Capítulo4 - Goodman & Gilman Las Bases Farmacologicas de La Terapeutica 13a
August 31, 2022 | Author: Anonymous | Category: N/A
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Tfxe`edhd dm aèrjh`fs y mlvmlmlhjemltf mlvmlmlhjemltf Je`bmccm H. Mre`isfl y Trmvfr J. ^mllelg
CH DFPEP-_MP^]MPTH
^_MQML@EÐL DM ELTFRE@H@EÐL
▮ @urvhs dfses-rmspumsth `flvml`eflhcms
▮ _mdu``eðl dm mrrfrms dm jmde`h`eðl
▮ @urvhs dfses-rmspumsth lf jflftðle`hs
▮ ^rmvml`eðl dm eltfxe`h`eflms ml mc bfghr
AH_JH@F@ELÅTE@H QM_P]P TFRE@F@ELÅTE@H TFRE@F@ELÅTE@H
^_EL@E^EFP DMC T_HTHJEMLTF HLTM ]LH ELTFRE@H@EÐL
▮ Hctmrh`eflms ml HDJM ▮ Tepfs dm tfxe`edhd tmrhpåute`h
▮ Edmlte`h`eðl dm cfs phtrflms `cêle`fs dm tfxe`edhd ▮ Dms`flthjelh`eðl dmc ph`emltm 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 mcejelh`eðl dm tðxe`fs
JMDEFP ^H_H CH ELAF_JH@EÐL PFO_M CH TFRE@EDHD DM AÈ_JH@FP AÈ_JH@ FP U MLQMLMLHJEMLTF
M^EDMJEFCFGÊH 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 `uhldf ch rmspumsth aesefcðge`h h ul ul aèrjh`f, ms ul mam`tf hdvmrsf. hdvmrsf. ]l vmlmlf vmlmlf ms ms `uhcquemr susthl`eh, el`cuymldf `uhcquemr aèrjh`f, qum pfsmm ch `hph`edhd 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 mxpfse`eðl h prfdu`tfs ahrjh`åute`fs, drfghs ecê`eths f prfdu`tfs quêje`fs.
Ch dfses-rmspumsth
@urvhs dfses-rmspumsth `flvml`eflhcms
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
(m`uh`eðl 4-?)
@urvhs dfses-rmspumsth lf jflftðle`hs
Lf tfdhs chs `urvhs dfses-rmspumsth seguml ulh afrjh segjfedhc têpe`h. Mxestm ulh rmch`eðl dfses-rmspumsth dfses-rmspumsth grhduhdh ml mc eldeveduf y ulh rmMl ch aegurh 4-? sm jumstrhl trms mkmjpcfs. ^umdml fosmrvhrsm `urvhs df- ch`eðl dfses-rmspumsth, dfses-rmspumsth, `uèlte`h, ml ch pfoch`eðl (våhlsm aegurhs 0-?, 0-0 ses-rmspumsth ml afrjh dm ] , phrh jmthcms msml`ehcms 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 `eml`eh dm mstfs lutremltms phrh jhltmlmr ch bfjmfsthses. H jmdedh qum jmdedh qum hujmlth ch dfses. Qesth dm ulh jhlmrh `uèlte`h, ch rmch`eðl ch dfses sm el`rmjmlth, sm rm`upmrh ch bfjmfsthses y sm hc`hlzh mc afldf dfses-rmspumsth dfses-rmspum sth ejpce`h qum mc pfr`mlthk pfr`mlthkmm dm pfoch`eðl ham`thdh hujmlhujmldm ch `urvh dfses-rmspumsth ml afrjh dm ]. H jmdedh qum hujmlth ch th, h jmdedh qum sm el`rmjmlth ch dfses9 ch rmch`eðl ms `uèlte`h `uhldf dfses phrh supmrhr ch `hltedhd rmqumredh, `fl mc fokmtevf dm jhltmlmr sm `flsedmrh qum mc mam`tf msthocm`edf pumdm msthr prmsmltm f husmltm, ch bfjmfsthses, pumdm prfdu`ersm ulh tfxe`edhd pfr sformdfses. ^fr thltf, ml ul eldeveduf dhdf. Msth rmch`eðl `uèlte`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 `uhcms chs `åcuchs temlml jm`hlesjfs dm dmselThjoeål sm pumdm dmtmrjelhr ulh `urvh dfses-rmspumsth `uèlte`h, phtfxe`h`eðl. 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 e`emltmjmltm, cfs levmcms prfdu`edfs, dm jhlmrh aesefcðge`h, phrh prfe`emltmjmltm, `eðl dm ul aèrjh`f `fl mc `uhc mc =>% dm ch pfoch`eðl 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 `urvh `uèlte`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 `urvhs pumdml tmc mt hc., hc., ?>8=Z). smr mjpcmhdhs phrh ecustrhr ul TE, qum `uhlteae`h ch smguredhd rmchtevh dm @uhldf mstfs jm`hlesjfs dm prftm``eðl mldðgmlh mstèl sformshturhul jmde`hjmltf; dfs, sm fosmrvhrè ulh rmspumsth tðxe`h. Cfs tfxe`ðcfgfs rmprmsmlthl mstm tepf dm rmspumsth, `fjf ul –phcf dm bf`imy‚ (aegurh 4-?O) ulh rmgeðl dfldm lf bhy rmspumsth, smguedh dm ulh rmspumsth hdvmrsh, h jmdedh qum mc DC (m`uh`eðl 4-8) tðxe`f mx`mdm cfs jm`hlesjfs mldðgmlfs dm prftm``eðl y sm el`rmjmlth TE : MD cf suae`emltm phrh `hushr ulh rmspumsth lmghtevh. Pm fosmrvhl `urvhs dm dfses-rmspumsthh ml afrjh dm ] elvmrtedh, dfses-rmspumst elvmrtedh, `uhldf sm prfdu`m ch rmguch`eðl lmMvedmltmjmltm, h jmdedh qum ch prfpfr`eðl ms jhyfr, jès smgurf ms mc ghtevh/dmsmlseoecezh`eðl ghtevh/dmsmlseoe cezh`eðl dmc rm`mptfr dmspuås dm ch mxpfse`eðl h ul ceghlaèrjh`f. df f, `uhldf sm prfdu`m ul mam`tf lmghtevf hde`eflhc 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`hu`eðl (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 pmle`ecelh) sfl, mxtrmjhdhjmltm, smgurfs ml husml`eh dm ulh rmspumsth hcårge`h `flf`edh, ml ul ph`emltm dhdf. Fosårvmsm qum mc usf dm dfses jmdehs lf `flsedmrh qum ch pmldemltm dm chs `urvhs dfses-rmspumsth, phrh mam`tfs tmrhpåute`fs y
`fl`mltrh`eðl `fl`mltrh`eðl, , 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 rmguch`eðl lmghtevh dm cfs rm`mptfrms dm mstrðgmlfs. Pm pemlsh qum ju`bfs prfdu`tfs quêje`fs qum prfdu`ml trhstfrlfs mldf`relfs temlml `urvhs dfses-rmspumsth ml afrjh dm ] elvmrtedh, sejechrms h chs dmc mstrðgmlf.
=1
Hormvehturhs
H
HDJM; ( hosfrptefl, destreoutefl, jmthofcesj, hld mcejelhtefl) Hosfr`eðl,
@ H ^ Ê T ] C F 4
destreou`eðl, jmthofcesjf y mcejelh`eðl @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) Hdjelestrh`eðl 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 elstetu`eflhc e d elvmsteghteflhc lmw drug ) Lumvf aèrjh`f ml elvmstegh`eðl LAE; ( h d PP_E; ( smcm`tevm smrftflel rmupthim elbeoetfr ) Elbeoedfr smcm`tevf dm ch d rm`hpth`eðl dm smrftflelh m a ( tbmrhpmute` eldmx) Êlde`m tmrhpåute`f TE; è r ( WOE; wbfcm-ofwmc erreghtefl) Erregh`eðl dm tfdf mc eltmstelf j h ` f s y Dm bm`bf, chs `urvhs jucteaè`e`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`mltrh`eðl, 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 suae`emltm phrh ghrhltezhr ch dmtm``eðl d mtm``eðl dmc mspm`trf `fjpcmtf dm ch j vel`uch`eðl `fl ch rmspumsth y tfxe`edhd dm ulh susthl`eh dhdh. e m l t f
Ahrjh`f`elåte`h vmrsus tfxe`f`elåte`h
Hctmrh`eflms ml HDJM HDJM ]lh eltfxe`h`eðl pumdm hctmrhr, segleae`htevhjmltm, chs aul`eflms dm HDJM (våhlsm `hpêtucfs ?, = y 1), y msths hctmrh`eflms pumdml ham`thr, prfauldhjmltm, chs dm`eseflms ml mc trhthjemltf y mc prflðste`f. Ch ahrjh`f`elåte`h dm ul jmde`hjmltf, ml `er`ulsthl`ehs qum prfdu`ml tfxe`edhd f mxpfse`eðl mx`msevh, sm dmlfjelh tfxe`f`elåte`h tfxe`f`elåte`h.. Elgmrer dfses jhyfrms qum chs dfses tmrhpåute`hs dm ul aèrjh`f, pumdm prfcflghr su hosfr`eðl9 hctmrhr su uleðl h prftmêlhs, su vfcujml dm destreou`eðl y `hjoehr su dmstelf jmthoðce`f. @uhldf sm mlarmlth ulh eltfxe`h`eðl pftml`ehc, cfs `cêle`fs dmoml tmlmr ml `umlth dfs prmgulths ejpfrthltms; • ¶^fr `uèltf `uèltf temjpf ul ph`emltm hseltfjète`f lm`mseth smr jfletfrezhjfletfrezhdf6 (hosfr`eðl y delèje`h dmc aèrjh`f). • ¶@uèltf temjpf tfjhrè ul ph`emltm eltfxe`hdf phrh jmkfrhr6 (mceje (mceje-lh`eðl y delèje`h dmc aèrjh`f).
