Ubururu bwa metilene ku ndwara z'ibihumyo mu nzara no ku ruhu: icyo igerageza ry'ubuvuzi bwa fotodinami ryagaragaje

Ibisubizo byo gushakisha ubururu bwa metilene ku bihumyo byo mu nzara bikunze kuvanga ibintu bibiri bitandukanye cyane. Kimwe ni icupa ry'irangi ry'ubururu umuntu yisiga mu rugo. Ikindi ni uburyo bwo kuvura bukorerwa kwa muganga, aho irangi risigwa, rigategerezwa igihe gito, hanyuma rigakanguwe n'ingano yapimwe y'urumuri rutukura. Hafi y'ibimenyetso byose byo mu bushakashatsi ku barwayi bireba ubwo buryo bwa kabiri. Iyi ngingo igereranya mu buryo butaziguye ubushakashatsi butatu bwa fotodinami, kugira ngo ubone ibyageragejwe koko n'icyo buri bushakashatsi bwagaragaje.

Uburyo byose bihuriraho buroroshye. Ubururu bwa metilene bwakira cyane urumuri rutukura, maze molekile yakiriye iyo mbaraga ikayiha ogisijeni, igakora ogisijeni yo mu bwoko bwa singlet n'utundi tunyabutabire twitabira vuba tukangiza uturemangingo tw'ibihumyo. Iyo nta rumuri ruhari, icyo gikorwa kiba gifite intege nke cyane. Ni yo mpamvu buri bushakashatsi bukurikira buhuza irangi n'itara ryagenwe, uburebure bw'umuraba bwagenwe n'ingano y'urumuri yagenwe, kandi ni yo mpamvu ibyavuye mu buryo bukoresha urumuri ntacyo bivuga ku gusiga akantu k'irangi ku rwara mu rumuri rwo ku manywa. Uburyo rusange ibyo bikoramo busobanurwa mu buryo burambuye mu ngingo isobanura ubuvuzi bwa fotodinami, naho imiterere yagutse y'ubushakashatsi ku kurwanya ibihumyo iboneka mu ncamake y'ubururu bwa metilene nk'ikinyabutabire kirwanya mikorobe.

Ibihumyo mu nzara z'amano: irangi n'urumuri ugereranyije na fluconazole itangwa buri cyumweru

Igerageza rinini kurusha ayandi ni igereranya ryakozwe ku barwayi 80 bafite ibihumyo mu nzara z'amano, bagabanyijwe mu matsinda ku buryo bwa tombola, ryatangajwe mu 2014. Kimwe cya kabiri cyahawe ubuvuzi bwa fotodinami, ikindi gihabwa fluconazole 300 mg inyobwa rimwe mu cyumweru, buri tsinda rikavurwa ibyumweru 24.

Uburyo bwo gukoresha urumuri bwari busobanutse. Umuti w'ubururu bwa metilene wa 2% ushongeshejwe mu mazi wasigwaga ku rwara, maze nyuma y'igihe gito cyo kuwureka ukaruhama, urwara rukamurikirwa na LED itukura ifite uburebure bw'umuraba bwa 630 nm, imiraba yayo idafite icyerekezo kimwe gihamye, itanga joules 18 kuri santimetero kare. Ubuvuzi bwasubirwagamo buri minsi 15, inshuro cumi n'ebyiri mu mezi atandatu. Mu matsinda yombi, inzara zifite ibisigazwa byinshi munsi yazo, imirongo igana mu burebure bwazo, cyangwa ikirundo cy'ibihumyo kizwi nka dermatophytoma zabanzaga gukurwaho ibyo bisigazwa hakoreshejwe ibikoresho, kubera ko urumuri n'umuti byombi bidashobora kurenga urukuta rwa keratine.

