Shuɗin methylene don tunawa da maida hankali: abin da gwaje-gwajen mutane suka auna

Wata takarda ta 2023 kan shuɗin methylene da ƙwaƙwalwar ɗan adam mai rai ta fara hujjarta da wata jimla da yanzu ake maimaitawa a bitoci, bidiyoyi, da shafukan kayayyaki: sinadarin “an kuma nuna cewa yana inganta aikin fahimta, koyo da tunawa gwargwadon adadin da aka bayar, a mutane da kuma dabbobin gwaji.”

Bangaren dabbobi na wannan jimla yana da sauƙin samun hujja. Bangaren mutane ya dogara da gwaje-gwaje kaɗan, kuma karanta su yana warware ma'anar kalmar “aikin fahimta”. Binciken da aka yi don wannan maƙala ya gano nazari biyar a mutane waɗanda suka auna fahimta ko hoton ƙwaƙwalwa, da ƙarin gwaje-gwajen tiyata uku da suka auna sakamakon fahimta. Gwaji ɗaya a manya masu lafiya ya nuna ingantuwar tunawa, amma hakan bai tabbata ba a kwatancen tsakanin rukunoni.

Ana yawan ɗaukar nau'o'in sakamako huɗu a mutane a matsayin abu ɗaya

Idan aka karanta wannan tebur daga sama zuwa ƙasa, tsarin sakamakon ya bayyana. Nazarin da suka auna sakamakon fahimta na gaske su ne na tiyata, kuma sun yi amfani da magani ta jijiya a marasa lafiya da aka yi wa maganin sa barci. Nazarin a masu sa kai masu lafiya sun auna siginar ƙwaƙwalwa maimakon tunani.

Abin da gwajin 2016 a manya masu lafiya ya gano

Nazarin mutane da aka fi ambata ya ba manya masu lafiya 26 kashi ɗaya na 280 mg ta baki, kusan 4 mg/kg, ko ƙwayar maganin bogi da aka cika da FD&C blue no. 2 don su yi kama. An ɗauki hoton ƙwaƙwalwar mahalarta kafin ba su kashin magani, sannan kuma bayan sa'a ɗaya, yayin da suke yin gwajin faɗakarwar motsa jiki da hankali, wanda ke auna saurin lura da wata alama mai sauƙi da ido, da kuma gwajin daidaita abin da aka gani da samfurin baya bayan ɗan jinkiri, wato gwajin tunawa da abin da aka gani na ɗan gajeren lokaci.

Martanin ƙwaƙwalwa ya sauya. Shuɗin methylene ya ƙara sigina a ɓawon insula a bangarorin ƙwaƙwalwa biyu yayin aikin maida hankali (Z = 2.9 to 3.4, P = .01 to .008) da kuma a yankunan gaba na ɓawon ƙwaƙwalwa, saman kai, da bayan kai yayin aikin tunawa (Z = 2.9 to 4.2, P = .03 to .0003).

Sakamakon da ya shafi yadda mahalarta suka yi aikin shi ne ɓangaren da ake taƙaitawa wajen sake ba da labarin.

1. Lokacin martani bai inganta ba. Rukunin maganin bogi ya tashi daga 230 zuwa 220 millisekondi. Rukunin shuɗin methylene ya tashi daga 230 zuwa 230 millisekondi. Kwatancen tsakanin rukunoni ya bayar da F = 0.65, P = .43.
2. Amsoshin tuna abin da aka gani daidai sun ƙaru da kusan 7% a cikin rukunin da aka ba maganin, da P = .01 a kwatancen kafin da bayan ba da maganin a cikin wannan rukuni.
3. Wannan 7% bai tabbata ba a gwajin tsakanin rukunoni. Kwatancen ma'aunai da aka maimaita na sauyin amsoshin daidai ya bayar da F = 2.96, P = .09.

Sauyi a cikin rukuni tare da mu'amalar da ba ta kai muhimmancin ƙididdiga ba alama ce ta sakamakon da zai iya zama na gaske ko kuma bambancin bazata. Kammalawar takardar kanta ta dace da iyakar shaidar: sakamakon “yana goyon bayan ra'ayin cewa shuɗin methylene yana inganta aikin tunawa” kuma yana samar da tushe don gwaje-gwaje na gaba. Tushe ba tabbataccen sakamakon bincike ba ne. Bitarmu ta faɗaɗɗiyar shaidar mutane tana bibiyar abin da aka gina a kan wannan tushe tun daga lokacin.

