Saturday, October 29, 2016
مرض الذئبة الحمراء مرض الذئبة الحمامي الشامل SYSTEMIC LUPUS ERYTHEMATOSUS 2013
مرض الذئبة الحمراء مرض الذئبة الحمامي الشامل SYSTEMIC LUPUS ERYTHEMATOSUS 2013
?? ?? ??? ????????? ???? ?? ????? ??????? ??????? autoimmune disease ???? ?? ????? ?????? ?? ??? ??????? ???? ????? ???????? ????? ?????? ???????? ??????? ??? ?? ????? ????? ????? ???? .
?????? ???? ??????? ?? ??? ???? ?? ???? ??????? ?????? ????? ??? ?????? ?????? ?? ???? ??????? ???????? ????? ?? ?????? ?? ?????????? ????????? ????????? ?????????? ????? ????? ??? ????? ??? ????? ????? ???????. ? ???? ???? ( Systemic ) ???? ???? ?? ????? ????? ????????? ??? ???? ?????? ( Lupus ) ??? ????? ?? ???? ??????? ???? ?????? ??? ??? ????? ?? ?????? ?????? ????? ???? ??? ??????? ????? ??? ??? ?????? ???? ????? ?????? ???????? ??????? ???????? ?? ??? ?????? ??????? ???? ??????? Erythematosus)) ????? ?? ???? ??????? ???? ???? ???? ??? ????? ??????.
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o ???? ????? ?????? ?????? ?? 9 ??? 1????? ???? ???? ?????? ???????? ?? ??????? ?????? ????? - ??? ?? 15???
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??? ?????? ?? ???? ?????? ???? ????? ?????? ????? ?? ????? ??????? ??????? ???????? ???? ????? ???: ?????? ????? ???? ???? ????? ? ?????????? ????????? ? ????? ???? ??????? ?????????? .
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1. ???? ????? ????? ???? ????? ?? ???? ????? ????? ??? ??? ?????? ?? ???? ???????? ????? .
2. ??????? ?????? ???? ??????? ????? ???? ???? ?????? ?? ??????? ???? ?????? ?????? ??????? ?? ??????? ???????? ?????? ?? ????? ?????? ?? ?????? ?? ??? ?? ????? ?????? ?????? ?????? .
3. ?? ???? ????? ???? ??????? ??????? ?? ???????? ?? ??? ?? ???? ?? ????? ?????.
4. ???? ????? ???????? ???????? ?? ???? ??????? ?????? ?????? ????? ???????:
o ??????? ?????? ?? ????? ??????
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o ????? ??? ??? ??? ?????? ???????? ?????? ???? ???? ??? ????? ???? ??????? ??? ???? ?????? ????? ??? ?????
o ??????? ?? ???? ????? ????? ?????? alopecia
o ???? ?? ??? ??????? ??? ?????? ????? ??? ???? ????? ???? ?? ???? ?? ???? (????? ?????Raynauds sign).
o ?????? ???????
o ??? ???????
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o ????? ??????
o ??????
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o ??? ?????
o ???? ????? - - ????? ???? ??? ?????? ?????? ??? ??? ??????? ???????? ??????? ??????? ?????????? ???? ?????? ??? ??????? ?????? ?????? ???? ???? ????? ????? ?????? ??? ????? ???? ???? ?? ????? ????????? ?? ??????? ???????? ???? ??????? .
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???? ??? ????? ?????? ?? ?? ?????? ??????? ??? ?????? ????? ???? ???? ?? ??????? ??????? ???? ?? ????? ???? ??? ?? ??????? ??? ?? ?????? .
??? ???? ?????? ?o ????? ????? ????? ??? ???? ???? ?? ??????? ????????? ?????? ??????? ?? ???????? ???????? ?????? ?? ??????? ??????? ????????
o ?????? ????? ?? ??????? ?????? ???? ??????? ????????? ?????? ?????????? ????? ???? ??? ??????? ?? ??????? ??? ????? ???? ?? ??????? ????? ?????.
o ??? ???????? ???? ????? ?? ??????? -????????- ??????? ?????? ?????? ?? ???????? ???? ?????.
