Kordhinta Colchicine iyo Gloriosa Lily Poison: Waa maxay sababta qaadashada Kiniinka Gout ee dheeraadka ah ee ololka¶

** Colchicine** (Colcrys, Mitigare, Gloperba) - alkaloids-ka-hortagga bararka ee qarniga jira ee loo qoray gout ba'an, qandhada qoyska Mediterranean-ka (FMF), iyo pericarditis - waxay leedahay mid ka mid ah daaqadaha daawaynta ugu cidhiidhi ah, uguna cafin ee dhammaan daawooyinka kiliinikada. Si ka duwan ibuprofen ama acetaminophen, halkaas oo bukaanku si qalad ah u malaynayo inay qaadan karaan sacab muggeed oo kiniin ah marka xanuunka gout-ka-xanuunku uu ku guuldareysto inuu hagaajiyo, ** liqidda kaliya 10 ilaa 20 kiniinada colchicine ee 0.6-milligram (6 ilaa 12 milligrams, ama in ka badan 0.15 milligrams maalin kasta) qaadashada antibiyootiko maalin kasta clarithromycin - waxay sababtaa sumoobid xun oo argagax leh, laba-jibbaaran oo xubno badan ah oo aan lahayn dawo ganacsi oo si ballaaran loo heli karo . Sunta dilaaga ah ee isku midka ah waxay dhacdaa marka caleentayaasha ama caruurtu ay cunaan digriiga, nalalka, ama caleemaha Flame Lily (Gloriosa superba ama ** Crocus dayrta (Colchicum autumnale*, ama marka la uruuriyo podophyllinpodofilox Xabagta burooyinka la mariyo waa la liqaa ama la mariyaa meelaha maqaarka ballaaran. Haddii qof uu qaato wax ka badan 3 kaniini oo loo qoray (1.8 mg) ee colchicine 24 saac gudahood, ama uu qaato Colchicum ama Gloriosa dhirta, wac deegaankaaga nambarada degdega ah isla markiiba - ** xitaa haddii ay si buuxda u fiicnaadaan saacadaha ugu horreeya. Xaaladaha degdegga ah ee sunta ah iyo dhiig-baxa ee la xidhiidha, la tasho calafka likaha duurjoogta ah iyo cunista dhirta sunta ah, qandhada neutropenic iyo xakamaynta dhuuxa laftaiyo sumowga cuntada, gastroenteritis ba'an, iyo fuuqbax.

Sumowga Colchicine waa sunta caadiga ah ** "waqtiga aamusnaanta-bamka" sun ** la mid ah amatoxin Death Cap boqoshaada iyo paraquat: ka dib 2-ilaa-12-saacadood oo calaamado la'aan ah daahitaan, Wajiga 1 wuxuu ku dhuftey walxaha qarxa, shuban-daacuun-u eg iyo shoog hypovolemic, oo ay ku xigto ** 24 ilaa 72 saacadood. (ARDS), beerka iyo kelyaha oo hawlgab, iyo aplasia dhuuxa oo dhamaystiran (eber unugyada dhiiga cad iyo platelets)**.

Hadda samee tan¶

1. ** Wac lambarkaaga deg-degga ah iyo Xakamaynta Sunta isla markiiba haddii qof uu liqo in ka badan 3 kiniin ah colchicine (1.8 mg) maalintii, ama wax kasta oo ah Dayrta Crocus / Gloriosa Lily.** Wac 911 gudaha Maraykanka iyo Kanada Boqortooyada, 000 gudaha Australia (Macluumaadka Sunta 13 11 26), ama la tasho hagahayaga nambarada degdega ah. Weligaa ha sugin calool xanuun ama matag inuu bilaabo; Marka colchicine uu ka soo nuugo mindhicirka oo uu ku xidhmo gudaha unugyada jidhka, lagama sifeyn karo dhiigga.
2. **Ku degdeg qaybta xaaladaha degdegga ah 1 ilaa 2 saacadood ee u horreeya gudahooda si aad xaalad degdeg ah dhuxusha firfircoon u shaqeyso (Multidose Activated Charcoal.
3. ** Isla markiiba jooji qaadashada colchicine haddii lagugu qoro antibiyootiko kasta oo macrolide ah (clarithromycin ama erythromycin), antifungal (itraconazole, ketoconazole), daroogada wadnaha (verapamil, diltiazem), ama cyclosporine - ama haddii aad cabto casiirka bambeelmada.** Daawooyinkan ayaa xannibaya CYP3A4 enzyme iyo P-glycoprotein Bamka dareeraha ah ee nadiifiya colchicine, oo u beddelaya qiyaas 2-kiniin ah oo gout caadi ah oo u beddelaya xad-dhaaf 10-laab ah oo dilaa ah.
4. **Haddii wajiga 1aad matag daran iyo shuban biyood/dhiigfuran uu mar hore bilowday, biloow beddelka dareeraha gardarrada leh inta aad sugayso ambalaasta - oo waligaa ha siin daawooyinka shubankaloperamide / Imodium())*cholera-like gastroenteritis). Siinta loperamide ama bismuth subsalicylate waxay dabinaysaa colchicine aan la nuugin gudaha mindhicirka si ay xitaa sun badan u nuugo dhiiga.
5. **Haddii podophyllin (podofilox) dareeraha burooyinka ay si lama filaan ah ugu daateen meelo badan oo maqaarka ah ama xuubabka xuubka, isla markiiba maqaarka si fiican ugu dhaq saabuun iyo biyo socda.
6. ** Keen dhalada kaniiniga colchicine (si ay dhakhaatiirtu u xisaabiyaan kaniiniyada maqan oo ay sax u xisaabiyaan mg/kg qiyaasta) ama sawirka/muunada guluubka geedka la dajiyay ama ubaxa < 0.5 mg/kg, 0.5 to 0.8 mg/kg, ama > 0.8 mg/kg isla markiiba waxay u sheegtaa kooxda daryeelka degdega ah saadaasha badbaadada saxda ah ee bukaanka iyo shuruudaha ICU.

