Suseme Dermatologia

 

 

CHQDESKGKOME 

^X^HDH „ Ethiïîk Prmdårme

 

 

Hsth hakkf thd nkdk kabhtmvk prhperer pere k nkinursk ^X^HDH-enecâdmnk akgsmste. Qhssegtedks quh k nkithòck chsth hakkf í rhsudmck h iîk chvh shr useck nkd k mitumtk ch sh hstucer edpgedhith skarh ks thdes equm prhshiths. Pkrteitk, hsth dethrmeg iîk nkithdpge tkces es mijkrdeïøhs ihnhssårmes cureith e jkrdeïîk enecâdmne.

Micmnedks ek eguik quh iîk thdhd nkdk dhtenursks shr eprkveck k usk cks nkithòcks prhshiths ikssks ck pgeikihsth PQK,nkinursk ks quems jkred hstruturecks pere rhjkrïk uimvhrsmtårmk

 

 

^XDÅQMK  H^SQXSXQE CE PHGH ........................................................................................................................ ................................................................ ........................................................ 3 UXHMDECXQE^ .................................................................................................................................... 3 HQMSQKCHQDME ................................................................................................................................. ................................................................. .................................................................. 50 P^KQÄE^H ............................................................................................................................................. ............................................................................ ................................................................. 51 PÒQPXQE JXGDMIEI^ .............................................................................................. .............................. ..................................................................................... ..................... 15 XQSMNÅQME EOXCE ............................................................................................................... .............................................. ............................................................................ ........... 18

 

 

H^SQXSXQE CE PHGH

UXHMDECXQE^ MISQKCXÏÎK Es quhmdecures nkistmtuhd ud mdpkrteith prkaghde ch seòch ik Aresmg. Uuesh dhtech cks nesks hivkgvh e pertmnmpeïîk ch nrmeiïes, shick es knkrrâinmes pkr hsnegcedhitks h pkr vmkgâinme ckdístmne es dems nkduis ihssh orupk. Ks mcksks tedaíd nkdprhhichd ud orupk ch rmsnk egtk, chvmck à dhikr nepenmcech ch rheïîk h às gmdmteïøhs jäsmnes.

 

  Es ghsøhs hd nkishquâinme ch quhmdecures sîk rhspkisåvhms pkr oreich perth cks jhrmdhitks h þamtks chnkrrhiths ch neuses hxthries ik Aresmg, essmd nkdk iudhrksks ejestedhitks ejestedhitks ck treaeglk, egíd ch shquhges juinmkiems h hstítmnes, tems nkdk nmnetrmzhs lmphrtrþjmnes, prminmpegdhith ie pkpugeïîk desnugmie. Pkr chjmimïîk, e quhmdecure í ude jhrmce treudåtmne nkd e chstrumïîk pernmeg ku tkteg ce phgh h shus eihxks, pkchick enkdhthr nedeces dems prkjuices nkdk thnmck nhguger suanutáihk, dòsnugks, thicøhs h kssks. Pkch shr neusece pkr treude tírdmnk, hgítrmnk, quädmnk ku recmketmvk. NGÄIMNE Ngmimnedhith, es quhmdecures pkchd vermer chsch ghsøhs hrmthdetkses etí jkrdes orevhs nepezhs ch chshinecher rhspkste smstâdmne (prkpkrnmkieg à hxthisîk h prkjuicmcech ce ghsîk). Ngessmjmneïîk ces quhmdecures2 Oreus2 chthrdmier k oreu ce quhmdecure smoimjmne chjmimr e prkjuicmcech ce ghsîk Oreus2  ie phgh. Ngessmnedhith, pkch shr hiquecrece hd trâs oreus2   5² Oreu2  Oreu2 Enkdhth e nedece dems hxthrie ce phgh (e hpmchrdh). Iîk prkvkne

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egthreïøhs lhdkcmiádmnes. E ghsîk í hrmthdetkse, quhith h ckgkrkse. Hxhdpgk2 quhmdecure skger.   1² Oreu2  Oreu2  Pkch shr ngessmjmnece hd suphrjmnmeg h prkjuice.1² oreu suphrjmnmeg

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(ku quhmdecure ch hsphssure pernmeg suphrjmnmeg)2 enkdhth tkce e hpmchrdh h perth ce chrdh, nkishrveick rezkåvhg queitmcech ch eihxks (jkgänugks pmgksks h ogáicuges suckräperes). Ngmimnedhith, vhdks akgles, hrmthde, hxsuceïîk h ckr mithise. Uueick es akgles sh rkdphd, vmsuegmzedks ude suphrjänmh rþshe h òdmce nkd hrksîk ku ugnhreïîk. Hd 53 e 15 cmes, knkrrh rhnkistmtumïîk tkteg ce phgh, nkd däimde jkrdeïîk ch nmnetrmzhs. Hxhdpgk2 quhmdecure pkr gäqumck suphrequhnmck.

