I-methylene blue yesikhunta sezinzipho: ubufakazi bokuhlolwa kwe-photodynamic

Imiphumela yokusesha nge-methylene blue yesikhunta sezinzipho ivame ukudida izinto ezimbili ezihluke kakhulu. Enye yibhodlela likafodayi oluhlaza okwesibhakabhaka ofakwa ekhaya. Enye yinqubo yasemtholampilo lapho kufakwa khona ufodayi, ushiywe isikhashana, bese wenziwa usebenze ngesilinganiso esikaliwe sokukhanya okubomvu. Cishe bonke ubufakazi basemtholampilo buhlobene nalena yesibili. Lesi sihloko siqhathanisa ngokuqondile izifundo ezintathu ze-photodynamic, ukuze ubone ukuthi yini ngempela eyahlolwa nokuthi ngasinye safakazela ini.

Indlela yokusebenza efanayo kuzo ilula. I-methylene blue imunca ukukhanya okubomvu ngamandla, bese i-molecule esesimweni esivuselelwe idlulisela lawo mandla ku-oksijini, ikhiqize i-oksijini esesimweni se-singlet nezinye izinhlobo zamakhemikhali asebenza kalula ezilimaza amaseli esikhunta. Ngaphandle kokukhanya, umphumela uba buthaka kakhulu. Yingakho ucwaningo ngalunye olungezansi luhlanganisa ufodayi nesibani, ubude begagasi, nesilinganiso sokukhanya okucacisiwe, futhi kungani imiphumela yezindlela ezisebenzisa ukukhanya ingasho lutho ngokugcoba ufodayi esiziphweni ekukhanyeni kwasemini. Indlela yokusebenza evamile ichazwe kabanzi encazelweni yokwelashwa nge-photodynamic, kanti umongo obanzi wocwaningo lokulwa nesikhunta utholakala ekubukezweni kwe-methylene blue njengento elwa namagciwane.

I-onychomycosis yezinzipho zezinyawo: ufodayi kanye nokukhanya kuqhathaniswa ne-fluconazole yamasonto onke

Ukuhlolwa okukhulu kunakho konke kwakuwukuqhathanisa okwabela iziguli ezingama-80 ezine-onychomycosis yezinzipho zezinyawo emaqenjini ngokungahleliwe, okwashicilelwa ngo-2014. Ingxenye yathola ukwelashwa nge-photodynamic, enye ingxenye yathola i-fluconazole ephuzwa ngomlomo engu-300 mg kanye ngesonto, zombili izindlela zaqhubeka amasonto angama-24.

Indlela yokusebenzisa ukukhanya yayicacisiwe. Isixazululo se-methylene blue esingu-2% emanzini safakwa esiziphweni, sabe sesikhanyiswa ngemva kwesikhathi esifushane sokushiywa kwaso nge-LED ebomvu engakhiphi ukukhanya oku-coherent, enobude begagasi obungu-630 nm, iletha ama-joule angu-18 ngesentimitha lesikwele. Izikhathi zokwelashwa zaziphindwa njalo ezinsukwini eziyi-15, izikhathi eziyishumi nambili phakathi nezinyanga eziyisithupha. Izinzipho ezinezinsalela eziwugqinsi ngaphansi kwazo, imigqa emide, noma i-dermatophytoma zaqala zakhuhlwa kusetshenziswa amathuluzi, kuwo womabili amaqembu, ngoba ukukhanya nomuthi ngokufanayo akukwazi ukudlula odongeni lwe-keratin.

Umphumela oyinhloko wavuna iqembu lokukhanya, futhi umehluko wawubalulekile ngokwezibalo. Imininingwane eyakhishwa kamuva embhalweni ophelele ibika ukusabela okucishe kube ngu-90% ngemva kokwelashwa kwezinyanga eziyisithupha uma kuqhathaniswa no-45% nge-fluconazole, kwehla kwacishe kwaba ngu-80% eqenjini lokukhanya ezinyangeni eziyishumi nambili ngemva kokuphela kokwelashwa. Ukuhlaziya kabusha okunemibandela eqinile, okwakufuna izinto ezintathu ngesikhathi esisodwa — ukungatholakali kwesikhunta ngesibonakhulu, ukungakhuli kwesikhunta lapho sikhuliswa elabhorethri, nokukhula kabusha okuphelele kozipho olubukeka lungenasifo — kwabeka izibalo zokugcina zokuphola okuphelele ku-50% uma kuqhathaniswa no-25%. La masethi amabili ezinombolo achaza izilinganiso zemiphumela ezihlukene, hhayi okutholakele okuphikisanayo, futhi umehluko phakathi kwawo uyisihloko sesigaba esilandelayo. Kwabikwa ukuthi ukwelashwa kwamukeleka kahle emizimbeni yeziguli, kwabhalwa isenzakalo esisodwa sobuhlungu nokushisa.

