Capítulo4 - Goodman & Gilman Las Bases Farmacologicas de La Terapeutica 13a

August 31, 2022 | Author: Anonymous | Category: N/A

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4

Tfxeèdhd dm aèrjh`fs y mlvmlmlhjemltf mlvmlmlhjemltf Je`bmccm H. Mreìsfl y Trmvfr J. ^mllelg

CH DFPEP-_MP^]MPTH

^_MQML@EÐL DM ELTFRE@H@EÐL

▮ @urvhs dfses-rmspumsth `flvmlèflhcms

▮ _mdu`èðl dm mrrfrms dm jmde`hèðl

▮ @urvhs dfses-rmspumsth lf jflftðle`hs

▮ ^rmvmlèðl dm eltfxe`hèflms ml mc bfghr

AH_JH@F@ELÅTE@H QM_P]P  TFRE@F@ELÅTE@H TFRE@F@ELÅTE@H

^_EL@EÊFP DMC T_HTHJEMLTF HLTM ]LH ELTFRE@H@EÐL

▮ Hctmrhèflms ml HDJM ▮ Tepfs dm tfxeèdhd tmrhpåute`h

▮ Edmlte﬈`hèðl dm cfs phtrflms `cêle`fs dm tfxeèdhd ▮ Dms`flthjelhèðl dmc phèmltm eltfxe`hdf

^_]MOHP DMP@_E^TEQHP DM TFRE@EDHD ML HLEJHCMP AH_JH@FCFGÊH AH_JH@FC FGÊH DM PMG]_EDHD U MLPHUFP @CÊLE@FP

▮ Jmkfrhldf ch mcejelhèðl dm tðxe`fs

JMDEFP ^H_H CH ELAF_JH@EÐL PFO_M CH TFRE@EDHD DM AÈ_JH@FP AÈ_JH@ FP U MLQMLMLHJEMLTF

MÊDMJEFCFGÊH DM CHP _MP^]MPTHP HDQM_PHP H CFP AÈ_JH@FP M ELTFRE@H@EFLMP ^F_ AÈ_JH@FP

Ch ahrjh`fcfgêh sm eltmrsm`th `fl ch tfxe`fcfgêh ùhldf ch rmspumsth aesefcðge`h h ul ul aèrjh`f, ms ul mam`tf hdvmrsf. hdvmrsf. ]l vmlmlf vmlmlf ms ms ùhcquemr susthlèh, el`cuymldf ùhcquemr aèrjh`f, qum pfsmm ch `hphèdhd dm dhøhr h ul frghlesjf vevf. Mc mlvmlmlhjemltf mlvmlmlhjemltf,, ml gmlmrhc, ejpce`h qum cfs mam`tfs aesefcðge`fs dhøelfs smhl mc rmsucthdf dm ch mxpfseèðl h prfdu`tfs ahrjh`åute`fs, drfghs ecêèths f prfdu`tfs quêje`fs.

Ch dfses-rmspumsth

@urvhs dfses-rmspumsth `flvmlèflhcms

cmthcms (tðxe`fs), pumdm deamrer (aegurh 4-8). @fjf ulh hctmrlhtevh, ch MD 55 phrh mc mam`tf tmrhpåute`f pumdm smr `fjphrhdh `fl ch DC 8 phrh ch cmthcedhd (mam`tf tðxe`f), phrh fotmlmr ul jhrgml dm smguredhd. Jhrgml Jhrgm l dm smguredhd smguredhd :

DC 8 MD55

(mùhèðl 4-?)

@urvhs dfses-rmspumsth lf jflftðle`hs

Lf tfdhs chs ùrvhs dfses-rmspumsth seguml ulh afrjh segjfedhc têpe`h. Mxestm ulh rmchèðl dfses-rmspumsth dfses-rmspumsth grhduhdh ml mc eldeveduf y ulh rmMl ch aegurh 4-? sm jumstrhl trms mkmjpcfs. ûmdml fosmrvhrsm ùrvhs df- chèðl dfses-rmspumsth, dfses-rmspumsth, ùèlte`h, ml ch pfochèðl (våhlsm aegurhs 0-?, 0-0 ses-rmspumsth ml afrjh dm ] , phrh jmthcms msmlèhcms y vethjelhs (aegurh y 0-1). 0-1) . Chs Ch s dfses dfs es g rhduhdhs dm ul u l aèr jh`f, hdjelestrhd hdjelestrhdhs hs h ul eldeveeld eve4-?H). Ml dfses ohkhs, sm fosmrvhl mam`tfs hdvmrsfs pfrqum bhy ulh dmaeduf, gmlmrhcjmltm sumcml `hushr ulh rmspumsth dm jhyfr jhgletud, h èmlèh dm mstfs lutremltms phrh jhltmlmr ch bfjmfsthses. H jmdedh qum jmdedh qum hujmlth ch dfses. Qesth dm ulh jhlmrh ùèlte`h, ch rmchèðl ch dfses sm el`rmjmlth, sm rmùpmrh ch bfjmfsthses y sm hc`hlzh mc afldf dfses-rmspumsth dfses-rmspum sth ejpce`h qum mc pfr`mlthk pfr`mlthkmm dm pfochèðl ham`thdh hujmlhujmldm ch ùrvh dfses-rmspumsth ml afrjh dm ]. H jmdedh qum hujmlth ch th, h jmdedh qum sm el`rmjmlth ch dfses9 ch rmchèðl ms ùèlte`h ùhldf dfses phrh supmrhr ch `hltedhd rmqumredh, `fl mc fokmtevf dm jhltmlmr sm `flsedmrh qum mc mam`tf msthocmèdf pumdm msthr prmsmltm f husmltm, ch bfjmfsthses, pumdm prfduèrsm ulh tfxeèdhd pfr sformdfses. ^fr thltf, ml ul eldeveduf dhdf. Msth rmchèðl ùèlte`h dm ch dfses-rmspumsth ms cfs mam`tfs hdvmrsfs pumdml fosmrvhrsm thltf ml dfses ohkhs `fjf hcths. utecezhdh phrh dmtmrjelhr ch DC=> dm cfs aèrjh`fs, `fjf sm mxpflm ml Hcgulfs Hcgulfs tðxe`fs, `fjf mc afrjhcdmbêdf, sfl thjoeål suoprfdu`tfs ch aegurh 4-8H. jmthoðce`fs phrh cfs ùhcms chs `åcuchs temlml jm`hlesjfs dm dmselThjoeål sm pumdm dmtmrjelhr ulh ùrvh dfses-rmspumsth ùèlte`h, phtfxe`hèðl. Hsê, dfses juy ohkhs dm afrjhcdmbêdf mxðgmlf lf mx`mdml, rh mc mam`tf tmrhpåute`f dm ul aèrjh`f phrh gmlmrhr MD=>9 ch `fl`mltrh- sua eèmltmjmltm, cfs levmcms prfduèdfs, dm jhlmrh aesefcðge`h, phrh prfeèmltmjmltm, èðl dm ul aèrjh`f `fl mc ùhc mc =>% dm ch pfochèðl tmldrè ch rmspumsth vf`hr ulh rmspumsth hdvmrsh segleae`htevh s egleae`htevh y lf shturhl cfs cf s jm`hlesjfs jm`hles jfs dmsmhdh y ulh ùrvh ùèlte`h dfses-rmspumsth, ml mc `hsf dm ch cmthcedhd dmseltfxe`hltms (p. mk., mc hc`fbfc dmsbedrfgmlhsh YHDB=/GPLF_9 ^flf`hseflhdh pfr mc jesjf aèrjh`f (aegurh 4-8O). Msths dfs ùrvhs pumdml tmc mt hc., hc., ?>8=Z). smr mjpcmhdhs phrh ecustrhr ul TE, qum ùhlteae`h ch smguredhd rmchtevh dm @uhldf mstfs jm`hlesjfs dm prftm`èðl mldðgmlh mstèl sformshturhul jmde`hjmltf; dfs, sm fosmrvhrè ulh rmspumsth tðxe`h. Cfs tfxe`ðcfgfs rmprmsmlthl mstm tepf dm rmspumsth, `fjf ul –phcf dm bfìmy‚ (aegurh 4-?O) ulh rmgeðl dfldm lf bhy rmspumsth, smguedh dm ulh rmspumsth hdvmrsh, h jmdedh qum mc DC (mùhèðl 4-8) tðxe`f mx`mdm cfs jm`hlesjfs mldðgmlfs dm prftm`èðl y sm el`rmjmlth TE : MD cf suaeèmltm phrh `hushr ulh rmspumsth lmghtevh. Pm fosmrvhl ùrvhs dm dfses-rmspumsthh ml afrjh dm ] elvmrtedh, dfses-rmspumst elvmrtedh, ùhldf sm prfdu`m ch rmguchèðl lmMvedmltmjmltm, h jmdedh qum ch prfpfrèðl ms jhyfr, jès smgurf ms mc ghtevh/dmsmlseoecezhèðl ghtevh/dmsmlseoe cezhèðl dmc rm`mptfr dmspuås dm ch mxpfseèðl h ul ceghlaèrjh`f. df f, ùhldf sm prfdu`m ul mam`tf lmghtevf hdeèflhc y deamrmltm ml ulh =>

=>

dmlevmc TE vhrêhl dm 8-? h jès 8>>. Cfs aèrjh`fsCfs `flvhcfrms ul ohkf dm TEhjpcehjmltm, dmoml hdjelestrhrsm `fl dm prm`huèðl (p. mk., mc gce`ðsedf `hrdeh`f degfxelh y cfs hgmltms quejeftmrhpåute`fs `fltrh mc `èl`mr). Cfs jmde`hjmltfs jmde`hjmltfs `fl ulh TE juy hcth (p. mk., ch pmleècelh) sfl, mxtrmjhdhjmltm, smgurfs ml husmlèh dm ulh rmspumsth hcårge`h `flfèdh, ml ul phèmltm dhdf. Fosårvmsm qum mc usf dm dfses jmdehs lf `flsedmrh qum ch pmldemltm dm chs ùrvhs dfses-rmspumsth, phrh mam`tfs tmrhpåute`fs y

`fl`mltrhèðl `fl`mltrhèðl, , jès hccè dm cf qum prfdu`mhctfs mc mam`tf pfsetevf prejhref. ^fr mkmjpcf, mc mstrðgmlf ml levmcms pumdm tmlmr mam`tfs jèxejfs. Pel mjohrgf, ml levmcms suprhaesefcðge`fs, cfs mam`tfs dmc mstrðgmlf sm rmdu`ml, prmsujeocmjmltm, dmoedf h ch rmguchèðl lmghtevh dm cfs rm`mptfrms dm mstrðgmlfs. Pm pemlsh qum ju`bfs prfdu`tfs quêje`fs qum prfdu`ml trhstfrlfs mldf`relfs temlml ùrvhs dfses-rmspumsth ml afrjh dm ] elvmrtedh, sejechrms h chs dmc mstrðgmlf.

=1

Hormvehturhs

H

HDJM; ( hosfrptefl, destreoutefl, jmthofcesj, hld mcejelhtefl) Hosfrèðl,

@ H ^ Ê    T ] C F 4

destreouèðl, jmthofcesjf y mcejelhèðl @U^; (`ytf`brfjm ^4=>) @etf`rfjf ^4=> DC=>; ( jmdehl cmtbhc dfsm) Dfses cmthc jmdeh MHJ; (hdvmrsm drug mvmlts) Mam`tfs hdvmrsfs dm cfs jmde`hjmltfs mcm`trf`hrdefgrhj) Mcm`trf`hrdefgrhjh M@G; ( MD=>; ( jmdehl maam`tevm dfsm) Dfses mam`tevh jmdeh ADH; ( ].P. Affd hld Drug Hdjelestrhtefl) Hdjelestrhèðl dm Hcejmltfs y Jmde`hjmltfs dm Msthdfs ]ledfs ghstrfeltmstelhc) Ghstrfeltmstelhc GE; (

T f x e   EG; ( ejjulfgcfoucel) Eljulfgcfoucelh ` E_O; ( Elstetuteflhc _mvemw Ofhrd) @fjetå dm rmveseðl elstetuèflhc e   d elvmsteghteflhc lmw drug ) Lumvf aèrjh`f ml elvmsteghèðl LAE; ( h d PP_E; ( smcm`tevm smrftflel rmupthim elbeoetfr ) Elbeoedfr smcm`tevf dm ch d rm`hpthèðl dm smrftflelh m a   ( tbmrhpmute` eldmx) Êlde`m tmrhpåute`f TE; è r ( WOE; wbfcm-ofwmc erreghtefl) Erreghèðl dm tfdf mc eltmstelf j h ` f s y Dm bm`bf, chs ùrvhs jucteaèè`hs ml afrjh dm ] sfl `fjulms ml sestm m jhs `fjpcmkfs, ml cfs qum ul `fjpumstf hdjelestrhdf prfvf`h mam`tfs l v jûctepcms h jmdedh qum hujmlth ch `fl`mltrhèðl, prejmrf ul mam`tf y m cumgf ftrf, pfseocmjmltm fpumstfs. Mstm amlðjmlf pflm dm jhleaemstf ch l m lm`msedhd dmc mjpcmf dm ul hjpcef rhlgf dm dfses y ul temjpf dm rmsrms l h pumsth suaeèmltm phrh ghrhltezhr ch dmtm`èðl d mtm`èðl dmc mspm`trf `fjpcmtf dm ch j velùchèðl `fl ch rmspumsth y tfxeèdhd dm ulh susthlèh dhdh. e   m l t   f

Ahrjh`fèlåte`h vmrsus tfxe`fèlåte`h

Hctmrhèflms ml HDJM HDJM ]lh eltfxe`hèðl pumdm hctmrhr, segleae`htevhjmltm, chs aulèflms dm HDJM (våhlsm `hpêtucfs ?, = y 1), y msths hctmrhèflms pumdml ham`thr, prfauldhjmltm, chs dmèseflms ml mc trhthjemltf y mc prflðste`f. Ch ahrjh`fèlåte`h dm ul jmde`hjmltf, ml èrùlsthlèhs qum prfdu`ml tfxeèdhd f mxpfseèðl mx`msevh, sm dmlfjelh tfxe`fèlåte`h tfxe`fèlåte`h.. Elgmrer dfses jhyfrms qum chs dfses tmrhpåute`hs dm ul aèrjh`f, pumdm prfcflghr su hosfrèðl9 hctmrhr su uleðl h prftmêlhs, su vfcujml dm destreouèðl y `hjoehr su dmstelf jmthoðce`f. @uhldf sm mlarmlth ulh eltfxe`hèðl pftmlèhc, cfs `cêle`fs dmoml tmlmr ml ùmlth dfs prmgulths ejpfrthltms; • ¶^fr ùèltf ùèltf temjpf ul phèmltm hseltfjète`f lm`mseth smr jfletfrezhjfletfrezhdf6 (hosfrèðl y delèje`h dmc aèrjh`f). • ¶@uèltf temjpf tfjhrè ul phèmltm eltfxe`hdf phrh jmkfrhr6 (mceje (mceje-lhèðl y delèje`h dmc aèrjh`f).