Igisubizo cy'ingenzi cyagaragaje ko itsinda ryakoresheje urumuri ryagize umusaruro mwiza kurushaho, kandi itandukaniro rikaba ryari rifite agaciro mu mibare y'ibarurishamibare. Isesengura ryakurikiyeho ry'inyandiko yuzuye rivuga ko hafi 90% bagaragaje impinduka nziza nyuma y'ubuvuzi bw'amezi atandatu, ugereranyije na 45% mu bakoresheje fluconazole; mu itsinda ryakoresheje urumuri, uwo mubare wagabanutse ukagera hafi kuri 80% nyuma y'amezi cumi n'abiri ubuvuzi burangiye. Isesengura rishya ryakoresheje ibisabwa bikomeye kurushaho, risaba ko ibintu bitatu byuzurizwa icyarimwe: kutabona ibihumyo kuri mikorosikopi, kutabikuriza mu bizamini, no kongera kumera k'urwara rwose rusukuye. Iryo sesengura ryashyize imibare ya nyuma yo gukira burundu kuri 50% ugereranyije na 25%. Ayo matsinda abiri y'imibare asobanura ibipimo bitandukanye by'ibyavuye mu buvuzi, ntabwo ari ibisubizo bivuguruzanya; kandi itandukaniro hagati yayo ni ryo igice gikurikira cyibandaho. Byatangajwe ko ubuvuzi bwihanganiwe neza, hakaba haranditswe inshuro imwe yo kubabara no kumva hotsa.

Hari ibintu bibiri by'ingenzi ku wese ubaza uko ubururu bwa metilene bwakoreshwa ku bihumyo byo mu nzara z'amano. Icya mbere, umuti wagereranyijwe na bwo wari fluconazole, ifite ubushobozi buringaniye bwo kuvura indwara z'inzara, ntabwo wari terbinafine ifite ubushobozi bukomeye kurushaho. Icya kabiri, ubukana bw'irangi bwari 2%, buri hejuru cyane y'ibigurishwa byo kwisiga mu rugo, kandi ryasigwaga rigenzurwa n'abaganga, hamwe no gukuraho ibisigazwa no gukoresha itara ryapimwe neza.

Indwara ikomeye y'inzara z'amano: irangi n'urumuri byiyongera kuri terbinafine

Ubushakashatsi bwa kabiri ku nzara, ari bwo igerageza ryagabanyije abarwayi mu matsinda ku buryo bwa tombola ku ndwara ikomeye y'ibihumyo bya dermatophytes mu nzara z'amano, bwatangajwe mu 2020, busubiza ikibazo cyihariye kurushaho. Abarwayi makumyabiri bari bafite uburwayi bwafashe hejuru ya 60% by'urwara rw'ino rinini bose bahawe terbinafine 250 mg inyobwa buri munsi mu byumweru cumi na bibiri, hamwe na urea yo koroshya igice gikomeye cy'urwara. Kuri ubwo buvuzi bw'ibanze, icumi bongeweho ubuvuzi bwa fotodinami bukoresha ubururu bwa metilene, naho icumi bahabwa ubuvuzi bwa fotodinami bukoresha ikindi kinyabutabire gikangurwa n'urumuri.

Itsinda ryakoresheje ubururu bwa metilene ryakoresheje umuti wa 2% ushongeshejwe mu mazi, rikawureka ku rwara hafi iminota itatu, hanyuma rigakoresha LED ya 635 nm itanga joules 37 kuri santimetero kare mu minota icumi. Ubuvuzi bwatanzwe inshuro icyenda, hagati yazo hakaba ibyumweru bibiri, mu gihe cy'ibyumweru cumi na bitandatu; amavuta arimo urea ya 40% yasigwaga nimugoroba ubanziriza buri nshuro y'ubuvuzi, kandi ibisigazwa bigakurwaho hakoreshejwe ibikoresho.

Ku cyumweru cya 52, hafi amezi icyenda nyuma y'inshuro ya nyuma yo gukoresha urumuri, igipimo cy'ubukana bw'indwara mu itsinda ryakoresheje ubururu bwa metilene cyari cyaragabanutse kiva hafi kuri 24 kigera munsi ya 1, igice cy'urwara cyafashwe kiva hafi kuri 65% kigera munsi ya 2%, naho gukira burundu, bivuze urwara rusa n'urusanzwe hamwe no kutongera kubona ibihumyo mu bizamini, kwari kuri 70%. Kutongera kubona ibihumyo mu bizamini ubwabyo byageze kuri 100% mu itsinda ryakoresheje ubururu bwa metilene, ugereranyije na 90% mu ryakoresheje ikindi kinyabutabire gikangurwa n'urumuri. Nta ngaruka mbi aho irangi n'urumuri byakoreshejwe zatangajwe; abarwayi babiri bagize kutamererwa neza mu rwungano ngogozi, byitirirwa terbinafine na yo bafataga.

