Lectura Antibiograma 2021

 

Ndtn Db`bj bjihn ihnkn kn am Duh Duhana anabb Hkt Hktmks mkshvb hvb 9> (9? (9?9>) 9>) 9=9 9=9---9?>99-5999599, 9?99. _nrn usb pmrsbkn`

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Ndtn Db`bjihnkn am Duhanab Hktmkshvb 9> (9?9>) 9=9---9% am `n pbi`ndhôk thmkm rmshstmkdhn `n pmkhdh`hkn> . @n Brenkhzndhôk Jukahn` am `n sn`ua y m` Dmktrb am prmvmkdhôk y dbktrb` am mklmrjmanams cnk ahrhehab sus mslumrzbs mk drmnr prbernjns pnrn `n vheh`nkdhn y dbktrb` am mstm nujmktb9 . Mstm hkdrmjmktb sm rm`ndhbkn dbk m` pbdb dbkbdhjhmktb qum sm thmkm am `n hktmrprmtndhôk am uk nkthihbernjn, `b qum dbk``mvn `n hknamdunan lbrju`ndhôk am nkthihôthdbs mk `ns hklmddhbkms indtmrhnkns6 pbr tn` jbthvb sm cndm lukanjmktn` qum tbab d`êkhdb smn dnpnz am hktmrprmtnr mstm mxnjmk> . @n ﬎kn`hana am` nkthihbernjn ms amtmrjhknr `n susdmpthih`hana am uk jhdrbbrenkhsjb n uk lîrjndb. @bs rmsu`tnabs sm mxprmsnk mk7 smkshi`m, hktmrjmahb b rmshstmktm4 , y mstn dntmebrhzndhôk d`êkhdn mstî insnan mk `bs vn`brms am dbkdmktrndhôk jêkhjn hkchihtbrhn (DJH) b cn`bs am hkchihdhôk1 , `bs dun`ms yn mstîk amtmrjhknabs pbr ahsthktbs dbjhtès dbjb7 m` D`hkhdn` nka  @nibrntbry  Ttnkanras Hksthtutm (D@TH), m` Murbpmnk Dbjjhttmm bk  Nkthjhdrbihn` Tusdmpthih`hty  Qmsthke (M]DNTQ) y `n Jmsn Mspnkːb`n am Kbrjn`hzndhôk am `n

Tmkshih`hana y Ymshstmkdhn n `bs Nkthjhdrbihnkbs= . Amtrîs am `b qum cby dbkbdmjbs cny aèdnans am hkvmsthendhôk, dbjmkznkab dbk m` amsduirhjhmktb am `bs nkthihôthdbs mk >89?, m` rmdbkbdhjhmktb am `bs prhjmrbs jmdnkhsjbs am rmshstmkdhn 9? nkbs kːbs amspuès y `n rm`ndhôk am mstbs dbk `n ln``n tmrnpèuthdn mk >8=?4 . N pnrthr am >83?, sm hktrbaudm m` dbkdmptb am `n `mdturn hktmrprmtnan am` nkthihbernjn `n dun` nibranrmjbs mk mstm nrtêdu`b. N dbkthkundhôk, sm prmsmktn ukn rmvhshôk am `bs nspmdtbs dbkdmptun`ms y sm rmn`hzn uk mklbqum pbr pnsbs am `n am `n `mdturn hktmrprmtnan.

Emkmrn`hanams Qèdkhdns am ah`udhôk y ahlushôk

Mxhstmk ahlmrmktms tèdkhdns pnrn `n rmn`hzndhôk am` nkthihbernjn7 tèdkhdns am ah`udhôk, ahlushôk, jètbabs ihbquêjhdbs y emkèthdbs. Amktrb am `ns tèdkhdns am ah`udhôk sm mkdumktrn

pbstmrhbrjmktm pbr jmahb am `n hkspmddhôk vhsun` sm mvn`÷n sh cuib b kb drmdhjhmktb= . @n tèdkhdn am ahlushôk mk ahsdb b Fhriy-Inumr sm insn mk db`bdnr sbirm uk jmahb (nenr) am indtmrhns uk pnpm` hjprmeknab am nkthihôthdb qum smrî hkduinab, lbrjnkab cn`bs n`rmamabr. Th m` ahîjmtrb am` cn`b ms am ernk tnjnː tnjnkb kː b hkahdnr hkahdnrîî qum `ns indtmrhns sbk smkshi`ms n `bs nkthihôthdbs, y sh pbr m` dbktrnrhb m` îrmn ms pmqumː pmqumkn, kːn, hkahdnrî qum ms rmshstmktm n` =,< lîrjndb uth`hznab . @n prumin am M-tmst dbjihkn `n tèdkhdn am ah`udhôk y ahlushôk. Mstn prumin dbkshstm mk uth`hznr thrns hjprmeknans am nkthihôthdb mk dbkdmktrndhbkms vnrhnans n `b `nreb am mstn, `ns dun`ms sm vnk db`bdnkab mk dbktndtb dbk m` jmahb am nenr, lbrjnkab ukn m`hpsm qum vnrên mk tnjnː tnjnkːb am ndumrab =,< n` vn`br am `n DJH . @bs jètbabs ihbquêjhdbs sbk jîs mspmdhn`hznabs y pmrjhtmk amtmrjhknr jmdnkhsjbs am rmshstmkdhn am ukn indtmrhn. ]k mgmjp`b am m``bs ms `n rmnddhôk mk dnamkn am `n pb`hjmrnsn qum pumam hamkth﬎dnr m` emk rmspbksni`m am `n pbdn b ku`n rmspumstn nkthihôthdn< . Am﬎khdhôk am dbkdmktrndhôk jêkhjn hkchihtbrhn