 

    1² oreu prkjuice (ku quhmdecure ch hsphssure pernmeg prkjuice)2  prkjuice)2  chstrþm

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quesh tkce e chrdh, nkdprkdhthick ks eihxks. Pkssum nkrkgeïîk dems pågmce, í dhiks ckgkrkse h prkvkne demkr rhphrnussîk smstâdmne. Hdakre pksse knkrrhr rhsteureïîk epþs 15 ces, k hpmtígmk rhníd jkrdeck í dumtk jrmåvhg, pkchick nurser nkd ugnhreïîk rhnkrrhith h jkrth thicâinme à nmnetrmzeïîk lmphrtrþjmne h jkrdeïîk ch nkitretures nmnetrmnmems. Pkr mssk, k tretedhitk usueg pkch hxmomr hxnmsîk teiohinmeg h hixhrtme ch phgh. Hxhdpgks2 quhmdecure pkr gäqumck suphrequhnmce, pkr mdhrsîk ku pkr nlede cmrhte. oreu2  enkdhth tkces es nedeces ce phgh. E ghsîk ngmimnedhith í shne,   >² oreu2 

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areine ienerece (phrkgece), nkd rhcuïîk ce hgestmnmcech thnmcueg, k quh e tkrie räomce. Pkch eprhshiter vesks seiouäihks trkdaksecks vmsävhms. Ch tîk prkjuice, chstrþm es thrdmieïøhs ihrvkses h, pkr mssk, í mickgkr. Hd egouis nesks, nkdk ies ghsøhs hgítrmnes, pkch enkdhthr thnmck nhguger suanutáihk, thisøhs, gmoedhitks h dòsnugks, pkchick nlhoer etí ks kssks. Hssh oreu ch quhmdecure iîk rhhpmthgmze h í ihnhssårme hixhrtme ch phgh. Kashrveïîk2 Es ghsøhs hgítrmnes pkchd ghver e dutmgeïøhs, shick ngessmjmneces pkr egouis eutkrhs nkdk ghsîk ch 3² oreu, essmd nkdk es århes nerakimzeces. Hxthisîk2 Hxthisîk2   chvhdks tedaíd negnuger e hxthisîk ce quhmdecure. Pere hjhmtk ch någnugk, sîk nkismchreces ephies es quhmdecures ch 1² h >² oreus. Xd cks dítkcks dems usecks chvmck e pretmnmcech h jenmg dhdkrmzeïîk í e "Qhore cks Ikvh" ch _eggenh. Hdakre iîk shbe dumtk prhnmsk, pkch shr utmgmzeck ie prmdhmre chthrdmieïîk ce hxthisîk ce århe quhmdece. E hxthisîk etmiomce í e nledece suphrjänmh nkrpkreg quhmdece (^NU). "Qhore cks Ikvh"2 nkismsth ie cmvmsîk ck nkrpk hd dògtmpgks ch =, nkijkrdh e jmoure 5. E neahïe hqumvegh e =%, nece dhdark suphrmkr e =%, e perth eithrmkr ck trkink e 5, A5?, A>?, A_5:, CQ?, A3:, A8?, N_5 H CU=. Aesheck hd kashrveïøhs ngäimnes h tmpeohd ck LGE, Lhishghi h Nrmstkplhrs, hd 5=0/30 eiks), nkd lmstþrme jedmgmeg

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pksmtmve jrhquhith, essknmeïîk nkd k LGE-Nw: c nkd ud nursk dems miståvhg h dems orevh6   Smpk MM2  MM2 jkrde dhiks orevh, ch miänmk dems tercmk, epþs ks >0/30 eiks, aemxe

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jrhquâinme ch lmstþrme jedmgmeg, aemxe essknmeïîk nkd LGE, shoumick ud nursk dems hståvhg ce ckhiïe.

Jetkrhs edamhitems2 E pskräesh pkssum ude jkrth mijguâinme ch jetkrhs edamhitems, quh pkchd shr oetmglks pere k suromdhitk ku pere k eorevedhitk ce ckhiïe.   Sreude2 Sreude2   k jetkr dems nkilhnmck í k treude, quh pkch ghver ek

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chshinechedhitk ch ghsøhs hd århes sîs. Hssh jhiódhik ch eperhnmdhitk ch ghsîk hd århe prhvmedhith sî í nkilhnmck nkdk jhiódhik ch Fkhaihr Hxmsth k jhiódhik ch Qhiakf, ku Fkhaihr rhvhrsk, hd quh ud treude gkneg e ude pgene ch pskräesh rhsugte ik chseperhnmdhitk ce ghsîk. Zegh rhssegter quh hsshs ckms jhiódhiks sîk hxngusmvks, ku shbe, quhd thd ud, iîk thd k kutrk.   Mijhnïøhs2 Mijhnïøhs2   pkchd chshinecher ku eorever e pskräesh, prminmpegdhith es

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aenthrmeies. Es dems rhghveiths sîk es mijhnïøhs hstrhptknþnmnes, prminmpegdhith jermiomth.

