Inqaku
Iimpawu ‘zokufa kweentsholongwane’ emva kwe-methylene blue: kutheni ingcaciso ibalulekile
Ukuziva ugula ngakumbi emva kokuthatha i-methylene blue akubonisi ukuba iintsholongwane ezibangela izifo ziyafa okanye ukuba iityhefu ziyaphuma emzimbeni wakho. Intloko ebuhlungu, isicaphucaphu, ukudinwa, okanye ukungcangcazela yinto oyiphawulayo. Ukuyibiza ngokuthi “kukufa kweentsholongwane” kongeza unobangela ongenakuqinisekiswa yiloo mpawu ngokwayo.
Ukuba uneempawu ezintsha, kuphephe ukuthatha enye idosi ngokuzigqibela ngoxa ufuna ingcebiso yezonyango. Iimpawu ezinzima okanye eziba mandundu ngokukhawuleza zifuna unyango olungxamisekileyo. Ukuba i-methylene blue ibinikwe kwindawo yonyango, yazisa iqela elikunyangelayo ngoko nangoko. Musa ukuzama ukunyamezela impendulo engathandekiyo ukuze wenze inkqubo yokuphila kakuhle “isebenze.”
Oko kucingelwa ngamabango “okufa kweentsholongwane”
Le ngcaciso idla ngokuquka amabango amathathu ahlukeneyo: kukho usulelo, i-methylene blue ilunyanga ngempumelelo, yaye unyango lubangela impendulo yokudumba. Ukuziva ugula emva kokuyisebenzisa akuqinisekisi naliphi na kula manyathelo.
Lo mahluko uluncedo ekwenzeni izigqibo. “Isicaphucaphu siqale kwiiyure ezimbini emva kokuba ndithathe le mveliso” kunika ingcali yezonyango ulwazi enokuluvavanya. “Ndisusa iityhefu emzimbeni” kubeka isigqibo endaweni yolo lwazi. Kunokwenza umntu angalihoyi elinye iyeza, impazamo kugxininiso lwemveliso, okanye isigulo esiqale ngexesha elinye nje ngamabona-ndenzile.
Andifumananga bungqina obuvela kuphando lwezonyango olulawulwayo obuqinisekisa “isindromu yokufa kweentsholongwane” enokuqikelelwa ngenxa ye-methylene blue kubantu abayithathela ukuphila kakuhle. Oku akulilo ibango lokuba yonke impendulo engachazwanga sele iphandiwe. Kuthetha ukuba akukho luhlu lweempawu okanye ixesha elilindelekileyo lokuqhubeka kwazo elixhaswa bubungqina elinokusetyenziswa ukuthomalalisa inkxalabo kuloo meko. Umbuzo owahlukileyo wokuba ingaba i-methylene blue isusa iintsimbi ezinzima okanye isebenza ekususeni iityhefu ufuna ubungqina bokususwa kwazo, hayi indlela umntu aziva ngayo emva koko.
Oko kuchazwa ngokwenene yimpendulo ye-Jarisch–Herxheimer
Eli gama lisetyenziswa kwimeko ethile yezonyango. Izikhokelo ze-CDC zonyango lwegcushuwa zichaza impendulo ye-Jarisch–Herxheimer njengempendulo ebukhali enxulumene nomkhuhlane enokuvela kwiiyure zokuqala ezingama-24 emva kokuqalisa unyango lwegcushuwa, edla ngokuhamba nentloko ebuhlungu neentlungu zezihlunu. Yahlulwe kwi-aleji ye-penicillin. Oku akuthethi ukuba nawuphi na umkhuhlane emva kwayo nayiphi na into elwa neentsholongwane uyimpendulo efanayo.
