Colchicine ƒe agbɔsɔsɔ fũ kple Gloriosa Lily ƒe Aɖi: Nusita Gout Atike Bubuwo Nono hena Dzoxɔxɔ Wua Ame¶

Kolchicine (Colcrys, . Mitigare, . Gloperba) - si nye alkaloid si tsia dzodzodzoetsitsi nu ƒe alafa ɖeka si woŋlɔ na gout flares, ƒome ƒe Mediterranea asrã (FMF), kple pericarditis - ƒe atikewɔwɔ ƒe fesre siwo le gbadzaa wu, siwo metsɔa ke o wu le atikewɔnyawo katã me la dometɔ ɖeka le esi. To vovo na ibuprofen alo acetaminophen, afisi dɔnɔ ate ŋu asusui vodadatɔe be yeate ŋu ano atikekui ʋɛ aɖewo kpee ne afɔbidɛ gãwo ƒe vevesese si le veve sem la mete ŋu nyo ɖe edzi o, colchicine atikekui 10 va ɖo 20 siwo wozãna ɖaa siwo ƒe kpekpeme nye miligram 0.6 ko mimi (miligram 6 va ɖo 12 le wo katã me, alo wu miligram 0.15 le kilogram ɖeka me) - alo nono esi sɔ gbesiagbe agbɔsɔsɔme kpe ɖe dɔlékuiwutike si bɔ si wɔa dɔ aduadu abe clarithromycin ene ŋu - hea aɖi dziŋɔ, si me aɖi le akpa eve me si me ŋutinu geɖe le si me atike si wodzrana le asi me aɖeke mele o. Aɖi si wua ame si sɔ la dzɔna ne nuɖuɖudilawo alo ɖeviwo ɖu Flame Lily (Gloriosa superba) alo Dada ƒe Akpɔkplɔ (Colchicum autumnale), alo ne wotsɔ podophyllin ( .podofilox) womia aŋɔ si wotsɔna ƒoa ƒui alo tsɔnɛ dea ŋutigbalẽ ƒe teƒe siwo keke. Ne ame aɖe no colchicine si wu atikekui 3 (1.8 mg) si woŋlɔ nɛ le gaƒoƒo 24 me, alo ɖu Colchicum alo Gloriosa numiemiewo la, ƒo ka na wò nutoa me tɔ xexlẽdzesi siwo wozãna kpata enumake - ne wose le wo ɖokui me be yewole nyuie keŋkeŋ le gaƒoƒo geɖe gbãtɔawo me gɔ̃ hã. Ne èdi aɖi kple ʋumenugbagbeviɣidɔ kpata siwo do ƒome kplii la, kpɔ ɖa gbemelãwo ƒe nuɖuɖu didi kple numiemie siwo me aɖi le ɖuɖu, . neutropenic fever kple ƒumeŋuɖui ƒe nutete, kple nuɖuɖu me aɖi, dɔgbo ƒe dɔléle sesẽ, kple tsikuɖiɖi.

Colchicine aɖi nye aɖi si wonya nyuie "silent time-bomb" toxin si sɔ kple amatoxin Death Cap mushrooms kple paraquat: le gaƒoƒo 2 va ɖo 12 ƒe heheɖemegbe si me dzesi aɖeke mele o si blea ame megbe la, Akpa 1 dzea aɖuɖɔtoe si me ʋu sina tona si le abe kolera ene kple hypovolemic shock, si kplɔe ɖo le gaƒoƒo 24 va ɖo 72 (Akpa 2) to dzitodzito ƒe ʋuʋu si womate ŋu axe mɔ na o, gbɔgbɔtsixetsixe (ARDS), aklã/ayiku ƒe dɔmawɔmawɔ nyuie, kple ƒumeŋuɖui ƒe aplasia blibo (ʋumenugbagbevi ɣiwo kple ʋumenugbagbevi dzĩwo ƒe zero).

Wɔ esia fifia¶

1. Ƒo ka na wò nutoa me ƒe xexlẽdzesi kpata kple Aɖidzikpɔƒe ƔEYIƔI ne ame aɖe mi colchicine atikekui siwo wu 3 (1.8 mg) le ŋkeke ɖeka me, alo Autumn Crocus / Gloriosa Lily agbɔsɔsɔme AÐEKAKE. Ƒo ka na 911 le United States kple Canada (US Poison Control 1-800-222-1222), 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 999 le United Kingdom, 000 le Australia (Aɖi Ŋuti Nyatakaka 13 11 26), alo kpɔ míaƒe nyatakakadzraɖoƒe si nye xexlẽdzesi siwo wozãna kpata. Mègalala gbeɖe be dɔgbo ƒe vevesese alo ʋuʋudedi nadze egɔme o; ne colchicine nya xɔ nu le dɔgboa me eye wòbla ɖe ŋutilãa ƒe lãmenugbagbeviwo me ko la, womate ŋu aɖee le ʋua me o.
2. Kpɔ kaba yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ le gaƒoƒo 1 va ɖo 2 gbãtɔwo me hena Activated Charcoal (Multidose Activated Charcoal). Esi wònye be colchicine toa enterohepatic recirculation geɖe me (aklãa ɖea colchicine si woxɔ la doa goe ɖe ʋumenugbagbeviɣia me, si gagbugbɔna ƒua gbe ɖe dɔgbo suea me ko be wòagaxɔe ake) ta la, kɔdzi activated charcoal nono enuenu gaƒoƒo 2 va ɖo 4 ɖesiaɖe léa colchicine ɖe dɔgboa me eye wònye mɔ ɖeka kolia si wɔa dɔ wu si dzi woato atɔ te agbɔsɔsɔ si wua ame be wòagaɖo dzia me o eye ƒumeŋuɖui.
3. DZO colchicine nono enumake ne woŋlɔ macrolide dɔlékuiwutike AMESIAME (clarithromycin alo erythromycin), dɔlékuiwutike (itraconazole, . ketoconazole), dzidɔtike ( .verapamil, . diltiazem), alo cyclosporine - alo ne èno weintsetse me tsi. Atike siawo xea mɔ na CYP3A4 enzyme kple P-glycoprotein efflux pump si kɔa colchicine, si trɔa gout ƒe agbɔsɔsɔ si wozãna ɖaa si me atikekui 2 le wòzua agbɔsɔsɔ si wua ame si wua ame zi gbɔ zi 10 le ememe.
4. Ne Akpa 1 ƒe ʋuʋudedi sesẽ kple tsi/ʋu ƒe aɖuɖɔtoe dze egɔme xoxo la, dze tsi ɖɔliɖɔli sesẽ gɔme esime nèle dɔnɔdzikpɔʋu lalam - eye MÈGANA atike siwo tsia aɖuɖɔtoetetedɔ nu GBEÐE o (loperamide / . Imodium). Colchicine nana lãmenugbagbeviwo ƒe mama le dɔgboa me tsia dzodzodzoe, si wɔnɛ be ʋumenugbagbevi dzĩ kple elektrikŋusẽ lita geɖe dona le dɔgboa me (cholera-like gastroenteritis). Loperamide alo bismuth subsalicylate nana léa colchicine si mexɔ o la ɖe dɔgboa me ale be aɖi geɖe wu gɔ̃ hã gena ɖe ʋukawo me.
5. Ne podophyllin (podofilox) ƒe ʋuʋudedi tsi kɔ ɖe ŋutigbalẽ ƒe akpa gãwo alo lãkusiwo dzi le vo me la, klɔ ŋutigbalẽa enumake eye nàtsɔ adzalẽ kple tsi si le sisim klɔ ŋutigbalẽa nyuie. Podophyllin resin si me wode tsii la xɔa nu kabakaba to ŋutigbalẽ si me gblẽ alo esi wovuvu me eye wòhea aɖi si sɔ kple mitotic-spindle, coma, peripheral neuropathy, kple ƒumeŋuɖui vɛ kpododonu.
6. Tsɔ colchicine atikekui ƒe aŋetu la vɛ (ale be ɖɔktawo nate ŋu axlẽ atikekui siwo bu eye woabu akɔnta pɛpɛpɛ mg/kg dose) alo numiemie ƒe bulb alo seƒoƒo si woɖu ƒe foto/kpɔɖeŋu. Nyanya ne dɔnɔa ɖui < 0.5 mg/kg, . 0.5 to 0.8 mg/kg, alo > 0.8 mg/kg enumake gblɔa dɔnɔa ƒe agbetsitsi ƒe nyagblɔɖi kple ICU ƒe nudidiwo na dɔnɔdzikpɔha si kpɔa dɔnɔwo gbɔ vevie.