Geedka go'aanka: colchicine, ubaxa Gloriosa, iyo kala soocida sumowga podophyllin¶

flowchart TD
    A["Qaadashada Colchicine ee laga shakisan yahay, Gloriosa Lily / Dayrta Crocus Ingestion, ama Soo-gaadhista Podophyllin"] --> B{"Xisaabi qiyaasta Colchicine ee la dhuuqay (mg/kg miisaanka jidhka) ama hubi isdhexgalka daroogada"}
    B -->|"Qiyaasta gout ee caadiga ah + Clarithromycin / Verapamil / Cyclosporine + shuban/ matag cusub"| C["Sunta IATROGENIC COLCHICINE: Jooji labada daawo oo isla markiiba u tag ER"]
    B -->|"Qiyaasta xad dhaafka ah ee ba'an <0.5 mg/kg (tusaale, 7 ilaa 30 mg qofka wayn ee 70-kg)"| D["KHATAR SARE: Gaadiidka EMS ee degdega ah ee Caloosha Caloosha (haddii <1 saac) + Dhuxul Dhaqdhaqaaq badan"]
    B -->|"Qiyaasta xad dhaafka ah ee 0.5 ilaa 0.8 mg/kg (35 ilaa 56 mg ee 70-kg qaangaar ah)"| E["Sunta Nolol-Halis-yaraanta ah: Filo shoog daran GI + Aplasia dhuuxa lafta (10% ilaa 50% dhimasho)"]
    B -->|"Qiyaasta xad dhaafka ah> 0.8 mg/kg (> 56 mg ee 70-kg qaangaar ah) ama dhammaan tuber Gloriosa"| F["QODOBKA LETHAL EE DHAQANKA AH (ku dhawaad 80% ilaa 100% dhimashada): Wareejin degdeg ah ICU / ECMO"]
    C --> G["Wajiga 1 (Saacadaha 2 ilaa 24): Dib u soo noolaynta Crystalloid IV ee xoogga leh ee Daacuunka-Sida GI Luminta dareeraha"]
    D --> G
    E --> G
    F --> G
    G --> H["Wajiga 2 (Maalmaha 1 ilaa 7): ICU Taageerada Wadnaha (Norepinephrine/VA-ECMO) + G-CSF (Filgrastim) ee Neutropenia"]

Sida colchicine iyo podophyllin u dilaan unugyada: xidhitaanka dunta mitotic¶

Si aad u fahamto sababta ku-sumowga colchicine uu marka hore ugu ekaado sumoobid cunto oo daran, ka dibna sida wadne qabad weyn, iyo shan maalmood ka dib sida xanuunka shucaaca ba'an ama sunta chemotherapy leukemia, baar sida unugyadu uga shaqeyso gudaha unug kasta oo bini'aadam ah.

Depolymerization Microtubule iyo xidhitaanka qaybinta unugyada ee metaphase¶

Unug kasta oo nool oo ku jira jidhka bini'aadamka waxa uu ka kooban yahay qalfoof qaabdhismeed gudaha ah iyo habka waddo wayn oo ka samaysan tuubooyinka borotiinka ee godan ee loo yaqaan microtubules, oo laga soo ururiyey dhismooyin la yiraahdo alpha-tubulin iyo beta-tubulin dimers. Microtubules waxay qabtaan laba shaqo oo muhiim ah:

1. ** Spindle-ka Mitotic inta lagu jiro kala qaybinta unugyada (mitosis):** Mar kasta oo unug tamo ah oo ku jira xuubka mindhicirkaaga, dhuuxa lafta, ama xuubabka timaha u kala qaybsamaan si ay u beddelaan unugyadii hore, microtubules waxay sameeyaan xadhko yaryar ( spindle mitotic ) kuwaas oo kala sooca koromosoomyada labanlaaban ee laba unug oo cusub oo gabdho ah.
2. ** Gaadiidka unugyada iyo qanjidhada myocardial gudaha unugyada aan kala qaybin:** Unugyada muruqyada wadnaha ee gudaha (cardiomyocytes), axon neerfaha, iyo unugyada beerka, microtubules waxay u dhaqmaan sidii suumanka gudbinta ee qaada mitochondria, kanaalka kaalshiyamka, iyo xididdada neurotransmitter ee unugyada.

