Methylene blue don cututtukan naman gwari na kusoshi da fata: abin da gwaje-gwajen photodynamic suka nuna

Sakamakon bincike kan methylene blue don naman gwari na kusoshi yakan gauraya abubuwa biyu masu matuƙar bambanci. Ɗaya shi ne kwalbar shuɗin rini da ake shafawa a gida. Ɗayan kuwa hanya ce ta magani a asibiti inda ake shafa rinin, a bar shi na ɗan lokaci, sannan a kunna shi da takamaiman adadin jan haske da aka auna. Kusan dukkan shaidar asibiti ta shafi hanya ta biyu. Wannan maƙala tana kwatanta nazarin photodynamic guda uku kai tsaye, domin ku ga abin da aka gwada a zahiri da abin da kowannensu ya tabbatar.

Hanyar aikin da suka yi tarayya a kai mai sauƙi ce. Methylene blue yana tsotse jan haske sosai, kuma ƙwayar sinadarinsa da hasken ya tayar tana miƙa wannan makamashi ga oxygen, tana samar da oxygen na singlet da wasu sinadarai masu saurin yin hulɗa waɗanda ke lalata ƙwayoyin naman gwari. Idan babu haske, tasirin ya fi rauni sosai. Shi ya sa kowane nazari da ke ƙasa ya haɗa rinin da takamaiman fitila, tsawon raƙuman haske, da adadin haske, kuma shi ya sa sakamakon hanyoyin magani da suka yi amfani da haske ba ya bayyana abin da zai faru idan aka ɗan shafa rini a ƙusa a hasken rana. An yi ƙarin bayani kan hanyar aikin gaba ɗaya a bayanin maganin photodynamic, kuma an tattauna faɗaɗɗen mahallin binciken yaƙi da naman gwari a bayanin methylene blue a matsayin sinadarin yaƙi da ƙananan halittu.

Onychomycosis na kusoshin ƙafa: rini da haske idan aka kwatanta da fluconazole na mako-mako

Gwaji mafi girma shi ne kwatancen da aka raba marasa lafiya 80 masu onychomycosis na kusoshin ƙafa zuwa rukuni bisa zaɓin bazata, wanda aka wallafa a 2014. Rabinsu sun karɓi maganin photodynamic, sauran rabin kuma sun karɓi fluconazole 300 mg ta baki sau ɗaya a mako, kowanne na tsawon makonni 24.

An ƙayyade tsarin amfani da hasken sosai. An shafa ruwan methylene blue mai ƙarfi 2% a ƙusa, sannan bayan an bar shi na ɗan lokaci, aka haska shi da jan LED wanda raƙuman haskensa ba su da daidaitaccen tafiya tare, a 630 nm, yana bayar da joules 18 a kowane santimita murabba'i. An maimaita zaman magani kowane kwana 15, sau goma sha biyu cikin watanni shida. A rukunin biyu, an fara da gogewa ta kayan aiki ga kusoshin da ke da kaurin tarkace a ƙarƙashinsu, layuka masu bin tsawon ƙusa, ko tarin naman gwari na dermatophytoma, domin haske da magani duk ba sa iya aiki yadda ya kamata idan bangon keratin ya tare su.

Babban sakamakon ya nuna fifiko ga rukunin haske, kuma bambancin yana da muhimmanci a ƙididdiga. Rahotannin da aka ciro daga cikakken rubutun daga baya sun nuna kusan 90% sun samu amsa ga magani bayan kammala watanni shida, idan aka kwatanta da 45% ga fluconazole; wannan ya ragu zuwa kusan 80% a rukunin haske a watanni goma sha biyu bayan an gama magani. Wani sake nazari mai tsauraran ƙa'idoji, wanda ya buƙaci abubuwa uku su faru tare—rashin samun naman gwari da madubin ƙara girma, rashin girma a al'adar dakin gwaje-gwaje, da cikakken sake girman ƙusa mara alamun cuta—ya sanya adadin cikakkiyar warkewa na ƙarshe a 50% idan aka kwatanta da 25%. Waɗannan rukunin adadi biyu suna bayyana ma'aunin sakamako daban-daban, ba sakamako masu saɓani ba, kuma tazarar da ke tsakaninsu ita ce batun sashe na gaba. An ruwaito cewa marasa lafiya sun jure maganin da kyau, tare da samun rahoton faruwar ciwo da jin ƙuna sau ɗaya.