Abin da gwaje-gwajen suke aunawa a zahiri

Babu ɗaya daga cikin waɗannan kayan aunawa da yake auna “tunawa” ko “maida hankali” a ma'anar da mai karatu yake nufi. Kowanne yana ɗora wa mutum wani takamaiman aiki kuma yana ba da maki ga martaninsa; iyakokin kayan aunawar kuma su ne iyakokin duk wata da'awar da aka gina a kansu.

Saboda haka, sakamako zai iya zama tabbatacce ta fuskar ƙididdiga amma har yanzu ya kasance mai ƙuntatacciyar ma'ana. Lokacin martanin da bai sauya ba yana nuna babu saurin gano alama; ba ya nuna cewa tuna darasi bai inganta ba. Ingantuwar maki a gwajin daidaita abin da aka gani da samfurin baya bayan ɗan jinkiri tana nufin an fi gane hoto sau da yawa; ba ta nufin mutumin zai tuna suna gobe. Jagorar yadda nazarin dabbobi ke auna tunawa tana bin wannan bambanci ta cikin hanyoyin ruɗani da gwaje-gwajen gane abubuwa da ke bayan yawancin da'awoyin.

Nazarin da ya biyo baya bai rubuta maki ko ɗaya ba

Shirin binciken guda ya wallafa wani nazari na biyu daga lokacin ɗaukar mahalarta guda, a jami'a guda, da kashi guda da maganin bogi guda; a wannan karon ya duba haɗin sadarwar ƙwaƙwalwa yayin hutawa. An shigar da mahalarta ashirin da takwas; nazarin hotunan ya yi amfani da kusan 13 zuwa 15 a kowane rukuni.

An danganta shuɗin methylene da raguwar kwararar jini a ƙwaƙwalwa cikin cibiyar sadarwar sarrafa gani da matsayi a sarari, da kuma ƙarin ƙarfin haɗin sadarwa yayin hutawa a wasu nau'i-nau'in sassa, ciki har da hippocampus na hagu da cerebellum na dama. Duka abubuwan lura ne masu ban sha'awa game da yadda cibiyar sadarwar take aiki. Babu ɗayansu da yake sakamakon tunawa, kuma takardar kanta ta faɗi haka: “Rashin maki na gwajin hali a wannan nazari ma iyaka ce.”

Rahotanni biyu daga rukuni guda, lokacin ɗaukar mahalarta guda, da kashi guda, gwaji ɗaya ne, ba biyu ba. Ba a maimaita shaidar hoton ƙwaƙwalwar ɗan adam kan amfanin fahimta ta hanyar wata ƙungiya mai zaman kanta ba.

Nazari mai zaman kansa ya gano sakamako a akasin alkibla

Aunawar mai zaman kanta ta fito daga wata ƙungiya kuma ta yi amfani da wata hanyar ba da magani. Singh da abokan aikinsa sun ba mata masu lafiya takwas magani ta jijiya, na maganin bogi da na 0.5 da 1 mg/kg na shuɗin methylene a ranaku daban-daban, sannan suka auna kwararar jini a ƙwaƙwalwa, ɗaukar oxygen daga jini, da saurin amfani da oxygen a ƙwaƙwalwa.

Duk ukun sun ragu. Kwararar jini a dukkan ƙwaƙwalwa ta ragu da kusan 8% a dukkan kashi biyun, kuma saurin amfani da oxygen ya ragu da muhimmancin ƙididdiga. Marubutan sun yi hasashen ƙaruwa, amma suka bayyana sakamakon akasin haka a fili, tare da bayar da bayani biyu: waɗannan kashi suna a yankin da tasirin shuɗin methylene ke sauyawa daga ƙarfafa aiki zuwa hana aiki, kuma ƙwaƙwalwa mai lafiya na iya samun ƙaramin damar ƙarin ingantawa.

Wannan sauyin alkibla shi ne dalilin da ya sa fassarar cewa “ƙari ya fi kyau” ba ta dace da wannan sinadari ba. Jagorar hormesis tana bayani kan siffar lanƙwasar; zangon kashi da aka bayyana yana ingantawa a waɗannan takardu shi ne 0.5 zuwa 4 mg/kg, kuma takardun da suka yi amfani da shi sun ce sama da 10 mg/kg alkiblar tasirin tana juyawa.

Sakamakon fahimta da ya sauya shi ne delirium bayan tiyata

Delirium yanayi ne na ruɗewar hankali mai tsanani da ke tasowa cikin sa'o'i zuwa kwanaki, musamman a tsofaffi bayan babban tiyata. Ba daidai yake da tuna inda makullai suke ba, amma ana auna shi da kayan aunawa da aka tabbatar da ingancinsu, kuma sakamakon fahimta ne.