Hosfrèðl dm aèrjh`fs Ch eltfxe`hèðl pfr hsperelh ms ulh dm chs prelèphcms `hushs dm jfroecedhd y jfrthcedhd pfr sformdfses, smgûl sm elafrjð h cfs `mltrfs dm `fltrfc dm mlvmlmlhjemltf dm Msthdfs ]ledfs (Orflstmel mt hc., hc., ?>>2). Ml ulh dfseae`hèðl tmrhpåute`h, ch hsperelh hc`hlzh chs `fl`mltrhèflms dm pchsjh jèxejhs ml, hprfxejhdhjmltm, 8 b. Pel mjohrgf, ch sformdfses dm hsperelh pumdm `hushr msphsjf dm ch vècvuch pecðre`h, rmtrhshldf ch mltrhdh dmc aèrjh`f ml mc eltmstelf dmcghdf. Ch hsperelh, mspmèhcjmltm `fl rmvmstejemltf mltåre`f, pumdm auseflhrsm y afrjhr omzfhrms, rmduèmldf ch supmraeèm mam`tevh phrh ch hosfrèðl. @fl`mltrhèflms jèxejhs dm shceèchtf pchsjète`f pfr sformdfses dm hsperelh pumdml lf hc`hlzhrsm dm 4 h 0= bfrhs, dmspuås dm ch elgmsteðl (_evmrh mt hc., hc., ?>>4).

Mcejelhèðl dm aèrjh`fs Ch thoch 4-8 mlujmrh hcgulfs prfdu`tfs ahrjh`åute`fs, lftfrefs pfr dmshrrfcchr cfs prejmrfs sêltfjhs dmspuås dmspuås dm dm ul pmrefdf têpe`f dm fosmrvhèðl dm 4 h 1 bfrhs, ml ulh mjmrgmlèh jåde`h (ùhdrf 4-8).

Tepfs dm tfxeèdhd tmrhpåute`h Ml ch tmrhpåute`h, ul aèrjh`f têpe`hjmltm prfdu`m lujmrfsfs mam`tfs pmrf, pfr cf rmguchr, sðcf ulf ms mc ous`hdf `fjf mc fokmtevf prejhref dmc trhthjemltf, ch jhyfr phrtm dm cfs dmjès sfl mam`tfs eldmsmhocms phrh msh elde`hèðl tmrhpåute`h. Cfs mam`tfs smùldhrefs dm smùldhrefs dm cfs aèrjh`fs sfl, gmlmrhcjmltm, jfcmstfs pmrf lf cmthcms. Ftrfs mam`tfs eldmsmhocms pumdml smr `hrh`tmrezhdfs `fjf tðxe`fs (aegurh 4-0).

   ) 8>>    %    (   l    ð    e   `   h    c    o   f   p   h    c   l   m    c   h =>   l   f    e   `   `   h   r    a    d   h    d    e    c   h    t   r   f    J

U

>

?

=

R

8>

=>

Dfses (jg/ig, ms`hch cfghrêtje`h)

O

MD58

8>>

  h    t   s   m   u   p   s   m   r   m    d =>   m    k   h    t   l   m   `   r   f    ^

DC=>

MD=> DC5

MD5

> >.8

8

8>

8>>

8 >>>

8> >>>

Dfses (jg/ig, ms`hch cfghrêtje`h)

Aegurh 4-8 _mchèflms dfses-rmspumsth . H. Ch DC => dm ul `fjpumstf sm dmtmrjelh, mxpmrejmlthcjmltm, dm jfdf usuhc, pfr hdjelestrhèðl dmc prfdu`tf quêje`f h rhtflms f rhths (pfr vêh frhc f eltrhpmretflmhc). Mc pultf jmdef dm ch ùrvh qum ecustrh mc pfr`mlthkm dm pfochèðl qum rmspfldm (rmspumsth hquê sm rmaemrm h ch jumrtm) vmrsus dfses (ms`hch cfghrêtje`h), rmprmsmlth ch DC =>, f => ch dfses dm aèrjh`f qum ms cmthc ml mc =>% dm ch pfochèðl. Cfs vhcfrms dm DC=> phrh hjofs `fjpumstfs sfl cfs jesjfs (8> jg/ig)9 sel mjohrgf, chs pmldemltms dm chs ùrvhs dfses-rmspumsth sfl juy deamrmltms. Hsê, armltm h ulh dfses eguhc h ch jethd dm ch DC => (= jg/ig), jmlfs dmc =% dm cfs hlejhcms mxpumstfs hc `fjpumstf U  jfrerêh9 jfrerêh9 sel mjohrgf, hprfxejhdhjmlt hprfxejhdhjmltmm mc ?=% dm cfs hlejhcms h cfs qum sm cms bhyh sujelestrhdf mc `fjpumstf R , jfrerêh. O. _mprmsmlthèðl dm MD y DC. Mc èrmh `ruzhdh mltrm ch MD58 (8> jg/ig) y ch DC5 (8>> jg/ig) farm`m ul mstejhdf dmc jhrgml dm smguredhd.

_mh`èflms dmpmldemltms dm ch dfses Cfs mam`tfs tðxe`fs dm cfs aèrjh`fs pumdml `chseae`hrsm `fjf ahrjh`fcðge- `fjf ahrjh`fcðge- `fs,, phtfcðge`fs `fs phtfcðge`fs f f gmlftðxe`fs. Ml gmlmrhc, ch elèdmlèh y grhvmdhd dm ch gmlftðxe`fs. Ml tfxeèdhd mstè, prfpfrèflhcjmltm, rmchèflhdh `fl ch `fl`mltrhèðl dmc aèrjh`f ml mc ùmrpf y ch durhèðl dm ch mxpfseèðl. Tfxeèdhd Tf xeèdhd ahrjh`fcðge`h. Ch dmprmseðl dmc @LP prfduèdh pfr ohroetûre`fs ms, ml grhl jmdedh, prmdmèocm pums dmpmldm dm chs `hrh`tmrêste`hs dm ch dfses. Ch prfgrmseðl dm cfs mam`tfs `cêle`fs vh dm ch hlseðceses h ch smdhèðl, ch sfjlfcmlèh y mc `fjh. Dm jhlmrh sejechr, mc grhdf dm bepftmlseðl prfduèdf pfr ch leamdepelh mstè rmchèflhdf `fl ch dfses dmc aèrjh`f hdjelestrhdf. Ch desèlmseh thrdêh (våhsm `hpêtucf 81), ul trhstfrlf jftfr mxtrhperhjedhc hsfèhdf `fl mc usf dm jmde`hjmltfs hltepse`ðte`fs, phrm`m dmpmldmr dm ch durhèðl dm ch mxpfseèðl. Ch tfxeèdhd ahrjh`fcðge`h thjoeål pumdm fùrrer ùhldf sm hdjelestrh ch dfses `frrm`th, pfr mkmjpcf, bhy aftftfxeèdhd hsfèhdh `fl ch mxpfseèðl h ch cuz sfchr ml phèmltms trhthdfs `fl tmtrhè`celhs, sucaflhjedhs, `cfrprfjhzelh y èèdf lhcedêxe`f. `flkughdfs lf Tfxeèdhd phtfcðge`h. Mc h`mthjelfaål ms jmthofcezhdf ml `flkughdfs tðxe`fs dm gcuùrðledf y sucahtf, lf tðxe`fsdmy @U^. ml ulMl jmthofcetf, tm, rmh`tevf LH^XE, h trhvås dm esfafrjhs ulh dfses hcthjmltmrhpåute`h dm h`mthjelfaål, ch LH^XE sm ulm hc gcuthteflflu`cmfaêce`f, pmrf ml ch sformdfses dm h`mthjelfaål, mc hgfthjemltf dmc gcuthteðl pumdm `flduèr hc bhcchzgf phtfcðge`f dm lm`rfses bmpète`h, dmoedf h ch dmrevhèðl dm LH^XE bhèh eltmrh`èflms `fl jh`rfjfcåùchs lu`cmfaêce`hs `mcuchrms (aegurh 4-4).

H   h   s   r   m   v    d   h   h    t   s   m   u   p   s   m    _

=7

O

Jumrtm

]jorhc dm rmspumsth hdvmrsh   h    t   s   m   u   p   s   m    _

_mgeðl dm bfjmfsthses

_mspumsth hdvmrsh P M @ @ E   Ð

_mgeðl dm bfjmfsthses

]jorhc dm rmspumsth hdvmrsh Dfses

L E

Dfses

@

  h    t   s   m   u   p   s   m    _

_mspumsth jèxejh _mgeðl suprh﬈sefcðge`h

Dfses

Aegurh 4-? _mchèflms dfses-rmspumsth lf jflftðle`hs. H. @urvh dfses-rmspumsth ml afrjh dm ] phrh jmthcms msmlèhcms y vethjelhs.O. @urvh dm dfses-rmspumsth ml

afrjh dm bfìmy phrh tðxe`fs qum thjoeål sfl suoprfdu`tfs jmthoðce`fs. @. @urvh dfses-rmspumsth elvmrsh ml ] phrh ceghldfs qum rmguchl lmghtevhjmltm dm susphcf rm`mptfrms. Mam`tfs gmlftðxe`fs. Pm shom qum ch rhdehèðl eflezhltm y ju`bfs quê- ohsðaecfs. Pe ch pfrèðl Aho dm ch jfcåùch dm hlteùmrpf sm ulm mltfl`ms, h ul hltêgmlf, sm ceomrhl vhrefs jmdehdfrms (p. mk., besthjelh, cmu`ftremlfs je`fs hjoemlthcms dhøhl mc HDL y pumdml dhr cughr h tfxeèdhdms juthvhsfdechthèðl, mdmjh y ulh rmspumsth elachgåle`hs f `hl`mrêgmlhs. Ju`bfs dm cfs hgmltms quejeftmrhpåute`fs phrh y prfsthgchldelhs) y `hushl vhsfdechthèðl, jhtfreh. Cfs prelèphcms ðrghlfs ochl`f dm mstm tepf dm rmh`èðl sfl mc mc `èl`mr (våhlsm `hpêtucfs 1=-12) pumdml smr gmlftðxe`fs (våhlsm `hpêtutrh`tf ghstrfeltmstelhc (hcmrgehs hcejmlthrehs)9 ch pemc (urte`hreh y dmrjhtecfs 1 y 7). tes htðpe`h)9 mc sestmjh rmsperhtfref (reletes y hsjh) y mc vhsùchr (`bfqum _mh`èflms hcårge`hs hlhaecè`te`f). Msths rmspumsths temldml h fùrrer, rèpedhjmltm, dmspuås dm ]lh hcmrgeh hcmrgeh ms ms ulh rmh`èðl hdvmrsh, jmdehdh pfr mc sestmjh eljulm, qum ch mstejuchèðl `fl ul hltêgmlf hc qum mc eldeveduf bh sedf smlseoecezhdf ms rmsucthdf dm ch smlseoecezhèðl prmveh h ul quêje`f ml phrteùchr f h y sm dmlfjelhl rmh`èflms dm bepmrsmlseoecedhd eljmdehths. eljmdehths. ulf qum ms mstru`turhcjmltm sejechr (våhsm `hpêtucf 04). Chs rmspumsths mstèl jmdehdhs thltf Tepf EE; rmh`èflms ètfcête`hs. Chs hcmrgehs dm tepf EE mstèl hcårge`hs bhl sedf devededhs ml ùhtrf `htmgfrêhs gmlmrhcms ohshdhs ml mc pfr hlteùmrpfs EgG `fjf EgJ y, pfr cf gmlmrhc, sm htreouyml h su `hphèjm`hlesjf dm ejpce`hèðl eljulfcðge`h. dhd phrh h`tevhr mc sestmjh dmc `fjpcmjmltf. Cfs prelèphcms tmkedfs dehTepf E; rmh`èflms hlh﬈cè`te`hs. Ch hlhaechxes mstè jmdehdh pfr pfr hlteùmr- lh, phrh chs rmh`èflms ètfcête`hs, sfl chs `åcuchs dmc sestmjh èrùchtfref. pfs EgM. Ch pfrèðl A` dm EgM pumdm ulersm h rm`mptfrms ml jhstfètfs y Mkmjpcfs dm rmspumsths hcårge`hs dm tepf EE el`cuyml hlmjeh bmjfcête`h

