Ðe wò ŋutilã sena le eɖokui me be agbe aɖeke mele ye ŋu oa? Ðe wònye Myasthenia Gravis (MG) ƒe dɔlélea? Mina míaƒo nu tso eŋu!

Ðe nèsena le ɖokuiwò me ɣeaɖewoɣi be ɖeɖi te ye ŋu vevie eye agbe mele ye si ne ŋkekea le yiyim oa? Vevietɔ ne wò ŋkuwo se le ɖokuiwò me abe ɖe wole ƒoƒom ene, eye wòsesẽna be nàƒo nu, aɖu nu, alo akɔ alɔ alo afɔ gɔ̃ hã ɖe dzia? Nu siawo ate ŋu anye nusi de ŋgɔ wu ɖeɖiteameŋu ko. Egbea míaƒo nu tso Myasthenia Gravis , alo (MG) kpuie, nɔnɔme si sesẽ vie, gake woate ŋu akpɔ egbɔ nyuie ne wokpɔ egbɔ nyuie ŋu .

Nukae nye Myasthenia Gravis? Kpuie ko la,...

Myasthenia gravis nye dɔléle si dɔlélenutsiŋutete ŋutɔ wɔna . Nukae wònye? Ele bɔbɔe ŋutɔ. Dɔlélenutsiŋutete le míaƒe ŋutilã me. Ele abe aʋakɔ aɖe le míaƒe ŋutilã me ene. Eƒe dɔe nye be wòakpɔ mía ta to avuwɔwɔ kple dɔlékuiwo kple dɔléle siwo tso egodo me. Gake, ɣeaɖewoɣi la, asrafoha sia wɔa vodada vi aɖe. Esusuna be lãmenugbagbevi siwo le lãmesẽ me le míaƒe ŋutilã me gɔ̃ hãe nye futɔ. Emegbe edzea lãmenugbagbevi mawo siwo le lãmesẽ me dzi dzedze gɔme. Emae nye nusi dzɔna le myasthenia gravis me.

Esia gblẽa nu le ƒunukpeƒewo ƒe lãmekawo ŋu koŋ . Eyae nye lãmeka siwo lé ɖe míaƒe ƒuwo ŋu eye wokpena ɖe mía ŋu míeʋãna. Bu eŋu kpɔ, èkɔ asi ɖe dzi, blu ŋku, ƒoa nu, koa nu, ɖua nu, zɔna... Lãmetsi siawo kpena ɖe esiawo katã ŋu. Le amesi ŋu myasthenia gravis le gome la, lãmeka siawo gbɔdzɔna eye agbe megale wo ŋu o.

Nu vevitɔe nye be lãmeka ƒe gbɔdzɔgbɔdzɔ sia dzina ɖe edzi ne èle dɔ wɔm hele dɔ wɔm, eye wòɖiɖina ne èɖi ɖe eme vie . Ne èfɔ le ŋdi me hã la, ne ŋkekea le yiyim eye nèle wò dɔ wɔm la, ɖeɖi tea ŋuwò vivivi eye wò lãmekawo hã nɔa gbɔdzɔgbɔdzɔm.

Esia nye dɔléle si nɔa anyi didi , si fia be medzona le ɣeyiɣi kpui aɖe me o. Gake mègatsi dzi o, atike nyuiwo li siwo akpe ɖe ŋuwò nàɖu wò dzesiwo dzi ahanɔ agbe si sɔ .

Nukatae esia le dzɔdzɔm? Nukae le dzɔdzɔm le míaƒe ŋutilã me?

Be míase esia gɔme la, mina míawɔ kpɔɖeŋu sue aɖe. Kpɔe ɖa le susu me be èle kriket-fefe aɖe kpɔm.

Míaƒe lãmekawoe nyea nugoe. Woawoe ɖoa gbedasiwo ɖe lãmekawo.

Míaƒe lãmekawoe léa nu. Woawoe léa gbedasia.

Woyɔa teƒe si ame eve siawo ɖɔlia gbedasiwo le be ahɔhɔ̃mekawo ƒe kadodo . Emae nye fefewɔƒea.

Fifia, ne ehiã be lãmeka aɖe naɖo gbedasi ɖe lãmeka aɖe la, lãmekaa ɖea atike aɖe si woyɔna be acetylcholine (esiae nye bɔl la) doa goe. Teƒe tɔxɛwo le lãmekawo si be woalé acetylcholine sia, si woyɔna be acetylcholine receptors (esiae nye lãdzikpɔla ƒe asigɛ).