Imininingwane emibili ibalulekile kunoma ubani obuza ukuthi i-methylene blue isetshenziswa kanjani esikhunteni sezinzipho zezinyawo. Okokuqala, umuthi okwaqhathaniswa nawo kwakuyi-fluconazole, umuthi osebenza ngokulingene esifweni sezinzipho, hhayi i-terbinafine enamandla kakhulu. Okwesibili, ukugxila kukafodayi kwakungu-2%, kuphakeme kakhulu kunalokho okuthengiswa ukuze kusetshenziswe ekhaya ngezinhloso zobuhle, futhi wawufakwa ngaphansi kokuqondisa, kuhambisana nokususwa kwezicubu nezinsalela kanye nesibani esikalwe ngokunembile.

Isifo esinzima sezinzipho zezinyawo: ufodayi kanye nokukhanya kwengezwa ku-terbinafine

Ucwaningo lwesibili lwezinzipho, ukuhlolwa okwabela iziguli ezinesifo esinzima sezinzipho zezinyawo esibangelwa ama-dermatophyte emaqenjini ngokungahleliwe, olwashicilelwa ngo-2020, luphendula umbuzo oqondene nesimo esithile. Iziguli ezingamashumi amabili, okwakuthinteke kuzo ngaphezu kuka-60% wozipho lozwane olukhulu, zonke zathola i-terbinafine ephuzwa ngomlomo engu-250 mg nsuku zonke amasonto ayishumi nambili, kanye nokuthanjiswa kozipho nge-urea. Ngaphezu kwalokho kwelashwa okuyisisekelo, eziyishumi zathola ukwelashwa nge-methylene blue ne-photodynamic, kanti eziyishumi zathola ukwelashwa nge-photodynamic zisebenzisa enye into eyenza ukukhanya kusebenze.

Iqembu le-methylene blue lasebenzisa isixazululo esingu-2% emanzini, esashiywa cishe imizuzu emithathu, kwabe sekusetshenziswa i-LED engu-635 nm eletha ama-joule angu-37 ngesentimitha lesikwele ngemizuzu eyishumi. Kwaba nezikhathi zokwelashwa eziyisishiyagalolunye, zihlukene ngamasonto amabili phakathi namasonto ayishumi nesithupha, kusetshenziswa amafutha ane-urea engu-40% kusihlwa ngaphambi kwesikhathi ngasinye sokwelashwa, kanye nokususwa kwezinsalela ngamathuluzi.

Ngesonto lama-52, cishe izinyanga eziyisishiyagalolunye ngemva kwesikhathi sokugcina sokwelashwa ngokukhanya, inkomba yobunzima besifo eqenjini le-methylene blue yayehle isuka cishe ku-24 yaba ngaphansi kuka-1, ingxenye yozipho ethintekile yasuka cishe ku-65% yaba ngaphansi kuka-2%, kanti ukuphola okuphelele, okusho uzipho olubukeka luvamile kanye nokungatholakali kwesikhunta ekuhlolweni, kwakungu-70%. Ukungatholakali kwesikhunta ekuhlolweni ngokwakho kwafinyelela ku-100% eqenjini le-methylene blue uma kuqhathaniswa no-90% ngenye into eyenza ukukhanya kusebenze. Ayikho imiphumela engemihle endaweni elashwayo ebangelwa ufodayi nokukhanya eyabikwa; iziguli ezimbili zaba nokungaphatheki kahle esiswini nasemathunjini okwabangelwa i-terbinafine ezaziyiphuza nazo.

Ukufunda lolu cwaningo ngokwethembeka kusho ukuthi alukwazi ukuhlukanisa umthelela kafodayi kowezinye izinto. Zonke iziguli zathola inkambo ephelele yomuthi ongcono kunayo yonke osebenza kuwo wonke umzimba kanye nokulungiswa okukhulu kwezinzipho, lalingekho iqembu elithola umuthi kuphela, futhi amaqembu amabili okukhanya athola imiphumela efanayo. Lokho olukubonisayo ukuthi indlela ye-methylene blue nokukhanya eyengezwe ekwelashweni okujwayelekile yaholela ekungatholakalini kwesikhunta ngezinga eliphezulu esifweni esinzima, ngokulandelelwa isikhathi eside, nokuthi izikhathi zokwelashwa ngokukhanya ngokwazo azizange zengeze imiphumela enobuthi endaweni elashwayo kuleli qembu elincane. Ukusebenzisana kwemithi nezingozi ezithinta wonke umzimba zezindlela zokwelashwa ezihlanganisiwe kuxoxwa ngakho kumhlahlandlela wokuphepha nokusebenzisana kwemithi.