@n dunkth﬎dndhôk am `n ndthvhana hk vhtrb am `bs nkthihôthdbs qum pmrjhtm mvn`unr `n susdmpthih`hana nkthjhdrbihnkn mstî anan pbr jètbabs lmkbtêphdbs (ah`udhôk y ahlushôk). Mktrm `bs jètbabs am ah`udhôk, `n jhdrbah`udhôk am` dn`ab y `bs shstmjns nutbjnthznabs pmrjhtmk `n DJH,mk `n dbkdmkdun` ms am﬎khan pbr `n dnpndhana am uk bitmkmr nkthjhdrbihnkb trndhbkms jêkhjns am hkchihr hk vhtrb n` jmkbs 4 ukhanams `benrêtjhdns, amsam uk k÷jmrb amtmrjhknab am db`bkhns mk uk jmahb mspmdê﬎db, aurnktm uk pmrhbab am >3-91 c am hkduindhôk=,< . M` jètbab am ahlushôk mk nenr kbs sujhkhstrn ahîjmtrbs am zbkns am hkchihdhôk y kb vn`brms am DJH. _br `b tnktb, mstns zbkns am hkchihdhôk amimk dbklrbktnrsm dbk `ns DJH mk insm n `bs puktbs am dbrtm d`êkhdbs mstni`mdhabs pnrn `ns ahlmrmktms dbkguendhbkms am jhdrbbrenkhsjbs y nkthihôthdbs5 . _nrn amtmrjhknr mstbs puktbs am dbrtm, sm uth`hznk jmdnkhsjbs lnrjndbdhkèthdbs, lnrjndbahkîjhdbs, am rmshstmkdhn y antbs d`êkhdbs= . Mstbs sbk mstni`mdhabs pbr dbjhtès mspmdê﬎dbs, mk Murbpn m` M]DNTQ y mk `bs Mstnabs ]khabs m` D@TH5 . @bs rmsu`tnabs pmrjhtmk d`nsh﬎dnr `bs jhdrbbrenkhsjbs mk

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`n ah`udhôk mk indtmrhns nenr , njins sm lukanjmktnk mk db`bdnr mk uk dn`ab du`thvbb am yn smn mk p`ndns b pbzbs dbk ukn dbkdmktrndhôk mstîkanr am nkthihôthdb qum

4amim dntmebrêns d`êkhdns7qum smkshi`m, hktmrjmahb y rmshstmktm. Tm tmkmr prmsmktm uk vn`br DJH jîs ingb kb shmjprm shekh﬎dn jnybr mlmdthvhana am` nkthihôthdb, anab qum dnan 9=4

Amsdnrenab pnrn Nkbkyjbus ]smr (k/n) mk ]khvmrshty bl @n Tninkn am D`hkhdn`Fmy.ms pbr M`smvhmr mk nirh` >9, 9?99. _nrn usb pmrsbkn`

mxd`ushvnjmktm. mxd`ushvnjmk tm. Kb sm pmrjhtmk btrbs usbs shk nutbrhzndhôk. Dbpyrhect ©9?99. M`smvhmr Hkd. Qbabs `bs amrmdcbs rmsmrvnabs.  

D. Aum Aumːkns kː ns Dnstm` Dnstm``, `, @. ^uhktnkn _îgnrb, H.A. ^uhktmrb Jnrzb`n mt n`. jhdrbbrenkhsjb mstî am﬎khab pbr DJH ahlmrmktms. @n smkshih`hana npuktn n ukn rmspumstn namdunan am` nkthihôthdb mk abshs cnihtun`ms, shmjprm y dunkab sm bitmken `ns dbkdmktrndhbkms namdunans mk m` shthb am `n hklmddhôk, qum pumam smr hjpbshi`m mk n`eukns bdnshbkms (p. mg., cumsb, shstmjn kmrvhbsb dmktrn`). _br m` dbktrnrhb, sh m` rmsu`tnab ms hktmrjmahb b rmshstmktm ms prbini`m qum `n rmspumstn n` trntnjhmktb kb smn lnvbrni`m< . Dntmebrêns d`êkhdns mk m` nkthihbernjn

Amsam `n hjp`mjmktndhôk am `bs nkthihbernjns cn mxhsthab dbklushôk y ahsdrmpnkdhns n` jbjmktb am d`nsh﬎dnr `bs jhdrbbrenkhsjbs nhs`nabs mk `bs hklbrjms am smkshih`hana, ms pbr m``b qum `n Hktmrknthbkn` Brenkhznthbk  lbr  Ttnkanrahznthbk amtmrjhkô `bs dbkdmptbs y puktun`hzô `ns dntmebrêns d`êkhdns tmkhmkab mk dumktn `n prbinih`hana am rmsu`tnabs lnvbrni`ms b am` lrndnsb tmrnpèuthdb mk7 smkshi`m, hktmrjmahb y rmshstmktm1 . •

Tmkshi`m7 hkchihdhôk hk vhtrb am ukn dmpn pbr `n abshs

rmdbjmkanan cnihtun`jmktm am uk nkthjhdrbihnkb qum sm rm`ndhbkn dbk n`tn prbinih`hana am èxhtb tmrnpèuthdb1,3. Ms amdhr, qum n` uth`hznr `ns dnkthanams cnihtun`ms sm mspmrn uk nvnkdm lnvbrni`m y snthslndtbrhb am `n hklmddhôk, shmjprm qum sm dbkshenk khvm`ms nprbphnabs mk m` `uenr am `n •

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hklmddhôk? . Ymshstmktm7 hkchihdhôk hk vhtrb am ukn dmpn pbr `n abshs rmdbjmkanan cnihtun`jmktm am uk nkthjhdrbihnkb qum sm rm`ndhbkn dbk n`tn prbinih`hana am lrndnsb tmrnpèuthdb, pbr `b emkmrn` amjumstrnk `n mxhstmkdhn am jmdnkhsjbs mspmdê﬎dbs am rmshstmkdhn jhdrbihnkn b qum `n m﬎dndhn d`êkhdn am` nkthjhdrbihnkb dbktrn m` brenkhsjb kb sm cn mstni`mdhab mk mstuahbs d`êkhdbs1,5,3,>?. Dnim rmsn`tnr qum vn`brms ingbs am DJH kb kmdmsnrhn-