Isesengura ritabogamye ni uko iri gerageza ridashobora gutandukanya uruhare rw'irangi n'urw'ibindi. Buri murwayi yahawe igihe cyose giteganyijwe cy'umuti mwiza kurusha indi ukora mu mubiri wose, hamwe no gutegura urwara mu buryo bwimbitse; nta tsinda ryahawe umuti wonyine ryari rihari, kandi amatsinda yombi yakoresheje urumuri yagize ibisubizo bisa. Icyo ryerekana ni uko uburyo bw'ubururu bwa metilene n'urumuri bwongewe ku buvuzi busanzwe bwatumye ibihumyo bishira ku rugero rwo hejuru mu ndwara ikomeye, hakabaho ikurikirana rirerire, kandi ko inshuro zo gukoresha urumuri ubwazo zitongeyeho ingaruka z'uburozi aho rwakoreshwaga muri iri tsinda rito. Imikoranire y'imiti n'ibyago ku mubiri wose by'ubuvuzi bukomatanyije biganirwaho mu nyandiko iyobora ku mutekano n'imikoranire y'imiti.

Indwara yo ku ruhu ititabira imiti: umurwayi umwe, igihumyo kimwe kigoye kuvura

Ibimenyetso bireba uruhu ni bike cyane kurushaho. Ubushakashatsi bwo mu 2026 ku buvuzi bw'ubururu bwa metilene n'urumuri ku gihumyo cya Trichophyton indotineae kititabira imiti bureba umurwayi umwe w'imyaka 25 wari ufite ahantu henshi ku ruhu hafashwe n'indwara yari imaze amezi umunani, nubwo yari yarafashe terbinafine 250 mg buri munsi, ikora mu mubiri wose, mu byumweru bitandatu. Ibizamini bya laboratwari byagaragaje ko ubukana buke bushoboka bwa terbinafine bubuza igihumyo gukura bwari mikorogarama 8.0 kuri mililitiro, ugereranyije na 1.0 ku bururu bwa metilene. Ibyo bihuje n'indwara y'ibihumyo byo ku ruhu ititabira imiti ubu iri gukwirakwira mu turere twinshi.

Ahantu ku ruhu hafashwe havuwe hakoreshejwe ubururu bwa metilene bwa 1% busigwa ku ruhu n'urumuri rutukura rufite uburebure bw'umuraba bwa hafi 630 nm, rutanga joules 100 kuri santimetero kare, rimwe mu cyumweru mu byumweru bine. Nyuma y'ibyumweru bibiri, ahavuwe ntihari hakigaragaza kuvuvuka k'uruhu, kandi ibizamini bya mikorosikopi ntibyabonaga ibihumyo; ku cyumweru cya kane, havuzwe ko hakize rwose hasigaye gusa ihinduka rito ry'ibara ry'uruhu, mu gihe ahasigwaga amavuta ya terbinafine hari hakigaragaza udushami tw'ibihumyo. Nta ngaruka zikomeye kandi nta kubabara byatangajwe.

Icyo ni igisubizo nyakuri cyemejwe n'ibizamini by'ibihumyo mu ndwara ititabira imiti, ariko nanone ni umurwayi umwe wakurikiranwe ibyumweru bine. Nta gihamya yanditswe y'uko nyuma y'ubuvuzi ibihumyo bitongeye gukura mu bizamini, uretse kutabibona kuri mikorosikopi; nta kurikirana ryo kureba niba indwara yongeye kugaruka nyuma y'amezi atatu, atandatu cyangwa cumi n'abiri; kandi nta tsinda ry'abantu rihari ryashingirwaho mu kubara igipimo cy'abagize impinduka nziza. Ibyo bishyigikira gukomeza ubushakashatsi, ntabwo ari inama yo gukoresha ubwo buvuzi. Ubwoko butitabira imiti n'ibizamini byo kureba uko ibihumyo byitabira imiti bisuzumwa birambuye mu nyandiko iyobora ku kutitabira imiti irwanya ibihumyo.

