Tuhinga
Te puru metilīni me te mate malaria: te whakamahi o mua me ngā whakamātautau hou
I te tau 1891, i whakamaimoatia ētahi tūroro tokorua e pāngia ana e te mate malaria ki tētahi waikano kikorangi mō te papanga. Kua kite a Paul Guttmann rāua ko Paul Ehrlich i te kaha o te puru metilīni ki te whakapoke motuhake i ngā pirinoa malaria. Nā reira, i whakaaro rāua, ki te āhei tētahi waikano ki te kōwhiri i te pirinoa kia kitea ai, tērā pea ka āhei hoki ki te kōwhiri i taua pirinoa kia tūkinohia ai. I ora mai ngā tūroro tokorua. Nā taua whakamātautau i noho ai te puru metilīni hei rongoā waihanga tuatahi mō te mate malaria, he maha ngā tekau tau i mua i te putanga mai o te chloroquine.
I muri iho, mō te nuinga o te rautau rua tekau, ka mimiti haere te whakamahinga o taua waikano. Ka whakakapia e ngā rongoā waihanga he māmā ake te kawe e te tinana, ā, tae rawa ki te wā hou, ko ōna whakamahinga matua he tauhohenga taiwhanga, he waikano tautuhi mate, he rongoā ohotata hoki mō tētahi atu mate o te toto. Nō reira, ehara tōna hokinga mai ki te rangahau malaria i Burkina Faso me Mali i te hiahia noa ki ngā mahi o mua. He whakapae motuhake tā ngā kairangahau: tērā pea ko taua matū hāora-whakaheke e taea ai te waikano te whakapoke pūtau ka whakararu i ngā whakangungu hāora-whakaheke o te pirinoa, ā, tērā pea mā tōna pānga ki te wāhanga tuku mate o te pirinoa e tutuki ai tētahi mahi kāore e tino tutuki i ngā rongoā paerewa. Hei whakamātau i taua whakapae, me āta whakahua i ia wā te huinga rongoā, te momo pirinoa, me te inenga putanga, nā te mea ki te huri tētahi o ēnei, ka huri hoki te whakatau.
Kei te puru metilīni i te ao rongoā te whakamārama whānui i te wehenga i waenga i ngā rongoā kua whakaaetia me ngā whakamahinga e rangahautia tonutia ana. Kei te taha rangahau te mate malaria: he mahi koiora tō te puru metilīni, kua whakamātautauria i roto i ngā huinga rongoā, engari ehara i te maimoatanga paerewa i raro i ngā aratohu.
He aha i whai hua ai te waikano a Ehrlich, ā, he aha i whakarērea ai
He tauira ngā pūrongo tōmua mō te āhua o te pānui i ngā taunakitanga nō mua i ngā tikanga rangahau o nāianei. I whakatau tata tētahi arotake o te tau 1904 mō ngā kēhi 425 i pūrongotia i kitea he urupare i te takiwā o te 85 ōrau. Heoi, nō mua aua kēhi i te tohatoha matapōkere, ngā inenga putanga paerewa, te whakaū i te momo pirinoa, me te aroturuki i te ātete rongoā. E whakaū ana ēnei he mahi tā taua pūhui ki te mate malaria e tika ana kia rangahautia tonutia, ehara i te auau whakaoranga ka taea te whakataurite ki tētahi whakamātautau hou.
Nā ngā take whakamahi i whakarērea ai, ehara nā te whakahē i tōna mahi. Ka huri te puru metilīni i te mimi kia kikorangi, kia kākāriki rānei, ka whakapoke i ngā kiko, ā, i ngā horopeta i whakamahia i taua wā ka puta he raruraru ki te ara kūnatu me te ara mimi, tae atu ki te ruaki me te mamae i te wā e mimi ana. Nā ngā rongoā hou ake i whakakore ngā pirinoa me te kore e waikano i te tūroro. E kōrero ana te arotake hītori e whai ana i te ara mai i te puru metilīni ki te chloroquine mō taua whakakapinga. Ka kohikohi hoki te arotake o ngā rongoā phenothiazinium mō te mate malaria i ngā ariā mō ngā tikanga mahi i mau ai te hiahia o ngā kairangahau i muri i te memeha haere o te whakamahinga haumanu.