?????? ???????:?????? ????? ??? ???? 4 ?????? ?? ?????? 11 ??????? ???? ?? ??? ??? ????? ?????? ???????? ?? ?????? ???????? ?? ??? ?????? ??? ?? ???? ??? ?? ????? ??????? ????????? ????:
1. ????? ?????? ??????? butterfly rash:
??? ??? ???? ???? ???? ?????? ????? ??? ???? ????? - ????? ??????
2. ???? ????? ?????? Photosensitivity: ??? ????? ???? ???? ????? ??? ?????? ????? ????? ????? ???? ??? ??????? ???????? ?? ????? ?? ????? ??????? ???????.
3. ??? ????? ??????? Discoid-lupus:
??? ??? ???? ?????? ???? ??? ???? ????? ??? ?????? ???? ????? ???????? ?????? ???????. ?????? ???? ??? ????? ???? ???? ???? ?? ?????. ???? ????? ?? ????? ?????? ??? ?? ??????? ????? ?????? ?????? ???????? ??????.
4. ?????? ??????? ???????? Mucosal ulcers:
??? ?????? ????? ???? ?? ???? ?????? ????? ???? ??? ???, ??? ?????? ????? ?? ???? ????? ?????? .
5. ?????? ??????? Arthritis: ????? ?? ?????? ?????? ????? ????? ????????? ?? ????? ?????? ?? ??????? ?? ???????? ?? ???????? ?? ??????? ?????? ?? ???????? ????????. ?????? ??????? ??????? ??????? ?? ???? ??????? ?? ???? ??? ???? ??? ??? ???? ?? ??? ??????? ??? ????? ????? ????? ???? ?????? ??????????? ?????? ???? ???? ??? ???????? ??? ?? ???? ?????? ?? ?????? ????? ?? ???????.
Raymonds-fingers-in-SLE
6. ?????? ??????? ???????:
? ????: ??? ?????? ?????? ??? ?? ???? ??????? Pleuritis ?? ?????? ??????? ??? ???? ????? pericarditis ?? ?????? ????. ????? ?????? ??? ??????? ??????? ???? ??????? ??? ????? ?? ???????. ??????? ?????? ???? ????? ?? ????? ????? ??? ?? ??????.
7. ??? ?????:
????? ???????? ?????? ?? ?????? ??? ?????? ??? ???????? ?????? ??? ??? ??????? ??? ???????? ?????? ???? ???? ????? ??????. ????? ???? ??? ????? ?? ??????? ???? ????? ????? ????? ?????? ???? ?? ???? ????? ????? ?????? ?????. ???????? ??? ??????? ??????? ??? ?? ???? ???? ?????? ?? ????? ?????? ?? ???? ?? 2/1 ???? ?????? ?? ?? ???? ????? ????? ??? ??? ????? ????????????.
8. ??? ?????? ??????:
????? ?????? ????????? ??????? ?? ???????? ?????? ?????? ??? ??????? ?? ??????? ??????? ?? ???? ?????? ???????? ?????? ?? ?????? ???????? ??? ?????? ???? ???? ???? ?? ?????? ???????? ? ??????? ??? ??????? ??? ???? ??? ???????? ??????? ?? ?????? ???????? ??????? ?? ???? ?????? ???? ???? ?? ??? ?? ??? ??????? ????????.
9. ???????? ????? ????:
?????? ?????? ?? ??????? ??????? ????? ??????? ????? ????? ????? ???? ???????? :
o ????? ???? ??????? : ??? ???? ???? ???????? ?? ??????? ??? ???? ????? ????? ??????? ???? ?????? ???? ????? ??? ??? ???? ????????? ???? ?????? ?? ???? ?????? ??????? ?? ?? ???? ?????? ???? ????? ???? ????? ??? ????? ????.
o ?????? ????? ???? ??????? ??? ?????? ?? ??? ????? ?????.
o ?????? ??????? ??????? ??? ???? ????? ????? ?? ?????? ?? ??????? ???????? ??? ????? ?????? ?????? ?? ?????? ?? ?? ????? ?? ??????.
10. ???????? ??????:
??? ??????? ??????? ????? ??????? ????? ???? ?? ?? ?????? ???? ????? ?????:
??- ??????? ??????? ?????? ?????? ?????? ) (anti-ds-DNA: ??? ???? ????? ?? ?????? ???????? ?? ??????? ????? ???? ????? ?? ???? ?????? ???? ?????? ???? ???? ????? ????? ???? ?? ???? ???? ????? ???? ??? ????? ??? ????? ?????? ?? ????? ???? ????? ?????? ?????? ???????.
