שלח לחבר תודה לך על המלצתך על e-Med לחבר

	24/07/2021

14/05/2019

ההשפעה של תחלואה נלווית על התפקוד הגופני בחולים עם Ankylosing Spondylitis ו-Psoriatic Arthritis (מתוך Arthritis Care Res)

44<P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><?xml:namespace prefix = "o" ns = "urn:schemas-microsoft-com:office:office" /><o:p> </o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'>במחקר גדול שכלל למעלה מ-700 חולים עם אבחנה של </SPAN><FONT face=Calibri><SPAN dir=ltr>Ankylosing Spondylitis</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> (</SPAN><FONT face=Calibri><SPAN dir=ltr>AS</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>) ולמעלה מ-700 חולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>Psoriatic Arthritis</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> (</SPAN><FONT face=Calibri><SPAN dir=ltr>PsA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>) מצאו חוקרים כי למרות דמיון בתחלואה נלווית בשתי הקבוצות, דפוס מחלות הרקע וההשפעה שלהן על התפקוד הגופני עשוי להיות שונה. <o:p></o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><o:p> </o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'>במסגרת המחקר ביקשו החוקרים לבחון את ההשפעה של מחלות רקע על התפקוד הגופני בחולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>AS</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> ו-</SPAN><FONT face=Calibri><SPAN dir=ltr>PsA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>. מבין המשתתפים במחקר </SPAN><FONT face=Calibri><SPAN dir=ltr>CARMA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> (</SPAN><FONT face=Calibri><SPAN dir=ltr>Cardiovascular in Rheumatology</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>), 21% מהחולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>PsA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> או </SPAN><FONT face=Calibri><SPAN dir=ltr>AS</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> סבלו מלפחות מחלת רקע אחת, עם מדד תחלואה נלווית של 1.32 בחולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>AS</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> ושל 1.30 באלו עם </SPAN><FONT face=Calibri><SPAN dir=ltr>PsA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>. <SPAN style="mso-spacerun: yes"> </SPAN>התפקוד הגופני נבחן באמצעות מדד </SPAN><FONT face=Calibri><SPAN dir=ltr>BASFI</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> (</SPAN><FONT face=Calibri><SPAN dir=ltr>Bath AS Functional Index</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>) ב-738 חולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>AS</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> ועל-בסיס שאלון </SPAN><FONT face=Calibri><SPAN dir=ltr>HAQ</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> (</SPAN><FONT face=Calibri><SPAN dir=ltr>Health Assessment Questionnaire</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>) ב-721 חולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>PsA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> שלקחו חלק בפרויקט </SPAN><FONT face=Calibri><SPAN dir=ltr>CARMA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> בין 2010-2012. <o:p></o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><o:p> </o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'>נטל מחלות הרקע נקשר בקשר בלתי-תלוי עם תפקוד גופני גרוע יותר רק בחולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>PsA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> (</SPAN><FONT face=Calibri><SPAN dir=ltr>p<0.001</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>) ולא בקרב אלו עם </SPAN><FONT face=Calibri><SPAN dir=ltr>AS</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> (</SPAN><FONT face=Calibri><SPAN dir=ltr>p=0.701</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>). החוקרים מציעים כי הבדלים אלו עשויים להיות קשורים לשימוש בשיטות מחקר שונות להערכת נטל תחלואה נלווית בשתי אוכלוסיות שונות אלו. ייתכן כי מחלות הרקע שנקשרו עם גיל מתקדם עשויות להיות בולטות יותר בחולי </SPAN><FONT face=Calibri><SPAN dir=ltr>AS</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> עם מחלה ממושכת יותר; הם מציינים כי החולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>AS</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> במחקר הנוכחי היו צעירים יותר מאלו עם </SPAN><FONT face=Calibri><SPAN dir=ltr>PsA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>. <o:p></o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><o:p> </o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'>כמו כן, מגדר נקבי, משך מחלה, פעילות מחלה, נוגדי-דלקת שאינם סטרואידים, גלוקוקורטיקואידים ותרופות ביולוגיות נקשרו עם תפקוד גרוע יותר בחולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>PsA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>. רמת השכלה גבוהה יותר נקשרה עם פחות מוגבלות. בחולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>AS</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN>, גיל, פעילות מחלה, נזק הדמייתי ושימוש בתרופות ביולוגיות נקשר עם תפקוד גרוע יותר, אך לא זוהה קשר עם נטל התחלואה הנלווית.<o:p></o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><o:p> </o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'>נוכחות מחלות רקע בחולים עם </SPAN><FONT face=Calibri><SPAN dir=ltr>PsA</SPAN><SPAN dir=rtl></SPAN></FONT><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><SPAN dir=rtl></SPAN> קשור בקשר בלתי-תלוי עם תפקוד גופני גרוע יותר, כאשר מהממצאים עולה כי באוכלוסיית חולים זו עם מספר גדול יותר של מחלות רקע תועד תפקודי גרוע יותר, בהשוואה לאלו עם מחלה נלווית אחת בלבד.<o:p></o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><o:p> </o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><FONT face=Calibri><SPAN dir=ltr>Arthritis Care Res 2019</SPAN><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><o:p></o:p></SPAN></FONT></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><o:p> </o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><A href="https://www.medpagetoday.org/rheumatology/arthritis/79753?vpass=1"><FONT color=#0000ff>לידיעה ב-<SPAN lang=EN-US style='FONT-FAMILY: "Calibri","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi' dir=ltr>MedPage Today</SPAN></FONT></A><o:p></o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><o:p> </o:p></SPAN></P> <P class=MsoNormal style="MARGIN: 0cm 0cm 0pt" dir=rtl><SPAN lang=HE style='FONT-FAMILY: "Arial","sans-serif"; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-bidi-theme-font: minor-bidi'><o:p> </o:p></SPAN></P>

כתובת נמען
נושא
שמך
כתובת הדואר שלך
הערה
	סגור חלון