلاتة فالمنتج هيطلع بلايلكن .. لكن مش زي ال
+
+232
+00:16:58,670 --> 00:17:01,710
+بلاي اللى كانت تنتج لما كان اربع هو تلتة و تلتة
+
+233
+00:17:01,710 --> 00:17:05,750
+كان هو اربع فده ايش اسمه Antigenic Valency هذه
+
+234
+00:17:05,750 --> 00:17:10,390
+ظاهرة تحدث في كثير من البكتيريا ومن ضمنها نيسيريا
+
+235
+00:17:10,390 --> 00:17:15,990
+و .. okay؟ يعني مش كل مرة بتطلع برا و بتغير .. لأ
+
+236
+00:17:15,990 --> 00:17:20,550
+هذه شغلة مستمرة قد تستطيع بعض البكتيريا أن تغير
+
+237
+00:17:20,550 --> 00:17:21,970
+Antigenات هوية داخل الجسم
+
+238
+00:17:26,400 --> 00:17:30,580
+يعني لكن مفهومين مختلفين هدا واحد لل antibodies و
+
+239
+00:17:30,580 --> 00:17:36,360
+واحد لل antibiotics طيب من ضمن المواصفات اللي تميز
+
+240
+00:17:36,360 --> 00:17:39,860
+فيها البكتيريا هذه coffee bean shape coffee زي
+
+241
+00:17:39,860 --> 00:17:43,340
+الجهة و حبات القهوة و حبات القهوة كيف تكون عملة زي
+
+242
+00:17:43,340 --> 00:17:48,740
+حرف ال D الأوجه المتقابلة flattened flattened يعني
+
+243
+00:17:48,740 --> 00:17:53,800
+مسطحة و بعض الأحيان بنشوفها عملة زي حبات الفصولة
+
+244
+00:17:56,660 --> 00:18:00,460
+هو بيسموها ال bean اللي هي الفصولية ال coffee او
+
+245
+00:18:00,460 --> 00:18:02,480
+ال bean ال bean فصولية و ال coffee قلنا اللي هو
+
+246
+00:18:02,480 --> 00:18:06,700
+القهوة shape او kidney bean shape kidney عارفين ال
+
+247
+00:18:06,700 --> 00:18:09,660
+kidney كيلية برضه اعتقد انه زي حبة الفصولية برضه
+
+248
+00:18:09,660 --> 00:18:17,040
+طبعا الان هناك نقطة بدنا نتكلم فيها مهمة احنا قلنا
+
+249
+00:18:17,040 --> 00:18:20,500
+ال only host is man و man مقصود فيها قلنا هنا ايه
+
+250
+00:18:20,500 --> 00:18:25,190
+الانسان مش الراجللنتكلم الآن عن الذكر و الأنثى في
+
+251
+00:18:25,190 --> 00:18:30,410
+هذا الموضوع مهمين جدا احنا ذكرنا مجموعة species
+
+252
+00:18:30,410 --> 00:18:35,750
+قلنا تنتم منهم infectious او virulent والباقي
+
+253
+00:18:35,750 --> 00:18:39,790
+normal microbiota واحدة الآن نتكلم عن واحدة منهم
+
+254
+00:18:39,790 --> 00:18:44,930
+فقط نيسيريا جونورية ال نيسيريا جونورية is
+
+255
+00:18:44,930 --> 00:18:48,650
+pathogenic مش مورده ان كان ورمى الفلورةلكن السيكا
+
+256
+00:18:48,650 --> 00:18:52,490
+واللاكتاميكا والفلافا والفلافيسنس هدولة normal
+
+257
+00:18:52,490 --> 00:18:56,990
+flora وين موجودين؟ موجودين للأسف normal flora of
+
+258
+00:18:56,990 --> 00:19:00,490
+the female vagina يعني لو .. و بعض الأحيان بنجيهم
+
+259
+00:19:00,490 --> 00:19:06,150
+في ال oral flora oral flora الآن لو أخدنا swab من
+
+260
+00:19:06,150 --> 00:19:11,050
+urethral discharge من female فمال يعني أنت و
+
+261
+00:19:11,050 --> 00:19:13,350
+عملناها ل gram stain و لجينا gram negative double
+
+262
+00:19:13,350 --> 00:19:15,750
+cocci هل تعني شيء؟
+
+263
+00:19:17,840 --> 00:19:21,840
+الجرام نيجاتف دبلو كوكاي بشكل عام قد تكون نيسيريا
+
+264
+00:19:21,840 --> 00:19:26,560
+جنورية أو قد تكون other نيسيريا ماحكمناش لكن لا
+
+265
+00:19:26,560 --> 00:19:32,100
+نستطيع أن نقول إن وجودها غريب لأنها موجودة بشكل
+
+266
+00:19:32,100 --> 00:19:37,360
+normal ميكروبيوتر لكن لو أخبرتكوا إن الورترا بتاعة
+
+267
+00:19:37,360 --> 00:19:43,240
+الميل لا يولد بها normal flora وقمت أنا بعمل gram
+
+268
+00:19:43,240 --> 00:19:48,380
+stain لميل اللي جيت عنده جرام نيجاتف دبلو كوكايهنا
+
+269
+00:19:48,380 --> 00:19:52,540
+الآن ايه؟ بتكون كاشفة عن مين؟ عن ان المريض هذا
+
+270
+00:19:52,540 --> 00:19:57,500
+احتمالية انه يكون مصاب بالناسيريا جونورية احتمالية
+
+271
+00:19:57,500 --> 00:20:01,240
+ايه؟ عالية وبيفرضوها على انها presumative
+
+272
+00:20:01,240 --> 00:20:04,320
+diagnosis ايش يعني presumative diagnosis؟ يعني
+
+273
+00:20:04,320 --> 00:20:07,600
+diagnosis افتراضي او diagnosis اولي ان المريض عنده
+
+274
+00:20:07,600 --> 00:20:13,610
+ناسيريا جونورية لكن عند اللذلك .. ممكن تكون ..
+
+275
+00:20:13,610 --> 00:20:17,190
+كمان مرة مابتقدرش تحكم انها normal flora ولا
+
+276
+00:20:17,190 --> 00:20:21,810
+باعتوجين لذلك حتى بعض المختبرات شباب بترفض تستقبل
+
+277
+00:20:21,810 --> 00:20:29,290
+urethral discharge يعني لو اجاك request form تمام؟
+
+278
+00:20:29,290 --> 00:20:33,090
+هاي الاسم، هاي الأمر، ومكتوب هنا female تمام؟
+
+279
+00:20:33,090 --> 00:20:38,930
+الجنس، gender تمام؟ ومطلوب ولاينا urethral
+
+280
+00:20:40,010 --> 00:20:45,130
+discharge ومطلوبش الآن granstein بيري التكنيسين
+
+281
+00:20:45,130 --> 00:20:51,810
+بتطلع اه female يبقى rejected مرفوض لو جالي
+
+282
+00:20:51,810 --> 00:21:00,110
+culture مقبول مافهمش ليش العقوى لسه انا قاعد بقول
+
+283
+00:21:00,110 --> 00:21:03,270
+انه انا قاعد بقول انه لو انا عملت granstein وانا
+
+284
+00:21:03,270 --> 00:21:05,970
+جاتي granine وانا جاتي cocaine ماذا يعني ذلك
+
+285
+00:21:05,970 --> 00:21:11,090
+nothing صح و ذلككمان مرة ما تقولش normal لأنه ممكن
+
+286
+00:21:11,090 --> 00:21:14,510
+تكون نيسيريا جنورية ليش أنا قولت موافق انا بقول
+
+287
+00:21:14,510 --> 00:21:18,990
+بوافق لو كان السؤال او المطلوب culture في ال
+
+288
+00:21:18,990 --> 00:21:24,070
+culture بقدر اميز بين normal microbiota وبين
+
+289
+00:21:24,070 --> 00:21:30,420
+pathogenic نيسيريا جنوريةهو يعني كان Gram Stain
+
+290
+00:21:30,420 --> 00:21:34,580
+يعني useless يعني مالوش قيمة هنا، هنا مالوش قيمة
+
+291
+00:21:34,580 --> 00:21:37,640
+هو طلب يعني انه يجيبك بس انه Gram Stain ماهي اللي
+
+292
+00:21:37,640 --> 00:21:40,660
+بحكيلك ايه انا Gram Stain for urethral discharge
+
+293
+00:21:40,660 --> 00:21:43,060
+وبالتالي rejected لو كان هنا mail
+
+294
+00:21:46,920 --> 00:21:53,060
+احنا جاني بنقولك انه hospital policy انه قد يسمح
+
+295
+00:21:53,060 --> 00:21:57,840
+لعمل جروح مسترين لكن لن يكون له فائدة، بينما لما
+
+296
+00:21:57,840 --> 00:22:00,200
+يكون male بيكون له فائدة في هذا الحال
+
+297
+00:22:03,030 --> 00:22:06,110
+إذا صرنا متفقين .. صرنا متفقين إن ال grammar stain
+
+298
+00:22:06,110 --> 00:22:10,490
+من ال urethral discharge لل female is of no value،
+
+299
+00:22:10,490 --> 00:22:14,930
+لكن لل male بيكون بعطي presumptive diagnosis، هلأ
+
+300
+00:22:14,930 --> 00:22:17,690
+أنا بقول للطبيب إنه أنا شوفت نيسيريا جنورية؟ و ليش
+
+301
+00:22:17,690 --> 00:22:23,400
+بقولله؟بقوله شفت gram negative diplococci مش بس
+
+302
+00:22:23,400 --> 00:22:28,280
+هيك بقوله شفت gram negative diplococci وشفت هل هي
+
+303
+00:22:28,280 --> 00:22:31,900
+intracellular ولا extracellular إيش يعني
+
+304
+00:22:31,900 --> 00:22:34,180
+intracellular و extracellular دعوني أشوف مع بعض مع
+
+305
+00:22:34,180 --> 00:22:35,920
+سنة الصورة مانعش متأخر شوية
+
+306
+00:22:46,870 --> 00:22:52,870
+ناخد الصورة على الجهة هذه الجهة البعيدة هذه
+
+307
+00:22:52,870 --> 00:22:56,930
+عبارة عن blood cells white blood cells لاحظولي
+
+308
+00:22:56,930 --> 00:23:02,910
+الكوريات الصغيرة الموجودة داخلها هذه عبارة عن دبلو
+
+309
+00:23:02,910 --> 00:23:07,450
+كوكاي دبلو كوكاي دبلو كوكاي دبلو كوكاي دبلو كوكاي
+
+310
+00:23:07,450 --> 00:23:10,050
+كوكاي دبلو كوكاي دبلو كوكاي دبلو كوكاي دبلو كوكاي
+
+311
+00:23:10,050 --> 00:23:11,270
+دبلو كوكاي دبلو كوكاي دبلو كوكاي دبلو كوكاي دبلو
+
+312
+00:23:11,270 --> 00:23:16,230
+كوكاي دبلو كوكاي دبلو كوكاي داللي بدأ أوصف ورا تحت
+
+313
+00:23:16,230 --> 00:23:19,650
+ال microscope هنا أنه فيه bus cells و لا فيش bus
+
+314
+00:23:19,650 --> 00:23:23,810
+cells و أنه ال bus cells عددها بال high power
+
+315
+00:23:23,810 --> 00:23:27,670
+field على سبيل المثال عشرة خمستاشر عشرين يعني بوصف
+
+316
+00:23:27,670 --> 00:23:31,690
+أو بال oil immersion بوصف عدد ال bus cells و بوصف
+
+317
+00:23:31,690 --> 00:23:36,870
+عدد الخلايا من ال bus cells المحتوية على النيسيريا
+
+318
+00:23:36,870 --> 00:23:41,810
+جنورية أو على ال ground positive دبلو كوكاينوباوصف
+
+319
+00:23:41,810 --> 00:23:45,710
+وجودها هل هو intracellular وهذا الحال ليش يعني
+
+320
+00:23:45,710 --> 00:23:51,430
+وجود intracellular اكثر من مين من ال extracellular
+
+321
+00:23:51,430 --> 00:23:55,130
+طب هل هناك فايدة من هذا الكلام اول حاجة انا ذكرت
+
+322
+00:23:55,130 --> 00:23:59,450
+لكم سابقا مرارا و تكرارا بان احنا في ال gram
+
+323
+00:23:59,450 --> 00:24:03,510
+staining او في اي staining مابنتعرف على البكتيريا
+
+324
+00:24:03,510 --> 00:24:08,090
+الا في حالات ال staining with specific antibody زي
+
+325
+00:24:08,090 --> 00:24:12,040
+ال fluorescentبينما في ال gram staining في الاسد
+
+326
+00:24:12,040 --> 00:24:17,540
+فاصل staining we just describe بنوصف ما نرا بدقة
+
+327
+00:24:17,540 --> 00:24:21,740
+فبنقول هنا gram negative diplokokai that are found
+
+328
+00:24:21,740 --> 00:24:27,980
+mostly intracellularly ايش اللي بيفهم منها الطبيب؟
+
+329
+00:24:27,980 --> 00:24:31,920
+بيفهم منها انها نيسيديا جنورية و انها acute stage
+
+330
+00:24:32,460 --> 00:24:36,800
+acute stage لو انا اشوف اسمير غير هذا الاسمير و
+
+331
+00:24:36,800 --> 00:24:40,660
+مكتوب فيه او التقرير تبقى بيقول اجرام negative
+
+332
+00:24:40,660 --> 00:24:46,680
+diplococci mostly found extracellularly بيفهم منها
+
+333
+00:24:46,680 --> 00:24:53,700
+نيسيريا جونورية chronic جونوريةchronic غنري واحدة
+
+334
+00:24:53,700 --> 00:24:57,820
+acute واحدة chronic ايش الفرق بينهم واحدة كانت
+
+335
+00:24:57,820 --> 00:25:02,720
+intracellular واحدة كانت extracellular اذا I just
+
+336
+00:25:02,720 --> 00:25:05,600
+describe what I see الصورة دي اللي قدامكوا هي
+
+337
+00:25:05,600 --> 00:25:08,360
+عبارة عن دبلو كوكايل مكبرة اكتر من الصورة
+
+338
+00:25:08,360 --> 00:25:12,600
+الأولانية لكن مش مأخوذة من pastels مأخوذة من طبق
+
+339
+00:25:13,370 --> 00:25:15,890
+يعني من culture تمام؟ من ال chocolate agar
+
+340
+00:25:15,890 --> 00:25:18,990
+وبالتالي شايفين bust cells انتوا في المنطقة؟ مافيش
+
+341
+00:25:18,990 --> 00:25:21,450
+bust cells وبالتالي هي pure culture of ground
+
+342
+00:25:21,450 --> 00:25:32,570
+negative diplococam تفضل كل الأسماء
+
+343
+00:25:32,570 --> 00:25:34,890
+اللي ذكرتها عدا التلاتة الأوارف
+
+344
+00:25:39,000 --> 00:25:42,840
+الناس من النجار كانوا كل ناسيريا مابترمبوا عليه و
+
+345
+00:25:42,840 --> 00:25:45,440
+لا بس فلها تتعامل؟ انا لو .. لو .. لو كل هما
+
+346
+00:25:45,440 --> 00:25:48,780
+بتبنموش عليه كان احنا ما حكينا المعلومة بهذه
+
+347
+00:25:48,780 --> 00:25:52,840
+الطريقة، يعني النجار اللي انا ذكرته .. النجار اللي
+
+348
+00:25:52,840 --> 00:25:57,460
+انا ذكرته ك differential character، ال pathogen
+
+349
+00:25:57,460 --> 00:26:02,100
+negative و ال non .. قبل مرة ذكرتك عن كل ال
+
+350
+00:26:02,100 --> 00:26:05,520
+pathogen، بتكلم عن مين؟ عن البعطلينك نيسيريا أو عن
+
+351
+00:26:05,520 --> 00:26:06,160
+ال نيسيريا
+
+352
+00:26:09,740 --> 00:26:13,560
+ال pathogenes ال pathogenes لا ينمو negative بينما
+
+353
+00:26:13,560 --> 00:26:22,940
+ال none patho positive لل growth فانا
+
+354
+00:26:22,940 --> 00:26:27,100
+استخدمته كصفة للتمييز ما بين نسيريا جنورية و
+
+355
+00:26:27,100 --> 00:26:30,620
+meningitis على جهة و الأخريات على جهة تانية
+
+356
+00:26:36,770 --> 00:26:40,730
+فيها يعني بعض ال evidence انها يعني قد تحدث بعض ال
+
+357
+00:26:40,730 --> 00:26:44,530
+infection خاصة في ال ear و ال oral cavity، بس
+
+358
+00:26:44,530 --> 00:26:46,750
+أولين تاني هم ال major pathogens، بقى احنا قولنا
+
+359
+00:26:46,750 --> 00:26:49,630
+.. بعدين احنا قولنا ان ال .. ال nyseria كتراريس
+
+360
+00:26:49,630 --> 00:26:53,750
+اللي معناه سخناها و شيلناها من مين؟ من ال nyseria
+
+361
+00:26:53,750 --> 00:26:56,750
+من أساسه، فانت ماتناقش .. ماتناقشاش أصلا من ضمن ان
+
+362
+00:26:56,750 --> 00:26:58,550
+ال nyseria، خلاص حطيناها اسم جزير
+
+363
+00:27:03,090 --> 00:27:06,970
+من الأشياء المهمة جدا يعرفها عن ال نيسيريا جونورية
+
+364
+00:27:06,970 --> 00:27:11,150
+انه they cannot survive they will survive only for
+
+365
+00:27:11,150 --> 00:27:14,770
+brief periods outside the body يعني قدرتهم على
+
+366
+00:27:14,770 --> 00:27:20,430
+البقاء خارج الدسم هي قدرة محدودة لذلك عندما تقوم
+
+367
+00:27:20,430 --> 00:27:26,520
+بجمع العينة عندما تقوم بجمع العينةلا تستخدم اي
+
+368
+00:27:26,520 --> 00:27:29,400
+disinfectant انا هقول ان اي traces من اي
+
+369
+00:27:29,400 --> 00:27:34,380
+disinfectant ممكن تقتلها هاي ايش نستخدم امسح العضو
+
+370
+00:27:34,380 --> 00:27:39,440
+المراد جمع العينة منه ب warm warm يعني دافي
+
+371
+00:27:39,440 --> 00:27:45,600
+sterile saline warm sterile saline ولما تجمع
+
+372
+00:27:45,600 --> 00:27:50,100
+العينة تجمعهاش على swab عادي لازم تستخدم ال
+
+373
+00:27:50,100 --> 00:27:51,920
+transport media transport
+
+374
+00:27:57,070 --> 00:28:02,470
+اسمه Transgroup ال
+
+375
+00:28:02,470 --> 00:28:09,450
+transport media عبارة عن swap عادي لكن
+
+376
+00:28:09,450 --> 00:28:16,930
+فيه هنا بعض المكونات جيلي like components
+
+377
+00:28:16,930 --> 00:28:22,140
+الغرض منها لما انا باخد ال swapو بروح و انا بعد ما
+
+378
+00:28:22,140 --> 00:28:25,460
+اخده بضغطه بداخله وين؟ جوا الـGel-like structure
+
+379
+00:28:25,460 --> 00:28:29,600
+هانا، لغلط منه مش عشان نمّل بكتيريا، عشان أحمل
+
+380
+00:28:29,600 --> 00:28:31,760
+الـBacteria، يعني اللي صح بيشعسل الآن في المنطقة
+
+381
+00:28:31,760 --> 00:28:34,940
+هذه،
+
+382
+00:28:34,940 --> 00:28:39,140
+هي الـBacteria هانا أو العينة، تمام؟ و الجزء
+
+383
+00:28:39,140 --> 00:28:41,860
+العلوي هانا عند الـHana واصل في عندي اللي هو
+
+384
+00:28:41,860 --> 00:28:46,040
+الـGel-like structure to protect the bacteria from
+
+385
+00:28:46,040 --> 00:28:51,690
+drying فقط لحمايتها من مين؟ من الجفافطيب احنا
+
+386
+00:28:51,690 --> 00:28:54,450
+قاعدين بنقول ان البكتيريا very fragile، very
+
+387
+00:28:54,450 --> 00:28:57,770
+fragile، very delicate، cannot survive for long
+
+388
+00:28:57,770 --> 00:29:01,110
+period outside the body، لذلك حتى في ال transport
+
+389
+00:29:01,110 --> 00:29:03,990
+media، مش معناة ان الحاجة انك حطيتها، اتحطها
+
+390
+00:29:03,990 --> 00:29:08,650
+ساعتين تلاتة، transport as soon as possible، مافيش
+
+391
+00:29:08,650 --> 00:29:11,930
+انها وقت طويل انضيعه لأن البكتيريا حتى في هذه
+
+392
+00:29:11,930 --> 00:29:17,560
+الظروف ممكن تموتإذا كمان مرة بنقول إن ناسيريا
+
+393
+00:29:17,560 --> 00:29:20,660
+جنورية should be collected in a way in a way to
+
+394
+00:29:20,660 --> 00:29:24,600
+avoid contact with any disinfectant it should be
+
+395
+00:29:24,600 --> 00:29:28,800
+placed in a transport أو special transport media
+
+396
+00:29:28,800 --> 00:29:31,840
+and it should be transported to the laboratory as
+
+397
+00:29:31,840 --> 00:29:35,580
+soon as possible يعني في أقصر فترة زمنية ممكن
+
+398
+00:29:41,140 --> 00:29:45,540
+الجولة اللي جابلها كانت مأخوذة مقتبسة من كتاب من
+
+399
+00:29:45,540 --> 00:29:52,000
+كتاب لكن يعني بتوضح نفس الكلام اللي احنا بدأنا فيه
+
+400
+00:29:52,000 --> 00:29:56,580
+محاضرتنا لما جناإن البكتيريا دي adapted للإنسان
+
+401
+00:29:56,580 --> 00:30:00,440
+فقط مصممة لمن؟ للإنسان the difficulty in growing
+
+402
+00:30:00,440 --> 00:30:03,380
+gonorrhea in the laboratory as well as their
+
+403
+00:30:03,380 --> 00:30:06,980
+failure to infect laboratory animals بمعنى صعوبة
+
+404
+00:30:06,980 --> 00:30:11,960
+تنميتنا للبكتيريا في المختبر رقم اتنين صعوبة انه
+
+405
+00:30:11,960 --> 00:30:14,580
+نعمل infection لل laboratory animals احنا كنا the
+
+406
+00:30:14,580 --> 00:30:20,290
+only non host for this organism ايش مين؟ manهو
+
+407
+00:30:20,290 --> 00:30:29,170
+يعني ان هذه
+
+408
+00:30:29,170 --> 00:30:34,250
+الميكروبات فقط مهتمة أو قادرة على ان تعمل
+
+409
+00:30:34,250 --> 00:30:37,670
+infection في من؟ في جسم الإنسان وليس في أي مخلوق
+
+410
+00:30:37,670 --> 00:30:44,030
+آخر وليس أي صنع أصلا في المحتمل طبعا ال mood of
+
+411
+00:30:44,030 --> 00:30:47,450
+transmission هي directly by كمان مرة sexual
+
+412
+00:30:47,450 --> 00:30:49,470
+contact
+
+413
+00:30:55,840 --> 00:31:02,020
+السؤال كمان عشان بس نوضحه هل البكتيريا موجودة في
+
+414
+00:31:02,020 --> 00:31:05,980
+قطاع غزة ولا مش موجودة؟ غالبا المجتمعات المسلمة
+
+415
+00:31:05,980 --> 00:31:11,220
+بشكل عام هذه الأمراض قد تكون موجودة لأن المجتمعات
+
+416
+00:31:11,220 --> 00:31:14,400
+الآن مفتاحة على كل العالم وليس كل المسلمين أصلا
+
+417
+00:31:14,400 --> 00:31:19,440
+منتزمين بالعلاقة الشريفي منهم عصاو مرتكبي ذنوب
+
+418
+00:31:19,440 --> 00:31:25,070
+يعنيوبالتالي قد نجدها لكن يعني خلينا نقول ال
+
+419
+00:31:25,070 --> 00:31:29,470
+percentage تبعتها ضئيلة بحيث انه انا الى عشرين سنة
+
+420
+00:31:29,470 --> 00:31:34,950
+بشتغل في قطاع في قطاع ال microbiology ولم اتمكن من
+
+421
+00:31:34,950 --> 00:31:38,090
+رؤية البكتيريا في اي ان من العيات او لم اسمع من
+
+422
+00:31:38,090 --> 00:31:40,910
+زملائي في المجال انهم عادلوا في يوم الأيام او
+
+423
+00:31:40,910 --> 00:31:45,530
+شافوا ناسيريا جنرية بينما عندما كنت طالبا ادرس في
+
+424
+00:31:45,530 --> 00:31:52,750
+الفلبين كناوشبه يوميا انشوف يعني مرة عملنا أحصائية
+
+425
+00:31:52,750 --> 00:31:57,210
+تقريبا ستة من عشرة من العينات اللي كنا نعملها
+
+426
+00:31:57,210 --> 00:32:01,250
+graph stain من اليولاترالدشارك كانت تكون positive
+
+427
+00:32:01,250 --> 00:32:05,170
+لإن سيريا جوانرية فهنا هتكون إجابة على سؤالك ان
+
+428
+00:32:05,170 --> 00:32:05,470
+شاء الله
+
+429
+00:32:11,930 --> 00:32:16,150
+طيب احنا قولنا انه ال symptoms مش كتير مزعجة
+
+430
+00:32:16,150 --> 00:32:21,190
+للمرضى ال symptoms قد تكون فقط شعور بال discomfort
+
+431
+00:32:21,190 --> 00:32:26,890
+و قد تصاحب كمان مرة باللي هو الإفراز الصديق اللي
+
+432
+00:32:26,890 --> 00:32:32,910
+حكينا عنه و غير مؤلم كمان مرة لكن هناك
+
+433
+00:32:32,910 --> 00:32:39,920
+هناكدلائل و evidence قوي بإنه repeated infection و
+
+434
+00:32:39,920 --> 00:32:44,100
+untreated infection قد تؤدي إلى ال sterility،
+
+435
+00:32:44,100 --> 00:32:49,980
+sterility يعني العقم، نعم العقم، وهذا ناتج عن ال
+
+436
+00:32:49,980 --> 00:32:54,540
+scars اللي بتنتج، scars يعني الأثار اللي بتتركها
+
+437
+00:32:54,540 --> 00:33:01,210
+أو الندوب باللغة العربيةممكن ان ال disease يظهر
+
+438
+00:33:01,210 --> 00:33:05,210
+بشكل cervicitis او cervicovaginitis او urethritis
+
+439
+00:33:05,210 --> 00:33:08,890
+و rectal و pharyngeal involvement هذا الكلام
+
+440
+00:33:08,890 --> 00:33:11,870
+ماكناش نقوله زمان احنا دلوقت كده rectal و
+
+441
+00:33:11,870 --> 00:33:15,230
+pharyngeal لكن مع الشدود الجنسي اللي موجود في
+
+442
+00:33:15,230 --> 00:33:20,990
+العالم كله دلوقت بدأ تظهر ان الجنورية can infect
+
+443
+00:33:20,990 --> 00:33:25,400
+اللي هو rectumوكمان اللي هو ال oropharyngeal
+
+444
+00:33:25,400 --> 00:33:29,500
+oropharyngeal اللي ناجم عن ال rectal sex او انا ال
+
+445
+00:33:29,500 --> 00:33:35,760
+sex او ال ناتج عن ال oral sex و كلا هما منتشرين
+
+446
+00:33:35,760 --> 00:33:41,480
+كشذوذ في العالم الغرب لان رقم اتنين من ال diseases
+
+447
+00:33:41,480 --> 00:33:46,840
+الأولان هذا كله جنورية و ما له و ما عليه فرقم
+
+448
+00:33:46,840 --> 00:33:49,360
+اتنين في انديها اسمها ophthalmia neonatrum
+
+449
+00:33:53,130 --> 00:33:56,170
+وإن هي ال infection اللي بتصيب ال conjunctiva
+
+450
+00:33:56,170 --> 00:34:01,610
+بتاعة الأطفال اللي مولودين لأمهات مصابين بالنسيريا
+
+451
+00:34:01,610 --> 00:34:05,490
+جنورية خلال مرورهم عبر قناة الولادة بياخدوا ال
+
+452
+00:34:05,490 --> 00:34:10,070
+micro organism بيصير فينا infection و ال infection
+
+453
+00:34:10,070 --> 00:34:14,950
+قد تؤدي إلى ال blindness if untreated blindness
+
+454
+00:34:14,950 --> 00:34:21,600
+يعني فقدان البصرلكن لأن المرض منتشر كتير و يعني
+
+455
+00:34:21,600 --> 00:34:27,720
+قلنا عنه انه the second most prevalent disease في
+
+456
+00:34:27,720 --> 00:34:35,160
+العالم الغربي فبالتالي كان فيه سياسة كل أم تلت
+
+457
+00:34:35,160 --> 00:34:40,940
+طفلها بيوضع في عينايه قطرة من silver nitrate two
+
+458
+00:34:40,940 --> 00:34:48,070
+percent silver nitrate كإجراء وقائعو طبعا الطب
+
+459
+00:34:48,070 --> 00:34:51,870
+الحديث استبدل Silver Nitrate ب Antibiotics يعني
+
+460
+00:34:51,870 --> 00:34:53,750
+بدنا نجترله جترا بال Antibiotics بدل Silver
+
+461
+00:34:53,750 --> 00:34:57,550
+Nitrate لأن Silver Nitrate ثبت إنها قد تؤذي عيناي
+
+462
+00:34:57,550 --> 00:35:04,230
+الطفل ولو شئا قليلا، إذا بالحماية أو للوقاية من ال
+
+463
+00:35:04,230 --> 00:35:07,790
+Ophthalmia Neonatrum احنا مضطرين نستخدم إيش منها
+
+464
+00:35:07,790 --> 00:35:12,630
+أو البديع عنه اللي هو Antibiotic Solutionفيند
+
+465
+00:35:12,630 --> 00:35:16,810
+الرقم تلاتة اللي هو ال PID أو Pelvic Inflammatory
+
+466
+00:35:16,810 --> 00:35:20,790
+Disease وهذا برضه عبارة عن complication .. عبارة
+
+467
+00:35:20,790 --> 00:35:25,450
+عن complication بتحدث
+
+468
+00:35:25,450 --> 00:35:27,650
+في مرضى اللي هم ال ..
+
+469
+00:35:30,820 --> 00:35:35,940
+هذه بقى الصور بتوضح ان ال .. طبعا لحظة في ان هذه
+
+470
+00:35:35,940 --> 00:35:39,620
+حاجة اسمها Arthritis ماذكرناش خالص لكن ال
+
+471
+00:35:39,620 --> 00:35:43,380
+arthritis هذه ناتجة ايضا عن القصة اللي حكينا فيها
+
+472
+00:35:43,380 --> 00:35:46,460
+زمان اللي هو ال deposition لل antigen-antibody
+
+473
+00:35:46,460 --> 00:35:49,790
+complexes في أماكن مختلفة في الجسموبالتالي
+
+474
+00:35:49,790 --> 00:35:53,270
+activation ل ال compliment وبالتالي أيضا
+
+475
+00:35:53,270 --> 00:36:00,030
+activation ل ال attack على الأنسجة تبعتنا وهذا
+
+476
+00:36:00,030 --> 00:36:05,430
+الأسف هذه حالة purely in discharge من من؟ من نيو
+
+477
+00:36:05,430 --> 00:36:09,590
+نيت اللي هو قد تؤدي إلى ال blindness
+
+478
+00:36:12,250 --> 00:36:15,530
+بالنسبة للـ diagnosis احنا في معرض حديثنا اتحدثنا
+
+479
+00:36:15,530 --> 00:36:18,310
+شويه عن ال diagnosis لما قولنا urethral discharge
+
+480
+00:36:18,310 --> 00:36:22,750
+gram stain تمام؟ gram stain لكن قولنا فقط لـ gram
+
+481
+00:36:22,750 --> 00:36:26,450
+stain من مين؟ من ال male و ليس من ال female لكن ال
+
+482
+00:36:26,450 --> 00:36:31,590
+golden standard تبعنا اللي هو ال culture الآن ال
+
+483
+00:36:31,590 --> 00:36:35,230
+culture البكتيريا احنا قولنا عنها ممكن تنمو على
+
+484
+00:36:35,230 --> 00:36:38,930
+بلد أجار لكن بنميها أو بنفضل نميها على شوكولات
+
+485
+00:36:38,930 --> 00:36:45,810
+أجارليش على تشيكولات أجار؟ عشان الفاكولات
+
+486
+00:36:45,810 --> 00:36:49,230
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+487
+00:36:49,230 --> 00:36:49,790
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+488
+00:36:49,790 --> 00:36:50,330
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+489
+00:36:50,330 --> 00:36:57,050
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+490
+00:36:57,050 --> 00:36:59,110
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+491
+00:36:59,110 --> 00:37:02,250
+الفاكولات الفاكولات الفاكولات الفاكولات الفاكولات
+
+492
+00:37:02,250 --> 00:37:05,630
+الفاك
+
+493
+00:37:07,980 --> 00:37:10,940
+فبنفضل الدم اللي مسخّن ليش؟ مش مش حاجة لـchocolate
+
+494
+00:37:10,940 --> 00:37:13,860
+agar هو نفسه blood agar بس هو أساس تسخينه تبقى على
+
+495
+00:37:13,860 --> 00:37:18,020
+تمانين درجه مائوية الآن التسخين على تمانين درجه
+
+496
+00:37:18,020 --> 00:37:20,800
+مائوية قد يقضي على كثير من ال toxic material
+
+497
+00:37:20,800 --> 00:37:24,560
+الموجود في الدم في الدم فبنفضل أن البكتيريا تنمو
+
+498
+00:37:24,560 --> 00:37:27,380
+عليه مش على .. على ال chocolate agar مش على blood
+
+499
+00:37:27,380 --> 00:37:32,520
+agar هذا رقم واحد رقم اتنين البكتيريا بدها بدها
+
+500
+00:37:32,520 --> 00:37:35,020
+ايش؟ بدها CO2
+
+501
+00:37:38,300 --> 00:37:43,700
+مش بيقولوا انا capnophilic مين بده CO2 من البكتيرى
+
+502
+00:37:43,700 --> 00:37:49,080
+عرفته؟
+
+503
+00:37:49,080 --> 00:38:01,880
+هيستخدمكوا
+
+504
+00:38:01,880 --> 00:38:06,790
+اربع مايكروبات تعرفوهمهيموفلس انفلونزا ناسيريا
+
+505
+00:38:06,790 --> 00:38:14,270
+مينيديتس و ناسيريا جونورية و كلهم مش بس بدهم CO2 و
+
+506
+00:38:14,270 --> 00:38:17,650
+كلهم ممكن يتموعلمين على شوكولات أجاد فإذا وان
+
+507
+00:38:17,650 --> 00:38:21,610
+شوكولات أجاد can .. and under CO2 can provide
+
+508
+00:38:21,610 --> 00:38:25,110
+growth for these fastidious أو delicate
+
+509
+00:38:25,110 --> 00:38:29,020
+microorganismsالـ temperature اللحظة اللي مكتوب
+
+510
+00:38:29,020 --> 00:38:32,300
+هناك كده كل الميكروبات اللي ذكرناهم في السابق كانت
+
+511
+00:38:32,300 --> 00:38:34,680
+على سبعة و تلاتين هذه خاصة نص الكتاب اللي كتبناه
+
+512
+00:38:34,680 --> 00:38:38,800
+العالمين على خمسة و تلاتين سبعة و تلاتين قد تقتل
+
+513
+00:38:38,800 --> 00:38:41,940
+البكتيري سبعة و تلاتين قد تقتل .. عشان انا جدتلكوا
+
+514
+00:38:41,940 --> 00:38:45,460
+.. عشان انا جدتلكوا انه صار تغيير في تفكير
+
+515
+00:38:45,460 --> 00:38:48,800
+العاملين في مجال الـ microbiology و أصبحنا نعمل ..
+
+516
+00:38:48,800 --> 00:38:53,920
+نعمل ال incubation بشكل عام على خمسة و تلاتين درجة
+
+517
+00:38:53,920 --> 00:38:58,080
+مئويةطبعا ال bacteria oxidase ال reaction تباعها
+
+518
+00:38:58,080 --> 00:39:01,560
+هو عبارة عن oxidase بُستب و هنقول إن هذا قودا
+
+519
+00:39:01,560 --> 00:39:07,300
+واحدا هو القوض الفصل في إنها نيسيريا أو نيسيريا أو
+
+520
+00:39:07,300 --> 00:39:11,680
+أسينيتو با أكتر لإن هما هي تنتهي بتشابهوا مع بعضهم
+
+521
+00:39:11,680 --> 00:39:16,050
+البعضفين دي هارسمها fluorescent antibody tagging
+
+522
+00:39:16,050 --> 00:39:19,810
+test وهو عبارة عن staining باستخدام اللي هو ال
+
+523
+00:39:19,810 --> 00:39:22,490
+antibody ال specific و هذا ال staining مش عادي
+
+524
+00:39:22,490 --> 00:39:27,270
+fluorescent label و تحت الميكروسكوب ممكن نشوفه فين
+
+525
+00:39:27,270 --> 00:39:30,890
+دي ال cta و ال cta فاكرين لما قلتلكوا أول محاضرة
+
+526
+00:39:30,890 --> 00:39:36,510
+قلتلكوا جلوكوزبوستف نيسيريا جنورية بينما النيسيريا
+
+527
+00:39:36,510 --> 00:39:41,770
+مينيديتس جلوكوز زاد مالتوز هذا الفحص البكتيريا
+
+528
+00:39:41,770 --> 00:39:46,410
+العادية البكتيريا العادية كنا نستخدملها off media
+
+529
+00:39:46,410 --> 00:39:49,830
+صح oxidation fermentation media هذه البكتيريا
+
+530
+00:39:49,830 --> 00:39:54,360
+مابنقدرش نستخدملها ال off لأنها fastidiousوبالتالي
+
+531
+00:39:54,360 --> 00:39:58,920
+صممنا لهواتف اسمه 16 triptychase أجار واحد ضفنا
+
+532
+00:39:58,920 --> 00:40:02,220
+عليه الجليكوز وواحد ضفنا عليه مالتوز وواحد ضفنا
+
+533
+00:40:02,220 --> 00:40:06,600
+عليه اللي هو الساكروز، النيسيريا جنورية فقط بصدف
+
+534
+00:40:06,600 --> 00:40:10,700
+لمين؟ للجليكوز، بينما نيسيريا من الريتايتس بصدف
+
+535
+00:40:10,700 --> 00:40:12,320
+للمالتوز وليه الجليكوز، good
+
+536
+00:40:19,100 --> 00:40:22,180
+لأ احنا .. احنا .. شباب في .. في .. في بعض الناس
+
+537
+00:40:22,180 --> 00:40:27,460
+يعني بتأخر عليهم وصول المعلومة بشكل واضح فبدنا
+
+538
+00:40:27,460 --> 00:40:31,840
+نأكد على حقيقة احنا لما بنشرح بنشرح بال
+
+539
+00:40:31,840 --> 00:40:37,020
+consecutive فحص طلوة الفحص لكن واقع العملي ..
+
+540
+00:40:37,020 --> 00:40:41,900
+الواقع العملي ليس فحص طلوة الفحص وانما فحصات جنبا
+
+541
+00:40:41,900 --> 00:40:47,340
+إلى جنب لأن الفحص طلو الفحص بده يوم و يوم و يوملكن
+
+542
+00:40:47,340 --> 00:40:51,600
+لما بتكلم عن مع بعض تلاتة نعملهم في يوم واحد غير
+
+543
+00:40:51,600 --> 00:40:54,800
+ان احنا نعملهم بعد تلات أيام فاحنا للتدريب و
+
+544
+00:40:54,800 --> 00:40:58,700
+للتفريق بنستخدم ال consecutive test اللي هي واحد
+
+545
+00:40:58,700 --> 00:41:02,920
+بعد واحد بينما في الواقع بنستخدم ال parallel test
+
+546
+00:41:02,920 --> 00:41:06,960
+هذه المستعمرات اللي على ال chocolate agar او البلد
+
+547
+00:41:06,960 --> 00:41:11,820
+اجار البكتيريا واضح انها glistening لامعة يعني
+
+548
+00:41:11,820 --> 00:41:13,040
+فيها بريق
+
+549
+00:41:20,170 --> 00:41:23,470
+فى وطن تانى احنا قولنا ناسيريا جونورية من أين
+
+550
+00:41:23,470 --> 00:41:26,310
+بناخدها؟ بناخدها من الـ urethral discharge، طب و
+
+551
+00:41:26,310 --> 00:41:28,730
+الـ urethra سواء كانت male ولا female مافيها
+
+552
+00:41:28,730 --> 00:41:35,140
+normal microbiotaبس الصعوبة في ال female انه اكتر
+
+553
+00:41:35,140 --> 00:41:37,800
+ال normal microbiota اكتر و من ضمنها نيسيريا other
+
+554
+00:41:37,800 --> 00:41:41,840
+than نيسيريا جونريا فإذا أنا بدي اعزل نيسيريا من
+
+555
+00:41:41,840 --> 00:41:44,280
+community من الميكروبات بدي selective media ولا
+
+556
+00:41:44,280 --> 00:41:47,200
+بديش selective media ال selective media تبعي اسمه
+
+557
+00:41:47,200 --> 00:41:50,500
+thiamartin medium ايش هو thiamartin medium؟ هو
+
+558
+00:41:50,500 --> 00:41:55,380
+عبارة عن very similar to chocolate agar لكن مضاف
+
+559
+00:41:55,380 --> 00:41:58,080
+له antibiotics بيسموهم
+
+560
+00:42:03,250 --> 00:42:10,910
+بنكميسين كوليستين نستاتين كمان مرة بنكميسين
+
+561
+00:42:10,910 --> 00:42:15,470
+كوليستين
+
+562
+00:42:15,470 --> 00:42:18,790
+نستاتين
+
+563
+00:42:18,790 --> 00:42:23,090
+البنكميسين
+
+564
+00:42:23,090 --> 00:42:24,970
+كلكم عرفت ان هو الـ ground positive بكتيريا
+
+565
+00:42:24,970 --> 00:42:28,730
+والكوليستين الـ ground negative بكتيريا النستاتين
+
+566
+00:42:28,730 --> 00:42:29,470
+للفطريات
+
+567
+00:42:36,180 --> 00:42:37,600
+تمام؟ وبنكمل المرة القادمة ان شاء الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vshf1KAA7wk_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vshf1KAA7wk_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..cd5fca2b0bc72b5c1e05499b0106e59600001898
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vshf1KAA7wk_raw.json
@@ -0,0 +1 @@
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عملناها ل gram stain و لجينا gram negative double cocci هل تعني شيء؟", "tokens": [1211, 19452, 21136, 1829, 4117, 995, 16070, 15040, 4117, 2655, 10943, 1829, 4117, 995, 16070, 5172, 15040, 5172, 995, 16070, 5172, 15040, 41185, 3794, 1863, 3794, 8032, 3215, 12610, 3660, 2710, 932, 3252, 4032, 9957, 3714, 29245, 23328, 9957, 22807, 3714, 29245, 23328, 9957, 24976, 10721, 3794, 5172, 2710, 932, 3252, 295, 264, 6556, 38963, 37495, 22653, 45164, 4386, 4032, 45030, 11242, 16247, 5016, 1829, 7649, 44945, 7435, 1829, 16095, 8978, 2423, 19338, 932, 3252, 19338, 932, 3252, 6024, 48506, 45164, 5551, 9778, 3215, 8315, 49840, 9154, 344, 265, 392, 2155, 21718, 9154, 6556, 6156, 2304, 6027, 37495, 22653, 14739, 2655, 4032, 6225, 42213, 8315, 11296, 5296, 21353, 16441, 4032, 5296, 7435, 1829, 8315, 21353, 3671, 3834, 21047, 537, 8032, 1211, 37279, 22653, 44049, 38207, 22807], "avg_logprob": -0.29133859487969105, "compression_ratio": 1.713235294117647, "no_speech_prob": 0.0, "words": [{"start": 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أن نقول إن وجودها غريب لأنها موجودة بشكل normal ميكروبيوتر لكن لو أخبرتكوا إن الورترا بتاعة الميل لا يولد بها normal flora وقمت أنا بعمل gram stain لميل اللي جيت عنده جرام نيجاتف دبلو كوكاي", "tokens": [6027, 7435, 2288, 10943, 8717, 1829, 7435, 9307, 5172, 11778, 36150, 2407, 9122, 2407, 4117, 47302, 4724, 8592, 28820, 6225, 10943, 12174, 3215, 6055, 30544, 8717, 1829, 3794, 13546, 25528, 10874, 1863, 13063, 10632, 34051, 12174, 3215, 6055, 30544, 661, 8717, 1829, 3794, 13546, 25528, 19446, 5016, 24793, 1863, 33599, 44381, 20193, 8717, 14851, 9566, 40228, 14739, 8717, 39648, 36145, 49610, 23328, 11296, 32771, 16572, 3555, 5296, 33456, 11296, 3714, 29245, 23328, 3660, 4724, 8592, 28820, 2710, 3714, 1829, 4117, 32887, 21292, 35473, 2288, 44381, 45164, 5551, 9778, 26890, 2655, 4117, 14407, 36145, 2423, 13063, 2655, 23557, 39894, 995, 27884, 9673, 26895, 20193, 7251, 12610, 3215, 4724, 11296, 2710, 932, 3252, 4032, 4587, 2304, 2655, 41850, 4724, 25957, 1211, 21353, 16441, 32767, 26895, 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1421.01, "end": 1448.51, "text": "وباوصف وجودها هل هو intracellular وهذا الحال ليش يعني وجود intracellular اكثر من مين من ال extracellular طب هل هناك فايدة من هذا الكلام اول حاجة انا ذكرت لكم سابقا مرارا و تكرارا بان احنا في ال gram staining او في اي staining مابنتعرف على البكتيريا الا في حالات ال staining with specific antibody زي ال fluorescent", "tokens": [37746, 995, 2407, 9381, 5172, 49610, 23328, 11296, 8032, 1211, 31439, 43358, 4164, 1040, 37037, 15730, 21542, 6027, 32239, 8592, 37495, 22653, 49610, 23328, 43358, 4164, 1040, 1975, 4117, 49115, 9154, 3714, 9957, 9154, 2423, 2857, 4164, 1040, 23032, 3555, 8032, 1211, 34105, 4117, 6156, 995, 25708, 3660, 9154, 23758, 2423, 28820, 10943, 1975, 12610, 11331, 26108, 3660, 1975, 8315, 29910, 37983, 2655, 5296, 24793, 8608, 16758, 4587, 995, 3714, 2288, 9640, 995, 4032, 6055, 37983, 9640, 995, 4724, 7649, 1975, 5016, 8315, 8978, 2423, 21353, 342, 3686, 1975, 2407, 8978, 1975, 1829, 342, 3686, 3714, 16758, 29399, 3615, 28480, 15844, 29739, 4117, 2655, 13546, 25528, 42963, 8978, 11331, 6027, 9307, 2423, 342, 3686, 365, 2685, 34507, 30767, 1829, 2423, 46735], "avg_logprob": -0.25345798520768276, "compression_ratio": 1.7752808988764044, "no_speech_prob": 1.1920928955078125e-07, "words": [{"start": 1421.01, "end": 1421.81, "word": "وباوصف", "probability": 0.817138671875}, {"start": 1421.81, "end": 1422.75, "word": " وجودها", "probability": 0.9908854166666666}, {"start": 1422.75, "end": 1423.03, "word": " هل", "probability": 0.917724609375}, {"start": 1423.03, "end": 1423.23, "word": " هو", "probability": 0.9453125}, {"start": 1423.23, "end": 1424.27, "word": " intracellular", "probability": 0.5785319010416666}, {"start": 1424.27, "end": 1424.85, "word": " وهذا", "probability": 0.653564453125}, {"start": 1424.85, "end": 1425.33, "word": " الحال", "probability": 0.58154296875}, {"start": 1425.33, "end": 1425.53, "word": " ليش", "probability": 0.338714599609375}, {"start": 1425.53, "end": 1425.71, "word": " يعني", "probability": 0.767822265625}, {"start": 1425.71, "end": 1426.21, "word": " وجود", "probability": 0.8955078125}, {"start": 1426.21, "end": 1427.51, "word": " intracellular", "probability": 0.71484375}, {"start": 1427.51, "end": 1428.49, "word": " اكثر", "probability": 0.6892903645833334}, {"start": 1428.49, "end": 1428.73, "word": " من", "probability": 0.97802734375}, {"start": 1428.73, "end": 1429.07, "word": " مين", "probability": 0.92236328125}, {"start": 1429.07, "end": 1430.05, "word": " من", "probability": 0.86572265625}, {"start": 1430.05, "end": 1430.15, "word": " ال", "probability": 0.818359375}, {"start": 1430.15, "end": 1431.43, "word": " extracellular", "probability": 0.8028971354166666}, {"start": 1431.43, "end": 1431.89, "word": " طب", "probability": 0.6856689453125}, {"start": 1431.89, "end": 1432.01, "word": " هل", "probability": 0.9609375}, {"start": 1432.01, "end": 1432.25, "word": " هناك", "probability": 0.96240234375}, {"start": 1432.25, "end": 1432.49, "word": " فايدة", "probability": 0.7652587890625}, {"start": 1432.49, "end": 1432.57, "word": " من", "probability": 0.982421875}, {"start": 1432.57, "end": 1432.69, "word": " هذا", "probability": 0.72607421875}, {"start": 1432.69, "end": 1433.05, "word": " الكلام", "probability": 0.89404296875}, {"start": 1433.05, "end": 1433.53, "word": " اول", "probability": 0.7159423828125}, {"start": 1433.53, "end": 1434.23, "word": " حاجة", "probability": 0.9889322916666666}, {"start": 1434.23, "end": 1434.75, "word": " انا", "probability": 0.920654296875}, {"start": 1434.75, "end": 1435.13, "word": " ذكرت", "probability": 0.8658854166666666}, {"start": 1435.13, "end": 1435.39, "word": " لكم", "probability": 0.90478515625}, {"start": 1435.39, "end": 1436.15, "word": " سابقا", "probability": 0.9434814453125}, {"start": 1436.15, "end": 1436.85, "word": " مرارا", "probability": 0.9512939453125}, {"start": 1436.85, "end": 1436.99, "word": " و", "probability": 0.57861328125}, {"start": 1436.99, "end": 1437.63, "word": " تكرارا", "probability": 0.8619384765625}, {"start": 1437.63, "end": 1438.33, "word": " بان", "probability": 0.87548828125}, {"start": 1438.33, "end": 1438.87, "word": " احنا", "probability": 0.8349609375}, {"start": 1438.87, "end": 1439.07, "word": " في", "probability": 0.9208984375}, {"start": 1439.07, "end": 1439.15, "word": " ال", "probability": 0.453369140625}, {"start": 1439.15, "end": 1439.45, "word": " gram", "probability": 0.22607421875}, {"start": 1439.45, "end": 1439.97, "word": " staining", "probability": 0.738037109375}, {"start": 1439.97, "end": 1440.47, "word": " او", "probability": 0.94970703125}, {"start": 1440.47, "end": 1440.59, "word": " في", "probability": 0.9296875}, {"start": 1440.59, "end": 1440.81, "word": " اي", "probability": 0.89697265625}, {"start": 1440.81, "end": 1441.39, "word": " staining", "probability": 0.737060546875}, {"start": 1441.39, "end": 1442.55, "word": " مابنتعرف", "probability": 0.848681640625}, {"start": 1442.55, "end": 1442.79, "word": " على", "probability": 0.71728515625}, {"start": 1442.79, "end": 1443.51, "word": " البكتيريا", "probability": 0.966015625}, {"start": 1443.51, "end": 1444.11, "word": " الا", "probability": 0.88037109375}, {"start": 1444.11, "end": 1444.39, "word": " في", "probability": 0.9345703125}, {"start": 1444.39, "end": 1444.79, "word": " حالات", "probability": 0.9567057291666666}, {"start": 1444.79, "end": 1444.91, "word": " ال", "probability": 0.9619140625}, {"start": 1444.91, "end": 1445.45, "word": " staining", "probability": 0.75634765625}, {"start": 1445.45, "end": 1446.03, "word": " with", "probability": 0.919921875}, {"start": 1446.03, "end": 1446.77, "word": " specific", "probability": 0.73388671875}, {"start": 1446.77, "end": 1447.47, "word": " antibody", "probability": 0.82177734375}, {"start": 1447.47, "end": 1448.09, "word": " زي", "probability": 0.86328125}, {"start": 1448.09, "end": 1448.21, "word": " ال", "probability": 0.71484375}, {"start": 1448.21, "end": 1448.51, "word": " fluorescent", "probability": 0.83935546875}], "temperature": 1.0}, {"id": 58, "seek": 147192, "start": 1450.02, "end": 1471.92, "text": "بينما في ال gram staining في الاسد فاصل staining we just describe بنوصف ما نرا بدقة فبنقول هنا gram negative diplokokai that are found mostly intracellularly ايش اللي بيفهم منها الطبيب؟ بيفهم منها انها نيسيديا جنورية و انها acute stage", "tokens": [3555, 9957, 15042, 8978, 2423, 21353, 342, 3686, 8978, 2423, 32277, 3215, 6156, 33546, 1211, 342, 3686, 321, 445, 6786, 44945, 2407, 9381, 5172, 19446, 8717, 23557, 47525, 28671, 6156, 3555, 1863, 39648, 34105, 21353, 3671, 11432, 453, 453, 1301, 300, 366, 1352, 5240, 17467, 617, 285, 1040, 356, 1975, 1829, 8592, 13672, 1829, 4724, 33911, 16095, 9154, 11296, 41950, 21292, 3555, 22807, 4724, 33911, 16095, 9154, 11296, 16472, 11296, 8717, 1829, 3794, 25708, 25528, 10874, 1863, 13063, 10632, 4032, 16472, 11296, 24390, 3233], "avg_logprob": -0.2961397100897396, "compression_ratio": 1.5299539170506913, "no_speech_prob": 0.0, "words": [{"start": 1450.02, "end": 1450.66, "word": "بينما", "probability": 0.9518229166666666}, {"start": 1450.66, "end": 1450.8, "word": " في", "probability": 0.94140625}, {"start": 1450.8, "end": 1450.86, "word": " ال", "probability": 0.74658203125}, {"start": 1450.86, "end": 1451.08, "word": " gram", "probability": 0.6875}, {"start": 1451.08, "end": 1451.6, "word": " staining", "probability": 0.7325439453125}, {"start": 1451.6, "end": 1451.82, "word": " في", "probability": 0.54541015625}, {"start": 1451.82, "end": 1452.04, "word": " الاسد", "probability": 0.4016520182291667}, {"start": 1452.04, "end": 1452.38, "word": " فاصل", "probability": 0.5480143229166666}, {"start": 1452.38, "end": 1452.72, "word": " staining", "probability": 0.60443115234375}, {"start": 1452.72, "end": 1453.3, "word": " we", "probability": 0.371826171875}, {"start": 1453.3, "end": 1453.64, "word": " just", "probability": 0.92138671875}, {"start": 1453.64, "end": 1454.5, "word": " describe", "probability": 0.8984375}, {"start": 1454.5, "end": 1455.36, "word": " بنوصف", "probability": 0.957763671875}, {"start": 1455.36, "end": 1455.8, "word": " ما", "probability": 0.974609375}, {"start": 1455.8, "end": 1456.66, "word": " نرا", "probability": 0.858642578125}, {"start": 1456.66, "end": 1457.54, "word": " بدقة", "probability": 0.90771484375}, {"start": 1457.54, "end": 1458.4, "word": " فبنقول", "probability": 0.880859375}, {"start": 1458.4, "end": 1458.6, "word": " هنا", "probability": 0.316162109375}, {"start": 1458.6, "end": 1459.02, "word": " gram", "probability": 0.7998046875}, {"start": 1459.02, "end": 1459.64, "word": " negative", "probability": 0.861328125}, {"start": 1459.64, "end": 1460.72, "word": " diplokokai", "probability": 0.71380615234375}, {"start": 1460.72, "end": 1461.02, "word": " that", "probability": 0.75244140625}, {"start": 1461.02, "end": 1461.24, "word": " are", "probability": 0.9599609375}, {"start": 1461.24, "end": 1461.74, "word": " found", "probability": 0.9111328125}, {"start": 1461.74, "end": 1462.64, "word": " mostly", "probability": 0.93603515625}, {"start": 1462.64, "end": 1464.92, "word": " intracellularly", "probability": 0.8390625}, {"start": 1464.92, "end": 1466.24, "word": " ايش", "probability": 0.7305501302083334}, {"start": 1466.24, "end": 1466.3, "word": " اللي", "probability": 0.6541748046875}, {"start": 1466.3, "end": 1466.5, "word": " بيفهم", "probability": 0.935546875}, {"start": 1466.5, "end": 1466.68, "word": " منها", "probability": 0.78515625}, {"start": 1466.68, "end": 1467.98, "word": " الطبيب؟", "probability": 0.9315185546875}, {"start": 1467.98, "end": 1468.58, "word": " بيفهم", "probability": 0.9202473958333334}, {"start": 1468.58, "end": 1468.98, "word": " منها", "probability": 0.97607421875}, {"start": 1468.98, "end": 1469.24, "word": " انها", "probability": 0.774658203125}, {"start": 1469.24, "end": 1469.64, "word": " نيسيديا", "probability": 0.575830078125}, {"start": 1469.64, "end": 1470.1, "word": " جنورية", "probability": 0.8583984375}, {"start": 1470.1, "end": 1470.72, "word": " و", "probability": 0.9638671875}, {"start": 1470.72, "end": 1470.92, "word": " انها", "probability": 0.78564453125}, {"start": 1470.92, "end": 1471.3, "word": " acute", "probability": 0.99072265625}, {"start": 1471.3, "end": 1471.92, "word": " stage", "probability": 0.95849609375}], "temperature": 1.0}, {"id": 59, "seek": 149100, "start": 1472.46, "end": 1491.0, "text": "acute stage لو انا اشوف اسمير غير هذا الاسمير و مكتوب فيه او التقرير تبقى بيقول اجرام negative diplococci mostly found extracellularly بيفهم منها نيسيريا جونورية chronic جونورية", "tokens": [326, 1169, 3233, 45164, 1975, 8315, 1975, 8592, 38688, 24525, 2304, 13546, 32771, 13546, 23758, 2423, 32277, 2304, 13546, 4032, 3714, 4117, 2655, 37746, 8978, 3224, 1975, 2407, 16712, 4587, 2288, 13546, 6055, 3555, 4587, 7578, 4724, 1829, 39648, 1975, 7435, 2288, 10943, 3671, 11432, 905, 905, 537, 5240, 1352, 16455, 617, 285, 1040, 356, 4724, 33911, 16095, 9154, 11296, 8717, 1829, 3794, 13546, 25528, 10874, 11536, 13063, 10632, 14493, 10874, 11536, 13063, 10632], "avg_logprob": -0.23458333134651185, "compression_ratio": 1.4378378378378378, "no_speech_prob": 0.0, "words": [{"start": 1472.46, "end": 1473.14, "word": "acute", "probability": 0.6395263671875}, {"start": 1473.14, "end": 1473.88, "word": " stage", "probability": 0.935546875}, {"start": 1473.88, "end": 1474.4, "word": " لو", "probability": 0.59716796875}, {"start": 1474.4, "end": 1474.68, "word": " انا", "probability": 0.780029296875}, {"start": 1474.68, "end": 1474.96, "word": " اشوف", "probability": 0.8942057291666666}, {"start": 1474.96, "end": 1475.32, "word": " اسمير", "probability": 0.5909830729166666}, {"start": 1475.32, "end": 1475.5, "word": " غير", "probability": 0.990478515625}, {"start": 1475.5, "end": 1475.64, "word": " هذا", "probability": 0.8330078125}, {"start": 1475.64, "end": 1476.5, "word": " الاسمير", "probability": 0.885986328125}, {"start": 1476.5, "end": 1476.8, "word": " و", "probability": 0.83837890625}, {"start": 1476.8, "end": 1477.22, "word": " مكتوب", "probability": 0.892578125}, {"start": 1477.22, "end": 1477.86, "word": " فيه", "probability": 0.951904296875}, {"start": 1477.86, "end": 1478.1, "word": " او", "probability": 0.968994140625}, {"start": 1478.1, "end": 1478.52, "word": " التقرير", "probability": 0.792724609375}, {"start": 1478.52, "end": 1478.7, "word": " تبقى", "probability": 0.7379150390625}, {"start": 1478.7, "end": 1479.14, "word": " بيقول", "probability": 0.7827962239583334}, {"start": 1479.14, "end": 1480.02, "word": " اجرام", "probability": 0.8426513671875}, {"start": 1480.02, "end": 1480.66, "word": " negative", "probability": 0.681640625}, {"start": 1480.66, "end": 1481.94, "word": " diplococci", "probability": 0.65032958984375}, {"start": 1481.94, "end": 1482.7, "word": " mostly", "probability": 0.93896484375}, {"start": 1482.7, "end": 1483.4, "word": " found", "probability": 0.9072265625}, {"start": 1483.4, "end": 1485.62, "word": " extracellularly", "probability": 0.84345703125}, {"start": 1485.62, "end": 1486.26, "word": " بيفهم", "probability": 0.9205729166666666}, {"start": 1486.26, "end": 1486.68, "word": " منها", "probability": 0.974853515625}, {"start": 1486.68, "end": 1487.48, "word": " نيسيريا", "probability": 0.81650390625}, {"start": 1487.48, "end": 1488.46, "word": " جونورية", "probability": 0.7894287109375}, {"start": 1488.46, "end": 1489.7, "word": " chronic", "probability": 0.8525390625}, {"start": 1489.7, "end": 1491.0, "word": " جونورية", "probability": 0.9268798828125}], "temperature": 1.0}, {"id": 60, "seek": 151260, "start": 1491.38, "end": 1512.6, "text": "chronic غنري واحدة acute واحدة chronic ايش الفرق بينهم واحدة كانت intracellular واحدة كانت extracellular اذا I just describe what I see الصورة دي اللي قدامكوا هي عبارة عن دبلو كوكايل مكبرة اكتر من الصورة الأولانية لكن مش مأخوذة من pastels مأخوذة من طبق", "tokens": [339, 10011, 32771, 1863, 16572, 36764, 24401, 3660, 24390, 36764, 24401, 3660, 14493, 1975, 1829, 8592, 27188, 2288, 4587, 49374, 16095, 36764, 24401, 3660, 25961, 2655, 43358, 4164, 1040, 36764, 24401, 3660, 25961, 2655, 2857, 4164, 1040, 1975, 15730, 286, 445, 6786, 437, 286, 536, 31767, 13063, 3660, 11778, 1829, 13672, 1829, 12174, 3215, 10943, 4117, 14407, 39896, 6225, 3555, 9640, 3660, 18871, 11778, 36150, 2407, 9122, 2407, 4117, 995, 26895, 3714, 4117, 26890, 3660, 1975, 4117, 2655, 2288, 9154, 31767, 13063, 3660, 16247, 12610, 7649, 10632, 44381, 37893, 3714, 10721, 9778, 2407, 8848, 3660, 9154, 1791, 1625, 3714, 10721, 9778, 2407, 8848, 3660, 9154, 23032, 3555, 4587], "avg_logprob": -0.2395355520992104, "compression_ratio": 1.7017543859649122, "no_speech_prob": 0.0, "words": [{"start": 1491.38, "end": 1491.92, "word": "chronic", "probability": 0.6717529296875}, {"start": 1491.92, "end": 1493.0, "word": " غنري", "probability": 0.53009033203125}, {"start": 1493.0, "end": 1493.7, "word": " واحدة", 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2487.79, "word": " ولا", "probability": 0.52294921875}, {"start": 2487.79, "end": 2488.21, "word": " female", "probability": 0.953125}, {"start": 2488.21, "end": 2488.73, "word": " مافيها", "probability": 0.7898763020833334}, {"start": 2488.73, "end": 2488.95, "word": " normal", "probability": 0.70849609375}, {"start": 2488.95, "end": 2489.63, "word": " microbiota", "probability": 0.870849609375}], "temperature": 1.0}, {"id": 100, "seek": 251808, "start": 2490.34, "end": 2518.08, "text": "بس الصعوبة في ال female انه اكتر ال normal microbiota اكتر و من ضمنها نيسيريا other than نيسيريا جونريا فإذا أنا بدي اعزل نيسيريا من community من الميكروبات بدي selective media ولا بديش selective media ال selective media تبعي اسمه thiamartin medium ايش هو thiamartin medium؟ هو عبارة عن very similar to chocolate agar لكن مضاف له antibiotics بيسموهم", "tokens": [3555, 3794, 31767, 3615, 37746, 3660, 8978, 2423, 6556, 16472, 3224, 1975, 4117, 2655, 2288, 2423, 2710, 33234, 5377, 1975, 4117, 2655, 2288, 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{"start": 2492.34, "end": 2492.92, "word": " ال", "probability": 0.7646484375}, {"start": 2492.92, "end": 2493.4, "word": " female", "probability": 0.5439453125}, {"start": 2493.4, "end": 2494.24, "word": " انه", "probability": 0.77294921875}, {"start": 2494.24, "end": 2495.14, "word": " اكتر", "probability": 0.9000244140625}, {"start": 2495.14, "end": 2495.3, "word": " ال", "probability": 0.56982421875}, {"start": 2495.3, "end": 2495.9, "word": " normal", "probability": 0.515625}, {"start": 2495.9, "end": 2496.46, "word": " microbiota", "probability": 0.3441162109375}, {"start": 2496.46, "end": 2496.8, "word": " اكتر", "probability": 0.960205078125}, {"start": 2496.8, "end": 2496.88, "word": " و", "probability": 0.953125}, {"start": 2496.88, "end": 2496.96, "word": " من", "probability": 0.7548828125}, {"start": 2496.96, "end": 2497.18, "word": " ضمنها", "probability": 0.9861653645833334}, {"start": 2497.18, "end": 2497.58, "word": " نيسيريا", "probability": 0.775}, {"start": 2497.58, "end": 2497.8, "word": " other", "probability": 0.8642578125}, {"start": 2497.8, "end": 2498.32, "word": " than", "probability": 0.9306640625}, {"start": 2498.32, "end": 2498.9, "word": " نيسيريا", "probability": 0.949609375}, {"start": 2498.9, "end": 2499.4, "word": " جونريا", "probability": 0.64599609375}, {"start": 2499.4, "end": 2500.26, "word": " فإذا", "probability": 0.8600260416666666}, {"start": 2500.26, "end": 2500.4, "word": " أنا", "probability": 0.6806640625}, {"start": 2500.4, "end": 2500.58, "word": " بدي", "probability": 0.618408203125}, {"start": 2500.58, "end": 2500.86, "word": " اعزل", "probability": 0.8585205078125}, {"start": 2500.86, "end": 2501.48, "word": " نيسيريا", "probability": 0.9861328125}, {"start": 2501.48, "end": 2501.84, "word": " من", "probability": 0.994140625}, {"start": 2501.84, "end": 2502.42, "word": " community", "probability": 0.74462890625}, {"start": 2502.42, "end": 2502.6, "word": " من", "probability": 0.9697265625}, {"start": 2502.6, "end": 2503.32, "word": " الميكروبات", "probability": 0.919189453125}, {"start": 2503.32, "end": 2503.58, "word": " بدي", "probability": 0.672119140625}, {"start": 2503.58, "end": 2504.0, "word": " selective", "probability": 0.8837890625}, {"start": 2504.0, "end": 2504.18, "word": " media", "probability": 0.90673828125}, {"start": 2504.18, "end": 2504.28, "word": " ولا", "probability": 0.312744140625}, {"start": 2504.28, "end": 2504.42, "word": " بديش", "probability": 0.638427734375}, {"start": 2504.42, "end": 2504.64, "word": " selective", "probability": 0.771484375}, {"start": 2504.64, "end": 2504.96, "word": " media", "probability": 0.931640625}, {"start": 2504.96, "end": 2505.76, "word": " ال", "probability": 0.33837890625}, {"start": 2505.76, "end": 2506.3, "word": " selective", "probability": 0.8955078125}, {"start": 2506.3, "end": 2506.56, "word": " media", "probability": 0.94287109375}, {"start": 2506.56, "end": 2506.86, "word": " تبعي", "probability": 0.75482177734375}, {"start": 2506.86, "end": 2507.2, "word": " اسمه", "probability": 0.9280598958333334}, {"start": 2507.2, "end": 2508.02, "word": " thiamartin", "probability": 0.58306884765625}, {"start": 2508.02, "end": 2508.32, "word": " medium", "probability": 0.8994140625}, {"start": 2508.32, "end": 2508.52, "word": " ايش", "probability": 0.8245442708333334}, {"start": 2508.52, "end": 2508.66, "word": " هو", "probability": 0.89501953125}, {"start": 2508.66, "end": 2509.38, "word": " thiamartin", "probability": 0.82598876953125}, {"start": 2509.38, "end": 2510.32, "word": " medium؟", "probability": 0.715576171875}, {"start": 2510.32, "end": 2510.5, "word": " هو", "probability": 0.88037109375}, {"start": 2510.5, "end": 2511.12, "word": " عبارة", "probability": 0.993896484375}, {"start": 2511.12, "end": 2511.56, "word": " عن", "probability": 0.99755859375}, {"start": 2511.56, "end": 2512.48, "word": " very", "probability": 0.861328125}, {"start": 2512.48, "end": 2513.1, "word": " similar", "probability": 0.95166015625}, {"start": 2513.1, "end": 2513.44, "word": " to", "probability": 0.9658203125}, {"start": 2513.44, "end": 2513.94, "word": " chocolate", "probability": 0.1824951171875}, {"start": 2513.94, "end": 2514.44, "word": " agar", "probability": 0.905517578125}, {"start": 2514.44, "end": 2514.82, "word": " لكن", "probability": 0.92724609375}, {"start": 2514.82, "end": 2515.38, "word": " مضاف", "probability": 0.98681640625}, {"start": 2515.38, "end": 2515.78, "word": " له", "probability": 0.37451171875}, {"start": 2515.78, "end": 2516.78, "word": " antibiotics", "probability": 0.386962890625}, {"start": 2516.78, "end": 2518.08, "word": " بيسموهم", "probability": 0.86845703125}], "temperature": 1.0}, {"id": 101, "seek": 254946, "start": 2523.25, "end": 2549.47, "text": "بنكميسين كوليستين نستاتين كمان مرة بنكميسين كوليستين نستاتين البنكميسين كلكم عرفت ان هو الـ ground positive بكتيريا والكوليستين الـ ground negative بكتيريا النستاتين للفطريات", "tokens": [3555, 1863, 24793, 1829, 3794, 9957, 9122, 12610, 1829, 14851, 9957, 8717, 14851, 9307, 9957, 9122, 2304, 7649, 3714, 25720, 4724, 1863, 24793, 1829, 3794, 9957, 9122, 12610, 1829, 14851, 9957, 8717, 14851, 9307, 9957, 29739, 1863, 24793, 1829, 3794, 9957, 9122, 23275, 2304, 6225, 28480, 2655, 16472, 31439, 2423, 39184, 2727, 3353, 4724, 4117, 2655, 13546, 25528, 16070, 4117, 12610, 1829, 14851, 9957, 2423, 39184, 2727, 3671, 4724, 4117, 2655, 13546, 25528, 28239, 14851, 9307, 9957, 24976, 5172, 9566, 16572, 9307], "avg_logprob": -0.3036521206419152, "compression_ratio": 2.1366906474820144, "no_speech_prob": 0.0, "words": [{"start": 2523.25, "end": 2524.23, "word": "بنكميسين", "probability": 0.5929972330729166}, {"start": 2524.23, "end": 2525.19, "word": " كوليستين", "probability": 0.862548828125}, {"start": 2525.19, "end": 2526.25, "word": " نستاتين", "probability": 0.9462890625}, {"start": 2526.25, "end": 2528.55, "word": " كمان", "probability": 0.40380859375}, {"start": 2528.55, "end": 2528.85, "word": " مرة", "probability": 0.94677734375}, {"start": 2528.85, "end": 2530.91, "word": " بنكميسين", "probability": 0.82708740234375}, {"start": 2530.91, "end": 2535.47, "word": " كوليستين", "probability": 0.97080078125}, {"start": 2535.47, "end": 2538.79, "word": " نستاتين", "probability": 0.98974609375}, {"start": 2538.79, "end": 2543.09, "word": " البنكميسين", "probability": 0.90234375}, {"start": 2543.09, "end": 2543.29, "word": " كلكم", "probability": 0.6269938151041666}, {"start": 2543.29, "end": 2543.55, "word": " عرفت", "probability": 0.8994140625}, {"start": 2543.55, "end": 2543.61, "word": " ان", "probability": 0.5400390625}, {"start": 2543.61, "end": 2543.69, "word": " هو", "probability": 0.11669921875}, {"start": 2543.69, "end": 2543.87, "word": " الـ", "probability": 0.4542236328125}, {"start": 2543.87, "end": 2544.01, "word": " ground", "probability": 0.294189453125}, {"start": 2544.01, "end": 2544.37, "word": " positive", "probability": 0.81494140625}, {"start": 2544.37, "end": 2544.97, "word": " بكتيريا", "probability": 0.838623046875}, {"start": 2544.97, "end": 2546.25, "word": " والكوليستين", "probability": 0.8863932291666666}, {"start": 2546.25, "end": 2546.63, "word": " الـ", "probability": 0.525390625}, {"start": 2546.63, "end": 2546.67, "word": " ground", "probability": 0.6904296875}, {"start": 2546.67, "end": 2546.95, "word": " negative", "probability": 0.91845703125}, {"start": 2546.95, "end": 2547.65, "word": " بكتيريا", "probability": 0.98271484375}, {"start": 2547.65, "end": 2548.73, "word": " النستاتين", "probability": 0.8341064453125}, {"start": 2548.73, "end": 2549.47, "word": " للفطريات", "probability": 0.87998046875}], "temperature": 1.0}, {"id": 102, "seek": 255760, "start": 2556.18, "end": 2557.6, "text": "تمام؟ وبنكمل المرة القادمة ان شاء الله", "tokens": [39237, 10943, 22807, 46599, 1863, 24793, 1211, 9673, 25720, 25062, 18513, 46007, 16472, 13412, 16606, 21984], "avg_logprob": -0.28653492647058826, "compression_ratio": 1.1111111111111112, "no_speech_prob": 0.0, "words": [{"start": 2556.18, "end": 2556.5, "word": "تمام؟", "probability": 0.8024088541666666}, {"start": 2556.5, "end": 2556.82, "word": " وبنكمل", "probability": 0.826171875}, {"start": 2556.82, "end": 2556.98, "word": " المرة", "probability": 0.786376953125}, {"start": 2556.98, "end": 2557.12, "word": " القادمة", "probability": 0.5508626302083334}, {"start": 2557.12, "end": 2557.24, "word": " ان", "probability": 0.6689453125}, {"start": 2557.24, "end": 2557.48, "word": " شاء", "probability": 0.990966796875}, {"start": 2557.48, "end": 2557.6, "word": " الله", "probability": 0.93310546875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2558.32825, "duration_after_vad": 2420.84749999999}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vw6Z8OjBY9A.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vw6Z8OjBY9A.srt
new file mode 100644
index 0000000000000000000000000000000000000000..4b9f2564392c4560abd20ed1ff5eb48d05d043fe
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/Vw6Z8OjBY9A.srt
@@ -0,0 +1,2151 @@
+1
+00:00:20,810 --> 00:00:23,430
+بسم الله الرحمن الرحيم هنتحدث اليوم إن شاء الله عن
+
+2
+00:00:23,430 --> 00:00:26,230
+الـ *Streptococcus agalactiae* و الـ *Streptococcus*
+
+3
+00:00:26,230 --> 00:00:28,870
+*pneumoniae*  و إن أسعفنا الوقت هنتحدث عن الـ Group D
+
+4
+00:00:28,870 --> 00:00:33,550
+streptococci إن شاء الله هذه البكتيريا هي الممثل
+
+5
+00:00:33,550 --> 00:00:37,510
+الوحيد عن Group B وهي أيضا beta-hemolytic و تذكروا
+
+6
+00:00:37,510 --> 00:00:41,910
+دائما أننا بنشوف الـ hemolysis على الـ blood agar
+
+7
+00:00:41,910 --> 00:00:45,790
+قبل ما نفكر أنها Group A ولا Group B، فالعمل
+
+8
+00:00:45,790 --> 00:00:48,970
+المشترك بين الـ *Streptococcus pyogenes* و
+
+9
+00:00:48,970 --> 00:00:52,130
+*Streptococcus agalactiae* من البداية هو الـ Beta
+
+10
+00:00:52,130 --> 00:00:56,020
+hemolysis. طبعا هذه البكتيريا اللي قلنا عنها هي part
+
+11
+00:00:56,020 --> 00:01:00,300
+of the oral and vaginal normal flora و ٥٪ إلى ١٥٪ من
+
+12
+00:01:00,300 --> 00:01:03,820
+الـ healthy individuals بيحملوا both organisms اللي
+
+13
+00:01:03,820 --> 00:01:06,860
+هما الـ *agalactiae* و الـ *pyogenes* in
+
+14
+00:01:06,860 --> 00:01:09,180
+their nasopharynx. ممكن تلاقيها في الـ pharynx، في الـ
+
+15
+00:01:09,180 --> 00:01:11,340
+vagina، ممكن تلاقيها في الأمعاء و الـ intestinal tract
+
+16
+00:01:11,340 --> 00:01:14,800
+و هنا النقطة اللي احنا ركزنا عليها المرة الماضية
+
+17
+00:01:14,800 --> 00:01:18,880
+في محاضراتنا، قلنا أن الـ newborns، بشكل عام أطفال
+
+18
+00:01:18,880 --> 00:01:23,110
+حديثي الولادة لأمهات بيحملوا هذا الميكروب in their
+
+19
+00:01:23,110 --> 00:01:25,850
+vagina بتلاقيها all over the body، وهنا الخطورة
+
+20
+00:01:25,850 --> 00:01:30,190
+اللي احنا تحدثنا عنها المرة السابقة. General
+
+21
+00:01:30,190 --> 00:01:33,270
+characteristics للبكتيريا هي بتنمو على الـ blood agar
+
+22
+00:01:33,270 --> 00:01:37,850
+و بتعمل beta-hemolysis. البكتيريا زي أي
+
+23
+00:01:37,850 --> 00:01:42,230
+*Streptococcus* هي catalase negative، يعني التصنيف
+
+24
+00:01:42,230 --> 00:01:46,900
+العام تبعها كان catalase negative. و فكرتكم، أو
+
+25
+00:01:46,900 --> 00:01:49,420
+ذكرتكم، بأن الـ *N-acetylglucosamine* و الجليكتوز
+
+26
+00:01:49,420 --> 00:01:51,840
+و الـ rhamnose، إذا بتتذكروا، وذكرتكم هذا بيشبه اللي هو الـ
+
+27
+00:01:51,840 --> 00:01:57,200
+blood group antigens وبالتالي قد يتغير أو تعمل
+
+28
+00:01:57,200 --> 00:02:00,440
+cross-reaction في الـ blood grouping إذا كان المريض
+
+29
+00:02:00,440 --> 00:02:04,160
+مصاب بـ infection with this microorganism. واتفقنا
+
+30
+00:02:04,160 --> 00:02:07,400
+أنها بتعمل hydrolysis للـ hippurate into benzoic acid
+
+31
+00:02:07,400 --> 00:02:10,560
+and glycine. واتفقنا أنه إذا أردنا نقوم بهذا الفحص
+
+32
+00:02:10,560 --> 00:02:14,480
+على أن يكون الـ media خالي من أي protein أو أي
+
+33
+00:02:14,480 --> 00:02:19,670
+amino acid. البكتيريا كمان resistant to الـ
+
+34
+00:02:19,670 --> 00:02:22,330
+bacitracin differential disk اللي استخدمناها لـ
+
+35
+00:02:22,330 --> 00:02:24,590
+اللي هو الـ *Streptococcus pyogenes*. كنا عنها
+
+36
+00:02:24,590 --> 00:02:27,930
+sensitive، و إذا كانت resistant فهي other beta-
+
+37
+00:02:27,930 --> 00:02:30,390
+hemolytic streptococci. ومن الـ other beta-
+
+38
+00:02:30,390 --> 00:02:33,470
+hemolytic streptococci،  *S. agalactiae*، إذا هذه
+
+39
+00:02:33,470 --> 00:02:35,850
+should be resistant to bacitracin.
+
+40
+00:02:38,470 --> 00:02:43,370
+هناك بعض الـ pathogenesis للـ adult اللي هي الأم غالبا
+
+41
+00:02:43,370 --> 00:02:46,050
+peri-partum sepsis و ممكن تعمل endocarditis، و أعتقد
+
+42
+00:02:46,050 --> 00:02:49,130
+peri-partum sepsis مرت معنا أكثر من مرة و تحدثنا عن
+
+43
+00:02:49,130 --> 00:02:51,890
+حمى النفاس اللي هي بتصيب الأم بعد
+
+44
+00:02:51,890 --> 00:02:55,610
+الولادة بتلات أيام. endocarditis and pneumonia لكن
+
+45
+00:02:55,610 --> 00:02:58,850
+أنا اللي  ألفت نظري أكثر اللي هو رقم أربعة اللي
+
+46
+00:02:58,850 --> 00:03:02,780
+قلنا عنه الـ neonatal infection which may be ranging
+
+47
+00:03:02,780 --> 00:03:07,120
+from pneumonia, septicemia, or meningitis. الأخيرة
+
+48
+00:03:07,120 --> 00:03:10,840
+هذه ليست للإنسان، هي بتعمل infection في البقر أو
+
+49
+00:03:10,840 --> 00:03:14,280
+الأبقار (bovine) اللي بتسبب الـ mastitis اللي هي
+
+50
+00:03:14,280 --> 00:03:17,200
+التهاب الضرع أو الثدي تبع الأبقار. لكن في الآخر
+
+51
+00:03:17,200 --> 00:03:21,400
+برضه هو بيؤدي علينا بالضرر بأنه الحليب يحتوي على
+
+52
+00:03:21,400 --> 00:03:26,450
+هذا الـ microorganism. البكتيريا بتنمو على general
+
+53
+00:03:26,450 --> 00:03:29,650
+media، الـ blood agar، و بتنمو على selective media،
+
+54
+00:03:29,650 --> 00:03:32,970
+الـ selective media هنا استخدمنا فيها crystal
+
+55
+00:03:32,970 --> 00:03:35,710
+violet in low concentration و استخدمنا colistin
+
+56
+00:03:35,710 --> 00:03:39,690
+sulfate و استخدمنا sulfamethoxazole-trimethoprim.
+
+57
+00:03:40,050 --> 00:03:44,250
+فاكرين الوسط اللي اتكلمنا فيه لـ *pyogenes* هو عبارة عن
+
+58
+00:03:44,250 --> 00:03:46,670
+blood agar أيضا لكن المضاف له three antibiotics:
+
+59
+00:03:46,670 --> 00:03:51,050
+gentamicin، colistin، و nalidixic acid. يعني العامل
+
+60
+00:03:51,050 --> 00:03:54,570
+المشترك هنا من الـ nalidixic acid، عفوا، الـ colistin
+
+61
+00:03:54,570 --> 00:03:58,530
+الـ colistin مشترك بين الوساطين. لكن سواء هذا الوسط
+
+62
+00:03:58,530 --> 00:04:02,470
+أو هذا الوسط، الاثنين مش selective لواحد microbe،
+
+63
+00:04:02,470 --> 00:04:07,210
+selective لللاثنين، بمعنى أنه can grow both *pyogenes*
+
+64
+00:04:07,210 --> 00:04:10,780
+و *agalactiae*. طبعا الـ differentiation بعد ذلك اللي هو
+
+65
+00:04:10,780 --> 00:04:14,740
+سهل، بالـ tests الـ laboratory diagnosis، فيه أني
+
+66
+00:04:14,740 --> 00:04:18,560
+مجموعة من الفحوصات سهلة جدا،  لـ Group B، نعم Group B، hippurate
+
+67
+00:04:18,560 --> 00:04:23,420
+hydrolysis. شفنا الفحص قبل شوية، بيحول الـ
+
+68
+00:04:23,420 --> 00:04:27,000
+hippurate إلى glycine و benzoic acid، و الـ glycine
+
+69
+00:04:27,000 --> 00:04:31,120
+could be detected by ninhydrin، اللي هي الفحص اللي
+
+70
+00:04:31,120 --> 00:04:34,340
+قبلنا هنا. الـ CAMP test which is the most famous
+
+71
+00:04:37,480 --> 00:04:40,820
+test for this organism. عندي الـ bile esculin وهو
+
+72
+00:04:40,820 --> 00:04:48,130
+مخصص للـ enterococci أو  enteric oxide بتكون negative،
+
+74
+00:04:48,130 --> 00:04:51,410
+عفوا، أن enteric oxide positive، بينما our
+
+75
+00:04:51,410 --> 00:04:54,170
+organism اللي احنا بنتحدث عنه اليوم هذا بيكون
+
+76
+00:04:54,170 --> 00:04:56,290
+negative. طبعا الـ latex agglutination أكثر من مرة
+
+77
+00:04:56,290 --> 00:05:00,730
+حكينا فيها، وهي أن نقوم بربط الـ antibody لـ latex
+
+78
+00:05:00,730 --> 00:05:04,030
+particle أو ربط الـ antigen لـ latex particle للبحث
+
+79
+00:05:04,030 --> 00:05:08,450
+عن الـ antibody to visualize the reaction. أول فحص في
+
+80
+00:05:08,450 --> 00:05:10,130
+المجموعة اللي هو الـ hippurate hydrolysis زي ما
+
+81
+00:05:10,130 --> 00:05:12,990
+حكينا لكم، هو عبارة عن media محتوى على الـ
+
+82
+00:05:12,990 --> 00:05:15,790
+hippurate. الـ hippurate بنعمل inoculating للبكتيريا
+
+83
+00:05:15,790 --> 00:05:21,110
+وبعد ٢٤ ساعة بنعمل spraying with ninhydrin. الـ ٩-
+
+84
+00:05:21,110 --> 00:05:24,170
+ninhydrin بيرتبط بأي amino acid، بأي amino acid
+
+85
+00:05:24,170 --> 00:05:27,290
+و بيعطي purple color. إذا صار في purple color، ما
+
+86
+00:05:27,290 --> 00:05:29,890
+فيه  amino acid من أين يجي amino acid؟ من
+
+87
+00:05:29,890 --> 00:05:34,310
+الـ hydrolysis of hippurate into benzoic acid and
+
+88
+00:05:34,310 --> 00:05:38,260
+glycine. و بعدها بيكون في عندي اللي هو الـ positive
+
+89
+00:05:38,260 --> 00:05:42,240
+result لأن لاحظوا الـ reaction واضح أنه purple، إن كده
+
+90
+00:05:42,240 --> 00:05:46,280
+الـ CAMP test، بدل ما نتكلم كل الكلام الموجودة على
+
+91
+00:05:46,280 --> 00:05:49,600
+اللوحة، بإننا ننتقل للصورة مباشرة و نشوف كيف
+
+92
+00:05:49,600 --> 00:05:55,940
+الفحص بينعمل هذا.
+
+93
+00:05:55,940 --> 00:06:01,200
+عبارة عن blood agar plate زرعناها بهذه الطريقة، الـ
+
+94
+00:06:01,200 --> 00:06:06,840
+*Staphylococcus aureus*. هنا في هذه الحالة البكتيريا
+
+95
+00:06:06,840 --> 00:06:10,840
+هي استخدامها كـ reagent، استخدامها كـ reagent، و لازم تكون
+
+96
+00:06:10,840 --> 00:06:15,600
+beta-hemolytic، يعني مش أي *aureus*. beta-hemolytic
+
+97
+00:06:16,180 --> 00:06:18,180
+عشان هيك في الثلاجة اللي عندك في الميكروبيلوجي لازم
+
+98
+00:06:18,180 --> 00:06:21,700
+يكون فيه، دائما، لازم يكون فيه storage لبعض
+
+99
+00:06:21,700 --> 00:06:24,500
+أنواع من البكتيريا that are used as reagents
+
+100
+00:06:24,500 --> 00:06:26,640
+منها الـ beta-hemolytic ... الـ
+
+101
+00:06:26,640 --> 00:06:29,840
+*Staphylococcus aureus*. اللي أنا suspected colony
+
+102
+00:06:29,840 --> 00:06:33,660
+و كمان مرة مش أي بكتيريا في الدنيا بعملها، أنا، CAMP
+
+103
+00:06:33,660 --> 00:06:37,540
+test. لازم تكون لها مواصفات، إيش مواصفاتها؟ أنها...
+
+104
+00:06:37,540 --> 00:06:40,560
+أنها gram-positive cocci، أنها catalase-negative،
+
+105
+00:06:40,560 --> 00:06:44,400
+أنها beta-hemolytic، أنها bacitracin-resistant. لما
+
+106
+00:06:44,400 --> 00:06:47,920
+نصل لهذه المرحلة، بيكون حان الوقت لإجراء فحص مين؟
+
+107
+00:06:47,920 --> 00:06:52,600
+اللي هو CAMP test. هذا gram-positive cocci
+
+108
+00:06:52,600 --> 00:07:05,000
+catalase-negative، beta-hemolytic، bacitracin-resistant.
+
+109
+00:07:05,000 --> 00:07:10,000
+ليه هذه الأربع أشياء اللي حكيناها؟ الشروط، التسلسل
+
+110
+00:07:10,000 --> 00:07:12,840
+المنطقي، هاي البكتيريا من هنا إلى هنا
+
+111
+00:07:15,600 --> 00:07:18,560
+*Streptococcus*. هنا نعرف البكتيريا، صحيح اسمها Beta-
+
+112
+00:07:18,560 --> 00:07:22,120
+hemolytic Streptococci، لكن لما نقول bacitracin
+
+113
+00:07:22,120 --> 00:07:25,540
+resistant، Beta-hemolytic Streptococci، for sure it is
+
+114
+00:07:25,540 --> 00:07:29,200
+not *pyogenes*، صح؟ يبقى ممكن تكون others، ومن ضمن الـ
+
+115
+00:07:29,200 --> 00:07:31,800
+others قلنا مين؟ اللي هي الـ *agalactiae*.  نحاول نعمل فحص
+
+116
+00:07:31,800 --> 00:07:34,820
+طيب.
+
+117
+00:07:34,820 --> 00:07:39,080
+نرجع مرة نرسم  الرسم من أول وجديد عشان نشوف كيف الـ
+
+118
+00:07:39,080 --> 00:07:43,580
+reaction حصل، قلنا
+
+119
+00:07:43,580 --> 00:07:48,210
+نزرع بشكل، يعني، من منتصف الطبق بـ *Staphylococcus*
+
+120
+00:07:48,210 --> 00:07:52,270
+*aureus* والـ suspect strain، ممكن نزرعهم
+
+121
+00:07:52,270 --> 00:07:56,890
+perpendicular، بشكل متعامد على خط الزراعة تبع الـ
+
+122
+00:07:56,890 --> 00:08:00,370
+*Staphylococcus aureus*. ممكن نقول Strain A، Strain B
+
+123
+00:08:00,370 --> 00:08:04,910
+أو واحد، اثنين،  نبدأ نخربط بين A و B، واحد، اثنين،
+
+124
+00:08:04,910 --> 00:08:06,710
+واحد، ثلاثة، واحد، ثلاثة، واحد، ثلاثة، واحد،
+
+125
+00:08:06,710 --> 00:08:06,790
+ثلاثة، واحد، ثلاثة، واحد، ثلاثة، واحد، ثلاثة،
+
+126
+00:08:06,790 --> 00:08:06,810
+واحد، ثلاثة، واحد، ثلاثة، واحد، ثلاثة، واحد،
+
+127
+00:08:06,810 --> 00:08:08,990
+ثلاثة، واحد، ثلاثة، واحد، ثلاثة، واحد، ثلاثة،
+
+128
+00:08:08,990 --> 00:08:13,450
+واحد،
+
+129
+00:08:13,450 --> 00:08:16,900
+ثلاثة. نأخذهم و نحطهم في incubator ٣٥ درجة
+
+130
+00:08:16,900 --> 00:08:22,180
+مئوية، twenty-four hours، حيصير في عندي الآن growth، و
+
+131
+00:08:22,180 --> 00:08:24,700
+associated with the growth is hemolysis. الاثنين
+
+132
+00:08:24,700 --> 00:08:27,960
+بيعملوا hemolysis، ولا لا؟ فاكرين الشرط اللي كان
+
+133
+00:08:27,960 --> 00:08:31,680
+هنا؟ هذا بيعمل hemolysis، وهذا بيعمل hemolysis، هاي
+
+134
+00:08:31,680 --> 00:08:33,600
+الـ hemolysis. لسة في الـ *Staphylococcus aureus*
+
+135
+00:08:33,600 --> 00:08:40,030
+المفروض أن هو هيك، و هذا المفروض أن هو هيك. هذا الشكل
+
+136
+00:08:40,030 --> 00:08:43,770
+الطبيعي للـ hemolysis، طبعا، لكن باللاحظ لو كانت
+
+137
+00:08:43,770 --> 00:08:48,750
+البكتيريا هي *agalactiae*،
+
+138
+00:08:48,750 --> 00:08:54,210
+أنه في منطقة الالتقاء ما بين الـ hemolytic area of
+
+139
+00:08:54,210 --> 00:08:58,510
+*Staphylococcus aureus* و hemolytic area itself تكون
+
+140
+00:08:58,510 --> 00:09:03,210
+ما يشبه الـ arrow head formation. من إيش تتكون الـ
+
+141
+00:09:03,210 --> 00:09:09,330
+arrow head formation هذا؟  مش داخل في التآزر مع بعض،
+
+142
+00:09:09,330 --> 00:09:13,570
+احنا
+
+143
+00:09:13,570 --> 00:09:18,610
+في الجامعة بنقول عمل فلان يضاف إلى عمل فلان
+
+144
+00:09:18,610 --> 00:09:22,130
+فبيساوي مجموع عملهم منفرد. هذا simple mathematics،
+
+145
+00:09:22,130 --> 00:09:27,910
+حساب addition، واحد زائد واحد يساوي اثنين. في الـ
+
+146
+00:09:27,910 --> 00:09:31,510
+synergism، في الـ synergism اللي هو التآزر باللغة
+
+147
+00:09:31,510 --> 00:09:36,230
+العربية، واحد زائد واحد يساوي أكثر من اثنين، أكثر من
+
+148
+00:09:36,230 --> 00:09:39,990
+اثنين. فلما التقى الـ hemolysin هذا مع الـ hemolysin
+
+149
+00:09:39,990 --> 00:09:43,930
+هذا، كان فيه synergistic effect، فزاد الـ zone، فأعطى
+
+150
+00:09:43,930 --> 00:09:46,590
+الشكل اللي احنا شايفينه اللي يسمى arrow head
+
+151
+00:09:46,590 --> 00:09:49,330
+formation. سواء المنطقة هذه أو المنطقة هذه أو في
+
+152
+00:09:49,330 --> 00:09:50,790
+الصورة اللي احنا شايفينها.
+
+153
+00:09:57,570 --> 00:09:59,770
+إيش الـ scenario اللي  حكينا عنه؟ حكينا عنه there is a
+
+154
+00:09:59,770 --> 00:10:08,610
+factor في الـ *Staphylococcus aureus* that enhanced، حسن، الـ reaction
+
+155
+00:10:08,610 --> 00:10:12,510
+تبع اللي هو الـ *Staphylococcus aureus* beta-hemolysin.
+
+156
+00:10:12,510 --> 00:10:15,950
+إيش سُمّي هذا الـ factor؟ CAMP factor، اللي سميّوه
+
+157
+00:10:15,950 --> 00:10:19,910
+CAMP على أسماء الحروف الأولى من العلماء الأربعة اللي
+
+158
+00:10:19,910 --> 00:10:22,830
+طوّروا هذا الفحص. بعدين بطلوا يقولوا factor، ثمّ
+
+159
+00:10:22,830 --> 00:10:24,990
+يقولوا CAMP test، وانتهى الموضوع.
+
+160
+00:10:27,870 --> 00:10:30,670
+الفحص الثالث و المهم جدا اللي هنتكلم عنه هو الـ bile
+
+161
+00:10:30,670 --> 00:10:31,590
+esculin test.
+
+162
+00:10:35,760 --> 00:10:38,880
+هذا الاختبار لن يكتشف فقط خاصية واحدة، بل سيكتشف
+
+163
+00:10:38,880 --> 00:10:44,440
+اثنتين، أولا، قدرة الميكروب في الـ bile،
+
+164
+00:10:44,440 --> 00:10:49,060
+inhibitory للبكتيريا. و كلكم فاكرين أننا أضفناه
+
+165
+00:10:49,060 --> 00:10:53,200
+أصلا على الـ MacConkey لـ يمنع نمو البكتيريا gram-positive.
+
+166
+00:10:53,200 --> 00:10:58,560
+لمنع نمو البكتيريا gram-positive. أضفناه على الـ MacConkey،
+
+167
+00:10:58,560 --> 00:11:01,540
+أضفناه على كثير من الأوساط الـ selective،
+
+168
+00:11:01,680 --> 00:11:05,980
+differential، وشبيهة. لكن هناك بعض أنواع من البكتيريا
+
+169
+00:11:05,980 --> 00:11:08,800
+معروفة بقدرتها على مقاومة الـ bile، مين هي
+
+170
+00:11:08,800 --> 00:11:15,360
+البكتيريا؟ اللي هي بتعيش داخل الأمعاء، عندها القدرة
+
+171
+00:11:15,360 --> 00:11:18,780
+على أن تتحمل الـ bile، أمر طبيعي لأن الـ bile أصلا
+
+172
+00:11:18,780 --> 00:11:24,230
+بالآخر بينكب وين؟ في الأمعاء. طبعا المسافة طويلة يا
+
+173
+00:11:24,230 --> 00:11:27,910
+شباب، مسافة طويلة. الـ resistance غالبا بحسب وين
+
+174
+00:11:27,910 --> 00:11:32,310
+الميكروب موجود، لإنه تأثير الـ bile، كل ما ابتعد عن
+
+175
+00:11:32,310 --> 00:11:35,570
+الـ bile duct، كل ما قلّ تأثيره، بيصير له degradation،
+
+176
+00:11:35,570 --> 00:11:40,430
+و بتكسر. فالميكروبات اللي أبعد بتكون أقل مقاومة، و
+
+177
+00:11:40,430 --> 00:11:47,690
+اللي أقرب بتكون أكثر مقاومة. أبعد عن bile duct اللي
+
+178
+00:11:47,690 --> 00:11:54,730
+هي القناة الصفراوية اللي بتصب ال
+
+223
+00:14:48,400 --> 00:14:52,120
+واضحة بينما في رقم اثنين milky appearance ماذا يعني
+
+224
+00:14:52,120 --> 00:14:56,820
+milky appearance؟ يعني ما فيه agglutination و
+
+225
+00:14:56,820 --> 00:15:00,620
+distribution لـ lattice particle في الـ solution
+
+226
+00:15:00,620 --> 00:15:05,790
+بشكل منتظم وبالتالي negative reaction  كلم مرة ال
+
+227
+00:15:05,790 --> 00:15:09,430
+Latex agglutination ممكن استخدمه لغرضين: إما للكشف
+
+228
+00:15:09,430 --> 00:15:15,650
+عن الـ antigen مباشرة باستخدام antibody  هل بالضبط
+
+229
+00:15:15,650 --> 00:15:19,310
+ينفعنا هذا الفحص؟ نعم ينفعنا كثيراً، تخيلوا يا شباب لو
+
+230
+00:15:19,310 --> 00:15:25,710
+أردنا إدراج فحص الـ Streptococcus agalactica
+
+231
+00:15:25,710 --> 00:15:30,410
+روتيني في مراكز رعاية الأمومة والطفولة، يعني كل أم
+
+232
+00:15:30,410 --> 00:15:35,490
+حامل، تمام؟ بدنا نعمل لها فحص عشان نقول لكم أن الجنين
+
+233
+00:15:35,490 --> 00:15:41,350
+قد يتأثر بالميكروبات الخارجة عبر قناة الولادة، أنه
+
+234
+00:15:41,350 --> 00:15:45,350
+أفضل نعمل culture ولا نعمل latex agglutination؟
+
+235
+00:15:46,940 --> 00:15:50,180
+تجدون في الاختبار، بقى السؤال اللي حكيته كم مرة، كلمة
+
+236
+00:15:50,180 --> 00:15:54,500
+أفضل، أفضل الـ culture، الـ culture من ناحية... من
+
+237
+00:15:54,500 --> 00:15:57,320
+ناحية إيه؟ دقة و sensitivity  وما أعرفه الـ الـ
+
+238
+00:15:57,320 --> 00:16:01,040
+antibiotic لكن من ناحية أرخص وأسرع، يمكن فإحنا
+
+239
+00:16:01,040 --> 00:16:04,900
+ممكن نستخدمه كـ screening test، اللي عنده يطلع إيجابي، نعمله culture،  صلا صلا يعني... يعني مش بديل عن الـ
+
+240
+00:16:04,900 --> 00:16:08,380
+culture، واللي يطلع سلبي فهو سلبي لأنه
+
+241
+00:16:08,380 --> 00:16:10,720
+يتميز بأنه rapidity and
+
+242
+00:16:10,720 --> 00:16:15,100
+sensitivity، وكلمة sensitivity  أساس يا شباب في أي
+
+243
+00:16:17,270 --> 00:16:21,170
+screening test في الدنيا، لازم يكون highly
+
+244
+00:16:21,170 --> 00:16:23,650
+sensitive، ليش highly sensitive؟ عشان الـ negative
+
+246
+00:16:28,070 --> 00:16:31,150
+يكون عن جد سلبي، مش ضال،  يُكون highly specific
+
+247
+00:16:31,150 --> 00:16:34,410
+لإن أنا بدي أعمل confirmatory test بعد ذلك، لإن فيه
+
+248
+00:16:34,410 --> 00:16:39,510
+فرق بين الـ sensitivity والـ specificity، طيب to sum
+
+249
+00:16:39,510 --> 00:16:43,420
+up، تلخيص، بس خليني ألخص المعلومة هذه، وبعدين نرجع
+
+250
+00:16:43,420 --> 00:16:46,920
+للموضوع، أنا عندي البكتيريا Hemorrhagic streptococci
+
+251
+00:16:46,920 --> 00:16:50,960
+من البداية عملتلها فحص الـ بيسترسي، كمان مرة، لما ألجأ لـ
+
+252
+00:16:50,960 --> 00:16:54,400
+serology، لما ألجأ لـ serology، والسبب في ذلك أن هناك
+
+253
+00:16:54,400 --> 00:16:58,330
+it is expensive، يعني الـ serology بالمقارنة مع، أتكلم
+
+254
+00:16:58,330 --> 00:17:01,490
+عن بيسترسين ديسك، أو أتكلم عن beta hemolysis، أو
+
+255
+00:17:01,490 --> 00:17:05,250
+أتكلم عن bile esculin، هذا very... very cheap
+
+256
+00:17:05,250 --> 00:17:08,150
+test، إذا مقاوم، وإذا حساس، إذا حساس
+
+257
+00:17:08,150 --> 00:17:11,710
+انتهينا، Streptococcus pyogenes، إذا مقاوم
+
+258
+00:17:11,710 --> 00:17:14,570
+بتعمل camp test، الـ camp test بسيط، فهي
+
+259
+00:17:14,570 --> 00:17:16,830
+Streptococcus agalactia، إذا كانت camp test
+
+260
+00:17:16,830 --> 00:17:20,740
+سالبة فهي other beta hemolytic streptococcus، هل
+
+261
+00:17:20,740 --> 00:17:24,120
+أكمل أم لا أكمل؟ بمعنى أن لو طلعت معي
+
+262
+00:17:24,120 --> 00:17:26,640
+البكتيريا other groups of beta-hemolytic
+
+263
+00:17:26,640 --> 00:17:30,100
+streptococci، أكمل أم لا أكمل؟ خذوا بالكم أنا
+
+264
+00:17:30,100 --> 00:17:33,540
+ذكرت لكم مرة عن مستوى الخدمات المقدمة في المختبرات
+
+265
+00:17:33,540 --> 00:17:37,540
+معتمد على من؟ على إمكانية هذه المختبرات، إذا
+
+266
+00:17:37,540 --> 00:17:41,960
+المختبر تبعكم من الدرجة الأولى، أنتم ممكن تعملون في هذه
+
+267
+00:17:41,960 --> 00:17:45,820
+الحالة، رسمة ABI strepto
+
+268
+00:17:47,390 --> 00:17:52,090
+مثل الـ ABI-20E، في ABI-strepto، ممكن تعملون ABI-strepto
+
+269
+00:17:52,090 --> 00:17:55,830
+تتعرف على الميكروب، لكن غالباً ما الفائدة؟ هنا
+
+270
+00:17:55,830 --> 00:17:58,750
+السؤال: ما الفائدة؟ فاكرين أول المحاضرة اللي فاتت؟
+
+271
+00:17:58,750 --> 00:18:03,970
+قلنا أهم groups من هما A وB وD في الـ... في الـ...
+
+272
+00:18:03,970 --> 00:18:06,750
+في الـ streptococci، بالإضافة هذه طبعاً لـ streptococci
+
+273
+00:18:06,750 --> 00:18:10,690
+الـ نيمونية، طب إيه هيها؟ في أين راحت؟ هي A اللي هي
+
+274
+00:18:10,690 --> 00:18:17,010
+بيوجينز، وهي B  معها، إيش بتكون؟ ودي ما أعرف علاقة بالـ
+
+275
+00:18:17,010 --> 00:18:20,650
+Beta hemolysis، ما أعرف علاقة بالـ Beta hemolysis، فزي
+
+276
+00:18:20,650 --> 00:18:23,430
+ما حكينا: يا إما القرار إنه نكمل أو ما نكمل في الـ
+
+277
+00:18:23,430 --> 00:18:25,870
+identification، مستمرة على مستوى الخدمات المقدمة في
+
+278
+00:18:25,870 --> 00:18:26,930
+المختبرات، فضلُوا  بجدك تحكي
+
+279
+00:18:32,970 --> 00:18:37,150
+العكس: أن أنا بدل ما أكشف عن antigen أكشف عن antibody
+
+280
+00:18:37,150 --> 00:18:44,110
+from the serum، أو بعمل detection للـ antigen من العينة
+
+281
+00:18:44,110 --> 00:18:46,030
+مباشرة، أو من خلال الـ
+
+282
+00:18:49,240 --> 00:18:51,640
+الميكروب الثالث في السلسلة اللي هو الـ Streptococcus
+
+283
+00:18:51,640 --> 00:18:54,940
+pneumonia، والـ Streptococcus pneumonia دبلو كوكاية
+
+284
+00:18:54,940 --> 00:18:58,300
+مشهورة gram-positive، بيسموها الـ lancet shape اللي
+
+285
+00:18:58,300 --> 00:19:07,220
+هي غير كاملة الاستدارة البكتيرية
+
+286
+00:19:07,220 --> 00:19:11,940
+هذه capsulated، يبقى Streptococcus pneumoniae بدنا نعرف
+
+287
+00:19:11,940 --> 00:19:16,460
+من الآن أنها دبلو كوكاي and capsulated، هيقول لي
+
+288
+00:19:16,460 --> 00:19:19,060
+واحد: أنه في  Streptococcus pneumoniae دبلو كوكاي ومش
+
+289
+00:19:19,060 --> 00:19:23,940
+capsulated، بقول له: نعم، أسمحوا
+
+290
+00:19:23,940 --> 00:19:30,440
+لي أن أقفز إلى صورة مشهورة
+
+291
+00:19:30,440 --> 00:19:35,360
+جداً، وعارفين أنتم هذه، بس خلينا برضه نؤكد على بعض
+
+292
+00:19:35,360 --> 00:19:39,040
+المعلومات اللي فيها، البكتيريا ما لهاش كابسول، لحظة
+
+293
+00:19:39,040 --> 00:19:42,280
+وعاملينها باللون الأزرق، والثانية لها كابسول وواضح
+
+294
+00:19:42,280 --> 00:19:46,280
+أنه فيه... لها غلاف، لما حقننا هذه البكتيريا
+
+295
+00:19:46,280 --> 00:19:51,000
+بالماوس، ما مات الـ... الـ... الـ mouse، بينما الـ...
+
+296
+00:19:51,000 --> 00:19:54,560
+الثانية مات الـ mouse، وهذه من التجربة الأولى
+
+297
+00:19:54,560 --> 00:19:58,580
+والثانية، استنتج العالم Griffith، وقال إنه الـ
+
+298
+00:19:58,580 --> 00:20:01,060
+capsulated strain of Streptococcus pneumoniae is
+
+299
+00:20:01,060 --> 00:20:04,820
+pathogenic، virulent، بينما الثانية non-pathogenic،
+
+300
+00:20:04,820 --> 00:20:10,000
+الآن، خذوا بقى، الكابسول، سُمِّيَ  smooth والثانية سُمِّيَ rough
+
+301
+00:20:10,000 --> 00:20:14,100
+الـ roughness والـ smoothness، أو هنا برمز لها بحرف
+
+302
+00:20:14,100 --> 00:20:19,480
+الـ R، وهنا برمز لها بحرف الـ S، لما تقول R colonies
+
+303
+00:20:19,480 --> 00:20:23,860
+بشكل عام، كلمة R colonies يعني rough colonies، يعني
+
+304
+00:20:23,860 --> 00:20:28,280
+non-capsulated، ولما تقول S colonies يعني smooth
+
+305
+00:20:28,280 --> 00:20:29,940
+colonies، يعني capsulated
+
+306
+00:20:33,140 --> 00:20:36,940
+لاحظوا هذا الفرق البسيط، موجود أو غير موجود،
+
+307
+00:20:36,940 --> 00:20:41,940
+الكابسول كان فرق برضه له دلالاته، الفرق بين
+
+308
+00:20:41,940 --> 00:20:47,000
+pathogen و non-pathogen، لكن إحنا لما نتكلم عن الـ
+
+309
+00:20:47,000 --> 00:20:48,800
+Streptococcus pneumoniae نتكلم عن أي واحد منهم؟
+
+310
+00:20:48,800 --> 00:20:53,700
+اللي هي الـ pathogenic، فببدأ مثلاً، لو وصلنا الصورة، نكمل
+
+311
+00:20:53,700 --> 00:20:58,470
+الفكرة تبعها، هنا أخذوا heat-killed smooth strain،
+
+312
+00:20:58,470 --> 00:21:03,090
+يعني heat-killed، heat-killed، مقتولة برضه، الفأر ماصار
+
+313
+00:21:03,090 --> 00:21:07,010
+إيش فيه، لكن لما حطوا الـ... الـ rough strain، وضعوا فيه
+
+314
+00:21:07,010 --> 00:21:12,170
+الـ heat-killed،  انتقلت جينات الكابسول من الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+315
+00:21:12,170 --> 00:21:16,020
+الكابسول من الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+316
+00:21:16,020 --> 00:21:16,180
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+317
+00:21:16,180 --> 00:21:16,960
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+318
+00:21:16,960 --> 00:21:17,240
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+319
+00:21:17,240 --> 00:21:17,440
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+320
+00:21:17,440 --> 00:21:17,820
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+321
+00:21:17,820 --> 00:21:17,900
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+322
+00:21:17,900 --> 00:21:23,800
+الت....ت....ت....ت....ت....
+
+323
+00:21:27,710 --> 00:21:34,010
+وهذه قلنا لكم استخدمت لاحقاً في إثبات أن الـ DNA هو
+
+324
+00:21:34,010 --> 00:21:37,270
+المادة الوراثية، وليس الـ... لأنه بعد ذلك، كمل العالم
+
+325
+00:21:37,270 --> 00:21:41,870
+Griffith، جاب الـ... الـ... الـ... الـ heat-killed smooth، وأخذ
+
+326
+00:21:41,870 --> 00:21:45,470
+منها فقط الـ DNA، وحطه مع الـ rough، ولجأ لنفس النتيجة،
+
+327
+00:21:45,470 --> 00:21:49,430
+فعرف أن المادة الوراثية هي الـ DNA، وليست الـ
+
+328
+00:21:49,430 --> 00:21:51,610
+protein، كما كان يُعتقد في السابق، يعني، اجتمع أنتم وأنا، كان الاعتقاد أنَّ
+
+329
+00:21:51,610 --> 00:21:55,330
+الحامل للصفات الوراثية
+
+330
+00:21:55,330 --> 00:21:57,530
+من كان الـ... الـ... الـ... الـ protein، ليش كان هو
+
+331
+00:21:57,530 --> 00:22:00,250
+الحامل للصفات الوراثية؟ أقول أو إيش... أو إيش
+
+332
+00:22:00,250 --> 00:22:03,130
+كان الاعتقاد؟ كانوا يعرفون حوالي عشرين amino acids،
+
+333
+00:22:03,130 --> 00:22:08,110
+هم عشرون amino acid، بينما الـ DNA مكون من أربعة
+
+334
+00:22:08,110 --> 00:22:15,000
+قواعد، من أكثر combinations ممكن يعطي في اللغة...
+
+335
+00:22:15,000 --> 00:22:18,600
+في اللغة كأحرف، أنا عندي عشرون حرف، عشرون amino
+
+336
+00:22:18,600 --> 00:22:22,340
+acids، بينما في القواعد عندي فقط أربعة أحرف، معروفة
+
+337
+00:22:22,340 --> 00:22:26,020
+عالمياً، أن اللغات... اللغات، اللغة العربية 28، و
+
+338
+00:22:26,020 --> 00:22:30,120
+اللغة الإنجليزية 26، كل، اللغة الفلبينية اللي درست
+
+339
+00:22:30,120 --> 00:22:34,280
+بها، درست أنا فيها عشرون حرف فقط، فكل ما زاد عدد
+
+340
+00:22:34,280 --> 00:22:38,980
+الأحرف، كل ما زاد غنى اللغة، غنى اللغة بالمفردات، فكان
+
+341
+00:22:38,980 --> 00:22:43,100
+المؤهل أنه يحمل الصفات الوراثية في ذاك الوقت
+
+342
+00:22:43,100 --> 00:22:47,440
+كمعلومات، هو الـ protein أو الـ amino acids، فكانت هذه
+
+343
+00:22:47,440 --> 00:22:51,500
+من أوائل الـ proof أنه لا، القواعد النيتروجينية
+
+344
+00:22:51,500 --> 00:22:54,160
+هي المسؤولة عن الـ...
+
+345
+00:22:59,210 --> 00:23:03,450
+البكتيريا عُزِلت بواسطة لويس باستير في القرن
+
+346
+00:23:03,450 --> 00:23:08,810
+التاسع عشر في نهايته، ألف وثمانمئة وثمانين، وأثبت
+
+347
+00:23:08,810 --> 00:23:12,990
+أنها المسبب لـ lobar pneumonia، وكلمة lobar
+
+348
+00:23:12,990 --> 00:23:16,430
+pneumonia معناها أن الـ whole lobe of the lung is
+
+349
+00:23:16,430 --> 00:23:19,570
+infected، يعني مش جزء واحد من الـ lung، وإنما الـ
+
+350
+00:23:19,570 --> 00:23:23,750
+lobe كلها بتكون مصابة، حكينا على الـ two variants
+
+351
+00:23:23,750 --> 00:23:25,650
+اللي هما الـ capsulated والـ non-capsulated، الـ
+
+352
+00:23:25,650 --> 00:23:30,110
+normal habitat، they are normal flora of the upper
+
+353
+00:23:30,110 --> 00:23:33,750
+respiratory tract، nasopharyngeal أو oral flora
+
+354
+00:23:33,750 --> 00:23:37,010
+خمسة في المائة من البالغين، وخمسة في المائة من
+
+355
+00:23:37,010 --> 00:23:41,090
+الأطفال اللي هم مش infected، are carrying this
+
+356
+00:23:41,090 --> 00:23:44,990
+organism، يعني مولود كـ normal flora، كيف
+
+357
+00:23:44,990 --> 00:23:48,450
+تفسرون؟ مولود كـ normal flora، في نفس الوقت سبب الـ
+
+358
+00:23:48,450 --> 00:23:54,590
+pneumonia انتهازية، انتهازية، وحنشوف إنها بالفعل إنها
+
+359
+00:23:54,590 --> 00:23:59,630
+انتهازية، لما نشوف الأمراض وماذا تسبب الأمراض، أخذنا
+
+360
+00:23:59,630 --> 00:24:00,430
+نمسح بصورة
+
+361
+00:24:11,160 --> 00:24:13,520
+أول حاجة بدنا نعرف أن الـ disease is pneumococcal
+
+362
+00:24:13,520 --> 00:24:17,120
+pneumonia، نموكوكال نيمونيا، سميناها عشان نميزها عن
+
+363
+00:24:17,120 --> 00:24:22,480
+أي نوع آخر نيمونيا، كلبسيلة نيمونيا، نيمونية، تمام؟
+
+364
+00:24:22,480 --> 00:24:26,020
+يبقى فيه عندي أنا مجموعة من الميكروبات بتسبب
+
+365
+00:24:26,020 --> 00:24:29,880
+نيمونيا، فكيف نميز بكتيريتنا عنها؟ نقول عنها
+
+366
+00:24:29,880 --> 00:24:35,740
+pneumococcal pneumonia، ولحظة أن pneumococci is the
+
+367
+00:24:35,740 --> 00:24:40,100
+common name of Streptococcus pneumoniae، pneumococci،
+
+368
+00:24:41,860 --> 00:24:44,080
+طب في اسم دلع آخر للبكتيريا؟ نعم، في عندنا
+
+369
+00:24:44,080 --> 00:24:48,120
+Neisseria meningitidis، بنسميها meningococci، و
+
+370
+00:24:48,120 --> 00:24:52,640
+Neisseria gonorrhoeae بنسميها gonococci، يبقى كلهم
+
+371
+00:24:52,640 --> 00:24:59,360
+الثلاثة اللي دلعناهم is
+
+372
+00:24:59,360 --> 00:25:04,560
+pneumonia، بنسميها pneumococci، وNeisseria
+
+373
+00:25:04,560 --> 00:25:06,120
+meningitidis
+
+374
+00:25:07,640 --> 00:25:13,960
+سميناها meningococci، وNeisseria gonorrhoeae سميناها
+
+375
+00:25:13,960 --> 00:25:18,380
+gonococci، gonococci، تمام، الثلاثة هدول
+
+376
+00:25:18,380 --> 00:25:21,600
+الأسماء الشائعة تبعهم، كلهم دبلو كوكاي، هدول
+
+377
+00:25:21,600 --> 00:25:26,080
+الأثنين gram-negative، وحيكونوا محور محاضرتنا
+
+378
+00:25:26,080 --> 00:25:30,300
+الجاية إن شاء الله، بإذن الله، والأمر وأنا أخطئ
+
+379
+00:25:30,300 --> 00:25:35,460
+ثانية، هدول الأثنين ولا واحدة؟ نعم، gram-negative، و
+
+380
+00:25:35,460 --> 00:25:35,900
+هذه gram-
+
+381
+00:25:38,880 --> 00:25:43,040
+طب تخيلوا يا شباب، تخيلوا واحد عمل gram stain لـ
+
+382
+00:25:43,040 --> 00:25:47,060
+Streptococcus pneumoniae من عينة CSF، من عينة CSF، و
+
+383
+00:25:47,060 --> 00:25:51,240
+لأن المريض أخذ antibiotic لحاله، على عادة جبايج، ما أخذ
+
+384
+00:25:51,240 --> 00:25:55,380
+طلعت البكتيريا عندي gram-negative diplococci، بيحصل
+
+385
+00:25:55,380 --> 00:26:00,820
+أو لا يحصل، أحد أسباب تحول البكتيريا لـ gram
+
+386
+00:26:00,820 --> 00:26:04,140
+positive لـ gram-negative، هو تعرضها لـ antibiotics
+
+387
+00:26:05,640 --> 00:26:09,660
+فإحنا هنعطي نتيجة عليها Gram-negative diplococci
+
+388
+00:26:09,660 --> 00:26:14,240
+طب Gram-negative diplococci في الـ CSF، هتفسر عليها
+
+389
+00:26:14,240 --> 00:26:17,520
+نيمونيا ولا عليها Neisseria meningitidis؟ Neisseria
+
+390
+00:26:17,520 --> 00:26:21,420
+meningitidis، لذلك بدنا نكون حذرين جداً في الـ reporting
+
+391
+00:26:21,420 --> 00:26:24,660
+تبعنا، فيه فرق كبير بين Streptococcus pneumoniae في
+
+
+445
+00:29:58,210 --> 00:30:01,470
+العوامل المؤهلة للمرض ممكن يكون لديك bronchitis,
+
+446
+00:30:01,590 --> 00:30:06,510
+sinusitis, otitis media, septicemia and .. خذوا
+
+447
+00:30:06,510 --> 00:30:13,410
+بالكم من هذه sinusitis
+
+448
+00:30:13,410 --> 00:30:16,850
+اللي هي التهاب الجيوب الأنفية و otitis media
+
+449
+00:30:16,850 --> 00:30:21,370
+التهاب الأذن الوسطى، كثير من مسببات الـ meningitis
+
+450
+00:30:21,370 --> 00:30:25,730
+قد تنشأ من sinusitis أو من otitis media
+
+451
+00:30:25,730 --> 00:30:28,530
+بتروح على الدم وبعدين بتروح على اللي هو الـ
+
+452
+00:30:28,530 --> 00:30:33,410
+meninges
+
+453
+00:30:33,410 --> 00:30:36,630
+الـ antigenic structures للبكتيريا بتاعتنا
+
+454
+00:30:36,630 --> 00:30:40,610
+الاستربتوكوكاس نيمونيا، كان الكابسولة أنتيجين، تخيلوا
+
+455
+00:30:40,610 --> 00:30:44,570
+يا شباب، أنا متعامل مع بكتيريا اللي لها كابسول
+
+456
+00:30:44,570 --> 00:30:45,930
+والكابسول
+
+457
+00:30:47,660 --> 00:30:53,520
+لهذه البكتيريا وصل عدد السلالات المختلفة إلى أكثر
+
+458
+00:30:53,520 --> 00:30:59,540
+من 84 Serotypes، يعني لو صبت في Serotype مش هيأملك
+
+459
+00:30:59,540 --> 00:31:03,580
+حماية
+
+460
+00:31:03,580 --> 00:31:07,960
+من other Serotypes، يعني نظريا لو واحد عنده
+
+461
+00:31:07,960 --> 00:31:12,260
+immunocompromised أو هو immunocompromised ممكن
+
+462
+00:31:12,260 --> 00:31:17,050
+يصاب بـ 84 مرة، هدول اللي بنعرفهم أربعة وثمانين مرة
+
+463
+00:31:17,050 --> 00:31:21,090
+استربتوكوكس نيمونيا، هذا نظريا، فلما بنكون
+
+464
+00:31:21,090 --> 00:31:26,370
+vaccine، احنا بنكون الـ vaccine مكون أو نشكل الـ vaccine
+
+465
+00:31:26,370 --> 00:31:30,970
+مكون من أربعة وثمانين نوع مختلف، هذا إرهاق لجهاز
+
+466
+00:31:30,970 --> 00:31:36,130
+المناعة، طب إيش الحل؟ وهل هناك vaccine؟ نعم هناك
+
+467
+00:31:36,130 --> 00:31:38,130
+vaccine، أو يكون أنك صار عندك استربتوكوكس
+
+468
+00:31:38,130 --> 00:31:39,410
+نيمونيا مع الحكي
+
+469
+00:31:42,080 --> 00:31:45,460
+بنبحث عن 84 .. لأ، بنبحث عن الـ most common
+
+470
+00:31:45,460 --> 00:31:50,440
+serotypes، بنروح على الدولة، بنعمل survey، وهنا
+
+471
+00:31:50,440 --> 00:31:55,440
+أهمية .. أهمية تعريف الميكروبات serologically، مش
+
+472
+00:31:55,440 --> 00:31:58,100
+فقط نقول Streptococcus pneumoniae، أو حتى بعض
+
+473
+00:31:58,100 --> 00:32:01,220
+اللي احنا في غزة بنكتفي بقول Streptococcus،
+
+474
+00:32:01,220 --> 00:32:06,370
+ما بنعرفش اسم الـ species، مهم جدا نعرف الـ species والـ
+
+475
+00:32:06,370 --> 00:32:10,030
+strain، عشان لما ييجي واحد بدي يعمل epidemiological
+
+476
+00:32:10,030 --> 00:32:13,830
+investigation أو .. أو .. أو يشوف الإحصائيات زي
+
+477
+00:32:13,830 --> 00:32:16,130
+مثلا قلنا بدنا نعمل vaccine، بدنا نشوف مين الـ
+
+478
+00:32:16,130 --> 00:32:21,450
+strains اللي موجودة في غزة أكثر، فنكون الـ vaccine ..
+
+479
+00:32:21,450 --> 00:32:26,750
+vaccines مكونة من 14 .. 14 serotype
+
+480
+00:32:28,770 --> 00:32:34,710
+وبنستخدمهم الآن بكثرة، غزة بدأت تنفذ نظام تطعيم
+
+481
+00:32:34,710 --> 00:32:37,330
+بالـ Streptococcus pneumoniae قبل يمكن تلات سنوات
+
+482
+00:32:37,330 --> 00:32:41,530
+طبعا هذا هيؤدي إلى انخفاض حاد في حالات الـ
+
+483
+00:32:41,530 --> 00:32:44,050
+meningitis caused by Streptococcus pneumoniae، هذا
+
+484
+00:32:44,050 --> 00:32:48,870
+أمر رائع جدا، يعني أمر رائع جدا، لكن تخيلوا يا شباب
+
+485
+00:32:48,870 --> 00:32:53,450
+تخيلوا، مش لازم أنا الـ vaccine، هذا الـ vaccine، تخيلوا
+
+486
+00:32:53,450 --> 00:32:57,490
+معايا التالي، أنا عندي في غزة خمسين نوع على سبيل
+
+487
+00:32:57,490 --> 00:33:01,930
+المثال، عملت لـ 14 منهم اللي هم أشهر 14 اللي هم
+
+488
+00:33:01,930 --> 00:33:04,930
+دايما بيهاجموا الناس ويعملوا لهم infection، عملت
+
+489
+00:33:04,930 --> 00:33:10,970
+لهم vaccine، بطل لهم رزق في غزة، صح؟ إما هيموتوا أو
+
+490
+00:33:10,970 --> 00:33:17,750
+أو إيش؟ أو يرحلوا، طبعا الآن مين اللي بيكون سوي هنا؟
+
+491
+00:33:17,750 --> 00:33:21,390
+اللي ليه رزق؟ مين اللي ليه رزق؟ الميكروبات اللي
+
+492
+00:33:21,390 --> 00:33:26,790
+ما لهمش أو ما عندناش protection لهم، ففي عندنا مصطلح
+
+493
+00:33:26,790 --> 00:33:28,270
+في الطب بيسموه Serotype replacement
+
+494
+00:33:33,920 --> 00:33:39,340
+وهو تعبير عن خشيتنا من أن الـ strains
+
+495
+00:33:39,340 --> 00:33:42,960
+اللي احنا اخذناها vaccination بالفعل تختفي، لكن
+
+496
+00:33:42,960 --> 00:33:47,800
+تستبدل بسلّالات أخرى قد تكون هي المنتشرة في البلد
+
+497
+00:33:47,800 --> 00:33:52,440
+لكن أطمئنكم من ناحية نظرية، هذه الخشية لحد الآن لم
+
+498
+00:33:52,440 --> 00:33:56,060
+يحدث ذلك في أي من الدول اللي طبقت اللي هو الـ
+
+499
+00:33:56,060 --> 00:33:56,360
+vaccine
+
+500
+00:33:59,160 --> 00:34:02,180
+الكابسول، كلكم بتعرفوا أن الوظيفة الأساسية تبعتها
+
+501
+00:34:02,180 --> 00:34:05,700
+في البكتيريا is to escape the process of
+
+502
+00:34:05,700 --> 00:34:08,700
+phagocytosis and for a specific attachment، تقول إن
+
+503
+00:34:08,700 --> 00:34:13,240
+هدول إذا فاكرين صفتين متضادّتين، تهرب من الـ
+
+504
+00:34:13,240 --> 00:34:16,380
+phagocytosis وفي نفس الوقت هي specific receptor
+
+505
+00:34:16,380 --> 00:34:21,700
+للـ attachment، اللي بنركز عليه اليوم في الـ
+
+506
+00:34:21,700 --> 00:34:23,600
+Streptococcus pneumoniae، زي ما ركزت على الـ
+
+507
+00:34:23,600 --> 00:34:28,540
+Streptococcus pyogenes في فحص اسمه ASOT، فاكرينه؟
+
+508
+00:34:29,680 --> 00:34:38,240
+بنركز اليوم على فحص اسمه CRP، CRP
+
+509
+00:34:38,240 --> 00:34:43,760
+تختصر لإيه CRP؟ C Reactive Protein، وكلمة C
+
+510
+00:34:43,760 --> 00:34:46,380
+مرت عليكم في المحاضرة السابقة لما قلنا C
+
+511
+00:34:46,380 --> 00:34:48,960
+-Polysaccharide، C-Polysaccharide الموجود في الـ
+
+512
+00:34:48,960 --> 00:34:52,780
+cell wall تبع الـ gram-positive streptococci اللي
+
+513
+00:34:52,780 --> 00:34:57,500
+جينا للمرضى اللي عندهم Streptococcus pneumoniae، لما
+
+514
+00:34:57,500 --> 00:35:00,880
+ناخد الـ serum تباعهم، الـ serum تباعهم بتفاعل مع الـ
+
+515
+00:35:00,880 --> 00:35:03,340
+C polysaccharide تبع الـ Streptococcus pneumoniae
+
+516
+00:35:03,340 --> 00:35:08,140
+فاتكلمنا وسمينا المادة اللي تفاعلت مع C
+
+517
+00:35:08,140 --> 00:35:12,800
+polysaccharide وقولنا عنها protein reacted with C
+
+518
+00:35:12,800 --> 00:35:17,620
+polysaccharide، protein reacted with C، فسموها C
+
+519
+00:35:17,620 --> 00:35:22,680
+reactive protein، اعتقدنا أنها عبارة عن Antibody
+
+520
+00:35:22,680 --> 00:35:25,640
+specific لمن؟ لـ C-Polysaccharide of Streptococcus
+
+521
+00:35:25,640 --> 00:35:30,620
+pneumonia، بعد فترة وجيزة وجدنا CRP بيطلع في كل
+
+522
+00:35:30,620 --> 00:35:36,100
+حالة الـ inflammation، فبطل الآن specific، إيش صار
+
+523
+00:35:36,100 --> 00:35:41,080
+الآن؟ non-specific test، زي مين؟ non-specific test
+
+524
+00:35:41,080 --> 00:35:46,660
+for inflammation، ده لصيغة سابقة، مش هندي أول حرف E
+
+525
+00:35:46,660 --> 00:35:48,720
+وثاني S وثاني R
+
+526
+00:35:58,720 --> 00:36:04,120
+الـ ESR أو الـ Erythrocyte sedimentation rate is a
+
+527
+00:36:04,120 --> 00:36:07,200
+very common test to detect non-specific
+
+528
+00:36:07,200 --> 00:36:07,960
+inflammation
+
+529
+00:36:29,020 --> 00:36:33,240
+إيش ميزات الـ CRP؟ خذوا بالكم، الـ ESR رائعة جدا برضه
+
+530
+00:36:33,240 --> 00:36:36,480
+يعني ده فحوصات من .. من .. من زمان موجودة لفحص هذا
+
+531
+00:36:36,480 --> 00:36:40,920
+ولحد اليوم بينطلق، يعني معناته حاجة أنه فعال، لكن
+
+532
+00:36:40,920 --> 00:36:48,680
+إيش ميزات الـ CRP عن الـ ESR؟ الـ CRP بيرتفع بارتفاع
+
+533
+00:36:48,680 --> 00:37:01,230
+أو بحدد الالتهاب، وإذا الالتهاب اختفى بينزل مباشرة، يعني
+
+534
+00:37:01,230 --> 00:37:08,200
+بيرتفع معاه وبينزل باختفائه، فمؤشر على حدوثه ومؤشر
+
+535
+00:37:08,200 --> 00:37:12,020
+على مين؟ على انتهائه كمان، على انتهائه، مش أنا لما
+
+536
+00:37:12,020 --> 00:37:15,440
+أعطي علاج، بدي أعرف أنه هل العلاج كان فعال ولا لأ
+
+537
+00:37:15,440 --> 00:37:18,440
+هل خفض الـ inflammation ولا ما خفضش، مش بدّي أعرف أنا
+
+538
+00:37:18,440 --> 00:37:21,560
+برضه هل الـ inflammation خفضت ولا ما خفضتش، لو
+
+539
+00:37:21,560 --> 00:37:25,420
+استخدمت الـ ESR، للأسف الـ ESR ترتفع بالفعل مع
+
+540
+00:37:25,420 --> 00:37:31,420
+الالتهاب، لكن قد تبقى مرتفعة لفترات طويلة بعد
+
+541
+00:37:31,420 --> 00:37:37,340
+اختفاء اللي هو مين؟ الالتهاب، يبقى مين أكثر أفضل
+
+542
+00:37:37,340 --> 00:37:42,380
+مؤشر لاختفاء الالتهاب؟ الـ CRP، أنا لكل فصل بدرس فيه
+
+543
+00:37:42,380 --> 00:37:46,060
+Diagnostic Microbiology بيقول للطلاب، راجعوا، ابحثوا
+
+544
+00:37:46,060 --> 00:37:51,540
+عن فوائد الـ CRP كـ test، ابحثوا عن فوائد الـ CRP كـ
+
+545
+00:37:51,540 --> 00:37:55,160
+test، أعطيكم مثال على فايدة عشان تعرفوا أنه مش بس
+
+546
+00:37:55,160 --> 00:38:00,220
+فقط non-specific inflammation، في عندي مرض اسمه
+
+547
+00:38:00,220 --> 00:38:06,460
+cystitis،  معاكم؟ التهاب المثانة، cystitis، وفي
+
+548
+00:38:06,460 --> 00:38:12,360
+pyelonephritis اللي
+
+549
+00:38:12,360 --> 00:38:18,940
+هو بصّ في الكلية، وفي cystitis، أنت الآن عملت
+
+550
+00:38:18,940 --> 00:38:23,500
+culture، عملت culture من وين؟ من الـ urine، وطلعت
+
+551
+00:38:23,500 --> 00:38:28,900
+positive، وطلعت positive، هل البكتيريا في
+
+552
+00:38:28,900 --> 00:38:34,700
+المثانة ولا في الكلية؟ بتعرف تعرف؟ ما بتقدرش تعرف، لأن
+
+553
+00:38:34,700 --> 00:38:39,980
+أنت أخذت من وين؟ هاي الكلية، تمام؟ وأخذت من
+
+554
+00:38:39,980 --> 00:38:43,660
+المثانة، يعني لو كانت البكتيريا هنا أو هنا، أنت في
+
+555
+00:38:43,660 --> 00:38:46,140
+الآخر أخذتها من وين؟ من هنا، فاختلطوا مع بعض، وأنت
+
+556
+00:38:46,140 --> 00:38:48,860
+ما بتعرفش من وين البكتيريا، وبالتالي مطلوب منك
+
+557
+00:38:48,860 --> 00:38:54,960
+تعرف هل هي pyelonephritis ولا cystitis، لو عملت CRP
+
+558
+00:38:56,800 --> 00:39:00,800
+وطلع positive فهي pyelonephritis، but not cystitis
+
+559
+00:39:00,800 --> 00:39:05,680
+لو طلع negative فهي cystitis، مش إيه؟ هي مثلا
+
+560
+00:39:05,680 --> 00:39:11,020
+استخدام يا شباب، في فحوصات، في فحوصات رائعة كثير لها
+
+561
+00:39:11,020 --> 00:39:16,600
+تطبيقات، لكن للأسف الأطباء مش كثير بيستفيدوا من اللي
+
+562
+00:39:16,600 --> 00:39:20,740
+بجهلنا نحن اللي بيعطيهم المعلومات الصحيحة، فأنا
+
+563
+00:39:20,740 --> 00:39:26,540
+بننصحكم أن تبحثوا عن uses of CRP، وتعالوا post
+
+564
+00:39:26,540 --> 00:39:30,440
+على الـ website Diagnostic Microbiology، تمام؟
+
+565
+00:39:30,440 --> 00:39:34,340
+Diagnostic Microbiology، مش .. مش واجب يعني، و
+
+566
+00:39:34,340 --> 00:39:40,630
+إنما شيء تستفيدوا منه، فضلا، سهل جدا، أنا عندي لأن
+
+567
+00:39:40,630 --> 00:39:44,310
+مزرعة بول طلعت positive، positive يعني في بكتيريا في
+
+568
+00:39:44,310 --> 00:39:47,450
+الجهاز البولي، الجهاز البولي مكون من إيه؟ من كلية
+
+569
+00:39:47,450 --> 00:39:50,670
+أو من إيه؟ من مثانة، طبعا، الحالة فهنا غالبا ما بصيرش في
+
+570
+00:39:50,670 --> 00:39:54,550
+لأنّه دائما في .. وأنّ الـ liquid بينزل، الآن بدي أعرف
+
+571
+00:39:54,550 --> 00:39:57,570
+من وين أنا الـ infection، هل هي في الكلية ولا في
+
+572
+00:39:57,570 --> 00:40:00,910
+المثانة، بعمل فحص اللي هو الـ CRP، إذا طلع positive
+
+573
+00:40:00,910 --> 00:40:04,510
+فمعناه الحكي أنه في الكلية، وإذا كان negative يكون
+
+574
+00:40:04,510 --> 00:40:10,900
+في المثانة، نعم، CRP واضح بالنسبة لنا التسمية من
+
+575
+00:40:10,900 --> 00:40:15,720
+اعتقادنا أن هذا البروتين محدّد فقط لمن؟ لـ C
+
+576
+00:40:15,720 --> 00:40:20,640
+-Polysaccharide، لكن واضح بعد ذلك أنه لأ، كان هو non
+
+577
+00:40:20,640 --> 00:40:23,520
+specific inflammation، وهذا الـ non-specific
+
+578
+00:40:23,520 --> 00:40:24,220
+inflammation
+
+579
+00:40:27,350 --> 00:40:32,790
+عطتنا .. أخذنا نقول فكرة أن نستخدم الفحص هذا بدل أو
+
+580
+00:40:32,790 --> 00:40:36,350
+جنبا إلى جنب، بدل اللي هو الـ C-E-S-R اللي أنتم
+
+581
+00:40:36,350 --> 00:40:39,910
+نسيانه، الـ M-protein وهو موجود في معظم الـ
+
+582
+00:40:39,910 --> 00:40:43,770
+streptococci، ويستخدم أيضا أو يوظف من قبل البكتيريا
+
+583
+00:40:43,770 --> 00:40:45,470
+كـ antifagocytic
+
+584
+00:40:47,480 --> 00:40:50,680
+الـ Virulence، في عندها polysaccharide كابسول وده
+
+585
+00:40:50,680 --> 00:40:53,600
+كده احنا اتفقنا عليه، الـ adherence ومقدرتها على الـ
+
+586
+00:40:53,600 --> 00:40:57,900
+attachment، الـ enzymes زي الـ hyaluronidase أفضل من
+
+587
+00:40:57,900 --> 00:41:00,760
+الـ neuraminidase وزي الـ proteases وهذه الـ
+
+588
+00:41:00,760 --> 00:41:08,920
+proteases أنا ذكرتلكم بيها، جمال هيكن then
+
+589
+00:41:08,920 --> 00:41:14,860
+الـ trachea عليها الـ IgA، بانتظار
+
+590
+00:41:17,060 --> 00:41:20,140
+بانتظار البكتيريا، قالت البكتيريا، المفروض مش همه
+
+591
+00:41:20,140 --> 00:41:24,660
+فيها، يرتبط فيها، إذا ارتبط فيها البكتيريا بتكون
+
+592
+00:41:24,660 --> 00:41:27,660
+غير فعّالة، مش هتنجح تمام ولا حاجة للبكتيريا، لكن
+
+593
+00:41:27,660 --> 00:41:34,200
+البكتيريا جاية ومعاها إنزيم بتلف حوالينه أو لما بتـ
+
+594
+00:41:34,200 --> 00:41:37,540
+.. أو لما بتـ .. بيرتبط فيها بتفرز الـ .. الـ
+
+595
+00:41:37,540 --> 00:41:42,280
+proteins تبعها الخاص بالـ IgA، هتكسر بفكك IgA اللي هو
+
+596
+00:41:42,280 --> 00:41:48,450
+الـ Ig، يبقى البكتيريا داخلة ومعاها سلاح ضد مين؟ ضد
+
+597
+00:41:48,450 --> 00:41:54,470
+أول دفاعات specific اللي هي الـ IgA، الـ IgA اللي هو
+
+598
+00:41:54,470 --> 00:41:58,250
+الـ secretory antibody اللي بيفرز جسم الإنسان على
+
+599
+00:41:58,250 --> 00:42:01,730
+الـ mucous membranes كـ first line of specific
+
+600
+00:42:01,730 --> 00:42:07,490
+defense، النيموليسين أو نيموليسين أو بيذكرنا بمين؟
+
+601
+00:42:07,490 --> 00:42:12,830
+بستربتوليسين أو اللي هو oxygen labile، هذا كان beta
+
+602
+00:42:12,830 --> 00:42:17,770
+hemolytic، هذا alpha hemolytic، لكن اتنين يا شباب
+
+603
+00:42:17,770 --> 00:42:22,910
+بيتحسّسون للأكسجين وبالتالي يجب أن نخفيهم عن الـ
+
+604
+00:42:22,910 --> 00:42:28,910
+oxygen، النقطة رقم خمسة، الـ autolysin، أمر قسمته
+
+605
+00:42:30,530 --> 00:42:35,310
+بيتّضّح في عالم الحيوان، يعني مثلا نمل بيضحّي عشرة
+
+606
+00:42:35,310 --> 00:42:39,870
+بيضحّوا بحالهم عشان خاطر المجموعة تعيش، تمام؟ البشر
+
+607
+00:42:39,870 --> 00:42:43,750
+عندهم تضحيات برضه في هذا الكلام، وأعتقد أنه في
+
+608
+00:42:43,750 --> 00:42:47,810
+مملكة الحيوان كمان في .. الآن هحكي لكم جزء عن النمل
+
+609
+00:42:47,810 --> 00:42:51,850
+عشان نكرّر الصورة، النمل هو جاي يعبر مجرى مائي
+
+610
+00:42:51,850 --> 00:42:55,590
+بده يعني ينتقل الـ .. الـ .. الـ .. الـ .. الـ أماكن ..
+
+611
+00:42:55,590 --> 00:43:00,190
+الطرف الآخر، وفي مجرى مائي، فبيروح أول نملة بتمسك
+
+612
+00:43:00,190 --> 00:43:03,770
+رجليها، الثانية بتزوجها في الميه، فبتشرب ميه والنملة
+
+613
+00:43:03,770 --> 00:43:09,370
+مش ميه، بتشرب ميه، بتنتفخ، بتنتفخ، بتصير floating، بتموت،
+
+614
+00:43:09,370 --> 00:43:12,630
+تبتدي وراها واحدة، تبتدي تمسك برجليها على طرف
+
+615
+00:43:12,630 --> 00:43:16,350
+النملة اللي .. اللي .. اللي ماتت وبتشرب ميه و
+
+616
+00:43:16,350 --> 00:43:20,470
+بتشرب ميه وبتشرب ميه، بصير عندي جسر من الـ .. من
+
+617
+00:43:20,470 --> 00:43:25,570
+النمل الميت، آه؟ اللي ضحّى بنفسه عشان النمل الثاني
+
+618
+00:43:25,570
+
+667
+00:47:03,850 --> 00:47:09,790
+بيتميزوا بصفات مشتركة، أهمها
+
+668
+00:47:09,790 --> 00:47:14,030
+encapsulated أهمها
+
+669
+00:47:14,030 --> 00:47:15,410
+أنها encapsulated
+
+670
+00:47:19,720 --> 00:47:23,800
+الـ hemophilus influenza  بدها chocolate
+
+671
+00:47:23,800 --> 00:47:26,980
+agar، بتعرفوه الـ chocolate agar؟ الـ pneumonia بتنمو
+
+672
+00:47:26,980 --> 00:47:29,920
+على blood agar، النيسيريا الـ meningitis برضه بتنمو
+
+673
+00:47:29,920 --> 00:47:37,080
+على blood agar،  الثلاثه بيحبوا الـ CO2، الثلاثه
+
+674
+00:47:37,080 --> 00:47:42,900
+بيسببوا meningitis، تمام؟
+
+675
+00:47:42,900 --> 00:47:46,260
+الآن لما تجيء عينة CSF، يمكن يكون فيها هذه أو هذه
+
+676
+00:47:46,260 --> 00:47:51,350
+أو هذه،  أزرع واحدة على blood agar، و أزرع
+
+677
+00:47:51,350 --> 00:47:55,230
+جزء على blood agar، و جزء على chocolate agar، ولا ثلاثة
+
+678
+00:47:55,230 --> 00:47:59,890
+أحط لهم طبق واحد، أحط لهم طبق واحد، بحط لهم one
+
+679
+00:47:59,890 --> 00:48:02,130
+plate، اللي هو chocolate agar، لأن اللي بينمو على blood
+
+680
+00:48:02,130 --> 00:48:05,010
+agar، بينمو على مين كمان؟ على chocolate agar، فبحط لهم
+
+681
+00:48:05,010 --> 00:48:08,810
+chocolate agar، و بحط الـ chocolate agar under مين؟ under
+
+682
+00:48:08,810 --> 00:48:14,970
+CO2، إذن الـ CO2 في هذه الحالة، و تشكيلة الأجار حطناهم
+
+683
+00:48:14,970 --> 00:48:18,110
+عشان نغطي الاحتمالات الثلاثه اللي هي الـ
+
+684
+00:48:18,110 --> 00:48:22,010
+influenza، و الـ pneumonia، و الـ نيسيريا meningitis من المرة
+
+685
+00:48:22,010 --> 00:48:23,090
+الجاية إن شاء الله.
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WKKMQl3l3ek_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WKKMQl3l3ek_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..45bc6845ad5efc80c108cb1b7286baef45463a72
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WKKMQl3l3ek_postprocess.srt
@@ -0,0 +1,2424 @@
+1
+00:00:20,810 --> 00:00:25,390
+بسم الله الرحمن الرحيم نكمل ضمن الميكروبات ال
+
+2
+00:00:25,390 --> 00:00:27,930
+spiral organism في أنهم الميكروب Leptospira
+
+3
+00:00:27,930 --> 00:00:31,870
+interrogans وزي ما انتوا شايفين الصورة اللي أمامكم
+
+4
+00:00:31,870 --> 00:00:39,050
+هي عبارة عن very tight and narrow curves للبكتيريا
+
+5
+00:00:39,050 --> 00:00:42,330
+وهي ما يتميز بيه ال Leptospira وإن الأطراف تبعتها
+
+6
+00:00:42,330 --> 00:00:44,430
+hooked وهذه نقطة كتير كمان مهمة في ال
+
+7
+00:00:44,430 --> 00:00:47,190
+differentiation بين Leptospira وبين اللي هو
+
+8
+00:00:47,190 --> 00:00:49,190
+Triponemia Pallidum
+
+9
+00:00:51,500 --> 00:00:54,340
+أه فماعرفش نلقي على الصورة مرة تانية الثقوب اللي
+
+10
+00:00:54,340 --> 00:00:59,560
+شايفينها دي تحت ال .. ال ..الصورة هذه لأنه
+
+11
+00:00:59,560 --> 00:01:02,760
+البكتيريا انفلترة على mainly poor membrane filter
+
+12
+00:01:02,760 --> 00:01:06,440
+ال membrane filter ال poor size تبعته هذه يمكن
+
+13
+00:01:06,440 --> 00:01:09,140
+point two micron point two micron لن تسمح
+
+14
+00:01:09,140 --> 00:01:13,240
+للبكتيريا بالمرور عبرها فعشانك بتلاحظوا انه
+
+15
+00:01:13,240 --> 00:01:19,940
+البكتيريا ماخده ال long very long size لكن at the
+
+16
+00:01:19,940 --> 00:01:24,020
+same time it is very thin يعني رفيع جدا وبالتالي
+
+17
+00:01:24,020 --> 00:01:26,060
+التريبونيميا
+
+18
+00:01:27,030 --> 00:01:31,430
+والـ Leptospira أحد مشاكلهم أنه ماجراش نصبغهم بشكل
+
+19
+00:01:31,430 --> 00:01:33,870
+جيد وبالتالي بنرجع لمين؟ لل dark field،
+
+20
+00:01:33,870 --> 00:01:37,790
+مايكروسكوبيا ال causative agent للـ Leptospirosis
+
+21
+00:01:37,790 --> 00:01:41,390
+وهو عبارة عن zoonotic disease و بالمناسبة ال
+
+22
+00:01:41,390 --> 00:01:46,840
+zoonotic diseasesتحتال مكانة مهمة جدا في حياتنا
+
+23
+00:01:46,840 --> 00:01:53,060
+كبشر وما .. يعني ما فاتقت أنها بتحتال مكانة أهم
+
+24
+00:01:53,060 --> 00:01:57,220
+مما كانت عليه من قبل على الرغم من التمدن والتحضر
+
+25
+00:01:57,220 --> 00:02:00,760
+والابتعاد عن الحيوانات أو الاعتكاك بالحيوانات بشكل
+
+26
+00:02:00,760 --> 00:02:05,700
+مباشر إلا أنه لم ننجح في الانفصال عن الحيوانات وقد
+
+27
+00:02:05,700 --> 00:02:09,020
+أستطيع أن أذكر بعض الأمثلة على الاعتكاك ما بيننا
+
+28
+00:02:09,020 --> 00:02:16,040
+وبين الحيواناتالـ pets المستخدمة للزينا، البغبغاء،
+
+29
+00:02:16,040 --> 00:02:19,900
+طيور اللي بنحطها في أقفاص في البيت للزينا، البعض
+
+30
+00:02:19,900 --> 00:02:24,440
+بيحط ال genie pigs، البعض بيربي في المنزل الفراخ
+
+31
+00:02:24,440 --> 00:02:31,000
+أو الدجاج أو البط،ممكن يكون قريب هو مكان سكنه الآن
+
+32
+00:02:31,000 --> 00:02:35,040
+في قطاع غزة مع الابتداد السكاني وانحسار المساحات
+
+33
+00:02:35,040 --> 00:02:39,460
+الزراعية أصبح الكثير من السكان جيران لمزارع
+
+34
+00:02:39,460 --> 00:02:43,600
+الأبقار ومزارع الدواجن هذا احتكاك مباشر مع
+
+35
+00:02:43,600 --> 00:02:46,700
+الحيوانات غير القطط المنزلية وقطط الشوارع وبعض
+
+36
+00:02:46,700 --> 00:02:51,340
+الحيال الكلاب الضالة والطيور اللي ممكن تنزل عندك
+
+37
+00:02:51,340 --> 00:02:55,720
+برضه في المنزل والطيور المهاجرة كلها احتكاكات
+
+38
+00:02:55,720 --> 00:03:02,490
+بالحيواناتاللي ممكن أكتر من 60% من الأمراض المعضية
+
+39
+00:03:02,490 --> 00:03:06,090
+هي أمراض مشتركة بين الإنسان و الحيوان وبتالي تعتبر
+
+40
+00:03:06,090 --> 00:03:10,350
+الحيوانات كحيوانات whole ككاملة يعني كحية مصدر مهم
+
+41
+00:03:10,350 --> 00:03:15,160
+هذا بالإضافة للمصدر التانيالحيوانات كغذاء، احنا
+
+42
+00:03:15,160 --> 00:03:20,380
+بنشتري دواجن و بنشتري لحوم، أبقار وماعز ومشتقاتها
+
+43
+00:03:20,380 --> 00:03:25,680
+من ألبان وحليب وخلافه وبالتالي مرة أخرى بنقول إن
+
+44
+00:03:25,680 --> 00:03:28,940
+الـ Zoonotic Diseases مش حاجة كمالية في الماكل
+
+45
+00:03:28,940 --> 00:03:32,240
+وبالبداية حاجة أساسية لأنها بتشكل حوالي 60% من
+
+46
+00:03:32,240 --> 00:03:38,480
+الأمراض المواضية للإنسان وكميتها كثيرة أو احتكاكنا
+
+47
+00:03:38,480 --> 00:03:44,110
+كثير في الحيواناتبالنسبة للـ Habitat يعني أين
+
+48
+00:03:44,110 --> 00:03:46,770
+البكتيريا بتعيش اللي هي الـ Leptospira غالبا في ال
+
+49
+00:03:46,770 --> 00:03:50,550
+domestic livestock في المعاشية و ال pets اللي
+
+50
+00:03:50,550 --> 00:03:53,090
+بتجود علي الحيوانات اللي هو القليفة mood of
+
+51
+00:03:53,090 --> 00:03:56,630
+transmission ممكن بال direct contact مع ال urine
+
+52
+00:03:56,630 --> 00:04:00,190
+of infected animals و كيف الإنسان ممكن يتواصل أو
+
+53
+00:04:00,190 --> 00:04:03,930
+يتصل أو يحتك بال urine تبقى infected animal أعطيكم
+
+54
+00:04:03,930 --> 00:04:07,930
+مثال بسيط قد يعني لا يخطر على بالكه بعض الأحيان
+
+55
+00:04:07,930 --> 00:04:12,860
+برك السباحة المنتشرة الآن في القطاعلما بدخل
+
+56
+00:04:12,860 --> 00:04:15,300
+الإنسان البركة و بطلع منها بياخد معاه شوية ميه على
+
+57
+00:04:15,300 --> 00:04:18,860
+الحواف تبعتها، صح ولا لأ؟ لأن عند ساعة معينة و
+
+58
+00:04:18,860 --> 00:04:23,300
+بتغلق البركة، بيصير فيه هدوء، في بعض ال .. ال ..
+
+59
+00:04:23,300 --> 00:04:25,820
+ال .. البرك بتكون في مناطق نائية نوعا ما أو مناطق
+
+60
+00:04:25,820 --> 00:04:28,800
+زراعية، فيه جردان بتكون في المنطقة، ممكن تصل
+
+61
+00:04:28,800 --> 00:04:32,240
+للمياه، إذا تبول أحد ال .. ال .. ال .. ال ..
+
+62
+00:04:32,240 --> 00:04:35,900
+الجردان في الماء هذا اللي على أطراف، مش هيتبول في
+
+63
+00:04:35,900 --> 00:04:40,950
+البركة نفسها، أمام؟وأجى واحد تانى تانى يوم ولمست
+
+64
+00:04:40,950 --> 00:04:46,210
+قدماء الماء اللى فيه urine ودخل جوا البركة فأخد
+
+65
+00:04:46,210 --> 00:04:51,540
+معاهية الى بركة السباحة ومن منكم ومن منكمعندما
+
+66
+00:04:51,540 --> 00:04:55,160
+يقوم بالسباحة لا يبتلع بعضا من الماء سواء من ميط
+
+67
+00:04:55,160 --> 00:04:58,400
+البركة أو ميط البحر يعني فيه ابتلال الماء فهي
+
+68
+00:04:58,400 --> 00:05:04,160
+طريقة من طول الاحتكاك عملية تنظيف اماكن او مخازن
+
+69
+00:05:04,160 --> 00:05:08,920
+قد يكون فيها جردان ايضا الاحتكاك في فترة الشتاء
+
+70
+00:05:08,920 --> 00:05:13,500
+فاصل الشتاء لما يكون مياه المطر غزيرة و ال system
+
+71
+00:05:14,240 --> 00:05:18,800
+غير كافي انه يمرر كل الميه فبصير فيه فيضان للمياه
+
+72
+00:05:18,800 --> 00:05:23,760
+لمياه المجاري وبالتالي مياه المجاري تحتوي على ال
+
+73
+00:05:23,760 --> 00:05:27,060
+urine تبع هذه الجيور ده، اذا فيه إمكانية للاحتكاج
+
+74
+00:05:27,060 --> 00:05:31,500
+water and soil currently or recently contaminated
+
+75
+00:05:31,500 --> 00:05:35,900
+with infected urine زي ما حكينا نفس المعنى انه
+
+76
+00:05:35,900 --> 00:05:41,260
+تربة او مياه طلبوها تحديثا بال urine تبع هذه
+
+77
+00:05:41,260 --> 00:05:47,000
+الحيواناتthe organism enters the body through واحة
+
+78
+00:05:47,000 --> 00:05:54,860
+skin lesions أي خدوش أو جروح في الجسم ممكن تسبب
+
+79
+00:05:54,860 --> 00:05:58,860
+دخول ال micro organism conjunctival mucous
+
+80
+00:05:58,860 --> 00:06:01,440
+membrane و احنا كنا فاكرين الإصبع و العين هذا نقطة
+
+81
+00:06:01,440 --> 00:06:05,380
+كتير مهمة ال ingestion تناول طعام ايضا محتوي او ما
+
+82
+00:06:05,380 --> 00:06:10,320
+محتوي على ال micro organismمن ال high risks أكتر
+
+83
+00:06:10,320 --> 00:06:14,240
+ناس ممكن يكونوا عرضة للإصابة بال lipospira،
+
+84
+00:06:14,240 --> 00:06:17,800
+farmers المزارعين كمان مرة قلتلكوا ال farmers لا
+
+85
+00:06:17,800 --> 00:06:23,160
+يعني مزارعين فقط بالنباتات وانما بتربية الحيوانات
+
+86
+00:06:23,160 --> 00:06:26,800
+نعم، sewer workers اللي هم عمال المجارير اللي
+
+87
+00:06:26,800 --> 00:06:30,060
+بينظفوا المجاري أو بسلكوها أو بيعني بيعملوا عمال
+
+88
+00:06:30,060 --> 00:06:35,660
+معينة صيانة الاخرالدزيز ليبتوسبيروسيز ال
+
+89
+00:06:35,660 --> 00:06:39,960
+incubation period من أسبوع لأسبوعين بينتج عن ال
+
+90
+00:06:39,960 --> 00:06:44,340
+infection بكتيريميا و من خلال هذه البكتيريميا ال
+
+91
+00:06:44,340 --> 00:06:48,000
+organism can reach to many organs such as liver و
+
+92
+00:06:48,000 --> 00:06:50,760
+spleen و kidney و ال meninges و الconductiva و
+
+93
+00:06:50,760 --> 00:06:53,960
+بيعمل multiplication و inflammation في تلك المناطق
+
+94
+00:06:55,600 --> 00:06:59,760
+ال .. ال clinical feature أول ال disease بيبدأ ك
+
+95
+00:06:59,760 --> 00:07:04,180
+influenza-like يعني symptoms مابنميزك عن مين عن ال
+
+96
+00:07:04,180 --> 00:07:08,960
+influenza لكن بيتبعها hepatitis and meningitis
+
+97
+00:07:08,960 --> 00:07:13,640
+عشان تعرفوا كلمة hepatitis البعض لأنه شاعر
+
+98
+00:07:16,200 --> 00:07:20,380
+كلمة hepatitis B و hepatitis C فالبعض خلاص يعني
+
+99
+00:07:20,380 --> 00:07:23,460
+خصص انه ال hepatitis هي عبارة عن viral لا ال
+
+100
+00:07:23,460 --> 00:07:26,300
+hepatitis condition that can be caused by several
+
+101
+00:07:26,300 --> 00:07:31,820
+of organism لكن أكثرها شهرة اللي هو ال virus ال B
+
+102
+00:07:31,820 --> 00:07:35,920
+و ال C و ال A و ال E و ال G و ال D في مجموعة كبيرة
+
+103
+00:07:35,920 --> 00:07:37,520
+من ال hepatitis virus
+
+104
+00:07:40,230 --> 00:07:43,710
+فيه انا كمان condition بيسموه wheel's disease وهو
+
+105
+00:07:43,710 --> 00:07:47,010
+عبارة عن severe leptospirosis بيأد إلى severe
+
+106
+00:07:47,010 --> 00:07:52,570
+headache و pain في الظهر تمام منطقة الظهر
+
+107
+00:07:52,570 --> 00:07:58,040
+prostration and jaundiceممكن الـ jaundice و يكون
+
+108
+00:07:58,040 --> 00:08:02,200
+فينا hemorrhage و أيضا كمان يؤدي الى renal failure
+
+109
+00:08:02,200 --> 00:08:06,100
+إذا ال clinical feature أولها بتبدأ ك influenza
+
+110
+00:08:06,100 --> 00:08:10,720
+-like بعدين ال will disease بيتميز بأنه في عنده
+
+111
+00:08:10,720 --> 00:08:13,100
+severe headache و في عنده pain in the back و
+
+112
+00:08:13,100 --> 00:08:16,140
+prostration jaundice و زي ما قلنا ممكن يصل لمرحلة
+
+113
+00:08:16,140 --> 00:08:21,880
+من الrenal failure تفضل يا عمرو habitate
+
+114
+00:08:23,840 --> 00:08:30,180
+هيبتايتس اه يستطيع هو يتخلص من الجسم من جسمه لحاله
+
+115
+00:08:30,180 --> 00:08:37,060
+بدون أدوية ال bacterial infection بختلف عن ال
+
+116
+00:08:37,060 --> 00:08:39,480
+viral infection غالبا ال bacterial infection ال
+
+117
+00:08:39,480 --> 00:08:42,320
+viral infection بتكون self-limited self-limited
+
+118
+00:08:42,320 --> 00:08:47,140
+يعني ال system تبع ال replication تبعها بيقدّي و
+
+119
+00:08:47,140 --> 00:08:50,060
+ال immune system تبعنا بيقدّي إلى أنه يتخلص منها
+
+120
+00:08:50,060 --> 00:08:54,400
+حتى لو ما استخدنا علاجوهي حالات نادرة اللى بيتطور
+
+121
+00:08:54,400 --> 00:08:58,480
+فيها الـ Hepatitis B أو الـ C يعني المعظم حتى هذه
+
+122
+00:08:58,480 --> 00:09:02,260
+الأمراض الخطيرة المعظم بتم الشفاء منها تلقائيا لكن
+
+123
+00:09:02,260 --> 00:09:07,180
+البكتيريا لأ البكتيريا غالبا الشفاء منها بده aid
+
+124
+00:09:07,180 --> 00:09:12,450
+بده antibioticsال lab diagnosis احنا زي ما ذكرنا
+
+125
+00:09:12,450 --> 00:09:17,330
+قلنا انه هذه البكتيريا رقيقة و thin وبالتالي صعب
+
+126
+00:09:17,330 --> 00:09:20,250
+ان انا اتعامل معاها بالصباغة وبالتالي افضل طريقة
+
+127
+00:09:20,250 --> 00:09:24,130
+اللي هي ال dark field مايكروسكوبي لعينات من الدم و
+
+128
+00:09:24,130 --> 00:09:28,930
+ال CSF احنا قلنا بتصل ال blood و بتنزرع في many
+
+129
+00:09:28,930 --> 00:09:32,570
+organs وممكن نجيها كما بتعمل عاملة meningitis
+
+130
+00:09:32,570 --> 00:09:37,220
+وبالتالي ممكن ناخد عينات CSFشفتوا الصورة اللي
+
+131
+00:09:37,220 --> 00:09:39,960
+بدأنا فيها المحاضرة؟ في ال dark field microscope
+
+132
+00:09:39,960 --> 00:09:43,320
+نتوقع صورة مثل هذه او مثل هذا الشكل اللي احنا
+
+133
+00:09:43,320 --> 00:09:48,940
+رأينا very long, hooked و ال curves بتاعتها small
+
+134
+00:09:48,940 --> 00:09:52,810
+و tightممكن نعمل Serial Diagnosis عن طريق اللي هو
+
+135
+00:09:52,810 --> 00:09:56,390
+Antibody Detection Leptospira can be cultured in
+
+136
+00:09:56,390 --> 00:10:01,750
+هذا الإسم اللي يعني بده عشرة شكل اللفظ تبعه اللي
+
+137
+00:10:01,750 --> 00:10:08,160
+هو Ellingson-McLowe-Johnson-Harris Mediumو باختصار
+
+138
+00:10:08,160 --> 00:10:12,460
+EMGH which is incubated at twenty-two هذه كمان
+
+139
+00:10:12,460 --> 00:10:14,680
+نقطة او عفوا twenty-eight to thirty degrees
+
+140
+00:10:14,680 --> 00:10:17,780
+centigrade هذه ال temperature عمرنا ما ذكرناها جاب
+
+141
+00:10:17,780 --> 00:10:20,960
+ال هيكد في ال incubation لأي بكتيريا أخرى فإذا لما
+
+142
+00:10:20,960 --> 00:10:23,920
+اتكلم عن twenty-eight to thirty degrees centigrade
+
+143
+00:10:23,920 --> 00:10:27,920
+بدك تعرف ان هذه ال temperature مميزة عن باقي أنواع
+
+144
+00:10:27,920 --> 00:10:33,830
+البكتيريا بقولنا ان ال positivityفي ال culture
+
+145
+00:10:33,830 --> 00:10:38,710
+غالبا بتكون من تلت أسابيع إلى تلت أشهر مش معناه
+
+146
+00:10:38,710 --> 00:10:43,030
+تلحق ان ال culture بتستمر هذه الفترة لأ الناس اللي
+
+147
+00:10:43,030 --> 00:10:46,990
+بيطلع عندهم positive بيكون ال disease فترته ال
+
+148
+00:10:46,990 --> 00:10:50,530
+disease فترته من تلت أسابيع لقداش لتلت شهور قبل
+
+149
+00:10:50,530 --> 00:10:53,970
+ذلك بتطلع negative و بعد ذلك بتطلع نيجاتيب مش
+
+150
+00:10:53,970 --> 00:10:56,350
+معناه .. مش معناه الحكي ان ال incubation period او
+
+151
+00:10:56,350 --> 00:11:01,370
+ال incubation لل culture هي تلت أسابيع لتلت شهور
+
+152
+00:11:01,370 --> 00:11:07,920
+لأمتى بيطلع postive المريض بعد مرور تلت أسابيع و
+
+153
+00:11:07,920 --> 00:11:11,640
+ليس بعد مرور تلت أشهر يعني في الفترة الواقعية بين
+
+154
+00:11:11,640 --> 00:11:15,000
+تلت أسابيع و تلت أشهر ال treatment and prevention
+
+155
+00:11:15,000 --> 00:11:21,790
+طبعا العلاج لل Leptospira هو ال penicillinلكن كما
+
+156
+00:11:21,790 --> 00:11:25,710
+ذكرتولكم سابقا انه إذا كان زورة ال disease فالأولى
+
+157
+00:11:25,710 --> 00:11:28,670
+إذا بنعمل immunization نعمل immunization لمين؟ لل
+
+158
+00:11:28,670 --> 00:11:32,490
+animals سمعهم proper treatment and disposal of
+
+159
+00:11:32,490 --> 00:11:36,550
+contaminated water بمعنى آخر بكلمات أخرى proper
+
+160
+00:11:36,550 --> 00:11:40,470
+waste water disposal أو treatment and disposal
+
+161
+00:11:40,470 --> 00:11:46,150
+تخيلوا يا شباب أنه المياه السيوج system أو السيوج
+
+162
+00:11:46,150 --> 00:11:52,760
+sea watersewage waste water ما تتعالج وتروح على
+
+163
+00:11:52,760 --> 00:11:57,800
+المزروعات والمزارعين المزارعين مايلبسوش PPE فاكرين
+
+164
+00:11:57,800 --> 00:12:01,460
+ال PPE ال personal protective equipment وبالتالي
+
+165
+00:12:01,460 --> 00:12:04,260
+احنا جونا ال entrance تبعها ممكن يكون عبر العين
+
+166
+00:12:04,260 --> 00:12:07,340
+ممكن يكون عبر الخدوش الموجودة في الجلب عبر تناول
+
+167
+00:12:07,340 --> 00:12:12,920
+طعم المزروعات الملوثة فالاصل انه بالفعل اهم نقطة
+
+168
+00:12:12,920 --> 00:12:17,140
+في ال prevention proper waste water treatment
+
+169
+00:12:19,190 --> 00:12:22,750
+الميكروب التالت في سلسلة الـ spiral organism هو
+
+170
+00:12:22,750 --> 00:12:27,070
+الـBorrelia Recurrentis ومن اسمها Recurrentis،
+
+171
+00:12:27,070 --> 00:12:31,950
+Recurrent يعني تحدث مرة أخرى، مرة أخرى، باللغة
+
+172
+00:12:31,950 --> 00:12:37,050
+العربية بيسموها حمى الراجعومفهومها انه بيشفى منها
+
+173
+00:12:37,050 --> 00:12:41,490
+المريض تماما تمام و بعد فترة واجيزة بيرجع المرض
+
+174
+00:12:41,490 --> 00:12:48,010
+مرة اخرى و هذا مثال صارخ على بكتيريا تمتلك مقدرة
+
+175
+00:12:48,010 --> 00:12:52,290
+على antigenic variation خلال عملية ال infection
+
+176
+00:12:52,290 --> 00:12:56,150
+نفسها يعني مش بتطلع برا و بتتغير لأ و هي داخل جسم
+
+177
+00:12:56,150 --> 00:13:00,450
+الإنسان بتتغير و هي سماء مشهورة في هذه البكتيريا
+
+178
+00:13:02,270 --> 00:13:08,370
+لكن على خلاف اللى ذكرناه للـ Leptospira و الـ
+
+179
+00:13:08,370 --> 00:13:11,010
+trypanemia ان they cannot be stained this bacteria
+
+180
+00:13:11,010 --> 00:13:14,050
+can be stained و can be stained by gemza stain
+
+181
+00:13:14,050 --> 00:13:17,910
+جمزا ستاين اللى ساخدنته لمن؟ لل blood film و هذه
+
+182
+00:13:17,910 --> 00:13:21,010
+بالفعل ناخد blood film او blood sample و بنعمله
+
+183
+00:13:21,010 --> 00:13:23,670
+blood film و بنعمله staining بالجمزا ستاين و بنشوف
+
+184
+00:13:23,670 --> 00:13:26,250
+البكتيريا عارفينى ايش معنى الحكى يا شباب لما نشوف
+
+185
+00:13:26,250 --> 00:13:30,770
+بكتيريا في blood filmمعنى الحاجة أن ال number
+
+186
+00:13:30,770 --> 00:13:34,890
+تبعها في الدم هو عالي جدا .. نعم عالي جدا وبتالي
+
+187
+00:13:34,890 --> 00:13:38,230
+يعني إما قريب من ال white blood cell أو من ال red
+
+188
+00:13:38,230 --> 00:13:41,990
+blood cell فلما يلاجيها بإعداد كبيرة زي ال red
+
+189
+00:13:41,990 --> 00:13:45,010
+blood cell معناه الحاجة أنها بالملايين في .. لكل
+
+190
+00:13:45,010 --> 00:13:50,410
+mil .. لكل mil من ال blood طيبCan grow in media
+
+191
+00:13:50,410 --> 00:13:53,770
+برضه على عكس الأورانيات هذه البكتيريا بتنمو في
+
+192
+00:13:53,770 --> 00:13:57,710
+ميديا موجود فيها سيرام وتيشيو اكستراكت high
+
+193
+00:13:57,710 --> 00:13:59,830
+frequency of antigenic variation الكلام اللي
+
+194
+00:13:59,830 --> 00:14:03,630
+حاكيناه in major surface protein ولو انه ال
+
+195
+00:14:03,630 --> 00:14:08,150
+antigenic variation in minor proteinكان الجسم
+
+196
+00:14:08,150 --> 00:14:13,170
+بتأثرش بس لإنه major protein بمعنى إنه جسمنا بيكون
+
+197
+00:14:13,170 --> 00:14:16,970
+أجسام مضادة بيكون أجسام مضادة ضد هذا ال major
+
+198
+00:14:16,970 --> 00:14:22,330
+protein فالآن أنا عندي protein X protein X كونته
+
+199
+00:14:22,330 --> 00:14:26,590
+Antibody بقدر أكافح البكتيرا من خلاله لكن لو X صار
+
+200
+00:14:26,590 --> 00:14:31,970
+X1ال antibody تبعي ما زال X وبالتالي .. بالظبط
+
+201
+00:14:31,970 --> 00:14:37,410
+فخلال الفترة ال antibody بيقضي على معظم البكتيريا
+
+202
+00:14:37,410 --> 00:14:41,370
+اللي بتحتوي على X تمام؟ لكن بيضل اللي واحدة او
+
+203
+00:14:41,370 --> 00:14:46,090
+تنتين من البكتيريا طوروا X1 فكل البكتيريا الأخرى
+
+204
+00:14:46,090 --> 00:14:49,140
+بتموت من معادها او تنتين فبيشفى المريضهدولا
+
+205
+00:14:49,140 --> 00:14:52,020
+التنتين بياخدوا وقت في الانقسام و الوصول الى رقم
+
+206
+00:14:52,020 --> 00:14:55,900
+اللى مطلوب لاحدث ال disease فبترجع الحب مرة اخرى
+
+207
+00:14:55,900 --> 00:14:59,060
+هذا العمل ممكن تتكرر لشباب من تلت الى خمس مرات فى
+
+208
+00:14:59,060 --> 00:15:05,220
+المريض الواحد ففي عندنا مشكلة كبيرة فى هذا ال
+
+209
+00:15:05,220 --> 00:15:08,760
+disease و خاصة لما نعرف ال symptoms كمان شوية و
+
+210
+00:15:08,760 --> 00:15:12,440
+خاصة لما نعرف طرق الانتقال يعنى بكتيريا عندها
+
+211
+00:15:12,440 --> 00:15:16,160
+المقدرة علىالـ Antigenic variation و عندها انتقال
+
+212
+00:15:16,160 --> 00:15:20,220
+بطرق عجيبة ممكن تنتقل عن طريق ال ticks الحشرات
+
+213
+00:15:20,220 --> 00:15:23,600
+اللي بتنتص الدم القرراد ممكن تنتقل عن طريق القمل
+
+214
+00:15:23,600 --> 00:15:27,580
+تمام سواء كان ال head lost أو ال body lost فيه
+
+215
+00:15:27,580 --> 00:15:34,620
+أنجمل احنا في فلسطين و لا خلص قمل ضايل مع ال gel
+
+216
+00:15:34,620 --> 00:15:39,680
+اللي بيستخدموه الشباب اليامها دي بزيد بالكم طيب
+
+217
+00:15:42,350 --> 00:15:46,130
+القمل هو ليس خدوا بالكه، ليس معبرا على النظافة
+
+218
+00:15:46,130 --> 00:15:50,950
+الشخصية، يعني قد تكون أنت من أنظف الناس، طبعا، لكن
+
+219
+00:15:50,950 --> 00:15:56,250
+اللي لاجي عندك جمل، كيف؟ واحد لو كان infested،
+
+220
+00:15:56,250 --> 00:15:58,930
+infested زي infected أه، بس احنا لما نتكلم عن
+
+221
+00:15:58,930 --> 00:16:02,150
+اكتوبرازايت بنقول infestation، بنقولش infection
+
+222
+00:16:02,150 --> 00:16:08,560
+أه، infected أو infestedفممكن ينقل .. ينقل للآخرين
+
+223
+00:16:08,560 --> 00:16:11,840
+القمل مع العلم أن الآخرين كنا كلهم إيه ال .. ال
+
+224
+00:16:11,840 --> 00:16:15,020
+hygiene تبعهم و ال personal hygiene موجود لكن م ..
+
+225
+00:16:15,020 --> 00:16:20,040
+واضح أنه بيزداد القمل في الظروف الصعبة زي الحروب،
+
+226
+00:16:20,040 --> 00:16:23,980
+الحصار، ال .. الأوقات اللي .. اللي مافيش فيها يعني
+
+227
+00:16:23,980 --> 00:16:28,680
+مياه صالحة لل .. للاستحمام أو لل .. للشرب هذه ..
+
+228
+00:16:28,680 --> 00:16:31,360
+هذه بتكون أوقات صعبة صحية و ممكن تتشر فيها القمل،
+
+229
+00:16:31,360 --> 00:16:33,720
+فضلا ليلة؟
+
+230
+00:16:36,250 --> 00:16:39,810
+هناك بعض ال .. ال .. اول حاجة نظافة شخصية جوناها و
+
+231
+00:16:39,810 --> 00:16:43,290
+في بعض المبيدات المستخدمة كيمويات المستخدمة احنا
+
+232
+00:16:43,290 --> 00:16:45,890
+على زماننا كانوا يستخدموا ال DDT در بالكو كانوا
+
+233
+00:16:45,890 --> 00:16:50,270
+يرشونا بالمدارس و انا و انا الصغار .. نعم كنا نطلع
+
+234
+00:16:50,270 --> 00:16:52,630
+من الصف .. انا بعد كنت في صف أول و صف تاني كانوا
+
+235
+00:16:52,630 --> 00:16:57,190
+بالفعل يستخدموا ال DDT بالعفاطة هذه الجدوية تمام؟
+
+236
+00:16:57,190 --> 00:17:00,730
+فكنا نطلع من الفصل كأنه طلعين من المطحنة من الدقيق
+
+237
+00:17:00,730 --> 00:17:05,840
+يعنيلكن كان effective في ال control للأكل للأسف
+
+238
+00:17:05,840 --> 00:17:10,660
+اكتشاف و بعد ذلك انه يعني very toxic لل human اللي
+
+239
+00:17:10,660 --> 00:17:16,880
+هو ال DDT و الآن هو يعني عالميا من المبيدات
+
+240
+00:17:16,880 --> 00:17:20,560
+الممنوعة لكن هناك مبيدات موجودة للقمر او أدوية
+
+241
+00:17:20,560 --> 00:17:27,040
+يعني لا لا دي راجعلك اذا كان فيه خدوش لو كان في
+
+242
+00:17:27,040 --> 00:17:32,730
+جروح في الرأس قد تقتل الإنسانvery toxic، هي صحيح
+
+243
+00:17:32,730 --> 00:17:35,990
+toxic لل .. لكن لو كان في جروح أو خدوش في الرأس قد
+
+244
+00:17:35,990 --> 00:17:39,830
+تقتل، انا عارف ان في practice موجود في غزة في هذا
+
+245
+00:17:39,830 --> 00:17:43,270
+الموضوع قديم لكن انقطع، يعني مافيش شغل ممكن عند
+
+246
+00:17:43,270 --> 00:17:48,670
+بعض الناس ضايق، اما ابتدالي مادة بيسموها براسيا من
+
+247
+00:17:48,670 --> 00:17:52,570
+منتجات النحاس اعتقد هي، اه، هذه سامة جدا لل ..
+
+248
+00:17:52,570 --> 00:17:56,630
+للحشرات وسامة للانسان نفسهإذا جونا ticks اللي هو
+
+249
+00:17:56,630 --> 00:18:01,290
+القراد والقمل ومن infected rodents to human ومن
+
+250
+00:18:01,290 --> 00:18:03,770
+infected human to human يعني من إنسان أيضا لمين
+
+251
+00:18:03,770 --> 00:18:10,250
+لإنسان إذا في عندها وسائل متنوعة في الانتقال ال
+
+252
+00:18:10,250 --> 00:18:14,950
+clinical feature في عندها بكتيريميا وفي عندها non
+
+253
+00:18:14,950 --> 00:18:18,310
+periodic rash at bite site وينما كان العضة بيكون
+
+254
+00:18:18,310 --> 00:18:23,470
+في طفح جلدي لكن غير صديدي مافيش فيه أي سوائل مافيش
+
+255
+00:18:23,470 --> 00:18:29,440
+فيه أي سوائلممكن ينتج أيضًا fever وارتعاش أو رعشة
+
+256
+00:18:29,440 --> 00:18:36,000
+غالبًا في فترة اللي هو الحمّة العالية وممكن ال
+
+257
+00:18:36,000 --> 00:18:42,800
+headache اللي هو الصداع لفترة أسابيع وتمتد إلى
+
+258
+00:18:42,800 --> 00:18:50,440
+شهر، إذا في عندي مجموعة من العراض الصعبة ممكن
+
+259
+00:18:50,440 --> 00:18:56,910
+كمرة تمتد من أسابيع إلى شهروبعد هذه المرحلة الأولى
+
+260
+00:18:56,910 --> 00:19:02,630
+برضه بأسابيع أو شهور ممكن يظهر عندنا أعراض متعلقة
+
+261
+00:19:02,630 --> 00:19:10,380
+بالقلب وبالأعصابو ايضا من اكتر ما يميز الاعراض في
+
+262
+00:19:10,380 --> 00:19:13,900
+هذا ال bacterial infection هو prominent arithritis
+
+263
+00:19:13,900 --> 00:19:17,940
+والارثريتس قد تكون ناجمة عن ال antigen antibody
+
+264
+00:19:17,940 --> 00:19:21,120
+binding يعني ارتباط الانتجن والانتي بادي وال
+
+265
+00:19:21,120 --> 00:19:27,040
+deposition في اللي هو ال knees اللي هو المفاصل او
+
+266
+00:19:27,040 --> 00:19:31,700
+الركب بالذات يعني وبالتالي بيصير فينا arithritis
+
+267
+00:19:31,700 --> 00:19:36,420
+prominent arithritisال lab diagnosis غالبا بيتم
+
+268
+00:19:36,420 --> 00:19:39,900
+عبر الجمزا stain بناخد عينة دم اللي عملها جمزا
+
+269
+00:19:39,900 --> 00:19:43,220
+stain وبنشوف البكتيريا اللي ذكرنالكوا شكلها قبل
+
+270
+00:19:43,220 --> 00:19:46,360
+قليل ممكن يكون ال detection لل IGM وال IGM كل كتير
+
+271
+00:19:46,360 --> 00:19:51,440
+في وجوده معبر عن recent infectionبينما إذا IGG
+
+272
+00:19:51,440 --> 00:19:55,960
+مضطرين نعمل ما يسمى بال rise antibody titer من ال
+
+273
+00:19:55,960 --> 00:19:59,220
+acute stage إلى ال convalescent stage بيقولنا
+
+274
+00:19:59,220 --> 00:20:03,000
+بنجيس ال antig على مرحلتين في مرحلة ال acute و
+
+275
+00:20:03,000 --> 00:20:06,400
+مرحلة ال convalescent طب حد بيسأل بيقولطب واش
+
+276
+00:20:06,400 --> 00:20:09,060
+استفادنا احنا؟ او واش استفاد المريض اللي ما يعمل
+
+277
+00:20:09,060 --> 00:20:10,960
+عينة تانية في فترة ال convalescent؟ ال
+
+278
+00:20:10,960 --> 00:20:13,820
+convalescent بمعناه تحكي ان المريض شوفية اصلا،
+
+279
+00:20:13,820 --> 00:20:18,780
+المريض شوفية، فهل هناك فائدة من انه نعمل diagnosis
+
+280
+00:20:18,780 --> 00:20:23,180
+بعد ما المريض شوفية؟ نعم هناك فائدةشيء بقى فيه هنا
+
+281
+00:20:23,180 --> 00:20:28,820
+حاسمة Epidemiological Investigation أحد أسوأ أشياء
+
+282
+00:20:28,820 --> 00:20:32,120
+في النظام الصحي الفلسطيني عندنا أنه ماعناش records
+
+283
+00:20:32,120 --> 00:20:34,860
+جيدة بالأمراض ليش ماعناش records جيدة بالأمراض
+
+284
+00:20:34,860 --> 00:20:38,420
+لسببين السبب الأول أنه عندنا bad records يعني
+
+285
+00:20:38,420 --> 00:20:42,380
+موضوع سجلات طبية عندنا في قطاع غزة سيئ للغاية يعني
+
+286
+00:20:42,380 --> 00:20:46,540
+تسجيل لو بدنا ناخد مثلا مائة حالة بمرض معين مستحيل
+
+287
+00:20:46,540 --> 00:20:51,090
+نلاقي مائة سجل كامل المعلوماتيبقى فينا مشكلة في
+
+288
+00:20:51,090 --> 00:20:53,730
+مين؟ في ال medical records لكن الأهم ال medical
+
+289
+00:20:53,730 --> 00:20:56,410
+records و قبل ال medical records المفروض اللي هو
+
+290
+00:20:56,410 --> 00:21:00,030
+ال diagnosis اننا نعمل correct diagnosis تخيلوا
+
+291
+00:21:00,030 --> 00:21:04,550
+واحد إيجانا fever و علجناه و احنا مش عارفين و كلمة
+
+292
+00:21:04,550 --> 00:21:09,190
+fever disease هو؟ ولا عرض؟ عرض و بيشترك فيها كام
+
+293
+00:21:09,190 --> 00:21:13,110
+مليون مرض كتير، مظبوط ولا لأ؟ واحد fever و أعطيناه
+
+294
+00:21:13,110 --> 00:21:17,150
+antibiotic و ماعرفناش السببيبقى مجددا انا هحط في
+
+295
+00:21:17,150 --> 00:21:20,190
+السيريلات ال diagnosis وبتالي انا ماجي اعمل
+
+296
+00:21:20,190 --> 00:21:24,290
+احصائية ال disease اللي انا علجته انا مش عارفه ايش
+
+297
+00:21:24,290 --> 00:21:31,080
+لسميهمااسموش فيبرة فبالتالي انا انا خسرت معلومات و
+
+298
+00:21:31,080 --> 00:21:34,280
+بيانات كان .. كان ممكن استفيد منها في التخطيط
+
+299
+00:21:34,280 --> 00:21:38,260
+للقضاء على أمراض معينة لو فترضنا انها موجودة
+
+300
+00:21:38,260 --> 00:21:41,680
+وبالتالي ال diagnosis يا شباب مهم جدا حتى لو
+
+301
+00:21:41,680 --> 00:21:47,440
+المريض المعني لم يستفد منه بشكل مباشر المجتمع اه
+
+302
+00:21:47,440 --> 00:21:51,720
+بيستفيد منه اذا مداشن يعني نفكر زي بعض التفكير
+
+303
+00:21:51,720 --> 00:21:57,070
+العقيم لبعض الناس انه لما بتعملي مزرعة انتبتقولي E
+
+304
+00:21:57,070 --> 00:21:59,610
+.coli ولا بتقولي Klebsiella ولا بتقولي stuff ولا
+
+305
+00:21:59,610 --> 00:22:03,530
+بتقولي انا اش .. اش فارقة معايا انا من تعملي قائمة
+
+306
+00:22:03,530 --> 00:22:06,250
+باسمها المضادات الحيوية اللي sensitive و resistant
+
+307
+00:22:06,250 --> 00:22:09,710
+لها البكتيريا فبختار ال antibiotic هذا .. هذا بعض
+
+308
+00:22:09,710 --> 00:22:14,430
+التفكير عند الناس موجود عند أطباءوكتير حوارنا
+
+309
+00:22:14,430 --> 00:22:18,110
+الناس دولة انه لا يا عم انتوا هيك مخطئين مش كل
+
+310
+00:22:18,110 --> 00:22:23,370
+مايكروب معزول هو أصلا مسبب لمرض وده نقطة مهمة مش
+
+311
+00:22:23,370 --> 00:22:25,990
+فيه normal microbiota بعض اللي هم تكون ال E coli
+
+312
+00:22:25,990 --> 00:22:30,430
+من ال stool تعني شيء لا تعني شيء رقم اتنين انت
+
+313
+00:22:30,430 --> 00:22:34,050
+لازم تكون حريص جدا على معارفة الميكروب بدقة حتى
+
+314
+00:22:34,050 --> 00:22:36,810
+تقدر تعرف ال epidemiology لأ ال diseases اللي
+
+315
+00:22:36,810 --> 00:22:42,610
+موجودة وبالتالي تضع سياسات لمكافحة أعطيكم مثلال ..
+
+316
+00:22:42,610 --> 00:22:46,990
+ال group B streptococci في أوروبا كانت number one
+
+317
+00:22:46,990 --> 00:22:51,450
+cause of meningitis neonatal meningitis عملوا
+
+318
+00:22:51,450 --> 00:22:54,450
+vaccine او عملوا بلاش فاكسين عفوا مش فاكسين عملوا
+
+319
+00:22:54,450 --> 00:22:58,990
+system لل diagnosis ولل treatment للأم خلال
+
+320
+00:22:58,990 --> 00:23:02,970
+الولادة خلال فترة الولادةالان من ال number one
+
+321
+00:23:02,970 --> 00:23:06,430
+cause of neonatal meningitis اتغير الرقم اتغير
+
+322
+00:23:06,430 --> 00:23:10,290
+لانه تدخلنا احنا احنا اتدخلنا نوعا ما بطريقة
+
+323
+00:23:10,290 --> 00:23:15,230
+ايجابية فالاصل ان معرفتي بالميكروبات ومسببات
+
+324
+00:23:15,230 --> 00:23:18,570
+الأمراض بتساعدني في التخطيط المستقبلي فلا تقوللي
+
+325
+00:23:18,570 --> 00:23:21,990
+ان المريض لازم ما استفادش حتى لو ما استفاد المريض
+
+326
+00:23:21,990 --> 00:23:25,690
+يبقى لازم نعمل احنا correct diagnosis طيب
+
+327
+00:23:28,940 --> 00:23:35,400
+rigors زي .. يعني تصلبات أو رعشات يعني .. رعشة
+
+328
+00:23:35,400 --> 00:23:42,280
+يبقى فينا طرق مطلقة لل .. لل lab diagnosis, gene
+
+329
+00:23:42,280 --> 00:23:46,220
+sustaining, detection of IgG أو rise in Ig .. عفوا
+
+330
+00:23:46,220 --> 00:23:50,280
+IgM أو rise in IgG و ال PCR و أنا كنت الصبح في
+
+331
+00:23:50,280 --> 00:23:53,920
+المحاضرة عن طالبات بقولهم ال PCRأصبح منتشر بشكل
+
+332
+00:23:53,920 --> 00:23:57,240
+كبير وبتالي هذا بيسهل اي عملية اللي هو ال
+
+333
+00:23:57,240 --> 00:24:01,080
+diagnosis البعض يظن ان ال PCR is expensive لأ
+
+334
+00:24:01,080 --> 00:24:05,900
+البعض قد تحول من ال culture إلى ال PCR حتى يقلل
+
+335
+00:24:05,900 --> 00:24:10,200
+المصاريف فالان ال PCR صارت تقنية شائعة ورخيصة
+
+336
+00:24:10,200 --> 00:24:13,360
+ومتوفرة بشكل كبير treatment and prevention في
+
+337
+00:24:13,360 --> 00:24:18,500
+عندنا ال amoxicillinوهو احد مشتقات البنسالين
+
+338
+00:24:18,500 --> 00:24:23,560
+السيطرة على تلت أشياء المهمة جدا اللي بتنقل المرض
+
+339
+00:24:23,560 --> 00:24:30,050
+اللي هم القملو القراد و القوارض هذه لازم نعمل
+
+340
+00:24:30,050 --> 00:24:32,210
+برامج سيطرة عليها ايش ان برامج سيطرة او برامج
+
+341
+00:24:32,210 --> 00:24:37,430
+مكافحة انتوا بتعرفوا في المدارس .. في المدارس كان
+
+342
+00:24:37,430 --> 00:24:43,390
+في سنة .. في سنين احنا كنا نحلج الشعر على درجة ..
+
+343
+00:24:43,390 --> 00:24:47,050
+درجة صفر بمعنى انه مافيش شعر يعني و السبب في ذلك
+
+344
+00:24:47,050 --> 00:24:51,330
+هو احد .. احد كانت اوجه مكافحة اللي هو القمر و
+
+345
+00:24:51,330 --> 00:24:55,250
+الحشرات تمام؟لأنه ال .. ال .. ال .. في حالة إنه
+
+346
+00:24:55,250 --> 00:24:59,930
+لما يكون الشعر طويل قد يكون مخفي لكن مافيش شعر،
+
+347
+00:24:59,930 --> 00:25:03,610
+مافيش بيئة مناسبة لل .. فكانت أحد الطرق المكافحة
+
+348
+00:25:03,610 --> 00:25:07,330
+استخدام المبيدات زي ما حكينا ال .. ال rodents كان
+
+349
+00:25:07,330 --> 00:25:14,620
+في فترة من فترة جوائزفي البلديات لمن يستعد عدد
+
+350
+00:25:14,620 --> 00:25:20,180
+معين من الطريقة العقيمة الطريقة الأفضل كانت الان
+
+351
+00:25:20,180 --> 00:25:23,580
+سارية ان مع انت بتروح تدفع واصل الميه في البلدية
+
+352
+00:25:23,580 --> 00:25:30,580
+بيعطوك ظرف فيه اللي هو مادة سامة للجردان هذه طريقة
+
+353
+00:25:30,580 --> 00:25:35,520
+جيدة لمكافحة الجردان وبالفعل خففت التوعيط الناس
+
+354
+00:25:35,520 --> 00:25:38,780
+الجردان وين بتيجي الجردان بتيجي على أماكن فيها
+
+355
+00:25:38,780 --> 00:25:43,240
+غذاء فيها غذاءواحد مربى دواجن و بيحطلهم قمح و كده
+
+356
+00:25:43,240 --> 00:25:46,880
+فبتلاقي الجوردان مردين فتوعيت الناس بطريقة التربية
+
+357
+00:25:46,880 --> 00:25:51,400
+بكيف انه يضعوا الأكل يخزنوه و كده هذه أشياء حدت من
+
+358
+00:25:51,400 --> 00:25:54,960
+اللي هو انتشار الجوردان ال hygienic measures اللي
+
+359
+00:25:54,960 --> 00:25:58,260
+هي الإجراءات النظافة و النظافة اللي اقصد فيها هنا
+
+360
+00:25:58,260 --> 00:26:01,480
+فقط النظافة الشخصية و انما النظافة العامة في
+
+361
+00:26:01,480 --> 00:26:05,720
+المجتمع وإن في نفايات في الشوارع ثق تماما انك
+
+362
+00:26:05,720 --> 00:26:11,330
+هتلاقي قطط و هتلاقي أيضا كمان اللي هو جوردانأحنا
+
+363
+00:26:11,330 --> 00:26:16,130
+بنكون أنهينا الـ Trypanemia و أنهينا الـ
+
+364
+00:26:16,130 --> 00:26:19,130
+Leptospira و أنهينا اللي هو الـ Borrelia بس في
+
+365
+00:26:19,130 --> 00:26:23,270
+نقطة لازم أقولها مش مذكورة عنها في الكتاب في
+
+366
+00:26:23,270 --> 00:26:27,170
+أمريكا مرض مشهور اسمه Lyme Disease Lyme Disease و
+
+367
+00:26:27,170 --> 00:26:30,970
+بتسببه برضه Borrelia اسمها Borrelia Burgdorferi
+
+368
+00:26:30,970 --> 00:26:35,910
+Borrelia Burgdorferi يبقى فيها إنه مجموعة من ال
+
+369
+00:26:35,910 --> 00:26:40,650
+spiral organism بيسببوا أمراض للإنسانمنها ما هو
+
+370
+00:26:40,650 --> 00:26:45,370
+sexual .. sexual transmitted زي تريبونيميا، منها
+
+371
+00:26:45,370 --> 00:26:49,530
+ما هو rodent transmitted، منها ما هو insect اللي
+
+372
+00:26:49,530 --> 00:26:50,370
+هو transmitted
+
+373
+00:26:57,640 --> 00:27:02,080
+يمكن في البكتيريا الموضوع الأخير أو القبض الأخير
+
+374
+00:27:02,080 --> 00:27:06,540
+اللى أمامكوا الآن اللى هو الكلاميديا والريكيزيا
+
+375
+00:27:06,540 --> 00:27:10,320
+والمايكو بلازم انا يمكن الانواع كلاميديا وريكيزيا
+
+376
+00:27:10,320 --> 00:27:14,240
+ومايكو بلازم وريكيزيا افضل ان اتكلم عنهم كلاميديا
+
+377
+00:27:14,240 --> 00:27:19,360
+وريكيزيا ومايكو بلازم خدوا بالكوا التلات أسماء
+
+378
+00:27:19,360 --> 00:27:22,720
+اللى قدامكوا هدولة مميزين لحالهم بدون ما اتكلم
+
+379
+00:27:22,720 --> 00:27:26,900
+عنهم ولا كلمةميزناهم و وضعنا لهم في ال
+
+380
+00:27:26,900 --> 00:27:33,020
+microbiology يعني من ذاكراتنا و من صفحاتنا أجزاء
+
+381
+00:27:33,020 --> 00:27:37,060
+مميزة ليش؟ لأن هم المميزين ال Clamydia و ال
+
+382
+00:27:37,060 --> 00:27:41,260
+Rickettsia على سبب المثال are the only obligate
+
+383
+00:27:41,260 --> 00:27:45,260
+intracellular parasites ايش يعني obligate
+
+384
+00:27:45,260 --> 00:27:49,120
+intracellular parasites؟ لا يستطيعوا لن يستطيعوا
+
+385
+00:27:49,120 --> 00:27:54,690
+المعيشة بشكل حر البتةليش؟ لأن عندهم مشكلة عندهم
+
+386
+00:27:54,690 --> 00:27:58,690
+مشكلة ليش مشكلتهم؟ هم بكتيريا كاملة .. كاملة
+
+387
+00:27:58,690 --> 00:28:03,890
+التكوين لكن ليس لديهم المقدر على إنتاج ال ATP ليس
+
+388
+00:28:03,890 --> 00:28:09,290
+لديهم المقدر على إنتاج ال ATP هل هناك إمكانية
+
+389
+00:28:09,290 --> 00:28:19,590
+لمخلوق انه يتبادل ويصنع ويعمل وينقل ويكون ويهضم
+
+390
+00:28:19,590 --> 00:28:24,170
+بدون ATP؟ مستحيلزي ما احنا في مجتمعاتنا بنشتري
+
+391
+00:28:24,170 --> 00:28:27,690
+بفلوس لفلوس تبعتنا، بعطيك انا خمسة برجال اتنين على
+
+392
+00:28:27,690 --> 00:28:31,790
+حسب السلعة، تمام؟ ال ATP كذلك، بدك تنجل فوسفات،
+
+393
+00:28:31,790 --> 00:28:34,490
+خدها، okay فوسفات، خد هاي اتنين ATP و رجالي
+
+394
+00:28:34,490 --> 00:28:37,690
+التالت، انا بعطيك تلاتة، هو بعطيني، باخد اتنين و
+
+395
+00:28:37,690 --> 00:28:42,840
+رجالي واحدبعطيه واحد بضيف لي عليهم كمان واحد يعني
+
+396
+00:28:42,840 --> 00:28:47,820
+أجار أجرة يبقى ال ATP ضرورة من الضرورات وبالتالي
+
+397
+00:28:47,820 --> 00:28:51,040
+لن يستطيعوا المعيشة بدون خلية لأنه مين اللي بنتج
+
+398
+00:28:51,040 --> 00:28:55,360
+ال ATP احنا اللي بنتج ال ATP الخلايا بشكل عام
+
+399
+00:28:55,360 --> 00:28:59,980
+وبالتالي البكتيريا مضطرة عشان تعيش لازم تعيش داخل
+
+400
+00:28:59,980 --> 00:29:04,960
+الخلاياطبعا الفيروسات كذلك الأمر بس الفيروسات
+
+401
+00:29:04,960 --> 00:29:09,900
+معتمدة اعتماد كامل على ال machinery of their cells
+
+402
+00:29:09,900 --> 00:29:13,820
+او their host cells بس هذه البكتيريا فقط بدها مين؟
+
+403
+00:29:13,820 --> 00:29:16,780
+ال ATP بدها ال ATP زاد الغذاء فضل
+
+404
+00:29:21,970 --> 00:29:25,350
+يعني العلاقة اللي درسناهم في أول فصل إذا أنت
+
+405
+00:29:25,350 --> 00:29:29,430
+بتتكلم عن ال description لل terminology للمصطلحات
+
+406
+00:29:29,430 --> 00:29:35,810
+احنا وصفنا علاقة مخلوقين ببعض إما ب mutualism صح
+
+407
+00:29:35,810 --> 00:29:40,850
+أو commensalism أو parasitism فبتالي هي علاقة
+
+408
+00:29:40,850 --> 00:29:44,050
+parasite وبتالي سميناها obligate intracellular
+
+409
+00:29:44,050 --> 00:29:47,570
+parasite لما هي استفيد مني أنا كخلايا و بتعملي
+
+410
+00:29:47,570 --> 00:29:50,430
+destruction في الآخر يبقى هي بتضرني وبتالي
+
+411
+00:29:50,430 --> 00:29:56,440
+parasitismالـ Mycoplasma اللي في النص ليش مميزها؟
+
+412
+00:29:56,440 --> 00:30:01,740
+واحد مالهاش cell wall رقم اتنين small it is the
+
+413
+00:30:01,740 --> 00:30:04,800
+smallest free living bacteria مش obligate انت
+
+414
+00:30:04,800 --> 00:30:08,560
+سياخدوا بالكوا هي مش obligate انت يعني بتعيش ممكن
+
+415
+00:30:08,560 --> 00:30:16,420
+نميها على أطباق artificial media طيب نبدأ
+
+416
+00:30:16,420 --> 00:30:20,320
+بالإقلاميةالكلاميديا ناخد بعض ال general
+
+417
+00:30:20,320 --> 00:30:22,900
+characteristics obligate intracellular بكتيريا
+
+418
+00:30:22,900 --> 00:30:26,480
+الكلها محاكينها have ribosomes like بكتيريا عارفين
+
+419
+00:30:26,480 --> 00:30:30,360
+ليش الجملة دي؟ عشان نقولكوا إنها حقا بكتيريا لإن
+
+420
+00:30:30,360 --> 00:30:33,240
+الفيروسات مافيش فيها organelles مافيش فيها
+
+421
+00:30:33,240 --> 00:30:37,560
+ريبوزومات بينما البكتيريا دي فيها ribosomes they
+
+422
+00:30:37,560 --> 00:30:40,080
+are metabolically deficient في عندها مشكلة في
+
+423
+00:30:40,080 --> 00:30:42,720
+الميتابولزم وحاكينها لكوا إيش المشكلة عدم مقدرتها
+
+424
+00:30:42,720 --> 00:30:46,440
+على تصنيها اللي قيتهاالـ Morphology دي are small
+
+425
+00:30:46,440 --> 00:30:50,740
+rounded organism multiply by binary fission cell
+
+426
+00:30:50,740 --> 00:30:54,180
+wall consist of inner and outer membrane وهد
+
+427
+00:30:54,180 --> 00:30:57,980
+الكلام لم نريده لفى ال gram negative بكتيريا لكن
+
+428
+00:30:57,980 --> 00:31:01,960
+تختلف عن ال gram negative بكتيريا بحاجة واحدة
+
+429
+00:31:01,960 --> 00:31:07,460
+اشهية لأ ان هد .. لأ بقى الكلام عن ال cell wall لأ
+
+430
+00:31:07,460 --> 00:31:10,850
+تحتوي على ال Peptidoglycanبينما الـ Gram Negative
+
+431
+00:31:10,850 --> 00:31:14,410
+بكتيريا فيها حتى و لو كان طبقة واحدة لكن هنا مافيش
+
+432
+00:31:14,410 --> 00:31:22,030
+بتدرج لايكان حقيقي من ال spaces المهمة نسمع
+
+433
+00:31:22,030 --> 00:31:25,330
+الأسماء لأن أسماء نوعا ما يعني البعض منها غريب
+
+434
+00:31:25,330 --> 00:31:30,650
+Clamydia Cetaceae ال P هنا ساكن Cetaceae جاية من
+
+435
+00:31:30,650 --> 00:31:37,090
+كلمة Cetacene و Cetacene معناها Cetacene معناها ال
+
+436
+00:31:37,090 --> 00:31:41,890
+باروتز باروتز اللي هي البغبغاءالببغاء أو البغبغاء
+
+437
+00:31:41,890 --> 00:31:44,750
+تمام اللي هو الطير المعروف الجميل واعتقدوا ان في
+
+438
+00:31:44,750 --> 00:31:49,630
+مننا كتير بيربوا من شبابنا ومن أبناءنا بيربوا
+
+439
+00:31:49,630 --> 00:31:55,410
+ببغاء في بيوتهم تمام كنوع من الزينة و الجمال إذا
+
+440
+00:31:55,410 --> 00:31:59,050
+الكلاميديا ستاسي خدوا بالكم مش مرتبين حسب الأهمية
+
+441
+00:31:59,050 --> 00:32:01,750
+مش مرتبين حسب الأهمية لقم تلاتة هي الأهم على
+
+442
+00:32:01,750 --> 00:32:05,320
+الإطلاقKlamydia Pneumonia سهلة Klamydia
+
+443
+00:32:05,320 --> 00:32:08,700
+Trachomatis بتسبب مرض باللغة العربية بيسموه
+
+444
+00:32:08,700 --> 00:32:12,960
+Trachoma واعتقد انه الاسم أصلا Trachomatis أُخد من
+
+445
+00:32:12,960 --> 00:32:17,800
+Trachoma لأن Trachoma مرض معروف زمان من زمان وهو
+
+446
+00:32:17,800 --> 00:32:22,460
+مرض يصيب العين ويؤدي إلى فقدان البصر إلى العمى
+
+447
+00:32:22,460 --> 00:32:26,800
+يعني blindness كمان
+
+448
+00:32:26,800 --> 00:32:30,880
+مرة Klamydia Cetaceae Klamydia Pneumonia Klamydia
+
+449
+00:32:30,880 --> 00:32:34,850
+Trachomatisالكالتشرال ال characteristics they may
+
+450
+00:32:34,850 --> 00:32:38,650
+be grown on .. احنا متفاقين مش اللي حيان موعالة
+
+451
+00:32:38,650 --> 00:32:41,170
+ماكنتوا على بلد اجار و لا بلد اجار لإنه obligate
+
+452
+00:32:41,170 --> 00:32:45,190
+intra silver parasite حيان موعالة chicken embryo
+
+453
+00:32:45,190 --> 00:32:48,790
+في ال sack يكساك او chicken embryo بتاع في البيضة
+
+454
+00:32:48,790 --> 00:32:51,470
+اللي جينا فيها كتكوت اللي هي ال ..الـ chicken
+
+455
+00:32:51,470 --> 00:32:55,370
+embryo نحقنها طبعا شباب انتوا بدرستوا في الفيروسات
+
+456
+00:32:55,370 --> 00:32:59,190
+بعرف ان كانت كثورة في الكتاب اظن اني بتوضح وين
+
+457
+00:32:59,190 --> 00:33:02,690
+ممكن يحقن اللي هو ال chicken embryo فاحنا هنا بقول
+
+458
+00:33:02,690 --> 00:33:06,090
+اذا بدك تنمي البكتيريا اللي اسمها chlamydia احقنها
+
+459
+00:33:06,090 --> 00:33:09,410
+في ال yolk sac تبقى ال chicken embryo او ممكن
+
+460
+00:33:09,410 --> 00:33:13,510
+بطريقة افضل على اللي هو ال tissue culture و
+
+461
+00:33:13,510 --> 00:33:16,810
+بنستخدم هنا ال mccoy's cells او ال mccoy's cells
+
+462
+00:33:16,810 --> 00:33:19,890
+نوع من انواع ال cell culture او ال tissue culture
+
+463
+00:33:21,090 --> 00:33:25,690
+البكتيريا بتعمل infection للـepithelial cells اللي
+
+464
+00:33:25,690 --> 00:33:29,670
+موردة في الـmucous membranes وفي الـlungs ويعتقد
+
+465
+00:33:29,670 --> 00:33:35,390
+أن الـviralness بتاعها ناتج عن مقدرتها على الهروب
+
+466
+00:33:35,390 --> 00:33:38,930
+مش من الـphagocytosis على الهروب من
+
+467
+00:33:38,930 --> 00:33:43,010
+الـphagolysosome fusion فاكرين هم؟ يعني بصير فيها
+
+468
+00:33:43,010 --> 00:33:46,920
+phagocytosisوبتدخل في الفاجوزوم المفروض انه يجي
+
+469
+00:33:46,920 --> 00:33:51,120
+معاهمين الآن ال lysozome يرتبط ليش بيسمي الارتباط
+
+470
+00:33:51,120 --> 00:33:55,440
+هذا فاجو lysozome المرحلة هذه البكتيريا بتنتج
+
+471
+00:33:55,440 --> 00:33:59,600
+chemical بتمنع ال lysozome ان يرتبط بالفاجوزوم اذا
+
+472
+00:33:59,600 --> 00:34:03,880
+it resist killing by phagocytosis عن طريق انه
+
+473
+00:34:03,880 --> 00:34:10,760
+بتمنع كمان مرة ال lysozome ان يرتبط بالفاجوزومطب
+
+474
+00:34:10,760 --> 00:34:14,300
+البكتيريا دخلت جوا ال macro phage او ال phagocyte
+
+475
+00:34:14,300 --> 00:34:18,440
+او ال host cell نحو وماصلهاش killing ايش هتعمل
+
+476
+00:34:18,440 --> 00:34:21,580
+الآن؟ هتعمل multiplication يبقى مزيد كتر جوا
+
+477
+00:34:21,580 --> 00:34:25,020
+الخلية وإلا كيف تكون obligate intra-cellular
+
+478
+00:34:25,020 --> 00:34:30,540
+برادات؟ كيف لها أن تكون obligate intra-cellular
+
+479
+00:34:30,540 --> 00:34:33,400
+برادات إذا ماعناش المقدرة أنها تعيش جوا الخلية؟
+
+480
+00:34:33,400 --> 00:34:36,880
+مستحيل كلمة بتنتج heat لبيلتوكسين
+
+481
+00:34:38,910 --> 00:34:44,410
+تستطيع ان تقتل الخلية الأدمية عن طريق التنافس على
+
+482
+00:34:44,410 --> 00:34:47,870
+الغذاء مش احنا بنحتاج مكونات معينة والبكتيريا
+
+483
+00:34:47,870 --> 00:34:51,750
+بتحتاج نفس المكونات مين أشطر فينا في الحصول على
+
+484
+00:34:51,750 --> 00:34:54,990
+هذه المكونات هو اللي can survive وانا حكيتلكوا عن
+
+485
+00:34:54,990 --> 00:34:58,470
+ذكاء Sodomonas في موضوع الحديد ابتنطل الصبغة
+
+486
+00:34:58,470 --> 00:35:03,270
+تبعتها وبتروح ترتبط الصبغة بمين بال iron الان ال
+
+487
+00:35:03,270 --> 00:35:07,190
+iron اللي ارتبطت في الصبغة الخلايا تبعتنا غير قادر
+
+488
+00:35:07,190 --> 00:35:10,890
+على استخدامهيبقى دلّا مين؟ دلّا الـIron، يبقى دلّا
+
+489
+00:35:10,890 --> 00:35:14,690
+Sodomonas Originosa، يبقى نفستنا على مين هي الآن؟
+
+490
+00:35:14,690 --> 00:35:18,050
+على الحديد، والحديد مطلوب إلي، ومطلوب للبكتيرا،
+
+491
+00:35:18,050 --> 00:35:23,230
+البكتيرا نجحت وانا فشلت، فخلايا ممكن تتأثر بعدم
+
+492
+00:35:23,230 --> 00:35:27,500
+مقدرتها على حصولة نوترياند معينةhost immune
+
+493
+00:35:27,500 --> 00:35:30,800
+response وهذه نقطة كتير مهمة may account for
+
+494
+00:35:30,800 --> 00:35:33,940
+inflammation and tissue destruction الآن البكتيريا
+
+495
+00:35:33,940 --> 00:35:38,860
+جوا خليانا ال immune system تعرف او عرف ان الخلايا
+
+496
+00:35:38,860 --> 00:35:43,000
+تبعتنا مصابة بكلاميديا بيجي حضرة ال immune system
+
+497
+00:35:43,000 --> 00:35:50,600
+بده يتصرف يعني مهمته انه يقتل الخلية او يحاصر
+
+498
+00:35:50,600 --> 00:35:57,520
+الخلايا المصابة ويدمرهافي محاولته للقيام بهذه
+
+499
+00:35:57,520 --> 00:36:02,040
+المهمة بنلاقيه over reacted أو بتصرف بطريقة مش
+
+500
+00:36:02,040 --> 00:36:07,340
+ذكية فبيعمل destruction ل normal cells و ل .. و ل
+
+501
+00:36:07,340 --> 00:36:12,780
+.. و ل .. و ل infected cellsواضحة النقطة ولا مش
+
+502
+00:36:12,780 --> 00:36:17,520
+واضحة هذه انه كيف ممكن يعني على المستوى البشري على
+
+503
+00:36:17,520 --> 00:36:24,340
+المستوى البشري واحد بده يطول او بده ينزع مثلا شوكة
+
+504
+00:36:24,340 --> 00:36:28,920
+معينة موجودة في جلد الانسان بتلاقي بيجيب بيجيب أول
+
+505
+00:36:28,920 --> 00:36:32,800
+حاجة بزامجها، بيجيب حاجة تنكسر معاه، بعدين بيصير
+
+506
+00:36:32,800 --> 00:36:36,140
+نكش في الجلد من هنا ونكش في الجلد من هنا، فبدمر
+
+507
+00:36:36,140 --> 00:36:40,590
+الجلد ولسه مش طاق المين الشوكةلكن هي محاولة منها
+
+508
+00:36:40,590 --> 00:36:45,670
+لإخراجها الشوكة نفس الجثة ال immune system قد يقوم
+
+509
+00:36:45,670 --> 00:36:49,150
+بتصرفات هي اللي تعمل أو تؤدي إلى tissue
+
+510
+00:36:49,150 --> 00:36:52,970
+destruction في محاولة منه كمان مرة لقضاء على
+
+511
+00:36:52,970 --> 00:36:57,370
+البكتيريا وانت عارفيه الكلام هذا مش غريب كل ال
+
+512
+00:36:57,370 --> 00:37:01,650
+viral hepatitis ثبت بالدليل القاطعإن الفيروسات
+
+513
+00:37:01,650 --> 00:37:05,750
+نفسها لا تدمر خلايا الكبد، مين يدمر خلايا الكبد؟
+
+514
+00:37:05,750 --> 00:37:09,810
+الـ T-cells، خلايانها بتروح تهاجم الخلايا
+
+515
+00:37:09,810 --> 00:37:13,450
+الـinfected وبتعمل destruction للـ liver cell، في
+
+516
+00:37:13,450 --> 00:37:18,290
+محاولة منها كام مرة للقضاء على الفيروس، بالظبط
+
+517
+00:37:21,450 --> 00:37:26,090
+ولا مرة واحنا بندرس microbiology تحدثنا عن life
+
+518
+00:37:26,090 --> 00:37:28,610
+cycle تركنا ال life cycle لميه لدكتور عدنان الهندي
+
+519
+00:37:28,610 --> 00:37:33,010
+في محاضرة الطفاليات، مظبوط؟ المرة الوحيدة اللي
+
+520
+00:37:33,010 --> 00:37:36,630
+هننافس فيها الدكتور عدنان هي المرة هذه هتكلم عن
+
+521
+00:37:36,630 --> 00:37:41,230
+بكتيريا هي الوحيدة اللي بنعرف إنه لها life cycle و
+
+522
+00:37:41,230 --> 00:37:43,890
+life cycle بسيطة مش life cycle معقدة يعني زي
+
+523
+00:37:43,890 --> 00:37:49,990
+الطفاليات وإنما في الآخر هي life cycle تلقوا اللي
+
+524
+00:37:49,990 --> 00:37:58,020
+معايا هناEB معناها elementary body ال elementary
+
+525
+00:37:58,020 --> 00:38:02,720
+body هو نوع من الخلايا اللي بتنتجها الكلاميديا it
+
+526
+00:38:02,720 --> 00:38:08,210
+will attach to cells andهتعمل cell entry بعد ذلك
+
+527
+00:38:08,210 --> 00:38:12,850
+cell entry عن طريق اللي هو الفاجوزوم وانا قلتلك
+
+528
+00:38:12,850 --> 00:38:17,470
+قبل شوية ان البكتيريا عندها المقدرة على منع ارتباط
+
+529
+00:38:17,470 --> 00:38:22,890
+من ال lysozome مع اللي هو الفاجوزوم وهنا بتقول ان
+
+530
+00:38:22,890 --> 00:38:28,430
+الفاجوزوم ال fusion inhibition منع الآن يفترض في
+
+531
+00:38:28,430 --> 00:38:30,730
+البكتيريا العادية زي السرمنولا وشتجلاش تعمل تبدأ
+
+532
+00:38:30,730 --> 00:38:36,190
+تنقسم ثنائي بسيط هذه لأبتتحول لـ spherical body و
+
+533
+00:38:36,190 --> 00:38:39,550
+الـ spherical body هذا بيسموه reticulate body
+
+534
+00:38:39,550 --> 00:38:43,010
+reticulate يبقى فين ده الآن ايش؟ two bodies
+
+535
+00:38:43,010 --> 00:38:47,090
+elementary اللي هو دخل الخلية وبعدين هتكلم عن مين
+
+536
+00:38:47,090 --> 00:38:50,870
+الآن؟ ع ال reticulate body ال reticulate body
+
+537
+00:38:50,870 --> 00:38:55,910
+بيصيرله maturation مضوج بيصير يتكاثر بال binary
+
+538
+00:38:55,910 --> 00:39:00,250
+fission جوا ال reticulate body هذا أيه، شايفينه؟
+
+539
+00:39:00,250 --> 00:39:05,540
+دائرة هذه، شايفينها؟هو الغشاية من الأول طبعا هو
+
+540
+00:39:05,540 --> 00:39:08,880
+الغشاية من الأول صار اللي قلنا كمرة maturation
+
+541
+00:39:08,880 --> 00:39:13,360
+نضوج كبير والانقسام صار في الداخل الآن في المرحلة
+
+542
+00:39:13,360 --> 00:39:15,400
+اللي بعدها انسوا هذا الجزء وانسوا هذا الجزء
+
+543
+00:39:15,400 --> 00:39:18,360
+المرحلة اللي بعدها ايش بصير هنا يا شباب؟ لاحظوا
+
+544
+00:39:18,360 --> 00:39:21,320
+تحول جزء من الكورات البيضاء اللي موجودة هنا مش
+
+545
+00:39:21,320 --> 00:39:25,040
+كورات بيضاء هي اللي اقصد فيها ال elementary عفوا
+
+546
+00:39:25,040 --> 00:39:28,520
+ال reticulate body بدأت تتحول للون ايه؟ الأسود
+
+547
+00:39:28,520 --> 00:39:33,240
+الاسود شو هو هذا؟Elementary body إذن هي عمليات
+
+548
+00:39:33,240 --> 00:39:37,700
+elementary body بيدخل الخلايا بتحول ل reticulate و
+
+549
+00:39:37,700 --> 00:39:41,340
+ال reticulate بينقسم و بيكون خلايا و بعدين بيحولها
+
+550
+00:39:41,340 --> 00:39:44,820
+لمين ل elementary body و بعدين بيطردها برا مين ال
+
+551
+00:39:44,820 --> 00:39:49,200
+infective stage في هذا الحالة؟الـElementary Body
+
+552
+00:39:49,200 --> 00:39:53,480
+الـInfected Stage هو المؤدي اللي بينتقل الخلايا هو
+
+553
+00:39:53,480 --> 00:39:56,920
+الـElementary Body إيش حد مزايا الشباب؟ إيه مزايا
+
+554
+00:39:56,920 --> 00:40:00,020
+الفكرة هذه؟ إن الـElementary Body is more
+
+555
+00:40:00,020 --> 00:40:04,100
+resistant to environmental conditions يعني عنده
+
+556
+00:40:04,100 --> 00:40:08,560
+مقدرة على مقاومة الظروف البيئية أكتر من مين من ال
+
+557
+00:40:08,560 --> 00:40:11,820
+reticulate body فهذا نوع من المحافظة على البكتيريا
+
+558
+00:40:11,820 --> 00:40:13,780
+في ال environment
+
+559
+00:40:17,240 --> 00:40:23,320
+نعم reticulate body نبدأ
+
+560
+00:40:23,320 --> 00:40:27,940
+نتكلم عن ال diseases او specific diseases انها
+
+561
+00:40:27,940 --> 00:40:32,940
+chlamydia cetaceae و زى ما ذكرنا cetaceae هى
+
+562
+00:40:32,940 --> 00:40:37,160
+cetacean bird بتقولنا اللى هى البقارات أو البقارات
+
+563
+00:40:37,160 --> 00:40:40,680
+chlamydia cetaceae is a zoonetic respiratory
+
+564
+00:40:40,680 --> 00:40:44,220
+disease احنا مش احنا اللى روحنا اليها احنا اللى
+
+565
+00:40:44,220 --> 00:40:48,060
+جيبناها عندناحد في كرابة طير جابل هيك في الجفص في
+
+566
+00:40:48,060 --> 00:40:54,380
+المنزل؟ طيب كنت تشوف الغبار او مخلفات الطير محصورة
+
+567
+00:40:54,380 --> 00:40:58,460
+في القفص ولا حوالين القفص فيه كمان؟ طيب هو المفروض
+
+568
+00:40:58,460 --> 00:41:02,140
+انه confined لأ بطير برا هيك ولا هيك محصور في
+
+569
+00:41:02,140 --> 00:41:08,480
+القفص لكن لما بطيربيعمل عملية طيارات هوائية بتخلخل
+
+570
+00:41:08,480 --> 00:41:13,180
+الهوى فى المنطقة فبتنعثر اما اجزاء من مخلفاته تمام
+
+571
+00:41:13,180 --> 00:41:16,100
+او من الغذاء اللى مولود او اشياء متعلقة بالريش
+
+572
+00:41:16,100 --> 00:41:23,160
+تبعه صح ولا لأ فالان كلمة غبار و نشره فى البيئة و
+
+573
+00:41:23,160 --> 00:41:26,700
+من ثم استنشاق و لا اخر لو كان هذا الطيروإذا كنا
+
+574
+00:41:26,700 --> 00:41:31,060
+حامل أو مصاب بالكلاميديا ستاسي وسط انشقناها احنا
+
+575
+00:41:31,060 --> 00:41:34,860
+بيصير عندنا pneumonia, pneumonia atypical غير
+
+576
+00:41:34,860 --> 00:41:39,980
+نمطية ناجمة عن جنة كمارة الانهليجيالمين لبكتيرة
+
+577
+00:41:39,980 --> 00:41:43,420
+اسمها كلاميديا ستاسي ليست منها zoonotic disease
+
+578
+00:41:43,420 --> 00:41:47,160
+انها انتقلت من الطير الى الانسانيبقى ال
+
+579
+00:41:47,160 --> 00:41:53,840
+transmission عبر ال inhalation ل ال dust المحتوي
+
+580
+00:41:53,840 --> 00:41:59,040
+على البكتيريا غالبا ناتج عن مين؟ ناتج عن ال faces
+
+581
+00:41:59,040 --> 00:42:00,040
+تبع ال birds
+
+582
+00:42:06,440 --> 00:42:11,760
+لل birds بشكل عام ال birds بشكل عام طيور لو صورت
+
+583
+00:42:11,760 --> 00:42:14,620
+شوي كان احنا اتكلمنا عن مين الاكتر فئة عرضة
+
+584
+00:42:14,620 --> 00:42:18,360
+للاصابة بال disease هتعرف ان هم ال poultry workers
+
+585
+00:42:18,360 --> 00:42:22,800
+او العاملين في قطاع الدواجن فالبكتيريا ممكن تكون
+
+586
+00:42:22,800 --> 00:42:25,040
+يعني ك normal habitat موجودة فيها في الطيور بشكل
+
+587
+00:42:25,040 --> 00:42:29,000
+عام لكن احنا متكلم معانامجتمع على سبيل المجتمع
+
+588
+00:42:29,000 --> 00:42:35,360
+مجتمع ليس بيه تربية طيور وانما فيه طيور منزلية فقط
+
+589
+00:42:35,360 --> 00:42:38,740
+بنربي ايش احنا في المنزل؟ بنحط جادة في جفص؟ ولا
+
+590
+00:42:38,740 --> 00:42:42,360
+بنحط عصافير؟ اللي هي من ضمنها هوينا مين؟ اللي من
+
+591
+00:42:42,360 --> 00:42:46,920
+أشهرها اللي هي البغبغوات بأشكالها المتنوعة؟ وانا
+
+592
+00:42:46,920 --> 00:42:51,480
+.. وانا ده الفكرة، فضل. لا لا الطير لأ، غالبا
+
+593
+00:42:51,480 --> 00:42:55,080
+بيكون normal .. normal flora، نعم normal flora أو
+
+594
+00:42:55,080 --> 00:43:01,300
+normal microbiotaDisease نيومونيا و Diagnosis بتم
+
+595
+00:43:01,300 --> 00:43:07,340
+عبر ال isolation of the organism من ال Sputum عن
+
+596
+00:43:07,340 --> 00:43:11,420
+طريق ال tissue culture لإن مستحيل جونا مرة نمي على
+
+597
+00:43:13,280 --> 00:43:17,260
+artificial media بدنا cell culture complement
+
+598
+00:43:17,260 --> 00:43:21,020
+fixation to detect اللي هو specific antibodies ال
+
+599
+00:43:21,020 --> 00:43:26,840
+treatment وهذا الكلام هيتكرر في كل العناوين
+
+600
+00:43:27,960 --> 00:43:31,340
+two drugs واحد تترسكلين هو drug of choice في ال
+
+601
+00:43:31,340 --> 00:43:35,740
+adults طبعا تترسكل الشباب أحد مساوقه أنه لا يُعطى
+
+602
+00:43:35,740 --> 00:43:39,280
+للحامل لا يُعطى للمرضى لا يُعطى للأطفال تمام
+
+603
+00:43:39,280 --> 00:43:42,180
+فبالتالي في هذه الحالة البديل اللي بيكون هو ال
+
+604
+00:43:42,180 --> 00:43:45,700
+erythromycin المرة الجاية ان شاء الله بنكمل باقي
+
+605
+00:43:45,700 --> 00:43:48,880
+ال eclamydia و بندخل على اللي هو ال rickettsia و
+
+606
+00:43:48,880 --> 00:43:49,840
+ال microplasma ان شاء الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WKKMQl3l3ek_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WKKMQl3l3ek_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..45bc6845ad5efc80c108cb1b7286baef45463a72
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WKKMQl3l3ek_raw.srt
@@ -0,0 +1,2424 @@
+1
+00:00:20,810 --> 00:00:25,390
+بسم الله الرحمن الرحيم نكمل ضمن الميكروبات ال
+
+2
+00:00:25,390 --> 00:00:27,930
+spiral organism في أنهم الميكروب Leptospira
+
+3
+00:00:27,930 --> 00:00:31,870
+interrogans وزي ما انتوا شايفين الصورة اللي أمامكم
+
+4
+00:00:31,870 --> 00:00:39,050
+هي عبارة عن very tight and narrow curves للبكتيريا
+
+5
+00:00:39,050 --> 00:00:42,330
+وهي ما يتميز بيه ال Leptospira وإن الأطراف تبعتها
+
+6
+00:00:42,330 --> 00:00:44,430
+hooked وهذه نقطة كتير كمان مهمة في ال
+
+7
+00:00:44,430 --> 00:00:47,190
+differentiation بين Leptospira وبين اللي هو
+
+8
+00:00:47,190 --> 00:00:49,190
+Triponemia Pallidum
+
+9
+00:00:51,500 --> 00:00:54,340
+أه فماعرفش نلقي على الصورة مرة تانية الثقوب اللي
+
+10
+00:00:54,340 --> 00:00:59,560
+شايفينها دي تحت ال .. ال ..الصورة هذه لأنه
+
+11
+00:00:59,560 --> 00:01:02,760
+البكتيريا انفلترة على mainly poor membrane filter
+
+12
+00:01:02,760 --> 00:01:06,440
+ال membrane filter ال poor size تبعته هذه يمكن
+
+13
+00:01:06,440 --> 00:01:09,140
+point two micron point two micron لن تسمح
+
+14
+00:01:09,140 --> 00:01:13,240
+للبكتيريا بالمرور عبرها فعشانك بتلاحظوا انه
+
+15
+00:01:13,240 --> 00:01:19,940
+البكتيريا ماخده ال long very long size لكن at the
+
+16
+00:01:19,940 --> 00:01:24,020
+same time it is very thin يعني رفيع جدا وبالتالي
+
+17
+00:01:24,020 --> 00:01:26,060
+التريبونيميا
+
+18
+00:01:27,030 --> 00:01:31,430
+والـ Leptospira أحد مشاكلهم أنه ماجراش نصبغهم بشكل
+
+19
+00:01:31,430 --> 00:01:33,870
+جيد وبالتالي بنرجع لمين؟ لل dark field،
+
+20
+00:01:33,870 --> 00:01:37,790
+مايكروسكوبيا ال causative agent للـ Leptospirosis
+
+21
+00:01:37,790 --> 00:01:41,390
+وهو عبارة عن zoonotic disease و بالمناسبة ال
+
+22
+00:01:41,390 --> 00:01:46,840
+zoonotic diseasesتحتال مكانة مهمة جدا في حياتنا
+
+23
+00:01:46,840 --> 00:01:53,060
+كبشر وما .. يعني ما فاتقت أنها بتحتال مكانة أهم
+
+24
+00:01:53,060 --> 00:01:57,220
+مما كانت عليه من قبل على الرغم من التمدن والتحضر
+
+25
+00:01:57,220 --> 00:02:00,760
+والابتعاد عن الحيوانات أو الاعتكاك بالحيوانات بشكل
+
+26
+00:02:00,760 --> 00:02:05,700
+مباشر إلا أنه لم ننجح في الانفصال عن الحيوانات وقد
+
+27
+00:02:05,700 --> 00:02:09,020
+أستطيع أن أذكر بعض الأمثلة على الاعتكاك ما بيننا
+
+28
+00:02:09,020 --> 00:02:16,040
+وبين الحيواناتالـ pets المستخدمة للزينا، البغبغاء،
+
+29
+00:02:16,040 --> 00:02:19,900
+طيور اللي بنحطها في أقفاص في البيت للزينا، البعض
+
+30
+00:02:19,900 --> 00:02:24,440
+بيحط ال genie pigs، البعض بيربي في المنزل الفراخ
+
+31
+00:02:24,440 --> 00:02:31,000
+أو الدجاج أو البط،ممكن يكون قريب هو مكان سكنه الآن
+
+32
+00:02:31,000 --> 00:02:35,040
+في قطاع غزة مع الابتداد السكاني وانحسار المساحات
+
+33
+00:02:35,040 --> 00:02:39,460
+الزراعية أصبح الكثير من السكان جيران لمزارع
+
+34
+00:02:39,460 --> 00:02:43,600
+الأبقار ومزارع الدواجن هذا احتكاك مباشر مع
+
+35
+00:02:43,600 --> 00:02:46,700
+الحيوانات غير القطط المنزلية وقطط الشوارع وبعض
+
+36
+00:02:46,700 --> 00:02:51,340
+الحيال الكلاب الضالة والطيور اللي ممكن تنزل عندك
+
+37
+00:02:51,340 --> 00:02:55,720
+برضه في المنزل والطيور المهاجرة كلها احتكاكات
+
+38
+00:02:55,720 --> 00:03:02,490
+بالحيواناتاللي ممكن أكتر من 60% من الأمراض المعضية
+
+39
+00:03:02,490 --> 00:03:06,090
+هي أمراض مشتركة بين الإنسان و الحيوان وبتالي تعتبر
+
+40
+00:03:06,090 --> 00:03:10,350
+الحيوانات كحيوانات whole ككاملة يعني كحية مصدر مهم
+
+41
+00:03:10,350 --> 00:03:15,160
+هذا بالإضافة للمصدر التانيالحيوانات كغذاء، احنا
+
+42
+00:03:15,160 --> 00:03:20,380
+بنشتري دواجن و بنشتري لحوم، أبقار وماعز ومشتقاتها
+
+43
+00:03:20,380 --> 00:03:25,680
+من ألبان وحليب وخلافه وبالتالي مرة أخرى بنقول إن
+
+44
+00:03:25,680 --> 00:03:28,940
+الـ Zoonotic Diseases مش حاجة كمالية في الماكل
+
+45
+00:03:28,940 --> 00:03:32,240
+وبالبداية حاجة أساسية لأنها بتشكل حوالي 60% من
+
+46
+00:03:32,240 --> 00:03:38,480
+الأمراض المواضية للإنسان وكميتها كثيرة أو احتكاكنا
+
+47
+00:03:38,480 --> 00:03:44,110
+كثير في الحيواناتبالنسبة للـ Habitat يعني أين
+
+48
+00:03:44,110 --> 00:03:46,770
+البكتيريا بتعيش اللي هي الـ Leptospira غالبا في ال
+
+49
+00:03:46,770 --> 00:03:50,550
+domestic livestock في المعاشية و ال pets اللي
+
+50
+00:03:50,550 --> 00:03:53,090
+بتجود علي الحيوانات اللي هو القليفة mood of
+
+51
+00:03:53,090 --> 00:03:56,630
+transmission ممكن بال direct contact مع ال urine
+
+52
+00:03:56,630 --> 00:04:00,190
+of infected animals و كيف الإنسان ممكن يتواصل أو
+
+53
+00:04:00,190 --> 00:04:03,930
+يتصل أو يحتك بال urine تبقى infected animal أعطيكم
+
+54
+00:04:03,930 --> 00:04:07,930
+مثال بسيط قد يعني لا يخطر على بالكه بعض الأحيان
+
+55
+00:04:07,930 --> 00:04:12,860
+برك السباحة المنتشرة الآن في القطاعلما بدخل
+
+56
+00:04:12,860 --> 00:04:15,300
+الإنسان البركة و بطلع منها بياخد معاه شوية ميه على
+
+57
+00:04:15,300 --> 00:04:18,860
+الحواف تبعتها، صح ولا لأ؟ لأن عند ساعة معينة و
+
+58
+00:04:18,860 --> 00:04:23,300
+بتغلق البركة، بيصير فيه هدوء، في بعض ال .. ال ..
+
+59
+00:04:23,300 --> 00:04:25,820
+ال .. البرك بتكون في مناطق نائية نوعا ما أو مناطق
+
+60
+00:04:25,820 --> 00:04:28,800
+زراعية، فيه جردان بتكون في المنطقة، ممكن تصل
+
+61
+00:04:28,800 --> 00:04:32,240
+للمياه، إذا تبول أحد ال .. ال .. ال .. ال ..
+
+62
+00:04:32,240 --> 00:04:35,900
+الجردان في الماء هذا اللي على أطراف، مش هيتبول في
+
+63
+00:04:35,900 --> 00:04:40,950
+البركة نفسها، أمام؟وأجى واحد تانى تانى يوم ولمست
+
+64
+00:04:40,950 --> 00:04:46,210
+قدماء الماء اللى فيه urine ودخل جوا البركة فأخد
+
+65
+00:04:46,210 --> 00:04:51,540
+معاهية الى بركة السباحة ومن منكم ومن منكمعندما
+
+66
+00:04:51,540 --> 00:04:55,160
+يقوم بالسباحة لا يبتلع بعضا من الماء سواء من ميط
+
+67
+00:04:55,160 --> 00:04:58,400
+البركة أو ميط البحر يعني فيه ابتلال الماء فهي
+
+68
+00:04:58,400 --> 00:05:04,160
+طريقة من طول الاحتكاك عملية تنظيف اماكن او مخازن
+
+69
+00:05:04,160 --> 00:05:08,920
+قد يكون فيها جردان ايضا الاحتكاك في فترة الشتاء
+
+70
+00:05:08,920 --> 00:05:13,500
+فاصل الشتاء لما يكون مياه المطر غزيرة و ال system
+
+71
+00:05:14,240 --> 00:05:18,800
+غير كافي انه يمرر كل الميه فبصير فيه فيضان للمياه
+
+72
+00:05:18,800 --> 00:05:23,760
+لمياه المجاري وبالتالي مياه المجاري تحتوي على ال
+
+73
+00:05:23,760 --> 00:05:27,060
+urine تبع هذه الجيور ده، اذا فيه إمكانية للاحتكاج
+
+74
+00:05:27,060 --> 00:05:31,500
+water and soil currently or recently contaminated
+
+75
+00:05:31,500 --> 00:05:35,900
+with infected urine زي ما حكينا نفس المعنى انه
+
+76
+00:05:35,900 --> 00:05:41,260
+تربة او مياه طلبوها تحديثا بال urine تبع هذه
+
+77
+00:05:41,260 --> 00:05:47,000
+الحيواناتthe organism enters the body through واحة
+
+78
+00:05:47,000 --> 00:05:54,860
+skin lesions أي خدوش أو جروح في الجسم ممكن تسبب
+
+79
+00:05:54,860 --> 00:05:58,860
+دخول ال micro organism conjunctival mucous
+
+80
+00:05:58,860 --> 00:06:01,440
+membrane و احنا كنا فاكرين الإصبع و العين هذا نقطة
+
+81
+00:06:01,440 --> 00:06:05,380
+كتير مهمة ال ingestion تناول طعام ايضا محتوي او ما
+
+82
+00:06:05,380 --> 00:06:10,320
+محتوي على ال micro organismمن ال high risks أكتر
+
+83
+00:06:10,320 --> 00:06:14,240
+ناس ممكن يكونوا عرضة للإصابة بال lipospira،
+
+84
+00:06:14,240 --> 00:06:17,800
+farmers المزارعين كمان مرة قلتلكوا ال farmers لا
+
+85
+00:06:17,800 --> 00:06:23,160
+يعني مزارعين فقط بالنباتات وانما بتربية الحيوانات
+
+86
+00:06:23,160 --> 00:06:26,800
+نعم، sewer workers اللي هم عمال المجارير اللي
+
+87
+00:06:26,800 --> 00:06:30,060
+بينظفوا المجاري أو بسلكوها أو بيعني بيعملوا عمال
+
+88
+00:06:30,060 --> 00:06:35,660
+معينة صيانة الاخرالدزيز ليبتوسبيروسيز ال
+
+89
+00:06:35,660 --> 00:06:39,960
+incubation period من أسبوع لأسبوعين بينتج عن ال
+
+90
+00:06:39,960 --> 00:06:44,340
+infection بكتيريميا و من خلال هذه البكتيريميا ال
+
+91
+00:06:44,340 --> 00:06:48,000
+organism can reach to many organs such as liver و
+
+92
+00:06:48,000 --> 00:06:50,760
+spleen و kidney و ال meninges و الconductiva و
+
+93
+00:06:50,760 --> 00:06:53,960
+بيعمل multiplication و inflammation في تلك المناطق
+
+94
+00:06:55,600 --> 00:06:59,760
+ال .. ال clinical feature أول ال disease بيبدأ ك
+
+95
+00:06:59,760 --> 00:07:04,180
+influenza-like يعني symptoms مابنميزك عن مين عن ال
+
+96
+00:07:04,180 --> 00:07:08,960
+influenza لكن بيتبعها hepatitis and meningitis
+
+97
+00:07:08,960 --> 00:07:13,640
+عشان تعرفوا كلمة hepatitis البعض لأنه شاعر
+
+98
+00:07:16,200 --> 00:07:20,380
+كلمة hepatitis B و hepatitis C فالبعض خلاص يعني
+
+99
+00:07:20,380 --> 00:07:23,460
+خصص انه ال hepatitis هي عبارة عن viral لا ال
+
+100
+00:07:23,460 --> 00:07:26,300
+hepatitis condition that can be caused by several
+
+101
+00:07:26,300 --> 00:07:31,820
+of organism لكن أكثرها شهرة اللي هو ال virus ال B
+
+102
+00:07:31,820 --> 00:07:35,920
+و ال C و ال A و ال E و ال G و ال D في مجموعة كبيرة
+
+103
+00:07:35,920 --> 00:07:37,520
+من ال hepatitis virus
+
+104
+00:07:40,230 --> 00:07:43,710
+فيه انا كمان condition بيسموه wheel's disease وهو
+
+105
+00:07:43,710 --> 00:07:47,010
+عبارة عن severe leptospirosis بيأد إلى severe
+
+106
+00:07:47,010 --> 00:07:52,570
+headache و pain في الظهر تمام منطقة الظهر
+
+107
+00:07:52,570 --> 00:07:58,040
+prostration and jaundiceممكن الـ jaundice و يكون
+
+108
+00:07:58,040 --> 00:08:02,200
+فينا hemorrhage و أيضا كمان يؤدي الى renal failure
+
+109
+00:08:02,200 --> 00:08:06,100
+إذا ال clinical feature أولها بتبدأ ك influenza
+
+110
+00:08:06,100 --> 00:08:10,720
+-like بعدين ال will disease بيتميز بأنه في عنده
+
+111
+00:08:10,720 --> 00:08:13,100
+severe headache و في عنده pain in the back و
+
+112
+00:08:13,100 --> 00:08:16,140
+prostration jaundice و زي ما قلنا ممكن يصل لمرحلة
+
+113
+00:08:16,140 --> 00:08:21,880
+من الrenal failure تفضل يا عمرو habitate
+
+114
+00:08:23,840 --> 00:08:30,180
+هيبتايتس اه يستطيع هو يتخلص من الجسم من جسمه لحاله
+
+115
+00:08:30,180 --> 00:08:37,060
+بدون أدوية ال bacterial infection بختلف عن ال
+
+116
+00:08:37,060 --> 00:08:39,480
+viral infection غالبا ال bacterial infection ال
+
+117
+00:08:39,480 --> 00:08:42,320
+viral infection بتكون self-limited self-limited
+
+118
+00:08:42,320 --> 00:08:47,140
+يعني ال system تبع ال replication تبعها بيقدّي و
+
+119
+00:08:47,140 --> 00:08:50,060
+ال immune system تبعنا بيقدّي إلى أنه يتخلص منها
+
+120
+00:08:50,060 --> 00:08:54,400
+حتى لو ما استخدنا علاجوهي حالات نادرة اللى بيتطور
+
+121
+00:08:54,400 --> 00:08:58,480
+فيها الـ Hepatitis B أو الـ C يعني المعظم حتى هذه
+
+122
+00:08:58,480 --> 00:09:02,260
+الأمراض الخطيرة المعظم بتم الشفاء منها تلقائيا لكن
+
+123
+00:09:02,260 --> 00:09:07,180
+البكتيريا لأ البكتيريا غالبا الشفاء منها بده aid
+
+124
+00:09:07,180 --> 00:09:12,450
+بده antibioticsال lab diagnosis احنا زي ما ذكرنا
+
+125
+00:09:12,450 --> 00:09:17,330
+قلنا انه هذه البكتيريا رقيقة و thin وبالتالي صعب
+
+126
+00:09:17,330 --> 00:09:20,250
+ان انا اتعامل معاها بالصباغة وبالتالي افضل طريقة
+
+127
+00:09:20,250 --> 00:09:24,130
+اللي هي ال dark field مايكروسكوبي لعينات من الدم و
+
+128
+00:09:24,130 --> 00:09:28,930
+ال CSF احنا قلنا بتصل ال blood و بتنزرع في many
+
+129
+00:09:28,930 --> 00:09:32,570
+organs وممكن نجيها كما بتعمل عاملة meningitis
+
+130
+00:09:32,570 --> 00:09:37,220
+وبالتالي ممكن ناخد عينات CSFشفتوا الصورة اللي
+
+131
+00:09:37,220 --> 00:09:39,960
+بدأنا فيها المحاضرة؟ في ال dark field microscope
+
+132
+00:09:39,960 --> 00:09:43,320
+نتوقع صورة مثل هذه او مثل هذا الشكل اللي احنا
+
+133
+00:09:43,320 --> 00:09:48,940
+رأينا very long, hooked و ال curves بتاعتها small
+
+134
+00:09:48,940 --> 00:09:52,810
+و tightممكن نعمل Serial Diagnosis عن طريق اللي هو
+
+135
+00:09:52,810 --> 00:09:56,390
+Antibody Detection Leptospira can be cultured in
+
+136
+00:09:56,390 --> 00:10:01,750
+هذا الإسم اللي يعني بده عشرة شكل اللفظ تبعه اللي
+
+137
+00:10:01,750 --> 00:10:08,160
+هو Ellingson-McLowe-Johnson-Harris Mediumو باختصار
+
+138
+00:10:08,160 --> 00:10:12,460
+EMGH which is incubated at twenty-two هذه كمان
+
+139
+00:10:12,460 --> 00:10:14,680
+نقطة او عفوا twenty-eight to thirty degrees
+
+140
+00:10:14,680 --> 00:10:17,780
+centigrade هذه ال temperature عمرنا ما ذكرناها جاب
+
+141
+00:10:17,780 --> 00:10:20,960
+ال هيكد في ال incubation لأي بكتيريا أخرى فإذا لما
+
+142
+00:10:20,960 --> 00:10:23,920
+اتكلم عن twenty-eight to thirty degrees centigrade
+
+143
+00:10:23,920 --> 00:10:27,920
+بدك تعرف ان هذه ال temperature مميزة عن باقي أنواع
+
+144
+00:10:27,920 --> 00:10:33,830
+البكتيريا بقولنا ان ال positivityفي ال culture
+
+145
+00:10:33,830 --> 00:10:38,710
+غالبا بتكون من تلت أسابيع إلى تلت أشهر مش معناه
+
+146
+00:10:38,710 --> 00:10:43,030
+تلحق ان ال culture بتستمر هذه الفترة لأ الناس اللي
+
+147
+00:10:43,030 --> 00:10:46,990
+بيطلع عندهم positive بيكون ال disease فترته ال
+
+148
+00:10:46,990 --> 00:10:50,530
+disease فترته من تلت أسابيع لقداش لتلت شهور قبل
+
+149
+00:10:50,530 --> 00:10:53,970
+ذلك بتطلع negative و بعد ذلك بتطلع نيجاتيب مش
+
+150
+00:10:53,970 --> 00:10:56,350
+معناه .. مش معناه الحكي ان ال incubation period او
+
+151
+00:10:56,350 --> 00:11:01,370
+ال incubation لل culture هي تلت أسابيع لتلت شهور
+
+152
+00:11:01,370 --> 00:11:07,920
+لأمتى بيطلع postive المريض بعد مرور تلت أسابيع و
+
+153
+00:11:07,920 --> 00:11:11,640
+ليس بعد مرور تلت أشهر يعني في الفترة الواقعية بين
+
+154
+00:11:11,640 --> 00:11:15,000
+تلت أسابيع و تلت أشهر ال treatment and prevention
+
+155
+00:11:15,000 --> 00:11:21,790
+طبعا العلاج لل Leptospira هو ال penicillinلكن كما
+
+156
+00:11:21,790 --> 00:11:25,710
+ذكرتولكم سابقا انه إذا كان زورة ال disease فالأولى
+
+157
+00:11:25,710 --> 00:11:28,670
+إذا بنعمل immunization نعمل immunization لمين؟ لل
+
+158
+00:11:28,670 --> 00:11:32,490
+animals سمعهم proper treatment and disposal of
+
+159
+00:11:32,490 --> 00:11:36,550
+contaminated water بمعنى آخر بكلمات أخرى proper
+
+160
+00:11:36,550 --> 00:11:40,470
+waste water disposal أو treatment and disposal
+
+161
+00:11:40,470 --> 00:11:46,150
+تخيلوا يا شباب أنه المياه السيوج system أو السيوج
+
+162
+00:11:46,150 --> 00:11:52,760
+sea watersewage waste water ما تتعالج وتروح على
+
+163
+00:11:52,760 --> 00:11:57,800
+المزروعات والمزارعين المزارعين مايلبسوش PPE فاكرين
+
+164
+00:11:57,800 --> 00:12:01,460
+ال PPE ال personal protective equipment وبالتالي
+
+165
+00:12:01,460 --> 00:12:04,260
+احنا جونا ال entrance تبعها ممكن يكون عبر العين
+
+166
+00:12:04,260 --> 00:12:07,340
+ممكن يكون عبر الخدوش الموجودة في الجلب عبر تناول
+
+167
+00:12:07,340 --> 00:12:12,920
+طعم المزروعات الملوثة فالاصل انه بالفعل اهم نقطة
+
+168
+00:12:12,920 --> 00:12:17,140
+في ال prevention proper waste water treatment
+
+169
+00:12:19,190 --> 00:12:22,750
+الميكروب التالت في سلسلة الـ spiral organism هو
+
+170
+00:12:22,750 --> 00:12:27,070
+الـBorrelia Recurrentis ومن اسمها Recurrentis،
+
+171
+00:12:27,070 --> 00:12:31,950
+Recurrent يعني تحدث مرة أخرى، مرة أخرى، باللغة
+
+172
+00:12:31,950 --> 00:12:37,050
+العربية بيسموها حمى الراجعومفهومها انه بيشفى منها
+
+173
+00:12:37,050 --> 00:12:41,490
+المريض تماما تمام و بعد فترة واجيزة بيرجع المرض
+
+174
+00:12:41,490 --> 00:12:48,010
+مرة اخرى و هذا مثال صارخ على بكتيريا تمتلك مقدرة
+
+175
+00:12:48,010 --> 00:12:52,290
+على antigenic variation خلال عملية ال infection
+
+176
+00:12:52,290 --> 00:12:56,150
+نفسها يعني مش بتطلع برا و بتتغير لأ و هي داخل جسم
+
+177
+00:12:56,150 --> 00:13:00,450
+الإنسان بتتغير و هي سماء مشهورة في هذه البكتيريا
+
+178
+00:13:02,270 --> 00:13:08,370
+لكن على خلاف اللى ذكرناه للـ Leptospira و الـ
+
+179
+00:13:08,370 --> 00:13:11,010
+trypanemia ان they cannot be stained this bacteria
+
+180
+00:13:11,010 --> 00:13:14,050
+can be stained و can be stained by gemza stain
+
+181
+00:13:14,050 --> 00:13:17,910
+جمزا ستاين اللى ساخدنته لمن؟ لل blood film و هذه
+
+182
+00:13:17,910 --> 00:13:21,010
+بالفعل ناخد blood film او blood sample و بنعمله
+
+183
+00:13:21,010 --> 00:13:23,670
+blood film و بنعمله staining بالجمزا ستاين و بنشوف
+
+184
+00:13:23,670 --> 00:13:26,250
+البكتيريا عارفينى ايش معنى الحكى يا شباب لما نشوف
+
+185
+00:13:26,250 --> 00:13:30,770
+بكتيريا في blood filmمعنى الحاجة أن ال number
+
+186
+00:13:30,770 --> 00:13:34,890
+تبعها في الدم هو عالي جدا .. نعم عالي جدا وبتالي
+
+187
+00:13:34,890 --> 00:13:38,230
+يعني إما قريب من ال white blood cell أو من ال red
+
+188
+00:13:38,230 --> 00:13:41,990
+blood cell فلما يلاجيها بإعداد كبيرة زي ال red
+
+189
+00:13:41,990 --> 00:13:45,010
+blood cell معناه الحاجة أنها بالملايين في .. لكل
+
+190
+00:13:45,010 --> 00:13:50,410
+mil .. لكل mil من ال blood طيبCan grow in media
+
+191
+00:13:50,410 --> 00:13:53,770
+برضه على عكس الأورانيات هذه البكتيريا بتنمو في
+
+192
+00:13:53,770 --> 00:13:57,710
+ميديا موجود فيها سيرام وتيشيو اكستراكت high
+
+193
+00:13:57,710 --> 00:13:59,830
+frequency of antigenic variation الكلام اللي
+
+194
+00:13:59,830 --> 00:14:03,630
+حاكيناه in major surface protein ولو انه ال
+
+195
+00:14:03,630 --> 00:14:08,150
+antigenic variation in minor proteinكان الجسم
+
+196
+00:14:08,150 --> 00:14:13,170
+بتأثرش بس لإنه major protein بمعنى إنه جسمنا بيكون
+
+197
+00:14:13,170 --> 00:14:16,970
+أجسام مضادة بيكون أجسام مضادة ضد هذا ال major
+
+198
+00:14:16,970 --> 00:14:22,330
+protein فالآن أنا عندي protein X protein X كونته
+
+199
+00:14:22,330 --> 00:14:26,590
+Antibody بقدر أكافح البكتيرا من خلاله لكن لو X صار
+
+200
+00:14:26,590 --> 00:14:31,970
+X1ال antibody تبعي ما زال X وبالتالي .. بالظبط
+
+201
+00:14:31,970 --> 00:14:37,410
+فخلال الفترة ال antibody بيقضي على معظم البكتيريا
+
+202
+00:14:37,410 --> 00:14:41,370
+اللي بتحتوي على X تمام؟ لكن بيضل اللي واحدة او
+
+203
+00:14:41,370 --> 00:14:46,090
+تنتين من البكتيريا طوروا X1 فكل البكتيريا الأخرى
+
+204
+00:14:46,090 --> 00:14:49,140
+بتموت من معادها او تنتين فبيشفى المريضهدولا
+
+205
+00:14:49,140 --> 00:14:52,020
+التنتين بياخدوا وقت في الانقسام و الوصول الى رقم
+
+206
+00:14:52,020 --> 00:14:55,900
+اللى مطلوب لاحدث ال disease فبترجع الحب مرة اخرى
+
+207
+00:14:55,900 --> 00:14:59,060
+هذا العمل ممكن تتكرر لشباب من تلت الى خمس مرات فى
+
+208
+00:14:59,060 --> 00:15:05,220
+المريض الواحد ففي عندنا مشكلة كبيرة فى هذا ال
+
+209
+00:15:05,220 --> 00:15:08,760
+disease و خاصة لما نعرف ال symptoms كمان شوية و
+
+210
+00:15:08,760 --> 00:15:12,440
+خاصة لما نعرف طرق الانتقال يعنى بكتيريا عندها
+
+211
+00:15:12,440 --> 00:15:16,160
+المقدرة علىالـ Antigenic variation و عندها انتقال
+
+212
+00:15:16,160 --> 00:15:20,220
+بطرق عجيبة ممكن تنتقل عن طريق ال ticks الحشرات
+
+213
+00:15:20,220 --> 00:15:23,600
+اللي بتنتص الدم القرراد ممكن تنتقل عن طريق القمل
+
+214
+00:15:23,600 --> 00:15:27,580
+تمام سواء كان ال head lost أو ال body lost فيه
+
+215
+00:15:27,580 --> 00:15:34,620
+أنجمل احنا في فلسطين و لا خلص قمل ضايل مع ال gel
+
+216
+00:15:34,620 --> 00:15:39,680
+اللي بيستخدموه الشباب اليامها دي بزيد بالكم طيب
+
+217
+00:15:42,350 --> 00:15:46,130
+القمل هو ليس خدوا بالكه، ليس معبرا على النظافة
+
+218
+00:15:46,130 --> 00:15:50,950
+الشخصية، يعني قد تكون أنت من أنظف الناس، طبعا، لكن
+
+219
+00:15:50,950 --> 00:15:56,250
+اللي لاجي عندك جمل، كيف؟ واحد لو كان infested،
+
+220
+00:15:56,250 --> 00:15:58,930
+infested زي infected أه، بس احنا لما نتكلم عن
+
+221
+00:15:58,930 --> 00:16:02,150
+اكتوبرازايت بنقول infestation، بنقولش infection
+
+222
+00:16:02,150 --> 00:16:08,560
+أه، infected أو infestedفممكن ينقل .. ينقل للآخرين
+
+223
+00:16:08,560 --> 00:16:11,840
+القمل مع العلم أن الآخرين كنا كلهم إيه ال .. ال
+
+224
+00:16:11,840 --> 00:16:15,020
+hygiene تبعهم و ال personal hygiene موجود لكن م ..
+
+225
+00:16:15,020 --> 00:16:20,040
+واضح أنه بيزداد القمل في الظروف الصعبة زي الحروب،
+
+226
+00:16:20,040 --> 00:16:23,980
+الحصار، ال .. الأوقات اللي .. اللي مافيش فيها يعني
+
+227
+00:16:23,980 --> 00:16:28,680
+مياه صالحة لل .. للاستحمام أو لل .. للشرب هذه ..
+
+228
+00:16:28,680 --> 00:16:31,360
+هذه بتكون أوقات صعبة صحية و ممكن تتشر فيها القمل،
+
+229
+00:16:31,360 --> 00:16:33,720
+فضلا ليلة؟
+
+230
+00:16:36,250 --> 00:16:39,810
+هناك بعض ال .. ال .. اول حاجة نظافة شخصية جوناها و
+
+231
+00:16:39,810 --> 00:16:43,290
+في بعض المبيدات المستخدمة كيمويات المستخدمة احنا
+
+232
+00:16:43,290 --> 00:16:45,890
+على زماننا كانوا يستخدموا ال DDT در بالكو كانوا
+
+233
+00:16:45,890 --> 00:16:50,270
+يرشونا بالمدارس و انا و انا الصغار .. نعم كنا نطلع
+
+234
+00:16:50,270 --> 00:16:52,630
+من الصف .. انا بعد كنت في صف أول و صف تاني كانوا
+
+235
+00:16:52,630 --> 00:16:57,190
+بالفعل يستخدموا ال DDT بالعفاطة هذه الجدوية تمام؟
+
+236
+00:16:57,190 --> 00:17:00,730
+فكنا نطلع من الفصل كأنه طلعين من المطحنة من الدقيق
+
+237
+00:17:00,730 --> 00:17:05,840
+يعنيلكن كان effective في ال control للأكل للأسف
+
+238
+00:17:05,840 --> 00:17:10,660
+اكتشاف و بعد ذلك انه يعني very toxic لل human اللي
+
+239
+00:17:10,660 --> 00:17:16,880
+هو ال DDT و الآن هو يعني عالميا من المبيدات
+
+240
+00:17:16,880 --> 00:17:20,560
+الممنوعة لكن هناك مبيدات موجودة للقمر او أدوية
+
+241
+00:17:20,560 --> 00:17:27,040
+يعني لا لا دي راجعلك اذا كان فيه خدوش لو كان في
+
+242
+00:17:27,040 --> 00:17:32,730
+جروح في الرأس قد تقتل الإنسانvery toxic، هي صحيح
+
+243
+00:17:32,730 --> 00:17:35,990
+toxic لل .. لكن لو كان في جروح أو خدوش في الرأس قد
+
+244
+00:17:35,990 --> 00:17:39,830
+تقتل، انا عارف ان في practice موجود في غزة في هذا
+
+245
+00:17:39,830 --> 00:17:43,270
+الموضوع قديم لكن انقطع، يعني مافيش شغل ممكن عند
+
+246
+00:17:43,270 --> 00:17:48,670
+بعض الناس ضايق، اما ابتدالي مادة بيسموها براسيا من
+
+247
+00:17:48,670 --> 00:17:52,570
+منتجات النحاس اعتقد هي، اه، هذه سامة جدا لل ..
+
+248
+00:17:52,570 --> 00:17:56,630
+للحشرات وسامة للانسان نفسهإذا جونا ticks اللي هو
+
+249
+00:17:56,630 --> 00:18:01,290
+القراد والقمل ومن infected rodents to human ومن
+
+250
+00:18:01,290 --> 00:18:03,770
+infected human to human يعني من إنسان أيضا لمين
+
+251
+00:18:03,770 --> 00:18:10,250
+لإنسان إذا في عندها وسائل متنوعة في الانتقال ال
+
+252
+00:18:10,250 --> 00:18:14,950
+clinical feature في عندها بكتيريميا وفي عندها non
+
+253
+00:18:14,950 --> 00:18:18,310
+periodic rash at bite site وينما كان العضة بيكون
+
+254
+00:18:18,310 --> 00:18:23,470
+في طفح جلدي لكن غير صديدي مافيش فيه أي سوائل مافيش
+
+255
+00:18:23,470 --> 00:18:29,440
+فيه أي سوائلممكن ينتج أيضًا fever وارتعاش أو رعشة
+
+256
+00:18:29,440 --> 00:18:36,000
+غالبًا في فترة اللي هو الحمّة العالية وممكن ال
+
+257
+00:18:36,000 --> 00:18:42,800
+headache اللي هو الصداع لفترة أسابيع وتمتد إلى
+
+258
+00:18:42,800 --> 00:18:50,440
+شهر، إذا في عندي مجموعة من العراض الصعبة ممكن
+
+259
+00:18:50,440 --> 00:18:56,910
+كمرة تمتد من أسابيع إلى شهروبعد هذه المرحلة الأولى
+
+260
+00:18:56,910 --> 00:19:02,630
+برضه بأسابيع أو شهور ممكن يظهر عندنا أعراض متعلقة
+
+261
+00:19:02,630 --> 00:19:10,380
+بالقلب وبالأعصابو ايضا من اكتر ما يميز الاعراض في
+
+262
+00:19:10,380 --> 00:19:13,900
+هذا ال bacterial infection هو prominent arithritis
+
+263
+00:19:13,900 --> 00:19:17,940
+والارثريتس قد تكون ناجمة عن ال antigen antibody
+
+264
+00:19:17,940 --> 00:19:21,120
+binding يعني ارتباط الانتجن والانتي بادي وال
+
+265
+00:19:21,120 --> 00:19:27,040
+deposition في اللي هو ال knees اللي هو المفاصل او
+
+266
+00:19:27,040 --> 00:19:31,700
+الركب بالذات يعني وبالتالي بيصير فينا arithritis
+
+267
+00:19:31,700 --> 00:19:36,420
+prominent arithritisال lab diagnosis غالبا بيتم
+
+268
+00:19:36,420 --> 00:19:39,900
+عبر الجمزا stain بناخد عينة دم اللي عملها جمزا
+
+269
+00:19:39,900 --> 00:19:43,220
+stain وبنشوف البكتيريا اللي ذكرنالكوا شكلها قبل
+
+270
+00:19:43,220 --> 00:19:46,360
+قليل ممكن يكون ال detection لل IGM وال IGM كل كتير
+
+271
+00:19:46,360 --> 00:19:51,440
+في وجوده معبر عن recent infectionبينما إذا IGG
+
+272
+00:19:51,440 --> 00:19:55,960
+مضطرين نعمل ما يسمى بال rise antibody titer من ال
+
+273
+00:19:55,960 --> 00:19:59,220
+acute stage إلى ال convalescent stage بيقولنا
+
+274
+00:19:59,220 --> 00:20:03,000
+بنجيس ال antig على مرحلتين في مرحلة ال acute و
+
+275
+00:20:03,000 --> 00:20:06,400
+مرحلة ال convalescent طب حد بيسأل بيقولطب واش
+
+276
+00:20:06,400 --> 00:20:09,060
+استفادنا احنا؟ او واش استفاد المريض اللي ما يعمل
+
+277
+00:20:09,060 --> 00:20:10,960
+عينة تانية في فترة ال convalescent؟ ال
+
+278
+00:20:10,960 --> 00:20:13,820
+convalescent بمعناه تحكي ان المريض شوفية اصلا،
+
+279
+00:20:13,820 --> 00:20:18,780
+المريض شوفية، فهل هناك فائدة من انه نعمل diagnosis
+
+280
+00:20:18,780 --> 00:20:23,180
+بعد ما المريض شوفية؟ نعم هناك فائدةشيء بقى فيه هنا
+
+281
+00:20:23,180 --> 00:20:28,820
+حاسمة Epidemiological Investigation أحد أسوأ أشياء
+
+282
+00:20:28,820 --> 00:20:32,120
+في النظام الصحي الفلسطيني عندنا أنه ماعناش records
+
+283
+00:20:32,120 --> 00:20:34,860
+جيدة بالأمراض ليش ماعناش records جيدة بالأمراض
+
+284
+00:20:34,860 --> 00:20:38,420
+لسببين السبب الأول أنه عندنا bad records يعني
+
+285
+00:20:38,420 --> 00:20:42,380
+موضوع سجلات طبية عندنا في قطاع غزة سيئ للغاية يعني
+
+286
+00:20:42,380 --> 00:20:46,540
+تسجيل لو بدنا ناخد مثلا مائة حالة بمرض معين مستحيل
+
+287
+00:20:46,540 --> 00:20:51,090
+نلاقي مائة سجل كامل المعلوماتيبقى فينا مشكلة في
+
+288
+00:20:51,090 --> 00:20:53,730
+مين؟ في ال medical records لكن الأهم ال medical
+
+289
+00:20:53,730 --> 00:20:56,410
+records و قبل ال medical records المفروض اللي هو
+
+290
+00:20:56,410 --> 00:21:00,030
+ال diagnosis اننا نعمل correct diagnosis تخيلوا
+
+291
+00:21:00,030 --> 00:21:04,550
+واحد إيجانا fever و علجناه و احنا مش عارفين و كلمة
+
+292
+00:21:04,550 --> 00:21:09,190
+fever disease هو؟ ولا عرض؟ عرض و بيشترك فيها كام
+
+293
+00:21:09,190 --> 00:21:13,110
+مليون مرض كتير، مظبوط ولا لأ؟ واحد fever و أعطيناه
+
+294
+00:21:13,110 --> 00:21:17,150
+antibiotic و ماعرفناش السببيبقى مجددا انا هحط في
+
+295
+00:21:17,150 --> 00:21:20,190
+السيريلات ال diagnosis وبتالي انا ماجي اعمل
+
+296
+00:21:20,190 --> 00:21:24,290
+احصائية ال disease اللي انا علجته انا مش عارفه ايش
+
+297
+00:21:24,290 --> 00:21:31,080
+لسميهمااسموش فيبرة فبالتالي انا انا خسرت معلومات و
+
+298
+00:21:31,080 --> 00:21:34,280
+بيانات كان .. كان ممكن استفيد منها في التخطيط
+
+299
+00:21:34,280 --> 00:21:38,260
+للقضاء على أمراض معينة لو فترضنا انها موجودة
+
+300
+00:21:38,260 --> 00:21:41,680
+وبالتالي ال diagnosis يا شباب مهم جدا حتى لو
+
+301
+00:21:41,680 --> 00:21:47,440
+المريض المعني لم يستفد منه بشكل مباشر المجتمع اه
+
+302
+00:21:47,440 --> 00:21:51,720
+بيستفيد منه اذا مداشن يعني نفكر زي بعض التفكير
+
+303
+00:21:51,720 --> 00:21:57,070
+العقيم لبعض الناس انه لما بتعملي مزرعة انتبتقولي E
+
+304
+00:21:57,070 --> 00:21:59,610
+.coli ولا بتقولي Klebsiella ولا بتقولي stuff ولا
+
+305
+00:21:59,610 --> 00:22:03,530
+بتقولي انا اش .. اش فارقة معايا انا من تعملي قائمة
+
+306
+00:22:03,530 --> 00:22:06,250
+باسمها المضادات الحيوية اللي sensitive و resistant
+
+307
+00:22:06,250 --> 00:22:09,710
+لها البكتيريا فبختار ال antibiotic هذا .. هذا بعض
+
+308
+00:22:09,710 --> 00:22:14,430
+التفكير عند الناس موجود عند أطباءوكتير حوارنا
+
+309
+00:22:14,430 --> 00:22:18,110
+الناس دولة انه لا يا عم انتوا هيك مخطئين مش كل
+
+310
+00:22:18,110 --> 00:22:23,370
+مايكروب معزول هو أصلا مسبب لمرض وده نقطة مهمة مش
+
+311
+00:22:23,370 --> 00:22:25,990
+فيه normal microbiota بعض اللي هم تكون ال E coli
+
+312
+00:22:25,990 --> 00:22:30,430
+من ال stool تعني شيء لا تعني شيء رقم اتنين انت
+
+313
+00:22:30,430 --> 00:22:34,050
+لازم تكون حريص جدا على معارفة الميكروب بدقة حتى
+
+314
+00:22:34,050 --> 00:22:36,810
+تقدر تعرف ال epidemiology لأ ال diseases اللي
+
+315
+00:22:36,810 --> 00:22:42,610
+موجودة وبالتالي تضع سياسات لمكافحة أعطيكم مثلال ..
+
+316
+00:22:42,610 --> 00:22:46,990
+ال group B streptococci في أوروبا كانت number one
+
+317
+00:22:46,990 --> 00:22:51,450
+cause of meningitis neonatal meningitis عملوا
+
+318
+00:22:51,450 --> 00:22:54,450
+vaccine او عملوا بلاش فاكسين عفوا مش فاكسين عملوا
+
+319
+00:22:54,450 --> 00:22:58,990
+system لل diagnosis ولل treatment للأم خلال
+
+320
+00:22:58,990 --> 00:23:02,970
+الولادة خلال فترة الولادةالان من ال number one
+
+321
+00:23:02,970 --> 00:23:06,430
+cause of neonatal meningitis اتغير الرقم اتغير
+
+322
+00:23:06,430 --> 00:23:10,290
+لانه تدخلنا احنا احنا اتدخلنا نوعا ما بطريقة
+
+323
+00:23:10,290 --> 00:23:15,230
+ايجابية فالاصل ان معرفتي بالميكروبات ومسببات
+
+324
+00:23:15,230 --> 00:23:18,570
+الأمراض بتساعدني في التخطيط المستقبلي فلا تقوللي
+
+325
+00:23:18,570 --> 00:23:21,990
+ان المريض لازم ما استفادش حتى لو ما استفاد المريض
+
+326
+00:23:21,990 --> 00:23:25,690
+يبقى لازم نعمل احنا correct diagnosis طيب
+
+327
+00:23:28,940 --> 00:23:35,400
+rigors زي .. يعني تصلبات أو رعشات يعني .. رعشة
+
+328
+00:23:35,400 --> 00:23:42,280
+يبقى فينا طرق مطلقة لل .. لل lab diagnosis, gene
+
+329
+00:23:42,280 --> 00:23:46,220
+sustaining, detection of IgG أو rise in Ig .. عفوا
+
+330
+00:23:46,220 --> 00:23:50,280
+IgM أو rise in IgG و ال PCR و أنا كنت الصبح في
+
+331
+00:23:50,280 --> 00:23:53,920
+المحاضرة عن طالبات بقولهم ال PCRأصبح منتشر بشكل
+
+332
+00:23:53,920 --> 00:23:57,240
+كبير وبتالي هذا بيسهل اي عملية اللي هو ال
+
+333
+00:23:57,240 --> 00:24:01,080
+diagnosis البعض يظن ان ال PCR is expensive لأ
+
+334
+00:24:01,080 --> 00:24:05,900
+البعض قد تحول من ال culture إلى ال PCR حتى يقلل
+
+335
+00:24:05,900 --> 00:24:10,200
+المصاريف فالان ال PCR صارت تقنية شائعة ورخيصة
+
+336
+00:24:10,200 --> 00:24:13,360
+ومتوفرة بشكل كبير treatment and prevention في
+
+337
+00:24:13,360 --> 00:24:18,500
+عندنا ال amoxicillinوهو احد مشتقات البنسالين
+
+338
+00:24:18,500 --> 00:24:23,560
+السيطرة على تلت أشياء المهمة جدا اللي بتنقل المرض
+
+339
+00:24:23,560 --> 00:24:30,050
+اللي هم القملو القراد و القوارض هذه لازم نعمل
+
+340
+00:24:30,050 --> 00:24:32,210
+برامج سيطرة عليها ايش ان برامج سيطرة او برامج
+
+341
+00:24:32,210 --> 00:24:37,430
+مكافحة انتوا بتعرفوا في المدارس .. في المدارس كان
+
+342
+00:24:37,430 --> 00:24:43,390
+في سنة .. في سنين احنا كنا نحلج الشعر على درجة ..
+
+343
+00:24:43,390 --> 00:24:47,050
+درجة صفر بمعنى انه مافيش شعر يعني و السبب في ذلك
+
+344
+00:24:47,050 --> 00:24:51,330
+هو احد .. احد كانت اوجه مكافحة اللي هو القمر و
+
+345
+00:24:51,330 --> 00:24:55,250
+الحشرات تمام؟لأنه ال .. ال .. ال .. في حالة إنه
+
+346
+00:24:55,250 --> 00:24:59,930
+لما يكون الشعر طويل قد يكون مخفي لكن مافيش شعر،
+
+347
+00:24:59,930 --> 00:25:03,610
+مافيش بيئة مناسبة لل .. فكانت أحد الطرق المكافحة
+
+348
+00:25:03,610 --> 00:25:07,330
+استخدام المبيدات زي ما حكينا ال .. ال rodents كان
+
+349
+00:25:07,330 --> 00:25:14,620
+في فترة من فترة جوائزفي البلديات لمن يستعد عدد
+
+350
+00:25:14,620 --> 00:25:20,180
+معين من الطريقة العقيمة الطريقة الأفضل كانت الان
+
+351
+00:25:20,180 --> 00:25:23,580
+سارية ان مع انت بتروح تدفع واصل الميه في البلدية
+
+352
+00:25:23,580 --> 00:25:30,580
+بيعطوك ظرف فيه اللي هو مادة سامة للجردان هذه طريقة
+
+353
+00:25:30,580 --> 00:25:35,520
+جيدة لمكافحة الجردان وبالفعل خففت التوعيط الناس
+
+354
+00:25:35,520 --> 00:25:38,780
+الجردان وين بتيجي الجردان بتيجي على أماكن فيها
+
+355
+00:25:38,780 --> 00:25:43,240
+غذاء فيها غذاءواحد مربى دواجن و بيحطلهم قمح و كده
+
+356
+00:25:43,240 --> 00:25:46,880
+فبتلاقي الجوردان مردين فتوعيت الناس بطريقة التربية
+
+357
+00:25:46,880 --> 00:25:51,400
+بكيف انه يضعوا الأكل يخزنوه و كده هذه أشياء حدت من
+
+358
+00:25:51,400 --> 00:25:54,960
+اللي هو انتشار الجوردان ال hygienic measures اللي
+
+359
+00:25:54,960 --> 00:25:58,260
+هي الإجراءات النظافة و النظافة اللي اقصد فيها هنا
+
+360
+00:25:58,260 --> 00:26:01,480
+فقط النظافة الشخصية و انما النظافة العامة في
+
+361
+00:26:01,480 --> 00:26:05,720
+المجتمع وإن في نفايات في الشوارع ثق تماما انك
+
+362
+00:26:05,720 --> 00:26:11,330
+هتلاقي قطط و هتلاقي أيضا كمان اللي هو جوردانأحنا
+
+363
+00:26:11,330 --> 00:26:16,130
+بنكون أنهينا الـ Trypanemia و أنهينا الـ
+
+364
+00:26:16,130 --> 00:26:19,130
+Leptospira و أنهينا اللي هو الـ Borrelia بس في
+
+365
+00:26:19,130 --> 00:26:23,270
+نقطة لازم أقولها مش مذكورة عنها في الكتاب في
+
+366
+00:26:23,270 --> 00:26:27,170
+أمريكا مرض مشهور اسمه Lyme Disease Lyme Disease و
+
+367
+00:26:27,170 --> 00:26:30,970
+بتسببه برضه Borrelia اسمها Borrelia Burgdorferi
+
+368
+00:26:30,970 --> 00:26:35,910
+Borrelia Burgdorferi يبقى فيها إنه مجموعة من ال
+
+369
+00:26:35,910 --> 00:26:40,650
+spiral organism بيسببوا أمراض للإنسانمنها ما هو
+
+370
+00:26:40,650 --> 00:26:45,370
+sexual .. sexual transmitted زي تريبونيميا، منها
+
+371
+00:26:45,370 --> 00:26:49,530
+ما هو rodent transmitted، منها ما هو insect اللي
+
+372
+00:26:49,530 --> 00:26:50,370
+هو transmitted
+
+373
+00:26:57,640 --> 00:27:02,080
+يمكن في البكتيريا الموضوع الأخير أو القبض الأخير
+
+374
+00:27:02,080 --> 00:27:06,540
+اللى أمامكوا الآن اللى هو الكلاميديا والريكيزيا
+
+375
+00:27:06,540 --> 00:27:10,320
+والمايكو بلازم انا يمكن الانواع كلاميديا وريكيزيا
+
+376
+00:27:10,320 --> 00:27:14,240
+ومايكو بلازم وريكيزيا افضل ان اتكلم عنهم كلاميديا
+
+377
+00:27:14,240 --> 00:27:19,360
+وريكيزيا ومايكو بلازم خدوا بالكوا التلات أسماء
+
+378
+00:27:19,360 --> 00:27:22,720
+اللى قدامكوا هدولة مميزين لحالهم بدون ما اتكلم
+
+379
+00:27:22,720 --> 00:27:26,900
+عنهم ولا كلمةميزناهم و وضعنا لهم في ال
+
+380
+00:27:26,900 --> 00:27:33,020
+microbiology يعني من ذاكراتنا و من صفحاتنا أجزاء
+
+381
+00:27:33,020 --> 00:27:37,060
+مميزة ليش؟ لأن هم المميزين ال Clamydia و ال
+
+382
+00:27:37,060 --> 00:27:41,260
+Rickettsia على سبب المثال are the only obligate
+
+383
+00:27:41,260 --> 00:27:45,260
+intracellular parasites ايش يعني obligate
+
+384
+00:27:45,260 --> 00:27:49,120
+intracellular parasites؟ لا يستطيعوا لن يستطيعوا
+
+385
+00:27:49,120 --> 00:27:54,690
+المعيشة بشكل حر البتةليش؟ لأن عندهم مشكلة عندهم
+
+386
+00:27:54,690 --> 00:27:58,690
+مشكلة ليش مشكلتهم؟ هم بكتيريا كاملة .. كاملة
+
+387
+00:27:58,690 --> 00:28:03,890
+التكوين لكن ليس لديهم المقدر على إنتاج ال ATP ليس
+
+388
+00:28:03,890 --> 00:28:09,290
+لديهم المقدر على إنتاج ال ATP هل هناك إمكانية
+
+389
+00:28:09,290 --> 00:28:19,590
+لمخلوق انه يتبادل ويصنع ويعمل وينقل ويكون ويهضم
+
+390
+00:28:19,590 --> 00:28:24,170
+بدون ATP؟ مستحيلزي ما احنا في مجتمعاتنا بنشتري
+
+391
+00:28:24,170 --> 00:28:27,690
+بفلوس لفلوس تبعتنا، بعطيك انا خمسة برجال اتنين على
+
+392
+00:28:27,690 --> 00:28:31,790
+حسب السلعة، تمام؟ ال ATP كذلك، بدك تنجل فوسفات،
+
+393
+00:28:31,790 --> 00:28:34,490
+خدها، okay فوسفات، خد هاي اتنين ATP و رجالي
+
+394
+00:28:34,490 --> 00:28:37,690
+التالت، انا بعطيك تلاتة، هو بعطيني، باخد اتنين و
+
+395
+00:28:37,690 --> 00:28:42,840
+رجالي واحدبعطيه واحد بضيف لي عليهم كمان واحد يعني
+
+396
+00:28:42,840 --> 00:28:47,820
+أجار أجرة يبقى ال ATP ضرورة من الضرورات وبالتالي
+
+397
+00:28:47,820 --> 00:28:51,040
+لن يستطيعوا المعيشة بدون خلية لأنه مين اللي بنتج
+
+398
+00:28:51,040 --> 00:28:55,360
+ال ATP احنا اللي بنتج ال ATP الخلايا بشكل عام
+
+399
+00:28:55,360 --> 00:28:59,980
+وبالتالي البكتيريا مضطرة عشان تعيش لازم تعيش داخل
+
+400
+00:28:59,980 --> 00:29:04,960
+الخلاياطبعا الفيروسات كذلك الأمر بس الفيروسات
+
+401
+00:29:04,960 --> 00:29:09,900
+معتمدة اعتماد كامل على ال machinery of their cells
+
+402
+00:29:09,900 --> 00:29:13,820
+او their host cells بس هذه البكتيريا فقط بدها مين؟
+
+403
+00:29:13,820 --> 00:29:16,780
+ال ATP بدها ال ATP زاد الغذاء فضل
+
+404
+00:29:21,970 --> 00:29:25,350
+يعني العلاقة اللي درسناهم في أول فصل إذا أنت
+
+405
+00:29:25,350 --> 00:29:29,430
+بتتكلم عن ال description لل terminology للمصطلحات
+
+406
+00:29:29,430 --> 00:29:35,810
+احنا وصفنا علاقة مخلوقين ببعض إما ب mutualism صح
+
+407
+00:29:35,810 --> 00:29:40,850
+أو commensalism أو parasitism فبتالي هي علاقة
+
+408
+00:29:40,850 --> 00:29:44,050
+parasite وبتالي سميناها obligate intracellular
+
+409
+00:29:44,050 --> 00:29:47,570
+parasite لما هي استفيد مني أنا كخلايا و بتعملي
+
+410
+00:29:47,570 --> 00:29:50,430
+destruction في الآخر يبقى هي بتضرني وبتالي
+
+411
+00:29:50,430 --> 00:29:56,440
+parasitismالـ Mycoplasma اللي في النص ليش مميزها؟
+
+412
+00:29:56,440 --> 00:30:01,740
+واحد مالهاش cell wall رقم اتنين small it is the
+
+413
+00:30:01,740 --> 00:30:04,800
+smallest free living bacteria مش obligate انت
+
+414
+00:30:04,800 --> 00:30:08,560
+سياخدوا بالكوا هي مش obligate انت يعني بتعيش ممكن
+
+415
+00:30:08,560 --> 00:30:16,420
+نميها على أطباق artificial media طيب نبدأ
+
+416
+00:30:16,420 --> 00:30:20,320
+بالإقلاميةالكلاميديا ناخد بعض ال general
+
+417
+00:30:20,320 --> 00:30:22,900
+characteristics obligate intracellular بكتيريا
+
+418
+00:30:22,900 --> 00:30:26,480
+الكلها محاكينها have ribosomes like بكتيريا عارفين
+
+419
+00:30:26,480 --> 00:30:30,360
+ليش الجملة دي؟ عشان نقولكوا إنها حقا بكتيريا لإن
+
+420
+00:30:30,360 --> 00:30:33,240
+الفيروسات مافيش فيها organelles مافيش فيها
+
+421
+00:30:33,240 --> 00:30:37,560
+ريبوزومات بينما البكتيريا دي فيها ribosomes they
+
+422
+00:30:37,560 --> 00:30:40,080
+are metabolically deficient في عندها مشكلة في
+
+423
+00:30:40,080 --> 00:30:42,720
+الميتابولزم وحاكينها لكوا إيش المشكلة عدم مقدرتها
+
+424
+00:30:42,720 --> 00:30:46,440
+على تصنيها اللي قيتهاالـ Morphology دي are small
+
+425
+00:30:46,440 --> 00:30:50,740
+rounded organism multiply by binary fission cell
+
+426
+00:30:50,740 --> 00:30:54,180
+wall consist of inner and outer membrane وهد
+
+427
+00:30:54,180 --> 00:30:57,980
+الكلام لم نريده لفى ال gram negative بكتيريا لكن
+
+428
+00:30:57,980 --> 00:31:01,960
+تختلف عن ال gram negative بكتيريا بحاجة واحدة
+
+429
+00:31:01,960 --> 00:31:07,460
+اشهية لأ ان هد .. لأ بقى الكلام عن ال cell wall لأ
+
+430
+00:31:07,460 --> 00:31:10,850
+تحتوي على ال Peptidoglycanبينما الـ Gram Negative
+
+431
+00:31:10,850 --> 00:31:14,410
+بكتيريا فيها حتى و لو كان طبقة واحدة لكن هنا مافيش
+
+432
+00:31:14,410 --> 00:31:22,030
+بتدرج لايكان حقيقي من ال spaces المهمة نسمع
+
+433
+00:31:22,030 --> 00:31:25,330
+الأسماء لأن أسماء نوعا ما يعني البعض منها غريب
+
+434
+00:31:25,330 --> 00:31:30,650
+Clamydia Cetaceae ال P هنا ساكن Cetaceae جاية من
+
+435
+00:31:30,650 --> 00:31:37,090
+كلمة Cetacene و Cetacene معناها Cetacene معناها ال
+
+436
+00:31:37,090 --> 00:31:41,890
+باروتز باروتز اللي هي البغبغاءالببغاء أو البغبغاء
+
+437
+00:31:41,890 --> 00:31:44,750
+تمام اللي هو الطير المعروف الجميل واعتقدوا ان في
+
+438
+00:31:44,750 --> 00:31:49,630
+مننا كتير بيربوا من شبابنا ومن أبناءنا بيربوا
+
+439
+00:31:49,630 --> 00:31:55,410
+ببغاء في بيوتهم تمام كنوع من الزينة و الجمال إذا
+
+440
+00:31:55,410 --> 00:31:59,050
+الكلاميديا ستاسي خدوا بالكم مش مرتبين حسب الأهمية
+
+441
+00:31:59,050 --> 00:32:01,750
+مش مرتبين حسب الأهمية لقم تلاتة هي الأهم على
+
+442
+00:32:01,750 --> 00:32:05,320
+الإطلاقKlamydia Pneumonia سهلة Klamydia
+
+443
+00:32:05,320 --> 00:32:08,700
+Trachomatis بتسبب مرض باللغة العربية بيسموه
+
+444
+00:32:08,700 --> 00:32:12,960
+Trachoma واعتقد انه الاسم أصلا Trachomatis أُخد من
+
+445
+00:32:12,960 --> 00:32:17,800
+Trachoma لأن Trachoma مرض معروف زمان من زمان وهو
+
+446
+00:32:17,800 --> 00:32:22,460
+مرض يصيب العين ويؤدي إلى فقدان البصر إلى العمى
+
+447
+00:32:22,460 --> 00:32:26,800
+يعني blindness كمان
+
+448
+00:32:26,800 --> 00:32:30,880
+مرة Klamydia Cetaceae Klamydia Pneumonia Klamydia
+
+449
+00:32:30,880 --> 00:32:34,850
+Trachomatisالكالتشرال ال characteristics they may
+
+450
+00:32:34,850 --> 00:32:38,650
+be grown on .. احنا متفاقين مش اللي حيان موعالة
+
+451
+00:32:38,650 --> 00:32:41,170
+ماكنتوا على بلد اجار و لا بلد اجار لإنه obligate
+
+452
+00:32:41,170 --> 00:32:45,190
+intra silver parasite حيان موعالة chicken embryo
+
+453
+00:32:45,190 --> 00:32:48,790
+في ال sack يكساك او chicken embryo بتاع في البيضة
+
+454
+00:32:48,790 --> 00:32:51,470
+اللي جينا فيها كتكوت اللي هي ال ..الـ chicken
+
+455
+00:32:51,470 --> 00:32:55,370
+embryo نحقنها طبعا شباب انتوا بدرستوا في الفيروسات
+
+456
+00:32:55,370 --> 00:32:59,190
+بعرف ان كانت كثورة في الكتاب اظن اني بتوضح وين
+
+457
+00:32:59,190 --> 00:33:02,690
+ممكن يحقن اللي هو ال chicken embryo فاحنا هنا بقول
+
+458
+00:33:02,690 --> 00:33:06,090
+اذا بدك تنمي البكتيريا اللي اسمها chlamydia احقنها
+
+459
+00:33:06,090 --> 00:33:09,410
+في ال yolk sac تبقى ال chicken embryo او ممكن
+
+460
+00:33:09,410 --> 00:33:13,510
+بطريقة افضل على اللي هو ال tissue culture و
+
+461
+00:33:13,510 --> 00:33:16,810
+بنستخدم هنا ال mccoy's cells او ال mccoy's cells
+
+462
+00:33:16,810 --> 00:33:19,890
+نوع من انواع ال cell culture او ال tissue culture
+
+463
+00:33:21,090 --> 00:33:25,690
+البكتيريا بتعمل infection للـepithelial cells اللي
+
+464
+00:33:25,690 --> 00:33:29,670
+موردة في الـmucous membranes وفي الـlungs ويعتقد
+
+465
+00:33:29,670 --> 00:33:35,390
+أن الـviralness بتاعها ناتج عن مقدرتها على الهروب
+
+466
+00:33:35,390 --> 00:33:38,930
+مش من الـphagocytosis على الهروب من
+
+467
+00:33:38,930 --> 00:33:43,010
+الـphagolysosome fusion فاكرين هم؟ يعني بصير فيها
+
+468
+00:33:43,010 --> 00:33:46,920
+phagocytosisوبتدخل في الفاجوزوم المفروض انه يجي
+
+469
+00:33:46,920 --> 00:33:51,120
+معاهمين الآن ال lysozome يرتبط ليش بيسمي الارتباط
+
+470
+00:33:51,120 --> 00:33:55,440
+هذا فاجو lysozome المرحلة هذه البكتيريا بتنتج
+
+471
+00:33:55,440 --> 00:33:59,600
+chemical بتمنع ال lysozome ان يرتبط بالفاجوزوم اذا
+
+472
+00:33:59,600 --> 00:34:03,880
+it resist killing by phagocytosis عن طريق انه
+
+473
+00:34:03,880 --> 00:34:10,760
+بتمنع كمان مرة ال lysozome ان يرتبط بالفاجوزومطب
+
+474
+00:34:10,760 --> 00:34:14,300
+البكتيريا دخلت جوا ال macro phage او ال phagocyte
+
+475
+00:34:14,300 --> 00:34:18,440
+او ال host cell نحو وماصلهاش killing ايش هتعمل
+
+476
+00:34:18,440 --> 00:34:21,580
+الآن؟ هتعمل multiplication يبقى مزيد كتر جوا
+
+477
+00:34:21,580 --> 00:34:25,020
+الخلية وإلا كيف تكون obligate intra-cellular
+
+478
+00:34:25,020 --> 00:34:30,540
+برادات؟ كيف لها أن تكون obligate intra-cellular
+
+479
+00:34:30,540 --> 00:34:33,400
+برادات إذا ماعناش المقدرة أنها تعيش جوا الخلية؟
+
+480
+00:34:33,400 --> 00:34:36,880
+مستحيل كلمة بتنتج heat لبيلتوكسين
+
+481
+00:34:38,910 --> 00:34:44,410
+تستطيع ان تقتل الخلية الأدمية عن طريق التنافس على
+
+482
+00:34:44,410 --> 00:34:47,870
+الغذاء مش احنا بنحتاج مكونات معينة والبكتيريا
+
+483
+00:34:47,870 --> 00:34:51,750
+بتحتاج نفس المكونات مين أشطر فينا في الحصول على
+
+484
+00:34:51,750 --> 00:34:54,990
+هذه المكونات هو اللي can survive وانا حكيتلكوا عن
+
+485
+00:34:54,990 --> 00:34:58,470
+ذكاء Sodomonas في موضوع الحديد ابتنطل الصبغة
+
+486
+00:34:58,470 --> 00:35:03,270
+تبعتها وبتروح ترتبط الصبغة بمين بال iron الان ال
+
+487
+00:35:03,270 --> 00:35:07,190
+iron اللي ارتبطت في الصبغة الخلايا تبعتنا غير قادر
+
+488
+00:35:07,190 --> 00:35:10,890
+على استخدامهيبقى دلّا مين؟ دلّا الـIron، يبقى دلّا
+
+489
+00:35:10,890 --> 00:35:14,690
+Sodomonas Originosa، يبقى نفستنا على مين هي الآن؟
+
+490
+00:35:14,690 --> 00:35:18,050
+على الحديد، والحديد مطلوب إلي، ومطلوب للبكتيرا،
+
+491
+00:35:18,050 --> 00:35:23,230
+البكتيرا نجحت وانا فشلت، فخلايا ممكن تتأثر بعدم
+
+492
+00:35:23,230 --> 00:35:27,500
+مقدرتها على حصولة نوترياند معينةhost immune
+
+493
+00:35:27,500 --> 00:35:30,800
+response وهذه نقطة كتير مهمة may account for
+
+494
+00:35:30,800 --> 00:35:33,940
+inflammation and tissue destruction الآن البكتيريا
+
+495
+00:35:33,940 --> 00:35:38,860
+جوا خليانا ال immune system تعرف او عرف ان الخلايا
+
+496
+00:35:38,860 --> 00:35:43,000
+تبعتنا مصابة بكلاميديا بيجي حضرة ال immune system
+
+497
+00:35:43,000 --> 00:35:50,600
+بده يتصرف يعني مهمته انه يقتل الخلية او يحاصر
+
+498
+00:35:50,600 --> 00:35:57,520
+الخلايا المصابة ويدمرهافي محاولته للقيام بهذه
+
+499
+00:35:57,520 --> 00:36:02,040
+المهمة بنلاقيه over reacted أو بتصرف بطريقة مش
+
+500
+00:36:02,040 --> 00:36:07,340
+ذكية فبيعمل destruction ل normal cells و ل .. و ل
+
+501
+00:36:07,340 --> 00:36:12,780
+.. و ل .. و ل infected cellsواضحة النقطة ولا مش
+
+502
+00:36:12,780 --> 00:36:17,520
+واضحة هذه انه كيف ممكن يعني على المستوى البشري على
+
+503
+00:36:17,520 --> 00:36:24,340
+المستوى البشري واحد بده يطول او بده ينزع مثلا شوكة
+
+504
+00:36:24,340 --> 00:36:28,920
+معينة موجودة في جلد الانسان بتلاقي بيجيب بيجيب أول
+
+505
+00:36:28,920 --> 00:36:32,800
+حاجة بزامجها، بيجيب حاجة تنكسر معاه، بعدين بيصير
+
+506
+00:36:32,800 --> 00:36:36,140
+نكش في الجلد من هنا ونكش في الجلد من هنا، فبدمر
+
+507
+00:36:36,140 --> 00:36:40,590
+الجلد ولسه مش طاق المين الشوكةلكن هي محاولة منها
+
+508
+00:36:40,590 --> 00:36:45,670
+لإخراجها الشوكة نفس الجثة ال immune system قد يقوم
+
+509
+00:36:45,670 --> 00:36:49,150
+بتصرفات هي اللي تعمل أو تؤدي إلى tissue
+
+510
+00:36:49,150 --> 00:36:52,970
+destruction في محاولة منه كمان مرة لقضاء على
+
+511
+00:36:52,970 --> 00:36:57,370
+البكتيريا وانت عارفيه الكلام هذا مش غريب كل ال
+
+512
+00:36:57,370 --> 00:37:01,650
+viral hepatitis ثبت بالدليل القاطعإن الفيروسات
+
+513
+00:37:01,650 --> 00:37:05,750
+نفسها لا تدمر خلايا الكبد، مين يدمر خلايا الكبد؟
+
+514
+00:37:05,750 --> 00:37:09,810
+الـ T-cells، خلايانها بتروح تهاجم الخلايا
+
+515
+00:37:09,810 --> 00:37:13,450
+الـinfected وبتعمل destruction للـ liver cell، في
+
+516
+00:37:13,450 --> 00:37:18,290
+محاولة منها كام مرة للقضاء على الفيروس، بالظبط
+
+517
+00:37:21,450 --> 00:37:26,090
+ولا مرة واحنا بندرس microbiology تحدثنا عن life
+
+518
+00:37:26,090 --> 00:37:28,610
+cycle تركنا ال life cycle لميه لدكتور عدنان الهندي
+
+519
+00:37:28,610 --> 00:37:33,010
+في محاضرة الطفاليات، مظبوط؟ المرة الوحيدة اللي
+
+520
+00:37:33,010 --> 00:37:36,630
+هننافس فيها الدكتور عدنان هي المرة هذه هتكلم عن
+
+521
+00:37:36,630 --> 00:37:41,230
+بكتيريا هي الوحيدة اللي بنعرف إنه لها life cycle و
+
+522
+00:37:41,230 --> 00:37:43,890
+life cycle بسيطة مش life cycle معقدة يعني زي
+
+523
+00:37:43,890 --> 00:37:49,990
+الطفاليات وإنما في الآخر هي life cycle تلقوا اللي
+
+524
+00:37:49,990 --> 00:37:58,020
+معايا هناEB معناها elementary body ال elementary
+
+525
+00:37:58,020 --> 00:38:02,720
+body هو نوع من الخلايا اللي بتنتجها الكلاميديا it
+
+526
+00:38:02,720 --> 00:38:08,210
+will attach to cells andهتعمل cell entry بعد ذلك
+
+527
+00:38:08,210 --> 00:38:12,850
+cell entry عن طريق اللي هو الفاجوزوم وانا قلتلك
+
+528
+00:38:12,850 --> 00:38:17,470
+قبل شوية ان البكتيريا عندها المقدرة على منع ارتباط
+
+529
+00:38:17,470 --> 00:38:22,890
+من ال lysozome مع اللي هو الفاجوزوم وهنا بتقول ان
+
+530
+00:38:22,890 --> 00:38:28,430
+الفاجوزوم ال fusion inhibition منع الآن يفترض في
+
+531
+00:38:28,430 --> 00:38:30,730
+البكتيريا العادية زي السرمنولا وشتجلاش تعمل تبدأ
+
+532
+00:38:30,730 --> 00:38:36,190
+تنقسم ثنائي بسيط هذه لأبتتحول لـ spherical body و
+
+533
+00:38:36,190 --> 00:38:39,550
+الـ spherical body هذا بيسموه reticulate body
+
+534
+00:38:39,550 --> 00:38:43,010
+reticulate يبقى فين ده الآن ايش؟ two bodies
+
+535
+00:38:43,010 --> 00:38:47,090
+elementary اللي هو دخل الخلية وبعدين هتكلم عن مين
+
+536
+00:38:47,090 --> 00:38:50,870
+الآن؟ ع ال reticulate body ال reticulate body
+
+537
+00:38:50,870 --> 00:38:55,910
+بيصيرله maturation مضوج بيصير يتكاثر بال binary
+
+538
+00:38:55,910 --> 00:39:00,250
+fission جوا ال reticulate body هذا أيه، شايفينه؟
+
+539
+00:39:00,250 --> 00:39:05,540
+دائرة هذه، شايفينها؟هو الغشاية من الأول طبعا هو
+
+540
+00:39:05,540 --> 00:39:08,880
+الغشاية من الأول صار اللي قلنا كمرة maturation
+
+541
+00:39:08,880 --> 00:39:13,360
+نضوج كبير والانقسام صار في الداخل الآن في المرحلة
+
+542
+00:39:13,360 --> 00:39:15,400
+اللي بعدها انسوا هذا الجزء وانسوا هذا الجزء
+
+543
+00:39:15,400 --> 00:39:18,360
+المرحلة اللي بعدها ايش بصير هنا يا شباب؟ لاحظوا
+
+544
+00:39:18,360 --> 00:39:21,320
+تحول جزء من الكورات البيضاء اللي موجودة هنا مش
+
+545
+00:39:21,320 --> 00:39:25,040
+كورات بيضاء هي اللي اقصد فيها ال elementary عفوا
+
+546
+00:39:25,040 --> 00:39:28,520
+ال reticulate body بدأت تتحول للون ايه؟ الأسود
+
+547
+00:39:28,520 --> 00:39:33,240
+الاسود شو هو هذا؟Elementary body إذن هي عمليات
+
+548
+00:39:33,240 --> 00:39:37,700
+elementary body بيدخل الخلايا بتحول ل reticulate و
+
+549
+00:39:37,700 --> 00:39:41,340
+ال reticulate بينقسم و بيكون خلايا و بعدين بيحولها
+
+550
+00:39:41,340 --> 00:39:44,820
+لمين ل elementary body و بعدين بيطردها برا مين ال
+
+551
+00:39:44,820 --> 00:39:49,200
+infective stage في هذا الحالة؟الـElementary Body
+
+552
+00:39:49,200 --> 00:39:53,480
+الـInfected Stage هو المؤدي اللي بينتقل الخلايا هو
+
+553
+00:39:53,480 --> 00:39:56,920
+الـElementary Body إيش حد مزايا الشباب؟ إيه مزايا
+
+554
+00:39:56,920 --> 00:40:00,020
+الفكرة هذه؟ إن الـElementary Body is more
+
+555
+00:40:00,020 --> 00:40:04,100
+resistant to environmental conditions يعني عنده
+
+556
+00:40:04,100 --> 00:40:08,560
+مقدرة على مقاومة الظروف البيئية أكتر من مين من ال
+
+557
+00:40:08,560 --> 00:40:11,820
+reticulate body فهذا نوع من المحافظة على البكتيريا
+
+558
+00:40:11,820 --> 00:40:13,780
+في ال environment
+
+559
+00:40:17,240 --> 00:40:23,320
+نعم reticulate body نبدأ
+
+560
+00:40:23,320 --> 00:40:27,940
+نتكلم عن ال diseases او specific diseases انها
+
+561
+00:40:27,940 --> 00:40:32,940
+chlamydia cetaceae و زى ما ذكرنا cetaceae هى
+
+562
+00:40:32,940 --> 00:40:37,160
+cetacean bird بتقولنا اللى هى البقارات أو البقارات
+
+563
+00:40:37,160 --> 00:40:40,680
+chlamydia cetaceae is a zoonetic respiratory
+
+564
+00:40:40,680 --> 00:40:44,220
+disease احنا مش احنا اللى روحنا اليها احنا اللى
+
+565
+00:40:44,220 --> 00:40:48,060
+جيبناها عندناحد في كرابة طير جابل هيك في الجفص في
+
+566
+00:40:48,060 --> 00:40:54,380
+المنزل؟ طيب كنت تشوف الغبار او مخلفات الطير محصورة
+
+567
+00:40:54,380 --> 00:40:58,460
+في القفص ولا حوالين القفص فيه كمان؟ طيب هو المفروض
+
+568
+00:40:58,460 --> 00:41:02,140
+انه confined لأ بطير برا هيك ولا هيك محصور في
+
+569
+00:41:02,140 --> 00:41:08,480
+القفص لكن لما بطيربيعمل عملية طيارات هوائية بتخلخل
+
+570
+00:41:08,480 --> 00:41:13,180
+الهوى فى المنطقة فبتنعثر اما اجزاء من مخلفاته تمام
+
+571
+00:41:13,180 --> 00:41:16,100
+او من الغذاء اللى مولود او اشياء متعلقة بالريش
+
+572
+00:41:16,100 --> 00:41:23,160
+تبعه صح ولا لأ فالان كلمة غبار و نشره فى البيئة و
+
+573
+00:41:23,160 --> 00:41:26,700
+من ثم استنشاق و لا اخر لو كان هذا الطيروإذا كنا
+
+574
+00:41:26,700 --> 00:41:31,060
+حامل أو مصاب بالكلاميديا ستاسي وسط انشقناها احنا
+
+575
+00:41:31,060 --> 00:41:34,860
+بيصير عندنا pneumonia, pneumonia atypical غير
+
+576
+00:41:34,860 --> 00:41:39,980
+نمطية ناجمة عن جنة كمارة الانهليجيالمين لبكتيرة
+
+577
+00:41:39,980 --> 00:41:43,420
+اسمها كلاميديا ستاسي ليست منها zoonotic disease
+
+578
+00:41:43,420 --> 00:41:47,160
+انها انتقلت من الطير الى الانسانيبقى ال
+
+579
+00:41:47,160 --> 00:41:53,840
+transmission عبر ال inhalation ل ال dust المحتوي
+
+580
+00:41:53,840 --> 00:41:59,040
+على البكتيريا غالبا ناتج عن مين؟ ناتج عن ال faces
+
+581
+00:41:59,040 --> 00:42:00,040
+تبع ال birds
+
+582
+00:42:06,440 --> 00:42:11,760
+لل birds بشكل عام ال birds بشكل عام طيور لو صورت
+
+583
+00:42:11,760 --> 00:42:14,620
+شوي كان احنا اتكلمنا عن مين الاكتر فئة عرضة
+
+584
+00:42:14,620 --> 00:42:18,360
+للاصابة بال disease هتعرف ان هم ال poultry workers
+
+585
+00:42:18,360 --> 00:42:22,800
+او العاملين في قطاع الدواجن فالبكتيريا ممكن تكون
+
+586
+00:42:22,800 --> 00:42:25,040
+يعني ك normal habitat موجودة فيها في الطيور بشكل
+
+587
+00:42:25,040 --> 00:42:29,000
+عام لكن احنا متكلم معانامجتمع على سبيل المجتمع
+
+588
+00:42:29,000 --> 00:42:35,360
+مجتمع ليس بيه تربية طيور وانما فيه طيور منزلية فقط
+
+589
+00:42:35,360 --> 00:42:38,740
+بنربي ايش احنا في المنزل؟ بنحط جادة في جفص؟ ولا
+
+590
+00:42:38,740 --> 00:42:42,360
+بنحط عصافير؟ اللي هي من ضمنها هوينا مين؟ اللي من
+
+591
+00:42:42,360 --> 00:42:46,920
+أشهرها اللي هي البغبغوات بأشكالها المتنوعة؟ وانا
+
+592
+00:42:46,920 --> 00:42:51,480
+.. وانا ده الفكرة، فضل. لا لا الطير لأ، غالبا
+
+593
+00:42:51,480 --> 00:42:55,080
+بيكون normal .. normal flora، نعم normal flora أو
+
+594
+00:42:55,080 --> 00:43:01,300
+normal microbiotaDisease نيومونيا و Diagnosis بتم
+
+595
+00:43:01,300 --> 00:43:07,340
+عبر ال isolation of the organism من ال Sputum عن
+
+596
+00:43:07,340 --> 00:43:11,420
+طريق ال tissue culture لإن مستحيل جونا مرة نمي على
+
+597
+00:43:13,280 --> 00:43:17,260
+artificial media بدنا cell culture complement
+
+598
+00:43:17,260 --> 00:43:21,020
+fixation to detect اللي هو specific antibodies ال
+
+599
+00:43:21,020 --> 00:43:26,840
+treatment وهذا الكلام هيتكرر في كل العناوين
+
+600
+00:43:27,960 --> 00:43:31,340
+two drugs واحد تترسكلين هو drug of choice في ال
+
+601
+00:43:31,340 --> 00:43:35,740
+adults طبعا تترسكل الشباب أحد مساوقه أنه لا يُعطى
+
+602
+00:43:35,740 --> 00:43:39,280
+للحامل لا يُعطى للمرضى لا يُعطى للأطفال تمام
+
+603
+00:43:39,280 --> 00:43:42,180
+فبالتالي في هذه الحالة البديل اللي بيكون هو ال
+
+604
+00:43:42,180 --> 00:43:45,700
+erythromycin المرة الجاية ان شاء الله بنكمل باقي
+
+605
+00:43:45,700 --> 00:43:48,880
+ال eclamydia و بندخل على اللي هو ال rickettsia و
+
+606
+00:43:48,880 --> 00:43:49,840
+ال microplasma ان شاء الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WhLRIPj5OCQ.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WhLRIPj5OCQ.srt
new file mode 100644
index 0000000000000000000000000000000000000000..17dd28e27213eafbb7d0639ca7e174e602bbed08
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WhLRIPj5OCQ.srt
@@ -0,0 +1,2009 @@
+1
+00:00:20,470 --> 00:00:24,550
+بسم الله الرحمن الرحيم نكمل الجزء المتبقي من
+
+2
+00:00:24,550 --> 00:00:28,430
+البروسيلا. توقفنا عند عملية الـprevention, how to
+
+3
+00:00:28,430 --> 00:00:31,570
+prevent the occurrence of بروسيلا. يمكن تناولنا في
+
+4
+00:00:31,570 --> 00:00:37,080
+سياق المحاضرة بعض العناصر، لكن لا بأس أن نركزها في
+
+5
+00:00:37,080 --> 00:00:44,760
+فقرة واحدة. Number two
+
+6
+00:00:44,760 --> 00:00:47,080
+is immunization of animals. إحنا قلنا في أي
+
+7
+00:00:47,080 --> 00:00:51,500
+zoonotic disease، إذا كان فيه إمكانية للتخلص من الـ
+
+8
+00:00:51,500 --> 00:00:54,520
+disease في الحيوانات فهو الأول، وبالتالي فالـ
+
+9
+00:00:54,520 --> 00:00:58,350
+immunization  تنطبق على الحيوانات. Eradication of
+
+10
+00:00:58,350 --> 00:01:02,010
+infected livestock. أي حيوان يثبت إصابته
+
+11
+00:01:02,010 --> 00:01:06,230
+بالبروسيلة يجب أن يتخلص منه بطرق آمنة، طرق آمنة
+
+12
+00:01:06,230 --> 00:01:12,290
+إما بالدفن أو بالحرق. رقم أربعة في اللوحة اللي هي الـ
+
+13
+00:01:12,290 --> 00:01:15,270
+Minimize Occupational Exposure. فاكرين إحنا اتكلمنا
+
+14
+00:01:15,270 --> 00:01:22,950
+عن ناس at risk، الـfarmers، مربي الماشية، الـ
+
+15
+00:01:22,950 --> 00:01:26,370
+veterinarians، العاملين في مصانع الألبان والأطباء.
+
+16
+00:01:26,370 --> 00:01:31,490
+هذولا كلهم كانوا at risk. فكلمة Minimize
+
+17
+00:01:31,490 --> 00:01:36,830
+Occupational Exposure، قلل من إمكانية الاتصال
+
+18
+00:01:36,830 --> 00:01:41,350
+بالميكروبات. كيف؟بدأ نحكي موضوع مهم، خطير، مهم وخطير
+
+19
+00:01:41,350 --> 00:01:45,530
+جداً، غير مُلتفت له في بلادنا، اللي هو الـpersonal
+
+20
+00:01:45,530 --> 00:01:50,590
+protective equipment. حاجة بنسميها PPE، personal
+
+21
+00:01:50,590 --> 00:01:53,810
+protective equipment. أنتم بتشوفوا المهندسين
+
+22
+00:01:53,810 --> 00:02:00,350
+لابسين خوذة في مواقع البناء، مظبوط؟ ليش لابسين خوذة
+
+23
+00:02:00,350 --> 00:02:03,960
+منظر، عشان تبين أنه مهندس يعني؟ ولا كيف؟ لأن هو معرض
+
+24
+00:02:03,960 --> 00:02:07,500
+أن يجي عليه أشياء، صح ولا لأ؟ وفي الآخر كمان هي لون
+
+25
+00:02:07,500 --> 00:02:10,560
+أصفر، حتى يميز من قبل الناس اللي في الأعلى، لو بده
+
+26
+00:02:10,560 --> 00:02:14,540
+يرمي شيء، يبقى عارف إنه في تحته. هذا من أُدمّين مميزين.
+
+27
+00:02:14,540 --> 00:02:18,740
+يبقى الـpersonal protective equipment لكل الفئات
+
+28
+00:02:18,740 --> 00:02:22,560
+تقريباً موجودة. أنتم في التخصصات الطبية أو في المخابر
+
+29
+00:02:22,560 --> 00:02:24,940
+بتلبس laboratory coat، بتلبس gloves،
+
+30
+00:02:24,940 --> 00:02:28,040
+بتلبس mask، وبعض الأحيان بتلبس goggles اللي هي النظارات.
+
+31
+00:02:28,600 --> 00:02:32,760
+في الكيمياء بتلبس الكمامة اللي ممكن تحميه من اللي هو
+
+32
+00:02:32,760 --> 00:02:37,840
+leaks of gases، أو بشكل عام الغازات السامة. إذا لكل
+
+33
+00:02:37,840 --> 00:02:42,200
+فئة من الفئات قد يكون لها personal protective
+
+34
+00:02:42,200 --> 00:02:46,000
+equipment، PPE. هذا مصطلح لازم يكون موجود لدينا.
+
+35
+00:02:46,000 --> 00:02:52,160
+فمثلاً المزارعين لازم يكونوا لابسين boots طويلة لحد
+
+36
+00:02:52,160 --> 00:02:56,160
+الركبة، على سبيل المثال. لازم الشباب كمان يكونوا لابسين
+
+37
+00:02:56,160 --> 00:03:02,840
+ملابس غير قابلة للخدش، غير قابلة للخدش، حتى لو صار
+
+38
+00:03:02,840 --> 00:03:07,200
+احتكاك بينه وبين أسلاك وهي موجودة بتكون في المزارع،
+
+39
+00:03:07,200 --> 00:03:11,200
+أنه يكون يعني protected، الـskin تبعه، لأنه إذا
+
+40
+00:03:11,200 --> 00:03:14,780
+بتذكروا الـskin operations أو الخدوش كانت عامل من
+
+41
+00:03:14,780 --> 00:03:20,850
+عوامل مهمة. يبقى الـgloves... ال... ال... أشياء خاصة
+
+42
+00:03:20,850 --> 00:03:26,030
+تحمي المزارع أو تحمي المتصل بالحيوانات. يعني مثلاً
+
+43
+00:03:26,030 --> 00:03:28,870
+الأطباء البيطريين، ما هو برضه بيتعامل مع الحيوانات عن
+
+44
+00:03:28,870 --> 00:03:35,150
+قرب، بده يلمسها، بده يعاينها، وبالتالي يجب عليه أن
+
+45
+00:03:35,150 --> 00:03:38,950
+يقوم بارتداء اللي هي الـprotective أو الـpersonal
+
+46
+00:03:38,950 --> 00:03:43,080
+protective equipment. الموضوع الثاني اللي إحنا
+
+47
+00:03:43,080 --> 00:03:45,300
+المفروض أنه عنوان محاضرتنا اليوم، اللي هي الـspiral
+
+48
+00:03:45,300 --> 00:03:47,940
+organisms، واللي من ضمنها التريبونيميا والليبتو
+
+49
+00:03:47,940 --> 00:03:51,880
+سبايرا والبوريليا. طبعاً أنا هتكلم اليوم بشكل مفصل
+
+50
+00:03:51,880 --> 00:03:56,080
+أكثر عن التريبونيميا، لكن لابد لنا من أن نميز تمييزاً
+
+51
+00:03:56,080 --> 00:03:59,320
+سريعاً بين الثلاث أصناف: التريبونيميا والبوريليا
+
+52
+00:03:59,320 --> 00:04:01,760
+والليبتو سبايرا. Morphologically, they can be
+
+53
+00:04:01,760 --> 00:04:05,000
+distinguished by the following points. Point one, point
+
+54
+00:04:06,260 --> 00:04:09,460
+تطلعوا على التريبونيميا، وتطلعوا على البوريليا،
+
+55
+00:04:09,460 --> 00:04:15,120
+هتلاقوا أن الـcoils، اللي هي اللفات يعني،  اللي قاعد في
+
+56
+00:04:15,120 --> 00:04:20,000
+التريبونيميا أكثر من مين؟ من البوريليا. لكن الليبتو
+
+57
+00:04:20,000 --> 00:04:24,860
+سبايرا أكثر من الاثنين. هذه بنسميها narrow, many
+
+58
+00:04:24,860 --> 00:04:30,500
+narrow, regular coils. الليبتو سبايرا: very many, very
+
+59
+00:04:30,500 --> 00:04:36,020
+narrow، يعني المسافة تبعتها أضيق من مين؟ من اللي هو
+
+60
+00:04:36,020 --> 00:04:39,500
+treponema. بالإضافة إلى ذلك، الـLeptospira يا
+
+61
+00:04:39,500 --> 00:04:42,160
+شباب، زي ما شايفين، فيها hooks على الأطراف،
+
+62
+00:04:43,260 --> 00:04:46,340
+hooked ends، بينما هذا الكلام مش موجود في الـ
+
+63
+00:04:46,340 --> 00:04:49,420
+Treponema. إذاً، الـTreponema والـLeptospira بيشبهوا
+
+64
+00:04:49,420 --> 00:04:54,360
+بعض في أنه عندهم too many coils، لكن مين أكثر
+
+65
+00:04:54,360 --> 00:04:59,760
+إضيقاً؟ اللي هي الـLeptospira. مين إلها hooked
+
+66
+00:04:59,760 --> 00:05:03,480
+ends؟ برضه الـLeptospira. بينما الـBorrelia قلنا
+
+67
+00:05:03,480 --> 00:05:08,780
+few, wide, irregular coils. نبدأ بمناقشة اللي هو الـ
+
+68
+00:05:08,780 --> 00:05:12,900
+Treponema. General characteristics للبكتيريا هذه هي
+
+69
+00:05:12,900 --> 00:05:18,820
+عبارة عن thin، وكلمة thin هنا محورية من كثر ما هي
+
+70
+00:05:18,820 --> 00:05:22,200
+thin. It cannot be visualized by light microscopy.
+
+71
+00:05:22,200 --> 00:05:25,440
+نقطة كتير مهمة، أن إحنا ما نتعاملش بالـlight
+
+72
+00:05:25,440 --> 00:05:28,760
+microscope لما نتكلم على الـTreponema. نتعامل مع
+
+73
+00:05:28,760 --> 00:05:31,580
+مين؟ مع الـdark field microscopy. إيش يعني dark
+
+74
+00:05:31,580 --> 00:05:36,150
+field microscopy؟ الكوندنسر، الكوندنسر اللي تحت اللي
+
+75
+00:05:36,150 --> 00:05:41,610
+بدل كلمة كوندنسر، هو يعني مُجمع مكثف للضوء. لكن
+
+76
+00:05:41,610 --> 00:05:45,970
+الكوندنسر تبع الـdark field microscopy، الضوء بيكون
+
+77
+00:05:45,970 --> 00:05:50,470
+داخله، بدل ما يجمعه بيشتته. فالضوء بيكون طالع بهذا
+
+78
+00:05:50,470 --> 00:05:54,190
+الشكل، وبهذا الشكل. إذا كان في شريحة وعليها
+
+79
+00:05:54,190 --> 00:05:58,490
+بكتيريا، بيصطدم بالبكتيريا، ويدخل في الـobjective.
+
+80
+00:05:59,390 --> 00:06:04,090
+لذلك لا نرى في الـdark field microscopy أشياء
+
+81
+00:06:04,090 --> 00:06:08,590
+مضيئة إلا البكتيريا أو الأشياء الموجودة في الشريحة.
+
+82
+00:06:08,590 --> 00:06:13,490
+بينما كل شيء بيكون معتماً بسبب أن الكوندنسر كده مرة، أن الـ
+
+83
+00:06:13,490 --> 00:06:19,750
+condenser بيشتت الإضاءة ولا يجمع هذه الإضاءة. هي
+
+84
+00:06:19,750 --> 00:06:22,850
+الميكروب رقم اثنين في السلسلة اللي درسناهم لحد
+
+85
+00:06:22,850 --> 00:06:28,790
+الآن، الذين لا يمكن تنميتهم على، أو لم نتمكن
+
+86
+00:06:28,790 --> 00:06:32,250
+من تنميتهم على Artificial Media. الميكروب الأول كان
+
+87
+00:06:32,250 --> 00:06:35,250
+Mycobacterium leprae، وهي، والميكروب الثاني اللي هو
+
+88
+00:06:35,250 --> 00:06:40,070
+Treponema pallidum. Cannot be visualized by light
+
+89
+00:06:40,070 --> 00:06:43,790
+microscope. ذكرناها. Rabbits could be infected with
+
+90
+00:06:43,790 --> 00:06:48,160
+these organisms. الآن، الأرانب، الأرانب ليست natural
+
+91
+00:06:48,160 --> 00:06:53,260
+host للبكتيريا، ولكن we experimentally could infect
+
+92
+00:06:53,260 --> 00:06:57,520
+male rabbits. Male rabbits، اللي هم الأرانب الذكور،
+
+93
+00:06:57,520 --> 00:07:02,140
+نحَقِن البكتيريا في الـtestis، في الخصية بتاعة الأرنب
+
+94
+00:07:02,140 --> 00:07:05,940
+الذكر، كمصدر للبكتيريا. أنا بحتاجش بكتيريا في
+
+95
+00:07:05,940 --> 00:07:09,300
+المختبر، بحتاج الـTreponema  for diagnosis, for
+
+96
+00:07:09,300 --> 00:07:13,140
+diagnosis. بحتاج البكتيريا، ما أنا بقدر أجيبها؟ ما ليش
+
+97
+00:07:13,140 --> 00:07:17,210
+غير المصدر هذا، اللي هو الـinfected male rabbits.
+
+98
+00:07:17,210 --> 00:07:21,710
+They are spiral, flexible organisms that move
+
+99
+00:07:21,710 --> 00:07:26,260
+without flagella. إذا فاكرين كنا زمان نقول إن كل
+
+100
+00:07:26,260 --> 00:07:30,620
+البكتيريا المتحركة متحركة بـflagella، ما عدا
+
+101
+00:07:30,620 --> 00:07:34,920
+الـTreponema. تتحرك بـaxial filaments. الـaxial
+
+102
+00:07:34,920 --> 00:07:38,500
+filament عبارة عن endoflagella. فلاجلة بدل ما هي
+
+103
+00:07:38,500 --> 00:07:43,940
+برا، ملفوفة على الخلية، ما بين الـcell membrane والـ
+
+104
+00:07:43,940 --> 00:07:47,960
+cell wall. فسميناها axial filament أو endoflagella.
+
+105
+00:07:47,960 --> 00:07:52,380
+إذن هي متحركة، لكن ليس بـflagella، وإنما بـaxial
+
+106
+00:07:52,380 --> 00:07:57,190
+filament. الانقسام تبعها by transverse binary fission.
+
+107
+00:07:57,190 --> 00:08:01,370
+أمر، كنت، كنت تسأل سؤال: أمر الصورة ليه يعني لما
+
+108
+00:08:01,370 --> 00:08:03,550
+تشوفها بالشكل؟ هل هي تشوفها من الـmicroscope ولا
+
+109
+00:08:03,550 --> 00:08:09,010
+كذا؟ هكذا؟ صحيح يعني هتشوف الـ... الـ... الـ...
+
+110
+00:08:09,010 --> 00:08:13,610
+التريبونيميا بشكل الـcoils تبعتها أكثر من اللي هو
+
+111
+00:08:13,610 --> 00:08:17,550
+الـBorrelia. هتشوف الـ... الـ... الـLeptospira أكثر
+
+112
+00:08:17,550 --> 00:08:20,130
+من الاثنين، أكثر من الاثنين، وهتشوف الـhook تبعتها.
+
+113
+00:08:22,490 --> 00:08:25,210
+لا لا، التريبونيميا، بس اللي هي ممكن، اللي هي ممكن الـ
+
+114
+00:08:25,210 --> 00:08:28,770
+culture في البداية، ممكن نعملهم culture، بس
+
+115
+00:08:28,770 --> 00:08:32,270
+الـTreponema pallidum اللي مش ممكن نعملها culture.
+
+116
+00:08:32,270 --> 00:08:36,090
+طيب.
+
+117
+00:08:36,090 --> 00:08:39,330
+Clinical description of the disease. إحنا أصلاً
+
+118
+00:08:39,330 --> 00:08:41,330
+حكينا شو الـdisease أساساً. إحنا نعمله description
+
+119
+00:08:41,330 --> 00:08:45,690
+للـdisease caused by this organism. بيقع فيه حاجة
+
+120
+00:08:45,690 --> 00:08:49,840
+اسمها، اسمها، شباب، إما syphilis اللي هو معروف
+
+121
+00:08:49,840 --> 00:08:53,140
+بالعربي الزهري، أما وليس مرض السيلان، خدوا بالكم.
+
+122
+00:08:53,140 --> 00:08:55,620
+السيلان، Neisseria gonorrhoeae اللي حكيناها.
+
+123
+00:08:55,620 --> 00:09:01,260
+يبقى syphilis and congenital syphilis. إيش الفرق بين
+
+124
+00:09:01,260 --> 00:09:04,640
+الاثنين؟ الأولاني بيصيب الـadults، اللي هو sexually
+
+125
+00:09:04,640 --> 00:09:09,120
+transmitted disease. الثاني هو بيصيب الأطفال اللي
+
+126
+00:09:09,120 --> 00:09:13,960
+يولدون لأمهات مصابات بالـsyphilis. بس خدوا بالكم، في
+
+127
+00:09:13,960 --> 00:09:18,400
+الجنرية مرّ معنا حالة مشابهة: ophthalmia neonatorum.
+
+128
+00:09:18,400 --> 00:09:22,100
+فاكرينها؟ لما الطفل بيمرّ عبر قناة الولادة بياخد
+
+129
+00:09:22,100 --> 00:09:27,600
+معه Neisseria gonorrhoeae. لكن متى... متى يُصاب؟ عند الولادة
+
+130
+00:09:27,600 --> 00:09:33,030
+خلال الولادة. بس في الـsyphilis، يُصاب في رحم الأم،
+
+131
+00:09:33,030 --> 00:09:36,570
+يعني بينتقل الـmicrobe عبر الـplacenta، عبر الـ
+
+132
+00:09:36,570 --> 00:09:40,490
+placenta. إذا حاجة اسمها congenital syphilis، هذه
+
+133
+00:09:40,490 --> 00:09:43,930
+كانت انتقلت عبر الـplacenta، وهذا أمر مختلف عن
+
+134
+00:09:43,930 --> 00:09:48,590
+اللي هو انتقال من الأم إلى الجنين.  اللي مش فاهم يطلع.
+
+135
+00:09:48,590 --> 00:09:52,010
+الأطفال يدخلوا على الجلسة، صحيح؟ ولا يدخلوا الـ
+
+136
+00:09:52,010 --> 00:09:56,150
+bacterium هناك؟ هو الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+137
+00:09:56,150 --> 00:09:56,210
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+138
+00:09:56,210 --> 00:09:57,110
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+139
+00:09:57,110 --> 00:09:57,810
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+140
+00:09:57,810 --> 00:10:05,990
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+141
+00:10:05,990 --> 00:10:07,190
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+142
+00:10:07,190 --> 00:10:07,490
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+143
+00:10:07,490 --> 00:10:08,770
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+144
+00:10:08,770 --> 00:10:10,970
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+145
+00:10:10,970 --> 00:10:11,250
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+146
+00:10:11,250 --> 00:10:11,410
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+147
+00:10:11,410 --> 00:10:11,790
+الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ... الـ...
+
+148
+00:10:11,790 --> 00:10:11,830
+الـ... الـ... الـ... الـ... الـ... الـ...
+
+149
+00:10:11,830 --> 00:10:12,490
+الـ... الـ... الـ... الـ... الـ... الـ...
+
+150
+00:10:20,810 --> 00:10:23,950
+طيب، اتفقنا أن إحنا فينا two forms of disease هنا،
+
+151
+00:10:23,950 --> 00:10:26,550
+اللي هو الـsyphilis اللي هو الـSTD أو الـsexually
+
+152
+00:10:26,550 --> 00:10:28,850
+transmitted disease أو الـvenereal disease، والـ
+
+153
+00:10:28,850 --> 00:10:30,870
+congenital syphilis. الـcongenital syphilis، هتكلم
+
+154
+00:10:30,870 --> 00:10:33,990
+عنه لاحقاً. خدنا نتكلم أنا، أنا، على الـsyphilis
+
+155
+00:10:33,990 --> 00:10:38,410
+نفسه. الـsyphilis من الأمراض اللي characterized by
+
+156
+00:10:38,410 --> 00:10:42,390
+stages، يا شباب، مراحل. إيش يعني المراحل؟ يعني مرحلة
+
+157
+00:10:42,390 --> 00:10:47,270
+بتخلص، بيفصل ما بين المرحلة والمرحلة. مرحلة بيسميها
+
+158
+00:10:47,270 --> 00:10:54,670
+latency period، فترة سكون. لا يمكن لأي مخلوق معرفة
+
+159
+00:10:54,670 --> 00:10:57,510
+أنه هذا الإنسان مصاب بالـsyphilis إلا من خلال فحص
+
+160
+00:10:57,510 --> 00:11:02,730
+serology، بصدفة، مطلوب له فحص لوظيفة، لـvisa، بده
+
+161
+00:11:02,730 --> 00:11:05,290
+يسافر على دولة أوروبية أو على... على أستراليا،
+
+162
+00:11:05,290 --> 00:11:09,110
+والسفارة طلبت منه يعمل إيه؟ فحوصات، عشان ياخد الـ
+
+163
+00:11:09,110 --> 00:11:12,910
+visa، لأنها شهادة صحية. يعني بعض السفارات تطلب فحص
+
+164
+00:11:12,910 --> 00:11:16,210
+اللي هو الـsyphilis. فممكن يطلع positive، حلوة. بس الـ
+
+165
+00:11:16,210 --> 00:11:19,390
+symptoms مافيش symptoms ما بين المرحلة الأولى و
+
+166
+00:11:19,390 --> 00:11:22,850
+الثانية في latency period، وما بين المرحلة الثانية
+
+167
+00:11:22,850 --> 00:11:27,810
+والثالثة في latency period. إذن كم مرحلة صاروا؟
+
+168
+00:11:27,810 --> 00:11:32,850
+خمس مراحل.  بينهم latency period. primary،
+
+169
+00:11:32,850 --> 00:1
+
+223
+00:15:36,200 --> 00:15:42,400
+الاختراق والتشبث يعني لما هي تخترق خلال عملية
+
+224
+00:15:42,400 --> 00:15:45,100
+الجنسية من الذكر إلى الأنثى أو الأنثى إلى الذكر
+
+225
+00:15:45,100 --> 00:15:51,520
+فتتبخر.. لأن شكلها  لولبي spiral فسهل عليها الاختراق
+
+226
+00:15:51,520 --> 00:15:56,300
+واللولبيات من بعيد خلصنا أخذنا العينة وفحصناها،
+
+227
+00:15:56,300 --> 00:16:00,810
+الآن إيش بيصير؟ إيش مصير الشانكر هذا؟ البثرة
+
+228
+00:16:00,810 --> 00:16:05,750
+الجنسية إيش مصيرها؟ مصيرها الشفاء سواء عُلجت أو لا
+
+229
+00:16:05,750 --> 00:16:14,170
+عُلجت وبتشفى دون أن تترك آثارًا. تخيلوا الآن عندي..
+
+230
+00:16:14,170 --> 00:16:21,690
+إيش عندي؟ عندي شانكر غير مؤلم painless، ما فيه ألم. مادام
+
+231
+00:16:21,690 --> 00:16:27,250
+ما فيه ألم، اتركوا الأمر للطبيب، ستشفى لوحدها خلاص يبقى
+
+232
+00:16:27,250 --> 00:16:32,280
+اهمَلُوها وانتهى الموضوع، دخل في مرحلة شفاء، اختفت تمامًا
+
+233
+00:16:32,280 --> 00:16:37,020
+المريض مش شايف أي أثر للمرض ولا يبدو عليه أي أثر
+
+234
+00:16:37,020 --> 00:16:44,080
+للمرض، وبيجعد في هذه المرحلة من ستة أسابيع إلى ستة أشهر
+
+235
+00:16:44,080 --> 00:16:48,820
+يعني من شهر ونصف إلى ستة أشهر وهو لا يعاني من أي
+
+236
+00:16:48,820 --> 00:16:51,100
+شيء، هذه الفترة اللي بيسميها latency period number
+
+237
+00:16:51,100 --> 00:16:56,680
+one. ما الذي يحدث بعد ذلك؟ يدخل مرحلة stage two كان
+
+238
+00:16:56,680 --> 00:17:01,500
+ينتقل إلى stage two وفي stage two بيصير عنده صداع
+
+239
+00:17:01,500 --> 00:17:06,040
+بيصير عنده malaise، generalized lymphadenopathy، كل
+
+240
+00:17:06,040 --> 00:17:09,760
+الغدد الليمفاوية اللي في جسمه بتصير تنتفخ وبيصير
+
+241
+00:17:09,760 --> 00:17:15,300
+فيها ألم and a variety of skin rashes، أنواع مختلفة
+
+242
+00:17:15,300 --> 00:17:19,160
+من الطفح الجلدي في أماكن متنوعة من جسمه،
+
+243
+00:17:19,160 --> 00:17:23,080
+hepatitis, meningitis, glomerulonephritis and..
+
+244
+00:17:23,080 --> 00:17:29,230
+يعني صار عنده أزمة صحية في معظم الأعضاء organs  تبعات
+
+245
+00:17:29,230 --> 00:17:34,890
+اللي هو الجسم، النفرانس غالبًا، شباب، بيكون ناتج عن
+
+246
+00:17:34,890 --> 00:17:38,770
+النفرانس يعني التهاب النفرانس، ناتج عن ال antigen
+
+247
+00:17:38,770 --> 00:17:41,250
+-antibody complexes، يعني ارتباط الأجسام المضادة اللي
+
+248
+00:17:41,250 --> 00:17:44,910
+اتكونت في الجسم مع بقايا البكتيريا اللي اترسبت في
+
+249
+00:17:44,910 --> 00:17:48,090
+الكلية. شفنا مرض زي كده، احنا في nephrotyphoid
+
+250
+00:17:48,090 --> 00:17:52,410
+نعم. في  آفات ثانوية secondary lesions كمان برضه
+
+251
+00:17:52,410 --> 00:17:55,630
+heals spontaneously over a period of several weeks
+
+252
+00:17:55,630 --> 00:17:59,910
+and then enters in latent stage number two. إذا
+
+253
+00:17:59,910 --> 00:18:04,950
+مرحلة رقم واحد ما عُولجوا، راح تمامًا، دخل لمرحلة
+
+254
+00:18:04,950 --> 00:18:09,490
+اتنين، تمام؟ مرحلة اتنين  الصحيحة هي مدعاة أن المريض
+
+255
+00:18:09,490 --> 00:18:12,850
+يخاف، ومدعاة أن المريض يروح لمين؟ للطبيب
+
+256
+00:18:12,850 --> 00:18:18,290
+فغالباً كثير من المرضى غير المثقفين ما بيروحوش في
+
+257
+00:18:18,290 --> 00:18:20,150
+المرحلة الأولى، كان بيروح في مين؟ في المرحلة
+
+258
+00:18:20,150 --> 00:18:22,930
+الثانية لأنها مرحلة ثانية فيها ألم وفيها يعني
+
+259
+00:18:22,930 --> 00:18:27,870
+أشياء مقلقة تظهر على الجسم وأعراض متنوعة، فبالتالي
+
+260
+00:18:28,300 --> 00:18:31,260
+كثير من المرضى بيسارعوا.. بيسارعوا ال.. ال..
+
+261
+00:18:31,260 --> 00:18:35,840
+الأطباء في مرحلة رقم اثنين، الآن نجي لمرحلة رقم
+
+262
+00:18:35,840 --> 00:18:38,500
+ثلاثة، خذوا بالكم،  جابوا المرحلة رقم ثلاثة، فيها
+
+263
+00:18:38,500 --> 00:18:43,480
+الناس بيقولوا لنا الـ tenth superior number two، الـ الـ
+
+264
+00:18:43,480 --> 00:18:48,040
+tertiary stage.. الـ tertiary stage اللي هي
+
+265
+00:18:48,040 --> 00:18:52,200
+المرحلة الثالثة، بيسموها the destructive stage of
+
+266
+00:18:52,200 --> 00:18:55,940
+the disease، المرحلة التدميرية أو المدمرة للمرض
+
+267
+00:18:58,520 --> 00:19:01,420
+لو رأيتم بعض الصور، لقوا ناس عندهم tertiary
+
+268
+00:19:01,420 --> 00:19:06,000
+syphilis، والعيادة بذا كان هم خارجين من جهنم، لماذا؟
+
+269
+00:19:06,000 --> 00:19:12,220
+ما الذي يعطي وجهك الجميل وجسمك الأنيق هو الهيكل
+
+270
+00:19:12,220 --> 00:19:15,880
+العظمي اللي ربنا أعطانا إياه بهذا التناظر والتنظيم
+
+271
+00:19:15,880 --> 00:19:20,900
+عظامنا، عظامنا اللي كسيت لحمًا حتى نبدو بهذا الشكل
+
+272
+00:19:20,900 --> 00:19:27,430
+لو العظام تبعنا صار فيها تشوّه، يعني الفك يبقى كده
+
+273
+00:19:27,430 --> 00:19:34,350
+تمام، انطقع، كيف بيكون شكل الواحد غريب، صح ولا لأ؟ لو
+
+274
+00:19:34,350 --> 00:19:38,330
+صار تضخم في العظم اللي موجود في الركبة برضه أو
+
+275
+00:19:38,330 --> 00:19:43,750
+الكتف أو الصدر، فبيصير فيه تشوهات، bone and teeth
+
+276
+00:19:43,750 --> 00:19:47,290
+deformations، bone and teeth deformation، في هذه
+
+277
+00:19:47,290 --> 00:19:52,350
+المرحلة، وبيصير حاجة خطيرة جدًا اسمها aneurism، تمدد
+
+278
+00:19:52,350 --> 00:19:59,330
+الأوعية، تعرفين القلب لما بضخ الدم، بضخه بقوة عشان
+
+279
+00:19:59,330 --> 00:20:03,650
+يوصله لأماكن متنوعة، من ضمن الأماكن اللي ما بتحملش
+
+280
+00:20:03,650 --> 00:20:07,770
+ال انقطاع عنها، اللي هو الدماغ، فتخيل مثلًا
+
+281
+00:20:07,770 --> 00:20:14,090
+عندك aneurism في الوعاء ده اللي طالع على الدماغ
+
+282
+00:20:14,090 --> 00:20:17,550
+إيش يعني aneurism؟ تكون تمدد؟ أظن أنك بتقع في الـ
+
+283
+00:20:17,550 --> 00:20:21,570
+.. بتسجل زراعة، أنت بتسجل زراعة، لما بيكون الوعاء
+
+284
+00:20:21,570 --> 00:20:27,590
+فيه، لما بيكون واسع، قعد الميتك وبتنزل جنبه، وهو نفس
+
+285
+00:20:27,590 --> 00:20:32,790
+الفكرة، القلب يعني بضخ دم، تمام؟ وفي وعاء ده متسع،
+
+286
+00:20:32,790 --> 00:20:37,090
+فالضغط بيكون أقل، ونسبة الدم اللي واصلة للدماغ بتكون
+
+287
+00:20:37,090 --> 00:20:41,660
+أقل، إذن في عندي مشكلة aneurism، وفي عندي مشكلة
+
+288
+00:20:41,660 --> 00:20:45,480
+تقولنا اللي هو bone and teeth deformation، وفي عندي
+
+289
+00:20:45,480 --> 00:20:50,480
+حاجة اسمها gomas، gomas بالترجمة الحرفية اللي لها
+
+290
+00:20:50,480 --> 00:20:54,560
+الأورام الصمغية، الأورام الصمغية، والصحيح هي عبارة
+
+291
+00:20:54,560 --> 00:21:01,160
+عن كتل، غالبًا تشريحيًا ممكن تشبه اللي هو الـ
+
+292
+00:21:01,160 --> 00:21:03,760
+tuberculosis اللي شفناها في الـ micro bacterium
+
+293
+00:21:03,760 --> 00:21:10,310
+tuberculosis. في عندي كمان 15% من الحالات قد تصاب بـ
+
+294
+00:21:10,310 --> 00:21:13,910
+Central Nervous System Diseases and Meningitis، لكن
+
+295
+00:21:13,910 --> 00:21:18,970
+الـ 80% هم الـ aneurism اللي كنا عنه، تمدد اللي هو
+
+296
+00:21:18,970 --> 00:21:24,510
+الأوعية الدموية، لكن متى.. متى بتبدأ المرحلة
+
+297
+00:21:24,510 --> 00:21:30,090
+الثالثة؟ احنا كنا بين الأولى والثانية شهر ونصف إلى ستة
+
+298
+00:21:30,090 --> 00:21:34,110
+أشهر، المرحلة الثانية للثالثة من خمس إلى عشرين سنة
+
+299
+00:21:34,110 --> 00:21:39,650
+شباب، من الـ initial infection، من خمس إلى عشرين سنة،
+
+300
+00:21:39,650 --> 00:21:42,750
+لذلك إذا لم يُعالجوا في المرحلة الأولى، ممكن
+
+301
+00:21:42,750 --> 00:21:45,150
+يُعالجوا في المرحلة الثانية، لكن إذا ظهر عليهم أعراض
+
+302
+00:21:45,150 --> 00:21:49,950
+المرحلة الثالثة، غالبًا الـ الـ الـ الـ الـ
+
+303
+00:21:49,950 --> 00:21:52,590
+damage بيكون irreversible، irreversible يعني غير
+
+304
+00:21:52,590 --> 00:21:56,310
+قابل للعلاج، حتى لو.. لو خلصنا من البكتيريا، غالبًا الضرر
+
+305
+00:21:56,310 --> 00:21:59,990
+قد حدث، احنا اتفقنا إذا primary, secondary، و
+
+306
+00:21:59,990 --> 00:22:01,230
+tertiary, syphilis
+
+307
+00:22:07,180 --> 00:22:19,520
+من ستة أسابيع.. نعم، ده
+
+308
+00:22:19,520 --> 00:22:21,340
+.. ده الـ secondary.. نعم، الـ secondary symptoms
+
+309
+00:22:21,340 --> 00:22:26,160
+مظبوط، إيش السؤال؟
+
+310
+00:22:26,160 --> 00:22:31,600
+لأ لأ لأ، هي الـ latency period اللي.. اللي.. اللي
+
+311
+00:22:31,600 --> 00:22:35,220
+بين الأولى.. بين الأوليين والثانية، بين الثانية و
+
+312
+00:22:35,220 --> 00:22:39,730
+الثالثة، بالظبط. هذا  اللي يُقال بالإنجليزي بالنسبة لـ
+
+313
+00:22:39,730 --> 00:22:44,150
+الـ congenital syphilis،  اللي هو اللي يُطلق عليه
+
+314
+00:22:44,150 --> 00:22:48,310
+syphilis اللي بيصيب الجنين أو الـ fetus، وفي هذه
+
+315
+00:22:48,310 --> 00:22:51,990
+الحالات، الجنين ممكن يصير له مجموعة من الخيارات، إما
+
+316
+00:22:51,990 --> 00:22:56,330
+يصير له إجهاض، أو يولد ميتًا، كلمة still born، يولد
+
+317
+00:22:56,330 --> 00:23:03,010
+ميتًا، أو live born، أو يولد حيًا، أو without clinical
+
+318
+00:23:03,010 --> 00:23:06,850
+evidence of syphilis، يعني ممكن يكون عنده مجموعة من
+
+319
+00:23:06,850 --> 00:23:10,150
+الخيارات، الخيار الأول إجهاض، الخيار
+
+320
+00:23:10,150 --> 00:23:13,610
+الثاني يولد ميتًا، الخيار الثالث أنه يولد بأعراض
+
+321
+00:23:13,610 --> 00:23:17,430
+syphilis، والخيار الرابع أنه يولد بدون أي أعراض لـ
+
+322
+00:23:17,430 --> 00:23:22,310
+syphilis. لما بيظهر عليه أعراض، غالبًا شباب، مش أعراض
+
+323
+00:23:22,310 --> 00:23:25,030
+الـ primary، بيظهر عليه أعراض من الـ secondary
+
+324
+00:23:25,030 --> 00:23:28,950
+syphilis، بيكون كل جسمه فيه الطفح rashes، يبقى بيولد
+
+325
+00:23:28,950 --> 00:23:33,190
+بيكون الـ already المرحلة الأولى تخطاها، المرحلة
+
+326
+00:23:33,190 --> 00:23:37,290
+الأولى تخطاها، فبيدخل في مرحلة الثانية، طبعًا في هذا
+
+327
+00:23:37,290 --> 00:23:41,470
+الحالة ممكن كمان يؤدي إلى العمى، الـ blindness، ده
+
+328
+00:23:41,470 --> 00:23:47,310
+بنتيجة اللي هو ضمور للعصب البصري، اللي هو الـ optic
+
+329
+00:23:47,310 --> 00:23:52,010
+atrophy، وممكن يصير عنده كمان deformed bones may
+
+330
+00:23:52,010 --> 00:23:55,570
+also occur، يعني ممكن يصير عنده تشوهات في العظام
+
+331
+00:23:55,570 --> 00:24:01,720
+نفس الكلام اللي حكيناه. يمكن الـ syphilis احنا عندنا
+
+332
+00:24:01,720 --> 00:24:05,160
+.. ممكن نسأل السؤال قبل هيك.  في أحد المحاضرات لما
+
+333
+00:24:05,160 --> 00:24:08,540
+اتكلمنا عن السيلان الجنوري، هل فيه سيلان جنوري في قطاع
+
+334
+00:24:08,540 --> 00:24:12,260
+غزة؟ نفس السؤال، هل فيه syphilis في قطاع غزة؟
+
+335
+00:24:12,260 --> 00:24:15,780
+وبنفس الجواب، بيقولوا إنه لأ تقريبًا، يعني لا يوجد أنها
+
+336
+00:24:15,780 --> 00:24:22,500
+حالات مُشخصة بأي من المرضين منذ سنوات طويلة، منذ
+
+337
+00:24:22,500 --> 00:24:25,240
+سنوات طويلة، ما فيش. كان في السابق، لما كان في عهد
+
+338
+00:24:25,240 --> 00:24:30,120
+الاحتلال، الطريقة مفتوحة وكان في بعض الناس يعني
+
+339
+00:24:30,120 --> 00:24:36,160
+يمارسوا الرذيلة في داخل الخط الأخضر، كان بالفعل في
+
+340
+00:24:36,160 --> 00:24:39,360
+بعض اللي هو الحالات، وحتى الـ HIV، هذه الحالات اللي
+
+341
+00:24:39,360 --> 00:24:42,840
+أنا قلت لكم هنا ممكن لا تتجاوز الثلاثين حالة على مدار
+
+342
+00:24:42,840 --> 00:24:48,300
+التاريخ، الـ HIV، ومعظم هذه الحالات كانت تأتي من اللي
+
+343
+00:24:48,300 --> 00:24:53,720
+هم من العائدين من الخارج. طيب لماذا نحن مهتمون في الـ
+
+344
+00:24:53,720 --> 00:24:57,520
+diagnostic microbiology، بالتريبونيما، باليدوم اللي
+
+345
+00:24:57,520 --> 00:25:00,380
+مسبب لمرض الـ syphilis، اللي هو مش موجود أصلاً عندنا
+
+346
+00:25:00,380 --> 00:25:03,140
+إحنا كنا كل عالم قارية صغيرة، قد نضطر أن نعمل في
+
+347
+00:25:03,140 --> 00:25:05,640
+مكان آخر غير هذا المكان، فلازم نكون مزودين
+
+348
+00:25:05,640 --> 00:25:09,060
+بالمعلومات، لكن اللي أهم من ذلك الصحيح أن التقنية
+
+349
+00:25:09,060 --> 00:25:13,400
+المستخدمة في تشخيص الـ الـ تريبونيما باليدوم
+
+350
+00:25:13,400 --> 00:25:17,820
+تقنيات مش common للميكروبات الأخرى، وبالتالي كويس أن
+
+351
+00:25:17,820 --> 00:25:22,400
+نطلع على هذه التقنيات، مثلًا، أول تقنية الميكروسكوبي
+
+352
+00:25:22,400 --> 00:25:25,760
+والميكروسكوبي اتفقنا على أنه إيش هيكون قبل عن مين
+
+353
+00:25:25,760 --> 00:25:29,000
+عن dark field microscope، واللوحة اللي قدامكم شرحت
+
+354
+00:25:29,000 --> 00:25:31,860
+تمامًا في بداية المحاضرة، لما قلنا لكم كيف نجمع
+
+355
+00:25:31,860 --> 00:25:37,620
+العينة، وإيش هنشوف تحت اللي هو الـ microscope. التقنية
+
+356
+00:25:37,620 --> 00:25:40,600
+الثانية اللي ما اتكلمنا عنها اللي هي serological
+
+357
+00:25:40,600 --> 00:25:43,520
+Testing، و serological Testing، الشباب بيقسموها
+
+358
+00:25:43,520 --> 00:25:49,980
+لقسمين، non-specific و specific، أو عشان اللغة اللي
+
+359
+00:25:49,980 --> 00:25:52,940
+مكتوبة هنا غير عن الكلام اللي أنا حكيته، non
+
+360
+00:25:52,940 --> 00:25:55,940
+-treponemal antigen test، وكلمة non-treponemal
+
+361
+00:25:55,940 --> 00:25:58,480
+antigen test، يعني non-specific test، يعني إحنا
+
+362
+00:25:58,480 --> 00:26:04,300
+ما بندورش specifically. تخيلوا شباب، مين درس معانا food
+
+363
+00:26:04,300 --> 00:26:06,880
+microbiology أو درس معانا، كنا نتكلم عن indicator،
+
+364
+00:26:06,880 --> 00:26:10,300
+مظبوط، كنا نتكلم عن indicator، واستخدامنا الـ
+
+365
+00:26:10,300 --> 00:26:13,400
+indicator كان للدلالة على وجود أشياء أخرى، صح ولا
+
+366
+00:26:13,400 --> 00:26:17,420
+لأ؟ فبعض الأحيان بنبحث عن شيء مش الأصلي، وجود الـ
+
+367
+00:26:17,420 --> 00:26:21,820
+indicator مؤشر، ففي هذه الحالة، لا الـ antigen اللي
+
+368
+00:26:21,820 --> 00:26:24,440
+علاقته بالتريبونيميا ولا الـ antibody اللي علاقة
+
+369
+00:26:24,440 --> 00:26:29,580
+بالتريبونيميا، لكن وجود الـ antibody هذا أو ما يشبه
+
+370
+00:26:29,580 --> 00:26:33,780
+الـ antibody في دم المريض مؤشر أنه عنده syphilis
+
+371
+00:26:33,780 --> 00:26:39,920
+لكن للأسف.. للأسف مش specific. طيب مادام مش
+
+372
+00:26:39,920 --> 00:26:43,100
+specific، ليش لليوم هو المستخدم في العالم كـ
+
+373
+00:26:43,100 --> 00:26:48,220
+screening test؟ لأن أنا جددت لكم يوم من الأيام ما هو
+
+374
+00:26:48,220 --> 00:26:51,600
+أو ما هي مواصفات الـ screening test؟ إيش مواصفاته؟
+
+375
+00:26:51,600 --> 00:26:56,860
+أنه sensitive لكن مش بالضرورة يكون specific. إيش
+
+376
+00:26:56,860 --> 00:27:01,240
+يعني sensitive؟ sensitive يعني لو الفحص طلع
+
+377
+00:27:01,240 --> 00:27:06,700
+negative فهو حقًا negative، لكن لو طلع positive بدنا
+
+378
+00:27:06,700 --> 00:27:11,920
+نعمل له confirmation. طيب في سؤال مهم بدنا نسأل و
+
+379
+00:27:11,920 --> 00:27:16,710
+نجاوب عليه، مين أكثر في أي community في الدنيا؟
+
+380
+00:27:16,710 --> 00:27:20,410
+المصابين أو السليمين؟ السليمين أكثر من المصابين،
+
+381
+00:27:20,410 --> 00:27:25,700
+صح ولا لأ؟ يبقى لو أنا فاحص ألف واحد، احتمالات الـ
+
+382
+00:27:25,700 --> 00:27:30,320
+negative إيه؟ أكثر، الـ positive قليل، الـ negative
+
+383
+00:27:30,320 --> 00:27:33,840
+هذا مضمون في الفحص، هذا مضمون أن الـ negative
+
+384
+00:27:33,840 --> 00:27:37,140
+negative حقيقي، بس اللي مش مضمون فيه مين؟ الـ
+
+385
+00:27:37,140 --> 00:27:40,520
+positive. يعني عملت لكم أنتم المجموعة أنتم
+
+386
+00:27:40,520 --> 00:27:45,800
+عملت لكم الفحص، طلع واحد بس اللي positive، والباقين
+
+387
+00:27:45,800 --> 00:27:49,640
+طلعوا إيه؟ negative، يبقى الـ negative حقيقي ولا
+
+388
+00:27:49,640 --> 00:27:53,460
+لأ؟ وهو يمكن يكون negative حقيقي، negative، لكن هو
+
+389
+00:27:53,460 --> 00:27:56,540
+طلع positive في الفحص هذا لأنه مش specific، بدي أعمل له
+
+390
+00:27:56,540 --> 00:27:59,800
+فحص ثاني specific، وهيطلع negative إن شاء الله،
+
+391
+00:27:59,800 --> 00:28:00,280
+تمام؟
+
+392
+00:28:03,040 --> 00:28:07,500
+يبقى هاي مواصفات إيش قلنا كده مرة الـ screening
+
+393
+00:28:07,500 --> 00:28:11,920
+test، أنه sensitive، مش بالضرورة يكون specific
+
+394
+0
+
+445
+00:31:52,670 --> 00:31:58,110
+برضه non-specific test non-specific test احنا مش
+
+446
+00:31:58,110 --> 00:32:00,310
+راح نجيب لك الـ complement fixation و مش راح نقول
+
+447
+00:32:00,310 --> 00:32:08,850
+طيب للي نسيه هذكره بس في الموضوع عندي أنا one drop
+
+448
+00:32:08,850 --> 00:32:14,690
+of serum، المفروض أن يكون فيه هاش antibodies لو ضفت
+
+449
+00:32:14,690 --> 00:32:19,410
+أنا antigen و
+
+450
+00:32:19,410 --> 00:32:22,530
+الـ antigen كان specific للـ antibody، إيش هيصير فيه؟
+
+451
+00:32:22,530 --> 00:32:27,810
+هنا جاب الـ agglutination لو كان الـ antigen صغير
+
+452
+00:32:27,810 --> 00:32:34,030
+هيبين الـ agglutination، مش هيبين، هيصير reaction غير
+
+453
+00:32:34,030 --> 00:32:39,390
+قابل للرؤية، كيف بدي أعرفه؟ أنا خذوا بالكم، الـ antigen
+
+454
+00:32:39,390 --> 00:32:42,010
+لما بيتفاعل مع الـ antibody بيستهلك
+
+455
+00:32:45,700 --> 00:32:49,320
+الـ complement، مش بيعمل activation، يبقى الـ serum
+
+456
+00:32:49,320 --> 00:32:53,820
+اللي هنا فقد الـ complement اللي فيه، فقد الـ
+
+457
+00:32:53,820 --> 00:32:58,240
+complement، المصطلح بنقول complement was fixed،
+
+458
+00:32:58,240 --> 00:33:02,920
+استهلكت، طبعا استنفذت، للأسف أنا ما أقدرش أعرف أن الـ
+
+459
+00:33:02,920 --> 00:33:06,180
+complement استنفذت أو ما استنفذتش، يبقى أنا ما قادر
+
+460
+00:33:06,180 --> 00:33:09,300
+أشوف الـ antigen antibody reaction، ولا قادر أشوف أن
+
+461
+00:33:09,300 --> 00:33:12,880
+الـ complement استهلكت أو لم تستهلك، فالحل إيش؟
+
+462
+00:33:13,510 --> 00:33:18,690
+بالظبط، بنضيف الـ red blood cell، مرتبط عليها
+
+463
+00:33:18,690 --> 00:33:23,990
+specific antibody كـ indicator للـ reaction، الآن هذه
+
+464
+00:33:23,990 --> 00:33:29,390
+الخلايا الـ red blood cell مع الـ antibody لا ينقصها
+
+465
+00:33:29,390 --> 00:33:33,770
+إلا الـ complement عشان تتحلل، الـ antibody مع الـ
+
+466
+00:33:33,770 --> 00:33:37,650
+antigen، المفروض أنه ما بيعملش، الآن بيعمل activation
+
+467
+00:33:37,650 --> 00:33:40,790
+لمين؟ للـ complement، حطينا الـ system هنا في
+
+468
+00:33:40,790 --> 00:33:45,990
+complement، في complement هتخلي الـ antibody يحلل مين؟ الـ
+
+469
+00:33:45,990 --> 00:33:50,330
+red blood cell، فبيصير الـ lysis، يبقى هي أحد النتائج
+
+470
+00:33:50,330 --> 00:33:57,930
+حطينا الـ system هنا، فش complement، no lysis، يبقى
+
+471
+00:33:57,930 --> 00:34:03,350
+النتيجة يا lysis يا no lysis، أو بالأحرى hemolysis،
+
+472
+00:34:03,350 --> 00:34:08,390
+no hemolysis، الآن إذا .. إذا صار فيه hemolysis، يبقى
+
+473
+00:34:08,390 --> 00:34:11,450
+فيه complement، إذا فيه complement يبقى الفحص،
+
+474
+00:34:11,450 --> 00:34:17,090
+negative، لأنه لم تستهلك، إذا ما فيش complement، no
+
+475
+00:34:17,090 --> 00:34:20,190
+hemolysis، ما فيش complement يبقى الفحص، و هذا ما
+
+476
+00:34:20,190 --> 00:34:24,830
+يسمى بالـ complement fixation، لكن سواء كان الفحص
+
+477
+00:34:24,830 --> 00:34:28,210
+الأولاني اللي هو الـ VDRL أو الـ RPR أو الـ
+
+478
+00:34:28,210 --> 00:34:32,310
+complement fixation، احنا مش جونا .. جونا sensitive
+
+479
+00:34:32,310 --> 00:34:35,250
+لكن جونا ممكن يكون فيه false positive، إيش يعني
+
+480
+00:34:35,250 --> 00:34:39,010
+false positive؟ يعني مش specific في كل من الأمراض
+
+481
+00:34:39,010 --> 00:34:41,910
+التالية، لو كان المريض عنده malaria بيعطينا positive،
+
+482
+00:34:41,910 --> 00:34:44,850
+لو كان عنده leprosy، فكان leprosy بيعطينا positive،
+
+483
+00:34:44,850 --> 00:34:48,130
+لو عنده infectious mononucleosis، المريض positive،
+
+484
+00:34:48,130 --> 00:34:51,990
+لو عنده measles، بيعطينا positive، لو عنده
+
+485
+00:34:51,990 --> 00:34:56,430
+SLE، systemic lupus erythematosus، عارفينه الـ SLE،
+
+486
+00:34:56,430 --> 00:34:59,930
+systemic lupus erythematosus،  أما الذئبة الحمراء،
+
+487
+00:34:59,930 --> 00:35:02,990
+باللغة العربية، الذئبة الحمراء اللي بيكون في
+
+488
+00:35:02,990 --> 00:35:06,850
+وجه المريض بيكون زي الفراشة، autoimmune
+
+489
+00:35:06,850 --> 00:35:11,070
+disease، malaria, leprosy, measles, infectious
+
+490
+00:35:11,070 --> 00:35:14,270
+mononucleosis and SLE، هدول كلهم بيعطوا false
+
+491
+00:35:14,270 --> 00:35:20,750
+positive results، يبقى من الـ non-treponemal
+
+492
+00:35:20,750 --> 00:35:26,760
+antigen test، شوفنا نوعين، النوع الأول اللي هو الـ
+
+493
+00:35:26,760 --> 00:35:31,040
+VDRL و الـ modification تبعه الـ RPR، و شوفنا الـ
+
+494
+00:35:31,040 --> 00:35:34,960
+complement fixation اللي هي الـ Wasserman-Kolmer
+
+495
+00:35:34,960 --> 00:35:38,960
+test، الآن نيجي لـ الـ antibody test، الـ antibody test
+
+496
+00:35:38,960 --> 00:35:42,460
+دول طبعا ها يكونوا specific test، specific test،
+
+497
+00:35:42,460 --> 00:35:45,740
+يبقى معنا اللي حكيناه إيش معناه؟ specific test يعني
+
+498
+00:35:45,740 --> 00:35:50,080
+ممكن يصلحوا كـ confirmatory test، فاكرين الشاب
+
+499
+00:35:50,080 --> 00:35:54,850
+اللي طلع عنده بالـ VDRL positive، وقلنا هذا بيستوجب ربما
+
+500
+00:35:54,850 --> 00:35:57,930
+يكون حقيقي و ربما مش حقيقي، فبنعمله إيش الآن؟ واحد
+
+501
+00:35:57,930 --> 00:36:02,410
+من هذه المجموعة من الفحوصات، الفحص الأول fluorescent
+
+502
+00:36:02,410 --> 00:36:08,610
+treponema antibody absorption test، أو FTA-ABS، FTA-
+
+503
+00:36:08,610 --> 00:36:13,590
+ABS، fluorescent treponema antibody absorption test،
+
+504
+00:36:13,590 --> 00:36:19,410
+ركزوا معايا عشان نرسم الشكل تبع الفحص،
+
+505
+00:36:22,170 --> 00:36:25,590
+الـ reagent طبعا يا شباب هو عبارة عن شرائح، شرائح
+
+506
+00:36:25,590 --> 00:36:33,310
+microscopic slide، fixed عليها Treponema pallidum،
+
+507
+00:36:33,310 --> 00:36:37,390
+killed، يعني هذه الشرائح ما بنعمل فيها هذه، بنشتريها
+
+508
+00:36:37,390 --> 00:36:40,430
+كـ reagent، بتكون موجودة عندنا في المختبر، شرائح
+
+509
+00:36:40,430 --> 00:36:44,430
+مجهزة عليها، كمان مرة، killed Treponema pallidum،
+
+510
+00:36:44,430 --> 00:36:49,630
+جيبنا قطرة من الـ patient serum، الـ patient serum مش
+
+511
+00:36:49,630 --> 00:36:55,850
+هيسوي، إذا في antibody، هيرتبط، للأسف كيف بجيب الـ
+
+512
+00:36:55,850 --> 00:36:58,910
+antibody مرتبط على البكتيريا؟ ما أقدرش، من من الـ
+
+513
+00:36:58,910 --> 00:37:01,730
+fluorescent، من المريض، أحط fluorescent على الـ ..
