Shuɗin methylene don cutar Lyme: sakamakon ɗakin gwaje-gwaje da shaidar asibiti

Farantar reno ba mara lafiya ba ce. Wannan bambanci yana bayyana kusan duk wata da'awa game da shuɗin methylene da cutar Lyme.

A ce masu karatu biyu sun ga jumla ɗaya: masu bincike sun “kawar” da ƙwayoyin cutar Lyme ta hanyar haɗin magunguna. Wani mai karatu yana fahimtar cewa babu abin da ya sake girma a cikin farantar gilashi har tsawon makonni biyu. Ɗayan yana fahimtar cewa marasa lafiya masu gajiya sun farfaɗo. Duka fahimtar biyu suna iya zuwa cikin sauƙi. Ta farko kaɗai ce ta dace da abin da gwajin ɗakin gwaje-gwajen ya auna.

Wannan labarin yana raba waɗannan abubuwa biyu. Yana nazarin abin da shuɗin methylene ya yi wa Borrelia burgdorferi a renon ɗakin gwaje-gwaje, abin da ya faru lokacin da aka haɗa shi cikin tsare-tsaren magani masu sarƙaƙiya ga marasa lafiya, da dalilin da ya sa babu ɗaya daga cikin sakamakon da ya amsa tsawon lokacin shan shuɗin methylene don Lyme.

Lyme cuta ce ta bakteriya, don haka shaidar da ta shafi ƙwayoyin parasit ba ta shafe ta kai tsaye ba

Borrelia burgdorferi, bakteriya mai siffar karkace wadda kaska ke yaɗawa, ce take haddasa cutar Lyme. Kulawar da aka saba amfani da ita ta ƙunshi magungunan kashe bakteriya kamar doxycycline, amoxicillin, ko cefuroxime, kamar yadda aka bayyana a jagorar Lyme ta 2020 daga IDSA, AAN, da ACR.

Kasancewarta bakteriya yana da muhimmanci domin shuɗin methylene yana da wani tarihin amfani daban kan ƙwayoyin parasit. An yi bincike a kansa kan ƙwayoyin parasit na zazzabin cizon sauro, kuma wani lokaci ana tattauna shi don Babesia, ƙwayar parasit da kaska ke yaɗawa wadda za ta iya kasancewa tare da Lyme. Sakamako kan ƙwayar parasit ba ya tabbatar da cewa hanyar aiki iri ɗaya tana shafar Borrelia. Waɗannan halittu sun bambanta a tsari, ayyukan sarrafa sinadarai, wuraren da magunguna ke kai hari, da ɓangaren jikin da suke kamuwa da shi. Bayaninmu na yadda shuɗin methylene yake aiki a ƙwayoyin halitta ya yi wannan magana a matakin gaba ɗaya: aikin redox yana da faɗi, amma sakamakon da zai samu a halitta har yanzu ya dogara da irin halittar da yanayin da take ciki.

Saboda haka, a raba tambayoyi biyu. Na farko, me shuɗin methylene yake yi wa Borrelia a reno da aka sarrafa yanayinsa? Na biyu, me yake faruwa ga mutanen da suke da cutar Lyme? Sauran wannan labarin yana bin wannan tsari.

Ƙwayoyin da suke dawwama duk da magani suna cikin wani yanayi ne, ba iri mafi ƙarfi ba

Magungunan kashe bakteriya sukan kashe mafi yawan Borrelia cikin sauri, su bar ƙaramin rukuni da yake iya jure musu. Lokacin da masu bincike suka sake renon waɗanda suka tsira, ƙwayoyin da suka fito daga gare su yawanci sun sake zama masu sauƙin shafar magani. Wannan yanayin yana nuna wani halin ayyukan ƙwayoyin da zai iya komawa yadda yake, maimakon juriya da ake gada. Ana samun bayyananniyar shaida a aikin Sharma da abokan aikinsa kan kashe ƙwayoyi a matakai biyu da sake girman ƙwayoyin da suka dawwama.

