Methylene blue pa matenda a bowa a zikhadabo ndi khungu: zimene mayesero a chithandizo choyambitsidwa ndi kuwala akusonyeza

Zotsatira za kufufuza methylene blue pochiza bowa wa zikhadabo zimakonda kusokoneza zinthu ziwiri zosiyana kwambiri. Chimodzi ndi botolo la utoto wabuluu wopaka kunyumba. Chinacho ndi njira ya kuchipatala imene utotowo umapakidwa, kusiyidwa kwa kanthawi, kenako kuyambitsidwa ndi kuwala kofiira kwa mlingo woyezedwa. Pafupifupi umboni wonse wachipatala umakhudza njira yachiwiriyi. Nkhaniyi ikuyerekezera mwachindunji kafukufuku atatu wa chithandizo choyambitsidwa ndi kuwala, kuti muone zimene zinayesedwadi ndi zimene aliyense anatsimikizira.

Njira imene zonsezi zimagwirira ntchito ndi yosavuta. Methylene blue imayamwa kwambiri kuwala kofiira, ndipo molekyulu yomwe yalandira mphamvuyo imapereka mphamvu imeneyo ku okosijeni, kupanga okosijeni wa mtundu wa singlet ndi zinthu zina zogwira ntchito mwamphamvu zimene zimawononga maselo a bowa. Popanda kuwala, mphamvu yake imakhala yochepa kwambiri. N’chifukwa chake kafukufuku aliyense pansipa amaphatikiza utotowo ndi nyali, utali wa funde la kuwala, ndi mlingo wa kuwala wotchulidwa bwino. N’chifukwa chakenso zotsatira za njira zogwiritsa ntchito kuwala sizimanena chilichonse chokhudza kungopaka utoto pa chikhadabo pa kuwala kwa masana. Njira yonseyi yafotokozedwa mwatsatanetsatane mu nkhani yofotokoza chithandizo choyambitsidwa ndi kuwala, ndipo nkhani yonse ya kafukufuku wolimbana ndi bowa ili mu chidule cha methylene blue monga chinthu cholimbana ndi tizilombo.

Onychomycosis ya zikhadabo za kumapazi: utoto ndi kuwala poyerekezera ndi fluconazole ya mlungu uliwonse

Mayesero akulu kwambiri ndi kuyerekezera kwa odwala 80 omwe anali ndi onychomycosis ya zikhadabo za kumapazi ndipo anagawidwa m'magulu mwachisawawa, komwe kunafalitsidwa mu 2014. Theka linalandira chithandizo choyambitsidwa ndi kuwala ndipo theka linalandira fluconazole 300 mg yomwa kamodzi pa mlungu, aliyense kwa masabata 24.

Njira ya kuwalayo inafotokozedwa bwino. Methylene blue ya 2% yosungunulidwa m'madzi inapakidwa pa chikhadabo, kenako, itasiyidwa kwa kanthawi, inaunikiridwa ndi LED yofiira ya kuwala kosagwirizana m'mafunde pa 630 nm, yopereka ma joule 18 pa sentimita imodzi ya sikweya. Magawo a chithandizo ankabwerezedwa masiku 15 aliwonse, ka khumi ndi kawiri m'miyezi isanu ndi umodzi. M'magulu onse awiri, zikhadabo zokhala ndi zotsalira zokhuthala pansi pake, mizere yautali, kapena mulu wa bowa wotchedwa dermatophytoma zinkakandidwa ndi zida kaye, chifukwa kuwala ndi mankhwala zonse sizingagwire bwino ntchito zikakumana ndi khoma la keratini.