 

    Jetkrhs dhteaþgmnks/hicþnrmiks2  dhteaþgmnks/hicþnrmiks2 lmpknegnhdme í ud jetkr chshinecheckr

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ce pskräesh pustuger ohihregmzece h k lmpktmrhkmcmsdk ce pustugkse pegdkpgeiter.   Dhcmnedhitks2 Dhcmnedhitks2   chstened-sh ks mduikamkgþomnks (pkr hjhmtk pereckxeg),

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ahte-agkquheckrhs, EMIH^ (iîk shghtmvks prminmpegdhith), gätmk, eitmdegårmnks, nkrtmnkmchs (prminmpegdhith pkr usk miechqueck), mHNE, hitrh kutrks. vmce2  tedaíd mithrjhrhd ik nursk ce ckhiïe, prminmpegdhith   Låamtks ch vmce2 

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ågnkkg, judk, kahsmcech h hstrhssh.

Mduikdhcmeïîk2 ^eahdks quh e pskräesh í ude ckhiïe mduikdhcmece h iîk eutkmduih, ude vhz quh emice iîk jkm hinkitreck ihilud eitmnkrpk hsphnäjmnk. Ie pskräesh, k smsthde mduikgþomnk í etmveck ch jkrde chskrchiece, hivkgvhick k smsthdes mduih mietk h eceptetmvk. Knkrrh ude säithsh hxeohrece ch jetkrhs prþ-mijgedetþrmes, quh neused egthreïîk ce phrdheamgmcech vesnuger, ghseick e aerrhmre nutáihe h hstmdugeick e qumdmktexme, thick nkdk rhsugteck e mijgedeïîk ck thnmck egvk. Hxmsth e pertmnmpeïîk ce rhspkste Sl5, Sl5? h Sl11, nkd gmahreïîk ch jetkrhs ch nrhsnmdhitk, ghveick e phgh e ud hsteck ch lmphrpkrgmjhreïîk. Hiqueitk ie phgh ikrdeg, ks quhretmiþnmtks chdkred eprkxmdecedhith 1< cmes pere nkdpghterhd shu nmngk, ie pskräesh chdkred ephies 8 cmes. NGÄIMNE Es ghsøhs täpmnes ch pskräesh sîk ghsîk hrmthdetkses, chsnedetmves (nkd es hsnedes eroâimnes, ku shbe, pretheces), hd pgenes ahd chgmdmteces. Hd ohreg, es ghsøhs sîk amgethrems smdítrmnes. H, pkr vhzhs, pkssuhd ud legk phrmjírmnk ngerk, quh í k legk ch _krkikjj. Ephser ch iîk shr nerenthrästmnk, dumtks penmhiths sh quhmxed ch prurmck ies ghsøhs etmves.

 

  H thdks tedaíd pere iks euxmgmer ik cmeoiþstmnk k smieg ch Euspmtz. E nurhteohd dhtþcmne ch Arknq í e deikare shdmkgþomne quh nerenthrmze e pgene pskrmåsmne, ephser ch iîk shr petkoikdóimne2 ik prmdhmrk dkdhitk, nurhteick-sh e pgene, chstened-sh es hsnedes areines ienereces, hstretmjmneces (smieg ce vhge), suromick e shoumr ude dhdareie areine treisperhith, quh ude vhz nurhtece cå guoer e ud seioredhitk puitmjkrdh ku krveglk seiouäihk, nledeck smieg ch Euspmtz. E pskräesh pkch thr cmvhrses jkrdes ngäimnes2 Zugoer ku hd pgenes2 í e jkrde ngåssmne, hd quh thdks pgenes hrmthdetkhsnedkses, hrmthdetkhsnedks es, ahd chgmdmteces, nkd vermecks oreus ch mijmgtreïîk. Hd ohreg smdítrmnes, ies jenhs hxthiskses cks dhdarks, nkurk neahguck h rhomîk senre. Outete ku hd oktes ku hruptmve2 í dems nkdud hd nrmeiïes, eckhgsnhiths h ecugtks bkvhis. Knkrrh k eperhnmdhitk sòamtk ch påpuges hrmthdetkchsnedetmves ch 0,8 e 5nd ch cmádhtrk, ohregdhith gknegmzece ik trkink h remz cks dhdarks. Nerenthrmstmnedhith, Nerenthrmstmnedhi th, í prhnhcmce pkr ude mijhnïîk hstrhptknþnmne, nkdudhith ch vmes eírhes suphrmkrhs, h nkstude rhskgvhr hspkiteihedhith epþs 1 e > dhshs, pkríd, pkch enkithnhr ch es ghsøhs phrsmstmrhd h eudhiterhd ch tedeilk, tkdeick es nerenthrästmnes ce pskräesh hd pgenes. Pustugkse2 pkch shr ohihregmzece ku gknegmzece. K penmhith pkch thr smitkdes ohrems nkdk jharh, deg hster, esthime h iåushe. E ohihregmzece pkch knkrrhr hd ohsteith, quh í nledece ch mdphtmok lhrphtmjkrdh ku pskräesh pustugkse ohihregmzece ce ohsteïîk ku hd iîk ohsteiths, quh í nledece ch Pskräesh ch Zki Rudausnl. Í dernece phge prhshiïe ch dògtmpges pòstuges cmdmiutes (1>dd) hd aesh hrmthdetkse, shick es pòstuges hstírhms. Jetkrhs chshinecheiths pkchd shr ohsteïîk, cmdmiumïîk arusne ch nkrtmnkmch, mijhnïøhs, lmpknegnhdme, hitrh kutrks.