A aikace, sabbin reno da suke matakin ƙaruwa cikin sauri suna ƙunshe da ƙwayoyi masu siffar karkace da ke motsi a mafi yawansu, kuma magungunan da aka saba amfani da su suna shafarsu cikin sauƙi. Tsofaffin reno da suke matakin tsayawar girma suna ƙunshe da ƙarin siffofi masu zagaye da siffofin ƙananan tarin ƙwayoyi masu haɗuwa, kuma suna fi jure wa magungunan nan. Waɗannan kalmomi suna bayyana siffofi da yanayin girma a cikin faranta. Ba hujja ba ne cewa waɗannan siffofi ne suke bayyana dalilin alamomin da suke ci gaba bayan an yi maganin cutar Lyme.

Hanyar fahimtar batun tana da sauƙi. Girma mai aiki yana bayyana wuraren da magani zai kai hari, kamar samar da bangon ƙwayar halitta. Girma a hankali ko sauyin yanayin girma yana ɓoye waɗannan wurare. Wani sinadari da yake taimakawa kan yanayi na biyu zai iya zama ba shi da muhimmanci kan na farko, kuma akasin haka ma gaskiya ne.

Abin da binciken tantancewa na 2015 ya gano a zahiri

Manazartar da aka fi ambata kan wannan batu ita ce binciken Feng da abokan aikinsa na tantance rumbun sinadaran FDA a 2015. Ya gwada sinadarai kan renon Borrelia da suka yi kwanaki bakwai a matakin tsayawar girma, na wasu kwanaki bakwai, da kowane sinadarin tantancewa a 50 micromolar.

Shuɗin methylene ya nuna aiki da ya isa ya jawo hankali, amma bai kawar da dukkan ƙwayoyin ba. A duba da na'urar hangen ƙananan abubuwa, kusan kashi 40 cikin ɗari na ƙwayoyin sun ci gaba da rayuwa bayan amfani da shuɗin methylene, idan aka kwatanta da kashi 93 cikin ɗari a rukunin kwatance da ba a yi wa magani ba, kashi 75 cikin ɗari bayan doxycycline, kashi 76 cikin ɗari bayan amoxicillin, kashi 49 cikin ɗari bayan cefuroxime, da kashi 35 cikin ɗari bayan daptomycin da aka yi amfani da shi don kwatantawa. Ba a iya amfani da sakamakon na'urar karanta faranta na shuɗin methylene ba, domin tsananin launinsa ya tsoma baki a gwajin walƙiyar haske, don haka an dogara da dubawa kai tsaye da na'urar hangen ƙananan abubuwa wajen yanke hukunci.

Wannan alama ce daga tantancewa, ba kawarwa ba. Ba a nuna cewa renon da aka yi wa shuɗin methylene sun ci gaba da kasancewa babu ƙwayoyi ba lokacin da aka sake renonsu na dogon lokaci ba tare da magani ba. Marubutan sun nemi a yi binciken haɗin magunguna da na dabbobi daga baya, wanda shi ne fahimtar da ta dace da binciken tantance rumbun sinadarai.

Dalilin da ya sa ake iya fahimtar sakamakon haɗin magunguna ba daidai ba cikin sauƙi

Sau da yawa ana haɗa wani bincike mai alaƙa na 2015 cikin wannan da'awar. A binciken Feng, Auwaerter, da Zhang kan haɗin magunguna ga Borrelia a matakin tsayawar girma, sakamakon ɗakin gwaje-gwaje mafi ƙarfi ya fito ne daga daptomycin da doxycycline da cefoperazone, kowanne a 10 micrograms a kowace milliliter na kwanaki bakwai. Bayan maganin, an rage yawan magungunan ta hanyar haɗa su da sabon ruwan reno, sannan aka sa ido kan renon don ganin ko ƙwayoyin za su sake girma.

Wannan haɗin magunguna uku kaɗai ne ya ci gaba da kasancewa babu halittun da za a iya ganowa bayan kwanaki 15 na sake reno. An bayyana iyakar ganowa da na'urar hangen ƙananan abubuwa a matsayin ƙasa da halittu 100,000, don haka “kawarwa” tana nufin cewa ba a ga sake girma da na'urar ba ƙarƙashin wannan tsarin gwaji. Ba yana nufin an tabbatar da rashin ko ƙwaya ɗaya ba ne, ko cewa maganin yana shiga kyallen jikin dabba, ko kuma yana warkar da mutum. Takardar binciken kanta ta yi gargaɗi game da ɗaukar sakamakon kai tsaye zuwa magani.