Nyametsotsoti: colchicine, Gloriosa lily, kple podophyllin ƒe aɖi ƒe vovototodedeameme¶

flowchart TD
    A["Wosusu be Colchicine ƒe agbɔsɔsɔ si gbɔ eme, Gloriosa Lily / Autumn Crocus ɖuɖu, alo Podophyllin ƒe Dodokpɔ"] --> B{"Bu Colchicine ƒe agbɔsɔsɔ si nèɖu (le mg/kg le ŋutilã ƒe kpekpeme me) alo lé ŋku ɖe Atikewo ƒe Kadodowo ŋu"}
    B -->|"Gout ƒe agbɔsɔsɔme si sɔ + Clarithromycin / Verapamil / Cyclosporine + aɖuɖɔtoe/ʋuʋudedi yeye"| C["IATROGENIC COLCHICINE TOXICITY: Dzudzɔ atike eveawo siaa eye nàyi ER enumake"]
    B -->|"Agbɔsɔsɔ si gbɔ eme kpata < 0.5 mg/kg (e.g., 7 va ɖo 30 mg le ame tsitsi si ƒe kpekpeme nye kilogram 70 me) ."| D["AFƆKU GÃ: EMS tsɔtsɔ yi Gastric Lavage (ne < 1 hr) + Multidose Activated Charcoal"]
    B -->|"Agbɔsɔsɔ si gbɔ eme kpata 0.5 va ɖo 0.8 mg/kg (35 va ɖo 56 mg le ame tsitsi si ƒe kpekpeme nye kilogram 70 me) ."| E["Aɖi VEVIE SI ATE ŊU AVƆ AGBE: Kpɔ mɔ na GI ƒe ʋuʋu sesẽ + Ƒumeŋuɖui ƒe Aplasia (10% va ɖo 50% ƒe ku) ."]
    B -->|"Agbɔsɔsɔ si gbɔ eme kpata > 0.8 mg/kg (> 56 mg le ame tsitsi si ƒe kpekpeme nye kilogram 70 me) alo Gloriosa-tuber bliboa"| F["FULMINANT LETHAL DOSE (Egogo 80% va ɖo 100% ƒe ku): ICU / ECMO ƒe Ʋuʋu enumake"]
    C --> G["Akpa 1 (Gaƒoƒo 2 vaseɖe 24): IV Crystalloid Gbugbɔgadzɔ Dzikutɔe na GI Tsi si Le abe Kɔlera ene ƒe Bubu"]
    D --> G
    E --> G
    F --> G
    G --> H["Akpa 2 (Ŋkeke 1 vaseɖe 7): ICU Dzidɔ ƒe Kpekpeɖeŋu (Norepinephrine/VA-ECMO) + G-CSF (Filgrastim) na Neutropenia"]

Alesi colchicine kple podophyllin wua lãmenugbagbeviwoe: mitotic spindle la ƒoƒo¶

Be nàse nusita colchicine ƒe aɖi le abe nuɖuɖu me aɖi sesẽ ene gbã, emegbe abe dzidɔ gã aɖe ene, eye le ŋkeke atɔ̃ megbe abe keklẽŋusẽdɔléle sesẽ alo ʋumenugbagbeviɣidɔ ƒe atikewɔmɔnu ƒe aɖi ene gɔme la, lé ŋku ɖe alesi molecule la wɔa dɔ le amegbetɔ ƒe lãmenugbagbevi ɖesiaɖe me ŋu.

Microtubule depolymerization kple lãmenugbagbeviwo ƒe mama ƒe léle le metaphase me¶

Lãmenugbagbevi gbagbe ɖesiaɖe si le amegbetɔ ƒe ŋutilã me la me ƒunukpeƒe ƒe wɔwɔme ememetɔ kple mɔdodo gã ƒe ɖoɖo si wotsɔ protein-mɔ̃ siwo me do le siwo woyɔna be microtubules, siwo woƒo ƒu tso xɔtunu siwo woyɔna be alpha-tubulin kple beta-tubulin dimers me la le. Microtubules wɔa dɔ vevi eve:

1. **Mitotic Spindle le lãmenugbagbeviwo ƒe mama me (mitosis).
2. Lãmenugbagbeviwo me ʋuɖoɖo kple dzitodzito ƒe ʋuʋu le lãmenugbagbevi siwo mema o me: Dzitodzito me lãmeka ƒe lãmenugbagbeviwo me (cardiomyocytes), ahɔhɔ̃mekawo, kple aklã me lãmenugbagbeviwo, microtubules wɔa dɔ abe mɔ̃ siwo tsɔa mitochondria, calcium mɔwo, kple ahɔhɔ̃mekawo toa lãmenugbagbevi la me ene.