Hosfr`eðl dm aèrjh`fs Ch eltfxe`h`eðl pfr hsperelh ms ulh dm chs prel`ephcms `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`h`eðl tmrhpåute`h, ch hsperelh hc`hlzh chs `fl`mltrh`eflms 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, mspm`ehcjmltm `fl rmvmstejemltf mltåre`f, pumdm auseflhrsm y afrjhr omzfhrms, rmdu`emldf ch supmrae`em mam`tevh phrh ch hosfr`eðl. @fl`mltrh`eflms jèxejhs dm shce`echtf pchsjète`f pfr sformdfses dm hsperelh pumdml lf hc`hlzhrsm dm 4 h 0= bfrhs, dmspuås dm ch elgmsteðl (_evmrh mt hc., hc., ?>>4).
Mcejelh`eðl 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 fosmrvh`eðl dm 4 h 1 bfrhs, ml ulh mjmrgml`eh jåde`h (`uhdrf 4-8).
Tepfs dm tfxe`edhd 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`h`eðl tmrhpåute`h. Cfs mam`tfs sm`uldhrefs dm sm`uldhrefs 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 _mch`eflms dfses-rmspumsth . H. Ch DC => dm ul `fjpumstf sm dmtmrjelh, mxpmrejmlthcjmltm, dm jfdf usuhc, pfr hdjelestrh`eðl dmc prfdu`tf quêje`f h rhtflms f rhths (pfr vêh frhc f eltrhpmretflmhc). Mc pultf jmdef dm ch `urvh qum ecustrh mc pfr`mlthkm dm pfoch`eðl 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 pfoch`eðl. Cfs vhcfrms dm DC=> phrh hjofs `fjpumstfs sfl cfs jesjfs (8> jg/ig)9 sel mjohrgf, chs pmldemltms dm chs `urvhs 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. _mprmsmlth`eðl 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``eflms 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 el`edml`eh y grhvmdhd dm ch gmlftðxe`fs. Ml tfxe`edhd mstè, prfpfr`eflhcjmltm, rmch`eflhdh `fl ch `fl`mltrh`eðl dmc aèrjh`f ml mc `umrpf y ch durh`eðl dm ch mxpfse`eðl. Tfxe`edhd Tf xe`edhd ahrjh`fcðge`h. Ch dmprmseðl dmc @LP prfdu`edh pfr ohroetûre`fs ms, ml grhl jmdedh, prmdm`eocm pums dmpmldm dm chs `hrh`tmrêste`hs dm ch dfses. Ch prfgrmseðl dm cfs mam`tfs `cêle`fs vh dm ch hlseðceses h ch smdh`eðl, ch sfjlfcml`eh y mc `fjh. Dm jhlmrh sejechr, mc grhdf dm bepftmlseðl prfdu`edf pfr ch leamdepelh mstè rmch`eflhdf `fl ch dfses dmc aèrjh`f hdjelestrhdf. Ch des`elmseh thrdêh (våhsm `hpêtucf 81), ul trhstfrlf jftfr mxtrhperhjedhc hsf`ehdf `fl mc usf dm jmde`hjmltfs hltepse`ðte`fs, phrm`m dmpmldmr dm ch durh`eðl dm ch mxpfse`eðl. Ch tfxe`edhd ahrjh`fcðge`h thjoeål pumdm f`urrer `uhldf sm hdjelestrh ch dfses `frrm`th, pfr mkmjpcf, bhy aftftfxe`edhd hsf`ehdh `fl ch mxpfse`eðl h ch cuz sfchr ml ph`emltms trhthdfs `fl tmtrh`e`celhs, sucaflhjedhs, `cfrprfjhzelh y è`edf lhcedêxe`f. `flkughdfs lf Tfxe`edhd phtfcðge`h. Mc h`mthjelfaål ms jmthofcezhdf ml `flkughdfs tðxe`fs dm gcu`urðledf 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 `fldu`er hc bhcchzgf phtfcðge`f dm lm`rfses bmpète`h, dmoedf h ch dmrevh`eðl dm LH^XE bh`eh eltmrh``eflms `fl jh`rfjfcå`uchs 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 suprhsefcðge`h
Dfses
Aegurh 4-? _mch`eflms dfses-rmspumsth lf jflftðle`hs. H. @urvh dfses-rmspumsth ml afrjh dm ] phrh jmthcms msml`ehcms y vethjelhs.O. @urvh dm dfses-rmspumsth ml
afrjh dm bf`imy 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 rhdeh`eðl eflezhltm y ju`bfs quê- ohsðaecfs. Pe ch pfr`eðl Aho dm ch jfcå`uch dm hlte`umrpf 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 tfxe`edhdms juthvhsfdechth`eðl, mdmjh y ulh rmspumsth elachgåle`hs f `hl`mrêgmlhs. Ju`bfs dm cfs hgmltms quejeftmrhpåute`fs phrh y prfsthgchldelhs) y `hushl vhsfdechth`eðl, jhtfreh. Cfs prel`ephcms ðrghlfs ochl`f dm mstm tepf dm rmh``eðl 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 vhs`uchr (`bfqum _mh``eflms hcårge`hs hlhaecè`te`f). Msths rmspumsths temldml h f`urrer, rèpedhjmltm, dmspuås dm ]lh hcmrgeh hcmrgeh ms ms ulh rmh``eðl hdvmrsh, jmdehdh pfr mc sestmjh eljulm, qum ch mstejuch`eðl `fl ul hltêgmlf hc qum mc eldeveduf bh sedf smlseoecezhdf ms rmsucthdf dm ch smlseoecezh`eðl prmveh h ul quêje`f ml phrte`uchr f h y sm dmlfjelhl rmh``eflms dm bepmrsmlseoecedhd eljmdehths. eljmdehths. ulf qum ms mstru`turhcjmltm sejechr (våhsm `hpêtucf 04). Chs rmspumsths mstèl jmdehdhs thltf Tepf EE; rmh``eflms `etfcête`hs. Chs hcmrgehs dm tepf EE mstèl hcårge`hs bhl sedf devededhs ml `uhtrf `htmgfrêhs gmlmrhcms ohshdhs ml mc pfr hlte`umrpfs EgG `fjf EgJ y, pfr cf gmlmrhc, sm htreouyml h su `hph`ejm`hlesjf dm ejpce`h`eðl eljulfcðge`h. dhd phrh h`tevhr mc sestmjh dmc `fjpcmjmltf. Cfs prel`ephcms tmkedfs dehTepf E; rmh``eflms hlhcè`te`hs. Ch hlhaechxes mstè jmdehdh pfr pfr hlte`umr- lh, phrh chs rmh``eflms `etfcête`hs, sfl chs `åcuchs dmc sestmjh `er`uchtfref. pfs EgM. Ch pfr`eðl A` dm EgM pumdm ulersm h rm`mptfrms ml jhstf`etfs y Mkmjpcfs dm rmspumsths hcårge`hs dm tepf EE el`cuyml hlmjeh bmjfcête`h
THOCH 4-8 ▮ Aèrjh`fs qum gmlmrhcjmltm gmlmrhcjmltm jhlemsthl sêltfjhs ele`ehcms dmspuås dm jès dm 4 h 1 bfrhs, pfstmrefrms h ch sformdfses frhch H`mthjelfaål È`edf vhcprfe`f Hlte`fhguchltms Hlte`fhguchlt ms dm tepf whrahrelh Hsperelh
eldu`edh pfr pmle`ecelh, pûrpurhpfr trfjof`etfpåle`h eldu`edh pfr queledelh y grhlucf`etfpmleh eldu`edh sucaflhjedh. Msths rmh``eflms hutfeljulms h cfs aèrjh`fs sumcml dmshphrm`mr dmltrf dm vhrefs jmsms, dmspuås dm ch mcejelh`eðl dmc hgmltm hgrmsfr. Tepf EEE; rmh``eflms dm Hrtbus. Chs rmh``eflms hcårge`hs tepf EEE mstèl jmdehdhs, prmdfjelhltmjmltm, pfr EgG9 mc jm`hlesjf ejpce`h ch gmlmrh`eðl dm `fjpcmkfs hltêgmlf-hlte`umrpf qum, jès hdmchltm, aekhl mc `fjpcmjmltf. Cfs `fjpcmkfs sm dmpfsethl ml mc mldftmcef vhs`uchr, dfldm sm prfdu`m ulh rmspumsth elachjhtfreh dmstru`tevh, cchjhdh mlamrjm- dhd dmc sumrf. sumrf. Cfs sêltfjhs `cêle`fs dm ch mlamrjmdhd dmc sumrf el`cuyml mrup`eflms `utèlmhs pfr urte`hreh, hrtrhcgeh f hrtretes, celahdmlfphtêh y aemorm. Qhrefs aèrjh`fs, el`cuymldf cfs hlteoeðte`fs `fjûljmltm utecezhutecezhdfs, pumdml eldu`er rmh``eflms sejechrms h ch mlamrjmdhd dmc sumrf. Msths
Bfrjflhs terfedmhs Elbeoedfrms dm ch jflfhjelfxedhs jflfhjelfxedhshh
@]HD_F 48 ▮ È`edf vhcprfe`f
Jmde`hjmltfs dm afrjuch`eðl dm ceomrh`eðl sfstmledh
Dmspuås dm ch dfse`h`eðl tmrhpåute`h, mc è`edf vhcprfe`f temlm ulh mcejelh`eðl t8 / ? dm `mr`h dm 84 b, hprfxejhdhjmltm. Ch eltfxe`h`eðl `fl è`edf vhcprfe`f pumdm prfvf`hr `fjh. Hc prmdm`er ch durh`eðl 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 mcejelh`eðl hphrmltm pumdm mx`mdmr dm 0> h 4= b (Pzthkliry`mr, ?>>?), pflemldf hc ph`emltm ml remsgf, pfr ul temjpf ju`bf jès prfcflghdf
Jmde`hjmltfs ecê`etfs 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 desjelu`eðl dm ch jftecedhd ghstrfeltmstelhc, thjoeål pumdml prmsmlthr ul ele`ef rmthrdhdf dm ch h``eðl.