Chotsatira chachikulu chinakomera gulu la kuwala, ndipo kusiyanako kunali kofunikira malinga ndi ziwerengero. Zowunikira zomwe zinatengedwa pambuyo pake m'nkhani yonse zimasonyeza kuti pafupifupi 90% anasonyeza kusintha atamaliza chithandizo cha miyezi isanu ndi umodzi, poyerekezera ndi 45% pa fluconazole; m'gulu la kuwala chiwerengerocho chinatsika kufika pafupifupi 80% pa miyezi khumi ndi iwiri kuchokera pamene chithandizo chinatha. Kuwunikanso kokhwima kwambiri, komwe kunafuna zinthu zonse zitatu nthawi imodzi—kusaoneka kwa bowa pa maikulosikopu, kusamera kwa bowa mu labotale, ndi kumera mokwanira kwa chikhadabo chopanda zizindikiro—kunapeza kuti kuchira kwathunthu komaliza kunali 50% poyerekezera ndi 25%. Magulu awiriwa a ziwerengero amafotokoza miyezo yosiyana ya zotsatira, osati zotsatira zotsutsana, ndipo kusiyana kwawo ndi nkhani ya gawo lotsatirali. Chithandizochi chinanenedwa kuti odwala anachipirira bwino, ndipo panalembedwa nthawi imodzi ya kupweteka ndi kumva kutentha.

Mfundo ziwiri n'zofunika kwa aliyense wofunsa mmene angagwiritsire ntchito methylene blue pa bowa wa zikhadabo za kumapazi. Choyamba, mankhwala oyerekezera nawo anali fluconazole, amene mphamvu yake pa matenda a zikhadabo ndi yapakatikati, osati terbinafine wamphamvu kwambiri. Chachiwiri, utotowo unali wa 2%, wamphamvu kwambiri kuposa chilichonse chogulitsidwa kuti chigwiritsidwe ntchito pa zodzoladzola kunyumba, ndipo unapakidwa moyang'aniridwa limodzi ndi kuchotsa minofu ndi zotsalira zowonongeka komanso nyali yokonzedwa kuti ipereke mlingo wolondola.

Matenda oopsa a zikhadabo za kumapazi: kuwonjezera utoto ndi kuwala pa terbinafine

Kafukufuku wachiwiri wa zikhadabo, mayesero omwe anagawa odwala mwachisawawa pa matenda oopsa a dermatophyte a zikhadabo za kumapazi, omwe anafalitsidwa mu 2020, akuyankha funso locheperapo. Odwala makumi awiri omwe matendawa anakhudza kuposa 60% ya chikhadabo cha chala chachikulu cha phazi onse analandira terbinafine 250 mg yomwa tsiku lililonse kwa masabata khumi ndi awiri, pamodzi ndi urea yofewetsa chikhadabo. Kuwonjezera pa chithandizo choyambirirachi, khumi analandira methylene blue ndi kuwala, ndipo khumi analandira chithandizo cha kuwala chokhala ndi chinthu china choyambitsidwa ndi kuwala.

Gulu la methylene blue linagwiritsa ntchito 2% yosungunulidwa m'madzi, n'kuisiya kwa pafupifupi mphindi zitatu, kenako kugwiritsa ntchito LED ya 635 nm yopereka ma joule 37 pa sentimita imodzi ya sikweya kwa mphindi khumi. Panali magawo asanu ndi anayi a chithandizo, opatsidwa pakadutsa masabata awiri aliwonse m'nyengo ya masabata khumi ndi asanu ndi limodzi. Mafuta a urea a 40% ankapakidwa madzulo a tsiku lisanafike gawo lililonse, ndipo zotsalira zinkachotsedwa ndi zida.

Pofika pa sabata 52, pafupifupi miyezi isanu ndi inayi kuchokera pa gawo lomaliza la kuwala, muyeso wa kuopsa kwa matenda m'gulu la methylene blue unatsika kuchoka pa pafupifupi 24 kufika pansi pa 1, ndipo gawo la chikhadabo lomwe linakhudzidwa linatsika kuchoka pa pafupifupi 65% kufika pansi pa 2%. Kuchira kwathunthu, kutanthauza chikhadabo chooneka bwino komanso kusapezeka kwa bowa m'mayeso, kunali 70%. Kusapezeka kwa bowa m'mayeso kokha kunafika pa 100% m'gulu la methylene blue, poyerekezera ndi 90% ndi chinthu china choyambitsidwa ndi kuwala. Palibe zotsatira zosafunika pamalo opakidwa chifukwa cha utoto ndi kuwala zomwe zinanenedwa; odwala awiri anali ndi kusamva bwino m'mimba ndi m'matumbo komwe kunagwirizanitsidwa ndi terbinafine yemwe ankamwanso.