Mō tōna tikanga mahi, he tika ake te kī he waikano hohe ki ngā tauhohenga hāora-whakaheke, kaua he mea kotahi anake tāna e aro ai. I roto i te ngongo whakamātautau, ka aukati ia i te whākōkī glutathione reductase o te pirinoa. I taua wā tonu, ka whakaawhiowhio ia i ngā irahiko mā ngā ara e whakapau ana i te kaha whakaheke e hiahiatia ana e te pirinoa, me te whakaputa hoki i te ahotea hāora; kua whakaarotia hoki ka whakararu ia i te whakakore i te paitini o te heme. Kāore anō kia mārama ko tēhea o ēnei mahi te mea matua i roto i te tūroro. Ko te hua nui, ehara i te tino ūnga o te rongoā, engari ko tōna pānga motuhake ki tētahi wāhanga o te huringa ora: he tino kaha te puru metilīni ki ngā gametocyte, arā, te wāhanga whakaputa uri me horomi e te waeroa kia haere tonu ai te tuku mate. Ka whakakore ngā huinga rongoā artemisinin paerewa i ngā pirinoa whakaputa uri takitahi e māuiui ai te tūroro, engari ka waiho pea ētahi gametocyte kua pakeke. Ki te whakapoto tētahi rongoā i te wā e kawea ana ngā gametocyte, ki te whakakore rānei i tō rātou kaha ki te whakapoke, ka aro taua rongoā ki te tuku mate tonu.
He aha i whakamātauria i ngā whakamātautau hou
Ko ia hua hou kei raro nei he hua nō tētahi huinga rongoā. He wāhanga o te kitenga te horopeta, te rongoā hoa, te momo pirinoa, me te inenga putanga.
| Te whakamātautau me te rōpū tāngata | Te mahere rongoā | Te inenga putanga me te hua | Te herenga |
|---|---|---|---|
| Burkina Faso 2005, 226 tamariki 6 ki te 59 marama te pakeke, mate malaria falciparum | Chloroquine me te puru metilīni 4 mg/kg/day mō te 3 rā, ka whakatauritea ki te chloroquine anake | He urupare tika i te rā-14 i te takiwā o te 56 ki te 46 ōrau; kāore he painga mārama | He horopeta waikano iti i te wāhi e ātete ana ngā pirinoa ki te chloroquine; he whakamātautau ngoikore mō tētahi mahere rongoā hou |
| Zoungrana 2008, wāhanga 2, 180 tamariki 6 ki te 10 tau te pakeke, mate malaria falciparum | Te puru metilīni me te artesunate, me te amodiaquine, te huinga artesunate-amodiaquine paerewa rānei; waikano 20 mg/kg/day mō te 3 rā | Ko te whakaoranga kua whakatikaina i te rā-28 he 62, 95, me te 82 ōrau, i taua raupapa; he tere rawa te whakakorenga i te huinga artesunate; nā ngā rōpū waikano e rua i whakaiti te kawe gametocyte i ngā rā 3, 7, me te 14 | He whakamātautau tuwhera me ngā rōpū iti; nā te iti o te whakaoranga i te huinga artesunate i whakaatu ko te rongoā hoa te mea e whakatau ana i te putanga |
| Coulibaly 2015, wāhanga IIb, 193 tamariki i te huinga tātari whaihuatanga, mate malaria falciparum | Artesunate-amodiaquine me te waikano 15 mg/kg/day mō te 3 rā, ka whakatauritea ki taua huinga anake | I te rā-7, i kitea ngā gametocyte mā te karu whārahi i te 1.2 ki te 8.9 ōrau; he paku tere ake te whakakorenga o ngā pirinoa whakaputa uri takitahi; he ōrite te whakaoranga kua whakatikaina, i te takiwā o te 80 ki te 85 ōrau | Ko te hekenga o te nui o te kitea o ngā gametocyte te tino painga, ehara i te whakaoranga; he nui ake te ruaki me te hekenga poto o te hemoglobin i te whakamahinga o te waikano |