Bayanan haɗin shuɗin methylene da suka zo daga baya sun fito daga wani matakin shaida daban kuma mafi rauni. Wata takardar binciken digiri na biyu ta Johns Hopkins a 2016 daga Megan Weitner ta gwada shuɗin methylene a 4 micrograms a kowace milliliter, wanda aka zaɓa da la'akari da matakin da zai iya kasancewa a ruwan jini, tare da magunguna kamar cefuroxime, doxycycline, azithromycin, rifabutin, rifaximin, nitrofurantoin, da pyrimethamine. An sa renon su fuskanci magungunan na kwanaki bakwai, sannan aka tantance su ta hanyar saka launin gwaji da dubawa da na'urar hangen ƙananan abubuwa. An ɗauki haɗin magunguna da ma'aunin ragowar ƙwayoyin masu rai bayan daidaitawa ya kasance ƙasa da 0.90 a matsayin masu aiki. Misali, shuɗin methylene da azithromycin sun kai 0.88, wanda ya inganta zuwa 0.64 lokacin da aka ƙara cefuroxime, yayin da wasu haɗin magunguna uku suka kai kusan 0.69 zuwa 0.82.

Waɗannan raguwar siginar launin gwaji ne, ba kawar da dukkan ƙwayoyin da ke cikin reno ba. Takardar digirin ba ta nuna cewa haɗin shuɗin methylene ya sa reno su kasance babu ƙwayoyin da ake iya ganowa na dogon lokaci kamar sakamakon haɗin magunguna uku da ya ƙunshi daptomycin ba. Haka kuma takardar digiri ce, ba takardar mujallar kimiyya da masana suka duba ba. Tana iya samar da hasashen bincike. Ba za ta iya ɗaukar nauyi ɗaya da shaidar gwajin asibiti mai rukunin kwatance ba.

Wannan ne ya sa ba za a iya ɗauko “tsarin maganin Lyme da shuɗin methylene” daga waɗannan takardu ba. Sanya halittu cikin magani a ɗakin gwaje-gwaje ba tare da katsewa ba na kwanaki bakwai ba ya bayyana adadin magani ga mutum, hanyar ba da shi, tsawon lokaci, yawan da zai kasance a kyallen jiki, ko matakin gubarsa da za a iya amincewa da shi. Haka kuma ba ya gwada shuɗin methylene shi kaɗai kan sakamakon asibiti da ke da muhimmanci ga marasa lafiya, kamar ciwo, gajiya, kumburin gaɓoɓi, alamomin jijiyoyi, ko dawowar cuta. Don taimako wajen rarrabe waɗannan matakan shaida, duba jagorarmu ta karanta da'awoyin bincike kan shuɗin methylene.

Daga faranta zuwa marasa lafiya: matakin asibiti da ya ɓace

Har zuwa lokacin rubuta wannan labarin, babu gwaji na bazuwar rarraba marasa lafiya ko gwajin bibiyar gaba mai rukunin kwatance da ya nuna cewa shuɗin methylene yana magance cutar Lyme. Abin da ake da shi a mutane shi ne rahotanni marasa rukunin kwatance, inda shuɗin methylene ya kasance wani ɓangare na tsarin magunguna da yawa.

Misali mafi bayyana shi ne aikin nazarin bayanan baya kan maganin haɗin dapsone da Horowitz, Fallon, da abokan aikinsu suka yi, ciki har da rahoton 2023 kan marasa lafiya 25 waɗanda aka riga aka yi wa magunguna da yawa. An bayar da rahoton cewa alamomin Lyme masu ci gaba sun gushe ga takwas cikin 25 na aƙalla watanni uku. Amma marasa lafiyan sun kuma karɓi dapsone, tetracyclines, rifampin ko rifabutin, macrolides, da kuma wasu ƙarin magunguna a wasu lokuta. Babu rukunin da ya karɓi shuɗin methylene shi kaɗai, kuma babu rukunin kwatance da aka zaɓa ta hanyar bazuwar rarrabawa. Ƙananan rahotannin marasa lafiya da suka zo daga baya suna da tsari iri ɗaya.