+
+514
+00:37:01,730 --> 00:37:07,390
+أنا حطيت هنا antibody من المريض، الآن بجيب antibody
+
+515
+00:37:07,390 --> 00:37:11,470
+ضد الـ antibody، anti-antibody، تمام؟ anti-human
+
+516
+00:37:11,470 --> 00:37:16,970
+antibody، anti-human antibody،
+
+517
+00:37:20,200 --> 00:37:24,640
+تمام؟ و بنضيفها على الشريحة، إذا الـ antibody يبقى
+
+518
+00:37:24,640 --> 00:37:29,420
+إنه مرتبط، هترتبط معاه، كيف بدي أعرف أن الـ antibody
+
+519
+00:37:29,420 --> 00:37:32,940
+حقيقي و اللي مش حقيقي؟ بغسل، إنما لو غسلنا الشريحة،
+
+520
+00:37:32,940 --> 00:37:38,080
+كل شيء غير مرتبط يزال، الآن تحت الـ microscope، أي
+
+521
+00:37:38,080 --> 00:37:43,050
+microscope؟ fluorescent microscope، أسقطنا الـ UV من
+
+522
+00:37:43,050 --> 00:37:48,650
+فوق و بيطلع أنا على الضوء المنعكس من الشريحة أو
+
+523
+00:37:48,650 --> 00:37:53,810
+المنبعث من الشريحة، شفت Treponema، ليش شفت
+
+524
+00:37:53,810 --> 00:37:59,260
+Treponema؟ لأنه .. لأنه مرتبط عليها fluorescent،
+
+525
+00:37:59,260 --> 00:38:02,720
+نعم، ليش فيه fluorescent؟ لأنه فيه antibody، ليش
+
+526
+00:38:02,720 --> 00:38:05,800
+فيه antibody؟ لأنه مرتبط بالـ antibody تبع المريض،
+
+527
+00:38:05,800 --> 00:38:08,760
+تمام؟ الـ antibody المريض تبع المريض، ليش موجود أصلا؟
+
+528
+00:38:08,760 --> 00:38:11,980
+لأنه مرتبط بالبكتيريا اللي fixed to the slide،
+
+529
+00:38:11,980 --> 00:38:14,720
+يبقى هيك بقول أنه عرفت أنه البكتيريا أو الـ .. أن
+
+530
+00:38:14,720 --> 00:38:19,640
+الـ patient بيحتوي على antibodies في الـ serum تبعه،
+
+531
+00:38:19,640 --> 00:38:24,820
+تمام؟ خلصنا من هذه، هذا الفحص كتير مهم وسريع،
+
+532
+00:38:24,820 --> 00:38:29,200
+Treponema immobilization test، كلمة mobile معناها
+
+533
+00:38:29,200 --> 00:38:34,960
+متحرك، immobilize يعني غير قادر على الحركة، يعني فحص
+
+534
+00:38:34,960 --> 00:38:38,320
+شل البكتيريا، هذا الفحص لشل البكتيريا،
+
+535
+00:38:41,080 --> 00:38:45,280
+فاكرين القرانب؟ إيش مال القرانب؟ could be infected
+
+536
+00:38:45,280 --> 00:38:48,660
+with the bacteria، و قلنا لكم الـ male rabbits،
+
+537
+00:38:48,660 --> 00:38:52,220
+بنحقنها في الـ testis، و بتكون عندنا في المختبر، و
+
+538
+00:38:52,220 --> 00:38:54,580
+وقت ما بدنا البكتيريا بناخد من الـ testis من الـ
+
+539
+00:38:54,580 --> 00:39:00,820
+rabbit، و بنحطه على شريحة و عليها cover slip، و على
+
+540
+00:39:00,820 --> 00:39:09,300
+dark field microscope، تمام؟ تحت الـ dark field
+
+541
+00:39:09,300 --> 00:39:13,640
+microscope، أنا اللي حاطط البكتيريا، إيش هشوف؟ thin
+
+542
+00:39:13,640 --> 00:39:19,760
+actively motile Treponema pallidum، بنجيب الـ
+
+543
+00:39:19,760 --> 00:39:24,420
+patient serum، و بنحط قطرة هنا يا شباب، patient
+
+544
+00:39:24,420 --> 00:39:28,540
+serum، و بحط قطرة، الآن القطرة جنب الـ cover slip،
+
+545
+00:39:28,540 --> 00:39:31,880
+إيش يصير فيها بالفعل؟ الـ capillary action، هتتغلغل
+
+546
+00:39:31,880 --> 00:39:36,560
+تحت الـ cover slip، إذا فيها antibody، هيرتبط مع مين؟
+
+547
+00:39:41,280 --> 00:39:46,480
+لما يرتبط الـ antibody مع البكتيريا بيشيل حركتها، إذا
+
+548
+00:39:46,480 --> 00:39:53,080
+توقفت البكتيريا عن الحركة أو أبطأت حركتها، معناه
+
+549
+00:39:53,080 --> 00:39:57,600
+الحكي، الفحص positive، إذا البكتيريا لسه بتتحرك بحرية و
+
+550
+00:39:57,600 --> 00:40:02,600
+بطلاقة، معناه الحكي هنا القطرة دي لم تحتوي على
+
+551
+00:40:02,600 --> 00:40:06,480
+antibodies، فالفحص negative، إيش اسم الفحص كده مرة ثانية؟
+
+552
+00:40:06,610 --> 00:40:10,110
+Treponema Pallidum Immobilization Test، عشان أنا
+
+553
+00:40:10,110 --> 00:40:12,810
+بقول لكم فيه نوع من الـ .. من الـ .. خدنا نقول
+
+554
+00:40:12,810 --> 00:40:16,150
+الإبداع في الفحوصات مختلفة عن الفحوصات اللي
+
+555
+00:40:16,150 --> 00:40:21,840
+بتعرفوها الأخرى، الفحص الأخير اللي هو Treponema
+
+556
+00:40:21,840 --> 00:40:24,640
+pallidum hemagglutination test، و كلنا عرفنا إنه
+
+557
+00:40:24,640 --> 00:40:28,720
+hemagglutination test، لكن مناسب إنه نمر مرور سريع على
+
+558
+00:40:28,720 --> 00:40:33,960
+اللوحة على أساس أني أذكركم بالفحص، Red cells are
+
+559
+00:40:33,960 --> 00:40:36,700
+treated to absorb treponemal antigens on their
+
+560
+00:40:36,700 --> 00:40:40,160
+surface، إذن بنجيب red blood cell و بيعالجوها
+
+561
+00:40:40,160 --> 00:40:45,400
+commercially to absorb اللي هو مين؟ Treponema
+
+562
+00:40:47,190 --> 00:40:50,690
+pallidum antigen على الـ surface، يبقى الآن الـ
+
+563
+00:40:50,690 --> 00:40:55,850
+reagent بتاعنا هو red blood cell زي الـ latex مركب
+
+564
+00:40:55,850 --> 00:41:02,230
+عليها antigens لـ Treponema pallidum، when mixed
+
+565
+00:41:02,230 --> 00:41:05,710
+with a serum containing، الآن هذه الـ reagent جيبنا
+
+566
+00:41:05,710 --> 00:41:12,110
+الـ patient serum، patient serum، إيش الـ patient
+
+567
+00:41:12,110 --> 00:41:16,230
+serum بيكون فيه؟ و هذا الـ reagent حطيناهم جنب بعض و
+
+568
+00:41:16,230 --> 00:41:21,950
+عملنا لهم mixing، الآن الـ antibody ده موجود هيرتبط
+
+569
+00:41:21,950 --> 00:41:27,630
+و هيرتبط بـ red blood cell ثانية، صح؟ و red blood
+
+570
+00:41:27,630 --> 00:41:31,110
+cell ثانية، هيرتبط بـ red blood cell ثانية و هكذا، و
+
+571
+00:41:31,110 --> 00:41:34,750
+بيصير عندنا agglutination، تي بيلاقهم
+
+572
+00:41:34,750 --> 00:41:42,730
+hemagglutination، hemagglutination، طبعا الـ VDRL و الـ
+
+573
+00:41:42,730 --> 00:41:46,110
+FTA-ABS، و خذوا بالكم، و هذا non-specific و هذا
+
+574
+00:41:46,110 --> 00:41:50,870
+specific، specific، هذا non-specific و هذا specific،
+
+575
+00:41:51,860 --> 00:41:54,700
+Test can be also performed on spinal fluids، يعني
+
+576
+00:41:54,700 --> 00:41:58,600
+ممكن تكون العينة مش بس دم، ممكن أيضا spinal fluid،
+
+577
+00:41:58,600 --> 00:42:01,680
+Antibodies do not reach the CSF from the
+
+578
+00:42:01,680 --> 00:42:06,040
+bloodstream، و هذه معلومة إنه لا يصل الـ antibody
+
+579
+00:42:06,040 --> 00:42:11,480
+للـ syphilis من الدم إلى الـ CSF، وإنما يُعتقد إنه
+
+580
+00:42:11,480 --> 00:42:16,440
+بتكون في نفس المنطقة، بالنسبة للعلاج الـ penicillin
+
+581
+00:42:16,440 --> 00:42:19,000
+is the treatment of choice for syphilis،
+
+582
+00:42:21,640 --> 00:42:24,880
+في other Treponema، يعني نحاول ننهي منهم اليوم
+
+583
+00:42:24,880 --> 00:42:30,000
+بشكل سريع، أقل شهرة من Treponema pallidum خالص، زي
+
+584
+00:42:30,000 --> 00:42:35,460
+مثلا اللي هو الـ yaws و الـ bejel، و طبعا الـ yaws و الـ bejel
+
+585
+00:42:35,460 --> 00:42:38,700
+two tropical diseases، tropical disease، يعني أمراض
+
+586
+00:42:38,700 --> 00:42:42,500
+استوائية، طبعا غالبا مش هنشوفه من هنا، لكن  لبقى اسمه
+
+587
+00:42:42,500 --> 00:42:46,540
+على الأسماء المسببة، Treponema pertenue لـ yaws،
+
+588
+00:42:46,540 --> 00:42:52,290
+و الـ bejel، في Treponema carateum، Treponema carateum
+
+589
+00:42:52,290 --> 00:42:56,350
+هي المسببة، طبعا غالبا بتنتقل عن طريق اللي هو الـ
+
+590
+00:42:56,350 --> 00:42:59,310
+skin contact، بقى عشان أنتم شفتوا أفلام وثائقية
+
+591
+00:42:59,310 --> 00:43:02,830
+على المناطق الاستوائية في كثير من البلدان
+
+592
+00:43:02,830 --> 00:43:07,050
+الاستوائية، الأطفال من شدة الحرارة بيكونوا تقريبا
+
+593
+00:43:07,050 --> 00:43:10,850
+يعني عراة، يعني فاللعب و الـ skin contact بينهم
+
+594
+00:43:10,850 --> 00:43:14,890
+بيكون موجود، فبيسهل أو بيسهل عليهم عملية اللي هو
+
+595
+00:43:14,890 --> 00:43:18,320
+الانتقال، زي ما حكينا، unlike syphilis it is
+
+596
+00:43:18,320 --> 00:43:22,300
+transmitted by non-sexual skin contact, often
+
+597
+00:43:22,300 --> 00:43:24,840
+between children living in conditions of poor
+
+598
+00:43:24,840 --> 00:43:28,080
+hygiene، بين الأطفال اللي عايشين في مناطق يقولوا
+
+599
+00:43:28,080 --> 00:43:33,900
+مستوى النظافة فيها قليل، الآن العلاج لهذه الأمراض ممكن
+
+600
+00:43:33,900 --> 00:43:37,120
+يكون برضه بالـ penicillin، و اللي هو الـ tetracycline
+
+601
+00:43:39,450 --> 00:43:42,790
+دائما و أبدا بنقول أن الـ prevention بيعتمد على الـ
+
+602
+00:43:42,790 --> 00:43:45,850
+transmission، بيعتمد على الـ transmission، فإذا كان
+
+603
+00:43:45,850 --> 00:43:49,570
+.. إذا قررت أن تضع سياسات للـ transmission .. للـ
+
+604
+00:43:49,570 --> 00:43:53,110
+عفوا، للـ prevention، بدك تعرف الـ cycle تبعت الـ
+
+605
+00:43:53,110 --> 00:43:57,510
+transmission عشان تقدر تعمل لها prevention، و المرة
+
+606
+00:43:57,510 --> 00:43:59,330
+اللي جاي إن شاء الله نكمل سويا
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WhLRIPj5OCQ_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WhLRIPj5OCQ_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..4b5e6d9bee0d9eef6fcaffd0e7f4b72886cccb3d
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/WhLRIPj5OCQ_postprocess.srt
@@ -0,0 +1,2424 @@
+1
+00:00:20,470 --> 00:00:24,550
+بسم الله الرحمن الرحيم نكمل الجزء المتبقي من
+
+2
+00:00:24,550 --> 00:00:28,430
+البروسيلا اتوقفنا عند عملية ال prevention how to
+
+3
+00:00:28,430 --> 00:00:31,570
+prevent the occurrence of بروسيلا يمكن تناولنا في
+
+4
+00:00:31,570 --> 00:00:37,080
+سياق المحاضرة بعض العناصر لكن لا بس انهنركزهم في
+
+5
+00:00:37,080 --> 00:00:44,760
+فقرة واحدة number two
+
+6
+00:00:44,760 --> 00:00:47,080
+is immunization of animals احنا قلنا في اي
+
+7
+00:00:47,080 --> 00:00:51,500
+zoonetic disease اذا كان فيه امكانية للتخلص من ال
+
+8
+00:00:51,500 --> 00:00:54,520
+disease في الحيوانات فهو الاولى وبالتالي فال
+
+9
+00:00:54,520 --> 00:00:58,350
+immunization بتنبل للحيواناتEradication of
+
+10
+00:00:58,350 --> 00:01:02,010
+infected livestock أي حيوان بيثبت إصابته
+
+11
+00:01:02,010 --> 00:01:06,230
+بالبروسيلة يجب أن يتخلص منه بطرق آمنة، طرق آمنة
+
+12
+00:01:06,230 --> 00:01:12,290
+إما بالدفن أو بالحرقرقم اربع في اللوحة اللي هي الـ
+
+13
+00:01:12,290 --> 00:01:15,270
+Minimize Ecubational Exposure فاكرين احنا اتكلمنا
+
+14
+00:01:15,270 --> 00:01:22,950
+جون في ناس at risk ال farmers مربي الماشية ال
+
+15
+00:01:22,950 --> 00:01:26,370
+veterinarians العاملين في مصانع الألبان والأشبان
+
+16
+00:01:26,370 --> 00:01:31,490
+هدولة كلهم كانوا at risk فكلمة Minimize
+
+17
+00:01:31,490 --> 00:01:36,830
+Ecubational Exposure قلل من إمكانية الاتصال
+
+18
+00:01:36,830 --> 00:01:41,350
+بالميكروبات كيف؟بدا نحكي موضوع مهم خطير مهم وخطير
+
+19
+00:01:41,350 --> 00:01:45,530
+جدا غير ملتفة في بلادنا اللي هو ال personal
+
+20
+00:01:45,530 --> 00:01:50,590
+protective equipment حاجة بنسميها PPE personal
+
+21
+00:01:50,590 --> 00:01:53,810
+protective equipment انتوا بتشوفوا المهندسين
+
+22
+00:01:53,810 --> 00:02:00,350
+لابسين خوذة في مواقع البناء مظبوط ليش لابسين خوذة
+
+23
+00:02:00,350 --> 00:02:03,960
+منظر عشان تبين انه مهندس يعني ولا كيف؟لأن هو معرض
+
+24
+00:02:03,960 --> 00:02:07,500
+أن يجي عليها أشياء صح ولا لأ وفي الآخر كمان هي لون
+
+25
+00:02:07,500 --> 00:02:10,560
+أصفر حتى يميز من قبل الناس اللي في الأعلى لو بده
+
+26
+00:02:10,560 --> 00:02:14,540
+يرمي إشي يبجي عارف إنه في تحتهيه من أدمين مميزين
+
+27
+00:02:14,540 --> 00:02:18,740
+يبجي ال personal protective equipment لكل الفئات
+
+28
+00:02:18,740 --> 00:02:22,560
+تقريبا موجودة إلكوا في التحيات الطبية أو يطبع
+
+29
+00:02:22,560 --> 00:02:24,940
+المخبرين انت بتلبس laboratory coat بتلبس gloves
+
+30
+00:02:24,940 --> 00:02:28,040
+تلبس mask و بعض الأحيان تلبس googles اللي هي نضرات
+
+31
+00:02:28,600 --> 00:02:32,760
+في الكيميا بلبس الكمامة اللى ممكن تحميه من اللى هو
+
+32
+00:02:32,760 --> 00:02:37,840
+leaks of gases او بشكل عام الغازات السامة اذا لكل
+
+33
+00:02:37,840 --> 00:02:42,200
+فئة من الفئات قد يكون لها personal protective
+
+34
+00:02:42,200 --> 00:02:46,000
+equipment PPE هذا مصطلح لازم يكون موجود لدينا
+
+35
+00:02:46,000 --> 00:02:52,160
+فمثلا المزارعين لازم يكون لابسين boots طويلة لحد
+
+36
+00:02:52,160 --> 00:02:56,160
+الركبة على سبيل المثاللازم الشباب كمان يكون لابسين
+
+37
+00:02:56,160 --> 00:03:02,840
+ملابس غير قابلة للخدش، غير قابلة للخدش، حتى لو صار
+
+38
+00:03:02,840 --> 00:03:07,200
+احتكاك بينه بين أسلاك وهي موجودة بتكون في المزارة،
+
+39
+00:03:07,200 --> 00:03:11,200
+انه يكون يعني protected ال skin تبعه، لأنه إذا
+
+40
+00:03:11,200 --> 00:03:14,780
+بتذكروا ال skin operations أو الخدوش كانت عامل من
+
+41
+00:03:14,780 --> 00:03:20,850
+عوامل مهمةيبجأ ال gloves .. ال .. ال .. أشياء خاصة
+
+42
+00:03:20,850 --> 00:03:26,030
+تحمي المزارع أو تحمي المتصل بالحيوانات يعني مثلا
+
+43
+00:03:26,030 --> 00:03:28,870
+طيور البيطري ما هو برضه بيتعامل مع الحيوانات عن
+
+44
+00:03:28,870 --> 00:03:35,150
+قرب، بده يلمسها، بده يعينها، وبالتالي يهجب عليه أن
+
+45
+00:03:35,150 --> 00:03:38,950
+يقوم بارتداء اللي هي ال protective أو ال personal
+
+46
+00:03:38,950 --> 00:03:43,080
+protective equipmentالموضوع التاني اللي احنا
+
+47
+00:03:43,080 --> 00:03:45,300
+المفروض انه عنوان محاضرتنا اليوم اللي هي ال spiral
+
+48
+00:03:45,300 --> 00:03:47,940
+organisms و اللي من ضمنها التريبونيميا والليبتو
+
+49
+00:03:47,940 --> 00:03:51,880
+سبايرا والبوريليا طبعا انا هتكلم اليوم بشكل مفصل
+
+50
+00:03:51,880 --> 00:03:56,080
+اكتر عن تريبونيميا لكن لابد لنا من انه نميز تمييز
+
+51
+00:03:56,080 --> 00:03:59,320
+سريع بين التلات أصناف عند تريبونيميا والبوريليا
+
+52
+00:03:59,320 --> 00:04:01,760
+والليبتو سبايرا morphologically they can be
+
+53
+00:04:01,760 --> 00:04:05,000
+distinguished by the following point one point
+
+54
+00:04:06,260 --> 00:04:09,460
+تطلعوا على التريبونيميا و تطلعوا على البوريليا
+
+55
+00:04:09,460 --> 00:04:15,120
+هتلاقوا ان ال coils اللي لفات يعني لحين قاعد في
+
+56
+00:04:15,120 --> 00:04:20,000
+التريبونيميا اكتر من مين؟ من البوريليا لكن الليبتو
+
+57
+00:04:20,000 --> 00:04:24,860
+سبايرا اكتر من الاتنين هذه بنسميها narrow many
+
+58
+00:04:24,860 --> 00:04:30,500
+narrow regular coils الليبتو سبايرا verymany very
+
+59
+00:04:30,500 --> 00:04:36,020
+narrow يعني المسافة تبعتها أضيق من مين من اللي هو
+
+60
+00:04:36,020 --> 00:04:39,500
+tree polymer بالإضافة إلى ذلك ال leptospira يا
+
+61
+00:04:39,500 --> 00:04:42,160
+شباب زي ما تشايفين في إليها hooks على الأطراف
+
+62
+00:04:43,260 --> 00:04:46,340
+hooked end بينما هذا الكلام مش مقول باسمين في ال
+
+63
+00:04:46,340 --> 00:04:49,420
+Tripolima إذا ال Tripolima و ال Leptospira بيشبهوا
+
+64
+00:04:49,420 --> 00:04:54,360
+بعض في أنه عندهم too many coils لكن مين أكتر
+
+65
+00:04:54,360 --> 00:04:59,760
+اديقاقا اللي هي ال Leptospira؟ مين إلها hooked
+
+66
+00:04:59,760 --> 00:05:03,480
+ends؟ برضه ال Leptospira بينما ال Borrelia قولنا
+
+67
+00:05:03,480 --> 00:05:08,780
+few wide irregular coils نبدأ بمناقشة اللي هو ال
+
+68
+00:05:08,780 --> 00:05:12,900
+Tripolimageneral characteristics للبكتيريا هذه هي
+
+69
+00:05:12,900 --> 00:05:18,820
+عبارة عن thin وكلمة thin هنا محورية من كتر ما هي
+
+70
+00:05:18,820 --> 00:05:22,200
+thin it cannot be visualized by light microscopy
+
+71
+00:05:22,200 --> 00:05:25,440
+نقطة كتير مهمة ان احنا نتعاملش بال light
+
+72
+00:05:25,440 --> 00:05:28,760
+microscope لما نتكلم على ال triponema نتعامل مع
+
+73
+00:05:28,760 --> 00:05:31,580
+مين؟ مع ال dark field microscopy ايش يعني dark
+
+74
+00:05:31,580 --> 00:05:36,150
+field microscopy؟الكندنسر الكندنسر اللي تحت اللي
+
+75
+00:05:36,150 --> 00:05:41,610
+بدل كلمة كندنسر هو يعني مجمع مكثف للضوء لكن
+
+76
+00:05:41,610 --> 00:05:45,970
+الكندنسر تبع ال dark field مايكروسكوبي الضوء بيكون
+
+77
+00:05:45,970 --> 00:05:50,470
+داخله بدل ما يجمعه بشتته فالضوء بيكون طالع بهذا
+
+78
+00:05:50,470 --> 00:05:54,190
+الشكل و بهذا الشكل إذا كان في شريحة و عليها
+
+79
+00:05:54,190 --> 00:05:58,490
+بكتيريا بيصطدم بالبكتيريا و يدخل في ال objective
+
+80
+00:05:59,390 --> 00:06:04,090
+لذلك لا نرى في ال dark field microscopy أشياء
+
+81
+00:06:04,090 --> 00:06:08,590
+مضيئة إلا البكتيريا أو الأشياء الموجودة في الشريحة
+
+82
+00:06:08,590 --> 00:06:13,490
+بينما كل شيء بيكون معتم بسبب اشي كنت كده مرة ان ال
+
+83
+00:06:13,490 --> 00:06:19,750
+condenser بشتت الإضاءة ولا يجمع هذه الإضاءةهي
+
+84
+00:06:19,750 --> 00:06:22,850
+الميكروب رقم اتنين في السلسلة اللي دراسناهم لحد
+
+85
+00:06:22,850 --> 00:06:28,790
+الآن الذين لا يمكن تنميتهم على او لم يمكن لم نتمكن
+
+86
+00:06:28,790 --> 00:06:32,250
+من تنميتهم على Artificial Media الميكروب الأول كان
+
+87
+00:06:32,250 --> 00:06:35,250
+Mycobacterium Libre وهي الميكروب التاني اللي هو
+
+88
+00:06:35,250 --> 00:06:40,070
+Tryponema Pallidum Cannot be visualized by light
+
+89
+00:06:40,070 --> 00:06:43,790
+microscope ذكرناها rabbits could be infected with
+
+90
+00:06:43,790 --> 00:06:48,160
+these organisms الآن الأرانب الأرانبمش natural
+
+91
+00:06:48,160 --> 00:06:53,260
+host للبكتيريا ولكن we experimentally could infect
+
+92
+00:06:53,260 --> 00:06:57,520
+male rabbits. male rabbits اللي هم الرانب الذكور
+
+93
+00:06:57,520 --> 00:07:02,140
+تحقن البكتيريا في ال testis في الخصية بتاعة الأرنب
+
+94
+00:07:02,140 --> 00:07:05,940
+الذكر كمصدر للبكتيريا انا بحتاجش بكتيريا في
+
+95
+00:07:05,940 --> 00:07:09,300
+المختبر بحتاج ال triponemia for diagnosis for
+
+96
+00:07:09,300 --> 00:07:13,140
+diagnosis بحتاج البكتيريا مانا بقدر أجيبها؟ ماليش
+
+97
+00:07:13,140 --> 00:07:17,210
+غير المصدر هذااللي هو ال infected male rabbits
+
+98
+00:07:17,210 --> 00:07:21,710
+they are spiral flexible organisms that moves
+
+99
+00:07:21,710 --> 00:07:26,260
+without flagellaإذا فاكرين كنا زمان نقول إن كل
+
+100
+00:07:26,260 --> 00:07:30,620
+البكتيريا المتحركة متحركة بـflagella ما عدا
+
+101
+00:07:30,620 --> 00:07:34,920
+الـtriponemia متعي by axial filaments الـ axial
+
+102
+00:07:34,920 --> 00:07:38,500
+filament عبارة عن endoflagella فلاجلة بدل ما هي
+
+103
+00:07:38,500 --> 00:07:43,940
+برا ملفوفة على الخلية ما بين ال cell membrane و ال
+
+104
+00:07:43,940 --> 00:07:47,960
+cell wall فسميناها axial filament أو endoflagella
+
+105
+00:07:47,960 --> 00:07:52,380
+إذن هي متحركة لكن ليس بـflagella وإنما بـ axial
+
+106
+00:07:52,380 --> 00:07:57,190
+filamentالانقسام تبعها by transverse binary vision
+
+107
+00:07:57,190 --> 00:08:01,370
+أمر كنت كنت تسأل سؤالي أمر الصورة ليه يعني لما
+
+108
+00:08:01,370 --> 00:08:03,550
+تشوفها للشكل؟ هل هي تشوفها من ال microscope ولا
+
+109
+00:08:03,550 --> 00:08:09,010
+كده؟ هده؟ صحيح يعني هتشوف ال .. ال .. ال ..
+
+110
+00:08:09,010 --> 00:08:13,610
+التريبونيميا بشكل ال coils تبعتها أكتر من اللي هو
+
+111
+00:08:13,610 --> 00:08:17,550
+ال borrelia هتشوف ال .. ال .. ال leptospira أكتر
+
+112
+00:08:17,550 --> 00:08:20,130
+من التنتين أكتر من التنتين و هتشوف ال hook تبعتها
+
+113
+00:08:22,490 --> 00:08:25,210
+لأ لأ التريبونيميا بس اللي هي ممكن اللي هي ممكن ال
+
+114
+00:08:25,210 --> 00:08:28,770
+culture ال beginning ممكن نعملهم culture بس
+
+115
+00:08:28,770 --> 00:08:32,270
+التريبونيميا palidum اللي مش ممكن نعملها culture
+
+116
+00:08:32,270 --> 00:08:36,090
+طيب
+
+117
+00:08:36,090 --> 00:08:39,330
+clinical description of the disease احنا اصلا
+
+118
+00:08:39,330 --> 00:08:41,330
+حاكينا شو ال disease أساسا احنا نعمله description
+
+119
+00:08:41,330 --> 00:08:45,690
+ال disease caused by this organism بيقع فيه حاجة
+
+120
+00:08:45,690 --> 00:08:49,840
+من تان تان شبابيا اما syphilis اللى هو معروف
+
+121
+00:08:49,840 --> 00:08:53,140
+بالعربي الزهري اما وليس مرض السيالان خدوا بالك
+
+122
+00:08:53,140 --> 00:08:55,620
+السيالان جونورية اللى حاكيناها ناسيريا جونورية
+
+123
+00:08:55,620 --> 00:09:01,260
+يبقى syphilis and congenital syphilis ايش الفرق من
+
+124
+00:09:01,260 --> 00:09:04,640
+التانين الاولانى بيصيب ال adults اللى هو sexually
+
+125
+00:09:04,640 --> 00:09:09,120
+transmitted disease التانى هو بيصيب الأطفال اللى
+
+126
+00:09:09,120 --> 00:09:13,960
+يولدون لأمهات مصابة بال syphilisبس خدوا بالكم في
+
+127
+00:09:13,960 --> 00:09:18,400
+الجنورية مر معانا حالة مشابهة ophthalmia neonatrum
+
+128
+00:09:18,400 --> 00:09:22,100
+فاكرينها لما الطفل بيمر عبر قناة الولادة بياخد
+
+129
+00:09:22,100 --> 00:09:27,600
+معانا سيريا جنورية لكن متى .. متى أصيب عند الولادة
+
+130
+00:09:27,600 --> 00:09:33,030
+خلال الولادة بس في ال syphilis يصابفي رحم الأم
+
+131
+00:09:33,030 --> 00:09:36,570
+يعني بينتقلوا ال microbe عبر ال placenta عبر ال
+
+132
+00:09:36,570 --> 00:09:40,490
+placenta إذا حاجة اسمينها congenital syphilis هذه
+
+133
+00:09:40,490 --> 00:09:43,930
+كانت انتقلت عبر قناة الولادة وهذا أمر مختلف عن
+
+134
+00:09:43,930 --> 00:09:48,590
+اللي هو انتقال من الأم إلى الجنيه صدر مش فاهم يطلع
+
+135
+00:09:48,590 --> 00:09:52,010
+الاطفال يدخلوا على الجلوس صحيح ولا يدخلوا ال
+
+136
+00:09:52,010 --> 00:09:56,150
+bacterium هناك؟هو ال ال ال ال ال ال ال ال ال ال ال
+
+137
+00:09:56,150 --> 00:09:56,210
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+138
+00:09:56,210 --> 00:09:57,110
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+139
+00:09:57,110 --> 00:09:57,810
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+140
+00:09:57,810 --> 00:10:05,990
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+141
+00:10:05,990 --> 00:10:07,190
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+142
+00:10:07,190 --> 00:10:07,490
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+143
+00:10:07,490 --> 00:10:08,770
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+144
+00:10:08,770 --> 00:10:10,970
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+145
+00:10:10,970 --> 00:10:11,250
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+146
+00:10:11,250 --> 00:10:11,410
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+147
+00:10:11,410 --> 00:10:11,790
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+148
+00:10:11,790 --> 00:10:11,830
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+149
+00:10:11,830 --> 00:10:12,490
+ال ال ال ال ال ال ال
+
+150
+00:10:20,810 --> 00:10:23,950
+طيب اتفقنا ان احنا فينا two forms of disease هنا
+
+151
+00:10:23,950 --> 00:10:26,550
+اللي هو ال syphilis اللي هو ال STD او ال sexual
+
+152
+00:10:26,550 --> 00:10:28,850
+transmitted disease او ال venereal disease و ال
+
+153
+00:10:28,850 --> 00:10:30,870
+congenital syphilis ال congenital syphilis هتكلم
+
+154
+00:10:30,870 --> 00:10:33,990
+عنه لاحقا خدنا نتكلم من انا انا على ال syphilis
+
+155
+00:10:33,990 --> 00:10:38,410
+نفسه ال syphilis من الأمراض اللي characterized by
+
+156
+00:10:38,410 --> 00:10:42,390
+stages يا شباب مراحل ايش يعني المراحل يعني مرحلة
+
+157
+00:10:42,390 --> 00:10:47,270
+بتخلص بيفصل ما بين المرحلة و المرحلة مرحلة بيسميها
+
+158
+00:10:47,270 --> 00:10:54,670
+latency period فترة سكونلا يمكن لأي مخلوق معرفة
+
+159
+00:10:54,670 --> 00:10:57,510
+إنه هذا الإنسان مصاب بال syphilis إلا من خلال فحص
+
+160
+00:10:57,510 --> 00:11:02,730
+serology، بصدفة، مطلوب له فحص لوظيفة، ل visa، بده
+
+161
+00:11:02,730 --> 00:11:05,290
+يسافر على ولا أوروبية أو على .. على أستراليا
+
+162
+00:11:05,290 --> 00:11:09,110
+والسفارة طلبت منه يعمل إيه؟ فحوصات، عشان ياخد ال
+
+163
+00:11:09,110 --> 00:11:12,910
+visa، لإنه شهادة صحية يعنيفبعض السفراء تطلب فحص
+
+164
+00:11:12,910 --> 00:11:16,210
+اللي هو الـ syphilis فممكن يطلع بوستفيل حلوة بس ال
+
+165
+00:11:16,210 --> 00:11:19,390
+symptoms مافيش symptoms مابين المرحلة الأولى و
+
+166
+00:11:19,390 --> 00:11:22,850
+التانية في latency period و مباري المرحلة التانية
+
+167
+00:11:22,850 --> 00:11:27,810
+و التالتة في latency period إذن كم مرحلة صاروا؟
+
+168
+00:11:27,810 --> 00:11:32,850
+خمس مرحلة تنتهي منهم latency period primary
+
+169
+00:11:32,850 --> 00:11:39,000
+secondary tertiaryلتنسى period number one لتنسى
+
+170
+00:11:39,000 --> 00:11:42,720
+period number two اذا primary secondary and
+
+171
+00:11:42,720 --> 00:11:45,480
+tertiary والتنتين اللي هانا قلنا عنهم سميناهم هنا
+
+172
+00:11:45,480 --> 00:11:48,540
+ايه اللي هم لتنسى period one and لتنسى period two
+
+173
+00:11:48,540 --> 00:11:57,610
+واضحة النقطة هذه؟ طيبالان مالذي يحدث في كل مرحلة
+
+174
+00:11:57,610 --> 00:12:01,290
+من هذه المراحل هو ماذا يظهر من أعراض على الإنسان
+
+175
+00:12:01,290 --> 00:12:04,730
+في ال primary syphilis احنا المحاضرة اللي سبقت هذه
+
+176
+00:12:04,730 --> 00:12:09,750
+المحاضرة بمحاضرة تحدثنا عن Hemophilus كلمنا عن
+
+177
+00:12:09,750 --> 00:12:13,910
+بكتيري اسمها Hemophilus Dukeri Hemophilus Dukeri
+
+178
+00:12:13,910 --> 00:12:16,730
+واحدة من ال species اللي مرت معانا في ال
+
+179
+00:12:16,730 --> 00:12:21,390
+Hemophilusوقلنا عنها STD sexually transmitted
+
+180
+00:12:21,390 --> 00:12:25,690
+disease وبتسبب disease اسمه Shankroid تيمنا
+
+181
+00:12:25,690 --> 00:12:31,590
+بالشنكر اللي بينتج عنه او بينتج عن مرض اللي هو ال
+
+182
+00:12:31,590 --> 00:12:34,430
+syphilis اللي بتسببه تريبونيما باليدو فإذا
+
+183
+00:12:34,430 --> 00:12:37,230
+بتلاحظوا الأن the primary syphilis collision the
+
+184
+00:12:37,230 --> 00:12:40,390
+Shanker appears في ال syphilis the Shanker is most
+
+185
+00:12:40,390 --> 00:12:43,930
+frequently أو most frequently a painless painless
+
+186
+00:12:43,930 --> 00:12:52,350
+يعني غير مؤلمماوش اي قلم with raised border and
+
+187
+00:12:52,350 --> 00:12:59,320
+necrotic baseشايفين الفتح هذا اللي قدامكوا هذه ال
+
+188
+00:12:59,320 --> 00:13:02,280
+borders تبعتها أعلى من القاعدة القاعدة إذا
+
+189
+00:13:02,280 --> 00:13:06,120
+بتلاحظوا فيها فبيكون شكلها بالظبط حفرة زي هذه
+
+190
+00:13:06,120 --> 00:13:08,740
+الحفرة اللي قدامكوا اللي موجودة على ال remote
+
+191
+00:13:08,740 --> 00:13:12,660
+control هذا يبجي هي عبارة عن raised border مرتفعة
+
+192
+00:13:12,660 --> 00:13:18,840
+و القاعة تبعتها depressed منقفلة هذه ال chunker
+
+193
+00:13:19,540 --> 00:13:22,700
+مهمة جدا في ال diagnosis مهمة جدا في ال diagnosis
+
+194
+00:13:22,700 --> 00:13:26,060
+أحد العينات المهمة جدا جدا في ال primary syphilis
+
+195
+00:13:26,060 --> 00:13:28,960
+اللى بناخدها بناخدها من هذا المكان وكيف بتتم
+
+196
+00:13:28,960 --> 00:13:31,900
+العملية فاكرين الجنورية شباب قولنا لك وانها
+
+197
+00:13:31,900 --> 00:13:36,180
+fragile صح ناسيديا جنورية وقعدنا يمكن خمس دقايق و
+
+198
+00:13:36,180 --> 00:13:43,040
+هنتبتلكوا انها مصممة خصيصا لمن يرتكبون الفحشة دعم
+
+199
+00:13:43,040 --> 00:13:44,480
+الان
+
+200
+00:13:46,210 --> 00:13:48,810
+الـTryponema Pallidum أيضًا تعتبر فراجيل مايكرو
+
+201
+00:13:48,810 --> 00:13:52,590
+Organism فإذا حاولنا نصبغها تتدمر بين إيدينا
+
+202
+00:13:52,590 --> 00:13:55,890
+فراجيل عشان أنك تستخدمنا مين نقولنا ال dark field
+
+203
+00:13:55,890 --> 00:14:00,950
+مايكروسكوبي بدون أي صباغة فكيف يتم جمع العين؟ you
+
+204
+00:14:00,950 --> 00:14:07,530
+moisten a cotton swab أو غوز with warm sterile
+
+205
+00:14:07,530 --> 00:14:11,570
+saline you wipe the area الجنital area سواء كان
+
+206
+00:14:11,570 --> 00:14:15,230
+مال أو في مال خدوا بالكوا في الجنital areaبنمسح
+
+207
+00:14:15,230 --> 00:14:20,130
+المنطقة بعدين بنجيب لانست شفرة شفرة بيكون لها طرف
+
+208
+00:14:20,130 --> 00:14:24,890
+حاد وطرف غير حاد بالطرف الغير حاد بنعمل عملية كشت
+
+209
+00:14:24,890 --> 00:14:33,590
+لل base للقاعدة اللي شفناها لل base دون أن نجرحها
+
+210
+00:14:33,590 --> 00:14:39,790
+يعني هو كأنك تعمل عملية استثارة لل skinالان بيبدأ
+
+211
+00:14:39,790 --> 00:14:46,890
+يطلع سائل أصفر وانت بتعمل scrapping بتجففه وبتنتظر
+
+212
+00:14:46,890 --> 00:14:52,790
+عشر دقائق تقريبا ساعة بيبدأ سائل أصفر يتكون في
+
+213
+00:14:52,790 --> 00:14:57,590
+الحفرة بتسحبه انت اما ب باستشر بيبت او بسرنج هذا
+
+214
+00:14:57,590 --> 00:15:01,550
+السائل بتاخده بتحطه على slide بتحط عليه cover slip
+
+215
+00:15:01,550 --> 00:15:05,450
+و بتفحصه under dark field microscopy ايش متوقع
+
+216
+00:15:05,450 --> 00:15:11,070
+تشوف؟تتوقع تشوف actively motile spiral
+
+217
+00:15:11,070 --> 00:15:15,270
+microorganism اللي هي تريبونيما actively motile
+
+218
+00:15:15,270 --> 00:15:18,590
+وال motility تبقى تلبس البكتيريا around its axis
+
+219
+00:15:18,590 --> 00:15:22,810
+زي البوردي طبعا زي ال screw فبسموها motility
+
+220
+00:15:22,810 --> 00:15:27,050
+around its axis و very rapid motility يعني حركة
+
+221
+00:15:27,050 --> 00:15:30,190
+سريعة وهذا الحركة على فكرة من الأشياء اللي بتميز
+
+222
+00:15:30,190 --> 00:15:36,200
+البكتيريا شكلهاال .. اللولبي و حركتها بتساعد على
+
+223
+00:15:36,200 --> 00:15:42,400
+الاختراق و التشبث يعني لما هي تخترق خلال عملية
+
+224
+00:15:42,400 --> 00:15:45,100
+الجنسية من الذكر إلى الأنثة أو الأنثة إلى الذكر
+
+225
+00:15:45,100 --> 00:15:51,520
+فتبتاخر .. لأن شكلها جونة spiral فسهل عليها تخترق
+
+226
+00:15:51,520 --> 00:15:56,300
+الولميوكاس من بعيد خلصنا أخدنا العينة و فحصناها،
+
+227
+00:15:56,300 --> 00:16:00,810
+الآن إيش بيصير؟ إيش مصير الشانكر هذا؟البثرة
+
+228
+00:16:00,810 --> 00:16:05,750
+الجنسية ايش مصيرها؟ مصيرها الشفاء سواء علجت او ما
+
+229
+00:16:05,750 --> 00:16:14,170
+علجت وبتشفى دون ان تترك اثران تخيلوا الان عندي ..
+
+230
+00:16:14,170 --> 00:16:21,690
+ايش عندي؟ عندي painless شنكر مافيش فيه قلم مادام
+
+231
+00:16:21,690 --> 00:16:27,250
+مافيش قلم اشروا على الطبيب هتشفى لحالها خلاص يبقى
+
+232
+00:16:27,250 --> 00:16:32,280
+أهملها وانتهى الموضوعدخل في مرحلة شفاء اختفت تماما
+
+233
+00:16:32,280 --> 00:16:37,020
+المريض مش شايف اي اثر للمرض ولا يبدو عليه اي اثر
+
+234
+00:16:37,020 --> 00:16:44,080
+للمرض وبيجعد في هذه المرحلة من ست أسابيع لست أشهر
+
+235
+00:16:44,080 --> 00:16:48,820
+يعني من شهر و نص إلى ست أشهر وهو لا يعاني من اي
+
+236
+00:16:48,820 --> 00:16:51,100
+شيء هذه الفترة اللي بيسميها latency period number
+
+237
+00:16:51,100 --> 00:16:56,680
+one ما الذي يحدث بعد ذلك بدخله مرحلة stage twoكان
+
+238
+00:16:56,680 --> 00:17:01,500
+ينتقل ل stage two وفي stage two بيصير عنده صداع
+
+239
+00:17:01,500 --> 00:17:06,040
+بيصير عنده malaise generalized lymphadenopathy كل
+
+240
+00:17:06,040 --> 00:17:09,760
+الغدد اللينفاوية اللي في جسمه بيصير تنتفخ و بيصير
+
+241
+00:17:09,760 --> 00:17:15,300
+فيها ألم and a variety of skin rashes أنواع مختلفة
+
+242
+00:17:15,300 --> 00:17:19,160
+من اللي هو الطفحة الجلدي في أماكن متنوعة من جسمه
+
+243
+00:17:19,160 --> 00:17:23,080
+hepatitis, meningitis, glomeral nephritis and ..
+
+244
+00:17:23,080 --> 00:17:29,230
+يعني صار عندهأزمة صحية في معظم ال organs تبعات
+
+245
+00:17:29,230 --> 00:17:34,890
+اللي هو الجسم النفرانس غالبا شباب بيكون ناتج عن
+
+246
+00:17:34,890 --> 00:17:38,770
+النفرانس يعني اتهاب النفرانس ناتج عن ال antigen
+
+247
+00:17:38,770 --> 00:17:41,250
+-antibody complexes يعني اتباط ال antibodies اللي
+
+248
+00:17:41,250 --> 00:17:44,910
+اتكونت بالجسم مع بقايا البكتيريا اللي اترسف في
+
+249
+00:17:44,910 --> 00:17:48,090
+الكلية شوفنا مرض زي الجبل احنا في ال nephrotyphoid
+
+250
+00:17:48,090 --> 00:17:52,410
+نعم في سنة اللي طيفةsecondary lesions كمان برضه
+
+251
+00:17:52,410 --> 00:17:55,630
+heals spontaneously over a period of several weeks
+
+252
+00:17:55,630 --> 00:17:59,910
+and then enters in latent stage number two اذا
+
+253
+00:17:59,910 --> 00:18:04,950
+مرحلة رقم واحد ما اتعالجو رأى خاف تماما دخل لمرحلة
+
+254
+00:18:04,950 --> 00:18:09,490
+اتنين تمام؟ مرحلة اتنين الصحيح هي مدعاة ان المريض
+
+255
+00:18:09,490 --> 00:18:12,850
+خاف و مدعاة ان المريض لو على مين؟ على الطبيب
+
+256
+00:18:12,850 --> 00:18:18,290
+فغالبا كتير من المرضى المش مثقفين بيروحوش في
+
+257
+00:18:18,290 --> 00:18:20,150
+المرحلة الأولى كان بيروح في مين؟ في المرحلة
+
+258
+00:18:20,150 --> 00:18:22,930
+التانية لأنها مرحلة تانية فيها ألم و فيها يعني
+
+259
+00:18:22,930 --> 00:18:27,870
+أشياء مقلقة تظهر على الجسم و أعراض متنوعة فبالتالي
+
+260
+00:18:28,300 --> 00:18:31,260
+كتير من المرضى بيساروا .. بيساروا ال .. ال ..
+
+261
+00:18:31,260 --> 00:18:35,840
+الاطباء في مرحلة رقم اتنى، الان نجي لمرحلة رقم
+
+262
+00:18:35,840 --> 00:18:38,500
+تلاتة، خدوا بالكوا، جاب المرحلة رقم تلاتة فيها
+
+263
+00:18:38,500 --> 00:18:43,480
+الناس يقولنا ال tenth superior number two ال .. ال
+
+264
+00:18:43,480 --> 00:18:48,040
+tertiary stage .. ال tertiary stage اللي هي
+
+265
+00:18:48,040 --> 00:18:52,200
+المرحلة الثالثية بيسموها the destructive stage of
+
+266
+00:18:52,200 --> 00:18:55,940
+the disease المرحلة التدميرية أو المدمرة للمرض
+
+267
+00:18:58,520 --> 00:19:01,420
+لو رأيتم بعض الصور لقوا ناس عندهم tertiary
+
+268
+00:19:01,420 --> 00:19:06,000
+syphilis والعيادة بذا كان هم خارجين من جهنم لماذا؟
+
+269
+00:19:06,000 --> 00:19:12,220
+ما الذي يعطي وجهك الجميل وجسمك الأنيق هو الهيكل
+
+270
+00:19:12,220 --> 00:19:15,880
+العظمي اللي ربنا أعطانا إياه بهذا التناظق والتناظم
+
+271
+00:19:15,880 --> 00:19:20,900
+عظامنا عظامنا اللي كسيت لحما حتى نبدو بهذا الشكل
+
+272
+00:19:20,900 --> 00:19:27,430
+لو العظام تبعتنا صار فيها تشوةيعني الفك تبقى كده
+
+273
+00:19:27,430 --> 00:19:34,350
+تمام انطعج كيف بيكون شكل الواحد غريب صح ولا لأ لو
+
+274
+00:19:34,350 --> 00:19:38,330
+صارت ضخم في العضم اللي موجود في الكوا برضه او
+
+275
+00:19:38,330 --> 00:19:43,750
+الكتف او الصدر فبصير فيه تشوهات bone and teeth
+
+276
+00:19:43,750 --> 00:19:47,290
+deformations bone and teeth deformation في هذا
+
+277
+00:19:47,290 --> 00:19:52,350
+المرحلة و بصير حاجة خطيرة جدا اسمها aneurism تمدد
+
+278
+00:19:52,350 --> 00:19:59,330
+القويةتعرفين القلب لما بدخ الدم بدخه بقوة عشان
+
+279
+00:19:59,330 --> 00:20:03,650
+يوصله لأماكن متنوعة من ضمن الأماكن اللي بتحملهاش
+
+280
+00:20:03,650 --> 00:20:07,770
+بتحملش الانقطاع عنها اللي هو الدماغ فتخيل مثلا
+
+281
+00:20:07,770 --> 00:20:14,090
+عندك aneurism في الأوري ده اللي طالع على الدماغ
+
+282
+00:20:14,090 --> 00:20:17,550
+ايش يعني aneurism؟ تكون تمدد؟ اظن انك بتقع في ال
+
+283
+00:20:17,550 --> 00:20:21,570
+.. بتسجل زراعة انت بتسجل زراعة، لما بيكون البربيشة
+
+284
+00:20:21,570 --> 00:20:27,590
+فيهالما بيكون واسع قعد الميتك و بتنزل جنبه وهو نفس
+
+285
+00:20:27,590 --> 00:20:32,790
+الفكرة القلب يعني بضخ دم تمام؟ وفي أولي ده متسعة
+
+286
+00:20:32,790 --> 00:20:37,090
+فالضغط بيكون أقل نسبة الدم اللي واصل للدماغ بيكون
+
+287
+00:20:37,090 --> 00:20:41,660
+أقلإذن في عندى مشكلة aneurysm وفي عندى مشكلة
+
+288
+00:20:41,660 --> 00:20:45,480
+تقولنا اللى هو bone and teeth deformation وفي عندى
+
+289
+00:20:45,480 --> 00:20:50,480
+حاجة اسمها gomas، gomas بالترجمة الحرفية اللى لها
+
+290
+00:20:50,480 --> 00:20:54,560
+الأورام الصمغية الأورام الصمغية والصحيح هي عبارة
+
+291
+00:20:54,560 --> 00:21:01,160
+عن كتل غالبا تشريحيا ممكن تشبه اللى هو ال
+
+292
+00:21:01,160 --> 00:21:03,760
+tuberculosis اللى شفناها في ال micro bacterium
+
+293
+00:21:03,760 --> 00:21:10,310
+tuberculosis في عندى كمان15% من الحلقات قد أصاب بـ
+
+294
+00:21:10,310 --> 00:21:13,910
+Central Nervous System Diseases and Meningitis لكن
+
+295
+00:21:13,910 --> 00:21:18,970
+الـ 80% هم الـ aneurysm اللي كنا عنه تمدد اللي هو
+
+296
+00:21:18,970 --> 00:21:24,510
+الأوعياء الدموية لكن متى .. متى بتبدأ المرحلة
+
+297
+00:21:24,510 --> 00:21:30,090
+الثالثة؟ احنا كنا بين الأولى والتانية شهر و نص لست
+
+298
+00:21:30,090 --> 00:21:34,110
+أشهر المرحلة التانية للتالتة من خمسة لعشرين سنة
+
+299
+00:21:34,110 --> 00:21:39,650
+شباب من ال initial infectionمن خمسة لعشرين سنة،
+
+300
+00:21:39,650 --> 00:21:42,750
+لذلك إذا لم يبقوا يعالجوا في المرحلة الأولى، ممكن
+
+301
+00:21:42,750 --> 00:21:45,150
+يعالجوا في المرحلة التانية، لكن إذا ظهر عليهم عراض
+
+302
+00:21:45,150 --> 00:21:49,950
+المرحلة التالتة، غالبا ال .. ال .. ال .. ال .. ال
+
+303
+00:21:49,950 --> 00:21:52,590
+damage بيكون irreversible، irreversible يعني غير
+
+304
+00:21:52,590 --> 00:21:56,310
+قابل، حتى لو .. لو خلصنا من البكتيريا، غالبا الدرر
+
+305
+00:21:56,310 --> 00:21:59,990
+قد حدد، احنا اتفقنا إذا primary, secondary و
+
+306
+00:21:59,990 --> 00:22:01,230
+tertiary, syphilis
+
+307
+00:22:07,180 --> 00:22:19,520
+من ستة أسابيع .. نعم ده
+
+308
+00:22:19,520 --> 00:22:21,340
+.. ده ال secondary .. نعم ال secondary symptoms
+
+309
+00:22:21,340 --> 00:22:26,160
+مظبوط إيش السؤال؟
+
+310
+00:22:26,160 --> 00:22:31,600
+لأ لأ لأ هي ال latency period اللي .. اللي .. اللي
+
+311
+00:22:31,600 --> 00:22:35,220
+بين الأول .. بين الأولين و التانية بين التانية و
+
+312
+00:22:35,220 --> 00:22:39,730
+التالتةبالظبط هذا التالت يقول بالإنجليزي بالنسبة ل
+
+313
+00:22:39,730 --> 00:22:44,150
+ال congenital syphilis جونه هو اللي يطلق على ال
+
+314
+00:22:44,150 --> 00:22:48,310
+syphilis اللي بصيب الجنين او ال fetus و في هذه
+
+315
+00:22:48,310 --> 00:22:51,990
+الحالات الجنين ممكن يصيرله مجموعة من الخيارات اما
+
+316
+00:22:51,990 --> 00:22:56,330
+يصيرله abortionأو يولد ميتا كلمة still born يولد
+
+317
+00:22:56,330 --> 00:23:03,010
+نيتا او life born او يولد حيا او without clinical
+
+318
+00:23:03,010 --> 00:23:06,850
+evidence of syphilis يعني ممكن يكون عنده مجموعة من
+
+319
+00:23:06,850 --> 00:23:10,150
+الخيارات الخيار الأول انه still اجهاض الخيار
+
+320
+00:23:10,150 --> 00:23:13,610
+التاني يولد ميتا الخيار التالت انه يولد باعراض
+
+321
+00:23:13,610 --> 00:23:17,430
+syphilis والخيار التالت انه يولد بدون اي اعراض لل
+
+322
+00:23:17,430 --> 00:23:22,310
+syphilisلما بيظهر عليه أعراض غالبا شباب مش أعراض
+
+323
+00:23:22,310 --> 00:23:25,030
+ال primary بيظهر عليه أعراض من ال secondary
+
+324
+00:23:25,030 --> 00:23:28,950
+syphilis بيكون كل جسمه فيه ال rashes يبقى بيولد
+
+325
+00:23:28,950 --> 00:23:33,190
+بيكون ال already المرحلة الأولى تخطاها المرحلة
+
+326
+00:23:33,190 --> 00:23:37,290
+الأولى تخطاها فبيدخل في مرحلة التانيةطبعا في هذا
+
+327
+00:23:37,290 --> 00:23:41,470
+الحالة ممكن كمان يؤدي الى العمى ال blindness ده
+
+328
+00:23:41,470 --> 00:23:47,310
+بنتيجة اللى هو دمور للعصب البصري اللى هو ال optic
+
+329
+00:23:47,310 --> 00:23:52,010
+اترافى وممكن يصير عنده كمان deformed bones may
+
+330
+00:23:52,010 --> 00:23:55,570
+also occur يعني ممكن يصير عنده تشوهات في الأعضاء
+
+331
+00:23:55,570 --> 00:24:01,720
+نفس الكلام اللى حكيناهيمكن ال syphilis احنا عندنا
+
+332
+00:24:01,720 --> 00:24:05,160
+.. ممكن نسأل السؤال قبل هيكد في أحد المحاضرات لما
+
+333
+00:24:05,160 --> 00:24:08,540
+اتكلمنا عن سوريا الجنورية، هل فيه جنورية في قطاع
+
+334
+00:24:08,540 --> 00:24:12,260
+غزة؟ نفس السؤال، هل فيه syphilis في قطاع غزة؟
+
+335
+00:24:12,260 --> 00:24:15,780
+وبنفس الجواب، بيقولكنه لأ تقريبا، يعني لا يود أنها
+
+336
+00:24:15,780 --> 00:24:22,500
+حالات مشخصة بأي من المرضين منذ سنواتطويلة منذ
+
+337
+00:24:22,500 --> 00:24:25,240
+سنوات طويلة مافيش كان في السابق لما كان في عهد
+
+338
+00:24:25,240 --> 00:24:30,120
+الاحتلال الطريقة مفتوحة وكان في بعض الناس يعني
+
+339
+00:24:30,120 --> 00:24:36,160
+يمارسوا الرذيلة في داخل الخط الأخضر كان بالفعل في
+
+340
+00:24:36,160 --> 00:24:39,360
+بعض اللي هو الحالات وحتى ال HIV هذه الحالات اللي
+
+341
+00:24:39,360 --> 00:24:42,840
+أنا قلتلكوا هنا ممكن لاتتجاوز ال 30 حالة على مدار
+
+342
+00:24:42,840 --> 00:24:48,300
+التاريخ ال HIV ومعظم هذه الحالات كانت تأتي من اللي
+
+343
+00:24:48,300 --> 00:24:53,720
+هم من العايدين من الخارجطيب لماذا نحن مهتمين في ال
+
+344
+00:24:53,720 --> 00:24:57,520
+diagnostic microbiology بالتريبونيما باليدوم اللى
+
+345
+00:24:57,520 --> 00:25:00,380
+مسبب لمرض ال syphilis اللى هو مش مورد اصلا عندنا
+
+346
+00:25:00,380 --> 00:25:03,140
+احنا كنا كل عالم قارية صغيرة قد نضطر ان العمل في
+
+347
+00:25:03,140 --> 00:25:05,640
+مكان اخر غير هذا المكان فلازم نكون مزودين
+
+348
+00:25:05,640 --> 00:25:09,060
+بالمعلومات لكن اللى أهم من ذلك الصحيح ان التقنية
+
+349
+00:25:09,060 --> 00:25:13,400
+المستخدمة في تشخيص ال .. ال .. تريبونيما باليدوم
+
+350
+00:25:13,400 --> 00:25:17,820
+تقنيات مش common للميكروبات الأخرى وبتالي كويس ان
+
+351
+00:25:17,820 --> 00:25:22,400
+نطلع على هذه التقنيات مثلاأول تقنية الميكروسكوبي
+
+352
+00:25:22,400 --> 00:25:25,760
+والميكروسكوبي اتفقنا على انه ايش هيكون قبل عن مين
+
+353
+00:25:25,760 --> 00:25:29,000
+عن dark field microscope واللوحة اللي قدامكوا شرحت
+
+354
+00:25:29,000 --> 00:25:31,860
+تماما في بداية المحاضرة لما قلنالكوا كيف نجمع
+
+355
+00:25:31,860 --> 00:25:37,620
+العينة وإيش هنشوف تحت اللي هو ال microscopeالتقنية
+
+356
+00:25:37,620 --> 00:25:40,600
+التانية اللى ما اتكلمنا عنها اللى هى Astrological
+
+357
+00:25:40,600 --> 00:25:43,520
+Testing و Astrological Testing الشباب بيقسموها
+
+358
+00:25:43,520 --> 00:25:49,980
+لقسمين non-specific و specific او عشان اللغة اللى
+
+359
+00:25:49,980 --> 00:25:52,940
+مكتوبة هنا غير عن الكلام اللى انا حكيته non
+
+360
+00:25:52,940 --> 00:25:55,940
+-tryponemial antigen test و كلمة non-tryponemial
+
+361
+00:25:55,940 --> 00:25:58,480
+antigen test يعني non-specific test يعني احنا
+
+362
+00:25:58,480 --> 00:26:04,300
+ماندورش specificallyتخيلوا شباب مين درس معانا food
+
+363
+00:26:04,300 --> 00:26:06,880
+microbiology أو درس معانا، كنا نتكلم عن indicator،
+
+364
+00:26:06,880 --> 00:26:10,300
+مظبوط، كنا نتكلم عن indicator، و استخدامنا ال
+
+365
+00:26:10,300 --> 00:26:13,400
+indicator كان للدلالة على وجود أشياء أخرى، صح ولا
+
+366
+00:26:13,400 --> 00:26:17,420
+لأ، فبعض الأحيان بنبحث عن شئ مش الأصلي، وجود ال
+
+367
+00:26:17,420 --> 00:26:21,820
+indicator مؤشر، ففي هذه الحالة لا ال antigen اللي
+
+368
+00:26:21,820 --> 00:26:24,440
+علاقة بالتريبونيميا ولا ال antibody اللي علاقة
+
+369
+00:26:24,440 --> 00:26:29,580
+بالتريبونيميالكن وجود ال antibody هذا او ما يشبه
+
+370
+00:26:29,580 --> 00:26:33,780
+ال antibody في دم المريض مؤشر انه عنده syphilis
+
+371
+00:26:33,780 --> 00:26:39,920
+لكن للأسف .. للأسف مش specific طيب مادام مش
+
+372
+00:26:39,920 --> 00:26:43,100
+specific ليش لليوم هو المستخدم في العالم ك
+
+373
+00:26:43,100 --> 00:26:48,220
+screening test؟لأن أنا جدتلكم يوم من الأيام ما هو
+
+374
+00:26:48,220 --> 00:26:51,600
+او ما هي مواصفات ال screening test ايش مواصفاته
+
+375
+00:26:51,600 --> 00:26:56,860
+انه sensitive لكن مش بالضروري يكون specific ايش
+
+376
+00:26:56,860 --> 00:27:01,240
+يعني sensitive؟ sensitive يعني لو الفحص طلع
+
+377
+00:27:01,240 --> 00:27:06,700
+negative فهو حقا negative لكن لو طلع positive بدنا
+
+378
+00:27:06,700 --> 00:27:11,920
+نعمله confirmation طب في سؤال مهم بدنا نسأل و
+
+379
+00:27:11,920 --> 00:27:16,710
+نجاوب عليهمين أكتر في أي community في الدنيا؟
+
+380
+00:27:16,710 --> 00:27:20,410
+المصابين ولا السليمين؟ السليمين أكتر من المصابين،
+
+381
+00:27:20,410 --> 00:27:25,700
+صح ولا لأ؟ يبجي لو أنا فحاصة ألف واحداحتمالات ال
+
+382
+00:27:25,700 --> 00:27:30,320
+negative ايه؟ اكتر ال positive قليل ال negative
+
+383
+00:27:30,320 --> 00:27:33,840
+هذا مضمون في الفحص هذا مضمون ان ال negative
+
+384
+00:27:33,840 --> 00:27:37,140
+negative حقيقي بس اللي مش مضمون فيه مين ال
+
+385
+00:27:37,140 --> 00:27:40,520
+positive يعني عملتلكوا انتوا المجموعة انتوا
+
+386
+00:27:40,520 --> 00:27:45,800
+عملتلكوا الفحص طلع واحد بس اللي positive والباقين
+
+387
+00:27:45,800 --> 00:27:49,640
+طلعوا ايه؟ negative يبقى الجامعة نيجاتف حقيقي ولا
+
+388
+00:27:49,640 --> 00:27:53,460
+لأ؟وهو يمكن يكون negative حقيقية negative لكن هو
+
+389
+00:27:53,460 --> 00:27:56,540
+طلع positive في الفحص هذا لأنه specific، بدي أعمله
+
+390
+00:27:56,540 --> 00:27:59,800
+فحص تاني specific و هيطلع negative ان شاء الله،
+
+391
+00:27:59,800 --> 00:28:00,280
+تمام؟
+
+392
+00:28:03,040 --> 00:28:07,500
+يبقى هاي مواصفات ايش قلنا كده مرة ال screening
+
+393
+00:28:07,500 --> 00:28:11,920
+test انه sensitive مش بالضرورة ياريت يكون specific
+
+394
+00:28:11,920 --> 00:28:16,640
+لكن غالبا الحلو مابيكملش على قولت اخواننا المصريين
+
+395
+00:28:16,640 --> 00:28:23,640
+انه الفحص ال screening غالبا بيكون فيه إشكالية لكن
+
+396
+00:28:23,640 --> 00:28:27,520
+ميزاته عالية بيكون sensitive بيكون رخيص بيكون
+
+397
+00:28:27,520 --> 00:28:33,450
+rapid بدونش تقنيات عالية وبالتالي هو المستخدمكيف
+
+398
+00:28:33,450 --> 00:28:37,970
+الفحص هذا من العامة اسمه VDRL على فكرة VDRL و VDRL
+
+399
+00:28:37,970 --> 00:28:42,310
+اختصار لمجموعة كلمات Venereal Disease Research
+
+400
+00:28:42,310 --> 00:28:47,470
+Laboratories هذه عبارة عن مجموعة مختبرات بتعمل في
+
+401
+00:28:47,470 --> 00:28:50,410
+تطوير فحوصات او تشخيص ال Venereal Disease ال
+
+402
+00:28:50,410 --> 00:28:52,390
+Venereal Disease اللي هي الأمراض المنتقلة عن طريق
+
+403
+00:28:52,390 --> 00:28:57,080
+الجنسطوروا هذا الفحص فسموه على اسم المختبر VDR-L
+
+404
+00:28:57,080 --> 00:29:01,200
+تمام وهو عبارة عن agglutination أو fluculation
+
+405
+00:29:01,200 --> 00:29:05,340
+test يعني انتجين مع antibody mixing إذا .. إذا صار
+
+406
+00:29:05,340 --> 00:29:11,060
+فيه agglutination الفحص بُست فبنستخدم انتجين مادة
+
+407
+00:29:11,060 --> 00:29:14,100
+اسمها cardio lipin عبارة عن phospholipid عبارة عن
+
+408
+00:29:14,100 --> 00:29:19,020
+phospholipid فبنكشف فيها عن antibody non specific
+
+409
+00:29:19,020 --> 00:29:23,430
+فبسموه رياجينفاستخدامنا Cardiolipin ليس لو علاقة
+
+410
+00:29:23,430 --> 00:29:27,710
+بالتريبونيما باليدوم وكشفنا فيه عن انتجن أيضا ليس
+
+411
+00:29:27,710 --> 00:29:33,310
+لو علاقة بمين بالتريبونيما باليدوم لكن وجود هذا ال
+
+412
+00:29:33,310 --> 00:29:41,230
+antibody تزامن مع كل حالات من التريبونيما باليدوم
+
+413
+00:29:41,230 --> 00:29:43,110
+فوجوده
+
+414
+00:29:44,310 --> 00:29:49,490
+indicator تمام indicator لكن للأسف هذا الرياجين
+
+415
+00:29:49,490 --> 00:29:55,270
+لاجناه في أمراض أخرى يبقى بطل specific وصل الصورة
+
+416
+00:29:55,270 --> 00:30:00,830
+لكن لا يولد مريض syphilis ماعندوش رياجينالله يفتح
+
+417
+00:30:00,830 --> 00:30:03,590
+عليك، تمام؟ يبقى يفهمنا إيش يعني sensitivity وإيش
+
+418
+00:30:03,590 --> 00:30:06,810
+يعني specificity إذا أحنا طلاب تحيات طبية وسنة
+
+419
+00:30:06,810 --> 00:30:08,990
+تالتة ومش عارفين الفرق بين sensitivity
+
+420
+00:30:08,990 --> 00:30:13,770
+وspecificity مانا بحكي we have to go back to first
+
+421
+00:30:13,770 --> 00:30:16,970
+year لازم نرجع لسنة أولى يا شباب، مهم جدا نبقى
+
+422
+00:30:16,970 --> 00:30:19,910
+عارفين هذه ال .. يعني من أهم الأسئلة في ال
+
+423
+00:30:19,910 --> 00:30:23,370
+interviews حتى لل .. لل .. لل .. للتوظيف، هذا
+
+424
+00:30:23,370 --> 00:30:26,810
+السؤال ما الفرق بين ال specificity وبين اللي هو
+
+425
+00:30:26,810 --> 00:30:31,570
+sensitivityهذا الفحص الأذكر لما كنت طالع في
+
+426
+00:30:31,570 --> 00:30:36,170
+المستشفى نتدرب ولا عمر نحنا كطلاب كنا نفت فيه انه
+
+427
+00:30:36,170 --> 00:30:39,870
+positive و لا negative لأن ال agglutination فيه
+
+428
+00:30:39,870 --> 00:30:43,150
+صعب ال visualization فكنا نوريه للدكتورة المسئولة
+
+429
+00:30:43,150 --> 00:30:45,630
+و نقولها اتفضلي بس شوفيه ان هي positive و لا
+
+430
+00:30:45,630 --> 00:30:51,130
+negative حتى هي ك expert كانت تاخد وقت و بعض
+
+431
+00:30:51,130 --> 00:30:54,030
+الأحيان تاخد جزء من العينة و تحت تحت ال microscope
+
+432
+00:30:54,030 --> 00:30:58,790
+عشان تشوف ال agglutinationفال VDRL أحد ما سوقه
+
+433
+00:30:58,790 --> 00:31:01,610
+صعوبة ال interpretation هل هو positive ولا
+
+434
+00:31:01,610 --> 00:31:06,210
+negative فطوروا منه يا شباب فحص اسمه RPR سموه
+
+435
+00:31:06,210 --> 00:31:11,510
+Rabbit Plasma Reagin هذا الفحص بيتميز بسهولة اللي
+
+436
+00:31:11,510 --> 00:31:16,110
+هو تفسيره أنه positive ولا negative كيف؟اضافه مع
+
+437
+00:31:16,110 --> 00:31:19,050
+الـ Cardiolipin اضافه معاه charcoal اضافه معاه
+
+438
+00:31:19,050 --> 00:31:24,010
+charcoal فصار سهل عملية ال visualization لمين ده
+
+439
+00:31:24,010 --> 00:31:27,870
+ال agglutination اذا ال VDRL او ال RPR هما نفس
+
+440
+00:31:27,870 --> 00:31:32,790
+الفحص لكن ال RPR عبارة عن modification ايش نوع ال
+
+441
+00:31:32,790 --> 00:31:39,550
+modification اضافنا charcoal على ال Cardiolipin to
+
+442
+00:31:39,550 --> 00:31:45,970
+visualize يعني عملية توضيح للي هو ال reactionالفحص
+
+443
+00:31:45,970 --> 00:31:48,310
+التاني يا شباب اللي هو ال compliment fixation و
+
+444
+00:31:48,310 --> 00:31:52,670
+بيسموه Wasserman-Kolmar test هذا اخدوا بقالكوا
+
+445
+00:31:52,670 --> 00:31:58,110
+برضه non specific test non specific test احنا مش
+
+446
+00:31:58,110 --> 00:32:00,310
+راح نجيب لك ال compliment fixation و مش راح نقوش
+
+447
+00:32:00,310 --> 00:32:08,850
+طيب للي نسيه هذكره بس في الموضوع عندي انا one drop
+
+448
+00:32:08,850 --> 00:32:14,690
+of serum المفروض ان يكون فيه هاشantibodies لو ضفت
+
+449
+00:32:14,690 --> 00:32:19,410
+انا antigen و
+
+450
+00:32:19,410 --> 00:32:22,530
+ال antigen كان specific لل antibody ايش هيصير فيه
+
+451
+00:32:22,530 --> 00:32:27,810
+هنا جاب ال agglutination لو كان ال antigen صغير
+
+452
+00:32:27,810 --> 00:32:34,030
+هيبين ال agglutination مش هيبين هيصير reaction غير
+
+453
+00:32:34,030 --> 00:32:39,390
+قابل للرؤية كي بدى اعرفه انا خدوا بالك ال antigen
+
+454
+00:32:39,390 --> 00:32:42,010
+لما بتفعل مع ال antibody بيستهلك
+
+455
+00:32:45,700 --> 00:32:49,320
+الـ compliment مش بعمله activation يبجى السيرام
+
+456
+00:32:49,320 --> 00:32:53,820
+اللى هنا فقد ال compliment اللى فيه فقد ال
+
+457
+00:32:53,820 --> 00:32:58,240
+compliment المصطلح بنقول compliment was fixed
+
+458
+00:32:58,240 --> 00:33:02,920
+استهلكت طبعا استنفذت للأسف انا ماقدرش اعرف ان ال
+
+459
+00:33:02,920 --> 00:33:06,180
+compliment استنفذت او ما استنفذتش يبجى لا انا جادر
+
+460
+00:33:06,180 --> 00:33:09,300
+اشوف ال antigen antibody reaction ولا جادر اشوف ان
+
+461
+00:33:09,300 --> 00:33:12,880
+ال compliment استهلكت او لم تستهلك فالحل ايش؟
+
+462
+00:33:13,510 --> 00:33:18,690
+بالظبط بنضاف ال red blood cell مرتبط عليها
+
+463
+00:33:18,690 --> 00:33:23,990
+specific antibody ك indicator لل reaction الآن هذه
+
+464
+00:33:23,990 --> 00:33:29,390
+الخلايا ال red blood cell مع ال antibody لا ينقصها
+
+465
+00:33:29,390 --> 00:33:33,770
+إلا ال complement عشان تتحلل ال antibody مع ال
+
+466
+00:33:33,770 --> 00:33:37,650
+antigen المفروض انه بعملش الآن بيعمل activation
+
+467
+00:33:37,650 --> 00:33:40,790
+لمن؟ لل complement حطينا ال system هنا في
+
+468
+00:33:40,790 --> 00:33:45,990
+complementفى compliment هتخلى الانتباد يحلل مين ال
+
+469
+00:33:45,990 --> 00:33:50,330
+blood cell فبصير ال lysis يبقى هى أحد النتائج
+
+470
+00:33:50,330 --> 00:33:57,930
+حطينا ال system هنا فش compliment، no lysis يبقى
+
+471
+00:33:57,930 --> 00:34:03,350
+النتيجة يا lysis يا no lysis أو بالأحرى hemolysis،
+
+472
+00:34:03,350 --> 00:34:08,390
+no hemolysisالان اذا .. اذا صار فيه hemolysis يبقى
+
+473
+00:34:08,390 --> 00:34:11,450
+فيه complement، اذا فيه complement يبقى الفحص،
+
+474
+00:34:11,450 --> 00:34:17,090
+negative، لأنه لم تستهلك، اذا مافيش complement، no
+
+475
+00:34:17,090 --> 00:34:20,190
+hemolysis، مافيش complement يبقى الفحص، و هذا ما
+
+476
+00:34:20,190 --> 00:34:24,830
+يسمى بال complement fixation، لكنسواء كان الفحص
+
+477
+00:34:24,830 --> 00:34:28,210
+الأولاني اللي هو ال VDRL أو ال RPR أو ال
+
+478
+00:34:28,210 --> 00:34:32,310
+compliment fixation احنا مش جونا .. جونا sensitive
+
+479
+00:34:32,310 --> 00:34:35,250
+لكن جونا ممكن يكون فيه false positive ايش يعني
+
+480
+00:34:35,250 --> 00:34:39,010
+false positive؟ يعني مش specific في كل من الأمراض
+
+481
+00:34:39,010 --> 00:34:41,910
+التاليةلو كان المريض عنده malaria بيعطينا positive
+
+482
+00:34:41,910 --> 00:34:44,850
+لو كان عنده liprosy فكان liprosy بيعطينا positive
+
+483
+00:34:44,850 --> 00:34:48,130
+لو عنده infectious mononucleosis المريض positive
+
+484
+00:34:48,130 --> 00:34:51,990
+لو عنده missiles positive بيعطينا positive لو عنده
+
+485
+00:34:51,990 --> 00:34:56,430
+SLE systemic lopus erythematosus عارفينه ال SLE
+
+486
+00:34:56,430 --> 00:34:59,930
+systemic lopus erythematosus امام الذئبه الحمراء
+
+487
+00:34:59,930 --> 00:35:02,990
+باللغه العربية الذئبه الحمراء اللى بيكون في
+
+488
+00:35:02,990 --> 00:35:06,850
+الفراشه وجه المريض بيكون زى الفراشه autoimmune
+
+489
+00:35:06,850 --> 00:35:11,070
+diseasemalaria, liprosy, measles, infectious
+
+490
+00:35:11,070 --> 00:35:14,270
+mononucleosis and SLE هدولة كلهم بيعطوا false
+
+491
+00:35:14,270 --> 00:35:20,750
+positive results يبقى من ال non-triponemial
+
+492
+00:35:20,750 --> 00:35:26,760
+antigen testشوفنا نوعين النوع الأول اللي هو ال
+
+493
+00:35:26,760 --> 00:35:31,040
+VDRL و ال modification تبعه ال RPR و شوفنا ال
+
+494
+00:35:31,040 --> 00:35:34,960
+complement fixation اللي هي ال Wasserman-Kolmar
+
+495
+00:35:34,960 --> 00:35:38,960
+test الآن نيجي ل ال antipody test ال antipody test
+
+496
+00:35:38,960 --> 00:35:42,460
+دولة طبعا هاش هيكونوا specific test specific test
+
+497
+00:35:42,460 --> 00:35:45,740
+يبجي معنا اللي حاكيه ايش معنا specific test يعني
+
+498
+00:35:45,740 --> 00:35:50,080
+ممكن يصلحوا cash ك confirmatory test فاكرين الشاب
+
+499
+00:35:50,080 --> 00:35:54,850
+اللي طلع عنده بال VDRL positiveوقلنا هذا بصتف ربما
+
+500
+00:35:54,850 --> 00:35:57,930
+يكون حقيقي و ربما مش حقيقي فبنعمله ايش الآن؟ واحد
+
+501
+00:35:57,930 --> 00:36:02,410
+من هذه المجموعة من الفحصات الفحص الأول fluorescent
+
+502
+00:36:02,410 --> 00:36:08,610
+tryponema antibody absorption test او FTA ABS FTA
+
+503
+00:36:08,610 --> 00:36:13,590
+ABS fluorescent tryponema antibody absorption test
+
+504
+00:36:13,590 --> 00:36:19,410
+تركزوا معايا عشان نرسم الشكل تبع الفحص
+
+505
+00:36:22,170 --> 00:36:25,590
+الـ Reagent طبعا يا شباب هو عبارة عن شرايح شرايح
+
+506
+00:36:25,590 --> 00:36:33,310
+microscopic slide fixed عليها tryponema pallidum
+
+507
+00:36:33,310 --> 00:36:37,390
+killed يعني هذه الشرايح ما بنسوي فيها هذه بنشتريها
+
+508
+00:36:37,390 --> 00:36:40,430
+كـ Reagent بتكون موجودة عندنا في المختبر شرايح
+
+509
+00:36:40,430 --> 00:36:44,430
+مجهزة عليهاش كمان مرة killed tryponema pallidum
+
+510
+00:36:44,430 --> 00:36:49,630
+جيبنا قطرة من ال patient serumال patient still مش
+
+511
+00:36:49,630 --> 00:36:55,850
+هيسوي إذا في antibody هيرتبط بالأسف كيف بجيب ال
+
+512
+00:36:55,850 --> 00:36:58,910
+antibody مرتبط على البكتيريا ماقدرش من من ال
+
+513
+00:36:58,910 --> 00:37:01,730
+fluorescent من المريض احط fluorescent على ال ..
+
+514
+00:37:01,730 --> 00:37:07,390
+انا حطيت هنا antibody من المريض الآن بجيب antibody
+
+515
+00:37:07,390 --> 00:37:11,470
+ضد ال antibody Anti antibody تمام Anti human
+
+516
+00:37:11,470 --> 00:37:16,970
+antibody Anti human antibody
+
+517
+00:37:20,200 --> 00:37:24,640
+تمام؟ وبنضيفها على الشريحة إذا ال antibody تبقى
+
+518
+00:37:24,640 --> 00:37:29,420
+إنه مرتبط، هترتبط معاه، كيف بدي أعرف إن التباط
+
+519
+00:37:29,420 --> 00:37:32,940
+حقيقي ولي مش حقيقي؟ بغسل، إنما لو غسلنا الشريحة،
+
+520
+00:37:32,940 --> 00:37:38,080
+كل شيء غير مرتبط يزال، الآن تحت ال microscope، أي
+
+521
+00:37:38,080 --> 00:37:43,050
+microscope؟florescent microscope أسقطنا ال UV من
+
+522
+00:37:43,050 --> 00:37:48,650
+فوق وبطلع أنا على الضوء المنعكس من الشريحة أو
+
+523
+00:37:48,650 --> 00:37:53,810
+المباعة من الشريحة شوفت تريبونيميا ليه شوفت
+
+524
+00:37:53,810 --> 00:37:59,260
+تريبونيميا؟لأنه .. لأنه مرتبط عليها fluorescent،
+
+525
+00:37:59,260 --> 00:38:02,720
+نعم، ليش فيه fluorescent؟ لأنه فيه antibody، ليش
+
+526
+00:38:02,720 --> 00:38:05,800
+فيه antibody؟ لأنه مرتبط بال antibody تبع المريض،
+
+527
+00:38:05,800 --> 00:38:08,760
+تمام؟ ال antibody مريض تبع المريض ليش مقوله أصلا؟
+
+528
+00:38:08,760 --> 00:38:11,980
+لأنه مرتبط بالبكتيريا اللي fixed to the slide،
+
+529
+00:38:11,980 --> 00:38:14,720
+يبقى هيك بقول أنه عرفت أنه البكتيريا أو ال .. أن
+
+530
+00:38:14,720 --> 00:38:19,640
+ال patient بيحتوي على antibodies في ال serum تبعه،
+
+531
+00:38:19,640 --> 00:38:24,820
+تمام؟ خلصنا من هذههذا الفحص كتير مهم وسريع
+
+532
+00:38:24,820 --> 00:38:29,200
+تريبونيميا immobilization test كلمة mobile معناها
+
+533
+00:38:29,200 --> 00:38:34,960
+متحرك immobilize يعني غير قادر على الحركة يعني فحص
+
+534
+00:38:34,960 --> 00:38:38,320
+شل البكتيريا هذا الفحص لشل البكتيريا
+
+535
+00:38:41,080 --> 00:38:45,280
+فاكرين القرانب؟ ايش مال القرانب؟ could be infected
+
+536
+00:38:45,280 --> 00:38:48,660
+with the bacteria وقولنالكوا ال male rabbits
+
+537
+00:38:48,660 --> 00:38:52,220
+بنحقنها في ال testis و بتكون عندنا في المختبر و
+
+538
+00:38:52,220 --> 00:38:54,580
+وقتنا بدنا البكتيريا بناخد من ال testis من ال
+
+539
+00:38:54,580 --> 00:39:00,820
+rabbit و بنحطه على شريحة و عليها cover slip و على
+
+540
+00:39:00,820 --> 00:39:09,300
+dark field microscope تمام؟تحت ال dark field
+
+541
+00:39:09,300 --> 00:39:13,640
+microscope انا اللي حاط البكتيريا ايش هشوف thin
+
+542
+00:39:13,640 --> 00:39:19,760
+actively motile tryponema pallidum بنجيب ال
+
+543
+00:39:19,760 --> 00:39:24,420
+patient serum و بنحط قطرة هنا يا شباب patient
+
+544
+00:39:24,420 --> 00:39:28,540
+serum و بحط قطرة الان القطرة الجنب ال cover slip
+
+545
+00:39:28,540 --> 00:39:31,880
+ايش هسير فيها بالفعل ال capillary action هتتغلغل
+
+546
+00:39:31,880 --> 00:39:36,560
+تحت ال cover slip اذا فيها antibody هيرتبط مع مين
+
+547
+00:39:41,280 --> 00:39:46,480
+لما يرتبط ال antibody مع البكتيريا بشيل حركتها إذا
+
+548
+00:39:46,480 --> 00:39:53,080
+توقفت البكتيريا عن الحركة أو أبطأت حركتها معناه
+
+549
+00:39:53,080 --> 00:39:57,600
+الحكي الفحص posted إذا البكتيريا دلت تتحرك بحرية و
+
+550
+00:39:57,600 --> 00:40:02,600
+طلاقة معناه الحكي هنا القطرة دي لم تحتوي على
+
+551
+00:40:02,600 --> 00:40:06,480
+antibodies فالفحص negative إيش اسم الفحص كده مرة؟
+
+552
+00:40:06,610 --> 00:40:10,110
+Triponema Palladium Immobilization Test عشان انا
+
+553
+00:40:10,110 --> 00:40:12,810
+بقولكوا فيه نوع من ال .. من ال .. خدنا نقول
+
+554
+00:40:12,810 --> 00:40:16,150
+الإبداع في الفحوصات مختلفة عن الفحوصات اللي
+
+555
+00:40:16,150 --> 00:40:21,840
+بتعرفوها الأخرالفحص الأخير اللي هو تريبونيميا
+
+556
+00:40:21,840 --> 00:40:24,640
+باليديوم هيم أجلوتناشين تست وكل كبتار عرفيش أنه
+
+557
+00:40:24,640 --> 00:40:28,720
+هيم أجلوتناشين تست لكن لبأس إنه انمر مرور سريع على
+
+558
+00:40:28,720 --> 00:40:33,960
+اللوحة على أساس أن أذكركوا بالفحص Red cells are
+
+559
+00:40:33,960 --> 00:40:36,700
+treated to absorb triponemal antigens on their
+
+560
+00:40:36,700 --> 00:40:40,160
+surface إذن بينجيب red blood cell وبيعالجوها
+
+561
+00:40:40,160 --> 00:40:45,400
+commercially to absorb اللي هو مين؟ تريبونيميا
+
+562
+00:40:47,190 --> 00:40:50,690
+باليديوم انتجين على ال surface يبقى الآن ال
+
+563
+00:40:50,690 --> 00:40:55,850
+reagent بتاعيش هو red blood cell زي ال latex مركّب
+
+564
+00:40:55,850 --> 00:41:02,230
+عليها انتجينات لتريبونيميا باليديوم when mixed
+
+565
+00:41:02,230 --> 00:41:05,710
+with a serum containing الآن هذه ال reagent جيبنا
+
+566
+00:41:05,710 --> 00:41:12,110
+ال patient serum patient serum ايش ال patient
+
+567
+00:41:12,110 --> 00:41:16,230
+serum بيكون فيه؟وهذا ال agent حطيناهم جنب اخر و
+
+568
+00:41:16,230 --> 00:41:21,950
+عملنا لهم mixing الان ال antibody ده موجود هيرتبط
+
+569
+00:41:21,950 --> 00:41:27,630
+و هيرتبط ب red blood cell تانية صح و red blood
+
+570
+00:41:27,630 --> 00:41:31,110
+cell تانية هيرتبط ب red blood cell تانية و هكذا و
+
+571
+00:41:31,110 --> 00:41:34,750
+بيصير فاندي agglutination تي بيلاقهم
+
+572
+00:41:34,750 --> 00:41:42,730
+hemagglutination hemagglutination طبعا ال VDRLو ال
+
+573
+00:41:42,730 --> 00:41:46,110
+FTA ABS و خدوا بالك و هذا non specific و هذا
+
+574
+00:41:46,110 --> 00:41:50,870
+specific specific هذا non specific و هذا specific
+
+575
+00:41:51,860 --> 00:41:54,700
+Test can be also performed on spinal fluids يعني
+
+576
+00:41:54,700 --> 00:41:58,600
+ممكن تكون العينة مش بس دم ممكن أيضا spinal fluid
+
+577
+00:41:58,600 --> 00:42:01,680
+Antibodies do not reach the CSF from the
+
+578
+00:42:01,680 --> 00:42:06,040
+bloodstream وإن هذه علومة إنه لا يصل ال antibody
+
+579
+00:42:06,040 --> 00:42:11,480
+للـ syphilis من الدم إلى ال CSF وإنما يعتقد إنه
+
+580
+00:42:11,480 --> 00:42:16,440
+بتكون في نفس المنطقة بالنسبة للعلاج ال penicillin
+
+581
+00:42:16,440 --> 00:42:19,000
+is the treatment of choice for syphilis
+
+582
+00:42:21,640 --> 00:42:24,880
+في other تريبونيميا يعني نحاول ننهي منهم اليوم
+
+583
+00:42:24,880 --> 00:42:30,000
+بشكل سريع أقل شهرة من تريبونيميا بيريديوم خالص زي
+
+584
+00:42:30,000 --> 00:42:35,460
+مثلا اللي هو الياوس والبنتا وطبعا الياوس والبنتا
+
+585
+00:42:35,460 --> 00:42:38,700
+two tropical diseases tropical disease يعني أمراض
+
+586
+00:42:38,700 --> 00:42:42,500
+استوائية طبعا غالبا مش هنشوفه من هنا لكن لبقى اسمه
+
+587
+00:42:42,500 --> 00:42:46,540
+على الأسماء المسببة تريبونيميا بيرتوني للياوس
+
+588
+00:42:46,540 --> 00:42:52,290
+والبنتا في تريبونيميا كاراتيومتريبونيميا كاراتيوم
+
+589
+00:42:52,290 --> 00:42:56,350
+هي المسببة طبعا غالبا بتنتقل عن طريق اللي هو ال
+
+590
+00:42:56,350 --> 00:42:59,310
+skin contact بقى عشان انتوا شفتوا أفلام وثائقية
+
+591
+00:42:59,310 --> 00:43:02,830
+على المناطق الاستوائية في كثير من البلدان
+
+592
+00:43:02,830 --> 00:43:07,050
+الاستوائية الأطفال من شدة الحرارة بيكونوا تقريبا
+
+593
+00:43:07,050 --> 00:43:10,850
+يعني وراه يعني فاللعب و ال skin contact بينهم
+
+594
+00:43:10,850 --> 00:43:14,890
+بيكون موجود فبسهل أو بسهل عليهم عملية اللي هو
+
+595
+00:43:14,890 --> 00:43:18,320
+الانتقالزي ما حكينا unlike syphilis it is
+
+596
+00:43:18,320 --> 00:43:22,300
+transmitted by non-sexual skin contact often
+
+597
+00:43:22,300 --> 00:43:24,840
+between children living in a condition of poor
+
+598
+00:43:24,840 --> 00:43:28,080
+hygiene، بين الأطفال اللي عايشين في مناطق يقولنا
+
+599
+00:43:28,080 --> 00:43:33,900
+مستوى النضارة فيها عالي، الآن العلاج للأمراض ممكن
+
+600
+00:43:33,900 --> 00:43:37,120
+يكون برضه بال penicillin واللي هو التتراع ساكلي
+
+601
+00:43:39,450 --> 00:43:42,790
+دائما و أبدا بنقول ان ال prevention بيعتمد على ال
+
+602
+00:43:42,790 --> 00:43:45,850
+transmission، بيعتمد على ال transmission، فإذا كان
+
+603
+00:43:45,850 --> 00:43:49,570
+.. إذا قررت أن تضع سياسات لل transmission .. لل
+
+604
+00:43:49,570 --> 00:43:53,110
+عفو .. لل prevention، بدك تعرف ال cycle تبعت ال
+
+605
+00:43:53,110 --> 00:43:57,510
+transmission عشان تقدر تعملها prevention، و المرة
+
+606
+00:43:57,510 --> 00:43:59,330
+اللي جاي ان شاء الله نكمل سويا
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ZitYVwg8dn0.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ZitYVwg8dn0.srt
new file mode 100644
index 0000000000000000000000000000000000000000..47d7e473c484ac676a254b03211780137132724c
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ZitYVwg8dn0.srt
@@ -0,0 +1,1982 @@
+1
+00:00:20,010 --> 00:00:24,770
+أنا رحيم، بدأنا نحن بالحديث المرة الماضية عن ال
+
+2
+00:00:24,770 --> 00:00:27,430
+non-lactose fermenting Enterobacteriaceae، و بدأنا
+
+3
+00:00:27,430 --> 00:00:33,730
+أعتقد بالسيراتيا، وتحدثنا عن الـ protease، ذكرنا
+
+4
+00:00:33,730 --> 00:00:36,750
+مجموعة أسماء، منها ما هو protease، ومنها ما هو
+
+5
+00:00:36,750 --> 00:00:40,790
+Providencia، ومنها ما هو Morganella، وسميناهم
+
+6
+00:00:40,790 --> 00:00:43,270
+protease group، وقلنا collectively they are
+
+7
+00:00:43,270 --> 00:00:48,410
+protease group. من الميزات التي تجمع كل المجموعة مع
+
+8
+00:00:48,410 --> 00:00:53,870
+بعض، ميزتان أساسيتان. الميزة الأولى أنهم يورياز
+
+9
+00:00:53,870 --> 00:00:58,010
+producer، يعني يورياز بوزيتيف، وكلهم actively motile.
+
+10
+00:00:58,010 --> 00:01:02,030
+كلهم actively motile، لكن من الآن فصاعداً برضه بنحاول نلاقي
+
+11
+00:01:02,030 --> 00:01:05,010
+طريقة نميز بين الـ Morganella أو الـ Providencia من
+
+12
+00:01:05,010 --> 00:01:09,130
+ناحية، وبين الـ Proteus من ناحية أخرى. الميزة
+
+13
+00:01:09,130 --> 00:01:12,840
+الأساسية هي production of H2S. من الذي
+
+14
+00:01:12,840 --> 00:01:16,880
+ينتج H2S؟ الـ Proteus. بينما الـ Morganella و
+
+15
+00:01:16,880 --> 00:01:21,040
+الـ Providencia، they do not produce H2S. يبقى أحد
+
+16
+00:01:21,040 --> 00:01:26,340
+الأساسيات في التمييز بينهم، لازم يكون الـ H2S. نبدأ
+
+17
+00:01:26,340 --> 00:01:29,440
+لأن نتكلم في الـ Morganella والـ Providencia. الـ Morganella
+
+18
+00:01:29,440 --> 00:01:36,380
+والـ Providencia قريبة بشكل كبير، شكلاً وصفاتاً،
+
+19
+00:01:36,380 --> 00:01:40,820
+إلى المجموعة التي حكينا عنها، وهي الـ protease
+
+20
+00:01:40,820 --> 00:01:41,080
+group.
+
+21
+00:01:44,150 --> 00:01:47,330
+بنرجع لها إن شاء الله، لأننا بنجمعهم كلهم مع بعض.
+
+22
+00:01:47,330 --> 00:01:49,930
+الثلاث أسماء، التي هي الـ Proteus، والـ Morganella، لما
+
+23
+00:01:49,930 --> 00:01:55,070
+نشوف كيف نميز بينهم. ربما الـ motility مهم جداً، و
+
+24
+00:01:55,070 --> 00:01:59,950
+الـ urease، لكن الـ indole ليس بذات الأهمية. لماذا ليس
+
+25
+00:01:59,950 --> 00:02:03,630
+بذات الأهمية؟ لأن الـ Proteus نفسها، فيها منها indole
+
+26
+00:02:03,630 --> 00:02:06,830
+بوزيتيف، ومنها indole نيجاتيف، وبالتالي لن نستطيع أن
+
+27
+00:02:06,830 --> 00:02:10,710
+نستخدم الـ indole كـ variable لتمييز بين المجموعتين
+
+28
+00:02:10,710 --> 00:02:15,260
+كلهما معاً. الـ Morganella morganii هي الـ representative
+
+29
+00:02:15,260 --> 00:02:17,520
+of the species، الوحيدة في المجموعة، والتي لها
+
+30
+00:02:17,520 --> 00:02:20,360
+أهمية طبية، وتسبب نفس الأمراض التي تسببها الـ other
+
+31
+00:02:20,360 --> 00:02:24,020
+Enterobacteriaceae، لكن with less frequency، يعني نسبة
+
+32
+00:02:24,020 --> 00:02:28,400
+حدوثها أقل. من ميزاتها، أو عفواً، فيه هنا الـ
+
+33
+00:02:28,400 --> 00:02:31,120
+chloramphenicol، بيقولوا أن هو drug of choice، لكن
+
+34
+00:02:31,120 --> 00:02:33,340
+أنا يعني، أحصائي المعلومات قديمة جداً.
+
+35
+00:02:33,340 --> 00:02:37,440
+الـ chloramphenicol من الأدوية التي أوقفت عالمياً
+
+36
+00:02:37,440 --> 00:02:41,870
+بسبب سميته، بسبب bone marrow depression، bone
+
+37
+00:02:41,870 --> 00:02:46,810
+marrow depression، ونوع من الأنيميا. لكن الـ
+
+38
+00:02:46,810 --> 00:02:49,550
+chloramphenicol الآن بيستخدم فقط topical
+
+39
+00:02:49,550 --> 00:02:53,150
+application، بمعنى أنه لو كان على الجلد، أو قطرة في
+
+40
+00:02:53,150 --> 00:02:55,650
+العين، أو التهابات الأذن، ممكن نستخدم الـ chloramphenicol
+
+41
+00:02:55,650 --> 00:03:00,100
+الذي هو topical application. من الصفات
+
+42
+00:03:00,100 --> 00:03:03,600
+تبع الـ Morganella التي تميزها عن الـ other
+
+43
+00:03:03,600 --> 00:03:06,740
+species، هو ornithine decarboxylase نيجاتيف، و الـ triple
+
+44
+00:03:06,740 --> 00:03:10,020
+sugar iron agar تبعها، فقط K على A، واتذكروا ما فيش
+
+45
+00:03:10,020 --> 00:03:14,420
+H2S. لو رجعنا على الـ Proteus، هنجد أن الـ Proteus K
+
+46
+00:03:14,420 --> 00:03:19,640
+على A، G بوزيتيف. فإحدى الأشياء المهمة فيها، كان
+
+47
+00:03:19,640 --> 00:03:23,960
+الذي هو، الذي هو الـ H2S production.  الـ reaction هنا
+
+48
+00:03:23,960 --> 00:03:27,360
+نيجاتيف، نيجاتيف. يعني بتشبه من؟
+
+49
+00:03:30,270 --> 00:03:33,070
+والـ...الـ...الـ... الخاتمة التي ختمنا فيها
+
+50
+00:03:33,070 --> 00:03:37,610
+محاضرتنا السابقة، لما قلنا أنه لا يمكن تشبيه اثنين
+
+51
+00:03:37,610 --> 00:03:40,690
+مختلفين مع بعض، حتى و إن تشابهوا، لأنه هذا واحد
+
+52
+00:03:40,690 --> 00:03:43,850
+lactose fermenter، وواحد non-lactose fermenter. فيا
+
+53
+00:03:43,850 --> 00:03:47,990
+أن تقع في هذا الخطأ مرة أخرى. خلاص، نحن بدأنا بأن
+
+54
+00:03:47,990 --> 00:03:51,150
+هما اثنين يختلفان عن بعض في lactose fermentation.
+
+55
+00:03:51,150 --> 00:03:54,070
+إذن، الـ enzyme، حتى لو تشابه الـ enzyme، ليس له أي معنى
+
+56
+00:03:54,070 --> 00:03:57,430
+أو أي قيمة. طبعاً، الـ motility، نحن اتفقنا أن كل
+
+57
+00:03:57,430 --> 00:04:02,930
+المجموعة actively motile. الـ Providencia يمكن
+
+58
+00:04:02,930 --> 00:04:07,910
+الواحدة لوحدها، ليست خالص واضحة. لكن الـ...الـ...الـ...
+
+59
+00:04:07,910 --> 00:04:10,710
+الـ Providencia غالباً associated with nosocomial
+
+60
+00:04:10,710 --> 00:04:16,210
+infection. لما نقول nosocomial infection، و...و...لا
+
+61
+00:04:16,210 --> 00:04:18,550
+بدنا...بدنا نتذكر كمان، شغلة أن...أن الناس الذين
+
+62
+00:04:18,550 --> 00:04:20,870
+في المستشفيات، غالباً بيكونوا immunocompromised.
+
+63
+00:04:20,870 --> 00:04:24,130
+فيعني، تصيب أكثر الحالات التي هي الـ
+
+64
+00:04:24,130 --> 00:04:27,410
+immunosuppressed patients. لكن في الآخر، أنا الذي
+
+65
+00:04:27,410 --> 00:04:30,590
+يهمني، هو كيف أعمل differentiation لهذه
+
+66
+00:04:30,590 --> 00:04:34,270
+البكتيريا، عن باقي الـ Enterobacteriaceae. طبعاً، هي non
+
+67
+00:04:34,270 --> 00:04:36,530
+lactose fermenter. أنا متفق، نقولها non-lactose
+
+68
+00:04:36,530 --> 00:04:40,420
+fermenter. urease positive ولا negative؟ بوزيتيف. نحن
+
+69
+00:04:40,420 --> 00:04:43,660
+قلنا كل المجموعة يورياز بوزيتيف، وأكتيفيتي بوزيتيف
+
+70
+00:04:43,660 --> 00:04:47,140
+و actively motile. لكن الـ hydrogen sulfide تبعها هنا
+
+71
+00:04:47,140 --> 00:04:51,740
+نيجاتيف. أنا، الـ lysine decarboxylase أيضاً نيجاتيف.
+
+72
+00:04:51,740 --> 00:04:56,020
+الـ lactose نيجاتيف. الـ triple sugar iron agar تبعها
+
+73
+00:04:56,020 --> 00:04:59,400
+K على A؟ وهذه تميزها عن من؟ عن الـ Morganella، التي
+
+74
+00:04:59,400 --> 00:05:03,940
+شبيهتها. هذه كانت A على A. الاثنتان لا ينتجان H
+
+75
+00:05:03,940 --> 00:05:09,010
+2S. Morganella و Providencia كلاهما نيجاتيف لـ
+
+76
+00:05:09,010 --> 00:05:12,170
+H2S، لكن الـ triple sugar iron agar تبع الـ Morganella
+
+77
+00:05:12,170 --> 00:05:19,630
+كان A على A، وهذه K على A. في
+
+78
+00:05:19,630 --> 00:05:23,210
+الحالة هذه، ما نقدرش نعرف. في الحالة هذه، لا نستطيع
+
+79
+00:05:23,210 --> 00:05:27,190
+المعرفة إلا إذا قمنا بإجراء فحص منفصل. لكن
+
+80
+00:05:27,190 --> 00:05:30,550
+كوني أنا أعرف إنها non-lactose fermenter
+
+81
+00:05:34,830 --> 00:05:38,490
+على المكونكي. مش أنا بكون زرعت على المكونكي. هذه نقطة
+
+82
+00:05:38,490 --> 00:05:42,990
+كثير مهمة. أنا، المعلومات التي أستقيها من الـ...الـ...
+
+83
+00:05:42,990 --> 00:05:45,570
+الـ...الـ culture، بنسميها cultural
+
+84
+00:05:45,570 --> 00:05:48,150
+characteristics.  حجم، شكل المستعمرة، لون
+
+85
+00:05:48,150 --> 00:05:52,410
+المستعمرة، ارتفاع المستعمرة، إذا كان فيه صفات
+
+86
+00:05:52,410 --> 00:05:54,970
+مميزة زي الـ  Himalayan  على blood agar، أو الـ lactose
+
+87
+00:05:54,970 --> 00:05:56,650
+fermentation أو الـ non-lactose fermentation على
+
+88
+00:05:56,650 --> 00:06:00,020
+المكونكي، كل هذه الأشياء أنا أشوفها بدون ما أعمل
+
+89
+00:06:00,020 --> 00:06:03,060
+فحوصات بيوكيميائية، مظبوط ولا لأ؟ فإذا الآن أنا
+
+90
+00:06:03,060 --> 00:06:05,060
+عملت أنها non-lactose fermenter، وراجعتها A على
+
+91
+00:06:05,060 --> 00:06:07,700
+A، فمعنى الحكاية، هي sucrose fermenter، هذا
+
+92
+00:06:07,700 --> 00:06:11,560
+استنتاج. طبعاً الـ enzyme تبعها positive، positive،
+
+93
+00:06:11,560 --> 00:06:15,460
+negative، positive. وبالنسبة للـ motility، it is
+
+94
+00:06:15,460 --> 00:06:18,800
+motile. لاحظوا أنتم يا شباب، في كل الـ enzyme التي
+
+95
+00:06:18,800 --> 00:06:22,360
+درسناها، بتكون positive لـ methyl red، بتكون
+
+96
+00:06:22,360 --> 00:06:25,100
+negative لـ Voges-Proskauer، أو العكس، بتكون
+
+97
+00:06:25,100 --> 00:06:27,540
+negative لـ methyl red، و positive لـ Voges-Proskauer.
+
+98
+00:06:27,540 --> 00:06:32,960
+فالخمة الغالبة، أن البكتيريا تكون تمتلك صفة من
+
+99
+00:06:32,960 --> 00:06:36,180
+الصفتين، يا إما methyl red، يا إما Voges-Proskauer.
+
+100
+00:06:36,180 --> 00:06:38,580
+تمام، واحدة من الاثنين، وليس كلاهما.
+
+101
+00:06:46,130 --> 00:06:49,130
+بدي مجموعة فحوصات أخرى زيادة، carbohydrate
+
+102
+00:06:49,130 --> 00:06:52,690
+fermentation test.  نحن لما قلنا أن الـ API، على سبيل
+
+103
+00:06:52,690 --> 00:06:58,470
+المثال، الـ API test، كم واحد بيحتوي على؟ عشرين.  هذه الـ
+
+104
+00:06:58,470 --> 00:07:02,630
+عشرون، الـ 20 wells، صح؟ لأ، لأ، عشرون wells. في عندي
+
+105
+00:07:02,630 --> 00:07:05,710
+كمان oxidase بينضاف إليهم، وممكن نأخذ كمان معلومات
+
+106
+00:07:05,710 --> 00:07:10,450
+أخرى، التي هي الـ NO3، الـ NO2، والـ N، يعني
+
+107
+00:07:10,450 --> 00:07:13,790
+تقريباً ثلاثة وعشرون فحص. ليش نحن زودنا على
+
+108
+00:07:13,790 --> 00:07:18,170
+الفحوصات؟ عشان، وأنا قلت لكم المعلومة، the more tests
+
+109
+00:07:18,170 --> 00:07:21,470
+you perform، the more accurate is your diagnosis.
+
+110
+00:07:21,470 --> 00:07:25,030
+ما نستطيع أن نعتمد على صفة واحدة فقط في التمييز.
+
+111
+00:07:25,030 --> 00:07:30,530
+لكن نأخذ major tests. مثلاً، بنقول أن الـ...الـ...الـ...
+
+112
+00:07:30,530 --> 00:07:32,930
+Klebsiella و الـ Enterobacter، ايش كان الـ M في
+
+113
+00:07:32,930 --> 00:07:36,010
+الاثنين؟  negative، negative، positive، positive. كده
+
+114
+00:07:36,010 --> 00:07:39,130
+ميزناهم. واحدة string test positive، واحدة string
+
+115
+00:07:39,130 --> 00:07:42,700
+test negative، على سبيل المثال. واحدة capsulated،
+
+116
+00:07:42,700 --> 00:07:46,220
+واحدة non-capsulated، واحدة motile،
+
+117
+00:07:46,220 --> 00:07:51,340
+واحدة non-motile. يبقى، لماذا لم نكتفي بـ single test؟
+
+118
+00:07:51,340 --> 00:07:56,200
+ما كان الـ motility تكفي، صح؟ الـ motility تكفي فضلاً
+
+119
+00:07:56,200 --> 00:07:58,720
+عن الـ motility، أن الـ Klebsiella التي عينيها هي non-motile.
+
+120
+00:07:58,720 --> 00:08:01,340
+ولكن الـ Klebsiella التي  aerogenes هي motile. لا، لا.
+
+121
+00:08:01,340 --> 00:08:03,360
+الـ Klebsiella، أصبحت أكثر، مش  كله  Klebsiella  التي
+
+122
+00:08:03,360 --> 00:08:07,280
+aerogenes. أنت جبت genus من واحدة، و species من
+
+123
+00:08:07,280 --> 00:08:11,160
+واحدة ثانية. اسمها Enterobacter aerogenes و
+
+124
+00:08:11,160 --> 00:08:15,400
+Enterobacter liquefaciens و Enterobacter sakazakii،
+
+125
+00:08:15,400 --> 00:08:18,640
+مظبوط؟ لكن ما فيش Klebsiella aerogenes، في
+
+126
+00:08:18,640 --> 00:08:21,240
+Klebsiella pneumoniae، في Klebsiella oxytoca، في
+
+127
+00:08:21,240 --> 00:08:25,180
+Klebsiella ornithinolytica. فعَن...عن أي...عن أي تقصد الـ
+
+128
+00:08:25,180 --> 00:08:28,400
+genus كله non-motile، الـ genus Klebsiella non-
+
+129
+00:08:28,400 --> 00:08:31,700
+motile، و الـ genus Enterobacter كله motile. فهذا
+
+130
+00:08:31,700 --> 00:08:36,040
+الفحص لحاله كافي يميز genus عن genus، لكن إذا أردت
+
+131
+00:08:36,040 --> 00:08:39,160
+تمييز الـ species بدقة، فعليك بإجراء الـ carbohydrate
+
+132
+00:08:39,160 --> 00:08:42,080
+fermentation test الموجودة في من؟ في الـ API
+
+133
+00:08:42,080 --> 00:08:47,100
+test. الـ Erwinia، التي هي الميكروب الأخير في السلسلة
+
+134
+00:08:47,100 --> 00:08:51,400
+التي هي عبارة عن plant pathogen، يعني الاعتقاد
+
+135
+00:08:51,400 --> 00:08:55,820
+السائد، أنه ما لهاش أي medical importance، لكن دراسات
+
+136
+00:08:55,820 --> 00:08:59,380
+حديثة يا شباب، بتقول برضه أنه they may cause، برضه
+
+137
+00:08:59,380 --> 00:09:02,600
+infection في الإنسان، ومنها wound infection، ومنها
+
+138
+00:09:02,600 --> 00:09:06,880
+septicemia، لكن السائد الغالب، أنها plant
+
+139
+00:09:06,880 --> 00:09:12,790
+pathogen، وتحتوي على pectinase و cellulase، two enzymes
+
+140
+00:09:12,790 --> 00:09:17,790
+that qualify this organism to infect plants، لأن
+
+141
+00:09:17,790 --> 00:09:22,150
+السليلوز والبيكتين هما موجودان في أنسجة النباتية.
+
+142
+00:09:22,150 --> 00:09:25,930
+وبالتالي، بتعمل لهم lyases، بتؤهلها تعمل invasion لهذه
+
+143
+00:09:25,930 --> 00:09:30,690
+الانسجة. إذن، الـ Erwinia بنعتبرها أنها plant pathogen.
+
+144
+00:09:30,690 --> 00:09:37,630
+نرجع لـ Proteus و
+
+145
+00:09:37,630 --> 00:09:42,480
+الـ diagnosis تبعها.  الـ Proteus genus، هي المجموعة الأهم
+
+146
+00:09:42,480 --> 00:09:45,640
+وهي الأشهر في المجموعة. Proteus mirabilis و
+
+147
+00:09:45,640 --> 00:09:49,960
+Proteus penneri و Proteus vulgaris. الـ triple
+
+148
+00:09:49,960 --> 00:09:55,760
+sugar iron agar، تجمع كل الصفات K على A، و G بوزيتيف.
+
+149
+00:09:55,760 --> 00:09:59,780
+يعني بتنتج غاز، وبتنتج H2S، لكنها non-lactose
+
+150
+00:09:59,780 --> 00:10:02,580
+fermenter، و non-sucrose fermenter. كيف عرفنا أنها
+
+151
+00:10:02,580 --> 00:10:07,080
+non-sucrose fermenter؟  اتطمنّا عليها، مظبوط أو لا؟ و
+
+152
+00:10:07,080 --> 00:10:09,020
+في نفس الوقت، هي مشهورة بأنها non-
+
+153
+00:10:11,900 --> 00:10:17,510
+الظاهرة swarming، ونموذجها. والتي تؤهل...تؤهل
+
+154
+00:10:17,510 --> 00:10:20,910
+الـ...الـ...الـ Proteus، نحن قلنا أنه هي عبارة عن
+
+155
+00:10:20,910 --> 00:10:22,930
+Gram negative، بس الـ like الـ triple sugar iron
+
+156
+00:10:22,930 --> 00:10:27,970
+agar تبعها كان K على A، G بوزيتيف، وأؤكد مرة أخرى على
+
+157
+00:10:27,970 --> 00:10:32,090
+أهمية الـ H2S في التعرف على الـ...الـ...الـ...الـ
+
+158
+00:10:32,090 --> 00:10:35,370
+Proteus، وتمييزها عن الـ Morganella، وعن الـ
+
+159
+00:10:35,370 --> 00:10:38,570
+Providencia، التي تتشابه معها في الصفات الأخرى.
+
+160
+00:10:38,570 --> 00:10:42,410
+التي قلنا عنها urease positive، و actively motile.
+
+161
+00:10:43,100 --> 00:10:46,960
+البكتيريا أيضاً تمتلك ميزة مميزة عن باقي أنواع
+
+162
+00:10:46,960 --> 00:10:50,780
+البكتيريا، وهو صفة الـ swarming، التي هي الحركة
+
+163
+00:10:50,780 --> 00:10:55,480
+على سطح الأجار، وهذه الصفة لا نراها...لا نراها في
+
+164
+00:10:55,480 --> 00:10:58,220
+الـ selective media، لا نراها في الـ inhibitory
+
+165
+00:10:58,220 --> 00:11:00,940
+media، نراها فقط في الـ...بالضبط في الـ general
+
+166
+00:11:00,940 --> 00:11:03,800
+media، زي الـ blood agar، أو الـ nutrient agar، أو
+
+167
+00:11:03,800 --> 00:11:07,660
+الـ Mueller-Hinton. أحد الميزات الأخرى التي لازم
+
+168
+00:11:07,660 --> 00:11:13,840
+نتبعها، أن لو الـ Proteus لوثت مستعمرة نوع آخر، نوع آخر من
+
+169
+00:11:13,840 --> 00:11:19,620
+البكتيريا، يصعب فصل الاثنين عن بعض. ليش؟
+
+170
+00:11:19,620 --> 00:11:25,060
+لأن الـ Proteus لا تستطيع تكوين مستعمرات منفصلة، فتحجب
+
+171
+00:11:25,060 --> 00:11:29,600
+على كل الطبق. فغالباً، هنجد مستعمرة الـ Proteus مغطية
+
+172
+00:11:29,600 --> 00:11:32,760
+على كل المستعمرات الأخرى. فكيف نفصل الاثنين عن
+
+173
+00:11:32,760 --> 00:11:37,040
+بعض؟ بدنا نلجأ إلى تقنيات معقدة، لكني ما
+
+223
+00:15:12,230 --> 00:15:15,530
+Protease تتفاعل مع الـ Antibodies تبعت الـ
+
+224
+00:15:15,530 --> 00:15:18,750
+Rickettsia و الـ Protease ما فيش أسهل من تنميتها في
+
+225
+00:15:18,750 --> 00:15:25,050
+المختبرات و رخيصة، تنمية سهلة ولا تكلف، فاستخدمنا الـ
+
+226
+00:15:25,050 --> 00:15:28,810
+Protease للكشف عن الـ Antibodies تبعت من تحت الـ
+
+227
+00:15:28,810 --> 00:15:36,340
+Rickettsia. وصلت الصورة؟ بس carry agent بنستخدم الـ
+
+228
+00:15:36,340 --> 00:15:40,860
+protease carry agent للكشف عن الـ antibodies تبعت
+
+229
+00:15:40,860 --> 00:15:44,920
+الـ Rickettsia. يعني لو جينا فيهم الأيام وجانا الـ
+
+230
+00:15:44,920 --> 00:15:47,460
+typhus fever، إيش علاقته بالـ protease؟ ما هوش علاقة
+
+231
+00:15:47,460 --> 00:15:53,800
+علاقته بمين؟ للـ typhus fever؟ علاقته بمين؟ ريكتسيا
+
+232
+00:15:53,800 --> 00:15:59,480
+فقط، لا غير، وإنما استخدمت بروتياس كـ reagent للكشف عن
+
+233
+00:15:59,480 --> 00:16:03,540
+الـ antibodies تبعها، ريكتسيا، من الـ antibodies أو
+
+234
+00:16:03,540 --> 00:16:08,540
+من السلالات المشهورة في البروتياس والمستخدمة لازال
+
+235
+00:16:08,540 --> 00:16:13,680
+لحد هذا الوقت، اللي هم Proteas Ox-K و Proteas Ox-19
+
+236
+00:16:13,680 --> 00:16:17,800
+و Proteas Ox-2. واسأل في غزة في مختبراتنا العتيدة
+
+237
+00:16:17,800 --> 00:16:22,440
+اسألهم عن Ox-19، الكل بيعرف هذا الفحص لأن مرض
+
+238
+00:16:22,440 --> 00:16:27,820
+التايفوس موجود عندنا في فلسطين، وينتشر في أواخر
+
+239
+00:16:27,820 --> 00:16:31,580
+الصيف على مدى شهرين أو ثلاثة بكثافة في قطاع غزة
+
+240
+00:16:31,580 --> 00:16:35,540
+وبالتالي المختبرات بتعرف هذا الفحص بشكل جيد، إيش
+
+241
+00:16:35,540 --> 00:16:41,800
+اسم الفحص؟ كده مرة Ox 19، وكلمة Ox هنا 19 أو Ox K هي
+
+242
+00:16:41,800 --> 00:16:45,960
+numbers بنعطيها إحنا للسلالات اللي بنعزلها أو
+
+243
+00:16:45,960 --> 00:16:51,070
+بنتعرف عليها. كمان مرة، مين اللي اكتشف هذا الـ .. الـ ..
+
+244
+00:16:51,070 --> 00:16:55,210
+الخاصية؟  اكتشاف كان يسموه الفحص Wheel and
+
+245
+00:16:55,210 --> 00:16:59,130
+Felix reaction، Wheel and Felix reaction، لكن الـ ..
+
+246
+00:16:59,130 --> 00:17:02,350
+الاسم الشائع اللي عندنا في قطاع غزة هو اللي هو Ox
+
+247
+00:17:02,350 --> 00:17:09,600
+19. هاي أول فحص بنستخدمه للكشف عن الـ fever، أول فحص
+
+248
+00:17:09,600 --> 00:17:12,760
+بنستخدمه لكشف عن الـ fever.  المحاضرة هات، إحنا هنتعرف
+
+249
+00:17:12,760 --> 00:17:16,760
+على فحص ثاني اسمه Vidal Test، Vidal Test، و الـ Vidal
+
+250
+00:17:16,760 --> 00:17:20,680
+Test بنستخدمه للكشف عن الـ Typhoid Fever، في Typhus،
+
+251
+00:17:20,680 --> 00:17:26,500
+OX 19 أو OX K أو OX 2، و الـ Vidal Test بنستخدمه
+
+252
+00:17:26,500 --> 00:17:32,580
+لكشف عن مين؟ عن الـ Typhoid Fever، Typhoid
+
+253
+00:17:32,580 --> 00:17:33,660
+لأ، سنونه لـ Typhie
+
+254
+00:17:37,340 --> 00:17:42,000
+نجي للميكروب المشهور جدا، والإخوة اللي درسوا معنا
+
+255
+00:17:42,000 --> 00:17:44,500
+في الـ food microbiology، قلنا لهم جملة مشهورة،
+
+256
+00:17:44,500 --> 00:17:49,480
+نكررها لكم: The presence of any serotype in food of
+
+257
+00:17:49,480 --> 00:17:52,620
+salmonella render that food unfit for human
+
+258
+00:17:52,620 --> 00:17:58,220
+consumption. وجود أي سلالة من السلمونيلا، ألاحظوا
+
+259
+00:17:58,220 --> 00:18:01,580
+التعبير، أي سلالة، أي strain، ممكن، ليش أي species؟
+
+260
+00:18:01,580 --> 00:18:07,190
+يعني أي صنف، أي نوع، في الغذاء يجعل هذا الغذاء غير
+
+261
+00:18:07,190 --> 00:18:10,830
+صالح للاستهلاك الآدمي. مؤشر على إيش؟ على إن كل الـ
+
+262
+00:18:10,830 --> 00:18:15,790
+salmonella تعتبر pathogenic، والسلمونيلا أحد
+
+263
+00:18:15,790 --> 00:18:21,190
+مزاياها يا شباب، أحد مزاياها الـ host range، إيش يعني
+
+264
+00:18:21,190 --> 00:18:26,510
+host range؟ يعني الطيف الواسع للعوائل اللي ممكن
+
+265
+00:18:26,510 --> 00:18:31,170
+تصيبها، سواء تصيبها بمرض أو تصيبها كمخزن، كـ carrier.
+
+266
+00:18:32,520 --> 00:18:41,340
+بتعرفوا السحالي،  حاردون، وأمبريز، وخلافه، وبتعرفوا
+
+267
+00:18:41,340 --> 00:18:45,020
+الدواجن بكل أنواعها، البط، والدجاج، وبتعرفوا حتى
+
+268
+00:18:45,020 --> 00:18:51,140
+التمساح، حتى السلاحف، ووجدوا إن فيها سالمونيلا بصورة
+
+269
+00:18:51,480 --> 00:18:56,480
+طبيعية، بصورة طبيعية، بمعنى إنه نوع من التحالف ..
+
+270
+00:18:56,480 --> 00:19:01,020
+نوع من التحالف، طبعا فرصة ميكروب زي السلمونيلا إنه
+
+271
+00:19:01,020 --> 00:19:04,640
+يخرج من host ويلاقي host ثاني عالية جدا لما يكون
+
+272
+00:19:04,640 --> 00:19:07,900
+on the wide range of host، لكن لما يكون host واحد،
+
+273
+00:19:07,900 --> 00:19:12,460
+إذا ما لاقاش الـ host تبعه مش هي .. مش هيتكاثر ولا
+
+274
+00:19:12,460 --> 00:19:17,500
+حي .. وبالتالي من السهل القضاء عليه. إذا أعطيكم
+
+275
+00:19:17,500 --> 00:19:21,360
+مثال برضه عشان نوصل الصورة أو نقرب الصورة، بتعرف
+
+276
+00:19:21,360 --> 00:19:28,080
+الدواجن مصدر غذاء عالمي لكل البشر، سواء كان الدجاج
+
+277
+00:19:28,080 --> 00:19:33,860
+اللحم أو البيض تبع الدواجن، نتخيل إن الدجاج صار فيه
+
+278
+00:19:33,860 --> 00:19:39,580
+سالمونيلا، والبيض اللي بناخده من الدواجن، في بعض
+
+279
+00:19:39,580 --> 00:19:44,220
+المناطق،صار يصلوا سالمونيلا، بمعنى إن الدجاج اللي
+
+280
+00:19:44,220 --> 00:19:47,340
+هو بيصنع البيض، بيحط معاه واحدة أو اتنين
+
+281
+00:19:47,340 --> 00:19:50,620
+سالمونيلا، عشان يقول اتفضل بالهنا والشفا، إنت تأكل
+
+282
+00:19:50,620 --> 00:19:54,820
+بيض بالسالمونيلا الآن.
+
+283
+00:19:54,820 --> 00:20:02,960
+هذا، هذا تخيلوا البيض ومشتقاته، وين بتدخل الدواجن
+
+284
+00:20:02,960 --> 00:20:09,350
+ومشتقاتها؟ وين بتدخل في صناعات؟ الدواجن غالبا في
+
+285
+00:20:09,350 --> 00:20:15,530
+الآخر كلحم، نطبخها، فالسالمونيلا بتموت صح؟ المشكلة
+
+286
+00:20:15,530 --> 00:20:17,210
+اللي وأنا عندي أنا .. المشكلة اللي وأنا يا شباب
+
+287
+00:20:17,210 --> 00:20:20,310
+إحنا كنا جايبين شوية cross reaction، في كلمة، مصطلح
+
+288
+00:20:20,310 --> 00:20:24,210
+ثاني اسمه cross contamination. هاي الدواجن حطيناها
+
+289
+00:20:24,210 --> 00:20:27,950
+على خشب التقطيع، واستخدمنا سكين .. سكين، سكين
+
+290
+00:20:27,950 --> 00:20:34,700
+للتقطيع، تمام؟ الآن السكين وخشب التقطيع أصبح
+
+291
+00:20:34,700 --> 00:20:38,080
+عليهم سالمونيلا، الدجاج خلصنا منه، طهيناه، ماتت
+
+292
+00:20:38,080 --> 00:20:43,420
+السالمونيلا، لكنه بقي على الخشبة وعلى السكين، إذا
+
+293
+00:20:43,420 --> 00:20:47,460
+لم يغسل جيدا، يمكن استخدام السكين لتقطيع خضروات
+
+294
+00:20:47,460 --> 00:20:52,410
+مثلا للسلطة، السلطة لا تُطهى، وبالتالي إحنا بناخد
+
+295
+00:20:52,410 --> 00:20:56,710
+سالمونيلا fresh، مش من الدجاج مباشرة، إنما من الـ
+
+296
+00:20:56,710 --> 00:21:01,330
+cross contamination، وبالتالي هذه الخشية موجودة في
+
+297
+00:21:01,330 --> 00:21:05,950
+كل العالم. السالمونيلا سبب رئيسي يا شباب لسحب كثير
+
+298
+00:21:05,950 --> 00:21:10,450
+من المنتجات، آخرها كان في منتج لـ Cadbury، شوكولاتة
+
+299
+00:21:10,450 --> 00:21:15,590
+بريطانية مشهورة، Cadbury، سُحبت من الأسواق لأن الحليب
+
+300
+00:21:15,590 --> 00:21:19,070
+المستخدم في الشوكولاتة كان مُحتوياً على
+
+301
+00:21:19,070 --> 00:21:25,860
+السالمونيلا. تخيلوا في العالم الغربي، لو مصنع تم
+
+302
+00:21:25,860 --> 00:21:30,180
+اكتشاف فيه salmonella في منتجه .. من منتجاته، مشكلته
+
+303
+00:21:30,180 --> 00:21:34,980
+مش إنه بس إنه رجع الإبضاعة، السمعة تبعته بتسقط لأن
+
+304
+00:21:34,980 --> 00:21:39,440
+المجتمعات الغربية selective في اختيار الأغذية بشكل
+
+305
+00:21:39,440 --> 00:21:43,740
+مجموعات، ضاغطة على كل مصنعي الأغذية، وعلى كل مصنعي
+
+306
+00:21:43,740 --> 00:21:48,080
+المنتجات، لأنهم selective، كيف يعني selective؟ يعني
+
+307
+00:21:48,080 --> 00:21:52,000
+أنا بأشتري أي منتج، إذا شعرت إن المنتج هذا فيه منه
+
+308
+00:21:52,000 --> 00:21:55,680
+ضرر، الكل بيقطعه بكل سهولة، بيقطعه، وما فيش واحد بيفتح
+
+309
+00:21:55,680 --> 00:22:00,860
+مصنع أو مؤسسة تجارية، ويخسر، فبدي أرضي مين؟ الزبائن
+
+310
+00:22:00,860 --> 00:22:04,900
+إرضاء للزبائن، أو في محاولة إرضاء للزبائن، بيصل
+
+311
+00:22:04,900 --> 00:22:09,460
+لأفضل مراحل التصنيع، وأنضف مراحل التصنيع، وبالتالي
+
+312
+00:22:09,460 --> 00:22:14,240
+هناك رقابة داخلية قبل أن تكون هناك رقابة خارجية في
+
+313
+00:22:14,240 --> 00:22:17,530
+المصانع، وبالتالي قلة من المنتجات اللي ممكن يحصل
+
+314
+00:22:17,530 --> 00:22:24,210
+فيها هذا الكلام.  ناخد تذكيراً بس بالـ .. إحنا وين في
+
+315
+00:22:24,210 --> 00:22:29,070
+الـ .. الـ Enterobacteriaciae، قبل ما نتكلم عن إن أنا
+
+316
+00:22:29,070 --> 00:22:32,430
+عندي oxidase test negative، عندي glucose
+
+317
+00:22:32,430 --> 00:22:35,370
+fermentation positive، فأنا وصلت لمرحلة من الـ
+
+318
+00:22:35,370 --> 00:22:38,200
+Enterobacteriaciae. لما وصلت لواحدة الـ
+
+319
+00:22:38,200 --> 00:22:41,020
+Enterobacteriaciae، قسمت البكتيريا لمجموعتين،
+
+320
+00:22:41,020 --> 00:22:44,220
+lactose fermenter و non lactose fermenter. أنا خلصت
+
+321
+00:22:44,220 --> 00:22:47,120
+الـ lactose fermenter، الإشريكية، وما تقوليش coli،
+
+322
+00:22:47,120 --> 00:22:50,240
+بنتكلم عن جنس إشريكية، و Enterobacter، و
+
+323
+00:22:50,240 --> 00:22:54,120
+Citrobacter، و Klebsiella. بعدين بدأت بالحديث عن مين؟
+
+324
+00:22:54,120 --> 00:22:57,940
+عن الـ non lactose fermenter، وبدأت بالحديث أول
+
+325
+00:22:57,940 --> 00:23:00,660
+مجموعة عن الـ non lactose fermenter في السيراتية، هل
+
+326
+00:23:00,660 --> 00:23:05,470
+تتذكروا؟ وبعدين دخلنا في الـ Proteus group، لاحظوا
+
+327
+00:23:05,470 --> 00:23:08,210
+في اللوحة اللي قدامي، أنا حاطط الـ Proteus، مش حاطط
+
+328
+00:23:08,210 --> 00:23:13,090
+مين؟ السيراتية ولا حاطط الأشياء الأخرى، لأنه أقرب
+
+329
+00:23:13,090 --> 00:23:16,970
+حاجة في الشبه للـ Proteus، اللي ممكن يكون مين؟ الـ
+
+330
+00:23:16,970 --> 00:23:19,910
+Proteus، إيش وجه الشبه بينهم؟ الاتنين متحركة،
+
+331
+00:23:19,910 --> 00:23:27,500
+والاتنين they produce، لأ، مش الرئيس، H2S، وأحد
+
+332
+00:23:27,500 --> 00:23:30,280
+الصفات اللي بنكشف فيها على السالمونيلا على
+
+333
+00:23:30,280 --> 00:23:34,340
+الأطباق يا شباب، قدرتها على إنتاج اللي هو الـ H2S
+
+334
+00:23:34,340 --> 00:23:39,320
+فسمع، ومميزة. فضل يا عزيزي، سؤال. فأنا بصراحة أحس في
+
+335
+00:23:39,320 --> 00:23:43,080
+كثير من حالات الدجاج، ما يبقاش في سوق البيت، يكون حتى
+
+336
+00:23:43,080 --> 00:23:48,620
+لما يتبادل الفلوس، بعد ما دبح الدجاج و سلخه وكل
+
+337
+00:23:48,620 --> 00:23:52,600
+شيء، فبدي أسأل يعني هذا السبب اللي إنت شايفه لـ
+
+338
+00:23:52,600 --> 00:23:56,160
+salmonella؟ هو عشان أكون دقيق معاك، وبناء على
+
+339
+00:23:56,160 --> 00:23:59,480
+معلومات حقيقية ودراسات وليست يعني توقعات أو
+
+340
+00:23:59,480 --> 00:24:03,000
+تخمينات. قطاع غزة، في السالمونيلا موجودة في قطاع غزة
+
+341
+00:24:03,000 --> 00:24:07,560
+لكن نسبة وجودها حقيقة مش عالية، يعني ربما يكون أفضل
+
+342
+00:24:07,560 --> 00:24:12,320
+من بلدان متطورة في هذا المجال. أحد الدراسات اللي
+
+343
+00:24:12,320 --> 00:24:15,440
+أجريناها لطالب ما، استهدفت على البيض في قطاع غزة،
+
+344
+00:24:15,440 --> 00:24:20,200
+أخذ من كل مزارع البيض في قطاع غزة، بقول قطاع غزة
+
+345
+00:24:20,200 --> 00:24:25,590
+يعني من رفح إلى بيت حانون، ولم يُعزل أي سالمونيلا من
+
+346
+00:24:25,590 --> 00:24:30,590
+البيض، عُزلت من مزرعة واحدة، من مخلفات الدواجن، وليس
+
+347
+00:24:30,590 --> 00:24:34,370
+من البيض، لكن نسبة السالمونيلا بشكل عام هي قليلة.
+
+348
+00:24:34,370 --> 00:24:38,930
+أما الممارسات اللي اتفضلت فيها حضرتك هي ممارسات
+
+349
+00:24:38,930 --> 00:24:44,210
+تساعد بالتأكيد على نقل السالمونيلا من إلى، من بشر
+
+350
+00:24:44,210 --> 00:24:48,410
+إلى بشر، من بشر إلى حيوان، ومن حيوان إلى البشر، فده
+
+351
+00:24:48,410 --> 00:24:54,380
+بالتأكيد يعني موجود. أسماء سهلة، مش كتير معقدة، اليوم
+
+352
+00:24:54,380 --> 00:24:59,420
+سلمونيلا تايفي، سلمونيلا بارا تايفي A، بارا تايفي B،
+
+353
+00:24:59,420 --> 00:25:04,700
+بارا تايفي C. لحد الآن الأمور سهلة. كمان تايفي وبارا
+
+354
+00:25:04,700 --> 00:25:11,030
+تايفي A وB وC، أعتقد إنهم كلهم سهلين. الرقم خمسة،
+
+355
+00:25:11,030 --> 00:25:16,650
+Enteritidis، ستة،  Enteritidis، ولاحظوا فيها حرف دي خفيف،
+
+356
+00:25:16,650 --> 00:25:22,430
+Enteritidis، لأن المرض Enteritis، gastroenteritis، فما فيش
+
+357
+00:25:22,430 --> 00:25:26,410
+فيه دي، المرض ما فيش فيه دي، بينما البكتيريا فيه دي،
+
+358
+00:25:26,410 --> 00:25:30,810
+وفي شبيه بهذا الكلام، نيسيريا مينيجايتدس، برضه فيها
+
+359
+00:25:30,810 --> 00:25:34,830
+حرف دي، والمرض مينيجايتدس، ما فيش حرف اللي هو الدي.
+
+360
+00:25:34,830 --> 00:25:40,210
+طيب، سلمونيلا بولروم، حلو هذا
+
+361
+00:25:40,210 --> 00:25:44,830
+الاسم، بولروم، وجاليناروم. أنا الآن يا شباب
+
+362
+00:25:44,830 --> 00:25:47,810
+بنقول لكم إن السنة الماضية في المعمل كانوا يضحكوا
+
+363
+00:25:47,810 --> 00:25:52,490
+عليكم ويقولوا لكم إن السالمونيلا كلها مُتحركة، اليوم
+
+364
+00:25:52,490 --> 00:25:56,030
+بنقول لكم، إنتوا كبرتوا ولازم تعرفوا الحقيقة المرة،
+
+365
+00:25:56,030 --> 00:26:00,250
+إن مش كل السالمونيلا متحركة، سلمونيلا بولروم و
+
+366
+00:26:00,250 --> 00:26:05,690
+سلمونيلا جاليناروم are non-motile. هذا بيؤكد
+
+367
+00:26:05,690 --> 00:26:09,090
+الحقيقة اللي حاولنا نغرسها في أدمغتكم مبكراً، هذا
+
+368
+00:26:09,090 --> 00:26:13,630
+الفصل، إن لا يوجد absolute .. بصراحة absolute
+
+369
+00:26:13,630 --> 00:26:19,990
+negative في موضوع الـ .. الـ .. الـ characteristics. They
+
+370
+00:26:19,990 --> 00:26:22,770
+are gram-negative bacilli، أكتر من ذلك ما بدي
+
+371
+00:26:22,770 --> 00:26:25,670
+وصف، ما بدي short ولا long، بدي فقط gram
+
+372
+00:26:25,670 --> 00:26:29,250
+-negative bacilli، كلهم motile with peritrichous
+
+373
+00:26:29,250 --> 00:26:33,270
+flagella،  ما عدا،  Bolerum and Galinarum، they are non
+
+374
+00:26:33,270 --> 00:26:35,530
+-encapsulated، يعني ما لهمش capsule، with some
+
+375
+00:26:35,530 --> 00:26:39,620
+exceptions طبعا، و they are gram-negative. الـ
+
+376
+00:26:39,620 --> 00:26:42,020
+Habitat، Wind Transmission، مكان معيشة السالمونيلا،
+
+377
+00:26:42,020 --> 00:26:44,960
+إحنا عملنا تقديم كويس، والصحيح للموضوع هذا، فمش
+
+378
+00:26:44,960 --> 00:26:48,220
+هتقولوا علينا صعب، السالمونيلا التايفية والباراتايفية
+
+379
+00:26:48,220 --> 00:26:51,590
+افصلوهم عن باقي السالمونيلا، افصلوهم عن باقي الـ
+
+380
+00:26:51,590 --> 00:26:54,750
+Salmonella، هدول الاتنين اللي هم التايفية والبارا
+
+381
+00:26:54,750 --> 00:27:00,270
+تايفية، the only host غالبا is man، اللي هو الإنسان
+
+382
+00:27:00,270 --> 00:27:04,770
+the only host is man. تايفية والباراتايفية، بينما الـ
+
+383
+00:27:04,770 --> 00:27:09,430
+other Salmonella، قلنا لكم في wide range of host، زي
+
+384
+00:27:09,430 --> 00:27:13,090
+الـ reptiles، الزواحف، حتى الـ cows، الـ goats، الـ sheeps
+
+385
+00:27:13,090 --> 00:27:16,590
+الآخرين، كل هذه الـ reservoirs للـ Salmonella.
+
+386
+00:27:19,280 --> 00:27:22,540
+طريقة الـ transmission غالبا fecal-oral
+
+387
+00:27:22,540 --> 00:27:28,200
+transmission. إيش يعني fecal-oral transmission؟ من
+
+388
+00:27:28,200 --> 00:27:32,420
+الـ feces للفم، للأسف، يعني هذا التعبير الدقيق، إنه من
+
+389
+00:27:32,420 --> 00:27:36,160
+
+445
+00:31:44,720 --> 00:31:48,540
+بيحميها الـ lymph nodes، الـ lymph nodes ممنوع أي
+
+446
+00:31:48,540 --> 00:31:52,300
+ميكروب يدخل إلى الدم، checkpoints منها مش هنجونا
+
+447
+00:31:52,300 --> 00:31:56,380
+نقاط تفتيش، لكن السلمونيلا يا شباب عندها القدرة ..
+
+448
+00:31:56,380 --> 00:32:01,380
+عندها القدرة على الـ intracellular existence، إيش
+
+449
+00:32:01,380 --> 00:32:04,680
+يعني intracellular existence؟ يعني موجودة في الـ
+
+450
+00:32:04,680 --> 00:32:07,860
+macrophage أو الـ phagocyte and can multiply
+
+451
+00:32:07,860 --> 00:32:11,780
+inside the macrophage، يعني الـ macrophage بطلت
+
+452
+00:32:11,780 --> 00:32:15,480
+قادرة عليه، إنّها تقتل السلمونيلا، بل السلمونيلا
+
+453
+00:32:15,480 --> 00:32:19,260
+قادرة على قتل الـ macrophage بعد ما تتكاثر جواها
+
+454
+00:32:22,020 --> 00:32:25,180
+existence، بس مش obligate، مش زي اللي قلناها لهم
+
+455
+00:32:25,180 --> 00:32:30,120
+بتتميز بين بكتيريا تستطيع تعيش معيشة حرة، و
+
+456
+00:32:30,120 --> 00:32:33,740
+intracellular، وبين obligate intracellular، هذه
+
+457
+00:32:33,740 --> 00:32:36,180
+بنسميها facultative intracellular، وهذه بنسميها
+
+458
+00:32:36,180 --> 00:32:41,160
+obligate intracellular، نمشي مع بعض كمان، بس خلينا
+
+459
+00:32:41,160 --> 00:32:45,610
+نكمل القصة بعدين، إذا كان في مجال أسئلة اشتغلوا
+
+460
+00:32:45,610 --> 00:32:48,390
+إنّها penetration الـ intestinal wall، وبعدين وصول للـ
+
+461
+00:32:48,390 --> 00:32:53,530
+lymph node، من الـ lymph node بتروح على الدم، في الدم
+
+462
+00:32:53,530 --> 00:32:58,490
+يا شباب، البكتيريا بفعل ضخ الدم من القلب، بدخّلها إلى
+
+463
+00:32:58,490 --> 00:33:03,050
+باقي الجسم، هناك أماكن بتفضّلها الـ Salmonella زي الـ
+
+464
+00:33:03,050 --> 00:33:06,050
+reticuloendothelial system، الـ reticulo-
+
+465
+00:33:06,050 --> 00:33:09,850
+endothelial system، يعني الـ .. الـ spleen، الـ liver،
+
+466
+00:33:09,850 --> 00:33:14,160
+الـ bone marrow، تمام؟ طب هذا إيش ميزاته الـ
+
+467
+00:33:14,160 --> 00:33:16,600
+reticuloendothelial system؟ ميزاته إنّه مليان
+
+468
+00:33:16,600 --> 00:33:21,380
+ماكروفاج، دلالة إنّ السلمونيلا بتدور على الـ organs
+
+469
+00:33:21,380 --> 00:33:29,700
+اللي فيها ماكروفاج، عشان هي تتكاثر داخلها، الآن خلال
+
+470
+00:33:29,700 --> 00:33:36,320
+عملية التكاثر، الجسم بيتعرف، الـ immune system بتعرف
+
+471
+00:33:36,320 --> 00:33:40,170
+على البكتيريا، وبيكون لها أجسام مضادة، الأجسام
+
+472
+00:33:40,170 --> 00:33:45,030
+المضادة، وظيفتها إنّها تكافح السلمونيلا، فجزء من
+
+473
+00:33:45,030 --> 00:33:48,690
+السلمونيلا بيموت في الدم، بيختفي تلقائيًا بدون أي
+
+474
+00:33:48,690 --> 00:33:54,570
+علاج، بسبب مين؟ بسبب ظهور الـ antibodies، تذكروا هي
+
+475
+00:33:54,570 --> 00:33:57,850
+من وين دخلت؟ من الـ intestine، فجزء منها ضايل في الـ
+
+476
+00:33:57,850 --> 00:34:00,830
+intestine، خدوا بالكم، مش كلها بتضحي بنفسها، كلها
+
+477
+00:34:00,830 --> 00:34:05,330
+جزء منها ضايل في الـ intestine، وجزء منها انتقل للدم
+
+478
+00:34:06,090 --> 00:34:11,010
+القصة اللي بنحكيها هذه، لأنّها مهمة جدًا جدًا في توقيت
+
+479
+00:34:11,010 --> 00:34:15,930
+أخذ العينات، ونوع العينات اللي بناخدها عشان نعمل
+
+480
+00:34:15,930 --> 00:34:18,210
+diagnosis لـ typhoid
+
+481
+00:34:22,410 --> 00:34:26,290
+اختفت من الدم؟ هل اختفت من الانتستين؟ للأسف، الـ
+
+482
+00:34:26,290 --> 00:34:30,170
+antibodies مش فعالة في الانتستين زي ما فعالة في
+
+483
+00:34:30,170 --> 00:34:33,670
+الدم والأنسجة، اتفقنا؟ وبالتالي، البكتيريا حتى
+
+484
+00:34:33,670 --> 00:34:36,510
+اللي هي اللي موجودة في الـ intestinal tract،
+
+485
+00:34:36,510 --> 00:34:42,730
+خلصنا الجثة، يبقى الـ execution للـ Salmonella بتم
+
+486
+00:34:42,730 --> 00:34:46,350
+عبر مين؟ عبر الـ stool،  لأنّه موجود في الـ intestinal
+
+487
+00:34:46,350 --> 00:34:51,170
+tract، متفقين لحد الآن؟ الكلام اللي على اللوحة
+
+488
+00:34:51,170 --> 00:34:57,460
+هذه تقريبًا هو اللي أنا شرحته، جاب لحظات على الشكل إنّ
+
+489
+00:34:57,460 --> 00:35:01,740
+البكتيريا تدخل عبر الفم، oral، تصل الـ intestine،
+
+490
+00:35:01,740 --> 00:35:04,740
+الـ intestinal wall، الـ penetration للـ lymph node،
+
+491
+00:35:04,740 --> 00:35:08,900
+للدم، circulation في different systems، في بعض
+
+492
+00:35:08,900 --> 00:35:13,920
+الحالات، السلمونيلا بتستقر في مكان غريب نوعًا ما، اللي
+
+493
+00:35:13,920 --> 00:35:19,490
+هو الـ gallbladder، والناس الـ carriers، غالبًا البكتيريا
+
+494
+00:35:19,490 --> 00:35:24,270
+بتستقر في gallbladder، لحظة، gallbladder إيش فيها؟ فيها
+
+495
+00:35:24,270 --> 00:35:28,790
+bile salts، والـ bile salts يا شباب معروف عنها إنها
+
+496
+00:35:28,790 --> 00:35:33,410
+inhibitory للبكتيريا، لكن كون السلمونيلا قادرة على
+
+497
+00:35:33,410 --> 00:35:37,160
+المعيشة في الـ gallbladder، ماذا يعني ذلك؟ إنها
+
+498
+00:35:37,160 --> 00:35:42,640
+resistant للـ bile salts، أحد المعلومات اللي استغلناها
+
+499
+00:35:42,640 --> 00:35:47,000
+في عملية عزل الـ Salmonella selectively، لأنّ احنا
+
+500
+00:35:47,000 --> 00:35:49,440
+حطينا في الأوساط الزراعية تبعتها high
+
+501
+00:35:49,440 --> 00:35:52,760
+concentration of bile salts، منعنا الـ gram positive
+
+502
+00:35:52,760 --> 00:35:57,060
+بكتيريا، ومنعنا كتير من الـ gram negative بكتيريا
+
+503
+00:35:57,060 --> 00:36:00,240
+فبظنّ إنها الـ Salmonella، طبعًا مش absolutely برضه
+
+504
+00:36:00,240 --> 00:36:04,560
+selective، لكن على الأقل بيعطينا فرصة أفضل في عملية
+
+505
+00:36:04,560 --> 00:36:05,740
+اللي هو العزل
+
+506
+00:36:10,270 --> 00:36:15,190
+من الـ serious complications اللي ممكن تنتج من الـ
+
+507
+00:36:15,190 --> 00:36:17,890
+typhoid fever أو الـ paratyphoid fever، هو قدرة
+
+508
+00:36:17,890 --> 00:36:21,030
+البكتيريا إنّها تتكاثر في الـ organs، تعمل abscess في
+
+509
+00:36:21,030 --> 00:36:25,690
+الـ organs، في الـ spleen، و elsewhere، طبعًا البكتيريا
+
+510
+00:36:25,690 --> 00:36:30,260
+في الدم، بكتيريا في الدم، وهي gram negative، لو ماتت
+
+511
+00:36:30,260 --> 00:36:33,740
+البكتيريا في الدم، إيش شعر إنّها endotoxin برضه، حاسس
+
+512
+00:36:33,740 --> 00:36:37,960
+إنّها shock، أو أعراض مش ضابطة، أعراض shock، وبالتالي
+
+513
+00:36:37,960 --> 00:36:46,740
+ممكن الحالة تتطور، ويصاب المريض بـ organ failures، أو
+
+514
+00:36:46,740 --> 00:36:50,800
+circulatory collapse، ويموت المريض، لذلك الـ typhoid
+
+515
+00:36:50,800 --> 00:36:54,160
+والـ paratyphoid fever، يعتبرا من الأمراض الخطيرة
+
+516
+00:36:54,640 --> 00:37:01,420
+جداً، واللي كانت تعتبر من المشاكل المستعصية
+
+517
+00:37:01,420 --> 00:37:06,620
+على معظم سكان العالم الثالث، الآن طبعًا المشكلة قلت
+
+518
+00:37:06,620 --> 00:37:11,980
+لكن لما نتكلم عن أي ميكروب في الدنيا بينتقل فمُعظم
+
+519
+00:37:11,980 --> 00:37:18,220
+oral، بتتذكروا إنّ احنا، احنا we are protected من
+
+520
+00:37:18,220 --> 00:37:22,580
+this bacteria، إذا عندنا system كويس، إذا عندنا نظام
+
+521
+00:37:23,510 --> 00:37:27,910
+النظام الصرف الصحي كويس، إذا صار فشل في نظام الصرف
+
+522
+00:37:27,910 --> 00:37:32,270
+الصحي في أي مؤسسة، في أي دولة في العالم، قد يحصل
+
+523
+00:37:32,270 --> 00:37:37,270
+فيها tie fight، فمتى ممكن يحصل مشاكل في أنظمة الصرف
+
+524
+00:37:37,270 --> 00:37:42,260
+الصحي؟ في الحروب؟ تقصف .. متعرفين محطة المعالجة
+
+525
+00:37:42,260 --> 00:37:46,660
+بتاعة الشيخ أجلين، اللي هي أكبر محطة معالجة عندنا في
+
+526
+00:37:46,660 --> 00:37:50,980
+.. في أحد الحروب قصفت، وجزء منها اتدمر، قطع
+
+527
+00:37:50,980 --> 00:37:54,600
+الكهرباء عن المحطات المعالجة، مش هذا بـ .. بيؤدي
+
+528
+00:37:54,600 --> 00:37:59,240
+لعدم معالجة، وبالتالي تصريف مياه عادمة، لو صار في
+
+529
+00:37:59,240 --> 00:38:03,170
+إضراب لعمال النظافة في .. في الـ .. في البلد، لو صار
+
+530
+00:38:03,170 --> 00:38:07,890
+عندنا حصار، لو صار عندنا آثار، لو صار عندنا
+
+531
+00:38:07,890 --> 00:38:11,810
+tsunami، فاكرين الـ tsunami؟ طب اسمعوا الأخبار
+
+532
+00:38:11,810 --> 00:38:14,110
+وراقبوا الأخبار أنتم، لما يصير في أي كارثة في
+
+533
+00:38:14,110 --> 00:38:21,000
+العالم، الله يفتح عليك، على طول بصير إنّ الـ WHO بتحذّر
+
+534
+00:38:21,000 --> 00:38:24,480
+وبتععلن، وبتقول إنّ هنا في تخوّف من انتشار الشغلة،
+
+535
+00:38:24,480 --> 00:38:27,920
+الـ cholera، الـ typhoid fever، الطاعون، يعني هناك
+
+536
+00:38:27,920 --> 00:38:33,340
+أمراض كثيرة تنتشر غالبًا بعد اللي هو الكوارث، سواء
+
+537
+00:38:33,340 --> 00:38:38,620
+الحروب أو الكوارث، يبقى متفقين على أنّ السلمونيلا
+
+538
+00:38:38,620 --> 00:38:42,320
+typhi بتسبب typhoid fever، و الـ paratyphoid fever،
+
+539
+00:38:42,320 --> 00:38:46,020
+both of which are dangerous diseases that may
+
+540
+00:38:46,020 --> 00:38:50,620
+cause death، طبعًا الخطورة أعلى لمين؟ لـ typhoid fever
+
+541
+00:38:50,620 --> 00:38:55,600
+من الـ paratyphoid fever، لا تخلطوا التيفوس، هو الـ Rickettsia،
+
+542
+00:38:55,600 --> 00:38:59,180
+ما تخلطوش، التيفوس هو الـ Rickettsia، بينما typhoid
+
+543
+00:38:59,180 --> 00:39:04,180
+Salmonella typhi، راجعوا المحاضرة بعد ذلك إن شاء الله
+
+544
+00:39:04,180 --> 00:39:07,850
+طيب، احنا فاكرين، يقول لنا الـ M-cells، حكينا عن الـ M-
+
+545
+00:39:07,850 --> 00:39:10,490
+cells، اللي هي الـ enterocytes، في الـ enterocytes
+
+546
+00:39:10,490 --> 00:39:16,210
+بتاخد عينة، خدوا بالكم، هذه الخلايا ليست phagocytic
+
+547
+00:39:16,210 --> 00:39:20,070
+in nature، مش phagocytic in nature، يعني مش طبيعتها
+
+548
+00:39:20,070 --> 00:39:24,070
+إنّها تعمل phagocytosis، إيش .. إيش .. إيش السلمون
+
+549
+00:39:24,070 --> 00:39:28,890
+اللي بتعمل؟ وهذا على تكرار من أجمل يعني المعلومات
+
+550
+00:39:28,890 --> 00:39:31,470
+الحديثة اللي اكتشفناها، إنّ في حاجة اسمها molecular
+
+551
+00:39:31,470 --> 00:39:34,850
+syringes، بتعرف syringe؟ إيش معناه syringe؟ سرنجة
+
+552
+00:39:35,930 --> 00:39:41,070
+molecular، مش أي molecular، يعني حجمها جزيئي، أو بعض
+
+553
+00:39:41,070 --> 00:39:44,450
+الأحيان يسموها nano، nano injections، nano
+
+554
+00:39:44,450 --> 00:39:48,330
+injections، السلمونيلا بتنزل، وبتترتب على receptors
+
+555
+00:39:48,330 --> 00:39:56,730
+على سطح، سطح الخلية، بتعمل injection لها، بـ system
+
+556
+00:39:56,730 --> 00:40:00,990
+بيسمّوه type 3 secretory system، type 3 secretory
+
+557
+00:40:00,990 --> 00:40:05,270
+system، إيش الـ system هذا بيعمل؟ بيعمل
+
+558
+00:40:06,980 --> 00:40:12,420
+polymerization للأكتين اللي موجود داخل الخلية، إيش
+
+559
+00:40:12,420 --> 00:40:17,360
+يعني polymerization؟ يعني تجميع للأكتين، إيش
+
+560
+00:40:17,360 --> 00:40:21,360
+الأكتين وظيفته في الخلية؟ هو الـ cytoskeleton، هو
+
+561
+00:40:21,360 --> 00:40:25,360
+الـ support تبع الخلية، هو اللي بيعطي الخلية شكلها،
+
+562
+00:40:25,360 --> 00:40:31,490
+تمام؟ فبيروح، هذا بيعمل arrangement بحيث إنّه يطلع
+
+563
+00:40:31,490 --> 00:40:35,830
+زوائد تعمل phagocytosis لمين؟ للسلمونيلا، تخيلوا
+
+564
+00:40:35,830 --> 00:40:41,270
+السلمونيلا، طبعًا مش مستحيل الكلام هذا، هي أذكى من ذلك
+
+565
+00:40:41,270 --> 00:40:45,030
+أنّها تقضي على نفسها، هي تريد من هذه الخلية الغير
+
+566
+00:40:45,030 --> 00:40:48,470
+قادرة على الـ phagocytosis، إنّها تعمل لها phagocytosis
+
+567
+00:40:48,470 --> 00:40:52,720
+وشو بيصير في الموقف هنا؟ بدل البكتيريا ما تموت
+
+568
+00:40:52,720 --> 00:40:57,860
+البكتيريا بتتكاثر جوا الخلية، كعمل لـ protection من
+
+569
+00:40:57,860 --> 00:41:00,960
+الـ immune system، وهذه طرق، أو طريقة من طرق خداع
+
+570
+00:41:00,960 --> 00:41:05,220
+البكتيريا لجهاز المناعة، احنا قلنا لكم اليهود في
+
+571
+00:41:05,220 --> 00:41:10,450
+أحد السنوات، لما دخلوا جنين، في الصمود الأسطوري
+
+572
+00:41:10,450 --> 00:41:16,050
+للإخوة في جنين، كانوا خايفين من المقاومة ما يطلعوا على
+
+573
+00:41:16,050 --> 00:41:19,970
+الشارع، كانوا يدخلوا بيت، ينتقلوا للبيت الآخر، وطبعًا
+
+574
+00:41:19,970 --> 00:41:23,830
+هنا مخيمات، بيوت مجاورة، زي الخلايا، فكانوا يدخلوا من
+
+575
+00:41:23,830 --> 00:41:28,030
+بيت إلى بيت، عبر فتحة أو ثغرة في جدار يحفرها
+
+576
+00:41:28,030 --> 00:41:32,470
+والبكتيريا السلمونيلا، اللي قادرة على إنّها تعمل هذا
+
+577
+00:41:32,470 --> 00:41:37,450
+الكلام، دخولها إلى داخل الخلية هو عبارة عن
+
+578
+00:41:37,450 --> 00:41:42,150
+protection من من من الـ immune system، وعملية خداع
+
+579
+00:41:42,150 --> 00:41:46,750
+لهذا الجهاز، هذه نفس الكلام اللي احنا حكيناه تلخيصًا
+
+580
+00:41:46,750 --> 00:41:50,890
+إنّه كيف الـ system لـ الـ الـ الـ pathogenesis،
+
+581
+00:41:50,890 --> 00:41:53,550
+ingestion of Salmonella، attachment، penetration،
+
+582
+00:41:53,550 --> 00:41:57,690
+multiplication، في الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+583
+00:41:57,690 --> 00:41:57,870
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+584
+00:41:57,870 --> 00:41:58,250
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+585
+00:41:58,250 --> 00:41:58,530
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+586
+00:41:58,530 --> 00:41:58,730
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+587
+00:41:58,730 --> 00:41:59,050
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+588
+00:41:59,050 --> 00:41:59,090
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+589
+00:41:59,090 --> 00:42:02,640
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ primary
+
+590
+00:42:02,640 --> 00:42:05,460
+bacteremia، ممكن تروح على الـ gallbladder، تعمل اللي هنا
+
+591
+00:42:05,460 --> 00:42:09,780
+يعني إيش؟ carrier state، ممكن تروح على الـ .. الـ
+
+592
+00:42:09,780 --> 00:42:14,500
+.. الـ organs، تعمل برضه infection للـ liver، الـ gallbladder،
+
+593
+00:42:14,500 --> 00:42:16,980
+gallbladder، spleen، kidney، والـ bone marrow، تعمل
+
+594
+00:42:16,980 --> 00:42:20,080
+حاسب ما secondary bacteremia، وبعدين بيظهر لنا اللي
+
+595
+00:42:20,080 --> 00:42:24,400
+هو الـ symptoms of the disease، والـ symptoms could
+
+596
+00:42:24,400 --> 00:42:28,360
+be complicated or subsided، يعني يا إمّا بتتفاقم
+
+597
+00:42:28,360 --> 00:42:33,570
+يا إمّا بتخف، حسب مناعة اللي هو الإنسان، أو حسب تدخل
+
+598
+00:42:33,570 --> 00:42:37,310
+الأطباء، هل أعطينا antibiotic ولا ما أعطيناش
+
+599
+00:42:37,310 --> 00:42:40,410
+antibiotic، والمرة الجاية إن شاء الله بنتكلم عن
+
+600
+00:42:40,410 --> 00:42:43,050
+أشكال أخرى من اللي هو Salmonella Typhi
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ZitYVwg8dn0_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ZitYVwg8dn0_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..6c50847ff3fa45b0eec9a5f0638d9af35513f710
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ZitYVwg8dn0_postprocess.srt
@@ -0,0 +1,2400 @@
+1
+00:00:20,010 --> 00:00:24,770
+أنا رحيم بدأنا احنا بالحديث المرة الماضية عن ال
+
+2
+00:00:24,770 --> 00:00:27,430
+non-lactose fermenting enterobacteriasi و بدأنا
+
+3
+00:00:27,430 --> 00:00:33,730
+أعتقد بالسيراتيا و تحدثنا عن ال protease ذكرنا
+
+4
+00:00:33,730 --> 00:00:36,750
+مجموعة أسماء منها ما هو protease و منها ما هو
+
+5
+00:00:36,750 --> 00:00:40,790
+providentia و منها ما هو morganella و سميناهم
+
+6
+00:00:40,790 --> 00:00:43,270
+protease group و قلنا collectively they are
+
+7
+00:00:43,270 --> 00:00:48,410
+protease groupمن الميزات اللي بتجمع كل المجموعة مع
+
+8
+00:00:48,410 --> 00:00:53,870
+بعض ميزتين أساسيتين الميزة الأولى ان هم يورياز
+
+9
+00:00:53,870 --> 00:00:58,010
+producer يعني يورياز بوستر وكلهم actively motile
+
+10
+00:00:58,010 --> 00:01:02,030
+كلهم actively motile لكن من الآن برضه بنحاول نلاقي
+
+11
+00:01:02,030 --> 00:01:05,010
+طريقة نميز بين ال مورجانيل أو ال providential من
+
+12
+00:01:05,010 --> 00:01:09,130
+ناحية و بين ال producers من ناحية أخرى الميزة
+
+13
+00:01:09,130 --> 00:01:12,840
+الأساسية هي production of edge to edgeمين اللي
+
+14
+00:01:12,840 --> 00:01:16,880
+بينتج H2S؟ البروتياز بينما المورجانيلا و
+
+15
+00:01:16,880 --> 00:01:21,040
+البروفيدنشيا they do not produce H2S يبقى أحد
+
+16
+00:01:21,040 --> 00:01:26,340
+الأساسيات في التمييز بينهم لازم يكون ال H2S نبدأ
+
+17
+00:01:26,340 --> 00:01:29,440
+لان اتكلم بالمورجانيلا و البروفيدنشيا المورجانيلا
+
+18
+00:01:29,440 --> 00:01:36,380
+و البروفيدنشيا قريبة بشكل كبير إلى شكلا و صفاتا
+
+19
+00:01:36,380 --> 00:01:40,820
+إلى المجموعة اللي حكينا عنها اللي هي البروتياز
+
+20
+00:01:40,820 --> 00:01:41,080
+group
+
+21
+00:01:44,150 --> 00:01:47,330
+بنرجع لها ان شاء الله لإننا بنجمع هم كلتهم مع بعض
+
+22
+00:01:47,330 --> 00:01:49,930
+التلت أسماء اللي هم ال protease و المرغنية لما
+
+23
+00:01:49,930 --> 00:01:55,070
+نشوف كيف نميز بينهم ربما ال motility مهم جدا و
+
+24
+00:01:55,070 --> 00:01:59,950
+الurease لكن الindole ليس بذك الأهمية لماذا ليس
+
+25
+00:01:59,950 --> 00:02:03,630
+بذك الأهمية لأن ال protease نفسها في منها indole
+
+26
+00:02:03,630 --> 00:02:06,830
+بسط و منها indole negative وبتالي لنستطيع أن
+
+27
+00:02:06,830 --> 00:02:10,710
+نستخدم الindole ك variable لتمييز بين المجموعتين
+
+28
+00:02:10,710 --> 00:02:15,260
+كلها لحدةالمورجانيلا مورجاني هي ال representative
+
+29
+00:02:15,260 --> 00:02:17,520
+of the species الوحيدة في المجموعة واللي إلها
+
+30
+00:02:17,520 --> 00:02:20,360
+أهمية طبية وبتسبب نفس الأوراض بتسببها ال other
+
+31
+00:02:20,360 --> 00:02:24,020
+enterobacteriasi لكن with less frequency يعني نسبة
+
+32
+00:02:24,020 --> 00:02:28,400
+حدوثها أقل من ميزاتها او عفوا فيه إن هنا ال
+
+33
+00:02:28,400 --> 00:02:31,120
+الchloramphenicol بيقولنا إن هو drug of choice لكن
+
+34
+00:02:31,120 --> 00:02:33,340
+أنا يعني أحصاني المعلومات القديمة جدا
+
+35
+00:02:33,340 --> 00:02:37,440
+الchloramphenicol من ال drugs اللي أوقفت عالميا
+
+36
+00:02:37,440 --> 00:02:41,870
+بسبب سميتهابسبب bone marrow depression، bone
+
+37
+00:02:41,870 --> 00:02:46,810
+marrow depression و نوع من الانيميا لكن ال
+
+38
+00:02:46,810 --> 00:02:49,550
+chlorine phenicol الان بيستخدم فقط topical
+
+39
+00:02:49,550 --> 00:02:53,150
+application بمعنى انه لو كان على الجلد او قطرة في
+
+40
+00:02:53,150 --> 00:02:55,650
+العين او التهابات القذوة ممكن نستخدم ال chlorine
+
+41
+00:02:55,650 --> 00:03:00,100
+phenicol اللي هو ال topical applicationمن الصفات
+
+42
+00:03:00,100 --> 00:03:03,600
+تبع المورجانيلا اللى بتميزها عن ال ال ال other
+
+43
+00:03:03,600 --> 00:03:06,740
+species او ornithine decarboxylase بُستف ال triple
+
+44
+00:03:06,740 --> 00:03:10,020
+sugar ionizer تبعها فقط A على A و اتذكروا مافيش
+
+45
+00:03:10,020 --> 00:03:14,420
+H2S لو رجعنا على ال Proteus هلاجي ان ال Proteus K
+
+46
+00:03:14,420 --> 00:03:19,640
+K على A G plus يفجأ أحد الأشياء المهمة فيها كان
+
+47
+00:03:19,640 --> 00:03:23,960
+اللى هو اللى هو ال H2S production ال reaction هنا
+
+48
+00:03:23,960 --> 00:03:27,360
+بُستف بُستف نيجاتيف نيجاتيف يعني بتشبه مين
+
+49
+00:03:30,270 --> 00:03:33,070
+وال .. ال .. ال .. الخاتمة اللي خدرنا فيها
+
+50
+00:03:33,070 --> 00:03:37,610
+محاضرتنا السابقة لما قلنا انه لا يمكن تشبيه اتنين
+
+51
+00:03:37,610 --> 00:03:40,690
+مختلفين مع بعض حتى و انت شابهه لأنه هديك واحد
+
+52
+00:03:40,690 --> 00:03:43,850
+lactose-fermenter واحدة non-lactose-fermenter فياك
+
+53
+00:03:43,850 --> 00:03:47,990
+أن تقع في هذا الخطأ مرة أخرى خلاص احنا بدأنا بإن
+
+54
+00:03:47,990 --> 00:03:51,150
+هما اتنين بيختلفوا عن بعض بال lactose-fermentation
+
+55
+00:03:51,150 --> 00:03:54,070
+إذن ال envic حتى لو تشابه ال envic ليس له أي معنى
+
+56
+00:03:54,070 --> 00:03:57,430
+أو أي قيمة طبعا ال motility احنا اتفقنا ان كل
+
+57
+00:03:57,430 --> 00:04:02,930
+المجموعة actively motileالـ Providentia يمكن مش
+
+58
+00:04:02,930 --> 00:04:07,910
+اللي لوحها لسه خالص مش واضحة لكن ال .. ال .. ال ..
+
+59
+00:04:07,910 --> 00:04:10,710
+ال Providentia غالبا associated with nosocomial
+
+60
+00:04:10,710 --> 00:04:16,210
+infection لما نقول nosocomial infectionو .. و لأ
+
+61
+00:04:16,210 --> 00:04:18,550
+بدنا .. بدنا نتذكر كمان شغل انه .. انه الناس اللي
+
+62
+00:04:18,550 --> 00:04:20,870
+في المستشفيات غالبا بيكونوا immunocompromised
+
+63
+00:04:20,870 --> 00:04:24,130
+فيعني بتصيب أكتر الحالات اللي هي ال
+
+64
+00:04:24,130 --> 00:04:27,410
+immunosuppressed patient لكن في الآخر انا اللي
+
+65
+00:04:27,410 --> 00:04:30,590
+بيعنيني اللي هو كيف اعمل differentiation لهذه
+
+66
+00:04:30,590 --> 00:04:34,270
+البكتيريا عن باقي ال enterobacterias طبعا هي non
+
+67
+00:04:34,270 --> 00:04:36,530
+-lactose fermenter انا متفق يقولها non-lactose
+
+68
+00:04:36,530 --> 00:04:40,420
+fermenter urease positive ولا negative؟بوستف احنا
+
+69
+00:04:40,420 --> 00:04:43,660
+جوننا كل المجموعة يورياز بوستف واكتفلي بوستف
+
+70
+00:04:43,660 --> 00:04:47,140
+واكتفلي موتايل لكن الهيدرولين سالفاية تبعها هنا
+
+71
+00:04:47,140 --> 00:04:51,740
+نيجاتيف انا اللايسينديكاربوكسليز ايضا نيجاتيف
+
+72
+00:04:51,740 --> 00:04:56,020
+اللاكتوز نيجاتيف ال triple sugar iron agar تبعها
+
+73
+00:04:56,020 --> 00:04:59,400
+كي على ايه؟ وهذه بتميز عن مين؟ عن المورجانيل اللي
+
+74
+00:04:59,400 --> 00:05:03,940
+شبيهتها هذي كانت ايه؟ على ايه؟ اتنتين بتدريوش اتش
+
+75
+00:05:03,940 --> 00:05:09,010
+تو اسالمورجانيلا والبروفيدنشيا كامان نيجاتيف لـ
+
+76
+00:05:09,010 --> 00:05:12,170
+H2S لكن الـ triple sugar iron agar تبع المورجانيلا
+
+77
+00:05:12,170 --> 00:05:19,630
+كان A على A وهذه K على A في
+
+78
+00:05:19,630 --> 00:05:23,210
+الحالة هذه ما بنقدرش نعرف في الحالة هذه لا نستطيع
+
+79
+00:05:23,210 --> 00:05:27,190
+المعرفة إلا إذا قمنا بإجراء فحص كاروز منفصل لكن
+
+80
+00:05:27,190 --> 00:05:30,550
+كوني أنا عارف إنها non-lactose fermenter
+
+81
+00:05:34,830 --> 00:05:38,490
+على المكونكي مش انا بكون زرع على المكونكي هذه نقطة
+
+82
+00:05:38,490 --> 00:05:42,990
+كتير مهمة انا المعلومات اللي بستقيها من ال .. ال
+
+83
+00:05:42,990 --> 00:05:45,570
+.. ال .. ال culture بنسميها cultural
+
+84
+00:05:45,570 --> 00:05:48,150
+characteristics جُنّة، شكل المستعمرة، لون
+
+85
+00:05:48,150 --> 00:05:52,410
+المستعمرة، ارتفاع المستعمرة، اذا كان فيه صفات
+
+86
+00:05:52,410 --> 00:05:54,970
+مميزة زي ال Himalayas على بلد أجار أو ال lactose
+
+87
+00:05:54,970 --> 00:05:56,650
+fermentation أو ال non lactose fermentation على
+
+88
+00:05:56,650 --> 00:06:00,020
+المكونكي، كل هذه الأشياء أنا بشوفهابدون ما أعمل
+
+89
+00:06:00,020 --> 00:06:03,060
+فحوصات بيو كيميائية، مظبوط ولا لأ؟ فإذا الآن أنا
+
+90
+00:06:03,060 --> 00:06:05,060
+عملت انهانال أكتروس فيرمنتر، و راجعتها إيه على
+
+91
+00:06:05,060 --> 00:06:07,700
+إيه، فمعناه الحكاية، هي ساكروز فيرمنتر، هذا
+
+92
+00:06:07,700 --> 00:06:11,560
+استنتاجاطبعا ال invic تبعها positive positive
+
+93
+00:06:11,560 --> 00:06:15,460
+negative positive و بالنسبة ل ال motility it is
+
+94
+00:06:15,460 --> 00:06:18,800
+motile لحظوا انتوا يا شباب في كل ال invic اللي
+
+95
+00:06:18,800 --> 00:06:22,360
+درسناهم بتكون positive ل ال methyl red بتكون
+
+96
+00:06:22,360 --> 00:06:25,100
+negative ل ال bogus broskauer او العكس بتكون
+
+97
+00:06:25,100 --> 00:06:27,540
+negative ل ال methyl red ال composite positive
+
+98
+00:06:27,540 --> 00:06:32,960
+فالثمة الغالبه ان البكتيريا بتكون تمتلك صفة من
+
+99
+00:06:32,960 --> 00:06:36,180
+الصفتان يا إما methyl red يا إما bogus broskauer
+
+100
+00:06:36,180 --> 00:06:38,580
+تمام واحدة من الاتنين و ليس كلاهم
+
+101
+00:06:46,130 --> 00:06:49,130
+بدي مجموعة فحصات أخرى زيادة Carbohydrate
+
+102
+00:06:49,130 --> 00:06:52,690
+Fermentation Test احنا لما قلنا ان ال ABI على سبيل
+
+103
+00:06:52,690 --> 00:06:58,470
+المثال ال ABI test أكم واحد بيحتوي ايه؟ عشرين هدول
+
+104
+00:06:58,470 --> 00:07:02,630
+عشرين ال 20 wells صح؟ لأ لأ عشرين wells في عندي
+
+105
+00:07:02,630 --> 00:07:05,710
+كمان Oxidase بينضاف إلهم وممكن ناخد كمان معلومات
+
+106
+00:07:05,710 --> 00:07:10,450
+أخرى اللي هم ال N O3 ال N O3 ال N O2 و ال N يعني
+
+107
+00:07:10,450 --> 00:07:13,790
+تقريبا تلاتة و عشرين فحصليش احنا زودنا على
+
+108
+00:07:13,790 --> 00:07:18,170
+الفحوصات؟ عشان وانا قلتلكوا المعلومة the more test
+
+109
+00:07:18,170 --> 00:07:21,470
+you perform the more accurate is your diagnosis
+
+110
+00:07:21,470 --> 00:07:25,030
+مابنقدرش اننا نعتمد عليها صفة واحدة فقط في التمييز
+
+111
+00:07:25,030 --> 00:07:30,530
+لكن بناخد major test مثلا بنقول انه ال .. ال .. ال
+
+112
+00:07:30,530 --> 00:07:32,930
+eclipsilla و ال enterobacter ايش كان ال M في
+
+113
+00:07:32,930 --> 00:07:36,010
+اكتبعهم؟ negative negative positive positive كده
+
+114
+00:07:36,010 --> 00:07:39,130
+ميزناهم واحدة string test positive واحدة string
+
+115
+00:07:39,130 --> 00:07:42,700
+test negative على سبيل المثالواحدة capsulated
+
+116
+00:07:42,700 --> 00:07:46,220
+واحدة capsulated واحدة non capsulated واحدة motile
+
+117
+00:07:46,220 --> 00:07:51,340
+واحدة non motile يبقى لماذا لم اكتفي ب single test
+
+118
+00:07:51,340 --> 00:07:56,200
+ماكان ال motility بتكفي صح؟ ال motility بتكفي فضلا
+
+119
+00:07:56,200 --> 00:07:58,720
+ال motility ان ال eclipse اللي عيوني هي non motile
+
+120
+00:07:58,720 --> 00:08:01,340
+ولكن ال eclipse اللي aerogeneous هي motile لا لا
+
+121
+00:08:01,340 --> 00:08:03,360
+ال interior بقى اكتر مش عاسمة eclipse اللي
+
+122
+00:08:03,360 --> 00:08:07,280
+aerogeneousانت جيبت genus من واحد و species من
+
+123
+00:08:07,280 --> 00:08:11,160
+واحدة تانية اسمها Enterobacter Aerogenes و
+
+124
+00:08:11,160 --> 00:08:15,400
+Enterobacter Lycophagens و Enterobacter Sakazaki،
+
+125
+00:08:15,400 --> 00:08:18,640
+مظبوط؟ لكن مافيش Klebsiella Aerogenes، في
+
+126
+00:08:18,640 --> 00:08:21,240
+Klebsiella Pneumonia، في Klebsiella Oxytica، في
+
+127
+00:08:21,240 --> 00:08:25,180
+Klebsiella Ornithinolithicaفعن اي .. عن اي تقصد ال
+
+128
+00:08:25,180 --> 00:08:28,400
+genus كله non-motile، ال genus الإكليبسيدا non
+
+129
+00:08:28,400 --> 00:08:31,700
+-motile و ال genus ال انترو بكتر كله motile فهذا
+
+130
+00:08:31,700 --> 00:08:36,040
+الفحص لحاله كافي يميز genus عن genus لكن إذا أردت
+
+131
+00:08:36,040 --> 00:08:39,160
+تمييز ال species بدقة فعليك بإجراء ال carbohydrate
+
+132
+00:08:39,160 --> 00:08:42,080
+fermentation test اللي موجودة في مين؟ في ال ABI
+
+133
+00:08:42,080 --> 00:08:47,100
+testالاروينيا اللي هي الميكروب الأخير في السلسلة
+
+134
+00:08:47,100 --> 00:08:51,400
+اللي هي عبارة عن plant pathogen يعني الاعتقاد
+
+135
+00:08:51,400 --> 00:08:55,820
+السائد انه مالهاش اي medical importance لكن دراسات
+
+136
+00:08:55,820 --> 00:08:59,380
+حديثة يا شباب بتقول برضه انه they may cause برضه
+
+137
+00:08:59,380 --> 00:09:02,600
+infection في الإنسان ومنها wound infection ومنها
+
+138
+00:09:02,600 --> 00:09:06,880
+septicemia لكن السماء الغالبة علي انها plant
+
+139
+00:09:06,880 --> 00:09:12,790
+pathogen وبتحتوي على بكتينيز وcellulaseto enzymes
+
+140
+00:09:12,790 --> 00:09:17,790
+that qualify this organism to infect plant لأن
+
+141
+00:09:17,790 --> 00:09:22,150
+السيرلوز والبكتين هم موجودين في الأنصر النباتية
+
+142
+00:09:22,150 --> 00:09:25,930
+وبالتالي بتعملهم lyases بتأهلة تعمل invasion لهذه
+
+143
+00:09:25,930 --> 00:09:30,690
+الأنصر إذا الأروينيا بنعتبرها انها plant pathogen
+
+144
+00:09:30,690 --> 00:09:37,630
+نرجع ل ال protease و
+
+145
+00:09:37,630 --> 00:09:42,480
+ال diagnosis تبعهاالبروتياس جونه هي المجموعة الأهم
+
+146
+00:09:42,480 --> 00:09:45,640
+و هي الأشهر في المجموعة البروتياس ميرابيلس و
+
+147
+00:09:45,640 --> 00:09:49,960
+البروتياس بينري و البروتياس فولجاريس ال triple
+
+148
+00:09:49,960 --> 00:09:55,760
+sugar iron agar جمع كل الصفات K على A و G و Plus
+
+149
+00:09:55,760 --> 00:09:59,780
+يعني بتنتج جاز و بتنتج H2S بس إنه non-lactose
+
+150
+00:09:59,780 --> 00:10:02,580
+fermenter و non-sucrose fermenter كيف عرفنا انها
+
+151
+00:10:02,580 --> 00:10:07,080
+non-sucrose fermenter؟ اتطنكي عليه، مظبوط او لا؟ و
+
+152
+00:10:07,080 --> 00:10:09,020
+في نفس الوقت هي مشهورة انها non
+
+153
+00:10:11,900 --> 00:10:17,510
+الظاهرة الـ swarming و النموذجواللي بتأهل .. بتأهل
+
+154
+00:10:17,510 --> 00:10:20,910
+ال .. ال .. ال protease احنا قولنا إنه هي عبارة عن
+
+155
+00:10:20,910 --> 00:10:22,930
+ال gram negative بس ال like ال triple sugar iron
+
+156
+00:10:22,930 --> 00:10:27,970
+agar تبعها كان K على A G plus وأؤكد مرة أخرى على
+
+157
+00:10:27,970 --> 00:10:32,090
+أهمية ال H2S في التعرف على ال .. ال .. ال .. ال
+
+158
+00:10:32,090 --> 00:10:35,370
+protease وتمييزها عن ال Morganella وعن ال
+
+159
+00:10:35,370 --> 00:10:38,570
+providentia اللي بيتشابه معها في الصفات الأخرى
+
+160
+00:10:38,570 --> 00:10:42,410
+اللي قولنا عنها urease positive وactively motile
+
+161
+00:10:43,100 --> 00:10:46,960
+البكتيريا أيضا تمتلك ميزة مميزة عن باقي أنواع
+
+162
+00:10:46,960 --> 00:10:50,780
+البكتيريا اللي هو صفة الـ swarming اللي هي الحركة
+
+163
+00:10:50,780 --> 00:10:55,480
+على سطح الأجار وهذه الصفة لا نراها .. لا نراها في
+
+164
+00:10:55,480 --> 00:10:58,220
+الـ selective media لا نراها في الـ inhibitory
+
+165
+00:10:58,220 --> 00:11:00,940
+media نراها فقط في الـ .. بالظبط في الـ general
+
+166
+00:11:00,940 --> 00:11:03,800
+media زي الـ blood agar أو الـ nutrient agar أو
+
+167
+00:11:03,800 --> 00:11:07,660
+الـ miller-hinton أحد الميزات الأخرى اللي لازم
+
+168
+00:11:07,660 --> 00:11:13,840
+نتبعها أن لو البروتياسلوثت مستعمرة اخر نوع اخر من
+
+169
+00:11:13,840 --> 00:11:19,620
+البكتيريا يصعب فصل الاتنين عن بعض ليش؟
+
+170
+00:11:19,620 --> 00:11:25,060
+لأن البروتياس لا تستطيع تكون مستعمرات منفصلة فهتمد
+
+171
+00:11:25,060 --> 00:11:29,600
+على كل الطلاب فغالبا هلاجي مستعمرة البروتياس مغطية
+
+172
+00:11:29,600 --> 00:11:32,760
+على كل المستعمرات الأخرى فكيف بنفسر اتنين اتنين عن
+
+173
+00:11:32,760 --> 00:11:37,040
+بعض؟ بدنا نلجأ لتقنيات معقدة لقي طول حديث عنها
+
+174
+00:11:37,040 --> 00:11:43,280
+الان لكن إذا البروتياس لوثتculture يصعب التخلص
+
+175
+00:11:43,280 --> 00:11:47,120
+منها اتفاقنا انها strong urease positive,
+
+176
+00:11:47,520 --> 00:11:50,660
+phenylalanine deaminase positive, lysine
+
+177
+00:11:50,660 --> 00:11:54,220
+decarboxylase negative, hydrogen sulfide positive
+
+178
+00:11:54,220 --> 00:11:59,080
+وactively mortal gun
+
+179
+00:11:59,080 --> 00:12:03,980
+powder نعم راحة البارودفي اندي اللوحة هنا اللي
+
+180
+00:12:03,980 --> 00:12:08,340
+قدامكوا بدنا ننتبه إيها كويس و بدنا عشان نقعد نكتب
+
+181
+00:12:08,340 --> 00:12:14,620
+بدنا نركز في المفهوم عشان كتير من الطلبة آخر الفصل
+
+182
+00:12:14,620 --> 00:12:20,900
+بيخطؤوا في الليوزية هذه بسبب ال confusionبيركزوش
+
+183
+00:12:20,900 --> 00:12:24,000
+في المحاضرة وبالتالي بيسندهم confusion فاليوم ان
+
+184
+00:12:24,000 --> 00:12:26,260
+احنا بدنا ان شاء الله نركز مع بعض فيه بكتيريا
+
+185
+00:12:26,260 --> 00:12:30,280
+يشبهها باسم ريكيزيا الريكيزيا ليس لها علاقة من
+
+186
+00:12:30,280 --> 00:12:34,520
+قريب ولا من بعيد بالبروتياز الريكيزيا بتسبب مرض
+
+187
+00:12:34,520 --> 00:12:39,860
+اسمه typhus fever حمّة الـtyphus وحمّة الـtyphus
+
+188
+00:12:39,860 --> 00:12:42,260
+is different from typhoid fever اللي بتسببه
+
+189
+00:12:42,260 --> 00:12:45,580
+السلمونيلا يبقى الريكيزيا بتسبب typhus fever
+
+190
+00:12:45,580 --> 00:12:52,820
+والسلمونيلا typhoid feverنرجع للريكتسيا ماذا نعرف
+
+191
+00:12:52,820 --> 00:12:56,880
+عن الريكتسيا؟ انا بقولكوا معلومتين صغار الريكتسيا
+
+192
+00:12:56,880 --> 00:13:01,740
+والكلاميديا الصنفين الواحدين من البكتيريا في
+
+193
+00:13:01,740 --> 00:13:06,240
+العالم اللي يعتبروا obligate intracellular
+
+194
+00:13:06,240 --> 00:13:09,080
+parasites ايش يعني obligate intracellular
+
+195
+00:13:09,080 --> 00:13:13,940
+parasites؟ لا يستطيعوا ان يعيشوا معيشة حرة لازم
+
+196
+00:13:13,940 --> 00:13:18,040
+تطفو الإجباري على الخلايا زي مين؟ زي الفيروسات
+
+197
+00:13:18,930 --> 00:13:24,050
+فالريكيزيا بتسبب infection للإنسان ومن ضمن ال
+
+198
+00:13:24,050 --> 00:13:27,430
+infections هذي جُنّا الـtyphus fever حمّة
+
+199
+00:13:27,430 --> 00:13:33,230
+الـtyphus الآن حمّة الـtyphus زي أي ميكروب تاني في
+
+200
+00:13:33,230 --> 00:13:37,490
+الجسم إذا دخل الجسم من الجسم بيكوّله أجسام مضادة
+
+201
+00:13:37,490 --> 00:13:41,690
+كيف يمكن أن نكشف عن هذه الأجسام المضادة باستخدام
+
+202
+00:13:41,690 --> 00:13:45,790
+أنتجينات الانتجين المنطقي اللي بدي أستخدمه هو
+
+203
+00:13:45,790 --> 00:13:50,910
+الريكيزيا ال cells خلايا الريكيزياخلايا الريكيزيا
+
+204
+00:13:50,910 --> 00:13:54,650
+ما هي الانتيجين بنكشف فيها علمين عن الانتباد الان
+
+205
+00:13:54,650 --> 00:13:57,390
+الريكيزيا يا شباب obligate intracellular parasites
+
+206
+00:13:57,390 --> 00:14:00,670
+يعني تنميتها صعبة مابلياش نميها على المقمك اللي
+
+207
+00:14:00,670 --> 00:14:05,250
+بتأجره وعلى ال routine media وإذا نميناها تكلفتها
+
+208
+00:14:05,250 --> 00:14:11,650
+هتكون expensive صعبة ففي عندي مشكلة في عملية تشخيص
+
+209
+00:14:11,650 --> 00:14:14,130
+الريكيزيا نظرا اللي قلنا كمان مرة صعوبة تنمية
+
+210
+00:14:14,130 --> 00:14:20,800
+الريكيزيا وتكلفتها العالي في ظاهرةتم اكتشافها
+
+211
+00:14:20,800 --> 00:14:25,420
+مصادفة من قبل عالم او عالمين اسمهم ويل و فليكس
+
+212
+00:14:25,420 --> 00:14:30,860
+الظاهرة ده ايش بتقول الظاهرة بتقول انه بعض سلالات
+
+213
+00:14:30,860 --> 00:14:34,380
+من ال protease و ال cross-react ايش يعني cross
+
+214
+00:14:34,380 --> 00:14:39,160
+-react؟ تتفاعل مع انتجينات او انت .. عفوا انتجينات
+
+215
+00:14:39,160 --> 00:14:41,480
+ال protease تتفاعل مع ال anti-protease لبعد مين؟
+
+216
+00:14:41,480 --> 00:14:45,680
+تحت الركيزيا خدوا بالكم من النقطة هذهاحنا طول
+
+217
+00:14:45,680 --> 00:14:49,640
+عمرنا بيقولولنا ان ال antigen is specific
+
+218
+00:14:49,640 --> 00:14:53,860
+specificity مع ال antibody لكن بتكون تعرفوا اليوم
+
+219
+00:14:53,860 --> 00:14:57,920
+في ال microbiology ان هذا الكلام مش absolute مش
+
+220
+00:14:57,920 --> 00:15:03,240
+مطلق بمعنى في ظواهر سميناها كذا مرة cross reaction
+
+221
+00:15:03,240 --> 00:15:06,960
+ايش يعني cross reaction one antigen can react with
+
+222
+00:15:06,960 --> 00:15:12,230
+two or more different antibodiesفلمّا وجدت ال
+
+223
+00:15:12,230 --> 00:15:15,530
+Protease تتفاعل مع ال Antibodies تبعت ال
+
+224
+00:15:15,530 --> 00:15:18,750
+Rickettsia و ال Protease مافيش أسهل من تنميتها في
+
+225
+00:15:18,750 --> 00:15:25,050
+المختبرات و رخيصة تنمية سهلة ولا تكلف فاستخدمنا ال
+
+226
+00:15:25,050 --> 00:15:28,810
+Protease للكشف عن ال Antibodies تبعت من تحت ال
+
+227
+00:15:28,810 --> 00:15:36,340
+Rickettsia وصل الصورة؟بس carry agent بنستخدم ال
+
+228
+00:15:36,340 --> 00:15:40,860
+protease carry agent للكشف عن ال antibodies تبعت
+
+229
+00:15:40,860 --> 00:15:44,920
+ال Rickettsia يعني لو جينا فيهم الأيام و جونا ال
+
+230
+00:15:44,920 --> 00:15:47,460
+typhus fever ايش علاقته بال protease ماهوش علاقة
+
+231
+00:15:47,460 --> 00:15:53,800
+علاقته بمين لل typhus fever؟علاقته بمين؟ بريكتسيا
+
+232
+00:15:53,800 --> 00:15:59,480
+فقط لغير وإنما استخدمت لبروتياس ك reagent للكشف عن
+
+233
+00:15:59,480 --> 00:16:03,540
+ال antibodies تبعها بريكتسيا من ال antibodies أو
+
+234
+00:16:03,540 --> 00:16:08,540
+من السلالات المشهورة في لبروتياس والمستخدمة لازالت
+
+235
+00:16:08,540 --> 00:16:13,680
+لحد هذا الوقت اللي همProteas Ox-K و Proteas Ox-19
+
+236
+00:16:13,680 --> 00:16:17,800
+و Proteas Ox-2 واسأل في غزة في مختبراتنا العتيدة
+
+237
+00:16:17,800 --> 00:16:22,440
+اسألهم عن Ox-19 الكل بيعرف هذا الفحص لأن مرض
+
+238
+00:16:22,440 --> 00:16:27,820
+التايفوس موجود عندنا في فلسطينوينتشر في أواخر
+
+239
+00:16:27,820 --> 00:16:31,580
+الصيف على مدى شهرين او تلاتة بكثافة في قطاع غزة
+
+240
+00:16:31,580 --> 00:16:35,540
+وبالتالي المختبرات بتعرف هذا الفحص بشكل جيد ايش
+
+241
+00:16:35,540 --> 00:16:41,800
+اسم الفحص كده مرة Ox 19 وكلمة Ox هنا 19 او Ox K هي
+
+242
+00:16:41,800 --> 00:16:45,960
+numbers بنعطيها احنا للسلالات اللي بنعزلها او
+
+243
+00:16:45,960 --> 00:16:51,070
+بنتعرف عليهكمان مرة مين اللي اكتشف هذا ال .. ال ..
+
+244
+00:16:51,070 --> 00:16:55,210
+الخاصية wheel .. اكتشاف كان يسموه الفحص wheel and
+
+245
+00:16:55,210 --> 00:16:59,130
+Felix reaction wheel and Felix reaction لكن ال ..
+
+246
+00:16:59,130 --> 00:17:02,350
+الاسم الشائع اللي عندنا في قطاع غزهانة اللي هو Ox
+
+247
+00:17:02,350 --> 00:17:09,600
+90 هاي أول فحص تستخدموه للكشف عن feverأول فحص
+
+248
+00:17:09,600 --> 00:17:12,760
+بنستخدمه لكشف عن الفبر المحاضرة هات احنا هنتعرف
+
+249
+00:17:12,760 --> 00:17:16,760
+علي فحص تاني اسمه Vidal Test Vidal Test و ال Vidal
+
+250
+00:17:16,760 --> 00:17:20,680
+Test بنستخدمه لكشف عن ال Typhoid Fever في Typhus
+
+251
+00:17:20,680 --> 00:17:26,500
+OX 19 أو OX K أو OX 2 و ال Vidal Test بنستخدمه
+
+252
+00:17:26,500 --> 00:17:32,580
+لكشف عن مين؟ عن ال Typhoid Fever Typhoid
+
+253
+00:17:32,580 --> 00:17:33,660
+لأ سنونه لTyphie
+
+254
+00:17:37,340 --> 00:17:42,000
+نجي للميكروب المشهور جدا والإخوة اللي درسوا معانا
+
+255
+00:17:42,000 --> 00:17:44,500
+في ال food microbiology قولنا لهم جملة مشهورة
+
+256
+00:17:44,500 --> 00:17:49,480
+نكررها لكم the presence of any serotype in food of
+
+257
+00:17:49,480 --> 00:17:52,620
+salmonella render that food unfit for human
+
+258
+00:17:52,620 --> 00:17:58,220
+consumption وجود أي سلالة من السلمونيلا ألاحظوا
+
+259
+00:17:58,220 --> 00:18:01,580
+التعبير أي سلالة أي strain ممكن ليش أي species
+
+260
+00:18:01,580 --> 00:18:07,190
+يعني أي صنف أي نوعفي الغذاء يجعل هذا الغذاء غير
+
+261
+00:18:07,190 --> 00:18:10,830
+صالح للاستهلاك القادم مؤشر على إيش؟ على إن كل ال
+
+262
+00:18:10,830 --> 00:18:15,790
+salmonella تعتبر pathogenic والسلمونيلا أحد
+
+263
+00:18:15,790 --> 00:18:21,190
+مزاياها يا شباب أحد مزاياها ال host range ايش يعني
+
+264
+00:18:21,190 --> 00:18:26,510
+host range؟ يعني الطيف الواسع للعوائل اللي ممكن
+
+265
+00:18:26,510 --> 00:18:31,170
+تصيبها سواء تصيبها بمرض أو تصيبها كمخزن ك career
+
+266
+00:18:32,520 --> 00:18:41,340
+بتعرفوا السحالي حاردون وامبريس وخلافه وبتعرفوا
+
+267
+00:18:41,340 --> 00:18:45,020
+الدواجن بكل أنواع البط و الدجاج وبتعرفوا حتى
+
+268
+00:18:45,020 --> 00:18:51,140
+التمسيح حتى السلاحف وردوا ان فيها سالمونيلا بصورة
+
+269
+00:18:51,480 --> 00:18:56,480
+طبيعية بصورة طبيعية بمعنى انه نوع من التحالف ..
+
+270
+00:18:56,480 --> 00:19:01,020
+نوع من التحالف طبعا فرصة ميكروب زي السلمونيلا انه
+
+271
+00:19:01,020 --> 00:19:04,640
+يخرج من host ويلاجه host تاني عالية جدا لما يكون
+
+272
+00:19:04,640 --> 00:19:07,900
+on the wide range of host لكن لما يكون host واحد
+
+273
+00:19:07,900 --> 00:19:12,460
+اذا مالاجهاش ال host تبعه مش هي .. مش هيتكاتر ولا
+
+274
+00:19:12,460 --> 00:19:17,500
+حيت .. وبالتالي من السهل القضاء عليهإذا أعطيكم
+
+275
+00:19:17,500 --> 00:19:21,360
+مثال برضه عشان نوصل الصورة أو نقرب الصورة بتعرف
+
+276
+00:19:21,360 --> 00:19:28,080
+الدواجن مصدر غذاء عالمي لكل البشر سواء كان الدجاج
+
+277
+00:19:28,080 --> 00:19:33,860
+اللحم أو البيض تبع الدواجن نتخيل إن الدجاج صار فيه
+
+278
+00:19:33,860 --> 00:19:39,580
+سلمونيلا والبيض اللي بناخده من الدواجن في بعض
+
+279
+00:19:39,580 --> 00:19:44,220
+المناطقصار يصلوا سالمونيلا لمعنى انه الدجاج اللي
+
+280
+00:19:44,220 --> 00:19:47,340
+هو يبتصنع البيض بتعبي معاه واحدة ولا تنتين
+
+281
+00:19:47,340 --> 00:19:50,620
+سالمونيلا عشان يقول اتفضل بالهنو الشفا انت تأكل
+
+282
+00:19:50,620 --> 00:19:54,820
+بيضا بالسالمونيلا الان
+
+283
+00:19:54,820 --> 00:20:02,960
+هذا هذا تخيلوا البيض ومشتقاته وين بتدخل الدواجن
+
+284
+00:20:02,960 --> 00:20:09,350
+ومشتقاتها وين بتدخل في صناعاتالدواجن غالبا في
+
+285
+00:20:09,350 --> 00:20:15,530
+الآخر كلحم نطبخها فالسلمون اللي بتموت صح؟ المشكلة
+
+286
+00:20:15,530 --> 00:20:17,210
+اللي وانا عندي أنا .. المشكلة اللي وانا يا شباب
+
+287
+00:20:17,210 --> 00:20:20,310
+احنا كنا جابا شوية cross reaction في كلمة مصطلح
+
+288
+00:20:20,310 --> 00:20:24,210
+تاني اسمه cross contamination هاي الدواجن حاطناها
+
+289
+00:20:24,210 --> 00:20:27,950
+على خشب التقطيع واستخدنا سمكة .. سمكة سكينة
+
+290
+00:20:27,950 --> 00:20:34,700
+للتقطيع تمام؟الان السكين والخشبة التقطية أصبح
+
+291
+00:20:34,700 --> 00:20:38,080
+عليهم سالمونيلا الدجاج خلصنا منه طهناه مات
+
+292
+00:20:38,080 --> 00:20:43,420
+السالمونيلا لكن ما تبقى على الخشبة وعلى السكين إذا
+
+293
+00:20:43,420 --> 00:20:47,460
+لم يغسل جيدا يمكن استخدام السكين لتقطية خضروات
+
+294
+00:20:47,460 --> 00:20:52,410
+مثلا للسلطة السلطة لا تطهىوبالتالي احنا بناخد
+
+295
+00:20:52,410 --> 00:20:56,710
+سالمونيلا fresh مش من الدجاج مباشرة انها من ال
+
+296
+00:20:56,710 --> 00:21:01,330
+cross contamination وبالتالي هذه الخشية موجودة في
+
+297
+00:21:01,330 --> 00:21:05,950
+كل العالم السالمونيلا سبب رئيسي يا شباب لسحب كثير
+
+298
+00:21:05,950 --> 00:21:10,450
+من المنتجات اخرها كان في منتج ل catbury شوكولاتة
+
+299
+00:21:10,450 --> 00:21:15,590
+بريطانية مشهورة catbury صحبت من الأسواق لإن الحليب
+
+300
+00:21:15,590 --> 00:21:19,070
+المستخدم في الشوكولاتة كان محتوى عالمين على
+
+301
+00:21:19,070 --> 00:21:25,860
+السالمونيلاتخيلوا في العالم الغربي لو مصنع تم
+
+302
+00:21:25,860 --> 00:21:30,180
+اكتشاف في salmonella في منتجه .. من منتجاته مشكلته
+
+303
+00:21:30,180 --> 00:21:34,980
+مش انه بس انه رجع الإبضاعة السمعة تبعته بتسقط لأن
+
+304
+00:21:34,980 --> 00:21:39,440
+المجتمعات الغربية selective في اختيار الأخذية بشكل
+
+305
+00:21:39,440 --> 00:21:43,740
+مجموعات ضاغطة على كل مصنعي الأخذية وعلى كل مصنعي
+
+306
+00:21:43,740 --> 00:21:48,080
+المنتجات لأنهم selective كيف يعني selective؟يعني
+
+307
+00:21:48,080 --> 00:21:52,000
+انا باشتريش اي منتج اذا شعرت ان المنتج هذا فيه منه
+
+308
+00:21:52,000 --> 00:21:55,680
+ضرر الكل بيقطعه بكل سهولة بيقطعه وفيش واحد بفتح
+
+309
+00:21:55,680 --> 00:22:00,860
+مصنع او مؤسسة تجارية ويخسر فبدي ارض مين الزبائن
+
+310
+00:22:00,860 --> 00:22:04,900
+ارضاه للزبائن او في محاولة ارضاه للزبائن بيصل
+
+311
+00:22:04,900 --> 00:22:09,460
+لأفضل مراحل التصنيع وأنظف مراحل التصنيع وبالتالي
+
+312
+00:22:09,460 --> 00:22:14,240
+هناك رقابة داخلية قبل ان تكون هناك رقابة خارجية في
+
+313
+00:22:14,240 --> 00:22:17,530
+المصانع وبالتاليقلة من المنتجات اللي ممكن يحصل
+
+314
+00:22:17,530 --> 00:22:24,210
+فيها هذا الكلام ناخد تذكيرا بس بال .. احنا وين في
+
+315
+00:22:24,210 --> 00:22:29,070
+ال .. ال enterobacteriasi قبل بنتكلم عن ان انا
+
+316
+00:22:29,070 --> 00:22:32,430
+عندي oxidase test negative عندش glucose
+
+317
+00:22:32,430 --> 00:22:35,370
+fermentation positive فانا وصلت لمرحلة من ال
+
+318
+00:22:35,370 --> 00:22:38,200
+enterobacteriasiلما وصلت لواحدة الـ
+
+319
+00:22:38,200 --> 00:22:41,020
+Enterobacteriasi قسمت البكتيريا إلى مجموعتين
+
+320
+00:22:41,020 --> 00:22:44,220
+lactose fermenter و non lactose fermenter أنا خلصت
+
+321
+00:22:44,220 --> 00:22:47,120
+ال lactose fermenter الاشريشيا و ما تقوليش coli
+
+322
+00:22:47,120 --> 00:22:50,240
+بنتكلم عن جينس اشريشيا و Enterobacter و
+
+323
+00:22:50,240 --> 00:22:54,120
+Citrobacter و Klebsiella بعدين بدأت بالحديث عن مين
+
+324
+00:22:54,120 --> 00:22:57,940
+عن ال non lactose fermenter و بدأت بالحديث أول
+
+325
+00:22:57,940 --> 00:23:00,660
+مجموعة عن ال non lactose fermenter في السيراتيه هل
+
+326
+00:23:00,660 --> 00:23:05,470
+تتذكروا؟وبعدين دخلنا في ال protest group، لاحظوا
+
+327
+00:23:05,470 --> 00:23:08,210
+في اللوحة اللي قدامي أنا حاط ال protest مش حاطة
+
+328
+00:23:08,210 --> 00:23:13,090
+مين السيراتيا ولا حاط الأشياء الأخرى لأنه أقرب
+
+329
+00:23:13,090 --> 00:23:16,970
+حاجة في الشبه لل ceremony اللي ممكن يكون مين ال
+
+330
+00:23:16,970 --> 00:23:19,910
+protest، إيش وجه الشبه بينهم؟ التنتين مطايل
+
+331
+00:23:19,910 --> 00:23:27,500
+والتنتين they produce، لأ مش الرئيسH2S و أحد
+
+332
+00:23:27,500 --> 00:23:30,280
+الصفات اللى بنكشف فيها على ال salmonella على
+
+333
+00:23:30,280 --> 00:23:34,340
+الأطباق يا شباب قدرتها على إنتاج اللى هو ال H2S
+
+334
+00:23:34,340 --> 00:23:39,320
+فسمع و مميزة فضل يا عزيزي سؤال فانا براح أحس في
+
+335
+00:23:39,320 --> 00:23:43,080
+كثير من حالات الدجاج ما يبقى في سوق البيت يكون حتى
+
+336
+00:23:43,080 --> 00:23:48,620
+لما يتبادل الفلوس بعد ما دبح الدجاج و سلخة و كل
+
+337
+00:23:48,620 --> 00:23:52,600
+شيء فبدي أسأل يعني هذا السبب اللى انت شارس
+
+338
+00:23:52,600 --> 00:23:56,160
+salmonellaهو عشان انا اكون دقيق معاك و بنال على
+
+339
+00:23:56,160 --> 00:23:59,480
+معلومات حقيقية و دراسات و ليست يعني توقعات او
+
+340
+00:23:59,480 --> 00:24:03,000
+تخمينات قطاع غزة في السلمونيا موجودة في قطاع غزة
+
+341
+00:24:03,000 --> 00:24:07,560
+لكن نسبت وجودها حقيقة مش عالي يعني ربما يكون افضل
+
+342
+00:24:07,560 --> 00:24:12,320
+من بلدان متطورة في هذا المجال احد الدراسات اللي
+
+343
+00:24:12,320 --> 00:24:15,440
+اجريناها لطالب مال استهير على البيض في قطاع غزة
+
+344
+00:24:15,440 --> 00:24:20,200
+اخد من كل مزارع البيض في قطاع غزة بقول قطاع غزة
+
+345
+00:24:20,200 --> 00:24:25,590
+يعني من رفح الى بيت حنونولم يعزل اي سالمونيلا من
+
+346
+00:24:25,590 --> 00:24:30,590
+البيض عزلها من مزرعة واحدة من مخلفات الدواجة وليس
+
+347
+00:24:30,590 --> 00:24:34,370
+من البيض لكن نسبة السالمونيلا بشكل عام هي قليلة
+
+348
+00:24:34,370 --> 00:24:38,930
+اما الممارسات اللي اتفضلت فيها حضرتك هي ممارسات
+
+349
+00:24:38,930 --> 00:24:44,210
+تساعد بالتأكيد على نقل السالمونيلا من الى من بشر
+
+350
+00:24:44,210 --> 00:24:48,410
+الى بشر من بشر الى حيوان ومن حيوان الى البشر فده
+
+351
+00:24:48,410 --> 00:24:54,380
+بالتأكيد يعني موجودأسماء سهلة مش كتير معقدة اليوم
+
+352
+00:24:54,380 --> 00:24:59,420
+سلمونيلا تايفي سلمونيلا بارا تايفي A بارا تايفي B
+
+353
+00:24:59,420 --> 00:25:04,700
+بارا تايفي C لحد الآن الأمور سهل كمان تايفي و بارا
+
+354
+00:25:04,700 --> 00:25:11,030
+تايفي A و B و C أعتقد أنهم كلهم سهلينالرقم خمسة
+
+355
+00:25:11,030 --> 00:25:16,650
+تفيموريوم ستة انترادايدس و لاحظوا فيها حرف دي خفيف
+
+356
+00:25:16,650 --> 00:25:22,430
+انترادايدس لأن المرض انترايدس gastroenteritis ففيش
+
+357
+00:25:22,430 --> 00:25:26,410
+فيها دي المرض فيش فيه دي بينما البكتيريا فيه دي
+
+358
+00:25:26,410 --> 00:25:30,810
+وفي شبيه بهذا الكلام نيسيريا مينيجاايدس برضه فيها
+
+359
+00:25:30,810 --> 00:25:34,830
+حرف دي و المرض مينيجاايدس مافيش حرف اللي هو الدي
+
+360
+00:25:34,830 --> 00:25:40,210
+طيبسلمونيلا كلها سويس و سلمونيلا بولروم حلو هذا
+
+361
+00:25:40,210 --> 00:25:44,830
+الاسم بولروم و جاليناروم انا الأوانى يا شباب
+
+362
+00:25:44,830 --> 00:25:47,810
+بنقولكوا ان السنة الماضية في المعمل كانوا يضحكوا
+
+363
+00:25:47,810 --> 00:25:52,490
+عليكوا و يقولكوا ان السلمونيلا كلها موطعين اليوم
+
+364
+00:25:52,490 --> 00:25:56,030
+بنقولكوا انتوا كبرتوا و لازم تعرفوا الحقيقة المرة
+
+365
+00:25:56,030 --> 00:26:00,250
+ان مش كل السلمونيلا موطعين سلمونيلا بولروم و
+
+366
+00:26:00,250 --> 00:26:05,690
+سلمونيلا جاليناروم are none موطعينهذا بيأكد
+
+367
+00:26:05,690 --> 00:26:09,090
+الحقيقة اللي حاولنا نغرسها في أدمغاتكم مبكرا هذا
+
+368
+00:26:09,090 --> 00:26:13,630
+الفصل ان لا يوجد absolute .. بصت ب absolute
+
+369
+00:26:13,630 --> 00:26:19,990
+negative في موضوع ال .. ال .. ال charactersThey
+
+370
+00:26:19,990 --> 00:26:22,770
+are gram-negative bacilli، أكتر من ذلك لا بدّي
+
+371
+00:26:22,770 --> 00:26:25,670
+وصف، لا بدّي short ولا long، بدّي فقط gram
+
+372
+00:26:25,670 --> 00:26:29,250
+-negative bacilli، كلهم motile with peritriches
+
+373
+00:26:29,250 --> 00:26:33,270
+فجلة معدك ونا، bolerum and galinarum، they are non
+
+374
+00:26:33,270 --> 00:26:35,530
+-encapsulated يعني ما ليهم مش capsule with some
+
+375
+00:26:35,530 --> 00:26:39,620
+exception طبعا، و they are gram-negativeالـ
+
+376
+00:26:39,620 --> 00:26:42,020
+Habitat Wind Transmission، مكان معيشة السلمونيلا،
+
+377
+00:26:42,020 --> 00:26:44,960
+احنا عملنا تقديم كويس الصحيح للموضوع هذا، فمش
+
+378
+00:26:44,960 --> 00:26:48,220
+هيقول علينا صعب، السلمونيلا الطائفي والبارا طائفي
+
+379
+00:26:48,220 --> 00:26:51,590
+افصلوهم عن باقي السلمونيلافصلهم عن باقي الـ
+
+380
+00:26:51,590 --> 00:26:54,750
+Salmonella هدولة التنتين اللي هم الطايفي والبارا
+
+381
+00:26:54,750 --> 00:27:00,270
+طايفي the only host غالبا is man اللي هو الإنسان
+
+382
+00:27:00,270 --> 00:27:04,770
+the only host is man طايفي والبارا طايفي بينما ال
+
+383
+00:27:04,770 --> 00:27:09,430
+other Salmonella قلنالكوا في wide range of host زي
+
+384
+00:27:09,430 --> 00:27:13,090
+ال reptiles الزواحف حتى ال cows ال goats ال sheeps
+
+385
+00:27:13,090 --> 00:27:16,590
+الاخرين كل هذه ال reservoir لل Salmonella
+
+386
+00:27:19,280 --> 00:27:22,540
+طريقة ال transmission غالبا فيكال oral
+
+387
+00:27:22,540 --> 00:27:28,200
+transmission ايش يعني فيكال oral transmission؟ من
+
+388
+00:27:28,200 --> 00:27:32,420
+ال faces للفم للأسف يعني هذا التعبير الدقيق انه من
+
+389
+00:27:32,420 --> 00:27:36,160
+البرازي للفم وكيف يتم ذلك احنا قلنالكم من برضه
+
+390
+00:27:36,160 --> 00:27:40,540
+بداية الفصل ان اكبر ملوث لمياه الشرب في العالم هو
+
+391
+00:27:40,540 --> 00:27:43,380
+المياه العادمة اللي هي المياه الأسنة اللي هي ال
+
+392
+00:27:43,380 --> 00:27:48,480
+waste water اللي من ضمنها المخلفات الأدمينفعندما
+
+393
+00:27:48,480 --> 00:27:51,920
+يكون في المجتمع مجموعة من الناس اما career او
+
+394
+00:27:51,920 --> 00:27:59,360
+مصابينوبيضخه في المجاري في شبكة المجاري والمجاري
+
+395
+00:27:59,360 --> 00:28:04,240
+لا تعالج للأسف ومن ثم تلوث مياه الشرب او حتى مياه
+
+396
+00:28:04,240 --> 00:28:08,880
+الاستجمام ومياه الاستجمام يعني ال recreational
+
+397
+00:28:08,880 --> 00:28:12,000
+water ممكن تكون fresh water مياه عذبة زي براك
+
+398
+00:28:12,000 --> 00:28:15,700
+السباحة واعتقد ان احنا في قطاع غزة الان ننعم بيه
+
+399
+00:28:15,700 --> 00:28:22,220
+يعني منتجات كثيرة بتقدم هذه الخدمةو ال sea water
+
+400
+00:28:22,220 --> 00:28:26,900
+ال sea water كمان برضه احنا بنكب مجارينا و بنلحقه
+
+401
+00:28:26,900 --> 00:28:30,740
+في الصيف اخسار انا بروح نسبح شوية فيه و انا
+
+402
+00:28:30,740 --> 00:28:33,580
+قولتلكم ان الدراسات اللي أجريناها على ال sea water
+
+403
+00:28:33,580 --> 00:28:38,600
+في قطاع غزة أثبتت نسب تلوث عالية جدا في كثير من
+
+404
+00:28:38,600 --> 00:28:42,640
+المناطق يعني شاطئ مدينة غزة على سبيل المثال من أول
+
+405
+00:28:42,640 --> 00:28:48,080
+لآخره تقريبا غير صالح للسبح او للستجمامكمدينة غزة
+
+406
+00:28:48,080 --> 00:28:51,280
+تمام؟ في بعض المناطق في الشمال وبعض المناطق في
+
+407
+00:28:51,280 --> 00:28:56,340
+الوسط والجنوب يعني نوعا ما مقبولة فالقصد من الكلام
+
+408
+00:28:56,340 --> 00:29:03,280
+ان ال sea water pollution is high in Gaza Strip
+
+409
+00:29:03,280 --> 00:29:08,900
+نظرا لإن اللي يضخ فيه مجاري إما معالجة جزئيا أو
+
+410
+00:29:08,900 --> 00:29:12,280
+غير معالجة البتة يعني مافيش فيها أي نوع من اللي هو
+
+411
+00:29:12,280 --> 00:29:18,730
+المعالجةلكن في النهاية ال transmission عبر ال
+
+412
+00:29:18,730 --> 00:29:23,650
+ingestion ال ingestion يعني تناول مياه او غذاء
+
+413
+00:29:23,650 --> 00:29:29,890
+ملوث بال سالمونيل هذه الصور اللي قدامنا بتورينا
+
+414
+00:29:29,890 --> 00:29:34,590
+يعني بعض مصادر ال .. ال .. ال ..How to contact or
+
+415
+00:29:34,590 --> 00:29:37,410
+contract in infection عندنا contact with animals,
+
+416
+00:29:37,770 --> 00:29:40,830
+eating contaminated food أو حتى contact with
+
+417
+00:29:40,830 --> 00:29:45,470
+patients يعني تتواصل مع مرضى مصابين بالبكتيريا
+
+418
+00:29:47,960 --> 00:29:51,500
+نستطيع أن .. أن .. نصنف .. أن نصنف الأمراض اللي
+
+419
+00:29:51,500 --> 00:29:54,240
+بتسميها السلمونية بشكل عام إلى three categories
+
+420
+00:29:54,240 --> 00:29:59,240
+صنف الأول septicemia صنف التاني gastroenteritis
+
+421
+00:29:59,240 --> 00:30:03,540
+الصنف التالت حاجة بنسميها enteric fever الحمّة
+
+422
+00:30:03,540 --> 00:30:07,140
+المعاوية ويمكن أكتر حاجة بنركز عليها في محاضرتنا
+
+423
+00:30:07,140 --> 00:30:10,040
+اليوم اللي هي ال enteric fever و ال enteric fever
+
+424
+00:30:10,040 --> 00:30:16,610
+إما typhoid أو paratyphoidأعتقد من المسمى تايفويد
+
+425
+00:30:16,610 --> 00:30:19,870
+وبارا تايفويد البارا يعني شبيه اللي بالتايفويد
+
+426
+00:30:19,870 --> 00:30:23,190
+يعني اتنين فيه نوع من الاتشابه بينهم والصحيح
+
+427
+00:30:23,190 --> 00:30:28,250
+اتشابه بيصل إلى حد ال cycle يعني ان كيف بتتم عملية
+
+428
+00:30:28,250 --> 00:30:32,050
+ال infection من أساسه فانا هركز كمان مرة على مين
+
+429
+00:30:32,050 --> 00:30:33,590
+على الentric في برسلا
+
+430
+00:30:37,150 --> 00:30:43,130
+اللي أمامنا شكل بيقولنا ان الانتري من وين جاي من
+
+431
+00:30:43,130 --> 00:30:46,590
+ال skin ولا من ال oral cavity من ال oral cavity
+
+432
+00:30:46,590 --> 00:30:50,050
+ingestion الآن الميكروب بيروح على ال intestine
+
+433
+00:30:50,050 --> 00:30:56,490
+طبعا بيدخل للمعدة اخدوا بالكم السلمونيلا مش highly
+
+434
+00:30:56,490 --> 00:31:00,550
+resistant لل acid مش highly resistant يعني رزق
+
+435
+00:31:00,550 --> 00:31:04,530
+كبير منها بيموت في وين؟ في ال acid لكن لو كانت
+
+436
+00:31:04,530 --> 00:31:10,920
+المعدة مليئةمليئة .. مليئة بإيش؟ بالأكل أو بالسائل
+
+437
+00:31:10,920 --> 00:31:15,580
+تمام هذا بيعمل dilution لل stomach acid فبالتالي
+
+438
+00:31:15,580 --> 00:31:21,480
+ممكن يهرب البعض إلى ال intestine وصلت البكتيريا لل
+
+439
+00:31:21,480 --> 00:31:25,100
+intestine بتقول ايه الشهر رائحة الكريهة اللي
+
+440
+00:31:25,100 --> 00:31:29,020
+موجودة جوا انا مكاني مش هنا انا لازم اروح على
+
+441
+00:31:29,020 --> 00:31:32,180
+المكان المخصص ليه؟ اين المكان المخصص لها؟ بتروح
+
+442
+00:31:32,180 --> 00:31:36,340
+الدمفجزء منها بيعمل penetration للـ intestinal
+
+443
+00:31:36,340 --> 00:31:40,680
+wall يبقى invasive بدل ان invasive invasive بتعمل
+
+444
+00:31:40,680 --> 00:31:44,720
+penetration لل intestinal wall طب ع مين بيجابلها؟
+
+445
+00:31:44,720 --> 00:31:48,540
+بيجابلها ال lymph nodes ال lymph nodes ممنوع أي
+
+446
+00:31:48,540 --> 00:31:52,300
+ميكروب يدخل إلى الدم checkpoints منها مش هنجونا
+
+447
+00:31:52,300 --> 00:31:56,380
+نقاط تفتيشلكن السلمونيلا يا شباب عندها المقدرة ..
+
+448
+00:31:56,380 --> 00:32:01,380
+عندها المقدرة على الـ intracellular existence ايش
+
+449
+00:32:01,380 --> 00:32:04,680
+يعني intracellular existence؟ يعني موجودة في ال
+
+450
+00:32:04,680 --> 00:32:07,860
+macro phage او ال phagocyte and can multiply
+
+451
+00:32:07,860 --> 00:32:11,780
+inside the macro phage يعني ال macro phage بطلت
+
+452
+00:32:11,780 --> 00:32:15,480
+قادرة عليه انها تقتل السلمونيلا بل السلمونيلا
+
+453
+00:32:15,480 --> 00:32:19,260
+قادرة على قتل ال macro phage بعد ما تتكاثر جواها
+
+454
+00:32:22,020 --> 00:32:25,180
+existence بس مش obligate مش زي اللي قلناها لهم
+
+455
+00:32:25,180 --> 00:32:30,120
+بتتميز بين بكتيريا تستطيع تعيش معيشة حرة و
+
+456
+00:32:30,120 --> 00:32:33,740
+intracellular و بين obligate intracellular هذه
+
+457
+00:32:33,740 --> 00:32:36,180
+بنسميها facultative intracellular وهذه بنسميها
+
+458
+00:32:36,180 --> 00:32:41,160
+obligate intracellular نمشي مع بعض كمان بس خلنا
+
+459
+00:32:41,160 --> 00:32:45,610
+نكمل القصة بعدين إذا كان في مجال الأسئلةاشتغلوا
+
+460
+00:32:45,610 --> 00:32:48,390
+انها penetration ال intestinal wall وبعدين وصول لل
+
+461
+00:32:48,390 --> 00:32:53,530
+lymph node من ال lymph node بتروح على الدم في الدم
+
+462
+00:32:53,530 --> 00:32:58,490
+شباب البكتيريا بفعل ضخ الدم من القلب بدخها الى
+
+463
+00:32:58,490 --> 00:33:03,050
+باقي الجسم هناك اماكن بتفضلها ال salmonella زي ال
+
+464
+00:33:03,050 --> 00:33:06,050
+reticulum endothelial system ال reticulum
+
+465
+00:33:06,050 --> 00:33:09,850
+endothelial system يعني ال .. ال spleen ال liver
+
+466
+00:33:09,850 --> 00:33:14,160
+ال bone marrow تمام؟طب هذا ايش ميزاته الـ
+
+467
+00:33:14,160 --> 00:33:16,600
+reticulum endothelial system؟ ميزاته انه مليان
+
+468
+00:33:16,600 --> 00:33:21,380
+ماكروفاج دلالة ان السلمونيلا بتدور على ال organs
+
+469
+00:33:21,380 --> 00:33:29,700
+اللي فيها ماكروفاج عشان هي تتكاثر داخلها الآن خلال
+
+470
+00:33:29,700 --> 00:33:36,320
+عملية تكاثر الجسم بيتعرف ال immune system بتعرف
+
+471
+00:33:36,320 --> 00:33:40,170
+على البكتيرا و بيكون لها أجسام مضادةالاجسام
+
+472
+00:33:40,170 --> 00:33:45,030
+المضادة وظيفتها انها تكافح السلمونيلا فجزء من
+
+473
+00:33:45,030 --> 00:33:48,690
+السلمونيلا بيموت في الدم بيختفي تلقائي بدون أي
+
+474
+00:33:48,690 --> 00:33:54,570
+علاج بسبب مين؟ بسبب ظهور ال antibodies تذكروا هي
+
+475
+00:33:54,570 --> 00:33:57,850
+من وان دخلت؟ من ال intestine فجزء منها ضايل في ال
+
+476
+00:33:57,850 --> 00:34:00,830
+intestine خدوا بالكم مش كلها بتضحيش بنفسها كلها
+
+477
+00:34:00,830 --> 00:34:05,330
+جزء منها ضايل في ال intestine وجزء منها انتقل للدم
+
+478
+00:34:06,090 --> 00:34:11,010
+القصة اللي بنحكيها هذه لإنها مهمة جدا جدا في توقيت
+
+479
+00:34:11,010 --> 00:34:15,930
+أخذ العينات و نوع العينات اللي بناخدها عشان نعمل
+
+480
+00:34:15,930 --> 00:34:18,210
+diagnosis لـtyphoid-7
+
+481
+00:34:22,410 --> 00:34:26,290
+اختفت من الدم؟ هل اختفت من الانتستين؟ للأسف ال
+
+482
+00:34:26,290 --> 00:34:30,170
+antibodies مش فعالة في الانتستين زي ما فعالة في
+
+483
+00:34:30,170 --> 00:34:33,670
+الدم والانسجار، اتفقنا؟ وبالتالي البكتيريا حتى
+
+484
+00:34:33,670 --> 00:34:36,510
+اللي هو اللي موجودة في ال intestinal، ال tract
+
+485
+00:34:36,510 --> 00:34:42,730
+خلصنا الجثة يبقى ال execution لل salmonella بتم
+
+486
+00:34:42,730 --> 00:34:46,350
+عبر مين؟ عبر ال stool لنمور ده في ال intestinal،
+
+487
+00:34:46,350 --> 00:34:51,170
+ال tract متفقين لحد الآن الكلام اللي على اللوحة
+
+488
+00:34:51,170 --> 00:34:57,460
+هذاتقريبا هو اللي انا شرحته جاب لحظات على الشكل ان
+
+489
+00:34:57,460 --> 00:35:01,740
+البكتيرا تدخل عبر الفكهة ال oral تصل ال intestine
+
+490
+00:35:01,740 --> 00:35:04,740
+ال intestinal wall ال penetration لل lymph node
+
+491
+00:35:04,740 --> 00:35:08,900
+للدم circulation في different systems في بعض
+
+492
+00:35:08,900 --> 00:35:13,920
+الحالات السلمونية بتستقر في مكان غريب نوعا ما اللي
+
+493
+00:35:13,920 --> 00:35:19,490
+هو ال goalوالناس ال carriers غالبا البكتيريا
+
+494
+00:35:19,490 --> 00:35:24,270
+بتستقر في جوال بلدر، لحظة جوال بلدر إيش فيها؟ فيها
+
+495
+00:35:24,270 --> 00:35:28,790
+bile salts وال bile salts شباب معروف عنها إنها
+
+496
+00:35:28,790 --> 00:35:33,410
+inhibitory للبكتيريا، لكن كون السلمونيلا قادر على
+
+497
+00:35:33,410 --> 00:35:37,160
+المعيشة في الجوال بلدر، ماذا يعني ذلك؟إنها
+
+498
+00:35:37,160 --> 00:35:42,640
+resistant للبيل سولت أحد المعلومات اللي استغلناها
+
+499
+00:35:42,640 --> 00:35:47,000
+في عملية عزل ال salmonella selectively لإن احنا
+
+500
+00:35:47,000 --> 00:35:49,440
+حطينا في الأوساط الزراعية تبعتها high
+
+501
+00:35:49,440 --> 00:35:52,760
+concentration of bile salt منعنا ال gram positive
+
+502
+00:35:52,760 --> 00:35:57,060
+بكتيريا ومنعنا كتير من ال gram negative بكتيريا
+
+503
+00:35:57,060 --> 00:36:00,240
+فبظلمين أنها ال salmonella طبعا مش absolutely برضه
+
+504
+00:36:00,240 --> 00:36:04,560
+selective لكن على الأقل بيعطينا فرصة أفضل في عملية
+
+505
+00:36:04,560 --> 00:36:05,740
+اللي هو العزل
+
+506
+00:36:10,270 --> 00:36:15,190
+من ال serious complications اللي ممكن تنتج من ال
+
+507
+00:36:15,190 --> 00:36:17,890
+typhoid fever او ال paratyphoid fever هو مقدرة
+
+508
+00:36:17,890 --> 00:36:21,030
+البكتيريا انها تتكاثر في ال organs تعمل abscess في
+
+509
+00:36:21,030 --> 00:36:25,690
+ال organs في ال spleen و elsewhere طبعا البكتيريا
+
+510
+00:36:25,690 --> 00:36:30,260
+في الدمبكتيريا فى الدم وهى gram negative لو مات
+
+511
+00:36:30,260 --> 00:36:33,740
+البكتيريا فى الدم ايه شعر انها اندوكسين برضه حاسس
+
+512
+00:36:33,740 --> 00:36:37,960
+انها shock او اعراض مش ضابط اعراض shock وبالتالي
+
+513
+00:36:37,960 --> 00:36:46,740
+ممكن الحالة تتطور ويصاب المريض ب organ failures او
+
+514
+00:36:46,740 --> 00:36:50,800
+circulatory collapse ويموت المريض لذلك ال typhoid
+
+515
+00:36:50,800 --> 00:36:54,160
+و الparatyphoid fever يعتبروا من الأمراض الخطيرة
+
+516
+00:36:54,640 --> 00:37:01,420
+جدا و اللى كانت تعتبر مشاكل من المشاكل المستعصية
+
+517
+00:37:01,420 --> 00:37:06,620
+على معظم سكان عالم الثالث الان طبعا المشكلة قلت
+
+518
+00:37:06,620 --> 00:37:11,980
+لكن لما نتكلم عن اى ميكروب فى الدنيا بينتقل فكل
+
+519
+00:37:11,980 --> 00:37:18,220
+oral بتتذكروا انه احنا احنا we are protected من
+
+520
+00:37:18,220 --> 00:37:22,580
+this bacteria اذا عندنا system كويس اذا عندنا نظام
+
+521
+00:37:23,510 --> 00:37:27,910
+النظام الصرف الصحي كويس، إذا صار فشل في نظام الصرف
+
+522
+00:37:27,910 --> 00:37:32,270
+الصحي في أي مؤسسة، في أي دولة في العالم، قد يحصل
+
+523
+00:37:32,270 --> 00:37:37,270
+فيها tie fight، فمتى ممكن يحصل مشاكل في أنظم الصرف
+
+524
+00:37:37,270 --> 00:37:42,260
+الصحي؟ في الحروب؟تقصف .. متعرفين محطة المعالجة
+
+525
+00:37:42,260 --> 00:37:46,660
+بتاعة الشيخ أجلين اللي هي أكبر محط معالجة عندنا في
+
+526
+00:37:46,660 --> 00:37:50,980
+.. في أحد الحروب قصفت و جزء منها اتدمر قطع
+
+527
+00:37:50,980 --> 00:37:54,600
+الكهرباء عن المحطات المعالجة مش هذا ب .. بيقدي
+
+528
+00:37:54,600 --> 00:37:59,240
+لعدم معالجة وبتالي تصريف مياه عادمة لو صار في
+
+529
+00:37:59,240 --> 00:38:03,170
+إضراب لعمال النظافة في .. في ال .. في البلدلو صار
+
+530
+00:38:03,170 --> 00:38:07,890
+عندنا حصار، لو صار عندنا أثار، لو صار عندنا
+
+531
+00:38:07,890 --> 00:38:11,810
+tsunami، فاكرين ال tsunami؟ طب اسمعوا الأخبار
+
+532
+00:38:11,810 --> 00:38:14,110
+وراقبوا الأخبار أنتوا لما يصير في أي كارثة في
+
+533
+00:38:14,110 --> 00:38:21,000
+العالمالله يفتح عليك، على طول بصير إن ال WHO بتجف
+
+534
+00:38:21,000 --> 00:38:24,480
+و بتعلن و بتقول إن هنا في تخوف من انتشار الشجلة،
+
+535
+00:38:24,480 --> 00:38:27,920
+ال cholera، ال typhoid fever، الطاعون، يعني هناك
+
+536
+00:38:27,920 --> 00:38:33,340
+أمراض كثيرة تنتشر غالبا بعد اللي هو الكوارث سواء
+
+537
+00:38:33,340 --> 00:38:38,620
+الحروب أو الخلافةيبقى متفقين على ان السيلمونيلا
+
+538
+00:38:38,620 --> 00:38:42,320
+تايفي بتسبب تايفويد fever و ال paratayfy paratayfy
+
+539
+00:38:42,320 --> 00:38:46,020
+fever both of which are dangerous disease that may
+
+540
+00:38:46,020 --> 00:38:50,620
+cause death طبعا الخطورة أعلى لمين لتايفويد fever
+
+541
+00:38:50,620 --> 00:38:55,600
+من ال paratayfy fever لأ تيفوس يبني الريكيزيا
+
+542
+00:38:55,600 --> 00:38:59,180
+ماتخلطش التيفوس هو الريكيزيا بينما تايفويد
+
+543
+00:38:59,180 --> 00:39:04,180
+سيلمونيلا تايفي راجع المحاضرة بعد ذلك ان شاء الله
+
+544
+00:39:04,180 --> 00:39:07,850
+طيباحنا فاكرين يقولنا ال M-cells حكينا عن ال M
+
+545
+00:39:07,850 --> 00:39:10,490
+-cells اللي هي ال enterocytes في ال enterocytes
+
+546
+00:39:10,490 --> 00:39:16,210
+بتاخد عينة خدوا بالكوا هذه الخلايا ليست phagocytic
+
+547
+00:39:16,210 --> 00:39:20,070
+in nature مش phagocytic in nature يعني مش طبيعتها
+
+548
+00:39:20,070 --> 00:39:24,070
+إنها تعمل phagocytosis إيش .. إيش .. إيش السيلمون
+
+549
+00:39:24,070 --> 00:39:28,890
+اللي بتعمل؟ وهذا على تكرة من أجمل يعني المعلومات
+
+550
+00:39:28,890 --> 00:39:31,470
+الحديثة اللي اكتشفناها إن في حاجة اسمها molecular
+
+551
+00:39:31,470 --> 00:39:34,850
+syringes بتعرف سيرنج؟ إيش معناه سيرنج؟ سيرنجة
+
+552
+00:39:35,930 --> 00:39:41,070
+موليكيلار مش اني موليكيلار يعني حجمها جزيئي أو بعض
+
+553
+00:39:41,070 --> 00:39:44,450
+الأحيان يسموها nano nano injections nano
+
+554
+00:39:44,450 --> 00:39:48,330
+injections السلمونيلا بتنزل و بترتبط على receptors
+
+555
+00:39:48,330 --> 00:39:56,730
+على سطح السطح الخليل بتعمل injection لها ب system
+
+556
+00:39:56,730 --> 00:40:00,990
+بيسموه type 3 secretory system type 3 secretory
+
+557
+00:40:00,990 --> 00:40:05,270
+system ايه ال system هذا بيعمل؟ بيعمل
+
+558
+00:40:06,980 --> 00:40:12,420
+Polymerization للأكتين اللي موجود داخل الخلية، إيش
+
+559
+00:40:12,420 --> 00:40:17,360
+يعني Polymerization؟ يعني تجميع للأكتين، إيش
+
+560
+00:40:17,360 --> 00:40:21,360
+الأكتين وظيفته في الخلية؟ هو الـ cytoskeleton هو
+
+561
+00:40:21,360 --> 00:40:25,360
+ال support تبع الخلية هو اللي بيعطي الخلية شكلها،
+
+562
+00:40:25,360 --> 00:40:31,490
+تمام؟فبروح هو هذا بيعمل arrangement بحيث انه يطلع
+
+563
+00:40:31,490 --> 00:40:35,830
+زوائد تعمل phagocytosis لمين؟ لسلمونيلا تخيلوا
+
+564
+00:40:35,830 --> 00:40:41,270
+السلمونيلا طبعا مش مستحيل كلام هذا هي أذكى من ذلك
+
+565
+00:40:41,270 --> 00:40:45,030
+أن تقضي على نفسها هي تريد من هذه الخلية الغير
+
+566
+00:40:45,030 --> 00:40:48,470
+قادرة على ال phagocytosis ان تعملها phagocytosis
+
+567
+00:40:48,470 --> 00:40:52,720
+وشو بيصير في المتصف هنا؟بدل البكتيريا ما تموت
+
+568
+00:40:52,720 --> 00:40:57,860
+البكتيريا بتتكاثر جوا الخلية كنعمل ل protection من
+
+569
+00:40:57,860 --> 00:41:00,960
+ال immune system وهذه طرق او طريقة من طرق خداع
+
+570
+00:41:00,960 --> 00:41:05,220
+البكتيريا لجهاز المناعة احنا قلنالكوا اليهود في
+
+571
+00:41:05,220 --> 00:41:10,450
+احد السنوات لما دخلوا جنينفي الصمود الاسطوري
+
+572
+00:41:10,450 --> 00:41:16,050
+للاخوة في جنين كانوا خشة من المقاومة ما يطلعوا على
+
+573
+00:41:16,050 --> 00:41:19,970
+الشارع كانوا يدخلوا بيت ينتقلوا للبيت الآخر وطبعا
+
+574
+00:41:19,970 --> 00:41:23,830
+هنا مخيمات بيوت مجاورة زي الخلايا فكانوا يدخلوا من
+
+575
+00:41:23,830 --> 00:41:28,030
+بيت إلى بيت عبر فتحة او ثغرة في جدار يحفرها
+
+576
+00:41:28,030 --> 00:41:32,470
+والبكتيريا السلمون اللي قادرة على انها تعمل هذا
+
+577
+00:41:32,470 --> 00:41:37,450
+الكلامدخولها إلى داخل الخلية هو عبارة عن
+
+578
+00:41:37,450 --> 00:41:42,150
+protection من من من ال immune system وعملية خداع
+
+579
+00:41:42,150 --> 00:41:46,750
+لهذا الجهاز هذه نفس الكلام اللي احنا حكيناه تلخيصا
+
+580
+00:41:46,750 --> 00:41:50,890
+انه كيف ال system ل ال ال ال pathogenesis
+
+581
+00:41:50,890 --> 00:41:53,550
+ingestion of salmonella attachment penetration
+
+582
+00:41:53,550 --> 00:41:57,690
+multiplication في ال ال ال ال ال ال ال ال ال ال ال
+
+583
+00:41:57,690 --> 00:41:57,870
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+584
+00:41:57,870 --> 00:41:58,250
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+585
+00:41:58,250 --> 00:41:58,530
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+586
+00:41:58,530 --> 00:41:58,730
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+587
+00:41:58,730 --> 00:41:59,050
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+588
+00:41:59,050 --> 00:41:59,090
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+589
+00:41:59,090 --> 00:42:02,640
+ال ال ال ال ال ال ال ال ال ال ال الفين ال primary
+
+590
+00:42:02,640 --> 00:42:05,460
+بكتيريميا ممكن تروح على الجول بلدر و تعمل اللي هنا
+
+591
+00:42:05,460 --> 00:42:09,780
+يعني ايش جونها career state ممكن تروح على ال .. ال
+
+592
+00:42:09,780 --> 00:42:14,500
+.. ال organs و تعمل برضه infection لل liver الجول
+
+593
+00:42:14,500 --> 00:42:16,980
+بلدر , spleen , kidney و ال bone marrow و تعمل
+
+594
+00:42:16,980 --> 00:42:20,080
+حاسب ما secondary بكتيريميا و بعدين بيظهر لنا اللي
+
+595
+00:42:20,080 --> 00:42:24,400
+هو ال symptoms of the disease و ال symptoms could
+
+596
+00:42:24,400 --> 00:42:28,360
+be complicated or subsidized يعني يا إما بتتفاقم
+
+597
+00:42:28,360 --> 00:42:33,570
+يا إما بتخف حسب مناعة اللي هو الإنسانأو حسب تدخل
+
+598
+00:42:33,570 --> 00:42:37,310
+الأجي هل أعطينا Antibiotic ولا ما أعطيناش
+
+599
+00:42:37,310 --> 00:42:40,410
+Antibiotic والمرة الجاية ان شاء الله بنتكلم عن
+
+600
+00:42:40,410 --> 00:42:43,050
+أشكال أخرى من اللي هو Salmonella Typhi
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/aetzQQ3Ffps.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/aetzQQ3Ffps.srt
new file mode 100644
index 0000000000000000000000000000000000000000..f23abfa0626f51f0e4045ef11b69266e52790e0a
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/aetzQQ3Ffps.srt
@@ -0,0 +1,1786 @@
+1
+00:00:20,550 --> 00:00:23,090
+بسم الله الرحمن الرحيم موضوعنا اليوم إن شاء الله
+
+2
+00:00:23,090 --> 00:00:27,630
+legionella pneumophila وطبعا هي ضمن سلسلة
+
+3
+00:00:27,630 --> 00:00:30,490
+البكتيريا الفاستيدياس التي تتبع الـ gram negative
+
+4
+00:00:30,490 --> 00:00:35,380
+ولكن هذه البكتيريا تعتبر من الميكروبات التي تم
+
+5
+00:00:35,380 --> 00:00:40,080
+اكتشافها مؤخرا، ولو أنَّ 1976 بالنسبة لكم هو زمن
+
+6
+00:00:40,080 --> 00:00:44,400
+قديم، لكن هذا الرقم بالنسبة لنا هو رقم حديث أو
+
+7
+00:00:44,400 --> 00:00:47,960
+تاريخ حديث، لأن معظم البكتيريا الممرضة تم اكتشافها
+
+8
+00:00:47,960 --> 00:00:51,300
+والتعرف عليها قبل خمسينيات القرن الماضي، وبالتالي
+
+9
+00:00:51,300 --> 00:00:55,760
+بعد خمسينيات القرن الماضي نعتبرها بكتيريا حديثة.
+
+10
+00:00:55,760 --> 00:01:01,940
+لها قصة اكتشاف البكتيريا في كان
+
+11
+00:01:01,940 --> 00:01:06,540
+رابطة محاربين قدامى مجتمعين، و هؤلاء
+
+12
+00:01:06,540 --> 00:01:09,960
+هم من كبار السن، يعني بعد
+
+13
+00:01:09,960 --> 00:01:14,280
+أيام من اجتماعهم، أصيب مجموعة منهم بأعراض pneumonia
+
+14
+00:01:14,280 --> 00:01:17,540
+لكن هذه الـ pneumonia atypical، بمعنى أنها غير نمطية.
+
+15
+00:01:17,770 --> 00:01:22,850
+وأحد الأشخاص توفي على إثر هذه الإصابة، سميت في تلك
+
+16
+00:01:22,850 --> 00:01:26,950
+الفترة المرض Legionnaire Disease، نظرا للـ Legion،
+
+17
+00:01:26,950 --> 00:01:28,790
+الـ Legion وهي الرابطة المحاربين القدامى التي
+
+18
+00:01:28,790 --> 00:01:32,370
+حكينا عنها، فسموها Legionnaire Disease، بعد عدة
+
+19
+00:01:32,370 --> 00:01:37,530
+محاولات تم عزل البكتيريا من الـ tissues تبع الـ lung
+
+20
+00:01:37,770 --> 00:01:42,710
+للمريض الذي توفي، وسميت البكتيريا Legionella
+
+21
+00:01:42,710 --> 00:01:46,570
+pneumophila، Legionella من اسم Legionnaire disease
+
+22
+00:01:46,570 --> 00:01:49,510
+من الـ Legion، وLegionella pneumophila لأنه عزلت من
+
+23
+00:01:49,510 --> 00:01:55,370
+الـ lungs، طبعا بعد العزل الأول للميكروب الذي
+
+24
+00:01:55,370 --> 00:01:59,310
+اسمه Legionella pneumophila، تتابعت عزلات أخرى من
+
+25
+00:01:59,310 --> 00:02:05,230
+نفس الـ genus لكن بأسماء مختلفة. البكتيريا
+
+26
+00:02:05,230 --> 00:02:07,890
+عبارة عن الـ gram negative، ولكن الـ staining
+
+27
+00:02:07,890 --> 00:02:12,330
+تبعها في الـ gram stain ضعيف للغاية إلا إذا زدنا
+
+28
+00:02:12,330 --> 00:02:15,870
+مدة الـ staining بالصفرانين
+
+29
+00:02:15,870 --> 00:02:19,630
+فالصفرانين، نحط لمدة كـ counter stain لمدة دقيقة أو
+
+30
+00:02:19,630 --> 00:02:23,950
+أقل من دقيقة. حتى لكن في حالة البكتيريا هذه، إذا
+
+31
+00:02:23,950 --> 00:02:27,230
+أردنا أن نصبغها بشكل جيد يجب أن نصبغها لفترات أطول
+
+32
+00:02:27,230 --> 00:02:32,000
+بالصفرانين، يعني two to five minutes بيكون جيد.
+
+33
+00:02:32,000 --> 00:02:35,240
+التوقيت slow growing، البكتيريا نحن
+
+34
+00:02:35,240 --> 00:02:38,660
+نقُل إنَّها fastidious، من يومين لخمسة أيام تتطلب في
+
+35
+00:02:38,660 --> 00:02:42,880
+enriched media تحتوي على شيئين أساسيين هما
+
+36
+00:02:42,880 --> 00:02:48,260
+cysteine زائد الـ ferric ion. الـ culture من
+
+37
+00:02:48,260 --> 00:02:52,880
+البكتيريا قد تظهر بعض الأشكال الغريبة من البكتيريا،
+
+38
+00:02:52,880 --> 00:02:57,460
+من ضمنها filamentous forms وswelling rods،
+
+39
+00:02:57,460 --> 00:03:01,240
+swelling يعني منتفخة، بالإضافة إلى كما ذكرنا
+
+40
+00:03:01,240 --> 00:03:04,700
+bizarre forms، أشكال متنوعة ومختلفة.
+
+41
+00:03:08,100 --> 00:03:11,600
+كذلك البكتيريا تنتج soluble pigment عندما نزرعها
+
+42
+00:03:11,600 --> 00:03:15,180
+على الوسط المشهور الذي اسمه BCYE، هذا
+
+43
+00:03:15,180 --> 00:03:19,480
+أول وسط ذكرناه للبكتيريا اسمه BCYE، البكتيريا
+
+44
+00:03:19,480 --> 00:03:22,780
+تتميز بأنها تنتج brownish discoloration أو
+
+45
+00:03:22,780 --> 00:03:27,220
+pigmentation على هذا الوسط، وستتميز بأنها water
+
+46
+00:03:27,220 --> 00:03:31,260
+soluble، مثل الـ pigment تبع pseudomonas aeruginosa.
+
+47
+00:03:32,540 --> 00:03:37,320
+البكتيريا أيضاً أظهرت مقدرة أو نمو جيد على وسط اسمه
+
+48
+00:03:37,320 --> 00:03:42,060
+charcoal yeast extract media. سنرى في لوحات لاحقة
+
+49
+00:03:42,060 --> 00:03:46,960
+الاسم، ونضيف له حرف الـ B  قبل charcoal yeast extract
+
+50
+00:03:46,960 --> 00:03:52,760
+لِنُغيّر أو نُقلل من التغير أو الـ fluctuation الذي
+
+51
+00:03:52,760 --> 00:03:57,420
+هو سُمِّيَ التذبذب في الـ pH تبع الوسط، فعملنا
+
+52
+00:03:57,420 --> 00:04:01,210
+له buffering. أريد أن أحكي عن الـ yeast extract، الـ yeast
+
+53
+00:04:01,210 --> 00:04:05,530
+extract هي component موجودة في كثير من الأوساط
+
+54
+00:04:05,530 --> 00:04:09,990
+الزراعية. لماذا الـ yeast extract؟ الـ yeast extract
+
+55
+00:04:09,990 --> 00:04:14,070
+تُعتبر source أو rich source of vitamins and
+
+56
+00:04:14,070 --> 00:04:17,700
+minerals. وبالتالي،  ممكن بتعرفوا حتى بعض المزارعين
+
+57
+00:04:17,700 --> 00:04:23,300
+يُضيفون الـ yeast نفسها على بعض المزروعات كـ growth
+
+58
+00:04:23,300 --> 00:04:28,900
+enhancing fertilizer، تمام؟ وفي بعض الـ
+
+59
+00:04:28,900 --> 00:04:34,890
+منتجات مثل الكوسة والخيار، إذا
+
+60
+00:04:34,890 --> 00:04:40,310
+عولجت بهذه المستخلصات تعطينا over growth، growth
+
+61
+00:04:40,310 --> 00:04:44,310
+غير طبيعي، وللأسف هذا يُعتبر أيضاً نوعاً من
+
+62
+00:04:44,310 --> 00:04:48,870
+الغش، لكن الحقيقة في الموضوع أنَّ الـ yeast extract is a
+
+63
+00:04:48,870 --> 00:04:53,830
+rich source of vitamins and minerals. النمو ممكن
+
+64
+00:04:53,830 --> 00:04:59,490
+يحدث بشكل جيد على بيئة هوائية في ظل 2.5%، وقد تصل
+
+65
+00:04:59,490 --> 00:05:05,730
+إلى 3%، وقد تصل إلى 4% CO2. most strains are
+
+66
+00:05:05,730 --> 00:05:09,230
+flagellated، يعني معظمها متحركة. الـ laboratory
+
+67
+00:05:09,230 --> 00:05:14,250
+diagnosis،  يتطلب cysteine and
+
+68
+00:05:14,250 --> 00:05:20,690
+iron salts، باستخدام الـ BCYE،  إضافة
+
+69
+00:05:20,690 --> 00:05:24,050
+كانت لكلمة buffered yeast أو charcoal yeast
+
+70
+00:05:24,050 --> 00:05:28,010
+extract. هذه النقطة مهمة جداً، أنَّ الـ antibiotics
+
+71
+00:05:28,010 --> 00:05:31,730
+غالباً تُضعف في هذا الوسط،  تُثبط non fastidious
+
+72
+00:05:31,730 --> 00:05:35,130
+organism. طبعاً من المنطق، شباب، بكتيريا slow
+
+73
+00:05:35,130 --> 00:05:40,630
+growing، two to five، two to five days requirement
+
+74
+00:05:40,630 --> 00:05:44,290
+for growth. عندما تكون معها بكتيريا أخرى مثل
+
+75
+00:05:44,290 --> 00:05:47,150
+Staphylococcus aureus أو Epidermis أو Escherichia
+
+76
+00:05:47,150 --> 00:05:50,470
+coli،  ونضعهم على نفس الوسط، والوسط غني
+
+77
+00:05:50,470 --> 00:05:54,090
+للـ fastidious ومناسب للـ fastidious،  نمو الـ non fastidious
+
+78
+00:05:54,090 --> 00:05:58,830
+وإذا نمت الـ non fastidious، فغالباً ستؤثر على الـ
+
+79
+00:05:58,830 --> 00:06:02,430
+fastidious من ناحيتين. رقم واحد، أنَّ
+
+80
+00:06:02,430 --> 00:06:06,770
+الغذاء سيستهلك، رقم اثنين الـ pH،  بالضبط الـ waste
+
+81
+00:06:06,770 --> 00:06:11,010
+products أو الـ pH metabolism أو الـ pH، التغيير في الـ
+
+82
+00:06:11,010 --> 00:06:13,630
+pH الناتج عن الـ metabolism أيضاً سيؤثر على النمو
+
+83
+00:06:13,630 --> 00:06:17,050
+الأولى، فممكن نضيف بعض الـ antibiotics. they grow
+
+84
+00:06:17,050 --> 00:06:21,390
+aerobically أو grow using three to five percent
+
+85
+00:06:21,390 --> 00:06:27,320
+CO2 at 35°C for three to five days. الـ optimum pH 6.9
+
+86
+00:06:27,320 --> 00:06:30,500
+colonies are small with a
+
+87
+00:06:30,500 --> 00:06:32,900
+crystalline، like ground glass appearance، يعني
+
+88
+00:06:32,900 --> 00:06:37,440
+المستعمرات تكون صغيرة، غالباً يكون فيها مثل بلورات
+
+89
+00:06:37,440 --> 00:06:41,060
+الزجاج المكسر أو المطحون، نسميه
+
+90
+00:06:43,700 --> 00:06:47,620
+ليست الصورة هذه تقنية، ولكنها أفضل من macro
+
+91
+00:06:47,620 --> 00:06:51,440
+virus. تحتوي على الميكروب، والميكروب له المقدرة على
+
+92
+00:06:51,440 --> 00:06:55,860
+أنه can exist intracellularly، هو ليس obligate
+
+93
+00:06:55,860 --> 00:06:59,480
+intracellular، لكن facultative، بمعنى أنه can grow
+
+94
+00:06:59,480 --> 00:07:02,480
+outside and inside. هو دليل على ذلك أنه ينمو على
+
+95
+00:07:02,480 --> 00:07:07,130
+الأوساط الزراعية العادية. هذه الصورة الرائعة التي هي
+
+96
+00:07:07,130 --> 00:07:10,730
+الـ fluorescent microscopy، ويمكن أن تكون الآن التقنية
+
+97
+00:07:10,730 --> 00:07:14,290
+الأشهر في التعرف على البكتيريا، وخاصة أنه فيه
+
+98
+00:07:14,290 --> 00:07:19,570
+strains مختلفة، وإذا بتلاحظوا البكتيريا هي المضيئة
+
+99
+00:07:19,570 --> 00:07:24,970
+و الـ background كلها معتمة، بسبب أنَّ البكتيريا صبغت
+
+100
+00:07:24,970 --> 00:07:26,470
+بـ fluorescent antibody.
+
+101
+00:07:30,210 --> 00:07:33,270
+من الـ characteristics المهمة جداً لهذه البكتيريا
+
+102
+00:07:33,270 --> 00:07:38,230
+أنها weak oxidase،  إيجابية، لكن strong catalase، إيجابية.
+
+103
+00:07:38,230 --> 00:07:43,150
+weak oxidase لكن strong catalase. it can liquefy
+
+104
+00:07:43,150 --> 00:07:49,130
+gelatin. it also capable of hydrolyzing hippurates.
+
+105
+00:07:49,130 --> 00:07:53,170
+هذه نقطة مهمة جداً، لأن كل الـ Legionella الأخرى، الـ
+
+106
+00:07:53,170 --> 00:07:57,130
+Legionellas الأخرى are negative، فنقول أنَّ هذه
+
+107
+00:07:57,130 --> 00:08:02,960
+الفحوصات مميزة للـ legionella بشكل عام، وهذه المميزة
+
+108
+00:08:02,960 --> 00:08:06,480
+للـ legionella pneumophila أن عندها المقدرة على عمل
+
+109
+00:08:06,480 --> 00:08:10,320
+hydrolysis للهيبيوريت، بينما باقي الـ legionella غير
+
+110
+00:08:10,320 --> 00:08:12,500
+قادرة على تحليل الهيبيوريت.
+
+111
+00:08:18,250 --> 00:08:22,170
+ما الذي يجعل هذه البكتيريا قادرة على إحداث المرض؟
+
+112
+00:08:22,170 --> 00:08:25,050
+يعني ماذا virulence factors أو الـ pathogenic
+
+113
+00:08:25,050 --> 00:08:28,450
+determinants لهذه البكتيريا؟ رقم واحد، its ability
+
+114
+00:08:28,450 --> 00:08:34,130
+to produce large amount of proteolytic enzymes. رقم
+
+115
+00:08:34,130 --> 00:08:36,470
+اثنين، عندها two types of toxins، term
+
+116
+00:08:36,470 --> 00:08:40,130
+characterization لهما، أو  التعرف عليهما. رقم واحد، x
+
+117
+00:08:40,130 --> 00:08:44,730
+-toxin، وهذا الـ x-toxin، عندما فُحص على الـ animal red
+
+118
+00:08:44,730 --> 00:08:47,870
+blood cell، يُحدث lysis للـ red blood cells.
+
+119
+00:08:47,870 --> 00:08:52,810
+الثاني، cytotoxin، أيضاً له effect على خلايا الـ
+
+120
+00:08:52,810 --> 00:08:56,850
+laboratory animals. بمعنى أن هذه البكتيريا تنتج
+
+121
+00:08:57,740 --> 00:09:01,460
+proteolytic enzymes، وأعتقد أنه مر علينا قبل ذلك
+
+122
+00:09:01,460 --> 00:09:05,080
+كثيراً من البكتيريا، أحد أهم الـ virulence factors
+
+123
+00:09:05,080 --> 00:09:08,420
+لديها، الـ proteolytic enzymes، وهذا تذكروا الـ flesh
+
+124
+00:09:08,420 --> 00:09:11,700
+eating bacteria، تذكرونها؟ قلنا لكم أن لديها
+
+125
+00:09:11,700 --> 00:09:15,060
+المقدرة على إنتاج كمية كبيرة من الـ proteolytic
+
+126
+00:09:15,060 --> 00:09:20,640
+enzymes. الـ Clinical Manifestation، يقول لنا أنَّ بعد
+
+127
+00:09:20,640 --> 00:09:23,620
+يومين لعشرة أيام incubation period، يكون الـ
+
+128
+00:09:23,620 --> 00:09:27,080
+incubation period من يومين لعشرة أيام، after
+
+129
+00:09:27,080 --> 00:09:31,280
+exposure with brief prodrome أو prodrome of
+
+130
+00:09:31,280 --> 00:09:34,260
+malaria and headache، followed rapidly by
+
+131
+00:09:34,260 --> 00:09:38,460
+prostration and high fever. هذه الأعراض
+
+132
+00:09:38,460 --> 00:09:42,580
+الأعراض نفسها التي يُشاهدها في الإنفلونزا، بمعنى
+
+133
+00:09:42,580 --> 00:09:46,280
+أنها أعراض غير محددة، أعراض غير محددة،
+
+134
+00:09:46,280 --> 00:09:50,100
+أعراض غير محددة. لكن الأعراض المحددة تكون في المرحلة
+
+135
+00:09:50,100 --> 00:09:53,300
+التي تليها. تتميز بـ rigorous cough، dyspnea،
+
+136
+00:09:53,300 --> 00:09:56,820
+اختناق،  uretic and abdominal pain، vomiting،
+
+137
+00:09:56,820 --> 00:10:01,460
+diarrhea، and unexplained encephalopathy. هذه كلها
+
+138
+00:10:01,460 --> 00:10:07,560
+الأعراض تظهر في المرحلة المحددة للمرض.
+
+139
+00:10:07,560 --> 00:10:14,040
+طبعاً، كونه يتحدث عن الرئتين والـ pneumonia، و
+
+140
+00:10:14,040 --> 00:10:16,960
+أعراض الـ typical pneumonia،  تمام، العينة الممثلة
+
+141
+00:10:16,960 --> 00:10:21,260
+ستكون الـ sputum، لكن يقول لنا أن الـ gram staining
+
+142
+00:10:21,260 --> 00:10:24,800
+في حالة legionella pneumophila is not
+
+143
+00:10:24,800 --> 00:10:29,120
+diagnostic، of no value، ليس له أي قيمة. تعالوا نشوف
+
+144
+00:10:29,120 --> 00:10:33,520
+المختبر، غير الـ microbiology، هل يمكن أن يساعدنا في
+
+145
+00:10:33,520 --> 00:10:37,180
+عملية تشخيص legionella pneumophila؟ أم لا؟ نرى معاً بعض
+
+146
+00:10:37,180 --> 00:10:42,060
+النتائج. أولاً، leukocytosis، رقم اثنين، يوجد
+
+147
+00:10:42,060 --> 00:10:47,480
+elevated ESR، رقم ثلاثة، يوجد بروتينوريا، أو
+
+148
+00:10:47,480 --> 00:10:51,960
+hematuria، تمام؟ hematuria،  أين هذه؟ abnormal serum
+
+149
+00:10:51,960 --> 00:10:54,400
+enzyme determinations؟  ماذا هي abnormal serum
+
+150
+00:10:54,400 --> 00:10:57,680
+enzymes؟ يعني لو أنتم تريدون عمل liver function test
+
+151
+00:10:57,680 --> 00:11:02,660
+أو kidney function test أو حتى cardiac function
+
+152
+00:11:02,660 --> 00:11:08,650
+test، ستجدون أن الـ enzymes مرتفعة جداً. سبب
+
+153
+00:11:08,650 --> 00:11:13,030
+الوفاة الرئيسي في legionella pneumophila غالباً اما
+
+154
+00:11:13,030 --> 00:11:16,630
+respiratory failure and shock، هذان السببان
+
+155
+00:11:16,630 --> 00:11:27,030
+الرئيسيان للوفاة.  الـ transmission
+
+156
+00:11:27,030 --> 00:11:31,770
+هذا صحيح، هو مكتوب via respiratory tract، لكن ليس
+
+157
+00:11:31,770 --> 00:11:36,470
+person to person، ليس person to person.  نقطة  مهمة جداً
+
+158
+00:11:36,470 --> 00:11:40,410
+سنقف عندها قليلاً، لأنه أول مرة تمر معنا
+
+159
+00:11:40,410 --> 00:11:45,110
+respiratory وليس person to person، respiratory، أنا
+
+160
+00:11:45,110 --> 00:11:47,830
+يجب أن آخذها من environmental source، من
+
+161
+00:11:47,830 --> 00:11:51,610
+environmental source.  طب لو أنا أخذتها وصار عندي
+
+162
+00:11:51,610 --> 00:12:00,710
+infection وسُعَلتُ لآخرين وأخذوها، لا يُصابون، كيف
+
+163
+00:12:00,710 --> 00:12:01,710
+تفسرون ذلك؟
+
+164
+00:12:05,780 --> 00:12:10,340
+مرة أخرى، أنَّ person to person transmission is not
+
+165
+00:12:10,340 --> 00:12:13,960
+possible، لكن environment to person is possible.
+
+166
+00:12:23,060 --> 00:12:26,620
+نفس الكلام، هذا الكلام الصحيح أو التفسير المنطقي
+
+167
+00:12:26,620 --> 00:12:29,780
+الصحيح ليس بالضرورة التفسير الصحيح، وإنما المنطقي
+
+168
+00:12:29,780 --> 00:12:33,420
+الصحيح، أنَّ في الـ environment يبدو أنَّه يصير لها
+
+169
+00:12:33,420 --> 00:12:38,380
+يعني changes، تأخذ changes معينة، تصبح more
+
+170
+00:12:38,380 --> 00:12:43,200
+virulent للـ transmission للآخرين، بينما من الإنسان
+
+171
+00:12:43,200 --> 00:12:45,840
+إلى الإنسان،  يبدو أنها تعتمد على الـ machinery تبعها
+
+172
+00:12:45,840 --> 00:12:49,760
+الإنسان، وتكون أقل virulence في انتقالها من إنسان
+
+173
+00:12:49,760 --> 00:12:54,310
+إلى إنسان. الـ specimen should be handled with care
+
+174
+00:12:54,310 --> 00:12:58,130
+in a biological safety cabinet. العينات ممكن نأخذ
+
+175
+00:12:58,130 --> 00:13:02,830
+lung biopsy أو autopsy،  وفرق بين الـ autopsy والـ
+
+176
+00:13:02,830 --> 00:13:06,450
+biopsy.  ما هو الـ autopsy؟ الـ autopsy، العينة بعد موت
+
+177
+00:13:06,450 --> 00:13:09,930
+المريض، التي تكون في عملية تشريح المريض. الـ biopsy
+
+178
+00:13:09,930 --> 00:13:13,790
+التي هي عينة تؤخذ من، تؤخذ من المريض الحالي. أنتم عندكم اليوم امتحان معمل أظن
+
+179
+00:13:13,790 --> 00:13:19,290
+إيه؟ معمل ميكروبيولوجي،  Okay. لأن أحد أسباب رفض العينات في
+
+180
+00:13:19,290 --> 00:13:26,920
+مختبر الـ microbiology هو استلام العينة في formalin،
+
+181
+00:13:
+
+223
+00:16:10,430 --> 00:16:15,330
+هو cooling towers أو الأبراج التبعتها اللي هو التبريد
+
+224
+00:16:20,980 --> 00:16:25,280
+بالنسبة لل diagnoses احنا بنشخص المرض عبر ال
+
+225
+00:16:25,280 --> 00:16:28,680
+clinical picture بالإضافة إلى isolation and
+
+226
+00:16:28,680 --> 00:16:32,080
+identification of Legionella from clinical
+
+227
+00:16:32,080 --> 00:16:36,420
+specimen والعزل بيتم إما على artificial media زي
+
+228
+00:16:36,420 --> 00:16:39,920
+BCYE او buffered charcoal yeast extract
+
+229
+00:16:39,920 --> 00:16:44,240
+تمام أو على guinea pigs اللي هم فئران التجارب
+
+230
+00:16:44,240 --> 00:16:48,960
+حيوانات التجارب أو Embryonated Hens' Eggs  ها دي ال
+
+231
+00:16:48,960 --> 00:16:52,340
+Guinea pigs حيوانات، صح؟ و ها دي اللي هي ال
+
+232
+00:16:52,340 --> 00:16:55,780
+Embryonated Eggs اللي هي البيض اللي موجود في
+
+233
+00:16:55,780 --> 00:16:58,440
+جنين، اللي بيستخدمه للفيروسات، بيستخدمه للفيروسات
+
+234
+00:16:58,440 --> 00:17:02,280
+لما واحد بيعرف أنه عنده ٣ خيارات: Artificial Media
+
+235
+00:17:02,280 --> 00:17:07,540
+ولا Guinea pigs ولا Hens' Egg Embryonated، مين
+
+236
+00:17:07,540 --> 00:17:12,470
+بيختار؟ الـ Artificial Media لأنه لا فيه Suffering
+
+237
+00:17:12,470 --> 00:17:15,750
+للحيوانات ولا فيه تعذيب للحيوانات ولا فيه
+
+238
+00:17:15,750 --> 00:17:20,050
+الإعدادات المعقدة المطلوبة للتعامل مع ال
+
+239
+00:17:20,050 --> 00:17:25,120
+Embryonated Hens' Eggs. طريقة ثانية في التشخيص: to
+
+240
+00:17:25,120 --> 00:17:29,820
+demonstrate a four-fold increase in antibody titer
+
+241
+00:17:29,820 --> 00:17:33,960
+بين مرحلتين: stage one و stage two. إيش stage
+
+242
+00:17:33,960 --> 00:17:37,420
+one؟ اللي هي الـ acute stage. الـ acute stage لما
+
+243
+00:17:37,420 --> 00:17:42,030
+بتكون الأعراض maximum. في مرحلة سميناها Convalescent
+
+244
+00:17:42,030 --> 00:17:45,870
+Stage. Convalescent Stage معناها مرحلة التماثل
+
+245
+00:17:45,870 --> 00:17:50,510
+للشفاء أو النقاهة. الآن، طب إذا هو بيقول لنا increase
+
+246
+00:17:50,510 --> 00:17:55,050
+in antibody titer، المقصود بالـ increase هي ده four-fold
+
+247
+00:17:55,050 --> 00:17:59,490
+أربع أضعاف ما بين مرحلة الـ acute و الـ convalescent.
+
+248
+00:17:59,490 --> 00:18:01,410
+طب و الـ convalescent يعني شوف، هي إيش بدنا في
+
+249
+00:18:01,410 --> 00:18:06,730
+التشخيص؟ إيش بدنا في التشخيص؟ إيش بيسموا التشخيص
+
+250
+00:18:06,730 --> 00:18:08,210
+في هذه الحالة؟ Retrospective
+
+251
+00:18:11,400 --> 00:18:16,280
+diagnosis. يعني غالبا المريض نفسه
+
+252
+00:18:16,280 --> 00:18:20,740
+ما بيستفيد منه، ما بيستفيدش منه، لكن ومع ذلك احنا
+
+253
+00:18:20,740 --> 00:18:25,640
+بنشجع، بنقول أنه سجلنا حالة. أعطيكم مثال واضح: هل
+
+254
+00:18:25,640 --> 00:18:33,740
+هناك Legionella في قطاع غزة؟ ليش قلت لأ؟
+
+255
+00:18:36,520 --> 00:18:40,180
+حسب الإحصائيات أنه لأ، لأنه ما فيش ولا واحدة، لكن في
+
+256
+00:18:40,180 --> 00:18:44,680
+الآخر أنا بقول لك أن كلامك صحيح، ما فيش لها أي سجل في
+
+257
+00:18:44,680 --> 00:18:48,500
+السجلات، التقارير الـ regional. هل هذا يعني أنها غير
+
+258
+00:18:48,500 --> 00:18:49,240
+موجودة؟
+
+259
+00:18:51,650 --> 00:18:56,170
+under diagnosis أو misdiagnosed أو اصلا it is not
+
+260
+00:18:56,170 --> 00:18:58,870
+looked for. ما بن دورش عليها أساسا في الـ diagnosis
+
+261
+00:18:58,870 --> 00:19:03,190
+وممكن يشفى المريض باستخدام simple antibiotics زي
+
+262
+00:19:03,190 --> 00:19:07,290
+الإريثروميسين دون معرفة التشخيص، وبالتالي أنا طالما
+
+263
+00:19:07,290 --> 00:19:10,430
+ما... الآن ما عنديش سجلات أن في عندي Legionella
+
+264
+00:19:10,430 --> 00:19:14,030
+pneumophila أو Legionellosis، هل أنا كوزارة الصحة
+
+265
+00:19:14,030 --> 00:19:17,960
+بعمل حساباتي في الخطط التابعة لي لمكافحة هذا المرض؟
+
+266
+00:19:17,960 --> 00:19:21,080
+ما بعملش لإنه مش عارف أنه أصلا موجودة في هذا
+
+267
+00:19:21,080 --> 00:19:26,120
+البكتيريا. فبعض الأحيان عدم المعرفة شيء مريح، صح؟ لكن
+
+268
+00:19:26,120 --> 00:19:31,520
+مريح لمن يفكر أو لمن يبذل الجهد، لكن غير مريح للناس
+
+269
+00:19:31,520 --> 00:19:35,560
+اللي بيخدموهم، اللي هم الشعب اللي بتلقى الخدمات
+
+270
+00:19:35,560 --> 00:19:36,000
+الصحية.
+
+271
+00:19:38,630 --> 00:19:41,090
+Demonstration of the organism in clinical specimen
+
+272
+00:19:41,090 --> 00:19:44,390
+by DFA. DFA هو الـ Direct Fluorescent Antibody Test.
+
+273
+00:19:44,390 --> 00:19:46,750
+شفت الصورة اللي شفناها؟ جاب شوية البكتيريا
+
+274
+00:19:46,750 --> 00:19:50,830
+الفلورية. لو أخذنا عينة من المريض، sputum على
+
+275
+00:19:50,830 --> 00:19:54,030
+ سبيل المثال، أو الـ tissue اللي عملناها في الفورمالدهايد و
+
+276
+00:19:54,030 --> 00:19:57,190
+عملنا منه section و عملنا له fixation على الشريحة
+
+277
+00:19:57,190 --> 00:20:00,830
+و صبغناها بـ fluorescent antibody وبعدين عملنا
+
+278
+00:20:00,830 --> 00:20:04,320
+عملية washing. إذا البكتيريا موجودة يا شباب، الـ
+
+279
+00:20:04,320 --> 00:20:07,680
+Antibody هيرتبط فيها، وإذا الـ Antibody ارتبط فيها
+
+280
+00:20:07,680 --> 00:20:12,040
+تحت الـ fluorescent microscope، بنشوف هذه البكتيريا. و
+
+281
+00:20:12,040 --> 00:20:16,560
+هذه عملية ممتازة، صحيح. يعني ممكن احنا لو ما عندناش
+
+282
+00:20:16,560 --> 00:20:19,660
+الإمكانيات التابعة للـ culture و الـ identification بالـ
+
+283
+00:20:19,660 --> 00:20:22,980
+conventional technique، نلجأ إلى هذا. بالإضافة إلى
+
+284
+00:20:22,980 --> 00:20:25,640
+أن معظم الميكروبات اليوم، ومن ضمنها الـ Legionella
+
+285
+00:20:25,640 --> 00:20:30,860
+could be diagnosed by PCR. و الـ PCR أصبح تقنية يا
+
+286
+00:20:30,860 --> 00:20:37,240
+شباب سهلة ومتوفرة، ومش بس سهلة ومتوفرة، كمان صارت
+
+287
+00:20:37,240 --> 00:20:41,200
+أقل سعرا، أو أقل حتى من اللي هو الـ culture.
+
+288
+00:20:41,200 --> 00:20:46,860
+وبالتالي يعني ال... ال... ال... الأشياء اللي كانت
+
+289
+00:20:46,860 --> 00:20:50,640
+معيقة من... من التكلفة العالية، أصبح حالها اليوم
+
+290
+00:20:50,640 --> 00:20:53,860
+اللي هو ال... ال... الـ PCR زي ما حكيت لكم بالنسبة
+
+291
+00:20:53,860 --> 00:20:57,940
+لـ treatment، لـ drug of choice التابعة له هو ال... ال...
+
+292
+00:20:57,940 --> 00:21:03,190
+الإريثروميسين. طبعا هذا بينهي الجزء الأول من
+
+293
+00:21:03,190 --> 00:21:07,290
+محاضرتنا اليوم اللي هو عن الـ Legionella، وسنتقل إن
+
+294
+00:21:07,290 --> 00:21:13,330
+شاء الله إلى الجزء الثاني المتعلق بـ البروسيلات من
+
+295
+00:21:13,330 --> 00:21:18,010
+العنوان اللي أمامكم هذا. أي من الصفات المشتركة
+
+296
+00:21:18,010 --> 00:21:21,330
+بين الأسماء أو بين الاسم الأول والأسماء الأخرى؟
+
+297
+00:21:21,330 --> 00:21:25,430
+الأسماء الأخرى اللي موجودة: تريبونيم، وليبتوسبيرا،
+
+298
+00:21:25,430 --> 00:21:30,490
+و بوريليا. تتميز بأنها spiral microorganism، بينما
+
+299
+00:21:30,490 --> 00:21:34,110
+البروسيلا هي تابعة المجموعة اللي كنا بنناقشها
+
+300
+00:21:34,110 --> 00:21:35,630
+سابقا. إيش هي؟
+
+301
+00:21:43,910 --> 00:21:46,390
+يمكن احنا موضوعنا اللي هو البروسيلا وليس
+
+302
+00:21:46,390 --> 00:21:50,530
+الأخريات، الأخريات اللي سنتخصص فيها إن شاء الله محاضرة
+
+303
+00:21:50,530 --> 00:21:54,230
+ثانية. الصورة هذه اللي قدامكم معبرة نوعا ما أن الـ
+
+304
+00:21:54,230 --> 00:22:01,330
+microbe ارتبط به اللي هو الحليب، لكن ليس هو
+
+305
+00:22:01,330 --> 00:22:07,730
+المصدر الوحيد للـ infection، لكن هذه البكتيريا حقيقة
+
+306
+00:22:07,730 --> 00:22:14,950
+بتشكل مرض خطير جدا، وبتشكل كمان خسارة اقتصادية لأن
+
+307
+00:22:14,950 --> 00:22:17,730
+هذا يعتبر من الأمراض المشتركة، الأمراض المشتركة
+
+308
+00:22:17,730 --> 00:22:22,860
+اللي هي ما بين الحيوان وبين الإنسان. لها اسم هنا:
+
+309
+00:22:22,860 --> 00:22:28,340
+بروسيلا. البكتيريا، الـ disease لها أكثر من اسم، أحد
+
+310
+00:22:28,340 --> 00:22:35,060
+الأسماء المشهورة: undulant fever، لأن الحمى ترتفع و
+
+311
+00:22:35,060 --> 00:22:41,980
+تنخفض، فبالتالي لو عملنا chart للمريض، هيجي أن
+
+312
+00:22:41,980 --> 00:22:47,420
+الحرارة تطلع فوق وتنزل تحت، فالـ chart بتكون عاملة
+
+313
+00:22:47,420 --> 00:22:49,960
+بهذا الشكل، فسموها undulant fever.
+
+314
+00:22:53,780 --> 00:22:56,660
+Medically important species.  نقل الأسماء مع بعض
+
+315
+00:22:56,660 --> 00:23:00,760
+سهلة كتير، أسماؤهم: بروسيلة أبيورتس، بروسيلة
+
+316
+00:23:00,760 --> 00:23:05,840
+ميلتنسس، بروسيلة كانيس، بروسيلة، بروسيلة أبيورتس، بروسيلة
+
+317
+00:23:05,840 --> 00:23:10,660
+ميلتنسس، بروسيلة كانيس، بروسيلة سويس.
+
+318
+00:23:10,660 --> 00:23:14,980
+الـ بروسيلة أبيورتس can infect cattle. cattle لها
+
+319
+00:23:14,980 --> 00:23:20,680
+الماشية بشكل عام، صحيح. ومن هنا اسم أبيورتس. بروسيلة
+
+320
+00:23:20,680 --> 00:23:25,000
+ميلتنسس can infect goats and sheep specifically.
+
+321
+00:23:25,000 --> 00:23:30,760
+الماعز والخراف. كانيس، ومن اسمه كانيس، dogs. من الكلاب.
+
+322
+00:23:30,760 --> 00:23:35,320
+وبروسيلة سويس للخنازير. فاحنا نتوقع أنه ممكن يكون
+
+323
+00:23:35,320 --> 00:23:40,860
+عندنا هادي وهادي وهادي، مضبوط؟ بينما الخنازير ما عندناش.
+
+324
+00:23:40,860 --> 00:23:44,930
+فبالتالي أكتر حاجة هيكون عندنا هادي وهادي، تمام؟ لأن
+
+325
+00:23:44,930 --> 00:23:48,230
+برضه احنا كمسلمين بنبتعد قدر الإمكان عن الكلاب
+
+326
+00:23:48,230 --> 00:23:51,930
+وما فيش احتكاك مباشر بينهم. بس بالنسبة للميلتنسس
+
+327
+00:23:51,930 --> 00:23:56,150
+والأبيورتس فيه إن فيه احتكاك مباشر سواء كان مع
+
+328
+00:23:56,150 --> 00:24:02,370
+الحيوانات نفسها أو مع منتجات هذه الحيوانات من حليب
+
+329
+00:24:02,370 --> 00:24:10,610
+أو حتى لحم لحيوانات مصابة. معلش نرجع، برجوع أنا ذكرت
+
+330
+00:24:10,610 --> 00:24:14,970
+قلت أن الأبيورتس بتصيب الماشية، الملتنس بتصيب الـ
+
+331
+00:24:14,970 --> 00:24:19,750
+goats والشيب، فيه نوع من ايه؟ من الـ specificity للـ
+
+332
+00:24:19,750 --> 00:24:24,290
+species بالإضافة لل... لل... لل... للـ animal
+
+333
+00:24:24,290 --> 00:24:29,750
+species they can infect man. يبقى عندهم قدرة...
+
+334
+00:24:29,750 --> 00:24:32,290
+بالضبط، قدرة الـ أبيورتس... الـ أبيورتس على
+
+335
+00:24:32,290 --> 00:24:36,050
+الـ cattle وعلى الإنسان. ميلتنسس، goats, sheep and
+
+336
+00:24:36,050 --> 00:24:40,870
+إنسان. بروسيلة كانيس برضه dogs and human. بروسيلة
+
+337
+00:24:40,870 --> 00:24:44,850
+سويس، swine and human. شوفوا كم اسم لل... للـ
+
+338
+00:24:44,850 --> 00:24:47,550
+disease موجودين.
+
+339
+00:24:53,500 --> 00:24:57,120
+Malta Fever، حمى المالطية بالعربي. Undulant Fever،
+
+340
+00:24:57,120 --> 00:25:01,240
+المتموجة اللي قلنا عنها. Mediterranean Fever، حمى
+
+341
+00:25:01,240 --> 00:25:05,180
+البحر الأبيض المتوسط. وهذا اسم شائع جدا، خدوا بالكم
+
+342
+00:25:05,180 --> 00:25:13,300
+في الورقة، دراسة حاجة اسمها FMF. الـ MF هذه هي
+
+343
+00:25:13,300 --> 00:25:22,040
+Mediterranean Fever. والـ F هذه familial. أنتو
+
+344
+00:25:22,040 --> 00:25:24,980
+حاطين الورقة ولا لسه؟ خدوا بالكم إن هذا
+
+345
+00:25:24,980 --> 00:25:49,920
+(Repeated word, likely a transcription error)
+
+346
+00:26:01,800 --> 00:26:04,200
+البكتيريا عبارة عن جرام نيجاتيف كوكاي، بس الله
+
+347
+00:26:06,720 --> 00:26:13,760
+chronically infected domestic animals أو الحيوانات
+
+348
+00:26:13,760 --> 00:26:17,020
+الأليفة، non-motile، non-spore forming.
+
+349
+00:26:17,020 --> 00:26:20,220
+البكتيريا، some species require supplemental carbon
+
+350
+00:26:20,220 --> 00:26:24,280
+dioxide for primary isolation. بدها CO2 for
+
+351
+00:26:24,280 --> 00:26:27,680
+isolation. isolation from clinical specimen
+
+352
+00:26:27,680 --> 00:26:31,400
+requires prolonged incubation. وأنا قلت لكم قد
+
+353
+00:26:31,400 --> 00:26:36,830
+تستمر إلى ستة أسابيع أو ثمانية أسابيع حتى... يعني زيها
+
+354
+00:26:36,830 --> 00:26:39,650
+زي مين؟ زي الـ mycobacteria. فاكرين الـ mycobacteria؟
+
+355
+00:26:39,650 --> 00:26:43,190
+هدول أطول two bacteria احنا درسناهم لحد
+
+356
+00:26:43,190 --> 00:26:45,630
+الآن، اللي هم الـ Mycobacterium tuberculosis
+
+357
+00:26:45,630 --> 00:26:51,950
+بالإضافة إلى الـ Brucella species. Brucella strains
+
+358
+00:26:51,950 --> 00:26:55,070
+always strains، always catalase positive. يعني
+
+359
+00:26:55,070 --> 00:27:00,310
+البكتيريا positive catalase. هذا الشكل التابع لها بالفعل
+
+360
+00:27:00,310 --> 00:27:03,590
+هي cocci بس الـ size صغيرة خالص.
+
+361
+00:27:07,960 --> 00:27:10,860
+transmission primarily animal disease زي ما حكينا
+
+362
+00:27:10,860 --> 00:27:15,740
+هي بالأساس بتصيب الحيوانات، وممكن تسبب للحيوانات
+
+363
+00:27:15,740 --> 00:27:20,700
+abortion and sterility. إجهاض وعقم، أو إجهاض و
+
+364
+00:27:20,700 --> 00:27:25,360
+بعدين عقم، بالتأكيد عشان
+
+365
+00:27:25,360 --> 00:27:30,060
+هي كانوا يسموها contagious animal infectious
+
+366
+00:27:30,060 --> 00:27:38,130
+abortion. يعني الإجهاض المعدي، أنه هذه أجهضت، المعز
+
+367
+00:27:38,130 --> 00:27:41,870
+الجنبها هي كمان أجهضت، فبالتالي في عدوى في
+
+368
+00:27:41,870 --> 00:27:46,330
+الإجهاض، لكن هو ما بقى الأمر، السبب أن العدوى كانت
+
+369
+00:27:46,330 --> 00:27:54,050
+بالبروسيلا اللي بتسبب اللي هو الإجهاض كلهم،
+
+370
+00:27:54,050 --> 00:27:58,120
+الاسم لمرض واحد، الاسم، الـ species لأ لأ
+
+371
+00:27:58,120 --> 00:28:01,720
+ما له علاقة، ما له علاقة. هم كلهم الـ species، أي منهم
+
+372
+00:28:01,720 --> 00:28:07,220
+سببها بتعطينا نفس اللي هو الأعراض. كيف بتنتقل الآن؟
+
+373
+00:28:07,220 --> 00:28:11,420
+هذه نقطة. كيف تنتقل from animal to animal and human
+
+374
+00:28:11,420 --> 00:28:17,400
+by abrasions in skin. يعني واحد مزارع وعنده
+
+375
+00:28:17,400 --> 00:28:21,980
+جروح واحتكاك بحيوان مصاب، تمام؟ ممكن تنتقل عبر الجلد.
+
+376
+00:28:21,980 --> 00:28:26,780
+inhalation، ممكن عبر التنفس. Ingestion of Contaminated
+
+377
+00:28:26,780 --> 00:28:32,100
+Milk and Cheese. هذه very very common لما نصنع أو
+
+378
+00:28:32,100 --> 00:28:37,880
+نبيع حليب غير مبستر، أو نصنع أجبان أو مشتقات للحليب
+
+379
+00:28:37,880 --> 00:28:42,280
+من مصادر مصابة، تمام؟ وأنتم عارفين كيف في المصانع
+
+380
+00:28:42,280 --> 00:28:45,440
+بيشتغلوا؟ يعني مثلا واحد بده يعمل مصنع لبن، إيش
+
+381
+00:28:45,440 --> 00:28:52,480
+بيعمل؟ بيجيب الحليب من مزارع متعددة وبيخلطها، و
+
+382
+00:28:52,480 --> 00:28:56,320
+طبعا بتتم عملية اللي هو البسترة بعد ذلك، لكن لو
+
+383
+00:28:56,320 --> 00:29:00,420
+كانت البسترة مش effective، كل المنتج لو كان واحد من
+
+384
+00:29:00,420 --> 00:29:05,060
+المصادر اللي فيها بروسيلة موجودة، خلاص كل المنتج
+
+385
+00:29:05,060 --> 00:29:09,480
+بيكون فيه بروسيلة. وأنا أذكر، يمكن قبل خمسة عشر سنة
+
+386
+00:29:10,100 --> 00:29:13,600
+صار فينا هنا مجموعة حالات من البروسيلة، وكان لما
+
+387
+00:29:13,600 --> 00:29:18,100
+حققوا في الموضوع، وَرَد أن مصدرها هو جبن محلي
+
+388
+00:29:18,100 --> 00:29:21,940
+أعتقد أنه مستورد من الضفة الغربية، وورد أن
+
+389
+00:29:21,940 --> 00:29:29,560
+ما قدروش يوصلوا للمورد الأساسي لهذه الأجبان، لكن
+
+390
+00:29:29,560 --> 00:29:34,010
+خدوا بالكم، إن شاء الله، هذه البكتيريا هنابيوصفوها
+
+391
+00:29:34,010 --> 00:29:38,130
+في المراجع أن حساسيتها لحمض المعدة، ومع
+
+392
+00:29:38,130 --> 00:29:42,830
+ذلك... ومع ذلك بتنتقل إلينا عبر اللي هو تناول
+
+393
+00:29:42,830 --> 00:29:46,930
+الحليب... تناول... يعني ليش تناول؟ من الأذن ولا من
+
+394
+00:29:46,930 --> 00:29:50,510
+الاسبراطوري؟ من الفم، يعني هتمر عبر المعدة، يعني
+
+395
+00:29:50,510 --> 00:29:54,000
+البكتيريا اللي بتصل للمعدة غالبا هتموت فيها، هتموت.
+
+396
+00:29:54,000 --> 00:29:59,000
+تمام؟ فكيف تنتقل؟ بيقولوا لنا قبل... قبل ما تصل للمعدة
+
+397
+00:29:59,000 --> 00:30:03,260
+ممكن من الـ oroph
+
+445
+00:33:32,740 --> 00:33:37,680
+مباستران، و الباستران كافية لقتل الـ micro أو
+
+446
+00:33:37,680 --> 00:33:43,170
+البروسيلة. طيب، الـ clinical feature of brucellosis
+
+447
+00:33:43,170 --> 00:33:47,050
+إيه الشكل السريري؟ الـ incubation period واحد
+
+448
+00:33:47,050 --> 00:33:50,970
+إلى ثلاث أسابيع. initially influenza-like، نفس الأعراض.
+
+449
+00:33:50,970 --> 00:33:53,550
+طبعاً الـ influenza في البداية، بعدين headache،
+
+450
+00:33:53,550 --> 00:33:57,190
+weakness، weight loss، أرترالجيا (الألم في المفاصل)،
+
+451
+00:33:57,190 --> 00:34:00,570
+liver dysfunction، بيصير فينا ارتفاع في liver
+
+452
+00:34:00,570 --> 00:34:04,680
+enzymes، و undulating fever، رجلنا ارتفاع وانخفاض في
+
+453
+00:34:04,680 --> 00:34:09,140
+درجة الحرارة. okay، fever for weeks and months، قد
+
+454
+00:34:09,140 --> 00:34:12,760
+تستمر العملية بدون علاج إذا لم يعالج المريض. هي
+
+455
+00:34:12,760 --> 00:34:16,080
+عبارة عن مرض مزمن (chronic illness). ممكن يصير فيه تضخم في
+
+456
+00:34:16,080 --> 00:34:19,600
+الـ spleen، ممكن يصير فينا تضخم كمان في اللي هو
+
+457
+00:34:19,600 --> 00:34:23,220
+الكبد، وفينا enlargement للـ lymph node، لأن
+
+458
+00:34:23,220 --> 00:34:26,720
+البكتيريا هذه برضه عندها القدرة على
+
+459
+00:34:26,720 --> 00:34:31,450
+intracellular replication، فبالتالي المكان المفضل
+
+460
+00:34:31,450 --> 00:34:34,150
+تبعها... المكان المفضل تبعها هو الـ
+
+461
+00:34:34,150 --> 00:34:38,090
+reticuloendothelial system. ليش؟ إيش في
+
+462
+00:34:38,090 --> 00:34:41,990
+reticuloendothelial system؟ ماكرو فاج، بتروح خاص
+
+463
+00:34:41,990 --> 00:34:47,610
+ّةً عشان تتكاثر جوا الماكرو فاج. إحدى السنوات كانت
+
+464
+00:34:47,610 --> 00:34:51,470
+وزارة الزراعة في عهد الاحتلال الإسرائيلي... إيش
+
+465
+00:34:51,470 --> 00:34:56,630
+تعمل؟ عشان تشجع المزارعين، تشجع المزارعين أنهم
+
+466
+00:34:56,630 --> 00:35:02,750
+يبلغوا عن الإصابات اللي عندهم من الأبقار، فكانوا
+
+467
+00:35:02,750 --> 00:35:06,750
+يقوموا بعملية تعويض، يعني ياخدوا البقرة المصابة،
+
+468
+00:35:06,750 --> 00:35:13,670
+يذبحوها، ويعوضوا نصف ثمنها للمزارع، وياخدوا الأحشاء
+
+469
+00:35:13,670 --> 00:35:18,330
+تبع الأبقار هذه، تمام؟ اللي من ضمنها الـ liver و الـ
+
+470
+00:35:18,330 --> 00:35:23,620
+spleen وغيرها، وهذه يقدموها ويعطوا الجثة للمزارع،
+
+471
+00:35:23,620 --> 00:35:27,640
+الذبيحة للمزارع، ويشترطوا عليه إذا بده يأكلها،
+
+472
+00:35:27,640 --> 00:35:31,200
+يأكلها مسلوقة، يعني ما يشويهاش ولا... لكن إحنا
+
+473
+00:35:31,200 --> 00:35:35,260
+المزارعين كانوا يتعافوا، فكانوا يرفضوا الذبيحة، لكن
+
+474
+00:35:35,260 --> 00:35:40,770
+لاحظوا لم يقتلوا هم الكبد و الـ spleen، تمام؟ لأنه ده
+
+475
+00:35:40,770 --> 00:35:46,250
+يحتوي على كميات كبيرة. ولأن هذه organs تحتاج حرارة
+
+476
+00:35:46,250 --> 00:35:50,350
+عالية في طهيها، فبالتالي يمكن أن تنجو بعض الـ strings،
+
+477
+00:35:50,350 --> 00:35:53,270
+فكانوا يعني... لكن زي ما حكيت لكم، المزارعين تبعنا
+
+478
+00:35:53,270 --> 00:35:58,150
+كانوا يرفضون أنهم يعني... وكانوا يتخلصوا من الجثة
+
+479
+00:35:58,150 --> 00:36:01,650
+مع باقي الأعضاء، بس أنا حابب أؤكد على الحقيقة، ليش
+
+480
+00:36:01,650 --> 00:36:04,890
+ما كانوا يعطوهم الـ internal organs، عشان... عشان
+
+481
+00:36:04,890 --> 00:36:10,530
+السبب اللي حكيناه قبل قليل. نفس المعلومات، ما فيش شيء
+
+482
+00:36:10,530 --> 00:36:12,470
+جديد أضيفه في هذه اللوحة.
+
+483
+00:36:18,650 --> 00:36:23,010
+الـ lab diagnosis عبارة عن blood sample و blood
+
+484
+00:36:23,010 --> 00:36:25,470
+culture. في هذه الحالة، خذوا بالكم، blood culture،
+
+485
+00:36:25,470 --> 00:36:31,570
+إحنا كنا نتكلم عن أسبوع، عشرة أيام، أربعة عشر يوماً، حد
+
+486
+00:36:31,570 --> 00:36:36,370
+أقصى للـ incubation، بس هنا it should be for at
+
+487
+00:36:36,370 --> 00:36:39,930
+least six weeks، تمام؟ و special blood culture
+
+488
+00:36:48,720 --> 00:36:52,960
+Lymph node and bone marrow biopsy، الـ culture
+
+489
+00:36:52,960 --> 00:37:01,480
+requires 5-10% CO2، يحتاج 5-10% CO2 لمدة ستة أسابيع،
+
+490
+00:37:01,480 --> 00:37:05,800
+بدك يبقى incubation في blood culture، خاصةً
+
+491
+00:37:05,800 --> 00:37:14,060
+تحتوي على... على فكرة، كان فيها وسط رائع جداً اسمه
+
+492
+00:37:14,060 --> 00:37:14,560
+Castaneda
+
+493
+00:37:24,310 --> 00:37:33,030
+هذه عبارة عن... عن زجاجة مضلعة،
+
+494
+00:37:33,030 --> 00:37:36,610
+يعني لها ثلاثة جوانب زي هيك.
+
+495
+00:37:42,950 --> 00:37:46,490
+هذه ثلاثة جوانب مثل الثمانية، وتحتها قاعدة تحت، وتحتها
+
+496
+00:37:46,490 --> 00:37:50,350
+غطاء. الآن في المنتصف اللي عند القاعدة فيه سائل اللي
+
+497
+00:37:50,350 --> 00:37:55,290
+هو liquid media، وعلى أحد الأطراف مصبوب أجار. فيها
+
+498
+00:37:55,290 --> 00:37:58,990
+liquid اللي عند القاعدة، والأجار مصبوب على كل الجانب.
+
+499
+00:37:58,990 --> 00:38:05,400
+هذا، وجواها غاز CO2، تمام؟ و Oxygen، فكانوا يسموها
+
+500
+00:38:05,400 --> 00:38:10,580
+Triphasic. ليش Triphasic؟ لأن فيها solid، فيها
+
+501
+00:38:10,580 --> 00:38:15,060
+liquid، وفيه gas. ليش عملوا الـ solid و الـ liquid؟
+
+502
+00:38:15,060 --> 00:38:18,020
+على فكرة، فكرة ذكية، يعني لو عملوها لكل blood
+
+503
+00:38:18,020 --> 00:38:22,230
+culture بيكون كويسة، ممتازة، لأن أنت بدل ما تعمل
+
+504
+00:38:22,230 --> 00:38:25,430
+subculture، بأنك تفتح الغطاء وتأخذ عينة وتزرعها
+
+505
+00:38:25,430 --> 00:38:29,150
+على blood agar، بس الـ subculture عبارة عن إيه؟ عن
+
+506
+00:38:29,150 --> 00:38:33,250
+أنك تميل الـ bottle، تخلي السائل يلامس مين؟ الـ solid،
+
+507
+00:38:33,250 --> 00:38:37,030
+وترجعه ثانيةً. أي بكتيريا كانت موجودة في السائل، و
+
+508
+00:38:37,030 --> 00:38:40,410
+تسقط على الـ agar، هتكون مستعمرات بعد ذلك. فأنت
+
+509
+00:38:40,410 --> 00:38:45,210
+بتعمل subculture بدون ما تطلع أو تفتح، لأنه فتح
+
+510
+00:38:45,210 --> 00:38:48,390
+الغطاء تبع الـ blood culture، في الغالب إيش بيعمل
+
+511
+00:38:48,390 --> 00:38:52,220
+الشباب؟ بيعمل عملية اللي هو contamination بشكل
+
+512
+00:38:52,220 --> 00:38:57,540
+مستمر. استيلولوجي فيه، طبعاً، الفحص ما نستطيع إلا أن
+
+513
+00:38:57,540 --> 00:39:05,560
+نتكلم عنه، اللي هو الـ rose bengal. أنا
+
+514
+00:39:05,560 --> 00:39:10,470
+بذكركم بثلاثة فحوصات درسناهم، هذه الثلاثة درسنا
+
+515
+00:39:10,470 --> 00:39:14,230
+الـ Widal، فاكرينه الـ Widal؟  تابعه لـ Typhoid، و الـ Ox
+
+516
+00:39:14,230 --> 00:39:17,970
+19 تبع الـ Rickettsia، اللي استخدمنا فيه Protein Strain،
+
+517
+00:39:17,970 --> 00:39:22,450
+وسنة، وهاي الـ rose bengal، هدول الثلاثة... ثلاثة هدول
+
+518
+00:39:22,450 --> 00:39:26,890
+بيطلبوهم الأطباء للمريض لما يكون الـ fever of
+
+519
+00:39:26,890 --> 00:39:31,630
+unknown origin، يعني المصدر مش معروف، fever of
+
+520
+00:39:31,630 --> 00:39:36,690
+unknown origin.
+
+521
+00:39:37,790 --> 00:39:46,010
+fever of unknown origin، يجب نستخدم rose bengal، لأن
+
+522
+00:39:46,010 --> 00:39:51,230
+الـ antigen اللي هي البكتيريا نفسها مصبوغة بصبغة اسمها
+
+523
+00:39:51,230 --> 00:39:57,570
+rose bengal. الـ treatment، ممكن نستخدم ciprofloxacin،
+
+524
+00:39:57,570 --> 00:40:04,210
+وممكن نستخدمها لمدة ستة أسابيع حتى نمنع الانتكاسة،
+
+525
+00:40:04,210 --> 00:40:08,330
+relapse، يعني عودة الـ disease، لأن البكتيريا موجودة
+
+526
+00:40:08,330 --> 00:40:11,670
+في الـ lymph node، موجودة في الـ macrophage، وبتشتغل
+
+527
+00:40:11,670 --> 00:40:16,610
+على شكل دفعات، على شكل دفعات. فأنا بطوّل فترة العلاج
+
+528
+00:40:16,610 --> 00:40:21,230
+ستة أسابيع، حتى أضمن أنه الـ microbe ما يرجع ثانيةً، و
+
+529
+00:40:21,230 --> 00:40:24,470
+المرة الجاية إن شاء الله نكمل بإذن الله، هذه الـ bottle،
+
+530
+00:40:24,470 --> 00:40:28,810
+بس هذه مش ثلاثية، اللحظة هي فيها solid media، وفيه
+
+531
+00:40:28,810 --> 00:40:31,290
+عندي هنا اللي هو liquid media، هذه بيسموها
+
+532
+00:40:31,290 --> 00:40:36,130
+diphasic، ليش فيها diphasic؟ لأن فيها solid و فيها
+
+533
+00:40:36,130 --> 00:40:39,910
+liquid، بس الثالثة اللي قلنا عنها، الثالثة اللي
+
+534
+00:40:39,910 --> 00:40:42,610
+قلنا عنها بيحطوا فيها اللي هو الـ gas، خلاص، نكمل مرة
+
+535
+00:40:42,610 --> 00:40:43,150
+أخرى إن شاء الله.
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/aetzQQ3Ffps_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/aetzQQ3Ffps_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..2a0bdb158aeb92b5c6c7df6d50dee33f3d70fd0e
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/aetzQQ3Ffps_raw.json
@@ -0,0 +1 @@
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"end": 21.69, "word": " الرحيم", "probability": 0.9930013020833334}, {"start": 21.69, "end": 22.55, "word": " موضوعنا", "probability": 0.92080078125}, {"start": 22.55, "end": 22.71, "word": " اليوم", "probability": 0.953857421875}, {"start": 22.71, "end": 22.83, "word": " ان", "probability": 0.36865234375}, {"start": 22.83, "end": 22.99, "word": " شاء", "probability": 0.97998046875}, {"start": 22.99, "end": 23.09, "word": " الله", "probability": 0.958984375}, {"start": 23.09, "end": 23.85, "word": " legionella", "probability": 0.694580078125}, {"start": 23.85, "end": 25.05, "word": " pneumophila", "probability": 0.6353352864583334}, {"start": 25.05, "end": 26.11, "word": " وطبعا", "probability": 0.85009765625}, {"start": 26.11, "end": 26.31, "word": " هي", "probability": 0.7568359375}, {"start": 26.31, "end": 27.11, "word": " ضمن", "probability": 0.992919921875}, {"start": 27.11, "end": 27.63, "word": " سلسلة", "probability": 0.99560546875}, {"start": 27.63, "end": 28.31, "word": " 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{"id": 77, "seek": 177154, "start": 1750.1, "end": 1771.54, "text": "صار فينا هنا مجموعة حلق من البروسيلة وكان لما حققوا في الموضوع ووردوا ان مصدرها هو جبن محلي اعتقد انه مستورد من الضفة الغربية ووردوا انه ماجدروش ييصلوا للمورد الاساسي لهذه الأشبان لكن خدوا بالكم ان شاء الله هذه البكتيريا هنا", "tokens": [9381, 9640, 8978, 8315, 34105, 3714, 7435, 2304, 2407, 27884, 11331, 1211, 4587, 9154, 2423, 26890, 41779, 26895, 3660, 4032, 41361, 5296, 15042, 11331, 4587, 4587, 14407, 8978, 9673, 2407, 11242, 45367, 4032, 13063, 3215, 14407, 16472, 3714, 9381, 3215, 2288, 11296, 31439, 10874, 3555, 1863, 3714, 5016, 20292, 1975, 34268, 28543, 16472, 3224, 3714, 14851, 13063, 3215, 9154, 6024, 114, 5172, 3660, 6024, 118, 25513, 10632, 4032, 13063, 3215, 14407, 16472, 3224, 3714, 26108, 3215, 32887, 8592, 7251, 1829, 36520, 14407, 5296, 19528, 13063, 3215, 2423, 32277, 32277, 1829, 46740, 24192, 16247, 8592, 3555, 7649, 44381, 16490, 3215, 14407, 20666, 24793, 16472, 13412, 16606, 21984, 29538, 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/aetzQQ3Ffps_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/aetzQQ3Ffps_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..a7f318310260dad823a6ca4485f2dfec12eba9ee
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/aetzQQ3Ffps_raw.srt
@@ -0,0 +1,2144 @@
+1
+00:00:20,550 --> 00:00:23,090
+بسم الله الرحمن الرحيم موضوعنا اليوم ان شاء الله
+
+2
+00:00:23,090 --> 00:00:27,630
+legionella pneumophila وطبعا هي ضمن سلسلة
+
+3
+00:00:27,630 --> 00:00:30,490
+البكتيريا الفاستيدياس اللى بتتبع ال gram negative
+
+4
+00:00:30,490 --> 00:00:35,380
+بس اللههذه البكتيريا تعتبر من الميكروبات اللي تم
+
+5
+00:00:35,380 --> 00:00:40,080
+اكتشافها مؤخرا و لو انه 1976 بالنسبة لكم هو زمن
+
+6
+00:00:40,080 --> 00:00:44,400
+قديم لكن هذا الرقم بالنسبة لنا هو رقم حديث او
+
+7
+00:00:44,400 --> 00:00:47,960
+تاريخ حديث لان معظم البكتيريا الممرضة تم اكتشافها
+
+8
+00:00:47,960 --> 00:00:51,300
+و التعرف عليها قبل خمسينيات القرن الماضي وبالتالي
+
+9
+00:00:51,300 --> 00:00:55,760
+بعد خمسينيات القرن الماضي اعتبرها بكتيريا حديثة
+
+10
+00:00:55,760 --> 00:01:01,940
+الها قصة اكتشاف ال .. ال .. ال ..البكتيريا في كان
+
+11
+00:01:01,940 --> 00:01:06,540
+رابطات محاربين قدامى مجتمعين و هاد ال .. ال .. ال
+
+12
+00:01:06,540 --> 00:01:09,960
+.. او .. و هم .. و هم من كبار السن يعنى بعد قدت
+
+13
+00:01:09,960 --> 00:01:14,280
+أيام من اجتماعهم اصيب مجموعة منهم بأعراض pneumonia
+
+14
+00:01:14,280 --> 00:01:17,540
+لكن هاد ال pneumonia atypical بمعنى انها غير نمطية
+
+15
+00:01:17,770 --> 00:01:22,850
+وأحد الأشخاص توفي على إثر هذه الإصابة سمية في تلك
+
+16
+00:01:22,850 --> 00:01:26,950
+الفترة المرض Legionnaire Disease نظرا لل Legion،
+
+17
+00:01:26,950 --> 00:01:28,790
+ال Legion اللي هي الرابط المحاربين القدم اللي
+
+18
+00:01:28,790 --> 00:01:32,370
+حكينا عنها فسموها Legionnaire Disease بعد عدة
+
+19
+00:01:32,370 --> 00:01:37,530
+محاولات تم عزل البكتيريا من ال tissues تبع ال lung
+
+20
+00:01:37,770 --> 00:01:42,710
+للمريض اللي توفيه وسميت البكتيريا Legionella
+
+21
+00:01:42,710 --> 00:01:46,570
+pneumophila Legionella من اسم Legionnaire disease
+
+22
+00:01:46,570 --> 00:01:49,510
+من ال Legion وLegionella pneumophila لإنه عزلت من
+
+23
+00:01:49,510 --> 00:01:55,370
+اللي هو ال lungs طبعا بعد العزل الأول ميكروب اللي
+
+24
+00:01:55,370 --> 00:01:59,310
+اسمه Legionella pneumophila تتابعت عزلات أخرى من
+
+25
+00:01:59,310 --> 00:02:05,230
+أسماء نفس ال genus لكن بأسماء مختلفةالبكتيريا
+
+26
+00:02:05,230 --> 00:02:07,890
+عبارة عن ال gram negative بس اللعي ال staining
+
+27
+00:02:07,890 --> 00:02:12,330
+تبعها هو بال gram stain ضعيف للغاية الا اذا زدنا
+
+28
+00:02:12,330 --> 00:02:15,870
+فترة اللي هو ال staining بالصفرانين بتاع
+
+29
+00:02:15,870 --> 00:02:19,630
+فالصفرانين بنحط لمدة ك counter stay لمدة دقيقة او
+
+30
+00:02:19,630 --> 00:02:23,950
+اقل من دقيقة حتى لكن في حالة البكتيريا دي اذا
+
+31
+00:02:23,950 --> 00:02:27,230
+اردنا ان نصبغها بشكل جيد يجب ان نصبغها لفترات اطول
+
+32
+00:02:27,230 --> 00:02:32,000
+بالصفرانينيعني two to five minutes بيكون جيد
+
+33
+00:02:32,000 --> 00:02:35,240
+التوقيت slow growing ال .. growing البكتيريا احنا
+
+34
+00:02:35,240 --> 00:02:38,660
+بقول إن هي fastidious من اتنين لخمس أيام تتطلب في
+
+35
+00:02:38,660 --> 00:02:42,880
+enriched media تحتوي على شغلتين أساسيات اللي هم
+
+36
+00:02:42,880 --> 00:02:48,260
+cysteine زائد اللي هو ferric ionال culture من
+
+37
+00:02:48,260 --> 00:02:52,880
+البكتيريا قد تظهر بعض الأشكال الغريبة من البكتيريا
+
+38
+00:02:52,880 --> 00:02:57,460
+من ضمنها filamentous forms و swallowing rods
+
+39
+00:02:57,460 --> 00:03:01,240
+swallowing يعني منتفخة بالإضافة إلى كما ذكرنا
+
+40
+00:03:01,240 --> 00:03:04,700
+bizarre forms أشكال متنوعة ومختلفة
+
+41
+00:03:08,100 --> 00:03:11,600
+كمان البكتيريا بتنتج soluble pigment لما بنزرعها
+
+42
+00:03:11,600 --> 00:03:15,180
+على اللي هو الوسط المشهور اللي اسمه filigarman هاي
+
+43
+00:03:15,180 --> 00:03:19,480
+اول وسط ذكرناه للبكتيريا اسمه filigarman البكتيريا
+
+44
+00:03:19,480 --> 00:03:22,780
+بتتميز انها بتنتج brownish discoloration او
+
+45
+00:03:22,780 --> 00:03:27,220
+pigmentation على هذا الوسط وهتتميز بانها water
+
+46
+00:03:27,220 --> 00:03:31,260
+soluble زي ال pigment زبعة pseudomonas erginosa
+
+47
+00:03:32,540 --> 00:03:37,320
+البكتيريا كمان أظهرت مقدرة أو نمو جيد على وسط اسمه
+
+48
+00:03:37,320 --> 00:03:42,060
+charcoal yeast extract media هنشوف في لوحات لاحقة
+
+49
+00:03:42,060 --> 00:03:46,960
+اسم وضيف له حرف ال بي بافرد charcoal yeast extract
+
+50
+00:03:46,960 --> 00:03:52,760
+عشان نغير او نقلل من التغير او ال fluctuation اللي
+
+51
+00:03:52,760 --> 00:03:57,420
+هو سموها التذبذب في اللي هو ال pH تبع الوسط فعملنا
+
+52
+00:03:57,420 --> 00:04:01,210
+له bufferingبدي أحكي عن ال yeast extract، ال yeast
+
+53
+00:04:01,210 --> 00:04:05,530
+extract هي component موجودة في كثير من الأوساط
+
+54
+00:04:05,530 --> 00:04:09,990
+الزراعية، ليش ال yeast extract؟ ال yeast extract
+
+55
+00:04:09,990 --> 00:04:14,070
+تعتبر source أو rich source of vitamins and
+
+56
+00:04:14,070 --> 00:04:17,700
+mineralsوبالتالي ممكن بتعرفوا حتى بعض المزارعين
+
+57
+00:04:17,700 --> 00:04:23,300
+بيحطوا ال yeast نفسها على بعض المزروعات ك growth
+
+58
+00:04:23,300 --> 00:04:28,900
+enhancing fertilizer تمام؟ وفي بعض المو .. ال ..
+
+59
+00:04:28,900 --> 00:04:34,890
+ال .. ال .. يعني المنتجات زي الكوسة والخيارإذا
+
+60
+00:04:34,890 --> 00:04:40,310
+عُلجت بهذه المستخلصات بتعطينا over growth، growth
+
+61
+00:04:40,310 --> 00:04:44,310
+مش طبيعي وللأسف هذا يعني برضه كمان يعتبر نوع من
+
+62
+00:04:44,310 --> 00:04:48,870
+الغش لكن الشهد في الموضوع إن ال yeast extract is a
+
+63
+00:04:48,870 --> 00:04:53,830
+rich source of vitamins and minerals النمو ممكن
+
+64
+00:04:53,830 --> 00:04:59,490
+يحدث بشكل جيد على بيئة هوائية في ظل 2.5 و قد تصل
+
+65
+00:04:59,490 --> 00:05:05,730
+إلى 3 و قد تصل إلى 4 CO2most strains are
+
+66
+00:05:05,730 --> 00:05:09,230
+flagellated يعني معظمها متحركة ال laboratory
+
+67
+00:05:09,230 --> 00:05:14,250
+diagnosis جوا ان احنا it requires cysteine and
+
+68
+00:05:14,250 --> 00:05:20,690
+iron salts باستخدام ال bcye جوا ان احنا ال b إضافة
+
+69
+00:05:20,690 --> 00:05:24,050
+كانت لكلمة buffered yeast او charcoal yeast
+
+70
+00:05:24,050 --> 00:05:28,010
+extract أجارهذه النقطة كتير مهمة ان ال antibiotics
+
+71
+00:05:28,010 --> 00:05:31,730
+غالبا تضعف لهذا الوسط ت inhibit non fastidious
+
+72
+00:05:31,730 --> 00:05:35,130
+organism طبعا من المنطقية شباب بكتيريا slow
+
+73
+00:05:35,130 --> 00:05:40,630
+growing two to five two to five days requirement
+
+74
+00:05:40,630 --> 00:05:44,290
+for growthلما يكون معها بكتيريا أخرى زي
+
+75
+00:05:44,290 --> 00:05:47,150
+Staphylococcus aureus أو Epidermis أو Escherichia
+
+76
+00:05:47,150 --> 00:05:50,470
+coli والتانين نحطهم على نفس الوسط والوسط غانى
+
+77
+00:05:50,470 --> 00:05:54,090
+للتانين ومناسب للتانين مالحينمو ال non fastidious
+
+78
+00:05:54,090 --> 00:05:58,830
+وإذا نمتت ال non fastidious فغالبا هتؤثر على ال
+
+79
+00:05:58,830 --> 00:06:02,430
+fastidious من أي ناحية من ناحيتينرقم واحد ان
+
+80
+00:06:02,430 --> 00:06:06,770
+الغذاء هيستهلك رقم اتنين ال pH بالظبط ال waste
+
+81
+00:06:06,770 --> 00:06:11,010
+products او ال pH metabolism او ال pH التغيير ال
+
+82
+00:06:11,010 --> 00:06:13,630
+pH الناجح على ال metabolism برضه هيأثر على النمو
+
+83
+00:06:13,630 --> 00:06:17,050
+الأولى فممكن نضيف بعض ال antibiotics they grow
+
+84
+00:06:17,050 --> 00:06:21,390
+aerobically or grow using three to five percent
+
+85
+00:06:21,390 --> 00:06:27,320
+CO2 at 35 for three to five daysالـ optimum pH 6.9
+
+86
+00:06:27,320 --> 00:06:30,500
+كولينيز are small within .. small with a
+
+87
+00:06:30,500 --> 00:06:32,900
+cristalline like ground glass appearance يعني
+
+88
+00:06:32,900 --> 00:06:37,440
+المستعمرات بتكون صغيرة غالبا بيكون فيها زي بلورات
+
+89
+00:06:37,440 --> 00:06:41,060
+الزجاج المكسر أو المطحون نسميه
+
+90
+00:06:43,700 --> 00:06:47,620
+مش كتير الصورة هذه تقنية لكن هي أبقى عن macro
+
+91
+00:06:47,620 --> 00:06:51,440
+virus بتحتوي على الميكروب والميكروب له المقدرة على
+
+92
+00:06:51,440 --> 00:06:55,860
+أنه can exist intracellularly هو مش obligate
+
+93
+00:06:55,860 --> 00:06:59,480
+intracellular لكن facultative بمعنى أنه can grow
+
+94
+00:06:59,480 --> 00:07:02,480
+outside and insideهو دليل على ذلك أنه بينمو على
+
+95
+00:07:02,480 --> 00:07:07,130
+الأوساط الزراعية العاديةهذه الصورة الرائعة اللي هي
+
+96
+00:07:07,130 --> 00:07:10,730
+ال fluorescent microscopy ويمكن هي الآن التقنية
+
+97
+00:07:10,730 --> 00:07:14,290
+الأشهر في التعرف على البكتيريا و خاصة إنه فيه
+
+98
+00:07:14,290 --> 00:07:19,570
+strains مختلفة و إذا بتلاحظوا البكتيريا هي المضيقة
+
+99
+00:07:19,570 --> 00:07:24,970
+و ال background كلها معتمة بسبب إنه البكتيريا صبغت
+
+100
+00:07:24,970 --> 00:07:26,470
+ب fluorescent antibody
+
+101
+00:07:30,210 --> 00:07:33,270
+من ال characteristics المهمة جدا لهذه البكتيريا
+
+102
+00:07:33,270 --> 00:07:38,230
+انها weak oxidase بسطف لكن strong catalase بسطف
+
+103
+00:07:38,230 --> 00:07:43,150
+weak oxidase لكن strong catalase it can liquefy
+
+104
+00:07:43,150 --> 00:07:49,130
+جيلاتين it also capable of hydrolyzing hippurates
+
+105
+00:07:49,130 --> 00:07:53,170
+هذه نقطة كتير مهمة لأن كل ال legionella الأخرى ال
+
+106
+00:07:53,170 --> 00:07:57,130
+legionellas الأخرى are negative فبنقول ان هذه
+
+107
+00:07:57,130 --> 00:08:02,960
+الفحوصاتالمميزة للليجونيلة بشكل عام وهذه المميزة
+
+108
+00:08:02,960 --> 00:08:06,480
+للليجونيلة النيموفيلة ان عندها المقدر على تعمل
+
+109
+00:08:06,480 --> 00:08:10,320
+hydrolysis للهيبيوريت بينما باقي الليجونيلة غير
+
+110
+00:08:10,320 --> 00:08:12,500
+قادرة على تحليل الهيبيوريت
+
+111
+00:08:18,250 --> 00:08:22,170
+ما الذي يجعل هذه البكتيريا قادرة على إحداث المرض
+
+112
+00:08:22,170 --> 00:08:25,050
+يعني إيش ال virulence factors أو ال pathogenic
+
+113
+00:08:25,050 --> 00:08:28,450
+determinants لهذه البكتيريا رقم واحد its ability
+
+114
+00:08:28,450 --> 00:08:34,130
+to produce large amount of proteolytic enzymesرقم
+
+115
+00:08:34,130 --> 00:08:36,470
+اتنين عندها two types of toxins term
+
+116
+00:08:36,470 --> 00:08:40,130
+characterization لهم او تعمل تعرف عليهم رقم واحد x
+
+117
+00:08:40,130 --> 00:08:44,730
+-toxin وهذا ال x-toxin لما فحصوه على ال animal red
+
+118
+00:08:44,730 --> 00:08:47,870
+blood cell لجوه بيعمل license لل red blood cells
+
+119
+00:08:47,870 --> 00:08:52,810
+التاني cytotoxin برضه لجوه effect على خلايا ال
+
+120
+00:08:52,810 --> 00:08:56,850
+laboratory animals بمعنى ان هاد البكتيريا بتنتج
+
+121
+00:08:57,740 --> 00:09:01,460
+protolytic enzymes واعتقد انه مر علينا قبل هيكد
+
+122
+00:09:01,460 --> 00:09:05,080
+كتير من البكتيريا احد اهم ال virulence factors
+
+123
+00:09:05,080 --> 00:09:08,420
+سبعتها ال protolytic enzymes وده بتذكروا ال flesh
+
+124
+00:09:08,420 --> 00:09:11,700
+eating بكتيريا فاكرينها؟ قولنالكوا انه صار عندها
+
+125
+00:09:11,700 --> 00:09:15,060
+المقدرة على إنتاج كمية كبيرة من ال protolytic
+
+126
+00:09:15,060 --> 00:09:20,640
+enzymesالـ Clinical Manifestation بيقولنا انه بعد
+
+127
+00:09:20,640 --> 00:09:23,620
+اتنين لعشر أيام incubation period يبقى ال
+
+128
+00:09:23,620 --> 00:09:27,080
+incubation period من اتنين لعشر أيام after
+
+129
+00:09:27,080 --> 00:09:31,280
+exposure with brief prodrome او prodrome of
+
+130
+00:09:31,280 --> 00:09:34,260
+malaria and headache followed rapidly by
+
+131
+00:09:34,260 --> 00:09:38,460
+prostration and high feverهذه ال .. ال .. ال .. ال
+
+132
+00:09:38,460 --> 00:09:42,580
+symptoms نفسها اللي بيشوفها في الانفلوانزا بمعنى
+
+133
+00:09:42,580 --> 00:09:46,280
+they are non specific symptoms .. non specific
+
+134
+00:09:46,280 --> 00:09:50,100
+symptoms لكن ال specific symptoms دي في المرحلة
+
+135
+00:09:50,100 --> 00:09:53,300
+اللي بعديهابتميز بـ rigorous cough، dyspnea
+
+136
+00:09:53,300 --> 00:09:56,820
+اختناق، uretic and abdominal pain، vomiting،
+
+137
+00:09:56,820 --> 00:10:01,460
+diarrhea and unexplained encephalopathy هذه كلها
+
+138
+00:10:01,460 --> 00:10:07,560
+النقاط بتكون ظاهرة في اللي هو ال specific stage لل
+
+139
+00:10:07,560 --> 00:10:14,040
+diseaseطبعا كونه بتكلم عن احنا lungs و pneumonia و
+
+140
+00:10:14,040 --> 00:10:16,960
+ايه typical pneumonia تمام يبقى العينة الممثلة
+
+141
+00:10:16,960 --> 00:10:21,260
+هتكون ال sputum لكن بيقولنا انه ال gram staining
+
+142
+00:10:21,260 --> 00:10:24,800
+في حالة ال legionella pneumophila is not
+
+143
+00:10:24,800 --> 00:10:29,120
+diagnostic of no value مالوش اي قيمةتعالى نشوف
+
+144
+00:10:29,120 --> 00:10:33,520
+المختبر غير ال microbiology هل يمكن أن يساعدنا في
+
+145
+00:10:33,520 --> 00:10:37,180
+عملية تشخيص ال legionella nemophila ولا لأ نطلع مع
+
+146
+00:10:37,180 --> 00:10:42,060
+بعض اول finding leukocytosis رقم اتنين في عندي
+
+147
+00:10:42,060 --> 00:10:47,480
+elevated ESR رقم تلاتة في عندي بروتينورياو
+
+148
+00:10:47,480 --> 00:10:51,960
+hematoria تمام؟ hematoria فين دي abnormal serum
+
+149
+00:10:51,960 --> 00:10:54,400
+enzyme determinations؟ ايش اني abnormal serum
+
+150
+00:10:54,400 --> 00:10:57,680
+enzymes؟ يعني لو انت عايز تعمل liver function test
+
+151
+00:10:57,680 --> 00:11:02,660
+او kidney function test او حتى cardiac function
+
+152
+00:11:02,660 --> 00:11:08,650
+test هتلاقي ان ال enzymes are highly elevatedسبب
+
+153
+00:11:08,650 --> 00:11:13,030
+الوفاء الرئيسي في اللي جنون الليموفيلة غالبا اما
+
+154
+00:11:13,030 --> 00:11:16,630
+respiratory failure and shock هدول السابين
+
+155
+00:11:16,630 --> 00:11:27,030
+الرئيسين للوفيه الترانزميشن
+
+156
+00:11:27,030 --> 00:11:31,770
+هذا فيه صحيح هو مكتوب via respiratory tract لكن مش
+
+157
+00:11:31,770 --> 00:11:36,470
+person to personمش person to person واحدة نقطة يدى
+
+158
+00:11:36,470 --> 00:11:40,410
+بقى النقف عندها مطولا لإنه أول مرة تمر معانا
+
+159
+00:11:40,410 --> 00:11:45,110
+respiratory ومش person to person respiratory أنا
+
+160
+00:11:45,110 --> 00:11:47,830
+لازم أخدها من environmental source من
+
+161
+00:11:47,830 --> 00:11:51,610
+environmental source طب لو أنا أخدتها وصار عندى
+
+162
+00:11:51,610 --> 00:12:00,710
+infection وكحيت لآخرين واخدوها لا يصابوا كيف
+
+163
+00:12:00,710 --> 00:12:01,710
+تفسروا ذلك؟
+
+164
+00:12:05,780 --> 00:12:10,340
+كمان مرة انه person to person transmission is not
+
+165
+00:12:10,340 --> 00:12:13,960
+possible لكن environment to person is possible
+
+166
+00:12:23,060 --> 00:12:26,620
+نفس الكلام هو هذا الكلام الصحيح أو التفسير المنطقي
+
+167
+00:12:26,620 --> 00:12:29,780
+الصحيح ليس بالضرورة التفسير الصحيح وانما المنطقي
+
+168
+00:12:29,780 --> 00:12:33,420
+الصحيح انه في ال environment يبدو انه بيصير لها
+
+169
+00:12:33,420 --> 00:12:38,380
+يعني changes بتاخد changes معينة بيصير more
+
+170
+00:12:38,380 --> 00:12:43,200
+virulent لل transmission للاخرين بينما من الإنسان
+
+171
+00:12:43,200 --> 00:12:45,840
+خلاص يبدو انها تعتمد على ال machinery تبعها
+
+172
+00:12:45,840 --> 00:12:49,760
+الإنسان وبيكون اقل virulent في انها تنتقل من إنسان
+
+173
+00:12:49,760 --> 00:12:54,310
+إلى إنسانالـ specimen should be handled with care
+
+174
+00:12:54,310 --> 00:12:58,130
+in a biological safety cabinet العينات ممكن ناخد
+
+175
+00:12:58,130 --> 00:13:02,830
+lung biopsy or autopsy وفي فرق بين ال autopsy و ال
+
+176
+00:13:02,830 --> 00:13:06,450
+biopsy شو هو ال autopsy؟ ال autopsy العينة بعد موت
+
+177
+00:13:06,450 --> 00:13:09,930
+المريض اللي هي في عملية تشريح المريض ال biopsy
+
+178
+00:13:09,930 --> 00:13:13,790
+اللي هي عينة تأخذ من نفس العينة تأخذ من اللي هو
+
+179
+00:13:13,790 --> 00:13:19,290
+المريض الحالي انتوا عندكوا اليوم امتحان معمل اظن
+
+180
+00:13:19,290 --> 00:13:26,920
+ايه؟ معمل microOkay لأن أحد أسباب رفض العينات في
+
+181
+00:13:26,920 --> 00:13:30,520
+مختبر ال microbiology استلام العينة في formalin
+
+182
+00:13:30,520 --> 00:13:35,300
+صح؟ لو جاتك عينة فيها tissue و فيها formalin
+
+183
+00:13:35,300 --> 00:13:40,400
+تقبلها ال culture؟ تقبلها؟لا تستطيع أنك تقبلها لأن
+
+184
+00:13:40,400 --> 00:13:44,980
+ال formalin بيكون قتل البكتيريا لكن هنا بيقولنا a
+
+185
+00:13:44,980 --> 00:13:47,880
+representative sample of the autopsy او ال biopsy
+
+186
+00:13:47,880 --> 00:13:52,000
+should be placed in 10% neutral formalin for
+
+187
+00:13:52,000 --> 00:13:55,140
+direct الانهاي السبب for direct fluorescent
+
+188
+00:13:55,140 --> 00:13:59,460
+antibody and histopathological examination مش لغرض
+
+189
+00:13:59,460 --> 00:14:05,510
+ال cultureculture يرفض العينات أو ترفض العينات
+
+190
+00:14:05,510 --> 00:14:08,670
+اللى موجودة فيه اللى هو ال formalin لأنه ال
+
+191
+00:14:08,670 --> 00:14:11,970
+formalin معروف عنه fixative بيقتل كل الميكروبات
+
+192
+00:14:11,970 --> 00:14:16,550
+لكن هنا لو بدى اعمل fluorescent staining او بدى
+
+193
+00:14:16,550 --> 00:14:19,150
+اعمل histopathological examination للعينة بحتاج
+
+194
+00:14:19,150 --> 00:14:23,510
+انه نعملها fixation في ال formalinممكن كمان نوع
+
+195
+00:14:23,510 --> 00:14:26,330
+تاني من العينات غير ال ال ال ال ال ال ال ال ال ال
+
+196
+00:14:26,330 --> 00:14:26,470
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+197
+00:14:26,470 --> 00:14:26,610
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+198
+00:14:26,610 --> 00:14:28,430
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+199
+00:14:28,430 --> 00:14:31,250
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+200
+00:14:31,250 --> 00:14:31,750
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+201
+00:14:31,750 --> 00:14:32,790
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+202
+00:14:32,790 --> 00:14:33,690
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+203
+00:14:33,690 --> 00:14:33,730
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+204
+00:14:33,730 --> 00:14:34,750
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+205
+00:14:34,750 --> 00:14:34,750
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+206
+00:14:34,750 --> 00:14:35,630
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+207
+00:14:35,630 --> 00:14:37,930
+ال ال ال ال الممكن ناخد
+
+208
+00:14:49,970 --> 00:14:54,890
+في من ضمن ال .. ال .. الاشياء اللي هي respiratory
+
+209
+00:14:54,890 --> 00:15:01,570
+therapy equipments يعني بعض الأجهزة المستخدمة في
+
+210
+00:15:01,570 --> 00:15:05,810
+العلاج .. العلاج لل .. للتنفس قد تنقل اللي هو ال
+
+211
+00:15:05,810 --> 00:15:10,350
+microbe طيب احكلكوا شغل كمان مهم كتير في الدنيا
+
+212
+00:15:10,350 --> 00:15:14,830
+فيها اسمه water jacket jacket يعني جاكيت اه كتير
+
+213
+00:15:14,830 --> 00:15:20,310
+من المكانبنبرد او بنسخن عبر ال water jacket كيف ال
+
+214
+00:15:20,310 --> 00:15:23,690
+water jacket يعني؟ يعني عندي انا اناء على سبيل
+
+215
+00:15:23,690 --> 00:15:29,730
+المثال سطوانة بروحنا عاملين كمان احنا وراها على
+
+216
+00:15:29,730 --> 00:15:34,010
+طول اناء الفرق بينهم مثلا خمسة صنطي الى عشرة صنطي
+
+217
+00:15:34,010 --> 00:15:39,390
+وبتعب هذا الاناء ايه؟ ميه سيبك ميه ميه برد ومش ميه
+
+218
+00:15:39,390 --> 00:15:45,600
+بردةفي الآخر هي ميّه الان ممكن نستخدمها لل heating
+
+219
+00:15:45,600 --> 00:15:52,750
+أو ممكن نستخدمها coolingطبعا water will circulate
+
+220
+00:15:52,750 --> 00:15:58,630
+غالبا هذه الميه مخزن رائع جدا لمن؟ لل Legion لليش؟
+
+221
+00:15:58,630 --> 00:16:02,230
+لأن الحرارة تبعتها مابتصلش لل boiling ولا بتصلش لل
+
+222
+00:16:02,230 --> 00:16:05,470
+freezing بتظلها خمسين خمسة واربعين واحدة درجة
+
+223
+00:16:05,470 --> 00:16:10,430
+رائعة جدا لنمو اللي هو البكتيريا فبسموها هذه اللي
+
+224
+00:16:10,430 --> 00:16:15,330
+هو cooling towers أو الأبراج تبعتها اللي هو التبرج
+
+225
+00:16:20,980 --> 00:16:25,280
+بالنسبة لل diagnoses احنا بنشخص المرض عبر ال
+
+226
+00:16:25,280 --> 00:16:28,680
+clinical picture بالاضافة الى isolation and
+
+227
+00:16:28,680 --> 00:16:32,080
+identification of Legionella from clinical
+
+228
+00:16:32,080 --> 00:16:36,420
+specimen والعزل بيتم اما على artificial media زي
+
+229
+00:16:36,420 --> 00:16:39,920
+philigorman او ال buffered charcoal yeast extract
+
+230
+00:16:39,920 --> 00:16:44,240
+تمام او على guinea pigs اللي هم فقران تجارب
+
+231
+00:16:44,240 --> 00:16:48,960
+حيوانات تجاربأو Embryonated Hens Egg ها دي ال
+
+232
+00:16:48,960 --> 00:16:52,340
+Genie Pigs حيوانات صح و ها دي اللي هي ال
+
+233
+00:16:52,340 --> 00:16:55,780
+Embryonated Eggs اللي هي ال بيض اللي موجود في
+
+234
+00:16:55,780 --> 00:16:58,440
+جنيني اللي بيستخدمه للفيروسات بيستخدمه للفيروسات
+
+235
+00:16:58,440 --> 00:17:02,280
+لما واحد بيعرف انه عنده 3 خيارات Artificial Media
+
+236
+00:17:02,280 --> 00:17:07,540
+ولا Genie Pigs ولا Hens Egg Embryonated مين
+
+237
+00:17:07,540 --> 00:17:12,470
+بيختار؟الـ Artificial Media لأنه لا فيها Suffering
+
+238
+00:17:12,470 --> 00:17:15,750
+للحيوانات ولا فيها تعذيب للحيوانات ولا فيها
+
+239
+00:17:15,750 --> 00:17:20,050
+الإعدادات المطلوبة المعقدة للتعامل مع ال
+
+240
+00:17:20,050 --> 00:17:25,120
+Embryonated Hensطريقة تانية في التشخيص to
+
+241
+00:17:25,120 --> 00:17:29,820
+demonstrate a four-fold increase in antibody titer
+
+242
+00:17:29,820 --> 00:17:33,960
+between two stages stage one و stage two ايش stage
+
+243
+00:17:33,960 --> 00:17:37,420
+one؟ اللي هي ال acute stage الا acute stage لما
+
+244
+00:17:37,420 --> 00:17:42,030
+بتكون الاعراض maximumفي مرحلة سمناها Convalescent
+
+245
+00:17:42,030 --> 00:17:45,870
+Stage Convalescent Stage معناها مرحلة التماثل
+
+246
+00:17:45,870 --> 00:17:50,510
+للشفاء أو النقاها الآن طب إذا هو بقولنا increase
+
+247
+00:17:50,510 --> 00:17:55,050
+in antibody titer مجدش ال increase هي ده four fold
+
+248
+00:17:55,050 --> 00:17:59,490
+أربع أضعاف ما بين مرحلة ال acute و ال convalescent
+
+249
+00:17:59,490 --> 00:18:01,410
+طب و ال convalescent يعني شوف هي ايش بدنا في
+
+250
+00:18:01,410 --> 00:18:06,730
+التشخيص؟ ايش بدنا في التشخيص؟ ايش بيسموا التشخيص
+
+251
+00:18:06,730 --> 00:18:08,210
+في هذا الحالة؟ Retro
+
+252
+00:18:11,400 --> 00:18:16,280
+expective diagnosis يعني غالبا المريض نفسه
+
+253
+00:18:16,280 --> 00:18:20,740
+مابيستفيد منه مابيستفيدش منه لكن و مع ذلك احنا
+
+254
+00:18:20,740 --> 00:18:25,640
+بنشجع بنقول انه سجلنا حالة اعطيكم مثال واضح هل
+
+255
+00:18:25,640 --> 00:18:33,740
+هناك Legionella في قطاع غزة؟ ليش قلت لأ؟
+
+256
+00:18:36,520 --> 00:18:40,180
+حسب الإحصائيات انه لأ انه مافيش ولا واحدة لكن في
+
+257
+00:18:40,180 --> 00:18:44,680
+الآخر انا بقولك ان كلامك صحيح مافيشيلها اي سجل في
+
+258
+00:18:44,680 --> 00:18:48,500
+السجلات التقارير ال regional هل هذا يعني انها غير
+
+259
+00:18:48,500 --> 00:18:49,240
+موجودة؟
+
+260
+00:18:51,650 --> 00:18:56,170
+under diagnosis او misdiagnosed او اصلا it is not
+
+261
+00:18:56,170 --> 00:18:58,870
+looked for مابندورش عليها اساسا في ال diagnosis
+
+262
+00:18:58,870 --> 00:19:03,190
+وممكن يشفى المريض باستخدام simple antibiotics زي
+
+263
+00:19:03,190 --> 00:19:07,290
+الارتروميسين دون معرفة التشخيص وبالتالي انا طالما
+
+264
+00:19:07,290 --> 00:19:10,430
+ما ..الان ماعنديش سجلات ان في عندي Legionella
+
+265
+00:19:10,430 --> 00:19:14,030
+pneumophila او Legionellosis هل انا كوزارة الصحة
+
+266
+00:19:14,030 --> 00:19:17,960
+بعمل حساباتيفي الخطط تبعتي على مكافحة هذا المرض
+
+267
+00:19:17,960 --> 00:19:21,080
+ماعملش لإنه مش عارف أنه أصلا موجودة في هذا
+
+268
+00:19:21,080 --> 00:19:26,120
+البكتيريا فبعض الأحيان عدم المعرفة شيء مريح صح لكن
+
+269
+00:19:26,120 --> 00:19:31,520
+مريح لمن يفكر أو لمن يبدر الجهد لكن غير مريح للناس
+
+270
+00:19:31,520 --> 00:19:35,560
+اللي مقتنع بهم اللي هم الشعب اللي بتلقى الخدمات
+
+271
+00:19:35,560 --> 00:19:36,000
+الصحية
+
+272
+00:19:38,630 --> 00:19:41,090
+Demonstration of the organism in clinical specimen
+
+273
+00:19:41,090 --> 00:19:44,390
+by DFA DFA هو الـ Direct Fluorescent Antibody Test
+
+274
+00:19:44,390 --> 00:19:46,750
+شفت الصورة اللي شفناها جاب شوية البكتيرا
+
+275
+00:19:46,750 --> 00:19:50,830
+الفلوريسنت لو أخدنا عينا من المريض الاسبوتام على
+
+276
+00:19:50,830 --> 00:19:54,030
+سبيل المثال أو ال tissue اللي عملناها في فرمالين و
+
+277
+00:19:54,030 --> 00:19:57,190
+عملنا منه section و عملنا له fixation على الشريحة
+
+278
+00:19:57,190 --> 00:20:00,830
+و صبغناها ب fluorescent antibody و بعدين عملنا
+
+279
+00:20:00,830 --> 00:20:04,320
+عملية washingإذا البكتيريا موجودة يا شباب ال
+
+280
+00:20:04,320 --> 00:20:07,680
+Antibody هيرتبط فيها وإذا ال Antibody رتبط فيها
+
+281
+00:20:07,680 --> 00:20:12,040
+تحت ال fluorescent microscope سارة هذه البكتيريا و
+
+282
+00:20:12,040 --> 00:20:16,560
+هذا عملية صحيح ممتازة يعني ممكن احنا لو ماعناش
+
+283
+00:20:16,560 --> 00:20:19,660
+الإمكانيات تبع ال culture و ال identification بال
+
+284
+00:20:19,660 --> 00:20:22,980
+conventional technique نلجأ إلى هذا بالإضافة إلى
+
+285
+00:20:22,980 --> 00:20:25,640
+أن معظم الميكروبات اليوم و من ضمنها ال Legionella
+
+286
+00:20:25,640 --> 00:20:30,860
+could be diagnosed by PCR و ال PCR أصبح تقنية يا
+
+287
+00:20:30,860 --> 00:20:37,240
+شبابسهلة ومتوفرة ومش بس سهلة متوفرة كمان صارت
+
+288
+00:20:37,240 --> 00:20:41,200
+تضاهف السعر او اقل حتى من اللي هو ال culture
+
+289
+00:20:41,200 --> 00:20:46,860
+وبالتالي يعني ال .. ال .. ال .. الأشياء اللي كانت
+
+290
+00:20:46,860 --> 00:20:50,640
+معيقة من .. من التكلفة العالية أصبح حالها اليوم
+
+291
+00:20:50,640 --> 00:20:53,860
+اللي هو ال .. ال .. ال PCR زي ما حكيتلكوا بالنسبة
+
+292
+00:20:53,860 --> 00:20:57,940
+ل treatment ل drug of choice تبعها هو ال .. ال ..
+
+293
+00:20:57,940 --> 00:21:03,190
+ال erythromycinطبعا هذا بينهي الجزء الأول من
+
+294
+00:21:03,190 --> 00:21:07,290
+محاضرتنا اليوم اللي هو عن ال legionella وسنتقل ان
+
+295
+00:21:07,290 --> 00:21:13,330
+شاء الله الى الجزء الثاني المتعلق بيه لبروسيلاليس
+
+296
+00:21:13,330 --> 00:21:18,010
+من العنوان اللي أمامك هذا أي من الصفات المشتركة
+
+297
+00:21:18,010 --> 00:21:21,330
+بين الأسماء أو بين الأسم الأول والأسماء الأخرى
+
+298
+00:21:21,330 --> 00:21:25,430
+الأسماء الأخرى اللي موجودة تريبونيما وليبتو سبايرا
+
+299
+00:21:25,430 --> 00:21:30,490
+و بوريليا تتميز بأنها spiral microorganism بينما
+
+300
+00:21:30,490 --> 00:21:34,110
+البروسيلا هي تابعة المجموعة اللي كنا بنناقشها
+
+301
+00:21:34,110 --> 00:21:35,630
+سابقا ايش هي؟
+
+302
+00:21:43,910 --> 00:21:46,390
+يمكن احنا موضوعنا اللي هو البروسيلا و ليس
+
+303
+00:21:46,390 --> 00:21:50,530
+الأخريات، الأخريات اللي هنتخصله ان شاء الله محاضرة
+
+304
+00:21:50,530 --> 00:21:54,230
+تانية الصورة هذه اللي قدامكم معبرة نوعا ما انه ال
+
+305
+00:21:54,230 --> 00:22:01,330
+microbe ارتبط بيه اللي هو الحليب لكن ليسليس هو
+
+306
+00:22:01,330 --> 00:22:07,730
+المصدر الوحيد لل infection لكن هذه البكتيريا حقيقة
+
+307
+00:22:07,730 --> 00:22:14,950
+بتشكل مرض خطير جدا و بتشكل كمان خسارة اقتصادية لأن
+
+308
+00:22:14,950 --> 00:22:17,730
+هذا يعتبر من الأمراض المشتركة، الأمراض المشتركة
+
+309
+00:22:17,730 --> 00:22:22,860
+اللي هي ما بين الحيوان و بين الإنسانالها اسم هنا
+
+310
+00:22:22,860 --> 00:22:28,340
+بروسيلا البكتيريا ال disease الو أكتر من اسم أحد
+
+311
+00:22:28,340 --> 00:22:35,060
+الأسماء المشهورة undulant fever لأن الحمى ترتفع و
+
+312
+00:22:35,060 --> 00:22:41,980
+تنخفض فبالتالي لو عملنا chart للمريض هلاجي أن
+
+313
+00:22:41,980 --> 00:22:47,420
+الحرارة تطلع فوق و تنزل تحت فال chart بتكون عاملة
+
+314
+00:22:47,420 --> 00:22:49,960
+بهذا الشكل فسموها undulant fever
+
+315
+00:22:53,780 --> 00:22:56,660
+medically important species نقل الأسماء مع بعض
+
+316
+00:22:56,660 --> 00:23:00,760
+سهلين كتير أسماءهم بوردتيلة أبورتس بوردتيلة
+
+317
+00:23:00,760 --> 00:23:05,840
+ميلتنسس بوردتيلة كانس بوردتيلة بروسيلة بروسيلة
+
+318
+00:23:05,840 --> 00:23:10,660
+أبورتس بروسيلة ميلتنسس بروسيلة كانس بروسيلة سويس
+
+319
+00:23:10,660 --> 00:23:14,980
+الاهل بروسيلة أبورتس can infect cattle cattle ليها
+
+320
+00:23:14,980 --> 00:23:20,680
+الماشية بشكل عام صحيح ومن هنا اسم أبورتسبروسيلة
+
+321
+00:23:20,680 --> 00:23:25,000
+ملتنسس can infect goats and sheeps specifically
+
+322
+00:23:25,000 --> 00:23:30,760
+الماعز والخرافة كانس ومن اسمة كانس dogs من كنعين
+
+323
+00:23:30,760 --> 00:23:35,320
+وبروسيلة سويس للخنازير فاحنا نتوقع انه ممكن يكون
+
+324
+00:23:35,320 --> 00:23:40,860
+عندنا هادي وهادي وهادي مصبوط بينما الخنازير ماعناش
+
+325
+00:23:40,860 --> 00:23:44,930
+فبالتالي اكتر حاجة هيكون عندنا هادي وهادي تمام؟لأن
+
+326
+00:23:44,930 --> 00:23:48,230
+برضه احنا كمسلمين بنبتعد قدر الإمكان عن الكلاب
+
+327
+00:23:48,230 --> 00:23:51,930
+ومافيش احتكاك personal بينهم بس بالنسبة للملتنسيس
+
+328
+00:23:51,930 --> 00:23:56,150
+والابورتس فيه ان احتكاك مباشر سواء كان مع
+
+329
+00:23:56,150 --> 00:24:02,370
+الحيوانات نفسها او مع منتجات هذه الحيوانات من حليب
+
+330
+00:24:02,370 --> 00:24:10,610
+او حتى لحم لحيوانات مصابة معلش نرجع برجوعأنا ذكرت
+
+331
+00:24:10,610 --> 00:24:14,970
+قلت ان الابورتاس بتصيب الماشية الملتنس بتصيب ال
+
+332
+00:24:14,970 --> 00:24:19,750
+goats والشيف فيه نوع من ايه؟ من ال specificity لل
+
+333
+00:24:19,750 --> 00:24:24,290
+speciesبالاضافة لل .. لل .. لل .. لل animal
+
+334
+00:24:24,290 --> 00:24:29,750
+species they can infect man يبقى عندهم مقدرة ..
+
+335
+00:24:29,750 --> 00:24:32,290
+بالظبط مقدرة على ال aportus .. ال aportus على
+
+336
+00:24:32,290 --> 00:24:36,050
+الكتلز و على الإنسان مالتنسس، goats, sheeps and
+
+337
+00:24:36,050 --> 00:24:40,870
+انسان بروسيلا كانس برضه dogs and human بروسيلا
+
+338
+00:24:40,870 --> 00:24:44,850
+سويس، swine and human شوفوا كام اسم لل .. لل
+
+339
+00:24:44,850 --> 00:24:47,550
+disease موجودين
+
+340
+00:24:53,500 --> 00:24:57,120
+Malta Fever حمّة المالطية بالعربي Undulant Fever
+
+341
+00:24:57,120 --> 00:25:01,240
+المتموج اللي قولنا عنها Mediterranean Fever حمّة
+
+342
+00:25:01,240 --> 00:25:05,180
+البحر الأبيض المتوسط وهذا اسم شائع جدا واخدوا بالك
+
+343
+00:25:05,180 --> 00:25:13,300
+في الوراقة دراسته حاجة اسمها FMF MF هذي هي
+
+344
+00:25:13,300 --> 00:25:22,040
+Mediterranean Fever و ال F هذي familial انتو
+
+345
+00:25:22,040 --> 00:25:24,980
+حاطة الوراقة ولا لسه؟أخدتولك إن هذا
+
+346
+00:25:24,980 --> 00:25:49,920
+الدرددردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردردر
+
+347
+00:26:01,800 --> 00:26:04,200
+البكتيريا عبارة عن جرام نيجاتف كوكو بس الله
+
+348
+00:26:06,720 --> 00:26:13,760
+chronically infected domestic animals او الاليف
+
+349
+00:26:13,760 --> 00:26:17,020
+الداجي الاليفة non motile non spore forming
+
+350
+00:26:17,020 --> 00:26:20,220
+البكتيريا some species require supplemental carbon
+
+351
+00:26:20,220 --> 00:26:24,280
+dioxide for primary isolation بدها CO2 for
+
+352
+00:26:24,280 --> 00:26:27,680
+isolation isolation from clinical specimen
+
+353
+00:26:27,680 --> 00:26:31,400
+requires prolonged incubation وانا قلتلكوا قد
+
+354
+00:26:31,400 --> 00:26:36,830
+تستمر إلى ستة أسابيع أو تمان أسابيع حتىيعني زيها
+
+355
+00:26:36,830 --> 00:26:39,650
+زي مين؟ زي ال micro bacteria فاكرين ال micro
+
+356
+00:26:39,650 --> 00:26:43,190
+bacteria؟ هدول أطول two bacteria احنا درستناهم لحد
+
+357
+00:26:43,190 --> 00:26:45,630
+الآن اللي هم ال micro bacterium tuberculosis
+
+358
+00:26:45,630 --> 00:26:51,950
+بالإضافة إلى ال brucella species brucella stain
+
+359
+00:26:51,950 --> 00:26:55,070
+always strains always catalase positive يعني
+
+360
+00:26:55,070 --> 00:27:00,310
+البكتيريا vintage catalase هذا الشكل تبعها بالفعل
+
+361
+00:27:00,310 --> 00:27:03,590
+هي cocoa بس ال lie صغيرة خالص
+
+362
+00:27:07,960 --> 00:27:10,860
+transmission primarily animal disease زي ما حكينا
+
+363
+00:27:10,860 --> 00:27:15,740
+هي بالاساس بتصيب الحيوانات وممكن تسبب للحيوانات
+
+364
+00:27:15,740 --> 00:27:20,700
+abortion and sterility اقم و اجهاض او اجهاض و
+
+365
+00:27:20,700 --> 00:27:25,360
+بعدين اقم بالتأكيد عشان
+
+366
+00:27:25,360 --> 00:27:30,060
+هي كانوا يسموها ك disease animal infectious
+
+367
+00:27:30,060 --> 00:27:38,130
+abortionيعني الإجهاد المعدى، أنه هذه أجهضت المعز
+
+368
+00:27:38,130 --> 00:27:41,870
+فالمعز الجنب هي كمان أجهضت فبتالي في عدوى في
+
+369
+00:27:41,870 --> 00:27:46,330
+الإجهاد لكن هو ماقى الأمر السبب أن العدوى كانت
+
+370
+00:27:46,330 --> 00:27:54,050
+بالبروكسيلة اللى بتسبب اللى هو الإجهاد كلهم،
+
+371
+00:27:54,050 --> 00:27:58,120
+الاسم لمرض واحدالاسمها ال .. ال species لأ لأ
+
+372
+00:27:58,120 --> 00:28:01,720
+مالاش علاقة مالاش علاقة هم كلهم ال species أي منهم
+
+373
+00:28:01,720 --> 00:28:07,220
+سببة بتعطينا نفسي اللي هو الأعراض كيف بتنتقل الآن
+
+374
+00:28:07,220 --> 00:28:11,420
+هذا نقطة كيف تنتقل from animal to animal and human
+
+375
+00:28:11,420 --> 00:28:17,400
+by aberrations in skins يعني واحد مزارع و عنده
+
+376
+00:28:17,400 --> 00:28:21,980
+جروح واحتك بحيوان مصاب تمام ممكن تنتقل عبر الجلد
+
+377
+00:28:21,980 --> 00:28:26,780
+inhalation ممكن عبر تنفسIngestion of Contaminated
+
+378
+00:28:26,780 --> 00:28:32,100
+Milk and Cheese هذي very very common لما نصنع أو
+
+379
+00:28:32,100 --> 00:28:37,880
+نبيع حليب غير مبسطر أو نصنع أشبان أو مشتقات للحليب
+
+380
+00:28:37,880 --> 00:28:42,280
+من مصادر مصعبة تمام؟ وانت عارفين كيف في المصانع
+
+381
+00:28:42,280 --> 00:28:45,440
+بيشتغلوا؟ يعني مثلا واحد بدي يعمله مصنع لبن، إيش
+
+382
+00:28:45,440 --> 00:28:52,480
+بيعمل؟ بيجيب الحليب من مزارع متعددة و بيخلطهاو
+
+383
+00:28:52,480 --> 00:28:56,320
+طبعا بتتم عملية اللي هو البسترة بعد ذلك لكن لو
+
+384
+00:28:56,320 --> 00:29:00,420
+كانت البسترة مش effective كل المنتج لو كان واحد من
+
+385
+00:29:00,420 --> 00:29:05,060
+المصادر اللي فيها بروسيلا موجود خلاص كل المنتج
+
+386
+00:29:05,060 --> 00:29:09,480
+بيكون في بروسيلا و انا اذكر يمكن قبل خمستاشر سنة
+
+387
+00:29:10,100 --> 00:29:13,600
+صار فينا هنا مجموعة حلق من البروسيلة وكان لما
+
+388
+00:29:13,600 --> 00:29:18,100
+حققوا في الموضوع ووردوا ان مصدرها هو جبن محلي
+
+389
+00:29:18,100 --> 00:29:21,940
+اعتقد انه مستورد من الضفة الغربية ووردوا انه
+
+390
+00:29:21,940 --> 00:29:29,560
+ماجدروش ييصلوا للمورد الاساسي لهذه الأشبان لكن
+
+391
+00:29:29,560 --> 00:29:34,010
+خدوا بالكم ان شاء الله هذه البكتيريا هنابيوصفوها
+
+392
+00:29:34,010 --> 00:29:38,130
+في الميكروبيريا انها sensitive to stomach acid ومع
+
+393
+00:29:38,130 --> 00:29:42,830
+ذلك .. ومع ذلك بتنتقل إلينا عبر اللي هو تناول
+
+394
+00:29:42,830 --> 00:29:46,930
+الحليب .. تناول .. يعني ليش تناول؟ من الأذن ولا من
+
+395
+00:29:46,930 --> 00:29:50,510
+الاسبراطوري؟ من الفم يعني هتمر عبر المعدة يعني
+
+396
+00:29:50,510 --> 00:29:54,000
+البكتيريا اللي بتصل للمعدة غالبا هتحصل فيهاهتموت
+
+397
+00:29:54,000 --> 00:29:59,000
+تمام؟ فكيف تنتقل؟ بقولنا قبل .. قبل ما تصل للمعدة
+
+398
+00:29:59,000 --> 00:30:03,260
+ممكن من الارو فارنجل .. الارو فارنجل من الفم في
+
+399
+00:30:03,260 --> 00:30:07,340
+منطقة الفم ممكن تخترق اللي هو ال tissue و تصل
+
+400
+00:30:07,340 --> 00:30:12,480
+لإنفنواد بيه قداممين هم الأشخاص ال at risk يعني
+
+401
+00:30:12,480 --> 00:30:18,040
+اللي أكتر عرضة للإصابة بالبروسيلوسز، dairy workers
+
+402
+00:30:18,040 --> 00:30:20,860
+and farmers كلمة dairy اللي هو اللي بيشتغلوا فيه
+
+403
+00:30:20,860 --> 00:30:24,220
+منتجات الحليب، منتجات الحليب and farmers المزارعين
+
+404
+00:30:24,220 --> 00:30:30,540
+وكلمة مزارعين كمان مرة، تربية الأبقار زراعة، تربية
+
+405
+00:30:30,540 --> 00:30:34,800
+الدواجن زراعة، تربية الأسماك زراعة، فلما بنقول
+
+406
+00:30:34,800 --> 00:30:37,640
+farmers بنقصد فيهم ال farmers اللي بيعتنوا بمين؟
+
+407
+00:30:37,640 --> 00:30:42,470
+بالحيواناتLivestock Handlers and Veterinarians
+
+408
+00:30:42,470 --> 00:30:47,970
+اللي هم طباء البيطاريين وLivestock Handlers اللي
+
+409
+00:30:47,970 --> 00:30:51,230
+هم اللي بتعاملوا مع الماشي يعني مربي الماشي يعني
+
+410
+00:30:51,230 --> 00:30:57,550
+Slotter houses employee عمال المسالخ عمال المسالخ
+
+411
+00:30:57,550 --> 00:30:59,450
+اللي هم Slotter houses employee
+
+412
+00:31:04,200 --> 00:31:07,940
+هنا باعطيك بعض المناطق اللي من وين ممكن تنتقل احنا
+
+413
+00:31:07,940 --> 00:31:10,520
+ماذكرناش احد المصادر المهمة جدا اللي هي ال
+
+414
+00:31:10,520 --> 00:31:14,480
+conjunctiva انا مرة حكتلكوا عن ال transmission by
+
+415
+00:31:14,480 --> 00:31:19,480
+finger تمام زي الفرانسسيلا tolerances لكن هنا في
+
+416
+00:31:19,480 --> 00:31:24,400
+عندي نقطة كتير مهمة الفاكسين شوفوا علشان لما يكون
+
+417
+00:31:24,400 --> 00:31:29,320
+في أمراض مشتركة بين الإنسان و الحيوان أنه أفضل
+
+418
+00:31:29,320 --> 00:31:34,680
+انطعم الإنسان و انطعم الحيوانشوف ال .. شوف الخيار
+
+419
+00:31:34,680 --> 00:31:41,030
+المكلف خيار المكلف تمام؟دائما و أبدا .. عفوا هذه
+
+420
+00:31:41,030 --> 00:31:44,330
+cycle بالأساس احنا نقول انه disease of animal
+
+421
+00:31:44,330 --> 00:31:48,310
+مظبوط يبقى بينتقل من الحيوان إلى الانسان طب لو
+
+422
+00:31:48,310 --> 00:31:53,770
+احنا انقرض الحيوان المصاب و أصبحنا حيوان محصان
+
+423
+00:31:53,770 --> 00:31:57,350
+يبقى مش هينتقل ال disease يبقى الأفضل أنه نروح
+
+424
+00:31:57,350 --> 00:32:00,690
+لمين للحق الأضعف اللي هو الحيوان و نعمله
+
+425
+00:32:00,690 --> 00:32:04,890
+vaccination و في غزة مننا هيك في غزة كان في برنامج
+
+426
+00:32:04,890 --> 00:32:11,540
+تطعيم و كان معتمد على وضعالبروسيلة كقطرة في العين
+
+427
+00:32:11,540 --> 00:32:16,000
+تبعت الحيوانات تمام طبعا هي attenuated attenuated
+
+428
+00:32:16,000 --> 00:32:20,000
+بروسيلة فكان صير فيه mild eye infection
+
+429
+00:32:20,000 --> 00:32:25,640
+conjunctivitis والحيوان صير عنده ايه يعني مناعة ضد
+
+430
+00:32:25,640 --> 00:32:29,580
+البروسيلة وبالتالي لو البروسيلة وصلته لكن مشكلتنا
+
+431
+00:32:29,580 --> 00:32:34,820
+وين؟ مشكلتنا ان مداخل الحيوانات عندنا كانت تأتي في
+
+432
+00:32:34,820 --> 00:32:39,270
+السابق من المستوطنات تهريبو لما .. بعض منها طبعا
+
+433
+00:32:39,270 --> 00:32:43,510
+مش الكل و لما اغلقت و طلعت المستوطنات صارنا مصدر
+
+434
+00:32:43,510 --> 00:32:47,910
+تاني من مصر بالانفاق تمام و تحت الانفاق هذه اللي
+
+435
+00:32:47,910 --> 00:32:52,110
+كانت مر عبر الانفاق صحيح هي مصدر اقتصادي مهم جدا
+
+436
+00:32:52,110 --> 00:32:55,310
+لسكان القطاع و مافي .. مافي يعني صحيح اللي كان
+
+437
+00:32:55,310 --> 00:32:59,090
+اهمه اللي كان الخيار لكن كان في ..خلّينا نقول فترة
+
+438
+00:32:59,090 --> 00:33:02,730
+فيها قصور في وزارة الزراعي انها ماعملت مراقبة على
+
+439
+00:33:02,730 --> 00:33:05,770
+هذه الحيوانات لكن اصلا ركوا الأمر وصاروا يعملوا
+
+440
+00:33:05,770 --> 00:33:10,570
+حجر صحي في المنطقة اللي في رفح و أي ماشي تدخل كان
+
+441
+00:33:10,570 --> 00:33:13,410
+يحطوها في هذا المكان ويرقبوها ويعملوا بعض الفحصات
+
+442
+00:33:13,660 --> 00:33:16,460
+في عندنا يعني مجموعة من الإجراءات اللي ممكن
+
+443
+00:33:16,460 --> 00:33:22,540
+نتاخذها للحد من انتقال البروسيلة من الحيوان إلى
+
+444
+00:33:22,540 --> 00:33:28,940
+الإنسان من ضمنها أن الحليب لا يستخدم إلا مباستران
+
+445
+00:33:28,940 --> 00:33:32,740
+مش ممكنية ناخد fresh milk زي زمان لازم يكون
+
+446
+00:33:32,740 --> 00:33:37,680
+مباستران و الباستران كافية لقتل ال micro أو
+
+447
+00:33:37,680 --> 00:33:43,170
+البروسيلةطيب ال clinical feature of brucellosis
+
+448
+00:33:43,170 --> 00:33:47,050
+ايه الشكل الصورة السلرية ال incubation period واحد
+
+449
+00:33:47,050 --> 00:33:50,970
+لتلات أسابيع initially influenza-like نفس الأعراض
+
+450
+00:33:50,970 --> 00:33:53,550
+طبعا ال influenza في البداية بعدين headache
+
+451
+00:33:53,550 --> 00:33:57,190
+weakness weight loss أرترالجيا الألم في المفاصل
+
+452
+00:33:57,190 --> 00:34:00,570
+liver dysfunction بيصير فينا ارتفاع في liver
+
+453
+00:34:00,570 --> 00:34:04,680
+enzymesandulating fever رجلنا ارتفاع وانخفاض في
+
+454
+00:34:04,680 --> 00:34:09,140
+درجة الحرارة okay fever for weeks and months قد
+
+455
+00:34:09,140 --> 00:34:12,760
+تستمر العملية بدون إداء إذا لم يعالج المريض هي
+
+456
+00:34:12,760 --> 00:34:16,080
+عبارة عن ال chronic illness ممكن يصير فيه تضخم في
+
+457
+00:34:16,080 --> 00:34:19,600
+ال spleen ممكن يصير فينا تضخم كمان في اللي هو
+
+458
+00:34:19,600 --> 00:34:23,220
+الكبد وفينا enlargement لل lymph node لأن
+
+459
+00:34:23,220 --> 00:34:26,720
+البكتيريا هذه برضه عندها المقدرة على ال
+
+460
+00:34:26,720 --> 00:34:31,450
+intracellular replication فبالتاليالمكان المفضل
+
+461
+00:34:31,450 --> 00:34:34,150
+تبعها .. المكان المفضل تبعها هو ال
+
+462
+00:34:34,150 --> 00:34:38,090
+reticuloendothelial system. ليش؟ ايش في
+
+463
+00:34:38,090 --> 00:34:41,990
+reticuloendothelial system؟ ماكرو فجأة، بتروح خاص
+
+464
+00:34:41,990 --> 00:34:47,610
+نص عشان تتكاتر جوا الماكرو فجأة. احد السنوات كانت
+
+465
+00:34:47,610 --> 00:34:51,470
+وزارة الزراعة في عهد الاحتلال الإسرائيلي .. ايش
+
+466
+00:34:51,470 --> 00:34:56,630
+تعمل؟عشان تشجع المزارعين تشجع المزارعين انهم
+
+467
+00:34:56,630 --> 00:35:02,750
+يبلغوا عن الإصابات اللي عندهم من الأبقار فكانوا
+
+468
+00:35:02,750 --> 00:35:06,750
+يجوموا بعملية تعويض يعني ياخدوا البقرة المصابة
+
+469
+00:35:06,750 --> 00:35:13,670
+يذبحوها ويعوضوا نصف ثمنها للمزارع وياخدوا الأحشاء
+
+470
+00:35:13,670 --> 00:35:18,330
+تبعت الأبقار هذه تمام؟ اللي من ضمنها ال liver و ال
+
+471
+00:35:18,330 --> 00:35:23,620
+spleen وغيرها وهذه يقدموهاويعطوا الجثة للمزارع
+
+472
+00:35:23,620 --> 00:35:27,640
+الذبيحة للمزارع ويشترطوا عليه إذا بدى ياكلها
+
+473
+00:35:27,640 --> 00:35:31,200
+ياكلها مسلوقة يعني ما يشويهاش ولا .. لكن احنا
+
+474
+00:35:31,200 --> 00:35:35,260
+المزارعين كانوا يتعاففوا فكانوا يرفضوا الذبيحة لكن
+
+475
+00:35:35,260 --> 00:35:40,770
+لاحظوا لم يقطوهمالكبد وده الـSpleen تمام؟ لأنه ده
+
+476
+00:35:40,770 --> 00:35:46,250
+شماله بكميات كبيرة ولأ وهذه organs تحترش حرارة
+
+477
+00:35:46,250 --> 00:35:50,350
+عالية في طهيها فبالتالي يمكن تنجوا بعض ال strings
+
+478
+00:35:50,350 --> 00:35:53,270
+فكانوا يعني .. لكن زي ما حكيتكوا المزارعين تبعونا
+
+479
+00:35:53,270 --> 00:35:58,150
+كانوا يرفضوا انهم يعني .. وكانوا يتخلصوا من الجثة
+
+480
+00:35:58,150 --> 00:36:01,650
+مع الباقي الأعضاء بس أنا حابب تأكد على الحقيقة ليش
+
+481
+00:36:01,650 --> 00:36:04,890
+ماكانوش بيعطوهم ال internal organs عشان .. عشان
+
+482
+00:36:04,890 --> 00:36:10,530
+السبب اللي حكيناه قبل قلبنفس المعلومات مافيش شندي
+
+483
+00:36:10,530 --> 00:36:12,470
+يعني جديد أضيفه في هذه اللوحة
+
+484
+00:36:18,650 --> 00:36:23,010
+ال lab diagnosis عبارة عن blood sample و blood
+
+485
+00:36:23,010 --> 00:36:25,470
+culture في هذا الحالة خدوا بالكم blood culture
+
+486
+00:36:25,470 --> 00:36:31,570
+احنا كنا نتكلم عن أسبوع عشر أيام اربعتاشر يوم حد
+
+487
+00:36:31,570 --> 00:36:36,370
+أقصى لل incubation بس هنا it should be for at
+
+488
+00:36:36,370 --> 00:36:39,930
+least six weeks تمام و special blood culture
+
+489
+00:36:48,720 --> 00:36:52,960
+Lymph node and bone marrow biopsy ال culture
+
+490
+00:36:52,960 --> 00:37:01,480
+requires 5-10% CO2 تخيّر 5-10% CO2 لمدة 6 أسابيع
+
+491
+00:37:01,480 --> 00:37:05,800
+بدك يبقى incubation في blood culture بطل خاصة
+
+492
+00:37:05,800 --> 00:37:14,060
+تحتوي على .. على فكرة كان فيها وسط رائع جدا اسمه
+
+493
+00:37:14,060 --> 00:37:14,560
+Castaneda
+
+494
+00:37:24,310 --> 00:37:33,030
+هذه عبارة عن .. عن زجاجة مضلعة،
+
+495
+00:37:33,030 --> 00:37:36,610
+يعني تلها ثلاث جوانب زي هيك
+
+496
+00:37:42,950 --> 00:37:46,490
+هذه تلت جوانب مثل الثمان و تقلها قاعة تحت و تقلها
+
+497
+00:37:46,490 --> 00:37:50,350
+غطاء الان في المنتصف اللي عند الهانة فيه سائل اللي
+
+498
+00:37:50,350 --> 00:37:55,290
+هو liquid media وعلى أحد الأطراف مصبوب أجار ففيها
+
+499
+00:37:55,290 --> 00:37:58,990
+liquid اللي عند الهان و الأجار مصبوب على كل الجانب
+
+500
+00:37:58,990 --> 00:38:05,400
+هذاو جواها غاز CO2 تمام؟ و Oxygen فكانوا يسموها
+
+501
+00:38:05,400 --> 00:38:10,580
+Triphasic ليش Triphasic؟ لأن فيها solid فيها
+
+502
+00:38:10,580 --> 00:38:15,060
+liquid و فيها gas ليش عملوا ال solid dual liquid؟
+
+503
+00:38:15,060 --> 00:38:18,020
+على فكرة فكرة ذكية يعني لو عملوها لكل blood
+
+504
+00:38:18,020 --> 00:38:22,230
+culture بيكون كويسة ممتازةلأن انت بدل ما تعمل
+
+505
+00:38:22,230 --> 00:38:25,430
+subculture بانك تفتح الغطاء و تاخد عينة و تزرعها
+
+506
+00:38:25,430 --> 00:38:29,150
+على blood agar بس ال subculture عبارة عن ايه؟ عن
+
+507
+00:38:29,150 --> 00:38:33,250
+انك تميل ال bottle تخلي السائل يلامس مين؟ ال solid
+
+508
+00:38:33,250 --> 00:38:37,030
+و ترجعه تاني اي بكتيريا كانت موجودة في السائل و
+
+509
+00:38:37,030 --> 00:38:40,410
+التسقط على ال agar هتكون مستعمرات بعد ذلك فانت
+
+510
+00:38:40,410 --> 00:38:45,210
+بتعمل subculture بدون ما تطلع او تفتح لأنه فتح
+
+511
+00:38:45,210 --> 00:38:48,390
+الغطاء تبع ال blood culture في الغالب ايش بيعمل
+
+512
+00:38:48,390 --> 00:38:52,220
+الشباب؟بيعمل عملية اللي هو contamination بشكل
+
+513
+00:38:52,220 --> 00:38:57,540
+مستمر استيلولوجي فيه طبعا الفحص لا نستطيع انه الا
+
+514
+00:38:57,540 --> 00:39:05,560
+انه نتكلم عنه اللي هو الروز بنجال انا
+
+515
+00:39:05,560 --> 00:39:10,470
+بتذكركوا بتلت فحوصات درسناهم هذا التلتدرسنا
+
+516
+00:39:10,470 --> 00:39:14,230
+الفيدال، فاكرينه الفيدال؟ تعسّنه لـ Typhie و ال Ox
+
+517
+00:39:14,230 --> 00:39:17,970
+-19 تبع الريكيزيا اللي استخدمنا فيه Protein Strain
+
+518
+00:39:17,970 --> 00:39:22,450
+سنة و هاي الروزبنجال هدولة التلاتة .. تلاتة هدولة
+
+519
+00:39:22,450 --> 00:39:26,890
+بيطلبوهم أطباء للمرض لما يكون ال fever unknown of
+
+520
+00:39:26,890 --> 00:39:31,630
+unknown origin يعني المصدر مش معروف fever of
+
+521
+00:39:31,630 --> 00:39:36,690
+unknown origin
+
+522
+00:39:37,790 --> 00:39:46,010
+fever of unknown origin يجب نستخدم روزبنجال لأن
+
+523
+00:39:46,010 --> 00:39:51,230
+الانتجن اللي هي البكتيرى نفسها مصبوغة بصبغة اسمها
+
+524
+00:39:51,230 --> 00:39:57,570
+روزبنجال ال treatment ممكن نستخدم سيبروفلوكسسين
+
+525
+00:39:57,570 --> 00:40:04,210
+وممكن نستخدمها لمدة ست أسابيع حتى نمنعالانتكاسة
+
+526
+00:40:04,210 --> 00:40:08,330
+relapse يعني عودة ال disease لأن البكتيريا موجودة
+
+527
+00:40:08,330 --> 00:40:11,670
+في ال lymph node موجودة في ال macro phage و بتشتغل
+
+528
+00:40:11,670 --> 00:40:16,610
+على شكل دفعات على شكل دفعات فانا بطول فترة القلاج
+
+529
+00:40:16,610 --> 00:40:21,230
+ستة أسابيع حتى أضمن أنه ال microbe مايرجع تاني و
+
+530
+00:40:21,230 --> 00:40:24,470
+المرة الجاي ان شاء اللهنكمل بإذن الله، هذه البطل،
+
+531
+00:40:24,470 --> 00:40:28,810
+بس هذه مش ثلاثية، اللحظة هي في solid media و فيه
+
+532
+00:40:28,810 --> 00:40:31,290
+عندى هنا اللي هو liquid media، هذه بيسموها
+
+533
+00:40:31,290 --> 00:40:36,130
+diphasic، ليش فيها diphasic؟ لإن فيها solid و فيها
+
+534
+00:40:36,130 --> 00:40:39,910
+liquid، بس التالتة اللي قلنا عنها، التالتة اللي
+
+535
+00:40:39,910 --> 00:40:42,610
+قلنا عنها بيحط فيها اللي هو ال gas، خلاص نكمل مرة
+
+536
+00:40:42,610 --> 00:40:43,150
+أجاى إن شاء الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/cfUGCZIP6_0_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/cfUGCZIP6_0_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..71532cdbe4da4c677767d775a429d29d17b9f339
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/cfUGCZIP6_0_postprocess.srt
@@ -0,0 +1,2552 @@
+1
+00:00:20,570 --> 00:00:24,790
+بسم الله الرحمن الرحيم اليوم هنبدأ موضوع جديد خالص
+
+2
+00:00:24,790 --> 00:00:30,870
+وهو ال mycology هحنحاول نتعرف على أهم المميزات
+
+3
+00:00:30,870 --> 00:00:36,670
+اللي بتميز الفطريات عن المخلوقات الأخرى ولماذا
+
+4
+00:00:36,670 --> 00:00:42,490
+يعني نهتم بدراسة هذا الجزء في ال micro biologyال
+
+5
+00:00:42,490 --> 00:00:45,390
+medical microbiology زي ما انتوا شايفينه على ال
+
+6
+00:00:45,390 --> 00:00:49,870
+diagram مقسمة إلى مجموعة علوم ال bacteriology اللي
+
+7
+00:00:49,870 --> 00:00:53,290
+احنا قضينا معظم الوقت في دراستها الفيروسات اللي
+
+8
+00:00:53,290 --> 00:00:57,590
+درستوها مع الدكتور محمد ال ال helminthology و ال
+
+9
+00:00:57,590 --> 00:01:00,310
+protozoology اللي بيشكلوا علم ال parasitology
+
+10
+00:01:00,310 --> 00:01:02,350
+درستهم مع الدكتور عدنان او هدرسهم مع الدكتور عدنان
+
+11
+00:01:02,990 --> 00:01:06,650
+في جنبهم علم صار يعني علم نظير كان زمان مدمج تحت
+
+12
+00:01:06,650 --> 00:01:10,070
+ال microbiology لكن نظرا لازدياد الحجم تبعه أصبح
+
+13
+00:01:10,070 --> 00:01:14,050
+علم قائم بذاته اللي هو ال immunology الآن نحنا
+
+14
+00:01:14,050 --> 00:01:16,690
+الجزء اللي بنتكلم عنه اللي هو ال mycology
+
+15
+00:01:16,690 --> 00:01:21,650
+والmycology بيهتم بدراسة الفطريات والفطريات تنقسم
+
+16
+00:01:21,650 --> 00:01:27,100
+إلى قسمين رئيسيينلهم ال yeast and mold لكن قبل ما
+
+17
+00:01:27,100 --> 00:01:32,520
+نتكلم عن التصنيفات هذه نتكلم عن الفطريات و دورها
+
+18
+00:01:32,520 --> 00:01:38,600
+في حياتنا كبشر هل لها دور كبير ام دور ثانوي تعالوا
+
+19
+00:01:38,600 --> 00:01:42,940
+نطلع مع بعضفي الصناعات الغذائية على سبيل المثال زي
+
+20
+00:01:42,940 --> 00:01:49,240
+الخبز المكون الرئيسي لعملية تصنيع الخبز هو الخميرة
+
+21
+00:01:49,240 --> 00:01:54,320
+least من ضمن الفطريات معظم الأشبان الصفراء مكونة
+
+22
+00:01:54,320 --> 00:01:58,280
+أو على الأقل جزء من تكوينها بيكون فطريات إذا لها
+
+23
+00:01:58,280 --> 00:02:02,580
+دور في تصنيع الأغذيةأيضا قديما كانت صنعة في
+
+24
+00:02:02,580 --> 00:02:07,200
+المشروبات ال yeast هي المسئولة عن تصنيع الخمور
+
+25
+00:02:07,200 --> 00:02:13,200
+وتصنيع ال .. ال .. ال بيرة لكن احنا كمسلمين ممكن
+
+26
+00:02:13,200 --> 00:02:16,140
+نستخدمها في إنتاج الكحول الكحول المستخدم في
+
+27
+00:02:16,140 --> 00:02:19,620
+المستشفيات نفسه هي المكوّل الأساسي ال mushrooms
+
+28
+00:02:19,620 --> 00:02:27,500
+اللي هي الفطريات التي تؤكل الفطريات تنتج toxinsو
+
+29
+00:02:27,500 --> 00:02:32,100
+ال toxins هذه قد يعني تؤدي الإنسان يبجي على مستوى
+
+30
+00:02:32,100 --> 00:02:37,200
+الاستفادة موجودة و على مستوى الدولار أيضا موجودة و
+
+31
+00:02:37,200 --> 00:02:41,340
+بشكل آخر ال disease آخر نقطة في اللوحة لكن في في
+
+32
+00:02:41,340 --> 00:02:45,290
+المنتصف بين التنتين كلمة biodegradationالـ
+
+33
+00:02:45,290 --> 00:02:49,490
+biodegradation يا شباب هو التحلل البيولوجي تخيلوا
+
+34
+00:02:49,490 --> 00:02:53,430
+لو أن الأجسام تبعد كل المخلوقات اللي بتموت تطلع لك
+
+35
+00:02:53,430 --> 00:02:57,990
+لم تتحللش دورة العناصر دورة العناصر في الطبيعة لن
+
+36
+00:02:57,990 --> 00:03:03,210
+تكتمل وإذا العناصر اختزنت في مركبات ولم تدور في
+
+37
+00:03:03,210 --> 00:03:07,610
+الطبيعة الحياة تنتهي على كوكب الأرضوالفطريات تعتبر
+
+38
+00:03:07,610 --> 00:03:11,010
+من ال decomposers يعني من المحللات بمعنى أخر تسهم
+
+39
+00:03:11,010 --> 00:03:15,970
+بشكل إيجابي في عمل تدوير العناصر إذن هي مهمة كتير
+
+40
+00:03:15,970 --> 00:03:18,170
+طبعا أنا اللي بانيني في الأخر في ال medical
+
+41
+00:03:18,170 --> 00:03:22,710
+microbiology أتكلم عن الصناعات ولا أتكلم عن ال
+
+42
+00:03:22,710 --> 00:03:24,750
+diseases أكيد أتكلم عن ال diseases وعشانك احنا
+
+43
+00:03:24,750 --> 00:03:29,530
+حاطينها في الأخر و باللون اللي هو الأحمروالصورة دى
+
+44
+00:03:29,530 --> 00:03:35,170
+كل الحسنات اللى حاكناهم بينشاله من صورة واحدة
+
+45
+00:03:35,170 --> 00:03:41,070
+بتبيننا skin infection لها caused by a fungi بعض
+
+46
+00:03:41,070 --> 00:03:44,230
+المصطلحات اللى لازم اتعرف عليهم اللى هو ال yeast و
+
+47
+00:03:44,230 --> 00:03:48,850
+ال yeast هى أحد شكلين موجودين في الفطرية تقولنا
+
+48
+00:03:48,850 --> 00:03:52,130
+yeast and mold ال yeast unicellular شباب
+
+49
+00:03:52,130 --> 00:03:57,230
+unicellular يعني دهت خلية واحدةبينما ال .. ال ..