jmktm sm trnaudmk mk jmgbr ndthvhana jhdrbihnkn, yn qum dnan mspmdhm indtmrhnkn m hkd`usb nemktm nkthjhdrbihnkb pbsmm am﬎khdhbkms ahlmrmktms am DJH pnrn cni`nr am smkshih`hana b rmshstmkdhn. _br m``b sm dbkshamrn qum `n hktmrprmtndhôk am `n smkshih`hana prmahdm jmgbr m` lrndnsb (dunkab ms rmshstmktm) qum m` èxhtb am uk trntnjhmktb< . _br btrb `nab, sm amim tmkmr mk dumktn qum mxhstmk btrbs lndtbrms qum amtmrjhknk `n rmspumstn d`êkhdn tn`ms dbjb7 rmspumstns am` cuèspma, shthb am hklmddhôk, prbauddhôk am tbxhkns pbr indtmrhns, `n prmsmkdhn am dnpn prbtmdtbrn, lnrjndbahkîjhdn am lîrjndbs, mktrm btrbs3 . Lmkbthpbs am smkshih`hana

Tm dbkshamrnk dbjb m` dbkguktb am pnutns b antbs mk m` nkthihbernjn pnrn nkthihôthdbs am ukn jhsjn lnjh`hn b qum sm vhkdu`nk smn pbr jmdnkhsjbs am nddhôk b am rmshstmkdhn1,< . Qmkhmkab mk dumktn mstbs pntrbkms pbamjbs mkdbktrnr lmkbthpbs cnihtun`ms, rnrbs m hjpbshi`ms< . Qnktb m` pmrsbkn` am

`nibrntbrhb dbjb `bs jèahdbs amimk dbkbdmr `bs lmkbthpbs am rmshstmkdhn knturn` am `bs pntôemkbs dbjukms mk su `bdn`hana, lnvbrmdhmkab nsê `n amtmrjhkndhôk am rmsu`tnabs hkusun`ms qum pbarênk mxp`hdnr kumvbs jmdnkhsjbs am rmshstmkdhn y pbr mkam rmprmsmktnrênk uk rhmseb pnrn `n sn`ua p÷i`hdn5 . Tm cni`n am lmkbthpbs cnihtun`ms mk nqum``bs pntrbkms duyn prmsmkdhn ms mphamjhb`ôehdnjmktm mspmrnan mk `n zbkn emberî﬎dn abkam sm mlmdt÷n m` nkthihbernjn1,>. @bs lmkbthpbs rnrbs sm prbaudmk pbr `n mxprmshôk am jmdnkhsjbs am rmshstmkdhn pbdb cnihtun`ms, dun`ms emkmrn`jmktm sbk am dnrndtmrhzndhôk tmjprnkb `bs b duyb hjpndtb b rm`mvnkdhn > mphamjhb`ôehdn ms pbr pbdb nprmdhni`m . _br ÷`thjb, `bs lmkbthpbs hjpbshi`ms sbk nqum``bs mk abkam kb cny ukn mxp`hdndhôk sme÷k `bs jmdnkhsjbs am rmshstmkdhn dbkbdhabs y, pbr `b tnktb, ms hkm`uahi`m rmn`hznr ukn dbk﬎rjndhôk am mstbs cn``nzebs1,>>. _br `b emkmrn`, shjib`hznk uk mrrbr mk `n thph﬎dndhôk am` pntôemkb b sm ank smdukanrhbs n hkdbkvmkhmktms tèdkhdbs mk `n mgmdudhôk am` nkthihbernjn, shk mjinreb, nktm `n rmhtmrndhôk am mstm lmkbthpb sm amim prmsujhr `n npnrhdhôk am uk kumvb jmdnkhsjb am rmshstmkdhn1,>. Mk mstm msdmknrhb, sm amim amtmrjhknr m` jmdnkhsjb hjp`hdnab y mkvhnr m` jhdrbbrenkhsjb n uk dmktrb am rmlmrmkdhn1 .

_uktbs am dbrtm d`êkhdb

@bs puktbs am dbrtm, yn smn mxprmsnab mk vn`brms am cn`bs am hkchihdhôk b am DJH, sm uth`hznk pnrn smpnrnr `ns dntmebrêns d`êkhdns amsdrhtns nktmrhbrjmktm. M` D@TH y m` Dbjhtè Kndhbkn` am _rumins am Tusdmpthih`hana Nkthjhdrbihnkn pnrn `bs Mstnabs ]khabs (]TDNTQ) sbk `bs mkdnrenabs am mstni`mdmr mk Murbpn y mk Mstnabs ]khabs, rmspmdthvnjmktm, mstbs puktbs am dbrtm1,=,5. @bs ahîjmtrbs am `ns zbkns am hkchihdhôk y `ns DJH amimk dbjpnrnrsm dbk `bs puktbs am dbrtm d`êkhdbs mstnkanrhznabs pnrn `ns ahlmrmktms dbjihkndhbkms am brenkhsjbs y nkthihôthdbs5 . _nrn amtmrjhknr `bs puktbs am dbrtm, m` D@TH uth`hzn jmdnkhsjbs lnrjndbdhkèthdbs, lnrjndbahkîjhdbs, am rmshstmkdhn y antbs d`êkhdbs, dbkshamrnkab dbjb susdmpthi`ms nqum``bs nhs`nabs qum sbk hkchihabs pbr `ns dbkdmktrndhbkms n`dnkzni`ms têphdns am uk nkthihôthdb dunkab sm usn `n abshs rmdbjmkanan pnrn trntnr m` shthb am hklmddhôk= . Mk M]DNTQ, `bs puktbs am hktmrrupdhôk sm mstni`mdmk am ndumrab dbk pnrîjmtrbs7 jhdrbihb`ôehdbs, lnrjndb`ôehdbs (rm`ndhôk mktrm m` êkahdm _F / _A y `n rmspumstn n` trntnjhmktb) y d`êkhdbs (`n jmgbr mvhamkdhn am `n `htmrnturn). Mk ÷`thjn hkstnkdhn, sm amrhvnk am mstuahbs d`êkhdbs mk cujnkbs qum dbjpnrnk `bs rmsu`tnabs dbk `bs DJH pnrn m` pntôemkb hklmddhbsb. _nrn dnan dbjihkndhôk am brenkhsjb-nkthihôthdb sm mstni`mdmk 9 puktbs am dbrtm (dbk m` ﬎k am bitmkmr `ns 4 dntmebrêns d`êkhdns). M` bigmthvb ms usnr `bs vn`brms am DJH pnrn smpnrnr `ns dmpns abkam mxhstm ukn n`tn prbinih`hana am èxhtb am` trntnjhmktb usnkab m` nkthihôthdb najhkhstrnab hk vhvb am nqum``bs duyb trntnjhmktb ms jîs prbini`m qum ln``m amihab n uk jmdnkhsjb am rmshstmkdhn5 . DBMTNKQ ms uk erupb ju`thahsdhp`hknr qum thmkm dbjb ﬎k prbjbvmr `n hjp`mjmktndhôk am `n kbrjns M]DNTQ, nsê dbjb rmvhsnr `n abdujmktndhôk dhmktê﬎dn mk m` îrmn am` nkthihbernjn qum pmrjhtnk `n rmn`hzndhôk am trningbs, prbpumstns b prbernjns mk m` dbktmxtb am `ns ndthvhanams am M]DNTQ>9 . 9=1

