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MAHAV

mahavMAHAV (Lepra), juzom, lepra, bemorii siroyatii odam. M. yake az qadimtarin bemorihoi insonist. Roje ba on dar dastnavishoi tarikhi, az jumla «Veda»-i hindiho (a. 15 – 10 to m.) bo nomi «Kushta», dar papirusi Ebers va Brungsh (a. 13 – 10 to m.) bo nomi «Saraat», kitobhoi qadimai chiniho (a. 10 – 9 to m.) bo nomi «Li – Feng» malumot hast.
To solhoi nazdik M.-ro bemorii ilojnopazir mehisobidand, ki badi chand soli purmashaqqat hatman bo marg anjom meyoft. Az in ru, shakhsoni giriftori M. boisi tarsu vahmi aholi meshudand. Dar asrhoi miyona odamoni giriftori M.-ro az shahru dehot merondand, ba onho aloqa kardani odamoni solim man bud. Vale badtar muqarrar gasht, ki M. bemorii kamsiroyat buda, onro muolija kardan mumkin ast.
Muvofiqi malumoti Sozmoni umumijahonii tandurusti dar dunyo taqr. 20 mln. bemoroni M. mavjudand. M. dar tamomi manotiqi dunyo qayd shudaast, ammo az hama beshtar dar mamoliki Janubu SHarqi Osiyo, Afriqo va Amrikoi Lotini ba mushohida merasad.
Davrai nihonii M. tulonist (ba hisobi miyona 5 – 7 sol). Jarayoni bemori muzmin buda, dar mavridi tabobat nakardan yo der sar kardani muolija boisi mayubi megardad.
Ba paydoishu intishori M. omilhoi ijtimoi, az jumla tanqisii iqtisodi, farhangivu marifati va migratsiyai aholi musoidat mekunand. Az in ru, shumorai ziyodi bemoron dar davlathoi qafomonda ba qayd girifta shudaand.
Bazeho chunin meshumorand, ki M. aslan az Janubu SHarqi Osiyo va Afriqoi Markazi buda, az on joyho bo rohhoi mukhtalif ba dig. manotiq pahn shudaast. Ba Avrupo on dar a. 5 – 3 to m. az YUnon va Finiqiya vorid gashtaast. Dar intishori on janghoi Iskandari Maqduni (a. 4 to m.) va Pompey (a. 1), dertar tokhtutozhoi salibdoron musoidat kardaand. Ba qitai Amriko M.-ro a.-hoi 14 – 18 avrupoiyon burdaand (az jumla tavassuti furushi gulomoni afriqoi).
Osiyoi Markazi mintaqai khosai M. ba hisob meravad. Miqdori bemoron dar jumhurii uzbekiston va Qazoqiston ziyodtarand. Dar Tojikiston M. beshtar dar Viloyati Mukhtori Kuhistoni Badakhshon duchor meoyad.
Barangezandai M. mikobakteriya meboshad. Onro s. 1874 olimi norvegi G. A. Hanzen (1841 – 1912) kashf kardaast. Dar joyhoi osebdida ba gayr az mikrobhoi doroi rangi yakkhela navhoi donachagi niz ba nazar merasand.
Mikobakteriyahoi M. bo namud, hajm, rangbardori va dig. khosiyathoyashon ba mikobakteriyahoi sil nazdik meboshand. Onho hog (spora) hosil namekunand, qamchinak nadorand, grammusbat buda, ranghoi gunoguni anilini va lyuminnestsenti ba vujud meorand.
Tasiri tulonii nuri oftob, mahluli formalin, doruvorihoi ziddi juzom ba sustivu mahvi mikobakteriyai M. bois megardand.
Tasnifoti hozirai M., ki dar Jalasai H baynalmilalii makhavshinoson (Bergen, 1973) qabul shudaast, az tarafi Ridli-Jonling s. 1966 peshnihod shuda bud. On dar asosi tasnifoti madridii M. tahiya yoftaast. Bartarii tasnifot dar on ast, ki khel va jarayoni M. dar asosi nishondodhoi masuni, gistologi va bakteriologi muqarrar karda meshavad.
Muvofiqi in tasnifot khelhoi qutbi va marzii M. mavjudand: a) M.-i silpustnamoi qutbi; b) M.-i marzii silpustnamo; v) M.-i marzi; g) M.-i marzii juzompusti; d) M.-i pustjuzomii qutbi.
Barangezandai M. ba badan az joyi pusti osebdida va luobpardai bini vorid shuda, ba tavassuti torhoi asab, ragu girehhoi limfavi va khun ba tamomi badan pahn megardad. Agar qobiliyati muhofizii organizm baland boshad, barangezanda mefavtad yo tagyir meyobad. Dar in surat M. metavonad biduni nishona padid oyad.