? - ??????? ??????? ?????) (anti-smith: ????? ???? ??? ????? ???? ????? ???? ??? ??????? ??????? ?? ???? ??? ????? ???? ?? ????? ??? ????? ??? ???? ????? ?? ???? ?? ?? ??? ??? .
?) ???? ??????? ??????? ???????? ?????????? antiphospholipid antibodies
???????? ??? 1
11. ??????? ??????? ????? ?????? Antinuclear antibodies :
????? ??????? ?? ?? ???? ?????? ??? ??? ???????? ?????? ???? ??????? ?? ???? ???????? ??????? ?????? ?? ?? ????? ??????? ??????? ?????? ?????? ?????? ?? ???? ???? ??? ??????? ??????? ????? ?????? ?? ???? ???? ?????????? ?????????? ?? ??????? ??? ??????? ?? ?? ????? ???? ?? ???? ?? ???? ?? ????? 5% ?? ??????? ???????.
?? ?? ????? ???????? ???????? ???????? ????? ?? ????? ????? ?????? ??? ?? ???? ??????? ???????? ????? ?????? ?? ??? ????????? ???????? ???? ?????? ???? ??????? ???? ????? ???????? ?????? ???????? ??????? ????????? ????? ??? ???????? ?? ???:
1. ???????? ????????:
??? ???? ?????? ???? ????? ???????? ??? ????? ????? ?????:
o ???? ????? ????? ???? ??????? Sedimentation rate ? ???????? ???????? C-reactive protein - ??????? ?????? ??? ???? ????????. ??????? ???????? ???????? - ?? ???? ?? ?????? ??????? ????? ?????? ???? ??? ???????? ???????? ??????? ?? ?????? ?? ??????? ???????. ??? ???? ???? ??????? ????? ?????? ??????.
o ????? ????? ???? ??????? ?? ???? ????? ?? ???? ?? ???????? ?? ????? ???? ??????? ?? ??????? ???????
o ???? ?????? ?? ???? ??? ???? ????? ?? ??????????????? gammaglobulin ???? ?????????? ?? ????? ?? ?????? ???? ?????? ????? ?????? ???????.
o ???????? ?????????? ?? ???? ?????? ????? ?? ??? ????? ?? ????? ?????? ???????????? ????????? ??????? ????? ???? ???????? ?? ??????? ????? ?? ??????? ??????? ??? ???? ??????.
o ?????? ????? ???? ?????? ??? ????? ????? ????? ???? ???????? ?????? ??? ?????? ????? ????? ????? ???? ????? ??? ?? ??? ????? ?? ???? ????.
??? ???? ??? ???????? ?????? ?????? ???????? ??? ???? ????? ?? ????? ?? ????? ?? ???? ?????? ?? ????? ?????? ?????.
o ??? ??? ??????? ?? ???? ?? ?????? ????? ????? ????? 24 ???? ????? ???? ?????? ??? ????? ?? ?????? ?????? ????? ?? ????? ????? ?? ?????.
2. ???????? ???????? Immunological tests: ????? :
o ??????? ??????? ????? ?????? Antinuclear antibodies ? ??????? ?????? ?????? Anti-native DNA antibodies ?????? ??????? ???????? ??????????. Antiphospholipid antibodies
o ???? ????? ???????? Complement ?? ???? ?? ???? ?????? ????? ?????.????????? ?? ????? ?????? ?? ?????? ????? ????? ?? ?????? ??? ???????? ?????? ??????? ??????? ?????????? ?????. ???????? 3 C?C4 ?? ?????? ?? ??????? ??????? ???? ??????? ?? ???? ???? ???? ??? ?????? ????? ??? ?????.
3. ?????? ????:
?????? ???? ????? ????? ????? ??? ??????? ???????? ????? ??? ???? ??????:
- ??? ???? ?? ???? ?????? ????? ??????? ???? ?? ??? ????? ???? ???????? ?????? ?????? ?? ?????? ?????? ???????.