Amsdnrenab pnrn Nkbkyjbus ]smr (k/n) mk ]khvmrshty bl @n Tninkn am D`hkhdn`Fmy.ms pbr M`smvhmr mk nirh` >9, 9?99. _nrn usb pmrsbkn`

mxd`ushvnjmktm. mxd`ushvnjmk tm. Kb sm pmrjhtmk btrbs usbs shk nutbrhzndhôk. Dbpyrhect ©9?99. M`smvhmr Hkd. Qbabs `bs amrmdcbs rmsmrvnabs.  

Ndtn Db`bjihnkn am Duhanab Hktmkshvb 9> (9?9>) 9=9---94 .

Jmdnk Jm dnkhsj hsjbs bs am rmshstmkdh rmshstmkdhn n indtmrhn indtmrhnkn kn

prhjmrns pmrtmkmdmk n `n d`nsm N y I, jhmktrns qum `ns jmtn`bdnrinpmkmjnsns sm d`nsh﬎dnk mk `n A>8 . Am `ns dnrinpmkmjnsns pmrtmkmdhmktms n `n d`nsm N, `n F_D (pbr sus she`ns mk hke`ès F`mishm``n  pkmujbkhnm dnrin pmkmjnsm) ms `n am jnybr rm`mvnkdhn mk `n prîdthdn d`êkhdn>= . M` mspmdtrb am rmshstmkdhn ms trnkslmrhab jmahnktm p`îsjhabs qum dbkthmkmk m` trnspbsôk Qk11>, qum n su vmz dbkthmkm m` emk I`nF_D qum dbah﬎dn `n mkzhjn. Am mstn lbrjn, mstn dnrinF.  pkmujbkhnm y pumam mstnr pmkmjnsn kb ms mxd`ushvn am `n F. pkmujbkhnm prmsmktm mk btrbs jhdrbbrenkhsjbs (tni`n >) qum naquhmrmk >8

Mxhstmk 3 thpbs am jmdnkhsjbs am rmshstmkdhn. N dbkthkundhôk sm amsdrhimk `bs jmdnkhsjbs jîs hjpbrtnktms am tbabs. Hkchihdhôk mkzhjîthdn

@n hkchihdhôk mkzhjîthdn pbr imtn`ndtnjnsns dbksthtuym m` prhkdhpn` jmdnkhsjb am `ns indtmrhns ernjkmenthvns pnrn emkmrnr rmshstmkdhn n `bs imtn`ndtîjhdbs>1 . @ns imtn`ndtnjnsns sbk mkzhjns dbah﬎dnans pbr emkms prbphbs am `n indtmrhn b trnkslmrhabs. _rbaudmk ukn ahsrupdhôk am` nkh``b imtn`ndtîjhdb am` nkthihôthdb y pbr mkam ahsjhkuymk su ndthvhana>= . Dunkab sbk prbaudtb am rmshstmkdhn naquhrhan pumamk smr hkndthvnans pbr `bs hkchihabrms am imtn`ndtnjnsns tn`ms dbjb m` îdhab d`nvu`îkhdb, su`indtnj b tnzbindtnj>< . _nrn mlmdtbs prîdthdbs, mk mstm nrtêdu`b sm jmkdhbknrîk nspmdtbs emkmrn`ms am `ns imtn`ndtnjnsns NjpD, imtn`ndtnjnsns am mspmdtrb mxtmkahab (I@MM) y dnrinpmkmjnsns. @ns NjpD pmrtmkmdmk n` erupb > am `n d`nsh﬎dndhôk am Iusc-Gndbiy-Jmamhrbs, ms amdhr, sbk mkzhjns dmln`bspbrhknsns duyn nddhôk charb`êthdn kb sm nlmdtn pbr sujhkhstrnr îdhab d`nvu`îkhdb, rmspbkahmkab n dmln`bspbrhkns am dunrtn emkmrndhôk y dnrinpmkèjhdbs>=,>5 . Kb bistnktm, yn sm cnk rmpbrtnab NjpD dbk dnjihbs qum hkaudmk rmshstmkdhn hkd`usb n mstns dmln`bspbrhkns, amkbjhkîkabsm NjpD am mspmdtrb mxtmkahab>5 . Btrb erupb hjpbrtnktm sbk `ns I@MM, qum dbjpnrtmk dbk `ns NjpD `n rmshstmkdhn n dmln`bspbrhkns am tmrdmrn emkmrndhôk y jbkbindtîjhdbs, pmrb sm ahlmrmkdhnk pbrqum kb thmkmk dnpndhana charb`êthdn mk `ns dmlnjhdhkns y sbk hkndthvnans pbr `bs hkchihabrms am imtn`ndtnjnsn>5 . Mstm mspmdtrb ms dbklmrhab pbr jbah﬎dndhbkms mk `bs njhkbîdhabs am `n mkzhjn, hklbrjndhôk trnkslmrhan jmahnktm p`îsjhabs>= . @bs jhdrbbrenkhsjbs qum prhkdhpn`jmktm prbaudmk mstm thpb am imtn`ndtnjnsns, sbk F`mishm``n  pkmujbkhnm (F.  pkmujbkhnm) y Msdcmrhdchn db`h (M. db`h)>3 . Mstb hjp`hdn qum, n` hamkth﬎dnr mstns indtmrhns mk uk nkthihbernjn, amimjbs amsdnrtnr qum smnk prbaudtbrns am I@MM, amihab n qum pumamk amsmkdnamknr hklmddhbkms jîs smvmrns>3 . Mstns imtn`ndtnjnsns pumamk d`nsh﬎dnrsm n ernkams rnsebs mk7 QMJ, TC\ y `n DQS. Mstn ÷`thjn thmkm jnybr ndthvhana mkzhjîthdn mk `n dmlbtnxhkn, jhmktrns qum `ns QMJ y TC\ thmkmk prmah`mddhôk pbr dmltnzhahkn y dmltrhnxbkn>1,>= . Btrn pnrthdu`nrhana ms qum `ns DQS sbk jnybrjmktm hkndthvnans pbr tnzbindtnj qum pbr btrbs hkchihabrms>1 . Tuihmkab mk m` msdn`nlôk, mkdbktrnjbs `n dnrinpmkmjnsns, `ns dun`ms sm pumamk d`nsh﬎dnr ampmkahmkab am sh pbsmmk uk sustrntb am smrhkn mk su shthb ndthvb (smrhk dnrinpmkmjnsns) b sh kmdmshtnk am` dhkd dbjb dblndtbr (jmtn`bdnrinpmkmjnsns). N` dbjihknr dbk `n d`nsh﬎dndhôk am Nji`mr am `ns imtn`ndtnjnsns, mkdbktrnjbs qum `ns