Colchicine (kple podophyllotoxin si tso Mayapple numiemie / ʋuʋudedi ƒe aŋɔ me, kple vinca alkaloids siwo wozãna le kansa ƒe atikewɔwɔ me) blana kple beta-tubulin dimers siwo me wodea tsii si womate ŋu atrɔ o kloe, si xea mɔ na microtubule ƒe nuwuwu si le tsitsim ale be wòʋuna eye wòlɔna (microtubule depolymerization).

• Le lãkusi siwo ma kabakaba me (Gut mucosa kple Bone marrow): Lãmenugbagbevi ɖesiaɖe si le mamam la tsia tsikpe tegbee le lãmenugbagbeviwo ƒe mama titina (metaphase arrest) eye wòtoa lãmenugbagbeviwo ƒe ku si ŋu wowɔ ɖoɖo ɖo me (apoptosis). Esi wònye be lãmenugbagbevi siwo le wò dɔgbo suea me la ɖɔlia wo ɖokui gaƒoƒo 24 va ɖo 48 ɖesiaɖe ta la, dɔgbo bliboa tsia dzodzodzoe le Ŋkeke 1 (Afɔɖeɖe 1 si le abe kolera ene). Esi wònye be ʋumenugbagbevi ɣiwo kple ʋumenugbagbevi dzĩ siwo le wò ƒumeŋuɖui me ɖɔlia wo ɖokui le ŋkeke 3 va ɖo 5 ɖesiaɖe ta la, wò dɔlélenutsiŋutete bliboa kple ʋu ƒe sisi ƒe ŋutete nu yina le Ŋkeke 3 va ɖo 7 (Afɔɖeɖe 2 pancytopenia kple sepsis).
• Le dzi ƒe lãmeka kple lãmeka ƒe lãmenugbagbeviwo me: Microtubule network ƒe ʋuʋu le dzitodzito ƒe lãmenugbagbeviwo me gblẽa sarcoplasmic calcium ƒe dɔwɔwɔ kple mitochondrial ŋusẽ ƒe tsɔtsɔ me, si wɔnɛ be dzitodzito ƒe ʋuʋu tẽ, dzitodzito ƒe ʋuʋu si mexɔa dɔ o, dzi ƒe ʋuʋu blibo, kple asystole kpata le gaƒoƒo 24 va ɖo 72 me.

Nusita ʋumenugbagbeviɣidɔ kple ʋudodo MATEŊU aɖe colchicine ɖa le ŋutilãa me o¶

To vovo na caffeine, lithium, alo salicylates (aspirin), siwo nɔa ʋukawo ƒe ʋumenugbagbeviɣi si me tsi le me afisi ʋumenugbagbeviɣimɔ̃ ate ŋu akɔ wo le la, colchicine si woxɔ la ƒua du dona le ʋuka me le gaƒoƒo 1 va ɖo 3 me eye wòxea tubulin proteins le ŋutilãa ƒe lãkusi sesẽwo me goglo, si wɔnɛ be woama a agbɔsɔsɔ gã aɖe (Vd = 2 to 12 L/kg, va ɖo 21 L/kg ne wozãe wògbɔ eme). Esi wònye be ŋutilã ƒe colchicine si mede 1 va ɖo 2 le alafa me o gakpɔtɔ nɔa tsia dzi le ʋua me ta la, viɖe aɖeke mele ʋumenugbagbeviɣidɔ, ʋumenugbagbeviɣidɔ, kple ʋu si wodona ɖe ʋuka me ŋu kura le colchicine ɖeɖeɖa me o (togbɔ be wogazãa ʋumenugbagbeviɣidɔ tsɔ doa alɔ dɔnɔ siwo ƒe ayikuwo mewɔa dɔ nyuie le Akpa 2 lia me o hã). Esia tae dɔgbo ƒe ɖiƒoƒo ɖa kaba kple Multidose Activated Charcoal do ŋgɔ na enterohepatic recycling kple le eƒe dɔwɔwɔ me le vevie ŋutɔ ɖo.

Se si wotu ɖe amewuwu dzi si wotu ɖe kpekpeme dzi (Bismuth & Baud classification) .¶

Le aɖiŋutinunya si wozãna le atikewɔnyawo me (si Bismuth, Baud, kple eƒe dɔwɔhati siwo le Paris Aɖinuwo Dzikpɔƒe ɖo anyi gbã) me la, wogblɔa alesi dɔnɔ aɖe tsi agbe le colchicine nono wògbɔ eme kpata megbe ɖi wòdea pɛpɛpɛ to akɔntabubu le miligram agbɔsɔsɔme si woɖu ŋu si woma ɖe dɔnɔa ƒe kpekpeme nu le kilogram me (mg/kg):

Colchicine kple Gloriosa Lily ƒe aɖi ƒe dɔdamɔnu ƒe akpa vovovo etɔ̃awo¶

Colchicine ƒe aɖi zɔna to dɔdamɔnu ƒe akpa etɔ̃ siwo kplɔ wo nɔewo ɖo me le ŋkeke 10 va ɖo 14 me:

Akpa 1: Dɔgbo & Hypovolemic Akpa (Gaƒoƒo 2 va ɖo 24 le nuɖuɖua ɖuɖu vɔ megbe) .¶

• Fesre ɣaɣla si xɔa gaƒoƒo 2 va ɖo 12 si blea ame: Le gaƒoƒo 2 va ɖo 6 gbãtɔ siwo me wòmi colchicine atikekuiwo ƒe agbɔsɔsɔ fũ alo Gloriosa / Colchicum bulb siwo woɖa vɔ la, dɔnɔa sena le eɖokui me be yesɔ keŋkeŋ (negbe dzobibi fafɛ ɣeaɖewoɣi le nu kple ŋɔti me ne eɖu numiemie ƒuƒu). Mègaflu wò be nànɔ aƒeme le fesre sia si me ɖoɖoezizi le la me o.
• Explosive "Cholera-Like" Gastroenteritis (Gaƒoƒo 6 va ɖo 24): Ne dɔgbo ƒe crypt mitosis nu tso eye mucosal cells le ʋuʋum la, dɔnɔa va xɔa ʋuʋudedi sesẽ, si womate ŋu akpɔ o, ʋuʋudedi, ƒodo ƒe ʋuʋu si kaka vevesesetɔe, kple aɖuɖɔtoe gã, si yia edzi, si me tsi le eye ʋu le dodom le "bli-tsi" me.
• Hypovolemic Shock kple Electrolyte Collapse: Tsi siwo bu tso dɔgboa me ateŋu agbɔ lita 5 va ɖo 10 (galɔn 1.3 va ɖo 2.6) le gaƒoƒo 24 me, si ana hypovolemic shock sesẽ, prerenal acute kidney injury, metabolic lactic acidosis, hypokalemia, hyponatremia, hypocalcemia, kple wode dzesii be early leukocytosis (ʋumenugbagbevi ɣiwo ƒe xexlẽme ƒe dzidziɖedzi si wɔa dɔ le gɔmedzedzea me wu 20,000/mcL hafi ƒumeŋuɖui la nagbã).

Akpa 2: Ŋutinu Geɖewo ƒe Dɔmawɔmawɔ, Dzidɔ, Kple Ƒumeŋuɖui ƒe Aplasia Akpa (Ŋkeke 1 vaseɖe 7) .¶

Abe alesi wòdze abe ʋuʋudedi kple aɖuɖɔtoea dzi ɖena kpɔtɔna le Gaƒoƒo 24 va ɖo 36 lɔƒo ene la, dɔnɔa gena ɖe akpa evelia si wua ame me:

1. Refractory Cardiogenic Shock and Arrhythmias (Gaƒoƒo 24 va ɖo 72 - Nu Vevitɔ si gbɔ Ku tsona):
2. Tubulin ƒe tsɔtsrɔ̃ tẽ le dzitodzito me lãmenugbagbeviwo me hea dzitodzito eve ƒe dɔmawɔmawɔ nyuie vɛ (left ventricular ejection fraction dropping below 15% to 20%), ʋusɔgbɔdɔ si nu sẽ si dzudzɔa dɔwɔwɔ ɖe ʋu me tsiwo kple ʋuka siwo tea ʋukawo ŋu, sinus bradycardia, atrioventricular heart block keŋkeŋ, ventricular tachycardia, kple asystolic cardiac arrest kpata.
3. Ƒemekawo ƒe Aplasia / Pancytopenia Blibo (Ŋkeke 3 vaseɖe 7):
4. Le Ŋkeke 3 kple Ŋkeke 7 dome la, dɔnɔa ƒe neutrophil xexlẽme bliboa ɖiɖina ɖoa zero (agranulocytosis) eye ʋumenugbagbevi dzĩwo ɖiɖina ɖe anyi wu 10,000 va ɖo 20,000/mcL (severe thrombocytopenia).
5. Elabena dɔgboa ƒe akpa si woɖe ɖa la bu mɔxenu si xea mɔ na dɔgboa me dɔlékuiwo le ɣeyiɣi ma ke si tututu me ʋumenugbagbevi ɣi siwo nye Gram-negative dɔlékui (E. coli, Klebsiella, Pseudomonas) kɔna tẽ tso dɔgboa me yia ʋukawo me, si hea fulminant neutropenic septic shock kple Disseminated Intravascular Coagulation (DIC) vɛ.
6. Yagbɔgbɔ ƒe Nuxaxa Sesẽ (ARDS), Rhabdomyolysis, kple Ascending Paralysis:
7. Ʋuka siwo me ʋu sina tona le lãkusiwo me hea aklã me ʋuʋu si menye dzitodzito vɛ o vɛ (ARDS) si hiã be woatsɔ mɔ̃ awɔ yae.
8. Ƒumeŋuɖui ƒe lãmeka kple axonal microtubule ƒe gbegblẽ tẽ hea myoneuropathy sesẽ vɛ (lãmeka si te ɖe eŋu ƒe gbɔdzɔgbɔdzɔ si srɔ̃a Guillain-Barré ƒe dɔlélea, creatine kinase si dzi ɖe edzi rhabdomyolysis, kple reflexes ƒe bu), tsɔ kpe ɖe aklã ƒe abixɔxɔ sesẽ, dɔgbo ƒe dɔléle, kple paralytic ileus ŋu.

Akpa 3: Gbɔdzɔe & Total Alopecia Akpa (Ŋkeke 7 vaseɖe Kwasiɖa 3+) .¶

Ne dɔnɔa tsi agbe le dzitodzito kple tsiɖɔɖɔ ƒe kuxi si nye Akpa 2 lia me le ICU:

• Rebound Leukocytosis: Ƒumeŋuɖui ƒe lãmenugbagbeviwo gadzea mama gɔme ake le Ŋkeke 7 va ɖo 10 lɔƒo, si wɔnɛ be ʋumenugbagbevi ɣiwo ƒe xexlẽme gagbugbɔna kabakaba.
• Taɖa ƒe ŋeŋe bliboe, si wɔ nuku ŋutɔ (Total Alopecia): Le Ŋkeke 7 va ɖo 14 lɔƒo la, esi taɖa ƒe ƒuƒoƒo ƒe lãmenugbagbeviwo ma kabakaba abe atikewɔdɔlélawo ene ta la, taɖa, ŋkume, kple ŋutilã ƒe fuwo katã gena ɖe ƒuƒoƒo me (egatsina keŋkeŋ mlɔeba le ɣleti 3 va ɖo 6 me). Ahɔhɔ̃mekawo ƒe dɔléle ƒe gbɔdzɔgbɔdzɔ ate ŋu axɔ kwasiɖa alo ɣleti geɖe ƒe ŋutilã ƒe ɖɔɖɔɖo hafi woakpɔ egbɔ.