| Mali 2018, wāhanga 2, 80 tāne kāore he hē o te G6PD, he whakapokenga falciparum whai gametocyte, kāore hoki he tohumate | Dihydroartemisinin-piperaquine me te waikano 15 mg/kg/day mō te 3 rā, ka whakatauritea ki te rongoā malaria anake | I waenga i ngā kaiuru i āhei ki te tuku mate i te tīmatanga, ko te hekenga tauwaenga o te kaha ki te whakapoke waeroa he 100 ōrau me te waikano, engari tata kore he hekenga ki te kore te waikano i te rā 2; i mau tonu te hua i te rā 7 | He 11 noa iho ngā kaiwhiwhi waikano i āhei ki te tuku mate i te whakataurite matua; he tāne anake, kāore he hē o te G6PD, he kaikawe mate kāore he tohumate; he inenga tuku mate, ehara i te whakamātautau whakaoranga |
| Burkina Faso 2019, 100 tamariki, mate malaria falciparum | Artesunate-amodiaquine me te waikano, ka whakatauritea ki taua huinga me tētahi horopeta kotahi o te primaquine | Ko te whakaoranga kua whakatikaina i te takiwā o te 96 ōrau i ngā rōpū e rua; he tere ake te whakakorenga i mua i te mutunga o te rā 1 me te waikano; ko ngā gametocyte i te rā-2 he 4 ki te 31 ōrau, ahakoa kāore te primaquine i hoatu kia tae ki te rā 2 | He iti, he tuwhera hoki te whakamātautau; nā te wā hoatu rongoā kāore i taurite ngā whakataurite gametocyte tōmua; ko te haumaru o te toto te aronga matua |
E rua ngā tauira e mau tonu ana puta noa i ēnei rangahau. Tuatahi, he mahi tūturu tā te waikano ki te Plasmodium falciparum, engari ki te whakamahia ko ia anake, he pōturi rawa te whakakore pirinoa, ā, ka āhei te mate ki te hoki mai nā ngā pirinoa e toe ana; i whakatau tētahi rangahau iti ki ngā pakeke me hono ia ki tētahi rongoā hoa tere te mahi. Tuarua, ko tōna uara tāpiri e tino kitea tonutia ana ina tāpirihia ki tētahi huinga rongoā hou kua tika te kōwhiri, kei ngā inenga gametocyte me te tuku mate, kaua i tētahi pikinga nui o te whakaoranga tikanga noa. Ko te rangahau whāngai waeroa mā te kiriuhi i Mali te whakaaturanga tino mārama o taua kōrero tuarua, nā te mea i tino heke te tūponotanga ka whakapokea ngā waeroa i kai i te toto o ngā kaiuru.
He rite tonu te hira o ngā herenga momo pirinoa ki ngā herenga huinga rongoā. Ko te nuinga rawa o ngā taunakitanga haumanu hou e whakapono nuitia ana e pā ana ki te mate malaria falciparum. Mō te mate malaria vivax, ko ngā taunakitanga haumanu he tirohanga o mua, me ngā mahi hou i roto i te ngongo whakamātautau me te whāngai waeroa. Kei roto i ēnei te pāngongotanga ki ngā kukū waikano nanomolar iti o ngā pirinoa i wehea mai i te rohe Thai-Myanmar, me te aukati kaha i te tuku mate i tētahi rangahau whāngai waeroa o te tau 2024. Kāore tētahi o ēnei e whakaū ana i te whakaoranga haumanu o ngā wāhanga vivax i te toto. Kāore hoki tētahi e aro ana ki ngā hypnozoite moe i te ate e hoki mai ai te mate vivax, me whai whakatau maimoatanga motuhake ēnei e hāngai ana ki taua momo pirinoa. Ki te whakawhānui i tētahi hua tuku mate falciparum hei kerēme mō ngā pirinoa katoa, ka tāruaruatia te hapa tawhito rawa o ēnei tuhinga rangahau. Nā tēnei take tonu ka whakawehea e te whare pukapuka rangahau ngā kitenga whakamātautau ki te tangata me ngā kitenga whakamātau taiwhanga ki ngā tīwae rerekē.
Ka haere tahi te haumaru me te mahere rongoā
E toru ngā mōrea me āta whakahaere, nā te mea mā ēnei e whakatau ko wai kāore e tika kia whakamātau.
