Inqaku
I-methylene blue kusulelo lomngundo lwezinzipho nolusu: oko kuboniswa zizilingo ze-photodynamic
Iziphumo zokukhangela i-methylene blue kumngundo wezinzipho zidla ngokudibanisa izinto ezimbini ezahluke kakhulu. Enye yibhotile yedayi eluhlaza okwesibhakabhaka efakwa ekhaya. Enye yinkqubo yaseklinikhi apho idayi iqatywa, ishiywe ixesha elifutshane, ize ivuselelwe ngomthamo olinganisiweyo wokukhanya okubomvu. Phantse bonke ubungqina beklinikhi bubhekiselele kule yesibini. Eli nqaku lithelekisa ngokuthe ngqo izifundo ezintathu ze-photodynamic, ukuze ubone oko kwavavanywa ngokwenene noko isifundo ngasinye sakungqinayo.
Indlela yokusebenza efanayo kuzo ilula. I-methylene blue ifunxa ngamandla ukukhanya okubomvu, ize imolekyuli evuselelweyo idlulisele loo mandla kwioksijini, ivelise ioksijini ekwimeko ye-singlet nezinye iindidi zeekhemikhali ezisebenza kakhulu ezonakalisa iiseli zomngundo. Ngaphandle kokukhanya, isiphumo siba buthathaka kakhulu. Yiloo nto isifundo ngasinye esingezantsi sidibanisa idayi nesibane esichaziweyo, ubude bamaza, nomthamo, nesizathu sokuba iziphumo zeenkqubo ezisebenzisa ukukhanya zingasixeleli nto ngokuthambisa idayi eluzipho ekukhanyeni kwemini. Le ndlela yokusebenza ngokubanzi ichazwe ngokweenkcukacha ngakumbi kwinqaku elicacisa unyango lwe-photodynamic, yaye umxholo obanzi wophando oluchasene nomngundo ufumaneka kwisishwankathelo se-methylene blue njengento echasene neentsholongwane.
I-onychomycosis yeenzipho zeenyawo: idayi nokukhanya xa kuthelekiswa ne-fluconazole yeveki nganye
Esona silingo sikhulu luthelekiso olwabiwa ngokungakhethiyo kwizigulana ezingama-80 ezine-onychomycosis yeenzipho zeenyawo, olwapapashwa ngo-2014. Isiqingatha safumana unyango lwe-photodynamic, esinye isiqingatha safumana i-fluconazole 300 mg ethathwa ngomlomo kanye ngeveki, ngalinye kangangeeveki ezingama-24.
Inkqubo yokukhanya yayichazwe ngokucacileyo. Ulwelo lwe-methylene blue lwe-2% olwenziwe ngamanzi lwafakwa eluzipho, lwaza emva kwexesha elifutshane lokulushiya eluzipho lwakhanyiselwa nge-LED ebomvu enamaza angahambelaniyo ngokwesigaba, kubude bamaza obuyi-630 nm, inika ii-joule ezili-18 ngesentimitha yesikwere. Iiseshoni zaphindwa rhoqo emva kweentsuku ezili-15, izihlandlo ezilishumi elinesibini kwiinyanga ezintandathu. Izinzipho ezinenkunkuma engqindilili ngaphantsi kwazo, imigca ehamba ngobude, okanye i-dermatophytoma zazikhuhlwa kuqala ngezixhobo, kuwo omabini amaqela, kuba ukukhanya nechiza ngokufanayo azikwazi ukusebenza xa zithintelwa ludonga lwe-keratin.
Isiphumo esiphambili sabonisa ukuba iqela lokukhanya lenza ngcono, umahluko ubalulekile ngokweenkcukacha-manani. Iingxelo zamva ezikhupha iinkcukacha kumbhalo opheleleyo zichaza malunga ne-90% yokusabela kunyango emva kwekhosi yeenyanga ezintandathu, xa kuthelekiswa ne-45% nge-fluconazole; kwiqela lokukhanya oku kwehla ukuya malunga ne-80% kwiinyanga ezilishumi elinesibini emva kokuphela konyango. Uhlalutyo oluphindiweyo olungqongqo ngakumbi, olwalufuna izinto ezintathu ngaxeshanye—ukungabonakali komngundo xa kuhlolwa nge-microscope, ukungakhuli komngundo elabhoratri, nokukhula ngokutsha okupheleleyo koluzipho olungenazimpawu zosulelo—lwabeka amanani okugqibela okuphila ngokupheleleyo kwi-50% xa kuthelekiswa ne-25%. Ezi seti zimbini zamanani zichaza imilinganiselo eyahlukileyo yeziphumo, kungekhona iziphumo eziphikisanayo, yaye umahluko phakathi kwazo ngumxholo wecandelo elilandelayo. Kwaxelwa ukuba unyango lwanyamezeleka kakuhle, kwabhalwa isiganeko esinye sentlungu nokutshisa.