+
+50
+00:03:57,230 --> 00:04:00,170
+ال .. ال mold بتكون multi cellular .. multi
+
+51
+00:04:00,170 --> 00:04:03,830
+cellular ال yeast غالبا تتكثر بال budding بتعرف ال
+
+52
+00:04:03,830 --> 00:04:07,770
+budding التبرعوم اللي هو زي إذا بتعرفوا الصبار
+
+53
+00:04:07,770 --> 00:04:10,310
+اللي موجود هنا في غزة متشير بشكل كبير بيكون فيه
+
+54
+00:04:10,310 --> 00:04:13,230
+لوح بيطلع منه لوح صغير بعض الأحيان بيكون أكتر من
+
+55
+00:04:13,230 --> 00:04:18,640
+اللوح من ال .. ال .. اللوح الأموبعض الأحيان بيكون
+
+56
+00:04:18,640 --> 00:04:22,560
+لوح طالع منه لوح ومنه لوح آخر فهذه الأشكال كلها
+
+57
+00:04:22,560 --> 00:04:26,540
+بنشوفها في ال yeast بعملية كمان مرة بنسميها
+
+58
+00:04:26,540 --> 00:04:31,760
+التبرعم أو ال body في ظاهرة يا شباب رائعة جدا في
+
+59
+00:04:31,760 --> 00:04:35,440
+الفطريات اسمها dimorphism انا قلت يا اما yeast يا
+
+60
+00:04:35,440 --> 00:04:39,420
+اما mold طب ايش رأيكوا ان في فطريات تاخد الشكلين؟
+
+61
+00:04:39,420 --> 00:04:44,470
+بتكون مثلا في البيئةمولد و لما تعمل infection
+
+62
+00:04:44,470 --> 00:04:48,410
+للإنسان بتكون yeast او مايشبه ال yeast يست او
+
+63
+00:04:48,410 --> 00:04:51,710
+مايشبه ال yeast خد بالك كتير نقطة مهمة هذه ليش
+
+64
+00:04:51,710 --> 00:04:56,250
+مهمة؟ في سؤال بيجي في ال medical microbiology why
+
+65
+00:04:56,250 --> 00:05:02,130
+مثلا كوكسوديود كوكسوديوديس اميتس is non-infectious
+
+66
+00:05:02,130 --> 00:05:05,290
+مابتنتقلش من إنسان لإنسان لماذا لا تنتقل من إنسان
+
+67
+00:05:05,290 --> 00:05:10,960
+لإنسان؟ لأن الطور المعدى هوالمولد والمولد موجود في
+
+68
+00:05:10,960 --> 00:05:13,960
+مين؟ في ال environment بينما هو الآن لما انا أخدته
+
+69
+00:05:13,960 --> 00:05:17,500
+صار yeast لو انا بدى أنقلك إياه هانقلك إياه مين؟
+
+70
+00:05:17,500 --> 00:05:21,680
+yeast بالظبط بتالي مش هيكون infective stage لازم
+
+71
+00:05:21,680 --> 00:05:25,260
+يروح على البيئة يتحول من yeast إلى mold وينتقل
+
+72
+00:05:25,260 --> 00:05:28,440
+لإنسانية المصدر دايما في هذا الحالة مين البيئة
+
+73
+00:05:28,440 --> 00:05:33,980
+وليس ال infected person مفهومة ديومورفزم اللي هو
+
+74
+00:05:33,980 --> 00:05:39,220
+إثنائية في الشكل إنه بياخد شكل yeast وشكل moldوزي
+
+75
+00:05:39,220 --> 00:05:42,920
+ما ذكرتلكوا في البيئة غالبا بياخد ال mold وفي
+
+76
+00:05:42,920 --> 00:05:47,040
+الإنسان أو الحيوان بياخد الشكل اللي هو ال yeast ال
+
+77
+00:05:47,040 --> 00:05:53,260
+hypha هي الخيوط بتاعة ال mold هي الخيوط ال hypha
+
+78
+00:05:53,260 --> 00:06:00,380
+بتاعة ال mold وفي منها شكلين يا شباب شكل مقطع يعني
+
+79
+00:06:00,380 --> 00:06:05,340
+فيه قواطق وشكل آخر أجواف أجواف يعني مافيش فيه
+
+80
+00:06:05,340 --> 00:06:10,300
+قواطقواحد اسمها septated اللي فيها السبتة والتانية
+
+81
+00:06:10,300 --> 00:06:15,900
+non-septated او اسم اخر سينوسيتك جوفاء سينوسيتك
+
+82
+00:06:15,900 --> 00:06:19,020
+حيمور معانا او في اخر المحاضرة في السمري حلج
+
+83
+00:06:19,020 --> 00:06:23,640
+المصطلح اذا ال hypha او ال hypha are multicellular
+
+84
+00:06:23,640 --> 00:06:27,540
+fungi which reproduce asexually and or sexually
+
+85
+00:06:27,540 --> 00:06:31,980
+ايش يعني sexually و asexually؟واحد واحد تكاثر لا
+
+86
+00:06:31,980 --> 00:06:36,460
+جنسي مافيش داعي انه يكون فيه ذكر وأنثى جميعه sides
+
+87
+00:06:36,460 --> 00:06:41,980
+واحد لأ بيحتاج فبيقولنا انه قد .. قد نجد فطر
+
+88
+00:06:41,980 --> 00:06:48,370
+بيتكاثر بالطريقتينبيقدر يتكاثر asexual و sexual
+
+89
+00:06:48,370 --> 00:06:54,170
+تمام و قد نجد فطريات فقط تمتلك خاصية واحدة من
+
+90
+00:06:54,170 --> 00:06:59,290
+الاتنتين يبقى and or تمام and or في مصطلح اخر كمان
+
+91
+00:06:59,290 --> 00:07:02,950
+اسمه pseudo hyphenالخمائر احنا اتفقنا الخمائر
+
+92
+00:07:02,950 --> 00:07:06,850
+عبارة عن ايه؟ عن unicellular تخيلوا هي خميرة
+
+93
+00:07:06,850 --> 00:07:12,770
+تكاثرت عملت برعم و كبرت زي امها صارت تمام؟ و كمان
+
+94
+00:07:12,770 --> 00:07:17,090
+واحدة اطلعت فتعطينا شكل ايه؟ انبوب الانبوب هذا
+
+95
+00:07:17,090 --> 00:07:23,100
+بيعطيك انطباع انه حيفة لكن حيفة ايه؟ كاذبةايش اللي
+
+96
+00:07:23,100 --> 00:07:27,500
+بميزلنا بين الهايفي والهايفي الكاذبة انه الهايفي
+
+97
+00:07:27,500 --> 00:07:33,320
+بتكون الخطين متوازين تماما مافيش فيهم indentation
+
+98
+00:07:33,320 --> 00:07:39,340
+مش مخنصرين هنا الله يفت عليك المكان الالتقى بيكون
+
+99
+00:07:39,340 --> 00:07:44,530
+في اللي هو الحواف تبعتهم من بين أوضةإذا الـPseudo
+
+100
+00:07:44,530 --> 00:07:48,110
+-hypha could be distinguished من الـTrue-hypha
+
+101
+00:07:48,110 --> 00:07:51,030
+through the presence of indentation اللي حاكينا
+
+102
+00:07:51,030 --> 00:07:55,530
+عنهم اللي هي انه توقعت هدى الداخلية فيه مجموعة من
+
+103
+00:07:55,530 --> 00:08:00,030
+.. اه okay نتكلم عن الـspores الفطريات تتكثر
+
+104
+00:08:00,030 --> 00:08:06,270
+بالـsporesالان لما بنقول Spores مش .. مش منطقي ما
+
+105
+00:08:06,270 --> 00:08:09,670
+نتذكرش ال Spores سبعة البكتيريا، صح ولا لأ، لكن
+
+106
+00:08:09,670 --> 00:08:13,270
+للأسف التنتين حاجتين مختلفتين تماما و لا يجوز
+
+107
+00:08:13,270 --> 00:08:18,410
+المقارنة بينهم أبدا، يعني مجرد المسمى فقط الموجود،
+
+108
+00:08:18,410 --> 00:08:22,170
+و لما نختلفين تماما، البكتيريا ال Indospore ده مش
+
+109
+00:08:22,170 --> 00:08:25,710
+ذاكر أو ال Spore، كان الغلط منها مش التكاثر و إنما
+
+110
+00:08:25,710 --> 00:08:29,290
+ال protection، خلية تحولت ل Spore، Spore بتحول
+
+111
+00:08:29,290 --> 00:08:34,500
+لخلية، صح؟ما زاد العدد بس هنا الـ spores are used
+
+112
+00:08:34,500 --> 00:08:38,820
+for reproduction one fungi may produce millions,
+
+113
+00:08:39,060 --> 00:08:43,000
+billions of spores تمام؟ يبقى الـ spores هنا بقدر
+
+114
+00:08:43,000 --> 00:08:47,500
+أشبهها أكتر للبذور تبعت النباتات يعني تستخدم لمين؟
+
+115
+00:08:47,500 --> 00:08:52,340
+للتكاثر عملية ايه؟ reproduction، learn
+
+116
+00:08:52,340 --> 00:08:55,060
+reproduction هذه كانت لمين؟ لل protection تبعت
+
+117
+00:08:55,060 --> 00:08:58,580
+البكتيريا إذا لا يجوز المقارنة الآن في اسم تاني
+
+118
+00:08:58,580 --> 00:09:03,860
+للـ spore في الفطريات Conidiaاسمها conidia فالان
+
+119
+00:09:03,860 --> 00:09:08,800
+بقدر اقول ان ال conidia انواع منها arthroponida
+
+120
+00:09:08,800 --> 00:09:13,560
+وكلمة arthroponida مفصالية مفصالية يعني واحدة
+
+121
+00:09:13,560 --> 00:09:17,690
+مركبة فوق واحدة تمام في بينهم زي المفاصلبقولنا
+
+122
+00:09:17,690 --> 00:09:20,730
+barrel shape ايش عاملة barrel shape برميل لأ
+
+123
+00:09:20,730 --> 00:09:23,830
+barrel shape معناه زي البرميل برميل فوق برميل تمام
+
+124
+00:09:23,830 --> 00:09:29,250
+بارل فوق بارل اكيد بينهم حواف برضه زي كمان مرة زي
+
+125
+00:09:29,250 --> 00:09:35,230
+الجصب تمام وبالتالي فيكون زي المفاصل ال clamidio
+
+126
+00:09:35,230 --> 00:09:39,290
+conidia عبارة عن round thick wall cells formed
+
+127
+00:09:39,290 --> 00:09:42,510
+from hypha or pseudohypha يبقى ال clamidio conidia
+
+128
+00:09:42,510 --> 00:09:49,920
+بيكون في كيس تمام جواتهجواته في ال sports الان
+
+129
+00:09:49,920 --> 00:09:53,840
+احنا قلنا ال hypha هي الخيط الرفية او ال hypha
+
+130
+00:09:53,840 --> 00:09:57,540
+اللى قلتلنا بالعربي ال hypha الخيط الرفية اللى
+
+131
+00:09:57,540 --> 00:10:02,220
+بشكل او عنصر اساسي من ال mold وقلنا عنه multi
+
+132
+00:10:02,220 --> 00:10:06,340
+cellular مظبوط هذا microscopic يا شباب غير قادر ان
+
+133
+00:10:06,340 --> 00:10:10,020
+احنا على رؤيته زى ال sports لا انا استطيع رؤية ال
+
+134
+00:10:10,020 --> 00:10:14,700
+sports ولا انا استطيع رؤية مين ال hypha لكن كنا
+
+135
+00:10:14,700 --> 00:10:19,060
+شوفنافنجان قهوة محطوط على المجلة له أربع أو خمس
+
+136
+00:10:19,060 --> 00:10:22,640
+أيام أو سبع أيام و لجينا فيه فطريات كنا شوفنا حبة
+
+137
+00:10:22,640 --> 00:10:28,100
+بندورة طماطم معفنة و طالع عليها عفن شوفنا تفاحة
+
+138
+00:10:28,100 --> 00:10:33,200
+بورتقالة غيره طب هذا اللي شوفناه احنا ايش؟ فطريات
+
+139
+00:10:33,200 --> 00:10:39,700
+طب كيف شوفناها؟اللي شفناها بالعين لأن الهايفة
+
+140
+00:10:39,700 --> 00:10:46,380
+تكاثرت إلى حجم ضخم جدا بحيث شكلت مجموع الهايفة
+
+141
+00:10:46,380 --> 00:10:50,610
+بنسميه myceliumيبقى ال mycelium هو مجموعة الـ
+
+142
+00:10:50,610 --> 00:10:55,530
+hypha وغالبا الشباب بيكون لونه أبيض طب أنتوا
+
+143
+00:10:55,530 --> 00:10:59,330
+الأشياء اللي بتشوفها أبيضة أخضر في أسود معفن
+
+144
+00:10:59,330 --> 00:11:04,410
+الأسود في عندك كمان أشياء أخرى ممكن تكون أصفر ممكن
+
+145
+00:11:04,410 --> 00:11:09,810
+تكون ألوان ما بين الأزرق و الأخضر يبقى في عندي
+
+146
+00:11:09,810 --> 00:11:14,510
+ألوان كثيرة طب و كيف أنا بقول أبيض؟المايسليوم
+
+147
+00:11:14,510 --> 00:11:18,530
+غالبا بيكون لونه أبيض واللون اللي انتوا بتشوفوه
+
+148
+00:11:18,530 --> 00:11:22,350
+أسود أخضر أصفر أو غيره هذا عبارة عن لون ال sports
+
+149
+00:11:22,350 --> 00:11:26,730
+لون ال sports وصلت سؤالة إذا هي غالب الأمر وهذا
+
+150
+00:11:26,730 --> 00:11:30,470
+الكلام عشان تتأكدوا منه اعمل simple search على
+
+151
+00:11:30,470 --> 00:11:35,090
+google على سبرود و fungi هتلاقي الفطريات لما نجلب
+
+152
+00:11:35,090 --> 00:11:38,930
+الطبق زي هيكد اللون من الخلف غالبا أبيض لكن لو
+
+153
+00:11:38,930 --> 00:11:42,570
+جلبناه هتلاقيه في المتصف تبعهأسود أو أخضر أو أصفر
+
+154
+00:11:42,570 --> 00:11:48,390
+أو ألوان أخرى إذا الميسيليوم هو مجموعة مجموعة جنه
+
+155
+00:11:48,390 --> 00:11:51,570
+كمان من الهايفيا أو الهايفات اللي بيكونها المول
+
+156
+00:11:51,570 --> 00:11:58,230
+كمان مرة الكنيديا اشجون عنها الكنيديا هي سنة
+
+157
+00:11:58,230 --> 00:12:02,410
+ومصلمين ل sports يعني كلمة مرادفة لكلمات sports
+
+158
+00:12:02,410 --> 00:12:05,910
+لكن sports في الفطريات تختلف عن ال sports فيه اللي
+
+159
+00:12:05,910 --> 00:12:06,890
+هو البكتير
+
+160
+00:12:09,230 --> 00:12:13,960
+في بعض الأحيان بنلاقي spores كبيرةفبسموها
+
+161
+00:12:13,960 --> 00:12:19,100
+macroconidia وفيه spores صغيرة نفس الفطر نفسه
+
+162
+00:12:19,100 --> 00:12:23,720
+بينتج الصنفين فبسموها macroconidia و microconidia
+
+163
+00:12:23,720 --> 00:12:28,980
+اذا هذا يكون متفقين ان الحجم والشكل مهم ليش الشكل
+
+164
+00:12:28,980 --> 00:12:32,300
+والحجم مهم لأن هو diagnostic feature ايش هي
+
+165
+00:12:32,300 --> 00:12:36,380
+diagnostic feature يعني صفة مهمة لل diagnosis
+
+166
+00:12:36,380 --> 00:12:40,740
+وبتالي مهم نعرف احنا ان هذا النوع لونه ايش
+
+167
+00:12:47,150 --> 00:12:56,390
+أخر فقرة في اللوحة تتكلم عن معلومات
+
+168
+00:12:56,390 --> 00:13:01,070
+تجميعية بيقولنا the presence or absence of
+
+169
+00:13:01,070 --> 00:13:05,110
+Canadian and their sizes يبقى خمس مرة وجود أو عدم
+
+170
+00:13:05,110 --> 00:13:10,290
+وجود هذا واحد ال size تبعها ال shape ال location
+
+171
+00:13:10,930 --> 00:13:13,930
+are major features that are used in the laboratory
+
+172
+00:13:13,930 --> 00:13:17,110
+to identify the species of fungus in clinical
+
+173
+00:13:17,110 --> 00:13:20,630
+specimens يعني إذا أردت أن تقوم بعملية تعرف على
+
+174
+00:13:20,630 --> 00:13:24,570
+الفطريات فعليك أن على الأقل تحدد وجود أو عدم وجود
+
+175
+00:13:24,570 --> 00:13:28,950
+إذا وجدت ما شكلها ما حجمها ما إيش ال arrangement
+
+176
+00:13:28,950 --> 00:13:32,410
+بعتها تمام؟ هل هي جوا كيس ولا برا كيس؟ هذه كل
+
+177
+00:13:32,410 --> 00:13:35,250
+الأشياء بتساعدنا في التعرف عالمين على الفطريات
+
+178
+00:13:36,970 --> 00:13:42,050
+أمامنا A وB على سبيل المثال مخلوق واحد اسمه
+
+179
+00:13:42,050 --> 00:13:46,430
+Candida .. عارفين Candida؟ Candida Albicans اسمته
+
+180
+00:13:46,430 --> 00:13:50,830
+في الإسم Candida Albicans سُقى لأحد الأطباء اللي
+
+181
+00:13:50,830 --> 00:13:53,830
+قاعد يعطي محاضرة في الفطريات جالله .. واحد جالله
+
+182
+00:13:53,830 --> 00:13:59,110
+جالله ما هي أهم عشر فطريات مسببة للأمراض للإنسان؟
+
+183
+00:13:59,390 --> 00:14:03,270
+فكتب على الصبورة واحد اتنين تلاتة عشرة وبدأ يعبي
+
+184
+00:14:03,270 --> 00:14:06,550
+كتب واحد كان ده البكنز اتنين كان ده البكنز تلاتة
+
+185
+00:14:06,550 --> 00:14:10,890
+لحد سبعة كان ده البكنز وبعدين كتب باق الفطريات في
+
+186
+00:14:10,890 --> 00:14:15,770
+التلاتة اللي هم الباقين من السبعةمؤشر على أنه
+
+187
+00:14:15,770 --> 00:14:21,030
+الكندرالبكانز كتير مهمة وكتير منتشرة أو بسبب أمراض
+
+188
+00:14:21,030 --> 00:14:24,710
+فين هنا ال .. ال .. ال blastoconidia and
+
+189
+00:14:24,710 --> 00:14:29,970
+pseudohypha كلمة pseudohypha فاكرين لما قولنا ال
+
+190
+00:14:29,970 --> 00:14:32,670
+indentation؟ هاي indentation، وين السهم؟ شايفين
+
+191
+00:14:32,670 --> 00:14:39,190
+السهم؟ هذا عبارة عن استطالةلكن واضح انه في خلية
+
+192
+00:14:39,190 --> 00:14:42,610
+وخلية مكان الالتقاء بين الخليتين اللي هو اللي فيه
+
+193
+00:14:42,610 --> 00:14:45,410
+ال indentation طبعا بالاضافة إلى اللي قلنا اللي هو
+
+194
+00:14:45,410 --> 00:14:49,490
+ال blastoconidia فين دي chlamydiospores للكندا؟
+
+195
+00:14:49,490 --> 00:14:53,190
+هذه chlamydiospores طالعة من اللي هو الكندا
+
+196
+00:14:53,190 --> 00:14:56,430
+الarthrospores اللي ويسمونها براميل فاكرينها؟
+
+197
+00:14:56,430 --> 00:15:00,750
+هياتها موجودة هذهمشهور فيها فترة اسمه Coxiodes
+
+198
+00:15:00,750 --> 00:15:03,830
+Emethes Coxiodes Emethes هيمر معناه اذكره كمان
+
+199
+00:15:03,830 --> 00:15:10,010
+شوية في ال .. في انديهانة الاسبورانجيا للميوكر
+
+200
+00:15:10,010 --> 00:15:13,730
+الميوكر هذا لو انتوا حاططوا طبق في مختبركو او هنا
+
+201
+00:15:13,730 --> 00:15:17,530
+في الغرفة هذه طبق تبع سبرود أجار وطلقتوا عشر دقائق
+
+202
+00:15:17,530 --> 00:15:22,760
+و بعد هسكرتوا وحاططوه لمدة اسبوعهتلاجوا الطبق
+
+203
+00:15:22,760 --> 00:15:28,300
+مليان cotton white وموزع شوية أسود عليه طب ما لو
+
+204
+00:15:28,300 --> 00:15:32,920
+فتح الطبق هتلاجى أنه اللون الأسود و الفطر واصل
+
+205
+00:15:32,920 --> 00:15:36,500
+وين؟ واصل الغطا يعني مش ده البكتيريا البكتيريا بجت
+
+206
+00:15:36,500 --> 00:15:39,920
+وين؟ البكتيريا تكون على ال .. على ال media هذه لأ
+
+207
+00:15:39,920 --> 00:15:44,820
+بتطلع .. بتصل ل aerial يعني هوائية تصل لفوق من
+
+208
+00:15:44,820 --> 00:15:47,960
+أكثر الملوثات في الدنيا شيوعا هو الميوكر هو
+
+209
+00:15:47,960 --> 00:15:52,440
+الميوكر اللى موجود هناشايفين الأصابع هذه الخمسة أو
+
+210
+00:15:52,440 --> 00:15:56,940
+الأكتر هما الخمسة دول عشرة ده طلعوا هذا بيسموها
+
+211
+00:15:56,940 --> 00:15:59,820
+microconidia وبيوصفوها in a finger-like
+
+212
+00:15:59,820 --> 00:16:03,740
+projections يعني زوائد زي إيه زي الأصابع وهي ال
+
+213
+00:16:03,740 --> 00:16:07,740
+sports تبعتها واحد اتنين تلاتة أربعة وهكذا يعني
+
+214
+00:16:07,740 --> 00:16:11,750
+مسفطين في أربعةجاب شوية كنت اتكلم عن microconidia
+
+215
+00:16:11,750 --> 00:16:15,710
+و macro .. اه عفوا الممثل لهذا الشكل هو ال
+
+216
+00:16:15,710 --> 00:16:20,110
+aspergillus و ال aspergillus هو اكثر عفن بتشوفوه
+
+217
+00:16:20,110 --> 00:16:24,750
+انتوا خاصة العفن الأسود اسمه aspergillus niger
+
+218
+00:16:24,750 --> 00:16:32,380
+نيجر أسود من نيجرو نيجرو معناها أسودفي عندي هنا ال
+
+219
+00:16:32,380 --> 00:16:35,680
+microconidia الصغيرة اللى شايفينها ال microconidia
+
+220
+00:16:35,680 --> 00:16:40,120
+و ال macroconidia لفطر اسمه microespora
+
+221
+00:16:40,120 --> 00:16:46,020
+microespora اذا في عندي أشكال متنوعة و مختلفة و
+
+222
+00:16:46,020 --> 00:16:51,180
+أحجام مختلفة لل espores تبع الفطريات وبالتالي
+
+223
+00:16:51,180 --> 00:16:55,580
+تعتبر هذه الأشياء diagnostic features يعني أشياء
+
+224
+00:16:55,580 --> 00:17:01,020
+متستخدمة في عملية التنييزباليست كنا بال budding
+
+225
+00:17:01,020 --> 00:17:04,220
+يست forming صدوهايفة زي ما حكينا شايفين ال
+
+226
+00:17:04,220 --> 00:17:07,800
+indentation هذه واضحة هذه ماحكيناش عنها اللي هي ال
+
+227
+00:17:07,800 --> 00:17:13,380
+germ tube ال germ tube هذا ال germ tube خاصية
+
+228
+00:17:13,380 --> 00:17:16,480
+بتكونها ال candida albicans بتكونها ال candida
+
+229
+00:17:16,480 --> 00:17:20,890
+albicansركزوا معايا لان هذه نقطة كتير مهمة
+
+230
+00:17:20,890 --> 00:17:24,190
+بتساعدنا احنا في تمييز ال candida albicans عن
+
+231
+00:17:24,190 --> 00:17:27,110
+باقيا نوع ال candida لو عزلنا candida شباب و
+
+232
+00:17:27,110 --> 00:17:30,010
+بنعرفها albicans ولا مش albicans بنعملها الفحص
+
+233
+00:17:30,010 --> 00:17:34,410
+التاني الفحص التالي اللي اسمه germ tube test كيف
+
+234
+00:17:34,410 --> 00:17:38,770
+بنعمل ال candida هيبقى على نيست بناخدها من الطبق و
+
+235
+00:17:38,770 --> 00:17:43,620
+بنحطها في انبوبة فيها سيراموبنعملها incubation
+
+236
+00:17:43,620 --> 00:17:47,700
+لمدة أربع ساعات وبناخد عينا من السيرم ونحطه على
+
+237
+00:17:47,700 --> 00:17:51,380
+شريحة ونعمله cover slip و under the microscope إذا
+
+238
+00:17:51,380 --> 00:17:55,800
+لجينا الشكل اللي قدامكوا هذا اللي هو ال germ tube
+
+239
+00:17:55,800 --> 00:18:01,020
+yeast امطلعة tube yeast امطلعة tube فهي candida
+
+240
+00:18:01,020 --> 00:18:06,300
+albicans وهذا المفحص كمان مرة germ tube test فيه
+
+241
+00:18:06,300 --> 00:18:11,420
+له كمان تطبيق تانيالـ Candida موجودة Normal Flora
+
+242
+00:18:11,420 --> 00:18:16,520
+في كثير من أمعاء البشر طب لما نعمل Stool Analysis
+
+243
+00:18:16,520 --> 00:18:22,360
+احنا وشوفناها هل تعني شيء لما ده Normal Flora هل
+
+244
+00:18:22,360 --> 00:18:27,040
+ستعني لكم شيئا لو انا تحت ال microscope شوفت ان
+
+245
+00:18:27,040 --> 00:18:30,820
+تميب هالستولاتك تعني شيء لأنها مش Normal
+
+246
+00:18:30,820 --> 00:18:33,780
+Microbiota بينما ال Candida اللي بي cancel Normal
+
+247
+00:18:33,780 --> 00:18:37,830
+Microbiota لا تعني شيءطيب انت بتعرفوا ان لو انا
+
+248
+00:18:37,830 --> 00:18:41,070
+أخدت Antibiotic لفترة طويلة قد تنمو لي Candida
+
+249
+00:18:41,070 --> 00:18:45,630
+Albicans وتنملي دياريا؟ طب كيف بتعرف دياريا سببها
+
+250
+00:18:45,630 --> 00:18:50,710
+Candida Albicans ولا انها Normal Flora؟إذا وانا
+
+251
+00:18:50,710 --> 00:18:54,750
+بفحص الستول شوفت candida albicans عاملة germ tube
+
+252
+00:18:54,750 --> 00:19:00,810
+فاعلموا فاعلموا ان هي the pathogenic form هي الآن
+
+253
+00:19:00,810 --> 00:19:04,550
+في طور ال invasive يعني هي اللي عاملة ال infection
+
+254
+00:19:04,550 --> 00:19:09,320
+فهي شغلتين استفدناها من مين؟من ال germ tube مرة في
+
+255
+00:19:09,320 --> 00:19:12,200
+التعرف على ال candida albicans تميزها عن باقي
+
+256
+00:19:12,200 --> 00:19:18,380
+الأنواع ال candida و مرة عرفنا انها ال pathogen في
+
+257
+00:19:18,380 --> 00:19:21,260
+الديارية او مش ال pathogen الشكل التاني اللي
+
+258
+00:19:21,260 --> 00:19:23,940
+قدامكوا هنا اللي هو ال hypha اللي قولنا عنها
+
+259
+00:19:23,940 --> 00:19:28,530
+septated فيها حواجز و لاحظوا كل نوكلياس في مينفي
+
+260
+00:19:28,530 --> 00:19:32,150
+خلية معينة بينما ال aseptate أو ال non-septated
+
+261
+00:19:32,150 --> 00:19:37,870
+حيفة الخلايا أو الأنوية موجودة بدون حوارز بدون
+
+262
+00:19:37,870 --> 00:19:41,830
+حوارز ايش الاسم التاني اللي هقولنا سينوسيتك حيفي
+
+263
+00:19:41,830 --> 00:19:51,550
+سينوسيتك حيفي طيب
+
+264
+00:19:53,230 --> 00:19:56,610
+خلّينا نطلع على الـ distinguishing characteristics
+
+265
+00:19:56,610 --> 00:20:00,510
+اللي بتميز بين الفنجاي والبكتيريا كتير مهمين نطلع
+
+266
+00:20:00,510 --> 00:20:04,050
+عليهم وناخدين احنا مثال على يعني في المقارنة في ال
+
+267
+00:20:04,050 --> 00:20:08,730
+size ال candida وماخدين ال Staphylococcus
+
+268
+00:20:08,730 --> 00:20:12,030
+البكتيريا is smaller in size حوالي واحد مايكروم
+
+269
+00:20:12,030 --> 00:20:17,350
+بينما ال candida حوالي أربع مايكروم طبيعة الخلية
+
+270
+00:20:17,350 --> 00:20:23,380
+اللي بيحددها مين؟النواة هل هي ايو كاريوتز ولا بلو
+
+271
+00:20:23,380 --> 00:20:26,500
+كاريوتز إذا كانت محاطة بنكليار ممبراين فهي ايو
+
+272
+00:20:26,500 --> 00:20:30,740
+وطلعت الفنجاي او الفطريات ايو كاريوتز هذه المعلومة
+
+273
+00:20:30,740 --> 00:20:35,100
+مهمة جدا ليش مهمة جدالأنه لما أنا بتكلم على
+
+274
+00:20:35,100 --> 00:20:38,260
+Antifungal خدوا بالكوا كنت أقول Antibiotics في
+
+275
+00:20:38,260 --> 00:20:40,840
+البكتيريا صح؟ Antibiotics اللي أنا بتكلم عن
+
+276
+00:20:40,840 --> 00:20:45,020
+Antifungal في سؤال بيجي .. سؤال بيجي بيقول لماذا
+
+277
+00:20:45,020 --> 00:20:49,020
+هناك عدد كبير من ال antibacterials بينما هناك عدد
+
+278
+00:20:49,020 --> 00:20:52,340
+قليل من ال Antifungal المستخدمة بطريقة طبية و
+
+279
+00:20:52,340 --> 00:20:54,140
+علاجية؟
+
+280
+00:20:55,830 --> 00:20:59,390
+لأن هي الجواب لإن أنا في اندي similarities بين ال
+
+281
+00:20:59,390 --> 00:21:02,770
+pathogen في هذا الحالة اندي similarities بين ال
+
+282
+00:21:02,770 --> 00:21:07,370
+pathogen و بين ال host احنا اتنين eukaryotes تخيل
+
+283
+00:21:07,370 --> 00:21:12,710
+لو انا اخترعت drug بيستهدف ال 40S ribosomal sub
+
+284
+00:21:12,710 --> 00:21:17,030
+unitوبيقتل الفطريات، ما هو هيقتل مين كمان؟ خلاياه
+
+285
+00:21:17,030 --> 00:21:20,950
+لإنه هيمنع ال protein synthesis عشان أحصل على ال
+
+286
+00:21:20,950 --> 00:21:25,970
+selective toxicity اللي ناضلنا من أجلها سابقا في
+
+287
+00:21:25,970 --> 00:21:30,970
+الفكتيريا لازم يكون بيستهدف مركبات موجودة في الفطر
+
+288
+00:21:30,970 --> 00:21:35,810
+ومش موجودة فيه زي مثلا ال cell wall موجود في الفطر
+
+289
+00:21:35,810 --> 00:21:39,920
+ومش موجود عندنافي مركبات هنشوفها الآن وهذا مهم جدا
+
+290
+00:21:39,920 --> 00:21:44,620
+في الفروقات انه موجودة في الفطريات ومش موجودة
+
+291
+00:21:44,620 --> 00:21:49,840
+عندنا مثلا الكوليسترول عندنا وعندها ergosterol ال
+
+292
+00:21:49,840 --> 00:21:53,240
+ergosterol غير عن الكوليسترول ففي drugs مشهورة جدا
+
+293
+00:21:53,240 --> 00:21:56,360
+تستخدم في مين فقط ال ergosterol هذه نقطة كتير ايضا
+
+294
+00:21:56,360 --> 00:22:01,700
+مهمة طبعا الcytoplasm زي وزي اي eukaryote في
+
+295
+00:22:01,700 --> 00:22:04,600
+mitochondria او في endoplasmic reticulum بينما في
+
+296
+00:22:04,600 --> 00:22:06,680
+البكتيريا انتوا عارفين الكلام هذا مش موجود مش
+
+297
+00:22:06,680 --> 00:22:10,670
+موجودالـ cell membrane فيه استرال طبعا الاسترال مش
+
+298
+00:22:10,670 --> 00:22:15,310
+موجود في البكتيريا ما عدا ما عدا ال microblast
+
+299
+00:22:15,310 --> 00:22:19,750
+ماعدا مشهورة المعلومة ال cell wall content بيحتوي
+
+300
+00:22:19,750 --> 00:22:23,150
+على كايتين بينما البكتيريا بيحتوي على بيبتيدو
+
+301
+00:22:23,150 --> 00:22:26,870
+إجلايكا بس بدي أضيف كمان غير الكايتين في حاجة
+
+302
+00:22:26,870 --> 00:22:30,370
+مميزة في الفطريات مش عارف موجودة قدامنا في الحلقة
+
+303
+00:22:30,370 --> 00:22:35,930
+اللي هي ال beta-glucan beta-glucan برضه موجودة في
+
+304
+00:22:35,930 --> 00:22:39,990
+الفطريات مش موجودة في البكتيرياالـ spores sexual
+
+305
+00:22:39,990 --> 00:22:43,630
+or asexual spores for reproduction الاندو سبورز
+
+306
+00:22:43,630 --> 00:22:46,950
+للبكتيريا for survival الكلام اللي بدأنا فيه
+
+307
+00:22:46,950 --> 00:22:50,130
+المحاضرة تبعتنا for survival but not for
+
+308
+00:22:50,130 --> 00:22:53,570
+reproduction thermal dimorphism و اعتقد كلمة
+
+309
+00:22:53,570 --> 00:22:56,930
+thermal dimorphism وضحت انا انه على ال
+
+310
+00:22:56,930 --> 00:22:59,010
+environmental temperature ال ambient temperature
+
+311
+00:22:59,010 --> 00:23:02,410
+they are mold وعلى ال host temperature they are
+
+312
+00:23:02,410 --> 00:23:07,110
+yeast هذا سميناها dimorphismلأن الحرارة هي اللي
+
+313
+00:23:07,110 --> 00:23:11,210
+تتحكم في الشكل فسميناها thermal dimorphism هذه
+
+314
+00:23:11,210 --> 00:23:14,230
+موجودة في الفطريات غير موجودة في البكتيريا الظاهرة
+
+315
+00:23:14,230 --> 00:23:21,250
+ال metabolism الفطريات requires organic carbon no
+
+316
+00:23:21,250 --> 00:23:25,610
+obligate anaerobic هذه نقطة كتير مهمة لا يوجد لا
+
+317
+00:23:25,610 --> 00:23:32,230
+يوجد في الفطرياتأي صنف ابن عرفه لحد الآن obligate
+
+318
+00:23:32,230 --> 00:23:36,570
+أنا إيروب، كلها Arabic and facultative أنا إيروب،
+
+319
+00:23:36,570 --> 00:23:39,810
+اما Arabic او facultative أنا إيروب، but not
+
+320
+00:23:39,810 --> 00:23:44,090
+obligate أنا إيروبطبعا تعرفين في البكتيريا في
+
+321
+00:23:44,090 --> 00:23:49,070
+أشكال و ألوان متنوعة، في منها photosynthetic
+
+322
+00:23:49,070 --> 00:23:52,930
+البكتيريا، يعني بتصنع غذائها لحالها، زي ال blue
+
+323
+00:23:52,930 --> 00:23:57,430
+green algae اللي هي سينو بكتيريا، هذه autotroph،
+
+324
+00:23:57,430 --> 00:24:01,510
+بس الفطريات كلها heterotroph، يعني متنوعة التغذية
+
+325
+00:24:03,250 --> 00:24:06,390
+طبعا هذا ال yeast and mold للتفريق انا حكيتلكوا في
+
+326
+00:24:06,390 --> 00:24:09,470
+البداية ان ال yeast grow as single cells that
+
+327
+00:24:09,470 --> 00:24:13,250
+reproduce by asexual budding و ال mold عبارة عن
+
+328
+00:24:13,250 --> 00:24:16,610
+hypha و mycelium هذا الكلام حاكيناه فاهمتاش انه ان
+
+329
+00:24:16,610 --> 00:24:21,230
+انا اخد فيه وقت طويل بدا مرور مرور سريع على بعض
+
+330
+00:24:21,230 --> 00:24:26,670
+الأشياء المهمة بتهمكوا كتير في ال ال microbiology
+
+331
+00:24:30,810 --> 00:24:36,530
+الان احنا بنتكلم على الفطريات على الفطريات و في
+
+332
+00:24:36,530 --> 00:24:40,090
+البكتيريا اكتر تركيزنا كان على مين على كيف
+
+333
+00:24:40,090 --> 00:24:44,310
+البكتيريا بتنتقل اليك و كيف بتعملك pathogenesis صح
+
+334
+00:24:44,310 --> 00:24:48,770
+ولا لأ؟ في الفطريات بنتناول الموضوع بطريقة أوسع
+
+335
+00:24:48,770 --> 00:24:52,310
+شوية احنا ممكن ناكل الفطريات نفسها الفطريات نفسنا
+
+336
+00:24:52,310 --> 00:24:56,660
+كلها كمشروم صح ولا لأ؟عمل جوجلينج على أمانيتا
+
+337
+00:24:56,660 --> 00:25:02,800
+مشروم أمانيتا مشروم أمانيتا هيته تمام؟ شايفين
+
+338
+00:25:02,800 --> 00:25:07,780
+الكلمة دي؟ أمانيتا مشروم سيظهر لك صور من أروع ما
+
+339
+00:25:07,780 --> 00:25:14,460
+يكون شكلًا جمالًا تقول لك كلني بس تقول الحيوانات
+
+340
+00:25:14,460 --> 00:25:19,920
+don't eat me الحيوانات تفهم لغة بعضبتعرف دفاقة
+
+341
+00:25:19,920 --> 00:25:25,740
+صغيرة في دفاقة ملونة دفاقة ملونة في منها تنتج أقوى
+
+342
+00:25:25,740 --> 00:25:32,480
+السموم أقوى السموم فالألوان في الطبيعة المخلوقات
+
+343
+00:25:32,480 --> 00:25:36,720
+اللي بتتعامل مع بعض الدنيا بتفهمها don't eat me
+
+344
+00:25:36,720 --> 00:25:41,280
+احنا البشر لإن بنحب الجمال و بنتغنى بالجمال فلما
+
+345
+00:25:41,280 --> 00:25:45,930
+نشوف حاجة ليه بناكل الجمال هذا برضهف it is very
+
+346
+00:25:45,930 --> 00:25:49,250
+toxic يبقى أكله نفسه ولا ينزلج تحت مين food
+
+347
+00:25:49,250 --> 00:25:55,270
+poisoning حاجة مسممة في كمان شغل تاني شباب انه انا
+
+348
+00:25:55,270 --> 00:26:00,030
+ممكن اتعرض لاليرجيانت بتعرف فى فصل الربيع الواحد
+
+349
+00:26:00,030 --> 00:26:03,710
+بيطلع بحجوب اللقاح البعض الناس بترجع عنده كإنه
+
+350
+00:26:03,710 --> 00:26:06,890
+influenza صح ولا لأ؟ حساسية .. فى بعض الناس بتاكل
+
+351
+00:26:06,890 --> 00:26:09,810
+أكل معينة بيصي عنده حساسية بيقعد بيجرسوا نحلة،
+
+352
+00:26:09,810 --> 00:26:16,410
+نملة، بعوضة، مش عارف إيه، بيلبس صوف، بيتعامل مع
+
+353
+00:26:16,410 --> 00:26:20,610
+غبار المنزل تمام؟ بيصي عنده حساسية، بياخد drugs،
+
+354
+00:26:20,610 --> 00:26:25,590
+بيصي عنده حساسية، allergy هل الفطرات بتسبب
+
+355
+00:26:25,590 --> 00:26:30,340
+allergy؟ نعم بتسبب allergyوبتسبب الارجي بما يشبه
+
+356
+00:26:30,340 --> 00:26:34,680
+الأزمة، يعني لو استنشق الإنسان الـspores تبع
+
+357
+00:26:34,680 --> 00:26:40,700
+الـaspergillus زي ما هو موجود في اللوحة هذه، ممكن
+
+358
+00:26:40,700 --> 00:26:45,280
+يصير عنده asmatic reaction
+
+359
+00:26:47,260 --> 00:26:50,480
+و لو عملنا له skin test ايش skin test؟ يعني أخدنا
+
+360
+00:26:50,480 --> 00:26:55,040
+ال extract تبع الفطريات و حقرنا الجلد فيه هيصير
+
+361
+00:26:55,040 --> 00:26:59,700
+عنده فاكرين ال induration و ال redness اللي هو ..
+
+362
+00:26:59,700 --> 00:27:02,420
+اللي هو اسم تاني wheel and flare reaction wheel
+
+363
+00:27:02,420 --> 00:27:05,680
+and flare reaction اللي هو الاحمرار و الانتفاخ هذا
+
+364
+00:27:05,680 --> 00:27:10,920
+هذا مش علاش على انه المريض عنده hypersensitivity
+
+365
+00:27:10,920 --> 00:27:16,670
+يعني حساس عنده حساسية من الفطريات طيبواحد عنده
+
+366
+00:27:16,670 --> 00:27:20,430
+حساسية يا شباب لأسباب غير معروفة بروح على طريق
+
+367
+00:27:20,430 --> 00:27:26,390
+الجلدية بعمله فحص بعمله فحص عارفين أكم فحص بعمله
+
+368
+00:27:26,390 --> 00:27:31,430
+في الفحص الواحد بعمله أكتر من سبعين فحص بيجيب إيده
+
+369
+00:27:31,430 --> 00:27:38,570
+بعملها خارطة عنده علبة kit فيه allergens مستخلصة
+
+370
+00:27:38,570 --> 00:27:46,830
+منأنا ذكرت قبل شوية غبار حبوب طلع لمخلوقات معينة
+
+371
+00:27:46,830 --> 00:27:51,530
+بعض الأطعمة صوف مش عارف مستخلصات لكثير يمكن نص أو
+
+372
+00:27:51,530 --> 00:27:57,250
+ربع العدد الفعوسات مأخوذ من فطريات دلال علاش على
+
+373
+00:27:57,250 --> 00:28:02,370
+أن الفطريات عامل مهم او من مسببات مين اللي هو ال
+
+374
+00:28:02,370 --> 00:28:02,530
+allergic
+
+375
+00:28:06,690 --> 00:28:10,630
+حضرة ال aspergillus ال أمينيتا قلنا دي عبارة عن
+
+376
+00:28:10,630 --> 00:28:14,430
+تكسين لو اتناولنا نفسنا تكسين تاني يا شباب اسمه
+
+377
+00:28:14,430 --> 00:28:18,910
+أفلا تكسين أفلا تكسين و هذا الأفلا تكسين قلنالكم
+
+378
+00:28:18,910 --> 00:28:21,670
+تنتجه برضه نوع من ال aspergillus اسمه aspergillus
+
+379
+00:28:21,670 --> 00:28:25,530
+flavus و aspergillus parasiticus تنتين بس مش
+
+380
+00:28:25,530 --> 00:28:30,170
+مذكورة تانية و هذا التكسين can produce liver
+
+381
+00:28:30,170 --> 00:28:34,490
+damage liver damage يعني بضار له اللي هو خلايا
+
+382
+00:28:34,490 --> 00:28:42,860
+الكبد كيف؟بيتحول في الكبد إلى ما يسمى بالـ Epoxide
+
+383
+00:28:42,860 --> 00:28:47,860
+والـ Epoxide معروف عنه انه Carcinogen القالية
+
+384
+00:28:47,860 --> 00:28:54,140
+المفترضة للـ Carcinogenesis ان الـ Aflatoxin بي
+
+385
+00:28:54,140 --> 00:28:59,760
+واحد بيعمل mutation في مين؟ في الـ B53 tumor
+
+386
+00:28:59,760 --> 00:29:03,180
+suppressor gene ايش كان ال tumor suppressor gene؟
+
+387
+00:29:03,710 --> 00:29:09,490
+يعني جين بينتج بروتين بيعمل suppression لمن؟ لـ
+
+388
+00:29:09,490 --> 00:29:13,330
+tumors طب صار في mutation هيطلع البروتين لكن
+
+389
+00:29:13,330 --> 00:29:15,070
+البروتين هذا غير قادر على انه يعمل suppression
+
+390
+00:29:15,070 --> 00:29:20,150
+لمن؟ لـ tumors وبالتالي هيصير عندنا tumors واد
+
+391
+00:29:20,150 --> 00:29:24,890
+الألية المفترضة طبعا كلنا أكلنا أفلاتوكسين شئنا
+
+392
+00:29:24,890 --> 00:29:30,520
+مقابينا أكلنا أفلاتوكسين هناك في الدقيقلذلك احنا
+
+393
+00:29:30,520 --> 00:29:34,960
+ممكن قبل سنتين عملت دورة للاخوة في وزارة الصحة في
+
+394
+00:29:34,960 --> 00:29:39,440
+how to detect how to detect aflatoxin from food
+
+395
+00:29:39,440 --> 00:29:44,160
+واشتغلوا فترة ويعني نتاج اللي انا في غزة مقبولة
+
+396
+00:29:44,160 --> 00:29:47,600
+ايش يعني مقبولة؟ في standards بيقولك انه ليجب ان
+
+397
+00:29:47,600 --> 00:29:51,060
+لا يزيد مستوى الaflatoxin عن هذا المستوى لأنه اذا
+
+398
+00:29:51,060 --> 00:29:52,860
+زاد بالفعل بيصير له accumulation بيصير عنه
+
+399
+00:29:52,860 --> 00:30:00,930
+toxicity كمان مرة شفناfood poisoning مباشرة من
+
+400
+00:30:00,930 --> 00:30:04,590
+تناول غذاء شوفنا allergic reaction شوفنا aflatoxin
+
+401
+00:30:04,590 --> 00:30:08,570
+اللي هو كارسينوجين غير عن ال pathogenesis اللي
+
+402
+00:30:08,570 --> 00:30:13,190
+بتسببه الفطريات بين الأصابع بين أصابع الرجلين
+
+403
+00:30:13,190 --> 00:30:16,510
+athlete foot القدم الرياضية تسمعوا فيها ولا بقى ال
+
+404
+00:30:16,510 --> 00:30:21,070
+athlete foot هذا مرض مشهور قد نرى meningitis
+
+405
+00:30:21,070 --> 00:30:24,330
+caused by cryptococcus neophormans مرض عادزة
+
+406
+00:30:24,330 --> 00:30:29,960
+للبكتيريا meningitisالامراض السيستيميك زي كوكسيديو
+
+407
+00:30:29,960 --> 00:30:35,680
+ديس اميتاس زي ال blastomycosis امراض كتيرة بتسببها
+
+408
+00:30:35,680 --> 00:30:40,160
+برضه الفطريات اذا كمان مرة الفطريات قد تسبب
+
+409
+00:30:40,160 --> 00:30:44,840
+allergy قد تسبب food poisoning قد تنتج توكسين هذه
+
+410
+00:30:44,840 --> 00:30:48,040
+التوكسين قد تؤدي الى ال cancer او قد تؤدي الى
+
+411
+00:30:48,040 --> 00:30:52,960
+infection عادي طيب جزء جزء كتير مهم ال laboratory
+
+412
+00:30:52,960 --> 00:30:58,000
+diagnosisال lab diagnosis بيتلخص في واحد من أربع
+
+413
+00:30:58,000 --> 00:31:02,500
+أشياء يا إما direct microscopy يعني نتطلع على ال
+
+414
+00:31:02,500 --> 00:31:05,180
+microscope على العينة و طبعا ممكن نعمل صباغة و
+
+415
+00:31:05,180 --> 00:31:09,640
+ممكن نعمل صباغة بأشكال و أنواع مختلفة و ممكن نعمل
+
+416
+00:31:09,640 --> 00:31:14,320
+culture لل micro organism نزرع البكتيريا على سبرود
+
+417
+00:31:14,320 --> 00:31:17,080
+ديكستروز أجار مارب معاكوا اسم سبرود في ال
+
+418
+00:31:17,080 --> 00:31:20,830
+diagnostic microDNA probes test وهذا يمكن الفحص
+
+419
+00:31:20,830 --> 00:31:25,290
+اللي الآن growing يعني interest فيه في العالم كله
+
+420
+00:31:25,290 --> 00:31:29,130
+لإنه rapid بيقصر الفترة الزمانية للتشخيص لإن
+
+421
+00:31:29,130 --> 00:31:33,110
+الفطريات مش زي البكتيريا 24 ساعة بتنمو بدها أسبوع
+
+422
+00:31:33,110 --> 00:31:36,350
+و أسبوع وقت طويل للتشخيص وبعد الأحيان بدها أسبوعين
+
+423
+00:31:37,020 --> 00:31:40,620
+والفحث الأخير اللى هو physiological test إما
+
+424
+00:31:40,620 --> 00:31:45,000
+microscopy إما culture إما DNA props test دعونا
+
+425
+00:31:45,000 --> 00:31:48,080
+نطلع على ال microscopy والأشهر على الإطلاق اللى هو
+
+426
+00:31:48,080 --> 00:31:57,560
+ال KOH طبعا استخدمتها في ال diagnostic ال KOH10%
+
+427
+00:31:57,560 --> 00:32:02,680
+بوتاسيوم هيدروكسيد تضعف قطرة او قطرتين منها
+
+428
+00:32:02,680 --> 00:32:09,100
+للتيشيو الموراد فحصه شعر ادفر skin scrapping
+
+429
+00:32:09,100 --> 00:32:12,440
+بيوبسيز
+
+430
+00:32:12,440 --> 00:32:18,500
+ايش الغرض من ال QH؟ to dissolve and clarify the
+
+431
+00:32:18,500 --> 00:32:24,390
+specimen ايش يعني dissolve؟ بدوّبالـ debris بسهولة
+
+432
+00:32:24,390 --> 00:32:30,810
+الفطريات resistant للـ KOH بمعنى يعني they cannot
+
+433
+00:32:30,810 --> 00:32:36,070
+be dissolved by KOH فلما أنا أدوب ما حواليها بتبين
+
+434
+00:32:36,070 --> 00:32:43,150
+واضح الآن ماذا أرى تحت الـ KOH وجود أو عدم وجود؟
+
+435
+00:32:43,350 --> 00:32:46,770
+Mycelium اللي هو الـ Hypha عفوًا تمام و ال Spores
+
+436
+00:32:46,770 --> 00:32:50,730
+موجود أو عدم وجود هذه نقطة كتير مهمة لذلك أحد
+
+437
+00:32:50,730 --> 00:32:54,550
+الأشياء اللي بتنطلب بشكل روتيني من قبل الطباء
+
+438
+00:32:54,550 --> 00:32:59,790
+الجلدية تمام هو ال KOH سمير الآن موجود أو عدم وجود
+
+439
+00:32:59,790 --> 00:33:03,350
+هذه نقطة النقطة التانية إذا وجود إيش شكل ال Spores
+
+440
+00:33:03,350 --> 00:33:08,250
+حجمها micro ولا macro مظبوط ال Hypha هل هي
+
+441
+00:33:08,250 --> 00:33:12,340
+sinusitic ولاسيرانسونس كيش يقولوا عنها جوفاء ولا
+
+442
+00:33:12,340 --> 00:33:16,900
+سبتيتد حيث يبقى في معلومات كويسة تطلع من الكيواتش
+
+443
+00:33:17,530 --> 00:33:20,010
+عارفين كم واحد بيشتري كيوات شاننا او كم مصدر تشتري
+
+444
+00:33:20,010 --> 00:33:24,310
+لنا؟ واحد او اتنين مع انه التقنية سهلة جدا بس بيدك
+
+445
+00:33:24,310 --> 00:33:27,230
+شوية ممارسة على التعرف على ال .. يعني بيدك بيدك
+
+446
+00:33:27,230 --> 00:33:30,770
+practice تمام؟ عشانك انا بقولكوا المحاضرات المسجلة
+
+447
+00:33:30,770 --> 00:33:33,710
+اللي نزلتلكوا اياهم على ال .. الموقع المجموع على
+
+448
+00:33:33,710 --> 00:33:37,070
+الفيسبوك يارد تسمعوهم بشكل جيد مهم جدا حتى لو انهم
+
+449
+00:33:37,070 --> 00:33:41,370
+مش داخلين في الامتحان الا انهم يعني بشكل مادة جيدة
+
+450
+00:33:41,370 --> 00:33:45,240
+لكلاء ال .. ال my college ان شاء اللهيبقى اتفاقنا
+
+451
+00:33:45,240 --> 00:33:51,600
+على عيش ال .. الكيواتش تقنية بسيطة وسهلة من
+
+452
+00:33:51,600 --> 00:33:57,600
+الأمثلة الشهيرة جدا جدا ل ال direct microscopy وين
+
+453
+00:33:57,600 --> 00:34:02,640
+بقدر ال direct microscopy يخدم مرادين مهمين انا
+
+454
+00:34:02,640 --> 00:34:07,600
+شخصياأتطلقت في شغل .. في .. في تدريبي بقى أنا طالب
+
+455
+00:34:07,600 --> 00:34:10,800
+لوحدة منهم اللي هي رقم اتنين اللي هي ال capsule
+
+456
+00:34:10,800 --> 00:34:14,200
+تبعت ال crypto .. ال cryptococcus neoformans كنا
+
+457
+00:34:14,200 --> 00:34:18,040
+نعمل ال CSF العيانة في ال CSF اللي بتجينا يا ما
+
+458
+00:34:18,040 --> 00:34:21,040
+كنا ندورها في المستشفى في الفلبين والبرض منتشر في
+
+459
+00:34:21,040 --> 00:34:27,210
+الفلبيننعمل ال India Ink مش كيوتش عفوا ال India
+
+460
+00:34:27,210 --> 00:34:30,210
+Ink ل .. اللي هو .. طبعا ال India Ink برضه Direct
+
+461
+00:34:30,210 --> 00:34:33,910
+Microscopy نحط قطرة من ال CSF و قطرة من ال India
+
+462
+00:34:33,910 --> 00:34:36,310
+Ink Mix و Cover Script وحطه تحت ال microscope
+
+463
+00:34:36,310 --> 00:34:39,950
+وانتهى الموضوع إذا Cryptococcus موجودة بتقولك هيني
+
+464
+00:34:39,950 --> 00:34:46,250
+أنا موجودة كيف خلية دائرة و عليها دائرة أكبر أكبر
+
+465
+00:34:46,250 --> 00:34:50,470
+بتلت أضعاف إلى أربع أضعافليش؟ إيش هي الدالة
+
+466
+00:34:50,470 --> 00:34:54,470
+التانية هذه؟ هي الكابسول إذا انت مش فاكر ان مش ال
+
+467
+00:34:54,470 --> 00:34:58,610
+India ink أصلا تستخدم لإظهار الكابسول صح ولا لأ
+
+468
+00:34:58,610 --> 00:35:02,650
+فالخميرة هذه اللي هي ال Cryptococcus neoformans هي
+
+469
+00:35:02,650 --> 00:35:07,130
+yeast أو capsulated yeast الكابسول تبعتها ال size
+
+470
+00:35:07,130 --> 00:35:11,790
+أكبر بكثير من مين من الخلية نفسها الشيء الأثناء
+
+471
+00:35:11,790 --> 00:35:18,030
+الاسفريول تبعت الكوكسديوديس اميتسالكوكسيديوهدس
+
+472
+00:35:18,030 --> 00:35:22,710
+اميتس بتكون في البيئة filamentous لكن في الانسجل
+
+473
+00:35:22,710 --> 00:35:27,250
+تبعتنا بتكون اسفريول زي بتذكرنا على فهمين
+
+474
+00:35:27,250 --> 00:35:32,370
+الاسفريول هادي في الاخلاميديا الاخلاميديا
+
+475
+00:35:33,640 --> 00:35:37,300
+كانت elementary body دخلت ديوب الخلية صار لها
+
+476
+00:35:37,300 --> 00:35:41,360
+differentiation الى spherule و جوا ال spherule
+
+477
+00:35:41,360 --> 00:35:45,660
+تشكلت ال reticulate body اللى صار لها maturation ل
+
+478
+00:35:45,660 --> 00:35:50,360
+elementary body هذا ل اللى فاكر ان احنا درسنا
+
+479
+00:35:50,360 --> 00:35:51,880
+كلميديا اصلا
+
+480
+00:35:54,550 --> 00:35:59,030
+مثالين مهمين جدا اللي هم ال .. ال .. ال spherules
+
+481
+00:35:59,030 --> 00:36:01,890
+تبعت الكوكسيديو .. coccidioides hematis و ال
+
+482
+00:36:01,890 --> 00:36:04,970
+capsule تبعت الكريبتو كوكس نيو four months من ال
+
+483
+00:36:04,970 --> 00:36:08,740
+spinal fluidفي كمان صبغة كتير حلوة انا اتمنى انه
+
+484
+00:36:08,740 --> 00:36:12,280
+.. انه ندخلها قريبا في الخدمة اللي هي ال
+
+485
+00:36:12,280 --> 00:36:15,220
+calcoflower white وهو عبارة عن fluorescent dye
+
+486
+00:36:15,220 --> 00:36:18,360
+بيرتبط specifically في ال cell wall تبع الفطريات
+
+487
+00:36:18,360 --> 00:36:22,320
+وبالتالي حتى لو كان موجود في أنسجها مدام الإرتباط
+
+488
+00:36:22,320 --> 00:36:25,860
+في الفطر مباشرة من غير .. دون عن غيره فبالتالي
+
+489
+00:36:25,860 --> 00:36:30,180
+بيظهر انها بشكل واضحفي كمان صبغة أخرى مثل نمين
+
+490
+00:36:30,180 --> 00:36:34,340
+silverstein برضه مستخدمة في ال diagnosis لكن هذي
+
+491
+00:36:34,340 --> 00:36:37,100
+غالبا من بيستخدموها to ال histopathology اللي
+
+492
+00:36:37,100 --> 00:36:45,740
+بيستخدموه الأنسجة المقطعة او الشرايح microscopy
+
+493
+00:36:45,740 --> 00:36:49,460
+culture seborrheic dextrose agar is the most
+
+494
+00:36:49,460 --> 00:36:52,820
+famous most common لل medical mycology بيستخدموه
+
+495
+00:36:53,900 --> 00:36:57,220
+وميزته انه بيعمل inhibition للبكتيريا بيعمل
+
+496
+00:36:57,220 --> 00:37:00,040
+inhibition للبكتيريا ليش بدنا نعمل inhibition
+
+497
+00:37:00,040 --> 00:37:05,540
+للبكتيريا البكتيريا are fast grower يعني لو حطينا
+
+498
+00:37:05,540 --> 00:37:08,800
+فطر مع بكتيريا في وسط بينام التانين مع بعض
+
+499
+00:37:08,800 --> 00:37:13,440
+البكتيريا هتنمو و هتاخد الأكل من الفطريات وبالتالي
+
+500
+00:37:13,440 --> 00:37:19,140
+الفطريات لن تنمو لأن هو slow grower فبدي وسط يعمل
+
+501
+00:37:19,140 --> 00:37:24,620
+تثبيت لنمو البكتيريا فبيسمح لمين للفطرياتعلى إيش
+
+502
+00:37:24,620 --> 00:37:27,700
+معتمد في قدرته على تطبيق البكتيريا على إن ال pH
+
+503
+00:37:27,700 --> 00:37:31,680
+تبقى منخفض وكثير من البكتيريا غير قادرة على إنها
+
+504
+00:37:31,680 --> 00:37:36,760
+تنمو في pH منخفض ويضاف له بعض الأحيان
+
+505
+00:37:36,760 --> 00:37:39,880
+chloramphenicol وcyclohexamide و there are two
+
+506
+00:37:39,880 --> 00:37:43,900
+drugs أعتقد أنه حكينا عنهم في ال food microbiology
+
+507
+00:37:43,900 --> 00:37:46,820
+للشباب اللي بدرسوا food microbiology لما اتكلمنا
+
+508
+00:37:46,820 --> 00:37:51,830
+عن ال yeast and mold countفي الـ yeast and mold
+
+509
+00:37:51,830 --> 00:37:55,850
+count، جزء أساسي من الـ structure تبع الـ تبع
+
+510
+00:37:55,850 --> 00:37:58,390
+الميديا أنه انضاف أنتيباتيك ت inhibit the growth
+
+511
+00:37:58,390 --> 00:38:01,470
+of بكتيريا وأشهرهم على الإطلاق بأنها الـ
+
+512
+00:38:01,470 --> 00:38:05,090
+chloramphenicol والـ cyclohexamide، هذا في الغالب
+
+513
+00:38:05,090 --> 00:38:09,310
+autoclavable، بمعنى أنه لست بحاجة أن أنا أقلق من
+
+514
+00:38:09,310 --> 00:38:13,150
+عملية اللي هو ال sterilization بال autoclave.إذا
+
+515
+00:38:13,150 --> 00:38:17,450
+السبروت ديكستروز أجار هو الوسط المستخدم بكثرة مش
+
+516
+00:38:17,450 --> 00:38:20,330
+هو الوحيد لكن هو المستخدم بكثرة يعني ممكن يستخدم
+
+517
+00:38:20,330 --> 00:38:23,790
+ال potato ديكستروز أجار وانضاف الواحد في بيتك
+
+518
+00:38:23,790 --> 00:38:28,840
+ويعطينا فعالية لبأسةالـ DNA techniques انتوا كلكوا
+
+519
+00:38:28,840 --> 00:38:33,800
+بتعرفوا ال DNA props PCR وبعدين hybridization و
+
+520
+00:38:33,800 --> 00:38:39,420
+التقنية is widely accepted انها بتعمل shortening ل
+
+521
+00:38:39,420 --> 00:38:42,440
+ال diagnostic period بدل ما المزرعة المستعمرة
+
+522
+00:38:42,440 --> 00:38:46,380
+تصيرها الجدى بيانه أسبوع كامل ممكن اخد جزء من
+
+523
+00:38:46,380 --> 00:38:50,460
+بداية المستعمرة من بداية المستعمرة واعمله DNA
+
+524
+00:38:50,460 --> 00:38:53,160
+technique وانتهى هذا الموضوع والان انا متوفر في
+
+525
+00:38:53,160 --> 00:38:58,760
+الأسواقفي التقنيات الفحص الكوكسيديويدس والهيستو
+
+526
+00:38:58,760 --> 00:39:03,300
+بلازما والبلاستو مايكوسس والكريبتو كوكس الكريبتو
+
+527
+00:39:03,300 --> 00:39:08,380
+كوكس نيوفورمانس احنا قبل دقائق لسه اتحدثنا عنها
+
+528
+00:39:08,380 --> 00:39:13,440
+لما كشفناها بمين بال India Inc في ال CSF تذكروا
+
+529
+00:39:13,440 --> 00:39:17,040
+انه لها كابسول ولما عرصنا ال bacteriology كنا
+
+530
+00:39:17,040 --> 00:39:21,910
+نتكلم عنهكنت أتكلم عن مين؟ عن نيسيريا مينينجايتس،
+
+531
+00:39:21,910 --> 00:39:24,870
+عن hemophilus influenza، عن streptococcus
+
+532
+00:39:24,870 --> 00:39:28,410
+pneumonia، سميناهم نجوم المينينجايتس، العامل
+
+533
+00:39:28,410 --> 00:39:31,570
+المشتلك غير أنهم يسببوا مينينجايتس، العامل المشتلك
+
+534
+00:39:31,570 --> 00:39:35,010
+تبعهم كانش أنه لهم capsule، وهذه اللي هي capsule،
+
+535
+00:39:35,010 --> 00:39:39,130
+عشان هيك أنا بقدر كمان أشخصها أشرب مين؟ بالسيروجين
+
+536
+00:39:40,470 --> 00:39:44,730
+زي ما اعملت diagnoses للانتجينات تبع الكابسول
+
+537
+00:39:44,730 --> 00:39:48,670
+بتاعة التلاتة نفس الطريقة بنقدر نعملها diagnoses
+
+538
+00:39:48,670 --> 00:39:53,810
+بال Latex Agglutination Test Latex Agglutination
+
+539
+00:39:53,810 --> 00:40:01,670
+Test لكن بقدر كمان بكل يعني تواضع اقول انه ال
+
+540
+00:40:01,670 --> 00:40:07,010
+serology فيه مشكلة ما عدا هذا الفحص ليش؟ دايما
+
+541
+00:40:07,010 --> 00:40:13,310
+الكشف عن الانتجين100% ممتاز بعطيني إشارة إن
+
+542
+00:40:13,310 --> 00:40:17,150
+الميكروب موجود لكن الكشف عن ال antibody فيه
+
+543
+00:40:17,150 --> 00:40:21,030
+إشكالية زي في الأول .. أول واحدة بقولنا إنه عشان
+
+544
+00:40:21,030 --> 00:40:24,410
+أنا أقدر أقول فيه diagnosis لازم يكون في increase
+
+545
+00:40:24,410 --> 00:40:29,110
+in أو rise in antibody بتاعة لو جدش بيقولك هو four
+
+546
+00:40:29,830 --> 00:40:33,810
+fourfold أربع أضعاف هذا الكلام يعني غالبا بيكون
+
+547
+00:40:33,810 --> 00:40:37,010
+جونه عنه سمنه في ال bacteriology Retrospective
+
+548
+00:40:37,010 --> 00:40:42,650
+diagnosis تشخيص بأثر رجعي طبعا مع أنه ركزنا على
+
+549
+00:40:42,650 --> 00:40:46,530
+أنه برضه مهم وللا للابديمولوجيكال reason من أشهر
+
+550
+00:40:46,530 --> 00:40:49,210
+الفحوصات المستخدمة في السيولوجيا هنا ال complement
+
+551
+00:40:49,210 --> 00:40:53,690
+fixation بيستخدموها لكوكسيديوميكوسس والهيستو
+
+552
+00:40:53,690 --> 00:40:59,000
+بلزموسس والبلاستو مايكوسس كمان في ال skin testمش
+
+553
+00:40:59,000 --> 00:41:01,500
+مذكورة للأسف يعني في الأول حالة كان .. حطوا اضيفوا
+
+554
+00:41:01,500 --> 00:41:04,400
+عندكم جملة skin test في كتير الفطريات اللي ممكن
+
+555
+00:41:04,400 --> 00:41:10,260
+نعملها skin test أكم واحد اللي ال diagnoses صاروا؟
+
+556
+00:41:10,260 --> 00:41:14,660
+وين تلقاها؟ عد طب عد لأ خلينا نعد مع بعض ال
+
+557
+00:41:14,660 --> 00:41:19,650
+diagnoses microscopy directأخدنا أمثلة KOH و India
+
+558
+00:41:19,650 --> 00:41:23,630
+Inc و Metamine Silver، أخدنا ال Kalkoflower، صح؟
+
+559
+00:41:23,630 --> 00:41:26,530
+هدول هي رقم واحد داريف ميكروسكوبي، رقم اتنين،
+
+560
+00:41:26,530 --> 00:41:28,990
+أخدنا Culture، Separate Dextrose أجارفنا بعض
+
+561
+00:41:28,990 --> 00:41:31,570
+المعلومات الأساسية عنه، اتكلمنا عن ال DNA
+
+562
+00:41:31,570 --> 00:41:34,330
+Techniques، اتكلمنا الآن عن اللي هو السيولوجيورفنا
+
+563
+00:41:34,330 --> 00:41:38,870
+مجموعة من اللي هو ال test المستخدمةفيها إن السؤال
+
+564
+00:41:38,870 --> 00:41:42,550
+يسأل نجرب شوية لماذا يوجد antibacterials أكتر من
+
+565
+00:41:42,550 --> 00:41:46,830
+antifungal ورافنا السبب، مابتداش نخد في تفاصيل
+
+566
+00:41:46,830 --> 00:41:49,290
+ندخل الموضوع اللي جدول على طول هذا اللي قدامكوا
+
+567
+00:41:50,260 --> 00:41:55,640
+كنظام أو كمثال رائع جدا على مجموعة من ال drugs
+
+568
+00:41:55,640 --> 00:41:59,140
+مهمين جدا المطلوب منكوا تعرفه بس اسم ال drug و ال
+
+569
+00:41:59,140 --> 00:42:02,600
+mechanism of action تبعته كيف بيشتغل و سهل مش
+
+570
+00:42:02,600 --> 00:42:05,580
+هتتغلبوا في ال mechanism of action لأنه هتشوفوا
+
+571
+00:42:05,580 --> 00:42:09,420
+انهم بيشتغلوا بطريقة يعني unique فريدة كل واحد
+
+572
+00:42:09,420 --> 00:42:13,910
+منهم نبدأ من الأخر ال graceful veinالـgressive
+
+573
+00:42:13,910 --> 00:42:18,750
+vein بيعمل disruption لـmyotic spindle by binding
+
+574
+00:42:18,750 --> 00:42:22,570
+to tubulin الميوتيك سبندل بدونها فيه إمكانية إنه
+
+575
+00:42:22,570 --> 00:42:26,150
+يصير فيه انقسام يبقى عمل inhibition لمين؟ لـgrowth
+
+576
+00:42:26,150 --> 00:42:30,210
+of fungi وانتهينا من الجثة يعني يوقف النمو الـflow
+
+577
+00:42:30,210 --> 00:42:36,970
+cytosine هذا بده شوية شرح هو عبارة عننوكليوتايد
+
+578
+00:42:36,970 --> 00:42:40,550
+انالوج ايش يعني نوكليوتايد انالوج شبيه
+
+579
+00:42:40,550 --> 00:42:43,790
+بالنوكليوتايد راجزوا معاه انت RNA بوليماريز وهي
+
+580
+00:42:43,790 --> 00:42:48,410
+يوراسيل وهي انالوج انت بالنسبالك مابتجرش تميز بين
+
+581
+00:42:48,410 --> 00:42:51,780
+اتنين؟اللي جات قدامك يوراسيل بتاخده بتحطه في ال
+
+582
+00:42:51,780 --> 00:42:56,080
+RNA اللي جات قدامك ال analog بتحطه الان لو حطيت
+
+583
+00:42:56,080 --> 00:42:59,960
+انت ال يوراسيل هتقدر تحط ولا اي حاجة تانية بعد ذلك
+
+584
+00:42:59,960 --> 00:43:03,440
+لكن لو حطت ال analog بيعمل block مش هتقدر تحط ولا
+
+585
+00:43:03,440 --> 00:43:08,300
+حاجة وقف تصنيع ال RNA او لو كان DNA analog وقف في
+
+586
+00:43:08,300 --> 00:43:16,680
+تصنيع ال DNA اذا عشان هي كده شباب معظم معظم ال ..
+
+587
+00:43:17,670 --> 00:43:21,070
+الدراجز المعتمل على هذا المبدأ اللي هو ال .. ال ..
+
+588
+00:43:21,070 --> 00:43:24,090
+ال analog غالبا بيكون لها toxicity عالية بيكون لها
+
+589
+00:43:24,090 --> 00:43:29,430
+toxicity عالية فال flow cytosine جونه بيعمل
+
+590
+00:43:29,430 --> 00:43:32,190
+inhibition لل DNA synthesis ال FC converted to
+
+591
+00:43:32,190 --> 00:43:35,590
+fluoro uracil which inhibits thymidine synthesis
+
+592
+00:43:35,590 --> 00:43:42,690
+بيواجه تصنيع اللي هو ال thymidine فهنا الالـ
+
+593
+00:43:42,690 --> 00:43:47,310
+Echinocandin زي الكسبوفانجين والمايكوفانجين وهذا
+
+594
+00:43:47,310 --> 00:43:55,550
+بيعمل انهيبشن للديجلوكان وهو عبارة عن component في
+
+595
+00:43:55,550 --> 00:44:01,510
+ال fungal cell wall تمام؟كمبوننت مهمة في الـ cell
+
+596
+00:44:01,510 --> 00:44:05,450
+wall في مجموعة ضخمة من ال antifungal اسمها الازولز
+
+597
+00:44:05,450 --> 00:44:08,530
+والازولز هذه مجموعة كتير مهمة زي الكيتوكنازول
+
+598
+00:44:08,530 --> 00:44:13,190
+والفلوكوكنازول والايوتراكنازول والبوساكنازول يعني
+
+599
+00:44:13,190 --> 00:44:17,590
+فينا مجموعة من الكنازول هذه كلها بتشتغل على مركب
+
+600
+00:44:17,590 --> 00:44:24,030
+واحد اسمهالارجسترال مش احنا قولنا الاسترال، هذا
+
+601
+00:44:24,030 --> 00:44:27,770
+بتمنع ال synthesis تبعه من أساسه، هذا يا شباب ال
+
+602
+00:44:27,770 --> 00:44:31,630
+cell membrane بدون الارجسترال بيفقد ال integrity
+
+603
+00:44:31,630 --> 00:44:38,110
+تبعته، تمام؟ الانفوترسين بيرتبطبال ergosterol
+
+604
+00:44:38,110 --> 00:44:41,130
+بيمنعش ال synthesis تمام؟ لكن ارتباطه بال
+
+605
+00:44:41,130 --> 00:44:45,290
+ergosterol و كأنه بينزعوا من مكانه تمام؟ وبالتالي
+
+606
+00:44:45,290 --> 00:44:48,630
+بيصير فيه ثقوب في ال brain و بيصير فيه leakage
+
+607
+00:44:48,630 --> 00:44:53,410
+هدولة بيكفوكوا اللوحة هذه من المحاضرة بالكثيكولا
+
+608
+00:44:53,410 --> 00:44:57,490
+ال antifungal مش هنطلبكوا بغيرها من ال antifungal
+
+609
+00:44:57,490 --> 00:44:58,790
+ك drugs okay؟
+
+610
+00:45:01,010 --> 00:45:05,770
+أعتقد أنه .. ده لأ في عندي انا ال .. ال .. اللوحة
+
+611
+00:45:05,770 --> 00:45:09,130
+الأخيرة دي summary نلخصلكوا فيها ال .. ال .. اللي
+
+612
+00:45:09,130 --> 00:45:14,210
+درسناها في هذا المحاضرة شباب عندنا ال .. ال ..
+
+613
+00:45:14,210 --> 00:45:20,850
+الفطريات شكلا بنصنفها إما إلى unicellular أو
+
+614
+00:45:20,850 --> 00:45:23,750
+multicellular ال unicellular اللي بنسميها yeast و
+
+615
+00:45:23,750 --> 00:45:28,610
+ال multicellular اللي بنسميها مولدزوالـ hypha هي
+
+616
+00:45:28,610 --> 00:45:34,710
+العنوان التجميع الكلية إليه يسميناها mycelium
+
+617
+00:45:34,710 --> 00:45:41,810
+واتفقنا على إنه بعض الفطريات قد تجمع بين الشكلين
+
+618
+00:45:41,810 --> 00:45:46,750
+ويسميناها dimorphism مش كلام عن شكل احنا
+
+619
+00:45:46,750 --> 00:45:52,270
+morphology dimorphism أخدت شكل yeast و أخدت شكل
+
+620
+00:45:52,270 --> 00:45:58,680
+moldلذلك لو سألناك سؤال و قلنا لك الفطر الفلاني
+
+621
+00:45:58,680 --> 00:46:02,300
+اللي هو زي الكوكسيديوديس اميتس أو ال blastomycosis
+
+622
+00:46:02,300 --> 00:46:09,300
+طبعا لا ينتقل من إنسان لإنسان السبب انه die
+
+623
+00:46:09,300 --> 00:46:12,780
+morphie، die morphie وبالتالي بدنا نكون عارفين هذا
+
+624
+00:46:12,780 --> 00:46:14,440
+الكلام، اللي لازم يروح على البيئة و في البيئة
+
+625
+00:46:14,440 --> 00:46:19,020
+يتحول إلى الشكل المعدل و بعدين ينتقل للإنسانالـ
+
+626
+00:46:19,020 --> 00:46:21,960
+hyphae هي الـ branching filamentous form اللي ممكن
+
+627
+00:46:21,960 --> 00:46:24,600
+يكون concepted أو قلنا عنه sinusitic اللي هو
+
+628
+00:46:24,600 --> 00:46:27,340
+الأجواف ال india ink ممكن تستخدم في ال
+
+629
+00:46:27,340 --> 00:46:30,140
+visualization الكابسول في بعض انواع الفطريات اللي
+
+630
+00:46:30,140 --> 00:46:34,180
+لها كابسول او ليست ال saparod agar او في حاجة اسمه
+
+631
+00:46:34,180 --> 00:46:36,920
+micro seal agar ما .. ما .. مارذكره معانا الصحيح
+
+632
+00:46:36,920 --> 00:46:41,400
+لكن برضه مشهور كتير كوسط اخر للفطرياتالـ
+
+633
+00:46:41,400 --> 00:46:47,320
+antifungal agents شفنا مجموعة منها من .. من هذه
+
+634
+00:46:47,320 --> 00:46:50,420
+المجموعة اللي هو الانفوترسين بيه اللي بيرتبط
+
+635
+00:46:50,420 --> 00:46:55,200
+بالارجسترول والأزولز اللي بتمنع تكوين اللي هو
+
+636
+00:46:55,200 --> 00:46:58,460
+الارجسترول من أساسه وبالتالي بيصير فيه انا
+
+637
+00:46:58,460 --> 00:47:01,120
+disruption لل cell member اعتقد ان وراك من هناك
+
+638
+00:47:01,120 --> 00:47:03,180
+نكون شهية الله لإن هنا هذه المحاضرة
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/cfUGCZIP6_0_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/cfUGCZIP6_0_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..9118d487f76d1292d354e4aeff8b1b3b48121a30
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/cfUGCZIP6_0_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 4035, "start": 20.57, "end": 40.35, "text": "بسم الله الرحمن الرحيم اليوم هنبدأ موضوع جديد خالص وهو ال mycology هحنحاول نتعرف على أهم المميزات اللي بتميز الفطريات عن المخلوقات الأخرى ولماذا يعني نهتم بدراسة هذا الجزء في ال micro biology", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 45595, 20498, 8032, 1863, 44510, 10721, 3714, 2407, 11242, 45367, 10874, 16254, 3215, 16490, 6027, 9381, 37037, 2407, 2423, 452, 66, 1793, 8032, 5016, 1863, 5016, 995, 12610, 8717, 2655, 3615, 28480, 15844, 5551, 16095, 9673, 2304, 1829, 11622, 9307, 13672, 1829, 39894, 2304, 1829, 11622, 27188, 9566, 16572, 9307, 18871, 9673, 9778, 1211, 30543, 9307, 16247, 34740, 7578, 4032, 19528, 45636, 995, 37495, 22653, 8717, 3224, 39237, 47525, 23557, 3794, 3660, 23758, 25724, 11622, 38207, 8978, 2423, 4532, 14956], "avg_logprob": -0.11718749784761005, "compression_ratio": 1.6417910447761195, "no_speech_prob": 0.0, "words": [{"start": 20.57, "end": 20.83, 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الواحد بعمله أكتر من سبعين فحص بيجيب إيده بعملها خارطة عنده علبة kit فيه allergens مستخلصة من", "tokens": [14407, 24401, 43242, 3224, 11331, 3794, 32277, 10632, 35186, 13412, 3555, 16758, 5296, 10721, 35457, 16758, 32771, 13546, 20449, 32887, 5172, 3660, 4724, 32887, 5016, 15844, 23032, 16572, 4587, 25724, 1211, 3215, 10632, 4724, 25957, 43761, 6156, 5016, 9381, 4724, 25957, 43761, 6156, 5016, 9381, 6225, 9640, 5172, 9957, 5551, 24793, 6156, 5016, 9381, 4724, 25957, 43761, 8978, 27188, 5016, 9381, 2423, 14407, 24401, 4724, 25957, 43761, 5551, 4117, 2655, 2288, 9154, 8608, 3555, 3615, 9957, 6156, 5016, 9381, 4724, 1829, 7435, 1829, 3555, 11933, 25708, 3224, 4724, 25957, 1211, 11296, 16490, 9640, 9566, 3660, 43242, 3224, 11203, 49401, 8260, 8978, 3224, 8722, 23212, 3714, 14851, 9778, 1211, 9381, 3660, 9154], "avg_logprob": -0.13616070696817978, "compression_ratio": 1.8208955223880596, "no_speech_prob": 0.0, "words": [{"start": 1635.91, "end": 1636.39, "word": "واحد", "probability": 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"probability": 0.941650390625}, {"start": 2781.16, "end": 2781.54, "word": " form", "probability": 0.88623046875}, {"start": 2781.54, "end": 2781.74, "word": " اللي", "probability": 0.816162109375}, {"start": 2781.74, "end": 2781.96, "word": " ممكن", "probability": 0.82861328125}, {"start": 2781.96, "end": 2782.22, "word": " يكون", "probability": 0.97900390625}, {"start": 2782.22, "end": 2782.68, "word": " concepted", "probability": 0.6292724609375}, {"start": 2782.68, "end": 2782.84, "word": " أو", "probability": 0.853515625}, {"start": 2782.84, "end": 2783.08, "word": " قلنا", "probability": 0.6256510416666666}, {"start": 2783.08, "end": 2783.42, "word": " عنه", "probability": 0.893310546875}, {"start": 2783.42, "end": 2784.32, "word": " sinusitic", "probability": 0.488037109375}, {"start": 2784.32, "end": 2784.52, "word": " اللي", "probability": 0.91015625}, {"start": 2784.52, "end": 2784.6, "word": " هو", "probability": 0.9501953125}, {"start": 2784.6, "end": 2785.16, "word": " الأجواف", "probability": 0.8990478515625}, {"start": 2785.16, "end": 2785.84, "word": " ال", "probability": 0.89794921875}, {"start": 2785.84, "end": 2786.12, "word": " india", "probability": 0.3197021484375}, {"start": 2786.12, "end": 2786.36, "word": " ink", "probability": 0.93359375}, {"start": 2786.36, "end": 2786.68, "word": " ممكن", "probability": 0.978515625}, {"start": 2786.68, "end": 2787.12, "word": " تستخدم", "probability": 0.9727783203125}, {"start": 2787.12, "end": 2787.26, "word": " في", "probability": 0.9326171875}, {"start": 2787.26, "end": 2787.34, "word": " ال", "probability": 0.67333984375}, {"start": 2787.34, "end": 2787.76, "word": " visualization", "probability": 0.87646484375}, {"start": 2787.76, "end": 2788.38, "word": " الكابسول", "probability": 0.82696533203125}, {"start": 2788.38, "end": 2788.54, "word": " في", "probability": 0.93896484375}, {"start": 2788.54, "end": 2788.92, "word": " بعض", "probability": 0.988037109375}, {"start": 2788.92, "end": 2789.44, "word": " انواع", "probability": 0.756591796875}, {"start": 2789.44, "end": 2790.0, "word": " الفطريات", "probability": 0.951171875}, {"start": 2790.0, "end": 2790.14, "word": " اللي", "probability": 0.966796875}, {"start": 2790.14, "end": 2790.42, "word": " لها", "probability": 0.7509765625}, {"start": 2790.42, "end": 2791.12, "word": " كابسول", "probability": 0.84735107421875}, {"start": 2791.12, "end": 2791.24, "word": " او", "probability": 0.75634765625}, {"start": 2791.24, "end": 2791.64, "word": " ليست", "probability": 0.714111328125}, {"start": 2791.64, "end": 2792.64, "word": " ال", "probability": 0.73193359375}, {"start": 2792.64, "end": 2793.1, "word": " saparod", "probability": 0.5381673177083334}, {"start": 2793.1, "end": 2793.52, "word": " agar", "probability": 0.837890625}, {"start": 2793.52, "end": 2793.7, "word": " او", "probability": 0.797607421875}, {"start": 2793.7, "end": 2793.82, "word": " في", "probability": 0.488037109375}, {"start": 2793.82, "end": 2794.04, "word": " حاجة", "probability": 0.7311197916666666}, {"start": 2794.04, "end": 2794.18, "word": " اسمه", "probability": 0.6288248697916666}, {"start": 2794.18, "end": 2794.4, "word": " micro", "probability": 0.79052734375}, {"start": 2794.4, "end": 2794.72, "word": " seal", "probability": 0.86376953125}, {"start": 2794.72, "end": 2795.18, "word": " agar", "probability": 0.962890625}, {"start": 2795.18, "end": 2795.46, "word": " ما", "probability": 0.6484375}, {"start": 2795.46, "end": 2795.46, "word": " ..", "probability": 0.57470703125}, {"start": 2795.46, "end": 2796.0, "word": " ما", "probability": 0.814453125}, {"start": 2796.0, "end": 2796.16, "word": " ..", "probability": 0.8212890625}, {"start": 2796.16, "end": 2796.46, "word": " مارذكره", "probability": 0.6462646484375}, {"start": 2796.46, "end": 2796.66, "word": " معانا", "probability": 0.91259765625}, {"start": 2796.66, "end": 2796.92, "word": " الصحيح", "probability": 0.9398193359375}, {"start": 2796.92, "end": 2797.2, "word": " لكن", "probability": 0.79150390625}, {"start": 2797.2, "end": 2797.8, "word": " برضه", "probability": 0.9322916666666666}, {"start": 2797.8, "end": 2798.12, "word": " مشهور", "probability": 0.994140625}, {"start": 2798.12, "end": 2798.52, "word": " كتير", "probability": 0.9521484375}, {"start": 2798.52, "end": 2799.24, "word": " كوسط", "probability": 0.9697265625}, {"start": 2799.24, "end": 2799.64, "word": " اخر", "probability": 0.896728515625}, {"start": 2799.64, "end": 2800.7, "word": " للفطريات", "probability": 0.85068359375}], "temperature": 1.0}, {"id": 123, "seek": 282318, "start": 2801.16, "end": 2823.18, "text": "الـ antifungal agents شفنا مجموعة منها من .. من هذه المجموعة اللي هو الانفوترسين بيه اللي بيرتبط بالارجسترول والأزولز اللي بتمنع تكوين اللي هو الارجسترول من أساسه وبالتالي بيصير فيه انا disruption لل cell member اعتقد ان وراك من هناك نكون شهية الله لإن هنا هذه المحاضرة", "tokens": [6027, 39184, 2511, 351, 1063, 304, 12554, 13412, 5172, 8315, 3714, 7435, 2304, 2407, 27884, 9154, 11296, 9154, 4386, 9154, 29538, 9673, 7435, 2304, 2407, 27884, 13672, 1829, 31439, 2423, 7649, 5172, 35473, 2288, 3794, 9957, 4724, 1829, 3224, 13672, 1829, 4724, 13546, 2655, 3555, 9566, 20666, 9640, 7435, 14851, 2288, 12610, 16070, 10721, 11622, 12610, 11622, 13672, 1829, 39894, 27842, 3615, 6055, 4117, 2407, 9957, 13672, 1829, 31439, 2423, 9640, 7435, 14851, 2288, 12610, 9154, 5551, 3794, 32277, 3224, 46599, 6027, 2655, 6027, 1829, 4724, 1829, 9381, 13546, 8978, 3224, 1975, 8315, 28751, 24976, 2815, 4006, 1975, 34268, 28543, 16472, 4032, 23557, 4117, 9154, 34105, 4117, 8717, 30544, 13412, 3224, 10632, 21984, 5296, 28814, 1863, 34105, 29538, 9673, 5016, 46958, 25720], "avg_logprob": -0.27286586092739573, "compression_ratio": 1.8306451612903225, "no_speech_prob": 0.0, "words": [{"start": 2801.16, "end": 2801.4, "word": "الـ", "probability": 0.5418701171875}, {"start": 2801.4, "end": 2801.94, "word": " antifungal", "probability": 0.812744140625}, {"start": 2801.94, "end": 2802.48, "word": " agents", "probability": 0.91552734375}, {"start": 2802.48, "end": 2803.84, "word": " شفنا", "probability": 0.8507486979166666}, {"start": 2803.84, "end": 2804.52, "word": " مجموعة", "probability": 0.93896484375}, {"start": 2804.52, "end": 2805.34, "word": " منها", "probability": 0.982666015625}, {"start": 2805.34, "end": 2806.7, "word": " من", "probability": 0.52880859375}, {"start": 2806.7, "end": 2806.7, "word": " ..", "probability": 0.263671875}, {"start": 2806.7, "end": 2807.02, "word": " من", "probability": 0.95556640625}, {"start": 2807.02, "end": 2807.32, "word": " هذه", "probability": 0.8466796875}, {"start": 2807.32, "end": 2807.86, "word": " المجموعة", "probability": 0.97265625}, {"start": 2807.86, "end": 2808.04, "word": " اللي", "probability": 0.89990234375}, {"start": 2808.04, "end": 2808.18, "word": " هو", "probability": 0.95849609375}, {"start": 2808.18, "end": 2809.02, "word": " الانفوترسين", "probability": 0.7317592075892857}, {"start": 2809.02, "end": 2809.42, "word": " بيه", "probability": 0.655517578125}, {"start": 2809.42, "end": 2809.94, "word": " اللي", "probability": 0.97412109375}, {"start": 2809.94, "end": 2810.42, "word": " بيرتبط", "probability": 0.9341796875}, {"start": 2810.42, "end": 2811.44, "word": " بالارجسترول", "probability": 0.8205973307291666}, {"start": 2811.44, "end": 2812.5, "word": " والأزولز", "probability": 0.6854248046875}, {"start": 2812.5, "end": 2812.82, "word": " اللي", "probability": 0.96826171875}, {"start": 2812.82, "end": 2813.3, "word": " بتمنع", "probability": 0.93310546875}, {"start": 2813.3, "end": 2813.98, "word": " تكوين", "probability": 0.978515625}, {"start": 2813.98, "end": 2814.92, "word": " اللي", "probability": 0.979736328125}, {"start": 2814.92, "end": 2815.2, "word": " هو", "probability": 0.99365234375}, {"start": 2815.2, "end": 2816.7, "word": " الارجسترول", "probability": 0.9872233072916666}, {"start": 2816.7, "end": 2816.96, "word": " من", "probability": 0.95068359375}, {"start": 2816.96, "end": 2817.48, "word": " أساسه", "probability": 0.9725341796875}, {"start": 2817.48, "end": 2817.96, "word": " وبالتالي", "probability": 0.9220703125}, {"start": 2817.96, "end": 2818.24, "word": " بيصير", "probability": 0.92919921875}, {"start": 2818.24, "end": 2818.36, "word": " فيه", "probability": 0.69921875}, {"start": 2818.36, "end": 2818.46, "word": " انا", "probability": 0.577880859375}, {"start": 2818.46, "end": 2818.76, "word": " disruption", "probability": 0.73583984375}, {"start": 2818.76, "end": 2819.04, "word": " لل", "probability": 0.783203125}, {"start": 2819.04, "end": 2819.32, "word": " cell", "probability": 0.77587890625}, {"start": 2819.32, "end": 2819.88, "word": " member", "probability": 0.458740234375}, {"start": 2819.88, "end": 2820.54, "word": " اعتقد", "probability": 0.7481282552083334}, {"start": 2820.54, "end": 2820.66, "word": " ان", "probability": 0.89501953125}, {"start": 2820.66, "end": 2820.84, "word": " وراك", 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/cfUGCZIP6_0_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/cfUGCZIP6_0_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..71532cdbe4da4c677767d775a429d29d17b9f339
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/cfUGCZIP6_0_raw.srt
@@ -0,0 +1,2552 @@
+1
+00:00:20,570 --> 00:00:24,790
+بسم الله الرحمن الرحيم اليوم هنبدأ موضوع جديد خالص
+
+2
+00:00:24,790 --> 00:00:30,870
+وهو ال mycology هحنحاول نتعرف على أهم المميزات
+
+3
+00:00:30,870 --> 00:00:36,670
+اللي بتميز الفطريات عن المخلوقات الأخرى ولماذا
+
+4
+00:00:36,670 --> 00:00:42,490
+يعني نهتم بدراسة هذا الجزء في ال micro biologyال
+
+5
+00:00:42,490 --> 00:00:45,390
+medical microbiology زي ما انتوا شايفينه على ال
+
+6
+00:00:45,390 --> 00:00:49,870
+diagram مقسمة إلى مجموعة علوم ال bacteriology اللي
+
+7
+00:00:49,870 --> 00:00:53,290
+احنا قضينا معظم الوقت في دراستها الفيروسات اللي
+
+8
+00:00:53,290 --> 00:00:57,590
+درستوها مع الدكتور محمد ال ال helminthology و ال
+
+9
+00:00:57,590 --> 00:01:00,310
+protozoology اللي بيشكلوا علم ال parasitology
+
+10
+00:01:00,310 --> 00:01:02,350
+درستهم مع الدكتور عدنان او هدرسهم مع الدكتور عدنان
+
+11
+00:01:02,990 --> 00:01:06,650
+في جنبهم علم صار يعني علم نظير كان زمان مدمج تحت
+
+12
+00:01:06,650 --> 00:01:10,070
+ال microbiology لكن نظرا لازدياد الحجم تبعه أصبح
+
+13
+00:01:10,070 --> 00:01:14,050
+علم قائم بذاته اللي هو ال immunology الآن نحنا
+
+14
+00:01:14,050 --> 00:01:16,690
+الجزء اللي بنتكلم عنه اللي هو ال mycology
+
+15
+00:01:16,690 --> 00:01:21,650
+والmycology بيهتم بدراسة الفطريات والفطريات تنقسم
+
+16
+00:01:21,650 --> 00:01:27,100
+إلى قسمين رئيسيينلهم ال yeast and mold لكن قبل ما
+
+17
+00:01:27,100 --> 00:01:32,520
+نتكلم عن التصنيفات هذه نتكلم عن الفطريات و دورها
+
+18
+00:01:32,520 --> 00:01:38,600
+في حياتنا كبشر هل لها دور كبير ام دور ثانوي تعالوا
+
+19
+00:01:38,600 --> 00:01:42,940
+نطلع مع بعضفي الصناعات الغذائية على سبيل المثال زي
+
+20
+00:01:42,940 --> 00:01:49,240
+الخبز المكون الرئيسي لعملية تصنيع الخبز هو الخميرة
+
+21
+00:01:49,240 --> 00:01:54,320
+least من ضمن الفطريات معظم الأشبان الصفراء مكونة
+
+22
+00:01:54,320 --> 00:01:58,280
+أو على الأقل جزء من تكوينها بيكون فطريات إذا لها
+
+23
+00:01:58,280 --> 00:02:02,580
+دور في تصنيع الأغذيةأيضا قديما كانت صنعة في
+
+24
+00:02:02,580 --> 00:02:07,200
+المشروبات ال yeast هي المسئولة عن تصنيع الخمور
+
+25
+00:02:07,200 --> 00:02:13,200
+وتصنيع ال .. ال .. ال بيرة لكن احنا كمسلمين ممكن
+
+26
+00:02:13,200 --> 00:02:16,140
+نستخدمها في إنتاج الكحول الكحول المستخدم في
+
+27
+00:02:16,140 --> 00:02:19,620
+المستشفيات نفسه هي المكوّل الأساسي ال mushrooms
+
+28
+00:02:19,620 --> 00:02:27,500
+اللي هي الفطريات التي تؤكل الفطريات تنتج toxinsو
+
+29
+00:02:27,500 --> 00:02:32,100
+ال toxins هذه قد يعني تؤدي الإنسان يبجي على مستوى
+
+30
+00:02:32,100 --> 00:02:37,200
+الاستفادة موجودة و على مستوى الدولار أيضا موجودة و
+
+31
+00:02:37,200 --> 00:02:41,340
+بشكل آخر ال disease آخر نقطة في اللوحة لكن في في
+
+32
+00:02:41,340 --> 00:02:45,290
+المنتصف بين التنتين كلمة biodegradationالـ
+
+33
+00:02:45,290 --> 00:02:49,490
+biodegradation يا شباب هو التحلل البيولوجي تخيلوا
+
+34
+00:02:49,490 --> 00:02:53,430
+لو أن الأجسام تبعد كل المخلوقات اللي بتموت تطلع لك
+
+35
+00:02:53,430 --> 00:02:57,990
+لم تتحللش دورة العناصر دورة العناصر في الطبيعة لن
+
+36
+00:02:57,990 --> 00:03:03,210
+تكتمل وإذا العناصر اختزنت في مركبات ولم تدور في
+
+37
+00:03:03,210 --> 00:03:07,610
+الطبيعة الحياة تنتهي على كوكب الأرضوالفطريات تعتبر
+
+38
+00:03:07,610 --> 00:03:11,010
+من ال decomposers يعني من المحللات بمعنى أخر تسهم
+
+39
+00:03:11,010 --> 00:03:15,970
+بشكل إيجابي في عمل تدوير العناصر إذن هي مهمة كتير
+
+40
+00:03:15,970 --> 00:03:18,170
+طبعا أنا اللي بانيني في الأخر في ال medical
+
+41
+00:03:18,170 --> 00:03:22,710
+microbiology أتكلم عن الصناعات ولا أتكلم عن ال
+
+42
+00:03:22,710 --> 00:03:24,750
+diseases أكيد أتكلم عن ال diseases وعشانك احنا
+
+43
+00:03:24,750 --> 00:03:29,530
+حاطينها في الأخر و باللون اللي هو الأحمروالصورة دى
+
+44
+00:03:29,530 --> 00:03:35,170
+كل الحسنات اللى حاكناهم بينشاله من صورة واحدة
+
+45
+00:03:35,170 --> 00:03:41,070
+بتبيننا skin infection لها caused by a fungi بعض
+
+46
+00:03:41,070 --> 00:03:44,230
+المصطلحات اللى لازم اتعرف عليهم اللى هو ال yeast و
+
+47
+00:03:44,230 --> 00:03:48,850
+ال yeast هى أحد شكلين موجودين في الفطرية تقولنا
+
+48
+00:03:48,850 --> 00:03:52,130
+yeast and mold ال yeast unicellular شباب
+
+49
+00:03:52,130 --> 00:03:57,230
+unicellular يعني دهت خلية واحدةبينما ال .. ال ..
+
+50
+00:03:57,230 --> 00:04:00,170
+ال .. ال mold بتكون multi cellular .. multi
+
+51
+00:04:00,170 --> 00:04:03,830
+cellular ال yeast غالبا تتكثر بال budding بتعرف ال
+
+52
+00:04:03,830 --> 00:04:07,770
+budding التبرعوم اللي هو زي إذا بتعرفوا الصبار
+
+53
+00:04:07,770 --> 00:04:10,310
+اللي موجود هنا في غزة متشير بشكل كبير بيكون فيه
+
+54
+00:04:10,310 --> 00:04:13,230
+لوح بيطلع منه لوح صغير بعض الأحيان بيكون أكتر من
+
+55
+00:04:13,230 --> 00:04:18,640
+اللوح من ال .. ال .. اللوح الأموبعض الأحيان بيكون
+
+56
+00:04:18,640 --> 00:04:22,560
+لوح طالع منه لوح ومنه لوح آخر فهذه الأشكال كلها
+
+57
+00:04:22,560 --> 00:04:26,540
+بنشوفها في ال yeast بعملية كمان مرة بنسميها
+
+58
+00:04:26,540 --> 00:04:31,760
+التبرعم أو ال body في ظاهرة يا شباب رائعة جدا في
+
+59
+00:04:31,760 --> 00:04:35,440
+الفطريات اسمها dimorphism انا قلت يا اما yeast يا
+
+60
+00:04:35,440 --> 00:04:39,420
+اما mold طب ايش رأيكوا ان في فطريات تاخد الشكلين؟
+
+61
+00:04:39,420 --> 00:04:44,470
+بتكون مثلا في البيئةمولد و لما تعمل infection
+
+62
+00:04:44,470 --> 00:04:48,410
+للإنسان بتكون yeast او مايشبه ال yeast يست او
+
+63
+00:04:48,410 --> 00:04:51,710
+مايشبه ال yeast خد بالك كتير نقطة مهمة هذه ليش
+
+64
+00:04:51,710 --> 00:04:56,250
+مهمة؟ في سؤال بيجي في ال medical microbiology why
+
+65
+00:04:56,250 --> 00:05:02,130
+مثلا كوكسوديود كوكسوديوديس اميتس is non-infectious
+
+66
+00:05:02,130 --> 00:05:05,290
+مابتنتقلش من إنسان لإنسان لماذا لا تنتقل من إنسان
+
+67
+00:05:05,290 --> 00:05:10,960
+لإنسان؟ لأن الطور المعدى هوالمولد والمولد موجود في
+
+68
+00:05:10,960 --> 00:05:13,960
+مين؟ في ال environment بينما هو الآن لما انا أخدته
+
+69
+00:05:13,960 --> 00:05:17,500
+صار yeast لو انا بدى أنقلك إياه هانقلك إياه مين؟
+
+70
+00:05:17,500 --> 00:05:21,680
+yeast بالظبط بتالي مش هيكون infective stage لازم
+
+71
+00:05:21,680 --> 00:05:25,260
+يروح على البيئة يتحول من yeast إلى mold وينتقل
+
+72
+00:05:25,260 --> 00:05:28,440
+لإنسانية المصدر دايما في هذا الحالة مين البيئة
+
+73
+00:05:28,440 --> 00:05:33,980
+وليس ال infected person مفهومة ديومورفزم اللي هو
+
+74
+00:05:33,980 --> 00:05:39,220
+إثنائية في الشكل إنه بياخد شكل yeast وشكل moldوزي
+
+75
+00:05:39,220 --> 00:05:42,920
+ما ذكرتلكوا في البيئة غالبا بياخد ال mold وفي
+
+76
+00:05:42,920 --> 00:05:47,040
+الإنسان أو الحيوان بياخد الشكل اللي هو ال yeast ال
+
+77
+00:05:47,040 --> 00:05:53,260
+hypha هي الخيوط بتاعة ال mold هي الخيوط ال hypha
+
+78
+00:05:53,260 --> 00:06:00,380
+بتاعة ال mold وفي منها شكلين يا شباب شكل مقطع يعني
+
+79
+00:06:00,380 --> 00:06:05,340
+فيه قواطق وشكل آخر أجواف أجواف يعني مافيش فيه
+
+80
+00:06:05,340 --> 00:06:10,300
+قواطقواحد اسمها septated اللي فيها السبتة والتانية
+
+81
+00:06:10,300 --> 00:06:15,900
+non-septated او اسم اخر سينوسيتك جوفاء سينوسيتك
+
+82
+00:06:15,900 --> 00:06:19,020
+حيمور معانا او في اخر المحاضرة في السمري حلج
+
+83
+00:06:19,020 --> 00:06:23,640
+المصطلح اذا ال hypha او ال hypha are multicellular
+
+84
+00:06:23,640 --> 00:06:27,540
+fungi which reproduce asexually and or sexually
+
+85
+00:06:27,540 --> 00:06:31,980
+ايش يعني sexually و asexually؟واحد واحد تكاثر لا
+
+86
+00:06:31,980 --> 00:06:36,460
+جنسي مافيش داعي انه يكون فيه ذكر وأنثى جميعه sides
+
+87
+00:06:36,460 --> 00:06:41,980
+واحد لأ بيحتاج فبيقولنا انه قد .. قد نجد فطر
+
+88
+00:06:41,980 --> 00:06:48,370
+بيتكاثر بالطريقتينبيقدر يتكاثر asexual و sexual
+
+89
+00:06:48,370 --> 00:06:54,170
+تمام و قد نجد فطريات فقط تمتلك خاصية واحدة من
+
+90
+00:06:54,170 --> 00:06:59,290
+الاتنتين يبقى and or تمام and or في مصطلح اخر كمان
+
+91
+00:06:59,290 --> 00:07:02,950
+اسمه pseudo hyphenالخمائر احنا اتفقنا الخمائر
+
+92
+00:07:02,950 --> 00:07:06,850
+عبارة عن ايه؟ عن unicellular تخيلوا هي خميرة
+
+93
+00:07:06,850 --> 00:07:12,770
+تكاثرت عملت برعم و كبرت زي امها صارت تمام؟ و كمان
+
+94
+00:07:12,770 --> 00:07:17,090
+واحدة اطلعت فتعطينا شكل ايه؟ انبوب الانبوب هذا
+
+95
+00:07:17,090 --> 00:07:23,100
+بيعطيك انطباع انه حيفة لكن حيفة ايه؟ كاذبةايش اللي
+
+96
+00:07:23,100 --> 00:07:27,500
+بميزلنا بين الهايفي والهايفي الكاذبة انه الهايفي
+
+97
+00:07:27,500 --> 00:07:33,320
+بتكون الخطين متوازين تماما مافيش فيهم indentation
+
+98
+00:07:33,320 --> 00:07:39,340
+مش مخنصرين هنا الله يفت عليك المكان الالتقى بيكون
+
+99
+00:07:39,340 --> 00:07:44,530
+في اللي هو الحواف تبعتهم من بين أوضةإذا الـPseudo
+
+100
+00:07:44,530 --> 00:07:48,110
+-hypha could be distinguished من الـTrue-hypha
+
+101
+00:07:48,110 --> 00:07:51,030
+through the presence of indentation اللي حاكينا
+
+102
+00:07:51,030 --> 00:07:55,530
+عنهم اللي هي انه توقعت هدى الداخلية فيه مجموعة من
+
+103
+00:07:55,530 --> 00:08:00,030
+.. اه okay نتكلم عن الـspores الفطريات تتكثر
+
+104
+00:08:00,030 --> 00:08:06,270
+بالـsporesالان لما بنقول Spores مش .. مش منطقي ما
+
+105
+00:08:06,270 --> 00:08:09,670
+نتذكرش ال Spores سبعة البكتيريا، صح ولا لأ، لكن
+
+106
+00:08:09,670 --> 00:08:13,270
+للأسف التنتين حاجتين مختلفتين تماما و لا يجوز
+
+107
+00:08:13,270 --> 00:08:18,410
+المقارنة بينهم أبدا، يعني مجرد المسمى فقط الموجود،
+
+108
+00:08:18,410 --> 00:08:22,170
+و لما نختلفين تماما، البكتيريا ال Indospore ده مش
+
+109
+00:08:22,170 --> 00:08:25,710
+ذاكر أو ال Spore، كان الغلط منها مش التكاثر و إنما
+
+110
+00:08:25,710 --> 00:08:29,290
+ال protection، خلية تحولت ل Spore، Spore بتحول
+
+111
+00:08:29,290 --> 00:08:34,500
+لخلية، صح؟ما زاد العدد بس هنا الـ spores are used
+
+112
+00:08:34,500 --> 00:08:38,820
+for reproduction one fungi may produce millions,
+
+113
+00:08:39,060 --> 00:08:43,000
+billions of spores تمام؟ يبقى الـ spores هنا بقدر
+
+114
+00:08:43,000 --> 00:08:47,500
+أشبهها أكتر للبذور تبعت النباتات يعني تستخدم لمين؟
+
+115
+00:08:47,500 --> 00:08:52,340
+للتكاثر عملية ايه؟ reproduction، learn
+
+116
+00:08:52,340 --> 00:08:55,060
+reproduction هذه كانت لمين؟ لل protection تبعت
+
+117
+00:08:55,060 --> 00:08:58,580
+البكتيريا إذا لا يجوز المقارنة الآن في اسم تاني
+
+118
+00:08:58,580 --> 00:09:03,860
+للـ spore في الفطريات Conidiaاسمها conidia فالان
+
+119
+00:09:03,860 --> 00:09:08,800
+بقدر اقول ان ال conidia انواع منها arthroponida
+
+120
+00:09:08,800 --> 00:09:13,560
+وكلمة arthroponida مفصالية مفصالية يعني واحدة
+
+121
+00:09:13,560 --> 00:09:17,690
+مركبة فوق واحدة تمام في بينهم زي المفاصلبقولنا
+
+122
+00:09:17,690 --> 00:09:20,730
+barrel shape ايش عاملة barrel shape برميل لأ
+
+123
+00:09:20,730 --> 00:09:23,830
+barrel shape معناه زي البرميل برميل فوق برميل تمام
+
+124
+00:09:23,830 --> 00:09:29,250
+بارل فوق بارل اكيد بينهم حواف برضه زي كمان مرة زي
+
+125
+00:09:29,250 --> 00:09:35,230
+الجصب تمام وبالتالي فيكون زي المفاصل ال clamidio
+
+126
+00:09:35,230 --> 00:09:39,290
+conidia عبارة عن round thick wall cells formed
+
+127
+00:09:39,290 --> 00:09:42,510
+from hypha or pseudohypha يبقى ال clamidio conidia
+
+128
+00:09:42,510 --> 00:09:49,920
+بيكون في كيس تمام جواتهجواته في ال sports الان
+
+129
+00:09:49,920 --> 00:09:53,840
+احنا قلنا ال hypha هي الخيط الرفية او ال hypha
+
+130
+00:09:53,840 --> 00:09:57,540
+اللى قلتلنا بالعربي ال hypha الخيط الرفية اللى
+
+131
+00:09:57,540 --> 00:10:02,220
+بشكل او عنصر اساسي من ال mold وقلنا عنه multi
+
+132
+00:10:02,220 --> 00:10:06,340
+cellular مظبوط هذا microscopic يا شباب غير قادر ان
+
+133
+00:10:06,340 --> 00:10:10,020
+احنا على رؤيته زى ال sports لا انا استطيع رؤية ال
+
+134
+00:10:10,020 --> 00:10:14,700
+sports ولا انا استطيع رؤية مين ال hypha لكن كنا
+
+135
+00:10:14,700 --> 00:10:19,060
+شوفنافنجان قهوة محطوط على المجلة له أربع أو خمس
+
+136
+00:10:19,060 --> 00:10:22,640
+أيام أو سبع أيام و لجينا فيه فطريات كنا شوفنا حبة
+
+137
+00:10:22,640 --> 00:10:28,100
+بندورة طماطم معفنة و طالع عليها عفن شوفنا تفاحة
+
+138
+00:10:28,100 --> 00:10:33,200
+بورتقالة غيره طب هذا اللي شوفناه احنا ايش؟ فطريات
+
+139
+00:10:33,200 --> 00:10:39,700
+طب كيف شوفناها؟اللي شفناها بالعين لأن الهايفة
+
+140
+00:10:39,700 --> 00:10:46,380
+تكاثرت إلى حجم ضخم جدا بحيث شكلت مجموع الهايفة
+
+141
+00:10:46,380 --> 00:10:50,610
+بنسميه myceliumيبقى ال mycelium هو مجموعة الـ
+
+142
+00:10:50,610 --> 00:10:55,530
+hypha وغالبا الشباب بيكون لونه أبيض طب أنتوا
+
+143
+00:10:55,530 --> 00:10:59,330
+الأشياء اللي بتشوفها أبيضة أخضر في أسود معفن
+
+144
+00:10:59,330 --> 00:11:04,410
+الأسود في عندك كمان أشياء أخرى ممكن تكون أصفر ممكن
+
+145
+00:11:04,410 --> 00:11:09,810
+تكون ألوان ما بين الأزرق و الأخضر يبقى في عندي
+
+146
+00:11:09,810 --> 00:11:14,510
+ألوان كثيرة طب و كيف أنا بقول أبيض؟المايسليوم
+
+147
+00:11:14,510 --> 00:11:18,530
+غالبا بيكون لونه أبيض واللون اللي انتوا بتشوفوه
+
+148
+00:11:18,530 --> 00:11:22,350
+أسود أخضر أصفر أو غيره هذا عبارة عن لون ال sports
+
+149
+00:11:22,350 --> 00:11:26,730
+لون ال sports وصلت سؤالة إذا هي غالب الأمر وهذا
+
+150
+00:11:26,730 --> 00:11:30,470
+الكلام عشان تتأكدوا منه اعمل simple search على
+
+151
+00:11:30,470 --> 00:11:35,090
+google على سبرود و fungi هتلاقي الفطريات لما نجلب
+
+152
+00:11:35,090 --> 00:11:38,930
+الطبق زي هيكد اللون من الخلف غالبا أبيض لكن لو
+
+153
+00:11:38,930 --> 00:11:42,570
+جلبناه هتلاقيه في المتصف تبعهأسود أو أخضر أو أصفر
+
+154
+00:11:42,570 --> 00:11:48,390
+أو ألوان أخرى إذا الميسيليوم هو مجموعة مجموعة جنه
+
+155
+00:11:48,390 --> 00:11:51,570
+كمان من الهايفيا أو الهايفات اللي بيكونها المول
+
+156
+00:11:51,570 --> 00:11:58,230
+كمان مرة الكنيديا اشجون عنها الكنيديا هي سنة
+
+157
+00:11:58,230 --> 00:12:02,410
+ومصلمين ل sports يعني كلمة مرادفة لكلمات sports
+
+158
+00:12:02,410 --> 00:12:05,910
+لكن sports في الفطريات تختلف عن ال sports فيه اللي
+
+159
+00:12:05,910 --> 00:12:06,890
+هو البكتير
+
+160
+00:12:09,230 --> 00:12:13,960
+في بعض الأحيان بنلاقي spores كبيرةفبسموها
+
+161
+00:12:13,960 --> 00:12:19,100
+macroconidia وفيه spores صغيرة نفس الفطر نفسه
+
+162
+00:12:19,100 --> 00:12:23,720
+بينتج الصنفين فبسموها macroconidia و microconidia
+
+163
+00:12:23,720 --> 00:12:28,980
+اذا هذا يكون متفقين ان الحجم والشكل مهم ليش الشكل
+
+164
+00:12:28,980 --> 00:12:32,300
+والحجم مهم لأن هو diagnostic feature ايش هي
+
+165
+00:12:32,300 --> 00:12:36,380
+diagnostic feature يعني صفة مهمة لل diagnosis
+
+166
+00:12:36,380 --> 00:12:40,740
+وبتالي مهم نعرف احنا ان هذا النوع لونه ايش
+
+167
+00:12:47,150 --> 00:12:56,390
+أخر فقرة في اللوحة تتكلم عن معلومات
+
+168
+00:12:56,390 --> 00:13:01,070
+تجميعية بيقولنا the presence or absence of
+
+169
+00:13:01,070 --> 00:13:05,110
+Canadian and their sizes يبقى خمس مرة وجود أو عدم
+
+170
+00:13:05,110 --> 00:13:10,290
+وجود هذا واحد ال size تبعها ال shape ال location
+
+171
+00:13:10,930 --> 00:13:13,930
+are major features that are used in the laboratory
+
+172
+00:13:13,930 --> 00:13:17,110
+to identify the species of fungus in clinical
+
+173
+00:13:17,110 --> 00:13:20,630
+specimens يعني إذا أردت أن تقوم بعملية تعرف على
+
+174
+00:13:20,630 --> 00:13:24,570
+الفطريات فعليك أن على الأقل تحدد وجود أو عدم وجود
+
+175
+00:13:24,570 --> 00:13:28,950
+إذا وجدت ما شكلها ما حجمها ما إيش ال arrangement
+
+176
+00:13:28,950 --> 00:13:32,410
+بعتها تمام؟ هل هي جوا كيس ولا برا كيس؟ هذه كل
+
+177
+00:13:32,410 --> 00:13:35,250
+الأشياء بتساعدنا في التعرف عالمين على الفطريات
+
+178
+00:13:36,970 --> 00:13:42,050
+أمامنا A وB على سبيل المثال مخلوق واحد اسمه
+
+179
+00:13:42,050 --> 00:13:46,430
+Candida .. عارفين Candida؟ Candida Albicans اسمته
+
+180
+00:13:46,430 --> 00:13:50,830
+في الإسم Candida Albicans سُقى لأحد الأطباء اللي
+
+181
+00:13:50,830 --> 00:13:53,830
+قاعد يعطي محاضرة في الفطريات جالله .. واحد جالله
+
+182
+00:13:53,830 --> 00:13:59,110
+جالله ما هي أهم عشر فطريات مسببة للأمراض للإنسان؟
+
+183
+00:13:59,390 --> 00:14:03,270
+فكتب على الصبورة واحد اتنين تلاتة عشرة وبدأ يعبي
+
+184
+00:14:03,270 --> 00:14:06,550
+كتب واحد كان ده البكنز اتنين كان ده البكنز تلاتة
+
+185
+00:14:06,550 --> 00:14:10,890
+لحد سبعة كان ده البكنز وبعدين كتب باق الفطريات في
+
+186
+00:14:10,890 --> 00:14:15,770
+التلاتة اللي هم الباقين من السبعةمؤشر على أنه
+
+187
+00:14:15,770 --> 00:14:21,030
+الكندرالبكانز كتير مهمة وكتير منتشرة أو بسبب أمراض
+
+188
+00:14:21,030 --> 00:14:24,710
+فين هنا ال .. ال .. ال blastoconidia and
+
+189
+00:14:24,710 --> 00:14:29,970
+pseudohypha كلمة pseudohypha فاكرين لما قولنا ال
+
+190
+00:14:29,970 --> 00:14:32,670
+indentation؟ هاي indentation، وين السهم؟ شايفين
+
+191
+00:14:32,670 --> 00:14:39,190
+السهم؟ هذا عبارة عن استطالةلكن واضح انه في خلية
+
+192
+00:14:39,190 --> 00:14:42,610
+وخلية مكان الالتقاء بين الخليتين اللي هو اللي فيه
+
+193
+00:14:42,610 --> 00:14:45,410
+ال indentation طبعا بالاضافة إلى اللي قلنا اللي هو
+
+194
+00:14:45,410 --> 00:14:49,490
+ال blastoconidia فين دي chlamydiospores للكندا؟
+
+195
+00:14:49,490 --> 00:14:53,190
+هذه chlamydiospores طالعة من اللي هو الكندا
+
+196
+00:14:53,190 --> 00:14:56,430
+الarthrospores اللي ويسمونها براميل فاكرينها؟
+
+197
+00:14:56,430 --> 00:15:00,750
+هياتها موجودة هذهمشهور فيها فترة اسمه Coxiodes
+
+198
+00:15:00,750 --> 00:15:03,830
+Emethes Coxiodes Emethes هيمر معناه اذكره كمان
+
+199
+00:15:03,830 --> 00:15:10,010
+شوية في ال .. في انديهانة الاسبورانجيا للميوكر
+
+200
+00:15:10,010 --> 00:15:13,730
+الميوكر هذا لو انتوا حاططوا طبق في مختبركو او هنا
+
+201
+00:15:13,730 --> 00:15:17,530
+في الغرفة هذه طبق تبع سبرود أجار وطلقتوا عشر دقائق
+
+202
+00:15:17,530 --> 00:15:22,760
+و بعد هسكرتوا وحاططوه لمدة اسبوعهتلاجوا الطبق
+
+203
+00:15:22,760 --> 00:15:28,300
+مليان cotton white وموزع شوية أسود عليه طب ما لو
+
+204
+00:15:28,300 --> 00:15:32,920
+فتح الطبق هتلاجى أنه اللون الأسود و الفطر واصل
+
+205
+00:15:32,920 --> 00:15:36,500
+وين؟ واصل الغطا يعني مش ده البكتيريا البكتيريا بجت
+
+206
+00:15:36,500 --> 00:15:39,920
+وين؟ البكتيريا تكون على ال .. على ال media هذه لأ
+
+207
+00:15:39,920 --> 00:15:44,820
+بتطلع .. بتصل ل aerial يعني هوائية تصل لفوق من
+
+208
+00:15:44,820 --> 00:15:47,960
+أكثر الملوثات في الدنيا شيوعا هو الميوكر هو
+
+209
+00:15:47,960 --> 00:15:52,440
+الميوكر اللى موجود هناشايفين الأصابع هذه الخمسة أو
+
+210
+00:15:52,440 --> 00:15:56,940
+الأكتر هما الخمسة دول عشرة ده طلعوا هذا بيسموها
+
+211
+00:15:56,940 --> 00:15:59,820
+microconidia وبيوصفوها in a finger-like
+
+212
+00:15:59,820 --> 00:16:03,740
+projections يعني زوائد زي إيه زي الأصابع وهي ال
+
+213
+00:16:03,740 --> 00:16:07,740
+sports تبعتها واحد اتنين تلاتة أربعة وهكذا يعني
+
+214
+00:16:07,740 --> 00:16:11,750
+مسفطين في أربعةجاب شوية كنت اتكلم عن microconidia
+
+215
+00:16:11,750 --> 00:16:15,710
+و macro .. اه عفوا الممثل لهذا الشكل هو ال
+
+216
+00:16:15,710 --> 00:16:20,110
+aspergillus و ال aspergillus هو اكثر عفن بتشوفوه
+
+217
+00:16:20,110 --> 00:16:24,750
+انتوا خاصة العفن الأسود اسمه aspergillus niger
+
+218
+00:16:24,750 --> 00:16:32,380
+نيجر أسود من نيجرو نيجرو معناها أسودفي عندي هنا ال
+
+219
+00:16:32,380 --> 00:16:35,680
+microconidia الصغيرة اللى شايفينها ال microconidia
+
+220
+00:16:35,680 --> 00:16:40,120
+و ال macroconidia لفطر اسمه microespora
+
+221
+00:16:40,120 --> 00:16:46,020
+microespora اذا في عندي أشكال متنوعة و مختلفة و
+
+222
+00:16:46,020 --> 00:16:51,180
+أحجام مختلفة لل espores تبع الفطريات وبالتالي
+
+223
+00:16:51,180 --> 00:16:55,580
+تعتبر هذه الأشياء diagnostic features يعني أشياء
+
+224
+00:16:55,580 --> 00:17:01,020
+متستخدمة في عملية التنييزباليست كنا بال budding
+
+225
+00:17:01,020 --> 00:17:04,220
+يست forming صدوهايفة زي ما حكينا شايفين ال
+
+226
+00:17:04,220 --> 00:17:07,800
+indentation هذه واضحة هذه ماحكيناش عنها اللي هي ال
+
+227
+00:17:07,800 --> 00:17:13,380
+germ tube ال germ tube هذا ال germ tube خاصية
+
+228
+00:17:13,380 --> 00:17:16,480
+بتكونها ال candida albicans بتكونها ال candida
+
+229
+00:17:16,480 --> 00:17:20,890
+albicansركزوا معايا لان هذه نقطة كتير مهمة
+
+230
+00:17:20,890 --> 00:17:24,190
+بتساعدنا احنا في تمييز ال candida albicans عن
+
+231
+00:17:24,190 --> 00:17:27,110
+باقيا نوع ال candida لو عزلنا candida شباب و
+
+232
+00:17:27,110 --> 00:17:30,010
+بنعرفها albicans ولا مش albicans بنعملها الفحص
+
+233
+00:17:30,010 --> 00:17:34,410
+التاني الفحص التالي اللي اسمه germ tube test كيف
+
+234
+00:17:34,410 --> 00:17:38,770
+بنعمل ال candida هيبقى على نيست بناخدها من الطبق و
+
+235
+00:17:38,770 --> 00:17:43,620
+بنحطها في انبوبة فيها سيراموبنعملها incubation
+
+236
+00:17:43,620 --> 00:17:47,700
+لمدة أربع ساعات وبناخد عينا من السيرم ونحطه على
+
+237
+00:17:47,700 --> 00:17:51,380
+شريحة ونعمله cover slip و under the microscope إذا
+
+238
+00:17:51,380 --> 00:17:55,800
+لجينا الشكل اللي قدامكوا هذا اللي هو ال germ tube
+
+239
+00:17:55,800 --> 00:18:01,020
+yeast امطلعة tube yeast امطلعة tube فهي candida
+
+240
+00:18:01,020 --> 00:18:06,300
+albicans وهذا المفحص كمان مرة germ tube test فيه
+
+241
+00:18:06,300 --> 00:18:11,420
+له كمان تطبيق تانيالـ Candida موجودة Normal Flora
+
+242
+00:18:11,420 --> 00:18:16,520
+في كثير من أمعاء البشر طب لما نعمل Stool Analysis
+
+243
+00:18:16,520 --> 00:18:22,360
+احنا وشوفناها هل تعني شيء لما ده Normal Flora هل
+
+244
+00:18:22,360 --> 00:18:27,040
+ستعني لكم شيئا لو انا تحت ال microscope شوفت ان
+
+245
+00:18:27,040 --> 00:18:30,820
+تميب هالستولاتك تعني شيء لأنها مش Normal
+
+246
+00:18:30,820 --> 00:18:33,780
+Microbiota بينما ال Candida اللي بي cancel Normal
+
+247
+00:18:33,780 --> 00:18:37,830
+Microbiota لا تعني شيءطيب انت بتعرفوا ان لو انا
+
+248
+00:18:37,830 --> 00:18:41,070
+أخدت Antibiotic لفترة طويلة قد تنمو لي Candida
+
+249
+00:18:41,070 --> 00:18:45,630
+Albicans وتنملي دياريا؟ طب كيف بتعرف دياريا سببها
+
+250
+00:18:45,630 --> 00:18:50,710
+Candida Albicans ولا انها Normal Flora؟إذا وانا
+
+251
+00:18:50,710 --> 00:18:54,750
+بفحص الستول شوفت candida albicans عاملة germ tube
+
+252
+00:18:54,750 --> 00:19:00,810
+فاعلموا فاعلموا ان هي the pathogenic form هي الآن
+
+253
+00:19:00,810 --> 00:19:04,550
+في طور ال invasive يعني هي اللي عاملة ال infection
+
+254
+00:19:04,550 --> 00:19:09,320
+فهي شغلتين استفدناها من مين؟من ال germ tube مرة في
+
+255
+00:19:09,320 --> 00:19:12,200
+التعرف على ال candida albicans تميزها عن باقي
+
+256
+00:19:12,200 --> 00:19:18,380
+الأنواع ال candida و مرة عرفنا انها ال pathogen في
+
+257
+00:19:18,380 --> 00:19:21,260
+الديارية او مش ال pathogen الشكل التاني اللي
+
+258
+00:19:21,260 --> 00:19:23,940
+قدامكوا هنا اللي هو ال hypha اللي قولنا عنها
+
+259
+00:19:23,940 --> 00:19:28,530
+septated فيها حواجز و لاحظوا كل نوكلياس في مينفي
+
+260
+00:19:28,530 --> 00:19:32,150
+خلية معينة بينما ال aseptate أو ال non-septated
+
+261
+00:19:32,150 --> 00:19:37,870
+حيفة الخلايا أو الأنوية موجودة بدون حوارز بدون
+
+262
+00:19:37,870 --> 00:19:41,830
+حوارز ايش الاسم التاني اللي هقولنا سينوسيتك حيفي
+
+263
+00:19:41,830 --> 00:19:51,550
+سينوسيتك حيفي طيب
+
+264
+00:19:53,230 --> 00:19:56,610
+خلّينا نطلع على الـ distinguishing characteristics
+
+265
+00:19:56,610 --> 00:20:00,510
+اللي بتميز بين الفنجاي والبكتيريا كتير مهمين نطلع
+
+266
+00:20:00,510 --> 00:20:04,050
+عليهم وناخدين احنا مثال على يعني في المقارنة في ال
+
+267
+00:20:04,050 --> 00:20:08,730
+size ال candida وماخدين ال Staphylococcus
+
+268
+00:20:08,730 --> 00:20:12,030
+البكتيريا is smaller in size حوالي واحد مايكروم
+
+269
+00:20:12,030 --> 00:20:17,350
+بينما ال candida حوالي أربع مايكروم طبيعة الخلية
+
+270
+00:20:17,350 --> 00:20:23,380
+اللي بيحددها مين؟النواة هل هي ايو كاريوتز ولا بلو
+
+271
+00:20:23,380 --> 00:20:26,500
+كاريوتز إذا كانت محاطة بنكليار ممبراين فهي ايو
+
+272
+00:20:26,500 --> 00:20:30,740
+وطلعت الفنجاي او الفطريات ايو كاريوتز هذه المعلومة
+
+273
+00:20:30,740 --> 00:20:35,100
+مهمة جدا ليش مهمة جدالأنه لما أنا بتكلم على
+
+274
+00:20:35,100 --> 00:20:38,260
+Antifungal خدوا بالكوا كنت أقول Antibiotics في
+
+275
+00:20:38,260 --> 00:20:40,840
+البكتيريا صح؟ Antibiotics اللي أنا بتكلم عن
+
+276
+00:20:40,840 --> 00:20:45,020
+Antifungal في سؤال بيجي .. سؤال بيجي بيقول لماذا
+
+277
+00:20:45,020 --> 00:20:49,020
+هناك عدد كبير من ال antibacterials بينما هناك عدد
+
+278
+00:20:49,020 --> 00:20:52,340
+قليل من ال Antifungal المستخدمة بطريقة طبية و
+
+279
+00:20:52,340 --> 00:20:54,140
+علاجية؟
+
+280
+00:20:55,830 --> 00:20:59,390
+لأن هي الجواب لإن أنا في اندي similarities بين ال
+
+281
+00:20:59,390 --> 00:21:02,770
+pathogen في هذا الحالة اندي similarities بين ال
+
+282
+00:21:02,770 --> 00:21:07,370
+pathogen و بين ال host احنا اتنين eukaryotes تخيل
+
+283
+00:21:07,370 --> 00:21:12,710
+لو انا اخترعت drug بيستهدف ال 40S ribosomal sub
+
+284
+00:21:12,710 --> 00:21:17,030
+unitوبيقتل الفطريات، ما هو هيقتل مين كمان؟ خلاياه
+
+285
+00:21:17,030 --> 00:21:20,950
+لإنه هيمنع ال protein synthesis عشان أحصل على ال
+
+286
+00:21:20,950 --> 00:21:25,970
+selective toxicity اللي ناضلنا من أجلها سابقا في
+
+287
+00:21:25,970 --> 00:21:30,970
+الفكتيريا لازم يكون بيستهدف مركبات موجودة في الفطر
+
+288
+00:21:30,970 --> 00:21:35,810
+ومش موجودة فيه زي مثلا ال cell wall موجود في الفطر
+
+289
+00:21:35,810 --> 00:21:39,920
+ومش موجود عندنافي مركبات هنشوفها الآن وهذا مهم جدا
+
+290
+00:21:39,920 --> 00:21:44,620
+في الفروقات انه موجودة في الفطريات ومش موجودة
+
+291
+00:21:44,620 --> 00:21:49,840
+عندنا مثلا الكوليسترول عندنا وعندها ergosterol ال
+
+292
+00:21:49,840 --> 00:21:53,240
+ergosterol غير عن الكوليسترول ففي drugs مشهورة جدا
+
+293
+00:21:53,240 --> 00:21:56,360
+تستخدم في مين فقط ال ergosterol هذه نقطة كتير ايضا
+
+294
+00:21:56,360 --> 00:22:01,700
+مهمة طبعا الcytoplasm زي وزي اي eukaryote في
+
+295
+00:22:01,700 --> 00:22:04,600
+mitochondria او في endoplasmic reticulum بينما في
+
+296
+00:22:04,600 --> 00:22:06,680
+البكتيريا انتوا عارفين الكلام هذا مش موجود مش
+
+297
+00:22:06,680 --> 00:22:10,670
+موجودالـ cell membrane فيه استرال طبعا الاسترال مش
+
+298
+00:22:10,670 --> 00:22:15,310
+موجود في البكتيريا ما عدا ما عدا ال microblast
+
+299
+00:22:15,310 --> 00:22:19,750
+ماعدا مشهورة المعلومة ال cell wall content بيحتوي
+
+300
+00:22:19,750 --> 00:22:23,150
+على كايتين بينما البكتيريا بيحتوي على بيبتيدو
+
+301
+00:22:23,150 --> 00:22:26,870
+إجلايكا بس بدي أضيف كمان غير الكايتين في حاجة
+
+302
+00:22:26,870 --> 00:22:30,370
+مميزة في الفطريات مش عارف موجودة قدامنا في الحلقة
+
+303
+00:22:30,370 --> 00:22:35,930
+اللي هي ال beta-glucan beta-glucan برضه موجودة في
+
+304
+00:22:35,930 --> 00:22:39,990
+الفطريات مش موجودة في البكتيرياالـ spores sexual
+
+305
+00:22:39,990 --> 00:22:43,630
+or asexual spores for reproduction الاندو سبورز
+
+306
+00:22:43,630 --> 00:22:46,950
+للبكتيريا for survival الكلام اللي بدأنا فيه
+
+307
+00:22:46,950 --> 00:22:50,130
+المحاضرة تبعتنا for survival but not for
+
+308
+00:22:50,130 --> 00:22:53,570
+reproduction thermal dimorphism و اعتقد كلمة
+
+309
+00:22:53,570 --> 00:22:56,930
+thermal dimorphism وضحت انا انه على ال
+
+310
+00:22:56,930 --> 00:22:59,010
+environmental temperature ال ambient temperature
+
+311
+00:22:59,010 --> 00:23:02,410
+they are mold وعلى ال host temperature they are
+
+312
+00:23:02,410 --> 00:23:07,110
+yeast هذا سميناها dimorphismلأن الحرارة هي اللي
+
+313
+00:23:07,110 --> 00:23:11,210
+تتحكم في الشكل فسميناها thermal dimorphism هذه
+
+314
+00:23:11,210 --> 00:23:14,230
+موجودة في الفطريات غير موجودة في البكتيريا الظاهرة
+
+315
+00:23:14,230 --> 00:23:21,250
+ال metabolism الفطريات requires organic carbon no
+
+316
+00:23:21,250 --> 00:23:25,610
+obligate anaerobic هذه نقطة كتير مهمة لا يوجد لا
+
+317
+00:23:25,610 --> 00:23:32,230
+يوجد في الفطرياتأي صنف ابن عرفه لحد الآن obligate
+
+318
+00:23:32,230 --> 00:23:36,570
+أنا إيروب، كلها Arabic and facultative أنا إيروب،
+
+319
+00:23:36,570 --> 00:23:39,810
+اما Arabic او facultative أنا إيروب، but not
+
+320
+00:23:39,810 --> 00:23:44,090
+obligate أنا إيروبطبعا تعرفين في البكتيريا في
+
+321
+00:23:44,090 --> 00:23:49,070
+أشكال و ألوان متنوعة، في منها photosynthetic
+
+322
+00:23:49,070 --> 00:23:52,930
+البكتيريا، يعني بتصنع غذائها لحالها، زي ال blue
+
+323
+00:23:52,930 --> 00:23:57,430
+green algae اللي هي سينو بكتيريا، هذه autotroph،
+
+324
+00:23:57,430 --> 00:24:01,510
+بس الفطريات كلها heterotroph، يعني متنوعة التغذية
+
+325
+00:24:03,250 --> 00:24:06,390
+طبعا هذا ال yeast and mold للتفريق انا حكيتلكوا في
+
+326
+00:24:06,390 --> 00:24:09,470
+البداية ان ال yeast grow as single cells that
+
+327
+00:24:09,470 --> 00:24:13,250
+reproduce by asexual budding و ال mold عبارة عن
+
+328
+00:24:13,250 --> 00:24:16,610
+hypha و mycelium هذا الكلام حاكيناه فاهمتاش انه ان
+
+329
+00:24:16,610 --> 00:24:21,230
+انا اخد فيه وقت طويل بدا مرور مرور سريع على بعض
+
+330
+00:24:21,230 --> 00:24:26,670
+الأشياء المهمة بتهمكوا كتير في ال ال microbiology
+
+331
+00:24:30,810 --> 00:24:36,530
+الان احنا بنتكلم على الفطريات على الفطريات و في
+
+332
+00:24:36,530 --> 00:24:40,090
+البكتيريا اكتر تركيزنا كان على مين على كيف
+
+333
+00:24:40,090 --> 00:24:44,310
+البكتيريا بتنتقل اليك و كيف بتعملك pathogenesis صح
+
+334
+00:24:44,310 --> 00:24:48,770
+ولا لأ؟ في الفطريات بنتناول الموضوع بطريقة أوسع
+
+335
+00:24:48,770 --> 00:24:52,310
+شوية احنا ممكن ناكل الفطريات نفسها الفطريات نفسنا
+
+336
+00:24:52,310 --> 00:24:56,660
+كلها كمشروم صح ولا لأ؟عمل جوجلينج على أمانيتا
+
+337
+00:24:56,660 --> 00:25:02,800
+مشروم أمانيتا مشروم أمانيتا هيته تمام؟ شايفين
+
+338
+00:25:02,800 --> 00:25:07,780
+الكلمة دي؟ أمانيتا مشروم سيظهر لك صور من أروع ما
+
+339
+00:25:07,780 --> 00:25:14,460
+يكون شكلًا جمالًا تقول لك كلني بس تقول الحيوانات
+
+340
+00:25:14,460 --> 00:25:19,920
+don't eat me الحيوانات تفهم لغة بعضبتعرف دفاقة
+
+341
+00:25:19,920 --> 00:25:25,740
+صغيرة في دفاقة ملونة دفاقة ملونة في منها تنتج أقوى
+
+342
+00:25:25,740 --> 00:25:32,480
+السموم أقوى السموم فالألوان في الطبيعة المخلوقات
+
+343
+00:25:32,480 --> 00:25:36,720
+اللي بتتعامل مع بعض الدنيا بتفهمها don't eat me
+
+344
+00:25:36,720 --> 00:25:41,280
+احنا البشر لإن بنحب الجمال و بنتغنى بالجمال فلما
+
+345
+00:25:41,280 --> 00:25:45,930
+نشوف حاجة ليه بناكل الجمال هذا برضهف it is very
+
+346
+00:25:45,930 --> 00:25:49,250
+toxic يبقى أكله نفسه ولا ينزلج تحت مين food
+
+347
+00:25:49,250 --> 00:25:55,270
+poisoning حاجة مسممة في كمان شغل تاني شباب انه انا
+
+348
+00:25:55,270 --> 00:26:00,030
+ممكن اتعرض لاليرجيانت بتعرف فى فصل الربيع الواحد
+
+349
+00:26:00,030 --> 00:26:03,710
+بيطلع بحجوب اللقاح البعض الناس بترجع عنده كإنه
+
+350
+00:26:03,710 --> 00:26:06,890
+influenza صح ولا لأ؟ حساسية .. فى بعض الناس بتاكل
+
+351
+00:26:06,890 --> 00:26:09,810
+أكل معينة بيصي عنده حساسية بيقعد بيجرسوا نحلة،
+
+352
+00:26:09,810 --> 00:26:16,410
+نملة، بعوضة، مش عارف إيه، بيلبس صوف، بيتعامل مع
+
+353
+00:26:16,410 --> 00:26:20,610
+غبار المنزل تمام؟ بيصي عنده حساسية، بياخد drugs،
+
+354
+00:26:20,610 --> 00:26:25,590
+بيصي عنده حساسية، allergy هل الفطرات بتسبب
+
+355
+00:26:25,590 --> 00:26:30,340
+allergy؟ نعم بتسبب allergyوبتسبب الارجي بما يشبه
+
+356
+00:26:30,340 --> 00:26:34,680
+الأزمة، يعني لو استنشق الإنسان الـspores تبع
+
+357
+00:26:34,680 --> 00:26:40,700
+الـaspergillus زي ما هو موجود في اللوحة هذه، ممكن
+
+358
+00:26:40,700 --> 00:26:45,280
+يصير عنده asmatic reaction
+
+359
+00:26:47,260 --> 00:26:50,480
+و لو عملنا له skin test ايش skin test؟ يعني أخدنا
+
+360
+00:26:50,480 --> 00:26:55,040
+ال extract تبع الفطريات و حقرنا الجلد فيه هيصير
+
+361
+00:26:55,040 --> 00:26:59,700
+عنده فاكرين ال induration و ال redness اللي هو ..
+
+362
+00:26:59,700 --> 00:27:02,420
+اللي هو اسم تاني wheel and flare reaction wheel
+
+363
+00:27:02,420 --> 00:27:05,680
+and flare reaction اللي هو الاحمرار و الانتفاخ هذا
+
+364
+00:27:05,680 --> 00:27:10,920
+هذا مش علاش على انه المريض عنده hypersensitivity
+
+365
+00:27:10,920 --> 00:27:16,670
+يعني حساس عنده حساسية من الفطريات طيبواحد عنده
+
+366
+00:27:16,670 --> 00:27:20,430
+حساسية يا شباب لأسباب غير معروفة بروح على طريق
+
+367
+00:27:20,430 --> 00:27:26,390
+الجلدية بعمله فحص بعمله فحص عارفين أكم فحص بعمله
+
+368
+00:27:26,390 --> 00:27:31,430
+في الفحص الواحد بعمله أكتر من سبعين فحص بيجيب إيده
+
+369
+00:27:31,430 --> 00:27:38,570
+بعملها خارطة عنده علبة kit فيه allergens مستخلصة
+
+370
+00:27:38,570 --> 00:27:46,830
+منأنا ذكرت قبل شوية غبار حبوب طلع لمخلوقات معينة
+
+371
+00:27:46,830 --> 00:27:51,530
+بعض الأطعمة صوف مش عارف مستخلصات لكثير يمكن نص أو
+
+372
+00:27:51,530 --> 00:27:57,250
+ربع العدد الفعوسات مأخوذ من فطريات دلال علاش على
+
+373
+00:27:57,250 --> 00:28:02,370
+أن الفطريات عامل مهم او من مسببات مين اللي هو ال
+
+374
+00:28:02,370 --> 00:28:02,530
+allergic
+
+375
+00:28:06,690 --> 00:28:10,630
+حضرة ال aspergillus ال أمينيتا قلنا دي عبارة عن
+
+376
+00:28:10,630 --> 00:28:14,430
+تكسين لو اتناولنا نفسنا تكسين تاني يا شباب اسمه
+
+377
+00:28:14,430 --> 00:28:18,910
+أفلا تكسين أفلا تكسين و هذا الأفلا تكسين قلنالكم
+
+378
+00:28:18,910 --> 00:28:21,670
+تنتجه برضه نوع من ال aspergillus اسمه aspergillus
+
+379
+00:28:21,670 --> 00:28:25,530
+flavus و aspergillus parasiticus تنتين بس مش
+
+380
+00:28:25,530 --> 00:28:30,170
+مذكورة تانية و هذا التكسين can produce liver
+
+381
+00:28:30,170 --> 00:28:34,490
+damage liver damage يعني بضار له اللي هو خلايا
+
+382
+00:28:34,490 --> 00:28:42,860
+الكبد كيف؟بيتحول في الكبد إلى ما يسمى بالـ Epoxide
+
+383
+00:28:42,860 --> 00:28:47,860
+والـ Epoxide معروف عنه انه Carcinogen القالية
+
+384
+00:28:47,860 --> 00:28:54,140
+المفترضة للـ Carcinogenesis ان الـ Aflatoxin بي
+
+385
+00:28:54,140 --> 00:28:59,760
+واحد بيعمل mutation في مين؟ في الـ B53 tumor
+
+386
+00:28:59,760 --> 00:29:03,180
+suppressor gene ايش كان ال tumor suppressor gene؟
+
+387
+00:29:03,710 --> 00:29:09,490
+يعني جين بينتج بروتين بيعمل suppression لمن؟ لـ
+
+388
+00:29:09,490 --> 00:29:13,330
+tumors طب صار في mutation هيطلع البروتين لكن
+
+389
+00:29:13,330 --> 00:29:15,070
+البروتين هذا غير قادر على انه يعمل suppression
+
+390
+00:29:15,070 --> 00:29:20,150
+لمن؟ لـ tumors وبالتالي هيصير عندنا tumors واد
+
+391
+00:29:20,150 --> 00:29:24,890
+الألية المفترضة طبعا كلنا أكلنا أفلاتوكسين شئنا
+
+392
+00:29:24,890 --> 00:29:30,520
+مقابينا أكلنا أفلاتوكسين هناك في الدقيقلذلك احنا
+
+393
+00:29:30,520 --> 00:29:34,960
+ممكن قبل سنتين عملت دورة للاخوة في وزارة الصحة في
+
+394
+00:29:34,960 --> 00:29:39,440
+how to detect how to detect aflatoxin from food
+
+395
+00:29:39,440 --> 00:29:44,160
+واشتغلوا فترة ويعني نتاج اللي انا في غزة مقبولة
+
+396
+00:29:44,160 --> 00:29:47,600
+ايش يعني مقبولة؟ في standards بيقولك انه ليجب ان
+
+397
+00:29:47,600 --> 00:29:51,060
+لا يزيد مستوى الaflatoxin عن هذا المستوى لأنه اذا
+
+398
+00:29:51,060 --> 00:29:52,860
+زاد بالفعل بيصير له accumulation بيصير عنه
+
+399
+00:29:52,860 --> 00:30:00,930
+toxicity كمان مرة شفناfood poisoning مباشرة من
+
+400
+00:30:00,930 --> 00:30:04,590
+تناول غذاء شوفنا allergic reaction شوفنا aflatoxin
+
+401
+00:30:04,590 --> 00:30:08,570
+اللي هو كارسينوجين غير عن ال pathogenesis اللي
+
+402
+00:30:08,570 --> 00:30:13,190
+بتسببه الفطريات بين الأصابع بين أصابع الرجلين
+
+403
+00:30:13,190 --> 00:30:16,510
+athlete foot القدم الرياضية تسمعوا فيها ولا بقى ال
+
+404
+00:30:16,510 --> 00:30:21,070
+athlete foot هذا مرض مشهور قد نرى meningitis
+
+405
+00:30:21,070 --> 00:30:24,330
+caused by cryptococcus neophormans مرض عادزة
+
+406
+00:30:24,330 --> 00:30:29,960
+للبكتيريا meningitisالامراض السيستيميك زي كوكسيديو
+
+407
+00:30:29,960 --> 00:30:35,680
+ديس اميتاس زي ال blastomycosis امراض كتيرة بتسببها
+
+408
+00:30:35,680 --> 00:30:40,160
+برضه الفطريات اذا كمان مرة الفطريات قد تسبب
+
+409
+00:30:40,160 --> 00:30:44,840
+allergy قد تسبب food poisoning قد تنتج توكسين هذه
+
+410
+00:30:44,840 --> 00:30:48,040
+التوكسين قد تؤدي الى ال cancer او قد تؤدي الى
+
+411
+00:30:48,040 --> 00:30:52,960
+infection عادي طيب جزء جزء كتير مهم ال laboratory
+
+412
+00:30:52,960 --> 00:30:58,000
+diagnosisال lab diagnosis بيتلخص في واحد من أربع
+
+413
+00:30:58,000 --> 00:31:02,500
+أشياء يا إما direct microscopy يعني نتطلع على ال
+
+414
+00:31:02,500 --> 00:31:05,180
+microscope على العينة و طبعا ممكن نعمل صباغة و
+
+415
+00:31:05,180 --> 00:31:09,640
+ممكن نعمل صباغة بأشكال و أنواع مختلفة و ممكن نعمل
+
+416
+00:31:09,640 --> 00:31:14,320
+culture لل micro organism نزرع البكتيريا على سبرود
+
+417
+00:31:14,320 --> 00:31:17,080
+ديكستروز أجار مارب معاكوا اسم سبرود في ال
+
+418
+00:31:17,080 --> 00:31:20,830
+diagnostic microDNA probes test وهذا يمكن الفحص
+
+419
+00:31:20,830 --> 00:31:25,290
+اللي الآن growing يعني interest فيه في العالم كله
+
+420
+00:31:25,290 --> 00:31:29,130
+لإنه rapid بيقصر الفترة الزمانية للتشخيص لإن
+
+421
+00:31:29,130 --> 00:31:33,110
+الفطريات مش زي البكتيريا 24 ساعة بتنمو بدها أسبوع
+
+422
+00:31:33,110 --> 00:31:36,350
+و أسبوع وقت طويل للتشخيص وبعد الأحيان بدها أسبوعين
+
+423
+00:31:37,020 --> 00:31:40,620
+والفحث الأخير اللى هو physiological test إما
+
+424
+00:31:40,620 --> 00:31:45,000
+microscopy إما culture إما DNA props test دعونا
+
+425
+00:31:45,000 --> 00:31:48,080
+نطلع على ال microscopy والأشهر على الإطلاق اللى هو
+
+426
+00:31:48,080 --> 00:31:57,560
+ال KOH طبعا استخدمتها في ال diagnostic ال KOH10%
+
+427
+00:31:57,560 --> 00:32:02,680
+بوتاسيوم هيدروكسيد تضعف قطرة او قطرتين منها
+
+428
+00:32:02,680 --> 00:32:09,100
+للتيشيو الموراد فحصه شعر ادفر skin scrapping
+
+429
+00:32:09,100 --> 00:32:12,440
+بيوبسيز
+
+430
+00:32:12,440 --> 00:32:18,500
+ايش الغرض من ال QH؟ to dissolve and clarify the
+
+431
+00:32:18,500 --> 00:32:24,390
+specimen ايش يعني dissolve؟ بدوّبالـ debris بسهولة
+
+432
+00:32:24,390 --> 00:32:30,810
+الفطريات resistant للـ KOH بمعنى يعني they cannot
+
+433
+00:32:30,810 --> 00:32:36,070
+be dissolved by KOH فلما أنا أدوب ما حواليها بتبين
+
+434
+00:32:36,070 --> 00:32:43,150
+واضح الآن ماذا أرى تحت الـ KOH وجود أو عدم وجود؟
+
+435
+00:32:43,350 --> 00:32:46,770
+Mycelium اللي هو الـ Hypha عفوًا تمام و ال Spores
+
+436
+00:32:46,770 --> 00:32:50,730
+موجود أو عدم وجود هذه نقطة كتير مهمة لذلك أحد
+
+437
+00:32:50,730 --> 00:32:54,550
+الأشياء اللي بتنطلب بشكل روتيني من قبل الطباء
+
+438
+00:32:54,550 --> 00:32:59,790
+الجلدية تمام هو ال KOH سمير الآن موجود أو عدم وجود
+
+439
+00:32:59,790 --> 00:33:03,350
+هذه نقطة النقطة التانية إذا وجود إيش شكل ال Spores
+
+440
+00:33:03,350 --> 00:33:08,250
+حجمها micro ولا macro مظبوط ال Hypha هل هي
+
+441
+00:33:08,250 --> 00:33:12,340
+sinusitic ولاسيرانسونس كيش يقولوا عنها جوفاء ولا
+
+442
+00:33:12,340 --> 00:33:16,900
+سبتيتد حيث يبقى في معلومات كويسة تطلع من الكيواتش
+
+443
+00:33:17,530 --> 00:33:20,010
+عارفين كم واحد بيشتري كيوات شاننا او كم مصدر تشتري
+
+444
+00:33:20,010 --> 00:33:24,310
+لنا؟ واحد او اتنين مع انه التقنية سهلة جدا بس بيدك
+
+445
+00:33:24,310 --> 00:33:27,230
+شوية ممارسة على التعرف على ال .. يعني بيدك بيدك
+
+446
+00:33:27,230 --> 00:33:30,770
+practice تمام؟ عشانك انا بقولكوا المحاضرات المسجلة
+
+447
+00:33:30,770 --> 00:33:33,710
+اللي نزلتلكوا اياهم على ال .. الموقع المجموع على
+
+448
+00:33:33,710 --> 00:33:37,070
+الفيسبوك يارد تسمعوهم بشكل جيد مهم جدا حتى لو انهم
+
+449
+00:33:37,070 --> 00:33:41,370
+مش داخلين في الامتحان الا انهم يعني بشكل مادة جيدة
+
+450
+00:33:41,370 --> 00:33:45,240
+لكلاء ال .. ال my college ان شاء اللهيبقى اتفاقنا
+
+451
+00:33:45,240 --> 00:33:51,600
+على عيش ال .. الكيواتش تقنية بسيطة وسهلة من
+
+452
+00:33:51,600 --> 00:33:57,600
+الأمثلة الشهيرة جدا جدا ل ال direct microscopy وين
+
+453
+00:33:57,600 --> 00:34:02,640
+بقدر ال direct microscopy يخدم مرادين مهمين انا
+
+454
+00:34:02,640 --> 00:34:07,600
+شخصياأتطلقت في شغل .. في .. في تدريبي بقى أنا طالب
+
+455
+00:34:07,600 --> 00:34:10,800
+لوحدة منهم اللي هي رقم اتنين اللي هي ال capsule
+
+456
+00:34:10,800 --> 00:34:14,200
+تبعت ال crypto .. ال cryptococcus neoformans كنا
+
+457
+00:34:14,200 --> 00:34:18,040
+نعمل ال CSF العيانة في ال CSF اللي بتجينا يا ما
+
+458
+00:34:18,040 --> 00:34:21,040
+كنا ندورها في المستشفى في الفلبين والبرض منتشر في
+
+459
+00:34:21,040 --> 00:34:27,210
+الفلبيننعمل ال India Ink مش كيوتش عفوا ال India
+
+460
+00:34:27,210 --> 00:34:30,210
+Ink ل .. اللي هو .. طبعا ال India Ink برضه Direct
+
+461
+00:34:30,210 --> 00:34:33,910
+Microscopy نحط قطرة من ال CSF و قطرة من ال India
+
+462
+00:34:33,910 --> 00:34:36,310
+Ink Mix و Cover Script وحطه تحت ال microscope
+
+463
+00:34:36,310 --> 00:34:39,950
+وانتهى الموضوع إذا Cryptococcus موجودة بتقولك هيني
+
+464
+00:34:39,950 --> 00:34:46,250
+أنا موجودة كيف خلية دائرة و عليها دائرة أكبر أكبر
+
+465
+00:34:46,250 --> 00:34:50,470
+بتلت أضعاف إلى أربع أضعافليش؟ إيش هي الدالة
+
+466
+00:34:50,470 --> 00:34:54,470
+التانية هذه؟ هي الكابسول إذا انت مش فاكر ان مش ال
+
+467
+00:34:54,470 --> 00:34:58,610
+India ink أصلا تستخدم لإظهار الكابسول صح ولا لأ
+
+468
+00:34:58,610 --> 00:35:02,650
+فالخميرة هذه اللي هي ال Cryptococcus neoformans هي
+
+469
+00:35:02,650 --> 00:35:07,130
+yeast أو capsulated yeast الكابسول تبعتها ال size
+
+470
+00:35:07,130 --> 00:35:11,790
+أكبر بكثير من مين من الخلية نفسها الشيء الأثناء
+
+471
+00:35:11,790 --> 00:35:18,030
+الاسفريول تبعت الكوكسديوديس اميتسالكوكسيديوهدس
+
+472
+00:35:18,030 --> 00:35:22,710
+اميتس بتكون في البيئة filamentous لكن في الانسجل
+
+473
+00:35:22,710 --> 00:35:27,250
+تبعتنا بتكون اسفريول زي بتذكرنا على فهمين
+
+474
+00:35:27,250 --> 00:35:32,370
+الاسفريول هادي في الاخلاميديا الاخلاميديا
+
+475
+00:35:33,640 --> 00:35:37,300
+كانت elementary body دخلت ديوب الخلية صار لها
+
+476
+00:35:37,300 --> 00:35:41,360
+differentiation الى spherule و جوا ال spherule
+
+477
+00:35:41,360 --> 00:35:45,660
+تشكلت ال reticulate body اللى صار لها maturation ل
+
+478
+00:35:45,660 --> 00:35:50,360
+elementary body هذا ل اللى فاكر ان احنا درسنا
+
+479
+00:35:50,360 --> 00:35:51,880
+كلميديا اصلا
+
+480
+00:35:54,550 --> 00:35:59,030
+مثالين مهمين جدا اللي هم ال .. ال .. ال spherules
+
+481
+00:35:59,030 --> 00:36:01,890
+تبعت الكوكسيديو .. coccidioides hematis و ال
+
+482
+00:36:01,890 --> 00:36:04,970
+capsule تبعت الكريبتو كوكس نيو four months من ال
+
+483
+00:36:04,970 --> 00:36:08,740
+spinal fluidفي كمان صبغة كتير حلوة انا اتمنى انه
+
+484
+00:36:08,740 --> 00:36:12,280
+.. انه ندخلها قريبا في الخدمة اللي هي ال
+
+485
+00:36:12,280 --> 00:36:15,220
+calcoflower white وهو عبارة عن fluorescent dye
+
+486
+00:36:15,220 --> 00:36:18,360
+بيرتبط specifically في ال cell wall تبع الفطريات
+
+487
+00:36:18,360 --> 00:36:22,320
+وبالتالي حتى لو كان موجود في أنسجها مدام الإرتباط
+
+488
+00:36:22,320 --> 00:36:25,860
+في الفطر مباشرة من غير .. دون عن غيره فبالتالي
+
+489
+00:36:25,860 --> 00:36:30,180
+بيظهر انها بشكل واضحفي كمان صبغة أخرى مثل نمين
+
+490
+00:36:30,180 --> 00:36:34,340
+silverstein برضه مستخدمة في ال diagnosis لكن هذي
+
+491
+00:36:34,340 --> 00:36:37,100
+غالبا من بيستخدموها to ال histopathology اللي
+
+492
+00:36:37,100 --> 00:36:45,740
+بيستخدموه الأنسجة المقطعة او الشرايح microscopy
+
+493
+00:36:45,740 --> 00:36:49,460
+culture seborrheic dextrose agar is the most
+
+494
+00:36:49,460 --> 00:36:52,820
+famous most common لل medical mycology بيستخدموه
+
+495
+00:36:53,900 --> 00:36:57,220
+وميزته انه بيعمل inhibition للبكتيريا بيعمل
+
+496
+00:36:57,220 --> 00:37:00,040
+inhibition للبكتيريا ليش بدنا نعمل inhibition
+
+497
+00:37:00,040 --> 00:37:05,540
+للبكتيريا البكتيريا are fast grower يعني لو حطينا
+
+498
+00:37:05,540 --> 00:37:08,800
+فطر مع بكتيريا في وسط بينام التانين مع بعض
+
+499
+00:37:08,800 --> 00:37:13,440
+البكتيريا هتنمو و هتاخد الأكل من الفطريات وبالتالي
+
+500
+00:37:13,440 --> 00:37:19,140
+الفطريات لن تنمو لأن هو slow grower فبدي وسط يعمل
+
+501
+00:37:19,140 --> 00:37:24,620
+تثبيت لنمو البكتيريا فبيسمح لمين للفطرياتعلى إيش
+
+502
+00:37:24,620 --> 00:37:27,700
+معتمد في قدرته على تطبيق البكتيريا على إن ال pH
+
+503
+00:37:27,700 --> 00:37:31,680
+تبقى منخفض وكثير من البكتيريا غير قادرة على إنها
+
+504
+00:37:31,680 --> 00:37:36,760
+تنمو في pH منخفض ويضاف له بعض الأحيان
+
+505
+00:37:36,760 --> 00:37:39,880
+chloramphenicol وcyclohexamide و there are two
+
+506
+00:37:39,880 --> 00:37:43,900
+drugs أعتقد أنه حكينا عنهم في ال food microbiology
+
+507
+00:37:43,900 --> 00:37:46,820
+للشباب اللي بدرسوا food microbiology لما اتكلمنا
+
+508
+00:37:46,820 --> 00:37:51,830
+عن ال yeast and mold countفي الـ yeast and mold
+
+509
+00:37:51,830 --> 00:37:55,850
+count، جزء أساسي من الـ structure تبع الـ تبع
+
+510
+00:37:55,850 --> 00:37:58,390
+الميديا أنه انضاف أنتيباتيك ت inhibit the growth
+
+511
+00:37:58,390 --> 00:38:01,470
+of بكتيريا وأشهرهم على الإطلاق بأنها الـ
+
+512
+00:38:01,470 --> 00:38:05,090
+chloramphenicol والـ cyclohexamide، هذا في الغالب
+
+513
+00:38:05,090 --> 00:38:09,310
+autoclavable، بمعنى أنه لست بحاجة أن أنا أقلق من
+
+514
+00:38:09,310 --> 00:38:13,150
+عملية اللي هو ال sterilization بال autoclave.إذا
+
+515
+00:38:13,150 --> 00:38:17,450
+السبروت ديكستروز أجار هو الوسط المستخدم بكثرة مش
+
+516
+00:38:17,450 --> 00:38:20,330
+هو الوحيد لكن هو المستخدم بكثرة يعني ممكن يستخدم
+
+517
+00:38:20,330 --> 00:38:23,790
+ال potato ديكستروز أجار وانضاف الواحد في بيتك
+
+518
+00:38:23,790 --> 00:38:28,840
+ويعطينا فعالية لبأسةالـ DNA techniques انتوا كلكوا
+
+519
+00:38:28,840 --> 00:38:33,800
+بتعرفوا ال DNA props PCR وبعدين hybridization و
+
+520
+00:38:33,800 --> 00:38:39,420
+التقنية is widely accepted انها بتعمل shortening ل
+
+521
+00:38:39,420 --> 00:38:42,440
+ال diagnostic period بدل ما المزرعة المستعمرة
+
+522
+00:38:42,440 --> 00:38:46,380
+تصيرها الجدى بيانه أسبوع كامل ممكن اخد جزء من
+
+523
+00:38:46,380 --> 00:38:50,460
+بداية المستعمرة من بداية المستعمرة واعمله DNA
+
+524
+00:38:50,460 --> 00:38:53,160
+technique وانتهى هذا الموضوع والان انا متوفر في
+
+525
+00:38:53,160 --> 00:38:58,760
+الأسواقفي التقنيات الفحص الكوكسيديويدس والهيستو
+
+526
+00:38:58,760 --> 00:39:03,300
+بلازما والبلاستو مايكوسس والكريبتو كوكس الكريبتو
+
+527
+00:39:03,300 --> 00:39:08,380
+كوكس نيوفورمانس احنا قبل دقائق لسه اتحدثنا عنها
+
+528
+00:39:08,380 --> 00:39:13,440
+لما كشفناها بمين بال India Inc في ال CSF تذكروا
+
+529
+00:39:13,440 --> 00:39:17,040
+انه لها كابسول ولما عرصنا ال bacteriology كنا
+
+530
+00:39:17,040 --> 00:39:21,910
+نتكلم عنهكنت أتكلم عن مين؟ عن نيسيريا مينينجايتس،
+
+531
+00:39:21,910 --> 00:39:24,870
+عن hemophilus influenza، عن streptococcus
+
+532
+00:39:24,870 --> 00:39:28,410
+pneumonia، سميناهم نجوم المينينجايتس، العامل
+
+533
+00:39:28,410 --> 00:39:31,570
+المشتلك غير أنهم يسببوا مينينجايتس، العامل المشتلك
+
+534
+00:39:31,570 --> 00:39:35,010
+تبعهم كانش أنه لهم capsule، وهذه اللي هي capsule،
+
+535
+00:39:35,010 --> 00:39:39,130
+عشان هيك أنا بقدر كمان أشخصها أشرب مين؟ بالسيروجين
+
+536
+00:39:40,470 --> 00:39:44,730
+زي ما اعملت diagnoses للانتجينات تبع الكابسول
+
+537
+00:39:44,730 --> 00:39:48,670
+بتاعة التلاتة نفس الطريقة بنقدر نعملها diagnoses
+
+538
+00:39:48,670 --> 00:39:53,810
+بال Latex Agglutination Test Latex Agglutination
+
+539
+00:39:53,810 --> 00:40:01,670
+Test لكن بقدر كمان بكل يعني تواضع اقول انه ال
+
+540
+00:40:01,670 --> 00:40:07,010
+serology فيه مشكلة ما عدا هذا الفحص ليش؟ دايما
+
+541
+00:40:07,010 --> 00:40:13,310
+الكشف عن الانتجين100% ممتاز بعطيني إشارة إن
+
+542
+00:40:13,310 --> 00:40:17,150
+الميكروب موجود لكن الكشف عن ال antibody فيه
+
+543
+00:40:17,150 --> 00:40:21,030
+إشكالية زي في الأول .. أول واحدة بقولنا إنه عشان
+
+544
+00:40:21,030 --> 00:40:24,410
+أنا أقدر أقول فيه diagnosis لازم يكون في increase
+
+545
+00:40:24,410 --> 00:40:29,110
+in أو rise in antibody بتاعة لو جدش بيقولك هو four
+
+546
+00:40:29,830 --> 00:40:33,810
+fourfold أربع أضعاف هذا الكلام يعني غالبا بيكون
+
+547
+00:40:33,810 --> 00:40:37,010
+جونه عنه سمنه في ال bacteriology Retrospective
+
+548
+00:40:37,010 --> 00:40:42,650
+diagnosis تشخيص بأثر رجعي طبعا مع أنه ركزنا على
+
+549
+00:40:42,650 --> 00:40:46,530
+أنه برضه مهم وللا للابديمولوجيكال reason من أشهر
+
+550
+00:40:46,530 --> 00:40:49,210
+الفحوصات المستخدمة في السيولوجيا هنا ال complement
+
+551
+00:40:49,210 --> 00:40:53,690
+fixation بيستخدموها لكوكسيديوميكوسس والهيستو
+
+552
+00:40:53,690 --> 00:40:59,000
+بلزموسس والبلاستو مايكوسس كمان في ال skin testمش
+
+553
+00:40:59,000 --> 00:41:01,500
+مذكورة للأسف يعني في الأول حالة كان .. حطوا اضيفوا
+
+554
+00:41:01,500 --> 00:41:04,400
+عندكم جملة skin test في كتير الفطريات اللي ممكن
+
+555
+00:41:04,400 --> 00:41:10,260
+نعملها skin test أكم واحد اللي ال diagnoses صاروا؟
+
+556
+00:41:10,260 --> 00:41:14,660
+وين تلقاها؟ عد طب عد لأ خلينا نعد مع بعض ال
+
+557
+00:41:14,660 --> 00:41:19,650
+diagnoses microscopy directأخدنا أمثلة KOH و India
+
+558
+00:41:19,650 --> 00:41:23,630
+Inc و Metamine Silver، أخدنا ال Kalkoflower، صح؟
+
+559
+00:41:23,630 --> 00:41:26,530
+هدول هي رقم واحد داريف ميكروسكوبي، رقم اتنين،
+
+560
+00:41:26,530 --> 00:41:28,990
+أخدنا Culture، Separate Dextrose أجارفنا بعض
+
+561
+00:41:28,990 --> 00:41:31,570
+المعلومات الأساسية عنه، اتكلمنا عن ال DNA
+
+562
+00:41:31,570 --> 00:41:34,330
+Techniques، اتكلمنا الآن عن اللي هو السيولوجيورفنا
+
+563
+00:41:34,330 --> 00:41:38,870
+مجموعة من اللي هو ال test المستخدمةفيها إن السؤال
+
+564
+00:41:38,870 --> 00:41:42,550
+يسأل نجرب شوية لماذا يوجد antibacterials أكتر من
+
+565
+00:41:42,550 --> 00:41:46,830
+antifungal ورافنا السبب، مابتداش نخد في تفاصيل
+
+566
+00:41:46,830 --> 00:41:49,290
+ندخل الموضوع اللي جدول على طول هذا اللي قدامكوا
+
+567
+00:41:50,260 --> 00:41:55,640
+كنظام أو كمثال رائع جدا على مجموعة من ال drugs
+
+568
+00:41:55,640 --> 00:41:59,140
+مهمين جدا المطلوب منكوا تعرفه بس اسم ال drug و ال
+
+569
+00:41:59,140 --> 00:42:02,600
+mechanism of action تبعته كيف بيشتغل و سهل مش
+
+570
+00:42:02,600 --> 00:42:05,580
+هتتغلبوا في ال mechanism of action لأنه هتشوفوا
+
+571
+00:42:05,580 --> 00:42:09,420
+انهم بيشتغلوا بطريقة يعني unique فريدة كل واحد
+
+572
+00:42:09,420 --> 00:42:13,910
+منهم نبدأ من الأخر ال graceful veinالـgressive
+
+573
+00:42:13,910 --> 00:42:18,750
+vein بيعمل disruption لـmyotic spindle by binding
+
+574
+00:42:18,750 --> 00:42:22,570
+to tubulin الميوتيك سبندل بدونها فيه إمكانية إنه
+
+575
+00:42:22,570 --> 00:42:26,150
+يصير فيه انقسام يبقى عمل inhibition لمين؟ لـgrowth
+
+576
+00:42:26,150 --> 00:42:30,210
+of fungi وانتهينا من الجثة يعني يوقف النمو الـflow
+
+577
+00:42:30,210 --> 00:42:36,970
+cytosine هذا بده شوية شرح هو عبارة عننوكليوتايد
+
+578
+00:42:36,970 --> 00:42:40,550
+انالوج ايش يعني نوكليوتايد انالوج شبيه
+
+579
+00:42:40,550 --> 00:42:43,790
+بالنوكليوتايد راجزوا معاه انت RNA بوليماريز وهي
+
+580
+00:42:43,790 --> 00:42:48,410
+يوراسيل وهي انالوج انت بالنسبالك مابتجرش تميز بين
+
+581
+00:42:48,410 --> 00:42:51,780
+اتنين؟اللي جات قدامك يوراسيل بتاخده بتحطه في ال
+
+582
+00:42:51,780 --> 00:42:56,080
+RNA اللي جات قدامك ال analog بتحطه الان لو حطيت
+
+583
+00:42:56,080 --> 00:42:59,960
+انت ال يوراسيل هتقدر تحط ولا اي حاجة تانية بعد ذلك
+
+584
+00:42:59,960 --> 00:43:03,440
+لكن لو حطت ال analog بيعمل block مش هتقدر تحط ولا
+
+585
+00:43:03,440 --> 00:43:08,300
+حاجة وقف تصنيع ال RNA او لو كان DNA analog وقف في
+
+586
+00:43:08,300 --> 00:43:16,680
+تصنيع ال DNA اذا عشان هي كده شباب معظم معظم ال ..
+
+587
+00:43:17,670 --> 00:43:21,070
+الدراجز المعتمل على هذا المبدأ اللي هو ال .. ال ..
+
+588
+00:43:21,070 --> 00:43:24,090
+ال analog غالبا بيكون لها toxicity عالية بيكون لها
+
+589
+00:43:24,090 --> 00:43:29,430
+toxicity عالية فال flow cytosine جونه بيعمل
+
+590
+00:43:29,430 --> 00:43:32,190
+inhibition لل DNA synthesis ال FC converted to
+
+591
+00:43:32,190 --> 00:43:35,590
+fluoro uracil which inhibits thymidine synthesis
+
+592
+00:43:35,590 --> 00:43:42,690
+بيواجه تصنيع اللي هو ال thymidine فهنا الالـ
+
+593
+00:43:42,690 --> 00:43:47,310
+Echinocandin زي الكسبوفانجين والمايكوفانجين وهذا
+
+594
+00:43:47,310 --> 00:43:55,550
+بيعمل انهيبشن للديجلوكان وهو عبارة عن component في
+
+595
+00:43:55,550 --> 00:44:01,510
+ال fungal cell wall تمام؟كمبوننت مهمة في الـ cell
+
+596
+00:44:01,510 --> 00:44:05,450
+wall في مجموعة ضخمة من ال antifungal اسمها الازولز
+
+597
+00:44:05,450 --> 00:44:08,530
+والازولز هذه مجموعة كتير مهمة زي الكيتوكنازول
+
+598
+00:44:08,530 --> 00:44:13,190
+والفلوكوكنازول والايوتراكنازول والبوساكنازول يعني
+
+599
+00:44:13,190 --> 00:44:17,590
+فينا مجموعة من الكنازول هذه كلها بتشتغل على مركب
+
+600
+00:44:17,590 --> 00:44:24,030
+واحد اسمهالارجسترال مش احنا قولنا الاسترال، هذا
+
+601
+00:44:24,030 --> 00:44:27,770
+بتمنع ال synthesis تبعه من أساسه، هذا يا شباب ال
+
+602
+00:44:27,770 --> 00:44:31,630
+cell membrane بدون الارجسترال بيفقد ال integrity
+
+603
+00:44:31,630 --> 00:44:38,110
+تبعته، تمام؟ الانفوترسين بيرتبطبال ergosterol
+
+604
+00:44:38,110 --> 00:44:41,130
+بيمنعش ال synthesis تمام؟ لكن ارتباطه بال
+
+605
+00:44:41,130 --> 00:44:45,290
+ergosterol و كأنه بينزعوا من مكانه تمام؟ وبالتالي
+
+606
+00:44:45,290 --> 00:44:48,630
+بيصير فيه ثقوب في ال brain و بيصير فيه leakage
+
+607
+00:44:48,630 --> 00:44:53,410
+هدولة بيكفوكوا اللوحة هذه من المحاضرة بالكثيكولا
+
+608
+00:44:53,410 --> 00:44:57,490
+ال antifungal مش هنطلبكوا بغيرها من ال antifungal
+
+609
+00:44:57,490 --> 00:44:58,790
+ك drugs okay؟
+
+610
+00:45:01,010 --> 00:45:05,770
+أعتقد أنه .. ده لأ في عندي انا ال .. ال .. اللوحة
+
+611
+00:45:05,770 --> 00:45:09,130
+الأخيرة دي summary نلخصلكوا فيها ال .. ال .. اللي
+
+612
+00:45:09,130 --> 00:45:14,210
+درسناها في هذا المحاضرة شباب عندنا ال .. ال ..
+
+613
+00:45:14,210 --> 00:45:20,850
+الفطريات شكلا بنصنفها إما إلى unicellular أو
+
+614
+00:45:20,850 --> 00:45:23,750
+multicellular ال unicellular اللي بنسميها yeast و
+
+615
+00:45:23,750 --> 00:45:28,610
+ال multicellular اللي بنسميها مولدزوالـ hypha هي
+
+616
+00:45:28,610 --> 00:45:34,710
+العنوان التجميع الكلية إليه يسميناها mycelium
+
+617
+00:45:34,710 --> 00:45:41,810
+واتفقنا على إنه بعض الفطريات قد تجمع بين الشكلين
+
+618
+00:45:41,810 --> 00:45:46,750
+ويسميناها dimorphism مش كلام عن شكل احنا
+
+619
+00:45:46,750 --> 00:45:52,270
+morphology dimorphism أخدت شكل yeast و أخدت شكل
+
+620
+00:45:52,270 --> 00:45:58,680
+moldلذلك لو سألناك سؤال و قلنا لك الفطر الفلاني
+
+621
+00:45:58,680 --> 00:46:02,300
+اللي هو زي الكوكسيديوديس اميتس أو ال blastomycosis
+
+622
+00:46:02,300 --> 00:46:09,300
+طبعا لا ينتقل من إنسان لإنسان السبب انه die
+
+623
+00:46:09,300 --> 00:46:12,780
+morphie، die morphie وبالتالي بدنا نكون عارفين هذا
+
+624
+00:46:12,780 --> 00:46:14,440
+الكلام، اللي لازم يروح على البيئة و في البيئة
+
+625
+00:46:14,440 --> 00:46:19,020
+يتحول إلى الشكل المعدل و بعدين ينتقل للإنسانالـ
+
+626
+00:46:19,020 --> 00:46:21,960
+hyphae هي الـ branching filamentous form اللي ممكن
+
+627
+00:46:21,960 --> 00:46:24,600
+يكون concepted أو قلنا عنه sinusitic اللي هو
+
+628
+00:46:24,600 --> 00:46:27,340
+الأجواف ال india ink ممكن تستخدم في ال
+
+629
+00:46:27,340 --> 00:46:30,140
+visualization الكابسول في بعض انواع الفطريات اللي
+
+630
+00:46:30,140 --> 00:46:34,180
+لها كابسول او ليست ال saparod agar او في حاجة اسمه
+
+631
+00:46:34,180 --> 00:46:36,920
+micro seal agar ما .. ما .. مارذكره معانا الصحيح
+
+632
+00:46:36,920 --> 00:46:41,400
+لكن برضه مشهور كتير كوسط اخر للفطرياتالـ
+
+633
+00:46:41,400 --> 00:46:47,320
+antifungal agents شفنا مجموعة منها من .. من هذه
+
+634
+00:46:47,320 --> 00:46:50,420
+المجموعة اللي هو الانفوترسين بيه اللي بيرتبط
+
+635
+00:46:50,420 --> 00:46:55,200
+بالارجسترول والأزولز اللي بتمنع تكوين اللي هو
+
+636
+00:46:55,200 --> 00:46:58,460
+الارجسترول من أساسه وبالتالي بيصير فيه انا
+
+637
+00:46:58,460 --> 00:47:01,120
+disruption لل cell member اعتقد ان وراك من هناك
+
+638
+00:47:01,120 --> 00:47:03,180
+نكون شهية الله لإن هنا هذه المحاضرة
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/eUYq8JyIKiw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/eUYq8JyIKiw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..18ac111ab1ed1a6ac8e21e8b97f6b342bac3a61e
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/eUYq8JyIKiw.srt
@@ -0,0 +1,2064 @@
+1
+00:00:20,470 --> 00:00:23,430
+بسم الله الرحمن الرحيم، نستكمل ما بدأناه في المحاضرة
+
+2
+00:00:23,430 --> 00:00:27,010
+السابقة في مناقشة العوامل التي تؤثر على نمو الـ
+
+3
+00:00:27,010 --> 00:00:31,610
+microorganism. ذكرنا في المحاضرة السابقة الـ nutrient
+
+4
+00:00:31,610 --> 00:00:34,050
+availability، وميزنا بينه وبين nutrient presence
+
+5
+00:00:34,050 --> 00:00:37,270
+لأنه يختلف عن nutrient availability، و الـ physical
+
+6
+00:00:37,270 --> 00:00:40,350
+environmental parameters مثل water activity، و
+
+7
+00:00:40,350 --> 00:00:44,350
+أيضًا ذكرنا أن هناك نوعان من الماء: نوع مرتبط، وهذا
+
+8
+00:00:44,350 --> 00:00:49,170
+غير متاح للبكتيريا، والنوع الآخر متاح أو حر، الذي
+
+9
+00:00:49,170 --> 00:00:52,770
+سميناه free water، و يُعبّر عنه بما يسمى بالـ water
+
+10
+00:00:52,770 --> 00:00:56,030
+activity.  في كمان نقطة مهمة جدًا، الـ osmotic
+
+11
+00:00:56,030 --> 00:01:01,880
+pressure، الدغط الأسموزي. يُعبّر عن ماذا؟ يُعبّر عن
+
+12
+00:01:01,880 --> 00:01:07,100
+تركيز الأملاح في البيئة التي تعيش فيها البكتيريا
+
+13
+00:01:07,100 --> 00:01:10,640
+أو الـ microorganisms. العامل الثاني هو الـ
+
+14
+00:01:10,640 --> 00:01:14,180
+oxygen، والثالث هو الـ pH. طبعًا الـ oxygen أنتم
+
+15
+00:01:14,180 --> 00:01:17,420
+درستموه في general microbiology، مجموعة من
+
+16
+00:01:17,420 --> 00:01:21,840
+الميكروبات مصنفة على حسب حاجتها للـ oxygen. فمثلًا
+
+17
+00:01:21,840 --> 00:01:25,040
+aerobic، anaerobic، facultative، microaerophilic،
+
+18
+00:01:25,040 --> 00:01:27,400
+وغيرها، سنناقشها قليلًا إن شاء الله.
+
+19
+00:01:28,200 --> 00:01:33,980
+الـ pH، قلنا أن الـ pH  له minimum، و optimum، و
+
+20
+00:01:33,980 --> 00:01:37,660
+maximum. minimum below which there is no growth،
+
+21
+00:01:37,660 --> 00:01:40,300
+maximum above which there is no growth، والـ
+
+22
+00:01:40,300 --> 00:01:43,220
+optimum  لـ growth البكتيريا يكون optimum at
+
+23
+00:01:43,220 --> 00:01:45,520
+that pH. طيب، هذه نقطة مهمة جدًا كذلك.  بالنسبة لـ
+
+24
+00:01:45,520 --> 00:01:49,020
+الـ temperature، نفس الكلام
+
+25
+00:01:49,020 --> 00:01:51,680
+أيضًا، فينا بكتيريا بتحب تعيش في low
+
+26
+00:01:51,680 --> 00:01:54,240
+temperature، و high temperature، و mesophilic
+
+27
+00:01:54,240 --> 00:01:56,860
+temperature. سأتحدث عنهم إن شاء الله. الـ host immune
+
+28
+00:01:56,860 --> 00:02:02,530
+system. ذكرنا مثالًا بسيطًا، مثلًا مرضى الـ HIV
+
+29
+00:02:02,530 --> 00:02:06,850
+أو مرضى الإيدز، ليس لديهم immune system، لذلك
+
+30
+00:02:06,850 --> 00:02:09,970
+نجد أن البكتيريا، سواء كانت
+
+31
+00:02:09,970 --> 00:02:13,310
+pathogenic أو non-pathogenic، تعمل pathogenesis،
+
+32
+00:02:13,310 --> 00:02:17,270
+يعني بمعنى آخر it can grow and multiply and
+
+33
+00:02:17,270 --> 00:02:21,510
+colonize and infect and cause disease. لماذا؟ لأنهم
+
+34
+00:02:21,510 --> 00:02:25,210
+لا يمتلكون immune system. بينما نحن جميعًا نستنشق
+
+35
+00:02:25,210 --> 00:02:29,650
+ميكروبات، ومع ذلك لا نصاب بالأمراض إلا نادرًا، لأن الـ
+
+36
+00:02:29,650 --> 00:02:33,790
+immune system يلعب دورًا كبيرًا جدًا في نمو أو عدم نمو
+
+37
+00:02:33,790 --> 00:02:39,790
+الميكروبات.  الـ nutrient availability، لنتركها
+
+38
+00:02:39,790 --> 00:02:43,230
+و ننتقل معًا لفكرة الـ nutrient
+
+39
+00:02:43,230 --> 00:02:47,030
+availability. أنتم في المعمل، اشتغلتم على blood
+
+40
+00:02:47,030 --> 00:02:50,770
+agar، و nutrient agar، و MacConkey، أوساط زراعية مشهورة
+
+41
+00:02:50,770 --> 00:02:56,300
+ومعروفة. لو قرأنا الـ label  تبع العلبة، سنجد أنّه
+
+42
+00:02:56,300 --> 00:03:01,070
+يحتوي على carbon source،  يعني مصدر كربوني
+
+43
+00:03:01,070 --> 00:03:05,270
+مثل الجلوكوز، أو السكروز، أو النشا، أو أي other
+
+44
+00:03:05,270 --> 00:03:07,830
+carbohydrate.  سنجد أيضًا nitrogen source.  ما هو
+
+45
+00:03:07,830 --> 00:03:10,930
+nitrogen source؟ البيبتون مثلًا، والبيبتون عبارة عن
+
+46
+00:03:10,930 --> 00:03:14,210
+مستخلص من اللحم، ويحتوي على amino acids. والـ amino
+
+47
+00:03:14,210 --> 00:03:17,170
+acids سميت amino acids لأنها تحتوي على الـ amino
+
+48
+00:03:17,170 --> 00:03:19,850
+group، وهي nitrogen.  يُلاحظ أنّه يوجد carbon
+
+49
+00:03:19,850 --> 00:03:23,230
+source، وعندي nitrogen source. هذان العنصران ضروريان
+
+50
+00:03:23,230 --> 00:03:28,330
+لشغلتين أساسيتين: إنتاج الطاقة، وإنتاج الـ
+
+51
+00:03:28,330 --> 00:03:32,170
+building blocks، وهي الوحدات البنائية لأي خلية
+
+52
+00:03:32,170 --> 00:03:35,550
+بكتيرية. وبالتالي مطلوب carbon source و
+
+53
+00:03:35,550 --> 00:03:39,950
+nitrogen source. يوجد مصطلح مهم جدًا، يسمى
+
+54
+00:03:39,950 --> 00:03:44,870
+fastidious.  يُشير إلى أنّ أي بكتيريا لها complex
+
+55
+00:03:44,870 --> 00:03:48,530
+nutritional requirements.  ماذا يعني complex؟ معقدة،
+
+56
+00:03:48,530 --> 00:03:52,610
+يعني تطلب أشياء غالبًا ما لا تطلبها البكتيريا الأخرى.
+
+57
+00:03:52,610 --> 00:03:57,310
+ويُضرب مثال عليها، في بكتيريا مشهورة اسمها Hemophilus
+
+58
+00:03:57,310 --> 00:04:02,530
+influenzae. هذه البكتيريا تُعرف بحاجتها لعنصرين
+
+59
+00:04:02,530 --> 00:04:08,910
+يُسميّانهما X و V factors. إذا لم يتوفر العنصران، ولو
+
+60
+00:04:08,910 --> 00:04:11,430
+وضعنا لها كل carbon sources و nitrogen sources
+
+61
+00:04:11,430 --> 00:04:15,210
+التي في العالم، والعناصر الأخرى، لن تنمو، تحتاج إلى
+
+62
+00:04:15,210 --> 00:04:18,670
+X و V factors.  هناك بكتيريا أخرى اسمها Brucella،
+
+63
+00:04:19,860 --> 00:04:26,140
+البروسيلة، تحتاج إلى الثيامين،  vitamin B1، بدونه لا تنمو.
+
+64
+00:04:26,140 --> 00:04:28,240
+ماذا نسمي البكتيريا في هذه الحالة؟ نقول أنّها
+
+65
+00:04:28,240 --> 00:04:32,420
+fastidious،  يعني من الناحية الغذائية، لها
+
+66
+00:04:32,420 --> 00:04:38,780
+مُتطلبات خاصة بها، تختلف عن البكتيريا الأخرى. الجزء
+
+67
+00:04:38,780 --> 00:04:41,980
+التالي من المحاضرة سيتحدث عن الـ major essential
+
+68
+00:04:41,980 --> 00:04:44,980
+elements، و minor essential elements. سأتحدث قليلًا
+
+69
+00:04:44,980 --> 00:04:47,140
+عن الـ minor essential، لأنّها مهمة جدًا،
+
+70
+00:04:47,140 --> 00:04:53,020
+لأن أي زيادة عنها عن الحد المسموح به، ستنقلب إلى عكسها،
+
+71
+00:04:53,020 --> 00:04:58,160
+بدلًا من أن تكون مطلوبة للنمو، ستُستخدم لقتل أو إيقاف
+
+72
+00:04:58,160 --> 00:05:03,310
+نشاط البكتيريا. وأشهر مثال عليها هو الـ copper، النحاس،
+
+73
+00:05:03,310 --> 00:05:07,570
+النحاس مطلوب بكمية قليلة، لكن نستخدم النحاس
+
+74
+00:05:07,570 --> 00:05:11,830
+في قتل البكتيريا، عندما يكون تركيزه ماذا؟ عاليًا، لذلك
+
+75
+00:05:11,830 --> 00:05:16,870
+هذه نقطة مهمة جدًا.  عندما نحضّر media، نحتاج إلى ماء،
+
+76
+00:05:16,870 --> 00:05:20,490
+ماء مقطر، distilled water، ليس ماء حنفية،
+
+77
+00:05:20,490 --> 00:05:25,050
+ليس tap water، distilled water.  كان زمان يستخدمون أجهزة
+
+78
+00:05:25,050 --> 00:05:28,730
+تقطير، أنابيبها مصنوعة من النحاس. الماء
+
+79
+00:05:28,730 --> 00:05:32,350
+المقطّر باستخدام هذه الأنابيب
+
+80
+00:05:32,350 --> 00:05:35,830
+النحاسية غير صالح للاستخدام في تحضير الأوساط
+
+81
+00:05:35,830 --> 00:05:38,910
+الزراعية، لأنه غني جدًا بالـ copper،  ويتلف
+
+82
+00:05:38,910 --> 00:05:44,290
+البكتيريا. هذه كلها نقاط مهمة جدًا.  الـ water activity
+
+83
+00:05:44,290 --> 00:05:47,330
+كما ذكرت، يُعبّر عنها بـ water activity، AW،
+
+84
+00:05:47,330 --> 00:05:55,830
+و AW تُمثّل،  نقطة مهمة جدًا في حياة
+
+85
+00:05:55,830 --> 00:05:59,670
+البكتيريا. بدون ماء، البكتيريا لن تستطيع العيش،
+
+86
+00:05:59,670 --> 00:06:03,210
+وتحتاج إلى نسبة معينة من الماء المتاح، نسبة معينة
+
+87
+00:06:03,210 --> 00:06:10,410
+إذا أضفت ملحًا، وأضفت ماءً،  أضفت مادة لها القدرة على
+
+88
+00:06:10,410 --> 00:06:14,880
+الارتباط بالماء،  لا يُحسب كل الماء الذي أضفته  free
+
+89
+00:06:14,880 --> 00:06:17,980
+water، جزء منه ارتبط، هذه نقطة مهمة أيضًا.
+
+90
+00:06:17,980 --> 00:06:22,820
+أيضًا، عندما أقول water activity، أتذكر شيءًا
+
+91
+00:06:22,820 --> 00:06:28,580
+واحدًا من أوائل طرق حفظ الأغذية كان
+
+92
+00:06:28,580 --> 00:06:35,180
+التجفيف، أليس كذلك؟ والتجفيف يعني نزع الماء، إزالة
+
+93
+00:06:35,180 --> 00:06:39,960
+الماء، تقليل water activity.  الطريقة الثانية كانت
+
+94
+00:06:39,960 --> 00:06:44,920
+التمليح، والتمليح يُحقق غرضين في نفس الوقت، أنه
+
+95
+00:06:44,920 --> 00:06:48,100
+يُقلل الماء، أو يزيد osmotic pressure الذي
+
+96
+00:06:48,100 --> 00:06:52,100
+تحدثنا عنه. لذلك، إذا أردنا  مربى، كما
+
+97
+00:06:52,100 --> 00:06:55,460
+تحدثنا، المربى فيه سكر، والسكر مثل الملح، هو
+
+98
+00:06:55,460 --> 00:06:59,720
+تقريبًا بنفس الفكرة، أليس كذلك؟ نعم، بنفس الفكرة، أنه
+
+99
+00:06:59,720 --> 00:07:02,980
+يمتص الماء، وفي نفس الوقت يزيد الـ osmotic
+
+100
+00:07:02,980 --> 00:07:05,600
+pressure. إذا وجدت بكتيريا في المربى، ستجدها
+
+101
+00:07:05,600 --> 00:07:09,140
+تموت بدلًا من أن تتكاثر، على الرغم من وجود كل العناصر
+
+102
+00:07:09,140 --> 00:07:12,700
+التي ذكرناها، وهي carbon source و
+
+103
+00:07:12,700 --> 00:07:16,900
+nitrogen source. إذن، لا يكفي أن نوفر للبكتيريا
+
+104
+00:07:16,900 --> 00:07:20,320
+العناصر الأساسية،  يجب أن نوفر لها جميع الظروف، جميع
+
+105
+00:07:20,320 --> 00:07:26,320
+الظروف.  الـ oxygen،  احفظوه معي على أصابع اليد، على الـ
+
+106
+00:07:26,320 --> 00:07:30,060
+... على الـ ... لا أعرف كيف تُسمى، ليست
+
+107
+00:07:30,060 --> 00:07:32,760
+قاعة يد اليسرى ولا شيء، هي مجرد أصابع اليد
+
+108
+00:07:32,760 --> 00:07:37,710
+نعد عليهم: obligate aerobic، obligate anaerobic،
+
+109
+00:07:37,710 --> 00:07:41,770
+في المنتصف facultative anaerobic. ثلاثة،  ثم
+
+110
+00:07:41,770 --> 00:07:45,310
+واحدة قريبة من الـ aerobic تُسمى microaerophilic.  انتبهوا،
+
+111
+00:07:45,310 --> 00:07:48,370
+الاكسجين في الجو تركيزه 20%، twenty
+
+112
+00:07:48,370 --> 00:07:52,950
+percent أو 21 percent. This is what is
+
+113
+00:07:52,950 --> 00:07:57,120
+known as aerobic environment. بينما البكتيريا الـ
+
+114
+00:07:57,120 --> 00:08:01,700
+microaerophilic تحتاج إلى 5% فقط. لذلك، إذا
+
+115
+00:08:01,700 --> 00:08:05,340
+أردتم زراعة بكتيريا microaerophilic، يجب أن توفرُوا
+
+116
+00:08:05,340 --> 00:08:10,730
+لها بيئة خاصة، تأخذون من الجو 15% من
+
+117
+00:08:10,730 --> 00:08:15,210
+الأكسجين أو 16% من الأكسجين، وتُبقون 5% فقط.
+
+118
+00:08:15,210 --> 00:08:17,350
+أجبنا عن السؤال.
+
+119
+00:08:17,350 --> 00:08:20,930
+obligate aerobic، obligate anaerobic، facultative
+
+120
+00:08:20,930 --> 00:08:24,090
+anaerobic،  ثم microaerophilic، وأخيرًا
+
+121
+00:08:24,090 --> 00:08:27,330
+aerotolerant anaerobic.  ركزوا معي في الـ
+
+122
+00:08:27,330 --> 00:08:32,430
+aerotolerant anaerobic. هي بكتيريا لا هوائية، طورت تقنية لتحمل، وليس لاستخدام
+
+123
+00:08:32,430 --> 00:08:38,090
+الأكسجين.  وهناك فرق بين كلمة تحمل tolerant، أو use، أو utilizes،
+
+124
+00:08:38,090 --> 00:08:43,610
+التي تعني استخدام،  تعني أنّها تستعمل الأكسجين في
+
+125
+00:08:43,610 --> 00:08:46,850
+عملياتها، في عملية الأكسدة. بينما تحمل، تعني قادرة
+
+126
+00:08:46,850 --> 00:08:51,370
+على التخلص من التأثيرات السامة للأكسجين،
+
+127
+00:08:51,370 --> 00:08:55,630
+إذن خمسة أنواع. والشيء المهم هنا؟ أنّه إذا
+
+128
+00:08:55,630 --> 00:09:01,370
+قمنا بعمل incubation هوائي،  من سيعيش هنا؟ الـ
+
+129
+00:09:01,370 --> 00:09:07,670
+aerobes و facultative anaerobes فقط، بينما الـ
+
+130
+00:09:07,670 --> 00:09:12,450
+aerotolerant و obligate anaerobes و
+
+131
+00:09:12,450 --> 00:09:15,550
+microaerophilic تحتاج بيئة خاصة. لذلك
+
+132
+00:09:15,550 --> 00:09:18,010
+طوّرنا CO2 incubation، وطوّرنا anaerobic
+
+133
+00:09:18,010 --> 00:09:21,150
+incubation، و microaerophilic incubation. هذا يختلف
+
+134
+00:09:21,150 --> 00:09:24,050
+عن aerobic incubation. بالنسبة للـ pH الذي
+
+135
+00:09:24,050 --> 00:09:29,370
+نُجري فيه الزراعة،  قلنا أنه يُقاس بـ hydrogen
+
+136
+00:09:29,370 --> 00:09:33,230
+ion concentration، درجة الحموضة، والمقياس من
+
+137
+00:09:33,230 --> 00:09:37,930
+صفر إلى أربعة عشر، سبعة متعادل، فوق سبعة قلوي،
+
+138
+00:09:37,930 --> 00:09:42,450
+تحت سبعة حمضي.  most medically important bacteria
+
+139
+00:09:42,450 --> 00:09:47,290
+can grow at a pH near neutrality. كلمة near
+
+140
+00:09:47,290 --> 00:09:50,970
+neutrality تعني من ستة ونصف إلى سبعة ونصف تقريبًا.  لكن
+
+141
+00:09:50,970 --> 00:09:54,770
+هناك استثناءات، والذين لديهم استثناءات في البكتيريا
+
+142
+00:09:54,770 --> 00:09:58,510
+نحاول استغلال الاستثناءات.  سأعطيكم مثالًا، الـ Vibrio
+
+143
+00:09:58,510 --> 00:10:02,170
+cholerae،  الـ pH المفضل له قلوي.  لذلك،
+
+144
+00:10:02,170 --> 00:10:07,290
+لمنع نموّه، يجب جعله حمضي.  مثال، قبل عدة سنوات،  وصل
+
+145
+00:10:07,290 --> 00:10:12,430
+أنّ وباء الكوليرا انتشر، وكانت إحدى النصائح المُعطاة
+
+146
+00:10:12,430 --> 00:10:15,410
+للناس: إذا لم تستطيعوا غلي الماء، ضعوا عليه
+
+147
+00:10:15,410 --> 00:10:19,770
+بضع قطرات من الليمون.  الليمون حمض، يُخفض
+
+148
+00:10:19,770 --> 00:10:24,810
+الـ pH  الماء وبالتالي يقتل Vibrio cholerae.
+
+149
+00:10:24,810 --> 00:10:29,510
+شيء آخر في نفس الإطار ونفس المثال، بما أنّ
+
+150
+00:10:29,510 --> 00:10:33,650
+Vibrio cholerae هي الوحيدة التي تحب الـ
+
+151
+00:10:33,650 --> 00:10:36,610
+alkaline pH، إذا بدأت عزله من stool
+
+152
+00:10:36,610 --> 00:10:39,970
+البراز،  هذا الـ stool يحتوي
+
+153
+00:10:39,970 --> 00:10:43,790
+على ملايين البكتيريا، أنواع مختلفة، كيف لي أن
+
+154
+00:10:43,790 --> 00:10:48,270
+أعزل Vibrio cholerae من كل هذه الميكروبات؟ نضعها في
+
+155
+00:10:48,270 --> 00:10:53,130
+بيئة قلوية، جميع الميكروبات الأخرى تموت تدريجيًا، مع
+
+156
+00:10:53,130 --> 00:10:58,150
+ذلك Vibrio cholerae تحب هذه البيئة وتبقى
+
+157
+00:10:58,150 --> 00:11:01,430
+مستمرة. أظن أنّ هذه نقطة جيدة في الوقاية وفي الـ control.
+
+158
+00:11:05,870 --> 00:11:11,830
+الـ temperature. هناك ثلاثة أقسام أو ثلاثة أصناف
+
+159
+00:11:11,830 --> 00:11:16,690
+من البكتيريا: psychrophilic، محبة للبرودة، أو العكس،
+
+160
+00:11:16,690 --> 00:11:22,550
+thermophilic، heat-loving، تحب درجات الحرارة
+
+161
+00:11:22,550 --> 00:11:27,290
+المرتفعة.  هناك تصنيفات أخرى غير
+
+162
+00:11:27,290 --> 00:11:31,150
+هذه، مثلًا extremophiles،
+
+163
+00:11:31,150 --> 00:11:35,850
+extremophiles،  تعني محبة لدرجات حرارة مرتفعة جدًا،
+
+164
+00:11:35,850 --> 00:11:41,330
+جداً جدًا، قد توجد في... ليست في
+
+165
+00:11:41,330 --> 00:11:45,390
+البراكين المعروفة، وإنّما في ما يُسمى
+
+166
+00:11:45,390 --> 00:11:49,030
+بالـ thermal vents، الفتحات الموجودة في
+
+167
+00:11:49,030 --> 00:11:52,970
+قاع المحيطات، التي تُخرج مياهًا ساخنة.  قاع المحيط
+
+168
+00:11:52,970 --> 00:11:58,730
+آلاف الأمتار عمقًا،  الضغط الماء... ضغط الماء
+
+169
+00:11:58,730 --> 00:12:02,370
+أو عمود الماء  يُحدث ضغطًا، لذلك درست
+
+170
+00:12:02,370 --> 00:12:06,450
+البكتيريا،  تتحمل ضغطًا 150، 200، و
+
+171
+00:12:06,450 --> 00:12:11,830
+أكثر،  قادرة على العيش في هذه الظروف. لكن،  لن أتوسع في هذا الموضوع،  يجب
+
+172
+00:12:11,830 --> 00:12:14,570
+أن نتفق على، عندما أقول بكتيريا، لا أقصد
+
+173
+00:12:14,570 --> 00:12:19,390
+بكتيريا واحدة.
+
+174
+00:12:20,610 --> 00:12:26,310
+البكتيريا أمم وشعوب وقبائل وعائلات،
+
+175
+00:12:26,310 --> 00:12:31,790
+كلها،  بمعنى أنّ لكلّ منها صفاتها، لذلك هناك
+
+176
+00:12:31,790 --> 00:12
+
+223
+00:15:53,760 --> 00:15:57,880
+حساب بكتيريا أخرى لما يزيد عددها، شباب، زي ما بعض
+
+224
+00:15:57,880 --> 00:16:00,820
+الناس لما بيكون واحد بيكون جبان، لما بيكونوا مجموعة
+
+225
+00:16:00,820 --> 00:16:05,180
+بيصيروا شجعان، هم كلهم مجموعة من الجبنة، لكن لما
+
+226
+00:16:05,180 --> 00:16:09,330
+بيشتموا مع بعض، بيشجعوا مع بعض، فيحدث، والبكتيريا على
+
+227
+00:16:09,330 --> 00:16:13,410
+فكرة تمتلك المقدرة على معرفة عددها، بظاهرة تسمى
+
+228
+00:16:13,410 --> 00:16:17,030
+Quorum Sensing، أشطر منكوا يعني يعني احنا لو غمضنا
+
+229
+00:16:17,030 --> 00:16:21,050
+عيوننا وقلنا لكوا شباب ادخلوا على القاعة، وقلنا عطوا
+
+230
+00:16:21,050 --> 00:16:24,730
+ان كم واحد صار في الفصل، مش هيقدر يعدهم لأنه مغمض
+
+231
+00:16:24,730 --> 00:16:28,150
+مش شايفهم، لكن البكتيريا على الرغم انها لا تمتلك
+
+232
+00:16:28,150 --> 00:16:32,250
+عينان ولا أذنان، تستطيع أن تعد أخواتها من البكتيريا
+
+233
+00:16:32,250 --> 00:16:35,970
+ولما يصل إلى عدد معين، يا شباب، آه لما يصل إلى عدد
+
+234
+00:16:35,970 --> 00:16:39,720
+معين، وافترض عشرة، لا قصر خمسة، اللي هو يعني مائة
+
+235
+00:16:39,720 --> 00:16:48,580
+ألف لكل جرام، ابتدأت عمليات جديدة تنشط في البكتيريا
+
+236
+00:16:48,580 --> 00:16:52,600
+لم تكن موجودة لما كان العدد أقل من ذلك، كلمة مرة
+
+237
+00:16:52,600 --> 00:16:56,560
+الظاهرة اسمها Quorum Sensing، الإحساس بالعدد
+
+238
+00:16:56,560 --> 00:17:01,990
+الإحساس بالعدد، لما يزيد العدد بتزيد إمكانية
+
+239
+00:17:01,990 --> 00:17:05,990
+البكتيريا تنتج توكسين، يعني تنتج توكسين، وهو بيُلقى
+
+240
+00:17:05,990 --> 00:17:10,110
+السبب ليه disease، إذًا الـ competition عملية مهمة
+
+241
+00:17:10,110 --> 00:17:14,400
+جدا لدينا في الـ microbiology، أعطتنا فكرة أن الـ post
+
+242
+00:17:14,400 --> 00:17:18,080
+cooking، post يعني ما بعد، post ما بعد، post cooking
+
+243
+00:17:18,080 --> 00:17:22,620
+contamination أخطر من الـ pre cooking، علمتنا أن الـ
+
+244
+00:17:22,620 --> 00:17:24,860
+balance، الـ imbalance اللي بيصير في الـ intestinal
+
+245
+00:17:24,860 --> 00:17:29,560
+tract، اللي ممكن يكون ناجم عن استخدام مفرط أو زائد
+
+246
+00:17:29,560 --> 00:17:32,800
+أو استخدام الـ broad spectrum antibiotic، قد يؤدي
+
+247
+00:17:32,800 --> 00:17:37,040
+إلينا إلى أيضًا أمراض أخرى نتيجة عن عدم الاتزان أو
+
+248
+00:17:37,040 --> 00:17:41,350
+عدم وجود الـ competition، okay، صحيح، في دي هلأ أن
+
+249
+00:17:41,350 --> 00:17:46,590
+كلمة niche؟ بدنا نفهمها برضه، هذه مصطلح كتير مهمة
+
+250
+00:17:46,590 --> 00:17:50,430
+الغرفة، ده الشيء اللي احنا قاعدين فيه، عبارة عن
+
+251
+00:17:50,430 --> 00:17:56,910
+ecosystem، نظام بيئي، طيب سؤال يعني منطقي وعقلاني،
+
+252
+00:17:56,910 --> 00:18:01,690
+هل تعتقدون أن الميكروبات اللي عايشة في الجو أو في
+
+253
+00:18:01,690 --> 00:18:06,390
+المنطقة هذه هي نفس الميكروبات اللي عايشة في الـ
+
+254
+00:18:06,390 --> 00:18:11,020
+breeze، الكهربا، ده اللي موجود هنا عندنا؟ ليش اختلف؟
+
+255
+00:18:11,020 --> 00:18:16,840
+اختلف، نسبة الإضاءة، الحرارة اختلفت، صح؟ وده لأنه
+
+256
+00:18:16,840 --> 00:18:21,000
+هنا في عندي سطح، نعم، جدًا، هناك سطح خشن، على سبيل
+
+257
+00:18:21,000 --> 00:18:24,500
+المثال، قد يساعد البكتيريا على الاتصال، هنا لا يساعد
+
+258
+00:18:24,500 --> 00:18:28,620
+على ... يبقى على الرغم من أن الغرف تبدو أن الواحدة
+
+259
+00:18:28,620 --> 00:18:33,660
+الأولى عليها ecosystem أو نظام بيئي واحد، إلا أن
+
+260
+00:18:33,660 --> 00:18:39,530
+كل منطقة في هذه الغرفة تعتبر ecosystem مصغر، الـ
+
+261
+00:18:39,530 --> 00:18:43,870
+ecosystem المصغر اسمه إيش؟ أنا؟ إيش؟ يعني هو عبارة
+
+262
+00:18:43,870 --> 00:18:48,510
+عن أصغر وحدة بيئية، تمام؟ أعطيكم مثال ثاني، على جسم
+
+263
+00:18:48,510 --> 00:18:54,010
+الإنسان، الفم، اللي هو رايح جاي فيه، وده لا ... صح؟
+
+264
+00:18:54,010 --> 00:18:57,550
+نقدر نحكي؟ اللي هو رايح جاي فيه، فنتوقع أن البكتيريا
+
+265
+00:18:57,550 --> 00:19:01,930
+اللي فيه هوائية ولا لا هوائية؟ أنا بدأ أقول لكم أن معظم
+
+266
+00:19:01,930 --> 00:19:06,750
+التهابات الفم تنتج عن بكتيريا لا هوائية، لأن بين السن
+
+267
+00:19:06,750 --> 00:19:12,300
+والسن بيئة، بين السن واللثة بيئة مختلفة، بين السن
+
+268
+00:19:12,300 --> 00:19:15,700
+واللثة، أعتقد أنه لو انفتحت وانت بتفرج أسنانك ودخلت
+
+269
+00:19:15,700 --> 00:19:20,880
+بكتيريا جوا وسكرت، هتتوفر ظروف لا هوائية، إذًا حتى
+
+270
+00:19:20,880 --> 00:19:25,280
+الفم اللي هو يعتبر يعني منطقة مُحتكة بالهواء، قد
+
+271
+00:19:25,280 --> 00:19:30,090
+تتوفر فيه بيئات لا هوائية، الـ Host immune system
+
+272
+00:19:30,090 --> 00:19:33,490
+أنا شرحته قبل شوية عن مثال الـ HIV أو مرض الـ AIDS
+
+273
+00:19:33,490 --> 00:19:39,150
+و الإنسان السليم، وكيف هذا بيسمح للميكروبات أن
+
+274
+00:19:39,150 --> 00:19:45,850
+تنمو، ولا آخر يسمح للميكروبات أن تنمو، من أعظم
+
+275
+00:19:45,850 --> 00:19:47,930
+التراكيب اللي موجودة في الـ Gram negative بكتيريا
+
+276
+00:19:47,930 --> 00:19:50,030
+أخذته في الـ general microbiology، اسمه Endotoxin
+
+277
+00:19:50,650 --> 00:19:51,930
+أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا
+
+278
+00:19:51,930 --> 00:19:52,930
+أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا
+
+279
+00:19:52,930 --> 00:19:55,750
+أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا
+
+280
+00:19:55,750 --> 00:19:55,870
+أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا
+
+281
+00:19:55,870 --> 00:19:57,430
+أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا
+
+282
+00:19:57,430 --> 00:20:02,930
+أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا
+
+283
+00:20:02,930 --> 00:20:03,010
+أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا أنا
+
+284
+00:20:03,010 --> 00:20:07,890
+أنا أنا أنا أنا أنا أنا أنا
+
+285
+00:20:07,890 --> 00:20:19,350
+أنا أنا أنا أنا أنا أنا أنا أنا
+
+286
+00:20:19,350 --> 00:20:23,600
+أنا، عشان أدل على أهمية التوكسين هذا أو على أهمية
+
+287
+00:20:23,600 --> 00:20:27,800
+تركيب هذا الـ Gram Negative، لو شلنا الـ
+
+288
+00:20:27,800 --> 00:20:30,960
+Lipopolysaccharide من الـ Gram Negative بكتيريا،
+
+289
+00:20:30,960 --> 00:20:36,420
+ثقوا تمامًا أن البكتيريا هتفقد قدرتها على أن تعمل
+
+290
+00:20:36,420 --> 00:20:40,300
+Virulence، يبقى بنقدر نثبت أنه الـ Major
+
+291
+00:20:40,300 --> 00:20:46,620
+Virulence Factor of Gram Negative بكتيريا، طيب، مدام
+
+292
+00:20:46,620 --> 00:20:49,980
+كل جرام نيجاتيف فيها ليبوبوليساكرايد، يبقى كل جرام
+
+293
+00:20:49,980 --> 00:20:56,720
+نيجاتيف فيها، إيش فيها؟ فيها الـEndotoxin، طيب، هل
+
+294
+00:20:56,720 --> 00:21:02,300
+كل جرام نيجاتيف بكتيريا pathogenic للإنسان؟ لأ، مش
+
+295
+00:21:02,300 --> 00:21:06,540
+كلها pathogenic، احنا قلنا الـ major virulence
+
+296
+00:21:06,540 --> 00:21:09,820
+factor، لكن لازم يكون معه other virulence factors
+
+297
+00:21:09,820 --> 00:21:15,280
+تؤهله أن يعمل pathogenesis، في عند الشباب نقطة كتير
+
+298
+00:21:15,280 --> 00:21:19,760
+مهمة، مصطلح septic shock، أو ممكن تضيفوا عليها جملة
+
+299
+00:21:19,760 --> 00:21:24,060
+إنتوا من عندكوا، gram negative septic shock، مريض
+
+300
+00:21:24,060 --> 00:21:29,380
+عنده septicemia، عملنا له مزرعة دم، في مزرعة الدم
+
+301
+00:21:29,380 --> 00:21:34,700
+عزلنا إشريشيا كولاي، عملنا sensitivity testing
+
+302
+00:21:34,700 --> 00:21:37,880
+وانتوا فاكرين المحاضرة الماضية، إيش قلنا فيها؟ دور الـ
+
+303
+00:21:37,880 --> 00:21:41,100
+diagnostic microbiologist بيتلخص فيه، نقطة ثانية
+
+304
+00:21:41,100 --> 00:21:46,720
+isolate and identify the pathogen، و determine the
+
+305
+00:21:46,720 --> 00:21:51,380
+susceptibility to antibiotics، فانعزلت وعُرفت
+
+306
+00:21:51,380 --> 00:21:55,600
+البكتيريا أنها E.coli، وعملنا لها susceptibility، و
+
+307
+00:21:55,600 --> 00:22:01,000
+طلع أفضل antibiotic لها الـ Gentamicin، وفي
+
+308
+00:22:01,000 --> 00:22:04,260
+الـGentamicin، أعطينا التقرير للطبيب، الطبيب أعطاه
+
+309
+00:22:04,260 --> 00:22:10,860
+Gentamicin، ماتت البكتيريا ومات المريض، مات
+
+310
+00:22:10,860 --> 00:22:16,900
+المريض من سموم البكتيريا، يا شباب، لأن البكتيريا لما
+
+311
+00:22:16,900 --> 00:22:20,940
+ماتت أطلقت كميات ضخمة من الـ endotoxin اللي بيبقوا
+
+312
+00:22:20,940 --> 00:22:24,360
+ليه؟ ليبوبوليساكرايد، واللي بيبقوا ليه؟ ليبوبوليساكرايد؟ اللي بيبقوا
+
+313
+00:22:24,360 --> 00:22:29,250
+له تأثيرات مُخيفة في جهاز المناعة، منها ارتفاع درجة
+
+314
+00:22:29,250 --> 00:22:33,130
+الحرارة، منها increase permeability، اللي هو الـ الـ
+
+315
+00:22:33,130 --> 00:22:37,970
+الـ vasodilatation، تمام، low blood pressure، كل هذه
+
+316
+00:22:37,970 --> 00:22:41,950
+العوامل بتؤدي في الآخر إلى shock، وبموت المريض
+
+317
+00:22:41,950 --> 00:22:47,130
+تمام؟ إذًا الإجراء من negative bacteria
+
+318
+00:22:49,540 --> 00:22:52,600
+خطيرة جدًا، نظرًا لاحتوائها على مين؟ على الـ lipopoly
+
+319
+00:22:52,600 --> 00:22:56,040
+saccharide أو الـ endotoxin، أحد تأثيرات الـ ... الـ ...
+
+320
+00:22:56,040 --> 00:22:59,540
+الـ ... الـ ... الـ endotoxin اللي ما نجعلها نتجاهلها هو
+
+321
+00:22:59,540 --> 00:23:04,460
+الـ activation للـ complement، الـ activation للـ
+
+322
+00:23:04,460 --> 00:23:07,300
+complement، بتعرفوا الـ complement ولا ما بتعرفوهاش؟
+
+323
+00:23:07,300 --> 00:23:10,600
+أيه الـ complement؟ عبارة عن مجموعة من البروتينات
+
+324
+00:23:10,600 --> 00:23:15,080
+في جهاز المناعة، من C1 to C9، من مع جلم اللغة العربية
+
+325
+00:23:19,090 --> 00:23:23,930
+لأن هذا القلم لا نستطيع إلا نقول إنه ... إنه ... لما
+
+326
+00:23:23,930 --> 00:23:27,330
+... يعني أحد يشوفه يقول جلم، لكن اللي حاولنا نكتب فيه
+
+327
+00:23:27,330 --> 00:23:33,490
+على السبورة ما بيكتب، ليش؟ لأنه بده يعتبره inactive
+
+328
+00:23:33,490 --> 00:23:38,030
+غير نشط الآن، غير نشط، كيف بيصير نشط؟ لما نعمل
+
+329
+00:23:38,030 --> 00:23:41,590
+cleavage له، بنجزئه، بنشيل fragment A، بيظهر لنا
+
+330
+00:23:41,590 --> 00:23:44,350
+fragment B، أو العكس، fragment B، وبيظهر لنا
+
+331
+00:23:44,350 --> 00:23:50,830
+fragment A، الآن في جهاز المناعة، الـ complement من
+
+332
+00:23:50,830 --> 00:23:53,370
+الحمد لله سبحانه وتعالى ومن رحمته علينا إنها
+
+333
+00:23:53,370 --> 00:24:00,670
+inactive، لأنه لو active، يُدمر خلايانا، فالـ endotoxin
+
+334
+00:24:00,670 --> 00:24:04,350
+بيعمل activation للـ complement، الـ complement
+
+335
+00:24:04,350 --> 00:24:09,210
+بتنشط الثانية، الثالثة، الرابعة، الخامسة، وفي الآخر
+
+336
+00:24:09,210 --> 00:24:13,150
+بتكون عندي مركب بنسميه membrane attack complex
+
+337
+00:24:14,720 --> 00:24:19,340
+يُفترض أن هذا يهاجم مين؟ البكتيريا، ويدمرها، أنا
+
+338
+00:24:19,340 --> 00:24:21,940
+قاعد بأقول لكم أن الـ lipopolysaccharide هو اللي عمل
+
+339
+00:24:21,940 --> 00:24:24,840
+activation للـ complement، طب الـ lipopolysaccharide
+
+340
+00:24:24,840 --> 00:24:28,900
+متى طلع؟ طلع لما ماتت البكتيريا، طب يبقى هذا الـ
+
+341
+00:24:28,900 --> 00:24:33,340
+membrane attack complex لازم يقتل حاجة، هيقتل مين؟
+
+342
+00:24:33,340 --> 00:24:37,180
+خلايانا، هيقتل خلايانا، شكرًا لكم
+
+343
+00:24:43,830 --> 00:24:48,770
+في كمان نقطة، الآن هاد الـ syringe، هاي الـ syringe
+
+344
+00:24:48,770 --> 00:24:54,770
+على سبيل المثال، غمصناها بماء ملوث، ماء مجاري، أكرمكم
+
+345
+00:24:54,770 --> 00:24:59,550
+الله، واحنا عقبناها، الآن لو عملنا testing للـ
+
+346
+00:24:59,550 --> 00:25:04,030
+syringe هاد، هتلاقيها sterile، لكن بواقي البكتيريا
+
+347
+00:25:04,030 --> 00:25:07,790
+موجودة، ومش موجودة، من ضمن بواقي البكتيريا ممكن مين
+
+348
+00:25:07,790 --> 00:25:13,770
+يكون؟  إندوتوكسين، لذلك يا شباب ممنوع يكون الـ syringe
+
+349
+00:25:13,770 --> 00:25:17,610
+أصلًا مش نظيفة قبل التعقيم، لازم تكون نظيفة من
+
+350
+00:25:17,610 --> 00:25:21,850
+مصدرها، وبعدين نعقمها، لا يكون فيها حبة بكتيريا
+
+351
+00:25:21,850 --> 00:25:26,270
+من الهواء أو من المكان، فنعقمها واحنا متأكدين
+
+352
+00:25:26,270 --> 00:25:30,010
+أنها إيش، نظيفة بالأساس، نظيفة بالأساس، حتى لا
+
+353
+00:25:30,010 --> 00:25:34,030
+تحتوي على مركبات البكتيريا اللي من ضمنها الـ
+
+354
+00:25:34,030 --> 00:25:36,570
+endoxin، فيه طبعًا مركبات الـgram-positive bacterium
+
+355
+00:25:38,830 --> 00:25:42,930
+الـ Exotoxins، قصة ثانية خالص، لأن التوكسين على الرغم إن
+
+356
+00:25:42,930 --> 00:25:48,450
+احنا شرحناها بسرعة، لكن أهميته كبيرة، صحيح، أهميته
+
+357
+00:25:48,450 --> 00:25:54,290
+كبيرة، الـ Exotoxin قسمناهم لصنفين، صنف بيؤثر على
+
+358
+00:25:54,290 --> 00:26:00,790
+خارج الخلية، وصنف بيستهدف cellular targets، يعني
+
+359
+00:26:00,790 --> 00:26:02,510
+أهداف داخل الخلية
+
+360
+00:26:04,920 --> 00:26:07,680
+قبل ما أبدأ في الـ ... الـ ... الـ cellular targets
+
+361
+00:26:07,680 --> 00:26:09,240
+ما أعرفش، محتاج ... محتاج ... مضطر أني آخذ الجرام
+
+362
+00:26:09,240 --> 00:26:14,700
+مرة كمان منكم، غالبًا الـ Exotoxins ... الـ Exotoxins
+
+363
+00:26:14,700 --> 00:26:20,700
+عبارة عن two fragments، مش نشط، ومش نشط، لأ، هو two
+
+364
+00:26:20,700 --> 00:26:27,000
+fragments، fragment A و fragment B، احفظ، A active، B
+
+365
+00:26:27,000 --> 00:26:36,700
+binding، binding، إدارة البنك، الآن هي A فوق، وB تحت
+
+366
+00:26:36,700 --> 00:26:42,420
+تمام؟ بيجي للخلية، الـ B بيكون له receptor على
+
+367
+00:26:42,420 --> 00:26:47,240
+الخلية، فبيرتبط فيها، وبصير internalization لمين؟ لـ
+
+368
+00:26:47,240 --> 00:26:52,000
+أي شيء جوا الخلية، إذًا في عندي A وB، هذا لا يعني أن الـ
+
+369
+00:26:52,000 --> 00:26:56,760
+toxin بيحتوي فقط على fragment A واحدة، وB واحدة، قد
+
+370
+00:26:56,760 --> 00:27:02,780
+يحتوي على A واحدة، وخمسة B، تخيلوا كيف الوضع؟ هي AB
+
+371
+00:27:02,780 --> 00:27:08,600
+B أخرى، وهكذا، فهذه العملية لما يكون فيه أكثر من B
+
+372
+00:27:08,600 --> 00:27:13,160
+بتسهل عملية الالتصاق، يعني وين مرابطة الإندوتوكسين
+
+373
+00:27:13,160 --> 00:27:19,140
+... العفو، أن الإندوتوكسين بيلاقي له مكان يرتبط فيه، من
+
+374
+00:27:19,140 --> 00:27:23,120
+أشهر الـ ... الـ toxins المشهورة في الـ AB model
+
+375
+00:27:23,120 --> 00:27:26,380
+اللي هو الـ Corynebacterium diphtheriae toxin، الـ
+
+376
+00:27:26,380 --> 00:27:31,120
+Corynebacterium diphtheriae toxin، له طريقة في قتل
+
+377
+00:27:31,120 --> 00:27:35,360
+البكتيريا، عن طريق حاجة بيسموها ADP ribosylation
+
+378
+00:27:35,360 --> 00:27:40,540
+ركّزوا معي بس في الجزئية هذه، كلمة ADP
+
+379
+00:27:40,540 --> 00:27:47,960
+ribosylation، يعني إضافة ADP لشيء ... لشيء معين، الآن الـ
+
+380
+00:27:47,960 --> 00:27:54,570
+ADP ribosylation، يعني الإضافة هذه إما إنها بتوقف
+
+381
+00:27:54,570 --> 00:28:00,850
+نشاط مركب نشط، أو بتنشط مركب مش نشط، وصلت الصورة؟
+
+382
+00:28:00,850 --> 00:28:05,010
+يعني إذا كان هو نشط وعملنا له ADP ribosylation
+
+383
+00:28:05,010 --> 00:28:10,010
+بيوقف نشاطه، وإذا كان هو أصلاً مش نشط، وضفنا له ADP
+
+384
+00:28:10,010 --> 00:28:14,130
+بنعمل له activation، يبقى activation أو deactivation
+
+385
+00:28:14,130 --> 00:28:17,650
+عن طريق اللي هو الـ ADP ribosylation، في حالة
+
+386
+00:28:17,650 --> 00:28:22,250
+الدفتيريا، الـ ... الـ mechanism of action كانت التالية،
+
+387
+00:28:22,250 --> 00:28:24,790
+بتعرفوا الـ protein synthesis إنتوا يا شباب؟ الـ protein
+
+388
+00:28:24,790 --> 00:28:29,010
+synthesis، عملية صنع الـ protein، ريبوزوم،
+
+389
+00:28:29,010 --> 00:28:33,510
+large subunit، small subunit، mRNA، صح؟ وبعدين
+
+390
+00:28:33,510 --> 00:28:38,010
+بيجي عملية الـ ... الـ amino acid synthesis، بتربط مع
+
+391
+00:28:38,010 --> 00:28:42,740
+... مع ... معاها عن طريق الـ aminoacyl tRNA، الآن في
+
+392
+00:28:42,740 --> 00:28:46,
+
+445
+00:32:59,110 --> 00:33:02,470
+Streptococcus هنعرف أن Streptococcus بتنتج اللي هو
+
+446
+00:33:02,470 --> 00:33:07,810
+Streptolysin O و Streptolysin S، الـ S تعني Stable و
+
+447
+00:33:07,810 --> 00:33:12,850
+Streptolysin O تعني  لايف من أمثلة هقول أن
+
+448
+00:33:12,850 --> 00:33:15,950
+Streptolysin O تبع Streptococcus و Streptolysin O
+
+449
+00:33:15,950 --> 00:33:21,040
+تبع Clostridium، النوع الأخير Detergent-like، كلكم
+
+450
+00:33:21,040 --> 00:33:23,080
+بتعرفوا الـ detergents اللي هي المنظفات الصناعية
+
+451
+00:33:23,080 --> 00:33:26,220
+الها hydrophilic end و hydrophobic end، و كذلك
+
+452
+00:33:26,220 --> 00:33:29,400
+الأمر بالنسبة لمين؟ للـ phospholipids لما يصير
+
+453
+00:33:29,400 --> 00:33:32,840
+interaction بين الـ phospholipids اللي موجود في الـ
+
+454
+00:33:32,840 --> 00:33:35,540
+cell membrane و ما بين الـ detergent، أيضا حلاج أن
+
+455
+00:33:35,540 --> 00:33:38,820
+يصل عنها disruption للـ integrity of the membrane
+
+456
+00:33:38,820 --> 00:33:43,500
+وهذه بتتميز يا شباب أنَّها بتعمل rapid lysis، rapid
+
+457
+00:33:43,500 --> 00:33:49,140
+lysis يعني تحلل سريع، الملخص الثلاث ... ثلاثة
+
+458
+00:33:49,140 --> 00:33:52,840
+ميكانيزمات مختلفة أدت في النهاية إلى نتيجة
+
+459
+00:33:52,840 --> 00:33:57,060
+واحدة، إيش هي النتيجة؟ Lysis، Lysis، أدت إلى
+
+460
+00:33:57,060 --> 00:34:01,420
+Lysis، الـ target تبعهم كله كان واحد، تمام؟ الـ
+
+461
+00:34:01,420 --> 00:34:04,760
+cell membrane، اختلفت آلية الاستهداف، آلية
+
+462
+00:34:04,760 --> 00:34:07,660
+الاستهداف، واحد أثر على الكوليسترول، واحد عمل
+
+463
+00:34:07,660 --> 00:34:11,390
+activation للـ ... عفواً، hydrolysis للفسفولي... الـ
+
+464
+00:34:11,390 --> 00:34:14,950
+... الـ lipid، واحد عمل عملية ... لأ، الت... الت...
+
+465
+00:34:14,950 --> 00:34:17,370
+الثالثة قلنا أنه detergent-like activity اللي هو
+
+466
+00:34:17,370 --> 00:34:19,970
+الـ interaction ما بين الـ ... الـ hydrophilic end
+
+467
+00:34:19,970 --> 00:34:23,170
+للاثنين عمل disruption للـ integrity of the
+
+468
+00:34:23,170 --> 00:34:26,070
+membrane، في الآخر lysis، الآن الـ lysis هذا يا
+
+469
+00:34:26,070 --> 00:34:28,210
+شباب لو كان في الـ red blood cell، إيش بنسميه؟
+
+470
+00:34:29,620 --> 00:34:33,280
+Hemolysis، نعم بنسميه Hemolysis، وكلكم بتعرفوا قد إيش
+
+471
+00:34:33,280 --> 00:34:35,100
+أهمية الـ Hemolysis في الـ diagnostic
+
+472
+00:34:35,100 --> 00:34:39,640
+microbiology، لما نقول Alpha و Beta و Gamma، هدول
+
+473
+00:34:39,640 --> 00:34:43,060
+الثلاث صفات اللي بناخدهم من blood agar، مشهورين في
+
+474
+00:34:43,060 --> 00:34:47,670
+إنهم بيستخدموا للتعرف على البكتيريا، يعني مثلاً الـ
+
+475
+00:34:47,670 --> 00:34:51,050
+beta-hemolytic streptococci هي ... هي Streptococcus
+
+476
+00:34:51,050 --> 00:34:53,650
+pyogenes أو Streptococcus agalactiae، بينما
+
+477
+00:34:53,650 --> 00:34:56,470
+Streptococcus pneumoniae هي alpha-hemolytic
+
+478
+00:34:56,470 --> 00:35:00,690
+streptococci، يبقى معناه الحكي أنه عملية الـ
+
+479
+00:35:00,690 --> 00:35:04,330
+hemolysis هي من الصفات المهمة اللي بنستخدمها
+
+480
+00:35:04,330 --> 00:35:06,270
+في عملية التعرف على الـ micro organisms
+
+481
+00:35:08,750 --> 00:35:13,390
+ناخد بعض الـ examples للـ ... للـ ... للـ exotoxins
+
+482
+00:35:13,390 --> 00:35:18,610
+اللي بتستهدف cellular targets، يعني جوا الخلية، فين
+
+483
+00:35:18,610 --> 00:35:24,190
+مصطلح مهم اسمه adenylate cyclase toxin، سيبونا من
+
+484
+00:35:24,190 --> 00:35:27,330
+الاسم كمان مرة، وخذوا نركز مع بعض في الفكرة
+
+485
+00:35:27,330 --> 00:35:32,050
+العامة لأي toxin سيطلق عليه adenylate cyclase
+
+486
+00:35:32,050 --> 00:35:39,720
+toxin، سمعتوا يا شباب عن Cyclic AMP؟ الآن لما بنقول
+
+487
+00:35:39,720 --> 00:35:46,720
+adenylate cyclase toxin، بنتكلم عن توكسين قادر على
+
+488
+00:35:46,720 --> 00:35:53,340
+تحويل الـ ATP إلى Cyclic AMP، طب الـ Cyclic AMP هو
+
+489
+00:35:53,340 --> 00:35:57,680
+مركب سام ولا طبيعي؟ طبيعي، وله normal function
+
+490
+00:35:57,680 --> 00:36:03,340
+في الجسم، عارفين؟ بدنا نلخص الـ function تبعته بجملة
+
+491
+00:36:03,340 --> 00:36:07,400
+بسيطة، أنه بيسمح لبعض المركبات أن تمتص جوا الخلية
+
+492
+00:36:07,400 --> 00:36:14,660
+ويمنع الـ secretion تبع بعض المركبات، بيسمح ويمنع
+
+493
+00:36:14,660 --> 00:36:21,420
+أي امتصاص وإفراز لبعض المركبات، وبالأخرى نتكلم عن
+
+494
+00:36:21,420 --> 00:36:24,460
+الـ electrolytes، عارفين عن الـ electrolytes؟ الـ
+
+495
+00:36:24,460 --> 00:36:27,040
+sodium والـ chloride والـ calcium والأمور هذه،
+
+496
+00:36:27,040 --> 00:36:31,420
+لأن تخيلوا معايا التالي، بزيادة كمية، واحد يقولوا
+
+497
+00:36:31,420 --> 00:36:38,650
+اتفضل، اطلع، ادخل، صاروا عشرة، صاروا يا شباب الآن عشرة، الـ
+
+498
+00:36:38,650 --> 00:36:42,210
+function تبعتهم زادت ولا قلت؟ زادت، بمقدارهم صاروا
+
+499
+00:36:42,210 --> 00:36:48,710
+مية، زادت أكثر، الآن في لحظة معينة بيتراكم كمية
+
+500
+00:36:48,710 --> 00:36:55,270
+كبيرة من الـ electrolytes خارج الخلية، كمان مرة الـ
+
+501
+00:36:55,270 --> 00:37:00,460
+electrolytes تراكمت خارج الخلية، إيش الشعور بتبقى
+
+502
+00:37:00,460 --> 00:37:05,320
+الخلية بيكون في هذه الحالة؟ شعور سيء، ليش؟ لأنه
+
+503
+00:37:05,320 --> 00:37:11,620
+تركيز الأملاح برة يبقى بتشكل ضغط اسموزي، إيش
+
+504
+00:37:11,620 --> 00:37:17,600
+الوضع الطبيعي؟ أنَّه تفرز ماء، تفرز ماء، إذا أفرزت
+
+505
+00:37:17,600 --> 00:37:24,950
+ماء في أوعية، في أوعية زي الأمعاء، بتسبب إسهال، إذا
+
+506
+00:37:24,950 --> 00:37:29,990
+أفرزت الماء في أماكن مش فيها أوعية، فبتسمى
+
+507
+00:37:29,990 --> 00:37:33,490
+الوذمة، عارفين الوذمة؟ اللي هو الاستسقاء، بيسموه
+
+508
+00:37:33,490 --> 00:37:36,310
+الاستسقاء المائي، أنه بيصير في العضو كمية كبيرة من
+
+509
+00:37:36,310 --> 00:37:40,370
+إيه؟ من الماء، بتنفخ الرجل، بينفخ الصدر، لأنه تكونت
+
+510
+00:37:40,370 --> 00:37:43,830
+كمية كبيرة إيه؟ من الماء، إيش سبب تكون الماء كمان
+
+511
+00:37:43,830 --> 00:37:48,410
+مرة؟ تراكم الـ electrolytes، ليش تراكمت الـ
+
+512
+00:37:48,410 --> 00:37:52,230
+electrolytes؟ لأن الـ Cyclic AMP زاد، مين اللي زود
+
+513
+00:37:52,230 --> 00:37:56,270
+الـ Cyclic AMP؟ ومين اللي حولّه؟ اللي هو الـ
+
+514
+00:37:56,270 --> 00:37:59,310
+adenylate cyclase toxin، زي مثال على مين؟ الـ
+
+515
+00:37:59,310 --> 00:38:01,730
+Bordetella species، الـ Bordetella اللي بتسبب
+
+516
+00:38:01,730 --> 00:38:05,730
+يا شباب سعال الديكي، سعال الديكي، اللي هو الـ
+
+517
+00:38:05,730 --> 00:38:09,430
+pertussis، سمعتوا فيه؟ أنا ما سمعت فيه، هذا جميل، أنا
+
+518
+00:38:09,430 --> 00:38:15,380
+سعال الديكي، لا مش دقيقة لكن أولا أن أعطي فكرة عنه
+
+519
+00:38:15,380 --> 00:38:21,100
+هذا مرض بيصيب الـ respiratory system، وبينتقل عبر
+
+520
+00:38:21,100 --> 00:38:25,000
+التنفس، غالباً بيصيب الأطفال، اللي بتأثر في السيليا
+
+521
+00:38:25,000 --> 00:38:29,700
+السيليا اللي موجودة في التراكيا اللي بتعمل طرد للـ
+
+522
+00:38:29,700 --> 00:38:33,920
+sputum اللي بتكون في الجسم، هو الغبار تبعه، هذه
+
+523
+00:38:33,920 --> 00:38:39,860
+بتتحرك بحركة منتظمة موجية إلى أعلى، الآن الميكروبات
+
+524
+00:38:39,860 --> 00:38:43,200
+الميكروبات اللي من نوع بورديتيلا اللي عندها القدرة
+
+525
+00:38:43,200 --> 00:38:48,140
+على الالتصاق في السيليا، فبيصير السيليا reaction هذا
+
+526
+00:38:48,140 --> 00:38:53,720
+مش normal، فبتتراكم عليها البكتيريا والغبار
+
+527
+00:38:53,720 --> 00:38:59,700
+والـ sputum، وبصير الشعور بالكحة، التوكسين بيعمل
+
+528
+00:38:59,700 --> 00:39:04,240
+vasoconstriction للتراكيا، فالطفل لما بيصير عنده التهابات
+
+529
+00:39:04,240 --> 00:39:07,540
+بيصير عنده coughing mechanism، اللي هي عاملة الكحة
+
+530
+00:39:07,540 --> 00:39:10,480
+عشان يطرد مين؟ البلغم اللي جا بسبب الـ irritation
+
+531
+00:39:10,480 --> 00:39:16,840
+فبيكح، الكحة الطبيعية أننا بنكح وبناخد نفس، هذا
+
+532
+00:39:16,840 --> 00:39:21,500
+الـ stimuli بتكون continuous، إيه يعني continuous؟
+
+533
+00:39:21,500 --> 00:39:25,400
+مستمرة، فبيضل يكح لما يخلص كل الهواء اللي في الـ
+
+534
+00:39:25,400 --> 00:39:29,510
+lungs، فلما يخلص الهواء الجسم طبيعي ما يريد أن
+
+535
+00:39:29,510 --> 00:39:32,710
+يفعل؟ ما يريد أن يدخل أكبر كمية من الهواء في
+
+536
+00:39:32,710 --> 00:39:38,290
+constricted trachea، اللي هي القصبة الهوائية مضيقة
+
+537
+00:39:38,290 --> 00:39:47,270
+فلما يمر الهواء بسرعة بيصير فيه صفير زي الديك، فسموه
+
+538
+00:39:47,270 --> 00:39:52,080
+السعال الديكي، طبعاً الـ ... الـ ... الـ mechanism of
+
+539
+00:39:52,080 --> 00:39:56,240
+disease هنشرحها لاحقاً، لكن الفكرة أنه في شغلتين
+
+540
+00:39:56,240 --> 00:40:00,220
+التوكسين نفسه بيعمل vasoconstriction، والبكتيريا
+
+541
+00:40:00,220 --> 00:40:03,160
+بتتربط بالسيليا وبيعملوا الاتنين مع بعض نفس العمل
+
+542
+00:40:03,160 --> 00:40:06,580
+تبعه، فين الـ anthrax toxin؟ وهذا الـ anthrax toxin
+
+543
+00:40:06,580 --> 00:40:13,480
+معقد شوية، هذا مكون من ثلاثة، واحد بي، واحد بي واثنين
+
+544
+00:40:13,480 --> 00:40:19,450
+إيه؟ اثنين إيه؟ بس A1 وA2، خذوا بالكوا، يعني A واحد
+
+545
+00:40:19,450 --> 00:40:25,450
+تختلف عن A اثنين، A واحد بيسموها edema factor أو EF
+
+546
+00:40:25,450 --> 00:40:33,570
+شايفينها؟ EF، و A اثنين الـ LF lethal factor، يبقى
+
+547
+00:40:33,570 --> 00:40:36,990
+بيختلفوا عن بعض A1 وA2، صح؟ edema factor والتاني
+
+548
+00:40:36,990 --> 00:40:38,370
+lethal factor
+
+549
+00:40:41,150 --> 00:40:44,910
+لاحظوا أو أشيروا أولا سواء اشتغل، increases in cyclic
+
+550
+00:40:44,910 --> 00:40:52,070
+AMP level، هيؤدي لإيش؟ احنا قلنا الكلمة قبل شوية،
+
+551
+00:40:52,070 --> 00:40:55,610
+صح؟ هيؤدي للوذمة، اللي هي الـ fluid accumulation
+
+552
+00:40:55,610 --> 00:40:58,770
+بينما الـ lethal factor اللي مرتبط هو طبعاً مايكونش
+
+553
+00:40:58,770 --> 00:41:03,330
+شو الـ PA؟ الـ PA هو الـ ... لا لا، الـ PA معناه fragment
+
+554
+00:41:05,300 --> 00:41:08,760
+protective antigen، معناها protective antigen، هي الـ
+
+555
+00:41:08,760 --> 00:41:11,860
+B fragment، هي الـ B fragment للتوكسين، يعني الـ B
+
+556
+00:41:11,860 --> 00:41:16,060
+إيه هي الـ B؟ الـ B، الصح؟ كيف؟ هذا الـ B إيه؟ هي الـ B
+
+557
+00:41:16,060 --> 00:41:19,700
+نعم، إذا أنا أقول أن احنا في A واحد وA اثنين
+
+558
+00:41:19,700 --> 00:41:24,820
+لكن أن أنا B واحد، يعني خلينا نقول قاعدة لـ two
+
+559
+00:41:24,820 --> 00:41:27,800
+toxins، إيه منها بيرتبط وبيدخل إلى داخل الخلية
+
+560
+00:41:37,030 --> 00:41:42,670
+الـ Botulinum Toxin، شوفوا هذا الـ toxin هو أقوى سم
+
+561
+00:41:42,670 --> 00:41:48,730
+معروف للإنسان على كوكب الأرض، أقوى سم، مجرد تذوق
+
+562
+00:41:48,730 --> 00:41:53,510
+طعام، مافيش تاني، تذوق مش مضغ وبلع، تذوق، وضع
+
+563
+00:41:53,510 --> 00:41:58,410
+اللسان، فإذا كان في طعام محتوي على الـ Botulinum
+
+564
+00:41:58,410 --> 00:42:04,380
+Toxin، والإنسان تذوقه، وقد يؤدي به إلى الموت، فهو أقوى
+
+565
+00:42:04,380 --> 00:42:08,700
+سم، واحد مليجرام، واحد مليجرام من الـ pure toxin
+
+566
+00:42:08,700 --> 00:42:13,700
+has twenty million lethal doses for mice، عشرين
+
+567
+00:42:13,700 --> 00:42:18,680
+مليون جرعة قاتلة، الـ LD50، فاكرين الـ LD50؟ لعشرين
+
+568
+00:42:18,680 --> 00:42:22,460
+مليون فار، واحد مليجرام، واحد مليجرام من الـ
+
+569
+00:42:22,460 --> 00:42:25,340
+toxin هذا، هذا الـ toxin اليوم بيستخدموه في عمليات
+
+570
+00:42:25,340 --> 00:42:29,410
+تجميل يا شباب، بيستخدموه في عمليات تجميل، فبيحقنه...
+
+571
+00:42:29,410 --> 00:42:33,010
+المشاهير بيحقنهم ب... بحقنة في المنطقة، وبيصير لهم
+
+572
+00:42:33,010 --> 00:42:37,910
+شلل ارتخائي... شلل ارتخائي، فلما ترتخي العضلات
+
+573
+00:42:37,910 --> 00:42:41,210
+بيبين أن مافيش تجاعيد، وبعد ست شهور بيطيب، بس طبعاً
+
+574
+00:42:41,210 --> 00:42:45,250
+الجرعة عايزة تكون منخفضة جداً جداً طبعاً
+
+575
+00:42:45,250 --> 00:42:48,440
+هذا... هذا... هذا يعني بس على سبيل المثال، يعني في
+
+576
+00:42:48,440 --> 00:42:52,520
+مثال آخر لاستخدام... بتعرفوا المرضى الشلل... المرضى
+
+577
+00:42:52,520 --> 00:42:58,560
+الشلل اللي هو ناتج عن مثلاً حوادث، خلل في النخاع
+
+578
+00:42:58,560 --> 00:43:03,390
+الشوكي، بعد ما بيخفف بيحاولوا يعملوا علاج طبيعي، فترة
+
+579
+00:43:03,390 --> 00:43:06,870
+الشلل بتكون طويلة، وبالتالي بيصير فيه تيبّس في
+
+580
+00:43:06,870 --> 00:43:10,750
+العضلات، فبرضه ممكن يحقنوه بجرعة مخففة جداً جداً من
+
+581
+00:43:10,750 --> 00:43:14,650
+هذا التوكسين حتى يعمل عنده إيه؟ ارتخاء، ويساعدهم في
+
+582
+00:43:14,650 --> 00:43:18,010
+عمليات اللي هو العلاج الطبيعي في هذا الموضوع، لكن
+
+583
+00:43:18,010 --> 00:43:24,300
+في الآخر، في الآخر الـ botulinum toxin سام جداً، وقلنا
+
+584
+00:43:24,300 --> 00:43:29,560
+كمان مرة جرعة بسيطة منه كافية لقتل إنسان، طيب كيف
+
+585
+00:43:29,560 --> 00:43:35,220
+بيشتغل هذا؟ قلنا الـ A-subunit، اللي هي الوحدة الـ A
+
+586
+00:43:35,220 --> 00:43:38,960
+irreversibly inhibits the release of the
+
+587
+00:43:38,960 --> 00:43:41,860
+stimulatory neurotransmitter acetylcholine، احنا
+
+588
+00:43:41,860 --> 00:43:46,040
+بنعرف أن الاستجابة الطبيعية، تمام؟ فين دي؟
+
+589
+00:43:48,060 --> 00:43:51,880
+contraction، وفي عنده relaxation، الـ contraction يا
+
+590
+00:43:51,880 --> 00:43:54,660
+شباب غالباً نتيجة عن اللي هو الـ release of
+
+591
+00:43:54,660 --> 00:43:57,920
+acetylcholine اللي هو الـ neurotransmitter مشهور
+
+592
+00:43:57,920 --> 00:44:03,500
+عنه، neurotransmitter، تخيل الآن أنه في blocking...
+
+593
+00:44:03,500 --> 00:44:06,400
+blocking للـ neurotransmitter، مش هيكون في
+
+594
+00:44:06,400 --> 00:44:09,160
+contraction، يبقى الكلام في إحنا فيه اندوستينيشي
+
+595
+00:44:09,160 --> 00:44:13,220
+اللي هو ارتخاء، وأخيراً بيسموا النوع ده من الشلل
+
+596
+00:44:13,220 --> 00:44:17,780
+flaccid paralysis، يعني شلل ارتخائي، flaccid
+
+597
+00:44:17,780 --> 00:44:21,900
+paralysis، على عكسه اللي هو تبع التيتانوس بيسبب
+
+598
+00:44:21,900 --> 00:44:26,200
+spastic paralysis، انقباضي، تمام، عكسه اللي هو
+
+599
+00:44:26,200 --> 00:44:29,340
+التيتانوس، وصلت الصورة؟ هتحط بوتوكس من البوتولينوم
+
+600
+00:44:29,340 --> 00:44:30,920
+الاندوستينيشي يستخدمه؟
+
+601
+00:44:35,560 --> 00:44:39,800
+طيب الـ ... الـ ... الكوليراتوكسين... الكوليراتوكسين، و
+
+602
+00:44:39,800 --> 00:44:45,320
+هذا هنختم به محاضرتنا اليوم إن شاء الله، هو عملية
+
+603
+00:44:45,320 --> 00:44:49,380
+ADP ribosylation،  الـ adenylate cyclase enzyme في الـ
+
+604
+00:44:49,380 --> 00:44:51,740
+human cells of the intestine، طالع معايا هنا الآن هي
+
+605
+00:44:51,740 --> 00:44:55,300
+الخلية تبع الـ intestine فيها إنزيمات بيسموها
+
+606
+00:44:55,300 --> 00:45:00,140
+adenylate cyclase، بيجي الكوليراتوكسين بيعملها ADP
+
+607
+00:45:00,140 --> 00:45:04,260
+ribosylation، لما يعمل ADP-ribosylation، الـ ATP
+
+608
+00:45:04,260 --> 00:45:11,180
+بتحول لـ Cyclic AMP، كمان مرة Cyclic AMP إيش هيعمل؟
+
+609
+00:45:11,180 --> 00:45:15,440
+هيمنع امتصاص، وهيزيد من إفراز الـ electrolytes
+
+610
+00:45:15,440 --> 00:45:18,560
+هتتراكم كمية كبيرة من الـ electrolytes في الـ human
+
+611
+00:45:18,560 --> 00:45:22,520
+cells of the intestine، شعور الجسم بأن هناك تركيز عالية
+
+612
+00:45:22,520 --> 00:45:27,500
+من الـ... من الـ... الـ... الـ electrolytes بيخلي الجسم
+
+613
+00:45:27,500 --> 00:45:31,760
+يفرز كمية كبيرة من الماء ويسبب إسهال، و
+
+614
+00:45:31,760 --> 00:45:36,960
+بيسموها حتى watery diarrhea، نظراً لكمية الماء المنتجة
+
+615
+00:45:36,960 --> 00:45:40,
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/gI74hM1aXuk.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/gI74hM1aXuk.srt
new file mode 100644
index 0000000000000000000000000000000000000000..f777917c99151eb68dcdef850c10bcf751c0c0e4
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/gI74hM1aXuk.srt
@@ -0,0 +1,2074 @@
+1
+00:00:20,520 --> 00:00:25,260
+بسم الله الرحمن الرحيم اليوم موضوع جديد خلصنا من
+
+2
+00:00:25,260 --> 00:00:29,620
+ما يسمى بمجموعة الـ *enterobacteriasi* لان الجزء
+
+3
+00:00:29,620 --> 00:00:33,960
+الثاني اللي يعني يعتبر بالترتيب الثاني بالأهمية في
+
+4
+00:00:33,960 --> 00:00:36,700
+الـ *gram negative* اللي هي مجموعة الـ *pseudomonas*
+
+5
+00:00:39,110 --> 00:00:42,530
+الموضوع الـ *Pseudomonas* بدأنا ننظر له نظرة مختلفة شوية
+
+6
+00:00:42,530 --> 00:00:46,510
+عن الـ *enterobacteriasi*، الـ *enterobacteriasi* كانت
+
+7
+00:00:46,510 --> 00:00:52,030
+مجموعة متجانسة تمتلك صفات متشابهة ذكرنا خمسة منها
+
+8
+00:00:52,030 --> 00:00:56,270
+على الأقل، إذا بتذكروهم، أهم صفاتهم كانت أنهم
+
+9
+00:00:56,270 --> 00:01:00,930
+الجلوكوز *fermenter* و *oxidase negative*. ما يميز
+
+10
+00:01:00,930 --> 00:01:05,660
+*Pseudomonas*، و دائماً في الجراثيم بنحطها مع مجموعة نسميها
+
+11
+00:01:05,660 --> 00:01:09,260
+*miscellaneous non-fermenters*. يبقى *pseudomonas* and
+
+12
+00:01:09,260 --> 00:01:12,160
+*miscellaneous* .. إيش معنى *miscellaneous*؟ متنوعة
+
+13
+00:01:12,160 --> 00:01:18,520
+*non-fermenters*. العامل المشترك بينهم صفة واحدة: أنهم
+
+14
+00:01:18,520 --> 00:01:22,760
+جرام نيجاتيف، *Gram-negative*،  بإضافة إلى أنهم *non-*
+
+15
+00:01:22,760 --> 00:01:26,480
+*-fermenters*. لأ، مش ضروري *oxidase* بوزيتيف. أنا بتكلم عن
+
+16
+00:01:26,480 --> 00:01:28,700
+المجموعة الكاملة: *Pseudomonas* and *Mycelinus*
+
+17
+00:01:28,700 --> 00:01:31,940
+*Nonfermenters*. الصفة التي تجمع بينهم، مرة أخرى، أنهم
+
+18
+00:01:31,940 --> 00:01:35,060
+جرام نيجاتيف، *Gram-negative*،  وأنهم *nonfermenters*.
+
+19
+00:01:35,060 --> 00:01:38,680
+*nonfermenters* لإيش؟ لِجُلوكُوز، وخذوا بالكم،
+
+20
+00:01:38,680 --> 00:01:41,980
+مدام *nonfermenter* للجلوكوز، يبقى *nonfermenter*
+
+21
+00:01:41,980 --> 00:01:46,550
+أيضاً لكل باقي السكريات. وهنا أبدأ أذكركم بالمعلومة
+
+22
+00:01:46,550 --> 00:01:50,510
+التي حكيناها سابقاً، أن كلمة *non-fermenter* تختلف عن
+
+23
+00:01:50,510 --> 00:01:53,330
+*non-oxidizer*. يعني البكتيريا ممكن تكون *non-*
+
+24
+00:01:53,330 --> 00:01:57,410
+*-fermenter* لكن تكون *oxidizer*، زي *Pseudomonas aeruginosa*.
+
+25
+00:01:57,410 --> 00:02:02,190
+It is oxidase positive for oxidation، لكن *oxidase*
+
+26
+00:02:02,190 --> 00:02:05,410
+negative for fermentation. إذا كلمة *positive* و
+
+27
+00:02:05,410 --> 00:02:09,890
+*negative* لازم نفهم و نعي ما هي مدلولاتها: هل هي
+
+28
+00:02:09,890 --> 00:02:15,160
+تخمير أم أكسدة؟ هذه نقطة مهمة. من الأسماء
+
+29
+00:02:15,160 --> 00:02:18,400
+المشهورة في *Pseudomonas*: three species، *Pseudomonas*
+
+30
+00:02:18,400 --> 00:02:22,600
+*aeruginosa*، *Pseudomonas pseudomallei* و *Pseudomonas*
+
+31
+00:02:22,600 --> 00:02:28,140
+*mallei*. الآن هذه الأسماء الأخيرة تم تغييرها حديثاً،
+
+32
+00:02:28,140 --> 00:02:31,680
+يعني قبل بضع سنوات، إلى اسم أصعب شوية من
+
+33
+00:02:31,680 --> 00:02:34,840
+*pseudomonas*، فأصبحت تدعى *Burkholderia*.
+
+34
+00:02:44,970 --> 00:02:48,970
+فحاليا، هذه الأسماء، نفس الأسماء: *Burkholderia pseudomallei*
+
+35
+00:02:48,970 --> 00:02:53,330
+و*Burkholderia mallei*، لكن مش هنلاقيهم في الكتب
+
+36
+00:02:53,330 --> 00:02:57,490
+الحديثة باسم من؟ *Pseudomonas*، على الرغم من أنهم
+
+37
+00:02:57,490 --> 00:03:00,890
+يمتلكون نفس الصفات، ما تغير شيء. المهم الذي تغير
+
+38
+00:03:00,890 --> 00:03:03,070
+فيهم هو: الاسم فقط، أي اسم.
+
+39
+00:03:06,520 --> 00:03:09,820
+أذكرنا أكثر من مرة، أو أكثر من تجربة،
+
+40
+00:03:09,820 --> 00:03:13,960
+بأن *Pasteurella pestis* صارت *Yersinia pestis*. *Enterobacter*
+
+41
+00:03:13,960 --> 00:03:17,860
+*sakazakii* صارت *Klebsiella sakazakii*. *Pseudomonas pseudomallei*
+
+42
+00:03:17,860 --> 00:03:24,240
+صارت *Burkholderia pseudomallei*. إحنا الـ*Pseudomonas*  التي
+
+43
+00:03:24,240 --> 00:03:28,040
+تهُمنا أكثر هي *Pseudomonas aeruginosa*. لو
+
+44
+00:03:28,040 --> 00:03:33,160
+ذهبنا إلى مستشفياتنا الحبيبة، و سألناهم، خاصة في
+
+45
+00:03:33,160 --> 00:03:37,280
+أقسام الحروق، و أقسام العمليات الجراحية: من العدو
+
+46
+00:03:37,280 --> 00:03:41,920
+الرقم واحد لديكم في المستشفى؟ الإجابة ستكون موحدة:
+
+47
+00:03:41,920 --> 00:03:46,680
+*Pseudomonas aeruginosa*. Why؟ It may grow in
+
+48
+00:03:46,680 --> 00:03:52,710
+disinfectants. أنا جايب مادة مطهرة، جايب مادة مطهرة، و
+
+49
+00:03:52,710 --> 00:03:56,690
+أستخدمها للتطهير، ومع ذلك البكتيريا استطاعت أن
+
+50
+00:03:56,690 --> 00:04:01,250
+تنمو في هذه المادة. استطاعت أن، جايب *contact*
+
+51
+00:04:01,250 --> 00:04:05,830
+lens solution، محلول لأضع و أحفظ فيه العدسات
+
+52
+00:04:05,830 --> 00:04:09,610
+اللاصقة. وهذا المحلول، يا شباب، يحتوي على مواد
+
+53
+00:04:09,610 --> 00:04:14,330
+قاتلة للبكتيريا، قاتلة للفطريات، قاتلة للفيروسات، و
+
+54
+00:04:14,330 --> 00:04:19,450
+مع ذلك البكتيريا نمت، نمت في هذا المحلول. المحلول
+
+55
+00:04:19,450 --> 00:04:23,430
+الطبي، *medicinal solutions*. Humidifiers of
+
+56
+00:04:23,430 --> 00:04:26,750
+respirators. تعرفون في المستشفيات أجهزة التنفس
+
+57
+00:04:26,750 --> 00:04:29,890
+الصناعي، التي توضع على المريض، الأكسجين يكون ليس
+
+58
+00:04:29,890 --> 00:04:32,470
+جائياً من أسطوانة الأكسجين، وإنما يكون جائياً من
+
+59
+00:04:32,470 --> 00:04:37,870
+أين؟ من خلال أنبوبة تدخل في وعاء فيه ماء، لكي
+
+60
+00:04:37,870 --> 00:04:42,510
+يُعمل *humidification*، ترطيب. فوجدنا أيضاً *Pseudomonas*
+
+61
+00:04:42,510 --> 00:04:47,480
+نامية في هذه الـ*humidifiers*. الـ
+
+62
+00:04:47,480 --> 00:04:51,360
+*Pseudomonas aeruginosa* موجودة في المستشفيات بشكل
+
+63
+00:04:51,360 --> 00:04:57,020
+يصعب التخلص منها. لما نذهب إلى المستشفى، و نأخذ
+
+64
+00:04:57,020 --> 00:05:02,420
+معنا باقة ورد، *bouquet* ورد، لمريض في قسم الحروق، نُهديه
+
+65
+00:05:02,420 --> 00:05:06,080
+معنا *Pseudomonas aeruginosa*، لأن الـ*bouquet*، الورد،
+
+66
+00:05:06,080 --> 00:05:10,220
+يحتوي على *Pseudomonas*، لأن البكتيريا *normal flora*
+
+67
+00:05:10,220 --> 00:05:15,070
+of plants، موجودة في النباتات. تخيل لو شربت مياه
+
+68
+00:05:15,070 --> 00:05:18,090
+معدنية، المياه المعدنية، *bottled* أو *mineral*
+
+69
+00:05:18,090 --> 00:05:21,550
+water. إيش فيها من مواد مغذية؟ مافيها مواد
+
+70
+00:05:21,550 --> 00:05:25,970
+مغذية، ومع ذلك، وجدنا *Pseudomonas aeruginosa* قادرة على
+
+71
+00:05:25,970 --> 00:05:32,070
+أن تنمو في المياه المعدنية. بكتيريا يعني الـ
+
+72
+00:05:32,070 --> 00:05:36,190
+*metabolism* تبعها يسمح لها بـ *survival* عالي في الـ
+
+73
+00:05:36,190 --> 00:05:40,790
+*environment*، وبالتالي، التخلص منها يكون صعب.
+
+74
+00:05:40,790 --> 00:05:45,830
+رقم اثنين، البكتيريا بطبيعتها مقاومة، *resistant*، للـ
+
+75
+00:05:45,830 --> 00:05:50,150
+*antibiotics*، يعني عندها *natural resistance*، وعندها
+
+76
+00:05:50,150 --> 00:05:53,810
+القدرة على اكتساب المقاومة، *acquiring resistance*. تمام، يبقى
+
+77
+00:05:53,810 --> 00:05:58,090
+فيها مقاومة طبيعية، وفيها مقاومة مكتسبة لهذه
+
+78
+00:05:58,090 --> 00:05:58,910
+البكتيريا.
+
+79
+00:06:01,920 --> 00:06:06,700
+It is obligate aerobic، *Gram-negative*.  بِسِّمِ الله، هذه
+
+80
+00:06:06,700 --> 00:06:08,900
+كانت *facultative anaerobic*، خذوا بالكم، هذه
+
+81
+00:06:08,900 --> 00:06:12,000
+*obligate aerobic*، يعني لا تستطيع أن تقوم بالتخمّر،
+
+82
+00:06:12,000 --> 00:06:16,850
+بالتأكيد. الـ *Gram-negative bacilli* كشكل
+
+83
+00:06:16,850 --> 00:06:19,810
+indistinguishable from other Gram-negative bacilli
+
+84
+00:06:19,810 --> 00:06:22,630
+of *enterobacteriaceae*. You cannot distinguish the
+
+85
+00:06:22,630 --> 00:06:26,010
+*Gram*-صبغة *Pseudomonas* عن صبغة
+
+86
+00:06:26,010 --> 00:06:29,250
+*enterobacteriaceae*. They are all Gram-negative
+
+87
+00:06:29,250 --> 00:06:32,350
+bacilli، just Gram-negative bacilli، *non-lactose*
+
+88
+00:06:32,350 --> 00:06:36,910
+*fermenter*. هذه المعلومة ليست معلومة غبية، لأن الأصل هو
+
+89
+00:06:36,910 --> 00:06:41,670
+بمفهوم أنها *non-glucose*، يبقى هي *non-lactose*، لكن
+
+90
+00:06:41,670 --> 00:06:45,730
+وضعناكم معها على السبورة هنا في هذه اللحظة لكي
+
+91
+00:06:45,730 --> 00:06:49,950
+نقُل لكم أنها تنمو على الماكونكي، والماكونكي استخدمناه
+
+92
+00:06:49,950 --> 00:06:52,650
+للتّمييز بين *lactose* و *non-lactose fermenter*.
+
+93
+00:06:52,650 --> 00:06:56,610
+فالبكتيريا هذه تنمو على الماكونكي بشكل عديم اللون،
+
+94
+00:06:56,610 --> 00:06:59,230
+*colonies*، مستعمرات عديمة اللون، يعني *non-lactose*
+
+95
+00:06:59,230 --> 00:07:03,890
+*fermenting*. Oxidase positive, glucose oxidizer but
+
+96
+00:07:03,890 --> 00:07:09,050
+not fermenter, catalase positive,  citrate positive.
+
+97
+00:07:09,050 --> 00:07:13,480
+Motile by a polar flagella. الحركة في
+
+98
+00:07:13,480 --> 00:07:17,200
+الـ*enterobacteriaceae* كانت *peritrichous flagella*، بينما هنا
+
+99
+00:07:17,200 --> 00:07:23,000
+فقط *polar flagella*. هنا *polar*, one single, one
+
+100
+00:07:23,000 --> 00:07:27,700
+single flagella, a polar flagella.  هذه الجملة ليس لها
+
+101
+00:07:27,700 --> 00:07:30,900
+علاقة صحيحة، يعني المفروض أن يكون *one single flagella*.
+
+102
+00:07:30,900 --> 00:07:36,140
+هكذا *polar flagella*. هذه البكتيريا، وهذه البكتيريا،
+
+103
+00:07:36,140 --> 00:07:41,920
+والبيبرُوكُولُيرا، والكامبيلوبكتر، كلهم يستخدمون
+
+104
+00:07:41,920 --> 00:07:46,260
+*polar flagella*، *monotrichous*. صحيح.
+
+105
+00:07:50,570 --> 00:07:55,310
+It produces Exotoxin A، وهذا  السمّ في المقدمة
+
+106
+00:07:55,310 --> 00:07:58,970
+تبع علم الأحياء الدقيقة. *It inhibits protein synthesis*
+
+107
+00:07:58,970 --> 00:08:02,590
+and produces tissue necrosis، يعني يموت الخلايا
+
+108
+00:08:02,590 --> 00:08:06,830
+عبر إيقاف تصنيع البروتين، وبالتالي يؤدي إلى
+
+109
+00:08:06,830 --> 00:08:11,210
+necrosis of tissue. رقم تسعة خطيرة جداً: *It produces*
+
+110
+00:08:11,210 --> 00:08:16,490
+collagenases and hyaluronidases، both of which are
+
+111
+00:08:16,490 --> 00:08:20,790
+holding the cells together in a tissue. الكولاجين
+
+112
+00:08:20,790 --> 00:08:25,210
+والهيالورونيك أسيد هو الذي يمسك الخلايا ببعضها البعض
+
+113
+00:08:25,210 --> 00:08:29,410
+في الأنسجة. فلما البكتيريا اكتسبت القدرة على تكسير
+
+114
+00:08:29,410 --> 00:08:34,360
+الهيالورونيك أسيد بالهيالورونيداز، والكولاجين بالكولاجينيز،
+
+115
+00:08:34,360 --> 00:08:37,120
+تمام، فبالتالي تفصل الخلايا عن بعضها البعض، وأنا
+
+116
+00:08:37,120 --> 00:08:40,620
+قلت لكم سابقاً: فصل الخلايا عن بعضها البعض يُوفر
+
+117
+00:08:40,620 --> 00:08:44,220
+أو يعطي مساحة للاختراق، *penetration*، للغزو، *invasion*. وفي نفس
+
+118
+00:08:44,220 --> 00:08:47,100
+الوقت، في خلايا تموت، نعم، في خلايا تموت، وبالتالي
+
+119
+00:08:47,100 --> 00:08:53,700
+تشكل غذاءً للبكتيريا. *It produces elastases which*
+
+120
+00:08:53,700 --> 00:08:56,740
+hydrolyzes elastin and is used by the organism for
+
+121
+00:08:56,740 --> 00:09:02,640
+invasion. رقم تسعة ورقم عشرة، طبعاً في
+
+122
+00:09:02,640 --> 00:09:04,780
+إحنا قلنا هنا *collagenase which*، هؤلاء .. بس في
+
+123
+00:09:04,780 --> 00:09:08,180
+إحنا أيضاً، واحدة غير مُضافة، قلنا: اللي هو من
+
+124
+00:09:08,180 --> 00:09:11,400
+الـ*hyaluronidase*، يبقى في عندي *hyaluronidase*، وفي عندي
+
+125
+00:09:11,400 --> 00:09:15,780
+أيضاً *collagenase*، وفي عندي *elastase*. أحد
+
+126
+00:09:15,780 --> 00:09:18,700
+السمات المميزة، *distinguishing hallmark*، لهذه البكتيريا، أن *it*
+
+127
+00:09:18,700 --> 00:09:22,530
+*produces pigment*، والصبغة هذه تتراوح من
+
+128
+00:09:22,530 --> 00:09:26,370
+أصفر إلى أزرق إلى أخضر، تمام؟ يعني ثلاثة ألوان
+
+129
+00:09:26,370 --> 00:09:29,430
+يمكننا أن نراها، وما بينها، إيش يعني ما بينها؟
+
+130
+00:09:29,430 --> 00:09:33,330
+يعني أصفر مخضر، أخضر مائل للزرقة، يعني أخضر
+
+131
+00:09:33,330 --> 00:09:37,630
+مائل للزرقة، أو أصفر مائل للأخضر، وهكذا،
+
+132
+00:09:37,630 --> 00:09:40,810
+فإنها ألوان متدرجة ما بين الأصفر و
+
+133
+00:09:40,810 --> 00:09:45,820
+الأخضر. أحد الصبغات، *pigment*، المشهورة
+
+134
+00:09:45,820 --> 00:09:49,060
+عندنا الـ*pyocyanin*، وفي عندي صبغة أخرى اسمها
+
+135
+00:09:49,060 --> 00:09:53,020
+*pyoverdine*.  الـ*pyocyanin* هو *blue green pigment*،
+
+136
+00:09:53,020 --> 00:09:58,000
+*blue green pigment*، و نراه بالعين مباشرة. في الـ
+
+137
+00:09:58,000 --> 00:10:01,820
+*pyoverdine*، وهو أصفر، ولو وضعنا عليه
+
+138
+00:10:01,820 --> 00:10:04,760
+ضوء فلورسنت، *fluorescent*، ليس *fluorescent light*، عفواً، وضعنا
+
+139
+00:10:04,760 --> 00:10:08,020
+عليه ضوء فوق بنفسجي، *ultraviolet light*، سنرى أنه يُصدر ضوء مرئي،
+
+140
+00:10:08,020 --> 00:10:11,880
+*visible light*،  فلهذا يُسمى *fluorescent dye* أو
+
+141
+00:10:11,880 --> 00:10:15,220
+*fluorescent pigment*. لذا في عندنا أهم الصبغات: الـ
+
+142
+00:10:15,220 --> 00:10:20,140
+*pyocyanin* والـ*pyoverdine*. أعتقد هذا الشرح
+
+143
+00:10:20,140 --> 00:10:23,940
+واضح. الآن، هنا حساسية للمضادات الحيوية، *antibiotic sensitivity*، لكن
+
+144
+00:10:23,940 --> 00:10:27,940
+الطبق بجانبه ليس بلونه، أنا عندي هنا لون أخضر
+
+145
+00:10:27,940 --> 00:10:33,600
+مصفر، أو بين الأصفر والأخضر، هنا أخضر مائل
+
+146
+00:10:33,600 --> 00:10:40,890
+للزرقة، أخضر مائل للزرقة. إذا، نقدر نقول أنّه
+
+147
+00:10:40,890 --> 00:10:43,190
+درسنا في المحاضرة بكتيريا، *say one bacteria*
+
+148
+00:10:43,190 --> 00:10:46,970
+that produces pigment، *Serratia*، وصبغة حمراء، وليست
+
+149
+00:10:46,970 --> 00:10:51,470
+*water soluble*. هنا تُنتج مجموعة من الصبغات، وفي نفس
+
+150
+00:10:51,470 --> 00:10:54,530
+الوقت *water soluble*، وزي ما شايفين، *it*
+
+151
+00:10:54,530 --> 00:10:59,270
+*diffuses in the agar*. كلّ
+
+152
+00:10:59,270 --> 00:11:02,350
+الصفات التي ذكرناها هذه للبكتيريا، ومع ذلك
+
+153
+00:11:02,350 --> 00:11:04,090
+البكتيريا لا تعتبر ممرضاً، *pathogen*.
+
+154
+00:11:10,060 --> 00:11:17,180
+تُعتبر ممرضاً انتهازياً، *opportunistic pathogen*. لماذا
+
+155
+00:11:17,180 --> 00:11:21,100
+انتهازية؟ لأن وجدوا أن *Pseudomonas aeruginosa* هي جَرْثُومَة غير
+
+156
+00:11:21,100 --> 00:11:26,400
+قادرة على أن تتخطى الدفاعات الأولى، التي من
+
+157
+00:11:26,400 --> 00:11:32,760
+ضمنها الجلد، لكن لو حصل *cut*، *cut* يعني جرح، خدش، أو
+
+158
+00:11:32,760 --> 00:11:36,200
+حرق للجلد، الجلد فقد آليات الدفاع، *defensive mechanism*،  التابعة له، وبالتالي البكتيريا *is*
+
+159
+00:11:39,300 --> 00:11:41,040
+capable of producing disease. دي الآن نسميها
+
+160
+00:11:41,040 --> 00:11:45,210
+نقولها مرة أخرى: *opportunistic disease*، لكن *it causes*
+
+161
+00:11:45,210 --> 00:11:49,870
+what is known as hard to treat infections، يعني
+
+162
+00:11:49,870 --> 00:11:53,310
+أمراض أو عدوى صعبة العلاج. مرة أخرى، لماذا صعبة
+
+163
+00:11:53,310 --> 00:11:57,190
+العلاج؟ لأنها مقاومة بطبيعتها، *naturally resistant*، للبكتيريا، و
+
+164
+00:11:57,190 --> 00:12:00,110
+عندها مقاومة مكتسبة، *acquired resistance*، وخاصة في، أنا أتحدث عن
+
+165
+00:12:00,110 --> 00:12:04,910
+الحروق، وأتحدث عن الجروح في العمليات الجراحية، أين
+
+166
+00:12:04,910 --> 00:12:08,690
+تتم هذه، ليست في المستشفيات. والمستشفيات تحتوي بين
+
+167
+00:12:08,690 --> 00:12:13,450
+جدرانها على أكبر عدد ممكن من الميكروبات المقاومة
+
+168
+00:12:13,450 --> 00:12:15,990
+للمضادات الحيوية، التي من ضمنها *Pseudomonas*
+
+169
+00:12:15,990 --> 00:12:16,590
+*aeruginosa*.
+
+171
+00:12:22,090 --> 00:12:2
+
+223
+00:15:55,210 --> 00:16:00,060
+concentration الأفضل بالإضافة لإتباع إجراءات أساسية
+
+224
+00:16:00,060 --> 00:16:02,800
+في الـ disinfection اللي هو cleaning the surface
+
+225
+00:16:02,800 --> 00:16:06,480
+before disinfecting. تبتخيل لو كان في عندي سطح
+
+226
+00:16:06,480 --> 00:16:11,300
+وعليه غبار، وسطح آخر نفس المستوى من البكتيريا لكن
+
+227
+00:16:11,300 --> 00:16:14,620
+ماعليهوش غبار، وحاطين على الاثنين نفس الـ disinfectant
+
+228
+00:16:14,620 --> 00:16:19,110
+لنفس الوقت، الاثنين، هيكون فعال أكثر الذي مالهوش غبار
+
+229
+00:16:19,110 --> 00:16:23,370
+لأنه organic material provide protection for the
+
+230
+00:16:23,370 --> 00:16:25,950
+microorganism.  فعملية disinfection عملية برضه خد
+
+231
+00:16:25,950 --> 00:16:31,690
+بالك بدها يعني إجراءات وعوامل متنوعة، بدنا نأخذ
+
+232
+00:16:31,690 --> 00:16:36,250
+بالنا منها لما نعملها، إن شاء الله.  اطلعوا على قائمة
+
+233
+00:16:36,250 --> 00:16:39,130
+الأمراض التي تسببها الـ Pseudomonas aeruginosa
+
+234
+00:16:39,130 --> 00:16:43,250
+هلاقي urinary tract infection. أعتقد أنه الذي
+
+235
+00:16:43,250 --> 00:16:46,070
+انتقاله بكتريّاسي معظمها خاصة الـ lactose fermenter
+
+236
+00:16:46,070 --> 00:16:49,010
+فاكرين؟ لكنها تعمل urinary tract infection، يعني
+
+237
+00:16:49,010 --> 00:16:52,130
+ممكن نزول أو تايتس ميل، يعني التهاب الأذن الوسطى،
+
+238
+00:16:52,130 --> 00:16:56,920
+wound infection، sinus infection، Bronchopneumonia،
+
+239
+00:16:57,300 --> 00:17:01,020
+Sepsis، Burn Infection، Meningitis، and
+
+240
+00:17:01,020 --> 00:17:04,360
+Endocarditis. عندي مجموعة من الأمراض، وأنا هذا
+
+241
+00:17:04,360 --> 00:17:09,280
+أخدوا بالكم، ليست قائمة نهائية، وإنما هذه أشهر الـ
+
+242
+00:17:09,280 --> 00:17:12,360
+conditions التي تسببها الـ Pseudomonas aeruginosa
+
+243
+00:17:12,360 --> 00:17:15,200
+لكن الـ Pseudomonas aeruginosa عزلت من كل أماكن
+
+244
+00:17:15,200 --> 00:17:18,840
+الجسم، من كل أماكن الجسم، وبالتالي هذه القائمة التي
+
+245
+00:17:18,840 --> 00:17:23,320
+قدامنا فقط هي الـ most common sites of isolation
+
+246
+00:17:23,320 --> 00:17:27,140
+لمين؟  لـ Pseudomonas aeruginosa.  احنا الصحيح يمكن زي ما
+
+247
+00:17:27,140 --> 00:17:31,600
+حكيت لكم، بنركز على الـ burn infection لأنها ما زالت
+
+248
+00:17:31,600 --> 00:17:37,000
+تشكل عندنا في غزة وفي العالم رقم واحد cause of
+
+249
+00:17:37,000 --> 00:17:45,540
+burn infection. آخر دراستين نشرناهم سنة 2013 عن الـ
+
+250
+00:17:45,540 --> 00:17:49,760
+burn units في قطاع غزة كانت بالفعل Pseudomonas
+
+251
+00:17:49,760 --> 00:17:52,840
+aeruginosa هي number one isolate سواء كانت من
+
+252
+00:17:52,840 --> 00:17:57,370
+المرضى أو من البيئة المحيطة. كلمة بيئة احنا أخذنا
+
+253
+00:17:57,370 --> 00:18:02,530
+عينات من الأسطح بتاعة المستشفيات، من الهواء بتاع
+
+254
+00:18:02,530 --> 00:18:06,630
+المستشفيات، أخذنا من أيدان العاملين، أيدان العاملين
+
+255
+00:18:06,630 --> 00:18:09,850
+هم من؟ العاملين في المستشفيات، أطباء وممرضين وعمال
+
+256
+00:18:09,850 --> 00:18:13,270
+نظافة أيضاً، ولجأنا برضه لمن عندهم Pseudomonas فهي
+
+257
+00:18:13,270 --> 00:18:16,210
+كانت number one isolate بالنسبة سواء كانت من
+
+258
+00:18:16,210 --> 00:18:19,700
+المرضى أو من الـ environment تبع المستشفى. طبعاً
+
+259
+00:18:19,700 --> 00:18:22,280
+بالنسبة للـ antimicrobial resistance، باعها مخيف
+
+260
+00:18:22,280 --> 00:18:28,700
+الصحيح، ونتائجه مقلقة جداً، متنوعة على infections بهذه
+
+261
+00:18:28,700 --> 00:18:31,980
+Pseudomonas aeruginosa. لاحظوا هذه eye infection
+
+262
+00:18:31,980 --> 00:18:35,100
+على الرغم أننا ما ذكرناش أنها تعمل eye infection، it
+
+263
+00:18:35,100 --> 00:18:40,270
+is a common eye infection. طيب، الـ identification لـ
+
+264
+00:18:40,270 --> 00:18:44,690
+الـ Pseudomonas aeruginosa زي ما ذكرت، لـ Gram stain
+
+265
+00:18:44,690 --> 00:18:48,110
+is of little value، يعني مالوش أهمية كبيرة، لـ Gram
+
+266
+00:18:48,110 --> 00:18:52,210
+stain في عملية التعرف إلاّ حقيقة واحدة، أنها Gram
+
+267
+00:18:52,210 --> 00:18:57,270
+negative. بس،  الـ culture، لا يوجد اختلاف كبير بين
+
+268
+00:18:57,270 --> 00:19:01,010
+الـ Enterobacteriaceae والـ Pseudomonas في عملية الـ
+
+269
+00:19:01,010 --> 00:19:05,330
+growth، they can all grow on the same media. بمعنى
+
+270
+00:19:05,330 --> 00:19:08,110
+Pseudomonas aeruginosa can grow on MacConkey، on blood
+
+271
+00:19:08,110 --> 00:19:12,690
+agar، and on nutrient agar. لكن زي ما ذكرت لكم، على
+
+272
+00:19:12,690 --> 00:19:15,210
+الـ general media، غالباً البكتيريا تنتج pigment و
+
+273
+00:19:15,210 --> 00:19:20,490
+بيكون لها لون مميز، اللون هذا أصفر، أخضر، أزرق، هذه
+
+274
+00:19:20,490 --> 00:19:23,130
+الثلاثة ألوان التي ممكن نشوفها، وما بينهم
+
+275
+00:19:26,750 --> 00:19:29,450
+colonies are two to four millimeters، يعني large
+
+276
+00:19:29,450 --> 00:19:32,710
+colonies، صح، مستعمرة كبيرة، in diameter، slightly
+
+277
+00:19:32,710 --> 00:19:37,890
+convex، grayish، they smell، ودي نقطة كتير مهمة، they
+
+278
+00:19:37,890 --> 00:19:39,810
+smell grape-like odor.
+
+279
+00:19:42,590 --> 00:19:47,010
+عنب، رائحة العنب، أو بعض الأحيان يسمونها fruity
+
+280
+00:19:47,010 --> 00:19:51,510
+odor. طبعاً هذا لا يعني أننا نمسك الطبق ونشمّه، وإنما
+
+281
+00:19:51,510 --> 00:19:59,990
+عندما تقوم بفتح الـ incubator وفتح الطبق لأخذ
+
+282
+00:19:59,990 --> 00:20:04,670
+مستعمرة، ستنبعث رائحة، ستنبعث رائحة، غالباً الرائحة
+
+283
+00:20:04,670 --> 00:20:07,810
+هذه مفضلة، يعني جيدة، اللي هي أقول أن أنا fruity
+
+284
+00:20:07,810 --> 00:20:12,590
+odor أو grape-like odor.  الـ nutrient agar، Pseudomonas
+
+285
+00:20:12,590 --> 00:20:16,050
+aeruginosa is easily recognized by the diffuse blue
+
+286
+00:20:16,050 --> 00:20:19,610
+-green pigmentation، يعني بنشوفها بشكل سهل
+
+287
+00:20:19,610 --> 00:20:22,970
+وسلس، لأنه فيه distinctive pigment، فيه distinctive لون مميز
+
+288
+00:20:22,970 --> 00:20:27,530
+للبكتيريا، فبالتالي أشهر بكتيريا عند طلبة أو عند
+
+289
+00:20:27,530 --> 00:20:30,850
+العاملين في مجال الـ microbiology بيشوفوها من بين
+
+290
+00:20:30,850 --> 00:20:33,790
+عشرين بكتيريا، بيقول هذه كده Pseudomonas aeruginosa، على
+
+291
+00:20:33,790 --> 00:20:39,000
+الرغم من ذلك، أنا لستُ مُحب هذه الطريقة، أن نشوف صفة ونقول هذا الـ
+
+292
+00:20:39,000 --> 00:20:43,760
+... الـ microbe هو كذا وكذا، طبعاً؟ قبل
+
+293
+00:20:43,760 --> 00:20:47,080
+عدة أيام، تم التواصل معه من قبل أحد الأخوة، وجاء
+
+294
+00:20:47,080 --> 00:20:51,200
+معه و... و... وسألنا عن بكتيريا من مستشفى النصر،
+
+295
+00:20:51,200 --> 00:20:52,700
+لأ، مش مستشفى النصر، من من من من من من من من من
+
+296
+00:20:52,700 --> 00:20:52,740
+من من من من من من من من من من من من من من من
+
+297
+00:20:52,740 --> 00:20:52,980
+من من من من من من من من من من من من من من من
+
+298
+00:20:52,980 --> 00:20:53,620
+من من من من من من من من من من من من من من من
+
+299
+00:20:53,620 --> 00:20:54,200
+من من من من من من من من من من من من من من من
+
+300
+00:20:54,200 --> 00:20:56,450
+من من من من مجال، اللي مش عارفين نعرف البكتيريا، فـ دكتورة
+
+301
+00:20:56,450 --> 00:20:59,350
+تساعدنا، قلت له: هات البكتيريا، وتعالى.  الصحيح،
+
+302
+00:20:59,350 --> 00:21:02,350
+الشكل الذي رآني ليس له علاقة بـ Pseudomonas aeruginosa
+
+303
+00:21:02,350 --> 00:21:05,570
+لكن لما عملنا فحوصات، طلعت Pseudomonas aeruginosa.  ففي
+
+304
+00:21:05,570 --> 00:21:09,410
+عندي دائماً exceptions في الشكل، فليس بالضرورة وجود
+
+305
+00:21:09,410 --> 00:21:13,570
+الصفة، ليس بالضرورة وجود الصفة أن يكون مؤشر على أن
+
+306
+00:21:13,570 --> 00:21:16,470
+هذه البكتيريا هي هي التي نحن مقصودون بها، لكن يصير
+
+307
+00:21:16,470 --> 00:21:22,130
+هي suspect ومؤشر في هذا الاتجاه، لكن ليس تعريف
+
+308
+00:21:22,130 --> 00:21:26,800
+نهائي للبكتيريا. أرجو أن يعني المفهوم هذا أن أؤكد
+
+309
+00:21:26,800 --> 00:21:33,960
+عليه، لا يوجد صفة أو خاصية واحدة تستطيع أن تحدد من
+
+310
+00:21:33,960 --> 00:21:37,220
+خلالها هوية البكتيريا، خاصة في الـ cultural
+
+311
+00:21:37,220 --> 00:21:40,620
+characteristics، وخاصة في morphology and staining
+
+312
+00:21:40,620 --> 00:21:44,940
+تمام؟ يعني هاتين الصفتين الأوليتين يساعداننا، نعم
+
+313
+00:21:44,940 --> 00:21:48,800
+لكن لا يُعرّفان البكتيريا، وإلا لجأنا لمن؟
+
+314
+00:21:48,800 --> 00:21:51,380
+للـ biochemical test والـ serological test.
+
+315
+00:21:54,170 --> 00:22:00,750
+طيب، أسماء عديدة سنقرأها، يعني بتمعنهم، Pseudomonas
+
+316
+00:22:00,750 --> 00:22:04,730
+Pseudomonas، وآخر واحدة Acinetobacter. أنا للخاطر
+
+317
+00:22:04,730 --> 00:22:08,490
+الصحيح أرفعها وأضعها جنبها، لكن خلوها تحت، لئلا
+
+318
+00:22:08,490 --> 00:22:12,470
+المقارنات بينهم. Pseudomonas، Acinetobacter
+
+319
+00:22:12,470 --> 00:22:17,390
+Acinetobacter، Acinetobacter، يعني ملونة، Acinetobacter
+
+320
+00:22:17,390 --> 00:22:20,210
+غير ملونة، Flavobacterium
+
+321
+00:22:21,560 --> 00:22:27,300
+وFlavobacterium على فكرة معناها أصفر أو ملون،  برضه، Kingella
+
+322
+00:22:27,300 --> 00:22:35,850
+،Brucella، Alcaligenes، Bordetella، Moraxella، Acinetobacter
+
+323
+00:22:35,850 --> 00:22:40,210
+أقرأ الأسماء مرة أخرى: Pseudomonas، Acinetobacter،
+
+324
+00:22:40,210 --> 00:22:47,150
+Flavobacterium، Kingella، Brucella، Alcaligenes، Bordetella،
+
+325
+00:22:47,150 --> 00:22:52,750
+Moraxella، و Acinetobacter.  طلعت معي هذه الأسماء
+
+326
+00:22:52,750 --> 00:22:55,230
+التي بدأ أُقسّم عليها.  الـ Brucella
+
+327
+00:22:57,230 --> 00:23:04,510
+والـ Bordetella، هادول سندرسهم في مقالين منفصلين،
+
+328
+00:23:04,510 --> 00:23:07,650
+بمعنى، سنأخذ لكل واحدة محاضرة،  اللي هم الـ
+
+329
+00:23:07,650 --> 00:23:11,530
+Brucella والـ Bordetella. لماذا سنأخذ لكل واحدة
+
+330
+00:23:11,530 --> 00:23:16,350
+محاضرة؟ لأن أهميتهم كبيرة، انتشارهم واسع، خطورة
+
+331
+00:23:16,350 --> 00:23:20,730
+أمراضهم، تمام؟ يعني لهم خصائص مميزة، يعني مثلاً الـ
+
+332
+00:23:20,730 --> 00:23:23,720
+Bordetella. السؤال الذي، احنا ممكن في أحد
+
+333
+00:23:23,720 --> 00:23:26,800
+المقدمات التي حكيناها في محاضراتنا، ذكرنا أن هذا
+
+334
+00:23:26,800 --> 00:23:29,680
+البكتيريا دي كان مرض مهم عندنا في قطاع غزة، وقد يكون
+
+335
+00:23:29,680 --> 00:23:34,260
+موجود، احنا ما نطبب، أنا ما أُشخص، الـ Brucella تنتقل عن
+
+336
+00:23:34,260 --> 00:23:39,800
+طريق الألبان للأبقار والماعز المصابة بالـ Brucella، وثبت وجودها في غزة مراراً وتكراراً، وبالتالي نحن
+
+337
+00:23:39,800 --> 00:23:43,600
+مهم جداً أن نتعرف على هذا الـ microbe. بينما الباقيين،
+
+338
+00:23:43,600 --> 00:23:47,630
+اللي هم Pseudomonas، وAcinetobacter، Flavobacterium، Kingella،
+
+339
+00:23:47,630 --> 00:23:51,950
+Alcaligenes، Moraxella، وAcinetobacter، كلهم نقدر ندرسهم
+
+340
+00:23:51,950 --> 00:23:56,350
+مع بعض.
+
+341
+00:23:56,350 --> 00:23:56,930
+مع بعض
+
+342
+00:24:02,020 --> 00:24:05,080
+بأنهم ما لهم requirements لـ growth، بمعنى أنهم
+
+343
+00:24:05,080 --> 00:24:08,300
+can grow on MacConkey، can grow on blood agar، can grow
+
+344
+00:24:08,300 --> 00:24:11,760
+on nutrient agar، 24 ساعة بس.  هادول عارفين
+
+345
+00:24:11,760 --> 00:24:16,480
+جداً، بدها دي ستة، سبعة،  لـ Brucella، الـ Bordetella بدها
+
+346
+00:24:16,480 --> 00:24:20,940
+أكثر من 72 ساعة، أو يومين، يعني ثلاثة أيام إلى خمسة
+
+347
+00:24:20,940 --> 00:24:26,320
+أيام، بدها أوساط زراعية مختلفة عن باقي الأوساط التي
+
+348
+00:24:26,320 --> 00:24:32,010
+تعرفونها أنتم سابقاً.  في الحقيقة، نحتاج أن نميّزهم عن
+
+349
+00:24:32,010 --> 00:24:37,790
+باقي أنواع الـ bacteria. لكن الجدول هذا الذي أمامكم،
+
+350
+00:24:38,750 --> 00:24:42,970
+هو العنوان الذي أنا بدأت فيه المحاضرة، Pseudomonas
+
+351
+00:24:42,970 --> 00:24:46,230
+aeruginosa أو Pseudomonas and miscellaneous non
+
+352
+00:24:46,230 --> 00:24:50,170
+-fermenter.  ما وجه الشبه بينهم؟ أنهم non-fermenter
+
+353
+00:24:50,170 --> 00:24:54,250
+أنهم Gram-negative bacilli.  وخذوا بالكم، كلمة
+
+354
+00:24:54,250 --> 00:24:57,670
+bacilli. احنا المحاضرة التي فاتت، لسة استثنينا واحدة
+
+355
+00:24:57,670 --> 00:25:01,550
+منهم، وقلنا عنها coccobacilli. وهنا they are Gram
+
+356
+00:25:01,550 --> 00:25:05,290
+-negative bacilli أو coccobacilli. يعني الـ Brucella
+
+357
+00:25:06,620 --> 00:25:11,160
+coccobacilli.  مُشهورة هذه، الـ Acinetobacter  cocci لكن
+
+358
+00:25:11,160 --> 00:25:14,420
+تشبه الـ cocci في أن cocci تشبه الـ cocci. سنرى لما
+
+359
+00:25:14,420 --> 00:25:19,400
+نصلها، نتكلم عنها شوية.  اطلعوا على الجدول هذا، كم
+
+360
+00:25:19,400 --> 00:25:25,480
+عمود فيه ثلاثة، طبعاً مستحيل ثلاثة أعمدة تُميّز لي هذا
+
+361
+00:25:25,480 --> 00:25:30,580
+العدد الكبير من البكتيريا، لكن على الأقل يعطينا
+
+362
+00:25:30,580 --> 00:25:35,160
+فكرة، من يشبه من كثيراً. اطلعوا، الـ Acinetobacter
+
+363
+00:25:36,230 --> 00:25:43,470
+negative، variable، non-motile.  مريح هذا، دي آه؟ هي
+
+364
+00:25:43,470 --> 00:25:45,410
+يُعتبَر أن بعضها يمكن أن تكون glucose
+
+365
+00:25:45,410 --> 00:25:49,710
+oxidation. لكن Pseudomonas التي كنا نقول عنها
+
+366
+00:25:49,710 --> 00:25:52,010
+oxidase absolutely positive.  المرة التي أتكلّم
+
+367
+00:25:52,010 --> 00:25:55,770
+عندما عن variable وglucose oxidation، برضه
+
+368
+00:25:55,770 --> 00:25:59,930
+variable. لكن الـ flagella موجود، يعني هي motile، ومش
+
+369
+00:25:59,930 --> 00:26:04,430
+بس motile، motile bipolar flagella.  نقطة كتير مهمة،
+
+370
+00:26:04,430 --> 00:26:10,380
+من من هادول polar؟ ولا واحدة. هي أول نقطة التمييز
+
+371
+00:26:10,380 --> 00:26:15,480
+بين Pseudomonas وباقي المجموعة.  طيب، الـ Acinetobacter أكثر
+
+372
+00:26:15,480 --> 00:26:19,260
+for sure positive... positive. خذوا بالكم، هذه تشبه مع من؟
+
+373
+00:26:19,260 --> 00:26:21,760
+مع هذه، لأن ممكن هذه تكون positive، وهذه ممكن تكون برضه
+
+374
+00:26:21,760 --> 00:26:27,020
+positive. لكن الاختلاف هنا من؟  الاثنتان متقلبتان، لكن الـ
+
+375
+00:26:27,020 --> 00:26:30,380
+... الـ ... الـ ... الـ ... الـ ... الـ ... الـ polar
+
+376
+00:26:30,960 --> 00:26:36,440
+الـ Flavobacterium والـ Kingella، الاثنتان positive وpositive
+
+377
+00:26:36,440 --> 00:26:40,700
+لكن non-motile.  الـ Brucella، قلنا لكم مستحيل
+
+378
+00:26:40,700 --> 00:26:44,380
+نخطئها معهم، لأنها لن تنمو خلال يوم ولا يومين ولا
+
+379
+00:26:44,380 --> 00:26:47,240
+ستة أسابيع، لأن هو بتالي أبعدوها... أبعدوها خالص
+
+380
+00:26:47,240 --> 00:26:50,860
+يعني الزمن تبعها على حاله، الـ time خالص. وهذا نفس
+
+381
+00:26:50,860 --> 00:26:57,340
+الشيء، الـ time، تمام.  الـ Alcaligenes positive، negative P
+
+382
+00:26:57,340 --> 00:27:01,670
+للـ oxidase. سيبقى الـ Alcaligenes ومن؟ والـ Alcaligenes مُبَاعِد
+
+383
+00:27:01,670 --> 00:27:05,290
+أكثر، نستطيع نميّزهم عن بعض عن طريق من؟ اللي هو
+
+384
+00:27:05,290 --> 00:27:08,950
+الـ glucose oxidation.  الـ Moraxella
+
+385
+00:27:10,520 --> 00:27:14,360
+والـ Acinetobacter، أكثر حكينا عنها، non-motile،  المراكز
+
+386
+00:27:14,360 --> 00:27:17,980
+اللي لحظة positive للأكسيديز، لكن negative لـ...
+
+387
+00:27:17,980 --> 00:27:21,960
+يعني في عندي... في عندي، خلّيني أقول مجموعة من
+
+388
+00:27:21,960 --> 00:27:27,720
+الصفات، من خلالها نستطيع أن على الأقل نميّز الـ
+
+389
+00:27:27,720 --> 00:27:31,760
+... الـ ... الـ ... الـ  genus. كلمة genus، أنا ما تكلمت
+
+390
+00:27:31,760 --> 00:27:34,940
+عن الـ species. تكلمت عن Pseudomonas aeruginosa أو كل
+
+391
+00:27:34,940 --> 00:27:39,610
+Pseudomonas في خانة، كل Acinetobacter في خانة، وهكذا. إذاً
+
+392
+00:27:39,610 --> 00:27:44,410
+هذا الجدول، الشيء المشترك فيه أن كلهم Gram-negative، بس
+
+393
+00:27:44,410 --> 00:27:49,230
+الله، أو cocci، بس الله. they are all non-fermenter
+
+394
+00:27:
+
+445
+00:31:33,470 --> 00:31:38,710
+بكتيريا التأثير والمثال الصارخ والواضح، سأبدأ بأذكركم
+
+446
+00:31:38,710 --> 00:31:44,090
+مرة أخرى وأخيرة، الـ E.coli تنقسم كل عشرين دقيقة
+
+447
+00:31:44,090 --> 00:31:50,810
+يعني في الساعة ثلاث مرات، الـ الـ الـ micro
+
+448
+00:31:50,810 --> 00:31:54,030
+bacterium tuberculosis تنقسم تقريباً كل عشرين
+
+449
+00:31:54,030 --> 00:31:58,710
+إلى أربع وعشرين ساعة، يعني كل يوم مرة، كل يوم مرة الآن
+
+450
+00:31:58,710 --> 00:32:02,670
+لو وضعنا خلية micro bacterium وخلية E.coli على
+
+451
+00:32:02,670 --> 00:32:08,060
+الجهة هذه، بعد أربع وعشرين ساعة، هذه ستكون مليارات، الـ
+
+452
+00:32:08,060 --> 00:32:16,000
+Mycobacterium والإشريكية كولاي مليارات تماماً بعد 24
+
+453
+00:32:16,000 --> 00:32:19,420
+ساعة، هاتان خليتان وهتان ملياران، من أسرع في
+
+454
+00:32:19,420 --> 00:32:22,960
+التكاثر؟ أكيد هذه، صح ولا لأ؟  عشان هيك يا شباب لما
+
+455
+00:32:22,960 --> 00:32:26,500
+لما لما واحد يمرض بالإشريكية كولاي، يعالجه
+
+456
+00:32:26,500 --> 00:32:30,870
+بأدوية منزلية لمدة ثلاثة أيام كحد أقصى، خمسة أيام، لما يمرض
+
+457
+00:32:30,870 --> 00:32:34,330
+بهذه البكتيريا، يعالجه ستة أشهر بأربعة أنواع من المضادات
+
+458
+00:32:34,330 --> 00:32:38,830
+الحيوية، أربعة أنواع من المضادات الحيوية، إذن هذا
+
+459
+00:32:38,830 --> 00:32:43,530
+المثال الصارخ يوضح لنا الفكرة التي حكيناها أو الـ
+
+460
+00:32:43,530 --> 00:32:46,770
+concept التي تقول أن تأثير الـ antibiotic
+
+461
+00:32:46,770 --> 00:32:50,910
+يكون أفضل ما يكون عندما تكون البكتيريا نشطة
+
+462
+00:32:50,910 --> 00:32:56,190
+أيضاً، فضل،  هل أكررها مرة أخرى؟
+
+463
+00:32:59,270 --> 00:33:01,970
+هنا لدينا doubling time، doubling time وهو زمن
+
+464
+00:33:01,970 --> 00:33:08,270
+الانقسام، عشرون دقيقة، و doubling time لبكتيريا
+
+465
+00:33:08,270 --> 00:33:13,490
+أربع وعشرون ساعة، مؤشر على ماذا؟ سرعة الانقسام، على
+
+466
+00:33:13,490 --> 00:33:20,530
+سرعة الأيض، metabolic rate هنا
+
+467
+00:33:20,530 --> 00:33:29,500
+سريعة وهنا منخفضة، الآن الـ metabolic rate تتناسب
+
+468
+00:33:29,500 --> 00:33:33,720
+تناسباً عكسياً مع الـ activity of the antibiotic، الـ
+
+469
+00:33:33,720 --> 00:33:38,120
+more metabolic rate، the more the effect of
+
+470
+00:33:38,120 --> 00:33:41,180
+antibiotic
+
+471
+00:33:41,180 --> 00:33:47,900
+the less the metabolic activity، the less the
+
+472
+00:33:47,900 --> 00:33:53,260
+activity of antibiotics، واضحة الآن إن شاء
+
+473
+00:33:53,260 --> 00:33:53,860
+الله؟ إن شاء الله
+
+474
+00:34:00,780 --> 00:34:06,740
+لقد ذكرت في، ربما في إحدى المحاضرات أيضاً، أن الـ
+
+475
+00:34:06,740 --> 00:34:13,340
+sensitivity testing عبارة عن contest، مسابقة بين من
+
+476
+00:34:13,340 --> 00:34:18,780
+ومن، بين الميكروب وبين الـ antibiotic، ماذا يعني
+
+477
+00:34:18,780 --> 00:34:24,850
+contest؟ هل يجوز أن أربط واحداً من يديه ورجليه، و
+
+478
+00:34:24,850 --> 00:34:28,090
+أدخله حلبة مصارعة وأقول: لنرَ من يغلب، أنت أم
+
+479
+00:34:28,090 --> 00:34:32,230
+فلان؟ لا يجوز، يجب توفير نفس الظروف للطرفين، و
+
+480
+00:34:32,230 --> 00:34:36,610
+تهيئة أفضل، ليس فقط نفس الظروف، بل أفضل الظروف، حتى
+
+481
+00:34:36,610 --> 00:34:40,610
+من يغلب في النهاية يكون قد غلب حقاً لأنه غلب
+
+482
+00:34:40,610 --> 00:34:46,560
+بجدارة، ليس بجدارة  باطلة، الآن أصبح
+
+483
+00:34:46,560 --> 00:34:51,800
+واضحاً أن الـ antibiotic أحدث تأثير على البكتيريا،
+
+484
+00:34:51,800 --> 00:34:57,460
+هذا التأثير الذي أحدثه، أحدثه لأن البكتيريا حساسة
+
+485
+00:34:57,460 --> 00:35:02,120
+للـ antibiotic، وليس لأن هناك عوامل أخرى حدت من نموها،
+
+486
+00:35:02,120 --> 00:35:06,900
+وليس لأن هناك عوامل أخرى ساهمت في إبطاء نموها
+
+487
+00:35:07,790 --> 00:35:10,970
+وصلة الصورة هذه، نقطة مهمة جداً، لأن عندما أعطي الـ
+
+488
+00:35:10,970 --> 00:35:14,210
+antibiotic للمريض، يكون تأثير الـ in vitro
+
+489
+00:35:14,210 --> 00:35:19,980
+هو نفسه تأثير الـ in vivo، كان أحد الأسئلة
+
+490
+00:35:19,980 --> 00:35:23,880
+التي كنا نطرحها في الامتحان، و نقول أن equal eye was
+
+491
+00:35:23,880 --> 00:35:26,260
+isolated sensitivity test ... أعفوني أستاذنا
+
+492
+00:35:26,260 --> 00:35:29,340
+السؤال كان: was isolated sensitivity test was
+
+493
+00:35:29,340 --> 00:35:32,120
+performed، gentamicin was found sensitive، the
+
+494
+00:35:32,120 --> 00:35:35,440
+patient prescribed gentamicin for five days، no
+
+495
+00:35:35,440 --> 00:35:40,350
+improvement for the patient، طبعاً، أُقلل من بريق
+
+496
+00:35:40,350 --> 00:35:43,530
+ماذا؟ بريق معلوماتك عن الـ sensitivity، ستقول أنت
+
+497
+00:35:43,530 --> 00:35:46,810
+لأنك ستشك في ماذا؟ في أن نتيجة الـ sensitivity result
+
+498
+00:35:46,810 --> 00:35:49,450
+لم تكن ... ستشك في أن نتيجة الـ sensitivity result لم تكن
+
+499
+00:35:49,450 --> 00:35:52,850
+مناسبة، نظرًا لأن الـ media لم تحتوي على
+
+500
+00:35:52,850 --> 00:35:56,070
+magnesium and calcium، لكن اطمئنوا، هذا السؤال لم يعد يُطرح
+
+501
+00:35:56,070 --> 00:36:00,370
+في الامتحانات، سودوموناس
+
+502
+00:36:00,370 --> 00:36:02,070
+أعني
+
+503
+00:36:06,900 --> 00:36:10,920
+أحدها؟ لا، يا أستاذي، لقد درستُ مثالاً اسمه
+
+504
+00:36:10,920 --> 00:36:13,860
+mycobacterium tuberculosis، mycobacterium
+
+505
+00:36:13,860 --> 00:36:16,420
+tuberculosis الذي يسبب مرض السل الرئوي
+
+506
+00:36:16,420 --> 00:36:20,040
+pseudomonas aeruginosa،  يعني it requires a longer
+
+507
+00:36:20,040 --> 00:36:25,820
+period than Escherichia coli، لكنها لا تستغرق أسبوعين،
+
+508
+00:36:25,820 --> 00:36:29,790
+لا تستغرق أسبوعين لعلاج السل، ليس لأنها بطيئة في
+
+509
+00:36:29,790 --> 00:36:33,930
+النمو، لأنها hard to treat، لأنها more resistant to
+
+510
+00:36:33,930 --> 00:36:37,510
+antibiotics،  لكن بالنسبة لـMycobacterium، هي التي
+
+511
+00:36:37,510 --> 00:36:42,430
+ذكرناها وذكرنا مثالاً عليها، أنها تحتاج إلى عشرين
+
+512
+00:36:42,430 --> 00:36:47,390
+إلى أربع وعشرين ساعة للانقسام، ما اسمها مرة أخرى؟
+
+513
+00:36:47,390 --> 00:36:52,930
+Mycobacterium Tuberculosis التي تسبب مرض السل الرئوي
+
+514
+00:36:52,930 --> 00:36:58,520
+صحيح، أو بـ tuberculosis pseudomonas
+
+515
+00:36:58,520 --> 00:37:02,740
+pseudomallei، الاسم الآخر لـ pseudomonas  المذكورة
+
+516
+00:37:02,740 --> 00:37:06,900
+سميناها بورخولديريا، بورخولديريا pseudomallei، تسبب مرضاً
+
+517
+00:37:06,900 --> 00:37:11,000
+اسمه melioidosis، والـ melioidosis هو عبارة عن
+
+518
+00:37:11,000 --> 00:37:14,980
+tropical disease، ماذا يعني tropical disease؟ مرض في
+
+519
+00:37:14,980 --> 00:37:18,240
+المناطق الاستوائية،  يعني ليس لدينا في مناطقنا
+
+520
+00:37:18,240 --> 00:37:25,480
+المعتدلة، uncommon، غير شائع، المشكلة هنا أن الـ
+
+521
+00:37:25,480 --> 00:37:30,140
+pulmonary manifestation، الأعراض الرئوية لهذا المرض
+
+522
+00:37:30,140 --> 00:37:36,800
+تجعله شبيهاً بمن؟ بـ tuberculosis،  يعني الطبيب غير
+
+523
+00:37:36,800 --> 00:37:41,100
+المتَمرس في هذا المرض قد يظن من الأعراض، وحتى من الـ X
+
+524
+00:37:41,100 --> 00:37:44,680
+-ray، من الـ X-ray، أن المرض هو tuberculosis
+
+525
+00:37:44,680 --> 00:37:47,420
+لذلك، الـ melioidosis could be confused with
+
+526
+00:37:47,420 --> 00:37:51,100
+tuberculosis characteristics، no pigment، لا يوجد هنا
+
+527
+00:37:51,100 --> 00:37:55,280
+pigment، تعمل esculin hydrolysis، وهذا أول مرة يمر
+
+528
+00:37:55,280 --> 00:38:01,320
+معنا، أليس كذلك؟ فحص الإسكولين، esculin hydrolysis
+
+529
+00:38:01,320 --> 00:38:04,760
+الـ esculin hydrolysis، سندرسه في بكتيريا اسمها group
+
+530
+00:38:04,760 --> 00:38:07,640
+B streptococci، أو لا أعرف، في الـ enterococci
+
+531
+00:38:07,640 --> 00:38:11,280
+سندرسه
+
+532
+00:38:11,280 --> 00:38:15,960
+كفحص أساسي، قلت لكم سأناجل فكرة طبعتها للـ enterococci
+
+533
+00:38:15,960 --> 00:38:22,200
+lactose oxidation positive، مرة أخرى، ليس fermentation
+
+534
+00:38:22,200 --> 00:38:26,520
+these characters،  طبعاً، نقول هذه الصفات، هذه
+
+535
+00:38:26,520 --> 00:38:33,320
+الصفات تستخدم لتمييز الـ pseudomonas pseudomallei
+
+536
+00:38:33,320 --> 00:38:38,820
+عن pseudomonas aeruginosa، طبعاً
+
+537
+00:38:38,820 --> 00:38:42,380
+ربما، نقول لكم هذه الصورة توضح ما هو
+
+538
+00:38:42,380 --> 00:38:47,220
+هو عن طريق الاستنشاق، inhalation، وهو mood
+
+539
+00:38:47,220 --> 00:38:49,980
+of the transmission، قد تصل الحالة إلى الجهاز العصبي المركزي
+
+540
+00:38:49,980 --> 00:38:54,740
+central nervous system، قد تسبب parotitis، قد تسبب
+
+541
+00:38:54,740 --> 00:38:59,100
+pneumonia، والـ pneumonia قلنا إنها تشبه إلى حد كبير
+
+542
+00:38:59,100 --> 00:39:02,360
+ماذا؟  الـ tuberculosis، تشبه إلى حد الـ
+
+543
+00:39:02,360 --> 00:39:05,820
+tuberculosis، قد تسبب أيضاً simple skin
+
+544
+00:39:05,820 --> 00:39:06,400
+infection
+
+545
+00:39:09,620 --> 00:39:13,120
+الـ بورخولديريا مالي أو pseudomonas mallei، المرض
+
+546
+00:39:13,120 --> 00:39:17,780
+يُسمى glanders، والـ glanders عبارة عن ulcerating
+
+547
+00:39:17,780 --> 00:39:24,300
+tubercle-like nodules، nodules،  يعني حبيبات أو عقد
+
+548
+00:39:24,300 --> 00:39:31,180
+عقد، تماماً، تتقرح هذه العقد، تتقرح، form in the
+
+549
+00:39:31,180 --> 00:39:34,920
+lungs and superficial lymph nodes and mucous
+
+550
+00:39:34,920 --> 00:39:37,760
+membrane، هذه الأماكن التي تكون فيها، وهي
+
+551
+00:39:37,760 --> 00:39:40,830
+الدرانات، this organism could be differentiated from
+
+552
+00:39:40,830 --> 00:39:42,850
+other pseudomonas species by carbohydrate
+
+553
+00:39:42,850 --> 00:39:47,190
+oxidation test،  يعني نحتاج إلى إجراء A,B,I، لا نستطيع
+
+554
+00:39:47,190 --> 00:39:50,750
+إجراؤه بـ one single test، نحتاج إلى مجموعة
+
+555
+00:39:50,750 --> 00:39:54,290
+carbohydrate fermentation test، أو عفواً، oxidation
+
+556
+00:39:54,290 --> 00:39:59,610
+test،  طب هو الـ A,B,I، هو الـ A,B,I عبارة عن oxidation
+
+557
+00:39:59,610 --> 00:40:04,190
+أم fermentation؟ ليس لدي الـ A,B,I
+
+558
+00:40:08,550 --> 00:40:13,290
+الـ ABI مُجسّم إلى جسمين، عشر فحوصات على هذا الطرف، و
+
+559
+00:40:13,290 --> 00:40:16,970
+عشر على هذا الطرف، الأول جيلاتين، والباقي
+
+560
+00:40:16,970 --> 00:40:22,950
+carbohydrate، تسعة carbohydrate، التسعة
+
+561
+00:40:22,950 --> 00:40:26,950
+carbohydrate، ليست fermentation ولا oxidation
+
+562
+00:40:26,950 --> 00:40:31,970
+شيء نسميه utilization، ما الفرق بين الثلاثة؟
+
+563
+00:40:31,970 --> 00:40:37,350
+الاستهلاك، هل هو fermentation؟ هل هو oxidation؟ أنا لا
+
+564
+00:40:37,350 --> 00:40:41,810
+أعرف المعنى، يعني لو ظهر ... لو أجريت ... لو وضعت  ثقافة
+
+565
+00:40:41,810 --> 00:40:43,050
+وأنا أراقب الـ glucose، سأرى
+
+566
+00:40:45,690 --> 00:40:51,330
+سأرى positive باش، positive باش، لكن في oxidation، لو الـ
+
+567
+00:40:51,330 --> 00:40:55,070
+equalize، ستظهر positive باش، لكن في fermentation هذا
+
+568
+00:40:55,070 --> 00:40:59,010
+الفحص، لأن حجم السائل قليل، ومفتوح على
+
+569
+00:40:59,010 --> 00:41:03,610
+العالم الخارجي، فيحتمل أن يكون من تحت عمل fermentation، و
+
+570
+00:41:03,610 --> 00:41:06,950
+من أسفل عمل من،  لذلك، لم أهتم بمعرفة
+
+571
+00:41:06,950 --> 00:41:11,010
+أنه oxidation أم fermentation، فقط عرفت أنه
+
+572
+00:41:11,490 --> 00:41:16,450
+Utilization، أنه تم استغلال السكر هذا، سواء كان
+
+573
+00:41:16,450 --> 00:41:22,890
+بطريقة الأكسدة أو بطريقة التخمير،  الـ اسينيتوباكتر
+
+574
+00:41:22,890 --> 00:41:28,230
+يا شباب، أحد الميكروبات التي لها خاصية مميزة، كان يُسمى زمان
+
+575
+00:41:28,230 --> 00:41:34,070
+يُسمى ميميا، لماذا
+
+576
+00:41:34,070 --> 00:41:40,090
+ميميا؟ ميميا جديدة، من كلمة mimic، و
+
+577
+00:41:40,090 --> 00:41:50,340
+mimic معناها يحاكي، يحاكي،  يعني تقلد، حتى
+
+578
+00:41:50,340 --> 00:41:55,440
+البكتيريا تقلد، تقلد من؟ البكتيريا هذه، عفواً، تحت
+
+579
+00:41:55,440 --> 00:41:59,800
+أي عنوان درسناها؟ لأنها gram negative bacillus
+
+580
+00:41:59,800 --> 00:42:03,860
+يعني المفروض أن تكون شكلها bacillus، لكن عندما تجد
+
+581
+00:42:03,860 --> 00:42:06,820
+البكتيريا نفسها bacillus، ومرة تجدها
+
+582
+00:42:11,280 --> 00:42:15,600
+ليس فقط cocci، diplococci، و Gram Negative، من هي Gram
+
+583
+00:42:15,600 --> 00:42:18,900
+Negative diplococci التي نعرفها؟ النيسيريا، Gram
+
+584
+00:42:18,900 --> 00:42:24,720
+Negative، النيسيريا،
+
+585
+00:42:24,720 --> 00:42:29,380
+إذن هي تحاكي النيسيريا، من أي ناحية تحاكي النيسيريا؟
+
+586
+00:42:29,380 --> 00:42:32,680
+بالشكل، إنها Gram Negative diplococci
+
+587
+00:42:44,220 --> 00:42:47,980
+حسناً، هذه مشكلة، أنني في يوم من الأيام أذهب لأُجري
+
+588
+00:42:47,980 --> 00:42:50,020
+عينة، Gram Stain، أجدها Gram Negative
+
+589
+00:42:50,020 --> 00:42:53,720
+Diplococci، في تاريخي في الـ microbiology
+
+590
+00:42:53,720 --> 00:42:57,660
+الدراسي، التشخيصي، أعرف أن بكتيريا واحدة في
+
+591
+00:42:57,660 --> 00:43:01,100
+الدنيا هي Gram Negative Diplococci، من هي البكتيريا
+
+592
+00:43:01,100 --> 00:43:04,560
+هذه؟ النيسيريا،  فأقول: يا نيسيريا مننجيتيدس، يا إما
+
+593
+00:43:04,560 --> 00:43:09,060
+نيسيريا غونوريا، كيف لي أن أطمئن أن هذه
+
+594
+00:43:09,060 --> 00:43:13,540
+نيسيريا، وليست اسينيتوباكتر؟ فحص الـ
+
+595
+00:43:13,540 --> 00:43:17,360
+oxidase
+
+596
+00:43:17,360 --> 00:43:21,100
+negative، الأسينيتوباكتر
+
+597
+00:43:21,100 --> 00:43:22,500
+أكثر من positive
+
+598
+00:43:25,730 --> 00:43:29,810
+هكذا عرفتم معلومة عن اسينيتوباكتر، أو
+
+599
+00:43:29,810 --> 00:43:34,070
+معلومتين، أصبحتم تعرفونهما، رقم واحد: Gram Negative
+
+600
+00:43:34,070 --> 00:43:42,710
+diplococci، رقم اثنين: oxidase positive،  أنا
+
+601
+00:43:42,710 --> 00:43:45,570
+أذكر هذه البكتيريا عندما كنا ندرسها، وكنا طلاباً، مثل
+
+602
+00:43:45,570 --> 00:43:50,010
+أفضلِكم، هكذا كان الدكتور يمر عليها ويقول: اسينيتوباكتر
+
+603
+00:43:50,010 --> 00:43:54,430
+a very minor pathogen، ويمر عليها مرور سريع، يعني
+
+604
+00:43:54,430 --> 00:43:59,270
+مرور سريع، لماذا في ذلك الوقت لم تكن ذات أهمية من أي
+
+605
+00:43:59,270 --> 00:44:03,930
+ناحية؟ من ناحية أن نسبة إحداثها للمرض كانت قليلة
+
+606
+00:44:03,930 --> 00:44:09,510
+واستجابتها للمضادات الحيوية كانت عالية، أقول لكم في
+
+607
+00:44:09,510 --> 00:44:12,530
+إحدى الدراسات التي أجريناها على اسينيتوباكتر
+
+608
+00:44:12,530 --> 00:44:18,390
+وجدنا أنها أصبحت مقاومة لجميع المضادات الحيوية
+
+609
+00:44:18,390 --> 00:44:24,290
+المتوفرة في وزارة الصحة، بمعنى الإصابة بهذا الميكروب
+
+610
+00:44:24,290 --> 00:44:29,670
+أصبحت تشكل خطورة تفوق أي ميكروب آخر تعرفه في
+
+611
+00:44:29,670 --> 00:44:34,770
+الدنيا، مثل methicillin resistant staphylococcus، أو
+
+612
+00:44:34,770 --> 00:44:40,810
+الأساسي الذي سميناه himares، نظرًا لماذا؟ لاكتسابها صفات
+
+613
+00:44:40,810 --> 00:44:45,610
+مقاومة جديدة، فأرجو ألا ننظر إلى البكتيريا
+
+614
+00:44:45,610 --> 00:44:48,490
+بحجم المعلومات المذكورة عنها في الكتاب، وإنما
+
+615
+00:44:48,490 --> 00:44:52,930
+بحجم ما تسببه من أمراض، مدى خطورتها
+
+616
+00:44:52,930 --> 00:44:55,990
+الأمراض التي تسببها، معاملتها عامل واحد، مدى
+
+617
+00:44:55,990 --> 00:44:59,210
+نسبة مقاومتها أو حساسيتها للـ المضادات الحيوية
+
+618
+00:45:00,660 --> 00:45:04,080
+it can cause diseases similar to that of
+
+619
+00:45:04,080 --> 00:45:07,660
+pseudomonas aeruginosa، يعني في الحلق، نجدها لكن
+
+620
+00:45:07,660 --> 00:45:10,580
+بدرجة أقل، كما قلنا لمن؟ كما قلنا لـ
+
+621
+00:45:10,580 --> 00:45:13,500
+enterobacter، و Escherichia coli، الـ Escherichia
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/hfiFXn9Z5Ck.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/hfiFXn9Z5Ck.srt
new file mode 100644
index 0000000000000000000000000000000000000000..b35b95321e06eaa9547a4d6d20630ea2e8ec157f
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/hfiFXn9Z5Ck.srt
@@ -0,0 +1,2034 @@
+1
+00:00:20,300 --> 00:00:23,260
+بسم الله الرحمن الرحيم نكمل مبدأنا في المحاضرة
+
+2
+00:00:23,260 --> 00:00:28,300
+الثانية في موضوع الexotoxins بداية أذكركم بتذكير
+
+3
+00:00:28,300 --> 00:00:33,480
+سريع بما تعلمناه عن الendotoxin وال exotoxinالـ
+
+4
+00:00:33,480 --> 00:00:39,040
+endotoxin هو تقريبا نوع واحد يشارك في كل gram
+
+5
+00:00:39,040 --> 00:00:45,740
+negative بكتيريا له تأثيرات متنوعة ومختلفة، أبسطها
+
+6
+00:00:45,740 --> 00:00:48,820
+أنه يسبب لنا ارتفاعا في درجة الحرارة، وأعقدها أنه
+
+7
+00:00:48,820 --> 00:00:53,760
+يسبب لنا وفيات، يعني يفوق الإكسوتوكسين.  تكلمنا عن
+
+8
+00:00:53,760 --> 00:00:58,860
+صنفين، صنف يؤثر على الcell membrane تبع الخلايا
+
+9
+00:00:58,860 --> 00:01:02,680
+وصنف آخر يستهدف cellular targets يعني
+
+10
+00:01:02,680 --> 00:01:07,440
+داخل الخلية، وبدأنا بالحديث عن بعض الأمثلة في
+
+11
+00:01:07,440 --> 00:01:11,180
+هذا المجال. تحدثنا عن الbordetella pertussis وتحدثنا
+
+12
+00:01:11,180 --> 00:01:14,620
+عن الadenylate cyclase تكسين، وقلنا أن المحصلة
+
+13
+00:01:14,620 --> 00:01:19,080
+النهائية لأي adenylate cyclase تكسين هي
+
+14
+00:01:19,080 --> 00:01:23,400
+accumulation of أو production of large amounts of
+
+15
+00:01:23,400 --> 00:01:25,500
+cyclic AMP، وبالتالي accumulation of
+
+16
+00:01:25,500 --> 00:01:28,580
+electrolytes. الaccumulation of electrolytes تؤدي
+
+17
+00:01:28,580 --> 00:01:29,340
+في النهاية إلى
+
+18
+00:01:32,060 --> 00:01:35,260
+إلى production of large quantities of water. قلنا
+
+19
+00:01:35,260 --> 00:01:38,340
+إذا كان في البشر، زي في الأمعاء، يكون إسهالا،
+
+20
+00:01:38,340 --> 00:01:41,820
+وإذا لم يكن في بشر، يكون أنه وذمة.  تكلمنا عن
+
+21
+00:01:41,820 --> 00:01:45,000
+الanthrax toxin. قلنا أنه معقد شوي، له
+
+22
+00:01:45,000 --> 00:01:49,560
+PA أنتيجين، الذي هو protective antigen، و two As،
+
+23
+00:01:49,560 --> 00:01:54,300
+اللذان هما lethal factor و edema factor. تحدثنا
+
+24
+00:01:54,300 --> 00:01:58,440
+أيضا عن البوتولينوم توكسين، وهو السم الأكثر قدرة على
+
+25
+00:01:58,440 --> 00:02:02,560
+القتل من كل السموم المعروفة للإنسان، وتحدثنا عن
+
+26
+00:02:02,560 --> 00:02:07,420
+وجود سبعة أنواع من هذا التوكسين antigenically
+
+27
+00:02:07,420 --> 00:02:15,680
+different. أشهرها ثلاثة: A وB وE. هذا غالبا
+
+28
+00:02:15,680 --> 00:02:20,880
+يُكتسب من المأكولات التي أصلها سمك، أو التي سنقول
+
+29
+00:02:20,880 --> 00:02:25,300
+أنها أسماك، خاصة ال canned fish، يعني الأسماك المعلبة.
+
+30
+00:02:25,300 --> 00:02:30,440
+بينما A وB غالبا مع canned food. canned food هي
+
+31
+00:02:30,440 --> 00:02:31,860
+المعلبة بشكل عام.
+
+32
+00:02:37,660 --> 00:02:41,080
+تحدثنا أن التوكسين هذا يستهدف من؟ يستهدف
+
+33
+00:02:41,080 --> 00:02:43,900
+الacetylcholine. تتذكرون الacetylcholine؟ الذي
+
+34
+00:02:43,900 --> 00:02:46,840
+يُطلق عليه neurotransmitter، والneurotransmitter
+
+35
+00:02:46,840 --> 00:02:52,330
+هذا إذا لم يُنتج... لن يكون هناك stimuli ولا
+
+36
+00:02:52,330 --> 00:02:54,990
+contraction، وبالتالي يصير فينا flaccid paralysis.
+
+37
+00:02:54,990 --> 00:02:57,830
+وبعدين انتقلنا في الحديث عن الكوليراتوكسين، وقلنا
+
+38
+00:02:57,830 --> 00:03:00,770
+أن الكوليراتوكسين تشتغل كـadenylate cyclase enzyme
+
+39
+00:03:00,770 --> 00:03:05,490
+تنتج cAMP بكمية كبيرة، produces large amount
+
+40
+00:03:05,490 --> 00:03:08,110
+of electrolytes، وبالتالي وذمة في التجويف تبع
+
+41
+00:03:08,110 --> 00:03:10,710
+الأمعاء. يعني لو رسمنا الأمعاء بهذا الشكل
+
+42
+00:03:10,710 --> 00:03:14,010
+وال adenylate
+
+43
+00:03:14,010 --> 00:03:16,810
+cyclase في المنطقة هذه، لأنه membrane bound.
+
+44
+00:03:17,660 --> 00:03:22,240
+الكوليراتوكسين يرتبط
+
+45
+00:03:22,240 --> 00:03:31,340
+بال adenylate cyclase. الارتباط
+
+46
+00:03:31,340 --> 00:03:34,180
+هذا يؤدي إلى تحويل ال ATP
+
+47
+00:03:40,330 --> 00:03:45,650
+الوظيفة الأولى أنه يعمل secretion لبعض المركبات، و
+
+48
+00:03:45,650 --> 00:03:51,570
+يساعد على امتصاص بعض المركبات الأخرى. هذا التزايد
+
+49
+00:03:51,570 --> 00:03:55,250
+يؤدي إلى التراكم الرهيب للElectrolytes في الإنسان.
+
+50
+00:03:55,250 --> 00:03:58,890
+هذا التراكم الرهيب قلنا عنه أنه يعتبر ساما للجسم.
+
+51
+00:03:58,890 --> 00:04:03,050
+والجسم، ليتخلص من هذا التأثير السام، يخرج
+
+52
+00:04:03,050 --> 00:04:07,630
+كميات كبيرة من الماء، وفي هذه الحالة، لأنه
+
+53
+00:04:07,630 --> 00:04:12,310
+يُنتج الإسهال، is produced.
+
+54
+00:04:12,310 --> 00:04:16,810
+وصفناه
+
+55
+00:04:16,810 --> 00:04:23,170
+الإسهال هذا بـماذا؟  تذكرون؟ rice water stool، مثل
+
+56
+00:04:23,170 --> 00:04:28,190
+ماء الأرز. المهم، ماء الأرز يكون لبني، يعني لونه
+
+57
+00:04:28,190 --> 00:04:30,770
+أبيض مُغبر، لونه أبيض ومُغبر.
+
+58
+00:04:40,810 --> 00:04:43,270
+والدفتيريوتوكسين أيضا ذكرناه في المحاضرة السابقة، لكن
+
+59
+00:04:43,270 --> 00:04:47,230
+لمن لم يحضره أو لمن لم يتابع بسرعة، الدفتيريوتوكسين يُوقف
+
+60
+00:04:47,230 --> 00:04:51,270
+عامل مهم جدا في الترجمة. تذكرون أن
+
+61
+00:04:51,270 --> 00:04:55,710
+الرايبوسوم، الوحدة الكبيرة، التي هي 60S و 40S
+
+62
+00:04:55,710 --> 00:05:00,830
+طبعا، هما اللذان يحملان mRNA، ويكون لدي
+
+63
+00:05:00,830 --> 00:05:08,370
+الكودونات، ويأتي ال amino acyl tRNA الذي يحمل
+
+64
+00:05:08,370 --> 00:05:15,900
+الحمض الأميني معه. amino acyl tRNA، تمام؟ الآن
+
+65
+00:05:15,900 --> 00:05:22,060
+هذه العملية تحدث بشكل طبيعي في وجود عامل اسمه
+
+66
+00:05:22,060 --> 00:05:27,400
+elongation factor.  عندما يحدث destruction أو
+
+67
+00:05:27,400 --> 00:05:31,760
+inactivation لelongation factor من قبل الدفتيريا
+
+68
+00:05:31,760 --> 00:05:35,760
+توكسين، عن طريق عملية، ماذا سمينا هذه العملية؟
+
+69
+00:05:35,760 --> 00:05:40,910
+هذه؟ ADP ribosylation.  عمل ADP ribosylation
+
+70
+00:05:40,910 --> 00:05:44,550
+inactivation ل elongation factor 2، ويوقف كل عملية
+
+71
+00:05:44,550 --> 00:05:48,090
+تركيب البروتين، واتفقنا أن بدون protein
+
+72
+00:05:48,090 --> 00:05:51,650
+synthesis there is no life for the cell.  ليس هناك أمل
+
+73
+00:05:51,650 --> 00:05:57,830
+أن تعيش الخلية الحية بدون تركيب البروتين. الصنف
+
+74
+00:05:57,830 --> 00:06:03,090
+السادس، هذا الذي توقفنا عنده المرة الماضية. جميل أن
+
+75
+00:06:03,090 --> 00:06:06,390
+نعرف أن ال... ال... الexotoxin A تبع Pseudomonas
+
+76
+00:06:06,390 --> 00:06:11,810
+Aeruginosa يعمل بنفس الآلية التي تعمل بها
+
+77
+00:06:11,810 --> 00:06:15,670
+الدفتيريا توكسين، مع أنه بكتيريا مختلفة
+
+78
+00:06:15,670 --> 00:06:19,470
+تماما، إلا أنه يعمل بنفس آلية الدفتيريا توكسين، يعني
+
+79
+00:06:19,470 --> 00:06:22,130
+لو جاء... لو جاء في الامتحان سؤال what is the
+
+80
+00:06:22,130 --> 00:06:26,270
+mechanism of action ل exotoxin A of Pseudomonas
+
+81
+00:06:26,270 --> 00:06:30,950
+Aeruginosa فلا تقولوا similar to diphtheria، لازم
+
+82
+00:06:30,950 --> 00:06:34,490
+تشرحوا لي آلية الدفتيريا توكسين. طيب، في أن الheat
+
+83
+00:06:34,490 --> 00:06:39,170
+labile enterotoxin، أو باختصار، الheat-labile toxin، نحن
+
+84
+00:06:39,170 --> 00:06:42,590
+في المحاضرة السابقة تحدثنا عن oxygen labile something.
+
+85
+00:06:42,590 --> 00:06:46,190
+تذكرونه؟ الذي هو ال... ال... الستربتولييسين أو
+
+86
+00:06:46,190 --> 00:06:49,090
+الهيموليسين تبع الستربتوكوكاس بيوجينز. قلنا عنه
+
+87
+00:06:49,090 --> 00:06:52,750
+oxygen labile، يعني يتأثر بالأكسجين، بينما اليوم
+
+88
+00:06:52,750 --> 00:06:56,890
+نتكلم عن heat labile، يعني يتأثر بالحرارة،
+
+89
+00:06:56,890 --> 00:07:00,190
+كما قلنا في oxygen stable وoxygen labile، كذلك
+
+90
+00:07:00,190 --> 00:07:05,950
+نقول هنا heat stable و heat labile.  الذي تنتجه
+
+91
+00:07:05,950 --> 00:07:09,110
+بكتيريا مشهورة جدا اسمها entero-toxigenic
+
+92
+00:07:09,110 --> 00:07:12,430
+Escherichia coli.  أيضا، لو حصل ودخل الحظ، سنقول عنها هنا
+
+93
+00:07:12,430 --> 00:07:16,370
+أنها it's similar or identical to  cholera
+
+94
+00:07:16,370 --> 00:07:19,470
+toxin الذي لسه شرحناه قبل قليل. هنا
+
+95
+00:07:19,470 --> 00:07:23,170
+أريد أن أنبه على شيء، قد لا نركز عليه في المحاضرة
+
+96
+00:07:23,170 --> 00:07:27,170
+الماضية أو في هذه المحاضرة، وهي ال phage-encoded
+
+97
+00:07:27,170 --> 00:07:33,650
+toxins.  تذكرون الكروموزوم الذي يُشفّر
+
+98
+00:07:33,650 --> 00:07:37,990
+المادة الوراثية في الخلية البكتيرية.  المادة
+
+99
+00:07:37,990 --> 00:07:39,990
+الوراثية في الخلية البكتيرية أساسا مكونة من
+
+100
+00:07:39,990 --> 00:07:43,630
+الكروموزوم، والبعض الآخر من البكتيريا يحتوي على
+
+101
+00:07:43,630 --> 00:07:48,390
+بلازميد، صحيح؟  العنصر الثالث الذي قد يضيف معلومات
+
+102
+00:07:48,390 --> 00:07:52,010
+للبيكتيريا هو  bacteriophage infection. phage يعني
+
+103
+00:07:52,010 --> 00:07:57,550
+infection للبكتيريا، ويبقى داخل الخلية.  يبقى هناك
+
+104
+00:07:57,550 --> 00:08:02,410
+three sources.  لاحظوا أنكم ستجدون الtoxins على
+
+105
+00:08:02,410 --> 00:08:05,850
+واحد من الثلاثة، إما chromosomally encoded، إما
+
+106
+00:08:05,850 --> 00:08:11,040
+plasmid encoded، إما phage encoded. ولا تستخفوا
+
+107
+00:08:11,040 --> 00:08:15,960
+في phage.  معظم الtoxins الخطيرة جدا التي نعرفها
+
+108
+00:08:15,960 --> 00:08:19,560
+هي phage-encoded، أو are phage-encoded، وأشهر مثال عليها من؟
+
+109
+00:08:19,560 --> 00:08:24,800
+الcornebacterium diphtheriae.  بدون bacteriophage
+
+110
+00:08:24,800 --> 00:08:29,440
+هي غير ممرضة، غير مُولدة للسموم، non-toxigenic.
+
+111
+00:08:29,440 --> 00:08:32,640
+لكن عند دخول bacteriophage تكتسب صفة إنتاج
+
+112
+00:08:32,640 --> 00:08:37,690
+الdiphtheria toxin.  أعطيكم مثالا آخر، قد تسمعون فيه
+
+113
+00:08:37,690 --> 00:08:42,890
+في الأخبار كمصطلح، flesh-eating bacteria، بكتيريا آكلة
+
+114
+00:08:42,890 --> 00:08:53,010
+اللحم.  هذا المرعب، flesh
+
+115
+00:08:53,010 --> 00:08:56,430
+يعني ماذا؟  لحم الإنسان.  لماذا سميت flesh-eating
+
+116
+00:08:56,430 --> 00:08:59,090
+bacteria؟  هي لا... لا... لا تأكل اللحم كما نحن
+
+117
+00:08:59,090 --> 00:09:03,930
+نأكل اللحم، وإنما لديها القدرة على هضم اللحم، يعني
+
+118
+00:09:03,930 --> 00:09:09,990
+تنتج proteases.  أعطيكم مثالا:  لو أصيب كتف
+
+119
+00:09:09,990 --> 00:09:13,290
+الإنسان، على سبيل المثال، بجرح، والتهاب، يؤدي
+
+120
+00:09:13,290 --> 00:09:19,210
+إلى أن البكتيريا، في اليوم التالي، قد ترى العظم، قد تستطيع أن
+
+121
+00:09:19,210 --> 00:09:23,090
+تأخذ نصف كيلوغرام من اللحم في اليوم الواحد، فيصبح
+
+122
+00:09:23,090 --> 00:09:28,590
+الإنسان exposed، معرض، يعني هي بكتيريا صعبة
+
+123
+00:09:28,590 --> 00:09:32,060
+للغاية. اسمها مشهور جدا عندنا في علم الأحياء الدقيقة.
+
+124
+00:09:32,060 --> 00:09:35,100
+Streptococcus pyogenes.  تعرفونها؟ Streptococcus
+
+125
+00:09:35,100 --> 00:09:37,480
+pyogenes، التي تسبب الالتهاب، التهاب اللوزتين،
+
+126
+00:09:37,480 --> 00:09:42,140
+التهاب الحلق العادي، بكتيريا عادية، ما الذي يختلف؟
+
+127
+00:09:42,140 --> 00:09:45,420
+أصيبت ببكتيريا وphage، أعطاها القدرة على إنتاج
+
+128
+00:09:45,420 --> 00:09:50,260
+كمية ضخمة من البروتينات.  إذا، عندما نتحدث عن phage
+
+129
+00:09:50,260 --> 00:09:54,200
+يجب أن نعرف أن phage قد يُكسِب البكتيريا صفات جديدة
+
+130
+00:09:54,200 --> 00:10:00,630
+من عوامل الضراوة.  طبعا، أخذنا... فتحنا موضوع
+
+131
+00:10:00,630 --> 00:10:04,270
+المادة الوراثية، لسبب البكتيريا، نتحدث عن how
+
+132
+00:10:04,270 --> 00:10:08,830
+bacteria may contribute knowledge to others.  نحن
+
+133
+00:10:08,830 --> 00:10:14,010
+لما... البشر، نتعاون بعضنا مع بعض، نُعلم بعضنا عن
+
+134
+00:10:14,010 --> 00:10:18,770
+طريق ال... ال... إما الصورة أو ال... يعني بالعين
+
+135
+00:10:18,770 --> 00:10:23,670
+بنشاهد، أو عن طريق السماعة. صحيح؟ نقوم بعملية نقل
+
+136
+00:10:23,670 --> 00:10:28,510
+المعلومات من إلى.  البكتيريا، للبكتيريا، لديها
+
+137
+00:10:28,510 --> 00:10:33,150
+العملية أبسط من ذلك بكثير وأفضل وأكثر فعالية.
+
+138
+00:10:33,150 --> 00:10:37,070
+تخيلوا لو أنا لدي شريحة صغيرة أدخلها في رأسك
+
+139
+00:10:37,070 --> 00:10:42,090
+تحفظ علم الأحياء الدقيقة، أو شريحة أكبر تجعلك تحفظ كل
+
+140
+00:10:42,090 --> 00:10:46,310
+التخصصات الطبية، أعتقد أن هذا مريح، وهذا ما لا تفعله البكتيريا،
+
+141
+00:10:46,310 --> 00:10:50,190
+بل تُعطي لبعضها البعض قطع من المادة الوراثية تُكسِبها المعرفة، وكأنها
+
+142
+00:10:50,190 --> 00:10:55,420
+كانت هي البكتيريا الأصلية.  نتخيل المحاضرة
+
+143
+00:10:55,420 --> 00:10:58,900
+السابقة، عندما تكلمنا عن العلاقات بين المخلوقات في
+
+144
+00:10:58,900 --> 00:11:03,120
+التعايش، كنا في التعايش المتبادل، وفي... صحيح؟  ذكرنا
+
+145
+00:11:03,120 --> 00:11:07,620
+جملة مهمة، كنا نقول نادرا ما توجد البكتيريا في بيئة
+
+146
+00:11:07,620 --> 00:11:13,120
+منعزلة، دائما تكون البكتيريا في بيئات مشتركة، نتخيل
+
+147
+00:11:13,120 --> 00:11:16,850
+أمعاء الإنسان، أو نتخيل المجاري، حفظكم الله، فيها
+
+148
+00:11:16,850 --> 00:11:20,250
+آلاف الأنواع من البكتيريا تموت، وبكتيريا تتنازع،
+
+149
+00:11:20,250 --> 00:11:24,570
+وبكتيريا مُتكيّفة، سعيدة، تنمو، تتكاثر حسب البيئة
+
+150
+00:11:24,570 --> 00:11:29,870
+الموجودة فيها.  قد تستطيع الميكروبات أن تنقل
+
+151
+00:11:29,870 --> 00:11:33,610
+الجينات لبعضها البعض بثلاث طرق، تعرفونها؟
+
+152
+00:11:33,610 --> 00:11:36,430
+transformation.  هذه مهمة جدا، على فكرة، وإن كان
+
+153
+00:11:36,430 --> 00:11:40,870
+العلماء يهملونها، لأنها مهمة، لأن the free take up
+
+154
+00:11:40,870 --> 00:11:44,450
+of DNA from the surrounding.  يعني الميكروب يأخذ أي
+
+155
+00:11:44,450 --> 00:11:49,540
+DNA من محيطه.  conjugation... conjugation، الذي هو
+
+156
+00:11:49,540 --> 00:11:52,940
+ال... ال... ال... الاقتران، والاختلاط الجنسي، و
+
+157
+00:11:52,940 --> 00:11:57,800
+transduction بنوعيه، الذي هو أينما وجدت الفريسة، و
+
+158
+00:11:57,800 --> 00:12:02,400
+وجد المفترس، لا يمكنك أن تجد أسدا يعيش في المدينة، و
+
+159
+00:12:02,400 --> 00:12:05,320
+الفريسة تعيش في الصحراء، يجب أن يكون هو موجودا هناك،
+
+160
+00:12:05,320 --> 00:12:09,720
+صحيح أم لا؟  البكتيريوفاج، من فريسته؟  البكتيريا.
+
+161
+00:12:09,720 --> 00:12:12,240
+فحتى البكتيريوفاج موجود في نفس البيئة التي
+
+162
+00:12:12,240 --> 00:12:16,520
+موجودة فيها البكتيريا، وبالتالي يُساهم في عملية نقل
+
+163
+00:12:16,520 --> 00:12:24,040
+الجينات من خلية إلى خلية أخرى. نقول هنا similar
+
+164
+00:12:24,040 --> 00:12:27,820
+to or identical to cholera toxin. هذا يفتح باب
+
+165
+00:12:27,820 --> 00:12:31,650
+النقاش.  هذه البكتيريا، الإشريكية القولونية، كنا طول عمرنا ونحن
+
+166
+00:12:31,650 --> 00:12:36,350
+صغار نعرف أنها إشريكية قولونية غير ممرضة في
+
+167
+00:12:36,350 --> 00:12:40,610
+الأمعاء. non-pathogen. بعد عدة سنوات من الدراسة
+
+168
+00:12:40,610 --> 00:12:44,290
+اكتشفنا أن لا، الE.coli اكتسبت صفات جديدة. كلمة
+
+169
+00:12:44,290 --> 00:12:47,230
+اكتسبت صفات جديدة، معناها أخذتها من أين؟ من
+
+170
+00:12:47,230 --> 00:12:51,650
+ميكروبات أخرى، مثل من هي مثلا في هذه الحالة؟ من
+
+171
+00:12:51,650 --> 00:12:55,510
+الكوليرا توكسين. هذا يعني ما يعتبره العلماء دليلا
+
+172
+00:12:55,510 --> 00:13:00,050
+مهما على أن البكتيريا تتبادل المعلومات فيما بينها.
+
+173
+00:13:00,050 --> 00:13:04,350
+عكس heat labile، الذي قلنا عنه أنه heat stable.
+
+174
+00:13:04,350 --> 00:13:14,690
+heat stable toxin من؟
+
+175
+00:13:14,690 --> 00:13:19,720
+الذي ينتجه أيضا الإشريكية القولونية. أي إشريكية قولونية، نفس
+
+176
+00:13:19,720 --> 00:1
+
+223
+00:16:40,030 --> 00:16:43,410
+يقوم يفتح الباب ويتم العملية، صح ولا لأ؟ فأي
+
+224
+00:16:43,410 --> 00:16:45,370
+signal .. لما بنقول signal transduction
+
+225
+00:16:45,370 --> 00:16:49,230
+interruption خربنا القناة اللي بتتواصل فيها
+
+226
+00:16:49,230 --> 00:16:53,800
+الخلية مع بعضها البعض، كيف؟ عن طريق الـ ADP
+
+227
+00:16:53,800 --> 00:16:57,340
+-ribosylation للـ GTP-hydrolyzing proteins within
+
+228
+00:16:57,340 --> 00:17:00,400
+unregulated adenylate cyclase and increased level
+
+229
+00:17:00,400 --> 00:17:04,060
+of cyclic AMP and GMP كمان مرة increased level of
+
+230
+00:17:04,060 --> 00:17:08,280
+cyclic AMP and GMP  إيش بدي أعمل increased level of
+
+231
+00:17:08,280 --> 00:17:12,200
+cyclic AMP and GMP؟ يعني
+
+232
+00:17:12,200 --> 00:17:16,520
+بدي أطلع ليه؟ بدي أطلع ليه؟ electrolytes ومن دخول ال
+
+233
+00:17:16,520 --> 00:17:19,640
+electrolytes هيصير accumulation. هذه البكتيريا
+
+234
+00:17:19,640 --> 00:17:21,320
+ماما بتصيب؟ في الأمعاء ولا في ال respiratory
+
+235
+00:17:21,320 --> 00:17:24,280
+tract؟ في ال respiratory .. يبقى مش هيكون في عندي
+
+236
+00:17:24,280 --> 00:17:27,480
+إسهال لإنه مش في الـ .. مش في اللي بقى في الأمعاء،
+
+237
+00:17:27,480 --> 00:17:33,140
+هيكون عندي secretions داخل القصبة الهوائية قد تؤدي إلى
+
+238
+00:17:33,140 --> 00:17:36,000
+cuffing أو تؤدي إلى إِدِيمة إذا كانت في الجهة
+
+239
+00:17:36,000 --> 00:17:38,460
+المعاكسة، يعني إذا كانت في القصبة الهوائية
+
+240
+00:17:38,460 --> 00:17:42,040
+الإفرازات، هتؤدي إلى إنه يصير فينا عملية cuffing
+
+241
+00:17:45,870 --> 00:17:48,670
+أحد التأثيرات الجانبية برضه لهذا التوكسين أنه بيعمل
+
+242
+00:17:48,670 --> 00:17:53,470
+inhibition لليوكوسايت كيموتاكسي و activity. إحنا
+
+243
+00:17:53,470 --> 00:17:58,830
+قلنا جاب شوية أنه هو ريسبتر على مين؟ على
+
+244
+00:17:58,830 --> 00:18:04,610
+البلعميات على البلعميات. فإذا ارتبط بالبلعميات
+
+245
+00:18:04,610 --> 00:18:10,910
+بيقوم بالشغل تاني بيسكتها طبعًا البلعميات وظيفتها
+
+246
+00:18:10,910 --> 00:18:18,130
+to phagocyte صح؟ to phagocytes بيده تاكل. كلمة
+
+247
+00:18:18,130 --> 00:18:22,490
+chemotaxis معناها جذب، إيش هنجذب؟ يعني إحنا في
+
+248
+00:18:22,490 --> 00:18:26,550
+مكان وبدنا نعمل chemotaxis لها من ال white blood
+
+249
+00:18:26,550 --> 00:18:31,050
+cells، بدنا نقول للخلايا تعالوا هنا، صح؟ الآن تيجي
+
+250
+00:18:31,050 --> 00:18:34,650
+الخلايا، الخلايا اللي هي وظيفتها، بتقوم بوظيفتها،
+
+251
+00:18:34,650 --> 00:18:40,260
+هو بيمنع الكيموتاكسي، بيمنع أنه نقول لها تعالي تمام؟ ولو
+
+252
+00:18:40,260 --> 00:18:44,580
+وصلت بيكون مُعَطِّل برضه إيه الـ function تبعها، إذا
+
+253
+00:18:44,580 --> 00:18:48,460
+الـ .. التوكسين هذا له أكثر من إيه؟ من function
+
+254
+00:18:48,460 --> 00:18:51,660
+شُكْلة
+
+255
+00:18:51,660 --> 00:18:56,900
+toxin ممكن أول مرة نذكره، لكن مهم جدًا نتطلع على الـ
+
+256
+00:18:56,900 --> 00:19:00,580
+mechanism of action، بسيطة أو سهلة، يا أتركزوا
+
+257
+00:19:00,580 --> 00:19:05,160
+معايا يا شباب نرجع
+
+258
+00:19:05,160 --> 00:19:07,420
+للـ protein synthesis، للـ protein synthesis
+
+259
+00:19:15,850 --> 00:19:18,330
+طبعًا أنتم عارفين إحنا حقيقيات نوى ولا بدائيات نوى؟
+
+260
+00:19:18,330 --> 00:19:25,510
+إحنا حقيقيات نوى حقيقيات نوى حقيقيات نوى حقيقيات نوى
+
+261
+00:19:25,510 --> 00:19:28,610
+حقيقيات نوى حقيقيات نوى حقيقيات نوى حقيقيات نوى
+
+262
+00:19:28,610 --> 00:19:28,930
+نوى حقيقيات نوى حقيقيات نوى حقيقيات نوى
+
+263
+00:19:28,930 --> 00:19:29,450
+نوى حقيقيات نوى حقيقيات نوى حقيقيات نوى
+
+264
+00:19:29,450 --> 00:19:32,990
+نوى حقيقيات نوى حقيقيات
+
+265
+00:19:32,990 --> 00:19:43,350
+نوى حقيقيات نوى حقيقيات نوى حقيقيات
+
+266
+00:19:47,000 --> 00:19:52,900
+الآن الـ 28S هذه هي integral part of the 60S، لو الـ
+
+267
+00:19:52,900 --> 00:19:57,980
+.. لو الشيقيلاتوكسين فصل هذا الجزء عن هذا الجزء،
+
+268
+00:19:57,980 --> 00:20:03,060
+لن يستطيع الـ amino acyl-tRNA تمام؟ أنه يشتغل على
+
+269
+00:20:03,060 --> 00:20:06,580
+الـ .. الـ .. أن يرتبط بالـ .. بالـ .. بالريبوزوم. طيب
+
+270
+00:20:06,580 --> 00:20:10,980
+إذا الـ amino-acyl-tRNA اللي هو حامل الـ amino
+
+271
+00:20:10,980 --> 00:20:14,260
+acids لم يستطع أن يرتبط بالمنطقة هذه، هل هيكون
+
+272
+00:20:14,260 --> 00:20:18,340
+protein synthesis؟ يبقى كمان مرة العملية توقفت
+
+273
+00:20:18,340 --> 00:20:22,840
+هيتنين اشتغلوا على مين؟ على protein synthesis. واحد
+
+274
+00:20:22,840 --> 00:20:27,680
+على الـ elongation factor. واحد اشتغل على الـ 28S
+
+275
+00:20:27,680 --> 00:20:33,440
+فصلها عن الـ 60S. لا بُدَّ طبعًا هو بدي آثار على ..
