Munharaunda yemishonga yemazuva ano, mishonga inorwisa mabhakitiriya yakaratidza kuva imwe yezvinyanya kukosha kufambira mberi, kuderedza zvakanyanya kuitika uye kufa kwehuwandu hwehutachiona hwehutachiona. Kukwanisa kwavo kushandura mhedzisiro yekiriniki yehutachiona hwehutachiona hwakawedzera hupenyu hwevarwere vasingaverengeki. Mishonga inorwisa mabhakitiriya yakakosha mumatanho ekurapa akaomarara, anosanganisira kuvhiyiwa, kuisirwa, kuiswa, uye chemotherapy. Zvisinei, kubuda kweutachiona husingaurayiwi nemishonga kwave kuri kunetsa, zvichideredza kushanda kwemishonga iyi nekufamba kwenguva. Zviitiko zvekuramba kwemishonga inorwisa mabhakitiriya zvakanyorwa mumapoka ese emishonga inorwisa mabhakitiriya sezvo hutachiona hwekuchinja hunoitika. Kudzvinyirirwa kwekusarudza kunoitwa nemishonga inorwisa utachiona kwakakonzera kukwira kwekusagadzikana, zvichiunza dambudziko rakakura kuhutano hwepasirese.
Kuti tirwise nyaya yekudzvanyirira yekurwisa utachiona, zvakakosha kuita mitemo yekudzivirira kutapukira inodzikamisa kupararira kweutachiona husingachinji, pamwe nekuderedza kushandiswa kwemishonga inorwisa mabhakitiriya. Uyezve, pane kudiwa kukuru kwedzimwe nzira dzokurapa. Hyperbaric Oxygen Therapy (HBOT) yakabuda senzira inovimbisa mumamiriro ezvinhu aya, inosanganisira inhalation ye100% okisijeni pane mamwe maitiro ekudzvinyirira kwenguva yakati. Yakaiswa semushonga wekutanga kana wekuwedzera kurapa hutachiona, HBOT inogona kupa tariro nyowani mukurapa hutachiona hunokonzerwa nehutachiona husingaurayiwi nemishonga.
Kurapa uku kuri kuwedzera kushandiswa seyekutanga kana kumwe kurapwa kwemamiriro akasiyana siyana, anosanganisira kuzvimba, carbon monoxide poisoning, maronda asingaperi, ischemic zvirwere, uye utachiona. Kushandiswa kwekiriniki kweHBOT mukurapwa kwehutachiona kwakadzama, zvichipa mabhenefiti akakosha kuvarwere.
Clinical Applications yeHyperbaric Oxygen Therapy muKutapukirwa
Humbowo hwazvino hunotsigira mashandisirwo eHBOT, ese seyakamira uye adjunctive kurapwa, ichipa mabhenefiti akakosha kuvarwere vane hutachiona. Munguva yeHBOT, arterial blood oxygen pressure inogona kukwira kusvika pa2000 mmHg, uye mhedzisiro yakakwira okisijeni-tishu yekumanikidza gradient inogona kusimudza matishu eokisijeni kusvika ku500 mmHg. Migumisiro yakadaro inonyanya kukosha mukusimudzira kuporeswa kwemhinduro dzinopisa uye microcirculatory disruptions inoonekwa munzvimbo dze ischemic, pamwe chete nekugadzirisa compartment syndrome.
HBOT inogona zvakare kukanganisa mamiriro anoenderana ne immune system. Tsvagiridzo inoratidza kuti HBOT inogona kudzvanya autoimmune syndromes uye antigen-induced immune immune mhinduro, zvichibatsira kuchengetedza kushivirira kwegraft nekudzikisira kutenderera kwemalymphocytes uye leukocytes uchigadzirisa mhinduro dzemuviri. Uyezve, HBOTinotsigira kuporesamune zvisingaperi zvironda zveganda nekukurudzira angiogenesis, chirongwa chakakosha chekuvandudza kupora. Kurapa uku kunokurudzirawo kuumbwa kwe collagen matrix, chikamu chakakosha mukupora kweronda.
Kunyanya kutariswa kunofanirwa kupihwa kune humwe hutachiona, kunyanya hwakadzama uye hwakaoma-kurapa hutachiona hwakadai necrotizing fasciitis, osteomyelitis, chisingaperi nyoro hutachiona hutachiona, uye inotapukira endocarditis. Imwe yeanonyanya kushandiswa kukiriniki yeHBOT ndeye ganda-yakapfava matishu utachiona uye osteomyelitis yakabatana neyakaderera okisijeni mazinga ayo anowanzo kukonzerwa neanaerobic kana kurwisa bhakitiriya.