THOCH 4-8 ▮ Aèrjh`fs qum gmlmrhcjmltm gmlmrhcjmltm jhle﬈msthl sêltfjhs eleèhcms dmspuås dm jès dm 4 h 1 bfrhs, pfstmrefrms h ch sformdfses frhch H`mthjelfaål Èèdf vhcprfe`f Hlte`fhguchltms Hlte`fhguchlt ms dm tepf whrahrelh Hsperelh

elduèdh pfr pmleècelh, pûrpurhpfr trfjofètfpåle`h elduèdh pfr queledelh y grhlucfètfpmleh elduèdh sucaflhjedh. Msths rmh`èflms hutfeljulms h cfs aèrjh`fs sumcml dmshphrm`mr dmltrf dm vhrefs jmsms, dmspuås dm ch mcejelhèðl dmc hgmltm hgrmsfr. Tepf EEE; rmh`èflms dm Hrtbus. Chs rmh`èflms hcårge`hs tepf EEE mstèl jmdehdhs, prmdfjelhltmjmltm, pfr EgG9 mc jm`hlesjf ejpce`h ch gmlmrhèðl dm `fjpcmkfs hltêgmlf-hlteùmrpf qum, jès hdmchltm, aekhl mc `fjpcmjmltf. Cfs `fjpcmkfs sm dmpfsethl ml mc mldftmcef vhsùchr, dfldm sm prfdu`m ulh rmspumsth elachjhtfreh dmstru`tevh, cchjhdh mlamrjmdhd dmc sumrf. sumrf. Cfs sêltfjhs `cêle`fs dm ch mlamrjmdhd dmc sumrf el`cuyml mrupèflms ùtèlmhs pfr urte`hreh, hrtrhcgeh f hrtretes, celahdmlfphtêh y aemorm. Qhrefs aèrjh`fs, el`cuymldf cfs hlteoeðte`fs `fjûljmltm utecezhutecezhdfs, pumdml elduèr rmh`èflms sejechrms h ch mlamrjmdhd dmc sumrf. Msths

Bfrjflhs terfedmhs Elbeoedfrms dm ch jflfhjelfxedhs jflfhjelfxedhshh

@]HD_F 4󰀪8 ▮ Èèdf vhcprfe`f

Jmde`hjmltfs dm afrjuchèðl dm ceomrhèðl sfstmledh

Dmspuås dm ch dfse﬈`hèðl tmrhpåute`h, mc èèdf vhcprfe`f temlm ulh mcejelhèðl t8 / ? dm `mr`h dm 84 b, hprfxejhdhjmltm. Ch eltfxe`hèðl `fl èèdf vhcprfe`f pumdm prfvf`hr `fjh. Hc prmdmèr ch durhèðl dmc `fjh ms ejpfrthltm `flsedmrhr qum, dmspuås dm ulh sformdfses, cfs prf`msfs jmthoðce`fs dm prejmr frdml, phrh mc vhcprfhtf, phrm`ml shturhrsm y ch t8/?, dm mcejelhèðl hphrmltm pumdm mx`mdmr dm 0> h 4= b (Pzthkliry`mr, ?>>?), pflemldf hc phèmltm ml remsgf, pfr ul temjpf ju`bf jès prfcflghdf

Jmde`hjmltfs ecêètfs ml mlvhsms dm gfjh f pcèste`f Pucaflecurmhs h Cfs aèrjh`fs elgmredfs

kultf `fl hgmltms qum temlml h`tevedhd hlte`fcelårge`h, dmoedf h ch desjeluèðl dm ch jftecedhd ghstrfeltmstelhc, thjoeål pumdml prmsmlthr ul eleèf rmthrdhdf dm ch h`èðl.

^

e   r l ` e   p e   f s g m l m r h c   m s

=2 MAM@TFP

@ H ^ Ê    T ] C F 4 T f x e   ` e   d h d d m a   è r j h ` f s y m l v m l m l h j e   m l t   f

DMPMHOCM (tmrhpåute`f)

ELDMPMHOCM

LFLDMCMTM_EF]P (mam`tfs smùldhrefs)

DMCMTM_EF]P (mam`tfs tðxe`fs) Ahrjh`fcðge`f ^htfcðge`f Gmlftðxe`f

Aegurh 4-0 Mspm`trf dm cfs mam`tfs dm cfs prfdu`tfs ahrjh`åute`fs .

mxtrmjh smlseoecedhd h dfses ohkhs f mxtrmjh elsmlseoecedhd h hcths dfses dm aèrjh`fs. ]l jm`hlesjf `fjûl ms ch uleðl dm ul aèrjh`f `fvhcmltm `fl prftmêlhs såre`hs qum `fldu`m h ch prmsmlthèðl dm ul bhptmlf mxtrhøf, dhldf `fjf rmsucthdf ulh rmspumsth eljulftfxe`fcðge`h. Ju`bhs deamrmlèhs eltmreldeveduhcms ml chs rmspumsths h cfs aèrjh`fs temlml ulh ohsm ahrjh`fgmlåte`h (våhsm ahrjh`fgmlåte`h (våhsm `hpêtucf 7). ]lh arh`èðl dm bfjorms dm pemc lmgrh (∳8>%) dmshrrfcchl ulh hlmjeh bmjfcête`h g rhvm ùhldf rmèoml prejhquelh, `fjf trhthjemltf hltejhcère`f9 msth mvfcuèðl sm dmom h ulh gmlåte`h dm gcu`fsh-1-afsahtf dmsbedrfgmlhsh mretrfèthreh. Cfs pfcejfraesjfs ml LHT? `fldu`ml h ulh destreouèðl juctejfdhc dm ch h`mtechèðl y mc h`chrhjemltf dm esflehzedh. (aegurhs 1>-0 y 1>-4). Ch vhrehoecedhd ml ch rmspumsth hlte`fhguchltm h ch whrahrelh sm dmom h pfcejfraesjfs ml @U^?@5 y QIF_@8 (våhsm aegurh 7-7, aegurh 0?-1 y thoch 0?-?). Hdmjès, @U^0H4 y @U^?D1 jmthofcezhl ul grhl lûjmrf dm aèrjh`fs ml mc bêghdf (våhsm aegurh 1-0). Chs vhrehltms pfcejðrae`hs dm ul sfcf lu`cmðtedf ml @U^0H4 ch h`tevedhd mlzejète`h y, pfr thltf, hctmrhr chy @U^?D1 t8 / ? dmc pumdml aèrjh`f.ham`thr Ch hdjelestrhèðl dm ul aèrjh`f qum ms ul sustrhtf dm @U^, ml `fjoelhèðl `fl ul aèrjh`f qum ms ul elbeoedfr dmc jesjf @ U^ U^,, pumdm `flduèr h tfxeèdhd pfr sformdfses dmc aèrjh`f. Ju`bfs prfspm`tfs phrh jmde`hjmltfs prfpfrèflhl elafrjhèðl dm prms`repèðl qum hdvemrtm dm msths eltmrh`èflms mltrm aèrjh`fs.

Eltmrh`èflms mltrm aèrjh`fs rmh`èflms, `fjûljmltm, durhl dm 1 h 8? dêhs y, cumgf qum mc hgmltm hgrmsfr sm mcejelh, dmshphrm`ml. Tepf EQ; rmh`èflms dm bepmrsmlseoecedhd b epmrsmlseoecedhd rmthrdhdhs. Msths rmh`èflms mstèl jmdehdhs pfr celafètfs T smlseoecezhdfs y jh`rðahgfs. @uhldf chs `åcuchs smlseoecezhdhs mltrhl ml `flth`tf `fl mc hltêgmlf, sm gmlmrh ulh rmh`èðl elachjhtfreh jmdehltm ch prfdu`èðl dm celafquelhs y ch pfstmrefr hacumlèh dm lmutrðaecfs y jh`rðahgfs. ]l mkmjpcf dm bepmrsmlseoecedhd dm tepf EQ f rmthrdhdh ms ch dmrjhtetes dm `flth`tf `hushdh pfr bemdrh vmlmlfsh.

_mh`èflms edefsel`rète`hs y `fltreouèflms ahrjh`fgmlåte`hs Ch edefsel`rhseh edefsel`rhseh ms ms ulh rmh`tevedhd hlfrjhc h ul prfdu`tf quêje`f qum ms pmùcehr ml ul eldeveduf dhdf, ch rmspumsth edefsel`rète`h pumdm smr dm

H`mthjelfaål BL@F@B0

BL@F@B0

BL@F@B0 FB @U^?M8

Pucahtf

L@F@B0

Gcuùrðledf LH^XE (eltmrjmdehref tðxe`f)

Gcuthteðl BL@F@B0

Jh`rfjfcåùchs `mcuchrms lu`cmfaêce`hs

BL@F@B0

Jh`rfjfcåùchs

Gcuthteðl FB

FB

Cfs phèmltms sfl `fjûljmltm trhthdfs `fl jès dm ul aèrjh`f, thjoeål pumdml msthr ushldf jmde`hjmltfs dm vmlth ceorm, vethjelhs y ftrfs supcmjmltfs –lhturhcms‚9 hdmjès, pumdml tmlmr demths elusuhcms. Tfdfs mstfs ah`tfrms pumdml `fltreouer h chs eltmrh`èflms jmde`hjmltfshs, ul arh`hsf dm ch tmrhpeh y ch tfxeèdhd. Ch aegurh ae gurh 4-= rmsujm cfs jm`hlesjfs y tepfs dm eltmrh`èflms. `hushr ul hujmltf f ulh Eltmrh`èðl dm hosfrèðl. ]l aèrjh`f pumdm `hushr desjeluèðl ml ch hosfrèðl dm ftrf aèrjh`f dmsdm mc cujml eltmstelhc eltmstelhc.. Ch rhletedelh ul hlthgflesth dm cfs rm`mptfrms dm besthjelh B ?, hujmlth mc pB ghstrfeltmstelhc y pumdm hujmlthr ch hosfrèðl dm aèrjh`fs oèse`fs `fjf mc trehzfchj (F―@fllfr-Pmjjms mt hc., hc., ?>>8). ^fr mc `fltrhref, mc smùmstrhdfr dm èèdf oecehr `fcmsterhjelh `fldu`m h `fl`mltrhèflms såre`hs, segleae`htevhjmltm, rmduèdhs dm prfprhlfcfc (Beoohrd mt hc., hc., 8524). Eltmrh`èðl dm ch uleðl dm prftmêlhs. Ju`bfs aèrjh`fs, `fjf ch hsperelh, cfs ohroetûre`fs, ch amletfêlh, chs sucaflhjedhs, mc èèdf vhcprfe`f y ch whrahrelh mstèl hcthjmltm ceghdfs h prftmêlhs ml mc pchsjh, y ms mc aèrjh`f ceorm (lf uledf) mc qum prfdu`m cfs mam`tfs `cêle`fs. Mstfs aèrjh`fs pumdml tmlmr ulh jhyfr tfxeèdhd ml ch sformdfses se cfs setefs dm uleðl h prftmêlhs sm shturhl, ml msthdfs aesefcðge`fs qum `fldu`ml h bepfhcoujelmjeh f ùhldf sm dmspchzhl dm prftmêlhs dm pchsjh pfr ftrfs aèrjh`fs (Gutbrem (Gut brem mt hc., hc., 855=). Eltmrh`èðl dmc jmthofcesjf. ]l aèrjh`f pumdm elacuer `fl armùmlèh ml mc jmthofcesjf dm ulf f vhrefs aèrjh`fs (våhsm `hpêtucf 1), mspmèhcjmltm ùhldf mstèl ejpce`hdfs cfs @U^ bmpète`fs. Mc h`mthjelfaål ms trhlsafrjhdf, phrèhcjmltm, pfr @U^?M8 hc jmthofcetf tðxe`f LH^XE (våhsm aegurh 4-4). Ch elgmsth dm mthlfc, ul pftmltm eldu`tfr dm @U^?M8, pumdm `flduèr h ulh jhyfr sus`mpteoecedhd h ch eltfxe`hèðl pfr h`mthjelfaål, dmspuås dm ulh sformdfses (Dhrt mt hc., hc., ?>>1). Eltmrh`èðl dm ch uleðl dmc rm`mptfr. Ch ouprmlfraelh ms ul fpefedm `fl h`tevedhdms dm hgflesth phrèhc y hlthgflesth ml mc rm`mptfr, `fjûljmltm utecezhdf phrh trhthr ch hde`èðl h cfs fpefedms. Mc aèrjh`f sm ulm h cfs rm`mptfrms fpeè`mfs `fl hcth haeledhd y pumdm prmvmler ch muafreh pfr mc usf `fl`fjethltm dm aèrjh`fs lhr`ðte`fs dm housf. Eltmrh`èðl dm ch h`èðl tmrhpåute`h. Ch hsperelh ms ul elbeoedfr dm ch hgrmghèðl pchqumthreh y ch bmphrelh bmphr elh ms ul hlte`fhguchltm9 sujelestrhdfs kultfs, pumdml hujmlthr mc remsgf dm shlgrhjemltf. Chs sucaflecurmhs `hushl bepfgcu`mjeh mstejuchldf ch ceomrhèðl dm elsucelh phl`rmète`h, jemltrhs qum cfs aèrjh`fs oeguhledh (p. mk., chjmtfafrjelh) `fldu`ml h ulh desjeluèðl dm ch prfdu`èðl dm gcu`fsh bmpète`h. Mstfs aèrjh`fs pumdml ushrsm kultfs phrh `fltrfchr ch bepmrgcu`mjeh dehoåte`h. Thcms eltmrh`èflms dm aèrjh`fs sfl hdetevhs hdetevhs,, ùhldf mc mam`tf `fjoelh`fjoelhdf dm dfs aèrjh`fs ms eguhc h ch sujh dmc mam`tf dm `hdh hgmltm hdjelestrhdf sfcf y, selårge`hs selårge`hs,, ùhldf mc mam`tf `fjoelhdf mx`mdm ch sujh dm cfs mam`tfs dm `hdh aèrjh`f hdjelestrhdf sfcf. Ch pftmlèhèðl dm ch tfxeèdhd tfxeèdhd dms`reom ch `rmhèðl dm ul mam`tf tðxe`f dm ul aèrjh`f, dmoedf h ch prmsmlèh dm ftrf aèrjh`f. Mc hlthgflesjf hlthgflesjf ms ms ch eltmramrmlèh dm ulh drfgh `fl ch

h`èðl dm ftrh. Mc hlthgflesjf aulèflhc f aesefcðge`f sm aesefcðge`f smchprfdu`m ùhldf aeprfdu`tfs quêje`fs prfvf`hl aulèflhc f mam`tfs fpumstfs sform jesjh aulèðl aedfs sefcðge`h. Mc hlthgflesjf quêje`f, quêje`f, f elh`tevhèðl elh`tevhèðl,, ms ulh rmh`èðl mltrm dfs Èèdf jmr`hptûre`f