+
+276
+00:20:33,440 --> 00:20:35,860
+طيب
+
+277
+00:20:37,120 --> 00:20:43,180
+النوع الثاني شيجا لايك توكسين. شيجا لايك واضح من
+
+278
+00:20:43,180 --> 00:20:47,180
+الكلام أنه بيشبه الشيجيلا لكن مش الشيجيلا بتنتجه
+
+279
+00:20:47,180 --> 00:20:54,360
+بِـِلنُّه بتنتجه الإيكولاي. إيش سميناها المرة هذه؟ الـ
+
+280
+00:20:54,360 --> 00:20:59,370
+الإيكولاي enterohemorrhagic Escherichia coli
+
+281
+00:20:59,370 --> 00:21:03,910
+فاكرين الـ LT توكسين والـ ST توكسين. إيه سميناهم أو
+
+282
+00:21:03,910 --> 00:21:07,290
+من البكتيريا اللي بتنتجهم؟ entero toxigenic
+
+283
+00:21:07,290 --> 00:21:11,730
+Escherichia coli. إذن اللي بتنتج LT وST هي entero
+
+284
+00:21:11,730 --> 00:21:15,510
+toxigenic. اللي بتنتج الشيجا لايك توكسين هي entero
+
+285
+00:21:15,510 --> 00:21:20,220
+hemorrhagic. طبعًا واضح من الكلام أن الـ mechanism of
+
+286
+00:21:20,220 --> 00:21:24,000
+action هنا هي نفس الـ mechanism of action هنا. بس
+
+287
+00:21:24,000 --> 00:21:27,800
+ياريت تركزوا معايا الآن نفهم لماذا سميت
+
+288
+00:21:27,800 --> 00:21:31,240
+hemorrhagic. hemorrhagic يعني في دم ولا لأ؟ في
+
+289
+00:21:31,240 --> 00:21:39,360
+نزيف. طيب تعالوا نطلع مع بعض ليش صار في نزيف. هاي
+
+290
+00:21:39,360 --> 00:21:44,500
+الـ intestine. هاي الـ villi. فاكرين الـ villi؟ إيش الـ
+
+291
+00:21:44,500 --> 00:21:49,890
+villi وظيفتها؟ امتصاص. الغذاء المهضوم بيصير له
+
+292
+00:21:49,890 --> 00:21:52,850
+امتصاص. طبعًا هاد الـ villi هي عبارة عن
+
+293
+00:21:52,850 --> 00:21:58,090
+epithelial cells. التوكسين قتلها. كيف قتلها؟ عن طريق
+
+294
+00:21:58,090 --> 00:22:03,370
+إيقاف تصنيع الـ protein. هاد الخلايا بيكون في عليها
+
+295
+00:22:03,370 --> 00:22:10,190
+mucus. يا عزيزي لما تموت الخلايا بيصير لها sloughing
+
+296
+00:22:10,190 --> 00:22:17,020
+تنزل. بتصير خلايا ميتة والميوكاس اللي عليها معها
+
+297
+00:22:17,020 --> 00:22:21,440
+الآن الجزء اللي وراها إيش بدي يكون ورا الخلايا هذه؟
+
+298
+00:22:21,440 --> 00:22:26,640
+بدأت تموت الخلايا، الطبقة الخلايا ماتت. إيش وراها؟ على
+
+299
+00:22:26,640 --> 00:22:30,580
+طول كابيلاريز. الله يفتح عليك. كابيلاريز. ليش
+
+300
+00:22:30,580 --> 00:22:34,020
+كابيلاريز؟ أتوقع أنه هتكون كابيلاريز لأنه امتصاص
+
+301
+00:22:34,020 --> 00:22:38,960
+للتغذية الدم. عشان الـ nutrients اللي هتروح على وين؟ على
+
+302
+00:22:38,960 --> 00:22:43,400
+الخلايا اللي في الـ body كلها. طيب هاذي مصنوعة من
+
+303
+00:22:43,400 --> 00:22:46,620
+قنابيب PVC؟ بلاستيك يعني ولا إيش مصنوعة؟ برضه
+
+304
+00:22:46,620 --> 00:22:50,980
+خلايا، مدة اللي مُتَعَرِّض. طيب هذا التوكسين أيضًا قد .. قد
+
+305
+00:22:50,980 --> 00:22:54,760
+.. قد .. يقوم .. مش قد يقوم، يقوم بقتل الخلايا،
+
+306
+00:22:54,760 --> 00:22:57,380
+اللي هي endothelial cells تمام؟ وبالتالي بيصير فيه
+
+307
+00:22:57,380 --> 00:23:00,420
+rupturing لمين؟ للكابيلاري. إذا صار rupture
+
+308
+00:23:00,420 --> 00:23:03,380
+للكابيلاري، من حقّه إنه هيصير فيه leakage، يعني
+
+309
+00:23:03,380 --> 00:23:07,820
+تسريب للدم، تعالوا تطلعوا على الـ stool اللي ناتج
+
+310
+00:23:07,820 --> 00:23:08,220
+هنا
+
+311
+00:23:10,900 --> 00:23:19,200
+المكونات النهائية: واحد epithelial cells صح؟ اتنين
+
+312
+00:23:19,200 --> 00:23:26,400
+mucus. قبل صح؟ اتنين mucus. معاهم تلاتة blood. و أي
+
+313
+00:23:26,400 --> 00:23:32,670
+blood نقصد فيها إحنا أنها red blood. طيب في كمان
+
+314
+00:23:32,670 --> 00:23:38,430
+حاجة رابعة، بس إحنا الحاجة الرابعة هادي ما ناقشناهاش
+
+315
+00:23:38,430 --> 00:23:42,890
+لما صار الـ rupture و موت الخلايا، صار في
+
+316
+00:23:42,890 --> 00:23:50,270
+كيموتاكسي للـ white blood cells. اتّت للمنطقة هادي
+
+317
+00:23:50,270 --> 00:23:57,390
+وبالتالي بدأت تكافح. تكافح مين؟ البكتيريا. فجزء منها
+
+318
+00:23:57,390 --> 00:23:59,650
+بيموت في المعركة. يبقى هيلقى وين الآن؟
+
+319
+00:24:02,790 --> 00:24:05,770
+يبقى لما يكون الـ stool characterized by diarrhea
+
+320
+00:24:05,770 --> 00:24:12,010
+containing epithelial cells, mucus و blood و pus،
+
+321
+00:24:12,010 --> 00:24:15,190
+مش بنسميها hemorrhagic، بنسميها الزحار، مين
+
+322
+00:24:15,190 --> 00:24:19,850
+اللي بنتجه أو مشهور أنه بيعمل الزحار؟ الشيجيلا
+
+323
+00:24:19,850 --> 00:24:24,130
+ديزنتريا. الشيجيلا ديزنتريا بتعمل الـ dysentery.  dysentery
+
+324
+00:24:24,130 --> 00:24:27,730
+باللغة العربية اسمه الزحار. الزحار في نوعين منه
+
+325
+00:24:27,730 --> 00:24:30,610
+زحار بتدرسهم مع الدكتور عدنان. الدكتور عدنان اللي
+
+326
+00:24:30,610 --> 00:24:34,330
+هيشرحهم في الطفيليات. يعني اللي هو الزحار الأميبي بسبب
+
+327
+00:24:34,330 --> 00:24:38,050
+الأميبا هيستوليتيكا، والزحار البكتيري. بكتيري لإنه اللي
+
+328
+00:24:38,050 --> 00:24:40,890
+بتسببه الشيجيلا اللي هي بكتيريا عصوية. فبسموه
+
+329
+00:24:40,890 --> 00:24:45,030
+amoebic dysentery و bacillary dysentery
+
+330
+00:24:47,500 --> 00:24:51,180
+طيب ولا واحد سأل، من وين جت أصلاً الإسهال؟ إيش
+
+331
+00:24:51,180 --> 00:24:57,080
+علاقة الـ protein synthesis inhibition بالإسهال؟
+
+332
+00:24:57,080 --> 00:24:59,720
+اتذكروا أن الخلايا اللي ماتت مين هي الخلايا اللي
+
+333
+00:24:59,720 --> 00:25:05,360
+بتِمتصّ؟ إذا الخلايا ما امتصت، هيترتب كم؟ الـ
+
+334
+00:25:05,360 --> 00:25:08,870
+electrolytes. طيب وده تراكم من الـ electrolytes. ما هو
+
+335
+00:25:08,870 --> 00:25:13,050
+هي .. كل الـ .. كل الـ mechanisms اللي .. اللي أدت
+
+336
+00:25:13,050 --> 00:25:15,510
+إلى الإسهال تُلَخَّص فيها أن في تراكم من الـ
+
+337
+00:25:15,510 --> 00:25:18,530
+electrolytes. صح ولا لأ؟ وبالتالي يا شباب وصلنا
+
+338
+00:25:18,530 --> 00:25:24,330
+إلى الإسهال. ليش سميناها hemorrhagic؟ لإنه في دم مصاحب
+
+339
+00:25:24,330 --> 00:25:28,930
+إلها. نتوسع
+
+340
+00:25:28,930 --> 00:25:35,010
+التوكسين. وهذا يعني .. ممكن صار لنا فكرة عنه، لكن لا
+
+341
+00:25:35,010 --> 00:25:40,410
+بأس أنه نذكره مرة أخرى. ركزوا معايا على الرسم اللي
+
+342
+00:25:40,410 --> 00:25:49,250
+درسناه. هذه بسيطة لكن إن شاء الله بتوضح الفكرة. لو
+
+343
+00:25:49,250 --> 00:25:53,210
+هنا فينا للعضلة، فينا انقباض وفينا
+
+344
+00:25:53,210 --> 00:25:59,830
+استرخاء. هاي الانقباض هنا، ما نسميها، وهنا
+
+345
+00:25:59,830 --> 00:26:01,110
+استرخاء
+
+346
+00:26:08,020 --> 00:26:11,540
+خلّيني أشوف هنا من الأول الفكرة .. الفكرتين عشان
+
+347
+00:26:11,540 --> 00:26:18,540
+أصير انقباض بدي acetylcholine صح؟
+
+348
+00:26:18,540 --> 00:26:26,880
+طيب عشان أصير استرخاء إيش بدي؟
+
+349
+00:26:26,880 --> 00:26:33,580
+بدي
+
+350
+00:26:33,580 --> 00:26:37,820
+مثبط ولا acetylcholine؟ يعني واحد شغل الضوء و
+
+351
+00:26:37,820 --> 00:26:40,820
+واحد بدي أطفئ الضوء. تمام؟ الـ inhibitor of
+
+352
+00:26:40,820 --> 00:26:43,560
+acetylcholine بيعمل inhibition للـ acetylcholine
+
+353
+00:26:43,560 --> 00:26:46,580
+وبالتالي اللي بيصير فيه هنا استرخاء. الـ stimuli
+
+354
+00:26:46,580 --> 00:26:51,860
+العصبية بتنتج acetylcholine. بتتوقف عن طريق normal هذا
+
+355
+00:26:51,860 --> 00:26:58,920
+الـ botulinum toxin اشتغل على مين؟ لا اشتغل على
+
+356
+00:26:58,920 --> 00:27:02,980
+acetylcholine. منع حدوثه. إيش صار عندي؟
+
+357
+00:27:05,670 --> 00:27:11,070
+لأ ما صارشي .. ما صارشي عندي انقباض من أصله لإنه
+
+358
+00:27:11,070 --> 00:27:14,570
+الـ stimulus كله هو اللي بيعمل الانقباض. فإذا
+
+359
+00:27:14,570 --> 00:27:18,370
+ما صارشي انقباض، حصيّر عندي الآن استرخاء. طيب
+
+360
+00:27:18,370 --> 00:27:22,450
+إذا صار عندي استرخاء دائم، مال الحكي؟ إنه شلل
+
+361
+00:27:22,450 --> 00:27:24,590
+ارتخاء، اللي هو اللي سمينا .. قلنا flaccid
+
+362
+00:27:24,590 --> 00:27:29,390
+paralysis. الآن في الحالة الثانية اللي قلنا عنها
+
+363
+00:27:29,390 --> 00:27:34,730
+اللي هي tetanus. الـ tetanus بيشتغل على مين؟ بيمنع هذا
+
+364
+00:27:36,530 --> 00:27:41,110
+إذا منع هذا، فش استرخاء. فش استرخاء. الحاجة اللي
+
+365
+00:27:41,110 --> 00:27:45,890
+عندك دلوقت انقباض بشكل مستمر، وبالتالي حاسس أن
+
+366
+00:27:45,890 --> 00:27:53,970
+العضلات قاسية. نفسية
+
+367
+00:27:53,970 --> 00:28:04,030
+أعملها. النوع اللي هنا flaccid
+
+368
+00:28:04,030 --> 00:28:11,290
+paralysis. وصلت الصورة. هذا هو باختصار. بنذكر أنه في
+
+369
+00:28:11,290 --> 00:28:14,230
+عملية ثانية، انقباض واسترخاء. الـ
+
+370
+00:28:14,230 --> 00:28:18,270
+انقباض بده acetylcholine. إذا أنا منعت الـ
+
+371
+00:28:18,270 --> 00:28:20,290
+acetylcholine، منعت الـ acetylcholine، مافيش
+
+372
+00:28:20,290 --> 00:28:23,870
+انقباض، يبقى صار عندي شيء للاسترخاء، الـ
+
+373
+00:28:23,870 --> 00:28:28,390
+استرخاء بدها inhibitor للـ acetylcholine. إذا منعت
+
+374
+00:28:28,390 --> 00:28:32,090
+الـ acetylcholine inhibitor، معناه الحق يصير عندي
+
+375
+00:28:32,090 --> 00:28:35,650
+spastic paralysis، انقباض بشكل مستمر.
+
+376
+00:28:41,340 --> 00:28:44,260
+التوكسين .. التوكسين هو اللي منع الـ .. الـ .. الـ
+
+377
+00:28:44,260 --> 00:28:46,000
+في هذه الحالة، البوتولينوم توكسين منع الـ
+
+378
+00:28:46,000 --> 00:28:48,720
+acetylcholine. والتيتانوس توكسين هو اللي منع الـ
+
+379
+00:28:48,720 --> 00:28:52,640
+inhibitor للـ acetylcholine. طيب ركزولي بس في نقطة
+
+380
+00:28:52,640 --> 00:28:58,780
+مهمة نتكلم فيها عن التيتانوس. يسمى المرض أحيانًا
+
+381
+00:28:58,780 --> 00:29:04,020
+lockjaw. Lockjaw يعني الفك المغلق. بتحسّه المريض
+
+382
+00:29:04,020 --> 00:29:08,780
+دايمًا مسكر أسنانه. وهم بالعربي ما يسمونه كزاز. المرض
+
+383
+00:29:08,780 --> 00:29:14,220
+هذا كزاز، لإنه الأسنان مُطبَّقة على بعضها البعض. وبعض
+
+384
+00:29:14,220 --> 00:29:18,740
+الأحيان يسمونه fixed smile. الابتسامة الثابتة، عشان
+
+385
+00:29:18,740 --> 00:29:22,460
+ذلك. مش كل واحد مبتسم بيكون سعيد، ممكن يكون عنده
+
+386
+00:29:22,460 --> 00:29:28,650
+tetanus. تمام؟ ممكن يكون عنده tetanus. الـ .. الـ
+
+387
+00:29:28,650 --> 00:29:32,410
+الكلستريديوم تيتاني توكسين is a very dangerous
+
+388
+00:29:32,410 --> 00:29:38,670
+toxin. very serious disease. الانقباضات مش عارف
+
+389
+00:29:38,670 --> 00:29:42,490
+إنه هو spastic paralysis. الانقباضات ممكن تكون
+
+390
+00:29:42,490 --> 00:29:45,930
+عنيفة، عنيفة لدرجة أنها تكسر العمود الفقري.
+
+391
+00:29:45,930 --> 00:29:50,970
+الناس بتجوز لقدام، مرضى الناس بيجوز لورا. بيكون حرف
+
+392
+00:29:50,970 --> 00:29:54,410
+C. عامل لورا تمام؟ لما يكون عنده الـ spastic
+
+393
+00:29:54,410 --> 00:30:01,010
+paralysis. هذا مثال، أو هذا المرض مثال
+
+445
+00:33:57,060 --> 00:34:00,160
+exotoxin حاجة أن هي تلقى bilase وهي stable
+
+446
+00:34:00,160 --> 00:34:04,740
+specific receptors on host target cells مع كل
+
+447
+00:34:04,740 --> 00:34:07,860
+توكسين كنا نقول باستقبله الخلايا الفلانية أو
+
+448
+00:34:07,860 --> 00:34:13,160
+ريسبته الفلانية بينما هذا diverse range of host
+
+449
+00:34:13,160 --> 00:34:17,300
+cell and system affected يعني بيأثر على أنواع
+
+450
+00:34:17,300 --> 00:34:22,180
+كثيرة من الخلايا وعلى أجهزة الجسم المتنوعة كمان
+
+451
+00:34:22,180 --> 00:34:29,880
+بالنسبة للتأثيرات عكسه، لأ نفس الكلام، تأثيرات تأثير
+
+452
+00:34:29,880 --> 00:34:34,760
+غالبا بيكون specific effect on the host ليش
+
+453
+00:34:34,760 --> 00:34:38,000
+specific effect شباب؟ لأنه أصلا هو إله specific
+
+454
+00:34:38,000 --> 00:34:42,240
+activity، إله specific activity هنا برضه diverse
+
+455
+00:34:42,240 --> 00:34:47,120
+range، أخبرنا جابش في بداية المحاضرة إنه ممكن من
+
+456
+00:34:47,120 --> 00:34:51,520
+simple fever ل shock، تمام؟  the activation of
+
+457
+00:34:51,520 --> 00:34:55,180
+complement, vasodilatation، low blood pressure،
+
+458
+00:34:55,180 --> 00:34:59,000
+مجموعة كبيرة من الأعراض قد يسببها أو التأثيرات قد
+
+459
+00:34:59,000 --> 00:35:00,300
+يسببها ال endotoxin
+
+460
+00:35:03,520 --> 00:35:06,560
+Toxoids can be made by treating with formalin
+
+461
+00:35:06,560 --> 00:35:10,740
+بينما في ال gram negative، في ال toxin، it cannot
+
+462
+00:35:10,740 --> 00:35:13,860
+وبالتالي هل نقدر نعمله vaccination؟ هل نقدر نعمله
+
+463
+00:35:13,860 --> 00:35:18,400
+vaccination؟ فيه حد عنده أي سؤال على ال toxins؟
+
+464
+00:35:18,400 --> 00:35:23,420
+واضحة المسألة إن شاء الله. طيب ننتقل للجزء اللي
+
+465
+00:35:23,420 --> 00:35:28,580
+بعده، بدنا نتكلم على نقطة كتير مهمة اسمها natural
+
+466
+00:35:28,580 --> 00:35:32,530
+habitat of microbes. أصل الميكروبات وين؟ زميلكم
+
+467
+00:35:32,530 --> 00:35:35,970
+قال لكم بشوية إن البكتيريا مولودة في التربة بشكل
+
+468
+00:35:35,970 --> 00:35:39,990
+مستمر، وأي وجهة إحنا ممكن نصاب فيها بالبكتيريا، فما هي
+
+469
+00:35:39,990 --> 00:35:44,430
+مصادر ال pathogens بشكل عام في الدنيا؟ واحد: soil،
+
+470
+00:35:44,430 --> 00:35:48,150
+المصدر الأساسي...المصدر الأساسي للميكروبات هو
+
+471
+00:35:48,150 --> 00:35:53,990
+التربة. قد تقع الأمطار على التربة وتجرف جزءًا من
+
+472
+00:35:53,990 --> 00:35:57,920
+التربة، وتنقلها إلى الأنهار والبحار.  حتى البكتيريا
+
+473
+00:35:57,920 --> 00:36:00,740
+اللي ممكن تكون في المياه، ممكن يكون مصدرها وين؟
+
+474
+00:36:00,740 --> 00:36:06,160
+التربة. قد تثير الرياح الغبار، وتنقل إلينا بعض
+
+475
+00:36:06,160 --> 00:36:09,780
+الميكروبات عبر الجو، لكن مصدرها الأساسي وين؟ التربة.
+
+476
+00:36:09,780 --> 00:36:13,060
+فالـ soil تعتبر مصدر أساسي، لكن كمان في مصادر تانية:
+
+477
+00:36:13,060 --> 00:36:16,960
+الإنسان، أمعاء، حيوانات، and animal products.
+
+478
+00:36:19,370 --> 00:36:24,230
+سمعتوا بال...بال microbial flora أو ال microbiota
+
+479
+00:36:24,230 --> 00:36:31,690
+...ال microbiota of human body. ما فيش إنسان قاعد في
+
+480
+00:36:31,690 --> 00:36:36,840
+الغرفة تبعتنا هذه sterile، معقّم. لو أخدنا مسحة من
+
+481
+00:36:36,840 --> 00:36:42,040
+وجهه، بما أنه متحمّم وجاي، مغسل وجاي، لو أخدنا من
+
+482
+00:36:42,040 --> 00:36:46,000
+فمه، هلاقي ملايين الميكروبات، تمام؟ طب هو بفرك
+
+483
+00:36:46,000 --> 00:36:49,780
+سنانه وشارب قهوة وشارب شاي سخن، يعني ممكن موت
+
+484
+00:36:49,780 --> 00:36:53,940
+بعض البكتيريا، لكن هلاقي بكتيريا. لو أخدنا من
+
+485
+00:36:53,940 --> 00:36:58,820
+الستول تبع الإنسان، هلاقي فيه micro organism،
+
+486
+00:36:58,820 --> 00:37:04,080
+ليس من الطبيعي...قال لنا جميعًا الطبيعي إنه نجد
+
+487
+00:37:04,080 --> 00:37:08,460
+تمام؟ اللي مش طبيعي إنه ما نلاقيش micro organism.
+
+488
+00:37:08,460 --> 00:37:10,920
+إذا ال normal microbiota أو normal flora في
+
+489
+00:37:10,920 --> 00:37:14,280
+الإنسان، بدنا نعرف إنه على ال skin، على سبيل المثال،
+
+490
+00:37:14,280 --> 00:37:18,900
+مليان micro organism زي Staphylococcus epidermidis
+
+491
+00:37:18,900 --> 00:37:21,920
+و Staphylococcus aureus. أنا مكتوب هنا ال gram
+
+492
+00:37:21,920 --> 00:37:24,520
+-positive بكتيريا are the most common، اللي هم
+
+493
+00:37:24,520 --> 00:37:27,320
+ماجبوني كمان مرة Staphylococcus epidermidis و
+
+494
+00:37:27,320 --> 00:37:31,530
+Staphylococcus aureus. شباب، أنا لأ أدرس ال normal
+
+495
+00:37:31,530 --> 00:37:34,410
+flora على جسم الإنسان، عشان أقول لكم إنه فيه بكتيريا
+
+496
+00:37:34,410 --> 00:37:37,890
+لازم تبقى عارف إنه كل كلمة بنحكيها في ال
+
+497
+00:37:37,890 --> 00:37:43,010
+microbiology لها مدلولاتها ولها استخداماتها عندما
+
+498
+00:37:43,010 --> 00:37:48,250
+أتعامل مع عينات مرضية أو مع مرضى وأنا أعرف أن
+
+499
+00:37:48,250 --> 00:37:55,150
+إيديا فيهم microorganism. ولما بقول مريض...لما
+
+500
+00:37:55,150 --> 00:37:57,810
+بقول مريض بيكونوا يعرفوا إن المريض بيختلف عنكم
+
+501
+00:37:57,810 --> 00:38:03,620
+شوية. أنتم متأثرين ممكن كأصحاء بالمايكروبات اللي
+
+502
+00:38:03,620 --> 00:38:06,830
+موجودة على ال normal flora، بعضها. أنتم بتسلموا
+
+503
+00:38:06,830 --> 00:38:10,910
+على بعض، وبتحضنوا بعض بعض الأحيان، صح؟ ولا بتتأثروا
+
+504
+00:38:10,910 --> 00:38:14,050
+لكن المرضى بيتعرفوا إنهم immunocompromised.
+
+505
+00:38:14,050 --> 00:38:17,670
+immunocompromised، وأنتم فاكرين المحاضرة اللي قلت
+
+506
+00:38:17,670 --> 00:38:21,230
+فيها: لا يوجد خط فاصل ما بين pathogen و non
+
+507
+00:38:21,230 --> 00:38:24,750
+pathogen. وبالتالي بدنا نكون حذرين جدًا في التعامل
+
+508
+00:38:24,750 --> 00:38:28,010
+مع المرضى، بدنا نكون حذرين في التعامل مع العينات،
+
+509
+00:38:28,010 --> 00:38:31,830
+حتى لا نلوث العينات بالميكروبات اللي موجودة على
+
+510
+00:38:31,830 --> 00:38:38,430
+أيدينا أو في أنفنا أو في فمنا عندما نتحدث، ونحن
+
+511
+00:38:38,430 --> 00:38:42,150
+نقوم بالزراعة، زراعة الميكروبات. أنتَ في الواقع
+
+512
+00:38:42,150 --> 00:38:45,810
+بتزرع ميكروبات من مين كمان؟ من الفم والأسنان.
+
+513
+00:38:45,810 --> 00:38:49,070
+الميكروبات لما تطلع على الطبق بتقول أنا من الفم وأنا
+
+514
+00:38:49,070 --> 00:38:53,410
+أنا من المريض. لأ، كلهم بيشبهوا بعض. وبالتالي المطلوب
+
+515
+00:38:53,410 --> 00:38:57,670
+منك إنك تحافظ على العينات تبعتك من التلوث.
+
+516
+00:39:02,570 --> 00:39:07,090
+الـ respiratory tract. سؤال بسيط: الـ respiratory
+
+517
+00:39:07,090 --> 00:39:10,470
+tract جوا الجسم ولا برا الجسم؟ أنا بقول لكم برا
+
+518
+00:39:10,470 --> 00:39:17,330
+الجسم. برا الجسم. اتخيل إنها بس بدل ما هي الكيس برا
+
+519
+00:39:17,330 --> 00:39:22,490
+حاطينه هنا جوا، في احتكاك مع العالم الخارجي، وبالتالي
+
+520
+00:39:22,490 --> 00:39:26,110
+هي صحيح internal، لكن اعتبرها external لو في اتصال
+
+521
+00:39:26,110 --> 00:39:30,820
+مع العالم الخارجي. طبعًا بيقسموا الـ respiratory tract
+
+522
+00:39:30,820 --> 00:39:35,380
+إلى عدة أجزاء: mouth and oropharynx. بتكونوا تتذكروا
+
+523
+00:39:35,380 --> 00:39:41,320
+إن الـ saliva، اللعاب، عارفين واحد ملي من اللعاب، واحد
+
+524
+00:39:41,320 --> 00:39:47,040
+مللي من الـ saliva بيحتوي
+
+525
+00:39:47,040 --> 00:39:56,900
+على عشرة أس تسعة لعشرة أس اثنا عشر cell per ml. طبعًا
+
+526
+00:39:56,900 --> 00:40:00,680
+ما عنديش معرفة بالتريليونات والمليونات، لكن ألف
+
+527
+00:40:00,680 --> 00:40:05,060
+مليون...ألف مليون...آه، لعد...لعد ألف...ألف
+
+528
+00:40:05,060 --> 00:40:11,280
+مليون خلية لكل ملي...لكل ملي من اللعاب اللي هو
+
+529
+00:40:11,280 --> 00:40:19,300
+الصليبان. رقم مهول، لو مش مهول، يشبه العدد في الكثافة
+
+530
+00:40:19,300 --> 00:40:23,540
+عدد البكتيريا في الستول. فاللعاب والستول بيحتويا
+
+531
+00:40:23,540 --> 00:40:28,760
+كميات ضخمة من الـ micro organism. عشان أنا كده في
+
+532
+00:40:28,760 --> 00:40:31,220
+بعض العادات عند بعض الناس إنه بيستخدم الـ saliva
+
+533
+00:40:31,220 --> 00:40:35,460
+تبعتها لأشياء معينة، لإلصاق طابع بريد، ولا عشان يفتح
+
+534
+00:40:35,460 --> 00:40:42,160
+صفحة. هذه العادة نرجو يعني إنه نبتعد عنها. teeth and
+
+535
+00:40:42,160 --> 00:40:52,320
+gums، الأسنان واللثة. nose and nasopharynx، العين، الـ
+
+536
+00:40:52,320 --> 00:40:56,440
+conjunctiva، ملتحمة العين. العين، خدوا بالكم
+
+537
+00:40:57,890 --> 00:41:01,670
+external ولا internal برضه؟ واضح إنها بتتعرض
+
+538
+00:41:01,670 --> 00:41:05,990
+للميكروبات من الهواء ومن أشياء كثيرة، لكن الـ
+
+539
+00:41:05,990 --> 00:41:10,850
+continuous washing، العملية الغسل المستمرة للعين،
+
+540
+00:41:10,850 --> 00:41:14,590
+تجعل من عدد الميكروبات في العين...تجعل العين شبه
+
+541
+00:41:14,590 --> 00:41:19,810
+sterile. بالإضافة إلى إنتاج العين اللي هو الدموع،
+
+542
+00:41:19,810 --> 00:41:23,470
+أو الـ tears، اللي فيها الـ lysozymes اللي بتكسر كثير
+
+543
+00:41:23,470 --> 00:41:25,270
+من الـ gram-positive bacteria.
+
+544
+00:41:27,900 --> 00:41:31,780
+الـ gram-positive بكتيريا إيش هي؟ بتتميز بإيش؟
+
+545
+00:41:31,780 --> 00:41:36,160
+multiple layer of peptidoglycan و cross link.
+
+546
+00:41:36,160 --> 00:41:41,140
+فاكرين؟ لأ، الـ gram-positive ما فيهاش outer membrane.
+
+547
+00:41:41,140 --> 00:41:44,160
+فيها multiple layer of peptidoglycan، طبقات متعددة
+
+548
+00:41:44,160 --> 00:41:51,720
+ومرتبطة ببعضها بـ cross links. الآن الـ lysozyme
+
+549
+00:41:51,720 --> 00:41:54,400
+بتكسر الـ peptidoglycan نفسه.
+
+550
+00:41:57,440 --> 00:42:01,860
+عشان هيك بنلاقي إن العين غالبًا لا تصاب بالـ gram
+
+551
+00:42:01,860 --> 00:42:05,580
+positive، تصاب بمين؟ بالـ gram negative، ما عدا
+
+552
+00:42:05,580 --> 00:42:08,320
+gram positive واحدة، احفظوها اسمها Streptococcus
+
+553
+00:42:08,320 --> 00:42:15,540
+pneumoniae، غالبًا
+
+554
+00:42:15,540 --> 00:42:18,180
+هي resistant لمين؟ للـ lysozymes.
+
+555
+00:42:22,270 --> 00:42:27,090
+يبقى الـ...فهمنا بعض المعلومات حولها. نيجي للـ ear.
+
+556
+00:42:27,090 --> 00:42:32,650
+فيها حجرة inner و middle و exterior. طبعًا الـ
+
+557
+00:42:32,650 --> 00:42:35,950
+exterior اللي هي الصيوان، الأذن، هذا هو يعتبر جزء من
+
+558
+00:42:35,950 --> 00:42:39,550
+الجلد، وبالتالي it is always colonized، لازم يكون فيه
+
+559
+00:42:39,550 --> 00:42:43,080
+عليها بكتيريا، لكن الـ inside والـ middle مش لازم
+
+560
+00:42:43,080 --> 00:42:46,020
+يكون فيه بكتيريا، ولكم بتعرفوا الشمع اللي في
+
+561
+00:42:46,020 --> 00:42:48,900
+الأذن، هذا...هذا الشمع اللي في الأذن هذا
+
+562
+00:42:48,900 --> 00:42:53,060
+antimicrobial substance، يعني له قدرة على قتل
+
+563
+00:42:53,060 --> 00:42:57,220
+البكتيريا. ليه؟ لأنه عبارة عن unsaturated
+
+564
+00:42:57,220 --> 00:43:00,860
+fatty acid. وبعض العلماء اللي استخدموه أخذوا الجزء
+
+565
+00:43:00,860 --> 00:43:06,800
+من الشمع...الشمع...الشمع بتاع الأذن، ووضعوه على
+
+566
+00:43:06,800 --> 00:43:12,430
+التهابات جروح، فشفيت. دليل على أنه الناس اللي
+
+567
+00:43:12,430 --> 00:43:16,370
+بتستخدم برضه باستمرار عملية تنظيف غير صحية، قد
+
+568
+00:43:16,370 --> 00:43:20,570
+يؤذي الجسم أو قد يؤذي الأذن، بأنه بيزيل هذه الطبقة
+
+569
+00:43:20,570 --> 00:43:26,630
+المهمة جدًا من الشمع. طب الـ gastrointestinal tract،
+
+570
+00:43:26,630 --> 00:43:33,170
+هذي completely outside ولا كلها inside؟ outside، فيه
+
+571
+00:43:33,170 --> 00:43:37,730
+فتحتين: فتحة الفم وفتحة الشرج. يعني مجرد إن أنا مركب جوا
+
+572
+00:43:37,730 --> 00:43:38,470
+مركب جوا
+
+573
+00:43:43,940 --> 00:43:48,920
+طبعًا طولها طويل جدًا، تتذكروا الأمعاء، الغليظة
+
+574
+00:43:48,920 --> 00:43:54,260
+والدقيقة، وبالتالي أنا لما أعرف كلمة niche،
+
+575
+00:43:54,260 --> 00:43:59,040
+فاكرينها؟ أصغر
+
+576
+00:43:59,040 --> 00:44:06,500
+واحدة بيئية، آلاف بيئة، حلقة في الأمعاء، آلاف، صح؟
+
+577
+00:44:06,500 --> 00:44:11,540
+باختلاف العمق وباختلاف الـ location والـ anatomy
+
+578
+00:44:11,540 --> 00:44:16,140
+تبع الأمعاء، وبالتالي بتوقع إن يكون فينا كمية كبيرة
+
+579
+00:44:16,140 --> 00:44:19,340
+من الميكروبات اللي موجودة في هذه الأماكن. طبعًا
+
+580
+00:44:19,340 --> 00:44:24,720
+المعدة حامضية، الـ pH منخفض جدًا، ما فيش حاجة اسمها
+
+581
+00:44:24,720 --> 00:44:27,720
+normal flora في المعدة. في بكتيريا واحدة قادرة على
+
+582
+00:44:27,720 --> 00:44:30,640
+أن تتم الـ infection اللي حتى الآن بنعرفها اسمها
+
+583
+00:44:30,640 --> 00:44:31,680
+Helicobacter pylori.
+
+584
+00:44:37,800 --> 00:44:41,020
+الاسوفاجوس غالبًا ما فيهوش micro organism إلا
+
+585
+00:44:41,020 --> 00:44:44,780
+transient، اللي بتنزل مع الأكل، لكن في الآخر ما فيش
+
+586
+00:44:44,780 --> 00:44:48,920
+colonization للبكتيريا في الاسوفاجوس، لكن الفم
+
+587
+00:44:48,920 --> 00:44:53,240
+ما حكينا عنه قبل شوية، saliva مليان بالـ micro
+
+588
+00:44:53,240 --> 00:44:57,720
+organism. حكينا إنه الـ gastric mucosa of stomach
+
+589
+00:44:57,720 --> 00:45:01,180
+acid is acid tolerant organism، فقط واحدة هي اللي
+
+590
+00:45:01,180 --> 00:45:04,740
+قلنا عنها مين؟ الـ H. pylori، لأن هذه resistant للحامض.
+
+591
+00:45:04,740 --> 00:45:08,240
+عارفين كيف resistant للحامض شباب هذه؟ هذه بتنتج
+
+592
+00:45:08,240 --> 00:45:13,620
+إنزيم اسمه يورياز. الـ يورياز بيكسر اليوريا لأمونيا.
+
+593
+00:45:13,620 --> 00:45:18,940
+الـ ammonia alkaline الآن، وهي بتسبح في الحامض،
+
+594
+00:45:18,940 --> 00:45:27,560
+كأنها بتسبح ومغطاة ب...زي واحد بيدخل مثلًا مكان فيه
+
+595
+00:45:27,560 --> 00:45:31,820
+حريق، وحاطط على نفسه blanket مية.
+
+596
+00:45:33,930 --> 00:45:37,170
+بتتأثر بالحريق؟ ما بتتأثرش. نفس الشيء، هي داخلة في
+
+597
+00:45:37,170 --> 00:45:42,130
+الحامض، لكن حواليها هالة من إيه؟ من الـ ammonia، لأنه
+
+598
+00:45:42,130 --> 00:45:46,090
+الـ ammonia alkaline، فبتعادل الحامض، فبتنجح. خدوا
+
+599
+00:45:46,090 --> 00:45:48,910
+بالكم، هي محتاجة إلى هذه ال...ال...ال...ال...
+
+600
+00:45:48,910 --> 00:45:49,330
+ال...ال...ال...ال...ال...ال...ال...ال...ال
+
+601
+00:45:49,440 --> 00:45:55,460
+الأمونيا لفترة وجيزة من دخولها المعدة إلى اختراقها
+
+602
+00:45:55,460 --> 00:45:59,740
+لجدارها. إذا اخترقت الجدار، ما بعد الجدار هو سبعة
+
+603
+00:45:59,740 --> 00:46:05,260
+وأربعة من عشرة، الـ pH متعادل، فبالتالي خلصت، خلصت مهمة
+
+604
+00:46:05,260 --> 00:46:10,280
+اللي هو اليورياز. لكن to survive، to survive it
+
+605
+00:46:10,280 --> 00:46:14,540
+should require، اللي هو اليورياز. بنكمل إن شاء الله
+
+606
+00:46:14,540 --> 00:46:15,720
+المرة القادمة.
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/hfiFXn9Z5Ck_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/hfiFXn9Z5Ck_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..8c20337665ca8d77a87e31807284e5f107b9302b
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/hfiFXn9Z5Ck_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 4386, "start": 20.3, "end": 43.86, "text": "بسم الله الرحمن الرحيم نكمل مبدأنا في المحاضرة الثانية في موضوع ال exotoxins بدا أذكركوا بس تذكير سريع بما اتعلمنا عن ال endotoxin و ال exotoxin ال endotoxin هو تقريبا نوع واحد بيشترك في كل gram negative بكتيريا له تأثيرات متنوعة و مختلفة", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 8717, 24793, 1211, 3714, 44510, 10721, 8315, 8978, 9673, 5016, 46958, 25720, 6024, 104, 7649, 10632, 8978, 3714, 2407, 11242, 45367, 2423, 454, 310, 5230, 1292, 4724, 28259, 5551, 8848, 37983, 4117, 14407, 4724, 3794, 6055, 8848, 4117, 13546, 8608, 16572, 3615, 4724, 15042, 1975, 2655, 3615, 19528, 8315, 18871, 2423, 917, 310, 5230, 259, 4032, 2423, 454, 310, 5230, 259, 2423, 917, 310, 5230, 259, 31439, 6055, 4587, 16572, 3555, 995, 8717, 45367, 36764, 24401, 4724, 1829, 8592, 2655, 31747, 8978, 28242, 21353, 3671, 4724, 4117, 2655, 13546, 25528, 46740, 6055, 10721, 12984, 13546, 9307, 44650, 1863, 2407, 27884, 4032, 3714, 46456, 46538, 3660], "avg_logprob": -0.13383152821789618, "compression_ratio": 1.72, "no_speech_prob": 0.0, "words": [{"start": 20.3, "end": 20.56, "word": "بسم", "probability": 0.80859375}, {"start": 20.56, "end": 20.68, "word": " الله", "probability": 0.93359375}, {"start": 20.68, "end": 20.96, "word": " الرحمن", "probability": 0.9449869791666666}, {"start": 20.96, "end": 21.38, "word": " الرحيم", "probability": 0.9918619791666666}, {"start": 21.38, "end": 22.08, "word": " نكمل", "probability": 0.9583333333333334}, {"start": 22.08, "end": 22.7, "word": " مبدأنا", "probability": 0.75909423828125}, {"start": 22.7, "end": 22.86, "word": " في", "probability": 0.9384765625}, {"start": 22.86, "end": 23.26, "word": " المحاضرة", "probability": 0.95849609375}, {"start": 23.26, "end": 23.68, "word": " الثانية", "probability": 0.86029052734375}, {"start": 23.68, "end": 25.06, "word": " في", "probability": 0.91650390625}, {"start": 25.06, "end": 25.66, "word": " موضوع", 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"end": 140.46, "word": " أو", "probability": 0.67041015625}, {"start": 140.46, "end": 140.68, "word": " اللي", "probability": 0.636474609375}, {"start": 140.68, "end": 140.88, "word": " هنقول", "probability": 0.673828125}, {"start": 140.88, "end": 141.08, "word": " انه", "probability": 0.6976318359375}, {"start": 141.08, "end": 141.42, "word": " fish", "probability": 0.90185546875}, {"start": 141.42, "end": 142.72, "word": " خاصة", "probability": 0.9534505208333334}, {"start": 142.72, "end": 143.12, "word": " ال", "probability": 0.97705078125}, {"start": 143.12, "end": 143.5, "word": " canned", "probability": 0.41162109375}, {"start": 143.5, "end": 143.78, "word": " fish", "probability": 0.95263671875}, {"start": 143.78, "end": 144.0, "word": " يعني", "probability": 0.815673828125}, {"start": 144.0, "end": 144.78, "word": " الأسماك", "probability": 0.80126953125}, {"start": 144.78, "end": 145.3, "word": " المعلبة", "probability": 0.716064453125}, {"start": 145.3, "end": 146.44, "word": 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هذا بيقدي لتحول ال ATP", "tokens": [6027, 4117, 12610, 13546, 9307, 2407, 4117, 3794, 9957, 4724, 13546, 2655, 3555, 9566, 20666, 7649, 1829, 20292, 11622, 995, 10874, 20292, 11622, 2423, 9640, 2655, 3555, 41193, 23758, 4724, 1829, 4587, 16254, 5296, 2655, 5016, 12610, 2423, 39202], "avg_logprob": -0.34394531697034836, "compression_ratio": 1.3263157894736841, "no_speech_prob": 0.0, "words": [{"start": 197.66, "end": 198.76, "word": "الكوليراتوكسين", "probability": 0.7919243706597222}, {"start": 198.76, "end": 202.24, "word": " بيرتبط", "probability": 0.867578125}, {"start": 202.24, "end": 202.98, "word": " بالانيليزا", "probability": 0.5789794921875}, {"start": 202.98, "end": 203.46, "word": " جليز", "probability": 0.6064453125}, {"start": 203.46, "end": 211.34, "word": " الارتباط", "probability": 0.903125}, {"start": 211.34, "end": 211.78, "word": " هذا", "probability": 0.82470703125}, {"start": 211.78, "end": 212.88, "word": " بيقدي", "probability": 0.581298828125}, {"start": 212.88, "end": 213.54, "word": " لتحول", "probability": 0.872802734375}, {"start": 213.54, "end": 213.68, "word": " ال", "probability": 0.7265625}, {"start": 213.68, "end": 214.18, "word": " ATP", "probability": 0.9326171875}], "temperature": 1.0}, {"id": 10, "seek": 22911, "start": 220.33, "end": 229.11, "text": "الوظيفة الأولى انه بيعمل secretion لبعض المركبات و بيساعد على انتصاص بعض المركبات الأخرى", "tokens": [6027, 2407, 19913, 33911, 3660, 16247, 12610, 7578, 16472, 3224, 4724, 1829, 25957, 1211, 4054, 313, 5296, 3555, 3615, 11242, 9673, 31747, 3555, 9307, 4032, 4724, 1829, 3794, 995, 22488, 15844, 16472, 2655, 9381, 33546, 45030, 11242, 9673, 31747, 3555, 9307, 16247, 34740, 7578], "avg_logprob": -0.21475694179534913, "compression_ratio": 1.4259259259259258, "no_speech_prob": 5.543231964111328e-06, "words": [{"start": 220.33, "end": 221.49, "word": "الوظيفة", "probability": 0.769189453125}, {"start": 221.49, "end": 222.01, "word": " الأولى", "probability": 0.84423828125}, {"start": 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الخطيرة جدا اللي بنعرفها is Fage او are Fage encoded و أشهر مثل عليها مين ال cornebacterium diphtheria بدون ال bacteriophage it is non pathogenic، non-toxigenic، non-toxigenic لكن في ورود ال bacteriophage بيكسبها صفة إنتاج ال diphtheria toxin", "tokens": [35473, 14851, 3224, 1863, 2407, 8592, 8978, 2423, 479, 609, 20449, 19913, 2304, 2423, 36104, 33962, 9566, 48923, 10874, 28259, 13672, 1829, 44945, 3615, 28480, 11296, 307, 479, 609, 1975, 2407, 366, 479, 609, 2058, 12340, 4032, 5551, 8592, 3224, 2288, 50113, 1211, 25894, 11296, 3714, 9957, 2423, 1181, 716, 65, 14125, 2197, 10460, 357, 511, 654, 47525, 11536, 2423, 9755, 72, 5317, 609, 309, 307, 2107, 3100, 25473, 12399, 2107, 12, 1353, 87, 3213, 299, 12399, 2107, 12, 1353, 87, 3213, 299, 44381, 8978, 4032, 2288, 23328, 2423, 9755, 72, 5317, 609, 4724, 1829, 4117, 35457, 11296, 20328, 5172, 3660, 11933, 29399, 26108, 2423, 10460, 357, 511, 654, 10357, 259], "avg_logprob": -0.24400111647056683, "compression_ratio": 1.5965665236051503, 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{"start": 496.44, "end": 496.96, "word": " Fage", "probability": 0.7802734375}, {"start": 496.96, "end": 497.18, "word": " او", "probability": 0.776611328125}, {"start": 497.18, "end": 497.36, "word": " are", "probability": 0.80908203125}, {"start": 497.36, "end": 497.66, "word": " Fage", "probability": 0.9599609375}, {"start": 497.66, "end": 498.14, "word": " encoded", "probability": 0.82080078125}, {"start": 498.14, "end": 498.58, "word": " و", "probability": 0.5458984375}, {"start": 498.58, "end": 498.82, "word": " أشهر", "probability": 0.8724365234375}, {"start": 498.82, "end": 499.02, "word": " مثل", "probability": 0.917724609375}, {"start": 499.02, "end": 499.3, "word": " عليها", "probability": 0.965576171875}, {"start": 499.3, "end": 499.56, "word": " مين", "probability": 0.95458984375}, {"start": 499.56, "end": 500.54, "word": " ال", "probability": 0.73876953125}, {"start": 500.54, "end": 501.52, "word": " cornebacterium", "probability": 0.67261962890625}, {"start": 501.52, 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بالأخبار كمصطلح flesh-eating bacteria بكتيريا آكلت اللحم في المرعب هذا flesh يعني إيه لحم الإنسان، هاه؟ ليش سموها flesh-eating bacteria؟ هي مش .. مش .. مابتاكلش اللحم زي ما أحنا بناكل لحم وإنما عندها المقدرة على هضم اللحم", "tokens": [10721, 3615, 9566, 1829, 24793, 9122, 2304, 7649, 50113, 6027, 7251, 43020, 6055, 38251, 3615, 14407, 8978, 3224, 20666, 10721, 9778, 3555, 9640, 9122, 2304, 9381, 9566, 1211, 5016, 12497, 12, 68, 990, 11763, 4724, 4117, 2655, 13546, 25528, 19753, 28820, 2655, 13672, 35571, 8978, 9673, 2288, 3615, 3555, 23758, 12497, 37495, 22653, 11933, 1829, 3224, 5296, 35571, 33688, 1863, 3794, 7649, 12399, 8032, 40294, 22807, 32239, 8592, 8608, 2304, 2407, 11296, 12497, 12, 68, 990, 11763, 22807, 39896, 37893, 4386, 37893, 4386, 3714, 16758, 2655, 995, 28820, 8592, 13672, 35571, 30767, 1829, 19446, 5551, 5016, 8315, 44945, 995, 28820, 5296, 35571, 4032, 28814, 1863, 15042, 43242, 11296, 9673, 28543, 25720, 15844, 8032, 11242, 2304, 13672, 35571], "avg_logprob": 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proteases اعطيكوا مثال لدرجة انه لو أصيب كتف الإنسان على سبيل المثال بجروح والتهب بيهدي البكتيريا تاني يوم ممكن تشوف العضم قد تستطيع ان تاخد نص كيلو جرام من اللحم في اليوم الواحد فبصير الإنسان exposed معرض يعني فهي يعني بكتيريا صعبة للغاية", "tokens": [40228, 22653, 39894, 29399, 7435, 5631, 1957, 1975, 3615, 9566, 1829, 4117, 14407, 50113, 6027, 5296, 3215, 47341, 3660, 16472, 3224, 45164, 5551, 9381, 1829, 3555, 9122, 2655, 5172, 33688, 1863, 3794, 7649, 15844, 8608, 21292, 1211, 9673, 12984, 6027, 4724, 7435, 32887, 5016, 4032, 6027, 47395, 3555, 4724, 1829, 3224, 16254, 29739, 4117, 2655, 13546, 25528, 6055, 7649, 1829, 7251, 20498, 3714, 43020, 6055, 8592, 38688, 18863, 11242, 2304, 12174, 3215, 6055, 14851, 9566, 40228, 16472, 6055, 47283, 3215, 8717, 9381, 9122, 26895, 2407, 10874, 2288, 10943, 9154, 13672, 35571, 8978, 45595, 20498, 2423, 14407, 24401, 6156, 3555, 9381, 13546, 33688, 1863, 3794, 7649, 9495, 20449, 43042, 37495, 22653, 6156, 3224, 1829, 37495, 22653, 4724, 4117, 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heat stable heat stable توكسين مين اللي بينتجه برضه", "tokens": [27842, 3714, 1829, 4117, 32887, 3555, 9307, 5551, 34740, 7578, 50113, 1211, 3714, 9957, 39896, 50113, 15040, 8978, 29538, 21542, 6027, 3660, 9154, 33251, 12610, 13546, 995, 6055, 2407, 4117, 3794, 9957, 23758, 37495, 22653, 13672, 1829, 11203, 2304, 16606, 4724, 1829, 34268, 26890, 2407, 3224, 11778, 20292, 1211, 3714, 16095, 15844, 14739, 29739, 4117, 2655, 13546, 25528, 6055, 2655, 44510, 1211, 9673, 30241, 20498, 9307, 8978, 15042, 49374, 16095, 6225, 4117, 3794, 3738, 16247, 37746, 995, 40228, 13672, 1829, 12174, 1211, 8315, 8978, 11296, 16472, 11296, 3738, 8351, 3738, 8351, 6055, 2407, 4117, 3794, 9957, 3714, 9957, 13672, 1829, 4724, 9957, 2655, 7435, 3224, 4724, 43042, 3224], "avg_logprob": -0.2197534436479621, "compression_ratio": 1.9065420560747663, "no_speech_prob": 0.0, "words": [{"start": 766.97, "end": 767.23, "word": "من", "probability": 0.86279296875}, {"start": 767.23, "end": 767.83, "word": " ميكروبات", 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/hfiFXn9Z5Ck_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/hfiFXn9Z5Ck_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..6e6661365ede778c341f8017be3757a6479f309d
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/hfiFXn9Z5Ck_raw.srt
@@ -0,0 +1,2472 @@
+1
+00:00:20,300 --> 00:00:23,260
+بسم الله الرحمن الرحيم نكمل مبدأنا في المحاضرة
+
+2
+00:00:23,260 --> 00:00:28,300
+الثانية في موضوع ال exotoxins بدا أذكركوا بس تذكير
+
+3
+00:00:28,300 --> 00:00:33,480
+سريع بما اتعلمنا عن ال endotoxin و ال exotoxin ال
+
+4
+00:00:33,480 --> 00:00:39,040
+endotoxin هو تقريبا نوع واحد بيشترك في كل gram
+
+5
+00:00:39,040 --> 00:00:45,740
+negative بكتيريا له تأثيرات متنوعة و مختلفةأبسطها
+
+6
+00:00:45,740 --> 00:00:48,820
+انه يصلوا لنا ارتفاع في درجة الحرارة و اعقدها انه
+
+7
+00:00:48,820 --> 00:00:53,760
+يصلوا لنا وفيات يعني وفاق الاجستوكسين اتكلمنا عن
+
+8
+00:00:53,760 --> 00:00:58,860
+صينفين صينف بيأثر على ال cell membrane تبع الخلايا
+
+9
+00:00:58,860 --> 00:01:02,680
+و صينف اثر بيستخدم بيستهدف cellular targets يعني
+
+10
+00:01:02,680 --> 00:01:07,440
+داخل الخلية و بدأنا بالحديث عنبعض ال examples في
+
+11
+00:01:07,440 --> 00:01:11,180
+هذا المجال تحدثنا عن ال borderline pertosis وحدثنا
+
+12
+00:01:11,180 --> 00:01:14,620
+عن ال adenylate cyclase تكسين وقلنا ان المحصلة
+
+13
+00:01:14,620 --> 00:01:19,080
+النهائية لأي adenylate cyclase تكسين هو
+
+14
+00:01:19,080 --> 00:01:23,400
+accumulation of او production of large amounts of
+
+15
+00:01:23,400 --> 00:01:25,500
+cyclic A and B وبالتالي accumulation of
+
+16
+00:01:25,500 --> 00:01:28,580
+electrolytes ال accumulation of electrolytes تؤدي
+
+17
+00:01:28,580 --> 00:01:29,340
+في النهاية إلى
+
+18
+00:01:32,060 --> 00:01:35,260
+الى production of large quantities of water، قلنا
+
+19
+00:01:35,260 --> 00:01:38,340
+إذا كان فيه humans زي في الانتستين، بيكون دياريا،
+
+20
+00:01:38,340 --> 00:01:41,820
+وإذا كان فيش human، بيكون أنه سيلانا ايديمة،
+
+21
+00:01:41,820 --> 00:01:45,000
+اتكلمنا عن ال anthrax-16، قلنا إنه معقد شوية، إله
+
+22
+00:01:45,000 --> 00:01:49,560
+PA أنتجين، اللي هو protective antigen، و two As،
+
+23
+00:01:49,560 --> 00:01:54,300
+اللي هم ال lethal factor و ال EDMA factorsتحدثنا
+
+24
+00:01:54,300 --> 00:01:58,440
+ايضا عن بوتلونيم توكسين هو السم الأكثر قدرة على
+
+25
+00:01:58,440 --> 00:02:02,560
+القتل في كل السموم المعروفة للإنسان وتحدثنا عن
+
+26
+00:02:02,560 --> 00:02:07,420
+وجود سبع أنواع من هذا التوكسين antigenically
+
+27
+00:02:07,420 --> 00:02:15,680
+different أشهرهم تلاتة هما A وB وEE هذا غالبا
+
+28
+00:02:15,680 --> 00:02:20,880
+يكتسب من المأكولات اللي أصلها سمك أو اللي هنقول
+
+29
+00:02:20,880 --> 00:02:25,300
+انه fish خاصة ال canned fish يعني الأسماك المعلبة
+
+30
+00:02:25,300 --> 00:02:30,440
+بينما A و B غالبا مع ال canned food canned food هي
+
+31
+00:02:30,440 --> 00:02:31,860
+المعلبة بشكل عام
+
+32
+00:02:37,660 --> 00:02:41,080
+تحدثنا إن الـToxin هذا بيستهدف مين؟ بيستهدف
+
+33
+00:02:41,080 --> 00:02:43,900
+الـacetylcholine تتذكروا الـacetylcholine؟ اللي
+
+34
+00:02:43,900 --> 00:02:46,840
+يقول عنه neurotransmitter والـ neurotransmitter
+
+35
+00:02:46,840 --> 00:02:52,330
+هذا إذالم ينتج .. لن يكون هناك stimuli ولا
+
+36
+00:02:52,330 --> 00:02:54,990
+contraction وبالتالي بيصير فينا flaccid paralysis
+
+37
+00:02:54,990 --> 00:02:57,830
+وبعدين انتقلنا في الحديث عن الكوليراتوكسين وكونا
+
+38
+00:02:57,830 --> 00:03:00,770
+الكوليراتوكسين تشتغل برضه adenylate cyclase enzyme
+
+39
+00:03:00,770 --> 00:03:05,490
+بتنتج cycle KMP بكمية كبيرة produces large amount
+
+40
+00:03:05,490 --> 00:03:08,110
+of electrolytes وبالتالي في اندي في التجويف تبع
+
+41
+00:03:08,110 --> 00:03:10,710
+الأمعاق يعني لو اختخينا الأمعاق بهذا الشكل
+
+42
+00:03:10,710 --> 00:03:14,010
+والadenylate
+
+43
+00:03:14,010 --> 00:03:16,810
+cyclase في المناطق هاي لأنه membrane bound
+
+44
+00:03:17,660 --> 00:03:22,240
+الكوليراتوكسين بيرتبط
+
+45
+00:03:22,240 --> 00:03:31,340
+بالانيليزا جليز الارتباط
+
+46
+00:03:31,340 --> 00:03:34,180
+هذا بيقدي لتحول ال ATP
+
+47
+00:03:40,330 --> 00:03:45,650
+الوظيفة الأولى انه بيعمل secretion لبعض المركبات و
+
+48
+00:03:45,650 --> 00:03:51,570
+بيساعد على انتصاص بعض المركبات الأخرىالتزايد هذا
+
+49
+00:03:51,570 --> 00:03:55,250
+بيقدّي للتراكم الرهيب لل Electrolytes في ال human
+
+50
+00:03:55,250 --> 00:03:58,890
+هذا التراكم الرهيب قلنا عنه انه يعتبر toxic للجسم
+
+51
+00:03:58,890 --> 00:04:03,050
+والجسم عشان يتخلص من ال toxic effect باه بينتش
+
+52
+00:04:03,050 --> 00:04:07,630
+كميات كبيرة من مين من ال H2O وفي هذا الحالة لإنه
+
+53
+00:04:07,630 --> 00:04:12,310
+فيها ان التجاربين في القمع ديارية is produced
+
+54
+00:04:12,310 --> 00:04:16,810
+وصفناها
+
+55
+00:04:16,810 --> 00:04:23,170
+المربط ديارية بإيش؟ تاكرين؟rice, water, stool زي
+
+56
+00:04:23,170 --> 00:04:28,190
+ماء الرز، المهم ماء الرز بتكون milky، يعني اللونها
+
+57
+00:04:28,190 --> 00:04:30,770
+أبيض وتربد، اللونها أبيض تكون وتربد
+
+58
+00:04:40,810 --> 00:04:43,270
+والدفتيراتوكسين ايضا ذكرناه المحاضرة السابقة لكن
+
+59
+00:04:43,270 --> 00:04:47,230
+لابقى سنة و مرة اللي مره سريع الدفتيراتوكسين بيوقف
+
+60
+00:04:47,230 --> 00:04:51,270
+عامل مهم جدا في ال translation فاكرينه ان ال
+
+61
+00:04:51,270 --> 00:04:55,710
+ribosome ال large subunit اللي هي 6TS و ال 40S
+
+62
+00:04:55,710 --> 00:05:00,830
+طبعا انها اللي همين ال mRNA و بيكون في عندي ال
+
+63
+00:05:00,830 --> 00:05:08,370
+codons و بيجي ال amino acyl TRNA اللي حامل على او
+
+64
+00:05:08,370 --> 00:05:15,900
+محامل معاه amino acidأمينو أكايل TRNA تمام؟ الآن
+
+65
+00:05:15,900 --> 00:05:22,060
+هذه العملية بتحدث بشكل طبيعي في وجود عامل اسمه
+
+66
+00:05:22,060 --> 00:05:27,400
+elongation factor لما يصير destruction او
+
+67
+00:05:27,400 --> 00:05:31,760
+inactivation لل elongation factor من قبل الديثيريا
+
+68
+00:05:31,760 --> 00:05:35,760
+تكسين عن طريق طبعا process ايش سميناها ال process
+
+69
+00:05:35,760 --> 00:05:40,910
+هذه؟ ADP ribosylationال ATP ribosylation عمل
+
+70
+00:05:40,910 --> 00:05:44,550
+inactivation ل ال elongation factor 2 وجف كل عملية
+
+71
+00:05:44,550 --> 00:05:48,090
+تصنية لبروتين واتفقنا على انه بدون protein
+
+72
+00:05:48,090 --> 00:05:51,650
+synthesis there is no life for the cell مافيش امل
+
+73
+00:05:51,650 --> 00:05:57,830
+ان الخلية الحية تعيش بدون تصنية بروتين الصينف
+
+74
+00:05:57,830 --> 00:06:03,090
+السادس هذا اللي توقفنا عنده المرة الماضيةجميل إنه
+
+75
+00:06:03,090 --> 00:06:06,390
+نعرف إنه ال .. ال .. ال X-Doxin A تاع Sodomonas
+
+76
+00:06:06,390 --> 00:06:11,810
+Aeruginosa هو يعمل بنفس القالية اللي بتشتغل فيها
+
+77
+00:06:11,810 --> 00:06:15,670
+مين الـ diphtheria toxin مع أنه بكتيريا مختلفة
+
+78
+00:06:15,670 --> 00:06:19,470
+تماما إلا إنه بيشتغل بنفس ال diphtheria toxin يعني
+
+79
+00:06:19,470 --> 00:06:22,130
+لو جالك .. لو جالك في الامتحان سؤال what is the
+
+80
+00:06:22,130 --> 00:06:26,270
+mechanism of action ل X-Doxin A of Sodomonas
+
+81
+00:06:26,270 --> 00:06:30,950
+Aeruginosaفما تقوليش similar to diphtheria لازم
+
+82
+00:06:30,950 --> 00:06:34,490
+تشرحلي مين ال diphtheria toxin طيب في ان ال heat
+
+83
+00:06:34,490 --> 00:06:39,170
+labile enterotoxin او باختصار التيتوكسين احنا
+
+84
+00:06:39,170 --> 00:06:42,590
+المحاضرة السابقة تحدثنا عن oxygen labile something
+
+85
+00:06:42,590 --> 00:06:46,190
+فاكرينه؟اللي هو ال .. ال .. الستربتولايسين أو
+
+86
+00:06:46,190 --> 00:06:49,090
+الهيموليسين تبع الستربتوكوكاس، biogenes، قولنا عنه
+
+87
+00:06:49,090 --> 00:06:52,750
+oxygen labile، يعني بيتأثر بالأكسجين، بينما اليوم
+
+88
+00:06:52,750 --> 00:06:56,890
+نتكلم عن heat labile، يعني يتأثر بمين؟ بالحرارة،
+
+89
+00:06:56,890 --> 00:07:00,190
+زي ما قولنا في oxygen stable و oxygen labile، برضه
+
+90
+00:07:00,190 --> 00:07:05,950
+بنقول هنا heat stable و heat labileاللي بتنتجه
+
+91
+00:07:05,950 --> 00:07:09,110
+بكتيريا مشهورة جدا اسمها entero-toxigenic
+
+92
+00:07:09,110 --> 00:07:12,430
+escherichia coli برضه لو حصل الحظ هنقول عنها هنا
+
+93
+00:07:12,430 --> 00:07:16,370
+ايه انها it's similar or identical to mean to
+
+94
+00:07:16,370 --> 00:07:19,470
+cholera toxin اللي لسه احنا شرحناها قبل قليل هنا
+
+95
+00:07:19,470 --> 00:07:23,170
+بدي تنتبه لشغل احنا ممكن ماركزش عليها المحاضرة
+
+96
+00:07:23,170 --> 00:07:27,170
+الماضية ولا المحاضرة هذه لسه اللي هي الفاج encoded
+
+97
+00:07:27,170 --> 00:07:33,650
+وين عنها نكرومزومة اللي encodedبنستذكر مع بعض
+
+98
+00:07:33,650 --> 00:07:37,990
+المادة الوراثية في الخلية البكتيرية المادة
+
+99
+00:07:37,990 --> 00:07:39,990
+الوراثية في الخلية البكتيرية أساسا مكونة من
+
+100
+00:07:39,990 --> 00:07:43,630
+الكروموزوم والبعض الآخر من البكتيريا بيحتوي على
+
+101
+00:07:43,630 --> 00:07:48,390
+بلازميد صح؟ العنصر الثالث اللي ممكن يضيف معلومات
+
+102
+00:07:48,390 --> 00:07:52,010
+للبكتيريا هو bacterophage infection phage يعني
+
+103
+00:07:52,010 --> 00:07:57,550
+infection لبكتيريا ويبقى داخل الخلية يبقى فيه
+
+104
+00:07:57,550 --> 00:08:02,410
+three sourcesولاحظوا انتوا ال toxins هتلاجوها على
+
+105
+00:08:02,410 --> 00:08:05,850
+واحد من التلاتة، يا اما chromosomally encoded، يا
+
+106
+00:08:05,850 --> 00:08:11,040
+اما plasmid encoded، يا اما phage encodedوتستهنوش
+
+107
+00:08:11,040 --> 00:08:15,960
+في ال Fage معظم ال toxins الخطيرة جدا اللي بنعرفها
+
+108
+00:08:15,960 --> 00:08:19,560
+is Fage او are Fage encoded و أشهر مثل عليها مين
+
+109
+00:08:19,560 --> 00:08:24,800
+ال cornebacterium diphtheria بدون ال bacteriophage
+
+110
+00:08:24,800 --> 00:08:29,440
+it is non pathogenic، non-toxigenic، non-toxigenic
+
+111
+00:08:29,440 --> 00:08:32,640
+لكن في ورود ال bacteriophage بيكسبها صفة إنتاج ال
+
+112
+00:08:32,640 --> 00:08:37,690
+diphtheria toxinأعطيكم كمان مثال يمكن تسمعوا فيه
+
+113
+00:08:37,690 --> 00:08:42,890
+بالأخبار كمصطلح flesh-eating bacteria بكتيريا آكلت
+
+114
+00:08:42,890 --> 00:08:53,010
+اللحم في المرعب هذا flesh
+
+115
+00:08:53,010 --> 00:08:56,430
+يعني إيه لحم الإنسان، هاه؟ ليش سموها flesh-eating
+
+116
+00:08:56,430 --> 00:08:59,090
+bacteria؟ هي مش .. مش .. مابتاكلش اللحم زي ما أحنا
+
+117
+00:08:59,090 --> 00:09:03,930
+بناكل لحم وإنما عندها المقدرة على هضم اللحميعني
+
+118
+00:09:03,930 --> 00:09:09,990
+بتنتج proteases اعطيكوا مثال لدرجة انه لو أصيب كتف
+
+119
+00:09:09,990 --> 00:09:13,290
+الإنسان على سبيل المثال بجروح والتهب بيهدي
+
+120
+00:09:13,290 --> 00:09:19,210
+البكتيريا تاني يوم ممكن تشوف العضم قد تستطيع ان
+
+121
+00:09:19,210 --> 00:09:23,090
+تاخد نص كيلو جرام من اللحم في اليوم الواحد فبصير
+
+122
+00:09:23,090 --> 00:09:28,590
+الإنسان exposed معرض يعني فهي يعني بكتيريا صعبة
+
+123
+00:09:28,590 --> 00:09:32,060
+للغايةاسمها مشهور جدا عندنا في ال microbiology
+
+124
+00:09:32,060 --> 00:09:35,100
+Striptococcus Biogenes بتعرفوها؟ Striptococcus
+
+125
+00:09:35,100 --> 00:09:37,480
+Biogenes اللي بتعمل اللواز، إتهاب اللواز،
+
+126
+00:09:37,480 --> 00:09:42,140
+تنسولايتس عادية، بكتيريا عادية، إيش اللي يختلف؟
+
+127
+00:09:42,140 --> 00:09:45,420
+أصيبت ببكتيريا و phage أعطاها المقدرة على إنتاج
+
+128
+00:09:45,420 --> 00:09:50,260
+كمية ضخمة من ال proteins إذا عندما نتحدث عن phage
+
+129
+00:09:50,260 --> 00:09:54,200
+بدنا نعرف إن ال phage قد يكسب البكتيريا صفات جديدة
+
+130
+00:09:54,200 --> 00:10:00,630
+من ال virulence factorsطبعا خدنا .. فتحنا موضوع ال
+
+131
+00:10:00,630 --> 00:10:04,270
+genetic material لسبب البكتيريا نتكلم عن how
+
+132
+00:10:04,270 --> 00:10:08,830
+bacteria may contribute knowledge to others احنا
+
+133
+00:10:08,830 --> 00:10:14,010
+لما .. البشر بدنا نتقف بعضنا بدنا نعلم بعضنا عن
+
+134
+00:10:14,010 --> 00:10:18,770
+طريق ال .. ال .. اما الصورة او ال .. يعني بالعين
+
+135
+00:10:18,770 --> 00:10:23,670
+بنشوف او عن طريق السماعة مظبوط بنعمل عملية نقل
+
+136
+00:10:23,670 --> 00:10:28,510
+المعلومات من الىالبكتيريا لأ البكتيريا عندها
+
+137
+00:10:28,510 --> 00:10:33,150
+العملية أبسط من ذلك بكثير و أفضل و أكثر فعالية
+
+138
+00:10:33,150 --> 00:10:37,070
+طبعا تخيل لو أنا عندي chip صغيرة أدخلها في راسك
+
+139
+00:10:37,070 --> 00:10:42,090
+تحفظ ال microbiology او chip أكبر أخليك تحفظ كل
+
+140
+00:10:42,090 --> 00:10:46,310
+التحرير الطبية أعتقد أن هذا مريح و ده لا البكتيريا
+
+141
+00:10:46,310 --> 00:10:50,190
+بتعطي لبعض قطع من المادة الوراثية تكسبها المعرفة و
+
+142
+00:10:50,190 --> 00:10:55,420
+كأنها كانت هي البكتيريا الأصلفنتخيل المحاضرة
+
+143
+00:10:55,420 --> 00:10:58,900
+السابقة لما اتكلمت عن العلاقات ما بين المخلوقات في
+
+144
+00:10:58,900 --> 00:11:03,120
+ال symbiosis كنا في mutualism و في .. مظبوط ذكرنا
+
+145
+00:11:03,120 --> 00:11:07,620
+جملة مهمة كنا نادرا managed البكتيريا في بيئة
+
+146
+00:11:07,620 --> 00:11:13,120
+منعزلة دايما بتكون البكتيريا في بيئات مشتركة نتخيل
+
+147
+00:11:13,120 --> 00:11:16,850
+أمعاء الإنسان أو نتخيل المجاري أكرامكم اللهفيها
+
+148
+00:11:16,850 --> 00:11:20,250
+ألاف الأنواع بكتيريا بتموت وبكتيريا بتنازع
+
+149
+00:11:20,250 --> 00:11:24,570
+وبكتيريا مكيفة مبسوطة بتنمو بتتكاتر حسب البيئة
+
+150
+00:11:24,570 --> 00:11:29,870
+اللي موجودة فيها قد تستطيع الميكروبات أن تنقل
+
+151
+00:11:29,870 --> 00:11:33,610
+الجينات لبعضها لبعض بتلات طلق عارفينها؟
+
+152
+00:11:33,610 --> 00:11:36,430
+transformation هذي مهم جدا على فكرة وإن كان
+
+153
+00:11:36,430 --> 00:11:40,870
+العلماء مهملينها لإن هي مهمة لإنه the free take up
+
+154
+00:11:40,870 --> 00:11:44,450
+of DNA from the surrounding يعني الميكروب بياخد أي
+
+155
+00:11:44,450 --> 00:11:49,540
+DNA من محيطهال conjugation .. conjugation اللي هو
+
+156
+00:11:49,540 --> 00:11:52,940
+ال .. ال .. ال .. ال six-pillar الاختلال الجنسي و
+
+157
+00:11:52,940 --> 00:11:57,800
+transduction بنوعيه اللي هو و أينما وجدت الفريسة و
+
+158
+00:11:57,800 --> 00:12:02,400
+وجد المفترس، ماينفعش تلاقي أسد عايش في المدينة و
+
+159
+00:12:02,400 --> 00:12:05,320
+الفريسته عايش في الصحراء، لازم يكون هو موجود هناك،
+
+160
+00:12:05,320 --> 00:12:09,720
+مظبوط ولا لأ؟البكتيروفاج مين فرائصه؟ البكتيريا
+
+161
+00:12:09,720 --> 00:12:12,240
+فحلاقي البكتيروفاج أيضا موجود في نفس البيئة اللي
+
+162
+00:12:12,240 --> 00:12:16,520
+موجود فيها البكتيريا وبالتالي بيساهم في عملية نقل
+
+163
+00:12:16,520 --> 00:12:24,040
+الجينات من خلية إلى خلية أخرة نقول هنا ال similar
+
+164
+00:12:24,040 --> 00:12:27,820
+to or identical to cholera toxin هذا بيفتح باب
+
+165
+00:12:27,820 --> 00:12:31,650
+النقاشهذه البكتيريا إيشريشيا كولاي كنا طول عمرنا و
+
+166
+00:12:31,650 --> 00:12:36,350
+احنا صغار نعرف إنها إيشريشيا كولاي non-pathogen في
+
+167
+00:12:36,350 --> 00:12:40,610
+الأمعاق non-pathogen بعد عدة سنوات من الدراسة
+
+168
+00:12:40,610 --> 00:12:44,290
+اكتشفنا إنه لا ال E.coli اكتسبت صفات جديدة كلمة
+
+169
+00:12:44,290 --> 00:12:47,230
+اكتسبت صفات جديدة معناها حكي نخدتها من وين؟من
+
+170
+00:12:47,230 --> 00:12:51,650
+ميكروبات أخرى مثل مين هي مثلا في هذه الحالة من
+
+171
+00:12:51,650 --> 00:12:55,510
+الكوليرا توكسين هذا يعني اللي علماء بيعتبروه دليل
+
+172
+00:12:55,510 --> 00:13:00,050
+مهم على أن البكتيريا تتبدل المعلومات فيما بينهم
+
+173
+00:13:00,050 --> 00:13:04,350
+عكس heat الأوبايع اللي قلنا فيها انها heat stable
+
+174
+00:13:04,350 --> 00:13:14,690
+heat stable توكسين مين
+
+175
+00:13:14,690 --> 00:13:19,720
+اللي بينتجه برضهإشريشيا كولاي أي إشريشيا كولاي نفس
+
+176
+00:13:19,720 --> 00:13:22,740
+الإشريشيا كولاي اللي احنا ذكرناها اللي تنتج labile
+
+177
+00:13:22,740 --> 00:13:26,640
+يعني it produces two types of toxin labile toxin
+
+178
+00:13:26,640 --> 00:13:31,520
+and stable toxin enterotoxin of إشريشيا كولاي etec
+
+179
+00:13:31,520 --> 00:13:38,020
+plasmid encoded فيه أن ال STP only produced by
+
+180
+00:13:38,020 --> 00:13:41,480
+strain isolated from animals يعني مابلاجهاش في
+
+181
+00:13:41,480 --> 00:13:46,530
+العزلات اللي بناخدها من اللي هو الإنسانال action
+
+182
+00:13:46,530 --> 00:13:48,750
+تبع ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+183
+00:13:48,750 --> 00:13:49,350
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+184
+00:13:49,350 --> 00:13:49,730
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+185
+00:13:49,730 --> 00:13:51,210
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+186
+00:13:51,210 --> 00:14:00,070
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+187
+00:14:00,070 --> 00:14:00,810
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+188
+00:14:00,810 --> 00:14:01,410
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+189
+00:14:01,410 --> 00:14:03,210
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+190
+00:14:03,210 --> 00:14:04,590
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+191
+00:14:04,590 --> 00:14:04,590
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+192
+00:14:04,590 --> 00:14:04,590
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+193
+00:14:04,590 --> 00:14:04,590
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+194
+00:14:04,590 --> 00:14:09,970
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+195
+00:14:12,760 --> 00:14:18,520
+وبتالي برضه بيساهمنا بإنتاج اللي هو Cyclic GMB ال
+
+196
+00:14:18,520 --> 00:14:24,600
+Pertosis Toxin وهو عبارة عن A 5B A 5B يعني A واحدة
+
+197
+00:14:24,600 --> 00:14:32,760
+و 5B ال 5B بيسموهم S1 to S5 S1 to S5 احنا كنا
+
+198
+00:14:32,760 --> 00:14:40,770
+فاكرين لما بكون عندي 1A هو اكتر من Bممكن يكون ال B
+
+199
+00:14:40,770 --> 00:14:45,290
+Identicals Identical يعني كلهم نفس النسخة و ممكن
+
+200
+00:14:45,290 --> 00:14:48,930
+ال B مايكونوش Identical كيف يعني مش Identical؟
+
+201
+00:14:48,930 --> 00:14:51,790
+يعني واحد بيرتبط على نوع معين من الخلايا، التاني
+
+202
+00:14:51,790 --> 00:14:58,630
+بيرتبط على نوع معين آخر يعني خلينا نقول انه نوع ال
+
+203
+00:14:58,630 --> 00:15:04,360
+receptorإذا كانوا كلهم من نفس الصنف بيرتبطوا على
+
+204
+00:15:04,360 --> 00:15:06,760
+نوع واحد من ال receptor إذا كانوا مختلفين أكيد
+
+205
+00:15:06,760 --> 00:15:09,860
+هرتبطوا على receptors مختلفة، مين بتفضلوا أنتوا؟
+
+206
+00:15:12,920 --> 00:15:17,660
+على خمس أيه؟ على خمس أنواع من الأنسجة أو الخلايا
+
+207
+00:15:17,660 --> 00:15:21,540
+المختلفة فهذا بيزيد .. بيزيد .. بيزيد من فرصه ..
+
+208
+00:15:21,540 --> 00:15:24,600
+بيزيد من فرصه في الارتباط في أنسجة متعددة في أماكن
+
+209
+00:15:24,600 --> 00:15:30,600
+مختلفة فمثال أن هنا بقولنا ال S2 اللي .. اللي هنا
+
+210
+00:15:30,600 --> 00:15:34,180
+طبعا كنا اعتبار بيه subunit binds to glycolipid
+
+211
+00:15:34,180 --> 00:15:36,960
+receptors on ciliated respiratory cells على ال
+
+212
+00:15:36,960 --> 00:15:40,120
+respiratory ciliated cells اللي مرودة في وين؟ في
+
+213
+00:15:40,120 --> 00:15:44,030
+التراكيبالأستيلاتة binds to glycolipids on
+
+214
+00:15:44,030 --> 00:15:46,850
+phagocytes يعني بيرتبط برضه على مين؟ على ال
+
+215
+00:15:46,850 --> 00:15:53,270
+phagocytes نيجي الآن لأهم نقطة في الموضوع اللي هي
+
+216
+00:15:53,270 --> 00:15:59,550
+كيف تعمل ل fragment A sub unit اللي هي A inhibit
+
+217
+00:15:59,550 --> 00:16:02,690
+signal transduction تركزوا معايا في كلمة signal
+
+218
+00:16:02,690 --> 00:16:05,810
+transduction عشان بس نفهمها بشكل جيد شباب لو انا
+
+219
+00:16:05,810 --> 00:16:08,230
+افترضنا ان احنا لازم في هذا الغرفة او هذا القاعة
+
+220
+00:16:09,150 --> 00:16:13,530
+وقالية الدخول للقاعة عبارة عن جرس، عبارة عن جرس
+
+221
+00:16:13,530 --> 00:16:19,510
+الجرس لما بينضغط نسمع واحنا، أنا بتحرك، بقشلك،
+
+222
+00:16:19,510 --> 00:16:22,690
+بقول افتحوا الباب، افتحوا الباب، بدخل الشخص، بتتم
+
+223
+00:16:22,690 --> 00:16:29,990
+العملية تخيل لو ان الجرس هذا فصل عنه الطيارهيدغط
+
+224
+00:16:29,990 --> 00:16:35,810
+الشخص المعتاد انقل الجرس مش هيعطي الصوت، قطعت ال
+
+225
+00:16:35,810 --> 00:16:40,030
+signal اللي انا كنت بعطي أوامر لفلان لفلان حتى
+
+226
+00:16:40,030 --> 00:16:43,410
+يقوم يفتح الباب و يتم العملية، صح ولا لأ؟ فأي
+
+227
+00:16:43,410 --> 00:16:45,370
+signal .. لما بنقول signal transduction
+
+228
+00:16:45,370 --> 00:16:49,230
+interruption خربنا القالية اللي بتتواصل فيها
+
+229
+00:16:49,230 --> 00:16:53,800
+الخلية مع بعضها البعض، كيف؟عن طريق الـ ADP
+
+230
+00:16:53,800 --> 00:16:57,340
+-ribosylation للـ JTP-hydrolyzing proteins within
+
+231
+00:16:57,340 --> 00:17:00,400
+unregulated adenylate cyclase and increased level
+
+232
+00:17:00,400 --> 00:17:04,060
+of cyclic A and B كمان مرة increased level of
+
+233
+00:17:04,060 --> 00:17:08,280
+cyclic A and B ايش بدي اعمل increased level of
+
+234
+00:17:08,280 --> 00:17:12,200
+cyclic A and B؟ يعني
+
+235
+00:17:12,200 --> 00:17:16,520
+بدي طلع ليه؟ بدي طلع ليه؟ electrolytes ومن دخول ال
+
+236
+00:17:16,520 --> 00:17:19,640
+electrolytes هيصير accumulationهي هذه البكتيريا
+
+237
+00:17:19,640 --> 00:17:21,320
+ماما بتصيب؟ في العماعة ولا في ال respiratory
+
+238
+00:17:21,320 --> 00:17:24,280
+tract؟ في ال respiratory .. يبقى مش هيكون في عندي
+
+239
+00:17:24,280 --> 00:17:27,480
+ديارية لإنه مش في ال .. مش في اللي بقى في العماعة،
+
+240
+00:17:27,480 --> 00:17:33,140
+هيكون عندي secretions داخل التراكيا قد تؤدي إلى ال
+
+241
+00:17:33,140 --> 00:17:36,000
+cuffing أو تؤدي إلى إديمة إذا كانت في الجهة
+
+242
+00:17:36,000 --> 00:17:38,460
+المعاكسة، يعني إذا كانت في القصبة الهوائية
+
+243
+00:17:38,460 --> 00:17:42,040
+الإفرازات، هتؤدي إلى إنه يصير فينا عملية cuffing
+
+244
+00:17:45,870 --> 00:17:48,670
+أحد التأثيرات الجانبية برضه لهذا التكسين انه بيعمل
+
+245
+00:17:48,670 --> 00:17:53,470
+inhibition لليوكوسايت كيموتاكسي و activity احنا
+
+246
+00:17:53,470 --> 00:17:58,830
+قولنا جاب شوية انه الهو ريسبتر على مين؟ على
+
+247
+00:17:58,830 --> 00:18:04,610
+الفاجوسايت على الفاجوسايت فإذا ارتبط بالفاجوسايت
+
+248
+00:18:04,610 --> 00:18:10,910
+بيقوم بالشغل تاني بيسكتها طبعا الفاجوسايت وظيفتها
+
+249
+00:18:10,910 --> 00:18:18,130
+to phagocyte صح؟ to phagocytes بيده تاكلالان كلمة
+
+250
+00:18:18,130 --> 00:18:22,490
+chemotaxis معناها جذب، ايش هنجذب؟ يعني احنا في
+
+251
+00:18:22,490 --> 00:18:26,550
+مكان و بدنا نعمل chemotaxis له من ال white blood
+
+252
+00:18:26,550 --> 00:18:31,050
+cell، بدنا نقول الخلايا تعالوا هان، صح؟ الان تيجي
+
+253
+00:18:31,050 --> 00:18:34,650
+الخلايا، الخلايا اللي هوا وظيفة، بتقوم بوظيفتها،
+
+254
+00:18:34,650 --> 00:18:40,260
+هو بيمنع التنتين، بيمنع انه نقولها تعالىتمام؟ و لو
+
+255
+00:18:40,260 --> 00:18:44,580
+وصلت بيكون ملعقة برضه إيه ال function تبعها، إذا
+
+256
+00:18:44,580 --> 00:18:48,460
+ال .. ال toxin هذا إله أكتر من إيه؟ من function
+
+257
+00:18:48,460 --> 00:18:51,660
+شكة
+
+258
+00:18:51,660 --> 00:18:56,900
+toxin ممكن أول مرة نذكره، لكن مهم جدا نتطلع على ال
+
+259
+00:18:56,900 --> 00:19:00,580
+mechanism of action، بسيطة أو سهلة، يا اتركزوا
+
+260
+00:19:00,580 --> 00:19:05,160
+معايا يا شباب نرجع
+
+261
+00:19:05,160 --> 00:19:07,420
+لل protein synthesis، لل protein synthesis
+
+262
+00:19:15,850 --> 00:19:18,330
+طبعا انتوا عارفين احنا ايو كاريوت ولا برو كاريوت
+
+263
+00:19:18,330 --> 00:19:25,510
+احنا ايو كاريوت ايو كاريوت ايو كاريوت ايو كاريوت
+
+264
+00:19:25,510 --> 00:19:28,610
+ايو كاريوت ايو كاريوت ايو كاريوت ايو كاريوت ايو
+
+265
+00:19:28,610 --> 00:19:28,930
+كاريوت ايو كاريوت ايو كاريوت ايو كاريوت ايو كاريوت
+
+266
+00:19:28,930 --> 00:19:29,450
+ايو كاريوت ايو كاريوت ايو كاريوت ايو كاريوت ايو
+
+267
+00:19:29,450 --> 00:19:29,450
+كاريوت ايو كاريوت ايو كاريوت ايو كاريوت ايو كاريوت
+
+268
+00:19:29,450 --> 00:19:32,990
+ايو كاريوت ايو كاريوت ايو
+
+269
+00:19:32,990 --> 00:19:43,350
+كاريوت ايو كاريوت ايو كاريوت ايو
+
+270
+00:19:43,350 --> 00:19:43,350
+ك
+
+271
+00:19:47,000 --> 00:19:52,900
+الان ال 28S هذه هي integral part of the 60S، لو ال
+
+272
+00:19:52,900 --> 00:19:57,980
+.. لو الشيقيلاتوكسين فصلت هذا الجزء عن هذا الجزء،
+
+273
+00:19:57,980 --> 00:20:03,060
+لن يستطيع ال amino acyl-trna تمام؟ انه يشتغل على
+
+274
+00:20:03,060 --> 00:20:06,580
+ال .. ال .. ان يرتبط بال .. بال .. بالريبوزونطب
+
+275
+00:20:06,580 --> 00:20:10,980
+إذا ال amino-alkyl-tRNA اللي هو حامل ال amino
+
+276
+00:20:10,980 --> 00:20:14,260
+acids لم يستطع أن يرتبط بالمنطقة هذه هل هيكون
+
+277
+00:20:14,260 --> 00:20:18,340
+protein synthesis؟ يبجي كمان مرة العملية توقفت
+
+278
+00:20:18,340 --> 00:20:22,840
+هيتنين اشتغلوا على مين؟ على protein synthesis واحد
+
+279
+00:20:22,840 --> 00:20:27,680
+على ال elongation factor واحد اشتغل على ال 28S
+
+280
+00:20:27,680 --> 00:20:33,440
+فصلها عن ال 60S لا يبوصوا طبعا هو بدي اثار على ..
+
+281
+00:20:33,440 --> 00:20:35,860
+طيب
+
+282
+00:20:37,120 --> 00:20:43,180
+النوع التاني شيجا لايك توكسين شيجا لايك مواضح من
+
+283
+00:20:43,180 --> 00:20:47,180
+الكلام انه بيشبه الشيجالة لكن مش الشيجالة تنتجه
+
+284
+00:20:47,180 --> 00:20:54,360
+ميلي تنتجه إيكولاي إيش سامناها المرة هذه؟ لا
+
+285
+00:20:54,360 --> 00:20:59,370
+الإيكولايentero hemorrhagic escherichia coli
+
+286
+00:20:59,370 --> 00:21:03,910
+فاكرين ال L-T توكسين وال S-T توكسين ايه سمناهم او
+
+287
+00:21:03,910 --> 00:21:07,290
+من البكتيريا اللي تنتجهم؟ entero toxigenic
+
+288
+00:21:07,290 --> 00:21:11,730
+escherichia coli لذن اللي تنتج L-T وS-T هي entero
+
+289
+00:21:11,730 --> 00:21:15,510
+toxigenic اللي تنتج الشيجا لايك توكسين هي entero
+
+290
+00:21:15,510 --> 00:21:20,220
+hemorrhagicطبعا واضح من الكلام انه ال mechanism of
+
+291
+00:21:20,220 --> 00:21:24,000
+action هنا هي نفس ال mechanism of action هنا بس
+
+292
+00:21:24,000 --> 00:21:27,800
+ياريت تتركزوا معايا الآن نفهم لماذا سميت
+
+293
+00:21:27,800 --> 00:21:31,240
+hemorrhagic hemorrhagic يعني في blood ولا لا في
+
+294
+00:21:31,240 --> 00:21:39,360
+نزيف طب تعالوا نطلع مع بعض ليش صار في نزيف هاي
+
+295
+00:21:39,360 --> 00:21:44,500
+ال intestine هاي ال villi فاكرين ال villi؟ ايش ال
+
+296
+00:21:44,500 --> 00:21:49,890
+villi وظيفتها؟absorption الغذاء المهضوم بيصير له
+
+297
+00:21:49,890 --> 00:21:52,850
+absorption طبعا هاد ال villi هي عبارة عن
+
+298
+00:21:52,850 --> 00:21:58,090
+epithelial cells التوكسين قتلها كيف قتلها؟ عن طريق
+
+299
+00:21:58,090 --> 00:22:03,370
+توقيف تصنيع ل protein هاد الخلايا بيكون في عليها
+
+300
+00:22:03,370 --> 00:22:10,190
+mucus يا عزيزي لما تموت الخلايا بيصيرها sloughing
+
+301
+00:22:10,190 --> 00:22:17,020
+تنزلبتصير خلايا ميتة و الميوكاس اللي عليها معاها
+
+302
+00:22:17,020 --> 00:22:21,440
+الآن الجزء اللي وراها إيش بدي يكون ورا الخلايا هذه
+
+303
+00:22:21,440 --> 00:22:26,640
+بدأت مات الخلايا الطبقة الخلايا ماتت إيش وراها على
+
+304
+00:22:26,640 --> 00:22:30,580
+طول كابيلاريز الله يفتح عليك كابيلاريز ليش
+
+305
+00:22:30,580 --> 00:22:34,020
+كابيلاريز اتوقع انه هتكون كابيلاريز لأنه انتصاص
+
+306
+00:22:34,020 --> 00:22:38,960
+لتغذي الدم عشان ال نوترين اللي هتروح على وين على
+
+307
+00:22:38,960 --> 00:22:43,400
+الخلايا اللي في ال body كلهاطب هاذي مصنوعة من
+
+308
+00:22:43,400 --> 00:22:46,620
+قنابيب PVC؟ Plastic يعني و لا إيش مصنوعة؟ برضه
+
+309
+00:22:46,620 --> 00:22:50,980
+خلايا، مدى اللي متعرض أطيب جهد تكسين أيضا قد .. قد
+
+310
+00:22:50,980 --> 00:22:54,760
+.. قد .. يقوم .. مش قد يقوم، يقوم بقتل الخلايا،
+
+311
+00:22:54,760 --> 00:22:57,380
+اللي is endothelial cells تمام؟ وبالتالي بيصير فيه
+
+312
+00:22:57,380 --> 00:23:00,420
+rupturing لمين؟ للكابلاري، إذا صار rupture
+
+313
+00:23:00,420 --> 00:23:03,380
+للكابلاري، مدى الحق إنه هيصير فيه leakage، يعني
+
+314
+00:23:03,380 --> 00:23:07,820
+تسريب للدم، تعالوا تطلعوا على ال stool اللي ناتج
+
+315
+00:23:07,820 --> 00:23:08,220
+هارا
+
+316
+00:23:10,900 --> 00:23:19,200
+المحاصرة النهائية واحد epithelial cells صح اتنين
+
+317
+00:23:19,200 --> 00:23:26,400
+ميوكاس قبل صح اتنين ميوكاس معاهم تلاتة blood و اي
+
+318
+00:23:26,400 --> 00:23:32,670
+blood نقصد فيها انا احنا انها red bloodطيب في كمان
+
+319
+00:23:32,670 --> 00:23:38,430
+حاجة رابعة بس احنا الحاجة الرابعة ها دي ماناقشنهاش
+
+320
+00:23:38,430 --> 00:23:42,890
+لما صار انهيانة rapture و موت الخلايا صار في
+
+321
+00:23:42,890 --> 00:23:50,270
+كيموتاكسي ال white blood cell اتت للمنطقة ها دي
+
+322
+00:23:50,270 --> 00:23:57,390
+وبالتالي بدت تكافح تكافح مين؟ البكتيريا فجزء منها
+
+323
+00:23:57,390 --> 00:23:59,650
+بيموت في المعركة يبجي هلاجي وين الآن؟
+
+324
+00:24:02,790 --> 00:24:05,770
+يبقى لما يكون ال stool characterized by diarrhea
+
+325
+00:24:05,770 --> 00:24:12,010
+containing epithelial cells, mucus و blood و بص،
+
+326
+00:24:12,010 --> 00:24:15,190
+مش بنسميها hemorrhagic، بنسميها dysentery، مين
+
+327
+00:24:15,190 --> 00:24:19,850
+اللي بنتج او مشهور انه بعمل dysentery؟الشيجلة
+
+328
+00:24:19,850 --> 00:24:24,130
+ديزنتيريا الشيجلة ديزنتيريا بتعمل ال ديزنتر ديزنتر
+
+329
+00:24:24,130 --> 00:24:27,730
+باللغة العربية اسمه الزحار الزحار في نوعين منه
+
+330
+00:24:27,730 --> 00:24:30,610
+زحار تدرسهم مع الدكتور عدنان الدكتور عدنان اللي
+
+331
+00:24:30,610 --> 00:24:34,330
+هنده في التفاليات يعني اللي هو الزحار الأميبي بسبب
+
+332
+00:24:34,330 --> 00:24:38,050
+أنتهي بها استراتيكا والزحار العصوي عصوي لإنه اللي
+
+333
+00:24:38,050 --> 00:24:40,890
+بتسببه الشيجلة اللي هي بكتيريا عصوية فبسموه
+
+334
+00:24:40,890 --> 00:24:45,030
+amoebic dysentery وbacillary dysentery
+
+335
+00:24:47,500 --> 00:24:51,180
+طب ولا واحد سأل، من وين قلت أصلا الدياريا؟ إيش
+
+336
+00:24:51,180 --> 00:24:57,080
+علاقة ال protein synthesis، inhibition، بدياريا؟
+
+337
+00:24:57,080 --> 00:24:59,720
+اتذكروا أن الخلايا اللي مات مين هي الخلايا اللي
+
+338
+00:24:59,720 --> 00:25:05,360
+بتنتص؟ إذا الخلايا مامتصتش، هيترقى كام؟ ال
+
+339
+00:25:05,360 --> 00:25:08,870
+electrolyteطب و ده تراكم من ال electrolyte ما هو
+
+340
+00:25:08,870 --> 00:25:13,050
+هي .. كل ال .. كل ال mechanisms اللي .. اللي أدت
+
+341
+00:25:13,050 --> 00:25:15,510
+إلى الديارية تلخص فيها ان في تراكم من ال
+
+342
+00:25:15,510 --> 00:25:18,530
+electrolyte صح ولا لأ؟ وبالتالي يا شباب صلنا
+
+343
+00:25:18,530 --> 00:25:24,330
+ديارية ليش سميناها hemorrhagic؟ لإن في دم مصاحب
+
+344
+00:25:24,330 --> 00:25:28,930
+إلها تتنوس
+
+345
+00:25:28,930 --> 00:25:35,010
+ال toxin وهذا يعني ..ممكن صار لنا فكرة عنه لكن لا
+
+346
+00:25:35,010 --> 00:25:40,410
+بأس انه نذكره مرة أخرى ركزوا معايا على الرسم اللي
+
+347
+00:25:40,410 --> 00:25:49,250
+درسوناه هذه بسيطة لكن ان شاء الله بتوضح الفكرة لو
+
+348
+00:25:49,250 --> 00:25:53,210
+هنا فينا لل muscle فينا contraction وفينا
+
+349
+00:25:53,210 --> 00:25:59,830
+relaxation هاي contraction هنا ما نسميها وهنا
+
+350
+00:25:59,830 --> 00:26:01,110
+relaxation
+
+351
+00:26:08,020 --> 00:26:11,540
+خلّيني أشوف هنا من الأول الفكرة .. الفكرتين عشان
+
+352
+00:26:11,540 --> 00:26:18,540
+أصير contraction بدي acetylcholine صح؟
+
+353
+00:26:18,540 --> 00:26:26,880
+طب عشان أصير لإن انا relaxation إيش بدي؟
+
+354
+00:26:26,880 --> 00:26:33,580
+بدي
+
+355
+00:26:33,580 --> 00:26:37,820
+inhibitor ولا acetylcholine؟يعني واحد شغل الضوء و
+
+356
+00:26:37,820 --> 00:26:40,820
+واحد بدي اطفل الضوء تمام ال inhibitor of
+
+357
+00:26:40,820 --> 00:26:43,560
+acetylcholine بيعمل inhibition ل ال acetylcholine
+
+358
+00:26:43,560 --> 00:26:46,580
+وبتاع اللي بيصير فيه هنا relaxation ال stimuli
+
+359
+00:26:46,580 --> 00:26:51,860
+تجدد بينتج acetylcholine بتوقف عن طريق normal هذا
+
+360
+00:26:51,860 --> 00:26:58,920
+ال botulinum toxin اشتغل على مين؟ لا اشتغل على
+
+361
+00:26:58,920 --> 00:27:02,980
+acetylcholine منع حدوثه ايش صار عندي؟
+
+362
+00:27:05,670 --> 00:27:11,070
+لأ ماصارش .. ماصارش عندي contraction من أصله لإن
+
+363
+00:27:11,070 --> 00:27:14,570
+ال style كله هو اللي بعمل ال contraction فإذا
+
+364
+00:27:14,570 --> 00:27:18,370
+ماصارش contraction حصيرا ناجي الآن relaxation طب
+
+365
+00:27:18,370 --> 00:27:22,450
+إذا صار عندي relaxation تان مال الحكي؟ إنه شلل
+
+366
+00:27:22,450 --> 00:27:24,590
+ارتخاء اللي هو اللي سمينا .. قولنا flaccid
+
+367
+00:27:24,590 --> 00:27:29,390
+paralysis الآن في الحالة التانية اللي قولنا عنها
+
+368
+00:27:29,390 --> 00:27:34,730
+اللي هي tetanus ال tetanus بشتر على مين؟ بمنع هذا
+
+369
+00:27:36,530 --> 00:27:41,110
+إذا مانع هذا فش relaxation فش relaxation حاجة اللي
+
+370
+00:27:41,110 --> 00:27:45,890
+عندك دلوقت contraction بشكل مستمر وبالتالي حاسس ان
+
+371
+00:27:45,890 --> 00:27:53,970
+البرازيز plastic هنفسي
+
+372
+00:27:53,970 --> 00:28:04,030
+اعملها النوع اللي هنا flaccid
+
+373
+00:28:04,030 --> 00:28:11,290
+paralysis وصل الصورةهذا هو باختصار بنذكر أنه في
+
+374
+00:28:11,290 --> 00:28:14,230
+عملية تانية contraction and relaxation ال
+
+375
+00:28:14,230 --> 00:28:18,270
+contraction بده acetylcholine إذا أنا منعت ال
+
+376
+00:28:18,270 --> 00:28:20,290
+acetylcholine منعت ال acetylcholine مافيش
+
+377
+00:28:20,290 --> 00:28:23,870
+contraction يبقى صار عندي شيء للارتخاء ال
+
+378
+00:28:23,870 --> 00:28:28,390
+relaxation بدها inhibitor للacetylcholine إذا منعت
+
+379
+00:28:28,390 --> 00:28:32,090
+ال acetylcholine inhibitor معناه الحق يصير عندي
+
+380
+00:28:32,090 --> 00:28:35,650
+spastic paralysis contraction بشكل مستمر
+
+381
+00:28:41,340 --> 00:28:44,260
+التوكسين .. التوكسين هو اللي منع ال .. ال .. ال ..
+
+382
+00:28:44,260 --> 00:28:46,000
+في هذا الحالة البطولان التوكسين منع الـ
+
+383
+00:28:46,000 --> 00:28:48,720
+acylcholine والتيتانوس التوكسين هو اللي منع ال
+
+384
+00:28:48,720 --> 00:28:52,640
+inhibitor of الacylcholine طيب ركزولي بس في نقطة
+
+385
+00:28:52,640 --> 00:28:58,780
+مهمة نتكلم فيها عن تيتانوسيسمى المرض بعض الأحيان
+
+386
+00:28:58,780 --> 00:29:04,020
+Black Joe Black Joe يعني الفك المغلق بتحسه المريض
+
+387
+00:29:04,020 --> 00:29:08,780
+دايما مسكر أسنانه وهم بالعربي ما يسمونه كزاز المرض
+
+388
+00:29:08,780 --> 00:29:14,220
+هذا كزاز لإن الأسنان مطبقة على بعضها البعض وبعض
+
+389
+00:29:14,220 --> 00:29:18,740
+الأحيان يسمونه fixed smile الإبتسامة الثابتة عشان
+
+390
+00:29:18,740 --> 00:29:22,460
+ذلك مش كل واحد مبتسم بيكون سعيد ممكن يكون عنده
+
+391
+00:29:22,460 --> 00:29:28,650
+tetanus تمام؟ ممكن يكون عنده tetanusال .. ال ..
+
+392
+00:29:28,650 --> 00:29:32,410
+الكلستروليوم تيتاني توكسين is a very dangerous
+
+393
+00:29:32,410 --> 00:29:38,670
+toxin very serious disease ال contractions مش عارف
+
+394
+00:29:38,670 --> 00:29:42,490
+انه هو asbestic paralysis ال contraction ممكن تكون
+
+395
+00:29:42,490 --> 00:29:45,930
+violent .. violent لدرجة انها تكسر العمود الفقري
+
+396
+00:29:45,930 --> 00:29:50,970
+الناس بتجوز لقدام مرضى الناس بيجوز لورا بيكون حرف
+
+397
+00:29:50,970 --> 00:29:54,410
+C عامل لورا تمام؟ لما يكون عنده ال asbestic
+
+398
+00:29:54,410 --> 00:30:01,010
+paralysis هذا مثالأو هذا المرض مثال على جداش
+
+399
+00:30:01,010 --> 00:30:06,730
+الثقافة في ال public عند الناس قد تساهم في القضاء
+
+400
+00:30:06,730 --> 00:30:10,550
+على الأمراض عندنا في المجتمع الفلسطيني على سبيل
+
+401
+00:30:10,550 --> 00:30:17,990
+المثال لا يوجد متعلم أو غير متعلمإلا ويعلم معلومة
+
+402
+00:30:17,990 --> 00:30:22,390
+بسيطة انه اذا غزك مصمار او .. او .. او حاجة روح
+
+403
+00:30:22,390 --> 00:30:25,730
+خده و اديه على العيادة اعطيه قبرة تيتانوس هي قبرة
+
+404
+00:30:25,730 --> 00:30:29,090
+ضد التيتانوس اللي كاهلة مسميها قبرة تيتانوس لذلك
+
+405
+00:30:29,090 --> 00:30:32,370
+بنلاقي تقريبا المرض من عشر سنوات لليوم تقريبا zero
+
+406
+00:30:32,370 --> 00:30:39,160
+cases ماعناش اي حالةكمان مرة مش بدى افتخر او نفتخر
+
+407
+00:30:39,160 --> 00:30:43,340
+بانه ماقناش الحالات هذه باننا نفتخر بانه و نفهم
+
+408
+00:30:43,340 --> 00:30:48,380
+انه الثقافة العامة قد توفر على الأمة يعني بمعنى
+
+409
+00:30:48,380 --> 00:30:53,680
+الثقافة الحقيقية توفر على الأمة ال burden او أعباء
+
+410
+00:30:53,680 --> 00:30:57,540
+تكلفة أمراض خطيرة قد تؤدي الى وفيات عالية زي مرض
+
+411
+00:30:57,540 --> 00:30:58,000
+اتنان
+
+412
+00:31:02,780 --> 00:31:10,160
+موجود نعم .. موجود نعم صحيح .. صحيح لكن احنا بيقول
+
+413
+00:31:10,160 --> 00:31:15,260
+كمام الرب إذا غزوا مصمار و نقلوا و عملنا .. في أن
+
+414
+00:31:15,260 --> 00:31:18,780
+تلت أشياء لازم نعملها proper care of wound يعني
+
+415
+00:31:18,780 --> 00:31:23,920
+الاهتمامالجيد في الجروح رقم اتنين اللي هو ال
+
+416
+00:31:23,920 --> 00:31:27,160
+immunization with vaccine و ال protection with
+
+417
+00:31:27,160 --> 00:31:31,700
+antitoxin و في كمان حاجة رابعة اللي هو treatment
+
+418
+00:31:31,700 --> 00:31:34,980
+with antibiotics و هذه الأربع أشياء في قطاع غزة او
+
+419
+00:31:34,980 --> 00:31:38,420
+في فلسطين متبعة بشكل جيد وبتالي ان عدد الحلقات
+
+420
+00:31:38,420 --> 00:31:46,900
+كمان مرة صفر ناخد كخاتمة لموضوع ال toxins اللي هي
+
+421
+00:31:46,900 --> 00:31:52,200
+طبعا احنا اشرحتها بشكل مختصر الصحيةcomparison
+
+422
+00:31:52,200 --> 00:31:56,860
+between x-toxin and endotoxins طبعا ال comparison
+
+423
+00:31:56,860 --> 00:32:00,960
+هنا مش فقط عشان خاطر الامتحان بل عشان خاطر نفهم
+
+424
+00:32:00,960 --> 00:32:04,600
+بعض الأمور منها على سبب المثال لما بنتكلم عن ال
+
+425
+00:32:04,600 --> 00:32:09,240
+toxin معظمها هنا ال x-toxin heat, labile, معادة
+
+426
+00:32:09,240 --> 00:32:13,040
+فاكرين ال stuff اللي جوه gas aureus؟
+
+427
+00:32:16,070 --> 00:32:19,850
+الستافيلوكوكاس أورياس هي ال exotoxin الوحيد اللي
+
+428
+00:32:19,850 --> 00:32:23,530
+بنعرفه اللي هو heat stable exception لمن؟ لل
+
+429
+00:32:23,530 --> 00:32:29,190
+exotoxin بينما كل ال intoxin heat stable يعني لو
+
+430
+00:32:29,190 --> 00:32:32,970
+سخلنا الأكل طريقة جيدة و كان في exotoxin هندمر و
+
+431
+00:32:32,970 --> 00:32:37,020
+مع دمين؟الـ Staphylococcus aureus طب بنرجع من
+
+432
+00:32:37,020 --> 00:32:41,120
+الأول ال X-Toxin can be produced by both Gram
+
+433
+00:32:41,120 --> 00:32:44,400
+بُسطي و Gram نيجاتي بينما ال N-Toxin it is only
+
+434
+00:32:44,400 --> 00:32:50,600
+for Gram نيجاتي فكتير يعني هذه ممكن تنتجها ل Gram
+
+435
+00:32:50,600 --> 00:32:54,180
+بُسطي و Gram نيجاتي بل إنها فقط مين ل Gram نيجاتي
+
+436
+00:32:54,180 --> 00:32:59,160
+released from the cell while the cell is alive
+
+437
+00:32:59,160 --> 00:33:03,380
+يعني الخلية بتكون حية و بننتج ال toxinبينما ال
+
+438
+00:33:03,380 --> 00:33:07,120
+endotoxin يعتبر جزء رئيسي من تكوين الخلية أو تكوين
+
+439
+00:33:07,120 --> 00:33:11,800
+السلول and it is not released unless the cells are
+
+440
+00:33:11,800 --> 00:33:16,660
+dead and lysed بأنه في دراسات حديثة بتقول انه they
+
+441
+00:33:16,660 --> 00:33:22,940
+can release very minute amounts كمية قليلة جدا غير
+
+442
+00:33:22,940 --> 00:33:28,680
+مفسرة لحد تلان لكن في كميات لبس بهاالتركيب
+
+443
+00:33:28,680 --> 00:33:32,440
+الكيميائي له هو عبارة عن protein بينما هناك lipid
+
+444
+00:33:32,440 --> 00:33:38,000
+A of lipopolysaccharideكتير أنواع مختلفة شفنا في
+
+445
+00:33:38,000 --> 00:33:41,020
+ال exotoxin اتناشر نوع اللي قلعناهم قبل شوية او
+
+446
+00:33:41,020 --> 00:33:46,160
+اتناشر اسم بينما هو نوع واحد اسمه endotoxin هذا لا
+
+447
+00:33:46,160 --> 00:33:48,820
+يعني ان ال endotoxin اللي في البكتيريا كله
+
+448
+00:33:48,820 --> 00:33:52,900
+identical لأ فيه تفاوت في التركيب لكن في الآخر
+
+449
+00:33:52,900 --> 00:33:57,060
+يعني مش قادرين نميزهم عن بعض بشكل زي ما اتميزنا ال
+
+450
+00:33:57,060 --> 00:34:00,160
+exotoxin حاجة ان هي تلقى bilase و هي stable
+
+451
+00:34:00,160 --> 00:34:04,740
+specific receptors on host target cellsمع كل
+
+452
+00:34:04,740 --> 00:34:07,860
+توكسين كنا نقول باستقبله الخلايا الفلانية أو
+
+453
+00:34:07,860 --> 00:34:13,160
+ريسبته الفلانية بينما هذا diverse range of host
+
+454
+00:34:13,160 --> 00:34:17,300
+cell and system affected يعني بيأثر على أنواع
+
+455
+00:34:17,300 --> 00:34:22,180
+كثيرة من الخلايا وعلى أجهزة الدسم المتنوعة كمان
+
+456
+00:34:22,180 --> 00:34:29,880
+بالنسبة للتأثيرات عكسه لأ نفس الكلام تأثيرات تأثير
+
+457
+00:34:29,880 --> 00:34:34,760
+غالبا بيكون specific effect on the hostليش
+
+458
+00:34:34,760 --> 00:34:38,000
+specific effect شباب؟ لأنه أصلا هو إله specific
+
+459
+00:34:38,000 --> 00:34:42,240
+activity، إله specific activity هنا برضه diverse
+
+460
+00:34:42,240 --> 00:34:47,120
+range، أخبرنا جابش في بداية المحاضرة إنه ممكن من
+
+461
+00:34:47,120 --> 00:34:51,520
+simple fever ل shock، تمام؟ ال activation of
+
+462
+00:34:51,520 --> 00:34:55,180
+complement, vasodilatation، ال low blood pressure،
+
+463
+00:34:55,180 --> 00:34:59,000
+مجموعة كبيرة من الأعراض قد يسببها أو التأثيرات قد
+
+464
+00:34:59,000 --> 00:35:00,300
+يسببها ال endotoxin
+
+465
+00:35:03,520 --> 00:35:06,560
+Toxoids can be made by treating with formalin
+
+466
+00:35:06,560 --> 00:35:10,740
+بينما في ال gram negative in the toxin it cannot
+
+467
+00:35:10,740 --> 00:35:13,860
+وبالتالي هل نقدر نعمله vaccination هل نقدر نعمله
+
+468
+00:35:13,860 --> 00:35:18,400
+vaccination؟ فى هد عنده اي سؤال على ال toxins
+
+469
+00:35:18,400 --> 00:35:23,420
+واضحة المسألة ان شاء الله طيب ننتقل للجزء اللى
+
+470
+00:35:23,420 --> 00:35:28,580
+بعده بدنا نتكلم على نقطة كتير مهمة اسمها natural
+
+471
+00:35:28,580 --> 00:35:32,530
+habitat of microbes أصل الميكروبات وين؟زميلكوا
+
+472
+00:35:32,530 --> 00:35:35,970
+جالجة بشوية أنه البكتيريا مولودة في التربة بشكل
+
+473
+00:35:35,970 --> 00:35:39,990
+مستمر و أي وجهة احنا ممكن نصاب في البكتيريا فما هي
+
+474
+00:35:39,990 --> 00:35:44,430
+مصادر ال pathogen بشكل عام من الدنيا؟ واحد soil
+
+475
+00:35:44,430 --> 00:35:48,150
+المصدر الأساسي .. المصدر الأساسي للميكروبات هو
+
+476
+00:35:48,150 --> 00:35:53,990
+التربة قد تقع الأمطار على التربة وتجرف جزء من
+
+477
+00:35:53,990 --> 00:35:57,920
+التربة وتنقلها إلى الأنهار والبحارفحتى البكتيريا
+
+478
+00:35:57,920 --> 00:36:00,740
+اللى ممكن تكون في المياه ممكن يكون مصدرها وين؟
+
+479
+00:36:00,740 --> 00:36:06,160
+التربة قد تثير الرياح الغبار وتنقل إلنا بعض
+
+480
+00:36:06,160 --> 00:36:09,780
+الميكروبات عبر الجو لكن مصدرها الأساسي وين؟ التربة
+
+481
+00:36:09,780 --> 00:36:13,060
+فال soil تعتبر مصدر أساسي لكن كمان في مصادر تانية
+
+482
+00:36:13,060 --> 00:36:16,960
+الإنسان، أمعاق، حيوانات and animal products
+
+483
+00:36:19,370 --> 00:36:24,230
+تسمعوا بال .. بالmicrobial flora او ال microbiota
+
+484
+00:36:24,230 --> 00:36:31,690
+.. ال microbiota of human body مافيش إنسان جاعد في
+
+485
+00:36:31,690 --> 00:36:36,840
+الغرفة تبعتنا هذه sterile، معقّملو أخدنا مسحة من
+
+486
+00:36:36,840 --> 00:36:42,040
+وجهه، بما أنه متحمم و جاى، مغسل و جاى، لو أخدنا من
+
+487
+00:36:42,040 --> 00:36:46,000
+فمه، هلاجي ملايين الميكروبات، تمام؟ طب هو بفرج
+
+488
+00:36:46,000 --> 00:36:49,780
+صنانه و شارب جهوة و شارب شاي سخن، يعني ممكن موت
+
+489
+00:36:49,780 --> 00:36:53,940
+بعض البكتيريا، لكن هلاجي بكتيريا، لو أخدنا من
+
+490
+00:36:53,940 --> 00:36:58,820
+الستول تبع الإنسان، هلاجي في عنده micro organism،
+
+491
+00:36:58,820 --> 00:37:04,080
+ليس من الطبيعي قال لنا جديعني الطبيعي إنه نجد
+
+492
+00:37:04,080 --> 00:37:08,460
+تمام؟ اللي مش طبيعي إنه مالناجيش micro organism
+
+493
+00:37:08,460 --> 00:37:10,920
+إذا ال normal microbiota أو normal flora في
+
+494
+00:37:10,920 --> 00:37:14,280
+الإنسان بدنا نعرف إنه على ال skin على سبيل المثال
+
+495
+00:37:14,280 --> 00:37:18,900
+مليان micro organism زي Staphylococcus epidermidis
+
+496
+00:37:18,900 --> 00:37:21,920
+و Staphylococcus aureus أنا مكتوب هنا ال gram
+
+497
+00:37:21,920 --> 00:37:24,520
+-bostef بكتيريا are the most common اللي هم
+
+498
+00:37:24,520 --> 00:37:27,320
+ماجبوني كمان مرة Staphylococcus epidermidis و
+
+499
+00:37:27,320 --> 00:37:31,530
+Staphylococcus aureus شبابأنا لأ أدرس ال normal
+
+500
+00:37:31,530 --> 00:37:34,410
+flora على دسم الإنسان عشان أقولكوا أن فيه بكتيريا
+
+501
+00:37:34,410 --> 00:37:37,890
+لازم تبقى عارف أنه كل كلمة بنحكيها في ال
+
+502
+00:37:37,890 --> 00:37:43,010
+microbiology لها مدلولاتها ولها استخداماتها عندما
+
+503
+00:37:43,010 --> 00:37:48,250
+أتعامل مع عينات مرضية أو مع مرضى وانا أعرف أن
+
+504
+00:37:48,250 --> 00:37:55,150
+إيديا فيهم microorganism ولما بقول مريض .. لما
+
+505
+00:37:55,150 --> 00:37:57,810
+بقول مريض بيكونوا يعرفوا أن المريض بيختلف عنكوا
+
+506
+00:37:57,810 --> 00:38:03,620
+شويةانتوا متأثروش ممكن كأصحاء بالمايكروبات اللي
+
+507
+00:38:03,620 --> 00:38:06,830
+موجودة على ال normal فضلاله تبعت بعضمانتوا بتسلموا
+
+508
+00:38:06,830 --> 00:38:10,910
+على بعض وبتحضروا بعض بعض الأحيان صح ولا بتأثروش
+
+509
+00:38:10,910 --> 00:38:14,050
+لكن المرضى بيتعرفوا انهم immunocompromised
+
+510
+00:38:14,050 --> 00:38:17,670
+immunocompromised وانا فاكرين المحاضرة اللي قلت
+
+511
+00:38:17,670 --> 00:38:21,230
+فيها لا يوجد خط فاصل ما بين pathogen و non
+
+512
+00:38:21,230 --> 00:38:24,750
+pathogen وبالتالي بدنا نكون حاذرين جدا في التعامل
+
+513
+00:38:24,750 --> 00:38:28,010
+مع المرضى بدنا نكون حاذرين في التعامل مع العينات
+
+514
+00:38:28,010 --> 00:38:31,830
+حتى لو لا نلوث العينات بالميكروبات اللي موجودة على
+
+515
+00:38:31,830 --> 00:38:38,430
+أيدينا او في أنفناأو في الفم عندما نتحدث و نحن
+
+516
+00:38:38,430 --> 00:38:42,150
+نقوم بالزراعة زراعة الميكروبات انت واقع الأمر
+
+517
+00:38:42,150 --> 00:38:45,810
+بتزراع ميكروبات من مين كمان؟ من الفم والأسف
+
+518
+00:38:45,810 --> 00:38:49,070
+الميكروبات لما تطلع على الطبق بتقول أنا من الفم و
+
+519
+00:38:49,070 --> 00:38:53,410
+أنا من المريض لأ كلهم بيشبهوا بعض وبالتالي المطلوب
+
+520
+00:38:53,410 --> 00:38:57,670
+منك انك تحافظ على العينات تبعتك من التلوث
+
+521
+00:39:02,570 --> 00:39:07,090
+الـ respiratory tract سؤال بسيط ال respiratory
+
+522
+00:39:07,090 --> 00:39:10,470
+tract جوا الدسم ولا برا الدسم؟ انا بقولكوا برا
+
+523
+00:39:10,470 --> 00:39:17,330
+الدسم برا الدسم اتخيل انها بس بدل ما هي الكيس برا
+
+524
+00:39:17,330 --> 00:39:22,490
+حاطينه هنا جوا في احتكاك مع العالم الخارجي وبتالي
+
+525
+00:39:22,490 --> 00:39:26,110
+هي صحيح internal لكن اعتبرها external لو في اتصال
+
+526
+00:39:26,110 --> 00:39:30,820
+مع العالم الخارجيطبعا بيجسموا ال respiratory tract
+
+527
+00:39:30,820 --> 00:39:35,380
+إلى عدة أجزاء mouth and oropharynx بتكونوا تتذكروا
+
+528
+00:39:35,380 --> 00:39:41,320
+ان ال saliva اللعاب عارفين واحد ملي من اللعاب واحد
+
+529
+00:39:41,320 --> 00:39:47,040
+مل من ال saliva بيحتوي
+
+530
+00:39:47,040 --> 00:39:56,900
+على عشرة اص تسعة لعشرة اص اتناش cell per mlطبعا
+
+531
+00:39:56,900 --> 00:40:00,680
+ماعنديش معرفة بالتريليونات والمليونات لكن الف
+
+532
+00:40:00,680 --> 00:40:05,060
+مليون .. الف مليون .. اه لعد .. لعد الف .. الف
+
+533
+00:40:05,060 --> 00:40:11,280
+مليون خلية لكل ملي .. لكل ملي من اللعاب اللي هو
+
+534
+00:40:11,280 --> 00:40:19,300
+الصليبان رقم مهول لو مش مهول يشبه العدد في الكثافة
+
+535
+00:40:19,300 --> 00:40:23,540
+عدد البكتيرا في الستول فاللعاب و الستول بيحتووا
+
+536
+00:40:23,540 --> 00:40:28,760
+عدد كميات ضخمة من ال micro organismعشان انا كده في
+
+537
+00:40:28,760 --> 00:40:31,220
+بعض العادات عند بعض الناس انه بيستخدم ال saliva
+
+538
+00:40:31,220 --> 00:40:35,460
+تبعته لأشياء معينة للاسق طابع بريد ولا عشان يفتح
+
+539
+00:40:35,460 --> 00:40:42,160
+صفحة هذه العادة نرجو يعني انه نبتعد عنها teeth and
+
+540
+00:40:42,160 --> 00:40:52,320
+gums الأسنان واللثة nose and nasopharynx العين ال
+
+541
+00:40:52,320 --> 00:40:56,440
+conjunctiva ملتحة مثل العين العين خدوا بالكوا
+
+542
+00:40:57,890 --> 00:41:01,670
+External ولا Internal برضه؟ واضح إنها بتتعرض
+
+543
+00:41:01,670 --> 00:41:05,990
+للميكروبات من الهواء ومن أشياء كثيرة لكن ال
+
+544
+00:41:05,990 --> 00:41:10,850
+continuous washing العملية الغسل المستمرة للعين
+
+545
+00:41:10,850 --> 00:41:14,590
+تجعل من عد الميكروبات في العين تجعل العين شبه
+
+546
+00:41:14,590 --> 00:41:19,810
+استيرايل بالاضافة إلى إنتاج العين اللي هو الدموع
+
+547
+00:41:19,810 --> 00:41:23,470
+أو ال tears اللي فيها ال lysozymes اللي بتكسر كثير
+
+548
+00:41:23,470 --> 00:41:25,270
+من ال gram-boosted bacteria
+
+549
+00:41:27,900 --> 00:41:31,780
+الـ gram-bostev بكتيريا إيش في بتتميز بإيش؟
+
+550
+00:41:31,780 --> 00:41:36,160
+multiple layer of peptidoglycan و cross link
+
+551
+00:41:36,160 --> 00:41:41,140
+فاكرين؟ لأ ال gram-bostev مافيهاش outer membrane
+
+552
+00:41:41,140 --> 00:41:44,160
+فيها multiple layer of peptidoglycan طبقات متعددة
+
+553
+00:41:44,160 --> 00:41:51,720
+و مرتبطة من بعض ب cross links الآن ال lysozyme
+
+554
+00:41:51,720 --> 00:41:54,400
+بتكسر ال peptidoglycan نفسه
+
+555
+00:41:57,440 --> 00:42:01,860
+عشان هيك بنلاقي ان الهاين غالبا لا تصاب بال ground
+
+556
+00:42:01,860 --> 00:42:05,580
+positive، تصاب بمين؟ بال ground negative، ماعدا
+
+557
+00:42:05,580 --> 00:42:08,320
+ground positive واحدة احفظوها اسمها stirtococcus
+
+558
+00:42:08,320 --> 00:42:15,540
+pneumonia غالبا
+
+559
+00:42:15,540 --> 00:42:18,180
+هي resistant لمين؟ للليزو زيبز
+
+560
+00:42:22,270 --> 00:42:27,090
+يبقى ال I فهمنا بعض المعلومات حولها نجي لل ear
+
+561
+00:42:27,090 --> 00:42:32,650
+فيها حاسمة inner و middle و exterior طبعا ال
+
+562
+00:42:32,650 --> 00:42:35,950
+exterior اللي هي الصيوان الأذن هذا هو يعتبر جزء من
+
+563
+00:42:35,950 --> 00:42:39,550
+الجلد وبالتالي it is always colonized لازم يكون في
+
+564
+00:42:39,550 --> 00:42:43,080
+عليها بكتيريالكن ال inside و ال middle مش لازم
+
+565
+00:42:43,080 --> 00:42:46,020
+يكون فيها بكتيريا و كلكم بتعرفوا الشميع اللي في
+
+566
+00:42:46,020 --> 00:42:48,900
+الأذن هذا هذا ال wax اللي في الأذن هذا
+
+567
+00:42:48,900 --> 00:42:53,060
+antimicrobial substance يعني له قدرة على قتل
+
+568
+00:42:53,060 --> 00:42:57,220
+البكتيريا له .. ليش؟ لأن هو عبارة عن unsaturated
+
+569
+00:42:57,220 --> 00:43:00,860
+fatty acid و بعض العلماء اللي استخدموه أخدوا الجزء
+
+570
+00:43:00,860 --> 00:43:06,800
+من الصمغ .. الصمغ .. الشميع بتاع الأذن و وضع على
+
+571
+00:43:06,800 --> 00:43:12,430
+التهابات جروح فشوفيتدليل على أنه فالناس اللي
+
+572
+00:43:12,430 --> 00:43:16,370
+بتستخدم برضه باستمرار عملية تنظيف الغير الصحية قد
+
+573
+00:43:16,370 --> 00:43:20,570
+يؤذي الجسم أو قد يؤذي الأذن بإنه بيزيل هذه الطبقة
+
+574
+00:43:20,570 --> 00:43:26,630
+المهمة جدا من الشمال طب ال gastrointestinal tract
+
+575
+00:43:26,630 --> 00:43:33,170
+هذي completely outside ولا كلها inside؟ outside في
+
+576
+00:43:33,170 --> 00:43:37,730
+فتحتين فتحت الفم وفتحت الشرج يعني مجرد أن أنا برضه
+
+577
+00:43:37,730 --> 00:43:38,470
+مركب جوا
+
+578
+00:43:43,940 --> 00:43:48,920
+طبعا طولها طويل جدا تتذكروا الأمعاء جدش الغليظة
+
+579
+00:43:48,920 --> 00:43:54,260
+والدقيقة وبالتالي أنا لما أعرفت كلمة niche
+
+580
+00:43:54,260 --> 00:43:59,040
+فاكرينها أصغر
+
+581
+00:43:59,040 --> 00:44:06,500
+واحدة بيئية أكم واحدة بيئية حلجة في الأمعاءالاف صح
+
+582
+00:44:06,500 --> 00:44:11,540
+باختلاف العمق و باختلاف ال location و ال anatomy
+
+583
+00:44:11,540 --> 00:44:16,140
+تبع الأضواء وبالتالي بتوقع ان يكون فينا كمية كبيرة
+
+584
+00:44:16,140 --> 00:44:19,340
+من الميكروبات اللي موجودة في هذا الاماكن طبعا
+
+585
+00:44:19,340 --> 00:44:24,720
+المعدة حامض ال pH منخفض جدا مافيش حاجة اسمها
+
+586
+00:44:24,720 --> 00:44:27,720
+normal flora في المعدة في بكتيريا واحدة قادرة على
+
+587
+00:44:27,720 --> 00:44:30,640
+ان تتم ال infection اللي حتى الآن بنعرفها اسمها
+
+588
+00:44:30,640 --> 00:44:31,680
+helicobacter pylori
+
+589
+00:44:37,800 --> 00:44:41,020
+الاسوفاجوس غالبا مافيش فيه micro organism إلا
+
+590
+00:44:41,020 --> 00:44:44,780
+transient اللى بتنزل مع الأكل لكن فى الآخر مافيش
+
+591
+00:44:44,780 --> 00:44:48,920
+colonization للبكتيريا فى الاسوفاجوس لكن الفم
+
+592
+00:44:48,920 --> 00:44:53,240
+ماحنا قوله قبل شوية saliva مليان بال micro
+
+593
+00:44:53,240 --> 00:44:57,720
+organism حكينا إنه ال gastric mucosa of stomach
+
+594
+00:44:57,720 --> 00:45:01,180
+acid is acid tolerant organism فقط واحد هي اللى
+
+595
+00:45:01,180 --> 00:45:04,740
+قلنا عنها مين ال H-Pylori لإن هذى resistant للاسد
+
+596
+00:45:04,740 --> 00:45:08,240
+عارفين كيف resistant ال acid شباب هذى؟هذه بتنتج
+
+597
+00:45:08,240 --> 00:45:13,620
+انزيم اسمه يورياز ال يورياز بيكسر اليوريا لأمونيا
+
+598
+00:45:13,620 --> 00:45:18,940
+ال ammonia alkaline الان و هي بتسبح في ال acid
+
+599
+00:45:18,940 --> 00:45:27,560
+كأنها بتسبح و مغطا ب .. زي واحد بدخل مثلا مكان فيه
+
+600
+00:45:27,560 --> 00:45:31,820
+حريق و حاط على حاله blanket مية
+
+601
+00:45:33,930 --> 00:45:37,170
+بتأثر بالحريق؟ بتأثرش، نفس الشيء هي داخلة في
+
+602
+00:45:37,170 --> 00:45:42,130
+الحامض لكن حواليها هالة من ايه؟ من ال ammonia لإنه
+
+603
+00:45:42,130 --> 00:45:46,090
+ال ammonia alkaline فبتعادل ال acid فبتنجح، اخدوا
+
+604
+00:45:46,090 --> 00:45:48,910
+بالكوا، هي بحاجة إلى هذه ال .. ال .. ال .. ال ..
+
+605
+00:45:48,910 --> 00:45:49,330
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+606
+00:45:49,330 --> 00:45:49,330
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+607
+00:45:49,330 --> 00:45:49,330
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+608
+00:45:49,330 --> 00:45:49,330
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+609
+00:45:49,330 --> 00:45:49,330
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+610
+00:45:49,330 --> 00:45:49,330
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+611
+00:45:49,330 --> 00:45:49,330
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+612
+00:45:49,330 --> 00:45:49,330
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+613
+00:45:49,440 --> 00:45:55,460
+الأمونيا لفترة وجيزة من دخولها المعدة إلى اختراقها
+
+614
+00:45:55,460 --> 00:45:59,740
+للجدار إذا اختراقت الجدار ما بعد الجدار هو سبعة
+
+615
+00:45:59,740 --> 00:46:05,260
+وأربعة من عشرة ال PH متعدد فبالتالي خلص خلصت مهمة
+
+616
+00:46:05,260 --> 00:46:10,280
+اللي هو اليوريز لكن حتى to survive to survive it
+
+617
+00:46:10,280 --> 00:46:14,540
+should require اللي هو اليوريز بنكمل ان شاء الله
+
+618
+00:46:14,540 --> 00:46:15,720
+المرة القادمة
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y.srt
new file mode 100644
index 0000000000000000000000000000000000000000..00887de76a91059580d4fe71e738c7b4fc06a7eb
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y.srt
@@ -0,0 +1,2094 @@
+1
+00:00:20,480 --> 00:00:22,760
+السلام عليكم ورحمة الله وبركاته بسم الله الرحمن
+
+2
+00:00:22,760 --> 00:00:25,820
+الرحيم اليوم برضه ميكروب جديد إن شاء الله اللي هو
+
+3
+00:00:25,820 --> 00:00:32,160
+الـ Vibrio الـ Vibrio بتميز عن الـ gram negative بس
+
+4
+00:00:32,160 --> 00:00:35,460
+بـ lie بالشكل ولذلك سمي Vibrio لأنه بيمتلك شكل
+
+5
+00:00:35,460 --> 00:00:43,380
+كومة أو curved، كومة أو كومة كيرف وبالتالي كلمة
+
+6
+00:00:43,380 --> 00:00:48,740
+Vibrio تعني الملوية، يعني المنحنية، الواوية هذا
+
+7
+00:00:48,740 --> 00:00:54,220
+الاسم مهم جداً نعرفه من البداية لأن إحنا بنقول أنه
+
+8
+00:00:54,220 --> 00:00:59,520
+في الـ stool، الـ gram stain العينة في الـ stool is of
+
+9
+00:00:59,520 --> 00:01:03,320
+no value in all bacterial infection except in one
+
+10
+00:01:03,320 --> 00:01:06,980
+case except in Vibrio ليش؟ لأن إحنا هنشوف في هذا
+
+11
+00:01:06,980 --> 00:01:13,530
+الحالة many يعني كتير of the curved بس الـ  لي وهذا
+
+12
+00:01:13,530 --> 00:01:17,950
+مؤشر عن أن المريض قد يكون مصاباً بالـ Vibrio  إذنليه
+
+13
+00:01:17,950 --> 00:01:22,330
+طبعاً أن هذه الحالة في الأوبئة هذا بيساعدنا في
+
+14
+00:01:22,330 --> 00:01:24,270
+بيقصر الوقت اللي هو التشخيص
+
+15
+00:01:26,720 --> 00:01:29,120
+الاسم المشهور واللي كلكم بتعرفوه هو الـ Vibrio
+
+16
+00:01:29,120 --> 00:01:31,940
+cholera لكن هناك أسماء أخرى غير الـ Vibrio cholera
+
+17
+00:01:31,940 --> 00:01:35,920
+زي مثلاً اللي هو الـ Vibromimicus ومن اسمها mimicus
+
+18
+00:01:35,920 --> 00:01:41,620
+من mimic، mimic يحاكي وهي حقاً تشبه إلى حد كبير في
+
+19
+00:01:41,620 --> 00:01:45,940
+الشكل والمواصفات إلى اللي هو الـ Vibrio cholera، الـ
+
+20
+00:01:45,940 --> 00:01:50,300
+Vibrio parahaemolyticus هذا ميكروب اشتهر أكثر في
+
+21
+00:01:50,300 --> 00:01:51,740
+الـ food microbiology
+
+22
+00:01:54,260 --> 00:01:58,220
+كـ food-borne pathogen، كـ food-borne pathogen، والأحرى
+
+23
+00:01:58,220 --> 00:02:04,020
+with seafood بالظبط
+
+24
+00:02:04,020 --> 00:02:08,900
+الآن الـ seafood بتعرفوا الطعام المشهور لليابانيين
+
+25
+00:02:08,900 --> 00:02:12,120
+اللي هو السوشي اللي هو السمك النيء اللي غير مطهي
+
+26
+00:02:12,120 --> 00:02:17,120
+بهذه الخدمة أو هذا النوع من الطعام شائع في كثير من
+
+27
+00:02:17,120 --> 00:02:23,440
+البلدان العالم كـ ثقافة غذائية نشرها اليابانيون في كل
+
+28
+00:02:23,440 --> 00:02:31,310
+مكان، وبالتالي الميكروب مرتبط بالأغذية البحرية
+
+29
+00:02:31,310 --> 00:02:33,890
+اللي غير المطهية اللي من ضمنها، جنباً إلى جنب السمك ومن
+
+30
+00:02:33,890 --> 00:02:37,970
+ضمنها الشيل فش هذا الميكروب is a marine organism
+
+31
+00:02:37,970 --> 00:02:43,990
+يعني ميكروب بحري وبالتالي هينتقل عبر هذه الأسماك
+
+32
+00:02:43,990 --> 00:02:48,080
+ويسبب لنا food poisoning cases، هنا الـ Vibrio
+
+33
+00:02:48,080 --> 00:02:51,340
+vulnificus كانت في السابق  يُعتَبَر non-pathogen لكن
+
+34
+00:02:51,340 --> 00:02:53,900
+الآن يُعتَبَر أنها بتسبب wound infection و
+
+35
+00:02:53,900 --> 00:02:57,500
+septicemia، إذاً في عندي كمان مرة Vibrio cholera وهي
+
+36
+00:02:57,500 --> 00:03:00,220
+الـ most common والـ most important species of all
+
+37
+00:03:00,220 --> 00:03:05,980
+هي المسبب لـ epidemic cholera، Vibrio mimicus لسه
+
+38
+00:03:05,980 --> 00:03:09,220
+important لكن أهميتها هنا بتشبه مين؟ الـ Vibrio
+
+39
+00:03:09,220 --> 00:03:12,710
+cholera شكلاً وbiochemically، مش disease، Vibrio
+
+40
+00:03:12,710 --> 00:03:17,930
+parahaemolyticus قلنا أنّه تزيد الاهتمام بها نظراً
+
+41
+00:03:17,930 --> 00:03:22,630
+لما قلنا أنها تزيد ثقافة تناول الأسماك غير
+
+42
+00:03:22,630 --> 00:03:26,470
+المطهية، الـ Vibrio vulnificus ثبت أنها بتسبب wound
+
+43
+00:03:26,470 --> 00:03:27,890
+infection والـ septicemia
+
+44
+00:03:30,830 --> 00:03:34,650
+البكتيريا الـ genus Vibrio الـ .. الـ .. الـ Vibrio
+
+45
+00:03:34,650 --> 00:03:39,170
+بنا بيتميز بالشكل تبعه، أنه comma shape أعتقد أن
+
+46
+00:03:39,170 --> 00:03:42,710
+الصورة اللي هناك على طرف بوب بتوضح لنا أن
+
+47
+00:03:42,710 --> 00:03:47,330
+البكتيريا بسيلي صحيح لكن مش straight، مش straight
+
+48
+00:03:47,330 --> 00:03:51,110
+يعني مش أدلة وبالتالي هي curved، they are small,
+
+49
+00:03:51,310 --> 00:03:54,630
+gram-negative, curved، بسيلي أو rods, motile,
+
+50
+00:03:54,750 --> 00:03:57,610
+bipolar flagella زي Pseudomonas يبقى وجه شبه الآن
+
+51
+00:03:57,610 --> 00:04:03,590
+بينها وبينها حاجتين، هنشوف كمان شوية إنها Oxidase
+
+52
+00:04:03,590 --> 00:04:06,110
+positive وPseudomonas aeruginosa برضه Oxidase
+
+53
+00:04:06,110 --> 00:04:11,190
+positive، هذه البكتيريا  مطاع  بـ bipolar flagella و
+
+54
+00:04:11,190 --> 00:04:14,390
+Pseudomonas aeruginosa برضه مطاع بـ bipolar flagella
+
+55
+00:04:14,390 --> 00:04:18,630
+لكن الفرق بينهم، هذه fermenter وهذه non-fermenter
+
+56
+00:04:18,630 --> 00:04:21,310
+فاكرين أداء جرام ولا فاكرينه؟ لأ، بتذكركوا فيه من
+
+57
+00:04:21,310 --> 00:04:25,830
+البداية، جرام negative بس الـ lie، أنجسمت جسمين
+
+58
+00:04:25,830 --> 00:04:30,590
+بناءً على فحص الـ Oxidase اللي بوستيف يبقى وجه الشبه
+
+59
+00:04:30,590 --> 00:04:33,910
+كم أن إحنا بينهم إثنين، أن إثنين بوستيف للإكسيديز
+
+60
+00:04:33,910 --> 00:04:37,990
+لكن واحدة للجلوكوز fermentation كانت negative اللي
+
+61
+00:04:37,990 --> 00:04:43,410
+وهي Pseudomonas وpositive كانت اللي هي الـ Vibrio، إذاً
+
+62
+00:04:43,410 --> 00:04:47,530
+الفرق بين Pseudomonas aeruginosa والـ Vibrio اللي
+
+63
+00:04:47,530 --> 00:04:50,950
+هو الجلوكوز fermentation بينما بيشتبهوا .. بتشبهوا
+
+64
+00:04:50,950 --> 00:04:55,470
+مع بعض في صفتين، صفة الأكسيديز و صفة اللي هو قلنا
+
+65
+00:04:55,470 --> 00:05:00,190
+الـ motility، bipolar flagella، الفيبرو الكوليرا بشكل
+
+66
+00:05:00,190 --> 00:05:05,090
+عام تعتبر aerobic and facultative anaerobe وهذا
+
+67
+00:05:05,090 --> 00:05:08,150
+السبب أنه لو بنقول facultative anaerobe بنقول
+
+68
+00:05:08,150 --> 00:05:10,910
+أنها قادرة على التعامل fermentation بس لو أنها
+
+69
+00:05:10,910 --> 00:05:13,970
+obligate aerobe زي Pseudomonas aeruginosa لن تكون
+
+70
+00:05:13,970 --> 00:05:16,070
+قادرة على الـ fermentation، لما تكون قادرة فقط على
+
+71
+00:05:16,070 --> 00:05:20,730
+الـ oxidation، الفيبرو
+
+72
+00:05:20,730 --> 00:05:26,420
+الكوليرا كبكتيريا can adhere to the intestinal cell
+
+73
+00:05:26,420 --> 00:05:31,080
+wall بدون ما تعمل أي invasion لـ intestinal cell
+
+74
+00:05:31,080 --> 00:05:36,110
+wall، يعني بمعنى آخر localized infection، طبعاً
+
+75
+00:05:36,110 --> 00:05:41,230
+السلمونيلا عملت invasion وتخطت الـ intestinal wall
+
+76
+00:05:41,230 --> 00:05:45,870
+والـ lymph node وراحت على الدم، الشيجيلا عملت
+
+77
+00:05:45,870 --> 00:05:49,150
+invasion للـ intestinal wall ولكن بقيت هناك لم
+
+78
+00:05:49,150 --> 00:05:54,330
+تستطع المرور عبر الـ lymph node إلى الدم، الـ Vibrio
+
+79
+00:05:54,330 --> 00:05:57,430
+الآن localized to the intestinal tract, no
+
+80
+00:05:57,430 --> 00:06:02,530
+invasion، كلكم تتذكروا الـ toxin تبع الـ Vibrio
+
+81
+00:06:02,530 --> 00:06:07,830
+وشرحناه إحنا بطريقة يعني نوعاً ما comic، يعني هزلية
+
+82
+00:06:07,830 --> 00:06:14,550
+قلنا لو كان هذا هو الـ intestinal walls تمام؟ الـ
+
+83
+00:06:14,550 --> 00:06:20,890
+toxin of cholera وأنا أفترض أنه هذا الملت بيعمل
+
+84
+00:06:20,890 --> 00:06:24,590
+binding مع إنزيم، إيه اسمه؟ قلنا عنه؟
+
+85
+00:06:29,190 --> 00:06:34,720
+adenylate cyclase enzyme، الارتباط تبع
+
+86
+00:06:34,720 --> 00:06:42,780
+التوكسين فيه بيحول الـ ATP إلى Cyclic AMP، قلنا الـ
+
+87
+00:06:42,780 --> 00:06:47,180
+amount of Cyclic AMP الكثيرة أو الكثيفة أو العالية
+
+88
+00:06:47,180 --> 00:06:51,940
+أو غير المعتادة هتزيد الـ function المنوطة بـ
+
+89
+00:06:51,940 --> 00:06:55,580
+Cyclic AMP اللي قلنا عنها تتلخص في شغلتين، منع
+
+90
+00:06:55,580 --> 00:07:02,210
+امتصاص لبعض الـ electrolyte وزيادة إفراز، increase لـ
+
+91
+00:07:02,210 --> 00:07:05,070
+لبعض الـ electrolytes وبالتالي صار في هنا
+
+92
+00:07:05,070 --> 00:07:09,930
+electrolyte accumulation
+
+93
+00:07:09,930 --> 00:07:18,910
+fluid sensed by the intestinal wall وبالتالي
+
+94
+00:07:18,910 --> 00:07:23,370
+diluted by large amount of H2O وبالتالي في هنا
+
+95
+00:07:23,370 --> 00:07:28,910
+إسهال، إسهال، هذه إذا تذكروا ووصفناها بأنها rice
+
+96
+00:07:28,910 --> 00:07:29,950
+water
+
+97
+00:07:32,960 --> 00:07:39,720
+طبعاً هذا characteristic مشهور لـ .. نعم، مشهور لـ ..
+
+98
+00:07:39,720 --> 00:07:43,760
+الـ .. الإسهال caused by Vibrio cholera، إيش
+
+99
+00:07:43,760 --> 00:07:47,240
+بالنسبة لكم كـ .. كـ تحاليل طبية أنتم بـ .. بيهِمُّكم
+
+100
+00:07:47,240 --> 00:07:51,630
+هذا الموضوع؟ الشباب، إحنا متفقين على أن الـ course
+
+101
+00:07:51,630 --> 00:07:55,010
+تبقى على اسمها medical diagnostic أو diagnostic
+
+102
+00:07:55,010 --> 00:07:59,450
+medical microbiology، فإحنا جزء في الـ diagnosis، جزء
+
+103
+00:07:59,450 --> 00:08:04,790
+في الـ medical ليس من أجل أن نصبح خبراء، نصبح خبراء
+
+104
+00:08:04,790 --> 00:08:11,330
+في التشخيص السريري للأمراض وإنما لمعرفة العينات
+
+105
+00:08:11,330 --> 00:08:17,480
+ماذا يجب أن نتوقع منها؟ ما هي الخصائص السبع للعينات؟
+
+106
+00:08:17,480 --> 00:08:20,040
+هي أنك تتكلم عن rice water stool، لو أنتَ شفتَ هذا
+
+107
+00:08:20,040 --> 00:08:23,880
+الـ character في عينة الـ stool، أليس هذا مدعاة
+
+108
+00:08:23,880 --> 00:08:26,800
+أنك تعمل suspicion أن البكتيريا المسببة هي Vibrio
+
+109
+00:08:26,800 --> 00:08:31,520
+cholera وبالتالي بتسهل عليك عملية اللي هو التفكير
+
+110
+00:08:31,520 --> 00:08:36,780
+والاتجاه في الـ diagnosis اللي أنت مؤهل للقيام به؟
+
+111
+00:08:38,400 --> 00:08:42,560
+الآن الـ rice water stool ليش بيحتوي؟ بقولنا بيحتوي
+
+112
+00:08:42,560 --> 00:08:46,000
+على الـ vibrios، وأعتقد أن الجملة هذه أو الكلمة هذه
+
+113
+00:08:46,000 --> 00:08:50,840
+بتوضح أن أهمية الـ gram stain لأن في هذه اللحظة
+
+114
+00:08:50,840 --> 00:08:55,460
+أكثر شيء هنشوفه في الـ stool مش هنشوفه في الـ stool
+
+115
+00:08:55,460 --> 00:08:58,560
+العادي ولا في الـ stool تبع أي إسهال آخر، اللي هو
+
+116
+00:08:58,560 --> 00:09:03,180
+شكل الـ Vibrio لكن كمان مرة it is not conclusive
+
+117
+00:09:04,170 --> 00:09:09,510
+يعني عدم وجود Vibrios في الـ stool لا يعني أن المصاب
+
+118
+00:09:09,510 --> 00:09:14,870
+مش مريض بالكوليرا، وصلت الصورة، لكن وجودها مش مثبت
+
+119
+00:09:14,870 --> 00:09:19,690
+مؤشر قوي لوجود الـ Vibrio فيها، أن أنا ممكن أيضاً
+
+120
+00:09:19,690 --> 00:09:25,190
+إيجاد Epithelial cells وممكن أيضاً أن mucus are
+
+121
+00:09:25,190 --> 00:09:28,410
+passed، يعني ماشية مع الـ stool، In acute cholera
+
+122
+00:09:28,410 --> 00:09:31,830
+cases, the rapid loss of fluid and electrolytes
+
+123
+00:09:31,830 --> 00:09:36,410
+lead to muscular cramps، إحنا جبنا المحاضرة ثانية أو
+
+124
+00:09:36,410 --> 00:09:42,270
+ثلاثة أن number one cause
+
+125
+00:09:42,270 --> 00:09:45,490
+of death among children is diarrhea، يعني الإسهال
+
+126
+00:09:45,490 --> 00:09:49,770
+هو المسبب رقم واحد للوفيات وحكينا عن جملتين، جبنا
+
+127
+00:09:49,770 --> 00:09:53,450
+electrolyte imbalance، يعني خلل .. صار خلل في عنده
+
+128
+00:09:53,450 --> 00:09:56,050
+في مين؟ في الـ electrolyte نتيجة اللي هو الـ .. الـ
+
+129
+00:09:56,050 --> 00:09:59,270
+.. الـ .. الـ .. الـ dehydration اللي هو loss of
+
+130
+00:09:59,270 --> 00:10:05,070
+water، فبالتالي إذا صار في أنه dehydration عالي قد
+
+131
+00:10:05,070 --> 00:10:09,270
+تؤدي إلى الوفيات فيه وخاصة في الأطفال، بيقول لنا
+
+132
+00:10:09,270 --> 00:10:13,870
+which if not .. which if not treated it is fatal
+
+133
+00:10:13,870 --> 00:10:15,870
+fatal، يعني قاتل
+
+134
+00:10:18,490 --> 00:10:22,070
+التوكسين اللي .. اللي .. اللي حكينا عنه هو عبارة
+
+135
+00:10:22,070 --> 00:10:27,470
+عن A 5B، هنا معمول 6B لكن هو 5B، الـ B هنا للـ binding
+
+136
+00:10:27,470 --> 00:10:31,430
+صار internalization، الـ A portion بيقولنا بيـ ..
+
+137
+00:10:31,430 --> 00:10:35,190
+بيرتبط بالـ protein G زائد NAD بيعمل ADP
+
+138
+00:10:35,190 --> 00:10:39,160
+ribosylation زائد نيكوتيناميد، طبعاً هذا بيعمل
+
+139
+00:10:39,160 --> 00:10:42,440
+activation لمين؟ لـ adenylate cyclase enzyme، الـ
+
+140
+00:10:42,440 --> 00:10:45,360
+activation لـ adenylate cyclase enzyme اللي وصفناها
+
+141
+00:10:45,360 --> 00:10:49,400
+في الخطوة هذه بيتحول معها الـ ATP إلى إيه؟ Cyclic
+
+142
+00:10:49,400 --> 00:10:51,840
+AMP، وقلنا بيؤدي إلى accumulation of electrolytes
+
+143
+00:10:51,840 --> 00:10:54,120
+بيؤدي في الآخر إلى اللي هو الـ secretion
+
+144
+00:10:57,890 --> 00:11:01,990
+الآن خلينا بس نوضح بعض الأمور المتعلقة
+
+145
+00:11:01,990 --> 00:11:07,650
+بالأورجانيزم عشان نعرف أفضل الطرق المناسبة لعزل
+
+146
+00:11:07,650 --> 00:11:08,870
+هذا الـ microbe
+
+147
+00:11:17,610 --> 00:11:22,290
+هذا ميكروب يمكن أن ينتشر، Epidemics of cholera
+
+148
+00:11:22,290 --> 00:11:26,050
+Epidemics of cholera يعني أوبئة من الانتشار واسع
+
+149
+00:11:26,050 --> 00:11:32,950
+وسريع للمرض وبالتالي ممكن نتجاوز عن الخطوات اللي
+
+150
+00:11:32,950 --> 00:11:40,350
+فاكرينها؟ الأربع خطوات، أذكركم فيها، cultural لا، لسه
+
+151
+00:11:40,350 --> 00:11:46,870
+morphology، يعني staining لا؟
+
+152
+00:11:47,630 --> 00:11:51,810
+biochemical، و4 serological و5 جينا عنها
+
+153
+00:11:51,810 --> 00:11:56,150
+others، تمام، وفاكرين في الشكل اللي قفزنا من الـ
+
+154
+00:11:56,150 --> 00:11:58,930
+culture، روحنا على مين؟ على الـ serological، صح ولا لا؟
+
+155
+00:11:58,930 --> 00:12:04,370
+فإحنا بدنا كمان نشوف في أي ميكروب، أي ميكروب
+
+156
+00:12:04,370 --> 00:12:09,290
+بيحدث بشكل وبائي انفجاري، epidemics، تمام، أو
+
+157
+00:12:09,290 --> 00:12:14,050
+outbreak، بدنا نحاول نشوف أقصر الطرق، هذا لا يعني أن
+
+158
+00:12:14,050 --> 00:12:18,240
+إحنا ننسى أطول الطرق، كنا أقصر الطرق للـ initial
+
+159
+00:12:18,240 --> 00:12:22,960
+report، وأطول الطرق اللي هي للـ final report، فإيش
+
+160
+00:12:22,960 --> 00:12:25,540
+الـ characteristics اللي ممكن أستفيدها أنا من
+
+161
+00:12:25,540 --> 00:12:30,840
+الميكروب عشان أقدر أعمل diagnoses قصيرة، جبل خدنا
+
+162
+00:12:30,840 --> 00:12:33,560
+ناخذ خصائصنا، رقم واحد البكتيريا قلنا عنها جرام
+
+163
+00:12:33,560 --> 00:12:37,890
+نيجاتيف، باسلي، طبعاً بس الـ lie is straight or curved
+
+164
+00:12:37,890 --> 00:12:42,630
+رقم اثنين they grow in alkaline pH، يعني بتحب الوسط
+
+165
+00:12:42,630 --> 00:12:46,730
+اللي هو المرتفع في الـ pH، هذه النقطة لحالها بدنا
+
+166
+00:12:46,730 --> 00:12:52,090
+نحطها يعني كـ target، نستهدف من خلاله هذا الهدف
+
+167
+00:12:52,090 --> 00:12:55,370
+نستهدف من خلاله عزل البكتيريا دون عن البكتيريا
+
+168
+00:12:55,370 --> 00:12:59,650
+الأخرى لأن كل البكتيريا الأخرى loves the pH of
+
+169
+00:12:59,650 --> 00:13:04,480
+neutrality، يعني بتحب تعيش في وسط قريب من مين؟ من
+
+170
+00:13:04,480 --> 00:13:09,220
+التعادل من السبعة، لو حطيناها في أنبوبة الـ stool
+
+171
+00:13:09,220 --> 00:13:17,760
+اللي بيحتوي من ضمنه واحد Vibrio cholera، حطيناها
+
+172
+00:13:17,760 --> 00:13:22,440
+في alkaline pH
+
+173
+00:13:22,440 --> 00:13:27,000
+يعني من ثمانية، تسعة، إيش اللي بيصير؟ أن هنا كل
+
+174
+00:13:27,000 --> 00:13:33,110
+الميكروبات اللي موجودة مش ملائم لها هذا الوسط
+
+175
+00:13:33,110 --> 00:13:38,390
+وبالتالي gradually will die، مين اللي بينمو فقط؟ الـ
+
+176
+00:13:38,390 --> 00:13:40,990
+Vibrio cholera، وهنا كمان خدوا بالكم، هاد اسمها
+
+177
+00:13:40,990 --> 00:13:41,390
+enrichment
+
+178
+00:13:44,210 --> 00:13:46,850
+هتشوفوه أكثر من نوع enrichment، شوفته مرة بالـ
+
+179
+00:13:46,850 --> 00:13:50,450
+selenite-F،
+
+223
+00:17:27,050 --> 00:17:32,110
+السكروز على الـTCPS إيش هيكون لونها؟ أصفر، يعني لما
+
+224
+00:17:32,110 --> 00:17:36,070
+أنا أقول لكم إن الـVibrio cholerae بتخمر السكروز،
+
+225
+00:17:36,070 --> 00:17:39,610
+بتتوقعوا إيش هيكون شكلها على الـTCPS؟ أصفر، طبعاً.
+
+226
+00:17:39,610 --> 00:17:43,250
+يبقى لما أنا أقول لكم what is a suspect colony أو
+
+227
+00:17:43,250 --> 00:17:47,010
+what is a typical colony of Vibrio cholerae on TCPS،
+
+228
+00:17:47,010 --> 00:17:49,490
+هتقولوا إيش أنتم؟ yellow colonies، مش بس yellow
+
+229
+00:17:49,490 --> 00:17:53,050
+colonies surrounded by a yellow zone as a result
+
+230
+00:17:53,050 --> 00:17:58,650
+of sucrose fermentation. يعني مستعمرات صفراء محاطة
+
+231
+00:17:58,650 --> 00:18:04,750
+بمنطقة صفراء كنتيجة لتخمير السكروز. خلصنا منها.
+
+232
+00:18:04,750 --> 00:18:09,330
+الجثة هي طيب.
+
+233
+00:18:09,330 --> 00:18:13,110
+نرجع
+
+234
+00:18:13,110 --> 00:18:21,670
+لعينة البراز. عملنا على الجهة دي وعلى
+
+235
+00:18:21,670 --> 00:18:22,290
+الجهة دي.
+
+236
+00:18:26,440 --> 00:18:31,020
+بعد أن رشّحناها، ما يكون هنا selected
+
+237
+00:18:31,020 --> 00:18:35,180
+وعلى أي من الـselective الأولانية أو الـselective
+
+238
+00:18:35,180 --> 00:18:41,260
+التانية، إيه يكون هنا suspect colonies. بس خلينا نعمل
+
+239
+00:18:41,260 --> 00:18:46,020
+تبديل للمسميات العامة لمسميات خاصة. الـenrichment
+
+240
+00:18:46,020 --> 00:18:54,000
+هنا يكون alkaline peptone water، صح؟ هنا TCBS.
+
+241
+00:18:54,000 --> 00:19:01,000
+هنا برضه TCBS. الآن، الـsuspect colony وصلنا
+
+242
+00:19:01,000 --> 00:19:04,220
+متفقين عليها وحفظناها: yellow colonies surrounded
+
+243
+00:19:04,220 --> 00:19:07,040
+by a yellow zone as a result of sucrose
+
+244
+00:19:07,040 --> 00:19:15,440
+fermentation. هنا السؤال: what is next؟ ما
+
+245
+00:19:15,440 --> 00:19:21,530
+الذي يجب علينا فعله؟ ما هي الصفات؟ خذوا بالكم، أتكلم
+
+246
+00:19:21,530 --> 00:19:25,830
+مرة أخرى على فترة قصيرة من الـdiagnosis. إذا طولنا
+
+247
+00:19:25,830 --> 00:19:29,610
+في الـdiagnosis، الشباب معنا في الحكي، احنا أعطينا فرصة
+
+248
+00:19:29,610 --> 00:19:33,050
+أكبر للميكروب بالانتشار. بدنا نحاول نحاصر
+
+249
+00:19:33,050 --> 00:19:38,370
+الميكروبات التي تنتشر بشكل مفاجئ وسريع ولها خطورة
+
+250
+00:19:38,370 --> 00:19:43,290
+عالية. إذا بدنا نبحث عن الفحوصات ذات الزمن القصير،
+
+251
+00:19:43,290 --> 00:19:47,350
+ذات الزمن القصير. من هذه الفحوصات، على سبيل المثال،
+
+252
+00:19:55,250 --> 00:20:02,170
+oxidase test. لازم تكونوا عارفين. لو طلعت معنا yellow
+
+253
+00:20:02,170 --> 00:20:06,210
+colonies surrounded by a zone of … color … برضه
+
+254
+00:20:06,210 --> 00:20:10,070
+yellow … yellowish zone، وطلعت oxidase negative،
+
+255
+00:20:10,070 --> 00:20:14,150
+يبقى البكتيريا مش Vibrio، يبقى هذا الفحص مش بيعملي
+
+256
+00:20:14,150 --> 00:20:18,810
+مش بيؤكد لي، بس كمان بيستثني لي، والاستثناء عملية
+
+257
+00:20:18,810 --> 00:20:21,690
+مهمة جداً في الـ … في الـ … في الـdiagnosis. بقول لكم
+
+258
+00:20:21,690 --> 00:20:25,310
+بدل ما أنا أشتغل ABI أو أعمل serology لكل
+
+259
+00:20:25,310 --> 00:20:29,490
+المستعمرات الصفراء، لأ، بأعملها هي oxidase test التي
+
+260
+00:20:29,490 --> 00:20:33,530
+بتطلع positive، بأستمر معاها. التي بتطلع negative، أحطها
+
+261
+00:20:33,530 --> 00:20:37,990
+على جانب. خلصنا منها، مش بكتيريا من التي نريدها. في
+
+262
+00:20:37,990 --> 00:20:42,090
+كمان فحص، يا شباب، تعرفونه أنتم أو عرفتموه في سياق
+
+263
+00:20:42,090 --> 00:20:49,850
+محاضراتنا، لما اتكلمنا عن string test. كيو
+
+264
+00:20:49,850 --> 00:20:54,710
+اتش، هي KOH test، برضه من أحد الفحوصات المهمة
+
+265
+00:20:54,710 --> 00:20:59,390
+جداً لـVibrio. لازم تطلع معنا الـstring test إيه؟
+
+266
+00:20:59,390 --> 00:21:04,810
+Positive. يبقى في عندي فحص oxidase، والثاني الذي قلنا
+
+267
+00:21:04,810 --> 00:21:08,650
+عنه، اللي هو الـstring test. في كمان فحص ثالث أنا
+
+268
+00:21:08,650 --> 00:21:16,840
+ممكن أعمله، اللي هو polyvalent agglutination. نعمل لكم
+
+269
+00:21:16,840 --> 00:21:19,880
+لحظة. وين … وين … وين حطيته أنا؟ آخر واحد … أول
+
+270
+00:21:19,880 --> 00:21:23,000
+واحد oxidase. إذا طلعت negative، استبعدتها من هناك، إذا
+
+271
+00:21:23,000 --> 00:21:25,380
+طلعت oxidase positive و string test negative،
+
+272
+00:21:25,380 --> 00:21:29,160
+استبعدتها، يعني لازم تطلع هذه وهذه، وبعدين أعملها
+
+273
+00:21:29,160 --> 00:21:31,660
+مين؟ اللي هو الـ … الـ … الـpolyvalent
+
+274
+00:21:31,660 --> 00:21:35,000
+agglutination. هذه ثلاث فحوصات. أنا هكذا أكون عملت …
+
+275
+00:21:35,000 --> 00:21:39,060
+طلعت كلّهم positive، أعمل initial report.
+
+276
+00:21:41,700 --> 00:21:44,480
+مش قُلت أنا … أنا ما قُلتش أنه بأعملهم مع بعض، أنا
+
+277
+00:21:44,480 --> 00:21:50,280
+قُلت بأعملهم sequentially. بأعمل oxidase، خلاص negative،
+
+278
+00:21:51,340 --> 00:21:55,200
+الفحص negative، لأنه لازم تكون … لازم تكون الثلاث
+
+279
+00:21:55,200 --> 00:21:58,120
+… الثلاث صفات. لازم تكون الثلاث صفات. لذلك أنا قُلت لكم
+
+280
+00:21:58,120 --> 00:22:02,060
+الذي من الأول، الذي لم تمتلك oxidase، أستبعدها.
+
+281
+00:22:02,060 --> 00:22:04,860
+التي امتلكت oxidase و negative للـ … للـstring
+
+282
+00:22:04,860 --> 00:22:07,960
+test، برضه أستبعدها. التي امتلكت الاثنين و negative
+
+283
+00:22:07,960 --> 00:22:11,960
+لـ … لـ … الأخيرة، برضه بنستبعدها. لكن احنا عجلنا
+
+284
+00:22:11,960 --> 00:22:15,080
+الثالث للآخر، لأنه هي the most expensive … the
+
+285
+00:22:15,080 --> 00:22:16,120
+most expensive.
+
+286
+00:22:25,100 --> 00:22:28,600
+نطلع الآن على اللوحة ونحاول نراجع مع بعض
+
+287
+00:22:28,600 --> 00:22:32,200
+الفحوصات. نقول إن الـalkaline peptone water هو الـ
+
+288
+00:22:32,200 --> 00:22:35,500
+enrichment، و الـpH تبقى من حوالي 8.6 من
+
+289
+00:22:35,500 --> 00:22:39,260
+10، يعني قريب التسعة. rapid isolation from feces.
+
+290
+00:22:39,260 --> 00:22:41,880
+بيساعدنا في عزل سريع من البراز. كلامكم الله.
+
+291
+00:22:41,880 --> 00:22:45,220
+selective medium TCBS. oxidase positive، gram negative،
+
+292
+00:22:45,220 --> 00:22:51,020
+curved rod. هذه نقطة مهمة. أنتم تعرفون أن
+
+293
+00:22:51,020 --> 00:22:53,140
+السفرانين هو الـcounter stain في الـgram stain،
+
+294
+00:22:53,140 --> 00:22:58,960
+تمام؟ خذوها قاعدة. لما الميكروب يكون curved أو
+
+295
+00:22:58,960 --> 00:23:03,260
+spiral، وبدنا نعمله staining، بلاش نستخدم
+
+296
+00:23:03,260 --> 00:23:07,780
+السفرانين، نستخدم مين؟ الـcarbol fuchsin، الـcarbol
+
+297
+00:23:07,780 --> 00:23:13,570
+اللي هو … وعنه هنا … carbol fuchsin. استخدمنا أين
+
+298
+00:23:13,570 --> 00:23:17,650
+carbol fuchsin؟ استخدمناها كـprimary stain، صح
+
+299
+00:23:17,650 --> 00:23:22,310
+ولا لا؟ احنا بنستخدم safranin كمادة counter
+
+300
+00:23:22,310 --> 00:23:26,730
+stain فقط في حالات مين؟ لما تكون البكتيريا كمان
+
+301
+00:23:26,730 --> 00:23:33,000
+مرة curved أو spiral microorganism. ليش؟ أقول إن هذه
+
+302
+00:23:33,000 --> 00:23:38,220
+البكتيريا، الـaffinity تبعها للسفرانين
+
+303
+00:23:38,220 --> 00:23:44,680
+منخفضة، وبالتالي أنتَ محتاج صبغة أخرى كـcounter
+
+304
+00:23:44,680 --> 00:23:48,680
+stain عشان تعمل الـcontrast اللي هو اللي ما بين
+
+305
+00:23:48,680 --> 00:23:52,060
+أنتَ فاكرين اللي لونان، الـviolet اللي هو الـgram
+
+306
+00:23:52,060 --> 00:23:55,900
+positive، والأحمر أو الـpink اللي هو الـgram
+
+307
+00:23:55,900 --> 00:23:56,440
+negative.
+
+308
+00:24:01,430 --> 00:24:04,190
+احنا مش عايزين نغير الـstain. احنا … احنا مش
+
+309
+00:24:04,190 --> 00:24:06,430
+قلنا يا شباب … شباب، احنا قلنا لكم في الأول …
+
+310
+00:24:06,430 --> 00:24:09,290
+أول خطوة في الـdiagnosis: culture، لو الثانية هي
+
+311
+00:24:09,290 --> 00:24:13,790
+morphology and staining. staining، أنا عامل الـ …
+
+312
+00:24:13,790 --> 00:24:17,970
+الـcurved rod، وهتقولوا أن … أنه أنا قفزت من
+
+313
+00:24:17,970 --> 00:24:22,470
+المرحلة الأولى لمرحلة الرابعة، مظبوط؟ مظبوط؟ لكن
+
+314
+00:24:22,470 --> 00:24:23,770
+أنا ما قفزتش أساساً.
+
+315
+00:24:26,810 --> 00:24:32,330
+وبالتالي عندي شعور أن هذه البكتيريا هي Vibrio
+
+316
+00:24:32,330 --> 00:24:38,410
+cholerae. كيف؟
+
+317
+00:24:38,570 --> 00:24:41,550
+هو ما فهمكش بقى، لأنكَ تظهر أن أنا بقعد أstaining، مش
+
+318
+00:24:41,550 --> 00:24:44,010
+هي أول مرحلة. تقول staining يعني … لأ لأ، هو بيسأل
+
+319
+00:24:44,010 --> 00:24:48,130
+سؤال مختلف عن سؤالك. هو بقول: أنا إيش بدي أعرفني إن
+
+320
+00:24:48,130 --> 00:24:52,270
+البكتيريا أصلاً spiral أو curved، عشان أختار لها الـ
+
+321
+00:24:52,270 --> 00:24:56,470
+carbol fuchsin. احنا بنقول إن if suspected، أنتَ تعمل
+
+322
+00:24:56,470 --> 00:24:59,850
+هذا الكلام، يعني بمعنى آخر، لو كانت البكتيريا بكتيريا
+
+323
+00:24:59,850 --> 00:25:03,070
+عادية، وحطيت Safranin، بيمشي الحال. عفواً، نعم، بيمشي
+
+324
+00:25:03,070 --> 00:25:07,370
+الحال. ولو حطيت Carbol fuchsin برضه بيمشي الحال. فلما
+
+325
+00:25:07,370 --> 00:25:11,570
+أنتَ يكون عندك suspicion، شك، بأن البكتيريا curved أو
+
+326
+00:25:11,570 --> 00:25:16,790
+spiral، استخدم Carbol fuchsin. بيمشي لمين؟ بيمشي
+
+327
+00:25:16,790 --> 00:25:20,850
+للبكتيريا العادية، ولهذه البكتيريا التي هي curved.
+
+328
+00:25:20,850 --> 00:25:27,890
+هذه الفكرة من النقاش. أول مرة أتكلم عن Fecal Swap.
+
+329
+00:25:29,350 --> 00:25:33,070
+Fecal swap. في حال عدم توفر الـstool. هل الـstool
+
+330
+00:25:33,070 --> 00:25:39,330
+ممكن ما يتوفرش عند المريض؟ نعم. بعد فترة ليست بالطويلة
+
+331
+00:25:39,330 --> 00:25:44,290
+من الـfrequency العالي في الإسهال، لما المريض يبقى
+
+332
+00:25:44,290 --> 00:25:46,690
+… يقول لنا في أحد الـ … الـ … الـ … في شجرة الـ
+
+333
+00:25:46,690 --> 00:25:50,730
+dysentery، إذا فاكرين، إن الـ … الـstool loses its
+
+334
+00:25:50,730 --> 00:25:54,650
+fecal characteristics، وبالتالي ما فيش يخرج إلا …
+
+335
+00:25:54,650 --> 00:26:00,010
+إلا عبر، أو خلينا نقول من مادة واحدة، اللي هي الـ …
+
+336
+00:26:00,010 --> 00:26:03,090
+الـ … الـmucus، وبعض الأحيان الـblood.
+
+337
+00:26:06,170 --> 00:26:10,550
+نعم، دزنتريا. فبالتالي، إذا في هذه الحالة المريض مش
+
+338
+00:26:10,550 --> 00:26:15,430
+قادر يجيب عينة stool، فممكن نأخذ عنها الـrectal swab.
+
+339
+00:26:15,430 --> 00:26:20,190
+لكن إذا في stool، فهو العينة المثلى. ما هو
+
+340
+00:26:20,190 --> 00:26:23,580
+العينة المثلى؟ قلنا الـenrichment: alkaline peptone
+
+341
+00:26:23,580 --> 00:26:26,120
+water. selected: TCBS، وذكرنا اسمه، اللي هو
+
+342
+00:26:26,120 --> 00:26:28,760
+Thiosulfate Citrate Bile Salts Sucrose agar.
+
+343
+00:26:28,760 --> 00:26:33,500
+والحلو أنه ما بنعملش enrichment لـ24 ساعة،
+
+344
+00:26:33,500 --> 00:26:37,120
+ما بنعمل enrichment فقط لمدة 4 إلى 6 ساعات، وبعدين
+
+345
+00:26:37,120 --> 00:26:41,340
+ما بنعمل subculture على اللي هو الـTCBS مرة أخرى.
+
+346
+00:26:43,490 --> 00:26:47,110
+كمان مرة، أشهر شكل المستعمرات: yellow colonies are
+
+347
+00:26:47,110 --> 00:26:50,870
+produced. عرفنا من وين مصدر اللون تبع الـ
+
+348
+00:26:50,870 --> 00:26:53,970
+sucrose fermentation.  الرسمة التي رسمناها على
+
+349
+00:26:53,970 --> 00:26:58,070
+السبورة قبل شوية. stool or rectal swab، على الجهة التي
+
+350
+00:26:58,070 --> 00:27:01,190
+… التي … التي هناك. الـselective media: TCBS، على
+
+351
+00:27:01,190 --> 00:27:04,770
+الجهة دي. enrichment. عملنا subculture. قلنا بعد
+
+352
+00:27:04,770 --> 00:27:08,210
+4 إلى 6 ساعات،  في 37 درجة مئوية، وبعد هذا، اللي شفناه
+
+353
+00:27:08,210 --> 00:27:11,330
+الـtypical colonies، وعملنا لها the following tests.
+
+354
+00:27:12,940 --> 00:27:16,040
+فين دي؟ هذه القائمة الطويلة، مش القائمة القصيرة
+
+355
+00:27:16,040 --> 00:27:19,360
+التي عملناها. احنا عملنا قائمة قصيرة، ثلاث فحوصات:
+
+356
+00:27:19,360 --> 00:27:25,080
+oxidase test،
+
+357
+00:27:25,080 --> 00:27:32,920
+catalase test، esculin test، motility test، طبعاً.
+
+358
+00:27:32,920 --> 00:27:36,040
+احنا ممكن نضيف الـmotility على القائمة كمان، يا شباب.
+
+359
+00:27:36,040 --> 00:27:40,280
+الـmotility فحص كويس. آه، أصبحوا أربعة. أنا الـ … الـ
+
+360
+00:27:40,280 --> 00:27:42,780
+… الأربع فحوصات التي أحكي لكم عنها، هي الأربع التي
+
+361
+00:27:42,780 --> 00:27:46,940
+اخترناها لما كان في وباء عندنا، لأذكر في سنة 1996
+
+362
+00:27:46,940 --> 00:27:52,360
+في غزة للكوليرا، وصار في نوع من الـ
+
+363
+00:27:52,360 --> 00:27:57,040
+… الـ … الاجتماع بين الجامعة وبين وزارة الصحة وبين
+
+364
+00:27:57,040 --> 00:28:01,040
+وكالة الغوث للمختبرات، وجلسنا جلسنا مع بعض وحددنا
+
+365
+00:28:01,040 --> 00:28:05,100
+الطريقة الأقصر والطريقة الأطول لـidentification،
+
+366
+00:28:05,100 --> 00:28:08,140
+بناءً على ما هو متوفر في المختبرات الثلاثة. مختبرات
+
+367
+00:28:08,140 --> 00:28:11,340
+الجامعات، ومختبرات الصحة، ومختبرات اللي هو وكالة
+
+368
+00:28:11,340 --> 00:28:14,240
+الغوث. وأنا أذكر أننا وضعنا الأربع فحوصات التي
+
+369
+00:28:14,240 --> 00:28:16,720
+حكيت لكم عنها، هي التي هي الـ … الـ … الـgram stain،
+
+370
+00:28:16,720 --> 00:28:20,380
+و الـ … الـ … هذا كـ … كـ … كـمرحلة الـoxidase، و
+
+371
+00:28:20,380 --> 00:28:24,480
+الـ … الـstring test، و الـ … الـmotility، و الـ …
+
+372
+00:28:24,480 --> 00:28:27,140
+الـpolyvalent agglutination antisera. هنا الـ … هنا
+
+373
+00:28:27,140 --> 00:28:30,020
+… هنا مهم جداً الفحص الذي ننده إليه positive، طبعاً الـ
+
+374
+00:28:30,020 --> 00:28:32,980
+Voges-Proskauer، إما positive أو negative. وهذه كثير
+
+375
+00:28:32,980 --> 00:28:38,260
+معلومة مهمة، هنستخدمها لاحقاً في التمييز بين صنفين من
+
+376
+00:28:38,260 --> 00:28:41,760
+الـVibrio cholerae. واحدة بتكون Indole، Voges-Proskauer
+
+377
+00:28:41,760 --> 00:28:45,600
+positive. واحدة Voges-Proskauer negative. sucrose
+
+378
+00:28:45,600 --> 00:28:49,420
+fermentation، هي متفقين عليها أنها positive، لأنها بنشوفها
+
+379
+00:28:49,420 --> 00:28:55,340
+من الوسط. lactose negative، mannitol positive. هذا الشكل الذي
+
+380
+00:28:55,340 --> 00:29:00,140
+قدامكم.  مش عارف، يمكن من الكمبيوتر أوضح من اللوحة
+
+381
+00:29:00,140 --> 00:29:04,600
+التي واضحة عندكم. اللوحة برضه أن الوسط أخضر، تمام؟
+
+382
+00:29:05,820 --> 00:29:09,780
+أمام؟ والمنطقة التي نمى فيها البكتيريا تحولت
+
+383
+00:29:09,780 --> 00:29:13,160
+إلى اللون الأصفر. لكن أنا بـ … بعتقد أنه لو شفتوها
+
+384
+00:29:13,160 --> 00:29:17,080
+من الـslides، هتكون الصورة أوضح. يعني لأنّ الـطبق كله
+
+385
+00:29:17,080 --> 00:29:21,760
+أخضر بالفعل، والمستعمرات هي فقط التي محاطة بمناطق
+
+386
+00:29:21,760 --> 00:29:22,240
+صفراء.
+
+387
+00:29:26,930 --> 00:29:29,090
+فاكرين لما قلنا tentative diagnosis؟ احنا مرة
+
+388
+00:29:29,090 --> 00:29:33,350
+tentative diagnosis، اللي هو مؤقت، اللي هو مصطلح
+
+389
+00:29:33,350 --> 00:29:36,910
+ثاني نسميه presumptive diagnosis، يعني tentative أو
+
+390
+00:29:36,910 --> 00:29:40,630
+presumptive، تقريباً بنفس المعنى. هنا الـpresumptive
+
+391
+00:29:40,630 --> 00:29:42,990
+diagnosis. الكلام الذي حكيت لكم عنه على السبورة، أو
+
+392
+00:29:42,990 --> 00:29:48,170
+الاختيار الأقصر، هو الذي أتكلم عنه. هذا الفحص،
+
+393
+00:29:48,170 --> 00:29:53,010
+string test. أعتقد أنه واضح جداً، هي المستعمرة ذابت،
+
+394
+00:29:53,010 --> 00:29:55,930
+حاولت أن أ
+
+445
+00:33:18,980 --> 00:33:22,580
+serotype، serovar و serotype
+
+446
+00:33:30,280 --> 00:33:34,660
+طيب جئنا للأصعب، في عندنا ثلاث أصناف سيرولوجية
+
+447
+00:33:34,660 --> 00:33:38,420
+وسنعطيكم لكل واحد شكل،  اللي بيحكيهم من أول مرة
+
+448
+00:33:38,420 --> 00:33:42,660
+للأسماء الغريبة اللي موجودة علاقة عادية، شو اسمها
+
+449
+00:33:42,660 --> 00:33:53,540
+جمعة؟ جمعة صحيح، أنا نسيت، جيمان؟
+
+450
+00:33:53,540 --> 00:33:56,120
+طيب، اللي جاء قبلها؟
+
+451
+00:33:59,160 --> 00:34:03,860
+إنابا وجاوا وهيكوجيما، جمعها على ثلاث أشكال، خلاص الآن
+
+452
+00:34:03,860 --> 00:34:08,880
+إيش الـ... إيش الـ... الـ... الفرق بينهم؟ الفرق بينهم
+
+453
+00:34:08,880 --> 00:34:13,300
+أنه واحد بيصير له agglutination... agglutination
+
+454
+00:34:13,300 --> 00:34:17,650
+يبقى أنت إنابا بينما بيصير له agglutination بالـ
+
+455
+00:34:17,650 --> 00:34:22,730
+Anti-Ogawa والعكس الثاني بيصير له agglutination بالـ
+
+456
+00:34:22,730 --> 00:34:26,550
+Anti-Ogawa بيصير له... بيصير له... بيصير له عفوا بالـ
+
+457
+00:34:26,550 --> 00:34:30,550
+Anti-Inaba لكن النوع الثالث فاجأنا بأنه يعمل
+
+458
+00:34:30,550 --> 00:34:34,050
+agglutination لمين؟ للاتنين، وبالتالي هذا يُعتقد
+
+459
+00:34:34,050 --> 00:34:38,700
+أنه variety that has acquired both antigens اللي هم
+
+460
+00:34:38,700 --> 00:34:42,900
+الإنابا والأوجاوا، وسمّيوه هيكوجيما، هدول بيسموهم
+
+461
+00:34:42,900 --> 00:34:48,260
+serovars أو serotypes، إذن هذه subtypes إنابا
+
+462
+00:34:48,260 --> 00:34:52,660
+أوجاوا، هيكوجيما، طبعا الـ Vibrio اللي بتعرفوا إنها
+
+463
+00:34:52,660 --> 00:34:57,780
+كونها بكتيريا motile يبقى في عندها كمان H أنتيجين
+
+464
+00:34:57,780 --> 00:35:01,520
+تمام، فبالتالي ممكن نعمل عملية identification للـ
+
+465
+00:35:01,520 --> 00:35:06,560
+Vibrio عبر الـ O وعبر الـ H أنتيجين، لكن إحنا غالبا في
+
+466
+00:35:06,560 --> 00:35:09,940
+مختبراتنا المتواضعة بنعمل stacking لمين؟ للـ
+
+467
+00:35:09,940 --> 00:35:10,820
+polyvalent
+
+468
+00:35:14,500 --> 00:35:20,540
+O-antigen ولا polyvalent O-antigen، عفوا H-
+
+469
+00:35:20,540 --> 00:35:25,400
+antigen، طبعا إحنا مش بنكون مخزنين الـ antigen
+
+470
+00:35:25,400 --> 00:35:31,500
+مخزنين الـ antibody، فبنسميها polyvalent O مش
+
+471
+00:35:31,500 --> 00:35:36,420
+antibodies، كمان بنسميها antiserum، لكن كلمة
+
+472
+00:35:36,420 --> 00:35:39,120
+antiserum مش معناها antibodies، هي المقصود فيها
+
+473
+00:35:39,120 --> 00:35:40,340
+antiserum معناها antibodies
+
+474
+00:35:44,360 --> 00:35:46,680
+نكشف على الأنتيجين، إيش الأنتيجين في هذه الحالة
+
+475
+00:35:46,680 --> 00:35:49,340
+هيكون؟ البكتيريا نفسها، يعني لما بنزل البكتيريا
+
+476
+00:35:49,340 --> 00:35:51,780
+اللي هي suspected، بنعملها agglutination
+
+477
+00:35:51,780 --> 00:35:57,740
+بالبوليفالنت، نجي لجزء الأخير من الـ Vibrio اللي هو
+
+478
+00:35:57,740 --> 00:36:01,600
+المتعلق بالـ treatment and antibiotic sensitivity
+
+479
+00:36:01,600 --> 00:36:05,080
+أعتقد أنه لا داعي للتكرار، ولا في داعي للتكرار، في
+
+480
+00:36:05,080 --> 00:36:10,340
+داعي للتكرار، بعلم الشطار، أي ديارية... أي ديارية
+
+481
+00:36:10,340 --> 00:36:15,560
+اتفقنا على أنه الحل العلاجي إليها water
+
+482
+00:36:15,560 --> 00:36:18,800
+replacement، electrolyte replacement وثالثة حاجة
+
+483
+00:36:18,800 --> 00:36:23,000
+اللي هي eradication of the causative agent، فده
+
+484
+00:36:23,000 --> 00:36:26,220
+الحالة الـ... الـ... الـ causative agent هو الـ Vibrio
+
+485
+00:36:26,220 --> 00:36:31,370
+كلها، فيش يعني خلاف على أنه لازم نرجع السوائل، لازم
+
+486
+00:36:31,370 --> 00:36:35,410
+نرجع الـ electrolyte ولازم نقضي على مين؟ على الـ
+
+487
+00:36:35,410 --> 00:36:40,250
+Vibrio، كده، نهي طبعا الـ Vibrio كده زيها زي أي
+
+488
+00:36:40,250 --> 00:36:43,130
+بكتيريا ثانية يا شباب، يعني عندها المقدرة عليها
+
+489
+00:36:43,130 --> 00:36:48,370
+تكون resistance وبالتالي إحنا بننصح باستمرار، أي
+
+490
+00:36:48,370 --> 00:36:53,420
+ميكروب في الدنيا إلا إذا ذكرنا عكس ذلك، إنه نعمله
+
+491
+00:36:53,420 --> 00:36:55,640
+antimicrobial sensitivity، لازم نعمله
+
+492
+00:36:55,640 --> 00:36:59,400
+antimicrobial sensitivity أو susceptibility
+
+493
+00:36:59,400 --> 00:37:02,680
+testing، بيقول لنا التتراسيكلين is the drug of choice
+
+494
+00:37:02,680 --> 00:37:06,000
+كيف؟
+
+495
+00:37:07,210 --> 00:37:09,650
+لأ، مثلا هو الـ first choice في الـ treatment
+
+496
+00:37:09,650 --> 00:37:13,730
+طبعا أنتم عارفين التتراسيكلين برضه كمان ما ينفعش لكل
+
+497
+00:37:13,730 --> 00:37:17,890
+الناس، يعني التتراسيكلين للأطفال ما ينفعش، للحوامل يبقى
+
+498
+00:37:17,890 --> 00:37:21,390
+لازم يكون في بدائل، لكن أنا قبل ما أقفز عن
+
+499
+00:37:21,390 --> 00:37:25,650
+أو أبحث عن البدائل، بدي أنبه أن however in recent
+
+500
+00:37:25,650 --> 00:37:31,390
+years تتراسيكلين resistant Vibrio variants يعني
+
+501
+00:37:31,390 --> 00:37:37,080
+سلالات... أصناف... سلالات have emerged، يعني بطلت كلمة
+
+502
+00:37:37,080 --> 00:37:41,120
+تتراسيكلين مطلقة، أن والله أي Vibrio cholera عاللها
+
+503
+00:37:41,120 --> 00:37:44,360
+بتتراسيكلين لأ، حياتها، هي فيه هنا Vibrio cholera كمان
+
+504
+00:37:44,360 --> 00:37:48,730
+resistant للتتراسيكلين، for this reason، أي reason
+
+505
+00:37:48,730 --> 00:37:53,170
+لظهور resistance strain sensitivity test must be
+
+506
+00:37:53,170 --> 00:37:55,750
+performed in all clinical cases، فأنا كمان مرة هذه
+
+507
+00:37:55,750 --> 00:37:58,510
+الجملة بعممها سواء على الـ Vibrio cholera أو غير الـ
+
+508
+00:37:58,510 --> 00:38:01,570
+Vibrio cholera، أنه sensitivity testing، وأنا بالمناسبة
+
+509
+00:38:01,570 --> 00:38:04,910
+حاطط لكم على الـ... على الموقع تبع الـ diagnostic
+
+510
+00:38:04,910 --> 00:38:08,490
+microbiology، الـ CLSI شفتوها؟
+
+511
+00:38:11,380 --> 00:38:17,720
+وثيقة مهمة جدا CLSI 2011، وثيقة مهمة جدا لعمل
+
+512
+00:38:17,720 --> 00:38:21,400
+sensitivity testing، موجودة وموضح لكم على
+
+513
+00:38:21,400 --> 00:38:25,300
+الفيسبوك، على الـ diagnostic microbiology M، تمام
+
+514
+00:38:25,300 --> 00:38:32,140
+اللي هي المجموعة تبعكم، في حد ما اشتركش فيها M، تمام
+
+515
+00:38:32,140 --> 00:38:36,570
+هذه المجموعة تبعكم، request addition، وإحنا إن شاء
+
+516
+00:38:36,570 --> 00:38:40,770
+الله بنضيفها في أقل فرصة، الآن الـ CLSI هذه الـ 2011
+
+517
+00:38:40,770 --> 00:38:44,790
+هي الـ guidelines للـ selection of antibiotics to be
+
+518
+00:38:44,790 --> 00:38:48,070
+used against each organism، يعني بتعطيك دليل إيش الـ
+
+519
+00:38:48,070 --> 00:38:50,370
+antibiotic اللي لازم تحطها على الميكروب اللي من
+
+520
+00:38:50,370 --> 00:38:54,250
+ضمنهم الـ Vibrio، وكده، طبعا إحنا قلنا إنه في
+
+521
+00:38:54,250 --> 00:38:59,180
+مشكلتين، أن التتراسيكلين أساسا ما بتنفع لكل شيء
+
+522
+00:38:59,180 --> 00:39:03,140
+رقم اثنين، البكتيريا في بعض من السلالات صارت منها
+
+523
+00:39:03,140 --> 00:39:06,460
+المقاومة، وبالتالي إيش البدائل؟ في عندي
+
+524
+00:39:06,460 --> 00:39:11,820
+sulfonamides, ampicillin, kanamycin, streptomycin
+
+525
+00:39:11,820 --> 00:39:16,520
+and trimethoprim, trimethoprim اللي هو بيكون دائما
+
+526
+00:39:16,520 --> 00:39:19,040
+مرتبط بالـ sulfamethoxazole, sulfamethoxazole و
+
+527
+00:39:19,040 --> 00:39:25,510
+trimethoprim, prevention of cholera، أعتقد أن كلمة
+
+528
+00:39:25,510 --> 00:39:29,470
+prevention لفecal oral pathogen، برضه إحدى النقاط
+
+529
+00:39:29,470 --> 00:39:34,110
+المهمة، أنّه sanitary conditions والـ public
+
+530
+00:39:34,110 --> 00:39:37,790
+health بشكل عام، good sanitation and personal
+
+531
+00:39:37,790 --> 00:39:43,230
+hygiene، لأن في عندنا immunization لكن الـ
+
+532
+00:39:43,230 --> 00:39:47,560
+immunization للـ Vibrio cholera is not lifelong، ماذا
+
+533
+00:39:47,560 --> 00:39:51,460
+يعني lifelong؟ يعني بتعطيك حماية للأبد، لأ،
+
+534
+00:39:51,460 --> 00:39:55,220
+بتعطيك short، وذي لفترة من الـ vaccine stimulate
+
+535
+00:39:55,220 --> 00:39:59,060
+local IgA production، غالبا من بيعطيها لـ... بيعطيها
+
+536
+00:39:59,060 --> 00:40:03,100
+للناس اللي بدهم يسافروا على أماكن موبوعة بالـ
+
+537
+00:40:03,100 --> 00:40:06,040
+Vibrio كلها، وإن في أماكن تعرفوها موبوعة في الـ
+
+538
+00:40:06,040 --> 00:40:12,610
+Vibrio كلها؟ لأ، الهند، وأكثر من الهند، بنغلادش
+
+539
+00:40:12,610 --> 00:40:18,630
+بنغلاديش، مهم هذا نفس المحيط، بنغلاديش والهند و
+
+540
+00:40:18,630 --> 00:40:21,990
+باكستان، المناطق الفقيرة منهم، هدول أكثر الدول اللي
+
+541
+00:40:21,990 --> 00:40:25,630
+ممكن يكون فيها Vibrio كثير، هذا لا يعني... هذا لا يعني
+
+542
+00:40:25,630 --> 00:40:29,900
+إنها مقتصرة، وأنا قلت لكم، وإن فيه فشل في نظام الصرف
+
+543
+00:40:29,900 --> 00:40:33,960
+الصحي في أي دولة في العالم، احتمالية ظهورها واردة،
+
+544
+00:40:33,960 --> 00:40:39,180
+عندنا في فلسطين ظهرت أكثر من مرة في تسعينيات القرن
+
+545
+00:40:39,180 --> 00:40:42,880
+الماضي، وفي سبعينيات... وفي أظن سبعينيات أو ثمانينيات
+
+546
+00:40:42,880 --> 00:40:46,940
+القرن الماضي، يعني احتمالية وجودها يعني واردة،
+
+547
+00:40:46,940 --> 00:40:49,680
+وبالتالي ما... ما... ما بنقدرش نقول إنه والله it
+
+548
+00:40:49,680 --> 00:40:52,500
+is confined to one area of the world، لأ، ممكن
+
+549
+00:40:52,500 --> 00:40:58,970
+تكون worldwide، كمان شغل لو إحنا صار عندنا نواب، و
+
+550
+00:40:58,970 --> 00:41:05,090
+الناس بتتعامل مع المرضى، فدول ناس أو contact
+
+551
+00:41:05,090 --> 00:41:08,710
+مع مرضى، contact يعني ناس تواصل مع مرضى، تمام، أو
+
+552
+00:41:08,710 --> 00:41:12,930
+suspected أنهم شربوا مياه ملوثة أو أكلوا طعام ملوث،
+
+553
+00:41:12,930 --> 00:41:17,930
+ممكن نعطيهم كإجراء وقائي، كلمة
+
+554
+00:41:17,930 --> 00:41:19,450
+chemoprophylaxis، إيش يعني؟
+
+555
+00:41:22,400 --> 00:41:26,340
+يعني تناول drug كإجراء وقائي، prophylaxis، كيمو prophylaxis،
+
+556
+00:41:26,340 --> 00:41:29,960
+يعني تناول drug كـ prophylaxis، with تتراسيكلين،
+
+557
+00:41:29,960 --> 00:41:33,600
+لـ close contact، مش يعني close contact الـ
+
+558
+00:41:33,600 --> 00:41:40,060
+family members، الأبناء، الأطفال، الإخوة، الأخوات، إحدى
+
+559
+00:41:40,060 --> 00:41:43,740
+أهم النقاط اللي أنا ذكرتها خلال السياق، prompt،
+
+560
+00:41:43,740 --> 00:41:48,700
+prompt يعني فوري، ما تخليش واحد يمشي كقنبلة موقوتة
+
+561
+00:41:48,700 --> 00:41:51,880
+في الـ... الـ... الـ... بين السكان، هو عنده Vibrio
+
+562
+00:41:51,880 --> 00:41:56,920
+cholera، لأنه كل ما قلّ وقت التشخيص، تمام، كل ما حصرنا
+
+563
+00:41:56,920 --> 00:42:00,080
+في العلاج، كل ما قلّلنا الإفرازات اللي ممكن يكون
+
+564
+00:42:00,080 --> 00:42:03,480
+فيها Vibrio cholera، وبالتالي بمقلّلنا نسبة التلوث،
+
+565
+00:42:03,480 --> 00:42:06,920
+وبالتالي حصرنا الـ disease، إذا prompt معناها فوري،
+
+566
+00:42:07,250 --> 00:42:14,150
+detection and treatment of carriers، طيب،
+
+567
+00:42:14,150 --> 00:42:19,310
+هذه يمكن يعني diagram طويل نختم فيه محاضرتنا اليوم،
+
+568
+00:42:19,310 --> 00:42:26,510
+نتطلع
+
+569
+00:42:26,510 --> 00:42:31,850
+مع بعض على الـ... الـ... فوق هنا قلنا specimen،
+
+570
+00:42:32,430 --> 00:42:39,940
+faeces or rectal swab، في حد اسمها caribler filter
+
+571
+00:42:39,940 --> 00:42:44,240
+paper، caribler، عبارة عن transport media، عبارة عن
+
+572
+00:42:44,240 --> 00:42:47,440
+transport media، يعني إحنا بناخد عينة الستول في
+
+573
+00:42:47,440 --> 00:42:56,040
+transport media، بنروح على الـ laboratory، كلمة
+
+574
+00:42:56,040 --> 00:43:00,300
+بنروح على الـ laboratory، ما بنفعش بعد ساعة، بعد ساعتين،
+
+575
+00:43:00,300 --> 00:43:08,890
+بعد ثلاث، promptly، خدوا بالكم، كثير من المستشفيات
+
+576
+00:43:08,890 --> 00:43:15,550
+لها sampling policies بتحدد فيها الزمن ما بين جمع
+
+577
+00:43:15,550 --> 00:43:21,470
+العينة وما بين وصولها لمين؟ للمختبر، وكنموذج على
+
+578
+00:43:21,470 --> 00:43:26,450
+ذلك الـ urine samples، الـ urine samples معروفة عنها
+
+579
+00:43:26,450 --> 00:43:32,470
+أن one hour، في بعض المختبرات بتسمح بساعتين، لكن في
+
+580
+00:43:32,470 --> 00:43:36,030
+النهاية في زمن محدد ما بين جمع العينة وما بين
+
+581
+00:43:36,030 --> 00:43:40,710
+وصولها للمختبر، لماذا هذا الزمن المحدد؟ لحفاظنا على
+
+582
+00:43:40,710 --> 00:43:45,290
+الـ viability of the organism اللي موجود في العينة
+
+583
+00:43:45,290 --> 00:43:48,250
+اللي بندور عليها، عملنا enrichment على الـ climb
+
+584
+00:43:48,250 --> 00:43:53,810
+pepton water، وزرعناها هنا على الـ TCBS، من هنا
+
+585
+00:43:53,810 --> 00:43:56,830
+إحنا كنا بنتكلم عن أربع لست ساعات، أنا كاتب خمس لـ
+
+586
+00:43:56,830 --> 00:43:59,910
+ثمان ساعات، على خمس وثلاثين درجة مئوية، وإحنا كنا
+
+587
+00:43:59,910 --> 00:44:02,730
+جاجلين... جايين على سبعة وثلاثين درجة مئوية، أخذنا
+
+588
+00:44:02,730 --> 00:44:08,310
+نتكلم عن الجزء هذا شوية، مهم كثير، هي خمس وثلاثين
+
+589
+00:44:08,310 --> 00:44:13,290
+ولا سبعة وثلاثين؟ طب ليش هنقول عن خمس وثلاثين؟ و
+
+590
+00:44:13,290 --> 00:44:16,190
+ليش هتلاقيها في الكتب كثير كمان خمس وثلاثين؟ لأن
+
+591
+00:44:16,190 --> 00:44:22,630
+في خلاف، هل الـ temperature الأمثل 35 ولا 37؟ ما
+
+592
+00:44:22,630 --> 00:44:26,410
+أنتم عارفين أجزاء من جسمنا ممكن تكون 37، والـ
+
+593
+00:44:26,410 --> 00:44:31,650
+external ممكن تكون أقل من ذلك، تمام؟ لكن القضية
+
+594
+00:44:31,650 --> 00:44:37,330
+برضه كمان مش هيك، في بعض الميكروبات حساسة لـ one
+
+595
+00:44:37,330 --> 00:44:41,470
+temperature، يعني أنا 37 ممكن ما تنمو، لكن أنا 30 ممكن تنمو، راحوا الـ... الـ... الـ... البعض ذهب إلى
+
+596
+00:44:47,380 --> 00:44:50,680
+أن البكتيريا كلها بتشترك بأنها ممكن تنمو على خمس
+
+597
+00:44:50,680 --> 00:44:54,860
+وثلاثين، لكن مش كلها بتنمو على... فإحنا إحنا نام سبعة
+
+598
+00:44:54,860 --> 00:44:57,480
+وثلاثين، خلي الـ incubation temperature العادي
+
+599
+00:44:57,480 --> 00:45:01,300
+المعروف والمتعارف عليها، خليها عالميا خمس وثلاثين،
+
+600
+00:45:01,300 --> 00:45:05,300
+فصارت الرقمين الآن موجودات، أبو السبعة والثلاثين، و
+
+601
+00:45:05,300 --> 00:45:08,420
+أبو الخمسة والثلاثين، فلما تقول خمس وثلاثين أنا...
+
+602
+00:45:08,420 --> 00:45:11,720
+يعني إحنا عارفين بيننا وبين بعضنا أن هي
+
+603
+00:45:11,720 --> 00:45:14,300
+temperature تبع الـ incubation يا خمس وثلاثين يا
+
+604
+00:45:14,300 --> 00:45:19,210
+إما سبعة وثلاثين، Incubate overnight، الـ 30 دقيقة
+
+605
+00:45:19,210 --> 00:45:23,770
+اللي هي لمدة 24 ساعة أو overnight، وأنا شرحت لكم
+
+606
+00:45:23,770 --> 00:45:27,270
+جابلك إيش يعني overnight، تمام، إنه يمضي عليها ليلة
+
+607
+00:45:27,270 --> 00:45:30,390
+حتى لو زرعتها الرابعة العصر، الخامسة العصر، السادسة العصر، تاني يوم
+
+608
+00:45:30,390 --> 00:45:34,460
+ممكن تقرأ الطبق، تمام؟ suspicious colonies، إيش يعني
+
+609
+00:45:34,460 --> 00:45:37,320
+suspicious colonies؟ اللي هي suspected colonies،
+
+610
+00:45:37,320 --> 00:45:40,720
+بنعمل لهم اللي هم الفحوصات اللي إحنا ذكرناها من
+
+611
+00:45:40,720 --> 00:45:44,260
+الشباب، بنعمل لهم عملية الـ identification، هنا نفس
+
+612
+00:45:44,260 --> 00:45:48,780
+الجثة، بس بمزيد خطوة، بعد ما عملنا incubation لثلاث
+
+613
+00:45:48,780 --> 00:45:53,040
+لخمس ساعات، أو أربع ساعات، أخذنا قطرة هنا من
+
+614
+00:45:53,040 --> 00:46:00,140
+البكتيريا، إيش عملنا هنا؟ هو هنا ذكرنا
+
+615
+00:46:00,140 --> 00:46:05,460
+الشريحة دي؟ اللي جواها... اللي جواها حفرة، تمام، و
+
+616
+00:46:05,460 --> 00:46:09,580
+جئنا بـ cover slip وحطينا عليها قطرة، وهنا عملنا
+
+617
+00:46:09,580 --> 0
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e131d0599b260cba5400f4862af5c3b62fd918c8
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y_postprocess.srt
@@ -0,0 +1,2524 @@
+1
+00:00:20,480 --> 00:00:22,760
+السلام عليكم ورحمة الله وبركاته بسم الله الرحمن
+
+2
+00:00:22,760 --> 00:00:25,820
+الرحيم اليوم برضه microbe جديد ان شاء الله اللي هو
+
+3
+00:00:25,820 --> 00:00:32,160
+ال vibrio ال vibrio بتميز عن ال gram negative بس
+
+4
+00:00:32,160 --> 00:00:35,460
+ال lie بالشكل ولذلك سميه vibrio لأنه بيمتلك شكل
+
+5
+00:00:35,460 --> 00:00:43,380
+كومة او curvedكومة أو كومة كيرب وبالتالي كلمة
+
+6
+00:00:43,380 --> 00:00:48,740
+vibrio تعني الملوية يعني المنحنية الواوية هذا
+
+7
+00:00:48,740 --> 00:00:54,220
+الاسم مهم جدا نعرفه من البداية لأن احنا بنقول انه
+
+8
+00:00:54,220 --> 00:00:59,520
+في الاستول ال gram stain العينة في الاستول is of
+
+9
+00:00:59,520 --> 00:01:03,320
+no value in all bacterial infection except in one
+
+10
+00:01:03,320 --> 00:01:06,980
+case except in vibrio ليش؟ لأن احنا هنشوف في هذا
+
+11
+00:01:06,980 --> 00:01:13,530
+الحالةmany يعني كتير of the curved بس اللاعي وهذا
+
+12
+00:01:13,530 --> 00:01:17,950
+مؤشر عن ان المريض قد يكون مصاب بالvibro ابنليه
+
+13
+00:01:17,950 --> 00:01:22,330
+طبعا ان هذه الحالة في الاوبئة هذا بيساعدنا في
+
+14
+00:01:22,330 --> 00:01:24,270
+بيقصر الوقت اللي هو التشخيص
+
+15
+00:01:26,720 --> 00:01:29,120
+الاسم المشهور و اللي كلكم بتعرفوه هو الـ Vibrio
+
+16
+00:01:29,120 --> 00:01:31,940
+cholera لكن هناك أسماء أخرى غير ال Vibrio cholera
+
+17
+00:01:31,940 --> 00:01:35,920
+زي مثلا اللي هو ال Vibromimicus و من اسمها mimicus
+
+18
+00:01:35,920 --> 00:01:41,620
+من mimic mimic يحاكي وهي حقا تشبه إلى حد كبير في
+
+19
+00:01:41,620 --> 00:01:45,940
+الشكل والمواصفات إلى اللي هو ال Vibrio cholera ال
+
+20
+00:01:45,940 --> 00:01:50,300
+Vibrio parahemolyticus هذا مايكروب اشتهر اكثر في
+
+21
+00:01:50,300 --> 00:01:51,740
+ال food microbiology
+
+22
+00:01:54,260 --> 00:01:58,220
+كفوود بورن باثوجين كفوود بورن باثوجين وبالأحرى
+
+23
+00:01:58,220 --> 00:02:04,020
+with seafood بالظبط
+
+24
+00:02:04,020 --> 00:02:08,900
+الآن ال seafood بتعرفوا الطعام المشهور لليابانيين
+
+25
+00:02:08,900 --> 00:02:12,120
+اللي هو السوشي اللي هو السمك النية اللي غير مطهي
+
+26
+00:02:12,120 --> 00:02:17,120
+بهذه الخدمة أو هذه النوع من الطعام شاعر في كثير من
+
+27
+00:02:17,120 --> 00:02:23,440
+البلدان العالم كثقافة غذائية نشرها اليابانين في كل
+
+28
+00:02:23,440 --> 00:02:31,310
+مكانفبالتالي الميكروب مرتبط بالأغضية البحرية
+
+29
+00:02:31,310 --> 00:02:33,890
+اللي غير المطهية اللي من ضمنها جنها السمك ومن
+
+30
+00:02:33,890 --> 00:02:37,970
+ضمنها الشيل فش هذا الميكروب is a marine organism
+
+31
+00:02:37,970 --> 00:02:43,990
+يعني ميكروب بحري وبالتالي هينتقل عبر هذه الأسماك
+
+32
+00:02:43,990 --> 00:02:48,080
+ويسببنا food poisoning casesفى هنا ال Vibrio
+
+33
+00:02:48,080 --> 00:02:51,340
+volnepicus كانت فى السابق اتبار non-pathogen لكن
+
+34
+00:02:51,340 --> 00:02:53,900
+الان بيعتبر انها بتسبب wound infection و
+
+35
+00:02:53,900 --> 00:02:57,500
+septicemia اذا فى عندى كمان مرة Vibrio cholera وهى
+
+36
+00:02:57,500 --> 00:03:00,220
+ال most common و ال most important species of all
+
+37
+00:03:00,220 --> 00:03:05,980
+هي المسبب لال epidemic cholera Vibrio mimicus لسه
+
+38
+00:03:05,980 --> 00:03:09,220
+important لكن اهميتها هنا بتشبه مين ال Vibrio
+
+39
+00:03:09,220 --> 00:03:12,710
+cholera مش شكلا و biochemical مش diseaseVibrio
+
+40
+00:03:12,710 --> 00:03:17,930
+parahemoneficas قلنا انها تزيد الاهتمام بها نظرا
+
+41
+00:03:17,930 --> 00:03:22,630
+لما قلنا انها تزيد ثقافة تناول الأسماك الغير
+
+42
+00:03:22,630 --> 00:03:26,470
+مطهية، ال Vibrio volneficas ثبت انها بتسبب وضعوه
+
+43
+00:03:26,470 --> 00:03:27,890
+بالإنفكاشين و السبسكترين
+
+44
+00:03:30,830 --> 00:03:34,650
+البكتيريا ال genus vibrio ال .. ال .. ال vibrio
+
+45
+00:03:34,650 --> 00:03:39,170
+بنا بيتميز بالشكل تبعه انه كما shape اعتقد ان
+
+46
+00:03:39,170 --> 00:03:42,710
+الصورة اللي هناك على طرف بوب بتوضح لنا ان
+
+47
+00:03:42,710 --> 00:03:47,330
+البكتيريا بسيلاي صحيح لكن مش straight مش straight
+
+48
+00:03:47,330 --> 00:03:51,110
+يعني مش ادلة وبالتالي هي curved they are small,
+
+49
+00:03:51,310 --> 00:03:54,630
+ground, negative, curved بسيلاي او rods, motile,
+
+50
+00:03:54,750 --> 00:03:57,610
+bipolar, flagella زي pseudomonas يبقى وجه شبه الآن
+
+51
+00:03:57,610 --> 00:04:03,590
+بينها و بينها حاجتينهنشوف كمان شوية إنها Oxidase
+
+52
+00:04:03,590 --> 00:04:06,110
+positive و Sodomonas aeruginosa برضه Oxidase
+
+53
+00:04:06,110 --> 00:04:11,190
+positive هذه البكتيريا مطاع ال bipolar flagella و
+
+54
+00:04:11,190 --> 00:04:14,390
+Sodomonas aeruginosa برضه مطاع ال bipolar flagella
+
+55
+00:04:14,390 --> 00:04:18,630
+لكن الفرق بينهم هذي fermenter و هذي non fermenter
+
+56
+00:04:18,630 --> 00:04:21,310
+فاكرين أداء جرامه ولا فاكرينه؟ لأ بتذكركوا فيه من
+
+57
+00:04:21,310 --> 00:04:25,830
+البداية الجرام negative بس ال lie انجسمت جسمين
+
+58
+00:04:25,830 --> 00:04:30,590
+بناء على فحص ال Oxidaseاللي بوستف يبقى وجه الشبه
+
+59
+00:04:30,590 --> 00:04:33,910
+كام ان احنا بينهم تنتين انه تنتين بوستف للإكسيدايز
+
+60
+00:04:33,910 --> 00:04:37,990
+لكن واحدة للجلوكوز fermentation كانت negative اللي
+
+61
+00:04:37,990 --> 00:04:43,410
+و هي صيدومونوس و بوستف كانت اللي هي ال Vibrio إذا
+
+62
+00:04:43,410 --> 00:04:47,530
+الفرق بين صيدومونوس و الارجنوزا و ال Vibrio اللي
+
+63
+00:04:47,530 --> 00:04:50,950
+هو الجلوكوز fermentation بينما بيشتبهوا .. بتشبهوا
+
+64
+00:04:50,950 --> 00:04:55,470
+مع بعض في صفتين صفة الإكسيدايز و صفة اللي هو قولنا
+
+65
+00:04:55,470 --> 00:05:00,190
+ال motility bipolar efflationالفيبرو الكوليرة بشكل
+
+66
+00:05:00,190 --> 00:05:05,090
+عام تعتبر aerobic and facultative أنا aerob و هذا
+
+67
+00:05:05,090 --> 00:05:08,150
+السبب انه لو بنقول facultative أنا aerob بنقول
+
+68
+00:05:08,150 --> 00:05:10,910
+انها قادرة على التعمل fermentation بس لو انها
+
+69
+00:05:10,910 --> 00:05:13,970
+obligate aerob زي Sodomonas aeruginosa لن تكون
+
+70
+00:05:13,970 --> 00:05:16,070
+قادرة على ال fermentation لما تكون قادرة فقط على
+
+71
+00:05:16,070 --> 00:05:20,730
+ال Oxidation الفيبرو
+
+72
+00:05:20,730 --> 00:05:26,420
+الكوليرةكبكتيريا can adhere to the intestinal cell
+
+73
+00:05:26,420 --> 00:05:31,080
+wall بدون ما تعمل اي invasion ل ال intestinal cell
+
+74
+00:05:31,080 --> 00:05:36,110
+wall يعني بمعنى اخر localized infectionطبعا
+
+75
+00:05:36,110 --> 00:05:41,230
+السلمونيلا عملت invasion وتخطط ال intestinal wall
+
+76
+00:05:41,230 --> 00:05:45,870
+و ال lymph node و راحت على الدم الشيجيلا عملت
+
+77
+00:05:45,870 --> 00:05:49,150
+invasion لل intestinal wall ولكن بقيت هناك لم
+
+78
+00:05:49,150 --> 00:05:54,330
+تستطع المرور عبر ال lymph node إلى الدم ال vibrio
+
+79
+00:05:54,330 --> 00:05:57,430
+الان localized to the intestinal tract, no
+
+80
+00:05:57,430 --> 00:06:02,530
+invasionكلكم تتذكروا الـ toxin تبع ال Vibrio
+
+81
+00:06:02,530 --> 00:06:07,830
+وشرحناه احنا بطريقة يعني نوعا ما comic يعني هزلية
+
+82
+00:06:07,830 --> 00:06:14,550
+قلنا لو كان هذا هو ال intestinal walls تمام؟ ال
+
+83
+00:06:14,550 --> 00:06:20,890
+toxin of cholera وانا افترض ان هو هذا المتلت بيعمل
+
+84
+00:06:20,890 --> 00:06:24,590
+binding مع انزيم ايه اسم قلنا عنه؟
+
+85
+00:06:29,190 --> 00:06:34,720
+Enzymeالاديناليت سايكليز انزايم الارتباط تبع
+
+86
+00:06:34,720 --> 00:06:42,780
+التوكسين فيه بيحول ال ATP إلى Cyclic AMB قلنا ال
+
+87
+00:06:42,780 --> 00:06:47,180
+amount of Cyclic AMB الكثيرة أو الكثيفة أو العالية
+
+88
+00:06:47,180 --> 00:06:51,940
+أو الغير معتادة هتزيد ال function المنوطة بال
+
+89
+00:06:51,940 --> 00:06:55,580
+Cyclic AMB اللي قلنا عنها تتلخص في شغلتين منع
+
+90
+00:06:55,580 --> 00:07:02,210
+امتصاص لبعض ال electrolyte وزيادة إفراز increaseلا
+
+91
+00:07:02,210 --> 00:07:05,070
+لبعض ال electrolytes وبالتالي صار فين دي هنا
+
+92
+00:07:05,070 --> 00:07:09,930
+electrolyte accumulation
+
+93
+00:07:09,930 --> 00:07:18,910
+filter sensed by the intestinal wall وبالتالي
+
+94
+00:07:18,910 --> 00:07:23,370
+diluted by large amount of H2O وبالتالي في هنا
+
+95
+00:07:23,370 --> 00:07:28,910
+ديارية ديارية هذي إذا تذكروا ووصفناها بإنها rice
+
+96
+00:07:28,910 --> 00:07:29,950
+water
+
+97
+00:07:32,960 --> 00:07:39,720
+طبعا هذا characteristic مشهور ل .. نعم مشهور ل ..
+
+98
+00:07:39,720 --> 00:07:43,760
+ال .. ال diarrhea caused by vibrio cholera ايش
+
+99
+00:07:43,760 --> 00:07:47,240
+بالنسبة لكوا ك .. كتحاليل طبية انتوا بي .. بيهمكوا
+
+100
+00:07:47,240 --> 00:07:51,630
+هذا الموضوع؟الشباب احنا متفقين على ان ال course
+
+101
+00:07:51,630 --> 00:07:55,010
+تبقى على اسمه medical diagnostic او diagnostic
+
+102
+00:07:55,010 --> 00:07:59,450
+medical microbiology فاحنا جزء في ال diagnosis جزء
+
+103
+00:07:59,450 --> 00:08:04,790
+في ال medical ليس من أجل انه نصير خبراء نصير خبراء
+
+104
+00:08:04,790 --> 00:08:11,330
+في التشخيص السريري للأمراض وانما لمعرفة العينات
+
+105
+00:08:11,330 --> 00:08:17,480
+ماذا يجب ان نتوقع منهاما هي الخصائص سبعة العينات؟
+
+106
+00:08:17,480 --> 00:08:20,040
+هى انك تتكلم عن rice water stool، لو انت شوفت هذا
+
+107
+00:08:20,040 --> 00:08:23,880
+ال character في عينة ال stool، أليس هذا مدعاكلك
+
+108
+00:08:23,880 --> 00:08:26,800
+انك تعمل suspicion ان البكتيرى المسببة هي vibrio
+
+109
+00:08:26,800 --> 00:08:31,520
+cholera وبالتالي بتسهل عليك عملية اللى هو التفكير
+
+110
+00:08:31,520 --> 00:08:36,780
+والاتجاه في ال diagnosis اللى انت مؤهل للقيام بيه؟
+
+111
+00:08:38,400 --> 00:08:42,560
+الان ال rice water stool عليش بيحتوي بقولنا بيحتوي
+
+112
+00:08:42,560 --> 00:08:46,000
+على ال vibrios و اعتقد ان الجملة هذه او الكلمة هذه
+
+113
+00:08:46,000 --> 00:08:50,840
+بتوضح ان اهمية ال gram stain لان في هذه اللحظة
+
+114
+00:08:50,840 --> 00:08:55,460
+اكتر شي هنشوفه في ال stool مش هنشوفه في ال stool
+
+115
+00:08:55,460 --> 00:08:58,560
+العادي ولا في ال stool تبع اي ديارية اخرى اللي هو
+
+116
+00:08:58,560 --> 00:09:03,180
+شكل ال vibrio لكن كمان مرة it is not conclusive
+
+117
+00:09:04,170 --> 00:09:09,510
+يعني عدم موجود Vibrios في الستول لا يعني ان المصاب
+
+118
+00:09:09,510 --> 00:09:14,870
+مش مريض بالكوليرا وصل الصورة لكن وجودها مش مثبت
+
+119
+00:09:14,870 --> 00:09:19,690
+مؤشر قوي لوجود ال Vibrio فيها ان انا ممكن ايضا
+
+120
+00:09:19,690 --> 00:09:25,190
+ايجاد Epithelial cells وممكن ايضا ان ميوكاس are
+
+121
+00:09:25,190 --> 00:09:28,410
+passed يعني ماشية مع الستول In acute cholera
+
+122
+00:09:28,410 --> 00:09:31,830
+cases, the rapid loss of fluid and electrolytes
+
+123
+00:09:31,830 --> 00:09:36,410
+lead to muscular crampsأحنا جبنا المحاضرة تانية او
+
+124
+00:09:36,410 --> 00:09:42,270
+تلاتة ان number one cause
+
+125
+00:09:42,270 --> 00:09:45,490
+of death among children is diarrhea يعني الإسهال
+
+126
+00:09:45,490 --> 00:09:49,770
+هو المسبب رقم واحد للوفيات وحكينا عن جملتين جبنا
+
+127
+00:09:49,770 --> 00:09:53,450
+electrolyte imbalanceيعني خلل .. صار خلل في عنده
+
+128
+00:09:53,450 --> 00:09:56,050
+في مين؟ في الـ electrolyte نتيجة اللي هو ال .. ال
+
+129
+00:09:56,050 --> 00:09:59,270
+.. ال .. ال .. ال dehydration اللي هو loss of
+
+130
+00:09:59,270 --> 00:10:05,070
+water فبالتالي إذا صار في أنه dehydration عالي قد
+
+131
+00:10:05,070 --> 00:10:09,270
+تؤدي إلى الوفيات فيه و خاصة في الأطفال بيقولنا
+
+132
+00:10:09,270 --> 00:10:13,870
+which if not .. which if not treated it is fatal
+
+133
+00:10:13,870 --> 00:10:15,870
+fatal يعني قاتل
+
+134
+00:10:18,490 --> 00:10:22,070
+التوكسين اللي .. اللي .. اللي حكينا عنه هو عبارة
+
+135
+00:10:22,070 --> 00:10:27,470
+عن A 5B هنا معمول 6B لكن هو 5B ال B هنا لل binding
+
+136
+00:10:27,470 --> 00:10:31,430
+صار internalization ال A portion بيقولنا بي ..
+
+137
+00:10:31,430 --> 00:10:35,190
+بيرتبط بال protein G زائد ناد بيعمل ADP
+
+138
+00:10:35,190 --> 00:10:39,160
+ribosylationوزائد نيكوتنامويد طبعا هذا بيعمل
+
+139
+00:10:39,160 --> 00:10:42,440
+activation لمين؟ لـadenylate cyclase enzyme ال
+
+140
+00:10:42,440 --> 00:10:45,360
+activation لـadenylate cyclase enzyme اللي وصفناها
+
+141
+00:10:45,360 --> 00:10:49,400
+في الخطوة هذه بيتحول معها ال ATP إلى إيه؟ Cyclic
+
+142
+00:10:49,400 --> 00:10:51,840
+AMP وقلنا بيقدي إلى accumulation of electrolytes
+
+143
+00:10:51,840 --> 00:10:54,120
+بيقدي في الآخر إلى اللي هو ال secretion
+
+144
+00:10:57,890 --> 00:11:01,990
+الان خلّينا بس نوضّح بعض الأمور المتعلقة
+
+145
+00:11:01,990 --> 00:11:07,650
+بالأورجانيزم عشان نعرف أفضل الطرق المناسبة لعزل
+
+146
+00:11:07,650 --> 00:11:08,870
+هذا ال microbe
+
+147
+00:11:17,610 --> 00:11:22,290
+هذا ميكروب يمكن ينتجلنا Epidemics of cholera
+
+148
+00:11:22,290 --> 00:11:26,050
+Epidemics of cholera يعني أوبئة من الانتشار واسع
+
+149
+00:11:26,050 --> 00:11:32,950
+وسريع للمرض وبالتالي ممكن نتجاوز عن الخطوات اللي
+
+150
+00:11:32,950 --> 00:11:40,350
+فاكرناهم الأربع خطوات أذكركوا فيهم cultural لا لسه
+
+151
+00:11:40,350 --> 00:11:46,870
+morphology يعني استيانين لا؟
+
+152
+00:11:47,630 --> 00:11:51,810
+بيو كيميكال واربع سيرولوجيكال وخمسة جينا عنها
+
+153
+00:11:51,810 --> 00:11:56,150
+others تمام وفاكرين في الشكل اللي قفزنا من ال
+
+154
+00:11:56,150 --> 00:11:58,930
+culture روحنا على مين؟ على السيرولوجيكال صح ولا لا
+
+155
+00:11:58,930 --> 00:12:04,370
+فاحنا بدنا كمان نشوف في أي مايكروب اي مايكروب
+
+156
+00:12:04,370 --> 00:12:09,290
+بيحدث بشكل وبائي انفجاري epidemics تمام او
+
+157
+00:12:09,290 --> 00:12:14,050
+outbreak بدنا نحاول نشوف اقصر الطرق هذا لا يعني ان
+
+158
+00:12:14,050 --> 00:12:18,240
+احنا ننسى أطول الطرقكنا أقصر الطرق لل initial
+
+159
+00:12:18,240 --> 00:12:22,960
+report و أطول الطرق اللي هي لل final report فإيش
+
+160
+00:12:22,960 --> 00:12:25,540
+ال characteristics اللي ممكن أستفيدها أنا من
+
+161
+00:12:25,540 --> 00:12:30,840
+الميكروب عشان أقدر أعمل diagnoses قصيرة جبل خدنا
+
+162
+00:12:30,840 --> 00:12:33,560
+ناخد خصائصنا رقم واحد البكتيرا قلنا عنها جلعب
+
+163
+00:12:33,560 --> 00:12:37,890
+نيجاتيف بسلعكطبعا بس ال life is straight or curved
+
+164
+00:12:37,890 --> 00:12:42,630
+رقم اتنين they grow in alkaline pH يعني بتحب الوسط
+
+165
+00:12:42,630 --> 00:12:46,730
+اللي هو المرتفع في ال pH هذه النقطة لحالها بدنا
+
+166
+00:12:46,730 --> 00:12:52,090
+نحطها يعني ك target نستهدف من خلاله هذا الهدف
+
+167
+00:12:52,090 --> 00:12:55,370
+نستهدف من خلاله عزل البكتيريا دون عن البكتيريا
+
+168
+00:12:55,370 --> 00:12:59,650
+الأخرى لأن كل البكتيريا الأخرى loves the pH of
+
+169
+00:12:59,650 --> 00:13:04,480
+neutralityيعني بتحب تعيش في وسط قريب من مين من
+
+170
+00:13:04,480 --> 00:13:09,220
+التعادل من السبع لو حاطناها في أنبوبة ال stool
+
+171
+00:13:09,220 --> 00:13:17,760
+اللي بيحتوي من ضمنه واحد vibrio cholera حاطناها
+
+172
+00:13:17,760 --> 00:13:22,440
+في alkaline pH
+
+173
+00:13:22,440 --> 00:13:27,000
+يعني من تمانية تسعة ايش اللي بيصير ان هنا كل
+
+174
+00:13:27,000 --> 00:13:33,110
+الميكروبات اللي موجودةمش ملائم إلها هذا الوسط
+
+175
+00:13:33,110 --> 00:13:38,390
+وبالتالي gradually will die مين اللي بينمو فقط ال
+
+176
+00:13:38,390 --> 00:13:40,990
+vibrio cholera وهنا كمان خدوا بالكوا هاد اسمها
+
+177
+00:13:40,990 --> 00:13:41,390
+enrichment
+
+178
+00:13:44,210 --> 00:13:46,850
+هيشوفته اكتر من نوع enrichment شوفته مرة بال
+
+179
+00:13:46,850 --> 00:13:50,450
+selenite-f كيف كانت selenite-f فكرته حطينا lactose
+
+180
+00:13:50,450 --> 00:13:54,190
+للاكتوز fermenting بكتيريا انما البكتيريا موتها
+
+181
+00:13:54,190 --> 00:13:57,370
+اللي هو مين ال selenious acid المرة اللي بعديها
+
+182
+00:13:57,370 --> 00:14:00,670
+أخدنا كمان نوع تاني من enrichment حطيناها بالتلاجة
+
+183
+00:14:00,670 --> 00:14:04,210
+بالظبط cold enrichment البكتيريا اللي بدناياها
+
+184
+00:14:04,210 --> 00:14:08,130
+تنمو في التلاجة و الآخرين بيموتوا هنا وضعناها في
+
+185
+00:14:08,130 --> 00:14:12,520
+مين؟في alkaline pH طبعا اختيارنا لل enrichment
+
+186
+00:14:12,520 --> 00:14:16,500
+معتمد على معرفتنا بصفات البكتيريا هنا عرفنا ان
+
+187
+00:14:16,500 --> 00:14:21,600
+البكتيريا هذه بتحب ال alkaline pH الوسط المستخدم
+
+188
+00:14:21,600 --> 00:14:28,740
+هنا اسمه alkaline peptone water او APW
+
+189
+00:14:28,740 --> 00:14:33,950
+اقتصارا alkaline peptone waterمن أشهر الأوساط
+
+190
+00:14:33,950 --> 00:14:37,750
+المستخدمة للبكتيريا ك selective media اللي هو ال
+
+191
+00:14:37,750 --> 00:14:43,770
+TCBS و هنتعرف على إيش هي TCBS Thyrosulfate نكتبهم
+
+192
+00:14:43,770 --> 00:14:47,550
+هلاجيهم
+
+193
+00:14:47,550 --> 00:14:51,330
+في لوحات تانية لكن لأ بقص ان اللوحة دي نستخدمها
+
+194
+00:14:51,330 --> 00:14:58,330
+كمدخل لل diagnosis كاملة تي وال سي وال بي اس
+
+195
+00:15:13,210 --> 00:15:18,410
+إذن هو عبارة عن ثيوسلفيت سيتريت بايل سولت ساكروس
+
+196
+00:15:18,410 --> 00:15:22,070
+طبعا الأحرف الأولى من كلهم اضططنوا اللى هو مين ال
+
+197
+00:15:22,070 --> 00:15:27,290
+TCBS كمان مرة ثيوسلفيت سيتريت بايل سولت ساكروس
+
+198
+00:15:27,290 --> 00:15:31,710
+اعتقد ان ال بال سولت عرفت ليش اللى بنضيفه؟ بنضيفه
+
+199
+00:15:31,710 --> 00:15:36,870
+عشان نقتل في مين؟الجرام positive بكتيريا وإذا
+
+200
+00:15:36,870 --> 00:15:39,490
+زودنا التركيز تبقى هو عشان نقتل بعض الجرام
+
+201
+00:15:39,490 --> 00:15:41,290
+negative بكتيريا مش كل جرام negative يعني
+
+202
+00:15:41,290 --> 00:15:43,850
+السلمونية اللي بتحب ال bile فاكريني مين بجتعيش؟ في
+
+203
+00:15:43,850 --> 00:15:46,570
+ال bile في ال gallbladder مظبوط ولا لما عملت ..
+
+204
+00:15:46,570 --> 00:15:49,830
+لما عملت career .. stage .. state and ال .. ال ..
+
+205
+00:15:49,830 --> 00:15:56,490
+and بعض الناس طيب تبقوا ليه على ال sacrose هذا هذا
+
+206
+00:15:56,490 --> 00:16:01,400
+ال sacrose انحط في الوسطcadiferential sugar زي
+
+207
+00:16:01,400 --> 00:16:05,320
+المقنكي مكان فيه لاكتوز لاكتوز fermenter و لاكتوز
+
+208
+00:16:05,320 --> 00:16:09,260
+fermenter زي ال manitol salt agar في الستفيل
+
+209
+00:16:09,260 --> 00:16:12,100
+الكوكاس اوريس مانحط فيه manitol عشان نقدر نميز ما
+
+210
+00:16:12,100 --> 00:16:15,860
+بين manitol fermenter و non-manitol fermenter ايضا
+
+211
+00:16:15,860 --> 00:16:21,520
+هذا السكر وضع في الTCP-S cadiferential sugar ال
+
+212
+00:16:21,520 --> 00:16:28,100
+Vibrio cholera is sucrose fermenterالـ Indicator
+
+213
+00:16:28,100 --> 00:16:32,700
+اللي موجود هنا هو .. إيش اسم ال Indicator الموجود
+
+214
+00:16:32,700 --> 00:16:44,480
+في السيطرات؟ الـ Bromethymol Blue الـ
+
+215
+00:16:44,480 --> 00:16:48,140
+Bromethymol Blue بيكون لونه أخضر فاكرين السيطرات
+
+216
+00:16:48,140 --> 00:16:53,600
+إيش كده؟اللي هو ال neutral pH تمام؟ بكله هو أخضر
+
+217
+00:16:53,600 --> 00:16:57,940
+يبقى ال TCPS هتلاقوا الأوساط تبعته لونها green
+
+218
+00:16:57,940 --> 00:17:02,680
+الآن
+
+219
+00:17:02,680 --> 00:17:10,020
+لاحظوا في السيطرات ال alkaline pH اتحول لمين؟ بس
+
+220
+00:17:10,020 --> 00:17:12,860
+أنا بتكلم عن sucrose fermentation بدي يصير
+
+221
+00:17:12,860 --> 00:17:19,170
+alkaline ولا acid؟ بدي يصير acid إذا صار acidيعني
+
+222
+00:17:19,170 --> 00:17:27,050
+الـ pH انخفض يعني yellowإذا المستعمرة اللي بتخمر
+
+223
+00:17:27,050 --> 00:17:32,110
+الساكروز على الTCPS إيش هيكون لونها؟ أصفر يعني لما
+
+224
+00:17:32,110 --> 00:17:36,070
+أنا أقولكوا إن ال vibrocholera بتخمر الساكروز
+
+225
+00:17:36,070 --> 00:17:39,610
+بتتوقع إن إيش هيكون شكلها على الTCPS أصفر طبعا
+
+226
+00:17:39,610 --> 00:17:43,250
+يبقى لما أنا أقولكوا what is a suspect colony أو
+
+227
+00:17:43,250 --> 00:17:47,010
+what is a typical colony of vibrocholera on TCPS
+
+228
+00:17:47,010 --> 00:17:49,490
+هتقوللي إيش انت؟ yellow colonies مش بس yellow
+
+229
+00:17:49,490 --> 00:17:53,050
+colonies surrounded by a yellow zone as a result
+
+230
+00:17:53,050 --> 00:17:58,650
+of sucrose fermentationيعني مستعمرة سفراء محاطة
+
+231
+00:17:58,650 --> 00:18:04,750
+بمنطقة سفراء كنتيجة لتخمير من الساكروس خلصنا منها
+
+232
+00:18:04,750 --> 00:18:09,330
+الجثة هى طيب
+
+233
+00:18:09,330 --> 00:18:13,110
+نرجع
+
+234
+00:18:13,110 --> 00:18:21,670
+لعينة الستول عملنا على الجهة دى وعلى
+
+235
+00:18:21,670 --> 00:18:22,290
+الجهة دى
+
+236
+00:18:26,440 --> 00:18:31,020
+بعد انرشمت مايكون هنا Selected
+
+237
+00:18:31,020 --> 00:18:35,180
+وعلى أي من ال selective الأولانية او السلكتف
+
+238
+00:18:35,180 --> 00:18:41,260
+التانية ايه يكون هنا Suspect كونرسي بس خلينا نعمل
+
+239
+00:18:41,260 --> 00:18:46,020
+تبديل للمسميات العامة لمسميات خاصة ال enrichment
+
+240
+00:18:46,020 --> 00:18:54,000
+هنا يكون alkaline, peptone, water صح هنا TCBS
+
+241
+00:18:54,000 --> 00:19:01,000
+هنابرضه تي سي بي اس الان ال suspect colony وصلنا
+
+242
+00:19:01,000 --> 00:19:04,220
+متفقين عليها وحفظناها yellow colonies surrounded
+
+243
+00:19:04,220 --> 00:19:07,040
+by a yellow zone as a result of sucrose
+
+244
+00:19:07,040 --> 00:19:15,440
+fermentation هنا السؤال what is next ما
+
+245
+00:19:15,440 --> 00:19:21,530
+الذي يجب علينا فعله ما هي الصفاتخدوا بالكوا بتكلم
+
+246
+00:19:21,530 --> 00:19:25,830
+كمان مرة على فترة قصيرة من ال diagnosis إذا طولنا
+
+247
+00:19:25,830 --> 00:19:29,610
+في ال diagnosis الشباب معنا الحكي احنا أعطينا فرصة
+
+248
+00:19:29,610 --> 00:19:33,050
+أكبر للميكروب بالانتشار بدنا نحاول نحاصر
+
+249
+00:19:33,050 --> 00:19:38,370
+الميكروبات اللي بتنتشر بشكل مفاجئ وسريع ولها خطورة
+
+250
+00:19:38,370 --> 00:19:43,290
+عالية إذا بدنا نبحث عن الفحوصات ذات الزمن القصير
+
+251
+00:19:43,290 --> 00:19:47,350
+ذات الزمن القصير من هذه الفحوصات على سبيل المثال
+
+252
+00:19:55,250 --> 00:20:02,170
+oxidase test لازم تكون عاشرطب لو طلعت معانا yellow
+
+253
+00:20:02,170 --> 00:20:06,210
+colonies ف around by a zone of .. color .. برضه
+
+254
+00:20:06,210 --> 00:20:10,070
+yellow .. yellowish zone و طلعت oxidized negative
+
+255
+00:20:10,070 --> 00:20:14,150
+يبجي البكتيريا مش fiber يبجي هذا الفحص مش بيعملي
+
+256
+00:20:14,150 --> 00:20:18,810
+مش بيأكدليه بس كمان بيستثنيلي والاستثناء عملية
+
+257
+00:20:18,810 --> 00:20:21,690
+مهمة جدا في ال .. في ال .. في ال diagnosis بقولنا
+
+258
+00:20:21,690 --> 00:20:25,310
+بدل ما انا اشتغل ABI او اعمل serology لكل
+
+259
+00:20:25,310 --> 00:20:29,490
+المستعمرات الصفر لأ بعملها هيoxidized test اللي
+
+260
+00:20:29,490 --> 00:20:33,530
+بتطلع positive بستمر معاها اللي بتطلع negative حطه
+
+261
+00:20:33,530 --> 00:20:37,990
+على جانب خلصنا منها مش بكتيريا من اللي بدناها في
+
+262
+00:20:37,990 --> 00:20:42,090
+كمان فحص شباب تعرفوه انتوا او عرفتوا في سياق
+
+263
+00:20:42,090 --> 00:20:49,850
+محاضراتنا لما اتكلمنا عن string test كيو
+
+264
+00:20:49,850 --> 00:20:54,710
+اتش هي كيو اتش test برضه من احد الفحوصات المهمة
+
+265
+00:20:54,710 --> 00:20:59,390
+جدا لل Vibrioلازم تطلع معانا ال string test ايه؟
+
+266
+00:20:59,390 --> 00:21:04,810
+بسطى يبقى في عندي فعصين اوكسدايز والتاني اللي قلنا
+
+267
+00:21:04,810 --> 00:21:08,650
+عنه اللي هو ال string test في كمان فعص تالت انا
+
+268
+00:21:08,650 --> 00:21:16,840
+ممكن اعمله اللي هو polyvalent agglutination نعملكن
+
+269
+00:21:16,840 --> 00:21:19,880
+لحظة وين .. وين .. وين حاطيته انا؟ اخر واحد .. اول
+
+270
+00:21:19,880 --> 00:21:23,000
+واحد oxidase إذا طلعت negative استثنت من هناك، إذا
+
+271
+00:21:23,000 --> 00:21:25,380
+طلعت oxidase positive و strength negative
+
+272
+00:21:25,380 --> 00:21:29,160
+استثنتها، يعني لازم تطلع هذه و هذه و بعدين عملها
+
+273
+00:21:29,160 --> 00:21:31,660
+مين؟ اللي هو ال .. ال .. ال polyvalent
+
+274
+00:21:31,660 --> 00:21:35,000
+agglutination هاي تلت فحوصات أنا هيك بكون عملت ..
+
+275
+00:21:35,000 --> 00:21:39,060
+طلعت كلهم طلتها positive بعمل initial report
+
+276
+00:21:41,700 --> 00:21:44,480
+مش مولت انا .. انا مقولتش انه بعملهم مع بعض، انا
+
+277
+00:21:44,480 --> 00:21:50,280
+قولت بعملهم sequential، بعمل أكسداز، خلاص negative
+
+278
+00:21:51,340 --> 00:21:55,200
+الفحص negative لأنه لازم تكون .. لازم تكون التلت
+
+279
+00:21:55,200 --> 00:21:58,120
+.. التلت صفات لازم تكون التلت صفات لذلك انا قولتلك
+
+280
+00:21:58,120 --> 00:22:02,060
+اللي من الأول اللي لم تمتلك ال oxidase استثنينها
+
+281
+00:22:02,060 --> 00:22:04,860
+اللي امتلكت ال oxidase و negative لل .. لل string
+
+282
+00:22:04,860 --> 00:22:07,960
+test برضه استثنينها اللي امتلكت التنين و negative
+
+283
+00:22:07,960 --> 00:22:11,960
+ل .. ل .. الأخيرة برضه بنستثنينه لكن احنا عجلنا
+
+284
+00:22:11,960 --> 00:22:15,080
+التالت للآخر لإنه هي the most expensive .. the
+
+285
+00:22:15,080 --> 00:22:16,120
+most expensive
+
+286
+00:22:25,100 --> 00:22:28,600
+نطلع على الان على اللوحة و نحاول نراجع مع بعض
+
+287
+00:22:28,600 --> 00:22:32,200
+الفحاصات نقول ان الالكالاين ببتون واتر هو ال
+
+288
+00:22:32,200 --> 00:22:35,500
+enrichment و ال pH تبقى من حوالى تمانية وست من
+
+289
+00:22:35,500 --> 00:22:39,260
+عشرة يعني جريب التسعة rapid isolation from face
+
+290
+00:22:39,260 --> 00:22:41,880
+بساعدنا في عزل سريع من البرازا كلامكم الله
+
+291
+00:22:41,880 --> 00:22:45,220
+selective medium tcps اكسيدايز بوستف gram negative
+
+292
+00:22:45,220 --> 00:22:51,020
+curved rad هذا نقطة مهمة انتوا بتعرفوا ان
+
+293
+00:22:51,020 --> 00:22:53,140
+السفرانين هو ال counter stain في ال gram stain
+
+294
+00:22:53,140 --> 00:22:58,960
+تمام؟خدوها قاعدة لما الميكروب يكون curved او
+
+295
+00:22:58,960 --> 00:23:03,260
+spiral و بدنا نعمله staining، بلاش نستخدم
+
+296
+00:23:03,260 --> 00:23:07,780
+الصفرانين، نستخدم مين؟ ال carbolfoxin، ال carbol
+
+297
+00:23:07,780 --> 00:23:13,570
+اللي هو وعنه هناالكاربولفوكسين استخدمنا اين
+
+298
+00:23:13,570 --> 00:23:17,650
+كاربولفوكسين استخدمنا؟ استخدمنا ك primary stain صح
+
+299
+00:23:17,650 --> 00:23:22,310
+ولا لا؟ احنا بنستخدم مبادرة السفرانين ك counter
+
+300
+00:23:22,310 --> 00:23:26,730
+stain فقط في حالات مين؟ لما تكون البكتيريا كمان
+
+301
+00:23:26,730 --> 00:23:33,000
+مرةcurved أو spiral microorganism ليش؟ بقول إن هذه
+
+302
+00:23:33,000 --> 00:23:38,220
+البكتيريا ال affinity تبعتها للصفرانين
+
+303
+00:23:38,220 --> 00:23:44,680
+منخفضة وبالتالي أنت محتاج صبغة أخرى ك counter
+
+304
+00:23:44,680 --> 00:23:48,680
+stain عشان تعمل ال contrast اللي هو اللي ما بين
+
+305
+00:23:48,680 --> 00:23:52,060
+أنت فاكرين اللي لونان ال violet اللي هو ال gram
+
+306
+00:23:52,060 --> 00:23:55,900
+positive والأحمر أو ال pink اللي هو ال gram
+
+307
+00:23:55,900 --> 00:23:56,440
+negative
+
+308
+00:24:01,430 --> 00:24:04,190
+أحنا مش عايزين نجران ال stain احنا .. احنا مش
+
+309
+00:24:04,190 --> 00:24:06,430
+قولنا يا شباب .. شباب احنا قولنالكوا في الأول ..
+
+310
+00:24:06,430 --> 00:24:09,290
+أول خطوة في ال diagnosis culture، لو تانية هي
+
+311
+00:24:09,290 --> 00:24:13,790
+morphology and staining، staining أنا عامل ال ..
+
+312
+00:24:13,790 --> 00:24:17,970
+ال curve drug، و هتقوللي ان .. انه أنا قفزت من
+
+313
+00:24:17,970 --> 00:24:22,470
+المرحلة الأولى لمرحلة الرابعة، مظبوط؟ مظبوط؟ لكن
+
+314
+00:24:22,470 --> 00:24:23,770
+أنا مش قفزت أساسا
+
+315
+00:24:26,810 --> 00:24:32,330
+وبتالي عندي شعور ان هذا البكتيريا هي Vibrio
+
+316
+00:24:32,330 --> 00:24:38,410
+cholera كيف؟
+
+317
+00:24:38,570 --> 00:24:41,550
+هو مافهمتكش بقى لإنك تظهر إن أنا بقعد أستيانج مش
+
+318
+00:24:41,550 --> 00:24:44,010
+هي أول مرحلة تقول أستيانج يعني .. لأ لأ هو بيسأل
+
+319
+00:24:44,010 --> 00:24:48,130
+سؤال مختلف عن سؤالك هو بقول أنا إيش بدي عرفني إن
+
+320
+00:24:48,130 --> 00:24:52,270
+البكتيريا أصلا spiral أو curved عشان أختارلها ال
+
+321
+00:24:52,270 --> 00:24:56,470
+carbofoxin احنا بنقول إن if suspected أنت بتعمل
+
+322
+00:24:56,470 --> 00:24:59,850
+هذا الكلام يعني بمعنى أخر لو كانت البكتيريا بصلية
+
+323
+00:24:59,850 --> 00:25:03,070
+عادية و حاطات صفرانين بيبشي الحالعفوا، نعم بيمشي
+
+324
+00:25:03,070 --> 00:25:07,370
+الحال و لو حطيت Carbolfoxin برضه بيمشي الحال فلما
+
+325
+00:25:07,370 --> 00:25:11,570
+أنت يكون عندك suspicion شك بإن البكتيريا curved أو
+
+326
+00:25:11,570 --> 00:25:16,790
+spiral استخدم Carbofoxin بيمشي لمين؟ بيمشي
+
+327
+00:25:16,790 --> 00:25:20,850
+للبكتيريا العادية و ده البكتيريا اللي هي curved،
+
+328
+00:25:20,850 --> 00:25:27,890
+هاي الفكرة من النقاش أول مرة بتكلم عن Fecal Swap
+
+329
+00:25:29,350 --> 00:25:33,070
+فيك ال swap في حال عدم توفر ال stool هل ال stool
+
+330
+00:25:33,070 --> 00:25:39,330
+ممكن متوفرش عند المريض نعم بعد فترةليست بالطويلة
+
+331
+00:25:39,330 --> 00:25:44,290
+من ال frequency العالي في الديارية لما المريض يبقى
+
+332
+00:25:44,290 --> 00:25:46,690
+.. يقولنا في احد ال .. ال .. ال .. في الشجرة ال
+
+333
+00:25:46,690 --> 00:25:50,730
+dysentery اذا فاكرين انه ال .. ال stool loses its
+
+334
+00:25:50,730 --> 00:25:54,650
+fecal characteristics وبالتالي مافيش يخرج الا ..
+
+335
+00:25:54,650 --> 00:26:00,010
+الا عبر او خلينا نقول من مادة واحدة اللي هي ال ..
+
+336
+00:26:00,010 --> 00:26:03,090
+ال .. ال mucus و بعض الأحيان ال blood
+
+337
+00:26:06,170 --> 00:26:10,550
+نعم دزنتري فبالتالي إذا في هذه الحالة المريض مش
+
+338
+00:26:10,550 --> 00:26:15,430
+قادر يجيب عينة stool فممكن يصطاد عنها ال vehicle
+
+339
+00:26:15,430 --> 00:26:20,190
+swap لكن إذا في stool فهو العينة المثلى ما هو
+
+340
+00:26:20,190 --> 00:26:23,580
+العينة المثلىقولنا ال enrichment alkaline ببتون
+
+341
+00:26:23,580 --> 00:26:26,120
+water selected TCBS وذكرنا اسمه اللي هو
+
+342
+00:26:26,120 --> 00:26:28,760
+thiosulfate citrate bile salt saccharose agar
+
+343
+00:26:28,760 --> 00:26:33,500
+والهنا الحلو أنه مابنعملش enrichment ل 24 ساعة
+
+344
+00:26:33,500 --> 00:26:37,120
+مابنعمل enrichment فقط لجداش ل 4 ل 6 ساعات و بعدين
+
+345
+00:26:37,120 --> 00:26:41,340
+مابنعمل sub culture على اللي هو ال TCBS مرة أخرى
+
+346
+00:26:43,490 --> 00:26:47,110
+كمان مرة اشهر الشكل المستعمرات yellow colonies are
+
+347
+00:26:47,110 --> 00:26:50,870
+produced وارفنا من وين مصدر اللون تبع ال
+
+348
+00:26:50,870 --> 00:26:53,970
+Saccharose fermentation الدجالة اللى رسمناها على
+
+349
+00:26:53,970 --> 00:26:58,070
+الصبورة قبل شوية stool orfical swab على الجهة اللى
+
+350
+00:26:58,070 --> 00:27:01,190
+.. اللى .. اللى هناك ال selective medias TCBS على
+
+351
+00:27:01,190 --> 00:27:04,770
+الجهة دى enrichment عملنا subculture قولنا بعد
+
+352
+00:27:04,770 --> 00:27:08,210
+اربعة لست ساعة لسبعة درجة معوية وبعد ده اللى شفنا
+
+353
+00:27:08,210 --> 00:27:11,330
+ال typical colonies وعملنا لها the following tests
+
+354
+00:27:12,940 --> 00:27:16,040
+فين دي؟ هاد القايمة الطويلة مش القايمة القصيرة
+
+355
+00:27:16,040 --> 00:27:19,360
+اللي احنا عملنا احنا عملنا قايمة قصيرة تلت فحوصات
+
+356
+00:27:19,360 --> 00:27:25,080
+اكسيدايز
+
+357
+00:27:25,080 --> 00:27:32,920
+تست كيتاليز تست اسكولين تست motility test طبعا
+
+358
+00:27:32,920 --> 00:27:36,040
+احنا ممكن نضيف ال motility على القايمة كمان شباب
+
+359
+00:27:36,040 --> 00:27:40,280
+ال motility فحص كويس اه بصيروا أربعو انا ال .. ال
+
+360
+00:27:40,280 --> 00:27:42,780
+.. الاربع فحوصات اللي بحكيلكوا عنهم هم الاربع اللي
+
+361
+00:27:42,780 --> 00:27:46,940
+اختارناهم لما كان في وابا عنا لأذكر في سنة ال سبعة
+
+362
+00:27:46,940 --> 00:27:52,360
+وتسعين ستة وتسعين في غزة للكلرة و صار في نوع من ال
+
+363
+00:27:52,360 --> 00:27:57,040
+.. ال ..الاجتماع بين الجامعة وبين وزارة الصحة وبين
+
+364
+00:27:57,040 --> 00:28:01,040
+وكالة الغوث للمختبرات وجعدنا جلسنا مع بعض وحددنا
+
+365
+00:28:01,040 --> 00:28:05,100
+الطريقة الأقصر والطريقة الأطول لل identification
+
+366
+00:28:05,100 --> 00:28:08,140
+بينا على ما هو متوفر في المختبرات الثلاثة مختبرات
+
+367
+00:28:08,140 --> 00:28:11,340
+الجامعات ومختبرات الصحة ومختبرات اللي هو وكالة
+
+368
+00:28:11,340 --> 00:28:14,240
+الغوثو انا اذكر انه احنا وضعنا الأربع فحوصات اللي
+
+369
+00:28:14,240 --> 00:28:16,720
+حكيتلكوا عنها هم اللي هم ال .. ال .. ال gram stain
+
+370
+00:28:16,720 --> 00:28:20,380
+و ال .. ال .. هذا ك .. ك .. ك مرحلة ال oxidase و
+
+371
+00:28:20,380 --> 00:28:24,480
+ال .. ال strain test و ال .. ال motility و ال ..
+
+372
+00:28:24,480 --> 00:28:27,140
+ال polyvalent agglutination antisera هنا ال .. هنا
+
+373
+00:28:27,140 --> 00:28:30,020
+.. هنا مهم جدا الفحص اللي اندوهال بوستف طبعا ال
+
+374
+00:28:30,020 --> 00:28:32,980
+vogas plus cover اما بوستف او negative وهذه كتير
+
+375
+00:28:32,980 --> 00:28:38,260
+معلومة مهمةهنستخدمها لاحقا فى التمييز بين صنفين من
+
+376
+00:28:38,260 --> 00:28:41,760
+ال Vibrio Kohlerite واحدة بتكون Indole Vagas Plus
+
+377
+00:28:41,760 --> 00:28:45,600
+Kauer بوسطف واحدة Vagas Plus Kauer نيجاتيف ساكروتس
+
+378
+00:28:45,600 --> 00:28:49,420
+فيرمنتشن هى متفقين عليها انها بوسطف لانها بنشوفها
+
+379
+00:28:49,420 --> 00:28:55,340
+من الوسط Lactose نيجاتف منتول بوسطف هذا الشكل اللى
+
+380
+00:28:55,340 --> 00:29:00,140
+قدامكوا مش عارف امكن من الكمبيوتر اوضح من اللوحة
+
+381
+00:29:00,140 --> 00:29:04,600
+اللى واضح عندكم اللوحة برضه انه الوسط أخضر تمام
+
+382
+00:29:05,820 --> 00:29:09,780
+أمام؟ و المنطقة اللي نامي فيها البكتيريا اتحولت
+
+383
+00:29:09,780 --> 00:29:13,160
+إلى اللون الأصفر لكن انا ب .. بعتقد انه لو شفتوها
+
+384
+00:29:13,160 --> 00:29:17,080
+من ال slides هتكون الصورة أوضح يعني لإن الوطبق كله
+
+385
+00:29:17,080 --> 00:29:21,760
+أخضر بالفعل و المستعمرات هي فقط اللي محاطة بمناطق
+
+386
+00:29:21,760 --> 00:29:22,240
+صفراء
+
+387
+00:29:26,930 --> 00:29:29,090
+فاكرين لما قولنا tentative diagnosis احنا مرة
+
+388
+00:29:29,090 --> 00:29:33,350
+tentative diagnosis اللي هو مؤقت اللي هو مصطلح
+
+389
+00:29:33,350 --> 00:29:36,910
+تاني بنسمي presumative diagnosis يعني tentative او
+
+390
+00:29:36,910 --> 00:29:40,630
+presumative تقريبا بنفس المعنى هنا ال presumative
+
+391
+00:29:40,630 --> 00:29:42,990
+diagnosis الكلام اللي حكيتلكوا عليه على السبورة او
+
+392
+00:29:42,990 --> 00:29:48,170
+الاختيار الاقصر هو اللي انا بتكلم عنههذا الفحص
+
+393
+00:29:48,170 --> 00:29:53,010
+string test اعتقد انه واضح جدا هي المستعمرة ذابت
+
+394
+00:29:53,010 --> 00:29:55,930
+حاول ان اخرج هي ال loop لاحظوا الخيط اللي تكوّن
+
+395
+00:29:55,930 --> 00:30:01,790
+تكوّن تكوّن الخيط الميكويدي هذا ناتج عن ايش قلنا
+
+396
+00:30:01,790 --> 00:30:05,640
+انه البكتيريا لأ مش الكابسول قلناقلنا إن البكتيريا
+
+397
+00:30:05,640 --> 00:30:09,660
+إذا ذهبت في ال KOH، موضوع ال DNA، ال DNA very
+
+398
+00:30:09,660 --> 00:30:13,200
+ميوكايد، ففي بعض البكتيريا ال DNA تبعها very very
+
+399
+00:30:13,200 --> 00:30:18,400
+ميوكايد و large amount of DNA بتكون present و هو
+
+400
+00:30:18,400 --> 00:30:20,240
+بتالي بيعطينا لميوكايدي appearance
+
+401
+00:30:23,870 --> 00:30:27,290
+أول مرة نتكلم عن Biotypes كنا نتكلم عن Serotypes
+
+402
+00:30:27,290 --> 00:30:30,410
+ومتكلم عن Phagotype ومتكلم عن Biocentyping
+
+403
+00:30:30,410 --> 00:30:32,310
+المحاضرة اللى فاترة اللى متكلمنا عن صدوموناس
+
+404
+00:30:32,310 --> 00:30:35,190
+ايرجنوز اقولنا بيو سين تايبن المرة اللى متكلم عنها
+
+405
+00:30:35,190 --> 00:30:42,490
+اسمها بيو تايبن بيو تعني ان انا بفرج الميكروبات مش
+
+406
+00:30:42,490 --> 00:30:46,270
+بناء على الانتجنات وانا بفرجها بناء على مين على
+
+407
+00:30:46,270 --> 00:30:50,990
+بعض الصفات البيو كيميائية زي ايش صفات بيو كيميائية
+
+408
+00:30:50,990 --> 00:30:56,910
+طلعوا هنافي عندي vogus bruscavar و احنا مش قولنا
+
+409
+00:30:56,910 --> 00:30:59,970
+قبل شويه واحدة بوسط واحدة negative في بكتيريا
+
+410
+00:30:59,970 --> 00:31:04,510
+اسمها eltar و واحدة اسمها classical هدولة التنتين
+
+411
+00:31:04,510 --> 00:31:08,470
+ال biotype يبجعك ان biotype يعني اتنين ارسمهم كمان
+
+412
+00:31:08,470 --> 00:31:14,050
+مرة eltar و classicalكلمة classical دايما بنطلقها
+
+413
+00:31:14,050 --> 00:31:18,730
+على ال old القديم على القديم فهذه هي الكلاسيكية
+
+414
+00:31:18,730 --> 00:31:23,090
+المعروفة اللي كانت زمان نعرفها وهذه يبدو أنها تفرق
+
+415
+00:31:23,090 --> 00:31:28,350
+منها طبعا سهل كتير الفرقات بينهم واحدة تمتلك الصفة
+
+416
+00:31:28,350 --> 00:31:31,710
+المجموعة اللي هي الالتور تمتلك جميع الصفات
+
+417
+00:31:31,710 --> 00:31:35,150
+والتانية لا تمتلك أي من الصفات positive positive
+
+418
+00:31:35,150 --> 00:31:38,330
+resistant negative negative sensitive بس خلنا نطلع
+
+419
+00:31:38,330 --> 00:31:42,140
+الصفات نعرف الصفاتعندي الرقم التلاتة اللي هي
+
+420
+00:31:42,140 --> 00:31:46,320
+sensitivity to polymyxin B ال polymyxin B هو عبارة
+
+421
+00:31:46,320 --> 00:31:50,080
+عن antibiotic هذا ال antibiotic أصلا toxic و لا
+
+422
+00:31:50,080 --> 00:31:51,920
+يستخدم إلا ال topical يعني لا يستخدم لعلاج
+
+423
+00:31:51,920 --> 00:31:55,200
+الفيبلوكولير أساسا فهنا مستخدمينه احنا ك
+
+424
+00:31:55,200 --> 00:31:58,540
+diagnostic test انشوف مين sensitive و مين
+
+425
+00:31:58,540 --> 00:32:02,740
+resistant ليس بغرض العلاج و انه بغرض التفريق بين
+
+426
+00:32:02,740 --> 00:32:05,940
+الميكروبات فبتكون الالتور resistant بينما ال
+
+427
+00:32:05,940 --> 00:32:09,830
+classical sensitiveheme agglutination test ايش
+
+428
+00:32:09,830 --> 00:32:13,590
+يعني heme agglutination test مقدرة البكتيريا على
+
+429
+00:32:13,590 --> 00:32:17,490
+مش تحليل تخثير كورادة يعني لو حطينا معاها chicken
+
+430
+00:32:17,490 --> 00:32:20,050
+red blood cells يعني ال chicken red blood cell
+
+431
+00:32:20,050 --> 00:32:23,070
+اللي هي الكورادة ده من الحمراء المأخوذة من الدجاج
+
+432
+00:32:23,070 --> 00:32:27,510
+حطينا خلطناها بالبكتيريا باللاج البكتيريا بتجمعها
+
+433
+00:32:27,510 --> 00:32:30,110
+مع بعض بتعملها agglutination ده بيسموها heme
+
+434
+00:32:30,110 --> 00:32:32,450
+agglutination لإنها بتعمل agglutination لل red
+
+435
+00:32:32,450 --> 00:32:36,070
+blood cellبسطف هنا و نيجاتف هنا بالنسبالى ال بوجرس
+
+436
+00:32:36,070 --> 00:32:40,470
+بلوسكوار قلنا في عندي اللى هو الالتور بسطف بينما
+
+437
+00:32:40,470 --> 00:32:46,210
+ال classical بتكون نيجاتف اذا ال bio types من فان
+
+438
+00:32:46,210 --> 00:32:50,350
+classical and التور التنميذ بينهم يتم عن طريق تلت
+
+439
+00:32:50,350 --> 00:32:54,010
+خصائص مش هم عن طريق تلت خصائص واحد بوجرس بلوسكوار
+
+440
+00:32:54,010 --> 00:33:00,810
+اتنين هى من أجل التلاتة بوليمكسين sensitivity كلمة
+
+441
+00:33:00,810 --> 00:33:07,680
+bio typeVar مأخوذة من variety، variety نوع وtype
+
+442
+00:33:07,680 --> 00:33:10,980
+برضه نوع، صح ولا لأ؟ فبعض الأحيان بيطلقوا عليها
+
+443
+00:33:10,980 --> 00:33:14,420
+biotype أو biovar مرات برضه في نفس الشيء في
+
+444
+00:33:14,420 --> 00:33:18,980
+السيرولوجيا، بيقولوا biovar، اه عفوا، serovar و
+
+445
+00:33:18,980 --> 00:33:22,580
+serotype، serovar و serotype
+
+446
+00:33:30,280 --> 00:33:34,660
+طيب جينا الأصعب في عندنا تلات أصناف سيريولوجية
+
+447
+00:33:34,660 --> 00:33:38,420
+وحنعطيكوا كل واحد شكل اللي بيحكيهم من أول مرة
+
+448
+00:33:38,420 --> 00:33:42,660
+للأسماء الغريبة اللي موجودة علاقة عادي شو اسمها
+
+449
+00:33:42,660 --> 00:33:53,540
+جمعة؟ جمعة صحيح أنا نسيت جيمان؟
+
+450
+00:33:53,540 --> 00:33:56,120
+طيب اللي جالي قبلها؟
+
+451
+00:33:59,160 --> 00:34:03,860
+انابا و جاوا هيكوجيما جمعها على ثلاث شكل خلاص الآن
+
+452
+00:34:03,860 --> 00:34:08,880
+ايش ال .. ايش ال .. ال .. الفرق بينهم الفرق بينهم
+
+453
+00:34:08,880 --> 00:34:13,300
+انه واحد بيصيرله agglutination .. agglutination
+
+454
+00:34:13,300 --> 00:34:17,650
+يبقى انت انابابينما بيصيرلوش agglutination بال
+
+455
+00:34:17,650 --> 00:34:22,730
+Anti-Ogawa والعكس التاني بيصيرلو agglutination بال
+
+456
+00:34:22,730 --> 00:34:26,550
+Anti-Ogawa بيصيرلو .. بيصيرلو .. بيصيرلوش عفوا بال
+
+457
+00:34:26,550 --> 00:34:30,550
+Anti-Inaba لكن النوع التالت فاجأنا بأنه بعمل
+
+458
+00:34:30,550 --> 00:34:34,050
+agglutination لمين؟ للتانين وبالتالي هذا بيعتقد
+
+459
+00:34:34,050 --> 00:34:38,700
+أنهvariety that has acquired both antigens اللي هم
+
+460
+00:34:38,700 --> 00:34:42,900
+الانابا والأجاوة وسميه بهيكوجيما هدول بيسموهم
+
+461
+00:34:42,900 --> 00:34:48,260
+serovars او serotypes اذا فين دي subtypes انابا
+
+462
+00:34:48,260 --> 00:34:52,660
+أجاوة هيكوجيماطبعا ال Vibrio اللي بتعرفوا انها
+
+463
+00:34:52,660 --> 00:34:57,780
+كونها بكتيريا motile يبقى في عندها كمان H انتجن
+
+464
+00:34:57,780 --> 00:35:01,520
+تمام فبتاعي ممكن نعمل عملية identification لل
+
+465
+00:35:01,520 --> 00:35:06,560
+Vibrio عبر ال O وعبر ال H انتجن لكن احنا غالبا في
+
+466
+00:35:06,560 --> 00:35:09,940
+مختبراتنا المتواضعة بنعمل stacking لمين لل
+
+467
+00:35:09,940 --> 00:35:10,820
+polyvalent
+
+468
+00:35:14,500 --> 00:35:20,540
+O-antigen و لا polyvalent O-antigen اعفوا H
+
+469
+00:35:20,540 --> 00:35:25,400
+-antigen طبعا احنا مش بنكون مخزنين ال antigen
+
+470
+00:35:25,400 --> 00:35:31,500
+مخزنين ال antibody فبنسميها polyvalent O مش
+
+471
+00:35:31,500 --> 00:35:36,420
+antibodies كمان بنسميها antiserum لكن كلمة
+
+472
+00:35:36,420 --> 00:35:39,120
+antiserum مش معناها antibodies هى المقصود فيها
+
+473
+00:35:39,120 --> 00:35:40,340
+antiserum معناها antibodies
+
+474
+00:35:44,360 --> 00:35:46,680
+نكشف على الانتجين، إيش الانتجين في هذا الحالة
+
+475
+00:35:46,680 --> 00:35:49,340
+هيكون؟ البكتيريا نفسها، يعني لما بنزل البكتيريا
+
+476
+00:35:49,340 --> 00:35:51,780
+اللي هي suspected، بنعملها agglutination
+
+477
+00:35:51,780 --> 00:35:57,740
+بالبوليفات نيجي لجزء الأخير من ال Vibrio اللي هو
+
+478
+00:35:57,740 --> 00:36:01,600
+المتعلق بال treatment and antibiotic sensitivity
+
+479
+00:36:01,600 --> 00:36:05,080
+أعتقد أنه لا داعي للتكرار، ولا في داعي للتكرار، في
+
+480
+00:36:05,080 --> 00:36:10,340
+داعي للتكرار، بعلم الشطارأي ديارية .. أي ديارية
+
+481
+00:36:10,340 --> 00:36:15,560
+اتفقنا على أنه الحل العلاجي إليها water
+
+482
+00:36:15,560 --> 00:36:18,800
+replacement، electrolyte replacement وتالت حاجة
+
+483
+00:36:18,800 --> 00:36:23,000
+اللي هي eradication of the causative agent فده
+
+484
+00:36:23,000 --> 00:36:26,220
+الحالة ال .. ال .. ال causative agent هو ال Vibrio
+
+485
+00:36:26,220 --> 00:36:31,370
+كلهافيش يعني خلاف على انه لازم نرجع السوائل، لازم
+
+486
+00:36:31,370 --> 00:36:35,410
+نرجع ال electrolyte و لازم نقضي على مين؟ على ال
+
+487
+00:36:35,410 --> 00:36:40,250
+vibrio كده، نهي طبعا ال vibrio كده زيها زي أي
+
+488
+00:36:40,250 --> 00:36:43,130
+بكتيرة تانية يا شباب، يعني عندها المقدرة عليها
+
+489
+00:36:43,130 --> 00:36:48,370
+تكون resistance وبالتالي احنا بننصح باستمرار اي
+
+490
+00:36:48,370 --> 00:36:53,420
+ميكروب في الدنياإلا إذا ذكرنا عكس ذلك، إنه نعمله
+
+491
+00:36:53,420 --> 00:36:55,640
+antimicrobial sensitivity، لازم نعمله
+
+492
+00:36:55,640 --> 00:36:59,400
+antimicrobial sensitivity أو susceptibility
+
+493
+00:36:59,400 --> 00:37:02,680
+testing، بيقولنا ترتراساكلين is the drug of choice
+
+494
+00:37:02,680 --> 00:37:06,000
+كيف؟
+
+495
+00:37:07,210 --> 00:37:09,650
+لأ مثلا هو ال first choice انه في ال treatment
+
+496
+00:37:09,650 --> 00:37:13,730
+طبعا انتوا عارفين تترا ساكلين برضه كمان منفعش لكل
+
+497
+00:37:13,730 --> 00:37:17,890
+الناس يعني تترا ساكلين للأطفال ممشيش للحوامل يبقى
+
+498
+00:37:17,890 --> 00:37:21,390
+لازم يكون فيانها بدائل لكن انا اللي قبل ما اقفز عن
+
+499
+00:37:21,390 --> 00:37:25,650
+او ابحث عن البدائل بدي أنبه ان however in recent
+
+500
+00:37:25,650 --> 00:37:31,390
+years تترا ساكلين resistant vibrio variants يعني
+
+501
+00:37:31,390 --> 00:37:37,080
+أصناع فسلالات have emergedيعني بطل كلمة
+
+502
+00:37:37,080 --> 00:37:41,120
+tetracycline مطلقة ان والله اي vibrocolera علشها
+
+503
+00:37:41,120 --> 00:37:44,360
+بتتراcycline لأ حياتها هي فيه هنا vibrocolera كمان
+
+504
+00:37:44,360 --> 00:37:48,730
+resistant لتتراcyclinefor this reason اي reason
+
+505
+00:37:48,730 --> 00:37:53,170
+لظهور resistance strain sensitivity test must be
+
+506
+00:37:53,170 --> 00:37:55,750
+performed in all clinical aisles فانا كمان مرة هذه
+
+507
+00:37:55,750 --> 00:37:58,510
+الجملة بعممها سواء على ال vibrocolora او غير ال
+
+508
+00:37:58,510 --> 00:38:01,570
+vibrocolora انه sensitivity testing وانا بالمناسبة
+
+509
+00:38:01,570 --> 00:38:04,910
+حاطلكوا على ال .. على الموقع تبع ال diagnostic
+
+510
+00:38:04,910 --> 00:38:08,490
+microbiology ال CLSI شفتواها؟
+
+511
+00:38:11,380 --> 00:38:17,720
+وثيقة مهمة جدا CLSI 2011 وثيقة مهمة جدا لعمل
+
+512
+00:38:17,720 --> 00:38:21,400
+sensitivity testing موجودة وموضحوكوا على ال
+
+513
+00:38:21,400 --> 00:38:25,300
+facebook على ال diagnostic microbiology M تمام
+
+514
+00:38:25,300 --> 00:38:32,140
+اللي هي المجموعة تبعتكم في حد ماشتركش فيها M تمام
+
+515
+00:38:32,140 --> 00:38:36,570
+هذه المجموعة تبعتكمrequest addition و احنا ان شاء
+
+516
+00:38:36,570 --> 00:38:40,770
+الله بنضيفها في اقل فرصة الان ال CLSI هذه ال 2001
+
+517
+00:38:40,770 --> 00:38:44,790
+هي ال guidelines لل selection of antibiotics to be
+
+518
+00:38:44,790 --> 00:38:48,070
+used against each organism يعني بتعطيك دليل ايش ال
+
+519
+00:38:48,070 --> 00:38:50,370
+antibiotic اللي لازم تحطها على الميكروبط اللي من
+
+520
+00:38:50,370 --> 00:38:54,250
+ضمنهم ال viper و كده طبعا احنا قولنا انه في
+
+521
+00:38:54,250 --> 00:38:59,180
+مشكلتين ان ال tetracycline أساساما بتنفع لكل إشي
+
+522
+00:38:59,180 --> 00:39:03,140
+رقم اتنين البكتيريا في بعض من السلسلات صارت منها
+
+523
+00:39:03,140 --> 00:39:06,460
+المقاومة وبالتالي إيش البدائل في عندي
+
+524
+00:39:06,460 --> 00:39:11,820
+selfonamides, ambicillin, kanamycin, streptomycin
+
+525
+00:39:11,820 --> 00:39:16,520
+and trimethoprim trimethoprim اللي هو بيكون دائما
+
+526
+00:39:16,520 --> 00:39:19,040
+مرتبط بالself-amethoxazole self-amethoxazole و
+
+527
+00:39:19,040 --> 00:39:25,510
+trimethoprim prevention of choleraاعتقد انه كلمة
+
+528
+00:39:25,510 --> 00:39:29,470
+prevention لفكال oral pathogen برضه احد النقاط
+
+529
+00:39:29,470 --> 00:39:34,110
+المهمة انه ال sanitary conditions و ال public
+
+530
+00:39:34,110 --> 00:39:37,790
+health بشكل عام good sanitation and personal
+
+531
+00:39:37,790 --> 00:39:43,230
+hygiene لان في اندي immunization لكن ال
+
+532
+00:39:43,230 --> 00:39:47,560
+immunization للvibrio cholera is not life longماذا
+
+533
+00:39:47,560 --> 00:39:51,460
+يعني lifelong؟يعني بتعطيك cash حماية للأبد، لأ
+
+534
+00:39:51,460 --> 00:39:55,220
+بتعطيك short وذي لفقة من ال vaccine stimulate
+
+535
+00:39:55,220 --> 00:39:59,060
+local IGA production غالبا من بيعطيها ل .. بيعطيها
+
+536
+00:39:59,060 --> 00:40:03,100
+للناس اللي بدهم يسافروا على أماكن موبوعة بال
+
+537
+00:40:03,100 --> 00:40:06,040
+Vibrio كلها، وان في أماكن تعرفوا موبوعة في ال
+
+538
+00:40:06,040 --> 00:40:12,610
+Vibrio كلها؟لأ الهند و اكتر من الهند بانجلديش
+
+539
+00:40:12,610 --> 00:40:18,630
+بانجلديش مهم هذا نفس المحيط بانجلديش و الهند و
+
+540
+00:40:18,630 --> 00:40:21,990
+باكستان المناطق الفقيرة منهم هدول اكتر الدول اللي
+
+541
+00:40:21,990 --> 00:40:25,630
+ممكن يكون فيها vibrio كتير هذا لا يعني هذا لا يعني
+
+542
+00:40:25,630 --> 00:40:29,900
+انها مقتصرة و انا قلتلكواوإن فيه فشل في نظام الصرف
+
+543
+00:40:29,900 --> 00:40:33,960
+الصحي في أي دولة في العالم احتمالية ظهورها واردة،
+
+544
+00:40:33,960 --> 00:40:39,180
+عندنا في فلسطين ظهرت أكثر من مرة في تسعينيات القرن
+
+545
+00:40:39,180 --> 00:40:42,880
+الماضي وفي سبع .. وفي أظن سبعينيات أو ثمانيات
+
+546
+00:40:42,880 --> 00:40:46,940
+القرن الماضي، يعني احتمالية وجودها يعني واردة،
+
+547
+00:40:46,940 --> 00:40:49,680
+وبالتالي ما .. ما .. ما بنقدرش نقول إنه والله it
+
+548
+00:40:49,680 --> 00:40:52,500
+is confined to one area of the world، لأ، ممكن
+
+549
+00:40:52,500 --> 00:40:58,970
+تكون worldwideكمان شغل لو احنا صار عن نوابا و
+
+550
+00:40:58,970 --> 00:41:05,090
+الناس بتتعامل مع المرضى فدول الناس او contact
+
+551
+00:41:05,090 --> 00:41:08,710
+لمرضى contact يعني ناس تواصل مع مرضى تمام او
+
+552
+00:41:08,710 --> 00:41:12,930
+suspected انهم شربوا مياه ملوث او اكلوا مياه غذاء
+
+553
+00:41:12,930 --> 00:41:17,930
+ملوث ممكن نعطيهم كإجراء وقائي كلمة
+
+554
+00:41:17,930 --> 00:41:19,450
+chemoprophylaxis ايش يعني؟
+
+555
+00:41:22,400 --> 00:41:26,340
+يعني تناول drug كإجراء ويقعي بروفلاكسي ويقعي كيمو
+
+556
+00:41:26,340 --> 00:41:29,960
+بروفلاكسي يعني تناول drug كبروفلاكسي with تترا
+
+557
+00:41:29,960 --> 00:41:33,600
+ساكلين to close contact مش يعني close contact ال
+
+558
+00:41:33,600 --> 00:41:40,060
+family members الأبناء الأطفال الإخوة الأخواتأحد
+
+559
+00:41:40,060 --> 00:41:43,740
+أهم النقاط اللي أنا ذكرتها خلال السياق برامبت
+
+560
+00:41:43,740 --> 00:41:48,700
+برامبت يعني فوري ماتخليش واحد يمشي ككمبولة موقوتة
+
+561
+00:41:48,700 --> 00:41:51,880
+في ال .. ال .. ال .. بين السكان هو عنده vibrio
+
+562
+00:41:51,880 --> 00:41:56,920
+cholera لأنه كل ما قل وقت التشخيص تمام كل ما حصرنا
+
+563
+00:41:56,920 --> 00:42:00,080
+في العلاج كل ما قللنا الإفرازات اللي ممكن يكون
+
+564
+00:42:00,080 --> 00:42:03,480
+فيها vibrio cholera وبالتالي بمقللنا نسبة التلوث
+
+565
+00:42:03,480 --> 00:42:06,920
+وبالتالي حصرنا ال disease إذا برامبت معناها فوري
+
+566
+00:42:07,250 --> 00:42:14,150
+detection and treatment of carriers طيب
+
+567
+00:42:14,150 --> 00:42:19,310
+هذه يمكن يعني diagram طويل نختم فيه محاضرتنا اليوم
+
+568
+00:42:19,310 --> 00:42:26,510
+نتطلع
+
+569
+00:42:26,510 --> 00:42:31,850
+مع بعض على ال .. ال .. فوق هنا قلنا specimen,
+
+570
+00:42:32,430 --> 00:42:39,940
+thesis or rectal swabفي حد اسمها caribler filter
+
+571
+00:42:39,940 --> 00:42:44,240
+paper caribler عبارة عن transport media عبارة عن
+
+572
+00:42:44,240 --> 00:42:47,440
+transport media يعني احنا بناخد عينة الستول في
+
+573
+00:42:47,440 --> 00:42:56,040
+transport media بنروح على ال laboratory كلمة
+
+574
+00:42:56,040 --> 00:43:00,300
+بنروح على ال laboratory بنفعش بعد ساعة بعد ساعتين
+
+575
+00:43:00,300 --> 00:43:08,890
+بعد تلاتةpromptly خدوا بالك اكتير من المستشفيات
+
+576
+00:43:08,890 --> 00:43:15,550
+لها sampling policies بتحدد فيها الزمن ما بين جمع
+
+577
+00:43:15,550 --> 00:43:21,470
+العينة و ما بين وصولها لمين للمختبر وكنموذج على
+
+578
+00:43:21,470 --> 00:43:26,450
+ذلك ال urine samples ال urine samples معروفة عنها
+
+579
+00:43:26,450 --> 00:43:32,470
+ان one hour في بعض المختبرات بتسمح بساعتينلكن في
+
+580
+00:43:32,470 --> 00:43:36,030
+النهاية في زمن محدد ما بين جمة العينة وما بين
+
+581
+00:43:36,030 --> 00:43:40,710
+وصولها للمختبر لماذا هذا الزمن المحدد؟ حفاظنا على
+
+582
+00:43:40,710 --> 00:43:45,290
+ال viability of the organism اللي موجود في العينة
+
+583
+00:43:45,290 --> 00:43:48,250
+اللي بندورها عليه عملنا enrichment على ال climb
+
+584
+00:43:48,250 --> 00:43:53,810
+ببتون ووتر وزرعان عالمين هنا على ال TCBSمن هنا
+
+585
+00:43:53,810 --> 00:43:56,830
+احنا كنا بتكلم عن اربع لتس ساعات انا كاتب خمس ل
+
+586
+00:43:56,830 --> 00:43:59,910
+تمان ساعات على خمس و تلاتين درجة مقوية و احنا كنا
+
+587
+00:43:59,910 --> 00:44:02,730
+جاجلين على جداش على سبعة و تلاتين درجة مقوية خدنا
+
+588
+00:44:02,730 --> 00:44:08,310
+نتكلم عن الجزئي هذا شوية مهم كتير هي خمس و تلاتين
+
+589
+00:44:08,310 --> 00:44:13,290
+ولا سبعة و تلاتين؟ طب ليش هنقول عن خمس و تلاتين؟ و
+
+590
+00:44:13,290 --> 00:44:16,190
+ليش هتلاجوها في الكتب كتير كمان خمس و تلاتين؟ لإن
+
+591
+00:44:16,190 --> 00:44:22,630
+في خلافهل ال temperature الأمثل 35 ولا 37؟ ما
+
+592
+00:44:22,630 --> 00:44:26,410
+أنتوا عارفين أجزاء من جسمنا ممكن تكون 37 و ال
+
+593
+00:44:26,410 --> 00:44:31,650
+external ممكن تكون أقل من ذلك، تمام؟ لكن القضية
+
+594
+00:44:31,650 --> 00:44:37,330
+برضه كمان مش هيك، في بعض الميكروبات حساسة ل one
+
+595
+00:44:37,330 --> 00:44:41,470
+temperature يعني انا 37 ممكن ماتنموش، لكن انا حاسس
+
+596
+00:44:41,470 --> 00:44:47,380
+30 ممكن تنموفراحوا ال .. ال .. ال .. البعض ذهب الى
+
+597
+00:44:47,380 --> 00:44:50,680
+انه البكتيريا كلها بتشترك بانها ممكن تنمو على خمس
+
+598
+00:44:50,680 --> 00:44:54,860
+تلاتين لكن مش كلها بتنمو على ..فانا احنا نام سبعة
+
+599
+00:44:54,860 --> 00:44:57,480
+و تلاتين خلي ال incubation temperature العادى
+
+600
+00:44:57,480 --> 00:45:01,300
+المعروف و المتعرف عليها خليها عالميا خمس و تلاتين
+
+601
+00:45:01,300 --> 00:45:05,300
+فصحر الرقمين الان موجودات أبو السبعة و تلاتين و
+
+602
+00:45:05,300 --> 00:45:08,420
+أبو الخمسة و تلاتين فلما تقول خمس و تلاتين انا ..
+
+603
+00:45:08,420 --> 00:45:11,720
+يعني احنا عارفين بيننا و بين بعضنا ان هي
+
+604
+00:45:11,720 --> 00:45:14,300
+temperature تبع ال incubation يا خمس و تلاتين يا
+
+605
+00:45:14,300 --> 00:45:19,210
+اما سبعة و تلاتينIncubate overnight ال 30 دقيقة
+
+606
+00:45:19,210 --> 00:45:23,770
+دلوقتي لمدة 24 ساعة او overnight وانا شرحتلكوا
+
+607
+00:45:23,770 --> 00:45:27,270
+جابليك ايش يعني overnight تمام انه يمضي عليها ليلة
+
+608
+00:45:27,270 --> 00:45:30,390
+حتى لو زلتها ال 4 العصر 5 العصر 6 العصر تاني يوم
+
+609
+00:45:30,390 --> 00:45:34,460
+ممكن تقرأ الطبق تمام؟suspicious colonies ايش يعني
+
+610
+00:45:34,460 --> 00:45:37,320
+suspicious colonies اللي هي suspected colonies
+
+611
+00:45:37,320 --> 00:45:40,720
+بنعملهم اللي هم الفحوصات اللي احنا ذكرناها من
+
+612
+00:45:40,720 --> 00:45:44,260
+الشباب بنعملهم عملية ال identification هنا نفس
+
+613
+00:45:44,260 --> 00:45:48,780
+الجثة بس بمزيد خطوة بعد ما عملنا incubation لتلت
+
+614
+00:45:48,780 --> 00:45:53,040
+لخمس ساعات او اربع ساعات أخدنا قطرة هنا من
+
+615
+00:45:53,040 --> 00:46:00,140
+البكتيريا ايش عملها هنا هو هنا تذكرين
+
+616
+00:46:00,140 --> 00:46:05,460
+الشريحة دي؟اللي جواها .. اللي جواها حفرة تمام و
+
+617
+00:46:05,460 --> 00:46:09,580
+جيبنا cover slip و حاطينا عليها قطرة و هانا عملنا
+
+618
+00:46:09,580 --> 00:46:14,030
+Vaseline او حاطيناها Vaselineو بعدين أخدنا الشريحة
+
+619
+00:46:14,030 --> 00:46:18,130
+و جلبناها بحيث أنه تكون القطرة داخلة وين؟ في
+
+620
+00:46:18,130 --> 00:46:23,210
+التجويف بعدين جلبنا الشريحة صارت القطرة هي ال
+
+621
+00:46:23,210 --> 00:46:26,890
+cover slip وهي القطرة هنا معلقة في التجويف فسمينا
+
+622
+00:46:26,890 --> 00:46:30,490
+hanging drop هذا الفحص ليش hanging drop؟ ده ال
+
+623
+00:46:30,490 --> 00:46:34,530
+motility ده ال motility كتير مهمة طبعا للغشيم
+
+624
+00:46:34,530 --> 00:46:39,110
+بمعنى لل unexperienced eye غالبا كل البكتيريا
+
+625
+00:46:39,110 --> 00:46:44,430
+بتطلع متحركةعارفين ليش؟ حركة ال .. ال brownian
+
+626
+00:46:44,430 --> 00:46:48,110
+movement of water بتحرك اللي هو البكتيريا يمنى
+
+627
+00:46:48,110 --> 00:46:52,070
+ويسارا لكن بتعترف ان الحركة الحقيقية هي بكتيريا
+
+628
+00:46:52,070 --> 00:46:57,570
+بتقطع مسافة و بتغير اتجاه تقطع مسافة و بتغير اتجاه
+
+629
+00:46:57,570 --> 00:47:00,810
+فبتتالفك تراقب حركة البكتيريا مش حركة اقتزازية و
+
+630
+00:47:00,810 --> 00:47:07,270
+انما حركة فيها قطع مسافة هذه نقطة كتير المهم المرة
+
+631
+00:47:07,270 --> 00:47:10,010
+الجاي ان شاء الله هتكلم عن اللي هو ال Campylobact
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..60eca43e44144cc16ffecc5f08d57fa84ee3fe59
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 3840, "start": 20.48, "end": 38.4, "text": "السلام عليكم ورحمة الله وبركاته بسم الله الرحمن الرحيم اليوم برضه microbe جديد ان شاء الله اللي هو ال vibrio ال vibrio بتميز عن ال gram negative بس ال lie بالشكل ولذلك سميه vibrio لأنه بيمتلك شكل كومة او curved", "tokens": [6027, 3794, 37440, 25894, 24793, 4032, 2288, 35571, 3660, 21984, 4032, 26890, 4117, 9307, 3224, 4724, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 45595, 20498, 4724, 43042, 3224, 4532, 650, 10874, 16254, 3215, 16472, 13412, 16606, 21984, 13672, 1829, 31439, 2423, 11666, 6584, 2423, 11666, 6584, 39894, 2304, 1829, 11622, 18871, 2423, 21353, 3671, 4724, 3794, 2423, 4544, 20666, 8592, 28820, 35525, 8848, 23275, 8608, 2304, 1829, 3224, 11666, 6584, 5296, 33456, 3224, 4724, 32640, 2655, 23275, 13412, 28820, 9122, 20498, 3660, 1975, 2407, 24991], "avg_logprob": -0.1648706872572844, "compression_ratio": 1.700507614213198, "no_speech_prob": 0.0, "words": [{"start": 20.48, "end": 20.92, 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"probability": 0.9851888020833334}, {"start": 24.7, "end": 24.82, "word": " ان", "probability": 0.54443359375}, {"start": 24.82, "end": 25.04, "word": " شاء", "probability": 0.983154296875}, {"start": 25.04, "end": 25.28, "word": " الله", "probability": 0.9267578125}, {"start": 25.28, "end": 25.54, "word": " اللي", "probability": 0.89306640625}, {"start": 25.54, "end": 25.82, "word": " هو", "probability": 0.970703125}, {"start": 25.82, "end": 26.22, "word": " ال", "probability": 0.93798828125}, {"start": 26.22, "end": 26.68, "word": " vibrio", "probability": 0.59271240234375}, {"start": 26.68, "end": 28.58, "word": " ال", "probability": 0.822265625}, {"start": 28.58, "end": 28.94, "word": " vibrio", "probability": 0.834228515625}, {"start": 28.94, "end": 29.68, "word": " بتميز", "probability": 0.8736572265625}, {"start": 29.68, "end": 30.2, "word": " عن", "probability": 0.96923828125}, {"start": 30.2, "end": 30.88, "word": " ال", "probability": 0.86181640625}, {"start": 30.88, "end": 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"start": 495.52, "end": 516.78, "text": "ما هي الخصائص سبعة العينات؟ هى انك تتكلم عن rice water stool، لو انت شوفت هذا ال character في عينة ال stool، أليس هذا مدعاكلك انك تعمل suspicion ان البكتيرى المسببة هي vibrio cholera وبالتالي بتسهل عليك عملية اللى هو التفكير والاتجاه في ال diagnosis اللى انت مؤهل للقيام بيه؟", "tokens": [15042, 39896, 33962, 9381, 16373, 9381, 8608, 3555, 27884, 18863, 1829, 8315, 2655, 22807, 8032, 7578, 16472, 4117, 6055, 2655, 4117, 19528, 18871, 5090, 1281, 35086, 12399, 45164, 16472, 2655, 13412, 38688, 2655, 23758, 2423, 2517, 8978, 6225, 9957, 3660, 2423, 35086, 12399, 5551, 20292, 3794, 23758, 3714, 3215, 3615, 995, 4117, 23275, 16472, 4117, 6055, 25957, 1211, 32020, 16472, 29739, 4117, 2655, 13546, 7578, 9673, 35457, 49401, 39896, 11666, 6584, 20961, 1663, 46599, 6027, 2655, 6027, 1829, 39894, 3794, 3224, 1211, 25894, 4117, 6225, 42213, 10632, 13672, 7578, 31439, 16712, 5172, 4117, 13546, 16070, 9307, 7435, 40294, 8978, 2423, 15217, 13672, 7578, 16472, 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" من", "probability": 0.96435546875}, {"start": 1557.73, "end": 1558.13, "word": " مادة", "probability": 0.9773763020833334}, {"start": 1558.13, "end": 1558.51, "word": " واحدة", "probability": 0.99169921875}, {"start": 1558.51, "end": 1558.67, "word": " اللي", "probability": 0.946533203125}, {"start": 1558.67, "end": 1559.37, "word": " هي", "probability": 0.94140625}, {"start": 1559.37, "end": 1559.81, "word": " ال", "probability": 0.96044921875}, {"start": 1559.81, "end": 1560.01, "word": " ..", "probability": 0.93994140625}, {"start": 1560.01, "end": 1560.99, "word": " ال", "probability": 0.9736328125}, {"start": 1560.99, "end": 1561.07, "word": " ..", "probability": 0.56884765625}, {"start": 1561.07, "end": 1561.07, "word": " ال", "probability": 0.91796875}, {"start": 1561.07, "end": 1561.55, "word": " mucus", "probability": 0.6995849609375}, {"start": 1561.55, "end": 1561.81, "word": " و", "probability": 0.5322265625}, {"start": 1561.81, "end": 1562.01, "word": " بعض", "probability": 0.9208984375}, {"start": 1562.01, "end": 1562.49, "word": " الأحيان", "probability": 0.8878173828125}, {"start": 1562.49, "end": 1562.79, "word": " ال", "probability": 0.66845703125}, {"start": 1562.79, "end": 1563.09, "word": " blood", "probability": 0.96240234375}], "temperature": 1.0}, {"id": 66, "seek": 158111, "start": 1566.17, "end": 1581.11, "text": "نعم دزنتري فبالتالي إذا في هذه الحالة المريض مش قادر يجيب عينة stool فممكن يصطاد عنها ال vehicle swap لكن إذا في stool فهو العينة المثلى ما هو العينة المثلى", "tokens": [1863, 25957, 11778, 11622, 29399, 16572, 6156, 3555, 6027, 2655, 6027, 1829, 11933, 15730, 8978, 29538, 21542, 6027, 3660, 9673, 16572, 11242, 37893, 12174, 18513, 2288, 7251, 7435, 1829, 3555, 6225, 9957, 3660, 35086, 6156, 2304, 43020, 7251, 9381, 9566, 18513, 18871, 11296, 2423, 5864, 18135, 44381, 11933, 15730, 8978, 35086, 6156, 3224, 2407, 18863, 9957, 3660, 9673, 12984, 23942, 19446, 31439, 18863, 9957, 3660, 9673, 12984, 23942], "avg_logprob": -0.302762672521066, "compression_ratio": 1.6477987421383649, "no_speech_prob": 0.0, "words": [{"start": 1566.17, "end": 1566.53, "word": "نعم", "probability": 0.843017578125}, {"start": 1566.53, "end": 1566.99, "word": " دزنتري", "probability": 0.3025970458984375}, {"start": 1566.99, "end": 1568.41, "word": " فبالتالي", "probability": 0.9189453125}, {"start": 1568.41, "end": 1568.77, "word": " إذا", "probability": 0.82421875}, {"start": 1568.77, "end": 1568.89, "word": " في", "probability": 0.95849609375}, {"start": 1568.89, "end": 1568.99, "word": " هذه", "probability": 0.3720703125}, {"start": 1568.99, "end": 1569.35, "word": " الحالة", "probability": 0.9781901041666666}, {"start": 1569.35, "end": 1570.45, "word": " المريض", "probability": 0.741943359375}, {"start": 1570.45, "end": 1570.55, "word": " مش", "probability": 0.97705078125}, {"start": 1570.55, "end": 1570.79, "word": " قادر", "probability": 0.90869140625}, {"start": 1570.79, "end": 1570.99, "word": " يجيب", "probability": 0.984375}, {"start": 1570.99, "end": 1571.69, "word": " عينة", "probability": 0.7823079427083334}, {"start": 1571.69, "end": 1572.99, "word": " stool", "probability": 0.9423828125}, {"start": 1572.99, "end": 1574.69, "word": " فممكن", "probability": 0.95361328125}, {"start": 1574.69, "end": 1574.95, "word": " يصطاد", "probability": 0.477294921875}, {"start": 1574.95, "end": 1575.13, "word": " عنها", "probability": 0.67578125}, {"start": 1575.13, "end": 1575.23, "word": " ال", "probability": 0.328857421875}, {"start": 1575.23, "end": 1575.43, "word": " vehicle", "probability": 0.755859375}, {"start": 1575.43, "end": 1576.01, "word": " swap", "probability": 0.71142578125}, {"start": 1576.01, "end": 1576.47, "word": " لكن", "probability": 0.86328125}, {"start": 1576.47, "end": 1577.37, "word": " إذا", "probability": 0.91845703125}, {"start": 1577.37, "end": 1577.49, "word": " في", "probability": 0.86279296875}, {"start": 1577.49, "end": 1577.93, "word": " stool", "probability": 0.424560546875}, {"start": 1577.93, "end": 1578.35, "word": " فهو", "probability": 0.97021484375}, {"start": 1578.35, "end": 1578.91, "word": " العينة", "probability": 0.9518229166666666}, {"start": 1578.91, "end": 1579.69, "word": " المثلى", "probability": 0.6261393229166666}, {"start": 1579.69, "end": 1580.05, "word": " ما", "probability": 0.58056640625}, {"start": 1580.05, "end": 1580.19, "word": " هو", "probability": 0.92626953125}, {"start": 1580.19, "end": 1580.59, "word": " العينة", "probability": 0.9905598958333334}, {"start": 1580.59, "end": 1581.11, "word": " المثلى", "probability": 0.9694010416666666}], "temperature": 1.0}, {"id": 67, "seek": 160134, "start": 1581.98, "end": 1601.34, "text": "قولنا ال enrichment alkaline ببتون water selected TCBS وذكرنا اسمه اللي هو thiosulfate citrate bile salt saccharose agar والهنا الحلو أنه مابنعملش enrichment ل 24 ساعة مابنعمل enrichment فقط لجداش ل 4 ل 6 ساعات و بعدين مابنعمل sub culture على اللي هو ال TCBS مرة أخرى", "tokens": [4587, 12610, 8315, 2423, 49900, 44220, 533, 4724, 3555, 2655, 11536, 1281, 8209, 34150, 8176, 4032, 8848, 37983, 8315, 24525, 2304, 3224, 13672, 1829, 31439, 258, 2717, 5757, 473, 4814, 4404, 18729, 5139, 4899, 7374, 541, 623, 289, 4032, 6027, 3224, 8315, 21542, 1211, 2407, 14739, 3224, 3714, 16758, 1863, 25957, 1211, 8592, 49900, 5296, 4022, 8608, 995, 27884, 3714, 16758, 1863, 25957, 1211, 49900, 6156, 47432, 5296, 7435, 3215, 33599, 5296, 1017, 5296, 1386, 8608, 45761, 9307, 4032, 39182, 9957, 3714, 16758, 1863, 25957, 1211, 1422, 3713, 15844, 13672, 1829, 31439, 2423, 34150, 8176, 3714, 25720, 5551, 34740, 7578], "avg_logprob": -0.3251856506460964, "compression_ratio": 1.5368852459016393, "no_speech_prob": 0.0, "words": [{"start": 1581.98, "end": 1582.28, "word": "قولنا", "probability": 0.4391682942708333}, {"start": 1582.28, "end": 1582.34, "word": " ال", "probability": 0.76904296875}, {"start": 1582.34, "end": 1582.7, "word": " enrichment", "probability": 0.9853515625}, {"start": 1582.7, "end": 1583.26, "word": " alkaline", "probability": 0.845703125}, {"start": 1583.26, "end": 1583.58, "word": " ببتون", "probability": 0.54229736328125}, {"start": 1583.58, "end": 1583.9, "word": " water", "probability": 0.837890625}, {"start": 1583.9, "end": 1584.3, "word": " selected", "probability": 0.2274169921875}, {"start": 1584.3, "end": 1584.98, "word": " TCBS", "probability": 0.39385986328125}, {"start": 1584.98, "end": 1585.66, "word": " وذكرنا", "probability": 0.833740234375}, {"start": 1585.66, "end": 1585.98, "word": " اسمه", "probability": 0.8898111979166666}, {"start": 1585.98, "end": 1586.0, "word": " اللي", "probability": 0.5538330078125}, {"start": 1586.0, "end": 1586.12, "word": " هو", "probability": 0.8359375}, {"start": 1586.12, "end": 1586.72, "word": " thiosulfate", "probability": 0.67645263671875}, {"start": 1586.72, "end": 1587.1, "word": " citrate", "probability": 0.81982421875}, {"start": 1587.1, "end": 1587.4, "word": " bile", "probability": 0.94921875}, {"start": 1587.4, "end": 1588.06, "word": " salt", "probability": 0.7001953125}, {"start": 1588.06, "end": 1588.42, "word": " saccharose", "probability": 0.5851236979166666}, {"start": 1588.42, "end": 1588.76, "word": " agar", "probability": 0.926025390625}, {"start": 1588.76, "end": 1590.52, "word": " والهنا", "probability": 0.603759765625}, {"start": 1590.52, "end": 1591.12, "word": " الحلو", "probability": 0.9176432291666666}, {"start": 1591.12, "end": 1591.6, "word": " أنه", "probability": 0.7099609375}, {"start": 1591.6, "end": 1591.94, "word": " مابنعملش", "probability": 0.8138020833333334}, {"start": 1591.94, "end": 1592.4, "word": " enrichment", "probability": 0.99658203125}, {"start": 1592.4, "end": 1592.6, "word": " ل", "probability": 0.97119140625}, {"start": 1592.6, "end": 1592.92, "word": " 24", "probability": 0.70458984375}, {"start": 1592.92, "end": 1593.5, "word": " ساعة", "probability": 0.8304036458333334}, {"start": 1593.5, "end": 1593.88, "word": " مابنعمل", "probability": 0.88935546875}, {"start": 1593.88, "end": 1594.2, "word": " enrichment", "probability": 0.99267578125}, {"start": 1594.2, "end": 1594.6, "word": " فقط", "probability": 0.970947265625}, {"start": 1594.6, "end": 1595.1, "word": " لجداش", "probability": 0.757080078125}, {"start": 1595.1, "end": 1595.54, "word": " ل", "probability": 0.90185546875}, {"start": 1595.54, "end": 1595.88, "word": " 4", "probability": 0.8056640625}, {"start": 1595.88, "end": 1596.36, "word": " ل", "probability": 0.68310546875}, {"start": 1596.36, "end": 1596.56, "word": " 6", "probability": 0.88525390625}, {"start": 1596.56, "end": 1596.9, "word": " ساعات", "probability": 0.9440104166666666}, {"start": 1596.9, "end": 1597.0, "word": " و", "probability": 0.3505859375}, {"start": 1597.0, "end": 1597.12, "word": " بعدين", "probability": 0.784423828125}, {"start": 1597.12, "end": 1597.32, "word": " مابنعمل", "probability": 0.858642578125}, {"start": 1597.32, "end": 1597.5, "word": " sub", "probability": 0.95166015625}, {"start": 1597.5, "end": 1598.0, "word": " culture", "probability": 0.55859375}, {"start": 1598.0, "end": 1598.68, "word": " على", "probability": 0.796875}, {"start": 1598.68, "end": 1599.1, "word": " اللي", "probability": 0.882080078125}, {"start": 1599.1, "end": 1599.34, "word": " هو", "probability": 0.935546875}, {"start": 1599.34, "end": 1599.84, "word": " ال", "probability": 0.74609375}, {"start": 1599.84, "end": 1600.74, "word": " TCBS", "probability": 0.7315673828125}, {"start": 1600.74, "end": 1601.0, "word": " مرة", "probability": 0.964599609375}, {"start": 1601.0, "end": 1601.34, "word": " أخرى", "probability": 0.9679361979166666}], "temperature": 1.0}, {"id": 68, "seek": 163133, "start": 1603.49, "end": 1631.33, "text": "كمان مرة اشهر الشكل المستعمرات yellow colonies are produced وارفنا من وين مصدر اللون تبع ال Saccharose fermentation الدجالة اللى رسمناها على الصبورة قبل شوية stool orfical swab على الجهة اللى .. اللى .. اللى هناك ال selective medias TCBS على الجهة دى enrichment عملنا subculture قولنا بعد اربعة لست ساعة لسبعة درجة معوية وبعد ده اللى شفنا ال typical colonies وعملنا لها the following tests", "tokens": [24793, 7649, 3714, 25720, 1975, 8592, 3224, 2288, 25124, 28820, 9673, 14851, 25957, 2288, 9307, 5566, 27981, 366, 7126, 4032, 9640, 5172, 8315, 9154, 4032, 9957, 3714, 9381, 3215, 2288, 13672, 11536, 6055, 3555, 3615, 2423, 19356, 7374, 541, 43161, 32748, 7435, 6027, 3660, 13672, 7578, 12602, 38251, 8315, 11296, 15844, 31767, 3555, 13063, 3660, 12174, 36150, 13412, 2407, 10632, 35086, 420, 1786, 304, 49840, 15844, 25724, 3224, 3660, 13672, 7578, 4386, 13672, 7578, 4386, 13672, 7578, 34105, 4117, 2423, 33930, 1205, 4609, 34150, 8176, 15844, 25724, 3224, 3660, 11778, 7578, 49900, 6225, 42213, 8315, 1422, 66, 8389, 12174, 12610, 8315, 39182, 1975, 25513, 27884, 5296, 14851, 8608, 995, 27884, 5296, 35457, 27884, 11778, 47341, 3660, 20449, 2407, 10632, 46599, 22488, 11778, 3224, 13672, 7578, 13412, 5172, 8315, 2423, 7476, 27981, 4032, 25957, 1211, 8315, 5296, 11296, 264, 3480, 6921], "avg_logprob": -0.316932628340755, "compression_ratio": 1.7692307692307692, "no_speech_prob": 0.0, "words": [{"start": 1603.49, "end": 1603.75, "word": "كمان", "probability": 0.7225341796875}, {"start": 1603.75, "end": 1604.01, "word": " مرة", "probability": 0.85107421875}, {"start": 1604.01, "end": 1604.29, "word": " اشهر", "probability": 0.639984130859375}, {"start": 1604.29, "end": 1604.77, "word": " الشكل", "probability": 0.7115478515625}, {"start": 1604.77, "end": 1605.59, "word": " المستعمرات", "probability": 0.95068359375}, {"start": 1605.59, "end": 1606.01, "word": " yellow", "probability": 0.2132568359375}, {"start": 1606.01, "end": 1606.49, "word": " colonies", "probability": 0.92236328125}, {"start": 1606.49, "end": 1607.11, "word": " are", "probability": 0.86279296875}, {"start": 1607.11, "end": 1607.93, "word": " produced", "probability": 0.92822265625}, {"start": 1607.93, "end": 1608.33, "word": " وارفنا", "probability": 0.82452392578125}, {"start": 1608.33, "end": 1608.49, "word": " من", "probability": 0.98681640625}, {"start": 1608.49, "end": 1608.81, "word": " وين", "probability": 0.9482421875}, {"start": 1608.81, "end": 1609.47, "word": " مصدر", "probability": 0.9932861328125}, {"start": 1609.47, "end": 1610.17, "word": " اللون", "probability": 0.989990234375}, {"start": 1610.17, "end": 1610.71, "word": " تبع", "probability": 0.8069661458333334}, {"start": 1610.71, "end": 1610.87, "word": " ال", "probability": 0.59423828125}, {"start": 1610.87, "end": 1611.35, "word": " Saccharose", "probability": 0.5530598958333334}, {"start": 1611.35, "end": 1611.85, "word": " fermentation", "probability": 0.8583984375}, {"start": 1611.85, "end": 1613.35, "word": " الدجالة", "probability": 0.5625}, {"start": 1613.35, "end": 1613.41, "word": " اللى", "probability": 0.758544921875}, {"start": 1613.41, "end": 1613.83, "word": " رسمناها", "probability": 0.95068359375}, {"start": 1613.83, "end": 1613.97, "word": " على", "probability": 0.80712890625}, {"start": 1613.97, "end": 1614.37, "word": " الصبورة", "probability": 0.75634765625}, {"start": 1614.37, "end": 1614.47, "word": " قبل", "probability": 0.73876953125}, {"start": 1614.47, "end": 1614.89, "word": " شوية", "probability": 0.89697265625}, {"start": 1614.89, "end": 1615.89, "word": " stool", "probability": 0.62890625}, {"start": 1615.89, "end": 1616.37, "word": " orfical", "probability": 0.6609700520833334}, {"start": 1616.37, "end": 1616.85, "word": " swab", "probability": 0.7685546875}, {"start": 1616.85, "end": 1617.43, "word": " على", "probability": 0.50537109375}, {"start": 1617.43, "end": 1617.71, "word": " الجهة", "probability": 0.7835286458333334}, {"start": 1617.71, "end": 1618.07, "word": " اللى", "probability": 0.909912109375}, {"start": 1618.07, "end": 1618.09, "word": " ..", "probability": 0.451416015625}, {"start": 1618.09, "end": 1618.37, "word": " اللى", "probability": 0.81494140625}, {"start": 1618.37, "end": 1618.37, "word": " ..", "probability": 0.85546875}, {"start": 1618.37, "end": 1618.67, "word": " اللى", "probability": 0.948974609375}, {"start": 1618.67, "end": 1619.17, "word": " هناك", "probability": 0.940185546875}, {"start": 1619.17, "end": 1619.57, "word": " ال", "probability": 0.8720703125}, {"start": 1619.57, "end": 1619.93, "word": " selective", "probability": 0.92919921875}, {"start": 1619.93, "end": 1620.39, "word": " medias", "probability": 0.61090087890625}, {"start": 1620.39, "end": 1621.03, "word": " TCBS", "probability": 0.4351806640625}, {"start": 1621.03, "end": 1621.19, "word": " على", "probability": 0.60693359375}, {"start": 1621.19, "end": 1621.43, "word": " الجهة", "probability": 0.9749348958333334}, {"start": 1621.43, "end": 1622.07, "word": " دى", "probability": 0.882568359375}, {"start": 1622.07, "end": 1622.49, "word": " enrichment", "probability": 0.96630859375}, {"start": 1622.49, "end": 1623.33, "word": " عملنا", "probability": 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بكتيريا", "probability": 0.96806640625}, {"start": 2812.07, "end": 2812.75, "word": " بتقطع", "probability": 0.966796875}, {"start": 2812.75, "end": 2813.57, "word": " مسافة", "probability": 0.9949544270833334}, {"start": 2813.57, "end": 2813.89, "word": " و", "probability": 0.61474609375}, {"start": 2813.89, "end": 2814.29, "word": " بتغير", "probability": 0.9361979166666666}, {"start": 2814.29, "end": 2814.77, "word": " اتجاه", "probability": 0.990234375}, {"start": 2814.77, "end": 2815.79, "word": " تقطع", "probability": 0.8321940104166666}, {"start": 2815.79, "end": 2816.35, "word": " مسافة", "probability": 0.994140625}, {"start": 2816.35, "end": 2816.49, "word": " و", "probability": 0.9130859375}, {"start": 2816.49, "end": 2816.99, "word": " بتغير", "probability": 0.97265625}, {"start": 2816.99, "end": 2817.57, "word": " اتجاه", "probability": 0.9947509765625}, {"start": 2817.57, "end": 2818.27, "word": " فبتتالفك", "probability": 0.6773856026785714}, {"start": 2818.27, "end": 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0.970458984375}, {"start": 2828.55, "end": 2828.71, "word": " هو", "probability": 0.970703125}, {"start": 2828.71, "end": 2828.85, "word": " ال", "probability": 0.60205078125}, {"start": 2828.85, "end": 2830.01, "word": " Campylobact", "probability": 0.7552734375}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2832.60225, "duration_after_vad": 2650.863124999988}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e131d0599b260cba5400f4862af5c3b62fd918c8
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/k8KHQkvXE7Y_raw.srt
@@ -0,0 +1,2524 @@
+1
+00:00:20,480 --> 00:00:22,760
+السلام عليكم ورحمة الله وبركاته بسم الله الرحمن
+
+2
+00:00:22,760 --> 00:00:25,820
+الرحيم اليوم برضه microbe جديد ان شاء الله اللي هو
+
+3
+00:00:25,820 --> 00:00:32,160
+ال vibrio ال vibrio بتميز عن ال gram negative بس
+
+4
+00:00:32,160 --> 00:00:35,460
+ال lie بالشكل ولذلك سميه vibrio لأنه بيمتلك شكل
+
+5
+00:00:35,460 --> 00:00:43,380
+كومة او curvedكومة أو كومة كيرب وبالتالي كلمة
+
+6
+00:00:43,380 --> 00:00:48,740
+vibrio تعني الملوية يعني المنحنية الواوية هذا
+
+7
+00:00:48,740 --> 00:00:54,220
+الاسم مهم جدا نعرفه من البداية لأن احنا بنقول انه
+
+8
+00:00:54,220 --> 00:00:59,520
+في الاستول ال gram stain العينة في الاستول is of
+
+9
+00:00:59,520 --> 00:01:03,320
+no value in all bacterial infection except in one
+
+10
+00:01:03,320 --> 00:01:06,980
+case except in vibrio ليش؟ لأن احنا هنشوف في هذا
+
+11
+00:01:06,980 --> 00:01:13,530
+الحالةmany يعني كتير of the curved بس اللاعي وهذا
+
+12
+00:01:13,530 --> 00:01:17,950
+مؤشر عن ان المريض قد يكون مصاب بالvibro ابنليه
+
+13
+00:01:17,950 --> 00:01:22,330
+طبعا ان هذه الحالة في الاوبئة هذا بيساعدنا في
+
+14
+00:01:22,330 --> 00:01:24,270
+بيقصر الوقت اللي هو التشخيص
+
+15
+00:01:26,720 --> 00:01:29,120
+الاسم المشهور و اللي كلكم بتعرفوه هو الـ Vibrio
+
+16
+00:01:29,120 --> 00:01:31,940
+cholera لكن هناك أسماء أخرى غير ال Vibrio cholera
+
+17
+00:01:31,940 --> 00:01:35,920
+زي مثلا اللي هو ال Vibromimicus و من اسمها mimicus
+
+18
+00:01:35,920 --> 00:01:41,620
+من mimic mimic يحاكي وهي حقا تشبه إلى حد كبير في
+
+19
+00:01:41,620 --> 00:01:45,940
+الشكل والمواصفات إلى اللي هو ال Vibrio cholera ال
+
+20
+00:01:45,940 --> 00:01:50,300
+Vibrio parahemolyticus هذا مايكروب اشتهر اكثر في
+
+21
+00:01:50,300 --> 00:01:51,740
+ال food microbiology
+
+22
+00:01:54,260 --> 00:01:58,220
+كفوود بورن باثوجين كفوود بورن باثوجين وبالأحرى
+
+23
+00:01:58,220 --> 00:02:04,020
+with seafood بالظبط
+
+24
+00:02:04,020 --> 00:02:08,900
+الآن ال seafood بتعرفوا الطعام المشهور لليابانيين
+
+25
+00:02:08,900 --> 00:02:12,120
+اللي هو السوشي اللي هو السمك النية اللي غير مطهي
+
+26
+00:02:12,120 --> 00:02:17,120
+بهذه الخدمة أو هذه النوع من الطعام شاعر في كثير من
+
+27
+00:02:17,120 --> 00:02:23,440
+البلدان العالم كثقافة غذائية نشرها اليابانين في كل
+
+28
+00:02:23,440 --> 00:02:31,310
+مكانفبالتالي الميكروب مرتبط بالأغضية البحرية
+
+29
+00:02:31,310 --> 00:02:33,890
+اللي غير المطهية اللي من ضمنها جنها السمك ومن
+
+30
+00:02:33,890 --> 00:02:37,970
+ضمنها الشيل فش هذا الميكروب is a marine organism
+
+31
+00:02:37,970 --> 00:02:43,990
+يعني ميكروب بحري وبالتالي هينتقل عبر هذه الأسماك
+
+32
+00:02:43,990 --> 00:02:48,080
+ويسببنا food poisoning casesفى هنا ال Vibrio
+
+33
+00:02:48,080 --> 00:02:51,340
+volnepicus كانت فى السابق اتبار non-pathogen لكن
+
+34
+00:02:51,340 --> 00:02:53,900
+الان بيعتبر انها بتسبب wound infection و
+
+35
+00:02:53,900 --> 00:02:57,500
+septicemia اذا فى عندى كمان مرة Vibrio cholera وهى
+
+36
+00:02:57,500 --> 00:03:00,220
+ال most common و ال most important species of all
+
+37
+00:03:00,220 --> 00:03:05,980
+هي المسبب لال epidemic cholera Vibrio mimicus لسه
+
+38
+00:03:05,980 --> 00:03:09,220
+important لكن اهميتها هنا بتشبه مين ال Vibrio
+
+39
+00:03:09,220 --> 00:03:12,710
+cholera مش شكلا و biochemical مش diseaseVibrio
+
+40
+00:03:12,710 --> 00:03:17,930
+parahemoneficas قلنا انها تزيد الاهتمام بها نظرا
+
+41
+00:03:17,930 --> 00:03:22,630
+لما قلنا انها تزيد ثقافة تناول الأسماك الغير
+
+42
+00:03:22,630 --> 00:03:26,470
+مطهية، ال Vibrio volneficas ثبت انها بتسبب وضعوه
+
+43
+00:03:26,470 --> 00:03:27,890
+بالإنفكاشين و السبسكترين
+
+44
+00:03:30,830 --> 00:03:34,650
+البكتيريا ال genus vibrio ال .. ال .. ال vibrio
+
+45
+00:03:34,650 --> 00:03:39,170
+بنا بيتميز بالشكل تبعه انه كما shape اعتقد ان
+
+46
+00:03:39,170 --> 00:03:42,710
+الصورة اللي هناك على طرف بوب بتوضح لنا ان
+
+47
+00:03:42,710 --> 00:03:47,330
+البكتيريا بسيلاي صحيح لكن مش straight مش straight
+
+48
+00:03:47,330 --> 00:03:51,110
+يعني مش ادلة وبالتالي هي curved they are small,
+
+49
+00:03:51,310 --> 00:03:54,630
+ground, negative, curved بسيلاي او rods, motile,
+
+50
+00:03:54,750 --> 00:03:57,610
+bipolar, flagella زي pseudomonas يبقى وجه شبه الآن
+
+51
+00:03:57,610 --> 00:04:03,590
+بينها و بينها حاجتينهنشوف كمان شوية إنها Oxidase
+
+52
+00:04:03,590 --> 00:04:06,110
+positive و Sodomonas aeruginosa برضه Oxidase
+
+53
+00:04:06,110 --> 00:04:11,190
+positive هذه البكتيريا مطاع ال bipolar flagella و
+
+54
+00:04:11,190 --> 00:04:14,390
+Sodomonas aeruginosa برضه مطاع ال bipolar flagella
+
+55
+00:04:14,390 --> 00:04:18,630
+لكن الفرق بينهم هذي fermenter و هذي non fermenter
+
+56
+00:04:18,630 --> 00:04:21,310
+فاكرين أداء جرامه ولا فاكرينه؟ لأ بتذكركوا فيه من
+
+57
+00:04:21,310 --> 00:04:25,830
+البداية الجرام negative بس ال lie انجسمت جسمين
+
+58
+00:04:25,830 --> 00:04:30,590
+بناء على فحص ال Oxidaseاللي بوستف يبقى وجه الشبه
+
+59
+00:04:30,590 --> 00:04:33,910
+كام ان احنا بينهم تنتين انه تنتين بوستف للإكسيدايز
+
+60
+00:04:33,910 --> 00:04:37,990
+لكن واحدة للجلوكوز fermentation كانت negative اللي
+
+61
+00:04:37,990 --> 00:04:43,410
+و هي صيدومونوس و بوستف كانت اللي هي ال Vibrio إذا
+
+62
+00:04:43,410 --> 00:04:47,530
+الفرق بين صيدومونوس و الارجنوزا و ال Vibrio اللي
+
+63
+00:04:47,530 --> 00:04:50,950
+هو الجلوكوز fermentation بينما بيشتبهوا .. بتشبهوا
+
+64
+00:04:50,950 --> 00:04:55,470
+مع بعض في صفتين صفة الإكسيدايز و صفة اللي هو قولنا
+
+65
+00:04:55,470 --> 00:05:00,190
+ال motility bipolar efflationالفيبرو الكوليرة بشكل
+
+66
+00:05:00,190 --> 00:05:05,090
+عام تعتبر aerobic and facultative أنا aerob و هذا
+
+67
+00:05:05,090 --> 00:05:08,150
+السبب انه لو بنقول facultative أنا aerob بنقول
+
+68
+00:05:08,150 --> 00:05:10,910
+انها قادرة على التعمل fermentation بس لو انها
+
+69
+00:05:10,910 --> 00:05:13,970
+obligate aerob زي Sodomonas aeruginosa لن تكون
+
+70
+00:05:13,970 --> 00:05:16,070
+قادرة على ال fermentation لما تكون قادرة فقط على
+
+71
+00:05:16,070 --> 00:05:20,730
+ال Oxidation الفيبرو
+
+72
+00:05:20,730 --> 00:05:26,420
+الكوليرةكبكتيريا can adhere to the intestinal cell
+
+73
+00:05:26,420 --> 00:05:31,080
+wall بدون ما تعمل اي invasion ل ال intestinal cell
+
+74
+00:05:31,080 --> 00:05:36,110
+wall يعني بمعنى اخر localized infectionطبعا
+
+75
+00:05:36,110 --> 00:05:41,230
+السلمونيلا عملت invasion وتخطط ال intestinal wall
+
+76
+00:05:41,230 --> 00:05:45,870
+و ال lymph node و راحت على الدم الشيجيلا عملت
+
+77
+00:05:45,870 --> 00:05:49,150
+invasion لل intestinal wall ولكن بقيت هناك لم
+
+78
+00:05:49,150 --> 00:05:54,330
+تستطع المرور عبر ال lymph node إلى الدم ال vibrio
+
+79
+00:05:54,330 --> 00:05:57,430
+الان localized to the intestinal tract, no
+
+80
+00:05:57,430 --> 00:06:02,530
+invasionكلكم تتذكروا الـ toxin تبع ال Vibrio
+
+81
+00:06:02,530 --> 00:06:07,830
+وشرحناه احنا بطريقة يعني نوعا ما comic يعني هزلية
+
+82
+00:06:07,830 --> 00:06:14,550
+قلنا لو كان هذا هو ال intestinal walls تمام؟ ال
+
+83
+00:06:14,550 --> 00:06:20,890
+toxin of cholera وانا افترض ان هو هذا المتلت بيعمل
+
+84
+00:06:20,890 --> 00:06:24,590
+binding مع انزيم ايه اسم قلنا عنه؟
+
+85
+00:06:29,190 --> 00:06:34,720
+Enzymeالاديناليت سايكليز انزايم الارتباط تبع
+
+86
+00:06:34,720 --> 00:06:42,780
+التوكسين فيه بيحول ال ATP إلى Cyclic AMB قلنا ال
+
+87
+00:06:42,780 --> 00:06:47,180
+amount of Cyclic AMB الكثيرة أو الكثيفة أو العالية
+
+88
+00:06:47,180 --> 00:06:51,940
+أو الغير معتادة هتزيد ال function المنوطة بال
+
+89
+00:06:51,940 --> 00:06:55,580
+Cyclic AMB اللي قلنا عنها تتلخص في شغلتين منع
+
+90
+00:06:55,580 --> 00:07:02,210
+امتصاص لبعض ال electrolyte وزيادة إفراز increaseلا
+
+91
+00:07:02,210 --> 00:07:05,070
+لبعض ال electrolytes وبالتالي صار فين دي هنا
+
+92
+00:07:05,070 --> 00:07:09,930
+electrolyte accumulation
+
+93
+00:07:09,930 --> 00:07:18,910
+filter sensed by the intestinal wall وبالتالي
+
+94
+00:07:18,910 --> 00:07:23,370
+diluted by large amount of H2O وبالتالي في هنا
+
+95
+00:07:23,370 --> 00:07:28,910
+ديارية ديارية هذي إذا تذكروا ووصفناها بإنها rice
+
+96
+00:07:28,910 --> 00:07:29,950
+water
+
+97
+00:07:32,960 --> 00:07:39,720
+طبعا هذا characteristic مشهور ل .. نعم مشهور ل ..
+
+98
+00:07:39,720 --> 00:07:43,760
+ال .. ال diarrhea caused by vibrio cholera ايش
+
+99
+00:07:43,760 --> 00:07:47,240
+بالنسبة لكوا ك .. كتحاليل طبية انتوا بي .. بيهمكوا
+
+100
+00:07:47,240 --> 00:07:51,630
+هذا الموضوع؟الشباب احنا متفقين على ان ال course
+
+101
+00:07:51,630 --> 00:07:55,010
+تبقى على اسمه medical diagnostic او diagnostic
+
+102
+00:07:55,010 --> 00:07:59,450
+medical microbiology فاحنا جزء في ال diagnosis جزء
+
+103
+00:07:59,450 --> 00:08:04,790
+في ال medical ليس من أجل انه نصير خبراء نصير خبراء
+
+104
+00:08:04,790 --> 00:08:11,330
+في التشخيص السريري للأمراض وانما لمعرفة العينات
+
+105
+00:08:11,330 --> 00:08:17,480
+ماذا يجب ان نتوقع منهاما هي الخصائص سبعة العينات؟
+
+106
+00:08:17,480 --> 00:08:20,040
+هى انك تتكلم عن rice water stool، لو انت شوفت هذا
+
+107
+00:08:20,040 --> 00:08:23,880
+ال character في عينة ال stool، أليس هذا مدعاكلك
+
+108
+00:08:23,880 --> 00:08:26,800
+انك تعمل suspicion ان البكتيرى المسببة هي vibrio
+
+109
+00:08:26,800 --> 00:08:31,520
+cholera وبالتالي بتسهل عليك عملية اللى هو التفكير
+
+110
+00:08:31,520 --> 00:08:36,780
+والاتجاه في ال diagnosis اللى انت مؤهل للقيام بيه؟
+
+111
+00:08:38,400 --> 00:08:42,560
+الان ال rice water stool عليش بيحتوي بقولنا بيحتوي
+
+112
+00:08:42,560 --> 00:08:46,000
+على ال vibrios و اعتقد ان الجملة هذه او الكلمة هذه
+
+113
+00:08:46,000 --> 00:08:50,840
+بتوضح ان اهمية ال gram stain لان في هذه اللحظة
+
+114
+00:08:50,840 --> 00:08:55,460
+اكتر شي هنشوفه في ال stool مش هنشوفه في ال stool
+
+115
+00:08:55,460 --> 00:08:58,560
+العادي ولا في ال stool تبع اي ديارية اخرى اللي هو
+
+116
+00:08:58,560 --> 00:09:03,180
+شكل ال vibrio لكن كمان مرة it is not conclusive
+
+117
+00:09:04,170 --> 00:09:09,510
+يعني عدم موجود Vibrios في الستول لا يعني ان المصاب
+
+118
+00:09:09,510 --> 00:09:14,870
+مش مريض بالكوليرا وصل الصورة لكن وجودها مش مثبت
+
+119
+00:09:14,870 --> 00:09:19,690
+مؤشر قوي لوجود ال Vibrio فيها ان انا ممكن ايضا
+
+120
+00:09:19,690 --> 00:09:25,190
+ايجاد Epithelial cells وممكن ايضا ان ميوكاس are
+
+121
+00:09:25,190 --> 00:09:28,410
+passed يعني ماشية مع الستول In acute cholera
+
+122
+00:09:28,410 --> 00:09:31,830
+cases, the rapid loss of fluid and electrolytes
+
+123
+00:09:31,830 --> 00:09:36,410
+lead to muscular crampsأحنا جبنا المحاضرة تانية او
+
+124
+00:09:36,410 --> 00:09:42,270
+تلاتة ان number one cause
+
+125
+00:09:42,270 --> 00:09:45,490
+of death among children is diarrhea يعني الإسهال
+
+126
+00:09:45,490 --> 00:09:49,770
+هو المسبب رقم واحد للوفيات وحكينا عن جملتين جبنا
+
+127
+00:09:49,770 --> 00:09:53,450
+electrolyte imbalanceيعني خلل .. صار خلل في عنده
+
+128
+00:09:53,450 --> 00:09:56,050
+في مين؟ في الـ electrolyte نتيجة اللي هو ال .. ال
+
+129
+00:09:56,050 --> 00:09:59,270
+.. ال .. ال .. ال dehydration اللي هو loss of
+
+130
+00:09:59,270 --> 00:10:05,070
+water فبالتالي إذا صار في أنه dehydration عالي قد
+
+131
+00:10:05,070 --> 00:10:09,270
+تؤدي إلى الوفيات فيه و خاصة في الأطفال بيقولنا
+
+132
+00:10:09,270 --> 00:10:13,870
+which if not .. which if not treated it is fatal
+
+133
+00:10:13,870 --> 00:10:15,870
+fatal يعني قاتل
+
+134
+00:10:18,490 --> 00:10:22,070
+التوكسين اللي .. اللي .. اللي حكينا عنه هو عبارة
+
+135
+00:10:22,070 --> 00:10:27,470
+عن A 5B هنا معمول 6B لكن هو 5B ال B هنا لل binding
+
+136
+00:10:27,470 --> 00:10:31,430
+صار internalization ال A portion بيقولنا بي ..
+
+137
+00:10:31,430 --> 00:10:35,190
+بيرتبط بال protein G زائد ناد بيعمل ADP
+
+138
+00:10:35,190 --> 00:10:39,160
+ribosylationوزائد نيكوتنامويد طبعا هذا بيعمل
+
+139
+00:10:39,160 --> 00:10:42,440
+activation لمين؟ لـadenylate cyclase enzyme ال
+
+140
+00:10:42,440 --> 00:10:45,360
+activation لـadenylate cyclase enzyme اللي وصفناها
+
+141
+00:10:45,360 --> 00:10:49,400
+في الخطوة هذه بيتحول معها ال ATP إلى إيه؟ Cyclic
+
+142
+00:10:49,400 --> 00:10:51,840
+AMP وقلنا بيقدي إلى accumulation of electrolytes
+
+143
+00:10:51,840 --> 00:10:54,120
+بيقدي في الآخر إلى اللي هو ال secretion
+
+144
+00:10:57,890 --> 00:11:01,990
+الان خلّينا بس نوضّح بعض الأمور المتعلقة
+
+145
+00:11:01,990 --> 00:11:07,650
+بالأورجانيزم عشان نعرف أفضل الطرق المناسبة لعزل
+
+146
+00:11:07,650 --> 00:11:08,870
+هذا ال microbe
+
+147
+00:11:17,610 --> 00:11:22,290
+هذا ميكروب يمكن ينتجلنا Epidemics of cholera
+
+148
+00:11:22,290 --> 00:11:26,050
+Epidemics of cholera يعني أوبئة من الانتشار واسع
+
+149
+00:11:26,050 --> 00:11:32,950
+وسريع للمرض وبالتالي ممكن نتجاوز عن الخطوات اللي
+
+150
+00:11:32,950 --> 00:11:40,350
+فاكرناهم الأربع خطوات أذكركوا فيهم cultural لا لسه
+
+151
+00:11:40,350 --> 00:11:46,870
+morphology يعني استيانين لا؟
+
+152
+00:11:47,630 --> 00:11:51,810
+بيو كيميكال واربع سيرولوجيكال وخمسة جينا عنها
+
+153
+00:11:51,810 --> 00:11:56,150
+others تمام وفاكرين في الشكل اللي قفزنا من ال
+
+154
+00:11:56,150 --> 00:11:58,930
+culture روحنا على مين؟ على السيرولوجيكال صح ولا لا
+
+155
+00:11:58,930 --> 00:12:04,370
+فاحنا بدنا كمان نشوف في أي مايكروب اي مايكروب
+
+156
+00:12:04,370 --> 00:12:09,290
+بيحدث بشكل وبائي انفجاري epidemics تمام او
+
+157
+00:12:09,290 --> 00:12:14,050
+outbreak بدنا نحاول نشوف اقصر الطرق هذا لا يعني ان
+
+158
+00:12:14,050 --> 00:12:18,240
+احنا ننسى أطول الطرقكنا أقصر الطرق لل initial
+
+159
+00:12:18,240 --> 00:12:22,960
+report و أطول الطرق اللي هي لل final report فإيش
+
+160
+00:12:22,960 --> 00:12:25,540
+ال characteristics اللي ممكن أستفيدها أنا من
+
+161
+00:12:25,540 --> 00:12:30,840
+الميكروب عشان أقدر أعمل diagnoses قصيرة جبل خدنا
+
+162
+00:12:30,840 --> 00:12:33,560
+ناخد خصائصنا رقم واحد البكتيرا قلنا عنها جلعب
+
+163
+00:12:33,560 --> 00:12:37,890
+نيجاتيف بسلعكطبعا بس ال life is straight or curved
+
+164
+00:12:37,890 --> 00:12:42,630
+رقم اتنين they grow in alkaline pH يعني بتحب الوسط
+
+165
+00:12:42,630 --> 00:12:46,730
+اللي هو المرتفع في ال pH هذه النقطة لحالها بدنا
+
+166
+00:12:46,730 --> 00:12:52,090
+نحطها يعني ك target نستهدف من خلاله هذا الهدف
+
+167
+00:12:52,090 --> 00:12:55,370
+نستهدف من خلاله عزل البكتيريا دون عن البكتيريا
+
+168
+00:12:55,370 --> 00:12:59,650
+الأخرى لأن كل البكتيريا الأخرى loves the pH of
+
+169
+00:12:59,650 --> 00:13:04,480
+neutralityيعني بتحب تعيش في وسط قريب من مين من
+
+170
+00:13:04,480 --> 00:13:09,220
+التعادل من السبع لو حاطناها في أنبوبة ال stool
+
+171
+00:13:09,220 --> 00:13:17,760
+اللي بيحتوي من ضمنه واحد vibrio cholera حاطناها
+
+172
+00:13:17,760 --> 00:13:22,440
+في alkaline pH
+
+173
+00:13:22,440 --> 00:13:27,000
+يعني من تمانية تسعة ايش اللي بيصير ان هنا كل
+
+174
+00:13:27,000 --> 00:13:33,110
+الميكروبات اللي موجودةمش ملائم إلها هذا الوسط
+
+175
+00:13:33,110 --> 00:13:38,390
+وبالتالي gradually will die مين اللي بينمو فقط ال
+
+176
+00:13:38,390 --> 00:13:40,990
+vibrio cholera وهنا كمان خدوا بالكوا هاد اسمها
+
+177
+00:13:40,990 --> 00:13:41,390
+enrichment
+
+178
+00:13:44,210 --> 00:13:46,850
+هيشوفته اكتر من نوع enrichment شوفته مرة بال
+
+179
+00:13:46,850 --> 00:13:50,450
+selenite-f كيف كانت selenite-f فكرته حطينا lactose
+
+180
+00:13:50,450 --> 00:13:54,190
+للاكتوز fermenting بكتيريا انما البكتيريا موتها
+
+181
+00:13:54,190 --> 00:13:57,370
+اللي هو مين ال selenious acid المرة اللي بعديها
+
+182
+00:13:57,370 --> 00:14:00,670
+أخدنا كمان نوع تاني من enrichment حطيناها بالتلاجة
+
+183
+00:14:00,670 --> 00:14:04,210
+بالظبط cold enrichment البكتيريا اللي بدناياها
+
+184
+00:14:04,210 --> 00:14:08,130
+تنمو في التلاجة و الآخرين بيموتوا هنا وضعناها في
+
+185
+00:14:08,130 --> 00:14:12,520
+مين؟في alkaline pH طبعا اختيارنا لل enrichment
+
+186
+00:14:12,520 --> 00:14:16,500
+معتمد على معرفتنا بصفات البكتيريا هنا عرفنا ان
+
+187
+00:14:16,500 --> 00:14:21,600
+البكتيريا هذه بتحب ال alkaline pH الوسط المستخدم
+
+188
+00:14:21,600 --> 00:14:28,740
+هنا اسمه alkaline peptone water او APW
+
+189
+00:14:28,740 --> 00:14:33,950
+اقتصارا alkaline peptone waterمن أشهر الأوساط
+
+190
+00:14:33,950 --> 00:14:37,750
+المستخدمة للبكتيريا ك selective media اللي هو ال
+
+191
+00:14:37,750 --> 00:14:43,770
+TCBS و هنتعرف على إيش هي TCBS Thyrosulfate نكتبهم
+
+192
+00:14:43,770 --> 00:14:47,550
+هلاجيهم
+
+193
+00:14:47,550 --> 00:14:51,330
+في لوحات تانية لكن لأ بقص ان اللوحة دي نستخدمها
+
+194
+00:14:51,330 --> 00:14:58,330
+كمدخل لل diagnosis كاملة تي وال سي وال بي اس
+
+195
+00:15:13,210 --> 00:15:18,410
+إذن هو عبارة عن ثيوسلفيت سيتريت بايل سولت ساكروس
+
+196
+00:15:18,410 --> 00:15:22,070
+طبعا الأحرف الأولى من كلهم اضططنوا اللى هو مين ال
+
+197
+00:15:22,070 --> 00:15:27,290
+TCBS كمان مرة ثيوسلفيت سيتريت بايل سولت ساكروس
+
+198
+00:15:27,290 --> 00:15:31,710
+اعتقد ان ال بال سولت عرفت ليش اللى بنضيفه؟ بنضيفه
+
+199
+00:15:31,710 --> 00:15:36,870
+عشان نقتل في مين؟الجرام positive بكتيريا وإذا
+
+200
+00:15:36,870 --> 00:15:39,490
+زودنا التركيز تبقى هو عشان نقتل بعض الجرام
+
+201
+00:15:39,490 --> 00:15:41,290
+negative بكتيريا مش كل جرام negative يعني
+
+202
+00:15:41,290 --> 00:15:43,850
+السلمونية اللي بتحب ال bile فاكريني مين بجتعيش؟ في
+
+203
+00:15:43,850 --> 00:15:46,570
+ال bile في ال gallbladder مظبوط ولا لما عملت ..
+
+204
+00:15:46,570 --> 00:15:49,830
+لما عملت career .. stage .. state and ال .. ال ..
+
+205
+00:15:49,830 --> 00:15:56,490
+and بعض الناس طيب تبقوا ليه على ال sacrose هذا هذا
+
+206
+00:15:56,490 --> 00:16:01,400
+ال sacrose انحط في الوسطcadiferential sugar زي
+
+207
+00:16:01,400 --> 00:16:05,320
+المقنكي مكان فيه لاكتوز لاكتوز fermenter و لاكتوز
+
+208
+00:16:05,320 --> 00:16:09,260
+fermenter زي ال manitol salt agar في الستفيل
+
+209
+00:16:09,260 --> 00:16:12,100
+الكوكاس اوريس مانحط فيه manitol عشان نقدر نميز ما
+
+210
+00:16:12,100 --> 00:16:15,860
+بين manitol fermenter و non-manitol fermenter ايضا
+
+211
+00:16:15,860 --> 00:16:21,520
+هذا السكر وضع في الTCP-S cadiferential sugar ال
+
+212
+00:16:21,520 --> 00:16:28,100
+Vibrio cholera is sucrose fermenterالـ Indicator
+
+213
+00:16:28,100 --> 00:16:32,700
+اللي موجود هنا هو .. إيش اسم ال Indicator الموجود
+
+214
+00:16:32,700 --> 00:16:44,480
+في السيطرات؟ الـ Bromethymol Blue الـ
+
+215
+00:16:44,480 --> 00:16:48,140
+Bromethymol Blue بيكون لونه أخضر فاكرين السيطرات
+
+216
+00:16:48,140 --> 00:16:53,600
+إيش كده؟اللي هو ال neutral pH تمام؟ بكله هو أخضر
+
+217
+00:16:53,600 --> 00:16:57,940
+يبقى ال TCPS هتلاقوا الأوساط تبعته لونها green
+
+218
+00:16:57,940 --> 00:17:02,680
+الآن
+
+219
+00:17:02,680 --> 00:17:10,020
+لاحظوا في السيطرات ال alkaline pH اتحول لمين؟ بس
+
+220
+00:17:10,020 --> 00:17:12,860
+أنا بتكلم عن sucrose fermentation بدي يصير
+
+221
+00:17:12,860 --> 00:17:19,170
+alkaline ولا acid؟ بدي يصير acid إذا صار acidيعني
+
+222
+00:17:19,170 --> 00:17:27,050
+الـ pH انخفض يعني yellowإذا المستعمرة اللي بتخمر
+
+223
+00:17:27,050 --> 00:17:32,110
+الساكروز على الTCPS إيش هيكون لونها؟ أصفر يعني لما
+
+224
+00:17:32,110 --> 00:17:36,070
+أنا أقولكوا إن ال vibrocholera بتخمر الساكروز
+
+225
+00:17:36,070 --> 00:17:39,610
+بتتوقع إن إيش هيكون شكلها على الTCPS أصفر طبعا
+
+226
+00:17:39,610 --> 00:17:43,250
+يبقى لما أنا أقولكوا what is a suspect colony أو
+
+227
+00:17:43,250 --> 00:17:47,010
+what is a typical colony of vibrocholera on TCPS
+
+228
+00:17:47,010 --> 00:17:49,490
+هتقوللي إيش انت؟ yellow colonies مش بس yellow
+
+229
+00:17:49,490 --> 00:17:53,050
+colonies surrounded by a yellow zone as a result
+
+230
+00:17:53,050 --> 00:17:58,650
+of sucrose fermentationيعني مستعمرة سفراء محاطة
+
+231
+00:17:58,650 --> 00:18:04,750
+بمنطقة سفراء كنتيجة لتخمير من الساكروس خلصنا منها
+
+232
+00:18:04,750 --> 00:18:09,330
+الجثة هى طيب
+
+233
+00:18:09,330 --> 00:18:13,110
+نرجع
+
+234
+00:18:13,110 --> 00:18:21,670
+لعينة الستول عملنا على الجهة دى وعلى
+
+235
+00:18:21,670 --> 00:18:22,290
+الجهة دى
+
+236
+00:18:26,440 --> 00:18:31,020
+بعد انرشمت مايكون هنا Selected
+
+237
+00:18:31,020 --> 00:18:35,180
+وعلى أي من ال selective الأولانية او السلكتف
+
+238
+00:18:35,180 --> 00:18:41,260
+التانية ايه يكون هنا Suspect كونرسي بس خلينا نعمل
+
+239
+00:18:41,260 --> 00:18:46,020
+تبديل للمسميات العامة لمسميات خاصة ال enrichment
+
+240
+00:18:46,020 --> 00:18:54,000
+هنا يكون alkaline, peptone, water صح هنا TCBS
+
+241
+00:18:54,000 --> 00:19:01,000
+هنابرضه تي سي بي اس الان ال suspect colony وصلنا
+
+242
+00:19:01,000 --> 00:19:04,220
+متفقين عليها وحفظناها yellow colonies surrounded
+
+243
+00:19:04,220 --> 00:19:07,040
+by a yellow zone as a result of sucrose
+
+244
+00:19:07,040 --> 00:19:15,440
+fermentation هنا السؤال what is next ما
+
+245
+00:19:15,440 --> 00:19:21,530
+الذي يجب علينا فعله ما هي الصفاتخدوا بالكوا بتكلم
+
+246
+00:19:21,530 --> 00:19:25,830
+كمان مرة على فترة قصيرة من ال diagnosis إذا طولنا
+
+247
+00:19:25,830 --> 00:19:29,610
+في ال diagnosis الشباب معنا الحكي احنا أعطينا فرصة
+
+248
+00:19:29,610 --> 00:19:33,050
+أكبر للميكروب بالانتشار بدنا نحاول نحاصر
+
+249
+00:19:33,050 --> 00:19:38,370
+الميكروبات اللي بتنتشر بشكل مفاجئ وسريع ولها خطورة
+
+250
+00:19:38,370 --> 00:19:43,290
+عالية إذا بدنا نبحث عن الفحوصات ذات الزمن القصير
+
+251
+00:19:43,290 --> 00:19:47,350
+ذات الزمن القصير من هذه الفحوصات على سبيل المثال
+
+252
+00:19:55,250 --> 00:20:02,170
+oxidase test لازم تكون عاشرطب لو طلعت معانا yellow
+
+253
+00:20:02,170 --> 00:20:06,210
+colonies ف around by a zone of .. color .. برضه
+
+254
+00:20:06,210 --> 00:20:10,070
+yellow .. yellowish zone و طلعت oxidized negative
+
+255
+00:20:10,070 --> 00:20:14,150
+يبجي البكتيريا مش fiber يبجي هذا الفحص مش بيعملي
+
+256
+00:20:14,150 --> 00:20:18,810
+مش بيأكدليه بس كمان بيستثنيلي والاستثناء عملية
+
+257
+00:20:18,810 --> 00:20:21,690
+مهمة جدا في ال .. في ال .. في ال diagnosis بقولنا
+
+258
+00:20:21,690 --> 00:20:25,310
+بدل ما انا اشتغل ABI او اعمل serology لكل
+
+259
+00:20:25,310 --> 00:20:29,490
+المستعمرات الصفر لأ بعملها هيoxidized test اللي
+
+260
+00:20:29,490 --> 00:20:33,530
+بتطلع positive بستمر معاها اللي بتطلع negative حطه
+
+261
+00:20:33,530 --> 00:20:37,990
+على جانب خلصنا منها مش بكتيريا من اللي بدناها في
+
+262
+00:20:37,990 --> 00:20:42,090
+كمان فحص شباب تعرفوه انتوا او عرفتوا في سياق
+
+263
+00:20:42,090 --> 00:20:49,850
+محاضراتنا لما اتكلمنا عن string test كيو
+
+264
+00:20:49,850 --> 00:20:54,710
+اتش هي كيو اتش test برضه من احد الفحوصات المهمة
+
+265
+00:20:54,710 --> 00:20:59,390
+جدا لل Vibrioلازم تطلع معانا ال string test ايه؟
+
+266
+00:20:59,390 --> 00:21:04,810
+بسطى يبقى في عندي فعصين اوكسدايز والتاني اللي قلنا
+
+267
+00:21:04,810 --> 00:21:08,650
+عنه اللي هو ال string test في كمان فعص تالت انا
+
+268
+00:21:08,650 --> 00:21:16,840
+ممكن اعمله اللي هو polyvalent agglutination نعملكن
+
+269
+00:21:16,840 --> 00:21:19,880
+لحظة وين .. وين .. وين حاطيته انا؟ اخر واحد .. اول
+
+270
+00:21:19,880 --> 00:21:23,000
+واحد oxidase إذا طلعت negative استثنت من هناك، إذا
+
+271
+00:21:23,000 --> 00:21:25,380
+طلعت oxidase positive و strength negative
+
+272
+00:21:25,380 --> 00:21:29,160
+استثنتها، يعني لازم تطلع هذه و هذه و بعدين عملها
+
+273
+00:21:29,160 --> 00:21:31,660
+مين؟ اللي هو ال .. ال .. ال polyvalent
+
+274
+00:21:31,660 --> 00:21:35,000
+agglutination هاي تلت فحوصات أنا هيك بكون عملت ..
+
+275
+00:21:35,000 --> 00:21:39,060
+طلعت كلهم طلتها positive بعمل initial report
+
+276
+00:21:41,700 --> 00:21:44,480
+مش مولت انا .. انا مقولتش انه بعملهم مع بعض، انا
+
+277
+00:21:44,480 --> 00:21:50,280
+قولت بعملهم sequential، بعمل أكسداز، خلاص negative
+
+278
+00:21:51,340 --> 00:21:55,200
+الفحص negative لأنه لازم تكون .. لازم تكون التلت
+
+279
+00:21:55,200 --> 00:21:58,120
+.. التلت صفات لازم تكون التلت صفات لذلك انا قولتلك
+
+280
+00:21:58,120 --> 00:22:02,060
+اللي من الأول اللي لم تمتلك ال oxidase استثنينها
+
+281
+00:22:02,060 --> 00:22:04,860
+اللي امتلكت ال oxidase و negative لل .. لل string
+
+282
+00:22:04,860 --> 00:22:07,960
+test برضه استثنينها اللي امتلكت التنين و negative
+
+283
+00:22:07,960 --> 00:22:11,960
+ل .. ل .. الأخيرة برضه بنستثنينه لكن احنا عجلنا
+
+284
+00:22:11,960 --> 00:22:15,080
+التالت للآخر لإنه هي the most expensive .. the
+
+285
+00:22:15,080 --> 00:22:16,120
+most expensive
+
+286
+00:22:25,100 --> 00:22:28,600
+نطلع على الان على اللوحة و نحاول نراجع مع بعض
+
+287
+00:22:28,600 --> 00:22:32,200
+الفحاصات نقول ان الالكالاين ببتون واتر هو ال
+
+288
+00:22:32,200 --> 00:22:35,500
+enrichment و ال pH تبقى من حوالى تمانية وست من
+
+289
+00:22:35,500 --> 00:22:39,260
+عشرة يعني جريب التسعة rapid isolation from face
+
+290
+00:22:39,260 --> 00:22:41,880
+بساعدنا في عزل سريع من البرازا كلامكم الله
+
+291
+00:22:41,880 --> 00:22:45,220
+selective medium tcps اكسيدايز بوستف gram negative
+
+292
+00:22:45,220 --> 00:22:51,020
+curved rad هذا نقطة مهمة انتوا بتعرفوا ان
+
+293
+00:22:51,020 --> 00:22:53,140
+السفرانين هو ال counter stain في ال gram stain
+
+294
+00:22:53,140 --> 00:22:58,960
+تمام؟خدوها قاعدة لما الميكروب يكون curved او
+
+295
+00:22:58,960 --> 00:23:03,260
+spiral و بدنا نعمله staining، بلاش نستخدم
+
+296
+00:23:03,260 --> 00:23:07,780
+الصفرانين، نستخدم مين؟ ال carbolfoxin، ال carbol
+
+297
+00:23:07,780 --> 00:23:13,570
+اللي هو وعنه هناالكاربولفوكسين استخدمنا اين
+
+298
+00:23:13,570 --> 00:23:17,650
+كاربولفوكسين استخدمنا؟ استخدمنا ك primary stain صح
+
+299
+00:23:17,650 --> 00:23:22,310
+ولا لا؟ احنا بنستخدم مبادرة السفرانين ك counter
+
+300
+00:23:22,310 --> 00:23:26,730
+stain فقط في حالات مين؟ لما تكون البكتيريا كمان
+
+301
+00:23:26,730 --> 00:23:33,000
+مرةcurved أو spiral microorganism ليش؟ بقول إن هذه
+
+302
+00:23:33,000 --> 00:23:38,220
+البكتيريا ال affinity تبعتها للصفرانين
+
+303
+00:23:38,220 --> 00:23:44,680
+منخفضة وبالتالي أنت محتاج صبغة أخرى ك counter
+
+304
+00:23:44,680 --> 00:23:48,680
+stain عشان تعمل ال contrast اللي هو اللي ما بين
+
+305
+00:23:48,680 --> 00:23:52,060
+أنت فاكرين اللي لونان ال violet اللي هو ال gram
+
+306
+00:23:52,060 --> 00:23:55,900
+positive والأحمر أو ال pink اللي هو ال gram
+
+307
+00:23:55,900 --> 00:23:56,440
+negative
+
+308
+00:24:01,430 --> 00:24:04,190
+أحنا مش عايزين نجران ال stain احنا .. احنا مش
+
+309
+00:24:04,190 --> 00:24:06,430
+قولنا يا شباب .. شباب احنا قولنالكوا في الأول ..
+
+310
+00:24:06,430 --> 00:24:09,290
+أول خطوة في ال diagnosis culture، لو تانية هي
+
+311
+00:24:09,290 --> 00:24:13,790
+morphology and staining، staining أنا عامل ال ..
+
+312
+00:24:13,790 --> 00:24:17,970
+ال curve drug، و هتقوللي ان .. انه أنا قفزت من
+
+313
+00:24:17,970 --> 00:24:22,470
+المرحلة الأولى لمرحلة الرابعة، مظبوط؟ مظبوط؟ لكن
+
+314
+00:24:22,470 --> 00:24:23,770
+أنا مش قفزت أساسا
+
+315
+00:24:26,810 --> 00:24:32,330
+وبتالي عندي شعور ان هذا البكتيريا هي Vibrio
+
+316
+00:24:32,330 --> 00:24:38,410
+cholera كيف؟
+
+317
+00:24:38,570 --> 00:24:41,550
+هو مافهمتكش بقى لإنك تظهر إن أنا بقعد أستيانج مش
+
+318
+00:24:41,550 --> 00:24:44,010
+هي أول مرحلة تقول أستيانج يعني .. لأ لأ هو بيسأل
+
+319
+00:24:44,010 --> 00:24:48,130
+سؤال مختلف عن سؤالك هو بقول أنا إيش بدي عرفني إن
+
+320
+00:24:48,130 --> 00:24:52,270
+البكتيريا أصلا spiral أو curved عشان أختارلها ال
+
+321
+00:24:52,270 --> 00:24:56,470
+carbofoxin احنا بنقول إن if suspected أنت بتعمل
+
+322
+00:24:56,470 --> 00:24:59,850
+هذا الكلام يعني بمعنى أخر لو كانت البكتيريا بصلية
+
+323
+00:24:59,850 --> 00:25:03,070
+عادية و حاطات صفرانين بيبشي الحالعفوا، نعم بيمشي
+
+324
+00:25:03,070 --> 00:25:07,370
+الحال و لو حطيت Carbolfoxin برضه بيمشي الحال فلما
+
+325
+00:25:07,370 --> 00:25:11,570
+أنت يكون عندك suspicion شك بإن البكتيريا curved أو
+
+326
+00:25:11,570 --> 00:25:16,790
+spiral استخدم Carbofoxin بيمشي لمين؟ بيمشي
+
+327
+00:25:16,790 --> 00:25:20,850
+للبكتيريا العادية و ده البكتيريا اللي هي curved،
+
+328
+00:25:20,850 --> 00:25:27,890
+هاي الفكرة من النقاش أول مرة بتكلم عن Fecal Swap
+
+329
+00:25:29,350 --> 00:25:33,070
+فيك ال swap في حال عدم توفر ال stool هل ال stool
+
+330
+00:25:33,070 --> 00:25:39,330
+ممكن متوفرش عند المريض نعم بعد فترةليست بالطويلة
+
+331
+00:25:39,330 --> 00:25:44,290
+من ال frequency العالي في الديارية لما المريض يبقى
+
+332
+00:25:44,290 --> 00:25:46,690
+.. يقولنا في احد ال .. ال .. ال .. في الشجرة ال
+
+333
+00:25:46,690 --> 00:25:50,730
+dysentery اذا فاكرين انه ال .. ال stool loses its
+
+334
+00:25:50,730 --> 00:25:54,650
+fecal characteristics وبالتالي مافيش يخرج الا ..
+
+335
+00:25:54,650 --> 00:26:00,010
+الا عبر او خلينا نقول من مادة واحدة اللي هي ال ..
+
+336
+00:26:00,010 --> 00:26:03,090
+ال .. ال mucus و بعض الأحيان ال blood
+
+337
+00:26:06,170 --> 00:26:10,550
+نعم دزنتري فبالتالي إذا في هذه الحالة المريض مش
+
+338
+00:26:10,550 --> 00:26:15,430
+قادر يجيب عينة stool فممكن يصطاد عنها ال vehicle
+
+339
+00:26:15,430 --> 00:26:20,190
+swap لكن إذا في stool فهو العينة المثلى ما هو
+
+340
+00:26:20,190 --> 00:26:23,580
+العينة المثلىقولنا ال enrichment alkaline ببتون
+
+341
+00:26:23,580 --> 00:26:26,120
+water selected TCBS وذكرنا اسمه اللي هو
+
+342
+00:26:26,120 --> 00:26:28,760
+thiosulfate citrate bile salt saccharose agar
+
+343
+00:26:28,760 --> 00:26:33,500
+والهنا الحلو أنه مابنعملش enrichment ل 24 ساعة
+
+344
+00:26:33,500 --> 00:26:37,120
+مابنعمل enrichment فقط لجداش ل 4 ل 6 ساعات و بعدين
+
+345
+00:26:37,120 --> 00:26:41,340
+مابنعمل sub culture على اللي هو ال TCBS مرة أخرى
+
+346
+00:26:43,490 --> 00:26:47,110
+كمان مرة اشهر الشكل المستعمرات yellow colonies are
+
+347
+00:26:47,110 --> 00:26:50,870
+produced وارفنا من وين مصدر اللون تبع ال
+
+348
+00:26:50,870 --> 00:26:53,970
+Saccharose fermentation الدجالة اللى رسمناها على
+
+349
+00:26:53,970 --> 00:26:58,070
+الصبورة قبل شوية stool orfical swab على الجهة اللى
+
+350
+00:26:58,070 --> 00:27:01,190
+.. اللى .. اللى هناك ال selective medias TCBS على
+
+351
+00:27:01,190 --> 00:27:04,770
+الجهة دى enrichment عملنا subculture قولنا بعد
+
+352
+00:27:04,770 --> 00:27:08,210
+اربعة لست ساعة لسبعة درجة معوية وبعد ده اللى شفنا
+
+353
+00:27:08,210 --> 00:27:11,330
+ال typical colonies وعملنا لها the following tests
+
+354
+00:27:12,940 --> 00:27:16,040
+فين دي؟ هاد القايمة الطويلة مش القايمة القصيرة
+
+355
+00:27:16,040 --> 00:27:19,360
+اللي احنا عملنا احنا عملنا قايمة قصيرة تلت فحوصات
+
+356
+00:27:19,360 --> 00:27:25,080
+اكسيدايز
+
+357
+00:27:25,080 --> 00:27:32,920
+تست كيتاليز تست اسكولين تست motility test طبعا
+
+358
+00:27:32,920 --> 00:27:36,040
+احنا ممكن نضيف ال motility على القايمة كمان شباب
+
+359
+00:27:36,040 --> 00:27:40,280
+ال motility فحص كويس اه بصيروا أربعو انا ال .. ال
+
+360
+00:27:40,280 --> 00:27:42,780
+.. الاربع فحوصات اللي بحكيلكوا عنهم هم الاربع اللي
+
+361
+00:27:42,780 --> 00:27:46,940
+اختارناهم لما كان في وابا عنا لأذكر في سنة ال سبعة
+
+362
+00:27:46,940 --> 00:27:52,360
+وتسعين ستة وتسعين في غزة للكلرة و صار في نوع من ال
+
+363
+00:27:52,360 --> 00:27:57,040
+.. ال ..الاجتماع بين الجامعة وبين وزارة الصحة وبين
+
+364
+00:27:57,040 --> 00:28:01,040
+وكالة الغوث للمختبرات وجعدنا جلسنا مع بعض وحددنا
+
+365
+00:28:01,040 --> 00:28:05,100
+الطريقة الأقصر والطريقة الأطول لل identification
+
+366
+00:28:05,100 --> 00:28:08,140
+بينا على ما هو متوفر في المختبرات الثلاثة مختبرات
+
+367
+00:28:08,140 --> 00:28:11,340
+الجامعات ومختبرات الصحة ومختبرات اللي هو وكالة
+
+368
+00:28:11,340 --> 00:28:14,240
+الغوثو انا اذكر انه احنا وضعنا الأربع فحوصات اللي
+
+369
+00:28:14,240 --> 00:28:16,720
+حكيتلكوا عنها هم اللي هم ال .. ال .. ال gram stain
+
+370
+00:28:16,720 --> 00:28:20,380
+و ال .. ال .. هذا ك .. ك .. ك مرحلة ال oxidase و
+
+371
+00:28:20,380 --> 00:28:24,480
+ال .. ال strain test و ال .. ال motility و ال ..