Gwaje-gwaje uku da aka raba mahalarta zuwa rukunoni ta bazata sun gwada ko kashi ta jijiya da aka bayar yayin tiyata yana rage shi.

Gwajin 2021 ya kuma ruwaito raguwar nakasar aikin fahimta a farkon lokacin bayan tiyata a rana ta bakwai, daga 40.2% zuwa 16.1% (OR 0.30, 95% CI 0.16 to 0.57, P < .001). Wani nazarin haɗa sakamakon gwaje-gwajen ukun na 2026, wanda ya ƙunshi marasa lafiya 779, ya haɗa sakamakon zuwa rabon yiwuwar 0.35 (95% CI 0.23 to 0.53), ba tare da rashin daidaiton sakamako mai muhimmanci ta fuskar ƙididdiga tsakanin nazarin ba.

Tasirin yana da girma idan aka kwatanta da ma'aunin kula da lafiya a lokacin kafin, yayin da bayan tiyata, amma ba tare da illa ba ne. A gwajin maye gurbin haɗin gaɓa, zazzaɓi bayan tiyata ya fi yawa a rukunin da aka ba maganin, 16.5% idan aka kwatanta da 7.4% (P = .039). Tun daga lokacin an wallafa wasiƙu zuwa ga editan mujalla game da gwaje-gwajen tiyatar pancreas da maye gurbin haɗin gaɓa; hakan kan faru idan sakamako ya fara sauya yadda ake aikin likitanci, kuma alama ce cewa ana nazarin cikakkun bayanansa.

Akwai kuma wata shaida da ke rage ƙarfin wannan hujja. Wani nazarin haɗa sakamako ta hanyar cibiyar kwatance na 2026 a The BMJ ya haɗa gwaje-gwaje 158 da marasa lafiya 41,084 don tsara magungunan rigakafin delirium bisa matsayi. Ya ware dexmedetomidine a matsayin wanda aka fi dogaro da shi, tare da corticosteroids, magungunan kunna masu karɓar melatonin, parecoxib, olanzapine, da insulin ta hanci. Shuɗin methylene ba ya cikin hanyoyin da wannan nazari ya ambata.

Dalilin da nasarar ɗakin tiyata ba ta komawa ga karatu

Bambance-bambance huɗu ne suka raba waɗannan yanayi.

1. Rukunin mutane. Gwaje-gwajen sun ɗauki mutanen da suka haura shekaru 60 da za a yi wa manyan tiyata, rukuni mai babban haɗarin ruɗewar hankali tun farko. Hana ruɗewar hankali a ƙwaƙwalwa mai rauni ba daidai yake da inganta wadda take aiki yadda ya kamata ba.
2. Hanyar ba da magani da yanayin da aka bayar da shi. Duk sakamakon da ya nuna amfani ya fito daga magani ta jijiya da aka bayar yayin sa barci. Ƙwayar magani tana ba da wani irin shigar magani a jiki; kwatancen hanyoyin ba da magani yana bayyana yawan sinadarin da aka sha ta baki da ke isa ƙwaƙwalwa.
3. Sakamakon da aka auna. Delirium al'amari ne na lafiya da likitoci ke tantancewa da tsararrun kayan aunawa. Ci gaba da maida hankali yayin aikin rana ba haka yake ba, kuma gwajin da ba zai iya ɓoye wa mahalarta maganin da suke karɓa sosai ba zai sha wahalar auna shi.
4. Hanyar aikin da aka gabatar. Takardun tiyata suna danganta tasirin da raguwar kumburin martanin jiki gaba ɗaya da kiyaye shingen jini da ƙwaƙwalwa, tare da ƙarancin IL-6. Wannan hujja ta bambanta da bayanin canja wurin electron a mitochondria da ake amfani da shi wajen tallata maida hankali, kuma shaidar mutane ta fi goyon bayan ta farko sosai fiye da ta biyu.

Gwajin mutane ɗaya da ya gano ingantacciyar tunawa

A wani gwajin 2014 a American Journal of Psychiatry, an ba manya 42 masu tsananin tsoron wurin da aka rufe 260 mg na shuɗin methylene ko maganin bogi nan take bayan zaman fuskantar abin tsoro shida, kowane na mintuna biyar, a ɗaki da aka rufe. Tunawa da yanayin horon, da aka gwada bayan kwana ɗaya da bayan kwanaki 30, ta fi kyau a rukunin da aka ba maganin.