Atike Siwo Wua Ame ƒe Kadodo: Alesi gout ƒe atikekui 2 ƒe agbɔsɔsɔ si sɔ va zua agbɔsɔsɔ si wua ame¶

Colchicine si woŋlɔ na ame ƒe aɖi si wua ame le kɔdziwo ƒe afã kple edzivɔ metsoa atikekui siwo woɖo koŋ zã wògbɔa eme gbɔ o**; wodzɔna le dɔnɔ siwo noa woƒe colchicine-tike siwo woŋlɔ na wo edziedzi siwo ƒe kpekpeme nye mg 0.6 siwo wona dɔlékuiwutike alo dzidɔ si bɔ le ɣeyiɣi ɖeka me, alo amesiwo ŋu ayiku alo aklãdɔléle si nɔa anyi didi le la dzi.

Eƒe... CYP3A4 kple P-glycoprotein (P-gp) mɔ̃ si wotsɔna ɖea nu me¶

Zi geɖe la, amegbetɔ ƒe lãmenugbagbeviwo tsɔa nugbagbeviwo ƒe pɔmpi eve kpɔa wo ɖokui ta tso colchicine si me:

1. P-glycoprotein ( .P-gp / . ABCB1): Lãmenugbagbeviwo ƒe sisi ƒe pɔmpi si le dɔ wɔm le dɔgbo ƒe lãmenugbagbeviwo, aklã ƒe biliary canaliculi, kple ayiku ƒe ʋukawo ƒe anyime si tsɔa colchicine doa goe le lãmenugbagbeviwo me yia aɖuɖɔ kple aɖuɖɔ me vevie.
2. Cytochrome P450 3A4 (CYP3A4): Aklã me enzyme si ɖea colchicine ƒe dɔmawɔmawɔ nyuie ɖa eye wònaa wòwɔa dɔ.

Numiemie siwo ƒe dzedzeme sɔ kple wo nɔewo: Gloriosa Superba (Dzobi ƒe Lily) kple Colchicum Autumnale (Adame Crocus) .¶

Colchicine dzadzɛ gbogbo aɖe le dzɔdzɔme numiemie eve siwo wodona le teƒe geɖe siwo nye atsyɔ̃ɖonuwo kple gbemelãwo me eye wohea aɖi wuame gbogbo aɖewo vɛ ƒe sia ƒe le aƒeme abɔdzikpɔlawo, gbeme-galik-nuɖulawo, kple ɖeviwo dome:

1. Colchicum autumnale (Dada ƒe Crocus / Gbedadaƒo Saffron / Nyɔnu Amama) .¶

• Gbegbe me Galik (Allium ursinum / Ramps) Foraging Trap: Le kele me la, Colchicum autumnale ɖoa aŋgba dama dama siwo le abe akplɔ ene siwo le keklẽm tso anyigba te bulb siwo le Europa kple Dziehe Amerika gbedadaƒo siwo xɔ dzo me - zi geɖe la, wotsina le Wild Garlic si woate ŋu aɖu la xa tututu (Allium ursinum / bear ƒe galik) alo ramps. Nuɖuɖudila siwo le gbeme galik aŋgbawo fɔm hena pesto alo mɔli la ƒoa Colchicum aŋgbawo nu ƒu kpe ɖe galik la ŋu le vo me.
• Alesi woade vovototo wo dome: Ne wogbã gbeme galik ƒe aŋgba si woate ŋu aɖu la, eɖea galik ƒe ʋeʋẽ sesẽ si ŋu ɖikeke mele o dona, eye eƒe aŋgbawo tsina ɖe ke ɖekaɖeka siwo tso bulb la me dzi; aɖi Colchicum autumnale aŋgbawo ƒe ʋeʋẽ lilili nye ZERO galik, wosẽna wu, eye woxatsaa wo nɔewo sesĩe le akɔta si wotsɔ ƒo xlãe me le eƒe gɔme. Colchicum aŋgba alo seƒoƒo ʋɛ aɖewo ko ɖuɖu naa colchicine ƒe agbɔsɔsɔ si wua ame. (De dzesii: Colchicum autumnale hã to vovo kura tso nuɖaɖa ƒe nu ʋeʋĩ vavãtɔ Saffron [Crocus sativus], si nye iris ƒomea me tɔ Iridaceae eye stigmas 3 le esi, gake aɖi Colchicum ya nye etɔ Colchicaceae eye stamen 6 le esi).

2. Gloriosa superba (Dzobi Lily / Ŋutikɔkɔe Lily / Lily Lili) .¶

• The Sweet Potato / Yam / Ginger Tuber Trap: Gloriosa superba nye weinka si lialia le teƒe xɔdzowo si wɔa nuku ŋutɔ eye seƒoƒo ƒe aŋgba siwo le abe dzobibi ene siwo ƒe amadede nye dzĩ kple ɣie la, wodona le Asia, Afrika, Australia, kple abe atsyɔ̃ɖoɖo ƒe aƒemenumiemie ene le United States kple Europa. Le anyigba te la, etsia lã **anyigba te atikutsetse siwo le abe V alo L ene siwo ɖi mɔli vivi, yam, cassava, alo ginger ke wòɖe dzesi ŋutɔ.
• Amewuwu si gbɔ eme: Gloriosa superba tuber ɖeka si ƒe kpekpeme nye gram 20 va ɖo 50 la me colchicine kple gloriosine dzadzɛ miligram 60 va ɖo 150 - si sɔ gbɔ be wòawu ame tsitsi eve va ɖo etɔ̃. Amesiame si ɖa Gloriosa tuber le vo me eye wòɖui la hiã be woaɖe dɔgbo ƒe ɖiƒoƒo ɖa le kɔdzi enumake hafi dɔgbo ƒe ʋuʋu gbãtɔ nadze egɔme gɔ̃ hã.

Podophyllin ( .Podofilox / Mayapple) Aɖi: afɔku si wotsɔna ƒoa ƒui si woyɔna be wart-resin¶

Podophyllin nye numiemie ƒe aŋɔ si wotsɔ ƒo ƒu si woɖe tso Amerika Mayapple (Podophyllum peltatum), si me aɖi si nye microtubule si le dɔ wɔm podophyllotoxin ( .podofilox / . Condylox). Woŋlɔe be wòanye 0.5% solution/gel alo wotsɔe ƒo ƒu abe 10% va ɖo 25% benzoin tincture ene be woatsɔ atɔ dzo vidzinuwo ƒe ʋuʋudedi (condyloma acuminata) kple afɔkpodzi ƒe ʋuʋudedi.