+
+372
+00:28:24,480 --> 00:28:27,140
+ال polyvalent agglutination antisera هنا ال .. هنا
+
+373
+00:28:27,140 --> 00:28:30,020
+.. هنا مهم جدا الفحص اللي اندوهال بوستف طبعا ال
+
+374
+00:28:30,020 --> 00:28:32,980
+vogas plus cover اما بوستف او negative وهذه كتير
+
+375
+00:28:32,980 --> 00:28:38,260
+معلومة مهمةهنستخدمها لاحقا فى التمييز بين صنفين من
+
+376
+00:28:38,260 --> 00:28:41,760
+ال Vibrio Kohlerite واحدة بتكون Indole Vagas Plus
+
+377
+00:28:41,760 --> 00:28:45,600
+Kauer بوسطف واحدة Vagas Plus Kauer نيجاتيف ساكروتس
+
+378
+00:28:45,600 --> 00:28:49,420
+فيرمنتشن هى متفقين عليها انها بوسطف لانها بنشوفها
+
+379
+00:28:49,420 --> 00:28:55,340
+من الوسط Lactose نيجاتف منتول بوسطف هذا الشكل اللى
+
+380
+00:28:55,340 --> 00:29:00,140
+قدامكوا مش عارف امكن من الكمبيوتر اوضح من اللوحة
+
+381
+00:29:00,140 --> 00:29:04,600
+اللى واضح عندكم اللوحة برضه انه الوسط أخضر تمام
+
+382
+00:29:05,820 --> 00:29:09,780
+أمام؟ و المنطقة اللي نامي فيها البكتيريا اتحولت
+
+383
+00:29:09,780 --> 00:29:13,160
+إلى اللون الأصفر لكن انا ب .. بعتقد انه لو شفتوها
+
+384
+00:29:13,160 --> 00:29:17,080
+من ال slides هتكون الصورة أوضح يعني لإن الوطبق كله
+
+385
+00:29:17,080 --> 00:29:21,760
+أخضر بالفعل و المستعمرات هي فقط اللي محاطة بمناطق
+
+386
+00:29:21,760 --> 00:29:22,240
+صفراء
+
+387
+00:29:26,930 --> 00:29:29,090
+فاكرين لما قولنا tentative diagnosis احنا مرة
+
+388
+00:29:29,090 --> 00:29:33,350
+tentative diagnosis اللي هو مؤقت اللي هو مصطلح
+
+389
+00:29:33,350 --> 00:29:36,910
+تاني بنسمي presumative diagnosis يعني tentative او
+
+390
+00:29:36,910 --> 00:29:40,630
+presumative تقريبا بنفس المعنى هنا ال presumative
+
+391
+00:29:40,630 --> 00:29:42,990
+diagnosis الكلام اللي حكيتلكوا عليه على السبورة او
+
+392
+00:29:42,990 --> 00:29:48,170
+الاختيار الاقصر هو اللي انا بتكلم عنههذا الفحص
+
+393
+00:29:48,170 --> 00:29:53,010
+string test اعتقد انه واضح جدا هي المستعمرة ذابت
+
+394
+00:29:53,010 --> 00:29:55,930
+حاول ان اخرج هي ال loop لاحظوا الخيط اللي تكوّن
+
+395
+00:29:55,930 --> 00:30:01,790
+تكوّن تكوّن الخيط الميكويدي هذا ناتج عن ايش قلنا
+
+396
+00:30:01,790 --> 00:30:05,640
+انه البكتيريا لأ مش الكابسول قلناقلنا إن البكتيريا
+
+397
+00:30:05,640 --> 00:30:09,660
+إذا ذهبت في ال KOH، موضوع ال DNA، ال DNA very
+
+398
+00:30:09,660 --> 00:30:13,200
+ميوكايد، ففي بعض البكتيريا ال DNA تبعها very very
+
+399
+00:30:13,200 --> 00:30:18,400
+ميوكايد و large amount of DNA بتكون present و هو
+
+400
+00:30:18,400 --> 00:30:20,240
+بتالي بيعطينا لميوكايدي appearance
+
+401
+00:30:23,870 --> 00:30:27,290
+أول مرة نتكلم عن Biotypes كنا نتكلم عن Serotypes
+
+402
+00:30:27,290 --> 00:30:30,410
+ومتكلم عن Phagotype ومتكلم عن Biocentyping
+
+403
+00:30:30,410 --> 00:30:32,310
+المحاضرة اللى فاترة اللى متكلمنا عن صدوموناس
+
+404
+00:30:32,310 --> 00:30:35,190
+ايرجنوز اقولنا بيو سين تايبن المرة اللى متكلم عنها
+
+405
+00:30:35,190 --> 00:30:42,490
+اسمها بيو تايبن بيو تعني ان انا بفرج الميكروبات مش
+
+406
+00:30:42,490 --> 00:30:46,270
+بناء على الانتجنات وانا بفرجها بناء على مين على
+
+407
+00:30:46,270 --> 00:30:50,990
+بعض الصفات البيو كيميائية زي ايش صفات بيو كيميائية
+
+408
+00:30:50,990 --> 00:30:56,910
+طلعوا هنافي عندي vogus bruscavar و احنا مش قولنا
+
+409
+00:30:56,910 --> 00:30:59,970
+قبل شويه واحدة بوسط واحدة negative في بكتيريا
+
+410
+00:30:59,970 --> 00:31:04,510
+اسمها eltar و واحدة اسمها classical هدولة التنتين
+
+411
+00:31:04,510 --> 00:31:08,470
+ال biotype يبجعك ان biotype يعني اتنين ارسمهم كمان
+
+412
+00:31:08,470 --> 00:31:14,050
+مرة eltar و classicalكلمة classical دايما بنطلقها
+
+413
+00:31:14,050 --> 00:31:18,730
+على ال old القديم على القديم فهذه هي الكلاسيكية
+
+414
+00:31:18,730 --> 00:31:23,090
+المعروفة اللي كانت زمان نعرفها وهذه يبدو أنها تفرق
+
+415
+00:31:23,090 --> 00:31:28,350
+منها طبعا سهل كتير الفرقات بينهم واحدة تمتلك الصفة
+
+416
+00:31:28,350 --> 00:31:31,710
+المجموعة اللي هي الالتور تمتلك جميع الصفات
+
+417
+00:31:31,710 --> 00:31:35,150
+والتانية لا تمتلك أي من الصفات positive positive
+
+418
+00:31:35,150 --> 00:31:38,330
+resistant negative negative sensitive بس خلنا نطلع
+
+419
+00:31:38,330 --> 00:31:42,140
+الصفات نعرف الصفاتعندي الرقم التلاتة اللي هي
+
+420
+00:31:42,140 --> 00:31:46,320
+sensitivity to polymyxin B ال polymyxin B هو عبارة
+
+421
+00:31:46,320 --> 00:31:50,080
+عن antibiotic هذا ال antibiotic أصلا toxic و لا
+
+422
+00:31:50,080 --> 00:31:51,920
+يستخدم إلا ال topical يعني لا يستخدم لعلاج
+
+423
+00:31:51,920 --> 00:31:55,200
+الفيبلوكولير أساسا فهنا مستخدمينه احنا ك
+
+424
+00:31:55,200 --> 00:31:58,540
+diagnostic test انشوف مين sensitive و مين
+
+425
+00:31:58,540 --> 00:32:02,740
+resistant ليس بغرض العلاج و انه بغرض التفريق بين
+
+426
+00:32:02,740 --> 00:32:05,940
+الميكروبات فبتكون الالتور resistant بينما ال
+
+427
+00:32:05,940 --> 00:32:09,830
+classical sensitiveheme agglutination test ايش
+
+428
+00:32:09,830 --> 00:32:13,590
+يعني heme agglutination test مقدرة البكتيريا على
+
+429
+00:32:13,590 --> 00:32:17,490
+مش تحليل تخثير كورادة يعني لو حطينا معاها chicken
+
+430
+00:32:17,490 --> 00:32:20,050
+red blood cells يعني ال chicken red blood cell
+
+431
+00:32:20,050 --> 00:32:23,070
+اللي هي الكورادة ده من الحمراء المأخوذة من الدجاج
+
+432
+00:32:23,070 --> 00:32:27,510
+حطينا خلطناها بالبكتيريا باللاج البكتيريا بتجمعها
+
+433
+00:32:27,510 --> 00:32:30,110
+مع بعض بتعملها agglutination ده بيسموها heme
+
+434
+00:32:30,110 --> 00:32:32,450
+agglutination لإنها بتعمل agglutination لل red
+
+435
+00:32:32,450 --> 00:32:36,070
+blood cellبسطف هنا و نيجاتف هنا بالنسبالى ال بوجرس
+
+436
+00:32:36,070 --> 00:32:40,470
+بلوسكوار قلنا في عندي اللى هو الالتور بسطف بينما
+
+437
+00:32:40,470 --> 00:32:46,210
+ال classical بتكون نيجاتف اذا ال bio types من فان
+
+438
+00:32:46,210 --> 00:32:50,350
+classical and التور التنميذ بينهم يتم عن طريق تلت
+
+439
+00:32:50,350 --> 00:32:54,010
+خصائص مش هم عن طريق تلت خصائص واحد بوجرس بلوسكوار
+
+440
+00:32:54,010 --> 00:33:00,810
+اتنين هى من أجل التلاتة بوليمكسين sensitivity كلمة
+
+441
+00:33:00,810 --> 00:33:07,680
+bio typeVar مأخوذة من variety، variety نوع وtype
+
+442
+00:33:07,680 --> 00:33:10,980
+برضه نوع، صح ولا لأ؟ فبعض الأحيان بيطلقوا عليها
+
+443
+00:33:10,980 --> 00:33:14,420
+biotype أو biovar مرات برضه في نفس الشيء في
+
+444
+00:33:14,420 --> 00:33:18,980
+السيرولوجيا، بيقولوا biovar، اه عفوا، serovar و
+
+445
+00:33:18,980 --> 00:33:22,580
+serotype، serovar و serotype
+
+446
+00:33:30,280 --> 00:33:34,660
+طيب جينا الأصعب في عندنا تلات أصناف سيريولوجية
+
+447
+00:33:34,660 --> 00:33:38,420
+وحنعطيكوا كل واحد شكل اللي بيحكيهم من أول مرة
+
+448
+00:33:38,420 --> 00:33:42,660
+للأسماء الغريبة اللي موجودة علاقة عادي شو اسمها
+
+449
+00:33:42,660 --> 00:33:53,540
+جمعة؟ جمعة صحيح أنا نسيت جيمان؟
+
+450
+00:33:53,540 --> 00:33:56,120
+طيب اللي جالي قبلها؟
+
+451
+00:33:59,160 --> 00:34:03,860
+انابا و جاوا هيكوجيما جمعها على ثلاث شكل خلاص الآن
+
+452
+00:34:03,860 --> 00:34:08,880
+ايش ال .. ايش ال .. ال .. الفرق بينهم الفرق بينهم
+
+453
+00:34:08,880 --> 00:34:13,300
+انه واحد بيصيرله agglutination .. agglutination
+
+454
+00:34:13,300 --> 00:34:17,650
+يبقى انت انابابينما بيصيرلوش agglutination بال
+
+455
+00:34:17,650 --> 00:34:22,730
+Anti-Ogawa والعكس التاني بيصيرلو agglutination بال
+
+456
+00:34:22,730 --> 00:34:26,550
+Anti-Ogawa بيصيرلو .. بيصيرلو .. بيصيرلوش عفوا بال
+
+457
+00:34:26,550 --> 00:34:30,550
+Anti-Inaba لكن النوع التالت فاجأنا بأنه بعمل
+
+458
+00:34:30,550 --> 00:34:34,050
+agglutination لمين؟ للتانين وبالتالي هذا بيعتقد
+
+459
+00:34:34,050 --> 00:34:38,700
+أنهvariety that has acquired both antigens اللي هم
+
+460
+00:34:38,700 --> 00:34:42,900
+الانابا والأجاوة وسميه بهيكوجيما هدول بيسموهم
+
+461
+00:34:42,900 --> 00:34:48,260
+serovars او serotypes اذا فين دي subtypes انابا
+
+462
+00:34:48,260 --> 00:34:52,660
+أجاوة هيكوجيماطبعا ال Vibrio اللي بتعرفوا انها
+
+463
+00:34:52,660 --> 00:34:57,780
+كونها بكتيريا motile يبقى في عندها كمان H انتجن
+
+464
+00:34:57,780 --> 00:35:01,520
+تمام فبتاعي ممكن نعمل عملية identification لل
+
+465
+00:35:01,520 --> 00:35:06,560
+Vibrio عبر ال O وعبر ال H انتجن لكن احنا غالبا في
+
+466
+00:35:06,560 --> 00:35:09,940
+مختبراتنا المتواضعة بنعمل stacking لمين لل
+
+467
+00:35:09,940 --> 00:35:10,820
+polyvalent
+
+468
+00:35:14,500 --> 00:35:20,540
+O-antigen و لا polyvalent O-antigen اعفوا H
+
+469
+00:35:20,540 --> 00:35:25,400
+-antigen طبعا احنا مش بنكون مخزنين ال antigen
+
+470
+00:35:25,400 --> 00:35:31,500
+مخزنين ال antibody فبنسميها polyvalent O مش
+
+471
+00:35:31,500 --> 00:35:36,420
+antibodies كمان بنسميها antiserum لكن كلمة
+
+472
+00:35:36,420 --> 00:35:39,120
+antiserum مش معناها antibodies هى المقصود فيها
+
+473
+00:35:39,120 --> 00:35:40,340
+antiserum معناها antibodies
+
+474
+00:35:44,360 --> 00:35:46,680
+نكشف على الانتجين، إيش الانتجين في هذا الحالة
+
+475
+00:35:46,680 --> 00:35:49,340
+هيكون؟ البكتيريا نفسها، يعني لما بنزل البكتيريا
+
+476
+00:35:49,340 --> 00:35:51,780
+اللي هي suspected، بنعملها agglutination
+
+477
+00:35:51,780 --> 00:35:57,740
+بالبوليفات نيجي لجزء الأخير من ال Vibrio اللي هو
+
+478
+00:35:57,740 --> 00:36:01,600
+المتعلق بال treatment and antibiotic sensitivity
+
+479
+00:36:01,600 --> 00:36:05,080
+أعتقد أنه لا داعي للتكرار، ولا في داعي للتكرار، في
+
+480
+00:36:05,080 --> 00:36:10,340
+داعي للتكرار، بعلم الشطارأي ديارية .. أي ديارية
+
+481
+00:36:10,340 --> 00:36:15,560
+اتفقنا على أنه الحل العلاجي إليها water
+
+482
+00:36:15,560 --> 00:36:18,800
+replacement، electrolyte replacement وتالت حاجة
+
+483
+00:36:18,800 --> 00:36:23,000
+اللي هي eradication of the causative agent فده
+
+484
+00:36:23,000 --> 00:36:26,220
+الحالة ال .. ال .. ال causative agent هو ال Vibrio
+
+485
+00:36:26,220 --> 00:36:31,370
+كلهافيش يعني خلاف على انه لازم نرجع السوائل، لازم
+
+486
+00:36:31,370 --> 00:36:35,410
+نرجع ال electrolyte و لازم نقضي على مين؟ على ال
+
+487
+00:36:35,410 --> 00:36:40,250
+vibrio كده، نهي طبعا ال vibrio كده زيها زي أي
+
+488
+00:36:40,250 --> 00:36:43,130
+بكتيرة تانية يا شباب، يعني عندها المقدرة عليها
+
+489
+00:36:43,130 --> 00:36:48,370
+تكون resistance وبالتالي احنا بننصح باستمرار اي
+
+490
+00:36:48,370 --> 00:36:53,420
+ميكروب في الدنياإلا إذا ذكرنا عكس ذلك، إنه نعمله
+
+491
+00:36:53,420 --> 00:36:55,640
+antimicrobial sensitivity، لازم نعمله
+
+492
+00:36:55,640 --> 00:36:59,400
+antimicrobial sensitivity أو susceptibility
+
+493
+00:36:59,400 --> 00:37:02,680
+testing، بيقولنا ترتراساكلين is the drug of choice
+
+494
+00:37:02,680 --> 00:37:06,000
+كيف؟
+
+495
+00:37:07,210 --> 00:37:09,650
+لأ مثلا هو ال first choice انه في ال treatment
+
+496
+00:37:09,650 --> 00:37:13,730
+طبعا انتوا عارفين تترا ساكلين برضه كمان منفعش لكل
+
+497
+00:37:13,730 --> 00:37:17,890
+الناس يعني تترا ساكلين للأطفال ممشيش للحوامل يبقى
+
+498
+00:37:17,890 --> 00:37:21,390
+لازم يكون فيانها بدائل لكن انا اللي قبل ما اقفز عن
+
+499
+00:37:21,390 --> 00:37:25,650
+او ابحث عن البدائل بدي أنبه ان however in recent
+
+500
+00:37:25,650 --> 00:37:31,390
+years تترا ساكلين resistant vibrio variants يعني
+
+501
+00:37:31,390 --> 00:37:37,080
+أصناع فسلالات have emergedيعني بطل كلمة
+
+502
+00:37:37,080 --> 00:37:41,120
+tetracycline مطلقة ان والله اي vibrocolera علشها
+
+503
+00:37:41,120 --> 00:37:44,360
+بتتراcycline لأ حياتها هي فيه هنا vibrocolera كمان
+
+504
+00:37:44,360 --> 00:37:48,730
+resistant لتتراcyclinefor this reason اي reason
+
+505
+00:37:48,730 --> 00:37:53,170
+لظهور resistance strain sensitivity test must be
+
+506
+00:37:53,170 --> 00:37:55,750
+performed in all clinical aisles فانا كمان مرة هذه
+
+507
+00:37:55,750 --> 00:37:58,510
+الجملة بعممها سواء على ال vibrocolora او غير ال
+
+508
+00:37:58,510 --> 00:38:01,570
+vibrocolora انه sensitivity testing وانا بالمناسبة
+
+509
+00:38:01,570 --> 00:38:04,910
+حاطلكوا على ال .. على الموقع تبع ال diagnostic
+
+510
+00:38:04,910 --> 00:38:08,490
+microbiology ال CLSI شفتواها؟
+
+511
+00:38:11,380 --> 00:38:17,720
+وثيقة مهمة جدا CLSI 2011 وثيقة مهمة جدا لعمل
+
+512
+00:38:17,720 --> 00:38:21,400
+sensitivity testing موجودة وموضحوكوا على ال
+
+513
+00:38:21,400 --> 00:38:25,300
+facebook على ال diagnostic microbiology M تمام
+
+514
+00:38:25,300 --> 00:38:32,140
+اللي هي المجموعة تبعتكم في حد ماشتركش فيها M تمام
+
+515
+00:38:32,140 --> 00:38:36,570
+هذه المجموعة تبعتكمrequest addition و احنا ان شاء
+
+516
+00:38:36,570 --> 00:38:40,770
+الله بنضيفها في اقل فرصة الان ال CLSI هذه ال 2001
+
+517
+00:38:40,770 --> 00:38:44,790
+هي ال guidelines لل selection of antibiotics to be
+
+518
+00:38:44,790 --> 00:38:48,070
+used against each organism يعني بتعطيك دليل ايش ال
+
+519
+00:38:48,070 --> 00:38:50,370
+antibiotic اللي لازم تحطها على الميكروبط اللي من
+
+520
+00:38:50,370 --> 00:38:54,250
+ضمنهم ال viper و كده طبعا احنا قولنا انه في
+
+521
+00:38:54,250 --> 00:38:59,180
+مشكلتين ان ال tetracycline أساساما بتنفع لكل إشي
+
+522
+00:38:59,180 --> 00:39:03,140
+رقم اتنين البكتيريا في بعض من السلسلات صارت منها
+
+523
+00:39:03,140 --> 00:39:06,460
+المقاومة وبالتالي إيش البدائل في عندي
+
+524
+00:39:06,460 --> 00:39:11,820
+selfonamides, ambicillin, kanamycin, streptomycin
+
+525
+00:39:11,820 --> 00:39:16,520
+and trimethoprim trimethoprim اللي هو بيكون دائما
+
+526
+00:39:16,520 --> 00:39:19,040
+مرتبط بالself-amethoxazole self-amethoxazole و
+
+527
+00:39:19,040 --> 00:39:25,510
+trimethoprim prevention of choleraاعتقد انه كلمة
+
+528
+00:39:25,510 --> 00:39:29,470
+prevention لفكال oral pathogen برضه احد النقاط
+
+529
+00:39:29,470 --> 00:39:34,110
+المهمة انه ال sanitary conditions و ال public
+
+530
+00:39:34,110 --> 00:39:37,790
+health بشكل عام good sanitation and personal
+
+531
+00:39:37,790 --> 00:39:43,230
+hygiene لان في اندي immunization لكن ال
+
+532
+00:39:43,230 --> 00:39:47,560
+immunization للvibrio cholera is not life longماذا
+
+533
+00:39:47,560 --> 00:39:51,460
+يعني lifelong؟يعني بتعطيك cash حماية للأبد، لأ
+
+534
+00:39:51,460 --> 00:39:55,220
+بتعطيك short وذي لفقة من ال vaccine stimulate
+
+535
+00:39:55,220 --> 00:39:59,060
+local IGA production غالبا من بيعطيها ل .. بيعطيها
+
+536
+00:39:59,060 --> 00:40:03,100
+للناس اللي بدهم يسافروا على أماكن موبوعة بال
+
+537
+00:40:03,100 --> 00:40:06,040
+Vibrio كلها، وان في أماكن تعرفوا موبوعة في ال
+
+538
+00:40:06,040 --> 00:40:12,610
+Vibrio كلها؟لأ الهند و اكتر من الهند بانجلديش
+
+539
+00:40:12,610 --> 00:40:18,630
+بانجلديش مهم هذا نفس المحيط بانجلديش و الهند و
+
+540
+00:40:18,630 --> 00:40:21,990
+باكستان المناطق الفقيرة منهم هدول اكتر الدول اللي
+
+541
+00:40:21,990 --> 00:40:25,630
+ممكن يكون فيها vibrio كتير هذا لا يعني هذا لا يعني
+
+542
+00:40:25,630 --> 00:40:29,900
+انها مقتصرة و انا قلتلكواوإن فيه فشل في نظام الصرف
+
+543
+00:40:29,900 --> 00:40:33,960
+الصحي في أي دولة في العالم احتمالية ظهورها واردة،
+
+544
+00:40:33,960 --> 00:40:39,180
+عندنا في فلسطين ظهرت أكثر من مرة في تسعينيات القرن
+
+545
+00:40:39,180 --> 00:40:42,880
+الماضي وفي سبع .. وفي أظن سبعينيات أو ثمانيات
+
+546
+00:40:42,880 --> 00:40:46,940
+القرن الماضي، يعني احتمالية وجودها يعني واردة،
+
+547
+00:40:46,940 --> 00:40:49,680
+وبالتالي ما .. ما .. ما بنقدرش نقول إنه والله it
+
+548
+00:40:49,680 --> 00:40:52,500
+is confined to one area of the world، لأ، ممكن
+
+549
+00:40:52,500 --> 00:40:58,970
+تكون worldwideكمان شغل لو احنا صار عن نوابا و
+
+550
+00:40:58,970 --> 00:41:05,090
+الناس بتتعامل مع المرضى فدول الناس او contact
+
+551
+00:41:05,090 --> 00:41:08,710
+لمرضى contact يعني ناس تواصل مع مرضى تمام او
+
+552
+00:41:08,710 --> 00:41:12,930
+suspected انهم شربوا مياه ملوث او اكلوا مياه غذاء
+
+553
+00:41:12,930 --> 00:41:17,930
+ملوث ممكن نعطيهم كإجراء وقائي كلمة
+
+554
+00:41:17,930 --> 00:41:19,450
+chemoprophylaxis ايش يعني؟
+
+555
+00:41:22,400 --> 00:41:26,340
+يعني تناول drug كإجراء ويقعي بروفلاكسي ويقعي كيمو
+
+556
+00:41:26,340 --> 00:41:29,960
+بروفلاكسي يعني تناول drug كبروفلاكسي with تترا
+
+557
+00:41:29,960 --> 00:41:33,600
+ساكلين to close contact مش يعني close contact ال
+
+558
+00:41:33,600 --> 00:41:40,060
+family members الأبناء الأطفال الإخوة الأخواتأحد
+
+559
+00:41:40,060 --> 00:41:43,740
+أهم النقاط اللي أنا ذكرتها خلال السياق برامبت
+
+560
+00:41:43,740 --> 00:41:48,700
+برامبت يعني فوري ماتخليش واحد يمشي ككمبولة موقوتة
+
+561
+00:41:48,700 --> 00:41:51,880
+في ال .. ال .. ال .. بين السكان هو عنده vibrio
+
+562
+00:41:51,880 --> 00:41:56,920
+cholera لأنه كل ما قل وقت التشخيص تمام كل ما حصرنا
+
+563
+00:41:56,920 --> 00:42:00,080
+في العلاج كل ما قللنا الإفرازات اللي ممكن يكون
+
+564
+00:42:00,080 --> 00:42:03,480
+فيها vibrio cholera وبالتالي بمقللنا نسبة التلوث
+
+565
+00:42:03,480 --> 00:42:06,920
+وبالتالي حصرنا ال disease إذا برامبت معناها فوري
+
+566
+00:42:07,250 --> 00:42:14,150
+detection and treatment of carriers طيب
+
+567
+00:42:14,150 --> 00:42:19,310
+هذه يمكن يعني diagram طويل نختم فيه محاضرتنا اليوم
+
+568
+00:42:19,310 --> 00:42:26,510
+نتطلع
+
+569
+00:42:26,510 --> 00:42:31,850
+مع بعض على ال .. ال .. فوق هنا قلنا specimen,
+
+570
+00:42:32,430 --> 00:42:39,940
+thesis or rectal swabفي حد اسمها caribler filter
+
+571
+00:42:39,940 --> 00:42:44,240
+paper caribler عبارة عن transport media عبارة عن
+
+572
+00:42:44,240 --> 00:42:47,440
+transport media يعني احنا بناخد عينة الستول في
+
+573
+00:42:47,440 --> 00:42:56,040
+transport media بنروح على ال laboratory كلمة
+
+574
+00:42:56,040 --> 00:43:00,300
+بنروح على ال laboratory بنفعش بعد ساعة بعد ساعتين
+
+575
+00:43:00,300 --> 00:43:08,890
+بعد تلاتةpromptly خدوا بالك اكتير من المستشفيات
+
+576
+00:43:08,890 --> 00:43:15,550
+لها sampling policies بتحدد فيها الزمن ما بين جمع
+
+577
+00:43:15,550 --> 00:43:21,470
+العينة و ما بين وصولها لمين للمختبر وكنموذج على
+
+578
+00:43:21,470 --> 00:43:26,450
+ذلك ال urine samples ال urine samples معروفة عنها
+
+579
+00:43:26,450 --> 00:43:32,470
+ان one hour في بعض المختبرات بتسمح بساعتينلكن في
+
+580
+00:43:32,470 --> 00:43:36,030
+النهاية في زمن محدد ما بين جمة العينة وما بين
+
+581
+00:43:36,030 --> 00:43:40,710
+وصولها للمختبر لماذا هذا الزمن المحدد؟ حفاظنا على
+
+582
+00:43:40,710 --> 00:43:45,290
+ال viability of the organism اللي موجود في العينة
+
+583
+00:43:45,290 --> 00:43:48,250
+اللي بندورها عليه عملنا enrichment على ال climb
+
+584
+00:43:48,250 --> 00:43:53,810
+ببتون ووتر وزرعان عالمين هنا على ال TCBSمن هنا
+
+585
+00:43:53,810 --> 00:43:56,830
+احنا كنا بتكلم عن اربع لتس ساعات انا كاتب خمس ل
+
+586
+00:43:56,830 --> 00:43:59,910
+تمان ساعات على خمس و تلاتين درجة مقوية و احنا كنا
+
+587
+00:43:59,910 --> 00:44:02,730
+جاجلين على جداش على سبعة و تلاتين درجة مقوية خدنا
+
+588
+00:44:02,730 --> 00:44:08,310
+نتكلم عن الجزئي هذا شوية مهم كتير هي خمس و تلاتين
+
+589
+00:44:08,310 --> 00:44:13,290
+ولا سبعة و تلاتين؟ طب ليش هنقول عن خمس و تلاتين؟ و
+
+590
+00:44:13,290 --> 00:44:16,190
+ليش هتلاجوها في الكتب كتير كمان خمس و تلاتين؟ لإن
+
+591
+00:44:16,190 --> 00:44:22,630
+في خلافهل ال temperature الأمثل 35 ولا 37؟ ما
+
+592
+00:44:22,630 --> 00:44:26,410
+أنتوا عارفين أجزاء من جسمنا ممكن تكون 37 و ال
+
+593
+00:44:26,410 --> 00:44:31,650
+external ممكن تكون أقل من ذلك، تمام؟ لكن القضية
+
+594
+00:44:31,650 --> 00:44:37,330
+برضه كمان مش هيك، في بعض الميكروبات حساسة ل one
+
+595
+00:44:37,330 --> 00:44:41,470
+temperature يعني انا 37 ممكن ماتنموش، لكن انا حاسس
+
+596
+00:44:41,470 --> 00:44:47,380
+30 ممكن تنموفراحوا ال .. ال .. ال .. البعض ذهب الى
+
+597
+00:44:47,380 --> 00:44:50,680
+انه البكتيريا كلها بتشترك بانها ممكن تنمو على خمس
+
+598
+00:44:50,680 --> 00:44:54,860
+تلاتين لكن مش كلها بتنمو على ..فانا احنا نام سبعة
+
+599
+00:44:54,860 --> 00:44:57,480
+و تلاتين خلي ال incubation temperature العادى
+
+600
+00:44:57,480 --> 00:45:01,300
+المعروف و المتعرف عليها خليها عالميا خمس و تلاتين
+
+601
+00:45:01,300 --> 00:45:05,300
+فصحر الرقمين الان موجودات أبو السبعة و تلاتين و
+
+602
+00:45:05,300 --> 00:45:08,420
+أبو الخمسة و تلاتين فلما تقول خمس و تلاتين انا ..
+
+603
+00:45:08,420 --> 00:45:11,720
+يعني احنا عارفين بيننا و بين بعضنا ان هي
+
+604
+00:45:11,720 --> 00:45:14,300
+temperature تبع ال incubation يا خمس و تلاتين يا
+
+605
+00:45:14,300 --> 00:45:19,210
+اما سبعة و تلاتينIncubate overnight ال 30 دقيقة
+
+606
+00:45:19,210 --> 00:45:23,770
+دلوقتي لمدة 24 ساعة او overnight وانا شرحتلكوا
+
+607
+00:45:23,770 --> 00:45:27,270
+جابليك ايش يعني overnight تمام انه يمضي عليها ليلة
+
+608
+00:45:27,270 --> 00:45:30,390
+حتى لو زلتها ال 4 العصر 5 العصر 6 العصر تاني يوم
+
+609
+00:45:30,390 --> 00:45:34,460
+ممكن تقرأ الطبق تمام؟suspicious colonies ايش يعني
+
+610
+00:45:34,460 --> 00:45:37,320
+suspicious colonies اللي هي suspected colonies
+
+611
+00:45:37,320 --> 00:45:40,720
+بنعملهم اللي هم الفحوصات اللي احنا ذكرناها من
+
+612
+00:45:40,720 --> 00:45:44,260
+الشباب بنعملهم عملية ال identification هنا نفس
+
+613
+00:45:44,260 --> 00:45:48,780
+الجثة بس بمزيد خطوة بعد ما عملنا incubation لتلت
+
+614
+00:45:48,780 --> 00:45:53,040
+لخمس ساعات او اربع ساعات أخدنا قطرة هنا من
+
+615
+00:45:53,040 --> 00:46:00,140
+البكتيريا ايش عملها هنا هو هنا تذكرين
+
+616
+00:46:00,140 --> 00:46:05,460
+الشريحة دي؟اللي جواها .. اللي جواها حفرة تمام و
+
+617
+00:46:05,460 --> 00:46:09,580
+جيبنا cover slip و حاطينا عليها قطرة و هانا عملنا
+
+618
+00:46:09,580 --> 00:46:14,030
+Vaseline او حاطيناها Vaselineو بعدين أخدنا الشريحة
+
+619
+00:46:14,030 --> 00:46:18,130
+و جلبناها بحيث أنه تكون القطرة داخلة وين؟ في
+
+620
+00:46:18,130 --> 00:46:23,210
+التجويف بعدين جلبنا الشريحة صارت القطرة هي ال
+
+621
+00:46:23,210 --> 00:46:26,890
+cover slip وهي القطرة هنا معلقة في التجويف فسمينا
+
+622
+00:46:26,890 --> 00:46:30,490
+hanging drop هذا الفحص ليش hanging drop؟ ده ال
+
+623
+00:46:30,490 --> 00:46:34,530
+motility ده ال motility كتير مهمة طبعا للغشيم
+
+624
+00:46:34,530 --> 00:46:39,110
+بمعنى لل unexperienced eye غالبا كل البكتيريا
+
+625
+00:46:39,110 --> 00:46:44,430
+بتطلع متحركةعارفين ليش؟ حركة ال .. ال brownian
+
+626
+00:46:44,430 --> 00:46:48,110
+movement of water بتحرك اللي هو البكتيريا يمنى
+
+627
+00:46:48,110 --> 00:46:52,070
+ويسارا لكن بتعترف ان الحركة الحقيقية هي بكتيريا
+
+628
+00:46:52,070 --> 00:46:57,570
+بتقطع مسافة و بتغير اتجاه تقطع مسافة و بتغير اتجاه
+
+629
+00:46:57,570 --> 00:47:00,810
+فبتتالفك تراقب حركة البكتيريا مش حركة اقتزازية و
+
+630
+00:47:00,810 --> 00:47:07,270
+انما حركة فيها قطع مسافة هذه نقطة كتير المهم المرة
+
+631
+00:47:07,270 --> 00:47:10,010
+الجاي ان شاء الله هتكلم عن اللي هو ال Campylobact
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/lG59Gp1r8F0.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/lG59Gp1r8F0.srt
new file mode 100644
index 0000000000000000000000000000000000000000..40694fb7559fb80025bf34241a5431e582677ba2
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/lG59Gp1r8F0.srt
@@ -0,0 +1,2100 @@
+1
+00:00:20,670 --> 00:00:24,030
+بسم الله الرحمن الرحيم، نكمل موضوع السلمونيلا
+
+2
+00:00:24,030 --> 00:00:28,670
+في المحاضرة الماضية، تحدثنا عن بعض صفات السلمونيلا
+
+3
+00:00:28,670 --> 00:00:31,710
+وبعض أسمائها، ذكرنا سلمونيلا تايفي وبرا تايفي A
+
+4
+00:00:31,710 --> 00:00:37,050
+وB وC، إنتريتيديس، كولارسويس، بولروم، جاليناروم، و...
+
+5
+00:00:37,050 --> 00:00:40,970
+بعدين تحدثنا عن الـ wide range of hosts
+
+6
+00:00:40,970 --> 00:00:46,910
+الذي تؤثر فيه السلمونيلا بشكل عام، إما كـ career
+
+7
+00:00:46,910 --> 00:00:51,050
+أو كـ infection، واستثنينا من هذا الـ wide
+
+8
+00:00:51,050 --> 00:00:53,930
+range of hosts، اللي هو السلمونيلا التايفي والبراتايفي
+
+9
+00:00:53,930 --> 00:00:58,150
+ولكن لنكن دقيقين، برا تايفي A وبرا تايفي B، لأن الـ
+
+10
+00:00:58,150 --> 00:01:02,650
+C لها host هو الخنزير - أعزكم الله - وبدأنا بالحديث عن
+
+11
+00:01:02,650 --> 00:01:07,090
+الأمراض التي تسببها السلمونيلا، وتحدثنا عن three
+
+12
+00:01:07,090 --> 00:01:12,490
+categories: septicemia، وfood infection type، الذي
+
+13
+00:01:12,490 --> 00:01:15,410
+قلنا عنه acute gastroenteritis، ورقم ثلاثة، الذي نحن
+
+14
+00:01:15,410 --> 00:01:19,150
+بدأنا بشرحه، وهو الـ enteric fevers، التيفوئيد
+
+15
+00:01:19,150 --> 00:01:21,950
+والبقري التيفوئيد، وما نقوله عن التيفوئيد ينطبق على
+
+16
+00:01:21,950 --> 00:01:27,410
+البقري التيفوئيد. تحدثنا عن sequence of events من الـ
+
+17
+00:01:27,410 --> 00:01:30,370
+ingestion إلى invasion of the intestinal wall إلى
+
+18
+00:01:30,370 --> 00:01:35,270
+lymph node، ومن ثم إلى الـ primary bacteremia أو
+
+19
+00:01:35,270 --> 00:01:38,350
+septicemia، وبعدين في الأعضاء يحدث multiplication
+
+20
+00:01:38,350 --> 00:01:42,290
+للبكتيريا، وبعدها مرة أخرى يحدث انتشار أكبر
+
+21
+00:01:42,290 --> 00:01:48,830
+وأوسع للبكتيريا بـ secondary septicemia، واختفاء، يصير
+
+22
+00:01:48,830 --> 00:01:52,970
+فينّا اختفاء كامل للسلمونيلا من الدم نتيجة
+
+23
+00:01:52,970 --> 00:01:56,250
+ظهور الـ antibodies، وكنا في بعض أنواع
+
+24
+00:01:56,250 --> 00:01:58,470
+السلمونيلا أو بعض حالات السلمونيلا، البكتيريا
+
+25
+00:01:58,470 --> 00:02:02,150
+تذهب إلى الـ gall bladder وتبقى هناك، وتشكل لنا
+
+26
+00:02:02,150 --> 00:02:08,250
+carrier state.  يبقى لما ذكرنا الـ sequence
+
+27
+00:02:08,250 --> 00:02:12,870
+of events، كانت العملية نفسها مهمة، عشان نعرف متى
+
+28
+00:02:12,870 --> 00:02:17,910
+نأخذ عينة، وإيش نوع العينة التي نأخذها، وفي أي فترة
+
+29
+00:02:17,910 --> 00:02:21,470
+في سبيل الحصول على أفضل diagnosis أو أفضل
+
+30
+00:02:21,470 --> 00:02:25,030
+laboratory diagnosis للتيفوئيد و para-typhoid في
+
+31
+00:02:25,030 --> 00:02:28,070
+البلد، لكن لسا احنا ما وصلنا لموضوع العينات، فثانياً
+
+32
+00:02:28,070 --> 00:02:32,260
+نكمل موضوع الأمراض، ثاني مرض سأسميه Nephrotyphoid، و
+
+33
+00:02:32,260 --> 00:02:36,380
+الـ Nephrotyphoid واضح من كلمة nephron، أي أن الـ
+
+34
+00:02:36,380 --> 00:02:39,980
+disease في الكلى، لكن خذوا بالكم، ليس المقصود
+
+35
+00:02:39,980 --> 00:02:43,240
+هنا أن الميكروب يعمل infection في الكلية، ولكن
+
+36
+00:02:43,240 --> 00:02:47,260
+إني قلت فيه antigen-antibody reaction،  مش
+
+37
+00:02:47,260 --> 00:02:51,040
+هيتكون antibody، يبقى السلمونيلا والـ antibody
+
+38
+00:02:51,040 --> 00:02:54,840
+هيتفاعلوا مع بعض. الآن، لما تكون السلمونيلا
+
+39
+00:02:54,840 --> 00:02:59,560
+بشكل debris، debris يعني بقايا سلمونيلا، سلمونيلا
+
+40
+00:02:59,560 --> 00:03:03,560
+ميتة، فالـ antibody يرتبط مع الـ antigen، الآن الـ
+
+41
+00:03:03,560 --> 00:03:07,840
+antigen-antibody complex يلف مع الدم، لما يلف مع
+
+42
+00:03:07,840 --> 00:03:11,420
+الدم، مش كل الدم يمر عبر الكلية، المفروض أن يصير
+
+43
+00:03:11,420 --> 00:03:15,140
+له removal أو filtration، لكن حجمه كبير، وبالتالي
+
+44
+00:03:15,140 --> 00:03:18,870
+يصير له precipitation في الكلى. الآن تذكروا حاجة
+
+45
+00:03:18,870 --> 00:03:24,030
+أنه في antigen مرتبط مع antibody، الـ antigen binding مع
+
+46
+00:03:24,030 --> 00:03:26,310
+الـ antigen يعمل activation للـ complement، الـ
+
+47
+00:03:26,310 --> 00:03:29,190
+complement يعمل attack، attack لمن في هالحالة؟
+
+48
+00:03:29,190 --> 00:03:32,730
+للnephron، اللي هو الكلية بتاعتي، يسمونه نفرو
+
+49
+00:03:32,730 --> 00:03:36,190
+تيفوئيد. ليس ناتج عن infection بكتيرية، إنما
+
+50
+00:03:36,190 --> 00:03:38,830
+ناتج عن ماذا؟ عن الـ immune complexes، immune
+
+51
+00:03:38,830 --> 00:03:42,140
+complexes، يعني antigen-antibody reaction. بينما الـ
+
+52
+00:03:42,140 --> 00:03:46,880
+osteomyelitis، هي ناتجة عن وصول البكتيريا إلى
+
+53
+00:03:46,880 --> 00:03:50,480
+العظم أو نخاع العظم، خاصة في الأطفال الذين عندهم
+
+54
+00:03:50,480 --> 00:03:52,880
+sickle cell anemia.
+
+55
+00:03:55,000 --> 00:03:58,600
+بقول لكم هنا أنه طبعاً التيفوئيد في الأطفال can
+
+56
+00:03:58,600 --> 00:04:02,420
+be found in the bone marrow. طب هذه نقطة كثيراً مهمة
+
+57
+00:04:02,420 --> 00:04:05,640
+in the bone marrow. ما كنا وعللنا هذا الكلام
+
+58
+00:04:05,640 --> 00:04:08,380
+في القصة، لما كنا قلنا أن البكتيريا تحب تذهب إلى
+
+59
+00:04:08,380 --> 00:04:11,680
+الـ reticulum endothelial system، الذي من ضمنه
+
+60
+00:04:11,680 --> 00:04:16,040
+الـ bone marrow، وبالتالي الـ bone marrow يصلح
+
+61
+00:04:16,040 --> 00:04:23,430
+عينة للـ culture، للبحث عن سلمونيلا. للتعافي طبعاً، ممكن
+
+62
+00:04:23,430 --> 00:04:26,910
+نعمل ما نسميه typhoid arthritis، أو abscess، نقول
+
+63
+00:04:26,910 --> 00:04:32,290
+أن الـ Salmonella will circulate in the blood and
+
+64
+00:04:32,290 --> 00:04:35,050
+reach to distant organs، تقريباً كل الأعضاء في الجسم
+
+65
+00:04:35,050 --> 00:04:37,590
+تصل إليها الـ Salmonella، ففي بعض الأحيان، الـ
+
+66
+00:04:37,590 --> 00:04:40,910
+multiplication في هذا العضو يعمل abscess، خرجات
+
+67
+00:04:40,910 --> 00:04:46,100
+قيحية. تمام؟ في هذه الحالة. طبعاً، أيضاً أحد الأمراض
+
+68
+00:04:46,100 --> 00:04:50,520
+التي يمكن أن تسببها السلمونيلا، تصوروا أن السلمونيلا
+
+69
+00:04:50,520 --> 00:04:53,500
+التايفي، بعد أن وصلت للدم، استطاعت أن تخترق حاجز
+
+70
+00:04:53,500 --> 00:04:57,900
+الدم والـ CSF، ووصلت إلى ماذا؟ إلى meninges، وهي
+
+71
+00:04:57,900 --> 00:05:00,660
+الأغشية المغلفة للدماغ، تماماً في هذه الحالة
+
+72
+00:05:00,660 --> 00:05:04,480
+السلمونيلا التايفي meningitis، which is  أيضاً very
+
+73
+00:05:04,480 --> 00:05:05,640
+difficult condition.
+
+74
+00:05:09,030 --> 00:05:12,670
+ما هي مُحددات أو الـ virulence factors، مُحددات الـ
+
+75
+00:05:12,670 --> 00:05:14,730
+pathogenesis أو الـ virulence factors للـ
+
+76
+00:05:14,730 --> 00:05:20,510
+Salmonella؟ نحن جميعاً متفقون على أن الـ
+
+77
+00:05:20,510 --> 00:05:24,570
+Salmonella هي Enterobacteriaceae، وبالتالي تمتلك Gram
+
+78
+00:05:24,570 --> 00:05:28,730
+negative cell wall.  cell wall،  يبقى تحتوي على
+
+79
+00:05:28,730 --> 00:05:32,770
+lipopolysaccharide، الذي من ضمنه ماذا؟ الذي هو من
+
+80
+00:05:32,770 --> 00:05:35,470
+ضمنه الـ O-antigen. من ضمنه الـ O-antigen، أقول الـ
+
+81
+00:05:35,470 --> 00:05:40,600
+surface antigen.  للـ surface علاقة كبيرة في قدرة
+
+82
+00:05:40,600 --> 00:05:42,960
+السلمونيلا على الـ attachment of surfaces on
+
+83
+00:05:42,960 --> 00:05:47,460
+surfaces.  يعني ترتبط بمن؟ بالأسطح. يبدو أن الأسطح
+
+84
+00:05:47,460 --> 00:05:51,360
+الخلايا... الخلايا  تمتلك receptors لمن؟
+
+85
+00:05:51,360 --> 00:05:54,840
+للـ O-Antigen أو للـ O-Receptors الموجودة على
+
+86
+00:05:54,840 --> 00:05:58,840
+السلمونيلا. قلنا يا شباب، من أهم الـ
+
+87
+00:05:58,840 --> 00:06:01,800
+virulence factors التي ذكرناها سابقاً في مقدماتنا في
+
+88
+00:06:01,800 --> 00:06:04,780
+الـ Microbiology، القدرة على الـ attachment، لأن بدون
+
+89
+00:06:04,780 --> 00:06:08,650
+attachment، قلنا... لا يوجد multiplication، لا يوجد
+
+90
+00:06:08,650 --> 00:06:11,630
+colonization، لا يوجد infection، لا يوجد disease.
+
+91
+00:06:11,630 --> 00:06:15,010
+وبالتالي، the first step is attachment. وبالتالي هذا
+
+92
+00:06:15,010 --> 00:06:20,310
+يوفر لها هذه القضية. طبعاً، بعض أنواع الـ Salmonella
+
+93
+00:06:20,310 --> 00:06:24,710
+فيها الـ Vi antigen، والـ Vi يُعبّر عن ماذا؟ عن
+
+94
+00:06:24,710 --> 00:06:28,390
+الكبسولة. طب الكبسولة تخدم غرضين، خذوا بالكم.
+
+95
+00:06:28,390 --> 00:06:32,390
+الكبسولة تخدم غرضين. الغرض الأول، يُقال عنه حماية
+
+96
+00:06:32,390 --> 00:06:36,750
+من الـ phagocytosis.  وأنا يعني هذه الصفة لا تلزمنا في
+
+97
+00:06:36,750 --> 00:06:39,290
+السلمونيلا، تعرفون لماذا؟ لأن السلمونيلا التي
+
+98
+00:06:39,290 --> 00:06:43,370
+قلنا عنها قادرة على الـ intracellular existence،
+
+99
+00:06:43,370 --> 00:06:47,210
+يعني لو الـ macrophage أخذتها داخلها، تستطيع أن تكثر
+
+100
+00:06:47,210 --> 00:06:50,370
+في الداخل، وهكذا، وبالتالي ليس هذا الغرض الأساسي
+
+101
+00:06:50,370 --> 00:06:54,260
+من ماذا؟ من الكبسولة، في هذه الحالة. لكن أيضاً أحد
+
+102
+00:06:54,260 --> 00:06:57,720
+الأشياء المهمة جداً عن الكبسولة، كما عرفنا، أنها
+
+103
+00:06:57,720 --> 00:07:01,340
+تساعد أيضاً في الـ attachment، ووظيفة عكس الهروب من
+
+104
+00:07:01,340 --> 00:07:05,380
+الـ phagocytosis.  لماذا؟ أو كيف؟ على الرغم من أنها
+
+105
+00:07:05,380 --> 00:07:09,700
+amyloid، كلمة amyloid تعني slippery،  يعني لو
+
+106
+00:07:09,700 --> 00:07:14,220
+جئنا نمسكها، لو الـ macrophage حاول أن يمسك البكتيريا التي
+
+107
+00:07:14,220 --> 00:07:19,400
+فيها كبسولة، الكبسولة لأنها slippery، يعني لزجة
+
+108
+00:07:19,400 --> 00:07:23,960
+فبالتالي تهرب، تهرب من ماذا؟ طب كيف تهرب وفي نفس
+
+109
+00:07:23,960 --> 00:07:28,880
+الوقت attachment؟ كيف تهرب وكيف attachment في
+
+110
+00:07:28,880 --> 00:07:33,230
+نفس الوقت؟ الآن، لما يكون الـ polysaccharide تبع
+
+111
+00:07:33,230 --> 00:07:38,050
+الكبسولة receptor على الخلايا، ففي هذه الحالة، لا الـ slippery
+
+112
+00:07:38,050 --> 00:07:43,170
+appearance ولا الـ slimy appearance يؤثر، لأن الآن
+
+113
+00:07:43,170 --> 00:07:47,290
+فيه specific receptor-receptor interaction،
+
+114
+00:07:47,290 --> 00:07:53,170
+وبالتالي الـ Vi أيضاً عامل مساعد، عامل مهم على الـ
+
+115
+00:07:53,170 --> 00:07:58,680
+attachment.  مرة أخرى، هي صفة عكس من؟ عكس ما هي to
+
+116
+00:07:58,680 --> 00:08:02,580
+escape the process of phagocytosis. رقم اثنين،
+
+117
+00:08:02,580 --> 00:08:06,040
+invasiveness. ذكرت لكم أنا في بداية القصة أن
+
+118
+00:08:06,040 --> 00:08:09,440
+البكتيريا، لئن وصلت للأمعاء، بعدين invaded
+
+119
+00:08:09,440 --> 00:08:12,780
+الـ intestinal wall، وذهبت للـ lymph node، و
+
+120
+00:08:12,780 --> 00:08:16,040
+بعدين راحت للدم. القدرة على الـ invasion
+
+121
+00:08:16,040 --> 00:08:19,900
+تعود إلى ماذا هنا؟ تعود إلى إنتاج ما يسمى
+
+122
+00:08:19,900 --> 00:08:20,760
+بالـ type III
+
+123
+00:08:25,680 --> 00:08:30,920
+secretory system، الذي سميناه باسم آخر، molecular
+
+124
+00:08:30,920 --> 00:08:34,400
+syringes. تتذكرون هذا المصطلح؟ يُقال عنه سرنجات
+
+125
+00:08:34,400 --> 00:08:39,360
+جزيئية، صغيرة الحجم، وبالتالي استطاعت البكتيريا
+
+126
+00:08:39,360 --> 00:08:43,380
+... أذكركم فقط على السريع، عشان لا نكون نسينا هذه
+
+127
+00:08:43,380 --> 00:08:46,680
+العملية، أن هذه الخلايا التي يُقال عنها هي أصلاً
+
+128
+00:08:46,680 --> 00:08:50,180
+ليست phagocytic cells. من الذي جعلها phagocytic cells؟
+
+129
+00:08:50,180 --> 00:08:56,170
+كيف جعلتها phagocytic cells؟ حقنتها بواسطة الـ type
+
+130
+00:08:56,170 --> 00:08:59,710
+III secretory system، وجعلت الـ cytoskeleton يعمل
+
+131
+00:08:59,710 --> 00:09:04,030
+عملية phagocytosis للخلية نفسها، إذن الـ
+
+132
+00:09:04,030 --> 00:09:10,170
+invasiveness مهم جداً. طبعاً، أيضاً القدرة الخاصة بها
+
+133
+00:09:10,170 --> 00:09:13,810
+على أنها تعمل intracellular existence، to escape
+
+134
+00:09:13,810 --> 00:09:18,210
+the killing action of phagocytes أو macrophages.
+
+135
+00:09:20,130 --> 00:09:23,430
+الـ endotoxin، ما هو جزء من ماذا؟ من الـ lipopolysaccharide.  قلت لكم، لا يوجد Gram negative
+
+136
+00:09:23,430 --> 00:09:26,970
+بكتيريا pathogen، تمام؟ والـ endotoxin تبعها ليس له دخل
+
+137
+00:09:26,970 --> 00:09:32,270
+في الـ pathogenesis. يعني هو جزء أساسي من الـ
+
+138
+00:09:32,270 --> 00:09:36,890
+pathogenesis. other factors. بعض أنواع Salmonella، نحن
+
+139
+00:09:36,890 --> 00:09:41,050
+لم نسميها fever، سميناها ماذا؟ enteric fever، و الـ
+
+140
+00:09:41,050 --> 00:09:45,290
+typhoid fever، سميناه أو وصفناه enteric fever،
+
+141
+00:09:45,290 --> 00:09:48,530
+فالبكتيريا غالباً تنتج enterotoxin. الآن، سنوضح
+
+142
+00:09:48,530 --> 00:09:52,150
+نقطة. قلنا exotoxin و endotoxin، صنفناهما بنوع الـ
+
+143
+00:09:52,150 --> 00:09:58,730
+mechanism of production. واحدة تنتج while the cell
+
+144
+00:09:58,730 --> 00:10:03,950
+is alive، سميناها exotoxin، وواحدة تنتج بعد أن تموت،
+
+145
+00:10:03,950 --> 00:10:08,450
+سميناها endotoxin. هذا based on mechanism of
+
+146
+00:10:08,450 --> 00:10:12,650
+production. لكن في تصنيفات أخرى للـ toxin، according
+
+147
+00:10:12,650 --> 00:10:18,950
+to the site affected. يعني لو كان التأثير على الـ
+
+148
+00:10:18,950 --> 00:10:23,310
+intestine، نسميه enterotoxin. لو كان على الخلايا
+
+149
+00:10:23,310 --> 00:10:26,930
+العصبية، نسميه neurotoxin. لو على الخلايا بشكل عام،
+
+150
+00:10:26,930 --> 00:10:31,030
+نسميه cytotoxin، بعض الأحيان نسميه leukocidin، قاتل
+
+151
+00:10:31,030 --> 00:10:36,170
+لمن؟ للleukocyte نفسه، وhemolysin، specific لمن؟
+
+152
+00:10:36,170 --> 00:10:44,970
+للـ red blood cell. وبالتالي، هذه التسمية أو هذا التصنيف
+
+153
+00:10:44,970 --> 00:10:47,750
+يعتمد على ماذا؟ على الـ site affected. نعم، الذي
+
+154
+00:10:47,750 --> 00:10:51,850
+الذي يتأثر. قلنا فيه enterotoxin، وفي أيضاً
+
+155
+00:10:51,850 --> 00:10:58,390
+أيضاً الـ cytotoxin. نجي للموضوع المتعلق
+
+156
+00:10:58,390 --> 00:11:00,770
+بالـ laboratory diagnosis of Salmonella، حد يسميها
+
+157
+00:11:00,770 --> 00:11:05,130
+classification of Salmonella.  في system مشهور في
+
+158
+00:11:05,130 --> 00:11:10,410
+العالم، اسمه Kaufmann-White system.
+
+159
+00:11:14,090 --> 00:11:19,990
+هذا الـ system صنف السلمونيلا بناء على الـ O والـ H
+
+160
+00:11:19,990 --> 00:11:25,810
+antigen.  الـ O antigen موجود في كل Gram negative
+
+161
+00:11:25,810 --> 00:11:30,270
+بكتيريا، والـ H antigen موجود فقط في تلك التي تتحرك،
+
+162
+00:11:30,270 --> 00:11:33,570
+التي عندها أهداب، التي عندها أهداب.
+
+163
+00:11:35,970 --> 00:11:39,550
+ممكن نحن نضيف في هذا الـ system، إذا كان الـ Vi
+
+164
+00:11:39,550 --> 00:11:45,670
+antigen موجود، إذا كان فيه Vi antigen، إذا three antigens
+
+165
+00:11:45,670 --> 00:11:49,230
+are used in this system، الذي اسمه كوفمان وايت
+
+166
+00:11:49,230 --> 00:11:53,030
+system. رقم واحد، اللي هو الـ O antigen، والـ H antigen، و
+
+167
+00:11:53,030 --> 00:11:59,190
+الـ Vi antigen. أذكركم فقط بالـ H antigen، فاكرين مرة
+
+168
+00:11:59,190 --> 00:12:03,370
+قلنا أن الـ H antigen له phase variation، phase
+
+169
+00:12:03,370 --> 00:12:10,430
+variation. H antigen. ويمكن أكثر ميكروب... أكثر ميكروب...
+
+170
+00:12:10,430 --> 00:12:19,510
+أكثر ميكروب... أكثر ميكروب...
+
+171
+00:12:19,510 --> 00:12:19,670
+أكثر ميكروب...
+
+172
+00:12:19,670 --> 00:12:20,450
+أكثر ميكروب...
+
+173
+00:12:20,450 --> 00:12:20,830
+أكثر ميكروب...
+
+174
+00:12:20,830 --> 00:12:26,290
+أكثر ميكروب...
+
+175
+00:12:26,290 --> 00:12:32,590
+أكثر ميكروب...
+
+176
+00:12:32,590 --> 00:12:37,150
+أكثر ميكروب... فقط للسلمونيلا، عشان هي يا شباب، it
+
+177
+00:12:37,150 --> 00:12:41,330
+is not practical for routine laboratories to stock
+
+178
+00:12:41,330 --> 00:12:47,090
+all the serological antibodies to detect the type
+
+179
+00:12:47
+
+223
+00:15:49,780 --> 00:15:55,830
+antigen groups A to Z. خلصنا الأحرف الأبجدية اللي 
+
+224
+00:15:55,830 --> 00:15:59,310
+هي الإنجليزية وبدنا نعطي أرقام fifty-one to sixty
+
+225
+00:15:59,310 --> 00:16:01,990
+one أو sixty-four to sixty-six.
+
+226
+00:16:05,320 --> 00:16:08,600
+فاكرين أول جملة حكيناها في السلمونيلا؟ قلنا كل
+
+227
+00:16:08,600 --> 00:16:13,540
+السلمونيلا على الإطلاق كلها تعتبر أيه؟ pathogen.
+
+228
+00:16:13,540 --> 00:16:17,000
+لأنه لما ذكرنا الجملة تبعها الـFDA، الـFDA اللي هي
+
+229
+00:16:17,000 --> 00:16:20,940
+الـfood and drug administration، منظمة أو إدارة
+
+230
+00:16:20,940 --> 00:16:23,800
+الغذاء والدواء في الولايات المتحدة من أشهر
+
+231
+00:16:23,800 --> 00:16:29,000
+المنظمات، المنظمة FDA، food and drug administration.
+
+232
+00:16:29,000 --> 00:16:36,530
+مافيش غذاء ولا علاج بياخد ترخيص إلا بيمر بفحوصات
+
+233
+00:16:36,530 --> 00:16:39,970
+دقيقة عشان ياخد ترخيص من هذه المؤسسة اللي هي الـ
+
+234
+00:16:39,970 --> 00:16:45,910
+FDA. الـFDA قالت إنه وجود أي سيروتيب في
+
+235
+00:16:45,910 --> 00:16:50,070
+السالمونيلا يجعل الغذاء أو الماء اللي محتوى على
+
+236
+00:16:50,070 --> 00:16:52,870
+السالمونيلا غير صالح للاستهلاك، الأدلة مؤشرة أن كلهم
+
+237
+00:16:52,870 --> 00:16:57,490
+pathogen، لكن بيقولنا هنا في الجملة many of the
+
+238
+00:16:57,490 --> 00:16:59,970
+medically important salmonella belong to the
+
+239
+00:16:59,970 --> 00:17:05,310
+groups A to G. يعني هذا المعنى أنه اللي بعد الـG
+
+240
+00:17:05,310 --> 00:17:11,110
+مش مهمين، أقل انتشارًا، أقل انتشارًا، لكن كلهم كمرة
+
+241
+00:17:11,110 --> 00:17:13,830
+ما بدنا نفهم من الجملة أنه في pathogen وفي non-
+
+242
+00:17:13,830 --> 00:17:20,290
+pathogen. نفهم أنه في منهم مهمين أكثر من الثانيين بس
+
+243
+00:17:20,290 --> 00:17:24,610
+each group has what is called a group factor. إيش
+
+244
+00:17:24,610 --> 00:17:30,540
+العامل المشترك بينكم أنتم؟  لأ، في المحاضرة هذه
+
+245
+00:17:30,540 --> 00:17:33,840
+إنكم مسجلين مساق diagnostic microbiology، لكن واحد
+
+246
+00:17:33,840 --> 00:17:36,800
+مسجل مساق hematology، واحد مسجل مساق clinical
+
+247
+00:17:36,800 --> 00:17:40,160
+chemistry. مش بالضروري أنكم تكونوا مسجلين نفس
+
+248
+00:17:40,160 --> 00:17:44,140
+المساقات، لكن عندي في المحاضرة هذه الشيء المشترك
+
+249
+00:17:44,140 --> 00:17:47,800
+بينكم أنكم كلكم مسجلين diagnostic microbiology.
+
+250
+00:17:47,800 --> 00:17:51,620
+فلما بنصنف الـgroups في serology، احنا بنقول فيه one
+
+251
+00:17:51,620 --> 00:17:56,000
+common antigen. هذا الـcommon antigen is unique to
+
+252
+00:17:56,000 --> 00:17:58,820
+this group. إيش يعني unique؟ فريد لهذا المجموعة، الـ
+
+253
+00:17:58,820 --> 00:18:04,800
+diagnostic microbiology تبعتنا، هذا الـunique
+
+254
+00:18:04,800 --> 00:18:09,040
+antigen بيسمّيه group factor، هو العامل اللي على
+
+255
+00:18:09,040 --> 00:18:14,840
+أساسه أعطيت المجموعة رقمها أو اسمها أو حرفها. This is
+
+256
+00:18:14,840 --> 00:18:18,760
+common to all members. يبقى هذا الانتيجين عبارة عن
+
+257
+00:18:18,760 --> 00:18:23,480
+واحد مشترك لكل المجموعة. For example, the factor for
+
+258
+00:18:23,480 --> 00:18:28,840
+group B is O antigen number 4. إذا إن group B لو
+
+259
+00:18:28,840 --> 00:18:31,620
+أنا قلت إن هذا السالمونيلا اللي تابعة لـgroup B لازم
+
+260
+00:18:31,620 --> 00:18:36,280
+تحتوي على مين؟ على انتيجين رقم 4. هذا الـgroup factor.
+
+261
+00:18:37,660 --> 00:18:41,000
+This means that all salmonella belonging to this
+
+262
+00:18:41,000 --> 00:18:45,620
+group possesses antigen 4 as one. خدوا بالكم، ليس
+
+263
+00:18:45,620 --> 00:18:50,100
+بالضروري أن يكون هو الوحيد. كمان مرة، ممكن يكون معاه
+
+264
+00:18:50,100 --> 00:18:55,660
+أنتيجينات أخرى، لكن أربعة واحد منهم، عشان أسمّي..
+
+265
+00:18:55,660 --> 00:19:00,240
+أسمّي الفرد هذا من ضمن group B، لازم يكون محتوي
+
+266
+00:19:00,240 --> 00:19:06,780
+على الأقل على انتيجين أربعة كـgroup factor. الـH antigen
+
+267
+00:19:06,780 --> 00:19:11,020
+وأنا حاولت أقدمه من البداية بإن فيه عندي phase
+
+268
+00:19:11,020 --> 00:19:14,300
+variation فيه، وهي نفس الكلام اللي.. اللي.. اللي
+
+269
+00:19:14,300 --> 00:19:17,340
+ذكرناه. phase one غالبًا بنعطيه alpha-methylglucoside،
+
+270
+00:19:17,340 --> 00:19:21,880
+وphase two بنعطيه numeral، numeral، يعني رقم. الـV
+
+271
+00:19:21,880 --> 00:19:25,160
+-I antigen. وأنا اتفقت معاكم من البداية إن معظم
+
+272
+00:19:25,160 --> 00:19:29,160
+السلمونيلا أصلًا مالهاش.. معظم السلمونيلا مالهاش V
+
+273
+00:19:29,160 --> 00:19:32,160
+-I antigen، لكن الـV-I antigen موجود في السلمونيلا
+
+274
+00:19:32,160 --> 00:19:34,420
+typhi والـparatyphi C.
+
+275
+00:19:38,400 --> 00:19:43,220
+هذا جدول، طلعوا عليه كويس. الجدول هذا اللي قدامنا هو
+
+276
+00:19:43,220 --> 00:19:47,680
+نموذج صغير، مصغر من جدول كبير جدًا، بيعطينا مثال
+
+277
+00:19:47,680 --> 00:19:52,040
+بيقولنا group B: سالمونيلا باراطيفي B، سالمونيلا
+
+278
+00:19:52,040 --> 00:19:55,840
+داربي، سالمونيلا تايفي موريوم، سالمونيلا هيدلبرج،
+
+279
+00:19:55,840 --> 00:19:58,080
+أسمائها حتى ما أملّش عليكم مظبوط.
+
+280
+00:20:19,810 --> 00:20:23,810
+ممكن تلاقي اثنين في مكان ثاني، ممكن تلاقي اثنين
+
+281
+00:20:23,810 --> 00:20:26,710
+في مكان ثاني، ممكن تلاقي اثنين في مكان ثاني. مثلًا
+
+282
+00:20:26,710 --> 00:20:29,530
+في هذه الحالة، فيه اثنين هنا، لكن الاثنين مش هو الـ
+
+283
+00:20:29,530 --> 00:20:32,250
+group factor. مين الـgroup factor هنا؟ أربعة. هنا
+
+284
+00:20:32,250 --> 00:20:36,450
+الـgroup factor اثنين، وها كده، إذًا لكل مجموعة فيه
+
+285
+00:20:36,450 --> 00:20:42,310
+عندي one common antigen، سميها group factor. نيجي
+
+286
+00:20:42,310 --> 00:20:46,490
+الآن للـ.. للـ.. للـ.. الـ.. برضه الاتجاه المعملي
+
+287
+00:20:46,490 --> 00:20:50,600
+في عملية الـdiagnosis. الـspecimen، مين بناخد؟ عينة
+
+288
+00:20:50,600 --> 00:20:57,820
+stool، ولا عينة blood، ولا urine؟ إيش العينات اللي
+
+289
+00:20:57,820 --> 00:21:02,690
+لازم إحنا نتعامل معاها؟  طالع عليّ. For the diagnosis
+
+290
+00:21:02,690 --> 00:21:06,050
+of enteric fever, specimen includes blood, feces
+
+291
+00:21:06,050 --> 00:21:10,850
+and urine for culture and may be used depending on
+
+292
+00:21:10,850 --> 00:21:15,050
+the course of illness. depending on the course of
+
+293
+00:21:15,050 --> 00:21:18,170
+illness. إيش يعني course of illness؟ مسار المرض،
+
+294
+00:21:18,170 --> 00:21:23,450
+مساره الزمني، مساره الزمني. يعني صار له أسبوع، صار له
+
+295
+00:21:23,450 --> 00:21:30,230
+أسبوعين، صار له ثلاثة. تعالوا نطلع الـblood. كمان مرة،
+
+296
+00:21:30,230 --> 00:21:33,030
+بتتكلم عن الـblood هنا مش للـserology، بتتكلم عن الـ
+
+297
+00:21:33,030 --> 00:21:36,030
+blood لمين؟ للـculture. يعني بتدعم الـblood culture.
+
+298
+00:21:36,030 --> 00:21:39,770
+عارفين كيف نتعامل مع الـblood culture؟ ولسه ما درستوهاش
+
+299
+00:21:39,770 --> 00:21:45,270
+في المعمل. طيب، خليني أتكلم عن الـblood culture. واحد
+
+300
+00:21:45,270 --> 00:21:50,910
+ممكن من الشباب، أنت تعالى
+
+301
+00:21:50,910 --> 00:21:57,450
+اشيل على الـjacket تبعتك. استعراض الآن.
+
+302
+00:21:59,120 --> 00:22:01,660
+إحنا في الوضع الطبيعي.. في الوضع الطبيعي، الشراب
+
+303
+00:22:01,660 --> 00:22:06,660
+غالبا بنطهر اللي.. لما بنسحب عينة دم عادية بنعمل
+
+304
+00:22:06,660 --> 00:22:10,200
+عملية swabbing بالقطن اللي فيه كحول للمنطقة
+
+305
+00:22:10,200 --> 00:22:13,820
+بسبعين في المئة، مظبوط ولا لأ؟ في الـmicrobiology، this
+
+306
+00:22:13,820 --> 00:22:21,480
+is not enough disinfecting procedure. بنحط كحول و
+
+307
+00:22:21,480 --> 00:22:26,840
+بنحط يود و بنتركه for two minutes، circular
+
+308
+00:22:26,840 --> 00:22:27,960
+motion، عشان أنتم عارفين
+
+309
+00:22:30,770 --> 00:22:36,930
+من الـcenter للـoutward، وبعدين بنزيل الـiodine لأن
+
+310
+00:22:36,930 --> 00:22:40,670
+الـiodine إحنا عاملينه بالدور تبعه، عقّم المنطقة أو طهّر
+
+311
+00:22:40,670 --> 00:22:45,210
+المنطقة. بنزيله بكحول تانى، ما نخلي أي traces، لأن لو
+
+312
+00:22:45,210 --> 00:22:49,890
+دخلنا الـneedle عشان ناخد عينة ودخل شوية iodine،
+
+313
+00:22:49,890 --> 00:22:52,870
+هنقتل البكتيريا اللي إحنا هنقتلها ولا هننمّيها؟
+
+314
+00:22:52,870 --> 00:22:59,110
+هننمّيها، وبالتالي بنزيله بالكحول. إذًا طبعًا لو أي واحد
+
+315
+00:22:59,110 --> 00:23:03,570
+كعادة الطلبة الجداد، الجداد مش واثقين من أنفسهم، بيروح
+
+316
+00:23:03,570 --> 00:23:07,250
+بيلمس كمان مرة المكان. إذا لمست مرة أخرى، بدك
+
+317
+00:23:07,250 --> 00:23:11,170
+تعيد الـprocedures من الأول. الآن بناخد اللي هو
+
+318
+00:23:11,170 --> 00:23:14,350
+طبعًا الـblood culture مش زي الـswab، والـblood
+
+319
+00:23:14,350 --> 00:23:17,550
+agar بنزرعها في bottles، بنزرعها في bottles فيها
+
+320
+00:23:17,550 --> 00:23:22,180
+liquid media. فيه نوعين منها، ممكن ندخل tube ونوصّله
+
+321
+00:23:22,180 --> 00:23:26,640
+مباشرة للـ.. للـ.. للـbottle، أو ناخد بسرنجة نسحبها
+
+322
+00:23:26,640 --> 00:23:30,940
+تمام، وبعدين نعمل injection لها في الـbottle، لكن
+
+323
+00:23:30,940 --> 00:23:34,420
+في الحالتين بدي أضمن مين؟ أنا بدي أضمن الـsterility،
+
+324
+00:23:34,420 --> 00:23:38,180
+عشان لما آخد أو يطلع معايا بكتيريا، هل البكتيريا هي
+
+325
+00:23:38,180 --> 00:23:41,660
+من الـskin تبعه ولا من الـblood تبعه؟ بيكون متأكد.
+
+326
+00:23:41,660 --> 00:23:45,100
+يعطيك العفو، بارك الله فيك. طيب،
+
+327
+00:23:46,370 --> 00:23:48,530
+مش هذا اللي بيهمني الصحيح، أنا هذا.. هذا شغل
+
+328
+00:23:48,530 --> 00:23:51,170
+practical، هتاخده في المعمل وهتشتغله إن شاء الله
+
+329
+00:23:51,170 --> 00:23:54,370
+بشكل جيد. أنا اللي بيهمني ليش اخترت الدم أنا
+
+330
+00:23:54,370 --> 00:23:58,810
+كعينة؟ اه، إذا بنذكر الـtyphoid fever، والـcourse
+
+331
+00:23:58,810 --> 00:24:02,290
+اللي حكينا عنه، ingestion، intestinal penetration، و
+
+332
+00:24:02,290 --> 00:24:06,410
+بعدين على الدم، لما بيكون فيه fever، والملد غالبًا
+
+333
+00:24:06,410 --> 00:24:11,130
+بيروح على الدم. متى لما بيصير عنده fever؟ فغالبا
+
+334
+00:24:11,130 --> 00:24:14,030
+بتكون البكتيريا اللي موجودة الآن في الدم. فبيقولنا
+
+335
+00:24:14,030 --> 00:24:21,120
+إن الـblood بيقدر يعطيني حساسية بنسبة خمسة وسبعين
+
+336
+00:24:21,120 --> 00:24:24,560
+إلى تسعين بالمئة من الـpatient during the first ten
+
+337
+00:24:24,560 --> 00:24:29,000
+days، بتكون positive. مفيش ولا واحد من هدول العينات
+
+338
+00:24:29,000 --> 00:24:31,700
+ولا من هدول الفحوصات بيقدر يعطينا هذا الرقم غير الـ
+
+339
+00:24:31,700 --> 00:24:35,480
+blood. إذًا الـblood في الـearly course للـtyphoid،
+
+340
+00:24:35,480 --> 00:24:37,740
+في الـearly course، يعني في الأيام الأولى العشرة،
+
+341
+00:24:37,740 --> 00:24:41,420
+الأيام الأولى، أفضل عينة هي مين؟ الـblood culture.
+
+342
+00:24:41,420 --> 00:24:45,760
+طبعًا هنا نقطة ومشكلة كبيرة إن في قطاع غزة لازم
+
+343
+00:24:45,760 --> 00:24:49,720
+نحلها، عشان حضراتكم لما تكونوا أصحاب قرار في
+
+344
+00:24:49,720 --> 00:24:53,490
+المختبرات، تغيروا من الـpolicy، اللي هو الـtime
+
+345
+00:24:53,490 --> 00:24:57,110
+required for saying that this is a negative blood
+
+346
+00:24:57,110 --> 00:25:01,590
+culture. إحنا بنعمل incubation في المعمل للـurine
+
+347
+00:25:01,590 --> 00:25:07,170
+24 to 48 hours. الـblood culture فيه عليها خلاف،
+
+348
+00:25:07,170 --> 00:25:10,190
+اللي بيعملها خمس أيام، بيعملها أسبوع، اللي بيعملها
+
+349
+00:25:10,190 --> 00:25:13,250
+أربعة عشر يوم، وهذا الكلام في الـtext، في الكتب،
+
+350
+00:25:13,250 --> 00:25:16,950
+وفي الـ.. فيه اختلافات، طبعًا الاختلافات مبنية على
+
+351
+00:25:16,950 --> 00:25:21,870
+عوامل كثيرة، منها العامل الاقتصادي. أنا لما بدي
+
+352
+00:25:21,870 --> 00:25:26,090
+incubator، وأنا عندي حجم شغل كبير، في مستشفى مثلًا، كل
+
+353
+00:25:26,090 --> 00:25:29,630
+يوم بيجيني عشر عينات، عشر عينات، لو بتعمل
+
+354
+00:25:29,630 --> 00:25:33,050
+incubation لمدة أسبوعين، هيتجمع عندي في الـ
+
+355
+00:25:33,050 --> 00:25:39,370
+incubator عشر ضرب أربعة عشر يوم، اللي هم رقم ضخم،
+
+356
+00:25:39,370 --> 00:25:42,090
+فبالتالي هيتسهّي الـincubator، فبالتالي أنا بحاجة إلى
+
+357
+00:25:42,090 --> 00:25:45,830
+مساحة أكبر. فبينزلوا، بدل ما يخلوها أسبوعين، بيخلوها
+
+358
+00:25:45,830 --> 00:25:48,670
+عشرة أيام. الـincubation، البعض بيقول لك لا يا عم أنا
+
+359
+00:25:48,670 --> 00:25:52,010
+الدقة عندي أهم من موضوع الـspace، لأن أنا عندي أصلًا
+
+360
+00:25:52,010 --> 00:25:56,150
+حجم الشغل قليل، وكم مزرعة بتجيني في الشهر قليلين،
+
+361
+00:25:56,150 --> 00:26:00,070
+وبالتالي لأ، خليهم أربعة عشر يوم. إذا كل واحد أيه
+
+362
+00:26:00,070 --> 00:26:04,310
+اللي هو مبرراته، وعلى حسب الـsystem المستخدم، في الـ
+
+363
+00:26:04,310 --> 00:26:07,430
+system بيسمّوه automated system. فيه واحد أوتوماتيكي،
+
+364
+00:26:07,430 --> 00:26:12,330
+automated، يعني بنحطه في الجهاز، والجهاز بيقولنا
+
+365
+00:26:12,330 --> 00:26:15,110
+تعال يا فلان، صار عندك blood culture في المكان
+
+366
+00:26:15,110 --> 00:26:19,650
+الفلاني صارت positive. بيزمّر لك، بيعطيك إشارة. متوفر
+
+367
+00:26:19,650 --> 00:26:22,830
+عندنا النظام هذا، ده هنجيب لكم إياه إن شاء الله يوم
+
+368
+00:26:22,830 --> 00:26:27,790
+إذًا الـblood culture مشكلتها هنا في قطاع غزة
+
+369
+00:26:27,790 --> 00:26:32,330
+موضوع اللي هو، قد إيش نعملها incubation before you
+
+370
+00:26:32,330 --> 00:26:33,890
+say it is negative.
+
+371
+00:26:37,810 --> 00:26:41,410
+سبعة أيام، عشرة أيام، أربعة عشر يوم، هذا موضوع
+
+372
+00:26:41,410 --> 00:26:45,270
+بنطرحه للنقاش إن شاء الله في الجزء العملي، ونحاول
+
+373
+00:26:45,270 --> 00:26:49,210
+قدر الإمكان إنه نبرّر أي وقت اللي إحنا بدنا نختاره،
+
+374
+00:26:49,210 --> 00:26:54,530
+إيش المبررات اللي بدنا نحطها لهذا الوقت، لكن يكون
+
+375
+00:26:54,530 --> 00:26:58,450
+لديكم معلومة، إنه كل ما طالت فترة الـincubation، كل
+
+376
+00:26:58,450 --> 00:27:03,150
+ما زادت من مين؟ نسبة الـsensitivity ونسبة الـrecovery
+
+377
+00:27:03,150 --> 00:27:09,340
+للـblood culture. نيجي للتانية. الـthesis. It can be
+
+378
+00:27:09,340 --> 00:27:13,640
+detected، أو تيزال البكتيريا من 40 إلى 50% من الـ
+
+379
+00:27:13,640 --> 00:27:15,880
+patient during the third week.
+
+380
+00:27:18,510 --> 00:27:22,490
+بعدين، طيب، أنا خدنا اختصرلكم الكلام بكلمتين صغيرين،
+
+381
+00:27:22,490 --> 00:27:26,750
+أفضل عينة للـdiagnosis هي الـblood culture، وأفضل
+
+382
+00:27:26,750 --> 00:27:30,810
+عينة للـfollow up هي الـstool culture. أنا عملت
+
+383
+00:27:30,810 --> 00:27:34,270
+diagnosis وطلع positive، وعطينا المريض علاج based
+
+384
+00:27:34,270 --> 00:27:38,990
+on antimicrobial susceptibility testing. طبعًا الآن
+
+385
+00:27:38,990 --> 00:27:43,490
+السالمونيلا تايفي أو الـparatyphi يجب أن لا يترك
+
+386
+00:27:43,490 --> 00:27:50,870
+المريض حتى الشفاء فقط. يجب أن لا يترك المريض إلا بعد
+
+387
+00:27:50,870 --> 00:27:55,750
+التأكد من خلوّه من السالمونيلا، بمعنى إنه يبطل يطلع
+
+388
+00:27:55,750 --> 00:27:59,050
+سالمونيلا في الـstool تبعه، عشان ما يتحولش من مريض إلى
+
+389
+00:27:59,050 --> 00:28:03,130
+carrier، على سبيل المثال، تمام؟ وبالتالي أنا أعطيته
+
+390
+00:28:03,130 --> 00:28:06,510
+علاج، بدي أضمن إنه العلاج كان effective in
+
+391
+00:28:06,510 --> 00:28:10,790
+eradicating. كلمة eradicating يعني removal، تخلص كامل
+
+392
+00:28:10,790 --> 00:28:14,130
+من الـmicroorganism. لازم يتم عبر اللي هو الـstool
+
+393
+00:28:14,130 --> 00:
+
+445
+00:32:03,430 --> 00:32:03,690
+يكون في
+
+446
+00:32:10,650 --> 00:32:17,570
+بدي اشتري من الشركة اقولهم اعطوني antibody من A ل
+
+447
+00:32:17,570 --> 00:32:25,470
+Z كلهم في vial واحدة توفيرا أي A ل Z كم antibody
+
+448
+00:32:25,470 --> 00:32:35,260
+أو كم antibody نعم كتير 28 أو 20 ولا 26؟ 2626
+
+449
+00:32:35,260 --> 00:32:38,660
+Antibody يبقى هذه هي الطريقة اللي بيسميها polyclonal
+
+450
+00:32:38,660 --> 00:32:44,300
+أو polyvalent polyvalent
+
+451
+00:32:44,300 --> 00:32:52,260
+antibody أخدت Salmonella أخدت على شريحة في one
+
+452
+00:32:52,260 --> 00:32:57,580
+drop of saline و one drop of the agent ايش ال
+
+453
+00:32:57,580 --> 00:33:02,060
+agent في هذه الحالة ال A to Z polyvalent
+
+454
+00:33:02,060 --> 00:33:07,320
+antibody إذا اتفعل معه عشان يحدث agglutination
+
+455
+00:33:07,320 --> 00:33:13,440
+فالبكتيريا سالمونلة هو استنتاج كويس مبدأ يعني أن
+
+456
+00:33:13,440 --> 00:33:18,780
+البكتيريا سالمونلة كم قطرة؟ خسرنا واحدة لسة الآن
+
+457
+00:33:18,780 --> 00:33:30,320
+بقولهم اعطوني A to G بدي البطل تمام؟ A to G و H مثلا
+
+458
+00:33:30,320 --> 00:33:37,980
+مثلا L تمام؟ و ايش بعد ال L؟ ال O؟ Okay O ل Z هذه
+
+459
+00:33:37,980 --> 00:33:42,580
+كم بطل سرعة؟ ثلاثة و الاولانية؟ اربعة تمام؟ هذه
+
+460
+00:33:42,580 --> 00:33:46,840
+أربعة مئة دولار صرنا صارفين فلوس لكن شوفوا الآن
+
+461
+00:33:46,840 --> 00:33:51,860
+هذه قطرة طلعت negative قطرة طلعت negative قطرة
+
+462
+00:33:51,860 --> 00:33:56,410
+طلعت positive يبقى أنا استثنيت هذين يبقى
+
+463
+00:33:56,410 --> 00:33:59,550
+البكتيريا اللي عندي ضالة أين؟ في ال O و ال Z يبقى
+
+464
+00:33:59,550 --> 00:34:04,610
+احنا بهذه الطريقة، طريقة ال grouping نوفر... نوفر
+
+465
+00:34:04,610 --> 00:34:09,610
+بدل ما نعمل trial على كل individual antigen فبنجمع
+
+466
+00:34:09,610 --> 00:34:12,090
+مجموعة antigens مع بعضهم البعض
+
+467
+00:34:15,090 --> 00:34:18,250
+الموضوع الأخطر على الإطلاق... الأخطر... احنا جونا
+
+468
+00:34:18,250 --> 00:34:24,930
+ال blood culture يعني جمع العينة يختلف عن العينات
+
+469
+00:34:24,930 --> 00:34:30,430
+الدم العادية لكن
+
+470
+00:34:30,430 --> 00:34:34,030
+ال...ال...ال...الصعب حقيقة في ال...في ال
+
+471
+00:34:34,030 --> 00:34:37,070
+Salmonella هو ال stool culture ليش ال stool
+
+472
+00:34:37,070 --> 00:34:38,010
+culture صعبة؟
+
+473
+00:34:41,880 --> 00:34:45,160
+هذا عنده فكرة ليست صعبة، ليست صعبة stool culture بشكل عام
+
+474
+00:34:55,960 --> 00:34:59,340
+الآلاف الأنواع من ال normal microbiota وأنت بدك تهزل
+
+475
+00:34:59,340 --> 00:35:02,620
+one organism selectively من هذه الملايين من هذه
+
+476
+00:35:02,620 --> 00:35:06,960
+الآلاف من الأنواع، صح؟ هذه وجه الصعوبة، هذه وجه الصعوبة
+
+477
+00:35:06,960 --> 00:35:12,500
+إذا يجب عليك أن تختار تقنية، تختار تقنية قادرة على
+
+478
+00:35:12,500 --> 00:35:19,300
+إما أن تعمل suppression تثبيط أو أن تسمح
+
+479
+00:35:19,300 --> 00:35:22,920
+للمicrobe تبعك أن ينمو دون أنعان الميكروبات الأخرى
+
+480
+00:35:23,280 --> 00:35:27,720
+هذه نقطة كتير مهمة فإندي هنا stool culture أو ال
+
+481
+00:35:27,720 --> 00:35:34,280
+stool كعينة في عندي طرفين نشتغلهم سويا في نفس
+
+482
+00:35:34,280 --> 00:35:40,320
+اللحظة، حالة اسمها enrichment وحالة
+
+483
+00:35:40,320 --> 00:35:49,020
+اسمها selective media طيب
+
+484
+00:35:49,020 --> 00:35:55,330
+ال enrichment بتنمي البكتيريا تبعتنا وغيرها لكن
+
+485
+00:35:55,330 --> 00:36:01,070
+بتنمي البكتيريا تبعتنا بدرجة ايه؟ أفضل فبنعمل لها
+
+486
+00:36:01,070 --> 00:36:06,730
+كمان مرة حالة اسمها selective يعني اللي بيطلع معاهم
+
+487
+00:36:06,730 --> 00:36:12,650
+ال enrichment بتظهر على مين؟ على ال selective اللي
+
+488
+00:36:12,650 --> 00:36:17,700
+بيطلع من ال selective هذا ومن ال selective هذا، كلمة
+
+489
+00:36:17,700 --> 00:36:21,900
+selective انتم عارفين، لما ماعليش يعني اذكركم بس
+
+490
+00:36:21,900 --> 00:36:27,720
+بنقطة اي وسط selective الأصل أن يكون فيه مواصفات
+
+491
+00:36:27,720 --> 00:36:32,320
+للبكتيريا اللي هتنمو عليه، مثلا ال mannitol salt
+
+492
+00:36:32,320 --> 00:36:35,530
+agar، ال mannitol salt agar للـ Staphylococcus
+
+493
+00:36:35,530 --> 00:36:40,130
+aureus، ايش مواصفات المستعمرة النموذجية تبعته؟
+
+494
+00:36:40,130 --> 00:36:44,390
+Yellow colonies surrounded by yellow zone as a
+
+495
+00:36:44,390 --> 00:36:47,350
+result of sucrose fermentation؟ يعني أنا عارف من
+
+496
+00:36:47,350 --> 00:36:52,290
+ناحية نظرية كيف تبدو مستعمرات البكتيريا على الـ
+
+497
+00:36:52,290 --> 00:36:56,160
+selective media، ف أنا مش بقول هنا أي مستعمرة
+
+498
+00:36:56,160 --> 00:37:01,580
+typical suspected، مشتبه بها، typical يعني نموذجية
+
+499
+00:37:01,580 --> 00:37:04,720
+سواء كانت طالعة من ال enrichment على ال selective
+
+500
+00:37:04,720 --> 00:37:07,660
+أو طالعة من ال stool مباشرة على ال
+
+501
+00:37:07,660 --> 00:37:15,460
+selective، كلمة suspected colony هنا نعود نرتب
+
+502
+00:37:15,460 --> 00:37:21,340
+جدولنا، أو جدولنا، دبعنا ابصر فيني أنا لوحة لأ لأسف
+
+503
+00:37:21,340 --> 00:37:28,360
+لأ، هذه اللوحة استخدمت فرصة المونيلا وزرعنا على
+
+504
+00:37:28,360 --> 00:37:32,520
+cellulite if broth هذا معكوس للجدول هذا، enrichment
+
+505
+00:37:32,520 --> 00:37:39,320
+هذه يا شباب enrichment وهذه selective، التنمية الآن زرعت
+
+506
+00:37:39,320 --> 00:37:41,560
+على selenite if broth كيف بيشتغل selenite if
+
+507
+00:37:41,560 --> 00:37:45,580
+broth؟ هذا فيه فخ، الفخ بيقول أن حطينا
+
+508
+00:37:45,580 --> 00:37:49,180
+للبكتيريا اللاكتوز، فستن مو اللاكتوز fermenter ولا non-lactose
+
+509
+00:37:49,180 --> 00:37:52,580
+fermenter؟ non-lactose مين اللي حينمو؟ لما أنا...
+
+510
+00:37:52,580 --> 00:37:56,240
+لما أنا بحط lactose، اللاكتوز fermenter اللي حينمو
+
+511
+00:37:56,240 --> 00:38:01,280
+يبقى أنا خالفت المعيار اللي ذكرته في الأول، أنا قلت
+
+512
+00:38:01,280 --> 00:38:05,120
+أن اسمح بنمو مين اللي بدي اياها، أنا اللي بدي
+
+513
+00:38:05,120 --> 00:38:07,940
+اياها non-lactose fermenter فلماذا سمحت بنمو
+
+514
+00:38:07,940 --> 00:38:16,360
+اللاكتوز fermenter؟ سمحت لها عشان أقتلها، اللي بينمو هو
+
+515
+00:38:16,360 --> 00:38:20,960
+اللي هيموت، لأن في مادة اسمها selenite، قاتلة،
+
+516
+00:38:20,960 --> 00:38:25,300
+فهتقتل مين؟ اللي بيتكاثر، وأنا قلت لكم زمان، من
+
+517
+00:38:25,300 --> 00:38:28,660
+أول مبادئنا في ال microbiology أن تأثير ال
+
+518
+00:38:28,660 --> 00:38:31,740
+antibiotics أو ال inhibitory substances على
+
+519
+00:38:31,740 --> 00:38:34,940
+البكتيريا بيكون أكبر ما يكون لما تكون البكتيريا
+
+520
+00:38:34,940 --> 00:38:39,970
+ناشطة، ولا يكون له تأثير لما تكون البكتيريا غير
+
+521
+00:38:39,970 --> 00:38:44,410
+ناشطة، فنشطنا البكتيريا اللي بدنا نموتها بوجود
+
+522
+00:38:44,410 --> 00:38:48,630
+اللاكتوز قتلناها بال selenite، مين ضال منها؟ ال
+
+523
+00:38:48,630 --> 00:38:52,630
+non-lactose fermenting زي مين؟ زي السلمونيلا، زي
+
+524
+00:38:52,630 --> 00:38:55,970
+الشيجيلا، زي البروتيوس، زي اليرسينيا، يعني أن احنا
+
+525
+00:38:55,970 --> 00:38:58,790
+قضينا في هذه العملية على مين؟ على ال lactose
+
+526
+00:38:58,790 --> 00:39:03,610
+fermenting، من أحنا نظريا، الجهة الثانية فإندي وسط
+
+527
+00:39:03,610 --> 00:39:07,590
+selective اسمه زي ال xylose lysine deoxycholate agar وسالمونيلا
+
+528
+00:39:07,590 --> 00:39:13,530
+شيجيلا agar وهيكتون إنتريك agar أسماء كثيرة وحمراء
+
+529
+00:39:13,530 --> 00:39:19,930
+معنا أسماء أكثر للأوساط الزراعية المستخدمة لعزل
+
+530
+00:39:19,930 --> 00:39:25,590
+السالمونيلا عموما، ايش عملنا هنا؟ enrichment وال
+
+531
+00:39:25,590 --> 00:39:28,430
+enrichment يا شباب بتكون في liquid، بتكون في liquid
+
+532
+00:39:28,430 --> 00:39:34,050
+عملنا subculture منها وأنزلنا على نفس الأوساط بس
+
+533
+00:39:34,050 --> 00:39:39,350
+مش نفس الأطباق، أوساط جديدة، يعني XLD, SSA or Hektoen
+
+534
+00:39:39,350 --> 00:39:44,930
+enteric agar أي من المستعمرات اللي بتنمو هنا أو هنا
+
+535
+00:39:44,930 --> 00:39:50,270
+وسميناها suspected colonies احنا مش تبقى فاهمين
+
+536
+00:39:51,270 --> 00:39:56,190
+بنشتبه في مستعمرات لها مواصفات معروفة، مثلا
+
+537
+00:39:56,190 --> 00:39:59,510
+colorless
+
+538
+00:39:59,510 --> 00:40:03,830
+colonies containing dark center، dark center يعني
+
+539
+00:40:03,830 --> 00:40:09,510
+الوسط تبقى المستعمرة لونها أسود، لماذا اللون أسود؟
+
+540
+00:40:09,510 --> 00:40:15,250
+هذه الأوساط معظمها بيكشف عن وجود ال H2S، فاكرين
+
+541
+00:40:15,250 --> 00:40:19,870
+ال H2S؟ ايش بيعطينا اللون؟ أسود، طبعا لأنه بيتفاعل
+
+542
+00:40:19,870 --> 00:40:22,070
+مع ال Thiosulfate اللي بيحطها في ال media
+
+543
+00:40:25,210 --> 00:40:30,450
+عديمة اللون وجواها لون أسود، هذه مستعمرة مشتبه أنها
+
+544
+00:40:30,450 --> 00:40:34,610
+تكون Salmonella، وكلمة مشتبه يعني مش مؤكد، صح ولا لأ؟
+
+545
+00:40:34,610 --> 00:40:39,110
+فكيف لنا أن نتأكد أنها Salmonella ولا مش
+
+546
+00:40:39,110 --> 00:40:42,890
+Salmonella؟ أكثر من طريقة، أن ال biochemical
+
+547
+00:40:42,890 --> 00:40:47,210
+testing، ونبدأ الآن نستغل مهاراتنا في الاستثناء،
+
+548
+00:40:47,210 --> 00:40:50,250
+تمام؟ البكتيريا اللي قدامنا non-lactose fermenter،
+
+549
+00:40:50,250 --> 00:40:54,870
+non-lactose fermenter مين ممكن يتشابه معاها ومين
+
+550
+00:40:54,870 --> 00:41:02,870
+ممكن ما يتشابهش معاها؟ الشيجيلة؟ ولا السالمونيلا؟
+
+551
+00:41:02,870 --> 00:41:07,850
+طب الشيجيلة ما بتنتجش H2S؟
+
+552
+00:41:09,060 --> 00:41:13,420
+البروتيوس بنتج H2S، يبقى ايش ال suspect colony
+
+553
+00:41:13,420 --> 00:41:16,680
+للسالمونيلا؟ هتختلف عن ال suspect colony لمين؟
+
+554
+00:41:16,680 --> 00:41:22,640
+للشيجيلة، إذا أنتجت H2S هتلاقيها black center، إذا
+
+555
+00:41:22,640 --> 00:41:26,720
+ما أنتجت H2S زي الشيجيلة يبقى بدون black center،
+
+556
+00:41:26,720 --> 00:41:28,780
+ايش الشبهة؟ هو الواجهة، الشبهة بين الاثنين، أن
+
+557
+00:41:28,780 --> 00:41:34,350
+الاثنين colorless colonies، عموما Suspect colony
+
+558
+00:41:34,350 --> 00:41:37,790
+for Salmonella or for Shigella are easily
+
+559
+00:41:37,790 --> 00:41:42,150
+distinguished from other bacteria by a negative
+
+560
+00:41:42,150 --> 00:41:48,690
+urease test، من
+
+561
+00:41:48,690 --> 00:41:52,050
+ال...ال...ال...ال negative، السالمونيلا والشيجيلا
+
+562
+00:41:52,050 --> 00:41:56,750
+are negative بينما ال proteus، لسة المحاضرة اللي
+
+563
+00:41:56,750 --> 00:42:00,770
+فاتت قلنا، قلنا أن كل المجموعة اشتركت في عاملين
+
+564
+00:42:00,770 --> 00:42:05,980
+العامل الأول ايش كان؟ actively motile و rapidly
+
+565
+00:42:05,980 --> 00:42:10,540
+fermented واختلفوا عن بعض في ال H2S، البروتيوس
+
+566
+00:42:10,540 --> 00:42:13,820
+الحقيقي بتنتج H2S، والبروفيدنسيا والمورديلا لا
+
+567
+00:42:13,820 --> 00:42:18,760
+بنتجوا H2S، خذ بالكم المحاضرة هذه صارت لنا حصيلة
+
+568
+00:42:18,760 --> 00:42:22,780
+كويسة أن نعمل، ال diagram اللي عملنا، احنا عملنا
+
+569
+00:42:22,780 --> 00:42:26,360
+ال diagram الأولاني لمين؟ لل lactose fermenter، اليوم
+
+570
+00:42:26,360 --> 00:42:30,820
+بدنا نبدأ نجهز حالنا أن نعمل diagram لمين؟ لل non
+
+571
+00:42:30,820 --> 00:42:35,260
+lactose fermenting لأن خذ بالكم إذا أنت انهيت الـ
+
+572
+00:42:35,260 --> 00:42:39,500
+Enterobacteriaceae بمهارة نظرية عالية واتدربت في
+
+573
+00:42:39,500 --> 00:42:47,080
+المعمل على ال methods of detection أنت أخذت 60% من
+
+574
+00:42:47,080 --> 00:42:51,440
+ال diagnostic microbiology لأن أكثر أو the most
+
+575
+00:42:51,440 --> 00:42:53,840
+commonly encountered بكتيريا في ال clinical
+
+576
+00:42:53,840 --> 00:42:58,100
+specimens هي عائلة ال Enterobacteriaceae وال pseudomonas
+
+577
+00:42:58,100 --> 00:43:02,630
+وزميلاتها، و Pseudomonas زميلتها و ال Enterobacteriaceae
+
+578
+00:43:02,630 --> 00:43:05,010
+ما هم مجرد بعض في ال techniques وفي ال
+
+579
+00:43:05,010 --> 00:43:08,150
+biochemical tests وفي كل حاجة في ال identification
+
+580
+00:43:08,150 --> 00:43:13,750
+بنعرفهم حتى ال API-20E، و E كلمة E تعني
+
+581
+00:43:13,750 --> 00:43:18,090
+Enterobacteriaceae لكن تطلعوا على أسماء البكتيريا
+
+582
+00:43:18,090 --> 00:43:22,090
+اللي بيغطيها ال API-20E هتلاقوا Pseudomonas وأخوتها
+
+583
+00:43:22,090 --> 00:43:25,130
+لأنهم بيشبهوا كتير مع مين؟ مع ال Enterobacteriaceae
+
+584
+00:43:26,380 --> 00:43:30,480
+طيب، طبعا هذه أوساط أنتم بتلاحظوا الأسماء الغالبة
+
+585
+00:43:30,480 --> 00:43:35,320
+فيهم ايش؟ أن فيها black colonies ناتجة عن ال
+
+586
+00:43:35,320 --> 00:43:41,700
+production of H2S، طبعا اسمها deoxycholate citrate
+
+587
+00:43:41,700 --> 00:43:44,420
+agar و Salmonella Shigella agar واحنا كل فصل
+
+588
+00:43:44,420 --> 00:43:48,280
+الحقيقة بنقولها هذا فيه اسمه bismuth sulfite agar
+
+589
+00:43:48,280 --> 00:43:54,040
+برضه كان من الأوساط الرائعة جداً للسالمونيلا، كل فصل
+
+590
+00:43:54,040 --> 00:43:58,960
+بيقول للطلاب ك assignment، كواجب، تمام؟ يا شباب فيه
+
+591
+00:43:58,960 --> 00:44:02,520
+ناس كثيرة مرت علينا في المحاضرة هذه من أوساط
+
+592
+00:44:02,520 --> 00:44:06,650
+زراعية تستخدم للسالمونيلا، أرجو من حضرتكم أن كنتم
+
+593
+00:44:06,650 --> 00:44:10,890
+تعملون assignment، ايش ال assignment هذه؟ أنه تعمل
+
+594
+00:44:10,890 --> 00:44:16,630
+search، والإنترنت مليء الآن بأدلة، أدلة، دليل يعني
+
+595
+00:44:16,630 --> 00:44:25,130
+أو كتالوجات للميديا، وأحد الشركات زي Oxoid،
+
+596
+00:44:25,130 --> 00:44:27,710
+ماعرفش اسمها في اسمها ده ولا لأ، Oxoid
+
+597
+00:44:30,770 --> 00:44:36,350
+هذه شركة محترمة جداً لإنتاج المستلزمات المخبرية في
+
+598
+00:44:36,350 --> 00:44:40,890
+ال microbiology وفي شركة هندية مطورة نوعاً ما اسمها
+
+599
+00:44:40,890 --> 00:44:43,330
+HiMedia
+
+600
+00:44:44,540 --> 00:44:48,920
+احنا ما بنعملش دعاية للشركات هنا لكن بنقول لكم أن
+
+601
+00:44:48,920 --> 00:44:54,560
+هذين الاثنين موفرين أو متاحين خلينا نقول معلومات
+
+602
+00:44:54,560 --> 00:44:58,440
+كتير مفصلة عن تركيبة الأوساط وعن ال quality
+
+603
+00:44:58,440 --> 00:45:02,040
+control وكيف بيطلع شكل البكتيريا الفلانية وكيف
+
+604
+00:45:02,040 --> 00:45:06,120
+بيطلع شكل البكتيريا الأخرى، يعني فيهن تفاصيل وبالتالي
+
+605
+00:45:06,120 --> 00:45:11,870
+مطلوب منكم يا طلاب أن نعرف الأوساط الزراعية المختلفة، ما
+
+606
+00:45:11,870 --> 00:45:17,290
+لون السالمونيلا بمعنى ما، مواصفات السالمونيلا،
+
+607
+00:45:17,290 --> 00:45:22,130
+ما مواصفات الشيجيلا وما مواصفات الميكروبات اللي ممكن
+
+608
+00:45:22,130 --> 00:45:26,210
+تنمو على هذه الأوساط، تمام؟ فهذا يعني جزء من
+
+609
+00:45:26,210 --> 00:45:35,810
+الواجبات المطلوبة
+
+610
+00:45:38,810 --> 00:45:41,810
+biochemical characteristics triple sugar iron agar
+
+611
+00:45:41,810 --> 00:45:46,910
+للبكتيريا هي عبارة عن alkaline slant acid butt
+
+612
+00:45:46,910 --> 00:45:50,370
+with a small amount of H2S، أسهلوا هذه الجملة، small
+
+613
+00:45:50,370 --> 00:45:53,130
+amount لكن مش دقيقة، الصحيحة يعني هيكون عشان ايش ال
+
+614
+00:45:53,130 --> 00:45:59,250
+reaction K على A plus، انت كلمة small أعطاك انطباع
+
+615
+00:45:59,250 --> 00:46:01,970
+أنها اختلفت، يعني ليش بتكون يعني يعني هي triple
+
+616
+00:46:01,970 --> 00:46:09,490
+sugar iron agar هي K اللي هو red وهي black، لكن ال
+
+617
+00:46:09,490 --> 00:46:13,550
+black ماخد ايه؟  نتفة صغيرة من أو جزء صغير من
+
+618
+00:46:13,550 --> 00:46:18,210
+الأجار، والباقي حاليا بين ايه؟ هذا الكلام نوعاً ما
+
+619
+00:46:18,210 --> 00:46:23,630
+ممكن يكون صحيح، ليش بيقول المعلومة هذه؟ هذه معلومة
+
+620
+00:46:23,630 --> 00:46:29,070
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/lG59Gp1r8F0_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/lG59Gp1r8F0_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..efcd0fa2df5547ff92477fd4f15147d4da8d6941
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/lG59Gp1r8F0_postprocess.srt
@@ -0,0 +1,2540 @@
+1
+00:00:20,670 --> 00:00:24,030
+بسم الله الرحمن الرحيم نكمل الموضوع السلمونيلا
+
+2
+00:00:24,030 --> 00:00:28,670
+المحاضرة الماضية اتحدثنا عن بعض الصفات للسلمونيلا
+
+3
+00:00:28,670 --> 00:00:31,710
+و بعض الأسماء ذكرنا سلمونيلا تايفي و بيرا تايفي A
+
+4
+00:00:31,710 --> 00:00:37,050
+و B و C انترادايدس كولارسويس بولروم جاليناروم و
+
+5
+00:00:37,050 --> 00:00:40,970
+بعدين اتحدثنا عن ال .. ال .. ال wide range hosts
+
+6
+00:00:40,970 --> 00:00:46,910
+اللي السلمونيلا بشكل عام بتأثر فيه اما جونا ك
+
+7
+00:00:46,910 --> 00:00:51,050
+career او ك infectionواستثنينا من هذا ال wide
+
+8
+00:00:51,050 --> 00:00:53,930
+range host اللي هو السلمونيلا التايفي والبراتايفي
+
+9
+00:00:53,930 --> 00:00:58,150
+ولأ خلينا نكون دقيق براتايفي A و براتايفي B لأن ال
+
+10
+00:00:58,150 --> 00:01:02,650
+C لها host الخنزير كلامكم الله وبدأنا بالحديث عن
+
+11
+00:01:02,650 --> 00:01:07,090
+الأمراض اللي بتسببها السلمونيلا وتحدثنا عن three
+
+12
+00:01:07,090 --> 00:01:12,490
+categories septicemiaو food infection type اللي
+
+13
+00:01:12,490 --> 00:01:15,410
+قولنا acute gastroenteritis ورقم تلاتة اللي احنا
+
+14
+00:01:15,410 --> 00:01:19,150
+بدأنا نشرح فيه اللي هو ال enteric fevers التايفويد
+
+15
+00:01:19,150 --> 00:01:21,950
+والبقرة تايفويد وما نقوله عن التايفويد ينطبق على
+
+16
+00:01:21,950 --> 00:01:27,410
+البقرة تايفويدتحدثنا عن ال sequence of event من ال
+
+17
+00:01:27,410 --> 00:01:30,370
+ingestion لل invasion of the intestinal wall لل
+
+18
+00:01:30,370 --> 00:01:35,270
+lymph node ومن ثم ل ال primary بكتيريميا أو
+
+19
+00:01:35,270 --> 00:01:38,350
+septicemia وبعدين ال organs بيصير multiplication
+
+20
+00:01:38,350 --> 00:01:42,290
+للبكتيريا وبعد مرة أخرى بيصير فيه انتشار أكبر
+
+21
+00:01:42,290 --> 00:01:48,830
+وأوسع للبكتيريا ب secondary septicemia واختفاءبصير
+
+22
+00:01:48,830 --> 00:01:52,970
+فينا اختفاء كمال من لسلمونيلا من ال blood نتيجة
+
+23
+00:01:52,970 --> 00:01:56,250
+ظهور ال antibodies وكنا في بعض الأنواع من
+
+24
+00:01:56,250 --> 00:01:58,470
+السلمونيلا أو بعض الحيات من السلمونيلا البكتيريا
+
+25
+00:01:58,470 --> 00:02:02,150
+تذهب إلى ال goal blooder وبتبقى هناك وبتشكلنا
+
+26
+00:02:02,150 --> 00:02:08,250
+وبتشكلنا كاريار استهيلة يبقى لما ذكرنا ال sequence
+
+27
+00:02:08,250 --> 00:02:12,870
+of events كنا العملية نفسها مهمة عشان نعرف متى
+
+28
+00:02:12,870 --> 00:02:17,910
+ناخد عينةوإيش نوع العينة اللي ناخدها وفي أي فترة
+
+29
+00:02:17,910 --> 00:02:21,470
+في سبيل الحصول على أفضل diagnosis أو أفضل
+
+30
+00:02:21,470 --> 00:02:25,030
+laboratory diagnosis لـtyphoid و para-typhoid في
+
+31
+00:02:25,030 --> 00:02:28,070
+البلد لكن لسه احنا ماوصلنا لموضوع العينات فبتاني
+
+32
+00:02:28,070 --> 00:02:32,260
+نكمل موضوع ال diseaseتانده هاسمها Nephrotyphoid و
+
+33
+00:02:32,260 --> 00:02:36,380
+الـ Nephrotyphoid هو واضح من كلمة نفر وين ال
+
+34
+00:02:36,380 --> 00:02:39,980
+disease في ال kidneys لكن خدوا بالكوا ليس المقصود
+
+35
+00:02:39,980 --> 00:02:43,240
+هنا ان الميكروب بيعمل infection في ال kidney و
+
+36
+00:02:43,240 --> 00:02:47,260
+انما انا قلت فيه antigen antibody reaction مش
+
+37
+00:02:47,260 --> 00:02:51,040
+هيتكون antibody يبجي السلمونيلةو ال antibody
+
+38
+00:02:51,040 --> 00:02:54,840
+هيتفاعلوا مع بعض، الآن لما بتكون ال salmonella
+
+39
+00:02:54,840 --> 00:02:59,560
+بشكل ديبرز، ديبرز يعني بقاية سلمونيلا، سلمونيلا
+
+40
+00:02:59,560 --> 00:03:03,560
+ميتة، فال antibody بيرتبط مع ال antigen، الان ال
+
+41
+00:03:03,560 --> 00:03:07,840
+antigen انتبادي complex بيلف مع الدم، لما يلف مع
+
+42
+00:03:07,840 --> 00:03:11,420
+الدم مش كل الدم بيمور عبر الكلية، المفروض انه يصير
+
+43
+00:03:11,420 --> 00:03:15,140
+له removal أو filtration، لكن حجمه كبير وبالتالي
+
+44
+00:03:15,140 --> 00:03:18,870
+بيصير له precipitation في الكدنالان تذكروا حاجة
+
+45
+00:03:18,870 --> 00:03:24,030
+انه في انتجن مرتبط مع antibody الانتجن binding مع
+
+46
+00:03:24,030 --> 00:03:26,310
+الانتجن بيعمل activation ل ال complement ال
+
+47
+00:03:26,310 --> 00:03:29,190
+complement و ال attack، attack مين في هالحالة؟
+
+48
+00:03:29,190 --> 00:03:32,730
+النفرون سبعت اللي هو ال kidney بتاعي يسمينا نفرو
+
+49
+00:03:32,730 --> 00:03:36,190
+تايفوي ليس ناتج عن البكتيريا ال infection انما
+
+50
+00:03:36,190 --> 00:03:38,830
+ناتج عن ايه؟ عن ال immune complexes immune
+
+51
+00:03:38,830 --> 00:03:42,140
+complexes يعني انتجن antibody reactionبينما ال
+
+52
+00:03:42,140 --> 00:03:46,880
+osteomyelitis لأ هي ناتجة عن وصول البكتيريا إلى
+
+53
+00:03:46,880 --> 00:03:50,480
+العضم أو نخاء العضم خاصة في الأطفال اللي عندهم
+
+54
+00:03:50,480 --> 00:03:52,880
+sickle cell anemia
+
+55
+00:03:55,000 --> 00:03:58,600
+بقولنا هنا انه طبعا ثلاثيمية تفويت in children can
+
+56
+00:03:58,600 --> 00:04:02,420
+be found in the bone marrow طب هذه نقطة كتير مهمة
+
+57
+00:04:02,420 --> 00:04:05,640
+in the bone marrow ما احنا كنا وعلّلنا هذا الكلام
+
+58
+00:04:05,640 --> 00:04:08,380
+في ال story لما كنا ان البكتيريا بتحب تروح لوين
+
+59
+00:04:08,380 --> 00:04:11,680
+على ال reticulum endothelial system اللي من ضمنه
+
+60
+00:04:11,680 --> 00:04:16,040
+ال bone marrow وبالتالي ال bone marrow قد يصلح
+
+61
+00:04:16,040 --> 00:04:23,430
+عينة لل culture للبحث عن سلمونية للتعافىطبعا بقى
+
+62
+00:04:23,430 --> 00:04:26,910
+ممكن نعمل نسموها typhoid arthritis ابسسز احنا نقول
+
+63
+00:04:26,910 --> 00:04:32,290
+ان ال salmonella will circulate in the blood and
+
+64
+00:04:32,290 --> 00:04:35,050
+reach to distant organs تقريبا كل الأعضاء في الجسم
+
+65
+00:04:35,050 --> 00:04:37,590
+تصل لها ال salmonella فبعض الأحيان ال
+
+66
+00:04:37,590 --> 00:04:40,910
+multiplication في هذا ال organ بيعمل ابسسز خرجات
+
+67
+00:04:40,910 --> 00:04:46,100
+دمامي تمام في هذه الليلةطبعا كمان احد ال diseases
+
+68
+00:04:46,100 --> 00:04:50,520
+اللى ممكن تسببها السلمونيلا تصوروا انه السلمونيلا
+
+69
+00:04:50,520 --> 00:04:53,500
+التايفي بعد ما وصلت الدم استطعت انها تخترق حاجز
+
+70
+00:04:53,500 --> 00:04:57,900
+الدم و ال CSF و وصلت لمين؟ للمنينجيز اللي هي
+
+71
+00:04:57,900 --> 00:05:00,660
+الأغشة المغلفة للدماء و تماما في هذا الحالة
+
+72
+00:05:00,660 --> 00:05:04,480
+السلمونيلا التايفي meningitis which is برضه very
+
+73
+00:05:04,480 --> 00:05:05,640
+difficult condition
+
+74
+00:05:09,030 --> 00:05:12,670
+ما هي محددات او ال virulence factors محددات ال
+
+75
+00:05:12,670 --> 00:05:14,730
+pathogenesis او ال virulence factors ل ال
+
+76
+00:05:14,730 --> 00:05:20,510
+salmonella type احنا كلنا متفقين متفقين على ان ال
+
+77
+00:05:20,510 --> 00:05:24,570
+salmonella هي انترو بكترياسي وبالتالي تمتلك gram
+
+78
+00:05:24,570 --> 00:05:28,730
+negative cell wall cell wall يبقى تحتوي على
+
+79
+00:05:28,730 --> 00:05:32,770
+lipopolysaccharide اللي من ضمنه مين؟ اللي هو من
+
+80
+00:05:32,770 --> 00:05:35,470
+ضمنه ال o-antigen من ضمنه ال o-antigen بقول ال
+
+81
+00:05:35,470 --> 00:05:40,600
+surface antigenالـ Surface له علاقة كبيرة في مقدرة
+
+82
+00:05:40,600 --> 00:05:42,960
+السلمونيلا على الـ Attachment of Surfaces On
+
+83
+00:05:42,960 --> 00:05:47,460
+Surface يعني ترتبط بمين؟ بالأسطح يبدو أن الأسطح
+
+84
+00:05:47,460 --> 00:05:51,360
+تبعتنا .. تبعت الأنسجل تبعتنا تمتلك Receptor لمين؟
+
+85
+00:05:51,360 --> 00:05:54,840
+للـ O-Antigen أو للـ O-Receptors اللي موجودة على
+
+86
+00:05:54,840 --> 00:05:58,840
+السلمونيلا احنا قلنا يا شباب بممكن من أهم يعني ال
+
+87
+00:05:58,840 --> 00:06:01,800
+Virulence Factors اللي ذكرناها سابقا في مقدمتنا في
+
+88
+00:06:01,800 --> 00:06:04,780
+ال Microbiology المقدرة على ال Attachment لأن بدون
+
+89
+00:06:04,780 --> 00:06:08,650
+Attachment قلنا ..فيش أنه مُلتبليجيشن فيش أنه
+
+90
+00:06:08,650 --> 00:06:11,630
+كورونايزيشن فيش أنه انفكشن فيش أنه disease
+
+91
+00:06:11,630 --> 00:06:15,010
+وبالتالي the first step is attachment وبالتالي هذا
+
+92
+00:06:15,010 --> 00:06:20,310
+بيوفرلها هذه القضية طبعا بعض ال .. ال salmonella
+
+93
+00:06:20,310 --> 00:06:24,710
+فيها ال V.I. antigen و ال V.I. معبر عن مين؟ عن
+
+94
+00:06:24,710 --> 00:06:28,390
+الكابسول طب الكابسول تخدم غرضين خدوا بالكم
+
+95
+00:06:28,390 --> 00:06:32,390
+الكابسول تخدم غرضين الغرض الأول بيقولنا عنه حماية
+
+96
+00:06:32,390 --> 00:06:36,750
+من الفاجو و cytosis و أنايعني الصفة دي بتلزمنيش في
+
+97
+00:06:36,750 --> 00:06:39,290
+ال salmonella، عارفين ليش؟ لأن ال salmonella اللي
+
+98
+00:06:39,290 --> 00:06:43,370
+قلنا عنها قادرة على ال intracellular existence،
+
+99
+00:06:43,370 --> 00:06:47,210
+يعني لو ال macro phage أخدتها جوا، تستطيع أن تكثر
+
+100
+00:06:47,210 --> 00:06:50,370
+في الداخل و هكذا، وبالتالي ليس هذا الغرض الأساسي
+
+101
+00:06:50,370 --> 00:06:54,260
+من مين؟ من الكابسول، فده الحالةلكن كمان احد
+
+102
+00:06:54,260 --> 00:06:57,720
+الأشياء المهمة جدا عن الكابسولة زى ما عرفها ان هي
+
+103
+00:06:57,720 --> 00:07:01,340
+بتساعد برضه فى ال attachment وضيفة عكس الهروب من
+
+104
+00:07:01,340 --> 00:07:05,380
+ال phagocytosis ليش او كيف على الرغم من انها
+
+105
+00:07:05,380 --> 00:07:09,700
+اميوكايدى كلمة اميوكايدى يعنى slippery يعنى لو
+
+106
+00:07:09,700 --> 00:07:14,220
+جينا نمسكها لو الماكرو فاج انا تمسك البكتيرا اللى
+
+107
+00:07:14,220 --> 00:07:19,400
+فيها كابسول الكابسول لإنها slippery يعني لزجة
+
+108
+00:07:19,400 --> 00:07:23,960
+فبالتالي بتهرب ايه بتهرب منها؟طب كيف تهرب و في نفس
+
+109
+00:07:23,960 --> 00:07:28,880
+الوقت attachment؟ كيف ابتحرب و كيف attachment في
+
+110
+00:07:28,880 --> 00:07:33,230
+نفس الوقت؟الان لما يكون ال polysaccharide تبع
+
+111
+00:07:33,230 --> 00:07:38,050
+الكبسول ريسبتور على الخلايا فدلحالة لا ال slippery
+
+112
+00:07:38,050 --> 00:07:43,170
+appearance ولا ال slimy appearance بيأثر لإن الان
+
+113
+00:07:43,170 --> 00:07:47,290
+في اندي specific receptor receptor interaction
+
+114
+00:07:47,290 --> 00:07:53,170
+وبالتالي ال VIN برضه كمان عامل مساعد عالميا على ال
+
+115
+00:07:53,170 --> 00:07:58,680
+attachmentكمان مرة هي صفة عكس مين عكس اللي هي to
+
+116
+00:07:58,680 --> 00:08:02,580
+escape the process of phagocytosis رقم اتنين
+
+117
+00:08:02,580 --> 00:08:06,040
+Invasiveness ذكرتلكوا انا في بداية القصة ان
+
+118
+00:08:06,040 --> 00:08:09,440
+البكتيريا ليزلت وصلت للانتستين بعدين it invaded
+
+119
+00:08:09,440 --> 00:08:12,780
+اللي هو ال intestinal wall وذهبت لل lymph node و
+
+120
+00:08:12,780 --> 00:08:16,040
+بعدين راحت على ال blood المقدر على ال invasion
+
+121
+00:08:16,040 --> 00:08:19,900
+عزونها على ايش هنا عزونها على ايش لإنتاج ما يسمى
+
+122
+00:08:19,900 --> 00:08:20,760
+بال type 3
+
+123
+00:08:25,680 --> 00:08:30,920
+secretory system اللي سمناها باسم تاني molecular
+
+124
+00:08:30,920 --> 00:08:34,400
+syringes بتذكروها المصطلح هذا؟ بيقولنا سرنجات
+
+125
+00:08:34,400 --> 00:08:39,360
+جزيئية يعني صغيرة الحجم وبالتالي استطاعت البكتيريا
+
+126
+00:08:39,360 --> 00:08:43,380
+.. اذاكركوا بس على السريع عشان بلاش نكون نسينا هذه
+
+127
+00:08:43,380 --> 00:08:46,680
+العملية ان هذه الخلايا اللي بيقولنا عنها هي أصلا
+
+128
+00:08:46,680 --> 00:08:50,180
+مش phagocytic cell مين اللي خليها phagocytic cell؟
+
+129
+00:08:50,180 --> 00:08:56,170
+كيف خلتها phagocytic cell؟حقنتها بواسطة الـ type
+
+130
+00:08:56,170 --> 00:08:59,710
+III secretory system وجعلت الـ cytoskeleton يعمل
+
+131
+00:08:59,710 --> 00:09:04,030
+عملية phago cytosis ل الخلية نفسها، إذن ال
+
+132
+00:09:04,030 --> 00:09:10,170
+invasiveness مهم جدا، طبعا كمان مرة المقضرة تبعتها
+
+133
+00:09:10,170 --> 00:09:13,810
+على إنها تعمل intracellular existence to escape
+
+134
+00:09:13,810 --> 00:09:18,210
+the killing action of phagocytes أو macrophages
+
+135
+00:09:20,130 --> 00:09:23,430
+الاندوتكسين ما هو جزء من مين؟ من ال life of
+
+136
+00:09:23,430 --> 00:09:26,970
+polysaccharides انا قلتلكوا لا يولد جرام نيجاتيف
+
+137
+00:09:26,970 --> 00:09:32,270
+بكتيريا pathogen تمام والاندوتكسين تبعها مالوش دخل
+
+138
+00:09:32,270 --> 00:09:36,890
+في ال pathogenesis يعني هو بجزء أساسي من ال
+
+139
+00:09:36,890 --> 00:09:41,050
+pathogenesisother factors بعض ال salmonella احنا
+
+140
+00:09:41,050 --> 00:09:45,290
+مش سمينا الفيفر سمينا ايش انتريك فيفر الواد
+
+141
+00:09:45,290 --> 00:09:48,530
+تايفايت فيفر سميناه او وصفناه انتريك فيفر
+
+142
+00:09:48,530 --> 00:09:52,150
+فالبكتيريا غالبا تنتج انتروتوكسين الآن خدنا نوضح
+
+143
+00:09:52,150 --> 00:09:58,730
+نقطةقلنا اكزوتوكسين واندوتوكسين صنفناهم بنوع ال
+
+144
+00:09:58,730 --> 00:10:03,950
+mechanism of production واحدة بتنتج while the cell
+
+145
+00:10:03,950 --> 00:10:08,450
+is alive سمنها اكزوتوكسين وواحدة بتنتج بعد بتموت
+
+146
+00:10:08,450 --> 00:10:12,650
+سمنها اندوتوكسين هذا based on mechanism of
+
+147
+00:10:12,650 --> 00:10:18,950
+production لكن في تصنيفات أخرى للتوكسين according
+
+148
+00:10:18,950 --> 00:10:23,310
+to the site affectedيعني لو كان التأثير على ال
+
+149
+00:10:23,310 --> 00:10:26,930
+intestine بنسميه enterotoxin لو كان على الخلايا
+
+150
+00:10:26,930 --> 00:10:31,030
+العصبية بنسميه neurotoxin لو على الخلايا بشكل عام
+
+151
+00:10:31,030 --> 00:10:36,170
+بسموه cytotoxin بعض الاحيان بسموه ليوكوسايدين قاتل
+
+152
+00:10:36,170 --> 00:10:41,370
+لمين؟ لليوكوسايد نفسه و hemolysin specific لمين؟
+
+153
+00:10:41,370 --> 00:10:44,970
+لل red blood cell وبالتالي التسمية هذه أو التصنيف
+
+154
+00:10:44,970 --> 00:10:47,750
+هذا بيننا على مين؟ على ال site affected نعم اللي
+
+155
+00:10:47,750 --> 00:10:51,850
+اللي بتأثرفقلنا في اين اين تيروتوكسين و في اين دي
+
+156
+00:10:51,850 --> 00:10:58,390
+ايضا كمان اللي هو cytotoxin نجي للموضوع المتعلق
+
+157
+00:10:58,390 --> 00:11:00,770
+بال laboratory of Salmonella حد يسميها
+
+158
+00:11:00,770 --> 00:11:05,130
+classification of Salmonella في system مشهور في
+
+159
+00:11:05,130 --> 00:11:10,410
+العالم اسمه Kaufmann-White system
+
+160
+00:11:14,090 --> 00:11:19,990
+هذا ال system صنّف السلمونيلا بناء على ال O و ال H
+
+161
+00:11:19,990 --> 00:11:25,810
+أنتجين ال O أنتجين مولود في كل جرام نيجاتيف
+
+162
+00:11:25,810 --> 00:11:30,270
+بكتيريا وال H أنتجين مولود فقط في تلك التي تتحرك
+
+163
+00:11:30,270 --> 00:11:33,570
+اللي عندها أفلاجلة، اللي عندها أفلاجلة
+
+164
+00:11:35,970 --> 00:11:39,550
+ممكن احنا نوظف في ال system هذا اذا كان ال V-I
+
+165
+00:11:39,550 --> 00:11:45,670
+انتجين اذا كان فيها V-I انتجين اذا three antigens
+
+166
+00:11:45,670 --> 00:11:49,230
+are used in this system اللي هو اسمه كوفمان وايد
+
+167
+00:11:49,230 --> 00:11:53,030
+system رقم واحد اللي هو ال O انتجين وال H انتجين و
+
+168
+00:11:53,030 --> 00:11:59,190
+ال V-I انتجين اذكركوا بس بال H انتجين فاكرين مرة
+
+169
+00:11:59,190 --> 00:12:03,370
+قولنا ان ال H انتجين او phase variation phase
+
+170
+00:12:03,370 --> 00:12:10,430
+variation H انتجينويمكن اكتر ميكروب اكتر ميكروب
+
+171
+00:12:10,430 --> 00:12:19,510
+اكتر ميكروب اكتر ميكروب
+
+172
+00:12:19,510 --> 00:12:19,670
+اكتر ميكروب اكتر ميكروب اكتر ميكروب اكتر ميكروب
+
+173
+00:12:19,670 --> 00:12:20,450
+اكتر ميكروب اكتر ميكروب اكتر ميكروب اكتر ميكروب
+
+174
+00:12:20,450 --> 00:12:20,830
+اكتر ميكروب اكتر ميكروب اكتر ميكروب اكتر ميكروب
+
+175
+00:12:20,830 --> 00:12:26,290
+اكتر ميكروب اكتر ميكروب اكتر ميكروب اكتر
+
+176
+00:12:26,290 --> 00:12:32,590
+ميكروب اكتر ميكروب اكتر ميكروب اكتر ميكروب اكتر
+
+177
+00:12:32,590 --> 00:12:37,150
+ميكروب اكتر مفقط للـ Salmonella عشان هي يا شباب it
+
+178
+00:12:37,150 --> 00:12:41,330
+is not practical for routine laboratories to stack
+
+179
+00:12:41,330 --> 00:12:47,090
+all the serological antibodies to detect the type
+
+180
+00:12:47,090 --> 00:12:50,150
+of Salmonella هاش لحل لما نازل Salmonella في بلدنا
+
+181
+00:12:50,150 --> 00:12:56,850
+كي بنعرف أي serotype في البلد اللي في العموم بيكون
+
+182
+00:12:56,850 --> 00:12:58,550
+فيها حاسبها reference laboratory
+
+183
+00:13:05,120 --> 00:13:09,000
+إيش يعني reference lab؟ يعني مختبر مرجعية بمعنى إن
+
+184
+00:13:09,000 --> 00:13:12,080
+لو أنا عزلت ميكروب أنا غير قادر على تحديد هويته
+
+185
+00:13:12,080 --> 00:13:15,320
+بالضبط بابعته لهذا المختبر غالبا في الدولة بيكون
+
+186
+00:13:15,320 --> 00:13:18,660
+في واحد أو اتنين أو إذا كان دولة مترامية الأطراف
+
+187
+00:13:18,660 --> 00:13:21,820
+بيكون في كل محافظة reference laboratory لكن احنا
+
+188
+00:13:21,820 --> 00:13:25,640
+للأسف في قطاع غزة الحبيب لحد الآن لا يولد
+
+189
+00:13:25,640 --> 00:13:30,360
+reference laboratory لكن .. لكن .. لا لا ولا في
+
+190
+00:13:30,360 --> 00:13:36,830
+مساعة حتى .. مولا في مساعةهذا حلم و حلم التحقيقه
+
+191
+00:13:36,830 --> 00:13:40,470
+مش سهل و بده إمكانات ضخمة لكن انا بقولكوا انه
+
+192
+00:13:40,470 --> 00:13:45,270
+نستطيع خلينا نقول نتعرف على ال salmonella ليس بدقة
+
+193
+00:13:45,270 --> 00:13:47,890
+ال reference lab ولكن على الأقل بدرجة و انا
+
+194
+00:13:47,890 --> 00:13:51,150
+هحكيلكوا موضوع التعرف على البكتيريا و الخدمات اللي
+
+195
+00:13:51,150 --> 00:13:56,150
+ممكن يقدمها مختبر ال microbiologyأحنا مستوى
+
+196
+00:13:56,150 --> 00:14:00,030
+الخدمات فاكرين لما قلنا Genes إشريشيا ومرة قلنا
+
+197
+00:14:00,030 --> 00:14:04,810
+إشريشيا Koli ومرة قلنا إشريشيا Koli O157H7
+
+198
+00:14:06,600 --> 00:14:08,980
+طب قبل ما انا اصل ايه شريشي اكولايا كنت اقول انترو
+
+199
+00:14:08,980 --> 00:14:11,400
+بكترياسي واحدة من الانترو بكترياسي و قبل انترو
+
+200
+00:14:11,400 --> 00:14:14,320
+بكترياسي كنت اقول جرام نيجاتيف بس الله في أحد
+
+201
+00:14:14,320 --> 00:14:18,400
+السنوات لما ماكانش فيانا اي امكانية في المختبر الا
+
+202
+00:14:18,400 --> 00:14:22,280
+لجرامستين كنا نعرف البكتيريا للطبيب و نقوله جرام
+
+203
+00:14:22,280 --> 00:14:24,860
+بوستف او جرام نيجاتيف بس الله و الله كوكساين هاي
+
+204
+00:14:24,860 --> 00:14:29,040
+مستوى الخدمات مبني على مين؟على ما هو متوفر لدينا
+
+205
+00:14:29,040 --> 00:14:33,500
+في الليلة لما زادت مستوى الخدمة صار عندنا إمكانية
+
+206
+00:14:33,500 --> 00:14:38,940
+نتعرف على ال genus نميزهم مثلًا مثلًا مثلًا مثلًا
+
+207
+00:14:38,940 --> 00:14:41,520
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+208
+00:14:41,520 --> 00:14:42,740
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+209
+00:14:42,740 --> 00:14:45,180
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا
+
+210
+00:14:45,180 --> 00:14:53,820
+مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مثلًا مث
+
+211
+00:14:54,090 --> 00:14:58,470
+بعد فترة صررنا serology صرنا نقول equalio157h7
+
+212
+00:14:58,470 --> 00:15:02,650
+يبقى المستوى الخدمات المقدمة مرتبط بمين بقدرة
+
+213
+00:15:02,650 --> 00:15:08,190
+المختبر لكن طبعا كل ما زادت او كل ما زادت دقة
+
+214
+00:15:08,190 --> 00:15:13,810
+التعريف كل ما ارتقت الخدمة المقدمة للجمهور وعقصد
+
+215
+00:15:13,810 --> 00:15:17,750
+جمهورنا مين احنا الاطباء او المرضى او الصحة العامة
+
+216
+00:15:17,750 --> 00:15:22,380
+او العاملين في مجال ال infection controlما بدنا
+
+217
+00:15:22,380 --> 00:15:26,620
+نخلّي عدم موجود reference lab انه والله خلاص هذا
+
+218
+00:15:26,620 --> 00:15:29,220
+يعني ان احنا السلمونيلا مش هتعرف عليها لأ احنا هنا
+
+219
+00:15:29,220 --> 00:15:33,600
+بنعزل سلمونيلا وبنحاول نتعرف على ال space تبعتها
+
+220
+00:15:33,600 --> 00:15:39,240
+وبعض الأحيان بنتعرف على what antigens are common
+
+221
+00:15:39,240 --> 00:15:44,320
+in Gaza بنحاول نتعرف عليهم برضه نيجي لل O antigen
+
+222
+00:15:44,320 --> 00:15:49,780
+ال O antigen وان السلمونيلا are grouped by their O
+
+223
+00:15:49,780 --> 00:15:55,830
+antigenas groups a to z خلصنا الأحرف الأبجدية اللي
+
+224
+00:15:55,830 --> 00:15:59,310
+هو الإنجليزية و بدنا نعطي أرقام fifty one to sixty
+
+225
+00:15:59,310 --> 00:16:01,990
+one او sixty four to sixty six
+
+226
+00:16:05,320 --> 00:16:08,600
+فاكرين أول جملة حكيناها في السلمونيلا؟ قولنا كل
+
+227
+00:16:08,600 --> 00:16:13,540
+السلمونيلا على الإطلاق كلها تعتبر ايه؟ pathogen
+
+228
+00:16:13,540 --> 00:16:17,000
+لأنه لما ذكرنا الجملة تبعها ال FDA ال FDA اللي هي
+
+229
+00:16:17,000 --> 00:16:20,940
+ال food and drug administration منظمة او إدارة
+
+230
+00:16:20,940 --> 00:16:23,800
+الغذاء والدواء في الولايات المتحدة من أشهر
+
+231
+00:16:23,800 --> 00:16:29,000
+المنظمات المنظمة FDA food and drug administration
+
+232
+00:16:29,000 --> 00:16:36,530
+مافيش غذاء مافيش علاجبياخد ترخيص إلا بيمر فحوصات
+
+233
+00:16:36,530 --> 00:16:39,970
+دقيقة عشان ياخد ترخيص من هذه المؤسسة اللي هي ال
+
+234
+00:16:39,970 --> 00:16:45,910
+FDA ال FDA جالت إنه وجود أي سيروتاعيب في
+
+235
+00:16:45,910 --> 00:16:50,070
+السالمونيلا يجعل الغذاء أو الماء اللي محتوى على
+
+236
+00:16:50,070 --> 00:16:52,870
+السالمونيلا غير صلاة استهلاك الأدب مؤشرة أن كلهم
+
+237
+00:16:52,870 --> 00:16:57,490
+pathogen لكن بيقولنا هنا في الجملة many of the
+
+238
+00:16:57,490 --> 00:16:59,970
+medically important salmonella belongs to the
+
+239
+00:16:59,970 --> 00:17:05,310
+group A to Gيعني هذا المعنى انه انه اللي بعد ال G
+
+240
+00:17:05,310 --> 00:17:11,110
+مش مش مهمين أقل انتشارا أقل انتشارا لكن كلهم كمرة
+
+241
+00:17:11,110 --> 00:17:13,830
+ما بداش نفهم من الجملة انه في pathogen و في none
+
+242
+00:17:13,830 --> 00:17:20,290
+pathogen نفهم انه في منهم مهمين اكتر من التانين بس
+
+243
+00:17:20,290 --> 00:17:24,610
+each group has what is called a group factor ايش
+
+244
+00:17:24,610 --> 00:17:30,540
+العامل المشترك بينكوا انتوا؟ لأفي المحاضرة هذه
+
+245
+00:17:30,540 --> 00:17:33,840
+انكم مسجلين مساق diagnostic microbiology لكن واحد
+
+246
+00:17:33,840 --> 00:17:36,800
+مسجل مساق hematology واحد مسجل مساق clinical
+
+247
+00:17:36,800 --> 00:17:40,160
+chemistry مش بالضروري انكم تكونوا مسجلين نفس
+
+248
+00:17:40,160 --> 00:17:44,140
+المساقات لكن عندي في المحاضرة هذه الشئ المشترك
+
+249
+00:17:44,140 --> 00:17:47,800
+بينكم انكم كلكم مسجلين diagnostic microbiology
+
+250
+00:17:47,800 --> 00:17:51,620
+فلما بنجسم ال groups في serology احنا بنقول في one
+
+251
+00:17:51,620 --> 00:17:56,000
+common antigenهذا ال common antigen is unique to
+
+252
+00:17:56,000 --> 00:17:58,820
+this group، ايش يعني unique؟ فريد لهذا المجموع، ال
+
+253
+00:17:58,820 --> 00:18:04,800
+diagnostic micro biology تبعتنا، هذا ال unique
+
+254
+00:18:04,800 --> 00:18:09,040
+antigen بيسميه group factor، هو العامل اللي على
+
+255
+00:18:09,040 --> 00:18:14,840
+أساسه أعطيت المجموعة رقمها أو اسمها أو حرفةthis is
+
+256
+00:18:14,840 --> 00:18:18,760
+common to all members يبقى هذا الانتجين عبارة عن
+
+257
+00:18:18,760 --> 00:18:23,480
+واحد مشترك لكل المجموعة for example the factor for
+
+258
+00:18:23,480 --> 00:18:28,840
+group B is O antigen number 4 اذا ان group B لو
+
+259
+00:18:28,840 --> 00:18:31,620
+انا قلت ان هذا السيومون اللي تاب على group B لازم
+
+260
+00:18:31,620 --> 00:18:36,280
+تحتوي على مين؟ على انتجن نقم 4 هذا ال group factor
+
+261
+00:18:37,660 --> 00:18:41,000
+this means that all salmonella belonging to this
+
+262
+00:18:41,000 --> 00:18:45,620
+group possesses antigen 4 as one خدوا بالكوا ليس
+
+263
+00:18:45,620 --> 00:18:50,100
+بالضروري أن يكون هو الوحيد كمان مرة ممكن يكون معاه
+
+264
+00:18:50,100 --> 00:18:55,660
+أنتجينات أخرى لكن أربعة واحد منهم عشان أسمي ..
+
+265
+00:18:55,660 --> 00:19:00,240
+أسمي الفرد هذا من ضمن group B لازم يكون محتوى
+
+266
+00:19:00,240 --> 00:19:06,780
+عالمين على أنتجين أربعة ك group factorالـ H انتجن
+
+267
+00:19:06,780 --> 00:19:11,020
+و انا حاولت اقدمله من البداية بإن في عندي phase
+
+268
+00:19:11,020 --> 00:19:14,300
+variation فيه وهي نفس الكلام اللي .. اللي .. اللي
+
+269
+00:19:14,300 --> 00:19:17,340
+ذكرناها phase one غالبا بناعطيه alpha metacoliter
+
+270
+00:19:17,340 --> 00:19:21,880
+و phase two بناعطيه numeral numeral يعني رقم ال V
+
+271
+00:19:21,880 --> 00:19:25,160
+-I انتجن و انا اتفقت معاكم من البداية ان معظم
+
+272
+00:19:25,160 --> 00:19:29,160
+السلمونيلا اصلا مالهاش .. معظم السلمونيلا مالهاش V
+
+273
+00:19:29,160 --> 00:19:32,160
+-I انتجن لكن ال V-I انتجن موجود في السلمونيلا
+
+274
+00:19:32,160 --> 00:19:34,420
+تايفي والبارا تايفي C
+
+275
+00:19:38,400 --> 00:19:43,220
+هذا جدول طلعوا عليه كويس الجدول هذا اللي قدامنا هو
+
+276
+00:19:43,220 --> 00:19:47,680
+نموذج صغير مصغر من جدول كبير جدا بيعطينا مثال
+
+277
+00:19:47,680 --> 00:19:52,040
+بقولنا group بي سالمونيلا بارا تايفي بي سالمونيلا
+
+278
+00:19:52,040 --> 00:19:55,840
+داربي سالمونيلا تايفي موريوم سالمونيلا هيدلبرج
+
+279
+00:19:55,840 --> 00:19:58,080
+اسمها حتى ما ممرضش عليكم مظبوط
+
+280
+00:20:19,810 --> 00:20:23,810
+ممكن تلاقي اتناش في مكان تاني .. ممكن تلاقي اتناش
+
+281
+00:20:23,810 --> 00:20:26,710
+في مكان تاني .. ممكن تلاقي اتناش في مكان تانيمثلًا
+
+282
+00:20:26,710 --> 00:20:29,530
+في هذه الحالة جدًا اتناش هنا لكن اتناش مش هو ال
+
+283
+00:20:29,530 --> 00:20:32,250
+group factor، مين ال group factor هنا؟ اربع، هنا
+
+284
+00:20:32,250 --> 00:20:36,450
+ال group factor اتنين، وها كده، إذًا لكل مجموعة في
+
+285
+00:20:36,450 --> 00:20:42,310
+عندي one common antigen سمنها group factor نيجي
+
+286
+00:20:42,310 --> 00:20:46,490
+الآن لل .. لل .. لل .. ال .. برضه الاتجاه المعملي
+
+287
+00:20:46,490 --> 00:20:50,600
+في عملية ال diagnosis، ال specimenمين ناخد؟ عينة
+
+288
+00:20:50,600 --> 00:20:57,820
+stool ولا عينة blood ولا urine؟ ايش العينات اللي
+
+289
+00:20:57,820 --> 00:21:02,690
+لازم احنا نتعامل معاها؟ طالع علياfor the diagnosis
+
+290
+00:21:02,690 --> 00:21:06,050
+of enteric fever specimen includes blood, feces
+
+291
+00:21:06,050 --> 00:21:10,850
+and urine for culture and may be used depending on
+
+292
+00:21:10,850 --> 00:21:15,050
+the course of illness depending on the course of
+
+293
+00:21:15,050 --> 00:21:18,170
+illness ايش يعني course of illness؟ مسار المرض
+
+294
+00:21:18,170 --> 00:21:23,450
+مساره زمني، مساره الزمني يعني صارله أسبوع، صارله
+
+295
+00:21:23,450 --> 00:21:30,230
+أسبوعين، صارله تلاتة تعالوا تطلع ال bloodكمان مرة
+
+296
+00:21:30,230 --> 00:21:33,030
+بتتكلم عن ال blood هنا مش لل serology بتتكلم عن ال
+
+297
+00:21:33,030 --> 00:21:36,030
+blood لمن؟ لل culture يعني بتدعم ال blood culture
+
+298
+00:21:36,030 --> 00:21:39,770
+عارفين كيف تتنامل ال blood culture و لسه مادرستاش
+
+299
+00:21:39,770 --> 00:21:45,270
+في المعمل طيب خليني اتكلم عن ال blood culture واحد
+
+300
+00:21:45,270 --> 00:21:50,910
+ممكن من الشباب انت تعالى
+
+301
+00:21:50,910 --> 00:21:57,450
+اشل على ال jacket تبعتك استعراض الان
+
+302
+00:21:59,120 --> 00:22:01,660
+احنا في الوضع الطبيعي .. في الوضع الطبيعي الشراب
+
+303
+00:22:01,660 --> 00:22:06,660
+غالبا تطلع اللي .. لما بنسحب عينة دم عادية بنعمل
+
+304
+00:22:06,660 --> 00:22:10,200
+عملية swapping بالكوتون اللي فيه كحول للمنطقة
+
+305
+00:22:10,200 --> 00:22:13,820
+بسبعين فمية، مظبوط ولا لأ؟ في ال microbiology this
+
+306
+00:22:13,820 --> 00:22:21,480
+is not enough disinfecting procedures بنحط كحول و
+
+307
+00:22:21,480 --> 00:22:26,840
+بنحط أيودين و بنتركه for two minutescircular
+
+308
+00:22:26,840 --> 00:22:27,960
+motion عشان انت عارفين
+
+309
+00:22:30,770 --> 00:22:36,930
+من ال center لل outward وبعدين بنزيل ال iodine لان
+
+310
+00:22:36,930 --> 00:22:40,670
+ال iodine احنا جام بالدور تبعه عقّم المنطقة او طهر
+
+311
+00:22:40,670 --> 00:22:45,210
+المنطقة بنزيله بكحول بدون اش نخلي اي traces لان لو
+
+312
+00:22:45,210 --> 00:22:49,890
+دخلنا ال needle عشان ناخد عينة ودخل شوية iodine
+
+313
+00:22:49,890 --> 00:22:52,870
+هنقتل البكتيرا اللي احنا هنقتلها ولا بننميها؟
+
+314
+00:22:52,870 --> 00:22:59,110
+بننميها وبالتالي بنزيله بالكحولإذن طبعا لو اي واحد
+
+315
+00:22:59,110 --> 00:23:03,570
+كعادة الطلبة الجداد الجداد مش واثقي من أنفسهم بروح
+
+316
+00:23:03,570 --> 00:23:07,250
+بلمس كمان مرة مين المكان إذا لمست مرة أخرى بدك
+
+317
+00:23:07,250 --> 00:23:11,170
+تعيد ال procedures مرتان من أول الآن بناخد اللي هو
+
+318
+00:23:11,170 --> 00:23:14,350
+طبعا ال blood culture مش زي المقنكي و ال blood
+
+319
+00:23:14,350 --> 00:23:17,550
+agar نزرعها في bottles نزرعها في bottles فيها
+
+320
+00:23:17,550 --> 00:23:22,180
+liquid mediaففي نوعين منها ممكن ندخل tube و نوصله
+
+321
+00:23:22,180 --> 00:23:26,640
+مباشرة لمين لل .. لل .. للبطل او ناخد بسرنج نسحبها
+
+322
+00:23:26,640 --> 00:23:30,940
+تمام و بعدين نعمل injection لها اللي هو البطل لكن
+
+323
+00:23:30,940 --> 00:23:34,420
+في الحالتين بدي اضمن مين انا بدي اضمن ال sterility
+
+324
+00:23:34,420 --> 00:23:38,180
+عشان لما اخد او يطلع معايا بكتيريا هل البكتيريا هي
+
+325
+00:23:38,180 --> 00:23:41,660
+من ال skin تبعه ولا من ال blood تبعه بيكون متأكد
+
+326
+00:23:41,660 --> 00:23:45,100
+يعطيك العفو برك الله فيك طيب
+
+327
+00:23:46,370 --> 00:23:48,530
+مش هذا اللي بيعنيني الصحيح أنا هذا .. هذا شغل
+
+328
+00:23:48,530 --> 00:23:51,170
+practical هتاخده في المعمل و هتشتغله ان شاء الله
+
+329
+00:23:51,170 --> 00:23:54,370
+بشكل جيد انا اللي بيعنيني ان ليش اخترت الدم انا
+
+330
+00:23:54,370 --> 00:23:58,810
+كعينة اه اذا بنذكر الـtyphoid fever و ال course
+
+331
+00:23:58,810 --> 00:24:02,290
+اللي حكينا عنه ingestion, intestinal penetration و
+
+332
+00:24:02,290 --> 00:24:06,410
+بعدين على الدم لما بيكون في fever و الملد غالبا
+
+333
+00:24:06,410 --> 00:24:11,130
+بيروح على الطيب متى لما بصير عنده fever فغالبا
+
+334
+00:24:11,130 --> 00:24:14,030
+بتكون البكتيرا اللي موجودة الآن في الدم فبقولنا
+
+335
+00:24:14,030 --> 00:24:21,120
+انهال blood بيقدر يعطيني حساسية بنسبة خمسة وسبعين
+
+336
+00:24:21,120 --> 00:24:24,560
+لتسعين بالمية من ال patient during the first ten
+
+337
+00:24:24,560 --> 00:24:29,000
+days بتكون positiveفيش ولا واحد من هدول العينات
+
+338
+00:24:29,000 --> 00:24:31,700
+ولا من هدول الفحوصات بيقدر يعطينا هذا الرقم غير ال
+
+339
+00:24:31,700 --> 00:24:35,480
+blood إذا ال blood في ال early course لات تيفويت
+
+340
+00:24:35,480 --> 00:24:37,740
+في ال early course يعني في الأيام الأولى العشرة
+
+341
+00:24:37,740 --> 00:24:41,420
+الأيام الأولى أفضل عينة هي مين ال blood culture
+
+342
+00:24:41,420 --> 00:24:45,760
+طبعا هنا نقطة ومشكلة كبيرة أن في قطاع غزة لازم
+
+343
+00:24:45,760 --> 00:24:49,720
+نوحلها عشان حضراتكم لما تكونوا أصحاب قرار في
+
+344
+00:24:49,720 --> 00:24:53,490
+المختبرات اتغيروا من ال policyاللي هو الـtime
+
+345
+00:24:53,490 --> 00:24:57,110
+required for saying that this is a negative blood
+
+346
+00:24:57,110 --> 00:25:01,590
+culture احنا بنعمل incubation في المعمل لل urine
+
+347
+00:25:01,590 --> 00:25:07,170
+24 to 48 hoursالـ blood culture في عليها خلاف،
+
+348
+00:25:07,170 --> 00:25:10,190
+اللي بيعملها خمس أيام، بيعملها أسبوع، اللي بيعملها
+
+349
+00:25:10,190 --> 00:25:13,250
+أربعة عشر يوم، و هذا الكلام في ال text، في الكتب،
+
+350
+00:25:13,250 --> 00:25:16,950
+و في ال .. في اختلافات، طبعا الاختلافات مبنية على
+
+351
+00:25:16,950 --> 00:25:21,870
+عوام الكثيرة، منها العامل الاقتصادي، أنا لما بدي
+
+352
+00:25:21,870 --> 00:25:26,090
+incubatorواندي حجم شغل كبير، في مستشفى مثلا، كل
+
+353
+00:25:26,090 --> 00:25:29,630
+يوم بيجيني عشر عينات، عشر عينات، لو بتعمل
+
+354
+00:25:29,630 --> 00:25:33,050
+incubation لمدة أسبوعين، هيتجمع عندي في ال
+
+355
+00:25:33,050 --> 00:25:39,370
+incubator عشرة ضرب أربعة عشر يوم، اللي هم رقم ضخم،
+
+356
+00:25:39,370 --> 00:25:42,090
+فبتالي لن يتسهي ال incubator، لبتالي أنا بحاجة إلى
+
+357
+00:25:42,090 --> 00:25:45,830
+مساحة أكبرفبينزلوا بدل ما يخلوها اسبوعين بيخلوها
+
+358
+00:25:45,830 --> 00:25:48,670
+عشر ايام ال incubation البعض بقولك لا يا عم انا
+
+359
+00:25:48,670 --> 00:25:52,010
+الدقة عندي اهم من موضوع ال space لان انا عندي اصلا
+
+360
+00:25:52,010 --> 00:25:56,150
+حجم الشغل قليل و اكم مزرعة بتجيني في الشهر قليلين
+
+361
+00:25:56,150 --> 00:26:00,070
+وبتالي لأ خليهم اربعة عشر يوم اذا في كل واحد ايه
+
+362
+00:26:00,070 --> 00:26:04,310
+اللي هو مبرراتهم وعلى حسب ال system المستخدم في
+
+363
+00:26:04,310 --> 00:26:07,430
+system بيسموه automated systemع فيه حد وات
+
+364
+00:26:07,430 --> 00:26:12,330
+automated يعني بنحطه في هالجهاز وهو الجهاز بيقولنا
+
+365
+00:26:12,330 --> 00:26:15,110
+تعايا فلان صار عندك blood culture في المكان
+
+366
+00:26:15,110 --> 00:26:19,650
+الفلاني صارت positive بيزمرلك بيعطيك إشارة متوفر
+
+367
+00:26:19,650 --> 00:26:22,830
+عندنا النظام هذا ده بيجي نوريكوا ان شاء الله يوم
+
+368
+00:26:22,830 --> 00:26:27,790
+إذا ال blood culture مشكلتها جونا في قطاع غزة
+
+369
+00:26:27,790 --> 00:26:32,330
+موضوع اللي هو جداش نعملها incubation before you
+
+370
+00:26:32,330 --> 00:26:33,890
+say it is negative
+
+371
+00:26:37,810 --> 00:26:41,410
+سبعة أيام، عشر أيام، أربع أشهر يوم هذا موضوع
+
+372
+00:26:41,410 --> 00:26:45,270
+بنطرحه للنقاش ان شاء الله في الجزء العملي ونحاول
+
+373
+00:26:45,270 --> 00:26:49,210
+قدر الإمكان انه نبرر اي وقت اللي احنا بدنا نختاره
+
+374
+00:26:49,210 --> 00:26:54,530
+ايش المبررات اللي بدنا نحطها لهذا الوقت لكن يكون
+
+375
+00:26:54,530 --> 00:26:58,450
+لديكم معلوم انه كل ما طالت فترة ال incubation كل
+
+376
+00:26:58,450 --> 00:27:03,150
+ما زادت منين نسبة ال sensitivity ونسبة ال recovery
+
+377
+00:27:03,150 --> 00:27:09,340
+لل blood culture نجي للتانية ال thesisIt can be
+
+378
+00:27:09,340 --> 00:27:13,640
+detected أو إيزال البكتيريا من 40 ل 50% من ال
+
+379
+00:27:13,640 --> 00:27:15,880
+patient during the third week
+
+380
+00:27:18,510 --> 00:27:22,490
+بعد طيب انا خدنا اختصرلكوا الكلام بكلمتان صغار
+
+381
+00:27:22,490 --> 00:27:26,750
+افضل عينة لل diagnosis هي ال blood culture و افضل
+
+382
+00:27:26,750 --> 00:27:30,810
+عينة لل follow up هي ال stool culture انا عملت
+
+383
+00:27:30,810 --> 00:27:34,270
+diagnosis و طلع positive وعطينا المريض علاج based
+
+384
+00:27:34,270 --> 00:27:38,990
+on antimicrobial susceptibility testing طبعا الان
+
+385
+00:27:38,990 --> 00:27:43,490
+ال salmonella taifi او ال parataifi يجب ان لا يترك
+
+386
+00:27:43,490 --> 00:27:50,870
+المريض للشفاء فقطيجب أن لا يترك المريض إلا بعد
+
+387
+00:27:50,870 --> 00:27:55,750
+التأكد من خلوه من السلمونيلا بمعنى إنه يبطل يطلع
+
+388
+00:27:55,750 --> 00:27:59,050
+سلمونيلا في الستولة تبعه عشان مايتحولش من مريض إلى
+
+389
+00:27:59,050 --> 00:28:03,130
+carrier على سبيل المثال تمام؟ وبالتالي أنا أعطته
+
+390
+00:28:03,130 --> 00:28:06,510
+علاج بدي أضمن إنه العلاج كان effective in
+
+391
+00:28:06,510 --> 00:28:10,790
+eradicating كلمة eradicating يعني removalتخلص كامل
+
+392
+00:28:10,790 --> 00:28:14,130
+من ال micro organism لازم يتم عبر اللي هو ال stool
+
+393
+00:28:14,130 --> 00:28:19,030
+culture بتأكد انه تم التخلص عن طريق ان انا اعمل و
+
+394
+00:28:19,030 --> 00:28:22,650
+يطلع عندي negative stool culture ال urine بعض
+
+395
+00:28:22,650 --> 00:28:27,010
+الأحيان بيقول انه بي detect in 25% بس واضح من
+
+396
+00:28:27,010 --> 00:28:30,250
+الكلام انه افضل عينة كانت منه اللي هو ال blood
+
+397
+00:28:30,250 --> 00:28:34,540
+cultureالـ Serum و هذا الـ Serum احنا المحاضرة
+
+398
+00:28:34,540 --> 00:28:37,700
+اللي فاتت كلامنا عن Ox 19 فاكرين؟ اللي فاتت و اللي
+
+399
+00:28:37,700 --> 00:28:40,680
+جابلها؟ اللي جابل .. المحاضرة اللي فاتت يلا يا سيد
+
+400
+00:28:40,680 --> 00:28:46,680
+اللي جابلها و اللي فاتت اللي فاتت تحت ال .. تحت ال
+
+401
+00:28:46,680 --> 00:28:49,880
+.. تحت ال .. تحت ال .. تحت ال .. تحت ال .. تحت ال
+
+402
+00:28:49,880 --> 00:28:49,960
+.. تحت ال .. تحت ال .. تحت ال .. تحت ال .. تحت ال
+
+403
+00:28:49,960 --> 00:28:51,020
+.. تحت ال .. تحت ال .. تحت ال .. تحت ال .. تحت ال
+
+404
+00:28:51,020 --> 00:28:52,720
+.. تحت ال .. تحت ال .. تحت ال .. تحت ال .. تحت ال
+
+405
+00:28:52,720 --> 00:28:54,220
+.. تحت ال .. تحت ال .. تحت ال .. تحت ال .. تحت ال
+
+406
+00:28:54,220 --> 00:29:01,720
+.. تحت ال .. تحت ال .. تحت ال .. تالكلام اللي بدنا
+
+407
+00:29:01,720 --> 00:29:04,720
+نحكيه بدنا نتكلم عن typhoid fever سلمونيلا تايفي
+
+408
+00:29:04,720 --> 00:29:10,380
+فين دي فحص اسمه Vidal Test طبعا ال W هذه تلفظ V
+
+409
+00:29:10,380 --> 00:29:15,760
+اللي أنا أكلمها ألمانيا Vidal ال Vidal يعني ايش
+
+410
+00:29:15,760 --> 00:29:21,340
+بيكشف بيكشف عن ال antibodies تبع السلمونيلا طب ايش
+
+411
+00:29:21,340 --> 00:29:23,640
+ال antibodies تبع السلمونيلا تبع التايفي فين دي T
+
+412
+00:29:23,640 --> 00:29:34,750
+O و T H B O أفوان A Oو A H و
+
+413
+00:29:34,750 --> 00:29:41,170
+B O و B H و فيه طبعا C O و C H ايش هدول الرموز
+
+414
+00:29:41,170 --> 00:29:44,910
+اللي احنا ذكرناهم على الصبورة دلوقت سيرمونيلا تاي
+
+415
+00:29:44,910 --> 00:29:49,630
+في Oسلمونيلا تايفي H انتجن تتكلم عن انتجينات
+
+416
+00:29:49,630 --> 00:29:55,010
+سلمونيلا بارا تايفي AO انتجن بارا تايفي AH و هكذا
+
+417
+00:29:55,010 --> 00:29:58,050
+احنا اقوللكوا الفلسطين غالبا ماعناش يعني اللي هو
+
+418
+00:29:58,050 --> 00:30:03,870
+مين ال CO وال CH لأن هاد السلمونيلا مرتبطة بال
+
+419
+00:30:03,870 --> 00:30:07,390
+pork ال pork اللي هم الخنزير او ال pigs ال pork
+
+420
+00:30:07,390 --> 00:30:11,730
+لحم الخنزير ال pig هو الخنزير نفسه تمام فبالتالي
+
+421
+00:30:11,730 --> 00:30:16,370
+انا في ال بدأ تبقى انا في غزة بندوي علىطيفي O
+
+422
+00:30:16,370 --> 00:30:22,410
+وطيفي H برة طيفي A و برة طيفي B كل من O وH هذا هو
+
+423
+00:30:22,410 --> 00:30:26,690
+الفيدال كيف يتم هذا الفحص ستجده في المعمل بس مش في
+
+424
+00:30:26,690 --> 00:30:30,290
+ال microbiology اعتقد في ال serology في ال
+
+425
+00:30:30,290 --> 00:30:36,600
+immunology و ال serology لكن باقتصادهو عبارة عن
+
+426
+00:30:36,600 --> 00:30:41,720
+فحص من خلاله بنستخدم أنتجينات للكشف عن antibodies
+
+427
+00:30:41,720 --> 00:30:46,160
+مرة واحدة في فحص واحد بنكشف عن كام واحد؟ أربعة
+
+428
+00:30:46,160 --> 00:30:51,320
+واتنين، أربعة لمين؟ لل A وال B، واتنين لمين؟
+
+429
+00:30:51,350 --> 00:30:55,870
+لاتعافى لسمن اللاتعافى جنب من إلى جنب كلهم بشكل
+
+430
+00:30:55,870 --> 00:31:02,590
+ستة انتيجينات تستخدم لكشف عن ستة أجسام مضادة في ال
+
+431
+00:31:02,590 --> 00:31:06,150
+serum تبع المرضى المشتبه لإنه يكون عندهم سمن
+
+432
+00:31:06,150 --> 00:31:09,230
+اللاتعافى طبعا هذا الفحص شبابيعني فقط قيمته
+
+433
+00:31:09,230 --> 00:31:13,010
+التشخيصية في كثير من البلدان يعني بطل ينظرله نظرا
+
+434
+00:31:13,010 --> 00:31:16,570
+ليه شغل تاني انه فيه بمعنى انه ممكن يطلع positive
+
+435
+00:31:16,570 --> 00:31:20,550
+ممكن يطلع positive في حالات في حالات مافيش أن
+
+436
+00:31:20,550 --> 00:31:24,270
+المرض عنده typhoid وصلت ففيه انه high cross
+
+437
+00:31:24,270 --> 00:31:28,740
+reactiongrouping and serotyping of salmonella انا
+
+438
+00:31:28,740 --> 00:31:32,480
+عزلت salmonella عزلت salmonella وقولنا لكوا احنا
+
+439
+00:31:32,480 --> 00:31:35,960
+it is really expensive to stock الفين و خمسمية
+
+440
+00:31:35,960 --> 00:31:39,280
+serotype هدولة فإذا بدى اشتري لكل واحد و كل vial
+
+441
+00:31:39,280 --> 00:31:43,610
+بتكلفني حوالي مائة دولارو ال ال ال ال ال ال ال ال
+
+442
+00:31:43,610 --> 00:31:43,930
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+443
+00:31:43,930 --> 00:31:43,950
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+444
+00:31:43,950 --> 00:32:03,430
+ال ال ال ال ال ال ممكن
+
+445
+00:32:03,430 --> 00:32:03,690
+يكون في
+
+446
+00:32:10,650 --> 00:32:17,570
+بدي اشتري من الشركة اقولهم اعطوني antibody من a ل
+
+447
+00:32:17,570 --> 00:32:25,470
+z كلهم في vial واحدة توفيرا اي a ل z اكم antibody
+
+448
+00:32:25,470 --> 00:32:35,260
+او اكم antibody نعم كتير 28 28 او 20 ولا 26 2626
+
+449
+00:32:35,260 --> 00:32:38,660
+Antibody يبقى هذه الفاية اللي بيسميها polyclonal
+
+450
+00:32:38,660 --> 00:32:44,300
+او polyvalent polyvalent
+
+451
+00:32:44,300 --> 00:32:52,260
+antibody أخدت Salmonella أخدت على شريحة في one
+
+452
+00:32:52,260 --> 00:32:57,580
+drop of saline و one drop of their agent ايش ال
+
+453
+00:32:57,580 --> 00:33:02,060
+agent في هذه الحالة ال a to z polyvalent o
+
+454
+00:33:02,060 --> 00:33:07,320
+antibodyإذا اتفعل معه عشان اتفعل agglutination
+
+455
+00:33:07,320 --> 00:33:13,440
+فالبكتيريا سالمونلة هو استنتاج كويس مبدأ يعني ان
+
+456
+00:33:13,440 --> 00:33:18,780
+البكتيريا سالمونلة أكم قطرة خسرنا واحدة لسه الآن
+
+457
+00:33:18,780 --> 00:33:30,320
+بقولهم اعطوني A to G بدي البطل تمام؟ A to G وHتو
+
+458
+00:33:30,320 --> 00:33:37,980
+مثلا L تمام؟ و إيش بعد ال L؟ ال O؟ Okay O ل Z هاي
+
+459
+00:33:37,980 --> 00:33:42,580
+كام بطل سهره؟ تلاتة و الأولانية؟ أربعة تمام؟ هاي
+
+460
+00:33:42,580 --> 00:33:46,840
+أربعة مية دولار صارنا صارفين فلوس لكن شوفوا الآن
+
+461
+00:33:46,840 --> 00:33:51,860
+هاي قطرة طلعت negative قطرة طلعت negative قطرة
+
+462
+00:33:51,860 --> 00:33:56,410
+طلعت positiveيبجي أنا استثنت هدول التنين يبجي
+
+463
+00:33:56,410 --> 00:33:59,550
+البكتيرا اللي عندي ضال وين؟ في ال O و ال Z يبجي
+
+464
+00:33:59,550 --> 00:34:04,610
+احنا بطريقة هذه طريقة ال grouping بنوفر .. بنوفر
+
+465
+00:34:04,610 --> 00:34:09,610
+بدل ما نعمل trial على كل individual antigen فبنجمع
+
+466
+00:34:09,610 --> 00:34:12,090
+مجموعة antigenات مع بعضهم البعض
+
+467
+00:34:15,090 --> 00:34:18,250
+الموضوع الأخطر على الإطلاق .. الأخطر .. احنا جونا
+
+468
+00:34:18,250 --> 00:34:24,930
+ال blood culture يعني جمع العينة بيختلف عن العينات
+
+469
+00:34:24,930 --> 00:34:30,430
+الدم العادية لكن
+
+470
+00:34:30,430 --> 00:34:34,030
+ال .. ال .. ال .. الصعب حقيقة في ال .. في ال
+
+471
+00:34:34,030 --> 00:34:37,070
+salmonella هو ال stool culture ليش ال stool
+
+472
+00:34:37,070 --> 00:34:38,010
+culture صعبة؟
+
+473
+00:34:41,880 --> 00:34:45,160
+هذا عنده فكرة ليست صعبة لستول culture بشكل عام
+
+474
+00:34:55,960 --> 00:34:59,340
+الاف الأنواع من ال normal microbiota وانت بدك تهزل
+
+475
+00:34:59,340 --> 00:35:02,620
+one organism selectively من هذه الملايين من هذه
+
+476
+00:35:02,620 --> 00:35:06,960
+الألف من الأنواع صح؟ هي وجه الصعوبة هي وجه الصعوبة
+
+477
+00:35:06,960 --> 00:35:12,500
+اذا يجب عليك ان تختار تقنية تختار تقنية قادرة على
+
+478
+00:35:12,500 --> 00:35:19,300
+اما ان تعمل suppression تثبيت او انها تسمح
+
+479
+00:35:19,300 --> 00:35:22,920
+لmicrobe تبعك ان ينمو دون انعان الميكروبات الأخرى
+
+480
+00:35:23,280 --> 00:35:27,720
+هذه نقطة كتير مهمة فاندي هنا stool culture او ال
+
+481
+00:35:27,720 --> 00:35:34,280
+stool كعينة في عندي طرفين نشتغلهم سويا في نفس
+
+482
+00:35:34,280 --> 00:35:40,320
+اللحظة حالة بسميها enrichment و
+
+483
+00:35:40,320 --> 00:35:49,020
+حالة اسمها selective media طيب
+
+484
+00:35:49,020 --> 00:35:55,330
+ال enrichmentبتنمي البكتيريا تبعتنا و غيرها لكن
+
+485
+00:35:55,330 --> 00:36:01,070
+بتنمي البكتيريا تبعتنا بدرج ايه؟ افضل فبنعمل لها
+
+486
+00:36:01,070 --> 00:36:06,730
+كمان مرة حال اسمها selective يعني اللي بطلع معاهم
+
+487
+00:36:06,730 --> 00:36:12,650
+ال enrichment بتظهر على مين؟ على ال selective اللي
+
+488
+00:36:12,650 --> 00:36:17,700
+بطلع من ال selective هذا و من ال selective هذاكلمة
+
+489
+00:36:17,700 --> 00:36:21,900
+selective انتوا عارفين لما ماعليش يعني اذكركوا بس
+
+490
+00:36:21,900 --> 00:36:27,720
+بنقطة اي وسط selective الاصل ان يكون فيه مواصفات
+
+491
+00:36:27,720 --> 00:36:32,320
+للبكتيريا اللي هتنمو عليه مثلا ال manitol salt
+
+492
+00:36:32,320 --> 00:36:35,530
+agarالـ Manitoulin salt agar للـ Staphylococcus
+
+493
+00:36:35,530 --> 00:36:40,130
+aureus، إيش مواصفات المستعمرة النموذجية تبعته
+
+494
+00:36:40,130 --> 00:36:44,390
+Yellow colonies surrounded by yellow zone as a
+
+495
+00:36:44,390 --> 00:36:47,350
+result of sucrose fermentation؟ يعني أنا عارف من
+
+496
+00:36:47,350 --> 00:36:52,290
+ناحية نظرية كيف تبدو مستعمرات البكتيريا على الـ
+
+497
+00:36:52,290 --> 00:36:56,160
+selective mediaفالان انا مش بقول هنا اي مستعمرة
+
+498
+00:36:56,160 --> 00:37:01,580
+typical suspected مشتبه بيها typical يعني نموذجية
+
+499
+00:37:01,580 --> 00:37:04,720
+سواء كانت طالعة من ال enrichment على ال selective
+
+500
+00:37:04,720 --> 00:37:07,660
+او طالعة من الاسطول ومشروعات العالمية على ال
+
+501
+00:37:07,660 --> 00:37:15,460
+selective كلمة suspected colony هنا نرفع نعود نرتب
+
+502
+00:37:15,460 --> 00:37:21,340
+جدولنا او دجالنا دبعنا ابصر فيني انا لوحة لأ لأسف
+
+503
+00:37:21,340 --> 00:37:28,360
+لأ هيهذه اللوحة استخدمت فرصة المونيلا و زرعنا على
+
+504
+00:37:28,360 --> 00:37:32,520
+cellulite if broth هذا معكوس للجدول هذا enrichment
+
+505
+00:37:32,520 --> 00:37:39,320
+هذي شباب enrichment و هذي كسل التنمية الآن زرعت
+
+506
+00:37:39,320 --> 00:37:41,560
+على cellulite if broth كيف بيشتغل cellulite if
+
+507
+00:37:41,560 --> 00:37:45,580
+broth هذا فيه فخ الفخ بيقول انه حطينا
+
+508
+00:37:45,580 --> 00:37:49,180
+للبكتيلالكتوزطب استنمو اللاكتوز فرمنتر و لا لاكتوز
+
+509
+00:37:49,180 --> 00:37:52,580
+فرمنتر؟ non-lactose مين اللي حينموه؟ لما انا ..
+
+510
+00:37:52,580 --> 00:37:56,240
+لما انا بحط lactose اللاكتوز فرمنتر اللي حينموه
+
+511
+00:37:56,240 --> 00:38:01,280
+يبقى انا خلفت المعيار اللي ذكرته في الأول انا قلت
+
+512
+00:38:01,280 --> 00:38:05,120
+انه اسمح بنمو مين اللي بدي اياها انا اللي بدي
+
+513
+00:38:05,120 --> 00:38:07,940
+اياها non-lactose fermenter فلماذا سمحت بنمو
+
+514
+00:38:07,940 --> 00:38:16,360
+اللاكتوز فرمنتر؟ سمحتلها عشان اقتلهااللي بينمو هو
+
+515
+00:38:16,360 --> 00:38:20,960
+اللي هيموت، لإن في مادة اسمها سيلينياس أسد قاتلة،
+
+516
+00:38:20,960 --> 00:38:25,300
+فهتقتل مين؟ اللي بيتكاثر، و أنا قلتلكوا زمان، من
+
+517
+00:38:25,300 --> 00:38:28,660
+أول مبادئنا ال microbiology إن تأثير ال
+
+518
+00:38:28,660 --> 00:38:31,740
+antibiotics أو ال inhibitory substances على
+
+519
+00:38:31,740 --> 00:38:34,940
+البكتيريا بيكون أكبر ما يكون لما تكون البكتيريا
+
+520
+00:38:34,940 --> 00:38:39,970
+ناشطةولا يكون له تأثير لما تكون البكتيريا غير
+
+521
+00:38:39,970 --> 00:38:44,410
+ناشطة فنشطنا البكتيريا اللى بدنا نموتها بوجود
+
+522
+00:38:44,410 --> 00:38:48,630
+اللاكتوز قتلناها بال سيلينياس أسد مين ضال عنها ال
+
+523
+00:38:48,630 --> 00:38:52,630
+non-lactose fermenting زي مين؟ زي السلمونيلا، زي
+
+524
+00:38:52,630 --> 00:38:55,970
+الشيجيلا، زي البروتياز، زي اليرسينيا، يعني ان احنا
+
+525
+00:38:55,970 --> 00:38:58,790
+قضينا في هذه العملية على مين؟ على ال lactose
+
+526
+00:38:58,790 --> 00:39:03,610
+fermenting، من أحنا نظرياالجهة التانية فاندي وسط
+
+527
+00:39:03,610 --> 00:39:07,590
+selective اسمه زي لوز ليس دكستروز أجار وسلمونيلا
+
+528
+00:39:07,590 --> 00:39:13,530
+شيجيلا أجار وهكتون انتريك أجار أسماء كثيرة وحمر
+
+529
+00:39:13,530 --> 00:39:19,930
+معانا أسماء أكثر للأوساط الزراعية المستخدمة لعزل
+
+530
+00:39:19,930 --> 00:39:25,590
+السمن عموماإيش عملنا هنا enrichment و ال
+
+531
+00:39:25,590 --> 00:39:28,430
+enrichment شباب بتكون في liquid بتكون فيه liquid
+
+532
+00:39:28,430 --> 00:39:34,050
+عملنا subculture منها و أنزلعنا على نفس الأوساط بس
+
+533
+00:39:34,050 --> 00:39:39,350
+مش نفس الأطباق أوساط جديدة يعني XLD, SSA or Hecton
+
+534
+00:39:39,350 --> 00:39:44,930
+interregal أي من المستعمرات اللي بتنمو هنا أو هنا
+
+535
+00:39:44,930 --> 00:39:50,270
+و سمناها suspected colonies احنا مش تبقى فاهمين
+
+536
+00:39:51,270 --> 00:39:56,190
+بنشتبه في مستعمرات لها مواصفات معروفة مثلا
+
+537
+00:39:56,190 --> 00:39:59,510
+colorless
+
+538
+00:39:59,510 --> 00:40:03,830
+colonies containing dark center dark center يعني
+
+539
+00:40:03,830 --> 00:40:09,510
+الوسط تبقى المستعمر لونه أسود لماذا اللون أسود؟
+
+540
+00:40:09,510 --> 00:40:15,250
+هذه الأوساط معظمهابيكشف عن وجود الـ H2S، فاكرين
+
+541
+00:40:15,250 --> 00:40:19,870
+الـ H2S؟ ايش بيعطينا اللون؟ أسود، طبعاً لأنه بتفعل
+
+542
+00:40:19,870 --> 00:40:22,070
+مع الـ Thiosulfate اللي بيحطها في ال media
+
+543
+00:40:25,210 --> 00:40:30,450
+عديمة اللون وجواها لون أسود هذه مستعمرة مشتبه انها
+
+544
+00:40:30,450 --> 00:40:34,610
+تكون Salmonella وكلمة مشتبه يعني مش مؤكد صح ولا لأ
+
+545
+00:40:34,610 --> 00:40:39,110
+فكيف لنا ان نتأكد انها Salmonella ولا مش
+
+546
+00:40:39,110 --> 00:40:42,890
+Salmonella ان اكتر من طريقة ان ال biochemical
+
+547
+00:40:42,890 --> 00:40:47,210
+testingونبدأ الأن نستغل مهاراتنا في الاستثناء،
+
+548
+00:40:47,210 --> 00:40:50,250
+تمام؟ البكتيرا اللي قدامنا non-lactose fermenter،
+
+549
+00:40:50,250 --> 00:40:54,870
+non-lactose fermenter مين ممكن يتشابه معاها ومين
+
+550
+00:40:54,870 --> 00:41:02,870
+ممكن مايتشابهاش معاها؟ الشيجيلة؟ ولا السيرمونيلا؟
+
+551
+00:41:02,870 --> 00:41:07,850
+طب الشيجيلة مابتنتجش H2S؟
+
+552
+00:41:09,060 --> 00:41:13,420
+البروتس بيمتج H2S يبجى ايش ال suspect colony
+
+553
+00:41:13,420 --> 00:41:16,680
+لسلمونيلا؟ هتختلف عن ال suspect colony لمين؟
+
+554
+00:41:16,680 --> 00:41:22,640
+للشيقلة، اذا انترت H2S هلاجيها black center، اذا
+
+555
+00:41:22,640 --> 00:41:26,720
+ما انترت H2S زي الشيقلة يبجى بدون black center،
+
+556
+00:41:26,720 --> 00:41:28,780
+ايش الشبهة؟ هو الواجهة الشبهة بين التنتين، ان
+
+557
+00:41:28,780 --> 00:41:34,350
+التنتين colorless colonistsعموماً Suspect colony
+
+558
+00:41:34,350 --> 00:41:37,790
+for Salmonella or for Shigella are easily
+
+559
+00:41:37,790 --> 00:41:42,150
+distinguished from other bacteria by a negative
+
+560
+00:41:42,150 --> 00:41:48,690
+urease test من
+
+561
+00:41:48,690 --> 00:41:52,050
+ال .. ال .. ال .. ال negative السلمونيلا و الشجلة
+
+562
+00:41:52,050 --> 00:41:56,750
+are negative بينما ال proteaseلسة المحاضرة اللى
+
+563
+00:41:56,750 --> 00:42:00,770
+فات قلنا قلنا ان كل المجموعة اشتركت في عاملين
+
+564
+00:42:00,770 --> 00:42:05,980
+العامل الاول ايش كان؟actively motile و rapidly
+
+565
+00:42:05,980 --> 00:42:10,540
+erased واختلفوا عن بعض من في ال H2S البروتياس
+
+566
+00:42:10,540 --> 00:42:13,820
+الحقيقية بتنتج H2S والبروفيدنش والموردين لا
+
+567
+00:42:13,820 --> 00:42:18,760
+بينتجوش H2S خد بالكم المحاضرة هذه صارتنا حصيلة
+
+568
+00:42:18,760 --> 00:42:22,780
+كويسة انه انعمق ال diagram اللي عملنا احنا عملنا
+
+569
+00:42:22,780 --> 00:42:26,360
+ال diagram الأولان لمين لل lactose fermenter اليوم
+
+570
+00:42:26,360 --> 00:42:30,820
+بدنا نبدأ نجهز حالنا انه نعمل diagram لمين لل non
+
+571
+00:42:30,820 --> 00:42:35,260
+lactose fermenting لإنه خد بالكمإذا انت انهيت الـ
+
+572
+00:42:35,260 --> 00:42:39,500
+Enterobacteriasi بمهارة نظرية عالية واتدربت في
+
+573
+00:42:39,500 --> 00:42:47,080
+المعمل على ال method of detection انت أخدت 60% من
+
+574
+00:42:47,080 --> 00:42:51,440
+ال diagnostic microbiology لأن اكتر او the most
+
+575
+00:42:51,440 --> 00:42:53,840
+commonly encountered بكتيريا في ال clinical
+
+576
+00:42:53,840 --> 00:42:58,100
+specimens هي عائلة ال Enterobacteriasi والصدومونس
+
+577
+00:42:58,100 --> 00:43:02,630
+وزميلاتهاو Sodomonas زملتها و ال enterobacteriasi
+
+578
+00:43:02,630 --> 00:43:05,010
+ما هم مجرد من بعض في ال techniques و في ال
+
+579
+00:43:05,010 --> 00:43:08,150
+biochemical test و في كل حاجة في ال identification
+
+580
+00:43:08,150 --> 00:43:13,750
+بنعرفهم حتى ال ABI-20E و E كلمة E تعني
+
+581
+00:43:13,750 --> 00:43:18,090
+enterobacteriasi لكن طلعوا على أسماء البكتيريا
+
+582
+00:43:18,090 --> 00:43:22,090
+اللي بيغطيها ال ABI-20E هتلاقوا Sodomonas و أخوتها
+
+583
+00:43:22,090 --> 00:43:25,130
+لأنهم بتشبهوا كتير مع مين مع ال enterobacteriasi
+
+584
+00:43:26,380 --> 00:43:30,480
+طيب طبعا هذه اوساط انت بتلاحظوا السماء الغالبة
+
+585
+00:43:30,480 --> 00:43:35,320
+فيهم ايش ان فيها black cornice ناتجة عن ال
+
+586
+00:43:35,320 --> 00:43:41,700
+production of H2S طبعا اسمها desoxiculate citrate
+
+587
+00:43:41,700 --> 00:43:44,420
+agar و salmonella shigella agar و احنا كل فصل
+
+588
+00:43:44,420 --> 00:43:48,280
+الحقيقة بنقولها هذا فيه اسمه bismuth sulfite agar
+
+589
+00:43:48,280 --> 00:43:54,040
+برضه كان من الاوساط الرائع جدا لسلمonellaكل فصل
+
+590
+00:43:54,040 --> 00:43:58,960
+بيقول للطلاب ك assignment، كواجب، تمام؟ شباب فيه
+
+591
+00:43:58,960 --> 00:44:02,520
+ناس كثيرة مرت علينا في المحاضرة هذه من أوصات
+
+592
+00:44:02,520 --> 00:44:06,650
+زراعية تستخدم السينمونيلانرجو من حضرتكم إن كنتم
+
+593
+00:44:06,650 --> 00:44:10,890
+تعملون assignment، إيش ال assignment هذه؟ إنه تعمل
+
+594
+00:44:10,890 --> 00:44:16,630
+search والإنترنت مليء بالآن أدلة، أدلة دليل يعني
+
+595
+00:44:16,630 --> 00:44:25,130
+أو كتالوجيات لالميديا، وأحد الشركات زي Oxide،
+
+596
+00:44:25,130 --> 00:44:27,710
+ماعرفش اسمها في اسمها ده ولا لأ، Oxide
+
+597
+00:44:30,770 --> 00:44:36,350
+هذه شركة محترمة جدا لإنتاج المستلزمات المخبرية في
+
+598
+00:44:36,350 --> 00:44:40,890
+ال microbiology وفي شركة هندية مطورة نوعا ما اسمها
+
+599
+00:44:40,890 --> 00:44:43,330
+high media
+
+600
+00:44:44,540 --> 00:44:48,920
+احنا مابنعملش دعاية للشركات هنا لكن بنقولكوا ان
+
+601
+00:44:48,920 --> 00:44:54,560
+هدول التنتين موفرين او متحين خلينا نقول معلومات
+
+602
+00:44:54,560 --> 00:44:58,440
+كتير مفصلة عن تركيبة الأوساط وعن ال quality
+
+603
+00:44:58,440 --> 00:45:02,040
+control وكيف بيطلع شكل البكتيريا الفلانية وكيف
+
+604
+00:45:02,040 --> 00:45:06,120
+بيطلع البكتيريا الأخرى يعني فيهن تفاصيل وبالتالي
+
+605
+00:45:06,120 --> 00:45:11,870
+مطلوب منك طلبة نعرفالأوساط الزراعية المختلفة ما
+
+606
+00:45:11,870 --> 00:45:17,290
+لون ال salmonella بمعنى ما مواصفات ال salmonella
+
+607
+00:45:17,290 --> 00:45:22,130
+ما مواصفات الشجلة وما مواصفات الميكروبات اللي ممكن
+
+608
+00:45:22,130 --> 00:45:26,210
+تنمو على هذا الأوساط تمام فهذا يعني جزء من
+
+609
+00:45:26,210 --> 00:45:35,810
+الواجبات صدر
+
+610
+00:45:38,810 --> 00:45:41,810
+بايو كيميكال كاركترستيكس triple sugar iron agar
+
+611
+00:45:41,810 --> 00:45:46,910
+بتاع البكتيريا هي عبارة عن alkaline slant acid but
+
+612
+00:45:46,910 --> 00:45:50,370
+with a small amount of H2O أسهلوا هذه الجملة small
+
+613
+00:45:50,370 --> 00:45:53,130
+amount لكن مش دقيقة الصحيحة يعني هيكون عشان ايش ال
+
+614
+00:45:53,130 --> 00:45:59,250
+reaction K على A plus انت كلمة small اعطاك انطباع
+
+615
+00:45:59,250 --> 00:46:01,970
+انه اختلفت يعني ليش بتكون يعني يعني هي triple
+
+616
+00:46:01,970 --> 00:46:09,490
+sugar iron agar هي K اللي هو red وهي blackلكن ال
+
+617
+00:46:09,490 --> 00:46:13,550
+black ماخد إيه؟ نتفة صغيرة من أو جزء صغير من
+
+618
+00:46:13,550 --> 00:46:18,210
+الأجار والباجي حاليا بين إيه؟ هذا الكلام نوعا ما
+
+619
+00:46:18,210 --> 00:46:23,630
+ممكن يكون صحيح ليش بيقول المعلومة هذه؟ هذه معلومة
+
+620
+00:46:23,630 --> 00:46:29,070
+out of experience أو طالعة من الخبرة لأن الشبيهة
+
+621
+00:46:29,070 --> 00:46:34,810
+ميها اليمين ال proteus في ال .. ان في أسود، غالبا
+
+622
+00:46:34,810 --> 00:46:41,360
+الأسود ممكن يكون واصل هانيعني مؤشرة لمين؟ على أن
+
+623
+00:46:41,360 --> 00:46:45,380
+البروتياز تمتش كمية أكبر من ال H2S than اللي هو
+
+624
+00:46:45,380 --> 00:46:49,460
+السلمون لكن في الآخر لأ استطيع أنه يعني أجزم
+
+625
+00:46:49,460 --> 00:46:53,740
+بالظبط فبتاعي خلاص بيكفيني أعرف K على A plus بينما
+
+626
+00:46:53,740 --> 00:46:58,040
+البروتياز ممكن يكون فيه gas هذه بتميزها عن اللي هو
+
+627
+00:46:58,040 --> 00:46:58,680
+السلمون
+
+628
+00:47:06,260 --> 00:47:08,240
+Limbic reaction negative positive negative
+
+629
+00:47:08,240 --> 00:47:12,080
+positive يعني السيطرة تبعتها positive ال motility
+
+630
+00:47:12,080 --> 00:47:17,080
+طبعا احنا متفقين انه كله motile معادة تنتهين و ال
+
+631
+00:47:17,080 --> 00:47:20,320
+urea تبعها negative هذه من أهم الصفات اللي
+
+632
+00:47:20,320 --> 00:47:25,140
+قلنالكوا أساسية في عملية التفريق ما بين ال
+
+633
+00:47:25,140 --> 00:47:28,720
+protease و ما بين ال salmonella antigen ال
+
+634
+00:47:28,720 --> 00:47:30,700
+protease positive هدولة تنتهين negative المرة
+
+635
+00:47:30,700 --> 00:47:32,360
+الجاية ان شاء الله نكمل بإذن الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nCdfUPiC4Ig.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nCdfUPiC4Ig.srt
new file mode 100644
index 0000000000000000000000000000000000000000..a6da8dd993f6f0a0357311406576efac8561f804
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nCdfUPiC4Ig.srt
@@ -0,0 +1,2165 @@
+1
+00:00:20,270 --> 00:00:23,370
+بسم الله الرحمن الرحيم، نكمل إن شاء الله اليوم، و
+
+2
+00:00:23,370 --> 00:00:27,410
+نبدأ بأول مايكروب بتفصيل في موضوع الـ
+
+3
+00:00:27,410 --> 00:00:31,290
+enterobacteriasi اللي هو الإشريكية طبعًا تعودتم أنه
+
+4
+00:00:31,290 --> 00:00:34,490
+لما نقول إشريكية على طول يقولوا وراها.. وراها كولاي
+
+5
+00:00:34,490 --> 00:00:36,570
+لكن واقع الأمر اليوم هتتعلموا أن فيه different
+
+6
+00:00:36,570 --> 00:00:42,460
+spaces لهذا المايكروب، بنؤكد على حقيقة واحدة أن هذه
+
+7
+00:00:42,460 --> 00:00:45,460
+البكتيريا هي normal inhabitant of the intestinal
+
+8
+00:00:45,460 --> 00:00:49,740
+tract of man and warm-blooded mammals، يعني الإنسان
+
+9
+00:00:49,740 --> 00:00:52,260
+والثدييات، ذوات الدم الحار، طبعًا ثدييات مهي
+
+10
+00:00:52,260 --> 00:00:57,090
+أصلًا ذوات الدم الحار، على الرغم من أن تركيزها في
+
+11
+00:00:57,090 --> 00:01:01,110
+الانتستين أو نسبتها ما بين البكتيريا الأخرى هي
+
+12
+00:01:01,110 --> 00:01:05,070
+point واحد في المئة، إلا أنه بنلاقي أن الإشريكية
+
+13
+00:01:05,070 --> 00:01:10,050
+كلها هي الأشهر، السبب في ذلك أن الـ most common
+
+14
+00:01:10,050 --> 00:01:12,190
+بكتيريا في الـ intestinal tract هي بكتيريا لا
+
+15
+00:01:12,190 --> 00:01:16,190
+هوائية إجبارية، اللي هي من نوع bacteroidis، وبالتالي
+
+16
+00:01:16,190 --> 00:01:19,850
+عندما نقوم بتنمية أي عينة براز، أكرِمكم الله، على ما
+
+17
+00:01:19,850 --> 00:01:23,690
+يكنّ، بنعملها incubation، إيش إحنا هوائي ولا لا هوائي؟
+
+18
+00:01:23,690 --> 00:01:26,780
+هوائي في الغالب، فبيلاقي أن الإشريكية الإيكولاي
+
+19
+00:01:26,780 --> 00:01:29,420
+هي اللي ظهرت، والأخرى لم تظهر لأن البيئة غير
+
+20
+00:01:29,420 --> 00:01:34,980
+مناسبة لها، لأنها بدها ظروف لا هوائية، لأن الإيكولاي is
+
+21
+00:01:34,980 --> 00:01:38,940
+not the most common، لكن هي the most famous، خلينا
+
+22
+00:01:38,940 --> 00:01:42,680
+نقول هي الأشهر، طبعًا سُمّيت هذه البكتيريا على اسم
+
+23
+00:01:42,680 --> 00:01:47,280
+الطبيب الألماني إيشيريش، اللي في العام ألف وثمانية
+
+24
+00:01:47,280 --> 00:01:53,790
+وخمسة وثمانين، عزل، واتعرف على هذه البكتيريا الـ
+
+25
+00:01:53,790 --> 00:01:57,050
+Species زي ما ذكرنا، فيها إشريكية كولاي، إشريكية
+
+26
+00:01:57,050 --> 00:02:02,690
+فرقسوني، إشريكية هرماني، إشريكية فولنيرس، كمان مرة
+
+27
+00:02:02,690 --> 00:02:07,590
+إشريكية فولنيرس، إشريكية هرماني، إشريكية فرقسوني،
+
+28
+00:02:07,590 --> 00:02:14,440
+وإشريكية كولاي، لأن إحنا اتفقنا أنها normal flora،
+
+29
+00:02:14,440 --> 00:02:18,040
+normal inhabitants of the intestinal tract of man
+
+30
+00:02:18,040 --> 00:02:22,340
+and animal، ومع ذلك، outside the intestinal tract
+
+31
+00:02:22,340 --> 00:02:27,380
+they cause disease، أحد الأمثلة المشهورة اللي
+
+32
+00:02:27,380 --> 00:02:30,200
+ذكرناها في محاضرات سابقة، الـ urinary tract
+
+33
+00:02:30,200 --> 00:02:33,300
+infection، لكن بدنا نعرف كمان شغلات تانية عن
+
+34
+00:02:33,300 --> 00:02:37,580
+المايكروب، أنه it is a very common clinical isolate،
+
+35
+00:02:38,170 --> 00:02:41,890
+مش يعني؟ very common clinical isolates، يعني في
+
+36
+00:02:41,890 --> 00:02:46,210
+المستشفى، لو راجعنا دفتر أو سجل المزارع، باختلاف
+
+37
+00:02:46,210 --> 00:02:51,070
+أنواعها، الإشريكية تعتبر super star ما بين
+
+38
+00:02:51,070 --> 00:02:54,710
+الميكروبات، من وين بنلاقيها؟ ممكن نلاقيها من الـ CSF؟
+
+39
+00:02:54,710 --> 00:03:00,470
+نعم، هي number one cause of neonatal meningitis،
+
+40
+00:03:00,470 --> 00:03:04,470
+التهاب السحايا تبع أطفال حديثي الولادة، وجودها
+
+41
+00:03:04,470 --> 00:03:07,530
+number one cause of urinary tract infection، كمان
+
+42
+00:03:07,530 --> 00:03:10,570
+هي cause of wound infection، كمان هي cause of
+
+43
+00:03:10,570 --> 00:03:15,580
+septicemia، بالإضافة إلى كل هذه الأشياء، اكتشفنا
+
+44
+00:03:15,580 --> 00:03:17,700
+حديثًا.. حديثًا أن، أنا عايش من عشرين سنة أو خمس
+
+45
+00:03:17,700 --> 00:03:21,400
+عشرين سنة، أنها may cause diarrhea، يعني بقت بريئة
+
+46
+00:03:21,400 --> 00:03:24,640
+تمامًا في الـ intestinal tract، في.. it may cause
+
+47
+00:03:24,640 --> 00:03:29,080
+diarrhea، طبعًا
+
+48
+00:03:29,080 --> 00:03:33,860
+تملك هذه البكتيريا virulence factors تبعون الـ
+
+49
+00:03:33,860 --> 00:03:37,660
+enterobacteriasi، اللي هم حكينا عنهم، الـ O antigen
+
+50
+00:03:37,660 --> 00:03:43,820
+أو الـ lipopolysaccharide تبعه، من الميكروبات أو من
+
+51
+00:03:43,820 --> 00:03:47,240
+السلالات الممرضة في الـ intestinal tract، انتقلوا
+
+52
+00:03:47,240 --> 00:03:51,280
+لتكسينجينك إشريكية كولاي، أذكركم يا شباب، بيادة
+
+53
+00:03:51,280 --> 00:03:55,660
+البكتيريا، أن إحنا درسناها لما درسنا التكسين أو
+
+54
+00:03:55,660 --> 00:03:59,800
+درسنا الـ exotoxin، قلنا دي produce toxin that is
+
+55
+00:03:59,800 --> 00:04:02,920
+similar، نعم، that is similar to، mean to
+
+56
+00:04:02,920 --> 00:04:05,120
+vibrocholera toxin، اللي هو اللي بيعمل التكسين هذا
+
+57
+00:04:05,120 --> 00:04:08,760
+الـ L-T toxin، كيف بيشتغل الـ vibrocholera toxin؟ يقول لنا
+
+58
+00:04:08,760 --> 00:04:11,980
+it binds to an adenylate cyclase enzyme in the
+
+59
+00:04:11,980 --> 00:04:17,260
+intestinal wall، ATP is converted to cyclic A and B،
+
+60
+00:04:17,260 --> 00:04:19,920
+cyclic A and B will increase the production of
+
+61
+00:04:19,920 --> 00:04:22,960
+electrolytes، accumulation في الـ intestinal lumen،
+
+62
+00:04:22,960 --> 00:04:27,400
+therefore body will reproduce or will produce
+
+63
+00:04:27,400 --> 00:04:31,440
+large amount of fluid، وبالتالي دياريا is produced،
+
+64
+00:04:31,950 --> 00:04:36,270
+إذا، الانتيرو توكسين جينك إشريكية كولاي، هي E.coli قادرة
+
+65
+00:04:36,270 --> 00:04:39,130
+على إنتاج الـ LT toxin، والتي قلنا is
+
+66
+00:04:39,130 --> 00:04:44,930
+similar in action to Vibrio toxin، الصنف الثاني
+
+67
+00:04:44,930 --> 00:04:48,070
+اللي بيعمل دياريا أيضًا من الـ E.coli، هو الانتيرو
+
+68
+00:04:48,070 --> 00:04:52,460
+باثوجينك إشريكية كولاي، كيف بيشتغل؟ انت روح باحث عن كـ
+
+69
+00:04:52,460 --> 00:04:55,540
+إشريشيا كلها؟ اللي لو حاش بتقول بتقول أنه by
+
+70
+00:04:55,540 --> 00:04:59,280
+poorly understood mechanisms، several poorly
+
+71
+00:04:59,280 --> 00:05:03,660
+understood mechanisms، يعني فيه آليات مقترحة لتفسير
+
+72
+00:05:03,660 --> 00:05:09,850
+حدوث الدياريا، لكن مش مفهومة بشكل جيد، لكن هناك one
+
+73
+00:05:09,850 --> 00:05:14,030
+mechanism، يعني يمكن برزت على السطح أكثر من غيرها،
+
+74
+00:05:14,030 --> 00:05:18,750
+وهي قدرة هذا النوع من البكتيريا على إنتاج
+
+75
+00:05:18,750 --> 00:05:23,850
+adhesins، adhesins، فاكرينها؟ اللي هي المركبات
+
+76
+00:05:23,850 --> 00:05:27,850
+القادرة أو اللي تؤهل البكتيريا على الإرتباط أو
+
+77
+00:05:27,850 --> 00:05:32,620
+الالتصاق على الـ surfaces، تخيلوا معي التالي، villi،
+
+78
+00:05:32,620 --> 00:05:36,920
+villi، intestinal villi، إيش وظيفتها؟ absorption،
+
+79
+00:05:36,920 --> 00:05:40,640
+للغذاء المهضوم، الآن البكتيريا التصقت على الجدار
+
+80
+00:05:40,640 --> 00:05:45,340
+تمامًا، يعني عملت طبقة عازلة ما بين الـ villi وما
+
+81
+00:05:45,340 --> 00:05:49,360
+بين الـ intestinal content، محتويات الانتستين، هل
+
+82
+00:05:49,360 --> 00:05:53,280
+هَيصير فيه امتصاص؟ يبقى برضه كمان مرة، حيصير في تراكم
+
+83
+00:05:53,280 --> 00:05:58,040
+لمين؟ للـ electrolyte، والدسم عنده مجسات بتقيس الـ
+
+84
+00:05:58,040 --> 00:06:02,300
+electrolyte بدقة، وعندما تزداد الـ electrolytes على
+
+85
+00:06:02,300 --> 00:06:06,240
+الحد، بيفرز fluid، إذا، طريقة مختلفة لكن في النهاية
+
+86
+00:06:06,240 --> 00:06:11,260
+أدت إلى برضه دياريا، الـ Enterohemorrhagic
+
+87
+00:06:11,260 --> 00:06:16,010
+Escherichia Coli، برضه درسناها، درسناها، جونها it
+
+88
+00:06:16,010 --> 00:06:21,670
+produces SLT، SLT-Shigalike-Toxin، Shigalike يعني
+
+89
+00:06:21,670 --> 00:06:25,990
+بتذكرنا بإيه الميكانيزم بتاعة الشيجلة، إنه بتعمل
+
+90
+00:06:25,990 --> 00:06:28,930
+inhibition للـ protein synthesis in the affected
+
+91
+00:06:28,930 --> 00:06:32,370
+cell، therefore these cells will stop.. will stop
+
+92
+00:06:32,370 --> 00:06:35,970
+protein synthesis، they will eventually die، الـ
+
+93
+00:06:35,970 --> 00:06:39,450
+death تبع هذه الخلايا بيجعلها غير قادرة على القيام
+
+94
+00:06:39,450 --> 00:06:45,360
+بوظيفتها، وبالتالي no absorption، برضه accumulation،
+
+95
+00:06:45,360 --> 00:06:51,980
+دياريا، لكن بالإضافة إلى الدياريا، هنشوف أشياء مميزة
+
+96
+00:06:51,980 --> 00:06:57,200
+في الدياريا هذه، واحد، هنشوف epithelial cells ميتة،
+
+97
+00:06:57,200 --> 00:07:01,620
+اللي ماتت من الـ inhibition للـ protein synthesis، هنشوف الـ
+
+98
+00:07:01,620 --> 00:07:05,940
+mucus، اللي كان عليها كلامك صحيح؟ هنشوف الآن، بعد الـ
+
+99
+00:07:05,940 --> 00:07:08,440
+epithelial، أن صار في destruction للـ blood vessels،
+
+100
+00:07:08,440 --> 00:07:11,780
+يبقى عايز يوضح أن فيه blood leakage، هلا تشوف blood
+
+101
+00:07:13,110 --> 00:07:16,190
+مدام صار فيه destruction للخلايا، الـ immune system
+
+102
+00:07:16,190 --> 00:07:20,130
+بيعمل إرسال بالـ.. بالـ WBCs، اللي هي الـ white
+
+103
+00:07:20,130 --> 00:07:24,110
+blood cells، وبالتالي برضه هتشوف pus cells، إذا دياريا
+
+104
+00:07:24,110 --> 00:07:29,510
+محتوية على أربعة عناصر بتكون.. أو سميناها اسم خاص
+
+105
+00:07:29,510 --> 00:07:35,610
+فيها، فاكرين؟ dysentery، dysenteria، الزحار، وقلنا
+
+106
+00:07:35,610 --> 00:07:40,110
+هناك نوعان، الزحار، الزحار عصوي وأميبي، الأميبي
+
+107
+00:07:40,110 --> 00:07:43,510
+بتسببه الأميبا هستوليتيكا، والعصوي بتسببه الشيجلة،
+
+108
+00:07:43,510 --> 00:07:47,590
+لكن هنا شفنا كمان ميكروبات أخرى غير الشيجلة تقدر
+
+109
+00:07:47,590 --> 00:07:53,550
+على القيام بهذا الكلام، E coli O157H7 is
+
+110
+00:07:53,550 --> 00:07:57,410
+representative of this type، يعني هذه نقطة كتير
+
+111
+00:07:57,410 --> 00:08:02,810
+مهمة، عندما نقوم، عندما نقوم بعزل إشريكية كولاي من
+
+112
+00:08:02,810 --> 00:08:06,750
+الـ stool، لا يكفي أن نعمل reporting ونقول إشريكية
+
+113
+00:08:06,750 --> 00:08:12,370
+كولاي، صح؟ ليش؟ لأننا كنا نحتاج إشريكية كولاي، لكن لو
+
+114
+00:08:12,370 --> 00:08:17,130
+كانت إيكولاي O157H7، على طول الطبيب بيعرف أنها
+
+115
+00:08:17,130 --> 00:08:20,610
+الـ pathogen وهي المسبب للدياريا أو الـ condition
+
+116
+00:08:20,610 --> 00:08:25,750
+اللي عند المريض، ما أعرفش في نقطة قاعدة هنا في الرسمة،
+
+117
+00:08:25,750 --> 00:08:29,930
+أو في الشكل، بتكلم عن viratoxigenic-echericia-coli،
+
+118
+00:08:29,930 --> 00:08:33,090
+مصطلح أول مرة مر معنا، viratoxigenic-echericia
+
+119
+00:08:33,090 --> 00:08:39,250
+-coli، وواجب علينا توضيح هذا المصطلح، أرجو التركيز،
+
+120
+00:08:39,250 --> 00:08:43,530
+ وعدم الكتابة حتى يتسنى لنا إن شاء الله فهم الفكرة،
+
+121
+00:08:43,530 --> 00:08:50,450
+بتعرف حاجة اسمها cell culture، بناخد خلايا من إما
+
+122
+00:08:50,450 --> 00:08:55,030
+إنسان أو من حيوان من أعضاء معينة، وبنميها in
+
+123
+00:08:55,030 --> 00:08:59,650
+vitro، في وسط صناعي، وسط صناعي، بنحط لها المواد
+
+124
+00:08:59,650 --> 00:09:02,970
+الغذائية بتاعتها، والـ pH المناسب، والـ incubation
+
+125
+00:09:02,970 --> 00:09:06,390
+المناسب، الخلايا في هذه الحالة لن تنمو وتشكل
+
+126
+00:09:06,390 --> 00:09:09,410
+النعوضة، لأنها لو أخذناها من كليه مش هتنمو تمامًا
+
+127
+00:09:09,410 --> 00:09:13,170
+كليه، وإنما هتعمل، هتعمل mono layer، mono
+
+128
+00:09:13,170 --> 00:09:17,470
+layer، يعني طبقة واحدة من الخلايا، غالبًا هذا النوع من
+
+129
+00:09:17,470 --> 00:09:21,790
+الخلايا بنستخدمه واحنا، لتنمية الفيروسات، مش
+
+130
+00:09:21,790 --> 00:09:28,190
+الفيروسات اللي على.. اللي في وسط حياة.. في حياة
+
+131
+00:09:28,190 --> 00:09:32,790
+يعني intracellular، وبالتالي هي تشكل الـ monolayer
+
+132
+00:09:32,790 --> 00:09:36,910
+للبكتيريا، مين اللي تشكل الـ monolayer؟ الـ cell culture
+
+133
+00:09:36,910 --> 00:09:41,930
+لمين؟ للفيروس، طيب، الـ cell cultures، وأنا في هذه
+
+134
+00:09:41,930 --> 00:09:46,590
+المناسبة، كنت بأود أن البعض منكم يحضر المحاضرة اللي
+
+135
+00:09:46,590 --> 00:09:51,230
+ألقاها الدكتور من السويد، زميلنا، قبل أربعة أيام و
+
+136
+00:09:51,230 --> 00:09:55,070
+ثلاثة أيام، في هذه القاعة، ألقاها عبر الـ skype، فقال
+
+137
+00:09:55,070 --> 00:09:58,210
+أنه ممكن تستخدم whole animal، حيوان كامل، تحقنه
+
+138
+00:09:58,210 --> 00:10:01,790
+بالمادة، وتشوف تأثير المادة على مين؟ على الحيوان، أو
+
+139
+00:10:01,790 --> 00:10:06,530
+على أعضاء الحيوان، أو تشيل عضو من الحيوان تأخذه تعمل
+
+140
+00:10:06,530 --> 00:10:10,860
+أي testing، كبد مثلًا، طبعًا خذ بالك، الحيوان وهذا واحد،
+
+141
+00:10:10,860 --> 00:10:14,500
+والكبد واحد، يعني كبد يساوي حيوان، صح؟ ماوفرناش
+
+142
+00:10:14,500 --> 00:10:19,560
+كتير، في أسلوب ثاني بيستخدم شرائح من الكبد، فالكبد
+
+143
+00:10:19,560 --> 00:10:22,940
+الواحد عن عشر حيوانات، عشرين حيوانة، حسب عدد
+
+144
+00:10:22,940 --> 00:10:26,500
+الشرائح اللي أُحضرت، وفي أسلوب آخر بيستخدم مين يا
+
+145
+00:10:26,500 --> 00:10:32,600
+شباب؟ بيستخدم الخلايا، كل خلية باعتبارها أسلوب مستقل
+
+146
+00:10:32,600 --> 00:10:38,050
+لحالها، لكن في النهاية أنا محتاج موديل، محتاج موديل
+
+147
+00:10:38,050 --> 00:10:43,390
+أفحص عليه تأثيرات مركبات معينة، مثلًا مركب بتنتجه
+
+148
+00:10:43,390 --> 00:10:49,030
+الإشريكية كولاي EO157H7، فروحت فحصته على خلايا الـ
+
+149
+00:10:49,030 --> 00:10:54,980
+cell culture اسمها Vero cell culture، لقيت toxic للـ
+
+150
+00:10:54,980 --> 00:10:58,920
+virus cell culture، فسمّوا التكسين لأنه في ذاك الوقت
+
+151
+00:10:58,920 --> 00:11:03,360
+لم يكن characterized، فسمّوه virotoxic، يعني سام
+
+152
+00:11:03,360 --> 00:11:06,520
+ لخلايا الفيروس، ما هي الـ virus cells المشهورة؟ الـ
+
+153
+00:11:06,520 --> 00:11:09,240
+virus cells على فكرة هي خلايا أو cell culture
+
+154
+00:11:09,240 --> 00:11:12,760
+مأخوذة من الـ kidneys تبع الـ African green monkeys،
+
+155
+00:11:12,760 --> 00:11:16,420
+اللي هي القرود الأفريقية الخضراء، مأخوذة من الـ
+
+156
+00:11:16,420 --> 00:11:20,130
+kidney تبعها، اسمها Vero cells، وضحت الصورة، لماذا
+
+157
+00:11:20,130 --> 00:11:24,030
+سُمّيت virotoxic Escherichia coli؟ لأنه بتنتج تكسين
+
+158
+00:11:24,030 --> 00:11:30,230
+له قدرة على إحداث ضرر أو damage للـ Vero cells،
+
+159
+00:11:30,230 --> 00:11:36,170
+الصنف الثالث اللي هو الـ entero، الربع هذا الربع،
+
+160
+00:11:36,170 --> 00:11:41,380
+enteroinvasive Escherichia coli، واضح من المصطلح
+
+161
+00:11:41,380 --> 00:11:46,000
+invasion، أنه البكتيريا لا تكتفي بالبقاء على الـ
+
+162
+00:11:46,000 --> 00:11:49,300
+intestinal wall، وإنما تغزو الـ intestinal wall،
+
+163
+00:11:49,300 --> 00:11:55,140
+بطريقة مشابهة أيضًا لمن؟ للشيجلة، لذلك هذا
+
+164
+00:11:55,140 --> 00:11:58,740
+المايكروب، الدياريا تبعته شبيهة برضه بالـ dysentery،
+
+165
+00:11:58,740 --> 00:12:02,440
+شبيهة بالـ dysentery، إيش بيكون فيها؟ بيكون فيها
+
+166
+00:12:02,440 --> 00:12:06,870
+blood، في الفقرة الثانية، blood و mucus، زائد
+
+167
+00:12:06,870 --> 00:12:12,130
+neutrophil، إذا هذه البكتيريا أضرارها شبيهة بأضرار
+
+168
+00:12:12,130 --> 00:12:18,160
+الشيجلة، خذ بالكم، النقطة، في نهاية اللوحة بتكلم عن
+
+169
+00:12:18,160 --> 00:12:22,880
+نوعين من البكتيريا، الـ enteroinvasive والـ entero
+
+170
+00:12:22,880 --> 00:12:27,480
+toxigenic are famous for what is known as traveler
+
+171
+00:12:27,480 --> 00:12:30,980
+diarrhea، إيش هي traveler diarrhea؟ اللي هي دياريا
+
+172
+00:12:30,980 --> 00:12:34,740
+المسافرين، لما واحد بيسافر من بلد إلى بلد، بيصير
+
+173
+00:12:34,740 --> 00:12:3
+
+223
+00:16:21,920 --> 00:16:25,100
+بعزل اشيريشيا كولاي في غزة على سبيل المثال بلاجي
+
+224
+00:16:25,100 --> 00:16:29,380
+منها resistant  للأميكاسين و بلاجي منها sensitive
+
+225
+00:16:29,380 --> 00:16:32,440
+للأميكاسين، هذا الـ string غير على الـ string هذا، صح؟
+
+226
+00:16:32,440 --> 00:16:37,180
+يبقى  لا ننظر نظرة سطحية لاسم البكتيريا أنه
+
+227
+00:16:37,180 --> 00:16:43,040
+اسم واحد، three antigens  بيجي، بس هكمل الجملة دي أن
+
+228
+00:16:43,040 --> 00:16:45,760
+شاء الله، بعدين أخليك تسأل عن antigen structure في عندي
+
+229
+00:16:45,760 --> 00:16:50,580
+O antigen و في عندي H antigen و في عندي K antigen أنا
+
+230
+00:16:50,580 --> 00:16:55,120
+اتفقت معاكم قبل شوية أن الـ K antigen مش موجود في كل
+
+231
+00:16:55,120 --> 00:17:00,840
+الـ H3H4 فقط في تلك التي قمنا بعزلها من مين؟ من الـ
+
+232
+00:17:00,840 --> 00:17:07,360
+neonatal meningitis، اتفضل، هذه  أنها certain
+
+233
+00:17:07,360 --> 00:17:11,920
+serological strains، أصناف محددة بتسبب conditions
+
+234
+00:17:11,920 --> 00:17:16,160
+محددة، ما فيش فيها مشكلة، صنف محدد، serological type
+
+235
+00:17:16,160 --> 00:17:20,640
+محدد زي E. coli O157 مثلاً مش بسبب condition محدد
+
+236
+00:17:20,640 --> 00:17:25,380
+اللي هو الـ enterohemorrhagic colitis، فهذا بنسميه
+
+237
+00:17:25,380 --> 00:17:28,360
+serotype محدد بسبب condition محدد
+
+238
+00:17:32,120 --> 00:17:35,040
+الآن نبدأ Diagnostic  حقيقي في التعرف على
+
+239
+00:17:35,040 --> 00:17:38,720
+الاشيريشيا E. coli، وبدنا نتفاعل مع بعض، وضع الأقلام
+
+240
+00:17:38,720 --> 00:17:44,020
+ركزوا معايا، E. coli كمان مرة، ما بدي كتابة، بدنا
+
+241
+00:17:44,020 --> 00:17:48,060
+نركز مع بعض، E. coli هي واحدة من الـ Enterobacteriaceae
+
+242
+00:17:48,060 --> 00:17:50,580
+يعني كل الصفات التي امتلكتها الـ Enterobacteriaceae
+
+243
+00:17:50,580 --> 00:17:53,540
+بتمتلكها الـ E. coli، منها أنها oxidase negative
+
+244
+00:17:53,540 --> 00:17:56,360
+glucose fermenter، gram negative، facultative
+
+245
+00:17:56,360 --> 00:17:59,380
+anaerobic،  nitrate، nitrite، الآن السؤال الذي
+
+246
+00:17:59,380 --> 00:18:04,850
+يطرح نفسه، هي الصفات التي تميز الـ E. coli عن باقي
+
+247
+00:18:04,850 --> 00:18:08,010
+الـ Enterobacteriaceae؟ ورقم واحد أنها lactose
+
+248
+00:18:08,010 --> 00:18:11,570
+fermenter، طيب للأسف هذه الكلمة lactose fermenter
+
+249
+00:18:11,570 --> 00:18:16,150
+في معاها لكن وفي مش معاها، صح؟ يبقى أنا فسرتها عن
+
+250
+00:18:16,150 --> 00:18:21,070
+جزء،  فـ lactose fermenter صفة كتير مهمة، رقم اتنين، في
+
+251
+00:18:21,070 --> 00:18:25,170
+ده فحص اسمه IMViC، بتعرف الـ IMViC، indole، methyl red،
+
+252
+00:18:25,170 --> 00:18:28,930
+و Voges-Proskauer، و citrate، هي positive، positive،
+
+253
+00:18:28,930 --> 00:18:32,430
+negative، negative، ايش يعني positive، positive؟ يعني
+
+254
+00:18:32,430 --> 00:18:36,350
+indole positive، methyl red positive، Voges-Proskauer
+
+255
+00:18:36,350 --> 00:18:40,430
+negative، citrate negative، أنا ببدأ أقول لكم الآن، حطوا
+
+256
+00:18:40,430 --> 00:18:43,330
+في دماغكم أنها citrate negative، بس بدي المعلومات
+
+257
+00:18:43,330 --> 00:18:48,020
+citrate negative، و lactose fermenter، نجي الآن لميكروبات
+
+258
+00:18:48,020 --> 00:18:51,000
+شبيهة بالاشيريشيا كولاي، تشتغل معاها في من؟ في الـ
+
+259
+00:18:51,000 --> 00:18:54,620
+lactose fermentation زي الـ E. coli، حط في مخيلتك و
+
+260
+00:18:54,620 --> 00:19:00,760
+في ذاكرتك أن الـ E. coli non motile، لأ هي lactose
+
+261
+00:19:00,760 --> 00:19:04,260
+fermentation، non motile، يبقى  اللي حطيناها في
+
+262
+00:19:04,260 --> 00:19:10,220
+مخيلتنا الـ E. coli، citrate negative،  citrate negative، و
+
+263
+00:19:10,220 --> 00:19:16,550
+الـ E. coli non motile، الـ  الـ الـ Citrobacter، H2S
+
+264
+00:19:16,550 --> 00:19:22,530
+positive، H2S positive، هاي ثلاث أصناف أو ثلاث صفات
+
+265
+00:19:22,530 --> 00:19:26,590
+رئيسية، الرابعة مطلوب نعرف عنها حاجة، و مش مطلوب
+
+266
+00:19:26,590 --> 00:19:33,070
+نعرف عنها حاجة، لحالة  القايد هتطلع في التصفيات
+
+267
+00:19:33,070 --> 00:19:38,260
+تمام؟ بدون ما نتكلم و نجرب مع بعض، عطونا بكتيريا يا
+
+268
+00:19:38,260 --> 00:19:41,560
+شباب، هاي بكتيريا، تعالوا ندرس صفاتها، أنا بدرس
+
+269
+00:19:41,560 --> 00:19:44,400
+الآن صفاتها، قاعد، طلعت gram negative، بس الـ lie،
+
+270
+00:19:44,400 --> 00:19:48,240
+طلعت oxidase negative، طلعت glucose fermenter،
+
+271
+00:19:48,240 --> 00:19:51,470
+طلعت lactose fermenter، الآن أنت على طول بيخطر على
+
+272
+00:19:51,470 --> 00:19:55,310
+بالك واحدة من مين؟ واحدة من أربع...واحدة من
+
+273
+00:19:55,310 --> 00:19:59,870
+أربع اللي هم إشيريشيا، ستربتوكوكس، إنتروباكتر أو
+
+274
+00:19:59,870 --> 00:20:03,310
+كليبسلا، إيش بدك تعرف أو تسألني عن معلومات...أنا
+
+275
+00:20:03,310 --> 00:20:06,210
+اللي...أنا اللي بفحص الآن، اسألني عن معلومات وأنا
+
+276
+00:20:06,210 --> 00:20:10,610
+بدي أزودك بالنتائج، يلّا قول لي شو الفحص اللي بدك
+
+277
+00:20:10,610 --> 00:20:19,030
+إيه أنت الحين؟ it is positive، what is
+
+278
+00:20:19,030 --> 00:20:28,270
+next؟ it is motile،  ايش استثنيت مين أنت دلوقت؟ كمان سؤال
+
+279
+00:20:28,270 --> 00:20:29,870
+it is negative
+
+280
+00:20:32,630 --> 00:20:36,970
+يبقى Enterobacter، دون أن تعرف أي معلومة عن الـ
+
+281
+00:20:36,970 --> 00:20:39,950
+Enterobacter، صح ولا لأ؟ وتوصلت إلى أن البكتيريا
+
+282
+00:20:39,950 --> 00:20:44,050
+الآن Enterobacter، This game of exclusion should be
+
+283
+00:20:44,050 --> 00:20:48,870
+practiced by everyone among you، كل واحد فيكم مع
+
+284
+00:20:48,870 --> 00:20:53,150
+زميله، بده يحاول يمارس هذه اللعبة، يقول أنا في دماغي
+
+285
+00:20:53,150 --> 00:20:56,570
+الآن سميت بكتيريا ويكتبها على ورقة صغيرة ويحطها في
+
+286
+00:20:56,570 --> 00:21:01,930
+جيبه، كويس؟ والآخر يسأل، خدوا بالكم، في الـ diagnostic
+
+287
+00:21:01,930 --> 00:21:05,810
+microbiology، السؤال لا يكفي أن يكون صح، لازم يكون
+
+288
+00:21:05,810 --> 00:21:09,830
+كمان ترتيبه صح، يعني ما ينفعش تسألني أنت من أول سؤال
+
+289
+00:21:09,830 --> 00:21:13,270
+تقول لي أن دول positive ولا أن دول negative، أول سؤال
+
+290
+00:21:13,270 --> 00:21:16,090
+لازم أسأله، هي gram positive ولا gram negative، بس الله
+
+291
+00:21:16,090 --> 00:21:19,630
+يولّه، cocci، تمام؟ oxidase positive ولا oxidase
+
+292
+00:21:19,630 --> 00:21:23,270
+negative؟ glucose fermenter ولا لا؟ glucose fermenter،
+
+293
+00:21:23,270 --> 00:21:27,250
+lactose fermenter ولا لا؟ lactose fermenter، indole، و...
+
+294
+00:21:27,250 --> 00:21:32,530
+و هكذا، يبقى لا يكفي السؤال الصحيح وإنما أيضاً
+
+295
+00:21:32,530 --> 00:21:37,530
+ترتيبه يجب أن يكون صحيح، وحنحاول أن نزودكم ببرنامج
+
+296
+00:21:37,530 --> 00:21:42,570
+قمت بالإشراف عليه، إعداده أنا وطالب من كلية الطب، لكن
+
+297
+00:21:42,570 --> 00:21:45,810
+خلينا نأجله شوية، لحد ما أسألكم شوية معلومات
+
+298
+00:21:45,810 --> 00:21:51,610
+نظرية عن الفحوصات، طيب، positive، positive، negative،
+
+299
+00:21:51,610 --> 00:21:56,090
+negative، في  الـ EMB، مشهور جداً، بيعطينا green
+
+300
+00:21:56,090 --> 00:22:02,310
+metallic sheen، فضلاً عن أربعة، هذا بس عشان يصير مقروء
+
+301
+00:22:02,310 --> 00:22:05,470
+يعني، الـ I هذا، هذا عشان بس يصير مقروء، يعني
+
+302
+00:22:05,470 --> 00:22:10,550
+منطوق، IMViC، لما هو الـ indole-methylred-Voges-
+
+303
+00:22:10,550 --> 00:22:13,470
+-Proskauer-citrate، هذا الـ I ليس لها علاقة بالفحص
+
+304
+00:22:13,470 --> 00:22:18,750
+في فحص اسمه lysin decarboxylase، البكتيريا إلها
+
+305
+00:22:18,750 --> 00:22:21,910
+positive، طبعاً هي lactose fermenter بالتأكيد
+
+306
+00:22:22,790 --> 00:22:26,390
+الـ serological زي ما ذكرت لكم يا شباب، مش دائماً بنلجأ
+
+307
+00:22:26,390 --> 00:22:28,630
+للـ serological في الأشياء الشكلية فقط، لما تكون العينة
+
+308
+00:22:28,630 --> 00:22:32,970
+من وين جاية؟ من stool sample أو من environmental
+
+309
+00:22:32,970 --> 00:22:36,890
+sample، لأن العينات البيئية ممكن نلجأ إلى الـ serological
+
+310
+00:22:36,890 --> 00:22:43,910
+بالنسبة لـ treatment، علاج، اقرأ الجملة الأولى تحت
+
+311
+00:22:43,910 --> 00:22:49,130
+treatment، وجعلوها قاعدة ذهبية في الـ microbiology
+
+312
+00:22:49,880 --> 00:22:53,660
+Antibiotic sensitivity should be performed for all
+
+313
+00:22:53,660 --> 00:22:58,740
+clinical isolates، لماذا؟ لأن في changing patterns
+
+314
+00:22:58,740 --> 00:23:03,460
+يعني في تغيرات في الأنماط تبع السلوك تبع البكتيريا
+
+315
+00:23:03,460 --> 00:23:08,980
+ضد المضادات الحيوية، وأعطيكم أمثلة بسيطة جداً في
+
+316
+00:23:08,980 --> 00:23:13,880
+بكتيريا اسمها enterococcus faecalis، إلها أخت مغمورة
+
+317
+00:23:13,880 --> 00:23:17,460
+مغمورة يعني مش مشهورة في عالم الطب، اسمها
+
+318
+00:23:17,460 --> 00:23:22,780
+enterococcus faecium، يبقى فينا اسمين، faecalis وفي faecium
+
+319
+00:23:22,780 --> 00:23:28,260
+الـ faecalis ما فيش كتاب microbiology اللي بتكلم عنها
+
+320
+00:23:28,260 --> 00:23:31,620
+بشئ من التفصيل، بينما الـ faecium بذكره على الهامش
+
+321
+00:23:31,620 --> 00:23:36,560
+أنه في another species، اليوم وبعدها
+
+322
+00:23:38,840 --> 00:23:44,240
+اكتشافنا للمقدرة الهائلة للـ enterococcus faecium
+
+323
+00:23:44,240 --> 00:23:48,640
+اللي هي المغمورة، على تكوين resistance، أصبحت شهرة
+
+324
+00:23:48,640 --> 00:23:56,070
+البكتيريا رقم 2 تفوق رقم 1، يبقى فيه تغير في مفهومنا
+
+325
+00:23:56,070 --> 00:24:00,730
+لمين؟ للبكتيريا وحساسيتها للـ antibiotic باستمرار
+
+326
+00:24:00,730 --> 00:24:04,890
+وأكبر دليل على ذلك، في الأربعينيات أو الخمسينيات
+
+327
+00:24:04,890 --> 00:24:08,490
+و الستينيات من القرن الماضي، كان البنسلين is very
+
+328
+00:24:08,490 --> 00:24:12,440
+effective against Staphylococcus aureus، كان الـ
+
+329
+00:24:12,440 --> 00:24:18,320
+magic drug لـ Staphylococcus aureus، الآن 99% من
+
+330
+00:24:18,320 --> 00:24:21,880
+الـ Staphylococcus aureus، وفي بعض البلدان 100% من
+
+331
+00:24:21,880 --> 00:24:25,380
+الـ Staphylococcus aureus resistant to penicillin، يجب
+
+332
+00:24:25,380 --> 00:24:30,280
+أن نكتفي بالمعلومات النظرية حول أن البكتيريا
+
+333
+00:24:30,280 --> 00:24:35,760
+sensitive أو resistant لـ antibiotic معين، يجب أن
+
+334
+00:24:35,760 --> 00:24:39,500
+نقوم بجمع البيانات المحلية، ومن هنا نجيب البيانات
+
+335
+00:24:39,500 --> 00:24:44,580
+المحلية، العزلات اللي بنعزلهم بنعملهم antimicrobial
+
+336
+00:24:44,580 --> 00:24:48,840
+susceptibility أو sensitivity testing، يعني بنعرف
+
+337
+00:24:48,840 --> 00:24:53,260
+عزلاتنا مش عزلات الأمريكان أو الأوروبيين أو بلدان
+
+338
+00:24:53,260 --> 00:24:58,370
+أخرى، وحتى مناطق أخرى في فلسطين، و صورة بدنا local
+
+339
+00:24:58,370 --> 00:25:02,210
+data، وعشان هيك أنا بقول خدوا قاعدة ذهبية أن
+
+340
+00:25:02,210 --> 00:25:05,410
+antibiotic sensitivity testing must be preferred
+
+341
+00:25:05,410 --> 00:25:08,950
+تخيلوا يا شباب لو أن الـ Streptococcus pyogenes
+
+342
+00:25:08,950 --> 00:25:14,330
+المسبب للتنّوسيتس، تمام، resistant للـ penicillin
+
+343
+00:25:14,330 --> 00:25:20,110
+الآن، و drug of choice في كل العالم لـ Streptococcus
+
+344
+00:25:20,110 --> 00:25:23,730
+pyogenes هو الـ penicillin، لكن في غزة البكتيريا
+
+345
+00:25:23,730 --> 00:25:29,760
+المقاومة له، ما فيش فائدة إعطاء البنسلين للمرضى، مش بس
+
+346
+00:25:29,760 --> 00:25:33,840
+ما فيش فائدة، وهناك ضرر إذا أنت أعطيت المريض الـ
+
+347
+00:25:33,840 --> 00:25:37,860
+antibiotic الغير ملائم، يا شباب، أنت أعقدت عملية
+
+348
+00:25:37,860 --> 00:25:43,400
+الشفاء، وربما عملت complication إضافية للمريض
+
+349
+00:25:43,400 --> 00:25:47,220
+وبالتالي مطلوب منا نعمل sensitivity، على أساس أن
+
+350
+00:25:47,220 --> 00:25:50,460
+نساعد الأطباء في اختيار الـ antibiotic الأنسب و
+
+351
+00:25:50,460 --> 00:25:55,230
+المناسب، من الـ antibiotics المعروفة سابقاً أنها بتأثر
+
+352
+00:25:55,230 --> 00:25:58,370
+على E. coli، مجموعة الـ aminoglycosides، مجموعة الـ
+
+353
+00:25:58,370 --> 00:26:02,810
+aminoglycosides تحتوي على مجموعة ضخمة من الـ...من
+
+354
+00:26:02,810 --> 00:26:06,450
+الـ antibiotics، زي الـ...الـ...الـ...الـ gentamicin
+
+355
+00:26:06,450 --> 00:26:11,710
+زي الـ amicacin، زي الـ streptomycin، الـ neomycin، و الـ
+
+356
+00:26:11,710 --> 00:26:15,430
+kanamycin، و الـ netilmicin، يعني مجموعة كبيرة من الـ
+
+357
+00:26:15,430 --> 00:26:19,590
+antibiotics المستخدمة في هذه أو في...في مكافحة
+
+358
+00:26:19,590 --> 00:26:26,200
+الـ E. coli، لكن بيقولوا أن الأميكاسين
+
+359
+00:26:26,200 --> 00:26:31,100
+هو أقل من الـ aminoglycosides
+
+360
+00:26:31,100 --> 00:26:36,690
+السمية، ليش هم الـ aminoglycosides سمية؟ لهم
+
+361
+00:26:36,690 --> 00:26:41,090
+three toxicities، three toxicities، واحد oto-
+
+362
+00:26:41,090 --> 00:26:46,530
+toxicity، عفواً toxicity، اللي بتضر بالعصب السمعي،
+
+363
+00:26:46,530 --> 00:26:52,390
+nephrotoxicity بتضر بالكلى، و neurotoxicity بتضر
+
+364
+00:26:52,390 --> 00:26:56,890
+بالأعصاب، الشكل العام، three toxicities، كتير يا
+
+365
+00:26:56,890 --> 00:27:00,950
+شباب، من الأطفال اللي أخذوا overdose أو جرعات مطولة
+
+366
+00:27:00,950 --> 00:27:04,890
+من الـ gentamicin، صار عندهم مشاكل في السمع، نعم
+
+367
+00:27:08,560 --> 00:27:15,220
+في قضية خلافية لازم نطرحها أمامكم، في موضوع علاج للـ
+
+368
+00:27:15,220 --> 00:27:19,060
+E.schericia coli بالـ antibiotics، وخاصة الـ E. coli
+
+369
+00:27:19,060 --> 00:27:26,640
+O157H7، احنا اتفقنا، إذا بنعالج بالـ antibiotic، و نقتل
+
+370
+00:27:26,640 --> 00:27:32,200
+البكتيريا، البكتيريا بتموت، ولما تموت جزء من مين؟ من
+
+371
+00:27:32,200 --> 00:27:35,180
+الـ endotoxin تبعها، أو هو الـ endotoxin تبعها بتحرر
+
+372
+00:27:35,180 --> 00:27:40,920
+وتحرر الـ endotoxin، قد يحدث ضرر كبير جداً للمريض، قد
+
+373
+00:27:40,920 --> 00:27:46,560
+يؤدي إلى الوفاة، السؤال الذي بيطرح نفسه، وهو كمان
+
+374
+00:27:46,560 --> 00:27:49,700
+مرة under debate، ايش يعني under debate؟ يعني في
+
+375
+00:27:49,700 --> 00:27:53,920
+حوار وفي جدال، نعالج بالـ antibiotic ولا ما نعالجش
+
+376
+00:27:53,920 --> 00:27:57,580
+بالـ antibiotic؟ وللأسف هذا الـ debate...هذا الـ
+
+377
+00:27:57,580 --> 00:28:03,590
+debate لحد الآن موجود، فالبعض...البعض بيقول أنه إذا
+
+378
+00:28:03,590 --> 00:28:09,490
+كان الموضوع متعلق بالـ E. coli O157H7، لأ ما تعالجش
+
+379
+00:28:09,490 --> 00:28:12,210
+بالـ antibiotic، اعمل supportive treatment، وقوّي
+
+380
+00:28:12,210 --> 00:28:16,690
+المناعة، وحاول تخلي الجسم لحاله يتخلص من مين؟ لأنه
+
+381
+00:28:16,690 --> 00:28:22,650
+ضرر...ضرر الـ E. coli O157H7 بيزداد بعد إعطاء
+
+382
+00:28:22,650 --> 00:28:26,630
+المريض اللي هو الـ antibiotics، وبالتالي هناك فيه خشية
+
+383
+00:28:26,630 --> 00:28:32,070
+على حدوث فشل كلوي تم عند مرضى الـ E. coli O157H7
+
+384
+00:28:32,070 --> 00:28:35,270
+وخاصة في الأطفال، طب هل البكتيريا دي موجودة في غزة
+
+385
+00:28:35,270 --> 00:28:41,060
+يا شباب؟ الـ E. coli O157H7، دراساتنا الميدانية مع طلبة
+
+386
+00:28:41,060 --> 00:28:46,060
+الـ master اللي عملوا فحوصات للأغذية، بتقول أن الـ E
+
+387
+00:28:46,060 --> 00:28:51,800
+.coli O157H7 موجودة في خضارنا، موجودة في خضارنا
+
+388
+00:28:51,800 --> 00:28:55,040
+وموجودة في اللحم المفروم تبعنا، اللحم المفروم اللي
+
+389
+00:28:55,040 --> 00:29:01,170
+بنعمل منه مثلاً كباب أو كفتة، و لأن الكباب و الكفتة
+
+390
+00:29:01,170 --> 00:29:05,710
+بي...لما...لما بنحطهم على النار، بيستغرقوش وقت
+
+391
+00:29:05,710 --> 00:29:11,730
+طويل عشان يعني ينضجوا، فبالتالي ربما الحرارة قد لا
+
+392
+00:29:11,730 --> 00:29:15,750
+تصل إلى منتصف الـ...الـ...الغذ
+
+445
+00:33:01,810 --> 00:33:05,590
+الآن وأصبحت الظروف مواتية لها، ولو كانت خلية واحدة
+
+446
+00:33:05,590 --> 00:33:08,310
+أو خليتين، وأنتم عرفتم زمان الانقسام عند
+
+447
+00:33:08,310 --> 00:33:11,410
+البكتيريا، يعني في البعض منها لديها جاوز fifteen
+
+448
+00:33:11,410 --> 00:33:13,210
+minutes، عشرة minutes، زي الـ *Clostridium*
+
+449
+00:33:13,210 --> 00:33:16,990
+*perfringens*، هذه البكتيريا تقريبا عشرين دقيقة،
+
+450
+00:33:13,210 --> 00:33:16,990
+*perfringens*، هذه البكتيريا تقريباً عشرين دقيقة،
+
+450
+00:33:16,990 --> 00:33:22,770
+وخلال تخزين سيء، تخزين سيء قد تنمو البكتيريا وتصبح
+
+451
+00:33:22,770 --> 00:33:26,570
+إلى عدد كبير جداً، وبالتالي عندما تصل إلى الطفل
+
+452
+00:33:26,570 --> 00:33:31,670
+الضعيف المناعة، مولود حديثاً ضعيف المناعة، قد تؤدي
+
+453
+00:33:31,670 --> 00:33:36,230
+إلى أمراض منها *septicemia* وقد تقتل الطفل، وفي دراسة
+
+454
+00:33:36,230 --> 00:33:42,250
+محلية قمنا بها في أحد المستشفيات التي تقدم خدمة
+
+455
+00:33:42,250 --> 00:33:49,160
+الحليب للأطفال في الحضانات، تتبعنا البكتيريا من
+
+456
+00:33:49,160 --> 00:33:56,580
+الماء المستخدم للبودرة، للأوعية، للخلطة، للنقل إلى
+
+457
+00:33:56,580 --> 00:34:00,400
+بطن المريض، سحبنا الأنبوبة التي يغذون فيها الطفل
+
+458
+00:34:00,400 --> 00:34:05,060
+وجسينا منها جزءاً وعملنا لها فحصاً، وللأسف وجدنا في بعض
+
+459
+00:34:05,060 --> 00:34:10,590
+الحالات *Enterobacter sakazakii*، هذا للأسف، يعني  خلاله نكتب
+
+460
+00:34:10,590 --> 00:34:17,130
+تقرير للمستشفى المعني، والحقيقة والتاريخ أن
+
+461
+00:34:17,130 --> 00:34:22,550
+الجماعة اهتموا بالموضوع اهتماماً غير عادي، ووقفوا
+
+462
+00:34:22,550 --> 00:34:27,170
+المطبخ الذي يصنع، وعملوا ثورة جديدة فيه، نضفوه خالصاً
+
+463
+00:34:27,170 --> 00:34:31,570
+يعني دهنوه، عملوا له طلاءً جديداً، ركبوا له *facilities* أخرى
+
+464
+00:34:31,570 --> 00:34:36,390
+جديدة، وأخذوا بالتوصيات التي نحن أوصينا فيها، و
+
+465
+00:34:36,390 --> 00:34:38,710
+نحن طبعاً بعد ذلك لم نتابع، لكن هم قاموا بهذه
+
+466
+00:34:38,710 --> 00:34:43,530
+الإجراءات، مشكلة قصد من الكلام أو من الفكرة كلها أن
+
+467
+00:34:43,530 --> 00:34:46,810
+طالما نحن *Enterobacter sakazakii*، هل الـ *Enterobacter*
+
+468
+00:34:46,810 --> 00:34:52,130
+*sakazakii* ما كانت موجودة زمان؟ كانت موجودة، بس نحن
+
+469
+00:34:52,130 --> 00:34:56,550
+ما كنا نعرف عنها، فبالتالي الآن هي مشهورة، ليس لأن هي
+
+470
+00:34:56,550 --> 00:35:00,870
+اكتسبت صفات جديدة، لأن نحن تعلمنا عنها شيئاً جديداً
+
+471
+00:35:00,870 --> 00:35:04,170
+وهذه النقطة كثيراً مهمة في تفكيرنا نحن في الـ
+
+472
+00:35:04,170 --> 00:35:09,870
+*microbiology*، أعطيكم مثالاً بسيطاً في أحد الـ..الـ..
+
+473
+00:35:09,870 --> 00:35:17,370
+الـ..الـ *chart*، نجد خطين ماشيين، واحد لـ *Salmonella*
+
+474
+00:35:17,370 --> 00:35:22,830
+واحد لـ *Campylobacter*، هي الزمن، وهي عدد البكتيريا، الآن
+
+475
+00:35:22,830 --> 00:35:25,390
+هي الـ *Salmonella* وهي الـ *Campylobacter* ماشيين بهذا
+
+476
+00:35:25,390 --> 00:35:30,270
+الشكل، عند سنة معينة نجد صار في *shift*، الـ
+
+477
+00:35:30,270 --> 00:35:34,830
+*Campylobacter* طالعة، و الـ *Salmonella*  في نفس المكان، طب
+
+478
+00:35:34,830 --> 00:35:37,670
+يأتي واحد يقول: بدي أحلل.. بدي أحلل نتائج، فماذا أقول؟ يقول: منذ سنة كذا بدأت ترتفع نسب من الـ
+
+479
+00:35:37,670 --> 00:35:45,050
+*Campylobacter*، هذا ظلم لمن؟ لـ *Campylobacter* أنه
+
+480
+00:35:45,050 --> 00:35:52,650
+فقط من سنة كذا ارتفعت، لكن واحد حاذق ينظر للموضوع
+
+481
+00:35:52,650 --> 00:35:57,230
+بطريقة مُفْتَلَّة، يقول: في السنوات التي ارتفعت فيها الـ
+
+482
+00:35:57,230 --> 00:36:00,350
+*Campylobacter*، قدرتنا في المختبرات أصلاً زادت على
+
+483
+00:36:00,350 --> 00:36:05,910
+عزل البكتيريا، تحسنت التقنية التي نعزل بها من؟
+
+484
+00:36:05,910 --> 00:36:10,230
+الـ *Campylobacter*، فبدلاً ما كانت الحساسية عشرين في
+
+485
+00:36:10,230 --> 00:36:13,310
+المئة، صارت ثمانين في المئة، يعني الزيادة حقيقية، و
+
+486
+00:36:13,310 --> 00:36:17,770
+غير حقيقية؟ غير حقيقية، هي زيادة في قدرتنا على الكشف
+
+487
+00:36:17,770 --> 00:36:23,470
+عن الـ *Campylobacter*، وليس زيادة في حالات الـ
+
+488
+00:36:23,470 --> 00:36:27,290
+*Campylobacter* نفسها، وصلت الصورة أم لم تصل؟ نعم
+
+489
+00:36:30,830 --> 00:36:34,250
+نعم، وصلناها، هذا مفهوم، لازم نكون قادرين على
+
+490
+00:36:34,250 --> 00:36:39,090
+أن.. يعني أن نفهم في الـ *microbiology*، طيب
+
+491
+00:36:39,090 --> 00:36:43,370
+*Enterobacter aerogenes*, *Klebsiella*, *Leclercia*, ونحن آسفون
+
+492
+00:36:43,370 --> 00:36:45,950
+نحن فكرنا أنه *sakazakii* غير موجودة، لكن هي موجودة الآن
+
+493
+00:36:45,950 --> 00:36:49,430
+*Enterobacter sakazakii*، وحقيقةً أنَّها ممكن تعمل داءً إسهالياً
+
+494
+00:36:49,430 --> 00:36:53,570
+*associated with infant formula*، اليوم هي حليب
+
+495
+00:36:53,570 --> 00:36:59,370
+الأطفال، الآن سُمِّيَتْ اسماً آخر، *Cronobacter*، يعني بقت
+
+496
+00:36:59,370 --> 00:37:02,590
+اسمها *Enterobacter sakazakii* صار اسمها *Cronobacter*
+
+497
+00:37:10,130 --> 00:37:14,130
+زمان كانوا يسمونها *Aerobacter*, often confused with
+
+498
+00:37:14,130 --> 00:37:18,530
+*Klebsiella*، يعني ممكن نخطئها على الطبق في المزرعة
+
+499
+00:37:18,530 --> 00:37:22,570
+على أنها *Klebsiella*، مؤشر على ماذا؟ بمَ تتميز الـ
+
+500
+00:37:22,570 --> 00:37:27,050
+*Klebsiella*? إنها طبق على طبق، بدنا نعرف أنها
+
+501
+00:37:27,050 --> 00:37:30,280
+متحركة أم غير متحركة على الطبق، *capsulated*
+
+502
+00:37:30,280 --> 00:37:35,480
+الـ *Klebsiella* كبيرة، و *mucoid colonies* كبيرة، و *mucoid*
+
+503
+00:37:35,480 --> 00:37:38,460
+*colonies* كبيرة، فالـ *Enterobacter*  برضه ممكن تعطينا كبيرة
+
+504
+00:37:38,460 --> 00:37:41,660
+و *mucoid colonies* كبيرة، البكتيريا هنا نامو طويل
+
+505
+00:37:41,660 --> 00:37:45,380
+أورنيثين ديكاربوكسيليز، *positive* في الـ *ODC*
+
+506
+00:37:50,480 --> 00:37:55,800
+الـ *ABI*, يا ريت كل الأسماء هذه، الـ الـ *OMBG* والـ
+
+507
+00:37:55,800 --> 00:37:59,120
+*LDC* والـ *ODC* تبقوا عارفينها كويس، إيش ما.. إيش
+
+508
+00:37:59,120 --> 00:38:02,560
+مفهوم، وما أعرفش بيفحصه، وعن من *positive* وعن من
+
+509
+00:38:02,560 --> 00:38:08,480
+*negative*، *it is positive* these tests، إن هذه الاختبارات
+
+510
+00:38:08,480 --> 00:38:12,180
+التي هي الـ *motility* والـ *ornithine decarboxylase* are
+
+511
+00:38:12,180 --> 00:38:15,840
+used to differentiate it from the genus *Klebsiella*
+
+512
+00:38:15,840 --> 00:38:19,080
+which is similar to *Enterobacter*، يعني في عندي
+
+513
+00:38:19,080 --> 00:38:24,380
+صفتين، صفة الـ *motility* و صفة الـ *ODC*، طب أنا جاب شوية
+
+514
+00:38:24,380 --> 00:38:28,580
+ونحن نلعب لعبة التعرف على الميكروبات، ذكرت فحصاً
+
+515
+00:38:28,580 --> 00:38:32,040
+واحد يفرق بينهما، الذي هو من؟ الـ *motility*، صحيح، الـ
+
+516
+00:38:32,040 --> 00:38:37,690
+*motility*، خذوا قاعدة: كلما زاد عدد الفحوصات المُستخدمة
+
+517
+00:38:37,690 --> 00:38:42,110
+كلما زادت دقة التعريف، يعني لو أنا قدرت أميز
+
+518
+00:38:42,110 --> 00:38:46,490
+بينكما بِعَشْرِ صفات، أفضل من أن أميز بينكما بِصفة
+
+519
+00:38:46,490 --> 00:38:50,650
+واحدة، لماذا؟ في البكتيريا يا شباب، الـ *exceptions*
+
+520
+00:38:50,650 --> 00:38:55,030
+موجودة دائماً بشكل مستمر، لما أنا قلت الـ *typical E*
+
+521
+00:38:55,030 --> 00:39:00,030
+*coli*، قلت ماذا؟ *positive positive negative negative*
+
+522
+00:39:00,030 --> 00:39:03,590
+يعني الـ *indulge* تبعها ماذا؟ لو قلت لكم أنه في
+
+523
+00:39:03,590 --> 00:39:07,610
+*equalized exception*، أن هؤلاء *negative*، طبعاً سأعمل لكم
+
+524
+00:39:07,610 --> 00:39:11,690
+*confusion* من الآن، لكن أنا أجل هذا الموضوع لِبَعْدَيْن
+
+525
+00:39:11,690 --> 00:39:17,330
+بس كفكرة، أن ليس في الغالب مئة بالمائة
+
+526
+00:39:17,330 --> 00:39:21,950
+*absolute* للبكتيريا، وبالتالي حتى لما نحن نعمل
+
+527
+00:39:21,950 --> 00:39:25,150
+قواعد بيانات، لا نعمل *positive* و *negative* يا شباب
+
+528
+00:39:25,150 --> 00:39:30,050
+في قواعد البيانات، نعمل نسبها المئوية، *percentage*، *percentage*
+
+529
+00:39:30,050 --> 00:39:36,070
+نقول الـ *E. coli* 90% *positive* for، أن هؤلاء one
+
+530
+00:39:36,070 --> 00:39:38,750
+percent *positive* for *citrate*، يعني غالباً هي
+
+531
+00:39:38,750 --> 00:39:42,250
+*negative*، غالباً هي *negative*، لكن في احتمالية أن يكون
+
+532
+00:39:42,250 --> 00:39:47,770
+منها أصناف مثلاً واحد في المئة *positive*، يبقى الصفات
+
+533
+00:39:47,770 --> 00:39:52,110
+لا نجدها *absolute* في معظم الأحيان، نجدها بشكل
+
+534
+00:39:52,110 --> 00:39:59,020
+نسب مئوية، بالمناسبة برنامج لازم يكون كنتم نزّلتموه
+
+535
+00:39:59,020 --> 00:40:06,560
+اسمه *ID based*، *ID based*، عبارة
+
+536
+00:40:06,560 --> 00:40:11,580
+عن *small software*، دوّروا عليه في جوجل، على
+
+537
+00:40:11,580 --> 00:40:17,030
+هذا البرنامج، ونزّلوا، لو عندكم اجعلوه *set up*، وشوفوا الـ..
+
+538
+00:40:17,030 --> 00:40:19,950
+الـ *matrices*، المصفوفات التي فيه، ستجدون الكلام الذي
+
+539
+00:40:19,950 --> 00:40:23,990
+نحكي لكم إياه، أنه مثلاً الـ *ODC* تسعين بالمئة، سبعين
+
+540
+00:40:23,990 --> 00:40:26,390
+بالمئة، لا يجدها *positive* و *negative*
+
+542
+00:40:33,730 --> 00:40:36,530
+طبعاً البكتيريا، نحن قلنا من أحد أهم صفاتها أنها
+
+543
+00:40:36,530 --> 00:40:40,150
+*motile by peritrichous flagella*، وهذه صفة من صفات من
+
+544
+00:40:40,150 --> 00:40:43,250
+الـ *Enterobacteriaceae*، إذا كانت متحركة فهي متحركة من
+
+545
+00:40:43,250 --> 00:40:43,410
+متحركة من متحركة من متحركة من متحركة من متحركة من
+
+546
+00:40:43,410 --> 00:40:44,490
+متحركة من متحركة من متحركة من متحركة من متحركة من
+
+547
+00:40:44,490 --> 00:40:44,970
+متحركة من متحركة من متحركة من متحركة من متحركة من
+
+548
+00:40:44,970 --> 00:40:45,170
+متحركة من متحركة من متحركة من متحركة من متحركة من
+
+549
+00:40:45,170 --> 00:40:53,390
+متحركة من متحركة من متحركة من متحركة من متحركة
+
+550
+00:40:53,390 --> 00:41:00,310
+من متحركة، بالنسبة للوصف والتغذية فيه أو  الغذل في شكل
+
+551
+00:41:00,310 --> 00:41:03,410
+البكتيريا تحت الميكروسكوب يا شباب، أنا برضه
+
+552
+00:41:03,410 --> 00:41:06,490
+أعطيتكم نوعاً من الـ *generalization* أو التعميم في
+
+553
+00:41:06,490 --> 00:41:11,150
+بيانات المحاضرات، يكفيني أعرف معلومة واحدة أنها *gram*
+
+554
+00:41:11,150 --> 00:41:17,720
+*negative*، بس، لكن أما الشكل قصيرة، طويلة، للأسف هذا
+
+555
+00:41:17,720 --> 00:41:22,820
+مرتبط بالـ *media* وحجم المستعمرة، وكم ساعة للمستعمرة
+
+556
+00:41:22,820 --> 00:41:27,540
+وبالتالي أمور يصعب ضبطها، ففقط يكفيني كمان مرة أنها
+
+557
+00:41:27,540 --> 00:41:30,940
+*gram negative*، بس، الله، بالنسبة لـ الـ *cultural*
+
+558
+00:41:30,940 --> 00:41:33,660
+*characteristics*، البكتيريا تنمو على، نحن في الآخر
+
+559
+00:41:33,660 --> 00:41:37,880
+نزرعها على مكونكي، في المكونكي *they will*
+
+560
+00:41:37,880 --> 00:41:44,180
+*appear as pink*، لماذا *pink*? لأن الـ *lactose* مُخَمِّرَة، وكان
+
+561
+00:41:44,180 --> 00:41:47,400
+الـ *lactose* مُخَمِّرَة، وهذه النقطة من الآن نبدأ يعني
+
+562
+00:41:47,400 --> 00:41:55,560
+نتفق عليها اتفاقاً مبدئياً حيوياً، أنها عينة زُرِعَتْ على
+
+563
+00:41:55,560 --> 00:42:01,700
+*blood agar*، ودائماً لما نزرع العينة نزرعها نبدأ
+
+564
+00:42:01,700 --> 00:42:06,240
+في من؟ نبدأ في من؟ في الـ *general media*، وننتقل
+
+565
+00:42:06,240 --> 00:42:11,280
+بعد ذلك إلى الـ *selective media*، زي المكونكي، الآن زرعنا
+
+566
+00:42:11,280 --> 00:42:15,500
+بغرض
+
+567
+00:42:15,500 --> 00:42:24,220
+الحصول على مستعمرات منعزلة، *isolated colonies*، وحصلنا
+
+568
+00:42:24,220 --> 00:42:31,240
+على مستعمرة منفصلة، *isolated colony*
+
+569
+00:42:31,240 --> 00:42:37,270
+هذه الـ *isolated colony*، اتفقنا على أنه إذا كانت *pink*
+
+570
+00:42:37,270 --> 00:42:45,750
+فهي تعني *lactose fermenter*، إذا
+
+571
+00:42:45,750 --> 00:42:46,750
+كانت عديمة اللون
+
+572
+00:42:50,010 --> 00:42:54,430
+فهي *non-lactose fermenter*، هذه المعلومة *essential*
+
+573
+00:42:54,430 --> 00:42:58,330
+يا شباب، مهمة، لا نستطيع تجاوزها، يعني *cultural*
+
+574
+00:42:58,330 --> 00:43:02,250
+*characteristics*، قدامي أنا أزرع البكتيريا لأُغْلِط
+
+575
+00:43:02,250 --> 00:43:05,950
+في نموها، لكن في نفس الوقت أحصل على معلومة أنها
+
+576
+00:43:05,950 --> 00:43:08,990
+*lactose fermenter* أم *non-lactose fermenter*، *just*
+
+577
+00:43:08,990 --> 00:43:14,150
+*by the color*، بدي تلاحظوا شغلة، أن قراءة الأطباق تتم
+
+578
+00:43:14,150 --> 00:43:18,700
+بعد ما يقارب من 24 ساعة، إيش نسمي أقل من 24 ساعة
+
+579
+00:43:18,700 --> 00:43:25,400
+دي؟ *overnight*، إيش يعني *overnight*? يعني أنتَ تزرع
+
+580
+00:43:25,400 --> 00:43:28,700
+الساعة الثامنة صباحاً، وتقرأ ثاني يوم ثامنة صباحاً،
+
+581
+00:43:28,700 --> 00:43:32,640
+تزرع الساعة العاشرة، وتقرأ ثامنة صباحاً ثاني يوم،
+
+582
+00:43:32,640 --> 00:43:36,960
+يعني الوقت الذي قضته المزرعة في الـ *incubator* هو
+
+583
+00:43:36,960 --> 00:43:42,380
+ليس بالضبط 24 ساعة، وإنما مرّ عليها ليلة كاملة، مرّ
+
+584
+00:43:42,380 --> 00:43:46,480
+عليها ليلة كاملة في عملية الـ..الـ..الـ
+
+585
+00:43:46,480 --> 00:43:49,380
+*incubation*، فهذا نسميه *overnight incubation*
+
+586
+00:43:53,070 --> 00:44:01,110
+الآن، في بعض المستعمرات تعمل شيئاً اسمه *line* أو
+
+587
+00:44:01,110 --> 00:44:04,390
+*precipitated line*، يعني هذه المستعمرة مثلاً، على سبيل
+
+588
+00:44:04,390 --> 00:44:08,730
+المثال، نكبر هنا المستعمرة، نجد حواليها
+
+589
+00:44:11,210 --> 00:44:17,730
+لوناً *dark*، أغمق من لون المكونكي نفسه، وليس له علاقة
+
+590
+00:44:17,730 --> 00:44:21,910
+بالمستعمرة، يعني عامل زي هالة حول المستعمرة، هذا
+
+591
+00:44:21,910 --> 00:44:28,050
+يسمى *precipitated pile*، مش المكونكي فيه *pile*، *pile*
+
+592
+00:44:28,050 --> 00:44:33,750
+*salt*، فهذا يترسب حوالين المستعمرة، لكن الـ
+
+593
+00:44:33,750 --> 00:44:39,820
+*precipitated pile* الذي على الإشريكية القولونية أكثر
+
+594
+00:44:39,820 --> 00:44:43,640
+بكثير من الـ *precipitated bile* الذي يكون على من؟
+
+595
+00:44:43,640 --> 00:44:46,260
+على الـ *Enterobacter*، مهمة هذه المعلومة أن نراها
+
+596
+00:44:46,260 --> 00:44:49,780
+برضه كـ *cultural characteristics*، شباب، بالنسبة للـ
+
+597
+00:44:49,780 --> 00:44:53,480
+*biochemical characteristics*، هنا البكتيريا أهم ما
+
+598
+00:44:53,480 --> 00:44:58,800
+نعرف أنها *Indole negative,  methyl red negative, Voges-Proskauer positive, citrate positive*، يعني *citrate positive*، بينما الـ *E. coli*
+
+599
+00:44:58,800 --> 00:45:03,840
+*citrate negative*، يبقى أنا قلت لكم احفظوا فقط من
+
+600
+00:45:04,640 --> 00:45:09,380
+الـ *Enterobacter*، هي *citrate negative*، دلالة على أن
+
+601
+00:45:09,380 --> 00:45:12,520
+ثلث الباجين *citrate positive*، قلت لكم احفظوا الـ
+
+602
+00:45:12,520 --> 00:45:16,380
+*citrate* أكثر، *H2S positive*، على أنه.. دلالة على أن
+
+603
+00:45:16,380 --> 00:45:19,860
+الباجين كلهم *negative*، قلت لكم الـ *Klebsiella* هي
+
+604
+00:45:19,860 --> 00:45:23,420
+الوحيدة الـ *non-motile*، *non-motile*، يبقى الباجين
+
+605
+00:45:23,420 --> 00:45:26,640
+كلهم *motile*، هذه النقاط التي نحن كنا نركز عليها
+
+607
+00:45:32,310 --> 00:45:39,950
+بالنسبة لـ *Triple Sugar Iron agar*، الـ *E. coli* والـ *E*
+
+608
+00:45:39,9
+
+667
+00:50:13,260 --> 00:50:18,260
+داخل المستشفى، إذن هناك إجراءات متنوعة وكثيرة يقوم
+
+668
+00:50:18,260 --> 00:50:21,420
+بها طواقم نسموهم احنا hospital infection control
+
+669
+00:50:21,420 --> 00:50:25,600
+committees  لجهود منع العدوى في المستشفيات من
+
+670
+00:50:25,600 --> 00:50:29,840
+isolation  من البحث على alternatives  من disinfection
+
+671
+00:50:29,840 --> 00:50:34,180
+procedures جديدة تماماً للتخلص من الـmicroorganism
+
+672
+00:50:35,830 --> 00:50:40,730
+الأساس إنه احنا كمان فيه نقطة كتير مهمة و بنهملها
+
+673
+00:50:40,730 --> 00:50:44,210
+لما نقع في المشكلة بنصير ندور على حل المشكلة إنه
+
+674
+00:50:44,210 --> 00:50:49,150
+نمنع أصلاً ظهور الـresistance كيف نمنع ظهور الـ
+
+675
+00:50:49,150 --> 00:50:52,670
+resistance؟ بندور على أسباب ظهور الـresistance
+
+676
+00:50:52,670 --> 00:50:55,490
+بالأساس يا شباب، أيش أسباب ظهور الـresistance
+
+677
+00:50:55,490 --> 00:50:57,290
+برأيكم؟ كثيراً
+
+678
+00:51:04,700 --> 00:51:09,200
+أنت بتضيف على الـ antibiotic  و الـ antibiotic موجودة
+
+679
+00:51:09,200 --> 00:51:12,500
+فعلاً، وهي تدرج على التطبيق فتتعرض عليها البكتيريا
+
+680
+00:51:12,500 --> 00:51:15,340
+و ربما عنده موضوع البكتيريا اللي تتسبب بالبكتيريا
+
+681
+00:51:15,340 --> 00:51:20,160
+الأخرى. طيب خلينا ناخد .. يعني كلامك طيب و كويس، صحيح
+
+682
+00:51:20,160 --> 00:51:24,520
+لكن خلينا ناخد فكرة عامة، لو الصف هذا كله، كله، كله
+
+683
+00:51:24,520 --> 00:51:28,340
+sensitive  لـ antibiotic معين، لسم معين، تمام؟ ما فيش
+
+684
+00:51:28,340 --> 00:51:31,460
+غير واحد resistant ، ما فيش غير واحد resistant
+
+685
+00:51:31,460 --> 00:51:35,100
+ورشنا السم هذا عليكم، نخلص منكم بالمرة في
+
+686
+00:51:35,100 --> 00:51:39,320
+المحاضرة هذه، من ايه؟ كلكم هتموتوا بعد واحد،
+
+687
+00:51:39,320 --> 00:51:45,300
+مظبوط؟ هذا اللي كان مكتوب، آلاف السموم حضراتكم
+
+688
+00:51:45,300 --> 00:51:50,260
+الآن هذا ينقسم، انقسم ثنائي بسيط، بصير بمعنى
+
+689
+00:51:50,260 --> 00:51:54,820
+استخدامي للسم أو الـ antibiotic عمل selection  لمين؟
+
+690
+00:51:54,820 --> 00:51:59,180
+للـ resistant mutants، the resistant mutants أنا
+
+691
+00:51:59,180 --> 00:52:03,500
+اللي نشرتهم .. أنا اللي نشرتهم باستخدامي المفرط،
+
+692
+00:52:03,500 --> 00:52:06,560
+أنا اللي .. اللي نشرتهم باستخدامي .. باستخدامي الـ
+
+693
+00:52:06,560 --> 00:52:11,440
+.. الـ .. الخطأ اللي هو misuse و abuse ، وتعالوا
+
+694
+00:52:11,440 --> 00:52:15,330
+نطلع على الـ .. الـ .. الـ practices في المجتمع، كلنا
+
+695
+00:52:15,330 --> 00:52:21,830
+بنشتغل أطباء، عطى واحد دواء، لما طيب أعطاه course من
+
+696
+00:52:21,830 --> 00:52:25,330
+الكبسولات الحمراء والزرقاء، تمام؟ فكمل نص الـ course و
+
+697
+00:52:25,330 --> 00:52:31,670
+خلى النص الثاني عنده لأنه طاب هو okay ف .. أعطاه لمن؟
+
+698
+00:52:31,670 --> 00:52:38,470
+لـ .. لزميله أو لصديقه، وبالتالي احنا underdose، ممكن
+
+699
+00:52:38,470 --> 00:52:41,530
+يكون expired، يعني هناك مجموعة كبيرة من العوامل إن
+
+700
+00:52:41,530 --> 00:52:44,310
+شاء الله بنبقى نفصل فيها في محاضرة أخرى، علامة
+
+701
+00:52:44,310 --> 00:52:46,330
+اللقاء إن شاء الله في المحاضرة القادمة، السلام
+
+702
+00:52:46,330 --> 00:52:47,530
+عليكم ورحمة الله وبركاته
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nCdfUPiC4Ig_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nCdfUPiC4Ig_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..a125b845711cb5698b609337414341eaae60c8c1
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nCdfUPiC4Ig_postprocess.srt
@@ -0,0 +1,2808 @@
+1
+00:00:20,270 --> 00:00:23,370
+بسم الله الرحمن الرحيم نكمل ان شاء الله اليوم و
+
+2
+00:00:23,370 --> 00:00:27,410
+نبدأ بأول مايكروب بتفصيل في موضوع ال
+
+3
+00:00:27,410 --> 00:00:31,290
+enterobacteriasi اللي هو الاشريشيا طبعا تعودتم انه
+
+4
+00:00:31,290 --> 00:00:34,490
+لما نقول اشريشيا ع طويل يقولوا ورا .. وراها كولاي
+
+5
+00:00:34,490 --> 00:00:36,570
+لكن واقع العمر اليوم هتعلم على ان في different
+
+6
+00:00:36,570 --> 00:00:42,460
+spaces لهذا ال مايكروببنأكد على حقيقة واحدة إن هذه
+
+7
+00:00:42,460 --> 00:00:45,460
+البكتيريا هي normal inhabitant of the intestinal
+
+8
+00:00:45,460 --> 00:00:49,740
+tract of man and worm blooded mammals يعني الإنسان
+
+9
+00:00:49,740 --> 00:00:52,260
+والإتثاليات، ذوات الدم الحار، طبعا إتثاليات مهي
+
+10
+00:00:52,260 --> 00:00:57,090
+أصلا ذوات الدم الحارعلى الرغم من انه تركيزها في
+
+11
+00:00:57,090 --> 00:01:01,110
+الانتستين او نسبتها ما بين البكتيريا الأخرى هي
+
+12
+00:01:01,110 --> 00:01:05,070
+point واحد في المية الا انه بنلاقي ان الاشريشيا
+
+13
+00:01:05,070 --> 00:01:10,050
+كلها هي الأشهر السبب في ذلك ان ال most common
+
+14
+00:01:10,050 --> 00:01:12,190
+بكتيريا في ال intestinal tract هي بكتيريا لا
+
+15
+00:01:12,190 --> 00:01:16,190
+هوائية إجبارية اللي هي من نوع bacteroidis وبالتالي
+
+16
+00:01:16,190 --> 00:01:19,850
+عندما نقوم بتنمية اي عينة بوراز اكرمكم الله على ما
+
+17
+00:01:19,850 --> 00:01:23,690
+كنكي بنعملها incubation ايش احنا هواي ولا لا هواي؟
+
+18
+00:01:23,690 --> 00:01:26,780
+هوايهوائي في الغالب فبيلاقي ان الاشريش الايكولاي
+
+19
+00:01:26,780 --> 00:01:29,420
+هي اللي ظهرت و الأخرى لم تظهر لإنه البيئة غير
+
+20
+00:01:29,420 --> 00:01:34,980
+مناسبة لها لإنه بدها ظروف لهوائي لإن الايكولاي is
+
+21
+00:01:34,980 --> 00:01:38,940
+not the most common لكن هي the most famous خلينا
+
+22
+00:01:38,940 --> 00:01:42,680
+نقول هي الأشهر طبعا صمت هذه البكتيريا على اسم
+
+23
+00:01:42,680 --> 00:01:47,280
+الطيب الألماني الاشريش اللي في العام الف و تمانية
+
+24
+00:01:47,280 --> 00:01:53,790
+و خمس و تمانين عزل و اتعرف على هذه البكتيرياالـ
+
+25
+00:01:53,790 --> 00:01:57,050
+Species زي ما ذكرنا فيها إشريشيا كولاي، إشريشيا
+
+26
+00:01:57,050 --> 00:02:02,690
+فرقسوني، إشريشيا هرماني، إشريشيا فولنيرس، كمان مرة
+
+27
+00:02:02,690 --> 00:02:07,590
+إشريشيا فولنيرس، إشريشيا هرماني، إشريشيا فرقسوني
+
+28
+00:02:07,590 --> 00:02:14,440
+وإشريشيا كولايالان احنا اتفقنا انها normal flora
+
+29
+00:02:14,440 --> 00:02:18,040
+normal inhabitants of the intestinal tract of man
+
+30
+00:02:18,040 --> 00:02:22,340
+and animal ومع ذلك outside the intestinal tract
+
+31
+00:02:22,340 --> 00:02:27,380
+they cause disease احد الأمثلة المشهورة اللي
+
+32
+00:02:27,380 --> 00:02:30,200
+ذكرناها في محاضرات سابقة ال urinary tract
+
+33
+00:02:30,200 --> 00:02:33,300
+infection لكن بدنا نعرف كمان شغلات تانية عن
+
+34
+00:02:33,300 --> 00:02:37,580
+الميكروب انه it is a very common clinical isolate
+
+35
+00:02:38,170 --> 00:02:41,890
+مش يعني؟ very common clinical isolates يعني في
+
+36
+00:02:41,890 --> 00:02:46,210
+المستشفى لو راجعنا دفتر أو سجل المزارع باختلاف
+
+37
+00:02:46,210 --> 00:02:51,070
+أنواعها حلاجل إشريشيا تعتبر super star ما بين
+
+38
+00:02:51,070 --> 00:02:54,710
+الميكروبات، من وين بنازلها؟ ممكن نازلها من ال CSF؟
+
+39
+00:02:54,710 --> 00:03:00,470
+نعمهي number one cause of neonatal meningitis،
+
+40
+00:03:00,470 --> 00:03:04,470
+التهاب الصحي تبع أطفال حديثي الولادة، وجودها
+
+41
+00:03:04,470 --> 00:03:07,530
+number one cause of urinary tract infection، كمان
+
+42
+00:03:07,530 --> 00:03:10,570
+هي cause of wound infection، كمان هي cause of
+
+43
+00:03:10,570 --> 00:03:15,580
+septicemiaبالاضافة إلى كل هذه الأشياء اكتشفنا
+
+44
+00:03:15,580 --> 00:03:17,700
+حديثا .. حديثا ان انا عايش من عشرين سنة او خمس
+
+45
+00:03:17,700 --> 00:03:21,400
+عشرين سنة انها may cause diarrhea يعني بطلت بريئة
+
+46
+00:03:21,400 --> 00:03:24,640
+تماما في ال intestinal tract في .. it may cause
+
+47
+00:03:24,640 --> 00:03:29,080
+diarrhea طبعا
+
+48
+00:03:29,080 --> 00:03:33,860
+تبتلك البكتيريا virulence factors تبعون ال
+
+49
+00:03:33,860 --> 00:03:37,660
+enterobacteriasi اللي هم حاكينا عنهم ال O antigen
+
+50
+00:03:37,660 --> 00:03:43,820
+او ال lipopolysaccharide تبعهمن الميكروبات أو من
+
+51
+00:03:43,820 --> 00:03:47,240
+السلالات الممرضة في الـ intestinal tract انتقروا
+
+52
+00:03:47,240 --> 00:03:51,280
+تكسجينكشريشيا كولايه أذكركوا يا شباب بيادة
+
+53
+00:03:51,280 --> 00:03:55,660
+البكتيريا ان احنا درسناها لما درسنا التكسين او
+
+54
+00:03:55,660 --> 00:03:59,800
+درسنا ال exotoxin قلنا دي produce toxin that is
+
+55
+00:03:59,800 --> 00:04:02,920
+similar نعم that is similar to mean to
+
+56
+00:04:02,920 --> 00:04:05,120
+vibrocholera toxin اللي هو اللي بيعي التكسين هذا
+
+57
+00:04:05,120 --> 00:04:08,760
+ال L-T تكسينوكيف بيشتغل ال vibrocular toxin يقولنا
+
+58
+00:04:08,760 --> 00:04:11,980
+it binds to an adenylate cyclase enzyme in the
+
+59
+00:04:11,980 --> 00:04:17,260
+intestinal wall ATP is converted to cyclic A and B
+
+60
+00:04:17,260 --> 00:04:19,920
+cyclic A and B will increase the production of
+
+61
+00:04:19,920 --> 00:04:22,960
+electrolytes accumulation في ال intestinal lumen
+
+62
+00:04:22,960 --> 00:04:27,400
+therefore body will reproduce or will produce
+
+63
+00:04:27,400 --> 00:04:31,440
+large amount of fluid وبالتالي ديارية is produced
+
+64
+00:04:31,950 --> 00:04:36,270
+إذا الانتيرو توكسجينكاشريشيا كولاي هي E.coli قادرة
+
+65
+00:04:36,270 --> 00:04:39,130
+على إنتاج ال التي توكسين والتي توكسين قلنا is
+
+66
+00:04:39,130 --> 00:04:44,930
+similar in action to Vibrio toxin الصنف التاني
+
+67
+00:04:44,930 --> 00:04:48,070
+اللي بيعمل دياري أيضا من ال E.coli هو الانتيرو
+
+68
+00:04:48,070 --> 00:04:52,460
+باطوجنكاشريشيا كولايكيف بيشتغل انت روح باحث انك
+
+69
+00:04:52,460 --> 00:04:55,540
+إشريش يا كلها؟ اللي لو حاش بتقول بتقول انه by
+
+70
+00:04:55,540 --> 00:04:59,280
+poorly understood mechanisms، several poorly
+
+71
+00:04:59,280 --> 00:05:03,660
+understood mechanisms يعني في قاليات مقترحة لتفسير
+
+72
+00:05:03,660 --> 00:05:09,850
+حدوث الديارية لكن مش مفهومة بشكل جيدلكن هناك one
+
+73
+00:05:09,850 --> 00:05:14,030
+mechanism يعني يمكن برزت على السطح أكتر من غيرها
+
+74
+00:05:14,030 --> 00:05:18,750
+وهي مقدرت هذا النوع من البكتيريا على إنتاج
+
+75
+00:05:18,750 --> 00:05:23,850
+adhesins، adhesins فاكرينها اللي هي المراكبات
+
+76
+00:05:23,850 --> 00:05:27,850
+القادرة أو اللي تؤهل البكتيريا على الإرتباط أو
+
+77
+00:05:27,850 --> 00:05:32,620
+الالتصاق على ال surfaces، تخيلوا معاه التاليVeli،
+
+78
+00:05:32,620 --> 00:05:36,920
+Veli، Intestinal Veli، إيش وظيفتها؟ Absorption،
+
+79
+00:05:36,920 --> 00:05:40,640
+للغذاء المهضوم، الآن البكتيريا التسقت على الجدار
+
+80
+00:05:40,640 --> 00:05:45,340
+تماما، يعني عملت طبقة عازلة ما بين ال Veli و ما
+
+81
+00:05:45,340 --> 00:05:49,360
+بين ال intestinal content، محتويات الانتستين، هل
+
+82
+00:05:49,360 --> 00:05:53,280
+هيصير فيه انتصاص؟يبقى برضه كمان مرة حيصير في تراكم
+
+83
+00:05:53,280 --> 00:05:58,040
+لمين؟ للـ electrolyte والدسم عنده مجسات بتقيص ال
+
+84
+00:05:58,040 --> 00:06:02,300
+electrolyte بدقة وعندما تزداد ال electrolytes على
+
+85
+00:06:02,300 --> 00:06:06,240
+طول بيفرز fluid إذا طريقة مختلفة لكن في النهاية
+
+86
+00:06:06,240 --> 00:06:11,260
+أدت إلى برضه ديارة الـ Enterohemorrhagic
+
+87
+00:06:11,260 --> 00:06:16,010
+Escherichia Coliبرضه دراسناها، دراسناها جونها it
+
+88
+00:06:16,010 --> 00:06:21,670
+produces SLT، SLT-Shigalike-Toxin Shigalike يعني
+
+89
+00:06:21,670 --> 00:06:25,990
+بتذكرنا بإيه الميكانيزم تبعت الشيجلة إنه بتعمل
+
+90
+00:06:25,990 --> 00:06:28,930
+inhibition لل protein synthesis in the affected
+
+91
+00:06:28,930 --> 00:06:32,370
+cell therefore these cells will stop .. will stop
+
+92
+00:06:32,370 --> 00:06:35,970
+protein synthesis they will eventually die ال
+
+93
+00:06:35,970 --> 00:06:39,450
+death تبع هذه الخلايا بيجعلها غير قادرة على القيام
+
+94
+00:06:39,450 --> 00:06:45,360
+بوظيفتها وبالتالي no absorptionبرضه accumulation
+
+95
+00:06:45,360 --> 00:06:51,980
+ديارية لكن بالإضافة إلى الديارية هنشوف أشياء مميزة
+
+96
+00:06:51,980 --> 00:06:57,200
+في الديارية هذه واحد هنشوف epithelial cells ميتة
+
+97
+00:06:57,200 --> 00:07:01,620
+اللي ماتت من ال inhibition للبوتينسينتسيز هنشوف ال
+
+98
+00:07:01,620 --> 00:07:05,940
+mucus اللي كان عليها كلامك صحيح؟ هنشوف الآن بعد ال
+
+99
+00:07:05,940 --> 00:07:08,440
+epithelial ان صار في destruction لل blood vessels
+
+100
+00:07:08,440 --> 00:07:11,780
+يبقى عايز يفيان دي blood leakage هلا تشوف blood
+
+101
+00:07:13,110 --> 00:07:16,190
+مدام صار فيه destruction للخلايا ال immune system
+
+102
+00:07:16,190 --> 00:07:20,130
+بيعمل إرسالية بال .. بال WBCs اللي هي ال white
+
+103
+00:07:20,130 --> 00:07:24,110
+blood cells وبتالي برضه هشوف bus cells، إذا دياريا
+
+104
+00:07:24,110 --> 00:07:29,510
+محتوية على أربع عناصر بتكون .. أو سميناها اسم خاص
+
+105
+00:07:29,510 --> 00:07:35,610
+فيها، فاكرين؟ dysentery، dysenteria، الذحار، وقلنا
+
+106
+00:07:35,610 --> 00:07:40,110
+هناك نوعا ما إن الذحار، الذحار عصويو أميبي الأميبي
+
+107
+00:07:40,110 --> 00:07:43,510
+بتسبب أن تميبها استراتيكا والعصوي بتسببه الشيجلة
+
+108
+00:07:43,510 --> 00:07:47,590
+لكن هنا شفنا كمان مايكروبات أخرى غير الشيجلة تقادر
+
+109
+00:07:47,590 --> 00:07:53,550
+على القيام بهذا الكلامE coli O157H7 is
+
+110
+00:07:53,550 --> 00:07:57,410
+representative of this type يعني هذه نقطة كتير
+
+111
+00:07:57,410 --> 00:08:02,810
+مهمة عندما نقوم عندما نقوم بيعزل إشيريشيا كولاي من
+
+112
+00:08:02,810 --> 00:08:06,750
+الستول لا يكفي أنه نعمل reporting ونقول إشيريشيا
+
+113
+00:08:06,750 --> 00:08:12,370
+كولاي صح؟ليش؟ لأننا كنا نحتاج إشريشيا كولاي لكن لو
+
+114
+00:08:12,370 --> 00:08:17,130
+كنا إيه كولاي O157H7 على طول الطبيب بيعرف إنه هي
+
+115
+00:08:17,130 --> 00:08:20,610
+ال pathogen وهي المسبب للديارية أو ال condition
+
+116
+00:08:20,610 --> 00:08:25,750
+اللي عند المريض ماعرفش في نقطة قاعدة هنا في الرسمة
+
+117
+00:08:25,750 --> 00:08:29,930
+أو في الشكل بتكلم عن viratoxigenic-echericia-coli
+
+118
+00:08:29,930 --> 00:08:33,090
+مصطلح أول مرة مر معانا viratoxigenic-echericia
+
+119
+00:08:33,090 --> 00:08:39,250
+-coli وايدب علينا توضيح هذا المصطلحأرجو التركيز
+
+120
+00:08:39,250 --> 00:08:43,530
+وعدم الكتابة حتى يتسنن لنا ان شاء الله فاهم الفكرة
+
+121
+00:08:43,530 --> 00:08:50,450
+بتعرف حاجة اسمها cell cultureبناخد خلايا من إما
+
+122
+00:08:50,450 --> 00:08:55,030
+إنسان أو من حيوان من أعضاء معينة و بننميها in
+
+123
+00:08:55,030 --> 00:08:59,650
+vitro في وسط صناعي وسط صناعي بنحط لها المواد
+
+124
+00:08:59,650 --> 00:09:02,970
+المجادية تبعتها و ال pH المناسب و ال incubation
+
+125
+00:09:02,970 --> 00:09:06,390
+المناسب الخلايا في هذا الحالة لن تنمو و تشكل
+
+126
+00:09:06,390 --> 00:09:09,410
+النعوضة لأنها لو أخدناها من كيليا مش هتنمو تماما
+
+127
+00:09:09,410 --> 00:09:13,170
+كيليا و انما هتعملش باب هتعمل mono layer mono
+
+128
+00:09:13,170 --> 00:09:17,470
+layer يعني طبقة واحدة من الخلاياغالبا هذا النوع من
+
+129
+00:09:17,470 --> 00:09:21,790
+الخلايا بنستخدم و احنا لتنمية الفيروسات مش
+
+130
+00:09:21,790 --> 00:09:28,190
+الفيروسات اللي على .. اللي في وسط حياة .. في حياة
+
+131
+00:09:28,190 --> 00:09:32,790
+يعني intracellular وبالتالي هي تشكل المكونكي
+
+132
+00:09:32,790 --> 00:09:36,910
+للبكتيريا مين اللي تشكل المكونكي؟ ال cell culture
+
+133
+00:09:36,910 --> 00:09:41,930
+لمين؟ للفيروس طيبالـ cell cultures وانا في هذه
+
+134
+00:09:41,930 --> 00:09:46,590
+المناسبة كنت باود ان البعض منكم يحضر المحاضرة اللي
+
+135
+00:09:46,590 --> 00:09:51,230
+القاها الدكتور من السويد زميلنا قبل اربع ايام و
+
+136
+00:09:51,230 --> 00:09:55,070
+تلات ايام في هذه القاعة القاها عبر ال skype فجال
+
+137
+00:09:55,070 --> 00:09:58,210
+انه ممكن تستخدم whole animal حيوان كامل تحقنه
+
+138
+00:09:58,210 --> 00:10:01,790
+بالمادة وتشوف تأثير المادة على مين؟ على الحيوان او
+
+139
+00:10:01,790 --> 00:10:06,530
+على عضام الحيوان او تشيل عضو من الحيوان تاخده تعمل
+
+140
+00:10:06,530 --> 00:10:10,860
+اي testing كبد مثلاطبعا خد بالك الحيوان و هذا واحد
+
+141
+00:10:10,860 --> 00:10:14,500
+و الكبد واحد يعني كبد يساوي حيوان صح؟ ماوفرناش
+
+142
+00:10:14,500 --> 00:10:19,560
+كتير في موضل تاني بيستخدم شرائح من الكبد فالكبد
+
+143
+00:10:19,560 --> 00:10:22,940
+الواحد عن عشر حيوانات عشرين حيوانة حسب كده عدد
+
+144
+00:10:22,940 --> 00:10:26,500
+الشرائح اللي جسمتها وفي موضل اخر بيستخدم مين يا
+
+145
+00:10:26,500 --> 00:10:32,600
+شباب؟ بيستخدم الخلايا كل خلية باعتبارها موضل مستقل
+
+146
+00:10:32,600 --> 00:10:38,050
+لحالهلكن في النهاية انا محتاج موديل محتاج موديل
+
+147
+00:10:38,050 --> 00:10:43,390
+افحص عليه تأثيرات مركبات معينة مثلا مركب بتنتج
+
+148
+00:10:43,390 --> 00:10:49,030
+الاشريشيا كولاي EO157H7 فروحت فحصته على خلايا ال
+
+149
+00:10:49,030 --> 00:10:54,980
+cell culture اسمها Vero cell cultureلقناه toxic لل
+
+150
+00:10:54,980 --> 00:10:58,920
+virus cell culture فسموا التكسين لأنه في ذاك الوقت
+
+151
+00:10:58,920 --> 00:11:03,360
+لم يكن characterized فسموه virotoxic يعني سام
+
+152
+00:11:03,360 --> 00:11:06,520
+لخلايا ال virus ما هي ال virus cells مشهورة ال
+
+153
+00:11:06,520 --> 00:11:09,240
+virus cells على فكرة هي خلايا او cell culture
+
+154
+00:11:09,240 --> 00:11:12,760
+ماخودة من ال kidneys تبعت ال African green monkeys
+
+155
+00:11:12,760 --> 00:11:16,420
+اللي هي القرود الأفريقية الخضرة ماخودة من ال
+
+156
+00:11:16,420 --> 00:11:20,130
+kidney تبعتها اسمها virus cells ودحت الصورةلماذا
+
+157
+00:11:20,130 --> 00:11:24,030
+سميت virotoxic Escherichia coli لأنه بتنتج تكسين
+
+158
+00:11:24,030 --> 00:11:30,230
+له مقدر على إحداث ضرر أو damage ل ال virus cells
+
+159
+00:11:30,230 --> 00:11:36,170
+الصنف الثالث اللي هو ال entero الربع هذا الربع
+
+160
+00:11:36,170 --> 00:11:41,380
+entero invasive Escherichia coliواضح من المصطلح
+
+161
+00:11:41,380 --> 00:11:46,000
+invasion انه البكتيريا لا تكتفي بالبقاء على ال
+
+162
+00:11:46,000 --> 00:11:49,300
+intestinal wall وانما تقترق ال intestinal wall
+
+163
+00:11:49,300 --> 00:11:55,140
+بيكون بطريقة مشابهة أيضا لمن؟ للشجلة لذلك هذا
+
+164
+00:11:55,140 --> 00:11:58,740
+الميكروب الديارة تبعته شبيهة برضه بال dysentery
+
+165
+00:11:58,740 --> 00:12:02,440
+شبيهة بال dysentery ايش بيكون فيها؟ بيكون فيها
+
+166
+00:12:02,440 --> 00:12:06,870
+blood في الفقرة التانيةblood و mucus زائد
+
+167
+00:12:06,870 --> 00:12:12,130
+neutrophil إذا هذه البكتيريا دررها شبيه بدرر من
+
+168
+00:12:12,130 --> 00:12:18,160
+الشجلة خد بالكم النقطةفي نهاية اللوحة بتكلم عن
+
+169
+00:12:18,160 --> 00:12:22,880
+نوعين من البكتيريا ال entero invasive و ال entero
+
+170
+00:12:22,880 --> 00:12:27,480
+toxigenic are famous for what is known as traveler
+
+171
+00:12:27,480 --> 00:12:30,980
+diarrhea ايش هي traveler diarrhea؟ اللي هي ديارية
+
+172
+00:12:30,980 --> 00:12:34,740
+المسافرين لما واحد بيسافر من بلد إلى بلد بيصير
+
+173
+00:12:34,740 --> 00:12:39,060
+عنده cramps ودياريةنتيجة سفره ليش نتيجة سفره
+
+174
+00:12:39,060 --> 00:12:43,160
+اختلاف البيئة واحنا حاكينا عن ال normal flora اي
+
+175
+00:12:43,160 --> 00:12:46,980
+خلل في ال normal flora قد يسهل ال colonization ب
+
+176
+00:12:46,980 --> 00:12:51,560
+new strains فهذه من المشهورين انهم بيعملوا دياريا
+
+177
+00:12:51,560 --> 00:12:56,380
+عند المسافرين هذه ملخص ل ال entero في طبعا أصناف
+
+178
+00:12:56,380 --> 00:13:01,060
+أخرى لم نذكرها زي entero aggregative Escherichia
+
+179
+00:13:01,060 --> 00:13:06,240
+coliinteragregative ايش انتجمع؟ aggregate يعني
+
+180
+00:13:06,240 --> 00:13:11,860
+انتجمع برضه بكتيريا تمتلك aggregation factor مقدرة
+
+181
+00:13:11,860 --> 00:13:19,140
+على التصاق ببعضها البعض و التصاق بمين بالاصل هذه
+
+182
+00:13:19,140 --> 00:13:23,040
+برضه تلخيص للخمس أنواع اللي احنا ذكرناهم
+
+183
+00:13:25,100 --> 00:13:27,740
+في ال pathogenes تلال الشريشية كلها احنا تحدثنا
+
+184
+00:13:27,740 --> 00:13:30,340
+كمان مرة وكنا صارحين جدا، قولنا في ال intestinal
+
+185
+00:13:30,340 --> 00:13:35,060
+tract they are non-pathogenic لكن هناك فقط بعض
+
+186
+00:13:35,060 --> 00:13:38,580
+السلالات that are intestinal pathogens وذكرناهم
+
+187
+00:13:38,580 --> 00:13:41,940
+بالاسم enteroinvasive, enterohemorrhagic,
+
+188
+00:13:42,060 --> 00:13:45,320
+enterotoxigenic و enteroinvasive و الأخيرة
+
+189
+00:13:45,320 --> 00:13:50,050
+enteroaggregative الشريشية كلهاإذاً كلهم non
+
+190
+00:13:50,050 --> 00:13:53,890
+-pathogen ما عدا الأصناف الخامسة هدولة pathogen في
+
+191
+00:13:53,890 --> 00:13:58,030
+الانتستين لكن elsewhere في أماكن أخرى غير ال
+
+192
+00:13:58,030 --> 00:14:01,090
+intestinal tract they are all pathogen وزي ما
+
+193
+00:14:01,090 --> 00:14:04,170
+ذكرنا it may cause urinary tract infection أول
+
+194
+00:14:04,170 --> 00:14:06,750
+واحدة انا .. اش بقول ده؟ ان انا سيستايتس سيستايتس
+
+195
+00:14:06,750 --> 00:14:10,730
+معناه التهاب المثانى meningitis التهاب السحاية
+
+196
+00:14:10,730 --> 00:14:14,370
+vaginitis التهاب ال vagina wound infection وهنا
+
+197
+00:14:14,370 --> 00:14:19,150
+قلنا very common in wound infectionكمان Epidemic
+
+198
+00:14:19,150 --> 00:14:23,030
+Diary of the New Born New Born اللي هم الموليد
+
+199
+00:14:23,030 --> 00:14:33,510
+الجدد شوفوا
+
+200
+00:14:33,510 --> 00:14:36,900
+الملاحظة هذه يا شباببقولنا it is now widely
+
+201
+00:14:36,900 --> 00:14:40,140
+accepted that certain serotypes are responsible
+
+202
+00:14:40,140 --> 00:14:45,460
+for outbreaks of epidemics of certain serotypes
+
+203
+00:14:45,460 --> 00:14:49,960
+يعني أنواع سيرولوجيا محددة إلها المقدر على إحداث
+
+204
+00:14:49,960 --> 00:14:55,140
+أمراض محددة أعطيكم مثال مشهور أنا قلت في بداية
+
+205
+00:14:55,140 --> 00:14:59,340
+المحاضرة أن البكتيريا مشهورة بإحداثها لل neonatal
+
+206
+00:14:59,340 --> 00:15:05,100
+meningitis صح؟Neonatal Meningitis لجوا ان العزلات
+
+207
+00:15:05,100 --> 00:15:09,780
+المأخوذة من مرضى الـ Neonatal Meningitis almost
+
+208
+00:15:09,780 --> 00:15:14,940
+always capsulated يعني إلها capsule سيرو تايبز
+
+209
+00:15:14,940 --> 00:15:19,640
+مميزة غير موجودة صفة في الميكروبات أو في البكتيريا
+
+210
+00:15:19,640 --> 00:15:23,860
+أو في الإشريشيا كولاي الأخرى طيب عن حين حصلنا بعض
+
+211
+00:15:23,860 --> 00:15:28,780
+ال confusion شباب عندما نتحدث عن إيه كولاي لنا
+
+212
+00:15:28,780 --> 00:15:33,870
+نتحدث عن شخص واحدو تفهموه إن كان الاسم واحد لكن ده
+
+213
+00:15:33,870 --> 00:15:39,630
+لا تكلم عن اسم واحد ما هو تعريف ال genus ايش تعريف
+
+214
+00:15:39,630 --> 00:15:44,010
+ال genus تعريف ال genus هو عبارة عن collection of
+
+215
+00:15:44,010 --> 00:15:48,470
+species of similar species تعريف ال species
+
+216
+00:15:48,470 --> 00:15:53,550
+collection of similar strains similar strains يعني
+
+217
+00:15:53,550 --> 00:15:57,670
+ال E.coli اللي هي species E.coli speciesفيها
+
+218
+00:15:57,670 --> 00:16:02,470
+مجموعة من ال strains المتشابهة لكن كلمة strains
+
+219
+00:16:02,470 --> 00:16:07,590
+جمع strain واحدة واحدة لو كلهم identical كان مجن
+
+220
+00:16:07,590 --> 00:16:12,310
+عنهم strains فيهم بعض الاختلافات فعندما نتحدث عن
+
+221
+00:16:12,310 --> 00:16:18,050
+اسم بكتيريا يجب اللي يخطر ببالك انها بكتيريا واحدة
+
+222
+00:16:18,050 --> 00:16:21,920
+نتكلم عن strainsوأكبر مثال على ذلك انه لما انا
+
+223
+00:16:21,920 --> 00:16:25,100
+بعزل اشيريشيا كولاي في غزة على سبب المثال بلاجي
+
+224
+00:16:25,100 --> 00:16:29,380
+منها resistant للاميكاسين و بلاجي منها sensitive
+
+225
+00:16:29,380 --> 00:16:32,440
+للاميكاسين هذا ال string غير على ال string هذا صح؟
+
+226
+00:16:32,440 --> 00:16:37,180
+يبقى بناشي ننظر النظرة السطحية لاسم البكتيريا انه
+
+227
+00:16:37,180 --> 00:16:43,040
+اسم واحدthree antigens بيجي بس هكمل الجملة ده ان
+
+228
+00:16:43,040 --> 00:16:45,760
+شاء الله بعد اخليك تسأل انتجينك structure في عندي
+
+229
+00:16:45,760 --> 00:16:50,580
+O انتجن و في عندي H انتجن و في عندي K انتجن انا
+
+230
+00:16:50,580 --> 00:16:55,120
+اتفقت معاكم قبل شوية ان ال K انتجن مش موجود في كل
+
+231
+00:16:55,120 --> 00:17:00,840
+الH3H4I فقط في تلك اللتي قمنا بعزلها من مين؟ من ال
+
+232
+00:17:00,840 --> 00:17:07,360
+neonatal meningitis اتفضلهذه انه certain
+
+233
+00:17:07,360 --> 00:17:11,920
+serological strains أصناف محددة بتسبب conditions
+
+234
+00:17:11,920 --> 00:17:16,160
+محددة مافيش فيها مشكلة صنف محدد serological type
+
+235
+00:17:16,160 --> 00:17:20,640
+محدد زي E.coli O157 مثلا مش بسبب condition محدد
+
+236
+00:17:20,640 --> 00:17:25,380
+اللي هو ال enterohemorrhagic colitis فهذا بنسميه
+
+237
+00:17:25,380 --> 00:17:28,360
+serotype محدد بسبب condition محدد
+
+238
+00:17:32,120 --> 00:17:35,040
+الان نبدأ Diagnostic حقيقي فى التعرف على
+
+239
+00:17:35,040 --> 00:17:38,720
+الاشيريشيا E.coli وبدنا نتفاعل معانا وضع الأقلام
+
+240
+00:17:38,720 --> 00:17:44,020
+ركزوا معايا E.coli كمان مرة ما بداش كتابة بدنا
+
+241
+00:17:44,020 --> 00:17:48,060
+نركز مع بعض E.coli هى واحدة من ال انترو بكترياسي
+
+242
+00:17:48,060 --> 00:17:50,580
+يعنى كل الصفات اللى امتلكتها الانترو بكترياسي
+
+243
+00:17:50,580 --> 00:17:53,540
+بتمتلكها ال E.coli منها انها اكسيدايز نيجاتيف
+
+244
+00:17:53,540 --> 00:17:56,360
+جليكوز فرمنتر جرام نيجاتيف بسالايفاكولتيدف
+
+245
+00:17:56,360 --> 00:17:59,380
+أنائيروب رديوز نيتيتو نيتريت الان السؤال اللى
+
+246
+00:17:59,380 --> 00:18:04,850
+بتطرح نفسهما هي الصفات التي تميز ال E.coli عن باقي
+
+247
+00:18:04,850 --> 00:18:08,010
+ال enterobacteriasi؟ ورقم واحد انها lactose
+
+248
+00:18:08,010 --> 00:18:11,570
+fermenter طيب للأسف هذه الكلمة lactose fermenter
+
+249
+00:18:11,570 --> 00:18:16,150
+في معاها لكن وفي مش معاها صح يبجي انا فسلتها عن
+
+250
+00:18:16,150 --> 00:18:21,070
+جزء فlactose fermenter صفة كتير مهمة رقم اتنينفين
+
+251
+00:18:21,070 --> 00:18:25,170
+ده فحص اسمه NVIC بتعرف ال NVIC اندول ميثيل ريد
+
+252
+00:18:25,170 --> 00:18:28,930
+واجس بروسكاور سايتريت هي positive positive
+
+253
+00:18:28,930 --> 00:18:32,430
+negative negative ايش يعني positive positive يعني
+
+254
+00:18:32,430 --> 00:18:36,350
+اندول positive ميثيل ريد positive واجس بروسكاور
+
+255
+00:18:36,350 --> 00:18:40,430
+negative سايتريت negative انا بدأ أقولكوا الآن حط
+
+256
+00:18:40,430 --> 00:18:43,330
+في دماغك إنها سايتريت negative بس بدي المعلومات
+
+257
+00:18:43,330 --> 00:18:48,020
+سايتريت negative أولاكتوس فرمنترنجي الآن لميكروبات
+
+258
+00:18:48,020 --> 00:18:51,000
+شبيهة بالاشريشيا كولاي تشتغل معاها في من؟ في ال
+
+259
+00:18:51,000 --> 00:18:54,620
+lactose fermentation زي ال E.coli حط في مخيلتك و
+
+260
+00:18:54,620 --> 00:19:00,760
+في ذاكرتك ان ال E.coli non motile لأ هي lactose
+
+261
+00:19:00,760 --> 00:19:04,260
+fermentation non motile يبجأش اللي حطيناها في
+
+262
+00:19:04,260 --> 00:19:10,220
+مخيلتنا ال E.coli سيطرت negative سيطرت negative و
+
+263
+00:19:10,220 --> 00:19:16,550
+ال E.coli non motileال .. ال .. ال citrobacter H2S
+
+264
+00:19:16,550 --> 00:19:22,530
+positive H2S positive هاي تلت أصناف أو تلت صفات
+
+265
+00:19:22,530 --> 00:19:26,590
+رئيسية الرابعة مطلوب نعرف عنها حاجة و مش مطلوب
+
+266
+00:19:26,590 --> 00:19:33,070
+نعرف عنها حاجة لحالة القائح هتطلع في التصفيات
+
+267
+00:19:33,070 --> 00:19:38,260
+تمام؟ بدون ما نتكلم و نجرب مع بعضعطونا بكتيريا يا
+
+268
+00:19:38,260 --> 00:19:41,560
+شباب، هاي بكتيريا، تعالى ندرس صفاتها، أنا بدرس
+
+269
+00:19:41,560 --> 00:19:44,400
+الآن صفاتها قاعد، طلعت gram negative بس ال lie،
+
+270
+00:19:44,400 --> 00:19:48,240
+طلعت oxidase negative، طلعت agelicose fermenter،
+
+271
+00:19:48,240 --> 00:19:51,470
+طلعت lactose fermenterالان انت على طول بيخطر على
+
+272
+00:19:51,470 --> 00:19:55,310
+بالك واحدة من مين؟ واحدة من أربعة .. واحدة من
+
+273
+00:19:55,310 --> 00:19:59,870
+أربعة اللي هم إشيريشيا، ستروباكتر، انتروباكتر أو
+
+274
+00:19:59,870 --> 00:20:03,310
+كليبسل إيش بدك تعرف أو تسألني عن معلومات .. أنا
+
+275
+00:20:03,310 --> 00:20:06,210
+اللي .. أنا اللي بفحص الآن اسألني عن معلومات وانا
+
+276
+00:20:06,210 --> 00:20:10,610
+بدي أزودك بالنتائج يلّا قوللي شو الفحص اللي بدك
+
+277
+00:20:10,610 --> 00:20:19,030
+إيه أنت الحين؟ it is positive what is
+
+278
+00:20:19,030 --> 00:20:28,270
+next؟it is motile اي استثنت مين انت دل كمان سؤال
+
+279
+00:20:28,270 --> 00:20:29,870
+it is negative
+
+280
+00:20:32,630 --> 00:20:36,970
+يبقى Enterobacter دون أن تعرف أي معلومة عن ال
+
+281
+00:20:36,970 --> 00:20:39,950
+Enterobacter صح ولا لأ؟ وتوصلت إلى أن البكتيريا
+
+282
+00:20:39,950 --> 00:20:44,050
+الآن Enterobacter This game of exclusion should be
+
+283
+00:20:44,050 --> 00:20:48,870
+practiced by everyone among you كل واحد فيكوا مع
+
+284
+00:20:48,870 --> 00:20:53,150
+زميله بده يحاول يمارس هذه اللعبة يقول أنا في دماغي
+
+285
+00:20:53,150 --> 00:20:56,570
+الآن سميت بكتيريا ويكتبها على ورقة صغيرة ويحطها في
+
+286
+00:20:56,570 --> 00:21:01,930
+جيبته كويس؟ والآخر يسأل خدوا بالكمفي ال diagnostic
+
+287
+00:21:01,930 --> 00:21:05,810
+microbiology السؤال لا يكفي ان يكون صح لازم يكون
+
+288
+00:21:05,810 --> 00:21:09,830
+كمان ترتيبه صح يعني مانفعش تسألني انت من أول سؤال
+
+289
+00:21:09,830 --> 00:21:13,270
+تقولي ان دول positive ولا ان دول negativeأول سؤال
+
+290
+00:21:13,270 --> 00:21:16,090
+لازم أسأله هي جرام بسطف ولا جرام نيجاتف، بس الله
+
+291
+00:21:16,090 --> 00:21:19,630
+يولّه كوكساي تمام؟ أكسيدايز بسطف ولا أكسيدايز
+
+292
+00:21:19,630 --> 00:21:23,270
+نيجاتف؟ إشليكوز فرمنتر ولا أنان؟ إشليكوز فرمنتر،
+
+293
+00:21:23,270 --> 00:21:27,250
+لاكتوز فرمنتر ولا أنان؟ لاكتوز فرمنتر، اندول و ..
+
+294
+00:21:27,250 --> 00:21:32,530
+و هكذا، يبقى لا يكفي السؤال الصحيح وإنما أيضا
+
+295
+00:21:32,530 --> 00:21:37,530
+ترتيبه يجب أن يكون صحيحو هنحاول انه نزودكم ببرنامج
+
+296
+00:21:37,530 --> 00:21:42,570
+قمت بإشراف عليه اعداده انا و طالب من كلية الطب لكن
+
+297
+00:21:42,570 --> 00:21:45,810
+خلينا نأجله شوية لعبين ما يسلنكم شوية معلومات
+
+298
+00:21:45,810 --> 00:21:51,610
+نظرية عن الفحوصة طيب فاستو بوستف بوستف نيجاتف
+
+299
+00:21:51,610 --> 00:21:56,090
+نيجاتف في انديهانة ال EMB مشهور جدا بيعطينا green
+
+300
+00:21:56,090 --> 00:22:02,310
+metallic sheet فضلا اربعةهذا بس عشان يصير مقروع
+
+301
+00:22:02,310 --> 00:22:05,470
+يعني، ال I هذا، هذا عشان بس يصير مقروع، يعني
+
+302
+00:22:05,470 --> 00:22:10,550
+منطوق، invic لما هو ال indole-methylred-vagus
+
+303
+00:22:10,550 --> 00:22:13,470
+-proskauer-cytrate، هذا ال I ليس لها علاقة بالفحص
+
+304
+00:22:13,470 --> 00:22:18,750
+في فحص اسمه lycindycarboxylase، البكتيريا إلهو
+
+305
+00:22:18,750 --> 00:22:21,910
+بوستف، طبعا هي lactose fermenter بالتاكيد
+
+306
+00:22:22,790 --> 00:22:26,390
+الثيرولوجي زى ما ذكرتلكوا يا شباب مش دايما بنلجأ
+
+307
+00:22:26,390 --> 00:22:28,630
+للثيرولوجي فى الاشياء الشكلية فقط لما تكون العينة
+
+308
+00:22:28,630 --> 00:22:32,970
+من وين جاية من stool sample أو من environmental
+
+309
+00:22:32,970 --> 00:22:36,890
+sample لإن العينات بيئية ممكن نلجأ إلى الثيرولوجي
+
+310
+00:22:36,890 --> 00:22:43,910
+بالنسبة لتريتمنت علاج اقرأ الجملة الأولى تحت
+
+311
+00:22:43,910 --> 00:22:49,130
+treatment وجعلوها قاعدة ذهبية فى ال micro biology
+
+312
+00:22:49,880 --> 00:22:53,660
+Antibiotic sensitivity should be performed for all
+
+313
+00:22:53,660 --> 00:22:58,740
+clinical isolates لماذا؟ لأن في changing patterns
+
+314
+00:22:58,740 --> 00:23:03,460
+يعني في تغيرات في الأنماط تبع السلوك تبع البكتيريا
+
+315
+00:23:03,460 --> 00:23:08,980
+ضد المضادات الحيوية وأعطيكم أمثلة بسيطة جدافي
+
+316
+00:23:08,980 --> 00:23:13,880
+بكتيريا اسمها enterococcus fecalis إلها أخت مغمورة
+
+317
+00:23:13,880 --> 00:23:17,460
+مغمورة يعني مش مشهورة في عالم الطب اسمها
+
+318
+00:23:17,460 --> 00:23:22,780
+enterococcus fecium يبقى فينا اسمين فكالس وفيسيام
+
+319
+00:23:22,780 --> 00:23:28,260
+الفكالس مافيش كتاب microbiology اللي بتكلم عنها
+
+320
+00:23:28,260 --> 00:23:31,620
+بشيء من التفصيل بينما الفيسيام بذكره على الهامش
+
+321
+00:23:31,620 --> 00:23:36,560
+أنه في another species اليوم وبعدها
+
+322
+00:23:38,840 --> 00:23:44,240
+اكتشافنا للمقدرة الهائلة لل enterococcus fisium
+
+323
+00:23:44,240 --> 00:23:48,640
+اللي هي المغمورة على تكوين resistance أصبحت شهرة
+
+324
+00:23:48,640 --> 00:23:56,070
+البكتيريا رقم 2 تفوق رقم 1يبقى فيه تغير في مفهومنا
+
+325
+00:23:56,070 --> 00:24:00,730
+لمين للبكتيريا وحساسيتها لل antibiotic باستمرار
+
+326
+00:24:00,730 --> 00:24:04,890
+وأكبر دليل على ذلك في الأربعينيات أو الخمسينيات
+
+327
+00:24:04,890 --> 00:24:08,490
+وستينيات من القرن الماضي كان البنسالين is very
+
+328
+00:24:08,490 --> 00:24:12,440
+effective against staphylococcus aureusكان ال
+
+329
+00:24:12,440 --> 00:24:18,320
+magic drug للاستفيلوكوكاس اورياس الان 99% من
+
+330
+00:24:18,320 --> 00:24:21,880
+الاستفيلوكوكاس اورياس وفي بعض البلدان 100% من
+
+331
+00:24:21,880 --> 00:24:25,380
+الاستفيلوكوكاس اورياس resistant to penicillin يجب
+
+332
+00:24:25,380 --> 00:24:30,280
+ان نكتفي بالمعلومات النظرية حولإن البكتيريا
+
+333
+00:24:30,280 --> 00:24:35,760
+sensitive أو resistant ل antibiotic معين يجب أن
+
+334
+00:24:35,760 --> 00:24:39,500
+نقوم بجمع البيانات المحلية ومن هنا نجيب البيانات
+
+335
+00:24:39,500 --> 00:24:44,580
+المحلية العزلات اللي بنعزلهم بنعملهم antimicrobial
+
+336
+00:24:44,580 --> 00:24:48,840
+susceptibility أو sensitivity testing يعني بنعرف
+
+337
+00:24:48,840 --> 00:24:53,260
+عزلاتنا مش عزلات الأمريكان أو الأوروبيين أو بلدان
+
+338
+00:24:53,260 --> 00:24:58,370
+أخرى وحتى مناطق أخرى في فلسطينوستصورة بدنا local
+
+339
+00:24:58,370 --> 00:25:02,210
+data وعشانك انا بقول خدوها قاعدة ذهبية ان
+
+340
+00:25:02,210 --> 00:25:05,410
+antibiotic sensitivity testing must be preferred
+
+341
+00:25:05,410 --> 00:25:08,950
+تخيلوا يا شباب لو ان الstriptococcus biogenes
+
+342
+00:25:08,950 --> 00:25:14,330
+المسبب للتنسوليتس تمام resistant لل penicillin
+
+343
+00:25:14,330 --> 00:25:20,110
+الآن و drug of choice في كل العالم للstriptococcus
+
+344
+00:25:20,110 --> 00:25:23,730
+biogenes هو ال penicillin لكن في غزة البكتيريا
+
+345
+00:25:23,730 --> 00:25:29,760
+المقاومة لهما فائدة اعطاء البنسيلين للمرضى مش بس
+
+346
+00:25:29,760 --> 00:25:33,840
+مافيش فائدة و هناك ضرر اذا انت اعطيت المريض ال
+
+347
+00:25:33,840 --> 00:25:37,860
+antibiotic الغير ملائم يا شباب انت اعقدت عملية
+
+348
+00:25:37,860 --> 00:25:43,400
+الشفاء و ربما عملت complication اضافية للمريض
+
+349
+00:25:43,400 --> 00:25:47,220
+وبالتالي مطلوب مننا نعمل sensitivity على اساس ان
+
+350
+00:25:47,220 --> 00:25:50,460
+نساعد الأطباء في اختيار ال antibiotic الأنسب و
+
+351
+00:25:50,460 --> 00:25:55,230
+المناسبمن ال antibiotics المعروفة سابقا انها بتأثر
+
+352
+00:25:55,230 --> 00:25:58,370
+ال E.coli مجموعة ال amino glycosides مجموعة ال
+
+353
+00:25:58,370 --> 00:26:02,810
+amino glycosides تحتوي على مجموعة ضخمة من ال .. من
+
+354
+00:26:02,810 --> 00:26:06,450
+ال antibiotics زي ال .. ال .. ال .. ال gentamicin
+
+355
+00:26:06,450 --> 00:26:11,710
+زي ال amicacin زي ال streptomycin ال neomycin و ال
+
+356
+00:26:11,710 --> 00:26:15,430
+kinamycin و ال nitrimycin يعني مجموعة كبيرة من ال
+
+357
+00:26:15,430 --> 00:26:19,590
+antibiotics المستخدمة في هذه او في .. في مكافحة
+
+358
+00:26:19,590 --> 00:26:26,200
+الشيكولا لكنبيقولون ان الاميكاسين
+
+359
+00:26:26,200 --> 00:26:31,100
+هو أقل من الأمينوجليكوسايد
+
+360
+00:26:31,100 --> 00:26:36,690
+السمية، ليش هم الأمينوجليكوسايد اللي هم سميات؟لهم
+
+361
+00:26:36,690 --> 00:26:41,090
+three toxicities، three toxicities، واحد auto
+
+362
+00:26:41,090 --> 00:26:46,530
+toxicities، عفوا toxicity اللي بتضر بالعصب السمعي،
+
+363
+00:26:46,530 --> 00:26:52,390
+nephrotoxicity بتضر بالكيليا، و neurotoxicity بتضر
+
+364
+00:26:52,390 --> 00:26:56,890
+بالعصاب الشكل العام، three toxicities، كتير يا
+
+365
+00:26:56,890 --> 00:27:00,950
+شباب من الأطفال اللي أخذوا overdose أو جرعات مطولة
+
+366
+00:27:00,950 --> 00:27:04,890
+من الجنت ميسين صار عندهم مشاكل في السمع، نعم
+
+367
+00:27:08,560 --> 00:27:15,220
+في قضية خلافية لازم نطرحها أمامكم في موضوع علاج لل
+
+368
+00:27:15,220 --> 00:27:19,060
+E.Shericia Coli بال Antibiotics وخاصة ال E.Coli
+
+369
+00:27:19,060 --> 00:27:26,640
+O157H7 احنا اتفقنا إذا بنعالجبال antibiotic و نقتل
+
+370
+00:27:26,640 --> 00:27:32,200
+البكتيريا البكتيريا بتموت و لما تموت جزء من مين من
+
+371
+00:27:32,200 --> 00:27:35,180
+ال endotoxin تبعها او هو ال endotoxin بتبعها بتحرر
+
+372
+00:27:35,180 --> 00:27:40,920
+و تحرر ال endotoxin قد يحدث ضرر كبير جدا للمريض قد
+
+373
+00:27:40,920 --> 00:27:46,560
+يؤدي الى الوفاةفالسؤال اللي بيطرح نفسه وهو كمان
+
+374
+00:27:46,560 --> 00:27:49,700
+مرة under debate، ايش يعني under debate؟ يعني في
+
+375
+00:27:49,700 --> 00:27:53,920
+حوار وفي جدال، انعالج بال antibiotic ولا مانعالجش
+
+376
+00:27:53,920 --> 00:27:57,580
+بال antibiotic؟ وللأسف هذا ال debate .. هذا ال
+
+377
+00:27:57,580 --> 00:28:03,590
+debate لحد الآن موجودفالبعض .. البعض بيقول انه إذا
+
+378
+00:28:03,590 --> 00:28:09,490
+كان الموضوع متعلق بال E coli O157H7 لأ ما تعالجش
+
+379
+00:28:09,490 --> 00:28:12,210
+بال antibiotic اعمل supportive treatment و قوى
+
+380
+00:28:12,210 --> 00:28:16,690
+المناعة و حاول تخلي الجسم لحاله يتخلص من مين؟لأنه
+
+381
+00:28:16,690 --> 00:28:22,650
+ضرر .. ضرر ال E coli O157H7 بيزداد بعد إعطاء
+
+382
+00:28:22,650 --> 00:28:26,630
+المريض اللي هو ال antibiotics وبتالي هناك فيه خشية
+
+383
+00:28:26,630 --> 00:28:32,070
+على حدوث فشل كلوي تم عند مرضى ال E coli O157H7
+
+384
+00:28:32,070 --> 00:28:35,270
+وخاصة في الأطفال طب هل البكتيريا دي موردة في غزة
+
+385
+00:28:35,270 --> 00:28:41,060
+شباب؟الـ E.coli O15787 دراساتنا الميدانية مع طلبة
+
+386
+00:28:41,060 --> 00:28:46,060
+ال master اللي عملوا فحوصات للأغذية بتقول ان ال E
+
+387
+00:28:46,060 --> 00:28:51,800
+.coli O15787 موجودة في خضروتنا موجودة في خضروتنا
+
+388
+00:28:51,800 --> 00:28:55,040
+وموجودة في اللحم المفروم تبعنا اللحم المفروم اللي
+
+389
+00:28:55,040 --> 00:29:01,170
+بنعمل منه مثلا كباب أو كفتةو لأن الكباب و الكفتة
+
+390
+00:29:01,170 --> 00:29:05,710
+بي .. لما .. لما بنحطهم على النار بيستغرقوش وقت
+
+391
+00:29:05,710 --> 00:29:11,730
+طويل عشان يعني يندجوا فبالتالي ربما الحرارة قد لا
+
+392
+00:29:11,730 --> 00:29:15,750
+تصل إلى منتصف ال .. ال .. الغذاء وبالتالي لا تقتل
+
+393
+00:29:15,750 --> 00:29:19,750
+كل البكتيريا في أوروبا بيسموا البكتيريا هذه او في
+
+394
+00:29:19,750 --> 00:29:22,810
+أمريكا بيسموها hamburger bustle line لأن
+
+395
+00:29:22,810 --> 00:29:25,870
+الهامبورجر برضه هو عبارة عن لحم مفرومفبالتالي
+
+396
+00:29:25,870 --> 00:29:29,590
+اخترعولهم .. اخترعولهم حتى ال .. ال .. ال .. البيت
+
+397
+00:29:29,590 --> 00:29:35,290
+ترمومتر خاص .. ترمومتر خاص بقياس درجة حرارة من ال
+
+398
+00:29:35,290 --> 00:29:40,080
+hamburgerعشان يضمنوا ان درجة الحرارة في النص وصلت
+
+399
+00:29:40,080 --> 00:29:45,600
+فوق 75 درجة مئاوي وصلت صورة يعني البكتيريا موجودة
+
+400
+00:29:45,600 --> 00:29:49,480
+هنا في غزة لكن الاهتمام فيها للأسف مش عالي من قبل
+
+401
+00:29:49,480 --> 00:29:53,060
+المختبرات ولا من قبل الأطباء وبالتالي ربما يكون
+
+402
+00:29:53,060 --> 00:29:56,840
+هناك حالة وفيها فشل كلوي عند الأطفال في قطع غزة
+
+403
+00:29:56,840 --> 00:30:01,780
+سببها ال E coli O157H7 وغير مدونة غير مسجلة لإن
+
+404
+00:30:01,780 --> 00:30:04,720
+احنا ماشخصناها بطريقة صحية
+
+405
+00:30:07,140 --> 00:30:11,080
+الميكروبب التاني اللي هو ال enterobacter دخلنا على
+
+406
+00:30:11,080 --> 00:30:14,800
+ال enterobacter و احنا عارفين عرفناها جاب ما ..
+
+407
+00:30:14,800 --> 00:30:17,340
+جاب ما ندخل عليها، مظبوط ولا لأ؟ عرفناها كيف
+
+408
+00:30:17,340 --> 00:30:22,980
+عرفناها؟ بالاستثناء لم تكن هي motileهي citrate
+
+409
+00:30:22,980 --> 00:30:30,280
+positive صح؟ هي non H2S producer، هي lactose
+
+410
+00:30:30,280 --> 00:30:33,280
+fermenter، هي lactose fermenter طيب، بالنسبة
+
+411
+00:30:33,280 --> 00:30:36,480
+للأمراض، كيف ممكن نوصف ال .. ال .. ال .. ال
+
+412
+00:30:36,480 --> 00:30:40,540
+enterobacter؟كل ما ذكرته عن الاشريشيا كولاي من
+
+413
+00:30:40,540 --> 00:30:45,940
+أمراض ممكن أقوله لمين لل enterobacter لكن نسبة
+
+414
+00:30:45,940 --> 00:30:50,540
+انتشار يعني بمعنى لو أنا جيت على سجلات المختبرات
+
+415
+00:30:50,540 --> 00:30:55,120
+مرة تانية و اتطلعت على دفاترهم مين أكتر انتشارا
+
+416
+00:30:55,120 --> 00:30:58,740
+هلاج الاشريشيا كولاي بينما ال enterobacter في ذال
+
+417
+00:30:58,740 --> 00:31:02,780
+القائمة لكن نفس المأماكن اللي عزلت منها ال E.coli
+
+418
+00:31:02,780 --> 00:31:08,790
+ممكن أعزل منها ال enterobacter ولكن بنسبة أقلاسمين
+
+419
+00:31:08,790 --> 00:31:13,530
+مشهورين انتروبكتر ايروجينز و انتروبكتر كلووكي
+
+420
+00:31:13,530 --> 00:31:16,930
+ايروجينز و كلووكي اضيفوا من عندي اسم تالت
+
+421
+00:31:16,930 --> 00:31:23,350
+انتروبكتر ساكازاكي اسم حلو Japanese ساكازاكي
+
+422
+00:31:23,350 --> 00:31:26,490
+ساكازاكي
+
+423
+00:31:26,490 --> 00:31:32,360
+زي ما سمعت اكتبها ساكازاكي اكتبها تمامالان ال
+
+424
+00:31:32,360 --> 00:31:37,880
+enterobacter sakazaki هدى ميكروب جديد مش جديد
+
+425
+00:31:37,880 --> 00:31:40,900
+بمعنى جديد يعنى مبارح لأ لكن احنا اللى ببقى بنقول
+
+426
+00:31:40,900 --> 00:31:43,840
+فى ال microballery خمستاشر لعشرين سنة تلاتين سنة
+
+427
+00:31:43,840 --> 00:31:47,960
+حتى كمان بنعتبرهم ايه جديد ليش جديد لإن معظم
+
+428
+00:31:47,960 --> 00:31:51,980
+الميكروبات تعرفنا عليهم فى خمسينيات القرن الماضى
+
+429
+00:31:51,980 --> 00:31:55,640
+فأى ميكروب بعد ذلك بيعتبر ايه يعني من الميكروبات
+
+430
+00:31:55,640 --> 00:31:59,890
+الجديدةطبعا التيروبكتر ساكزاكي ميزناها في هذه
+
+431
+00:31:59,890 --> 00:32:05,010
+المحاضرة على الرغم من أنها إضافة جديدة و أصبحت
+
+432
+00:32:05,010 --> 00:32:09,310
+أشهر من الميكروبين الأم اللي هم الأصل الـAerogenes
+
+433
+00:32:09,310 --> 00:32:13,850
+و الـCloaca لماذا؟ لأنه تعلمنا عن هذا الميكروب
+
+434
+00:32:13,850 --> 00:32:18,350
+معلومات جديدة، تعلمنا معلومات جديدة لجينا أن هذا
+
+435
+00:32:18,350 --> 00:32:22,830
+الميكروب له قدرة على تحمل درجات حرارة أعلى من
+
+436
+00:32:22,830 --> 00:32:27,190
+زميله في العيلةوبالتالي لما بيحضروا الحليب تبع
+
+437
+00:32:27,190 --> 00:32:31,610
+الأطفال لاجوا انه هذا ال microbe can survive in
+
+438
+00:32:31,610 --> 00:32:35,390
+the powder .. بودرة .. بودرة الحليب.الان حضرنا ..
+
+439
+00:32:35,390 --> 00:32:39,810
+حضرنا حليب و بدنا نحله .. بدنا .. بدنا نعمل رضعة
+
+440
+00:32:39,810 --> 00:32:43,390
+للطفل فبنحط كمية معينة من البودرة و كمية من الماء
+
+441
+00:32:43,390 --> 00:32:48,850
+الدافع، حليبالشباب الحالي الحليب يعتبر غذاء almost
+
+442
+00:32:48,850 --> 00:32:54,110
+the perfect food يسموه almost يعني تقريبا الغذاء
+
+443
+00:32:54,110 --> 00:32:58,570
+الأقرب إلى الكمالليس فقط للإنسان والحيوان، وإنما
+
+444
+00:32:58,570 --> 00:33:01,810
+أيضا لمن؟ للبكتيريا، فلما البكتيريا تكون موجودة
+
+445
+00:33:01,810 --> 00:33:05,590
+الآن واصبحت الظروف مواتية لها، ولو كانت خلية واحدة
+
+446
+00:33:05,590 --> 00:33:08,310
+أو خليتين، وانتوا عرفتوا زمان الانقسام عند
+
+447
+00:33:08,310 --> 00:33:11,410
+البكتيريا، يعني في البعض منها لديها جاوز fifteen
+
+448
+00:33:11,410 --> 00:33:13,210
+minutes، عشرة minutes، زي ال clostridium
+
+449
+00:33:13,210 --> 00:33:16,990
+perifringens، هذه البكتيريا تقريبا عشرين دقيقة،
+
+450
+00:33:16,990 --> 00:33:22,770
+خلالتخزين سيء تخزين سيء قد تنمو البكتيريا وتصبح
+
+451
+00:33:22,770 --> 00:33:26,570
+الى عدد كبير جدا وبالتالي عندما تصل الى الطفل
+
+452
+00:33:26,570 --> 00:33:31,670
+الضعيف المناعة مولود حديثا ضعيف المناعة قد تؤدي
+
+453
+00:33:31,670 --> 00:33:36,230
+الى امراض منها septicemia وقد تقتل الطفل وفي دراسة
+
+454
+00:33:36,230 --> 00:33:42,250
+محلية قمنا بها في احد المستشفيات اللى بتقدم خدمة
+
+455
+00:33:42,250 --> 00:33:49,160
+الحليب للاطفال في الحضانات تتبعناالبكتيريا من
+
+456
+00:33:49,160 --> 00:33:56,580
+الماء المستخدم للبودرة، للأوعية، للخلطة، للنقل إلى
+
+457
+00:33:56,580 --> 00:34:00,400
+بطن المريض سحبنا الأنبوبة اللي بيغذوا فيها الطفل
+
+458
+00:34:00,400 --> 00:34:05,060
+وجسينا منها جزء وعملنا لها فحص وللأسف وجدنا في بعض
+
+459
+00:34:05,060 --> 00:34:10,590
+الحالات انتروبكتر سكسكهذا للأسف يعني خلّاله نكتب
+
+460
+00:34:10,590 --> 00:34:17,130
+تقرير للمستشفى المعني و للحقيقة و التاريخ أن
+
+461
+00:34:17,130 --> 00:34:22,550
+الجماعة اهتموا بالموضوع اهتمام غير عاديووقفوا
+
+462
+00:34:22,550 --> 00:34:27,170
+المطبخ اللي بيصنع وعملوا ثورة جديدة فيه نضفوه خالص
+
+463
+00:34:27,170 --> 00:34:31,570
+يعني دهنوه عملوه بنوم جديد ركبوله facilities أخرى
+
+464
+00:34:31,570 --> 00:34:36,390
+جديدة و أخدوا بالتوصيات اللي احنا أوصينا فيها و
+
+465
+00:34:36,390 --> 00:34:38,710
+احنا طبعا بعد ذلك ما تبعلش لكن هم قاموا بهذه
+
+466
+00:34:38,710 --> 00:34:43,530
+الإجراءات مشكلة قصد من الكلام او من الفكرة كلها ان
+
+467
+00:34:43,530 --> 00:34:46,810
+طول احنا انترو باكتر ساكذاكي هل الانترو باكتر
+
+468
+00:34:46,810 --> 00:34:52,130
+ساكذاكي ماكنتش موجود زمان؟كانت موجودة بس احنا
+
+469
+00:34:52,130 --> 00:34:56,550
+ماكناش نعرف عنها فبالتالي الان هي مشهورة مش لإن هي
+
+470
+00:34:56,550 --> 00:35:00,870
+اكتسبت صفات جديدة لإن احنا اتعلمنا عنها شيئا جديدا
+
+471
+00:35:00,870 --> 00:35:04,170
+وهذه النقطة كتير مهمة في تفكيرنا احنا في ال
+
+472
+00:35:04,170 --> 00:35:09,870
+microbiology اعطيكم مثال بسيط في احد ال .. ال ..
+
+473
+00:35:09,870 --> 00:35:17,370
+ال .. ال chart بنلاقي خطين ماشيين واحد لسلمونيلا
+
+474
+00:35:17,370 --> 00:35:22,830
+واحد لكمبيلوباكتر هي الزمنوهي عدد البكتيريا الآن
+
+475
+00:35:22,830 --> 00:35:25,390
+هي السلمونيلا وهي ال Campylobacter ماشيين بهذا
+
+476
+00:35:25,390 --> 00:35:30,270
+الشكل عند سنة معينة بنلاقي صار في shift ال
+
+477
+00:35:30,270 --> 00:35:34,830
+Campylobacter طلعت والسلمونيلا دال نفس المكان طب
+
+478
+00:35:34,830 --> 00:35:37,670
+يجي واحد بيقول بدي أحلل .. بدي أحلل نتائج فماشي
+
+479
+00:35:37,670 --> 00:35:45,050
+بقول؟ بيقول منذ سنة كذا بدأت ترتفع نسب من ال
+
+480
+00:35:45,050 --> 00:35:52,650
+Campylobacter هذا وظلملمين؟ لـ Campylobacter انه
+
+481
+00:35:52,650 --> 00:35:57,230
+فقط من سنة كده ارتفعت لكن واحد حاذق بيطلع للموضوع
+
+482
+00:35:57,230 --> 00:36:00,350
+بطريقة مفتلة بيقول في السنوات اللي ارتفعت فيها ال
+
+483
+00:36:00,350 --> 00:36:05,910
+Campylobacter مقدرتنا في المختبرات أصلا زادت على
+
+484
+00:36:05,910 --> 00:36:10,230
+عزل البكتيريا اتحسنت التقنية اللي بنزل فيها مين؟
+
+485
+00:36:10,230 --> 00:36:13,310
+ال Campylobacter فبدل ما كانت الحساسية عشرين في
+
+486
+00:36:13,310 --> 00:36:17,770
+المية صارت تمانين في المية يعني الزيادة حقيقية و
+
+487
+00:36:17,770 --> 00:36:23,470
+مش حقيقية؟ مش حقيقيةهي زيادة في قدرتنا على الكشف
+
+488
+00:36:23,470 --> 00:36:27,290
+عن ال Campylobacter وليس زيادة في حالات ال
+
+489
+00:36:27,290 --> 00:36:30,830
+Campylobacter نفسها، وصلت الصورة ولا ماوصلتش؟ أه
+
+490
+00:36:30,830 --> 00:36:34,250
+الجنات كنا وصلتها، هذا مفهوم لازم نكون قادرين على
+
+491
+00:36:34,250 --> 00:36:39,090
+أنه .. يعني أن نفهم في ال microbiologyطيب
+
+492
+00:36:39,090 --> 00:36:43,370
+انتروبكتر ايروجينز كليووكا ليكوفاشنز و احنا اسفين
+
+493
+00:36:43,370 --> 00:36:45,950
+احنا فكرنا انه سكزاكي مش موجودة لكن هي موجودة الان
+
+494
+00:36:45,950 --> 00:36:49,430
+انتروبكتر سكزاكي وحاكي ان انا ممكن تعمل ديارية
+
+495
+00:36:49,430 --> 00:36:53,570
+associated with infant formula اليوم هي حليب
+
+496
+00:36:53,570 --> 00:36:59,370
+الأطفال الآن سموها اسم تاني chronobacter يعني بقتر
+
+497
+00:36:59,370 --> 00:37:02,590
+اسمها انتروبكتر سكزاكي صار اسمها chronobacter
+
+498
+00:37:10,130 --> 00:37:14,130
+زمان كانوا يسموها aerobacter often confused with
+
+499
+00:37:14,130 --> 00:37:18,530
+Klebsiella يعني ممكن نخطأها على الطبق في المقنكي
+
+500
+00:37:18,530 --> 00:37:22,570
+على إنها Klebsiella مؤشر على إيش؟ بيش تتميز ال
+
+501
+00:37:22,570 --> 00:37:27,050
+Klebsiella؟ إنها طبق على طبق، بدنا نعرف إنها
+
+502
+00:37:27,050 --> 00:37:30,280
+متحركة ولا غير متحركة على الطبقCapsulated
+
+503
+00:37:30,280 --> 00:37:35,480
+الكليبسيلة كبيرة و ميوكويد كولونيز كبيرة و ميوكويد
+
+504
+00:37:35,480 --> 00:37:38,460
+كولونيز كبيرة فال انتروبكتر برضه ممكن تعطينا كبيرة
+
+505
+00:37:38,460 --> 00:37:41,660
+و ميوكويد كولونيز كبيرة البكتيريا هانامو طايل
+
+506
+00:37:41,660 --> 00:37:45,380
+أورنيثين دي كربوكسليز بوسطي في ال ODC
+
+507
+00:37:50,480 --> 00:37:55,800
+ال ABI يا ريت كل الأسماء هذه ال ال ال OMBG و ال
+
+508
+00:37:55,800 --> 00:37:59,120
+LDC و ال ODC تبقوا عارفين هم كويس ايش ما .. ايش
+
+509
+00:37:59,120 --> 00:38:02,560
+مفهوم و ماعرفش بيفحصه و عن مين positive و عن مين
+
+510
+00:38:02,560 --> 00:38:08,480
+negativeit is positive these tests انومي تست اللي
+
+511
+00:38:08,480 --> 00:38:12,180
+هم ال motility و ال ornithine decarboxylase are
+
+512
+00:38:12,180 --> 00:38:15,840
+used to differentiate it from the genus Klebsiella
+
+513
+00:38:15,840 --> 00:38:19,080
+which is similar to Enterobacter يعني في عندي
+
+514
+00:38:19,080 --> 00:38:24,380
+صفتين صفة ال motility و صفة ال ODC طب أنا جاب شوية
+
+515
+00:38:24,380 --> 00:38:28,580
+و احنا بنلعب لعبة التعرف على الميكروبات ذكرت فحص
+
+516
+00:38:28,580 --> 00:38:32,040
+واحد فرق بينهم اللي هو مين ال motility صح ال
+
+517
+00:38:32,040 --> 00:38:37,690
+motilityخدوا قاعدة كلما زاد عدد الفحوصات المستخدمة
+
+518
+00:38:37,690 --> 00:38:42,110
+كلما زادت دقة التعريف يعني لو انا اقدرت اميز
+
+519
+00:38:42,110 --> 00:38:46,490
+بينكوا بينه بعشر صفات افضل من ان اميز بينكوا بصفة
+
+520
+00:38:46,490 --> 00:38:50,650
+واحدة ليش؟ في البكتيريا يا شباب ال exceptions
+
+521
+00:38:50,650 --> 00:38:55,030
+موجودة دايما بشكل مستمر لما انا قلت الinvical E
+
+522
+00:38:55,030 --> 00:39:00,030
+coli قلت ايش؟ positive positive negative negative
+
+523
+00:39:00,030 --> 00:39:03,590
+يعني ال indulge تبعها ايش؟لو قلتلكوا انه في
+
+524
+00:39:03,590 --> 00:39:07,610
+equalize exception ان دول نيجاتيف طبعا هعملكوا
+
+525
+00:39:07,610 --> 00:39:11,690
+confusion من الآن لكن انا بأجل الموضوع هذا لبعدين
+
+526
+00:39:11,690 --> 00:39:17,330
+بس كفكرة ان مافيش صفة في الغالب hundred percent
+
+527
+00:39:17,330 --> 00:39:21,950
+absolute للبكتيريا وبالتالي حتى لما احنا بنعمل
+
+528
+00:39:21,950 --> 00:39:25,150
+قواعد بيانات مابنعملش positive و negative يا شباب
+
+529
+00:39:25,150 --> 00:39:30,050
+في قواعد البيانات بنعمل percentageها percentage
+
+530
+00:39:30,050 --> 00:39:36,070
+بنقول ال equal I 90% positive for ان دول one
+
+531
+00:39:36,070 --> 00:39:38,750
+percent positive for citrate يعني غالبا هي
+
+532
+00:39:38,750 --> 00:39:42,250
+negative غالبا هي negative لكن في احتمالية ان يكون
+
+533
+00:39:42,250 --> 00:39:47,770
+منها اصناف مثلا واحد في المية positive يبقى الصفات
+
+534
+00:39:47,770 --> 00:39:52,110
+مابنلاجهاش absolute في معظم الأحيان بنلاجيها بشكل
+
+535
+00:39:52,110 --> 00:39:59,020
+نسب مئويو في بالمناسبة برنامج لازم يكون كنت نزله
+
+536
+00:39:59,020 --> 00:40:06,560
+اسمه ID backed ID backed عبارة
+
+537
+00:40:06,560 --> 00:40:11,580
+عن small software دو على الجوجل على
+
+538
+00:40:11,580 --> 00:40:17,030
+هذا البرنامجو نزل لو عندك اعمله set up وشوف ال ..
+
+539
+00:40:17,030 --> 00:40:19,950
+ال matrices المصففات اللي فيه هتلاقي الكلام اللي
+
+540
+00:40:19,950 --> 00:40:23,990
+بنحكيكوا يا انه مثلا ال ODC تسعين بالمية سبعين
+
+541
+00:40:23,990 --> 00:40:26,390
+بالمية بيلاقيهاش positive و negative
+
+542
+00:40:33,730 --> 00:40:36,530
+طبعا البكتيريا احنا قلنا من احد اهم صفاتها انها
+
+543
+00:40:36,530 --> 00:40:40,150
+motile by peritricous flagella وهذه صفة من صفات من
+
+544
+00:40:40,150 --> 00:40:43,250
+ال antihelobacteria اذا كانت موطيلة فهي موطيلة من
+
+545
+00:40:43,250 --> 00:40:43,410
+موطيلة من موطيلة من موطيلة من موطيلة من موطيلة من
+
+546
+00:40:43,410 --> 00:40:44,490
+موطيلة من موطيلة من موطيلة من موطيلة من موطيلة من
+
+547
+00:40:44,490 --> 00:40:44,970
+موطيلة من موطيلة من موطيلة من موطيلة من موطيلة من
+
+548
+00:40:44,970 --> 00:40:45,170
+موطيلة من موطيلة من موطيلة من موطيلة من موطيلة من
+
+549
+00:40:45,170 --> 00:40:53,390
+موطيلة من موطيلة من موطيلة من موطيلة من موطيلة
+
+550
+00:40:53,390 --> 00:41:00,310
+من موطبالنسبة للوصف والتغذل فيه او الغذل في شكل
+
+551
+00:41:00,310 --> 00:41:03,410
+البكتيريا تحت الميكروسكوب يا شباب انا برضه
+
+552
+00:41:03,410 --> 00:41:06,490
+اعطيتكوا نوع من ال generalization او التعميم في
+
+553
+00:41:06,490 --> 00:41:11,150
+بيانة المحاضرات يكفيني اعرف معلومة واحدة انها gram
+
+554
+00:41:11,150 --> 00:41:17,720
+negative بس lie اما الشكل اجصيرة طويلة للأسفهذا
+
+555
+00:41:17,720 --> 00:41:22,820
+مرتبط بال media وحجب المستعمرة وكم ساعة للمستعمرة
+
+556
+00:41:22,820 --> 00:41:27,540
+وبالتالي أمور يصعب ضبطها ففقط يكفيني كمان مرة انها
+
+557
+00:41:27,540 --> 00:41:30,940
+gram negative بس الله بالنسبة ل ال cultural
+
+558
+00:41:30,940 --> 00:41:33,660
+characteristics البكتيريه بتنمو على احنا في الآخر
+
+559
+00:41:33,660 --> 00:41:37,880
+بنزرع عالمين عليها مكونكي في المكونكي they will
+
+560
+00:41:37,880 --> 00:41:44,180
+appear as pinkليش pink؟ لإن ال lactose فرمنته وكان
+
+561
+00:41:44,180 --> 00:41:47,400
+ال lactose فرمنته وهذه النقطة من الآن نبدأ يعني
+
+562
+00:41:47,400 --> 00:41:55,560
+نتفق عليها اتفاق مبدئي حيوي انه هي عينة زرعت على
+
+563
+00:41:55,560 --> 00:42:01,700
+blood agar ودائما لما بنزرع العينة بنزرعها بنبدأ
+
+564
+00:42:01,700 --> 00:42:06,240
+في مين؟ بنبدأ في مين؟ في ال general media و بننتقل
+
+565
+00:42:06,240 --> 00:42:11,280
+بعد ذلك ل ال selective media زي المكونكيالان زرعنا
+
+566
+00:42:11,280 --> 00:42:15,500
+بغرض
+
+567
+00:42:15,500 --> 00:42:24,220
+الحصول عالمين على isolated colonies وحصلنا
+
+568
+00:42:24,220 --> 00:42:31,240
+على مستعمرة منفصلة isolated colony
+
+569
+00:42:31,240 --> 00:42:37,270
+هذه ال isolated colony اتفقنا على انهإذا كانت pink
+
+570
+00:42:37,270 --> 00:42:45,750
+فهي تعني lactose fermenter إذا
+
+571
+00:42:45,750 --> 00:42:46,750
+كانت colorless
+
+572
+00:42:50,010 --> 00:42:54,430
+فهي non-lactose fermenter هذه المعلومة essential
+
+573
+00:42:54,430 --> 00:42:58,330
+يا شباب مهمة مابنقدرش نتجاوزها يعني cultural
+
+574
+00:42:58,330 --> 00:43:02,250
+characteristic قدامي انا زال البكتيريا لغلط
+
+575
+00:43:02,250 --> 00:43:05,950
+تنميتها لكن في نفس الوقت بحصل على معلومة انها
+
+576
+00:43:05,950 --> 00:43:08,990
+lactose fermenter ولا non-lactose fermenter just
+
+577
+00:43:08,990 --> 00:43:14,150
+by the color بدي اتلاحظوا شغلة ان قراة الأطباق تتم
+
+578
+00:43:14,150 --> 00:43:18,700
+بعد جداشاقل من 24 ساعة ايش بنسمي الاقل من 24 ساعة
+
+579
+00:43:18,700 --> 00:43:25,400
+دي over night ايش يعني over night؟يعني أنت بتزرع
+
+580
+00:43:25,400 --> 00:43:28,700
+الساعة تمانية الصبح و بتقرأ تاني يوم تمانية الصبح،
+
+581
+00:43:28,700 --> 00:43:32,640
+بتزرع الساعة عشرة و بتقرأ تمانية الصبح تاني يوم،
+
+582
+00:43:32,640 --> 00:43:36,960
+يعني الوقت اللي قدته المزرعة في ال incubator هو
+
+583
+00:43:36,960 --> 00:43:42,380
+ليس بالضبط 24 ساعة و إنما مر عليها ليلة كاملة، مر
+
+584
+00:43:42,380 --> 00:43:46,480
+عليها ليلة كاملة في عملية ال .. ال .. ال
+
+585
+00:43:46,480 --> 00:43:49,380
+incubation، فهذا نسميه overnight incubation
+
+586
+00:43:53,070 --> 00:44:01,110
+الان في اندي المستعمرات بتعمل حاجة اسمها line او
+
+587
+00:44:01,110 --> 00:44:04,390
+precipitated line يعني هاي المستعمرة مثلا على سبيل
+
+588
+00:44:04,390 --> 00:44:08,730
+المثال بنكبر هنا المستعمرة بنلاجأ حواليها
+
+589
+00:44:11,210 --> 00:44:17,730
+لون dark أغمق من لون المكونكي نفسه وليس له علاقة
+
+590
+00:44:17,730 --> 00:44:21,910
+بالمستعمرة يعني عامل زي هالة حول المستعمرة هذا
+
+591
+00:44:21,910 --> 00:44:28,050
+يسمى precipitated pile مش المكونكي فيه pile، pile
+
+592
+00:44:28,050 --> 00:44:33,750
+salt فهذا بترسّب حوالين المستعمرة لكن ال
+
+593
+00:44:33,750 --> 00:44:39,820
+precipitated pile اللي علىالإشريشيا كولاي أكتر
+
+594
+00:44:39,820 --> 00:44:43,640
+بكثير من ال precipitated bile اللي بيكون على مين؟
+
+595
+00:44:43,640 --> 00:44:46,260
+على ال enterobacter مهمة المعلومة هذه أن نشوفها
+
+596
+00:44:46,260 --> 00:44:49,780
+برضه ك cultural characteristics شباب بالنسبة لل
+
+597
+00:44:49,780 --> 00:44:53,480
+biochemical characteristics هنا البكتيريا أهمش
+
+598
+00:44:53,480 --> 00:44:58,800
+نعرف أنها invocation negative negative positive
+
+599
+00:44:58,800 --> 00:45:03,840
+positive يعني citrate positive بينما ال E coli
+
+600
+00:45:04,640 --> 00:45:09,380
+citrate negative يبجى انا قلتلكوا احفظوا فقط مين
+
+601
+00:45:09,380 --> 00:45:12,520
+ال equal اين هي citrate negative دلال علاش على ان
+
+602
+00:45:12,520 --> 00:45:16,380
+تلت الباجين citrate positive قلتلكوا احفظوا ال
+
+603
+00:45:16,380 --> 00:45:19,860
+citrobot اكتر h2s positive على انه .. دلال على ان
+
+604
+00:45:19,860 --> 00:45:23,420
+الباجين كلهم negative قلتلكوا ال eclipsella هي
+
+605
+00:45:23,420 --> 00:45:26,640
+الوحيدة ال none motile none motile يبجى الباجين
+
+606
+00:45:26,640 --> 00:45:30,800
+كلهم motile هذه النقاط اللي احنا كنا بنركز عليه
+
+607
+00:45:32,310 --> 00:45:39,950
+بالنسبة لـ triple sugar iron agar ال E.coli و ال E
+
+608
+00:45:39,950 --> 00:45:45,430
+.clipsilla و ال enterobacter كلهم نفس ال reaction
+
+609
+00:45:45,430 --> 00:45:53,030
+ايش ال reaction هنا؟ A على A with gasطب ال
+
+610
+00:45:53,030 --> 00:45:55,130
+citrobot اكتر ايش بتختلف عنه من ال citrobot اكتر
+
+611
+00:45:55,130 --> 00:45:59,950
+انها هتكون فيها H2S ايش لون ال H2S؟ أسود يبجيش
+
+612
+00:45:59,950 --> 00:46:06,390
+هيكون ال reaction تبعها A على A plus يبجي triple
+
+613
+00:46:06,390 --> 00:46:10,910
+sugar iron agar كمان مرة بنعيد الصورة إلى الأذهان
+
+614
+00:46:10,910 --> 00:46:14,990
+جديش أهمية هذا الفحص العظيم في ال initial
+
+615
+00:46:14,990 --> 00:46:17,510
+differentiation لل enterobacterias
+
+616
+00:46:20,260 --> 00:46:23,640
+ديجي لالميكروب التالت اللي هو ال Eclipsella و ال
+
+617
+00:46:23,640 --> 00:46:27,840
+Eclipsella احنا حاطين يعني صورة أشعة دلالة على ان
+
+618
+00:46:27,840 --> 00:46:31,920
+اسم البكتيريا اللي علاقة بالصدر لما نقول
+
+619
+00:46:31,920 --> 00:46:35,920
+Eclipsella pneumonia ال pneumonia ماني بتصير؟ في
+
+620
+00:46:35,920 --> 00:46:38,840
+الأذن ولا في ال lungs؟ في ال lungs فبتاع ال
+
+621
+00:46:38,840 --> 00:46:40,620
+Eclipsella pneumonia بتسبب ال pneumonia و ال
+
+622
+00:46:40,620 --> 00:46:44,520
+pneumonia هي infection في ال lungs
+
+623
+00:46:47,690 --> 00:46:51,330
+طبعا هذه البكتيريا بتتكلم عنها مقدمة وبعدين
+
+624
+00:46:51,330 --> 00:46:53,430
+المحاضرة اللي جاي ان شاء الله بنكمل المعلومات
+
+625
+00:46:53,430 --> 00:46:59,370
+الأخرى عنها المقدمة تبعتها كالتالي بتسمعوا
+
+626
+00:46:59,370 --> 00:47:04,190
+بنوزوكوميا ال infection ال health care associated
+
+627
+00:47:04,190 --> 00:47:10,610
+infection تمام دي انت ذاك المصطلح الجديدنجوم نجوم
+
+628
+00:47:10,610 --> 00:47:14,410
+ال health care associated infections او ال
+
+629
+00:47:14,410 --> 00:47:17,690
+nosocomial infection هي ال eclipsilla انيومونية ما
+
+630
+00:47:17,690 --> 00:47:22,150
+يميزها عن البكتيريا الأخرى أيضا مقدرتها على اكتساب
+
+631
+00:47:22,150 --> 00:47:27,150
+ال resistance بطريقة سهلة بطريقة سهلة شباب احنا
+
+632
+00:47:27,150 --> 00:47:31,570
+على مدار ال antibiotics اتطورنا من generation ل
+
+633
+00:47:31,570 --> 00:47:35,430
+generation و من family ل family في ال antibiotics
+
+634
+00:47:37,160 --> 00:47:42,480
+فش فاميلي حصلنا عليها إلا الإكليبسيلة تدورلها على
+
+635
+00:47:42,480 --> 00:47:49,400
+resistance آخر family اسمها carbapneins بيسموها
+
+636
+00:47:49,400 --> 00:47:55,330
+the most broadest spectrum of all antibioticsأكتر
+
+637
+00:47:55,330 --> 00:48:00,150
+antibiotic واسع الطيف بيقضي على جرعه بصي على جرعه
+
+638
+00:48:00,150 --> 00:48:03,630
+نيجاتيف للأسف اللي جاي هنا في غزة اكليبسيلا
+
+639
+00:48:03,630 --> 00:48:09,290
+نيومونيا منتجة لكربابنيمز كربابنيمز يعني انها
+
+640
+00:48:09,290 --> 00:48:13,470
+قادرة على تكسير الكربابنيمز وبالتالي اكليبسيلا
+
+641
+00:48:13,470 --> 00:48:19,840
+نيومونيابنحطها من ضمن الميكروبات التي يجب علينا أن
+
+642
+00:48:19,840 --> 00:48:25,340
+نكافحها في المشافي أو في المستشفيات نظرا لقدرة
+
+643
+00:48:25,340 --> 00:48:30,200
+العالية لتكوين ال resistance طبعا البكتيريا عندها
+
+644
+00:48:30,200 --> 00:48:34,920
+مقدرة أيضا على الارتباط بالأسطح فالتخلص منها هيكون
+
+645
+00:48:34,920 --> 00:48:38,540
+برضه أيه يا شباب؟ صعب وهذه كمان نقطة مهمة، تفضل
+
+646
+00:48:38,540 --> 00:48:45,610
+كيف بنتخلص منها؟ كيف الحل؟فبقى نحنا في ال .. ال ..