Ubushakashatsi butatu bugereranyijwe

Gukira kugaragarira amaso si ugukira kwemejwe n'ibizamini by'ibihumyo

Gusoma izi nyandiko bisaba gutandukanya ikintu kimwe. Gukira kugaragarira amaso bivuze ko urwara cyangwa uruhu rusa n'urusanzwe. Gukira kwemejwe n'ibizamini by'ibihumyo bivuze ko kuri mikorosikopi no mu bizamini byo kubikuza nta bihumyo biboneka. Gukira burundu bivuze byombi icyarimwe. Inzara zongera kumera buhoro, bityo urwara rushobora kugaragara ko rumeze neza kurushaho amezi menshi mbere y'uko ibihumyo bishira, kandi ibisigazwa by'ibihumyo byapfuye bishobora gutuma ikizamini gikomeza kubigaragaza nyuma y'uko indwara irangiye. Igerageza rya Souza ryerekana izo ngaruka mu buryo butaziguye: ibisabwa bitaremereye byo kwemeza impinduka nziza bitanga 80 kugeza kuri 90%, mu gihe gusaba urwara rusukuye hamwe n'ibizamini bitagaragaza ibihumyo bitanga 50%. Nta mubare muri iyo itari yo. Ipima ibintu bitandukanye, kandi ibivugwa byose ku bushobozi bwo kuvura bikwiye kuvuga uwo mubare byifashisha.

Icyo ibi bisobanuye mu gufata ibyemezo by'ubuvuzi

Umwanzuro ukomeye ushingiye ku isesengura ryitondewe usigarana ibintu bitatu. Icya mbere, ubururu bwa metilene bufatanyijwe n'urumuri rutukura rwapimwe neza bwatumye ibihumyo byo mu nzara z'amano bishira koko mu magerageza abiri yakoresheje amatsinda yatoranyijwe ku buryo bwa tombola: rimwe bugereranywa na fluconazole yonyine, ubundi bwongerwa kuri terbinafine hamwe no gutegura urwara hakoreshejwe urea. Icya kabiri, raporo imwe ku ndwara yo ku ruhu ititabira imiti itanga icyizere, ariko yonyine nta kintu kinini yemeza; nta bimenyetso biraboneka mu magerageza yakoresheje amatsinda yatoranyijwe ku buryo bwa tombola ku ndwara z'ibihumyo bya dermatophytes ku ruhu zavuwe hakoreshejwe irangi n'urumuri. Icya gatatu, ibisubizo byiza byose byavuye ku buryo bukomatanyije bwagenzurwaga: irangi ryujuje ubuziranenge bwo gukoreshwa mu miti rya 1 kugeza kuri 2%, igihe cyagenwe cyo kurireka ku hantu havurwa, ingano y'urumuri yapimwe, kandi akenshi hamwe no gukuraho ibisigazwa cyangwa umuti ukora mu mubiri wose.

Nta na kimwe muri ibi cyakoreshwa nk'igihamya cyo kwisiga mu rugo irangi rigurishwa mu maduka. Kwisiga mu rugo ntibigira ingano y'urumuri yapimwe, ntibigenzura igihe irangi rimara ku hantu havurwa, ntibikuraho ibisigazwa, ntibikoresha ibizamini by'ibihumyo kandi ntibigira ikurikirana; ibyo bikuraho buri kintu amagerageza yari ashingiyeho. Umuntu wese utekereza gukoresha ubuvuzi bushingiye ku rumuri akwiye kujyana ubu buryo bwakoreshejwe mu bushakashatsi ku muganga w'indwara z'uruhu, akabaza niba ubuvuzi bwa fotodinami bugenzurwa buboneka, aho kwigana ibara gusa akareka uburyo bwo kuvura.