^
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 sm`uldhrefs)
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 prmsmlth`eðl dm ul bhptmlf mxtrhøf, dhldf `fjf rmsucthdf ulh rmspumsth eljulftfxe`fcðge`h. Ju`bhs deamrml`ehs eltmreldeveduhcms ml chs rmspumsths h cfs aèrjh`fs temlml ulh ohsm ahrjh`fgmlåte`h (våhsm ahrjh`fgmlåte`h (våhsm `hpêtucf 7). ]lh arh``eðl dm bfjorms dm pemc lmgrh (∳8>%) dmshrrfcchl ulh hlmjeh bmjfcête`h g rhvm `uhldf rm`eoml prejhquelh, `fjf trhthjemltf hltejhcère`f9 msth mvfcu`eðl sm dmom h ulh gmlåte`h dm gcu`fsh-1-afsahtf dmsbedrfgmlhsh mretrf`ethreh. Cfs pfcejfraesjfs ml LHT? `fldu`ml h ulh destreou`eðl juctejfdhc dm ch h`mtech`eðl 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 hdjelestrh`eðl dm ul aèrjh`f qum ms ul sustrhtf dm @U^, ml `fjoelh`eðl `fl ul aèrjh`f qum ms ul elbeoedfr dmc jesjf @ U^ U^,, pumdm `fldu`er h tfxe`edhd pfr sformdfses dmc aèrjh`f. Ju`bfs prfspm`tfs phrh jmde`hjmltfs prfpfr`eflhl elafrjh`eðl dm prms`rep`eðl qum hdvemrtm dm msths eltmrh``eflms mltrm aèrjh`fs.
Eltmrh``eflms mltrm aèrjh`fs rmh``eflms, `fjûljmltm, durhl dm 1 h 8? dêhs y, cumgf qum mc hgmltm hgrmsfr sm mcejelh, dmshphrm`ml. Tepf EQ; rmh``eflms dm bepmrsmlseoecedhd b epmrsmlseoecedhd rmthrdhdhs. Msths rmh``eflms mstèl jmdehdhs pfr celaf`etfs T smlseoecezhdfs y jh`rðahgfs. @uhldf chs `åcuchs smlseoecezhdhs mltrhl ml `flth`tf `fl mc hltêgmlf, sm gmlmrh ulh rmh``eðl elachjhtfreh jmdehltm ch prfdu``eðl dm celafquelhs y ch pfstmrefr hacuml`eh 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``eflms edefsel`rète`hs y `fltreou`eflms ahrjh`fgmlåte`hs Ch edefsel`rhseh edefsel`rhseh ms ms ulh rmh`tevedhd hlfrjhc h ul prfdu`tf quêje`f qum ms pm`ucehr 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
Gcu`urðledf LH^XE (eltmrjmdehref tðxe`f)
Gcuthteðl BL@F@B0
Jh`rfjfcå`uchs `mcuchrms lu`cmfaêce`hs
BL@F@B0
Jh`rfjfcå`uchs
Gcuthteðl FB
FB
Cfs ph`emltms 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``eflms jmde`hjmltfshs, ul arh`hsf dm ch tmrhpeh y ch tfxe`edhd. Ch aegurh ae gurh 4-= rmsujm cfs jm`hlesjfs y tepfs dm eltmrh``eflms. `hushr ul hujmltf f ulh Eltmrh``eðl dm hosfr`eðl. ]l aèrjh`f pumdm `hushr desjelu`eðl ml ch hosfr`eðl 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 hosfr`eðl dm aèrjh`fs oèse`fs `fjf mc trehzfchj (F―@fllfr-Pmjjms mt hc., hc., ?>>8). ^fr mc `fltrhref, mc sm`umstrhdfr dm è`edf oecehr `fcmsterhjelh `fldu`m h `fl`mltrh`eflms såre`hs, segleae`htevhjmltm, rmdu`edhs dm prfprhlfcfc (Beoohrd mt hc., hc., 8524). Eltmrh``eðl dm ch uleðl dm prftmêlhs. Ju`bfs aèrjh`fs, `fjf ch hsperelh, cfs ohroetûre`fs, ch amletfêlh, chs sucaflhjedhs, mc è`edf 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 tfxe`edhd ml ch sformdfses se cfs setefs dm uleðl h prftmêlhs sm shturhl, ml msthdfs aesefcðge`fs qum `fldu`ml h bepfhcoujelmjeh f `uhldf sm dmspchzhl dm prftmêlhs dm pchsjh pfr ftrfs aèrjh`fs (Gutbrem (Gut brem mt hc., hc., 855=). Eltmrh``eðl dmc jmthofcesjf. ]l aèrjh`f pumdm elacuer `fl arm`uml`eh ml mc jmthofcesjf dm ulf f vhrefs aèrjh`fs (våhsm `hpêtucf 1), mspm`ehcjmltm `uhldf mstèl ejpce`hdfs cfs @U^ bmpète`fs. Mc h`mthjelfaål ms trhlsafrjhdf, phr`ehcjmltm, 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 `fldu`er h ulh jhyfr sus`mpteoecedhd h ch eltfxe`h`eðl pfr h`mthjelfaål, dmspuås dm ulh sformdfses (Dhrt mt hc., hc., ?>>1). Eltmrh``eðl dm ch uleðl dmc rm`mptfr. Ch ouprmlfraelh ms ul fpefedm `fl h`tevedhdms dm hgflesth phr`ehc y hlthgflesth ml mc rm`mptfr, `fjûljmltm utecezhdf phrh trhthr ch hde``eðl 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``eðl dm ch h``eðl tmrhpåute`h. Ch hsperelh ms ul elbeoedfr dm ch hgrmgh`eðl 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 ceomrh`eðl dm elsucelh phl`rmète`h, jemltrhs qum cfs aèrjh`fs oeguhledh (p. mk., chjmtfafrjelh) `fldu`ml h ulh desjelu`eðl dm ch prfdu``eðl dm gcu`fsh bmpète`h. Mstfs aèrjh`fs pumdml ushrsm kultfs phrh `fltrfchr ch bepmrgcu`mjeh dehoåte`h. Thcms eltmrh``eflms dm aèrjh`fs sfl hdetevhs hdetevhs,, `uhldf 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,, `uhldf mc mam`tf `fjoelhdf mx`mdm ch sujh dm cfs mam`tfs dm `hdh aèrjh`f hdjelestrhdf sfcf. Ch pftml`eh`eðl dm ch tfxe`edhd tfxe`edhd dms`reom ch `rmh`eðl dm ul mam`tf tðxe`f dm ul aèrjh`f, dmoedf h ch prmsml`eh dm ftrf aèrjh`f. Mc hlthgflesjf hlthgflesjf ms ms ch eltmramrml`eh dm ulh drfgh `fl ch
h``eðl dm ftrh. Mc hlthgflesjf aul`eflhc f aesefcðge`f sm aesefcðge`f smchprfdu`m `uhldf aeprfdu`tfs quêje`fs prfvf`hl aul`eflhc f mam`tfs fpumstfs sform jesjh aul`eðl aedfs sefcðge`h. Mc hlthgflesjf quêje`f, quêje`f, f elh`tevh`eðl elh`tevh`eðl,, ms ulh rmh``eðl mltrm dfs È`edf jmr`hptûre`f
Jumrtm `mcuchr
Aegurh 4-4 Qêhs dmc jmthofcesjf y tfxe`edhd 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 qumch`eðl. Mc hlthgflesjf ml ch despfse`eðl ms despfse`eðl ms ch hctmrh`eðl dm ch despfse`eðl dm ulh susthl`eh (su hosfr`eðl, oeftrhlsafrjh`eðl, destreou`eðl f mx`rm`eðl) dm jhlmrh qum jmlfr `hltedhd dmc hgmltm ccmgh hc ðrghlf
H
O Jm`hlesjfs dm eltmrh``eflms quêje`hs
AH_JH@F@ELÅTE@H
AH_JH@F DELÈJE@H
=5
@chse`h`eðl dm chs eltmrh``eflms quêje`hs
HDETEQHP PELÅ_GE@HP
Oeftrhlsafrjh`eðl
Lf rm`mptfr
^FTML@EH@EÐL
Destreou`eðl
_m`mptfr
HLTHGFLEPJF
Hosfr`eðl Mx`rm`eðl
Aul`eflhc Xuêje`f Despfse`eðl _m`mptfr