+
+647
+00:48:45,610 --> 00:48:49,290
+ال .. نوزوكوميا ال infection إلها procedures و
+
+648
+00:48:49,290 --> 00:48:54,010
+precautions و خلّيني أقول مجموعة من الاحتياطات
+
+649
+00:48:54,010 --> 00:48:58,810
+ليه؟ أول حاجة منع انتشارها وإذا وردناها كيف أنا
+
+650
+00:48:58,810 --> 00:49:03,490
+أتخلص منهم؟الان لما انا اكون عندى Klebsiella
+
+651
+00:49:03,490 --> 00:49:07,910
+pneumonia مثلا كرب ابن ميز resistance طبعا، غالبا
+
+652
+00:49:07,910 --> 00:49:13,170
+بافشل في علاجها، بافشل في علاجها في الوقت الحالي،
+
+653
+00:49:13,170 --> 00:49:18,170
+مافيش alternatives، مافيش alternatives، ليش؟ لأن
+
+654
+00:49:18,170 --> 00:49:23,110
+اللي يكتسب صفة الكرب ابن ميز resistance غالبا حتى
+
+655
+00:49:23,110 --> 00:49:27,570
+بيكون resistant لل penicillins و للستفالوس بورينز
+
+656
+00:49:28,140 --> 00:49:30,580
+فبكون فى عندى مشكلة فى اللى عايشه الآن فى علاجها
+
+657
+00:49:30,580 --> 00:49:35,260
+فتخيلوا واحد عنده نيومونيا بكليبسيلا نيومونيا وانا
+
+658
+00:49:35,260 --> 00:49:39,620
+غير قادر على علاجه هتتطور لسبتسيميا والسبتسيميا قد
+
+659
+00:49:39,620 --> 00:49:44,560
+تقتل من المريض المشكلة فى مين الآن المشكلة فى
+
+660
+00:49:44,560 --> 00:49:48,320
+المستشفى اللى صار فى كليبسيلا نيومونيا وفىها
+
+661
+00:49:48,320 --> 00:49:51,980
+كربابنمايز رزستان ال patient should be isolated
+
+662
+00:49:51,980 --> 00:49:57,720
+يجب ان يتم عزلهمالميكرو أورجانيزم اللى .. اللى
+
+663
+00:49:57,720 --> 00:50:01,240
+بعزول منهم يجب ان يفحص ضد كل أنواع ال antibiotics
+
+664
+00:50:01,240 --> 00:50:06,300
+اللى متوفرة والغير متوفرة حتى على وعسى اللاجئة one
+
+665
+00:50:06,300 --> 00:50:08,860
+antibiotic that is sensitive اللى هو البكتيريا
+
+666
+00:50:08,860 --> 00:50:13,260
+وبالتالي نعالج منه المرض ونخلص ونشر الميكروبفي
+
+667
+00:50:13,260 --> 00:50:18,260
+داخل المستشفى، إذن هناك إجراءاتمتنوعة و كثيرة يقوم
+
+668
+00:50:18,260 --> 00:50:21,420
+بها طواقم نسموهم احنا hospital infection control
+
+669
+00:50:21,420 --> 00:50:25,600
+committees لجهان منع العدوى في المستشفيات من
+
+670
+00:50:25,600 --> 00:50:29,840
+isolation من بحث على alternatives من disinfection
+
+671
+00:50:29,840 --> 00:50:34,180
+procedures جديدة تمام لتخلص من ال micro organism
+
+672
+00:50:35,830 --> 00:50:40,730
+الأساس إنه احنا كمان فيه نقطة كتير مهمة و بنهملها
+
+673
+00:50:40,730 --> 00:50:44,210
+لما نجع في المشكلة بنصير ندور على حل المشكلة إنه
+
+674
+00:50:44,210 --> 00:50:49,150
+نمنع أصلا ظهور ال resistance كيف نمنع ظهور ال
+
+675
+00:50:49,150 --> 00:50:52,670
+resistance؟ بندور على أسباب ظهور ال resistance
+
+676
+00:50:52,670 --> 00:50:55,490
+بالأساس يا شباب أيش أسباب ظهور ال resistance
+
+677
+00:50:55,490 --> 00:50:57,290
+برأيكم؟ بكثة
+
+678
+00:51:04,700 --> 00:51:09,200
+أنت بيوتك تعدين على antibiotic و antibiotic موجودة
+
+679
+00:51:09,200 --> 00:51:12,500
+فعلا و هي تدرع على التطبيق فتتعارض عليها البكتيريا
+
+680
+00:51:12,500 --> 00:51:15,340
+و ربما عنده موضوع البكتيريا اللي تتسبب بالبكتيريا
+
+681
+00:51:15,340 --> 00:51:20,160
+الأخرىطيب خلينا ناخد .. يعني كلامك طيب و كويس صحيح
+
+682
+00:51:20,160 --> 00:51:24,520
+لكن خلينا ناخد فكرة عامة لو الصف هذا كلهته كله كله
+
+683
+00:51:24,520 --> 00:51:28,340
+sensitive ل antibiotic معين لسم معين تمام؟ مافيش
+
+684
+00:51:28,340 --> 00:51:31,460
+غير واحد resistance مافيش غير واحد resistance
+
+685
+00:51:31,460 --> 00:51:35,100
+ورشينا السم هذا عليكوا نخلص منكوا بالمرة في
+
+686
+00:51:35,100 --> 00:51:39,320
+المحاضرة هذه من ايه؟ كلكوا هتموتوا بعد واحد،
+
+687
+00:51:39,320 --> 00:51:45,300
+مظبوط؟هيدلوا هذا اللي كان مكاتب آلاف سمين حضراتكم
+
+688
+00:51:45,300 --> 00:51:50,260
+الآن هذا بينقسم انقسم ثنائي بسيط وبصير بمعنى
+
+689
+00:51:50,260 --> 00:51:54,820
+استخدامي للسم او ال antibiotic عمل selection لمين
+
+690
+00:51:54,820 --> 00:51:59,180
+لل resistance mutantsthe resistant and mutants أنا
+
+691
+00:51:59,180 --> 00:52:03,500
+اللي نشرتهم .. أنا اللي نشرتهم باستخدامي المفرط،
+
+692
+00:52:03,500 --> 00:52:06,560
+أنا اللي .. اللي نشرتهم باستخدامي .. باستخدامي ال
+
+693
+00:52:06,560 --> 00:52:11,440
+.. ال .. الخطأ اللي هو misuse و abuse و تعالوا
+
+694
+00:52:11,440 --> 00:52:15,330
+نطلع على ال .. ال .. ال practices في المجتمعكلنا
+
+695
+00:52:15,330 --> 00:52:21,830
+بنشتغل أطباء عطوان طاب لما طيب أعطاه course من
+
+696
+00:52:21,830 --> 00:52:25,330
+الكابوسيلات الحمر والزرج تمام فكمل نص ال course و
+
+697
+00:52:25,330 --> 00:52:31,670
+خل نص التاني عنده لإنه طاب هو okay ف .. أعطاه لمن؟
+
+698
+00:52:31,670 --> 00:52:38,470
+ل .. لزميله أو لصديقه وبالتالي احنا underdoseممكن
+
+699
+00:52:38,470 --> 00:52:41,530
+يكون expired يعني هناك مجموعة كبيرة من العوامل ان
+
+700
+00:52:41,530 --> 00:52:44,310
+شاء الله بنبقى نفصل فيها في محاضرة أخرى علامة
+
+701
+00:52:44,310 --> 00:52:46,330
+اللقاء ان شاء الله في المحاضرة القادمة السلام
+
+702
+00:52:46,330 --> 00:52:47,530
+عليكم ورحمة الله وبركاته
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nCdfUPiC4Ig_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nCdfUPiC4Ig_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..fbc51471a15c5a1adb141729d6b2f0475f8c1dbb
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nCdfUPiC4Ig_raw.json
@@ -0,0 +1 @@
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2247.57, "end": 2247.67, "word": " غير", "probability": 0.98291015625}, {"start": 2247.67, "end": 2248.11, "word": " متحركة", "probability": 0.9866943359375}, {"start": 2248.11, "end": 2248.21, "word": " على", "probability": 0.89501953125}, {"start": 2248.21, "end": 2248.57, "word": " الطبق", "probability": 0.9806315104166666}], "temperature": 1.0}, {"id": 99, "seek": 226538, "start": 2249.5, "end": 2265.38, "text": "Capsulated الكليبسيلة كبيرة و ميوكويد كولونيز كبيرة و ميوكويد كولونيز كبيرة فال انتروبكتر برضه ممكن تعطينا كبيرة و ميوكويد كولونيز كبيرة البكتيريا هانامو طايل أورنيثين دي كربوكسليز بوسطي في ال ODC", "tokens": [34, 2382, 6987, 33251, 20292, 3555, 3794, 26895, 3660, 9122, 3555, 48923, 4032, 3714, 1829, 2407, 4117, 2407, 25708, 9122, 12610, 11536, 1829, 11622, 9122, 3555, 48923, 4032, 3714, 1829, 2407, 4117, 2407, 25708, 9122, 12610, 11536, 1829, 11622, 9122, 3555, 48923, 6156, 6027, 16472, 2655, 32887, 3555, 4117, 2655, 2288, 4724, 43042, 3224, 3714, 43020, 6055, 3615, 9566, 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"end": 2254.52, "word": " كبيرة", "probability": 0.8717447916666666}, {"start": 2254.52, "end": 2254.9, "word": " و", "probability": 0.7841796875}, {"start": 2254.9, "end": 2255.48, "word": " ميوكويد", "probability": 0.9789225260416666}, {"start": 2255.48, "end": 2255.92, "word": " كولونيز", "probability": 0.9826171875}, {"start": 2255.92, "end": 2256.26, "word": " كبيرة", "probability": 0.724853515625}, {"start": 2256.26, "end": 2256.42, "word": " فال", "probability": 0.724365234375}, {"start": 2256.42, "end": 2257.28, "word": " انتروبكتر", "probability": 0.6286795479910714}, {"start": 2257.28, "end": 2257.54, "word": " برضه", "probability": 0.92041015625}, {"start": 2257.54, "end": 2257.78, "word": " ممكن", "probability": 0.9677734375}, {"start": 2257.78, "end": 2258.22, "word": " تعطينا", "probability": 0.92197265625}, {"start": 2258.22, "end": 2258.46, "word": " كبيرة", "probability": 0.8673502604166666}, {"start": 2258.46, "end": 2258.6, "word": " و", "probability": 0.97705078125}, {"start": 2258.6, "end": 2259.08, "word": " ميوكويد", "probability": 0.985107421875}, {"start": 2259.08, "end": 2259.74, "word": " كولونيز", "probability": 0.9880859375}, {"start": 2259.74, "end": 2259.74, "word": " كبيرة", "probability": 0.97314453125}, {"start": 2259.74, "end": 2260.94, "word": " البكتيريا", "probability": 0.84013671875}, {"start": 2260.94, "end": 2261.32, "word": " هانامو", "probability": 0.5394287109375}, {"start": 2261.32, "end": 2261.66, "word": " طايل", "probability": 0.6809895833333334}, {"start": 2261.66, "end": 2263.24, "word": " أورنيثين", "probability": 0.67783203125}, {"start": 2263.24, "end": 2263.4, "word": " دي", "probability": 0.948486328125}, {"start": 2263.4, "end": 2264.3, "word": " كربوكسليز", "probability": 0.8357979910714286}, {"start": 2264.3, "end": 2264.82, "word": " بوسطي", "probability": 0.640380859375}, {"start": 2264.82, "end": 2264.88, "word": " في", "probability": 0.57666015625}, {"start": 2264.88, "end": 2264.96, "word": " ال", "probability": 0.79736328125}, {"start": 2264.96, "end": 2265.38, "word": " ODC", "probability": 0.751220703125}], "temperature": 1.0}, {"id": 100, "seek": 228290, "start": 2270.48, "end": 2282.9, "text": "ال ABI يا ريت كل الأسماء هذه ال ال ال OMBG و ال LDC و ال ODC تبقوا عارفين هم كويس ايش ما .. ايش مفهوم و ماعرفش بيفحصه و عن مين positive و عن مين negative", "tokens": [6027, 316, 11291, 35186, 12602, 36081, 28242, 16247, 38251, 16606, 29538, 2423, 2423, 2423, 16954, 33, 38, 4032, 2423, 441, 25619, 4032, 2423, 422, 25619, 6055, 3555, 4587, 14407, 6225, 9640, 5172, 9957, 8032, 2304, 9122, 45865, 3794, 1975, 1829, 8592, 19446, 4386, 1975, 1829, 8592, 3714, 5172, 3224, 20498, 4032, 19446, 3615, 28480, 8592, 4724, 33911, 5016, 9381, 3224, 4032, 18871, 3714, 9957, 3353, 4032, 18871, 3714, 9957, 3671], "avg_logprob": -0.21919014798083775, "compression_ratio": 1.4573170731707317, "no_speech_prob": 0.0, "words": [{"start": 2270.48, "end": 2270.7, "word": "ال", "probability": 0.9580078125}, {"start": 2270.7, "end": 2271.22, "word": " ABI", "probability": 0.7822265625}, {"start": 2271.22, "end": 2271.96, "word": " يا", "probability": 0.329833984375}, {"start": 2271.96, "end": 2272.26, "word": " ريت", "probability": 0.921142578125}, {"start": 2272.26, "end": 2272.58, "word": " كل", "probability": 0.900390625}, {"start": 2272.58, "end": 2273.32, "word": " الأسماء", "probability": 0.94580078125}, {"start": 2273.32, "end": 2273.72, "word": " هذه", "probability": 0.466064453125}, {"start": 2273.72, "end": 2274.2, "word": " ال", "probability": 0.90576171875}, {"start": 2274.2, "end": 2274.46, "word": " ال", "probability": 0.65185546875}, {"start": 2274.46, "end": 2274.72, "word": " ال", "probability": 0.85400390625}, {"start": 2274.72, "end": 2275.46, "word": " OMBG", "probability": 0.6792399088541666}, {"start": 2275.46, "end": 2275.72, "word": " و", "probability": 0.6162109375}, {"start": 2275.72, "end": 2275.8, "word": " ال", "probability": 0.8583984375}, {"start": 2275.8, "end": 2276.34, "word": " LDC", "probability": 0.8564453125}, {"start": 2276.34, "end": 2276.58, "word": " و", "probability": 0.9931640625}, {"start": 2276.58, "end": 2276.68, "word": " ال", "probability": 0.86474609375}, {"start": 2276.68, "end": 2277.14, "word": " ODC", "probability": 0.93212890625}, {"start": 2277.14, "end": 2277.46, "word": " تبقوا", "probability": 0.8133544921875}, {"start": 2277.46, "end": 2277.72, "word": " عارفين", "probability": 0.9730224609375}, {"start": 2277.72, "end": 2277.84, "word": " هم", "probability": 0.77783203125}, {"start": 2277.84, "end": 2278.24, "word": " كويس", "probability": 0.9930013020833334}, {"start": 2278.24, "end": 2278.42, "word": " ايش", "probability": 0.750732421875}, {"start": 2278.42, "end": 2278.56, "word": " ما", "probability": 0.321044921875}, {"start": 2278.56, "end": 2278.7, "word": " ..", "probability": 0.7666015625}, {"start": 2278.7, "end": 2279.12, "word": " ايش", "probability": 0.93359375}, {"start": 2279.12, "end": 2279.52, "word": " مفهوم", "probability": 0.9703369140625}, {"start": 2279.52, "end": 2279.62, "word": " و", "probability": 0.361328125}, {"start": 2279.62, "end": 2279.78, "word": " ماعرفش", "probability": 0.7208251953125}, {"start": 2279.78, "end": 2280.3, "word": " بيفحصه", "probability": 0.9001953125}, {"start": 2280.3, "end": 2280.74, "word": " و", "probability": 0.9765625}, {"start": 2280.74, "end": 2280.88, "word": " عن", "probability": 0.6220703125}, {"start": 2280.88, "end": 2281.04, "word": " مين", "probability": 0.98583984375}, {"start": 2281.04, "end": 2281.42, "word": " positive", "probability": 0.5009765625}, {"start": 2281.42, "end": 2282.34, "word": " و", "probability": 0.9951171875}, {"start": 2282.34, "end": 2282.46, "word": " عن", "probability": 0.984375}, {"start": 2282.46, "end": 2282.56, "word": " مين", "probability": 0.99462890625}, {"start": 2282.56, "end": 2282.9, "word": " negative", "probability": 0.97509765625}], "temperature": 1.0}, {"id": 101, "seek": 231246, "start": 2284.32, "end": 2312.46, "text": "it is positive these tests انومي تست اللي هم ال motility و ال ornithine decarboxylase are used to differentiate it from the genus Klebsiella which is similar to Enterobacter يعني في عندي صفتين صفة ال motility و صفة ال ODC طب أنا جاب شوية و احنا بنلعب لعبة التعرف على الميكروبات ذكرت فحص واحد فرق بينهم اللي هو مين ال motility صح ال motility", "tokens": [270, 307, 3353, 613, 6921, 16472, 20498, 1829, 6055, 14851, 13672, 1829, 8032, 2304, 2423, 2184, 1140, 4032, 2423, 420, 77, 355, 533, 979, 289, 4995, 5088, 651, 366, 1143, 281, 23203, 309, 490, 264, 1049, 301, 17053, 929, 414, 3505, 597, 307, 2531, 281, 10399, 996, 14125, 37495, 22653, 8978, 18871, 16254, 20328, 5172, 2655, 9957, 20328, 5172, 3660, 2423, 2184, 1140, 4032, 20328, 5172, 3660, 2423, 422, 25619, 23032, 3555, 41850, 10874, 16758, 13412, 2407, 10632, 4032, 1975, 5016, 8315, 44945, 1211, 3615, 3555, 5296, 3615, 49401, 16712, 3615, 28480, 15844, 9673, 1829, 4117, 32887, 3555, 9307, 29910, 37983, 2655, 6156, 5016, 9381, 36764, 24401, 6156, 2288, 4587, 49374, 16095, 13672, 1829, 31439, 3714, 9957, 2423, 2184, 1140, 20328, 5016, 2423, 2184, 1140], "avg_logprob": -0.2172619015687988, "compression_ratio": 1.6111111111111112, "no_speech_prob": 0.0, "words": [{"start": 2284.32, "end": 2284.54, "word": "it", "probability": 0.11669921875}, {"start": 2284.54, "end": 2284.7, "word": " is", "probability": 0.89013671875}, {"start": 2284.7, "end": 2285.12, "word": " positive", "probability": 0.896484375}, {"start": 2285.12, "end": 2286.06, "word": " these", "probability": 0.1890869140625}, {"start": 2286.06, "end": 2286.54, "word": " tests", "probability": 0.88916015625}, {"start": 2286.54, "end": 2287.18, "word": " انومي", "probability": 0.4794921875}, {"start": 2287.18, "end": 2287.52, "word": " تست", "probability": 0.531005859375}, {"start": 2287.52, "end": 2288.48, "word": " اللي", "probability": 0.865234375}, {"start": 2288.48, "end": 2288.68, "word": " هم", "probability": 0.862548828125}, {"start": 2288.68, "end": 2288.86, "word": " ال", "probability": 0.87451171875}, {"start": 2288.86, "end": 2289.36, "word": " motility", "probability": 0.798095703125}, {"start": 2289.36, "end": 2289.98, "word": " و", "probability": 0.39013671875}, {"start": 2289.98, "end": 2290.08, "word": " ال", "probability": 0.466064453125}, {"start": 2290.08, "end": 2290.62, "word": " ornithine", "probability": 0.72930908203125}, {"start": 2290.62, "end": 2291.62, "word": " decarboxylase", "probability": 0.93955078125}, {"start": 2291.62, "end": 2292.18, "word": " are", "probability": 0.84326171875}, {"start": 2292.18, "end": 2292.76, "word": " used", "probability": 0.93359375}, {"start": 2292.76, "end": 2293.2, "word": " to", "probability": 0.94287109375}, {"start": 2293.2, "end": 2293.8, "word": " differentiate", "probability": 0.84716796875}, {"start": 2293.8, "end": 2294.2, "word": " it", "probability": 0.84130859375}, {"start": 2294.2, "end": 2294.44, "word": " from", "probability": 0.9111328125}, {"start": 2294.44, "end": 2294.62, "word": " the", "probability": 0.9091796875}, {"start": 2294.62, "end": 2295.1, "word": " genus", "probability": 0.93505859375}, {"start": 2295.1, "end": 2295.84, "word": " Klebsiella", "probability": 0.751922607421875}, {"start": 2295.84, "end": 2296.0, "word": " which", "probability": 0.73193359375}, {"start": 2296.0, "end": 2296.24, "word": " is", "probability": 0.9609375}, {"start": 2296.24, "end": 2296.62, "word": " similar", "probability": 0.92041015625}, {"start": 2296.62, "end": 2296.82, "word": " to", "probability": 0.96826171875}, {"start": 2296.82, "end": 2297.58, "word": " Enterobacter", "probability": 0.6680501302083334}, {"start": 2297.58, "end": 2298.36, "word": " يعني", "probability": 0.869384765625}, {"start": 2298.36, "end": 2298.86, "word": " في", "probability": 0.84765625}, {"start": 2298.86, "end": 2299.08, "word": " عندي", "probability": 0.6617431640625}, {"start": 2299.08, "end": 2299.66, "word": " صفتين", "probability": 0.919189453125}, {"start": 2299.66, "end": 2300.26, "word": " صفة", "probability": 0.8603515625}, {"start": 2300.26, "end": 2300.38, "word": " ال", "probability": 0.94580078125}, {"start": 2300.38, "end": 2300.8, "word": " motility", "probability": 0.934814453125}, {"start": 2300.8, "end": 2301.52, "word": " و", "probability": 0.97021484375}, {"start": 2301.52, "end": 2301.9, "word": " صفة", "probability": 0.86328125}, {"start": 2301.9, "end": 2302.4, "word": " ال", "probability": 0.93212890625}, {"start": 2302.4, "end": 2302.92, "word": " ODC", "probability": 0.801513671875}, {"start": 2302.92, "end": 2303.6, "word": " طب", "probability": 0.927978515625}, {"start": 2303.6, "end": 2303.7, "word": " أنا", "probability": 0.50830078125}, {"start": 2303.7, "end": 2303.88, "word": " جاب", "probability": 0.707763671875}, {"start": 2303.88, "end": 2304.38, "word": " شوية", "probability": 0.74072265625}, {"start": 2304.38, "end": 2304.58, "word": " و", "probability": 0.89453125}, {"start": 2304.58, "end": 2304.7, "word": " احنا", "probability": 0.869140625}, {"start": 2304.7, "end": 2305.66, "word": " بنلعب", "probability": 0.94482421875}, {"start": 2305.66, "end": 2305.98, "word": " لعبة", "probability": 0.9752604166666666}, {"start": 2305.98, "end": 2306.52, "word": " التعرف", "probability": 0.9700520833333334}, {"start": 2306.52, "end": 2306.7, "word": " على", "probability": 0.73095703125}, {"start": 2306.7, "end": 2307.4, "word": " الميكروبات", "probability": 0.8963216145833334}, {"start": 2307.4, "end": 2308.28, "word": " ذكرت", "probability": 0.9423828125}, {"start": 2308.28, "end": 2308.58, "word": " فحص", "probability": 0.96435546875}, {"start": 2308.58, "end": 2308.94, "word": " واحد", "probability": 0.98974609375}, {"start": 2308.94, "end": 2309.48, "word": " فرق", "probability": 0.8302408854166666}, {"start": 2309.48, "end": 2309.76, "word": " بينهم", "probability": 0.96630859375}, {"start": 2309.76, "end": 2309.86, 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"word": " في", "probability": 0.334228515625}, {"start": 2395.66, "end": 2396.44, "word": " بالمناسبة", "probability": 0.96376953125}, {"start": 2396.44, "end": 2398.02, "word": " برنامج", "probability": 0.9892578125}, {"start": 2398.02, "end": 2398.36, "word": " لازم", "probability": 0.9332682291666666}, {"start": 2398.36, "end": 2398.54, "word": " يكون", "probability": 0.5440673828125}, {"start": 2398.54, "end": 2398.68, "word": " كنت", "probability": 0.45648193359375}, {"start": 2398.68, "end": 2399.02, "word": " نزله", "probability": 0.8888346354166666}, {"start": 2399.02, "end": 2399.44, "word": " اسمه", "probability": 0.9217122395833334}, {"start": 2399.44, "end": 2400.22, "word": " ID", "probability": 0.460205078125}, {"start": 2400.22, "end": 2400.82, "word": " backed", "probability": 0.48876953125}, {"start": 2400.82, "end": 2401.8, "word": " ID", "probability": 0.1622314453125}, {"start": 2401.8, "end": 2403.24, "word": " backed", "probability": 0.84423828125}, {"start": 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generalization او التعميم في بيانة المحاضرات يكفيني اعرف معلومة واحدة انها gram negative بس lie اما الشكل اجصيرة طويلة للأسف", "tokens": [3555, 6027, 1863, 35457, 3660, 24976, 2407, 9381, 5172, 16070, 2655, 17082, 8848, 1211, 8978, 3224, 1975, 2407, 6024, 118, 8848, 1211, 8978, 13412, 28820, 29739, 4117, 2655, 13546, 25528, 6055, 33753, 9673, 1829, 4117, 32887, 3794, 4117, 37746, 35186, 13412, 3555, 16758, 1975, 8315, 4724, 43042, 3224, 1975, 3615, 9566, 36081, 4117, 14407, 8717, 45367, 9154, 2423, 2674, 2144, 1975, 2407, 16712, 25957, 32640, 8978, 4724, 1829, 7649, 3660, 9673, 5016, 46958, 2288, 9307, 7251, 4117, 5172, 9957, 1829, 1975, 3615, 28480, 20449, 1211, 20498, 3660, 36764, 24401, 3660, 16472, 11296, 21353, 3671, 4724, 3794, 4544, 1975, 15042, 25124, 28820, 1975, 7435, 9381, 48923, 23032, 2407, 26895, 3660, 24976, 10721, 3794, 5172], "avg_logprob": -0.14884868538693377, "compression_ratio": 1.634453781512605, "no_speech_prob": 0.0, "words": [{"start": 2456.39, "end": 2457.11, 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{"start": 2474.47, "end": 2475.45, "word": " اجصيرة", "probability": 0.8243408203125}, {"start": 2475.45, "end": 2476.17, "word": " طويلة", "probability": 0.970703125}, {"start": 2476.17, "end": 2476.97, "word": " للأسف", "probability": 0.87939453125}], "temperature": 1.0}, {"id": 109, "seek": 249944, "start": 2477.08, "end": 2499.44, "text": "هذا مرتبط بال media وحجب المستعمرة وكم ساعة للمستعمرة وبالتالي أمور يصعب ضبطها ففقط يكفيني كمان مرة انها gram negative بس الله بالنسبة ل ال cultural characteristics البكتيريه بتنمو على احنا في الآخر بنزرع عالمين عليها مكونكي في المكونكي they will appear as pink", "tokens": [3224, 15730, 3714, 43500, 3555, 9566, 20666, 3021, 4032, 5016, 7435, 3555, 9673, 14851, 25957, 25720, 4032, 24793, 8608, 995, 27884, 5296, 19528, 14851, 25957, 25720, 46599, 6027, 2655, 6027, 1829, 5551, 2304, 13063, 7251, 9381, 3615, 3555, 48812, 3555, 9566, 11296, 6156, 5172, 47432, 7251, 4117, 5172, 9957, 1829, 9122, 2304, 7649, 3714, 25720, 16472, 11296, 21353, 3671, 4724, 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{"start": 2525.24, "end": 2525.66, "word": " و", "probability": 0.8828125}, {"start": 2525.66, "end": 2526.24, "word": " بننتقل", "probability": 0.828857421875}, {"start": 2526.24, "end": 2526.46, "word": " بعد", "probability": 0.96923828125}, {"start": 2526.46, "end": 2526.74, "word": " ذلك", "probability": 0.966064453125}, {"start": 2526.74, "end": 2526.96, "word": " ل", "probability": 0.74755859375}, {"start": 2526.96, "end": 2527.38, "word": " ال", "probability": 0.71435546875}, {"start": 2527.38, "end": 2527.84, "word": " selective", "probability": 0.93896484375}, {"start": 2527.84, "end": 2528.36, "word": " media", "probability": 0.95458984375}, {"start": 2528.36, "end": 2528.7, "word": " زي", "probability": 0.96728515625}, {"start": 2528.7, "end": 2529.3, "word": " المكونكي", "probability": 0.70550537109375}], "temperature": 1.0}, {"id": 111, "seek": 255512, "start": 2530.2, "end": 2555.12, "text": "الان زرعنا بغرض الحصول عالمين على isolated colonies وحصلنا على مستعمرة منفصلة isolated colony هذه ال isolated colony اتفقنا على انه", "tokens": [6027, 7649, 30767, 2288, 3615, 8315, 4724, 17082, 43042, 21542, 9381, 12610, 6225, 45340, 9957, 15844, 14621, 27981, 4032, 5016, 36520, 8315, 15844, 3714, 14851, 25957, 25720, 9154, 5172, 36520, 3660, 14621, 23028, 29538, 2423, 14621, 23028, 1975, 2655, 5172, 4587, 8315, 15844, 16472, 3224], "avg_logprob": -0.13739809555851895, "compression_ratio": 1.4887218045112782, "no_speech_prob": 0.0, "words": [{"start": 2530.2, "end": 2530.64, "word": "الان", "probability": 0.85888671875}, {"start": 2530.64, "end": 2531.28, "word": " زرعنا", "probability": 0.915771484375}, {"start": 2531.28, "end": 2535.5, "word": " بغرض", "probability": 0.9479166666666666}, {"start": 2535.5, "end": 2535.76, "word": " الحصول", "probability": 0.9905598958333334}, {"start": 2535.76, "end": 2536.22, "word": " عالمين", "probability": 0.5567220052083334}, {"start": 2536.22, "end": 2536.8, "word": " على", "probability": 0.80029296875}, {"start": 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new file mode 100644
index 0000000000000000000000000000000000000000..80c172e0f99e393a8b143f66e69547bd74ea3833
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/nWaQMosRWpo_raw.json
@@ -0,0 +1 @@
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بيستخدميها الأكل والشرب هذه ممكن نسميها كلها forms لا لا مش مش patient مش patient related يعني طيب اتفقنا احنا على انه", "tokens": [3224, 24192, 28242, 11296, 34051, 16247, 3215, 2407, 9307, 13672, 1829, 4724, 1829, 14851, 9778, 40448, 1829, 11296, 16247, 28820, 16070, 8592, 25513, 29538, 3714, 43020, 8717, 38251, 1829, 11296, 28242, 11296, 6422, 20193, 20193, 37893, 37893, 4537, 37893, 4537, 4077, 37495, 22653, 23032, 1829, 3555, 1975, 2655, 5172, 4587, 8315, 1975, 5016, 8315, 15844, 16472, 3224], "avg_logprob": -0.23464439475330814, "compression_ratio": 1.5194805194805194, "no_speech_prob": 0.0, "words": [{"start": 1938.49, "end": 1939.21, "word": "هذه", "probability": 0.72119140625}, {"start": 1939.21, "end": 1939.47, "word": " كلها", "probability": 0.762939453125}, {"start": 1939.47, "end": 1939.79, "word": " أو", "probability": 0.1441650390625}, {"start": 1939.79, "end": 1940.13, "word": " الأدوات", "probability": 0.97265625}, {"start": 1940.13, "end": 1940.23, "word": " اللي", 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لل infection أن يكون في عندي attachment أو adherence بدون ال attachment و ال adherence يا شباب you cannot make an infection", "tokens": [10721, 24401, 5551, 16095, 28239, 4587, 41193, 9673, 16095, 10874, 28259, 8978, 6225, 42213, 10632, 34051, 8978, 36632, 6225, 42213, 10632, 24976, 11764, 14739, 7251, 30544, 8978, 18871, 16254, 19431, 34051, 30106, 655, 47525, 11536, 2423, 19431, 4032, 2423, 30106, 655, 35186, 13412, 3555, 16758, 291, 2644, 652, 364, 11764], "avg_logprob": -0.19316788689762937, "compression_ratio": 1.5548387096774194, "no_speech_prob": 0.0, "words": [{"start": 1966.05, "end": 1966.43, "word": "أحد", "probability": 0.920654296875}, {"start": 1966.43, "end": 1966.73, "word": " أهم", "probability": 0.9541015625}, {"start": 1966.73, "end": 1967.25, "word": " النقاط", "probability": 0.9425455729166666}, {"start": 1967.25, "end": 1967.59, "word": " المهم", "probability": 0.94921875}, {"start": 1967.59, "end": 1967.93, "word": " جدا", "probability": 0.867919921875}, 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تحط البكتيريا في محلول او solution water environment water environment او liquid environment تمام عشان يصير في احتكاك مباشرة بين البكتيريا وبين النوترين اما على solid surface لازم تعمل هي attachment", "tokens": [76, 723, 72, 4770, 399, 6055, 4117, 5718, 104, 2288, 16472, 7251, 30544, 8978, 3224, 14739, 3224, 1829, 19431, 1975, 2407, 16472, 4117, 6055, 5016, 9566, 29739, 4117, 2655, 13546, 25528, 8978, 3714, 5016, 1211, 12610, 1975, 2407, 3827, 1281, 2823, 1281, 2823, 1975, 2407, 6553, 2823, 46811, 10943, 6225, 8592, 7649, 7251, 9381, 13546, 8978, 1975, 33753, 4117, 995, 4117, 3714, 3555, 33599, 25720, 49374, 29739, 4117, 2655, 13546, 25528, 46599, 9957, 28239, 35473, 2288, 9957, 1975, 15042, 15844, 5100, 3753, 5296, 31377, 2304, 6055, 25957, 1211, 39896, 951, 23908], "avg_logprob": -0.17442255224222722, "compression_ratio": 1.6944444444444444, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 2038.0700000000002, "end": 2038.91, "word": "multiplication", "probability": 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the", "probability": 0.5859375}, {"start": 2943.82, "end": 2944.1, "word": " mere", "probability": 0.85400390625}, {"start": 2944.1, "end": 2944.62, "word": " presence", "probability": 0.9541015625}, {"start": 2944.62, "end": 2946.32, "word": " يعني", "probability": 0.57769775390625}, {"start": 2946.32, "end": 2947.26, "word": " فقط", "probability": 0.9638671875}, {"start": 2947.26, "end": 2947.56, "word": " وجودها", "probability": 0.9296875}, {"start": 2947.56, "end": 2947.68, "word": " في", "probability": 0.99072265625}, {"start": 2947.68, "end": 2948.0, "word": " الدم", "probability": 0.991455078125}, {"start": 2948.0, "end": 2948.52, "word": " يعتبر", "probability": 0.966796875}, {"start": 2948.52, "end": 2949.18, "word": " بكتيريميا", "probability": 0.9488118489583334}, {"start": 2949.18, "end": 2949.42, "word": " اذا", "probability": 0.6065673828125}, {"start": 2949.42, "end": 2950.1, "word": " السبتسيميا", "probability": 0.8749186197916666}, {"start": 2950.1, "end": 2951.04, "word": " معبرة", "probability": 0.9694010416666666}, {"start": 2951.04, "end": 2951.44, "word": " عن", "probability": 0.9775390625}, {"start": 2951.44, "end": 2952.36, "word": " بكتيريا", "probability": 0.96962890625}, {"start": 2952.36, "end": 2952.48, "word": " و", "probability": 0.56591796875}, {"start": 2952.48, "end": 2952.94, "word": " تكاثر", "probability": 0.9830078125}, {"start": 2952.94, "end": 2953.16, "word": " في", "probability": 0.99365234375}, {"start": 2953.16, "end": 2954.18, "word": " الدم", "probability": 0.94873046875}], "temperature": 1.0}, {"id": 117, "seek": 296743, "start": 2958.41, "end": 2967.43, "text": "عندما يتم إعطاء المريض علاج لقتل هذه البكتيريا تموت البكتيريا بشكل مفاجئ ومن ثم", "tokens": [3615, 41260, 15042, 7251, 39237, 11933, 3615, 9566, 16606, 9673, 16572, 11242, 11203, 26108, 5296, 38149, 1211, 29538, 29739, 4117, 2655, 13546, 25528, 46811, 35473, 29739, 4117, 2655, 13546, 25528, 4724, 8592, 28820, 3714, 5172, 26108, 19986, 4032, 27842, 38637, 2304], "avg_logprob": -0.10193452114860217, "compression_ratio": 1.4215686274509804, "no_speech_prob": 0.0, "words": [{"start": 2958.41, "end": 2958.97, "word": "عندما", "probability": 0.9085286458333334}, {"start": 2958.97, "end": 2959.57, "word": " يتم", "probability": 0.967529296875}, {"start": 2959.57, "end": 2960.13, "word": " إعطاء", "probability": 0.925537109375}, {"start": 2960.13, "end": 2960.69, "word": " المريض", "probability": 0.9837239583333334}, {"start": 2960.69, "end": 2961.41, "word": " علاج", "probability": 0.980712890625}, {"start": 2961.41, "end": 2963.23, "word": " لقتل", "probability": 0.857421875}, {"start": 2963.23, "end": 2963.41, "word": " هذه", "probability": 0.77978515625}, {"start": 2963.41, "end": 2964.13, "word": " البكتيريا", "probability": 0.904296875}, {"start": 2964.13, "end": 2965.19, "word": " تموت", "probability": 0.74853515625}, {"start": 2965.19, "end": 2965.75, "word": " البكتيريا", "probability": 0.98359375}, {"start": 2965.75, "end": 2966.05, "word": " بشكل", "probability": 0.9889322916666666}, {"start": 2966.05, "end": 2966.61, "word": " مفاجئ", "probability": 0.984130859375}, {"start": 2966.61, "end": 2967.07, "word": " ومن", "probability": 0.736572265625}, {"start": 2967.07, "end": 2967.43, "word": " ثم", "probability": 0.983642578125}], "temperature": 1.0}, {"id": 118, "seek": 299135, "start": 2969.17, "end": 2991.35, "text": "الاندوكسين بكميات كبيرة بيصير له release والتأثيرات اللي ذكرنا عليها اللي ناتجة عن الاندوكسين اللي من ضمنها تنشيط ال compliment إذا بتذكره ورفع الحرارة وخفض الضغط الدم وتوسيع الأوعية كل هذه الأشياء بتؤدي إلى shock وعشان نكسب منها gram negative septic shock وانشاء الله المرة القادمة بنكمل مع بعض", "tokens": [6027, 7649, 3215, 2407, 4117, 3794, 9957, 4724, 24793, 1829, 9307, 9122, 3555, 48923, 4724, 1829, 9381, 13546, 46740, 4374, 16070, 2655, 10721, 12984, 13546, 9307, 13672, 1829, 29910, 37983, 8315, 25894, 11296, 13672, 1829, 8717, 9307, 7435, 3660, 18871, 2423, 7649, 3215, 2407, 4117, 3794, 9957, 13672, 1829, 9154, 48812, 27842, 11296, 6055, 1863, 8592, 1829, 9566, 2423, 16250, 11933, 15730, 39894, 8848, 37983, 3224, 4032, 28480, 3615, 21542, 2288, 9640, 3660, 4032, 9778, 5172, 11242, 6024, 114, 17082, 9566, 32748, 2304, 34683, 41779, 40228, 16247, 45367, 10632, 28242, 29538, 16247, 8592, 1829, 16606, 39894, 33604, 16254, 30731, 5588, 4032, 3615, 8592, 7649, 8717, 4117, 35457, 9154, 11296, 21353, 3671, 23891, 299, 5588, 4032, 7649, 8592, 16606, 21984, 9673, 25720, 25062, 18513, 46007, 44945, 24793, 1211, 20449, 45030, 11242], "avg_logprob": -0.13334924255618613, "compression_ratio": 1.7813620071684588, "no_speech_prob": 0.0, "words": [{"start": 2969.17, "end": 2969.93, "word": "الاندوكسين", "probability": 0.8796735491071429}, {"start": 2969.93, "end": 2970.49, "word": " بكميات", "probability": 0.9796142578125}, {"start": 2970.49, "end": 2970.97, "word": " كبيرة", "probability": 0.984375}, {"start": 2970.97, "end": 2971.43, "word": " بيصير", "probability": 0.92236328125}, {"start": 2971.43, "end": 2971.51, "word": " له", "probability": 0.7373046875}, {"start": 2971.51, "end": 2971.97, "word": " release", "probability": 0.72900390625}, {"start": 2971.97, "end": 2973.49, "word": " والتأثيرات", "probability": 0.9296875}, {"start": 2973.49, "end": 2973.59, "word": " اللي", "probability": 0.748779296875}, {"start": 2973.59, "end": 2973.95, "word": " ذكرنا", "probability": 0.9763997395833334}, {"start": 2973.95, "end": 2974.37, "word": " عليها", "probability": 0.986328125}, {"start": 2974.37, "end": 2974.69, "word": " اللي", "probability": 0.61328125}, {"start": 2974.69, "end": 2975.11, "word": " ناتجة", "probability": 0.942626953125}, {"start": 2975.11, "end": 2975.27, "word": " عن", "probability": 0.95068359375}, {"start": 2975.27, "end": 2975.89, "word": " الاندوكسين", "probability": 0.9681919642857143}, {"start": 2975.89, "end": 2976.03, "word": " اللي", "probability": 0.958984375}, {"start": 2976.03, "end": 2976.19, "word": " من", "probability": 0.9931640625}, {"start": 2976.19, "end": 2976.75, "word": " ضمنها", "probability": 0.99267578125}, {"start": 2976.75, "end": 2977.55, "word": " تنشيط", "probability": 0.96201171875}, {"start": 2977.55, "end": 2977.71, "word": " ال", "probability": 0.90234375}, {"start": 2977.71, "end": 2978.07, "word": " compliment", "probability": 0.447509765625}, {"start": 2978.07, "end": 2978.27, "word": " إذا", "probability": 0.7286376953125}, {"start": 2978.27, "end": 2978.95, "word": " بتذكره", "probability": 0.68438720703125}, {"start": 2978.95, "end": 2979.73, "word": " ورفع", "probability": 0.89306640625}, {"start": 2979.73, "end": 2980.35, "word": " الحرارة", "probability": 0.9871826171875}, {"start": 2980.35, "end": 2980.89, "word": " وخفض", "probability": 0.971923828125}, {"start": 2980.89, "end": 2981.37, "word": " الضغط", "probability": 0.9384765625}, {"start": 2981.37, "end": 2981.75, "word": " الدم", "probability": 0.966064453125}, {"start": 2981.75, "end": 2982.33, "word": " وتوسيع", "probability": 0.7918294270833334}, {"start": 2982.33, "end": 2983.77, "word": " الأوعية", "probability": 0.76025390625}, {"start": 2983.77, "end": 2984.39, "word": " كل", "probability": 0.6982421875}, {"start": 2984.39, "end": 2984.57, "word": " هذه", "probability": 0.72216796875}, {"start": 2984.57, "end": 2984.97, "word": " الأشياء", "probability": 0.9930419921875}, {"start": 2984.97, "end": 2985.39, "word": " بتؤدي", "probability": 0.8728841145833334}, {"start": 2985.39, "end": 2985.77, "word": " إلى", "probability": 0.86376953125}, {"start": 2985.77, "end": 2986.19, "word": " shock", "probability": 0.86669921875}, {"start": 2986.19, "end": 2986.41, "word": " وعشان", "probability": 0.9017333984375}, {"start": 2986.41, "end": 2986.63, "word": " نكسب", "probability": 0.681640625}, {"start": 2986.63, "end": 2986.97, "word": " منها", "probability": 0.988037109375}, {"start": 2986.97, "end": 2987.29, "word": " gram", "probability": 0.6005859375}, {"start": 2987.29, "end": 2987.85, "word": " negative", "probability": 0.84130859375}, {"start": 2987.85, "end": 2988.55, "word": " septic", "probability": 0.935546875}, {"start": 2988.55, "end": 2988.91, "word": " shock", "probability": 0.962890625}, {"start": 2988.91, "end": 2989.19, "word": " وانشاء", "probability": 0.7625732421875}, {"start": 2989.19, "end": 2989.27, "word": " الله", "probability": 0.7431640625}, {"start": 2989.27, "end": 2989.43, "word": " المرة", "probability": 0.94970703125}, {"start": 2989.43, "end": 2989.89, "word": " القادمة", "probability": 0.9889322916666666}, {"start": 2989.89, "end": 2990.81, "word": " بنكمل", "probability": 0.9375}, {"start": 2990.81, "end": 2991.07, "word": " مع", "probability": 0.994140625}, {"start": 2991.07, "end": 2991.35, "word": " بعض", "probability": 0.9931640625}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2992.4485, "duration_after_vad": 2805.412499999989}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/npF5dsfBfwQ.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/npF5dsfBfwQ.srt
new file mode 100644
index 0000000000000000000000000000000000000000..fc04670f058002e2f1bd57786e05c0a704f99221
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/npF5dsfBfwQ.srt
@@ -0,0 +1,2058 @@
+1
+00:00:20,840 --> 00:00:23,960
+بسم الله الرحمن الرحيم الموضوع الذي بدأنا فيه
+
+2
+00:00:23,960 --> 00:00:26,260
+المحاضرة السابقة كان ال gram-booster بسم الله إن أنا
+
+3
+00:00:26,260 --> 00:00:30,100
+أندوسبور فارمينج وتحدثنا فيه عن two organisms
+
+4
+00:00:30,100 --> 00:00:32,940
+تحدثنا عن الكوريني بكتيريوم تحدثنا عن الأمراض
+
+5
+00:00:32,940 --> 00:00:36,120
+أو المرض تحدثنا عن التوكسين تحدثنا عن ال
+
+6
+00:00:36,120 --> 00:00:40,000
+isolation and identification وتحدثنا أيضًا عن ال
+
+7
+00:00:40,000 --> 00:00:42,720
+treatment بعدين انتقلنا للـ *Erysipelothrix*
+
+8
+00:00:42,720 --> 00:00:47,010
+*rhusiopathiae*حدثنا عن أن *Erysipelothrix* في لها
+
+9
+00:00:47,010 --> 00:00:50,430
+three forms الشكل الأول كان يبقى عبارة عن
+
+10
+00:00:50,430 --> 00:00:53,750
+*erysipeloid* أو red skin localized في اليد وال
+
+11
+00:00:53,750 --> 00:00:58,770
+أصابع أو generalized skin infection والشكل
+
+12
+00:00:58,770 --> 00:01:01,890
+الثالث كان سبتيسيميا خاصة في الـ immunocompromised
+
+13
+00:01:01,890 --> 00:01:06,950
+اليوم هأتكلم عن *Listeria monocytogenes* وهي أيضًا لها
+
+14
+00:01:06,950 --> 00:01:12,150
+أربع أشكال سريرية أو clinical entities non-specific
+
+15
+00:01:12,150 --> 00:01:15,390
+flu-like illness during pregnancy or puerperal
+
+16
+00:01:15,390 --> 00:01:21,290
+sepsis حمى النفاس التي هي طبعًا تتلو الولادة أو
+
+17
+00:01:21,290 --> 00:01:26,350
+خلال عملية الحمل pregnancy. كلمة flu-like
+
+18
+00:01:26,350 --> 00:01:31,410
+تعني زي أعراض الإنفلونزا يعني يعني بماذا تتميز الإنفلونزا؟
+
+19
+00:01:31,410 --> 00:01:35,850
+رنوريا، الذي هو إفرازات من الأنف وما شابه
+
+20
+00:01:35,850 --> 00:01:39,480
+ذلك.neonatal sepsis and later meningitis لاحظوا
+
+21
+00:01:39,480 --> 00:01:42,440
+الفئتين اللتين أتحدث عنهما pregnant woman والـ
+
+22
+00:01:42,440 --> 00:01:46,600
+neonate وهذه نقطة كثيرة أهمية وخطيرة في مجال رعاية
+
+23
+00:01:46,600 --> 00:01:50,500
+الأمومة والطفولة. sepsis or meningitis in
+
+24
+00:01:50,500 --> 00:01:53,620
+immunocompromised والشكل الرابع الذي هو الـ food
+
+25
+00:01:53,620 --> 00:01:58,000
+poisoning والآن أصبحت *Listeria monocytogenes*
+
+26
+00:01:58,000 --> 00:02:01,880
+واحدًا من أهم الميكروبات في الفحوصات، يعني بمعنى آخر
+
+27
+00:02:01,880 --> 00:02:05,340
+في المواصفات لما تدرسوا في food microbiology في
+
+28
+00:02:05,340 --> 00:02:08,180
+المواصفات نعرف في total blood count في
+
+29
+00:02:08,180 --> 00:02:12,440
+*coliform* في *fecal coliform* في *Salmonella* في
+
+30
+00:02:12,440 --> 00:02:18,110
+*Shigella* في *Listeria* أحد المكونات التي نفحصها التي
+
+31
+00:02:18,110 --> 00:02:22,250
+هي *Listeria* أحد مسببات food poisoning. الصفات
+
+32
+00:02:22,250 --> 00:02:27,010
+المهمة التي سنستخدمها في تشخيص الميكروب نفسه أنها
+
+33
+00:02:27,010 --> 00:02:32,050
+gram-positive. بسلايد كلمة short و long بتذكرنا
+
+34
+00:02:32,050 --> 00:02:36,770
+short، long، و large، و thin هذه بتذكرنا أيام كنا
+
+35
+00:02:36,770 --> 00:02:40,170
+نتكلم عن gram-negative. بسلايد كنا نقول عنها هي ليست
+
+36
+00:02:40,870 --> 00:02:46,850
+مهمة، ليست كثيرة الأهمية. متى أعطيناها أهمية؟ فقط فقط في الـ
+
+37
+00:02:46,850 --> 00:02:50,730
+*Campylobacter*. تمام أن *it's very small* وتكلمنا في
+
+38
+00:02:50,730 --> 00:02:53,870
+الـ large لما تكلمنا عن الـ gram-positive spore
+
+39
+00:02:53,870 --> 00:03:00,000
+forming بسلّعي زي *Bacillus* وزي الـ *Clostridium* non-
+
+40
+00:03:00,000 --> 00:03:03,060
+spore forming. طبعًا كلمة shorter، أ thinner هنا
+
+41
+00:03:03,060 --> 00:03:05,560
+بالمقارنة مع من؟ مع التي جابتها، التي *Erysipelothrix*
+
+42
+00:03:05,560 --> 00:03:08,820
+*rhusiopathiae*. facultative أنا أوروب وأذكركم المرة
+
+43
+00:03:08,820 --> 00:03:12,300
+الماضية قلنا إنه أيضًا *Erysipelothrix rhusiopathiae* facultative
+
+44
+00:03:12,300 --> 00:03:16,360
+facultative anaerobic لكن هذه كانت catalase-negative
+
+45
+00:03:16,360 --> 00:03:21,240
+وهذه catalase-positive وناقشنا قضية مهمة، قلنا إن
+
+46
+00:03:21,240 --> 00:03:25,940
+البكتيريا التي تكون قادرة على المعيشة والتكاثر في
+
+47
+00:03:25,940 --> 00:03:28,920
+وجود الأكسجين يجب أن يكون عندها system يجب أن يكون
+
+48
+00:03:28,920 --> 00:03:34,440
+عندها نظام يؤهلها للتعامل مع الأكسجين. طيب إذا ما
+
+49
+00:03:34,440 --> 00:03:36,900
+عندها catalase ماذا يجب أن يكون عندها البديل؟
+
+50
+00:03:36,900 --> 00:03:40,720
+الـ peroxidase؟ قلنا الفرق بين الاثنين أنه الـ catalase
+
+51
+00:03:40,720 --> 00:03:44,880
+في reaction تبعه في تحويل الـ H2O2 إلى ماء
+
+52
+00:03:44,880 --> 00:03:47,960
+وجزيء
+
+53
+00:03:47,960 --> 00:03:52,580
+أكسجين. لكن الـ peroxidase لا يطلع جزيء أكسجين.
+
+54
+00:03:52,580 --> 00:03:56,200
+يستخدم الأكسجين في أكسدة مواد أصلًا مختزلة، وبالتالي
+
+55
+00:03:56,200 --> 00:04:00,770
+لا يوجد عندي bubbles. أيضًا كما ذكرت جلال سبق في *Vassal*
+
+56
+00:04:00,770 --> 00:04:03,650
+*Lightnance Performing faculty* في anaerobic بالإضافة
+
+57
+00:04:03,650 --> 00:04:08,430
+إلى النقطة المهمة جدًا التي هي الـ beta-hemolytic on
+
+58
+00:04:08,430 --> 00:04:12,650
+blood agar وهذه النقطة يا شباب تحدثنا عنها سابقًا لما
+
+59
+00:04:12,650 --> 00:04:15,590
+تحدثنا عن group A streptococci وأن group A
+
+60
+00:04:15,590 --> 00:04:19,290
+streptococci التي هي من نوع *Streptococcus pyogenes*
+
+61
+00:04:19,290 --> 00:04:23,890
+تكون مستعمرات صغيرة جدًا pinpoint، مثل رأس الدبوس
+
+62
+00:04:23,890 --> 00:04:30,290
+محاطة بـ large zone of beta-hemolysis وهذا يجعلها
+
+63
+00:04:30,290 --> 00:04:34,610
+تقع في دائرة الشبهة مع *Listeria monocytogenes*.
+
+64
+00:04:34,610 --> 00:04:38,310
+كيف ميزنا بين الاثنتين؟ *Listeria monocytogenes*
+
+65
+00:04:38,310 --> 00:04:43,470
+هي catalase-positive بينما group A streptococci
+
+66
+00:04:43,470 --> 00:04:47,910
+التي هي *Streptococcus pyogenes* هي catalase-negative.
+
+67
+00:04:47,910 --> 00:04:51,010
+biochemical characteristics.لأن هذه مهمة،
+
+68
+00:04:51,010 --> 00:04:54,650
+وسنختزلها معنا في نهاية الصفحة سيكون أن الـ
+
+69
+00:04:54,650 --> 00:04:58,150
+diagnosis ليس حاطينه نحن في اللوحة. هذه هي الصفات
+
+70
+00:04:58,150 --> 00:05:02,330
+المهمة التي نستخدمها في التشخيص. الـ motility على
+
+71
+00:05:02,330 --> 00:05:06,850
+وجهين. الوجه الأول لو زرعناها في الـ media تبع الـ
+
+72
+00:05:06,850 --> 00:05:10,750
+motility، هلاجة تعمل umbrella type growth، شكلها
+
+73
+00:05:10,750 --> 00:05:15,560
+شكل ماذا؟ المضلة. ولو شفناها تحت المجهر بالـ
+
+74
+00:05:15,560 --> 00:05:19,220
+hanging drop technique سنرى أنها تتشتت، تعمل
+
+75
+00:05:19,220 --> 00:05:24,280
+tumbling motility، tumbling حركات بهلوانية. catalase
+
+76
+00:05:24,280 --> 00:05:27,420
+positive و Voges-Proskauer positive. الـ specimen and
+
+77
+00:05:27,420 --> 00:05:30,760
+culture media سنتحدث عن ماذا؟ عن الأمراض التي
+
+78
+00:05:30,760 --> 00:05:35,740
+تحدثنا عنها. تحدثنا عن puerperal sepsis، تحدثنا عن
+
+79
+00:05:35,740 --> 00:05:39,460
+meningitis، عن septicemia، مظبوط أم لا؟ وتحدثنا
+
+80
+00:05:39,460 --> 00:05:42,860
+عن food poisoning. في الـ food poisoning، ما هو التوقع
+
+81
+00:05:42,860 --> 00:05:47,120
+للعينة أن تكون؟ leftover food، بقايا الطعام، واحد
+
+82
+00:05:47,120 --> 00:05:52,820
+أكل من طعام معين وأصيب بالتسمم، نحن نأخذ بقايا
+
+83
+00:05:52,820 --> 00:05:56,530
+الطعام، نفحصها. بينما لما يكون عندي septicemia، آخذ
+
+84
+00:05:56,530 --> 00:06:00,250
+blood. عندي مشكلة في الـ ... الـ ... الـ ... الـ central
+
+85
+00:06:00,250 --> 00:06:02,850
+nervous system، نأخذ cerebral spinal fluid، ممكن
+
+86
+00:06:02,850 --> 00:06:04,910
+نأخذ genital tract infection لأنه ممكن البكتيريا
+
+87
+00:06:04,910 --> 00:06:07,710
+تكون أيضًا في genital tract. الـ media
+
+88
+00:06:07,710 --> 00:06:13,110
+المستخدمة *Brain Heart Infusion agar*. معانا
+
+89
+00:06:13,110 --> 00:06:17,190
+الـ jello بسمِّيه، بس بدل ما هو agar، broth. BHIB كثيرًا
+
+90
+00:06:17,190 --> 00:06:20,290
+ما هو معانا الاسم هذا الذي هو الـ ... الـ *Brain Heart*
+
+91
+00:06:20,290 --> 00:06:24,930
+*Infusion agar* زائد five percent sheep blood. يبقى
+
+92
+00:06:24,930 --> 00:06:32,550
+يجب أن نضع نحن على الـ BHIA 5% sheep blood. ممكن يكون
+
+93
+00:06:32,550 --> 00:06:37,230
+عندنا أيضًا نستخدم BHIB. نجي الآن لعمل مقارنة بسيطة
+
+94
+00:06:37,230 --> 00:06:40,290
+ما بين الـ liquid والـ solid media. لو أنا عندي من
+
+95
+00:06:40,290 --> 00:06:44,170
+نفس الـ media شكلين: شكل liquid بدون agar، وشكل
+
+96
+00:06:44,170 --> 00:06:52,010
+solid. الآن الميزات تبع واحد منهما تكون مساوية للثاني.
+
+97
+00:06:52,010 --> 00:06:57,870
+أعطيكم مثالًا على الـ liquid media: no colonies
+
+98
+00:06:57,870 --> 00:07:03,010
+are formed، هذا سيئ، هذا disadvantage، بتكون ميزة
+
+99
+00:07:03,010 --> 00:07:08,690
+لمن؟ للـ solid لأنه تتكون مستعمرة. لماذا هي ميزة؟ لأنه
+
+100
+00:07:08,690 --> 00:07:11,550
+أنا أفرض أن كل مستعمرة نشأت من خلية واحدة،
+
+101
+00:07:11,550 --> 00:07:14,770
+وبالتالي المستعمرة هذه pure culture. أستطيع أن أعرف
+
+102
+00:07:14,770 --> 00:07:18,590
+عليها، أشوف شكلها، أستطيع أن آخذ منها بكتيريا وأنا متأكد
+
+103
+00:07:18,590 --> 00:07:20,970
+أنها pure culture. أستطيع أن أعمل لها staining أو
+
+104
+00:07:20,970 --> 00:07:24,650
+biochemical test.  بس في الـ liquid media لا أستطيع. طيب
+
+105
+00:07:24,650 --> 00:07:26,810
+ما هي الميزة التي في الـ liquid media موجودة، ليست
+
+106
+00:07:26,810 --> 00:07:30,890
+موجودة في الـ solid media؟ *Its ability to enhance*
+
+107
+00:07:30,890 --> 00:07:35,470
+growth أفضل من الـ solid media. لماذا؟ لأن الـ
+
+108
+00:07:35,470 --> 00:07:39,230
+bacteria in direct contact مع من؟ مع الـ
+
+109
+00:07:39,230 --> 00:07:42,570
+nutrient. يبينها في الـ solid media، الـ nutrient are
+
+110
+00:07:42,570 --> 00:07:48,250
+trapped in the agar، مرتبطة أو محصورة من قبل الـ
+
+111
+00:07:48,250 --> 00:07:51,610
+agar. يعني في حرية في الـ liquid media أكثر من من؟
+
+112
+00:07:51,610 --> 00:07:55,690
+من الـ solid media، وبالتالي تعطيه nutrient أكثر،
+
+113
+00:07:55,690 --> 00:07:59,290
+إذا لو أنا عندي بكتيريا وضعها ضعيف، ماذا يعني
+
+114
+00:07:59,290 --> 00:08:04,310
+وضعها ضعيف؟ يعني أريد أن أعمل لها enrichment. موجودة في
+
+115
+00:08:04,310 --> 00:08:09,530
+مجموعة، أريد أن أعطيها أفضل بيئة للنمو، بأنمّيها في من؟
+
+116
+00:08:09,530 --> 00:08:11,650
+في liquid media، وبعدين ممكن أعمل لها subculture على
+
+117
+00:08:11,650 --> 00:08:16,090
+ثلاثة من، بس في عندي selective media، مهم جدًا اسمها
+
+118
+00:08:16,090 --> 00:08:20,230
+الآن الـ *Listeria Selective* *Listeria agar*. والبكتيريا
+
+119
+00:08:20,980 --> 00:08:23,080
+طبعًا على blood agar التي قلنا يجب أن يكون شكلها
+
+120
+00:08:23,080 --> 00:08:26,980
+small colonies surrounded by large zone of beta-
+
+121
+00:08:26,980 --> 00:08:31,540
+hemolysis. لكن على الـ *Listeria selective* agar
+
+122
+00:08:31,540 --> 00:08:35,960
+يكون لونها brown to black colonies، يعني من
+
+123
+00:08:35,960 --> 00:08:41,460
+مستعمرات من اللون البني إلى اللون الأسود.
+
+124
+00:08:41,460 --> 00:08:46,850
+سنرى صورة لها إن شاء الله. الـ identification نحن
+
+125
+00:08:46,850 --> 00:08:49,530
+ممكن نقول هذا demonstration of gram-positive bacilli
+
+126
+00:08:49,530 --> 00:08:54,830
+from stain smear. يعني لو أخذنا عينة من CSF أو من
+
+127
+00:08:54,830 --> 00:08:58,470
+genital tract أو food sample، تمام، ولجأنا لـ gram
+
+128
+00:08:58,470 --> 00:09:02,310
+positive bacilli. هذا مؤشر جيد على أن البكتيريا لأن
+
+129
+00:09:02,310 --> 00:09:04,450
+الـ gram-positive bacilli التي درسناها، ما هي التي
+
+130
+00:09:04,450 --> 00:09:08,590
+درسناها؟ الـ gram-positive. أما *Erysipelothrix* أو *Corynebacterium*
+
+131
+00:09:08,590 --> 00:09:11,250
+التي ليست spore forming. فبتبقى *Listeria*
+
+132
+00:09:11,250 --> 00:09:14,390
+عددهم. فلما أجدها في طعام أو أجدها في CSF، نحن
+
+133
+00:09:14,390 --> 00:09:17,150
+أتحدث عن من؟ غالبًا أتحدث عن *Listeria*
+
+134
+00:09:17,150 --> 00:09:21,090
+*monocytogenes*. culture and isolation on blood agar
+
+135
+00:09:21,090 --> 00:09:23,570
+or selective *Listeria* agar. biochemical tests،  ما
+
+136
+00:09:23,570 --> 00:09:26,070
+تحدثنا عن catalase و Voges-Proskauer و motility test، والـ
+
+137
+00:09:26,070 --> 00:09:29,090
+motility بشكلها الـ hanging drop أو النوع الثاني
+
+138
+00:09:29,090 --> 00:09:32,030
+الذي قلنا عنه الـ semi-solid media. physiological
+
+139
+00:09:32,030 --> 00:09:35,190
+testing. أيضًا هذه نقطة كثيرة الأهمية، التي
+
+140
+00:09:35,190 --> 00:09:38,790
+هي agglutination with specific antiserum. ركّزوا
+
+141
+00:09:38,790 --> 00:09:44,070
+معي. طالما الـ pathogen أصبح food microbiology
+
+142
+00:09:44,070 --> 00:09:49,970
+pathogen أعرف أن أهميته زادت، وبالتالي سأجد أشكالًا
+
+143
+00:09:49,970 --> 00:09:53,250
+متنوعة من الشركات. يعني لو أنتم عملتم بـ simple search
+
+144
+00:09:53,250 --> 00:09:57,430
+على جوجل وكتبتُم *Listeria* Diagnostics، Diagnostics
+
+145
+00:09:57,430 --> 00:09:59,650
+يعني الأشياء التي تستخدم في الـ diagnosis التي
+
+146
+00:09:59,650 --> 00:10:02,990
+ستجدون مئات الآلاف من المواقع تقول لكم تفضلوا، هذه
+
+147
+00:10:02,990 --> 00:10:08,200
+products أو منتجات لتشخيص *Listeria*. الـ ... الـ
+
+148
+00:10:08,200 --> 00:10:10,960
+therapy أو الـ treatment. هي combined therapy of
+
+149
+00:10:10,960 --> 00:10:13,560
+penicillin plus aminoglycosides. يعني نستخدم
+
+150
+00:10:13,560 --> 00:10:17,280
+penicillin زائد، مثلًا على سبيل المثال، *Gentamicin* أو
+
+151
+00:10:17,280 --> 00:10:23,380
+*Amikacin*. اثنين، ليس واحدًا. أو tetracycline  وحدها is used
+
+152
+00:10:23,380 --> 00:10:27,180
+as a second line. يعني لو كان المريض لديه أي حساسية
+
+153
+00:10:27,180 --> 00:10:30,280
+من penicillin أو الـ aminoglycosides، ما هو نحن
+
+154
+00:10:30,280 --> 00:10:33,820
+وضعنا اثنين، صدمنا اثنين، صحيح؟ لم نتناقش نحن
+
+155
+00:10:33,820 --> 00:10:36,500
+في قضية لماذا قد نستخدم اثنين من antibiotics؟
+
+156
+00:10:42,180 --> 00:10:46,160
+أنت حاليًا ذكرت سببًا وهو synergism. قلت إنه ممكن
+
+157
+00:10:46,160 --> 00:10:49,040
+الاثنان معًا يعطينا effect أفضل ممّا لو استخدمنا
+
+158
+00:10:49,040 --> 00:10:53,420
+واحدًا وحده، وهذا بالفعل مطلوب في بعض الحالات.
+
+159
+00:10:53,420 --> 00:10:57,700
+الحالة الثانية المهمة جدًا التي هي أن نمنع الـ
+
+160
+00:10:57,700 --> 00:11:01,100
+emergence of resistance strains، لأن البكتيريا
+
+161
+00:11:01,100 --> 00:11:03,520
+إذا كونّت resistance لأحد الـ antibiotics، الثاني
+
+162
+00:11:03,520 --> 00:11:07,840
+يقتلها. وكلما زاد عدد الـ antibiotics، نظريًا، كلما
+
+163
+00:11:07,840 --> 00:11:12,840
+قلت احتمالية نشوء أنواع مقاومة. يعني بالمنطق، أربعة
+
+164
+00:11:12,840 --> 00:11:15,540
+antibiotics أفضل من ثلاثة، أفضل من اثنين، أفضل من
+
+165
+00:11:15,540 --> 00:11:19,200
+واحد. في الـ resistance، لأن لو كونّت resistant هذه
+
+166
+00:11:19,200 --> 00:11:22,320
+البكتيريا resistant لأحد اثنين، ثلاثة،
+
+167
+00:11:22,320 --> 00:11:27,250
+وأربعة، *still can kill it*، صحيح؟ قُتلت في مهدها. يعني
+
+168
+00:11:27,250 --> 00:11:30,190
+بمعنى آخر، لم تظهر كونها resistant هي لـ one
+
+169
+00:11:30,190 --> 00:11:34,410
+antibiotic، لكن لم تظهر في العلن لأنها ماتت من الـ
+
+170
+00:11:34,410 --> 00:11:38,730
+other antibiotics، هذا هو المطلوب، هذا هو المطلوب. إذا
+
+171
+00:11:38,730 --> 00:11:43,290
+طبعًا لو كان هناك أي من المرضى حساسًا لأي من المنتجين
+
+172
+00:11:43,290 --> 00:11:46,150
+الاثنين، الذي هو الـ aminoglycosides أو الـ
+
+173
+00:11:46,150 --> 00:11:49,130
+penicillin، ممكن نستخدم *tetracycline* as a second
+
+174
+00:11:49,130 --> 00:11:52,190
+line، second line يعني خط دفاع ثاني في هذه الحالة.
+
+175
+00:11:53,950 --> 00:11:57,210
+هذه الصورة التي أمامكم توضح أن ... طبعًا ليست كثيرة
+
+176
+00:11:57,210 --> 00:12:01,630
+وضوحًا على اللوحة لكن الفراغات ... هذا *blood agar*.
+
+177
+00:12:01,630 --> 00:12:05,470
+ليس *blood
+
+223
+00:15:15,810 --> 00:15:20,470
+الحمامات، لما بيكون في عندنا أشياء مش جادّة نشيلها
+
+224
+00:15:20,470 --> 00:15:24,390
+بالصابون، بيضاف إليها ميّط النار، ميّط النار اللي هي
+
+225
+00:15:24,390 --> 00:15:28,890
+الـ HCL، اللي هي حمض الهيدروكلوريك، acid معروف عنه
+
+226
+00:15:28,890 --> 00:15:33,810
+أنه مزيل للون أكثر من الـ.. فتحدّينا وقال لنا it is
+
+227
+00:15:33,810 --> 00:15:37,110
+difficult to decolorize even in the presence of
+
+228
+00:15:37,110 --> 00:15:43,950
+strong acid ومن هنا التسمية acid fast الصبغ
+
+229
+00:15:43,950 --> 00:15:48,710
+المقاوم للحمض، الصبغ المقاوم للحمض، إذاً acid fast
+
+230
+00:15:48,710 --> 00:15:55,830
+بكتيريا الأنواع بتعطينا انطباعات أنّ هذه البكتيريا أنّ
+
+231
+00:15:55,830 --> 00:15:59,690
+ما بتنصبغش بالـ gram stain، ما بتنصبغش بالـ gram stain
+
+232
+00:15:59,690 --> 00:16:02,710
+يبقى مش هنشوفها لو صبغنا العينة بتاعتنا اللي فيها
+
+233
+00:16:02,710 --> 00:16:06,330
+البكتيريا بالـ gram stain ولا بالـ simple stain، لازم
+
+234
+00:16:06,330 --> 00:16:11,570
+نصبغها فقط بالـ acid fast stain، أرجع مرّة ثانية و
+
+235
+00:16:11,570 --> 00:16:16,210
+أكد لكم على التحدي، أنّها acid fast stain، لما
+
+236
+00:16:16,210 --> 00:16:19,730
+عملنا decolarization في الـ gram stain، استخدمنا
+
+237
+00:16:19,730 --> 00:16:24,740
+كحول فقط، صح؟ و ميّئنا الشريحة وصبّينا من أعلى
+
+238
+00:16:24,740 --> 00:16:30,940
+الشريحة وصرنا نراقب السائل اللي بينزل، لما خلص ينزل
+
+239
+00:16:30,940 --> 00:16:35,200
+اللون في فترة لا تتجاوز ثلاثين ثانية، ثلاثين ثانية
+
+240
+00:16:35,200 --> 00:16:35,780
+ثلاثين ثانية، ثلاثين ثانية، ثلاثين ثانية، ثلاثين
+
+241
+00:16:35,780 --> 00:16:37,140
+ثلاثين ثانية، ثلاثين ثانية، ثلاثين ثانية، ثلاثين
+
+242
+00:16:37,140 --> 00:16:37,260
+ثانية، ثلاثين ثانية، ثلاثين ثانية، ثلاثين ثانية
+
+243
+00:16:37,260 --> 00:16:38,360
+ثلاثين ثانية، ثلاثين ثانية، ثلاثين ثانية، ثلاثين
+
+244
+00:16:38,360 --> 00:16:48,360
+ثانية، ثلاثين ثانية، ثلاثين ثانية، ثلاثين ثانية، تتحدّى
+
+245
+00:16:48,360 --> 00:16:53,140
+واضح، دقيقتين ومش مائل، اللي بسرعة يمرّ عليها، لأ
+
+246
+00:16:53,140 --> 00:16:58,600
+مستقرّ عليها، ومع ذلك فشل الـ acid، وخليط الكحول مع الـ
+
+247
+00:16:58,600 --> 00:17:01,720
+acid، بإنه يزيل اللون، اللي دا هي الفعل هي acid fast
+
+248
+00:17:01,720 --> 00:17:06,620
+إحنا كل الأسماء اللي بتعرفوها في الـ micro bacteria
+
+249
+00:17:06,620 --> 00:17:08,640
+أسماء بسيطة بتعرفوها، micro bacterium tuberculosis
+
+250
+00:17:08,640 --> 00:17:12,530
+و micro bacterium leprae، اللي هي آخر واحدة، وأول
+
+251
+00:17:12,530 --> 00:17:16,390
+واحدة، تمام؟ لكن واقع الأمر الميكوبكتيريا عائلة
+
+252
+00:17:16,390 --> 00:17:21,070
+كبيرة، عائلة كبيرة ومتنوعة ومختلفة، يعني في منها
+
+253
+00:17:21,070 --> 00:17:24,870
+ما هو fast growing، fast growing يعني تنمو خلال
+
+254
+00:17:24,870 --> 00:17:32,320
+ثلاث أيام، و slow growing يعني بدها ستة أسابيع، و..
+
+255
+00:17:32,320 --> 00:17:35,880
+و.. و non-grower، non-grower يعني للأسف لحد الآن
+
+256
+00:17:35,880 --> 00:17:38,880
+وهي أول مرّة بنعترف لكم إحنا في الـ microbiology هذه
+
+257
+00:17:38,880 --> 00:17:44,000
+البكتيريا لم ننجح لحد الآن في تنميتها في المختبرات
+
+258
+00:17:44,000 --> 00:17:49,000
+non-cultivable.. non-cultivable، طيب، نذكر الأسماء
+
+259
+00:17:49,000 --> 00:17:52,160
+عشان بس يكونوا familiar، Mycobacterium tuberculosis
+
+260
+00:17:52,160 --> 00:17:56,100
+Mycobacterium bovis، و Mycobacterium africanum، تحت
+
+261
+00:17:56,100 --> 00:17:59,260
+أي عنوان، حطيناهم Mycobacterium tuberculosis
+
+262
+00:17:59,260 --> 00:18:02,940
+complex، أيش معنى complex في هذه الحالة؟ المهم، لأ، مش
+
+263
+00:18:02,940 --> 00:18:07,200
+باقصد معناها اللغوي، معناها التقني هنا أنّ هذول الـ
+
+264
+00:18:07,200 --> 00:18:12,120
+ثلاث... الثلاث ميكروبات أو الثلاث أسماء بيشبهوا بعض
+
+265
+00:18:12,120 --> 00:18:16,020
+إلى حد كبير، يصعب علينا بالتقنيات العادية اللي
+
+266
+00:18:16,020 --> 00:18:19,140
+نميزهم مع بعض، بيبقى تقنيات متطورة أكثر، فبالتالي هم
+
+267
+00:18:19,140 --> 00:18:22,640
+بيعتبروهم complex، يعني بنصل لمرحلة أنّ ممكن تكون
+
+268
+00:18:22,640 --> 00:18:24,820
+البكتيريا واحدة من الثلاث، يا إمّا tuberculosis، يا
+
+269
+00:18:24,820 --> 00:18:28,940
+بوفيس، يا إمّا africanum، سهلة الأسماء، Non
+
+270
+00:18:28,940 --> 00:18:33,180
+-tuberculosis Mycobacteria، Atypical بيقسموها لجسمين
+
+271
+00:18:33,180 --> 00:18:38,220
+A و B، Atypical Mycobacteria، Atypical يعني غير نمطيّة
+
+272
+00:18:38,220 --> 00:18:44,220
+و Non-cultivable، اتفقنا عليها، من هي؟ الـ leprae
+
+273
+00:18:44,220 --> 00:18:51,720
+الآن Mycobacterium avium intracellulari، في I معلش
+
+274
+00:18:51,720 --> 00:18:58,200
+في I في الـ intracellulari، ركّزوا معايا شويّة هنا، نفس
+
+275
+00:18:58,200 --> 00:19:02,940
+الفكرة اللي حكيناها هنا، نحكيها هنا، الشرح اللي بين
+
+276
+00:19:02,940 --> 00:19:06,080
+الاثنين هذا الـ dash avium intracellulari، معناه اللي
+
+277
+00:19:06,080 --> 00:19:10,060
+حاكيه أنّ هذول two species، two species، لكن are
+
+278
+00:19:10,060 --> 00:19:13,280
+difficult to differentiate، فبرضه هما الاثنين بنقدر
+
+279
+00:19:13,280 --> 00:19:16,820
+نقول أنّهم mycobacterium avium intracellulari
+
+280
+00:19:16,820 --> 00:19:20,940
+complex، هذه البكتيريا ما كنا نسمع فيها أيام ما كنا
+
+281
+00:19:20,940 --> 00:19:25,860
+نطلعها في الكتب، ولا كنا نعرف أنّها أصلاً موجودة
+
+282
+00:19:25,860 --> 00:19:30,600
+لكن بعد ظهور مرض الـ AIDS، أصبحت هذه البكتيريا as
+
+283
+00:19:30,600 --> 00:19:35,020
+famous as mycobacterium tuberculosis، وأعتقد أنّ
+
+284
+00:19:35,020 --> 00:19:38,580
+هي number one cause of tuberculosis in HIV
+
+285
+00:19:38,580 --> 00:19:43,210
+patients، مرضى الـ HIV، mycobacterium marinum
+
+286
+00:19:43,210 --> 00:19:46,050
+marinum، جاي من marine، marine معناها أحواض الأسماك
+
+287
+00:19:46,050 --> 00:19:48,630
+أو أحواض الأسماك، وهي fish tanks، fish tanks
+
+288
+00:19:48,630 --> 00:19:53,050
+scrofulaceum، هذه بتعمل infection of the neck
+
+289
+00:19:53,050 --> 00:19:58,250
+غالباً، تمام، ففي عندي مجموعة من البكتيريا، بطلت الـ
+
+290
+00:19:58,250 --> 00:20:02,410
+mycobacterium فقط، مقصود على اسمين، الاسم الأول الـ
+
+291
+00:20:02,410 --> 00:20:05,470
+tuberculosis، والـ leprae، وإنما عندي مجموعة أخرى
+
+292
+00:20:05,470 --> 00:20:09,470
+من اللي هو أسماؤها كلمة bovis، معلومة لكم، bovis
+
+293
+00:20:09,470 --> 00:20:15,560
+اللي هي الأبقار، فهي بتصيب اللي هو الأبقار، طيب، نرجع
+
+294
+00:20:15,560 --> 00:20:19,660
+ونأخذ الآن general characteristics للبكتيريا، it
+
+295
+00:20:19,660 --> 00:20:23,200
+is acid fast، straight or slightly curved rods، it
+
+296
+00:20:23,200 --> 00:20:25,540
+is non-motile، non-spore forming
+
+297
+00:20:28,480 --> 00:20:32,980
+one of the most frankly aerobic bacteria، يعني لو
+
+298
+00:20:32,980 --> 00:20:37,340
+قلنا لك، هات مثال على بكتيريا هوائية، فعندك أنت تقعد
+
+299
+00:20:37,340 --> 00:20:39,940
+في مثالين كويسين، اللي هما الـ pseudomonas
+
+300
+00:20:39,940 --> 00:20:43,580
+aeruginosa، والـ mycobacterium tuberculosis، لكن
+
+301
+00:20:43,580 --> 00:20:47,140
+بالإضافة إلى أنّها aerobic، it is capnophilic،
+
+302
+00:20:47,140 --> 00:20:50,220
+capnophilic، أيش قلنا عنها؟ محبّة للـ CO2، ده five
+
+303
+00:20:50,220 --> 00:20:56,230
+to ten percent CO2، نجي لرقم خمسة من المعلومات اللي
+
+304
+00:20:56,230 --> 00:21:00,930
+هي برضه مهمّة جداً، it is slow growing bacteria، الرقم
+
+305
+00:21:00,930 --> 00:21:04,330
+اللي موجود معاكم هذا أقصر doubling time، أنا أقرأه
+
+306
+00:21:04,330 --> 00:21:06,930
+أقصر doubling time، يعني في doubling time، بتكلم عن
+
+307
+00:21:06,930 --> 00:21:10,830
+عشرين ساعة، بتكلم عن أربع وعشرين ساعة، تمام؟ ليش في
+
+308
+00:21:10,830 --> 00:21:13,870
+اختلافات في doubling time؟ الـ doubling time مرهون
+
+309
+00:21:13,870 --> 00:21:20,530
+بأيّ بكتيريا، بـ media محددة، بـ media، بوسط معيّن، بظروف
+
+310
+00:21:20,530 --> 00:21:26,800
+معيّنة، بظروف معيّنة، يبدو أنّ هذا اللي وصلنا له ناتج عن
+
+311
+00:21:26,800 --> 00:21:30,620
+ميديا... في ميديا جديدة اسمها Middlebrook Broth
+
+312
+00:21:30,620 --> 00:21:34,220
+بَقوا زمان يستخدموها، الـ Einstein Jensen agar اللي
+
+313
+00:21:34,220 --> 00:21:38,280
+هندرسها اليوم هنا في محاضرتنا، لكن طُوّر وسط سائل
+
+314
+00:21:38,280 --> 00:21:41,740
+اسمه Middlebrook Broth، لحظة، الـ broth، الـ broth اللي
+
+315
+00:21:41,740 --> 00:21:47,800
+بيوفر فرصة أفضل لمين؟ لإنه عموماً لما اتكلّمنا على
+
+316
+00:21:47,800 --> 00:21:50,320
+Clostridium perfringens، مين بتذكر قد ايش
+
+317
+00:21:50,320 --> 00:21:51,460
+doubling time عنه؟
+
+318
+00:21:54,580 --> 00:22:01,520
+10 دقائق إلى 12 ساعة، يعني، افترض، افترض جدلاً أنّ
+
+319
+00:22:01,520 --> 00:22:08,840
+البكتيريا، 12 ساعة، كم مرّة بتنقسم في اليوم؟ مرتين، طيب
+
+320
+00:22:08,840 --> 00:22:14,480
+قارنوا ليّ المرتين هذول، صارت خليتين، بعد أربع وعشرين
+
+321
+00:22:14,480 --> 00:22:18,360
+ساعة، مع الإشريكية القولونية، الـ doubling time تبعها
+
+322
+00:22:18,360 --> 00:22:23,440
+twenty minutes، يعني في الساعة الواحدة كم مرّة؟
+
+323
+00:22:23,440 --> 00:22:27,960
+ثلاث، ثلاث في أربع وعشرين؟ ثمانية وسبعين؟
+
+324
+00:22:27,960 --> 00:22:34,000
+بقى تحط رقم اثنين، أُس اثنين وسبعين، اثنين أُس اثنين
+
+325
+00:22:34,000 --> 00:22:39,780
+وَسبعين، يعني مليارات في اليوم الواحد، بالمقارنة مع
+
+326
+00:22:39,780 --> 00:22:43,320
+مين؟ مع خليتين لـ Mycobacterium، هذه النقطة اللي
+
+327
+00:22:43,320 --> 00:22:47,700
+حكيت فيها قبل كده، وأنا أؤكد عليها من ناحية
+
+328
+00:22:47,700 --> 00:22:55,320
+العلاج، الـ E.coli، بسرعتها ويعني سهولة تكاثرها
+
+329
+00:22:55,320 --> 00:22:59,960
+استغرق معانا من ثلاث إلى خمسة أيام، course علاج
+
+330
+00:22:59,960 --> 00:23:06,890
+بينما هذه البكتيريا، أقصر فترة اللي هي الآن نحن بها
+
+331
+00:23:06,890 --> 00:23:13,290
+أقصر فترة علاجية هي ستة أشهر، ستة أشهر، بالضبط،
+
+332
+00:23:13,290 --> 00:23:17,150
+ستة أشهر، قبل ذلك كانت ثلاث سنوات، قبل ذلك كان
+
+333
+00:23:17,150 --> 00:23:21,390
+ما فيش علاج، كان ما فيش علاج، تخيّل ثلاث سنوات، كان في
+
+334
+00:23:21,390 --> 00:23:26,880
+مستشفى في مخيّم البرج، مين فيكم من المنطقة؟ مخيّم البرج
+
+335
+00:23:26,880 --> 00:23:29,200
+كان في مستشفى اسمه مستشفى الـ TB، ناس بتعرفوا اسم
+
+336
+00:23:29,200 --> 00:23:31,920
+المستشفى... الآن هو مدرسة، أغلق هذا الـ... لإنه كان
+
+337
+00:23:31,920 --> 00:23:34,800
+يعالج حالات كبيرة، بس الآن يعالج حالات في قطاع غزة
+
+338
+00:23:34,800 --> 00:23:39,240
+لا تتجاوز عشر حالات سنوياً، عشر حالات سنوياً، وطبعاً تحسّن
+
+339
+00:23:39,240 --> 00:23:42,500
+نوعاً ما في السنوات الأخيرة، الوضع يعني كان بالأول
+
+340
+00:23:42,500 --> 00:23:47,980
+خمسة عشر، سبعة عشر حالة، قاموا بحملة توعوية على كيفية
+
+341
+00:23:47,980 --> 00:23:51,460
+استخدام الـ vaccine، لأن الـ vaccine هنا بشكل مشكلة
+
+342
+00:23:51,460 --> 00:23:54,420
+هنتكلم عنها كمان شويّة، بس حاولنا نرجع لموضوع اللي هو الـ
+
+343
+00:23:54,420 --> 00:24:00,740
+treatment، slow growth، يبقى effect للبكتيريا، effect
+
+344
+00:24:00,740 --> 00:24:05,120
+للـ antibiotic أضعف، أبطأ، وبالتالي نلجأ لفترة طويلة
+
+345
+00:24:05,120 --> 00:24:08,640
+وزي ما حكى زميلكم، شاعت أنّنا بنضطر نستخدم للـ
+
+346
+00:24:08,640 --> 00:24:12,780
+combined therapy، الـ combined therapy، نفس السببين
+
+347
+00:24:12,780 --> 00:24:15,220
+اللي ذكرناهم في هذه المحاضرة، أنّنا بدنا synergism
+
+348
+00:24:15,220 --> 00:24:21,920
+وبدنا نمنع الـ resistance، لأنّه في بعد اكتشاف الـ INH
+
+349
+00:24:21,920 --> 00:24:26,470
+والـ rifampicin في السبعينيّات من القرن الماضي، بدأت
+
+350
+00:24:26,470 --> 00:24:30,970
+تظهر بعض
+
+351
+00:24:30,970 --> 00:24:34,670
+الأصوات تقول بفخر واعتزاز، بأنّه قضينا على
+
+352
+00:24:34,670 --> 00:24:38,010
+tuberculosis في العالم، tuberculosis اللي كان
+
+353
+00:24:38,010 --> 00:24:43,470
+بيسمّوه one of the most dreadful diseases، خطيرة
+
+354
+00:24:43,470 --> 00:24:50,610
+ومؤثّرة، خطيرة ومُمْرِضة، كان بيقتل الناس بكميّات كبيرة
+
+355
+00:24:51,480 --> 00:24:54,620
+وبالتالي، ونسبة الإصابة فيها عالية جداً، والانتقال
+
+356
+00:24:54,620 --> 00:24:58,880
+تبعه سهل، وبينتشر في مناطق وين فيه فقر، يعني ما فيش
+
+357
+00:24:58,880 --> 00:25:02,760
+تغذية كويسة، لذلك بيشترك في الإصابة لهذه الأمراض
+
+358
+00:25:02,760 --> 00:25:07,800
+الناس اللي مش ضروري يكونوا فقراء، اللي مثلاً فيه أدباء
+
+359
+00:25:08,730 --> 00:25:13,890
+بيستهلك نفسه في الكتابة أو في الفن أو في التعبير
+
+360
+00:25:13,890 --> 00:25:17,270
+أو في... أو في... و بينسى... بينسى نفسه في الأكل
+
+361
+00:25:17,270 --> 00:25:20,670
+فهذا برضه ممكن يكون عرض للإصابة بالـ tuberculosis، والـ
+
+362
+00:25:20,670 --> 00:25:23,050
+فقر يعني، الاثنين اشتركوا في حالة إنّهم ما بيأكلوش
+
+363
+00:25:23,050 --> 00:25:28,070
+تمام؟ مين ممكن ما يصير يأكل بشكل جيد؟ الناس اللي
+
+364
+00:25:28,070 --> 00:25:34,050
+في الحروب، لو استمرت الحرب لمدة أشهر على منطقة في العالم، تمام؟
+
+365
+00:25:34,050 --> 00:25:37,980
+حاسس إنّ في نقص في الغذاء، صح
+
+366
+00:25:37,980 --> 00:25:42,300
+ولا لأ؟ وبالتالي إمكانيّة انتشار الميكروب بتكون
+
+367
+00:25:42,300 --> 00:25:46,160
+عالية جداً، فعالم لما اكتشفوا الـ antibiotics اللي
+
+368
+00:25:46,160 --> 00:25:48,780
+يقولون عنهم الـ INH والـ pyrazinamide، صار فيه نوع من
+
+369
+00:25:48,780 --> 00:25:53,420
+الفرحة والإعلان، أنّه قضينا على مين؟ على الـ
+
+370
+00:25:53,420 --> 00:25:57,850
+tuberculosis، لكن بعد أقل من عشر سنوات، بدأت تظهر
+
+371
+00:25:57,850 --> 00:26:02,130
+علامات رجوع وعودة قوية للـ Tuberculosis، أو لـ
+
+372
+00:26:02,130 --> 00:26:06,750
+Mycobacterium Tuberculosis، وبشكل أكثر شراسة، لأنه
+
+373
+00:26:06,750 --> 00:26:10,430
+رجعت مقاومة لمضادات الحيوية، فصار عندي MDR
+
+374
+00:26:10,430 --> 00:26:14,230
+Tuberculosis، وبعد فترة زمنيّة، ودي صار عندي XDR
+
+375
+00:26:14,230 --> 00:26:19,730
+Tuberculosis، X تعبير عن Extended Multiple Drug
+
+376
+00:26:19,730 --> 00:26:23,940
+Resistant Tuberculosis، إذن الـ Mycobacterium، على
+
+377
+00:26:23,940 --> 00:26:29,340
+الرغم من أنّه بطيئة في النمو، إلا إنّ علاجها صعب،
+
+378
+00:26:29,340 --> 00:26:34,800
+علاجها صعب، لما اكتشفنا لها علاج، هي أيضاً طورت
+
+379
+00:26:34,800 --> 00:26:38,080
+نظام مقاومة لمضادات الحيوية، فهذه نقطة كتير
+
+380
+00:26:38,080 --> 00:26:44,380
+مهمّة، قول، سؤالي، بالنسبة لعدم الطعام مثلاً،
+
+381
+00:26:46,820 --> 00:26:49,180
+الـ immune system تبع الإنسان، إيش له علاقة
+
+382
+00:26:49,180 --> 00:26:51,880
+بالتغذية، الـ immune system، وهذه البكتيريا معتمدة
+
+383
+00:26:51,880 --> 00:26:56,040
+اعتماد كامل على ضعف جهاز المناعة، بمعنى، يعني هنا لو
+
+384
+00:26:56,040 --> 00:26:59,540
+إحنا روحنا على قسم صدريّة في مستشفى الشفاء أو في أو
+
+385
+00:26:59,540 --> 00:27:04,640
+في قسم آخر أو في مستشفى آخر، هنجد أنّ عمال skin
+
+386
+00:27:04,640 --> 00:27:07,980
+test للمرض، للأطباء والممرضين اللي هناك، هنجدهم
+
+387
+00:27:07,980 --> 00:27:11,220
+positive للـ tuberculosis، البكتيريا موجودة عندهم
+
+388
+00:27:11,220 --> 00:27:13,840
+لكن مش جادّة، تمام، موجودة، ليش؟ لأنّ جهاز المناعة عندهم
+
+389
+00:27:14,210 --> 00:27:18,630
+قوي، لو ضعف جهاز المناعة، قد يحدث، جزء منكم قد يحمل الـ
+
+390
+00:27:18,630 --> 00:27:22,190
+tuberculosis في صدره، جزء منكم قد يحمل الـ
+
+391
+00:27:22,190 --> 00:27:26,070
+tuberculosis في صدره، لكن البكتيريا غير قادرة على
+
+392
+00:27:26,070 --> 
+
+445
+00:31:23,600 --> 00:31:28,340
+بعض الخلايا زي اللي هو الـ monocytes اللي بيقتلونا
+
+446
+00:31:28,340 --> 00:31:33,300
+الصحيح أكثر إحنا مين الـ productive type بنتخيل مع
+
+447
+00:31:33,300 --> 00:31:38,980
+بعض الموقف يا شباب، فاكرين لما قلنا إحنا بكتيريا
+
+448
+00:31:38,980 --> 00:31:41,500
+obligate intracellular و facultative
+
+449
+00:31:41,500 --> 00:31:45,200
+intracellular، هذي إيش بتكون؟ obligate كيف
+
+450
+00:31:45,200 --> 00:31:49,260
+obligate؟ facultative مستحيل تكون obligate وأنا
+
+451
+00:31:49,260 --> 00:31:52,420
+بقدر أنميها على طبق، على لوينشتاين
+
+452
+00:31:52,420 --> 00:31:56,940
+جنسن اجار لو  .. لو إنّها obligate، ما بقدرش أنميها
+
+453
+00:31:56,940 --> 00:32:00,300
+إلا في cell culture أو في animals، تمام؟ بس فكّر ..
+
+454
+00:32:00,300 --> 00:32:05,380
+هذي facultative وبتنمو داخل الـ macrophage لأنّ الـ
+
+455
+00:32:05,380 --> 00:32:09,220
+macrophage وظيفتها إنها تلتقط من البكتيريا الغريبة
+
+456
+00:32:09,220 --> 00:32:14,520
+تلتقط من البكتيريا لكن بتفشل إنها تحتويها وبالتالي
+
+457
+00:32:14,520 --> 00:32:17,820
+بتنتج cytokines بتقول لجهاز المناعة اللي في الجسم
+
+458
+00:32:17,820 --> 00:32:23,020
+يا جهاز المناعة تعال في خلية أنا مش قادر أسيطر عليها، بكتيريا
+
+459
+00:32:23,020 --> 00:32:29,200
+أنا مش قادر أسيطر عليها، اقتلوني، ادفنوني مع الخلايا
+
+460
+00:32:30,020 --> 00:32:36,690
+فبنلاقي أولًا الدرنة، تمام، الـ center تبعها
+
+461
+00:32:36,690 --> 00:32:41,150
+عبارة عن large multinucleated giant cells
+
+462
+00:32:41,150 --> 00:32:44,990
+containing mycobacterium tuberculosis كيف بتصير الـ
+
+463
+00:32:44,990 --> 00:32:48,770
+multinucleated giant cell؟ multinucleated giant
+
+464
+00:32:48,770 --> 00:32:52,990
+cell معناها خلايا اتحدت مع بعضها، صار لها
+
+465
+00:32:52,990 --> 00:32:56,150
+fusion، صار لها fusion، كيف صار لها fusion؟ بأنّ الـ
+
+466
+00:32:56,150 --> 00:32:59,510
+mycobacterium اخترقت واحدة والتانية مباشرة
+
+467
+00:32:59,510 --> 00:33:04,710
+فلزجتهم مع بعض، فصار عندي خلية كبيرة بيتكاثر فيها
+
+468
+00:33:04,710 --> 00:33:08,590
+البكتيريا ونفس الـ macrophages غير قادر على قتل
+
+469
+00:33:08,590 --> 00:33:12,870
+البكتيريا، يبقى multi-nucleated cells containing من
+
+470
+00:33:12,870 --> 00:33:16,910
+الـ mycobacterium tuberculosis، الـ mid zone هي
+
+471
+00:33:16,910 --> 00:33:21,410
+عبارة عن pale epithelial cells، رقم تلاتة، الـ
+
+472
+00:33:21,410 --> 00:33:24,310
+peripheral zone اللي الحفر اللي خلقوا فيها
+
+473
+00:33:24,310 --> 00:33:30,680
+فيبروبلاست، فيها lymphocytes and monocytes كلهم اجوا
+
+474
+00:33:30,680 --> 00:33:37,200
+غطوا على مين؟ على الـ macrophage اللي جواها الـ
+
+475
+00:33:37,200 --> 00:33:41,600
+mycobacterium، الآن ده الوضع استقر بهذا الشكل وجهاز
+
+476
+00:33:41,600 --> 00:33:46,500
+المناعة قام بدوره ممتاز، تمام؟ هذا الجزء من الـ
+
+477
+00:33:46,500 --> 00:33:52,460
+lesion بينصب عليه calcium، بينصب عليه calcium
+
+478
+00:33:52,460 --> 00:34:00,430
+فبتتحجر عشان ما تخليش سهولة للبكتيريا تطلع، calcium
+
+479
+00:34:00,430 --> 00:34:03,330
+لو بنتصور إحنا صورة أشعة يا شباب، إيش اللي بيبين؟ أن
+
+480
+00:34:03,330 --> 00:34:07,190
+الأضلع بتاعتنا، العظم، والعمود الفقري، القلب بتاعنا
+
+481
+00:34:07,190 --> 00:34:12,730
+بيبين حاجة  هيكدة يعني مش واضحة، والـ lungs كذلك
+
+482
+00:34:12,730 --> 00:34:16,070
+الأمر بالنسبة إن إحنا  الطبيب جاي يتطلع على صورة
+
+483
+00:34:16,070 --> 00:34:18,510
+الأشعة ويقول طلع إيش فيها، وإحنا مش شايفين عن إيش
+
+484
+00:34:18,510 --> 00:34:25,550
+بحكي صح؟ إحنا بنشوف بس الـ ribs، الـ bone، عبارة عن X
+
+485
+00:34:25,550 --> 00:34:28,830
+-ray opaque، معتم بالنسبة لصورة الأشعة، لأن الأشعة
+
+486
+00:34:28,830 --> 00:34:33,950
+لا تقدر تخترقه وبالتالي يظهر جسم أبيض على اللوحة
+
+487
+00:34:36,530 --> 00:34:39,030
+ليه ما بتقدرش تخترقه؟ يقول إن فيه calcium؟ فالـ
+
+488
+00:34:39,030 --> 00:34:43,090
+calcium هو الـ x-ray opaque، تمام؟ فلما يتكون درنة
+
+489
+00:34:43,090 --> 00:34:48,990
+عليها calcium، عليها calcium، وصورنا أشعة، هيظهر في
+
+490
+00:34:48,990 --> 00:34:53,510
+الـ lungs بتاعتنا حاجة كورة أو حاجة مبينة، تمام؟
+
+491
+00:34:53,510 --> 00:34:56,730
+بيشوفها الطبيب و بيعرف إن هذا عبارة عن إيه؟ عن
+
+492
+00:34:56,730 --> 00:35:03,170
+lesion، هذا ممكن يكون بهذا الحجم، نعم، إذا .. إذا ..
+
+493
+00:35:04,530 --> 00:35:12,690
+صار عندي معرفة بأنّه تكون lesion، خد بالك، قد يتكون
+
+494
+00:35:12,690 --> 00:35:15,910
+الـ lesion و يصبح له classification وينتهي من
+
+495
+00:35:15,910 --> 00:35:20,390
+الجسم تمامًا ويتخلص منه الجسم بدون أي أعراض ولا أي
+
+496
+00:35:20,390 --> 00:35:26,410
+حاجة، الحكم في هذه القضية هو أن يحصل regression أو
+
+497
+00:35:26,410 --> 00:35:29,590
+progression، regression يعني انحصار، و progression يعني تطور
+
+498
+00:35:29,590 --> 00:35:32,890
+جهاز المناعة و number of virulent bacteria اللي
+
+499
+00:35:32,890 --> 00:35:37,830
+دخلت ده جسم الإنسان، يمكن الصورة هذه اللي أنا كنت
+
+500
+00:35:37,830 --> 00:35:41,530
+بدي أشرحها، للجرانيلوما، لحظة، هي الـ macrophage، تمام،
+
+501
+00:35:41,530 --> 00:35:46,010
+اللي في الأول، وفيها طبعًا الـ bacteria بتتكاثر، بعدين
+
+502
+00:35:46,010 --> 00:35:48,630
+الـ epithelial cells، وبعدين اللي هم الخلايا اللي
+
+503
+00:35:48,630 --> 00:35:52,750
+قلنا عنهم الـ monocyte والـ lymphocytes، وبعد ذلك
+
+504
+00:35:52,750 --> 00:35:56,030
+اللي هو بيصير فيه عملية قلنا calcification أو تكون
+
+505
+00:35:56,030 --> 00:36:03,230
+الـ calcium، symptoms of tuberculosis، ما هي أعراض الـ
+
+506
+00:36:03,230 --> 00:36:07,660
+disease؟ fever، ودايمًا أو معظم الناس اللي بيكون
+
+507
+00:36:07,660 --> 00:36:11,580
+فيه فرع عالي بيكون فيه chills، في sweating، تعرق، و
+
+508
+00:36:11,580 --> 00:36:15,140
+خاصةً يا شباب night sweating، إيش هي night sweating؟
+
+509
+00:36:15,140 --> 00:36:18,020
+يعني في الليل، إيه، عفواً، night sweating هي night
+
+510
+00:36:18,020 --> 00:36:22,060
+sweats، flu like symptoms، أول أعراض تبدأ عند المريض
+
+511
+00:36:22,060 --> 00:36:25,240
+زي الـ influenza أو زي الرشح، gastrointestinal
+
+512
+00:36:25,240 --> 00:36:27,700
+symptoms، ممكن يصير عنده vomiting، حتى ممكن يصير
+
+513
+00:36:27,700 --> 00:36:31,480
+عنده vomiting، weight loss، ودي one whole mark
+
+514
+00:36:31,480 --> 00:36:36,450
+في نقص في الوزن، وأول ما بيظهر بيظهر على الـ  .. الـ ..
+
+515
+00:36:36,450 --> 00:36:40,690
+بيسموه كشكسك فيس، المنطقة اللي .. الخدين دول
+
+516
+00:36:40,690 --> 00:36:45,850
+بتصير غائرة و بيفقد فيها وزن، loss of appetite، غير
+
+517
+00:36:45,850 --> 00:36:49,750
+قادر هو أصلاً، مشكلته نتجت عن عدم تناول الطعام من
+
+518
+00:36:49,750 --> 00:36:53,910
+أساسها، وكمان بيفقد من كمان الشهية، weakness بشكل
+
+519
+00:36:53,910 --> 00:36:59,390
+عام، و fatigue بشكل برضه عام، قد لا .. قد لا يعني
+
+520
+00:36:59,390 --> 00:37:04,050
+تحدث كل هذه الصفات عند نفس الشخص، لكن على الأقل
+
+521
+00:37:04,050 --> 00:37:06,790
+يعني سبعين في المئة من هذه الأعراض هتظهر عند هذا
+
+522
+00:37:06,790 --> 00:37:09,950
+المريض، في كمان مثلًا أحد الـ .. أحد الأعراض المهمة
+
+523
+00:37:09,950 --> 00:37:14,370
+جدا، حاجة اسمها hemoptysis، hemoptysis يعني اللي هو
+
+524
+00:37:14,370 --> 00:37:19,870
+البلغم المدمم، إيش يعني البلغم المدمم؟ لما بيكح
+
+525
+00:37:19,870 --> 00:37:23,730
+المريض بيخرج مع الـ .. الـ sputum بيخرج معاه دم، هذا
+
+526
+00:37:23,730 --> 00:37:26,670
+نتيجة لإيش؟ نتيجة لأنّ الـ tubercle صار
+
+527
+00:37:26,670 --> 00:37:30,950
+لها lysis، اتحللت، وما عاد في مكانها
+
+528
+00:37:30,950 --> 00:37:34,990
+destruction لنسيج الـ lungs مليانة capillaries وبالتالي
+
+529
+00:37:34,990 --> 00:37:37,630
+بيصير فيه نزيف داخل الـ lungs
+
+530
+00:37:43,430 --> 00:37:46,750
+كيف لنا أن نقوم بتشخيص الـ tuberculosis؟ إحنا قلنا
+
+531
+00:37:46,750 --> 00:37:49,730
+أهم شكل من أشكال الـ tuberculosis هو كان الـ
+
+532
+00:37:49,730 --> 00:37:52,070
+pulmonary tuberculosis، والكلام اللي إحنا حكينا
+
+533
+00:37:52,070 --> 00:37:56,130
+الصحيح، حكينا على pulmonary tuberculosis، ففي هذا
+
+534
+00:37:56,130 --> 00:38:00,290
+الغالب بيكون في عندنا sputum، لكن في أحيانًا المريض
+
+535
+00:38:00,290 --> 00:38:03,770
+بيكون غير قادر على إنتاج الـ sputum، وأنا حكيتلكوا
+
+536
+00:38:03,770 --> 00:38:06,570
+قبل، هي كده بالـ cupping، إذا فاكرين الموضوع إنّا
+
+537
+00:38:06,570 --> 00:38:09,870
+بنعمل cupping، لكن في حال عدم مقدرتنا على الحصول
+
+538
+00:38:09,870 --> 00:38:13,670
+على العينة، ممكن نحصل على gastric aspirate or
+
+539
+00:38:13,670 --> 00:38:18,510
+washing، ليش؟ معظم مرضى الـ tuberculosis بيكح في
+
+540
+00:38:18,510 --> 00:38:24,090
+الليل وما بيخرجش الـ sputum إلى الخارج، بيبتلعوه، ميزة
+
+541
+00:38:24,090 --> 00:38:28,150
+البكتيريا هذه إنها resistant to acid and alkali
+
+542
+00:38:28,150 --> 00:38:35,210
+يعني مقاومة للأحماض ومقاومة للقواعد، وبالتالي يعني
+
+543
+00:38:35,210 --> 00:38:39,050
+ممكن مش لا .. ما فيش تجارب ثمب، لكن لو أخذناها من الـ
+
+544
+00:38:39,050 --> 00:38:43,930
+lung، غالبًا بناخذها وهي لسة حية، لكن العينة المفضلة
+
+545
+00:38:43,930 --> 00:38:46,890
+اللي هي عينات الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+546
+00:38:46,890 --> 00:38:46,930
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+547
+00:38:46,930 --> 00:38:47,130
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+548
+00:38:47,130 --> 00:38:47,410
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+549
+00:38:47,410 --> 00:38:50,240
+الـ .. الـ .. الـ .. الـ .. إذا كان في urinary tract
+
+550
+00:38:50,240 --> 00:38:53,880
+tuberculosis، بنضطر نأخذ عينات urine، والـ urine هذا
+
+551
+00:38:53,880 --> 00:39:00,280
+بيُجمع لمدة 24 ساعة، pleural fluid، قد تخرج البكتيريا
+
+552
+00:39:00,280 --> 00:39:05,560
+في السائل المحيط بالـ lungs، CSF، joint fluid، biopsy
+
+553
+00:39:05,560 --> 00:39:10,940
+materials، لـ stain، smear، إحنا ما قلنا إلا نعمل acid
+
+554
+00:39:10,940 --> 00:39:16,900
+fast stain، أو في فحص أو staining آخر بيسمّوه
+
+555
+00:39:16,900 --> 00:39:20,960
+rhodamine auramine، أو auramine rhodamine fluorescent
+
+556
+00:39:20,960 --> 00:39:24,480
+staining، كمان مرة auramine rhodamine
+
+557
+00:39:26,820 --> 00:39:31,960
+هذا الـ stain رائع جدًا، ممكن نستخدمه كبديل عن الزيلة
+
+558
+00:39:31,960 --> 00:39:36,280
+إنتوا عملتوا الفحص هذا، الـ acid fast، عملتوه، طيب
+
+559
+00:39:36,280 --> 00:39:44,890
+بأختصار،  درستموه، وهذا نوصله لأدقّ الآن، الـ
+
+560
+00:39:44,890 --> 00:39:49,470
+.. الـ acid fast stain، بنقدر نفحصه على الـ oil
+
+561
+00:39:49,470 --> 00:39:53,810
+immersion، وبنستغرق في السمير تقريبًا أربع ساعات، و
+
+562
+00:39:53,810 --> 00:39:57,950
+إحنا بنفحص في السمير عشان نشوف خلية أو خليتين من
+
+563
+00:39:57,950 --> 00:40:02,870
+الـ acid fast، ميزة الـ auramine rhodamine هذا، صبغة قد
+
+564
+00:40:02,870 --> 00:40:06,290
+تُفحص، تستطيع فحصها على الـ high power، لكن مش على
+
+565
+00:40:06,290 --> 00:40:08,810
+الميكروسكوب العادي، على الـ fluorescent microscope
+
+566
+00:40:08,810 --> 00:40:13,700
+يبقى بتفحص إنت على الـ high power، ولأنّ البكتيريا
+
+567
+00:40:13,700 --> 00:40:19,520
+مضيئة، فبالتالي إنت بتقول، هي بتقول لك تعال شوف إنّها
+
+568
+00:40:19,520 --> 00:40:23,280
+هنا، أنا موجودة، يعني إنت لا تبذل جهدًا كبيرًا في
+
+569
+00:40:23,280 --> 00:40:27,620
+البحث عنها، بيقدر إنّك تتحرّك، فالبكتيريا المضيئة بتبين
+
+570
+00:40:27,620 --> 00:40:31,860
+لأنّ وظائف الصحة، بدأوا إحنا اشتغلنا الصيدلة التقنية
+
+571
+00:40:31,860 --> 00:40:36,840
+في الجامعة يعني منذ أكثر من 15 سنة وجرّبناها
+
+572
+00:40:36,840 --> 00:40:39,760
+ونَصَحنا الأخوة في وظائف الصحة إنّهم يستخدموها، الـ
+
+573
+00:40:39,760 --> 00:40:45,010
+culture، عبارة عن، والـ sputum هنا ما بينفعش نشطر عليه
+
+574
+00:40:45,010 --> 00:40:49,610
+مباشرة، عدد البكتيريا مهما كان في الـ sputum بيكون
+
+575
+00:40:49,610 --> 00:40:53,230
+قليل، ولأنّ sputum مليانة من الـ mucus بتكون
+
+576
+00:40:53,230 --> 00:40:57,450
+البكتيريا متوزعة في أماكن مختلفة، والمشكلة الأكبر
+
+577
+00:40:57,450 --> 00:41:03,270
+أنّ sputum خرج من وين؟ من الفم، ومن الفم saliva
+
+578
+00:41:03,270 --> 00:41:07,330
+contaminants، بكتيريا، بدأت ست أسابيع لتنمو، يجب أن
+
+579
+00:41:07,330 --> 00:41:11,740
+نتخلص من كل الـ contaminants، فبتضرب عصا بنار، و
+
+580
+00:41:11,740 --> 00:41:17,040
+أعمل حاجة بنسميها concentration للبكتيريا، وبتركّز
+
+581
+00:41:17,040 --> 00:41:20,860
+البكتيريا، و decontamination، أزيل كل الـ normal
+
+582
+00:41:20,860 --> 00:41:25,380
+flora، أموّتها، اعتمادًا على مين؟ اعتمادًا على معرفتي
+
+583
+00:41:25,380 --> 00:41:30,340
+بأنّ البكتيريا قادرة على الـ survival في كل من الـ acid
+
+584
+00:41:30,340 --> 00:41:33,780
+وفي كل من اللي هو الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+585
+00:41:33,780 --> 00:41:33,900
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+586
+00:41:33,900 --> 00:41:34,520
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+587
+00:41:34,520 --> 00:41:35,100
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+588
+00:41:35,100 --> 00:41:37,040
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+589
+00:41:37,040 --> 00:41:39,940
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+590
+00:41:39,940 --> 00:41:41,040
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+591
+00:41:41,040 --> 00:41:41,300
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+592
+00:41:41,300 --> 00:41:41,560
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+593
+00:41:41,560 --> 00:41:42,740
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+594
+00:41:42,740 --> 00:41:47,080
+الـ الـ الـ الـ الـ الـ
+
+595
+00:41:54,260 --> 00:41:58,800
+test tube، و فيها glass beads، بتعرفوا الجلول الزجاجية
+
+596
+00:41:58,800 --> 00:42:05,420
+الحديد، هدول الجلول بنحطّهم في القنبوبة اللي فيها
+
+597
+00:42:05,420 --> 00:42:08,560
+equal volume من الـ sputum ومن الـ NaOH، وبنعمل
+
+598
+00:42:08,560 --> 00:42:13,800
+عملية mixing، بنكسر الـ sputum، وبنخلّي الـ sodium
+
+599
+00:42:13,800 --> 00:42:19,220
+hydroxide يحلّل، بيسمّوه lytic agent، يعني عامل محلّل
+
+600
+00:42:19,220 --> 00:42:23,190
+فالـ bacteria الآن بتتحرر من مين؟ من الـ mucus، من
+
+601
+00:42:23,190 --> 00:42:27,370
+الـ mucus، homogenize by shaking for a few minutes
+
+602
+00:42:27,370 --> 00:42:32,510
+centrifuge at 3000 rpm for twenty to thirty
+
+603
+00:42:32,510 --> 00:42:35,050
+minutes، لاحظوا جدًّا الـ centrifugation، عشرين لتلاتين
+
+604
+00:42:35,050 --> 00:42:40,710
+دقيقة على تلاتة آلاف، هذه العملية بتكون كافية لتركيز
+
+605
+00:42:40,710 --> 00:42:46,120
+البكتيريا في القاع، بناخد الـ supernatant ونتخلص منه
+
+606
+00:42:46,120 --> 00:42:49,140
+خدوا بالكم، و نتخلص من الـ supernatant، هذا .. هذا
+
+607
+00:42:49,140 --> 00:42:53,100
+mycobacterium، مش .. مش أيّ بكتيريا، بنتخلص من الـ ..
+
+608
+00:42:53,100 --> 00:42:57,940
+مش في الحوض، وبنحطه في this disinfectant، مادة مطهّرة
+
+609
+00:42:57,940 --> 00:43:03,140
+.. مادة مطهّرة زي الـ Detol، مين ضال عندي الآن؟ اللي
+
+610
+00:43:03,140 --> 00:43:05,260
+هو الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+611
+00:43:05,260 --> 00:43:05,300
+.. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ
+
+612
+00:43:05,300 --> 00:43:05,660
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. ال
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/npF5dsfBfwQ_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/npF5dsfBfwQ_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..6d17a3e6ad04a9dc815f62208b652ea9854b528f
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/npF5dsfBfwQ_raw.srt
@@ -0,0 +1,2588 @@
+1
+00:00:20,840 --> 00:00:23,960
+بسم الله الرحمن الرحيم الموضوع اللي بدأنا فيه
+
+2
+00:00:23,960 --> 00:00:26,260
+المحاضرة السابقة كان ال gram-booster بسالله ان انا
+
+3
+00:00:26,260 --> 00:00:30,100
+اندو سبور فارمينج وتحدثنا فيه عن two organism
+
+4
+00:00:30,100 --> 00:00:32,940
+تحدثنا عن الكوريني بكتيريوم تحدثنا عن ال diseases
+
+5
+00:00:32,940 --> 00:00:36,120
+او ال disease تحدثنا عن التكسين تحدثنا عن ال
+
+6
+00:00:36,120 --> 00:00:40,000
+isolation and identification وتحدثنا ايضا عن ال
+
+7
+00:00:40,000 --> 00:00:42,720
+treatment بعدين انتقلنا للercipulothrix
+
+8
+00:00:42,720 --> 00:00:47,010
+rossiopathiaحدثنا عن ان ال air cephalotrix في لها
+
+9
+00:00:47,010 --> 00:00:50,430
+three forms الشكل الأول كان يبقى عبارة عن air
+
+10
+00:00:50,430 --> 00:00:53,750
+cephaloid او red skin localized في ال hand و ال
+
+11
+00:00:53,750 --> 00:00:58,770
+fingers او generalized skin infection والشكل
+
+12
+00:00:58,770 --> 00:01:01,890
+التالت كان سبتسيميا خاصة في ال immunocompromised
+
+13
+00:01:01,890 --> 00:01:06,950
+اليوم هتكلم عن listeria monocytogenes وهي ايضالها
+
+14
+00:01:06,950 --> 00:01:12,150
+أربع أشكال سريرية أو clinical entites non-specific
+
+15
+00:01:12,150 --> 00:01:15,390
+flu-like illness during pregnancy or puerperal
+
+16
+00:01:15,390 --> 00:01:21,290
+sepsis حمى النفاس اللي هي طبعا تتلو الولادة أو
+
+17
+00:01:21,290 --> 00:01:26,350
+خلال عملية اللي هو الحمل ل pregnancy كلمة flu-like
+
+18
+00:01:26,350 --> 00:01:31,410
+تعني زي أعراض الرشح يعني يعني بإيش بتميز الرشح
+
+19
+00:01:31,410 --> 00:01:35,850
+رينورية اللي هو إفرازات من اللي هو الأنف وما شبه
+
+20
+00:01:35,850 --> 00:01:39,480
+ذلكneonatal sepsis and later meningitis لاحظوا
+
+21
+00:01:39,480 --> 00:01:42,440
+الفئتين اللي بتكلم عنهم pregnant woman ون ال
+
+22
+00:01:42,440 --> 00:01:46,600
+neonate وهذه نقطة كتير مهمة وخطيرة في مجال رعاية
+
+23
+00:01:46,600 --> 00:01:50,500
+الأمومة و الطفولة sepsis or meningitis in
+
+24
+00:01:50,500 --> 00:01:53,620
+immunocompromised والشكل الرابع اللي هو ال food
+
+25
+00:01:53,620 --> 00:01:58,000
+poisoningوالان أصبحت ال استيريا mono-cytogenes
+
+26
+00:01:58,000 --> 00:02:01,880
+واحد من أهم الميكروبات في الفحوصات يعني بمعنى آخر
+
+27
+00:02:01,880 --> 00:02:05,340
+في المواصفات لما تدرسوا في ال food microbiology في
+
+28
+00:02:05,340 --> 00:02:08,180
+المواصفات احنا نعرف في total blood count في
+
+29
+00:02:08,180 --> 00:02:12,440
+coliform في fecal coliform في salmonella في
+
+30
+00:02:12,440 --> 00:02:18,110
+shigella في الاستيرياأحد المكونات اللي نفحصها اللي
+
+31
+00:02:18,110 --> 00:02:22,250
+هي الاستيرانة أحد مسببات ال food poisoning الصفات
+
+32
+00:02:22,250 --> 00:02:27,010
+المهمة اللي هنستخدمها في تشخيص الميكروب نفسه انها
+
+33
+00:02:27,010 --> 00:02:32,050
+gram positive بسلاي كلمة short و long بتذكرنا
+
+34
+00:02:32,050 --> 00:02:36,770
+short long و large و thin هذه بتذكرنا ايام كنا
+
+35
+00:02:36,770 --> 00:02:40,170
+نتكلم عن gram negative بسلاي كنا نقول عنها هي مش
+
+36
+00:02:40,870 --> 00:02:46,850
+مهمة مش كتير مهمة متى أعطيناها أهمية فقط فقط في ال
+
+37
+00:02:46,850 --> 00:02:50,730
+campylobacter تمام ان it's very small و اتكلمنا في
+
+38
+00:02:50,730 --> 00:02:53,870
+ال large لما اتكلمنا عن ال gram bustive spore
+
+39
+00:02:53,870 --> 00:03:00,000
+forming بسلعي زي البسلس و زي ال eclostridiumnon
+
+40
+00:03:00,000 --> 00:03:03,060
+-spore forming طبعا كلمة shorter أن thinner هنا
+
+41
+00:03:03,060 --> 00:03:05,560
+بالمقارنة مع مين مع اللي جابتها اللي الارس
+
+42
+00:03:05,560 --> 00:03:08,820
+بيلوثريكس facultative أنا أوروب وذكركم المرة
+
+43
+00:03:08,820 --> 00:03:12,300
+الماضية قلنا إنه برضه الارس بيلوثريكس facultative
+
+44
+00:03:12,300 --> 00:03:16,360
+facultative أنا أوروب لكن هذه كانت كتاليز negative
+
+45
+00:03:16,360 --> 00:03:21,240
+وهذه كتاليز positive وناقشنا قضية مهمة قلنا إن
+
+46
+00:03:21,240 --> 00:03:25,940
+البكتيريا اللي بتكون قادرة على المعيشة والتكاثر في
+
+47
+00:03:25,940 --> 00:03:28,920
+ولود الأكسجين لازم يكون عندها system لازم يكون
+
+48
+00:03:28,920 --> 00:03:34,440
+عندهانظام يؤهلها للتعامل مع الأكسجين طيب إذا ما
+
+49
+00:03:34,440 --> 00:03:36,900
+عندهاش كتاليز إيش بده يكون عندها البديل
+
+50
+00:03:36,900 --> 00:03:40,720
+البروكسيدايز؟ قلنا الفرق بين الاتنين إنه الكتاليز
+
+51
+00:03:40,720 --> 00:03:44,880
+في ال reaction تبعه في تحويل ال H2O2 إلى ماء
+
+52
+00:03:44,880 --> 00:03:47,960
+وموليكلار
+
+53
+00:03:47,960 --> 00:03:52,580
+أكسجين لكن البروكسيدايز ما بيطلع موليكلار أكسجين
+
+54
+00:03:52,580 --> 00:03:56,200
+بيستخدم الأكسجين في أكسط مواد أصلا مختزلة وبالتالي
+
+55
+00:03:56,200 --> 00:04:00,770
+مافيش عندي bubblesأيضا كما مرة جلال بسطى في Vassal
+
+56
+00:04:00,770 --> 00:04:03,650
+Lightnance Performing faculty في أنايروب بالاضافة
+
+57
+00:04:03,650 --> 00:04:08,430
+إلى النقطة المهمة جدا اللي هي ال beta hemolytic on
+
+58
+00:04:08,430 --> 00:04:12,650
+blood اجاري و هذه النقطة يا شباب حكيناها سابقا لما
+
+59
+00:04:12,650 --> 00:04:15,590
+تحدثنا عن group A streptococci و ان group A
+
+60
+00:04:15,590 --> 00:04:19,290
+streptococci اللي هي من نوع streptococcus biogenes
+
+61
+00:04:19,290 --> 00:04:23,890
+بتكون مستعمرات صغيرة جدا pinpoint زي رأس الدبوس
+
+62
+00:04:23,890 --> 00:04:30,290
+محاطة ب large zone of beta hemolysisوهذا يجعلها
+
+63
+00:04:30,290 --> 00:04:34,610
+تقع في دائرة الشبهة مع الاستيريا مونو سايتو جينز
+
+64
+00:04:34,610 --> 00:04:38,310
+كيف ميزنا بين الاتنتين جون الاستيريا مونو سايتو
+
+65
+00:04:38,310 --> 00:04:43,470
+جينز هي كتاليز بوسطف بينما group A streptococci
+
+66
+00:04:43,470 --> 00:04:47,910
+اللي هي streptococcus by genes هي كتاليز نيجاتفال
+
+67
+00:04:47,910 --> 00:04:51,010
+biochemical characteristics عشان هدول مهمين و
+
+68
+00:04:51,010 --> 00:04:54,650
+هيختزلوا معانا في نهاية الصفحة حيكون ان ال
+
+69
+00:04:54,650 --> 00:04:58,150
+diagnosis مش حاطينه احنا في اللوحة فهذه هي الصفات
+
+70
+00:04:58,150 --> 00:05:02,330
+المهمة اللي نستخدمها في التشخيص ال motility على
+
+71
+00:05:02,330 --> 00:05:06,850
+وجهين الوجه الأول لو زرعناها في ال media تبع ال
+
+72
+00:05:06,850 --> 00:05:10,750
+motility هلاجة بتعمل umbrella type growth شكلها
+
+73
+00:05:10,750 --> 00:05:15,560
+شكل ايه المضلةو لو شفناها تحت الميكروسكوب بال
+
+74
+00:05:15,560 --> 00:05:19,220
+hanging drop technique هنشوفها تتشجلب تعمل
+
+75
+00:05:19,220 --> 00:05:24,280
+tumbling motility، tumbling حركات بهلوانية كتاليز
+
+76
+00:05:24,280 --> 00:05:27,420
+بوستف و واجوس بروسكاوار بوستف ال specimen and
+
+77
+00:05:27,420 --> 00:05:30,760
+culture media هتكلم عن أيش أيش ال disease اللي
+
+78
+00:05:30,760 --> 00:05:35,740
+كلمنا عنهمكلمنا عن bioreparal sepsis، كلمنا عن
+
+79
+00:05:35,740 --> 00:05:39,460
+meningitis، عن septicemia، مظلوط ولا لأ؟ واتكلمنا
+
+80
+00:05:39,460 --> 00:05:42,860
+عن food poisoning في ال food poisoning ايه توقع
+
+81
+00:05:42,860 --> 00:05:47,120
+العينة تكون؟ left over food، بقايا الطعام، واحد
+
+82
+00:05:47,120 --> 00:05:52,820
+أكل من غذاء معين واصيب بالتسمم، احنا بناخد بقايا
+
+83
+00:05:52,820 --> 00:05:56,530
+الطعام نفحصهمبينما لما أكون عندى septicemia باخد
+
+84
+00:05:56,530 --> 00:06:00,250
+blood عندي مشكلة في ال .. ال .. ال .. ال central
+
+85
+00:06:00,250 --> 00:06:02,850
+nervous system بناخد cerebral spinal fluid ممكن
+
+86
+00:06:02,850 --> 00:06:04,910
+ناخد genital tract infection لإنه ممكن البكتيريا
+
+87
+00:06:04,910 --> 00:06:07,710
+تبقى برضه genital tract infection الميديا
+
+88
+00:06:07,710 --> 00:06:13,110
+المستخدمة brain heart infusion agar مار معانا
+
+89
+00:06:13,110 --> 00:06:17,190
+الجاباليك الاسم بس بدل ما هو agar broth BHIB كتير
+
+90
+00:06:17,190 --> 00:06:20,290
+مار معانا الاسم هذا اللي هو ال .. ال brain heart
+
+91
+00:06:20,290 --> 00:06:24,930
+infusion agar زائد five percent شي ب bloodيبقى
+
+92
+00:06:24,930 --> 00:06:32,550
+لازم نحط احنا على ال bhia 5% sheep blood ممكن يكون
+
+93
+00:06:32,550 --> 00:06:37,230
+عندنا كمان نستخدم bhiv نيجي الآن لعمل مقارنة بسيطة
+
+94
+00:06:37,230 --> 00:06:40,290
+ما بين ال liquid و ال solid media لو انا عندي من
+
+95
+00:06:40,290 --> 00:06:44,170
+نفس ال media شكلين شكل liquid بدون اجار و شكل
+
+96
+00:06:44,170 --> 00:06:52,010
+solid الان الميزات تبعت واحد منهم بتكون مساول
+
+97
+00:06:52,010 --> 00:06:57,870
+التاني اعطيكم مثالعلى ال liquid media no colonies
+
+98
+00:06:57,870 --> 00:07:03,010
+are formed، هذا سوء، هذا disadvantage، بتكون ميزة
+
+99
+00:07:03,010 --> 00:07:08,690
+لمين؟لل solid لأنه بتتكون مستعمرة ليش هي ميزة لأنه
+
+100
+00:07:08,690 --> 00:07:11,550
+انا بفترض انه كل مستعمرة نشهد من خلية واحدة
+
+101
+00:07:11,550 --> 00:07:14,770
+وبالتالي المستعمرة دي pure culture بقدر اتعرف
+
+102
+00:07:14,770 --> 00:07:18,590
+عليها اشوف شكلها بقدر اخد منها بكتيريا وانا متأكد
+
+103
+00:07:18,590 --> 00:07:20,970
+انها pure culture بقدر اعملها staining او
+
+104
+00:07:20,970 --> 00:07:24,650
+biochemical test بس في ال liquid media مابقدرش طب
+
+105
+00:07:24,650 --> 00:07:26,810
+ايش الميزة اللي في ال liquid media موجودة مش
+
+106
+00:07:26,810 --> 00:07:30,890
+موجودة في ال solid media؟Its ability to enhance
+
+107
+00:07:30,890 --> 00:07:35,470
+growth أفضل من ال solid media. ليش؟ لأن ال
+
+108
+00:07:35,470 --> 00:07:39,230
+bacteria is in direct contact مع مين؟مع ال
+
+109
+00:07:39,230 --> 00:07:42,570
+nutrient بيبينها في ال solid media ال nutrient are
+
+110
+00:07:42,570 --> 00:07:48,250
+trapped in the agar مرتبطة أو مستعدة من قبل ال
+
+111
+00:07:48,250 --> 00:07:51,610
+agar يعني في حرية في ال liquid media أكتر من مين
+
+112
+00:07:51,610 --> 00:07:55,690
+من ال solid media وبالتالي بتعطيها nutrient أكتر،
+
+113
+00:07:55,690 --> 00:07:59,290
+إذا لو أنا عندي بكتيريا وضعها تعبان، إيش يعني
+
+114
+00:07:59,290 --> 00:08:04,310
+وضعها تعبان؟يعني بدي اعملها enrichment موجودة في
+
+115
+00:08:04,310 --> 00:08:09,530
+مجموعة بدي اعطيها افضل بيئة للنمو بانميها في مين؟
+
+116
+00:08:09,530 --> 00:08:11,650
+في liquid media وبعدين ممكن اعملها subculture على
+
+117
+00:08:11,650 --> 00:08:16,090
+ثلاث مين بس في اندي selective media مهم جدا اسمها
+
+118
+00:08:16,090 --> 00:08:20,230
+الآن ال stereo selective stereo agar والبكتيريا
+
+119
+00:08:20,980 --> 00:08:23,080
+طبعا البلد الأجارة اللي احنا قلناه بده يكون شكلها
+
+120
+00:08:23,080 --> 00:08:26,980
+small colonies surrounded by large zone of beta
+
+121
+00:08:26,980 --> 00:08:31,540
+hemolysis لكن على ال selective listeria الأجار
+
+122
+00:08:31,540 --> 00:08:35,960
+بيكون لونها brown to black colonies يعني من
+
+123
+00:08:35,960 --> 00:08:41,460
+مستعمرات من اللون البني إلى اللون اللي هو الأسود
+
+124
+00:08:41,460 --> 00:08:46,850
+هنشوف صورة لها ان شاء اللهال identification احنا
+
+125
+00:08:46,850 --> 00:08:49,530
+ممكن نقول ده demonstration of gram-bostafbacilli
+
+126
+00:08:49,530 --> 00:08:54,830
+from stain smeared يعني لو أخدنا عينة من CSF او من
+
+127
+00:08:54,830 --> 00:08:58,470
+genital tract او food sample تمام و لجينا gram
+
+128
+00:08:58,470 --> 00:09:02,310
+-bostafbacilli هذا مؤشر جيد على ان البكتيريا لان
+
+129
+00:09:02,310 --> 00:09:04,450
+ال gram-bostafbacilli اللي درسناهم ايش هم اللي
+
+130
+00:09:04,450 --> 00:09:08,590
+درسناهم ال gram-bostafاما Erspilothrex أو كورنيل
+
+131
+00:09:08,590 --> 00:09:11,250
+بكتيروم اللي مالهمه مش Sporforma فبتقالي اجلال
+
+132
+00:09:11,250 --> 00:09:14,390
+عددهم فلما لاجيها في غذاء او لاجيها في CSF احنا
+
+133
+00:09:14,390 --> 00:09:17,150
+متكلم عن مين؟ غالبا متكلم عن Listeria
+
+134
+00:09:17,150 --> 00:09:21,090
+Monocytogenesculture and isolation on blood agar
+
+135
+00:09:21,090 --> 00:09:23,570
+or selective listeria agar بيو كيميكال تيست دي ما
+
+136
+00:09:23,570 --> 00:09:26,070
+حكينا كتاليز و بوجس بروسكوار و motility test و ال
+
+137
+00:09:26,070 --> 00:09:29,090
+motility بشكلها ال hanging drop أو النوع التاني
+
+138
+00:09:29,090 --> 00:09:32,030
+اللي قلنا عنه ال semi-solid media physiological
+
+139
+00:09:32,030 --> 00:09:35,190
+testing برضه كمان هذه نقطة كتير إضافية مهمة اللي
+
+140
+00:09:35,190 --> 00:09:38,790
+هي agglutination with specific antiserum تركزوا
+
+141
+00:09:38,790 --> 00:09:44,070
+معايا طالما ال pathogen صار food microbiology
+
+142
+00:09:44,070 --> 00:09:49,970
+pathogen اعرف أن أهمته زادتوبالتالي هلاجي أشكال
+
+143
+00:09:49,970 --> 00:09:53,250
+متنوعة من الشركات يعني لو انت عملت ب simple search
+
+144
+00:09:53,250 --> 00:09:57,430
+على الجوجل وكتبت Listeria Diagnostics Diagnostics
+
+145
+00:09:57,430 --> 00:09:59,650
+يعني الأشياء اللي بتستخدم في ال diagnosis اللي
+
+146
+00:09:59,650 --> 00:10:02,990
+هتلاجي مئات الألف من المواقع بتقولك اتفضل هيفياننا
+
+147
+00:10:02,990 --> 00:10:08,200
+products او منتجات لتعريف الليستيرياال .. ال
+
+148
+00:10:08,200 --> 00:10:10,960
+therapy او ال treatment فين دي combined therapy of
+
+149
+00:10:10,960 --> 00:10:13,560
+penicillin plus aminoglycosides يعني بنستخدم
+
+150
+00:10:13,560 --> 00:10:17,280
+penicillin زاد مثلا على سبيل المثال Gentamicin او
+
+151
+00:10:17,280 --> 00:10:23,380
+Amicacin اتنين مش واحد او تتراسيكلين لحاله is used
+
+152
+00:10:23,380 --> 00:10:27,180
+as a second line يعني لو كان المريض عنده اي حساسية
+
+153
+00:10:27,180 --> 00:10:30,280
+من ال penicillin او ال amino glycosides ما هو احنا
+
+154
+00:10:30,280 --> 00:10:33,820
+حاطينا اتنين صدمنا اتنين صح؟ عمرا ما اتناقشنا احنا
+
+155
+00:10:33,820 --> 00:10:36,500
+قضية لماذا ممكن ان نستخدم اتنين من ال antibiotics
+
+156
+00:10:42,180 --> 00:10:46,160
+أنت حاليا ذكرت سبب اللي هو synergism قلت إنه ممكن
+
+157
+00:10:46,160 --> 00:10:49,040
+التنين مع بعض يعطيهنا effect أفضل مما لو استخدرنا
+
+158
+00:10:49,040 --> 00:10:53,420
+واحد لحاله و هذا بالفعل مطلوب في بعض الحالات
+
+159
+00:10:53,420 --> 00:10:57,700
+الحالة التانية المهمة جدا اللي هو إنه نمنع ال
+
+160
+00:10:57,700 --> 00:11:01,100
+emergence of resistance strains بإنه لأن البكتيريا
+
+161
+00:11:01,100 --> 00:11:03,520
+إذا كوّنت resistance لأحد ال antibiotics التاني
+
+162
+00:11:03,520 --> 00:11:07,840
+بيقتلهاوكل ما زاد عدل ال antibiotic نظريا كل ما
+
+163
+00:11:07,840 --> 00:11:12,840
+قلت احتمالية نشوء انواع مقاومة يعني بالمنطق اربع
+
+164
+00:11:12,840 --> 00:11:15,540
+antibiotics افضل من تلاتة افضل من اتنين افضل من
+
+165
+00:11:15,540 --> 00:11:19,200
+واحد فال resistance لانه لو تكون resistant هاي
+
+166
+00:11:19,200 --> 00:11:22,320
+البكتيريا تكون resistant لو احد اتنين اتلاتة
+
+167
+00:11:22,320 --> 00:11:27,250
+واربعة still can kill it صح فقتلوها في المهديعني
+
+168
+00:11:27,250 --> 00:11:30,190
+بمعنى أخر لم تظهر كونة resistant هي ل one
+
+169
+00:11:30,190 --> 00:11:34,410
+antibiotic لكن لم تظهر في العلن لأنه ماتت من ال
+
+170
+00:11:34,410 --> 00:11:38,730
+other antibiotic، هذا هو المطلوب، هذا المطلوب، إذا
+
+171
+00:11:38,730 --> 00:11:43,290
+طبعا لو كان في أي من المرضى حساس لأي من المنتجين
+
+172
+00:11:43,290 --> 00:11:46,150
+الاتنين اللي هو ال amino glycosides أو ال
+
+173
+00:11:46,150 --> 00:11:49,130
+penicillin ممكن نستخدم tetracycline as a second
+
+174
+00:11:49,130 --> 00:11:52,190
+line، second line يعني خط دفاع ثاني في هذا الحالة
+
+175
+00:11:53,950 --> 00:11:57,210
+هذه الصورة اللي قدامكوا بتوضح انه .. طبعا مش كتير
+
+176
+00:11:57,210 --> 00:12:01,630
+واضحة على اللوحة لكن الفراغات .. هذا blood agar
+
+177
+00:12:01,630 --> 00:12:05,470
+ليس blood agar الفراغات اللي قدامكوا هذه اللي هي
+
+178
+00:12:05,470 --> 00:12:08,730
+ال hemolysis لو جينا ندجج النظر بنلاقي ان
+
+179
+00:12:08,730 --> 00:12:13,920
+المستعمراتبالفعل صغيرة جدا بحيث لا يمكن يعني خلنا
+
+180
+00:12:13,920 --> 00:12:18,980
+نقول تميزها بشكل جيد بالعن المجردة لكن المميز كويس
+
+181
+00:12:18,980 --> 00:12:22,140
+فيها مين الهيمولاسيس وهذا الشكل اللي برضه شفناه
+
+182
+00:12:22,140 --> 00:12:24,540
+شفناه في احنا في مين شفناه في ال group A
+
+183
+00:12:24,540 --> 00:12:28,400
+streptococcus عشان انا قلتلكوا وجه الشبه بينهم
+
+184
+00:12:28,400 --> 00:12:31,380
+cultural characteristics بينما واحدة جرامبوستف
+
+185
+00:12:31,380 --> 00:12:34,740
+كوكساي واحدة جرامبوستف بس اللي هي بيختلفوا عن بعض
+
+186
+00:12:34,740 --> 00:12:40,250
+تماماهذا شكلها على ال stereo selective أجار اللي
+
+187
+00:12:40,250 --> 00:12:47,510
+حكينا عنه واللون تبقى واضح انه أسود اللون كمان
+
+188
+00:12:47,510 --> 00:12:51,210
+شغل في ال stereo monocytogen انه بتعمل camp test
+
+189
+00:12:51,210 --> 00:12:56,610
+positive زي مين؟ زي ال group B streptococcus
+
+190
+00:12:58,530 --> 00:13:00,810
+الـ break احنا بنكون انهينا الجزء الأول من
+
+191
+00:13:00,810 --> 00:13:03,890
+محاضرتنا اليوم و هنتقل ان شاء الله للجزء الثاني
+
+192
+00:13:03,890 --> 00:13:09,530
+اللي هو بتكلم عن بكتيريا أخرى لا تقل أهمية وهي ال
+
+193
+00:13:09,530 --> 00:13:14,350
+micro bacteria نعمل تقديم بسيط لل بكتيريا أو
+
+194
+00:13:14,350 --> 00:13:19,530
+للموضوعدرسونا في سنة في الفصل الماضي قالولكوا في
+
+195
+00:13:19,530 --> 00:13:25,810
+المختبر ان gram stain can classify bacteria into
+
+196
+00:13:25,810 --> 00:13:29,130
+two large groups, the gram positive and the gram
+
+197
+00:13:29,130 --> 00:13:33,150
+negative وكانت هذه أحد الأشياء اللي بنميز فيها ال
+
+198
+00:13:33,150 --> 00:13:37,720
+gram stain كميزةبعد فترة واجيزة جالونا لأ انه مش
+
+199
+00:13:37,720 --> 00:13:40,500
+كل البكتيريا بتنقسم إلى gram-positive في بعضها غير
+
+200
+00:13:40,500 --> 00:13:49,380
+قابل للصباغة بال gram stain ووصفوا البكتيريا ال
+
+201
+00:13:49,380 --> 00:13:52,440
+micro bacteria بإنها جالو عنها micro bacteria is
+
+202
+00:13:52,440 --> 00:13:56,100
+difficult to stain صعبة ماجالوش مستحيلة جالو صعبة
+
+203
+00:13:56,810 --> 00:13:59,830
+but once stained it is difficult to decolorize
+
+204
+00:13:59,830 --> 00:14:03,910
+even in the presence of strong acid نقطع الجملة
+
+205
+00:14:03,910 --> 00:14:08,350
+مقاطع و نحاول نفسر كل واحدة لحالي it is difficult
+
+206
+00:14:08,350 --> 00:14:13,430
+to stain why because it contains large amount of
+
+207
+00:14:13,430 --> 00:14:18,050
+waxy lipids اللي هو ال mycolic acid وبالتالي يصعب
+
+208
+00:14:18,050 --> 00:14:22,450
+شمع يصعب على الصبغة ان تعمل penetration داخل
+
+209
+00:14:22,450 --> 00:14:27,390
+الخليجbut once stained يبقى فينا طرق لصبغتها كيف؟
+
+210
+00:14:27,390 --> 00:14:30,450
+عن طريق التسخين على سبيل المثال حاطنا الصبغة و
+
+211
+00:14:30,450 --> 00:14:33,830
+سخنا من تحت صار في penetration او في ال cold
+
+212
+00:14:33,830 --> 00:14:36,910
+method باستخدام تجري تول او ترجي تول اللي بيعمل ال
+
+213
+00:14:36,910 --> 00:14:40,990
+penetration للصبغة يبقى it is stained الان الشق
+
+214
+00:14:40,990 --> 00:14:45,450
+التالت منbut once stained it is difficult to
+
+215
+00:14:45,450 --> 00:14:49,610
+decolorize و هناك تحدي واضح even in the presence
+
+216
+00:14:49,610 --> 00:14:53,450
+of strong acid لما صبغنا في ال gram stain و عملنا
+
+217
+00:14:53,450 --> 00:14:56,410
+الخطوة التالتة اللي هي ال decolorization استخدمنا
+
+218
+00:14:56,410 --> 00:15:02,090
+ال ethanol او ال acetoneبنذكركوا ان الاسيتون
+
+219
+00:15:02,090 --> 00:15:05,710
+والإيثانول نعم هم مزيلين لللون، بيزيلوا اللون
+
+220
+00:15:05,710 --> 00:15:09,210
+والدريل عندنا نمسح إيدينا، بيكون على حبر أو حاجة،
+
+221
+00:15:09,210 --> 00:15:13,290
+بيكون أسهل من الصابون إزالته، لكن اللي أقوى منهم
+
+222
+00:15:13,290 --> 00:15:15,810
+في زالة اللون اللي هو ال acid في المطابق، في
+
+223
+00:15:15,810 --> 00:15:20,470
+الحمامات، لما بيكون في عنا أشياء مش جادين نشيلها
+
+224
+00:15:20,470 --> 00:15:24,390
+بالصابون، بيضاف إليها ميط النار، ميط النار اللي هي
+
+225
+00:15:24,390 --> 00:15:28,890
+ال HCL، اللي هي حمض الهيدركلوريكفالacid معروف عنه
+
+226
+00:15:28,890 --> 00:15:33,810
+انه مزيل لللون اكتر من ال .. فتحدينا وقالنا it is
+
+227
+00:15:33,810 --> 00:15:37,110
+difficult to decolorize even in the presence of
+
+228
+00:15:37,110 --> 00:15:43,950
+strong acid ومن هنا التسمية acid fast الصبغ
+
+229
+00:15:43,950 --> 00:15:48,710
+المقاوم للحمض الصبغ المقاوم للحمض اذا acid fast
+
+230
+00:15:48,710 --> 00:15:55,830
+بكتيريا الانيش بتعطينا انطباعات هذه البكتيرياانه
+
+231
+00:15:55,830 --> 00:15:59,690
+مابتنصبغش بال gram stain مابتنصبغش بال gram stain
+
+232
+00:15:59,690 --> 00:16:02,710
+يبقى مش هنشوفها لو صبغنا العين تبعتنا اللي فيها
+
+233
+00:16:02,710 --> 00:16:06,330
+البكتيريا بال gram stain ولا بال simple stain لازم
+
+234
+00:16:06,330 --> 00:16:11,570
+نصبغها فقط بال acid fast stain ارجع مرة تانية و
+
+235
+00:16:11,570 --> 00:16:16,210
+اكدلكوا على التحدي انه هي acid fast stain لما
+
+236
+00:16:16,210 --> 00:16:19,730
+عملنا decolarization في ال gram stain استخدمنا
+
+237
+00:16:19,730 --> 00:16:24,740
+كحول فقط صح؟وميّننا الشريحة وصبّينا من أعلى
+
+238
+00:16:24,740 --> 00:16:30,940
+الشريحة وصرنا نراقب السائل اللي بينزل لما خلص ينزل
+
+239
+00:16:30,940 --> 00:16:35,200
+اللون في فترة لا تتجاوز تلاتين ثانية تلاتين ثانية
+
+240
+00:16:35,200 --> 00:16:35,780
+تلاتين ثانية تلاتين ثانية تلاتين ثانية تلاتين
+
+241
+00:16:35,780 --> 00:16:35,780
+ثانية تلاتين ثانية تلاتين ثانية تلاتين ثانية
+
+242
+00:16:35,780 --> 00:16:37,140
+تلاتين ثانية تلاتين ثانية تلاتين ثانية تلاتين
+
+243
+00:16:37,140 --> 00:16:37,260
+ثانية تلاتين ثانية تلاتين ثانية تلاتين ثانية
+
+244
+00:16:37,260 --> 00:16:38,360
+تلاتين ثانية تلاتين ثانية تلاتين ثانية تلاتين
+
+245
+00:16:38,360 --> 00:16:48,360
+ثانية تلاتين ثانية تلاتين ثانية تلاتين ثانية تتحدي
+
+246
+00:16:48,360 --> 00:16:53,140
+واضح دقيقتين ومش مائل اللي بسرعة يمر عليها لأ
+
+247
+00:16:53,140 --> 00:16:58,600
+مستقر عليها ومع ذلك فشل ال acid وخليط الكحول مع ال
+
+248
+00:16:58,600 --> 00:17:01,720
+acid بإنه زيه اللون اللي دا هي الفعل هي acid fast
+
+249
+00:17:01,720 --> 00:17:06,620
+احنا كل الأسماء اللي بتعرفوها في ال micro bacteria
+
+250
+00:17:06,620 --> 00:17:08,640
+أسماء بسيطة بتعرفوا micro bacterium tuberculosis
+
+251
+00:17:08,640 --> 00:17:12,530
+وmicro bacterium libre اللي هي أخر واحدةوأول
+
+252
+00:17:12,530 --> 00:17:16,390
+واحدة، تمام؟ لكن واقع الأمر الميكوبكتيريا عائلة
+
+253
+00:17:16,390 --> 00:17:21,070
+كبيرة، عائلة كبيرة ومتنوعة ومختلفة، يعني في منها
+
+254
+00:17:21,070 --> 00:17:24,870
+ما هو fast growing، fast growing يعني تنمو خلال
+
+255
+00:17:24,870 --> 00:17:32,320
+تلات أيام، و slow growing يعني بدها ستة أسابيعو ..
+
+256
+00:17:32,320 --> 00:17:35,880
+و .. و non-grower non-grower يعني للأسف لحد الآن
+
+257
+00:17:35,880 --> 00:17:38,880
+وهي أول مرة بنعترفلكوا احنا في ال microbiology هذه
+
+258
+00:17:38,880 --> 00:17:44,000
+البكتيريا لم ننجح لحد الآن في تنميتها في المختبرات
+
+259
+00:17:44,000 --> 00:17:49,000
+non-cultivable .. non-cultivable طيب نقل الأسماء
+
+260
+00:17:49,000 --> 00:17:52,160
+عشان بس يكونوا familiar Mycobacterium tuberculosis
+
+261
+00:17:52,160 --> 00:17:56,100
+Mycobacterium bovis و Mycobacterium Africanum تحت
+
+262
+00:17:56,100 --> 00:17:59,260
+أي عنوان حطيناهم Mycobacterium tuberculosis
+
+263
+00:17:59,260 --> 00:18:02,940
+complex ايش معنى complex في ده الحالة؟المهم لأ مش
+
+264
+00:18:02,940 --> 00:18:07,200
+باقصد معناها اللغوي معناها التقني هنا ان هدول ال
+
+265
+00:18:07,200 --> 00:18:12,120
+تلت .. التلت مايكروبات أو تلت أسماء بيشبهوا بعض
+
+266
+00:18:12,120 --> 00:18:16,020
+إلى حد كبير يصعب علينا بالتقنيات العادية اللي
+
+267
+00:18:16,020 --> 00:18:19,140
+ميزهم مع بعض بيبقى تقنيات متطورة أكتر فبالتالي هم
+
+268
+00:18:19,140 --> 00:18:22,640
+بيعتبرهم complex يعني بنصل لمرحلة أنه ممكن تكون
+
+269
+00:18:22,640 --> 00:18:24,820
+البكتيريا واحدة من التلاتة يا إما tuberculosis يا
+
+270
+00:18:24,820 --> 00:18:28,940
+مابوفس يا إما Africano سهلين الأسماءNon
+
+271
+00:18:28,940 --> 00:18:33,180
+-tuberculosis Mycobacteria Antium بيجسموها لجسمين
+
+272
+00:18:33,180 --> 00:18:38,220
+A وB Atypical Mycobacteria Atypical يعني غير نمطية
+
+273
+00:18:38,220 --> 00:18:44,220
+و Non-cultivable نتفقنا عليها من هي من؟ ال Libra
+
+274
+00:18:44,220 --> 00:18:51,720
+الان Mycobacterium Avium Intracellulari في I معلش
+
+275
+00:18:51,720 --> 00:18:58,200
+في I في ال Intracellulari تركزوا معايا شوية هنانفس
+
+276
+00:18:58,200 --> 00:19:02,940
+الفكرة اللى حكيناها هنا نحكيها هان الشحط اللى بين
+
+277
+00:19:02,940 --> 00:19:06,080
+التنين هذا ال dash avium intracellularي معناه اللى
+
+278
+00:19:06,080 --> 00:19:10,060
+حاكيه ان هدول two species two species لكن are
+
+279
+00:19:10,060 --> 00:19:13,280
+difficult to differentiate فبرضه هم التنين بنقدر
+
+280
+00:19:13,280 --> 00:19:16,820
+نقول انهم mycobacterium avium intracellularي
+
+281
+00:19:16,820 --> 00:19:20,940
+complex هذه البكتيريا ماكننا نسمع فيها أيام ماكننا
+
+282
+00:19:20,940 --> 00:19:25,860
+طلبهافي الكتب و لا كنا نعرف أنها أصلا بها توجين
+
+283
+00:19:25,860 --> 00:19:30,600
+لكن بعد ظهور مرض ال aids أصبحت هذه البكتيريا as
+
+284
+00:19:30,600 --> 00:19:35,020
+famous as mycobacterium tuberculosis و أعتقد أنه
+
+285
+00:19:35,020 --> 00:19:38,580
+هي number one cause of tuberculosis in HIV
+
+286
+00:19:38,580 --> 00:19:43,210
+patients مرضى ال HIVmycobacterium مارينيوم
+
+287
+00:19:43,210 --> 00:19:46,050
+مارينيوم جاي من مارينة مارينة معناها حواض الأسماك
+
+288
+00:19:46,050 --> 00:19:48,630
+او حواض الأسماك و هي fish tanks fish tanks
+
+289
+00:19:48,630 --> 00:19:53,050
+scarfalcium ها دي بتعمل infection of the neck
+
+290
+00:19:53,050 --> 00:19:58,250
+جالبا تمام ففي عندي مجموعة من البكتيريا بطلت ال
+
+291
+00:19:58,250 --> 00:20:02,410
+mycobacterium فقط مقصود على اسمين الاسم الأول ال
+
+292
+00:20:02,410 --> 00:20:05,470
+tuberculosis و ال library و انما عندي مجموعة أخرى
+
+293
+00:20:05,470 --> 00:20:09,470
+من اللي هو الأسماء كلمة Bovis معفومة لكوا Bovis
+
+294
+00:20:09,470 --> 00:20:15,560
+اللي هي الأبقار فهي بتصير اللي هو الأبقارطيب نرجع
+
+295
+00:20:15,560 --> 00:20:19,660
+و ناخد الان general characteristics للبكتيريا it
+
+296
+00:20:19,660 --> 00:20:23,200
+is acid fast straight or slightly curved rods it
+
+297
+00:20:23,200 --> 00:20:25,540
+is non motile non spore forming
+
+298
+00:20:28,480 --> 00:20:32,980
+one of the most frank aerobic bacteria يعني لو
+
+299
+00:20:32,980 --> 00:20:37,340
+قلنا لك هات مثال على بكتيريا هوائية فعندك انت تقعد
+
+300
+00:20:37,340 --> 00:20:39,940
+في مثالين كويسين اللي هم الـ pseudomonas
+
+301
+00:20:39,940 --> 00:20:43,580
+aeruginosa و ال mycobacterium tuberculosis لكن
+
+302
+00:20:43,580 --> 00:20:47,140
+بالاضافة إلى إنها aerobic it is capnophilic،
+
+303
+00:20:47,140 --> 00:20:50,220
+capnophilic إيش قولنا عنها؟ محبة للـCO2، ده five
+
+304
+00:20:50,220 --> 00:20:56,230
+to ten percent CO2نجي لرقم خمسة من المعلومات اللي
+
+305
+00:20:56,230 --> 00:21:00,930
+هي برضه مهمة جدا it is slow growing bacteria الرقم
+
+306
+00:21:00,930 --> 00:21:04,330
+اللي موجود معاكوا هذا اقصر doubling time انا اقرأه
+
+307
+00:21:04,330 --> 00:21:06,930
+اقصر doubling time يعني في doubling time بتكلم عن
+
+308
+00:21:06,930 --> 00:21:10,830
+عشرين ساعة بتكلم عن اربع عشرين ساعة تمام؟ ليش في
+
+309
+00:21:10,830 --> 00:21:13,870
+اختلافات في doubling time؟ ال doubling time مرهون
+
+310
+00:21:13,870 --> 00:21:20,530
+لأي بكتيريا ب media محددة ب media بوسط معين بظروف
+
+311
+00:21:20,530 --> 00:21:26,800
+معين بظروف معينفيبدو أن هذا اللي وصلنا له ناتج عن
+
+312
+00:21:26,800 --> 00:21:30,620
+ميديا .. في ميديا جديدة اسمها Middlebrook Broth
+
+313
+00:21:30,620 --> 00:21:34,220
+بقوا زمان استخدموها الـ Einstein Jensen أجار اللي
+
+314
+00:21:34,220 --> 00:21:38,280
+هندرسونا اليوم هنا في محاضرتنا لكن طور واسط سائل
+
+315
+00:21:38,280 --> 00:21:41,740
+اسمه Middlebrook Broth، لحظة البروث البروث اللي
+
+316
+00:21:41,740 --> 00:21:47,800
+بيقفر فرصة أفضل لمين؟ لإنه عموما لما اتكلمنا على
+
+317
+00:21:47,800 --> 00:21:50,320
+Clostridium Perifringens مين بتذكر جديش
+
+318
+00:21:50,320 --> 00:21:51,460
+Dublingtonine عنه؟
+
+319
+00:21:54,580 --> 00:22:01,520
+10 دقائق ل 12 ساعة يعني بدأ افترض افترض جدلا ان
+
+320
+00:22:01,520 --> 00:22:08,840
+البكتيريا 12 ساعة كم مرة بتنقسم في اليوم مرتينطيب
+
+321
+00:22:08,840 --> 00:22:14,480
+قارنولي المرتين هدولة صارت خليتين بعد أربع و عشرين
+
+322
+00:22:14,480 --> 00:22:18,360
+ساعة مع إشيريشيا كولاي ال doubling time تبعها
+
+323
+00:22:18,360 --> 00:22:23,440
+twenty minutes يعني في الساعة الواحدة كام مرة؟
+
+324
+00:22:23,440 --> 00:22:27,960
+تلاتة تلاتة في أربع و عشرين؟ تمانية؟ اتنين و سبعين
+
+325
+00:22:27,960 --> 00:22:34,000
+بقى تحط رقم اتنين قص اتنين و سبعين اتنين قص اتنين
+
+326
+00:22:34,000 --> 00:22:39,780
+و سبعينيعني مليارات في اليوم الواحد بالمقارنة مع
+
+327
+00:22:39,780 --> 00:22:43,320
+مين؟ مع خليتين لـMycobacterium هذا النقطة اللي
+
+328
+00:22:43,320 --> 00:22:47,700
+حكيت فيها قبلها كده وانا أؤكد عليها من ناحية
+
+329
+00:22:47,700 --> 00:22:55,320
+العلاج الـE.coli بسرعتها ويعني سهولة تكاثرها
+
+330
+00:22:55,320 --> 00:22:59,960
+استغلقت معانا من ثلاث إلى خمس أيام course علاج
+
+331
+00:22:59,960 --> 00:23:06,890
+بينما هذه البكتيرياأقصر فترة اللي هي الأن نحن بيها
+
+332
+00:23:06,890 --> 00:23:13,290
+أقصر فترة علاجية هي ستة أشهر، ستة أشهر، بالظبط،
+
+333
+00:23:13,290 --> 00:23:17,150
+ستة أشهر، قبل ذلك كانت تلت سنوات، قبل ذلك كان
+
+334
+00:23:17,150 --> 00:23:21,390
+مافيش علاج، كان مافيش علاج، تخيل تلت سنوات كان في
+
+335
+00:23:21,390 --> 00:23:26,880
+مستشفى في مخيم البرج، مين فيكم المنطقة؟مخيم البرج
+
+336
+00:23:26,880 --> 00:23:29,200
+كان في مستشفى اسمه مستشفى ال TB ناس بتعرفوا اسم
+
+337
+00:23:29,200 --> 00:23:31,920
+المستشفى ..الان هو مدرسة اغلق هذا ال .. لإنه كان
+
+338
+00:23:31,920 --> 00:23:34,800
+عادل حالات كبيرة بس الان عادل حالات في قطاع غزة
+
+339
+00:23:34,800 --> 00:23:39,240
+لاتجاوز عشر سنويين عشر حالات سنويين و طبعا تحسن
+
+340
+00:23:39,240 --> 00:23:42,500
+نوعا ما في السنوات الأخيرة الوضع يعني كان بالأول
+
+341
+00:23:42,500 --> 00:23:47,980
+خمستاشر سبعتاشر حالة قاموا بحملة توقية على كيفية
+
+342
+00:23:47,980 --> 00:23:51,460
+استخدام ال vaccine لإن ال vaccine هنا بشكل مشكلة
+
+343
+00:23:51,460 --> 00:23:54,420
+هتنولها كمان شوية بس حاولنا نرجع لموضوع اللي هو ال
+
+344
+00:23:54,420 --> 00:24:00,740
+treatmentslow growth يبقى effect للبكتيريا effect
+
+345
+00:24:00,740 --> 00:24:05,120
+لل antibiotic أضعف أبطأ وبالتالي نلجأ لفترة طويلة
+
+346
+00:24:05,120 --> 00:24:08,640
+وزي ما حكى زميلكو شاعت أنه بنضطر نستخدم لل
+
+347
+00:24:08,640 --> 00:24:12,780
+combined therapy ال combined therapy نفس السببين
+
+348
+00:24:12,780 --> 00:24:15,220
+اللي ذكرناهم في هذا المحاضرة أنه بدنا synergism
+
+349
+00:24:15,220 --> 00:24:21,920
+وبدنا نمنع ال resistance لأنه في بعد اكتشاف ال INH
+
+350
+00:24:21,920 --> 00:24:26,470
+و ال rifampicin في السبعينيات من القرن الماضيبدأت
+
+351
+00:24:26,470 --> 00:24:30,970
+تظهر بعض
+
+352
+00:24:30,970 --> 00:24:34,670
+الأصوات تقول بفخر واعتزاز بأنه قضينا على
+
+353
+00:24:34,670 --> 00:24:38,010
+tuberculosis في العالم tuberculosis اللي كان
+
+354
+00:24:38,010 --> 00:24:43,470
+بيسموه one of the most dreadful diseases خطيرة
+
+355
+00:24:43,470 --> 00:24:50,610
+ومؤثرة خطيرة ومجرمة كان بيقتل الناس بكميات كبيرة
+
+356
+00:24:51,480 --> 00:24:54,620
+وبالتالي و نسبة الإصابة فيها عالية جدا و الانتقال
+
+357
+00:24:54,620 --> 00:24:58,880
+تبعه سهل وبينتشر في مناطق وين فيه فقر، يعني مافيش
+
+358
+00:24:58,880 --> 00:25:02,760
+تغذية كويسة، لذلك بيشترك في الإصابة لهذه الأمراض
+
+359
+00:25:02,760 --> 00:25:07,800
+الناس اللي مش ضرور يكون فقراء، اللي مثلا فيه أدباء
+
+360
+00:25:08,730 --> 00:25:13,890
+بيستهلك نفسه في الكتابة أو في الفن أو في التعبير
+
+361
+00:25:13,890 --> 00:25:17,270
+أو في .. أو في .. و بينسى .. بينسى نفسه في الأكل
+
+362
+00:25:17,270 --> 00:25:20,670
+فهذا برضه ممكن يكون عرض للإصابة بال tuberculosis و
+
+363
+00:25:20,670 --> 00:25:23,050
+الفقرة يعني التانين اشتركوا في حالة انهم بيأكلوش
+
+364
+00:25:23,050 --> 00:25:28,070
+تمام؟ مين ممكن مايصيرش ياكل بشكل جيد؟ الناس اللي
+
+365
+00:25:28,070 --> 00:25:34,050
+في الحروب لو استمرت الحرب لمدة أشهر على أعطاء
+
+366
+00:25:34,050 --> 00:25:37,980
+منطقة في العالم تمام؟حاسس ان في نقص في الغذاء صح
+
+367
+00:25:37,980 --> 00:25:42,300
+ولا لأ وبالتالي إمكانية انتشار الميكروب بتكون
+
+368
+00:25:42,300 --> 00:25:46,160
+عالية جدا فالعالم لما اكتشفوا ال antibiotics اللي
+
+369
+00:25:46,160 --> 00:25:48,780
+يقولون عنهم ال INH و ال Phenbosin صار فيه نوع من
+
+370
+00:25:48,780 --> 00:25:53,420
+الفرحة و الإعلان انه قضينا على مين؟ على ال
+
+371
+00:25:53,420 --> 00:25:57,850
+tuberculosis لكن بعد أقل من عشر سنواتبدأت تظهر
+
+372
+00:25:57,850 --> 00:26:02,130
+علامات رجوع وعودة قوية للـ Tuberculosis أو لـ
+
+373
+00:26:02,130 --> 00:26:06,750
+Mycobacterium Tuberculosis وبشكل أكتر شراسة لأنه
+
+374
+00:26:06,750 --> 00:26:10,430
+رجعت مقاومة لمواطنة الحيوية فصار عندى MDR
+
+375
+00:26:10,430 --> 00:26:14,230
+Tuberculosis وبعد فترة زمانية ودي صار عندى XDR
+
+376
+00:26:14,230 --> 00:26:19,730
+Tuberculosis X تعبير على Extended Multiple Drug
+
+377
+00:26:19,730 --> 00:26:23,940
+Resistant Tuberculosis إذن ال Mycobacteriumعلى
+
+378
+00:26:23,940 --> 00:26:29,340
+الرغم من أنه بطيئة في النمو، إلا إن علاجها صعب،
+
+379
+00:26:29,340 --> 00:26:34,800
+علاجها صعب، لما اكتشفنا إلها علاج، هي أيضا طورت
+
+380
+00:26:34,800 --> 00:26:38,080
+نظام مقاومة لمضادات الحيوانات، فهذه نقطة كتير
+
+381
+00:26:38,080 --> 00:26:44,380
+مهمة، قول. سؤالي، بالنسبة لعدم الطعام مثلا،
+
+382
+00:26:46,820 --> 00:26:49,180
+ال immune system تبقى الإنسان إيه له علاقة
+
+383
+00:26:49,180 --> 00:26:51,880
+بالتغذية ال immune system وهذه البكتيريا معتمدة
+
+384
+00:26:51,880 --> 00:26:56,040
+اعتماد كامل على ضعف جهاز المناعة بمعنى يعني هنا لو
+
+385
+00:26:56,040 --> 00:26:59,540
+احنا روحنا على قسم صدرية في مستشفى الشفاء او في او
+
+386
+00:26:59,540 --> 00:27:04,640
+في قسم اخر او في مستشفى اخر هلاجي انه عمانة skin
+
+387
+00:27:04,640 --> 00:27:07,980
+test للمرض للاطباء والممرضين اللي هناك هلاجيهم
+
+388
+00:27:07,980 --> 00:27:11,220
+positive لل tuberculosis البكتيريا موردة في عشانهم
+
+389
+00:27:11,220 --> 00:27:13,840
+لكن مش جادة تماما موردة ليش لأن جهاز المناعة عندهم
+
+390
+00:27:14,210 --> 00:27:18,630
+لو ضعف جهاز المناعة قد يحدث جزء منكم قد يحمل ال
+
+391
+00:27:18,630 --> 00:27:22,190
+tuberculosis في صدره جزء منكم قد يحمل ال
+
+392
+00:27:22,190 --> 00:27:26,070
+tuberculosis في صدره لكن البكتيريا غير قادرة على
+
+393
+00:27:26,070 --> 00:27:29,690
+إحداث المرض لإنه جهاز المناعة بشكل جيد جرب الآن
+
+394
+00:27:29,690 --> 00:27:33,710
+اقعد شهر ما تتغداش بشكل جيد تمام وشوف كيف جهاز
+
+395
+00:27:33,710 --> 00:27:40,400
+المناعة تبعك بيضعف وصلت؟ طيبالان احنا حكينا عن
+
+396
+00:27:40,400 --> 00:27:43,820
+النقطة نقم 6 هذه احنا حكينا عنها انه البكتيريا
+
+397
+00:27:43,820 --> 00:27:46,780
+بتقاوم اللي هو الصباغة بال basic dyes نظرى لووجود
+
+398
+00:27:46,780 --> 00:27:51,380
+كمية كبيرة من اللي هو ال lipid content طيب ال
+
+399
+00:27:51,380 --> 00:27:56,080
+disease أشهر شكل بتعرفوه انتوا لل tuberculosis هو
+
+400
+00:27:56,080 --> 00:27:59,380
+ال palmonary tuberculosis لكن قبل ما أبدأ الحديث
+
+401
+00:27:59,380 --> 00:28:04,400
+عنه بدأ أكدلكوا ان هو ليس او ليس هو الشكل الوحيد
+
+402
+00:28:04,400 --> 00:28:08,620
+من ال tuberculosis في meningitisفي
+
+403
+00:28:08,620 --> 00:28:13,500
+gastrointestinal tuberculosis في bone tuberculosis
+
+404
+00:28:13,500 --> 00:28:16,740
+يعني في عندنا أشكال مختلفة من ال tuberculosis لكن
+
+405
+00:28:16,740 --> 00:28:21,580
+أشهرها ال palmonary tuberculosis المعروف عندنا
+
+406
+00:28:21,580 --> 00:28:26,700
+باللغة العربية السل الرئوي أو التدرن أو الدرن و
+
+407
+00:28:26,700 --> 00:28:30,320
+ليش درن لأنه بيكون درنات زي ما هنشوف كمان شوية
+
+408
+00:28:32,500 --> 00:28:35,600
+اللوحة اللي أمامك وهذه بتوضح لنا مجموعة من الحقائق
+
+409
+00:28:35,600 --> 00:28:40,020
+بدنا نقرأهم واحدة واحدة ونتطلع عليهم organism in
+
+410
+00:28:40,020 --> 00:28:43,680
+droplets is in droplets هذي مش مش مش is in
+
+411
+00:28:43,680 --> 00:28:47,680
+droplets of one to five micrometer are inhaled and
+
+412
+00:28:47,680 --> 00:28:51,000
+reaches alveoli هذي بتوضح لنا ال mood of the
+
+413
+00:28:51,000 --> 00:28:54,700
+transmission هو respiratory هو respiratory عبر ايش
+
+414
+00:28:54,700 --> 00:28:58,660
+عبر ال droplets ال droplets ليها الرذاذ اللي قطرها
+
+415
+00:28:58,660 --> 00:29:02,850
+واحد لخمسة مايكرو لما أنا بحكيالبكتيريا اللى جوا
+
+416
+00:29:02,850 --> 00:29:06,350
+ال droplets هتكون اصغر ولا اكبر؟ اكيد اصغر فهي في
+
+417
+00:29:06,350 --> 00:29:11,250
+المتوسط اصلا هي واحد micron واحد micron هذا النوع
+
+418
+00:29:11,250 --> 00:29:15,310
+من ال droplets اللى ببنستنشقه احنا تمام من الجو
+
+419
+00:29:15,310 --> 00:29:20,410
+غالبا بيصل لل alveoli يعني الفلاتر اللى فى الأنف
+
+420
+00:29:20,410 --> 00:29:28,530
+بتفلتروش بيمر عبرها و بيصلالمرض بينتج من شغلتان،
+
+421
+00:29:28,530 --> 00:29:33,470
+من قدرة البكتيريا على الاستقرار والتكاثر ومن تفاعل
+
+422
+00:29:33,470 --> 00:29:38,630
+جهاز المناعة ضدهاthe production and development of
+
+423
+00:29:38,630 --> 00:29:41,710
+lesions and their healing or progression يعني إما
+
+424
+00:29:41,710 --> 00:29:47,170
+شفائها أو تطور المرض are determined chiefly by the
+
+425
+00:29:47,170 --> 00:29:50,410
+number of mycobacteria and their multiplications
+
+426
+00:29:50,410 --> 00:29:54,570
+الآن ال number of mycobacteria فاكرين كلمة
+
+427
+00:29:54,570 --> 00:29:59,420
+infective dose أذكركم بال infective doseأذكركم لما
+
+428
+00:29:59,420 --> 00:30:03,520
+اتكلمنا عن الـ Vibrio cholera كنا نحتاج إلى حوالي
+
+429
+00:30:03,520 --> 00:30:08,060
+مليون خلية تمام عشان يصير لنا infection بدنا large
+
+430
+00:30:08,060 --> 00:30:12,780
+او huge infectious dose لكن لما اتكلمنا عن الشجلة
+
+431
+00:30:12,780 --> 00:30:17,680
+كنا واحدة إلى عشرة كافين طب تخيلوا معانا أخدنا
+
+432
+00:30:17,680 --> 00:30:24,670
+جرعة احنا من الشجلة مليوناعتقد انه اعتقد انه ال
+
+433
+00:30:24,670 --> 00:30:28,570
+incubation period كمان هتكون ايه اقل و نسبة
+
+434
+00:30:28,570 --> 00:30:33,650
+احتمالية الإصابة بالمرض نفسه هتزيد نفس الفكرة انها
+
+435
+00:30:33,650 --> 00:30:38,910
+لو صار فيندي inhalation لرقم كبير من البكتيريا
+
+436
+00:30:38,910 --> 00:30:42,730
+تمام البكتيريا تكاثرت ليش تكاثرت البكتيريا لأن
+
+437
+00:30:42,730 --> 00:30:48,270
+جهاز المنعها ضعيف ففي حالتين عامل مؤثريني انا او
+
+438
+00:30:48,270 --> 00:30:53,240
+البكتيرياأنا بجهاز المناع تبعي والبكتيريا بعددها
+
+439
+00:30:53,240 --> 00:30:58,280
+هناك شكلين من ال legions اللي ممكن تنشأ من ال
+
+440
+00:30:58,280 --> 00:31:01,380
+mycobacterium tuberculosis infection واحد بيسموه
+
+441
+00:31:01,380 --> 00:31:05,340
+oxidative type والتاني بيسموه productive type ال
+
+442
+00:31:05,340 --> 00:31:10,240
+oxidative type هو عبارة عنيعني لو أخدنا صورة أشعة
+
+443
+00:31:10,240 --> 00:31:15,860
+للمريض غالبا بيظهر الشكل وكأنه المريض عنده
+
+444
+00:31:15,860 --> 00:31:19,620
+pneumonia عنده ال pneumonia وهي نتجة عن ال acute
+
+445
+00:31:19,620 --> 00:31:23,600
+inflammatory reaction and edema fluid قد يكون هناك
+
+446
+00:31:23,600 --> 00:31:28,340
+بعض الخلايا زي اللي هو ال mono sites اللي بيقنننا
+
+447
+00:31:28,340 --> 00:31:33,300
+الصحيح أكتر احنا مين ال productive type بنتخيل مع
+
+448
+00:31:33,300 --> 00:31:38,980
+بعض الموقف يا شبابفاكرين لما قولنا احنا بكتيريا
+
+449
+00:31:38,980 --> 00:31:41,500
+obligate intracellular و facultative
+
+450
+00:31:41,500 --> 00:31:45,200
+intracellular، هذي ايش بتكون؟ obligate كيف
+
+451
+00:31:45,200 --> 00:31:49,260
+obligate؟ facultative مستحيل تكون obligate و انا
+
+452
+00:31:49,260 --> 00:31:52,420
+بقدر أناميها على طبق، على .. على .. على لوينشتайн
+
+453
+00:31:52,420 --> 00:31:56,940
+دينسون اجار لو .. لو انها obligate، بقدرش أناميها
+
+454
+00:31:56,940 --> 00:32:00,300
+غير في cell culture أو في animals، تمام؟ بس فك ..
+
+455
+00:32:00,300 --> 00:32:05,380
+هذي facultativeوبتنمو داخل ال macro phage لان ال
+
+456
+00:32:05,380 --> 00:32:09,220
+macro phage وظيفتها انها تلتق من البكتيريا الغريبة
+
+457
+00:32:09,220 --> 00:32:14,520
+تلتق من البكتيريا لكن بتفشل انها تحتويها وبالتالي
+
+458
+00:32:14,520 --> 00:32:17,820
+بتنتج cytokines بتقول لجهاز المناعة اللي في الجسم
+
+459
+00:32:17,820 --> 00:32:23,020
+يا جهاز المناعة تعال في خلية انا مش جاء او بكتيريا
+
+460
+00:32:23,020 --> 00:32:29,200
+انا مش قادر اسيطر عليها اقتلوني ادفنوني مع الخلايا
+
+461
+00:32:30,020 --> 00:32:36,690
+فبنلاقي أول أولهي الدرنة تمام ال center تبعها
+
+462
+00:32:36,690 --> 00:32:41,150
+عبارة عن large multinucleated giant cells
+
+463
+00:32:41,150 --> 00:32:44,990
+containing mycobacterium tuberculosis كيف بتصير ال
+
+464
+00:32:44,990 --> 00:32:48,770
+multinucleated giant cell؟ multinucleated giant
+
+465
+00:32:48,770 --> 00:32:52,990
+cell معناها خلايا اتحدت مع بعضها صارت صارلها
+
+466
+00:32:52,990 --> 00:32:56,150
+fusion صارلها fusion كيف صارلها fusion؟ بإن ال
+
+467
+00:32:56,150 --> 00:32:59,510
+mycobacterium اخترقت واحد و واحدة التانية مباشرة
+
+468
+00:32:59,510 --> 00:33:04,710
+فلزجتهم مع بعضفصار عندي خلية كبيرة يتكثر فيها
+
+469
+00:33:04,710 --> 00:33:08,590
+البكتيريا و نفس ال macrophages غير قادر على قتل
+
+470
+00:33:08,590 --> 00:33:12,870
+البكتيريا يبقى multi-negligent cells containing من
+
+471
+00:33:12,870 --> 00:33:16,910
+ال microbacterium tuberculosis ال mid zone هي
+
+472
+00:33:16,910 --> 00:33:21,410
+عبارة عن pale epithelial cells رقم تلاتة a
+
+473
+00:33:21,410 --> 00:33:24,310
+peripheral zone اللي الحفر اللي خلقاش فيها
+
+474
+00:33:24,310 --> 00:33:30,680
+فيبروبلاست فيها lymphocytes and monocytesكلهم أجوا
+
+475
+00:33:30,680 --> 00:33:37,200
+غطوا على مين؟ على ال microfage اللي جواها ال
+
+476
+00:33:37,200 --> 00:33:41,600
+mycobacterium الآن ده الوضع استقر بهذا الشكل وجهاز
+
+477
+00:33:41,600 --> 00:33:46,500
+المناعة جام بدوره ممتاز تمام؟ هذا الجزء من ال
+
+478
+00:33:46,500 --> 00:33:52,460
+Legion بينصب عليه calcium بينصب عليه calcium
+
+479
+00:33:52,460 --> 00:34:00,430
+فبتتحجر عشان ماتخليش سهولة البكتيريا تطلعcalcium
+
+480
+00:34:00,430 --> 00:34:03,330
+لو بنتصور احنا صورة أشعة يا شباب إيش اللي بيبين أن
+
+481
+00:34:03,330 --> 00:34:07,190
+الأضلع تبعتنا العضم و الأمود الفقري الجلب تبعنا
+
+482
+00:34:07,190 --> 00:34:12,730
+تبين حاجة هيكده يعني مش واضحة و ال lungs كذلك
+
+483
+00:34:12,730 --> 00:34:16,070
+الأمر بالنسبة إن احنا الطيب جاي يتطلع على صورة
+
+484
+00:34:16,070 --> 00:34:18,510
+الأشعة و يقول طلع إيش فيها و احنا مش شايفين عن إيش
+
+485
+00:34:18,510 --> 00:34:25,550
+بحكي صح؟ احنا بنشوف بس ال ribs ال boneعبارة عن X
+
+486
+00:34:25,550 --> 00:34:28,830
+-ray opaque معتم بالنسبة لصورة الأشعة، لأن الأشعة
+
+487
+00:34:28,830 --> 00:34:33,950
+لا تقدر تخترقه وبالتالي يظهر جسم أبيض على اللوحة
+
+488
+00:34:36,530 --> 00:34:39,030
+ليش مابتقدرش تختار يقول انه فيه calcium؟ فال
+
+489
+00:34:39,030 --> 00:34:43,090
+calcium هو ال x-ray opaque تمام؟ فلما يتكون درنة
+
+490
+00:34:43,090 --> 00:34:48,990
+عليها calcium عليها calcium وصورنا أشياء هيظهر في
+
+491
+00:34:48,990 --> 00:34:53,510
+ال lungs تبعتنا حاجة كورة أو إشي مبين تمام؟
+
+492
+00:34:53,510 --> 00:34:56,730
+بيشوفوا الطبيب وبيعرفوا أن هذا عبارة عن إيه؟ عن
+
+493
+00:34:56,730 --> 00:35:03,170
+lesion هذا ممكن تكون بهذا الحجم نعم إذا .. إذا ..
+
+494
+00:35:04,530 --> 00:35:12,690
+صار عندي معرفة بأنه تكون Legion خد بالك قد يتكون
+
+495
+00:35:12,690 --> 00:35:15,910
+ال Legion و يصبح له classification و ينتهي من
+
+496
+00:35:15,910 --> 00:35:20,390
+الجسم تماما و يتخلص منه الجسم بدون أي أعراض ولا أي
+
+497
+00:35:20,390 --> 00:35:26,410
+حاجةالحكم في هذه القضية هو ان يحصل ريجريشن او
+
+498
+00:35:26,410 --> 00:35:29,590
+بروجريشن ريجريشن يعني انحصار و بروجريشن يعني تطور
+
+499
+00:35:29,590 --> 00:35:32,890
+جهاز المناعة وال number of virulent bacteria اللي
+
+500
+00:35:32,890 --> 00:35:37,830
+دخلت ديه جسم الإنسانيمكن الصورة هذه اللي انا كنت
+
+501
+00:35:37,830 --> 00:35:41,530
+بدي اشرحها لجرانيلومة لحظة هي ال macro phage تمام
+
+502
+00:35:41,530 --> 00:35:46,010
+اللي بالأول وفيها طبعا ال bacteria بتتكاتر بعدين
+
+503
+00:35:46,010 --> 00:35:48,630
+ال epithelial cells وبعدين اللي هم الخلايا اللي
+
+504
+00:35:48,630 --> 00:35:52,750
+قلنا عنهم ال monocyte و ال lymphocytes وبعد ذلك
+
+505
+00:35:52,750 --> 00:35:56,030
+اللي هو بيصير فيه عملية قلنا calcification او تكون
+
+506
+00:35:56,030 --> 00:36:03,230
+ال calcium symptoms of tuberculosis ما هي أعراض ال
+
+507
+00:36:03,230 --> 00:36:07,660
+disease feverو دايما او او معظم الناس اللي بيكون
+
+508
+00:36:07,660 --> 00:36:11,580
+فيه فرع عالي بيكون فيه chills في sweating تعرق و
+
+509
+00:36:11,580 --> 00:36:15,140
+خاصة شباب night sweating ايش هي night sweating
+
+510
+00:36:15,140 --> 00:36:18,020
+يعني في الليل ايه عفوا night sweating هي night
+
+511
+00:36:18,020 --> 00:36:22,060
+sweats flu like symptoms اول اعرض تبدأ عند المريض
+
+512
+00:36:22,060 --> 00:36:25,240
+زي ال influenza او زي الرشح gastrointestinal
+
+513
+00:36:25,240 --> 00:36:27,700
+symptoms ممكن يصير عنده vomiting حتى ممكن يصير
+
+514
+00:36:27,700 --> 00:36:31,480
+عنده vomiting weight loss وهدي one whole mark
+
+515
+00:36:31,480 --> 00:36:36,450
+فقدام في الوزنوأول ما بيظهر بيظهر على ال .. ال ..
+
+516
+00:36:36,450 --> 00:36:40,690
+بيسموه كشكسك فيس المنطقة اللي .. الخدين هدولة
+
+517
+00:36:40,690 --> 00:36:45,850
+بتصير غائرة وبيفقد فيها وزن loss of appetite غير
+
+518
+00:36:45,850 --> 00:36:49,750
+قادر هو أصلا مشكلته نتجت عن عدم تناوض الطعام من
+
+519
+00:36:49,750 --> 00:36:53,910
+أساسها وكمان بيفقد من كمان الشهية weakness بشكل
+
+520
+00:36:53,910 --> 00:36:59,390
+عام و fatigue بشكل برضه عامقد لا .. قد لا يعني
+
+521
+00:36:59,390 --> 00:37:04,050
+تحدث كل هذه الصفات عند نفس الشخص لكن على الأقل
+
+522
+00:37:04,050 --> 00:37:06,790
+يعني سبعين في المئة من هذه الأعراض هتظهر عند هذا
+
+523
+00:37:06,790 --> 00:37:09,950
+المريض في كمان مثلا أحد ال .. أحد الأعراض المهم
+
+524
+00:37:09,950 --> 00:37:14,370
+جدا، حاجة اسمها hemoptysis hemoptysis يعني اللي هو
+
+525
+00:37:14,370 --> 00:37:19,870
+البوساق المدمم، إيش يعني البوساق المدمم؟ لما بيكحل
+
+526
+00:37:19,870 --> 00:37:23,730
+مريض بيخرج مع ال .. ال sputum بيخرج معاه دمهذا
+
+527
+00:37:23,730 --> 00:37:26,670
+نتجى على ايش؟ نتجى على ان الـ tubercle صار
+
+528
+00:37:26,670 --> 00:37:30,950
+الهالايسز اتحللت وماكنش بتصير في مكانها
+
+529
+00:37:30,950 --> 00:37:34,990
+destruction لنسيج و ال lungs مليانة كبلاريز وبتالي
+
+530
+00:37:34,990 --> 00:37:37,630
+بيصير فيانا نظيف داخل ال lungs
+
+531
+00:37:43,430 --> 00:37:46,750
+كيف لنا أن نقوم بتشخيص ال tuberculosis؟ احنا قلنا
+
+532
+00:37:46,750 --> 00:37:49,730
+أهم شكل من أشكال ال tuberculosis هو كان ال
+
+533
+00:37:49,730 --> 00:37:52,070
+palmonary tuberculosis والكلام اللي احنا حكينا
+
+534
+00:37:52,070 --> 00:37:56,130
+الصحيح حكينا على palmonary tuberculosis ففي هذا
+
+535
+00:37:56,130 --> 00:38:00,290
+الغالب بيكون في عندنا dispute لكن في أحيانا المريض
+
+536
+00:38:00,290 --> 00:38:03,770
+بيكون غير قادر علىانتاج الـ sputum وانا حكيتلكوا
+
+537
+00:38:03,770 --> 00:38:06,570
+قبل هي كده بال cupping إذا فكرين الموضوع إننا
+
+538
+00:38:06,570 --> 00:38:09,870
+بنعمل cupping لكن في حال عدم مقدرتنا على الحصول
+
+539
+00:38:09,870 --> 00:38:13,670
+على العينة ممكن نحصل على gastric aspirate or
+
+540
+00:38:13,670 --> 00:38:18,510
+washing ليش؟ معظم مرضى ال tuberculosis بيكح في
+
+541
+00:38:18,510 --> 00:38:24,090
+الليل وما بيخرجش ال sputum إلى الخارج بيبتلهموميزة
+
+542
+00:38:24,090 --> 00:38:28,150
+البكتيريا هذه انها resistant to acid and alkali
+
+543
+00:38:28,150 --> 00:38:35,210
+يعني مقاومة للأحماض ومقاومة للقواعد وبالتالي يعني
+
+544
+00:38:35,210 --> 00:38:39,050
+ممكن مش لا .. مافيش تجارب ثمب لكن لو أخدناها من ال
+
+545
+00:38:39,050 --> 00:38:43,930
+lung غالبا بناخدها وهي لسه حية لكن العينة المفضلة
+
+546
+00:38:43,930 --> 00:38:46,890
+اللي هي عينات ال .. ال .. ال .. ال .. ال .. ال ..
+
+547
+00:38:46,890 --> 00:38:46,930
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+548
+00:38:46,930 --> 00:38:47,130
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+549
+00:38:47,130 --> 00:38:47,410
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+550
+00:38:47,410 --> 00:38:47,410
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+551
+00:38:47,410 --> 00:38:47,410
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+552
+00:38:47,410 --> 00:38:47,410
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+553
+00:38:47,410 --> 00:38:50,240
+ال .. ال .. ال .. ال ..إذا كان فينا urinary tract
+
+554
+00:38:50,240 --> 00:38:53,880
+tuberculosis بنضطر ناخد عينات urine و ال urine هذا
+
+555
+00:38:53,880 --> 00:39:00,280
+بيجمع لمدة 24 ساعةPlural Fluid قد تخرج البكتيريا
+
+556
+00:39:00,280 --> 00:39:05,560
+في السائل المحيط بالـlungs CSF Joint Fluid Biopsy
+
+557
+00:39:05,560 --> 00:39:10,940
+Materials لـ Stain Smear احنا ماقلنا الا نعمل Acid
+
+558
+00:39:10,940 --> 00:39:16,900
+Fast Stain او في فحص او Staining اخر بيسموه
+
+559
+00:39:16,900 --> 00:39:20,960
+Rodamine Oramine او Oramine Rodamine Fluorescent
+
+560
+00:39:20,960 --> 00:39:24,480
+Staining كمان مرة Oramine Rodamine
+
+561
+00:39:26,820 --> 00:39:31,960
+هذا ال stain رائع جدا ممكن نستخدمه كبديل عن الزيلة
+
+562
+00:39:31,960 --> 00:39:36,280
+انتوا عملتوا الفحص هذا ال acid fast عملته طيب
+
+563
+00:39:36,280 --> 00:39:44,890
+بناشر نختلف درستوا درستوا وهذا نوصلها لأدقالان ال
+
+564
+00:39:44,890 --> 00:39:49,470
+.. ال acid fast stain بنقدر نفحصه على ال oil
+
+565
+00:39:49,470 --> 00:39:53,810
+immersion و بنستغرق في السمير تقريبا اربع ساعة و
+
+566
+00:39:53,810 --> 00:39:57,950
+احنا بنفحص في السمير عشان نشوف خلية او خليتين من
+
+567
+00:39:57,950 --> 00:40:02,870
+ال acid fast ميزة القرمين رودامين هذا صبغة قد
+
+568
+00:40:02,870 --> 00:40:06,290
+تفحصها تستطيع فحصها على ال high power لكن مش على
+
+569
+00:40:06,290 --> 00:40:08,810
+الميكروسكوب العادى على ال fluorescent microscope
+
+570
+00:40:08,810 --> 00:40:13,700
+يبقى بتفحص انت على ال high powerولأن البكتيريا
+
+571
+00:40:13,700 --> 00:40:19,520
+مضيئةفبالتالي انت بتقول هي بتقولك تعال شوف انها
+
+572
+00:40:19,520 --> 00:40:23,280
+هنا ناني موجودة يعني انت لا تبذل جهدا كبيرا في
+
+573
+00:40:23,280 --> 00:40:27,620
+البحث عنها بيقدر انك تتحرك فالبكتير المضيقة بتبين
+
+574
+00:40:27,620 --> 00:40:31,860
+لان وظائف الصحة بدأوا احنا اشتغلنا الصيادة التقنية
+
+575
+00:40:31,860 --> 00:40:36,840
+في الجامعة يعني منذ اكثر من 15 سنة وجربناها
+
+576
+00:40:36,840 --> 00:40:39,760
+وانصحنا الأخوة في وظائف الصحة انهم يستخدموها ال
+
+577
+00:40:39,760 --> 00:40:45,010
+culture عبارة عنوالـ Sputum هنا مابينفعش نشطر عليه
+
+578
+00:40:45,010 --> 00:40:49,610
+مباشرة عدّل البكتيريا مهما كان في الـ Sputum بيكون
+
+579
+00:40:49,610 --> 00:40:53,230
+قليل ولأن Sputum مليانة من الـ mucus بتكون
+
+580
+00:40:53,230 --> 00:40:57,450
+البكتيريا متوزعة في أماكن مختلفة والمشكلة الأكبر
+
+581
+00:40:57,450 --> 00:41:03,270
+أن Sputum خرج من وين؟ من الفم ومن الفم Saliva
+
+582
+00:41:03,270 --> 00:41:07,330
+Contaminants بكتيريا بدأت ست أسابيع لتنمو يجب أن
+
+583
+00:41:07,330 --> 00:41:11,740
+تخلص من كل ال Contaminantsفبتضرب عصفران بحجر و
+
+584
+00:41:11,740 --> 00:41:17,040
+أعمل حاجة بنسميها concentration للبكتيريا وبتركز
+
+585
+00:41:17,040 --> 00:41:20,860
+البكتيريا و decontamination أزيل كل ال normal
+
+586
+00:41:20,860 --> 00:41:25,380
+flora موتها اعتمادا على مين؟ اعتمادا على معارفتي
+
+587
+00:41:25,380 --> 00:41:30,340
+بإن البكتيرياقادرة على ال survival في كل من الأسد
+
+588
+00:41:30,340 --> 00:41:33,780
+وفي كل من اللي هو ال ال ال ال ال ال ال ال ال ال ال
+
+589
+00:41:33,780 --> 00:41:33,900
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+590
+00:41:33,900 --> 00:41:34,520
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+591
+00:41:34,520 --> 00:41:35,100
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+592
+00:41:35,100 --> 00:41:37,040
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+593
+00:41:37,040 --> 00:41:39,940
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+594
+00:41:39,940 --> 00:41:41,040
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+595
+00:41:41,040 --> 00:41:41,300
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+596
+00:41:41,300 --> 00:41:41,300
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+597
+00:41:41,300 --> 00:41:41,560
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+598
+00:41:41,560 --> 00:41:41,560
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+599
+00:41:41,560 --> 00:41:42,740
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+600
+00:41:42,740 --> 00:41:47,080
+ال ال ال ال ال ال ال
+
+601
+00:41:54,260 --> 00:41:58,800
+تست تيوب واش فيها glass beads بتعرف الجلول الزار
+
+602
+00:41:58,800 --> 00:42:05,420
+الحديد هدول ال جلول بنحطهم في القنبوبة اللي فيها
+
+603
+00:42:05,420 --> 00:42:08,560
+equal volume من ال Sputum و من النيواتش و بنعمل
+
+604
+00:42:08,560 --> 00:42:13,800
+عملية mixing بنكسر ال Sputum و بنخلي ال Sodium
+
+605
+00:42:13,800 --> 00:42:19,220
+Hydroxide يحلل بيسموه lytic agent يعني عامل محلل
+
+606
+00:42:19,220 --> 00:42:23,190
+فالبكتير الآن بتتحرر من مين؟من الميوكاس من
+
+607
+00:42:23,190 --> 00:42:27,370
+الميوكاس homogenize by shaking for a few minutes
+
+608
+00:42:27,370 --> 00:42:32,510
+centrifuge at 3000 rpm for twenty to thirty
+
+609
+00:42:32,510 --> 00:42:35,050
+minutes لاحظوا جدش ال centrifugation عشرين لتلاتين
+
+610
+00:42:35,050 --> 00:42:40,710
+دقيقة على تلات تلاف هذه العملية بتكون كافية لتركيز
+
+611
+00:42:40,710 --> 00:42:46,120
+البكتيريا في القاعبناخد ال supernatant و نتخلص منه
+
+612
+00:42:46,120 --> 00:42:49,140
+خدوا بالك و تخلص من ال supernatant هدى .. هدى
+
+613
+00:42:49,140 --> 00:42:53,100
+mycobacterium مش .. مش اى بكتيريا بنتخلص من ال ..
+
+614
+00:42:53,100 --> 00:42:57,940
+مش فى الحوض و بنحطه فى this infectant مادة مطهرة
+
+615
+00:42:57,940 --> 00:43:03,140
+.. مادة مطهرة زى ال Detol مين ضال عندي الآن؟اللي
+
+616
+00:43:03,140 --> 00:43:05,260
+هو ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+617
+00:43:05,260 --> 00:43:05,260
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+618
+00:43:05,260 --> 00:43:05,300
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+619
+00:43:05,300 --> 00:43:05,660
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+620
+00:43:05,660 --> 00:43:05,920
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+621
+00:43:05,920 --> 00:43:07,420
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+622
+00:43:07,420 --> 00:43:07,860
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+623
+00:43:07,860 --> 00:43:08,520
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+624
+00:43:08,520 --> 00:43:08,600
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+625
+00:43:08,600 --> 00:43:13,420
+ال .. ال ..
+
+626
+00:43:13,420 --> 00:43:15,400
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+627
+00:43:15,400 --> 00:43:16,000
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+628
+00:43:16,000 --> 00:43:16,000
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+629
+00:43:16,000 --> 00:43:16,440
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+630
+00:43:19,640 --> 00:43:22,400
+بس لو طولت عليها كمان شوية برضه بكتيريتي انا كمان
+
+631
+00:43:22,400 --> 00:43:27,080
+هتموت فايش نعمل؟ بنروح و احنا ضايفين كمان قطرة من
+
+632
+00:43:27,080 --> 00:43:33,060
+الفنوريد وضايفين قطرة قطرة HCL عشان نعمل ال
+
+633
+00:43:33,060 --> 00:43:37,670
+neutralization لمين؟لل ل ل ل ل ل ل ل ل ل ل ل ل ل ل
+
+634
+00:43:37,670 --> 00:43:37,670
+ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل
+
+635
+00:43:37,670 --> 00:43:38,650
+ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل
+
+636
+00:43:38,650 --> 00:43:47,390
+ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل
+
+637
+00:43:47,390 --> 00:43:49,670
+ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل
+
+638
+00:43:49,670 --> 00:43:51,190
+ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل
+
+639
+00:43:51,190 --> 00:43:51,190
+ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل
+
+640
+00:43:51,190 --> 00:43:51,190
+ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل
+
+641
+00:43:51,190 --> 00:43:51,190
+ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل ل
+
+642
+00:43:51,190 --> 00:43:58,800
+ل ل ل ل ل ل ل ل ل لالـ Sputum المركز بدل مكان خمسة
+
+643
+00:43:58,800 --> 00:44:02,380
+صنطي مثلا فيهم عشر حبات بكتيريا صار عندنا الآن نص
+
+644
+00:44:02,380 --> 00:44:05,260
+صنطي في عشر حبات بكتيريا فعملنا ايش الآن؟
+
+645
+00:44:05,260 --> 00:44:10,060
+Concentration and Decontamination
+
+646
+00:44:10,060 --> 00:44:13,160
+ليه ازالة البكتيريا والمرة الجاية ان شاء الله نكمل
+
+647
+00:44:13,160 --> 00:44:13,880
+البقية
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/p7qM3jWS85I_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/p7qM3jWS85I_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..6b29cfbf7237075df03b0bb0178479018210cb12
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/p7qM3jWS85I_postprocess.srt
@@ -0,0 +1,2464 @@
+1
+00:00:21,210 --> 00:00:24,770
+بسم الله الرحمن الرحيم الميكروب الثاني في سلسلة
+
+2
+00:00:24,770 --> 00:00:28,270
+الكلستردية هو الكلسترديوم perifringens وبدأنا قبل
+
+3
+00:00:28,270 --> 00:00:31,310
+حديثة عنه في المقدمة الماضية انه بيعمل مجموعة من
+
+4
+00:00:31,310 --> 00:00:36,150
+العدوى منها ال wound infection و ال gas gangrene
+
+5
+00:00:36,150 --> 00:00:39,410
+اللي سميناها myonecrosis و اتكلمنا ايضا عن
+
+6
+00:00:39,410 --> 00:00:42,850
+necrotizing jejunitis او سمينها gangrene of the
+
+7
+00:00:42,850 --> 00:00:47,370
+intestine اتكلمنا عن simple condition ممكن يحدث من
+
+8
+00:00:47,370 --> 00:00:51,070
+نتيجة البكتيريا اللي هو ال food poisoningو أيضا
+
+9
+00:00:51,070 --> 00:00:55,530
+very severe condition اللي هو ال meningitis الان
+
+10
+00:00:55,530 --> 00:01:01,630
+نتكلم عن ال toxins المهمة جدا اللي بتأهل البكتيريا
+
+11
+00:01:01,630 --> 00:01:05,990
+للأنواع المختلفة من الأمراض فمثلا عندنا ال alpha
+
+12
+00:01:05,990 --> 00:01:09,890
+وهو common to all clostridium perifringens strains
+
+13
+00:01:09,890 --> 00:01:14,430
+يعني بمعنى آخر مشترك في كل المجموعةهو عبارة عن
+
+14
+00:01:14,430 --> 00:01:18,910
+phospholipase C او لسيثينيز اذا phospholipase او
+
+15
+00:01:18,910 --> 00:01:23,730
+الفا توكسين او لسيثينيز ليه سموه phospholipase
+
+16
+00:01:23,730 --> 00:01:27,010
+لأنه في حالة ال phospholipid الليسيثين وبالتالي
+
+17
+00:01:27,010 --> 00:01:31,690
+سمينا ايضا لسيثينيز وين الليسيثين موجود هذا موجود
+
+18
+00:01:31,690 --> 00:01:35,150
+في ال cell membrane تبع بعض الخلايا او كثير من
+
+19
+00:01:35,150 --> 00:01:39,320
+الخلايا اذا الليسيثين موجود في خلايانامن ضمن
+
+20
+00:01:39,320 --> 00:01:41,640
+الخلايا هذه ال white blood cell و ال red blood
+
+21
+00:01:41,640 --> 00:01:45,960
+cell و ال muscle cells وبالتالي هذا التوكسين بيقتل
+
+22
+00:01:45,960 --> 00:01:49,860
+او بيدمر ال RBCs و ال white BCs و بيدمر ال muscle
+
+23
+00:01:49,860 --> 00:01:54,530
+cellsالنوع التالت من التوكسين يسمى Beta وهو عبارة
+
+24
+00:01:54,530 --> 00:02:00,790
+عن نيكروتك توكسين لمين؟ للميكوزا تبع الانتستين
+
+25
+00:02:00,790 --> 00:02:04,490
+وإله كمان تأثير على الـcentral nervous system إذا
+
+26
+00:02:04,490 --> 00:02:09,270
+بتوقع أن البكتيريا اللي عندها Beta توكسين انها
+
+27
+00:02:09,270 --> 00:02:12,990
+تعمل necrotizing degenitis أو اللي اللي سمناها
+
+28
+00:02:12,990 --> 00:02:17,650
+intestinal gangrene النوع التالت اللي هو الابسلون
+
+29
+00:02:18,910 --> 00:02:22,690
+والإبسلون والإيوتا بيمتلكوا نفس ال action أو ال
+
+30
+00:02:22,690 --> 00:02:25,350
+ميكانيزم of action لكن بيختلفوا في التركيب
+
+31
+00:02:25,350 --> 00:02:28,470
+بيختلفوا في التركيب يعني شكلهم مختلف لكن ال
+
+32
+00:02:28,470 --> 00:02:33,420
+function تبعتهم واحدةطبعا ال function تبعتهم غالبا
+
+33
+00:02:33,420 --> 00:02:37,200
+بتعمل symptoms في ال gastro intestinal tract
+
+34
+00:02:37,200 --> 00:02:41,440
+وبالتالي نتوقع أنه نجيها أو ال epsilon و اليوتا
+
+35
+00:02:41,440 --> 00:02:44,700
+نتوقع أنه نجيهم في أي نوع من السلالات في السلالات
+
+36
+00:02:44,700 --> 00:02:49,040
+اللي بتعمل food poisoning إذا ال alpha common للكل
+
+37
+00:02:49,420 --> 00:02:52,940
+البيتا في تلك البكتيريا القادرة على ان تتعمل
+
+38
+00:02:52,940 --> 00:02:57,340
+intestinal gangrene او necrotizing jejunitis
+
+39
+00:02:57,340 --> 00:03:00,580
+الابسلون والايوتا قادرين على انهم يعملوا food
+
+40
+00:03:00,580 --> 00:03:04,860
+poisoning بيقولنا ان الابسلون غالبا بيكون inactive
+
+41
+00:03:04,860 --> 00:03:11,100
+يعني لو اتناولنا مع الطعام مباشرة هو نفسه غير قادر
+
+42
+00:03:11,100 --> 00:03:14,980
+على احداث اي تأثير لكن خلال مروره في ال intestinal
+
+43
+00:03:14,980 --> 00:03:21,750
+tract تمام؟ في ال intestinal tractفي عندنا enzymes
+
+44
+00:03:21,750 --> 00:03:25,050
+هدى ال enzymes بتعمل activation للتكسين تعمل
+
+45
+00:03:25,050 --> 00:03:28,110
+activation للتكسين وبالتالي احنا جسمنا اللى
+
+46
+00:03:28,110 --> 00:03:31,810
+بيحولوا الى active من inactive اذا alpha, beta,
+
+47
+00:03:32,010 --> 00:03:35,630
+epsilon and iota وبناء على هدى التكسين وجودها
+
+48
+00:03:35,630 --> 00:03:40,330
+بنقسم السلالات الى خمس أصناف أو خمس أنواع من
+
+49
+00:03:40,330 --> 00:03:45,210
+الklostridium peripherensisلحظوا a,b,c,d,e هذه
+
+50
+00:03:45,210 --> 00:03:49,030
+التسمية لخمس أصناف نتطلع على ال toxins اللي
+
+51
+00:03:49,030 --> 00:03:52,010
+بتنتجها كل واحدة منهم لحظوا ال alpha common to all
+
+52
+00:03:52,010 --> 00:03:58,190
+صح موجود في كل المجموعة alpha لكن beta موجود فقط
+
+53
+00:03:58,190 --> 00:04:05,980
+في ال b و ال cالإبسلون موجود في ال B و ال D بينما
+
+54
+00:04:05,980 --> 00:04:11,040
+ال إيوتا موجود فقط في ال A إذا في عندي خمس أصناف
+
+55
+00:04:11,040 --> 00:04:16,420
+موزعة بحسب إنتاجها لمين لل four toxins الفور
+
+56
+00:04:16,420 --> 00:04:19,340
+توكسين ألفا بيتا إبسلون و إيوتا
+
+57
+00:04:21,970 --> 00:04:24,850
+الاوحدة المهمة دي عبارة عن summary او تلخيص
+
+58
+00:04:24,850 --> 00:04:29,550
+للبقاعات الينسيز دلوقت الاسترديوم في افراد الينسيز
+
+59
+00:04:29,550 --> 00:04:31,010
+بقول ان في ال open ones
+
+60
+00:04:34,740 --> 00:04:38,420
+المصدر الرئيسي اللي شفناه في الكلستردium تتني تتني
+
+61
+00:04:38,420 --> 00:04:41,260
+Contaminated with soil إذا صار في contamination
+
+62
+00:04:41,260 --> 00:04:44,820
+with soil يبقى خدنا نتكلم كمان مرة إن المصدر
+
+63
+00:04:44,820 --> 00:04:48,920
+الرئيسي ده الكلستردية بشكل عام هو ال soil لكن هنا
+
+64
+00:04:48,920 --> 00:04:52,560
+اللي يجب أن نؤكد على مصدر آخر لأن البكتيريا هذه
+
+65
+00:04:52,560 --> 00:05:00,260
+عبارة عن normal flora in many many intestinal
+
+66
+00:05:00,260 --> 00:05:04,860
+tract of man and animalيبقى في هن دي البكتيريا
+
+67
+00:05:04,860 --> 00:05:07,920
+بتكون موجودة كnormal flora وبالتالي احنا بنقول
+
+68
+00:05:07,920 --> 00:05:11,460
+water contaminated with sewage هيحتوى على مين
+
+69
+00:05:11,460 --> 00:05:15,940
+الآن؟ على البكتيريا، لإذن مش بس ال ال ال sparks
+
+70
+00:05:15,940 --> 00:05:19,830
+بتشكل مصدر مهم وانما ايضا كمان مين؟اللي هو ال
+
+71
+00:05:19,830 --> 00:05:23,510
+water contaminated with sewage، spore may
+
+72
+00:05:23,510 --> 00:05:26,790
+germinate، organism may multiply، produces alpha
+
+73
+00:05:26,790 --> 00:05:29,610
+-toxin، ال alpha-toxin بيساعد على ال cell death،
+
+74
+00:05:29,610 --> 00:05:31,750
+اللي احنا قولنا انه بيأثر على ال red blood cell و
+
+75
+00:05:31,750 --> 00:05:35,240
+على ال white و بيأثر على ال muscle cellsOther
+
+76
+00:05:35,240 --> 00:05:38,180
+toxin ممكن تعمل increases لـ capillary
+
+77
+00:05:38,180 --> 00:05:41,980
+permeability and muscle death في كمان شغل كتير مهم
+
+78
+00:05:41,980 --> 00:05:45,020
+حكيناها المرة الماضية اللي هو ال enzymes that will
+
+79
+00:05:45,020 --> 00:05:49,200
+produce gas at the end يعني في النهاية عملية ال
+
+80
+00:05:49,200 --> 00:05:53,300
+fermentation اللي بتتم من قبل البكتيريا is
+
+81
+00:05:53,300 --> 00:05:58,980
+associated with gas productionالغاز فاكرين ماعرف
+
+82
+00:05:58,980 --> 00:06:02,100
+حكينا عن مثال تبقى رغيف الخبز ولا ماحكيناه انه
+
+83
+00:06:02,100 --> 00:06:06,560
+عملية النفخ الناتجة عن تمدد الغاز تهدأك تمدت
+
+84
+00:06:06,560 --> 00:06:12,060
+بالحرارة في عاملة الخبز لكن هنا تمدت بعملية ال
+
+85
+00:06:12,060 --> 00:06:14,660
+accumulation عملية اللي هو التراكم كل ما تراكم
+
+86
+00:06:14,660 --> 00:06:18,820
+الغاز كل ما صار عنده شكل ضغط أكبر كل ما شكل ضغط
+
+87
+00:06:18,820 --> 00:06:23,380
+أكبر الان هو بده يهرب من مكان الأضعف فبتالي بيفتح
+
+88
+00:06:23,380 --> 00:06:27,770
+المكان الأضعفالان اذا كان المكان الأضعف هو مكان
+
+89
+00:06:27,770 --> 00:06:31,810
+التقاء عضلتين بعضهم البعض فهيصير فين تفسخ للعضلات
+
+90
+00:06:31,810 --> 00:06:36,870
+جزء من الكابلاريز اللي كانت بتغذي العضلتين واحدة
+
+91
+00:06:36,870 --> 00:06:41,190
+منهم او التنتين هيفقده اللي هو التغذية الدمويةإذا
+
+92
+00:06:41,190 --> 00:06:44,450
+فقدت التغذية الدموية سواء كان بشكل كلي أو بشكل
+
+93
+00:06:44,450 --> 00:06:49,290
+جزئي بيصير في عندي موطلي الأنسجة وبالتالي نكروسيك
+
+94
+00:06:49,290 --> 00:06:52,170
+تذكروا المحاضرة الصحيفة اللي قبل ما اتكلمنا عن
+
+95
+00:06:52,170 --> 00:06:55,710
+الكوليسترديوم تيتاني بإن أفضل ميديا إلها cooked
+
+96
+00:06:55,710 --> 00:07:01,150
+meatاللحم المطبوخ يعني بمعنى آخر ال muscles تمام
+
+97
+00:07:01,150 --> 00:07:05,890
+هتشكل غذاء مهم جدا للبكتيريا خاصة الأعضالات اللي
+
+98
+00:07:05,890 --> 00:07:09,590
+جونا ميتة ال necrotic tissue وبالتالي جزء مهم جدا
+
+99
+00:07:09,590 --> 00:07:12,890
+من عملية ال treatment انه ازالة اللي هو ال
+
+100
+00:07:12,890 --> 00:07:15,750
+devitalized tissue أو الأنسجة التالفة أو الأنسجة
+
+101
+00:07:15,750 --> 00:07:21,170
+الميتة عن طريق جونا better الأعضاء أو قطع اذا في
+
+102
+00:07:21,170 --> 00:07:26,810
+عندي كمان مرةنتيجة حتمية لشغل تاني رقم واحد
+
+103
+00:07:26,810 --> 00:07:30,450
+النكروسيز الناتج عن ال alpha-toxin والنكروسيز
+
+104
+00:07:30,450 --> 00:07:34,710
+الناتج عن ال gas production ان في اندي كام كبير من
+
+105
+00:07:34,710 --> 00:07:38,790
+الأنسجة هتصير ميتة هذا بسهل عملية نمو الميكرو
+
+106
+00:07:38,790 --> 00:07:43,420
+أورجينزيمالصورة ده مش واضحة كتير لكن هي فكرتها انه
+
+107
+00:07:43,420 --> 00:07:47,480
+ال .. ال .. ال .. ال sport لو انا اعطيت البكتيريا
+
+108
+00:07:47,480 --> 00:07:50,600
+اللي هي sport forming بكتيريا اعطيتها درجة حرارة
+
+109
+00:07:50,600 --> 00:07:54,520
+مناسبة درجة حرارة مناسبة حتلاقيها .. حتلاقيها
+
+110
+00:07:54,520 --> 00:07:57,220
+عاملة germination ايش يعني germination؟ تحولت من
+
+111
+00:07:57,220 --> 00:08:02,640
+خلية resting resting يعني مستريحة غير ناشطة أيضيا
+
+112
+00:08:02,640 --> 00:08:06,860
+إلى خلية vegetative يعني ناشطة أيضيا تتكاثر،
+
+113
+00:08:06,860 --> 00:08:10,210
+تنقسم، تتغذىو على فكرة لازم .. لازم ننوح لهذا
+
+114
+00:08:10,210 --> 00:08:13,270
+النقطة الـ Clostridium Perifringens من أسرع
+
+115
+00:08:13,270 --> 00:08:17,430
+الميكروبات على وجه الأرض انقساما فتحتاج ten
+
+116
+00:08:17,430 --> 00:08:22,030
+minutes only to divide .. to multiply يعني أقصر من
+
+117
+00:08:22,030 --> 00:08:25,450
+مين؟ أقصر من اللي هو ال .. ال .. ال .. ال time
+
+118
+00:08:25,450 --> 00:08:29,490
+required for each E.coli ال very common بكتيريا
+
+119
+00:08:29,490 --> 00:08:33,420
+عشرين دقيقة نعم في حالة عشرين دقيقةإذا هذه very
+
+120
+00:08:33,420 --> 00:08:37,180
+rapid growing بكتيريا تخيلوا انه هتصل ل ال quorum
+
+121
+00:08:37,180 --> 00:08:41,460
+sensing تبعها في وقت قصير جدا وقت قصير جدا
+
+122
+00:08:41,460 --> 00:08:45,720
+وبالتالي إنتاجها للتكسين برضه هيكون very rapid
+
+123
+00:08:45,720 --> 00:08:50,720
+انتجت تكسين في الغذاء لوثت الغذاء وصار في عندي
+
+124
+00:08:50,720 --> 00:08:56,840
+تكسين في الغذاء الآن غالبا الغذاء بنرفع حرارته
+
+125
+00:08:56,840 --> 00:09:00,630
+احنا صح ولا لا؟ممكن يا شباب ان معظم ال X-Toxin انت
+
+126
+00:09:00,630 --> 00:09:04,210
+عارفين كلها heat labile heat labile ممكن الجزء منه
+
+127
+00:09:04,210 --> 00:09:08,290
+يتدمر بالحرارة لكن لو كان عملية تسخين تدفئة فقط
+
+128
+00:09:08,290 --> 00:09:13,370
+للغذاء مش تسخين ال toxin will be there وفي كمان
+
+129
+00:09:13,370 --> 00:09:17,690
+نقطة كتير مهمة لما نسخن الحرارة لدرجة غير مناسبة
+
+130
+00:09:17,690 --> 00:09:23,460
+لنمو البكتيريا هتتجرثم هتكون sport مرة تانيةتكوّل
+
+131
+00:09:23,460 --> 00:09:28,020
+الـ spore مرة تانية هيعمل عندى قضية تانية ايش
+
+132
+00:09:28,020 --> 00:09:33,780
+القضية ان ال spores و هي بتتجرثم هتتحلل من الخلية
+
+133
+00:09:33,780 --> 00:09:37,440
+جزء من التكسين اللى كان جوا الخلايا هيطلع برضه الى
+
+134
+00:09:37,440 --> 00:09:42,360
+الخارج فسواء البكتيريا vegetative و بتنتج تكسينأو
+
+135
+00:09:42,360 --> 00:09:45,760
+Spirulating هيتكوم من برضه إيه؟ تكسين، إذا فين دي
+
+136
+00:09:45,760 --> 00:09:49,800
+كمية تكسين؟ لا بأس بيها هذا التكسين إذا كان من نوع
+
+137
+00:09:49,800 --> 00:09:52,800
+Ipsilin أو Iota قد يحدث زي ما حكينا
+
+138
+00:09:52,800 --> 00:09:55,600
+gastrointestinal symptoms اللي هي ال food
+
+139
+00:09:58,860 --> 00:10:01,880
+هذه الصورة بتوضح أنها بالظبط يعني الفكرة الأساسية
+
+140
+00:10:01,880 --> 00:10:06,040
+لل food poisoning في عندي في المنطقة هنا spore
+
+141
+00:10:06,040 --> 00:10:11,080
+contamination cooking يعني غير كافي ال cooking
+
+142
+00:10:11,080 --> 00:10:17,300
+لقتل الجراثيم slow cooling التبريد البطيء التبريد
+
+143
+00:10:17,300 --> 00:10:23,260
+البطيء للغذاءبكون أحد أهم أسباب مقدرة البكتيريا
+
+144
+00:10:23,260 --> 00:10:27,600
+على النمو بشكل كثيف خاصة لما تصل للحرارة خمسة و
+
+145
+00:10:27,600 --> 00:10:31,280
+خمسين درجة مئوية بتلاقي أنه الأسبوع صار لها
+
+146
+00:10:31,280 --> 00:10:34,960
+germination و multiplication سريع ومتكلم عن cooked
+
+147
+00:10:34,960 --> 00:10:39,280
+meat صح؟ cooked meat واحنا قلنا قبل شوية أن الوسط
+
+148
+00:10:39,280 --> 00:10:44,480
+المفضل للبكتيريا هو ال cooked meat إذا فين دي ظروف
+
+149
+00:10:44,480 --> 00:10:48,350
+مثالية لنمو البكتيريابيصير ان دي germination بيصير
+
+150
+00:10:48,350 --> 00:10:51,910
+ان دي rapid proliferation بيصير ان او لا اللي هو
+
+151
+00:10:51,910 --> 00:10:55,690
+الطعام اللي محتوى على التكسين ليس بالضرورة
+
+152
+00:10:55,690 --> 00:10:57,910
+البكتيريا وانما فقط التكسين بيصير ان اللي هو ال
+
+153
+00:10:57,910 --> 00:11:01,630
+gastro intestinal illness كمان شغل تكون فيه دياريا
+
+154
+00:11:01,630 --> 00:11:06,870
+يبقى دياريا وال .. يعني ال organism ال organism
+
+155
+00:11:06,870 --> 00:11:08,770
+will be .. لأ ال organism will be discharged into
+
+156
+00:11:08,770 --> 00:11:12,550
+the environmentيعني بتاعة ال cycle بتكتمل ان ال
+
+157
+00:11:12,550 --> 00:11:16,510
+environment هتلوث الغذاء و مرة تانية هيرجع
+
+158
+00:11:16,510 --> 00:11:21,850
+لالانسان ال pathology تبع البكتيريا بقولنا it is
+
+159
+00:11:21,850 --> 00:11:26,260
+not highly invasiveلكن شوفوا .. هي صحيح مش
+
+160
+00:11:26,260 --> 00:11:31,900
+invasive لكن ال effect تبعها very invasive، ليش؟
+
+161
+00:11:31,900 --> 00:11:35,840
+لأنه حتى و هي local infection عملت destruction في
+
+162
+00:11:35,840 --> 00:11:40,600
+مناطق بعيدة، نتيجة من؟ نتيجة الغاز اللي أنتجته،
+
+163
+00:11:40,600 --> 00:11:43,780
+نتيجة التكسين اللي أنتجته، وبالتالي هي صحيح non
+
+164
+00:11:43,780 --> 00:11:47,840
+-invasive لكن للأسف can produce devastating effect
+
+165
+00:11:48,930 --> 00:11:51,810
+requires damaged and dead tissue for anaerobic
+
+166
+00:11:51,810 --> 00:11:54,590
+condition أحد الميزات لدى البكتيريا اللى يجب أن
+
+167
+00:11:54,590 --> 00:11:57,190
+نذكرها ونميزها عن باقي أنواع البكتيريا من نوع
+
+168
+00:11:57,190 --> 00:12:00,530
+الكلسترديو أنه it is not strictly anaerobic
+
+169
+00:12:00,530 --> 00:12:04,130
+البكتيريا not strictly anaerobic لما قسمنا
+
+170
+00:12:04,130 --> 00:12:09,270
+البكتيريا بحسب حالتها للأكسجينقسمناها إلى خمس
+
+171
+00:12:09,270 --> 00:12:13,070
+أصناف أذكركم فيهم aerobic على الجهة هذه anaerobic
+
+172
+00:12:13,070 --> 00:12:16,750
+على الجهة هذه في النصف facultative micro
+
+173
+00:12:16,750 --> 00:12:19,730
+aerophilic اللي قريبة من ال aerobic و هنا حاجة
+
+174
+00:12:19,730 --> 00:12:22,530
+اسمها aerotolerant anaerobic ال aerotolerant
+
+175
+00:12:22,530 --> 00:12:26,690
+anaerobic معناها ان هي لا هوائية لا تستطيع استخدام
+
+176
+00:12:26,690 --> 00:12:31,240
+ال oxygenلكنها طورت قالية لتحمل وجود الأكسجين
+
+177
+00:12:31,240 --> 00:12:35,460
+بينما ال .. ال .. ال obligate anaerobic لم تتحمل
+
+178
+00:12:35,460 --> 00:12:39,160
+وجود الأكسجين، إذن مين أفضل، اللي له أفضلية، الـ
+
+179
+00:12:39,160 --> 00:12:43,080
+Aerotolerant، anaerobic، هي بكتيرية لا هواية، لكن
+
+180
+00:12:43,080 --> 00:12:48,000
+لو وجدت في بيئة فيها أكسجين، تمام؟ عارفين ليش مهم
+
+181
+00:12:48,000 --> 00:12:53,780
+نقول كلام هذا؟ لأنه كان أحد العلاجات المقترحة هو
+
+182
+00:12:53,780 --> 00:12:55,200
+تهوية الأنسجة
+
+183
+00:12:57,460 --> 00:13:00,920
+إيش هي تهوية الأنسجة؟ بكتيريا ليها هوائية، لو انت
+
+184
+00:13:00,920 --> 00:13:04,220
+وفرت لها ظروف من ال oxygen، يعني تحط oxygen على
+
+185
+00:13:04,220 --> 00:13:07,020
+الأنسجة، تمام؟ انت بتعمل destruction لمين؟
+
+186
+00:13:07,020 --> 00:13:10,040
+للبكتيريا، لكن البكتيريا هذه طلعت ايه؟
+
+187
+00:13:10,040 --> 00:13:14,320
+Aerotolerant، Aerotolerant Anaero. كمان مرة فيندي
+
+188
+00:13:14,320 --> 00:13:17,260
+هنا اللي هو ال fermentation of muscle carbohydrate
+
+189
+00:13:17,260 --> 00:13:20,000
+result in the formation of gas، الغاز هذا
+
+190
+00:13:20,000 --> 00:13:23,350
+بنستفيدله شوية دلتين، عشان يبقى معاهم تانيالغاز ان
+
+191
+00:13:23,350 --> 00:13:26,490
+الفكرة اللي حاكيناها في فصل الأضلات عن بعضها البعض
+
+192
+00:13:26,490 --> 00:13:29,750
+أو الأنسج عن بعضها البعض وفي كمان شغل تاني انه it
+
+193
+00:13:29,750 --> 00:13:34,930
+produces foul smelling .. foul smelling odor يعني
+
+194
+00:13:34,930 --> 00:13:41,840
+رائحة كريهة من مكان اللي هو الإصابةهذه صورة لأنسجة
+
+195
+00:13:41,840 --> 00:13:46,860
+فيها البكتيريا وهو بتبيننا gas-filled spaces يبجى
+
+196
+00:13:46,860 --> 00:13:50,140
+وين فيه بكتيريا، فيه عندي ايش الآن؟ فيه عندي
+
+197
+00:13:50,140 --> 00:13:54,460
+فراغات، الفراغات ناتجة عن اللي هو تكون الغاز
+
+198
+00:13:54,460 --> 00:13:58,260
+البكتيريا
+
+199
+00:13:58,260 --> 00:13:59,020
+sports
+
+200
+00:14:02,000 --> 00:14:05,620
+هنا بالكتير اعرفوا فرق بينها و بين الكلسترديوم
+
+201
+00:14:05,620 --> 00:14:10,340
+تيتانى ان الكلسترديوم تيتانى كانت ال sport
+
+202
+00:14:10,340 --> 00:14:15,400
+terminal صح هنا central او sub terminal للأسف يعني
+
+203
+00:14:15,400 --> 00:14:19,480
+مش في موقع واحد برضه في موقعين يا اما sub terminal
+
+204
+00:14:19,480 --> 00:14:24,650
+يا اما central لكن ovalcan survive exposure to
+
+205
+00:14:24,650 --> 00:14:27,610
+oxygen for short periods of time and sometimes
+
+206
+00:14:27,610 --> 00:14:29,910
+referred to as aerotolerant أنا أقوله بالكلام اللي
+
+207
+00:14:29,910 --> 00:14:33,450
+حكيناه في اللوحة السابقة 3000 خط تحت non-motile
+
+208
+00:14:33,450 --> 00:14:37,610
+لإنه المعلومة السابقة عن الهيكلسطرديوم تتني إنها
+
+209
+00:14:37,610 --> 00:14:41,530
+motile with peritricous flagella إذن أحد الصفات
+
+210
+00:14:41,530 --> 00:14:45,810
+اللي بنميز التنتين عن بعضهم terminal و sub
+
+211
+00:14:45,810 --> 00:14:49,750
+terminal sport أو central واحدة motile واحدة non
+
+212
+00:14:49,750 --> 00:14:53,470
+-motilethey form capsule و هذا اللي اعتقد انه
+
+213
+00:14:53,470 --> 00:14:59,710
+تكوينها لكابسول بتشبه في صفتها هذه بتشبه له قصة ال
+
+214
+00:14:59,710 --> 00:15:04,330
+basilis anthracis انه داخل جسم الحيوان المصاب او
+
+215
+00:15:04,330 --> 00:15:09,250
+الإنسان المصاب بتكون انها capsuleمن ال enzymes
+
+216
+00:15:09,250 --> 00:15:12,250
+اللي مشهورة وبتنتجها البكتيريا دي حال اسمها
+
+217
+00:15:12,250 --> 00:15:15,750
+collagenase حال اسمها hyaluronidase وحال اسمها
+
+218
+00:15:15,750 --> 00:15:19,450
+DNA's يمكن فاطما نذكر في بداية المحاضرات عن
+
+219
+00:15:19,450 --> 00:15:23,690
+الاخلسترديوم ان هي واحدة من ال most diverse
+
+220
+00:15:23,690 --> 00:15:26,790
+metabolic activity يعني عندها تمتلك metabolic
+
+221
+00:15:26,790 --> 00:15:31,380
+activity متنوعةبتذكرنا بمين ب Sodomonas aeruginosa
+
+222
+00:15:31,380 --> 00:15:35,340
+مع فارق التشبيه هدى gram positive هدى gram
+
+223
+00:15:35,340 --> 00:15:40,460
+negative هدى aerobic وهدى anaerobic لكن التنتين
+
+224
+00:15:40,460 --> 00:15:43,560
+بيشتركوا في صفة انه عندهم مقدرة هائلة على ال
+
+225
+00:15:43,560 --> 00:15:47,140
+metabolism and they can survive in low nutrient
+
+226
+00:15:47,140 --> 00:15:53,080
+media يعني في أوصات زراعية ضعيفة التخذية مستوى
+
+227
+00:15:53,080 --> 00:15:55,980
+التخذية فيها او ال nutrients ضعيف تستطيع التنتين
+
+228
+00:15:55,980 --> 00:15:59,580
+انهم ينمو فيهاالـ cultural characteristics
+
+229
+00:15:59,580 --> 00:16:04,660
+البكتيريا بتنمو على blood agar تنمو على ال blood
+
+230
+00:16:04,660 --> 00:16:08,240
+agar producing double zone of hemolysis ايه يعني
+
+231
+00:16:08,240 --> 00:16:11,180
+double؟ أول مرة المصطلح هتمر معانا كنا بنتكلم عن
+
+232
+00:16:11,180 --> 00:16:15,400
+zone of hemolysis، ياما Alpha، ياما Beta، ياما بس،
+
+233
+00:16:15,400 --> 00:16:19,700
+في غيرهم؟ الجامعة مافيش فيها hemolysis لكن هنا it
+
+234
+00:16:19,700 --> 00:16:22,180
+produces كمان مرة double zone of hemolysis،
+
+235
+00:16:22,180 --> 00:16:25,160
+هحنحاول نشوف صورة إيها، يارد تكون واضحة الصورة
+
+236
+00:16:25,160 --> 00:16:29,600
+هنا، هاي المستعمرة، تطلع عليهاشوفوا الماوس اللي
+
+237
+00:16:29,600 --> 00:16:32,380
+أنا على مين بقشر على منطقة خالية من اللون تماما
+
+238
+00:16:32,380 --> 00:16:38,740
+Beta Hemolytic لكن في منطقة كمان شايفينها هي حدود
+
+239
+00:16:38,740 --> 00:16:44,880
+وهي حدود بيبينها مش مبينة عندكوا الأولى complete
+
+240
+00:16:44,880 --> 00:16:48,480
+hemolysis التانية مش complete hemolysis فبسموها
+
+241
+00:16:48,480 --> 00:16:51,440
+double zone of hemolysis البكتيريا قدامكوا هنا
+
+242
+00:16:51,440 --> 00:16:55,220
+مبينة اشي مصبوغ gram negative واشي مصبوغ gram
+
+243
+00:16:55,220 --> 00:16:58,770
+positive هل يمكن ذلك البكتيرياgram positive ولا
+
+244
+00:16:58,770 --> 00:17:01,930
+gram negative؟ gram positive هذه البكتيريا ترليفاش
+
+245
+00:17:01,930 --> 00:17:05,390
+يبين من جزء منها إذا ملاحظين هنا فيها مثلا حمرا
+
+246
+00:17:05,390 --> 00:17:12,380
+وهذه purple صح؟ لأ مش capsuleلأن البكتيريا لما
+
+247
+00:17:12,380 --> 00:17:17,120
+تبدأ تكون Spores تمام بتفقد ال cell أو بتفقد ال
+
+248
+00:17:17,120 --> 00:17:20,400
+vitality بس ال wall ومين المسؤول عن انه gram
+
+249
+00:17:20,400 --> 00:17:22,420
+positive ولا gram negative؟ هو ال cell wall
+
+250
+00:17:22,420 --> 00:17:25,460
+فبتلاقي بالفعل بعض البكتيريا .. بعض الخلايا
+
+251
+00:17:25,460 --> 00:17:29,440
+هتلاقيها gram negative ولكن لاحظوا they are large
+
+252
+00:17:29,440 --> 00:17:32,880
+bacteria they are large بس ال life they are not
+
+253
+00:17:32,880 --> 00:17:35,400
+like those of Escherichia coli أو Sodomonas
+
+254
+00:17:35,400 --> 00:17:40,560
+aeruginosa they are huge بس ال lifeهي كمان صورة
+
+255
+00:17:40,560 --> 00:17:42,960
+بتوضح لنا كمان الكلام اللي حاكيناه هي في عندي هنا
+
+256
+00:17:42,960 --> 00:17:47,400
+مجموعة من الخلايا أو المستعمرات محاطة ب zone of
+
+257
+00:17:47,400 --> 00:17:51,200
+homolysis وفي عندي هنا بعيد شايفينها؟ شايفين هذه
+
+258
+00:17:51,200 --> 00:17:56,280
+ال zone؟ ولا مش مبينة؟ و انا بقى بال mouse؟ لا مش
+
+259
+00:17:56,280 --> 00:17:59,360
+مبين كتير بس هتشوفوها في ال slide ان شاء الله
+
+260
+00:17:59,360 --> 00:18:04,000
+هتكون واضحة كتير في ال slides لأن ال zone very
+
+261
+00:18:04,000 --> 00:18:07,920
+large و بعيدة كتير عن ال zone اللي هو الأصليهذه
+
+262
+00:18:07,920 --> 00:18:11,020
+صورة لـ Necrotic Tissue صورة لـ Necrotic Tissue
+
+263
+00:18:11,020 --> 00:18:16,680
+يعني نسيج body يموت و لاحظه اللون اللي هو الأسود
+
+264
+00:18:16,680 --> 00:18:19,700
+واضح فيه طبعا اللون الأسود هذا ممكن يكون ناتج عن
+
+265
+00:18:19,700 --> 00:18:23,760
+ال H2S اللي هو بينتج من ال .. طبعا برتباطه مع
+
+266
+00:18:23,760 --> 00:18:26,340
+مركبة الحديد اللي في الأنسجة يعني أن هذا اللون
+
+267
+00:18:27,640 --> 00:18:32,200
+المايكروب الثالث في السلسلة مايكروب جدا خطير اللي
+
+268
+00:18:32,200 --> 00:18:36,700
+هو الكلوستروديوم بوتلونيوم و ذكرنا مرة معلومة عنه
+
+269
+00:18:36,700 --> 00:18:40,960
+انه the most potent toxin known to man اعلى او او
+
+270
+00:18:40,960 --> 00:18:44,340
+اقوى سم معروف للانسان هو الكلوستروديوم بوتلونيوم
+
+271
+00:18:47,500 --> 00:18:51,620
+although rare على الرغم من قدرته إلا أنه بيكتسب
+
+272
+00:18:51,620 --> 00:18:58,120
+publicity إعلاميا نظرا لل end result أذكر كنا
+
+273
+00:18:58,120 --> 00:19:02,100
+بندرس في ال master لطلبة طلبة ال food microbiology
+
+274
+00:19:02,100 --> 00:19:04,300
+وكنا بنعرض عليهم case study فحتة ال case studies
+
+275
+00:19:04,300 --> 00:19:08,920
+اللي وقعت بين أدينا عن شعب أو راجل مصري عايش في
+
+276
+00:19:08,920 --> 00:19:13,120
+الولايات المتحدة الأمريكية توفي و من ثم توفي
+
+277
+00:19:13,120 --> 00:19:18,170
+تزوجته أو العكس مش فاكر بالضبط القصةو تم التحقق من
+
+278
+00:19:18,170 --> 00:19:20,770
+.. احنا بتكلم على كيف انحقق في حالات ال food
+
+279
+00:19:20,770 --> 00:19:25,510
+poisoning فتم التحقق و في الآخر لاجينا انه السبب
+
+280
+00:19:25,510 --> 00:19:31,350
+هو الفسيخ مابقطله فسيخ من مصر من أهله تمام؟
+
+281
+00:19:31,460 --> 00:19:35,420
+والفسيخة ده كانت معمولة بطريقة غير دقيقة الملح لم
+
+282
+00:19:35,420 --> 00:19:40,440
+يغطي كل المناطق فببعض النقاط في السمك لم يصلها
+
+283
+00:19:40,440 --> 00:19:43,320
+الملح وبالتالي استطاعت البكتيريا تنمو في تلك
+
+284
+00:19:43,320 --> 00:19:48,420
+المناطق وتنتج تكسين فكمية قليلة من التكسين في كمية
+
+285
+00:19:48,420 --> 00:19:52,120
+قليلة من نسيج السمك كانت كافية لقتل الراجل وزوجته
+
+286
+00:19:52,120 --> 00:19:56,960
+بال Clostridium Botulinumخلّينا نقول إنه على الرغم
+
+287
+00:19:56,960 --> 00:20:00,860
+من ندرة المرض إلا إنه نهاياته devastating فبالتالي
+
+288
+00:20:00,860 --> 00:20:08,200
+بيكتسب فعلاميا سمعة سيّارة it is a disease caused
+
+289
+00:20:08,200 --> 00:20:11,480
+by the ingestion of food containing the neurotoxin
+
+290
+00:20:11,480 --> 00:20:14,160
+produced by Clostridium Botulinum إذن Botulism
+
+291
+00:20:14,160 --> 00:20:20,920
+هيتعريفه هو عبارة عن مرض ينتج عن تناول طعام بيحتوي
+
+292
+00:20:20,920 --> 00:20:23,960
+على ال neurotoxin بتاع اللي هو Clostridium
+
+293
+00:20:23,960 --> 00:20:27,850
+Botulinumشوفوا ال symptoms بقولنا ان ال symptoms
+
+294
+00:20:27,850 --> 00:20:33,230
+ال early ones usually are يعني acute digestive
+
+295
+00:20:33,230 --> 00:20:37,670
+disturbances بيتبعها nausea و vomiting and
+
+296
+00:20:37,670 --> 00:20:42,630
+possibly دياريا بيصحبهم ايضا fatigue تعب و
+
+297
+00:20:42,630 --> 00:20:47,230
+dizziness يعني نوع من الدخة و ال headache او الصدع
+
+298
+00:20:47,230 --> 00:20:51,730
+بعد ال دياريا و ال vomiting بصير عنده constipation
+
+299
+00:20:51,730 --> 00:20:55,210
+امساكو ممكن يصير عنده double vision شوف الواحد
+
+300
+00:20:55,210 --> 00:20:58,970
+اتنين تمام double vision بس عنده كمان أيضا
+
+301
+00:20:58,970 --> 00:21:01,830
+difficulty in swallowing and difficulty in
+
+302
+00:21:01,830 --> 00:21:05,630
+speaking يعني صعوبة في البلاء و صعوبة في التحدث قد
+
+303
+00:21:05,630 --> 00:21:11,230
+يشكو المريض من جفاف في الحلق وشبه يعني ضيقاق في
+
+304
+00:21:11,230 --> 00:21:17,200
+الحنجرة تبعتهالان هذه الأعراض كلها مش مشكلة نيجي
+
+305
+00:21:17,200 --> 00:21:20,840
+للعراض الرئيسي اللي بيقتل المريض اللي هو ال
+
+306
+00:21:20,840 --> 00:21:24,320
+involuntary muscle become paralyzed العضلات اللي
+
+307
+00:21:24,320 --> 00:21:28,240
+لا إيرادية يحصل فيها paralysis و ال paralysis may
+
+308
+00:21:28,240 --> 00:21:30,620
+spread to the respiratory system و غالبا المريض
+
+309
+00:21:30,620 --> 00:21:35,280
+بيموت بالفعل من respiratory failure فشل في الجهاز
+
+310
+00:21:35,280 --> 00:21:40,820
+التنافذ تذكروا في ال tetanus اتكلمنا عن حاجة
+
+311
+00:21:40,820 --> 00:21:45,580
+نيوناتل تيتانوسسأعطيكم سؤال في الامتحان، ما هي
+
+312
+00:21:45,580 --> 00:21:48,400
+أمراض للـ Neonates؟ اتعرفونها؟ اتعرفونها؟
+
+313
+00:21:48,400 --> 00:21:51,480
+اتعرفونها؟
+
+314
+00:21:51,480 --> 00:21:54,260
+اتعرفونها؟
+
+315
+00:21:55,460 --> 00:22:02,600
+أخدت حاسمة neonatal tetanus وأخدت group B
+
+316
+00:22:02,600 --> 00:22:06,900
+streptococci اللي هو مولود لما بيولد و بيمر لأم
+
+317
+00:22:06,900 --> 00:22:13,160
+مصابة او كاريار بياخد جنة اما نيومونيا او سبتسيميا
+
+318
+00:22:13,160 --> 00:22:16,800
+او meningitis اذا في مجموعة كبيرة من الميكروبات
+
+319
+00:22:16,800 --> 00:22:20,600
+اللي درسناهم قد يحدثوا أضرار لمين للنيوناتر
+
+320
+00:22:23,810 --> 00:22:27,550
+Infant Potualism، عشان نربطكم إيها بمعلومة شعبية
+
+321
+00:22:27,550 --> 00:22:33,390
+بتعرفوها أن الرضّع لا يسمح لهم بتناول عسل،
+
+322
+00:22:33,390 --> 00:22:36,970
+بتعرفوها المعلومة أصلا ولا بتعرفوها أشلأ هو السبب
+
+323
+00:22:36,970 --> 00:22:43,590
+الحقيقي لعدم اعطاء او لمنع اعطاء الرضّع العسل هو
+
+324
+00:22:43,590 --> 00:22:47,070
+احتواء العسل على ال spores تبع ال Clostridium
+
+325
+00:22:47,070 --> 00:22:50,550
+Botulinum يعني اذا اردت ان تقوم بعزل Clostridium
+
+326
+00:22:50,550 --> 00:22:54,310
+Botulinum Spores تعزلها من وين؟ من العسل طب لماذا
+
+327
+00:22:54,310 --> 00:22:57,850
+الرضّع بالذات لا يسمح لهم؟ لماذا ال adult؟ لو انت
+
+328
+00:22:57,850 --> 00:23:02,750
+اخدت طنمن ال .. البكتيريا وأكلتوا أكل لن يحدث لك
+
+329
+00:23:02,750 --> 00:23:07,670
+شيء تمام؟ بينما .. بينما ال infants لأنه ال normal
+
+330
+00:23:07,670 --> 00:23:12,190
+microbiota بتكون غير مكتملة فلا تستطيع مكافحة أو
+
+331
+00:23:12,190 --> 00:23:14,710
+مجابهة من ال clostridium botulinum وبالتالي اللي
+
+332
+00:23:14,710 --> 00:23:16,770
+بيصير فيه هنا growth and multiplication في ال
+
+333
+00:23:16,770 --> 00:23:20,470
+intestinal tract للبكتيريا وبتنتج botulinum texin
+
+334
+00:23:20,470 --> 00:23:23,970
+ويمتص عبر مين؟ عبر الأمعاق فبصير عنده infant
+
+335
+00:23:23,970 --> 00:23:31,860
+botulism وهو برضه كمان خاترإذا .. إذا قصة عدم
+
+336
+00:23:31,860 --> 00:23:36,740
+اجتمال ال normal micro بيوتر، إذا الأطفال الرضع لا
+
+337
+00:23:36,740 --> 00:23:40,680
+يسمح لهم أو لا ينصح بيعطاهم جنة العسل على الأقل
+
+338
+00:23:40,680 --> 00:23:47,340
+مدة سنةبيعتبروه واحد من أهم أسباب الموت الفجائي
+
+339
+00:23:47,340 --> 00:23:50,700
+للأطفال، فجأة، كان كويس الأولاد، مافي عندهم مشكلة،
+
+340
+00:23:50,700 --> 00:23:54,060
+فجأة مات، موت الفجأة، تمام؟ عند الأطفال، هذا أحد
+
+341
+00:23:54,060 --> 00:23:58,820
+أسباب الموت الفجأة، في كمان الأكبار ممكن يصيروا
+
+342
+00:23:58,820 --> 00:24:03,460
+عندهم botulism دون أن يتناولوا ال toxin، لو صار
+
+343
+00:24:03,460 --> 00:24:11,690
+عندنا تلوثتلوث للجروح بالبكتيريا، البكتيريا بتقدر
+
+344
+00:24:11,690 --> 00:24:15,610
+تتكتر في الجروح تبقى و تنتج التوكسين أيضا و بسمها
+
+345
+00:24:15,610 --> 00:24:19,650
+wound botulism، ففي عندي botulism اللي هو ال food
+
+346
+00:24:19,650 --> 00:24:23,070
+poisoning، في عندي infant botulism و في عندنا اللي
+
+347
+00:24:23,070 --> 00:24:24,210
+هو ال wound botulism
+
+348
+00:24:29,760 --> 00:24:34,080
+هذه بتوضح لنا التلات أنواع من البوتوليزم زي ما
+
+349
+00:24:34,080 --> 00:24:36,000
+نقول ناكل استوديو بوتولانم in food، توكسين
+
+350
+00:24:36,000 --> 00:24:40,020
+produced، توكسين ingested، توكسين in bloodstream،
+
+351
+00:24:40,020 --> 00:24:43,080
+ممكن يصيح لنا attacks in neurons، وبعدين بيعملنا
+
+352
+00:24:43,080 --> 00:24:45,800
+ال flaccid paralysis. ليه سميناه flaccid paralysis
+
+353
+00:24:45,800 --> 00:24:51,130
+احنا؟ عكس من التتانوس، سميناه spastic paralysisالـ
+
+354
+00:24:51,130 --> 00:24:54,270
+Flaccid Paralysis هنا لأنه كانت الميكانيزم of
+
+355
+00:24:54,270 --> 00:24:58,090
+action للتكسين اللي درسناها سابقا بتقول انه it
+
+356
+00:24:58,090 --> 00:25:02,430
+prevents the production of neurotransmitter اللي
+
+357
+00:25:02,430 --> 00:25:06,750
+هو ايش اسمه؟ أسيتالكولين إذا مافيش عندي release
+
+358
+00:25:06,750 --> 00:25:11,270
+لأو إنتاج لل neurotransmitter اللي هو
+
+359
+00:25:11,270 --> 00:25:14,830
+الأسيتالكولين يبقى مافيش عندي response فبتعرفي
+
+360
+00:25:14,830 --> 00:25:17,230
+عندي Flaccid Paralysis وانا قلتلكوا أحد
+
+361
+00:25:17,230 --> 00:25:22,500
+الاستخدامات للبوتلونين تكسينبالتجميل إنه واحد
+
+362
+00:25:22,500 --> 00:25:24,840
+اختيار زي .. زي .. زي الاختيار اللي قدامنه هنا
+
+363
+00:25:24,840 --> 00:25:30,400
+عنده تجعيد حقنها صار عنده شلل في العضلات شلل
+
+364
+00:25:30,400 --> 00:25:33,740
+ارتخائي فبترتخي العضلات فهو كأنه عيش لها مافيش
+
+365
+00:25:33,740 --> 00:25:38,340
+تجعيد لكن بعد فترة بيستعيد لإنه بيحقنوه بكميات
+
+366
+00:25:38,340 --> 00:25:43,160
+ضئيلة جدا جدا .. لما نقول جدا من هنا لآخر الفصل
+
+367
+00:25:43,160 --> 00:25:44,100
+جدا لإنه
+
+368
+00:25:46,690 --> 00:25:50,590
+قد يستخدم كعلاج طبي للناس اللي عندهم asbestic
+
+369
+00:25:50,590 --> 00:25:56,210
+paralysis واحد صار عنده شرل نصفين مابيقدروش يعملوا
+
+370
+00:25:56,210 --> 00:25:59,470
+rehabilitation إعادة تأهيل للعضلات إلا بعد فترة
+
+371
+00:25:59,470 --> 00:26:05,930
+لما يستقر وضعه الصح فبتكون العضلات تيبست فبكون فيه
+
+372
+00:26:05,930 --> 00:26:15,010
+صعوبة هذه الصعوبة
+
+373
+00:26:16,160 --> 00:26:20,220
+بنتجاوزها بإنه ممكن يحقن المريض بيه اللي هو ال ..
+
+374
+00:26:20,220 --> 00:26:23,600
+ال botulinum toxin اللي هو كمان مرة very diluted
+
+375
+00:26:23,600 --> 00:26:26,560
+بيعمل عكس ال .. ال .. ال asbestos بيعملش لان
+
+376
+00:26:26,560 --> 00:26:30,840
+flaccid protein فبتسيل عضلات لينا فيمكن حينها انه
+
+377
+00:26:30,840 --> 00:26:35,570
+القيام بعمليات مريض رياضيInfant botulism حكينا عنه
+
+378
+00:26:35,570 --> 00:26:36,530
+و wound botulism حكينا عنه
+
+379
+00:26:36,530 --> 00:26:53,230
+فشششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششششش
+
+380
+00:26:54,870 --> 00:26:58,270
+حكينا عن التوكسين انه عبارة عن heat لبي يعني لو
+
+381
+00:26:58,270 --> 00:27:04,030
+سخننا الغذاء بشكل كافي غالبا بيدمر التوكسين if
+
+382
+00:27:04,030 --> 00:27:07,530
+heated to a certain temperature so it can be
+
+383
+00:27:07,530 --> 00:27:10,510
+destroyed if heated and held at 80 degrees for 10
+
+384
+00:27:10,510 --> 00:27:14,190
+minutes or longer عادة 80 درجة مئوية لمدة 10 دقايق
+
+385
+00:27:14,190 --> 00:27:19,010
+او اطول غالبا التوكسين بتدمرفى نقطة بدى أحكيلكوا
+
+386
+00:27:19,010 --> 00:27:24,250
+إياها نقطة كتير مهمة انه الاطبط ال botulinum أو ال
+
+387
+00:27:24,250 --> 00:27:29,130
+botulism بالمعلبات فى نوعين من المعلبات فى
+
+388
+00:27:29,130 --> 00:27:33,490
+commercial canned food و فى home made canned food
+
+389
+00:27:33,770 --> 00:27:37,190
+ماذا يعني homemade؟ يعني تصنيع بيتي طبعا احنا مش
+
+390
+00:27:37,190 --> 00:27:40,490
+شائع اننا في فلسطين هذا الكلام ماعناش حاجة اسمها
+
+391
+00:27:40,490 --> 00:27:45,190
+canned food منزلي لكن في الريف الأوروبي والامريكي
+
+392
+00:27:45,190 --> 00:27:51,030
+غالبا بيصنعوا معلبات زي الذرة زي المربيات المربة
+
+393
+00:27:51,030 --> 00:27:59,610
+يعني بشكل منزلي الان في اني canned food كمرة
+
+394
+00:27:59,610 --> 00:28:04,710
+commercial تجاريمطلوب من احنا نثق في الناس في مثلا
+
+395
+00:28:04,710 --> 00:28:06,950
+على سبيل المثال المفاتيشين الصحيين نقولهم لما
+
+396
+00:28:06,950 --> 00:28:11,110
+تروحوا على ال supermarket لو شوفتوا قلبة منتفخة
+
+397
+00:28:11,110 --> 00:28:14,190
+منتفخة يعني انت بتعرفوا ال mustard تبقى المفروض
+
+398
+00:28:14,190 --> 00:28:21,130
+انه flat فإذا دغط عليها لجت إلها إما تقوس في
+
+399
+00:28:21,130 --> 00:28:26,290
+الغطاء أو في حركة معينة بتدغطها بتعطينا الشعور
+
+400
+00:28:26,290 --> 00:28:31,890
+بإنه في هوا جوا هذا العلبةبنرفضها على طول نسحب
+
+401
+00:28:31,890 --> 00:28:36,630
+لبضاعة علينها فاسدة بيجي واحد بتطلع بلاجة بتعرف
+
+402
+00:28:36,630 --> 00:28:41,130
+الكاراتين المعلبات خلال عاملة النقل قد تتعرض
+
+403
+00:28:41,130 --> 00:28:46,470
+لحوادث فبعض المعلبات ممكن تنبعجبتنضرب هو هانا ولا
+
+404
+00:28:46,470 --> 00:28:51,650
+هانا فبيجي أخونا الفيلوسوف بقول ما هي من تفخة لإن
+
+405
+00:28:51,650 --> 00:28:55,050
+ما هي منبعجة من هانا لإنها متوجة من هانا، صح؟
+
+406
+00:28:55,050 --> 00:28:57,790
+فبصير يفتح على مزاول يقول انه طب انت هل عندك مقدرة
+
+407
+00:28:57,790 --> 00:29:02,810
+انك انت تقول ان والله الحجم هذا مساوي للحجم هذا،
+
+408
+00:29:02,810 --> 00:29:06,170
+صعب جدا في ال canvas، ده ده واحد، رقم اتنين انتوا
+
+409
+00:29:06,170 --> 00:29:09,370
+عارفين كيف العلبة بتتصنع، اعطيني الدفتر اللي بعك
+
+410
+00:29:09,370 --> 00:29:17,360
+هذا، نمزق من ورقة بعد أذنكبعطيك أسابع بعدين تفضل
+
+411
+00:29:17,360 --> 00:29:23,420
+المعلمات بتصنع من استوانة بتكون بهذا الشكل بيلفوها
+
+412
+00:29:23,420 --> 00:29:30,160
+و الحواف .. الحواف تبعتها بتنثني بطريقة و بحطوا
+
+413
+00:29:30,160 --> 00:29:33,400
+بينها لاسق .. بحطوا بينها لاسق تمام؟ و بصير انه
+
+414
+00:29:33,400 --> 00:29:36,500
+استوانة و بعدين براكبولها الغطاء و القاعدة تبعتها
+
+415
+00:29:36,500 --> 00:29:41,360
+او القاعدة بعدين براكبولها الغطاءالان اي خلل في
+
+416
+00:29:41,360 --> 00:29:44,940
+الحام اللى هو اللى رابط الاستوانة مع بعضها البعض
+
+417
+00:29:44,940 --> 00:29:51,320
+هذا قد يؤدي الى تبادل ما بين ال environment ما بين
+
+418
+00:29:51,320 --> 00:29:57,590
+ال can بتزيد مشاكل الخلل لو انطعجتبتلاقي أمركم
+
+419
+00:29:57,590 --> 00:30:01,710
+لاحظته معلبات بتكون من منطقة مسضية من منطقة قريبة
+
+420
+00:30:01,710 --> 00:30:04,570
+من المنطقة هذا معناته ليش؟ معناته بحكي أنه في خلل
+
+421
+00:30:04,570 --> 00:30:08,130
+في التصنيع هنا وبالتالي هذه العلبة غير صالحة
+
+422
+00:30:08,130 --> 00:30:11,730
+للاستهلاك واحنا بننصح الناس بنقولهم never ever
+
+423
+00:30:11,730 --> 00:30:16,890
+taste a suspect foodsuspect food يعني غذاء مشتبه
+
+424
+00:30:16,890 --> 00:30:21,630
+فيه، ما تتذوقه لأنه مجرد تذوق طعام بيحتوي على
+
+425
+00:30:21,630 --> 00:30:26,070
+كلاستروديوم و بوترونيوم قد يؤدي بك إلى الوفاة، إذن
+
+426
+00:30:26,070 --> 00:30:30,270
+علبة مشتبه بيها أيضا كمان قد تؤدي إلى الوفاة
+
+427
+00:30:30,270 --> 00:30:32,570
+وبالتالي بنتخلص منها، إذا مافيش أنها حادثة مع
+
+428
+00:30:32,570 --> 00:30:40,370
+إجتهادات، أي انتفاخ، أي خلل فيهالسيم في انتهاء
+
+429
+00:30:40,370 --> 00:30:43,650
+الصلاحية يجب ان تطلع في المعلبات تماما تطلعوا على
+
+430
+00:30:43,650 --> 00:30:47,090
+التوكسين عشان تكونوا انت تتكلموا عنه باحترام و
+
+431
+00:30:47,090 --> 00:30:51,910
+تقدير one milligram of your toxin has a twenty
+
+432
+00:30:51,910 --> 00:30:58,290
+million lethal mice doses عشرين مليون جرعة قاتلة
+
+433
+00:30:58,290 --> 00:31:03,990
+ال ال ال ال ال الفيرعان هذا رقم مهول جدايعني very
+
+434
+00:31:03,990 --> 00:31:10,750
+toxic substance تصنيف التوكسين واضح أنه زي ماكان
+
+435
+00:31:10,750 --> 00:31:14,970
+الكلوسترديوم بيرفرنديوم بيتلونيوم بيتلونيوم
+
+436
+00:31:14,970 --> 00:31:15,570
+بيتلونيوم بيتلونيوم بيتلونيوم بيتلونيوم بيتلونيوم
+
+437
+00:31:15,570 --> 00:31:17,430
+بيتلونيوم بيتلونيوم بيتلونيوم بيتلونيوم بيتلونيوم
+
+438
+00:31:17,430 --> 00:31:21,210
+بيتلونيوم بيتلونيوم بيتلونيوم بيتلونيوم بيتلونيوم
+
+439
+00:31:21,210 --> 00:31:26,510
+بيتلونيوم بيتلونيوم بيتلونيوم بيتلونيوم بيتلونيوم
+
+440
+00:31:26,510 --> 00:31:28,930
+بيتلونيوم بيتلونيوم بيتلونيوم بيتلونيومOnly A, B,
+
+441
+00:31:29,150 --> 00:31:33,810
+E and F affects human يعني من التمانية أن أربعة
+
+442
+00:31:33,810 --> 00:31:36,850
+بيأثر على الإنسان ال F اللي طلع على الأخير هذا
+
+443
+00:31:36,850 --> 00:31:40,370
+الرقم أربعة similar to A and B has been isolated
+
+444
+00:31:40,370 --> 00:31:44,150
+in Denmark يعني غالبا ووجد فيه بقعة جغرافية محددة
+
+445
+00:31:44,150 --> 00:31:49,510
+وبالتالي مين أشهر تلاتة هيكونه؟ type A وB وE لذلك
+
+446
+00:31:49,510 --> 00:31:55,690
+خدوا بالكم من شغلالأعراض ظهورها لوفاة المريض قد لا
+
+447
+00:31:55,690 --> 00:32:02,150
+تطول أكتر من 48 ساعة وبالتالي العلاج .. العلاج إن
+
+448
+00:32:02,150 --> 00:32:06,350
+ما تمش earlier as soon as possible والعلاج بيتم
+
+449
+00:32:06,350 --> 00:32:10,010
+بإيش؟ احنا اللي سيبقى عندنا ال disease إيش هو؟
+
+450
+00:32:10,010 --> 00:32:13,470
+التوكسين مش البكتيريا فبدي أكون بال antitoxin
+
+451
+00:32:13,470 --> 00:32:17,750
+وبالتالي هلاجي أن أحد أهم نقاط العلاج أول حالة
+
+452
+00:32:17,750 --> 00:32:21,550
+طبعا التشخيصلازم يتشخّص المريض إذا تشخّص المريض
+
+453
+00:32:21,550 --> 00:32:27,450
+العلاج بيكون سهل بما يسمى بالـ trivalent tri واحد
+
+454
+00:32:27,450 --> 00:32:32,170
+اتنين تلاتة ايش هما التلاتة؟ A وB وE trivalent
+
+455
+00:32:32,170 --> 00:32:35,230
+antitoxin
+
+456
+00:32:35,230 --> 00:32:38,890
+إذا لازم يكون عندنا في ال emergency في المستشفيات
+
+457
+00:32:38,890 --> 00:32:45,490
+تبعتنا stuck مخزون من ال trivalent antitoxin اللي
+
+458
+00:32:45,490 --> 00:32:48,510
+هو مكون من A وB وE antitoxin
+
+459
+00:32:51,050 --> 00:32:54,590
+Morphological characteristics spores are oval and
+
+460
+00:32:54,590 --> 00:32:58,910
+subterminal زي مين؟ زي الكلستردium peripherensis
+
+461
+00:32:58,910 --> 00:33:02,510
+يبقى هي تشبهت مع الكلستردium peripherensis لكن ايش
+
+462
+00:33:02,510 --> 00:33:07,290
+اختلفت عنها؟ هدى كان non-motile، هدى motile، إذا
+
+463
+00:33:07,290 --> 00:33:11,490
+انتظروا أندي تنتين motile، واحدة non-motile،
+
+464
+00:33:11,490 --> 00:33:15,210
+الأولى motile، التالتة motile، اللي في النص non
+
+465
+00:33:15,210 --> 00:33:21,870
+-motileطبعا هذه الصورة بتوضحلكوا كيف بتتحول من
+
+466
+00:33:21,870 --> 00:33:28,170
+عجوز إلى صبية في لحظات تمام لحظات نعم بتتأثر على
+
+467
+00:33:28,170 --> 00:33:31,570
+ال .. ال .. ال .. ال muscles بتعملعنا relaxation
+
+468
+00:33:31,570 --> 00:33:34,550
+ده ال muscle بإنه فيه هنا flaccid paralysis وبتالي
+
+469
+00:33:34,550 --> 00:33:39,110
+بيكون فيه هنا لكن هذا القضية البعض كتب كتير مقالة
+
+470
+00:33:39,110 --> 00:33:42,910
+عنها إنه في المستقبل قد تؤدي إلى تشوء كبير في
+
+471
+00:33:42,910 --> 00:33:47,070
+الجلد عند المستخدمين لهذا النوع من ال treatment
+
+472
+00:33:49,120 --> 00:33:53,680
+summary of the pathogenesis of botulism in
+
+473
+00:33:53,680 --> 00:33:57,760
+question of contaminated home canned food home
+
+474
+00:33:57,760 --> 00:34:01,320
+canned food يعني بتنة كده مع مين؟ مع ال commercial
+
+475
+00:34:01,320 --> 00:34:04,880
+لكن هذا لا يعني ان ال commercial canned food مافيش
+
+476
+00:34:04,880 --> 00:34:09,880
+.. خلاص يعني zero لكن التشريعات والقوانين اللي
+
+477
+00:34:09,880 --> 00:34:13,760
+أصدرت من قبل منظمات الغذاء والدواء في العالم كله
+
+478
+00:34:14,800 --> 00:34:18,280
+حققت مطلب جيد انه حد يسموها commercial
+
+479
+00:34:18,280 --> 00:34:21,360
+sterilization ايش يعني commercial sterilization
+
+480
+00:34:21,360 --> 00:34:25,140
+فبنعرف ال sterilization بتعريفها absolute killing
+
+481
+00:34:25,140 --> 00:34:28,460
+of all forms of life صح ولا لأ هذا لأ ال
+
+482
+00:34:28,460 --> 00:34:31,900
+sterilization بينما ال commercial sterilization هي
+
+483
+00:34:31,900 --> 00:34:38,980
+درجة اقل من ال absoluteهي درجة صممت للقضاء على الـ
+
+484
+00:34:38,980 --> 00:34:42,980
+spores of pathogenic microorganisms وجازدين فيها
+
+485
+00:34:42,980 --> 00:34:47,300
+مين هما الكلستردium و البوتلونيوم بالتحديد فصار
+
+486
+00:34:47,300 --> 00:34:51,660
+فينا بالفعل ندرة في حدوث المرض لكن بقيتكوا قصة عن
+
+487
+00:34:51,660 --> 00:34:55,280
+الارجنتين او البرازيل لأ اعتقد الارجنتين في مصنع
+
+488
+00:34:55,280 --> 00:34:59,100
+بيعمل معلبات بيصنع معلباته و بيستخدمش حتي ما نقول
+
+489
+00:34:59,100 --> 00:35:03,540
+في cooking في المعلبات في طبخالتبريد وين بتتم؟
+
+490
+00:35:03,540 --> 00:35:08,480
+بياخدوا صناديق المعلبات وجنبهم نهر بالرافعة من
+
+491
+00:35:08,480 --> 00:35:13,740
+المصنع مباشرة علويان على النهر بنزل الصناديق اللي
+
+492
+00:35:13,740 --> 00:35:16,380
+طالع من ال .. من ال .. من ال cooking بيطلعها وين
+
+493
+00:35:16,380 --> 00:35:21,520
+بيحطها بيبردها في النهر في أحد السنوات أحد ال
+
+494
+00:35:21,520 --> 00:35:26,620
+batches أو الدفعات اللي أنتجتكان في خلل في مين؟
+
+495
+00:35:26,620 --> 00:35:30,600
+فاكرين ال .. ال seam هذا بيسموه seam اللي هي الحام
+
+496
+00:35:30,600 --> 00:35:35,720
+اللي بين الطرفين .. ال .. ال .. الستوانة تمام؟ صار
+
+497
+00:35:35,720 --> 00:35:39,240
+فيه خلل و مع التسخين و التبدل و الفاجئ زاد فيبدو
+
+498
+00:35:39,240 --> 00:35:44,500
+أنه فيه تسرب ميه بكميات ضئيلة إلى نسبة من المعلبات
+
+499
+00:35:44,500 --> 00:35:48,410
+اللي موجودة و حدث حالات botulism من وراهاطبعا
+
+500
+00:35:48,410 --> 00:35:52,470
+هنعرفنا كيف الجثة لما صار حالة botulism روحنا
+
+501
+00:35:52,470 --> 00:35:55,950
+نحقق، عرفنا المونتاج، روحنا نقع المصنع، عرفنا
+
+502
+00:35:55,950 --> 00:35:59,390
+الجثة تبع المصنع، فعرفنا من وين إجا مصدر اللي هو
+
+503
+00:35:59,390 --> 00:36:04,430
+التلوى، إذا ال botulism قد يحدث أيضا من مين؟ من ال
+
+504
+00:36:04,430 --> 00:36:09,190
+commercially canned food لكن تخيلوا أنتوا .. أنا
+
+505
+00:36:09,190 --> 00:36:12,730
+أنبقى لكوا نقطة كتير مهمة في ال .. في هذا المجال،
+
+506
+00:36:12,730 --> 00:36:17,410
+احنا بنحط قوانينأحنا في العالم الأعربي بشكل عام
+
+507
+00:36:17,410 --> 00:36:23,710
+بنحط قوانين الشعب بتفنن في كيف يعني يهرب من
+
+508
+00:36:23,710 --> 00:36:28,970
+القوانين و تطبيقها في الغرب بيعملوا عكس ذلك تماما
+
+509
+00:36:28,970 --> 00:36:34,220
+احنا بنحط قوانين او الغرب بيحط قوانينوالشعب او
+
+510
+00:36:34,220 --> 00:36:38,600
+الناس اللي بتفننوا كيف يطبقوا افضل من القوانين
+
+511
+00:36:38,600 --> 00:36:42,840
+اللي هم حاطينها يعني اذا جال .. اذا جالنا انه
+
+512
+00:36:42,840 --> 00:36:45,520
+ممنوع يكون فيها ال sports تبع ال Clostridium
+
+513
+00:36:45,520 --> 00:36:49,160
+Botulinum هم بيسأوا انه مايكونش فيها sports لأي
+
+514
+00:36:49,160 --> 00:36:52,690
+بكتيريا أخرى على سبب المثال طبعا؟وبالتالي فيه
+
+515
+00:36:52,690 --> 00:36:57,950
+مصطلح اسمه due diligence بتثبتلي ان انت بدلت اقصر
+
+516
+00:36:57,950 --> 00:37:02,470
+جهدك اقصر مافي جهدك ساسامحك لو كان عندك خطأ
+
+517
+00:37:02,470 --> 00:37:07,030
+ساسامحك لو كان عندك خطأ بينما احنا كما ذكرت وهذا
+
+518
+00:37:07,030 --> 00:37:10,430
+احد اسباب تخلف الصناعة في الوطن العربي تبدأ جيدة
+
+519
+00:37:11,060 --> 00:37:14,800
+وبعد فترة بيصير فيه تراجع في المستوى فبالتالي
+
+520
+00:37:14,800 --> 00:37:18,820
+بيصير المستهلك .. المستهلك يعني بغض النظر عن مستوى
+
+521
+00:37:18,820 --> 00:37:23,240
+المادي بيحاول قدر الممكن أنه يبحث عن المنتج الجيد
+
+522
+00:37:23,240 --> 00:37:26,760
+فبالتالي الصناعة المحلية بتذوي باستمرار والصناعة
+
+523
+00:37:26,760 --> 00:37:31,460
+الأجنبية بتتقدم لإن هو بيحافظ على مستوى معين من
+
+524
+00:37:31,460 --> 00:37:33,880
+الجودة احنا للأسف ما بنقدر نحافظ عليه
+
+525
+00:37:36,860 --> 00:37:40,320
+البري أصبح إكسدوكسين في الطعام، إكسدوكسين يتدفق من
+
+526
+00:37:40,320 --> 00:37:42,720
+الدم، يدخل في الدم، ويصل إلى النافذات البرفيرالية،
+
+527
+00:37:42,720 --> 00:37:48,320
+ثم يعمل انهيبشن لإطلاق أسيتالكولين، لا يظهر أيضًا
+
+528
+00:37:48,320 --> 00:37:49,420
+أيضًا أيضًا أيضًا أيضًا أيضًا أيضًا أيضًا أيضًا
+
+529
+00:37:49,420 --> 00:37:55,480
+أيضًا أيضًا أيضًا أيضًا أيضًا أيضًا أيضًا
+
+530
+00:37:59,000 --> 00:38:02,340
+الميكروب هذا الرابع اعتقد في السلسلة اللي هو ال
+
+531
+00:38:02,340 --> 00:38:05,480
+Clostridium septicum وانا قلتلكم من البداية ان ال
+
+532
+00:38:05,480 --> 00:38:09,280
+septicum و النوفي حطوهم مع مين؟ مع ال paraparygens
+
+533
+00:38:09,280 --> 00:38:13,800
+كلا هما بيجوم بنفس الأعراض اللي هي ال gas أو ال
+
+534
+00:38:13,800 --> 00:38:18,560
+gas جانجرين لكن نسبة إحداثهم من المرض بدرجة أقل
+
+535
+00:38:20,580 --> 00:38:26,720
+الإنسان في بعض الأحيان يسبب في حالات ميونكروسية
+
+536
+00:38:26,720 --> 00:38:30,500
+كلستردية
+
+537
+00:38:30,500 --> 00:38:34,840
+بسيطة و بسيطة و بسيطة و بسيطة و بسيطة و بسيطة و
+
+538
+00:38:34,840 --> 00:38:38,360
+بسيطة و بسيطة
+
+539
+00:38:39,470 --> 00:38:41,590
+على ما يبدو أن الـ Clostridium Septicum
+
+540
+00:38:41,590 --> 00:38:44,730
+occasionally escaped from wounds and is carried by
+
+541
+00:38:44,730 --> 00:38:47,750
+the bloodstream to other parts of the body يعني
+
+542
+00:38:47,750 --> 00:38:50,730
+البكتيريا هنا الها ميزة عن ال Clostridium
+
+543
+00:38:50,730 --> 00:38:55,130
+Perifringens مش ميزة خدنا نقول شبيهة بال
+
+544
+00:38:55,130 --> 00:38:58,550
+Clostridium برضه ممكن تصل إلى ال bloodstream وتذهب
+
+545
+00:38:58,550 --> 00:39:02,570
+إلى أماكن أخرى غير تلك التي كانت موجودة بها
+
+546
+00:39:03,560 --> 00:39:06,180
+generalized clostridium septicum infection may
+
+547
+00:39:06,180 --> 00:39:08,440
+occur in leukemia patients يعني الناس عندهم
+
+548
+00:39:08,440 --> 00:39:13,500
+لوكيميا سرطان الدم نسبة او امكانية ان يصير فيه
+
+549
+00:39:13,500 --> 00:39:16,480
+generalized infection بالبكتيريا بتكون اعلى طبعا
+
+550
+00:39:16,480 --> 00:39:19,540
+اكيد لان عندهم ال immune system بيكون ضعيف
+
+551
+00:39:24,270 --> 00:39:28,150
+طبعا نفس الحالة مش بس مع ال leukemia patient كمان
+
+552
+00:39:28,150 --> 00:39:33,650
+ممكن مع الناس اللي بياخدوا anti metabolites زي ال
+
+553
+00:39:33,650 --> 00:39:38,170
+cancer patient بشكل عام أو immunosuppressive drugs
+
+554
+00:39:38,170 --> 00:39:42,710
+ناس بياخدوا مطبطات لجهاز المناعة لإنه نقلوا كلية
+
+555
+00:39:42,710 --> 00:39:47,330
+نقلوا كبد whatsoever وبالتالي فينا دائما ضعف جهاز
+
+556
+00:39:47,330 --> 00:39:51,780
+المناعةالكلسترديوم ديفسل اللى الرابع انا بتقل
+
+557
+00:39:51,780 --> 00:39:54,840
+الخامسة انا الصحيح بدأت فيها ده بتذكروا فاكرين
+
+558
+00:39:54,840 --> 00:39:59,780
+الكلسترديوم
+
+559
+00:39:59,780 --> 00:40:02,320
+ديفسل جونه هي number one cause of nosocomial
+
+560
+00:40:02,320 --> 00:40:08,320
+diarrhea صح نوزوكوميال دياريا جونه انه سبب حدوث
+
+561
+00:40:08,320 --> 00:40:11,260
+البكتيريا او حدوث المرض من هذه البكتيريا هو
+
+562
+00:40:11,260 --> 00:40:15,780
+استخدام ال antibioticوسمينا ال disease antibiotic
+
+563
+00:40:15,780 --> 00:40:20,480
+induced pseudomembrane scolitis بمعنى ان اللي سبب
+
+564
+00:40:20,480 --> 00:40:24,520
+ال membrane scolitis هو استخدام ال antibiotic كيف
+
+565
+00:40:24,520 --> 00:40:29,080
+ذلك؟الـ Antibiotic قتل الـ Normal Microbiota، هذي
+
+566
+00:40:29,080 --> 00:40:33,580
+جزء من الـ Microbiota، لم تموت، تكاثرت، تكاثرت على
+
+567
+00:40:33,580 --> 00:40:36,800
+حساب البكتيرا اللي ماتت، وصل رقمها إلى Quorum
+
+568
+00:40:36,800 --> 00:40:40,720
+Sensing، بدأت تنتج تكسين A و تكسين B، وسببات مين؟
+
+569
+00:40:40,720 --> 00:40:42,500
+اللي هو ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+570
+00:40:42,500 --> 00:40:42,900
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+571
+00:40:42,900 --> 00:40:43,100
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+572
+00:40:43,100 --> 00:40:43,160
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+573
+00:40:43,160 --> 00:40:44,320
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+574
+00:40:44,320 --> 00:40:47,790
+ال .. ال .. ال .. ال .. الإذا إذا أردنا إذا أردنا
+
+575
+00:40:47,790 --> 00:40:52,150
+أن نقلل من الإصابة بهذا الميكروب أو بهذا ال
+
+576
+00:40:52,150 --> 00:40:57,670
+disease ماذا نفعل؟ يجب علينا استخدام neuro
+
+577
+00:40:57,670 --> 00:41:00,270
+spectrum antibiotic في العلاج neuro spectrum
+
+578
+00:41:00,270 --> 00:41:02,010
+antibiotic في العلاج
+
+579
+00:41:06,210 --> 00:41:09,430
+إذا علمنا نوع الميكروب وعملنا neurosensitivity
+
+580
+00:41:09,430 --> 00:41:12,970
+بنستخدم neuro spectrum لكن إذا مش عارفين نوع
+
+581
+00:41:12,970 --> 00:41:18,790
+الميكروب قد نضطر لاستخدامه طيب متى بنستخدم ال
+
+582
+00:41:18,790 --> 00:41:21,730
+broad spectrum و متى بنستخدم ال neuro spectrum
+
+583
+00:41:21,730 --> 00:41:23,930
+راجزوا معايا بعيدا عن المحاضرة
+
+584
+00:41:28,050 --> 00:41:31,230
+الان بدنا نجسم ال infectious diseases إلى قسمين
+
+585
+00:41:31,230 --> 00:41:36,750
+حاجة بنسميها life threatening infection و non life
+
+586
+00:41:36,750 --> 00:41:41,170
+threatening infection واحد عنده eye infection eye
+
+587
+00:41:41,170 --> 00:41:46,450
+infection تمام simple one external ear infection
+
+588
+00:41:46,450 --> 00:41:49,910
+external wound infection urinary tract infection
+
+589
+00:41:49,910 --> 00:41:54,050
+هدولة بنسميهم non life threatening يعني لو ما
+
+590
+00:41:54,050 --> 00:41:58,520
+علجلش المريض الآن مش هيتأثربينما لو كان عنده
+
+591
+00:41:58,520 --> 00:42:03,160
+meningitis لو كان عنده تتانوس لو كان عنده gas
+
+592
+00:42:03,160 --> 00:42:07,800
+gangrene meningitis تمام بيكون في عنده life
+
+593
+00:42:07,800 --> 00:42:12,120
+-threatening infection ويجب أن نعطي علاج فوري إذا
+
+594
+00:42:12,120 --> 00:42:14,860
+قسمنا الأمراض في الإنسان المؤدية إلى life
+
+595
+00:42:14,860 --> 00:42:18,140
+-threatening و non life-threatening في ال life
+
+596
+00:42:18,140 --> 00:42:24,210
+-threatening you cannot waitcollect your sample او
+
+597
+00:42:24,210 --> 00:42:31,770
+specimen administer antibiotic based on
+
+598
+00:42:31,770 --> 00:42:35,850
+the best guess افضل تخمين .. تخمين لمين؟ تخمين
+
+599
+00:42:35,850 --> 00:42:40,300
+الراجل الشارع وده الطبيبتخمين الطبيب وتخمين الطبيب
+
+600
+00:42:40,300 --> 00:42:45,240
+بيسموه educated guess يعني تخمين متعلم ليش متعلم؟
+
+601
+00:42:45,240 --> 00:42:49,080
+لأنه بيخمن بناء على معلومات عنده في الذاكرة عن
+
+602
+00:42:49,080 --> 00:42:55,120
+مسببات المرض المحتملة وعنده بيانات محلية سواء كان
+
+603
+00:42:55,120 --> 00:42:59,580
+في فلسطين أو في مكان اخر بيانات محلية بتقول ان ال
+
+604
+00:42:59,580 --> 00:43:03,580
+most common cause of this disease واحد اتنين تلاتة
+
+605
+00:43:03,580 --> 00:43:07,470
+فهو بيعطي انت بيتك بناء على مين؟بنان على اللي هو
+
+606
+00:43:07,470 --> 00:43:12,090
+المعلومات المتوفرة محلية، لكن بعد ما يجمع مين؟ بعد
+
+607
+00:43:12,090 --> 00:43:15,030
+ما يجمع عينة، يعني بيجمع عينة وبعدين بيعطي انت
+
+608
+00:43:15,030 --> 00:43:17,630
+بياتك، بس في ال non-life threatening infection
+
+609
+00:43:18,930 --> 00:43:23,810
+للأسف هو دي النقطة المهمة انه في ال non-life
+
+610
+00:43:23,810 --> 00:43:27,750
+threatening برضه أطبان في الغالب بيعطوا اللي هو
+
+611
+00:43:27,750 --> 00:43:32,250
+ايه؟ Antibiotic مباشرة ومع أنه في فرصة ننتظر لمين؟
+
+612
+00:43:32,250 --> 00:43:35,950
+ننتظر اللي هو التشخيص وننتظر المزرعة و الحساسية
+
+613
+00:43:35,950 --> 00:43:39,730
+وبالتالي ممكن نعطي specific و narrow spectrum وهيك
+
+614
+00:43:39,730 --> 00:43:42,510
+احنا بنقلل استخدام ال antibiotic المفرض في
+
+615
+00:43:42,510 --> 00:43:45,530
+المستشفيات وبالتالي بنقلل نسبة الإصابة بال
+
+616
+00:43:45,530 --> 00:43:46,230
+Clostridium
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/p7qM3jWS85I_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/p7qM3jWS85I_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..4bc8fa5618f76dfb2f30e43d221acf1fafb0e2d6
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/p7qM3jWS85I_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 4971, "start": 21.21, "end": 49.71, "text": "بسم الله الرحمن الرحيم الميكروب الثاني في سلسلة الكلستردية هو الكلسترديوم perifringens وبدأنا قبل حديثة عنه في المقدمة الماضية انه بيعمل مجموعة من العدوى منها ال wound infection و ال gas gangrene اللي سميناها myonecrosis و اتكلمنا ايضا عن necrotizing jejunitis او سمينها gangrene of the intestine اتكلمنا عن simple condition ممكن يحدث من نتيجة البكتيريا اللي هو ال food poisoning", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 9673, 1829, 4117, 32887, 3555, 6024, 104, 7649, 1829, 8978, 8608, 1211, 3794, 37977, 2423, 28820, 14851, 2288, 3215, 10632, 31439, 2423, 28820, 14851, 2288, 3215, 1829, 20498, 680, 351, 2937, 694, 4032, 44510, 10721, 8315, 12174, 36150, 11331, 16254, 12984, 3660, 18871, 3224, 8978, 9673, 28543, 46007, 9673, 46958, 10632, 16472, 3224, 4724, 1829, 25957, 1211, 3714, 7435, 2304, 2407, 27884, 9154, 18863, 3215, 2407, 7578, 9154, 11296, 2423, 10999, 11764, 4032, 2423, 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"word": " الثاني", "probability": 0.81756591796875}, {"start": 24.13, "end": 24.25, "word": " في", "probability": 0.87890625}, {"start": 24.25, "end": 24.77, "word": " سلسلة", "probability": 0.9913330078125}, {"start": 24.77, "end": 25.91, "word": " الكلستردية", "probability": 0.5914713541666666}, {"start": 25.91, "end": 26.03, "word": " هو", "probability": 0.80615234375}, {"start": 26.03, "end": 26.55, "word": " الكلسترديوم", "probability": 0.7611083984375}, {"start": 26.55, "end": 27.35, "word": " perifringens", "probability": 0.51739501953125}, {"start": 27.35, "end": 28.17, "word": " وبدأنا", "probability": 0.8397216796875}, {"start": 28.17, "end": 28.27, "word": " قبل", "probability": 0.774169921875}, {"start": 28.27, "end": 28.53, "word": " حديثة", "probability": 0.81298828125}, {"start": 28.53, "end": 28.69, "word": " عنه", "probability": 0.94189453125}, {"start": 28.69, "end": 28.79, "word": " في", "probability": 0.91552734375}, {"start": 28.79, "end": 29.27, "word": " 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على ان تتعمل intestinal gangrene او necrotizing jejunitis الابسلون والايوتا قادرين على انهم يعملوا food poisoning بيقولنا ان الابسلون غالبا بيكون inactive يعني لو اتناولنا مع الطعام مباشرة هو نفسه غير قادر على احداث اي تأثير لكن خلال مروره في ال intestinal tract تمام؟ في ال intestinal tract", "tokens": [6027, 21292, 2655, 995, 8978, 6055, 23275, 29739, 4117, 2655, 13546, 25528, 25062, 18513, 25720, 15844, 16472, 6055, 2655, 25957, 1211, 21098, 2071, 10145, 32252, 1975, 2407, 408, 66, 10536, 3319, 1506, 10010, 16074, 2423, 16758, 3794, 1211, 11536, 16070, 47302, 35473, 995, 12174, 18513, 2288, 9957, 15844, 16472, 16095, 7251, 25957, 1211, 14407, 1755, 36778, 4724, 1829, 39648, 8315, 16472, 2423, 16758, 3794, 1211, 11536, 32771, 6027, 3555, 995, 4724, 1829, 30544, 294, 12596, 37495, 22653, 45164, 1975, 2655, 8315, 12610, 8315, 20449, 41950, 3615, 10943, 3714, 3555, 33599, 25720, 31439, 8717, 36178, 3224, 32771, 13546, 12174, 18513, 2288, 15844, 1975, 24401, 5718, 104, 1975, 1829, 6055, 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فيه دياريا يبقى دياريا وال .. يعني ال organism ال organism will be .. لأ ال organism will be discharged into the environment", "tokens": [3555, 1829, 9381, 13546, 16472, 11778, 1829, 19858, 2486, 4724, 1829, 9381, 13546, 16472, 11778, 1829, 7558, 24398, 44987, 4724, 1829, 9381, 13546, 16472, 1975, 2407, 20193, 13672, 1829, 31439, 41950, 3615, 10943, 13672, 1829, 3714, 33753, 2407, 7578, 15844, 16712, 4117, 3794, 9957, 32239, 3794, 20666, 11242, 2288, 13063, 3660, 29739, 4117, 2655, 13546, 25528, 4032, 7649, 15042, 6156, 47432, 16712, 4117, 3794, 9957, 4724, 1829, 9381, 13546, 16472, 13672, 1829, 31439, 2423, 17898, 340, 21098, 2071, 10152, 9122, 2304, 7649, 13412, 17082, 1211, 6055, 30544, 8978, 3224, 11778, 1829, 9640, 25528, 7251, 3555, 4587, 7578, 11778, 1829, 9640, 25528, 16070, 4386, 37495, 22653, 2423, 24128, 2423, 24128, 486, 312, 4386, 5296, 10721, 2423, 24128, 486, 312, 37081, 666, 264, 2823], "avg_logprob": -0.2007113867174319, "compression_ratio": 1.8953488372093024, 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31, "seek": 68305, "start": 669.95, "end": 683.05, "text": "يعني بتاعة ال cycle بتكتمل ان ال environment هتلوث الغذاء و مرة تانية هيرجع لالانسان ال pathology تبع البكتيريا بقولنا it is not highly invasive", "tokens": [40228, 22653, 39894, 995, 27884, 2423, 6586, 39894, 4117, 39237, 1211, 16472, 2423, 2823, 8032, 2655, 1211, 2407, 12984, 6024, 118, 8848, 16606, 4032, 3714, 25720, 6055, 7649, 10632, 39896, 47341, 3615, 5296, 6027, 7649, 3794, 7649, 2423, 3100, 1793, 6055, 3555, 3615, 29739, 4117, 2655, 13546, 25528, 4724, 39648, 8315, 309, 307, 406, 5405, 30894], "avg_logprob": -0.2316337740212156, "compression_ratio": 1.3540372670807452, "no_speech_prob": 0.0, "words": [{"start": 669.95, "end": 670.11, "word": "يعني", "probability": 0.60205078125}, {"start": 670.11, "end": 670.35, "word": " بتاعة", "probability": 0.55615234375}, {"start": 670.35, "end": 670.49, "word": " ال", "probability": 0.78662109375}, {"start": 670.49, "end": 670.89, "word": " cycle", "probability": 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أنتجته، نتيجة التكسين اللي أنتجته، وبالتالي هي صحيح non-invasive لكن للأسف can produce devastating effect", "tokens": [1211, 19452, 13412, 38688, 14407, 4386, 39896, 20328, 5016, 1829, 5016, 37893, 30894, 44381, 2423, 1802, 6055, 3555, 3615, 11296, 588, 30894, 12399, 32239, 8592, 22807, 5296, 33456, 3224, 11331, 49975, 4032, 39896, 2654, 11764, 6225, 42213, 2655, 13563, 8978, 9154, 41193, 4587, 45030, 25708, 3660, 12399, 8717, 31371, 7435, 3660, 9154, 22807, 8717, 31371, 7435, 3660, 6024, 118, 31377, 13672, 1829, 14739, 2655, 7435, 47395, 12399, 8717, 31371, 7435, 3660, 16712, 4117, 3794, 9957, 13672, 1829, 14739, 2655, 7435, 47395, 12399, 46599, 6027, 2655, 6027, 1829, 39896, 20328, 5016, 1829, 5016, 2107, 12, 259, 39211, 44381, 24976, 10721, 3794, 5172, 393, 5258, 21280, 1802], "avg_logprob": -0.1429834912689227, "compression_ratio": 1.680672268907563, "no_speech_prob": 0.0, "words": [{"start": 683.98, "end": 684.66, "word": "لكن", "probability": 0.781005859375}, {"start": 684.66, 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/pd2PZxK6X1Y_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/pd2PZxK6X1Y_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..7feaf35be447041310ed4d1ddb10849bc956458e
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/pd2PZxK6X1Y_postprocess.srt
@@ -0,0 +1,2440 @@
+1
+00:00:20,910 --> 00:00:23,670
+بسم الله الرحمن الرحيم في محاضرتنا الأولى ان شاء
+
+2
+00:00:23,670 --> 00:00:28,210
+الله هتناول ال course syllabus ومقدمة عن ال
+
+3
+00:00:28,210 --> 00:00:31,290
+diagnostic medical microbiology ال course syllabus
+
+4
+00:00:31,290 --> 00:00:35,990
+مفهومه هو العقد اللي بين الطالب و بين المدرس اللي
+
+5
+00:00:35,990 --> 00:00:40,570
+من خلاله تتوضح العلاقة سواء في المحتوى المساق
+
+6
+00:00:40,570 --> 00:00:44,790
+أهداف المساق أو حتى كيفية تقييم المدرس للطلبة يعني
+
+7
+00:00:44,790 --> 00:00:50,530
+الدرجات بال .. بال .. بالأحرى كيف بنوزعهاإيش ال ..
+
+8
+00:00:50,530 --> 00:00:54,150
+ال .. ال .. ال intended learning outcomes أو
+
+9
+00:00:54,150 --> 00:00:57,350
+المخرجات التعلم اللي بدي اتعلمها الطالب خلال هذا
+
+10
+00:00:57,350 --> 00:01:00,750
+الفصل ان شاء الله ففينا ال course specification
+
+11
+00:01:00,750 --> 00:01:05,830
+اللي بني جزء كما ذكرت في بداية المحاضرة على إنه
+
+12
+00:01:05,830 --> 00:01:09,270
+لازم يكوننا دارسين essential medical microbiology
+
+13
+00:01:09,270 --> 00:01:11,410
+يعني اللي مش دارس essential medical microbiology
+
+14
+00:01:11,410 --> 00:01:16,040
+لا يستطيع أن يكمل معانا ان شاء اللهعدد الساعات
+
+15
+00:01:16,040 --> 00:01:20,900
+المعتمدة تلت ساعات الاوقات اللقاء هذا الفصل ان شاء
+
+16
+00:01:20,900 --> 00:01:27,140
+الله هتكون من الساعة تسعة لساعة عشرة ماعنش مكتوبة
+
+17
+00:01:27,140 --> 00:01:32,300
+بطريقة خاطئة هنا من تسعة لعشرة سبت اتنين اربعة ان
+
+18
+00:01:32,300 --> 00:01:39,180
+شاء الله نفس اللقاء عالية M601 كما ذكرت مدرسكم
+
+19
+00:01:39,180 --> 00:01:43,140
+الدكتور عبدالله في المنعمة المكتبي انا M616 في نفس
+
+20
+00:01:43,140 --> 00:01:47,350
+الدور هذا في نفس الطابقال .. التليفون الداخلي تبع
+
+21
+00:01:47,350 --> 00:01:52,290
+المكتب 2750 لكن أنا لأ أفضل الصحيح التواصل عبر
+
+22
+00:01:52,290 --> 00:01:56,710
+التليفون وإنما عبر ال email أنا يعني أعيدكم بإنه
+
+23
+00:01:56,710 --> 00:02:00,510
+أرد على استفسارتكم كلها عبر اللي هو ال email
+
+24
+00:02:00,510 --> 00:02:05,050
+ابعتلي بالمطلوب وإن شاء الله هنرد عليك في أقرب
+
+25
+00:02:05,050 --> 00:02:08,760
+فرصةهي ال email المعتمد ليه للتواصل ال manama
+
+26
+00:02:08,760 --> 00:02:13,280
+underscore 144 yahoo.com ال website زي ما ذكرتلكوا
+
+27
+00:02:13,280 --> 00:02:16,360
+هو ال google site اللي موجود على .. او اللي موجود
+
+28
+00:02:16,360 --> 00:02:22,340
+المصائق عليهوصف المساق احنا الصحيح في ال
+
+29
+00:02:22,340 --> 00:02:25,500
+diagnostic medical microbiology كما ذكرتلكم ان
+
+30
+00:02:25,500 --> 00:02:29,580
+اهتم اكتر شباب في قضية اللي هو ال characterization
+
+31
+00:02:29,580 --> 00:02:33,340
+و ال identification لل micro organism وعملية ال
+
+32
+00:02:33,340 --> 00:02:36,200
+characterization غالبا بتتم بالاستثناء ايه يعني
+
+33
+00:02:36,200 --> 00:02:44,460
+بالاستثناء؟ لو افترضنا ان شخصا ما يريد ان يحصل على
+
+34
+00:02:44,460 --> 00:02:49,830
+معلومة من طالب موجود في القاعةفنخرج له على الباب
+
+35
+00:02:49,830 --> 00:02:55,450
+فيعطينا مواصفات يقول هو طالب طبعا طالب ذكر وانتم
+
+36
+00:02:55,450 --> 00:02:59,830
+كلكم ذكور فهذه المعلومة أثبتت لي انه بتحدث عنكم
+
+37
+00:02:59,830 --> 00:03:04,350
+متحدثش عن مين؟ عن الطالبات رقم اتنين جلف المواصفة
+
+38
+00:03:04,350 --> 00:03:08,370
+انه لابس نضارة بيلبس نضارة يبقى كل من لم ي .. من
+
+39
+00:03:08,370 --> 00:03:11,110
+لايلبس نضارة هو مستثنى الآن استثنينهم .. انا كدا
+
+40
+00:03:11,110 --> 00:03:15,370
+محدد في الفصل اللي لابس نضارة اتنين واحد اتنينيبجى
+
+41
+00:03:15,370 --> 00:03:19,250
+الآن انا استثنت كل من لم يمتلك الصفة كل من لم
+
+42
+00:03:19,250 --> 00:03:24,510
+يمتلك الصفة قال هو غير ملتحي هو غير ملتحي خد بالك
+
+43
+00:03:24,510 --> 00:03:28,950
+غير ملتحي هي صفة سلبية صح صفة سلبية يعني غير
+
+44
+00:03:28,950 --> 00:03:33,430
+موجودة هي القصد النضارة كانت موجودة لكن غير ملتحي
+
+45
+00:03:33,430 --> 00:03:36,580
+غير موجودةبالنسبة إن في ال microbiology سواء كانت
+
+46
+00:03:36,580 --> 00:03:40,600
+الصفة سلبية أو إيجابية لها نفس الوزن ومن خلالها
+
+47
+00:03:40,600 --> 00:03:44,180
+لما جونا غير ملتاح يتعرفنا على الشخص على إن هو
+
+48
+00:03:44,180 --> 00:03:48,740
+المطلوب إذن عملية تعرف على الميكروبات أيضا تتم
+
+49
+00:03:48,740 --> 00:03:53,080
+بنفس الطريقة بالاستثناءطبعا عشان أنا أقدر أستثنى
+
+50
+00:03:53,080 --> 00:03:57,080
+الميكروبات لازم أكون عندي حصيلة نظرية حصيلة نظرية
+
+51
+00:03:57,080 --> 00:04:01,900
+عن مواصفات الميكروبات حتى لما حد يعطيني صفة سواء
+
+52
+00:04:01,900 --> 00:04:05,600
+كانت إيجابية أو سلبية أقدر أستثنى الميكروبات التي
+
+53
+00:04:05,600 --> 00:04:09,720
+تمتلك أو لا تمتلك هذه الصفة فبقولنا إن هذا ال
+
+54
+00:04:09,720 --> 00:04:13,300
+course بيركز بالأساس على ال medical aspects of
+
+55
+00:04:13,300 --> 00:04:16,320
+bacterial pathogens بيركز على ال cultural
+
+56
+00:04:16,320 --> 00:04:19,850
+characteristicsايش الصفات المزرعية؟ شكل الـ
+
+57
+00:04:19,850 --> 00:04:24,210
+Staphylococcus auris على البلد أجار، أيش؟ هل هي
+
+58
+00:04:24,210 --> 00:04:29,890
+المستعمرات Large، Small، Elevated؟ فيه Hemolysis؟
+
+59
+00:04:29,890 --> 00:04:32,950
+هداش ميسميها كلتها صفات مزرعية أو cultural
+
+60
+00:04:32,950 --> 00:04:35,990
+characteristics بيركز على ال biochemical
+
+61
+00:04:35,990 --> 00:04:39,110
+characteristics هل هي كتاليز بوستف؟ كواجوليز
+
+62
+00:04:39,110 --> 00:04:43,430
+بوستف؟ مظبوط، هذي خدتهم في ال essential بيركز أيضا
+
+63
+00:04:43,430 --> 00:04:46,050
+على ال physiological characteristics فاكرين أنتوا؟
+
+64
+00:04:47,550 --> 00:04:52,430
+باسم بكتيريا E.coli O157H7 درستوها في الـEssential
+
+65
+00:04:52,430 --> 00:04:57,130
+الـO هو الـH الـO أنتجين والـH هي الـH أنتجين يمكن
+
+66
+00:04:57,130 --> 00:05:00,090
+أنا أتكلم عن Serology بعض الأحيان لا يكفي التعرف
+
+67
+00:05:00,090 --> 00:05:04,690
+على الميكروب فقط أن نقول E.coli يجب أن نذكر
+
+68
+00:05:04,690 --> 00:05:10,810
+الـSerotype الخاص بهذا الميكروبother unique
+
+69
+00:05:10,810 --> 00:05:13,510
+characteristics ايش معناه unique characteristics
+
+70
+00:05:13,510 --> 00:05:19,610
+يعني صفات فريدة مثال الكوليسترديوم تيتاني معروف
+
+71
+00:05:19,610 --> 00:05:23,470
+عنها انه لها drumstick appearance هاي صفة مميزة
+
+72
+00:05:23,470 --> 00:05:27,250
+للكوليسترديوم تيتاني ال corebacterium diphtheria
+
+73
+00:05:27,250 --> 00:05:31,230
+الشكل تبع الخلايا وترتيبها عبارة عن chinese letter
+
+74
+00:05:31,230 --> 00:05:34,690
+characters زي الأحرف الصينية وبالتالي هادي معتبرها
+
+75
+00:05:34,690 --> 00:05:38,730
+برضه ايه؟unique characters فاحنا و احنا بندرس ال
+
+76
+00:05:38,730 --> 00:05:42,070
+diagnostic microbiology او بالاخرى و احنا بندرس
+
+77
+00:05:42,070 --> 00:05:45,950
+مايكروب معين بديكون فى بالنا ال medical aspects ال
+
+78
+00:05:45,950 --> 00:05:47,470
+cultural characteristics ال biochemical
+
+79
+00:05:47,470 --> 00:05:50,630
+characteristics ال serology ان وجد و ال unique
+
+80
+00:05:50,630 --> 00:05:55,350
+characteristics ايضا اه ان وجدطبعا كل هذا الكلام
+
+81
+00:05:55,350 --> 00:05:58,970
+مش بدنا نحفظه عشان احنا بدنا نحفظه فقط to aid in
+
+82
+00:05:58,970 --> 00:06:01,910
+the process of identification of bacterial
+
+83
+00:06:01,910 --> 00:06:06,450
+pathogens للمساعدة في عملية تعرف على ال bacterial
+
+84
+00:06:06,450 --> 00:06:12,800
+pathogensهي كمان يعني نقطة كتير مهمة الـ Gramstein
+
+85
+00:06:12,800 --> 00:06:17,460
+اللي دراسناه في الفصل السابق كان بيتكلم على أنه
+
+86
+00:06:17,460 --> 00:06:20,760
+بيصنف البكتيريا إلى صنفين Gram positive و Gram
+
+87
+00:06:20,760 --> 00:06:24,020
+negative وفي قول آخر إلى أربع أصناف كيف أربع
+
+88
+00:06:24,020 --> 00:06:27,320
+أصناف؟ Gram positive كوكساي Gram negative كوكساي
+
+89
+00:06:27,320 --> 00:06:31,100
+Gram negative بسلاي Gram positive بسلاي لأن
+
+90
+00:06:31,100 --> 00:06:34,940
+الشكلين الأساسيين اللي عندنا لما كوكساي و بسلاي
+
+91
+00:06:34,940 --> 00:06:38,430
+مظبوط بجسده أربعخد بالكم من النقطة هذه الـ Gram
+
+92
+00:06:38,430 --> 00:06:42,110
+Stain مازال .. مازال بالـ Diagnostic Microbiology
+
+93
+00:06:42,110 --> 00:06:46,350
+هو التقنية الأهم على الإطلاق لأنه أي تعريف ..
+
+94
+00:06:46,350 --> 00:06:49,390
+ماعرفاش أول أول في المثال اللي ذكرناه قبل قليل
+
+95
+00:06:49,390 --> 00:06:55,570
+تحدثنا عن ذكر و أنثى طالب و طالبة صح؟ و نتحدث الآن
+
+96
+00:06:55,570 --> 00:07:00,740
+عن Gram Positive و لا Gram Negativeالتغير
+
+97
+00:07:00,740 --> 00:07:04,460
+الدراماتيكي في اختيار الفحوصات بتتم في هذه المرحلة
+
+98
+00:07:04,460 --> 00:07:07,540
+يعني معرفتي بإن البكتيريا gram positive ولا gram
+
+99
+00:07:07,540 --> 00:07:11,840
+negative هو اللي بيحدد what is next وبتالي الخطوة
+
+100
+00:07:11,840 --> 00:07:14,120
+الأولى لازم أعرف إنها gram positive ولا gram
+
+101
+00:07:14,120 --> 00:07:18,320
+negative في كمان شغل ممكن ندرسها ده أسعفنا الوقت
+
+102
+00:07:18,320 --> 00:07:21,220
+إن شاء الله اللي بيسموها unclassified pathogenes
+
+103
+00:07:21,220 --> 00:07:24,920
+اللي خارج نطاقالـ Gram Stain زي الـ Mycobacterium
+
+104
+00:07:24,920 --> 00:07:28,020
+زي الـ Spirulium زي الـ Leptospira زي الـ
+
+105
+00:07:28,020 --> 00:07:30,980
+Trypanemia هذه مايكروبات ماليها علاقة بالـ Gram
+
+106
+00:07:30,980 --> 00:07:34,460
+Stain وأيضا إن شاء الله إذا أسعفنا الوقت هاجرس بعض
+
+107
+00:07:34,460 --> 00:07:39,260
+اللي هو الفطريات الطبية أهداف
+
+108
+00:07:39,260 --> 00:07:43,700
+المصاق أنا بدا أقسم الأهداف تبع المصاق إلى قسمين
+
+109
+00:07:43,700 --> 00:07:49,420
+رئيسيين القسم الأول كل هذه النقاط من الأول للآخر
+
+110
+00:07:49,420 --> 00:07:58,860
+بدي أعتبرهم واحد هدولةوها دي اتنين الاول هذا او
+
+111
+00:07:58,860 --> 00:08:04,740
+اليزي الاول هذا كله بيتمحور حول التعرف عزل والتعرف
+
+112
+00:08:04,740 --> 00:08:09,540
+على الميكروب المسبب بالمرض سواء كان انترو بكترياسي
+
+113
+00:08:09,540 --> 00:08:11,900
+بتعرف ان الانترو بكترياسي العائلة العريقة في
+
+114
+00:08:11,900 --> 00:08:15,440
+الميكروبات عائلة ضخمة فيها اربعتاشر genus فيها
+
+115
+00:08:15,440 --> 00:08:18,320
+اكتر من اتنين species فيها الاف ال stereotypes
+
+116
+00:08:18,320 --> 00:08:24,790
+كلها هنحاول قدر المكان انحطالمعايير اللازمة
+
+117
+00:08:24,790 --> 00:08:28,410
+والتقنيات اللازمة لتعرف عليها بعد ما اتعرف علي
+
+118
+00:08:28,410 --> 00:08:32,010
+الميكروبات في عندنا كمان task مهم جدا يا شباب اللي
+
+119
+00:08:32,010 --> 00:08:35,530
+هو determination of the antimicrobial
+
+120
+00:08:35,530 --> 00:08:39,050
+susceptibility of the bacteria او the isolated
+
+121
+00:08:39,050 --> 00:08:44,010
+bacteria against some antibiotics ايش يعني؟ يعني
+
+122
+00:08:44,010 --> 00:08:49,080
+الميكروبيل اللي انا عزلتهالمفروض ان احنا عارفين ان
+
+123
+00:08:49,080 --> 00:08:54,240
+الـ E.coli حساسة لـ Antibiotic XY و Z و Resistance
+
+124
+00:08:54,240 --> 00:08:58,980
+لسينو صادعين هذا theoretically نظريا لكن النظر
+
+125
+00:08:58,980 --> 00:09:02,480
+اللي معرفتنا بان البكتيرا لها القدرة على اكتساب
+
+126
+00:09:02,480 --> 00:09:06,760
+صفة ال resistance او المقاومة فنقول لكم انه من
+
+127
+00:09:06,760 --> 00:09:12,020
+الضروري جدا جدا جدا ان نقوم بفحص كل عزلة من
+
+128
+00:09:12,020 --> 00:09:16,100
+العزلات اللي بنعزلها في المختبر ونشوف مدى مقاومتها
+
+129
+00:09:16,100 --> 00:09:23,250
+المضاداتوصل الصورة إلى two tasks أساسيين واحد عزل
+
+130
+00:09:23,250 --> 00:09:27,070
+isolation and identification of bacterial pathogen
+
+131
+00:09:27,070 --> 00:09:31,960
+رقم اتنينthe antimicrobial susceptibility testing
+
+132
+00:09:31,960 --> 00:09:37,220
+of that pathogen ماذا يستفيد من .. الطبيب يستفيد
+
+133
+00:09:37,220 --> 00:09:39,920
+من .. من هذه العملية انا اتعرفت على الميكروب
+
+134
+00:09:39,920 --> 00:09:44,480
+وحددتله قائمة باسماء المضادات الحيوية اللي
+
+135
+00:09:44,480 --> 00:09:49,580
+البكتيريا حساسة لهم او مقاومة لهم يبقى انا مش بعمل
+
+136
+00:09:49,580 --> 00:09:55,220
+انا بساعد الطبيب في الاختيار الانسب للعلاج لهذا
+
+137
+00:09:55,220 --> 00:09:59,940
+المريضطبعا ال learning outcomes تقريبا هي نفس ال
+
+138
+00:09:59,940 --> 00:10:04,300
+objectives لكن مصاغة بطريقة مختلفة مش هاخد وقت
+
+139
+00:10:04,300 --> 00:10:06,320
+طويل فيها ياري تتطلعوا عليها
+
+140
+00:10:09,730 --> 00:10:12,850
+من أين هدرس المصادق تبعنا؟ هدرس المصادق تبعنا من
+
+141
+00:10:12,850 --> 00:10:18,150
+دوسيه hand out من أدادي أنا موجودة على ال website
+
+142
+00:10:18,150 --> 00:10:21,970
+بتنزلوها بملف PDF لكن هناك مراجع رئيسية عندي
+
+143
+00:10:21,970 --> 00:10:25,050
+مرجعين رئيسيين اللي هو Bailey and Scott مشهور جدا
+
+144
+00:10:25,050 --> 00:10:28,490
+المرجع هذا زائد اللي هو ال laboratory diagnosis of
+
+145
+00:10:28,490 --> 00:10:30,770
+infectious diseases essential وده اللي على فكرة
+
+146
+00:10:30,770 --> 00:10:33,810
+موجودين electronic والنسخة الوراقية منهم موجودة في
+
+147
+00:10:33,810 --> 00:10:37,070
+المكتبة المركزية تستطيعوا الحصول عليها ان شاء الله
+
+148
+00:10:37,070 --> 00:10:43,230
+الاستعانة بهاإذن مصدر الرئيسي للمصاق هو ال hand
+
+149
+00:10:43,230 --> 00:10:47,770
+out أو الدوسية اللي احنا في شكل كتيب تم تحديثها
+
+150
+00:10:47,770 --> 00:10:53,370
+ميرانا و تكرانا بحسب السنوات السابقةال course
+
+151
+00:10:53,370 --> 00:10:56,190
+evaluation كيف احنا بدنا نقيم الطلبة خلال الفصل
+
+152
+00:10:56,190 --> 00:10:59,510
+هذا؟ غالبا فين دي حاجة اسمها continuous assessment
+
+153
+00:10:59,510 --> 00:11:02,930
+ال continuous assessment تنقسم إلى مجموعة عناصر ال
+
+154
+00:11:02,930 --> 00:11:06,930
+attendance حضور و غياب عندي ال .. ال quizzes حيكون
+
+155
+00:11:06,930 --> 00:11:09,710
+فيهنا quizzes حيكون فيهنا presentations and
+
+156
+00:11:09,710 --> 00:11:12,310
+assignments يعني ممكن نسألكوا بعض الأسئلة و
+
+157
+00:11:12,310 --> 00:11:15,830
+نقولكوا بدنا إلها إجابات تاني يوم أو في المحاضرة
+
+158
+00:11:15,830 --> 00:11:20,190
+التي تليهاهذا عالية 15% ال midterm examination
+
+159
+00:11:20,190 --> 00:11:24,610
+عالية 25% و ال final assessment عالية 60% درجة
+
+160
+00:11:24,610 --> 00:11:27,950
+مياوي هذه الملاحظة بتقول أنه النظام الأكاديمي في
+
+161
+00:11:27,950 --> 00:11:28,770
+الجامعة الإسلامية
+
+162
+00:11:31,620 --> 00:11:37,960
+بيقول انه الطالب عليه ان يحضر اكتر من خمسة وسبعين
+
+163
+00:11:37,960 --> 00:11:40,940
+في المية من محاضرة المصدق يعني لو غاب عن اكتر من
+
+164
+00:11:40,940 --> 00:11:45,920
+خمسة وعشرين لا يلزقله انه يدخل الامتحان انهي فنرجو
+
+165
+00:11:45,920 --> 00:11:49,020
+منكم الالتزام ويارتن الالتزام كمان برضه بوقت
+
+166
+00:11:49,020 --> 00:11:52,920
+الحضور لانه التأخير غالبا بيعمل عمل التشويش على
+
+167
+00:11:52,920 --> 00:12:01,310
+المحاضرال course content عندي موزع على أسابيع،
+
+168
+00:12:01,310 --> 00:12:04,830
+الأسابيع هذه الأسبوع الأول اللي احنا الآن بدأنا
+
+169
+00:12:04,830 --> 00:12:08,750
+فيه هو عبارة عن introduction وغالبا ال
+
+170
+00:12:08,750 --> 00:12:14,010
+introduction تشمل ال revision أو المراجعة لل host
+
+171
+00:12:14,010 --> 00:12:17,940
+parasite interactionأعتقد أنه من المهم جدا أعرف
+
+172
+00:12:17,940 --> 00:12:23,780
+كيف تتعامل الميكروبات وكيف يتعامل معها جهاز
+
+173
+00:12:23,780 --> 00:12:29,080
+المناعة، هذا مهم جدا لمجموعة من العناصر اللي هتطرق
+
+174
+00:12:29,080 --> 00:12:32,640
+لها في حينها إن شاء الله، عندنا أضخم مجموعة من
+
+175
+00:12:32,640 --> 00:12:34,480
+البكتيريا بتوجهنا سريريا اللي هي الـ
+
+176
+00:12:34,480 --> 00:12:37,500
+Enterobacteriasi، هناخد فيها تقريبا أسبوعين،
+
+177
+00:12:37,500 --> 00:12:40,430
+Enterobacteriasi part one و part twoفى عندى
+
+178
+00:12:40,430 --> 00:12:43,790
+lactose fermenter و لا lactose fermenter فى عندى
+
+179
+00:12:43,790 --> 00:12:47,230
+اللى هو ال Sodomonas and Miscellaneous
+
+180
+00:12:47,230 --> 00:12:51,150
+Nonfermenters سمعته ب Sodomonas و ده لأسودامونس
+
+181
+00:12:51,150 --> 00:12:55,130
+فيها مجموعة من الميكروبات غير متجانسة معاها الشيء
+
+182
+00:12:55,130 --> 00:12:58,030
+الوحيد المشترك بينهم انهم كلهم gram-negative
+
+183
+00:12:58,030 --> 00:13:01,270
+-bacilli و انهم non-fermenter و لما بقول non
+
+184
+00:13:01,270 --> 00:13:04,530
+-fermenter اقصد فيها non-glucose-fermenter يعني
+
+185
+00:13:04,530 --> 00:13:09,250
+كلهم اللي بيجمعهم صفتين ايش هم الصفتين؟ واحد انهم
+
+186
+00:13:09,250 --> 00:13:13,510
+gram-negative-bacilli رقم اتنين انهم non-fermenter
+
+187
+00:13:13,510 --> 00:13:16,410
+هذه فقط الصفات اللي بتجمعهم فبسموهم miscellaneous
+
+188
+00:13:16,410 --> 00:13:20,900
+non-fermenterفي أن السبوع الخامس هيكون عن ال
+
+189
+00:13:20,900 --> 00:13:24,440
+Vibrio و ال Campylobacter و ال Helicobacter ال
+
+190
+00:13:24,440 --> 00:13:27,340
+week سادس او السبوع السادس gram positive cocci
+
+191
+00:13:27,340 --> 00:13:30,000
+هدرس فيه ال Staphylococci و اللي بعده هدرس ال
+
+192
+00:13:30,000 --> 00:13:32,680
+streptococci اذا ال staphylococci و ال
+
+193
+00:13:32,680 --> 00:13:36,480
+streptococci بيغطوا ال gram positive cocci ال gram
+
+194
+00:13:36,480 --> 00:13:39,800
+negative cocci الصحيح احنا حاطينها في السبوع لكن
+
+195
+00:13:39,800 --> 00:13:44,620
+هي لن تأخد معنى سوى محاضرة واحدة و الممثل الوحيد
+
+196
+00:13:44,620 --> 00:13:49,270
+لهذه المجموعةهو النيسيريا النيسيريا جونورية و
+
+197
+00:13:49,270 --> 00:13:52,950
+النيسيريا مينيزدايدس دراستهم برضه كاسمه انتوا في
+
+198
+00:13:52,950 --> 00:13:56,270
+ال essential microbiology واحده بتسبب مرض السيالان
+
+199
+00:13:56,270 --> 00:13:59,910
+مرض بينتقل عن طريق الجنس و المرض الآخر اللي هو
+
+200
+00:13:59,910 --> 00:14:03,530
+التهاب الصحي او ال meningitis اللي هي من اسمها
+
+201
+00:14:03,530 --> 00:14:06,470
+نيسيريا مينيزدايدس بتسبب meningitis
+
+202
+00:14:09,020 --> 00:14:13,160
+الاسبوع التاسع ال gram-bostef-bacilli وجسمناهم إلى
+
+203
+00:14:13,160 --> 00:14:17,060
+جسمين spore-former واعتقد ان كنتوا درستوا نوعين من
+
+204
+00:14:17,060 --> 00:14:23,780
+ال spore-former، مين بيذكرهم؟ Spore-formers، بصلص
+
+205
+00:14:23,780 --> 00:14:27,860
+و كلسترديوم، بصلص و كلسترديوم، و ال non-spore
+
+206
+00:14:27,860 --> 00:14:30,860
+-former اللي هم منها الكورين البكتيريوم
+
+207
+00:14:30,860 --> 00:14:32,060
+والليستيريوم
+
+208
+00:14:34,840 --> 00:14:38,940
+الاسبوع ال 11 المايكوبكتيريا و بتستهل منها الصحي
+
+209
+00:14:38,940 --> 00:14:42,680
+اسبوع المايكوبكتيريا في منها اسمين مشهورين اللي هم
+
+210
+00:14:42,680 --> 00:14:44,840
+ال micro bacterium tuberculosis بسبب ال
+
+211
+00:14:44,840 --> 00:14:47,620
+tuberculosis و ال micro bacterium liberi اللي بسبب
+
+212
+00:14:47,620 --> 00:14:52,140
+مرض اللي هو الجذام كلا هم من الميكروبات المهمة جدا
+
+213
+00:14:52,140 --> 00:14:58,820
+الاسبوع الثاني عشر بدي اشبكم مع اللي هو ال ..
+
+214
+00:15:00,250 --> 00:15:03,750
+الخامس والرابع والتالت والتاني دول ايش .. ايش ..
+
+215
+00:15:03,750 --> 00:15:11,250
+ايش الصفة المشتركة بينهم كلهم
+
+216
+00:15:11,250 --> 00:15:13,850
+ال gram negative بس ال lie كلهم gram negative بس
+
+217
+00:15:13,850 --> 00:15:16,750
+ال lie هذه الأخيرة اللي .. اللي .. اللي .. اللي
+
+218
+00:15:16,750 --> 00:15:21,310
+دكرناها اللي هي ال respiratory gram negative برضه
+
+219
+00:15:21,310 --> 00:15:25,470
+هي gram negative لكن لماذا فصلناهم لحالهم لأنهم
+
+220
+00:15:25,470 --> 00:15:29,030
+بيتميزوا ببعض الصفات اللي بتخلينا نحطهم في مجموعة
+
+221
+00:15:29,030 --> 00:15:33,680
+لوحدهمواحد they are respiratory pathogens لسبب
+
+222
+00:15:33,680 --> 00:15:37,500
+كليتهم التهاباتري اوي رقم اتنين they are
+
+223
+00:15:37,500 --> 00:15:40,060
+fastidious اعتقد ان كلمة fastidious مش غريبة
+
+224
+00:15:40,060 --> 00:15:43,480
+عليكوا يعني they are او they require special
+
+225
+00:15:43,480 --> 00:15:48,240
+nutritional requirements بدهم مطالبات غذائية خاصة
+
+226
+00:15:48,240 --> 00:15:56,750
+بيهم مدلة لأ ال brucellaوالتريبونيميا والليبتو
+
+227
+00:15:56,750 --> 00:16:01,530
+سبايرا والبروليا طبعا البروسيلة لو جيبناها لحال
+
+228
+00:16:01,530 --> 00:16:05,650
+مشهورة بسبب الحمض الملطية بس التلاتة الأخرانين
+
+229
+00:16:05,650 --> 00:16:09,650
+تريبونيميا وليبتو سبايرا وبروليا هدولة التلاتة
+
+230
+00:16:09,650 --> 00:16:11,330
+عبارة عن spiral organism
+
+231
+00:16:14,160 --> 00:16:17,340
+يعني نشيل منهم البروسيلا والباقين مش بدهم يكونوا
+
+232
+00:16:17,340 --> 00:16:21,740
+spiral هدول ال spiral احنا في ال objectives بتاعت
+
+233
+00:16:21,740 --> 00:16:26,100
+المصاق قولنا او في وصف المصاق قولنا هندرس ال
+
+234
+00:16:26,100 --> 00:16:30,280
+classified و ال unclassified هدول من ضمن مين؟ من
+
+235
+00:16:30,280 --> 00:16:33,520
+ضمن ال unclassified لأنهم لا هم جرام بسطي ولا هم
+
+236
+00:16:33,520 --> 00:16:38,520
+جرام negative او او عفوا لا هم بصلاي ولا هم
+
+237
+00:16:38,520 --> 00:16:43,800
+كوكساية التعبير الأدقالاسبوع الرابع عشر عندي
+
+238
+00:16:43,800 --> 00:16:49,000
+كلاميديا وريكيزيا ودول التانين مشهورين جدا بصفة
+
+239
+00:16:49,000 --> 00:16:52,940
+واحدة انهم التانين obligate intracellular
+
+240
+00:16:52,940 --> 00:16:57,300
+parasites obligate intracellular parasites يعني لا
+
+241
+00:16:57,300 --> 00:17:01,300
+يستطيعوا ان يعيشوا معيشة حرة لازم يكونوا داخل
+
+242
+00:17:01,300 --> 00:17:05,960
+الخلية زي مين؟ زي الفيروسات زي الفيروسات حتى قديما
+
+243
+00:17:05,960 --> 00:17:10,570
+اول ما اكشفهم العلماء قالوا انههدولة بشكل حلقة وصل
+
+244
+00:17:10,570 --> 00:17:17,090
+طبعا علماء اللي بيؤمنوا بنظرية التطور بيستمتعوا
+
+245
+00:17:17,090 --> 00:17:20,770
+لما يلاجوا حلقات وصل فاتهموا هذا البكتيريا انها
+
+246
+00:17:20,770 --> 00:17:24,450
+حلقة وصل ما بين الفيروسات ما بين اللي هو البكتيريا
+
+247
+00:17:24,450 --> 00:17:29,710
+العادية لكن ثبت بعد دراسة معمقة انه هي بكتيريا
+
+248
+00:17:29,710 --> 00:17:34,430
+كاملة الأوصاف ما عدا مشكلة واحدة عندها عدم المقدر
+
+249
+00:17:34,430 --> 00:17:39,130
+على إنتاج ال ATP فعشان هي كدهطب يطلق عليها حتى لقب
+
+250
+00:17:39,130 --> 00:17:44,470
+اسم energy parasites يعني تتطفل من أجل الطاقة مش
+
+251
+00:17:44,470 --> 00:17:49,210
+من أجل الغذاء فقط وانما من أجل الطاقة ال micro
+
+252
+00:17:49,210 --> 00:17:53,290
+plasma اللي معهم في المجموعة برضه لها ميزة تتميز
+
+253
+00:17:53,290 --> 00:17:56,830
+عن باقي أنواع البكتيريا ألا وهي إنها مالهاش cell
+
+254
+00:17:56,830 --> 00:18:01,510
+wall wall-less بكتيريا وتتبر the smallest برضه
+
+255
+00:18:01,510 --> 00:18:04,550
+بكتيريا the smallest بكتيريا فهذه كمان برضه ميزة
+
+256
+00:18:04,550 --> 00:18:09,140
+إلاالجزء الأخير أو الأسبوع الأخير اللي هو اللي ان
+
+257
+00:18:09,140 --> 00:18:11,840
+شاء الله قلناه إذا أسعفنا الوقت بندرس منه اللي هو
+
+258
+00:18:11,840 --> 00:18:15,280
+ال mycology و بندرس فيه ال medically important
+
+259
+00:18:15,280 --> 00:18:20,540
+yeast and fungi أعتقد إنه إذا نجحنا هذا الفصل إنه
+
+260
+00:18:20,540 --> 00:18:24,420
+ندرس هذا بيكونوا أنتوا أول ناس أخدوا ال diagnostic
+
+261
+00:18:24,420 --> 00:18:27,740
+بالفطريات بالفطريات بطعم الفطريات
+
+262
+00:18:32,700 --> 00:18:37,120
+نبدأ في محاضرتنا او في مقدماتنا احنا كده بس نلخص
+
+263
+00:18:37,120 --> 00:18:40,760
+ننساش عن ايش كنا نحكي كنا بنحكي عن ال course
+
+264
+00:18:40,760 --> 00:18:44,920
+syllabus العقد اللي بيننا عرفته مين مدرسكم عرفته
+
+265
+00:18:44,920 --> 00:18:48,700
+موقعه عرفته كيف تتواصله معاه عبر ال email عرفته
+
+266
+00:18:48,700 --> 00:18:52,280
+كيف يقيمكوا في الدرجات عرفته المراجعة اللي بتتبعها
+
+267
+00:18:52,280 --> 00:18:57,220
+او بيستخدمها في التدريس سبعتهعرفتوا هداف المصاق
+
+268
+00:18:57,220 --> 00:19:02,020
+الوصف المصاق يعني المطلبات
+
+269
+00:19:02,020 --> 00:19:05,780
+المصاق السابقة تحدثنا عنها كلها فنرجو منكم أنه
+
+270
+00:19:05,780 --> 00:19:09,600
+كمان مرة أن تقوموا بمراجعة ال essential medical
+
+271
+00:19:09,600 --> 00:19:13,160
+microbiology مراجعة سريعة حتى تتمكنوا من السيط
+
+272
+00:19:13,160 --> 00:19:19,840
+بشكل جيد في هذا المصاق محاضرتنا اليوم مكونة من
+
+273
+00:19:19,840 --> 00:19:23,600
+مجموعة عناصرهتكلم عن فرضية كوخ اعتقد انه مرت
+
+274
+00:19:23,600 --> 00:19:27,120
+عليكوا فرضية كوخ قبل هيك هتكلم عن بعض التعريفات
+
+275
+00:19:27,120 --> 00:19:31,700
+الأساسية وانا الصحيح بشجع الطلبة في مراحة
+
+276
+00:19:31,700 --> 00:19:35,520
+البكاريوس انهم يحفظوا اكبر قدر ممكن من التعريفات
+
+277
+00:19:35,520 --> 00:19:40,460
+المتعلقة بالتخصص سبعهم ليش بنقول الكلام هذا ان
+
+278
+00:19:40,460 --> 00:19:47,510
+التعريفات مهمة to define is to identifyلما احنا
+
+279
+00:19:47,510 --> 00:19:52,950
+بنقول what is this، إيه الجواب؟ جلم، مظبوط، أكم
+
+280
+00:19:52,950 --> 00:19:57,370
+واحد فيده جلم، كلكم معاكم أقلام، هل تنطبق مواصفات
+
+281
+00:19:57,370 --> 00:20:01,950
+هذا القلم على الأقلام اللي معاكم؟لما بدك تقولي ما
+
+282
+00:20:01,950 --> 00:20:04,930
+مسمى بيقولي قلم لكن لما أقولك عرف هذا القلم بدك
+
+283
+00:20:04,930 --> 00:20:08,870
+تذكرلي بعض المواصفات اللي بتخلي هذا القلم مميز عن
+
+284
+00:20:08,870 --> 00:20:13,430
+مين؟ عن الآخرين فغالبا ال definition هو مصطلح أوسع
+
+285
+00:20:13,430 --> 00:20:17,350
+من كلمة معنى، معنى كلمة، مظبوط؟ فبالتالي بدنا نكون
+
+286
+00:20:17,350 --> 00:20:20,930
+على المقدر أن نتعرف على بعض التعريفات المهمة
+
+287
+00:20:20,930 --> 00:20:24,860
+factors controlling the growth of microorganismإذا
+
+288
+00:20:24,860 --> 00:20:27,980
+ما عرفناش ما هي العوامل التي تؤثر على نمو
+
+289
+00:20:27,980 --> 00:20:32,240
+الميكروبات لن نستطيع السيطرة على هذه الميكروبات
+
+290
+00:20:32,240 --> 00:20:36,140
+ولن نستطيع أن ننمي هذه الميكروبات في المعمد عشان
+
+291
+00:20:36,140 --> 00:20:41,180
+احنا بيقول ان احد اهم الأهداف بتاعة هذا المصاق هو
+
+292
+00:20:41,180 --> 00:20:46,440
+to isolateكلمة isolated يعني بدها culturing بدها
+
+293
+00:20:46,440 --> 00:20:49,800
+نمو ايش العوامل اللي بتأثر على النمو حرارة و ال
+
+294
+00:20:49,800 --> 00:20:54,480
+oxygen و ال nutrients ال macro و ال micro ال pH ال
+
+295
+00:20:54,480 --> 00:20:59,120
+water content كل هذه الأشياء ال endotoxin اللي هو
+
+296
+00:20:59,120 --> 00:21:04,020
+polysaccharide طبعا عامل مهم جدا جدا في عملية ال
+
+297
+00:21:04,020 --> 00:21:05,900
+path في نفسي استباحة ال gram negative بكتيريا
+
+298
+00:21:06,260 --> 00:21:09,260
+البكتيريا الاكزوتوكسين انا بتكلم على تيتانوس
+
+299
+00:21:09,260 --> 00:21:12,800
+والبوتلونيوم توكسين اتكلم على اليوكليستروديوم
+
+300
+00:21:12,800 --> 00:21:17,460
+بيرفرينجينز كتير من البكتيريا اللي مقدرة على إنتاج
+
+301
+00:21:17,460 --> 00:21:20,800
+اكزوتوكسين زي ال Vibrio cholera comparisons of
+
+302
+00:21:20,800 --> 00:21:24,240
+bacteria اللي بنعمل مقارنة بين التانين اللي هو ال
+
+303
+00:21:24,240 --> 00:21:29,700
+endotoxin والبكتيريا الاكزوتوكسين بنحاول ننلخص
+
+304
+00:21:29,700 --> 00:21:34,650
+العلاقة ما بين ال host و ما بين البرزاقالـ
+
+305
+00:21:34,650 --> 00:21:38,630
+pathogen virulence بدأ
+
+306
+00:21:38,630 --> 00:21:41,350
+أحكيلكوا بس نقطة عشان بس نستوعب الموضوع هذا، في
+
+307
+00:21:41,350 --> 00:21:45,390
+خاصية من خواص بعض البكتيريا اللي هي المقدرة على ال
+
+308
+00:21:45,390 --> 00:21:48,410
+attachment، مين المسؤول عن ال attachment؟ ال
+
+309
+00:21:48,410 --> 00:21:51,830
+بالاي، ال بالاي مسئولة عن ال attachment، يسموها
+
+310
+00:21:51,830 --> 00:21:57,310
+حتى attachment بالايهذا الـ attachment ply بتعطي
+
+311
+00:21:57,310 --> 00:22:00,870
+البكتيريا المقدرة على أنها تعمل attach to itself
+
+312
+00:22:00,870 --> 00:22:05,070
+itself يعني to other cells و to surfaces للأسطح
+
+313
+00:22:05,070 --> 00:22:09,330
+عارفين مقدرة البكتيريا على أنها تعمل attachment
+
+314
+00:22:09,330 --> 00:22:13,330
+على الأسطح بتزيد من ال viralness بتاعتها؟ ليش؟
+
+315
+00:22:13,330 --> 00:22:17,190
+أعطيكم مثالبتاع في الـ urinary tract مكوّنة من
+
+316
+00:22:17,190 --> 00:22:21,590
+kidneys و من ureter و من ال blooder صح؟ و من
+
+317
+00:22:21,590 --> 00:22:25,450
+urethra البكتيريا تدخل من ال urethra إلى ال
+
+318
+00:22:25,450 --> 00:22:30,170
+blooder الآن لاحظوا قطرة البول اللي جاية من
+
+319
+00:22:30,170 --> 00:22:36,470
+الكيلية حجمها كقطرة بول بنسبة حجم البكتيريا شلال
+
+320
+00:22:37,580 --> 00:22:41,660
+فلو البكتيريا طالعة و قطرة البول نازلة، إيش بيعمل؟
+
+321
+00:22:41,660 --> 00:22:45,860
+wash out، بتغسلها، بتطلعها برا، فلن يكون هناك
+
+322
+00:22:45,860 --> 00:22:50,320
+مقدرة للبكتيريا على الصمود في هذا المكان إلا إذا
+
+323
+00:22:50,320 --> 00:22:55,060
+كان لها مقدرة على مين؟ على الـattachment، فعامل
+
+324
+00:22:55,060 --> 00:22:59,000
+صغير، attachment، أعطى البكتيريا المقدرة أو ماعطاش
+
+325
+00:22:59,000 --> 00:23:03,120
+المقدرة أنها تعمل infection في مكان هذا، هنحاول
+
+326
+00:23:03,120 --> 00:23:05,820
+قدر الإمكان نشوف العوامل اللي بتأثر
+
+327
+00:23:09,820 --> 00:23:14,440
+فرضية كوخ لعالم كوخ افترض فرضية صحيح يعني كانت في
+
+328
+00:23:14,440 --> 00:23:19,000
+تا .. في ذاك الوقت فرضية رائعة جدا استطاع من
+
+329
+00:23:19,000 --> 00:23:26,240
+خلالها اثبات ان ال microbe X هو المسبب لمرض Xكيف
+
+330
+00:23:26,240 --> 00:23:29,960
+يعني؟ قال الـBacillus anthracis هي اللي بتسبب مرض
+
+331
+00:23:29,960 --> 00:23:33,980
+الجمر الخبيثة الـantarax تمام؟ الـVibrio cholera
+
+332
+00:23:33,980 --> 00:23:39,120
+هي اللي بتسبب مرض الكوليرة كيف قام وكيف أسس
+
+333
+00:23:39,120 --> 00:23:44,780
+للقاعدة المشهورة باسمه فرضية كوخ؟ قال يجب أن يكون
+
+334
+00:23:44,780 --> 00:23:53,540
+الميكروب في الحيوان المصاب وليس في السليم وإذا
+
+335
+00:23:54,660 --> 00:24:00,820
+حاولنا يجب أن نقوم بعزله من الحيوان المصاب وليس من
+
+336
+00:24:00,820 --> 00:24:06,940
+السليم وإذا أخذناه من الحيوان
+
+337
+00:24:06,940 --> 00:24:11,140
+المصاب وعزلناه وحققناه في السليم يجب أن تظهر عليه
+
+338
+00:24:11,140 --> 00:24:15,000
+نفس الأعراض اللي كانت عند الحيوان المصاب ويجب أن
+
+339
+00:24:15,000 --> 00:24:18,940
+نقوم بعزله مرة أخرى بصورة نقيبة كانت فأدية باختصار
+
+340
+00:24:18,940 --> 00:24:23,860
+فرضية كوخلو كوخ جاعد معانا اليوم كان بيقول لي يا
+
+341
+00:24:23,860 --> 00:24:27,120
+عم انتوا انا .. انا كنت في ذاك الوقت المعلومات
+
+342
+00:24:27,120 --> 00:24:30,480
+اللي عندنا متوفرة هي اللي كانت موجودة بس اليوم انا
+
+343
+00:24:30,480 --> 00:24:35,640
+بقولكوا فرضيتها دي مش صحيحة سقطت فرضية كوخ لماذا؟
+
+344
+00:24:35,640 --> 00:24:39,900
+لأنه ليس بالضرورة ان يكون الميكروب الممرض فقط في
+
+345
+00:24:39,900 --> 00:24:46,460
+الحيوان المصاب قد يكون أيضا في مين؟ في السليم حامض
+
+346
+00:24:46,460 --> 00:24:49,180
+المرض وفي أشياء أخرى normal flora أعطيكم مثل مش
+
+347
+00:24:49,180 --> 00:24:53,860
+حيوانات في الإنساناحنا بنحمل في الأنف تبعنا
+
+348
+00:24:53,860 --> 00:24:58,480
+بكتيريا Staphylococcus aureus normal لكن ال
+
+349
+00:24:58,480 --> 00:25:01,980
+Staphylococcus aureus معروف عنها بتعمل respiratory
+
+350
+00:25:01,980 --> 00:25:05,360
+tract infection بتعمل wound infection بتعمل
+
+351
+00:25:05,360 --> 00:25:08,160
+gastroenteritis بتعمل meningitis بتعمل septicemia
+
+352
+00:25:08,160 --> 00:25:12,060
+كل هذه الأمراض بسبب مين؟ ال Staphylococcus aureus
+
+353
+00:25:12,060 --> 00:25:15,520
+اللي أصلا موجودة في مين؟ في أنف الإنسان بصورة
+
+354
+00:25:15,520 --> 00:25:16,200
+طبيعية
+
+355
+00:25:24,650 --> 00:25:28,630
+النقطة التانية اللي اكد عليها وركز عليها جال يأتي
+
+356
+00:25:28,630 --> 00:25:33,650
+بعزل الميكروب بصورة نقيةطب هناك بعض الميكروبات لحد
+
+357
+00:25:33,650 --> 00:25:38,970
+الآن لم نستطع عزلها بصورة نقيه لكن استدلنا على ان
+
+358
+00:25:38,970 --> 00:25:42,450
+هي المسبب للمرض بطرق مختلفة ومتنوعة غير العزل
+
+359
+00:25:42,450 --> 00:25:46,190
+تمام؟ غير عزل ال micro إذا فرضية كوخ في حينها كانت
+
+360
+00:25:46,190 --> 00:25:50,670
+رائعة جدا و أثبتت علاقة كثير من الميكروبات بكثير
+
+361
+00:25:50,670 --> 00:25:57,830
+من الأمراض هذه الصورة بتعطي فكرة عن نفس المعلومات
+
+362
+00:25:59,450 --> 00:26:03,970
+زي ما حكينا إنه الحيوان المصاب عزلنا منه و بعدين
+
+363
+00:26:03,970 --> 00:26:06,870
+حقلناه في السليم و السليم صار برضه sick و بعدين
+
+364
+00:26:06,870 --> 00:26:11,170
+عزلنا منه مرة أخرى نبدأ نتعرف على بعض ال
+
+365
+00:26:11,170 --> 00:26:13,250
+definitions المهمة جدا في ال microbiology في إن
+
+366
+00:26:13,250 --> 00:26:15,610
+حاجة اسمها independence و independence معناها
+
+367
+00:26:15,610 --> 00:26:18,750
+استقلال و الاستقلال لا يعني أن انت تكون مافيش
+
+368
+00:26:18,750 --> 00:26:22,930
+حوالك يعني من أدمين بس لأ هذا تعريف رائع جدا ليس
+
+369
+00:26:22,930 --> 00:26:25,450
+الاستقلال البكتيريا و انما ايضا الاستقلال البشر
+
+370
+00:26:27,160 --> 00:26:31,760
+living free from the influence يعني معيشة حرة
+
+371
+00:26:31,760 --> 00:26:39,780
+بعيدا عن التأثر أو الإرشاد تمام أو السيطرة من كائن
+
+372
+00:26:39,780 --> 00:26:45,920
+آخر هذه هي الحرية ال independence هذا هو الاستقلال
+
+373
+00:26:49,230 --> 00:26:54,930
+لا نستطيع أن نجد في الواقع
+
+374
+00:26:54,930 --> 00:26:58,830
+بالنسبة للميكروبات، الميكروبات تعيش بشكل مستقل،
+
+375
+00:26:58,830 --> 00:27:01,590
+غالباً الميكروبات تعيش في communities، في مجتمعات،
+
+376
+00:27:01,590 --> 00:27:06,790
+في مجتمعات، فقد تعيش معيشة هرة وقد تعيش معيشة
+
+377
+00:27:06,790 --> 00:27:12,410
+مرتبطة، كلمة معيشة مرتبطة يعني symbiosis، علاقة في
+
+378
+00:27:12,410 --> 00:27:17,800
+أكتر من واحد فيها، أكتر من واحد،واحد بنسميه
+
+379
+00:27:17,800 --> 00:27:21,360
+symbiotes والتاني symbiotes تلاحظوا فيه فرق بين
+
+380
+00:27:21,360 --> 00:27:25,680
+الكلمتين بحرف ال N موجود هنا لكن الشرط انه لما
+
+381
+00:27:25,680 --> 00:27:28,980
+نقول symbiotes ان العلاقة تكون بين two dissimilar
+
+382
+00:27:28,980 --> 00:27:31,620
+ايش يعني dissimilar؟ يعني غير متشابهين، غير
+
+383
+00:27:31,620 --> 00:27:38,200
+متشابهين الآن العلاقات التالية تصف العلاقة الأولى
+
+384
+00:27:38,200 --> 00:27:44,460
+يعني العلاقة دي ممكن تكون mutualism لأ
+
+385
+00:27:46,690 --> 00:27:50,570
+التكاملية .. هدول .. التنين .. التنين بيكملوا بعض
+
+386
+00:27:50,570 --> 00:27:55,730
+.. يعني هذا بيستفيد و هذا بيستفيد .. هذا ال
+
+387
+00:27:55,730 --> 00:28:00,770
+mutualism ال commensalism تعيشية .. واحد بيستفيد و
+
+388
+00:28:00,770 --> 00:28:04,850
+التاني .. التاني متضررش .. خد بالكوا .. هذا
+
+389
+00:28:04,850 --> 00:28:08,610
+العلاقة .. هذا العلاقة غالبا هي نفس العلاقة
+
+390
+00:28:08,610 --> 00:28:13,530
+الأولانيةاللي هي mutualism بس هنا الاستفادة للكائن
+
+391
+00:28:13,530 --> 00:28:17,650
+الآخر قد تكون غير معلومة لدينا قد تكون غير معلومة
+
+392
+00:28:17,650 --> 00:28:20,930
+أعطيكم مثال معظم الميكروبات اللي في أمعاق الإنسان
+
+393
+00:28:20,930 --> 00:28:23,890
+بيقولوا أنها commensals بس احنا بنعرف أن في إلها
+
+394
+00:28:23,890 --> 00:28:29,050
+فوائد تمام؟ فممكن تكون mutualism فهدول الاتنين
+
+395
+00:28:29,050 --> 00:28:34,170
+عموما بينتجش منهم ضرر، بينتجش منهم ضررالتالتة اللي
+
+396
+00:28:34,170 --> 00:28:36,290
+هي العلاقة السيئة اللي احنا بيقول عنها ال
+
+397
+00:28:36,290 --> 00:28:41,310
+parasitism او اللي هي التطفل و التطفل واحد من ال
+
+398
+00:28:41,310 --> 00:28:44,930
+.. من ال .. من الاتنين بيستفيد و الآخر بيقولنا بي
+
+399
+00:28:44,930 --> 00:28:47,070
+.. بينضر أو بيحدث له ضرر
+
+400
+00:28:49,920 --> 00:28:54,180
+في مصطلح benign أو malignant كلمة benign حميد
+
+401
+00:28:54,180 --> 00:28:58,460
+وغالبا بنطلقها على condition على condition مش
+
+402
+00:28:58,460 --> 00:29:02,280
+طبيعي خدوا بالكم مش طبيعي لكن does not affect the
+
+403
+00:29:02,280 --> 00:29:06,380
+health or the life of the patient يعني لا بيأثر
+
+404
+00:29:06,380 --> 00:29:11,530
+على صحة ولا على اللي هو بعكس طبعا منين؟الماليجنانت
+
+405
+00:29:11,530 --> 00:29:14,990
+الماليجنانت غالبا بيكون disease tending to become
+
+406
+00:29:14,990 --> 00:29:20,110
+progressively worse بيتطور إلى الأسوأ بيتطور إلى
+
+407
+00:29:20,110 --> 00:29:23,850
+الأسوأ في مصطلح career اللي ذكرته قبل شوية انت
+
+408
+00:29:23,850 --> 00:29:29,310
+career career يعني حامل للميكروب الممرض لكن لا
+
+409
+00:29:29,310 --> 00:29:33,270
+يظهر عليه أي أعراض لكن خد بالك بالنسبة إن احنا هذا
+
+410
+00:29:33,270 --> 00:29:43,520
+يشكل خطورة كبيرة ليش؟هو مخزن أو reservoir للمرض
+
+411
+00:29:43,520 --> 00:29:49,140
+وفي قصة مشهورة يا شباب اسمها Typhoid Mary واحدة
+
+412
+00:29:49,140 --> 00:29:56,600
+كانت تشتغل طباخة في بريطانيا أينما حلت Mary حلت
+
+413
+00:29:56,600 --> 00:30:02,740
+Typhoid أينما حلت Mary حلت Typhoidفكان أحد الأطباء
+
+414
+00:30:02,740 --> 00:30:06,200
+.. طبعا هي غير مصابة .. فكان أحد الأطباء يتبع
+
+415
+00:30:06,200 --> 00:30:10,380
+المرض فلاحظ أنه وين هو كان فيه انتشار للـtyphoid
+
+416
+00:30:10,380 --> 00:30:15,960
+كان يشوف ماري و أخر مرة شافه هوين في السجنبتعمل
+
+417
+00:30:15,960 --> 00:30:19,100
+طباخة للمساجين يعني طباخة للمساجين و برضه صار
+
+418
+00:30:19,100 --> 00:30:22,720
+عندهم outbreak ل .. اللي هو ال .. وهي قصة مشهورة
+
+419
+00:30:22,720 --> 00:30:25,460
+باسم typhoid malaria يعني ممكن تعمل googling و
+
+420
+00:30:25,460 --> 00:30:30,740
+تشوف هذه القصة من مين؟ من carrier الآن نجي ل ال
+
+421
+00:30:30,740 --> 00:30:38,350
+pathogenicity مصطلحبينأكد من خلاله على أن الميكروب
+
+422
+00:30:38,350 --> 00:30:43,370
+له المقدرة على إحداث المرض يبقى عكسها لما بنقول
+
+423
+00:30:43,370 --> 00:30:49,650
+ميكروب بيمتلك pathogenicity يعني pathogen pathogen
+
+424
+00:30:49,650 --> 00:30:53,730
+العكسه non pathogen non pathogen
+
+425
+00:30:56,060 --> 00:31:01,260
+بدي اتفق معاكم من المحاضرة هذه على انه لا يوجد خط
+
+426
+00:31:01,260 --> 00:31:06,360
+واضح ما بين ال pathogen و ال non pathogen كيف
+
+427
+00:31:06,360 --> 00:31:13,500
+يعني؟ احنا ننطلق في حياتنا كمسلمين من قبل صلاة
+
+428
+00:31:13,500 --> 00:31:17,740
+الفجر قبل ما يقدم نصحى لو واحد في ليلة ضلماء طلع
+
+429
+00:31:17,740 --> 00:31:21,320
+على السطح وضلوا جاعد لساعة سبع أو تمانية الصبح
+
+430
+00:31:21,320 --> 00:31:26,900
+بتكون عتمة خالص على الساعة أربعو الساعة تمانية
+
+431
+00:31:26,900 --> 00:31:30,500
+بتكون شمس خالص لكن لو تذكر المراحل اللي مار فيهم
+
+432
+00:31:30,500 --> 00:31:35,260
+من الأربعة الصبح لتمانية الصبح هلاجئ انه الظلام
+
+433
+00:31:35,260 --> 00:31:40,500
+كان حالك بدأت تغزو بعض النور او يغزو بعض النور و
+
+434
+00:31:40,500 --> 00:31:44,620
+بعد شوية خف الظلام اكتر زاد النور اكتر لما انتقل
+
+435
+00:31:45,200 --> 00:31:48,120
+الان ال .. النور والظلام خدنا نحطهم قطعين باصلة
+
+436
+00:31:48,120 --> 00:31:52,160
+نقول pathogen و none pathogen لكن معظم الميكروبات
+
+437
+00:31:52,160 --> 00:31:56,760
+ماشية بين الفترتين يعني اشي قريب من ال non
+
+438
+00:31:56,760 --> 00:32:01,080
+pathogen واشي قريب من ال pathogen ليش ببقى بنحكي
+
+439
+00:32:01,080 --> 00:32:05,540
+الكلام هذا؟ لأن ال absolute terms او مصطلحات
+
+440
+00:32:05,540 --> 00:32:13,190
+المطلقة تؤدي إلى أفكار .. إلى أفكار وفكر صلببينما
+
+441
+00:32:13,190 --> 00:32:17,650
+المصطلحات غير المطلقة بتعطينا فكرة مرونة بتعطينا
+
+442
+00:32:17,650 --> 00:32:21,170
+نوع من إيه؟ من أنواع المرونة احنا بنقولكم من الآن
+
+443
+00:32:21,170 --> 00:32:25,530
+أن هناك microbat كنا ندرسها على إنها non-pathogen
+
+444
+00:32:25,530 --> 00:32:31,950
+ثبت إنها بعد ذلك pathogen وما هو pathogen لمجموعة
+
+445
+00:32:31,950 --> 00:32:35,890
+من الناس قد لا يكون pathogen لمجموعة أخرى من الناس
+
+446
+00:32:35,890 --> 00:32:40,050
+فبدنا نحاول نبتعد قدر الإمكان عن مين عن إنه نخل
+
+447
+00:32:40,050 --> 00:32:45,230
+المصطلح مطلقفي عندي مصطلح اخر اسمه virulence ال
+
+448
+00:32:45,230 --> 00:32:49,550
+virulence يعني بنقيس في شدة اللي هو ال
+
+449
+00:32:49,550 --> 00:32:53,850
+pathogenicity طبعا في حد اسمها virulence factors
+
+450
+00:32:53,850 --> 00:32:56,010
+حكينا عنها قبل شوية زي قولنا ال ply و ال
+
+451
+00:32:56,010 --> 00:32:59,250
+attachment فاكرينها؟ و في كتير virulence factors
+
+452
+00:32:59,250 --> 00:33:04,390
+زي الكابسول في عندي ال toxins اللي ذكرناهم ال
+
+453
+00:33:04,390 --> 00:33:07,090
+endoxin و ال exotoxin دول عبارة عن برضه virulence
+
+454
+00:33:07,090 --> 00:33:09,410
+factors في عندي dosage
+
+455
+00:33:12,450 --> 00:33:16,530
+لو أعطينا واحد عشر حبات بكتيريا يشربهم و واحد
+
+456
+00:33:16,530 --> 00:33:19,330
+أعطينا مائة حبات بكتيريا ايش بنقول عن العشرة
+
+457
+00:33:19,330 --> 00:33:24,810
+والمائة والمية فهذه دوس جرعة وهذه جرعة فالدوس هي
+
+458
+00:33:24,810 --> 00:33:29,190
+الكمية اللي .. و احنا غالبا بنجيسها بال number
+
+459
+00:33:29,190 --> 00:33:34,230
+بنجيسها بال number number of microorganism في
+
+460
+00:33:34,230 --> 00:33:40,790
+مصطلحين انا LD50 وفي انا مصطلح تاني ID50 مروا
+
+461
+00:33:40,790 --> 00:33:49,430
+عليكم هذين المصطلحين؟لو اعطينا جرعة X لمئة حيوان
+
+462
+00:33:49,430 --> 00:33:56,580
+تجارب خمسين بالمية منهم ماتوايبقى هذه الجرعة هي ال
+
+463
+00:33:56,580 --> 00:34:02,060
+LD50 هي ال LD50 التي قتلت نصف اللي هو حيارات تجارب
+
+464
+00:34:02,060 --> 00:34:07,440
+ال ID50 بدل ما تقتلهم بتسببلهم فقط إيه اللي هو
+
+465
+00:34:07,440 --> 00:34:11,900
+إمراض وبتاع اللي بيسميها Infectious Dose طبعا خدوا
+
+466
+00:34:11,900 --> 00:34:14,580
+بالكوا بتختلف الميكروبات عن بعض على بعض أعطيكوا
+
+467
+00:34:14,580 --> 00:34:20,400
+مثال بسيط الفيبروكوليرة عشان تصيبك بالمرض بدك
+
+468
+00:34:20,400 --> 00:34:29,300
+مليون خلية تتناول تشرببينما الشجرة خلية ل 100 خلية
+
+469
+00:34:29,300 --> 00:34:34,460
+كافين انهم يعملوا لك شجرالوسيس يبقى اختلفت الجرعة
+
+470
+00:34:34,460 --> 00:34:42,360
+من مايكروب ل مايكروب يبقى ال ID50 اللي احنا بنقول
+
+471
+00:34:42,360 --> 00:34:49,220
+مائة خلية و مليون خلية هي ايضا معشر على مين؟ على
+
+472
+00:34:49,220 --> 00:34:52,340
+ال virulence يعني بنجيس ال virulence بمين؟ بال
+
+473
+00:34:52,340 --> 00:34:58,680
+ID50 او ال LD50في ال morbidity و ال mortality ال
+
+474
+00:34:58,680 --> 00:35:03,300
+morbidity هي نسبة الإصابة بالمرض يعني ميكروب معين
+
+475
+00:35:03,300 --> 00:35:06,460
+بنقول ال morbidity rate تبعته كذا و كذا و هذكر
+
+476
+00:35:06,460 --> 00:35:10,340
+مثال او مثلين عشان تكون الصورة واضحة بينما ال
+
+477
+00:35:10,340 --> 00:35:14,340
+mortality rate معناها نسبة الوفيات من هذا المرض
+
+478
+00:35:14,340 --> 00:35:18,300
+يبقى ال morbidity نسبة حدوث المرض ده نذكر مثلين
+
+479
+00:35:18,300 --> 00:35:24,020
+قلنا مهمين جدا لترسيخ هذا المفهومInfluenza الطيور
+
+480
+00:35:24,020 --> 00:35:29,620
+تسمعوا فيها وInfluenza الخنازير Influenza الطيور
+
+481
+00:35:29,620 --> 00:35:34,820
+يا شباب اللي بتلفلف في العالم جاعدة حوالي يمكن من
+
+482
+00:35:34,820 --> 00:35:41,400
+2007 او 2006 زمان عدد اللي ماتوا او عفوا عدد اللي
+
+483
+00:35:41,400 --> 00:35:45,960
+قصيبوا يعني morbidity لا تجاوز ال 2000 لحد الآن لا
+
+484
+00:35:45,960 --> 00:35:50,380
+تجاوز ال 2000 لكن اللي ماتوا منهم اكتر من 65% من
+
+485
+00:35:50,380 --> 00:35:55,700
+هو الشبابيعني نسبة الإمراض قليلة ونسبة الوفيات
+
+486
+00:35:55,700 --> 00:36:01,040
+عالية لما تقول 65% وفيات عالية جدا لكن لما تقول
+
+487
+00:36:01,040 --> 00:36:05,700
+2001 في العالم كله هذا منقفض جدا منقفض تعالوا على
+
+488
+00:36:05,700 --> 00:36:10,600
+الانفلوانزا الخنازية أصابت معظم سكان العالم ونتكلم
+
+489
+00:36:10,600 --> 00:36:15,520
+عن مليارات من البشر لكن نسبة الوفيات فيها point
+
+490
+00:36:15,520 --> 00:36:24,960
+001 ولا حاجة؟احسب التنتين مع بعض احسب ال morbidity
+
+491
+00:36:24,960 --> 00:36:28,820
+rate مع ال mortality rate هتلاقي ان اللي مات من
+
+492
+00:36:28,820 --> 00:36:31,800
+influenza الخنازير اكتر من اللي مات من influenza
+
+493
+00:36:31,800 --> 00:36:35,720
+الطيور الموضوع مش مش موضوع percentage لكن تدمجوا
+
+494
+00:36:35,720 --> 00:36:38,880
+التنين مع بعض تمام تدمجوا التنين مع بعض هذه كتير
+
+495
+00:36:38,880 --> 00:36:42,460
+نقطة مهمة
+
+496
+00:36:42,460 --> 00:36:48,240
+طيب true pathogen true pathogen any microorganism
+
+497
+00:36:48,240 --> 00:36:52,630
+capable of causing diseaseويعني أي ميكروب عنده
+
+498
+00:36:52,630 --> 00:36:55,570
+المقدرة على إحتياط المرض بنسميه احنا true pathogen
+
+499
+00:36:55,570 --> 00:36:58,330
+بينما ال opportunistic واحدة نقطة كتير مهمة
+
+500
+00:36:58,330 --> 00:37:01,970
+بنعرفها لأن هذا المصطلح اللي بنطلقه بعض الأحيان
+
+501
+00:37:01,970 --> 00:37:05,970
+على الميكروبات اللي مابتعملش infection عند الناس
+
+502
+00:37:05,970 --> 00:37:09,970
+الأصحى فقط عند مين بتعمل infection؟ عند ال
+
+503
+00:37:09,970 --> 00:37:14,110
+immunocompromised اللي عندهم جهاز المناعة تضرر أو
+
+504
+00:37:14,110 --> 00:37:17,090
+تأثق خدوا بالكوا جهاز المناعة انتوا درستوا المناعة
+
+505
+00:37:17,090 --> 00:37:22,450
+ولا لسه؟طيب، بدأ عشان نلخصه بتلت كلمات، Diazepam
+
+506
+00:37:22,450 --> 00:37:27,330
+هي innate و adaptive immune system، ال innate
+
+507
+00:37:27,330 --> 00:37:33,710
+بتعلمش زي الجلد، زي الشعر في الأنف، تمام؟ ال acid
+
+508
+00:37:33,710 --> 00:37:39,480
+في المعدة؟غير متخصص بتعلمش يعني هو هو مش بقت حاجة
+
+509
+00:37:39,480 --> 00:37:43,920
+بتعلمش لإنه مش نافع هو قائم بدور عظيم جدا اعطيكم
+
+510
+00:37:43,920 --> 00:37:48,580
+مثال بسيط الجلب is impenetrable غير قابل للاختراق
+
+511
+00:37:48,580 --> 00:37:52,520
+من قبل معظم الميكروبات من قبل معظم الميكروبات لو
+
+512
+00:37:52,520 --> 00:37:58,610
+انخدش انجرح او احترقبصير الجسم عرضة للانتنات
+
+513
+00:37:58,610 --> 00:38:01,990
+والالتهابات في هذا الحالة الميكروبات اللي استغلت
+
+514
+00:38:01,990 --> 00:38:07,390
+فرصة ان الجلد صار فيه خدش او breach طبعا الان
+
+515
+00:38:07,390 --> 00:38:11,330
+بنسميها opportunistic pathogens طبعا opportunistic
+
+516
+00:38:11,330 --> 00:38:16,220
+يعني انتقلت للفرصة ال infectionعبارة عن
+
+517
+00:38:16,220 --> 00:38:19,840
+colonization او invasion and multiplication of
+
+518
+00:38:19,840 --> 00:38:22,600
+pathogenic microorganism in the host with or
+
+519
+00:38:22,600 --> 00:38:25,060
+without the manifestation of disease فهذه نقطة
+
+520
+00:38:25,060 --> 00:38:29,680
+كتير بدنا نفهمها انه مش في معنى الحاجة ان انت
+
+521
+00:38:29,680 --> 00:38:34,130
+infected ان انت صار عندك diseaseلأ بس ال infected
+
+522
+00:38:34,130 --> 00:38:39,350
+هو عبارة عن نجاح في استعمار ان البكتيريا استعمرت
+
+523
+00:38:39,350 --> 00:38:44,370
+هذا المكان في جسمك قد تؤدي هذا الاستعمار الى احداث
+
+524
+00:38:44,370 --> 00:38:48,630
+مرض او عدم احداث مرض و قد يتحول الى career stay
+
+525
+00:38:48,630 --> 00:38:53,010
+لذلك ليس بالضرورة ان انت infected لانه ليش انا
+
+526
+00:38:53,010 --> 00:38:59,200
+بأكد على المعلومة هذه لانه لغويالغويا في ال .. بين
+
+527
+00:38:59,200 --> 00:39:01,900
+المتحدثين باللغة الإنجليزية لو بدي أقوله عن نفسه
+
+528
+00:39:01,900 --> 00:39:06,920
+إن أنا مريض بقولك I got infection أنا أخدتها عدوى
+
+529
+00:39:06,920 --> 00:39:11,760
+هو بيقصد في هذه الحالة إيش؟ إنه مرض لكن علميا احنا
+
+530
+00:39:11,760 --> 00:39:16,000
+بيقولكوا ال infection قد تؤدي أو لا تؤدي إلى مرض
+
+531
+00:39:16,000 --> 00:39:20,620
+هذه نقطة كتير مهمة يبقى ال .. ال infection ال
+
+532
+00:39:20,620 --> 00:39:25,120
+colonization مرحل مرحل مين؟ ال multiplication مرحل
+
+533
+00:39:25,120 --> 00:39:31,900
+مرحل مين؟الكورونازيين يبقى اول حاجة entry دخول
+
+534
+00:39:31,900 --> 00:39:35,180
+الميكروب رقم اتنين multiplication رقم تلاتة
+
+535
+00:39:35,180 --> 00:39:38,600
+colonization رقم اربعة infection وقد يكون هناك
+
+536
+00:39:38,600 --> 00:39:44,500
+disease او ما يكون هناك diseaseالمرض بيسموه ..
+
+537
+00:39:44,500 --> 00:39:47,740
+بيعرفوه تعريف يعني شويه واسع .. هو بيتكلمش عن
+
+538
+00:39:47,740 --> 00:39:50,760
+المرض .. المرض الميكروبي بشكل عام المرض disease an
+
+539
+00:39:50,760 --> 00:39:54,980
+abnormal condition of body functions or structure
+
+540
+00:39:54,980 --> 00:40:00,600
+that is considered to be harmful to the affected
+
+541
+00:40:00,600 --> 00:40:02,920
+individual اللي هو ال .. ال .. ال .. الهواصفة
+
+542
+00:40:02,920 --> 00:40:09,100
+للحياة تعريف أخر وهو تعريف يعني وسع المرض تماما
+
+543
+00:40:09,100 --> 00:40:14,490
+any deviationfrom .. وراحت .. انا deviation from
+
+544
+00:40:14,490 --> 00:40:18,430
+or interruption of the normal structure or
+
+545
+00:40:18,430 --> 00:40:21,590
+function of any part, organ or system of the body
+
+546
+00:40:21,590 --> 00:40:26,310
+كيش مع ال deviation .. deviation انحراف انا
+
+547
+00:40:26,310 --> 00:40:31,270
+deviation معناها انحراف او interruption يعني
+
+548
+00:40:34,250 --> 00:40:40,290
+بشكل سلبي عمل أحد الأجزاء في الجسم قد تعرض لل
+
+549
+00:40:40,290 --> 00:40:46,550
+interruption وجف وجفنا عوقنا هذا يعتبر المريض فانت
+
+550
+00:40:46,550 --> 00:40:52,870
+الآن لو صحيت من النوم ومش normal ايش يعني مش
+
+551
+00:40:52,870 --> 00:40:57,690
+normal؟ مش طبيعي يا ناس مش طبيعي يعني خد بالك على
+
+552
+00:40:57,690 --> 00:41:06,190
+مستوى .. هذا طبيعي أصلا نعسىأه ..عندك صداع عندك
+
+553
+00:41:06,190 --> 00:41:12,270
+صداع هذا مش طبيعي هذا مش طبيعي لاتستطيع أن تحرك
+
+554
+00:41:12,270 --> 00:41:18,330
+بعض المفاصل من جسمك مش طبيعي اصحيت في مزاج متعكر
+
+555
+00:41:18,330 --> 00:41:22,270
+جدا هذا برضه مش طبيعي حتى المرض او لان المرض
+
+556
+00:41:22,270 --> 00:41:26,110
+الجانب النفسي مهم جدا في موضوع المرض فالتعريف
+
+557
+00:41:26,110 --> 00:41:29,930
+الأخير هذا الصحيح تعريف واسع جدا لعملية المرض هو
+
+558
+00:41:29,930 --> 00:41:33,350
+any deviation من اللي هو ال normal status
+
+559
+00:41:36,850 --> 00:41:41,850
+طيب من أهم الأشياء اللي جنا بدنا نعرفها في هذه
+
+560
+00:41:41,850 --> 00:41:44,950
+المحاضرة اللي هو ال controlling أو ال factors
+
+561
+00:41:44,950 --> 00:41:50,550
+controlling the growth of microorganisms تخيلوا يا
+
+562
+00:41:50,550 --> 00:41:56,090
+شباب أنه في عندنا مايكروبات حاطناهم في مرتبان مربع
+
+563
+00:41:56,090 --> 00:42:00,690
+مربع بتعرف المربع؟ اه؟ لأن إيش فيه في جوا في
+
+564
+00:42:00,690 --> 00:42:04,910
+المربع؟ فيه فاكهة وفيه سكر وفيه ميه صح أو لأ؟
+
+565
+00:42:05,490 --> 00:42:08,890
+الفكهة مش فيها شباب الفكهة، فيها Minerals و
+
+566
+00:42:08,890 --> 00:42:14,490
+Vitamins، عناصر كتيرة، يعني المفروض أنه انقول
+
+567
+00:42:14,490 --> 00:42:18,990
+للبكتيريا انت الآن أمامك كل ال nutrients، تفضلي
+
+568
+00:42:18,990 --> 00:42:25,930
+تغذي وتكاتري، لكن بنلاحظ أن البكتيريا ما بتتغذاش
+
+569
+00:42:25,930 --> 00:42:30,690
+في المربّة و بتموت، عشانك المربّة ما بتفسدش بسهولة
+
+570
+00:42:31,770 --> 00:42:35,930
+لأن كمية السكر اللي فيه كمية عالية جدا بحيث ان
+
+571
+00:42:35,930 --> 00:42:42,050
+الماء اللي احنا شايفينه جوا تمام ليس ماء حر مش
+
+572
+00:42:42,050 --> 00:42:47,390
+free water وانما bound water والبكتيريا لا تستطيع
+
+573
+00:42:47,390 --> 00:42:50,710
+الاستفادة من مين؟ من ال bound water بستفيد فقط من
+
+574
+00:42:50,710 --> 00:42:56,650
+ال free water احنا شايفين ان في water لكن غير متاح
+
+575
+00:42:57,520 --> 00:43:02,420
+و كذلك الأمر بعض الأحيان ال nutrient بتكون موجودة
+
+576
+00:43:02,420 --> 00:43:07,020
+لكن غير كلمة presence nutrient presence غير عن
+
+577
+00:43:07,020 --> 00:43:10,140
+nutrient availability availability يعني ال
+
+578
+00:43:10,140 --> 00:43:13,600
+nutrient متاح على مين لاستخدام البكتيريا زي عندك
+
+579
+00:43:13,600 --> 00:43:17,940
+في البيت حاطينك أكل و شرب في التلاجة و مساكرين
+
+580
+00:43:17,940 --> 00:43:24,760
+تلاجة الأكل موجود not available not available مش
+
+581
+00:43:24,760 --> 00:43:30,320
+متاح تمام؟في عندي physiological environmental
+
+582
+00:43:30,320 --> 00:43:33,400
+parameters زي ال water activity أو osmotic
+
+583
+00:43:33,400 --> 00:43:36,960
+pressure حكينا عن ال water activity قولنا إنه لازم
+
+584
+00:43:36,960 --> 00:43:40,580
+يكون نسبة عالية من الماء متاحة للبكتيريا حتى تنمو
+
+585
+00:43:40,580 --> 00:43:45,500
+لو قللنا هذه النسبة بنمنع نمو البكتيريا وما حفظوا
+
+586
+00:43:45,500 --> 00:43:51,900
+الأغضية بالتمليح أو بوضع السكر إلا
+
+587
+00:43:54,570 --> 00:43:58,110
+تأثير على ال water activity و على ال osmotic
+
+588
+00:43:58,110 --> 00:44:01,150
+pressure .. ال osmotic pressure ليش البحر الميت
+
+589
+00:44:01,150 --> 00:44:02,630
+بيقولوا عنه ميت؟
+
+590
+00:44:05,420 --> 00:44:08,840
+لماذا مافيش فيه حياة؟ تركيز الملح اللي فيه .. طبعا
+
+591
+00:44:08,840 --> 00:44:11,600
+فيه بكتيريا بتعيش في البحر الميت، بطة الميت، تمام؟
+
+592
+00:44:11,600 --> 00:44:14,960
+اسم البكتيريا Halobacterium Halopium بتحب الملح،
+
+593
+00:44:14,960 --> 00:44:18,720
+هي محبة للملح، يعني في بعض الميكروبات، و هذا نقطة
+
+594
+00:44:18,720 --> 00:44:22,840
+نبدأ فيها من الآن، ان الكلام اللي بنحكي مافيش عامل
+
+595
+00:44:22,840 --> 00:44:26,770
+مناسب لكل الميكروبات و عامل سيء لكل الميكروباتهناك
+
+596
+00:44:26,770 --> 00:44:30,430
+مايكروبات تعيش في درجة حرارة تقريبا 95 درجة مائوية
+
+597
+00:44:30,430 --> 00:44:34,430
+وهناك مايكروبات تعيش في كهوف حمضية ال pH غير قابل
+
+598
+00:44:34,430 --> 00:44:39,330
+القياس أقل من واحد تمام؟ وهناك مايكروبات تعيش في
+
+599
+00:44:39,330 --> 00:44:45,470
+درجة حرارة منخفضة جدا إذا هناك تنوع طبيعي في هذه
+
+600
+00:44:45,470 --> 00:44:49,550
+المخلوقة نسبة ال Oxygen و ال pH و ال temperature و
+
+601
+00:44:49,550 --> 00:44:55,240
+المنافسة إيش المنافسة؟مش المعنى المفهوم انا قولت
+
+602
+00:44:55,240 --> 00:44:58,420
+في بداية المحاضرة انه نادرا managed البكتيريا
+
+603
+00:44:58,420 --> 00:45:00,860
+بتعيش منفردة وانما في communities ايش هي ال
+
+604
+00:45:00,860 --> 00:45:05,790
+communities؟ مجتمعات والمجتمعات فيها تنافسفكيف
+
+605
+00:45:05,790 --> 00:45:09,050
+تتنافس البكتيريا مع بعضها البعض هذا كمان قصة
+
+606
+00:45:09,050 --> 00:45:13,870
+هتتكلم عنها لاحقا ال host immune system برضه ان
+
+607
+00:45:13,870 --> 00:45:17,410
+شاء الله المحاضرة القادمة بإذن الله هنحاول انه
+
+608
+00:45:17,410 --> 00:45:19,570
+نفسر فيها، بإنها دي اللوحة اللي ختمنا فيها
+
+609
+00:45:19,570 --> 00:45:22,650
+محاضرتنا اليوم، هنبدأ فيها المحاضرة القادمة ان شاء
+
+610
+00:45:22,650 --> 00:45:24,790
+الله، حد عنده يستفسر أوي سؤال؟
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/rHI5W1zePCg_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/rHI5W1zePCg_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e1d9ec34e2a8cbeaa2002c3081810879e1c27b90
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/rHI5W1zePCg_raw.srt
@@ -0,0 +1,2492 @@
+1
+00:00:20,700 --> 00:00:23,480
+بسم الله الرحمن الرحيم موضوع جديد خالص اليوم اللي
+
+2
+00:00:23,480 --> 00:00:27,160
+هو ال gram positive oxide بعد ما قضينا حوالي خمسة
+
+3
+00:00:27,160 --> 00:00:30,320
+أسابيع في الحديث عن ال gram negative بس الله أعنا
+
+4
+00:00:30,320 --> 00:00:34,840
+لنا أن نأخذ وقت مستقطع سنعود ان شاء الله لمناقشة
+
+5
+00:00:34,840 --> 00:00:38,320
+الباقي منهاهنتكلم اليوم ان شاء الله عن مجموعة
+
+6
+00:00:38,320 --> 00:00:41,660
+اسمها ground positive cocci اللى بتنقسم الى قسمين
+
+7
+00:00:41,660 --> 00:00:46,840
+رئيسيين بفعل فحص مهم جدا اللى هو ال catalase test
+
+8
+00:00:46,840 --> 00:00:51,480
+بينقسم البكتيريا الى negative streptococci و
+
+9
+00:00:51,480 --> 00:00:56,280
+positive staphylococci اذا انا في هندي كمان مرةتو
+
+10
+00:00:56,280 --> 00:00:59,600
+جيناس مهمين جدا في الكلام بصطف كوكساى الاستفيل
+
+11
+00:00:59,600 --> 00:01:03,520
+الكوكاى والاستريبتو كوكاى و ال differentiation على
+
+12
+00:01:03,520 --> 00:01:06,120
+الرغم من انه يبدو morphologically they are
+
+13
+00:01:06,120 --> 00:01:09,480
+different يعني واحدة in clusters و واحدة in chains
+
+14
+00:01:09,480 --> 00:01:14,020
+في سلسل زي الاستريبتو سلسل بينما الاستفيل الكوكاى
+
+15
+00:01:14,020 --> 00:01:17,360
+cluster الا انه ال differentiation الرئيسي لهم عبر
+
+16
+00:01:17,360 --> 00:01:21,120
+مين عبر فحص الكتاليز which is a one minute test
+
+17
+00:01:21,120 --> 00:01:25,640
+يعني مش هياخد مننا وقت طويل للفحصهنبدأ اليوم ان
+
+18
+00:01:25,640 --> 00:01:28,560
+شاء الله بمناقشة الـ Staphylococci اللي من الصورة
+
+19
+00:01:28,560 --> 00:01:31,440
+مبين انها ال arrangement تبع الخلياها يقولنا in
+
+20
+00:01:31,440 --> 00:01:35,360
+clusters حوالي
+
+21
+00:01:35,360 --> 00:01:38,660
+تلاتة و تلاتين species موجودين في ال genus على
+
+22
+00:01:38,660 --> 00:01:42,760
+الرغم من ان احنا ندرس فقط من تلاتة species تلاتة و
+
+23
+00:01:42,760 --> 00:01:47,180
+تلاتين species the most important of which are
+
+24
+00:01:47,180 --> 00:01:50,280
+three Staphylococcus aureus Staphylococcus
+
+25
+00:01:50,280 --> 00:01:55,470
+epidermidis Staphylococcus saprophyticusAureus
+
+26
+00:01:55,470 --> 00:01:59,230
+which is the most important of all times يعني من
+
+27
+00:01:59,230 --> 00:02:04,010
+.. منذ زمن طويل حتى أيام احنا كنا طلبة كان عندنا
+
+28
+00:02:04,010 --> 00:02:07,090
+ال staff اللي كوكبش Aureus بتعتبر number one
+
+29
+00:02:07,090 --> 00:02:09,890
+pathogen حتى هدولة كانوا يعتبروا non pathogen
+
+30
+00:02:09,890 --> 00:02:14,730
+بمعنىإنه كل الستفيلوكوكا يعني كانت none بعتجين ما
+
+31
+00:02:14,730 --> 00:02:18,530
+عدا الستفيلوكوكاس بس اليوم لأ اليوم اختلف الكلام
+
+32
+00:02:18,530 --> 00:02:22,230
+معلوماتنا زادت صرنا نعرف انه مثلا الستفيلوكوكاس
+
+33
+00:02:22,230 --> 00:02:25,450
+epidermidis مش may cause endocarditis it causes
+
+34
+00:02:25,450 --> 00:02:29,910
+endocarditis الستفيلوكوكاس saprophyticis مش may
+
+35
+00:02:29,910 --> 00:02:33,570
+cause cystitis it causes cystitis بمعنى صار عننا
+
+36
+00:02:33,570 --> 00:02:37,570
+تدرج في ال evidence ايش يعني ال evidence الأدلة
+
+37
+00:02:37,570 --> 00:02:42,700
+انه مشتبه هنا بتسبب كدهربما بتسبب كذا لأن أصبحت
+
+38
+00:02:42,700 --> 00:02:47,540
+مؤكدة أنها بتسبب هذا المرض لأنزيدكم كمان معلومة
+
+39
+00:02:47,540 --> 00:02:52,560
+أخطر هذه البكتيريا يفترض أنها هي الوحيدة لل
+
+40
+00:02:52,560 --> 00:02:58,040
+Parathogen كما كان معلوماتنا في السابق و الأخريات
+
+41
+00:02:58,040 --> 00:03:01,940
+معناها بحكي أنه ليس لهم ذكر في ال Parathogenesis
+
+42
+00:03:03,080 --> 00:03:09,280
+اليوم لو طلعنا على causes of septicemia in
+
+43
+00:03:09,280 --> 00:03:14,700
+hospitals حلاج الـ Staphylococcus epidermidis نسبة
+
+44
+00:03:14,700 --> 00:03:19,320
+إحداثها أعلى من مين؟ من الـ Staphylococcus aureus
+
+45
+00:03:19,320 --> 00:03:25,990
+هذا مؤشر على إيش؟انه احنا بعض الأحيان بنحاول
+
+46
+00:03:25,990 --> 00:03:30,510
+نستخدم المعلومات بمجرد انه نتعرف على المعلومة دون
+
+47
+00:03:30,510 --> 00:03:35,050
+التحقق منها او انه تقنياتنا كما ذكرت في محاولة
+
+48
+00:03:35,050 --> 00:03:39,590
+سابقة كانت غير كافية للفتوى بان هذا ال micro
+
+49
+00:03:39,590 --> 00:03:43,670
+pathogen او غير pathogen او مافيش ادلة متوفرة على
+
+50
+00:03:43,670 --> 00:03:50,710
+هذا الكلامالمؤكد ان الحقيقة الثابتة الوحيدة هو
+
+51
+00:03:50,710 --> 00:03:54,210
+تغير المعلومات معلوماتنا دايما تتغير هذا حقيقة
+
+52
+00:03:54,210 --> 00:03:57,710
+ثابتة ان احنا دايما بتتغير المعلومات عندنا لذلك
+
+53
+00:03:57,710 --> 00:04:00,730
+بدأ نقسم ال .. ال .. ال .. الاستفادة الى كوكاي إلى
+
+54
+00:04:00,730 --> 00:04:06,950
+صينتين كو أجيوليز positive و كو أجيوليز negative
+
+55
+00:04:11,110 --> 00:04:18,190
+C-Coagulase Negative Staphylococci مصطلح CNS
+
+56
+00:04:18,190 --> 00:04:21,130
+Coagulase Negative Staphylococci مش central
+
+57
+00:04:21,130 --> 00:04:25,910
+nervous system هذا المصطلح
+
+58
+00:04:25,910 --> 00:04:30,540
+كده مرةكان زمان يستخدم لتفريق ال Staphylococcus
+
+59
+00:04:30,540 --> 00:04:33,800
+aureus اللي هي ال pathogen عن ال non pathogen بس
+
+60
+00:04:33,800 --> 00:04:37,780
+اليوم لأ اليوم بيستخدم بأن هذه مجموعة pathogens
+
+61
+00:04:37,780 --> 00:04:40,740
+مختلفة عن مين على ال Staphylococcus aureus، هذه
+
+62
+00:04:40,740 --> 00:04:44,710
+كتير مهمة المعلومةالـ general characteristics
+
+63
+00:04:44,710 --> 00:04:49,930
+للمجموعة كلهم بيشتركوا بإنهم gram-bostev-cocci
+
+64
+00:04:49,930 --> 00:04:53,850
+arranged in clusters، يعني بشكل عنقيد، they are
+
+65
+00:04:53,850 --> 00:04:56,030
+strongly gram-bostev، إيش يعني strongly gram
+
+66
+00:04:56,030 --> 00:05:00,630
+-bostev؟ يعني ال color اللي هو ال purple بيكون
+
+67
+00:05:00,630 --> 00:05:05,170
+intense، يعني كثيف نعمIt ferments many
+
+68
+00:05:05,170 --> 00:05:07,810
+carbohydrates with the production of lactic acid,
+
+69
+00:05:08,250 --> 00:05:12,890
+but not gas، تنتج لاكتك أسد as an end product في
+
+70
+00:05:12,890 --> 00:05:17,270
+ال fermentation of carbohydrate، non-motile، non
+
+71
+00:05:17,270 --> 00:05:22,030
+-spore formingغير متحركة والامدنعامم All cocci are
+
+72
+00:05:22,030 --> 00:05:26,430
+non-motile All cocci are non-motile All cocci
+
+73
+00:05:26,430 --> 00:05:30,130
+أيضًا are non-spore forming وانا بقول هنا cocci
+
+74
+00:05:30,130 --> 00:05:33,370
+سواء كانت جرام negative أو جرام positive وبقول هنا
+
+75
+00:05:33,370 --> 00:05:35,670
+كمان cocci سواء كانت جرام positive أو جرام
+
+76
+00:05:35,670 --> 00:05:41,370
+negative إنها non-spore forming لستفي الكوكساورس
+
+77
+00:05:41,370 --> 00:05:44,150
+اللي سمناها ال number one pathogen أو the most
+
+78
+00:05:44,150 --> 00:05:49,160
+important pathogen of the groupأخدت اسمها Aureus
+
+79
+00:05:49,160 --> 00:05:54,340
+من أحرى من لون المستعمرات على البلد أجار بالذات it
+
+80
+00:05:54,340 --> 00:05:58,260
+produces golden yellow pigment و Aurora معناها
+
+81
+00:05:58,260 --> 00:06:02,020
+باللاتين الذهب فأخذها اللون الذهبي من لون
+
+82
+00:06:02,020 --> 00:06:05,940
+المستعمرات فحتى باللغة العربية بترجموها المكورات
+
+83
+00:06:05,940 --> 00:06:16,280
+الأنقوضية الذهبية المكورات الأنقوضية الذهبية
+
+84
+00:06:19,280 --> 00:06:22,500
+الان الـ diseases produced by this organism may
+
+85
+00:06:22,500 --> 00:06:27,060
+range from simple bioderma يعني حبوب بعد الحلاجة
+
+86
+00:06:27,060 --> 00:06:31,480
+على سبيل المثال لما واحد بيلج دجنه او شعره الى
+
+87
+00:06:31,480 --> 00:06:35,800
+toxic shock syndrome toxic shock syndrome أخدناها
+
+88
+00:06:35,800 --> 00:06:41,000
+لما درسنا ال exotoxins toxic shock syndrome toxin
+
+89
+00:06:41,000 --> 00:06:45,540
+TSST toxic shock syndrome toxin هتكلم عنه كمان
+
+90
+00:06:45,540 --> 00:06:48,400
+شوية بس خلينا نمرور سريع على أسماء الأمراض
+
+91
+00:06:49,290 --> 00:06:53,170
+Septicemia, Meningitis, Food Poisoning برضه مارب
+
+92
+00:06:53,170 --> 00:06:57,310
+معانا الـ Food Poisoning فرنكلز اللي هي الأفسد
+
+93
+00:06:57,310 --> 00:07:01,570
+الخراجات, Impetigo نوع من ال skin infection برضه
+
+94
+00:07:01,570 --> 00:07:07,270
+بالـ Staphylococcus aureus نيومونيا وBioderma ناخد
+
+95
+00:07:07,270 --> 00:07:12,030
+رقم واحد نذكركوا فيها toxic shock syndrome ال
+
+96
+00:07:12,030 --> 00:07:15,450
+toxic shock syndrome ارتبط الصحيح ارتبط اكتر
+
+97
+00:07:15,450 --> 00:07:21,530
+بالسيداتو الفتيات من الذكور نظرا لإنه في علاقة بين
+
+98
+00:07:21,530 --> 00:07:26,350
+التانية الفتاة عندما تبلغ تبدأ معاها حالة في
+
+99
+00:07:26,350 --> 00:07:28,390
+استيولوجيا احنا بنسميها الدورة الشهرية اللي هي ال
+
+100
+00:07:28,390 --> 00:07:34,770
+menstrual period فبصير تستخدم الحفاضات النسائية
+
+101
+00:07:34,770 --> 00:07:39,850
+الحفاضات النسائية تمطس كمية من الدم كمية من الدم
+
+102
+00:07:39,850 --> 00:07:45,270
+تذكروا إن الدمأحنا ضفناها في المعمل على ال
+
+103
+00:07:45,270 --> 00:07:49,610
+nutrient agar أو على basic media to enrich the
+
+104
+00:07:49,610 --> 00:07:55,090
+media يعني ال blood نفسه يعتبر غذاء جيد و ممتاز
+
+105
+00:07:55,090 --> 00:07:59,390
+لمن؟ للبكتيريا ال Staphylococcus aureus موجودة
+
+106
+00:07:59,390 --> 00:08:02,290
+أكتر ما هي موجودة في الأنف تبعنا و على ال skin
+
+107
+00:08:02,290 --> 00:08:06,150
+تبعناالان الحفاظات النسية كمان مرة و هي موجودة على
+
+108
+00:08:06,150 --> 00:08:09,890
+ال skin و فيها دم و الاستفيل الكوكاس اورياس موجودة
+
+109
+00:08:09,890 --> 00:08:13,510
+اذا نمت البكتيريا و وصلت ل quorum sensing فاكرين
+
+110
+00:08:13,510 --> 00:08:17,290
+ال quorum sensing ال number عشر لاقوس خمسة لكل
+
+111
+00:08:17,290 --> 00:08:23,370
+millمن الدم عد البكتيريا بتبدأ تنتج للتكسين
+
+112
+00:08:23,370 --> 00:08:28,130
+التكسين اللي هو toxic shock syndrome toxin this
+
+113
+00:08:28,130 --> 00:08:30,770
+toxin will be absorbed through the mucous membrane
+
+114
+00:08:30,770 --> 00:08:34,170
+of the vagina causing what is known as toxic shock
+
+115
+00:08:34,170 --> 00:08:37,490
+syndrome كيف بتصير ال toxic shock syndrome بتكون
+
+116
+00:08:37,490 --> 00:08:41,670
+تركزوا معايا فهذا الموضوع كتير مهم انتوا بتعرفوا
+
+117
+00:08:41,670 --> 00:08:47,450
+ال immune system ال immune system خلية بتكلف خلية
+
+118
+00:08:48,840 --> 00:08:52,440
+macrophage بتكلف T-lymphocyte الـ T-lymphocyte
+
+119
+00:08:52,440 --> 00:08:56,400
+بتكلف B-lymphocyte لإنتاج antibody معين هذا
+
+120
+00:08:56,400 --> 00:09:01,440
+العملية ال specific one macrophage will bind to
+
+121
+00:09:01,440 --> 00:09:06,380
+one T-cell و one T-cell will bind to one برضه B
+
+122
+00:09:06,380 --> 00:09:11,660
+-cell ليش ال binding؟ في انها اسمها class او MHC
+
+123
+00:09:11,660 --> 00:09:18,050
+class twoهذا بيعمل Antigen Presentation Antigen
+
+124
+00:09:18,050 --> 00:09:23,770
+Presentation الان هاد الميكروفير مثلا بيجي ال T
+
+125
+00:09:23,770 --> 00:09:28,790
+cell ال T cell لازم يكون ال receptor اللي عليها
+
+126
+00:09:28,790 --> 00:09:36,030
+مطابق لمين لل Antigen تمام؟ اذا كان مش مطابق
+
+127
+00:09:36,030 --> 00:09:40,170
+مابترتبتش بتيجي تلينفوسات تانية لما تلاقي
+
+128
+00:09:40,170 --> 00:09:45,580
+تلينفوساتها المناسبةالان هذا بيقدر الاش زي مدرس
+
+129
+00:09:45,580 --> 00:09:50,180
+بيقول لواحد من المجموعة انت أجب عن السؤال اذا
+
+130
+00:09:50,180 --> 00:09:56,890
+أشارله بطريقة صحيحة هو اللي بيجاوب لكن انتجاوب كل
+
+131
+00:09:56,890 --> 00:10:01,210
+المجموعة هتجاوب، مظبوط ولا لأ؟ أعتقد أنه في فرق ما
+
+132
+00:10:01,210 --> 00:10:04,910
+بين إجابة واحدة بصوت واحد وما بين عشرات الإجابات
+
+133
+00:10:04,910 --> 00:10:09,390
+أعتقد أنه بيصير فيه شوشرة في ال immune system وعدم
+
+134
+00:10:09,390 --> 00:10:15,750
+استجابة صحيحة لل .. لل .. لل antigen وبالتالي
+
+135
+00:10:15,750 --> 00:10:19,230
+عندنا حضرة ال toxin هذا إيش بيعمل؟
+
+136
+00:10:21,910 --> 00:10:25,130
+بيخلّي أي T-Lymphocyte قريبة من Macrophage وبروح
+
+137
+00:10:25,130 --> 00:10:32,010
+برتبط بينهم بجسر بربطهم إذا ربطهم مع بعض صار
+
+138
+00:10:32,010 --> 00:10:36,650
+interaction صار activation يبقى
+
+139
+00:10:36,650 --> 00:10:40,110
+كل Macrophage قريبة من T-Lymphocyte حصلاش الآن
+
+140
+00:10:40,110 --> 00:10:43,610
+activation وهذا ال activation إيش بنسميه non
+
+141
+00:10:43,610 --> 00:10:47,840
+-specific activationزي بالظبط ما قلت انا اقرأ
+
+142
+00:10:47,840 --> 00:10:51,300
+للشجّة كلياتها فكلهم بدأوا يقرأوا كل الـ T
+
+143
+00:10:51,300 --> 00:10:55,300
+lymphocyte بدأت الآن تشتغل وبالتالي عاملات لردد
+
+144
+00:10:55,300 --> 00:10:59,480
+فعل منعية غير طبيعية قد تؤدي الى الوفاة قد تؤدي
+
+145
+00:10:59,480 --> 00:11:02,760
+الى shock تمام؟ toxic shock syndrome هذا الكلام هل
+
+146
+00:11:02,760 --> 00:11:07,320
+ممكن يحدث مع الرجال؟ نعمأعطيكم مثال، بظبط حالة
+
+147
+00:11:07,320 --> 00:11:11,680
+نظيف احنا متعودين انه يمكن صار لنا في انطباع ذهني
+
+148
+00:11:11,680 --> 00:11:15,440
+انه اذا واحد ميزروح وحاطينه علي قطن لازم يكون الدم
+
+149
+00:11:15,440 --> 00:11:18,960
+طالع من وين، مبين من ال .. فإذا ببين .. إذا بين
+
+150
+00:11:18,960 --> 00:11:21,840
+بنحط كمان علي قطن فبالتالي بصيحة عندي كمية كبيرة
+
+151
+00:11:21,840 --> 00:11:25,890
+من مين برضه؟ من الدمو طبعا الجلد بيبقى محتوى على
+
+152
+00:11:25,890 --> 00:11:29,370
+ال micro organism فإيه تطور ما بين ذهبه إلى
+
+153
+00:11:29,370 --> 00:11:32,550
+المستشفى أو الجرح و ذهبه إلى المستشفى قد يحدث لديه
+
+154
+00:11:32,550 --> 00:11:36,230
+برضه ايه toxic shock syndrome عبر الجروح أيضا من
+
+155
+00:11:36,230 --> 00:11:40,090
+الأنف لما بيصير فيه نزيف و بيحطه لففات قطنية في
+
+156
+00:11:40,090 --> 00:11:42,790
+الأنف حتى تمنع النزيف طب ما هو الأنف احنا قد
+
+157
+00:11:42,790 --> 00:11:46,590
+يقولكوا هو مصدر لمين للاستفل .. للاستفل الكوكس
+
+158
+00:11:46,590 --> 00:11:50,830
+اوريس بالذات وبالتالي قد يحدث اللي هو ال toxic
+
+159
+00:11:50,830 --> 00:11:55,770
+shock syndromeشباب احنا يمكن ال .. ال .. ال .. ال
+
+160
+00:11:55,770 --> 00:11:59,130
+.. الـ Staphylococcus aureus الكل بيعرفها اللي طلع
+
+161
+00:11:59,130 --> 00:12:02,490
+له حب في وجهه او في ايده و حاول انه يتخلص من
+
+162
+00:12:02,490 --> 00:12:06,270
+الصديد اللي جواها هذا الصديد غالبا بيحتوي على
+
+163
+00:12:06,270 --> 00:12:10,530
+white blood cell زائد Staphylococcus aureus فهي من
+
+164
+00:12:10,530 --> 00:12:15,170
+اهم مسببات ال skin infection اللي منها ال impetigo
+
+165
+00:12:15,170 --> 00:12:17,950
+و حاليا بجاني اوريكم بعض الصور ايه له و ال
+
+166
+00:12:17,950 --> 00:12:22,860
+biodermaالفرنكلز ال abscess و ال abscess ممكن تكون
+
+167
+00:12:22,860 --> 00:12:27,420
+سطحية و ممكن تكون داخلية حسب المكان ال food
+
+168
+00:12:27,420 --> 00:12:33,940
+poisoning احنا قلنالكم ما حدث انا ننسي نوصف حاجة
+
+169
+00:12:33,940 --> 00:12:39,340
+هنا الصحيح المركب
+
+170
+00:12:39,340 --> 00:12:41,680
+اللي قادر ان يعمل non specific activation لل T
+
+171
+00:12:41,680 --> 00:12:44,520
+lymphocyte اللي اسمه معروف و مشهور اسمه super
+
+172
+00:12:44,520 --> 00:12:45,020
+antigen
+
+173
+00:12:48,020 --> 00:12:53,180
+Super ليش super؟ لأن الانتجين الواحد العادي اللي
+
+174
+00:12:53,180 --> 00:12:57,200
+مش super بيعمل activation لمين؟ لتليمفوسايت واحدة،
+
+175
+00:12:57,200 --> 00:13:00,740
+هذا عمل activation لكل تليمفوسايت اللي .. اللي ..