Iinkcukacha ezimbini zibalulekile kuye nabani na obuza indlela yokusebenzisa i-methylene blue kumngundo wezinzipho zeenyawo. Okokuqala, ichiza lothelekiso yayiyi-fluconazole, ichiza elisebenza ngokulinganiselweyo kwisifo sezinzipho, kungekhona i-terbinafine enamandla ngakumbi. Okwesibini, uxinaniso lwedayi lwaluyi-2%, luphezulu kakhulu kunalo naluphi na oluthengiselwa ukusetyenziswa ekhaya ngeenjongo zokuhombisa, yaye yafakwa phantsi kweliso lengcali, kususwa izinto ezonakeleyo eluzipho kwaye kusetyenziswa isibane esilungelelaniswe ngokomlinganiselo.
Isifo esiqatha sezinzipho zeenyawo: idayi nokukhanya kongezwa kwi-terbinafine
Isifundo sesibini sezinzipho, isilingo esabiwa ngokungakhethiyo kusulelo oluqatha lwezinzipho zeenyawo olubangelwa zii-dermatophyte, esapapashwa ngo-2020, siphendula umbuzo onomda omxinwa ngakumbi. Zonke izigulana ezingamashumi amabini, ezazinosulelo oluchaphazela ngaphezu kwe-60% yoluzipho lukabhontsi wonyawo, zafumana i-terbinafine 250 mg ethathwa ngomlomo yonke imihla kangangeeveki ezilishumi elinesibini, kunye nokuthanjiswa koluzipho nge-urea. Ukongeza kolo nyango lusisiseko, ezilishumi zafumana unyango lwe-photodynamic nge-methylene blue, ezinye ezilishumi zafumana unyango lwe-photodynamic ngento eyahlukileyo evuselelwa kukukhanya.
Iqela le-methylene blue lasebenzisa ulwelo lwe-2% olwenziwe ngamanzi, lushiywa malunga nemizuzu emithathu, kulandelwe i-LED ye-635 nm enika ii-joule ezingama-37 ngesentimitha yesikwere kwimizuzu elishumi. Iiseshoni ezisithoba zaqhutywa rhoqo emva kweeveki ezimbini kwisithuba seeveki ezilishumi elinesithandathu, kusetyenziswa isithambiso se-urea esiyi-40% ngeengokuhlwa ezingaphambi kweseshoni nganye, kunye nokususwa kwenkunkuma ngezixhobo.
Ngeveki yama-52, malunga neenyanga ezisithoba emva kweseshoni yokugqibela yokukhanya, isalathisi sobuzaza kwiqela le-methylene blue sasihle ukusuka malunga nama-24 saya ngaphantsi kwe-1, inxalenye yoluzipho echaphazelekayo yehla ukusuka malunga ne-65% yaya ngaphantsi kwe-2%, kwaye ukuphila ngokupheleleyo, okuthetha uluzipho olubonakala luqhelekile kunye nokuphela komngundo kuvavanyo, kwakuyi-70%. Ukuphela komngundo kuvavanyo ngokwako kwafikelela kwi-100% kwiqela le-methylene blue, xa kuthelekiswa ne-90% kwiqela elalisebenzisa enye into evuselelwa kukukhanya. Akuzange kuxelwe ziphumo ebezingalindelekanga kwindawo enyangwayo ezibangelwe yidayi nokukhanya; izigulana ezibini zaba nokungakhululeki esiswini nasemathunjini okwabalelwa kwi-terbinafine ezaziyithatha nazo.
Ukufunda esi silingo ngokunyanisekileyo kubonisa ukuba asinakwahlula igalelo ledayi. Sonke isigulana safumana ikhosi epheleleyo yelona chiza lisebenza kakuhle emzimbeni wonke, kunye nokulungiselelwa ngokunzulu kwezinzipho; kwakungekho qela lifumana ichiza kuphela, yaye amaqela omabini okukhanya afumana iziphumo ezifanayo. Oko sikubonisayo kukuba inkqubo ye-methylene blue nokukhanya eyongezwa kunyango oluqhelekileyo yavelisa ukuphela komngundo ngezinga eliphezulu kwisifo esiqatha, ngokulandelelwa ixesha elide, nokuba iiseshoni zokukhanya ngokwazo azizange zongeze ubuthi kwindawo enyangwayo kweli qela lincinane. Ukusebenzisana kwamachiza nemingcipheko emzimbeni wonke yeenkqubo zonyango ezidityanisiweyo kuxoxwa ngayo kwisikhokelo sokhuseleko nokusebenzisana kwamachiza.
