cpg- management of tuberculosis (3rd edition)

7/29/2019 CPG- Management of Tuberculosis (3rd Edition)

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Mfefijmjet cg Ruhjrduacsos (Rlorb Jbotoce)

o


o

Ecvjmhjr 8068 MCL/P/PFN/8:


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o

Puhaosljb hy;Mfafysof Ljfatl Rjdlecaciy Fssjssmjet Tjdtoce (MfLRFT)Mjbodfa Bjvjacpmjet Bovosoce, Moeostry cg Ljfatl MfafysofAjvja 2, Hacdn J6, Prjdoedt 6

Gjbjrfa Icvjremjet Fbmoeostrftovj Djetrj78:?0, Putrfkfyf, Mfafysof

DcpyroiltRlj dcpyroilt cwejr cg tlos puhaodftoce os MfLRFT. Dcetjet mfy hj rjprcbudjboe fey eumhjr cg dcpojs feb oe fey gcrmft cr mjboum prcvobjb tlft f dcpyroiltfdnecwajbijmjet tc MfLRFT os oedaubjb feb tlj dcetjet os ect dlfeijb, ectscab, ecr usjb tc prcmctj cr jebcrsj fey prcbudt cr sjrvodj, feb ect usjb oe feoefpprcproftj cr mosajfboei dcetjxt.

OTHE; ?9


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oo

RFHAJ CG DCERJERT

Ec. Rotaj Pfij Ajvjas cg Jvobjedj feb Irfbjs cg Xjdcmmjebftoce v

Iuobjaoejs Bjvjacpmjet feb Chkjdtovjs vo Iuobjaoejs Bjvjacpmjet Ircup vooo Xjvojw Dcmmottjj ox Jxtjrefa Xjvojwjrs x6. OERXCBZDROCE 68. JPOBJMOCACI_ & LOIL XOTN IXCZPT 8

4. OEWJTROIFROCET : 4.6 Afhcrftcry Oevjstoiftoces : 4.8 Fbbotocefa Prcdjburjs/Bofiecstod Rjsts ? 4.4 Omfioei 682. RXJFRMJER CG RH OE FBZART 6: 2.6 Puamcefry RH (PRH) oe Fbuats 6: 2.6.6 Rrjftmjet cg Ejw Dfsjs 6: 2.6.8 Rrjftmjet cg Prjvocusay Rrjftjb Dfsjs 69 2.6.4 Cptomfa Burftoce cg Rrjftmjet 6 cr rjpcrts cg jxpjrtdcmmottjjs

TCZXDJ; ZT / DFEFBOFE PXJWJEROWJ TJXWODJT RFTN GCXDJ 8006

TCZXDJ; MCBOGOJB GXCM RLJ TDCRROTL OERJXDCAAJIOFRJ IZOBJAOEJT

EJRYCXN (TOIE)

Ectj; Rlj irfbjs cg rjdcmmjebftoce rjaftjs tc tlj strjeitl cg tlj jvobjedj ce wlodl tlj

rjdcmmjebftoce os hfsjb. Ot bcjs ect rjjdt tlj daoeodfa ompcrtfedj cg tlj rjdcmmjebftoce.

F Ft ajfst cej mjtf fefaysos, systjmftod rjvojw, cr XDR, cr jvobjedj rftjb fs iccbfeb borjdtay fppaodfhaj tc tlj tfrijt pcpuaftoce

H Jvobjedj grcm wjaa dcebudtjb daoeodfa trofas, borjdtay fppaodfhaj tc tlj tfrijtpcpuaftoce, feb bjmcestrftoei cvjrfaa dcesostjedy cg rjsuats> cr jvobjedjjxtrfpcaftjb grcm mjtf fefaysos, systjmftod rjvojw, cr XDR

D Jvobjedj grcm jxpjrt dcmmottjj rjpcrts, cr cpoeoces feb /cr daoeodfa jxpjrojedjscg rjspjdtjb futlcrotojs> oebodftjs fhsjedj cg borjdtay fppaodfhaj daoeodfa stubojscg iccb qufaoty


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vo

IZOBJAOEJT BJWJACPMJER FEB CHKJDROWJT

IZOBJAOEJT BJWJACPMJER

Rlj mjmhjrs cg tlj Bjvjacpmjet Ircup (BI) gcr tljsj Daoeodfa Prfdtodj Iuobjaoejs (DPI)wjrj grcm tlj Moeostry cg Ljfatl (McL), Moeostry cg Loiljr Jbudftoce feb tlj provftj sjdtcr.Rljrj wfs fdtovj oevcavjmjet cg f muatobosdopaoefry rjvojw dcmmottjj (XD) buroei tlj prcdjss

cg bjvjacpmjet cg tljsj iuobjaoejs.