Jumrtm `mcuchr

Aegurh 4-4 Qêhs dmc jmthofcesjf y tfxeèdhd dmc h`mthjelfaål . Mc LH^XE eltmrjmdehref tðxe`f ms L -h`mtec-h`mtec-p-omlzfquelflmejelh.

prfdu`tfs quêje`fs phrh lmutrhcezhr sus mam`tfs, `fjf sm fosmrvh `fl ch tmrhpeh dm qumchèðl. Mc hlthgflesjf ml ch despfseèðl ms despfseèðl ms ch hctmrhèðl dm ch despfseèðl dm ulh susthlèh (su hosfrèðl, oeftrhlsafrjhèðl, destreouèðl f mx`rmèðl) dm jhlmrh qum jmlfr `hltedhd dmc hgmltm ccmgh hc ðrghlf

H

O Jm`hlesjfs dm eltmrh`èflms quêje`hs

AH_JH@F@ELÅTE@H

AH_JH@F DELÈJE@H

=5

@chse﬈`hèðl dm chs eltmrh`èflms quêje`hs

HDETEQHP PELÅ_GE@HP

Oeftrhlsafrjhèðl

Lf rm`mptfr

^FTML@EH@EÐL

Destreouèðl

_m`mptfr

HLTHGFLEPJF

Hosfrèðl Mx`rmèðl

Aulèflhc Xuêje`f Despfseèðl _m`mptfr

Aegurh 4-= Jm`hlesjfs y `chseae`hèðl dm chs eltmrh`èflms ahrjh`fcðge`hs . dehlh u ðrghlf dm dmstelf, f sm rmdu`m su pmrsestmlèh ml mc jesjf. Mc hlthgflesjf ml mc rm`mptfr   (qum segleae`h rm`mptfr, mlzejh, trhlspfrthdfr dm aèrjh`fs, `hlhc eðle`f, mt`.) ms mc ocfqumf dmc mam`tf dm ul aèrjh`f pfr ftrf qum `fjpetm ml mc setef dmc rm`mptfr.

^rumohs dms`reptevhs dm tfxeèdhd ml hlejhcms Dfs prelèpefs, f supumstfs auldhjmlthcms, suoyh`ml h tfdhs chs prumohs dms`reptevhs dm tfxeèdhd rmhcezhdhs ml hlejhcms. ^rejmrf, cfs mam`tfs dm cfs prfdu`tfs quêje`fs prfduèdfs ml hlejhcms dm chofrhtfref, ùhldf mstèl `hceae`hdfs dmoedhjmltm, sm hpce`hl h ch tfxeèdhd bujhlh. @uhldf sm `hcùch sform ch ohsm dm ch dfses pfr uledhd dm supmraeèm dmc ùmrpf, cfs mam`tfs tðxe`fs ml smrms bujhlfs, gmlmrhcjmltm sm mlùmltrhl ml mc jesjf rhlgf dm `fl`mltrhèflms qum ml cfs hlejhcms dm mxpmrejmlthèðl. Pform ch ohsm dmc pmsf `frpfrhc, cfs smrms bujhlfs, ml gmlmrhc, sfl jès vuclmrhocms qum cfs hlejhcms dm mxpmrejmlthèðl. Pmguldf, ch mxpfseèðl dm cfs hlejhcms dm mxpmrejmlthèðl h hgmltms tðxe`fs, ml dfses mcmvhdhs, ms ul jåtfdf lm`mshref y vècedf phrh dmsùorer pfseocms pmcegrfs phrh cfs smrms bujhlfs, qum mstèl mxpumstfs h dfses ju`bf jès ohkhs. Mstm prelèpef sm ohsh ml mc `fl`mptf ùèlte`f dfses-rmspumsth. @fjf ùmsteðl dm prh`teèdhd, mc lûjmrf dm hlejhcms utecezhdfs ml mxpmrejmltfs `fl jhtmrehcms tðxe`fs, pfr cf rmguchr, smrè pmqumøf `fjphrhdf `fl mc thjhøf dm chs pfochèflms bujhlhs, pftmlèhcjmltm ml remsgf. ^fr mkmjpcf, mc >.>8% dm elèdmlèh dm ul mam`tf tðxe`f grhvm (`fjf mcThc `èl`mr) rmprmsmlth ?= >>> pmrsflhs hcth. ml ulh jeccflms. elèdmlèh ms, elh`mpthocmjmltm, Pelpfochèðl mjohrgf,dm ch ?=> dmtm`èðl mxpmrejmlthc dm ulh elèdmlèh dm >.>8%, thc vmz, rmqumrerêh ul jêlejf dm 0> >>> hlejhcms. ^hrh mstejhr mc remsgf h dfses ohkhs, sm dmoml dhr grhl g rhl-dms dfses h grupfs rmchtevhjmltm pmqumøfs. pmqumøfs. Ch vhcedmz dm ch mxtrhpfchèðl lm`mshreh ms, `chrhjmltm, ulh ùmsteðl `ruèhc `r uèhc.. Cfs prfdu`tfs quêje`fs sm prumohl prejmrf ml ùhltf h ch tfxeèdhd jmdehltm ch mstejhèðl dm ch DC=> ml dfs mspmèms hlejhcms pfr dfs vêhs dm hdjelestrhèðl, ulf dm mccfs ms ch ruth prmvesth dm mxpfseèðl dm cfs smrms bujhlfs hc prfdu`tf quêje`f qum sm mstè prfohldf. Pm rmgestrh mc lûjmrf dm hlejhcms qum jumrml ml ul pmrefdf dm 84 dêhs, dmspuås dm ulh dfses ûle`h. Cfs hlejhcms thjoeål sfl mxhjelhdfs phrh dmtm`thr seglfs dm eltfxe`hèðl, cmthrgf, jfdeae`hèðl dm ch `fldu`th y jfroecedhd. Mc prfdu`tf quêje`f sm prfohrè dm lumvf ml ùhltf h tfxeèdhd pfr mxpfseèðl rmpmtedh, usuhcjmltm durhltm 5> dêhs. Mstm mstudef sm rmhcezh `fl jhyfr armùmlèh ml dfs mspmèms, pfr ch vêh dm usf prmvestf f ch mxpfseèðl `fl, hc jmlfs, trms dfses. ]lh smrem dm phrèjmtrfs sm `fltrfchl durhltm mstm pmrefdf, y hc aelhc dmc mstudef, cfs ðrghlfs y tmkedfs sfl mxhjelhdfs pfr ul phtðcfgf. Mstudefs h chrgf f sestmjète`fs sm rmhcezhl hlejhcms, jesjf temjpf qum sm ccmvhlpchzf h `hof mlshyfs `cêle`fs. ^hrh cfsmlaèrjh`fs, ch hc durhèðl dm ch mxpfseèðl dmpmldm, ml èmrth jmdedh, dmc usf `cêle`f prmvestf. Pe mc aèrjh`f sm utecezh, lfrjhcjmltm, durhltm pmrefdfs `frtfs y ohkf supmrveseðl jåde`h, hc eguhc qum ul hgmltm hlteje`rfoehlf, ulh mxpfseèðl sestmjète`h dm cfs hlejhcms durhltm smes jmsms pfdrêh smr suaeèmltm. Pe mc aèrjh`f sm utecezh ml smrms bujhlfs pfr pmrefdfs jès chrgfs, pumdm smr

lm`mshref ul mstudef sestmjète`f dm su usf durhltm dfs høfs. Cfs mstudefs sform mxpfseèðl sestmjète`h, h jmludf sm utecezhl phrh dmtmrjelhr mc pftmlèhc `hrèlfgåle`f dm cfs prfdu`tfs quêje`fs. Mstfs mstudefs, gmlmrhcjmltm, sm rmhcezhl ml rhths y rhtflms durhltm mc pmrefdf dm vedh prfjmdef dm ch mspmèm. Ftrhs prumohs mstèl desmøhdhs phrh mvhcuhr ch tmrhtfgmleèdhd (jhcafrjhèflms `flgåleths), ch tfxeèdhd pmrelhthc y pfslhthc y cfs mam`tfs sform ch amrtecedhd. Cfs mstudefs dm tmrhtfgmleèdhd, gmlmrhcjmltm sm rmhcezhl hdjelestrhldf aèrjh`fs h rhths mjohrhzhdhs y `flmkfs, durhltm mc pmrefdf dm frghlfgålmses. Cfs jåtfdfs `fjputhèflhcms dm sestmjhs dm oefcfgêh quêje`h el sece`f, sece`f, pumdml `fltreouer prfltf h thcms mstudefs.

Ahrjh`fcfgêh dm smguredhd y mlshyfs `cêle`fs Jmlfs dm ul tmrèf dm cfs jmde`hjmltfs, prfohdfs ml mlshyfs `cêle`fs, ccmghl hc jmr`hdf. Ch cmy amdmrhc msthdfuledmlsm y chs `flsedmrhèflms åte`hs mxegml qum mc mstudef dm lumvfs aèrjh`fs, ml smrms bujhlfs, sm ccmvm h `hof dm hùmrdf `fl lfrjhs mstre`ths. ]lh vmz qum ul aèrjh`f sm kuzgh cestf phrh smr mstudehdf ml smrms bujhlfs, ulh sfceètud dm LAE dmom smr prmsmlthdh `fl ch HJJ. Mc LAE el`cuym 8) elafrjhèðl sform ch `fjpfseèðl y aumltm dmc aèrjh`f9 ?) elafrjhèðl quêje`h y dm ahore`hèðl9 0) tfdfs cfs dhtfs dm mstudefs ml hlejhcms9 4) pchlms y prftf`fcfs `cêle`fs prfpumstfs9 =) cfs lfjorms y `rmdmlèhcms dm cfs jåde`fs qum ccmvhrèl h `hof cfs mlshyfs `cêle`fs, y 1) ulh rm`fpechèðl dm cfs dhtfs `chvm, rmcmvhltms phrh mstudehr mc aèrjh`f ml bujhlfs, pumstfs h despfseèðl dm cfs elvmsteghdfrms y sus E_O. Cfs mlshyfs ml smrms bujhlfs `fjemlzhl, sfchjmltm, dmspuås dm qum sm bhl `fjpcmthdf mstudefs suaeèmltms dm tfxeèdhd hgudh y suohgudh, ml hlejhcms. Chs prumohs dm smguredhd `rðle`hs ml hlejhcms, el`cuedfs cfs mstudefs dm `hrèlfgmleèdhd, sumcml rmhcezhrsm sejuctèlmhjmltm `fl mlshyfs `cêle`fs. Ch hùjuchèðl y mc hlèceses dm tfdfs cfs dhtfs lm`mshrefs, h jmludf rmquemrml dm 4 h 1 høfs dm prumohs `cêle`hs. Ml `hdh ulh dm chs trms ahsms afrjhcms dm cfs mlshyfs `cêle`fs, cfs vfculthrefs f phèmltms dmoml smr elafrjhdfs dmc msthdf dm ch elvmsteghèðl dmc aèrjh`f, hsê `fjf cfs pfseocms remsgfs, y dmoml smr hutfrezhdfs h dm`celhr f h`mpthr su phrteèphèðl y mc `flsujf dmc jmde`hjmltf. Mstfs rmgchjmltfs rmg chjmltfs sm ohshl ml cfs prelèpefs åte`fs msthocmèdfs ml ch Dm`chrhèðl dm Bmcselie. HdmHdmjès, ul E_O eltmrdesèpcelhref, ml ch elsthchèðl dfldm sm ccmvhrè h `hof mc mlshyf `cêle`f dm jmde`hjmltfs, dmom rmveshr y hprfohr cfs pchlms èmltêae`fs y åte`fs phrh chs prumohs ml smrms bujhlfs. Chs ahsms prms`reths, chs cêlmhs dm temjpf y cfs `fstfs phrh dmshrrfcchr ul lumvf aèrjh`f sm prmsmlthl ml ch thoch 8-8 y ch aegurh 8-8.

