Chinyorwa
Methylene blue pazvirwere zvefungus zvenzara neganda: zvinoratidzwa nemiedzo yephotodynamic
Zvinobuda pakutsvaga methylene blue yekurapa fungus yenzara zvinowanzovhenganisa zvinhu zviviri zvakasiyana zvikuru. Chimwe ibhodhoro redhayi rebhuruu rinozorwa kumba. Chimwe chirongwa chinoitwa kukiriniki, umo dhayi inozorwa, yosiyiwa kwenguva pfupi, yobva yamutswa nechiedza chitsvuku chine chiyero chakayerwa. Hunenge humbowo hwose hwemumakiriniki hunobva pane chechipiri. Nyaya ino inoenzanisa zvakananga zvidzidzo zvitatu zvephotodynamic, kuti uone zvakanyatsoedzwa uye zvakatsigirwa nechimwe nechimwe.
Mashandiro akafanana muzvidzidzo izvi ari nyore kunzwisisa. Methylene blue inotora chiedza chitsvuku zvakanyanya, uye morekuru rinenge rawana simba iroro rinoripa kuoxygen, richigadzira singlet oxygen nezvimwe zvinhu zvinokurumidza kupinda mumaitiro emakemikari zvinokuvadza masero efungus. Pasina chiedza, kushanda kwayo kunenge kusina simba zvikuru. Ndokusaka chidzidzo chimwe nechimwe chiri pasi apa chichibatanidza dhayi nerambi, wavelength, uye chiyero chechiedza zvakatarwa, uye nei zvakabuda muzvirongwa zvine chiedza zvisingatauri chinhu nezvekungozora dhayi par nzara muchiedza chemasikati. Mashandiro acho anotsanangurwa zvakadzama muchinyorwa chinotsanangura kurapa kwephotodynamic, uye mamiriro akakura etsvakurudzo yekurwisa fungus ari muongororo yemethylene blue sechinhu chinorwisa tupukanana.
Onychomycosis yenzara dzetsoka: dhayi nechiedza zvichienzaniswa nefluconazole yevhiki nevhiki
Muedzo mukuru pane yose waienzanisa mapoka akapatsanurwa zvisina kusarudzwa muvarwere 80 vaiva neonychomycosis yenzara dzetsoka, uye wakabudiswa muna 2014. Hafu yakarapwa nephotodynamic, uye imwe hafu yakapiwa fluconazole 300 mg yekunwa kamwe pavhiki, boka rimwe nerimwe kwemavhiki 24.
Maitirwo echiedza akanga akatarwa zvakajeka. Mushonga wemethylene blue wakanyungudutswa mumvura une 2% wakazorwa panzara, wobva wavhenekerwa mushure menguva pfupi yokusiya mushonga uchishanda, pachishandiswa LED tsvuku ine chiedza chisina kufambirana pamasaisai pa630 nm, ichipa 18 joules per square centimetre. Zvirongwa izvi zvaidzokororwa mazuva 15 oga oga, kagumi nekaviri mumwedzi mitanhatu. Nzara dzaiva nezvinhu zvakakora zvakaungana pasi padzo, mitsetse yaitevedza kureba kwenzara, kana dermatophytoma dzaitanga dzakweshwa nemidziyo, mumapoka ose ari maviri, nokuti chiedza nemushonga zvose hazvigoni kushanda zvakanaka kana zvakavharirwa nemadziro ekeratin.
Mhedzisiro huru yakaratidza kuti boka rechiedza rakaita zviri nani, uye musiyano wacho waikosha maererano nenhamba dzetsvakurudzo. Ongororo dzakazotevera dzakatora mashoko kubva muchinyorwa chakazara dzinoti vakaratidza kuvandudzika vaiva vangangosvika 90% mushure mekurapwa kwemwedzi mitanhatu, zvichienzaniswa ne45% yefluconazole; muboka rechiedza izvi zvakadzikira kusvika pa80% mwedzi gumi nemiviri mushure mekunge kurapwa kwapera. Kuongororazve kwakashandisa zviyero zvakaomarara, kuchida zvinhu zvitatu zvose panguva imwe chete — kusawanikwa kwefungus pamakorosikopu, kusakura kwefungus mubvunzo yekuirimisa, uye kukura patsva kwakazara kwenzara yakachena — kwakaisa zviverengero zvekupora kwakazara kwekupedzisira pa50% zvichienzaniswa ne25%. Mapoka maviri enhamba aya anotsanangura zviyero zvakasiyana zvemhedzisiro, kwete zvakawanikwa zvinopikisana, uye musiyano wacho ndiwo musoro wechikamu chinotevera. Zvakanzi varwere vakatsungirira kurapwa zvakanaka, paine chiitiko chimwe chete chakanyorwa chemarwadzo nokunzwa kupisa.