 

  Es jkrdes gknegmzeces sîk2 Enrkchrdetmth ch Leggkpheu, quh knkrrh ies dîks,, h e Pskräesh Pustugkse Pegdkpgeiter, quh í hxtrhdmcechs cks chcks ces dîks dernece pkr surtks ch dògtmpges pòstuges ie rhomîk nhitreg pegdkpgeiter h nevk pgeiter. Hrmtrkcírdmne2 Hrmtrkchrdme í e prhshiïe ch hrmthde h chsnedeïîk hd dems ch .  Exmeg2 enkdhth nkguie vhrthareg h/ku ertmnugeïîk senrkmgäene, des tedaíd pkch thr enkdhtmdhitk ertmnuger phrmjírmnk essknmeck. Ks ckhiths ohregdhith sîk LGE-A1? pksmtmve h pkchd eprhshiter nkinkdmteithdhith nkinkdmteithdhith ckhiïe mijgedetþrme mithstmieM h uvhäth. 3.  Dutmgeith2 vermeith dems rere. Ks penmhiths eprhshited ertrmth ch hvkguïîk råpmce h orevh, nkd chstrumïîk ertmnuger h chjkrdmcechs phrdeihiths. Nrmtírmks NE^PEQ pere Ertrmth Pskrmåsmne (100:) Ckhiïe ertmnuger mijgedetþrme hsteahghnmce + phgk dhiks trâs pkitks iks shoumiths nrmtírmks2  Pskräesh nutáihe etueg

1 pkitks

Lmstþrme ch pskräesh

5 pkitk

Lmstþrme jedmgmer ch pskräesh

5 pkitk

Centmgmth

5 pkitk

Ihkjkrdeïîk þsshe buste-ertmnuger

5 pkitk

Jetkr rhudetkmch ihoetmvk

5 pkitk

 

  Hd 100: jkm rhegmzeck ud hsnkrh pere cmeoiþstmnk ch Ertrmth Pskrmåsmne, quh sîk ks nrmtírmks Nesper. Hssh hsnkrh thite eudhiter e shismamgmcech h hsphnmjmnmcech ck cmeoiþstmnk.

CMEOIÞ^SMNK K cmeoiþstmnk ce pskräesh í ngäimnk. Hd ohreg, iîk rhquhr nkdpghdhiteïîk geakretkrmeg. Chvhdks ghdarer ce nurhteohd ch Arknq, quh thd oreich vegkr shdmkgþomnk. Nesk ihnhssårmk, pkch-sh rhegmzer amþpsme ch ude ghsîk pere eiågmsh lmstkpetkgþomne.. Ks prminmpems enlecks sîk2 perenhretksh (prhshiïe ch iònghks ie lmstkpetkgþomne nedece nþrihe), eneitksh rhouger (hsphssedhitk ce hpmchrdh), echgoeïedhitk suprepepmger, pepmgkdetksh (hghveïîk ce suphrjänmh neusece pkr lmphrpgesme h eudhitk ces pepmges círdmnes), hntesme ch vesks, pòstuge hspkiomksmjkrdh ch Fkokb (enòdugk ch ihutrþjmgks eaemxk ce nþrihe) h dmnrkeasnhssk ch Duirk (enòdugk ch ihutrþjmgks ie edece nþrihe). SQESEDHISK E pskräesh í ude ckhiïe ch hvkguïîk nróimne, h quegquhr tretedhitk chvh ghver hd nkismchreïîk e ihnhssmcech ck usk prkgkioeck ch dhcmnedhitks. E eakrceohd threpâutmne chvh shr micmvmcuegmzece, chphichick iîk skdhith k tmpk ngäimnk h e hxthisîk ce ckhiïe, des tedaíd nerenthrästmnes nkdk mcech, shxk, knupeïîk, dktmveïîk phsskeg h kutrks prkaghdes ch seòch Hxmsthd cmvhrses kpïøhs threpâutmnes pere e pskräesh, nkd vermecks dhneimsdks ch eïîk, pkchick mithrjhrmr hd cmjhrhiths pkitks ce nechme mduikgþomne rhspkisåvhg phge ckhiïe ku nkd eïîk ephies skarh e prkgmjhreïîk cks quhretmiþnmtks. K tretedhitk sh jez phgk usk ch dhcmneïøhs tþpmnes, jktkthrepme h crkoes ch usk smstâdmnk.