M.-i silpustnamoi qutbi dar shakhsone dida meshavad, ki qobiliyati khudmuhofizii organizmi onho baland ast. In navi M., odatan, sabuk meguzarad. Agar qobiliyati muhofizii organizm past boshad, navi vazninu shadidi M. – juzomi lempromatozii qutbi paydo meshavad. SHakhsoni qobiliyati muhofizii organizmashon nomuayyan ba M.-i marzi giriftor meshavand.
Alomathoi avvalini bemori badi 4 – 6 soli siroyat, bazan dertar paydo shuda, odatan, nomalum yo bo beholi va tab ogoz meyoband. Minbad dar pust doghoi safedtob yo surkh paydo meshavand (in joyhoi pust ba garmi va khunuki nohassos buda, dard va lamsro his namekunand). Tadrijan pust sakht shuda, uqdayu reshho ba vujud meoyand. Dar asnoi tabobat nakardani M. abruvon rekhta, narmai gush kalon meshavad, bini furu meravad, chehra tagyir meyobad, chashm bequvvat (ba darajai nobinoi) megardad, ovoz khirri shuda, nafastangi, illati uzvhoi daruni, falaj ba vujud meoyad, dastu po dard mekunad.
Tabobati M. tuloni – az chand moh to chand sol (vobasta ba ogozi tabobat) ast. Dar avval marizonro ba muassisai makhsusi tabobati (makhavkhonaho) joygir karda, dar on jo onhoro nafaqat muolija, balki muvofiqi qobiliyat ba mehnat niz jalb menamoyand. Tabobati bosamar nishon medihad, ki chunin marizonro dar sharoiti khona ham muolija metavon kard.
Bemorone, ki baroi tabobati minbadai ambulatori az makhavkhonaho javob meshavand, baroi atrofiyon khavf nadorand va dar bayni odamon mehnatu zindagi karda metavonand.
Baroi peshgirii bemori tadbirhoi behdoshti va hifzi salomati khele muhimand. Rioyai qoidahoi behdoshti shakhsi va ba tabiri A. Ganzen «tozagi va sobun behtarin rohi peshgirii makhav meboshand». Bemor boyad joykhobi judogona, asbobu anjom va khurokii khudro doshta boshad, bo diqqat shustushuy kunad, reshhoi juzomiro muntazam bandad va tabobat namoyad.
Dar sharoiti hozira dar bisyor davlatho makhavkhonaho mavjudand, ki bemoronro ba tabobat faro megirand. Dar baze mamlakatho (Angliya, Faronsa va g.) muassisahoi makhsus vujud nadorand va marizon dar bemoristoni kasalihoi siroyati tabobat meyobad.
Ahamiyati moyakubi (VVS) dar peshgirii makhsusi M. isbot nashudaast, ammo az sababi nabudani rohhoi digar, istifodai on dar mintaqahoi khosai in bemori qobili qabul meboshad. Ashkhosero, ki bo marizon tamosi tuloni dorand, bo tabobati peshgiri faro megirand. Tabobat bo yak davo az 6 moh to 3 sol davom mekunad. Sokinoni mintaqahoi khosi bemori muntazam az nazar guzaronda meshavand.
Azoi oilai bemoron zeri nazorat meboshand. Muoyanai tibbiro dar mavridhoi lozim ba tariqi ozmoishi dar har 2 moh 2 marotiba guzarondan lozim ast. Nazorati tibbi dar mamoliki gunogun az 3 to 10 sol idoma meyobad.
Kudakoni M.-i modarzodiro to sinni 2 –3-solagi bo modar memonand. Badi 3-solagi onhoro to shifo yoftani modar ba kudakistonho mesuporand. Korhoi behdoshtivu talimiro dar bayni bemoron va azoi oilai onho, hamchunin aholi alohida ba roh mondan lozim ast.
Malumoti durust dar borai M., peshgiri va sarivaqt tabobat kardani on, hamchunin baland bardoshtani marifati tibbii aholi baroi bartaraf kardani tarsu vahm az M., samarabakhshii muborizai ziddi on ahamiyati kalon dorad.
Ad.: Qosimov A. M., Osobennosti epidemiologii, klinicheskogo techeniya, effektivnosti terapii, profilaktiki i prognoza lepri v Respublike Tadjikistan. Zdravookhranenie Tadjikistana, 2002, № 4; hamon muallif, Lepra v Tadjikistane, D., 2005; hamon muallif, K voprosu istorii lepri v Tadjikistane, Astrakhan, 2008.

A. M. Qosimov.

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