Pane zvinhu zviviri zvinokosha kune anobvunza mashandisirwo emethylene blue pafungus yenzara dzetsoka. Chekutanga, mushonga wakaenzaniswa nawo waiva fluconazole, mushonga unoshanda zvine mwero pazvirwere zvenzara, kwete terbinafine ine simba guru. Chechipiri, kuwanda kwedhayi mumushonga kwaiva 2%, kwakakwirira zvikuru kupfuura kwezvinhu zvinotengeswa kuti zvishandiswe pakuzvishongedza kumba, uye waizorwa uchitarisirwa nenyanzvi, pamwe nekubvisa zvinhu zvakafa kana zvakaungana uye kushandisa rambi rakagadziriswa kuti ripe chiedza chakayerwa.
Chirwere chakanyanya chenzara dzetsoka: dhayi nechiedza zvichiwedzerwa paterbinafine
Chidzidzo chechipiri chenzara, muedzo wemapoka akapatsanurwa zvisina kusarudzwa pachirwere chakanyanya chenzara dzetsoka chinokonzerwa nedermatophytes, chakabudiswa muna 2020, chinopindura mubvunzo wakamanikana. Varwere makumi maviri vane chirwere chaibata zvinopfuura 60% yenzara huru yetsoka vose vakapiwa terbinafine 250 mg yekunwa zuva nezuva kwemavhiki gumi nemaviri, pamwe nekupfavisa nzara neurea. Pamusoro pechirongwa ichocho, gumi vakarapwa nephotodynamic vachishandisa methylene blue, uye gumi vakarapwa nephotodynamic vachishandisa chimwe chinhu chinomutswa nechiedza.
Boka remethylene blue rakashandisa mushonga wakanyungudutswa mumvura une 2%, wakasiyiwa uchishanda kwemaminitsi angangoita matatu, ndokuzoshandisa LED ye635 nm yaipa 37 joules per square centimetre mumaminitsi gumi. Zvirongwa zvipfumbamwe zvakaitwa mavhiki maviri oga oga mukati memavhiki gumi nematanhatu, pachishandiswa mafuta eurea ane 40% manheru aitangira chirongwa chimwe nechimwe uye kubvisa zvinhu zvakaungana nemidziyo.
Pakasvika vhiki 52, ingangoita mwedzi mipfumbamwe mushure mechirongwa chekupedzisira chechiedza, chiyero chekuoma kwechirwere muboka remethylene blue chakanga chadzika kubva pa24 kusvika pasi pe1, chikamu chenzara chakabatwa kubva pa65% kusvika pasi pe2%, uye kupora kwakazara, kureva nzara inooneka yakajairika pamwe nekusawanikwa kwefungus pabvunzo, kwaiva 70%. Kusawanikwa kwefungus pachako kwakasvika 100% muboka remethylene blue zvichienzaniswa ne90% neboka rakashandisa chimwe chinhu chinomutswa nechiedza. Hapana migumisiro isingadiwi panzvimbo yakarapwa yakakonzerwa nedhayi nechiedza yakashumwa; varwere vaviri vaiva nekusagadzikana kwemudumbu nemuura kwakanzi kwakakonzerwa neterbinafine yavaitorawo.
Kuverenga kwakavimbika kunoratidza kuti muedzo uyu haugoni kupatsanura kuti dhayi pachayo yakabatsira zvakadii. Murwere mumwe nomumwe akapiwa chirongwa chakazara chemushonga unoshanda mumuviri wose wakanakisisa, pamwe nekugadzirira nzara zvakanyanya; pakanga pasina boka raingopiwa mushonga chete, uye mapoka maviri echiedza akaita zvakafanana. Zvaunoratidza ndezvokuti chirongwa chemethylene blue nechiedza chakawedzerwa pakurapwa kwakajairika chakaita kuti fungus isawanikwe kuvarwere vakawanda vane chirwere chakanyanya, varwere vachiteverwa kwenguva refu, uye kuti zvirongwa zvechiedza pachazvo hazvina kuwedzera kukuvadza panzvimbo yakarapwa muboka iri diki. Kudyidzana kwemishonga uye njodzi kumuviri wose dzezvirongwa zvinobatanidza mishonga zvinokurukurwa mugwaro rekuchengeteka nekudyidzana kwemishonga.