** Colchicine ** (iyo sidoo kale ** podophyllotoxin ** laga bilaabo warshadda Mayapple / wart resin, iyo vinca alkaloids loo isticmaalo kiimoterabiga kansarka) waxay ku xidhan tahay xiriir dhow oo aan laga noqon karin ilaa dimers beta-tubulin, oo daboolaya dhamaadka sii kordhaya ee microtubule si ay u furfurto oo u milmaan (**)

• ** Unugyada sida degdega ah u qaybsada (Xubabka xiidmaha iyo dhuuxa lafta):** Unug kasta oo tariim ah oo qaybiya waxa uu si joogto ah u barafoobayaa badhtamaha qaybta unugaapoptosis). Sababtoo ah unugyada ku dahaaran mindhicirkaaga yar waxay is beddelaan 24 ilaa 48 saacadoodba mar, dhammaan xuubka mindhicirku wuu damayaa maalinta 1 (** Wajiga 1 shuban u eg daacuun**). Sababtoo ah unugyada dhiiga cad iyo platelets ee ku jira dhuuxa laftaada waxay bedelaan 3 ilaa 5 maalmoodba mar, dhammaan habka difaacaaga iyo habka xinjirowga dhiiggaaga ayaa baaba'aya maalmaha 3 ilaa 7 (** Wajiga 2 pancytopenia iyo sepsis**).
• Muruqa wadnaha iyo unugyada dareemayaasha: Kala dirida shabakada microtubule ee gudaha unugyada muruqa wadnaha waxay carqaladaynaysaa maaraynta kaalshiyamka sarcoplasmic iyo gaadiidka tamarta mitochondrial, taasoo keenta ** fajac toos ah myocardial, shoog wadnaha refractory, wadnaha oo dhamaystiran, iyo asystole degdeg ah ** 24 ilaa 72 saacadood.

Waa maxay sababta dhiigbaxa dhiigbaxa iyo dhiigbaxa ay eysan ka saari karin colchicine jirka¶

Si ka duwan caffeine, lithium, ama salicylates (aspirin), kuwaas oo ku dhex milma balasmaha biyaha ee dhiigga halkaasoo mashiinka sifaynta uu ka soo saari karo iyaga, colchicine nuugaya ayaa ka soo baxaya dhiigga 1 ilaa 3 saacadood waxayna si adag u xirtaa borotiinnada tubulin ** qoto dheer gudaha unugyada adag ee jidhka , abuurista qaybinta ballaaranVd = 2 to 12 L/kg, ilaa 21 L/kg oo xad dhaaf ah). Sababtoo ah in ka yar 1 ilaa 2 boqolkiiba colchicine jidhku waxay ku sii jirtaa dhiiga, ** dhiigbaxa dhiigbaxa, dhiigbaxa dhiigbaxa, iyo dhiigbaxa dhuxusha ayaa gabi ahaanba faa'iido lahayn si ay meesha uga saaraan colchicine** (inkasta oo sifaynta sifaynta wali loo isticmaalo in lagu taageero bukaanada kelyahooda ku fashilmeen Wajiga 2). Tani waa sababta ** sun-saaritaanka mindhicirka hore ee Dhuxusha Dhaqdhaqaaqa Badan ee Dawooyinka ** ka hor iyo inta lagu jiro dib-u-warshadaynta enterohepatic waa mid aad muhiim u ah.

Xeerka dilaaga ku salaysan miisaanka (Bismuth & Baud classification)¶

Marka la eego toxicology kiliinikada (asal ahaan waxaa aasaasay Bismuth, Baud, iyo asxaabtiisa Xarunta Xakamaynta Sunta ee Paris), badbaadada bukaanka ka dib qiyaasta xad dhaafka ah ee colchicine ayaa lagu saadaaliyay saxnaanta qaboojinta iyada oo la xisaabinayo qiyaasta milligaraam ee la nuugay oo loo qaybiyay miisaanka jidhka bukaanka kiiloogaraam (kilogram).mg/kg):

Saddexda weji ee caafimaad ee kala duwan ee Colchicine iyo Gloriosa Lily sumowga¶

Sumeynta Colchicine waxay ku socotaa saddex marxaladood oo isku xigta oo bukaan socod ah 10 ilaa 14 maalmood:

Marxaladda 1: Marxaladda dheef-shiid kiimikaad & Dhiig-karka (Saacadaha 2 ilaa 24 ka dib marka la cuno)¶

• Daaqadda qarsoon ee 2-ilaa-12-saacadood ah: 2 ilaa 6 saacadood ee ugu horreeya ka dib marka la liqo xaddi xad dhaaf ah oo kiniiniyada colchicine ah ama cunista la kariyey Gloriosa / Colchicum nalalka, bukaanku waxa uu dareemaa si buuxda caadi (marka laga reebo gubasho khafiif ah oo marmar ah afka iyo cunaha). Ha ku khiyaamin inaad guriga joogtid inta lagu jiro daaqadan aamusan.
• Qarax "Cholera-Like" Gastroenteritis (Saacadaha 6 ilaa 24): Marka uu joogsado crypt mitosis xiidmaha iyo unugyada xuubka xuubka xuubka, bukaanku wuxuu yeelanayaa lallabbo xoog leh, lallabbo oo aan la qabsan karin, matag, casiraad caloosha oo fidsan, iyo ** shuban weyn, joogto ah, biyo iyo dhiig "bariis".
• Shoogga Hypovolemic iyo Collapse Electrolyte:** Khasaaraha dareeraha ah ee ka yimaada mindhicirka wuxuu dhaafi karaa **5 ilaa 10 litir (1.3 ilaa 2.6 gallon) 24 saacadood gudahood, taasoo keenta shoog hypovolemic daran, dhaawaca kelyaha degdega ah ee prerenal, dheef-shiid kiimikaad acidosis, hypokalemia, hyponatremia, hypocalcytemia. falcelinta falcelinta unugyada dhiiga cad ee ka sarreeya 20,000/mcL ka hor shilalka dhuuxa).