Mpedmjefcfgêh dm chs rmspumsths hdvmrshs h cfs aèrjh`fs m eltfxe`hèflms pfr aèrjh`fs

Ch eltfxe`hèðl pumdm fùrrer dm ju`bhs jhlmrhs, dmspuås dm mxpfseèflms tmrhpåute`hs y lf tmrhpåute`hs h aèrjh`fs f prfdu`tfs quêje`fs (thoch 4-?). Ml Msthdfs ]ledfs, sm mstejh qum ? jeccflms dm phèmltms bfspethcezhdfs temlml rmh`èflms hdvmrshs grhvms `hdh høf y hcrmdmdfr dm 8>> >>> suarml rmh`èflms hdvmrshs, ahthcms h cfs jmde`hjmltfs (Chzhrfu mt hc., hc.,

P M @ @ E   Ð   L E   ^

e   r l ` e   p e   f s g m l m r h c   m s

1>

@ H ^ Ê    T ] C F 4 T f x e   ` e   d h d d m a   è r j h ` f s y m l v m l m l h j e   m l t   f

THOCH 4-? ▮ Ms`mlhrefs pftmlèhcms phrh ch fùrrmlèh dmc mlvmlmlhjemltf

THOCH 4-4 ▮ Aèrjh`fs hsfèhdfs hc jhyfr lûjmrf dm pårdedhs bujhlhs, ahthcms pfr eltfxe`hèðl

Tfxeèdhd tmrhpåute`h dm cfs aèrjh`fs

Pmdhltms/beplðte`fs/ hltepse`ðte`fs Jmde`h Jmd e`hjml jmltf tfss `hr `hrdef defvhs vhsùc ùchr hrms ms H`mthjelfaål (sfcf y ml `fjoelhèðl) PP_E Fpeè`mfs

Mxpfseèðl mxpcfrhtfreh pfr leøfs pmqumøfs Mxpfseèðl hjoemlthc Mxpfseèðl fùphèflhc Housf rm`rmhtevf Mrrfrms dm ch prms`repèðl, despmlshèðl f hdjelestrhèðl

Mstejuchltms y drfghs `hccmkmrhs Hc`fbfcms Hc`fbf cms PP_E

@fjf sm elafrjð ml Jfwry mt hc., ?>8=.

Hdjelestrhèðl Hdjelestrh èðl eltmlèflhc dm hutfcmseðl Hdjelestrhèðl Hdjelestrh èðl eltmlèflhc phrh dhøhr h ftrh pmrsflh

^rmvmlèðl dm eltfxe`hèðl

_mdu`èðl dm mrrfrms dm jmde`hèðl 8552). Mc usf dm oumlfs prelèpefs dm prms`repèðl, `fjf sm dms`reom ml mc hpålde`m E y ch thoch 4-=, pumdm hyudhr h mvethr thcms rmsucthdfs hdvmrsfs. Hcgulhs tfxeèdhdms dm aèrjh`fs pumdml prmdmèrsm ohsèldfsm ml su jm`hlesjf ahrjh`fcðge`f `flfèdf, sel mjohrgf, h jmludf mc pmraec dm tfxeèdhd tmrhpåute`h dm ul aèrjh`f sfcf sm bh`m mvedmltm durhltm mc pmpm refdf pfstmrefr h ch `fjmrèhcezhèðl. Mc sestmjh dm lfteae`hèðl dm mvmltfs hdvmrsfs dm ch ADH sm ohsh ml dfs smøhcms phrh dmtm`thr MHJ , jmlfs `fjulms. Ml prejmr cughr, ch ADH mxegm h cfs ahore`hltms dm aèrjh`fs rmhcezhr vegechlèh pfs`fjmrèhcezhèðl dm jmde`hjmltfs rm`mthdfs y prfdu`tfs sel rm`mth jåde`h. Ml smguldf cughr, ch ADH fpmrh ul sestmjh dm elafrjhèðl vfculthreh ( JmdWht`b, JmdWht`b, ml bttp;//www.adh.gfv/Phamty/ JmdWht`b) despfleocm thltf phrh prfamseflhcms dm ch shcud, `fjf phrh

Durhltm ch ûctejh då`hdh, sm bh prmsthdf `flsedmrhocm htmlèðl h ch rmdu`èðl dm cfs mrrfrms dm jmde`hèðl y cfs MHJ. Cfs mrrfrms dm jmde`hèðl pumdml fùrrer ml ùhcquemr phrtm dmc prf`msf dm prms`repèðl f usf dm jmde`hjmltfs, jemltrhs qum cfs MHJ sfl cmseflms rmchèflhdhs `fl mc usf f lf dm jmde`hjmltfs. Pm `rmm qum cfs mrrfrms dm jmde`hèðl sfl dm => h 8>> vm`ms jès armùmltms qum cfs MHJ (Ohtms mt hc., hc., 855=). Cfs –èl`f `frrm`tfs‚ smøhchdfs ml mc ùhdrf 4-? pumdml smrver `fjf `frrm`tevfs. Ml ch prè`te`h, cfgrhr ulh rmdu`èðl ml cfs mrrfrms dm jmde`hèðl ejpce`h ul ms`rutelef dm cfs sestmjhs elvfcu`rhdfs ml ch prms`repèðl, dfùjmlthèðl, trhls`repèðl, despmlshèðl, hdjelestrhèðl y jfletfrezhèðl dm ulh tmrhpeh, `fjf sm prmsmlth ml mc hpålde`m E. Chs oumlhs prè`te`hs dm usf dm jmde`hjmltfs temlml pultfs dm vmreae`hèðl foceghtfreh y rmduldhltm (aegurh 4-1), `fjf tmlmr ul ahrjh`åute`f, ul jåde`f y ulh mlamrjmrh9 tfdfs rmveshl y `flaerjhl, hltms dm ch hdjelestrhèðl dmc aèrjh`f, qum ulh dfses frdmlhdh dm ul jmde`hjmltf ms hprfpehdh phrh mc phèmltm. Qhrehs mstrhtmgehs prè`te`hs pumdml hyudhr h rmduèr cfs mrrfrms dm jmde`hèðl ml cfs mltfrlfs dm htmlèðl jåde`h (thoch 4-=).

cfs `flsujedfrms. Cfs bfspethcms thjoeål pumdml hpfyhr h cfs `fjetås phrh elvmsteghr cfs MHJ pftmlèhcms. Dmshafrtulhdhjmltm, ms prfohocm qum ùhcquemr `flkultf lhèflhc dm dhtfs suomstejm ch jfroecedhd y jfrthcedhd htreoueocm h cfs MHJ dmoedf h ch ahcth dm lfteae`hèðl y h ch deaeùcdea eùcthd phrh edmlteae`hr mc dmlfjelhdfr dm ch mxpfseèðl tfthc dm cfs phèmltms. ^rmvmlèðl dm eltfxe`hèflms ml mc bfghr Ch tfxeèdhd ahrjh`fcðge`h tmrhpåute`h ms sðcf ul suo`flkultf dm ch Mxestml vhrefs `fltmxtfs h cfs qum pumdm deregersm ch prmvmlèðl dmc mleltfxe`hèðl, `fjf sm elde`h ml ch thoch 4-?. Mc jhc usf y housf dm cfs aèr vmlmlhjemltf (thoch 4-?).Ch dmprmseðl y chs eltmlèflms sueèdhs lm`mselm`m sejh`fs rm`mthdfs y chs drfghs ecêèths sfl prfocmjhs ejpfrthltms dm shcud thl smr edmlteae`hdhs y trhthdhs. Ch mxpfseèðl h cfs pmcegrfs ml mc bfghr, pûoce`h. Ch elèdmlèh dm mlvmlmlhjemltf lf ehtrfgåle`f lf eltmlèflhc hc herm ceorm y ml chs èrmhs dm trhohkf dmom rmduèrsm h levmcms, rhzflhocmms oejfdhc, ham`thldf prelèphcjmltm, h cfs leøfs ml sfldmf, dm 8 h = høfs y hlèhlfs. Ch sformdfses eltmlèflhc eltmlèflhc `fl `fl aèrjh`fs ms jès `fjûl ml jmltm, hc`hlzhocms. Chs mstrhtmgehs dm prmvmlèðl dm ch eltfxe`hèðl pumdml `chsea e`hrsm `fjf phsevhs e`hrsm phsevhs,, lf rmqueremldf lelgûl `hjoef dm ch hdfcms`mlèh y durhltm ch mdhd hducth. Chs susthlèhs ejpce`hdhs, `fl `fjpfrthjemltf pfr phrtm dmc eldeveduf f h`tevhs h`tevhs,, hqumcchs qum rmquemjhyfr armùmlèh, ml mxpfseèflms y jumrtms bujhlhs sm prmsmlthl ml rml hdhpthèðl sfstmledh phrh tmlmr åxetf. Chs mstrhtmgehs dm prmvmlèðl chs thochs 4-0 y 4-4, rmspm`tevhjmltm. phsevhs sfl chs jès mae`h`ms (thoch 4-1). Ch elèdmlèh dm eltfxe`hèðl ml cfs leøfs bh desjeluedf, lftfrehjmltm, ml chs ûctejhs ùhtrf då`hdhs, ml grhl phrtm dmoedf hc jmkfrhjemltf dm ch smguredhd dm cfs mlvhsms dm jmde`hjmltfs, cejpehdfrms dm drmlhkm, trmjmltelh y ftrfs prfdu`tfs

THOCH 4-0 ▮ Pusthlèhs elvfcu`rhdhs `fl jès armùmlèh armùmlèh ml mc mlvmlmlhjemltf bujhlf

quêje`fs dfjåste`fs9 jhyfr maeèmlèh ml chh`mr`h afrjhèðl htmlèðl jåjå de`h y mc hujmltf dm ch `flèmlèh pûoce`h dm cfsy ch pftmlèhcms vm-lmlfs.

P]PTHL@EH

%

Hlhcgåse`fs

88.0

^rfdu`tfs dm begemlm pmrsflhc

7.7

Pusthlèhs dm cejpemzh

7.7

Pmdhltms/beplðte`fs/hltepse`ðte`fs

=.5

Hltedmprmsevfs

4.4

Hltebesthjêle`fs

4.>

Jmde`hjmltfs `hrdefvhsùchrms

4.>

@umrp rpffs mxtrhøfs/k /kuugumtms/devmrsfs

0.5

@]HD_F 4󰀪? ▮ @el`f prelèpefs dm ch jmde`hèðl smgurh

^msteèdhs

0.?

@ujpcer `fl cfs –èl`f `frrm`tfs‚ dm ch hdjelestrhèðl smgurh dm ch jmde`hèðl, pumdm hyudhr h cfs prfamseflhcms h mvethr mrrfrms dm jmde`hèðl;

Ml mc suogrupf dm mxpfseèflms pmdeètre`hs (mdhd 3= høfs), cfs prfdu`tfs `fsjåte`fs/dm ùedhdf pmrsflhc y cfs prfdu`tfs dm cejpemzh dfjåste`h, rmprmsmlthrfl mc ?=% dm cfs `hsfs, smguedfs dm hlhcgåse`fs (5.0%), ùmrpfs mxtrhøfs/ kugumtms (1.7%), vethjelhs (4.=%) y hltebesthjêle`fs (4.0%). Aumltm; Dhtfs dm Jfwry mt hc., ?>8=. mt

^relèpefs dmc trhthjemltf hltm ulh eltfxe`hèðl @uhldf sm mspmrh f sm prfdu`m ulh tfxeèdhd, chs prefredhdms dmc trhthjemltf dm ch eltfxe`hèðl sfl; • Jhltmlmr aulèflms aesefcðge`hs vethcms. vethcms. • _mduèr f prmvmler ch hosfrèðl y jmkfrhr ch mcejelhèðl phrh jelejezhr ch `fl`mltrhèðl dmc tðxe`f. tðxe`f. • @fjohter cfs mam`tfs tfxe`fcðge`fs dmc tðxe`f ml cfs setefs rm`mptfrms (ùhdrf 4 -0).

Jmde`hjmltf `frrm`tf, phèmltm `frrm`tf, dfses `frrm`th, ruth `frrm`th, temjpf hdmùhdf

H

Mrrfr

O

Mam`tf hdvmrsf

Mrrfr

Aegurh 4-1 Mc jfdmcf –qumsf suezf‚ dmc mrrfr dm ch jmde`hèðl. Mxestml vhrefs pultfs dm `fltrfc qum, têpe`hjmltm, pumdml edmlteae`hr y prmvmler ul mvmltf hdvmrsf dm drfghs, y msm mvmltf hdvmrsf sðcf pumdm fùrrer se cfs hgukmrfs ml vhrefs sestmjhs sm hcelmhl. H. ]l mrrfr sestmjète`f lf `fldu`m h ul mvmltf hdvmrsf pfrqum ms ejpmdedf pfr ul fostèùcf ml mc sestmjh. O. Qhrefs mrrfrms sestmjète`fs pumdml hcelmhrsm phrh pmrjeter qum fùrrh ul mvmltf hdvmrsf. (Dhtfs dm; Ch rhzðl K. Or Jmd K  ?>>>90?>;712-77>). ?>>>90?>;712-77>).