Abe alesi ko ne bɔl la ƒo asigɛa ene la, lãmekaa ƒoa ƒu, si fia be ewɔa dɔ, ne acetylcholine la yi ɖabla ɖe xɔla mawo ŋu. Esia dzɔna kabakaba ŋutɔ, nutsotso aɖeke manɔmee, le ame si le lãmesẽ me ƒe ŋutilã me.

Gake, nusi dzɔna le amesi ŋu myasthenia gravis le ŋue nye be dɔlélenutsiŋutete si ŋu míeƒo nu tsoe va yi la gblẽa acetylcholine xɔla siawo (catcher’s glove) vodadatɔe alo xea mɔ na wo . Ekema gbedasi (bɔl la) si tso lãmekaa me la mate ŋu alé lãmeka (kpɔla) la nyuie o. Gbedasiwo ɖɔliɖɔli la dzɔna blewu ŋutɔ, alo medzɔna kura o. Esia tae lãmekawo gbɔdzɔna ɖo. Èse egɔmea?

Ðe myasthenia gravis ƒomevi vovovowo lia?

Ẽ, ƒomevi vovovowo koŋue li:

• Autoimmune myasthenia: Esiae nye ƒomevi si bɔ wu. Abe alesi míedzro eme va yi ene la, dɔlélenutsiŋutete ƒe dɔmawɔmawɔ nyuie gbɔe wòtsona. Togbɔ be womenya nusi tututu gbɔ esia tso o hã la, woxɔe se be dɔlékuiwutike ƒomevi aɖewo wɔwɔ gbɔe wòtso .
• Vidzĩ ƒe myasthenia: Esia dzɔna ne vidzĩ xɔ dɔlékuiwutike aɖewo tso vidada si ŋu myasthenia gravis le gbɔ le fufɔɣi. Le vidzidzi megbe la, ate ŋu afa avi vie eye wòasesẽ nɛ be wòano no. Gake esia nyea ɣeyiɣi kpui aɖe ko eye zi geɖe la, enyona ɖe edzi le abe ɣleti etɔ̃ ene megbe.
• Myasthenia si wodzina: Esia menye dɔléle si dɔlélenutsiŋutete ŋutɔ nana o. Enye ƒomevi aɖe si mebɔ o si domenyiŋusẽfianu ƒe tɔtrɔ hena vɛ .

Autoimmune myasthenia gravis ƒe hatsotso sue vevi eve hã li:

1. Ocular myasthenia: Le esia me la, lãmeka siwo ʋãa ŋkuwo eye wodoa ŋkumeʋuʋu ɖe dzi la gbɔdzɔna. Ŋkuawo ate ŋu aɖiɖi (ptosis) , alo asesẽ be woana ŋkuawo nanɔ ʋuʋu ɖi. Ame aɖewo hã ate ŋu akpɔ nu eve (nukpɔkpɔ eve). Zi geɖe la, ŋku ƒe gbɔdzɔgbɔdzɔ ƒe dzesi gbãtɔe nye ŋkuwo ƒe gbɔdzɔgbɔdzɔ . Ame siwo ŋu ŋku ƒe ʋuʋu sia ƒomevi le ƒe afã lɔƒo ava xɔ ƒomevi bubua emegbe.

2. Generalized myasthenia: Le esia me la, tsɔ kpe ɖe ŋku ƒe lãmekawo ŋu la, mo, kɔ, abɔ, afɔ, kple ŋɔti ƒe lãmekawo hã gbɔdzɔna. Ate ŋu asesẽ be nàƒo nu, ami nuɖuɖu, akɔ abɔwo ɖe dzi, afɔ tso zikpui dzi, azɔ mɔ didiwo, ahalia atrakpuiwo.

Nukawoe nye myasthenia gravis ƒe dzesiwo?