mstnBtrb rmshstmkdhn thpb am p`nsjêahdn rmshstmkdhn jmahnan pbr mkzhjns ms bismrvnan lrmktm n `bs njhkbe`udôshabs, n trnvès am `ns mkzhjns jbah﬎dnktms am njhkbe`udôshabs, dbksthtuymkab m` prhkdhpn` jmdnkhsjb am rmshstmkdhn n mstbs lîrjndbs>= . Mstns mkzhjns rmn`hznk ukn n`tmrndhôk mk `n mstrudturn am` lîrjndb jmahnktm uk prbdmsb am ndmth`ndhôk am` erupb njhkb (ndmth`trnkslmrnsns), namkh`ndhôk am` erupb charbxh`b (namkh`trnkslmrnsns) b jmahnktm lbslbrh`ndhôk (lbslbtrnkslmrnsns) am mstm jhsjb erupb mk m` nkthihôthdb9?,9>. @b nktmrhbr prbaudm ukn jmkbr n﬎khana am` njhkbe`udôshab pbr m` rhibsbjn indtmrhnkb y pbr mkam ahsjhkuym `n dnpndhana pnrn hkchihr `n sêktmshs prbtmhdn am `n indtmrhn9? . N`eukns am mstns mkzhjns sbk dnpndms am rmn`hznr ukn nddhôk aun` mk m` njhkbe`udôshab, amkbjhkîkabsm mkzhjns ihlukdhbkn`ms. ]k mgmjp`b am m``ns ms `n NND (=,9? . Nahdhbkn` n mstm cn``nzeb, sm cnk mkdbktrnab mkzhjns jbah﬎dnktms am njhkbe`udôshabs qum jbah﬎dnk n `n dhprb﬉bxndhkn jmahnktm ndmth`ndhôk y pbr mkam ukn ahsjhkudhôk mk m` jmdnkhsjb am nddhôk am mstbs nkthihôthdbs9? . @bs jndrô`habs, `hkdbsnjhans y mstrmptbernjhkns tnjihèk pumamk smr hkndthvnabs pbr mkzhjns, shk mjinreb mk m``bs prmabjhknk btrbs jmdnkhsjbs am rmshstmkdhn indtmrhnkn>= . N`tmrndhôk mk `ns inrrmrns am pmrjmnih`hana

@ns indtmrhns ernjkmenthvns n ahlmrmkdhn am `ns ernjpbshthvns pbsmmk ukn dnpn erumsn am `hpbpb`hsndîrhabs qum ndt÷n dbjb ukn inrrmrn n `bs nkthjhdrbihnkbs. M` pnsb am mstbs ÷`thjbs pbr `n jmjirnkn mstî dbkahdhbknab pbr `ns prbphmanams am` lîrjndb>=,99. Am mstn lbrjn, `bs jmahdnjmktbs am pmqumːkb pmqum ːkb tnjnː tnjnːkkb, b, dbk dnrens kmutrns m charblê`hdbs, dbjb m` hjhpmkmj, ntrnvhmsnk jîs lîdh`jmktm `n pnrma indtmrhnkn>= . Kb bistnktm, m` pnsb am `bs nkthihôthdbs charblê`hdbs sm sugmtn n `n prmsmkdhn am  pbrhkns, qum bpmrnk dbjb dnkn`ms sm`mdthvbs b kb sm`mdthvbs mk `n jmjirnkn mxtmrkn am `n indtmrhn>1,>= . _umam surehr rmshstmkdhn nkthjhdrbihnkn smdukanrhn n jutndhbkms mk `ns pbrhkns, prhkdhpn`jmktm pnrn nqum``bs jmahdnjmktbs qum thmkmk prmah`mddhôk pbr uk dnkn`. ]k mgmjp`b am m``b, ms `n rmshstmkdhn am _smuabjbkns nmruehkbsn n hjhpmkmj, pbr dnjihbs mk `n pbrhkn BprA b prbtmêkn A9 am `n dun` ampmkam prhjbrahn`jmktm m` hkermsb am mstm nkthihôthdb>1,>=. @ns ibjins am m﬉ugb b am mxpu`shôk tnjihèk mstîk hjp`hdnans mk `n rmshstmkdhn indtmrhnkn. Tbk trnkspbrtnabrms am sustnkdhns amsam m` hktmrhbr am `n indtmrhn n` jmahb mxtmrkb99 . Mstrudturn`jmktm, pumamk lukdhbknr jmahnktm 9==

Amsdnrenab pnrn Nkbkyjbus ]smr (k/n) mk ]khvmrshty bl @n Tninkn am D`hkhdn`Fmy.ms pbr M`smvhmr mk nirh` >9, 9?99. _nrn usb pmrsbkn`

mxd`ushvnjmktm. mxd`ushvnjmk tm. Kb sm pmrjhtmk btrbs usbs shk nutbrhzndhôk. Dbpyrhect ©9?99. M`smvhmr Hkd. Qbabs `bs amrmdcbs rmsmrvnabs.  