Kutanthauzira koona n'kwakuti mayeserowa sangathe kusiyanitsa zomwe utotowo wokha unathandiza. Wodwala aliyense analandira mankhwala abwino kwambiri ogwira ntchito m'thupi lonse kwa nthawi yonse yofunika, komanso kukonzekera chikhadabo mozama; panalibe gulu lolandira mankhwala okha, ndipo magulu awiri a kuwala anachita mofanana. Zimene akusonyeza n'zakuti kuwonjezera njira ya methylene blue ndi kuwala pa chithandizo chokhazikika kunachotsa bowa pamlingo waukulu pa matenda oopsa, ndi kutsatira odwala kwa nthawi yaitali. Akusonyezanso kuti magawo a kuwala omwewo sanawonjezere kuwonongeka pamalo ochiritsidwa m'gulu laling'onoli. Mmene mankhwala amachitirana komanso zoopsa m'thupi lonse za njira zophatikiza mankhwala zafotokozedwa m'buku lotsogolera za chitetezo ndi kuchitirana kwa mankhwala.

Matenda a khungu osamva mankhwala: wodwala mmodzi, bowa mmodzi wovuta kuchotsa

Umboni wokhudza khungu ndi wochepa kwambiri. Kafukufuku wa 2026 wa chithandizo cha methylene blue ndi kuwala polimbana ndi Trichophyton indotineae yosamva mankhwala ukukhudza wodwala mmodzi wa zaka 25 wokhala ndi malo ambiri a khungu okhudzidwa ndi matenda omwe anakhalapo kwa miyezi isanu ndi itatu, ngakhale analandira terbinafine yogwira ntchito m'thupi lonse ya 250 mg tsiku lililonse kwa masabata asanu ndi limodzi. Mayeso a labotale anasonyeza kuti mlingo wochepa kwambiri wa terbinafine woletsa kukula kwa bowayo unali ma microgram 8.0 pa mililita, poyerekezera ndi 1.0 wa methylene blue. Izi zikugwirizana ndi dermatophytosis yosamva mankhwala yomwe ikufalikira m'madera ambiri masiku ano.

Malo okhudzidwawo anachiritsidwa ndi methylene blue ya 1% yopaka pakhungu komanso kuwala kofiira kwa pafupifupi 630 nm, kopereka ma joule 100 pa sentimita imodzi ya sikweya, kamodzi pa mlungu kwa masabata anayi. Patapita masabata awiri, kusenda kwa khungu kunatha pamalo ochiritsidwawo ndipo bowa sunaonekenso pa maikulosikopu. Pofika pa sabata lachinayi, malowo anafotokozedwa kuti anachira kwathunthu, kutsala kusintha kochepa chabe kwa mtundu wa khungu, pamene malo omwe anapatsidwa kirimu wa terbinafine anali adakali ndi ulusi wa bowa wooneka. Palibe kusamvana kwakukulu ndi chithandizochi kapena kupweteka komwe kunanenedwa.

Kumeneku ndi kusintha kwenikweni kotsimikizidwa ndi mayeso a bowa pa matenda osamva mankhwala, koma ndi kwa wodwala mmodzi yekha yemwe anaonedwa kwa masabata anayi. Panalibe zolembedwa zosonyeza kuti, chithandizo chitatha, bowa sunamerenso m'mayeso a labotale kupatula kusapezeka kwake pa maikulosikopu. Panalibenso kutsatira kuti aone ngati matendawa abwereranso pa miyezi itatu, isanu ndi umodzi, kapena khumi ndi iwiri, komanso panalibe gulu la anthu lomwe lingagwiritsidwe ntchito kuwerengera kuchuluka kwa amene anasonyeza kusintha. Izi zikuthandiza kuti kafukufuku wina achitike, osati kuti chithandizochi chilangizidwe. Mitundu yosamva mankhwala ndi mayeso a mmene bowa amamvera mankhwala zafotokozedwanso m'buku lotsogolera za kusamva mankhwala olimbana ndi bowa.