 

  DHCMNEÏØH^ SÞPMNE^ Hdkgmhiths h nhretkgätmnks2  nhretkgätmnks2  nkdk dhcmce ohreg, rhnkdhice-sh k usk ch þghks ku kutrks hdmgmhiths pere e ebucer ie rhdkïîk ch hsnedes h deithr e phgh lmcretece. Chrmvecks ck egnetrîk (nkegter h GNC)2  GNC)2  eohd mimamick e prkgmjhreïîk cks quhretmiþnmtks, egíd ch thr hjhmtk eitm-mijgedetþrmk. K nkegter thd eïîk ahiíjmne prminmpegdhith queick essknmeck à jktkthrepme, quh í k nledeck dítkck ch Okhnfhrdei. Eitregmie2  í ud chrmveck ck eitrenhik h enrhcmte-sh quh shu hjhmtk shbe Eitregmie2  nmtkståtmnk, rhcuzmick e etmvmcech dmtþtmne ces níguges hpmcírdmnes pskrmåsmnes. Negnmpktrmkg2  Negnmpktrmkg2  í ud eiågkok ce vmtedmie C>, cmdmium e prkgmjhreïîk h micuz e cmjhrhinmeïîk cks quhretmiþnmtks, egíd ch dkcmjmner e rhspkste mduikgþomne. Mimamckrhs ce negnmihurmie (tenrkgmdus h pmdhnrkgmdus)2  pmdhnrkgmdus)2  sîk mduikdkcugeckrhs tþpmnks. tþpmnks2   ks nkrtmnkmchs tâd eïîk eitmprkgmjhretmve, eitm-mijgedetþrme, Nkrtmnkmchs tþpmnks2 mduikssuprhsskre h eitmprurmomikse, k quh ks tkrie hxnhghiths hsnkgles pere e pskräesh. Pkríd, seah-sh quh hxmsth ude nleinh ch rhakth h pkssuhd hjhmtks nkgethrems nkdk etrkjme ce phgh h thgeiomhntecmes, shick pkr mssk utmgmzecks ks ch aemxe ku dícme pktâinme pere thiter dmimdmzer hsshs hjhmtks. Pkrteitk, pkchd shr jhmtks, des nkd micmneïîk echquece, pktâinme nkrrhte, vhänugk nkrrhtk h pkr thdpk chthrdmieck. JKSKSHQEPME2 E jktkthrepme í ude neamih ch guz hd quh queitmcechs prí-chthrdmieces ch hihrome XZ vîk etmiomr k penmhith pkr ud thdpk prí-chthrdmieck. K dhneimsdk ch eïîk í pkr etmvmcech eitmprkgmjhretmve, eitm-mijgedetþrme h mduikssuprhskre.

 

  Skcks ks tmpks ch pskräesh pkchd shr tretecks nkd jktkthrepme. E jktkthrepme tmpk XZA, quh phihtre dhiks, í dhglkr pere pskräesh dkchrece, nkd prhckdäimk ch pgenes jmies. H k PXZE, quh k penmhith jez usk ch ude crkoe jktksshismamgmzeith (pskreghik .  Mimamïîk ces vmes Sl5 h Sl5?2 usthfmiudeah (agkquhme MG-51/1>) h shnuqumiudeah (agkquhme MG-5?).

PÒQPXQE JXGDMIEI^ MISQKCXÏÎK Purpure jugdmieis í ude hrupïîk purpòrmne eouce nerenthrmzece pkr nkeougeïîk ce dmnrkvesnugeture, rhsugteick hd ghsøhs purpòrmnes h ihnrksh ce phgh. Í ud quecrk repmcedhith prkorhssmvk h ohregdhith í enkdpeileck pkr nkeougeïîk mitrevesnuger cmsshdmiece h nkgepsk nmrnugetþrmk, shick ude vhrcechmre hdhroâinme chrdetkgþomne. Í ude hitmcech rhgetmvedhith rere. E texe ch dkrtegmcech vhd cmdmiumick nkd ks numcecks ch supkrth, k ohrhinmedhitk eprmdkreck ch nkdpgmneïøhs shnuicårmes h egouis tretedhitks cmrhnmkiecks, des nkitmiue shick ude nkicmïîk minepenmteith, ohregdhith rhsugteick hd oreichs edputeïøhs iequhghs quh skarhvmvhd. K jetkr neuseg dems nkdud hd ecugtks í e shpsh, shick e aentírme dems essknmece ek quecrk e Ihmsshrme dhimiomtmcms.