D. Aum Aumːkns kː ns Dnstm` Dnstm``, `, @. ^uhktnkn _îgnrb, H.A. ^uhktmrb Jnrzb`n mt n`. Qni`n >

_rhkdhpn`ms imtn`ndtnjnsns y mspmdtrb am charô`hshs

Imtn`ndtnjnsn

Indtmrhns

Ymshstmkdhn jmahdnjmktbsn

NjpD  n

Ymshstmkdhn knturn`7

Njhkbpmkhdh`hkns Dmlnjhdhkns (dmlbxhthk y dmlbtmtnk) Bxhjhkbdmln`bspbrhkns (dmltnzhahkn, dmlbtnxhkn y dmltrhnxbkn) Jbkbindtnjhdbs (nztrmbknj) Imtn`ndtîjhdbs++ hkchihabrms am imtn`ndtnjnsns Imtn`ndtîjhdbs

 Nmrbjbkns spp. Jbrenkm``n jbrenkkh _rbvhamkdhn spp. _smuabjbkns nmruehkbsn _rbtmus spp. Dhtrbindtmr   lrmukahh lrmukahh Mktmrbindtmr  spp. Tmrrnthn spp.

Ymshstmkdhn naquhrhan7 F`mishm``n spp. Tn`jbkm``n spp. I@MM  n , i , d

F`mishm``n  pkmujbkhnm F`mishm``n pkmujbkhnm Msdcmrhdchn db`h Dhtrbindtmr  spp. _rbtmus spp. Mktmrbindtmr spp. Tn`jbkm``n spp.

Dmln`bspbrhkns am tmrdmrn emkmrndhôk Jbkbindtîjhdbs

Dnrinpmkmjnsns a

D`nsm N*

_mkhdh`hkns Dmln`bspbrhkns hkd`uhans `ns dmlnjhdhkns Jbkbindtîjhdbs Dnrinpmkèjhdbs

Msdcmrhdchn db`h Tmrrnthn spp. Tn`jbkm``n spp. _smuabjbkns nmruehkbsn Mktmrbindtmr  spp. Jbrenkm``n F`mishm``n bxytbdn

D`nsm I

Dnrinpmkèjhdbs

 Nmrbjbknsspp.  Ndhkmtbindtmr spp. _smuabjbkns nmruehkbsn Dcrysmbindtmrhuj Ttmkbtrbpcbjbkns spp.

D`nsm A

_mkhdh`hkns Dmln`bspbrhkn Dnrinpmkèjhdbs Bxndh`hkn y d`bxndh`hkn

 Ndhkmtbindtmr inujnkkhh  Ndhkmtbindtmr  inujnkkhh

* Jhd Jhdrbb rbbren renkhs khsjbs jbs F_D. F_D. Lumktms7 n Na Nanp nptn tnan an am Tmrn Tmrn`` mt n` n`..>5 . i Na Nanp nptn tnan an am Bpn` Bpn` mt n` n`..>= . d Nan Nanptn ptnan an am Jbrmgô Jbrmgôkk Enrdên Enrdên J. Imt Imtn`n n`ndtn dtnjns jnsns ns am msp mspmdt mdtrb rb mxtmka mxtmkahab hab.. Ymv Dui Duinkn nkn Jma. Jma. 9?>46= 9?>46=979 9795959---3? -3?.. a Nanp Nanptn tnan an am \mr mrnn-@m @mhv hvnn mt n`. n`.>8 .

uk shstmjn am jmjirnkn shjp`m b am abi`m jmjirnkn,

smeukans dbk﬎mrmk uk mspmdtrb am rmshstmkdhn qum ninrdn

mstmmxpu`shôk ÷`thjb am` dbkstn am prbtmêkns hktmrrm`ndhbknans 94 . N` heun` qum `ns pbrhkns,pnrn `ns `n lîrjndb ibjins am m﬉ugb pumamk smr sm`mdthvns b hkmspmdê﬎dns, `ns

jîs amamuk nkthihôthdb y dbksmdumktmjmktm m` >1 . Tm d`nsh﬎dnk mk 9, 9?99. _nrn usb pmrsbkn`

mxd`ushvnjmktm. mxd`ushvnjmk tm. Kb sm pmrjhtmk btrbs usbs shk nutbrhzndhôk. Dbpyrhect ©9?99. M`smvhmr Hkd. Qbabs `bs amrmdcbs rmsmrvnabs.  

Ndtn Db`bjihnkn am Duhanab Hktmkshvb 9> (9?9>) 9=9---9= .

qum mk `bs ernjpbshthvbs `n jîs rm`mvnktm ms `n JLT91 . Mstns ibjins pumamk mxpu`snr `bs sheuhmktms jmahdnjmktbs>= 7 • • • • •

Qmtrndhd`hkns Jndrô`habs Mstrmptbernjhkns Imtn`ndtîjhdbs ^uhkb`bkns

Dnim rmsn`tnr qum `n prmsmkdhn am mstns ibjins pbr sê sb`ns sb`b prbaudmk dnjihbs jêkhjbs mk `n DJH y d`êkhdnjmktm `n rmshstmkdhn lnrjndb`ôehdn npnrmdm dbk `n dbmxhstmkdhn am btrbs jmdnkhsjbs mk `n jhsjn indtmrhn (tni`n 9)>1 .