- ??? ???? ?? ?????: ????? ?? ????? ????? ?????? ???????? ?? ??????? ??????? ?? ????? ?????? ??? ????? ??????? ?? ????? ????? ??????? ???????? ????? ??????
- ???? ????? ?????? ??????? ??????.
- ????? ???????? ????? ECG ?????? ??? ????? ?????? ?????.
- ?????? ????? ??????? pulmonary functions.
- ????? ???????? ??????. EEG
- ??????? ?????????? ??????? ???????? ?????? ??????.
- ??? ????? ?? ????? ????? ???????? ??? ??? ?????.
?? ???????? ???? ????? ??????? ????o ?? ???? ???? ???? ??? ????? ??? ????? ?? ???????? ???????? ?? ??????? ?? ??????? ????? ??????? ?? ?????? ???????? ????????.
o ??? ????? ????? ???? ?????? ?? ???? ???? ??? ?????? ??????? ????? ????? ?? ??????? ?????? ?? ????? ????? ?????? ??? ??????? ????????.
o ?? ?????? ?? ??????? ????? ?????? ?????? ?? ????? ??? ???? ????? ?? ???? ???? ???? ???? ?? ?????? ?????.
?? ?? ???????? ?????????
?????? ??????? ?? ??? ?????? ???? ?? ?????????? ????? ???????? ???? ??? ????? ??? ??????????.
???? ???? ??????? ?? ??????? -?? ?????? ????????? ??? ????? ??????- ????? ??? ????? ?????:
o ??????? ??????? ???????? ??? ?????????? Non-steroidal anti-inflammatory drugs (NSAIDs)??????? ?????? ??? ?????? ??????? ????? ???? ????? ????? ??? ?? ????? ????????? ???????? ??? ?? ???? ?????? ???????. ????? ??? ???????? ?????? ?? ??????? ???????? ??? ???? ???????? ????? ?????? ?? ?????? ??? ?????? ?????? ???????? ??? ??? ??? ?? ??? ?????? ????? ?? ??????? ????? ????? ??????? ?????? ?? ??????? ??????? ???????? ?????????? ???? ???? ???? ????.
o ??????? ??????? ????????:
??? ???? ???????????????????? hydroxychloroquine ??? ????? ???? ?? ???? ????? ????? ?????? ??????? ????? ??? ??? ????? ??????? ???????? ?????? ?? ????? ?????? ??????? ???? ????? ??? ?? ?????? ?????? ??? ???? ??? ???? ??????? ????????. ?????? ?? ???? ????? ?????? ??? ???????? ???? ??????.
o ?????? ?????????:
??? ??????????? prednisone ?? ????????????? ??? ?? ???? ??????? ?????? ?????? ???????? ????? ?????? ??????? ??? ??????? ????? ?????? ??????? ???? ????? ????? ?? ???? ?????? ??????? ?? ??? ????? ???? ????? ????? ????? ?? ??? ??????? ????? ?????? ????? ?? ?????? ?? ?????? ??????? ???? ?????. ?????? ?????? ???????? ?????? ?????? ??????? ??? ????? ???????? ???????? ??? ??????? ??????? ??????? ?? ???? ???? ?? ?????? ?? ?????? ????? ??? ???? ????????? ?? ??? ?????? ?????? ??????? ?? ??????? ?????? ???????? ?? ??? ?????. ????? ??????? ???????? ????? ???? ?? ??????? ?????? ?????? ???? ???? ?? ????? ??????. ???? ?????? ?? ??????? ??????? ????? ???? ???? ?????? ??? ??? ???? ????? ?????? ??? ??? ?????? ?? ??? ????? ?????? ?? ???? ????? ???? ????? ?????????? ???? ?????? ?? ?????? ?????? ?????? ?? ?? ????? ????? ?????? ??? ???????
??? ??? ??????? ????? ????? ?? ?????? ???????? ???? ??????? ?? ?????? ??????? ?? ??????? ??? ???? ??? ?????? ???? ?? ?????? ?? ?? ?????? ?? ????? ?????? ?? ????? ???? ??? ??????? ??? ????? ?? ???? ??????? ?????? ??????? ??? ???? ??? ??????? ?????? ??????? ???? ????? ?? ????? ??????? ???? ??????? ????.