 

  HSMKPESKOHIME Purpure jugdmieis í ude säicrkdh dernece phgk miänmk eouck ch lhdkrreome h ihnrksh nutáihe nkd råpmck prkorhssk, neusece pkr trkdaksh vesnuger círdmne h ihnrksh mitrevesnuger cmsshdmiece. Í nkismchreck ud smieg ch nhrtes ckhiïes smstâdmnes h iîk ude ckhiïe hd sm. Ks trâs tmpks ch pòrpure jugdmieith sîk2 ihkieteg, mijhnnmkse h mcmkpåtmne. E vermeith mijhnnmkse knkrrh cureith ude ckhiïe eouce, ohregdhith nkd quecrk síptmnk, chvmck e hicktkxmies prkcuzmces pkr aentírmes ored-ihoetmves, nkdk, pkr hxhdpgk, ude mijhnïîk dhimioknþnmne. Skcks ks tmpks hivkgvhd cmsjuiïîk ce lhdkstesme nkd ude duceiïe pere ud hsteck ch prþ-nkeougeïî prþ-nkeougeïîkk mdpkrteith. Pòrpure jugdmieith ihkieteg2  ihkieteg2  hstå essknmece e ude chjmnmâinme lhrhcmtårme ces prkthäies eitmnkeougeiths N h ^. E prkthäie N í ud cks prminmpems mimamckrhs ck smsthde ch nkeougeïîk  queick etmvece, mimah ks jetkrhs Ze h ZMMMe quh, pkr sue vhz, rhouged e säithsh ch trkdamie. Ks ihkietks ohregdhith eprhshited trkdaksh vhikse h erthrmeg denmïe ce phgh h ch kutrks þroîks hd etí 8 cmes epþs k iesnmdhitk. tretedhitk í cmrhnmkieck e hsses chjmnmâinmes. –

Pòrpure jugdmieith mcmkpåtmne2  mcmkpåtmne2  í nkismchrece ud cmstòramk eutk-mduih pþsmijhnnmksk, ohregdhith epþs ude ckhiïe jharmg, quh dems terch ghve e ghsøhs purpòrmnes repmcedhith prkorhssmves. Ihste jkrde, enrhcmte-sh quh ude chjmnmâinme rhgetmve ch prkthäie ^, pkr chshivkgvmdhitk ch eitmnkrpks eitm-prkthäie ^, thile pertmnmpeïîk ie jmsmkpetkgkome. eouce2  í k tmpk dems nkdud. Deimjhste-sh nkdk Pòrpure jugdmieith mijhnnmkse eouce2  ud enleck nutáihk iks penmhiths síptmnks dems orevhs, ahd nkdk ie jesnmth ihnrkseith, nkd prhcmghïîk pkr nhrtks eohiths mijhnnmksks. Hstå essknmece e ude chjmnmâinme ecqumrmce ce prkthäie N, nkd mithrrupïîk ck hqumgäarmk ce nkeougeïîk. Hicktkxmies aenthrmeies chshinechmed k nkisudk ces prkthäies N h ^ h ce

 

  eitmtrkdamie MMM, ghveick e ud hsteck prþ-nkeougetmvk quh ohre trkdakshs cks vesks círdmnks h nkeougeïîk mitrevesnuger cmsshdmiece. Es ghsøhs nutáihes pkchd sh eprhshiter prhnknhdhith nkdk hrupïøhs nutáihes phthqumems, quh prkormchd repmcedhith pere århes demkrhs ch hqumdksh. Pksthrmkrdhith, pkchd jkrder-sh akgles lhdkrråomnes quh nkitrmauhd pere es hsneres cures ngåssmnes nerenthrästmnes ce pòrpure jugdmieith. NGÄIMNE Hrupïîk phthqumeg ku lhdetkdes hd ud penmhith ihkieteg ku síptmnk chvhd shdprh iks eghrter pere e pkssmamgmcech ch pòrpure jugdmieith. Ks enlecks nutáihks ce pòrpure jugdmieith tâd eperâinme h hvkguïîk nerenthrästmnes. Hd ohreg, sh mimnme nkd ud hrmthde, quh chshivkgvh århes mrrhougerhs ch ihnrksh lhdkrråomne ezug hihorhnmce ik shu nhitrk, pkchick levhr vhsänuges h akgles. E phgh ejhtece mimnmegdhith í ckgkrkse h hicurhnmce, des iks hståomks pksthrmkrhs, pkch levhr ude phrce ce shismamgmcech. E ihnrksh pkch sh hsthichr eks thnmcks dems prkjuicks h chvhdks hster shdprh ethitks à mijhnïîk shnuicårme chssh thnmck dkrtk. Ks nkdpkihiths ce lmstþrme ck penmhith minguhd ude lmstþrme ch mijhnïøhs ku treudes orevhs, ahd nkdk hspghihntkdme eithrmkr. Chvmck à essknmeïîk nkd penmhiths nkd NMZC, pkch knkrrhr seioredhitk ch vårmks sätmks, mingumick dhdareies dunkses, århes ch treude ku rhtk. Chvmck à essknmeïîk nkd nlkquh síptmnk orevh, k penmhith pkch eprhshiter smitkdes ch ceiks ch kutrks þroîks, nkdk lhdetòrme, kgmoòrme h cmspihme. EZEGMEÏÎK Iävhms hsphnäjmnks ch eitmtrkdamie MMM, prkthäie N gmvrh h prkthäie ^ gmvrh h tkteg pkchd ebucer e nkijmrder k cmeoiþstmnk, hsphnmegdhith ie jkrde ihkieteg ce ckhiïe.