1. Diabetic Foot Infections
Chirwere cheshugamaronda idambudziko rakatekeshera pakati pevarwere veshuga, rinobata kusvika 25% yehuwandu uhu. Zvirwere zvinowanzoitika mumaronda aya (zvichiverengera 40% -80% yezviitiko) uye zvinotungamirira kukuwedzera kwezvirwere uye kufa. Diabetic foot infections (DFIs) kazhinji kacho ine polymicrobial infections ine akasiyana anaerobic bacteria pathogens akaonekwa. Zvinhu zvakasiyana-siyana, zvinosanganisira fibroblast basa kukanganisa, collagen kugadzirwa nyaya, cellular immune system, uye phagocyte basa, zvinogona kutadzisa kuporesa maronda muvarwere vane chirwere cheshuga. Tsvakurudzo dzinoverengeka dzakaona kusakanganiswa kweokisijeni yeganda sechinhu chakasimba chengozi yekudimburwa zvine chekuita neDFIs.
Seimwe yeazvino sarudzo dzeDFI kurapwa, HBOT yakashumwa kuti inokurudzira zvikuru kuporesa mazinga emakumbo echirwere cheshuga, zvichizoderedza kudiwa kwekudimburwa uye kupindira kwakaoma kwekuvhiya. Izvo hazvingodzikisi kukosha kwemaitiro-akasimba-maitiro, sekuvhiyiwa kweflap uye kubatanidza ganda, asi zvakare inopa yakaderera mutengo uye kushoma mhedzisiro kana zvichienzaniswa nekuvhiya sarudzo. Chidzidzo chakaitwa naChen et al. yakaratidza kuti zvinopfuura zvikamu zve10 zveHBOT zvakakonzera kuvandudzwa kwe78.3% muhutano hwekuporesa maronda muvarwere vane chirwere cheshuga.
2. Necrotizing Soft Tissue Infections
Necrotizing soft tissue infections (NSTIs) inowanzova polymicrobial, kazhinji inomuka kubva mukusanganiswa kweaerobic uye anaerobic bacteria pathogens uye inowanzobatanidzwa nekugadzirwa kwegesi. Nepo maNSTI ari mashoma, anopa huwandu hwevanhu vanofa nekuda kwekukurumidza kufambira mberi. Kuongororwa panguva uye kwakakodzera uye kurapwa ndizvo zvakakosha pakuwana mhedzisiro yakanaka, uye HBOT yakakurudzirwa senzira yekuwedzera yekutarisira NSTIs. Kunyangwe kuchine kukakavara kwakatenderedza kushandiswa kweHBOT muNSTIs nekuda kwekushaikwa kwezvidzidzo zvinodzorwa,humbowo hunoratidza kuti inogona kuve yakabatana nekuvandudzwa kwemazinga ekupona uye kuchengetedza nhengo muvarwere veNSTI.. Ongororo yakadzokororwa yakaratidza kuderera kukuru kwehuwandu hwekufa pakati pevarwere veNSTI vanogamuchira HBOT.
1.3 Kuvhiya Saiti Zvirwere
SSIs inogona kuverengerwa zvichienderana nenzvimbo yeatomical yehutachiona uye inogona kubuda kubva kune akasiyana hutachiona, kusanganisira ese ari maviri aerobic uye anaerobic mabhakitiriya. Pasinei nekufambira mberi mumatanho ekudzivirira hutachiona, senge nzira dzekuita sterilization, kushandiswa kweprophylactic antibiotics, uye kuwedzera mukuvhiya maitiro, SSIs inoramba iri dambudziko rinoramba riripo.
Imwe ongororo yakakosha yakaongorora kushanda kweHBOT mukudzivirira zvakadzika SSIs mukuvhiya neuromuscular scoliosis. Preoperative HBOT inogona kuderedza zvakanyanya kuitika kweSSIs uye kuita kuti maronda apore. Iyi isiri-invasive therapy inogadzira nzvimbo iyo mazinga eokisijeni mumaronda maronda anokwidziridzwa, ayo akave akabatanidzwa neiyo oxidative kuuraya chiito kurwisa hutachiona. Pamusoro pezvo, inogadzirisa kudzikiswa kweropa uye oksijeni mazinga anobatsira mukuvandudza kweSSIs. Kupfuura mamwe maitiro ekudzivirira kutapukira, HBOT yakakurudzirwa kunyanya kuvhiya ine hutachiona hwakachena senge colorectal maitiro.