Togbɔ be dzesiawo ate ŋu ato vovo hã la, esiwo bɔ wue nye:

• Lãmetsiwo ƒe gbɔdzɔgbɔdzɔ le abɔwo, asibidɛwo, afɔwo, kple kɔ me.
• Ðeɖiteameŋu ŋutɔ (ɖeɖiteameŋu) .
• Ŋku ƒe ʋuʋudedi si le gegem ɖe anyi (ptosis) .
• Nukpɔkpɔ si me mekɔ o alo nukpɔkpɔ eve .
• Mo ƒe dzedzeme ɖeɖefia sesẽ (abe alɔgbɔnukoko nyuie, mo wɔwɔ ene).
• Nuƒoƒo, nu mimi, alo nuɖuɖu ɖuɖu sesẽ . Le kpɔɖeŋu me, wò gbe ate ŋu atrɔ vivivi ne èle nu ƒom, si ana nàɖi abe ɖe nèle nu ƒom kple gbe si me kɔ o ene.
• Azɔlizɔzɔ sesẽ .

Myasthenia gravis ƒe dzesi gbãtɔwo ate ŋu adze zi ɖeka kloe. Abe alesi míegblɔe va yi ene la, wò lãmekawo gbɔdzɔna ne èle dɔ wɔm, eye ŋusẽ gaɖoa wo ŋu ne ègbɔ ɖe eme . Alesi lãmekawo ƒe gbɔdzɔgbɔdzɔ sia nu sẽe ate ŋu ato vovo tso ŋkeke yi ŋkeke. Ame geɖe ƒe dzi dzea eme le ŋkekea ƒe gɔmedzedze eye wogbɔdzɔna wu le nuwuwu.

Ƒã ŋutɔ hafi myasthenia gravis ate ŋu akpɔ ŋusẽ ɖe gbɔgbɔtsixe ƒe lãmekawo hã dzi . Esia ate ŋu ana gbɔgbɔtsixe natsi ame alo gbɔgbɔtsixetsixe si nu sẽ wu. Ne èse le ɖokuiwò me be gbɔgbɔ le sesẽm na ye la, ke enye nusi dzɔ kpata. Ele be nàyi kɔdzi si te ɖe ŋuwò enumake. Zi geɖe la, esia medzɔna zi ɖeka o.

Amekae le afɔku me wu le esia ta?

Togbɔ be myasthenia gravis ate ŋu adzɔ le ƒe ɖesiaɖe me hã la, zi geɖe la, ebɔ ɖe nyɔnu siwo mexɔ ƒe 40 haɖe o kple ŋutsu siwo xɔ wu ƒe 60 me wu .

Ðewohĩ ànɔ afɔku me be nàxɔ dɔléle sia le susu siwo gbɔna ta:

• Ne dɔlélenutsiŋutete ƒe dɔléle bubuwo le ŋuwò (e.g. ƒunukpeƒetetedɔ, lupus).
• Ne lãkusidɔ le ŋuwò la .

Ne myasthenia gravis le ŋuwò xoxo la, nu aɖewo ate ŋu ana wò dzesiwo nagagblẽ ɖe edzi:

• Atike aɖewo na asrã kple dzi ƒe tsotso ƒe dɔmawɔmawɔ nyuie.
• Amekoko si wole wɔwɔm .
• Dɔlékui aɖe si woxɔna .

Ƒomedodo kae le thymus gland kple myasthenia gravis dome?

Ame geɖe siwo ŋu myasthenia gravis le la ƒe kuxiwo le woƒe thymus gland ŋu . Thymus gland nye ŋutinu sue aɖe si le míaƒe akɔta ƒe akpa si le etame, si le no ƒe ƒu te tututu. Enye míaƒe ʋukawo ƒe dɔwɔwɔ ƒe akpa aɖe. Enye ŋutinu si wɔa ʋumenugbagbevi ɣiwo eye wòkpena ɖe ame ŋu wòwɔa avu kple dɔlékuiwo.

Ame siwo ŋu myasthenia gravis le la dometɔ siwo ade eve le etɔ̃ me xɔ thymic hyperplasia , si nye nɔnɔme si me thymus gland la wɔa dɔ akpa. Tsɔ kpe ɖe eŋu la, ame siwo ade ɖeka le ewo ɖesiaɖe me xɔa dɔdzẽ le lãkusi si woyɔna be thymomas me. Esiawo ate ŋu anye kansa alo esiwo me dɔléle aɖeke mele o. Wosusu be thymus gland ƒe dɔmawɔmawɔ nyuie siawoe nana dɔlélenutsiŋutete megawɔa dɔ nyuie o.

Nukawoe nye kuxi siwo ate ŋu ado tso myasthenia gravis me?