 

  Iks kutrks nesks, e evegmeïîk ch penmhiths nkd pòrpure jugdmieith shouh e evegmeïîk ce neuse suabenhith. E ausne phgk tmpk ch mijhnïîk chvh shoumr es cmrhtrmzhs ch shpsh. Í mdpkrteith skgmnmter eiågmsh ch gäqumck nhjegkrrequmcmeik, lhdkorede, juiïøhs lhpåtmne, rhieg h hghtrþgmtks, quh pkchrîk hster egthrecks ch enkrck nkd e nkicmïîk ngäimne ch aesh. Chvmck à jkrth essknmeïîk nkd e nkeougeïîk mitrevesnuger cmsshdmiece, chvh-sh tedaíd evegmer trkdaknmtkphime, jetkrhs ch nkeougeïîk hghvecks (PS, PSS), eudhitk ch C-cädhrk h cmdmiumïîk ck iävhg ch jmarmikoâimk. SQESEDHISK K tretedhitk ch tkcks ks tmpks ch pòrpure jugdmieith sh mimnme nkd numcecks ch supkrth h lmcreteïîk echquece. E eitmnkeougeïîk pkch shr mimnmece pere hvmter dems ihnrksh h chvh-sh evegmer e ihnhssmcech ch treisjusîk ch lhdkchrmvecks. Ie jkrde ihkieteg, e lmcreteïîk, treisjusîk ch pgequhtes/pgesde jrhsnk nkiohgeck, nkd dkimtkrmzeïîk cks iävhms ch prkthäie N h ^, sîk e aesh ck tretedhitk. Lhpermie h werjermie tâd smck utmgmzecks nkdk eitmnkeougeiths h, pksthrmkrdhith, pkch shr ecmnmkieck nkinhitreck ch prkthäie N sh hsse chjmnmâinme jkr hinkitrece. K tretedhitk ce pòrpure jugdmieith mcmkpåtmne í shdhgleith ek chsnrmtk enmde. Egíd cmssk, perhnh levhr ahihjänmk ik usk ch nkrtmnksthrkmchs phgk pephg mduikdkcugeckr. Ie jkrde mijhnnmkse eouce, egíd ch tkces es dhcmces ch supkrth, ks eitmamþtmnks ch edpgk hsphntrk chvhd mingumr e nkahrture ces hspínmhs Ihmsshrme dhimiomtmcms, ^trhptknknnus, ^teplygknknnus h Ngkstrmcmud. Jrhq÷hithdhith, sîk useces nkdamieïøhs ch neraephiâdmnks ku veinkdmnmie nkd ahte-gentádmnks +

 

  mimamckrhs ch ahte-gentedeshs. E ngmicedmnmie í jrhquhithdhith minguäce pkms pkssum prkprmhcechs hsphnäjmnes quh mimahd egoudes hicktkxmies. E threpme nkd mduikogkaugmie mitrevhikse tedaíd pkch shr usece. E prkthäie N etmvece pkch shr ecdmimstrece pere rhcuzmr e nesnete mijgedetþrme h rhsteurer k hqumgäarmk ce nkeougeïîk, cmdmiumick e prkorhssîk ce ghsîk purpòrmne. E chnmsîk ch eitmnkeouger chvh shr aeshece ie knkrrâinme ch NMZC smdugtáihe. Hd tkces es jkrdes ce ckhiïe, sîk rhegmzeces evegmeïøhs rhphtmces cks thnmcks nkd chsarmcedhitk ces århes ejhteces, nkijkrdh ihnhssårmk. E rhtmrece ck thnmck chsvmtegmzeck cmdmium e dkrtegmcech.

XQSMNÅQME EOXCE MISQKCXÏÎK E urtmnårme í nerenthrmzece phgk eperhnmdhitk sòamtk ch urtmnes, es quems pkchd shr enkdpeileces phgk eiomkhchde. K hchde ce chrdh suphrjmnmeg í chikdmieck urtmnårme, hiqueitk k hchde ce chrdh prkjuice, ck suanutáihk h ck tretk oestrkmithstmieg í nledeck ch eiomkhchde. E urtmne í ude ghsîk g hsîk hghdhiter chrdetkgþomne h í dernece pkr ud hchde nhitreg ch tedeilk vermeck, nmrnuiceck pkr hrmthde rhjghxk, nkd prurmck essknmeck h ch ieturhze hjâdhre, nkd e phgh rhtkrieick ek esphntk ikrdeg ohregdhith hd phräkck quh verme ch ude e 13 lkres. K eiomkhchde í chjmimck pkr hchde sòamtk h enhitueck ce chrdh prkjuice h suanutáihkdemkr. Pkssum jrhq÷âinme ch ckr hd rhgeïîk ek prurmck h enkdhth jrhq÷hithdhith es dhdareies dunkses. E rhskguïîk ck quecrk knkrrh hd tkrik ch ?1 lkres...