@mdturn @mdtu rn hktmrprmt hktmrprmtnan nan _nrn `n namdunan hktmrprmtndhôk am` nkthihbernjn kb instn dbk `n dntmebrhzndhôk am smkshi`m, hktmrjmahb b rmshstmktm, pnrn m``b sm cndm hkahspmksni`m `n `mdturn hktmrprmtnan qum iusdn n trnvès am `bs rmsu`tnabs bitmkhabs ukn nprbxhjndhôk n` jmdnkhsjb am rmshstmkdhn, `bernkab uk namdunab jnkmgb am `bs nkthihôthdbs y ukn jmgbr vheh`nkdhn y dbktrb` am `n rmshstmkdhn indtmrhnkn1,>>. M` mslumrzb y m` mstuahb am judcbs nkbs kːbs pmrjhthmrbk ﬎kn`jmktm qum, mk `n aèdnan am `bs kbvmktn, _ntrhdm Dburvn`hk am﬎khmrn `bs 4 ph`nrms lukanjmktn`ms am `n `mdturn hktmrprmtnan7 n) Am﬎khr mk lmkbthpb am rmshstmkdhn n pnrthr am` mstuahb am smkshih`hana, i) amauddhôk am` jmdnkhsjb am rmshstmkdhn, d) amtmrjhkndhôk am jbah﬎dndhbkms mk m` lmkbthpb am rmshstmkdhn>>,9=. Nktms am hkhdhnr amimjbs dbkbdmr `bs dbkdmptbs am pntrôk am rmshstmkdhn9< 7 Ju`thlnrjndbrrmshstmktm7 Ymshstmkdhn n 4 lnjh`hns am nkthihôthdb ahsthktbs. Mxtrmjnanjmktm lnrjndbrrmshstmktm7 Ymshstmkdhn n 4 b jîs lnjh`hns am nkthjhdrbihnkbs hkd`uhab uk dnrinpmkèjhdb. _nklnrjndbrrmshstmktm7 Ymshstmktm n tbabs `bs nkthjhdrbihnkbs ahspbkhi`ms.

Mklb Mk lbqu qum m pbr pbr pnsb pnsbss am `n `mdtur `mdturn n hktmrp hktmrprmt rmtna nan n Nktmrhbrjmktm `n `mdturn am` nkthihbernjn mrn judcb jîs smkdh``n insîkabsm sb`b mk `n najhkhstrndhôk am` nkthihôthdb n` dun` m` jhdrbbrenkhsjb sm jbstrnin smkshi`m. Ndtun`jmktm, amihab n j÷`thp`ms jmdnkhsjbs am rmshstmkdhn qum `bs jhdrbbrenkhsjbs cnk drmnab pnrn m`uahr m` mlmdtb am `bs nkthihôthdbs, `n hktmrprmtndhôk am` nkthihbernjn cn tbjnab n`e÷k ernab am dbjp`mghana, kndhmkab nsê m` dbkdmptb am `mdturn hktmrprmtnan am` nkthihbernjn4 . _nrn ukn dbrrmdtn hktmrprmtnan am` nkthihbernjn ms kmdmsnrhb dbkbdmr y`mdturn snimr np`hdnr ukbs pnsbs msmkdhn`ms. N dbkthkundhôk, amsdrhihrmjbs `bs qum dbkshamrnjbs `bs pnsbs jîs hjpbrtnktms n `n cbrn am ukn dbrrmdtn hktmrprmtndhôk. ²M` pndhmktm2

]kb am `bs ph`nrms lukanjmktn`ms ms `n dbkahdhôk d`hkhdbpntb`ôehdn am` pndhmktm. Cny qum mvn`unr `ns dbjbrih`hanams amihab n qum n`eukns dbkahdhbkms prmmxhstmktms pumamk prmahspbkmr n `n db`bkhzndhôk am dhmrtbs eèrjmkms. _nrn mvn`unr mstm rhmseb ms kmdmsnrhb dn`du`nr m` êkahdm am Dcnr`sbk, m` dun` kbs mvn`÷n m` prbkôsthdb n 4? aêns y n uk nkb. kːb. Lum drmnab mk >835 y ms shk auan m` jîs uth`hznab6 dbkshstm mk >8 dbkahdhbkms jèahdns dnan ukn am `ns dun`ms ukn rmprmsmktn uk puktngm, m` dun` vn am ? n ; 3 puktbs y kbs mvn`÷nk m` rhmseb msthjnab am dbjbrih`hanams am` pndhmktm. ]k hkahvhaub dbk jîs am 1 puktbs prmsmktn uk n`tb rhmseb am hklmddhôk pbr eèrjmkms ju`thlnrjndbrrmshstmktms  95 . ²Duî` ms m` jhdrbbrenkhsjb hamkth﬎dnab mk m` nkthihbernjn2

Ms hjpbrtnktm qum `n amtmrjhkndhôk am` jhdrbbrenkhsjb dnusn` am `n hklmddhôk smn tnktb mk eèkmrb dbjb mk mspmdhm, yn qum jhdrbbrenkhsjbs am` jhsjb eèkmrb pmrb am mspmdhms ahsthktns pumamk prmsmktnr rmspumstn vnrhni`m nktm uk jhsjb nkthihôthdb. Btrb nspmdtb n tmkmr mk dumktn ms `n DJH `n dun` sme÷k `bs ahlmrmktms dbksmksbs hktmrkndhbkn`ms ms ahsthktn pnrn dnan jhdrbbrenkhsjb6 nsê, ukn DJH am uk nkthihôthdb pumam smr smkshi`m pnrn uk jhdrbbrenkhsjb, pmrb pnrn0 btrb kb. y_br jhdrbbrenkhsjb S, dbk ukn DJH > je/a` uk mgmjp`b, puktb am uk dbrtm pnrn msm jhsjb nkthihôthdb am 9 je/a` dbjpnrnab dbk uk nkthihôthdb X dbk ukn DJH am 0 > je/a` pmrb dbk uk puktb am dbrtm am 3 je/a` m` nkthihôthdb dbk jnybr dnpndhana am hkchihdhôk smrên m` nkthihôthdb X yn qum thmkm uk jnybr rnkeb mktrm `n DJH y m` puktb am dbrtm pnrn cndmr rmshstmkdhn, pbr msb sm cndm am vhtn` hjpbrtnkdhns hkd`uhr mk dnan rmpbrtm am nkthihbernjn `bs irmnfpbhkts mstni`mdhabs pbr `ns euêns hktmrkndhbkn`ms >-4). ). dbjb `n DT@H, DBMTNKQ b M]DNTQ-4 ²Duî` ms su pmr﬎` am rmshstmkdhn2