Wajiga 2: Fashilka Xubnaha Kala Duwan, Shoogga Wadnaha, iyo dhuuxa Lafta Wajiga Aplasia (Maalmaha 1 ilaa 7)¶

Sida matagga iyo shubanku u muuqdaan inay hoos u dhacayaan saacadaha 24 ilaa 36, bukaanku wuxuu galaa wejiga labaad ee dilaaga ah:

1. ** Shock Cardiogenic Refractory and Arrhythmias (Saacadaha 24 ilaa 72 - Sababta Aasaasiga ah ee Dhimashada):**
2. Burburka tooska ah ee tuubbooyinka gudaha myocytes ee wadnaha ayaa sababa wadnaha laba-geesoodka ah (biventricular failure).left ventricular ejection fraction dropping below 15% to 20%), hypotension qoto dheer oo joojiya ka jawaabista dareerayaasha IV iyo vasopressors, sinus bradycardia, xannibaadda wadnaha atrioventricular oo dhammaystiran, tachycardia ventricular, iyo ** wadne istaagid kedis ah**.
3. ** Buuxi dhuuxa lafta Aplasia / Pancytopenia (Maalmaha 3 ilaa 7):**
4. Inta u dhaxaysa maalinta 3 iyo maalinta 7, tirada neutrophils ee buuxa ee bukaanku waxay hoos ugu dhacaysaa ** eber (agranulocytosis** iyo platelets waxay hoos uga dhacaan 10,000 ilaa 20,000/mcL (severe thrombocytopenia).
5. Sababtoo ah xuubka mindhicirka ee la caddeeyey ayaa lumiyay xannibaadkii bakteeriyada mindhicirka isla markiiba jidhku wuxuu leeyahay eber unugyada dhiiga cad, bakteeriyada Gram-negativeE. coli, Klebsiella, Pseudomonas) waxay si toos ah mindhicirka uga shubaan qulqulka dhiiga, taasoo keenta fulminant neutropenic septic shock iyo Faafinta Xididdada Xididka Xididka (DIC).
6. ** Xanuunka Dhibaatada Neefsiga ee Ba'an (ARDS), Rhabdomyolysis, iyo Curyaan kor u kaca:**
7. Dhiigbaxa sambabada ayaa sababa bararka sambabada ee aan wadnogenine ahayn (ARDS) u baahan hawo farsamo.
8. Muruqyada lafaha tooska ah iyo dhaawaca microtubule axonal waxay sababtaa myoneuropathy (daciifnimada murqaha ee u dhow oo la mid ah Guillain-Barré syndrome, creatine kinase oo sarreeya rhabdomyolysis, iyo luminta falcelinta), oo ay weheliso dhaawaca beerka ee ba'an, pankreatit, iyo curyaanka ileus.

Wajiga 3: Soo kabashada & Wadarta Wajiga Alopecia (Maalinta 7 ilaa Usbuuca 3+)¶

Haddii bukaanku ka badbaado qalalaasaha wadnaha iyo septic ee Wajiga 2 ee ICU:

• Leukocytosis oo dib u soo laabatay: Unugyada asliga ah ee dhuuxa lafta waxay dib u bilaabayaan qaybinta qiyaastii maalinta 7 ilaa 10, taasoo keenta in tirooyinka unugyada dhiiga cad ay dib u soo noqdaan.
• ** Dhamaystir, daataan yaab lehTotal Alopecia:** Qiyaastii maalinta 7 ilaa 14-aad, sababtoo ah unugyada timaha-follicle matrix-ka ayaa si degdeg ah u qaybsada sida bukaan-jiifka kiimoterabiga, dhammaan madaxa, sunniyaha, iyo timaha jidhku waxay soo daataan isku-duubni (waxay si buuxda dib ugu koraan 3 ilaa 6 bilood). Daciifnimada Neuromyopathy waxay qaadan kartaa toddobaadyo ama bilo oo baxnaanin jireed si loo xalliyo.

Isdhexgalka Maandooriyaha dilaaga ah: Sida qiyaasta 2-pill gout ee caadiga ah ay u noqoto qiyaas xad dhaaf ah oo dilaa ah¶

In ka badan ** kala badh dhammaan sumowga colchicine ee lagu qoray isbitaallada kama yimaadaan kiniinka xad-dhaafka ah ee ula kac ah**; Waxay ku dhacaan bukaanada qaata kaniiniyada colchicine ee caadiga ah ee 0.6-mg kuwaas oo isku mar la siiyo antibiyootiko ama kiniinka wadnaha, ama qaba cudur kelyaha ama beerka raaga.