???????? ???? ?? ?? ????????? ???? ?? ????? ???? ????? ?????? ????? ??????? (??? ???????) ?????? ???? ?? ?????? ???? ???????? ?? ??????? ??? ????? ????? ?????????? ????? ???? ???? ????? ??????? ??????? ?? ???? ??????? ??? ??????? ????? ?? ????? ?? ????? ???? ????? ??? ????? ?? ?? ?????? ????? ?????????? ?????? ?????? ????? ?? ????? ???? ????? ??????? ??? ???? ???? ??? ?? ??? ??????? ????? ?????? ????? ??????? ??? ?? ???? ????? ????? ???????. ????? ???? ????? ???? ??? ??????? ???? ???? ?? ???? ??? ???? ?????.
o ??????? ??????? ??????? Immunosuppressive agents:
??? ???????????? azathioprine ( ????????? ) ?? ????????????????? cyclophosphamide . ???? ??????? ???? ??? ???????? ?? ????? ????? ??? ??????? ???? ??????? ?? ?????. ??????? ???? ??? ???? ????? ????????? ??? ????? ??? ?????? ?? ???? ????? ?? ??? ???? ???? ?????? ????? ????????? ?? ??? ???????? ?? ??????? ??????? ????? ?? ????? ????????? ???????? ??????? ?? ???? ??????? ???? ???? ??? ??? ????? ????? ???? ???? ???????? ?? ??????? ?? ???? ?? ??????? ????? ????????? ????? ???? ???????? ???????? ????? ??? ?????
?????? ??? ??????? ?? ??? ????? ???? ?????? ?? ?????? ???? ?? ???? ?? ??? ???????? ?? ??? ???? ??????? ????????????????? ?????? ?????? ????? ?????? ????? ?????? ??????????? ??????? ???????? ????? ???? ???? ???? ????? ?? ??? ?????? ?? ???? ?????? (??????? 10-15 ??? ???? ?? ???? ???? ) ????? ?? ???? ?? ???? ???? ????? ?????? ?? ???????? ???????? ??? ?????? ?????? ?? ????????.
o ??????? ??????? Biological drugs:
????? ????? ???? ????? ??????? ????? ??????? ?? ????? ??? ???????? ??? ????????? ?? ??? ?????? ?? ??? ??? ??????? ??????? ?????? ?? ??????? ???????? ???? ?????. ???????? ?? ??????? ????? ??????? ??????? ??? ?????? ????? ?????? ?????? ????????? ?? ????? ??????? ??? ???????? ???????? ??????? ?? ??? ????? ????? ????? ????? ??? ????? ???? ?????? ???????. ??????? ???? ?????? ?? ???????? ???????? ????? ???? ??????? ????? ????? ??? ???? ???????? ???? ??????? ??????? ???????? ???? ?????.
?? ?? ?????? ???????? ??????? ????????? ?
??????? ????????? ????? ??? ?????? ????? ???? ????? ?? ???? ?????? ?? ?????? ???????? (?????? ???????? ???? ?????? ?????? ???????).
1. ??????? ??????? ???????? ??? ??????????? ???? ???? ????? ?? ?????? ??????? ?????? ??????? ?? ?????? ????? ???? ?????????? ??? ???? ??????. ? ????? ?? ???? ????? ?????? ?? ???????? ??????? ??????? ???? ?????? ?? ????? ????? ??????.
2. ??? ??????? ??????? ???????? ???? ??? ????? ??? ?? ??? ????? ????? ????? ??? ??? ?????? ????? ?????????? ??? ?????? ???? ???? ??? ?????? ???? ??????.
3. ??? ????? ????????? ???? ???? ?????? ????? ??? ????? ?????? ??????? ????? ????? ??????? ???? ?????? ???????? ??? ??????? ????? ????? ?? ??? ??????? ????? ??? ????? ???? ????? ???? ??? ????? ?????? ?????? ??? ????????? ????? ????? . ???? ?????? ???????? ?? ???:
o ?????? ?? ??? ????? ??? ???? ??????: ????? ????? ?????? ??????? ????? ??? ??? ?????? ?????? ????? ?? ???? ???? ???????? ?? ???? ?????? ?? ????? ??????.
o ????? ?????? ??????? ??????????? ????????? ???? ???? ????? ????? ?????? ????? ???????? ???? ??????? ??? ???? ??????? ???? ???? ????? ????? ?? ????? ?????? ???? ???? ???????? ??????? ??? ?? ???? ????? ???? ?? ??????? ??????? ????? ????? ( ????? ???? ).