Usulelo lolusu olunganyangekiyo ngamachiza: isigulana esinye, umngundo omnye onenkani
Ubungqina bolusu buncinane kakhulu. Isifundo sango-2026 sonyango lwe-methylene blue nokukhanya oluchasene ne-Trichophyton indotineae enganyangekiyo ngamachiza siphathelele kwisigulana esinye esineminyaka engama-25, esineendawo ezonakeleyo zolusu ezibanzi ezazihlale iinyanga ezisibhozo, nangona sasifumene i-terbinafine esebenza emzimbeni wonke kwi-250 mg yonke imihla kangangeeveki ezintandathu. Uvavanyo lwaselebhu lwabonisa ukuba obona xinaniso buncinane be-terbinafine obuthintela ukukhula babuyi-8.0 ye-microgram ngemililitha, xa kuthelekiswa ne-1.0 ye-methylene blue, nto leyo ehambelana ne-dermatophytosis enganyangekiyo ngamachiza esasazekayo ngoku kwimimandla emininzi.
Iindawo ezonakeleyo zolusu zanyangwa nge-methylene blue ye-1% efakwa eluswini, kunye nokukhanya okubomvu okubude bamaza bumalunga ne-630 nm, okunika ii-joule ezili-100 ngesentimitha yesikwere, kanye ngeveki kangangeeveki ezine. Emva kweeveki ezimbini, iindawo ezinyangiweyo zabonisa ukuphela kokuxobuka kolusu, kungabonakali mngundo xa kuhlolwa nge-microscope, yaye ngeveki yesine zachazwa njengeziphile ngokupheleleyo, kushiyeke kuphela utshintsho oluncinane lombala wolusu, ngoxa iindawo ezanyangwa ngekhrimu ye-terbinafine zazisenemisonto yomngundo ebonakalayo. Akuzange kuxelwe miphumela iqatha okanye ntlungu.
Oku kukusabela kokwenene okuboniswe luvavanyo lomngundo kwisifo esinganyangekiyo ngamachiza, kodwa kukwasisigulana esinye esaqwalaselwa iiveki ezine. Akuzange kubhalwe ukutshintsha kwesiphumo sokukhuliswa komngundo elabhoratri emva konyango, ngaphandle kovavanyo lwe-microscope; kwakungekho kulandelela ukubuya kosulelo kwiinyanga ezintathu, ezintandathu, okanye ezilishumi elinesibini, yaye kwakungekho qela labantu ekunokubalwa kulo izinga lokusabela kunyango. Oku kuxhasa ukufunda ngakumbi, kungekhona icebiso lonyango. Iindidi ezinganyangekiyo ngamachiza novavanyo lokuba zichaphazeleka kangakanani ngamachiza zihlolwa ngakumbi kwisikhokelo sokuxhathisa amachiza achasene nomngundo.
Izifundo ezintathu xa zithelekiswa
| Souza 2014, uluzipho lonyawo | Alberdi noGomez 2020, usulelo oluqatha loluzipho lonyawo | Xu 2026, iindawo ezonakeleyo zolusu ezinganyangekiyo ngamachiza | |
|---|---|---|---|
| Uyilo nobungakanani | Ukwabiwa ngokungakhethiyo, 40 kwiqela ngalinye | Ukwabiwa ngokungakhethiyo, 10 kwiqela ngalinye zahlalutywa | Isigulana esinye, iindawo ezonakeleyo zisetyenziswa njengolawulo lothelekiso kweso sigulana |
| Uhlobo lomngundo | Iindidi ezixubileyo zee-dermatophyte, iigwele, nokungunda | T. rubrum okanye T. mentagrophytes | T. indotineae, engasabeliyo kwi-terbinafine |
| Idayi nexesha lokuyishiya | 2% emanzini, imizuzu | 2% emanzini, malunga nemizuzu emi-3 | 1% efakwa eluswini, isigqubuthelo esingangenwa kukukhanya ngokwenkqubo yombhalo wokuqala ongekavavanywa ziingcali |
| Ukukhanya | 630 nm LED, 18 J nge-cm2 | 635 nm LED, 37 J nge-cm2 | Malunga ne-630 nm, 100 J nge-cm2 |
| Iiseshoni | 12, rhoqo emva kweentsuku ezili-15 kwiinyanga ezi-6 | 9, rhoqo emva kweeveki ezi-2 kwiiveki ezili-16 | 4, kanye ngeveki |
| Unyango oluhamba nalo | Ukukhuhlwa koluzipho xa kuyimfuneko; ikhapsuli ye-placebo | Terbinafine 250 mg yonke imihla kangangeeveki ezili-12, 40% urea, ukususwa kwezinto ezonakeleyo | Akukho kwiindawo ezinyangiweyo; ikhrimu ye-terbinafine kwiindawo zolawulo lothelekiso |