1.4 Kusvirwa
Kupisa kukuvadzwa kunokonzerwa nekupisa kwakanyanya, magetsi, makemikari, kana mwaranzi uye zvinogona kukonzera hurwere hwepamusoro uye huwandu hwevanhu vanofa. HBOT inobatsira mukurapa kutsva nekuwedzera huwandu hweokisijeni mumatishu akakuvadzwa. Nepo zvidzidzo zvemhuka nemakiriniki zvinopa mhedzisiro yakasanganiswa maereranokushanda kweHBOT mukupisa kurapwa, chidzidzo chinosanganisira varwere vanopisa 125 chakaratidza kuti HBOT haina kuratidza kukosha kwehuwandu hwekufa kana nhamba yekuvhiyiwa kwakaitwa asi yakaderedza nguva yekuporesa nguva (mazuva 19.7 achienzaniswa nemazuva 43.8). Kubatanidza HBOT ine yakazara kupisa manejimendi inogona kunyatso kudzora sepsis muvarwere vanopisa, zvichitungamira kupfupi nguva dzekuporesa uye kuderedzwa kwemvura zvinodiwa. Nekudaro, kumwe kutsvagisa kwakawedzera kunodiwa kuti usimbise basa reHBOT mukutarisira kupisa kwakanyanya.
1.5 Osteomyelitis
Osteomyelitis chirwere chepfupa kana mwongo kazhinji chinokonzerwa nehutachiona hwehutachiona. Kurapa osteomyelitis kunogona kuve kwakaoma nekuda kwekushaikwa kweropa kumapfupa uye kushomeka kwekupinda kwemishonga inorwisa mabhakitiriya mumwongo. Chronic osteomyelitis inoratidzirwa nehutachiona hunoramba huripo, kuzvimba zvishoma, uye necrotic bone tishu kuumbwa. Refractory osteomyelitis inoreva zvirwere zvemapfupa zvisingaperi zvinopfuurira kana kudzoka pasinei nekurapa kwakakodzera.
HBOT yakaratidzwa kuvandudza zvakanyanya mazinga eokisijeni mumapfupa ane hutachiona. Nhamba dzakawanda dzekesi dzakatevedzana uye cohort zvidzidzo zvinoratidza kuti HBOT inosimudzira mhedzisiro yekiriniki yevarwere ve osteomyelitis. Inoratidzika kushanda kuburikidza nenzira dzakasiyana-siyana, kusanganisira kuwedzera basa remetabolism, kudzvinyirira hutachiona hwehutachiona, kuwedzera mishonga inorwisa mabhakitiriya, kuderedza kuzvimba, nekusimudzira kuporesa.maitiro. Post-HBOT, 60% kusvika 85% yevarwere vane chronic, refractory osteomyelitis vanoratidza zviratidzo zvekudzvinyirira utachiona.
1.6 Fungal Zvirwere
Pasi rose, vanopfuura mamirioni matatu vanhu vanotambura nechirwere chisingaperi kana chinopinda fungal, zvichikonzera kufa kwe600,000 pagore. Mhedzisiro yekurapa kwehutachiona hwefungal inowanzokanganiswa nekuda kwezvinhu zvakaita senge kuchinjika immune system, hosha dziri pasi, uye pathogen virulence maitiro. HBOT iri kuita sarudzo inoyevedza yekurapa muzvirwere zvakakomba zvefungal nekuda kwekuchengetedzeka kwayo uye kusapinda kwayo. Zvidzidzo zvinoratidza kuti HBOT inogona kushanda pakurwisa fungal pathogens seAspergillus uye Mycobacterium tuberculosis.
HBOT inokurudzira antifungal mhedzisiro nekudzivisa kuumbwa kwebiofilm yeAspergillus, nekuwedzera kwehunyanzvi hunocherechedzwa mumatambudziko asina superoxide dismutase (SOD) majini. Mamiriro ehupoxic panguva yehutachiona hwefungal anounza matambudziko kune antifungal zvinodhaka kuendesa, zvichiita kuti kuwedzera okisijeni mazinga kubva kuHBOT kuve kupindira kunobatsira, kunyangwe kumwe kutsvagisa kwakakodzera.
