de san sinh dii só lirgng nirdre tieu loang (thircfng tir 6-8 cóc/ngay).
Tiiy thuoc vao loai soi, cac thuóc hay cac phiTofng phap khac eo the dugc yeu cau de ngan chan tai phat.
19. SOT RET
Sót r e t la mot benh n h i l m ky sinh trung lay truyen tiT ngif&i nay sang ngi/cfi khac do mu6i dot. Benh gay ra nhOrng ccfn sot kem theo ret run tai d i l n va c6 the gay tilr vong.
Ddu hi^u vd tri^u chiing
Benh dac triftig bdi nhflng can t a i dien vdi cac daii hieu va trieu chifng sau:
• Ret run ti( vtia den nang • Sot cao
• Todt mo hoi đm dia khi het sot
/ I
• Cam gidc kho d .
Cac trieu chufng khac gom dau dau, buon non, non, tieu chaỵ
Nguyen nhdn
Nguyen nhan gay benh sot ret la ky sinh trung dan bao Plas- modium. Co khoang 170 loai Plasmodium, nhiAig chi c6 4 loai gay sót ret cf ngirori la:
• P. falciparum. Chu yen gap d chdu Phi, gay trieu chiing nang nhdt vd chiem phdn Idn cac trildng hap t^ vong do sot
ret.
• P. vivax. Chu yen gap d vimg nhiet đi cua chdu A, gdy trieu chiing nhe hon nhiCng c6 the ton tai trong gan vd gdy tai phdt benh trong nhieu nam.
• P. malariaẹ Bugc phdt hien thdy d chdu Phi, c6 the gdy trieu chiing sot ret dien hinh nhung trong mot so it trUdng hap CO the nam yen trong mdu ma khong gdy trieu chiing. Benh nhdn c6 the Idm Idy ky sinh trung sang ngUdi khdc qua vet dot cua muoi hoac qua truyen mdụ
56 • t w ^ / w e ^ / * ^ ^ ;
^6nfl r gfrt g ^ u
• p. ovalẹ Chil yeu gap d vimg Tdy Phị Tuy hiem gap nhUng
Cling CO the gdy benh tdi phdt.
Xet nghi^m vd chdn dodn
. Xet nghiem k i n h phet: Lay mau lam tieu ban nhuom va soi di/cJi k i n h hien v i de t i m ky sinh trung. 2 mau mau lay each nhau
6 giof CO the xac nhan sir c6 mat ciia k y sinh trung sot ret la loai
Icy sinh trung naọ Cung mot liic ngiTofi benh c6 the bi n h i l m nhieu loai Plasmodium khac nhaụ
Dieu tri ' '
- Benh sót ret, nhát la sót ret do n h i l m P. falciparum, can difgfc kham va dieu t r i kip thdị Cac thuóc chóng sót ret hien nay gom:
• Chloroquine * • Quinine sulfate
• Hydroxychloroquine
• Phoi hap sulfadoxine vd pyrimethamine • Mefloquine
• Phdi hap atovaquone vd proguanil • Doxycycline
- Mot nhom thuóc khac thuorng difcfc ke dcfn d chau A hien nay la cac dan xuát cua artemisinin, v i du nhif artesunatẹ
- Halofantrine doi k h i cung dirac dung de dieu t r i sót ret. Khong dung halofantrine cho ngudi dang dung mefloquine de phong sot ret hoac ngiTcfi bi benh t i m .
- Primaquine c6 the diigc dimg de chóng lai dang ky s i n h trung an trong gan va phong ngiTa tai phat. Khong dimg thuóc cho phu niJ CO thai hoac nguori bi thiéu men G6PD (glucose-6-phosphate dehydrogenase).
Phong b?nh.
• Hien chiXa c6 vaccin phdng sot ret. Cdch phbng berth chd yeu Id ngdn khong cho muSi dot, bao gom ntm man tdm thudc diet muoi vd phun thudc diet mudi trong nhd.
• Dieu tri du phbng bdng cdc thudc chdng sot ret.
• Boi thudc xua con triing nhit DEET len vung da hd vd phun thudc diet mudi tai nai d.
• Mac qudn do bdo họ ' • Nam mdn khi ngụ •
20. L O A N G X a O N G
L o a n g xi/crng la mot rói loan chuyen hoa
cua bo xifofng l a m ton thiTcfng sdc manh ciia
xifcfng difa den tang nguy cof gay xifcfng cho con ngifcfị Sufc m a n h cua xUomg bao gom sir toan ven ca ve khói lirgng ciia xiTOng.
Lodng xitomg la gỉ
L o a n g xUcfng la mot rol loan chuyen hoa cua bo xUcfng l a m ton thiTofng siifc m a n h ciia xuang dua den tang nguy cof gay xUOng cho con ngucfị SiJfc manh ciia xiTtfng bao gom sir toan ven ca ve khoi lirgng ciia xufcfng.
Cdc yeu to nguy cof cua b^nh lodng xiiang '"
• Benh lodng xUang se trd nen ndng ne hen, sdm hem, nhieu bien chdng han... neu ngitdi benh c6 them mot hoac nhieu yeu to nguy ca dildi day:
• Kem phdt trien thi chat til khi con nhd, đc biet Id coi xUang, suy dinh dudng, che do dn thieu Protid, thieu Calci hoac ty le Calci / Phospho trong che do dn khong hap ly, thieu vitamin D hade ca the khong hap thu diCgc vitamin D... vi vdy khoi liCgng khodng chat dinh cua xiCang d tu6i trUdng
58 •:• T i W ^ < 2 y « j a ^ ,
thdnh thdp, đy dUgc coi Id yeu to nguy ca quan trong nhdt cda benh lodng xilong.
tt hoat dgng the luc, it hoat dgng ngodi trdi (cdc tien vita- min D nen dnh hudng toi viec hap thu calci).