The CYP3A4 iyo P-glycoprotein (P-gp) dabinka nadiifinta¶

Sida caadiga ah, unugyada bini'aadamku waxay iska ilaaliyaan colchicine iyaga oo isticmaalaya laba bambooyin bayooloji ah:

1. ** P-glycoprotein (P-gp / ABCB1):** Bamka dheecaanka gacanta ee firfircoon ee dusha sare ee unugyada mindhicirka, beerka biliary kanaliculi, iyo tubbada kelyaha oo ** si firfircoon uga soo saarta colchicine unugyada gudaha saxarada iyo kaadida**.
2. ** Cytochrome P450 3A4 (CYP3A4):** Insaymamka beerka ee demethylates oo aan firfircoonayn colchicine.

U ekaansho dhireed: Gloriosa Superba (Flame Lily) iyo Colchicum Autumnale (Dayrta Crocus)¶

Laba dhirta qurxinta iyo duurjoogta ah ee aadka u koray waxay ka kooban yihiin xaddi badan oo dabiici ah oo ah colchicine saafi ah waxayna sababtaa daraasiin sumowga dilaaga ah sanad walba beeralayda guriga, kuwa caleenta toon, iyo carruurta:

1. * Colchicum autumnale* (Dayrta Crocus / Meadow Saffron / Haweenka Qaawan)¶

• ** Toonta Duurjoogta ahAllium ursinum / Ramps) Dabin caleenta:** Guga, Colchicum autumnale waxay soo dirtaa caleemo cagaaran oo dhalaalaya oo dhalaalaya nalalka dhulka hoostiisa ee cawska qoyan ee Yurub iyo Waqooyiga Ameerika - badanaa waxay koraan ** midigta xigta dhanka Toonta Duur-joogta ah.Allium ursinum / toonta orso)** ama ramps. Caleenta caleenta caleenta toon duurjoogta ah ee pesto ama maraq waxay si lama filaan ah u ururiyaan caleenta * Colchicum* iyo toonta.
• Sida loo kala saaro: Burburinta caleen toon duurjoogta ah oo la cuni karo waxay soo daynaysaa ur aan la garan karin ** ur toon ah**, caleemihiisuna waxay ka soo baxaan laamo gaar ah oo ka soo baxa guluubka; caleemaha Colchicum autumnale sun ah waxay leeyihiin ur ZERO oo toonta ah, way adag yihiin, waxayna isku duubaan si adag oo midba midka kale gashado galka ah ee saldhigga ah. Cunista dhawr caleemood Colchicum ama ubax waxay keentaa qiyaas dilaa ah oo colchicine ah. (Fiiro gaar ah: * Colchicum autumnale * sidoo kale gabi ahaanba wuu ka duwan yahay uunsiga cuntada ee runta ah ** Saffron [Crocus sativus]**, kaas oo ka tirsan qoyska iris Iridaceae wuxuuna leeyahay 3 dhaleeceyn, halka sunta Colchicum ay leedahay Colchicaceae waxayna leedahay 6 stamen).

2. Gloriosa superba (Flame Lily / Lily Sharafta¶

• ** Baradhada macaan / Yam / Ginger Trap Trap:** Gloriosa superba waa geed canab ah oo kulaylaha ah oo aad u qurux badan oo leh ubaxyo ubaxyo casaan iyo jaalle ah oo ololaya oo ka baxa Aasiya, Afrika, Australia, iyo sida geedo-guri oo qurxin ah oo ku yaal Mareykanka iyo Yurub. Ciidda hoosteeda, waxay ka baxdaa V-qaabeeya ama L-qaabeeya oo jidh leh ** digriiga dhulka hoostiisa ah *** kuwaas oo si cajiib ah ugu eg ** baradhada macaan, yaanyada, cassava, ama xidid sinjibiil**.
• Dhibaato aad u daran: Hal 20-ilaa-50-gram Gloriosa superba tuber ka kooban 60 ilaa 150 milligaraam oo colchicine saafiya ah iyo gloriosin - ku filan inuu dilo laba ilaa saddex qof oo waaweyn. Qof kasta oo si kama' ah wax u kariya oo u cuna tuber Gloriosa wuxuu u baahan yahay is-miidhsi degdeg ah oo cisbitaalka ah xitaa ka hor inta uusan xanuunka caloosha ugu horreeya bilaabmin.

Podophyllin (Podofilox / Mayapple) Sumaynta: khatarta burooyinka-resinka jirka la mariyo¶

Podophyllin waa resin dhir uruursan oo laga soosaaray xididada Mayapple AmericanPodophyllum peltatum*, oo ay ku jirto sunta microtubule firfircoon podophyllotoxinpodofilox / Condylox). Waxaa loo qoraa sida 0.5% xal / jel ama la isku daray 10% ilaa 25% benzoin tincture si loo gubo burooyinka xubinta taranka (condyloma acuminata) iyo burooyinka dhirta.