Ukutheleleka kwesikhumba okumelana nemithi: isiguli esisodwa, isikhunta esisodwa esinenkani

Ubufakazi besikhumba buncane kakhulu. Ucwaningo lwango-2026 lokwelashwa nge-methylene blue nokukhanya ngokumelene ne-Trichophyton indotineae emelana nemithi lumayelana nesiguli esisodwa esineminyaka engama-25 esasinezilonda ezisabalele esikhumbeni ezazihlale izinyanga eziyisishiyagalombili naphezu kwamasonto ayisithupha sithola i-terbinafine esebenza kuwo wonke umzimba engu-250 mg nsuku zonke. Ukuhlolwa elabhorethri kwabonisa ukuthi ukugxila okuncane kwe-terbinafine okudingekayo ukuvimbela ukukhula kwesikhunta kwakungama-microgram angu-8.0 ngemililitha uma kuqhathaniswa no-1.0 we-methylene blue, okuhambisana ne-dermatophytosis emelana nemithi esisabalala ezifundeni eziningi manje.

Izilonda zalashwa nge-methylene blue engu-1% efakwa esikhumbeni kanye nokukhanya okubomvu okucishe kube ngu-630 nm, okuletha ama-joule angu-100 ngesentimitha lesikwele, kanye ngesonto amasonto amane. Ngemva kwamasonto amabili, izilonda ezalashwa zabonisa ukuphela kokuxebuka kwesikhumba, futhi isikhunta asitholakalanga lapho kuhlolwa ngesibonakhulu. Ngesonto lesine zachazwa njengeziphole ngokuphelele, kusele kuphela ushintsho oluncane lombala wesikhumba, kuyilapho izilonda ezalashwa ngokhilimu we-terbinafine zazisenezintambo zesikhunta ezibonakalayo. Akubikwanga ukusabela okunzima noma ubuhlungu.

Lokho kuwumphumela wangempela wokuhlolwa kwesikhunta esifweni esimelana nemithi, kodwa futhi kuseyisiguli esisodwa esabhekwa amasonto amane. Akukho ukuguquka okubhaliwe kokuhlolwa ngokukhulisa isikhunta ngemva kokwelashwa, ngaphandle kokuhlolwa ngesibonakhulu, akukho ukulandelela ukubuyela kwesifo ngemva kwezinyanga ezintathu, eziyisithupha, noma eziyishumi nambili, futhi alikho iqembu labantu okungabalwa kulo izinga lokusabela. Lokhu kusekela ucwaningo olwengeziwe, hhayi isincomo sokwelashwa. Izinhlobo ezimelana nemithi nokuhlolwa kokuzwela emithini kucutshungulwa kabanzi kumhlahlandlela wokumelana nemithi yokulwa nesikhunta.

Izifundo ezintathu ziqhathaniswa

	Souza 2014, uzipho lozwane	Alberdi noGomez 2020, isifo esinzima sozipho lozwane	Xu 2026, izilonda zesikhumba ezimelana nemithi
Uhlelo nobukhulu	Ukwabelwa ngokungahleliwe, abangama-40 eqenjini ngalinye	Ukwabelwa ngokungahleliwe, kwahlaziywa abayi-10 eqenjini ngalinye	Isiguli esisodwa, izilonda zaso zisetshenziswa ukuqhathanisa
Isidalwa	Ama-dermatophyte, imvubelo, nezikhunta zesikhunta sokubola ezixubile	T. rubrum noma T. mentagrophytes	T. indotineae, engasabeli ku-terbinafine
Ufodayi nesikhathi sokushiywa	2% emanzini, imizuzu	2% emanzini, cishe imizuzu emi-3	1% efakwa esikhumbeni, isembozo esivimba ukukhanya ngokwendlela esembhalweni owandulela ukushicilelwa
Ukukhanya	630 nm LED, 18 J per cm2	635 nm LED, 37 J per cm2	Cishe 630 nm, 100 J per cm2
Izikhathi zokwelashwa	12, njalo ezinsukwini eziyi-15 phakathi nezinyanga eziyisi-6	9, njalo emasontweni ama-2 phakathi namasonto ayi-16	4, masonto onke
Ukwelashwa okuhambisana nakho	Ukukhuhlwa kozipho lapho kudingeka; ikhepsuli engenawo umuthi osebenzayo	Terbinafine 250 mg nsuku zonke amasonto ayi-12, 40% urea, ukususwa kwezicubu nezinsalela	Akukho ezilondeni ezalashwa; ukhilimu we-terbinafine ezilondeni zokuqhathanisa
Umphumela obonakala emtholampilo	Cishe 90% ukusabela ekupheleni kokwelashwa, cishe 80% ezinyangeni eziyi-12	Inkomba yobunzima isuka cishe ku-24 iye ngaphansi kuka-1; 70% ukuphola okuphelele ngesonto lama-52	Ukuxebuka kwaphela ngesonto lesi-2, zaphola ngesonto lesi-4
Umphumela wokuhlolwa kwesikhunta	Ukuphola okuphelele ngemibandela eqinile 50% uma kuqhathaniswa no-25% ekulandeleleni kokugcina	100% akutholakalanga isikhunta nge-PAS nangokukhuliswa kwaso ngesonto lama-52	Isikhunta asitholakalanga ngesibonakhulu emasontweni ama-2; akubikwanga ukuhlolwa ngokukhulisa isikhunta ngemva kokwelashwa
Ukulandelela	Izinyanga eziyi-12 ngemva kokwelashwa	Cishe izinyanga eziyi-9 ngemva kwesikhathi sokugcina sokwelashwa ngokukhanya	Amasonto ama-4, akukho datha yokubuyela kwesifo
Imiphumela engemihle	Isenzakalo esisodwa sobuhlungu nokushisa	Ayikho imiphumela endaweni elashwayo; ukungaphatheki kahle emathunjini ngenxa ye-terbinafine kwabayi-2 kwabayi-10	Akukho ukusabela okunzima, akukho buhlungu

