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DOTS+ strategiiT mkurnalobis 7 wliani gamocdileba indoeTSi: Sedegebi, SezRudvebi da daskvnebi tuberkulozisa da filtvis daavadebaTa saerTaSoriso gaerTianebis (The UNION) Jurnali 13(8): 976-981 “samSabaToba”, 06.10.09 indoeTSi DOTS+ starategiis danergvis winapirobebi: • 1997 wlidan tep-is farglebSi DOTS strategiiT mkurnalobis warumatebeli gamosavali warsulSi namkurnaleb pacientTa saSualod 6%-Si fiqsirdeboda; • winaswari kvlevebiT MDR-TB dafiqsirda “axal SemTxvevaTa” 3%-Si (6,8%); “warsulSi namkurnaleb SemTxvevaTa” 12-18%-Si (27,4%); • DOTS strategiis muSaoba qveynis masStabiT Sefasda dadebiTad; • 2002 wlis ianvridan piloturi programis farglebSi DOTS+ strategiiT mkurnaloba daiwyo LRS institutSi (1997 wlidan DOTS strategiiT namkurnalebi 1,6 milioni pacientiT). CarTvis kriteriumebi: • sawyis etapze pilotur programaSi CasarTavad II kategoriis “uSedego” gamosavlis mqone pacientebi SeirCnen; • kvlevaSi DST-is SedegebiT dadasturebuli MDR-TB pacientebi CaerTvnen; • kvlevas meTvalyureobda institutis eTikuri komiteti; gamoricxvis kriteriumebi: • kvlevaSi ar moxvdnen II rigis preparatebiT 1 Tveze meti xangrZlivobiT namkurnalebi; • fexmZime; • HIV/AIDS pozitiuri pacientebi. sabolood SeirCa da retrospeqtuli analizi Catarda 126 pacientis monacemebze (2002-2006 ww); meTodebi: • LRS referens-laboratoriaSi tardeboda: 2 ulufa naxvelis baqterioskopia; DST ganisazRvreboda saerTaSoriso rekomendaciebis gaTvaliswinebiT (BACTEC, H – 0,4µg/ml (0.2); R – 128µg/ml (40); S – 16µg/ml (4); E – 8µg/ml (2)); • ZiriTadi samkurnalo reJimi: intensiur fazaSi _ 6(max9) Km+Cs+Ofx+Eth+Z (Km – 750 mg (1000mg); Cs – 500-750 mg (1000mg); Ofx – 600-800 mg (1000mg); Eth – 500-570 mg (1000mg); ; Z – 1500 mg); gagrZelebis fazaSi _ 12 Cs+Ofx+Eth; • PAS-iT Canacvleba xdeboda Z-is mimarT rezistentobis, an romelime preparatis autanlobis SemTxvevaSi; • yvela pacients minimum 1 Tvis ganmavlobaSi utardeboda stacionaluri mkurnaloba; • intensiur fazaSi yovel TveSi, xolo gagrZelebis fazaSi yovel II TveSi tardeboda 1 kulturaluri gamokvleva (ganmeorebiTi DST???); • statistikuri analizi tardeboda Epi Info version 10.0 (CDC, Atlanta, USA). MDR-TB - Km(Cm)+Lfx+Pto+Cs+Pas+(E)+(Z) XDR-TB - Cm+Mfx+Pto+Cs+PAS+Cfz+Amx/Clv+Clr+(E)+(Z) Sedegebi: • pacientTa saSualo asaki _ 26 w. iyo; • MDR-TB kontaqti dafiqsirda SemTxvevaTa 4%-Si; • warsulSi Catarebuli mkurnalobis xangrZlivoba saSualod 18,4 Tve iyo; • MDR-TB-is diagnostireba saSualod 5 (4.2) TviT gviandeboda; • MDR-TB-is mkurnalobis dawyeba saSualod 3.3 (1.6) TviT gviandeboda; • rentgenologiurad moculobiTi (infiltracia da kavitacia moicavs 1-ze met wils) paTologia dafiqsirda 81%-Si; bilateraluri 78%-Si; mxolod kavitacia 43%-Si; naxvelis kulturaluri konversia moxda • sul 100 (79%) pacientTan _ mkurnalobis pirvel 8 TveSi; maTgan 82%-Si _ pirvel 3 TveSi; 98%-Si _ pirvel 6 TveSi. naxvelis kulturaluri konversia ar