Iyo Antimicrobial Properties yeHBOT
Iyo hyperoxic nharaunda yakagadzirwa neHBOT inotanga shanduko yemuviri uye biochemical inosimudzira antibacterial properties, zvichiita kuti ive inoshanda adjunct therapy yehutachiona. HBOT inoratidza mhedzisiro inoshamisa kurwisa aerobic mabhakitiriya uye kunyanya anaerobic mabhakitiriya kuburikidza nenzira dzakadai seyakananga bactericidal chiitiko, kukwidziridzwa kwemhinduro dzekudzivirira, uye synergistic mhedzisiro ine chaiwo antimicrobial agents.
2.1 Yakananga Antibacterial Migumisiro yeHBOT
Iyo yakananga antibacterial mhedzisiro yeHBOT inonyanya kuverengerwa kuchizvarwa cheiyo reactive oxygen marudzi (ROS), ayo anosanganisira superoxide anions, hydrogen peroxide, hydroxyl radicals, uye hydroxyl ions-zvose izvo zvinomuka panguva ye cellular metabolism.
Kudyidzana pakati peO₂ nemasero emasero kwakakosha pakunzwisisa maitiro eROS mukati memasero. Pasi pemamwe mamiriro ezvinhu anonzi oxidative stress, kuenzana pakati peROS kuumbwa uye kuparara kwayo kunovhiringidzwa, zvichiita kuti mazinga akakwirira eROS mumasero. Kugadzirwa kwe superoxide (O₂⁻) kunokonzerwa ne superoxide dismutase, iyo inozoshandura O₂⁻ kuita hydrogen peroxide (H₂O₂). Shanduko iyi inowedzerwazve nekuita kweFenton, iyo inoita kuti Fe²⁺ igadzire hydroxyl radicals (·OH) uye Fe³⁺, nokudaro ichitanga inokuvadza redox kutevedzana kweROS kuumbwa uye kukuvara kweserura.
Iyo muchetura mhedzisiro yeROS inonangana yakakosha maseru zvikamu zvakaita seDNA, RNA, mapuroteni, uye lipids. Zvikurukuru, DNA ndiyo inonyanya kunangwa yeH₂O₂-mediated cytotoxicity, sezvo ichikanganisa zvimiro zve deoxyribose uye kukuvadza nheyo dzekutanga. Kukuvadzwa kwemuviri kunokonzerwa neROS kunosvika kune helix chimiro cheDNA, zvingangove zvichikonzerwa ne lipid peroxidation inokonzereswa neROS. Izvi zvinosimbisa mhedzisiro yakaipa yemazinga akakwira eROS mukati mebiological system.
Antimicrobial Action yeROS
ROS inoita basa rakakosha mukudzivirira kukura kwehutachiona, sezvakaratidzwa kuburikidza neHBOT-induced ROS chizvarwa. Iyo muchetura mhedzisiro yeROS yakanangana nemasero seDNA, mapuroteni, uye lipids. Yakanyanya kuwanda yeanoshanda okisijeni marudzi anogona kukuvadza zvakananga lipids, zvichitungamira kune lipid peroxidation. Iyi nzira inokanganisa kutendeseka kwesero membranes uye, nekudaro, kushanda kwe membrane-inosanganiswa receptors uye mapuroteni.
Uyezve, mapuroteni, ayo ariwo akakosha mamorekuru anotariswa eROS, anoiswa chaiwo oxidative gadziriso pane akasiyana amino acid masara senge cysteine, methionine, tyrosine, phenylalanine, uye tryptophan. Semuenzaniso, HBOT yakaratidzwa kuti inokonzera kuchinja kweoxidative mumapuroteni akati wandei muE. coli, kusanganisira elongation factor G neDnaK, zvichikanganisa mashandiro emasero.
Kuvandudza Kudzivirirwa Kuburikidza neHBOT
Iyo anti-inflammatory properties yeHBOTzvakanyorwa, zvichiratidza zvakakosha mukuderedza kukuvara kwetishu uye kudzvanyirira kufambira mberi kwehutachiona. HBOT inokanganisa zvakanyanya kutaura kwema cytokines uye mamwe madhiraivha ekuzvimba, achipesvedzera maitiro ekudzivirira. Yakasiyana-siyana yekuedza masisitimu yakacherekedza shanduko yekuchinja kwemajini uye mapuroteni chizvarwa post-HBOT, iyo inosimudzira kana kuderedza kukura zvinhu uye cytokines.