+
+176
+00:13:00,740 --> 00:13:05,340
+اللي جدر يتبط معاه، تمام؟ فسمينا super انتجينالـ
+
+177
+00:13:05,340 --> 00:13:08,620
+food poisoning احنا كنا البكتيريا بتنمو في الغذاء
+
+178
+00:13:08,620 --> 00:13:13,380
+و خاصة بعد عملية ال cooking و التخلص من جميع
+
+179
+00:13:13,380 --> 00:13:17,040
+المنافسين بيبدأ الميكروبط تنمو مرة أخرى فإذا كانت
+
+180
+00:13:17,040 --> 00:13:21,280
+تلوثت بستفيل الكوكاس اوريس هتنتج برضه توكسين، الآن
+
+181
+00:13:21,280 --> 00:13:26,440
+التوكسين هذاتناولنا عبر ايش هنا؟ عبر الفم، وقلنالك
+
+182
+00:13:26,440 --> 00:13:30,780
+هو الوحيد من كل ال toxins اللي هي ال X-toxins، هو
+
+183
+00:13:30,780 --> 00:13:34,260
+الوحيد ال heat stable، يعني حتى لو سخنت الطعام أو
+
+184
+00:13:34,260 --> 00:13:38,940
+غليت الطعام، لن يفقد حيويته، هيضله biologically
+
+185
+00:13:38,940 --> 00:13:43,950
+active، تناولنا عبر اللي هو الفموصل ال .. ال .. ال
+
+186
+00:13:43,950 --> 00:13:46,430
+.. ال .. كيف بيعمل ال .. ال .. ال .. ال .. ال
+
+187
+00:13:46,430 --> 00:13:49,450
+symptoms تبعته بيقول إن هو برضه super antigen
+
+188
+00:13:49,450 --> 00:13:54,210
+super antigen زي مين؟ زي أخوه ال toxic shock
+
+189
+00:13:54,210 --> 00:13:57,970
+syndrome toxin لكن كونه localized في ال intestine
+
+190
+00:13:57,970 --> 00:14:01,570
+فال effect تبقى و بيكون فقط diarrhea and vomiting
+
+191
+00:14:01,570 --> 00:14:05,390
+diarrhea and vomiting لذلك هو local أو localized
+
+192
+00:14:05,390 --> 00:14:12,040
+super antigenSepticemia يعني البكتيريا ملتبلة في
+
+193
+00:14:12,040 --> 00:14:15,740
+الدم، meningitis it can multiply in the central
+
+194
+00:14:15,740 --> 00:14:21,340
+nervous system اللي قدامك هو هذه اللوحة، بناخد
+
+195
+00:14:21,340 --> 00:14:25,320
+منها عبرةوين ممكن نلاقي Staphylococcus aureus؟ ايش
+
+196
+00:14:25,320 --> 00:14:28,660
+العينات اللي مدينة على المختبر بيلاقي فيها
+
+197
+00:14:28,660 --> 00:14:31,880
+Staphylococcus aureus؟ خدوا بالكوا ولا واحدة منهم
+
+198
+00:14:31,880 --> 00:14:34,900
+مكتوبة لها urinary tract infection ولا واحدة منهم
+
+199
+00:14:34,900 --> 00:14:37,600
+مكتوبة لها urinary tract infection تعالوا نطلع
+
+200
+00:14:37,600 --> 00:14:41,680
+نتائج المختبرات عندنا بتلاقي ان ال Staphylococcus
+
+201
+00:14:41,680 --> 00:14:45,160
+aureus موجودة في تقارير كثير من نتائج ال urine
+
+202
+00:14:45,160 --> 00:14:49,800
+culture على الرغم من انها غير معترف بيها انها مسبب
+
+203
+00:14:49,800 --> 00:14:54,740
+لل urinary tract infectionفبنعرف الأمراض كمان مرة
+
+204
+00:14:54,740 --> 00:14:58,120
+عشان نعرف مين ال pathogen و مين ال non pathogen
+
+205
+00:15:02,390 --> 00:15:07,330
+أنا أذكر أني مرة من المرات حكيتلكوا أنه ممنوع نحفظ
+
+206
+00:15:07,330 --> 00:15:12,290
+وصف لمستعمرة بكتيرية أو خصائص مستعمرة بكتيرية إلا
+
+207
+00:15:12,290 --> 00:15:15,930
+ونرفقها بالوصف تبعها مثلا قلنا Staphylococcus
+
+208
+00:15:15,930 --> 00:15:20,170
+aureus produces large golden yellow pigmented
+
+209
+00:15:20,170 --> 00:15:23,910
+surrounded by a beta zone of hemolysis on blood
+
+210
+00:15:23,910 --> 00:15:29,130
+agarيبقى الوصف بدي يكون مرتبط مع مين؟ مع ال media،
+
+211
+00:15:29,130 --> 00:15:33,930
+بنفعش أوصف بكتيريا دون ذكر الوسط الزراعي، ليش؟
+
+212
+00:15:33,930 --> 00:15:36,850
+لأنه أعطيكم مثال، انتوا عملت واجب في السيمان اللي
+
+213
+00:15:36,850 --> 00:15:40,820
+هو الشيء اللي مظبوطو قلت ان شكل السلمونيلا على ال
+
+214
+00:15:40,820 --> 00:15:45,180
+SSA شكل السلمونيلا على ال XLD شكل السلمونيلا على
+
+215
+00:15:45,180 --> 00:15:49,280
+الماكنكي في اختلاف ولا مافيش اختلاف؟ فيهم في H2S
+
+216
+00:15:49,280 --> 00:15:52,940
+واحد مافيش فيه H2S لان الماكنكي مابيكشفش عن من؟ عن
+
+217
+00:15:52,940 --> 00:15:56,500
+ال H2S لذلك كمان مرة نؤكد على هذه الحقيقة لا
+
+218
+00:15:56,500 --> 00:16:01,820
+تستطيع انك تحفظ وصف لمستعمرة بكتيرية من نوع معين
+
+219
+00:16:01,820 --> 00:16:06,300
+الا و تقرنها بالوصف تبعهطبعا البكتيريا هذه ما ..
+
+220
+00:16:06,300 --> 00:16:09,140
+مالهاش مطلبات خاصة الـ cephalococcus aureus تستطيع
+
+221
+00:16:09,140 --> 00:16:12,340
+أن تنمو على nutrient agar، على blood agar، على
+
+222
+00:16:12,340 --> 00:16:14,700
+manitol salt agar ال manitol salt agar في هذه
+
+223
+00:16:14,700 --> 00:16:23,840
+الحالة إيش اسمه؟ إيش وصفه؟ selective medium أرجع
+
+224
+00:16:23,840 --> 00:16:27,920
+بيكوا بسؤال basic ومنطقي لماذا نحتاج إلى selective
+
+225
+00:16:27,920 --> 00:16:34,380
+medium؟ حد يحاول لماذا نحتاج في أي ميكروب؟
+
+226
+00:16:37,060 --> 00:16:40,260
+ليش طيب احنا .. هل الميكروبات او العزلات اللي
+
+227
+00:16:40,260 --> 00:16:44,260
+بتجينا .. بتجينا pure culture ولا mixed culture؟
+
+228
+00:16:44,260 --> 00:16:48,560
+مش دايما، ما احنا اتفقنا جسمنا الدسم .. جسمنا
+
+229
+00:16:48,560 --> 00:16:52,700
+الدسم لاسترال لاسترال، فلو كانت من عين استرال فهي
+
+230
+00:16:52,700 --> 00:16:55,240
+هي، يعني مافيش شي غيرها، مابتحتارش .. مابتحتارش
+
+231
+00:16:55,240 --> 00:16:59,540
+على selective isolation، لكن لو أخدنا .. بدنا
+
+232
+00:16:59,540 --> 00:17:04,390
+نازلها من تربةمن stool، من غذاء، بدنا selective
+
+233
+00:17:04,390 --> 00:17:08,570
+media إذا ال selective media صممت لعزل الميكروب من
+
+234
+00:17:08,570 --> 00:17:14,210
+communities، من مجتمع متنوّق blood agar، nutrient
+
+235
+00:17:14,210 --> 00:17:16,990
+agar، يقول إن هدولة ال general media مافيحتارش ال
+
+236
+00:17:16,990 --> 00:17:19,710
+general selective media لكن ال selective media
+
+237
+00:17:19,710 --> 00:17:23,250
+اللي هنستخدمها أحنا في ال diagnostic هي ال menitol
+
+238
+00:17:23,250 --> 00:17:27,430
+salt agar اسم
+
+239
+00:17:27,430 --> 00:17:34,020
+الوسط salt agarمعتمد على ميزة تتميز بها الستفيلو
+
+240
+00:17:34,020 --> 00:17:37,680
+كوكاي بشكل عام انها halophilic halophilic معناها
+
+241
+00:17:37,680 --> 00:17:43,540
+محبة
+
+242
+00:17:43,540 --> 00:17:50,790
+للملحخد بالكم احب الملح فيه بتحبت، اه يعني مثلا ان
+
+243
+00:17:50,790 --> 00:17:54,850
+البحر الميت اعتقد تلاتين في المية، نسبة الملوحة
+
+244
+00:17:54,850 --> 00:18:00,030
+فيه البحيط او البحر انا تلاتة في المية، هد هالوفلك
+
+245
+00:18:00,030 --> 00:18:03,890
+وهد هالوفلك، لكن الهادي اللي بتعيش هنا very
+
+246
+00:18:03,890 --> 00:18:08,440
+extremely هالوفلك، extremely هالوفلكما علينا احنا
+
+247
+00:18:08,440 --> 00:18:13,000
+نتعامل مع بكتيريا ممرضة فبالتالي لا نجد في الغالب
+
+248
+00:18:13,000 --> 00:18:20,880
+لا نجد بكتيريا مقاومة ل 7.5% Sodium Chloride
+
+249
+00:18:20,880 --> 00:18:25,870
+الكثيرلكن الـ Staphylococcus aureus مقاومة لهذه
+
+250
+00:18:25,870 --> 00:18:30,010
+النسبة وبالتالي وضعنا هذه النسبة في الوسط فأصبح
+
+251
+00:18:30,010 --> 00:18:35,230
+معظم أنواع البكتيريا لا ينمو معظم أنواع البكتيريا
+
+252
+00:18:35,230 --> 00:18:40,230
+كمان مرة مش مطلقة مش مطلقة و هذكركم مثال كمان شوية
+
+253
+00:18:40,230 --> 00:18:45,550
+القضية مش مطلقة فالان احنا استثنائنا جزء كبير من
+
+254
+00:18:45,550 --> 00:18:50,770
+الميكروبات اللي في الدنيا لا لا لا على سبعة و نص
+
+255
+00:18:50,770 --> 00:18:57,540
+في الميةلازم تنمو على 30% طيب
+
+256
+00:18:57,540 --> 00:19:04,140
+نرجع برجوعنمت البكتيريا على وسط في 7.5% يبقى هذه
+
+257
+00:19:04,140 --> 00:19:06,520
+البكتيريا بدنا نفترض جدلا انه فيش غير ال
+
+258
+00:19:06,520 --> 00:19:08,560
+Staphylococcus aureus أو ال Staphylococci عفوا
+
+259
+00:19:08,560 --> 00:19:12,420
+بتنمو عليها still we have to know whether the
+
+260
+00:19:12,420 --> 00:19:17,020
+bacteria is aureus or other staphylococci دورنا
+
+261
+00:19:17,020 --> 00:19:20,380
+على صفة من الصفات لجينا انه ال Manitoulin
+
+262
+00:19:20,380 --> 00:19:24,500
+fermentation صفة تميز ل Staphylococcus aureus عن
+
+263
+00:19:24,500 --> 00:19:31,720
+أخواتها الأخريات فضفنا على وسط كمانمانيتول وضفنا
+
+264
+00:19:31,720 --> 00:19:36,780
+pH Indicator تمام
+
+265
+00:19:36,780 --> 00:19:43,680
+ال pH Indicator هينخفض لما البكتيرى تخمر المانيتول
+
+266
+00:19:43,680 --> 00:19:51,490
+لما ينخفض ال pH هيتغير اللون الى اللون الأصفرإذا
+
+267
+00:19:51,490 --> 00:19:56,870
+مستعمرة صفراء محاطة بـ zone صفراء بتذكركوا بمين
+
+268
+00:19:56,870 --> 00:20:00,310
+اللون هذا ال Vibrio cholera بس مش على ال
+
+269
+00:20:00,310 --> 00:20:05,110
+Manitoulin salt أجابه على مين؟ على ال TCBS قلنا
+
+270
+00:20:05,110 --> 00:20:08,350
+عنها برضه ال Vibrio cholera yellow colonies
+
+271
+00:20:08,350 --> 00:20:12,750
+surrounded by yellow zone as a result of sucrose
+
+272
+00:20:12,750 --> 00:20:16,050
+fermentation هنا yellow colonies surrounded by
+
+273
+00:20:16,050 --> 00:20:19,430
+yellow zone as a result of Manitoulinو اتذكروا هذه
+
+274
+00:20:19,430 --> 00:20:25,490
+الـ alkaline pH هنا بنتكلم عن مين؟ عن 7.5% Sodium
+
+275
+00:20:25,490 --> 00:20:29,070
+Chloride إذا المنطول صلت أجار من الأوساط الرائعة
+
+276
+00:20:29,070 --> 00:20:32,130
+لعزل أو حتى عد البكتيريا اللي من نوع
+
+277
+00:20:32,130 --> 00:20:35,790
+Staphylococcus aureus ليش لعد البكتيريا؟ لأن أنا
+
+278
+00:20:35,790 --> 00:20:40,410
+بقدر أشوف مصطعمة صفراء اللون محاطة به وهذا الوسط
+
+279
+00:20:40,410 --> 00:20:44,430
+اللي بنستخدمه هنا أصلا في ال food microbiology وفي
+
+280
+00:20:44,430 --> 00:20:45,950
+وسط تاني اسمه BIRD
+
+281
+00:20:50,640 --> 00:20:55,160
+برت باركر أجار برضه بنستخدمه في عزل ال .. و تاني
+
+282
+00:20:55,160 --> 00:20:58,400
+ما يتسافر لكوكاس أوي، إذا ليس فقط ال manitol salt
+
+283
+00:20:58,400 --> 00:21:01,500
+أجار، لكن هو ال most common و ال most famous media
+
+284
+00:21:01,500 --> 00:21:02,160
+في هذا المجال
+
+285
+00:21:05,610 --> 00:21:10,550
+طبعا البكتيريا مش محتاجة أي ظروف خاصة فيها تستطيع
+
+286
+00:21:10,550 --> 00:21:14,770
+ان تنمو هوائيا و تستطيع ان تنمو على 35 او 37 درجة
+
+287
+00:21:14,770 --> 00:21:18,610
+مئاوية و خلال 24 ساعة بنشوف مستعمراتها اللي قلنا
+
+288
+00:21:18,610 --> 00:21:22,030
+عنها قد تصل الى 4 ميلي متر يعني نعتبرها large
+
+289
+00:21:22,030 --> 00:21:26,190
+colonies ال aurea
+
+290
+00:21:26,190 --> 00:21:26,770
+ال aureas
+
+291
+00:21:29,520 --> 00:21:32,240
+هذه المستعمرات او هذه ال description للمستعمرات
+
+292
+00:21:32,240 --> 00:21:35,360
+على الوساطين المشهورين تبقى منها on blood agar
+
+293
+00:21:35,360 --> 00:21:38,340
+plates on metal agar on blood agar بيقولنا they
+
+294
+00:21:38,340 --> 00:21:42,060
+are two to four millimeter in diameter جانم اتنين
+
+295
+00:21:42,060 --> 00:21:45,620
+لاربعة خدوا بالكهو ال size هنا مهم لأن معظم على
+
+296
+00:21:45,620 --> 00:21:49,000
+سبيل المثال stripped cocaine small اصغر من اتنين
+
+297
+00:21:49,000 --> 00:21:53,000
+مليمتر فانت من اتنين لاربعة مليمتر rounded and
+
+298
+00:21:53,000 --> 00:21:55,760
+slightly elevated جاني slightly elevated لو انا
+
+299
+00:21:55,760 --> 00:22:00,610
+مساكت الطبقعلى مستوى النظر هلاج المستعمرات مش flat
+
+300
+00:22:00,610 --> 00:22:05,610
+وإننا مرتفعة عن الطبق بشكل طفيف slightly elevated
+
+301
+00:22:05,610 --> 00:22:12,630
+دربلت .. خدوا بالكوا المصطلحات إلها علاقة بالاسماء
+
+302
+00:22:12,630 --> 00:22:18,650
+بمعنى إذا قلت انت droplet مثلا du droplet فيه
+
+303
+00:22:18,650 --> 00:22:22,800
+بكتير اسمها pastorella شكلها زي قطرة الندىو لو
+
+304
+00:22:22,800 --> 00:22:25,840
+سحلنا الطبق و وجفنا الطبق بدل ما هو هيك وجفنا ممكن
+
+305
+00:22:25,840 --> 00:22:31,660
+تنزل زي قطرة الماء بالظبط فالمصطلحات يجب أن تستخدم
+
+306
+00:22:31,660 --> 00:22:38,040
+بدقة لوصف الأسماء المتخصصة كمان مرة most
+
+307
+00:22:38,040 --> 00:22:41,640
+pathogenic strains of staphylococcus aureus
+
+308
+00:22:41,640 --> 00:22:47,970
+produces a zone of beta hemolysisيعني خدنا نقول ان
+
+309
+00:22:47,970 --> 00:22:53,210
+نصيغي العبارة بطريقة تانية العزلات الممرضة في
+
+310
+00:22:53,210 --> 00:22:58,930
+غالبيتها بتنتج Beta Hemolysis لكن لا استخدم ال
+
+311
+00:22:58,930 --> 00:23:02,550
+Beta Hemolysis انا كصفة رئيسية في تمييز ال
+
+312
+00:23:02,550 --> 00:23:06,670
+Staphylococciمتى بنستخدم الـ Hemolysis في التمييز؟
+
+313
+00:23:06,670 --> 00:23:10,210
+أكتر في الـ Streptococci هتسمعوا بـ Alpha
+
+314
+00:23:10,210 --> 00:23:13,110
+Hemolytic, Streptococci Beta Hemolytic,
+
+315
+00:23:13,210 --> 00:23:18,470
+Streptococci و Gamma Hemolytic لكن هي صفة قد تكون
+
+316
+00:23:18,470 --> 00:23:20,890
+موجودة هنا في الـ Staphylococcus aureus في معظم
+
+317
+00:23:20,890 --> 00:23:25,210
+العزلات و قد لا تكون موجودة أيضا وجودها مؤشر عدم
+
+318
+00:23:25,210 --> 00:23:28,550
+وجودها ليس بالضرورة ان هي في صفة Staphylococcus
+
+319
+00:23:28,550 --> 00:23:33,330
+aureusأهم نقطة هنتكلم عنها مين golden yellow
+
+320
+00:23:33,330 --> 00:23:37,650
+pigment on manitol salt agar انا شرحت اللوحة
+
+321
+00:23:37,650 --> 00:23:40,890
+السابقة وقولت انها produces yellow colonies
+
+322
+00:23:40,890 --> 00:23:45,510
+surrounded by yellow zone resulting من اللي هو ال
+
+323
+00:23:45,510 --> 00:23:46,570
+manitol fermentation
+
+324
+00:23:49,500 --> 00:23:53,760
+الـ Gram stain للبكتيريا الصحيح مساعد وقد يعطينا
+
+325
+00:23:53,760 --> 00:23:58,000
+انطباع جيد على ان البكتيريا هي Staphylococci لكن
+
+326
+00:23:58,000 --> 00:24:03,380
+كمان مرة انا بدأت اللوحة تبعتي بال Catalase وكون
+
+327
+00:24:03,380 --> 00:24:07,440
+ال Catalase يعني مش expensive test ولا time
+
+328
+00:24:07,440 --> 00:24:10,930
+consuming testو ولا test difficult يعني it can be
+
+329
+00:24:10,930 --> 00:24:15,210
+performed easily و ال result طبعته مش صعب انه
+
+330
+00:24:15,210 --> 00:24:20,290
+نعملها interpretation فيلابد لك ان تقوم بعمل هذا
+
+331
+00:24:20,290 --> 00:24:24,650
+الفحص ل ال differentiation يبقى
+
+332
+00:24:24,650 --> 00:24:30,430
+catalyst test هنا مهم جدا الان ميزنا الاستفيل
+
+333
+00:24:30,430 --> 00:24:35,730
+الكوكس بشكل عام على الاستربتو كوكس بجرام 2 زائد
+
+334
+00:24:35,730 --> 00:24:41,130
+كتاليز what is nextأنا عمال قعدت بقول انه كنا نجسم
+
+335
+00:24:41,130 --> 00:24:44,530
+البكتيريا الى Staphylococcus aureus و باق ال
+
+336
+00:24:44,530 --> 00:24:47,170
+Staphylococci سميناهم Coagulase Negative و
+
+337
+00:24:47,170 --> 00:24:50,790
+Staphylococci اللي هي ال CNS فالان انا عندي فحص
+
+338
+00:24:50,790 --> 00:24:56,270
+مهم جدا اللي هو ال Coagulase و قد نستعيد عنهأو
+
+339
+00:24:56,270 --> 00:25:01,330
+نضيف اليه، مين بتفضلوا أنتوا، نستعيد ولا نضيف؟
+
+340
+00:25:01,330 --> 00:25:04,850
+نضيف لإن احنا قلنا لكوا القاعدة العامة، the more
+
+341
+00:25:04,850 --> 00:25:08,010
+test you use, the more accurate is your
+
+342
+00:25:08,010 --> 00:25:11,410
+identification، فإنكوا اجلاز، او DNA،
+
+343
+00:25:14,090 --> 00:25:17,650
+شايفين المصطلح الغلط اللي لحد دلوقتي موجود؟
+
+344
+00:25:17,650 --> 00:25:20,870
+different from none pathogenic staphylococci كانت
+
+345
+00:25:20,870 --> 00:25:23,530
+مقصود فيها مين؟ اللي هي ال other staphylococci لكن
+
+346
+00:25:23,530 --> 00:25:27,130
+واقع الأمر احنا غيرنا هذا المفهوم وقلنا لك و لأ
+
+347
+00:25:27,130 --> 00:25:30,430
+مافيش حاسبها absolutely none pathogenic و لأ
+
+348
+00:25:30,430 --> 00:25:33,590
+بالعكس لجينا ان ال staphylococcus epidermidis ال N
+
+349
+00:25:33,590 --> 00:25:39,410
+هي أهم في المستشفيات من مين أو مش بال .. برضه مش
+
+350
+00:25:39,410 --> 00:25:42,930
+على إطلاقهافي الـ septicemia أهم من مين؟ من الـ
+
+351
+00:25:42,930 --> 00:25:44,310
+cephalococcus aureus
+
+352
+00:25:46,830 --> 00:25:50,670
+هذه صورة كتير واضحة لا .. ال .. ال .. لاحظوا اننا
+
+353
+00:25:50,670 --> 00:25:55,750
+كنا .. وصفنا احنا كنا strong .. لأ غير strong gram
+
+354
+00:25:55,750 --> 00:26:00,850
+stain ال purple color تبعها كتير واضحة الصورة اللي
+
+355
+00:26:00,850 --> 00:26:04,430
+غاد .. اللي هناك دلوقتي للأسف هذه نموذج سيء على
+
+356
+00:26:04,430 --> 00:26:08,470
+gram stain لما درستوا انتوا ال gram stain في
+
+357
+00:26:08,470 --> 00:26:13,700
+المعمل اعتقدنبهوكوا لبعض القضايا قالولكوا انه
+
+358
+00:26:13,700 --> 00:26:17,620
+never do او perform a gram stain from old culture
+
+359
+00:26:17,620 --> 00:26:21,260
+Penicillin
+
+360
+00:26:21,260 --> 00:26:28,080
+treated بكتيريا usually produces false او faulty
+
+361
+00:26:28,080 --> 00:26:33,560
+gram result بكتيريا اتعاملت او اوجدت بالبنسالين او
+
+362
+00:26:33,560 --> 00:26:38,860
+كانت في وجود البنسالين قد تؤدي الى نتائج خاطئة في
+
+363
+00:26:38,860 --> 00:26:39,800
+ال gram stain
+
+364
+00:26:42,280 --> 00:26:50,080
+طيب هذا error ناتج عن عمر البكتيريا او ضرفها طب في
+
+365
+00:26:50,080 --> 00:26:54,880
+errors ناتج عن شغلنا احنا قبل
+
+366
+00:26:54,880 --> 00:26:59,200
+ال declarizer من اول حاجة من الفيلم نفسه من الفيلم
+
+367
+00:26:59,200 --> 00:27:03,600
+نفسه و انا بعمل smear تمام بيكون heavy smear
+
+368
+00:27:06,380 --> 00:27:11,180
+هذا واحد اتنين over-fixation او under-fixation
+
+369
+00:27:11,180 --> 00:27:14,480
+يعني شوهها شوه البكتيريا على اللهب و بقى مالها
+
+370
+00:27:14,480 --> 00:27:19,660
+fixation تمام او انه يعني خاف انه تنهي عليك
+
+371
+00:27:19,660 --> 00:27:22,700
+فبتاعلي مامراش على اللهب مامراش فوق اللهب بشكل
+
+372
+00:27:22,700 --> 00:27:26,840
+عالي جدا في الحالتين بصير عندي erroneous results
+
+373
+00:27:27,610 --> 00:27:30,450
+الـ timing تبع الـ crystal vital concentration
+
+374
+00:27:30,450 --> 00:27:33,550
+عمية ال washing ال decolourization اللي قلت عنها
+
+375
+00:27:33,550 --> 00:27:37,850
+خطوة كتير مهمة كل هذه الخطوات أي خطوة منها إذا كان
+
+376
+00:27:37,850 --> 00:27:43,410
+فيها خلل قد تؤدي إلى إيرانياس result ال
+
+377
+00:27:43,410 --> 00:27:45,550
+biochemical characteristics قلنا كتاليز بوستف
+
+378
+00:27:45,550 --> 00:27:49,470
+منطول فرمنتر can grow well on 7.5% Sodium chloride
+
+379
+00:27:49,470 --> 00:27:54,120
+كواجوليز بوستف، ديانيز بوستف، جليكوز فرمنترخدوا
+
+380
+00:27:54,120 --> 00:27:57,280
+بالكم يعني لو عملنا لها triple sugar iron agar يا
+
+381
+00:27:57,280 --> 00:28:02,340
+شباب بنفع؟
+
+382
+00:28:02,340 --> 00:28:09,080
+بنفع؟ خدوا بالكم لو واحد غلط و .. و .. و جال عن ال
+
+383
+00:28:09,080 --> 00:28:12,300
+.. عن ال cephalococcus aureus إنها gram negative
+
+384
+00:28:12,300 --> 00:28:16,900
+بسلّاي و زرعها على triple sugar iron agar هتعطيه A
+
+385
+00:28:16,900 --> 00:28:18,640
+على A
+
+386
+00:28:24,210 --> 00:28:28,450
+جليكوز جليكوز و Lactose Fermenter كمان Lactose
+
+387
+00:28:28,450 --> 00:28:33,470
+Fermenter نعم القصد من الكلام ان ال triple sugar
+
+388
+00:28:33,470 --> 00:28:39,850
+iron أجارهنا ظلم ليش ظلم استخدم في موقف غير موقفهم
+
+389
+00:28:39,850 --> 00:28:44,250
+مش لازم نستخدمه أصلا ايش اللي خلانا نستخدمه ان
+
+390
+00:28:44,250 --> 00:28:48,270
+احنا أخطأنا من البداية في ان البكتيريا مش يجرأ
+
+391
+00:28:48,270 --> 00:28:51,130
+انبوسطف كوكساي لو عرفنا ان هي جرأ انبوسطف كوكساي
+
+392
+00:28:51,130 --> 00:28:56,240
+في هذا الفحص مش لازمطب ممكن استخدم ال triple sugar
+
+393
+00:28:56,240 --> 00:28:59,700
+iron agar لغرض أخر غير ال identification أنا
+
+394
+00:28:59,700 --> 00:29:03,100
+بقولكنها يعني أنا بخزن البكتيريا لإنه ماعنديش DB
+
+395
+00:29:03,100 --> 00:29:07,420
+freezer وماعنديش التقنية الأخرى بستخدم ال triple
+
+396
+00:29:07,420 --> 00:29:10,060
+sugar iron agar في عملية تخزين البكتيريا يعني أي
+
+397
+00:29:10,060 --> 00:29:13,280
+بكتيريا بعزلها و بديهاها بزراعها على triple sugar
+
+398
+00:29:13,280 --> 00:29:18,680
+iron agar بحطها في ال incubator overnight و بعدين
+
+399
+00:29:18,680 --> 00:29:22,600
+بحطها في التلاجة لمدة two weeks
+
+400
+00:29:24,470 --> 00:29:28,190
+بس للحفظ يعني مش لل identification يعني اما انا ال
+
+401
+00:29:28,190 --> 00:29:31,270
+.. ال .. ال .. ال .. اتعلمته معاكوا انا هو عبارة
+
+402
+00:29:31,270 --> 00:29:36,790
+عن ماذا؟ عن identification طيب كمان مرة كتاليز
+
+403
+00:29:36,790 --> 00:29:40,990
+بوزتف ميلاتول فرمنتر grow in 7.5% Sodium Chloride
+
+404
+00:29:40,990 --> 00:29:45,430
+كواجليز بوزتف ديانيز بوزتف and glucose fermenter
+
+405
+00:29:45,430 --> 00:29:49,990
+هاي بعض الصور المتعلقة بالفحوصات او بالخصاص اللي
+
+406
+00:29:49,990 --> 00:29:50,790
+احنا ذكرناهم
+
+407
+00:29:55,010 --> 00:29:58,850
+Catalase وطبعا اعطوكوا تعليمات في المعمل never
+
+408
+00:29:58,850 --> 00:30:03,590
+perform catalase from bacteria collected from
+
+409
+00:30:03,590 --> 00:30:04,210
+blood agar
+
+410
+00:30:07,510 --> 00:30:10,450
+البلد فيه كتاليز البلد نفسه فيه الانزيم اللي اسمه
+
+411
+00:30:10,450 --> 00:30:13,150
+كتاليز ال coagulase لاحظوا ال klut اللي في قاع
+
+412
+00:30:13,150 --> 00:30:15,930
+النبوبة هنا هذا tube method وانت بتعرف ان احنا
+
+413
+00:30:15,930 --> 00:30:18,710
+بنستخدم اما tube method او slide method بتمتعين ما
+
+414
+00:30:18,710 --> 00:30:22,990
+بنستخدمهم هذا ال dianase شايفين ال halo اللي هي
+
+415
+00:30:22,990 --> 00:30:27,970
+المنطقة الخالية المحيطة بيه المستعمرة بعد اضافة
+
+416
+00:30:27,970 --> 00:30:31,290
+اللي هو ال hcl تمام؟ لجينا المنطقة اللي حوالي
+
+417
+00:30:31,290 --> 00:30:34,130
+المستعمرة clearهذه الـ Manitoulin Salt
+
+418
+00:30:34,130 --> 00:30:36,630
+Fermentation هي الـ pink color الـ original color
+
+419
+00:30:36,630 --> 00:30:41,110
+of ال media وهي اللي هو المستعمرات المحاولة الوسط
+
+420
+00:30:41,110 --> 00:30:42,370
+إلى اللون الأصفر
+
+421
+00:30:45,820 --> 00:30:48,780
+الان كيف بتتم عملية التعرف اعتقد انه من خلال
+
+422
+00:30:48,780 --> 00:30:52,200
+الصفات ولا لا اذا عزلنا البكتيريا على blood agar
+
+423
+00:30:52,200 --> 00:30:55,060
+ولاجيناها gram-bostef-coccyte وعملنا لها catalase
+
+424
+00:30:55,060 --> 00:30:58,200
+test طلعت catalase بوستف تمام يبجي في عندي
+
+425
+00:30:58,200 --> 00:31:01,100
+catalase test في عندي coagulase manitol
+
+426
+00:31:01,100 --> 00:31:04,400
+fermentation ونمو برضه كمان على سبعة ونص وهذا كلام
+
+427
+00:31:04,400 --> 00:31:08,540
+من وين ممكن نحصل عليه من ال MSA اللي هو ال manitol
+
+428
+00:31:08,540 --> 00:31:13,880
+salt agar او نعمله فحص خاص نيجي نعمل ال tube عشان
+
+429
+00:31:13,880 --> 00:31:18,790
+فيها brothتمام؟ ال process ده بس بالظبط بنضيف عليه
+
+430
+00:31:18,790 --> 00:31:21,650
+سبعة و نص في المية Sodium Chloride وبالتالي بنقدر
+
+431
+00:31:21,650 --> 00:31:25,410
+نعرف مش ضالون نحط indicator حتى لإن البكتيريا
+
+432
+00:31:25,410 --> 00:31:28,830
+بتنمو يا بتنموش إذا نمت تعمل تربيدتي ما نمتش
+
+433
+00:31:28,830 --> 00:31:32,150
+مابتعملاش تربيدتي ال cause of اللي هي ال oxidation
+
+434
+00:31:32,150 --> 00:31:35,210
+fermentation و دي طبعا اللي هو الفحص الأخير ال DNS
+
+435
+00:31:35,210 --> 00:31:39,130
+أول مرة اتمر معانا هذه
+
+436
+00:31:44,510 --> 00:31:47,370
+طيب اذا اذكركوا بكلمة typing اكملها مرة معاها يعني
+
+437
+00:31:47,370 --> 00:31:52,470
+zero ايش
+
+438
+00:31:52,470 --> 00:31:53,150
+كمان؟
+
+439
+00:32:06,550 --> 00:32:10,990
+يعني صار عندنا أكم typing أربع, serotyping هذي
+
+440
+00:32:10,990 --> 00:32:14,610
+صرنا مشهورين فيها, ال biocin typing فقط لبكتيريا
+
+441
+00:32:14,610 --> 00:32:18,150
+واحدة اللي هي pseudomonas aeruginosa, ال biotyping
+
+442
+00:32:18,150 --> 00:32:21,710
+أخدناها لالتوريو كلاسيكل فاكرينهم التلاتة,
+
+443
+00:32:22,110 --> 00:32:27,050
+agglutination فقط في ال vibrio cholera, لما كنا
+
+444
+00:32:27,050 --> 00:32:31,690
+فيه تلات خصائص, رقم واحدagglutination of red blood
+
+445
+00:32:31,690 --> 00:32:34,950
+cell رقم اتنين vogas bruscavar رقم تلاتة
+
+446
+00:32:34,950 --> 00:32:38,770
+sensitivity to polymyxin وقلنا الالتار positive
+
+447
+00:32:38,770 --> 00:32:41,310
+positive resistant والتانين negative negative
+
+448
+00:32:41,310 --> 00:32:45,490
+sensitive عموما الفحش typing خدنا ناخد عنه مقدمة
+
+449
+00:32:45,490 --> 00:32:49,490
+صغيرة بلكن نستوعب ان شاء الله الفكرة لمرة واحدة
+
+450
+00:32:49,490 --> 00:32:54,250
+فقط لأخرسيبنا نلعب الصبورة و نتكلم مع بعض عن ال
+
+451
+00:32:54,250 --> 00:32:57,110
+bacteriophage what is bacteriophage؟ bacteriophage
+
+452
+00:32:57,110 --> 00:33:00,730
+is a virus that attacks bacteria
+
+453
+00:33:02,470 --> 00:33:05,790
+الان زي ما احنا بنعرف ان الانتجين بيرتبط ب
+
+454
+00:33:05,790 --> 00:33:09,350
+specific أو specifically ب antibody برضه ال
+
+455
+00:33:09,350 --> 00:33:13,290
+bacteriophage ايه له host محدد؟مش يعني host محدد
+
+456
+00:33:13,290 --> 00:33:18,170
+يعني عائل محدد لا يستطيع يعني انت staphylococcus
+
+457
+00:33:18,170 --> 00:33:20,650
+aureus انت staphylococcus epidermidis ايه لل
+
+458
+00:33:20,650 --> 00:33:23,130
+bacteriophage تبع ال epidermidis مش هيقدر يعملك
+
+459
+00:33:23,130 --> 00:33:27,440
+infection هيعمل فقط لمين؟ لل epidermidisطب إذا أنا
+
+460
+00:33:27,440 --> 00:33:30,100
+عرفت هذه المعلومة يبقى أنا بقدر أستخدم ال
+
+461
+00:33:30,100 --> 00:33:33,880
+bacterium phage ك reagent للتعرف على مين؟ على
+
+462
+00:33:33,880 --> 00:33:37,780
+الميكروبات خدوا بالكم الكلام اللي بحكيه أنا اتكلمت
+
+463
+00:33:37,780 --> 00:33:41,480
+عن phage ل species و ال species aureus و مين و
+
+464
+00:33:41,480 --> 00:33:47,050
+epidermis طيب انا لو قلتلكوا انه strainsمش ال
+
+465
+00:33:47,050 --> 00:33:51,470
+space الواحدة مكونة من strains تمام؟ لو قلتلكوا
+
+466
+00:33:51,470 --> 00:33:54,550
+انه لكل strain من ال Staphylococcus aureus فيه
+
+467
+00:33:54,550 --> 00:33:59,450
+Fage فلو أنا عزلت Staphylococcus aureus معينة، بدي
+
+468
+00:33:59,450 --> 00:34:03,790
+أعرف أنهي strain، أنهي strain، يبقى بدي أستخدم
+
+469
+00:34:03,790 --> 00:34:09,900
+مين؟فاجات مختلفة للـ strains المختلفة الفاج هو my
+
+470
+00:34:09,900 --> 00:34:14,900
+reagents يعني فاج واحد اتنين تلاتة اربعة خمسة ستة
+
+471
+00:34:14,900 --> 00:34:20,760
+موجهينه لمن؟ type one type two type three type
+
+472
+00:34:20,760 --> 00:34:26,040
+four type five طب كيف الفحص بيتم أساسا كيف بعرف ان
+
+473
+00:34:26,040 --> 00:34:31,340
+الفاج specific لمن؟ للبكتير ركزوا معايا هاي طبق
+
+474
+00:34:32,050 --> 00:34:35,370
+فاكرين كيف بنزرع احنا البكتيريا ل sensitivity؟
+
+475
+00:34:35,370 --> 00:34:40,730
+بنستخدم .. بنستخدم loop ولا بنستخدم swap؟ cotton
+
+476
+00:34:40,730 --> 00:34:46,650
+swap بنجيب البكتيريا اللي هي بنفحصها و بنغمر ال
+
+477
+00:34:46,650 --> 00:34:50,370
+swap فيها و بنمسحه على الطبق كله
+
+478
+00:34:53,560 --> 00:34:57,540
+بحيث ان البكتيريا ما تنموش بشكل مستعمرات تنمو بشكل
+
+479
+00:34:57,540 --> 00:35:03,440
+لون لون يعني مش لون color طبقة تمام فيلم الان بجيب
+
+480
+00:35:03,440 --> 00:35:07,500
+فاج واحد و بحطها فاج واحد عبارة عن ايش عبارة عن
+
+481
+00:35:07,500 --> 00:35:11,520
+محلول او قرص قرص disk محطوط على البكتيريا فاج او
+
+482
+00:35:11,520 --> 00:35:17,870
+محلول بنحط قطرة هي واحدهذه اتنين وهذه تلاتة وهذه
+
+483
+00:35:17,870 --> 00:35:24,610
+اربعة وهذه خمسة وهذه ستة وهذه سبعة مثلا طبعا الان
+
+484
+00:35:24,610 --> 00:35:26,490
+البكتيريا دا staphylococcus aureus دا
+
+485
+00:35:26,490 --> 00:35:31,410
+staphylococcus aureus والبكتيريا دولة كلهم لمين دا
+
+486
+00:35:31,410 --> 00:35:36,310
+staphylococcus aureus بس لسلولات مختلفة السلالة
+
+487
+00:35:36,310 --> 00:35:42,270
+اللى بتعمل license للبكتيريا اللى حواليها طبعا
+
+488
+00:35:43,630 --> 00:35:48,030
+يبجى هي اللي نجحت في نتامة ال infection، كونت نجحت
+
+489
+00:35:48,030 --> 00:35:50,630
+في نتامة ال infection، يعني ال .. يعني الفاج
+
+490
+00:35:50,630 --> 00:35:55,290
+specific لمين؟ للبكتيريا، يبجى أنا عارفه ولا مش
+
+491
+00:35:55,290 --> 00:35:59,380
+عارفه هذا؟الـ phage مانا .. انا اللي انا مستخدمه
+
+492
+00:35:59,380 --> 00:36:01,860
+انا هجي طالع و مطلع من التلاجة تبع المختبر و
+
+493
+00:36:01,860 --> 00:36:05,480
+مستخدمه و عارف رقمهم وبالتالي بقول ان ال bacteria
+
+494
+00:36:05,480 --> 00:36:09,540
+الان اللي عزلتها هي bacterium phage 6 او phage
+
+495
+00:36:09,540 --> 00:36:13,440
+type 6 Staphylococcus aureus phage type 6 هاي شكل
+
+496
+00:36:13,440 --> 00:36:17,600
+الفراغات اللي بتشوفوها هذه بسموها zone of
+
+497
+00:36:17,600 --> 00:36:19,780
+inhibition زي ال .. زي ال antibiotic بسموها blacks
+
+498
+00:36:19,780 --> 00:36:21,700
+بسموها blacks و blacks
+
+499
+00:36:26,310 --> 00:36:31,830
+بالـ Q بقى بـ blacks إذا
+
+500
+00:36:31,830 --> 00:36:34,390
+هو واضح بالنسبة الناس يعني Fage typing Fage typing
+
+501
+00:36:34,390 --> 00:36:38,230
+هو استخدام ال bacteriophage في التعرف على ال
+
+502
+00:36:38,230 --> 00:36:42,050
+stereotypes المختلفة من خلال اللي هو ال
+
+503
+00:36:42,050 --> 00:36:43,990
+interaction ما بين ال bacteriophage و ما بين
+
+504
+00:36:43,990 --> 00:36:47,930
+البكتيريا بالنسبة للصورة يعني كل يعني زوم
+
+505
+00:36:47,930 --> 00:36:52,730
+bacteriophage مختلف؟ هنا أهبس البكتيريا هي نفس
+
+506
+00:36:52,730 --> 00:36:57,210
+البكتيريا؟ هي نفس البكتيريا الصورة هنا بس بتوضحنا
+
+507
+00:36:57,210 --> 00:37:01,050
+.. بتوضحنا ال .. ال .. ال .. ال blacks أنا بتوضحاش
+
+508
+00:37:01,050 --> 00:37:03,790
+كيفية إجراء الفحص بتوضحاش .. بتوضحاش كيفية إجراء
+
+509
+00:37:03,790 --> 00:37:08,590
+.. بتوضحانا ظهور اللي هو ال blacks فقط اللي هي
+
+510
+00:37:08,590 --> 00:37:11,390
+الصورة اللي عنده البكتيريا فاج قضى على البكتيريا؟
+
+511
+00:37:11,390 --> 00:37:14,970
+حللها نعم حللها هو خدوا بالك البكتيريا فاج كلمة
+
+512
+00:37:14,970 --> 00:37:19,850
+فاج مش معنات فاج لقمةوبكتيروفاج لقيمات البكتيريا
+
+513
+00:37:19,850 --> 00:37:24,810
+التسمية غلط اللاقمة غالبا بتعطي حق بأنها بتلتقم
+
+514
+00:37:24,810 --> 00:37:31,210
+البكتيريا البكتيروفاج أصغر بيعمل infection داخل
+
+515
+00:37:31,210 --> 00:37:34,410
+البكتيريا وبيحللها from inside
+
+516
+00:37:38,920 --> 00:37:42,080
+نجي للقضية اللى .. اللى .. اللى .. اللى .. اللى
+
+517
+00:37:42,080 --> 00:37:44,580
+خدنا نقول اللى أهم في موضوعنا اليوم الـ
+
+518
+00:37:44,580 --> 00:37:47,260
+Staphylococcus aureus و الـ Antimicrobial
+
+519
+00:37:47,260 --> 00:37:54,840
+sensitivity testing في
+
+520
+00:37:54,840 --> 00:38:00,220
+أربعينيات القرن الماضي لما كشف البنسالينيعني اعتبر
+
+521
+00:38:00,220 --> 00:38:06,060
+magic drug اللي هو يعني سحرية
+
+522
+00:38:06,060 --> 00:38:13,500
+والصحيح انه يعني عمل نهضة كبيرة في العالم حتى يعني
+
+523
+00:38:13,500 --> 00:38:17,340
+البعض بتكلم عن انه غير موازين القوة في العالم
+
+524
+00:38:17,340 --> 00:38:24,600
+الجريح اللي كان ينخدشكان خلاص يطلع من المعركة
+
+525
+00:38:24,600 --> 00:38:28,620
+ومايرجعش بالبنسالين صار يرجع بعد يومين تلاتة انه
+
+526
+00:38:28,620 --> 00:38:33,500
+خلاص بيبطل يسلم دول اتهابات في الجروح على
+
+527
+00:38:33,500 --> 00:38:37,960
+مستوى العالم الأمراض اللي كانت بتصيب الإنسان
+
+528
+00:38:37,960 --> 00:38:42,120
+المعديها الأمراض المعديها كتيرة جدا استطاعت
+
+529
+00:38:42,120 --> 00:38:47,160
+بنسالين انه يخلص العالم من جزء كبير منها وبالتالي
+
+530
+00:38:47,160 --> 00:38:53,480
+استخدامه شاع في كل العالم بسرعة رهيبةالاستخدام
+
+531
+00:38:53,480 --> 00:38:58,460
+الكثير والمفرط ادى الى ان البكتيرا تكون resistance
+
+532
+00:38:58,460 --> 00:39:01,620
+خاصة الـ Staphylococcus aureus اللى قلنالكوا
+
+533
+00:39:01,620 --> 00:39:07,060
+الاشريشيا كولاي في ال انترو بكترياس هي الأشهر صح؟
+
+534
+00:39:07,060 --> 00:39:10,940
+و Sodomonas aeruginosa في ال non-fermenter هي
+
+535
+00:39:10,940 --> 00:39:14,940
+الأشهر و Staphylococcus aureus هي الأشهر في ال
+
+536
+00:39:14,940 --> 00:39:19,850
+gram-bostef على الإطلاقيعني تتوقع أنه أشهر تلات
+
+537
+00:39:19,850 --> 00:39:23,850
+أسماء عندك مين هم الآن؟ إشريشيا و Sodomonas و
+
+538
+00:39:23,850 --> 00:39:29,390
+Staphylococcus aureus ليه شهرتها؟ شفتوا القائمة
+
+539
+00:39:29,390 --> 00:39:34,950
+الأمراض؟ و مثلها و مثلها يعني في قائم أخرى غيرها
+
+540
+00:39:34,950 --> 00:39:39,530
+يعني it causes infection from head to toe من أعلى
+
+541
+00:39:39,530 --> 00:39:44,850
+الرأس إلى أخمص القدم و everywhere بالجسم وبالتالي
+
+542
+00:39:44,850 --> 00:39:48,380
+it is a common pathogenوبالتالي احتكاكها
+
+543
+00:39:48,380 --> 00:39:52,760
+بالبنسالين بالتأكيد زاد، فكوّنت Resistance
+
+544
+00:39:52,760 --> 00:39:54,540
+للبنسالين. أنا لما أعطي محاضرات عن ال
+
+545
+00:39:54,540 --> 00:39:57,040
+antimicrobial resistance، هو كان محاضرة عامة أو
+
+546
+00:39:57,040 --> 00:40:04,440
+مقدمة لطلاب في التخصص معين، دايما و أبدا الاستفادة
+
+547
+00:40:04,440 --> 00:40:07,740
+ل Coccus aureus هي المثال الأول اللي بنبدأ في قصة
+
+548
+00:40:07,740 --> 00:40:12,440
+حياة ال resistance.تخيلوا من one hundred percent
+
+549
+00:40:12,440 --> 00:40:15,880
+sensitivity to one hundred percent resistance لأن
+
+550
+00:40:15,880 --> 00:40:19,000
+نادرًا ما تجد ال strain من ال Staphylococcus
+
+551
+00:40:19,000 --> 00:40:25,020
+aureus sensitive لمن؟ ده ال penicillin طيب طورنا
+
+552
+00:40:25,020 --> 00:40:28,120
+ال penicillin احنا عملنا حاجة اسمها semi-synthetic
+
+553
+00:40:28,120 --> 00:40:32,330
+penicillinزي الامبيسيلين والاموكسيلين هدول عايش
+
+554
+00:40:32,330 --> 00:40:36,730
+معاهم هدول عبارة عن modification للموليكيول الأم
+
+555
+00:40:36,730 --> 00:40:39,430
+اللي هو ال penicillin G اللي بيسموه natural
+
+556
+00:40:39,430 --> 00:40:43,150
+penicillin برضه البكتيريا كوّنت له resistance
+
+557
+00:40:43,150 --> 00:40:47,610
+Antibiotic Tamases روحنا عاملنا Antibiotic اسمه
+
+558
+00:40:47,610 --> 00:40:53,100
+Methicillin هذا ال Methicillinالبكتيريا المقاومة
+
+559
+00:40:53,100 --> 00:40:59,200
+للبنسيلنات اللى جابله حساسة إله حساسة إله بعد فترة
+
+560
+00:40:59,200 --> 00:41:06,060
+واجيزة ظهر لنا مثيسيلين
+
+561
+00:41:06,060 --> 00:41:13,400
+مقاومة استفيلوكوكاس اوريس يعني احنا بنطور وهي ايضا
+
+562
+00:41:13,400 --> 00:41:18,910
+تطور لكن كنا بالأول شايفين حالنا شويةسبجين
+
+563
+00:41:18,910 --> 00:41:22,090
+البكتيريا بقينا مجموعة Antibiotic بدائل كثيرة
+
+564
+00:41:22,090 --> 00:41:26,110
+فكننا مرتاحين شوية لدرجة انه جلستلكوا بعض صار يعني
+
+565
+00:41:26,110 --> 00:41:29,910
+حاول انه يطلع مؤتمرات صحيفية ويعلن عن انتهاء
+
+566
+00:41:29,910 --> 00:41:34,210
+بكتيريا معينة من كوكب الأرض لكن البكتيريا
+
+567
+00:41:34,210 --> 00:41:37,870
+البكتيريا أثار حفيظة البكتيريا وبالتالي بدأت
+
+568
+00:41:37,870 --> 00:41:42,970
+البكتيريا تستشرس أكتر والان بمقاييس القوة
+
+569
+00:41:42,970 --> 00:41:47,260
+البكتيريا is winningهى الفائزة او او او فى طورها
+
+570
+00:41:47,260 --> 00:41:49,960
+للفوز على الانسان لأنه عدد ال antibiotics اللى
+
+571
+00:41:49,960 --> 00:41:53,960
+بنتشفها اقل من سرعة البكتيرى يعنى البكتيرى اسرع فى
+
+572
+00:41:53,960 --> 00:41:57,560
+تكوين ال resistance من اكتشافنا ل new antibiotics
+
+573
+00:41:57,560 --> 00:42:03,460
+ضع على الاندوشيفة كمان حاسمة visa S
+
+574
+00:42:03,460 --> 00:42:08,400
+A خلاص Staphylococcus aureus تمام؟Visa لأ Visa
+
+575
+00:42:08,400 --> 00:42:12,780
+مانع Vancomycin Intermediate يعني مش resistant لسه
+
+576
+00:42:12,780 --> 00:42:18,380
+لكن احنا في غزة سبجناها على طول سبجناها VVRSA
+
+577
+00:42:18,380 --> 00:42:23,660
+Vancomycin Resistance Teflococcus Aureus طبعا ايش
+
+578
+00:42:23,660 --> 00:42:27,620
+ال Vancomycin هذا ال Vancomycin ال WHO ايش جالت
+
+579
+00:42:27,620 --> 00:42:33,620
+عنه جالت هو the last bullet in our arsenal
+
+580
+00:42:39,130 --> 00:42:44,910
+WHO استخدمت مصطلحات حربية للدلالة على ما نحن فيه
+
+581
+00:42:44,910 --> 00:42:48,730
+في موضوع الresistance، آخر طلقة في ترسانتنا، فلما
+
+582
+00:42:48,730 --> 00:42:53,270
+البكتيريا أصبح vancomycin resistant، معناه الحكي
+
+583
+00:42:53,270 --> 00:42:58,530
+أن أنا أصبحت خايف جدا الشباب من انتشار،إنه بكتيريا
+
+584
+00:42:58,530 --> 00:43:00,790
+بسيطة زي الـ Staphylococcus aureus في السابق كنا
+
+585
+00:43:00,790 --> 00:43:06,010
+نعالجها بنسالينجي اليوم super bug بمعنى
+
+586
+00:43:13,680 --> 00:43:20,120
+بكتيريا resistant to most antibiotics تخيلوا واحد
+
+587
+00:43:20,120 --> 00:43:22,920
+يصاب ب Staphylococcus aureus في التهاب في الجروح
+
+588
+00:43:22,920 --> 00:43:26,240
+مانقدرش نعالجه البكتيريا تروح على الدم وبعدين
+
+589
+00:43:26,240 --> 00:43:29,100
+مانقدرش نعالجه برضه وبعدين تروح على ال CSF ويموت
+
+590
+00:43:29,100 --> 00:43:34,210
+المريض من سنبل Staphylococcus aureusنتيجة ايش؟
+
+591
+00:43:34,210 --> 00:43:38,210
+نتيجة عدم موجود Antibiotic ملائم لهذه البكتيريا
+
+592
+00:43:38,210 --> 00:43:42,170
+لذلك احنا بنقول ان اي عزلة من العزلات ال .. ال ..
+
+593
+00:43:42,170 --> 00:43:45,010
+ال Staphylococcus aureus should undergo يجب ان
+
+594
+00:43:45,010 --> 00:43:49,630
+تخضع لمين ل sensitivity testing طبعا هذه القصة
+
+595
+00:43:49,630 --> 00:43:51,590
+اللي انا حكيتلكوا إياها اللي هي موضوع ال .. ال ..
+
+596
+00:43:51,590 --> 00:43:58,570
+ال .. ال antimicrobial resistance تبع ال MRSA ال
+
+597
+00:43:58,570 --> 00:44:04,190
+MRSAبقونا low carriage rate in community الان احنا
+
+598
+00:44:04,190 --> 00:44:07,350
+متوقع ال resistance وان يكون اعلى في المستشفيات
+
+599
+00:44:07,350 --> 00:44:12,930
+ولا في المجتمع في المستشفياتهنا بقولنا انه مازال
+
+600
+00:44:12,930 --> 00:44:15,390
+في .. طبعا بنتكلم على .. في شكل عام هو ده معلومات
+
+601
+00:44:15,390 --> 00:44:18,030
+شويه قديمة انه low .. low carriage rate in
+
+602
+00:44:18,030 --> 00:44:21,010
+community انا بقولكوا في انا دراسة الآن شغالة جاني
+
+603
+00:44:21,010 --> 00:44:23,850
+بناخد MR .. بناخد Staphylococcus aureus من أنوف
+
+604
+00:44:23,850 --> 00:44:27,390
+الناس مش من المرضى و لجينا نسبة يعني أنا لسه مش ..
+
+605
+00:44:27,390 --> 00:44:29,990
+مش حاجة أصرح عنها الآن لإنه لسه في طور تحليل
+
+606
+00:44:29,990 --> 00:44:33,430
+البيانات لكن الطالب بيخبرني اللي هو اللي بيقوم
+
+607
+00:44:33,430 --> 00:44:37,310
+بهذه الدراسة انه اكتر من خمسين بالمائة من العينات
+
+608
+00:44:37,310 --> 00:44:40,610
+اللي تم عزل Staphylococcus aureus من المجتمع كانوا
+
+609
+00:44:40,610 --> 00:44:44,560
+MRSAعزلنا بكتيريا من البحر، من البحر اللي بهم
+
+610
+00:44:44,560 --> 00:44:47,800
+نستهام فيه في الصيف، لجينا فيها نسبة ليبقى سببها
+
+611
+00:44:47,800 --> 00:44:51,660
+من ال MRSA، إذا ال MRSA صارت تشكل خطر مش بس في
+
+612
+00:44:51,660 --> 00:44:55,460
+المستشفيات كمان فيمين في المجتمع، طبعا بالغالب
+
+613
+00:44:55,460 --> 00:44:57,780
+اللي لجيها أعلى في المستشفيات من اللي هو ال
+
+614
+00:44:57,780 --> 00:45:01,830
+communitymode of transmission من أدوات المرضى يعني
+
+615
+00:45:01,830 --> 00:45:05,230
+غالبا هي اللي بنستخدمها وممكن من ال staff يعني
+
+616
+00:45:05,230 --> 00:45:09,030
+الدكاتر هم اللي بينقله الممرضين هم اللي بينقله
+
+617
+00:45:09,030 --> 00:45:14,150
+لذلك هناك سياسات في المستشفيات انه كل مريض اعفن كل
+
+618
+00:45:14,150 --> 00:45:19,190
+staff member طبيب او بنعمله مسحات من الأنف و بنشوف
+
+619
+00:45:19,190 --> 00:45:23,110
+إذا عنده staphylococcus aureus من نوع MRSA بنعطيه
+
+620
+00:45:23,110 --> 00:45:26,830
+cream local حتى نتخلص من اللي هو ال MRSA عشان
+
+621
+00:45:26,830 --> 00:45:31,820
+ماينقلش البكتيريا لمينللمرضى والاخرى المرة الجاية
+
+622
+00:45:31,820 --> 00:45:35,320
+ان شاء الله بتكلم عن اللي هو البقية المتعلقة
+
+623
+00:45:35,320 --> 00:45:39,580
+بالأمراض أو خطورة ال MRSA في المجتمع
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/rU3r1mJ2OXY.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/rU3r1mJ2OXY.srt
new file mode 100644
index 0000000000000000000000000000000000000000..6664467085c7e8390127a36a3e765345a1efb837
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/rU3r1mJ2OXY.srt
@@ -0,0 +1,2105 @@
+1
+00:00:20,750 --> 00:00:23,850
+بسم الله الرحمن الرحيم اليوم الموضوع سيكون
+
+2
+00:00:23,850 --> 00:00:27,390
+Shigella إن شاء الله، الـ Shigella هي العضو الثاني
+
+3
+00:00:27,390 --> 00:00:31,430
+المهم جداً من الـ non-lactose fermenting
+
+4
+00:00:31,430 --> 00:00:37,170
+enterobacteriasi بعد السلمونيلا، الـ genus Shigella
+
+5
+00:00:37,170 --> 00:00:39,510
+يختلف قليلاً عن السلمونيلا في بعض الأمور، نريد
+
+6
+00:00:39,510 --> 00:00:44,670
+أن نوضحها من البداية، there are fewer species، يعني عدد
+
+7
+00:00:44,670 --> 00:00:50,970
+الأفراد في الـ genus Shigella أقل من السلمونيلا، كمان
+
+8
+00:00:50,970 --> 00:00:55,330
+نوعية الأمراض التي تسببها الشيجيلا هي نوعية واحدة، وهي
+
+9
+00:00:55,330 --> 00:00:59,450
+ gastroenteritis type، يعني إسهال، بينما رأيتم
+
+10
+00:00:59,450 --> 00:01:03,290
+السلمونيلا كانت تعمل septicemia، وتعمل enteric
+
+11
+00:01:03,290 --> 00:01:06,610
+fever، وتعمل food infection type، يعني كان فيه
+
+12
+00:01:06,610 --> 00:01:11,530
+تنوع في الأمراض، بينما في الشيجيلا فقط فقط ماذا؟
+
+13
+00:01:12,870 --> 00:01:16,250
+Gastroenteritis أو إسهال، Shigella
+
+14
+00:01:16,250 --> 00:01:19,850
+Dysenteria was isolated by Shiga in Japan in 1898.
+
+15
+00:01:19,850 --> 00:01:22,990
+يعني أيضاً من الميكروبات القديمة، والتي تم التعرف
+
+16
+00:01:22,990 --> 00:01:29,170
+عليها منذ أكثر من مائة عام، الشيجيلا ارتبط اسمها
+
+17
+00:01:29,170 --> 00:01:33,170
+بالسلمونيلا، ارتباط وثيق، نظراً لأن الشيجيلا
+
+18
+00:01:33,170 --> 00:01:37,290
+يتشاركان في بعض الصفات، لكن سنرى في سياق المحاضرة
+
+19
+00:01:37,290 --> 00:01:41,690
+هذه أن الشيجيلا تختلف اختلافاً كبيراً عن السلمونيلا،
+
+20
+00:01:41,690 --> 00:01:46,330
+قلنا أول اختلاف في ماذا؟ في عدد الأفراد، عدد بسيط
+
+21
+00:01:46,330 --> 00:01:57,650
+حوالي أربعة فقط، نوع الأمراض نوع واحد فقط، الأسماء
+
+22
+00:01:57,650 --> 00:02:00,310
+المشهورة، قلنا في هذا الـ genus هم Shigella Dysenteria
+
+23
+00:02:00,310 --> 00:02:05,900
+وShigella Flexneri، وShigella Sonnei، وShigella Boydii. مرة
+
+24
+00:02:05,900 --> 00:02:09,520
+Shigella Boydii, Shigella Sonnei, Shigella Flexneri
+
+25
+00:02:09,520 --> 00:02:12,500
+وShigella Dysenteriae، أعتقد أن الـ type species
+
+26
+00:02:12,500 --> 00:02:16,520
+تبع الـ genus هي الأولى التي أعطت اللقب الذي
+
+27
+00:02:16,520 --> 00:02:19,920
+هو الـ dysentery للـ disease الذي يتميز بماذا؟
+
+28
+00:02:22,150 --> 00:02:26,050
+تعني أنهم معاً، غير الإسهال، أننا نجد أربعة
+
+29
+00:02:26,050 --> 00:02:29,150
+characteristics مصاحبة قبل الـ blood، نجد الـ
+
+30
+00:02:29,150 --> 00:02:32,510
+epithelial cells، والـ mucus، وبعدين الـ blood، زي
+
+31
+00:02:32,510 --> 00:02:36,890
+هذا الذي هو الـ pus، هذه الصفات الأربع قد نجدها في
+
+32
+00:02:36,890 --> 00:02:41,530
+أمراض أخرى غير الشيجيلا، تمام؟ بمعنى الـ
+
+33
+00:02:41,530 --> 00:02:43,570
+amoebic dysentery، الذي نجد فيه الـ Entamoeba
+
+34
+00:02:43,570 --> 00:02:47,490
+histolytica، أيضاً نفس المواصفات للبراز، لكن أيضاً
+
+35
+00:02:47,490 --> 00:02:50,190
+في differentiation، ممكن نميزهم عن بعضهم.
+
+36
+00:02:53,440 --> 00:02:58,580
+أفضل شيء في الـ... الـ... البكتيريا أن نجد صفة
+
+37
+00:02:58,580 --> 00:03:04,260
+تميز البكتيريا عن الأخريات... عن الأخريات.
+
+38
+00:03:04,260 --> 00:03:07,960
+مثلاً هنا استخدمنا الـ manitol fermentation
+
+39
+00:03:07,960 --> 00:03:12,800
+character كـ initial differentiation between الذين
+
+40
+00:03:12,800 --> 00:03:16,580
+هم الشيجيلا ديزنتيريا which was non-manitol
+
+41
+00:03:16,580 --> 00:03:19,800
+fermenter، يعني لا تعمل تخمير للمانيتول، والباقي
+
+42
+00:03:19,800 --> 00:03:23,000
+يعملون manitol fermentation، إذا لو عزلنا الشيجيلا
+
+43
+00:03:23,320 --> 00:03:26,880
+ونريد تمييز هل هي dysentery أم others، أول فحص نعمله
+
+44
+00:03:26,880 --> 00:03:29,720
+هو manitol fermentation، طبعاً الأولى negative
+
+45
+00:03:29,720 --> 00:03:33,620
+والباقي يكونوا positive، الـ morphology and
+
+46
+00:03:33,620 --> 00:03:36,240
+staining، اتفقنا أنها gram negative، لكن
+
+47
+00:03:36,240 --> 00:03:38,980
+لأنها enterobacteriasi، non-encapsulated، لا تملك
+
+48
+00:03:38,980 --> 00:03:43,320
+capsule، non-motile، لا تتحرك، يعني من معظم صفاتها هي
+
+49
+00:03:43,320 --> 00:03:46,740
+non... أن non... أيضاً non-spore forming، it is a gram
+
+50
+00:03:46,740 --> 00:03:53,740
+negative، لكن... يعني بعكس السلمونيلا، قلنا الـ habitat
+
+51
+00:03:53,740 --> 00:03:58,360
+تبع الشيجيلا، man is the only known host for this
+
+52
+00:03:58,360 --> 00:04:02,160
+organism، يعني الإنسان هو المخلوق الوحيد الذي يحمل
+
+53
+00:04:02,160 --> 00:04:05,700
+harboring لهذا الميكروب، وبالتالي لو علاجنا من ناحية
+
+54
+00:04:05,700 --> 00:04:09,620
+نظرية، علاجنا البشر المصابين، والحاملين لهذا الـ
+
+55
+00:04:09,620 --> 00:04:13,440
+micro، سنتخلص من الشيجيلوزيس forever، لكن هذه
+
+56
+00:04:13,440 --> 00:04:18,620
+العملية أيضاً ليست بالسهلة، لأن هناك أشخاص يحملون هذا
+
+57
+00:04:18,620 --> 00:04:23,220
+الميكروب دون ظهور أي أعراض عليه، إذا متفقين على
+
+58
+00:04:23,220 --> 00:04:28,060
+أن الإنسان فقط، هذا أيضاً فرق بينها وبين
+
+59
+00:04:28,060 --> 00:04:30,840
+السلمونيلا، السلمونيلا نجد wide range of
+
+60
+00:04:30,840 --> 00:04:35,190
+hosts، وإن carriers of pathogenic strains can
+
+61
+00:04:35,190 --> 00:04:38,390
+excrete the organism up to two weeks after
+
+62
+00:04:38,390 --> 00:04:42,210
+infection and occasionally for longer periods، يعني
+
+63
+00:04:42,210 --> 00:04:47,410
+فترة إفراز الميكروب في البيئة تكون طويلة جداً، by
+
+64
+00:04:47,410 --> 00:04:50,830
+this time، الميكروب can survive in the environment
+
+65
+00:04:50,830 --> 00:04:54,050
+if it reaches water، water الذي نقصد فيه
+
+66
+00:04:54,050 --> 00:04:59,080
+مياه الشرب، في غالب الأمر، many people are using
+
+67
+00:04:59,080 --> 00:05:02,540
+the same source، وبالتالي يصير لدينا epidemic أو
+
+68
+00:05:02,540 --> 00:05:06,620
+outbreak of shigellosis في فلسطين وفي قطاع غزة في
+
+69
+00:05:06,620 --> 00:05:09,960
+shigellosis، لكن نحن نطلق عليه كـ epidemiology
+
+70
+00:05:09,960 --> 00:05:14,440
+sporadic cases، يعني حالات متفرقة، أو حالات متقطعة، ليس
+
+71
+00:05:14,440 --> 00:05:20,640
+بشكل epidemic، أكبر نسبة إصابة بالشيجيلوز تحدث في
+
+72
+00:05:20,640 --> 00:05:23,300
+المناطق التي بها poor sanitary conditions، ماذا يعني
+
+73
+00:05:23,300 --> 00:05:25,920
+الـ poor sanitary conditions؟ يعني الظروف الصحية، و
+
+74
+00:05:25,920 --> 00:05:29,700
+ظروف النظافة فيها منخفضة، وأنا يمكن المحاضرة
+
+75
+00:05:29,700 --> 00:05:34,640
+السابقة، لما تحدثت عن السلمونيلا، تحدثت بشكل مفصل
+
+76
+00:05:34,640 --> 00:05:39,140
+عن أن الـ sewage system إذا تعطّل لأي سبب من
+
+77
+00:05:39,140 --> 00:05:43,030
+الأسباب، سواء كان غير موجود أساساً، أو تعطّل بسبب المطر
+
+78
+00:05:43,030 --> 00:05:46,870
+الغزير، العواصف، الحروب، whatever reason، غالباً تتفشى
+
+79
+00:05:46,870 --> 00:05:52,630
+مثل هذه الأمراض التي من ضمنها الشيجيلا، الشيجيلا
+
+80
+00:05:52,630 --> 00:05:55,730
+تنمو على الأوساط الزراعية التي ذكرناها للـ
+
+81
+00:05:55,730 --> 00:05:58,790
+enterobacteriasi، تنمو على الـ blood agar، وتنمو
+
+82
+00:05:58,790 --> 00:06:03,650
+على المكونكي، لكن... يعني آن الأوان أن نتكلم عن
+
+83
+00:06:03,650 --> 00:06:06,230
+ما الذي نعني بالـ selective medium؟ نحن نقول
+
+84
+00:06:06,230 --> 00:06:10,790
+سلمونيلا الشيجيلا أجار، البعض قد يتصور أنه لن ينمو
+
+85
+00:06:10,790 --> 00:06:14,850
+على سلمونيلا الشيجيلا أجار إلا سلمونيلا والشيجيلا،
+
+86
+00:06:14,850 --> 00:06:19,650
+نوضح هذا المفهوم بمجموعة من العبارات، أرجو أن
+
+87
+00:06:19,650 --> 00:06:23,070
+تتذكروها جيداً، رقم واحد، never ever trust the
+
+88
+00:06:23,070 --> 00:06:28,520
+selectivity of a selective medium، لا تثق بأي حال من
+
+89
+00:06:28,520 --> 00:06:32,880
+الأحوال بالـ selectivity تبع الـ selective media.
+
+90
+00:06:32,880 --> 00:06:36,480
+ماذا... ماذا... ماذا يعني هذا؟ لما أقول
+
+91
+00:06:36,480 --> 00:06:40,540
+مكونكي is selective for gram negative، يبقى كل ما
+
+92
+00:06:40,540 --> 00:06:47,390
+سينمو على المكونكي هو... وهذا الكلام ليس صحيحاً، يبقى
+
+93
+00:06:47,390 --> 00:06:52,670
+لو افترضت الـ absolute selectivity، يبقى أنا
+
+94
+00:06:52,670 --> 00:06:56,290
+أقول أن كل ما ينمو على المكونكي هو gram negative.
+
+95
+00:06:56,290 --> 00:07:00,390
+الآن لو افترضت أن الـ absolute selectivity للـ SSA
+
+96
+00:07:00,390 --> 00:07:02,870
+يبقى كل ما ينمو على سلمونيلا شيجيلا أجار هو
+
+97
+00:07:02,870 --> 00:07:06,370
+سلمونيلا أو شيجيلا، وهذا أيضاً غير صحيح، إذاً
+
+98
+00:07:06,370 --> 00:07:11,170
+لماذا سُمّيت selective؟ ولماذا خصصناها بهذا المسمى؟
+
+99
+00:07:11,170 --> 00:07:16,810
+هناك نقطة لنوضحها، Blood Agar, MacConkey
+
+100
+00:07:16,810 --> 00:07:21,910
+Agar, Salmonella Shigella Agar، ثلاث أوساط مختلفة،
+
+101
+00:07:21,910 --> 00:07:25,850
+لدي عينة واحدة تحتوي على Salmonella وShigella
+
+102
+00:07:25,850 --> 00:07:30,990
+وتحتوي على آلاف الأنواع الأخرى من الميكروبات، خليط
+
+103
+00:07:30,990 --> 00:07:34,330
+زرعتها على الـ MacConkey، عفواً، على الـ Blood Agar،
+
+104
+00:07:34,330 --> 00:07:38,170
+زرعتها على الـ MacConkey، وزرعتها على الـ SSA، على
+
+105
+00:07:38,170 --> 00:07:44,780
+الثلاث الآن، تعالوا نحاول نقيس فرص السلمونيلا
+
+106
+00:07:44,780 --> 00:07:48,160
+والشيجيلا على الثلاث أطباق، الثلاثة، نقول فرص
+
+107
+00:07:48,160 --> 00:07:50,320
+السلمونيلا والشيجيلا على الـ blood agar، شيء مهم،
+
+108
+00:07:50,320 --> 00:07:53,860
+قليلة، إنها تنمو في وجود من؟ الميكروبات الأخرى،
+
+109
+00:07:53,860 --> 00:07:58,470
+التي تغطيها، فرصة نموها في المكونكي أفضل من
+
+110
+00:07:58,470 --> 00:08:02,770
+فرصة نموها على الـ blood agar، فرصة نموها على السلمونيلا
+
+111
+00:08:02,770 --> 00:08:06,930
+والشيجيلا أجار أفضل من المكونكي، يبقى الـ
+
+112
+00:08:06,930 --> 00:08:11,250
+selectivity لا تعني absolute selectivity، وإنما الـ
+
+113
+00:08:11,250 --> 00:08:14,970
+chances أو الـ probabilities of growth is higher on
+
+114
+00:08:14,970 --> 00:08:20,130
+that media than other media، إذا افترضت ودخلت هذا
+
+115
+00:08:20,130 --> 00:08:23,750
+المفهوم في ذهنك من الآن، سنرتاح معك في المستقبل
+
+116
+00:08:23,750 --> 00:08:26,750
+لأن لما تأتي للتعرف على البكتيريا، مثال بسيط،
+
+117
+00:08:26,750 --> 00:08:30,910
+صارخ، من الأوساط المشهورة اسمها TCBS، وهذا الوسط
+
+118
+00:08:30,910 --> 00:08:34,710
+نسميه Vibrio cholera selective media للـ
+
+119
+00:08:34,710 --> 00:08:40,050
+Vibrio cholera، والشكل المستعمرة الـ typical، نقول
+
+120
+00:08:40,050 --> 00:08:44,840
+على الـ typical colonies التي هي Yellow colonies
+
+121
+00:08:44,840 --> 00:08:47,980
+surrounded by yellow zone as a result of sucrose
+
+122
+00:08:47,980 --> 00:08:53,860
+fermentation، يحتوي على ساكروز، الـ TCBS، لو كل
+
+123
+00:08:53,860 --> 00:09:00,060
+مستعمرة صفراء نمت على الـ TCBS، يعني
+
+124
+00:09:00,060 --> 00:09:02,860
+معناه الذي قلناه، هي ماذا؟ Vibrio، وهذا الأمر
+
+125
+00:09:02,860 --> 00:09:08,440
+للأسف غير صحيح، غير صحيح، وبالتالي... وبالتالي إذا أنا
+
+126
+00:09:08,440 --> 00:09:12,360
+من الأساس لدي الإعتقاد، ولدي المعرفة بأن هذا ليس
+
+127
+00:09:12,360 --> 00:09:16,260
+absolutely selective، وهذه الصفة قد تشترك مع
+
+128
+00:09:16,260 --> 00:09:18,760
+ميكروبات أخرى أعرفها أو لا أعرفها، فبالتالي
+
+129
+00:09:18,760 --> 00:09:22,940
+يكون من السهل عليّ أن لا أخطئ، وأعرف بكتيريا أخرى
+
+130
+00:09:22,940 --> 00:09:26,360
+عليها، vibrio كلها، هذا المفهوم يجب أن نعرفه
+
+131
+00:09:26,360 --> 00:09:31,980
+جيداً، طيب نرجع لـ characteristics تبع الشيجيلا، all
+
+132
+00:09:31,980 --> 00:09:34,060
+members of Shigella are aerobic and facultative
+
+133
+00:09:34,060 --> 00:09:37,340
+anaerobic، يعني ليس فيها obligate anaerobic، هي
+
+134
+00:09:37,340 --> 00:09:39,740
+كل الـ enterobacterias نقول أنها facultative
+
+135
+00:09:39,740 --> 00:09:43,360
+anaerobic، grow readily in cultural media، ده pH 6.4
+
+136
+00:09:43,360 --> 00:09:46,720
+to 7.8، هذا الـ range تبع الـ pH الذي ترونه
+
+137
+00:09:46,720 --> 00:09:50,340
+أمامكم هو عبارة عن تقريباً الـ neutral pH، يعني
+
+138
+00:09:50,340 --> 00:09:54,460
+slightly acidic و slightly alkaline، لكن الـ
+
+139
+00:09:54,460 --> 00:09:59,260
+average تبعها يكون في المنتصف، it can grow at 10
+
+140
+00:09:59,260 --> 00:10:02,540
+degree centigrade up to 40 degree centigrade with
+
+141
+00:10:02,540 --> 00:10:05,380
+an optimum temperature of 37، هذا مثال صارخ، على
+
+142
+00:10:05,380 --> 00:10:10,080
+شوفوا الـ range من عشرة إلى أربعين، لكن الـ optimum قريب
+
+143
+00:10:10,080 --> 00:10:14,700
+من ماذا؟ من الماكسيموم، قريب من الماكسيموم، يعني ليس
+
+144
+00:10:14,700 --> 00:10:16,900
+بالضرورة الـ optimum يكون في المنتصف، في المنتصف، لا،
+
+145
+00:10:16,900 --> 00:10:22,270
+ممكن يكون قريباً من أحد extremities، the colonies
+
+146
+00:10:22,270 --> 00:10:26,770
+المستعمرات are circular, convex, colorless, but
+
+147
+00:10:26,770 --> 00:10:30,830
+moderately translucent، شفافة نوعاً ما، with smooth
+
+148
+00:10:30,830 --> 00:10:34,550
+surface، smooth surface، يعني الحواف تبعها
+
+149
+00:10:34,550 --> 00:10:41,390
+و حوافها أملس، نحن نمسكه، نحن نراه، نزرعه فقط
+
+150
+00:10:41,390 --> 00:10:47,170
+and entire edges، entire edges معناها تعرف
+
+151
+00:10:47,170 --> 00:10:52,600
+المستعمرة، هي طبق، المستعمرات ممكن تكون بهذا الشكل
+
+152
+00:10:59,950 --> 00:11:04,230
+هذه lobulate، يعني مفصصة، هذه دائرية كاملة،
+
+153
+00:11:04,230 --> 00:11:09,190
+الاستدارة نسميها entire، يعني كاملة الاستدارة، ليس
+
+154
+00:11:09,190 --> 00:11:13,170
+فيه أي انحناءات، على الرغم من أن بعض الأحيان نجد
+
+155
+00:11:13,170 --> 00:11:17,690
+لدينا شيء اسمه hair-like projections، يعني زوائد
+
+156
+00:11:17,690 --> 00:11:21,530
+تشبه الشعيرات، خارجة من ماذا؟ من الشيجيلا colonies، هذا
+
+157
+00:11:21,530 --> 00:11:25,950
+الكلام ممكن نشوفه، يعني ممكن بهذا الشكل، entire edge
+
+158
+00:11:25,950 --> 00:11:35,290
+أو بهذا الشكل، يكون فيه زوائد شعرية محددة.
+
+159
+00:11:38,610 --> 00:11:41,330
+small tangled hair-like projections can sometimes
+
+160
+00:11:41,330 --> 00:11:45,330
+be seen at one or more points on the periphery.
+
+161
+00:12:07,070 --> 00:12:12,190
+ولا نسيت الموضوع أين أنا؟ إن شاء الله طيب،
+
+162
+00:12:12,190 --> 00:12:17,530
+تمام، إذا المطلوب مني أن أعرف شيئين، أقول إنها
+
+163
+00:12:17,530 --> 00:12:21,510
+typical colony.
+
+164
+00:12:21,510 --> 00:12:24,590
+لأن
+
+165
+00:12:24,590 --> 00:12:27,290
+لما نشاهد مستعمرة، نقول عنها suspected
+
+166
+00:12:33,920 --> 00:12:35,200
+ماذا يعني الـ typical colonies والـ suspected
+
+167
+00:12:35,200 --> 00:12:39,400
+colonies؟ الوصف الذي أوصفه لكم، أو الشركة
+
+168
+00:12:39,400 --> 00:12:43,780
+المصنعة للميديا توصفه لكم، هذا نسميه typical
+
+169
+00:12:43,780 --> 00:12:48,180
+colonies، لما ترى أنت الـ typical colonies على طبق
+
+170
+00:12:48,180 --> 00:12:52,040
+حقيقي أنت زرعته، تسميها suspected colonies، إذا الـ
+
+171
+00:12:52,040 --> 00:12:55,220
+suspected هي التي نراها، والـ typical هي ماذا؟
+
+172
+00:12:55,220 --> 00:12:58,980
+هي الوصف الدقيق لهذه المستعمرة.
+
+173
+00:13:03,180 --> 00:13:06,660
+يقال إذا كان ما جاءنا typical colonies،
+
+174
+00:13:06,660 --> 00:13:11,950
+suspected colonies، يعني، تمام؟ على الـ selective
+
+175
+00:13:11,950 --> 00:13:15,250
+media سواء كان المكونكي، أو كان الـ Hektoen enteric
+
+176
+00:13:15,250 --> 00:13:19,430
+أو الـ XLD أو الـ SSA، أي من الأوساط، يقال a
+
+177
+00:13:19,430 --> 00:13:21,950
+tentative diagnosis، يمكن أول مرة يظهر معنا
+
+178
+00:13:21,950 --> 00:13:24,870
+المصطلح tentative، tentative معناها مؤقت، يعني
+
+179
+00:13:24,870 --> 00:1
+
+223
+00:16:41,780 --> 00:16:43,900
+يعني الـ environmental والـ cultural
+
+224
+00:16:43,900 --> 00:16:47,880
+characteristics كلها بتكون تحت ضمن هذا الجزء،
+
+225
+00:16:47,880 --> 00:16:51,380
+الجزء الثاني احنا وصفناها أول ما وصفناها جرام
+
+226
+00:16:51,380 --> 00:16:54,650
+negative بس اللي، جرام negative بس اللي رقم
+
+227
+00:16:54,650 --> 00:16:57,050
+ثلاثة الـ biochemical characteristics قلنا لكم
+
+228
+00:16:57,050 --> 00:17:00,750
+عنها يورياز نيجاتيف، non-motile، non-capsulated،
+
+229
+00:17:00,750 --> 00:17:03,090
+non-spore forming، كل هذه الصفات، عفوا، non-
+
+230
+00:17:03,090 --> 00:17:07,010
+spore forming مالهاش علاقة بالـ non- .. قلنا ..
+
+231
+00:17:07,010 --> 00:17:09,290
+non-motile، كل هذه اسمها biochemical
+
+232
+00:17:09,290 --> 00:17:12,450
+characteristics، اتكلمنا عن الـ serology؟ لسه
+
+233
+00:17:12,450 --> 00:17:15,390
+ماتكلمناش بتفصيل عن الـ serology، لكن عرفنا أنه في
+
+234
+00:17:15,390 --> 00:17:22,680
+شغلة polyvalent antiserum، صح؟ أنا اكتفيت بالـ
+
+235
+00:17:22,680 --> 00:17:26,700
+cultural characteristics ورحت على مين؟ على
+
+236
+00:17:26,700 --> 00:17:29,020
+physiological characteristics قفزت عن الـ
+
+237
+00:17:29,020 --> 00:17:31,940
+morphology وقفزت عن الـ biochemical كمان مرة لأي
+
+238
+00:17:31,940 --> 00:17:37,460
+غرض لتقصير فترة الـ diagnosis، متى بنلجأ لهذا الكلام؟
+
+239
+00:17:37,460 --> 00:17:42,460
+لما تكون الحالات أو الوضع بيتطلب ذلك زي ما كنا
+
+240
+00:17:42,460 --> 00:17:46,640
+مثلا في حالة اللي هو الـ epidemic، طبعا هذا لا يعني
+
+241
+00:17:46,640 --> 00:17:51,720
+أنّي بقفز وبنسى هدول، بقفز مؤقتا وبأعمل
+
+242
+00:17:51,720 --> 00:17:55,700
+tentative diagnosis وبعدين برجع بشتغل الشغل مرة
+
+243
+00:17:55,700 --> 00:18:00,600
+أخرى، يعني إذا بعطي نتيجة أولية، tentative مؤقتة، و
+
+244
+00:18:00,600 --> 00:18:04,880
+بعدين بعطي نتيجة نهائية، لأ مش بقفز وبنساهم، لأ
+
+245
+00:18:04,880 --> 00:18:06,400
+برجع لهم مرة أخرى
+
+246
+00:18:17,970 --> 00:18:20,730
+طبقنا احنا على الـ shigella الانزيمات للـ biochemical
+
+247
+00:18:20,730 --> 00:18:24,110
+characteristics، all fermented glucose، some ferment
+
+248
+00:18:24,110 --> 00:18:27,230
+manitol، أعتقد اتفقنا الديزنتريا هي الوحيدة اللي
+
+249
+00:18:27,230 --> 00:18:30,970
+بتعملش fermentation للمانيتول، دي do not form acetyl
+
+250
+00:18:30,970 --> 00:18:32,570
+methyl carbonyl والشيء يعنيها دي
+
+251
+00:18:38,840 --> 00:18:41,700
+they do not produce acetyl methyl carbonyl، يعني
+
+252
+00:18:41,700 --> 00:18:46,080
+فوجس بروسكاورياس negative، does not hydrolyze urea
+
+253
+00:18:46,080 --> 00:18:49,360
+or liquify جيلاتين، يعني negative برضه for urea، و
+
+254
+00:18:49,360 --> 00:18:52,820
+negative for جيلاتين liquefaction، citrate negative
+
+255
+00:18:52,820 --> 00:18:57,600
+قلت لكم بتتميز بأنه كتير negative فيها، triple الـ
+
+256
+00:18:57,600 --> 00:19:01,100
+triple sugar iron أجار تبعها alkaline slant over
+
+257
+00:19:01,100 --> 00:19:09,510
+acid butt، K على إيه مظبوط؟ K على إيه؟ الانفكت تبعها أول
+
+258
+00:19:09,510 --> 00:19:13,250
+واحد V variable اللي هو الاندول positive اللي هو
+
+259
+00:19:13,250 --> 00:19:17,110
+الـ methyl red، لكن احنا متفقين أنه فوجس بروسكاور
+
+260
+00:19:17,110 --> 00:19:20,270
+negative، وcitrate rate negative، إذا هي variable
+
+261
+00:19:20,270 --> 00:19:24,130
+positive، negative، negative، وأنا اتفق معاكم سابقا
+
+262
+00:19:24,130 --> 00:19:27,630
+أنّ الفوجس بروسكاور إذا كان positive الـ methyl red
+
+263
+00:19:27,630 --> 00:19:30,690
+بيكون negative والعكس هو الصحيح في معظم الحالات
+
+264
+00:19:32,360 --> 00:19:35,740
+البعض من الـ determinants للشيجيلا شبيه بيه اللي هو
+
+265
+00:19:35,740 --> 00:19:38,480
+السالمونيلا، أيضا في عندها الـ O antigen واحنا
+
+266
+00:19:38,480 --> 00:19:42,000
+اتفقنا برضه سالمونيلا الـ invasiveness مقدرة
+
+267
+00:19:42,000 --> 00:19:45,020
+البكتيريا، كمان الشيجيلا عندها المقدرة عليها تنتج
+
+268
+00:19:45,020 --> 00:19:48,120
+type 3 secretory system وبالتالي بتعمل invasion
+
+269
+00:19:48,120 --> 00:19:52,400
+لكن invasion تبعها فقط intestinal، بمعنى أنّها
+
+270
+00:19:52,400 --> 00:19:57,440
+بتروحش بعد الـ intestinal، يعني لو جينا نسأل سؤال من
+
+271
+00:19:57,440 --> 00:20:01,300
+المعلومة هذه، هل يمكن عزل السالمونيلا من أماكن
+
+272
+00:20:01,300 --> 00:20:08,060
+أخرى غير الأمعاء؟ أنا بقول لكم الاحتمالية شبه 0%، أنا
+
+273
+00:20:08,060 --> 00:20:13,160
+بقول شبه لأنه يعني لأ يعني لأ، مظبوط، احنا غالبا نترك
+
+274
+00:20:13,160 --> 00:20:17,640
+مجال دايما لـ exceptions، لكن لم تعزل الشيجيلا من
+
+275
+00:20:17,640 --> 00:20:20,460
+أماكن أخرى غير الـ intestinal tract، دلالة على أنه
+
+276
+00:20:20,460 --> 00:20:24,200
+حتى لو عملت invasion ووصلت لما بعد الـ intestine
+
+277
+00:20:24,200 --> 00:20:29,670
+يبدو أنه مش successful outside the intestine، أخرى
+
+278
+00:20:29,670 --> 00:20:33,550
+توكسينات لديها بروتين توكسين يمكن أن يكون نيورا
+
+279
+00:20:33,550 --> 00:20:37,450
+توكسيك، سايتوتوكسيك، وانتروتوكسيك، أعتقد أنه لما أنا
+
+280
+00:20:37,450 --> 00:20:40,790
+قلت المرة الماضية تفصيل الـ exotoxin والانتروتوکسین
+
+281
+00:20:40,790 --> 00:20:44,670
+قلنا based on mechanism of production، هنا based on
+
+282
+00:20:44,670 --> 00:20:47,810
+the site affected، في عندي انتروتوكسين، في عندي
+
+283
+00:20:47,810 --> 00:20:51,460
+سايتوتوكسين، وفي عندي نيوروتوكسين، كلكم فاكرين كيف
+
+284
+00:20:51,460 --> 00:20:54,800
+بيشتغل الانتروتوکسین؟ بيعمل inhibition لبروتين،
+
+285
+00:20:54,800 --> 00:20:58,240
+synthesis في الـ affected cell وبالتالي الخلايا
+
+286
+00:20:58,240 --> 00:21:01,120
+بتموت، لما تموت الخلايا بيصير لها sloughing،
+
+287
+00:21:01,120 --> 00:21:03,860
+فاكرين اللي بيصير لها sloughing؟ الـ absorption
+
+288
+00:21:03,860 --> 00:21:06,840
+بيقل، بيصير accumulation للـ.. اللي هو الـ
+
+289
+00:21:06,840 --> 00:21:12,520
+electrolyte، إسهال is produced، نعم صحيح
+
+290
+00:21:17,120 --> 00:21:19,200
+البشيليا ديزنترية forms a powerful
+
+291
+00:21:19,200 --> 00:21:21,980
+enterotoxin، it is associated with epidemics of
+
+292
+00:21:21,980 --> 00:21:23,980
+bacillary dysentery، طبعا الـ bacillary dysentery
+
+293
+00:21:23,980 --> 00:21:28,720
+كان اسم مخيف جدا في الماضي وخاصة في دول العالم
+
+294
+00:21:28,720 --> 00:21:36,990
+الثالث، عدد كبير من الناس كانت تصاب، كمان مرة أي مرض
+
+295
+00:21:36,990 --> 00:21:41,590
+بينتقل fecal-oral، توقع
+
+296
+00:21:41,590 --> 00:21:45,190
+أنه إذا صار فيه فشل في النظام المائي، مياه الشرب،
+
+297
+00:21:45,190 --> 00:21:49,570
+مياه الشرب صار فيها فشل، نسبة كبيرة من الناس هتصاب
+
+298
+00:21:49,570 --> 00:21:54,990
+بأمراض من الـ fecal-oral route، لماذا؟ لأن أكبر مصدر
+
+299
+00:21:54,990 --> 00:21:58,830
+ملوث لمياه الشرب هو مياه العادمة، ومياه العادمة
+
+300
+00:21:58,830 --> 00:22:02,670
+تحتوي على اللي هو، قد تحتوي على الشيجيلا، مش بس
+
+301
+00:22:02,670 --> 00:22:06,070
+الشيجيلا و other microbes، طبعا كلمة Bacillary
+
+302
+00:22:06,070 --> 00:22:09,360
+dysentery مخيفة من أي ناحية مخيفة؟ أول حاجة اللي
+
+303
+00:22:09,360 --> 00:22:13,420
+كنت عارفه أنه الـ dysentery تمام فيها يعني عدد
+
+304
+00:22:13,420 --> 00:22:19,440
+مرات الـ identification قد يتجاوز الـ 50 مرة في
+
+305
+00:22:19,440 --> 00:22:23,140
+اليوم، قد يتجاوز الـ 50 مرة في اليوم، لدرجة أن الـ
+
+306
+00:22:23,140 --> 00:22:27,220
+stool بيفقد الـ characteristics تبعته، بي بطل stool
+
+307
+00:22:27,220 --> 00:22:31,700
+بي بطل stool، فقط بيصير ينزل مخاط و خلايا و صديد
+
+308
+00:22:31,700 --> 00:22:33,880
+تمام، فبالتالي
+
+309
+00:22:35,300 --> 00:22:40,680
+كمية الإسهال تؤدي إلى dehydration، فلما يكون في
+
+310
+00:22:40,680 --> 00:22:44,600
+أطفال، غالبا الـ dehydration وفقدان الـ electrolyte
+
+311
+00:22:44,600 --> 00:22:47,460
+اللي هو بيسموه electrolyte imbalance قد يؤدي إلى
+
+312
+00:22:47,460 --> 00:22:51,080
+الوفاة، وبتكون تعرفوا كمان شغل مهم، number one
+
+313
+00:22:51,080 --> 00:22:55,330
+killer all over the world is diarrhea، مش ضروري بس
+
+314
+00:22:55,330 --> 00:22:58,750
+الديزنتريا، تمام؟ لكن diarrhea is number one
+
+315
+00:22:58,750 --> 00:22:59,890
+killer of children
+
+316
+00:23:07,510 --> 00:23:10,310
+في الإنسان، بنقول شغيلوسيس بيبدأ بـ acute
+
+317
+00:23:10,310 --> 00:23:12,890
+gastroenteritis which is accompanied by abdominal
+
+318
+00:23:12,890 --> 00:23:17,470
+pain، وده يعني فيه مغص، وفيه اللي هو إسهال، as
+
+319
+00:23:17,470 --> 00:23:20,610
+it progresses، كل ما تطور الموضوع، إسهال becomes
+
+320
+00:23:20,610 --> 00:23:24,510
+more frequent، يعني الإنسان بيشعر بحاجة للذهاب إلى
+
+321
+00:23:24,510 --> 00:23:28,890
+الدورة مرارا وتكرارا، تقصر الفترات ما بين الفترة و
+
+322
+00:23:28,890 --> 00:23:34,180
+الأخرى، عادة يتجاوز بشعور كوليكي، باين هناك كان مغص
+
+323
+00:23:34,180 --> 00:23:40,920
+هنا مغص كوليكي باين، يعني مغص شديد، بعد ذلك البراز
+
+324
+00:23:40,920 --> 00:23:47,720
+يفقد شكله، البراز أو قوامه البراز، وبيصير في غالب
+
+325
+00:23:47,720 --> 00:23:51,720
+الأمر مخاط وبس، مع دم، البراز، العنوان عادة
+
+326
+00:23:51,720 --> 00:23:58,100
+يتجاوز بشعور قيء وارتفاع حرارة، it is also known that
+
+327
+00:23:58,100 --> 00:24:01,840
+children are more frequently attacked than adult
+
+328
+00:24:01,840 --> 00:24:05,840
+person، and the symptoms are more severe، هو حاجة
+
+329
+00:24:05,840 --> 00:24:09,100
+طبعا ليش الأطفال مش الكبار، مع أنه مصدر مياه
+
+330
+00:24:09,100 --> 00:24:12,700
+الشرب واحد، شوفوا يا عزيزي احنا في الـ research، في
+
+331
+00:24:12,700 --> 00:24:15,600
+الدراسات اللي بيجريها، لما بيكون الدراسة فيها
+
+332
+00:24:15,600 --> 00:24:20,040
+factors، risk factors، بنلاقي الـ age بعض الأحيان
+
+333
+00:24:20,040 --> 00:24:24,120
+risk factor، الـ age risk factor، طبعا لما بنفسر
+
+334
+00:24:24,120 --> 00:24:27,580
+لماذا هو risk factor، هذا إنسان وهذا إنسان، هذا
+
+335
+00:24:27,580 --> 00:24:31,950
+تناول وهذا تناول، ليش هذا more immune؟ الـ age
+
+336
+00:24:31,950 --> 00:24:35,930
+بينظرو له من ناحية أنه الجهاز المناعة بتاع الإنسان
+
+337
+00:24:35,930 --> 00:24:41,150
+اتطور أحسن أو ضعف، لما حتى برضه الـ age الكبيرة
+
+338
+00:24:41,150 --> 00:24:47,850
+ثمانين وسبعين وستين مثلا، زي الطفل هذا، واحد، رقم
+
+339
+00:24:47,850 --> 00:24:52,050
+اثنين، الـ activity تبع الأطفال وتمييزهم بين الـ
+
+340
+00:24:52,050 --> 00:24:57,730
+right والـ wrong، يعني الأطفال على سبيل المثال أول
+
+341
+00:24:57,730 --> 00:25:01,370
+ما بيصيروا يمشوا، يعني يتحركوا، تمام؟ بيصيروا
+
+342
+00:25:01,370 --> 00:25:04,850
+يتعرفوا على الأشياء، ليش يتعرفوا على الأشياء؟
+
+343
+00:25:04,850 --> 00:25:08,850
+بيبتموا، الكلام اللي أقوله، الله أعلم، بيلعقوا،
+
+344
+00:25:08,850 --> 00:25:13,250
+بيلمسوا، أي شيء موجود على الأرض بيحاولوا يتذوقوه،
+
+345
+00:25:13,250 --> 00:25:15,890
+يعني يتعرفوا على الأشياء من خلال إيه؟ التذوق
+
+346
+00:25:16,400 --> 00:25:20,800
+وبالتالي الـ behavior تبع الأطفال يعني بيكون أقل
+
+347
+00:25:20,800 --> 00:25:25,080
+صحي، يعني مش صحي، وبالتالي نسبة إصابتهم بتكون أعلى
+
+348
+00:25:25,080 --> 00:25:29,080
+في الغالب، مناعتھم هم أقل، تمام؟ احنا بنسميهم
+
+349
+00:25:29,080 --> 00:25:35,780
+vulnerable، يعني أكثر عرضة من غيرهم، وبالتالي إذا
+
+350
+00:25:35,780 --> 00:25:39,800
+أصيب الأطفال، حجم الطفل كله حجم صغير، وبالتالي
+
+351
+00:25:39,800 --> 00:25:43,640
+فقدانه لجزء بسيط من السوائل اللي قد يؤدي به إلى
+
+352
+00:25:43,640 --> 00:25:44,540
+الجفاف
+
+353
+00:25:48,840 --> 00:25:54,540
+vulnerable يعني هش، نفس
+
+354
+00:25:54,540 --> 00:25:58,740
+الفكرة، فاكرين الـ M cells؟ دلوقت السالمونيلا، إيه نفس
+
+355
+00:25:58,740 --> 00:26:00,580
+الفكرة عند الشيجيلا؟ فيها أن عملية اللي هو
+
+356
+00:26:00,580 --> 00:26:05,720
+internalization، والشيجيلا تتكاثر، ولاحظوا الشيجيلا برضه
+
+357
+00:26:05,720 --> 00:26:10,760
+انتقلت من خلية إلى خلية مجاورة، كان بودي الصحيح
+
+358
+00:26:10,760 --> 00:26:14,480
+أوريكم مقطع فيديو لبكتيريا اسمها listeria
+
+359
+00:26:14,480 --> 00:26:19,590
+monocytogenes، بيسموا حركتها actin rockets، rockets
+
+360
+00:26:19,590 --> 00:26:24,370
+يعني صاروخ، بتكون جوا الخلية تتحرك، تمام؟ عشان تنتقل
+
+361
+00:26:24,370 --> 00:26:27,910
+للخلية الثانية، بتاخد مجال، بترجع لورا شوية، بتاخد
+
+362
+00:26:27,910 --> 00:26:32,670
+مجال سرعة جديدة، وبتضرب نفسها ضربة فتتشايف الجدار هذا
+
+363
+00:26:32,670 --> 00:26:36,450
+كيف صار بتخترق الجدار هذا وبتروح الجدار الثاني
+
+364
+00:26:36,450 --> 00:26:39,750
+بكل سهولة، وبالتالي بتستقر في هذا المكان الجديد
+
+365
+00:26:39,750 --> 00:26:44,480
+فبيسموه actin rockets، الـ laboratory diagnosis ده
+
+366
+00:26:44,480 --> 00:26:47,500
+الشيء اللي أنا رابطت دايما المعلومة اللي قلنا
+
+367
+00:26:47,500 --> 00:26:49,840
+السالمونيلا، لأن الشيء اللي هو البراز، والدياجرام اللي
+
+368
+00:26:49,840 --> 00:26:54,260
+عملناها المرة الماضية كان برضه للسالمونيلا، the only
+
+369
+00:26:54,260 --> 00:26:57,680
+satisfactory method of laboratory diagnosis is to
+
+370
+00:26:57,680 --> 00:27:01,440
+cultivate the best life from the patient، الآن هذه
+
+371
+00:27:01,440 --> 00:27:06,160
+نقطة جوهرية بدنا نركز عندها، المحاضرة الماضية لما
+
+372
+00:27:06,160 --> 00:27:09,180
+اتكلمنا عن الـ diagnosis، بقى الـ salmonella بنقولنا
+
+373
+00:27:09,180 --> 00:27:12,460
+فينا blood culture، فينا stool culture، فينا urine
+
+374
+00:27:12,460 --> 00:27:17,060
+culture، فينا serology، صح؟ فينا serology، هنا بنقولنا
+
+375
+00:27:17,060 --> 00:27:21,060
+the only reliable method is to cultivate the best
+
+376
+00:27:21,060 --> 00:27:24,900
+life from stool، مافيش هنا حل آخر، مافيش هنا حل ثاني
+
+377
+00:27:24,900 --> 00:27:29,250
+غير هذا الحل، طبعا الـ.. الـ.. الـ.. الـ culture هي
+
+378
+00:27:29,250 --> 00:27:32,570
+نفس الـ culture اللي حكينا عنها للسالمونيلا، لنقسم
+
+379
+00:27:32,570 --> 00:27:37,470
+نذكركم فيها مرة ثانية، قلنا stool هننزله على مين؟
+
+380
+00:27:37,470 --> 00:27:43,550
+selanite F على XLD أو SSA، وعلى الجهة الثانية قلنا
+
+381
+00:27:43,550 --> 00:27:48,410
+مين؟ اللي هو الـ SSA أو الـ XLD، والـ suspect colony
+
+382
+00:27:48,410 --> 00:27:53,630
+من أي من هدول، suspect colony هنعمل له الآن أول فحص
+
+383
+00:27:56,140 --> 00:28:01,980
+urease، إذا urease negative، كمل، إذا urease
+
+384
+00:28:01,980 --> 00:28:05,580
+positive، stop، خلصنا البكتيريا لا هي Salmonella ولا
+
+385
+00:28:05,580 --> 00:28:09,900
+هي Shigella، وبالتالي هنرجع من الصفر لأنه خلصنا
+
+386
+00:28:09,900 --> 00:28:12,040
+المزرعة بتاعتنا مافيش فيها Salmonella، مافيش فيها
+
+387
+00:28:12,040 --> 00:28:15,500
+Shigella، وخلّيني عند النقطة هذه نتكلم عن موضوع
+
+388
+00:28:15,500 --> 00:28:19,860
+يعني برضه عام في الـ diagnostic microbiology، من
+
+389
+00:28:19,860 --> 00:28:24,260
+اللي أمرني أنه لما تجي لك عينة براز، تعملها فقط
+
+390
+00:28:24,260 --> 00:28:27,970
+Salmonella و Shigella، هل السالمونيلا والشيجيلا هم فقط
+
+391
+00:28:27,970 --> 00:28:29,610
+الواحين في الدنيا اللي بيعملوا إسهال من
+
+392
+00:28:29,610 --> 00:28:33,430
+البكتيريا؟ لأ، هتلاقوا الـ Campylobacter، هتلاقوا
+
+393
+00:28:33,430 --> 00:28:36,830
+الـ Vibrio cholera، هتلاقوا أنواع من الـ E.coli
+
+394
+00:28:36,830 --> 00:28:41,330
+..عارف أنه بيعمل إسهال، خمسة، مظبوطة ولا لأ؟ و..
+
+395
+00:28:41,330 --> 00:28:44,870
+وYersinia enterocolitica، وفي بعض الـ yeast زي الـ
+
+396
+00:28:44,870 --> 00:28:46,790
+Candida albicans، وبعض البكتيريا
+
+445
+00:32:07,210 --> 00:32:14,070
+your years positive خلصنا، مش ملغيها، المظلة
+
+446
+00:32:14,070 --> 00:32:18,050
+تبعتناش معناها no salmonella, no sugar، اللي هو
+
+447
+00:32:18,050 --> 00:32:22,070
+بالتالي negative for ايه؟ for salmonella
+
+448
+00:32:22,070 --> 00:32:24,710
+and shigella. يرجع ال report تبعك مابتكون negative و
+
+449
+00:32:24,710 --> 00:32:28,810
+خلاص negative for salmonella and shigella حتى لو
+
+450
+00:32:28,810 --> 00:32:33,410
+طبيب مش .. مش .. مش متمرس في طلب الفحصات يقرأ
+
+451
+00:32:33,410 --> 00:32:36,050
+نتيجتك و يقول اه و الله هدم، اعطيني نتيجة دقيقة و
+
+452
+00:32:36,050 --> 00:32:38,910
+بقوللي انه لأ، ممكن يكون في أشياء أخرى بس هي
+
+453
+00:32:38,910 --> 00:32:45,090
+negative for salmonella and shigella. متفهم من الكلام؟
+
+454
+00:32:45,090 --> 00:32:51,910
+طيب شكل الشجلة على الأطباق الـ SSA و الـ XLD هيكون
+
+455
+00:32:51,910 --> 00:32:54,910
+مختلف عن مين؟ عن السلمونيلا، السلمونيلا احنا
+
+456
+00:32:54,910 --> 00:32:58,030
+اتفقنا انه بيكون فيها dark center. لماذا dark
+
+457
+00:32:58,030 --> 00:33:01,850
+center؟ edge to us production بينما الشجلة مافيهاش
+
+458
+00:33:01,850 --> 00:33:04,990
+edge to us production وبالتالي هتكون colorless
+
+459
+00:33:04,990 --> 00:33:08,790
+colonies على هذا الأطباق لأنها non-lactose
+
+460
+00:33:08,790 --> 00:33:11,310
+fermenting وبالتالي colorless. طيب
+
+461
+00:33:13,910 --> 00:33:17,290
+بقولنا isolation of the causative organism from
+
+462
+00:33:17,290 --> 00:33:21,150
+the feces is usually accomplished without
+
+463
+00:33:21,150 --> 00:33:24,810
+difficulties by using the same special media and
+
+464
+00:33:24,810 --> 00:33:27,790
+methods employed for salmonella.
+
+465
+00:33:36,330 --> 00:33:43,250
+اختصارا، زراعة البكتيريا من الستول خاصة خلال الأربع
+
+466
+00:33:43,250 --> 00:33:47,570
+أو الخمس أيام الأولى من المرض. وبعدين لو عملنا
+
+467
+00:33:47,570 --> 00:33:51,190
+smear من الستول، تخيل لو عملنا smear من الستول، بنلاقي
+
+468
+00:33:51,190 --> 00:33:53,790
+Gram negative بس الـ lie appearing singly. للأسف هذه
+
+469
+00:33:53,790 --> 00:33:59,870
+المعلومة احنا يمكن حاطينها ويعني متلاددين الصح في
+
+470
+00:33:59,870 --> 00:34:03,490
+قولها لأنه ممكن تكون confusing عند البعض وعند
+
+471
+00:34:03,490 --> 00:34:12,240
+البعض. الستول ممكن مفيد
+
+472
+00:34:12,240 --> 00:34:18,980
+فقط في حالة واحدة في الـ Vibrio cholera.
+
+473
+00:34:34,850 --> 00:34:37,990
+فبالتالي بتكون distinguished. فبالتالي هذه المعلومة
+
+474
+00:34:37,990 --> 00:34:43,230
+أنا أرجو أنّه disregard، ننساها خالص، تمام؟ ننساها
+
+475
+00:34:43,230 --> 00:34:47,250
+خالص. الـ Triple Sugar Iron agar تبع حجورنا K على A
+
+476
+00:34:47,250 --> 00:34:51,430
+no gas, no H2S. الـ invic reaction حكينا الـ variable
+
+477
+00:34:51,430 --> 00:34:55,390
+indole بينما positive. الميثيريد و تانين negative.
+
+478
+00:34:55,390 --> 00:34:59,430
+physiological examination. عكس السلمونيلا لكلمة مرة
+
+479
+00:34:59,430 --> 00:35:02,630
+هذه كانت فيها 2500 serotypes. هذه الـ serotypes
+
+480
+00:35:02,630 --> 00:35:06,790
+بتاعتها قليلة وبالتالي أستطيع أن أتحدى، أتعرف عليها
+
+481
+00:35:06,790 --> 00:35:17,850
+أو أحدد هويتها من خلال few antibodies. هذه
+
+482
+00:35:17,850 --> 00:35:19,690
+ممكن أتداجرها كويس، كويس.
+
+483
+00:35:29,390 --> 00:35:34,190
+طبعا أيه معناها؟ ايش هذه؟ أيه معناها acid؟ يعني
+
+484
+00:35:34,190 --> 00:35:37,770
+acidification. Acidification يعني أن أنا بصير تمام
+
+485
+00:35:37,770 --> 00:35:44,430
+في عندي اللي هو الـ sugar. لحظوا، نعملهش هنا ليه؟
+
+486
+00:35:44,430 --> 00:35:48,670
+لأن lactose fermentation هذه كثير، نقطة مهمة.
+
+487
+00:35:48,670 --> 00:35:51,790
+خليكم معايا، هذه معناها الحكي اللي هتطلع الـ ONPG.
+
+488
+00:35:51,790 --> 00:35:58,770
+تبقى عايش، هيكون الـ ONPG. ايش وظيفته الـ ONPG؟ أن
+
+489
+00:35:58,770 --> 00:36:03,720
+احنا في الـ EPR؟ الـ ONPG بيطلع +ve في حالتين فقط.
+
+490
+00:36:03,720 --> 00:36:07,780
+لما يكون، لما يكون lactose fermenting البكتيريا أو
+
+491
+00:36:07,780 --> 00:36:11,460
+delayed lactose fermentation. فده هيطلع +ve، مش
+
+492
+00:36:11,460 --> 00:36:15,020
+هيطلع negative، تمام؟ طبعا كلهم مش glucose، بالتأكيد
+
+493
+00:36:15,020 --> 00:36:18,200
+كلهم مش glucose. ده إنهم انتروباكتيرياسية بس مش كلهم
+
+494
+00:36:18,200 --> 00:36:20,800
+manitol. الـ manitol مكتوب خاطئ هناك، مش كلهم manitol.
+
+495
+00:36:20,800 --> 00:36:24,620
+الـ manitol فقط لمين؟ للتلاتة، والأولى كانت negative.
+
+496
+00:36:24,620 --> 00:36:28,340
+فالـ lactose فيها إنّه كلهم negative، مع عدا الأخيرة
+
+497
+00:36:28,340 --> 00:36:32,660
+اللي delayed lactose fermentation. هل يمكن من خلال
+
+498
+00:36:32,660 --> 00:36:35,880
+هذا الجدول البسيط أن نميز الشيجيلا species عن
+
+499
+00:36:35,880 --> 00:36:40,260
+بعضها اللي مش ممكن؟ من أول واحدة، هذه .. هذه
+
+500
+00:36:40,260 --> 00:36:48,040
+لشيجيلا dysenteriae، صح؟ صح؟ هي ميزناها، شيلناها
+
+501
+00:36:48,040 --> 00:36:52,760
+خالص، لأن نيجي لهذول، هذول الإثنين ميزناهم عن
+
+502
+00:36:52,760 --> 00:36:53,140
+مين؟
+
+503
+00:36:56,340 --> 00:37:00,880
+عن الأخيرة. لكن هل ميزنا الـ flexneri على الـ boydii؟ يبقى
+
+504
+00:37:00,880 --> 00:37:05,140
+محتاجين ايش؟ other biochemical tests. طبعا الـ ABI
+
+505
+00:37:05,140 --> 00:37:07,420
+كنت أقول لكم بيغطي مجموعة أكبر من الكربوهيدرات.
+
+506
+00:37:07,420 --> 00:37:12,940
+وبالتالي بكل سهولة بميزّه، هاي تمييز نوعا ما.
+
+507
+00:37:23,730 --> 00:37:26,070
+non-lactose-fermenting, non-motile organism,
+
+508
+00:37:26,770 --> 00:37:29,190
+manitol negative, Shigella dysenteriae. طبعا هنتكلم
+
+509
+00:37:29,190 --> 00:37:31,330
+عن فوق هناك، لازم تكون Shigella، العنوان تبعنا لازم
+
+510
+00:37:31,330 --> 00:37:34,500
+تكون Shigella. Manitol negative، Shigella sonnei، manitol
+
+511
+00:37:34,500 --> 00:37:37,540
+positive. ممكن نعمل lactose fermentation. Shigella sonnei
+
+512
+00:37:37,540 --> 00:37:40,720
+هانهاش delayed lactose fermenter، non-lactose
+
+513
+00:37:40,720 --> 00:37:43,200
+fermenter. في عندي indole test اللي هو الفحص اللي
+
+514
+00:37:43,200 --> 00:37:45,400
+مش متكوّن في الجدول، هو الـ indole test. Indole
+
+515
+00:37:45,400 --> 00:37:48,760
+positive لـ flexneri، و indole negative هي Shigella boydii.
+
+516
+00:37:48,760 --> 00:37:53,340
+اتنهات الـ diagram. لو بدأنا هنا بكلمة Shigella احنا
+
+517
+00:37:53,340 --> 00:37:57,040
+واضح الأمر، كام واحدة؟ كام قسم عندي؟ هي واحدة، هي اتنين،
+
+518
+00:37:57,140 --> 00:38:00,320
+هتلاقيها أربعة، يبقى غطيت الـ species، يبقى قلتّها
+
+519
+00:38:00,320 --> 00:38:06,560
+السابق. لو حطينا فيه عمود، إنتهى الموضوع. طيب
+
+520
+00:38:08,300 --> 00:38:11,640
+الشيجيلة غالبا تجدها إلا في الـ feces. الجملة
+
+521
+00:38:11,640 --> 00:38:15,200
+اللي حكيتها في سياق الحديث، أنّه لم نجدها إلا في الـ
+
+522
+00:38:15,200 --> 00:38:16,040
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+523
+00:38:16,040 --> 00:38:18,400
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+524
+00:38:18,400 --> 00:38:18,900
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+525
+00:38:18,900 --> 00:38:18,920
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+526
+00:38:18,920 --> 00:38:19,320
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+527
+00:38:19,320 --> 00:38:19,860
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+528
+00:38:19,860 --> 00:38:20,180
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+529
+00:38:20,180 --> 00:38:20,680
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+530
+00:38:20,680 --> 00:38:28,680
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+531
+00:38:28,680 --> 00:38:29,480
+ال .. ال ..
+
+532
+00:38:33,220 --> 00:38:37,620
+الـ microscopic examination of stain smear is of
+
+533
+00:38:37,620 --> 00:38:42,560
+no use. يعني مالهوش أي فايدة، مالهوش أي فايدة for
+
+534
+00:38:42,560 --> 00:38:46,180
+the identification of، إلا  في حقيقة أنّه
+
+535
+00:38:46,180 --> 00:38:48,860
+it is gram negative. إلا أعتقد أن هذه الجملة
+
+536
+00:38:48,860 --> 00:38:53,500
+أكدنا عليها مرارا وتكرارا، أنّه مافيش فايدة من الـ
+
+537
+00:38:53,500 --> 00:38:57,300
+Gram stain إلا المعلومة. on general and selective
+
+538
+00:38:57,300 --> 00:39:01,120
+media، they usually appear similar. يعني بيشبهوا بعض
+
+539
+00:39:01,120 --> 00:39:05,380
+فمثلا on blood agar، they are smooth، gray and
+
+540
+00:39:05,380 --> 00:39:08,120
+opaque. ياريت تحفظوا الجملة هذه، smooth، gray،
+
+541
+00:39:08,320 --> 00:39:11,880
+opaque؟ كيف نحفظها؟ أو ليش نحفظها؟ لأن كل الـ
+
+542
+00:39:11,880 --> 00:39:16,690
+Enterobacteria تقريبا بتشابه على blood agar. وصفاتهم
+
+543
+00:39:16,690 --> 00:39:21,170
+smooth، gray and opaque. طبعا في بعض منهم بيتميز
+
+544
+00:39:21,170 --> 00:39:24,690
+على الثاني زي مثلا الـ E.coli بتكون larger than
+
+545
+00:39:24,690 --> 00:39:28,510
+others. لكن في الغالب معظم الـ Enterobacteriaceae هم
+
+546
+00:39:28,510 --> 00:39:32,510
+بيقولوا smooth، gray and opaque. Most Salmonella
+
+547
+00:39:32,510 --> 00:39:36,630
+species produces H2S and therefore will be black
+
+548
+00:39:36,630 --> 00:39:40,390
+on bismuth sulfide agar. فهذا وسط اللي هو الـ BSA.
+
+549
+00:39:44,130 --> 00:39:46,710
+بقولنا إنّه لو احنا زرعنا اللي استخدمه، لو شغل على
+
+550
+00:39:46,710 --> 00:39:51,250
+الأثنين هذي، بتنتج مستعمرة، هتكون اللون
+
+551
+00:39:51,250 --> 00:39:57,230
+اللي هو الأسود. هذا الجدول أو الـ .. الـ .. الـ table
+
+552
+00:39:57,230 --> 00:40:01,650
+اللي أمامنا بيوضح فروقات أساسية بين السلمونيلا و
+
+553
+00:40:01,650 --> 00:40:05,150
+الشيجيلا. مثلا الـ disease typhoid fever الأساسي
+
+554
+00:40:05,150 --> 00:40:08,850
+تبعها، و الشيجيلا Bacillus dysenteriae. و هذا على فكرة
+
+555
+00:40:08,850 --> 00:40:13,090
+يعني تمييز ما بين سلمونيلا طيفية .. سلمونيلا طيفية
+
+556
+00:40:13,090 --> 00:40:17,410
+و ما بين الشيجيلا ديسنتيرية. يعني مش بين السلمونيلا
+
+557
+00:40:17,410 --> 00:40:21,290
+كولية و بين الشيجيلا .. بين السلمونيلا الطيفية و بين
+
+558
+00:40:21,290 --> 00:40:25,410
+الشيجيلا الديسنتيرية. Motility، motile، non-motile. لأنّه
+
+559
+00:40:25,410 --> 00:40:27,490
+لو احنا بنتكلم عن الـ motility بشكل عام في السنوات
+
+560
+00:40:27,490 --> 00:40:30,850
+اللي فيها exception، الـ H2S positive. بينما هناك
+
+561
+00:40:30,850 --> 00:40:33,930
+negative. الـ Triple Sugar Iron agar K على A بينما
+
+562
+00:40:33,930 --> 00:40:37,490
+هناك K على A فقط. الـ nature of infection systemic
+
+563
+00:40:37,490 --> 00:40:41,290
+واحنا قلنا أنّه intestinal. وبعدين blood و other
+
+564
+00:40:41,290 --> 00:40:44,690
+organs. هناك فقط gastrointestinal tract. الـ
+
+565
+00:40:44,690 --> 00:40:50,520
+immunity. كلمة lasting يعني لأ، مش متأخرة، تدوم، تدوم
+
+566
+00:40:50,520 --> 00:40:54,140
+أطول. بينما الشيجيلة، لو أنتُ صُبِتَ فيها اليوم، بعد ستة
+
+567
+00:40:54,140 --> 00:40:56,460
+شهور وأنتَ صُبِتَ فيها كمان مرة، برضه حصل عندك
+
+568
+00:40:56,460 --> 00:41:00,760
+شيغيلُنوسيس، ماناش، يعني الجسم بيكوّنلهاش مناعة طويلة.
+
+569
+00:41:00,760 --> 00:41:05,280
+الـ metabolite. أكثر حاجة في أنّ هنا بتأثر اللي هو الـ
+
+570
+00:41:05,280 --> 00:41:09,260
+endotoxin نفسه. هنا كده كلاهما، endotoxin and
+
+571
+00:41:09,260 --> 00:41:15,160
+exotoxin. إذن هاي الفرقات الرئيسية بين الاثنين. نيجي
+
+572
+00:41:15,160 --> 00:41:17,810
+للـ treatment. وأنا وعدتكم أنّه في الـ treatment هأتكلم
+
+573
+00:41:17,810 --> 00:41:21,430
+عن الـ treatment بشكل عام لأي ديارية. ركزوا معايا
+
+574
+00:41:21,430 --> 00:41:24,850
+شباب، في هذا المفهوم اللي بنحكيه الآن، ايش النقطتين
+
+575
+00:41:24,850 --> 00:41:29,250
+الأساسيتين في الديارية؟ فقدان water، water اللي هو
+
+576
+00:41:29,250 --> 00:41:34,410
+fluid. بيؤدي لجفاف؟ عدم امتصاص الـ electrolytes
+
+577
+00:41:34,410 --> 00:41:36,690
+بيؤدي لفقدان الـ electrolytes وبالتالي بيؤدي لما
+
+578
+00:41:36,690 --> 00:41:41,110
+يسمى electrolyte imbalance. وكلاهما سواء كان فقدان
+
+579
+00:41:41,110 --> 00:41:46,650
+الماء أو الـ electrolyte imbalance كلاهما life
+
+580
+00:41:46,650 --> 00:41:51,710
+threatening، مهدد لحياة الإنسان. الآن الديارية can be
+
+581
+00:41:51,710 --> 00:41:57,070
+caused by several pathogens، viral، protozoa،
+
+582
+00:41:57,590 --> 00:42:00,450
+بكتيريا. ولما بنقول بكتيريا، بنتكلم عن أنواع
+
+583
+00:42:00,450 --> 00:42:04,730
+مختلفة أيضا من البكتيريا، ففي جملة ثالثة بنقولها
+
+584
+00:42:04,730 --> 00:42:09,830
+المسببات مختلفة، مسببات مختلفة. إذًا ماء،
+
+585
+00:42:09,830 --> 00:42:14,510
+electrolytes، واِيش كمان؟ أنواع بكتيريا مختلفة. الحل
+
+586
+00:42:14,510 --> 00:42:19,370
+الأول أني أُعيد الماء زي ما كانت. المريض بيخسر ماء،
+
+587
+00:42:19,370 --> 00:42:24,470
+أنا أعوّضه الماء. المريض بيخسر electrolytes، أعوّضه electrolytes.
+
+588
+00:42:24,470 --> 00:42:30,090
+بدأة المشكلة الثالثة to eradicate the pathogen. كلمة
+
+589
+00:42:30,090 --> 00:42:33,330
+to eradicate يعني تتخلص. الآن في عندي مشكلة في كلمة
+
+590
+00:42:33,330 --> 00:42:37,210
+to eradicate. بعض الميكروبات وأنا بتخلص منها، بتموت،
+
+591
+00:42:37,210 --> 00:42:38,890
+endotoxin.
+
+592
+00:42:40,440 --> 00:42:45,160
+هل الـ endotoxin هيزيد
+
+593
+00:42:45,160 --> 00:42:48,240
+المشكلة، هيقلل المشكلة؟ بيتوقف على نوع الـ micro
+
+594
+00:42:48,240 --> 00:42:51,880
+organism. فمثلا معظم أنواع السلمونيلا اللي بتاعة من
+
+595
+00:42:51,880 --> 00:42:55,300
+الـ gastroenteritis فقط، مش enteric fever، تمام؟ لا
+
+596
+00:42:55,300 --> 00:43:01,100
+ينصح، لا يُنصح بالـ antimicrobial treatment فقط
+
+597
+00:43:01,100 --> 00:43:06,460
+electrolyte and fluid replacement. والجسم تلقائيا
+
+598
+00:43:06,460 --> 00:43:10,100
+هيتخلص من الـ microorganism. لكن في حالة الـ typhoid
+
+599
+00:43:11,420 --> 00:43:15,500
+التيفويد، life-threatening infection، فممكن نستخدم
+
+600
+00:43:15,500 --> 00:43:18,500
+الامبيسيلين أو الـ sulfamethoxazole-trimethoprim
+
+601
+00:43:18,500 --> 00:43:22,420
+أو نستخدم السيبرفلوكساسين to eradicate the organism.
+
+602
+00:43:22,420 --> 00:43:27,440
+لذلك هناك بعض الميكروبات مطلوب نعمل لها eradication.
+
+603
+00:43:27,440 --> 00:43:30,680
+والميكروبات الأخرى، أو بعض الميكروبات مش مطلوب
+
+604
+00:43:30,680 --> 00:43:35,560
+الشيجيلة. مطلوب أن نتخلص من الميكروبات، لكن بدنا نفهم
+
+605
+00:43:35,560 --> 00:43:41,380
+أن أي ديارية في الدنيا do not stop. ديارية، توقفش
+
+606
+00:43:41,380 --> 00:43:43,240
+دياريا. لأن الديارية هي reaction طبيعي من الجسم
+
+607
+00:43:43,240 --> 00:43:47,580
+للتخلص من الـ toxins. أنتَ كمان، طبعا ماتبقى بنوقف
+
+608
+00:43:47,580 --> 00:43:50,080
+الدياريا، إذا شعرنا أن الدياريا صارت life
+
+609
+00:43:50,080 --> 00:43:54,920
+threatening، مهددة أكثر من إنها فائدة. لكن water
+
+610
+00:43:54,920 --> 00:43:57,900
+replacement، electrolyte replacement، eradicate، ده
+
+611
+00:43:57,900 --> 00:44:02,940
+اللي هو causative agent. Antibiotic therapy is
+
+612
+00:44:02,940 --> 00:44:05,960
+required في الشيجيلة زي ما حكى هنا، to eliminate ده
+
+613
+00:44:05,960 --> 00:44:11,210
+organism. يعني الجملة المشهورة اللي حاولتكم في
+
+614
+00:44:11,210 --> 00:44:14,970
+البداية، أن أي ميكروب بينزل، تمام؟ لازم نتعرف على الـ
+
+615
+00:44:14,970 --> 00:44:19,070
+antimicrobial susceptibility testing له، وبالتالي
+
+616
+00:44:19,070 --> 00:44:22,150
+ليه؟ لأنّه فيه resistance عالي في الدنيا، وبالتالي
+
+617
+00:44:22,150 --> 00:44:25,590
+بنخاف أنّه نشوف أنواع جديدة أو صورة جديدة من اللي
+
+618
+00:44:2
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/rU3r1mJ2OXY_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/rU3r1mJ2OXY_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..d8817ff30f54dc317d9ac542a8b0b8ac05bc367b
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/rU3r1mJ2OXY_raw.srt
@@ -0,0 +1,2552 @@
+1
+00:00:20,750 --> 00:00:23,850
+بسم الله الرحمن الرحيم اليوم الموضوع هيكون
+
+2
+00:00:23,850 --> 00:00:27,390
+Shigella ان شاء الله ال Shigella هي العضو الثاني
+
+3
+00:00:27,390 --> 00:00:31,430
+المهم جدا من ال non-lactose fermenting
+
+4
+00:00:31,430 --> 00:00:37,170
+enterobacteriasi بعد السلمونيلا ال genus Shigella
+
+5
+00:00:37,170 --> 00:00:39,510
+بيختلف شوية عن السلمونيلا في بعض الأمور بدنا
+
+6
+00:00:39,510 --> 00:00:44,670
+نوضحها من البداية there are fewer species يعني عدد
+
+7
+00:00:44,670 --> 00:00:50,970
+الأفراد في ال genus Shigella أقل من السلمونيلاكمان
+
+8
+00:00:50,970 --> 00:00:55,330
+نوعية الأمراض اللى بتحدثها الشجلة هي نوعية واحدة و
+
+9
+00:00:55,330 --> 00:00:59,450
+هي gastroenteritis type يعني ديارية بينما شفتوا
+
+10
+00:00:59,450 --> 00:01:03,290
+السلمونيلا كانت بتعمل septicemia و بتعمل enteric
+
+11
+00:01:03,290 --> 00:01:06,610
+fever و بتعمل food infection type يعني كان فيه
+
+12
+00:01:06,610 --> 00:01:11,530
+تنوع في الأمراض بينما في الشجلة فقط فقط ايش؟
+
+13
+00:01:12,870 --> 00:01:16,250
+Gastroenteritis أو دياريال تايت Shigella
+
+14
+00:01:16,250 --> 00:01:19,850
+Dysenteria was isolated by Shiga in Japan in 1898
+
+15
+00:01:19,850 --> 00:01:22,990
+يعني برضه من الميكروبات القديمة و اللي تم تعرف
+
+16
+00:01:22,990 --> 00:01:29,170
+عليها منذ اكتر من مائة عام الشيجيلا ارتبط اسمها
+
+17
+00:01:29,170 --> 00:01:33,170
+بالسلمونيلا يمكن ارتباط وثيق نظرا لان الشيجيلا
+
+18
+00:01:33,170 --> 00:01:37,290
+بيشتركوا في بعض الصفاتلكن هنشوف في سياق المحاضرة
+
+19
+00:01:37,290 --> 00:01:41,690
+هذه ان الشجلة تختلف اختلاف كبير عن السلمونيلا،
+
+20
+00:01:41,690 --> 00:01:46,330
+قولنا أول اختلاف في من؟ في عدد الأفراد، عدد بسيط
+
+21
+00:01:46,330 --> 00:01:57,650
+حوالي أربعة فقط، نوع الأمراض فقط نوع واحد الأسماء
+
+22
+00:01:57,650 --> 00:02:00,310
+المشهورة قولنا في هذا ال genus هم شجلة ديزنتيريا
+
+23
+00:02:00,310 --> 00:02:05,900
+وشجلة فليكسنيري وشجلة سنعي وشجلة بويديكمان مرة
+
+24
+00:02:05,900 --> 00:02:09,520
+Shigella Poidi, Shigella Sunni, Shigella Flexneri
+
+25
+00:02:09,520 --> 00:02:12,500
+وShigella Dysenteria اعتقد ان ال type species
+
+26
+00:02:12,500 --> 00:02:16,520
+تبعها ال genus هي الأولى اللى هى اعطت اللقب اللى
+
+27
+00:02:16,520 --> 00:02:19,920
+هو ال dysentery لل disease اللى كنا بيتميز بماذا
+
+28
+00:02:22,150 --> 00:02:26,050
+تعني أنهم مع بعض غير ديارية في أننا جونا أربع
+
+29
+00:02:26,050 --> 00:02:29,150
+characteristics مصاحبة قبل ال blood جونا ال
+
+30
+00:02:29,150 --> 00:02:32,510
+epithelial cells و ال mucus و بعدين ال blood زي
+
+31
+00:02:32,510 --> 00:02:36,890
+هذا اللي هو ال pus هذه الصفات الأربع قد نجدها في
+
+32
+00:02:36,890 --> 00:02:41,530
+أمراض أخرى غير الشجلة ديزنترية تمام؟ بمعنى ال
+
+33
+00:02:41,530 --> 00:02:43,570
+amoebic dysentery اللي جونا عنها الإنت ميبا
+
+34
+00:02:43,570 --> 00:02:47,490
+هستولتكا حلاجة برضه نفس المواصفات للستول لكن برضه
+
+35
+00:02:47,490 --> 00:02:50,190
+في differentiation ممكن نميزهم عن بعضهم
+
+36
+00:02:53,440 --> 00:02:58,580
+أفضل حاجة في ال .. ال .. البكتيريا ان نلاقي صفة
+
+37
+00:02:58,580 --> 00:03:04,260
+تقسم للبكتيريا على جهة عن الأخريات .. عن الأخريات
+
+38
+00:03:04,260 --> 00:03:07,960
+مثلا ان هنا استخدمنا ال manitol fermentation
+
+39
+00:03:07,960 --> 00:03:12,800
+character ك initial differentiation between اللي
+
+40
+00:03:12,800 --> 00:03:16,580
+هم الشجلة ديزنتيريا which was non-manitol
+
+41
+00:03:16,580 --> 00:03:19,800
+fermenter يعني ماتعملش تخمير للمانيتل والباقي
+
+42
+00:03:19,800 --> 00:03:23,000
+بيعملوا manitol fermentation إذا لو عزلنا الشجلة
+
+43
+00:03:23,320 --> 00:03:26,880
+وبننميز هل هي dysentery ولا others أول فحص بنعمله
+
+44
+00:03:26,880 --> 00:03:29,720
+هو manitol fermentation طبعا الأولى negative
+
+45
+00:03:29,720 --> 00:03:33,620
+والباقين بيكونوا positive ال morphology and
+
+46
+00:03:33,620 --> 00:03:36,240
+staining احنا اتفقنا انه هي gram negative بس الله
+
+47
+00:03:36,240 --> 00:03:38,980
+لإنها enterobacteriasi none encapsulated مالعش
+
+48
+00:03:38,980 --> 00:03:43,320
+capsule none motile none يعني من معظم صفاتها هي
+
+49
+00:03:43,320 --> 00:03:46,740
+none اه انه none برضه spore forming it is a gram
+
+50
+00:03:46,740 --> 00:03:53,740
+negative بس الله يعنيبعكس السلمونيلا قلنا ال habit
+
+51
+00:03:53,740 --> 00:03:58,360
+تبعت الشجلة man is the only known host for this
+
+52
+00:03:58,360 --> 00:04:02,160
+organism يعني الإنسان هو المخلوق الوحيد اللي بيعمل
+
+53
+00:04:02,160 --> 00:04:05,700
+harboring لهذا ال micro وبالتالي لو علجنا من ناحية
+
+54
+00:04:05,700 --> 00:04:09,620
+نضرية علجنا البشر المصابين و الحاملين لهذا ال
+
+55
+00:04:09,620 --> 00:04:13,440
+micro هنتخلص من مين من الشجلوسis forever لكن هذه
+
+56
+00:04:13,440 --> 00:04:18,620
+العملية برضه ليست بالسهلة لأن هناك وناسيحملون هذا
+
+57
+00:04:18,620 --> 00:04:23,220
+الميكروب دون اظهور اي اعراض عليه، اذا متفقين على
+
+58
+00:04:23,220 --> 00:04:28,060
+انه ان الانسان فقط اللي هو هذا كمان فرق بينها وبين
+
+59
+00:04:28,060 --> 00:04:30,840
+ال salmonella، ال salmonella جولنا wide range of
+
+60
+00:04:30,840 --> 00:04:35,190
+hostsوإن careers of pathogenic strains can
+
+61
+00:04:35,190 --> 00:04:38,390
+execrate the organism up to two weeks after
+
+62
+00:04:38,390 --> 00:04:42,210
+infection and occasionally for longer periods يعني
+
+63
+00:04:42,210 --> 00:04:47,410
+فترة إفراز الميكروب في البيئة بتكون طويلة جدا، by
+
+64
+00:04:47,410 --> 00:04:50,830
+this time الميكروب can survive in the environment
+
+65
+00:04:50,830 --> 00:04:54,050
+if it reaches water، water اللي هو نقصد فيه
+
+66
+00:04:54,050 --> 00:04:59,080
+drinking water في غالب الأمرmany people are using
+
+67
+00:04:59,080 --> 00:05:02,540
+the same source وبتالي بيصير فينا epidemic او
+
+68
+00:05:02,540 --> 00:05:06,620
+outbreak of shiguelosis في فلسطين وفي قطاع غزة في
+
+69
+00:05:06,620 --> 00:05:09,960
+shiguelosis لكن احنا بنطلق عليه كepidemiology
+
+70
+00:05:09,960 --> 00:05:14,440
+sporadic cases يعني حالات متفرقة او حالات متقطة مش
+
+71
+00:05:14,440 --> 00:05:20,640
+بشكل epidemicأكبر نسبة إصابة بشجللوس تحدث في
+
+72
+00:05:20,640 --> 00:05:23,300
+المناطق اللي فيها poor sanitary conditions ايش ان
+
+73
+00:05:23,300 --> 00:05:25,920
+ال poor sanitary conditions؟ يعني الظروف الصحية و
+
+74
+00:05:25,920 --> 00:05:29,700
+الظروف النظافة فيها منخفضة و انا يمكن المحاضرة
+
+75
+00:05:29,700 --> 00:05:34,640
+السابقة لما اتحدثت عن السلمونيلا اتحدثت بشكل مفصل
+
+76
+00:05:34,640 --> 00:05:39,140
+عن ان ال sewage system اذا تعطل بالأي سبب من
+
+77
+00:05:39,140 --> 00:05:43,030
+الأسباب سواء كان مش موجود أساساأو تعطل بسبب المطر
+
+78
+00:05:43,030 --> 00:05:46,870
+الغزير العواصف الحروب whatever reason غالبا حتى
+
+79
+00:05:46,870 --> 00:05:52,630
+تتفشى مثل هذه الأمراض اللي من ضمنها الشجلة الشجلة
+
+80
+00:05:52,630 --> 00:05:55,730
+بتنمو على الأوساط الزراعية اللي ذكرناها لل
+
+81
+00:05:55,730 --> 00:05:58,790
+enterobacteriasia بتنمو على ال blood agarوبتنمو
+
+82
+00:05:58,790 --> 00:06:03,650
+على المكونكي لكن يعني يمكن أن الأوان انه يتكلم عن
+
+83
+00:06:03,650 --> 00:06:06,230
+ما الذي نعنيه بال selective medium احنا بنقول
+
+84
+00:06:06,230 --> 00:06:10,790
+سلمونيلا الشجلة أجار البعض قد يتصور انه لن ينمو
+
+85
+00:06:10,790 --> 00:06:14,850
+على السلمونيلا الشجلة أجار الا سلمونيلا والشجلة
+
+86
+00:06:14,850 --> 00:06:19,650
+بنوضح المفهوم هذا بمجموعة من العبارات ارجو ان
+
+87
+00:06:19,650 --> 00:06:23,070
+اتذكرها جيدا رقم واحد never ever trust the
+
+88
+00:06:23,070 --> 00:06:28,520
+selectivity of a selective mediumلا تثق بأي حال من
+
+89
+00:06:28,520 --> 00:06:32,880
+الأحوال بال selectivity تبع ال selective media
+
+90
+00:06:32,880 --> 00:06:36,480
+ماذا .. ماذا .. ماذا يعني بذلك؟ لما أنا بقول
+
+91
+00:06:36,480 --> 00:06:40,540
+مكونكي is selective for ground negative يبقى كل ما
+
+92
+00:06:40,540 --> 00:06:47,390
+سينمو على المكونكي هو، وهذا الكلام ليس صحيحايبجى
+
+93
+00:06:47,390 --> 00:06:52,670
+لو انا افترضت ال absolute selectivity يبقى انا
+
+94
+00:06:52,670 --> 00:06:56,290
+بحكي انه كل ما ينمو على المكنكي هو gram negative
+
+95
+00:06:56,290 --> 00:07:00,390
+الان لو افترضت انه ال absolute selectivity لل SSA
+
+96
+00:07:00,390 --> 00:07:02,870
+يبقى كل ما ينمو على السلمونيلا شيجيلا اجار هو
+
+97
+00:07:02,870 --> 00:07:06,370
+سلمونيلا او شيجيلا وهذا ايضا كمان غير صحيح اذا
+
+98
+00:07:06,370 --> 00:07:11,170
+لماذا سميت selective؟ ولماذا خصصناها بهذا المسمى؟
+
+99
+00:07:11,170 --> 00:07:16,810
+هناك نقطة خلنا ان انا نوضحهاBlood Agar, Makunke
+
+100
+00:07:16,810 --> 00:07:21,910
+Agar, Salmonella Shigella Agar، تلت أوساط مختلفة،
+
+101
+00:07:21,910 --> 00:07:25,850
+عندي عين واحدة تحتوي على Salmonella وShigella
+
+102
+00:07:25,850 --> 00:07:30,990
+وتحتوي على آلاف الأنواع الأخرى من الميكروبات، خلطة
+
+103
+00:07:30,990 --> 00:07:34,330
+زرعتها على ال Makunke، عفوا، على ال Blood Agar،
+
+104
+00:07:34,330 --> 00:07:38,170
+زرعتها على ال Makunke وزرعتها على ال SSA، على
+
+105
+00:07:38,170 --> 00:07:44,780
+التلاتةالان تعالوا نحاول نقيس فرص السيمونيلا
+
+106
+00:07:44,780 --> 00:07:48,160
+والشيجيلة على التلات أطباق التلاتة، بنقول فرص
+
+107
+00:07:48,160 --> 00:07:50,320
+السيمونيلا والشيجيلة على البلد أجار،شي بهمون
+
+108
+00:07:50,320 --> 00:07:53,860
+عادمة، انها تنمو في وجود من؟ الميكروبات الأخرى،
+
+109
+00:07:53,860 --> 00:07:58,470
+اللي هيغطوا عليهافرصة نموها في المكونكي أفضل من
+
+110
+00:07:58,470 --> 00:08:02,770
+فرصة نموها على البدأجار، فرصة نموها على السلمون
+
+111
+00:08:02,770 --> 00:08:06,930
+اللاشيجي للأجار أفضل من المكونكي، يبقى ال
+
+112
+00:08:06,930 --> 00:08:11,250
+selectivity لاتعني absolute selectivity وانما ال
+
+113
+00:08:11,250 --> 00:08:14,970
+chances أو ال probabilities of growth is higher on
+
+114
+00:08:14,970 --> 00:08:20,130
+that media than other mediaإذا افترضت ودخلت هذه
+
+115
+00:08:20,130 --> 00:08:23,750
+المفهوم في دماغك من الآن هنرتاح معاك في المستقبل
+
+116
+00:08:23,750 --> 00:08:26,750
+عشان لما تيجي تتعرف علي البكتيريا بتاعة مثال بسيط
+
+117
+00:08:26,750 --> 00:08:30,910
+صارخ من الأوساط المشهورة اسمها TCBS ودا الوسط
+
+118
+00:08:30,910 --> 00:08:34,710
+بننامي عليه ال Vibrio cholera selective media لل
+
+119
+00:08:34,710 --> 00:08:40,050
+Vibrio cholera والشكل المستعمر ال typical بنقولوا
+
+120
+00:08:40,050 --> 00:08:44,840
+على ال typical colonies اللي هيYellow colonies
+
+121
+00:08:44,840 --> 00:08:47,980
+surrounded by yellow zone as a result of sacrose
+
+122
+00:08:47,980 --> 00:08:53,860
+fermentation بيحتوي على ساكروز ال TCBS لو كل
+
+123
+00:08:53,860 --> 00:09:00,060
+مستعمرة صفرة بيادة المفهوم نمت على ال TCBS يعني
+
+124
+00:09:00,060 --> 00:09:02,860
+معناه اللي حاكيناه هي إيه؟ Vibricular و هذا الأمر
+
+125
+00:09:02,860 --> 00:09:08,440
+للأسف مش صحيح مش صحيحوبالتالي .. وبالتالي إذا أنا
+
+126
+00:09:08,440 --> 00:09:12,360
+من الأساس عندي الإعتقاد وعندي المعرفة بإنه هذا مش
+
+127
+00:09:12,360 --> 00:09:16,260
+absolutely selective والصفة هذه قد تشترك مع
+
+128
+00:09:16,260 --> 00:09:18,760
+microbot أخرى أنا عارفها أو لا يعرفها فبالتالي
+
+129
+00:09:18,760 --> 00:09:22,940
+بيكون من السهل عليا إني ماخطئش وأعرف بكتيريا أخرى
+
+130
+00:09:22,940 --> 00:09:26,360
+عليها vibrio كلها هذا المفهوم لازم نكون عارفينه
+
+131
+00:09:26,360 --> 00:09:31,980
+كويس طيبنرجع لـ characteristics تبع الشجلة all
+
+132
+00:09:31,980 --> 00:09:34,060
+member of shigella are aerobic and facultative
+
+133
+00:09:34,060 --> 00:09:37,340
+anaerobic يعني مافيش فيها obligate anaerobic ماهي
+
+134
+00:09:37,340 --> 00:09:39,740
+كل ال enterobacterias يقولون أنها facultative
+
+135
+00:09:39,740 --> 00:09:43,360
+anaerobic grow readily in cultural media ده pH 6.4
+
+136
+00:09:43,360 --> 00:09:46,720
+to 7.8 هذا ال range تبع ال pH اللي انتوا شايفينه
+
+137
+00:09:46,720 --> 00:09:50,340
+جدامكوا هو عبارة عن تقريبا ال neutral pH يعني
+
+138
+00:09:50,340 --> 00:09:54,460
+slightly acidic و slightly اللي هو alkaline لكن ال
+
+139
+00:09:54,460 --> 00:09:59,260
+average تبعتهم بتكون في النصit can grow at 10
+
+140
+00:09:59,260 --> 00:10:02,540
+degree centigrade up to 40 degree centigrade with
+
+141
+00:10:02,540 --> 00:10:05,380
+an optimum temperature of 37 هذا مثال صارخ على
+
+142
+00:10:05,380 --> 00:10:10,080
+شوفوا ال range من عشرة لاربعين لكن ال optimum جريب
+
+143
+00:10:10,080 --> 00:10:14,700
+من مين؟ من الماكسيمون، جريب من الماكسيمون، يعني مش
+
+144
+00:10:14,700 --> 00:10:16,900
+بالضرورة ال optimum يكون في الوسط، في الوسط، لأ
+
+145
+00:10:16,900 --> 00:10:22,270
+ممكن يكون قريب من أحد ال extremesthe colonies
+
+146
+00:10:22,270 --> 00:10:26,770
+المستعمرات are circular convex colorless but
+
+147
+00:10:26,770 --> 00:10:30,830
+moderately translucent شفافة نوعا ما with smooth
+
+148
+00:10:30,830 --> 00:10:34,550
+surface smooth surface يعني الحواف تبعتها
+
+149
+00:10:34,550 --> 00:10:41,390
+والاقبصاتها أملس احنا بنمسكه احنا بنشوفه بنرع فقط
+
+150
+00:10:41,390 --> 00:10:47,170
+and entire edges entire edges معناها بتعرف
+
+151
+00:10:47,170 --> 00:10:52,600
+المستعمرة هي طبقالمستعمرات ممكن تكون بهذا الشكل
+
+152
+00:10:59,950 --> 00:11:04,230
+هذه loopulated يعني مفصصة هذه دائرية كامة
+
+153
+00:11:04,230 --> 00:11:09,190
+الاستدارة بنسميها entire يعني كامل الاستدارة مافيش
+
+154
+00:11:09,190 --> 00:11:13,170
+فيه اي انحنات على الرغم من ان بعض الأحيان بنلاقي
+
+155
+00:11:13,170 --> 00:11:17,690
+عندنا حد اسمها hair-like projections يعني زوائد
+
+156
+00:11:17,690 --> 00:11:21,530
+تشبه الشعيرات طالعة من مين من الشجلة كورنس هذا
+
+157
+00:11:21,530 --> 00:11:25,950
+الكلام ممكن نشوفه يعني ممكنبهذا الشكل entire edge
+
+158
+00:11:25,950 --> 00:11:35,290
+أو بهذا الشكل بيكون فيها زواق شعري محددة
+
+159
+00:11:38,610 --> 00:11:41,330
+small tangled hair like projections can sometimes
+
+160
+00:11:41,330 --> 00:11:45,330
+be seen at one or more points on the periphery
+
+161
+00:12:07,070 --> 00:12:12,190
+ولا نسيت الموضوع نوين انا فيني ان شاء الله طيب
+
+162
+00:12:12,190 --> 00:12:17,530
+تمام اذا المطلوب من ان انا اعرف شغلتين اقول انها
+
+163
+00:12:17,530 --> 00:12:21,510
+typical colony
+
+164
+00:12:21,510 --> 00:12:24,590
+عشان
+
+165
+00:12:24,590 --> 00:12:27,290
+لما نشوف مستعمر نقول عنها suspected
+
+166
+00:12:33,920 --> 00:12:35,200
+إيش يعني ال typical colonies و ال suspected
+
+167
+00:12:35,200 --> 00:12:39,400
+colonies؟ الوصف اللي أنا بوصفلكيه أو الشركة
+
+168
+00:12:39,400 --> 00:12:43,780
+المصنعة للميديا بتوصفلكيها هذا بنسميه typical
+
+169
+00:12:43,780 --> 00:12:48,180
+colonies لما تشوف أنت ال typical colonies على طبق
+
+170
+00:12:48,180 --> 00:12:52,040
+حقيقي أنت زارعه بتسميها suspect colonies إذا ال
+
+171
+00:12:52,040 --> 00:12:55,220
+suspect هي اللي بنشوفها و ال typical هي اللي إيه؟
+
+172
+00:12:55,220 --> 00:12:58,980
+هي الوصف الدقيق لهذه المستعمر
+
+173
+00:13:03,180 --> 00:13:06,660
+بقولنا إذا كان اللي جاينا typical colonies،
+
+174
+00:13:06,660 --> 00:13:11,950
+suspected colonies يعني، تمام؟على ال selective
+
+175
+00:13:11,950 --> 00:13:15,250
+media سواء كان المكونكي او على كان ال hectoenteric
+
+176
+00:13:15,250 --> 00:13:19,430
+او ال XLD او ال SSA اي من الاوساط بقولنا a
+
+177
+00:13:19,430 --> 00:13:21,950
+tentative diagnosis يمكن اول مرة يطلع معانا
+
+178
+00:13:21,950 --> 00:13:24,870
+المصطلح tentative tentative معاناها مؤقت يعني
+
+179
+00:13:24,870 --> 00:13:29,110
+tentative مؤقت diagnosis can be made by direct
+
+180
+00:13:29,110 --> 00:13:31,810
+slide agglutination test ايش هي slide
+
+181
+00:13:31,810 --> 00:13:35,550
+agglutination test هاي المستعمرة المشتبه فيها
+
+182
+00:13:35,550 --> 00:13:38,370
+بنجيب شريحة one drop of saline
+
+183
+00:13:42,320 --> 00:13:46,440
+بناخد يزرع من المستعمرة وبنعمله mix وال mixing هنا
+
+184
+00:13:46,440 --> 00:13:50,520
+عشان نعمل عملية suspension يا شباب انه ندوب
+
+185
+00:13:50,520 --> 00:13:54,920
+المستعمرة تماما في قطرة ال saline وبعد ذلك يضاف
+
+186
+00:13:54,920 --> 00:14:02,220
+إليها polyvalent antiserum
+
+187
+00:14:02,220 --> 00:14:05,680
+لمن
+
+188
+00:14:05,680 --> 00:14:11,880
+ال antipolyvalent شجلة مش لسه من اللهحطينا one
+
+189
+00:14:11,880 --> 00:14:16,860
+drop هنا و عملنا لهم mixing إذا صار agglutination
+
+190
+00:14:16,860 --> 00:14:20,040
+يرجى معنا الحكي أن البكتيريا هي شجلة لكن أي نوع من
+
+191
+00:14:20,040 --> 00:14:23,260
+الشجلة we really don't know لكن هذه أعطتنا
+
+192
+00:14:23,260 --> 00:14:27,040
+tentative diagnosis أن هذه .. متى بنلجأ لكلام هذا؟
+
+193
+00:14:27,040 --> 00:14:31,840
+لحظة من مستعمرة من مستعمرة مباشرة ل diagnosis
+
+194
+00:14:31,840 --> 00:14:34,800
+ماعملناش biochemical test عملنا biochemical test؟
+
+195
+00:14:34,800 --> 00:14:40,290
+لأقفزنا عن الخطوات .. الخطوات المعروفة قفزنا على
+
+196
+00:14:40,290 --> 00:14:43,450
+ال biochemical test متى بنلجأ هذا الكلام؟ لما يكون
+
+197
+00:14:43,450 --> 00:14:47,630
+مثلا في عندي epidemic كلما قصرنا فترة ال diagnosis
+
+198
+00:14:47,630 --> 00:14:51,350
+كلما حصرنا ال epidemic بشكل أفضل، تمام؟ في بعض
+
+199
+00:14:51,350 --> 00:14:53,930
+الأحيان في ال microbiology هم الخطوات تبعتنا
+
+200
+00:14:53,930 --> 00:14:58,970
+مشهورين أذكركوا فيهم عشان نكون متفقين ان شاء الله
+
+201
+00:15:05,310 --> 00:15:07,990
+أنا فاندي في أي diagnosis في البكتيريا فاندي تلت
+
+202
+00:15:07,990 --> 00:15:10,710
+مراحل أربع مراحل حد يسميها cultural
+
+203
+00:15:10,710 --> 00:15:20,650
+characteristics و morphology and
+
+204
+00:15:20,650 --> 00:15:29,290
+staining biochemical characteristics
+
+205
+00:15:29,290 --> 00:15:32,230
+أربع serological
+
+206
+00:15:37,030 --> 00:15:42,370
+طبعا الخامسة غالبا احنا بنسميها others سمينها
+
+207
+00:15:42,370 --> 00:15:44,870
+others لإنه بحسب نوع الميكروبات في بعض الميكروبات
+
+208
+00:15:44,870 --> 00:15:48,990
+بنطبقش عليها جزء من هذا العملية أو بحاجة إلى
+
+209
+00:15:48,990 --> 00:15:53,630
+إجراءات إضافية أخرى زي مثلا في بكتيريا اسمها
+
+210
+00:15:53,630 --> 00:15:57,010
+كورينو بكتيريوم دفتيريا او كورينو بكتيريوم دفتيريا
+
+211
+00:15:57,010 --> 00:16:01,970
+بنحتاج ان نعملها toxicity assayمابنجيش نحطها في
+
+212
+00:16:01,970 --> 00:16:04,770
+ولا واحد من هدولة، طب نعطيها تحت أنوان ايه؟
+
+213
+00:16:04,770 --> 00:16:07,690
+Others، في حاجة مافيهاش typing للاستفادة من
+
+214
+00:16:07,690 --> 00:16:10,850
+Cocasaurias، مابتنتميش في ولا واحد من هدولة، طب
+
+215
+00:16:10,850 --> 00:16:14,330
+نحطها تحت من؟ Others، إذا الأساسيات من هم
+
+216
+00:16:14,330 --> 00:16:18,150
+cultural، ناخد مثالاحنا قاعدين عاملا بنشرح بنقول
+
+217
+00:16:18,150 --> 00:16:24,090
+انه وصف للشجلة انها circular او convex و entire
+
+218
+00:16:24,090 --> 00:16:28,470
+edge slightly translucent with hair-like
+
+219
+00:16:28,470 --> 00:16:34,820
+projections وصف هذا لمين؟ للشجلة، هذا عيش كلتهونمت
+
+220
+00:16:34,820 --> 00:16:36,940
+على مين وما نمتش على مين برضه هذا cultural
+
+221
+00:16:36,940 --> 00:16:39,500
+characteristics، نمت على temperature وما نمتش على
+
+222
+00:16:39,500 --> 00:16:41,780
+temperature برضه هذا cultural characteristics،
+
+223
+00:16:41,780 --> 00:16:43,900
+يعني ال environmental و ال cultural
+
+224
+00:16:43,900 --> 00:16:47,880
+characteristics كلها بتكون تحت ضمن هذا الجزء،
+
+225
+00:16:47,880 --> 00:16:51,380
+الجزء التاني احنا وصفناها اول ما وصفناها جونا gram
+
+226
+00:16:51,380 --> 00:16:54,650
+negative بس ال lie، gram negative بس ال lieرقم
+
+227
+00:16:54,650 --> 00:16:57,050
+تلاتة ال biochemical characteristics قلنا لكوا
+
+228
+00:16:57,050 --> 00:17:00,750
+عنها يورياز نيجاتيف، none motile، none capsulated،
+
+229
+00:17:00,750 --> 00:17:03,090
+none spore forming، كل هذه الصفات، عفوا، none
+
+230
+00:17:03,090 --> 00:17:07,010
+spore forming مالاش علاقة بالـ none .. قلنا ..
+
+231
+00:17:07,010 --> 00:17:09,290
+none motile، كل هذه اسمها biochemical
+
+232
+00:17:09,290 --> 00:17:12,450
+characteristics، اتكلمنا عن ال serology؟ لسه
+
+233
+00:17:12,450 --> 00:17:15,390
+ماتكلمناش بتفصيل عن ال serology، لكن عرفنا انه في
+
+234
+00:17:15,390 --> 00:17:22,680
+لشجلة polyvalent antiserum، صح؟أنا اكتفيت بال
+
+235
+00:17:22,680 --> 00:17:26,700
+cultural characteristics و روحت على مين؟ على
+
+236
+00:17:26,700 --> 00:17:29,020
+physiological characteristics قفزت عن ال
+
+237
+00:17:29,020 --> 00:17:31,940
+morphology و قفزت عن ال biochemical كمان مرة لأي
+
+238
+00:17:31,940 --> 00:17:37,460
+غرض لتقصير فترة ال diagnosis متى بنلجأ لهذا الكلام
+
+239
+00:17:37,460 --> 00:17:42,460
+لما تكون الحالات أو الوضع بيتطلب ذلك زي ما كنا
+
+240
+00:17:42,460 --> 00:17:46,640
+مثلا في حالة اللي هو ال epidemicطبعا هذا لا يعني
+
+241
+00:17:46,640 --> 00:17:51,720
+ان انا بقفز و بنس هدولة، بقفز مؤقتا و بعمل
+
+242
+00:17:51,720 --> 00:17:55,700
+tentative diagnosis و بعدين برجع بشتغل الشغل مرة
+
+243
+00:17:55,700 --> 00:18:00,600
+أخرى، يعني اذا بعطي نتيجة أولية، tentative مؤقتة و
+
+244
+00:18:00,600 --> 00:18:04,880
+بعدين بعطي نتيجة نهائية، لأ مش بقفز و بنساهم، لأ
+
+245
+00:18:04,880 --> 00:18:06,400
+برجعلهم مرة أخرى
+
+246
+00:18:17,970 --> 00:18:20,730
+طبقنا احنا على الastrology الانيجيا لل biochemical
+
+247
+00:18:20,730 --> 00:18:24,110
+characteristics all fermented glucose some ferment
+
+248
+00:18:24,110 --> 00:18:27,230
+manitol اعتقد اتفقنا الدزنتيريا هي الوحيدة اللي
+
+249
+00:18:27,230 --> 00:18:30,970
+بتعملش fermentation للمانيتل دي do not form acetyl
+
+250
+00:18:30,970 --> 00:18:32,570
+methyl carbon والاشي يعنيها دي
+
+251
+00:18:38,840 --> 00:18:41,700
+they do not produce acetyl methyl carbonyl يعني
+
+252
+00:18:41,700 --> 00:18:46,080
+فوجس بروسكاورياش negative does not hydrolyze urea
+
+253
+00:18:46,080 --> 00:18:49,360
+or liquify جيلاتين يعني negative برضه for ureas و
+
+254
+00:18:49,360 --> 00:18:52,820
+negative for جيلاتين liquefaction citrate negative
+
+255
+00:18:52,820 --> 00:18:57,600
+قولتلكم بتتميز بإنه كتير negative فيها triple ال
+
+256
+00:18:57,600 --> 00:19:01,100
+triple sugar iron أجار تبعها alkaline slant over
+
+257
+00:19:01,100 --> 00:19:09,510
+acid but K على ايه مظبوط K على ايهالانفكتبعها اول
+
+258
+00:19:09,510 --> 00:19:13,250
+واحد V variable اللي هو الاندول positive اللي هو
+
+259
+00:19:13,250 --> 00:19:17,110
+ال متيل ريد لكن انا متفقين انه فوجسفروسكوار
+
+260
+00:19:17,110 --> 00:19:20,270
+negative وsite rate negative اذا هي variable
+
+261
+00:19:20,270 --> 00:19:24,130
+positive negative negative وانا اتفق معاكوا سابقا
+
+262
+00:19:24,130 --> 00:19:27,630
+ان الفوجسفروسكوار اذا كان positive ال متيل ريد
+
+263
+00:19:27,630 --> 00:19:30,690
+بيكون negative و العكس هو الصحيح في معظم الحالات
+
+264
+00:19:32,360 --> 00:19:35,740
+البعض من ال determinants للشيجيلة شبيه بيه اللي هو
+
+265
+00:19:35,740 --> 00:19:38,480
+ال salmonella أيضا في عندها ال o أنتجين و احنا
+
+266
+00:19:38,480 --> 00:19:42,000
+اتفقنا برضه سلمونيلا ال invasiveness مقدرة
+
+267
+00:19:42,000 --> 00:19:45,020
+البكتيريا كمان الشيجيلة عندها المقدرة عليها تنتج
+
+268
+00:19:45,020 --> 00:19:48,120
+type 3 secretory system وبالتالي بتعمل invasion
+
+269
+00:19:48,120 --> 00:19:52,400
+لكنال invasion تبعها فقط intestinal بمعنى انها
+
+270
+00:19:52,400 --> 00:19:57,440
+بتروحش بعد ال intestinal يعني لو جينا نسأل سؤال من
+
+271
+00:19:57,440 --> 00:20:01,300
+المعلومة هذه هل يمكن عزل ال salmonella من اماكن
+
+272
+00:20:01,300 --> 00:20:08,060
+اخرى غير الاستول انا بقولكوا الاحتمالية شبه 0% انا
+
+273
+00:20:08,060 --> 00:20:13,160
+بقول شبه لانه يعني لأ يعني لأ بظبط احنا غالبا نترك
+
+274
+00:20:13,160 --> 00:20:17,640
+مجال دايما الا exceptionsلكن لم تعزل الشجلة من
+
+275
+00:20:17,640 --> 00:20:20,460
+أماكن أخرى غير ال intestinal tract دلالة على أنه
+
+276
+00:20:20,460 --> 00:20:24,200
+حتى لو عملت invasion وصلت لما بعد ال intestine
+
+277
+00:20:24,200 --> 00:20:29,670
+يبدو أنه مش successful outside the intestineأخرى
+
+278
+00:20:29,670 --> 00:20:33,550
+تكسينات لديها بروتين تكسين يمكن أن يكون نيرو
+
+279
+00:20:33,550 --> 00:20:37,450
+تكسيك، سايتوكسيك و انترو تكسيك اعتقد انه لما انا
+
+280
+00:20:37,450 --> 00:20:40,790
+قلت المرة الماضية تفصيل ال إكسو تكسين و الانتوكسين
+
+281
+00:20:40,790 --> 00:20:44,670
+قلنا based on mechanism of production هنا based on
+
+282
+00:20:44,670 --> 00:20:47,810
+the site affected في عندي انترو تكسين في عندي
+
+283
+00:20:47,810 --> 00:20:51,460
+سايتو تكسين و في عندي نيرو تكسينوكلكم فاكرين كيف
+
+284
+00:20:51,460 --> 00:20:54,800
+بيشتغل الانتروتوكسين بيعمل inhibition لبروتين،
+
+285
+00:20:54,800 --> 00:20:58,240
+synthesis في ال affected cell وبالتالي الخلايا
+
+286
+00:20:58,240 --> 00:21:01,120
+بتموت، لما تموت الخلايا بيصير لها sloughing،
+
+287
+00:21:01,120 --> 00:21:03,860
+فاكرين اللي بيصير لها sloughing؟ ال absorption
+
+288
+00:21:03,860 --> 00:21:06,840
+بيقل، بيصير accumulation ل .. اللي هو ال
+
+289
+00:21:06,840 --> 00:21:12,520
+electrolyte، ديارية is produced نعم صحيح
+
+290
+00:21:17,120 --> 00:21:19,200
+الباطينوسيليا ديزنتيري forms a powerful
+
+291
+00:21:19,200 --> 00:21:21,980
+enterotoxin it is associated with epidemics of
+
+292
+00:21:21,980 --> 00:21:23,980
+bacillary dysentery طبعا ال bacillary dysentery
+
+293
+00:21:23,980 --> 00:21:28,720
+كان اسم مخيف جدا في الماضي و خاصة في دول العالم
+
+294
+00:21:28,720 --> 00:21:36,990
+الثالث عدد كبير من الناس كانت تصاب كمان مرةأي مرض
+
+295
+00:21:36,990 --> 00:21:41,590
+بينتقل الفكال oral توقع
+
+296
+00:21:41,590 --> 00:21:45,190
+إنه إذا صار فيه فشل في النظام المائي، مياه الشرب،
+
+297
+00:21:45,190 --> 00:21:49,570
+مياه الشرب صار فيها فشل، نسبة كبيرة من الناس هتصاد
+
+298
+00:21:49,570 --> 00:21:54,990
+بأمراض من الفكال oral routeلماذا؟ لأن أكبر مصدر
+
+299
+00:21:54,990 --> 00:21:58,830
+ملوث لمياه الشرب هو مياه العادمة ومياه العادمة
+
+300
+00:21:58,830 --> 00:22:02,670
+تحتوي على اللي هو قد تحتوي على ال spaces مش بس
+
+301
+00:22:02,670 --> 00:22:06,070
+الشجلة و other microbes طبعا كلمة Bacilla
+
+302
+00:22:06,070 --> 00:22:09,360
+representally مخيفة من أي ناحية مخيفةأول حاجة اللي
+
+303
+00:22:09,360 --> 00:22:13,420
+كنت عارفه انه الـ dysentery تمام فيها يعني عدد
+
+304
+00:22:13,420 --> 00:22:19,440
+مرات ال identification قد يتجاوز ال 50 مرة في
+
+305
+00:22:19,440 --> 00:22:23,140
+اليوم قد يتجاوز ال 50 مرة في اليوم لدرجة ان ال
+
+306
+00:22:23,140 --> 00:22:27,220
+stool بيفقد ال characteristics تبعته بيبطل stool
+
+307
+00:22:27,220 --> 00:22:31,700
+بيبطل stool فقط بيصير ينزل ميوكاس و خلايا و صديد
+
+308
+00:22:31,700 --> 00:22:33,880
+تمام فبالتالي
+
+309
+00:22:35,300 --> 00:22:40,680
+كمية الدياريا تؤدي إلى dehydration فلما يكون في
+
+310
+00:22:40,680 --> 00:22:44,600
+أطفال غالبا ال dehydration و فقدان ال electrolyte
+
+311
+00:22:44,600 --> 00:22:47,460
+اللي هو بيسموه electrolyte imbalance قد يؤدي إلى
+
+312
+00:22:47,460 --> 00:22:51,080
+الوفاة وبتكون تعرفوا كمان شغل مهم number one
+
+313
+00:22:51,080 --> 00:22:55,330
+killerall over the world is diarrhea مش ضروري بس
+
+314
+00:22:55,330 --> 00:22:58,750
+الا ردزينتري تمام لكن diarrhea is number one
+
+315
+00:22:58,750 --> 00:22:59,890
+killer of children
+
+316
+00:23:07,510 --> 00:23:10,310
+في الإنسان بقولنا شغلوسيس بيبدأ بـ acute
+
+317
+00:23:10,310 --> 00:23:12,890
+gastroenteritis which is accompanied by abdominal
+
+318
+00:23:12,890 --> 00:23:17,470
+pain and ده يعني فيه مغص وفيه أنها اللي هو أسهل as
+
+319
+00:23:17,470 --> 00:23:20,610
+it progresses كل ما اتطور الموضوع دياريا becomes
+
+320
+00:23:20,610 --> 00:23:24,510
+more frequent يعني الإنسان بيشعر بحاجة للذهاب إلى
+
+321
+00:23:24,510 --> 00:23:28,890
+الدورة مرارا ومتكرارا تقصر الفترات ما بين الفترة و
+
+322
+00:23:28,890 --> 00:23:34,180
+الأخرىعادة تتجاوز بشعور كوليكي باين هناك كان مغص
+
+323
+00:23:34,180 --> 00:23:40,920
+هنا مغص كوليكي باين يعني مغص شديد بعد ذلك البرازي
+
+324
+00:23:40,920 --> 00:23:47,720
+يفقد شكله البرازي أو قوامه البرازي و بيصير في غالب
+
+325
+00:23:47,720 --> 00:23:51,720
+الأمر ميوكاس و بس مع دماء البرازي العنوان عادة
+
+326
+00:23:51,720 --> 00:23:58,100
+تتجاوز بشعور كفر و مارك تعرقit is also known that
+
+327
+00:23:58,100 --> 00:24:01,840
+children are more frequently attacked than adult
+
+328
+00:24:01,840 --> 00:24:05,840
+person and the symptoms are more severe هو حاجة
+
+329
+00:24:05,840 --> 00:24:09,100
+طبعا ليش الأطفال مش ال adults مع أنه مصدر مياه
+
+330
+00:24:09,100 --> 00:24:12,700
+الشرب واحدشوفوا يا عزيزي احنا في ال research في
+
+331
+00:24:12,700 --> 00:24:15,600
+الدراسات اللي بيجريها لما بيكون الدراسة فيها
+
+332
+00:24:15,600 --> 00:24:20,040
+factors risk factors بنلاقي ال age بعض الأحيان
+
+333
+00:24:20,040 --> 00:24:24,120
+risk factor ال age risk factor طبعا لما بنفسر
+
+334
+00:24:24,120 --> 00:24:27,580
+لماذا هو risk factor هذا بنادم و هذا بنادم هذا
+
+335
+00:24:27,580 --> 00:24:31,950
+تناول و هذا تناول ليش هذا more immuneال age
+
+336
+00:24:31,950 --> 00:24:35,930
+بينظروله من ناحية انه الجهاز المناعة بتاع الإنسان
+
+337
+00:24:35,930 --> 00:24:41,150
+اتطور احسن او ضعف لما حتى برضه ال age الكبيرة
+
+338
+00:24:41,150 --> 00:24:47,850
+تمانين و سبعين و ستين مثلا زي الطفل هذا واحد رقم
+
+339
+00:24:47,850 --> 00:24:52,050
+اتنين ال activity تبع الأطفال وتمييزهم بين ال
+
+340
+00:24:52,050 --> 00:24:57,730
+right و ال wrongيعني الأطفال على سبيل المثال أول
+
+341
+00:24:57,730 --> 00:25:01,370
+ما بيصيروا يسبحوا، يعني يتحركوا، تمام؟ بيصيروا
+
+342
+00:25:01,370 --> 00:25:04,850
+يتعرفوا على الأشياء، ليش يتعرفوا على الأشياء؟
+
+343
+00:25:04,850 --> 00:25:08,850
+بيبتموا، الأكلام اللي أقوله الله ألحذاق بيلعقوا،
+
+344
+00:25:08,850 --> 00:25:13,250
+بيفهموا، أي شيء مورد على الأرض بيحاول يتذوقوا،
+
+345
+00:25:13,250 --> 00:25:15,890
+يعني يتعرفوا على الأشياء من خلال إيه؟ التذوق
+
+346
+00:25:16,400 --> 00:25:20,800
+وبالتالي ال behavior تبع الأطفال يعني بيكون أقل
+
+347
+00:25:20,800 --> 00:25:25,080
+صحي يعني مش صحي وبالتالي نسبة إصابتهم بتكون أعلى
+
+348
+00:25:25,080 --> 00:25:29,080
+في الغالب منعتهم هم أقل تمام احنا بسميهم
+
+349
+00:25:29,080 --> 00:25:35,780
+vulnerable يعني أكثر أرضة من غيرهم وبالتالي إذا
+
+350
+00:25:35,780 --> 00:25:39,800
+أصيب الأطفال حجم الطفل كله حجم صغير وبالتالي
+
+351
+00:25:39,800 --> 00:25:43,640
+فقدانه لجزء بسيط من السواء اللي قد يؤدي به إلى
+
+352
+00:25:43,640 --> 00:25:44,540
+الجفاف
+
+353
+00:25:48,840 --> 00:25:54,540
+vulnerable يعني هش نفس
+
+354
+00:25:54,540 --> 00:25:58,740
+الفكرة فاكرين ال m cells دلوقت السيرمونيلا ايه نفس
+
+355
+00:25:58,740 --> 00:26:00,580
+الفكرة عند الشجلة فيها ان عملية اللي هو
+
+356
+00:26:00,580 --> 00:26:05,720
+internalization والشجلة تتكاثر ولاحظوا الشجلة برضه
+
+357
+00:26:05,720 --> 00:26:10,760
+انتقلت من خلية إلى خلية مجاورة كان بودي الصحيح
+
+358
+00:26:10,760 --> 00:26:14,480
+اوريكوا مقطع فيديو لبكتيريا اسمها listeria
+
+359
+00:26:14,480 --> 00:26:19,590
+monocytogenesبيسموا الحركتها اكتين راكتس راكتس
+
+360
+00:26:19,590 --> 00:26:24,370
+يعني صاروخ بتكون جوا الخلية تتحرك تمام عشان تنتقل
+
+361
+00:26:24,370 --> 00:26:27,910
+للخلية التانية بتاخد مجال بترجع لورا شوية بتاخد
+
+362
+00:26:27,910 --> 00:26:32,670
+مجال سرعة نه و بتضرب حالها ضرب فتشايف الجدار هذا
+
+363
+00:26:32,670 --> 00:26:36,450
+كيف صار بتخترق الجدار هذا و بتروح الجدار التاني
+
+364
+00:26:36,450 --> 00:26:39,750
+بكل سهولة وبالتالي بتستقر في هذا المكان الجديد
+
+365
+00:26:39,750 --> 00:26:44,480
+فبيسموه اكتين راكتسالـ laboratory diagnosis ده
+
+366
+00:26:44,480 --> 00:26:47,500
+الشيء اللي أنا رابطت دايما المعلومة اللي قلنا
+
+367
+00:26:47,500 --> 00:26:49,840
+سلمونيها لان الشيء اللي هو الاستول والدياجرام اللي
+
+368
+00:26:49,840 --> 00:26:54,260
+عملناها المرة الماضية كان برضه للتنام the only
+
+369
+00:26:54,260 --> 00:26:57,680
+satisfactory method of laboratory diagnosis is to
+
+370
+00:26:57,680 --> 00:27:01,440
+cultivate the best life from the patient الان هذه
+
+371
+00:27:01,440 --> 00:27:06,160
+نقطة جوهرية بدنا نجح عندهاالمحاضرة الماضية لما
+
+372
+00:27:06,160 --> 00:27:09,180
+اتكلمنا عن ال diagnosis بقى ال salmonella بقولنا
+
+373
+00:27:09,180 --> 00:27:12,460
+فينا blood culture فينا stool culture فينا urine
+
+374
+00:27:12,460 --> 00:27:17,060
+culture فينا serology صح؟ فينا serology هنا بقولنا
+
+375
+00:27:17,060 --> 00:27:21,060
+the only reliable method is to cultivate the best
+
+376
+00:27:21,060 --> 00:27:24,900
+life from stool مافيش هنا حل اخر مافيش هنا حل تاني
+
+377
+00:27:24,900 --> 00:27:29,250
+غير هذا الحلطبعا ال .. ال .. ال .. ال culture هي
+
+378
+00:27:29,250 --> 00:27:32,570
+نفس ال culture اللي حاكينا عنها لسلمونيلا لبقسم
+
+379
+00:27:32,570 --> 00:27:37,470
+نذكركوا فيها مرة تانية قولنا stool هنزلوا على مين
+
+380
+00:27:37,470 --> 00:27:43,550
+سيلانايت F على XLD او SSA وعلى الجهة التانية قولنا
+
+381
+00:27:43,550 --> 00:27:48,410
+مين اللي هو ال SSA او ال XLD و ال suspect colony
+
+382
+00:27:48,410 --> 00:27:53,630
+من اي من هدولة suspect colony هنعملاش الآن اول فحص
+
+383
+00:27:56,140 --> 00:28:01,980
+Euryase إذا Euryase negative كمل إذا Euryase
+
+384
+00:28:01,980 --> 00:28:05,580
+positive stop خلصنا البكتيريا لا هي Salmonella ولا
+
+385
+00:28:05,580 --> 00:28:09,900
+هي Shigella وبالتالي هنرجع من الصفر لأنه خلصنا
+
+386
+00:28:09,900 --> 00:28:12,040
+المزرعة تبعتنا مافيش فيها Salmonella مافيش فيها
+
+387
+00:28:12,040 --> 00:28:15,500
+Shigella وخلّيني عند النقطة هذه نتكلم عن موضوع
+
+388
+00:28:15,500 --> 00:28:19,860
+يعني برضه عام في ال diagnostic microbiology من
+
+389
+00:28:19,860 --> 00:28:24,260
+اللي أمرني إنه لما تجيشي نعين تستول عملها فقط
+
+390
+00:28:24,260 --> 00:28:27,970
+Salmonella وShigellaهل السلمونيلا والشيجيلا هم فقط
+
+391
+00:28:27,970 --> 00:28:29,610
+الواحدين في الدنيا اللي بيعملوا دياريا من
+
+392
+00:28:29,610 --> 00:28:33,430
+البكتيريا؟ لأ، هتلاقوا ال Campylobacter، هتلاقوا
+
+393
+00:28:33,430 --> 00:28:36,830
+ال Vibrio cholera، هتلاقوا أكام نوع من ال E.coli
+
+394
+00:28:36,830 --> 00:28:41,330
+.. عارف أنه بيعمل دياريا، خمسة، مظبوطة ولا لأ؟و ..
+
+395
+00:28:41,330 --> 00:28:44,870
+و senior enterocolitica و في بعض ال yeast زي ال
+
+396
+00:28:44,870 --> 00:28:46,790
+candida albicans و بعض البكتيريا زي ال
+
+397
+00:28:46,790 --> 00:28:49,510
+staphylococcus aureus يعني في عندي مجموعة كبيرة
+
+398
+00:28:49,510 --> 00:28:54,150
+فلماذا نبحث فقط عن ال cinema و الشغل لأن أنا بتكلم
+
+399
+00:28:54,150 --> 00:29:02,810
+عن مفهوم مختلف شوية و
+
+400
+00:29:02,810 --> 00:29:06,850
+المفهوم هذا بتكلم عن routine
+
+401
+00:29:11,340 --> 00:29:15,100
+stool وكلمة stool هحطها في صندوق اللي بنطبق عليها
+
+402
+00:29:15,100 --> 00:29:21,960
+بنطبق علي أشياء تانية culture و special برضه stool
+
+403
+00:29:21,960 --> 00:29:25,480
+culture
+
+404
+00:29:25,480 --> 00:29:28,500
+لو
+
+405
+00:29:28,500 --> 00:29:33,370
+طلب منا في غزةit's two cultures احنا بالفعل لن
+
+406
+00:29:33,370 --> 00:29:37,350
+نبحث الا عن مين عن السليمانيلا والشيجيلا لماذا
+
+407
+00:29:37,350 --> 00:29:42,870
+اخترنا السليمانيلا والشيجيلا العروف في العالم كان
+
+408
+00:29:42,870 --> 00:29:47,030
+هو هيك سائد فبالتالي انتقلت ان المعرفة واشتغلنا
+
+409
+00:29:47,030 --> 00:29:50,350
+بين عالمين على ان السليمانيلا والشيجيلا هم ال
+
+410
+00:29:50,350 --> 00:29:53,190
+routine ليش هم اختاروا ال routine هذا في بلادهم
+
+411
+00:29:53,190 --> 00:29:56,270
+لأن السليمانيلا والشيجيلا كانت number one cause of
+
+412
+00:29:56,270 --> 00:30:01,290
+diarrhea بالنسبة لهم هم على قمة اللائحةفهم ال most
+
+413
+00:30:01,290 --> 00:30:05,070
+common هم ال most common طبعا هذا الكلام في سابق
+
+414
+00:30:05,070 --> 00:30:09,150
+الزمن كان صحيح لكن لما اتطورت معلوماتنا وانتوا
+
+415
+00:30:09,150 --> 00:30:11,610
+فاكرين مرة اتحدثنا عن ال Campylobacter انها صارت
+
+416
+00:30:11,610 --> 00:30:15,470
+تطلع اكتر من مين؟ من السلمونيلا واتفقنا على انه
+
+417
+00:30:15,470 --> 00:30:19,690
+حتى الطلوع تبقى هذا مش طلوع حقيقي وانما قدرتنا على
+
+418
+00:30:19,690 --> 00:30:22,430
+الكشف عن الميكروب زادت وبتالي صرنا نعدل الحالات
+
+419
+00:30:22,430 --> 00:30:25,890
+بشكل افضل فال Campylobacter صارت صاروخ في عالم
+
+420
+00:30:25,890 --> 00:30:29,950
+الدياريةوالكمبيلوبا أكتر تذكر المنظمة الصحية
+
+421
+00:30:29,950 --> 00:30:32,870
+العالمية بتقول ان number one cause of diarrhea in
+
+422
+00:30:32,870 --> 00:30:36,230
+the middle east is كمبيلوبا أكتر لكن انا في غزة
+
+423
+00:30:36,230 --> 00:30:41,590
+احنا في ال middle east هوين؟ في ال middle east فمع
+
+424
+00:30:41,590 --> 00:30:46,820
+ذلك لا نجد أحد يتحدث عن الكمبيلوبا أكترتمام؟
+
+425
+00:30:46,820 --> 00:30:50,280
+وبالتالي مشكلتنا ان احنا ال routine اللي احنا
+
+426
+00:30:50,280 --> 00:30:53,760
+استخدمنا هو routine we copied it يعني نسخناها من
+
+427
+00:30:53,760 --> 00:30:58,000
+برا واستخدمناها عندنا دون النظر الى مين مسببات
+
+428
+00:30:58,000 --> 00:31:01,240
+دياريا في ال .. ال .. ال bacterial دياريا في قطع
+
+429
+00:31:01,240 --> 00:31:05,880
+غزة و .. و نبني عليها ال routine بين على معلومات
+
+430
+00:31:05,880 --> 00:31:09,690
+محليةمثلا في بعض البلدان اللي انا روتيني اتغير صار
+
+431
+00:31:09,690 --> 00:31:13,690
+يتكلموا عن سالمونيلا وشجلة وكمبيلوب أكتر في
+
+432
+00:31:13,690 --> 00:31:18,490
+بتكلموا عن سالمونيلا وشجلة و E coli O157H7 صارت في
+
+433
+00:31:18,490 --> 00:31:24,130
+مصحف الكبار ال E coli O157H7 طيب طلبنا مزرعة وطلعت
+
+434
+00:31:24,130 --> 00:31:29,490
+negative لسالمونيلا وشجلة و E coli O157H7 still
+
+435
+00:31:29,490 --> 00:31:32,710
+the clinical impression of the physician bacterial
+
+436
+00:31:32,710 --> 00:31:37,350
+diarrheaمش الحل .. الحل التاني ان هو بطلب الان
+
+437
+00:31:37,350 --> 00:31:40,610
+special stool culture ايش بقول في ال special stool
+
+438
+00:31:40,610 --> 00:31:45,730
+culture بيقول stool culture for vibrocholera يبقى
+
+439
+00:31:45,730 --> 00:31:49,330
+الان هو ايش اللي الطبيب عمل حددنا نوع البكتيريا
+
+440
+00:31:49,330 --> 00:31:52,370
+ضمن الإطار يبقى فيه اندي انا routine stool culture
+
+441
+00:31:52,370 --> 00:31:56,730
+we look for salmonella and shigella stool ..
+
+442
+00:31:56,730 --> 00:31:59,690
+special .. special culture بيدور على مين؟ على
+
+443
+00:31:59,690 --> 00:32:04,330
+الميكروب اللي هو ذكره الطبيبأحنا اللي خدنا نتكلم
+
+444
+00:32:04,330 --> 00:32:07,210
+في الموضوع هذا أساساً لما قلنا لكوا إنه إذا طلعت
+
+445
+00:32:07,210 --> 00:32:14,070
+your years positive خلصنا، مش منلغيها، المظلة
+
+446
+00:32:14,070 --> 00:32:18,050
+تبعتنااش معناها no salmonella, no sugar، اللي هو
+
+447
+00:32:18,050 --> 00:32:22,070
+بالتالي negativenegative for ايه؟ for salmonella
+
+448
+00:32:22,070 --> 00:32:24,710
+and shigel يرجع ال report تبعك مابتكون negative و
+
+449
+00:32:24,710 --> 00:32:28,810
+خلاص negative for salmonella and shigel حتى لو
+
+450
+00:32:28,810 --> 00:32:33,410
+طبيب مش .. مش .. مش متمرس في طلب الفحصات يقرأ
+
+451
+00:32:33,410 --> 00:32:36,050
+نتيجتك و يقول اه و الله هدم اعطيني نتيجة دقيقة و
+
+452
+00:32:36,050 --> 00:32:38,910
+بقوللي انه لأ ممكن يكون في أشياء أخرى بس هي
+
+453
+00:32:38,910 --> 00:32:45,090
+negative for salmonella and shigelمتفهم من الكلام؟
+
+454
+00:32:45,090 --> 00:32:51,910
+طيب شكل الشجلة على الأطباق ال SSA و ال XLD هيكون
+
+455
+00:32:51,910 --> 00:32:54,910
+مختلف عن مين؟ عن السلمونيلا، السلمونيلا احنا
+
+456
+00:32:54,910 --> 00:32:58,030
+اتفقنا انه بيكون فيها dark center لماذا dark
+
+457
+00:32:58,030 --> 00:33:01,850
+center؟ edge to us production بينما الشجلة مافيهاش
+
+458
+00:33:01,850 --> 00:33:04,990
+edge to us production وبالتالي هتكون colorless
+
+459
+00:33:04,990 --> 00:33:08,790
+colonies على هذا الأطباق لأنها non-lactose
+
+460
+00:33:08,790 --> 00:33:11,310
+fermenter وبالتالي colorless طيب
+
+461
+00:33:13,910 --> 00:33:17,290
+بقولنا isolation of the causative organism from
+
+462
+00:33:17,290 --> 00:33:21,150
+the feces is usually accomplished without
+
+463
+00:33:21,150 --> 00:33:24,810
+difficulties by using the same special media and
+
+464
+00:33:24,810 --> 00:33:27,790
+methods employed for salmonella
+
+465
+00:33:36,330 --> 00:33:43,250
+اختصارا زراعة البكتيريا من الستول خاصة خلال الاربع
+
+466
+00:33:43,250 --> 00:33:47,570
+او الخمس أيام اللي قول من المرض وبعدين لو عملنا
+
+467
+00:33:47,570 --> 00:33:51,190
+سمير من الستول تخيل لو عملنا سمير من الستول بنلاقي
+
+468
+00:33:51,190 --> 00:33:53,790
+gram negative بس ال lie appearing singly للأسف هذه
+
+469
+00:33:53,790 --> 00:33:59,870
+المعلومة احنا يمكن حاطينها ويعني متلاددين الصح في
+
+470
+00:33:59,870 --> 00:34:03,490
+قولها لأنه ممكن تكون confusing عند البعض وعند
+
+471
+00:34:03,490 --> 00:34:12,240
+البعضالستول ممكن مفيد
+
+472
+00:34:12,240 --> 00:34:18,980
+فقط في حالة واحدة في ال vibrio cholera
+
+473
+00:34:34,850 --> 00:34:37,990
+فبالتالي بتكون distinguished فبالتالي هذه المعلومة
+
+474
+00:34:37,990 --> 00:34:43,230
+انا ارجو انه ت disregard ننساها خالص تمام ننساها
+
+475
+00:34:43,230 --> 00:34:47,250
+خالص ال triple sugar iron agar تبع حجورنا K على A
+
+476
+00:34:47,250 --> 00:34:51,430
+no gas no H2S ال invic reaction حكينا ال variable
+
+477
+00:34:51,430 --> 00:34:55,390
+اندول بينما positive الميثيريد و تانين negative
+
+478
+00:34:55,390 --> 00:34:59,430
+physiological examinationعكس السلمونية لكلمة مرة
+
+479
+00:34:59,430 --> 00:35:02,630
+هذه كانت فيها 2500 stereotypes هذه ال stereotypes
+
+480
+00:35:02,630 --> 00:35:06,790
+بتاعتها قليلة وبالتالي استطيع ان اتحدى اتعرف عليها
+
+481
+00:35:06,790 --> 00:35:17,850
+او احدد هويتها من خلال few antibodies هذه
+
+482
+00:35:17,850 --> 00:35:19,690
+ممكن اتداجرها بكويس لكوا
+
+483
+00:35:29,390 --> 00:35:34,190
+طبعا ايه معناها ايش هذه ايه معناها acid يعني
+
+484
+00:35:34,190 --> 00:35:37,770
+acidification acidification يعني ان انا بصتف تمام
+
+485
+00:35:37,770 --> 00:35:44,430
+في عندي اللي هو الشجرة الصنعي لحظوا نعمليش هنا ليه
+
+486
+00:35:44,430 --> 00:35:48,670
+اتقاش lactose fermentation هذه كتير نقطة مهمة
+
+487
+00:35:48,670 --> 00:35:51,790
+خليكم معايا هذه معناها الحكي اللي هتطلع ال OMBG
+
+488
+00:35:51,790 --> 00:35:58,770
+تبقى عايش حكون ال OMBGايش وظيفته ال ام بيجيب ان
+
+489
+00:35:58,770 --> 00:36:03,720
+احنا في ال EPR؟ال OMBG بيطلع بسطف فى حالتين فقط
+
+490
+00:36:03,720 --> 00:36:07,780
+لما يكون لما يكون lactose fermenting البكتيريا أو
+
+491
+00:36:07,780 --> 00:36:11,460
+delayed lactose fermentation فده هيطلع بسطف مش
+
+492
+00:36:11,460 --> 00:36:15,020
+هيطلع negative تمام؟ طبعا كلهم مش glucose بالتأكيد
+
+493
+00:36:15,020 --> 00:36:18,200
+كلهم مش glucose ده انهم انترو بكترياسى بس مش كلهم
+
+494
+00:36:18,200 --> 00:36:20,800
+manitol ال manitol مكتوب خاطئ هناك مش كلهم manitol
+
+495
+00:36:20,800 --> 00:36:24,620
+ال manitol فقط لمين؟ للتلاتة والأولى كانت negative
+
+496
+00:36:24,620 --> 00:36:28,340
+فال lactose فيها انها كلهم negative مع عدى الأخيرة
+
+497
+00:36:28,340 --> 00:36:32,660
+اللى delayed lactose fermentationهل يمكن من خلال
+
+498
+00:36:32,660 --> 00:36:35,880
+هذا الجدول البسيط ان نميز الشيجيلا species عن
+
+499
+00:36:35,880 --> 00:36:40,260
+بعضها اللي مش ممكن؟ من أول واحدة هذه .. هذه
+
+500
+00:36:40,260 --> 00:36:48,040
+لشيجيلا dysenteria صح؟ صح؟ هي ميزناها، شيلناها
+
+501
+00:36:48,040 --> 00:36:52,760
+خالص، لأن نيجي لهدولة، هدولة التنتين ميزناهم عن
+
+502
+00:36:52,760 --> 00:36:53,140
+مين؟
+
+503
+00:36:56,340 --> 00:37:00,880
+عن الأخيرة لكن هل ميزن الفليكسنيل على البويضي يبقى
+
+504
+00:37:00,880 --> 00:37:05,140
+محتاجين ايش other biochemical test طبعا ال ABI
+
+505
+00:37:05,140 --> 00:37:07,420
+كنتوا اقولكوا بيغطي مجموعة اكبر من الكربويتين
+
+506
+00:37:07,420 --> 00:37:12,940
+وبالتالي بكل سهولة بميزه هاي تمييز نوعا ما
+
+507
+00:37:23,730 --> 00:37:26,070
+non-lactose-fermenting non-motile organism,
+
+508
+00:37:26,770 --> 00:37:29,190
+manitol negative, shigella dysentery، طبعا هنتكلم
+
+509
+00:37:29,190 --> 00:37:31,330
+عن فوق هناك لازم تكون shigella، العنوان تبعنا لازم
+
+510
+00:37:31,330 --> 00:37:34,500
+تكون shigellaمانيطول نيجاتيف شجلة زنتاليا مانيطول
+
+511
+00:37:34,500 --> 00:37:37,540
+بوستف ممكن نعمل lactose fermentation شجلة سنجو
+
+512
+00:37:37,540 --> 00:37:40,720
+نهان هاياش delayed lactose fermenter non lactose
+
+513
+00:37:40,720 --> 00:37:43,200
+fermenter في عندي indole test اللي هو الفحص اللي
+
+514
+00:37:43,200 --> 00:37:45,400
+مش متكوه في الجدول هو ال indole test indole
+
+515
+00:37:45,400 --> 00:37:48,760
+boustif لكسنيري و indole نيجاتف هي شجلة بويض
+
+516
+00:37:48,760 --> 00:37:53,340
+اتنهات ال diagram لو بدأنا هنا بكلمة شجلة احنا
+
+517
+00:37:53,340 --> 00:37:57,040
+واضح الامر كام واحدة كام قسم عندي هي واحد هي اتنين
+
+518
+00:37:57,140 --> 00:38:00,320
+هيتلاقيتها اربعة يبقى غطيت ال species يبقى قلتته
+
+519
+00:38:00,320 --> 00:38:06,560
+السابق لو حطينا فيه عمود ان دول انتهى الموضوع طيب
+
+520
+00:38:08,300 --> 00:38:11,640
+الشيجيلة غالبًا تجاوزها إلا في الـ feces الجملة
+
+521
+00:38:11,640 --> 00:38:15,200
+اللي حكيتها في سياق الحديث أنه لم نجدها إلا في ال
+
+522
+00:38:15,200 --> 00:38:16,040
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+523
+00:38:16,040 --> 00:38:18,400
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+524
+00:38:18,400 --> 00:38:18,900
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+525
+00:38:18,900 --> 00:38:18,920
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+526
+00:38:18,920 --> 00:38:19,320
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+527
+00:38:19,320 --> 00:38:19,860
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+528
+00:38:19,860 --> 00:38:20,180
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+529
+00:38:20,180 --> 00:38:20,680
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+530
+00:38:20,680 --> 00:38:20,680
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+531
+00:38:20,680 --> 00:38:28,680
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+532
+00:38:28,680 --> 00:38:29,480
+ال .. ال ..
+
+533
+00:38:33,220 --> 00:38:37,620
+الـ microscopic examination of stain smear is of
+
+534
+00:38:37,620 --> 00:38:42,560
+no use يعني مالهوش أي فايدة مالهوش أي فايدة for
+
+535
+00:38:42,560 --> 00:38:46,180
+the identification of بس الله except the fact that
+
+536
+00:38:46,180 --> 00:38:48,860
+it is gram negative بس الله اعتقد ان هذه الجملة
+
+537
+00:38:48,860 --> 00:38:53,500
+اكدنا عليها مرارا وتكرارا انه مافيش فايدة من ال
+
+538
+00:38:53,500 --> 00:38:57,300
+gram stain الا المعلومةon general and selective
+
+539
+00:38:57,300 --> 00:39:01,120
+media they usually appear similar يعني بيشبهوا بعض
+
+540
+00:39:01,120 --> 00:39:05,380
+فمثلا on blood agar they are smooth, gray and
+
+541
+00:39:05,380 --> 00:39:08,120
+opaque يارت تحفظوا الجملة هذه smooth, gray,
+
+542
+00:39:08,320 --> 00:39:11,880
+opaque؟ كيف نحفظها؟ او ليش نحفظها؟ لأن كل ال
+
+543
+00:39:11,880 --> 00:39:16,690
+enterobacteria تقريبا بتشابه على blood agarوصفاتهم
+
+544
+00:39:16,690 --> 00:39:21,170
+smooth, gray and opaque طبعا في بعض منهم بيتميز
+
+545
+00:39:21,170 --> 00:39:24,690
+على التاني زي مثلا ال eclipsella بتكون larger than
+
+546
+00:39:24,690 --> 00:39:28,510
+others لكن في الغالب معظم ال enterobacteriasi هم
+
+547
+00:39:28,510 --> 00:39:32,510
+بيقولنا smooth, gray and opaque most salmonella
+
+548
+00:39:32,510 --> 00:39:36,630
+species produces H2S and therefore will be black
+
+549
+00:39:36,630 --> 00:39:40,390
+on bismuth sulfide agar فهذا وسط اللي هو ال BSA
+
+550
+00:39:44,130 --> 00:39:46,710
+بقولنا إنه لو احنا زالعنا اللي استخدمه لو شغل على
+
+551
+00:39:46,710 --> 00:39:51,250
+التنين هذي بتنتج اشتراك سبتالي مستعمرة هتكون اللون
+
+552
+00:39:51,250 --> 00:39:57,230
+اللي هو الأسودهذا الجدول أو ال .. ال .. ال table
+
+553
+00:39:57,230 --> 00:40:01,650
+اللي أمامنا بيوضح فروقات أساسية بين السلمونيلا و
+
+554
+00:40:01,650 --> 00:40:05,150
+الشيجيلا مثلا ال disease typhoid fever الأساسي
+
+555
+00:40:05,150 --> 00:40:08,850
+تبعها و الشيجيلا Bacillus Dysentery و هذا على فكرة
+
+556
+00:40:08,850 --> 00:40:13,090
+يعني تمييز ما بين سلمونيلا طايفي .. سلمونيلا طايفي
+
+557
+00:40:13,090 --> 00:40:17,410
+و ما بين الشيجيلا ديزنترية يعني مش بين السلمونيلا
+
+558
+00:40:17,410 --> 00:40:21,290
+كوكول و بين الشيجيلا .. بين السلمونيلا طايفي و بين
+
+559
+00:40:21,290 --> 00:40:25,410
+الشيجيلا ديزنترmotility, motile, non-motile لأنه
+
+560
+00:40:25,410 --> 00:40:27,490
+لو احنا بنتكلم عن ال motility بشكل عام في السنوات
+
+561
+00:40:27,490 --> 00:40:30,850
+اللي لا فيها exception ال H2S بسطه بينما هناك
+
+562
+00:40:30,850 --> 00:40:33,930
+negative ال triple sugar iron agar K على A بينما
+
+563
+00:40:33,930 --> 00:40:37,490
+هناك K على A فقط ال nature of infection systemic
+
+564
+00:40:37,490 --> 00:40:41,290
+واحنا قلنا انه intestinal وبعدين blood و other
+
+565
+00:40:41,290 --> 00:40:44,690
+organs هناك فقط gastro intestinal tract ال
+
+566
+00:40:44,690 --> 00:40:50,520
+immunity كلمة lasting يعني لأ مش متأخرة تدومتدوم
+
+567
+00:40:50,520 --> 00:40:54,140
+أطول بينما الشيجلة لو انت نصبت فيها اليوم بعد ست
+
+568
+00:40:54,140 --> 00:40:56,460
+شهر وانت نصبت فيها كمان مرة برضه حصل عندك
+
+569
+00:40:56,460 --> 00:41:00,760
+شيجلنوسيس ماناش يعني الجسم بيكوّلهاش مناعة طويلا
+
+570
+00:41:00,760 --> 00:41:05,280
+ال metabolite أكثر حاجة في أن هنا بتأثر اللي هو ال
+
+571
+00:41:05,280 --> 00:41:09,260
+endotoxin نفسه هنا كده كلا هما endotoxin and
+
+572
+00:41:09,260 --> 00:41:15,160
+exotoxin إذن هاي الفرقات الرئيسية بين اتنين نيجي
+
+573
+00:41:15,160 --> 00:41:17,810
+لل treatmentوأنا وعدكوا أنه في ال treatment بتتكلم
+
+574
+00:41:17,810 --> 00:41:21,430
+عن ال treatment بشكل عام لأي ديارية ركزوا معايا
+
+575
+00:41:21,430 --> 00:41:24,850
+شباب في هذا المفهوم اللي بنحكيه الآن إيش النقطتين
+
+576
+00:41:24,850 --> 00:41:29,250
+الأساسيتين في الديارية فقدان water water اللي هو
+
+577
+00:41:29,250 --> 00:41:34,410
+fluid بيقديله جفاف؟الان عدم امتصاص ال electrolyte
+
+578
+00:41:34,410 --> 00:41:36,690
+بيؤدي لفقدان ال electrolyte وبالتالي بيؤدي لما
+
+579
+00:41:36,690 --> 00:41:41,110
+يسمى electrolyte imbalance وكلاهما سواء كان فقدان
+
+580
+00:41:41,110 --> 00:41:46,650
+الماء او ال electrolyte imbalance كلاهما life
+
+581
+00:41:46,650 --> 00:41:51,710
+threatening مهدد لحياة الإنسانالان الدياريا can be
+
+582
+00:41:51,710 --> 00:41:57,070
+caused by several pathogens، viral, protozoa,
+
+583
+00:41:57,590 --> 00:42:00,450
+بكتيريا و لما بنقول بكتيريا، بنتكلم عن أنواع
+
+584
+00:42:00,450 --> 00:42:04,730
+مختلفة أيضا من البكتيريا، ففينا جملة تالتة بنقولها
+
+585
+00:42:04,730 --> 00:42:09,830
+المسببات مختلفة، مسببات مختلفة، إذا ميه،
+
+586
+00:42:09,830 --> 00:42:14,510
+electrolytes، وإيش كمان؟ أنواع بكتيريا مختلفةالحل
+
+587
+00:42:14,510 --> 00:42:19,370
+الأول اني ارجع المي زي ما كانت المريض بيخسر ماء
+
+588
+00:42:19,370 --> 00:42:24,470
+انا اعوضه الماء المريض بيخسر الهواتف اعوضه الهواتف
+
+589
+00:42:24,470 --> 00:42:30,090
+بدا المشكلة التالتة to eradicate the pathogen كلمة
+
+590
+00:42:30,090 --> 00:42:33,330
+to eradicate يعني تتخلص الان في اندي مشكلة في كلمة
+
+591
+00:42:33,330 --> 00:42:37,210
+to eradicate بعض الميكروبات وانا بتخلص منها بتموت
+
+592
+00:42:37,210 --> 00:42:38,890
+اندوكسين
+
+593
+00:42:40,440 --> 00:42:45,160
+هل الاندوكسين هيزيد
+
+594
+00:42:45,160 --> 00:42:48,240
+المشكلة، هيقلل المشكلة؟ بيتمد على نوع ال micro
+
+595
+00:42:48,240 --> 00:42:51,880
+organism فمثلا معظم أنواع السلمونية اللي بتاعة من
+
+596
+00:42:51,880 --> 00:42:55,300
+ال gastroenteritis فقط مش enteric fever تمام؟ لا
+
+597
+00:42:55,300 --> 00:43:01,100
+ينصح، لا ينصح بال antimicrobial treatment فقط
+
+598
+00:43:01,100 --> 00:43:06,460
+electrolyte and fluid replacement والجسم تلقائي
+
+599
+00:43:06,460 --> 00:43:10,100
+هيتخلص من ال micro organism لكن في حالة الtyphoid
+
+600
+00:43:11,420 --> 00:43:15,500
+التيفويد life-threatening infection فممكن نستخدم
+
+601
+00:43:15,500 --> 00:43:18,500
+الامبيسيلين او ال self-epithexazole trimethoprim
+
+602
+00:43:18,500 --> 00:43:22,420
+او نستخدم السيبرفلوكسسين to eradicate the organism
+
+603
+00:43:22,420 --> 00:43:27,440
+لذلك هناك بعض الميكروبات مطلوب نعملها eradication
+
+604
+00:43:27,440 --> 00:43:30,680
+والميكروبات الأخرى أو بعض الميكروبات مش مطلوب
+
+605
+00:43:30,680 --> 00:43:35,560
+الشجلة مطلوب انه نتخلص من الميكروبات لكن بدنا نفهم
+
+606
+00:43:35,560 --> 00:43:41,380
+ان اي ديارية في الدنيا do not stop دياريةتوقفش
+
+607
+00:43:41,380 --> 00:43:43,240
+دياريا لإن دياريا هي reaction طبيعي من الجسم
+
+608
+00:43:43,240 --> 00:43:47,580
+للتخلص من ال toxins انت كمان طبعا ماتبقى بنوقف
+
+609
+00:43:47,580 --> 00:43:50,080
+الدياريا إذا شعرنا إن الدياريا صارت life
+
+610
+00:43:50,080 --> 00:43:54,920
+threatening مهددة أكتر من إنها فائدة لكن water
+
+611
+00:43:54,920 --> 00:43:57,900
+replacement، electrolyte replacement eradicate ده
+
+612
+00:43:57,900 --> 00:44:02,940
+اللي هو causative agent Antibiotic therapy is
+
+613
+00:44:02,940 --> 00:44:05,960
+required في الشجلة زي ما حكي هنا to eliminate ده
+
+614
+00:44:05,960 --> 00:44:11,210
+organismيعني الجملة المشهورة اللي حاولتكوا في
+
+615
+00:44:11,210 --> 00:44:14,970
+البداية أن أي ميكروب بنازله تمام لازم نتعرف على ال
+
+616
+00:44:14,970 --> 00:44:19,070
+antimicrobial susceptibility testing له وبالتالي
+
+617
+00:44:19,070 --> 00:44:22,150
+ليش؟ لأنه فيه resistance عالي في الدنيا وبالتالي
+
+618
+00:44:22,150 --> 00:44:25,590
+بنخاف أنه نشوق أنواع جديدة أو صورة جديدة من اللي
+
+619
+00:44:25,590 --> 00:44:28,290
+هوالرزستانس من ال .. من ال antimicrobial
+
+620
+00:44:28,290 --> 00:44:31,710
+sulfonamide tetracycline طبعا tetracycline لا يعطر
+
+621
+00:44:31,710 --> 00:44:34,670
+الأطفال ولا الحوامل ال chloramphenicol قلنالك وقف
+
+622
+00:44:34,670 --> 00:44:36,850
+استخدمه فبتاع اللي في عندي sulfonamide في عندي
+
+623
+00:44:36,850 --> 00:44:40,830
+ampicillin وفي عندي اللي هو ال streptomycin
+
+624
+00:44:41,350 --> 00:44:44,410
+Effective in treatment of ..شي كده ال Immunity
+
+625
+00:44:44,410 --> 00:44:49,810
+قلتلكوا short-lived .. short-lived و طبعا هذا ال
+
+626
+00:44:49,810 --> 00:44:54,050
+.. ال vaccine عاملين ينقلها vaccine لكن للأسف مش
+
+627
+00:44:54,050 --> 00:44:58,750
+ناجح على الرغم انه عمل stimulation لانتاج اللي هو
+
+628
+00:44:58,750 --> 00:45:01,510
+ال IGA و انت عارفين ال IGA بيكون في الميوكوزا ل
+
+629
+00:45:01,510 --> 00:45:06,050
+preventionطبعا اللي بيعرف السبب الانتقال وكيفية
+
+630
+00:45:06,050 --> 00:45:09,090
+الانتقال لازم يعرف اش هو ال prevention sanitary
+
+631
+00:45:09,090 --> 00:45:12,290
+precautions good personal hygiene النظافة الشخصية
+
+632
+00:45:12,290 --> 00:45:17,230
+العامة hand washing hand washing prevent eighty
+
+633
+00:45:17,230 --> 00:45:20,630
+percent of infectious diseases hand washing only
+
+634
+00:45:20,630 --> 00:45:24,950
+hand washing only ويتستطيع انك تعمل googling على
+
+635
+00:45:24,950 --> 00:45:28,810
+handwashing.org handwashing recommendations هتلاقي
+
+636
+00:45:28,810 --> 00:45:34,790
+آلاف فيخمستاش عشرة من كل عام اسمه hand washing day
+
+637
+00:45:34,790 --> 00:45:39,770
+يوم غسل اليدين نكتفي بهذا القدر و بنكمل المرة
+
+638
+00:45:39,770 --> 00:45:40,150
+القادمة
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/s6fu5bKjDe0_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/s6fu5bKjDe0_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e2a8e15ac1e8eb1fc29501aeedf781da728fda62
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/s6fu5bKjDe0_raw.srt
@@ -0,0 +1,2596 @@
+1
+00:00:20,250 --> 00:00:23,250
+بسم الله الرحمن الرحيم اليوم موضوعنا ان شاء الله
+
+2
+00:00:23,250 --> 00:00:26,010
+عن اليارسينيا اليارسينيا اللي هي أحد أعضاء ال
+
+3
+00:00:26,010 --> 00:00:29,370
+enterobacteriasi و اللي بتمتلك ضمن أعضائها
+
+4
+00:00:29,370 --> 00:00:33,110
+البكتيري المسمى يارسينيا بيستس و اليارسينيا بيستس
+
+5
+00:00:33,110 --> 00:00:37,830
+هي المسبب لمرض الطعون بتحكلم عن مرض الطعون كمقدمة
+
+6
+00:00:37,830 --> 00:00:43,420
+اليوممرض الطعون ذُكر في العهد القديم من الاناجيل
+
+7
+00:00:43,420 --> 00:00:47,320
+ذُكر في حديثة الرسول صلى الله عليه و سلم و أعطي
+
+8
+00:00:47,320 --> 00:00:51,860
+لقب شهيد من مات مطعونا .. مطعونا أي مات بالطعون و
+
+9
+00:00:51,860 --> 00:00:56,600
+كان أسس الحجر الصحي الحديث هي اللي أرسى قواعدها
+
+10
+00:00:56,600 --> 00:00:59,200
+الرسول صلى الله عليه و سلم عندما أخبرنا بإن إذا
+
+11
+00:00:59,200 --> 00:01:02,520
+كان الطعون في أرض فلا تدخلوها و إذا كنتم بيها فلا
+
+12
+00:01:02,520 --> 00:01:07,750
+تخرجوا منها واصبروا يعني بمفهوم أنهال .. ال .. ال
+
+13
+00:01:07,750 --> 00:01:14,650
+.. ال .. ربط الأجر و المثوبة و في نفس الوقت منع لي
+
+14
+00:01:14,650 --> 00:01:20,390
+انتشار هذا المرض كمان هذا المرض يمكن ذكرته ..
+
+15
+00:01:20,390 --> 00:01:25,590
+درسته في التاريخ انه فشل حملة نابليون على عكا كان
+
+16
+00:01:25,590 --> 00:01:30,310
+أحد أسبابه انه أصيب جنوده بالطعون جيشه أصيبه
+
+17
+00:01:30,310 --> 00:01:36,250
+بالطعونفي كمان في التاريخ الحديث بيقولنا ان نصف
+
+18
+00:01:36,250 --> 00:01:41,630
+سكان أوروبا ماتوا بأحد أو بقعة التعامل نصف سكان
+
+19
+00:01:41,630 --> 00:01:44,810
+أوروبا كان عدد سكان أوروبا تقريبا 400 مليون 200
+
+20
+00:01:44,810 --> 00:01:51,120
+مليون ماتوا منهمفالطعون اللى بينتمى المسبب تبعه ده
+
+21
+00:01:51,120 --> 00:01:55,680
+ال genus Yersinia مرض خطير جدا لكن ليس هو الوحيد
+
+22
+00:01:55,680 --> 00:01:59,120
+بمعنى ان Yersinia enterocolitica و Yersinia
+
+23
+00:01:59,120 --> 00:02:03,800
+pseudotuberculosis بنصنفهم ك enteropathogens ايش
+
+24
+00:02:03,800 --> 00:02:07,560
+يعني enteropathogens؟ يعني pathogens قادر على حدث
+
+25
+00:02:07,560 --> 00:02:10,300
+infection في ال intestinal tract زى السلمونيلا و
+
+26
+00:02:10,300 --> 00:02:14,020
+زى الشجلة و زى ال E.coli ال entero hemorrhagic و
+
+27
+00:02:14,020 --> 00:02:19,920
+ال enterotoxicالاسماء أمامنا على الصبورة يرسينيا
+
+28
+00:02:19,920 --> 00:02:22,560
+بيستس اللى بسبب قولنا plague أو اللى هو مرض الطعون
+
+29
+00:02:22,560 --> 00:02:26,680
+يرسينيا انتروكولاتيكا ويرسينيا سودو تبركولوسس
+
+30
+00:02:26,680 --> 00:02:30,880
+التنتين ال condition بنسميه Yersinosis لكن ما
+
+31
+00:02:30,880 --> 00:02:34,260
+طبيعي Yersinosis هو gastrointestinal tract
+
+32
+00:02:34,260 --> 00:02:38,490
+infectionالـ General Characteristics خدوا بالكوا
+
+33
+00:02:38,490 --> 00:02:40,930
+احنا يعني الصمة العامة للـ Enterobacterium in a
+
+34
+00:02:40,930 --> 00:02:44,450
+gram negative بسالاين هنا بدنا نوقف و نقول ال
+
+35
+00:02:44,450 --> 00:02:47,630
+exception تبعنا هذه البكتيريا مش بسالاين cocoa
+
+36
+00:02:47,630 --> 00:02:52,250
+بسالاين cocoa بسالاين يعني خلينا نقول جاية حالة
+
+37
+00:02:52,250 --> 00:02:57,050
+وسط ما بين الكوكساي و ما بين البسالاين هذه الميزة
+
+38
+00:02:57,050 --> 00:02:58,590
+الأولى cocoa بسالاين
+
+39
+00:03:02,200 --> 00:03:05,800
+الميزة التانية انه لما بنجي بنصبغها بصبغة خاصة
+
+40
+00:03:05,800 --> 00:03:12,840
+اسمها وايسون استين بنلاقي
+
+41
+00:03:12,840 --> 00:03:16,800
+في الوايسون استين انه مش كل البكتيريا صابغت وانما
+
+42
+00:03:16,800 --> 00:03:23,950
+ال poles يعني الأقطاب تبعتهافقطب واحد وقطب اتنين
+
+43
+00:03:23,950 --> 00:03:28,070
+تمام هم اللي بينصبغوا وباقى البكتيريا بتبدو
+
+44
+00:03:28,070 --> 00:03:32,610
+كhalostructure عشان halostructure يعني فراغة يعني
+
+45
+00:03:32,610 --> 00:03:36,670
+انا بالظبط كفراغة هذا الشكل بتذكركم مين؟ بتعرف
+
+46
+00:03:36,670 --> 00:03:41,930
+الدبوس؟ المشبك اللي بنضغطه و بنسكره فبسمو الشكل
+
+47
+00:03:41,930 --> 00:03:47,550
+هذا safety pin appearance
+
+48
+00:03:50,660 --> 00:03:54,600
+وهذه أحد الأشياء المهمة جدا جدا بالنسبة
+
+49
+00:03:54,600 --> 00:03:58,980
+لcharacterization of يرسينيا بشكل عام كوكبا سلاي
+
+50
+00:03:58,980 --> 00:04:03,280
+bipolar reaction أو bipolarly stained اللي بتعطينا
+
+51
+00:04:03,280 --> 00:04:07,080
+شكل جنمين safety pen appearance كمان ميزة من
+
+52
+00:04:07,080 --> 00:04:10,840
+الميزات اللي بتتميز فيها اليرسينيا احنا لما بنعمل
+
+53
+00:04:10,840 --> 00:04:13,960
+فحص الموتيل اللي تشرب نعمله على اي درجة حرارة على
+
+54
+00:04:13,960 --> 00:04:18,650
+سبعةو تلاتين درجة مئوية الحين كل اليرسينيا على
+
+55
+00:04:18,650 --> 00:04:22,550
+سبعة و تلاتين درجة مئوية non motile كلها non
+
+56
+00:04:22,550 --> 00:04:27,690
+motile لكن اكتشفنا ان اليرسينيا enterocolitica
+
+57
+00:04:27,690 --> 00:04:34,090
+اللي قدامنا هنا يرسينيا enterocolitica ويرسينيا
+
+58
+00:04:34,090 --> 00:04:38,450
+pseudotuberculosis are motile at twenty two degree
+
+59
+00:04:38,450 --> 00:04:42,790
+centigrade يعني على اتنين و عشرين درجة مئوية هدول
+
+60
+00:04:42,790 --> 00:04:43,950
+اتنتين motile
+
+61
+00:04:47,680 --> 00:04:50,840
+متفقين على المعلومة دي؟ مهم كتير يعني كل مهم على
+
+62
+00:04:50,840 --> 00:04:54,460
+ال 37 احنا بنعمل الفحص كمان مرة على هي أول مرة
+
+63
+00:04:54,460 --> 00:04:59,900
+بنذكر كلمة 22 درجة مئوية في موضوع الموتلد او حتى
+
+64
+00:04:59,900 --> 00:05:03,420
+في موضوع ال biochemical reactions بشكل عام فقلت
+
+65
+00:05:03,420 --> 00:05:06,060
+تبقى نيروب هي صفة من صفات ال enterobacteriasi
+
+66
+00:05:06,060 --> 00:05:10,060
+كتاليز بوستف برضه صفة من صفاتها اوكسديز نيجاتيف
+
+67
+00:05:10,060 --> 00:05:13,520
+برضه من صفاتها بتقولكم كمان شغل عن اليارسينيا
+
+68
+00:05:13,520 --> 00:05:15,200
+اليارسينيا كان زمان اسمها pastorella
+
+69
+00:05:20,690 --> 00:05:24,650
+كان اسمها Pasturella اليوم لازال في بكتيريا اسمها
+
+70
+00:05:24,650 --> 00:05:29,370
+Pasturella يبقى بدنا نعرف كمان من الآن ان هناك وجه
+
+71
+00:05:29,370 --> 00:05:35,630
+تشابه بين Yersinia و بين Pasturella لكن نستطيع ان
+
+72
+00:05:35,630 --> 00:05:38,830
+نميز بينهم و إلا لما فصلنا ال Yersinia عن اللي هو
+
+73
+00:05:38,830 --> 00:05:42,610
+Pasturella يعني كان تصوروا ال Yersinia Pistis كان
+
+74
+00:05:42,610 --> 00:05:47,420
+اسمها Pasturella Pistisمين اللي اتغير ال genus ولا
+
+75
+00:05:47,420 --> 00:05:50,980
+ال species؟ ال genus غيرنا بعض الشرقين اللي لو
+
+76
+00:05:50,980 --> 00:05:55,980
+سمناها Yersinia وغالبا لما بننقل بكتيريا من إلى
+
+77
+00:05:55,980 --> 00:06:00,060
+مسمى جديد ال species بتضالها موجودة و ال genus هو
+
+78
+00:06:00,060 --> 00:06:04,880
+اللي بتغير زي مثلا انتولوباكتر ساكازاكي فاكرينها؟
+
+79
+00:06:04,880 --> 00:06:08,260
+صار اسم مكرونوباكتر ساكازاكي فاحتفظت باسم ال
+
+80
+00:06:08,260 --> 00:06:14,760
+species وغيرنا اسم ال genusطيب اليفسين نفسي يقول
+
+81
+00:06:14,760 --> 00:06:17,520
+إن هي المسبب لمرض الطعون أو ال plague و ال plague
+
+82
+00:06:17,520 --> 00:06:20,220
+في منه تلت أشكال يا شباب تلت أشكال واحد بيسموه
+
+83
+00:06:20,220 --> 00:06:24,160
+paponic plague paponic plague septicemic plague و
+
+84
+00:06:24,160 --> 00:06:27,780
+التالت اللي هو pneumonic plague تعالوا نطلع على
+
+85
+00:06:27,780 --> 00:06:33,720
+المفهوم العام و كيف ينتقل أصلا الطعون الطعون
+
+86
+00:06:33,720 --> 00:06:39,130
+بينتقل عبر الجردان لكن مش ببشرة في وسيطبتعرفوا في
+
+87
+00:06:39,130 --> 00:06:42,610
+براغيث اسمها fleas باللغة الإنجليزية fleas براغيث
+
+88
+00:06:42,610 --> 00:06:46,390
+البراغيث هي تخصصية، إيش هي تخصصية؟ يعني البراغيث
+
+89
+00:06:46,390 --> 00:06:50,490
+اللي بتصيب الفقران أو بتتغذى على الفقران أو بتتطفل
+
+90
+00:06:50,490 --> 00:06:53,710
+على الفقران غالبا ما بتتطفل على الكلاب و القطط
+
+91
+00:06:53,710 --> 00:06:59,150
+فلكل نوع فيه براغيث خاصة فيه كمرة بنقول فيه نوع من
+
+92
+00:06:59,150 --> 00:07:04,510
+ايه؟ من ال specificity أو ال host specificityالان
+
+93
+00:07:04,510 --> 00:07:08,450
+البراغيث الفقران
+
+94
+00:07:08,450 --> 00:07:12,810
+او الجوردان قد تصاب و قد تكون carrier
+
+95
+00:07:12,810 --> 00:07:18,330
+لاليارسينابستس قد تصاب و قد تكون carrier في كل
+
+96
+00:07:18,330 --> 00:07:24,470
+الحالات الفلي بتتغذى على الدم تبع الجوردان فبتاخد
+
+97
+00:07:24,470 --> 00:07:29,150
+من الدم و اذا كان جواها البكتيريا بتاخدها معاها
+
+98
+00:07:30,000 --> 00:07:34,580
+طبعا البكتيريا يعني في نوع من التحالف بينها وبين
+
+99
+00:07:34,580 --> 00:07:38,360
+الفلي بتخلي
+
+100
+00:07:38,360 --> 00:07:41,640
+دايما الفلي تشعر بالجوع ال Yersinia Pistis لما
+
+101
+00:07:41,640 --> 00:07:48,380
+تدخل داخل الفليز بتخلي الحشرة تشعر بالجوع فبس
+
+102
+00:07:48,380 --> 00:07:52,980
+تمراها بتهيأها بدواجبة دم فممكن ماتلاقيش فار او
+
+103
+00:07:52,980 --> 00:07:58,510
+جرذ فتروح تلاقي انسان يقولك يلا بيسد الرمقيعني على
+
+104
+00:07:58,510 --> 00:08:03,350
+قلوبية كمان مش أنه حاجة ممتعة فوهي بتاخد الجرعة
+
+105
+00:08:03,350 --> 00:08:08,690
+تبعتها بتحقق الإنسان بمين؟ بالإرسين، إذا ال fleece
+
+106
+00:08:08,690 --> 00:08:14,060
+هي اللي نقلت اللي هو ال bacteriaالان مكان العضة
+
+107
+00:08:14,060 --> 00:08:18,000
+مكان ال bite اللى أخدت منه الدم بيصير فيه
+
+108
+00:08:18,000 --> 00:08:21,080
+inflammation من البكتيريا لأن البكتيريا بتتكاثر
+
+109
+00:08:21,080 --> 00:08:26,200
+الان إذا كان في lymph node قريبة من المكان فال
+
+110
+00:08:26,200 --> 00:08:29,580
+lymph node بيقوم بواجبها ايش واجبها check point
+
+111
+00:08:29,580 --> 00:08:34,180
+check point لكن للأسف البكتيريا تستطيع انها تتغلب
+
+112
+00:08:34,180 --> 00:08:36,740
+على كل ال macrofib اللى موجودة في المين في ال
+
+113
+00:08:36,740 --> 00:08:39,360
+lymph node فبصير لها enlargement و inflammation
+
+114
+00:08:40,540 --> 00:08:44,680
+فبتلتب ال lymph node في المنطقة المصابة فبتنتفخ
+
+115
+00:08:44,680 --> 00:08:48,240
+المنطقة انتفاخ المنطقة راجع المينجون كده مرة عن
+
+116
+00:08:48,240 --> 00:08:51,420
+انتفاخ ال lymph node لماذا انتفخت ال lymph node
+
+117
+00:08:51,420 --> 00:08:56,700
+inflamed غير قادرة عليها تتعامل مع البكتيرين هذا
+
+118
+00:08:56,700 --> 00:09:03,470
+الانتفاخ بيسموه ببو عشان اسم المرض bubonic plagueو
+
+119
+00:09:03,470 --> 00:09:06,950
+تصورة يبقى الانتفاخ هذا او الورم اللي صار هو اسم
+
+120
+00:09:06,950 --> 00:09:10,150
+ببو و من هنا و من هنا اطلق على اسم babonic plague
+
+121
+00:09:10,150 --> 00:09:15,170
+الان اذا المريض ماتش في ال babonic plague stage
+
+122
+00:09:15,170 --> 00:09:21,430
+غالبا هيتحول ل septicemic في حالين انه يموت او
+
+123
+00:09:21,430 --> 00:09:28,270
+يشفى في مرحلة من البابونك اذا ماتش في مرحلة
+
+124
+00:09:28,270 --> 00:09:34,030
+البابونك هيتحول ل septicemicوهي تتحول لسبسمك يعني
+
+125
+00:09:34,030 --> 00:09:37,050
+البكتيريا اللي صارت هنا الآن في الدم هيتحول
+
+126
+00:09:37,050 --> 00:09:41,890
+eventually ل نيومونك وغالبا كل نيومونك patient
+
+127
+00:09:41,890 --> 00:09:47,880
+will dieإذا وصلت المرحلة إلى نيومونيك نسبة الوفيه
+
+128
+00:09:47,880 --> 00:09:53,400
+تقريبا تصل لمين؟ لمائة بالمائة كمان مرة بابونيك من
+
+129
+00:09:53,400 --> 00:09:56,720
+الفلي مكان العضة inflamed ممكن الإنسان في هذه
+
+130
+00:09:56,720 --> 00:10:02,780
+الحالة يشفى او يموت او يتطور لسبت سمك وإذا اتطور
+
+131
+00:10:02,780 --> 00:10:05,680
+لسبت سمك متأكدين انهم هيرقوا على مين؟ على نيومونيك
+
+132
+00:10:05,680 --> 00:10:10,880
+الحلو في الموضوع انه في المرحلة الأولى والتانية
+
+133
+00:10:10,880 --> 00:10:15,150
+مافيش human to human transmissionمافيش .. يعني لو
+
+134
+00:10:15,150 --> 00:10:18,790
+اعتنينا بمصاب اعتنينا بمصاب عنده pneumonic فقط مش
+
+135
+00:10:18,790 --> 00:10:22,750
+هينتقل إلى المرض لكن لو وصلت الحالة لل pneumonic
+
+136
+00:10:22,750 --> 00:10:28,390
+بصير human to human transmission المريض بصير ينقل
+
+137
+00:10:28,390 --> 00:10:32,590
+للمريض .. للآخر دون اللجوء لمين؟ للحشرة اللي
+
+138
+00:10:32,590 --> 00:10:36,590
+اسمناها ال flee ال rat flee تمام؟وانا الخطورة ان
+
+139
+00:10:36,590 --> 00:10:39,750
+يكون واحد ماشي في الشارع عنده pneumonic plague
+
+140
+00:10:39,750 --> 00:10:43,510
+تمام وبي ensure الميكروبات قبل عدة سنوات في الهند
+
+141
+00:10:43,510 --> 00:10:49,540
+صار عندنا واباةو طبعا احنا قلنالكوا ان المرض خطيره
+
+142
+00:10:49,540 --> 00:10:53,200
+بيقتل مئات الألاف من الأشخاص او الملايين لكن تم
+
+143
+00:10:53,200 --> 00:10:57,620
+حصرته في أقل من أسبوعين او تلاتة عارفين ليش؟ لأنه
+
+144
+00:10:57,620 --> 00:11:00,200
+الآن فين Antibiotics في السابق ماكانش فيه
+
+145
+00:11:00,200 --> 00:11:03,080
+Antibiotics اليوم الـTetracycline اللي هو من أبسط
+
+146
+00:11:03,080 --> 00:11:07,100
+أنواع ال Antibiotics و أقدمها يعتبر ما زال فعال
+
+147
+00:11:07,100 --> 00:11:10,340
+جدا في قتل البكتيرى اسمها Hercenia Bistris اذا
+
+148
+00:11:10,340 --> 00:11:17,020
+خطورة المرض الآن زالت بوجود منلكن لو احنا افترضنا
+
+149
+00:11:17,020 --> 00:11:20,160
+انه مافيش في المنطقة stocks يعني تخزين لل
+
+150
+00:11:20,160 --> 00:11:23,720
+antibiotic المناسب قد تؤدي الى نسبة وفيات عالية
+
+151
+00:11:23,720 --> 00:11:26,080
+يعني مازالة الميكروب محتفظة ب viral incidence
+
+152
+00:11:26,080 --> 00:11:27,720
+factor مرتفع جدا
+
+153
+00:11:32,240 --> 00:11:34,560
+في ملاحظة احنا ممكن هذا الكلام كله ذاكرناه بس
+
+154
+00:11:34,560 --> 00:11:37,880
+الملاحظة الأخيرة اللي لتحت اللي هي plague is an
+
+155
+00:11:37,880 --> 00:11:40,580
+internationally reportable disease وهذا أول مرة
+
+156
+00:11:40,580 --> 00:11:44,320
+بنتكلم عن حاجة اسمها reportable disease ما نقصد او
+
+157
+00:11:44,320 --> 00:11:48,320
+ماذا نقصد ب reportable disease الآن هذا لو حدث
+
+158
+00:11:48,320 --> 00:11:52,140
+المرض في أي دولة في العالم انا في غزة لازم اعرف
+
+159
+00:11:52,140 --> 00:11:55,700
+عنهكي بده يعرف عنه؟ هو بدي اتصل فيه ويقول انه فيه
+
+160
+00:11:55,700 --> 00:12:00,840
+disease؟ لأ بتصل في جهة .. بتصل في جهة محلية أقرب
+
+161
+00:12:00,840 --> 00:12:06,640
+واحدة هيئة ذات سلطة صحية وبيبلغها انه في حالة
+
+162
+00:12:06,640 --> 00:12:11,220
+تعوم، بيتأكدوا منها وبيتم الاتصال بال WHOمنظمة
+
+163
+00:12:11,220 --> 00:12:14,980
+الصحة العالمية لماذا منظمة الصحة العالمية؟ فيها
+
+164
+00:12:14,980 --> 00:12:19,120
+إجراءات للحاجة للصح مانع السفر أو مانع استقبال
+
+165
+00:12:19,120 --> 00:12:22,680
+الناس من المنطقة اللي عندهم تعون حتى يحدوا من هذا
+
+166
+00:12:22,680 --> 00:12:26,840
+الوباء إذا هناك كلمة internationally reportable
+
+167
+00:12:26,840 --> 00:12:29,840
+disease يعني المرض يجب أن يعرف عنه كل العالم طبعا
+
+168
+00:12:29,840 --> 00:12:33,620
+عن طريق إبلاغ جهاد معينة في منظمة الصحة العالمية
+
+169
+00:12:33,620 --> 00:12:38,400
+في locally reportable diseaseمحلي، يعني طب انت لو
+
+170
+00:12:38,400 --> 00:12:41,980
+صار عندك مثلا X من ال .. من ال disease طبعا كل
+
+171
+00:12:41,980 --> 00:12:45,960
+دولة إلها قوائمها A و B و C من الأمراض اللي يجب
+
+172
+00:12:45,960 --> 00:12:48,840
+أنه نبلغ عنها، الأمراض اللي بيسموها reportable
+
+173
+00:12:48,840 --> 00:12:49,500
+disease
+
+174
+00:12:53,550 --> 00:12:57,530
+زي ما ذكرتلكوا أنا الاسم الآخر لهذا ال disease
+
+175
+00:12:57,530 --> 00:13:01,850
+black death الموت الأسود وسمي الموت الأسود أنا
+
+176
+00:13:01,850 --> 00:13:05,590
+أعتقد أن اللون الأسود أصلا يعني في معتقدات كثير من
+
+177
+00:13:05,590 --> 00:13:09,290
+العالم أنه لون يوحي بالموت و بالظلام و بال
+
+178
+00:13:09,290 --> 00:13:12,710
+darkness و كده لكن هناك اختلاف لماذا سمي ال black
+
+179
+00:13:12,710 --> 00:13:17,460
+deathالبعض بيقول انه سمى black death نظرا لان
+
+180
+00:13:17,460 --> 00:13:21,560
+الموتى اللى بيموته من هذا المرض بيكون على جسمهم
+
+181
+00:13:21,560 --> 00:13:26,280
+بقع سوداء، بقع سوداء، من اين حصلنا على البقع
+
+182
+00:13:26,280 --> 00:13:30,180
+السوداء؟ هذا ال disease فاكرين احنا لما اتكلمنا عن
+
+183
+00:13:30,180 --> 00:13:33,210
+ال endotoxinوجودنا الانتوكسين بيعمل عملية
+
+184
+00:13:33,210 --> 00:13:38,090
+vasodilatation تمام؟ وبيعمل .. ممكن يعمل عملية
+
+185
+00:13:38,090 --> 00:13:42,290
+destruction حتى للكابلاريز فتخيلوا لما يصير .. او
+
+186
+00:13:42,290 --> 00:13:43,010
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+187
+00:13:43,010 --> 00:13:43,770
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+188
+00:13:43,770 --> 00:13:44,830
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+189
+00:13:44,830 --> 00:13:45,970
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+190
+00:13:45,970 --> 00:13:46,650
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+191
+00:13:46,650 --> 00:13:46,650
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+192
+00:13:46,650 --> 00:13:46,890
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+193
+00:13:46,890 --> 00:13:50,930
+.. و .. و .. و .. و .. و .. و .. و .. و .. و .. و
+
+194
+00:13:50,930 --> 00:13:51,570
+.. و ..
+
+195
+00:13:54,450 --> 00:13:58,470
+كلكوا أكيد اتعلطوا في يوم من الأيام لضربة بالشكوش
+
+196
+00:13:58,470 --> 00:14:03,770
+أو بال .. بالباب و أظافركم أحمرت و بعدين سودت و
+
+197
+00:14:03,770 --> 00:14:07,390
+بعدين صارت بني فاللون .. نعم هذا اللون الأسود هو
+
+198
+00:14:07,390 --> 00:14:09,650
+ناتج عن الدم اللي موجود تحت .. اللي هو
+
+199
+00:14:09,650 --> 00:14:13,370
+subcutaneous hemorrhage اللي نزف تحت الجلد وبتالي
+
+200
+00:14:13,370 --> 00:14:17,490
+قيل إنه سمى الموت الأسود لهذا السبب أو للسبب اللي
+
+201
+00:14:17,490 --> 00:14:21,550
+ذكرته أنا أن اللون الأسود مرتبط بيه اللي هو الموت
+
+202
+00:14:21,550 --> 00:14:26,120
+نفسهال middle ages دى العصور البسطى 200 مليون شخص
+
+203
+00:14:26,120 --> 00:14:29,600
+ماتوا من الطعام طبعا الأوروبيين كانوا يغرقون في
+
+204
+00:14:29,600 --> 00:14:34,440
+الجهل في تلك الفترة وبالتالي كان يمكن هذه المرحلة
+
+205
+00:14:34,440 --> 00:14:39,830
+اللى فصلت الكنيسة عن المجتمعلأن الكنيسة لم تستطع
+
+206
+00:14:39,830 --> 00:14:43,590
+.. كانت الكنيسة دايما توجد فتوة .. فتاوية .. توجد
+
+207
+00:14:43,590 --> 00:14:47,170
+مبررات لكن في تلك الفترة لم تستطع الكنيسة إيجاد
+
+208
+00:14:47,170 --> 00:14:50,370
+مبررات وبالتالي الناس فقدوا إيمانهم .. إيمانهم ب
+
+209
+00:14:50,370 --> 00:14:53,810
+.. الكنيسة ال .. ال .. في أوروبا نظر اللعنة مقدرة
+
+210
+00:14:53,810 --> 00:14:57,170
+حتى على تفسير هذه الظاهرة سواء إنها لعنة من الرب
+
+211
+00:14:57,170 --> 00:15:00,150
+.. لعنة من الرب طبعا اللعنة من الرب كانت تصيب برضه
+
+212
+00:15:00,150 --> 00:15:04,010
+الرهبان اللي هم موجودين في تلك المنطقة ففشلوا في
+
+213
+00:15:04,010 --> 00:15:04,850
+تفسير هذه الظاهرة
+
+214
+00:15:07,490 --> 00:15:10,490
+أنا قولت ببو شايفها لما هذه المنطقة الانتفاخ ال
+
+215
+00:15:10,490 --> 00:15:13,010
+swelling اللي في الرقب هنا وفي swelling هنا في
+
+216
+00:15:13,010 --> 00:15:17,730
+الإيد نفسها هذه منطقة اللي هو when ال .. ال .. ال
+
+217
+00:15:17,730 --> 00:15:21,910
+.. ال .. الفليز أخدت ليها واجبة الدم تبعتها هنا في
+
+218
+00:15:21,910 --> 00:15:24,330
+أنه .. في ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+219
+00:15:24,330 --> 00:15:24,750
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+220
+00:15:24,750 --> 00:15:24,770
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+221
+00:15:24,770 --> 00:15:25,290
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+222
+00:15:25,290 --> 00:15:25,870
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+223
+00:15:25,870 --> 00:15:26,650
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+224
+00:15:26,650 --> 00:15:29,630
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+225
+00:15:29,630 --> 00:15:29,690
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+226
+00:15:29,690 --> 00:15:33,690
+ال .. ال .. ال ..
+
+227
+00:15:33,690 --> 00:15:39,850
+ال .. الالان عندي هنا transmission cycle ..
+
+228
+00:15:39,850 --> 00:15:42,690
+transmission cycle لاحظوا في عندي two cycles، حد
+
+229
+00:15:42,690 --> 00:15:47,090
+اسمها sylvatic cycle و حد اسمها urban cycle urban
+
+230
+00:15:47,090 --> 00:15:52,170
+يعني المدنية اللي هي المدن، sylvatic cycle اللي هي
+
+231
+00:15:52,170 --> 00:15:56,830
+متعلقة بالغابات، متعلقة بالغابات اللي هي بيسموها
+
+232
+00:15:56,830 --> 00:16:02,530
+ال natural cycle أصلا للبكتيريا، when wild rodents
+
+233
+00:16:02,530 --> 00:16:07,920
+القوارد البريةinfected fleas, wild rodents,
+
+234
+00:16:08,400 --> 00:16:13,500
+infected fleas، يعني من القوارض إلى البراغيث، وهذا
+
+235
+00:16:13,500 --> 00:16:17,340
+ال cycle موجودة، راح جمعة على الغابة، طاشش، ماشي
+
+236
+00:16:17,340 --> 00:16:23,700
+الحال، او راح تكشف بالغلط أصيبتمام؟ ك human
+
+237
+00:16:23,700 --> 00:16:28,080
+accidentally يعني مش جزء من ال cycle هو لكن يمكن
+
+238
+00:16:28,080 --> 00:16:32,900
+أن يصاب من ال sylvatic cycle لكن في ال urban cycle
+
+239
+00:16:32,900 --> 00:16:35,960
+شوفوا الآن نفس ال .. نفس ال cycle تبقى من؟ ال
+
+240
+00:16:35,960 --> 00:16:42,090
+sylvatic بس لإن احتكاكنا احنا مع ال ratsأكتر لإن
+
+241
+00:16:42,090 --> 00:16:45,690
+احنا و اياهم في نفس البيئة، في نفس البيئة، أعتقد
+
+242
+00:16:45,690 --> 00:16:48,670
+إن الجردان هنا في فلسطين في فترة من الفترات كانت
+
+243
+00:16:48,670 --> 00:16:51,930
+منتشرة بشكل كبير، يمكن يخفوا ال .. لإن في مكافحة
+
+244
+00:16:51,930 --> 00:16:56,040
+كويسة من البلديات، لكن ..احنا وياهم وعلى فكرة هم
+
+245
+00:16:56,040 --> 00:17:00,420
+very successful survivors يعني الجوردان معروفين ان
+
+246
+00:17:00,420 --> 00:17:04,640
+انتوا عارفين انه فى فلسطين التاريخية مالهمش عندنا
+
+247
+00:17:04,640 --> 00:17:11,440
+وجود كبير بعدد كبيرة بس انتقلوا يعني الاعتقاد انهم
+
+248
+00:17:11,440 --> 00:17:18,740
+انتقلوا مع السفن زوج او زوجين عبوا القاراتفعندهم
+
+249
+00:17:18,740 --> 00:17:21,360
+مقدرة انتوا عارفين انهم بيعملوا nesting على
+
+250
+00:17:21,360 --> 00:17:25,540
+الأشجار الآن بيعشوا على الشجر بيستخدموا كل الحيال
+
+251
+00:17:25,540 --> 00:17:29,220
+اللي ممكن يستخدمها مخلوق في البقاء حي فبتالي يعني
+
+252
+00:17:29,220 --> 00:17:33,660
+إمكانية انتشارهم مرة أخرى بيكون موجودة يعني
+
+253
+00:17:33,660 --> 00:17:37,840
+المقادرات عاديهم تماما احناإذن rats, fleas, rats,
+
+254
+00:17:37,960 --> 00:17:41,080
+fleas بيجي لمين الآن؟ ال human و نالكوا ال human
+
+255
+00:17:41,080 --> 00:17:44,820
+في stage one و stage two مابينقللوش لبعض فقط في ال
+
+256
+00:17:44,820 --> 00:17:50,580
+stage رقم تلاتة اللي هو pneumonic epilepsy متفقين؟
+
+257
+00:17:55,040 --> 00:17:59,480
+شوفوا المرحلة اللي في الـSepsimic Plague لما يكون
+
+258
+00:17:59,480 --> 00:18:03,940
+البكتيريا وصلت لدم واضح ان هذا طبعا اللون الأسود
+
+259
+00:18:03,940 --> 00:18:07,500
+عبارة عن Necrosis يعني هذا الأصابع ماتت أصلا
+
+260
+00:18:07,500 --> 00:18:12,740
+المنطقة دي ماتت ال blood supply بطل يصلها ليش بطل
+
+261
+00:18:12,740 --> 00:18:15,420
+يصلها؟ زي ما قلتلكوا أنا في اندي disseminated
+
+262
+00:18:15,420 --> 00:18:21,270
+intravascular coagulation جلطات قدتسد تمام اللي هو
+
+263
+00:18:21,270 --> 00:18:24,370
+الكابليرز وبالتالي الدم بيبطل يصل طبعا هذا ممكن
+
+264
+00:18:24,370 --> 00:18:28,590
+يكون برضه عبارة عن rashes في حالة ان هو pneumonic
+
+265
+00:18:28,590 --> 00:18:32,630
+plague طيب
+
+266
+00:18:32,630 --> 00:18:34,970
+عرفنا ال diseases و احنا جونا مش اطباء احنا
+
+267
+00:18:34,970 --> 00:18:38,070
+diagnostic microbiologist وبالتالي ليس من مهمنا
+
+268
+00:18:38,070 --> 00:18:42,590
+انه انشخص المرض ك disease تمام من ال clinical
+
+269
+00:18:42,590 --> 00:18:46,390
+picture لكن بندرس بعض الصفات
+
+270
+00:18:48,720 --> 00:18:53,240
+عن المرض حتى نستطيع ان نحدد ما هي العينة المثلة
+
+271
+00:18:53,240 --> 00:18:59,340
+لتشخيص المرض ففي حالة ال paponic plague من اين
+
+272
+00:18:59,340 --> 00:19:03,700
+بناخد البكتيريا من الببو نفسه من الببو نفسه بنعمل
+
+273
+00:19:03,700 --> 00:19:07,980
+aspiration ايش هي aspiration يعني شفط بنحط needle
+
+274
+00:19:07,980 --> 00:19:13,800
+و syringe و بنشفط طب اذا ماطلعش معانا سائلبنحقق من
+
+275
+00:19:13,800 --> 00:19:18,840
+عنا سائل saline مؤقّم في الببو نفسه تمام؟ بنعمل
+
+276
+00:19:18,840 --> 00:19:23,020
+washing يعني بنغسل .. بنحط saline فبنغسل المنطقة و
+
+277
+00:19:23,020 --> 00:19:26,460
+بنسحقها مرة تانية مش في هذا الحالة ال saline احتكب
+
+278
+00:19:26,460 --> 00:19:30,140
+ال tissue إذا كان فيه بكتيريا أخدناها منه وبتاعي
+
+279
+00:19:30,140 --> 00:19:34,360
+بيسموها ببوز أسبيريت تمام؟ ففي هذا الحالة بيكون
+
+280
+00:19:34,360 --> 00:19:40,520
+انت ماخد احتياطاتكلابس كمامة و gloves و لما تتخلص
+
+281
+00:19:40,520 --> 00:19:42,960
+من كل الأدوات اللى استخدمتها بتتخلص منها بطريقة
+
+282
+00:19:42,960 --> 00:19:47,740
+آمنة واحد بيقولك طب و هو مش معدي فى المرحلة دى مش
+
+283
+00:19:47,740 --> 00:19:54,380
+معدي انت لأ تستطيع ان تحدد ان هل هو اصلا ما زال في
+
+284
+00:19:54,380 --> 00:19:57,960
+ال babonic plague ولا ممكن يكون اصلا متطور ل other
+
+285
+00:19:57,960 --> 00:20:02,720
+stages هذا رقم واحد رقم اتنين انت بتكشف تساهم فى
+
+286
+00:20:02,720 --> 00:20:07,200
+نشر البكتيريا فى ال environmentفلازم تاخد احتياطك
+
+287
+00:20:07,200 --> 00:20:10,740
+بشكل جيد رقم اتنين blood بقى اعتقد احنا المحاضرة
+
+288
+00:20:10,740 --> 00:20:13,440
+اللى فات او اللى جابلها قولنا لكوا ان ال blood
+
+289
+00:20:13,440 --> 00:20:15,920
+culture تبعاتنا بتختلف عن ال blood collection عادي
+
+290
+00:20:15,920 --> 00:20:20,020
+بدنا نعمل عملية اللى هوا disinfection بكحول و
+
+291
+00:20:20,020 --> 00:20:22,720
+بعدين ابتكتشار of iodine لمدة دقيقتين و بعدين
+
+292
+00:20:22,720 --> 00:20:26,860
+ازالة بكحول العينة التالتة وهي ايضا عينة من
+
+293
+00:20:26,860 --> 00:20:32,060
+العينات الصعبة اللى الالـ Sputum قولنا مدى صعوبته
+
+294
+00:20:32,060 --> 00:20:34,920
+هو معبر عن الـ Pulmonary Infection الـ Pneumonic
+
+295
+00:20:34,920 --> 00:20:38,420
+Plague في هذا الحالة لكن مدى .. ايش الصعوبة فيه؟
+
+296
+00:20:38,420 --> 00:20:41,620
+انه لما بنجمعه بيمر قبر الفم و الفم بيحتوي على
+
+297
+00:20:41,620 --> 00:20:44,940
+Normal Microbiota وبالتالي نسبة ال Contamination
+
+298
+00:20:44,940 --> 00:20:49,580
+بتكون عالية فبدنا نعطي Instructions لل patient how
+
+299
+00:20:49,580 --> 00:20:54,080
+to collect a proper specimen في ال Sputum كيف؟
+
+300
+00:20:54,080 --> 00:20:58,630
+بنقوله Gargle، Gargle يعني غرجل، بالماءtwice،
+
+301
+00:20:58,630 --> 00:21:03,710
+thrice، مرتين، تلاتة، تمام؟ ثرلي، بعدين بنعطيه
+
+302
+00:21:03,710 --> 00:21:07,610
+wide mouth container، مابنعطهوش نبوبة، بنعطيه wide
+
+303
+00:21:07,610 --> 00:21:11,030
+mouth container، أفضل، أي أفضل حاجة نجمع فيها
+
+304
+00:21:11,030 --> 00:21:15,170
+sputum petri dish، عارفين ال petri dish؟ واسع،
+
+305
+00:21:15,170 --> 00:21:18,450
+تمام؟ أيه ده معناهش؟ screw capped bottle، screw
+
+306
+00:21:18,450 --> 00:21:23,180
+capped bottleلكن wide mouth يعني الفم تبعها أو
+
+307
+00:21:23,180 --> 00:21:27,620
+الفتحة تبعها كبيرة، عارفين ليش؟ فتحة كبيرة؟ عشان
+
+308
+00:21:27,620 --> 00:21:32,060
+مانجبرش المريض أنه لما يكح عشان يركز لـ sputum في
+
+309
+00:21:32,060 --> 00:21:36,560
+المكان اللي بديه يحط فيه العينة، مايمسكهاش بين
+
+310
+00:21:36,560 --> 00:21:40,690
+شفافه أصنعهموأنا قلنالكوا الأسنان والشفافيف ال
+
+311
+00:21:40,690 --> 00:21:43,770
+holding ال sputum بيعرض ال .. ال sputum لمين؟ لل
+
+312
+00:21:43,770 --> 00:21:47,630
+saliva فبتالي بتفير إنها contamination إذا لم يحدث
+
+313
+00:21:47,630 --> 00:21:52,110
+المقدرة من قبل المريض على إنه يعطينا sputum و ال
+
+314
+00:21:52,110 --> 00:21:54,210
+sputum المواصفات في ال diagnostic في المعمل
+
+315
+00:21:54,210 --> 00:21:58,570
+هتدرسوها أكمبس سيلز في ال high power field وإذا
+
+316
+00:21:58,570 --> 00:22:03,650
+كان فيه أكتر من خمستاشر لعشرين epithelial في ال
+
+317
+00:22:03,650 --> 00:22:08,210
+high power field يبقى العينا مش bus وبتالي أو عفوا
+
+318
+00:22:08,210 --> 00:22:12,120
+مش sputum وبتالي بنعملها rejectionالان اذا ما
+
+319
+00:22:12,120 --> 00:22:16,900
+اجدرناش ايش من الحل؟ فيندي حالين، الحل الاول ان
+
+320
+00:22:16,900 --> 00:22:20,880
+انا اعمله induction ل ال sputum production عن طريق
+
+321
+00:22:20,880 --> 00:22:26,260
+ال cupping ال cupping اللي هي عملية وضع الكف تبع
+
+322
+00:22:26,260 --> 00:22:31,500
+الايد بيد الشكل و من ثم اضرب على ظهر المريض برقة
+
+323
+00:22:31,500 --> 00:22:35,960
+تمام؟ من تحت الاعلى مع طلب من المريض الادعاء
+
+324
+00:22:35,960 --> 00:22:42,190
+بالكحةتضرب وهو بيصير كح انت بتعمله induction و
+
+325
+00:22:42,190 --> 00:22:44,930
+بتكون ال container جنبه إذا طلّع سيوتان بيطلع عنيه
+
+326
+00:22:44,930 --> 00:22:49,250
+فشلنا في هذا الحالة بدنا نرجع لخيار رقم تلاتة اللي
+
+327
+00:22:49,250 --> 00:22:52,310
+هو Trans Tracheal Aspirate بدنا ندخل مش احنا طبعا
+
+328
+00:22:52,310 --> 00:22:56,570
+بدنا skilled physician skilled physician او
+
+329
+00:22:56,570 --> 00:23:00,930
+qualified nurse انه يدخل needle Trans Tracheal هنا
+
+330
+00:23:00,930 --> 00:23:06,050
+و بيعملشفت طبعا هذه العينة أفضل عينة لنا ليش بمرش
+
+331
+00:23:06,050 --> 00:23:10,890
+عبر الفم لكن هي أصعب عين لمن؟ للمريض وبالتالي يعني
+
+332
+00:23:10,890 --> 00:23:13,850
+برضه احنا بناخد موازنات ما بين ال patient
+
+333
+00:23:13,850 --> 00:23:20,010
+convenience وبين العينة الأفضل ممكن كمان ناخد عينة
+
+334
+00:23:20,010 --> 00:23:22,810
+أخيرة جون عنها اللي هي ال biopsy من ال lymph node
+
+335
+00:23:24,230 --> 00:23:28,610
+احنا كنا فيها ببوز و الببوز عبارة عن مين؟ عبارة عن
+
+336
+00:23:28,610 --> 00:23:33,290
+lymph nodes وبالتالي ممكن ناخد منهم عينة و خاصة ان
+
+337
+00:23:33,290 --> 00:23:37,170
+البكتيريا هتكون موجودة هناك بكثرة شديدة جدا
+
+338
+00:23:37,170 --> 00:23:41,970
+Staining and culture media اتفقنا ان البكتيريا دي
+
+339
+00:23:41,970 --> 00:23:47,610
+انتروبكترياسيمش اسمها خطير وصعبة وكده لكن تنمو على
+
+340
+00:23:47,610 --> 00:23:49,650
+الأوساط الزراعية اللي بتنمو عليها الاشريشيا
+
+341
+00:23:49,650 --> 00:23:52,930
+الكولاي من حصة الحضنة طبعا ال ايكولاي والسليمونيلا
+
+342
+00:23:52,930 --> 00:23:55,510
+والشيجيلا بكل سهولة و يسهولة تنمو على بلد أجار
+
+343
+00:23:55,510 --> 00:23:58,030
+تنمو على الماكنكي تنمو على ال نوترياند أجار حتى
+
+344
+00:23:58,030 --> 00:24:03,730
+تمام؟ وهذه الصفات بدنا نستخدمها للتمييز بينها وبين
+
+345
+00:24:03,730 --> 00:24:06,810
+ال
+
+346
+00:24:06,810 --> 00:24:10,570
+باستريلا تمام؟ لأن ال باستريلا لن تنمو على
+
+347
+00:24:10,570 --> 00:24:14,810
+نوترياند أجار هي رقم واحدرقم اتنين الباس توريلا لن
+
+348
+00:24:14,810 --> 00:24:19,910
+تنمو على الماكنكي رقم اتنين رقم تلاتة الباس توريلا
+
+349
+00:24:19,910 --> 00:24:27,310
+لن تنمو على ال room temperature بينما
+
+350
+00:24:27,310 --> 00:24:31,090
+العكس لمن؟ لليرسينيا it can grow at room
+
+351
+00:24:31,090 --> 00:24:35,170
+temperature بدي أجلبهم بالمجلوب و أحفظهم بالمجلوب
+
+352
+00:24:35,170 --> 00:24:38,990
+بدي أقول لليرسينيا ال يرسينيا can grow on ماكنكي
+
+353
+00:24:38,990 --> 00:24:42,990
+and nutrient agarand can grow at room temperature
+
+354
+00:24:42,990 --> 00:24:48,250
+بينما الباستريلا لا يمكن الفحص الأخير والمميز
+
+355
+00:24:48,250 --> 00:24:54,510
+الأساسي اللي هم مش هدول التلاتة الباستريلا
+
+356
+00:24:54,510 --> 00:24:58,950
+اكسيدايز positive بينما اليرسينيا انتيروبكتريازي
+
+357
+00:24:58,950 --> 00:25:03,270
+صح يبقى اكسيدايزي نيجاتيف هذه نقطة نقطة أساسية طيب
+
+358
+00:25:07,360 --> 00:25:10,880
+أحنا قلنا إن عملية ال cultivation على ال routine
+
+359
+00:25:10,880 --> 00:25:13,400
+ال laboratory media مافيش فيها أي أشكالية لأننا
+
+360
+00:25:13,400 --> 00:25:16,080
+نتكلم عن ال identification by biochemical test
+
+361
+00:25:16,080 --> 00:25:19,600
+بقولنا يرسينيا pistis is differentiated from other
+
+362
+00:25:19,600 --> 00:25:22,260
+Yersinia species by a negative urease test مين ال
+
+363
+00:25:22,260 --> 00:25:26,550
+negative urease test؟اليرسينابستس يبقى الأخرى هيش
+
+364
+00:25:26,550 --> 00:25:30,190
+هيكونه يوريايز بوسط، بس خدوا بقالكوا، هد هتملنا
+
+365
+00:25:30,190 --> 00:25:33,650
+confusion مع مين الآن؟ مع السلمونيلا، صح ولا لأ؟
+
+366
+00:25:33,650 --> 00:25:37,810
+مع السلمونيلا، لإنه السلمونيلا والشجلة وهي
+
+367
+00:25:37,810 --> 00:25:42,590
+اليرسينابستس كلهم التلاتة هي يوريايز نيجاتيف، لكن
+
+368
+00:25:42,590 --> 00:25:45,970
+من حصن حظنا إن هد البكتيريا كوكوباصيلا، من حصن
+
+369
+00:25:45,970 --> 00:25:49,430
+حظنا إن هد البكتيريا safety pin appearance، يعني
+
+370
+00:25:49,430 --> 00:25:55,510
+بتختلف شكلا مع مين؟ على السلمونيلا وعن الشجلةأحد
+
+371
+00:25:55,510 --> 00:25:58,330
+الفحوصات المهمة اللى قلنا عنها ممكن تساعدنا اللى
+
+372
+00:25:58,330 --> 00:26:02,390
+هى ال motility at 37 degrees they are all non
+
+373
+00:26:02,390 --> 00:26:09,870
+motile لكن ال ال ال الاليسينيا و ال اليسينيا both
+
+374
+00:26:09,870 --> 00:26:17,050
+are motile at 22 degree centigrade هذا
+
+375
+00:26:17,050 --> 00:26:20,650
+الشكل اللى قلنا عنه safety pin appearance طلعه
+
+376
+00:26:25,050 --> 00:26:28,390
+بالظبط زي الدبوس اللي هو ال mash bag اللي .. اللي
+
+377
+00:26:28,390 --> 00:26:33,330
+بيستخدموه للأطفال عارفينه و مش عارفينه؟ دبوس؟ أيوه
+
+378
+00:26:33,330 --> 00:26:36,790
+شكله زيك تجربة بيكون زي الزنبارك بيفتح و بيبقوا
+
+379
+00:26:36,790 --> 00:26:41,890
+يلو safety مدخل .. mash bag اما انها mash bag شكرا
+
+380
+00:26:41,890 --> 00:26:47,710
+على المصطلح mash bag safety pin bipolar stain rod
+
+381
+00:26:49,820 --> 00:26:52,080
+هذه المستعمرة عليها البلد أجار بيقولها sometimes
+
+382
+00:26:52,080 --> 00:27:00,600
+it is hemolytic يعني مش دايما أو مش صفة مميزة على
+
+383
+00:27:00,600 --> 00:27:03,120
+ما كنكي أجار هي none lactose fermenting in a raw
+
+384
+00:27:03,120 --> 00:27:03,680
+bacterium
+
+385
+00:27:07,150 --> 00:27:09,570
+طبعا ال triptocase soy broth غالبا هو الوسط
+
+386
+00:27:09,570 --> 00:27:12,810
+المشهور هذه ال blood culture فاكرين لما حكينا عن
+
+387
+00:27:12,810 --> 00:27:16,570
+ال blood culture بطل احنا بناخد الدم و بنزرعه داخل
+
+388
+00:27:16,570 --> 00:27:21,390
+هذا ال بطل ال .. ال ايد مسحناها كحول ايودين كحول
+
+389
+00:27:21,390 --> 00:27:24,630
+البطل من هنا احنا مابنفتحش البطل خدوا بالكوا احنا
+
+390
+00:27:24,630 --> 00:27:27,770
+بس بنشيل غطة و فيه .. اللي ها rubber .. rubber
+
+391
+00:27:27,770 --> 00:27:31,150
+ممكن ندخل فيه syringe لكن بنمسح ال rubber برضه
+
+392
+00:27:31,150 --> 00:27:35,480
+بكحول و بأيودين و بنمسحه بعد ذلك بمين؟باللي هو
+
+393
+00:27:35,480 --> 00:27:39,060
+الكحول يعني اللي عملناه على إيد زميلكو بنعمله نفس
+
+394
+00:27:39,060 --> 00:27:44,080
+الاشي هنا حتى نضمن إن الميكروب بالفعل مش من البيئة
+
+395
+00:27:44,080 --> 00:27:47,360
+ولا من إيد المريض وانما من دم المريض فقط لغاية
+
+396
+00:27:47,360 --> 00:27:50,200
+البكتيريا بتنمو بشكل جيد على هذا الوصف
+
+397
+00:27:53,780 --> 00:27:56,920
+السيرولوجي احنا ممكن نستخدم عارفين السيرولوجي دي
+
+398
+00:27:56,920 --> 00:27:59,860
+two ways ولا لا السيرولوجي بنكشف عن انتجن باستخدام
+
+399
+00:27:59,860 --> 00:28:03,760
+antibody او بنكشف عن antibody باستخدام انتجن
+
+400
+00:28:03,760 --> 00:28:07,220
+الانتجن اللي هو البكتيريا نفسها تمام بنستخدمها
+
+401
+00:28:07,220 --> 00:28:11,160
+للكشف عن ال antibodies في الvision serum او ال
+
+402
+00:28:11,160 --> 00:28:13,380
+antibodies اللي هي commercially available
+
+403
+00:28:13,380 --> 00:28:17,880
+بنستخدمها لما بنعزل البكتيريا suspected بنعمل
+
+404
+00:28:17,880 --> 00:28:22,840
+agglutination بالantibody ضد اللي هو الياسينيا
+
+405
+00:28:26,160 --> 00:28:29,600
+الـ Antimicrobial Sensitivity أو Susceptibility
+
+406
+00:28:29,600 --> 00:28:32,820
+Testing تركزوا معايا في الجزء هذا لأنه هذا أول مرة
+
+407
+00:28:32,820 --> 00:28:36,800
+برضه مر معناه معلوم من هالنوع هذا انت بتعرفوا حاجة
+
+408
+00:28:36,800 --> 00:28:41,650
+اسمها In Vitro و In Vivoالانفيترو يعني يعني في
+
+409
+00:28:41,650 --> 00:28:45,370
+الطبق في الانبوبة في المعمل الانفيفو في ال ..
+
+410
+00:28:45,370 --> 00:28:48,470
+غالبا ال antibiotic behavior في الانفيفو و
+
+411
+00:28:48,470 --> 00:28:52,990
+الانفيترو واحد يعني اللي بنجيسه على الطبق بنقدر ان
+
+412
+00:28:52,990 --> 00:28:57,310
+.. ان .. خدنا نقول ان عامة معالمين على الجسم with
+
+413
+00:28:57,310 --> 00:29:00,910
+some exception هذه البكتيريا one exception مثال
+
+414
+00:29:00,910 --> 00:29:05,690
+بقولنا البنسالين may show slight to wide zone of
+
+415
+00:29:05,690 --> 00:29:11,440
+inhibition يعني يعطيناانطباع ان البكتيريا ماتت من
+
+416
+00:29:11,440 --> 00:29:14,440
+من من البنسالين مش ان ال zone of inhibition هي
+
+417
+00:29:14,440 --> 00:29:18,300
+مقياس لمدى موت البكتيريا وبينجيسه وبيعدم يحدد ان
+
+418
+00:29:18,300 --> 00:29:22,840
+هو ال sense of ده لأAlthough penicillin has no in
+
+419
+00:29:22,840 --> 00:29:26,000
+vivo activity against this organism على الرغم من
+
+420
+00:29:26,000 --> 00:29:31,120
+ذلك ال penicillin لا يعطي او لا يعطي اي نشاط ضد
+
+421
+00:29:31,120 --> 00:29:35,720
+البكتيريا في جسم المريض وصل الصورة دلال عليها على
+
+422
+00:29:35,720 --> 00:29:39,340
+ان في change ما بين ال in vitro و ال in vivo
+
+423
+00:29:39,340 --> 00:29:43,630
+behaviorالـ sensitivity result should be
+
+424
+00:29:43,630 --> 00:29:46,610
+recommended by اللي هو او sensitivity testing
+
+425
+00:29:46,610 --> 00:29:51,030
+should be recommended by ال CLSI CLSI اللي هي احد
+
+426
+00:29:51,030 --> 00:29:54,990
+اشهر المؤسسات وانا يعني هاعط .. هاعطلكوا ان شاء
+
+427
+00:29:54,990 --> 00:29:58,130
+الله قريبا ملف CLSI
+
+428
+00:30:01,530 --> 00:30:07,130
+ملف من هذه المؤسسة هذا الملف بيعطيك التوصيات لكل
+
+429
+00:30:07,130 --> 00:30:10,270
+ميكروب من الميكروبات بمعنى لو انت عزالت انترو
+
+430
+00:30:10,270 --> 00:30:14,190
+بكترياسي ماذا يجب عليك ان تضع من المضادات الحيوية
+
+431
+00:30:14,190 --> 00:30:19,450
+ايش الميزة في هذه المؤسسة انه almost followed all
+
+432
+00:30:19,450 --> 00:30:23,850
+over the world يعني اكتر أثيقة او اكتر مؤسسة متبعة
+
+433
+00:30:23,850 --> 00:30:26,330
+في ال sensitivity testing في العالم كلها لو انا
+
+434
+00:30:26,330 --> 00:30:32,900
+بدأ اعمل researchو أشوف أستخدم مضادات حيوية بروح
+
+435
+00:30:32,900 --> 00:30:36,770
+وأنا أمسك الوثيقة هي كمرجعةإذا جالولي ال انترو
+
+436
+00:30:36,770 --> 00:30:39,770
+بكتيريا سيبدها X و Y و Z و C و صد و I من ال
+
+437
+00:30:39,770 --> 00:30:43,170
+antibiotic لازم أتبع هذه القائمة و أفحص البكتيريا
+
+438
+00:30:43,170 --> 00:30:46,870
+تبعتي لهذه القائمة وبالتالي بتوفرلي هذه مرجعية
+
+439
+00:30:46,870 --> 00:30:51,290
+ممتازة updated يعني محدثة باستمرار كل سنة أو سنتين
+
+440
+00:30:51,290 --> 00:30:56,610
+بيحدثوها التحديث بيكون مبني على زيادة في معلوماتنا
+
+441
+00:30:56,610 --> 00:30:59,650
+أو تغيير في ال behavior تبع ال micro organism
+
+442
+00:31:01,680 --> 00:31:05,340
+متفقين على ان ال in vitro و ال in vivo هنا
+
+443
+00:31:05,340 --> 00:31:08,760
+behavior انتباطك مختلف شوية لكن بيقولنا ان ال
+
+444
+00:31:08,760 --> 00:31:09,940
+tetracycline
+
+445
+00:31:11,900 --> 00:31:16,540
+الدراجة الخيار للبكتيريا تتراثاكلين هو مش واحد،
+
+446
+00:31:16,540 --> 00:31:20,000
+مجموعة تتراثاكلين استراتومايسين أو الكلورامفينيكول
+
+447
+00:31:20,000 --> 00:31:23,800
+وسيلفونوميتز هم مفيدين في التعامل مع بلاي لحد الآن
+
+448
+00:31:23,800 --> 00:31:27,940
+مافيش معلومات عن ال resistance أنها مقاومة أو
+
+449
+00:31:27,940 --> 00:31:34,360
+أصبحت مقاومة لكن كإجراء عالمي standard علينا أن
+
+450
+00:31:34,360 --> 00:31:36,680
+نقوم بعمل sensitivity testing لكل اللي هما
+
+451
+00:31:36,680 --> 00:31:37,520
+isolates
+
+452
+00:31:40,070 --> 00:31:42,030
+اليرسينيا enterocolitica ويرسينيا
+
+453
+00:31:42,030 --> 00:31:45,390
+pseudotuberculosis جونا احنا هدول الاتنين بيختلفوا
+
+454
+00:31:45,390 --> 00:31:48,310
+تماما عن اليرسينيا pestis هداك ال .. هداك
+
+455
+00:31:48,310 --> 00:31:51,870
+البكتيريا بتسبب انها ليه الطعون بينما هدولها بسببه
+
+456
+00:31:51,870 --> 00:31:56,870
+intestinal infection اللي هو جونا عنهدياريا
+
+457
+00:31:56,870 --> 00:31:59,590
+انتراليتس او terminal ileitis clinical symptoms
+
+458
+00:31:59,590 --> 00:32:02,010
+cannot be distinguished from those caused by other
+
+459
+00:32:02,010 --> 00:32:05,330
+enteric pathogens يعني لا استطيع من خلال الأعراض
+
+460
+00:32:05,330 --> 00:32:10,490
+السريرية ان يقول these symptoms are caused by
+
+461
+00:32:10,490 --> 00:32:13,330
+Yersinia Enterocolitica يمكن Yersinia
+
+462
+00:32:13,330 --> 00:32:15,810
+Enterocolitica يمكن Salmonella يمكن Shigella يمكن
+
+463
+00:32:15,810 --> 00:32:19,370
+Vibrio لا استطيع based on symptoms يعني كلهم
+
+464
+00:32:19,370 --> 00:32:22,670
+بتشابهوا مع بعض عشان انا قلتلك و ال stool culture
+
+465
+00:32:23,640 --> 00:32:28,520
+هي من أصعب المزارع نظرا لكثرة مسببات الديارية
+
+466
+00:32:28,520 --> 00:32:32,020
+وهيضيفوا على القائمة الآن أننا أخدنا الـ E.coli
+
+467
+00:32:32,020 --> 00:32:36,480
+بأنواعها صح؟ أخدنا السلمونيلا، أخدنا الشيجيلا،
+
+468
+00:32:36,480 --> 00:32:39,780
+أخدنا اليرسينيا، هناخد كمان اللي هم ال
+
+469
+00:32:39,780 --> 00:32:42,880
+Campylobacter و ال Vibrio و ال Staphylococcus
+
+470
+00:32:42,880 --> 00:32:48,840
+فهيكون لنا مجموعة كبيرةزي اي gastrointestinal
+
+471
+00:32:48,840 --> 00:32:51,420
+tract infection فيك ال oral transmission هو ال
+
+472
+00:32:51,420 --> 00:32:55,040
+mean الأساسي لانتقال مش الأساسي الوحيد لانتقال على
+
+473
+00:32:55,040 --> 00:32:57,740
+الرغم من انه في evidence بتقول انه ممكن ينتقل عبر
+
+474
+00:32:57,740 --> 00:33:01,000
+ال earth robots ايش ال earth robots اللي هم
+
+475
+00:33:01,000 --> 00:33:03,780
+الحشرات يعني ممكن كمان برضه عن طريق العضات تبعت ال
+
+476
+00:33:03,780 --> 00:33:06,840
+human to human transmission is well documented
+
+477
+00:33:07,870 --> 00:33:10,630
+بمعنى اخر انه من انسان الى انسان الانتقال اللى
+
+478
+00:33:10,630 --> 00:33:15,730
+موجود الان الان في نقطة مهمة جدا البكتيريا هذى ال
+
+479
+00:33:15,730 --> 00:33:17,830
+Yersinia enterocolitica و Yersinia subtropicus
+
+480
+00:33:17,830 --> 00:33:22,490
+موجودة في قطاعنا الحبيب في قطاع غزة في فلسطين لو
+
+481
+00:33:22,490 --> 00:33:28,190
+فتشنا على دفاتر السجلات المزارع تبعت ال stool في
+
+482
+00:33:28,190 --> 00:33:31,350
+كل مختبرات قطاع غزة مش هلاجة البكتيريا مش هلاجة
+
+483
+00:33:31,350 --> 00:33:35,990
+لها اسم هل هذا يعني ان البكتيريا مش موجودة؟لش مش
+
+484
+00:33:35,990 --> 00:33:39,230
+موجود اسمها؟ لإن احنا مابندورش عليها specifically،
+
+485
+00:33:39,230 --> 00:33:42,770
+بندورش عليها يعني مافيش عندنا حد طبيب بيطلب
+
+486
+00:33:42,770 --> 00:33:46,830
+selective أو special culture لاليرسينيا تيرا
+
+487
+00:33:46,830 --> 00:33:51,350
+كوليتكا، لكن الدراسات اللي أجريناها، أجرينا دراسة
+
+488
+00:33:51,350 --> 00:33:57,530
+واحدة، دراسة واحدةعلى مياه الشرب، المياه العادمة،
+
+489
+00:33:57,530 --> 00:34:01,570
+ميات البحر، الأشبان، الألبان، الحليب، اللحم،
+
+490
+00:34:01,570 --> 00:34:05,150
+ووجدنا اليرسينيا في معظم العينات هذه، مش في
+
+491
+00:34:05,150 --> 00:34:08,510
+معظمها، اقصد يعني .. يعني انه .. انه تسعين بالمية
+
+492
+00:34:08,510 --> 00:34:10,630
+من العين .. من نوع العينة، لأ، يعني على الأقل
+
+493
+00:34:10,630 --> 00:34:14,150
+عزلناها من مرة من كل العينات أو من معظم العينات
+
+494
+00:34:14,750 --> 00:34:18,830
+فاليرسينيا انترو .. عزلناها كمان من ال appendices
+
+495
+00:34:18,830 --> 00:34:21,310
+تبعت الناس اللي بيعملوا appendectomy اللي بيعملوا
+
+496
+00:34:21,310 --> 00:34:26,730
+إزالة زايدة دودية، تمام؟ فاليرسينيا انتروكوليتكا
+
+497
+00:34:26,730 --> 00:34:33,250
+موجودة لكن عدم اهتمامنا وعدم تركيزنا على .. وعمل
+
+498
+00:34:33,250 --> 00:34:36,770
+selective stool culture لها البكتيريا بيجعلنا
+
+499
+00:34:36,770 --> 00:34:40,790
+نتجاوزها وكاينها غير موجودة وللأسف هذا الكلام مش
+
+500
+00:34:40,790 --> 00:34:43,830
+بس للبكتيريا هذه ال other bacteria أيضا
+
+501
+00:34:47,200 --> 00:34:53,780
+بشبهوا فكرتهم انه بيبقى برضه invasion تمام ولكن
+
+502
+00:34:53,780 --> 00:34:59,540
+غالبا مابيصلوش لمرحلة ال blood فاكرينش شجلة؟
+
+503
+00:34:59,770 --> 00:35:04,050
+الشيجيلة والسلمونيلا اتنين اخترقوا ال intestinal
+
+504
+00:35:04,050 --> 00:35:07,530
+wall لكن السلمونيلا نجحت من ان تصل لل blood بينما
+
+505
+00:35:07,530 --> 00:35:10,030
+الشيجيلة فشلت صار لها clearance تمام صار لها
+
+506
+00:35:10,030 --> 00:35:15,190
+clearance فغالبا بره يوم واحد يمكن ان تصل لكن ال
+
+507
+00:35:15,190 --> 00:35:19,550
+ال main infection او ال most of the cases are
+
+508
+00:35:19,550 --> 00:35:24,150
+confined to the intestinal tractcollection and
+
+509
+00:35:24,150 --> 00:35:29,190
+processing of the specimen في عندى الستول كعينة
+
+510
+00:35:29,190 --> 00:35:31,590
+مهمة جدا واحنا قول نجابة شوية انه ممكن تصل ل blood
+
+511
+00:35:31,590 --> 00:35:36,750
+فبالتالي ممكن ناخد عينات blood excised mesenteric
+
+512
+00:35:36,750 --> 00:35:38,750
+lymph node وين ال mesenteric lymph nodes هذان
+
+513
+00:35:38,750 --> 00:35:41,510
+الموجودين؟ في ال intestine عبارة عن لما بيدخل
+
+514
+00:35:41,510 --> 00:35:45,810
+بمنظر بياخدوا جزء من ال mesenteric lymph node
+
+515
+00:35:45,810 --> 00:35:52,550
+للمزرعة طبعا ليش ممكن يلجأ الطريق لمنظر هنا؟لأنه
+
+516
+00:35:52,550 --> 00:35:55,630
+مش عارف السبب عمل salmonella عمل shigella عمل
+
+517
+00:35:55,630 --> 00:35:59,930
+entero عفوا عمل stool routine analysis لا في
+
+518
+00:35:59,930 --> 00:36:04,330
+أنتميبة ولا في gardia ولا في أي عامل مسبب فبضطر
+
+519
+00:36:04,330 --> 00:36:08,350
+الطبيب في هذه الحالة يلجأ ويدخل بمين؟ بمنظر فخلال
+
+520
+00:36:08,350 --> 00:36:11,550
+دخوله في المنظر بيشوف inflamed mesenteric lymph
+
+521
+00:36:11,550 --> 00:36:18,890
+node بياخد جزء و بيطلع ايه؟ كعينةمن هي وسط يعني من
+
+522
+00:36:18,890 --> 00:36:22,450
+الأوساط اللي very highly selective very highly
+
+523
+00:36:22,450 --> 00:36:26,070
+selective وانا ميزت الدور اللي فات بين general و
+
+524
+00:36:26,070 --> 00:36:29,650
+selective و highly selective لما اتكلمت عن
+
+525
+00:36:29,650 --> 00:36:33,210
+السليمانية لو فرصت ففاكرين وبالتالي انا قلت وصفت
+
+526
+00:36:33,210 --> 00:36:36,730
+ان في بعض الأوساط تعتبر highly selective افضل نظر
+
+527
+00:36:36,730 --> 00:36:39,350
+يرسينيا selective agar is an excellent selective
+
+528
+00:36:39,350 --> 00:36:41,610
+medium for the isolation of yersinia
+
+529
+00:36:41,610 --> 00:36:46,110
+enterocolitica from stool or sputumSputum يعني فيه
+
+530
+00:36:46,110 --> 00:36:50,050
+إمكانيك يعمل صلوين لاللي هو تمل .. تمل نيومونيا
+
+531
+00:36:50,050 --> 00:36:57,330
+تمل النيومونيا ميكروب في الستول اتفقنا إنه في
+
+532
+00:36:57,330 --> 00:37:02,030
+صعوبة جدا شباب في عزله أي ميكروب هذه البكتيريا
+
+533
+00:37:02,030 --> 00:37:05,590
+استغلنا صفة واحدة إن هذه البكتيريا تستطيع تنمو at
+
+534
+00:37:05,590 --> 00:37:09,810
+low temperature at low temperature بتوقع يبجي هذه
+
+535
+00:37:09,810 --> 00:37:14,360
+البكتيريا تنتشر في الصيف ولا في الشتاءفي الشتاء،
+
+536
+00:37:14,360 --> 00:37:17,620
+اتوقع ان البكتيريا، هذي كمان أشياء ما هي بتهمنا
+
+537
+00:37:17,620 --> 00:37:20,400
+كتير في الـEpidemiology، لما أنا عارف المعلومات عن
+
+538
+00:37:20,400 --> 00:37:23,040
+البكتيريا بشكل جيد، بتساعدني في ال isolation،
+
+539
+00:37:23,040 --> 00:37:25,580
+بتساعدني في ال Epidemiology، بتساعدني في كل حاجة،
+
+540
+00:37:25,580 --> 00:37:29,080
+وبالتالي أخدنا عينة الستول و حاطناها في التلاجة،
+
+541
+00:37:29,080 --> 00:37:33,900
+فقط، وسموا ال technique called enrichment
+
+542
+00:37:33,900 --> 00:37:34,860
+technique
+
+543
+00:37:37,490 --> 00:37:42,550
+بعد مرور الوقت في لوتن بريتشار كل البكتيريا ستمتع
+
+544
+00:37:42,550 --> 00:37:47,350
+ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها
+
+545
+00:37:47,350 --> 00:37:48,370
+ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها
+
+546
+00:37:48,370 --> 00:37:52,210
+ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها
+
+547
+00:37:52,210 --> 00:37:53,290
+ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها
+
+548
+00:37:53,290 --> 00:37:56,210
+ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها ببعضها
+
+549
+00:37:56,210 --> 00:38:05,350
+ببعضها ببعضها ببعضها
+
+550
+00:38:05,350 --> 00:38:10,680
+ببعضها ببيعالجوا عينة الستول بال QH والدراسة اللي
+
+551
+00:38:10,680 --> 00:38:13,420
+احنا اجريناها الصحيح استخدمنا هذه التقنية بالاضافة
+
+552
+00:38:13,420 --> 00:38:15,860
+إلى ال cold enrichment ولاجينا ان التقنية دي افضل
+
+553
+00:38:15,860 --> 00:38:20,480
+حتى من ال cold enrichment اذا اذا اردت ان تقوم
+
+554
+00:38:20,480 --> 00:38:24,640
+بعزل ياسينيا انترا كوليتكا من عينة غذاء من عينة
+
+555
+00:38:24,640 --> 00:38:29,580
+برازا كرامكم الله فعليك بال cold enrichment او
+
+556
+00:38:29,580 --> 00:38:30,780
+بطريقة اللي هو ال QH
+
+557
+00:38:34,300 --> 00:38:37,120
+الـ Biochemical Identification عند اليرسينيا
+
+558
+00:38:37,120 --> 00:38:41,280
+انترقوليتكا لgrowth at 4 degree centigrade and on
+
+559
+00:38:41,280 --> 00:38:44,700
+Makunkei and nutrient agar مطالع at 22 degree
+
+560
+00:38:44,700 --> 00:38:47,960
+centigrade ان دول production variable ممكن بسط و
+
+561
+00:38:47,960 --> 00:38:51,680
+ممكن نيجاتيف اليوريايز التفاقيم من الأساس احنا لما
+
+562
+00:38:51,680 --> 00:38:54,320
+ميزنا اليرسينيا انترقوليتكا و سوديو تباكلتها على
+
+563
+00:38:54,320 --> 00:38:58,480
+جهة وعلى الجهة التانية اليورسينيا بيستس جونها دي
+
+564
+00:38:58,480 --> 00:39:02,340
+كده، اليوريايز نيجاتيف هدوله، اليوريايز بسطODC
+
+565
+00:39:02,340 --> 00:39:04,980
+positive ODC positive اللي هو Ornithine
+
+566
+00:39:04,980 --> 00:39:08,420
+decarboxylase اليرسينيا pseudotuberculosis في
+
+567
+00:39:08,420 --> 00:39:13,340
+المقابل كل الصفات اللي ذكرناها فوق نفسها لكن تتميز
+
+568
+00:39:13,340 --> 00:39:19,180
+عن زميلتها اليرسينيا انترا كوليتكا بياش ب sorbitol
+
+569
+00:39:19,180 --> 00:39:22,160
+negative test and negative ornithine decarboxylase
+
+570
+00:39:22,160 --> 00:39:25,100
+يعني لو احنا ممكن نضيف هنا ايش دلوقتي sorbitol
+
+571
+00:39:29,620 --> 00:39:32,760
+أصلا عند الفحصين الأخرانيين هدولة اللي هم ال
+
+572
+00:39:32,760 --> 00:39:37,900
+ornithine و ال sorbitol تمام ميزونا ال yersinia
+
+573
+00:39:37,900 --> 00:39:40,720
+enterocolitica اللي هم بوصة في هذا الحالة عن ال
+
+574
+00:39:40,720 --> 00:39:43,540
+yersinia pseudotemercolosa اللي هم في هذا الحالة
+
+575
+00:39:43,540 --> 00:39:44,760
+اتنين نيجاتي
+
+576
+00:39:47,590 --> 00:39:52,030
+تلاتة صاروا تلاتة و تعالى نلخصهم مع بعض تعالى
+
+577
+00:39:52,030 --> 00:39:56,210
+نلخصهم مع بعض عشان نطلع من المحاضرة هذه عارفين كيف
+
+578
+00:39:56,210 --> 00:40:00,910
+نميز اليرسينيا عن باقي ال انترو بكترياسي و نميز
+
+579
+00:40:00,910 --> 00:40:04,310
+اليرسينيا التلاتة عن بعضهم البعض هاي انترو
+
+580
+00:40:04,310 --> 00:40:13,210
+بكترياسي الان لجرامستين الاصلهو جزء من عملية
+
+581
+00:40:13,210 --> 00:40:16,710
+التعرف صح ولا لأ يعني المحاضرة من بارحة قلنالكوا
+
+582
+00:40:16,710 --> 00:40:19,690
+معلومة مهمة قلنالكوا cultural characteristics
+
+583
+00:40:19,690 --> 00:40:22,050
+morphology and staining biochemical
+
+584
+00:40:22,050 --> 00:40:26,430
+characteristics and others لكن الخطوة رقم اتنين
+
+585
+00:40:26,430 --> 00:40:30,130
+ايش كانت morphology and staining يعني جزء من عملية
+
+586
+00:40:30,130 --> 00:40:33,530
+التعرف يطلع عندي انا gram stain هعمل gram stain
+
+587
+00:40:33,530 --> 00:40:38,810
+هيطلع عندي gram negative بس الله كاملة او gram
+
+588
+00:40:38,810 --> 00:40:46,290
+negative ايشcoco-bacillus أنا عملت هنا oxidase
+
+589
+00:40:46,290 --> 00:40:52,230
+طلعت negative ليش أنا عملت oxidase؟ طيب أنا خايف
+
+590
+00:40:52,230 --> 00:40:57,030
+خايف من مين؟ من البستوريلا البستوريلا بتشبهها نفس
+
+591
+00:40:57,030 --> 00:40:59,870
+الشكل لما نصل لبستوريلا هنوصفلكوا إيها هنقولكوا
+
+592
+00:40:59,870 --> 00:41:03,170
+coco-bacillus و هنقولكوا bipolarly stained يعني
+
+593
+00:41:03,170 --> 00:41:05,150
+safety pin يعني مشبك
+
+594
+00:41:08,960 --> 00:41:11,800
+بالظبط انتهينا من الموهان اجراء نيجاتيف باسوللايز
+
+595
+00:41:11,800 --> 00:41:13,840
+او coco-bacillus صارت نعمل oxidase صارت الآن
+
+596
+00:41:13,840 --> 00:41:17,340
+oxidase نيجاتيف انا الآن صرت مطمئن ان البكتيريا
+
+597
+00:41:17,340 --> 00:41:21,420
+يارسينيا صرت مطمئن ان البكتيريا يارسينيا الآن بعد
+
+598
+00:41:21,420 --> 00:41:28,720
+ذلك ما الذي يستطيع الفني عمله خلاصة الغربش و نطلع
+
+599
+00:41:28,720 --> 00:41:35,900
+فوق انت من انا من وين؟ من كلمة يارسينيا اول فحص
+
+600
+00:41:39,840 --> 00:41:43,500
+إذا negative صح
+
+601
+00:41:43,500 --> 00:41:52,340
+إذا positive sorbitol زاد من ODC إذا positive وإذا
+
+602
+00:41:52,340 --> 00:41:56,100
+negative إذا positive فهي اللي هي enterocolitica
+
+603
+00:41:56,100 --> 00:42:00,360
+وإذا
+
+604
+00:42:00,360 --> 00:42:05,440
+negative فهي pseudo tuberculosis
+
+605
+00:42:05,440 --> 00:42:09,040
+تمام
+
+606
+00:42:09,040 --> 00:42:14,320
+هيك؟وصار عندي الآن عملية differentiation من
+
+607
+00:42:14,320 --> 00:42:17,800
+البكتيريا
+
+608
+00:42:17,800 --> 00:42:20,260
+عن الـother انترو بكتيرياسي من البكتيريا عن
+
+609
+00:42:20,260 --> 00:42:24,920
+شبيهتها البستريلة و ال three species عن بعضهم اللي
+
+610
+00:42:24,920 --> 00:42:32,900
+هم البعض اللوحة
+
+611
+00:42:32,900 --> 00:42:36,460
+الأخيرة في المحاضرة تبعتنا اليوم اللي هي
+
+612
+00:42:36,460 --> 00:42:37,100
+الcellology
+
+613
+00:42:40,160 --> 00:42:43,180
+الصيرولوجي احنا اتفقنا في ال yersinia pistis انه
+
+614
+00:42:43,180 --> 00:42:46,680
+واحدة من تنتين يا ما بنكشف عن ال antigen يعني لو
+
+615
+00:42:46,680 --> 00:42:49,920
+عزلنا بكتيريا بنحط عليها antibody او بكون عندي
+
+616
+00:42:49,920 --> 00:42:52,320
+antibody بس .. antigen و بكشف فيها عن ال antibody
+
+617
+00:42:52,320 --> 00:42:56,250
+في ال patient serum نفس الفكرة هنا يا شباباما
+
+618
+00:42:56,250 --> 00:42:59,670
+باكشف عن البكتيريا ب specific antibody تمام او
+
+619
+00:42:59,670 --> 00:43:02,170
+باكشف عن ال antibodies في السيران ب specific
+
+620
+00:43:02,170 --> 00:43:05,290
+antigen بالنسبالى treatment اعتقد ان ال antibiotic
+
+621
+00:43:05,290 --> 00:43:07,830
+لحظة هم نفس ال antibiotic اللى استخدامناهم
+
+622
+00:43:07,830 --> 00:43:11,570
+لليرسينيا بيستس فى اظن ان عندي كمان لوحة اه كذلك
+
+623
+00:43:11,570 --> 00:43:16,150
+هذه اللوحة اللى ختمية اللى بنميز فيها اليرسينيا عن
+
+624
+00:43:16,150 --> 00:43:23,360
+بعضها البعضطبعا أنا بتأمل انه بنهاية بتولكوا ال
+
+625
+00:43:23,360 --> 00:43:26,020
+enterobacteriasi انه سياننا مقدر علشان نعمل
+
+626
+00:43:26,020 --> 00:43:29,660
+diagrams كلتنا individually كل واحد فينا لحاله
+
+627
+00:43:29,660 --> 00:43:32,600
+يعمل ال diagram الخاص فيه في كيف ت differentiate
+
+628
+00:43:32,600 --> 00:43:35,000
+between the different species اللي اكتوز في
+
+629
+00:43:35,000 --> 00:43:38,940
+المنطقة اللحال و اللي اكتوز في المنطقة اللحالعندي
+
+630
+00:43:38,940 --> 00:43:41,820
+ال lycine دي carboxylase، ال ornithine فقط اللي
+
+631
+00:43:41,820 --> 00:43:44,740
+يرسينا ال enterocolitica جُنّا اللي هي positive ال
+
+632
+00:43:44,740 --> 00:43:48,020
+motility at room temperature من 22 إلى 26 اللي هم
+
+633
+00:43:48,020 --> 00:43:50,260
+اللي يرسينا ال pseudo tuberculosis و ال
+
+634
+00:43:50,260 --> 00:43:52,900
+enterocolitica هم اللي positive بينما ال pistis و
+
+635
+00:43:52,900 --> 00:43:56,540
+هذه نقطة كتير مهمة إنها هي الوحيدة ال negative ال
+
+636
+00:43:56,540 --> 00:43:58,500
+urea هي الوحيدة ال negative التنتيهين برضه
+
+637
+00:43:58,500 --> 00:44:01,920
+positive ال menitol التلاتة positive ال sorbitol
+
+638
+00:44:01,920 --> 00:44:04,900
+هذي positive negative بينما هذي كده positive احنا
+
+639
+00:44:04,900 --> 00:44:09,580
+على اخر ميزناها مظبوطاللي هتذكره للثورة بتقول
+
+640
+00:44:09,580 --> 00:44:14,040
+positive or negative يعني إيش هي variableهل هذا
+
+641
+00:44:14,040 --> 00:44:20,020
+مدعاء لإنه نعمل confusion ما بين ال Yersinia
+
+642
+00:44:20,020 --> 00:44:22,860
+pestis و Yersinia enterocolitica؟ احنا من الأول
+
+643
+00:44:22,860 --> 00:44:26,020
+ميزنهم عن طريق اللي هم ال motility و عن طريق ال
+
+644
+00:44:26,020 --> 00:44:28,660
+urease و عن طريق other tests وبالتالي مافيش داعي
+
+645
+00:44:28,660 --> 00:44:32,400
+لإنه نعمل confusion بينهم، إذا خلينا نقول الفحوصات
+
+646
+00:44:32,400 --> 00:44:35,800
+اللي موجودة في الجدول اللي ممكن تتميز ال three
+
+647
+00:44:35,800 --> 00:44:38,860
+spaces عن بعض هي اللي بنستخدمها في عملية اللي هو
+
+648
+00:44:38,860 --> 00:44:42,950
+ال diagramبيكفل يوم ان شاء الله و بنكمل المرة
+
+649
+00:44:42,950 --> 00:44:43,510
+القادمة بدنا
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/u1i05VFdVOg_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/u1i05VFdVOg_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..2a1d6f8377a008e2ad8cd00b71f5161f048ba0f9
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/u1i05VFdVOg_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 4581, "start": 20.93, "end": 45.81, "text": "اليوم استكمالا للموضوع اللي بدأناه في ال Vibrio فانا مجموعة شبيهة ال Campylobacter و ال Helicobacter شبيهة لأن في يوم الأيام كانت ال Campylobacter تسمى Vibrio و كانت ال Helicobacter تسمى Campylobacter وبالتالي في وجه شبه بين ال Helicobacter و ال Campylobacter و ال Vibrio ألا وهو الشكل كلهم curved نعم اللي هم انحناء", "tokens": [6027, 1829, 20498, 44713, 24793, 6027, 995, 5296, 19528, 2407, 11242, 45367, 13672, 1829, 47525, 10721, 8315, 3224, 8978, 2423, 691, 897, 6584, 6156, 7649, 995, 3714, 7435, 2304, 2407, 27884, 13412, 21292, 3224, 3660, 2423, 9189, 88, 752, 65, 14125, 4032, 2423, 6128, 299, 996, 14125, 13412, 21292, 3224, 3660, 5296, 33456, 8978, 7251, 20498, 16247, 1829, 10943, 25961, 2655, 2423, 9189, 88, 752, 65, 14125, 6055, 38251, 7578, 691, 897, 6584, 4032, 25961, 2655, 2423, 6128, 299, 996, 14125, 6055, 38251, 7578, 9189, 88, 752, 65, 14125, 46599, 6027, 2655, 6027, 1829, 8978, 49610, 3224, 13412, 3555, 3224, 49374, 2423, 6128, 299, 996, 14125, 4032, 2423, 9189, 88, 752, 65, 14125, 4032, 2423, 691, 897, 6584, 5551, 15040, 37037, 2407, 25124, 28820, 28242, 16095, 24991, 8717, 25957, 13672, 1829, 8032, 2304, 16472, 5016, 1863, 16606], "avg_logprob": -0.1869338786472445, "compression_ratio": 1.9872340425531916, "no_speech_prob": 1.1920928955078125e-07, "words": [{"start": 20.930000000000007, "end": 21.750000000000004, "word": "اليوم", "probability": 0.6241861979166666}, {"start": 21.750000000000004, "end": 22.57, "word": " استكمالا", "probability": 0.921630859375}, {"start": 22.57, "end": 22.97, "word": " للموضوع", "probability": 0.926171875}, {"start": 22.97, "end": 23.05, "word": " اللي", "probability": 0.810791015625}, {"start": 23.05, "end": 23.45, "word": " بدأناه", "probability": 0.914794921875}, {"start": 23.45, "end": 23.59, "word": " في", "probability": 0.9130859375}, {"start": 23.59, "end": 23.91, "word": " ال", "probability": 0.95068359375}, {"start": 23.91, "end": 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1769.45, "end": 1769.97, "word": " بكتيريتنا", "probability": 0.9488932291666666}, {"start": 1769.97, "end": 1770.11, "word": " من", "probability": 0.26318359375}, {"start": 1770.11, "end": 1770.21, "word": " كل", "probability": 0.6611328125}, {"start": 1770.21, "end": 1770.31, "word": " ما", "probability": 0.54736328125}, {"start": 1770.31, "end": 1770.59, "word": " نعرفه", "probability": 0.66644287109375}, {"start": 1770.59, "end": 1770.71, "word": " انها", "probability": 0.6934814453125}, {"start": 1770.71, "end": 1771.17, "word": " مقاومة", "probability": 0.9796875}, {"start": 1771.17, "end": 1771.77, "word": " لمن؟", "probability": 0.63232421875}, {"start": 1771.77, "end": 1772.63, "word": " لبوليمكسين", "probability": 0.7009102957589286}, {"start": 1772.63, "end": 1773.23, "word": " مقاومة", "probability": 0.96787109375}, {"start": 1773.23, "end": 1773.45, "word": " ل", "probability": 0.9072265625}, {"start": 1773.45, "end": 1774.97, "word": " Trimethabrine", "probability": 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اسمها can be bab باب can be bab باب هو blood agar plate blood agar plate it contains vancomycin فقط و tri-methyl ibuprofen فاكرين ال skero كان هذا و هذا لا التانية الموجودين كانوا زاد مين polymyxin بيه هذا فقط شرنا منه ال polymyxin", "tokens": [41185, 13412, 45761, 8978, 18863, 9381, 2288, 21542, 16254, 12984, 37495, 22653, 9154, 6225, 8592, 25720, 8608, 1863, 2407, 9307, 4032, 10874, 47302, 16490, 1211, 9566, 3660, 24525, 2304, 11296, 393, 312, 7564, 4724, 16758, 393, 312, 7564, 4724, 16758, 31439, 3390, 623, 289, 5924, 3390, 623, 289, 5924, 309, 8306, 3161, 1112, 88, 20021, 6156, 47432, 4032, 1376, 12, 76, 3293, 88, 75, 39073, 1010, 340, 6570, 6156, 995, 37983, 9957, 2423, 1110, 2032, 25961, 23758, 4032, 23758, 20193, 16712, 7649, 10632, 9673, 29245, 23328, 9957, 25961, 14407, 30767, 18513, 3714, 9957, 6754, 2226, 87, 259, 4724, 1829, 3224, 23758, 6156, 47432, 13412, 2288, 8315, 9154, 3224, 2423, 6754, 2226, 87, 259], "avg_logprob": -0.3182565658761744, "compression_ratio": 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"end": 2813.21, "word": " لل", "probability": 0.544921875}, {"start": 2813.21, "end": 2813.71, "word": " helicobacter", "probability": 0.82708740234375}, {"start": 2813.71, "end": 2814.13, "word": " pylori", "probability": 0.77734375}, {"start": 2814.13, "end": 2814.83, "word": " معنى", "probability": 0.86474609375}, {"start": 2814.83, "end": 2814.93, "word": " ان", "probability": 0.333740234375}, {"start": 2814.93, "end": 2815.29, "word": " نفهم", "probability": 0.9222005208333334}, {"start": 2815.29, "end": 2815.41, "word": " ال", "probability": 0.97216796875}, {"start": 2815.41, "end": 2815.85, "word": " principle", "probability": 0.84521484375}, {"start": 2815.85, "end": 2816.39, "word": " تبعها", "probability": 0.89599609375}, {"start": 2816.39, "end": 2816.83, "word": " ك", "probability": 0.9443359375}, {"start": 2816.83, "end": 2817.61, "word": " diagnostic", "probability": 0.78076171875}, {"start": 2817.61, "end": 2818.27, "word": " test", "probability": 0.9443359375}, {"start": 2818.27, "end": 2818.75, "word": " نكمل", "probability": 0.8733723958333334}, {"start": 2818.75, "end": 2818.97, "word": " المرة", "probability": 0.972900390625}, {"start": 2818.97, "end": 2819.23, "word": " الجاية", "probability": 0.9352213541666666}, {"start": 2819.23, "end": 2819.39, "word": " ان", "probability": 0.82470703125}, {"start": 2819.39, "end": 2819.57, "word": " شاء", "probability": 0.99609375}, {"start": 2819.57, "end": 2819.65, "word": " الله", "probability": 0.9365234375}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2820.4815, "duration_after_vad": 2688.0324999999857}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/vcYES6tQ9a0_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/vcYES6tQ9a0_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e3f8a9391e4cfb7dfacf2c897bf2a8a6d82eb4a5
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/vcYES6tQ9a0_postprocess.srt
@@ -0,0 +1,2648 @@
+1
+00:00:20,740 --> 00:00:24,120
+بسم الله الرحمن الرحيم المحاضرة الماضية وقفنا عند
+
+2
+00:00:24,120 --> 00:00:26,460
+موضوع ال antimicrobial resistance أو ال antibiotic
+
+3
+00:00:26,460 --> 00:00:30,240
+resistance للstaphylococcus aureus واستعرضنا يعني
+
+4
+00:00:30,240 --> 00:00:34,600
+تاريخيا اكتشاف البنسالين وكيف كان اثره على
+
+5
+00:00:34,600 --> 00:00:38,320
+البكتيريا و بعدين بدأت تظهر سلالات مقاومة
+
+6
+00:00:38,320 --> 00:00:41,580
+للبنسالين وحتى للموديفايد او ال semi-synthetic
+
+7
+00:00:41,580 --> 00:00:45,530
+penicillins ايضا لجينا ان البكتيرياوصلت لمرحلة
+
+8
+00:00:45,530 --> 00:00:48,230
+سميناها methylene resistant staphylococcus aureus
+
+9
+00:00:48,230 --> 00:00:51,070
+وزدنا على ذلك vancomycin intermediate
+
+10
+00:00:51,070 --> 00:00:54,990
+staphylococcus aureus وزدنا على ذلك vancomycin
+
+11
+00:00:54,990 --> 00:01:01,350
+resistant staphylococcus aureusال MRSA تبقى تهديد
+
+12
+00:01:01,350 --> 00:01:07,790
+حقيقي وخطير في كل العالم وبدأنا بالحديث عن إنها في
+
+13
+00:01:07,790 --> 00:01:11,310
+المجتمعات غالبا بيكون نسبة ال carriage اللي لها
+
+14
+00:01:11,310 --> 00:01:13,810
+أقل من المستشفيات بينما في المستشفيات بيكون طبعا
+
+15
+00:01:13,810 --> 00:01:19,250
+أعلي لكن بدي أكد على حقيقة إن في قطاع غزة كونه في
+
+16
+00:01:19,250 --> 00:01:26,990
+كثافة سكانية عاليةولا يوجد أنظمة سيطرة على العدوى
+
+17
+00:01:26,990 --> 00:01:31,950
+في المشافى خدنا نقول أنظمة فعالة يعني في أنظمة لكن
+
+18
+00:01:31,950 --> 00:01:37,770
+ليست فعالة بدرجة المطلوبة وبالتالي يعتقد ولا اعتقد
+
+19
+00:01:37,770 --> 00:01:41,390
+هذا له مبرره ان نسبة ال carriage في ال community
+
+20
+00:01:41,390 --> 00:01:47,010
+هتكون عالية اكثر من دول اخرى وبعض الدراسات الأولى
+
+21
+00:01:47,010 --> 00:01:50,090
+اللي اجروها طلابنا يعني دراسات غير منشورة او أبحاث
+
+22
+00:01:50,090 --> 00:01:55,040
+غير منشورةأظهرت بالفعل نسبة عالية لـ Methicillin
+
+23
+00:01:55,040 --> 00:01:58,180
+-resistant Staphylococcus aureus و لل Vancomycin
+
+24
+00:01:58,180 --> 00:02:05,260
+-resistant Enterococci ال MRSA بتسبب يعني مجموعة
+
+25
+00:02:05,260 --> 00:02:11,490
+من الأمراض اللي بتنتشربشكل كبير و غالبا بتكون
+
+26
+00:02:11,490 --> 00:02:16,910
+lethal infections يعني infection قاتلة عندها
+
+27
+00:02:16,910 --> 00:02:20,970
+المقدرة على أنه تنقل ال resistance إلى مايكروبات
+
+28
+00:02:20,970 --> 00:02:24,070
+أخرى وبالتالي هذه بتشكل كمان خطورة يعني لو كان
+
+29
+00:02:24,070 --> 00:02:28,370
+عندنا نسبةمن الـ Staphylococci sensitive
+
+30
+00:02:28,370 --> 00:02:32,170
+للميتيسيلين في community معينة، بنتوقع أن هذه
+
+31
+00:02:32,170 --> 00:02:36,490
+البكتيريا تقل نسبتها بشكل سريع نظرا لسرعة انتقال
+
+32
+00:02:36,490 --> 00:02:39,170
+ال resistance gene من ال MRSA لل other
+
+33
+00:02:39,170 --> 00:02:44,730
+staphylococciبقولنا انه غالبا ال overuse انا اعتقد
+
+34
+00:02:44,730 --> 00:02:47,870
+انه مرة شراحت الموضوع هذا الاستخدام المفرط لل
+
+35
+00:02:47,870 --> 00:02:50,330
+antibiotic هو اللي بيعمل selection ل resistance
+
+36
+00:02:50,330 --> 00:02:56,590
+تاني و بيساعد في ظهور السلالات غالبا يعني في .. في
+
+37
+00:02:56,590 --> 00:02:59,690
+إصابة فيها MRSA مش جادرين ان اعالجها بال
+
+38
+00:02:59,690 --> 00:03:03,510
+antibiotic بيصير في multiple organ failure للمرضى
+
+39
+00:03:03,510 --> 00:03:09,410
+و في الغالب بيصير فيها انها deathكيف نمنع أو نسيطر
+
+40
+00:03:09,410 --> 00:03:13,690
+على ال Staphylococcus infection احنا قلنا انه في
+
+41
+00:03:13,690 --> 00:03:17,850
+المستشفيات بالدرجة الأولى الناقل الأساسي لل
+
+42
+00:03:17,850 --> 00:03:20,910
+Staphylococcus aureus هم ال medical staff ال
+
+43
+00:03:20,910 --> 00:03:24,310
+medical staff ال nurse و ال physicians تمام و ممكن
+
+44
+00:03:24,310 --> 00:03:27,450
+حتى عمال نظافة لأنهم بيحتكوا بالمرضى في مستشفياتنا
+
+45
+00:03:27,450 --> 00:03:32,670
+للأسففبالتالي احنا لازم نعمل periodic check-up
+
+46
+00:03:32,670 --> 00:03:34,890
+احنا قولنا لكوا مرة في الجامعة او سبيل المثال في
+
+47
+00:03:34,890 --> 00:03:39,530
+الكافتيريا اللي بتقدم خدمات طعام عمال خدمات الطعام
+
+48
+00:03:39,530 --> 00:03:43,750
+او موظفي خدمات الطعام بيخضعوا للفحص كل ستة اشهر
+
+49
+00:03:43,750 --> 00:03:49,030
+للكشف عن السيارة اللي هو الشغل ضمن نظام معمول بيه
+
+50
+00:03:49,030 --> 00:03:54,530
+بالجامعة لمنع انتشار امرض امراض انتقل عن طريق
+
+51
+00:03:54,530 --> 00:04:00,530
+الأخذية تمام؟ الآن في المستشفيات في أنظمة برضهحتى
+
+52
+00:04:00,530 --> 00:04:03,450
+احنا بيقولنا المصدر الأساسي مين؟ الأطباء و
+
+53
+00:04:03,450 --> 00:04:06,350
+الممرضين فبالتالي لازم نعمل .. احنا ندور عليهم ..
+
+54
+00:04:06,350 --> 00:04:09,850
+ندور عليهم و نشوف من عنده MRSA و نتخلص من ال MRSA
+
+55
+00:04:09,850 --> 00:04:13,630
+اللي موجودة عندهم الملابس اللي بنستخدمها في
+
+56
+00:04:13,630 --> 00:04:17,910
+المستشفيات لازم تغلى أو تغسل أو تتعرض لدرجة حرارة
+
+57
+00:04:17,910 --> 00:04:22,650
+أكتر من سبعين درجة مئوية ممكن نستخدم ال antiseptic
+
+58
+00:04:22,650 --> 00:04:26,430
+soaps اللي هو الصابون اللي موجود فيه detol اللي هو
+
+59
+00:04:26,430 --> 00:04:33,180
+مطهرالناس اللى عندهم جنه career فى الأنف تبعهم
+
+60
+00:04:33,180 --> 00:04:37,020
+ممكن نستخدم لهم nasal cream كريمة بتنحط جنه فى
+
+61
+00:04:37,020 --> 00:04:42,080
+الأنف محتوى اما على جنته ميسين او ميبريسين وممكن
+
+62
+00:04:42,080 --> 00:04:44,440
+نستخدم oral antibiotics وال oral antibiotics دى
+
+63
+00:04:44,440 --> 00:04:49,200
+اللى من مزاياها انه بتتركز عاليا فى ال secretions
+
+64
+00:04:49,200 --> 00:04:53,970
+يعنى بتكوناحنا بناخدها oral او injection و بتلف في
+
+65
+00:04:53,970 --> 00:04:57,770
+الجسم تمام؟ بتلف في الجسم لكن تركيزها بيكون أعلى
+
+66
+00:04:57,770 --> 00:05:01,430
+ما يكون في مين في ال secretions في الإفرازات اللي
+
+67
+00:05:01,430 --> 00:05:04,550
+تضمن أنه يتخلص من وين من اللي هو البكتيريا في
+
+68
+00:05:04,550 --> 00:05:09,400
+الأنف زي السيبرفلكسيين ورفينبسيينأيضا
+
+69
+00:05:09,400 --> 00:05:12,100
+chemoprophylaxis و أعتقد المصطلح بطل غريب علينا،
+
+70
+00:05:12,100 --> 00:05:16,060
+قلنا استخدام ال antibiotics لمنع العدوى يسمى
+
+71
+00:05:16,060 --> 00:05:19,120
+chemoprophylaxis و chemoprophylaxis معناها إجراء
+
+72
+00:05:19,120 --> 00:05:26,300
+وقائم باستخدام من كمان مرة ال antibiotics بنقول
+
+73
+00:05:26,300 --> 00:05:29,280
+chemoprophylaxis معناها إجراء وقائم باستخدام ال
+
+74
+00:05:29,280 --> 00:05:33,160
+antibioticsيعني واحد بده ياخد .. بده يعمل عملية
+
+75
+00:05:33,160 --> 00:05:37,920
+جراحية وخايفين من ال .. ال infection بال .. بال
+
+76
+00:05:37,920 --> 00:05:41,500
+MRSA ممكن نعطيه antibiotic قبل إجراء العملية و
+
+77
+00:05:41,500 --> 00:05:45,280
+نعطيه antibiotic كمان بعد إجراء العملية، هو لم يصب
+
+78
+00:05:45,280 --> 00:05:49,900
+بالبكتيريا ولكن كإجراء وقائي منعنا اللي هو حصول ال
+
+79
+00:05:49,900 --> 00:05:54,410
+infectionالتشارت اللي امامنا هذه هي عبارة عن
+
+80
+00:05:54,410 --> 00:06:00,350
+summary رائع جدا بسيط لتمييز ال .. ال .. ال .. ال
+
+81
+00:06:00,350 --> 00:06:05,190
+.. التفيل الكوكاي بشكل خاص لل species اللي ..
+
+82
+00:06:05,190 --> 00:06:07,550
+التلاتة اللي ذكرناهم اللي هم الأورياس والإبدرميس
+
+83
+00:06:07,550 --> 00:06:11,110
+والسابروفايتكاسلكن بالاساس احنا عندنا جينا العنوان
+
+84
+00:06:11,110 --> 00:06:13,930
+الرئيسى لموضوعنا اللى و جرام بوستف كوكساى
+
+85
+00:06:13,930 --> 00:06:17,150
+بالكتاليز اذا نيجاتف فهي الستفيل الكوكاى و هتشارت
+
+86
+00:06:17,150 --> 00:06:20,190
+الها لحالها لكن اذا بوستف فهي الستفيل الكوكاى
+
+87
+00:06:20,190 --> 00:06:24,670
+استخدمنا تلت فحوصات الفحص الاول الكواجوليز الفحص
+
+88
+00:06:24,670 --> 00:06:28,110
+التانى المنيتول والفحص التالت جلوكوز اوكسدايشن او
+
+89
+00:06:28,110 --> 00:06:33,030
+fermentation ووجدنا انه الجدول او التلت فحوصات
+
+90
+00:06:33,030 --> 00:06:38,270
+اللى قسمونا البكتيريا الى تلت انواعالأول لجرام
+
+91
+00:06:38,270 --> 00:06:41,970
+بوستف استفيل الكوكاى اللى استفيل الكوكاس اورياس
+
+92
+00:06:41,970 --> 00:06:46,350
+كانت بوستف كوكاج جليز بوستف منطول fermentation و
+
+93
+00:06:46,350 --> 00:06:50,630
+fermentative لليلكوز على الطرف التانى انسلوب الوسط
+
+94
+00:06:50,630 --> 00:06:57,100
+الآنالنجاتيف لأ ال coagulase النجاتيف ده ال
+
+95
+00:06:57,100 --> 00:07:01,100
+manitol و ال glucose تبعها fermentative هاد ال
+
+96
+00:07:01,100 --> 00:07:04,900
+staphylococcus اي بي درمس فالنص في اندي حاجة ليس
+
+97
+00:07:04,900 --> 00:07:08,800
+لها علاقة بالstaphylococcus كاسم صح اسمها
+
+98
+00:07:08,800 --> 00:07:12,460
+micrococcus الآن من ون قريت ال micrococcus في هذا
+
+99
+00:07:12,460 --> 00:07:16,280
+ال diagram خدوا بالك و في family عارفين كلمة
+
+100
+00:07:16,280 --> 00:07:21,420
+الامتداد ل family AC صح انترو بكترياسي AC في الآخر
+
+101
+00:07:22,220 --> 00:07:26,460
+فيه family اسمها micrococcus ال micrococcus فيها
+
+102
+00:07:26,460 --> 00:07:33,020
+two names استفيلوكوكس وفيها micrococcus يبقى ال
+
+103
+00:07:33,020 --> 00:07:39,500
+micrococcus genus موازي لمين لل استفيلوكوكس ايش
+
+104
+00:07:39,500 --> 00:07:44,200
+وجه الشرح بين اتنين؟واجه الشبه ان اتنين جرام بوسطف
+
+105
+00:07:44,200 --> 00:07:48,540
+كوكساي اتنين كتاليز بوسطف اخدوا بقى لكوا الآن
+
+106
+00:07:48,540 --> 00:07:54,300
+أجاكوا معلومة بدنا نحاول نستخدمها ونوظفها ليس كل
+
+107
+00:07:54,300 --> 00:07:57,760
+كتاليز بوسطف هي استفيلو كوكاي بطلت الان كلمة
+
+108
+00:07:57,760 --> 00:08:01,120
+استفيلو كوكاي مطلقة في هذا الحالة مين معاها كمان
+
+109
+00:08:01,120 --> 00:08:06,180
+كيبنا نميز ال micrococcus عن الاستفيلو كوكاس
+
+110
+00:08:09,240 --> 00:08:12,760
+لأ، رقم تلاتة، رقم تلاتة أهم شيء ان الوجليكوكس بقى
+
+111
+00:08:12,760 --> 00:08:16,800
+ايه؟ oxidative كل استفيل الكوكاعي fermentative لكن
+
+112
+00:08:16,800 --> 00:08:19,620
+ال micrococcus بتكون oxidative طبعا هي negative
+
+113
+00:08:19,620 --> 00:08:24,120
+للمنطال و negative برضه لمين؟ للكواجلس لكن في كمان
+
+114
+00:08:24,120 --> 00:08:26,040
+شغل اللي بتخليكوا تعملوا confusion مع ال
+
+115
+00:08:26,040 --> 00:08:29,980
+micrococcus و الاستفيل الكوكاس aureus بالذات احنا
+
+116
+00:08:29,980 --> 00:08:32,520
+قلنا الاستفيل الكوكاس aureus produces golden
+
+117
+00:08:32,520 --> 00:08:35,920
+yellow pigment صح؟ و بعدين قلنا يعني من اسمها
+
+118
+00:08:35,920 --> 00:08:41,520
+استفيل الكوكاس aureusال micrococcus بتنتج برضه
+
+119
+00:08:41,520 --> 00:08:46,560
+yellow pigment لكن yellow مش golden yellow، يعني
+
+120
+00:08:46,560 --> 00:08:51,060
+لون فاقة، أصفر فاقة فبالتالي كونها pigmented،
+
+121
+00:08:51,060 --> 00:08:54,860
+الريك pigmented البعض قد يظن و قد لا يفرق بين
+
+122
+00:08:54,860 --> 00:08:57,480
+اللونين و يظن عليها و خاصة إنها Grand-Bostef-Cocci
+
+123
+00:08:57,480 --> 00:09:01,340
+و خاصة إنها Catalese-Bostef فهيظن إنها
+
+124
+00:09:01,340 --> 00:09:02,800
+Staphylococcus Aureus
+
+125
+00:09:05,670 --> 00:09:08,390
+طيب نجي لـ Coagulase Negative خدوا بالكوا في لسه
+
+126
+00:09:08,390 --> 00:09:10,650
+Sabrophytic اسمه ماراش عنيها صح لحكينا عن
+
+127
+00:09:10,650 --> 00:09:14,590
+Epidermis بس ماحكينا عن Sabrophytic تاني نطلع لـ
+
+128
+00:09:14,590 --> 00:09:18,350
+Coagulase Negative Staphylococci وقلنا CNS كمان
+
+129
+00:09:18,350 --> 00:09:24,390
+مرة اختصار نعم Normal Flora في ال skin Anterior
+
+130
+00:09:24,390 --> 00:09:28,770
+Narris في الأنف External Ear Canal Cell Wall
+
+131
+00:09:28,770 --> 00:09:31,530
+Contains Tychoic Acid والـ Tychoic Acid موجود في
+
+132
+00:09:31,530 --> 00:09:33,410
+كل جرام بُصطف تقريبا
+
+133
+00:09:36,280 --> 00:09:40,160
+white non-hemolytic corneas on blood vessels، إيش
+
+134
+00:09:40,160 --> 00:09:43,600
+ما هي البكتيريا؟
+
+135
+00:09:43,600 --> 00:09:48,740
+لأ، لسه كواكوليز نيجاتيف استفيلو كواكايت، بشكل عام
+
+136
+00:09:49,700 --> 00:09:55,140
+لكن بتتلاحظوا انه ال Staphylococcus aureus كان ال
+
+137
+00:09:55,140 --> 00:09:58,660
+.. ال color تبع ال pigment تبعها golden yellow هنا
+
+138
+00:09:58,660 --> 00:10:01,100
+على طول لقفتنا نقوله باللون ايه انه مش golden
+
+139
+00:10:01,100 --> 00:10:04,920
+yellow و غالبا white اصلا كلمة epidermidis او
+
+140
+00:10:04,920 --> 00:10:07,460
+Staphylococcus epidermidis كان اسمها زمان
+
+141
+00:10:07,460 --> 00:10:12,500
+Staphylococcus albusاللي بس عارفين من أين جاية؟ من
+
+142
+00:10:12,500 --> 00:10:16,380
+Albino، Albino مش معناها white، Albino معناها
+
+143
+00:10:16,380 --> 00:10:20,340
+white، فكانت هذه golden yellow pigmented وهذه
+
+144
+00:10:20,340 --> 00:10:24,100
+Albino، بمعنى أن هذه أبيض وهذه كده، لونها أصفر
+
+145
+00:10:29,980 --> 00:10:33,040
+بشكل عام ال cocoa glaze نيجاتيف، الستفيل الكوكاي
+
+146
+00:10:33,040 --> 00:10:38,060
+اللون تبعها نائل إلى الأبيض، لكن أكثر واحدة شهرة
+
+147
+00:10:38,060 --> 00:10:44,240
+فيهم هي أصلا للستفيل الكوكاس ابتنسطبعا ال .. ال
+
+148
+00:10:44,240 --> 00:10:48,560
+bacteria sensitive to novobiosin .. novobiosin لكن
+
+149
+00:10:48,560 --> 00:10:51,440
+ال Sabrophytic is resistant، يمكن أن نتكلم عن
+
+150
+00:10:51,440 --> 00:10:54,760
+صينفين الآن، في الجملة الأخيرة هذه حددنا الصينفين
+
+151
+00:10:54,760 --> 00:10:58,620
+الرئيسين ال Epidermidis و حدثنا .. و حددنا ال
+
+152
+00:10:58,620 --> 00:11:03,410
+Sabrophytic كيف ميازنهم مع بعض؟بالنوفو بيوسين، إيش
+
+153
+00:11:03,410 --> 00:11:06,790
+النوفو بيوسين؟ هو عبارة عن antibiotic disk which
+
+154
+00:11:06,790 --> 00:11:11,090
+is used to differentiate saprophyticase which is
+
+155
+00:11:11,090 --> 00:11:14,430
+resistant from the epidermis which is sensitive
+
+156
+00:11:14,430 --> 00:11:18,510
+إذا لو جينا نعمل داجران مرة تانية، ال coagulase
+
+157
+00:11:18,510 --> 00:11:22,230
+positive و ال coagulase negative، ال coagulase
+
+158
+00:11:22,230 --> 00:11:27,350
+negative أول فحص اللي بتعمله؟Novobiosin إذا كانت
+
+159
+00:11:27,350 --> 00:11:31,410
+resistant فهي Sabrophytic وإذا كانت sensitive فهي
+
+160
+00:11:31,410 --> 00:11:36,830
+Epidermis خلصنا .. احنا خلصنا .. عفوا مش ميزناهم
+
+161
+00:11:36,830 --> 00:11:39,970
+من ال .. من ال .. من الأساس ميزناها بمفهنهم أنا
+
+162
+00:11:39,970 --> 00:11:43,710
+شوية لك الفحص إذا وظفته في غير مكانه مالوش قيمة
+
+163
+00:11:43,710 --> 00:11:47,290
+بالعكس كمان هو هيعمللي confusion أكتر وبالتالي أنا
+
+164
+00:11:47,290 --> 00:11:50,210
+لأ مدام استثنيته مارجعلوش مرة تانية مدام استثنيت
+
+165
+00:11:50,210 --> 00:11:55,670
+الميكروب مارجعلوش بأوجه شبه أخرىdiseases caused by
+
+166
+00:11:55,670 --> 00:11:58,490
+staphylococcus epidermidis most infections are
+
+167
+00:11:58,490 --> 00:12:02,570
+hospital acquired يعني أكتر أشيوعا في المستشفيات
+
+168
+00:12:02,570 --> 00:12:06,090
+it is opportunistic pathogen وهذا السبب إنها
+
+169
+00:12:06,090 --> 00:12:09,170
+موجودة في المستشفيات لأن مين اللي بيروح على
+
+170
+00:12:09,170 --> 00:12:13,000
+المستشفيات شباب؟هما المرضى، المرضى مالهم دولة؟
+
+171
+00:12:13,000 --> 00:12:16,960
+غالباً بيكون عنده جهاز المناعة منخفض عشان هيك
+
+172
+00:12:16,960 --> 00:12:21,000
+بنقول احنا الأطباء لما بي .. ال .. ال .. ال .. ما
+
+173
+00:12:21,000 --> 00:12:23,640
+هم بيروحوا على بيوتهم الأطباء لما بيكونوا career
+
+174
+00:12:23,640 --> 00:12:26,640
+بينقلوا الميكروبات لأبناءهم كمان، مظبوط ولا لأ؟
+
+175
+00:12:26,640 --> 00:12:29,280
+لكن أبناءهم وعائلة ما بتمرضش، ليش؟ لأنهم مش
+
+176
+00:12:29,280 --> 00:12:32,420
+immunocompromised بس في المستشفيات لو نقلوا هذه
+
+177
+00:12:32,420 --> 00:12:35,740
+الميكروبات ل immunocompromised بيكون سهل الإصابة
+
+178
+00:12:35,740 --> 00:12:40,990
+بهذه الميكروباتبقولنا strongly associated و هذه
+
+179
+00:12:40,990 --> 00:12:43,810
+نقطة كتير مهمة with foreign bodies، ايش ان ال
+
+180
+00:12:43,810 --> 00:12:47,050
+foreign bodies؟ واحد زرعناله صمام، واحد حطناله
+
+181
+00:12:47,050 --> 00:12:51,590
+كانيولا، واحد ركبناله قصطرة في المثانا، فوين في
+
+182
+00:12:51,590 --> 00:12:57,110
+foreign body في الجسم، في إمكانية التهاب بمين؟
+
+183
+00:12:57,110 --> 00:13:02,540
+بالstaphylococcus epidermis، أحد أهمال .. ال .. ال
+
+184
+00:13:02,540 --> 00:13:04,760
+.. الاشياء الغريبة اللي احنا نقولها موجودة في
+
+185
+00:13:04,760 --> 00:13:08,480
+الجسم ال prostatic heart valves اللي هي الصمامات
+
+186
+00:13:08,480 --> 00:13:13,040
+الصناعية في القلب هذا مؤشر على اياش؟ مؤشر على ان
+
+187
+00:13:13,040 --> 00:13:15,500
+البكتيريا عندها المقدرة علي تعمل attachment
+
+188
+00:13:15,500 --> 00:13:19,920
+مقدرتها بتزيد في ال attachment لما يكون ال
+
+189
+00:13:19,920 --> 00:13:24,800
+surfaces مش tissue هذا ال .. ال .. ال .. لما نقول
+
+190
+00:13:24,800 --> 00:13:28,920
+صمام صناعي tissue هذاهذا ممكن مصنوع من بوليسترين
+
+191
+00:13:28,920 --> 00:13:31,920
+أو يعني مواد .. مواد بلاستيكية في الغالب، اتمام؟
+
+192
+00:13:31,920 --> 00:13:36,020
+وبالتالي احنا مانجدش بنحسها soft الا انه بالنسبة
+
+193
+00:13:36,020 --> 00:13:42,100
+للبكتيريا هي خشنة وتستطيع البكتيريا تلتصق فيهاال
+
+194
+00:13:42,100 --> 00:13:44,900
+IV catheters اللي هم اللي بنسميهم احنا ال canula
+
+195
+00:13:44,900 --> 00:13:50,240
+ال urinary catheters خاصة في الكبار السن ممكن CSF
+
+196
+00:13:50,240 --> 00:13:54,300
+shunts بيركبوا في ال central nervous system وصلات
+
+197
+00:13:54,300 --> 00:13:58,020
+برضه ممكن تماما meningitis peritoneal dialysis
+
+198
+00:13:58,020 --> 00:14:00,880
+catheters انت بتعرفوا ال dialysis فيها حاجة اسمها
+
+199
+00:14:00,880 --> 00:14:05,120
+hemodialysis اللي هوالدياليزا اللي هو غسيل الكيلة،
+
+200
+00:14:05,120 --> 00:14:08,080
+غسيل الكيلة في منه صنفين، في منه بياخدوا من ال ..
+
+201
+00:14:08,080 --> 00:14:10,000
+من ال veins و في بياخدوا من البطن بيسموه
+
+202
+00:14:10,000 --> 00:14:13,060
+peritoneal dialysis فهذا اللي بياخدوه من ال .. او
+
+203
+00:14:13,060 --> 00:14:16,980
+.. او بيطلعوله و اصلاه من البطن بيدخله فيه برضه
+
+204
+00:14:16,980 --> 00:14:21,180
+كاتيتار فهذه برضه قد تؤثر او قد تصيب المرضى
+
+205
+00:14:21,180 --> 00:14:25,900
+بstaphylococcus epidermis يعني mostly associated
+
+206
+00:14:25,900 --> 00:14:30,120
+with foreign bodies in the human body و associated
+
+207
+00:14:30,120 --> 00:14:30,980
+مع مين؟
+
+208
+00:14:35,740 --> 00:14:40,620
+كانت مستشفة في المستشفات يعني كثير من الاتحادات و
+
+209
+00:14:40,620 --> 00:14:46,840
+الوظائفأنا ذكرت المحاضرة الماضية لما في معرض تفريق
+
+210
+00:14:46,840 --> 00:14:51,160
+بين الستفيلو كوكاس اوريس والستفيلو كوكاس ال .. ال
+
+211
+00:14:51,160 --> 00:14:53,140
+other استفيلو كوكاى اللي جوناه كواجليز نيجاتيف
+
+212
+00:14:53,140 --> 00:14:57,560
+نبّهتلى نقطة جولت زمان كنا نقول ان الكواجليز
+
+213
+00:14:57,560 --> 00:15:00,520
+نيجاتيف استفيلو كوكاى are non pathogenic هذا كلام
+
+214
+00:15:00,520 --> 00:15:03,920
+حكيناه المحاضرة السابق لكن جونا المفهوم هذا بدأ
+
+215
+00:15:03,920 --> 00:15:08,230
+يتغير تماما و جونا لو عملنا googlingعال google
+
+216
+00:15:08,230 --> 00:15:14,630
+search وقولنا septicemia in hospitals هلاجي ان
+
+217
+00:15:14,630 --> 00:15:18,090
+number one cause of septicemia in hospitals is
+
+218
+00:15:18,090 --> 00:15:20,270
+coagulase negative Staphylococci اللي من ضمنها
+
+219
+00:15:20,270 --> 00:15:25,730
+مين؟ Staphylococcus epidermisهذا مؤشر على إيش؟
+
+220
+00:15:25,730 --> 00:15:31,930
+سبتسيميا خد بالك سبتسيميا في المستشفيات أول حاجة
+
+221
+00:15:31,930 --> 00:15:35,150
+إن المرضى بالفعل immunocompromised لقم اتنين ال
+
+222
+00:15:35,150 --> 00:15:38,670
+medical procedures ال invasive procedures جدّيش
+
+223
+00:15:38,670 --> 00:15:42,190
+أننا بنغز المرضى إبر عشان ناخد منهم دم أو عشان
+
+224
+00:15:42,190 --> 00:15:48,210
+نعملهم drugs أو نكيب لهم IV كاتيترز كل ما زادت ال
+
+225
+00:15:48,210 --> 00:15:50,770
+medical procedures كل ما زادت فرصة أن يصير عندهم
+
+226
+00:15:50,770 --> 00:15:55,020
+infection وخاصةإذا ما اتبعناش الـ Aseptic
+
+227
+00:15:55,020 --> 00:15:59,400
+technique و أنا ذكرت لكم سابقا بإن في المستشفيات
+
+228
+00:15:59,400 --> 00:16:04,400
+غالبا الإخوة الأطباء و الممرضين بينسوا ال
+
+229
+00:16:04,400 --> 00:16:07,560
+microbiology اللي اتعلموه في ال bachelor's تبعهم
+
+230
+00:16:07,560 --> 00:16:11,350
+خالصو بصيروا يشتغلوا بعيدا عن ايه؟ عن ال aseptic
+
+231
+00:16:11,350 --> 00:16:16,350
+technique وبالتالي مستشفياتنا تعتبر بيئة خاصبة جدا
+
+232
+00:16:16,350 --> 00:16:20,990
+لنقل العدوى و خاصة العدوى اللي الأصل بكل سهولة و
+
+233
+00:16:20,990 --> 00:16:24,550
+يسهر ممكن يتخلص منها كمان مرة الميكروبه اللي موجود
+
+234
+00:16:24,550 --> 00:16:29,990
+على الجلدغالبا بدخل إلى الدم عبر ال invasive
+
+235
+00:16:29,990 --> 00:16:33,830
+procedures وصل الصورة وبالتالي لو انا استخدمت
+
+236
+00:16:33,830 --> 00:16:38,270
+technique جيد انا بمؤكد هخفض عدد اللي هو حالة ال
+
+237
+00:16:38,270 --> 00:16:43,440
+infection بهذه البكتيريانيجيلامين للستافيل الكوكاس
+
+238
+00:16:43,440 --> 00:16:47,880
+Sabrophytic اسمها Sabrophytic من Sabrophite
+
+239
+00:16:47,880 --> 00:16:52,820
+Sabrophite معناها مترممة مترممة يعني تتغذى على
+
+240
+00:16:52,820 --> 00:16:57,960
+الأشياء الميتة مؤشر على إنها مش متطفلة عكس متطفلة
+
+241
+00:16:57,960 --> 00:17:02,660
+مترممة تعيش معيشة حرة لكن تستطيع أيضا إنها تعيش
+
+242
+00:17:02,660 --> 00:17:05,980
+على اللي هو الإنسان أو تعمل infection في الإنسان
+
+243
+00:17:06,550 --> 00:17:10,890
+كلمة Subrotic Fetid in life معناها جونها أنها
+
+244
+00:17:10,890 --> 00:17:14,250
+بتعيش عيشة مترممة resistant to novobiosin هذه
+
+245
+00:17:14,250 --> 00:17:16,990
+جونها نقطة للتفريق بينها وبين ال Staphylococcus
+
+246
+00:17:16,990 --> 00:17:20,810
+Epidermis most infection are community acquired
+
+247
+00:17:20,810 --> 00:17:24,310
+عكس ال Epidermis كانت مش مالها كانت ال hospital
+
+248
+00:17:24,310 --> 00:17:29,810
+acquired Primary UTI in 10% to 20% of young adult
+
+249
+00:17:29,810 --> 00:17:35,430
+womenهى المسبب للـ urinary tract تمام في عشرة من
+
+250
+00:17:35,430 --> 00:17:39,850
+العشرين في المية من ال young adult woman يعتقد انه
+
+251
+00:17:39,850 --> 00:17:44,310
+young adult woman يعني الفتيات البالغات حديثا تمام
+
+252
+00:17:44,310 --> 00:17:49,130
+بقولك اعتقادا .. اعتقاد ال .. ال .. ال .. ليش ال
+
+253
+00:17:49,130 --> 00:17:51,890
+.. ال .. بتسبب infection احنا بنعرف ان ال vagina
+
+254
+00:17:51,890 --> 00:17:55,630
+فيها low pH نتيجة عن ال lactobacillus الهي normal
+
+255
+00:17:55,630 --> 00:17:58,250
+flora البلوغ
+
+256
+00:17:59,420 --> 00:18:04,360
+بيصحبوا hormonal changes ال hormonal changes هذه
+
+257
+00:18:04,360 --> 00:18:10,340
+قد تؤدي إلى تغيير في ال secretions في الفجاينة
+
+258
+00:18:10,340 --> 00:18:16,220
+وبالتالي يتغير ال normal flora يرتفع ال pH يصير
+
+259
+00:18:16,220 --> 00:18:19,680
+البيئة مناسبة لمن؟ لل infection ب other microbes
+
+260
+00:18:19,680 --> 00:18:24,230
+هذا هو التفسير اللي موجود حالياغالبا في عندها
+
+261
+00:18:24,230 --> 00:18:28,050
+resistance لل antibiotics للبنسيلين والسفالوسبورين
+
+262
+00:18:28,050 --> 00:18:32,010
+راجزوا معايا Staphylococcus aureus ذكرنا قائمة
+
+263
+00:18:32,010 --> 00:18:35,810
+كبيرة من الأمراض لم نذكر منها ال urinary tract
+
+264
+00:18:35,810 --> 00:18:41,070
+infection ونالكوا برضه في المحاضرة السابقة ان كتير
+
+265
+00:18:41,070 --> 00:18:45,530
+من النتائج لل urine culture تطلع عندنا باسم
+
+266
+00:18:45,530 --> 00:18:50,620
+Staphylococcus aureus على الرغم من انهالعلم لم
+
+267
+00:18:50,620 --> 00:18:53,460
+يعترف بإن هو مسبب ل .. ل .. ل .. لكن لو جلنا
+
+268
+00:18:53,460 --> 00:18:58,800
+Sabrophytic اس it is acceptable بينما Aureus مش
+
+269
+00:18:58,800 --> 00:19:02,080
+acceptable cause of urinary tract infection
+
+270
+00:19:02,080 --> 00:19:08,860
+نيجاتيب
+
+271
+00:19:08,860 --> 00:19:14,080
+بتطلع عن يعني normal growth
+
+272
+00:19:19,430 --> 00:19:22,270
+تقول إن هو السبب هو الـ Staphylococcus aureus و لا
+
+273
+00:19:22,270 --> 00:19:25,190
+هو بيعرف المصدر؟ لأ، احنا .. احنا .. أفوان احنا
+
+274
+00:19:25,190 --> 00:19:28,070
+الأصل إنه نكتب .. احنا ك .. ك medical technologist
+
+275
+00:19:28,070 --> 00:19:31,290
+لو عزلنا Staphylococcus aureus من ال urine ما
+
+276
+00:19:31,290 --> 00:19:35,930
+نكتبها نكتب نتيجة إيه؟ negative لأسف جهلنا ..
+
+277
+00:19:35,930 --> 00:19:39,370
+جهلنا ب .. ال true pathogenes في ال general tract
+
+278
+00:19:39,370 --> 00:19:41,810
+infection بيخلينا نكتب Staphylococcus aureus الآن
+
+279
+00:19:41,810 --> 00:19:44,790
+لما بنعطيها للطبيب، الطبيب بيعالج المريض على
+
+280
+00:19:44,790 --> 00:19:48,780
+Staphylococcus aureusوستصورة فاحنا عملنا
+
+281
+00:19:48,780 --> 00:19:52,340
+misleading دلوقت طباء ولأ طباء لإن هم مش متبقين
+
+282
+00:19:52,340 --> 00:19:55,460
+برضه كويس في ال micro biology غالبا بياخدوا مننا
+
+283
+00:19:55,460 --> 00:19:59,480
+النتائج وبيشتغلوا على أساس لكن كمان مرة لو جينا
+
+284
+00:19:59,480 --> 00:20:02,840
+staphylococcus saprophytic بيكون بالفعل هي
+
+285
+00:20:02,840 --> 00:20:06,060
+acceptable cause وخاصة cystitis اللي هو التهاب
+
+286
+00:20:06,060 --> 00:20:12,660
+المثل طيب نلخص ال staphylococci هنبدأ في الموضوع
+
+287
+00:20:12,660 --> 00:20:13,260
+الجديد
+
+288
+00:20:16,970 --> 00:20:22,170
+أول مجموعة في جروب سميناها gram-positive-coccyte
+
+289
+00:20:22,170 --> 00:20:25,970
+تميزت بأنها كتاليز بوستف تميزت بأنها بتحول
+
+290
+00:20:25,970 --> 00:20:30,290
+السكريات إلى لكتك أسد تميزت بأنها facultative
+
+291
+00:20:30,290 --> 00:20:34,570
+أنائيروب none motile none spore forming درسنا
+
+292
+00:20:34,570 --> 00:20:38,210
+تلاتة species منهم aureus, epidermis,
+
+293
+00:20:38,530 --> 00:20:41,030
+saprophyticis عرفنا أن ال aureus is the most
+
+294
+00:20:41,030 --> 00:20:46,560
+important تمام؟لكن في معرض تفريقنا بين ال aureus و
+
+295
+00:20:46,560 --> 00:20:50,160
+ال epidermis تطرقنا لبكتيريا أخرى ليس لعلاقة
+
+296
+00:20:50,160 --> 00:20:52,760
+بالموضوع خالص بقى عنها اللي هي اسمها micrococcus
+
+297
+00:20:52,760 --> 00:20:56,960
+وعطينا بعض الوصف إليها جونا عنها أنه بتشترك مع
+
+298
+00:20:56,960 --> 00:20:59,960
+الاستفيلو كوكس اوريس بمعلومتين ground positive
+
+299
+00:20:59,960 --> 00:21:03,920
+coccyt catalase positive لكن تميز عنها بأنها
+
+300
+00:21:03,920 --> 00:21:08,870
+oxidative وليسبعدين انتقلنا للتفريق بين
+
+301
+00:21:08,870 --> 00:21:12,190
+Epidermidis و Sabrophyticus وكان التفريق في إما
+
+302
+00:21:12,190 --> 00:21:15,530
+مكان الإصابة، يعني المرض اللي بتسببه، هذه بسبب
+
+303
+00:21:15,530 --> 00:21:18,670
+Endocarditis، هذه بسبب Cystitis، هذه hospital
+
+304
+00:21:18,670 --> 00:21:22,130
+acquired، هذه community acquired، هذه sensitive
+
+305
+00:21:22,130 --> 00:21:26,820
+للنوفوبيوسين والتانية resistant للنوفوبيوسينشوفوا
+
+306
+00:21:26,820 --> 00:21:29,740
+يا شباب ال gram-bostig كتير سهلة، كتير كتير سهلة
+
+307
+00:21:29,740 --> 00:21:33,820
+التعرف عليها لإنه طلعوا .. احسبوا على دي الفحصات
+
+308
+00:21:33,820 --> 00:21:37,460
+اللازمة اللي لنا، gram-bostig أول واحد، gram
+
+309
+00:21:37,460 --> 00:21:42,460
+-bostig كتاليزي، صعب نعمل كتاليز؟ مين فيكوا اللي
+
+310
+00:21:42,460 --> 00:21:47,260
+بيعرفش نعمل كتاليز؟ one
+
+311
+00:21:47,260 --> 00:21:51,960
+minute test تمام؟ سهل نعمل نفو بيو سين test ولا
+
+312
+00:21:51,960 --> 00:21:55,760
+صعب؟الcourse حطه على ال antibiotic وانت حطه على
+
+313
+00:21:55,760 --> 00:21:58,080
+البكتيريا و بعد 24 ساعة شوف sensitive ولا
+
+314
+00:21:58,080 --> 00:22:01,580
+resistant ال coagulase برضه one minute test وخاصة
+
+315
+00:22:01,580 --> 00:22:04,760
+slide method يا positive يا negative ال menitol
+
+316
+00:22:04,760 --> 00:22:07,280
+fermentation ما انت عاملها على ال menitol salt
+
+317
+00:22:07,280 --> 00:22:11,400
+agar لو زرعت البكتيريا على menitol salt agarال ..
+
+318
+00:22:11,400 --> 00:22:15,780
+الاستفيل الكوكاى بالذات ميلي جرام بوسطف very easy
+
+319
+00:22:15,780 --> 00:22:19,580
+to distinguish from other bacteria و very easy to
+
+320
+00:22:19,580 --> 00:22:24,420
+identify وصلت الصورة ننتقل الأن للمجموعة الأكبر
+
+321
+00:22:25,630 --> 00:22:29,910
+يعني الجرام بصت في كوكاي مجموعتين Staphylococci
+
+322
+00:22:29,910 --> 00:22:33,970
+واستريبتو كوكاي الاستريبتو كوكاية على أهميتها
+
+323
+00:22:33,970 --> 00:22:37,250
+عددها محدود اللي متعامل معاه لكن الاستريبتو كوكاية
+
+324
+00:22:37,250 --> 00:22:41,110
+برضه على أهميتها اللي أقل لكن من الاستريبتو كوكاية
+
+325
+00:22:41,110 --> 00:22:47,410
+لكن أسماء عديدة وأمراض كثيرة جدا لدرجة انهم يقولوا
+
+326
+00:22:47,410 --> 00:22:51,710
+انهال genus اللي اسمه streptococci هو أكثر genus
+
+327
+00:22:51,710 --> 00:22:56,910
+بسبب أكثر أنواع مش أكتر عدد أكتر أنواع من الأمراض
+
+328
+00:22:56,910 --> 00:23:01,530
+ووصف لما أنا مرة قلت from head to toe بينطبق أكتر
+
+329
+00:23:01,530 --> 00:23:04,970
+على مين على ال streptococci وحنشوف كمان شوية بعض
+
+330
+00:23:04,970 --> 00:23:10,930
+الأسماء streptococcus biogenesstriptococcus
+
+331
+00:23:10,930 --> 00:23:15,190
+agalactia striptococcus fecalis اللي سمناها
+
+332
+00:23:15,190 --> 00:23:19,590
+enterococcus fecalis striptococcus pneumonia إذن
+
+333
+00:23:19,590 --> 00:23:23,090
+بتوقع و أنا بحكي عن ال striptococcus أقول إسمانه
+
+334
+00:23:23,090 --> 00:23:28,310
+أقول striptococcus و أقول enterococcus لإن كنا فيه
+
+335
+00:23:28,310 --> 00:23:31,290
+جزء منها تتحول من striptococcus زي striptococcus
+
+336
+00:23:31,290 --> 00:23:33,410
+fecalis اللي رقم تلاتة صار اسمها what?
+
+337
+00:23:34,070 --> 00:23:38,950
+enterococcus fecalis striptococcus
+
+338
+00:23:38,950 --> 00:23:43,370
+pneumoniaو viridance group، viridance group مانها
+
+339
+00:23:43,370 --> 00:23:48,930
+المجموع الخضراء، ليش خضراء؟
+
+340
+00:23:48,930 --> 00:23:54,530
+بتعمل alpha hemolysis، بتعمل alpha hemolysis، و ال
+
+341
+00:23:54,530 --> 00:23:59,670
+alpha hemolysis ليش لونه؟ أخ لونه partial، لونه
+
+342
+00:23:59,670 --> 00:24:03,330
+أخضر، صحيحكمان مرة نقول اسمها streptococcus
+
+343
+00:24:03,330 --> 00:24:07,250
+biogenes, streptococcus agalactia, streptococcus
+
+344
+00:24:07,250 --> 00:24:10,410
+fecalis أو enterococcus fecalis, streptococcus
+
+345
+00:24:10,410 --> 00:24:13,350
+pneumoniae و streptococcus viridans
+
+346
+00:24:15,940 --> 00:24:18,900
+they are gram-bostef-coccyte arranged in chains،
+
+347
+00:24:18,900 --> 00:24:21,420
+they are catalase-negative و أنا قلتلكوا المعلومة
+
+348
+00:24:21,420 --> 00:24:26,760
+الأولانية يعني قد نخطئ فيها تحت الميكروسكوب لو ال
+
+349
+00:24:26,760 --> 00:24:31,400
+chains إتت فوق بعضها هتعطينا شكل clusters تمام؟ و
+
+350
+00:24:31,400 --> 00:24:36,200
+لو cluster اتفرفت عن بعضه ممكن يعطينا شكل chains
+
+351
+00:24:36,200 --> 00:24:40,880
+وبالتالي وجدنا النقطة الأهم في التفريق بينهم هو
+
+352
+00:24:40,880 --> 00:24:45,770
+فحص الكتلاز كتلاز بوستف ولا كتلاز نيجاتيفكل نزار
+
+353
+00:24:45,770 --> 00:24:49,130
+صغير كنا في ال .. ال .. ال .. ال .. ال staff نقول
+
+354
+00:24:49,130 --> 00:24:53,090
+two to four هذا one to two millimeter في منهم
+
+355
+00:24:53,090 --> 00:24:57,470
+بنوصفها بأنها pinpoint جدرس دبوس pinpoint يعني
+
+356
+00:24:57,470 --> 00:25:02,010
+صغيرة خالص Striptococcus
+
+357
+00:25:02,010 --> 00:25:04,490
+could be classified based on their hemolytic
+
+358
+00:25:04,490 --> 00:25:09,970
+activity إلى ثلاث أصنافيعني لو جيبنا أي strip
+
+359
+00:25:09,970 --> 00:25:13,810
+كوكاي في الدنيا وحطيناها على blood agar فهتعطينا
+
+360
+00:25:13,810 --> 00:25:18,210
+reaction واحد من تلاتة ايش الواحد من تلاتة؟ اما
+
+361
+00:25:18,210 --> 00:25:23,230
+complete hemolysis او incomplete hemolysis او no
+
+362
+00:25:23,230 --> 00:25:27,290
+hemolysis ال complete hemolysis كلكم بتعرفوا ال
+
+363
+00:25:27,290 --> 00:25:31,030
+blood agar لونه أحمرالـ Complete Hemolysis is
+
+364
+00:25:31,030 --> 00:25:35,430
+manifested by ..يعني بنجر نشوفه من خلال .. تمام؟
+
+365
+00:25:35,430 --> 00:25:40,250
+بنشوفه من خلال تكون zone of colorless area .. area
+
+366
+00:25:40,250 --> 00:25:45,110
+with no color راح الدم راح لهم الدم تماما ف
+
+367
+00:25:45,110 --> 00:25:49,590
+Complete Hemolysis وبنسميها Beta يبقى الـ Beta
+
+368
+00:25:49,590 --> 00:25:52,770
+Hemolysis هو عبارة عن أيه يا شباب؟ Complete
+
+369
+00:25:52,770 --> 00:25:58,320
+Hemolysis كيف بنعرفه؟clear zone clear zone الـ
+
+370
+00:25:58,320 --> 00:26:02,980
+alpha hemolyticهو incomplete أو partial hemolysis
+
+371
+00:26:02,980 --> 00:26:07,360
+و could be visualized by the presence of greenish
+
+372
+00:26:07,360 --> 00:26:10,620
+discoloration around the colonies يعني المستعمرات
+
+373
+00:26:10,620 --> 00:26:14,920
+بيكون محاطة بلون أخضر حول المستعمرات إذا في عندي
+
+374
+00:26:14,920 --> 00:26:19,760
+complete و incomplete ال complete سمينا beta ال
+
+375
+00:26:19,760 --> 00:26:23,940
+incomplete سمينا alpha و عشان ماتزعلش التالتة اللي
+
+376
+00:26:23,940 --> 00:26:29,550
+مابتعملش حاجة عطناها لقب gamma hemolyticفاندي ألفة
+
+377
+00:26:29,550 --> 00:26:34,990
+و Beta و Gamma و أذكركم بما قلته في ال
+
+378
+00:26:34,990 --> 00:26:38,250
+Staphylococcus aureus قلت most strain of
+
+379
+00:26:38,250 --> 00:26:42,750
+Staphylococcus aureus are beta hemolyticلكن لم
+
+380
+00:26:42,750 --> 00:26:47,610
+استخدم صفة الـ Hemolysis كوسيلة لتصنيف الـ
+
+381
+00:26:47,610 --> 00:26:53,150
+Staphylococci لكن هنا استخدمتها كوسيلة أساسية في
+
+382
+00:26:53,150 --> 00:26:57,570
+التعرف على الـ Staphylococci فبقول أنا و أنا بشرح
+
+383
+00:26:57,570 --> 00:27:01,110
+للدكتور أو بشرح للطلاب بقوله Beta Hemolytic
+
+384
+00:27:01,110 --> 00:27:04,170
+Staphylococci Alpha Hemolytic Staphylococci أو
+
+385
+00:27:04,170 --> 00:27:07,330
+Gamma Hemolytic Staphylococci طبعا هذا التصنيف
+
+386
+00:27:07,330 --> 00:27:10,770
+هستفيد منه ان شاء الله لاحقا لكن تعالى نشوف مثلا
+
+387
+00:27:10,770 --> 00:27:16,490
+عندي هنامن أهم الأصناف اللي بتعطي Alpha-Hemolytic
+
+388
+00:27:16,490 --> 00:27:20,570
+Striptococcus pneumonia و Viridans Striptococci
+
+389
+00:27:20,570 --> 00:27:23,410
+هدولة بتنتين Alpha-Hemolytic و أنا قبل شوية قلت
+
+390
+00:27:23,410 --> 00:27:28,010
+سميت Viridans لإنها بتعمل Alpha-Hemolysis ال Beta
+
+391
+00:27:28,010 --> 00:27:30,290
+-Hemolytic جونا produces complete zone زي
+
+392
+00:27:30,290 --> 00:27:33,630
+Striptococcus Biodens و Striptococcus Agalactia
+
+393
+00:27:33,630 --> 00:27:36,350
+هدولة أهم هذا البعثجين اللي هو Striptococcus
+
+394
+00:27:36,350 --> 00:27:41,460
+Biodens اللي هوخلّاكوا أو خلّا أهليكوا يودّوكوا
+
+395
+00:27:41,460 --> 00:27:44,480
+على المستشفيات أو علي إيادات أكتر من المرة خلال
+
+396
+00:27:44,480 --> 00:27:49,980
+مرحل حياتكم اللواز التهاب اللواز, tonsillitis من
+
+397
+00:27:49,980 --> 00:27:53,720
+منّا لم يُصب مرة على الأقل بالـ tonsillitis؟ مين
+
+398
+00:27:53,720 --> 00:27:59,900
+أنت؟ مين اللي لم يُصب؟ normal
+
+399
+00:27:59,900 --> 00:28:04,580
+أنت حضرتك؟ طبيعي يعني؟ ولا من كوكب آخر؟ كوكب آخرة
+
+400
+00:28:04,580 --> 00:28:04,960
+كده؟
+
+401
+00:28:08,830 --> 00:28:12,870
+عاموما جونا الستوكوكاس بيوجينز والستوكوكاس بيوجينز
+
+402
+00:28:12,870 --> 00:28:17,430
+هي ال .. ال .. ال .. ال species الأشهر و ياخدوا
+
+403
+00:28:17,430 --> 00:28:21,170
+بقلكوا المشكلة مش في انها بتسبب تنسوليتس المشكلة
+
+404
+00:28:21,170 --> 00:28:25,890
+في ميبعت التنسوليتس ان complications سيئة للغاية
+
+405
+00:28:25,890 --> 00:28:31,630
+autoimmune complicationsهذه البكتيريا من ميزاتها
+
+406
+00:28:31,630 --> 00:28:35,850
+أن أنتجيناتها تشبه أنتجيناتنا احنا، فلما الرسم
+
+407
+00:28:35,850 --> 00:28:39,230
+بيكون أجسام مضادة، الأجسام مضادة مابيش بس بتهاجم
+
+408
+00:28:39,230 --> 00:28:43,130
+البكتيريا، بتهاجم خلاينا، بتهاجم القلب، بتهاجم
+
+409
+00:28:43,130 --> 00:28:47,630
+المفاصل، تخيلوا واحد عمره خمس عشر سنة و قلبه عمره
+
+410
+00:28:47,630 --> 00:28:52,650
+سبعين سنةأو عمره خمسان سنة والمفاصل تبعته عمره
+
+411
+00:28:52,650 --> 00:28:56,510
+سبعين سنة، نتيجة الـrepeated infection with
+
+412
+00:28:56,510 --> 00:29:01,650
+streptococcus by your genes، لذلك الـtonsillitis
+
+413
+00:29:01,650 --> 00:29:05,410
+أو الـpharyngitis is not a simple infection، يعني
+
+414
+00:29:05,410 --> 00:29:09,310
+infection should be monitored closely، لازم الواحد
+
+415
+00:29:09,310 --> 00:29:14,450
+يلقيفها بشكل جيد ويعالجها بشكل أيضا جيدالصنف
+
+416
+00:29:14,450 --> 00:29:17,630
+الأخير و بعدين نرجع لل .. ده في أسئلة الصنف الأخير
+
+417
+00:29:17,630 --> 00:29:21,870
+هو ال gamma hemolytic أو non hemolytic وهذا بي ..
+
+418
+00:29:21,870 --> 00:29:25,030
+طبعا احنا قولنا انه مابيعملش اي نوع من التغيير على
+
+419
+00:29:25,030 --> 00:29:28,950
+المستعمرات وبالتالي أعطينا مصطلح gamma لإنه أعطينا
+
+420
+00:29:28,950 --> 00:29:32,630
+alpha و beta للي بيعملوا الدرر المعين من أشهر
+
+421
+00:29:32,630 --> 00:29:34,990
+الميكروبات اللي هو ال enterococcus fecalis فضلنا
+
+422
+00:29:51,720 --> 00:29:57,320
+طبعا، اه قبل التأكيد، لكن في الآخر انت متى بتحتاج
+
+423
+00:29:57,320 --> 00:30:00,020
+انك تعمل diagnosis؟ لما يكون في عندك symptoms،
+
+424
+00:30:00,020 --> 00:30:03,090
+مظبوط؟By the time there is a symptoms بتكون
+
+425
+00:30:03,090 --> 00:30:06,210
+البكتيريا عملت colonization صح ولا لأ وعملت
+
+426
+00:30:06,210 --> 00:30:09,990
+infection وبدأت مقرحة ال disease فبالتالي حتى لو
+
+427
+00:30:09,990 --> 00:30:14,370
+انت علجت الجسم تعرف على البكتيريا وكون لها أجسام
+
+428
+00:30:14,370 --> 00:30:18,850
+مضادة فانت ممكن تقضي على البكتيريا لكن لن تقضي على
+
+429
+00:30:18,850 --> 00:30:24,070
+ال complications اللي نتجت عن الإصابة بالبكتيريا
+
+430
+00:30:24,070 --> 00:30:28,110
+لذلك الناس اللي بيوصابوابيتنصرات بشكل مستمر
+
+431
+00:30:28,110 --> 00:30:33,530
+بيعطوهم long acting penicillin اللي هو كل شهر
+
+432
+00:30:33,530 --> 00:30:37,490
+بيعطوه إبرة أو كل 45 بيعطوه إبرة لما يكبر و يصير
+
+433
+00:30:37,490 --> 00:30:40,710
+عنده مناعة كويس اتحسن مناعته تمام عشان لا يوصاب
+
+434
+00:30:40,710 --> 00:30:45,060
+مرة أخرى لإنه إذا أصيبنسبة إمكانية تنشيط جهاز
+
+435
+00:30:45,060 --> 00:30:48,380
+المناع أو إنتاج أجسام مضادة كبير .. طبعا الأجسام
+
+436
+00:30:48,380 --> 00:30:51,660
+المضادة كمان مرة الأصل هتكون فصالها الجسم لكن لما
+
+437
+00:30:51,660 --> 00:30:55,660
+تهاجم الجسم بيصير في هذا الحالة مضرة مضرة مضرة
+
+438
+00:30:55,660 --> 00:30:57,640
+مضرة مضرة مضرة مضرة مضرة مضرة مضرة مضرة مضرة مضرة
+
+439
+00:30:57,640 --> 00:30:58,960
+مضرة مضرة مضرة مضرة مضرة مضرة مضرة مضرة مضرة مضرة
+
+440
+00:30:58,960 --> 00:31:05,200
+مضرة مضرة مضرة م
+
+441
+00:31:12,470 --> 00:31:15,970
+صحيح لما يصير .. لما يصير ضرارهم اكتر من نافعهم
+
+442
+00:31:15,970 --> 00:31:19,330
+غالبا بيزالوا متى بيصير ضرارهم اكتر من نافعهم يا
+
+443
+00:31:19,330 --> 00:31:25,270
+شباب؟ لما بيتضخموا ال level تبع الدم بي .. ال ..
+
+444
+00:31:25,270 --> 00:31:29,490
+ال supply بيقل عليهم وبالتالي بيبطلوا هم فاعلين
+
+445
+00:31:29,490 --> 00:31:33,050
+فلكن بيصير هم substrate للبكتيريا substrate يعني
+
+446
+00:31:33,050 --> 00:31:36,890
+لو كانك انت حاط .. حاطلهم حاجة ينمو عليها ال ..