Chirwere cheganda chisingakundwi nemishonga: murwere mumwe, fungus imwe yakaoma kubvisa
Humbowo hweganda hushoma zvikuru. Chidzidzo cha2026 chekurapa nemethylene blue nechiedza pachirwere chinokonzerwa neTrichophyton indotineae isingakundwi nemishonga chinotaura nezvemurwere mumwe chete ane makore 25, aiva nenzvimbo dzakawanda dzeganda dzakabatwa nechirwere chakanga chagara kwemwedzi misere pasinei nekushandisa terbinafine inoshanda mumuviri wose pa250 mg zuva nezuva kwemavhiki matanhatu. Bvunzo dzemurabhoritari dzakaratidza kuti huwandu hushoma hweterbinafine hwaikwanisa kumisa kukura kwefungus hwaiva 8.0 micrograms per millilitre, zvichienzaniswa ne1.0 yemethylene blue, zvinoenderana nedermatophytosis isingakundwi nemishonga iri kupararira munzvimbo dzakawanda zvino.
Nzvimbo dzakabatwa dzakarapwa nemethylene blue yekuzora ine 1% uye nechiedza chitsvuku cheinenge 630 nm chaipa 100 joules per square centimetre, kamwe pavhiki kwemavhiki mana. Mushure memavhiki maviri, nzvimbo dzakarapwa dzakaratidza kupera kwekusvuuka kweganda uye kusawanikwa kwefungus pamakorosikopu; pakasvika vhiki rechina dzakatsanangurwa sedzakanga dzapora zvizere, kwangosara kushanduka kuduku kweruvara rweganda, asi nzvimbo dzakarapwa nekirimu yeterbinafine dzainge dzichine tambo dzefungus dzaioneka. Hapana zvakakomba zvakaitika uye hapana marwadzo zvakashumwa.
Izvi zvinoratidza shanduko chaiyo pabvunzo dzefungus pachirwere chisingakundwi nemishonga, asi zvakare zvinobva pamurwere mumwe chete akaongororwa kwemavhiki mana. Hapana humbowo hwakanyorwa hwekuti bvunzo yekurimisa fungus yakashanduka kubva pakuiwana kusvika pakusaiwana mushure mekurapwa, kunze kwekuiongorora nemakorosikopu; hapana kutevera kudzoka kwechirwere pamwedzi mitatu, mitanhatu, kana gumi nemiviri, uye hapana boka revanhu rinogona kushandiswa kuverenga chikamu chevanhu vanovandudzika. Izvi zvinotsigira kumwe kuongorora, kwete kurudziro yekurapa. Mhando dzisingakundwi nemishonga uye bvunzo dzekuti fungus inonzwa sei kumishonga dzinoongororwa zvakadzama mugwaro rekusakundwa nemishonga inorwisa fungus.
Zvidzidzo zvitatu zvichienzaniswa
| Souza 2014, nzara dzetsoka | Alberdi naGomez 2020, chirwere chakanyanya chenzara dzetsoka | Xu 2026, nzvimbo dzeganda dzine chirwere chisingakundwi nemishonga | |
|---|---|---|---|
| Magadzirirwo nehukuru | Mapoka akapatsanurwa zvisina kusarudzwa, 40 muboka rimwe nerimwe | Mapoka akapatsanurwa zvisina kusarudzwa, 10 muboka rimwe nerimwe vakaongororwa | Murwere mumwe, nzvimbo dzakabatwa dzichishandiswa pakuenzanisa kurapwa |
| Chikonzero chechirwere | Musanganiswa wedermatophytes, yeasts, nemoulds | T. rubrum kana T. mentagrophytes | T. indotineae, isingavandudziki neterbinafine |
| Dhayi nenguva yokuisiyira ichishanda | 2% yakanyungudutswa mumvura, maminitsi | 2% yakanyungudutswa mumvura, anenge maminitsi 3 | 1% yekuzora, chifukidziro chisingapindi chiedza maererano nemaitirwo ari mugwaro rakabudiswa risati raongororwa nedzimwe nyanzvi |
| Chiedza | 630 nm LED, 18 J per cm2 | 635 nm LED, 37 J per cm2 | Inenge 630 nm, 100 J per cm2 |
| Zvirongwa | 12, mazuva 15 oga oga mumwedzi 6 | 9, mavhiki 2 oga oga mukati memavhiki 16 | 4, vhiki nevhiki |
| Kumwe kurapwa kwakaitwa pamwe chete | Kukwesha nzara pazvaidiwa; kapisi risina mushonga unoshanda | Terbinafine 250 mg zuva nezuva kwemavhiki 12, 40% urea, kubvisa zvinhu zvakafa kana zvakaungana | Hapana panzvimbo dzakarapwa; kirimu yeterbinafine panzvimbo dzekuenzanisa |