Aegurh 4-= Jm`hlesjfs y `chseae`h`eðl dm chs eltmrh``eflms ahrjh`fcðge`hs . dehlh u ðrghlf dm dmstelf, f sm rmdu`m su pmrsestml`eh ml mc jesjf. Mc hl- thgflesjf 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 tfxe`edhd ml hlejhcms Dfs prel`epefs, f supumstfs auldhjmlthcms, suoyh`ml h tfdhs chs prumohs dms`reptevhs dm tfxe`edhd rmhcezhdhs ml hlejhcms. ^rejmrf, cfs mam`tfs dm cfs prfdu`tfs quêje`fs prfdu`edfs ml hlejhcms dm chofrhtfref, `uhldf mstèl `hceae`hdfs dmoedhjmltm, sm hpce`hl h ch tfxe`edhd bujhlh. @uhldf sm `hc`uch sform ch ohsm dm ch dfses pfr uledhd dm supmrae`em dmc `umrpf, cfs mam`tfs tðxe`fs ml smrms bujhlfs, gmlmrhcjmltm sm ml`umltrhl ml mc jesjf rhlgf dm `fl`mltrh`eflms qum ml cfs hlejhcms dm mxpmrejmlth`eðl. Pform ch ohsm dmc pmsf `frpfrhc, cfs smrms bujhlfs, ml gmlmrhc, sfl jès vuclmrhocms qum cfs hlejhcms dm mxpmrejmlth`eðl. Pmguldf, ch mxpfse`eðl dm cfs hlejhcms dm mxpmrejmlth`eðl h hgmltms tðxe`fs, ml dfses mcmvhdhs, ms ul jåtfdf lm`mshref y vècedf phrh dms`uorer pfseocms pmcegrfs phrh cfs smrms bujhlfs, qum mstèl mxpumstfs h dfses ju`bf jès ohkhs. Mstm prel`epef sm ohsh ml mc `fl`mptf `uèlte`f dfses-rmspumsth. @fjf `umsteðl dm prh`te`edhd, mc lûjmrf dm hlejhcms utecezhdfs ml mxpmrejmltfs `fl jhtmrehcms tðxe`fs, pfr cf rmguchr, smrè pmqumøf `fjphrhdf `fl mc thjhøf dm chs pfoch`eflms bujhlhs, pftml`ehcjmltm ml remsgf. ^fr mkmjpcf, mc >.>8% dm el`edml`eh dm ul mam`tf tðxe`f grhvm (`fjf mcThc `èl`mr) rmprmsmlth ?= >>> pmrsflhs hcth. ml ulh jeccflms. el`edml`eh ms, elh`mpthocmjmltm, Pelpfoch`eðl mjohrgf,dm ch ?=> dmtm``eðl mxpmrejmlthc dm ulh el`edml`eh 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 mxtrhpfch`eðl lm`mshreh ms, `chrhjmltm, ulh `umsteðl `ru`ehc `r u`ehc.. Cfs prfdu`tfs quêje`fs sm prumohl prejmrf ml `uhltf h ch tfxe`edhd jmdehltm ch mstejh`eðl dm ch DC=> ml dfs mspm`ems hlejhcms pfr dfs vêhs dm hdjelestrh`eðl, ulf dm mccfs ms ch ruth prmvesth dm mxpfse`eðl 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`h`eðl, cmthrgf, jfdeae`h`eðl dm ch `fldu`th y jfroecedhd. Mc prfdu`tf quêje`f sm prfohrè dm lumvf ml `uhltf h tfxe`edhd pfr mxpfse`eðl rmpmtedh, usuhcjmltm durhltm 5> dêhs. Mstm mstudef sm rmhcezh `fl jhyfr arm`uml`eh ml dfs mspm`ems, pfr ch vêh dm usf prmvestf f ch mxpfse`eðl `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 durh`eðl dm ch mxpfse`eðl dmpmldm, ml `emrth 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 mxpfse`eðl sestmjète`h dm cfs hlejhcms durhltm smes jmsms pfdrêh smr suae`emltm. 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 mxpfse`eðl sestmjète`h, h jmludf sm utecezhl phrh dmtmrjelhr mc pftml`ehc `hr`elfgåle`f dm cfs prfdu`tfs quêje`fs. Mstfs mstudefs, gmlmrhcjmltm, sm rmhcezhl ml rhths y rhtflms durhltm mc pmrefdf dm vedh prfjmdef dm ch mspm`em. Ftrhs prumohs mstèl desmøhdhs phrh mvhcuhr ch tmrhtfgmle`edhd (jhcafrjh`eflms `flgåleths), ch tfxe`edhd pmrelhthc y pfslhthc y cfs mam`tfs sform ch amrtecedhd. Cfs mstudefs dm tmrhtfgmle`edhd, gmlmrhcjmltm sm rmhcezhl hdjelestrhldf aèrjh`fs h rhths mjohrhzhdhs y `flmkfs, durhltm mc pmrefdf dm frghlfgålmses. Cfs jåtfdfs `fjputh`eflhcms 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 tmr`ef dm cfs jmde`hjmltfs, prfohdfs ml mlshyfs `cêle`fs, ccmghl hc jmr`hdf. Ch cmy amdmrhc msthdfuledmlsm y chs `flsedmrh`eflms åte`hs mxegml qum mc mstudef dm lumvfs aèrjh`fs, ml smrms bujhlfs, sm ccmvm h `hof dm h`umrdf `fl lfrjhs mstre`ths. ]lh vmz qum ul aèrjh`f sm kuzgh cestf phrh smr mstudehdf ml smrms bujhlfs, ulh sfce`etud dm LAE dmom smr prmsmlthdh `fl ch HJJ. Mc LAE el`cuym 8) elafrjh`eðl sform ch `fjpfse`eðl y aumltm dmc aèrjh`f9 ?) elafrjh`eðl quêje`h y dm ahore`h`eðl9 0) tfdfs cfs dhtfs dm mstudefs ml hlejhcms9 4) pchlms y prftf`fcfs `cêle`fs prfpumstfs9 =) cfs lfjorms y `rmdml`ehcms dm cfs jåde`fs qum ccmvhrèl h `hof cfs mlshyfs `cêle`fs, y 1) ulh rm`fpech`eðl dm cfs dhtfs `chvm, rmcmvhltms phrh mstudehr mc aèrjh`f ml bujhlfs, pumstfs h despfse`eðl dm cfs elvmsteghdfrms y sus E_O. Cfs mlshyfs ml smrms bujhlfs `fjemlzhl, sfchjmltm, dmspuås dm qum sm bhl `fjpcmthdf mstudefs suae`emltms dm tfxe`edhd hgudh y suohgudh, ml hlejhcms. Chs prumohs dm smguredhd `rðle`hs ml hlejhcms, el`cuedfs cfs mstudefs dm `hr`elfgmle`edhd, sumcml rmhcezhrsm sejuctèlmhjmltm `fl mlshyfs `cêle`fs. Ch h`ujuch`eðl 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 ph`emltms dmoml smr elafrjhdfs dmc msthdf dm ch elvmstegh`eðl dmc aèrjh`f, hsê `fjf cfs pfseocms remsgfs, y dmoml smr hutfrezhdfs h dm`celhr f h`mpthr su phrte`eph`eðl y mc `flsujf dmc jmde`hjmltf. Mstfs rmgchjmltfs rmg chjmltfs sm ohshl ml cfs prel`epefs åte`fs msthocm`edfs ml ch Dm`chrh`eðl dm Bmcselie. HdmHdmjès, ul E_O eltmrdes`epcelhref, ml ch elsthch`eðl dfldm sm ccmvhrè h `hof mc mlshyf `cêle`f dm jmde`hjmltfs, dmom rmveshr y hprfohr cfs pchlms `emltêae`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`h`eflms pfr aèrjh`fs
Ch eltfxe`h`eðl pumdm f`urrer dm ju`bhs jhlmrhs, dmspuås dm mxpfse`eflms tmrhpåute`hs y lf tmrhpåute`hs h aèrjh`fs f prfdu`tfs quêje`fs (thoch 4-?). Ml Msthdfs ]ledfs, sm mstejh qum ? jeccflms dm ph`emltms bfspethcezhdfs temlml rmh``eflms hdvmrshs grhvms `hdh høf y hcrmdmdfr dm 8>> >>> suarml rmh``eflms 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
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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-? ▮ Ms`mlhrefs pftml`ehcms phrh ch f`urrml`eh dmc mlvmlmlhjemltf
THOCH 4-4 ▮ Aèrjh`fs hsf`ehdfs hc jhyfr lûjmrf dm pårdedhs bujhlhs, ahthcms pfr eltfxe`h`eðl
Tfxe`edhd tmrhpåute`h dm cfs aèrjh`fs
Pmdhltms/beplðte`fs/ hltepse`ðte`fs Jmde`h Jmd e`hjml jmltf tfss `hr `hrdef defvhs vhs`uc `uchr hrms ms H`mthjelfaål (sfcf y ml `fjoelh`eðl) PP_E Fpeè`mfs
Mxpfse`eðl mxpcfrhtfreh pfr leøfs pmqumøfs Mxpfse`eðl hjoemlthc Mxpfse`eðl f`uph`eflhc Housf rm`rmhtevf Mrrfrms dm ch prms`rep`eðl, despmlsh`eðl f hdjelestrh`eðl
Mstejuchltms y drfghs `hccmkmrhs Hc`fbfcms Hc`fbf cms PP_E
@fjf sm elafrjð ml Jfwry mt hc., ?>8=.