Vevietɔ enye nɔnɔme aɖe si woyɔna be myasthenic crisis . Le esia me la, lãmeka siwo kpena ɖe ŋuwò nègbɔa ya la gbɔdzɔna ŋutɔ. Emegbe, àte ŋu ahiã nane abe mɔ̃ (yagbɔgbɔmɔ̃/mɔ̃ si me ya sina tona) be wòakpe ɖe ŋuwò nàgbɔ ya. Esia nye atikewɔwɔ kpata si ate ŋu ade ame ƒe agbe afɔku me.Wogblɔ be amesiwo ŋu myasthenia gravis le abe ame ɖeka le atɔ̃ ɖesiaɖe me ene akpɔ nɔnɔme sia zi ɖeka ya teti le woƒe agbenɔɣi.

Tsɔ kpe ɖe eŋu la, lãmekawo ƒe gbɔdzɔgbɔdzɔ kple ɖeɖiteameŋu sia ate ŋu ana màkpɔ gome le nuwɔna siwo doa dzidzɔ na wò la me o. Ate ŋu ahe nuteɖeamedzi kple blanuiléle hã vɛ . Gake numekukuwo ɖee fia be ame geɖe siwo ŋu myasthenia gravis le ate ŋu awɔ dɔ siwo mesẽ o ahade kame gbesiagbe.

Aleke ɖɔktawo wɔa anya dɔléle si nye myasthenia gravis?

Ne wò ɖɔkta ke ɖi esia le toɖoɖo wò dzesiwo kple ŋutilãmedɔdada vɔ megbe la, woawɔ dodokpɔ geɖe atsɔ aɖo kpe edzi:

• Ʋu me dɔlékuiwutikewo dodokpɔ: Ame siwo ŋu myasthenia gravis le ƒe 85% lɔƒo ƒe acetylcholine receptor antibodies sɔ gbɔ ɖe woƒe ʋu me le mɔ si mesɔ o nu. 6% bubuwo ƒe dɔlékuiwutikewo le lãmekawo ƒe kinase (MuSK) ŋu .
• Nɔnɔmetatawo ɖeɖe: Wowɔa MRI (Magnetic Resonance Imaging) alo CT (Computed Tomography scan) tsɔ léa ŋku ɖe kuxiwo abe dɔdzẽ ene le thymus gland me ŋu.
• Electromyography (EMG): Dodokpɔ sia dzidzea elektrikŋusẽ ƒe dɔwɔwɔ le lãmekawo kple lãmekawo me. Ate ŋu ade dzesi kuxi siwo le lãmekawo kple lãmekawo dome kadodo me.

Ðɔktawo daa myasthenia gravis ɖe hatsotsowo me le alesi dɔlélea nu sẽe nu. Zi geɖe la, hatsotso atɔ̃e li (Klass I - V). Dɔnɔdzikpɔƒe I nye dɔléle si nu mesẽ o si gblẽa nu le ŋkuwo ŋu ko, gake Klass V nye dɔléle sesẽ aɖe si gblẽa nu le gbɔgbɔ ŋu, eye ɣeaɖewoɣi la, ebiana be woatsɔ ya ade mɔ̃ me alo woatsɔ mɔ̃ agbɔ yae .

Nukae nye atikewɔwɔ na myasthenia gravis?

Atike aɖeke meli na myasthenia gravis o , gake atike nyui aɖewo li siwo ate ŋu akpe ɖe ŋuwò nàkpɔ wò dzesiwo gbɔ ahanɔ agbe nyui.