Munguva yeHBOT maitiro, kuwedzera kweO₂ mazinga anokonzera huwandu hwemhinduro dzemaserura, sekudzvinyirira kuburitswa kwevamiriri vepro-inflammatory uye kukurudzira lymphocyte uye neutrophil apoptosis. Pamwe chete, zviito izvi zvinosimudzira immune system's antimicrobial mechanisms, nekudaro kufambisa kuporeswa kwehutachiona.
Uyezve, zvidzidzo zvinoratidza kuti kuwedzera O₂ mazinga panguva yeHBOT inogona kuderedza kutaura kwepro-inflammatory cytokines, kusanganisira interferon-gamma (IFN-γ), interleukin-1 (IL-1), uye interleukin-6 (IL-6). Shanduko idzi dzinosanganisira kudzikisira reshiyo yeCD4: CD8 T masero uye modulating mamwe soluble receptors, pakupedzisira kusimudza interleukin-10 (IL-10) mazinga, ayo akakosha pakurwisa kuzvimba uye kukurudzira kuporeswa.
Mabasa eAntimicrobial eHBOT akabatana nemaitiro akaomarara ehupenyu. Zvose zviri zviviri superoxide uye kudzvinyirirwa kwakakwirira zvakanzi zvisingaenderani kukurudzira HBOT-induced antibacterial activity uye neutrophil apoptosis. Kutevera HBOT, kukwidziridzwa kweokisijeni kunowedzera kugona kwebhaktericidal neutrophils, chikamu chakakosha chemhinduro yekudzivirira. Uyezve, HBOT inodzvinyirira neutrophil adhesion, iyo inopindirana nekubatana kwe-β-integrins pane neutrophils ne intercellular adhesion molecules (ICAM) pamasero endothelial. HBOT inhibisa basa re neutrophil β-2 integrin (Mac-1, CD11b / CD18) kuburikidza ne nitric oxide (NO) -mediated process, zvichiita kuti kutama kweutrophils kunzvimbo yehutachiona.
Iyo chaiyo rearrangement ye cytoskeleton inodiwa kuti neutrophils ibudirire phagocytize zvirwere. S-nitrosylation ye actin yakaratidzwa kukurudzira actin polymerization, inogona kufambisa basa rephagocytic reneutrophils mushure meHBOT isati yarapwa. Zvakare, HBOT inosimudzira apoptosis mumitsara yeT cell yemunhu kuburikidza nemitochondrial nzira, nekukasira kufa kwelymphocyte post-HBOT ichitaurwa. Kuvhara caspase-9-pasina kukanganisa caspase-8-yakaratidza immunomodulatory migumisiro yeHBOT.
Iyo Synergistic Migumisiro yeHBOT ine Antimicrobial Agents
Mumakiriniki ekushandisa, HBOT inowanzoshandiswa pamwe chete nemishonga inorwisa mabhakitiriya kurwisa zvirwere zvinobudirira. Iyo hyperoxic state inowanikwa panguva yeHBOT inogona kukanganisa kushanda kwemamwe mishonga inorwisa mabhakitiriya. Tsvagiridzo inoratidza kuti chaiyo bactericidal mishonga, senge β-lactams, fluoroquinolones, uye aminoglycosides, haingoite chete kuburikidza nemasikirwo maitiro asi zvakare inotsamira zvishoma pane aerobic metabolism yebhakitiriya. Naizvozvo, kuvepo kweokisijeni uye maitiro emagetsi ehutachiona akakosha pakuwongorora maitiro ekurapa kwemishonga inorwisa mabhakitiriya.
Humbowo hunokosha hwakaratidza kuti mazinga eokisijeni akaderera anogona kuwedzera kupikisa kwePseudomonas aeruginosa kune piperacillin/tazobactam uye kuti nzvimbo yakaderera yeokisijeni inobatsirawo mukuwedzera kupikisa kweEnterobacter cloacae kune azithromycin. Sezvineiwo, mamwe hypoxic mamiriro anogona kuwedzera bhakitiriya senitivity kune tetracycline mishonga inorwisa mabhakitiriya. HBOT inoshanda senzira inogoneka yekurapa nekuita aerobic metabolism uye reoxygenating hypoxic utachiona tishu, zvichizowedzera kunzwisiswa kwehutachiona kune mishonga inorwisa mabhakitiriya.