+
+447
+00:31:36,890 --> 00:31:38,770
+فبالتالي في هذه الحالة بيصير ضرارهم اكتر وبالتالي
+
+448
+00:31:38,770 --> 00:31:39,950
+بيزالوا ال .. ال tonsils
+
+449
+00:31:45,000 --> 00:31:49,500
+من التكسور الغير كامل للهموجلبيين لأ مش بيث
+
+450
+00:31:49,500 --> 00:31:51,640
+هموجلبيين بيوفيردين اعتقد اسمه بيوفيردين
+
+451
+00:31:54,550 --> 00:31:57,870
+احنا صنفنا البكتيريا في اللوحة السابقة او اللوحتان
+
+452
+00:31:57,870 --> 00:32:01,190
+السابقتان based on hemolytic activity جنا فينا
+
+453
+00:32:01,190 --> 00:32:06,390
+Alpha وفينا Beta وفينا Gamma في كمان تصنيف تاني
+
+454
+00:32:06,390 --> 00:32:10,630
+مبني على serology اللي هو Lansfield grouping هذا
+
+455
+00:32:10,630 --> 00:32:15,090
+Lansfield عبارة عن او السيدة Rebecca Lansfield
+
+456
+00:32:15,750 --> 00:32:19,150
+Rebecca Lansfield صنفت الـ streptococci إلى
+
+457
+00:32:19,150 --> 00:32:22,370
+مجموعات حسب الـ C carbohydrate أنتجين الموجود في
+
+458
+00:32:22,370 --> 00:32:25,510
+الcell wall مش حسب ال O أنتجين يعني اللي تبقى ال
+
+459
+00:32:25,510 --> 00:32:29,650
+gram negative بكتيريا وانما C polysaccharide اللي
+
+460
+00:32:29,650 --> 00:32:33,530
+موجود في ال cell wall تبع ال streptococci جسمتهم
+
+461
+00:32:33,530 --> 00:32:40,520
+من ال group A to Uلكن بقولنا ان الـ groups A,B وD
+
+462
+00:32:40,520 --> 00:32:44,400
+are of great pathogenic significance بمعنى ان
+
+463
+00:32:44,400 --> 00:32:48,920
+المجموعات الالف والبا والدال هم المجموعات الأهم
+
+464
+00:32:48,920 --> 00:32:54,300
+على الإطلاق في الـ streptococcus خد بالك التصنيف
+
+465
+00:32:54,300 --> 00:32:57,140
+تبع Rebecca Lansfield مبني على السيرولوجيا،
+
+466
+00:32:57,140 --> 00:33:01,000
+أنتيجينات بينما التصنيف الأولاني كان مبني على الـ
+
+467
+00:33:01,000 --> 00:33:04,260
+Hemolysis اللي بتشوفه بعينك اللي لا يكلفك شيء
+
+468
+00:33:05,540 --> 00:33:08,740
+بتشوفها Alpha، بتشوفها Beta، بتشوفها Gamma، هذا
+
+469
+00:33:08,740 --> 00:33:12,980
+يسمى له Serology، وكلمة group ماذا تعني group؟
+
+470
+00:33:12,980 --> 00:33:17,840
+يعني مش microbe واحد، مش microbe واحد، ان group A
+
+471
+00:33:17,840 --> 00:33:21,260
+مثلا Striptococcus biogenes، خد بالك، group A
+
+472
+00:33:21,260 --> 00:33:25,400
+Striptococcus biogenes، في اللوحات السادقة ال
+
+473
+00:33:25,400 --> 00:33:30,060
+Striptococcus biogenes كانت تحت مين؟باتا هيموليتك
+
+474
+00:33:30,060 --> 00:33:35,700
+فلو انا لجيت ان هي الوحيدة من group A اللي باتا
+
+475
+00:33:35,700 --> 00:33:39,960
+هيموليتك و قلت بتعبير group A باتا هيموليتك بكون
+
+476
+00:33:39,960 --> 00:33:40,580
+قصد مين؟
+
+477
+00:33:44,700 --> 00:33:49,520
+لأ لإن ال galaxy هتلاحظ group مين؟ group B فلما
+
+478
+00:33:49,520 --> 00:33:52,300
+أنا قلت group A beta hemolytic phenagossate
+
+479
+00:33:52,300 --> 00:33:55,440
+streptococcus لإنه هي الوحيدة اللي اشتركت في
+
+480
+00:33:55,440 --> 00:33:58,820
+الصفتين و الصحيح إنه النظامين بيستخدموا بهذا
+
+481
+00:33:58,820 --> 00:34:01,700
+الطريقة إن احنا بندمج بين النظامين فبنقول group A
+
+482
+00:34:01,700 --> 00:34:05,160
+beta hemolytic streptococcus أو group B beta
+
+483
+00:34:05,160 --> 00:34:10,670
+hemolytic streptococcusطبعا هذا كلام وردي وحلو ان
+
+484
+00:34:10,670 --> 00:34:13,470
+احنا نصنف ال bacteria cellologically الى مجموعات
+
+485
+00:34:13,470 --> 00:34:18,850
+هناك شباب بعض أنواع من ال Striptococci سموها non
+
+486
+00:34:18,850 --> 00:34:24,370
+-typeable يعني غير قابلة للتصنيف بي اللي هو
+
+487
+00:34:24,370 --> 00:34:28,570
+Rebecca Lansfield من هذه الميكروبات ميكروب مشهور
+
+488
+00:34:28,570 --> 00:34:30,430
+جدا في Striptococci اللي هو Striptococcus
+
+489
+00:34:30,430 --> 00:34:34,870
+pneumonia Striptococcus pneumonia لا يتبع اي تصنيف
+
+490
+00:34:34,870 --> 00:34:37,650
+من تصنيفات اللي هو Rebecca Lansfield
+
+491
+00:34:47,820 --> 00:34:51,660
+الـ C Police كانت تبعه غير قابل إنه يندرج تحت أي
+
+492
+00:34:51,660 --> 00:34:58,520
+من المجموعات اللي ذكرتفلاحظوا الملاحظة الأخيرة في
+
+493
+00:34:58,520 --> 00:35:01,860
+اللوحة بتقول ان many textbooks uses a combination
+
+494
+00:35:01,860 --> 00:35:03,740
+of the lands field and the hemolytic
+
+495
+00:35:03,740 --> 00:35:06,240
+classification او hemolytic classification زي ما
+
+496
+00:35:06,240 --> 00:35:10,780
+ذكرت قبل قليل قلت group B beta hemolytic
+
+497
+00:35:10,780 --> 00:35:14,520
+streptococci هذا عبارة عن ايش؟ عن دمج للنظامين
+
+498
+00:35:14,520 --> 00:35:18,180
+سويا group A serological و beta hemolytic هو
+
+499
+00:35:18,180 --> 00:35:25,270
+التصنيف البصري اللي شفناه قبل قلبديجي الأول مجموعة
+
+500
+00:35:25,270 --> 00:35:27,630
+.. أول واحدة في ال .. في ال Structococci اللي هي
+
+501
+00:35:27,630 --> 00:35:31,950
+Structococcus Biogenes و هي كمان مرة تحت .. يعني و
+
+502
+00:35:31,950 --> 00:35:37,310
+أنا أقولكم يمكن الأطباء القادمين شوية يمكن الإسم
+
+503
+00:35:37,310 --> 00:35:41,070
+التحتاني أشهر من الإسم الفقاني لل .. للألوي يعني
+
+504
+00:35:41,070 --> 00:35:44,410
+group A Beta Hemolytic Structococci عندهم أشهر من
+
+505
+00:35:44,410 --> 00:35:46,910
+مين؟ من Structococcus Biogenes
+
+506
+00:35:50,030 --> 00:35:53,110
+it is ground positive cocci, non-motile, non-spore
+
+507
+00:35:53,110 --> 00:35:55,930
+forming اعتقد انا قلتلكم المعلومتين هدول عمّمتهم،
+
+508
+00:35:55,930 --> 00:36:00,870
+نعم، occurs in chains or in pair of cells خدوا
+
+509
+00:36:00,870 --> 00:36:07,470
+بالكوا سلسلها قد تصل إلى مئات، خاصة لو نمنها في
+
+510
+00:36:07,470 --> 00:36:12,230
+liquid media، خاصة لو نمنها في liquid media، ليش
+
+511
+00:36:12,230 --> 00:36:17,380
+في liquid media؟ it will grow freelyعشان هيك
+
+512
+00:36:17,380 --> 00:36:19,880
+اتبطلع انا في القنبوبة اللي نميها فيها الاستربت
+
+513
+00:36:19,880 --> 00:36:24,800
+كوكاس بيوجينز وبطلع بلج وكأنه فيها cotton ball
+
+514
+00:36:24,800 --> 00:36:31,200
+cotton ball يعني زي كرة من القطنواقع الأمر هي مش
+
+515
+00:36:31,200 --> 00:36:35,720
+كرة من القطن وإنما هي إيه؟ هي عبارة عن .. عبارة عن
+
+516
+00:36:35,720 --> 00:36:41,200
+نمو للبكتيريا بشكل سلاسل متداخلة مع بعضها فعملة
+
+517
+00:36:41,200 --> 00:36:44,160
+كثافة زي بتضغط مجيب سلسلة طويلة و تحطها في فنجان
+
+518
+00:36:44,160 --> 00:36:47,580
+مثلا انت وتتشبك مع بعضها، مظبوط، فالبكتيريا تتشبك
+
+519
+00:36:47,580 --> 00:36:52,140
+وتعمل إيه؟ فلو أنت أخدت منها قطرةبدون ما تعمل
+
+520
+00:36:52,140 --> 00:36:56,880
+disturbance، disturbance يعني خط للأنبوبة أو رجل
+
+521
+00:36:56,880 --> 00:37:01,180
+للأنبوبة، قد تحصل عندك على سلاسل طويلة جدا، around
+
+522
+00:37:01,180 --> 00:37:06,580
+to avoid cells, 0.6 to 1.5 micrometer, catalase
+
+523
+00:37:06,580 --> 00:37:09,840
+negative, requires enriched medium containing
+
+524
+00:37:09,840 --> 00:37:14,930
+blood in order to grow، هنا نقطةتختلف عن الستفيلو
+
+525
+00:37:14,930 --> 00:37:18,510
+كوكاي فيها البكتيريا لأ تستطيع البكتيريا تنمو على
+
+526
+00:37:18,510 --> 00:37:21,190
+ال nutrient agar شباب لأ تستطيع تنمو على ال
+
+527
+00:37:21,190 --> 00:37:25,510
+nutrient agar حتى لما نعملها sensitivity testing
+
+528
+00:37:25,510 --> 00:37:29,250
+مابنعملهاش sensitivity testing على ميرار هنتون
+
+529
+00:37:29,250 --> 00:37:33,210
+مابنعملها sensitivity testing على blood agar لأن
+
+530
+00:37:33,210 --> 00:37:38,090
+البكتيريا نموها ضعيف إلى معدوم في ال .. في ال ..
+
+531
+00:37:38,090 --> 00:37:40,890
+في ال .. في ال media اللي مافيش فيها blood لازم
+
+532
+00:37:40,890 --> 00:37:49,330
+نميها على مين؟على بلد اجر ايش المصطلح؟
+
+533
+00:37:49,330 --> 00:37:52,610
+بس اخدت المصطلح الأولاني يعني بس اخدت المصطلح
+
+534
+00:37:52,610 --> 00:37:56,390
+الأولاني بقول اتفضل
+
+535
+00:37:56,390 --> 00:38:02,410
+لأ لأ لأ مش كلهم فيه بدهم التشوكلت فيه أسوأ
+
+536
+00:38:02,410 --> 00:38:06,610
+الانترو كوكا على سبيل المثال تنمو على نوتر اجر
+
+537
+00:38:06,610 --> 00:38:09,500
+عاديالانترو كوكاية ممكن تنمو علي الماكنكي يا
+
+538
+00:38:09,500 --> 00:38:12,480
+أبوناي فاكرين اللي ما قلتلكوا الماكنكي هو selected
+
+539
+00:38:12,480 --> 00:38:15,400
+لجرام نيجاتي لكن في صنفين بينمو عليه الاستفيلو
+
+540
+00:38:15,400 --> 00:38:19,040
+كوكاس والانترو كوكاس لأ مش كلهم بيشتركوا أنا بكلم
+
+541
+00:38:19,040 --> 00:38:24,060
+عن مايكروب محدد اللي هو استفيلو كوكاس بيوجينز
+
+542
+00:38:24,060 --> 00:38:30,000
+بيعمل complete hemolysis on blood again شوف النقطة
+
+543
+00:38:30,000 --> 00:38:33,620
+اللي انا حاط على ال pointer هنا بتاع الماوس
+
+544
+00:38:33,620 --> 00:38:38,850
+الدائرة الكبيرة هذه مش هي المستعمرةلو تدققنا النظر
+
+545
+00:38:38,850 --> 00:38:44,750
+هنشوف في هذه نقطة صغيرة تمام و حواليها منطقة خالية
+
+546
+00:38:44,750 --> 00:38:48,730
+من النمو النقطة الصغيرة هي المستعمرة والهموليسز
+
+547
+00:38:48,730 --> 00:38:53,890
+أضعاف حجم المستعمرة الهموليسز حجمه أكبر بكثير لحظة
+
+548
+00:38:53,890 --> 00:38:57,320
+الوسط في المنطقة هذهخالي من ال .. ال .. ال
+
+549
+00:38:57,320 --> 00:39:00,540
+hemolysis لأن مافيشش بكتيريا بينما في المنطقة اللي
+
+550
+00:39:00,540 --> 00:39:05,400
+فيها كثافة عالية من البكتيريا بنلاحظ أنه مافيش
+
+551
+00:39:05,400 --> 00:39:09,520
+أصلا لي البلد كل الدم اختفى لأنه تم تحلله هذه
+
+552
+00:39:09,520 --> 00:39:12,300
+الصورة اللي على جانب ال gram stain بتوضح لنا سلاسل
+
+553
+00:39:12,300 --> 00:39:15,860
+هذه .. هذه خدوا بالكم من عينة مش من مزرعة مش من
+
+554
+00:39:15,860 --> 00:39:19,240
+مزرعة يعني مأخودة من حاجة فيها صديد هذه خلايا
+
+555
+00:39:19,240 --> 00:39:23,300
+الصديد اللي شايفينهم وهذه الخلايا اللي هي السلسلة
+
+556
+00:39:23,300 --> 00:39:27,420
+الطويلة اللي حكينا عنهافي هذه الحالة يعني الصحيح
+
+557
+00:39:27,420 --> 00:39:31,400
+انطباع ناخد انطباع جيد على انه ملي جرامستين على ان
+
+558
+00:39:31,400 --> 00:39:35,380
+البكتيريا هي streptococci لكن لا نستطيع كمان مرة
+
+559
+00:39:35,380 --> 00:39:40,700
+الجزم بانه البكتيريا streptococci ال viral loss
+
+560
+00:39:40,700 --> 00:39:44,020
+factorأحد أهم الـ Virulence Factors اللي ممكن
+
+561
+00:39:44,020 --> 00:39:47,320
+نشوفهم في البكتيريا هذه Striptolysin O و
+
+562
+00:39:47,320 --> 00:39:50,560
+Striptolysin S و أعتقد أنا شرحت قبلك يا شباب
+
+563
+00:39:50,560 --> 00:39:55,060
+Striptolysin O أذكركوا فيه
+
+564
+00:39:58,760 --> 00:40:04,200
+درسنا في المقدمة تبعتنا في ال diagnostic
+
+565
+00:40:04,200 --> 00:40:09,300
+microbiology تحدثنا قولنا ان البكتيريا بتنتج تنتج
+
+566
+00:40:09,300 --> 00:40:17,100
+oxygen labile hemolysin وبالتالي اي مزرعةبنشتبه او
+
+567
+00:40:17,100 --> 00:40:20,260
+اي عينة بنشتبه انه يكون فيها streptococcus biogens
+
+568
+00:40:20,260 --> 00:40:23,620
+لانك تفهي بزراعة البكتيريا على الطبق وانما نقوم
+
+569
+00:40:23,620 --> 00:40:29,220
+بعمل طعن، ليش عمل طعن؟ حتى نخفي البكتيريا بعيدا عن
+
+570
+00:40:29,220 --> 00:40:33,860
+الأكسجين، لماذا؟ قد تنتج البكتيريا streptolysin O
+
+571
+00:40:34,400 --> 00:40:37,240
+إذا أنترت الـ Streptolysin O وفي وجود الـ Oxygen،
+
+572
+00:40:37,240 --> 00:40:40,120
+الـ Oxygen هيدمر الـ Streptolysin، مش هيبين الـ
+
+573
+00:40:40,120 --> 00:40:44,140
+Hemolysis، مش هيبين الـ Hemolysis، لكن لو كانت
+
+574
+00:40:44,140 --> 00:40:48,880
+البكتيريا بعيدا عن الـ Oxygen و أنترت الـ
+
+575
+00:40:48,880 --> 00:40:54,120
+Streptolysin O، هتتحلل أو مش هتتحلل؟ يبقى أنا زرعت
+
+576
+00:40:54,120 --> 00:40:59,390
+على السطحوزرعتها باين كده مرة تحت السطح عشان
+
+577
+00:40:59,390 --> 00:41:05,230
+ابعدها عن ال oxygen ليش الغلط من الفكرة هذه؟ الغلط
+
+578
+00:41:05,230 --> 00:41:10,870
+هو إن إذا كانت بتنتج فقط streptomycin O إنه نبعد
+
+579
+00:41:10,870 --> 00:41:13,510
+ال oxygen عنها وبالتالي نقدر نشوف اللي هو ال
+
+580
+00:41:13,510 --> 00:41:18,100
+hemolysisطبعا ال antibody اللي يسمونه بيكونه ل ..
+
+581
+00:41:18,100 --> 00:41:21,740
+ال striptolysin بنسميه antistriptolysin O
+
+582
+00:41:21,740 --> 00:41:26,760
+antistriptolysin O ال antistriptolysin O او اختصار
+
+583
+00:41:26,760 --> 00:41:37,940
+ASO اكتب عندك ASO و
+
+584
+00:41:37,940 --> 00:41:43,360
+T بده اكبر ال T هنا شوية عشان نعرف ايش الفكرة منها
+
+585
+00:41:46,580 --> 00:41:51,020
+الان ال ASO قلنا هو ال Anti Streptolysin O ماذا
+
+586
+00:41:51,020 --> 00:41:56,420
+نعني بال T؟ ال Titer تايتر معناها مقياس مقياس
+
+587
+00:41:56,420 --> 00:42:00,380
+تركيز يعني احنا قلنا ان معظمنا أصيب بتنسوليتس ما
+
+588
+00:42:00,380 --> 00:42:05,900
+ده أخونا اللي جامن كوكب الظهرة الان طالما ان احنا
+
+589
+00:42:05,900 --> 00:42:09,100
+معظمنا أصيبنا يبجي معنا الحاجة يجيس ان في أجسام
+
+590
+00:42:09,100 --> 00:42:12,880
+مضادة ضد هذا ال antigen يبجي لو عملنا لك احنا فحص
+
+591
+00:42:12,880 --> 00:42:15,940
+الآن و لجيناك positive ماذا يعني ذلك؟اللي ربما
+
+592
+00:42:15,940 --> 00:42:20,160
+تكون إصابة سابقة فكيف بدنا نعرف نتميز بين إصابة
+
+593
+00:42:20,160 --> 00:42:26,860
+حالية وبين إصابة سابقة؟ بدنا نجيس كمية ال antigen
+
+594
+00:42:26,860 --> 00:42:29,740
+عفوا ال antibody اللي هو ال .. اللي هو ال
+
+595
+00:42:29,740 --> 00:42:32,980
+antistreptolazine O وبالتالي إيش .. إيش .. إيش اسم
+
+596
+00:42:32,980 --> 00:42:36,640
+الفحص صار؟ antistreptolazine O تايتر لإن احنا
+
+597
+00:42:36,640 --> 00:42:39,020
+قاعدين بنجيس مش positive، negative وإنما بنجيس
+
+598
+00:42:39,020 --> 00:42:43,580
+concentrationيبجى عملنا الـ titer و لجينا الـ
+
+599
+00:42:43,580 --> 00:42:47,240
+titer أكتر من 200 international unit أو أقل من 200
+
+600
+00:42:47,240 --> 00:42:50,160
+international unit حتى نحط فاصل جونا اللي أقل من
+
+601
+00:42:50,160 --> 00:42:55,400
+200 هذا previous infection اللي أعلى من 200 هذا
+
+602
+00:42:55,400 --> 00:42:59,840
+recent infection إذا أحد أهم الفحوصات اللي
+
+603
+00:42:59,840 --> 00:43:02,440
+اتعلمناها اليوم في هذه المحاضرة هو الـ
+
+604
+00:43:02,440 --> 00:43:06,900
+Antistreptomycin O مهم جدا نعرفه أكم فحص اتعلمت في
+
+605
+00:43:06,900 --> 00:43:08,800
+ال diagnostic غير ال cultures serology
+
+606
+00:43:11,260 --> 00:43:17,380
+مجموعة كبيرة اذاكركوا فيهم Vidal في السلمونيلا صح
+
+607
+00:43:17,380 --> 00:43:21,640
+و تاعت Taifos ال Ox-19 فاكرين اللي قبل ال protest
+
+608
+00:43:21,640 --> 00:43:28,280
+ال Ox-19 صح؟ و اتعلمته ال body detection لليرسينيا
+
+609
+00:43:28,280 --> 00:43:34,730
+في الطعونو كثير من الأمراض اللى اتكلمنا عنها و
+
+610
+00:43:34,730 --> 00:43:37,110
+خاصة ال Yersinia enterocolitica و Yersinia
+
+611
+00:43:37,110 --> 00:43:41,030
+tuberculosis و Yersinia pistis تمام السلمونيلا
+
+612
+00:43:41,030 --> 00:43:44,950
+الشيجيلا جون لأ تمام الشيجيلا بنعمل detection
+
+613
+00:43:44,950 --> 00:43:48,170
+للبكتيريا باستخدام ال antibody إذن و أحنا بندرس في
+
+614
+00:43:48,170 --> 00:43:51,990
+ال diagnostic microbiology نحاول نفرز الفحوصات
+
+615
+00:43:51,990 --> 00:43:55,530
+السيرولوجية على جهة عشان نجزق منها بنحاول ندرسه
+
+616
+00:43:55,530 --> 00:43:58,870
+برضه في المعمل إن تمكننا إن شاء الله طيب نرجع
+
+617
+00:43:58,870 --> 00:43:59,870
+لموضوعنا
+
+618
+00:44:03,420 --> 00:44:08,540
+Streptococcus Biogenic Exotoxin أو SPE A and C SPE
+
+619
+00:44:08,540 --> 00:44:11,740
+اللي هو اختصار ل Streptococcus Biogenic Exotoxin
+
+620
+00:44:11,740 --> 00:44:17,280
+في منه A و في منه C Streptokinase Streptokinase يا
+
+621
+00:44:17,280 --> 00:44:25,470
+شباب هذا درسناه برضه في المقدمةالستريبتو كاينيز هو
+
+622
+00:44:25,470 --> 00:44:30,110
+انزايم بتنتجه الستريبتو كوكاس قادرة على تكسير ال
+
+623
+00:44:30,110 --> 00:44:33,370
+Clot فابرين ال Clot فابرين ال Clot فاكرين ال
+
+624
+00:44:33,370 --> 00:44:36,630
+Staphylococcus aureus ايش بتعمل؟ بتعمل Clot بال
+
+625
+00:44:36,630 --> 00:44:41,010
+Coagulase هذا بفكفك ال Clot لذا خدوا بالكوا
+
+626
+00:44:41,010 --> 00:44:45,670
+الستريبتو كاينيز بيستخدم في وحدات القلب في
+
+627
+00:44:45,670 --> 00:44:51,100
+المستشفيات للناس اللي عندهم جلطاتاما عشان يعجبهم
+
+628
+00:44:51,100 --> 00:44:55,300
+من جلطة او عشان يمنعوهم من حدوث جلطة واصلا مستخدم
+
+629
+00:44:55,300 --> 00:45:00,560
+من مين هذا مأخوذ من الستربتوكوكاس بيو جينس فى
+
+630
+00:45:00,560 --> 00:45:05,520
+هيلوردايز وفى استربتوستربتو دورانايز وفى بيبتدايز
+
+631
+00:45:05,520 --> 00:45:10,040
+كلها انزيمات بتساعد البكتيريا علي انها تتخطى
+
+632
+00:45:10,040 --> 00:45:13,880
+دفاعات الجسم وتعمل destruction لمين؟ لالخلايا
+
+633
+00:45:14,750 --> 00:45:20,270
+أذكركوا ببكتيريا ذكرناها في سياق حديث ممكن سابقا
+
+634
+00:45:20,270 --> 00:45:25,530
+اسمها بكتيريا أكلة اللحم flesh eating bacteria نحن
+
+635
+00:45:25,530 --> 00:45:29,960
+نتحدث عن نفس البكتيرياالفرق بين البكتيريا اللى
+
+636
+00:45:29,960 --> 00:45:33,000
+بتسبب تنسوليتس والبكتيريا اللى بتاكل اللحم اللى
+
+637
+00:45:33,000 --> 00:45:36,640
+حكينا عنها اللى فليش eating بكتيريا ان الفليش
+
+638
+00:45:36,640 --> 00:45:42,000
+eating بكتيريا أصيبت ببكتيريا فهاج اعطاها مقدرة
+
+639
+00:45:42,000 --> 00:45:47,520
+مهولة على إنتاج ال ببتديزيزأكتر من البكتيريا
+
+640
+00:45:47,520 --> 00:45:52,100
+العادية أو ال proteases اللي بتكسر البروتينات
+
+641
+00:45:52,100 --> 00:45:55,540
+وبالتالي أصبعت مقدرتها لكن الاسم هو هو
+
+642
+00:45:55,540 --> 00:45:59,300
+streptococcus biogenes إذن ال streptococcus
+
+643
+00:45:59,300 --> 00:46:02,220
+biogenes اللي بتسبب .. اللي بتسبب simple
+
+644
+00:46:02,220 --> 00:46:05,620
+tonsillitis أيضا could cause اللي قولنا عنها اللي
+
+645
+00:46:05,620 --> 00:46:10,640
+هي ال flesh eating بكتيرهذا بوضح ان ال cell wall
+
+646
+00:46:10,640 --> 00:46:15,160
+structure بعض ال stream بتكون encapsulated وفيه ان
+
+647
+00:46:15,160 --> 00:46:17,600
+طبعا اللي هو ال cell wall اللي فيه tychoic acid و
+
+648
+00:46:17,600 --> 00:46:22,040
+ليبوتايكوك أسد و التراكيب الأخرى اللي احنا عرفناها
+
+649
+00:46:22,040 --> 00:46:27,060
+في الفصل الماضيشوف ال disease القائمة اللى هنجهها
+
+650
+00:46:27,060 --> 00:46:29,880
+فى عينها طبعا اللوحة دى ersepallas اللى هو red
+
+651
+00:46:29,880 --> 00:46:33,300
+skin just red skin and pain فقط احمرها على الجلد و
+
+652
+00:46:33,300 --> 00:46:36,820
+ألم otitis media التهيأب الأذن الوسطى peripheral
+
+653
+00:46:36,820 --> 00:46:39,740
+fever او peripheral sepsis اللى هي حمى النفاس
+
+654
+00:46:39,740 --> 00:46:43,740
+wound infection اللى هي الاتهابات الجروح sepsis
+
+655
+00:46:43,740 --> 00:46:47,900
+ومميز السيح ال sepsis هنا باسم scarlet fever او
+
+656
+00:46:47,900 --> 00:46:54,210
+الحمى القرمزية sinusitisرقم ستة sorry throat اللي
+
+657
+00:46:54,210 --> 00:46:56,870
+هي التهابات الحلق بما فيها الفارنجايتس
+
+658
+00:46:56,870 --> 00:47:01,830
+والتنسولايتس استيوميلايتس اندوكاردايتس ميننجايتس
+
+659
+00:47:01,830 --> 00:47:06,710
+رقم احداشر واطناش هدولة immune complication واحد
+
+660
+00:47:06,710 --> 00:47:10,330
+ممكن سبب acute glomeral nephritis واحد سبب
+
+661
+00:47:10,330 --> 00:47:12,910
+rheumatic fever والتانين امراض خطيرة جدا قد تؤدي
+
+662
+00:47:12,910 --> 00:47:16,050
+الى الوفاة نكمل المرة القادمة ان شاء الله
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/vcYES6tQ9a0_raw.json b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/vcYES6tQ9a0_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..c733c4ffdfddf276554e458ee43972fbc9aa110b
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/vcYES6tQ9a0_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 4382, "start": 20.74, "end": 43.82, "text": "بسم الله الرحمن الرحيم المحاضرة الماضية وقفنا عند موضوع ال antimicrobial resistance أو ال antibiotic resistance للstaphylococcus aureus واستعرضنا يعني تاريخيا اكتشاف البنسالين وكيف كان اثره على البكتيريا و بعدين بدأت تظهر سلالات مقاومة للبنسالين وحتى للموديفايد او ال semi-synthetic penicillins ايضا لجينا ان البكتيريا", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 9673, 5016, 46958, 25720, 9673, 46958, 10632, 4032, 4587, 5172, 8315, 43242, 3714, 2407, 11242, 45367, 2423, 46141, 299, 16614, 831, 7335, 34051, 2423, 37828, 7335, 24976, 372, 569, 3495, 5842, 905, 1149, 257, 540, 301, 36764, 14851, 3615, 43042, 8315, 37495, 22653, 6055, 9640, 1829, 9778, 25528, 1975, 4117, 2655, 8592, 31845, 29739, 1863, 3794, 6027, 9957, 4032, 4117, 33911, 25961, 1975, 49115, 3224, 15844, 29739, 4117, 2655, 13546, 25528, 4032, 39182, 9957, 47525, 10721, 2655, 6055, 19913, 3224, 2288, 8608, 1211, 6027, 9307, 3714, 4587, 995, 20498, 3660, 24976, 3555, 1863, 3794, 6027, 9957, 4032, 33753, 7578, 5296, 19528, 2407, 16254, 5172, 995, 25708, 1975, 2407, 2423, 12909, 12, 82, 18656, 3532, 3435, 299, 373, 1292, 1975, 1829, 11242, 995, 5296, 7435, 1829, 8315, 16472, 29739, 4117, 2655, 13546, 25528], "avg_logprob": -0.13875439658131397, "compression_ratio": 1.7201365187713311, "no_speech_prob": 0.0, "words": [{"start": 20.74, "end": 21.02, "word": "بسم", "probability": 0.890869140625}, {"start": 21.02, "end": 21.14, "word": " الله", "probability": 0.96484375}, {"start": 21.14, "end": 21.42, "word": " الرحمن", "probability": 0.90673828125}, {"start": 21.42, "end": 21.82, "word": " الرحيم", "probability": 0.9890950520833334}, {"start": 21.82, "end": 22.84, "word": " المحاضرة", "probability": 0.9730224609375}, {"start": 22.84, "end": 23.22, "word": " الماضية", "probability": 0.93896484375}, {"start": 23.22, "end": 23.7, "word": " وقفنا", "probability": 0.9166259765625}, {"start": 23.7, "end": 24.12, "word": " عند", "probability": 0.947265625}, {"start": 24.12, "end": 24.68, "word": " موضوع", "probability": 0.926513671875}, {"start": 24.68, "end": 24.78, "word": " ال", "probability": 0.79296875}, {"start": 24.78, "end": 25.44, "word": " antimicrobial", "probability": 0.8189697265625}, {"start": 25.44, "end": 25.92, "word": " resistance", "probability": 0.95703125}, {"start": 25.92, "end": 26.1, "word": " أو", "probability": 0.681640625}, {"start": 26.1, "end": 26.18, "word": " ال", "probability": 0.8349609375}, {"start": 26.18, "end": 26.46, "word": " antibiotic", "probability": 0.833984375}, {"start": 26.46, "end": 26.96, "word": " resistance", "probability": 0.92529296875}, {"start": 26.96, "end": 27.7, "word": " للstaphylococcus", "probability": 0.7636282784598214}, {"start": 27.7, "end": 28.1, "word": " aureus", "probability": 0.9417317708333334}, {"start": 28.1, "end": 29.78, "word": " واستعرضنا", "probability": 0.84404296875}, {"start": 29.78, "end": 30.24, "word": " 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"كل نزار صغير كنا في ال .. ال .. ال .. ال .. ال staff نقول two to four هذا one to two millimeter في منهم بنوصفها بأنها pinpoint جدرس دبوس pinpoint يعني صغيرة خالص Striptococcus could be classified based on their hemolytic activity إلى ثلاث أصناف", "tokens": [28820, 8717, 11622, 9640, 20328, 17082, 13546, 9122, 8315, 8978, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 4386, 2423, 3525, 8717, 39648, 732, 281, 1451, 23758, 472, 281, 732, 17942, 8978, 9154, 16095, 44945, 2407, 9381, 5172, 11296, 4724, 33456, 11296, 40837, 10874, 3215, 2288, 3794, 11778, 3555, 41779, 40837, 37495, 22653, 20328, 17082, 48923, 16490, 6027, 9381, 20390, 662, 905, 905, 1149, 727, 312, 20627, 2361, 322, 641, 415, 3280, 356, 40907, 5191, 30731, 38637, 1211, 5718, 104, 5551, 9381, 8315, 5172], "avg_logprob": -0.2591145836881229, "compression_ratio": 1.4405286343612336, "no_speech_prob": 0.0, "words": [{"start": 1484.81, "end": 1485.41, "word": "كل", "probability": 0.395751953125}, {"start": 1485.41, "end": 1485.77, 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"end": 1527.81, "word": " agar", "probability": 0.9833984375}, {"start": 1527.81, "end": 1528.09, "word": " لونه", "probability": 0.9015299479166666}, {"start": 1528.09, "end": 1528.49, "word": " أحمر", "probability": 0.8948567708333334}], "temperature": 1.0}, {"id": 68, "seek": 155475, "start": 1529.23, "end": 1554.75, "text": "الـ Complete Hemolysis is manifested by ..يعني بنجر نشوفه من خلال .. تمام؟ بنشوفه من خلال تكون zone of colorless area .. area with no color راح الدم راح لهم الدم تماما ف Complete Hemolysis وبنسميها Beta يبقى الـ Beta Hemolysis هو عبارة عن أيه يا شباب؟ Complete Hemolysis كيف بنعرفه؟", "tokens": [6027, 39184, 34687, 18568, 401, 4642, 307, 42775, 538, 4386, 40228, 22653, 44945, 7435, 2288, 8717, 8592, 38688, 3224, 9154, 16490, 1211, 6027, 4386, 46811, 10943, 22807, 44945, 8592, 38688, 3224, 9154, 16490, 1211, 6027, 6055, 30544, 6668, 295, 2017, 1832, 1859, 4386, 1859, 365, 572, 2017, 12602, 39319, 32748, 2304, 12602, 39319, 5296, 16095, 32748, 2304, 46811, 10943, 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0.606689453125}, {"start": 1533.19, "end": 1533.49, "word": " بنجر", "probability": 0.7796223958333334}, {"start": 1533.49, "end": 1533.79, "word": " نشوفه", "probability": 0.85308837890625}, {"start": 1533.79, "end": 1533.91, "word": " من", "probability": 0.9853515625}, {"start": 1533.91, "end": 1534.39, "word": " خلال", "probability": 0.9939778645833334}, {"start": 1534.39, "end": 1534.75, "word": " ..", "probability": 0.544921875}, {"start": 1534.75, "end": 1535.43, "word": " تمام؟", "probability": 0.88037109375}, {"start": 1535.43, "end": 1535.93, "word": " بنشوفه", "probability": 0.9385986328125}, {"start": 1535.93, "end": 1536.03, "word": " من", "probability": 0.99755859375}, {"start": 1536.03, "end": 1536.45, "word": " خلال", "probability": 0.9938151041666666}, {"start": 1536.45, "end": 1537.05, "word": " تكون", "probability": 0.820068359375}, {"start": 1537.05, "end": 1537.99, "word": " zone", "probability": 0.64892578125}, {"start": 1537.99, "end": 1538.65, "word": " of", "probability": 0.966796875}, {"start": 1538.65, "end": 1539.35, "word": " colorless", "probability": 0.860107421875}, {"start": 1539.35, "end": 1539.75, "word": " area", "probability": 0.8525390625}, {"start": 1539.75, "end": 1539.89, "word": " ..", "probability": 0.388427734375}, {"start": 1539.89, "end": 1540.25, "word": " area", "probability": 0.387939453125}, {"start": 1540.25, "end": 1540.87, "word": " with", "probability": 0.951171875}, {"start": 1540.87, "end": 1541.17, "word": " no", "probability": 0.958984375}, {"start": 1541.17, "end": 1541.55, "word": " color", "probability": 0.92431640625}, {"start": 1541.55, "end": 1542.27, "word": " راح", "probability": 0.681884765625}, {"start": 1542.27, "end": 1542.73, "word": " الدم", "probability": 0.92041015625}, {"start": 1542.73, "end": 1542.99, "word": " راح", "probability": 0.83154296875}, {"start": 1542.99, "end": 1543.33, "word": " لهم", "probability": 0.77734375}, {"start": 1543.33, "end": 1544.09, "word": " الدم", "probability": 0.862548828125}, {"start": 1544.09, "end": 1544.85, "word": " تماما", "probability": 0.9778645833333334}, {"start": 1544.85, "end": 1545.11, "word": " ف", "probability": 0.939453125}, {"start": 1545.11, "end": 1545.57, "word": " Complete", "probability": 0.455810546875}, {"start": 1545.57, "end": 1546.13, "word": " Hemolysis", "probability": 0.9705403645833334}, {"start": 1546.13, "end": 1547.33, "word": " وبنسميها", "probability": 0.871826171875}, {"start": 1547.33, "end": 1548.25, "word": " Beta", "probability": 0.830078125}, {"start": 1548.25, "end": 1549.35, "word": " يبقى", "probability": 0.808349609375}, {"start": 1549.35, "end": 1549.49, "word": " الـ", "probability": 0.820068359375}, {"start": 1549.49, "end": 1549.59, "word": " Beta", "probability": 0.826171875}, {"start": 1549.59, "end": 1550.23, "word": " Hemolysis", "probability": 0.962890625}, {"start": 1550.23, "end": 1550.73, "word": " هو", "probability": 0.8173828125}, {"start": 1550.73, "end": 1550.95, "word": " عبارة", "probability": 0.9852294921875}, {"start": 1550.95, "end": 1551.09, "word": " عن", "probability": 0.982421875}, {"start": 1551.09, "end": 1551.21, "word": " أيه", "probability": 0.714599609375}, {"start": 1551.21, "end": 1551.31, "word": " يا", "probability": 0.78076171875}, {"start": 1551.31, "end": 1552.23, "word": " شباب؟", "probability": 0.94287109375}, {"start": 1552.23, "end": 1552.77, "word": " Complete", "probability": 0.87353515625}, {"start": 1552.77, "end": 1553.23, "word": " Hemolysis", "probability": 0.9806315104166666}, {"start": 1553.23, "end": 1553.85, "word": " كيف", "probability": 0.838623046875}, {"start": 1553.85, "end": 1554.75, "word": " بنعرفه؟", "probability": 0.9484375}], "temperature": 1.0}, {"id": 69, "seek": 155932, "start": 1555.42, "end": 1559.32, "text": "clear zone clear zone الـ alpha hemolytic", "tokens": [43679, 6668, 1850, 6668, 2423, 39184, 8961, 415, 3280, 356, 40907], "avg_logprob": -0.5686848759651184, "compression_ratio": 1.0, "no_speech_prob": 0.0, "words": [{"start": 1555.42, "end": 1555.92, "word": "clear", "probability": 0.12481689453125}, {"start": 1555.92, "end": 1556.48, "word": " zone", "probability": 0.93115234375}, {"start": 1556.48, "end": 1557.06, "word": " clear", "probability": 0.327880859375}, {"start": 1557.06, "end": 1557.66, "word": " zone", "probability": 0.5947265625}, {"start": 1557.66, "end": 1558.32, "word": " الـ", "probability": 0.6220703125}, {"start": 1558.32, "end": 1558.58, "word": " alpha", "probability": 0.5595703125}, {"start": 1558.58, "end": 1559.32, "word": " hemolytic", "probability": 0.80023193359375}], "temperature": 1.0}, {"id": 70, "seek": 158812, "start": 1560.6, "end": 1588.12, "text": "هو incomplete أو partial hemolysis و could be visualized by the presence of greenish discoloration around the colonies يعني المستعمرات بيكون محاطة بلون أخضر حول المستعمرات إذا في عندي complete و incomplete ال complete سمينا beta ال incomplete سمينا alpha و عشان ماتزعلش التالتة اللي مابتعملش حاجة عطناها لقب gamma hemolytic", "tokens": [3224, 2407, 31709, 34051, 14641, 415, 3280, 356, 17122, 4032, 727, 312, 5056, 1602, 538, 264, 6814, 295, 3092, 742, 2983, 401, 9357, 926, 264, 27981, 37495, 22653, 9673, 14851, 25957, 2288, 9307, 4724, 1829, 30544, 3714, 5016, 41193, 3660, 4724, 1211, 11536, 5551, 9778, 11242, 2288, 11331, 12610, 9673, 14851, 25957, 2288, 9307, 11933, 15730, 8978, 18871, 16254, 3566, 4032, 31709, 2423, 3566, 8608, 2304, 1829, 8315, 9861, 2423, 31709, 8608, 2304, 1829, 8315, 8961, 4032, 6225, 8592, 7649, 3714, 9307, 11622, 30241, 8592, 16712, 6027, 2655, 3660, 13672, 1829, 3714, 16758, 2655, 25957, 1211, 8592, 11331, 26108, 3660, 6225, 9566, 8315, 11296, 5296, 4587, 3555, 15546, 415, 3280, 356, 40907], "avg_logprob": -0.19911503791809082, "compression_ratio": 1.6394052044609666, "no_speech_prob": 0.0, "words": [{"start": 1560.6, "end": 1560.9, "word": "هو", "probability": 0.7308349609375}, {"start": 1560.9, "end": 1561.4, "word": " incomplete", 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"probability": 0.839599609375}, {"start": 1567.36, "end": 1568.48, "word": " discoloration", "probability": 0.6163736979166666}, {"start": 1568.48, "end": 1568.9, "word": " around", "probability": 0.953125}, {"start": 1568.9, "end": 1569.12, "word": " the", "probability": 0.80712890625}, {"start": 1569.12, "end": 1569.44, "word": " colonies", "probability": 0.55078125}, {"start": 1569.44, "end": 1569.96, "word": " يعني", "probability": 0.58038330078125}, {"start": 1569.96, "end": 1570.62, "word": " المستعمرات", "probability": 0.9677734375}, {"start": 1570.62, "end": 1570.9, "word": " بيكون", "probability": 0.9326171875}, {"start": 1570.9, "end": 1571.42, "word": " محاطة", "probability": 0.9647216796875}, {"start": 1571.42, "end": 1571.78, "word": " بلون", "probability": 0.9500325520833334}, {"start": 1571.78, "end": 1572.64, "word": " أخضر", "probability": 0.96044921875}, {"start": 1572.64, "end": 1573.1, "word": " حول", "probability": 0.975830078125}, {"start": 1573.1, "end": 1573.88, "word": " المستعمرات", "probability": 0.991796875}, {"start": 1573.88, "end": 1574.4, "word": " إذا", "probability": 0.4864501953125}, {"start": 1574.4, "end": 1574.56, "word": " في", "probability": 0.75732421875}, {"start": 1574.56, "end": 1574.92, "word": " عندي", "probability": 0.89404296875}, {"start": 1574.92, "end": 1575.88, "word": " complete", "probability": 0.9169921875}, {"start": 1575.88, "end": 1576.28, "word": " و", "probability": 0.99072265625}, {"start": 1576.28, "end": 1577.16, "word": " incomplete", "probability": 0.880859375}, {"start": 1577.16, "end": 1577.94, "word": " ال", "probability": 0.88671875}, {"start": 1577.94, "end": 1578.32, "word": " complete", "probability": 0.869140625}, {"start": 1578.32, "end": 1578.76, "word": " سمينا", "probability": 0.76702880859375}, {"start": 1578.76, "end": 1579.18, "word": " beta", "probability": 0.59521484375}, {"start": 1579.18, "end": 1579.76, "word": " ال", "probability": 0.80908203125}, {"start": 1579.76, "end": 1580.16, "word": " incomplete", "probability": 0.978515625}, {"start": 1580.16, "end": 1580.68, "word": " سمينا", "probability": 0.832763671875}, {"start": 1580.68, "end": 1581.4, "word": " alpha", "probability": 0.307861328125}, {"start": 1581.4, "end": 1582.06, "word": " و", "probability": 0.921875}, {"start": 1582.06, "end": 1582.44, "word": " عشان", "probability": 0.8597005208333334}, {"start": 1582.44, "end": 1582.94, "word": " ماتزعلش", "probability": 0.840869140625}, {"start": 1582.94, "end": 1583.56, "word": " التالتة", "probability": 0.921630859375}, {"start": 1583.56, "end": 1583.94, "word": " اللي", "probability": 0.894287109375}, {"start": 1583.94, "end": 1584.44, "word": " مابتعملش", "probability": 0.94677734375}, {"start": 1584.44, "end": 1584.92, "word": " حاجة", "probability": 0.9938151041666666}, {"start": 1584.92, "end": 1586.22, "word": " عطناها", "probability": 0.558837890625}, {"start": 1586.22, "end": 1586.7, "word": " لقب", "probability": 0.99658203125}, {"start": 1586.7, "end": 1587.38, "word": " gamma", "probability": 0.75634765625}, {"start": 1587.38, "end": 1588.12, "word": " hemolytic", "probability": 0.8447265625}], "temperature": 1.0}, {"id": 71, "seek": 160137, "start": 1588.49, "end": 1601.37, "text": "فاندي ألفة و Beta و Gamma و أذكركم بما قلته في ال Staphylococcus aureus قلت most strain of Staphylococcus aureus are beta hemolytic", "tokens": [5172, 7649, 16254, 5551, 46538, 3660, 4032, 33286, 4032, 24723, 1696, 4032, 5551, 8848, 37983, 24793, 4724, 15042, 12174, 1211, 47395, 8978, 2423, 745, 569, 3495, 5842, 905, 1149, 257, 540, 301, 12174, 1211, 2655, 881, 14249, 295, 745, 569, 3495, 5842, 905, 1149, 257, 540, 301, 366, 9861, 415, 3280, 356, 40907], "avg_logprob": -0.36631945493044676, "compression_ratio": 1.2442748091603053, "no_speech_prob": 0.0, "words": [{"start": 1588.49, "end": 1588.99, "word": "فاندي", "probability": 0.3170369466145833}, {"start": 1588.99, "end": 1589.55, "word": " ألفة", "probability": 0.6761067708333334}, {"start": 1589.55, "end": 1589.87, "word": " و", "probability": 0.77392578125}, {"start": 1589.87, "end": 1590.17, "word": " Beta", "probability": 0.56396484375}, {"start": 1590.17, "end": 1590.59, "word": " و", "probability": 0.97412109375}, {"start": 1590.59, "end": 1592.17, "word": " Gamma", "probability": 0.786376953125}, {"start": 1592.17, "end": 1592.57, "word": " و", "probability": 0.63330078125}, {"start": 1592.57, "end": 1593.37, "word": " أذكركم", "probability": 0.80584716796875}, {"start": 1593.37, "end": 1594.39, "word": " بما", "probability": 0.94873046875}, {"start": 1594.39, "end": 1594.79, "word": " قلته", "probability": 0.84423828125}, {"start": 1594.79, "end": 1594.89, "word": " في", "probability": 0.82763671875}, {"start": 1594.89, "end": 1594.99, "word": " ال", "probability": 0.54443359375}, {"start": 1594.99, "end": 1595.75, "word": " Staphylococcus", "probability": 0.8386027018229166}, {"start": 1595.75, "end": 1596.35, "word": " aureus", "probability": 0.9031575520833334}, {"start": 1596.35, "end": 1597.09, "word": " قلت", "probability": 0.6637369791666666}, {"start": 1597.09, "end": 1597.39, "word": " most", "probability": 0.33544921875}, {"start": 1597.39, "end": 1598.01, "word": " strain", "probability": 0.7724609375}, {"start": 1598.01, "end": 1598.25, "word": " of", "probability": 0.91845703125}, {"start": 1598.25, "end": 1599.65, "word": " Staphylococcus", "probability": 0.896484375}, {"start": 1599.65, "end": 1600.21, "word": " aureus", "probability": 0.8987630208333334}, {"start": 1600.21, "end": 1600.55, "word": " are", "probability": 0.8720703125}, {"start": 1600.55, "end": 1600.81, "word": " beta", "probability": 0.39013671875}, {"start": 1600.81, "end": 1601.37, "word": " hemolytic", "probability": 0.8121337890625}], "temperature": 1.0}, {"id": 72, "seek": 163127, "start": 1601.99, "end": 1631.27, "text": "لكن لم استخدم صفة الـ Hemolysis كوسيلة لتصنيف الـ Staphylococci لكن هنا استخدمتها كوسيلة أساسية في التعرف على الـ Staphylococci فبقول أنا 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Factors اللي ممكن نشوفهم في البكتيريا هذه Striptolysin O و Striptolysin S و أعتقد أنا شرحت قبلك يا شباب Striptolysin O أذكركوا فيه", "tokens": [10721, 24401, 5551, 16095, 2423, 39184, 7566, 425, 655, 33375, 830, 13672, 1829, 3714, 43020, 8717, 8592, 38688, 16095, 8978, 29739, 4117, 2655, 13546, 25528, 29538, 20390, 662, 401, 749, 259, 422, 4032, 20390, 662, 401, 749, 259, 318, 4032, 5551, 34268, 28543, 41850, 13412, 2288, 33753, 12174, 36150, 4117, 35186, 13412, 3555, 16758, 20390, 662, 401, 749, 259, 422, 5551, 8848, 37983, 4117, 14407, 8978, 3224], "avg_logprob": -0.24264706189141555, "compression_ratio": 1.376543209876543, "no_speech_prob": 0.0, "words": [{"start": 2381.9, "end": 2382.3, "word": "أحد", "probability": 0.897216796875}, {"start": 2382.3, "end": 2382.58, "word": " أهم", "probability": 0.9677734375}, {"start": 2382.58, "end": 2382.78, "word": " الـ", "probability": 0.57861328125}, {"start": 2382.78, "end": 2383.16, "word": " Virulence", "probability": 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"start": 2398.76, "end": 2415.5, "text": "درسنا في المقدمة تبعتنا في ال diagnostic microbiology تحدثنا قولنا ان البكتيريا بتنتج تنتج oxygen labile hemolysin وبالتالي اي مزرعة", "tokens": [3215, 2288, 3794, 8315, 8978, 9673, 28543, 46007, 6055, 3555, 34268, 8315, 8978, 2423, 27897, 33234, 1793, 6055, 24401, 12984, 8315, 12174, 12610, 8315, 16472, 29739, 4117, 2655, 13546, 25528, 39894, 29399, 7435, 6055, 29399, 7435, 9169, 2715, 794, 415, 3280, 356, 19767, 46599, 6027, 2655, 6027, 1829, 1975, 1829, 3714, 11622, 2288, 27884], "avg_logprob": -0.23196022022854199, "compression_ratio": 1.3289473684210527, "no_speech_prob": 0.0, "words": [{"start": 2398.76, "end": 2399.42, "word": "درسنا", "probability": 0.88427734375}, {"start": 2399.42, "end": 2400.08, "word": " في", "probability": 0.8583984375}, {"start": 2400.08, "end": 2402.94, "word": " المقدمة", "probability": 0.8743489583333334}, {"start": 2402.94, "end": 2403.34, "word": " تبعتنا", "probability": 0.7493896484375}, {"start": 2403.34, "end": 2403.48, "word": " في", "probability": 0.830078125}, {"start": 2403.48, "end": 2403.68, "word": " ال", "probability": 0.82568359375}, {"start": 2403.68, "end": 2404.2, "word": " diagnostic", "probability": 0.67626953125}, {"start": 2404.2, "end": 2405.08, "word": " microbiology", "probability": 0.93701171875}, {"start": 2405.08, "end": 2406.46, "word": " تحدثنا", "probability": 0.9022216796875}, {"start": 2406.46, "end": 2406.86, "word": " قولنا", "probability": 0.5663655598958334}, {"start": 2406.86, "end": 2407.02, "word": " ان", "probability": 0.55712890625}, {"start": 2407.02, "end": 2407.58, "word": " البكتيريا", "probability": 0.95791015625}, {"start": 2407.58, "end": 2408.32, "word": " بتنتج", "probability": 0.9200846354166666}, {"start": 2408.32, "end": 2409.3, "word": " تنتج", "probability": 0.76025390625}, {"start": 2409.3, "end": 2410.44, "word": " oxygen", "probability": 0.64208984375}, {"start": 2410.44, "end": 2411.54, "word": " labile", "probability": 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tuberculosis و Yersinia pistis تمام السلمونيلا الشيجيلا جون لأ تمام الشيجيلا بنعمل detection للبكتيريا باستخدام ال antibody إذن و أحنا بندرس في ال diagnostic microbiology نحاول نفرز الفحوصات السيرولوجية على جهة عشان نجزق منها بنحاول ندرسه برضه في المعمل إن تمكننا إن شاء الله طيب نرجع لموضوعنا", "tokens": [2407, 9122, 12984, 13546, 9154, 16247, 29973, 46958, 13672, 7578, 1975, 2655, 4117, 19528, 8315, 18871, 11296, 4032, 16490, 33546, 3660, 2423, 398, 433, 259, 654, 3242, 4154, 270, 2262, 4032, 398, 433, 259, 654, 39847, 49379, 4032, 398, 433, 259, 654, 12273, 271, 46811, 10943, 21136, 19528, 11536, 1829, 15040, 25124, 1829, 7435, 1829, 15040, 10874, 11536, 5296, 10721, 46811, 10943, 25124, 1829, 7435, 1829, 15040, 44945, 25957, 1211, 17784, 24976, 3555, 4117, 2655, 13546, 25528, 4724, 995, 14851, 9778, 3215, 10943, 2423, 34507, 11933, 8848, 1863, 4032, 5551, 5016, 8315, 44945, 3215, 2288, 3794, 8978, 2423, 27897, 33234, 1793, 8717, 5016, 995, 12610, 8717, 5172, 2288, 11622, 27188, 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2790.68, "word": " just", "probability": 0.59130859375}, {"start": 2790.68, "end": 2791.0, "word": " red", "probability": 0.81982421875}, {"start": 2791.0, "end": 2791.36, "word": " skin", "probability": 0.9443359375}, {"start": 2791.36, "end": 2791.58, "word": " and", "probability": 0.9501953125}, {"start": 2791.58, "end": 2791.9, "word": " pain", "probability": 0.935546875}, {"start": 2791.9, "end": 2792.34, "word": " فقط", "probability": 0.948486328125}, {"start": 2792.34, "end": 2792.68, "word": " احمرها", "probability": 0.63653564453125}, {"start": 2792.68, "end": 2792.8, "word": " على", "probability": 0.69775390625}, {"start": 2792.8, "end": 2793.16, "word": " الجلد", "probability": 0.80859375}, {"start": 2793.16, "end": 2793.3, "word": " و", "probability": 0.65771484375}, {"start": 2793.3, "end": 2794.02, "word": " ألم", "probability": 0.60003662109375}, {"start": 2794.02, "end": 2794.56, "word": " otitis", "probability": 0.882568359375}, {"start": 2794.56, "end": 2794.88, "word": " media", "probability": 0.9248046875}, {"start": 2794.88, "end": 2795.18, "word": " التهيأب", "probability": 0.682275390625}, {"start": 2795.18, "end": 2795.44, "word": " الأذن", "probability": 0.951171875}, {"start": 2795.44, "end": 2796.26, "word": " الوسطى", "probability": 0.863037109375}, {"start": 2796.26, "end": 2796.82, "word": " peripheral", "probability": 0.60498046875}, {"start": 2796.82, "end": 2797.4, "word": " fever", "probability": 0.6591796875}, {"start": 2797.4, "end": 2797.78, "word": " او", "probability": 0.8017578125}, {"start": 2797.78, "end": 2798.22, "word": " peripheral", "probability": 0.88623046875}, {"start": 2798.22, "end": 2798.7, "word": " sepsis", "probability": 0.9482421875}, {"start": 2798.7, "end": 2798.82, "word": " اللى", "probability": 0.974609375}, {"start": 2798.82, "end": 2798.94, "word": " هي", "probability": 0.40771484375}, {"start": 2798.94, "end": 2799.16, "word": " حمى", "probability": 0.747802734375}, {"start": 2799.16, "end": 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خطيرة جدا قد تؤدي الى الوفاة نكمل المرة القادمة ان شاء الله", "tokens": [2288, 4587, 2304, 8608, 2655, 3660, 2597, 12394, 13672, 1829, 39896, 16712, 11296, 3555, 9307, 21542, 1211, 4587, 4724, 15042, 8978, 11296, 27188, 9640, 1863, 7435, 995, 36081, 3794, 16070, 2655, 1863, 3794, 12610, 995, 36081, 3794, 44713, 1829, 20498, 26895, 995, 36081, 3794, 16472, 3215, 2407, 4117, 9640, 3215, 995, 36081, 3794, 3714, 9957, 1863, 7435, 995, 36081, 3794, 12602, 4587, 2304, 1975, 24401, 33599, 2288, 4032, 41193, 1863, 33599, 8032, 3215, 12610, 3660, 11992, 1209, 8758, 36764, 24401, 3714, 43020, 8608, 3555, 3555, 24390, 1563, 14301, 304, 408, 950, 24580, 36764, 24401, 8608, 3555, 3555, 50100, 449, 2399, 18277, 16070, 2655, 7649, 9957, 1975, 29973, 46958, 16490, 9566, 48923, 10874, 28259, 12174, 3215, 6055, 33604, 16254, 2423, 7578, 2423, 38688, 995, 3660, 8717, 24793, 1211, 9673, 25720, 25062, 18513, 46007, 16472, 13412, 16606, 21984], "avg_logprob": -0.21840784236462446, "compression_ratio": 1.725, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 2811.61, "end": 2811.95, "word": "رقم", "probability": 0.85546875}, {"start": 2811.95, "end": 2812.45, "word": " ستة", "probability": 0.8059895833333334}, {"start": 2812.45, "end": 2813.41, "word": " sorry", "probability": 0.327392578125}, {"start": 2813.41, "end": 2813.95, "word": " throat", "probability": 0.89501953125}, {"start": 2813.95, "end": 2814.21, "word": " اللي", "probability": 0.536865234375}, {"start": 2814.21, "end": 2814.35, "word": " هي", "probability": 0.76220703125}, {"start": 2814.35, "end": 2814.81, "word": " التهابات", "probability": 0.85205078125}, {"start": 2814.81, "end": 2815.31, "word": " الحلق", "probability": 0.9601236979166666}, {"start": 2815.31, "end": 2815.95, "word": " بما", "probability": 0.95947265625}, {"start": 2815.95, "end": 2816.17, "word": " فيها", "probability": 0.985595703125}, {"start": 2816.17, "end": 2816.87, "word": " الفارنجايتس", "probability": 0.7284109933035714}, 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ycW2i58PRdc.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ycW2i58PRdc.srt
new file mode 100644
index 0000000000000000000000000000000000000000..0a61d67e30f17924a814f33f7cd5ba8fa9efb529
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ycW2i58PRdc.srt
@@ -0,0 +1,2076 @@
+1
+00:00:20,520 --> 00:00:22,960
+بسم الله الرحمن الرحيم. نبدأ محاضرتنا إن شاء الله
+
+2
+00:00:22,960 --> 00:00:26,420
+اليوم بالميكروب الثاني من سلسلة الباسلس، اللي هو
+
+3
+00:00:26,420 --> 00:00:30,120
+البا سلس سيرياس، والصورة اللي أمامنا بتوضح أنه
+
+4
+00:00:30,120 --> 00:00:34,720
+البكتيريا إلى حد كبير تشبه في شكل مستعمرتها
+
+5
+00:00:34,720 --> 00:00:40,540
+البا سلس أنتراسس، لكن تتميز بوجود beta hemolysis.
+
+6
+00:00:40,540 --> 00:00:44,270
+و الـ beta hemolysis يتضح من الحواف تبع المستعمرات.
+
+7
+00:00:44,270 --> 00:00:49,810
+بتلاقوا أنه في هنا فراغ، هذا الفراغ بيتميز في اللون
+
+8
+00:00:49,810 --> 00:00:52,870
+عن باقي الطبق. هنشوف صورة أوضح إن شاء الله، اللي هو
+
+9
+00:00:52,870 --> 00:00:56,470
+في المرحلة الثانية، إذا بتطلعوا على الصورة هذه اللي
+
+10
+00:00:56,470 --> 00:00:59,530
+أمامكم، هتلاقوا أنه فيه beta hemolysis واضح جدا
+
+11
+00:00:59,530 --> 00:01:03,750
+للمستعمرات أيضا. المستعمرات large, huge colonies.
+
+12
+00:01:03,750 --> 00:01:09,120
+وهذه من سمات الباسلس بشكل عام. البكتيريا هي عبارة عن
+
+13
+00:01:09,120 --> 00:01:12,920
+Gram-positive bacilli. طبعا زيها زي أي باسلس، و
+
+14
+00:01:12,920 --> 00:01:16,260
+spore-forming بكتيريا، لكن بتنتج beta hemolysis on
+
+15
+00:01:16,260 --> 00:01:18,280
+blood agar. هذه الصفة اللي لما نجدها، قلنا
+
+16
+00:01:18,280 --> 00:01:22,900
+البا سلس أنتراسس. pathogenesis and clinical
+
+17
+00:01:22,900 --> 00:01:28,080
+features. البكتيريا غالبا موجودة everywhere, most
+
+18
+00:01:28,080 --> 00:01:31,340
+especially in cereals، cereals اللي هي الحبوب،
+
+19
+00:01:31,340 --> 00:01:35,060
+عشان هي اسمها Bacillus cereus، أحد أنواع الحبوب
+
+20
+00:01:35,060 --> 00:01:39,620
+المشهورة في  المطبخ في جنوب شرق آسيا، اللي هو الـ
+
+21
+00:01:39,620 --> 00:01:45,240
+rice. الـ bacteria is heat resistant، زيها زي أي
+
+22
+00:01:45,240 --> 00:01:48,140
+باسلس. أنتم عارفين أكثر bacteria resistant في
+
+23
+00:01:48,140 --> 00:01:52,860
+العالم للحرارة، اسمها باسلس  stereothermophilus. يعني
+
+24
+00:01:52,860 --> 00:01:55,820
+من الـ genus نفسه تبع مين؟ تبع الباسلس. طبعا نغير
+
+25
+00:01:55,820 --> 00:02:01,120
+اسمها، اسمها  Geobacillus. يبقى الـ bacteria is heat
+
+26
+00:02:01,120 --> 00:02:04,960
+resistant. الـ spores heat resistant and can survive
+
+27
+00:02:04,960 --> 00:02:08,320
+rapid frying.  فري رز، يعني قالي أنتم بتستخدموا
+
+28
+00:02:08,320 --> 00:02:13,000
+الجلي للرز، كلمة قالي للرز، بتستخدموها بس في جنوب
+
+29
+00:02:13,000 --> 00:02:19,080
+شرق آسيا. موضوع قالي الرز زي تسخين الرز، تمام؟ جزء
+
+30
+00:02:19,080 --> 00:02:23,040
+من العادات الغذائية عندهم إنهم بيسخنوا الرز، أو بي
+
+31
+00:02:23,040 --> 00:02:26,930
+glue، تمام؟ قالي fry، فبقول لنا إن الـ spores can
+
+32
+00:02:26,930 --> 00:02:30,190
+survive rapid frying. يعني لو قلي سريع، البكتيريا
+
+33
+00:02:30,190 --> 00:02:35,850
+بتتحمله. they produce enterotoxin in that food. If
+
+34
+00:02:35,850 --> 00:02:38,650
+ingested, it will cause food poisoning. Short
+
+35
+00:02:38,650 --> 00:02:41,070
+incubation period. الـ IP هذا مش الـ IP address تبع
+
+36
+00:02:41,070 --> 00:02:44,170
+الكمبيوتر أمامنا؟ هذا incubation period من أربع لست
+
+37
+00:02:44,170 --> 00:02:47,910
+ساعات، وبيشبه إلى حد كبير في الأعراض تبعته
+
+38
+00:02:47,910 --> 00:02:52,210
+الاستافيلوكوكال food poisoning، من إنه بيكون فيه
+
+39
+00:02:52,210 --> 00:02:57,950
+إسهال و vomiting. غالبا الـ treatment لا تشتمل الـ
+
+40
+00:02:57,950 --> 00:03:02,170
+antibiotics المذكورة، تحت فقط في حالات قليلة جدا ممكن
+
+41
+00:03:02,170 --> 00:03:05,970
+أنه نستخدم البنسلين. الاستخدام الأفضل هو
+
+42
+00:03:05,970 --> 00:03:09,570
+symptomatic treatment. مش هو عنده vomiting وعنده
+
+43
+00:03:09,570 --> 00:03:13,670
+إسهال؟ يبقى في عنده مشكلتين: liquid أو fluid
+
+44
+00:03:13,670 --> 00:03:16,370
+replacement و electrolyte replacement. فبالتالي
+
+45
+00:03:16,370 --> 00:03:21,620
+اللي فيه هنا symptomatic fluid replacement. هذه
+
+46
+00:03:21,620 --> 00:03:24,700
+اللوحة يعني إضافية، مش مبالغة عندكم في الـ .. في الـ
+
+47
+00:03:24,700 --> 00:03:28,200
+text، في .. في عبارة عن تمييز ما بين الـ bacillus
+
+48
+00:03:28,200 --> 00:03:31,340
+anthracis و الـ bacillus cereus بشكل مفصل. في عند الـ
+
+49
+00:03:31,340 --> 00:03:33,680
+growth requirement of thiamine، يعني هل الثيامين
+
+50
+00:03:33,680 --> 00:03:37,260
+مطلوب للنمو أو غير مطلوب للنمو بالنسبة لـ bacillus
+
+51
+00:03:37,260 --> 00:03:41,180
+anthracis؟ مطلوب، بينما الأخرى غير مطلوب. الـ
+
+52
+00:03:41,180 --> 00:03:42,880
+hemolysis of blood agar، كلكم بتعرفوا أن الـ
+
+53
+00:03:42,880 --> 00:03:46,120
+anthracis، أو الـ anthracis does not produce beta
+
+54
+00:03:46,120 --> 00:03:50,410
+hemolysis.  glutamine polypeptide capsule، الوحيدة
+
+55
+00:03:50,410 --> 00:03:52,330
+اللي في الدنيا، هي اللي بنعرفها medically
+
+56
+00:03:52,330 --> 00:03:57,030
+important، وإلها capsule مكونة من polypeptide، هي
+
+57
+00:03:57,030 --> 00:04:00,510
+الـ bacillus anthracis lysis by gamma. فإن احنا جينا
+
+58
+00:04:00,510 --> 00:04:04,790
+very specific test عامّة للـ bacillus anthracis. الـ
+
+59
+00:04:04,790 --> 00:04:07,310
+motility، it is negative. وذكرناها مرة ومتكررة، هي
+
+60
+00:04:07,310 --> 00:04:10,530
+هذه الصفة من الصفات الرئيسية في البكتيريا اللي
+
+61
+00:04:10,530 --> 00:04:14,230
+بتميزها عن الأخريات. growth on  chlorhydrate agar،
+
+62
+00:04:14,230 --> 00:04:17,240
+نوع من الـ agar مضعف بـ chlorhydrate. البكتيريا
+
+63
+00:04:17,240 --> 00:04:20,160
+تبعنا، اللي هي الـ anthracis does not grow، بينما
+
+64
+00:04:20,160 --> 00:04:23,880
+البا سلس السيرياس can grow. إذا، ففي دي مجموعة من
+
+65
+00:04:23,880 --> 00:04:27,440
+الصفات can be used to distinguish between Bacillus
+
+66
+00:04:27,440 --> 00:04:31,680
+anthracis and other bacilli، اللي من ضمنها الباسلس الـ
+
+67
+00:04:31,680 --> 00:04:32,120
+سيرياس.
+
+68
+00:04:34,740 --> 00:04:37,900
+الجزء الثاني من موضوعنا .. احنا حكينا في الجزء
+
+69
+00:04:37,900 --> 00:04:42,680
+الأول أنه بنتكلم عن الـ spore-forming aerobic
+
+70
+00:04:42,680 --> 00:04:45,960
+bacteria، اللي هم الباسلس أنتراسس والباسلس
+
+71
+00:04:45,960 --> 00:04:49,620
+سيرياس. فالجزء الثاني من محاضرتنا، هتكلم عن الـ
+
+72
+00:04:49,620 --> 00:04:56,050
+anaerobic spore-forming Gram-positive bacilli. وإن
+
+73
+00:04:56,050 --> 00:04:59,090
+أرجعكوا للـ diagram اللي شرحناها المرة الماضية لما
+
+74
+00:04:59,090 --> 00:05:02,030
+قلنا أنه الـ Gram-positive bacilli could be
+
+75
+00:05:02,030 --> 00:05:04,770
+classified based on the presence of spore into
+
+76
+00:05:04,770 --> 00:05:08,130
+spore-former and non-spore-former. If spore-former،
+
+77
+00:05:08,130 --> 00:05:10,770
+if it is aerobic، it is bacillus. If it is anaerobic،
+
+78
+00:05:10,770 --> 00:05:14,190
+it is Clostridium species. وبالتالي احنا هنتكلم عن
+
+79
+00:05:14,190 --> 00:05:19,150
+هذا الجزء من البكتيريا اليوم إن شاء الله. تصنيف آخر
+
+80
+00:05:19,150 --> 00:05:22,470
+للبكتيريا بعيدا عن كلمة spore-former. لو جيبنا
+
+81
+00:05:22,470 --> 00:05:25,590
+العنوان الرئيسي، يقول لنا Gram-positive Bacilli
+
+82
+00:05:25,590 --> 00:05:29,610
+Gram-positive Bacilli based on their oxygen
+
+83
+00:05:29,610 --> 00:05:32,530
+requirement. They are either classified into
+
+84
+00:05:32,530 --> 00:05:38,230
+anaerobes، زي الكلستريديّة والأكتينومايسيس، أو aerobes
+
+85
+00:05:38,230 --> 00:05:41,350
+زي المجموعة اللي أمامكم، منها كورنيباكتيريوم،
+
+86
+00:05:41,350 --> 00:05:46,490
+ليستريا، باسلس، جاردنريلا، ونوكارديا. إذا في عندي
+
+87
+00:05:46,490 --> 00:05:52,890
+مجموعة من الأسماء، ممكن نصنفها على إنها هوائيّة أكثر
+
+88
+00:05:52,890 --> 00:05:56,730
+من تلك التي تصنف على إنها لاهوائيّة. فقط الـ
+
+89
+00:05:56,730 --> 00:05:59,070
+Clostridium و Actinomyces.
+
+90
+00:06:02,560 --> 00:06:04,700
+الآن بنتكلم عن الكلستريديّة وعن الـ general
+
+91
+00:06:04,700 --> 00:06:07,800
+characteristics تبعها. رقم واحد: أناerobic Gram-
+
+92
+00:06:07,800 --> 00:06:11,440
+positive. بس الله. رقم اثنين: they are spore-former.
+
+93
+00:06:11,440 --> 00:06:14,180
+رقم ثلاثة: they are characterized أو will
+
+94
+00:06:14,180 --> 00:06:16,440
+be characterized by their ability to decompose
+
+95
+00:06:16,440 --> 00:06:19,780
+proteins. decompose يعني to hydrolyze. نعم، to
+
+96
+00:06:19,780 --> 00:06:24,560
+hydrolyze. they produce exotoxins، يعني معظمها بتنتج
+
+97
+00:06:24,560 --> 00:06:28,080
+toksins outside، مش زي الـ .. الـ .. الـ .. الـ .. الـ ..
+
+98
+00:06:28,080 --> 00:06:28,780
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+99
+00:06:28,780 --> 00:06:30,840
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+100
+00:06:30,840 --> 00:06:30,880
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+101
+00:06:30,880 --> 00:06:31,620
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+102
+00:06:31,620 --> 00:06:31,640
+الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ .. الـ ..
+
+103
+00:06:31,640 --> 00:06:35,240
+الـ natural habitat تبعها يا إما الـ soil، يا
+
+104
+00:06:35,240 --> 00:06:38,660
+إما الـ gastrointestinal tract of man and animals.
+
+105
+00:06:38,660 --> 00:06:41,860
+يعني اللي can be found in stool أو can be found in
+
+106
+00:06:41,860 --> 00:06:45,880
+soil. some motile، others non-motile. يبقى صفة الـ motility
+
+107
+00:06:45,880 --> 00:06:51,220
+هنا بدنا نوظفها في التفريق ما بين الـ .. الـ .. الـ
+
+108
+00:06:51,220 --> 00:06:54,420
+species تبعها. الـ  glycerin دي are catalase negative.
+
+109
+00:06:54,420 --> 00:06:59,420
+خدوا بالكم، احنا استنفذنا استخدامات الـ catalase
+
+110
+00:06:59,420 --> 00:07:04,200
+تماماً، اللي درستوها في المعمل، الفصل الماضي.
+
+111
+00:07:04,200 --> 00:07:07,540
+استخدام الأول كان للتفريق بين الـ Staphylococci و
+
+112
+00:07:07,540 --> 00:07:11,220
+الـ Streptococci.  التفريق الثاني كان بين الـ Beta-
+
+113
+00:07:11,220 --> 00:07:14,640
+hemolytic Streptococci و الـ Stereptomonocytogenes، و
+
+114
+00:07:14,640 --> 00:07:18,200
+التفريق الثالث الآن بين الباسلس which is positive، و
+
+115
+00:07:18,200 --> 00:07:21,000
+بين الكلستريديّة اللي هي which is negative. إذن الفحص
+
+116
+00:07:21,000 --> 00:07:25,400
+الكتاليزي البسيط هذا له تطبيقات رائعة جدا في حال
+
+117
+00:07:25,400 --> 00:07:30,710
+تفريق البكتيريا المتشابهة عن بعضها البعض. الأسماء
+
+118
+00:07:30,710 --> 00:07:34,430
+اللي هتدرسوها أو هتتعاملوا معها: Clostridium tetani أو
+
+119
+00:07:34,430 --> 00:07:37,890
+التيتاني، Clostridium perfringens، Clostridium
+
+120
+00:07:37,890 --> 00:07:42,530
+botulinum، Clostridium septicum، Clostridium novyi،
+
+121
+00:07:42,530 --> 00:07:50,820
+Clostridium difficile. اللي قفزنا عنها. الآن اللي أنا
+
+122
+00:07:50,820 --> 00:07:54,420
+هبدأ أركز عليهم في محاضراتنا اليوم والمرة القادمة
+
+123
+00:07:54,420 --> 00:07:57,880
+إن شاء الله، اللي هم واحد، اثنين، ثلاثة، خمسة
+
+124
+00:07:57,880 --> 00:08:01,600
+Clostridium difficile. وحبدأ في difficile الآن
+
+125
+00:08:01,600 --> 00:08:07,460
+عشان أنهي من قصة البكتيريا هذه اللي بدأت تكتسب
+
+126
+00:08:07,460 --> 00:08:13,600
+أهمية خاصة برضه باستخدام الـ antibiotics. كيف تركزوا
+
+127
+00:08:13,600 --> 00:08:19,520
+معايا؟ عشان بدنا نوصل لفكرة كيفية إحداثها للمرض. إنسان
+
+128
+00:08:19,520 --> 00:08:27,880
+أصيب بالتهاب في جروح عميقة، والتهاب حاد ببكتيريا
+
+129
+00:08:27,880 --> 00:08:32,380
+زي Pseudomonas aeruginosa. أعطي المريض antibiotic
+
+130
+00:08:32,380 --> 00:08:39,860
+لفترة تجاوزت العشرين يوماً. طبعاً الـ antibiotic أعطيه
+
+131
+00:08:39,860 --> 00:08:42,820
+وما عطوش أوامر يودّوه على الجروح، فقط يقتل البكتيريا
+
+132
+00:08:42,820 --> 00:08:46,800
+وين فيه بكتيريا بيلتقي فيها، هو قادر على قتلها،
+
+133
+00:08:46,800 --> 00:08:49,880
+بيقتلها. من ضمن هذه البكتيريا، البكتيريا اللي هي
+
+134
+00:08:49,880 --> 00:08:52,260
+normal microbiota، وهي موجودة في الـ intestinal
+
+135
+00:08:52,260 --> 00:08:58,740
+tract. هيقتل مجموعات، فالـ antibiotic قادر على قتل كل
+
+136
+00:08:58,740 --> 00:09:03,080
+البكتيريا، فهيقتل مجموعات، فيعمل imbalance في الـ
+
+137
+00:09:03,080 --> 00:09:06,200
+normal microbiota. هيسمح للبكتيريا اللي اسمها
+
+138
+00:09:06,200 --> 00:09:10,260
+Clostridium difficile، وهي normal flora عند كثير من
+
+139
+00:09:10,260 --> 00:09:15,310
+الناس، تبدأ تنمو وتتكاثر. هي ازدادت وتكاثر، ووصلت لـ
+
+140
+00:09:15,310 --> 00:09:17,910
+quorum sensing. فاكرين مصطلح quorum sensing؟ اللي
+
+141
+00:09:17,910 --> 00:09:22,110
+هو العدد اللي بعده البكتيريا بتقرر تنتج الـ
+
+142
+00:09:22,110 --> 00:09:26,770
+virulence factors تبعها. هتنتج توكسينات، توكسين A و
+
+143
+00:09:26,770 --> 00:09:32,270
+توكسين B، وتعمل disease known as Clostridium
+
+144
+00:09:32,270 --> 00:09:37,050
+difficile-associated diarrhea، أو اسم ثاني:
+
+145
+00:09:37,050 --> 00:09:42,800
+antibiotic-induced pseudomembranous colitis. لاحظوا
+
+146
+00:09:42,800 --> 00:09:47,340
+إسهال و pseudomembranous colitis. خدوا الجملة
+
+147
+00:09:47,340 --> 00:09:52,770
+الآن، اللي بتعبر عن قد ايه وصلنا أو وصلت أهمية هذه
+
+148
+00:09:52,770 --> 00:09:56,650
+البكتيريا في المستشفيات. It is number one cause of
+
+149
+00:09:56,650 --> 00:09:59,990
+hospital-acquired diarrhea. Number one cause of
+
+150
+00:09:59,990 --> 00:10:02,890
+hospital-acquired diarrhea. وعرفتوا أنتم الآن ليش هي
+
+151
+00:10:02,890 --> 00:10:05,710
+hospital-acquired؟ لأن في المستشفى بنعطي الـ
+
+152
+00:10:05,710 --> 00:10:10,110
+antibiotics لفترات طويلة، وبالتالي قد نخلق مشكلة جديدة
+
+153
+00:10:10,110 --> 00:10:14,390
+اللي هي عن طريق الـ .. الـ .. الـ .. الـ normal microbiota
+
+154
+00:10:14,390 --> 00:10:18,250
+imbalance. عدم اتزان في الـ normal microbiota. طبعاً
+
+155
+00:10:18,250 --> 00:10:21,030
+برضه بنعالجها بـ antibiotics، لما تصير المشكلة
+
+156
+00:10:21,030 --> 00:10:25,450
+بنعالجها برضه بـ antibiotics. نرجع لـ Clostridium
+
+157
+00:10:25,450 --> 00:10:31,370
+tetani. كنا بنسمع بالتيتانوس. هل هناك حالات تيتانوس في
+
+158
+00:10:31,370 --> 00:10:36,410
+قطاع غزة؟ سمعتوا فيها يعني، قريب، صديق، أهل، معرفة لأ
+
+159
+00:10:36,410 --> 00:10:40,970
+سؤال. هل سمعتم بأحد أصيب بالمرض هذا؟ سؤال ليه؟ مش من
+
+160
+00:10:40,970 --> 00:10:46,410
+وين بنصيب المرض؟ عارفين ليش؟ لأن صار فينا ثقافة، ثقافة
+
+161
+00:10:46,410 --> 00:10:52,050
+مجتمعية، إنه أي جرح عميق، وخاصة من شيء ملوّث من
+
+162
+00:10:52,050 --> 00:10:55,970
+التربة، تمام؟ إنه التربة، زي المسامير وخلافه، أن
+
+163
+00:10:55,970 --> 00:11:01,110
+يقوم الأهل بعرض المصاب على العيادة، ومن ثم تطهير
+
+164
+00:11:01,110 --> 00:11:04,570
+الجرح، ويعطيه إبرة تيتانوس، أو اللي هي بيسميها إبرة
+
+165
+00:11:04,570 --> 00:11:09,310
+ضد التيتانوس. واقع الأمر، لكن ثقافة مجتمعية كاملة سواء
+
+166
+00:11:09,310 --> 00:11:14,620
+صغير، كبير، متعلم، غير متعلم، عنده هذه الثقافة. وهذا خير
+
+167
+00:11:14,620 --> 00:11:18,040
+دليل على إن الـ investment أو الاستثمار في الـ
+
+168
+00:11:18,040 --> 00:11:22,360
+public awareness، اللي هي زيادة وعي الجماهير، هو أمر
+
+169
+00:11:22,360 --> 00:11:27,620
+مهم جداً،  ليس أقل أهمية من تطوير القطاع الصحي، أو
+
+170
+00:11:27,620 --> 00:11:32,600
+استحداث مصانع أدوية. لأ، الاستثمار في البشر هو أمر
+
+171
+00:11:32,600 --> 00:11:39,980
+جيد أيضاً لمنع الـ infection. طيب، مرض fatal، قاتل،
+
+172
+00:11:41,360 --> 00:11:44,220
+Clostridium perfringens، بتسبب مرض اسمه gas
+
+173
+00:11:44,220 --> 00:11:48,380
+gangrene، الغرغرينا الغازية. سمعتوا بفلان أصيب
+
+174
+00:11:48,380 --> 00:11:53,420
+بغرغرينا، قطعت، قطعت أصابع قدمه، وبعدين قطعت قدمه، و
+
+175
+00:11:5
+
+223
+00:15:36,120 --> 00:15:42,590
+مسميها localized infection كيف الاسم كله بتأثر؟
+
+224
+00:15:42,590 --> 00:15:47,250
+التوكسين اللي بتنتجه بيروح عبر الدم و بيصل للمناطق
+
+225
+00:15:47,250 --> 00:15:52,510
+المختلفة و بيأثر على الأعصاب، إذن كـ infection إيش
+
+226
+00:15:52,510 --> 00:15:57,410
+بنسميها؟ localized مش systemic infection. The
+
+227
+00:15:57,410 --> 00:15:59,990
+disease is transmitted to man through infected
+
+228
+00:15:59,990 --> 00:16:04,640
+wounds. زي ما حكينا بينتقل عن طريق الجروح الملوثة و
+
+229
+00:16:04,640 --> 00:16:09,060
+غالباً كانت ملوثة بمصدرين، احنا كنا مصادر .. مصادر
+
+230
+00:16:09,060 --> 00:16:12,240
+الأساسية للـ .. للـ .. الـ spores من وين؟ من التربة و
+
+231
+00:16:12,240 --> 00:16:15,200
+الـ stool، صح هذا لأ؟ فأي مصدر .. أي من المصدرين قد
+
+232
+00:16:15,200 --> 00:16:20,410
+يحمل مخاطر. Spores enter into wounds within or with
+
+233
+00:16:20,410 --> 00:16:23,610
+soil or material contaminated with soil. زي ما
+
+234
+00:16:23,610 --> 00:16:27,670
+حكينا الجروح أو البكتيريا تدخل أو الـ spores بتاعة
+
+235
+00:16:27,670 --> 00:16:32,970
+البكتيريا تدخل مع المواد الملوثة بالتربة. The
+
+236
+00:16:32,970 --> 00:16:36,670
+infection is localized in the area of entry. Growth
+
+237
+00:16:36,670 --> 00:16:39,550
+of the toxin. هذه نقطة كتير مهمة بتكلم فيها. Growth
+
+238
+00:16:39,550 --> 00:16:42,690
+and toxin production is aided by the following. نمو
+
+239
+00:16:42,690 --> 00:16:47,360
+البكتيريا اللاهوائية هي بكتيريا لاهوائية. ما الذي يجعل
+
+240
+00:16:47,360 --> 00:16:51,160
+البكتيريا اللاهوائية تنمو في مكان ممكن يكون فيه
+
+241
+00:16:51,160 --> 00:16:56,380
+Oxygen؟ تلعبوا احنا لما قولنا المصمار او الجروح
+
+242
+00:16:56,380 --> 00:17:01,920
+تمام. إيش الجروح عبارة عن؟ cut، قطعة قطعة يعني
+
+243
+00:17:01,920 --> 00:17:06,980
+destruction، destruction للخلايا. في خلايا هتموت، يبقى
+
+244
+00:17:06,980 --> 00:17:11,460
+الـ necrotic tissue اللي موجود هذا هيوفر أول حاجة
+
+245
+00:17:11,460 --> 00:17:15,740
+بيئة غذائية ملائمة للبكتيريا. للـ spores to
+
+246
+00:17:15,740 --> 00:17:20,600
+germinate، يعني للبذرة عشان تنبت، تمام؟ Calcium
+
+247
+00:17:20,600 --> 00:17:23,860
+salts مهم جدا في عملية الـ germination. Calcium
+
+248
+00:17:23,860 --> 00:17:27,720
+salts من جاية برضه من الـ necrotic tissue. رقم تلاتة
+
+249
+00:17:27,720 --> 00:17:31,240
+وهي الأهم على الإطلاق أنه يكون مع البكتيريا
+
+250
+00:17:31,240 --> 00:17:36,100
+بكتيريا تانية. أنا عندي Staphylococcus aureus على
+
+251
+00:17:36,100 --> 00:17:38,620
+سبيل المثال، Staphylococcus aureus، إيش رايك يا
+
+252
+00:17:38,620 --> 00:17:42,300
+كولاي؟ هدول مش بنوصفهم من ناحية حالتهم للإكسجين
+
+253
+00:17:42,300 --> 00:17:47,520
+facultative. أنا يارب، أنا يارب. لأن لما البكتيريا
+
+254
+00:17:47,520 --> 00:17:51,340
+تنمو هذه مش بتاخد الأكسجين من الـ environment، بتوفر
+
+255
+00:17:51,340 --> 00:17:54,400
+ظروف لمين؟ ده البكتيريا الأخرى بتوفرها ظروف لا
+
+256
+00:17:54,400 --> 00:17:58,880
+هوائية، فالبكتيريا الهوائية تستهلك الهواء لصالح
+
+257
+00:17:58,880 --> 00:18:03,460
+مين؟ Clostridium tetani، وصلت الصورة؟ إذا لو كان في
+
+258
+00:18:03,460 --> 00:18:08,320
+عندي التلات أشياء و هم موجودين، مستحيل تجد الـ spores
+
+259
+00:18:08,320 --> 00:18:11,240
+تبع البكتيريا في environment مافيش فيها بكتيريا
+
+260
+00:18:11,240 --> 00:18:14,940
+أخرى. تربة، بتتكلم عن تربة ملايين الأنواع من
+
+261
+00:18:14,940 --> 00:18:17,520
+البكتيريا بتكون موجودة في التربة، فأكيد لازم يدخل
+
+262
+00:18:17,520 --> 00:18:23,140
+مايكروبات أخرى غير الـ Clostridium tetani.
+
+263
+00:18:23,140 --> 00:18:28,540
+التيتانوس بِزَمن هو التوكسين اللي بينتجه البكتيريا
+
+264
+00:18:28,540 --> 00:18:32,040
+هو عبارة عن heat-labile toxin. بتفيدنا بحاجة
+
+265
+00:18:32,040 --> 00:18:37,670
+للمعلومة هذه؟ heat-labile toxin. طيب هو الـ toxin وين
+
+266
+00:18:37,670 --> 00:18:42,270
+موجود؟ معلش هو وين موجود الآن؟ لما الـ bacteria تكون
+
+267
+00:18:42,270 --> 00:18:46,950
+موجودة جوا، يعني أنا مش هسخن الجسم لـ 65 درجة
+
+268
+00:18:46,950 --> 00:18:50,890
+مئوية، لكن هذه معلومة بنوضح فيها أن الـ toxin
+
+269
+00:18:50,890 --> 00:18:55,090
+معمليا هو heat-labile، لكن clinically مافيش منها
+
+270
+00:18:55,090 --> 00:18:58,630
+فائدة. البعض .. البعض قد يظن، بتعرفوا عندنا في
+
+271
+00:18:58,630 --> 00:19:01,810
+practice في قطاع غزة أن اللي بينصاب بمصمار بيروح
+
+272
+00:19:01,810 --> 00:19:06,130
+يجيب قطعة حاجة مولعة أو سجارة، تمام، و بيحطها على
+
+273
+00:19:06,130 --> 00:19:11,630
+مكان الجروح. هذا الـ practice أسوأ ما يكون. أسوأ ما
+
+274
+00:19:11,630 --> 00:19:15,290
+يكون، بيساعد في تكوين الظروف الهوائية للبكتيريا،
+
+275
+00:19:15,290 --> 00:19:18,670
+ليش؟ تخيلوا مع بعض .. لا، تخيلوا مع بعض احنا
+
+276
+00:19:18,670 --> 00:19:24,590
+الولاعة وولعناها وحطينا إيدنا فوقها،  بيدينا الشعور
+
+277
+00:19:24,590 --> 00:19:29,910
+بالحرارة، تمام؟ بتتم بعد ما تنهرج إيدنا ولا جبل؟
+
+278
+00:19:29,910 --> 00:19:34,830
+جبل، هو جبل! ما تنهرج إيدنا بنشيلها، متحملهاش، بنشيلها،
+
+279
+00:19:34,830 --> 00:19:39,800
+نهايات الأعصاب وين موجودة؟ في الجلد. الآن لما بنقرّب
+
+280
+00:19:39,800 --> 00:19:43,420
+بشيء، احنا البكتيريا على بعد سنتين على سبيل المثال
+
+281
+00:19:43,420 --> 00:19:48,580
+وهي spore-former و resistant لمن؟ للحرارة. احنا
+
+282
+00:19:48,580 --> 00:19:52,340
+ما بنحملش حرارة جداً، هي بتتحمل حرارة. احنا اللي
+
+283
+00:19:52,340 --> 00:19:55,820
+بنعمله بنسخّن الجروح، نقتل الخلايا اللي موجودة هنا
+
+284
+00:19:55,820 --> 00:19:59,800
+بالحرارة و بنسخّن الجروح، بنوفر ظروف هوائية. إذا هذا
+
+285
+00:19:59,800 --> 00:20:04,120
+الـ practice اللي موجود، practice سيء و قد يساعد في
+
+286
+00:20:04,120 --> 00:20:08,910
+توفير ظروف هوائية. التوكسين يمكن أن يصل إلى نظام
+
+287
+00:20:08,910 --> 00:20:11,800
+العصبي. it blocks the release of inhibitory
+
+288
+00:20:11,800 --> 00:20:12,920
+mediators of the motor neurons. أعتقد هذا التوكسين
+
+289
+00:20:12,920 --> 00:20:15,240
+أخذناه للميكانيزم أوف أكشن. it blocks the release of
+
+290
+00:20:15,240 --> 00:20:18,240
+inhibitory mediators of the motor neurons. احنا
+
+291
+00:20:18,240 --> 00:20:21,940
+قلنا أن في عندنا acetylcholine هو اللي بينقل
+
+292
+00:20:21,940 --> 00:20:25,820
+الإشارة العصبية. الـ acetylcholine بيعمل الانقباض
+
+293
+00:20:25,820 --> 00:20:31,520
+طبعاً. الآن المفروض أن يصير فيه glycine. الـ glycine
+
+294
+00:20:31,520 --> 00:20:34,520
+يعمل inhibition لـ الـ acetylcholine عشان يصير فيه
+
+295
+00:20:34,520 --> 00:20:39,020
+استرخاء. هذا بيمنع الـ glycine من أنه ينتج
+
+296
+00:20:39,020 --> 00:20:42,760
+وبالتالي، عشان في عندي دائماً انقباض دائم. الانقباض
+
+297
+00:20:42,760 --> 00:20:47,040
+الدائم هو اللي بنعني فيه الـ spastic paralysis. الـ
+
+298
+00:20:47,040 --> 00:20:52,150
+spastic paralysis. خذوا بالكم. قد يصاب المريض بنوبات
+
+299
+00:20:52,150 --> 00:20:58,410
+.. بنوبات من الـ violent spasm، يعني تشنجات عنيفة قد
+
+300
+00:20:58,410 --> 00:21:03,070
+تؤدي إلى كسر العمود الفقري تبعه، لأن غالباً التشنجات
+
+301
+00:21:03,070 --> 00:21:07,390
+بتتم إلى الخلف، تمام؟ فبتكون عنيفة لدرجة أنه ممكن
+
+302
+00:21:07,390 --> 00:21:11,290
+ينكسر عنده العمود الفقري ويصاب بشلل دائم. الماء
+
+303
+00:21:12,240 --> 00:21:16,460
+فالمرض خطر جداً، ده يطلع هنا، this اللي هو الـ
+
+304
+00:21:16,460 --> 00:21:18,820
+mechanism of the toxin، this results in extreme
+
+305
+00:21:18,820 --> 00:21:23,560
+hyperreflexia، hyperreflexia. الاستجابة، الـ reflex
+
+306
+00:21:23,560 --> 00:21:27,160
+بيكون بزيادة، تمام؟ يعني لو الواحد بده يتحرك، بده
+
+307
+00:21:27,160 --> 00:21:30,560
+يحرك شيء على أنفه، بيعمل زي هيك و بيحركه، صح ولا
+
+308
+00:21:30,560 --> 00:21:36,040
+لأ؟ لكن لو واحد عنده تيتانوس بيكون الأمر عملية صعبة
+
+309
+00:21:36,040 --> 00:21:39,400
+معقدة. بيسموها hyperreflexia and violent spasm of
+
+310
+00:21:39,400 --> 00:21:42,940
+skeletal muscles in response to any stimuli. The
+
+311
+00:21:42,940 --> 00:21:46,500
+toxin is inactivated by the proteolytic enzymes of the
+
+312
+00:21:46,500 --> 00:21:49,760
+digestive system. يعني لو أنت تتناولت الـ toxin كطعام
+
+313
+00:21:49,760 --> 00:21:54,960
+تمام، ما بيأثر عليك الـ toxin لو أخذته أنت عبر الأكل
+
+314
+00:21:54,960 --> 00:21:58,780
+ما عندك مشكلة فيه. ليش؟ لأنه بيصير له inactivation
+
+315
+00:21:58,780 --> 00:22:01,840
+inactivation بالـ proteolytic enzymes اللي موجودة في
+
+316
+00:22:01,840 --> 00:22:05,810
+المعدة. لكن لو أخذناه عبر الدم، فش الـ .. فش الـ .. فش
+
+317
+00:22:05,810 --> 00:22:08,630
+الـ proteolytic enzymes. لو أخذناها من المصمار
+
+318
+00:22:08,630 --> 00:22:12,570
+من مكان الإصابة بتخش المايدة وبتالي النشاط تبعه
+
+319
+00:22:12,570 --> 00:22:17,430
+بعيد عن المايدة. طالع الـ .. الـ .. الـ .. الـ toxicity
+
+320
+00:22:17,430 --> 00:22:21,150
+برضه عالية. One milligram of the pure toxin has six
+
+321
+00:22:21,150 --> 00:22:25,490
+million lethal mouse doses. برضه رقم مهول شباب، يعني
+
+322
+00:22:25,490 --> 00:22:27,510
+الـ toxicity تبعته عالية جداً.
+
+323
+00:22:31,110 --> 00:22:35,390
+طبعاً هذه ممكن صور بتوضح لنا اللي هو الـ .. الـ .. طرق
+
+324
+00:22:35,390 --> 00:22:42,210
+الإصابة، هذه عضة، تمام، هذه عضة، هذه ممكن من .. من
+
+325
+00:22:42,210 --> 00:22:45,330
+مصمار، هذه الـ .. حتى القطط، عضة الـ .. عضة .. عضة
+
+326
+00:22:45,330 --> 00:22:49,190
+القطة قد تؤدي إلى اللي هو الإصابة بـ tetanus.
+
+327
+00:22:56,540 --> 00:23:02,540
+بعد انتشار من ثلاثة إلى واحد وعشرين يوم في معظم
+
+328
+00:23:02,540 --> 00:23:07,300
+الحالات، في فترة أربعة أشهر، يوم، مع عاملية أُت ديز
+
+329
+00:23:07,300 --> 00:23:12,840
+يعني الـ range الواسع من ثلاثة إلى واحد وعشرين في
+
+330
+00:23:12,840 --> 00:23:15,420
+عاملية أُت ديز خلال أربعة أشهر، يوم، يعني أربعة أشهر
+
+331
+00:23:15,420 --> 00:23:22,090
+يوم، مقبل العاملية غالباً ثمانية أيام. The farther ..
+
+332
+00:23:22,090 --> 00:23:24,890
+هذه نقطة كتير مهمة. The farther the injury site is
+
+333
+00:23:24,890 --> 00:23:26,850
+from the central nervous system, the longer the
+
+334
+00:23:26,850 --> 00:23:31,110
+incubation period. كلما ابتعدت الجروح عن الجهاز
+
+335
+00:23:31,110 --> 00:23:35,550
+العصبي المركزي كلما زادت اللي هو فترة الـ incubation
+
+336
+00:23:35,550 --> 00:23:41,300
+period. the shorter the incubation period, the higher
+
+337
+00:23:41,300 --> 00:23:45,920
+the risk of death. كلما قصرت فترة الـ incubation
+
+338
+00:23:45,920 --> 00:23:52,160
+period، زادت إمكانية الوفاة. أحكي لكم نقطة مهمة جداً
+
+339
+00:23:52,160 --> 00:23:57,620
+جداً جداً. ميم تتوقع يتوفر فيها ظروف لاهوائية أكثر؟ جروح
+
+340
+00:23:57,620 --> 00:24:02,340
+عميقة ولا جروح سطحية؟ كلما ازداد العمق كلما ازدادت
+
+341
+00:24:02,340 --> 00:24:06,540
+إمكانية أن تتوفر فيها ظروف لاهوائية. أحد الأطباء لاحظ
+
+342
+00:24:06,540 --> 00:24:11,260
+ملاحظة قيّمة، صحيح لازم نناقشها معاكم كـ concept عشان
+
+343
+00:24:11,260 --> 00:24:15,320
+تعرفوا أن بعض الأحيان في بصير تحول في الأفكار
+
+344
+00:24:15,320 --> 00:24:20,680
+نتيجة تدخلاتنا، احنا تدخلاتنا احنا البشر، احنا
+
+345
+00:24:20,680 --> 00:24:26,660
+متفقين على أنه الجروح العميقة من زمان هي الأخطر
+
+346
+00:24:26,660 --> 00:24:30,830
+بالنسبة لتكوين الـ tetanus. فصار فيه اهتمام بالجروح
+
+347
+00:24:30,830 --> 00:24:36,280
+العميقة، وبالتالي قلت نسبة حدوث التيتانوس من الجروح
+
+348
+00:24:36,280 --> 00:24:40,380
+العميقة. ركزنا على الجروح العميقة ولا نركز على مين؟
+
+349
+00:24:40,380 --> 00:24:44,780
+على الجروح السطحية. فإحصائياً أصبحنا نعاني من حالات
+
+350
+00:24:44,780 --> 00:24:50,100
+تيتانوس ناتجة عن جروح سطحية أكثر مما نعاني من جروح
+
+351
+00:24:50,100 --> 00:24:52,980
+عميقة. أوصلت الصورة؟ طبعاً هذا السبب ليش اللي خلاه
+
+352
+00:24:52,980 --> 00:24:57,620
+يتغير. دخلنا احنا و أصبحنا نهتم. نعم، مش اتكيفت هو
+
+353
+00:24:57,620 --> 00:25:03,600
+يعني احنا كده كمرّة بنقول: the chance of forming
+
+354
+00:25:03,600 --> 00:25:07,580
+anaerobic conditions أعلى لما تكون الجروح أعمق.
+
+355
+00:25:07,580 --> 00:25:10,800
+أعلى، مش أنه مافيش chance خالص لما تكون سطحية، فيه
+
+356
+00:25:10,800 --> 00:25:14,120
+chance، لكن ركزنا على الجروح العميقة و ما ركزنا على
+
+357
+00:25:14,120 --> 00:25:19,900
+الجروح السطحية. طبعاً هذه أحد الـ .. الـ .. الـ ..
+
+358
+00:25:19,900 --> 00:25:23,780
+النوبات. إذا بتلاحظوا فيه الرأس جاعد أو الرقبة
+
+359
+00:25:23,780 --> 00:25:27,620
+بتتحرك إلى اللي هو الخلف. طبعاً هنا في عندي fixed
+
+360
+00:25:27,620 --> 00:25:31,580
+jaw، في locked jaw في المنطقة في الست هذه المصابة.
+
+361
+00:25:35,000 --> 00:25:38,320
+أحد الأمراض اللي كانت منتشرة زمان اللي هي الـ
+
+362
+00:25:38,320 --> 00:25:41,980
+neonatal .. neonatal tetanus. فهي كتير مهمة. الصورة
+
+363
+00:25:41,980 --> 00:25:45,400
+اللي أمامكم بتوضح لنا من وين بيجي الـ neonatal
+
+364
+00:25:45,400 --> 00:25:51,090
+tetanus. الآن الحبل السري بيتقطع عند الولادة، تمام؟
+
+365
+00:25:51,090 --> 00:25:56,110
+فتخيلوا الأدوات المستخدمة: المجص أو الشفرة أو الحجر
+
+366
+00:25:56,110 --> 00:25:59,330
+زمان كانوا يستخدموا حجر، ماضي، عشان يحس أنه يعني في
+
+367
+00:25:59,330 --> 00:26:03,010
+الـ .. لحد الآن في بعض القرى الولادة بتتم فيها
+
+368
+00:26:03,010 --> 00:26:07,310
+بالطريقة اللي منذ الخليقة، تمام؟ يعني بدأية خالص
+
+369
+00:26:07,310 --> 00:26:12,690
+بدأية خالص في بيولدوا تحت المي، كويس؟ مجتمعات ففي
+
+370
+00:26:12,690 --> 00:26:17,350
+عندنا أنواع كثيرة من الولادة في المستشفيات. تخيلوا
+
+371
+00:26:17,350 --> 00:26:22,770
+أنه كيف ممكن تتلوث الأشياء. احنا لما بنروح على
+
+372
+00:26:22,770 --> 00:26:30,250
+المستشفى، بنروح طيران، سباحة ولا بنروح ماشي بالسيارة؟
+
+373
+00:26:30,250 --> 00:26:34,930
+لكن في الآخر بننزل ورجلينا يعني اللي بياخدوا تراب
+
+374
+00:26:34,930 --> 00:26:39,410
+من الشارع، تمام؟ سواء كان الشارع نظيف خالص ولا طريق
+
+375
+00:26:39,410 --> 00:26:43,230
+ترابي، بناخد بقايا من الأتربة على أحديتنا وبنروح
+
+376
+00:26:43,230 --> 00:26:47,490
+فيها على المستشفى. هذا التراب مش هو مصدر للميكروبات
+
+377
+00:26:47,490 --> 00:26:49,950
+ومن ضمن الميكروبات هذه الـ spore-forming اللي من
+
+378
+00:26:49,950 --> 00:26:55,130
+ضمنها الـ Clostridium tetani. نعم. ندخل المستشفى، الغبار
+
+379
+00:26:55,130 --> 00:26:59,030
+هذا بدوله مطرحه. بفعد الحركة، ممكن يتحرك وينتقل
+
+380
+00:26:59,030 --> 00:27:03,270
+لأشياء ويلوثها. من ضمن الأشياء اللي هي المجسات أو
+
+381
+00:27:03,270 --> 00:27:06,570
+الشفرات اللي بنستخدمها اللي هي ممكن تكون non-
+
+382
+00:27:06,570 --> 00:27:12,030
+sterile. في هذه الحالة إيش نعمل؟ عشان يمنعوا هذا
+
+383
+00:27:12,030 --> 00:27:16,890
+الموضوع عملوا غرفة transient. إذا أنت جاي من برا
+
+384
+00:27:16,890 --> 00:27:19,930
+كطبيب أو nurse أو أي واحد بدو يدخل هذا المكان، تمام؟
+
+385
+00:27:19,930 --> 00:27:24,510
+ممنوع يدخل بحذائه. بيلبسوا حذاء عمره ما شايف الشارع.
+
+386
+00:27:25,460 --> 00:27:29,460
+بيخلع حذائه، بيحطه، و بينتقل للجهة التانية بياخد حذاء
+
+387
+00:27:29,460 --> 00:27:32,760
+موجود من المستشفى و بيدخل فيه. طبعاً اليوم في أحذية
+
+388
+00:27:32,760 --> 00:27:37,600
+disposable بيلبسها. زي الغطاء للرأس، بيلبس برضه غطاء
+
+389
+00:27:37,600 --> 00:27:41,660
+على الحذاء و بيدخل فيها. هذه العملية طبعاً مع تحسين
+
+390
+00:27:41,660 --> 00:27:46,280
+عملية الـ sterilization و استخدام disposables لمرة
+
+391
+00:27:46,280 --> 00:27:50,870
+واحدة. قلت نسبة الـ tetanus تبع حديثي الولادة إلى
+
+392
+00:27
+
+445
+00:31:09,510 --> 00:31:09,550
+بتلوث الجرح بتلوث الجرح بتلوث الجرح بتلوث
+
+446
+00:31:09,550 --> 00:31:09,650
+الجرح بتلوث الجرح بتلوث الجرح بتلوث الجرح
+
+447
+00:31:09,650 --> 00:31:09,770
+بتلوث الجرح بتلوث الجرح بتلوث الجرح بتلوث
+
+448
+00:31:09,770 --> 00:31:09,790
+الجرح بتلوث الجرح بتلوث الجرح بتلوث الجرح
+
+449
+00:31:09,790 --> 00:31:16,370
+بتلوث الجرح بتلوث الجرح
+
+450
+00:31:16,370 --> 00:31:22,510
+بتلوث الجرح بتلretrograde كلمة retrograde يعني
+
+451
+00:31:22,510 --> 00:31:27,030
+بطريقة عكسية للإشارة العصبية to the spinal cord binds
+
+452
+00:31:27,030 --> 00:31:30,490
+to gangliocyte receptors of anterior horn cells
+
+453
+00:31:30,490 --> 00:31:33,930
+بعدين بيعمل inhibition of the release of inhibitory
+
+454
+00:31:33,930 --> 00:31:36,450
+mediators اللي هو الـ glycine اللي حكينا عنه اللي
+
+455
+00:31:36,450 --> 00:31:41,230
+بيعمل inhibition لمين؟ لـ acetylcholine continuous
+
+456
+00:31:41,230 --> 00:31:46,350
+excitement يعني في عندي إثارة مستمرة لـ motor
+
+457
+00:31:46,350 --> 00:31:52,780
+neurons وسينادي اللي هو muscle spasm. The organism does
+
+458
+00:31:52,780 --> 00:31:56,740
+not spread، it is localized، no tissue damage،
+
+459
+00:31:56,740 --> 00:32:00,180
+بيعملش destruction للنسيج، النسيج اللي كان بالأول
+
+460
+00:32:00,180 --> 00:32:04,640
+destroyed كان نادى عن الجروح نفسه، no invasion of
+
+461
+00:32:04,640 --> 00:32:09,120
+adjacent tissue، مافيش غزو، هي بالفعل ينطبق
+
+462
+00:32:09,120 --> 00:32:14,620
+عليها localized أو local infection. Treatment زي ما
+
+463
+00:32:14,620 --> 00:32:16,840
+ذكرنا أن هذا الـ disease is a life-threatening
+
+464
+00:32:16,840 --> 00:32:23,420
+disease، و treatment consists of two steps. واحد الـ
+
+465
+00:32:23,420 --> 00:32:26,620
+patient is given antibiotics to kill the bacteria
+
+466
+00:32:26,620 --> 00:32:30,380
+و هذا الـ antibiotic إما بيكون metronidazole اللي
+
+467
+00:32:30,380 --> 00:32:34,700
+هو معروف عنه باسم فلاجيل والذي يستخدم ضد الـ
+
+468
+00:32:34,700 --> 00:32:39,460
+protozoa اللي درسوها مع الدكتور عدنان. الـ protozoa
+
+469
+00:32:40,970 --> 00:32:44,510
+أو الـ anaerobic bacteria. يعني هذا بيستخدم فقط
+
+470
+00:32:44,510 --> 00:32:48,570
+البروتزوا والـ anaerobic bacteria. أو الـ  هذا الجزء
+
+471
+00:32:48,570 --> 00:32:52,630
+الأول. شوف الجزء التاني، الصعب. injection of
+
+472
+00:32:52,630 --> 00:32:57,530
+antitoxin are also given. الآن الـ antitoxin يا شباب
+
+473
+00:32:57,530 --> 00:33:04,150
+من وين بيجيبوها؟ من ناس أنصابوا بتتانوس وأولجوا
+
+474
+00:33:04,150 --> 00:33:10,230
+بياخدوا منهم سيرم، بياخدوا منهم سيرم وبيعملوا pooling
+
+475
+00:33:10,230 --> 00:33:13,770
+من أكثر من واحد يعني، وبيعملوا pooling وبيعطوا المريض
+
+476
+00:33:13,770 --> 00:33:18,010
+عدد أو كم كبير من الـ antitoxins. خدوا بالكم النقطة
+
+477
+00:33:18,010 --> 00:33:23,050
+الـ antitoxin هيرتبط بالتوكسين، وأن بيرتبط بالتوكسين
+
+478
+00:33:23,050 --> 00:33:26,430
+التوكسين اللي غير مرتبط، بس التوكسين اللي مرتبط
+
+479
+00:33:26,430 --> 00:33:33,230
+مرتبط مظبوط ولا لأ؟ فبالتالي قد ننجح في العلاج لكن
+
+480
+00:33:33,230 --> 00:33:37,410
+قد لا ننجح في إعادة المريض إلى الحالة الأولى التي
+
+481
+00:33:37,410 --> 00:33:42,610
+كان عليها. بنوقف الـ toxin production. نقطة البكتيريا
+
+482
+00:33:42,610 --> 00:33:46,550
+بنعمل neutralization للـ toxin لكن للأسف ما بتقدرش
+
+483
+00:33:46,550 --> 00:33:51,490
+تخلص من مين؟ من الـ toxin اللي already bound، تمام؟
+
+484
+00:33:51,490 --> 00:33:54,170
+عشان هيك أنا قلت لكم كمان مرة الـ strategy تبعتنا لازم
+
+485
+00:33:54,170 --> 00:33:56,090
+تكون prevention وليس
+
+486
+00:33:59,410 --> 00:34:02,530
+الـ Antitoxin is a substance، وطبعا مش فقط إحنا في
+
+487
+00:34:02,530 --> 00:34:04,530
+المرحلة اللي بنعرف فيها شو الـ substance هذا، هو عبارة
+
+488
+00:34:04,530 --> 00:34:07,590
+عن antibody، that reacts with and destroys the
+
+489
+00:34:07,590 --> 00:34:11,350
+toxin. The patient may also need medication to control
+
+490
+00:34:11,350 --> 00:34:14,130
+muscle spasm، ممكن نعطيهم برضه علاجات حتى يخففوا
+
+491
+00:34:14,130 --> 0:34:18,430
+من الانقباضات، اللي هو العضلات. In severe cases,
+
+492
+00:34:18,910 --> 00:34:21,450
+patients may have to be placed on artificial
+
+493
+00:34:21,450 --> 00:34:25,210
+respiration. تخيلوا يا شباب، لو صار في عندنا
+
+494
+00:34:25,210 --> 00:34:29,190
+failure في الـ respiratory system. بيروحوا بيحطوا
+
+495
+00:34:29,190 --> 00:34:34,870
+المرضى في أجهزة تنفس خاصة، أجهزة تنفس خاصة، بتقوم
+
+496
+00:34:34,870 --> 00:34:39,890
+بعملية الشهيق والزفير اللي المريض غصب عنه لأنه عنده
+
+497
+00:34:39,890 --> 00:34:44,030
+muscle تمام في الـ .. عفواً عنده paralysis في الـ
+
+498
+00:34:44,030 --> 00:34:48,710
+lungs نفسها. فهذا عشان أقول لكم أنه recovery takes
+
+499
+00:34:48,710 --> 00:34:52,470
+six weeks، حوالي شهر ونص، or more after the patient is
+
+500
+00:34:52,470 --> 00:34:56,570
+.. is .. is better أو يتحسن المريض، he or she should
+
+501
+00:34:56,570 --> 00:34:59,770
+receive the tetanus vaccine to protect against
+
+502
+00:34:59,770 --> 00:35:02,810
+future .. future episodes of the disease. يعني حتى
+
+503
+00:35:02,810 --> 00:35:05,650
+بعد .. بعد الشفاء بنعطيه اللي هو vaccination
+
+504
+00:35:09,140 --> 00:35:14,540
+لأ، إحنا بنعرف أن استخدام الـ immunization
+
+505
+00:35:14,540 --> 00:35:18,440
+بيقول لنا عنه في حاجتين، بنعطي passive immunity و
+
+506
+00:35:18,440 --> 00:35:20,580
+active immunity. الـ vaccine هو الـ active
+
+507
+00:35:20,580 --> 00:35:23,820
+immunization، تمام؟ و الـ antitoxin اللي هي الـ
+
+508
+00:35:23,820 --> 00:35:26,260
+antibodies اللي هي الـ passive تمام؟ immunization
+
+509
+00:35:26,260 --> 00:35:29,600
+بس مش vaccination، تمام؟ الـ vaccine بنعطيه الـ
+
+510
+00:35:29,600 --> 00:35:30,500
+antitoxoid
+
+511
+00:35:33,170 --> 00:35:36,470
+التوكسويد، اللي هو التوكسين اللي حولناه لتوكسويد
+
+512
+00:35:36,470 --> 00:35:40,290
+بينما الـ antitoxin هو حاجة من جهة برا، وأعطيناها
+
+513
+00:35:40,290 --> 00:35:48,670
+للمريض. من ضمن الـ vaccines المشهورة اللي هو الـ DPT
+
+514
+00:35:48,670 --> 00:35:56,840
+أو الـ DTP أو الـ DPT، وفي الآن في عندنا DTAP، واحد
+
+515
+00:35:56,840 --> 00:36:02,540
+جديد طلع عندنا اسمه DTAP. عموماً الـ T هي للتتانوس
+
+516
+00:36:02,540 --> 00:36:08,640
+و الـ D للدفتيريا، و الـ P سواء كان A P ولا P لحالها
+
+517
+00:36:08,640 --> 00:36:14,380
+للبرتوسيز، البرتوسيز اللي هو السعال الديكي. إذن هذا
+
+518
+00:36:14,380 --> 00:36:16,780
+الـ vaccine اللي أخذتوها أنتم صغار، مراراً و
+
+519
+00:36:16,780 --> 00:36:20,320
+مرات، تمام؟ ولو لزم الأمر ممكن تأخذوا منه
+
+520
+00:36:20,320 --> 00:36:22,920
+booster dose. إيش يعني booster dose؟
+
+521
+00:36:30,020 --> 00:36:34,060
+تذكروا يا شباب اللي درستوا مناعة ولا ما درستوها حتى
+
+522
+00:36:34,060 --> 00:36:36,180
+لو ما درستوا مناعة، أنا بذكر أنّه اتكلمنا عن
+
+523
+00:36:36,180 --> 00:36:39,580
+الموضوع هذا، كنا في الـ response تبع الجسم للـ
+
+524
+00:36:39,580 --> 00:36:44,000
+antigen لأول مرة. بيبدأ إنتاج الـ antibody من الـ zero
+
+525
+00:36:44,000 --> 00:36:47,340
+تمام؟
+
+526
+00:36:47,340 --> 00:36:51,580
+بيبدأ إنتاج الـ antibody من وين؟ من الـ zero، صح؟ وبياخد
+
+527
+00:36:51,580 --> 00:36:57,460
+لو جينا نحط فترة زمنية يعني
+
+528
+00:36:57,460 --> 00:37:03,510
+هي الـ time، تمام؟ وهي الـ concentration بيبدأ ظهوره
+
+529
+00:37:03,510 --> 00:37:10,310
+بعدها، بعد فترة معينة، حوالي من عشرة إلى أربعة عشر يوم
+
+530
+00:37:10,310 --> 00:37:16,520
+من دخول الـ antigen. لكن الـ antigen لو دخل مرة ثانية، تمام
+
+531
+00:37:16,520 --> 00:37:20,440
+مثلاً في الفترة هذه، في الفترة هذه بنلاقي الـ
+
+532
+00:37:20,440 --> 00:37:23,040
+antibody، ما  حد ما دخل الـ antigen. هي نقطة دخول
+
+533
+00:37:23,040 --> 00:37:26,980
+الـ antigen. الـ time، تمام؟ هيطلع عندي antibody وبنسبة
+
+534
+00:37:26,980 --> 00:37:29,680
+أعلى في الـ primary response. it takes time، بس في الـ
+
+535
+00:37:29,680 --> 00:37:32,960
+secondary response it takes no time. ليش؟ لأن في
+
+536
+00:37:32,960 --> 00:37:37,020
+عندي memory cells
+
+537
+00:37:38,360 --> 00:37:40,760
+فالـ secondary response، فإحنا لما نعطي booster dose
+
+538
+00:37:40,760 --> 00:37:44,320
+إحنا واقع الأمر بس بنذكر جهاز المناعة، مش بن ..
+
+539
+00:37:44,320 --> 00:37:47,840
+بنعلّمه لأ، بنذكّره. المرة الأولانية علّمناه، والمرة
+
+540
+00:37:47,840 --> 00:37:49,040
+الثانية ذكرناه.
+
+541
+00:37:53,280 --> 00:37:59,460
+Also، mothers should receive a vaccine to prevent neonatal
+
+542
+00:37:59,460 --> 00:38:03,200
+tetanus for their babies during cutting the
+
+543
+00:38:03,200 --> 00:38:07,640
+umbilical cord. أعتقد الـ practice هذا is no longer
+
+544
+00:38:07,640 --> 00:38:11,280
+used in Palestine. ما عنديش فكرة بالضبط هل مازالوا
+
+545
+00:38:11,280 --> 00:38:15,020
+يستخدموه أو بطلوا وأوقفوا استخدامه، بس أعتقد أنهم
+
+546
+00:38:15,020 --> 00:38:17,640
+وقفوا استخدامه. Make sure that wounds are
+
+547
+00:38:17,640 --> 00:38:21,490
+thoroughly cleaned. هذه نقطة كتير مهمة. يجب أن نقوم
+
+548
+00:38:21,490 --> 00:38:25,450
+بتطهير الجروح بطريقة جيدة. A wound should also be
+
+549
+00:38:25,450 --> 00:38:28,010
+treated with antibiotic cream and covered with a
+
+550
+00:38:28,010 --> 00:38:31,090
+bandage، ما تخليه مفتوح ومُطروح. Wounds that do
+
+551
+00:38:31,090 --> 00:38:35,090
+not heal should be examined by a doctor. أي جروح
+
+552
+00:38:35,090 --> 00:38:43,630
+ما بتطول شفاؤها should be examined by a physician. الصنف
+
+553
+00:38:43,630 --> 00:38:47,690
+الثاني أو الاسم الثاني للاكلوستريدية والاسم
+
+554
+00:38:47,690 --> 00:38:53,650
+الشهير جداً هو الـ Clostridium perfringens. It causes a
+
+555
+00:38:53,650 --> 00:38:57,230
+wide variety of infections. لكن الاسم الشهير للمرض
+
+556
+00:38:57,230 --> 00:39:01,950
+تمام، أشهر مرض على الإطلاق اللي هو gas gangrene
+
+557
+00:39:01,950 --> 00:39:08,050
+وهذا مرض بحد ذاته اسمه مخيف، الغرغرينة الغازية. طيب
+
+558
+00:39:08,050 --> 00:39:11,990
+wound infection. خدوا بالكم، مافيش gas gangrene
+
+559
+00:39:11,990 --> 00:39:16,410
+اللي بتبدأ بـ wound infection. يعني غالباً بيكون فيه
+
+560
+00:39:16,410 --> 00:39:25,650
+التهاب صار من جرح. مرض خطير جداً، necrotizing
+
+561
+00:39:25,650 --> 00:39:30,870
+enteritis. بدل ما الغرغرينة في العضلات، الغرغرينة في
+
+562
+00:39:30,870 --> 00:39:36,940
+الأمعاء. يعني هذا gangrene وغرغرينة الأمعاء. رقم
+
+563
+00:39:36,940 --> 00:39:40,840
+أربعة يا طلاب، الـ food microbiology، food poisoning
+
+564
+00:39:40,840 --> 00:39:44,780
+food poisoning بسيطة. هذا الـ food poisoning. خمسة،
+
+565
+00:39:44,780 --> 00:39:47,600
+meningitis. طبعاً بالمقارنة مع الأمراض اللي أنا
+
+566
+00:39:47,600 --> 00:39:50,400
+ذكرتها، دي الـ food poisoning بالفعل because by
+
+567
+00:39:50,400 --> 00:39:53,340
+Clostridium perfringens is a very simple condition
+
+568
+00:39:53,340 --> 00:39:58,800
+إيه ده الموضوع؟ gas، necrotizing، food poisoning، و
+
+569
+00:39:58,800 --> 00:40:02,620
+meningitis. هذه الأمراض بسببها البكتيريا. الآن شوفوا
+
+570
+00:40:02,620 --> 00:40:04,960
+الفكرة في كلمة gas gangrene
+
+571
+00:40:07,930 --> 00:40:14,270
+تعرفوا الخبز لما بن .. بن .. بيكون عجين، هو بنعرضه
+
+572
+00:40:14,270 --> 00:40:17,390
+للحرارة، مش بيتنفخ؟ بيتنفخ، وفي الآخر بنلاقي إنه
+
+573
+00:40:17,390 --> 00:40:21,510
+انقسم نصين، صار فيه يعني قطعة وقطعة مع أنه كان
+
+574
+00:40:21,510 --> 00:40:26,150
+قطعة واحدة. الغاز بطبيعته يا شباب بيحبش ينحشر في
+
+575
+00:40:26,150 --> 00:40:29,750
+مكان أو ينضغط في مكان. فإذا اتكون فيه ضغط، عادة بيحب
+
+576
+00:40:29,750 --> 00:40:34,110
+يدور على أضعف منطقة يخرج منها، يخرج منها. لما بتمدد
+
+577
+00:40:34,110 --> 00:40:38,370
+الغاز، بتمدد الغاز بفعل الحرارة أو بفعل التراكم
+
+578
+00:40:38,370 --> 00:40:48,190
+يعني تخيلوا بكتيريا جوا عضلات وبدأت تتكاثر، و
+
+579
+00:40:48,190 --> 00:40:51,330
+تكاثرها والـ fermentation الناتج عنها بينتج عنه
+
+580
+00:40:51,330 --> 00:40:55,370
+غاز. أظن أن في المعمل كنا نشوف الـ triple sugar iron
+
+581
+00:40:55,370 --> 00:40:59,350
+agar رافع فوق، آه، لأن كمية الغاز اللي طالعة كمية
+
+582
+00:40:59,350 --> 00:41:04,600
+كبيرة. فلما البكتيريا هتنتج غاز، غالباً يا شباب الغاز
+
+583
+00:41:04,600 --> 00:41:09,900
+هذا بيحاول أنه يهرب، فبيهرب، بيلاقي الأماكن اللي هو
+
+584
+00:41:09,900 --> 00:41:16,800
+سالكة في أمامه بيدخل فيها. بالآخر بتكون ضغط
+
+585
+00:41:16,800 --> 00:41:20,700
+بتكون ضغط. تخيلوا لو عضلتين جنب بعض، وافترقهم عن بعض
+
+586
+00:41:20,700 --> 00:41:27,120
+الغاز. واحدة منهم كان بينهم شبكة شعيرات دموية، و
+
+587
+00:41:27,120 --> 00:41:30,740
+واحدة منهم هتتخلى عن الشعيرات الدموية، فممكن يصير
+
+588
+00:41:30,740 --> 00:41:33,980
+كتلة كاملة، عضلة كاملة يصير فيها necrosis
+
+589
+00:41:36,760 --> 00:41:41,560
+Necrosis، موت، لحمة ميتة، لحمة ميتة، يبقى البكتيريا
+
+590
+00:41:41,560 --> 00:41:44,200
+.. يبقى البكتيريا الآن بيصير اللي هي غذاء ممتازة
+
+591
+00:41:44,200 --> 00:41:47,900
+جداً فهتتكاثَر. هتبقى الواحد اللي بدك تعرف أن العضلة
+
+592
+00:41:47,900 --> 00:41:51,100
+هادي skeletal muscle، قد تكون عضلة كبيرة، ده .. ده
+
+593
+00:41:51,100 --> 00:41:53,860
+.. ده التأثير على الـ locomotion تبعت الإنسان
+
+594
+00:41:53,860 --> 00:41:58,520
+فبالتالي بيصير في أن هذه العضلة لن نستطيع إرجاعها
+
+595
+00:41:58,520 --> 00:42:02,240
+للحياة ولن تنمو مرة أخرى، وبالتالي بيصير بنروح لمرحلة
+
+596
+00:42:02,240 --> 00:42:07,700
+أنه better، هو أو أو أو مصطلح ألطف، removal أو
+
+597
+00:42:07,700 --> 00:42:11,320
+surgical removal of devitalized tissue. يعني التدخل
+
+598
+00:42:11,320 --> 00:42:16,240
+الجراحي لإزالة الأنسجة الميتة، تمام؟ وهو تعبير آخر
+
+599
+00:42:16,240 --> 00:42:18,600
+عن الـ debridement. تعبير آخر عن الـ debridement.
+
+600
+00:42:21,530 --> 00:42:26,590
+نفس الشيء نعم، لما نقول gangrene، بس مش gangrene غازية
+
+601
+00:42:26,590 --> 00:42:31,790
+الـ gangrene بشكل عام هي الـ necrosis، تمام؟ أو موت
+
+602
+00:42:31,790 --> 00:42:37,550
+الخلايا، أنها بتصير عن نقص وصول الدم لمنطقة معينة
+
+603
+00:42:37,550 --> 00:42:41,630
+اللي أنا بتكلم عنه سببه البكتيريا، ده بيتسبب بأسباب
+
+604
+00:42:41,630 --> 00:42:42,830
+أخرى مختلفة.
+
+605
+00:42:45,860 --> 00:42:49,780
+ووصلنا الآن لمرحلة أنّه بنقول gas gangrene
+
+606
+00:42:49,780 --> 00:42:53,800
+واللي غالباً غرغرينة اللي مسببها هنا بكتيريا. مدام
+
+607
+00:42:53,800 --> 00:42:56,700
+سببها بكتيريا، يبقى بنحاول نعالجها بالـ antibiotic،
+
+608
+00:42:56,700 --> 00:43:00,560
+آه، لأ، عندنا مشكلة، مدام antibiotic يبقى بدنا ..
+
+609
+00:43:00,560 --> 00:43:03,460
+بدنا نتذكر شغلة، هل الـ الـ الـ الـ bacteria
+
+610
+00:43:03,460 --> 00:43:07,380
+من النوع العادي ولا الـ spore former؟ spore former،
+
+611
+00:43:07,380 --> 00:43:09,500
+يبقى البكتيريا لو حطيناها لـ antibiotic، okay
+
+612
+00:43:09,500 --> 00:43:13,530
+البعض منها هيموت، لكن البعض الآخر هيتحول لمين؟ لشيل
+
+613
+00:43:13,530 --> 00:43:17,250
+الـ antibiotic، هترجع الـ endospore كمان مرة. إذا عملتي
+
+614
+00:43:17,250 --> 00:43:21,730
+العلاج كمان مرة. عملية ليست بالعملية السهلة، ومن
+
+615
+00:43:21,730 --> 00:43:25,470
+هنا نقول لكم مرة أخرى، رابعة أو خامسة أو ألف،
+
+616
+00:43:25,470 --> 00:43:30,830
+prevention is all important. proper care. مدام الـ
+
+617
+00:43:30,830 --> 00:43:33,970
+gas gangrene بدأ بمين؟ بـ wound infection. يبقى هأتكلم
+
+618
+00:43:33,970 --> 00:43:38,930
+عن مين؟ عن gas gangrene. يبقى اعمل proper wound
+
+619
+00:43:38,930 --> 00:43:43,890
\ No newline at end of file
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ycW2i58PRdc_postprocess.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ycW2i58PRdc_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..37b15fd3ad58db3745368170398decb5218d79a3
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ycW2i58PRdc_postprocess.srt
@@ -0,0 +1,2484 @@
+1
+00:00:20,520 --> 00:00:22,960
+بسم الله الرحمن الرحيم نبدأ محاضرتنا ان شاء الله
+
+2
+00:00:22,960 --> 00:00:26,420
+اليوم بالميكروبط الثاني من سلسلة الباسللس اللي هو
+
+3
+00:00:26,420 --> 00:00:30,120
+الباسللس سيرياس والصورة اللي أمامنا بتوضح انه
+
+4
+00:00:30,120 --> 00:00:34,720
+البكتيريا إلى حد كبير تشبه في شكل مستعمرتها
+
+5
+00:00:34,720 --> 00:00:40,540
+الباسللس أنتراسس لكن تتميز بوجود beta hemolysis ال
+
+6
+00:00:40,540 --> 00:00:44,270
+beta hemolysisيتضح من الحواف تبع المستعمرات
+
+7
+00:00:44,270 --> 00:00:49,810
+بتلاقوا انه في هنا فراغ هذا الفراغ بيتميز في اللون
+
+8
+00:00:49,810 --> 00:00:52,870
+عن باقي الطبق هنشوف صورة أوضح ان شاء الله اللي هو
+
+9
+00:00:52,870 --> 00:00:56,470
+في المرحلة التانية إذا بتطلعوا على الصورة هذه اللي
+
+10
+00:00:56,470 --> 00:00:59,530
+أمامكم هتلاقوا انه فيه انه يبته موليس واضح جدا
+
+11
+00:00:59,530 --> 00:01:03,750
+للمستعمرات ايضا المستعمرات large huge colonies
+
+12
+00:01:03,750 --> 00:01:09,120
+وهذا سمن سمات البسلس بشكل عامالبكتيريا هي عبارة عن
+
+13
+00:01:09,120 --> 00:01:12,920
+ground positive bacilli طبعا زيها زي أي باسيلاس و
+
+14
+00:01:12,920 --> 00:01:16,260
+sport forming بكتيريا لكن بتنتج beta hemolysis on
+
+15
+00:01:16,260 --> 00:01:18,280
+blood أجار هذا الصفة اللي لما نجدها فيه قلنا
+
+16
+00:01:18,280 --> 00:01:22,900
+الباسيلاس أنتراسيس ال pathogenesis and clinical
+
+17
+00:01:22,900 --> 00:01:28,080
+featureالبكتيريا غالبا موجودة everywhere، most
+
+18
+00:01:28,080 --> 00:01:31,340
+especially in cereals، cereals اللي هي الحبوب،
+
+19
+00:01:31,340 --> 00:01:35,060
+عشان هي اسمها Bacillus cereus، أحد الأنواع الحبوب
+
+20
+00:01:35,060 --> 00:01:39,620
+المشهورة في المستقبل في جنوب شرق أسيا اللي هو ال
+
+21
+00:01:39,620 --> 00:01:45,240
+riceالرز ال bacteria is heat resistant زيها زي أي
+
+22
+00:01:45,240 --> 00:01:48,140
+بصلص انتوا عارفين اكتر bacteria resistant في
+
+23
+00:01:48,140 --> 00:01:52,860
+العالم للحرارة اسمها بصلص stereothermophilous يعني
+
+24
+00:01:52,860 --> 00:01:55,820
+من ال genus نفسه تبع مين تاع البصلص طبعا نغير
+
+25
+00:01:55,820 --> 00:02:01,120
+اسمها اسمها geo-bacillusيبقى ال bacteria is heat
+
+26
+00:02:01,120 --> 00:02:04,960
+resistant ال sports heat resistant and can survive
+
+27
+00:02:04,960 --> 00:02:08,320
+rapid frying فرايين يعني قالي انتوا بتستخدموا
+
+28
+00:02:08,320 --> 00:02:13,000
+الجلي للرز كلمة قالي للرز بتستخدموها بس في جنوب
+
+29
+00:02:13,000 --> 00:02:19,080
+شرق أسيا موضوع قالي الرز زي تسخين الرز تمام فجزء
+
+30
+00:02:19,080 --> 00:02:23,040
+من العادات الغذائية عندهم انهم بيسخنوا الرز او بي
+
+31
+00:02:23,040 --> 00:02:26,930
+glue تمام قالي fryفبقولنا إن الـ spores can
+
+32
+00:02:26,930 --> 00:02:30,190
+survive rapid frying يعني لو قلي سريع البكتيريا
+
+33
+00:02:30,190 --> 00:02:35,850
+بتتحمله they produce enterotoxin in that food if
+
+34
+00:02:35,850 --> 00:02:38,650
+ingested it will cause food poisoning short
+
+35
+00:02:38,650 --> 00:02:41,070
+incubation period ال IP هذا مش ال IP address تبع
+
+36
+00:02:41,070 --> 00:02:44,170
+الكمبيوتر أمام؟ هذا incubation period من أربع لست
+
+37
+00:02:44,170 --> 00:02:47,910
+ساعات وبيشبه إلى حد كبير في الأعراض تبعته
+
+38
+00:02:47,910 --> 00:02:52,210
+الاستفيلوكوكل food poisoning من إنه بيكون فينا
+
+39
+00:02:52,210 --> 00:02:57,950
+ديارية and vomitingغالبا ال treatment لا تشتمل ال
+
+40
+00:02:57,950 --> 00:03:02,170
+antibiotic المذكور تحت فقط في حالات قليلة جدا ممكن
+
+41
+00:03:02,170 --> 00:03:05,970
+انه نستخدم البنسالين الاستخدام الأفضل هو
+
+42
+00:03:05,970 --> 00:03:09,570
+symptomatic treatment مش هو عنده vomiting و عنده
+
+43
+00:03:09,570 --> 00:03:13,670
+دياريا يبقى في عنده مشكلتين liquid او fluid
+
+44
+00:03:13,670 --> 00:03:16,370
+replacement و electrolyte replacement فبالتالي
+
+45
+00:03:16,370 --> 00:03:21,620
+اللي فيه هنا symptomatic fluid replacementهذه
+
+46
+00:03:21,620 --> 00:03:24,700
+اللوحة يعني إضافية مش مبالغة عندكم في ال .. في ال
+
+47
+00:03:24,700 --> 00:03:28,200
+text في .. في عبارة عن تمييز ما بين ال bacillus
+
+48
+00:03:28,200 --> 00:03:31,340
+anthracis و ال bacillus cereus بشكل مفصل في عند ال
+
+49
+00:03:31,340 --> 00:03:33,680
+growth requirement of ثيامين يعني هل الثيامين
+
+50
+00:03:33,680 --> 00:03:37,260
+مطلوب للنمو أو غير مطلوب للنمو بالنسبة ل bacillus
+
+51
+00:03:37,260 --> 00:03:41,180
+anthracis مطلوب بينما الأخرى غير مطلوب ال
+
+52
+00:03:41,180 --> 00:03:42,880
+hemolysis of blood agaric كلكم بتعرفوا أن ال
+
+53
+00:03:42,880 --> 00:03:46,120
+anthracis أو ال anthracis does not produce beta
+
+54
+00:03:46,120 --> 00:03:50,410
+hemolysisglutamine polypeptide capsule الوحيدة
+
+55
+00:03:50,410 --> 00:03:52,330
+اللي في الدنيا جنا اللي بنعرفها medically
+
+56
+00:03:52,330 --> 00:03:57,030
+important وإلها capsule مكوّنة من polypeptide هي
+
+57
+00:03:57,030 --> 00:04:00,510
+الbacillus anthracis lysis by gamma فإن احنا جنا
+
+58
+00:04:00,510 --> 00:04:04,790
+very specific testamine للbacillus anthracis ال
+
+59
+00:04:04,790 --> 00:04:07,310
+motility it is negative وذكرناها مرة ومتكررة جنا
+
+60
+00:04:07,310 --> 00:04:10,530
+هذه الصفة من الصفات الرئيسية في البكتيريا اللي
+
+61
+00:04:10,530 --> 00:04:14,230
+بتميزها عن الأخريات growth on chlorhydrate agar
+
+62
+00:04:14,230 --> 00:04:17,240
+نوع من الagar مضعف إلى chlorhydrateالبكتيريا
+
+63
+00:04:17,240 --> 00:04:20,160
+تبعتنا اللي هي ال anthracis does not grow بينما
+
+64
+00:04:20,160 --> 00:04:23,880
+البصيلة ال serious can grow، إذا فين دي مجموعة من
+
+65
+00:04:23,880 --> 00:04:27,440
+الصفات can be used to distinguish between Bacillus
+
+66
+00:04:27,440 --> 00:04:31,680
+anthracis and other بصيلة اللي من ضمنها البصيلة ال
+
+67
+00:04:31,680 --> 00:04:32,120
+serious
+
+68
+00:04:34,740 --> 00:04:37,900
+الجزء التاني من موضوعنا .. احنا حكينا في الجزء
+
+69
+00:04:37,900 --> 00:04:42,680
+الاول انه بنتكلم عن ال sport forming aerobic
+
+70
+00:04:42,680 --> 00:04:45,960
+bacteria اللي هم البصيلاس انتراسي و البصيلاس
+
+71
+00:04:45,960 --> 00:04:49,620
+سيرياس فالجزء التاني من محاضرتنا هتكلم عن ال
+
+72
+00:04:49,620 --> 00:04:56,050
+anaerobic sport forming ground positive bacilliوإن
+
+73
+00:04:56,050 --> 00:04:59,090
+رجعكوا لل diagram اللي شرحناها المرة الماضية لما
+
+74
+00:04:59,090 --> 00:05:02,030
+قلنا إنه ال ground positive bacilli could be
+
+75
+00:05:02,030 --> 00:05:04,770
+classified based on the presence of spore into
+
+76
+00:05:04,770 --> 00:05:08,130
+spore former and non spore former if spore former
+
+77
+00:05:08,130 --> 00:05:10,770
+if it is aerobic it is bacillus if it is anaerobic
+
+78
+00:05:10,770 --> 00:05:14,190
+it is clostridium species وبالتالي احنا هتكلم عن
+
+79
+00:05:14,190 --> 00:05:19,150
+هذا الجزء من البكتيريا اليوم إن شاء اللهتصنيف آخر
+
+80
+00:05:19,150 --> 00:05:22,470
+للبكتيريا بعيدا عن كلمة Spore Former لو جيبنا
+
+81
+00:05:22,470 --> 00:05:25,590
+العنوان الرئيسي يقولنا Grambustive Bacilli
+
+82
+00:05:25,590 --> 00:05:29,610
+Grambustive Bacilli based on their oxygen
+
+83
+00:05:29,610 --> 00:05:32,530
+requirement they are either classified into
+
+84
+00:05:32,530 --> 00:05:38,230
+anaerobes زي الأكلستردية والأكتينومايس أو aerobes
+
+85
+00:05:38,230 --> 00:05:41,350
+زي المجموعة اللي أمامكوا منها كورنباكتيريوم،
+
+86
+00:05:41,350 --> 00:05:46,490
+لستيريا، باسلس، جاردنريلا ونوكارديإذا في عندي
+
+87
+00:05:46,490 --> 00:05:52,890
+مجموعة من الأسماء ممكن تصنفها علينها هوائية أكتر
+
+88
+00:05:52,890 --> 00:05:56,730
+من تلك اللتي تصنف علينها لاهوائية، فقط ال
+
+89
+00:05:56,730 --> 00:05:59,070
+Clostridium Actinomyces
+
+90
+00:06:02,560 --> 00:06:04,700
+الان بنتكلم عن الكلستردية وعن ال general
+
+91
+00:06:04,700 --> 00:06:07,800
+characteristics تبعتها رقم واحد أنا aerobic gram
+
+92
+00:06:07,800 --> 00:06:11,440
+-boosted بس الله رقم اتنين they are spore-former
+
+93
+00:06:11,440 --> 00:06:14,180
+رقم تلاتة they are characterized او will
+
+94
+00:06:14,180 --> 00:06:16,440
+characterized by their ability to decompose
+
+95
+00:06:16,440 --> 00:06:19,780
+proteins decompose يعني to hydrolyze نعم to
+
+96
+00:06:19,780 --> 00:06:24,560
+hydrolyze they produce exotoxins يعني معظمها بتنتج
+
+97
+00:06:24,560 --> 00:06:28,080
+تكسين outside مش زي ال .. ال .. ال .. ال .. ال ..
+
+98
+00:06:28,080 --> 00:06:28,780
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+99
+00:06:28,780 --> 00:06:30,840
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+100
+00:06:30,840 --> 00:06:30,880
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+101
+00:06:30,880 --> 00:06:31,620
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+102
+00:06:31,620 --> 00:06:31,640
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+103
+00:06:31,640 --> 00:06:35,240
+الالـ natural habit التباعتها يا إما الـ soil يا
+
+104
+00:06:35,240 --> 00:06:38,660
+إما ال gastro intestinal tract of man and animal
+
+105
+00:06:38,660 --> 00:06:41,860
+يعني اللي can be found in stool أو can be found in
+
+106
+00:06:41,860 --> 00:06:45,880
+soil some motiles others none يبقى صفة ال motility
+
+107
+00:06:45,880 --> 00:06:51,220
+هنا بدنا نوظفها في التفريق ما بين ال .. ال .. ال
+
+108
+00:06:51,220 --> 00:06:54,420
+species تباعت ال glycerin دي are catalase negative
+
+109
+00:06:54,420 --> 00:06:59,420
+خدوا بالكم احنا استنفذنا استخدامات ال catalase
+
+110
+00:06:59,420 --> 00:07:04,200
+تمامااللي درستهم في المعمل العامل الفصل الماضي
+
+111
+00:07:04,200 --> 00:07:07,540
+استخدام الأول كان للتفريق بين الـ Staphylococci و
+
+112
+00:07:07,540 --> 00:07:11,220
+الـ Streptococci تفريق التاني كان بين الـ Beta
+
+113
+00:07:11,220 --> 00:07:14,640
+-Hemolytic Streptococci و الـ Stereomonocytogen و
+
+114
+00:07:14,640 --> 00:07:18,200
+التفريق التالت الآن بين البسلس which is positive و
+
+115
+00:07:18,200 --> 00:07:21,000
+بين الكلستردية اللي هي which is negative إذن الفحص
+
+116
+00:07:21,000 --> 00:07:25,400
+الكتاليزي البسيط هذا له تطبيقات رائعة جدا في حال
+
+117
+00:07:25,400 --> 00:07:30,710
+تفريق البكتيريا المتشابهة عن بعضها البعضالاسماء
+
+118
+00:07:30,710 --> 00:07:34,430
+اللى هدرسها او هتعامل معها كلستردium tetany او
+
+119
+00:07:34,430 --> 00:07:37,890
+تتناعى، كلستردium perifringens، كلستردium
+
+120
+00:07:37,890 --> 00:07:42,530
+botulonium، كلستردium septicum، كلستردium novi،
+
+121
+00:07:42,530 --> 00:07:50,820
+كلستردium difficile اللى قفزنا عنهاالان اللي انا
+
+122
+00:07:50,820 --> 00:07:54,420
+بدأ اركز عليهم في محاضراتنا اليوم والمرة القادمة
+
+123
+00:07:54,420 --> 00:07:57,880
+ان شاء الله اللي هم واحد اتنين تلاتة خمسة
+
+124
+00:07:57,880 --> 00:08:01,600
+Lyclostridium Difficile وحبدأ في difficile الآن
+
+125
+00:08:01,600 --> 00:08:07,460
+عشان أنهي من قصة البكتيريا هذه اللي بدأت تكتسب
+
+126
+00:08:07,460 --> 00:08:13,600
+أهمية خاصة برضه باستخدام ال antibiotics كيف تركزوا
+
+127
+00:08:13,600 --> 00:08:19,520
+معايا عشان بدنا نصل لفكرة كيفية إحداثها للمرضانسان
+
+128
+00:08:19,520 --> 00:08:27,880
+أصيب بالتهاب في الجروح عميق والتهاب حاد ببكتيريا
+
+129
+00:08:27,880 --> 00:08:32,380
+زي pseudomonas aeruginosa اعطي المريض antibiotic
+
+130
+00:08:32,380 --> 00:08:39,860
+لفترة تجاوزت العشرين يوم طبعا ال antibiotic اعطيه
+
+131
+00:08:39,860 --> 00:08:42,820
+وماعطوش أوامر يودوه على الجروح فقط يقتل البكتيريا
+
+132
+00:08:42,820 --> 00:08:46,800
+وين فيه بكتيريا بيلتقي فيها هو قادر على قتلها
+
+133
+00:08:46,800 --> 00:08:49,880
+بيقتلهامن ضمن هذه البكتيريا البكتيريا اللي هي
+
+134
+00:08:49,880 --> 00:08:52,260
+normal microbiota و هي موجودة في ال intestinal
+
+135
+00:08:52,260 --> 00:08:58,740
+tract هيقتل مجموعات فشي انتبايتك قادر على قتل كل
+
+136
+00:08:58,740 --> 00:09:03,080
+البكتيريا فهيقتل مجموعات فيعمل imbalance في ال
+
+137
+00:09:03,080 --> 00:09:06,200
+normal microbiota هيسمح للبكتيريا اللي اسمها
+
+138
+00:09:06,200 --> 00:09:10,260
+clostridium difficile وهي normal flora عند كثير من
+
+139
+00:09:10,260 --> 00:09:15,310
+الناس بينها تنمو وتتكاثرهي دنامت وتكاثرت ووصلت لـ
+
+140
+00:09:15,310 --> 00:09:17,910
+Quorum Sensing فاكرين مصطلح Quorum Sensing؟ اللي
+
+141
+00:09:17,910 --> 00:09:22,110
+هو العدد اللي بعده البكتيريا بتقرر تنتج ال
+
+142
+00:09:22,110 --> 00:09:26,770
+Virulence Factors سبعتها هتنتج تكسينات تكسين A و
+
+143
+00:09:26,770 --> 00:09:32,270
+تكسين B و تعمل disease known as Clostridium
+
+144
+00:09:32,270 --> 00:09:37,050
+Difficile Associated Diarrhea أو اسم تاني
+
+145
+00:09:37,050 --> 00:09:42,800
+Antibiotic Induced Pseudomebraneous Colitisلاحظوا
+
+146
+00:09:42,800 --> 00:09:47,340
+دياريا و pseudomembraneous colitis خدوا الجملة
+
+147
+00:09:47,340 --> 00:09:52,770
+الآناللي بتعبر عن جديش وصلنا أو وصلت أهمية هذه
+
+148
+00:09:52,770 --> 00:09:56,650
+البكتيريا في المستشفيات it is number one cause of
+
+149
+00:09:56,650 --> 00:09:59,990
+hospital acquired diarrhea number one cause of
+
+150
+00:09:59,990 --> 00:10:02,890
+hospital acquired diarrhea وعرفت انتوا الآن ليش هي
+
+151
+00:10:02,890 --> 00:10:05,710
+hospital acquired لإن في المستشفى بنعطي ال
+
+152
+00:10:05,710 --> 00:10:10,110
+antibiotic لفترات طويلة وبتالي قد نخلق مشكلة جديدة
+
+153
+00:10:10,110 --> 00:10:14,390
+اللي هي عن طريق ال ال ال ال normal microbiota
+
+154
+00:10:14,390 --> 00:10:18,250
+imbalance عدم اتزان في ال normal microbiotaطبعا
+
+155
+00:10:18,250 --> 00:10:21,030
+برضه بنعالجها ب antibiotics لما صير المشكلة
+
+156
+00:10:21,030 --> 00:10:25,450
+بنعالجها برضه ب antibiotic نرجع برجوع Clostridium
+
+157
+00:10:25,450 --> 00:10:31,370
+Tetani كنا بنسمع بالتتانوس هل هناك حالات تتانوس في
+
+158
+00:10:31,370 --> 00:10:36,410
+قطاع غز اسمته فيها يعني قريب صديق أهل معرفة لأ
+
+159
+00:10:36,410 --> 00:10:40,970
+سؤال هل سمعتم بأحد أصيب بالمرض هذا سؤال ليه مش من
+
+160
+00:10:40,970 --> 00:10:46,410
+وين بنصيب المرض عارفين ليش لأن صار فينا ثقافةتقافة
+
+161
+00:10:46,410 --> 00:10:52,050
+مجتمعية بإنه أي جرح عميق وخاصة من شيء ملوث من
+
+162
+00:10:52,050 --> 00:10:55,970
+التربة تمام بالإنه التربة زي المسامير وخلافه أن
+
+163
+00:10:55,970 --> 00:11:01,110
+يقوم الأهل بعرض المصاب على العيادة ومن ثم تطهير
+
+164
+00:11:01,110 --> 00:11:04,570
+الجرح ويعطاه إبرة تيتانوس أو اللي هي بيسميها إبرة
+
+165
+00:11:04,570 --> 00:11:09,310
+ضد تيتانوس واقع الأمر لكن تقافة مجتمعية كاملة سواء
+
+166
+00:11:09,310 --> 00:11:14,620
+صغير كبير متعلم غير متعلم عنده هذا التقافةوهذا خير
+
+167
+00:11:14,620 --> 00:11:18,040
+دليل على إن ال investment أو الاستثمار في ال
+
+168
+00:11:18,040 --> 00:11:22,360
+public awareness اللي هي زيادة وعي الجماهير هو أمر
+
+169
+00:11:22,360 --> 00:11:27,620
+مهم جدا للاقل أهمية عن تطوير القطاع الصحي أو
+
+170
+00:11:27,620 --> 00:11:32,600
+استحداث مصانع أدوية لأ الاستثمار في البشر هو أمر
+
+171
+00:11:32,600 --> 00:11:39,980
+جيد أيضا لمنع ال infection طيب مرض fatal قاتل
+
+172
+00:11:41,360 --> 00:11:44,220
+Clostridium Perifringens بتسبب مرض اسمه gas
+
+173
+00:11:44,220 --> 00:11:48,380
+gangrene الغرغرينة الغازية سمعتهم بفلان وصيب
+
+174
+00:11:48,380 --> 00:11:53,420
+بغرغرينة قطعت قطعت أصابر قدمه و بعدين قطعت قدمه و
+
+175
+00:11:53,420 --> 00:11:57,880
+بعدين بدأ .. دلنا نجازجلس فيه لما خلص بمعنى أن هذا
+
+176
+00:11:57,880 --> 00:12:06,320
+المرض يصعب علاجه يصعب علاجه بجيهم نعم بس هذا موضوع
+
+177
+00:12:06,320 --> 00:12:09,220
+مختلف ال .. ال .. هذا بيسموها diabetic food
+
+178
+00:12:09,220 --> 00:12:13,350
+diabetic foodأه نعم غير كليسترديوم بوتلونيوم
+
+179
+00:12:13,350 --> 00:12:18,450
+كليسترديوم بوتلونيوم بكتيريا بتنتج أقوى سم معروف
+
+180
+00:12:18,450 --> 00:12:21,190
+للإنسان على وجه الأرض واحد milligram من التكسين
+
+181
+00:12:21,190 --> 00:12:26,210
+كافي أو بيحمل في طياته عشرين مليون lethal dose
+
+182
+00:12:26,210 --> 00:12:31,930
+للميسس عشرين مليون lethal dose رقم مخيف فهذا أقوى
+
+183
+00:12:31,930 --> 00:12:37,710
+سم طبيعي معروف للإنسان على وجه الأرض طيب بكتيريا
+
+184
+00:12:40,320 --> 00:12:45,580
+لو جينا نعالجها بال antibiotic هتتحول ل .. ل .. ل
+
+185
+00:12:45,580 --> 00:12:50,500
+.. ل spores تماما ل spores وبالتالي مش هي .. يعني
+
+186
+00:12:50,500 --> 00:12:52,560
+مش هيتأثر فيها .. مش هيتأثر فيها ال antibiotic
+
+187
+00:12:52,560 --> 00:12:59,320
+العلاج غالبا .. غالبا بيفشل .. فشل ذريع في معظم
+
+188
+00:12:59,320 --> 00:13:04,320
+حالات ال spore former infectionsيعني حتى ال
+
+189
+00:13:04,320 --> 00:13:08,020
+bacillus anthracis اللي حكينا عنه بقولنا إنه fatal
+
+190
+00:13:08,020 --> 00:13:11,980
+صح ولا لأ لذلك ما هي الاستراتيجية العامة لمنظمة
+
+191
+00:13:11,980 --> 00:13:15,920
+الصحة العالمية ضد هذه الأمراض prevention كمان مرة
+
+192
+00:13:15,920 --> 00:13:20,240
+الاستراتيجية هي مش ال treatment بالأساس ال
+
+193
+00:13:20,240 --> 00:13:24,240
+prevention الوقاية
+
+194
+00:13:24,240 --> 00:13:29,220
+رقم واحد بعدين ممكن نتكلم عن مين عن ال treatment
+
+195
+00:13:30,520 --> 00:13:34,200
+لأنه في treatment لكن مش فعالة زي مين زي ال
+
+196
+00:13:34,200 --> 00:13:38,040
+prevention لكن لما أنت تطبق سياسة prevention هل
+
+197
+00:13:38,040 --> 00:13:42,080
+السياسة هذه غالبا بتكون absolute بمعنى أنه طبقنا
+
+198
+00:13:42,080 --> 00:13:46,700
+سياسة prevention معينة هل بتحمي كل البشر؟ ممكن
+
+199
+00:13:46,700 --> 00:13:50,240
+يفلت منها بعض الحالات، تبقى يصيروا مرضى فاحنا
+
+200
+00:13:50,240 --> 00:13:55,800
+مضطرين ندولة على مين؟ على اتريبملخص الحوار أو
+
+201
+00:13:55,800 --> 00:13:59,880
+الحديث اللي حكيناه الآن انه في ال sport former
+
+202
+00:13:59,880 --> 00:14:03,920
+بكتيريا تمام ال infection اللي فيها بنحاول قدر
+
+203
+00:14:03,920 --> 00:14:09,460
+الإمكان نمنع حدوثها و ليس نحاول علاجها لأن علاجها
+
+204
+00:14:09,460 --> 00:14:17,310
+بيحمل في طياته خدنا نقول نسبة فشل عالية جداأعتقد
+
+205
+00:14:17,310 --> 00:14:20,950
+أنه لو جونا تيتانوس والمسامير في غزة مرتبطين
+
+206
+00:14:20,950 --> 00:14:26,510
+بالأذهان بنفس المظبوط ان احنا الانسان أصيب بحادث
+
+207
+00:14:26,510 --> 00:14:30,790
+انه انغلص مصمار في قدمه على طول بيندى على العيادة
+
+208
+00:14:30,790 --> 00:14:35,230
+نعمله تطهير للجروح كمان مرة إبرة بانسالين زائد
+
+209
+00:14:35,230 --> 00:14:39,390
+اللي هو anti-tetanos autoxide to activate اللي هو
+
+210
+00:14:39,390 --> 00:14:41,150
+ال immune system تبع المرضى
+
+211
+00:14:44,420 --> 00:14:47,760
+المرض اسمه tetanus او luck jaw وبعض الأحيان بتلقوا
+
+212
+00:14:47,760 --> 00:14:51,560
+عليه fixed smile الإبتسامة الثابتة لذا لا تظن أن
+
+213
+00:14:51,560 --> 00:14:55,380
+من يبتسم في وجهك هو سعيد برؤياك اللي ربما يكون
+
+214
+00:14:55,380 --> 00:15:00,740
+مصاب بالتتانوس وسموه luck jaw أو بالعربي الكزاز
+
+215
+00:15:00,740 --> 00:15:05,040
+لأن الأسنان بتكون مطبقة على بعضها يصعب فتح الفكين
+
+216
+00:15:05,040 --> 00:15:11,360
+لأنه بيصير فيه paralysis في عضلات الفكمن مزايا هذا
+
+217
+00:15:11,360 --> 00:15:15,360
+ال disease انه localized infection بمعنى على الرغم
+
+218
+00:15:15,360 --> 00:15:19,860
+من ان ال symptoms تبعته systematic بتأثر على كل
+
+219
+00:15:19,860 --> 00:15:23,500
+الجسم الا ان مكان ال infection هو مكان دخول
+
+220
+00:15:23,500 --> 00:15:27,240
+الميكروب يعني دخلت في القدم اتنين صنط عمق بتظل
+
+221
+00:15:27,240 --> 00:15:31,380
+هناك البكتيريا مابتنتشرش مابتروحش تعمل سبتسيميا
+
+222
+00:15:31,380 --> 00:15:36,120
+وبتعمل meningitis زي مثلا نيسيريا meningitis اذا
+
+223
+00:15:36,120 --> 00:15:42,590
+مسميها localized infectionكيف الاسم كله بتأثر؟
+
+224
+00:15:42,590 --> 00:15:47,250
+التكسين اللي بتنتجه بيروح عبر الدم و بيصل للمناطق
+
+225
+00:15:47,250 --> 00:15:52,510
+المختلفة و بيأثر على الأعصاب، إذن ك infection إيش
+
+226
+00:15:52,510 --> 00:15:57,410
+بنسميها؟ localized مش systemic infection The
+
+227
+00:15:57,410 --> 00:15:59,990
+disease is transmitted to man through infected
+
+228
+00:15:59,990 --> 00:16:04,640
+woundsزي ما حكينا بينتقل عن طريق الجروح الملوثة و
+
+229
+00:16:04,640 --> 00:16:09,060
+غالباً كنا ملوثة بمصدرين، احنا كنا مصادر .. مصادر
+
+230
+00:16:09,060 --> 00:16:12,240
+الأساسية لل .. لل .. ال studio من وين؟ من التربة و
+
+231
+00:16:12,240 --> 00:16:15,200
+ال stool، صح هذا لأ؟ فأي مصدر .. أي من المصدرين قد
+
+232
+00:16:15,200 --> 00:16:20,410
+يحمل مخاطرSpores enter into wounds within or with
+
+233
+00:16:20,410 --> 00:16:23,610
+soil or material contaminated with soil زي ما
+
+234
+00:16:23,610 --> 00:16:27,670
+حكينا الجروح أو البكتيرا تدخل أو ال Spores بتاعة
+
+235
+00:16:27,670 --> 00:16:32,970
+البكتيرا تدخل مع المواد الملوثة بالتربة The
+
+236
+00:16:32,970 --> 00:16:36,670
+infection is localized in the area of entry Growth
+
+237
+00:16:36,670 --> 00:16:39,550
+of the toxin هذه نقطة كتير مهمة بتكلم فيها Growth
+
+238
+00:16:39,550 --> 00:16:42,690
+and toxin production is aided by the following نمو
+
+239
+00:16:42,690 --> 00:16:47,360
+البكتيرا اللاهوائية هي بكتيرا لاهوائيةما الذي يجعل
+
+240
+00:16:47,360 --> 00:16:51,160
+البكتيريا لا هوائية تنمو في مكان ممكن يكون فيه
+
+241
+00:16:51,160 --> 00:16:56,380
+Oxygen تلعبوا احنا لما قولنا المصمار او الجروح
+
+242
+00:16:56,380 --> 00:17:01,920
+تمام ايش الجروح عبارة عن cut قطق قطق يعني
+
+243
+00:17:01,920 --> 00:17:06,980
+destruction destruction للخلايا في خلايا هتموتيبقى
+
+244
+00:17:06,980 --> 00:17:11,460
+الـ necrotic tissue اللي موجود هذا هيوفر أول حاجة
+
+245
+00:17:11,460 --> 00:17:15,740
+بيئة غذائية ملائمة للبكتيريا لل spores to
+
+246
+00:17:15,740 --> 00:17:20,600
+germinate يعني للبذرة عشان تنبت تمام؟ calcium
+
+247
+00:17:20,600 --> 00:17:23,860
+salts مهم جدا في عملية ال germination calcium
+
+248
+00:17:23,860 --> 00:17:27,720
+salts من جاية برضه من ال necrotic tissue رقم تلاتة
+
+249
+00:17:27,720 --> 00:17:31,240
+وهي الأهم على الإطلاق انه يكون مع البكتيريا
+
+250
+00:17:31,240 --> 00:17:36,100
+بكتيريا تانيةأنا عند Staphylococcus aureus على
+
+251
+00:17:36,100 --> 00:17:38,620
+سبيل المثال، Staphylococcus aureus، إيش ريش يا
+
+252
+00:17:38,620 --> 00:17:42,300
+كولاي؟ هدول مش بنوصفهم من ناحية حالتهم للإكسجين
+
+253
+00:17:42,300 --> 00:17:47,520
+facultative أنا يارب، أنا ياربالان لما البكتيريا
+
+254
+00:17:47,520 --> 00:17:51,340
+تنمو هذه مش بتاخد الأكسجين من ال environment بتوفر
+
+255
+00:17:51,340 --> 00:17:54,400
+ظروف لمين، ده البكتيريا الأخرى بتوفرها ظروف لا
+
+256
+00:17:54,400 --> 00:17:58,880
+هوائية، فالبكتيريا الهوائية تستهلك الهواء لصالح
+
+257
+00:17:58,880 --> 00:18:03,460
+مين؟ بكلسترديوم تيتاني، وصل الصورة إذا لو كان في
+
+258
+00:18:03,460 --> 00:18:08,320
+عندي تلت أشياء و هم موجودينمستحيل تجد الـ spores
+
+259
+00:18:08,320 --> 00:18:11,240
+تبعت البكتيريا في environment مافيش فيها بكتيريا
+
+260
+00:18:11,240 --> 00:18:14,940
+أخرى تربة، بتتكلم عن تربة ملايين الأنواع من
+
+261
+00:18:14,940 --> 00:18:17,520
+البكتيريا بتكون موجودة في التربة فأكيد لازم يدخل
+
+262
+00:18:17,520 --> 00:18:23,140
+مايكروبات أخرى غير الـ Clostridium Titanium
+
+263
+00:18:23,140 --> 00:18:28,540
+التيتانوس بزمين هو التوكسين اللي بينتجه البكتيريا
+
+264
+00:18:28,540 --> 00:18:32,040
+هو عبارة عن heat labile toxin بتفيدنا بحاجة
+
+265
+00:18:32,040 --> 00:18:37,670
+للمعلومة هذه؟ heat labile toxinطيب هو ال toxin وين
+
+266
+00:18:37,670 --> 00:18:42,270
+موجود؟معلش هو وين موجود الآن لما ال bacteria تكون
+
+267
+00:18:42,270 --> 00:18:46,950
+موجودة جوا يعني انا مش هنسخن الجسم لمين ل 65 درجة
+
+268
+00:18:46,950 --> 00:18:50,890
+مئاوية لكن هذه معلومة بنوضح فيها ان ال toxin
+
+269
+00:18:50,890 --> 00:18:55,090
+معمليا هو heat لا bite لكن clinically مافيش منها
+
+270
+00:18:55,090 --> 00:18:58,630
+فائدة البعض .. البعض قد يظن بتعرفوا عندنا في
+
+271
+00:18:58,630 --> 00:19:01,810
+practice في قطاع غزة ان اللي بينصاب بمصمار بيروح
+
+272
+00:19:01,810 --> 00:19:06,130
+جيب قطعة حاجة مولعة او سجارة تمام و بيحطها على
+
+273
+00:19:06,130 --> 00:19:11,630
+مكان الجروح هذا ال practice أسوأ ما يكونأسوأ ما
+
+274
+00:19:11,630 --> 00:19:15,290
+يكونه بيساعد في تكوين الظروف الهوائية للبكتيريا،
+
+275
+00:19:15,290 --> 00:19:18,670
+ليش؟ اتخيلوا مع بعض .. لا اتخيلوا مع بعض احنا
+
+276
+00:19:18,670 --> 00:19:24,590
+الولاعة وولعناها وحطنا ايدنا فوق بيد الشكل الاحساس
+
+277
+00:19:24,590 --> 00:19:29,910
+بالحرارة، تمام؟ بتتم بعد ما تنهرج ايدنا ولا جبل؟
+
+278
+00:19:29,910 --> 00:19:34,830
+جبل، هو جبل متنهرج ايدنا بنشيل، متحملش بنشيل،
+
+279
+00:19:34,830 --> 00:19:39,800
+نهايات الأعصاب وين موجودة؟ في الجلدالان لما بنقرر
+
+280
+00:19:39,800 --> 00:19:43,420
+بشيء احنا البكتيريا على بعد 2 صنطة على سبيل المثال
+
+281
+00:19:43,420 --> 00:19:48,580
+وهي sport former و resistant لمن؟ للحرارة احنا
+
+282
+00:19:48,580 --> 00:19:52,340
+مابنتحملش حرارة جدا هي بتتحمل حرارة احنا اللي
+
+283
+00:19:52,340 --> 00:19:55,820
+بنعمله بنسكر الجروح نقتل الخلايا اللي موجودة هنا
+
+284
+00:19:55,820 --> 00:19:59,800
+بالحرارة و بنسكر الجروح بنوفر ظروف لهوائي اذا هذا
+
+285
+00:19:59,800 --> 00:20:04,120
+ال practice اللي موجود practice سيء و قد يساعد في
+
+286
+00:20:04,120 --> 00:20:08,910
+توفير ظروف لهوائيالتوكسين يمكن أن يصل إلى نظام
+
+287
+00:20:08,910 --> 00:20:11,800
+الحرارةit blocks the release of inhibitory
+
+288
+00:20:11,800 --> 00:20:12,920
+mediators of the motor neurons اعتقد هذا التوكسين
+
+289
+00:20:12,920 --> 00:20:15,240
+أخدنا للميكانيزم باكشن it blocks the release of
+
+290
+00:20:15,240 --> 00:20:18,240
+inhibitory mediators of the motor neurons احنا
+
+291
+00:20:18,240 --> 00:20:21,940
+قلنا ان في عندنا acetylcholine هو اللي بينقل
+
+292
+00:20:21,940 --> 00:20:25,820
+الإشارة العصبية ال acetylcholine بيعمل الانقباض
+
+293
+00:20:25,820 --> 00:20:31,520
+طبعا الان المفروض ان يصير فيه glycine ال glycine
+
+294
+00:20:31,520 --> 00:20:34,520
+يعمل inhibition ل ال acetylcholine عشان يصير فيه
+
+295
+00:20:34,520 --> 00:20:39,020
+أنها relaxationهذا بيمنع ال glycine من انه ينتج
+
+296
+00:20:39,020 --> 00:20:42,760
+وبالتالي عشان في عندي دايما انقباض دائم الانقباض
+
+297
+00:20:42,760 --> 00:20:47,040
+الدائم هو اللي بنعني فيه ال asbestic paralysis ال
+
+298
+00:20:47,040 --> 00:20:52,150
+asbestic paralysis خدوا بالكمقد يصاب البريض بنوبات
+
+299
+00:20:52,150 --> 00:20:58,410
+.. بنوبات من ال violent spasm يعني تشنجات عنيفة قد
+
+300
+00:20:58,410 --> 00:21:03,070
+تؤدي إلى كسر العمود الفقري تبعه لأن غالبا التشنجات
+
+301
+00:21:03,070 --> 00:21:07,390
+بتتم إلى الخلف تمام فبتكون عنيفة لدرجة انه ممكن
+
+302
+00:21:07,390 --> 00:21:11,290
+ينكسر بين مين العمود الفقري ويصاب بشلل دائم الماء
+
+303
+00:21:12,240 --> 00:21:16,460
+فالمرضي خطر جدا، ده يطلع هنا، this اللي هو الـ
+
+304
+00:21:16,460 --> 00:21:18,820
+mechanism of the toxin، this result in extreme
+
+305
+00:21:18,820 --> 00:21:23,560
+hyperreflexia، hyperreflexia الاستجابة، ال reflex
+
+306
+00:21:23,560 --> 00:21:27,160
+بيكون بزيادة، تمام؟ يعني لو الواحد بده يتحرك، بده
+
+307
+00:21:27,160 --> 00:21:30,560
+يحرك شيء على أنفه، بيعمل زي هيك و بيحركه، صح ولا
+
+308
+00:21:30,560 --> 00:21:36,040
+لأ؟ لكن لو واحد عنده تيتا نصهيكون الأمر عملية صعبة
+
+309
+00:21:36,040 --> 00:21:39,400
+معقدة بيسموها hyper reflexia and violent spasm of
+
+310
+00:21:39,400 --> 00:21:42,940
+skeletal muscles in response to any stimuli the
+
+311
+00:21:42,940 --> 00:21:46,500
+toxin is inactivated by the proteic enzyme of the
+
+312
+00:21:46,500 --> 00:21:49,760
+digestive system يعني لو انت تتناولت ال toxin كطعم
+
+313
+00:21:49,760 --> 00:21:54,960
+تمام ما بيأثر عليك ال toxin لو أخدته انت عبر الأكل
+
+314
+00:21:54,960 --> 00:21:58,780
+ما عندك مشكلة فيه ليش؟ لأنه بيصيرله inactivation
+
+315
+00:21:58,780 --> 00:22:01,840
+inactivation بال proteotic enzyme اللي موجودة في
+
+316
+00:22:01,840 --> 00:22:05,810
+المعدة لكن لو أخدناه عبر الدمفش ال .. فش ال .. فش
+
+317
+00:22:05,810 --> 00:22:08,630
+ال proteolytic بتخش المايدة لو أخدناها من المصمار
+
+318
+00:22:08,630 --> 00:22:12,570
+من مكان الإصابة بتخش المايدة وبتالي النشاط تبعه
+
+319
+00:22:12,570 --> 00:22:17,430
+بعيد عن المايد طالع ال .. ال .. ال .. ال toxicity
+
+320
+00:22:17,430 --> 00:22:21,150
+برضه عالية one milligram من ال pure toxin has six
+
+321
+00:22:21,150 --> 00:22:25,490
+million lethal mice doses برضه رقم مهول شباب يعني
+
+322
+00:22:25,490 --> 00:22:27,510
+ال toxicity بتبعته عالية جدا
+
+323
+00:22:31,110 --> 00:22:35,390
+طبعا هذه ممكن صور بتوضحلنا اللي هو ال .. ال .. طرق
+
+324
+00:22:35,390 --> 00:22:42,210
+الإصابة، هذه عضة تمام، هناك عضة، هذه ممكن من .. من
+
+325
+00:22:42,210 --> 00:22:45,330
+مصمار، هذه ال .. حتى القطط، عضة ال .. عضة .. عضة
+
+326
+00:22:45,330 --> 00:22:49,190
+القطة قد تؤدي إلى اللي هو الإصابة بال tetanus
+
+327
+00:22:56,540 --> 00:23:02,540
+بعد انتشار من تلاتة الى واحد عشرين يوم في معظم
+
+328
+00:23:02,540 --> 00:23:07,300
+الحالات في فترة اربعة اشهر يوم مع عاملية ات دايز
+
+329
+00:23:07,300 --> 00:23:12,840
+يعني ال range الواسع من تلاتة الى واحد عشرين في
+
+330
+00:23:12,840 --> 00:23:15,420
+عاملية ات دايز خلال اربعة اشهر يوم يعني اربعة اشهر
+
+331
+00:23:15,420 --> 00:23:22,090
+يوم مقبل العاملية غالبا تمان أيامThe farther ..
+
+332
+00:23:22,090 --> 00:23:24,890
+هذه نقطة كتير مهمة The farther the injury site is
+
+333
+00:23:24,890 --> 00:23:26,850
+from the central nervous system, the longer the
+
+334
+00:23:26,850 --> 00:23:31,110
+incubation period كلما ابتعد الجروح عن الجهاز
+
+335
+00:23:31,110 --> 00:23:35,550
+العصب المركزي كلما زادت اللي هو فترة ال incubation
+
+336
+00:23:35,550 --> 00:23:41,300
+periodthe shorter the incubation period the higher
+
+337
+00:23:41,300 --> 00:23:45,920
+the risk of death كلما قصرت فترة ال incubation
+
+338
+00:23:45,920 --> 00:23:52,160
+period زادت امكانية الوفاة احكي لكوا نقطة مهمة جدا
+
+339
+00:23:52,160 --> 00:23:57,620
+جدا جدا ميم تتوقع يتوفر في غروف لها أو ايها؟ جروح
+
+340
+00:23:57,620 --> 00:24:02,340
+عميق ولا جروح سطحية؟كلما ازداد العمق كلما ازداد
+
+341
+00:24:02,340 --> 00:24:06,540
+امكانية ان تتوفر في ظروف لاهوية احد الأطباء لاحظ
+
+342
+00:24:06,540 --> 00:24:11,260
+ملاحظة قيمة صحيح لازم نناقشها معاكم ك concept عشان
+
+343
+00:24:11,260 --> 00:24:15,320
+تعرفوا ان بعض الأحيان في بصير تحول في الأفكار
+
+344
+00:24:15,320 --> 00:24:20,680
+نتيجة تدخلاتنا احنا تدخلاتنا احنا البشر احنا
+
+345
+00:24:20,680 --> 00:24:26,660
+متفقين على انه الجروح العميقة من زمان هي الأخطر
+
+346
+00:24:26,660 --> 00:24:30,830
+بالنسبة لتكوين ال tetanusفصار فيه اهتمام بالجروح
+
+347
+00:24:30,830 --> 00:24:36,280
+العميقةوبالتالي قلت نسبة حدوث التيتانوس من الجروح
+
+348
+00:24:36,280 --> 00:24:40,380
+العميقة ركزنا على الجروح العميقة ولا نركز على مين؟
+
+349
+00:24:40,380 --> 00:24:44,780
+على الجروح السطحية فإحصائيا أصبحنا نعاني من حالات
+
+350
+00:24:44,780 --> 00:24:50,100
+تيتانوس ناتجة عن جروح سطحية أكتر مما نعاني من جروح
+
+351
+00:24:50,100 --> 00:24:52,980
+عميقة أوصل الصورة طبعا هذا السبب ليش اللي خلاه
+
+352
+00:24:52,980 --> 00:24:57,620
+يتغير دخلنا احنا و أصبحنا نهتم نعم مش اتكيفت هو
+
+353
+00:24:57,620 --> 00:25:03,600
+يعني احنا كده كمرة بنقول the chanceof forming
+
+354
+00:25:03,600 --> 00:25:07,580
+anaerobic conditions أعلى لما تكون الجروح أعمق
+
+355
+00:25:07,580 --> 00:25:10,800
+أعلى مش أنه مافيش chance خالص لما تكون سطحية فيه
+
+356
+00:25:10,800 --> 00:25:14,120
+chance لكن ركزنا على الجروح العميقة وماركزنا على
+
+357
+00:25:14,120 --> 00:25:19,900
+الجروح السطحية طبعا هذه أحد ال .. ال .. ال ..
+
+358
+00:25:19,900 --> 00:25:23,780
+النوبات إذا بتلاحظوا فيه الرأس جاعد أو الرقبة
+
+359
+00:25:23,780 --> 00:25:27,620
+بتتحرك إلى اللي هو الخلف طبعا هنا في عندي fixed
+
+360
+00:25:27,620 --> 00:25:31,580
+jaw في luck jaw في المنطقة في الست هذا المصابة
+
+361
+00:25:35,000 --> 00:25:38,320
+أحد الأمراض اللي كانت منتشرة زمان اللي هي ال
+
+362
+00:25:38,320 --> 00:25:41,980
+neonatal .. neonatal tetanus فهي كتير مهمة الصورة
+
+363
+00:25:41,980 --> 00:25:45,400
+اللي أمامكوا بتوضحلنا من وين بيجي ال neonatal
+
+364
+00:25:45,400 --> 00:25:51,090
+tetanusالان الحبل السري بتم قطع عند الولادة تمام
+
+365
+00:25:51,090 --> 00:25:56,110
+فتخيلوا الأداء المستخدمة المجص أو الشفرة أو الحجر
+
+366
+00:25:56,110 --> 00:25:59,330
+زمان كانوا يستخدموا حجر ماضي عشان يحس انه يعني في
+
+367
+00:25:59,330 --> 00:26:03,010
+ال .. لحد الآن في بولدان الولادة بتتم فيها
+
+368
+00:26:03,010 --> 00:26:07,310
+بالطريقة اللي منذ الخليقة تمام يعني بدأية خالص
+
+369
+00:26:07,310 --> 00:26:12,690
+بدأية خالص في بيولدوا تحت المي كويس؟ مجتمعات ففي
+
+370
+00:26:12,690 --> 00:26:17,350
+عندنا أنواع كثيرة من الولادة في المستشفياتتخيلوا
+
+371
+00:26:17,350 --> 00:26:22,770
+انه كيف ممكن تتلوث الأشياء احنا لما بنروح على
+
+372
+00:26:22,770 --> 00:26:30,250
+المستشفى بنروح طيران سباحة ولا بنروح ماشي بالسيارة
+
+373
+00:26:30,250 --> 00:26:34,930
+لكن في الآخر بننزل ورجلينا يعني اللي بياخدوا تراب
+
+374
+00:26:34,930 --> 00:26:39,410
+من الشارع تمام سواء كان الشارع نظيف خالص ولا طريق
+
+375
+00:26:39,410 --> 00:26:43,230
+ترابي بناخد بضأ من الأتربة على أحديتنا و بنروح
+
+376
+00:26:43,230 --> 00:26:47,490
+فيها على المستشفىهذا التراب مش هو مصدر للميكروبات
+
+377
+00:26:47,490 --> 00:26:49,950
+ومن ضمن الميكروبات هذه ال sport forming اللي من
+
+378
+00:26:49,950 --> 00:26:55,130
+ضمنها ال glycerin تتانى نعم ندخل المستشفى الغبار
+
+379
+00:26:55,130 --> 00:26:59,030
+هذا بدلوش مطرحه بفعد الحركة ممكن يتحرك وينتقل
+
+380
+00:26:59,030 --> 00:27:03,270
+الأشياء ويلوثها من ضمن الأشياء اللي هي المجسات أو
+
+381
+00:27:03,270 --> 00:27:06,570
+الشفرات اللي بنستخدمها اللي هي ممكن تكون non
+
+382
+00:27:06,570 --> 00:27:12,030
+-sterile في هذا الحالة ايش عمله؟عشان يمنعوا هذا
+
+383
+00:27:12,030 --> 00:27:16,890
+الموضوع عملوا غرفة transient اذا انت جاي من برا
+
+384
+00:27:16,890 --> 00:27:19,930
+كطبيب او nurse او اي واحد بدو يدخل هذا المكان تمام
+
+385
+00:27:19,930 --> 00:27:24,510
+ممنوع يدخل بحذائه بيلبسوا حذاء عمره ما شايف الشارع
+
+386
+00:27:25,460 --> 00:27:29,460
+بيخلع حذاءه بيحطه و بنتقل للجهة التانية بياخد حذاء
+
+387
+00:27:29,460 --> 00:27:32,760
+موجود من المستشفى و بيدخل فيه طبعا اليوم في أحذية
+
+388
+00:27:32,760 --> 00:27:37,600
+disposable بيلبسها زي الغطى للرأس بيلبس برضه غطى
+
+389
+00:27:37,600 --> 00:27:41,660
+على الحذاء و بيدخل فيها هذه العملية طبعا مع تحسين
+
+390
+00:27:41,660 --> 00:27:46,280
+عملية ال sterilization و استخدام disposables لمرة
+
+391
+00:27:46,280 --> 00:27:50,870
+واحدةقلّت من الـ tetanus تبع الحديث الولادة إلى
+
+392
+00:27:50,870 --> 00:27:53,350
+نسبة الصفر عندنا في الفلسطين لا يوجد عندنا لا
+
+393
+00:27:53,350 --> 00:27:57,030
+tetanus neonatal ولا tetanus اللي هو ال adults
+
+394
+00:27:57,030 --> 00:28:02,710
+اللي احنا بنعرفه هذه حالة tetanus يعني مخيفة جدا
+
+395
+00:28:02,710 --> 00:28:07,530
+برضه violent spasm و لاحظوا حتى الطفل برضه عمل حرف
+
+396
+00:28:07,530 --> 00:28:13,150
+C في الانقباضات تبعتهit is completely rigid يعني
+
+397
+00:28:13,150 --> 00:28:16,770
+الطفل كله متصلب ليش لأنه لسه عنده asbestic
+
+398
+00:28:16,770 --> 00:28:20,750
+paralysis أيوة
+
+399
+00:28:20,750 --> 00:28:24,950
+نفس الشيء he cannot breast feed or open his mouth
+
+400
+00:28:24,950 --> 00:28:28,410
+because his the muscle in his face have become so
+
+401
+00:28:28,410 --> 00:28:32,190
+tight خلاص لا بيقدر يرضع ولا بيقدر يحرك فطبعا
+
+402
+00:28:32,190 --> 00:28:35,270
+بيدخلوله tube من وين من الانت عشان يعملوله feeding
+
+403
+00:28:35,270 --> 00:28:36,490
+في هذه الحالة
+
+404
+00:28:38,900 --> 00:28:41,420
+morphology للبكتيريا it is ground boosted
+
+405
+00:28:41,420 --> 00:28:44,680
+anaerobic بكتيريا موطعي with peritricous flagella
+
+406
+00:28:44,680 --> 00:28:48,720
+هذه نقطة كتير مهمة موطعي with peritricous flagella
+
+407
+00:28:48,720 --> 00:28:52,820
+terminal rounded spore وهذه أيضا نقطة مهمة إذا هذه
+
+408
+00:28:52,820 --> 00:28:58,260
+الصفتين اتنين و تلاتة بنعتبرهم hallmark البكتيريا
+
+409
+00:28:58,970 --> 00:29:03,290
+large بس ال lie وعلى الطرف تبعها ال sport لذلك
+
+410
+00:29:03,290 --> 00:29:07,030
+بيسموها drum stick appearance زي عصات الطبل زي
+
+411
+00:29:07,030 --> 00:29:12,430
+عصات الطبل drum stick appearance بالاضافة لذلك ان
+
+412
+00:29:12,430 --> 00:29:15,190
+هي .. لو .. لو اعملنا الفلاجل الارستاني هي ايش?
+
+413
+00:29:15,650 --> 00:29:17,410
+Piri, Trikas, Flagelle
+
+414
+00:29:22,540 --> 00:29:24,980
+كلمة drumstick هي موجودة هنا نشيرها بس مش واضحة
+
+415
+00:29:24,980 --> 00:29:29,200
+باللون تبع ال powerpoint media of choice any
+
+416
+00:29:29,200 --> 00:29:32,020
+medium with thioglycolate under anaerobic
+
+417
+00:29:32,020 --> 00:29:36,120
+condition يعني أي وسط بيحتوي على thioglycolate تحت
+
+418
+00:29:36,120 --> 00:29:40,400
+ظروف الهوائية قد يكون مناسب من أسهل الأوساط و
+
+419
+00:29:40,400 --> 00:29:45,200
+أشهرها حاجة اسمها cooked meat media يعني اللحم
+
+420
+00:29:45,200 --> 00:29:48,760
+المطبوخ وسط اللحم المطبوخ زي ما قلتلكوا بتفضل هي
+
+421
+00:29:48,760 --> 00:29:51,810
+اللي هيال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+422
+00:29:51,810 --> 00:29:52,030
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+423
+00:29:52,030 --> 00:29:53,630
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+424
+00:29:53,630 --> 00:29:53,690
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+425
+00:29:53,690 --> 00:29:53,710
+ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال ال
+
+426
+00:29:53,710 --> 00:30:03,690
+ال الت فضل
+
+427
+00:30:05,400 --> 00:30:09,200
+هذا شكل الصورة تقريبا ال sports هنا مصبوغة إذا
+
+428
+00:30:09,200 --> 00:30:13,620
+بتلاحظوا باللون المغير طبعا هو المفروض أنه يكون
+
+429
+00:30:13,620 --> 00:30:16,580
+أخضر بس هنا مصبوغة باللون الأزرق ماعرفش ليش الصورة
+
+430
+00:30:16,580 --> 00:30:18,460
+نفسها ماكان ميكونش واضحة بس المفروض أنه يكون لون
+
+431
+00:30:18,460 --> 00:30:22,760
+أخضر نفس الشيء هذه الصورة هذه gram stain لاحظوا
+
+432
+00:30:22,760 --> 00:30:26,080
+المنطقة الفارغة هنا هي ال sport لأنه لما تصبح بال
+
+433
+00:30:26,080 --> 00:30:31,320
+gram stain بينما العصا نفسها صبيقة هذه برضه .. هذه
+
+434
+00:30:31,320 --> 00:30:36,010
+كتير رائعة هذه الصورة .. شايفين هذه؟شايفينها؟ بس
+
+435
+00:30:36,010 --> 00:30:39,430
+الـLye و الـSpores تبقى تبقى برضه Gram، Stain و مش
+
+436
+00:30:39,430 --> 00:30:43,090
+مصبوغة لـSpores عشانك بتبين هالو Structure، هالو
+
+437
+00:30:43,090 --> 00:30:48,370
+Structure تلخيص للـPathogenesis of Tetanus it
+
+438
+00:30:48,370 --> 00:30:51,470
+occurs in traumatic open wounds contaminated with
+
+439
+00:30:51,470 --> 00:30:58,690
+soil إذن أكتر الحالات حدوثة ناتجة عن Trauma، جروح،
+
+440
+00:30:58,690 --> 00:31:02,250
+accident تمام؟ يعني انتوا عارفين إن واحد مثلا وجعل
+
+441
+00:31:02,250 --> 00:31:02,850
+Motorcycle
+
+442
+00:31:07,670 --> 00:31:08,710
+بتجرح، بتلوث الجرحه بتلوث الجرحه بتلوث الجرحه
+
+443
+00:31:08,710 --> 00:31:09,490
+بتلوث الجرحه بتلوث الجرحه بتلوث الجرحه بتلوث
+
+444
+00:31:09,490 --> 00:31:09,510
+الجرحه بتلوث الجرحه بتلوث الجرحه بتلوث الجرحه
+
+445
+00:31:09,510 --> 00:31:09,550
+بتلوث الجرحه بتلوث الجرحه بتلوث الجرحه بتلوث
+
+446
+00:31:09,550 --> 00:31:09,650
+الجرحه بتلوث الجرحه بتلوث الجرحه بتلوث الجرحه
+
+447
+00:31:09,650 --> 00:31:09,770
+بتلوث الجرحه بتلوث الجرحه بتلوث الجرحه بتلوث
+
+448
+00:31:09,770 --> 00:31:09,790
+الجرحه بتلوث الجرحه بتلوث الجرحه بتلوث الجرحه
+
+449
+00:31:09,790 --> 00:31:16,370
+بتلوث الجرحه بتلوث الجرحه
+
+450
+00:31:16,370 --> 00:31:22,510
+بتلوث الجرحه بتلretrograde كلمة retrograde يعني
+
+451
+00:31:22,510 --> 00:31:27,030
+بطريقة عكسية للإشارة العصبية to spinal cord binds
+
+452
+00:31:27,030 --> 00:31:30,490
+to gangliocyte receptors of anterior horn cells
+
+453
+00:31:30,490 --> 00:31:33,930
+بعدين بيعمل inhibition لل release of inhibitory
+
+454
+00:31:33,930 --> 00:31:36,450
+mediators اللي هو ال glycine اللي حكينا عنه اللي
+
+455
+00:31:36,450 --> 00:31:41,230
+بيعمل inhibition لمين للacetylcholine continuous
+
+456
+00:31:41,230 --> 00:31:46,350
+excitement يعني في عندي إيثارة مستمرة ل motor
+
+457
+00:31:46,350 --> 00:31:52,780
+neuron وسينادي اللي هو muscle spasmالorganism does
+
+458
+00:31:52,780 --> 00:31:56,740
+not spread، it is localized، no tissue damage،
+
+459
+00:31:56,740 --> 00:32:00,180
+بيعملش destruction للنسيج، النسيج اللي كان بالأول
+
+460
+00:32:00,180 --> 00:32:04,640
+destroyed كان نادى عن الجروح نفسه، no invasion of
+
+461
+00:32:04,640 --> 00:32:09,120
+adjacent tissue، مافيش أنها غزو، هي بالفعل ينطبق
+
+462
+00:32:09,120 --> 00:32:14,620
+عليها localized أو local infectionTreatment زي ما
+
+463
+00:32:14,620 --> 00:32:16,840
+ذكرنا ان هذا ال disease is a life-threatening
+
+464
+00:32:16,840 --> 00:32:23,420
+disease و treatment consist of two steps واحد ال
+
+465
+00:32:23,420 --> 00:32:26,620
+patient is given antibiotics to kill the bacteria
+
+466
+00:32:26,620 --> 00:32:30,380
+و هذا ال antibiotic اما بيكون metronidazole اللي
+
+467
+00:32:30,380 --> 00:32:34,700
+هو معروف عنه باسم فلاجيل والذي يستخدم ضد ال
+
+468
+00:32:34,700 --> 00:32:39,460
+protozoa اللي درسوها مع الدكتور عدنان ال protozoa
+
+469
+00:32:40,970 --> 00:32:44,510
+أو الانيروبيك بكتيريا يعني هذا بيستخدم فقط
+
+470
+00:32:44,510 --> 00:32:48,570
+البروتزوة والانيروبيك بكتيريا أو ال بنسل هذا الجزء
+
+471
+00:32:48,570 --> 00:32:52,630
+الأول شوف الجزء التاني الصعب injection of
+
+472
+00:32:52,630 --> 00:32:57,530
+antitoxin are also given الان الانتوتكسين يا شباب
+
+473
+00:32:57,530 --> 00:33:04,150
+من وين بيجيبوها من ناس انصابوا بتتانوس وأولجوا
+
+474
+00:33:04,150 --> 00:33:10,230
+بياخدوا منهم سيرم بياخدوا منهم سيرموبعمله pooling
+
+475
+00:33:10,230 --> 00:33:13,770
+من اكتر من واحد يعني وبعمله pooling وبيعطوا المريض
+
+476
+00:33:13,770 --> 00:33:18,010
+عدد او كم كبير من ال antitoxins خدوا بالكم النقطة
+
+477
+00:33:18,010 --> 00:33:23,050
+ال antitoxin هيرتبط بالتوكسين وان بيرتبط بالتوكسين
+
+478
+00:33:23,050 --> 00:33:26,430
+التوكسين اللي غير مرتبط بس التوكسين اللي مرتبط
+
+479
+00:33:26,430 --> 00:33:33,230
+مرتبط مظبوط ولا لأ فبالتاليقد ننجح في العلاج لكن
+
+480
+00:33:33,230 --> 00:33:37,410
+قد لا ننجح في إعادة المريض إلى الحالة الأولى التي
+
+481
+00:33:37,410 --> 00:33:42,610
+كان عليها بنوقف ال toxin production نقطة البكتيريا
+
+482
+00:33:42,610 --> 00:33:46,550
+بنعمل neutralization لل toxin لكن للأسف ما بتقدرش
+
+483
+00:33:46,550 --> 00:33:51,490
+تخلص من مين؟ من ال toxin اللي already bound تمام؟
+
+484
+00:33:51,490 --> 00:33:54,170
+عشانك انا قلتلكوا كمان مرة ال strategy تبعتنا لازم
+
+485
+00:33:54,170 --> 00:33:56,090
+تكون prevention وليس
+
+486
+00:33:59,410 --> 00:34:02,530
+الـ Antitoxin is a substance، وطبعا مش فقط احنا في
+
+487
+00:34:02,530 --> 00:34:04,530
+المرحلة اللي بنعرفين شو ال substance هدا، هو عبارة
+
+488
+00:34:04,530 --> 00:34:07,590
+عن antibody، that reacts with and destroy the
+
+489
+00:34:07,590 --> 00:34:11,350
+toxin. Patient may also need medication to control
+
+490
+00:34:11,350 --> 00:34:14,130
+muscle spasm، ممكن نعطيهم برضه علاجات حتى يخففوا
+
+491
+00:34:14,130 --> 00:34:18,430
+من الإنقباضات، اللي هو العضلات. In severe cases,
+
+492
+00:34:18,910 --> 00:34:21,450
+patients may have to be placed on artificial
+
+493
+00:34:21,450 --> 00:34:25,210
+respiration. تخيلوا يا شباب، لو صار في عندنا
+
+494
+00:34:25,210 --> 00:34:29,190
+failure في ال respiratory system.بيروح بيحطوا
+
+495
+00:34:29,190 --> 00:34:34,870
+المرضى في أجهزة تنفس خاصة، أجهزة تنفس خاصة، بتجوم
+
+496
+00:34:34,870 --> 00:34:39,890
+بعملية الشهيق والزفاف اللي المريض غصب عنهلأنه عنده
+
+497
+00:34:39,890 --> 00:34:44,030
+muscle تمام في ال .. عفوا عنده paralysis في ال
+
+498
+00:34:44,030 --> 00:34:48,710
+lungs نفسها فهذا عشان اقول لكوا انه recovery takes
+
+499
+00:34:48,710 --> 00:34:52,470
+six weeks حوال شهر و نص or more after patient is
+
+500
+00:34:52,470 --> 00:34:56,570
+.. is .. is bitter او تحسن المريض he or she should
+
+501
+00:34:56,570 --> 00:34:59,770
+receive the tetanus vaccine to protect against
+
+502
+00:34:59,770 --> 00:35:02,810
+future .. future episodes of the disease يعني حتى
+
+503
+00:35:02,810 --> 00:35:05,650
+بعد .. بعد الشفاء بنعطيه اللي هو vaccination
+
+504
+00:35:09,140 --> 00:35:14,540
+لأ احنا بنعرف انه الاستخدام ل ال immunization
+
+505
+00:35:14,540 --> 00:35:18,440
+بيقولنا عنه فينا حاجتين بنعطي passive immunity و
+
+506
+00:35:18,440 --> 00:35:20,580
+active immunity ال vaccine هو ال active
+
+507
+00:35:20,580 --> 00:35:23,820
+immunization تمام؟ و ال antitoxin اللي هي ال
+
+508
+00:35:23,820 --> 00:35:26,260
+antibodies اللي هي ال passive تمام؟ immunization
+
+509
+00:35:26,260 --> 00:35:29,600
+بس مش vaccination تمام؟ ال vaccine بنعطيه ال
+
+510
+00:35:29,600 --> 00:35:30,500
+antitoxide
+
+511
+00:35:33,170 --> 00:35:36,470
+التوكسايد اللى هو التوكسين اللى حولناه لتوكسايد
+
+512
+00:35:36,470 --> 00:35:40,290
+بينما الانتوتكسين هو حاجة من جهزة برا واطماطيها
+
+513
+00:35:40,290 --> 00:35:48,670
+للموارد من ضمن ال vaccines المشهورة اللى هو الDPT
+
+514
+00:35:48,670 --> 00:35:56,840
+او ال DTP او الDPT وفي اصلا الان فينا DTAPواحد
+
+515
+00:35:56,840 --> 00:36:02,540
+جديد طلع عندنا اسمه D T A P عموما ال T هي لتتانوس
+
+516
+00:36:02,540 --> 00:36:08,640
+و ال D لدفتيريا و ال P سواء كان A P و لا P لحالها
+
+517
+00:36:08,640 --> 00:36:14,380
+للبرتوسيز البرتوسيز اللي هو السعال الديكي إذن هذا
+
+518
+00:36:14,380 --> 00:36:16,780
+ال vaccine اللي أخدتوه أنتوا صغار ميرالا و
+
+519
+00:36:16,780 --> 00:36:20,320
+ماتكرالا تمام؟ و لو لزم الأمر ممكن تاخدوا منه
+
+520
+00:36:20,320 --> 00:36:22,920
+booster dose إيش يعني booster dose؟
+
+521
+00:36:30,020 --> 00:36:34,060
+فاكدوا يا شباب اللي درستوا مناعة ولا دستانتو حتى
+
+522
+00:36:34,060 --> 00:36:36,180
+لو ما درستوش مناعة انا بتذكر انه اتكلمنا عن
+
+523
+00:36:36,180 --> 00:36:39,580
+الموضوع هذا كنا في ال response تبع الجسم لل
+
+524
+00:36:39,580 --> 00:36:44,000
+antigen لأول مرة بيبدأ انتج الانتباد من ال zero
+
+525
+00:36:44,000 --> 00:36:47,340
+تمام؟
+
+526
+00:36:47,340 --> 00:36:51,580
+بيبدأ انتج الانتباد من وين؟ من ال zero صح؟ وبياخد
+
+527
+00:36:51,580 --> 00:36:57,460
+لو جينا نحط فترة زمانية يعني
+
+528
+00:36:57,460 --> 00:37:03,510
+هي ال time تمام؟وهي ال concentration بيبدأ ظهوره
+
+529
+00:37:03,510 --> 00:37:10,310
+بعدها بعد فترة معينة حوالي من عشرة لاربعتاشر يوم
+
+530
+00:37:10,310 --> 00:37:16,520
+من دخول الانتجينلكن الانتجين لو دخل مرة تانية تمام
+
+531
+00:37:16,520 --> 00:37:20,440
+مثلا في الفترة هذه في الفترة هذه بنلاقي ال
+
+532
+00:37:20,440 --> 00:37:23,040
+antibody ما حد ما دخل الانتجين هي نقطة دخول
+
+533
+00:37:23,040 --> 00:37:26,980
+الانتجين ال time تمام هيطلع أنها antibody و بنسبة
+
+534
+00:37:26,980 --> 00:37:29,680
+أعلى في ال primary response it takes time بس في ال
+
+535
+00:37:29,680 --> 00:37:32,960
+secondary response it takes no time ليش؟ لأن في
+
+536
+00:37:32,960 --> 00:37:37,020
+عندي memory cells
+
+537
+00:37:38,360 --> 00:37:40,760
+فالsecondary response فاحنا لما نعطي poster دوس
+
+538
+00:37:40,760 --> 00:37:44,320
+احنا واقع الامر بس بنذكر الرياض المناعة مش بن ..
+
+539
+00:37:44,320 --> 00:37:47,840
+بنعلمه لأ بنذكره المرة الأولانية علمناها و المرة
+
+540
+00:37:47,840 --> 00:37:49,040
+التانية ذكرناها
+
+541
+00:37:53,280 --> 00:37:59,460
+also should receive a vaccine to prevent neonatal
+
+542
+00:37:59,460 --> 00:38:03,200
+tetanus for their babies during cutting the
+
+543
+00:38:03,200 --> 00:38:07,640
+umbilical cord اعتقد ال practice هدا is no longer
+
+544
+00:38:07,640 --> 00:38:11,280
+used in palestine ماعنديش فكرة بالضبط هل مازالوا
+
+545
+00:38:11,280 --> 00:38:15,020
+يستخدموا او بطلوا و اوقفوا استخدامه بس اعتقد انهم
+
+546
+00:38:15,020 --> 00:38:17,640
+وقفوا استخدامه make sure that wounds are
+
+547
+00:38:17,640 --> 00:38:21,490
+thoroughly cleaned هذه نقطة كتير مهمةيجب أن نقوم
+
+548
+00:38:21,490 --> 00:38:25,450
+بتطهير الجروح بطريقة جيدة، a wound should also be
+
+549
+00:38:25,450 --> 00:38:28,010
+treated with antibiotic cream and covered with
+
+550
+00:38:28,010 --> 00:38:31,090
+bandage، ما تخليه مفتوح و مطروق، wounds that do
+
+551
+00:38:31,090 --> 00:38:35,090
+not heal should be examined by a doctor، أي جروح
+
+552
+00:38:35,090 --> 00:38:43,630
+طول شفاءه should be examined by a physicianالصنف
+
+553
+00:38:43,630 --> 00:38:47,690
+التاني او الاسم الثاني في الاخلستردية والاسم
+
+554
+00:38:47,690 --> 00:38:53,650
+الشهير جدا هو الاخلستردium perfringens it causes a
+
+555
+00:38:53,650 --> 00:38:57,230
+wide variety of infections لكن الاسم الشهير للمرض
+
+556
+00:38:57,230 --> 00:39:01,950
+تمام أشهر مرض على الإطلاق اللي هو gas gangrene
+
+557
+00:39:01,950 --> 00:39:08,050
+وهذا مرض بحد ذاته اسمه مخيف الغرغرينة الغازيةطيب
+
+558
+00:39:08,050 --> 00:39:11,990
+wound infection خدوا بالكم مافيش انديجياز جانجرين
+
+559
+00:39:11,990 --> 00:39:16,410
+اللي بتبدأ ب wound infection يعني غالبا بيكون فيه
+
+560
+00:39:16,410 --> 00:39:25,650
+التهاب صار من جرحه مرض خطير جدا necrotizing
+
+561
+00:39:25,650 --> 00:39:30,870
+degenitis بدل ما الغرغرينة في العضلات الغرغرينة في
+
+562
+00:39:30,870 --> 00:39:36,940
+الأمعاء يعني هذا نجرنجوان و غرغرينة الأمعاءرقم
+
+563
+00:39:36,940 --> 00:39:40,840
+أربعة يا طلاب ال food microbiology food poisoning
+
+564
+00:39:40,840 --> 00:39:44,780
+food poisoning بسيطة هذا ال food poisoning خمسة
+
+565
+00:39:44,780 --> 00:39:47,600
+meningitis طبعا بالمقارنة مع الأمراض اللي أنا
+
+566
+00:39:47,600 --> 00:39:50,400
+ذكرتها دي ال food poisoning بالفعل because by
+
+567
+00:39:50,400 --> 00:39:53,340
+clostridium peripheral is a very simple condition
+
+568
+00:39:53,340 --> 00:39:58,800
+ايه ده الموضوع؟ gas, necrotizing, food poisoning و
+
+569
+00:39:58,800 --> 00:40:02,620
+meningitis هذه الأمراض بسببها البكتيريا الآن شوفوا
+
+570
+00:40:02,620 --> 00:40:04,960
+الفكرة في كلمة gas gangrene
+
+571
+00:40:07,930 --> 00:40:14,270
+تعرف الخبز لما بن .. بن .. بيكون عجين هو بنعرضه
+
+572
+00:40:14,270 --> 00:40:17,390
+للحرارة مش بنتفخ؟ بنتفخ و في الآخر بنلاقي إنه
+
+573
+00:40:17,390 --> 00:40:21,510
+انجسم نصين صار فيه يعني قطعة و قطعة مع أنه كان
+
+574
+00:40:21,510 --> 00:40:26,150
+قطعة واحدةالغاز بطبيعته يا شباب بيحبش ينحشر في
+
+575
+00:40:26,150 --> 00:40:29,750
+مكان أو ينضغط في مكان فإذا اتكون فيه ضغط عادة بيحب
+
+576
+00:40:29,750 --> 00:40:34,110
+دوة على أضعف منطقة يخرج منها يخرج منها لما بتمدد
+
+577
+00:40:34,110 --> 00:40:38,370
+الغاز بتمدد الغاز بفعل الحرارة أو بفعل التراكم
+
+578
+00:40:38,370 --> 00:40:48,190
+يعني تخيلوا بكتيريا جوا عضلاتو بدأت تتكاثر و
+
+579
+00:40:48,190 --> 00:40:51,330
+تكاثرها و ال fermentation الناتج عنها بينتج عنه
+
+580
+00:40:51,330 --> 00:40:55,370
+غاز اظن ان في المعمل كنا نشوف ال triple sugar iron
+
+581
+00:40:55,370 --> 00:40:59,350
+agar رافع فوق اه لان كمية الغاز اللي طالعة كمية
+
+582
+00:40:59,350 --> 00:41:04,600
+كبيرةفلما البكتيريا هيتنتج غاز غالبا شباب الغاز
+
+583
+00:41:04,600 --> 00:41:09,900
+هذا بيحاول انه يهرب فبيهرب بلاقي الأماكن اللي هو
+
+584
+00:41:09,900 --> 00:41:16,800
+سالكة في أمامه بيدخل فيها بالآخر بنحشر بتكون ضغط
+
+585
+00:41:16,800 --> 00:41:20,700
+بتكون ضغط تخيل لو عضلتين جان بعض وفسخهم عن بعض
+
+586
+00:41:20,700 --> 00:41:27,120
+الغاز واحدة منهم كان بينهم شبكة شعيرات دمويةو
+
+587
+00:41:27,120 --> 00:41:30,740
+واحدة منهم هتتخلى عن الشعارات الدموية فممكن يصير
+
+588
+00:41:30,740 --> 00:41:33,980
+كتلة كاملة عضلة كاملة يصير فيها necrosis
+
+589
+00:41:36,760 --> 00:41:41,560
+Necrosis، موت، لحمة ميتة، لحمة ميتة، يبجي البكتيرا
+
+590
+00:41:41,560 --> 00:41:44,200
+.. يبجي البكتيرا الآن بيقى اللي هى غذائية ممتازة
+
+591
+00:41:44,200 --> 00:41:47,900
+جدا فهتتكارت هتبقى الواحد اللي بدك تعرف ان العضلة
+
+592
+00:41:47,900 --> 00:41:51,100
+ها دى skeletal muscle قد تكون عضلة كبيرة، ده .. ده
+
+593
+00:41:51,100 --> 00:41:53,860
+.. ده التأثير على ال locomotion تبقى للإنسان
+
+594
+00:41:53,860 --> 00:41:58,520
+فبالتالي بيصير في أن هذه العضلة لن نستطيع ارجعها
+
+595
+00:41:58,520 --> 00:42:02,240
+للحياةولن تنمو مرة أخرى وبالتالي بيصير بنصر لمرحلة
+
+596
+00:42:02,240 --> 00:42:07,700
+أنه betterها هو او او او مصطلح الألطف removal أو
+
+597
+00:42:07,700 --> 00:42:11,320
+surgical removal of revitalized tissue يعني التدخل
+
+598
+00:42:11,320 --> 00:42:16,240
+الجراحي لإزالة الأنسجة الميتة تمام؟ وهو تعبير آخر
+
+599
+00:42:16,240 --> 00:42:18,600
+عن ال better تعبير آخر عن ال better
+
+600
+00:42:21,530 --> 00:42:26,590
+نفس الشي نعم لما سنده جانجرين بس مش جانجرين غازية
+
+601
+00:42:26,590 --> 00:42:31,790
+الجانجرين بشكل عام هي ال necrosis تمام او موت
+
+602
+00:42:31,790 --> 00:42:37,550
+الخلايا انها تجعل عن نقص وصول الدم الى منطقة معينة
+
+603
+00:42:37,550 --> 00:42:41,630
+اللي انا بتكلم عنه سببه البكتيريا ده بيتسئله أسباب
+
+604
+00:42:41,630 --> 00:42:42,830
+أخرى مختلفة
+
+605
+00:42:45,860 --> 00:42:49,780
+ووصلنا الأن لجنا لمرحلة انه بنقول gas gangrene
+
+606
+00:42:49,780 --> 00:42:53,800
+واللي غاري غارينا اللي مسببها هنا بكتيريا، مدام
+
+607
+00:42:53,800 --> 00:42:56,700
+سببها بكتيريا يبجي بنجري نعالجها بال antibiotic،
+
+608
+00:42:56,700 --> 00:43:00,560
+اه لأ عندنا مشكلة، مدام antibiotic يبجي بدنا ..
+
+609
+00:43:00,560 --> 00:43:03,460
+بدنا نتذكر شغل، هل ال .. ال .. ال .. ال bacteria
+
+610
+00:43:03,460 --> 00:43:07,380
+من النوع العادي ولا ال sperm former؟ sperm former،
+
+611
+00:43:07,380 --> 00:43:09,500
+يبجي البكتيريا لو حاطيناها ل antibiotic، okay
+
+612
+00:43:09,500 --> 00:43:13,530
+البعض منها هيموت، لكن البعض الأخر هتكوّل لمين؟شيل
+
+613
+00:43:13,530 --> 00:43:17,250
+ال antibiotic هترجع ال endospor كمان مرة اذا عملتي
+
+614
+00:43:17,250 --> 00:43:21,730
+العلاج كمان مرة عملية ليست بيه العملية السهلة و من
+
+615
+00:43:21,730 --> 00:43:25,470
+هنا نقول لكم مرة اخرى رابعة او خامسة او الف
+
+616
+00:43:25,470 --> 00:43:30,830
+prevention is all important proper care مدام ال
+
+617
+00:43:30,830 --> 00:43:33,970
+gas جانجرين بدأ بمين؟ ب wound infection يبجى هتكلم
+
+618
+00:43:33,970 --> 00:43:38,930
+عن مين؟عن جاز جانجرين يبقى اعمل proper wound
+
+619
+00:43:38,930 --> 00:43:43,890
+caring للجروح وبالتالي ستمنع بالرسبة الكبيرة
+
+620
+00:43:43,890 --> 00:43:48,310
+الحدوث اللي هو الجاز جانجرين يكفي اليوم نكمل انشاء
+
+621
+00:43:48,310 --> 00:43:49,250
+الله المرة القادمة
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ymegUm0UB7c_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ymegUm0UB7c_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..086d0bb7852af046539d488bd3cfc8afddb6a56c
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/ymegUm0UB7c_raw.srt
@@ -0,0 +1,2252 @@
+1
+00:00:20,210 --> 00:00:24,250
+بسم الله الرحمن الرحيم اليوم استكمالا للجزئية اللى
+
+2
+00:00:24,250 --> 00:00:27,710
+حكينا عنها ال gram negative اللى خارج اطار
+
+3
+00:00:27,710 --> 00:00:31,650
+المجموعات اللى درسناهم بدأنا المحاضرة السابقة بأى
+
+4
+00:00:31,650 --> 00:00:39,290
+مجموعة Francicilla
+
+5
+00:00:39,290 --> 00:00:43,770
+tolerances و اليوم هتكلم عن Hemophilus و هتكلم عن
+
+6
+00:00:43,770 --> 00:00:45,790
+Bordella و ان شاء الله المحاضرة اللى جاية هتكلم عن
+
+7
+00:00:45,790 --> 00:00:50,800
+ال legionellaنبدأ ان شاء الله بال Hemophilus بدي
+
+8
+00:00:50,800 --> 00:00:53,780
+أطلع بس قدامكوا تطلعوا قدام على اللوحة اللي أمامنا
+
+9
+00:00:53,780 --> 00:00:56,960
+هنا فيها صورة معبرة الصحيح البكتيريا بناخدها gram
+
+10
+00:00:56,960 --> 00:01:01,000
+negative بسولاي في منها إذا بتلاحظوا filamentous
+
+11
+00:01:01,000 --> 00:01:05,310
+forms filamentous يعني خيطيةهذه الصفة قد نراها في
+
+12
+00:01:05,310 --> 00:01:09,570
+الهيموفلس وإذا رأيناها فهي مؤشر ان البكتيريا هي
+
+13
+00:01:09,570 --> 00:01:13,130
+هيموفلس احد النقاط المهمة اللي لازم نبدأ فيها ايضا
+
+14
+00:01:13,130 --> 00:01:18,170
+اليوم في محاضرتنا ان الهيموفلس في معلومات مرتبطة
+
+15
+00:01:18,170 --> 00:01:21,730
+بها وليس بغيرها هذه البكتيريا gram variable يعني
+
+16
+00:01:21,730 --> 00:01:25,250
+قد تصبح gram positive وقد تصبح gram negative هذه
+
+17
+00:01:25,250 --> 00:01:28,870
+مشكلةإنه تكون البكتيريا مش واضحة المعالم هل هي
+
+18
+00:01:28,870 --> 00:01:32,210
+gram positive ولا gram negative في كمان صفة يجب أن
+
+19
+00:01:32,210 --> 00:01:36,830
+نلصقها بال hemophilus influenza منذ الآن وهي its
+
+20
+00:01:36,830 --> 00:01:40,210
+requirement for X and V factors هذا أعتقد انكم في
+
+21
+00:01:40,210 --> 00:01:47,330
+المعمل دراستوه فال X and V factor يعني جزء من ال
+
+22
+00:01:47,330 --> 00:01:50,450
+requirement للبكتيريا وجزء من عملية التعرف على
+
+23
+00:01:50,450 --> 00:01:57,490
+البكتيريا بالأساس على chocolate agarالان عندي
+
+24
+00:01:57,490 --> 00:02:00,930
+مجموعة كبيرة من ال species في القائمة عندي
+
+25
+00:02:00,930 --> 00:02:03,650
+hemophilus influenza و ال biotype B هو ال most
+
+26
+00:02:03,650 --> 00:02:07,490
+important among the hemophilus influenza عندي
+
+27
+00:02:07,490 --> 00:02:11,150
+hemophilus para influenza, hemophilus hemolyticus,
+
+28
+00:02:11,650 --> 00:02:16,690
+hemophilus duqueryHemophilus Afrophilus و
+
+29
+00:02:16,690 --> 00:02:27,910
+Hemophilus Para-Afrophilus و Hemophilus
+
+30
+00:02:27,910 --> 00:02:30,450
+Cygnus و Hemophilus Aegyptiaceae
+
+31
+00:02:38,620 --> 00:02:41,140
+Hemophilus influenza, hemophilus para influenza,
+
+32
+00:02:41,600 --> 00:02:44,520
+hemophilus hemolyticus, hemophilus educari,
+
+33
+00:02:44,840 --> 00:02:48,420
+hemophilus afrophilus, hemophilus para afrophilus,
+
+34
+00:02:48,760 --> 00:02:54,030
+hemophilus cygnus and hemophilus egiptusالخاصية
+
+35
+00:02:54,030 --> 00:02:57,990
+العامة للبكتيريا هي جرام نيجاتيف بسلاي لكنها
+
+36
+00:02:57,990 --> 00:03:02,410
+بيليومورفك واتفقنا كلمة بيليومورفك قد تتخذ شكلات
+
+37
+00:03:02,410 --> 00:03:03,630
+مختلفة وشكلات مختلفة وشكلات مختلفة
+
+38
+00:03:12,540 --> 00:03:17,120
+لكن ال cell wall تبعها التركيب تبعه هو عبارة عن
+
+39
+00:03:17,120 --> 00:03:22,100
+gram negative cell wall يعني فيه outer membrane و
+
+40
+00:03:22,100 --> 00:03:28,800
+ال peptidoglycan layer فيه فيه single layer of
+
+41
+00:03:28,800 --> 00:03:33,570
+peptidoglycanالان لماذا هي gram variable هتكلم
+
+42
+00:03:33,570 --> 00:03:36,790
+عنها ان شاء الله لاحقا facultative anaerobic طبعا
+
+43
+00:03:36,790 --> 00:03:41,550
+هذه فيها تفسيرات متعددة لكن لا يوجد شيء يعني نعتمد
+
+44
+00:03:41,550 --> 00:03:44,750
+عليه و نقول ان هذا هو السبب لانها بتعمل gram
+
+45
+00:03:44,750 --> 00:03:49,220
+variable facultative anaerobicrequires CO2 for
+
+46
+00:03:49,220 --> 00:03:52,740
+growth، requires growth factors اللي هتقول عنهم X
+
+47
+00:03:52,740 --> 00:03:56,760
+and V factor والـ X هو اسمه همين والـ V اللي هو
+
+48
+00:03:56,760 --> 00:04:00,840
+انها هتتعرف عليهم وهتتعرف على وظائفهم في البكتيريا
+
+49
+00:04:00,840 --> 00:04:05,680
+ولماذا تحتاجهم البكتيرياmaby capsulated or non
+
+50
+00:04:05,680 --> 00:04:07,440
+-capsulated يعني ممكن ياكلها capsule وممكن
+
+51
+00:04:07,440 --> 00:04:10,820
+ماياكلها اش capsule والصحيح انه هتبقى بتكلم عن ال
+
+52
+00:04:10,820 --> 00:04:14,040
+characteristics للمجموعة كلها اعطيك مثال ال
+
+53
+00:04:14,040 --> 00:04:18,300
+hemophilus influenza are capsulated و based on
+
+54
+00:04:18,300 --> 00:04:21,540
+their capsule they are classified into serotypes
+
+55
+00:04:21,540 --> 00:04:27,460
+مهمين جدا في ال vaccines اللي احنا قلنا عشان نعمل
+
+56
+00:04:27,460 --> 00:04:32,300
+vaccine بديكون عنديجمع لل common serotypes في
+
+57
+00:04:32,300 --> 00:04:38,770
+المنطقة وبالتالي نعمل vaccine خاصبحسب البيانات
+
+58
+00:04:38,770 --> 00:04:42,790
+المحلية للـ Epidemiology في المنطقة للـ Hemophilus
+
+59
+00:04:42,790 --> 00:04:47,370
+Influenza وحنقولكوا جملة كمان شوية وننصفها أنها
+
+60
+00:04:47,370 --> 00:04:51,130
+number one cause of meningitis in young children
+
+61
+00:04:51,130 --> 00:04:55,490
+هذا الكلام قبل ما نخترع أو نطور ال vaccine فلما
+
+62
+00:04:55,490 --> 00:04:59,170
+ادخل الإنسان بال vaccine غير المفهوم هذا وبالتالي
+
+63
+00:04:59,170 --> 00:05:02,090
+قلت بدل ما كانت number one صارت number three أو
+
+64
+00:05:02,090 --> 00:05:07,300
+four على القائمةلكن تبقى .. يعني تبقى سبب مهم من
+
+65
+00:05:07,300 --> 00:05:11,640
+أسباب الـ meningitis most strains are ان دول بُسطة
+
+66
+00:05:11,640 --> 00:05:14,220
+إذا إن أنا في عندي مجموعة من ال characteristics
+
+67
+00:05:14,220 --> 00:05:19,900
+gram negative small بسلعي polymorphic الجرام
+
+68
+00:05:19,900 --> 00:05:23,060
+reaction تبعها variable عندي فكولتات في أنا إيروب
+
+69
+00:05:23,060 --> 00:05:26,400
+require CO2 عندي requirement لل X and B factor
+
+70
+00:05:26,400 --> 00:05:29,540
+يقول إن هذه نقطة كتير مهمة الآن بالنسبة للهيموفلس
+
+71
+00:05:29,540 --> 00:05:36,850
+بشكل عاميابتطلب X يابتطلب V يابتطلب اتنين X and V
+
+72
+00:05:36,850 --> 00:05:40,010
+factors يقولنا ممكن تكون encapsulated ممكن ماتكونش
+
+73
+00:05:40,010 --> 00:05:43,850
+encapsulated ممكن يكون اندول positive نيجي الآن
+
+74
+00:05:43,850 --> 00:05:46,710
+للهموفلس انفلونزا pathogenicity
+
+75
+00:05:48,320 --> 00:05:50,760
+أحنا ذكرنا الجملة اللى .. اللى .. اللى هتقولها
+
+76
+00:05:50,760 --> 00:05:53,860
+الآن وقلنا إنه نسفناها it is the most common
+
+77
+00:05:53,860 --> 00:05:58,360
+etiologic agent of acute bacterial meningitis in
+
+78
+00:05:58,360 --> 00:06:01,340
+young children طب بعد ما استخدمنا الفاكسينة الكلام
+
+79
+00:06:01,340 --> 00:06:06,580
+بطل صحيح بطل صحيح إذا نزلت لمرة تبقى متدنية هذا لا
+
+80
+00:06:06,580 --> 00:06:10,900
+ينكر إنه في المناطق اللي لسه ما طبقت الفاكسين إنه
+
+81
+00:06:10,900 --> 00:06:14,180
+هي still number one cause of acute bacterial
+
+82
+00:06:14,180 --> 00:06:18,140
+meningitis in young childrenالـ Hemophilus
+
+83
+00:06:18,140 --> 00:06:21,820
+Influenza ما بين الـ Species الأخرى في الـ
+
+84
+00:06:21,820 --> 00:06:26,940
+Hemophilus هي الأهم على الإطلاق والـ B هي الأهم
+
+85
+00:06:26,940 --> 00:06:30,000
+على الإطلاق من كل الـ Hemophilus Influenza itself
+
+86
+00:06:30,910 --> 00:06:34,130
+طلعوا ال diseases caused by this organism مش واحد
+
+87
+00:06:34,130 --> 00:06:37,470
+او اتنين مجموعة كبيرة طلعوا it is the most common
+
+88
+00:06:37,470 --> 00:06:39,630
+cause of meningitis in children هذه متفقين عليها
+
+89
+00:06:39,630 --> 00:06:43,070
+causes epiglottitis و اول مرة نتكلم عن بكتيريا
+
+90
+00:06:43,070 --> 00:06:47,070
+بتسبب التهاب لسان المظمار او ال epiglottitis وهو
+
+91
+00:06:47,070 --> 00:06:50,430
+يعني condition صعب و it requires يعني
+
+92
+00:06:50,430 --> 00:06:53,460
+hospitalizationوخد مش بس
+
+93
+00:06:53,460 --> 00:07:06,180
+الهيسبوطالاتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتياتيات
+
+94
+00:07:08,070 --> 00:07:11,430
+لأن معظم مسببات الـ otitis media هي نفسها مسببات
+
+95
+00:07:11,430 --> 00:07:14,910
+ال meningitis، وبالتالي حتى احنا بنقول انه في
+
+96
+00:07:14,910 --> 00:07:19,550
+الأطفال ال otitis media condition أو التهاب الأضم
+
+97
+00:07:19,550 --> 00:07:23,090
+بشكل عام، condition لا يمكن السكوت عنه، بمعنى راجع
+
+98
+00:07:23,090 --> 00:07:29,010
+فيه الطبيبendocarditis and pericarditis برضه
+
+99
+00:07:29,010 --> 00:07:32,090
+condition صعب may enter the bloodstream of women
+
+100
+00:07:32,090 --> 00:07:34,510
+during birth causing peripheral sepsis هي صراحة
+
+101
+00:07:34,510 --> 00:07:37,630
+انها مجموعة كبيرة من الميكروبات بتاع من حمى النفاس
+
+102
+00:07:37,630 --> 00:07:41,170
+the complication of which may threaten the life of
+
+103
+00:07:41,170 --> 00:07:44,300
+mother او mother life يعني بتهدد حياة الأمEye
+
+104
+00:07:44,300 --> 00:07:48,060
+Infection و Conjectivitis يعني هذه القائمة من
+
+105
+00:07:48,060 --> 00:07:51,020
+الأمراض اللي ذكرناها احنا لان Caused by Hemophilus
+
+106
+00:07:51,020 --> 00:07:55,380
+Influenza هي مؤشر لنا من وين ممكن نعزل احنا
+
+107
+00:07:55,380 --> 00:07:58,280
+البكتيريا اسمها Hemophilus Influenza
+
+108
+00:08:02,660 --> 00:08:07,680
+صحيح دخل .. اه نعم دخل الخدمة قبل يمكن خمس سنوات
+
+109
+00:08:07,680 --> 00:08:15,760
+ويعني المؤشرات من تقارير وزارة الصحة تشير الى نسبة
+
+110
+00:08:15,760 --> 00:08:18,720
+اقل في عزل لمفلس انفلوانزا من حالات ال meningitis
+
+111
+00:08:18,960 --> 00:08:22,400
+فيعني هذا مؤشر انه effective وفي كمان واكسين تاني
+
+112
+00:08:22,400 --> 00:08:26,460
+دخل خدمة قبل تلت سنوات اللي هو ال .. ال
+
+113
+00:08:26,460 --> 00:08:28,780
+Structococcus pneumonia vaccine برضه وبرضه كمان
+
+114
+00:08:28,780 --> 00:08:31,340
+هذا عمل reduction ل Structococcus pneumonia
+
+115
+00:08:31,340 --> 00:08:35,650
+meningitis cases فهذا أمر جيدعشان احنا بنقول انه
+
+116
+00:08:35,650 --> 00:08:43,210
+vaccine preventable diseases اذا احنا كعالم متحضر
+
+117
+00:08:43,210 --> 00:08:48,470
+وصلنا لمرحلة انه نغطي كل ال vaccine preventable
+
+118
+00:08:48,470 --> 00:08:53,110
+diseases في البشر، هذا قد يقلل بنسبة كبيرة من
+
+119
+00:08:53,110 --> 00:09:00,230
+الأمراض المعدية في العالمالبكتيريا is part of the
+
+120
+00:09:00,230 --> 00:09:02,850
+normal flora of the upper respiratory tract of man
+
+121
+00:09:02,850 --> 00:09:06,210
+و man مقصود فيها ان الإنسان يعني مش في الذكاء ال
+
+122
+00:09:06,210 --> 00:09:09,090
+specimens زي ما ذكرنا احنا مجموعة الأمراض بتعطينا
+
+123
+00:09:09,090 --> 00:09:13,370
+فكرة عن اللي هو العينات اللي في واحدة بس منهم بدأ
+
+124
+00:09:13,370 --> 00:09:17,930
+نخصصها ال hemophilus dukeri ما حكينا عنها حاجة هذه
+
+125
+00:09:17,930 --> 00:09:23,770
+البكتيريا لا تسبب رسبراتوري و انما بتسبب STD أو
+
+126
+00:09:23,770 --> 00:09:27,290
+sexually transmitted diseaseالمايكروسكوبي small
+
+127
+00:09:27,290 --> 00:09:30,350
+non-motile gram negative وقولنا لكوا it may show
+
+128
+00:09:30,350 --> 00:09:33,910
+gram variable it may show gram positive not only
+
+129
+00:09:33,910 --> 00:09:42,650
+gram negative طيب في أحد السنوات تم الاتصال بيه من
+
+130
+00:09:42,650 --> 00:09:50,810
+قبل أحد المؤسسات الصحية مختبرات وبالتحديد مختبر في
+
+131
+00:09:50,810 --> 00:09:55,150
+مستشفى للأطفال الدكتور احنا بنعاني من المشكلةإنه
+
+132
+00:09:55,150 --> 00:09:58,810
+ال .. ال .. ال gram stain بتطلع negative لكن ال
+
+133
+00:09:58,810 --> 00:10:03,170
+culture بتطلع positive و العينة بيكون فيها bust
+
+134
+00:10:03,170 --> 00:10:07,290
+cells واضح وبالتالي يعني ال .. ال .. ال value of
+
+135
+00:10:07,290 --> 00:10:09,770
+gram staining اللي احنا بدناياها تقصر الفترة
+
+136
+00:10:09,770 --> 00:10:13,370
+الزمنية في ال reporting فقدت تطلع positive في ال
+
+137
+00:10:13,370 --> 00:10:18,210
+culture و هذا بده 24 ساعة فاشي المشكلةفعطول خطر في
+
+138
+00:10:18,210 --> 00:10:20,990
+بالي انا اللي هو ال hemophilus influenza ونبهته
+
+139
+00:10:20,990 --> 00:10:24,530
+الى انه يجب ان يستخدم مع ال gram stain مثلين blue
+
+140
+00:10:24,530 --> 00:10:27,550
+stain لأن ال gram stain could هذه البكتيريا could
+
+141
+00:10:27,550 --> 00:10:30,750
+be missed ممكن نفقدها في ال gram stain وبالتالي
+
+142
+00:10:30,750 --> 00:10:34,430
+مفضل ان نعمل مثلين blue stain وانت بتذكره في
+
+143
+00:10:34,430 --> 00:10:37,990
+المعمل تبعكوا هذا الفصل انتوا لما أخدتوا عينة ال
+
+144
+00:10:37,990 --> 00:10:42,330
+CSF كان ال CSF وطالع منه اربع أسهم على جانب واحدة
+
+145
+00:10:42,330 --> 00:10:45,870
+gram stain واحدة مثلين blue هذا للي فاكر gram
+
+146
+00:10:45,870 --> 00:10:50,970
+stainMethylene Blue India Ink and Whitemount أربع
+
+147
+00:10:50,970 --> 00:10:55,650
+أنواع من ال microscopy اعتمدناهم لل CSF الميثيل
+
+148
+00:10:55,650 --> 00:11:00,130
+البلو بشكل انخاص حتى لا نفقد من ال Hemophilus
+
+149
+00:11:00,130 --> 00:11:04,110
+Influenza لأنها برضه بكتيريا من النوع الفرجال وال
+
+150
+00:11:04,110 --> 00:11:09,870
+Gram خدنا نقول Staining بيتطلب كام خطوة أربع خطوات
+
+151
+00:11:09,870 --> 00:11:13,790
+Stainingواربع حطوات washing وبالتالي هذه العملية
+
+152
+00:11:13,790 --> 00:11:21,510
+عملية بتعرض البكتيريا لظروف قد تؤذيها فممكن نفقدها
+
+153
+00:11:21,510 --> 00:11:24,710
+لأنها fragile البكتيريا بينما other بكتيريا can
+
+154
+00:11:24,710 --> 00:11:27,470
+survive this process فبالتالي ال methanol blue
+
+155
+00:11:27,470 --> 00:11:30,630
+simple stain just stain with methanol blue وال
+
+156
+00:11:30,630 --> 00:11:33,290
+affinity بتاعت البكتيريا ل ال methanol blue أعلى
+
+157
+00:11:33,290 --> 00:11:38,960
+من affinity بتاعتها ل other stainsمتفقين الان
+
+158
+00:11:38,960 --> 00:11:43,940
+البكتيريا الرسم اللى وضحتلكوا إياها هان في بداية
+
+159
+00:11:43,940 --> 00:11:48,140
+المحاضرة لما قولتلكوا انه بعض الأحيان بنجد long
+
+160
+00:11:48,140 --> 00:11:54,100
+thread أو filaments في ال old culture او في ال
+
+161
+00:11:54,100 --> 00:11:57,680
+smears اللى مأخودة من CSF خدوا بالكم هذا الشكل
+
+162
+00:11:57,680 --> 00:12:02,350
+اللى احنا شايفينه أو الطويلإذا وجدناه فهو مؤشر جيد
+
+163
+00:12:02,350 --> 00:12:05,790
+على إن البكتيريا Hemophilus influenza بس إذا ما
+
+164
+00:12:05,790 --> 00:12:08,790
+موجدناهوش مش معنى تلحق إن البكتيريا مش Hemophilus
+
+165
+00:12:08,790 --> 00:12:12,850
+influenza يعني مجردش ننفي لكن بتساعدنا في إثبات إن
+
+166
+00:12:12,850 --> 00:12:14,250
+البكتيريا Hemophilus influenza
+
+167
+00:12:18,970 --> 00:12:22,170
+بنسبة ال culture البكتيريا جونا عنها فكولتات اناء
+
+168
+00:12:22,170 --> 00:12:26,190
+ايروب لكن ال growth ايروبي افضل و جونا بتحتاج CO2
+
+169
+00:12:26,190 --> 00:12:32,230
+و بتحتاج وسط بيحتوي على ال X و V فاكتور ماهو X و V
+
+170
+00:12:32,230 --> 00:12:37,520
+فاكتور؟ X فاكتور لواله مين؟بتستخدموا البكتيريا في
+
+171
+00:12:37,520 --> 00:12:41,940
+تصنيع بعض الانزيمات المهمة جدا زي الـ cytochrome
+
+172
+00:12:41,940 --> 00:12:47,140
+oxidases زي الكتاليز والبروكسيدايز. إذن البكتيريا
+
+173
+00:12:47,140 --> 00:12:50,100
+البكتيريا بتحتاج للهيمين لل production of
+
+174
+00:12:50,100 --> 00:12:54,270
+essential enzymesالان ال V-factor اللي هو الناد
+
+175
+00:12:54,270 --> 00:12:56,790
+طبعا كلكم بتعرفه الناد هو عبارة عن نيكوتيناميد
+
+176
+00:12:56,790 --> 00:13:00,830
+أدينين داي نيكليوتايد ويستخدم من قبل البكتيريا
+
+177
+00:13:00,830 --> 00:13:04,030
+كإلكترون كاريار في عمليات ال oxidation reduction
+
+178
+00:13:04,030 --> 00:13:08,850
+وفيش في الخلية حياة بدون oxidation reduction
+
+179
+00:13:08,850 --> 00:13:14,390
+وبالتالي مهم جدا وجوده للبكتيريا، الآن البكتيريا
+
+180
+00:13:14,390 --> 00:13:18,890
+غير قادرة على تصنيع الهيمين ولاتصنيع اللي هو الناد
+
+181
+00:13:18,890 --> 00:13:24,390
+وبالتالي هي بحاجة إلى مصدر خارجي يزودها بهذه
+
+182
+00:13:24,390 --> 00:13:28,150
+المصادر مين بالنسبة ان احنا هذا المصدر اللي هو ال
+
+183
+00:13:28,150 --> 00:13:32,300
+chocolate أجربدي اكد على حقيقة ان ال chocolate
+
+184
+00:13:32,300 --> 00:13:38,000
+agar هو عبارة عن blood agar لكن تم تسخينه على جدهش
+
+185
+00:13:38,000 --> 00:13:41,000
+على تمانين درجة تمانين خمس و تمانين درجة مئوية
+
+186
+00:13:41,000 --> 00:13:45,080
+الان خدوا بالكم ان شاء الله لو غلينا ال agar
+
+187
+00:13:45,080 --> 00:13:48,260
+هيعطينا لون بني و شكل ال chocolate agar و لو
+
+188
+00:13:48,260 --> 00:13:51,380
+سخنناه على سبعين هيعطينا برضه لون chocolate agar
+
+189
+00:13:52,590 --> 00:13:58,270
+إذا ليس كل شوكولات أجار هو شوكولات أجار بمعنى ليس
+
+190
+00:13:58,270 --> 00:14:03,470
+كل شوكولات أجار يوفر إلنا x and v factor إلا إذا
+
+191
+00:14:03,470 --> 00:14:06,950
+حضر properly و properly على درجة الحرارة اللي احنا
+
+192
+00:14:06,950 --> 00:14:13,140
+ذكرناها سابقاطيب إذا أنا مش واثق من قدرتي على
+
+193
+00:14:13,140 --> 00:14:16,980
+تحضير أو قدرة مختبري أو قدرة المؤسسة اللي بشتغل
+
+194
+00:14:16,980 --> 00:14:21,580
+فيها على تحضير تشكولة أجار يوفر X and B factor
+
+195
+00:14:21,580 --> 00:14:26,040
+خدوا بالكوا نقطة كتير مهمة بمعنى إنه أنا زرعت
+
+196
+00:14:26,040 --> 00:14:28,540
+البكتيريا على تشكولة أجار وانا معتقد انه تشكولة
+
+197
+00:14:28,540 --> 00:14:31,640
+أجار و هيوفر X and B factor فلو كانت ال Hemophilus
+
+198
+00:14:31,640 --> 00:14:34,280
+influenza موجودة في العينية هيطلع العينية negative
+
+199
+00:14:35,190 --> 00:14:38,350
+وإذا تشوف الأجارة مش موفرلها ال X and Z factor
+
+200
+00:14:38,350 --> 00:14:42,390
+فهتطلع المزرعة negative وانا هعمل reporting
+
+201
+00:14:42,390 --> 00:14:47,890
+negative لعينة positive أساسا فهداش مسميها false
+
+202
+00:14:47,890 --> 00:14:51,490
+negative والfalse negative نتج عن خطأ في التكنيج
+
+203
+00:14:51,490 --> 00:14:55,050
+خطأ في التكنيجطب ايش اعمل فى دى الحالة عشان اضمن
+
+204
+00:14:55,050 --> 00:14:57,830
+ان انا ماجعش فى هاد الخطأ بعض المختبره تقولك يا عم
+
+205
+00:14:57,830 --> 00:15:01,690
+لا انا مابدي اتحضر شكلة اجار انا بحضر nutrient
+
+206
+00:15:01,690 --> 00:15:05,030
+اجار او molar hindon اجار و بجيب من عندى باشتري
+
+207
+00:15:05,030 --> 00:15:09,430
+اللى هو ال X factor في اقراس و ال V factor باقراس
+
+208
+00:15:09,430 --> 00:15:12,850
+و فيه عندي X و V factor فى قرص واحد تمام مدمجين فى
+
+209
+00:15:12,850 --> 00:15:17,960
+قرص واحد و بصير ازرعالبكتيريا وبحط عليها اللي هو
+
+210
+00:15:17,960 --> 00:15:22,680
+الأقراس هذه أو بضيف ك supplement على ال media بضيف
+
+211
+00:15:22,680 --> 00:15:27,760
+عليها x and v factor commercially availableإذا في
+
+212
+00:15:27,760 --> 00:15:32,620
+عندي حلول كثيرة عندي حل رقم واحد انه انا احضر ال
+
+213
+00:15:32,620 --> 00:15:38,700
+chocolate agar بطريقة صحيحة رقم اتنين انه انا اعمل
+
+214
+00:15:38,700 --> 00:15:42,340
+supplement ل media بال X and V factor commercially
+
+215
+00:15:42,340 --> 00:15:46,120
+او اضيف اقراس زي ما ذكرنا بعد الزراعة X and V
+
+216
+00:15:46,120 --> 00:15:49,260
+factor وفي خيار تلت هتكلم عنه لكن هذا الخيار مش
+
+217
+00:15:49,260 --> 00:15:54,710
+كتير محبب لكن لو الواحد انزنج له ممكن يستخدمهالـ
+
+218
+00:15:54,710 --> 00:15:57,810
+identification للبكتيريا معتمدة على نفس الخاصية
+
+219
+00:15:57,810 --> 00:16:00,110
+اللي احنا رابطناها فيها اللي هي its requirement to
+
+220
+00:16:00,110 --> 00:16:04,410
+x and v factor في ظاهرة اسمها satelliteism
+
+221
+00:16:04,410 --> 00:16:07,410
+بنستخدمها احنا للتعرف على اللي هو ال hemophilus
+
+222
+00:16:07,410 --> 00:16:10,230
+influenza أخدته عنده في المعمل، بدي أشرحلكم إياها
+
+223
+00:16:10,230 --> 00:16:17,750
+من خلال الصورة هذهالان عندي blood agar محتوي على
+
+224
+00:16:17,750 --> 00:16:22,510
+الهيمين اللي هو ال X factor لكن لا يحتوي على ال V
+
+225
+00:16:22,510 --> 00:16:25,130
+factor فلو زرعت hemophilus influenza على blood
+
+226
+00:16:25,130 --> 00:16:31,420
+agar هتنمو؟ مش هتنمو لن تنموطيب روحت أنا عملت في
+
+227
+00:16:31,420 --> 00:16:35,300
+خط المنتصف زراعة Staphylococcus aureus وال
+
+228
+00:16:35,300 --> 00:16:38,520
+Staphylococcus aureus معروف عنها إن هوية بتتكاثر
+
+229
+00:16:38,520 --> 00:16:44,000
+بتنتج إنها دق اللي هو ال V-factor إذا صار في عندي
+
+230
+00:16:44,000 --> 00:16:50,260
+في منطقة ما في الطبق ال X-factor متوفر في كل الطبق
+
+231
+00:16:50,260 --> 00:16:54,640
+و ال V-factor متوفر في منطقة حوالين مين؟الـ
+
+232
+00:16:54,640 --> 00:16:58,780
+Staphylococcus aureus بعد 24 ساعة من زراعة العينة
+
+233
+00:16:58,780 --> 00:17:02,140
+بتاعة البكتيريا تبعتي مع ال Staphylococcus aureus
+
+234
+00:17:02,140 --> 00:17:06,080
+بنشوف إذا البكتيريا الهيبافلس انفلوانزا موجودة
+
+235
+00:17:06,080 --> 00:17:13,280
+هلاجي إنه المستعمرات القريبة من خط الزراع large in
+
+236
+00:17:13,280 --> 00:17:17,620
+comparison large يعني كبيرة وكل ما ابتعدنا عن خط
+
+237
+00:17:17,620 --> 00:17:24,290
+الزراع ابتصغر فبسمو الظاهرة ديفأحد أهم .. أحد أهم
+
+238
+00:17:24,290 --> 00:17:27,790
+الصفات اللى ممكن من خلال اتعرف على البكتيريا اللى
+
+239
+00:17:27,790 --> 00:17:30,270
+هى بيقولنا ضائرة setolitis من ال hemophilus
+
+240
+00:17:30,270 --> 00:17:37,240
+influenzaهذه صورة حقيقية لطبق إذا بتلاحظوا ان
+
+241
+00:17:37,240 --> 00:17:40,520
+البكتيريا مزروعة على كل الطبق خدوا بالك البكتيريا
+
+242
+00:17:40,520 --> 00:17:44,700
+ليها hemophilus وهذا الخط هو staphylococcus aureus
+
+243
+00:17:44,700 --> 00:17:50,600
+الخاتين دول ال X فإذا بتلاحظوا فقط وين الزراع أو
+
+244
+00:17:50,600 --> 00:17:57,000
+البكتيريا موجودةمسافة قصيرة و لو دججنا النظر اكتر
+
+245
+00:17:57,000 --> 00:17:59,720
+يعني كبرنا الصورة هلاجي ان حجم المصطلحات بالفعل
+
+246
+00:17:59,720 --> 00:18:03,300
+هنا كبير و حجم هنا صغير فكل ما ابتعدنا عن الخط
+
+247
+00:18:03,300 --> 00:18:08,600
+الذراع بيكون صغير النمو طبعا في أشياء هنا شايفينها
+
+248
+00:18:08,600 --> 00:18:11,700
+كبيرة يمكنها هذي مش مخلص ان فلو انا زي هذي تلوث من
+
+249
+00:18:11,700 --> 00:18:13,460
+بتاعة ال Staphylococcus aureus
+
+250
+00:18:17,030 --> 00:18:21,790
+هذه طريقة أخرى لعملية التعرف أو استخدام الـ X and
+
+251
+00:18:21,790 --> 00:18:25,450
+V factor هنا محطوط V factor لحال و هنا X factor
+
+252
+00:18:25,450 --> 00:18:29,110
+لحال و هنا ان في X and V factor لحال
+
+253
+00:18:31,880 --> 00:18:34,500
+ع المنطقة، مع أنه خد بالك، لو هدا التانين جربناهم
+
+254
+00:18:34,500 --> 00:18:37,760
+مع بعض، تمام؟ لازم .. لو جربناهم مع بعض، هلاجي في
+
+255
+00:18:37,760 --> 00:18:41,460
+النص هنا نمو، لكن احنا انبعدين همان عشان مايصيش
+
+256
+00:18:41,460 --> 00:18:44,560
+هذا ال effect بدأ معانا عندي واحد تالت، بقدر
+
+257
+00:18:44,560 --> 00:18:47,900
+أستغنى عن هذا الفحص ولا بقدر أستغنى عنه هذا؟ بقدر،
+
+258
+00:18:47,900 --> 00:18:50,340
+جرب التانين مع بعض دولة، بصير المنطقة اللي في
+
+259
+00:18:50,340 --> 00:18:54,600
+المنتصف، تمام؟هي اللي فيها إنه لو البكتيريا بتحتاج
+
+260
+00:18:54,600 --> 00:18:59,360
+X and V factor هذا أيش ميزته؟ بقولّي لو البكتيريا
+
+261
+00:18:59,360 --> 00:19:02,580
+نمت هنا فقط يبقى معناه الحكي X and V factor
+
+262
+00:19:02,580 --> 00:19:06,440
+required مع بعضها لو نمت هنا و هنا فتحتاج إلى X لو
+
+263
+00:19:06,440 --> 00:19:10,180
+نمت إلى هنا و هنا إلى V لو نمت في كل الطبق يبقى
+
+264
+00:19:10,180 --> 00:19:14,880
+محتاجش لا X ولا V factor صح؟ إذا نمت في كل الطبق
+
+265
+00:19:14,880 --> 00:19:17,900
+مابتحتاجش X and V factor وبالتالي هي ليست
+
+266
+00:19:17,900 --> 00:19:22,320
+Hemophilusلأن هنا فلسة زي ما ذكرنا .. زي ما ذكرنا،
+
+267
+00:19:22,320 --> 00:19:25,900
+يا بتحتاج X، يا بتحتاج V، يا بتحتاج كلا هما، يا
+
+268
+00:19:25,900 --> 00:19:32,920
+بتحتاج كلهم يبقى متفقين على النقطة هذه احنا بنقول
+
+269
+00:19:32,920 --> 00:19:36,920
+إنه إذا البكتيريا نمت على القرص أو على ال filter
+
+270
+00:19:36,920 --> 00:19:40,980
+paper اللي محتوى على التنين لحالهم، تمام؟ فمعنا
+
+271
+00:19:40,980 --> 00:19:43,360
+الحكاية إن البكتيريا بحاجة إلى التنين، ال X و ال V
+
+272
+00:19:43,360 --> 00:19:45,980
+factor إذا نمت على هذا و هذا
+
+273
+00:19:48,980 --> 00:19:54,740
+هذا X وهذا V منفصلين وهذا X and V مع بعض فإذا نمت
+
+274
+00:19:54,740 --> 00:20:00,100
+هنا وهنا فتحتاج X إذا نمت هنا وهنا فتحتاج V إذا
+
+275
+00:20:00,100 --> 00:20:05,260
+نمت على كل الطبق لا تحتاج X ولا تحتاج V وبالتالي
+
+276
+00:20:05,260 --> 00:20:08,680
+ليست Hemophilus بالأساسبقول أن ال biochemical
+
+277
+00:20:08,680 --> 00:20:12,000
+tests are seldom used لكن في بعض الصفات زي الوريز
+
+278
+00:20:12,000 --> 00:20:15,200
+والاندول وال hemolysis and blood agar بالاضافة إلى
+
+279
+00:20:15,200 --> 00:20:18,760
+رقم تلاتة اللي هي جون عنها it's requirement for X
+
+280
+00:20:18,760 --> 00:20:25,780
+and V factors فضل لأ
+
+281
+00:20:28,620 --> 00:20:32,460
+لا على ال X ولا على ال X نقدرش نفتي من الفحص هذا
+
+282
+00:20:32,460 --> 00:20:37,580
+لوحده لكن إذا نمت على ال X and B factor تمام قد
+
+283
+00:20:37,580 --> 00:20:41,480
+تكون Hemophilus influenza لكن إذا لم تنمو أفضل إذا
+
+284
+00:20:41,480 --> 00:20:45,560
+احتجت فقط ال X أو احتجت ال V فقط فهي بالتأكيد ليس
+
+285
+00:20:45,560 --> 00:20:46,420
+Hemophilus influenza
+
+286
+00:20:50,810 --> 00:20:54,650
+ممكن نعم، لكن .. لكن .. لكن إذا كانت X and B
+
+287
+00:20:54,650 --> 00:20:57,230
+factor فربما تكون هموفلغص انفلواط، سنشوف
+
+288
+00:20:57,230 --> 00:21:01,440
+الـJudgment الآن اللي بيأكدك الكلام يعنيإذا بتلاحظ
+
+289
+00:21:01,440 --> 00:21:04,300
+في الجدول هنا في اندي x and v factor مين .. مين
+
+290
+00:21:04,300 --> 00:21:06,720
+بيحتاجهم hemophilus influenza ومين كمان
+
+291
+00:21:06,720 --> 00:21:11,480
+hemolyticus يبقى عشان اميز بين التنتين بعمل هو ال
+
+292
+00:21:11,480 --> 00:21:13,880
+hemolysis on blood agar فبالتالي هذه البكتيريا
+
+293
+00:21:13,880 --> 00:21:18,160
+بتكون positive وهذه بتكون negative إذا ليست الحاجة
+
+294
+00:21:18,160 --> 00:21:22,160
+على ال x و ال v لحالها هي المميزة وطبعا الشباب زي
+
+295
+00:21:22,160 --> 00:21:31,210
+ما فيه أنABI-20E للإنتيرو بكترياسي وABI-staph وABI
+
+296
+00:21:31,210 --> 00:21:34,930
+-stript فيانا كمان ABI للهيموفلاز انفلوانزا
+
+297
+00:21:34,930 --> 00:21:37,730
+وبالتالي فيانا مجموعة other biochemical test used
+
+298
+00:21:37,730 --> 00:21:41,890
+to identify في بالنسبة لل treatment طبعا الجدول
+
+299
+00:21:41,890 --> 00:21:46,660
+اللي قدامكوا هذاالجدول التوضيحي يعني لا يستطيع أن
+
+300
+00:21:46,660 --> 00:21:48,880
+يميز بين كل البكتيرا المذكورة في الجدول إذا
+
+301
+00:21:48,880 --> 00:21:53,640
+بتلاحظوا هي هذه وهذه شبهين بعض خالص التنتين
+
+302
+00:21:53,640 --> 00:21:57,960
+بيحتاجوا فقط ال X V Factor ال X Factor مابيحتاجوش
+
+303
+00:21:57,960 --> 00:22:01,580
+ال V Factor تمام؟ والتنتين اللي ممكن تستبعهم يا
+
+304
+00:22:01,580 --> 00:22:04,880
+أما negative يا أما slight فبالتالي بدهم further
+
+305
+00:22:04,880 --> 00:22:08,560
+test to be distinguished from each other لكن واضح
+
+306
+00:22:09,160 --> 00:22:12,240
+إن ولا واحدة من الهيموفراص اللي موجودة أمامنا إلا
+
+307
+00:22:12,240 --> 00:22:17,360
+بتحتاج يا X and يا X يا V يا كلهما بالنسبة لل
+
+308
+00:22:17,360 --> 00:22:19,960
+treatment بقولنا if sensitive ambicylin is the
+
+309
+00:22:19,960 --> 00:22:23,570
+drug of choiceإذا if sensitive، إيش يعني if
+
+310
+00:22:23,570 --> 00:22:27,170
+sensitive؟ يعني إذا البكتيريا في بلدكوا، في
+
+311
+00:22:27,170 --> 00:22:30,990
+منطقتكوا ما زالت sensitive أو ال isolate تبعك هو
+
+312
+00:22:30,990 --> 00:22:34,090
+sensitive لل ambicylin ف it is the drug of its
+
+313
+00:22:34,090 --> 00:22:36,150
+choice طبعا ال chloramphenicol أنا قلتلكوا الغو
+
+314
+00:22:36,150 --> 00:22:39,690
+خالص من كل ال hands out اللي موجودة معاكوا و
+
+315
+00:22:39,690 --> 00:22:44,390
+tetracycline could be also usedفي أن ميكروبجون عنه
+
+316
+00:22:44,390 --> 00:22:47,530
+homophilus duquery اللي حكي عنه STD اللي هو
+
+317
+00:22:47,530 --> 00:22:49,830
+sexually transmitted disease وهو عبارة عن gram
+
+318
+00:22:49,830 --> 00:22:53,510
+negative بس ال lie cultured on chocolate agar
+
+319
+00:22:53,510 --> 00:22:56,750
+requires only X factor مش ده homophilus influenza
+
+320
+00:22:56,750 --> 00:23:03,750
+كانت بدها التنتين causesشانكرايد وشانكرايد ايد ايد
+
+321
+00:23:03,750 --> 00:23:08,230
+شبيه بحاجة بتعرفوا التريبونيما تريبونيما باليدوم
+
+322
+00:23:08,230 --> 00:23:12,190
+اللي بسبب مرض السيفلس بتعمل ليجين على ال genital
+
+323
+00:23:12,190 --> 00:23:17,440
+area لل infected people بيسموها شانكرالان الشنكر
+
+324
+00:23:17,440 --> 00:23:20,920
+ال Legion اسمه شنكر تمام اللي هي بيسموه البثرة
+
+325
+00:23:20,920 --> 00:23:24,620
+الجنسية البثرة الجنسية اللي هي بيسبفها كمان مرة
+
+326
+00:23:24,620 --> 00:23:28,020
+البكتيريا ال syphilis فهذه البكتيريا بتعمل برضه
+
+327
+00:23:28,020 --> 00:23:31,280
+بثرة على ال external genitalia لإنفكت people تشبه
+
+328
+00:23:31,280 --> 00:23:35,200
+البثرة تبعت مين تحت مرض ال syphilis يسموها شنكرويد
+
+329
+00:23:35,200 --> 00:23:39,380
+لإنها شبيهة بشنكر اللي تبع ال syphilis treatment
+
+330
+00:23:39,380 --> 00:23:42,860
+ceftriaxone أو ciprofloxacin ممكن تستخدمه لعلاج
+
+331
+00:23:42,860 --> 00:23:50,020
+هذه البكتيريافي ميكروب تالت له علاقة بالهيموفلس
+
+332
+00:23:50,020 --> 00:23:54,780
+اسمه gardenella gardenella vaginalis وكان اسمه في
+
+333
+00:23:54,780 --> 00:23:57,240
+يوم من الأيام زي ما تشوفين في سطر تاني شباب كان
+
+334
+00:23:57,240 --> 00:24:01,040
+اسمه ايه هيموفلس vaginalis يعني فيه له خدنا نقول
+
+335
+00:24:01,040 --> 00:24:07,360
+صفات تشبه الهيموفلس احد ميزات هذه البكتيريا انها
+
+336
+00:24:07,360 --> 00:24:11,740
+normal flora of fifty percent of normal healthy
+
+337
+00:24:11,740 --> 00:24:17,460
+femalesتخيلوا يعني بنقدر نقول انها normal part of
+
+338
+00:24:17,460 --> 00:24:21,080
+the vaginal normal flora طب كيف تعمل disease؟
+
+339
+00:24:21,080 --> 00:24:26,700
+طلعوا على جملة التالتة بتقول it is found in small
+
+340
+00:24:26,700 --> 00:24:31,160
+numbers in vaginal secretions of fifty percent of
+
+341
+00:24:31,160 --> 00:24:36,280
+normal woman small numbers يبقى ال number تبعها
+
+342
+00:24:36,280 --> 00:24:40,000
+نحدودفاكرين لما كنا نتكلم عن الخلل في ال normal
+
+343
+00:24:40,000 --> 00:24:43,640
+flora في ال intestine نتيجة تناول antibiotics أو
+
+344
+00:24:43,640 --> 00:24:48,120
+نتيجة خلل معين or moral change؟ كانصير فيه موت
+
+345
+00:24:48,120 --> 00:24:52,560
+لبعض ال normal microbiota و overgrowth لأخريات
+
+346
+00:24:52,560 --> 00:24:56,460
+فلمّا يزيد عددها هذه البكتيريا ابتهم ال vaginitis
+
+347
+00:24:56,460 --> 00:25:01,320
+bacterial vaginitis characterized by إفرازات من ال
+
+348
+00:25:01,320 --> 00:25:06,600
+vagina ده ترائحة كريهةبسموها fish-like odor فشي
+
+349
+00:25:06,600 --> 00:25:10,660
+اوضر زي راحة السمك بس راحة السمك بتكون كريهة ال
+
+350
+00:25:10,660 --> 00:25:14,240
+lab diagnosis الشباب رائع جدا سهل بال gram stain
+
+351
+00:25:14,240 --> 00:25:20,080
+قد نرا خلية بسموها clue cell clue cell شوفت ال
+
+352
+00:25:20,080 --> 00:25:26,070
+clue cell ايش ال clue cell عبارة عنepithelial cell
+
+353
+00:25:26,070 --> 00:25:33,050
+مغطية مغطاة بالبكتيريا الاسمة Gardner's vaginalis
+
+354
+00:25:33,050 --> 00:25:37,070
+تشوفوها الصورة هاي ال normal epithelial cells من
+
+355
+00:25:37,070 --> 00:25:40,810
+ال vagina تمام طبعا عليها بكتيريا واحدة اتنين
+
+356
+00:25:40,810 --> 00:25:43,930
+تلاتة اربعة تلعبوا على ال clue cell شوفوا ال clue
+
+357
+00:25:43,930 --> 00:25:50,680
+cell ال clue cell عبارة عن خلية paintedمدهونها
+
+358
+00:25:50,680 --> 00:25:56,340
+بالبكتيريا، يعني كلها داخلها بكتيريا، لكن هنا إنها
+
+359
+00:25:56,340 --> 00:26:00,380
+واضحة، الـ cytoplasm واضح، الخلية واضحة هنا، فهذه
+
+360
+00:26:00,380 --> 00:26:06,060
+بيسموها Clusel، وجود Clusel من vaginal smear
+
+361
+00:26:06,060 --> 00:26:10,460
+بيعطينا مؤشر قوي إن البكتيريا المسببة بالمرض مين؟
+
+362
+00:26:10,460 --> 00:26:12,240
+gardenella vaginalis
+
+363
+00:26:14,890 --> 00:26:18,050
+المكروب التالي في السلسلة اللي احنا كنا في
+
+364
+00:26:18,050 --> 00:26:21,930
+محاضرتنا مقسم إلى قسمين Hemophilus and Bordetella
+
+365
+00:26:21,930 --> 00:26:27,130
+ال Bordetella ال species الأساسية اللي المعنية
+
+366
+00:26:27,130 --> 00:26:29,450
+فيها احنا اسمها Bordetella pertosis
+
+367
+00:26:33,370 --> 00:26:36,130
+السؤال اللي اديكي .. السؤال اللي اديكي
+
+368
+00:26:36,130 --> 00:26:39,690
+بورتيلابيرتوز هي السؤال اللي اديكي نعم وجزء من
+
+369
+00:26:39,690 --> 00:26:44,070
+تلاتة .. جزء من تلاتة فاكرين لما درسنا ال DPT؟ كنا
+
+370
+00:26:44,070 --> 00:26:49,830
+دفتيريا بيرتوز تيتانوس احنا درسنا الدفتيريا و
+
+371
+00:26:49,830 --> 00:26:54,130
+درسنا التيتانوس طلعنا ليهم مين؟البردوتيلة بيكون
+
+372
+00:26:54,130 --> 00:26:58,310
+غطينا ال vaccine اللي اسمه ال DBT البردوتيلة
+
+373
+00:26:58,310 --> 00:27:01,890
+بيرتوسس هي موضوع حديثنا اليوم طبعا الصورة اللي
+
+374
+00:27:01,890 --> 00:27:07,530
+هناك معبرة عن جداش بيطلع رذاذ عند العطس او عند
+
+375
+00:27:07,530 --> 00:27:12,820
+اللي هو السعال من الإنسانوهذه الصورة بما بنحطها
+
+376
+00:27:12,820 --> 00:27:15,880
+لما بنحط أي disease بينتقل عبر ال respiratory
+
+377
+00:27:15,880 --> 00:27:20,120
+tract فهي respiratory transmitted اذا ال
+
+378
+00:27:20,120 --> 00:27:23,060
+transmission by the respiratory tract route from
+
+379
+00:27:23,060 --> 00:27:27,200
+early case and possibly via carriers يعني اللي
+
+380
+00:27:27,200 --> 00:27:32,020
+مؤكد انه تنتقل من انسان مصاب الى انسان سليم لكن قد
+
+381
+00:27:32,020 --> 00:27:39,030
+تنتقل ايضا من carrier الى انسان سليمتعالى نطلع على
+
+382
+00:27:39,030 --> 00:27:41,910
+ال disease بس خلينا مع بعض نتخيل الوضع التالي
+
+383
+00:27:41,910 --> 00:27:44,950
+الترتفه في التراكيا تراكيا القصبة اللي هو ايه؟
+
+384
+00:27:44,950 --> 00:27:49,510
+فيها سيليا احنا لو جولنا ال lungs ال lungs مفتوحة
+
+385
+00:27:49,510 --> 00:27:53,430
+على العالم الخارجي بنتنفس و بناخد هوا مرات من الفم
+
+386
+00:27:53,430 --> 00:27:56,430
+و الفم مليان اصلا بكتيريا و الهوا مليان بكتيريا
+
+387
+00:27:56,430 --> 00:27:59,350
+فدائما في بكتيريا في ال lungs لكن ال lungs
+
+388
+00:27:59,350 --> 00:28:04,470
+اعتبرناها sterile ليش؟لأن فيها ميكانيزم لطرد ال
+
+389
+00:28:04,470 --> 00:28:09,710
+micro organism للاستياد الميكروبات عن طريق
+
+390
+00:28:09,710 --> 00:28:12,670
+الميوكاس ومن ثم طرد هذا الميوكاس وبالتالي ال lungs
+
+391
+00:28:12,670 --> 00:28:16,970
+دايما ايه اللي قلناها استيراية الان مين المسئول عن
+
+392
+00:28:16,970 --> 00:28:23,990
+الطرد هذا الحركة المنظمة للسيليائي بهذا الشكل الان
+
+393
+00:28:23,990 --> 00:28:26,970
+تخيل انت جاعة تشتغل بهذا الشكل و انا واحد مش علاج
+
+394
+00:28:26,970 --> 00:28:32,600
+بيدكوتنان شالا جوهانا كيف يصيح الحركات؟ حركات غير
+
+395
+00:28:32,600 --> 00:28:37,380
+منتظمة الحركة الغير منتظمة تؤثر على المصعد وسموه
+
+396
+00:28:37,380 --> 00:28:41,120
+مصعد لأنه يطلع هو من الأسفل إلى أعلى المصعد
+
+397
+00:28:41,120 --> 00:28:46,240
+المرتبط بالسيليانالان تراكم الـ sputum في المنطقة
+
+398
+00:28:46,240 --> 00:28:50,760
+وتحلل البكتيريا .. تحلل البكتيريا لإن برضه
+
+399
+00:28:50,760 --> 00:28:54,720
+البكتيريا بتموت تحلل البكتيريا و الخلايا بيعمل
+
+400
+00:28:54,720 --> 00:28:58,740
+irritation لإتراكيا هذا ال irritation بيعمل
+
+401
+00:28:58,740 --> 00:29:03,240
+triggering لل cuff mechanism لقالية اللي هو الكحة
+
+402
+00:29:03,240 --> 00:29:10,190
+احنا مش بنكحبنطرد يعني هي reaction طبيعي من الجسم
+
+403
+00:29:10,190 --> 00:29:13,390
+reaction طبيعي من الجسم لإن احنا بنكح و بناخد نفس
+
+404
+00:29:13,390 --> 00:29:18,670
+نرتاح بنكل كحة و كحة لكن لما يكون ال irritation
+
+405
+00:29:18,670 --> 00:29:26,650
+continuousبيضطر الإنسان إن كحّة متواصلة قد يفقد كل
+
+406
+00:29:26,650 --> 00:29:30,230
+الهواء لأن الكحّة أصلا معتمدة علاقة على مدافع من
+
+407
+00:29:30,230 --> 00:29:32,310
+الهواء، صح أو لا؟ مدافع من الهواء، من ال lungs
+
+408
+00:29:32,310 --> 00:29:35,950
+فبالتالي بيفقد ال content من الهواء في ال lungs
+
+409
+00:29:35,950 --> 00:29:41,330
+فما بيخلص الكحّة تبعته النوبة تبعته اللي هو he's
+
+410
+00:29:41,330 --> 00:29:45,590
+hungry for air المريض بيصير جوعان للهواء أو
+
+411
+00:29:45,590 --> 00:29:52,310
+للأكسجينفبروحوا وشافت بأكثر بأقصى سرعة عبر عبر
+
+412
+00:29:52,310 --> 00:29:56,390
+constructed ايش انا constructed؟ يعني اضيقت اللي
+
+413
+00:29:56,390 --> 00:29:59,410
+هي تراكيا بفعل التكسين بيصير فيها construction
+
+414
+00:29:59,410 --> 00:30:05,610
+فلما يمر هوا بشكل سريع إلى تراكيا بيحدث اللي هو ال
+
+415
+00:30:05,610 --> 00:30:08,070
+whoops اللي احنا بيسميها whooping cough او اللي
+
+416
+00:30:08,070 --> 00:30:12,430
+بيسميها السعال الديكي باللغة العربي اذا هذا هو ال
+
+417
+00:30:12,430 --> 00:30:15,690
+.. ال .. السبب في انه او كيف ال mechanism بتحدث من
+
+418
+00:30:15,690 --> 00:30:20,220
+ال diseaseالمرض يمر بثلاث مراحل كاترال استاج
+
+419
+00:30:20,220 --> 00:30:24,180
+وبراجزومال استاج وconvalescent استاج خدوا بالكم
+
+420
+00:30:24,180 --> 00:30:28,620
+الشغل أيه
+
+421
+00:30:28,620 --> 00:30:32,860
+الآن موجود الكاترال استاج with an irritating cough
+
+422
+00:30:32,860 --> 00:30:38,790
+which lasts for one to two weeksيعني بتستمر هذه
+
+423
+00:30:38,790 --> 00:30:41,410
+الفترة و هنقولكوا كيف .. ايش العارف تبعتها؟ العارف
+
+424
+00:30:41,410 --> 00:30:44,850
+تبعتها غالبا بتعرفه لما الواحد بيرشح ايش بيكون
+
+425
+00:30:44,850 --> 00:30:51,090
+عنده runny nose يعني بيصير الانف سيل تمام ممكن low
+
+426
+00:30:51,090 --> 00:30:53,710
+grade fever سبعة و تلاتين و نص تمان و تلاتين درجة
+
+427
+00:30:53,710 --> 00:30:59,170
+مقاوية لكن مش تسعة و تلاتين واربعين الفترة الزمنية
+
+428
+00:30:59,170 --> 00:31:02,810
+اللي بيستمر هذا المرحلة من واحد إلى اتنين أسبوع
+
+429
+00:31:03,270 --> 00:31:07,990
+مرحلة خطيرة جدا وصعبة جدا اللي هي مرحلة البرجزينال
+
+430
+00:31:07,990 --> 00:31:11,820
+استيشنوهذه المرحلة التمييز بالـ Symptoms اللي انا
+
+431
+00:31:11,820 --> 00:31:15,740
+ذكرتلكوا هي الكف العنيف اللي حكيته و characterized
+
+432
+00:31:15,740 --> 00:31:18,100
+by violent coughs followed by high respiratory
+
+433
+00:31:18,100 --> 00:31:24,320
+whoops last for two to six weeks من أسبوعين لست
+
+434
+00:31:24,320 --> 00:31:28,180
+أسابيع المرحلة التالتة اللي هي مرحلة التماثل
+
+435
+00:31:28,180 --> 00:31:31,500
+للشفاء اللي بيسميها النقاها Convalescent stage
+
+436
+00:31:31,500 --> 00:31:34,840
+where the cough gradually decreases in frequency
+
+437
+00:31:34,840 --> 00:31:40,790
+and severity last for several weeksهى نفس المرحلة
+
+438
+00:31:40,790 --> 00:31:46,950
+الاولانية لكن ال frequency ما بين الكف والكف بيطول
+
+439
+00:31:46,950 --> 00:31:50,710
+بدل ما كان كل ساعة ساعتين بيصير كل اربع ساعات او
+
+440
+00:31:50,710 --> 00:31:56,330
+كل خمس ساعات او مرتين في اليوم تمام لكن الكف بيظل
+
+441
+00:31:56,330 --> 00:32:04,550
+ايه موجود و قد تستمر لعدة اسابيع خد بالكم ال
+
+442
+00:32:04,550 --> 00:32:09,460
+fatality rate مش هى الرقم هذا اللى 75بقولنا إن
+
+443
+00:32:09,460 --> 00:32:13,960
+الوفيات اللي بتحدث تمام من هذا المرض خمسة وسبعين
+
+444
+00:32:13,960 --> 00:32:18,900
+في المية من الوفيات تحدث من؟ في الرضع ليش الرضع
+
+445
+00:32:18,900 --> 00:32:23,460
+بالذات؟ كيف؟
+
+446
+00:32:25,580 --> 00:32:29,900
+أول حاجة ال .. ال .. ال .. ال secretions اللي
+
+447
+00:32:29,900 --> 00:32:34,000
+بتنتج منه مش هيف يتعامل معها زي الطفل ال .. ال ..
+
+448
+00:32:34,000 --> 00:32:38,000
+ال .. الواعي أو المدرك تمام عملية ال .. ال .. ال
+
+449
+00:32:38,000 --> 00:32:41,200
+nutrition أو التغذية بتكون برضه سيئة لإنه تت ..
+
+450
+00:32:41,200 --> 00:32:44,620
+يعني الرضاعة هتتأثر بعملية اللي هو ال coughing
+
+451
+00:32:44,620 --> 00:32:48,260
+النوم هيتأثر بعملية ال coughing فال immune system
+
+452
+00:32:48,260 --> 00:32:54,360
+تبعه كله بيكون ضعيفSigns and symptoms زى ما حكينا
+
+453
+00:32:54,360 --> 00:32:56,980
+في الأول بيكون في عندنا runny nose, sneezing,
+
+454
+00:32:57,020 --> 00:33:00,500
+أعطس, mild cough, low grade fever لكن بعد هيك
+
+455
+00:33:00,500 --> 00:33:07,260
+تبقون ممكن تتحول لبروجزيمال stage الآن في نقطة
+
+456
+00:33:07,260 --> 00:33:11,280
+كتير مهمة بدنا نقشها هنا بتعرفوا أن ال viral
+
+457
+00:33:11,280 --> 00:33:16,690
+infection characterized by lymphocytosisيعني لو
+
+458
+00:33:16,690 --> 00:33:20,710
+احنا عملنا differential blood film من ال blood
+
+459
+00:33:20,710 --> 00:33:24,630
+film حلاجة ال lymphocyte عالية الوضع الطبيعي يكون
+
+460
+00:33:24,630 --> 00:33:27,670
+أعلى ال neutrophil وال bacterial infection ال
+
+461
+00:33:27,670 --> 00:33:32,250
+neutrophil بكون دائما مرتفع اكتر ال neutrophil في
+
+462
+00:33:32,250 --> 00:33:35,290
+هذا الحالة لو أخدنا عينة دم من المريض حلاجة عنده
+
+463
+00:33:35,290 --> 00:33:39,380
+lymphocytes عالية lymphocytosisهذا ال
+
+464
+00:33:39,380 --> 00:33:46,740
+lymphocytosis ليس ناجم عن lymphocytosis حقيقي لكن
+
+465
+00:33:46,740 --> 00:33:49,580
+للأسف أنا ماقدرش أميز أنا في المختبر ماقدرش أقولك
+
+466
+00:33:49,580 --> 00:33:52,580
+هذا lymphocytosis حقيقي ولا مش حقيقي أنا بقدر
+
+467
+00:33:52,580 --> 00:33:56,780
+أقولك إنه في lymphocytosis فكنت بي confused with
+
+468
+00:33:56,780 --> 00:34:01,600
+viral infection بقدر أكون أعرف إنه في حالة ال
+
+469
+00:34:01,600 --> 00:34:04,760
+border telepertosis ال lymphocyte ترتفع لماذا
+
+470
+00:34:04,760 --> 00:34:08,560
+ترتفع ال lymphocytes طلع عليهمبقولنا ال bordella
+
+471
+00:34:08,560 --> 00:34:11,940
+pertosis strains contains peptide that promotes
+
+472
+00:34:11,940 --> 00:34:16,760
+marked lymphocytosis in the host ايش يعني marked؟
+
+473
+00:34:16,760 --> 00:34:23,620
+marked واضح lymphocytosis كيف؟ نتخيل مع بعض نقاط
+
+474
+00:34:23,620 --> 00:34:29,080
+مراقبة .. نقاط مراقبة بتطلع دوريات الدوريات هذه
+
+475
+00:34:29,080 --> 00:34:33,500
+lymphocytesالان ال lymphocyte طلعت على الدم ومعها
+
+476
+00:34:33,500 --> 00:34:37,980
+فترة زمانية محددة تعمل الجولة تبعتها وترجع على
+
+477
+00:34:37,980 --> 00:34:43,260
+مكان إقامتها هذا ال peptide بيمنع عودة ال
+
+478
+00:34:43,260 --> 00:34:49,680
+lymphocyteفالان الدفعة طلعت هيطلع دفعة تانية هيطلع
+
+479
+00:34:49,680 --> 00:34:54,200
+دفعة تالتة دون عودة من اللي هم ال lymphocytes
+
+480
+00:34:54,200 --> 00:34:57,680
+الأولانين وبالتالي في سيرفندي في الدم كمية كبيرة
+
+481
+00:34:57,680 --> 00:35:02,080
+من ال lymphocytes ليس بسبب انها رايحت كافح اللي هو
+
+482
+00:35:02,080 --> 00:35:06,080
+ال ال ال ال portulapertosis وانما لأن ال peptide
+
+483
+00:35:06,080 --> 00:35:13,370
+منعها من العودة مرة أخرى إلى قوائلهذه صورة لطفل في
+
+484
+00:35:13,370 --> 00:35:17,210
+.. أثناء النوبة وانا بانصحكم من الإطلاع على يعني
+
+485
+00:35:17,210 --> 00:35:23,670
+فيديوهات visit youtube واطلع على whooping cough او
+
+486
+00:35:23,670 --> 00:35:27,910
+pertosis videos هتلاقي بعض الفيديوهات المؤذية جدا
+
+487
+00:35:27,910 --> 00:35:30,750
+للأطفال لكن لا بأس انك تطلع عليها عشان تشوف ال
+
+488
+00:35:30,750 --> 00:35:36,340
+symptoms تبعدال borrelia pertosis بيشبه .. إذا
+
+489
+00:35:36,340 --> 00:35:38,320
+بتلاحظوا احنا حاطين احنا مين لإنه ال cholratoxin
+
+490
+00:35:38,320 --> 00:35:41,580
+.. ال cholratoxin لإنه .. إيه؟ ده تقريبا نفس
+
+491
+00:35:41,580 --> 00:35:44,180
+الفكرة لكن احنا جونا هدا في ال intestine و هدا في
+
+492
+00:35:44,180 --> 00:35:49,780
+اللي هو ال .. ال respiratory tractOrganism short
+
+493
+00:35:49,780 --> 00:35:53,160
+avoid يعني بيضاوي نوعا ما جرام negative بس الله
+
+494
+00:35:53,160 --> 00:35:56,400
+ايروبيك يعني بنقدر نقول برضه هي cocoa بس الله
+
+495
+00:35:56,400 --> 00:36:00,460
+ايروبيك complex هذه نقطة كتير مهمة complex
+
+496
+00:36:00,460 --> 00:36:04,100
+enriched media is required for the isolation اسم
+
+497
+00:36:04,100 --> 00:36:09,110
+الميديا بوردت جينجو أجار بوردت جينجو أجارإذاً هذا
+
+498
+00:36:09,110 --> 00:36:12,930
+الوسط اللي لازم نربطه بالبكتيريا زي الـLorinstein
+
+499
+00:36:12,930 --> 00:36:17,510
+جنس أجار في الميكوبكتيريا زي الـTCPS في الـVibrio
+
+500
+00:36:17,510 --> 00:36:21,510
+cholera بنربط الboard الجينجو في الboard البرتوس
+
+501
+00:36:21,510 --> 00:36:25,250
+it is non-motile, urease negative, nitrate
+
+502
+00:36:25,250 --> 00:36:30,930
+negative هنا كل مرة بناخد العينة و بنزرعها صح؟ هنا
+
+503
+00:36:30,930 --> 00:36:35,910
+ممكن نعمل حاجة مختلفة بيسموا الطبق أو التقنية cuff
+
+504
+00:36:35,910 --> 00:36:41,760
+plateالطفل عندما يحصل عنده النوبة يفتح الطبق و
+
+505
+00:36:41,760 --> 00:36:47,850
+يجربوا منه مسافة معينة و الطفل يصير كحو .. و .. و
+
+506
+00:36:47,850 --> 00:36:51,450
+الرضاد اللي بيطلع يزرع مين؟ يزرع الطبق نفسه، بنسكر
+
+507
+00:36:51,450 --> 00:36:55,190
+الطبق و بنعمله incubation في ال .. سموه calf plate
+
+508
+00:36:55,190 --> 00:36:59,470
+جداش بدنا ال .. ال .. ال plates 35 degree
+
+509
+00:36:59,470 --> 00:37:02,070
+centigrade يعني سابقة تلاتين يعني برضه، من اتنين
+
+510
+00:37:02,070 --> 00:37:06,030
+لخمس أيام، إذا البكتيريا بالفعل fastidious ما
+
+511
+00:37:06,030 --> 00:37:11,070
+بتنموش خلال اربع عشرين ساعةمين درسنا من ال
+
+512
+00:37:11,070 --> 00:37:19,850
+bacteria that resembles mercury droplets هو
+
+513
+00:37:19,850 --> 00:37:24,230
+ما احنا أخدنا من بارد فرانسسيلا تولرانسس على CGPA
+
+514
+00:37:24,230 --> 00:37:28,790
+فرانسسيلا تولرانسس لكن هذا مش على اللي هو
+
+515
+00:37:28,790 --> 00:37:33,630
+الفرانسسيلا هذا على اللي هو ال board جينجو أجار و
+
+516
+00:37:33,630 --> 00:37:37,230
+برضه بيعطينا mercury droplet colonies برضه
+
+517
+00:37:37,230 --> 00:37:41,650
+surrounded by a zone of hemolysisعشان نقدر نتأكد
+
+518
+00:37:41,650 --> 00:37:44,990
+من ان المستعمرات بورديلابيرتوسز بإن الكولانيز are
+
+519
+00:37:44,990 --> 00:37:47,930
+confirmed by agglutinating with polyvalent او
+
+520
+00:37:47,930 --> 00:37:49,410
+monovalent antiserum
+
+521
+00:37:54,600 --> 00:37:59,220
+في انديانا الأمراض أخرى يمكن غير ال bordetella
+
+522
+00:37:59,220 --> 00:38:02,080
+pertosis احنا ال bordetella pertosis بتعمل برتوسس
+
+523
+00:38:02,080 --> 00:38:07,420
+في ال parapertosis برضه بتعمل برتوسس لكن شكل أخف
+
+524
+00:38:07,420 --> 00:38:11,200
+حد أو أقل حد من اللي هو ال bordetella pertosis اذا
+
+525
+00:38:11,200 --> 00:38:15,420
+bordetella pertosis bordetella parapertosis شفتوا
+
+526
+00:38:15,420 --> 00:38:18,780
+انتوا هذا المسميات كتيرة typhoid وparatyphoid
+
+527
+00:38:19,620 --> 00:38:22,760
+Hemophilus influenza, Parainfluenza, Hemophilus
+
+528
+00:38:22,760 --> 00:38:26,440
+Afrophilus, Hemophilus Parafrophilus هاي كمان
+
+529
+00:38:26,440 --> 00:38:31,000
+بوردتلا بيرتوسس و بوردتلا بارا بيرتوسس بس في انها
+
+530
+00:38:31,000 --> 00:38:35,640
+برونكيو سيبتيكا بوردتلا برونكيو سيبتيكا برضه بسبب
+
+531
+00:38:35,640 --> 00:38:41,560
+برونكيو بالموناري disease الطلاع الجدول هذا كتير
+
+532
+00:38:41,560 --> 00:38:44,860
+مهم للجدول و الجدول هذا كتير بيميزن البكتيريا عن
+
+533
+00:38:44,860 --> 00:38:48,700
+بعضهابقول يفهم دي مجموعة من ال features زي ال
+
+534
+00:38:48,700 --> 00:38:51,760
+growth on blood free media كلمة blood free media
+
+535
+00:38:51,760 --> 00:38:56,380
+يعني وسط خالي من الدم motility, urease, citrate,
+
+536
+00:38:56,500 --> 00:38:57,860
+nitrate reduction لاحظوا ال blood free media
+
+537
+00:38:57,860 --> 00:39:01,940
+البرتوسز نيجاتيف for all it cannot grow on a blood
+
+538
+00:39:01,940 --> 00:39:06,160
+free media بدها blood في الميديا it is non motile
+
+539
+00:39:06,160 --> 00:39:09,480
+it is urease negative it is citrate negative it is
+
+540
+00:39:09,480 --> 00:39:12,360
+nitrate reduction negative يبقى نيجاتيف لكل الصفات
+
+541
+00:39:12,360 --> 00:39:18,170
+بينما ال parapertosispositive لكل الصفات معها
+
+542
+00:39:18,170 --> 00:39:21,410
+صفتين ال motility و ال nitrate reduction و ال
+
+543
+00:39:21,410 --> 00:39:25,130
+bronchieuceptica positive لكل الصفات اذا هذا
+
+544
+00:39:25,130 --> 00:39:29,770
+الجدول اعتقد مش على عكس ما رأيناه في ال hemophilus
+
+545
+00:39:29,770 --> 00:39:33,170
+هذا بيميز بين ال three species اللي احنا ذكرنا
+
+546
+00:39:33,170 --> 00:39:35,850
+بالنسبة لل treatment بدنا نتكلم معاها شوية و ننهي
+
+547
+00:39:35,850 --> 00:39:39,190
+فيها محاضرتنا ان شاء الله اللي هو ال erythromycin
+
+548
+00:39:39,190 --> 00:39:44,190
+is a drug of choice خدوا بالكم الشغلالان احنا
+
+549
+00:39:44,190 --> 00:39:49,110
+غالبا في ال treatment .. في ال treatment بنمنع ال
+
+550
+00:39:49,110 --> 00:39:51,770
+progression of the disease و بن .. بن .. بن ..
+
+551
+00:39:51,770 --> 00:39:56,770
+خدنا نقول بنقصر فترة المرض نفسه هذا ال treatment
+
+552
+00:39:56,770 --> 00:40:04,830
+هنا غالبا مابتقصرش كتير فترة المرضيعني بمعنى اخر
+
+553
+00:40:04,830 --> 00:40:07,370
+احنا مش جولنا فيه three stages فاكرينهم؟ catural,
+
+554
+00:40:07,690 --> 00:40:11,390
+paroxysmal وconvalescent بقولنا course of the
+
+555
+00:40:11,390 --> 00:40:15,350
+disease سواء اعطيت treatment او ما اعطيت treatment
+
+556
+00:40:15,350 --> 00:40:20,320
+ال course هيمر بالثلاث مراحللكن ال treatment ممكن
+
+557
+00:40:20,320 --> 00:40:24,920
+تقلل من ال suffering من يعني الألم من عدد ال
+
+558
+00:40:24,920 --> 00:40:30,140
+frequency وممكن كمان تساعد في عدم نقل العدوى عدم
+
+559
+00:40:30,140 --> 00:40:34,180
+نقل العدوى من المصاب إلى الآخرين لإنه بيصير
+
+560
+00:40:34,180 --> 00:40:37,520
+البكتيريا هنا inactivated لكن ال course of the
+
+561
+00:40:37,520 --> 00:40:40,720
+disease غالبا ما بيتأثر المرة اللي جاي بإذن الله
+
+562
+00:40:40,720 --> 00:40:45,640
+هنتكلم عن اللي هو ال legionella pneumophila وهذه
+
+563
+00:40:45,640 --> 00:40:49,680
+هتكونيمكن أخر بكتيريا في المجموعة الصغيرة
+
diff --git a/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/z22vrEWh5vM_raw.srt b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/z22vrEWh5vM_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..a304d8561f48427df5f9497e79b0bf3e6df028da
--- /dev/null
+++ b/PL9fwy3NUQKwa_IUmPLSdzu8haq0_fdQUd/z22vrEWh5vM_raw.srt
@@ -0,0 +1,2576 @@
+1
+00:00:21,060 --> 00:00:26,040
+بسم الله الرحمن الرحيم to sum up اللي أخدناه في
+
+2
+00:00:26,040 --> 00:00:29,460
+المحاضرة السابقة احنا أخدنا أنوان جديد Gram
+
+3
+00:00:29,460 --> 00:00:33,800
+Negative Diplococci وبدأنا بالحديث عن نيسيريا شفنا
+
+4
+00:00:33,800 --> 00:00:38,460
+species متنوعة جونا رقم واحد واتنين هم الأساس في
+
+5
+00:00:38,460 --> 00:00:41,840
+المجموعة والباقي non pathogen لكن رقم تلاتة
+
+6
+00:00:41,840 --> 00:00:44,820
+طلعناها من نيسيريا وصار اسمها Brannhamella
+
+7
+00:00:44,820 --> 00:00:48,890
+caturalisقلنا إن سيريا جونورية يعني one of the
+
+8
+00:00:48,890 --> 00:00:51,010
+most أو the second most common sexually
+
+9
+00:00:51,010 --> 00:00:53,690
+transmitted disease في ال western hemisphere في
+
+10
+00:00:53,690 --> 00:00:57,370
+العالم الغربي وقلنا إن هذه البكتيريا ليست جديدة
+
+11
+00:00:57,370 --> 00:01:02,050
+وإنما تم الإسم أو أعطاها الإسم 130 جونورية أعطاها
+
+12
+00:01:02,050 --> 00:01:06,830
+اسم بواسطة gallon في 130 ميلادية لكن نيسر هو
+
+13
+00:01:06,830 --> 00:01:10,990
+اكشفها اكشف حقيقي علمي وتكريما له سمة البكتيريا
+
+14
+00:01:10,990 --> 00:01:14,690
+على اسمه وقلنا إن ال host الوحيد لهذه البكتيريا هو
+
+15
+00:01:14,690 --> 00:01:18,470
+الإنسانطرقنا لبعض ال characteristics لدى
+
+16
+00:01:18,470 --> 00:01:20,850
+البكتيريا، قولنا عنها إنها Gram-nated بلوكوكايوكس
+
+17
+00:01:20,850 --> 00:01:23,930
+دايز بُستف، قولنا هذه نقطة كتير أساسية، its
+
+18
+00:01:23,930 --> 00:01:29,870
+ability to utilize dextrose only، بينما ال نيسيريا
+
+19
+00:01:29,870 --> 00:01:34,170
+من الهيزايتس اللي هو ال both maltose and قولنا
+
+20
+00:01:34,170 --> 00:01:39,050
+dextrose. كمان ذكرنا نقطة كتير مهمة، عدم مقدرتها
+
+21
+00:01:39,050 --> 00:01:42,410
+على النمو على أوساط زي ال nutrient agar، بينما ال
+
+22
+00:01:42,410 --> 00:01:47,740
+other bacteria، ال other non pathogen can grow.في
+
+23
+00:01:47,740 --> 00:01:49,960
+كمان نقطة كتير مهمة ذكرناها المرة الماضية بس
+
+24
+00:01:49,960 --> 00:01:52,900
+نذكركوا فيها الـ Antigenic Variation للبيلعي اللي
+
+25
+00:01:52,900 --> 00:01:56,500
+كنا بنستخدمه كأساس للموليكلر Characterization أو
+
+26
+00:01:56,500 --> 00:01:58,880
+الابديموليكال Characterization وفي نفس الوقت
+
+27
+00:01:58,880 --> 00:02:06,360
+بنستخدمه كتفسير لماذا لا يعني توفر الإصابة حماية
+
+28
+00:02:06,360 --> 00:02:09,840
+من إصابة أخرى على نظرنا لأنه فينا Antigenic
+
+29
+00:02:09,840 --> 00:02:14,150
+Variation كلمة عن الشكل وعن كيفالبكتيريا ممكن
+
+30
+00:02:14,150 --> 00:02:16,690
+نعملها Gram Stain من Urethral Discharge وميزنا
+
+31
+00:02:16,690 --> 00:02:19,710
+بيها Urethral Discharge من Male ومن Female، جُدنا
+
+32
+00:02:19,710 --> 00:02:23,950
+من Male Presumptively انها ناسيريا جنورية، لكن من
+
+33
+00:02:23,950 --> 00:02:26,870
+Female لاتعني شيء لأنه ممكن يكون يا normal
+
+34
+00:02:26,870 --> 00:02:33,290
+effluent ذكرنا كمان بالنسبة لتوزيع البكتيريا في ال
+
+35
+00:02:33,290 --> 00:02:36,050
+.. في الاسمير، جُدنا إذا كان Intracellular تعني
+
+36
+00:02:36,050 --> 00:02:39,770
+acute وإذا Extracellular تعني chronic infection
+
+37
+00:02:40,960 --> 00:02:46,080
+تحدثنا عن الـ chocolate agar ك media و ذكرنا ان هي
+
+38
+00:02:46,080 --> 00:02:49,260
+ممكن تنمو على blood agar لكن او المكونات تبع ال
+
+39
+00:02:49,260 --> 00:02:52,660
+blood agar قد تسمح بنمو البكتيريا لكن كون
+
+40
+00:02:52,660 --> 00:02:56,820
+البكتيريا كانت حساسة قلنا عنها delicate فربما يكون
+
+41
+00:02:56,820 --> 00:03:00,600
+هناك component في ال blood agar سام لمين للبكتيريا
+
+42
+00:03:00,600 --> 00:03:03,940
+فلو انا سخنت الدم عن طريق ان انا بدي اكون
+
+43
+00:03:03,940 --> 00:03:07,280
+chocolate agar مضطر اسخن الدم الى تمانية درجة نوية
+
+44
+00:03:07,280 --> 00:03:12,250
+هعملية تسخين هذهتقضي على معظم الـ toxic material
+
+45
+00:03:12,250 --> 00:03:15,750
+الموجودة في مين؟ في ال blood وكونها بتحتاج CO2
+
+46
+00:03:15,750 --> 00:03:20,330
+أصلا لنموه شباب فهذا كمان مدعاي ان احنا نميها على
+
+47
+00:03:20,330 --> 00:03:24,390
+شوكولات أجر حكينا عن ال transport media اللي هو
+
+48
+00:03:24,390 --> 00:03:28,210
+transport media فقط لحماية البكتيريا من الجفاف
+
+49
+00:03:28,210 --> 00:03:32,550
+خلال فترة ما بين جامعة العينة واللي هو ال
+
+50
+00:03:32,550 --> 00:03:35,750
+processing تبعها لأن البكتيريا is very sensitive
+
+51
+00:03:35,750 --> 00:03:39,710
+to dryingو اتكلمنا اخر شي على ما اذكر على الثير
+
+52
+00:03:39,710 --> 00:03:42,870
+مارتين اجار و انه بيحتوي على three antibiotics one
+
+53
+00:03:42,870 --> 00:03:46,510
+for pancomycin, colestin and nestatine و ال
+
+54
+00:03:46,510 --> 00:03:52,170
+nestatine ضفنا لغرض انه مايكونش فيه لو كان فيه
+
+55
+00:03:52,170 --> 00:03:54,470
+fungal infection و خاصة ال candida albicans ..
+
+56
+00:03:54,470 --> 00:03:57,170
+candida albicans اللي هي الخميرة و ال candida
+
+57
+00:03:57,170 --> 00:03:59,650
+albicans قد تكون normal flora بعض الأحيان في ال
+
+58
+00:03:59,650 --> 00:04:03,430
+vagina لل femaleوبالتالي في عدم موجود antifungal
+
+59
+00:04:03,430 --> 00:04:06,970
+it will overgrow .. overgrow يعني حتنمو و اتغطي
+
+60
+00:04:06,970 --> 00:04:11,110
+الطبق على حساب مين؟ على حساب ان سيريا جونريا و
+
+61
+00:04:11,110 --> 00:04:14,690
+هاركوا أطباق الآن الفرق ما بين إضافة antibiotic و
+
+62
+00:04:14,690 --> 00:04:20,970
+على إضافة antibiotics .. Candida Albicans ..
+
+63
+00:04:20,970 --> 00:04:22,690
+اللي مش عارفين اسم ميادة
+
+64
+00:04:51,740 --> 00:04:56,640
+هذا الصورة اللي قدامنا بتوضح التالي بتوضح انه على
+
+65
+00:04:56,640 --> 00:05:01,670
+طبق شوكولات أجار عينة مزروعةعلى طبقين واحد general
+
+66
+00:05:01,670 --> 00:05:03,630
+median اللي هو تشوف الاجار والتاني ال selective
+
+67
+00:05:03,630 --> 00:05:06,070
+اللي هو الثير مارتن اجار على الطبق ال general
+
+68
+00:05:06,070 --> 00:05:11,550
+بنلاحظ ان النمو كثيف جدا هذا مؤشر على ايش على انه
+
+69
+00:05:11,550 --> 00:05:14,790
+مش بس ناسيريا جنورية اللي نمت والاخريات اللي
+
+70
+00:05:14,790 --> 00:05:18,110
+موجودة في العين ايضا نمو لكن في الثير مارتن اجار
+
+71
+00:05:18,110 --> 00:05:21,830
+النمو خفيف جدا مؤشر على انه مين اللي نم فقط
+
+72
+00:05:21,830 --> 00:05:27,210
+ناسيرياوانا مرارا واتكرارا بنقول انه يا شباب نحتاج
+
+73
+00:05:27,210 --> 00:05:32,190
+selective media عندما يكون الميكروب المعني المراد
+
+74
+00:05:32,190 --> 00:05:39,430
+عزله موجود في بيئة مش وحده موجود مع others ال
+
+75
+00:05:39,430 --> 00:05:42,830
+diagram
+
+76
+00:05:42,830 --> 00:05:48,460
+هذا يعني بدي اركز على معلومتان صغار فيهأول حاجة
+
+77
+00:05:48,460 --> 00:05:51,080
+انهم كلهم oxidized positive كل الناس هنا سواء
+
+78
+00:05:51,080 --> 00:05:52,640
+pathogenic او non pathogenic كلهم oxidized
+
+79
+00:05:52,640 --> 00:05:57,840
+positive لكن قدرتهم على ال utilization لل
+
+80
+00:05:57,840 --> 00:06:01,360
+carbohydrate زي ما انتوا شايفين مختلف لكن انا بدي
+
+81
+00:06:01,360 --> 00:06:06,020
+اميز ال pathogens عن ال non pathogens بسرعة بيطلع
+
+82
+00:06:06,020 --> 00:06:10,080
+على low growth or no trend اجار نيجاتيف نيجاتيف
+
+83
+00:06:10,080 --> 00:06:13,610
+لمين؟للـ Parthogen نيسيريا جنورية، نيسيريا جنورية
+
+84
+00:06:13,610 --> 00:06:17,470
+و نيسيريا من الريضايلوس، والباقي بوستر، they can
+
+85
+00:06:17,470 --> 00:06:20,630
+grow on nutrients etc. طبعا نفس العمود على التاني
+
+86
+00:06:20,630 --> 00:06:23,430
+لكن هذا في .. في عليه شوية علامات، فاستفهان بإننا
+
+87
+00:06:23,430 --> 00:06:28,470
+نلغي خالص من الجدول، فين دي الآن هنا؟ميزت الاتنين
+
+88
+00:06:28,470 --> 00:06:31,750
+عن الباقي بعدم المقدر على نوترينت أجار النمو على
+
+89
+00:06:31,750 --> 00:06:34,530
+نوترينت أجار الانكيبدة ميزهم عن بعض النايسيريا
+
+90
+00:06:34,530 --> 00:06:37,770
+مينيديتس والنايسيريا جونورية التنتين ديكستروز
+
+91
+00:06:37,770 --> 00:06:40,850
+positive لكن النايسيريا مينيديتس بالاضافة
+
+92
+00:06:40,850 --> 00:06:44,250
+للديكستروز عندها الملتوز بينما النايسيريا جونورية
+
+93
+00:06:44,250 --> 00:06:51,650
+negative نجاتي طبعا الأخريات فيها variation هذا
+
+94
+00:06:51,650 --> 00:06:53,510
+الأمور اللي حكيناها صحيحناها وشرحناها
+
+95
+00:06:59,560 --> 00:07:06,220
+هذه الصورة وضعناها برضه طيب هذه الصورة حقيقية ل بس
+
+96
+00:07:06,220 --> 00:07:11,060
+stain smear وعندي ال white blood cell إذا بتلاحظوا
+
+97
+00:07:11,060 --> 00:07:14,140
+في white blood cell محتوى على دبل كوكاية بشكل كتيف
+
+98
+00:07:14,140 --> 00:07:18,000
+جدا و white blood cell غير محتوى لكن قلت أنا في
+
+99
+00:07:18,000 --> 00:07:21,610
+عندي intracellularوفي extra cellar لو جينا نقارنها
+
+100
+00:07:21,610 --> 00:07:25,490
+بالمقارنة ايش ممكن نقرأ من اللوحة دي؟ بنقرأ انه في
+
+101
+00:07:25,490 --> 00:07:29,690
+boss cells واحد اتنين تلاتة اربع خمسة ستة سبعة
+
+102
+00:07:29,690 --> 00:07:33,210
+تمانية يعني number of white blood cell رقم اتنين
+
+103
+00:07:33,210 --> 00:07:36,530
+ال .. ال .. ال .. البكتيريا موجودة البكتيريا
+
+104
+00:07:36,530 --> 00:07:40,270
+موجودة موجودة وين؟ intra cellar ولا extra cellar؟
+
+105
+00:07:40,270 --> 00:07:43,470
+موجودة intra cellar وبتالي هاي ال report تبعي boss
+
+106
+00:07:43,470 --> 00:07:46,990
+cells ground made with cocaine و ال location تبعها
+
+107
+00:07:46,990 --> 00:07:50,080
+هل هو intra cellar ولا extra cellarهذه الصورة قلنا
+
+108
+00:07:50,080 --> 00:07:54,480
+لكم إنها مأخوذة من culture، يعني pure culture،
+
+109
+00:07:54,480 --> 00:07:59,080
+مافيش past cells في هذه الصورة البكتيريا بتنمو على
+
+110
+00:07:59,080 --> 00:08:03,320
+خمسة و تلاتين درجه مقاوية under CO2 tension على
+
+111
+00:08:03,320 --> 00:08:06,300
+وسط إما الـchocolate agar أو على الـthiamartin
+
+112
+00:08:06,300 --> 00:08:09,700
+agar والthiamartin agar يقول إنه وسط يشبه إلى حد
+
+113
+00:08:09,700 --> 00:08:13,240
+كبير ال .. ال .. ال .. ال chocolate agar لكن مضاف
+
+114
+00:08:13,240 --> 00:08:18,750
+إليه الخلطة اللي حكينا عنها ال VCNوال Oxidase test
+
+115
+00:08:18,750 --> 00:08:21,850
+قلنا عنها بوستف و ال confirmatory حكينا على ال
+
+116
+00:08:21,850 --> 00:08:26,010
+fluorescent antibody tagging test و اتكلمنا على
+
+117
+00:08:26,010 --> 00:08:29,730
+انه ال oxidation لل carbohydrate اللي شفناهم
+
+118
+00:08:29,730 --> 00:08:33,790
+التلاتة لا يتم على ال media اللي بتعرفوها لل
+
+119
+00:08:33,790 --> 00:08:36,490
+enterobacterias اللي هي ال off media وينما بتتم
+
+120
+00:08:36,490 --> 00:08:41,090
+على وسط اسمه CTA cysteine tryptocase agar هذا
+
+121
+00:08:41,090 --> 00:08:45,470
+enriched media مناسب لل نيسيريا بينما ال off غير
+
+122
+00:08:45,470 --> 00:08:47,270
+مناسب لهذه البكتيريا
+
+123
+00:08:50,920 --> 00:08:53,820
+نفس الجثة نفس الصورة اللي شفناها مقارنة ما بين
+
+124
+00:08:53,820 --> 00:08:57,960
+chocolate agar over growth والتاني fewer growth
+
+125
+00:08:57,960 --> 00:09:02,580
+وجفنا عند هذا اللوحة والان بدنا نفصل في بعض
+
+126
+00:09:02,580 --> 00:09:05,780
+التفاصيل ور ال resistance يمكن أخدنا برضه مقدمة عن
+
+127
+00:09:05,780 --> 00:09:09,400
+الموضوع هذا البكتيريا وصفناها fragile وصفناها
+
+128
+00:09:09,400 --> 00:09:14,900
+delicate حساسة رقيقة سهلة الكسر مؤشرة على إيش؟
+
+129
+00:09:16,030 --> 00:09:18,630
+easily killed by drying for two hours يعني لو
+
+130
+00:09:18,630 --> 00:09:22,750
+تركناها اتجف لمدة ساعتين بتكون لحالها ماتت moist
+
+131
+00:09:22,750 --> 00:09:26,810
+heat الحرارة الراطبة عند خمسة و خمسين درجة ماء
+
+132
+00:09:26,810 --> 00:09:28,970
+اوية عارفين شو هي خمسة و خمسين درجة ماء اوية يعني
+
+133
+00:09:28,970 --> 00:09:31,930
+المي اللي بنغسل فيها إيدينا في الشتاء عشان نتوضى
+
+134
+00:09:31,930 --> 00:09:36,390
+بندفيها شوية تمام خمسة و خمسين درجة لمدة قداش في
+
+135
+00:09:36,390 --> 00:09:39,430
+أقل من خمس دقائق البكتيريا بتموت بينما ال other
+
+136
+00:09:39,430 --> 00:09:42,830
+bacteria maybe require سبعين تمانين البكتيريا
+
+137
+00:09:42,830 --> 00:09:47,640
+العاديةمش المقاوم يعني حتى كمان very susceptible
+
+138
+00:09:47,640 --> 00:09:52,230
+to antisepticsوهذا المعنى هو برضه حاجة نهائية
+
+139
+00:09:52,230 --> 00:09:56,450
+وقلنا لكوا ممنوع تستخدموا مواد متاهرة في تطهير
+
+140
+00:09:56,450 --> 00:09:59,490
+المكان اللي بيكونوا تاخدوا منه العيينة ليش؟ لأنه
+
+141
+00:09:59,490 --> 00:10:03,790
+قلنا أي أثار متبقية لهذا ال antiseptic قد تقتل
+
+142
+00:10:03,790 --> 00:10:08,370
+البكتيريا فتخيل على سبيل المثال ال silver nitrate
+
+143
+00:10:08,370 --> 00:10:12,610
+أحد المراكبات المستخدمة بتركيز واحد لأربع تلاف
+
+144
+00:10:12,610 --> 00:10:17,350
+يعني one part من silver nitrate لأربع تلاف part من
+
+145
+00:10:17,350 --> 00:10:21,030
+ال diluent اللي هو المي في الغالبكافي لقتل
+
+146
+00:10:21,030 --> 00:10:30,650
+الناسيريا جنورية in two minutes سؤالك
+
+147
+00:10:30,650 --> 00:10:37,890
+ما ليس له علاقة بالموضوع خالص ايه دصيتته؟ احنا
+
+148
+00:10:37,890 --> 00:10:41,110
+الناسيريا جنورية من أين بناخدها؟ناخدها من الدم؟
+
+149
+00:10:41,110 --> 00:10:45,390
+ناخدها من الوريثرا او من ال vagina فهي عبارة عن
+
+150
+00:10:45,390 --> 00:10:49,870
+swabs لكن انت بتمسح وخايف ان ال swabs تتلوث فبتمسح
+
+151
+00:10:49,870 --> 00:10:57,590
+ب sterile warm salineOkay طيب بقولنا احنا ممكن في
+
+152
+00:10:57,590 --> 00:11:00,850
+المختبر بتشوفوا بعض الأحيان الأطباق مورودة وين فوق
+
+153
+00:11:00,850 --> 00:11:04,190
+ال incubator هذي خلصنا من ال incubation تبعها و
+
+154
+00:11:04,190 --> 00:11:07,850
+حاطينها فوق اما بنعملها bio chemical test او
+
+155
+00:11:07,850 --> 00:11:10,910
+بننتظر انه نتخلص منها بال autoclaving نتخلص منها
+
+156
+00:11:10,910 --> 00:11:14,730
+بال autoclaving فلو تركناها بقولك الأطباق هذي
+
+157
+00:11:14,730 --> 00:11:17,710
+بتاعة النسية الجنورية لمدة يومين بتكون ال bacteria
+
+158
+00:11:17,710 --> 00:11:21,960
+ماتتلو الأطباق دلت في ال incubator هي الدرجة
+
+159
+00:11:21,960 --> 00:11:26,580
+المفضلة له ممكن خلال أربع لست أيام برضه تموت يبقى
+
+160
+00:11:26,580 --> 00:11:31,500
+البكتيريا سهلة الموت في كل الظروف إلا في مين لما
+
+161
+00:11:31,500 --> 00:11:35,960
+بتكون داخل جسم الإنسان طبعا تأكيد على كلام اللي
+
+162
+00:11:35,960 --> 00:11:42,060
+حكيناه سابقا الان بس ننتبه لنقطة مهمة جدا هنا ان
+
+163
+00:11:42,060 --> 00:11:46,640
+ال cultures may die إذا تركناهم برا at room
+
+164
+00:11:46,640 --> 00:11:52,020
+temperatureخلال يوم أو يومين طب إذا هذا كان الكلام
+
+165
+00:11:52,020 --> 00:11:55,440
+و هي في أفضل أوضاح في ال media في ال culture media
+
+166
+00:11:55,440 --> 00:11:59,080
+فده ذاك لما تكون على ال surfaces زي هذه مافيش غذاء
+
+167
+00:11:59,080 --> 00:12:03,220
+و فيه جفاف فبالتالي الموضوع تباعها بيكون سريع عشان
+
+168
+00:12:03,220 --> 00:12:07,100
+اللي قلنالكوا it is specifically designed الأن
+
+169
+00:12:07,100 --> 00:12:11,940
+نيجي لنقطة تانية gonococci are susceptible to
+
+170
+00:12:11,940 --> 00:12:17,010
+sulphuramides and penicillinsalthough resistant
+
+171
+00:12:17,010 --> 00:12:23,550
+strains have emerged يعني في البداية كان العلاج
+
+172
+00:12:23,550 --> 00:12:28,410
+سلفة وبعدين صارت resistant وبعدين صار ال
+
+173
+00:12:28,410 --> 00:12:32,090
+penicillin و برضه كمان صار resistance أحكيلكوا عن
+
+174
+00:12:32,090 --> 00:12:39,080
+أحد الأرقام في ال resistanceسنة 1993 عندما كنت ..
+
+175
+00:12:39,080 --> 00:12:42,620
+يعني قريبا التخرج من المجستير كان مطلوب مني أقدم
+
+176
+00:12:42,620 --> 00:12:46,520
+presentation عن ال antimicrobial resistance فلجيت
+
+177
+00:12:46,520 --> 00:12:50,240
+ورقة .. ورقة يعني مش ورقة .. بحث يعني .. لجت بحث
+
+178
+00:12:50,240 --> 00:12:54,060
+المكتبة عن إن سيريا الجنورية في هونج كونج كان
+
+179
+00:12:54,060 --> 00:12:59,800
+بيتكلم عن 99% resistance للبنسيلين 99% resistant
+
+180
+00:12:59,800 --> 00:13:03,720
+للبنسيلينعند طالبات زميلاتي طالبات في المحاضرة
+
+181
+00:13:03,720 --> 00:13:07,300
+سألتهم سؤال قلتلهم ايش معنى البكتيريا قادرة على
+
+182
+00:13:07,300 --> 00:13:11,380
+انها تكون resistance ضد ال antibiotics وغير قادرة
+
+183
+00:13:11,380 --> 00:13:14,200
+على انها تكون resistance ضد الحرارة على سبيل
+
+184
+00:13:14,200 --> 00:13:17,920
+المثال او ضد الchlor على سبيل المثال او ضد ال
+
+185
+00:13:17,920 --> 00:13:21,060
+antiseptics الأخرى اللي احنا نستخدمها باستمرار و
+
+186
+00:13:21,060 --> 00:13:27,260
+بشكل مكثف فإيش كان يا ترى الجواب عند الشباب هي كان
+
+187
+00:13:27,260 --> 00:13:29,640
+الجواب اه
+
+188
+00:13:31,400 --> 00:13:34,600
+كمان مرة قلت السؤال كمان مرة لماذا تستطيع
+
+189
+00:13:34,600 --> 00:13:38,400
+البكتيريا إنها تكون resistance بسهولة لل
+
+190
+00:13:38,400 --> 00:13:42,780
+antibiotics ولا تستطيع أن تكون resistance بسهولة
+
+191
+00:13:42,780 --> 00:13:54,000
+لل antiseptics و ال disinfectants يعني
+
+192
+00:13:54,000 --> 00:13:59,120
+نصيغي الكلام على فكرة الجواب دقيق و جيد بس بنتكمله
+
+193
+00:14:00,240 --> 00:14:03,840
+الان انت بتكلم بتقول انه specific action يعني
+
+194
+00:14:03,840 --> 00:14:08,220
+بمعنى آخرTetracycline binds to the 3rd S ribosomal
+
+195
+00:14:08,220 --> 00:14:11,540
+subunit thus preventing protein synthesis لو صار
+
+196
+00:14:11,540 --> 00:14:15,380
+أي تغيير في ال binding site بتاع Tetracycline ال
+
+197
+00:14:15,380 --> 00:14:17,820
+Tetracycline will no longer be effective يبقى
+
+198
+00:14:17,820 --> 00:14:21,460
+البكتيرا صارت resistance يبقى specific action هي
+
+199
+00:14:21,460 --> 00:14:25,920
+ال keyword لكن لو الchlor بيخزج السطح تبع ال cell
+
+200
+00:14:25,920 --> 00:14:29,000
+wall و ال cell membrane و بضرب البروتين و بضرب ال
+
+201
+00:14:29,000 --> 00:14:34,050
+DNA فالبكتيرا لن تستطيعلأن انت استطيع أن تكون
+
+202
+00:14:34,050 --> 00:14:40,810
+resistance لذلك بيسمو ال actionالـ Single Specific
+
+203
+00:14:40,810 --> 00:14:44,070
+بينما الـ Multiple بيسموه Oligodynamic Action
+
+204
+00:14:44,070 --> 00:14:49,350
+Oligo متعدد، Dynamic يعني بضرب في كل مكان،
+
+205
+00:14:49,350 --> 00:14:53,030
+Oligodynamic Action إذن هي السبب في عدم مقدرة
+
+206
+00:14:53,030 --> 00:14:55,810
+البكتيريا على إنها .. وخدوا بالكم مش معناها الحاجة
+
+207
+00:14:55,810 --> 00:14:58,650
+إنها هدى عدم المقدرة أبدية ربما في يوم الأيام
+
+208
+00:14:58,650 --> 00:15:02,370
+نلاجي super strain قادر على أولاجينها في بعض ال ..
+
+209
+00:15:02,370 --> 00:15:03,810
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+210
+00:15:03,810 --> 00:15:03,890
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+211
+00:15:03,890 --> 00:15:04,130
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+212
+00:15:04,130 --> 00:15:04,410
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+213
+00:15:04,410 --> 00:15:04,810
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+214
+00:15:04,810 --> 00:15:06,930
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+215
+00:15:06,930 --> 00:15:13,270
+ال .. المتفقين إن الآن البكتيريا هذه لها مقدرة على
+
+216
+00:15:13,270 --> 00:15:16,870
+تشكيل resistance وبالتالي susceptibility أو
+
+217
+00:15:16,870 --> 00:15:20,690
+sensitivity test should be performed on all
+
+218
+00:15:20,690 --> 00:15:25,230
+isolates بلا نيسيريا جونريا to determine what is
+
+219
+00:15:25,230 --> 00:15:29,600
+the best antibioticsالميكروبط تاني اليوم في
+
+220
+00:15:29,600 --> 00:15:32,400
+سلسلتنا اللي هنحاول ننهي ان شاء الله اللي هو
+
+221
+00:15:32,400 --> 00:15:35,760
+ناسيريا meningitis طبعا المعلومات اللي عليها يمكن
+
+222
+00:15:35,760 --> 00:15:38,580
+يكون أكتر من ناسيريا جنورية وخطورته إنه في غزة
+
+223
+00:15:38,580 --> 00:15:44,200
+أكتر من ناسيريا جنورية لكن بيتشابه إلى حد كبير في
+
+224
+00:15:44,200 --> 00:15:47,580
+المعلومات على الأقل في ال morphology في ال
+
+225
+00:15:47,580 --> 00:15:51,700
+isolation في ال identification بيتشابه بطريقة
+
+226
+00:15:51,700 --> 00:15:56,200
+لأنهم من نفس ال genusNesiria meningitis causes
+
+227
+00:15:56,200 --> 00:16:02,420
+dramatic and explosive epidemics of cerebrospinal
+
+228
+00:16:02,420 --> 00:16:09,120
+meningitis طبعا كما الاسم بيوحي it is a major
+
+229
+00:16:09,120 --> 00:16:13,640
+cause of meningitis وانا قلتلكوا الحجاج بيت الله
+
+230
+00:16:13,640 --> 00:16:17,060
+الحرام من كل بلدان العالم قبل ما يغادروا الى
+
+231
+00:16:17,060 --> 00:16:20,340
+السعودية بياخدوا تطايم تطايم هذا ضد اللي هو
+
+232
+00:16:20,340 --> 00:16:24,570
+Nesiria meningitis ليش بياخدوه؟هذا gathering
+
+233
+00:16:24,570 --> 00:16:30,050
+التجمع من كل أنحاء العالم على فكرة يمكن في إعجاز
+
+234
+00:16:30,050 --> 00:16:34,010
+رباني يعني في هذا الموضوع مش يعني يعني المفروض
+
+235
+00:16:34,010 --> 00:16:39,970
+يكون ملموس لكل إنسان أي تجمع في العالم من أماكن
+
+236
+00:16:39,970 --> 00:16:44,510
+مختلفة هناك خشية عالية جدا من انتشار الأوبي أو
+
+237
+00:16:44,510 --> 00:16:49,750
+الأمراض طب أنت تخيل من أين يأتي المسلمينأو
+
+238
+00:16:49,750 --> 00:16:52,850
+المسلمون من كل أنحاء العالم وبيجي على هذا المكان
+
+239
+00:16:52,850 --> 00:16:57,270
+من دول فقيرة موبوعة زي أفريقيا من دول جنوب شرق
+
+240
+00:16:57,270 --> 00:17:01,630
+أسيا من شرق الأوسط من أمريكا من كل بلدان من كل فجن
+
+241
+00:17:01,630 --> 00:17:07,330
+عميق وبتجمعوا في هذا المكان لكن لا يحدث بهم أوبئة
+
+242
+00:17:07,330 --> 00:17:12,830
+بشكل كبير أو شكل غير عن المعتاد عند الناس أو في
+
+243
+00:17:12,830 --> 00:17:17,370
+الجامعة التانية لكن الجامعة التانية مثلاالمجندين
+
+244
+00:17:17,370 --> 00:17:21,630
+الجدد ال military recruits اللي بيجندوهم في الجيوش
+
+245
+00:17:21,630 --> 00:17:25,290
+هدول اللي بيجندوهم من هنا و بيجعدوهم في أماكن بعد
+
+246
+00:17:25,290 --> 00:17:28,350
+شوية بسرعة بينتشر فيهم الأمراض طلاب الجامعات اللي
+
+247
+00:17:28,350 --> 00:17:32,410
+بيسكنوا سكن داخلي برضه هدول جايين من وين من تجمعات
+
+248
+00:17:32,410 --> 00:17:38,150
+مختلفة مع أنهم young و healthy لكن بينتشر فيهم
+
+249
+00:17:38,150 --> 00:17:44,150
+كثير من الأمراض لكن نرجع لموضوعناإن سيريا من
+
+250
+00:17:44,150 --> 00:17:49,090
+انجدايتس واحدة من المخاطر اللي كانت أثر على الحجاج
+
+251
+00:17:49,090 --> 00:17:53,510
+تاريخيا في أماكن تجمعهم قبل مناطق الإحرام كان
+
+252
+00:17:53,510 --> 00:17:57,270
+المسلمين في فترة من الفترات وهذا مش عايب ان نتكلم
+
+253
+00:17:57,270 --> 00:18:01,890
+فيه بكل صراحة و أرياحية ليس لهم علاقة بالدين إلا
+
+254
+00:18:01,890 --> 00:18:08,190
+الشعائر إلا الشعائر بمعنى بيصلي و بصوم و بيتصدق و
+
+255
+00:18:08,190 --> 00:18:12,820
+بده يحج هيده كمان لكن مستوى النظافة عندهم متدنىزي
+
+256
+00:18:12,820 --> 00:18:17,120
+ما بعض الأحيان بتشوف أنه في الشوارع أنه المنزل من
+
+257
+00:18:17,120 --> 00:18:21,220
+جوا نظيف تماما وممتاز لكن أمام بيت المنزل المستوى
+
+258
+00:18:21,220 --> 00:18:24,280
+النظافة مش .. مش .. فمافيش اهتمام واضح كان
+
+259
+00:18:24,280 --> 00:18:29,000
+بالنظافة في تلك الفترة فكان historically الحجاج
+
+260
+00:18:29,000 --> 00:18:33,780
+أكتر ناس هم بيعانوا قبل التجمع كمان مرة في
+
+261
+00:18:33,780 --> 00:18:36,960
+التجمعات الصغيرة اللي هي ما قبل أماكن الإحرام أو
+
+262
+00:18:36,960 --> 00:18:41,150
+في أماكن الإحرامفكان يجتمع الناس و مستوى النظرها
+
+263
+00:18:41,150 --> 00:18:45,290
+منخفض فكان يصيب عندهم أوبيات من الجائزة لكن في
+
+264
+00:18:45,290 --> 00:18:50,530
+الموسم نفسه لحظة هل سمعتم عن انتشار مثلا ل
+
+265
+00:18:50,530 --> 00:18:56,990
+influenza ولا SARS ولا مافيش وهذا من فضل الله
+
+266
+00:18:56,990 --> 00:18:57,710
+سبحانه وتعالى
+
+267
+00:19:01,850 --> 00:19:07,070
+أحد النقاط اللي بنستخدمها لإثبات فشل نظرية أو
+
+268
+00:19:07,070 --> 00:19:11,090
+فرضية روبرت كوخ أول مبدأ كان مبني عليه فرضية كوخ
+
+269
+00:19:11,090 --> 00:19:15,770
+أنه الميكروب الممرض تمام لازم يكون في الإنسان
+
+270
+00:19:15,770 --> 00:19:20,190
+المصاب و مش في الإنسان السليم اسمه الجملة هذه ال
+
+271
+00:19:20,190 --> 00:19:22,970
+organism live in the nasopharynx of apparently
+
+272
+00:19:22,970 --> 00:19:26,170
+healthy individuals and are passed from man to man
+
+273
+00:19:26,170 --> 00:19:30,500
+via respiratory tractيعني موجود في أنوف الناس اللي
+
+274
+00:19:30,500 --> 00:19:37,420
+هم healthy، المعنى بينتظر فرصة إلك أنت أنك تضعف أو
+
+275
+00:19:37,420 --> 00:19:41,460
+إنه ينتقل منك لإنسان تاني هو أصلا المناعة تبعته
+
+276
+00:19:41,460 --> 00:19:46,860
+ضعيف، إذا الفرضية تبعت كوخ في هذا الحالة خدنا نقول
+
+277
+00:19:46,860 --> 00:19:50,700
+لا تنطبق على هذا النموذجmorphogen unstaining يا
+
+278
+00:19:50,700 --> 00:19:53,640
+شباب بدل ما العينة كانت من erythral discharge لما
+
+279
+00:19:53,640 --> 00:19:58,600
+نتكلم عن عينة CSF أو بعض الأحيان بتقرفه في ال
+
+280
+00:19:58,600 --> 00:20:01,830
+بكتيريا بتاعة ما تلحق اسمها Bacterial Rashesاللي
+
+281
+00:20:01,830 --> 00:20:04,750
+طفح جلدي بيكون فيه عبارة عن subcutaneous
+
+282
+00:20:04,750 --> 00:20:08,650
+hemorrhage نظيف تحت الجلد بشكل بُقعة صغيرة فلو
+
+283
+00:20:08,650 --> 00:20:13,010
+أخدنا جزء من الدم هلاج البكتيريا بالجرامستين تخيل
+
+284
+00:20:13,010 --> 00:20:18,110
+لما أنت تشوف البكتيريا في قطر الدم أه بالجرامستين
+
+285
+00:20:18,110 --> 00:20:21,350
+عارفش معناه الحكي؟ معناه الحكي أن عدد البكتيريا
+
+286
+00:20:21,350 --> 00:20:25,730
+صار عدد قريب من الكورات الدم الحمراء جديش الكورات
+
+287
+00:20:25,730 --> 00:20:29,070
+الدم الحمراء في الدم؟ خمس مليون أظن أربعة و نص
+
+288
+00:20:29,070 --> 00:20:35,270
+مليون أو خمس مليونفي كل ملي ليتر صح في كل ملي ليتر
+
+289
+00:20:35,270 --> 00:20:38,310
+من الدم وهذا رقم مهول جدا لما تشوف البكتيريا
+
+290
+00:20:38,310 --> 00:20:40,950
+بتزحمه مادة حاجة ان ال number تبعها في الدم نفس
+
+291
+00:20:40,950 --> 00:20:44,570
+الشيء ف it causes fulminant septicemia يعني
+
+292
+00:20:44,570 --> 00:20:49,250
+سبتسيميا مليانة اللي هو نيسيريا من الريتايدس طبعا
+
+293
+00:20:49,250 --> 00:20:58,980
+البكتيريا كمرة من ال CSF او من قلنا الالذي يظهر
+
+294
+00:20:58,980 --> 00:21:04,780
+مثل نسيريا جنورية جرام نيجاتيف دبلو كوكاي كوفي بين
+
+295
+00:21:04,780 --> 00:21:10,480
+شيب المصطلح اللي بتعرفه most of the isolated
+
+296
+00:21:10,480 --> 00:21:14,360
+strains of group one and group two types have
+
+297
+00:21:14,360 --> 00:21:14,920
+capsules
+
+298
+00:21:18,230 --> 00:21:22,390
+عزلات من مجموعة واحد ومجموعة اتنين غالبا تكون فيها
+
+299
+00:21:22,390 --> 00:21:25,530
+capsule طبعا هذا الكلام بيذكرنا و بيربطنا مع مين
+
+300
+00:21:25,530 --> 00:21:28,870
+بيربطني كمان مرة مع ال streptococcus pneumonia ومع
+
+301
+00:21:28,870 --> 00:21:31,630
+ال hemophilus influenza اللي قلتلكوا عنهم يا شباب
+
+302
+00:21:31,630 --> 00:21:35,750
+نجوم ال meningitis هم نجوم ال meningitis كلهم
+
+303
+00:21:35,750 --> 00:21:37,790
+بيشتركوا كمان انهم لهم capsule
+
+304
+00:21:40,760 --> 00:21:42,820
+cultural characteristics بيقولنا انه it requires
+
+305
+00:21:42,820 --> 00:21:45,780
+rich medium زي blood او شوكولات اجار او بحتوى على
+
+306
+00:21:45,780 --> 00:21:49,180
+أساتيك ال fluid and dextrose على blood اجار
+
+307
+00:21:49,180 --> 00:21:54,320
+المستعمرات بيقولنا small و glistening فيها لمعان
+
+308
+00:21:54,320 --> 00:22:01,570
+slightly convex يعني محدب نوعا ماGrowth occur at
+
+309
+00:22:01,570 --> 00:22:07,390
+aerobic condition at 37 degrees for 37 .. او at 37
+
+310
+00:22:07,390 --> 00:22:13,270
+degrees and 5 to 10% CO2 within 48 .. 24 to 48
+
+311
+00:22:13,270 --> 00:22:18,430
+hours، يعني المستعمرة بتظهر خلال 24 إلى 48 ساعة،
+
+312
+00:22:18,430 --> 00:22:21,950
+بس المستعمرة متفقين، chocolate agar أو blood agar،
+
+313
+00:22:21,950 --> 00:22:24,070
+بدأت تنمو على blood agar أو على chocolate agar،
+
+314
+00:22:24,070 --> 00:22:26,850
+وبدأ CO2 يبجي برحيل عالمين كم مرة على chocolate
+
+315
+00:22:26,850 --> 00:22:31,550
+agarالـ pathogenicity هو حد من انا اعرف انه في
+
+316
+00:22:31,550 --> 00:22:34,910
+عندي three steps في ال .. ال .. في ال transmission
+
+317
+00:22:34,910 --> 00:22:38,070
+في عندي implantation في ال nasopharynx كيف
+
+318
+00:22:38,070 --> 00:22:42,310
+implantation؟ واحد عنده ناسيريا عطس طلع ال
+
+319
+00:22:42,310 --> 00:22:45,870
+droplets اللي هي الرذاذ تبعه وانا استنشغته وين
+
+320
+00:22:45,870 --> 00:22:49,970
+بتروح البكتيريا؟ في أماكن متنوعة لكن ال .. المكان
+
+321
+00:22:49,970 --> 00:22:52,550
+اللي can favor its growth اللي هو ال nasopharynx
+
+322
+00:22:52,550 --> 00:22:56,350
+تم ال implantation من غيره هناكو بعد ال
+
+323
+00:22:56,350 --> 00:23:01,410
+implantation it may reaches the blood و إذا وصلت
+
+324
+00:23:01,410 --> 00:23:06,290
+الدم جنة ممكن تعمل meningococcemia
+
+325
+00:23:14,260 --> 00:23:19,660
+يعني septicemia caused by Neisseria meningitis أو
+
+326
+00:23:19,660 --> 00:23:24,620
+septicemia caused by the gonococci هذي ليش
+
+327
+00:23:24,620 --> 00:23:28,180
+ميزناها؟ ليش مقولنا سبتسيميا و خلاص؟ ميزناها لأنه
+
+328
+00:23:28,180 --> 00:23:32,200
+قلنالكوا it is life threatening
+
+329
+00:23:34,410 --> 00:23:38,170
+يعني غالبا مهدد الحياة للإنسان وميزنها لإنه قلنا
+
+330
+00:23:38,170 --> 00:23:42,230
+لكوا بيطلع فيها ال particular rashes اللي قلنا
+
+331
+00:23:42,230 --> 00:23:45,470
+عنها يوشايو ممكن تكون مصدر لعينة من عينات السياسة
+
+332
+00:23:46,020 --> 00:23:50,360
+إذن implantation في الـ nasopharynx رقم اتنين
+
+333
+00:23:50,360 --> 00:23:52,900
+entrance to the blood stream with resulting
+
+334
+00:23:52,900 --> 00:23:56,740
+septicemia اللي سمناها meningococcemia ثلاثة
+
+335
+00:23:56,740 --> 00:24:01,240
+equalization in the meninges يعني هتمركز في الآخر
+
+336
+00:24:01,240 --> 00:24:05,200
+في الأغشية
+
+337
+00:24:05,200 --> 00:24:06,800
+المغلطة للدماء
+
+338
+00:24:11,750 --> 00:24:14,370
+الـ Transmission عبر إيش بده يكون يا شباب؟ عبر ال
+
+339
+00:24:14,370 --> 00:24:18,070
+respiratory tract إيش اللي .. اللي .. اللي .. اللي
+
+340
+00:24:18,070 --> 00:24:20,930
+بيحمل ال microbe هو ال droplets ال droplets اللي
+
+341
+00:24:20,930 --> 00:24:23,750
+هي الرذاد اللي بيطلع مع العطس أو الكحة أو الحديد
+
+342
+00:24:23,750 --> 00:24:27,050
+طبعا
+
+343
+00:24:27,050 --> 00:24:31,650
+هل هذي بيسموها الحمش شوكية؟ ال meningitis بشكل عام
+
+344
+00:24:31,650 --> 00:24:36,670
+هي الحمش شوكية لكن مساببتها كثر يعني أنا بتقول حمش
+
+345
+00:24:36,670 --> 00:24:40,810
+شوكية أنت .. و الامتحان ما تقيم امتحان احنا؟وقتش
+
+346
+00:24:40,810 --> 00:24:47,390
+يعني بيطلع .. سبت الجهة يعني .. طوال يعني لسه ..
+
+347
+00:24:47,390 --> 00:24:51,690
+لما بيقولوا احنا الاشريشيا collide بتسبب
+
+348
+00:24:51,690 --> 00:24:55,190
+meningitis يعني هم شوكية .. ده ما .. الان ال
+
+349
+00:24:55,190 --> 00:24:59,550
+meningitis can be caused by several microorganisms
+
+350
+00:24:59,550 --> 00:25:02,690
+وخدنا لما فتحنا الموضوع نتكلم شوية عن الموضوع هذا
+
+351
+00:25:03,660 --> 00:25:07,080
+الـ meningitis سواء كان سببها نسيريا الـ
+
+352
+00:25:07,080 --> 00:25:10,240
+meningitis أو streptococcus pneumonia أو
+
+353
+00:25:10,240 --> 00:25:13,240
+pseudomonas aeruginosa أو Acinetobacter أو
+
+354
+00:25:13,240 --> 00:25:16,800
+Staphylococcus أو streptococcus biogenes أو أي من
+
+355
+00:25:16,800 --> 00:25:20,980
+الميكروبات اللي مروا معانا و هيمروا معانا غالبا ال
+
+356
+00:25:20,980 --> 00:25:25,420
+symptoms تبعتها واحد ال symptoms تبعتها واحدة
+
+357
+00:25:25,420 --> 00:25:31,220
+fever احد ال symptoms severe headache تمام في عندي
+
+358
+00:25:31,220 --> 00:25:37,480
+signs مهمة جداالمريض لو أنا نيمته على سطح مستوي زي
+
+359
+00:25:37,480 --> 00:25:41,900
+الطاولة اللي أمامك وها دي و حاولت هط إيد على صدره
+
+360
+00:25:41,900 --> 00:25:48,160
+و إيد تانية تحت الرأس و حاولت أرفع الرأس تبعه إلى
+
+361
+00:25:48,160 --> 00:25:51,960
+الأعلى، تمام؟ يعني مش على أعفع جسمه كله، بس الرأس،
+
+362
+00:25:51,960 --> 00:25:55,680
+يعني أنا ضغط على صدره و بدا أرفع الرأسبيلاجيه
+
+363
+00:25:55,680 --> 00:26:00,320
+بيعمل resistance للرفع بيحاول هو الطفل او المريض
+
+364
+00:26:00,320 --> 00:26:03,900
+ان يرجع لقصه لو انا بيسموها نك ال افا نك
+
+365
+00:26:03,900 --> 00:26:09,140
+reflection resistance المقاومة لتحريك الاله و لو
+
+366
+00:26:09,140 --> 00:26:14,190
+انا رفعتها تلقائي ركب و بنتنيوركبه بنتنيو يعني بدل
+
+367
+00:26:14,190 --> 00:26:17,890
+ما هو كان مبتوح مستوي بصير ان ركبه طلعت لفوق لفوق
+
+368
+00:26:17,890 --> 00:26:22,350
+امام؟ ليش؟ لأنه حركة القائي بصير عنده قلم شديد جدا
+
+369
+00:26:22,350 --> 00:26:26,750
+فعشان يخفف من الانحناء او من ال stretching بثنى
+
+370
+00:26:26,750 --> 00:26:31,460
+الركب تبعت فبقى بيسموها neckleg reflection هدى
+
+371
+00:26:31,460 --> 00:26:35,500
+signs تانية ال sign التالتة او لو انا جيت انا
+
+372
+00:26:35,500 --> 00:26:38,980
+مساكت تبتعرف احنا بنرفع ال .. ال .. ال .. الصق
+
+373
+00:26:38,980 --> 00:26:43,420
+تبعتنا عسب الامر تبعتنا الشباب الزغار برفعوا
+
+374
+00:26:43,420 --> 00:26:47,820
+لمستوى عالي جدا صح احنا الاختريل زينا بنرفع لمستوى
+
+375
+00:26:47,820 --> 00:26:53,390
+قليلstraight لكن لو بنرفع و نتن الركبة ممكن نرفعها
+
+376
+00:26:53,390 --> 00:26:58,510
+على مستوى أعلى فبنعمل احنا نضغط على الركبة و بنرفع
+
+377
+00:26:58,510 --> 00:27:04,690
+القدم من تحت تمام straight بنلاقي ان الطفل بيبكي
+
+378
+00:27:04,690 --> 00:27:09,950
+جدا و مؤلم جدا الحركة دي لان كمان مرة ال ال ال ال
+
+379
+00:27:09,950 --> 00:27:13,550
+ال meninges تبعت الدماغ و ال cerebrospinal fluid
+
+380
+00:27:13,550 --> 00:27:17,830
+are inflamedطبعا مافي عندي science مجموعة من ال
+
+381
+00:27:17,830 --> 00:27:21,230
+science كلها في الآخر بيبقى عنها science of .. او
+
+382
+00:27:21,230 --> 00:27:25,050
+cardinal science of meningitis لكن المسببات متنوعة
+
+383
+00:27:25,050 --> 00:27:28,070
+قد تكون parasite قد تكون yeast قد تكون بكتيريا
+
+384
+00:27:28,070 --> 00:27:35,190
+والبكتيريا أنواع واسماء مختلفة احب ان انت تحكي عن
+
+385
+00:27:35,190 --> 00:27:38,530
+طفل او اقبار او تقديم بس في المرادة ماعدي جاج
+
+386
+00:27:38,530 --> 00:27:41,750
+اكبار ولا مشكلة من الغالب يعني ايش dependent
+
+387
+00:27:43,700 --> 00:27:45,700
+المفروض ان الوضع البكتيري اللي احنا بنتكلم فيها
+
+388
+00:27:45,700 --> 00:27:49,360
+اليوم انه كل ما كبرنا في العمر كل ما زادت المناعة
+
+389
+00:27:49,360 --> 00:27:52,220
+تبعتنا ضدها يعني احتمالية الإصابة بيها عند الكبارش
+
+390
+00:27:52,220 --> 00:27:56,260
+بتكون اقل ما يكون لكن لما بنكبر اكتر و اكتر و اكتر
+
+391
+00:27:56,260 --> 00:28:00,780
+بنصير old age و بنرجع اطفال مرة اخرى فهي بتصيب ال
+
+392
+00:28:00,780 --> 00:28:05,160
+young children و بتصيب ال old age و انا بدأت
+
+393
+00:28:05,160 --> 00:28:09,140
+اذكركم بنقطة مهمة جدا برضه في نفس السياق اللي سأل
+
+394
+00:28:09,140 --> 00:28:14,640
+فيه الاخإنه ال equali لما جاوبناه قولنا ال equali
+
+395
+00:28:14,640 --> 00:28:18,040
+بتسبب meningitis اتذكروا بتسبب أي نوع من ال
+
+396
+00:28:18,040 --> 00:28:21,320
+meningitis او عن مين بتسبب ال meningitis قولنا it
+
+397
+00:28:21,320 --> 00:28:26,260
+causes neonatal meningitis group B streptococci
+
+398
+00:28:26,260 --> 00:28:29,500
+برضه قولنا عنها neonatal meningitis يبقى في هندي
+
+399
+00:28:29,500 --> 00:28:36,450
+اناage-dependent pathogens بمعنى إن الـ meningitis
+
+400
+00:28:36,450 --> 00:28:40,450
+في الأمر هذه هي نجومها في الأمر التاني هي نجومها
+
+401
+00:28:40,450 --> 00:28:44,630
+يعني ممكن يكونوا مختلفين عن بعضهم البعض هذا ال
+
+402
+00:28:44,630 --> 00:28:50,330
+diagram اللي أمامكوا بعطينا فكرة أو ملخص عن ما
+
+403
+00:28:50,330 --> 00:28:53,410
+يحدث في ال transmission meningococcal carrier
+
+404
+00:28:53,410 --> 00:28:59,120
+droplets infectionattaches to الكلام اللي حكيناه
+
+405
+00:28:59,120 --> 00:29:01,880
+اللي هو ال implantation في ال nasopharynx of a new
+
+406
+00:29:01,880 --> 00:29:06,660
+person ممكن هو نفس الشخص هذا يعمل droplet
+
+407
+00:29:06,660 --> 00:29:11,280
+infection وينقل للاخرين او انه يصل لحالة اللي
+
+408
+00:29:11,280 --> 00:29:14,000
+يقولنا البكتيريميا او ال septicemia اللي يسمينها
+
+409
+00:29:14,000 --> 00:29:19,610
+meningococcemia ممكن مباشرة تمام؟عبر المنطقة اللى
+
+410
+00:29:19,610 --> 00:29:22,770
+موجودة في ال .. الواصلات اللى مابين ال .. ال
+
+411
+00:29:22,770 --> 00:29:26,950
+sinuses و مابين ال middle ear و ال nasopharynx و
+
+412
+00:29:26,950 --> 00:29:30,610
+بقى اشتغلت نوات دلوقت للمنينجيز و طبعا فدبس
+
+413
+00:29:30,610 --> 00:29:33,490
+هتحفظها و هتعملن اللى هو ال meningitis اللى
+
+414
+00:29:33,490 --> 00:29:37,710
+هيدكفيفرستفنك الكلام اللى شرحناه قبل شوية من
+
+415
+00:29:37,710 --> 00:29:42,830
+الاعلاماتالبكتيريميا أو السبسيميا قولنا it can
+
+416
+00:29:42,830 --> 00:29:45,870
+migrate to the skin و تماما اللي هو ال particular
+
+417
+00:29:45,870 --> 00:29:49,210
+rashes اللي احنا حكينا عنهم و قولنا دول بيستخدموه
+
+418
+00:29:49,210 --> 00:29:54,070
+ك diagnostic areas أو specimen ممكن تعمل release
+
+419
+00:29:54,070 --> 00:29:58,050
+لل endotoxin و نرجع لمربع مين لان ال endotoxin
+
+420
+00:29:58,050 --> 00:30:01,030
+برجعنا لمين؟ لجرام نيجاتيف البكتيريا و البكتيريا
+
+421
+00:30:01,030 --> 00:30:06,140
+هذه عبارة عن جرام نيجاتيفالـ Endotoxin مسؤول
+
+422
+00:30:06,140 --> 00:30:09,200
+بالدرجة الأولى عن معظم الـ symptoms caused by this
+
+423
+00:30:09,200 --> 00:30:15,450
+organismمن ضمنها it activates the clotting cascade
+
+424
+00:30:15,450 --> 00:30:21,030
+يعني عملية التجلط في الدم فتخيل البكتيريا بتحول ال
+
+425
+00:30:21,030 --> 00:30:24,930
+fibrinogen إلى fibrin وين بتحوله؟ في الدم مش في
+
+426
+00:30:24,930 --> 00:30:29,490
+الجلد في جروح لأ في الدم فهيتكون عندي disseminated
+
+427
+00:30:29,490 --> 00:30:33,030
+intravascular coagulation في كل الجسم فيه جلطات
+
+428
+00:30:33,030 --> 00:30:38,710
+هذه الجلطات قد تقوم بعمل blockingأو اغلاق لبعض ال
+
+429
+00:30:38,710 --> 00:30:42,810
+capillaries لذلك بعض الناس ممكن يشفى من ال .. لكن
+
+430
+00:30:42,810 --> 00:30:46,450
+بعد قطع أعضاء من جسمه، ليش؟ لأنه فقدت ال blood
+
+431
+00:30:46,450 --> 00:30:49,270
+supply فقدت ال blood supply شغل فيها نسكيميا و
+
+432
+00:30:49,270 --> 00:30:51,290
+بعدين necrosis للعوم
+
+433
+00:30:54,170 --> 00:30:58,430
+الفيرولينز فاكتور اعتقد احنا لسه مانسيناهاش انه
+
+434
+00:30:58,430 --> 00:31:01,010
+بنتكلم عن الايبو بوليساكراد اللي هو الاندو توكسين
+
+435
+00:31:01,010 --> 00:31:04,230
+اللي جونه بيعمل ديسمينات الاندروفاسكولار
+
+436
+00:31:04,230 --> 00:31:08,910
+الimmunity لو الإنسان انصعت بالبكتيريا اللي هي
+
+437
+00:31:08,910 --> 00:31:11,690
+نيسيريا منجدايتس وشوف يا منها سواء بال treatment
+
+438
+00:31:11,690 --> 00:31:16,950
+بال drugs او تلقائي غالبا بتوفرله moderate degree
+
+439
+00:31:16,950 --> 00:31:21,920
+of immunityيعني بتوفرلوش immunity مدى الحياة حتى
+
+440
+00:31:21,920 --> 00:31:29,400
+الفاكسين بوفرش immunity مدى الحياة بالنسبة للرضع
+
+441
+00:31:29,400 --> 00:31:34,480
+إذا كانت الام عندها antibodies فال antibodies
+
+442
+00:31:34,480 --> 00:31:38,740
+بتنتقل للمولود عبر ال placenta عن طريق اللي هو ال
+
+443
+00:31:38,740 --> 00:31:43,620
+IgG AntibodyAntigenic Structure and Grouping
+
+444
+00:31:43,620 --> 00:31:49,880
+بقولنا فيه حوال 9 مجموعات A,B,C,D,E و W135 و X,Y و
+
+445
+00:31:49,880 --> 00:31:55,100
+Z طبعا التصنيف هذا مبني على ال polysaccharide اللي
+
+446
+00:31:55,100 --> 00:31:59,760
+موجود في الكابسول و بقولنا ان group A و B و C are
+
+447
+00:31:59,760 --> 00:32:02,720
+responsible for epidemics of meningitis يعني أشهر
+
+448
+00:32:02,720 --> 00:32:07,320
+مجموعات هم ال A,B,C لكن في عندي كمان strain اللي
+
+449
+00:32:07,320 --> 00:32:14,380
+هو 135هذا كمان ثبت أنه يعني ممكن يعمل meningitis
+
+450
+00:32:14,380 --> 00:32:18,580
+فبالتالي ال vaccine تبعنا اللي موجود الآن vaccine
+
+451
+00:32:18,580 --> 00:32:25,090
+ثلاثي مكون من A و C و W135وين بي؟ مش بيقولنا احنا
+
+452
+00:32:25,090 --> 00:32:30,450
+مجموعة A وB وC بيقولنا بي not immunogenic ايش يعني
+
+453
+00:32:30,450 --> 00:32:35,690
+not immunogenic؟ يعني حتى لو حققناه داخل الجسم
+
+454
+00:32:35,690 --> 00:32:38,710
+الإنسان، جسم الإنسان مش هيكوّله أجسام مضادة، فهل
+
+455
+00:32:38,710 --> 00:32:41,270
+بينفع عادة نحطه في ال vaccine؟ بينفعش في ال
+
+456
+00:32:41,270 --> 00:32:44,770
+vaccine، إذن ال vaccine مابيحملاش تغتلل من ال
+
+457
+00:32:44,770 --> 00:32:49,250
+meningitis، لكن بيقلل من احتمالية الإصابة بال
+
+458
+00:32:49,250 --> 00:32:52,170
+meningitis، بيقولنا group B is not immunogenic
+
+459
+00:32:54,360 --> 00:32:58,460
+diagnosis اعرفنا الأمراض ايش الأمراض مينجايتس
+
+460
+00:32:58,460 --> 00:33:02,600
+سبتسيميا و اعرفنا ال career نازو فرنجل اذا انا
+
+461
+00:33:02,600 --> 00:33:06,480
+عيناتي يا اما نازو فرنجل swap نازو فرنجل swap يا
+
+462
+00:33:06,480 --> 00:33:11,240
+اما blood يا اما CSF وقلنا في ال skin ممكن ناخد ب
+
+463
+00:33:11,240 --> 00:33:15,220
+TLA rashes اذا كانت ال blood اذا كانت ال blood
+
+464
+00:33:15,220 --> 00:33:17,820
+احنا بنعمل ال blood culture مافيش انا مشاكل في
+
+465
+00:33:17,820 --> 00:33:22,750
+الموضوع هذالكن لو كانت عينة أخرى من التلاتة CSF
+
+466
+00:33:22,750 --> 00:33:28,010
+swap من اللي هو الـ nasopharyngeal أو قطرة من الدم
+
+467
+00:33:28,010 --> 00:33:30,990
+اللي موجود هنا هدفنا نعمله striking على إيش؟ زراع
+
+468
+00:33:30,990 --> 00:33:34,350
+على إيش؟ على تشكولة أجار بالأساس على تشكولة أجار
+
+469
+00:33:34,350 --> 00:33:38,630
+خدوا بالكم الشغل فإن سوريا جنوبية كنا نفضل fire
+
+470
+00:33:38,630 --> 00:33:42,590
+martin agar ليش؟ لأنه selective لأن العينة مأخوذة
+
+471
+00:33:42,590 --> 00:33:48,510
+من أماكن فيها other microorganism بس هنا CSFايش
+
+472
+00:33:48,510 --> 00:33:55,330
+بده يكون فيه .. CSF .. ال CSF .. ال sterile .. ال
+
+473
+00:33:55,330 --> 00:33:58,810
+sterile لكن لو نزل فرنجل ممكن أستخدم fire martin
+
+474
+00:33:58,810 --> 00:34:03,350
+agar وسط الصورة فمعتبد علىيبجي ايا تشيرت اجار ايا
+
+475
+00:34:03,350 --> 00:34:07,670
+تاير مارتن اجار و ال incubation على 36 degrees
+
+476
+00:34:07,670 --> 00:34:12,730
+برضه على خمسة لعشرة CO2 tension و البكتيرى اللى
+
+477
+00:34:12,730 --> 00:34:16,010
+بيطلع معاها بنعملها Oxidase test زي اد اجرام ..
+
+478
+00:34:16,010 --> 00:34:20,050
+اجرام تان زي اد Oxidase test اذا جرام نيجتف دبلوكو
+
+479
+00:34:20,050 --> 00:34:24,430
+دبلوكو قايم Oxidase test بص تفاهية نيسيريا نيسيريا
+
+480
+00:34:24,430 --> 00:34:29,080
+ايش؟واجب ان انا اعرف تنمو على نوترينت أجار يبقى مش
+
+481
+00:34:29,080 --> 00:34:32,500
+pathogenic مابتنموش على نوترينت أجار يبقى واحد من
+
+482
+00:34:32,500 --> 00:34:36,560
+التنتين يا جنورية يا إما meningitis طب ألا يكفيك
+
+483
+00:34:36,560 --> 00:34:41,820
+أن أجيها من ال CSF؟ ألا يكفيك أن أجيها من ال CSF؟
+
+484
+00:34:41,820 --> 00:34:45,480
+أنها ما تكونش ناجية؟ هل أنا ذكرت في شرح لجنورية
+
+485
+00:34:45,480 --> 00:34:51,640
+أنها ممكن أن أزيلها من ال CSF؟ لكن لا يكفيو you
+
+486
+00:34:51,640 --> 00:34:54,040
+should confirm you should confirm by ال
+
+487
+00:34:54,040 --> 00:34:56,860
+carbohydrate utilization اللي هم التلاتة اللي
+
+488
+00:34:56,860 --> 00:35:02,200
+حكينا عنهم المرة الماضية treatment و ان ال
+
+489
+00:35:02,200 --> 00:35:07,140
+penicillin is the drug of choice انا اتكلمت عن ان
+
+490
+00:35:07,140 --> 00:35:11,600
+سيريا جانورية انها resistant طبعا ماكانتش
+
+491
+00:35:11,600 --> 00:35:15,100
+resistant هي هي كانت sensitive و لما بقول شكرة
+
+492
+00:35:15,100 --> 00:35:19,140
+resistance لحاجة كانت هي sensitive لهابس البنسالين
+
+493
+00:35:19,140 --> 00:35:23,440
+still is the drug of choice لنسيريا من انجدايتس
+
+494
+00:35:23,440 --> 00:35:28,160
+على الرغم من انه في بعض السلالات لكن مش بنسبة تسعة
+
+495
+00:35:28,160 --> 00:35:33,340
+وتسعين بالمية زي مين زي نسيريا جدري it penetrates
+
+496
+00:35:33,340 --> 00:35:38,610
+خدوا بالك البنسالينأصلا في الوضع الطبيعي مابيخترقش
+
+497
+00:35:38,610 --> 00:35:43,470
+ال .. ال meninges العادية فبتعرف كيف دي صلى لل ..
+
+498
+00:35:43,470 --> 00:35:47,250
+للبكتيريا لكن لما تكون ال meninges inflamed
+
+499
+00:35:47,250 --> 00:35:52,330
+بيخترقها لذلك خدوا بالكوا نقطة كتير مهمة انا بعالج
+
+500
+00:35:52,330 --> 00:35:55,930
+بال penicillin بعالج بال .. بال penicillin لكن ال
+
+501
+00:35:55,930 --> 00:36:01,640
+source وين؟في الـ nasopharyngeal غالبا أن
+
+502
+00:36:01,640 --> 00:36:05,680
+البنسالين ما ينفعش يخلصنا من البكتيريا الموجودة في
+
+503
+00:36:05,680 --> 00:36:09,180
+الـ nasopharyngeal فبنعالج بالبنسالين لأنه عنده
+
+504
+00:36:09,180 --> 00:36:12,880
+مقدر على اختراق فقط ال inflamed meninges في هذا
+
+505
+00:36:12,880 --> 00:36:17,360
+الحالة و بمشي الحالة طبعا إذا كان المريض عنده
+
+506
+00:36:17,360 --> 00:36:20,700
+حساسية للبنسالين و أحنا شفنا حالات في أحد
+
+507
+00:36:20,700 --> 00:36:24,350
+المحاضراتأو تحدثنا عن الـ penicillin نعمل فحص
+
+508
+00:36:24,350 --> 00:36:27,030
+الحاسية إذا sensitive اللي ال patient للبنسالين
+
+509
+00:36:27,030 --> 00:36:30,470
+عنده حاسية بنغيرله إياه زي مثلا في ال stiffed
+
+510
+00:36:30,470 --> 00:36:33,050
+coccus biodeins إذا sensitive بنستخدم الاثرو
+
+511
+00:36:33,050 --> 00:36:36,890
+مايسين هنا بنستخدم stiffed-reaxone وهو أحد استفادة
+
+512
+00:36:36,890 --> 00:36:40,090
+السبوريز المهم جدا اللي لحد الآن موظفة وفعالة
+
+513
+00:36:40,090 --> 00:36:45,370
+وممتازة جدا للقضاء على البكتيري طبعا هذه ال
+
+514
+00:36:45,370 --> 00:36:51,760
+stiffed-reaxoneأحد ميزاته عن الفنسالين انه بيغطي
+
+515
+00:36:51,760 --> 00:36:56,300
+range واسع من الميكروبات، من الميكروبات اللي احنا
+
+516
+00:36:56,300 --> 00:37:00,800
+قلنا عنهم نجوم ال meningitis، بمعنى لو انا عطيته
+
+517
+00:37:00,800 --> 00:37:08,050
+الآن، عطيته وانا مش عارف المسببفبكون نسبة إمكانية
+
+518
+00:37:08,050 --> 00:37:12,930
+إنه يشفى المريض أعلى، ليش؟ لإنه لا يقتل فقط إنه
+
+519
+00:37:12,930 --> 00:37:15,870
+Syria meningitis وإنما يقتل كمان من ال other
+
+520
+00:37:15,870 --> 00:37:19,550
+باثوجينز زي ال hemophilus influenza و ال
+
+521
+00:37:19,550 --> 00:37:23,420
+streptococcus pneumonia، هم من هدولة؟نفسيريا
+
+522
+00:37:23,420 --> 00:37:26,580
+مينيجدايتس استيطفوكوكس نيمونيا مفلس الانفلوانزا
+
+523
+00:37:26,580 --> 00:37:30,220
+يقول عنهم نجوم المينيجدايتس فالceftriaxone قد
+
+524
+00:37:30,220 --> 00:37:36,660
+يُعطى في حال يعني خدّينا نقول ال empirical therapy
+
+525
+00:37:36,660 --> 00:37:40,740
+إيش ال empirical therapy؟ العلاج النظري إن أنا
+
+526
+00:37:40,740 --> 00:37:46,740
+أخدت عينا من المريض ووقتها على المختبر هل بإمكاني
+
+527
+00:37:46,740 --> 00:37:50,860
+الإنتظار حتى تظهروا النتائج؟ ولا بتعطيه أنتبايتك؟
+
+528
+00:37:51,270 --> 00:37:56,670
+لكن ما تعطيه انتبايتك، أخدت العينة و بعدتها و بدت
+
+529
+00:37:56,670 --> 00:37:59,910
+أعطي انتبايتك، مانفعش أعطي انتبايتك و بعدين أخد
+
+530
+00:37:59,910 --> 00:38:05,190
+عينةولا بنفع قاعدة اننا لازم ناخد العينة وبعدين
+
+531
+00:38:05,190 --> 00:38:09,370
+نبدأ نعطي antibiotic فال empirical therapy هو مبني
+
+532
+00:38:09,370 --> 00:38:12,070
+دايما علاش الشباب يكون مبني مبني على local
+
+533
+00:38:12,070 --> 00:38:17,330
+protocols local data انا كل سنة بطلع عندى بعض
+
+534
+00:38:17,330 --> 00:38:20,410
+الالاف الميكروبات في المستشفيات مظبوط ولا لأ؟
+
+535
+00:38:20,410 --> 00:38:23,390
+والألاف الميكروبات بنعملها sensitivity testing
+
+536
+00:38:23,390 --> 00:38:27,940
+الاصل في نهاية العاميكون في عندي تحليل البيانات ال
+
+537
+00:38:27,940 --> 00:38:31,760
+E.coli اللي عزلناها عزلنا ألف من ألف E.coli
+
+538
+00:38:31,760 --> 00:38:37,240
+بنجسمهم على مصادر العزل من ال urine من ال CSF من
+
+539
+00:38:37,240 --> 00:38:43,160
+ال wound infection وبنشوف جداش كل E.coli من هذه ال
+
+540
+00:38:43,160 --> 00:38:46,400
+E.coli كانت resistant لل-ampicillin جداش كانت
+
+541
+00:38:46,400 --> 00:38:50,640
+resistant لل-ceftriaxone للسيبرفلوكسين وبصير عندي
+
+542
+00:38:50,640 --> 00:38:54,790
+في الآخر قائمةE coli resistant percentage لل
+
+543
+00:38:54,790 --> 00:38:58,030
+Antibiotic إذا كان ال percentage لبعض ال
+
+544
+00:38:58,030 --> 00:39:02,310
+resistance منخفض سابقا أني مستخدم ال antibiotic في
+
+545
+00:39:02,310 --> 00:39:06,150
+ال empirical therapy للبكتيريا هذه لكن لو لجيت إنه
+
+546
+00:39:06,150 --> 00:39:10,790
+البكتيريا صارت resistant بالنسبة ل 90% و روحت
+
+547
+00:39:10,790 --> 00:39:13,350
+أقطاط نفسي لل Antibiotic هذا قمة الغباء صح ولا لأ؟
+
+548
+00:39:13,350 --> 00:39:19,490
+لأن فرصة الشفاء هتكون كم؟ 10%وبالتالي كلمة مرة
+
+549
+00:39:19,490 --> 00:39:24,590
+بقولكوا ال ال empirical therapy هو معتمد على local
+
+550
+00:39:24,590 --> 00:39:28,910
+data او local protocols معتمد على local data يعني
+
+551
+00:39:28,910 --> 00:39:31,770
+مانفعش اخد نسبة ال resistance و ال sensitivity من
+
+552
+00:39:31,770 --> 00:39:35,690
+أمريكا و اعمل protocol لغزة لازم اعمل ال protocol
+
+553
+00:39:35,690 --> 00:39:41,690
+مبني على من؟ على البيانات اللي موجودة من غزة طيب
+
+554
+00:39:41,690 --> 00:39:44,450
+at the end of therapy with penicillin in adults
+
+555
+00:39:44,450 --> 00:39:49,970
+give ciprofloxacinبعد ما خلصت علاج للمريض
+
+556
+00:39:49,970 --> 00:39:55,610
+بالبنسالين اعطيه سبروفلوكساسين ليش؟ to eradicate
+
+557
+00:39:55,610 --> 00:40:00,010
+meningococci because penicillin does not eradicate
+
+558
+00:40:00,010 --> 00:40:02,830
+from nasopharynx otherwise patient will becomeأه
+
+559
+00:40:02,830 --> 00:40:07,330
+كاريات طب انا ما صدقت هذا المريض وصل لاندي وانا
+
+560
+00:40:07,330 --> 00:40:12,810
+الآن في حوزته بمعنى ان انا بدي اتأكد من شفاءه
+
+561
+00:40:12,810 --> 00:40:17,470
+واتأكد من انه ما يتحول لمين لكاريا اذا علشته
+
+562
+00:40:17,470 --> 00:40:23,420
+بالبنسلين هيخف هيطيبلكن حيطيب و انا ما قضيت على
+
+563
+00:40:23,420 --> 00:40:26,080
+البكتيرا في مين؟ في الـ nasopharynx سبع تي
+
+564
+00:40:26,080 --> 00:40:29,160
+سيبروفلوكسسين يجب جماعنا اللي حاكي يخدوا بالكم ان
+
+565
+00:40:29,160 --> 00:40:35,040
+شاء الله بكرا هيجيكوا عينات من ناس للتشخيص و
+
+566
+00:40:35,040 --> 00:40:39,960
+هيجيكوا عينات من ناس أخدوا علاج بدنا نطمئن ان ال
+
+567
+00:40:39,960 --> 00:40:44,220
+microbe is no longer there مثال على ذلك سلموني
+
+568
+00:40:44,220 --> 00:40:49,440
+الله بقولنا بنعالجبين العالمين على diagnosis اما
+
+569
+00:40:49,440 --> 00:40:53,640
+clinical او على blood culture وبنوجف العلاج بين
+
+570
+00:40:53,640 --> 00:40:58,320
+العالمين بناء على مصر عامل stool احنا علشناه طعام
+
+571
+00:40:58,320 --> 00:41:03,000
+المريض لكن الان بدنا ناخد عينة stool حتى نتأكد ان
+
+572
+00:41:03,000 --> 00:41:09,420
+ال microbe is no longer شد in stool مداشي يتحول
+
+573
+00:41:09,420 --> 00:41:12,940
+لcurial ويصير source لل infection في ال .. ال ..
+
+574
+00:41:12,940 --> 00:41:16,280
+الاخرين prevention
+
+575
+00:41:19,440 --> 00:41:22,840
+لجنا واحد في العائلة مصاب يا شباب واحد في العائلة
+
+576
+00:41:22,840 --> 00:41:26,380
+مصاب ايش معناه الحاجة ايه؟ معناه الحاجة انه عطس
+
+577
+00:41:26,380 --> 00:41:29,880
+بالظبط فوزع على ال .. على الأفراد العائلة فكل ال
+
+578
+00:41:29,880 --> 00:41:33,560
+.. على فكرة كسياسة عامة في غزة أنه نسيريا مينيديدس
+
+579
+00:41:33,560 --> 00:41:37,700
+اللي بتشخص في العائلة واحد كل العائلة بتاخد على
+
+580
+00:41:37,700 --> 00:41:41,140
+نزر فارنجلسواب وبياخدوا Prophylaxis Antibiotics
+
+581
+00:41:41,140 --> 00:41:45,280
+فهذه سياسة كويسة to prevent the spread of this
+
+582
+00:41:45,280 --> 00:41:49,900
+organismرفانبين هذا كان drug of choice في يوم
+
+583
+00:41:49,900 --> 00:41:53,140
+الأيام، الآن السيبق الفاكسيين هو drug of choice،
+
+584
+00:41:53,140 --> 00:41:55,440
+Venezuela does not eradicate carriers still كما
+
+585
+00:41:55,440 --> 00:42:01,260
+حكينا، يعني مانفعش لمين؟ يعني مانفعش لمين؟ لل
+
+586
+00:42:01,260 --> 00:42:04,480
+carriers، مانفعش لا ال carriersالـ due to
+
+587
+00:42:04,480 --> 00:42:07,060
+inadequate penetration of uninflamed nasal .. هذا
+
+588
+00:42:07,060 --> 00:42:10,040
+.. هذا السبب ليش؟ لإن الفنسالين مينفعش، لإن هو غير
+
+589
+00:42:10,040 --> 00:42:12,880
+قادر على إنه يعمل penetration للـ nasopharyngeal
+
+590
+00:42:12,880 --> 00:42:16,920
+mucosa، poor secretion in saliva، برضه ضعيف،
+
+591
+00:42:16,920 --> 00:42:20,520
+افرادته في اللوعاب، ال chemoprophylaxis و إنه
+
+592
+00:42:20,520 --> 00:42:26,140
+كإجراء وقائي، واحد تعرض في منزل، تعرض لشخص مصاب من
+
+593
+00:42:26,140 --> 00:42:30,430
+العيلة، بنعطيه إحدى superfluxacينالفاكسين زي ما
+
+594
+00:42:30,430 --> 00:42:34,470
+حكينا في عندنا group A و group C وهذا الـdivalent
+
+595
+00:42:34,470 --> 00:42:37,090
+يعني بيعطيه فاكسين مكوّن من اتنين او
+
+596
+00:42:37,090 --> 00:42:40,550
+الـquadrivalent والانصار في عندي A, C وY واعتقد ان
+
+597
+00:42:40,550 --> 00:42:43,850
+هذا الان هو ال common في غزة الرباعي اللي فيه ال A
+
+598
+00:42:43,850 --> 00:42:49,780
+و ال C و ال Y و ال 135للأسف قلتلكم مش موجود في
+
+599
+00:42:49,780 --> 00:42:53,440
+against group B لإنه group B ال not .. not
+
+600
+00:42:53,440 --> 00:42:58,840
+immunogenic بيعطى لمين؟ للناس اللي موجودين في ال
+
+601
+00:42:58,840 --> 00:43:02,220
+.. المعسكرات الجيوش و خاصة اللي هم يقولنا ال
+
+602
+00:43:02,220 --> 00:43:06,260
+military recruits ممكن كمان during epidemics اللي
+
+603
+00:43:06,260 --> 00:43:07,260
+هو خلال الأوقات
+
+604
+00:43:10,470 --> 00:43:15,010
+اللوحة القابلة الأخيرة اعتقد ها دى بتوضح ان ما هي
+
+605
+00:43:15,010 --> 00:43:18,890
+الفروقات بين ال junococcus و ال meningococcus ال
+
+606
+00:43:18,890 --> 00:43:24,050
+junococcus أبطأ شوية في النمو من ال meningococcus
+
+607
+00:43:24,050 --> 00:43:28,330
+و بتكون مستعمرات أصغر ال junococcus بتنتج acid من
+
+608
+00:43:28,330 --> 00:43:30,830
+الجلوكاز بينما التانية بتنتج acid من الجلوكاز و هي
+
+609
+00:43:30,830 --> 00:43:35,910
+الملتازالجونوكوكاس هو أقل مخلوقات وجينيبيكس من
+
+610
+00:43:35,910 --> 00:43:40,610
+انجوكوكاس، يعني مهنا أخر هذه البكتيريا لو حقنها في
+
+611
+00:43:40,610 --> 00:43:44,610
+الفقران هتعطي أثر أكبر من مين من ال نيسيريا
+
+612
+00:43:44,610 --> 00:43:47,550
+جونورية، ال similarities حكيناهم يمكن ال
+
+613
+00:43:47,550 --> 00:43:51,870
+resistance تبعهم للأشياء يعني قريب من بعضه، يعني
+
+614
+00:43:51,870 --> 00:43:55,980
+حساسيتهم ده الأشياء برضه حساسين التنينالتنين
+
+615
+00:43:55,980 --> 00:44:00,620
+مرتبطين بالإنسان مابنعرفش مصادر أخرى غير الإنسان،
+
+616
+00:44:00,620 --> 00:44:05,140
+رقم تلاتة توزيحهم في ال inflammatory exudates في
+
+617
+00:44:05,140 --> 00:44:08,080
+الإفرازات سواء كان intracellular أو extracellular
+
+618
+00:44:08,080 --> 00:44:12,000
+بيكون تقريبا the same وبينمو على أوساط زراعية زي
+
+619
+00:44:12,000 --> 00:44:17,330
+الchocolate agar بطريقة متشابهةاللوحة الأخيرة اللي
+
+620
+00:44:17,330 --> 00:44:22,410
+برانهاميلا اللي قلنا عنها نيسيريا كاتراليس اللي
+
+621
+00:44:22,410 --> 00:44:26,190
+قلنا عنها برانهاميلا كاتراليس formerly called
+
+622
+00:44:26,190 --> 00:44:31,090
+نيسيريا كاتراليس كانت في السابق شكلا لا نستطيع
+
+623
+00:44:31,090 --> 00:44:34,930
+تمييزها عن النيسيريا يعني بمعنى أخر تحت
+
+624
+00:44:34,930 --> 00:44:36,870
+الميكروسكوب دي will appear Gram Negative
+
+625
+00:44:36,870 --> 00:44:41,810
+DiplococciIt is a part of the oral flora of the
+
+626
+00:44:41,810 --> 00:44:46,930
+throat يعني في المنطقة الأولى الـ cavity موجودة في
+
+627
+00:44:46,930 --> 00:44:49,830
+الـ الـ mucous membrane أيضا في الـ respiratory
+
+628
+00:44:49,830 --> 00:44:53,530
+tract non-pathogenic characterized by its
+
+629
+00:44:53,530 --> 00:44:57,430
+inability to ferment any carbohydrate يعني ماعنداش
+
+630
+00:44:57,430 --> 00:45:00,610
+مقدرة انها تعمل هي كلمة ferment هنا قلتلكوا غلط هي
+
+631
+00:45:00,610 --> 00:45:05,250
+to oxidize لأن هي بكتيريا obligatory وبالتالي غير
+
+632
+00:45:05,250 --> 00:45:11,420
+قادرة على انها تعمل oxidation لأي من الكربولماذا
+
+633
+00:45:11,420 --> 00:45:14,560
+فصلناها عن ال نيسيريا يا شباب واطلعناها من ال
+
+634
+00:45:14,560 --> 00:45:19,900
+نيسيريا لأنه لما عملنا DNA homology studies دراسات
+
+635
+00:45:19,900 --> 00:45:23,560
+تشابه ال DNA اللي جيناها بتختلف اختلاف كبير عن
+
+636
+00:45:23,560 --> 00:45:28,990
+اللي هو ال genus نيسيريا ابتديت تفصلها منهابهيك
+
+637
+00:45:28,990 --> 00:45:31,930
+بممكن احنا ان شاء الله نهينا ال .. ال nasiria يمكن
+
+638
+00:45:31,930 --> 00:45:34,130
+اذا أسعفنا الوقت في يوم من الأيام نعمل عملية
+
+639
+00:45:34,130 --> 00:45:39,230
+revision و نحاول .. نحاول نعمل كام ده جرام لكل من
+
+640
+00:45:39,230 --> 00:45:43,110
+ال enterobacteria C و ال .. ال .. ال gram-bostric
+
+641
+00:45:43,110 --> 00:45:46,390
+oxide و أيضا اللي هو ال nasiria مع تذكير بإن ال
+
+642
+00:45:46,390 --> 00:45:49,470
+software اللي أعطتكوا إيها يجب عليكوا أنكوا تكونوا
+
+643
+00:45:49,470 --> 00:45:54,830
+اتعرفته أو مارستوا بعض اللي هو ال .. ال .. التمرين
+
+644
+00:45:54,830 --> 00:45:57,990
+على هذا ال software اللي هو ال consecutive test
+