• Atikewo:
• Cholinesterase inhibitors / anticholinesterase: Atike siawo wɔa dɔ to kadodo si le lãmekawo kple lãmekawo dome ƒe nyonyo me, si naa lãmekawo ƒe ŋusẽ dzina ɖe edzi.
• Dɔlélenutsiŋutete ƒe dɔlékuiwutikewo: Atikewo abe corticosteroids ene wɔa dɔ to dɔlélenutsiŋutete ƒe dɔwɔwɔ fũu akpa dzi ɖeɖe kpɔtɔ kple dɔlékuiwutike gbegblẽ mawo wɔwɔ dzi ɖeɖe kpɔtɔ me.
• Dɔlékuiwutike siwo nye monoclonal antibodies: Esiawo nye protein siwo wowɔ le nugbagbewo me. Wodoa wo abe atike si wodona ɖe ʋuka me (IV) alo atike si wodona ɖe ŋutigbalẽ te (SQ) ene. Wokpɔa ŋusẽ ɖe dɔlélenutsiŋutete ƒe dɔwɔwɔ fũ akpa dzi.
• Plasma exchange / plasmapheresis: Mɔ̃ aɖe ɖea ʋumenugbagbeviɣi si le ʋua me, si me dɔlékuiwutike siwo gblẽa nu le ame ŋu le, eye wòtsɔa ʋumenugbagbeviɣi alo ʋumenugbagbeviɣi si tso ame si tsɔ ʋu na ame gbɔ la ɖoa eteƒe.
• Dɔlékuiwutike si wodona ɖe ʋuka me alo esi wodona ɖe ŋutigbalẽ te (IV alo SQ Immunoglobulin - IVIG alo SCIG): Wodoa dɔlékuiwutike siwo tso nunala gbɔ to ʋuka me (IV) dodo me le ŋkeke eve va ɖo atɔ̃ me. Esia nye atikewɔwɔ na myasthenic crisis kpakple generalized myasthenia gravis.
• Amekoko: Thymectomy nye amekoko be woaɖe thymus gland la ɖa. Wokafu amekoko sia na amesiwo ŋu thymoma le, kpakple amesiwo ŋu thymus tumor mele o.

Atikewɔwɔ siawo katã ate ŋu agblẽ nu le ame ŋu vie, eyata ƒo nu kple wò ɖɔkta hafi nàdze atike yeye ɖesiaɖe zazã gɔme.

Nukae mate ŋu awɔ le aƒeme be wòaɖe dzesiawo dzi akpɔtɔ?

Ne myasthenia gravis le ŋuwò la, te nu siawo kpɔ be ɖeɖiteameŋu si nèsena le ɖokuiwò me dzi naɖe akpɔtɔ eye nàdzi lãmekawo ƒe ŋusẽ ɖe edzi:

• De kame edziedzi: Gake ne èbia wò ɖɔkta vɔ ko hafi nàdze kamedede ƒe ɖoɖo si le dedie si asɔ na wò gɔme. Kamedede doa ŋusẽ lãmekawo, enaa seselelãme nyona ɖe edzi, eye wònaa ŋusẽ wò ŋutilã.
• Ƒo asa na gota le yame ƒe dzoxɔxɔ ŋutɔ me: Dzoxɔxɔ ate ŋu ana dzesiawo nagagblẽ ɖe edzi. Ne èse le ɖokuiwò me be yexɔ dzo ŋutɔ la, da avɔ si wotsɔ tsi fafɛ ƒo ɖe wò kɔ kple ŋgonu.
• De protein kple carbohydrates geɖe wò nuɖuɖu me: Wonaa ŋusẽ geɖe ŋutilãa.
• Wɔ dɔ siwo nèkpɔ be ɖeɖi tea ŋuwò wu le ŋkekea ƒe gɔmedzedze: ɣemaɣie ŋusẽ nɔa ŋuwò wu.
• Midɔ alɔ̃ vie alo ɖi ɖe eme le ŋkekea me: Esia ana wò ŋutilã nagbɔ ɖe eme vie.

Nukae nye myasthenia gravis ƒe etsɔme? (Nukpɔsusu) .

Myasthenia gravis nye dɔléle si woate ŋu ada . Dzesiawo ate ŋu atso esiwo nu mesẽ o dzi va ɖo esiwo nu sẽ dzi. Zi geɖe la, dzesiawo ɖoa woƒe kɔkɔƒe le ƒe ɖeka va ɖo etɔ̃ me tso esime wokpɔ dɔlélea le gɔmedzedzea me.

Ame geɖe nɔa agbe si yɔ fũ kple dɔmedzoedoname kple atikewɔwɔ.

Ɣeaɖewoɣi la, dɔlélea ate ŋu ayi edzi aɖiɖi . Esia fia be dzesiawo nu yina hena ɣeyiɣi aɖe. Esia ate ŋu anɔ anyi ɣeyiɣi kpui aɖe alo anɔ anyi ɖaa. Ne edzɔ alea la, wò ɖɔkta atrɔ wò atikewɔwɔ ƒe ɖoɖoa.