Wannan tsarin bincike yana iya bayyana sakamako. Ba zai iya danganta shi ga shuɗin methylene ba. Sauƙin da aka samu zai iya fitowa daga wani magani, haɗin magungunan, yadda yanayin cutar yake tafiya da kansa, tasirin placebo, sa ido na kusa, ko zaɓen marasa lafiya da suke da damar samun sauƙi. Teburi yana bayyana wannan giɓi a fili.

Saboda haka, abin da ake da shi shi ne tantancewa tare da haɗin magunguna a takardar digiri da rahotannin magunguna da yawa marasa rukunin kwatance. Wannan jerin ya fi rauni da tasirin magani da aka tabbatar a gwajin asibiti.

Babu amsar tsawon lokacin shansa da ta dogara da shaida

Ana iya fahimtar dalilin neman “tsawon lokacin shan shuɗin methylene don Lyme.” Alamomin da suke ci gaba suna sa a ji matsin yin wani abu. Amma magana kan tsawon lokaci tana ɗauka cewa an riga an tabbatar da adadin magani mai tasiri, kuma babu gwaji da ya tabbatar da ɗaya don Lyme.

Shuɗin methylene magani ne da yake aiki a ko'ina cikin jiki kuma yana da muhimman ƙuntatawa. Bayanin maganin da ake bayarwa da takardar likita a Amurka don methemoglobinemia da aka samu daga baya ya bayyana 1 mg a kowace kg ta cikin jijiya a tsawon mintuna 5 zuwa 30, wanda ya shafi wata cuta, wata hanyar bayarwa, da wata manufa daban, kuma ba za a iya mayar da shi adadin magani don Lyme ba. Bayanin maganin yana ɗauke da gargaɗi a cikin akwati kan ciwon yawan serotonin lokacin da aka haɗa shuɗin methylene da magungunan da suke shafar serotonin, musamman SSRIs, SNRIs, da masu hana MAO, kuma ya hana amfani da shi ga masu ƙarancin G6PD saboda haɗarin ƙarancin jini da rushewar jajayen ƙwayoyin jini ke haddasawa. Duk wanda yake tunanin amfani da shi yana buƙatar ƙwararren mai kula da lafiya ya duba magungunansa, yanayin G6PD, ciki, aikin koda, da mu'amalar magunguna. Taƙaitaccen bayaninmu kan aminci da yadda ake sarrafa shi yana bayyana dalilin da ya sa tsabta da kulawar likita suke da muhimmanci kafin kowane amfani da zai shafi jiki gaba ɗaya.

Ga alamomin da suke ci gaba bayan maganin Lyme da aka ba da shawara, ba tare da tabbatacciyar shaidar sake kamuwa ko gazawar magani ba, jagorar IDSA ba ta ba da shawarar ƙarin maganin kashe ƙwayoyin cuta ba, kuma ta ce babu shaidar asibiti da take goyon bayan tsare-tsaren da suke kai hari musamman ga ƙwayoyin masu dawwama ko siffofin ƙwayoyi da suka sauya. Wannan ba musun cewa akwai ƙwayoyin da suke jure magani a faranta ba ne. Yana cewa ba a riga an tabbatar da alaƙar wannan da abin da yake faruwa a marasa lafiya ba.

Hanya mai amfani ta karanta da'awar da za ka haɗu da ita a gaba ita ce ka yi tambayoyi uku. Shin sakamakon ya fito ne daga reno a ruwan gina jiki, daga dabba, ko daga marasa lafiya? Shin an gwada shuɗin methylene shi kaɗai ne, ko a cikin haɗin magunguna da yawa kawai? Shin abin da aka auna shi ne sake girma a faranta, ko farfaɗowar mutane? Idan amsoshin su ne faranta, haɗin magunguna, da sake girma, to binciken yana samar da hasashen da za a ƙara gwadawa ne. Ba tsarin magani ba ne.