Sinh di nhieu Idn, nuoi con bdng sUa me md khong dn udng du chdt đc biet Id Protid cd Calci de bii đp laị Bi cdc benh mdn tinh dudng tieu hod (do, đy, rugt...) Idm han che hap thu calci, vitamin D, protid...
Co thai quen sii dung nhieu rilau, bia, cd phe, thudc Id... Idm tdng thdi calci qua dudng than vd gidm hap thu calci d dudng tieu hoạ
Thieu ndng cdc tuyen sinh due nam vd nU (suy buong trdng sdm, mdn kinh sdm, cdt buong trdng, thiiu ndng tinh hodn...). Bdt dgng qud Idu ngdy do benh tat (chdn thiCang cot song, phdi bdt dgng), do nghe nghiep (nhUng ngiCdi du hdnh vu tru khi tdu vd tru di ra ngodi khong gian) vi khi bdt dgng Idu ngdy cdc te bdo huy xUang tdng hoat tinh.
Bi cdc benh ngi tiet : cUdng tuyen gidp, eUdng tuyen can gidp, cUdng tuyen v6 cUdng than, tieu dudng...
Bi benh suy than mdn hoac phdi chay than nhdn tao Idu ngdy gdy rdi loan chuyen hoa vd mat calci qua dudng tiet nieụ
Mdc cdc benh xUang khdp mdn tinh khdc đc biet Id Viem khdp dang thdp vd Thodi hod khdp
Phdi sit dung đi han mot so thudc: chdng dgng kinh (Dihydan), thudc ehUa benh tieu dudng (Insulin), thudc chdng dong (Heparin) vd đc biet la cdc thudc khdng viem nhom Cortiosteroid (cortiosteroid mot mat de chetrUc tiep qud trinh tao xUang, mat khdc lam gidm hap thu calci d rugt, tdng bdi xudt calci d than vd lam tdng qud trinh huy xUang).
Tri^u Chang
• Bau mdi ma ho d cot song, dau doc cac xi/ang đi (đc biet
xUang cdng chdn), dau mdi ca bap, dn Iqnh, hay bi chuot rut (vqp bi) cac cạ..
• Bau thuc sU cot song, dau Ian theo khoang lien siidn, dau khi ngoi Idu, khi thay đi tU thẹ Co the dau man tinh hoac cap tinh sau chdn thiCang (gay xUang cd tay, gay lun dot song, gay cd xUang duị..)
• Bay bung cham tieu, nqng ngUc kho thd • Gil liCng, gidm chieu cao
• Tuy nhien, lodng xUang la benh diin bien dm thdm, ngudi ta thiCdng vl benh gidng nhu mot ten dn cdp thdm Idng, hdng ngdy cti Idy dan calci trong ngdn hang du trU xUang cila ca thi con ngUdị Khi c6 đu hieu lam sang, thitdng la liic đ CO bien chiing, ca the da bi mat tdi 30% khoi lugng xUang
Bien chvCng ciia lodng xUcfng
• Bau keo đi do chen ep than kinh • Gil veo cot song, bien dang long ngUc...
• Gay xUang cd tay, gay lun dot song, gay c6 xicang dui • Gidm khd ndng van dgng, dnh hudng nghiem trgng tdi chat
liCgng song cua ngicdi c6 tudị
Lam thenao de phdt hỉn s&m b?nh
1. P h a t hien cac yeu to" nguy cor gay loang xifcfng thuf phat (da neu tren) neu tren)
2. D i k h a m benh sdrni, ngay k h i c6 cac dau hieu dau moi mof ho Of cot song, or he thong xiiong khdp, doc cac xi/ong dai (dac biet Of cot song, or he thong xiiong khdp, doc cac xi/ong dai (dac biet
xuong cang chan), dau moi co bap, vgp bẹ..
60 • T/^-^Aạ^C,/^^^^
f)6na Y gfrt Cac bac si chuyen khoa se cho k i e m tra:
• Chup X-quang xUang hodc cot song
• Bo khdi luang xUang (Bone Mass Bensity - BMB) • Lam cac xet nghiem kiim tra
• Kham vd phdt hien cac yeu to nguy ca
K h a m benh v a theo doi dinh k y (tuy mijfc do benh) Luon CO y thuTc phong benh (suót cuoc dcfi)
Che do sinh hoqt, tap luyen tdng cUdng hoqt dgng ngodi trdi, tap van dgng thudng xuyen vd phu hap vdi siCc khoi, duy tri loi song ndng dgng, trdnh cdc thoi quen xdu: udng nhieu bia, rilau, cafe, thudc Id...
• Che do dn udng luon luon bdo dam mot che do dn udng day
da Protein vd khodng chat, đc biet la Calcị Vi vdy sUa vd
cdc che phdm til sUa (Ba, Phoma, Yaourt...) Id thiic dn ly tudng cho mot khung xitang hhoe mqnh.
he do nay can ducfc duy tri suót cuoc dori mOi ngifofị
K i e m soat tót cac benh ly anh hirdng v a cac yeu to nguy cO cua benh
So* dung cdc thuoc dieu tri lodng xiiofng
1. K e t hop thuoc chóng hiiy xuong va thuoc tang tao xiTOng: - Bisphosphonate + Calci va Vitamin D - Bisphosphonate + Calci va Vitamin D