• Sida suntu u dhacdo: Liqitaanka shilalka ah ee dhalo burooyinka ka saara ee socod baradka ah, cunista miraha Mayapple ee cagaarka ah/xididdada kaynta dhexdeeda, ama **codso 10% ilaa 25% podophyllin resin weyn, cayriin, dhiigbaxa xubinta taranka ama burooyinka xubinta taranka iyo ku guuldareysiga in la dhaqo ka dib 1 ilaa 4 saacadood.
• ** Qallooca neerfaha gaarka ah oo ay weheliso cilladda dhuuxa lafta:** Sida colchicine, podophyllin waxay xidhaa lafdhabarta mitotic waxayna sababtaa matag/ shuban daran Wajiga 1 oo ay ku xigto Wajiga 2 ** Pancytopenia dhuuxa lafta, beerka oo shaqadiisa gabay, iyo shoog ***. Intaa waxaa dheer, podophyllin waxay ka gudubtaa xannibaadda dhiigga-maskaxda si ka sii xoog badan colchicine, taasoo keenta ** ba'an nidaamka dhexe ee neerfayaasha encephalopathy ( wareer, muuqaal muuqaal ah, caajisnimo, miyir-beel, suuxdin) gudaha 6 ilaa 24 saacadood *, oo ay ku xigto mid daran, waqti dheer ** dareemayaasha dareemayaasha peripheral neuropathy

Maamulka Isbitaalka ICU ee Colchicine iyo Podophyllin sunta¶

1. Dhaqdhaqaaqa Caloosha ee degdega ah (60 daqiiqo gudahood) iyo Dhuxul Dhaqdhaqaaq Dhaqaale badan leh (MDAC):
2. Sababtoo ah dhimashada ka sarreysa 0.5 ilaa 0.8 mg/kg aad ayey u sareysaa, sifeyntuna waa fashilantay, daaweeyayaashu waxay sameeyaan hammi/naasogastric hore haddii bukaanku yimaado 1 saac gudahooda ee la nuugo oo la maamulo ** dhuxul firfircoon (50 g bilawga, oo ay ku xigto 25 g 2 ilaa 4 saacadood kasta)
3. ** Resuscitation Hemodynamic Early Hemodynamic iyo VA-ECMO:**
4. Beddelka dareeraha weyn ee crystalloid (0.9% normal saline ama Ringer's lactate) oo lagu hagayo echocardiography ee sariirta inta lagu jiro Wajiga 1, oo si degdeg ah ugu wareegaya norepinephrine / epinephrine faleebooyin *** iyo horraantii ** Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) haddii shoogga wadnaha refractory uu ku soo baxo Wajiga 2 dib u soo kabashada 5 ilaa 7 maalmood ka dib).
5. Arrinta Kicinta Gumaysiga Hore ee GranulocyteG-CSF / Filgrastimiyo Ka-hortagga Sebsis Neutropenic:
6. Kahor ama isla marka tirada unugyada cad cad ee dhiiga cad bilaabato inay hoos u dhacdo Maalinta 2 ilaa 3, dhakhaatiirta xinjirowga iyo sunta waxay maamulaan maalin kasta oo ka mid ah maqaarka hoostiisa ama xididdada filgrastim (G-CSF, 5 mcg/kg/maalintii) si loo kiciyo unugyada tarma ee dhuuxa lafta ee badbaadaya lana soo gaabiyo muddada neutropenia dilaaga ah, oo ay weheliso antibiyootik faleebo ballaarancefepime, piperacillin-tazobactam, ama meropenem) iyo ku shubista platelet.
7. ** Baaritaanka Colchicine-Specific Fab Jajabka Antibody-ka:** Xarumo toxicology ah oo Yurub ah (France), tijaabo colchicine-gaar ah jajabka geedka geedeedka (oo loo qaabeeyey si la mid ah Digibind/DigiFab oo loo isticmaalo qiyaasta digoxin ee xad-dhaafka ah) ayaa si guul leh uga soo saaray colchicine shoogga unugyo iyo unugyo la heli karo. hab-raac adeegsi naxariis leh.