Iinkcukacha eziluncedo zakutshanje zivela kuhlalutyo lwesibini lowama-2025 lolingo lwegcushuwa olwabiwa ngokungakhethiyo. Abaphandi bavavanya abantu abadala abangama-249 abanegcushuwa ekwinqanaba lokuqala emva konyango lwabo lokuqala lwe-benzathine penicillin G olutofwa kwisihlunu. Amashumi amahlanu anesithoba, okanye i-23.7%, axela iimpawu ezihambelana nale mpendulo. Ixesha eliphakathi lokuqala kweempawu laliyi-4.9 yeeyure, yaye ixesha eliphakathi lokuqhubeka kwazo laliyi-12.8 yeeyure. Iimpawu zaqokelelwa kusetyenziswa uluhlu olusemgangathweni, kunokuba ziqinisekiswe luvavanyo olunye lwaselabhoratri lokuxilonga.
La manani achaza usulelo oluthile, unyango oluthile, neqela labantu elithile elaliphononongwa. Akalilo ixesha lokulinda kumntu oziva egula emva kokuthatha i-methylene blue ngomlomo. Nakumxholo ofanelekileyo wonyango losulelo, ingcali yezonyango kufuneka iqwalasele ezinye iingcaciso ezinokwenzeka. Igama lodwa aliqinisekisi ukuba kukhuselekile ukuhlala ekhaya.
Itheyibhile yokwahlula: okuphawulwayo, ingcaciso, inyathelo elilandelayo
Le theyibhile yahlula oko kunokuxelwa koko kusafuna ukuvavanywa. Sisixhobo sokunceda incoko, hayi inkqubo yokunika amanqaku ukuze kuxilongwe.
| Oko ukuphawulayo | Oko kungakuqinisekisiyo | Oko kufanele kuvavanywe |
|---|---|---|
| Intloko ebuhlungu, isicaphucaphu, okanye urhudo emva kokuyisebenzisa | Ukuba iintsholongwane zibulewe okanye iityhefu zikhutshiwe | Imveliso, isixa, ixesha, iimpawu ezihamba nazo, nabanye oonobangela abanokwenzeka |
| Ukubila, ukuphazamiseka nokungazinzi, umkhuhlane, okanye ukungcangcazela, ingakumbi xa zidityanisiwe | Inqanaba elinqwenelekayo lokuziqhelanisa komzimba | Ityhefu enokubangelwa yi-serotonin okanye esinye isigulo esibukhali; funa uvavanyo olungxamisekileyo |
| Ubuthathaka obutsha, ukuphelelwa ngumoya, amehlo amthubi, okanye umchamo omnyama | Ukuba umzimba ususa iityhefu | I-anemia okanye esinye isifo esinokwenzeka; funa uvavanyo lwezonyango ngokukhawuleza, ngokungxamisekileyo ukuba iimpawu zinzima |
| Irhashalala ehamba nokudumba kobuso okanye komqala, ukuphefumla okunomlozi, okanye ukuwa | “I-Herx” engenabungozi | Impendulo ye-aleji enzima enokwenzeka; tsalela iinkonzo zongxamiseko |
| Umkhuhlane neentlungu emva konyango olukhokelwa yingcali yezonyango lwegcushuwa exilongiweyo | Ubungqina bokuba zonke iimpawu ezilandela kamva zinonobangela omnye | Iqela elikunyangelayo linokuvavanya impendulo ye-Jarisch–Herxheimer enokwenzeka kunye ne-aleji nabanye oonobangela |
Umqolo wokuqala uquka iimpawu ezidweliswe phakathi kweempendulo ezingathandekiyo kulwazi lokumisela i-PROVAYBLUE. Elo phepha lolwazi lithetha ngonyango olumiselwe ngugqirha, olunikwa emthanjeni, lwe-methemoglobinemia efunyenweyo. Amanqanaba okwenzeka kwezo ziphumo akufanele asetyenziswe kwiimveliso ezithathwa ngabathengi ngomlomo, kodwa iingozi ezibhaliweyo zalo nyango nazo akufanele zibizwe ngokuba “kukususwa kweetyhefu.” Likwalumkisa ngesindromu ye-serotonin enzima, iimpendulo ze-aleji ezinzima, ne-anemia yokonakala kweeseli ezibomvu zegazi, kuquka umngcipheko okhethekileyo kubantu abanokusilela kwe-G6PD. I-anemia inokulibaziseka ivele emva kosuku okanye ngaphezulu emva konyango.