Edmlte﬈`hèðl dm cfs phtrflms `cêle`fs dm tfxeèdhd ]l bestfrehc jåde`f pumdm pmrjeter ch `rmhèðl dm ulh cesth dm jmde`hjmltfs despfleocms f prfdu`tfs quêje`fs ejpce`hdfs ml ul mvmltf dm eltfxe`hèðl. H jmludf, ulh fosmrvhèðl dm sêltfjhs y seglfs aêse`fs pumdm smr ch ûle`h pesth hdeèflhc h ul dehglðste`f dm mlvmlmlhjemltf. Cfs grupfs dm seglfs y sêltfjhs aêse`fs hsfèhdfs `fl sêldrfjms dm eltfxe`hèðl mspm`êae`fs sm `flf`ml `fjf tfxedrfjms (Mreìsfl mt hc., hc., ?>>79 Fstmrbfudt, (thoch 4-7). Ch prumoh?>>4) tfxe`fcðge`h dm aèrjh`fs ml frelh ms ul eljulfmlshyf desmøhdf phrh dmtm`thr aèrjh`fs dm housf `fjulms, `fjf hlamthjelhs, ohroetûre`fs, omlzfdeh`mpelhs, `hllhoes, `f`hêlh y fpeè`mfs. ^fr cf gmlmrhc, ch eltfxe`hèðl hgudh `fl msths susthlèhs sm pumdm dmtmrjelhr pfr rhzflms `cêle`hs, pmrf cfs rmsucthdfs dm mstfs mlshyfs, `fl armùmlèh lf mstèl despfleocms `fl ch suaeèmltm rhpedmz phrh guehr ch msthoecezhèðl. Hdmjès, ch dmtm`èðl dm aèrjh`fs f sus jmthofcetfs ml ul eljulfmlsh yf dm frelh lf segleae`h qum mc aèrjh`f dmtm`thdf smh rmspflshocm dm ch mlamrjmdhd fosmrvhdh pfr eltfxe`hèðl. @uhldf ch elgmsteðl dm h`mthjelfaål f hsperelh lf pumdm smr mx`cuedh, `chrhjmltm, h trhvås dm ch bestfreh dm ch mxpfseèðl, mxpfseèðl, sm rm`fjemldh ch ùhlteae`hèðl såre`h dm mstfs aèrjh`fs. ]l M@G pumdm smr ûtec phrh dmtm`thr ocfqumf `hrdeh`f, ocfqumhdfr

THOCH 4-1 ▮ Mstrhtmgehs y mkmjpcfs mkmjpcfs dm prmvmlèðl prmvmlèðl dm eltfxe`hèðl phsevh _mdu`èðl dm ch ahore`hèðl/vml ahore`hèðl/vmlth th dm aèrjh`fs tðxe`fs _mterhdh dm ch amlafrjelh dmc jmr`hdf ahrjh`åute`f msthdfuledmlsm Desjeluèðl dm ch `hltedhd dm aèrjh`f ml ul prfdu`tf dm `flsujf Cejethèðl dmc lûjmrf dm pêcdfrhs ml ul arhs`f dm hsperelhs pmqumøf ^rmvmler mc h``msf hc aèrjh`f ]tecezhèðl dm mlvhsms rmsestmltms h cfs leøfs @hjoehr ch afrjuchèðl dmc prfdu`tf Mcejelhr mthlfc dmc mlkuhgum ou`hc

dm cfs `hlhcms dmc Lh+, f ocfqumhdfr dm cfs `hlhcms dmc I +, hsfèhdfs `fl `chsms mspm`êae`hs dm jmde`hèðl (thoch 4-2). Cfs hlèceses dm chofrhtfref hdeèflhcms dmoml hdhpthrsm h ch èrùlsthlèh eldeveduhc dm ch eltfxe`hèðl.

Dms`flthjelhèðl dmc phèmltm eltfxe`hdf Chs eltfxe`hèflms pfr mxpfseèflms pumdml smr pfr elbhchèðl, pfr hosfrèðl ùtèlmh f ju`fsh, pfr elym`èðl f pfr elgmsteðl. Mc prejmr phsf phrh prmvmler ch hosfrèðl dm tðxe`f ms dmtmlmr ùhcquemr mxpfseèðl `flteluh. Pe ms lm`mshref, cfs fkfs y ch pemc dmoml chvhrsm, `fpefshjmltm. Ch dmseltfxe`hèðl ghstrfeltmstelhc prmvemlm f rmdu`m ch hosfrèðl dm ulh susthlèh dmspuås dm bhomr sedf elgmredh. Chs mstrhtmgehs phrh ch dmseltfxe`hèðl ghstrfeltmstelhc sfl mc vhèhjemltf gèstre`f, ch hdsfrèðl dmc tðxe`f, mc WOE WOE y mc mjpcmf dm `htèrte`fs. Chs jêlejhs elde`hèflms phrh `flsedmrhr ch dmseltfxe`hèðl ghstrfeltmstelhc el`cuyml; •• Mc tðxe`f dmom tðxe`f smrdmom pftmlèhcjmltm pftmlèhcjmltm pmcegrfsf.ml mc mstðjhgf f mc eltms Mc tðxe`f hûl lf bhomr sedf hosfroedf eltms-telf, pfr cf qum dmom rmhcezhrsm eljmdehthjmltm dmspuås dm ch elgmsteðl. • Mc prf`mdejemltf dmom rmhcezhrsm dm afrjh smgurh y `fl ch tå`le`h hdmhdm ùhdh. Mc vhèhjemltf gèstre`f ms rm`fjmldhdf, rhrh vmz (Jhlfgumrrh y @fohugb, ?>>=), pmrf ch hdjelestrhèðl dm `hroðl h`tevhdf y mc dmsmjpmøf dm WOE seguml semldf fpèflms tmrhpåute`hs. Mc vhèhdf gèstre`f rmdu`m ch hosfrèðl dmc aèrjh`f ml hcrmdmdfr dm ul tmrèf, ml `fldeèflms ðptejhs (H`hdmjeh Hjmre`hlh dm Tfxe`fcfgêh @cêle`h, ?>>4, Tmlmlomel mt hc., hc., 8527) (våhsm ch sm`èðl qum segum dm khrhom dm epm`hùhlh).

Hdsfrèðl

THOCH 4-= ▮ Chs jmkfrms rm`fjmldhèflms rm`fjmldhèflms prè`te`hs phrh rmduèr cfs mrrfrms ml ch hdjelestrhèðl dm jmde`hjmltfsh @F_TF ^CH[F • Jhltmlmr cfs sestmjhs dm destreouèðl dm dfses ulethrehs phrh

jmde`hjmltfs lf mjmrgmltms

• Tml Tmlmr mr prmphrhdhs ml chs ahrjhèhs sfcuèflms eltrhvmlfshs • Mcejelhr cfs jmde`hjmltfs, elbmrmltmjmltm elbmrmltmjmltm pmcegrfsfs (p. mk., I@c

`fl`mltrhdf) dm chs èrmhs dm htmlèðl hc phèmltm

• Dmshrrfcchr prf`mdejemltfs mspmèhcms mspmèhcms phrh aèrjh`fs dm hctf remsgf • Jmkfrhr cfs rmùrsfs dm elafrjhèðl elafrjhèðl `cêle`h rmchèflhdfs `fl cfs

jmde`hjmltfs

• Jmkfrhr ch mdu`hèðl mdu`hèðl dm ch hdjelestrhèðl dm jmde`hjmltfs jmde`hjmltfs phrh

cfs jåde`fs

• Mdu`hr h cfs phèmltms sform mc usf smgurf y prmèsf dm cfs

jmde`hjmltfs

• Jmkfrhr mc h``msf dm cfs jåde`fs jåde`fs dm `hom`mrh h cfs ahrjh`åute`fs

CH_GF ^CH[F

Ch hdsfrèðl dm ul tðxe`f sm rmaemrm h ch auseðl dm ul tðxe`f `fl ch supmraeèm dm ftrh susthlèh, phrh qum mc tðxe`f mstå jmlfs despfleocm phrh smr

@]HD_F 4󰀪0 ▮ Msthoecezhèðl eleèhc dmc phèmltm mlvmlmlhdf Ch jlmjftm`leh –HO@DM‚ –HO@DM‚ dm htmlèðl dm mjmrgmlèh sm hpce`h hc trhthjemltf dm ch eltfxe`hèðl hgudh; Qêh hårmh

Jhltemlm ch pmrjmhoecedhd

_msperhèðl

Jhltemlm ch fxegmlhèðl y vmltechèðl hdmùhdhs

@erùchèðl

Jhltemlm ch pmrauseðl dm cfs ðrghlfs vethcms

Des`hphèdhd

Mvhcûh ch desaulèðl dmc @LP

Pe sm dmtm`th ulh des`hphèdhd lmurfcðge`h, tmlgh ml ùmlth; ùmlth; Hdjelestrhèðl dm F? (`bmqumf dm fxejmtrêh dm pucsf) Hdjelestrhèðl dm dmxtrfsh (vmre﬈`hr Ygcu`fshZ ml shlgrm) Hdjelestrhèðl dm lhcfxflh (`flsedmrhr ul mlshyf mjpêre`f) Tehjelh (phrh phèmltms hductfs qum rmèoml dmxtrfsh)

Ejpcmjmlthr shcvhguhrdehs ohshdhs ml ch tm`lfcfgêh;

• • • •

Mxpfseèðl

Mltrhdh `fjputhrezhdh dm dm ðrdmlms ðrdmlms @fjprfohèðl `fjputhrezhdh `fjputhrezhdh dm dfses y hcmrgehs Pmguejemltf dm jmde`hjmltfs `fjputhrezhdf `fjputhrezhdf ]sf dm `ðdegfs dm ohrrhs f cm`tfrms cm`tfrms mcm`trðle`fs phrh ch prmphrh-

èðl y hdjelestrhèðl dm jmde`hjmltfs

h Qåhsm @fhceèðl dm Jhssh`busmtts phrh ch prmvmlèðl dm mrrfrms jåde`fs, ?>87.

󲀯

󲀯

󲀯

󲀯

Mvhcuhr ul –tfxeldrfjm‚ (våhsm thoch 4-7)

Ml `hsfs grhvms, ch eltuohèðl e ltuohèðl mldftrhqumhc, ch vmltechèðl jm`èle`h, mc sfpfrtm ahrjh`fcðge`f dm ch prmseðl hrtmrehc f mc sfpfrtm èrùchtfref mxtrh`frpðrmf, pumdml smr lm`mshrefs y hprfpehdfs.

18

P M @ @ E   Ð   L E   ^

e   r l ` e   p e   f s g m l m r h c   m s

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@ H ^ Ê    T ] C F 4 T f x e   ` e   d h d d m a   è r j h ` f s y m l v m l m l h j e   m l t   f

THOCH 4-7 ▮ Tfxeldrfjms `fjulms MPTHDF JMLTHC

@CHPMP DM D_FGHP

MKMJ^CFP

Pejpète`fjejåte`f

@fcelårge`f

@f`hêlh, hlamthjelh Deamlbedrhjelh Htrfpelh Frghlfafsahtfs

Fpefedm

Bmrfêlh

Pfjlfcmlèh @fjh Pfjlfcmlèh

Fxe`fdflh Omlzfdeh`mpelhs Ohroetûre`fs Hsperelh

@fjh Pfjlfcmlèh @fjh @flauseðl

Hlte`fcelårge`f

Pmdhltm beplðte`f Phceèchtf

T

THJHØF DM CH ^]ÊCH

↘

↘

↘

Tmjocfr Dehafrmses

↘

↘

↘

Êcmf, ruomah`èðl

↘

←

PC]DGM,h ahsèùchèðl

←

←

B_

O^

Hgethèðl

↘

Dmceref

↘

Ocfqumhdfr dm cfs `hlhcms dmc @h ?+ Qmrhphjecf

← ← ↘ ←

__

FT_FP

← ↘

↘

Dehafrmses, vðjetf

←

O^ (ocffd prmssurm); prmseðl hrtmrehc9 B_ (bmhrt rhtm); armùmlèh `hrdeh`h9 __ ( rmsperhtfry rhtm); armùmlèh rmsperhtfreh9 T ( tmjpmrhturm); tmjpmrhturh. h PC]DGM; mam`tfs jus`hrêle`fs dm shcevhèðl, chgrejmf, je`èðl, dmam`hèðl, `ðce`fs gèstre`fs y mjmses.

hosfroedf. Ch temrrh dm Auccmr sm bh sugmredf `fjf hdsfromltm hd sfromltm phrh mc phErreghèðl dm tfdf mc eltmstelf rhquht9 mc hzuc dm ^ruseh ulm mc thcef y mc `msef, y mc pfcemstermlf dm sfdef Ch erreghèðl dm tfdf mc eltmstelf ejpce`h ch hdjelestrhèðl mltmrhc dm pumdm hdsfromr mc cetef. Mc hdsfromltm jès `fjûl, utecezhdf ml mc trhthgrhldms `hltedhdms dm ulh sfcuèðl mcm`trfcête`h esffsjðte`h dm pfcemtejemltf dm ch sformdfses hgudh dm aèrjh`fs, ms mc `hroðl h`tevhdf. cmlgce`fc, dm hctf pmsf jfcmùchr `fl mc fokmtevf dm mcejelhr mc tðxe`f pfr @hroðl h`tevhdf. Mc `hroðl vmgmthc sm `rmh h trhvås dm ch perðceses `fltrf- mc rm`tf, hltms qum pumdh smr hosfroedf. Cfs `hldedhtfs pftmlèhcms phrh mc WOE el`cuyml; chdh dm jhtmreh frgèle`h y sm h`tevh, h trhvås dm vhpfr f trhthjemltf quêje`f, cf qum hujmlth su mstru`turh eltmrlh dm pfrfs y su `hphèdhd • ^hqumtms `frpfrhcms; pmrsflhs `fl phqumtms eltmstelhcms dm drfghs ecê supmraeèhc dm hdsfrèðl. èths. Ch supmraeèm dmc `hroðl h`tevhdf `fltemlm rmstfs dm `hroflf qum sfl • ^hèmltms `fl sformdfses dm bemrrf. `hph`ms dm hdsfromr cfs tðxe`fs. Ch dfses rm`fjmldhdh ms, têpe`hjmltm, • ^hèmltms qum bhl elgmredf aèrjh`fs ml prmsmlthèðl dm phr`bm. dm >.=-? g/ig dm pmsf `frpfrhc, bhsth ulh dfses jèxejh tfcmrhdh dm hcrm • ^hèmltms `fl sformdfses dm aèrjh`fs dm ceomrhèðl ceomrhèðl sfstmledh f afrjhafrjhdmdfr dm 7=-8>> g. @fjf ulh mstejhèðl hprfxejhdh, sm mspmrh qum 8> dfrms dm omzfhrms (jhshs lf degmreocms). g dm `hroðl h`tevhdf smh suaeèmltm phrh hdsfromr 8 g dm aèrjh`f. Cfs hc`fbfcms, `frrfsevfs, bedrf`hrourfs y jmthcms lf sfl oeml hdsfroedfs Ch sfcuèðl dm mcm`trfcetf dm pfcemtecmlgce`fc sm hdjelestrh, têpe`hjmltm, pfr mc `hroðl. Chs `fjpce`hèflms dm ch tmrhpeh `fl `hroðl h`tevhdf elml ulh thsh dm ?=-4> jC/ig/b bhsth qum mc macumltm rm`thc mstå `chrf y lf `cuyml vðjetfs, mstrmøejemltf, hsperhèðl pucjflhr y jumrtm. Ch hdjehphrmz`hl jès rmsedufs dmc vmlmlf. ^hrh cfgrhr mstfs hctfs levmcms dm errelestrhèðl lhsfgèstre`h dm `hroðl vmgmthc el`rmjmlth ch elèdmlèh dm ghèðl sm pumdm utecezhr ul tuof lhsfgèstre`f. Ch erreghèðl dm tfdf mc el v ðjetfs (Fstmrbfudt mt hc., ðjetfs hc., ?>>4) y pumdm hujmlthr mc remsgf dm hsperhtmstelf mstè `fltrhelde`hdh ml `hsfs dm fostru`èðl eltmstelhc f pmrafrhèðl èðl pucjflhr. Mc `hroðl lf dmom hdjelestrhrsm h phèmltms `fl sfspm y sm pumdm `fjpce` `fjpce`hr hr pfr destmlseðl destmlseðl hodfjelhc f hsperhèðl hsperhèðl pucjflhr pucjflhr.. `bh dm pmrafrhèðl ghstrfeltmstelhc f h hqumccfs h cfs qum sm vhyh h rmhcezhr mldfs`fpeh. Mc usf dm `hroðl h`tevhdf ml mc trhthjemltf dm el@htèrte`fs. Chs dfs `htmgfrêhs jès `fjulms dm `htèrte`fs sejpcms sfl chs ?+ tfxe`hèflms bh desjeluedf ml cfs ûctejfs ?> høfs h ?.8% dm cfs `hsfs ml shcms dm Jg , thcms `fjf ètrhtf dm jhglmsef y sucahtf dm jhglmsef, y cfs ?>84 (Jfwry mt hc., hc., ?>8=). `hrofbedrhtfs lf degmreocms, thcms `fjf mc sfroetfc. Mc usf dm `htèrte`fs sejpcms bh sedf hohldflhdf, `fjf mstrhtmgeh dm dmseltfxe`hèðl ghs-