| Isiphumo ngokwenkangeleko | Malunga ne-90% yokusabela ekupheleni konyango, malunga ne-80% kwiinyanga ezili-12 | Isalathisi sobuzaza ukusuka malunga nama-24 ukuya ngaphantsi kwe-1; 70% yokuphila ngokupheleleyo ngeveki yama-52 | Ukuxobuka kwaphela ngeveki yesi-2, zaphila ngeveki yesi-4 |
| Isiphumo sovavanyo lomngundo | Ukuphila ngokupheleleyo ngokwemilinganiselo engqongqo 50% xa kuthelekiswa ne-25% ekulandeleni kokugqibela | 100% zingenamngundo kwi-PAS nasekukhulisweni elabhoratri ngeveki yama-52 | Akubonakali mngundo nge-microscope kwiiveki ezi-2; akukho siphumo sokukhuliswa komngundo elabhoratri esaxelwayo emva konyango |
| Ukulandelela | Iinyanga ezili-12 emva konyango | Malunga neenyanga ezili-9 emva kweseshoni yokugqibela yokukhanya | Iiveki ezi-4, akukho datha yokubuya kosulelo |
| Iziphumo ebezingalindelekanga | Isiganeko esinye sentlungu nokutshisa | Akukho ziphumo kwindawo enyangwayo; ukungakhululeki emathunjini okubangelwe yi-terbinafine kwaba-2 kwabali-10 | Akukho miphumela iqatha, akukho ntlungu |
Ukuphila ngokwenkangeleko akuthethi ukuphela komngundo kuvavanyo
Ukufunda la maphepha kufuna ukuqonda umahluko omnye. Ukuphila ngokwenkangeleko kuthetha ukuba uluzipho okanye ulusu lubonakala luqhelekile. Ukuphela komngundo kuvavanyo kuthetha ukuba ukuhlolwa nge-microscope nokukhuliswa elabhoratri akufumani mngundo. Ukuphila ngokupheleleyo kuthetha zombini ezi zinto ngaxeshanye. Izinzipho zikhula ngokutsha kancinane, ngoko uluzipho lunokubonakala lungcono kwiinyanga ngaphambi kokuba umngundo uphele, yaye iintsalela zomngundo ofileyo zinokwenza uvavanyo luqhubeke lubonisa ubukho bomngundo emva kokuba usulelo luphelile. Isilingo sikaSouza sibonisa umphumo woku ngokuthe ngqo: imilinganiselo engangqongqo yokusabela inika i-80 ukuya kwi-90%, ngoxa ukufuna uluzipho olungenazimpawu zosulelo kunye novavanyo olungafumani mngundo kunika i-50%. Akukho nani lingachananga kula mabini. Alinganisa izinto ezahlukileyo, yaye naliphi na ibango ngokusebenza konyango kufuneka lichaze ukuba licaphula liphi.
Oku kuthetha ntoni kwizigqibo zonyango
Izigqibo ezintathu zisaxhaswa nakukufunda okungqongqo. Okokuqala, i-methylene blue kunye nokukhanya okubomvu okulungelelaniswe ngokomlinganiselo kuye kwavelisa ukuphela kokwenene komngundo wezinzipho zeenyawo kwizilingo ezimbini ezabiwa ngokungakhethiyo, kwesinye kuthelekiswa ne-fluconazole kuphela, kwesinye kongezwa kwi-terbinafine kunye nokulungiselela nge-urea. Okwesibini, ingxelo enye yolusu olunganyangekiyo ngamachiza iyakhuthaza kodwa ingqina phantse akukho nto iyodwa; i-dermatophytosis yolusu enyangwa ngedayi nokukhanya ayikabi nabungqina obuvela kwizilingo ezabiwa ngokungakhethiyo. Okwesithathu, sonke isiphumo esihle savela kumdibaniso ophantsi kweliso lengcali: idayi yomgangatho wamayeza kwi-1 ukuya kwi-2%, ixesha elibekiweyo lokuyishiya, umthamo olinganisiweyo wokukhanya, kwaye ngokuqhelekileyo ukususwa kwezinto ezonakeleyo okanye ichiza elisebenza emzimbeni wonke elihamba nalo.
Akukho nanye kwezi enokusetyenziswa njengobungqina bokufaka idayi ethengiswa ezivenkileni ekhaya. Ukufaka ekhaya akunamthamo ulinganisiweyo wokukhanya, akukho kulawula ixesha lokushiya idayi, akukho kususa izinto ezonakeleyo, akukho vavanyo lomngundo, kwaye akukho kulandelela, nto leyo esusa yonke into ezazixhomekeke kuyo izilingo. Nabani na ocinga ngonyango olusekelwe ekukhanyeni ufanele azise ezi nkqubo kugqirha wolusu aze abuze ukuba luyafumaneka na unyango lwe-photodynamic oluphantsi kweliso lengcali, kunokuba aphinde nje umbala aze ayishiye inkqubo.