Mā te korenga o te whākōkī glucose-6-phosphate dehydrogenase e hua ai te mōrea hemolysis, arā, te pakaru o ngā pūtau toto whero. I tētahi tātari whakakotahi o ngā rangahau e whā ki ngā tamariki i Burkina Faso, e kapi ana i ngā tamariki 1,005, i kitea he āhua nui ake ngā hekenga hemoglobin i muri i te whiwhi waikano i ngā kaiuru i tino hapa taua whākōkī. E rua hoki ngā pānga hemolysis i ngā tamariki i whiwhi waikano, he hapa whākōkī tō rātou, he heterozygote rānei. E kī ana te tapanga o te United States mō te puru metilīni werohia kia kaua e whakamahia mēnā he hapa G6PD, nā te mea ka puta pea he hemolysis kino. He rerekē ngā mahere rongoā ā-waha mō te malaria i te horopeta ohotata mā te ia toto, nō reira kāore e taea te huri ā-tau i taua tapanga hei mōrahi horopeta mō te malaria. Heoi, he ōrite te ahunga koiora. Me whai wāhi te arowhai me te tirotiro ngaio ki ngā whakamahinga tōtika katoa.
Me whakaaro tahi hoki ki ngā pāhekoheko e pā ana ki te serotonin. Ka aukati te puru metilīni e rere ana i te tinana i te monoamine oxidase, ā, ka whakaoho pea i te mate serotonin ina whakamahia me ngā rongoā aukati tīpako i te whakahoki-ngongo serotonin, ngā rongoā aukati i te whakahoki-ngongo serotonin-norepinephrine, ngā rongoā aukati monoamine oxidase, me ētahi rongoā opioid me ngā rongoā mare; kua pūrongotia hoki ētahi matenga. Kei ngā pānga taha, ngā āhuatanga e aukati ana i te whakamahinga, me te haumaru ngā kōrero taipitopito mō te pāhekoheko, ngā aukatinga whakamahi, me te aroturuki.
Ko te āhei o te tinana ki te kawe i te rongoā te ārai kāore e tino rangona. He mea e tūmanakohia ana te mimi kikorangi-kākāriki, ā, kāore e kino. Heoi, he tino kitea, ā, nō ngā tau 1890 mai anō kua whakaiti tēnei i te whakaae a te tangata ki te rongoā. E whakawhirinaki ana te ruaki ki te horopeta me te hanganga o te rongoā, ā, nā tēnei i puta ai ētahi tamariki i ngā whakamātautau. I tētahi whakataurite o muri mai, i tae te ruaki ki te 40 ōrau o ngā kaiwhiwhi waikano, ki te 14 ōrau o ngā kaiwhiwhi primaquine. Ki te ruakina e ngā tamariki tētahi rongoā, mō aua tamariki kei runga pepa anake tōna whaihuatanga.
He aha i kore ai ēnei taunakitanga e tautoko i te whakamaimoa i a koe anō
E tono ana ngā aratohu malaria o nāianei kia whakaūngia te pirinoa, ā, ka kōwhiria te maimoatanga i runga i te momo pirinoa, te taumaha o te mate, te āhua o te ātete rongoā i te rohe, te pakeke me te taumaha o te tangata, te hapūtanga, me te tūnga G6PD. Ko ngā huinga rongoā artemisinin te paerewa mō te mate falciparum. Kāore he mea i roto i ngā tuhinga rangahau mō te waikano e whakakapi ana i taua ara whakatau. He pōturi rawa te maimoatanga ki te rongoā kotahi, mā te kōwhiringa o te rongoā hoa e whakatau te whakaoranga, me whai maimoatanga motuhake ngā hypnozoite vivax, ka herea te whakamahinga e te tūnga G6PD, ā, ka puta he pāhekoheko mōrearea ki te whakamahia ngātahitia ngā rongoā e pā ana ki te serotonin. Mā te maimoatanga hē ka mahue pea he whakapokenga falciparum ka hoki mai nā ngā pirinoa e toe ana, ka ngaro i te tirohanga te hokinga mai o te vivax, ka whakaoho i te hemolysis, ā, ka pēhi ngoikore i ngā pirinoa mā te rongoā, e tautoko ai te whanaketanga o te ātete.
He whāiti ake te whakarāpopototanga pono i tā te hunga tautoko me te hunga whakahē e hiahia ana. He mahi rongoā tūturu tō tētahi waikano nō te rautau tekau mā iwa i te rautau rua tekau mā tahi. Ko tōna tino takoha hou ko te aukati i te tuku mate falciparum ina tāpirihia ki tētahi huinga rongoā tika i raro i te tirotiro o tētahi whakamātautau. He kitenga tēnei mō te haukoti i te horapa i roto i ngā rōpū tāngata kua rangahautia, ehara i te tohutohu kia whakamaimoa koe i a koe anō.