_nrn ukn hktmrprmtndhôk hktmern` am` nkthihbernjn ms hjpbrtnktm tmkmr dbkbdhjhmktbs emkmrn`ms sbirm `bs jmdnkhsjbs am rmshstmkdhn indtmrhnkn. @n rmshstmkdhn pumam smr knturn` b naquhrhan. Mk `n prhjmrn, `ns indtmrhns pbsmmk hktrêksmdnjmktm ahdcbs jmdnkhsjbs, nuk shk mxpbshdhôk n n`e÷k nkthihôthdb, jhmktrns qum mk `n smeukan kb cny rmspumstn 9=5

Amsdnrenab pnrn Nkbkyjbus ]smr (k/n) mk ]khvmrshty bl @n Tninkn am D`hkhdn`Fmy.ms pbr M`smvhmr mk nirh` >9, 9?99. _nrn usb pmrsbkn`

mxd`ushvnjmktm. mxd`ushvnjmk tm. Kb sm pmrjhtmk btrbs usbs shk nutbrhzndhôk. Dbpyrhect ©9?99. M`smvhmr Hkd. Qbabs `bs amrmdcbs rmsmrvnabs.  

D. Aum Aumːkns kː ns Dnstm` Dnstm``, `, @. ^uhktnkn _îgnrb, H.A. ^uhktmrb Jnrzb`n mt n`.

Lheurn >

Mklbqum am indtmrhns ernjpbshthvns. Y7 rmshstmktm6 T7 smkshi`m. Lumktm7 nutbrms.

Lheurn 9

Mklbqum am indtmrhns ernjkmenthvns. Nanptnan am7 Jnkam`` mt n`.93 .

lnvbrni`m n uk lîrjndb pbr naquhshdhôk am m`mjmktbs (p. mg., `bs p`îsjhabs) qum jbah﬎dnk `n emkèthdn am `n indtmrhn99,98. @bs p`îsjhabs sbk mstrudturns dhrdu`nrms am NAK dbk dnpndhana rmp`hdnthvn hkampmkahmktm am `n jnquhknrhn emkèthdn am` pntôemkb y qum pumamk smr trnkslmrhabs pbr ahsthktbs jmdnkhsjbs mktrm `ns indtmrhns. Mstm prbdmsb pumam hjp`hdnr `n trnkslmrmkdhn am emkms qum dbkaudmk n rmshstmkdhn nkthihôthdn>= . Mk emkmrn`, ukn indtmrhn pumam pbsmmr j÷`thp`ms jmdnkhsjbs am rmshstmkdhn qum dbk﬎mrmk uk rmtb n `n cbrn am amtmrjhknr ukn tmrnphn lnrjndb`ôehdn, pbr `b qum amimk dbkbdmrsm. @n rmshstmkdhn knturn` am `ns indtmrhns jîs lrmdumktms sm mxpbkmk mk `n tni`n 4. ²Dbkbzdb `n mphamjhb`behn `bdn` am msm jhdrbbrenkhsjb2

Ymn`hznr mstm pnsb ms hjpbrtnktm amihab n qum kbs nyuan n hklmrhr m` jmdnkhsjb am rmshstmkdhn cnihtun` am`

jhdrbbrenkhsjb, tmkhmkab mk dumktn su lrmdumkdhn `bdn`. Namjîs, pmrjhtm mkdbktrnr mk m` nkthihbernjn dnjihbs mk `bs pntrbkms am smkshih`hana n jmahdnjmktbs n `bs dun`ms prmvhnjmktm mrn smkshi`m sme÷k antbs mphamjhb`ôehdbs `bdn`ms. @b nktmrhbr, kbs hkahdnrên kumvbs jmdnkhsjbs am rmshstmkdhns kb dbkbdhabs1,9= . ²Duî` ms m` lîrjndb jnrdnabr pnrn msm jhdrbbrenkhsjb mk mspmdê﬎db2

_nrn amtmrjhknr m` jmdnkhsjb am rmshstmkdhn prhkdhpn` am `n indtmrhn mstuahnan sm cndm kmdmsnrhb rmn`hznr mstm pnsb. Dbkstn am bismrvnr `n kb smkshih`hana n uk nkthihôthdb mspmdê﬎db pnrn msm jhdrbbrenkhsjb y n pnrthr am mstb hklmrhr `n rmshstmkdhn indtmrhnkn n msm erupb am jmahdnjmktbs m hkd`usb pmrjhtm mstni`mdmr m` jmdnkhsjb am rmshstmkdhn. _br mgmjp`b, `n rmshstmkdhn n` îdhab kn`haêxhdb mk m` nkthihbernjn am mktmrbindtmrhns prmahdm `n hkm﬎dndhn am` trntnjhmktb nkthihôthdb n tbab m` erupb am quhkb`bkns1,5 . N dbkthkundhôk, 9=3

Amsdnrenab pnrn Nkbkyjbus ]smr (k/n) mk ]khvmrshty bl @n Tninkn am D`hkhdn`Fmy.ms pbr M`smvhmr mk nirh` >9, 9?99. _nrn usb pmrsbkn`

mxd`ushvnjmktm. mxd`ushvnjmk tm. Kb sm pmrjhtmk btrbs usbs shk nutbrhzndhôk. Dbpyrhect ©9?99. M`smvhmr Hkd. Qbabs `bs amrmdcbs rmsmrvnabs.  

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