Ukuphola ngokubukeka akufani nokungatholakali kwesikhunta ekuhlolweni

Ukufunda la maphepha kudinga ukuhlukanisa into eyodwa. Ukuphola ngokubukeka emtholampilo kusho ukuthi uzipho noma isikhumba kubukeka kuvamile. Ukuphola ngokokuhlolwa kwesikhunta kusho ukuthi ukuhlola ngesibonakhulu nokukhulisa isikhunta akutholi sikhunta. Ukuphola okuphelele kusho kokubili ngesikhathi esisodwa. Izinzipho zikhula kabusha kancane, ngakho uzipho lungabukeka lungcono ezinyangeni ngaphambi kokuba isikhunta siphele, futhi izinsalela zesikhunta esifile zingagcina ukuhlolwa kubonisa ukuthi sisekhona ngisho nangemva kokuphela kokutheleleka. Ukuhlolwa kukaSouza kubonisa umphumela walokhu ngokuqondile: imibandela yokusabela engacini inikeza u-80 kuya ku-90%, kuyilapho ukufuna uzipho olungenasifo kanye nokuhlolwa okungatholi sikhunta kunikeza u-50%. Asikho kulezi zibalo esingalungile. Zikala izinto ezihlukene, futhi noma yisiphi isimangalo ngokusebenza kokwelashwa kufanele sisho ukuthi sibhekisela kusiphi.

Lokhu kusho ukuthini ezinqumweni zokwelashwa

Iziphetho ezintathu zisekhona ngisho nalapho kufundwa ngemibandela eqinile. Okokuqala, i-methylene blue enokukhanya okubomvu okulinganiswe ngokunembile iholele ekususweni kwangempela kwesikhunta sezinzipho zezinyawo ekuhlolweni okubili okwabela iziguli emaqenjini ngokungahleliwe, kokunye iqhathaniswa ne-fluconazole kuphela, kokunye yengezwa ku-terbinafine ngokulungiswa kwezinzipho nge-urea. Okwesibili, umbiko owodwa wesikhumba esinesifo esimelana nemithi uyakhuthaza kodwa ngokwawo awufakazeli cishe lutho; okwamanje abukho ubufakazi bokuhlolwa okwabela iziguli emaqenjini ngokungahleliwe kwe-dermatophytosis yesikhumba elashwa ngofodayi nokukhanya. Okwesithathu, yonke imiphumela emihle yavela enhlanganisweni eyayiqondiswa ochwepheshe: ufodayi wezinga lezemithi ongu-1 kuya ku-2%, isikhathi esibekiwe sokushiywa kwawo, isilinganiso sokukhanya esikaliwe, futhi ngokuvamile ukususwa kwezicubu nezinsalela noma umuthi osebenza kuwo wonke umzimba okuhambisana nalokho.

Akukho kulokhu okungadluliselwa ekufakeni ufodayi othengwa ezitolo ekhaya. Ukufaka ekhaya akunaso isilinganiso sokukhanya esikaliwe, akukho ukulawulwa kwesikhathi sokushiywa kukafodayi, akukho ukususwa kwezicubu nezinsalela, akukho ukuhlolwa kwesikhunta, futhi akukho ukulandelela, okususa zonke izinto ukuhlolwa okwakuncike kuzo. Noma ubani ocabangela ukwelashwa okusebenzisa ukukhanya kufanele ahambise lezi zindlela kudokotela wesikhumba futhi abuze ukuthi kuyatholakala yini ukwelashwa nge-photodynamic okuqondiswa ochwepheshe, kunokuphinda umbala kodwa ashiye ngaphandle inqubo.