| Mhedzisiro pakuonekwa kwechirwere | Vanenge 90% vakavandudzika pakupera kwekurapwa, vanenge 80% pamwedzi 12 | Chiyero chekuoma kwechirwere kubva pa24 kusvika pasi pe1; 70% vakapora zvizere pavhiki 52 | Kusvuuka kwakapera pakasvika vhiki 2, nzvimbo dzakapora pakasvika vhiki 4 |
| Mhedzisiro pabvunzo dzefungus | Kupora kwakazara maererano nezviyero zvakaomarara 50% zvichienzaniswa ne25% pakutevera kwekupedzisira | 100% vaisawanikwa fungus pabvunzo dzePAS nedzekuirimisa pavhiki 52 | Fungus haina kuwanikwa pamakorosikopu pamavhiki 2; hapana bvunzo yekurimisa fungus mushure mekurapwa yakashumwa |
| Kutevera varwere | Mwedzi 12 mushure mekurapwa | Inenge mwedzi 9 mushure mechirongwa chekupedzisira chechiedza | Mavhiki 4, hapana mashoko ekudzoka kwechirwere |
| Migumisiro isingadiwi | Chiitiko chimwe chemarwadzo nokunzwa kupisa | Hapana migumisiro panzvimbo yakarapwa; kusagadzikana kwemudumbu neterbinafine mu2 pa10 | Hapana zvakakomba zvakaitika, hapana marwadzo |
Kupora pakuonekwa hakusi kupora pabvunzo dzefungus
Kuverenga mapepa aya kunoda kunzwisisa musiyano mumwe. Kupora pakuonekwa kunoreva kuti nzara kana ganda zvinooneka zvakajairika. Kupora pabvunzo dzefungus kunoreva kuti makorosikopu nebvunzo yekurimisa fungus hazviwani fungus. Kupora kwakazara kunoreva zvose izvi panguva imwe chete. Nzara dzinokura patsva zvishoma nezvishoma, saka nzara inogona kutaridzika zviri nani mwedzi yakawanda fungus isati yapera, uye zvinhu zvefungus yakafa zvinogona kuita kuti bvunzo irambe ichiratidza fungus kunyange chirwere chapera. Muedzo waSouza unoratidza izvi zvakananga: zviyero zvisina kuomarara zvekuvandudzika zvinopa 80 kusvika 90%, asi kuda nzara yakachena pamwe nebvunzo dzisina fungus kunopa 50%. Hapana nhamba isina kururama. Dzinoyera zvinhu zvakasiyana, uye chero chirevo chekushanda kwekurapwa chinofanira kutaura kuti chiri kushandisa ipi.
Zvinorehwa neizvi pakusarudza kurapwa
Pane mhedziso nhatu dzinoramba dzakatsigirwa kana zvinyorwa zvichiverengwa zvakasimba. Chekutanga, methylene blue pamwe nechiedza chitsvuku chakagadziriswa kuti chipe chiyero chakatarwa zvakaita kuti fungus yenzara dzetsoka isawanikwe mumiedzo miviri yemapoka akapatsanurwa zvisina kusarudzwa, kamwe zvichienzaniswa nefluconazole chete uye kamwe zvichiwedzerwa paterbinafine pamwe nekugadzirira nzara neurea. Chechipiri, mushumo mumwe chete wechirwere cheganda chisingakundwi nemishonga unokurudzira asi wega hauratidzi zvizhinji; hapasati paine humbowo hwemiedzo yemapoka akapatsanurwa zvisina kusarudzwa hwedermatophytosis yeganda yakarapwa nedhayi nechiedza. Chechitatu, mhedzisiro yose yakanaka yakabva mumubatanidzwa waitarisirwa nenyanzvi: dhayi yemhando inosangana nezviyero zvemishonga ine 1 kusvika 2%, nguva yakatarwa yokusiya dhayi ichishanda, chiyero chechiedza chakayerwa, uye kazhinji kubvisa zvinhu zvakafa kana zvakaungana kana kushandisa mushonga unoshanda mumuviri wose pamwe chete nazvo.
Hapana pane izvi chinoshanda pakungozora dhayi inotengwa muzvitoro kumba. Kuzora kumba hakuna chiyero chechiedza chakayerwa, kudzora nguva yokusiya dhayi ichishanda, kubvisa zvinhu zvakafa kana zvakaungana, bvunzo dzefungus, kana kutevera murwere, zvichibvisa chinhu chimwe nechimwe chaivimbwa nacho nemiedzo iyi. Munhu anofunga nezvekurapwa kunoshandisa chiedza anofanira kuenda nemaitirwo aya kuna chiremba weganda obvunza kana kurapwa kwephotodynamic kunotarisirwa nenyanzvi kuchiwanikwa, pane kungotevedzera ruvara achisiya maitirwo acho.