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

• Mareykanka iyo Kanada: Wac 911 iyo US Xakamaynta Sunta 1-800-222-1222 (Kanada: 1-844-POISON-X). Maamulka Cunnada iyo Dawooyinka ee Maraykanka (FDA) Colcrys (Colchicine) Calaamadaynta Badbaadada waxay amar ku bixisay 1.8 mg ugu badnaan 3-kiniini ah koofiyad ba'an oo gout ah (1.2 mg oo ay ku xigto 0.6 mg 1 saac ka dib) waxayna xanbaarsan tahay liddi ku ah Sanduuqa Madow ee ka dhanka ah maamulida colchicine CYP3A4/P-gp ka hortagga (clarithromycin, ritonavir/Paxlovid, cyclosporine) bukaanada qaba kelyaha ama beerka liidata.
• United Kingdom: Wac 999 isla markiiba wixii looga shakiyo colchicine ama Colchicum qaadashada xad dhaafka ah. Hay'adda Nidaaminta Dawooyinka iyo Alaabooyinka Daryeelka Caafimaadka ee UK (MHRA) iyo Adeegga Macluumaadka Sumowga Qaranka (NPIS/TOXBASE) waxay u kala saaraan qiyaas kasta oo ula kac ah ama shil ah sida xaalad caafimaad oo degdeg ah oo nafta halis gelisa oo u baahan in isbitaalka la seexiyo, Dhuxul Dhaqaale badan oo firfircoon, iyo ugu yaraan 24-saacadood oo wadnaha ah/haddii kiimikaad la arki karo.
• Midowga Yurub: Wac 112. Isbahaysiga Yurub ee Ururada Rheumatology-ga (EULAR) Tilmaamaha gout iyo Xakamaynta Sunta Faransiiska / Ururka Yurub ee Xarumaha Sunta iyo Xeerarka Kiliinikada Sunta (EAPCCT) ayaa si toos ah u qoraya colchicine-dose hoose, ka fogaansho adag oo macrolide ah, iyo u gudbinta hore ee ICU/VA-ECMO ee galinta>= 0.5 mg/k
• Australia iyo New Zealand: Wac 000 gudaha Australia (Macluumaadka Sunta 13 11 26) ama 111 gudaha New Zealand (0800 764 766). Maamulka Alaabada Therapeutic (TGA) iyo Medsafe NZ waxay si adag uga digayaan "qaadashada ilaa shubanka" qiyaasta gout.
• Hindiya iyo Aasiya-Pacific:** Wac 112 gudaha Hindiya, 995 gudaha Singapore, 119 gudaha Japan iyo Kuuriyada Koonfureed, ama 999 gudaha Malaysia iyo Hong Kong. Hindiya iyo Sri Lanka, Gloriosa superba (Karthigai Kilangu / Niyagala) tuber-ku-sumowga waa sababta ugu weyn ee la aqoonsan yahay ee pancytopenia sunta ah iyo shoogga wadnaha oo u baahan in si degdeg ah loogu gudbiyo isbitaal jaamacadeed. Kala tasho hagahayaga lambarada degdega ah ee caalamiga ah.

Su'aalaha soo noqnoqda¶

Waa maxay tirada ugu badan ee badbaadada leh ee kiniiniyada colchicine ee loo qaato weerarka ba'an ee gout?¶

FDA-da casriga ah iyo tilmaamaha caalamiga ah ee rheumatology (oo ku salaysan tijaabada caafimaad ee AGREE) waxay caddeeyeen in qiyaasta ugu badan ee badbaadada iyo waxtarka leh ee xanuunka gout ba'an ee qof weyn oo kelyaha iyo beerka leh ay tahay laba kiniin oo 0.6-miligram ah (1.2 mg) oo la qaato calaamadda ugu horeysa ee ololka, oo ay ku xigto hal kaliya oo dheeraad ah 0.6-milligram) kaniini ah 0.6 saac ka dib oo kaniini ah 0.6 saacadood ka dib. (1.8 mg). Ka dib waa inaad joojisaa oo aad sugtaa ugu yaraan 72 saacadood ka hor intaadan qaadan koorsada kale ee degdega ah. Qaadashada 6, 10, ama 15 kaniini maalintii kama dhigayso xanuunka gout inuu si dhakhso ah u baxo oo waxay sababi kartaa sumowga xubnaha badan ee dilaaga ah.

Maxay takhaatiirtu waagii hore ugu sheegeen bukaannada gout inay sii wadaan qaadashada colchicine saacad kasta ilaa ay shubanayaan, maxaase taas loo joojiyay?¶

Tobannaan sano ka hor intaan la samayn daraasado kala duwan oo casri ah, takhaatiirtu waxay waayeen beddelaad badbaado leh oo ka hortagga caabuqa waxayna ku tiirsan yihiin qaanuunkii qarniga 19-aad ee siinta 1 kiniin ah colchicine saacad kasta ilaa bukaanku uu yeesho shuban iyo matag daran. Dhakhaatiirta sunta ah ee caafimaadku waxay aakhirkii xaqiiqsadeen in shubanka uu keeno colchicine aanu ahayn waxyeello aan waxyeello lahayn - waa calaamadda tooska ah ee ah in daawadu ay sumaysay oo dishay unugyadii asliga ahaa ee kala qaybsanaa ee ku dahaadhay xiidmahaaga yar, iyo in qiyaasta shubanku keenayso ay si toos ah ula wareegto qiyaasta sababta dhuuxa laf dhabarta iyo wadne xanuunka dilaaga ah.

Waa maxay sababta ay khatar u tahay in la qaato antibiyootiga clarithromycin ama COVID-19 Paxlovid marka la qaadanayo colchicine maalinle ah?¶

Jidhkaagu waxa uu ku tiirsan yahay bamka gacanta ee loo yaqaan P-glycoprotein iyo enzyme beerka loo yaqaan CYP3A4 si uu colchicine unugyadaada ugu shubo xadhkaha iyo kaadida si aanu u dhismin. Clarithromycin (Biaxin), erythromycin, dawooyinka fangas sida itraconazole, iyo qaybta ritonavir ee COVID-19 Paxlovid ayaa gabi ahaanba xidhay P-glycoprotein iyo CYP3A4 labadaba. Haddii aad sii wadato qaadashada 1 ama 2 kaniiniga maalinlaha ah ee colchicine markaad qaadanayso clarithromycin ama Paxlovid, dabinnada colchicine ee ku jira wadnahaaga iyo dhuuxa lafta 3 ilaa 4 jeer heerka caadiga ah, taasoo keenta sumo dilaa ah maalmo gudahood.