Muzvidzidzo zvepamberi, kusanganiswa kweHBOT-kunoitwa kaviri zuva nezuva kwemaawa masere pa280 kPa-pamwe chete netobramycin (20 mg/kg/zuva) yakaderedza zvakanyanya mitoro yebhakitiriya muStaphylococcus aureus infectious endocarditis. Izvi zvinoratidza kugona kweHBOT senzira yekubatsira. Kumwe kuongorora kwakaratidza kuti pasi pe37 ° C uye 3 ATA kumanikidzwa kwemaawa 5, HBOT yakawedzera zvakanyanya mhedzisiro ye imipenem kurwisa macrophage-infected Pseudomonas aeruginosa. Uyezve, iyo yakasanganiswa modality yeHBOT ne cephalolin yakawanikwa ichinyanya kushanda mukurapa Staphylococcus aureus osteomyelitis mumhando dzemhuka zvichienzaniswa necephazolin chete.
HBOT inowedzerawo zvakanyanya bactericidal action ye ciprofloxacin paPseudomonas aeruginosa biofilms, kunyanya kutevera maminetsi makumi mapfumbamwe ekuratidzwa. Kuwedzeredzwa uku kunokonzerwa nekuumbwa kweendogenous reactive oxygen marudzi (ROS) uye inoratidza kukwidziridzwa kwekunzwa mu peroxidase-yakakanganisa mutants.
Mumienzaniso yepleuritis inokonzerwa nemethicillin-resistant Staphylococcus aureus (MRSA), kushandiswa kwekubatana kwevancomycin, teicoplanin, uye linezolid neHBOT yakaratidza zvakanyanya kuwedzera kushanda kweMRSA. Metronidazole, mushonga unorwisa mabhakitiriya unoshandiswa zvakanyanya mukurapa hutachiona hweanaerobic uye polymicrobial hwakadai sechirwere cheshuga tsoka (DFIs) uye hutachiona hwenzvimbo yekuvhiya (SSIs), yakaratidza kushanda kwepamusoro kweantimicrobial pasi pemamiriro eanaerobic. Zvidzidzo zvenguva yemberi zvinotenderwa kuongorora synergistic antibacterial mhedzisiro yeHBOT yakasanganiswa nemetronidazole mune zvese mu vivo uye in vitro marongero.
The Antimicrobial Efficacy yeHBOT pane Resistant Bacteria
Nekushanduka-shanduka uye kupararira kwemhando dzinopesana, maantibioti echinyakare anowanzorasikirwa nesimba rawo nekufamba kwenguva. Pamusoro pezvo, HBOT inogona kuratidza yakakosha mukurapa nekudzivirira hutachiona hunokonzerwa nehutachiona husingaurayiwi nemishonga yakawanda, huchishanda senzira yakakosha kana kurapwa kwemishonga inorwisa mabhakitiriya kwakundikana. Ongororo dzakawanda dzakataura kukosha kwebhakitiriya mhedzisiro yeHBOT pane mabhakitiriya anoenderana nekiriniki. Semuenzaniso, 90-maminetsi HBOT musangano pa2 ATM yakaderedza zvakanyanya kukura kweMRSA. Pamusoro pezvo, mumamodeli ereshiyo, HBOT yakawedzera maantibacterial mhedzisiro yeakasiyana maantibioti kurwisa hutachiona hweMRSA. Mishumo yakasimbisa kuti HBOT inoshanda mukurapa osteomyelitis inokonzerwa neOXA-48-inobudisa Klebsiella pneumoniae pasina kudiwa chero adjunctive antibiotics.
Muchidimbu, hyperbaric oxygen therapy inomiririra nzira ine mativi mazhinji ekudzora hutachiona, inosimudzira maitiro ekudzivirira uye ichiwedzera kushanda kweiyo iripo antimicrobial agents. Nekutsvagisa kwakadzama nekusimudzira, inobata mukana wekudzikamisa mhedzisiro yekuramba kwemishonga inorwisa mabhakitiriya, ichipa tariro muhondo inoenderera mberi yekurwisa hutachiona hwehutachiona.
Nguva yekutumira: Feb-28-2025