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Familial Mediterranean Fever (FMF) In Iranian Traditional Medicine
Majid Avijgan Professor of Infectious Diseases, Neda Pari Zangeneh Resident of Infectious Diseases, Mahtab Avijgan Biomedical Science student at UoN, Shiva Shabani Resident of Infectious Diseases,
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Abstract Hereditary disease Mutation in gene MEFV
180 mutations in exon 10 Treatment: Colchicine Iranian Traditional Medicine and FMF Trigger agents : physical or emotional exertion, the menstrual cycle, and bleeding in women
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Theory about FMF Racial and ethic disease Mostly seen in Jews
Sephardi Jews come from western Asia and Africa – Muslim/Arabic countries Ashkenazi Jews come from Armenia, Germany and France – Christian countries ITM ancientness
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Fever overview What is fever? Heat is assigned for animals :
Innate heat Natural heat Exogenic heat Layers in human body : Main organs humors Rouh (Energy movement)
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Fever overview Types of fever : Deghiyeh fever Kheltiyeh fever Youmiyeh fever Regarding the fact that FMF conforms to some characteristics of Youmiyeh fever, thus this type of of fever is explained here. (Youmiyeh fever in most cases will be removed in 24 hours, unless it transforms to another type of fever, but in very rare cases this can last for 3 days.)
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Daily fever Youmiyeh fever basis: Dehydration → exercise, pain, inflammation, dyspepsia, fluid loss, obstruction, hunger and thirst Reduction in natural heat excretion → sun exposure, cold exposure, filthy skin or swimming in mineral water containing ZAJ and sulfur High heat production → anger, sadness, overthinking and fear (mental emotional status)
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Daily fever 9 major symptoms and overview on Daily fever treatment:
Weakness, malaise, sleepiness before fever Fever without chilly sensation No high fever Insidious attack of fever Cold extremities Natural face complexion Fast and large pulse Normal morning urine Maximum 24 hours of fever duration
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Reasons of daily fever Sever sadness (Gham) Faint Worriedness (Hamm)
Excess thirst Sever fear (Tars) Excess hunger Overthinking Micro-emboly and obstruction Sever anger (Khashm) Thickness of skin, filthy skin and obstruction of skin pores Excess joy (Shadi) Dyspepsia Sever insomnia Inflammation Long sleeping, no bath/exercise Hot nature food Fatigue and pain Postnasal discharge and rhinorrhea Body fluid loss Muscle spasm and twitching Pain
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Epidemiology Epidemic in Mediterranean region (Sephardic Jews, Turks, Arabs, and Armenians) Prevalence of FMF: Turkey 1/1000 non-Ashkenazi Jews 1/256 to 1/500 Sephardic and Iraqi Jews 1/250 to 1/1000 Ashkenazi Jews 1/73,000 Armenia 1/500 North African countries, Greece, Germany, France, Italy, the USA, Australia, Canada, India and Japan
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Molecular genetics and maternal transmission of FMF
Mono gene autosomal recessive disease → mutation in MEFV gene MEFV is on short section of chromosome of 16p 13.3 5 common mutations for FMF happen in genes: M694V → Jewish, Turkish, Armenian (sever form) M680I → Armenian M694I → Arab E148Q → European, Turkish (mild form) V726A → (mild form) More sever in Armenians in the USA and Turkish kids in Germany } (as sever as M694V)
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Theoretical conclusion
Some patients with mutation but no clinical manifestations Some patients without mutation but with clinical manifestations Environmental factors (physical or emotional, Diet, Menstruation and 21 factors of ITM) lead to fever Innate system in conventional medicine and PVS in traditional medicine are main factors for triggering and self-limiting the fever ITM for decreasing fever temperature recommends Diet, Bath and herbal medicine Theory: FMF is a type of daily fever in ITM and can be treated too
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Clinical manifestations
Attack length 1–3 days Serosa Pleurisy, peritonitis; asymptomatic pericardial effusions Skin Erysipeloid erythema Joints Acute monoarthritis; chronic hip arthritis (rare) Muscle Exercise-induced myalgia (common); protracted febrile myalgia( rare) GI Abdominal pain. Some individuals have constipation lasting all the attack length, while diarrhea is more frequent in children. In a small percentage of patients the attacks are characterized by afebrile recurrent abdominal pain. Eyes, ears heart genitourinary Uncommon asymptomatic pericardial effusions Self-limited orchitis, Renal amyloidosis, proteinuria CNS Other clinical manifestations Aseptic meningitis ,headache protracted febrile myalgia, Relapsing polychondritis
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Şahru Yüksel1, Lilit Ayvazyan and Armen Yuri Gasparyan
Şahru Yüksel1, Lilit Ayvazyan and Armen Yuri Gasparyan. 3Familial Mediterranean Fever as an Emerging Clinical Model of Atherogenesis Associated with Low-Grade Inflammation. The Open Cardiovascular Medicine Journal, 2010, 4, 51-56
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Conclusion Duration of fever is less than 3 days
Fever as a major clinical symptom No complications after relieving No chills accompanied with fever No high fever Self limited of any attack Geographical distribution
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Thank you for your attention
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