• Alesi aɖi dzɔnae: Vidzĩ si le zɔzɔm ƒe aŋetu si ɖea ʋuʋudedi mimi le vo me, Mayapple atikutsetse/ke dama siwo metsi o ɖuɖu le ave me, alo podophyllin resin 10% va ɖo 25% sisi ɖe vidzinu alo ƒunukpeƒe ƒe ʋuʋudedi gã, ƒuƒu, si me ʋu le dodom le dzi eye mete ŋu klɔe le gaƒoƒo 1 va ɖo 4 megbe o (ɖe mɔ na wò be wòalolo ŋutɔ ɖoɖowɔɖi ƒe ʋuʋudedi to ŋutigbalẽ me).
• Ahɔhɔ̃mekawo ƒe ʋuʋu tɔxɛ kpe ɖe ƒumeŋuɖui ƒe dɔmawɔmawɔ nyuie ŋu: Abe colchicine ene la, podophyllin xea mitotic spindle eye wòhea Akpa 1 ƒe ʋuʋudedi/aɖuɖɔtoe sesẽ vɛ eye Akpa 2 kplɔnɛ ɖo ƒumeŋuɖui ƒe pancytopenia, aklã ƒe dɔmawɔmawɔ nyuie, kple dzidziƒoame. Tsɔ kpe ɖe eŋu la, podophyllin tsoa ʋu kple ahɔhɔ̃ ƒe mɔxenu la sesĩe wu colchicine, si hea acute central nervous system encephalopathy (tɔtɔ, nukpɔkpɔ ƒe susumenuwo, kuviawɔwɔ, alɔ̃madɔmadɔ, alɔ̃madɔmadɔ) vɛ le gaƒoƒo 6 va ɖo 24 me, eye sensorimotor peripheral neuropathy (sensorimotor peripheral neuropathy (nu ƒe ʋuʋu, vevesese si le dzo dam, kple afɔ/asibidɛ ƒe ɖiɖi) kple autonomic ileus.

Kɔdzi ƒe ICU dzikpɔkpɔ le Colchicine kple Podophyllin ƒe aɖi ŋu¶

1. Gastric Lavage Enumake (le miniti 60 me) kple Multidose Activated Charcoal (MDAC):
2. Esi wònye be ku si wu 0.5 va ɖo 0.8 mg/kg sɔ gbɔ ŋutɔ eye ʋumenugbagbeviɣidɔ do kpo nu ta la, atikewɔlawo wɔa nasogastric aspiration/lavage kaba ne dɔnɔa va ɖo le gaƒoƒo 1 me tso esime wònoe eye wodoa activated charcoal (50 g le gɔmedzedzea me, eye wotsɔa 25 g kplɔe ɖo gaƒoƒo 2 va ɖo 4 ɖesiaɖe) kpe ɖe IV ondansetron ŋu be wòatso enterohepatic biliary nusiwo wogbugbɔ zãna.
3. Aggressive Early Hemodynamic Resuscitation kple VA-ECMO:
4. Crystalloid tsi gã aɖe ɖɔliɖɔli (0.9% normal saline alo Ringer's lactate) si wofia mɔe to abadzivɔ ƒe echocardiography dzi le Akpa 1 lia me, etrɔna kabakaba yia norepinephrine / epinephrine dodo kple Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) ƒe gɔmedzedze ne dzitodzito ƒe dzidziɖedzi si mexɔa dzo o do mo ɖa le Akpa 2 lia me (VA-ECMO xɔ na dɔnɔ gbogbo aɖewo siwo ɖu > 0.8 mg/kg vaseɖe esime woƒe dzitodzito me ʋuka suewo gagbugbɔ wɔ le ŋkeke 5 va ɖo 7 megbe).
5. Nu si doa ŋusẽ Granulocyte Colony Gbãtɔ (G-CSF / . Filgrastim) kple Neutropenic Sepsis ƒe Mɔxexeɖenu:
6. Hafi ʋumenugbagbevi ɣiwo ƒe xexlẽme dze ɖiɖi gɔme le Ŋkeke 2 va ɖo 3 ko la, ʋumenugbagbeviɣiŋutinunyalawo kple aɖiŋutinunyalawo doa filgrastim (G-CSF, 5 mcg/kg/ŋkeke) be wòaʋã ƒumeŋuɖui me lãmenugbagbevi siwo tsi agbe eye wòana neutropenia si wua ame ƒe ɣeyiɣi didi nanɔ kpuie, tsɔ kpe ɖe dɔlékuiwutike siwo wodona ɖe ʋuka me siwo ƒe dɔwɔwɔ keke ta ŋu (cefepime, . piperacillin-tazobactam, alo meropenem) kple ʋumenugbagbevi dzĩwo dodo.
7. Numekuku Colchicine-Specific Fab Antibody Fragments: Le Europa aɖiŋutinunyaƒe tiatia aɖewo (France), dodokpɔ colchicine-koŋ ƒe ovine Fab fragments (siwo ƒe ɖoɖo sɔ kple Digibind/DigiFab si wozãna na digoxin ƒe agbɔsɔsɔme si gbɔ eme) he colchicine tso lãmenugbagbeviwo me dzidzedzetɔe yi ɖe aɖuɖɔ me eye wòtrɔ dzitodzito ƒe dzidziɖedzi si wua ame ne ele edzi veveseseɖeamenu-zã ƒe ɖoɖowɔɖiwo.