Abubuwa biyu suna da muhimmanci ga duk wanda ke tambayar yadda ake amfani da methylene blue don naman gwari na kusoshin ƙafa. Na farko, maganin da aka yi kwatanci da shi shi ne fluconazole, wanda tasirinsa kan cutar ƙusa bai yi ƙarfi sosai ba, ba terbinafine wanda ya fi ƙarfi ba. Na biyu, ƙarfin rinin ya kasance 2%, wanda ya zarce sosai na kayayyakin da ake sayarwa don kwalliya a gida, kuma an shafa shi ƙarƙashin kulawa tare da cire tarkace da amfani da fitilar da aka daidaita.

Tsananin cutar kusoshin ƙafa: ƙara rini da haske a kan terbinafine

Nazarin ƙusa na biyu, gwajin da aka raba mahalarta bisa zaɓin bazata kan tsananin kamuwa da naman gwari na dermatophyte a kusoshin ƙafa, wanda aka wallafa a 2020, yana amsa tambaya mafi takamaimai. Dukkan marasa lafiya ashirin da cutar ta shafi fiye da 60% na ƙusar babban yatsan ƙafarsu sun karɓi terbinafine 250 mg ta baki kullum na makonni goma sha biyu, tare da amfani da urea don tausasa farantin ƙusa. A kan wannan tushen magani, goma sun karɓi maganin photodynamic da methylene blue, goma kuma sun karɓi maganin photodynamic da wani sinadarin daban da haske ke kunnawa.

Rukunin methylene blue ya yi amfani da ruwan sinadarin mai ƙarfi 2%, wanda aka bari na kusan mintuna uku, sannan aka yi amfani da LED na 635 nm wanda ya bayar da joules 37 a kowane santimita murabba'i cikin mintuna goma. An gudanar da zaman magani guda tara da tazarar makonni biyu cikin makonni goma sha shida, tare da shafa man urea 40% da yamma kafin kowane zaman magani da cire tarkace ta kayan aiki.

Zuwa mako na 52, kusan watanni tara bayan zaman haske na ƙarshe, ma'aunin tsananin cuta a rukunin methylene blue ya ragu daga kusan 24 zuwa ƙasa da 1, yawan yankin ƙusa da cutar ta shafa ya ragu daga kusan 65% zuwa ƙasa da 2%, kuma cikakkiyar warkewa, wato ƙusa mai kamannin al'ada tare da rashin samun naman gwari a gwaje-gwaje, ta kai 70%. Rashin samun naman gwari a gwaje-gwaje shi kaɗai ya kai 100% a rukunin methylene blue idan aka kwatanta da 90% ga ɗayan sinadarin da haske ke kunnawa. Ba a ruwaito illolin rini da haske a wurin da aka yi maganin ba; marasa lafiya biyu sun samu rashin jin daɗi a ciki da hanji wanda aka danganta da terbinafine da su ma suke sha.

Fassara ta gaskiya ita ce wannan gwajin ba zai iya ware gudummawar rinin ba. Kowane mara lafiya ya karɓi cikakken zangon maganin da ke aiki a duk jiki mafi inganci, tare da shiri mai zurfi na ƙusa; babu rukunin da ya karɓi magani kaɗai, kuma sakamakon rukunin haske guda biyu ya yi kama. Abin da ya nuna shi ne cewa ƙara tsarin methylene blue da haske a kan maganin da aka saba amfani da shi ya samar da yawan kawar da naman gwari a tsananin cuta tare da bibiyar sakamako na dogon lokaci, kuma zaman hasken da kansu ba su ƙara wata illa a wurin magani ba a wannan ƙaramin rukuni. An tattauna hulɗar magunguna da haɗarin haɗa hanyoyin magani ga duk jiki a jagorar aminci da hulɗar magunguna.

Cutar fata mai juriya: mara lafiya ɗaya, naman gwari ɗaya mai taurin kai

Shaidar da ta shafi fata ta fi ƙaranci sosai. Wani nazarin 2026 kan maganin methylene blue da haske a kan Trichophyton indotineae mai juriya ga magunguna ya shafi mara lafiya ɗaya mai shekara 25 da ke da raunukan fata masu yaɗuwa waɗanda suka daɗe na watanni takwas duk da shan terbinafine mai aiki a duk jiki a 250 mg kullum na makonni shida. Gwajin dakin gwaje-gwaje ya nuna cewa mafi ƙarancin ƙarfin terbinafine da ke hana girman naman gwari shi ne micrograms 8.0 a kowane millilitre, idan aka kwatanta da 1.0 ga methylene blue, abin da ya yi daidai da dermatophytosis mai juriya da yanzu ke yaɗuwa a yankuna da yawa.