Ame geɖe siwo ŋu myasthenia gravis le la nɔa agbe si sɔ . Ne gbɔgbɔ gblẽ nu le ame ŋu ko hafi emetsonu siwo ate ŋu ade ame ƒe agbe afɔku me, abe myasthenic ƒe kuxi si ŋu míeƒo nu tsoe ene.

Myasthenia gravis kple fufɔfɔ

Ƒã hafi fufɔfɔ ate ŋu ana myasthenia gravis ƒe dzesiwo nadze zi gbãtɔ. Ne dɔlélea le ŋuwò xoxo la, wò dzesiwo ate ŋu agblẽ ɖe edzi le fufɔfɔ ƒe ɣleti etɔ̃ gbãtɔ me alo le viwò dzidzi vɔ megbe. Gake le go aɖewo me la, wò dzesiwo ate ŋu anyo ɖe edzi le fufɔɣi.

Atikewɔwɔ aɖewo mele dedie le fufɔfɔ kple no nana me o . Eyata ele vevie be nàdi wò ɖɔkta ƒe mɔfiafia le ɣeyiɣi sia me be nàkpɔ egbɔ be yefɔ fu le lãmesẽ me.

Ɣekaɣie wòle be makpɔ ɖɔkta?

Kpɔ ɖɔkta ne dzesi siawo le ŋuwò:

• Nukpɔkpɔ si me mekɔ o alo nukpɔkpɔ eve.
• Azɔlizɔzɔ, nuƒoƒo, alo nuɖuɖu sesẽ.
• Lãmetsiwo ƒe ɖeɖiteameŋu alo gbɔdzɔgbɔdzɔ sesẽ.
• Yagbɔgbɔ sesẽ.

Ðo ŋku edzi be ne gbɔgbɔ sesẽ na wò la, ke nudzɔdzɔ kpatae wònye! Ƒo ka na 911 (si le mia gbɔ ƒe xexlẽdzesi kpata) enumake alo yi kɔdzi si te ɖe ŋuwò.

Nya kawoe wòle be mabia nye ɖɔkta?

Àte ŋu abia ɖɔktaa nya siawo abe esiawo ene:

• Nukae hea dzesi siawo vɛ?
• Nukae nye atikewɔmɔnu nyuitɔ kekeake nam?
• Nukawoe nye atikeawo ƒe nugbegblẽ le ame ŋu?
• Agbenɔnɔ ƒe tɔtrɔ kawoe wòle be mawɔ?
• Dzesi kawo ŋue wòle be malé ŋku ɖo ku ɖe kuxi siwo dona tso eme ŋu?
• Ðe mate ŋu adze kamedede ƒe ɖoɖo aɖe gɔme dediea?
• Ðe dɔnɔdzikpɔha aɖe li si me mate ŋu age ɖoa?

Mlɔeba la, nusi dzi nàɖo ŋkui (Take-Home Message) .

Myasthenia Gravis ate ŋu anye nɔnɔme sesẽ aɖe. Togbɔ be èdi be yeayi edzi anɔ dɔ dzi hã la, ɖeɖi tea ŋuwò ŋutɔ eye wògbɔdzɔna ɣeaɖewoɣi. Esia ate ŋu akpɔ ŋusẽ ɖe wò susu kple ŋutilã ƒe lãmesẽ dzi le ɣeyiɣi aɖe megbe.

Gake ɖo ŋku edzi be togbɔ be atike aɖeke meli o hã la, ne wowɔ atike na ame geɖe la, woate ŋu anɔ agbe si me dzidzeme le, si me wowɔa dɔ le. Nuwɔametɔnyenye sesẽ si tso myasthenia gravis gbɔ mebɔ o. Wò ɖɔkta ate ŋu aɖo aɖaŋu le mɔ siwo dzi nàto akpɔ wò dzesiwo gbɔ ale be nàte ŋu anɔ lãmesẽ me. Mègatsi dzodzodzoe o, eye mègadze agbagba be yeakpɔ esia ɖeɖeko gbɔ o. Wɔ ɖe wò ɖɔkta ƒe aɖaŋuɖoɖo dzi eye nàxɔ kpekpeɖeŋu si nèhiã. Medi be nàhaya kaba!

` Myasthenia Gravis, Myasthenia Gravis, Lãmetsiŋusẽ ƒe gbɔdzɔgbɔdzɔ, Dɔlélenutsiŋutete ƒe dɔlélewo, Acetylcholine, Thymus gland, Neuromuscular junction