THOCH 4-2 ▮ Dehglðste`f deamrmlèhc dm eltfxe`hèðl (cesthdf phrèhc) phrh jhleamsthèflms dm tfxeèdhd mcm`trf`hrdefgrè﬈`hs O_HDE@H_DEH/OCFX]MF @H_DEH@F

^_FCFLGH@EÐL DMC ELTM_QHC ELTM_QHCF F X_P

Aèrjh`fs hltehrrêtje`fs Ouprfpeðl @cfrfquelh Deamlbedrhjelh Hgmltms sejphte`fcête`fs sejphte`fcête`fs Hlthgflesths dm rm`mptfrο Chjftregelh @cfledelh Amlftehzelhs Fpeè`mfs ^rfprhlfcfc Ftrfs Hltedmprmsevfs Degfxelh tre`ê`ce`fs Ocfqumhdfrms dm cfs ?+ `hlhcms dmc @h Cetef Hgmltms `fcelårge`fs `fcelårge`fs

Aesfstegjelh Lmfstegjelh Frghlfafsahtfs @hrohjhtfs

^_FCFLGH@EÐL DMC ELTM_QHC ELTM_QHCF F XT@

Qåhsm @rmdeocmJmds® Cesth dm XTDrugs; bttps;//www. `rmdeocmjmds.frg/ lmw-drug-cest/

trfeltmstelhc. phrh mc chvhdf gèstre`f rmquemrm mc tuof Chvhdf gèstre`f. Mc prf`mdejemltf phrh frfgèstre`f ml mc mstðjhgf, `fl mc phèmltm ml ch pfsturh dm dm`ûoetf chtmrhc ezquemrdf, `fl ch `homzh jès ohkh qum cfs pems. Dmspuås dm rmterhr mc `fltmledf mstfjh`hc, sm hdjelestrh 8>-8= 8>-8= jC/ig (bhsth ?=> jC) dm cêquedf dm chvhdf shcelf qum cumgf ms rmterhdf. Mstm prf`msf `fltelûh bhsth qum mc cêquedf dm chvhdf hphrmz`h `chrf. Chs `fjpce`hèflms dmc prf`mdejemltf el`cuyml trhujhtesjf jm`èle`f ml mc mstðjhgf f mc msðahgf9 hsperhèðl pucjflhr dmc `fltmledf mstfjh`hc y mstejuchèðl dmc lmrvef vhgf. Khrhom dm epm`hùhlh. epm`hùhlh. Cfs hc`hcfedms `mahcelh y mjmtelh, mjmtelh, ml mc khrhom dm epm`hùhlh, h`tûhl `fjf mjåte`fs, dmoedf h ul mam`tf errethltm, cf`hc, sform mc sestmjh mltåre`f y ul mam`tf `mltrhc sform mc quejefrrm`mptfr pfstrmjf dm ch jåduch. Pform ch ohsm dm ch rmveseðl dm chs prumohs mxestmltms, ch H`hdmjeh Hjmre`hlh dm ^mdehtrê ^mdehtrêhh yh lf rm`fjemldh mc khrhom dm epm`hùhlh `fjf phrtm dm su prfgrhjh dm prmvmlèðl dm cmseflms elahltecms9 h su vmz, ch H`h- dmjeh Hjmre`hlh dm Tfxe`fcfgêh @cêle`h lf elde`h mc usf rutelhref dmc vhèh- jemltf gèstre`f ml mc phèmltm mlvmlmlhdf. mlvmlmlhdf. @fjf rmsucthdf, ch epm`hùhlh sm hdjelestrð ml sðcf >.>>1% dm tfdfs cfs eldevedufs `fl eltfxe`hèflms ml Msthdfs ]ledfs ml ?>84 (Jfwry mt hc., hc., ?>8=).

Jmkfrhldf ch mcejelhèðl dm tðxe`fs ]lh vmz hosfroedfs, cfs mam`tfs dmcmtårmfs, tfxe`fdelèje`fs, pumdml smr rmduèdfs h trhvås dm jåtfdfs qum h`mcmrhl su mcejelhèðl dmc ùmrpf, `fjf sm dms`reom h `flteluhèðl.

Jhlepuchèðl dmc pB urelhref; hc`hcelezhèðl urelhreh

THOCH 4-5 ▮ Hltêdftfs `fjulms y sus elde`hèflms Cfs aèrjh`fs sukmtfs h dmpurhèðl rmlhc sfl mx`rmthdfs ml ch frelh pfr aectrhèðl gcfjmruchr y sm`rmèðl tuouchr h`tevh9 cfs `fjpumstfs lf efleELDE@H@EÐL󰀢MP󰀥 zhdfs pumdml smr rmhosfroedfs ju`bf jès rèpedhjmltm qum chs jfcåù HLTÊDFTF MLQMLMLHJEMLTF chs pfchrms eflezhdhs (våhsm `hpêtucf ?). Cfs aèrjh`fs dm hèdmz dåoec sfl sus`mpteocms sus`mp teocms h ch –`hpturh dm eflms‚ ml ch frelh. Ch hsperelh ms ul èèdf H`mthtf dm f`trmðtedf Pucaflecurmh elduèdh dåoec `fl ul pI pI h : 0.>. @uhldf mc pB dm ch frelh hujmlth, jès shceè`htf, bepfgcu`mjeh sm mlùmltrh ml su afrjh eflezhdh ml mqueceoref y jès sm deauldm mc èèdf H`mtecèstmêlh H`mthjelfaål shce`êce`f ml mc cujml tuouchr dmc reøðl. r eøðl. Thjoeål sm `rmm qum ch hc`hcelezhèðl urelhreh h`mcmrh ch mcejelhèðl dmc amlfohroethc, ch `cfrprfphjedh, mc Hzuc dm jmtecmlf Jmthbmjfgcfoelmjeh jmtftrmxhtf y mc bmroeèdh `cfrfamlfxe. Ch H`hdmjeh Hjmre`hlh dm TfxeOmlztrfpelh Destflêh elduèdh pfr aèrjh`fs `fcfgêh @cêle`h rm`fjemldh ch hc`hcelezhèðl dm ch frelh `fjf ul trhthjemltf dm prejmrh cêlmh sðcf, y dm afrjh jfdmrhdh, phrh `hsfs dm Oe`hroflhtf dm sfdef Ocfqumf dm `hlhcms dmc Lh+ mlvmlmlhjemltf grhvm pfr shceèchtf y qum lf ùjpcml `fl cfs `retmrefs Orfjf`reptelh Pêldrfjm lmurfcåpte`f dm bmjfdeèceses (^rfudafft mt hc., hc., ?>>4). ^hrh cfgrhr ch hc`hcelezhèðl dm ch frelh, 8>>-8=> jMq dm oe`hroflhtf jhceglf dm sfdef ml 8 C dm dmxtrfsh hc =% ml hguh (D=W, =% dmxtrfsm el whtmr ) sm @hrletelh Bepmrhjflmjeh pfr vhcprfhtf hdjelestrh dfs vm`ms, pfr vêh eltrhvmlfsh, jhltmlemldf cfs rmqumrejemlHlthgflesths ο-hdrmlårge`fs tfs dm acuedfs y `fl`mltrhldf mc mam`tf. Ch bepf`hc`mjeh dmom smr trhthdh9 w dm cf `fltrhref, `fltrhref, deaeùcthrè cfs msaumrzfs msaumrz fs phrh hc`hcelezhr ch frelh dmoedf hc @cfrb @cf rbedr edrht htff dm bedrfx bedrfxf`f f`fohc ohchje hjelh lh @eh @ehlur lurff eltmr`hjoef B+-I+ ml mc reøðl. Ch hc`hcelezhèðl dm ch frelh mstè `fltrhel@cfrbedrhtf ddmm lhcfxflh Fpefedms de`hdh ml `hsfs dm elsuaeèmlèh rmlhc, f ùhldf ch hdjelestrhèðl dm cêquedfs pumdm mjpmfrhr mc mdmjh pucjflhr f ch elsuaeèmlèh `hrdeh`h @cfrbed edrrhtf dm pere reddfxelh @flvucsef efllms `fl esflehzedh `flgmstevh. Ch h`mthzfchjedh lf sm utecezh phrh hc`hcelezhr ch frelh, yh qum @cfrur @cf rurff dm prhc prhcedf edfxej xejhh (?-^ (?-^HJ HJ)) ^chgue ^ch gueèd èdhs hs frgh frghlfa lfafsa fsafr frhdf hdfss prfjumvm ch hèdmjeh. @hroðl h`tevhdf `fl dfses jûctepcms Mc `hroðl h`tevhdf hosfrom cfs aèrjh`fs bhèh su supmraeèm y pmrjetm su tfthc mcejelhèðl. Chs dfses jûctepcms dm `hroðl h`tevhdf pumdml h`mcmrhr ch mcejelhèðl dm ch drfgh hosfroedh pfr dfs jm`hlesjfs; mc `hroðl pumdm eltmrrujper ch èrùchèðl mltmrfbmpète`h dmc aèrjh`f jmthofcezhdf, bmpète`hjmltm, y mx`rmthdf ml ch oeces, y thjoeål pumdm `rmhr ul grhdemltm dm deauseðl h trhvås dm ch ju`fsh GE y prfvf`hr ul acuedf dmc aèrjh`f, dmc tfrrmltm shlguêlmf bhèh mc `hroðl, ml mc cujml eltmstelhc. Mc `hroðl h`tevhdf sm pumdm hdjelestrhr ml dfses jûctepcms 8?.= g/b `hdh 8, ?, f 4 b (sm pumdml mjpcmhr pmqumøhs dfses ml cfs leøfs). Mc `hroðl jmkfrh ch mcejelhèðl dm ju`bfs aèrjh`fs dm ohkf pmsf jfcmùchr, pmqumøf vfcujml dm destreouèðl y maeèmltm t8/? dm mcejelhèðl. Pm pemlsh qum chs dfses jûctepcms dm `hroðl h`tevhdf temlml ch jhyfr utecedhd pftmlèhc ml chs sformdfses dm `hrohjhzmpelh, dhpsflh, amlfohroethc, quelelh, tmfaecelh y ch hdmca h hjhrecch (H`hdmjeh Hjmre`hlh dm Tfxe`fcfgêh @cêle`h, 85559 85559 Pecvh mt hc., hc., ?>>0).

@rfthcedh @rft hcedhmm pfcevhcmlt pfcevhcmltmm eljulm eljulm Aho Mlvmlmlh Mlvmlmlhjemlt jemltff pfr smrpemltm smrpemltm `rfthcelh lfrtmhjmre`hlh Dhltrfcmlf Bepmrtmrjeh jhceglh Dmamrfxhjelh Bemrrf Deamlbedrhjelh Destflêh elduèdh pfr aèrjh`fs Dejmr`hprfc (OHC) ^cfjf, jmrùref, hrsåle`f MDTH, @hLh? Mthlfc Ahoo dm Ah dm elj eljul uled edhd hd h ch ch deg degfx fxelh elh Acujhzmlec Acujhzmlec Gcu` Gc u`fl flht htff f `cfr `cfrur urff dm `hc `hcè èff

Mxtrh`èðl mxtrh`frpðrmh dm aèrjh`fs

Elsucelh (dfses hcth)

Mc aèrjh`f edmhc sus`mpteocm dm mcejelhèðl pfr bmjfdeèceses temlm ul ohkf pmsf jfcmùchr, ul ohkf vfcujml dm destreouèðl, ulh hcth sfcuoecedhd ml hguh y ul jêlejf mlch`m prftme`f. Ch bmjfpmrauseðl ejpce`h phshr ch shlgrm h trhvås dm ul `hrtu`bf qum `fltemlm phrtêùchs hdsfromltms. Chs eltfxe`hèflms jès `fjulms phrh cfs qum sm utecezh h vm`ms bmjfdeèceses, el`cuyml shceèchtf, jmthlfc, mtecmlgce`fc, cetef, `hrohjhzmpelh y vhcprfhtf.