moxda • 26 (21%) pacientTan maTgan 14 gardaicvala; 8-m Sewyvita mkurnaloba; mxolod 4-Tan (3,2%-Si) dafiqsirda uSedego mkurnaloba. mkurnalobis monitoringi wonis koreqciis mixedviT: • mkurnalobis dawyebisas pacientTa 30%-is wona ≤ 30 kg-ze; kursis ganmavlobaSi 28%-ma moimata 6-10 kg; 20%-ma 11-15 kg; 11%-ma >15 kg-ze. • sul gardaicvala 24 pacienti maTgan 7(29%) mkurnalobis I TveSi; 13(54%) pirvel 4 TveSi; mxolod 1 pacienti gardaicvala kulturis konversiis Semdeg; 20(83%) warsulSi namkurnalebi SemTxveva iyo, rentgenologiurad yvelas aReniSneboda moculobiTi infiltracia, mravlobiTi kavernebiT. mkurnalobis Sewyvetis ZiriTadi mizezi migracia iyo II rigis TB preparatebis toqsiurobiT gamowveuli gverdiTi movlenebi msubuqi gverdiTi movlenebi gemos SegrZnebis daqveiTeba madis daqveiTeba msubuqi dispepsiuri movlenebi msubuqi depresia saxsrebis msubuqi tkivili Tavbrusxveva gamonayari kanze mwvave gverdiTi movlenebi fsiqiuri aSliloba (Cs) smenis daqveiTeba/Zlieri Tavbrusxveva (Km) arTralgia (Z/Ofx) 26 (20.6%) 30 (23.8%) 22 (17.5%) 20 (15.9%) 10 (7.9%) 6 (4.8%) 5 (4%) 15 (12%) 5 (4%) 1 (1%) MDR-TB mkurnalobis gamosavali 76 (61%) 22 (17%) 4 (3%) SezRudvebi: • MDR-TB-is diagnostikis dagvianeba 3-5 TviT (arasrulyofili laboratoriuli momsaxureba, teritoriuli problemebi, didi populacia); • regionaluri DOTS wertilebis kargi muSaobis miuxedavad maT Soris cudi kolaboracia, regionebSi aradamakmayo-filebeli laboratoriuli momsaxureba; • individualuri samkurnalo reJimebis gamoyenebis SeuZlebloba; • xSiri migracia; daskvnebi: • gamoyenebuli samkurnalo reJimi 6(max9) KmCsOfxEthZ/12(max18)CsOfxEth efeqturia 79%-Si naxvelis konversia; 61%-is gankurneba; 3%-is uSedego mkurnaloba; 28%-Si wonis 6-10 kg-iT koreqcia, 20%-Si wonaSi <15 kg-iT mateba; • mkurnalobis pirvel TveebSi maRali sikvdilianobis mizezi dagvianebuli diagnostikaa • aucilebelia regionebis srulyofili laboratoriuli momsaxurebiT uzrunvelyofa (regionSi min. erTi laboratoria kvlevis swrafi meTodebiT _ hainis testebis danergva); • qveyanaSi meoradi rezistentobis maRali da pirveladi rezistentobis dabali maCveneblis gaTvaliswinebiT rekomendebulia DST-is Sedegebamde MDR-TB-is empiriuli reJimiT mkurnalobis dawyeba; • retrospeqtuli analizis safuZvelze da saerTaSoriso standartebis gaTvaliswinebiT cvlileba Sevida MDR-TB-is erovnul gaidlainSi _ standartul samkurnalo reJims VI preparatad daemata E; axali TB preparatebis SeqmnisaTvis mimdinare samecniero kvlevebi vizualuri masala parafinis magvari organuli nivTierebebisa da cilovani SenaerTisagan (Acyl Lipids) Semdgari wyalgaumtari Sre gram-dadebiTi baqteria lipid bilayer peptidoglycan mikobaqteria gram-uaryofiTi baqteria lipid + LPS porins acyl lipids MYCOLATE LAM arabinogalactan sensitiuri TB-is mkurnaloba I rigis preparatebiT MDR-TB-is mkurnaloba II rigis preparatebiT Semcirebuli arCevani XDR-TB-is mkurnalobisas preparatebi, romlebzeac mimdinareobs kvlevebi gmadlobT yuradRebisaTvis