An yi wa raunukan magani da methylene blue 1% na shafawa da jan haske na kusan 630 nm wanda ke bayar da joules 100 a kowane santimita murabba'i, sau ɗaya a mako na makonni huɗu. Bayan makonni biyu, ɓarewar fata a raunukan da aka yi wa maganin ta gushe, kuma ba a sami naman gwari da madubin ƙara girma ba. Zuwa mako na huɗu, an bayyana su a matsayin waɗanda suka warke gaba ɗaya, sai ɗan sauyin launin fata da ya rage, yayin da raunukan da aka yi wa magani da man terbinafine har yanzu suke ɗauke da zaren naman gwari da ake iya gani. Ba a ruwaito mummunan martani ko ciwo ba.

Wannan amsa ce ta gaske ta raguwar naman gwari a cuta mai juriya, amma kuma ta shafi mara lafiya ɗaya ne da aka lura da shi na makonni huɗu. Ba a rubuta shaidar sauyawa zuwa rashin girman naman gwari a al'adar dakin gwaje-gwaje bayan magani ba, fiye da abin da aka gani da madubin ƙara girma; babu bibiyar sake dawowar cutar a watanni uku, shida, ko goma sha biyu; kuma babu rukunin jama'a da za a iya ƙididdige adadin amsa ga magani daga gare shi. Wannan yana goyon bayan ƙarin nazari, ba shawarar amfani da maganin ba. An ƙara nazarin nau'o'in da ke da juriya da gwajin yadda suke amsa wa magunguna a jagorar juriya ga magungunan naman gwari.

Kwatanta nazarin guda uku

Warkewar bayyanar cuta ba ita ce kawar da naman gwari ba

Karanta waɗannan takardu yana buƙatar fahimtar bambanci guda ɗaya. Warkewar bayyanar cuta na nufin ƙusa ko fata sun yi kama da na al'ada. Warkewa bisa gwajin naman gwari na nufin ba a sami naman gwari da madubin ƙara girma da al'adar dakin gwaje-gwaje ba. Cikakkiyar warkewa na nufin duka biyun sun faru tare. Kusoshi suna sake girma a hankali, don haka ƙusa na iya yin kyau watanni kafin naman gwari ya ƙare, kuma mataccen naman gwari zai iya sa gwaji ya ci gaba da nuna samuwarsa bayan cutar ta mutu. Gwajin Souza ya nuna sakamakon wannan kai tsaye: ƙa'idojin amsa ga magani marasa tsauri suna bayar da 80 zuwa 90%, yayin da buƙatar ƙusa mara alamun cuta tare da gwaje-gwajen da ba su gano naman gwari ba take bayar da 50%. Babu adadin da yake kuskure. Suna auna abubuwa daban-daban, kuma duk wata magana kan ingancin magani ya kamata ta bayyana wanne take ambata.

Abin da wannan ke nufi ga yanke shawarar magani

Ƙarshe guda uku suna nan bayan karatu mai tsauri. Na farko, methylene blue tare da jan hasken da aka daidaita ya samar da kawar da naman gwari na kusoshin ƙafa da gaske a gwaje-gwaje biyu da aka raba mahalarta bisa zaɓin bazata: sau ɗaya idan aka kwatanta da fluconazole kaɗai, sau ɗaya kuma a matsayin ƙari ga terbinafine tare da shiri da urea. Na biyu, rahoto guda ɗaya na cutar fata mai juriya yana ba da ƙwarin gwiwa, amma shi kaɗai kusan ba ya tabbatar da komai; har yanzu babu shaidar gwajin da aka raba mahalarta bisa zaɓin bazata kan maganin dermatophytosis na fata da rini da haske. Na uku, kowane sakamako mai kyau ya fito ne daga haɗin abubuwa ƙarƙashin kulawa: rini mai ingancin da ya dace da magunguna a 1 zuwa 2%, takamaiman lokacin barinsa kafin haskawa, adadin hasken da aka auna, kuma yawanci tare da cire tarkace ko maganin da ke aiki a duk jiki.

Babu ɗaya daga cikin waɗannan da za a iya ɗora wa shafa rinin da ake sayarwa a gida. Shafawa a gida ba ta da adadin hasken da aka auna, sarrafa lokacin barin rinin, cire tarkace, gwajin naman gwari, ko bibiyar sakamako, don haka tana rasa kowane muhimmin abu da gwaje-gwajen suka dogara da shi. Duk wanda ke tunanin maganin da ya dogara da haske ya kamata ya kai waɗannan hanyoyin magani ga likitan fata, ya tambayi ko ana samun maganin photodynamic ƙarƙashin kulawa, maimakon kwaikwayon launin kawai tare da barin tsarin maganin.