o ???????? ????? ?????? ???? ????? ???????? ??????? ???? ??????? ?? ????? ???? ?????? ??????.
o ?????? ??? ????.
o ??? ??????? ??? ??? ??? ??????? ????? ?? ???? ???? ????? ?? ?????? ?? ?????? .
o ???????? ?? ??????? ???? ???????? ???? ??? ???? ?????? ?????? ???? ??????
o ?????? ?????? ??????? ??? ???????? ????? ??????.
o ??????? ??????? ?????? ??????? ( ????? ?????? ) ?????? ????.
o ????? (??? ?????) ?????? ????? ??????? ?? ??? ????? ??????? ????????? ???????? ?????? ????? ?????????? ?????? ????? ????????? ???????? ?. ???? ????????? ????? ?? ???? ?? ????? ?????? ? ?????? ?????????.
o ???? ????? ??????.
??? ????? ????? ?? ?????? ???????? ?????? ????????? ???? ????? ????? ??? ????? ?????? ?? ????? ?????? ??? ??????? ??????? ??????? ??? ???? ???? ?????? ???? (????????? ???? ???? ?????? ???????) ???? ???????? ???? ?? ?????? ???????.
?? ????? ???? ?????? ??? ?? ????? ?????? ?? ??? ????? ??????? . ?????? ??? ?????? ???? ??? ?? ??????? ????????? ?? ????? ????????? ?????? ???? ???? ??????? ?????? ??? ????? ????? ???? ??? ????? ?????? ??? ?????? ??????? ???? ?? ??? ??????? ?? ???? ?????? ????? ?????? ?????? ??? ??????? ?? ?????? ???? ?????? ??? ???? ????? ?? ?????? ??? ???? ???? ?????.
????? ?? ???????? ??? ????????? ?? ????????
?? ???? ?????? ????? ???? ?????.??????? ?? ??????? ??????? ???? ?????? ??? ??????. ??? ????? ?? ???? ????? ????? ?? ??????? ?????? ??? ??????? ????????. ??? ???? ??????? ???? ???? ?????? ????? ??????? ?? ???? ????? ??????? ??????????? ??? ??????? ????? ??????? ??????? ?? ??????? ??????? ???? ??? ??? ?? ???????? ???????? ??????. ???????? ????? ????? ???? ??? ?????? ?????? ?????? ????? ??????? ????? ???? ?? ??? ???? ????? ????? ??? ??????? ????? ?? ???? ??????? ?????? ????? ????? ????????? ??????? ??? ??? ????? ?????.
?? ?? ???????? ??????? ????????????????? ??????? ????????? ???? ??? ?????? ?? ??????? ???? ???? ?? ????? ????? ???? ????? ?? ?????? ???? ???? ??? ?????? ??????.
??????? ???????? ?????? ???? ??? ???? ???? ???? ?????? ????? ????? ?????? ????? ???? ???? ????? ??? ???? ????? ????? ???????? ?? ???? ?????? ??????? ??????? ?????? ?????? ?????? ?????? ???? ??????? ?????? ????? ???? ???? ?????? ???????? ??????? ??????? ?????? ?? ?? ????? ???? ??????? ?????? ???? ????? ?? ????? ??? ??????? ???????.
??? ?????? ?? ???? ????? ??? ?????? ????? ?? ???? ????? ?? ???? ??? ?????.
???? ??? ?????? ?????? ??????? ??????? ????????? ?? ????? ??????? ??????? ?????? ????? ????? ???? ????? ????? ?????.
???????? ?????????? ?????? ??????? ????????? ?????? ?????????? ??????? ?? ??????? ?????? ????? ??????? ?? ?????? ??????? ???????? ???? ??????.
?? ????? ???? ??????
????? ??? ?????? ?????? ??????? ????? ?? ???? ???? ????? ??????? ???? ????? ????? ????? ??? ????? ?????? ???? ????? ?????? ?? ???? ?? ?? ??? ??? ???????? ???? ???? ?? ???? ??? ??????? ?????? ?? ?????? ????.
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?? ?? ??????? ?? ??????? ????? ????? ??????
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