Kafukufuku atatuwo moyerekezera

Kuchira kwa maonekedwe si kuchira kotsimikizidwa ndi mayeso a bowa

Powerenga nkhani za kafukufukuzi, muyenera kusiyanitsa chinthu chimodzi. Kuchira kwa maonekedwe kumatanthauza kuti chikhadabo kapena khungu zikuoneka bwino. Kuchira kotsimikizidwa ndi mayeso a bowa kumatanthauza kuti maikulosikopu ndi mayeso omeretsa bowa sizikupeza bowa. Kuchira kwathunthu kumatanthauza zonse ziwiri nthawi imodzi. Zikhadabo zimameranso pang'onopang'ono, motero chikhadabo chikhoza kuoneka bwino miyezi ingapo bowa asanatheretu. Ndipo zotsalira za bowa wakufa zingapitirize kuchititsa mayeso kusonyeza bowa ngakhale matendawa atha. Mayesero a Souza akusonyeza zotsatira zake mwachindunji: miyezo yosakhwima kwambiri ya kusintha imapereka 80 mpaka 90%, pamene kufuna chikhadabo chopanda zizindikiro komanso mayeso osapeza bowa kumapereka 50%. Palibe chiwerengero cholakwika mwa ziwirizi. Zimayeza zinthu zosiyana, ndipo mawu aliwonse okhudza mphamvu ya chithandizo ayenera kunena kuti akugwiritsa ntchito chiwerengero chiti.

Tanthauzo lake pa kusankha chithandizo

Mfundo zitatu zikadali zolondola pambuyo powerenga mosamalitsa. Choyamba, methylene blue yokhala ndi kuwala kofiira kokonzedwa kuti kapereke mlingo wolondola yachotsa bowa wa zikhadabo za kumapazi m'mayesero awiri omwe anagawa odwala mwachisawawa: kamodzi poyerekezera ndi fluconazole yokha, komanso kamodzi powonjezeredwa pa terbinafine ndi kukonzekera chikhadabo pogwiritsa ntchito urea. Chachiwiri, lipoti limodzi la matenda a khungu osamva mankhwala likulimbikitsa, koma lokha silitsimikizira pafupifupi chilichonse; palibe umboni wa mayesero ogawa odwala mwachisawawa wa dermatophytosis ya khungu yochiritsidwa ndi utoto ndi kuwala mpaka pano. Chachitatu, zotsatira zonse zabwino zinachokera pa kuphatikiza koyang'aniridwa: utoto wa muyezo wa mankhwala pa 1 mpaka 2%, nthawi yoikidwa yosiyira utoto, mlingo woyezedwa wa kuwala, ndipo nthawi zambiri kuchotsa minofu ndi zotsalira zowonongeka kapena kugwiritsa ntchito mankhwala ogwira ntchito m'thupi lonse limodzi nawo.

Palibe mwa izi chomwe chingagwiritsidwe ntchito pofotokoza zotsatira za kupaka utoto wogulitsidwa m'masitolo kunyumba. Kupaka kunyumba kulibe mlingo woyezedwa wa kuwala, kuwongolera nthawi yosiyira utoto, kuchotsa minofu ndi zotsalira zowonongeka, mayeso a bowa, kapena kutsatira zotsatira. Choncho kumachotsa chilichonse chimene mayeserowo anadalira. Aliyense amene akuganiza za chithandizo chogwiritsa ntchito kuwala ayenera kupita ndi njira zimenezi kwa dokotala wa khungu ndi kufunsa ngati chithandizo choyambitsidwa ndi kuwala choyang'aniridwa chilipo, m'malo mongofanana ndi mtundu wa utoto koma n'kusiya njira yonse ya chithandizo.