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

• United States kple Canada: Ƒo ka na 911 kple US Aɖidzikpɔkpɔ le 1-800-222-1222 (Canada: 1-844-POISON-X). United States ƒe Nuɖuɖu Kple Atike Ŋuti Dɔwɔƒe (FDA) Colcrys (Colchicine) Dedienɔnɔ ƒe Dzesidede de se be woatsɔ 1.8 mg maximum 3-tablet acute gout flare cap (1.2 mg kplɔe ɖo 0.6 mg le gaƒoƒo 1 megbe) eye wòtsɔa Black Box ƒe tsitretsitsi ɖe colchicine zazã ɖekae kple CYP3A4/ .P-gp mɔxexeɖedɔlékuiwo (clarithromycin, . ritonavir/Paxlovid, . cyclosporine) le dɔnɔ siwo ƒe ayiku alo aklã me gblẽ ŋu.
• United Kingdom: Ƒo ka na 999 enumake ne èxɔ colchicine alo Colchicum ƒe agbɔsɔsɔ si wosusu be ezã wògbɔ eme. Eŋlisiawo ƒe Atikewo Kple Lãmesẽnyawo Gbɔkpɔha ƒe Dɔwɔƒe (MHRA) kple Dukɔa ƒe Aɖiwo Ŋuti Nyatakaka Dɔwɔƒe (NPIS / TOXBASE) bu colchicine zazã fũu akpa AMESIAME alo le vo me be enye atikewɔwɔ kpata si ate ŋu ade ame ƒe agbe afɔku me si abia be woaxɔ ame ɖe kɔdzi enumake, Multidose Activated Charcoal, eye woalé ŋku ɖe dzi/nu gbagbewo ƒe dɔwɔwɔ ŋu gaƒoƒo 24 ya teti ne dzesi aɖeke mele eŋu o gɔ̃ hã.
• Europa Dukɔwo ƒe Habɔbɔ: Ƒo ka na 112. Europa Alliance of Associations for Rheumatology (EULAR) ƒe gout ŋuti mɔfiamewo kple Franseawo ƒe Aɖiŋutinunyalawo ƒe Habɔbɔ / Europa Aɖiŋutinunyalawo ƒe Habɔbɔ kple Aɖiŋutinunyalawo ƒe Habɔbɔ (EAPCCT) ƒe ɖoɖowo fiaa mɔ colchicine si ƒe agbɔsɔsɔme le sue ŋɔŋlɔ, macrolide ƒoƒo asa na vevie, kple ICU/VA-ECMO ɖoɖo ɖe ame kaba hena nuɖuɖu >= 0.5 mg/kg.
• Australia kple New Zealand: Ƒo ka na 000 le Australia (Aɖi Ŋuti Nyatakaka 13 11 26) alo 111 le New Zealand (0800 764 766). Atikewɔwɔ ƒe Adzɔnuwo Dzikpɔƒe (TGA) kple Medsafe NZ xlɔ̃ nu vevie tso "no vaseɖe esime aɖuɖɔtoe" gout ƒe agbɔsɔsɔme ŋu.
• India kple Asia-Pacific: Ƒo ka na 112 le India, 995 le Singapore, 119 le Japan kple South Korea, alo 999 le Malaysia kple Hong Kong. Le India kple Sri Lanka la, Gloriosa superba (Karthigai Kilangu / Niyagala) tuber aɖi nye nu vevi aɖe si wonya be ehea aɖi ƒe pancytopenia sesẽ kple dzitodzito ƒe ʋuʋu vɛ si hiã be woaɖoe ɖe kɔdzi etɔ̃lia enumake. Kpɔ míaƒe nyatakakadzraɖoƒe si nye dukɔwo dome xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu.

Nya siwo wobiaa amewo enuenu¶

Nukae nye colchicine atikekui agbɔsɔsɔme si le dedie wu si woano na gout ƒe amedzidzedze sesẽ?¶

Egbegbe FDA kple dukɔwo dome lãmekaŋutinunya ƒe mɔfiamewo (siwo wotu ɖe AGREE ƒe dɔdamɔnu dodokpɔ ɖedzesi dzi) ɖo kpe edzi be agbɔsɔsɔ si le dedie eye wòwɔa dɔ nyuie wu na gout ƒe dɔléle sesẽ le ame tsitsi si ƒe ayiku kple aklã sɔ gbɔe nye atikekui eve siwo ƒe lolome nye miligram 0.6 (1.2 mg) siwo woano le dɔlélea ƒe dzesi gbãtɔ me, eye woatsɔ atikekui 0.6-milligram 0.6 (0.6 mg) bubu ÐEKA pɛ ko akplɔe ɖo le gaƒoƒo 1 pɛpɛpɛ megbe - na atikekui 3 (1.8 mg) ƒe ƒuƒoƒo. Emegbe ele be nàtɔ ahalala gaƒoƒo 72 ya teti hafi awɔ acute flare course bubu. Atikekui 6, 10, alo 15 nono le ŋkeke ɖeka me menaa gout ƒe vevesese nu yina kabakaba o eye ate ŋu ahe aɖi si wua ame le ŋutinu geɖe me vɛ.

Nukatae ɖɔktawo gblɔna na gout dɔnɔwo tsã be woayi edzi anɔ colchicine nom gaƒoƒo ɖesiaɖe vaseɖe esime woaxɔ aɖuɖɔtoe, eye nukatae wodzudzɔ ema?¶

Ƒe bla nanewo hafi woawɔ egbegbe atikewo ƒe agbɔsɔsɔme ŋuti numekukuwo la, atike siwo tsia dɔdzẽ nu siwo le dedie menɔ atikewɔlawo si o eye woɖo ŋu ɖe ƒe alafa 19 lia me se aɖe si wokpɔ le nuteƒekpɔkpɔ me si nye be woana colchicine ƒe atikekui 1 gaƒoƒo ɖesiaɖe vaseɖe esime dɔnɔa naxɔ aɖuɖɔtoe kple aɖuɖɔtoe sesẽwo. Atikewɔwɔ me aɖiŋutinunyalawo va kpɔe mlɔeba be aɖuɖɔtoe si colchicine hena vɛ menye nugbegblẽ aɖeke o - enye dzesi tẽ be atike la de aɖi eye wòwu lãmenugbagbevi siwo le mamam siwo le wò dɔgbo suea me, eye be agbɔsɔsɔ si hea aɖuɖɔtoe vɛ la sɔ kple agbɔsɔsɔme si nana ƒumeŋuɖuiwo mewɔa dɔ nyuie o eye dzidɔ si wua ame.

Nukatae wònye afɔku be woano dɔlékuiwutike si nye clarithromycin alo COVID-19 Paxlovid esime wole colchicine nom gbesiagbe?¶

Wò ŋutilã ɖoa ŋu ɖe lãmenugbagbeviwo ƒe pɔmpi si woyɔna be P-glycoprotein kple aklã me enzyme si woyɔna be CYP3A4 ŋu be woatsɔ colchicine ado goe le wò lãmenugbagbeviwo me ayi ʋumenugbagbeviɣi kple aɖuɖɔ me ale be wòagaƒo ƒu o. Clarithromycin (Biaxin), erythromycin, atike siwo wua fungi abe itraconazole, kple ritonavir ƒe akpa si le COVID-19 Paxlovid me la tsi P-glycoprotein kple CYP3A4 siaa nu keŋkeŋ. Ne èyi edzi le wò colchicine-tike 1 alo 2 nom gbesiagbe esime nèle clarithromycin alo Paxlovid nom la, colchicine léa wò dzi kple ƒumeŋuɖui me le agbɔsɔsɔ si sɔ ƒe teƒe 3 va ɖo 4, si wɔnɛ be aɖi si wua ame le ŋkeke aɖewo megbe.