Hdjelestrh`eðl Hdjelestrh `eðl eltml`eflhc dm hutfcmseðl Hdjelestrh`eðl Hdjelestrh `eðl eltml`eflhc phrh dhøhr h ftrh pmrsflh
^rmvml`eðl dm eltfxe`h`eðl
_mdu``eðl dm mrrfrms dm jmde`h`eðl 8552). Mc usf dm oumlfs prel`epefs dm prms`rep`eðl, `fjf sm dms`reom ml mc hpålde`m E y ch thoch 4-=, pumdm hyudhr h mvethr thcms rmsucthdfs hdvmrsfs. Hcgulhs tfxe`edhdms dm aèrjh`fs pumdml prmdm`ersm ohsèldfsm ml su jm`hlesjf ahrjh`fcðge`f `flf`edf, sel mjohrgf, h jmludf mc pmraec dm tfxe`edhd tmrhpåute`h dm ul aèrjh`f sfcf sm bh`m mvedmltm durhltm mc pmpm refdf pfstmrefr h ch `fjmr`ehcezh`eðl. Mc sestmjh dm lfteae`h`eðl 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 vegechl`eh pfs`fjmr`ehcezh`eðl dm jmde`hjmltfs rm`mthdfs y prfdu`tfs sel rm`mth jåde`h. Ml smguldf cughr, ch ADH fpmrh ul sestmjh dm elafrjh`eðl 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 html`eðl h ch rmdu``eðl dm cfs mrrfrms dm jmde`h`eðl y cfs MHJ. Cfs mrrfrms dm jmde`h`eðl pumdml f`urrer ml `uhcquemr phrtm dmc prf`msf dm prms`rep`eðl f usf dm jmde`hjmltfs, jemltrhs qum cfs MHJ sfl cmseflms rmch`eflhdhs `fl mc usf f lf dm jmde`hjmltfs. Pm `rmm qum cfs mrrfrms dm jmde`h`eðl sfl dm => h 8>> vm`ms jès arm`umltms qum cfs MHJ (Ohtms mt hc., hc., 855=). Cfs –`el`f `frrm`tfs‚ smøhchdfs ml mc `uhdrf 4-? pumdml smrver `fjf `frrm`tevfs. Ml ch prè`te`h, cfgrhr ulh rmdu``eðl ml cfs mrrfrms dm jmde`h`eðl ejpce`h ul ms`rutelef dm cfs sestmjhs elvfcu`rhdfs ml ch prms`rep`eðl, df`ujmlth`eðl, trhls`rep`eðl, despmlsh`eðl, hdjelestrh`eðl y jfletfrezh`eðl 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`h`eðl 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 hdjelestrh`eðl dmc aèrjh`f, qum ulh dfses frdmlhdh dm ul jmde`hjmltf ms hprfpehdh phrh mc ph`emltm. Qhrehs mstrhtmgehs prè`te`hs pumdml hyudhr h rmdu`er cfs mrrfrms dm jmde`h`eðl ml cfs mltfrlfs dm html`eðl jåde`h (thoch 4-=).
cfs `flsujedfrms. Cfs bfspethcms thjoeål pumdml hpfyhr h cfs `fjetås phrh elvmsteghr cfs MHJ pftml`ehcms. Dmshafrtulhdhjmltm, ms prfohocm qum `uhcquemr `flkultf lh`eflhc dm dhtfs suomstejm ch jfroecedhd y jfrthcedhd htreoueocm h cfs MHJ dmoedf h ch ahcth dm lfteae`h`eðl y h ch deae`ucdea e`ucthd phrh edmlteae`hr mc dmlfjelhdfr dm ch mxpfse`eðl tfthc dm cfs ph`emltms. ^rmvml`eðl dm eltfxe`h`eflms ml mc bfghr Ch tfxe`edhd ahrjh`fcðge`h tmrhpåute`h ms sðcf ul suo`flkultf dm ch Mxestml vhrefs `fltmxtfs h cfs qum pumdm deregersm ch prmvml`eðl dmc mleltfxe`h`eðl, `fjf sm elde`h ml ch thoch 4-?. Mc jhc usf y housf dm cfs aèr vmlmlhjemltf (thoch 4-?).Ch dmprmseðl y chs eltml`eflms sue`edhs lm`mselm`m sejh`fs rm`mthdfs y chs drfghs ecê`eths sfl prfocmjhs ejpfrthltms dm shcud thl smr edmlteae`hdhs y trhthdhs. Ch mxpfse`eðl h cfs pmcegrfs ml mc bfghr, pûoce`h. Ch el`edml`eh dm mlvmlmlhjemltf lf ehtrfgåle`f lf eltml`eflhc hc herm ceorm y ml chs èrmhs dm trhohkf dmom rmdu`ersm h levmcms, rhzflhocmms oejfdhc, ham`thldf prel`ephcjmltm, h cfs leøfs ml sfldmf, dm 8 h = høfs y hl`ehlfs. Ch sformdfses eltml`eflhc eltml`eflhc `fl `fl aèrjh`fs ms jès `fjûl ml jmltm, hc`hlzhocms. Chs mstrhtmgehs dm prmvml`eðl dm ch eltfxe`h`eðl pumdml `chsea e`hrsm `fjf phsevhs e`hrsm phsevhs,, lf rmqueremldf lelgûl `hjoef dm ch hdfcms`ml`eh y durhltm ch mdhd hducth. Chs susthl`ehs ejpce`hdhs, `fl `fjpfrthjemltf pfr phrtm dmc eldeveduf f h`tevhs h`tevhs,, hqumcchs qum rmquemjhyfr arm`uml`eh, ml mxpfse`eflms y jumrtms bujhlhs sm prmsmlthl ml rml hdhpth`eðl sfstmledh phrh tmlmr åxetf. Chs mstrhtmgehs dm prmvml`eðl chs thochs 4-0 y 4-4, rmspm`tevhjmltm. phsevhs sfl chs jès mae`h`ms (thoch 4-1). Ch el`edml`eh dm eltfxe`h`eðl ml cfs leøfs bh desjeluedf, lftfrehjmltm, ml chs ûctejhs `uhtrf 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 ▮ Pusthl`ehs elvfcu`rhdhs `fl jès arm`uml`eh arm`uml`eh ml mc mlvmlmlhjemltf bujhlf
quêje`fs dfjåste`fs9 jhyfr mae`eml`eh ml chh`mr`h afrjh`eðl html`eðl jåjå de`h y mc hujmltf dm ch `fl`eml`eh pûoce`h dm cfsy ch pftml`ehcms vm-lmlfs.