Haddii qof uu liqay kiniinka colchicine dheeraad ah 3 saacadood ka hor oo uu weli dareemayo 100% caadi, miyay ka baxeen khatar?¶

Maya - daaqada aan calaamaduhu lahayn waa dabinka ugu khatarta badan ee sumowga colchicine. Colchicine waxay qaadataa 2 ilaa 12 saacadood si ay u carqaladayso lafdhabarta microtubule ee qaybinta unugyada mindhicirka, markaa bukaan kastaa wuxuu dareemaa gabi ahaanba fiicnaan dhowrka saacadood ee ugu horreeya ka dib markii uu liqo qiyaas dilaa ah. Sugitaanka guriga ilaa matag daran iyo shuban dhiig leh uu ka bilaabmo waxay la macno tahay in suntu mar hore ka tagtay mindhicirka oo ay si aan leexleexad lahayn ugu xidhatay gudaha muruqa wadnaha iyo dhuuxa, halkaasoo sifaynta aan la gaadhi karin. Tagitaanka qolka gargaarka degdegga ah 1 ilaa 2 saacadood ee ugu horreeya aamusnaanta dhuxusha firfircoon waxay badbaadin kartaa nolosha bukaanka.

Sidee bay dadku si lama filaan ah ugu sumoobaan dhirta Crocus ee Dayrta ama Gloriosa Lily?¶

Guga, dayrta Crocus sunta leh (Colchicum autumnale) waxay ka soo baxaan caws qoyan oo ay la socdaan toonta duurjoogta ah ee la cuni karo (Allium ursinum / ramps); caleenta caleenta ah ee aan urin caleen kasta oo udgoon toon ah ayaa si lama filaan ah ugu daraa caleemaha Colchicum oo ay isku daraan pesto-toon ama maraq. Gobollada kulaylaha iyo kuwa hoose (iyo guryaha leh ubaxyada qurxinta qurxinta), digriiga dhulka hoostiisa ee Flame Lily (Gloriosa superba) waxay u egyihiin baradhada macaan yar yar, yams, ama xidid sinjibiil, iyo cunista xitaa nuska tuber waxay keenaysaa qadar aad u weyn oo dhimasho ah oo colchicine ah.

Ilaha iyo hanuuninta rasmiga ah¶

• ** Maamulka Cunnada iyo Dawooyinka ee Maraykanka (FDA, Maraykanka):** Qoritaanka Macluumaadka iyo Hagaha Dawaynta ee Colcrys (Colchicine, USP) Kiniinnada iyo *Xidhiidhinta Badbaadada Dawooyinka FDA: Is-dhexgalka Dawada dilaaga ah ee udhaxeeya Colchicine iyo P-Glycoprotein / Strong CYP3A4 Inhibitors (Critovirna)
• ** Terkeltaub RA iyo al. (Arthritis & Rheumatism, Tijaabada HESHIISKA):** *Qiyaas hoose oo ka soo horjeeda afka Colchicine ee Xannuunka Hore ee xiiqda: Natiijada Xarunta Kala Duwan ee Koowaad, Randomized, Double-Indhon, Placebo-Controlled, Parallel-Kooxda, Qiyaasta-Comparituson
• Finkelstein Y, Aks SE, Hutson JR, Juurlink DN, Baud FJ iyo al. (Clinical Toxicology): * Sumowga Colchicine: Dhinaca Madow ee Dawooyinka Qadiimiga ah* (Miisaan Bismuth/Baud ku salaysan mg/kg dhimista dhimista, horumarka bukaan-socodka ee 3-waji, dib-u-wareejin-heterohepatic, Dhuxul Dhaqdhaqaaq Dhaqaale badan, iyo daryeelka degdega ah ee G-CSF/VA-ECMO).
• ** Daawooyinka iyo Alaabooyinka Daryeelka Caafimaadka Hay'adda Nidaaminta (MHRA) & Adeegga Macluumaadka Sumowga Qaranka (NPIS, Boqortooyada Ingiriiska):** * Cusboonaysiinta Badbaadada Daroogada: Colchicine - Tusaha Daawaynta aadka u Cidhiidhsan iyo Khatarta xad-dhaafka ah ee dhimashada*.
• Ururka Caafimaadka Adduunka (WHO) & Tilmaamaha Xarumaha Sunta: * Maareynta Kiliinikada ee Sunta Dhirta: Colchicum autumnale (Autumn Crocus), Gloriosa superba (Flame Lily), iyo Podophyllum peltatum (Podophyllin Resin)*.

Tilmaamaha la xidhiidha¶

• Qulqulka likaha duurjoogta ah, amatoxin, iyo cunista dhirta sunta ah
• Qandhada Neutropenic, caabuqa kiimoterabiga, iyo xaaladaha degdegga ah ee caafimaadka oncologic
• Dhaawac kelyo oo ba'an, rhabdomyolysis, iyo kala soocida firfircoonida kaadida mugdiga ah
• Sumowga cuntada, gastroenteritis ba'an, iyo fuuqbax
• Sunta gargaarka degdegga ah iyo soo-gaadhista sunta