Sakamakon tsoron ya danganta da yanayin da aka kammala zaman. Mahalartan da suka ƙare zaman fuskantar abin tsoro da ƙaramin tsoro sun fi samun sauƙi bayan wata ɗaya idan sun karɓi shuɗin methylene; waɗanda zamansu ya ƙare da tsoro mai tsanani sun fi nuna muni. Saboda haka, abin da ya fi kusantar tabbataccen tasirin tunawa a nazarin mutane shi ne tuna wani taron koyo guda a dakin gwaje-gwaje, wanda ya inganta lokacin da aka ba da maganin bayan taron. Jagorar maganin fuskantar abin tsoro tana nazarin wannan tsarin sakamako.

Inda aka nemi tasirin amma ba a same shi ba

Gwajin shuɗin methylene da fahimta mafi tsawo a mutane ya ɗauki watanni shida. A wani nazarin musayar magani da aka raba mahalarta ta bazata a masu cutar bipolar, marasa lafiya 37 da suke shan lamotrigine sun karɓi 15 mg a matsayin maganin kwatance da ya yi kama da mai aiki, ko 195 mg a matsayin kashin magani mai aiki. Makin damuwa ta depression da fargaba sun inganta da kashi mafi yawa. Rahoton takardar kan fahimta jimla ɗaya ne: “Tasirin shuɗin methylene kan alamomin matsalar fahimta bai kai muhimmancin ƙididdiga ba.”

An tsara gwajin da maganin kwatance mai aiki saboda shuɗin methylene yana sauya launin fitsari, kuma marubutan sun yi hukuncin cewa maganin bogi marar aiki ba zai iya ci gaba da ɓoye bambancin ba. Wannan matsalar ɓoye maganin tana maimaituwa a wannan fanni, kuma jagorar dalilin da gwaje-gwajen shuɗin methylene suke da wahalar ɓoyewa tana bayyana tasirinta ga fassarar sakamakon da ya dogara da bayanin mahalarta.

Manyan gwaje-gwajen tunawa a mutane sun yi amfani da wani sinadari daban

Gwaji mafi girma na maganin da ke cikin dangin shuɗin methylene don tunawa shi ne shirin Alzheimer's, kuma bai yi amfani da shuɗin methylene ba. Ya yi amfani da hydromethylthionine mesylate, nau'in wannan ginshiƙin phenothiazine da aka rage ta fuskar sinadarai kuma aka daidaita shi a matsayin gishiri, wanda aka ƙirƙira don hana taruwar tau. Gwajin mataki na 3 na baya-bayan nan ya shigar da mahalarta 598 masu ƙaramin raunin fahimta ko dementia na Alzheimer's mai sauƙi zuwa matsakaici a cibiyoyi 82, kuma bai cimma manyan ma'aunan sakamako biyu da aka tsara a makonni 52 ba. Dalilin da aka bayar yana da darasi: rukunin kwatance ya inganta, abin da marubutan suka danganta da maganin kwatancen kansa, 4 mg na methylthioninium chloride sau biyu a mako, wanda aka zaɓa a matsayin sinadarin sauya launin fitsari marar aiki domin kiyaye ɓoyewar magani. Bambanci mai muhimmancin ƙididdiga ya bayyana ne kawai a ƙaramin rukunin masu ƙaramin raunin fahimta, a makonni 78 da 104, a nazarin jinkirta fara magani. Wani rahoton mataki na 3 na baya daga wannan shirin ya samo sakamakonsa masu muhimmancin ƙididdiga daga nazarin da aka gyara kafin bayyana maganin da kowa ya karɓa, yana kwatanta ƙananan rukunonin masu amfani da magani ɗaya da ba a raba su ta bazata ba. Jagorar gwaje-gwajen Alzheimer's tana bayani kan abin da waɗannan gwaje-gwajen suka tabbatar.

Yadda nazarin da ya cancanci amincewa zai kasance

Gwajin da zai iya tallafa wa da'awa game da tunawa ko maida hankali zai buƙaci manya masu lafiya da ba su da wata matsalar fahimta da ake korafi a kai, maimaita kashi na tsawon makonni, kwatancen da ke ɓoye wace ƙwayar magani ce wacce, sakamakon da aka ƙayyade tun da farko, da ƙungiyar masu bincike mai zaman kanta. Babu wani abu a wannan jerin da ya wuce hankali. Kawai dai ba a yi shi ba tukuna.

Idan duk da haka kana tunanin amfani da shi

Muhimman batutuwan aminci biyu suna zuwa kafin duk wata tattaunawa kan amfani. Shuɗin methylene yana hana aikin monoamine oxidase A, abin da ke jawo batun haɗa shi da magungunan depression da likita ya rubuta da sauran magungunan da ke shafar serotonin; abin damuwa shi ne ciwon taruwar serotonin, ba ƙaramin tasirin haɗuwar magunguna ba. Haka kuma bai dace a yi amfani da shi ga masu ƙarancin G6PD ba saboda anemia da ke haifar da rushewar jajayen ƙwayoyin jini. Madogarar bayanan aminci da jagorar hulɗar magunguna suna tsara waɗannan tambayoyi bisa rukunin magani.