P]PTHL@EH
%
Hlhcgåse`fs
88.0
^rfdu`tfs dm begemlm pmrsflhc
7.7
Pusthl`ehs dm cejpemzh
7.7
Pmdhltms/beplðte`fs/hltepse`ðte`fs
=.5
Hltedmprmsevfs
4.4
Hltebesthjêle`fs
4.>
Jmde`hjmltfs `hrdefvhs`uchrms
4.>
@umrp rpffs mxtrhøfs/k /kuugumtms/devmrsfs
0.5
@]HD_F 4? ▮ @el`f prel`epefs dm ch jmde`h`eðl smgurh
^mste`edhs
0.?
@ujpcer `fl cfs –`el`f `frrm`tfs‚ dm ch hdjelestrh`eðl smgurh dm ch jmde`h`eðl, pumdm hyudhr h cfs prfamseflhcms h mvethr mrrfrms dm jmde`h`eðl;
Ml mc suogrupf dm mxpfse`eflms pmdeètre`hs (mdhd 3= høfs), cfs prfdu`tfs `fsjåte`fs/dm `uedhdf pmrsflhc y cfs prfdu`tfs dm cejpemzh dfjåste`h, rmprmsmlthrfl mc ?=% dm cfs `hsfs, smguedfs dm hlhcgåse`fs (5.0%), `umrpfs mxtrhøfs/ kugumtms (1.7%), vethjelhs (4.=%) y hltebesthjêle`fs (4.0%). Aumltm; Dhtfs dm Jfwry mt hc., ?>8=. mt
^rel`epefs dmc trhthjemltf hltm ulh eltfxe`h`eðl @uhldf sm mspmrh f sm prfdu`m ulh tfxe`edhd, chs prefredhdms dmc trhthjemltf dm ch eltfxe`h`eðl sfl; • Jhltmlmr aul`eflms aesefcðge`hs vethcms. vethcms. • _mdu`er f prmvmler ch hosfr`eðl y jmkfrhr ch mcejelh`eðl phrh jelejezhr ch `fl`mltrh`eðl dmc tðxe`f. tðxe`f. • @fjohter cfs mam`tfs tfxe`fcðge`fs dmc tðxe`f ml cfs setefs rm`mptfrms (`uhdrf 4 -0).
Jmde`hjmltf `frrm`tf, ph`emltm `frrm`tf, dfses `frrm`th, ruth `frrm`th, temjpf hdm`uhdf
H
Mrrfr
O
Mam`tf hdvmrsf
Mrrfr
Aegurh 4-1 Mc jfdmcf –qumsf suezf‚ dmc mrrfr dm ch jmde`h`eðl. Mxestml vhrefs pultfs dm `fltrfc qum, têpe`hjmltm, pumdml edmlteae`hr y prmvmler ul mvmltf hdvmrsf dm drfghs, y msm mvmltf hdvmrsf sðcf pumdm f`urrer 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 fostè`ucf ml mc sestmjh. O. Qhrefs mrrfrms sestmjète`fs pumdml hcelmhrsm phrh pmrjeter qum f`urrh ul mvmltf hdvmrsf. (Dhtfs dm; Ch rhzðl K. Or Jmd K ?>>>90?>;712-77>). ?>>>90?>;712-77>).
Edmlte`h`eðl dm cfs phtrflms `cêle`fs dm tfxe`edhd ]l bestfrehc jåde`f pumdm pmrjeter ch `rmh`eðl dm ulh cesth dm jmde`hjmltfs despfleocms f prfdu`tfs quêje`fs ejpce`hdfs ml ul mvmltf dm eltfxe`h`eðl. H jmludf, ulh fosmrvh`eðl dm sêltfjhs y seglfs aêse`fs pumdm smr ch ûle`h pesth hde`eflhc h ul dehglðste`f dm mlvmlmlhjemltf. Cfs grupfs dm seglfs y sêltfjhs aêse`fs hsf`ehdfs `fl sêldrfjms dm eltfxe`h`eðl mspm`êae`fs sm `flf`ml `fjf tfxedrfjms (Mre`isfl 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`h`eðl hgudh `fl msths susthl`ehs sm pumdm dmtmrjelhr pfr rhzflms `cêle`hs, pmrf cfs rmsucthdfs dm mstfs mlshyfs, `fl arm`uml`eh lf mstèl despfleocms `fl ch suae`emltm rhpedmz phrh guehr ch msthoecezh`eðl. Hdmjès, ch dmtm``eðl 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`h`eðl. @uhldf ch elgmsteðl dm h`mthjelfaål f hsperelh lf pumdm smr mx`cuedh, `chrhjmltm, h trhvås dm ch bestfreh dm ch mxpfse`eðl, mxpfse`eðl, sm rm`fjemldh ch `uhlteae`h`eðl 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 prmvml`eðl prmvml`eðl dm eltfxe`h`eðl phsevh _mdu``eðl dm ch ahore`h`eðl/vml ahore`h`eðl/vmlth th dm aèrjh`fs tðxe`fs _mterhdh dm ch amlafrjelh dmc jmr`hdf ahrjh`åute`f msthdfuledmlsm Desjelu`eðl dm ch `hltedhd dm aèrjh`f ml ul prfdu`tf dm `flsujf Cejeth`eðl dmc lûjmrf dm pêcdfrhs ml ul arhs`f dm hsperelhs pmqumøf ^rmvmler mc h``msf hc aèrjh`f ]tecezh`eðl dm mlvhsms rmsestmltms h cfs leøfs @hjoehr ch afrjuch`eðl dmc prfdu`tf Mcejelhr mthlfc dmc mlkuhgum ou`hc
dm cfs `hlhcms dmc Lh+, f ocfqumhdfr dm cfs `hlhcms dmc I +, hsf`ehdfs `fl `chsms mspm`êae`hs dm jmde`h`eðl (thoch 4-2). Cfs hlèceses dm chofrhtfref hde`eflhcms dmoml hdhpthrsm h ch `er`ulsthl`eh eldeveduhc dm ch eltfxe`h`eðl.
Dms`flthjelh`eðl dmc ph`emltm eltfxe`hdf Chs eltfxe`h`eflms pfr mxpfse`eflms pumdml smr pfr elbhch`eðl, pfr hosfr`eðl `utèlmh f ju`fsh, pfr elym``eðl f pfr elgmsteðl. Mc prejmr phsf phrh prmvmler ch hosfr`eðl dm tðxe`f ms dmtmlmr `uhcquemr mxpfse`eðl `flteluh. Pe ms lm`mshref, cfs fkfs y ch pemc dmoml chvhrsm, `fpefshjmltm. Ch dmseltfxe`h`eðl ghstrfeltmstelhc prmvemlm f rmdu`m ch hosfr`eðl dm ulh susthl`eh dmspuås dm bhomr sedf elgmredh. Chs mstrhtmgehs phrh ch dmseltfxe`h`eðl ghstrfeltmstelhc sfl mc vh`ehjemltf gèstre`f, ch hdsfr`eðl dmc tðxe`f, mc WOE WOE y mc mjpcmf dm `htèrte`fs. Chs jêlejhs elde`h`eflms phrh `flsedmrhr ch dmseltfxe`h`eðl ghstrfeltmstelhc el`cuyml; •• Mc tðxe`f dmom tðxe`f smrdmom pftml`ehcjmltm pftml`ehcjmltm 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 `uhdh. Mc vh`ehjemltf gèstre`f ms rm`fjmldhdf, rhrh vmz (Jhlfgumrrh y @fohugb, ?>>=), pmrf ch hdjelestrh`eðl dm `hroðl h`tevhdf y mc dmsmjpmøf dm WOE seguml semldf fp`eflms tmrhpåute`hs. Mc vh`ehdf gèstre`f rmdu`m ch hosfr`eðl dmc aèrjh`f ml hcrmdmdfr dm ul tmr`ef, ml `flde`eflms ðptejhs (H`hdmjeh Hjmre`hlh dm Tfxe`fcfgêh @cêle`h, ?>>4, Tmlmlomel mt hc., hc., 8527) (våhsm ch sm``eðl qum segum dm khrhom dm epm`h`uhlh).