Ne ame aɖe mi colchicine-tike bubuwo gaƒoƒo 3 enye sia eye wògase le eɖokui me kokoko be yeƒe lãme sẽ 100% la, ɖe wòdo le afɔku mea?¶

Ao - fesre ma si me dzesi aɖeke mele o ye nye mɔ̃ si me afɔku le wu le colchicine ƒe aɖi me. Colchicine xɔa gaƒoƒo 2 va ɖo 12 hafi wògblẽa microtubule spindles siwo le dɔgboa ƒe lãmenugbagbevi siwo ma me, eyata dɔnɔ ɖesiaɖe senɛ le eɖokui me be yeƒe lãme sẽ keŋkeŋ le gaƒoƒo geɖe gbãtɔwo me le agbɔsɔsɔ si wua ame mimi vɔ megbe. Lala le aƒeme vaseɖe esime ʋuʋudedi sesẽ kple aɖuɖɔtoe si me ʋu le nadze egɔme fia be aɖia do le dɔgboa me xoxo eye wòtu ɖe dzi ƒe lãmeka kple ƒumeŋuɖui me si womate ŋu atrɔ o, afisi ʋumenugbagbeviɣidɔ mate ŋu aɖo o. Ne èyi xɔ si me wokpɔa dɔnɔwo gbɔ kpata le le gaƒoƒo 1 va ɖo 2 gbãtɔ siwo me tomefafa le me hena dzoka xɔxɔ si wotsɔ wɔa dɔe ate ŋu axɔ dɔnɔa ƒe agbe.

Aleke Autumn Crocus alo Gloriosa Lily numiemiewo dea aɖi amewo le vo me?¶

Le kele me la, Autumn Crocus (Colchicum autumnale) ƒe aŋgba siwo me aɖi le la miena le gbenyigba xɔdzowo dzi le gbe me galik si woate ŋu aɖu (Allium ursinum / ramps) xa tututu; nuɖuɖudila siwo mesea aŋgba ɖesiaɖe ƒe ʋeʋẽ hena galik ƒe ʋeʋẽ o la tsɔa Colchicum aŋgbawo tsakaa gbeme-galik pesto alo mɔli le vo me. Le nuto xɔdzowo kple teƒe xɔdzowo (kple le aƒe siwo me atsyɔ̃ɖonu lilitiwo le me) la, Flame Lily (Gloriosa superba) ƒe anyigba te ƒe aŋgbawo le abe mɔli suewo, yam, alo ginger ke ene, eye aŋe afã gɔ̃ hã ɖuɖu naa colchicine ƒe agbɔsɔsɔ gã aɖe si wua ame.

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• U.S. Nuɖuɖu Kple Atike Ŋuti Dɔwɔƒe (FDA, United States): Nyatakaka Kple Atikewo Ŋɔŋlɔ Ŋuti Mɔfiame na Colcrys (Colchicine, USP) Atikekuiwo kple FDA Atikewo ƒe Dedienɔnɔ Ŋuti Kadodo: Atikewo ƒe Kadodo Si Wua Ame Le Colchicine Kple P-Glycoprotein / CYP3A4 Mɔxenu Sesẽwo Dome (Clarithromycin, Cyclosporine, Ritonavir) ƒe atike.
• Terkeltaub R. A. kple exɔlɔ̃wo. (Arthritis & Rheumatism, The AGREE Trial): Colchicine si Wonona ƒe Agbɔsɔsɔme Si Wozãna Le Nu Me ƒe Agbɔsɔsɔme Si Wozãna Le Agbɔsɔsɔme Siwo Me Wozãna Le Agbɔsɔsɔme Siwo Me Wozãna Le Gout Gbãtɔ Ŋu: Gaƒoƒo Blaeve Vɔ Ene ƒe Emetsonu le Multicenter Gbãtɔ, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Dose-Comparison Colchicine Study.
• Finkelstein Y, Aks S. E., Hutson J. R., Juurlink D. N., Baud F. J. kple ame bubuwo. (Clinical Toxicology): Colchicine Poisoning: Blema Atike aɖe ƒe Akpa Doviviti (Bismuth/Baud ƒe kpekpeme dzi wotu mg/kg ku ƒe hatsotsowo me toto, dɔdamɔnu ƒe ŋgɔyiyi le akpa 3 me, aklã me ʋu ƒe sisi ake, Multidose Activated Charcoal, kple G-CSF/VA-ECMO ƒe beléle sesẽe).
• Atikewo kple Lãmesẽnyawo Gbɔkpɔha ƒe Dɔwɔƒe (MHRA) & Dukɔa ƒe Aɖiwo Ŋuti Nyatakaka Dɔwɔƒe (NPIS, United Kingdom): Atikewo ƒe Dedienɔnɔ Ŋuti Nyatakaka: Colchicine - Atikewɔwɔ ƒe Dzesi si le kpuie ŋutɔ kple Afɔku si le atikewo zazã fũu akpa si wua ame me.
• Xexeame ƒe Lãmesẽ Habɔbɔ (WHO) & Aɖi Dɔwɔƒewo ƒe Mɔfiamewo: Numiemiewo ƒe Aɖiwo Dzi Kpɔkpɔ le Dɔdaƒe: Colchicum autumnale (Autumn Crocus), Gloriosa superba (Flame Lily), kple Podophyllum peltatum (Podophyllin Resin).

Mɔfiame siwo do ƒome kplii¶

• Gbemelãwo ƒe nuɖuɖu didi, amatoxin, kple numiemie siwo me aɖi le ɖuɖu
• Neutropenic fever, atikewɔmɔnu ƒe dɔléle, kple kansa ŋuti atikewɔwɔ kpata
• Ayiku ƒe abixɔxɔ sesẽ, rhabdomyolysis, kple aɖuɖɔtoe ƒe agbagbadzedze viviti ƒe vovototodedeameme
• Nuɖuɖu me aɖi, dɔgbo ƒe dɔléle sesẽ, kple tsikuɖiɖi
• Aɖidede kpekpeɖeŋunana gbãtɔ kple aɖi ƒe agbɔsɔsɔ