Idan tunawa ko maida hankali sun sauya da gaske, matakin farko ba ƙarin abinci ba ne. Cutar thyroid, ɗaukewar numfashi yayin barci, ƙarancin B12, depression, da wasu magungunan da likita ke rubutawa suna haifar da irin alamar da ake sayen abin ƙarfafa fahimta don gyarawa, kuma jagorar shaidar thyroid tana nuna yadda wani dalili da za a iya magancewa yake yawan kasancewa a ƙarƙashin matsalar.

Sinadarin kansa wani abu ne da zai iya bambanta a kowane nazarin da ke sama

Kowane kashi da aka bayyana a nan adadi ne da aka auna na takamaiman sinadari, daga masana'antar magunguna, tare da takardar shaidar binciken inganci. Kwalba daga mai sayarwa da ba a tabbatar da shi ba ba haka take ba. Bin ƙa'idojin monograph na USP shi ne ma'aunin da mai saye zai iya bincikawa; sinadarin da bai cika su ba yana yiwuwa ya kasance na matakin amfani a masana'antar yadi, wanda zai iya ɗauke da ƙazantar sinadarai masu carbon kamar Azure B, ragowar sinadaran narkarwa, da ƙarafa masu nauyi a matakan da ƙa'idar magunguna ke iyakancewa. Abin da alamar USP take tabbatarwa da wanda ba ta tabbatarwa ba yana bayani kan matakin ingancin kansa.

Yawancin masu sayarwa da ke bayyana kaya a matsayin waɗanda wata ƙungiya mai zaman kanta ta gwada suna binciken ƙarafa masu nauyi kawai, sannan su gabatar da wannan gwaji guda a matsayin cikakken cika ƙa'idoji. Blupreme yana gwada dukkan ƙa'idodin USP: tabbatar da ainihin sinadari, tsabta, ƙazantar sinadarai masu carbon, ragowar sinadaran narkarwa, ƙazantar abubuwan sinadarai, ragowar bayan ƙonawa, iyakokin ƙananan ƙwayoyin halitta, da gubar endotoxin ta ƙwayoyin bacteria. Kowane rukuni na samarwa yana zuwa da takardar shaidar binciken inganci, kuma karanta ta daidai yana nufin daidaita lambar rukunin samarwa da dakin gwaje-gwajen da kwalbar da ke hannunka. Babu wani daga cikin waɗannan da ke haifar da amfanin fahimta, kuma samfurin da ba zai iya bayar da takardar tabbatar da ainihinsa ba bai dace a fara gwada da'awa da shi ba.

A taƙaice

Babu wani gwaji da ya ba manya masu lafiya shuɗin methylene sannan ya nuna fifikon tunawa ko maida hankali a kan maganin bogi. Gwajin 2016 ya sauya siginar ƙwaƙwalwa, ya bar lokacin martani ba tare da sauyi ba, kuma ya nuna ingantuwar tuna abin da aka gani wadda ba ta kai muhimmancin ƙididdiga ba lokacin da aka kwatanta rukunoni. Takardar da ta biyo bayansa ba ta rubuta maki na gwaji ba. Wata ƙungiya mai zaman kanta ta gano raguwar kwararar jini da amfani da oxygen, ba ƙaruwa ba.

Sakamakon fahimta a mutane da shaidar ta goya baya ya fito ne daga tiyata, inda kashi ta jijiya a tsofaffin marasa lafiya ya rage yawan delirium bayan tiyata da kusan rabi a gwaje-gwaje uku da nazarin haɗa sakamakonsu. Wannan sakamako ne na gaske game da marasa lafiya masu tsananin rashin lafiya, kuma babban nazarin haɗa shaidar rigakafin delirium mai zaman kansa bai ware wannan maganin ba. Da'awar ta fi wadda ake tallatawa ƙuntata sosai, kuma wurinta yana asibiti.

Taswirar hanyoyin aikin sinadarin a ƙwayoyin halitta tana bayyana abin da sinadarin yake yi a tsarin gwaje-gwajen dakin bincike, bitar shaidar ADHD tana bin tambayar maida hankali zuwa cikin rukunin mutanen da aka tabbatar da matsalar, kuma ɗakin karatun bincike yana jera nazarin da ke bayan kowace da'awa a wannan shafi.