Kutheni indibaniselwano yeempawu ibalulekile
Ukuphazamiseka kwesisu okukodwa akuxilongi isindromu ye-serotonin. Indibaniselwano yokutshintsha kwemeko yengqondo, ukunyuka kobushushu bomzimba, ukubila, nokusebenza kwezihlunu ngendlela engaqhelekanga ixhalabisa ngakumbi. I-MedlinePlus ichaza isindromu ye-serotonin njengenokubeka ubomi esichengeni yaye icacisa ukuba uvavanyo luquka imbali yamayeza nokukhupha abanye oonobangela abanokwenzeka. Musa ukulinda ukuba zonke iimpawu ezinokwenzeka zivele ngaphambi kokufuna uncedo.
Umngcipheko wokudibanisa izinto wenza ukuba ukusebenzisana kwe-methylene blue namanye amayeza kubaluleke nokuba umntu uyibiza into ayithathileyo ngokuba sisongezelelo. Yiza noluhlu olupheleleyo lwamayeza, kuquka amayeza okudakumba, amayeza eentlungu, iimveliso zokukhohlela, nezinye izongezelelo. Musa ukuziyeka ngokwakho iziyobisi ezimiselweyo okanye uzenzele ishedyuli yokulinda ukuba amayeza aphume emzimbeni ukuze uqhubeke ne-methylene blue.
I-hemolysis ithetha ukonakala kweeseli ezibomvu zegazi. I-NHLBI icacisa ukuba i-anemia yokonakala kweeseli ezibomvu zegazi ivela xa ukutshatyalaliswa kwazo kungaphezulu kokwenziwa kwezinye, yaye ukuxilongwa kufuna uvavanyo lwezonyango novavanyo lwegazi. Iimpawu ze-anemia zinokuquka ukuphelelwa ngumoya, ubuthathaka, ukuba tyheli kwesikhumba namehlo, nomchamo omnyama. Ezi ayizomilinganiselo yokususwa kweetyhefu. I-methylene blue ngokwayo inokutshintsha umbala womchamo, ngoko nombala wodwa awunakuqinisekisa unobangela.
Tsalela iinkonzo zongxamiseko xa kukho ubunzima bokuphefumla, ukuwa, ukuxhuzula, ukubhideka kakhulu, okanye impendulo eba mandundu ngokukhawuleza. Musa ukuziqhubela ukuba unesiyezi, ubhidekile, okanye awukwazi ukuqhuba kakuhle ngenxa yenye imeko.
Bhala ukusetyenziswa kwemveliso ngaphandle kokubeka uxilongo
Kwiimpawu ezingeyomeko yongxamiseko, qhagamshelana nengcali yezonyango okanye usokhemesti ngokukhawuleza uze usebenzise irekhodi yeempawu nokusetyenziswa kwemveliso ukubhala ezi nkcukacha zine:
- Igama lemveliso, indlela eyenziwe ngayo, ugxininiso lwayo, nefoto yeleyibhile.
- Isixa esisetyenzisiweyo nendlela esingene ngayo emzimbeni, amaxesha okusetyenziswa, nalo naluphi na utshintsho lwakutshanje.
- Iimpawu ngolwimi oluqhelekileyo, ixesha eziqale ngalo, ubunzima bazo, nokuba ziyaphucuka okanye ziba mandundu.
- Amanye amayeza nezongezelelo, iimeko zempilo ezifanelekileyo, nasiphi na isiphumo sovavanyo lwe-G6PD esaziwayo.
Musa ukuthatha enye idosi ukuze uvavanye ukuba iimpawu ziyabuya na. Musa ukongeza into “ebopha iityhefu,” iseshoni yesauna, isicwangciso sokuzila ukutya, okanye indibaniselwano yezongezelelo ukuze ulawule impendulo ocinga ukuba yeyokususwa kweetyhefu. Amanyathelo ongezelelweyo enza kube nzima ukutolika imbali yokusetyenziswa kwezinto yaye akaqinisekisi unobangela wokuqala. Isikhokelo esibanzi sokhuseleko lwe-methylene blue sicacisa iziphumo ezingathandekiyo ezaziwayo nendlela yokuxela impendulo ekrokrelwayo.