 

  JM^MKPESKGKOME2 Es deimjhsteïøhs ngäimnes ce urtmnårme sîk chnkrrhiths ce hstmdugeïîk cks destþnmtks pkr dhneimsdks mduikgþomnks h iîk mduikgþomnks. Ks dhneimsdks mduikgþomnks sîk nerenthrmzecks phge etmveïîk cks destþnmtks etrevís ce gmoeïîk ck eitäohik ek eitmnkrpk MoH, knkrrhick e gmahreïîk ch lmstedmie quh í rhspkisåvhg pkr hstmduger e prkcuïîk ch prksteogeicmies h ghunktrmhiks, enerrhteick ies jeshs mdhcmete h tercme ce rhspkste mduikgþomne. E gmahreïîk ch tems dhcmeckrhs prkdkvh veskcmgeteïîk neuseick hrmthde, eudhitk ce phrdheamgmcech vesnuger h treisuceïîk ch jgumcks, rhsugteick hd hchde. Knkrrh, nkinkdmteithdhith, hstädugk ces thrdmieïøhs ihrvkses rhspkisåvhms phgk prurmck h phge gmahreïîk gm ahreïîk ch lmstedmie cks destþnmtks. Ks dhneimsdks iîk mduikgþomnks sîk nerenthrmzecks pkr hstädugk cmrhtk skarh ks destþnmtks, prkvknecks pkr nkitresths, dhcmnedhitks h egmdhitks, quh chsoreiuged destþnmtks cmrhtedhith, shd e prhshiïe ch MoH.

NGÄIMNE Es ghsøhs sîk pgenes hrmthdetk-hchdetkses oreichs, prurmomikses, ch miänmk sòamtk h cureïîk hjâdhre, enkdpeileces, nkd jrhq÷âinme, ch jhiódhiks ohrems. K hpmsþcmk ch urtmnårme eouce pkch phrsmstmr pkr lkres h etí cmes. Iîk í cmjänmg hinkitrer k jetkr chshinecheith, hsteick, hd ohreg, rhgenmkieck às neuses gmsteces ck quecrk eaemxk. Hd ohreg, iîk rhquhr mivhstmoeïîk, e iîk shr equhge suohrmce phgks cecks ce eiedihsh.

 

 

NEX^E^ CE XQSMNÅQME EOXCE Mcmkpåtmne Egmdhitks (hxhdpgks2 jrutes, jrutks ck der, nesteiles) Dhcmnedhitks (hxhdpgks2 eitmamþtmnks, EE^, EMIHs) Lhdkchrmvecks Qecmknkitresths Mijhnïøhs vmrems h ckhiïes jharms Mishtks (pmnece ch eahgle h vhspe)

Es rheïøhs dhcmeces phge MoH e egírohiks edamhitems (tems nkdk k gåthx, nesteiles ku phmxh), queick neuses ce urtmnårme eouce ku urtmnårme ch nkitetk, pkchd shr mivhstmoeces phgk thsth nutáihk ch ghmture mdhcmete (prmnf thst) ku hitîk phgk QE^S (recmkegghrokskrahit thst) ik seiouh. Lå quh rhssegter k jetk ch quh, pere shr vegkrmzeck, k rhsugteck ch edaks chvh shr nkrrhgenmkieck nkd k nkithxtk ngäimnk. SQESEDHISK E eakrceohd threpâutmne ces urtmnårmes eouces í juicedhitece ik usk cks eitmlmstedäimnks ch shouice ohreïîk (iîk shceiths) nkdk eakrceohd pecrîk. Pkchsh essknmer nkrtmnkmch pere nkitrkgh dems repmck cks smitkdes h rhskguïîk dems råpmce ce ckhiïe. eiejmgexme (hchde  (hchde ch germioh, ^h lkuvhr eiomkhchde nkd smiems ch hvkguïîk pere eiejmgexme hchde ch ogkth, arkinkhspedk, iåushes, vódmtks, lmpkthisîk erthrmeg)2

 

    Ecrhiegmie

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hd skguïîk 525000 (5do/dg) vme suanutáihe ku, prhjhrhinmegdhith, ik dòsnugk vestk gethreg, e nece 8, 50 ku 58 dmiutks (ikrthecks ohihrmnedhith phge orevmcech ck quecrk, phgk iävhg ch rhspkste à epgmneïîk eithrmkr h phgk eperhnmdhitk ch hjhmtks nkgethrems). Ecdmimstrer 0,> 0,8 dG hd ecugtks h 0,05do/fo hd nrmeiïes (dåxmdk ch 0,> do ch ckshe tkteg).

  Chvh-sh deithr dhcmces ch supkrth ek penmhith2 kxmoâimk iks nesks nkd

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hivkgvmdhitk rhspmretþrmk, enhssk vhiksk, jgumcks msktóimnks pkr vme hickvhikse h hghveïîk ch dhdarks mijhrmkrs pere nkitrkgh mimnmeg ce prhssîk erthrmeg.   Eitm-lmstedäimnks2

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agkquheckrhs L5 h L1 sîk rhnkdhicecks (cmjhimcredmie 18 e 80 do 3/3 ku ch :/:l HZ h reimtmcmie 80 do etí ch