Hdsfr`eðl
THOCH 4-= ▮ Chs jmkfrms rm`fjmldh`eflms rm`fjmldh`eflms prè`te`hs phrh rmdu`er cfs mrrfrms ml ch hdjelestrh`eðl dm jmde`hjmltfsh @F_TF ^CH[F • Jhltmlmr cfs sestmjhs dm destreou`eðl dm dfses ulethrehs phrh
jmde`hjmltfs lf mjmrgmltms
• Tml Tmlmr mr prmphrhdhs ml chs ahrjh`ehs sfcu`eflms eltrhvmlfshs • Mcejelhr cfs jmde`hjmltfs, elbmrmltmjmltm elbmrmltmjmltm pmcegrfsfs (p. mk., I@c
`fl`mltrhdf) dm chs èrmhs dm html`eðl hc ph`emltm
• Dmshrrfcchr prf`mdejemltfs mspm`ehcms mspm`ehcms phrh aèrjh`fs dm hctf remsgf • Jmkfrhr cfs rm`ursfs dm elafrjh`eðl elafrjh`eðl `cêle`h rmch`eflhdfs `fl cfs
jmde`hjmltfs
• Jmkfrhr ch mdu`h`eðl mdu`h`eðl dm ch hdjelestrh`eðl dm jmde`hjmltfs jmde`hjmltfs phrh
cfs jåde`fs
• Mdu`hr h cfs ph`emltms sform mc usf smgurf y prm`esf 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 hdsfr`eðl dm ul tðxe`f sm rmaemrm h ch auseðl dm ul tðxe`f `fl ch supmrae`em dm ftrh susthl`eh, phrh qum mc tðxe`f mstå jmlfs despfleocm phrh smr
@]HD_F 40 ▮ Msthoecezh`eðl ele`ehc dmc ph`emltm mlvmlmlhdf Ch jlmjftm`leh –HO@DM‚ –HO@DM‚ dm html`eðl dm mjmrgml`eh sm hpce`h hc trhthjemltf dm ch eltfxe`h`eðl hgudh; Qêh hårmh
Jhltemlm ch pmrjmhoecedhd
_msperh`eðl
Jhltemlm ch fxegmlh`eðl y vmltech`eðl hdm`uhdhs
@er`uch`eðl
Jhltemlm ch pmrauseðl dm cfs ðrghlfs vethcms
Des`hph`edhd
Mvhcûh ch desaul`eðl dmc @LP
Pe sm dmtm`th ulh des`hph`edhd lmurfcðge`h, tmlgh ml `umlth; `umlth; Hdjelestrh`eðl dm F? (`bmqumf dm fxejmtrêh dm pucsf) Hdjelestrh`eðl dm dmxtrfsh (vmre`hr Ygcu`fshZ ml shlgrm) Hdjelestrh`eðl dm lhcfxflh (`flsedmrhr ul mlshyf mjpêre`f) Tehjelh (phrh ph`emltms hductfs qum rm`eoml dmxtrfsh)
Ejpcmjmlthr shcvhguhrdehs ohshdhs ml ch tm`lfcfgêh;
• • • •
Mxpfse`eðl
Mltrhdh `fjputhrezhdh dm dm ðrdmlms ðrdmlms @fjprfoh`eðl `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-
`eðl y hdjelestrh`eðl dm jmde`hjmltfs
h Qåhsm @fhce`eðl dm Jhssh`busmtts phrh ch prmvml`eðl dm mrrfrms jåde`fs, ?>87.
Mvhcuhr ul –tfxeldrfjm‚ (våhsm thoch 4-7)
Ml `hsfs grhvms, ch eltuoh`eðl e ltuoh`eðl mldftrhqumhc, ch vmltech`eðl jm`èle`h, mc sfpfrtm ahrjh`fcðge`f dm ch prmseðl hrtmrehc f mc sfpfrtm `er`uchtfref mxtrh`frpðrmf, pumdml smr lm`mshrefs y hprfpehdfs.
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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
Pfjlfcml`eh @fjh Pfjlfcml`eh
Fxe`fdflh Omlzfdeh`mpelhs Ohroetûre`fs Hsperelh
@fjh Pfjlfcml`eh @fjh @flauseðl
Hlte`fcelårge`f
Pmdhltm beplðte`f Phce`echtf
T
THJHØF DM CH ^]^ECH
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↘
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Tmjocfr Dehafrmses
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Êcmf, ruomah``eðl
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←
PC]DGM,h ahs`e`uch`eðl
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←
B_
O^
Hgeth`eðl
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Dmceref
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Ocfqumhdfr dm cfs `hlhcms dmc @h ?+ Qmrhphjecf
← ← ↘ ←
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FT_FP
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Dehafrmses, vðjetf
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O^ (ocffd prmssurm); prmseðl hrtmrehc9 B_ (bmhrt rhtm); arm`uml`eh `hrdeh`h9 __ ( rmsperhtfry rhtm); arm`uml`eh rmsperhtfreh9 T ( tmjpmrhturm); tmjpmrhturh. h PC]DGM; mam`tfs jus`hrêle`fs dm shcevh`eðl, chgrejmf, je``eðl, dmam`h`eðl, `ðce`fs gèstre`fs y mjmses.
hosfroedf. Ch temrrh dm Auccmr sm bh sugmredf `fjf hdsfromltm hd sfromltm phrh mc phErregh`eðl dm tfdf mc eltmstelf rhquht9 mc hzuc dm ^ruseh ulm mc thcef y mc `msef, y mc pfcemstermlf dm sfdef Ch erregh`eðl dm tfdf mc eltmstelf ejpce`h ch hdjelestrh`eðl mltmrhc dm pumdm hdsfromr mc cetef. Mc hdsfromltm jès `fjûl, utecezhdf ml mc trhthgrhldms `hltedhdms dm ulh sfcu`eðl mcm`trfcête`h esffsjðte`h dm pfcemtejemltf dm ch sformdfses hgudh dm aèrjh`fs, ms mc `hroðl h`tevhdf. cmlgce`fc, dm hctf pmsf jfcm`uchr `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 pftml`ehcms 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 `hph`edhd • ^hqumtms `frpfrhcms; pmrsflhs `fl phqumtms eltmstelhcms dm drfghs ecê supmrae`ehc dm hdsfr`eðl. `eths. Ch supmrae`em dmc `hroðl h`tevhdf `fltemlm rmstfs dm `hroflf qum sfl • ^h`emltms `fl sformdfses dm bemrrf. `hph`ms dm hdsfromr cfs tðxe`fs. Ch dfses rm`fjmldhdh ms, têpe`hjmltm, • ^h`emltms qum bhl elgmredf aèrjh`fs ml prmsmlth`eðl dm phr`bm. dm >.=-? g/ig dm pmsf `frpfrhc, bhsth ulh dfses jèxejh tfcmrhdh dm hcrm • ^h`emltms `fl sformdfses dm aèrjh`fs dm ceomrh`eðl ceomrh`eðl sfstmledh f afrjhafrjhdmdfr dm 7=-8>> g. @fjf ulh mstejh`eðl hprfxejhdh, sm mspmrh qum 8> dfrms dm omzfhrms (jhshs lf degmreocms). g dm `hroðl h`tevhdf smh suae`emltm phrh hdsfromr 8 g dm aèrjh`f. Cfs hc`fbfcms, `frrfsevfs, bedrf`hrourfs y jmthcms lf sfl oeml hdsfroedfs Ch sfcu`eðl dm mcm`trfcetf dm pfcemtecmlgce`fc sm hdjelestrh, têpe`hjmltm, pfr mc `hroðl. Chs `fjpce`h`eflms 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, hsperh`eðl pucjflhr y jumrtm. Ch hdjehphrmz`hl jès rmsedufs dmc vmlmlf. ^hrh cfgrhr mstfs hctfs levmcms dm errelestrh`eðl lhsfgèstre`h dm `hroðl vmgmthc el`rmjmlth ch el`edml`eh dm gh`eðl sm pumdm utecezhr ul tuof lhsfgèstre`f. Ch erregh`eðl 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``eðl eltmstelhc f pmrafrh`eðl `eðl pucjflhr. Mc `hroðl lf dmom hdjelestrhrsm h ph`emltms `fl sfspm y sm pumdm `fjpce` `fjpce`hr hr pfr destmlseðl destmlseðl hodfjelhc f hsperh`eðl hsperh`eðl pucjflhr pucjflhr.. `bh dm pmrafrh`eðl 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`h`eflms bh desjeluedf ml cfs ûctejfs ?> høfs h ?.8% dm cfs `hsfs ml shcms dm Jg , thcms `fjf `etrhtf 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`h`eðl ghs-
THOCH 4-2 ▮ Dehglðste`f deamrml`ehc dm eltfxe`h`eðl (cesthdf phr`ehc) phrh jhleamsth`eflms dm tfxe`edhd 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 ph`emltm 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`h`eflms dmc prf`mdejemltf el`cuyml trhujhtesjf jm`èle`f ml mc mstðjhgf f mc msðahgf9 hsperh`eðl pucjflhr dmc `fltmledf mstfjh`hc y mstejuch`eðl dmc lmrvef vhgf. Khrhom dm epm`h`uhlh. epm`h`uhlh. Cfs hc`hcfedms `mahcelh y mjmtelh, mjmtelh, ml mc khrhom dm epm`h`uhlh, 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`h`uhlh `fjf phrtm dm su prfgrhjh dm prmvml`eðl dm cmseflms elahltecms9 h su vmz, ch H`h- dmjeh Hjmre`hlh dm Tfxe`fcfgêh @cêle`h lf elde`h mc usf rutelhref dmc vh`eh- jemltf gèstre`f ml mc ph`emltm mlvmlmlhdf. mlvmlmlhdf. @fjf rmsucthdf, ch epm`h`uhlh sm hdjelestrð ml sðcf >.>>1% dm tfdfs cfs eldevedufs `fl eltfxe`h`eflms ml Msthdfs ]ledfs ml ?>84 (Jfwry mt hc., hc., ?>8=).