Cmu`fvfrelh dm `hcèf Fxêgmlf bepmroère`f ^mleèchjelh Phceèchtf dm dm aeaesfstegjelh

Tmrhpeh `fl hltêdftfs

Pu`èjmr (DJPH) Pucahtf dm htrfpelh

^cfjf Jmthlfc, mtecmlgce`fc Gcu` Gc u`ðs ðsed edfs fs `h `hrd rdeh eh`f `fss Jmthlfc, mtecmlgce`fc Omlzfdeh`mpelhs Cfss aèrj Cf aèrjh` h`fs fs ocf ocfqu qumh mhdf dfrm rmss dmc dmc `hlhc dmc @h?+, acufrurf Ocfqumhdfrms dm `hlhcms dmc @h?+ Jmtftrmxhtf Jflðxedf dm `hroflf ^cfjf, jmrùref, `form Pêldrfjm hl hlte`fcelårge`f ^cfjf, jmrùref, hrsåle`f ^msteèdhs frghlfafsafrhdfs y dm `hrohjhtf @ehlurf @fujhrelh, el eldhlmdeflh

Ch tmrhpeh `fl hltêdftfs ejpce`h mc hlthgflesjf f ch elh`tevhèðl quêje`h dm ul vmlmlf hosfroedf. Mltrm cfs hltêdftfs mspm`êae`fs jès `fjulms mstèl ch L -h`mtec-C -h`mtec-C-èstmêlh phrh mc mlvmlmlhjemltf `fl h`mthjelfaål9 cfs hlthgflesths fpeè`mfs phrh sformdfses dm fpefedms y cfs hgmltms qumchltms phrh mc mlvmlmlhjemltf `fl èmrtfs jmthcms eflms. Ml ch thoch 4-5 sm prmsmlth ulh cesth dm hltêdftfs utecezhdfs. Ch ahrjh`fdelèje`h dm ul tðxe`f pumdm vmrsm hctmrhdh pfr `fjpmter ml ul rm`mptfr, `fjf ml mc hlthgflesjf prfpfrèflhdf pfr ch tmrhpeh `fl lhcfxflh ml mc `hsf dm ch sformdfses dm bmrfêlh. ]l hltêdftf aesefcðge`f pumdm utecezhr ul jm`hlesjf phrh supmrhr cfs mam`tfs dm ul tðxe`f, `fjf ml mc usf dm g cu`hgðl phrh mvethr ul rm`mptfr ο-hdrmlårge`f ocfcu`hgðl qumhdf y hujmlthr ch h`tevedhd `mcuchr HJ^ `ê`ce`h, ml mc `fltmxtf dm ulh sformdfses dm ul hlthgflesth ο-hdrmlårge`f. Cfs hltevmlmlfs y cfs hgmltms qumchltms sm ulml m elh`tevhl h cfs vmlmlfs dm afrjh derm`th. Ch oeftrhlsafrjhèðl dm ul aèrjh`f thjoeål pumdm smr hctmrhdh pfr ul hl têdftf, pfr mkmjpcf, mc afjmpezfc elbeom ch dmsbedrfgmlhsh dmc hc`fbfc y

Elafrjhèðl hdeèflhc sform eltfxe`hèðl pfr aèrjh`fs y prfdu`tfs quêje`fs pumdm smr ml`fltrhdh ml ju`bfs ceorfs dmde`hdfs h ch tfxe`fcfgêh (Acfjmlohuj mt hc., ?>>19 hc., ?>>19 Ichhssml, ?>809 Fcsfl, ?>889 Pbhllflmt hc., hc., ?>>7). ]lh ohsm dm dhtfs `fjputhrezhdh pfpuchr phrh elafrjhèðl sform

dmtemlm ch afrjhèðl dm utecezhdfs jmthofcetfs tðxe`fs, mtecmlgce`fc y jmthlfc. Ju`bfs aèrjh`fs ml èèdfs, mc ùedhdf dm uldmphèmltm eltfxe`hdf (hlte`flvucsevfs, hgmltms vhsf`flstre`tfrms, mt`.) pumdml smr `flsedmrhdfs hltêdftfs aulèflhcms lf mspm`êae`fs. Mc pechr dm ch tmrhpeh, phrh ulh eltfxe`hèðl, ms mc ouml hpfyf dm ch vêh hårmh, ch rmsperhèðl, ch èrùchèðl y cfs prf`msfs jmthoðce`fs vethcms dmc phèmltm mlvmlmlhdf, bhsth qum mc tðxe`f sm mcejelh dmc ùmrpf.

susthlèhs tðxe`hs msdm^FEPELMDR® ( Je`rfjmdmx, Je`rfjmdmx , El`., Dmlvmr, @F). Ch Oeoceftm`h Lhèflhc Jmdeèlh farm`m elafrjhèðl sform tfxe`fcfgêh y shcud hjoemlthc (bttp;//ses.lcj.leb.gfv/mlverf.btjc), el`cuymldf ul mlml ch`m h TFRLMT® (bttp;//tfxlmt.lcj.leb.gfv/). Cfs `mltrfs rmgeflhcms dm `fltrfc dmc mlvmlmlhjemltf sfl ul rmùrsf vhcefsf phrh fotmlmr elafrjhèðl sform mstm tmjh y pumdml smr `flth`thdfs ml Msthdfs ]ledfs, h trhvås dm ch Cêlmh dm hyudh dm ^fesfl ^fesfl;; 8-2>>-???-8???.

Tefsucahtf sðde`f Qethjelh I8 ( aeaetflhdeflh)

Jmdefs phrh ch elafrjhèðl sform ch tfxeèdhd dm aèrjh`fs y mlvmlmlhjemltf

10

P M @ @ E   Ð   L E   ^

e   r l ` e   p e   f s g m l m r h c   m s

14

@urtes D. Ichhssml y Imvel Fstmrbfudt `fltreouymrfl `fltr eouymrfl h mstm _m`flfèjemltf; `hpêtucf ml mdeèflms rmèmltms dm mstm ceorf. Bmjfs tmledf ml ùmlth hcgulfs dm sus tmxtfs ml ch mdeèðl h`tuhc.

Oeocefgrhaêh @ H ^ Ê    T ] C F 4 T f x e   ` e   d h d d m a   è r j h ` f s y m l v m l m l h j e   m l t   f

Hjmre`hl H`hdmjy fa @cele`hc Tfxe`fcfgy hld tbm Murfpmhl Hssfèhtefl fa ^fesfls @mltrms hld @cele`hc Tfxe`fcfgests. ^fsetefl phpmr; ghstre` chvhgm. K Tfxe`fc @cel @cel Tfxe`fc ?>>494?;500‐540. Hjmre`hl H`hdmjy fa @cele`hc Tfxe`fcfgy hld tbm Murfpmhl Hssfèhtefl fa ^fesfls @mltrms hld @cele`hc Tfxe`fcfgests. ^fsetefl sthtmjmlt hld prh`te`m guedmcelms fl tbm usm fa jucte-dfsm h`tevhtmd `bhr`fhc el tbm trmhtjmlt fa hùtm pfesflelg. @cel Tfxe`fc 8555 907 ;708‐7=8. ;708‐7=8. Ohtms DW, mt hc. _mchteflsbep omtwmml jmde`htefl mrrfrs hld hdvmrsm drug mvmlts. K Gml Eltmrl Jmd 855=98>;855‐?>=. mt hc Orflstmel H@, . ?>>7 Hlluhc rmpfrt fa tbm Hjmre`hl Hssfèhtefl fa ^fesfl @fltrfc @mltmrs― Lhteflhc ^fesfl Dhth Pystmj (L^DP); ?=tb hlluhc rmpfrt. @cel Tfxe`fc ?>>2941;5?7‐8>=7. @rmdeocmJmds. XTDrugs Cest. Hvhechocm ht; bttps;//`rmdeocmjmds.frg. H``mssmd Jhy ?4, ?>87. Dhrt _@, mt hc. H`mthjelfpbml pfesflelg; hl mvedml`m-ohsm mvedml`m-ohsmdd `flsmlsus guedmcelm afr fut-fa-bfspeth fut-fa-bfspethcc jhlhgmjmlt. @cel Tfxe`fc ?>>1944 ;8‐82. dm Pecvh BH, mt hc. Juctepcm-dfsm h`tevhtmd `bhr`fhc afr trmhtjmlt fa ymccfw fcmhldmr pfesflelg; h selgcm-oceld, rhldfjezmd, pch`mof-`fltrfccmd trehc. Chl`mt ?>>09018;850=‐8502. Mreìsfl TM, mt hc. Tbm hpprfh`b tf tbm phtemlt wetb hl ulilfwl fvmr?>>79?=;?45‐?28. dfsm. Mjmrg Jmd @cel Lfrtb Hj Acfjmlohuj LM, mt hc. (mds.). Gfcdarhli―s Tfxe`fcfge` Mjmrgmlèms, 2tb md. Lmw Ufri; J`Grhw-Becc9 ?>>1. Gutbrem PI, mt hc. Bypftbmsezmd eltmrh`tefl omtwmml vhcprfe` hèd hld whrahrel. K @cel ^sy`bfpbhrjh`fc 855=98=;802‐805. Beoohrd DJ, mt hc. Maam`ts fa `bfcmstyrhjelm hld `fcmstepfc fl tbm pchsjh `fl`mltrhtefls fa prfprhcfcfc. Or K @cel ^bhrjh`fc 8524982; Ichhssml 007‐04?. @D (md.). @hshrmtt hld Dfucc―s Tfxe`fcfgy; Tbm Ohse` Pèml`m fa ^fesfls. 2tb md. Lmw Ufri; J`Grhw-Becc9 ?>80.

Chzhrfu K, mt hc. Elèdml`m fa hdvmrsm drug rmh`tefls el bfspethcezmd phtemlts; h jmth-hlhcyses fa prfspm`tevm studems. KHJH 85529?75;8?>>‐8?>=. Jhlfgumrrh HP, @fohugb DK. Guedmcelms afr tbm Jhlhgmjmlt fa ^fesf?>>=940;8‐8>. lelgs @flsmlsus ^hlmc. @cel Tfxe`fc Jhssh`busmtts @fhcetefl afr tbm ^rmvmltefl fa Jmde`hc Mrrfrs. ?>87. Hvhechocm ht; jh`fhcetefl.frg. H``mssmd Jhy ?4, ?>87. Jfwry KO, mt hc. ?>84 Hlluhc rmpfrt fa tbm Hjmre`hl Hssfèhtefl fa ^fesfl @fltrfc @mltmrs― Lhteflhc ^fesfl Dhth Pystmj (L^DP); 0?ld ?>8=9=0;51?‐8847. hlluhc rmpfrt. @cel Tfxe`fc F―@fllfr-Pmjjms F―@fllfr-Pmj jms _C, mt hc. Maam`t fa rhletedelm fl tbm pbhrjh`fielmte`s fa trehzfchj hld hcpbh-bydrfxytrehzfchj el oftb yfulg hld fcdmr pmfpcm. @cel ^bhrjh`fc Tbmr   ?>>897>;8?1‐808. Fcsfl I_ (md.). ^fesflel ^fesflelgg & Drug Fvmrdfsm . 1tb md. Lmw Ufri; J`GrhwBecc9 ?>88. Fstmrbfudt I@. Lf syjphtby afr h ofy wetb fotuldhtefl. ^mdehtr Mjmrg ?>>49?>;4>0‐4>1. @hrm Fstmrbfudt I@, mt hc. _esi ah`tfrs afr mjmses hatmr tbmrhpmute` usm fa h`te vhtmd `bhr`fhc el hùtmcy pfesflmd `becdrml. ^mdehtre`s ?>>49880; 2>1‐28>. ^rfudafft HT, mt hc. ^fsetefl phpmr fl urelm hcihcelezhtefl. K Tfxe`fc @cel Tfxe`fc ?>>494?;8‐?1. ^fltmc CH, mt hc. Mldfgmlfus afrjhcdmbydm es h bmjhtfpfemt bmjhtfpfemte` e` stmj `mcc gmlftfxel hld jmthofce` `hrèlfgml. Jfc @mcc ?>8=91>;877‐822. _mhsfl K. Bujhl mrrfr; jfdmcs hld jhlhgmjmlt. Or Jmd K   ?>>>90?>; 712‐77>. _evmrh W, mt hc. Dmchymd shce`ychtm tfxeèty ht 0= bfurs wetbfut mhrcy jhleamsthtefls jhleamsthtef ls afccfwelg h selgcm shce`ychtm elgmstefl. Hll ^bhrjh`f- tbmr   ?>>4902;8821‐8822. Pbhllfl JW, mt hc. (mds.). Bhddhd hld Wel`bmstmr―s @cele`hc Jhlhgmjmlt fa ^fesflelg hld Drug Fvmrdfsm. 4tb md. ^bechdmcpbeh; Phuldmrs/Mcsm vemr9 ?>>7. Pzthkliry`mr JD. Qhcprfe` hèd tfxeèty; fvmrvemw hld jhlhgmjmlt. @cel Tfxe`fc ?>>?94>;725‐2>8. Tmlmlomel J, mt hc. Maae`h`y fa epm`h`-eldu`md mjmses, frfghstre` chvhgm, hld h`tevhtmd `bhr`fhc afr hùtm drug fvmrdfsm. Hll Mjmrg Jmd 8527981;202‐248.

Capítulo4 - Goodman & Gilman Las Bases Farmacologicas de La Terapeutica 13a

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