Jmkfrhldf ch mcejelh`eðl dm tðxe`fs ]lh vmz hosfroedfs, cfs mam`tfs dmcmtårmfs, tfxe`fdelèje`fs, pumdml smr rmdu`edfs h trhvås dm jåtfdfs qum h`mcmrhl su mcejelh`eðl dmc `umrpf, `fjf sm dms`reom h `flteluh`eðl.
Jhlepuch`eðl dmc pB urelhref; hc`hcelezh`eðl urelhreh
THOCH 4-5 ▮ Hltêdftfs `fjulms y sus elde`h`eflms Cfs aèrjh`fs sukmtfs h dmpurh`eðl rmlhc sfl mx`rmthdfs ml ch frelh pfr aectrh`eðl gcfjmruchr y sm`rm`eðl tuouchr h`tevh9 cfs `fjpumstfs lf efleELDE@H@EÐLMP zhdfs pumdml smr rmhosfroedfs ju`bf jès rèpedhjmltm qum chs jfcå`u HLTÊDFTF MLQMLMLHJEMLTF chs pfchrms eflezhdhs (våhsm `hpêtucf ?). Cfs aèrjh`fs dm h`edmz dåoec sfl sus`mpteocms sus`mp teocms h ch –`hpturh dm eflms‚ ml ch frelh. Ch hsperelh ms ul è`edf H`mthtf dm f`trmðtedf Pucaflecurmh eldu`edh dåoec `fl ul pI pI h : 0.>. @uhldf mc pB dm ch frelh hujmlth, jès shce`e`htf, bepfgcu`mjeh sm ml`umltrh ml su afrjh eflezhdh ml mqueceoref y jès sm deauldm mc è`edf H`mtec`estmêlh H`mthjelfaål shce`êce`f ml mc cujml tuouchr dmc reøðl. r eøðl. Thjoeål sm `rmm qum ch hc`hcelezh`eðl urelhreh h`mcmrh ch mcejelh`eðl dmc amlfohroethc, ch `cfrprfphjedh, mc Hzuc dm jmtecmlf Jmthbmjfgcfoelmjeh jmtftrmxhtf y mc bmroe`edh `cfrfamlfxe. Ch H`hdmjeh Hjmre`hlh dm TfxeOmlztrfpelh Destflêh eldu`edh pfr aèrjh`fs `fcfgêh @cêle`h rm`fjemldh ch hc`hcelezh`eðl 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 shce`echtf y qum lf `ujpcml `fl cfs `retmrefs Orfjf`reptelh Pêldrfjm lmurfcåpte`f dm bmjfdeèceses (^rfudafft mt hc., hc., ?>>4). ^hrh cfgrhr ch hc`hcelezh`eðl 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, deae`ucthrè 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`hcelezh`eðl dm ch frelh mstè `fltrhel@cfrbedrhtf ddmm lhcfxflh Fpefedms de`hdh ml `hsfs dm elsuae`eml`eh rmlhc, f `uhldf ch hdjelestrh`eðl dm cêquedfs pumdm mjpmfrhr mc mdmjh pucjflhr f ch elsuae`eml`eh `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 gue`ed `edhs hs frgh frghlfa lfafsa fsafr frhdf hdfss prfjumvm ch h`edmjeh. @hroðl h`tevhdf `fl dfses jûctepcms Mc `hroðl h`tevhdf hosfrom cfs aèrjh`fs bh`eh su supmrae`em y pmrjetm su tfthc mcejelh`eðl. Chs dfses jûctepcms dm `hroðl h`tevhdf pumdml h`mcmrhr ch mcejelh`eðl dm ch drfgh hosfroedh pfr dfs jm`hlesjfs; mc `hroðl pumdm eltmrrujper ch `er`uch`eðl 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 bh`eh 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 mcejelh`eðl dm ju`bfs aèrjh`fs dm ohkf pmsf jfcm`uchr, pmqumøf vfcujml dm destreou`eðl y mae`emltm t8/? dm mcejelh`eðl. Pm pemlsh qum chs dfses jûctepcms dm `hroðl h`tevhdf temlml ch jhyfr utecedhd pftml`ehc 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 eldu`edh pfr aèrjh`fs Dejmr`hprfc (OHC) ^cfjf, jmr`uref, 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 `hc`e `eff
Mxtrh``eðl mxtrh`frpðrmh dm aèrjh`fs
Elsucelh (dfses hcth)
Mc aèrjh`f edmhc sus`mpteocm dm mcejelh`eðl pfr bmjfdeèceses temlm ul ohkf pmsf jfcm`uchr, ul ohkf vfcujml dm destreou`eðl, 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 phrtê`uchs hdsfromltms. Chs eltfxe`h`eflms jès `fjulms phrh cfs qum sm utecezh h vm`ms bmjfdeèceses, el`cuyml shce`echtf, jmthlfc, mtecmlgce`fc, cetef, `hrohjhzmpelh y vhcprfhtf.
Cmu`fvfrelh dm `hc`ef Fxêgmlf bepmroère`f ^mle`echjelh Phce`echtf dm dm aeaesfstegjelh
Tmrhpeh `fl hltêdftfs
Pu``ejmr (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, jmr`uref, `form Pêldrfjm hl hlte`fcelårge`f ^cfjf, jmr`uref, hrsåle`f ^mste`edhs frghlfafsafrhdfs y dm `hrohjhtf @ehlurf @fujhrelh, el eldhlmdeflh
Ch tmrhpeh `fl hltêdftfs ejpce`h mc hlthgflesjf f ch elh`tevh`eðl quêje`h dm ul vmlmlf hosfroedf. Mltrm cfs hltêdftfs mspm`êae`fs jès `fjulms mstèl ch L -h`mtec-C -h`mtec-C-`estmêlh phrh mc mlvmlmlhjemltf `fl h`mthjelfaål9 cfs hlthgflesths fpeè`mfs phrh sformdfses dm fpefedms y cfs hgmltms qumchltms phrh mc mlvmlmlhjemltf `fl `emrtfs 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 prfpfr`eflhdf 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 oeftrhlsafrjh`eðl dm ul aèrjh`f thjoeål pumdm smr hctmrhdh pfr ul hl têdftf, pfr mkmjpcf, mc afjmpezfc elbeom ch dmsbedrfgmlhsh dmc hc`fbfc y
Elafrjh`eðl hde`eflhc sform eltfxe`h`eðl 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 elafrjh`eðl sform
dmtemlm ch afrjh`eðl dm utecezhdfs jmthofcetfs tðxe`fs, mtecmlgce`fc y jmthlfc. Ju`bfs aèrjh`fs ml è`edfs, mc `uedhdf dm uldmph`emltm eltfxe`hdf (hlte`flvucsevfs, hgmltms vhsf`flstre`tfrms, mt`.) pumdml smr `flsedmrhdfs hltêdftfs aul`eflhcms lf mspm`êae`fs. Mc pechr dm ch tmrhpeh, phrh ulh eltfxe`h`eðl, ms mc ouml hpfyf dm ch vêh hårmh, ch rmsperh`eðl, ch `er`uch`eðl y cfs prf`msfs jmthoðce`fs vethcms dmc ph`emltm ml- vmlmlhdf, bhsth qum mc tðxe`f sm mcejelh dmc `umrpf.
susthl`ehs tðxe`hs msdm^FEPELMDR® ( Je`rfjmdmx, Je`rfjmdmx , El`., Dmlvmr, @F). Ch Oeoceftm`h Lh`eflhc Jmde`elh farm`m elafrjh`eðl 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 rm`ursf vhcefsf phrh fotmlmr elafrjh`eðl 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 elafrjh`eðl sform ch tfxe`edhd 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`flf`ejemltf; `hpêtucf ml mde`eflms rm`emltms dm mstm ceorf. Bmjfs tmledf ml `umlth hcgulfs dm sus tmxtfs ml ch mde`eðl 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 Hssf`ehtefl 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 Hssf`ehtefl 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 h`utm 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 Hssf`ehtefl 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. Mre`isfl 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` Mjmrgml`ems, 2tb md. Lmw Ufri; J`Grhw-Becc9 ?>>1. Gutbrem PI, mt hc. Bypftbmsezmd eltmrh`tefl omtwmml vhcprfe` h`ed 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` P`eml`m fa ^fe- sfls. 2tb md. Lmw Ufri; J`Grhw-Becc9 ?>80.
Chzhrfu K, mt hc. El`edml`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 Hssf`ehtefl 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 h`utmcy 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` `hr`elfgml. 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 tfxe`ety 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` h`ed tfxe`ety; 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 h`utm drug fvmrdfsm. Hll Mjmrg Jmd 8527981;202‐248.
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