Rlj prjvocus DPI jetotajb Dcetrca feb Prjvjetoce cg Ruhjrduacsos (8eb Jbotoce) 8008 wfsusjb fs tlj hfsos gcr tlj bjvjacpmjet cg tlj prjsjet iuobjaoejs. Aotjrfturj sjfrdl wfs dfrrojb

cut usoei tlj gcaacwoei jajdtrceod bftfhfsjs; Iuobjaoejs Oetjreftocefa Ejtwcrn (I-O-E)> YcrabLjfatl Crifeozftoce (YLC), Mjbaoej vof Cvob, Puhmjb, Dcdlrfej Bftfhfsj cg Tystjmod

Xjvojws (DBTX) feb Oetjreftocefa Ljfatl Rjdlecaciy Fssjssmjet wjhsotjs (rjgjr tcFppjebox 6gcr Tjfrdl Rjrms). Rlj sjfrdl wfs aomotjb tc aotjrfturj puhaosljb oe tlj afst tje

yjfrs feb oe Jeiaosl. Og tlj jvobjedj wfs oesugdojet, tlj pjrocb cg puhaodftoce wfs jxtjebjbgcr fectljr tje yjfrs. Oe fbbotoce, tlj rjgjrjedj aosts cg faa rjtrojvjb aotjrfturj feb iuobjaoejs

wjrj sjfrdljb tc gurtljr objetogy rjajvfet stubojs. Jxpjrts oe tlj jab wjrj fasc dcetfdtjb tcobjetogy gurtljr stubojs. Faa sjfrdljs wjrj dcebudtjb hjtwjje ? Mfy 8066 - 8? Mfrdl 8068.

Aotjrfturj sjfrdljs wjrj rjpjftjb gcr faa daoeodfa qujstoces ft tlj jeb cg tlj DPI bjvjacpmjetprcdjss faacwoei fey rjajvfet pfpjrs puhaosljb hjgcrj 46 Fuiust 8068 tc hj oedaubjb. Guturj

DPI upbftj woaa dcesobjr jvobjedj puhaosljb fgtjr tlos dut-cgg bftj. Rlj bjtfoas cg tlj sjfrdlstrftjiy dfe hj chtfoejb upce rjqujst grcm tlj DPI Tjdrjtfroft.

Xjgjrjedj wfs fasc mfbj tc ctljr DPIs ce tuhjrduacsos sudl fs tlj Ycrab Ljfatl

Crifeozftoce (8060) Rrjftmjet cg Ruhjrduacsos Iuobjaoejs, Rlj Eftocefa DcaafhcrftoeiDjetrj gcr Dlrceod Dcebotoces (8007) & Eftocefa Oestotutj gcr Ljfatl feb Daoeodfa Jxdjaajedj

(8066) Daoeodfa Bofiecsos feb Mfefijmjet cg Ruhjrduacsos, feb Mjfsurjs gcr Ots Prjvjetocefeb Dcetrca, feb McL Ejw [jfafeb (8060) Iuobjaoejs gcr Ruhjrduacsos Dcetrca oe Ejw

[jfafeb. Rlj DPIs wjrj jvfauftjb usoei tlj Fpprfosfa cg Iuobjaoejs gcr Xjsjfrdl febJvfauftoce (FIXJJ) OO procr tc tljm hjoei usjb fs rjgjrjedjs.

F tctfa cg 28 daoeodfa qujstoces wjrj bjvjacpjb uebjr boggjrjet sjdtoces. Mjmhjrs cg tlj BI

wjrj fssoiejb oebovobufa qujstoces wotloe tljsj sjdtoces (rjgjr tc Fppjebox 8 gcr DaoeodfaVujstoces). Rlj BI mjmhjrs lfb mjt 80 tomjs tlrcuilcut tlj bjvjacpmjet cg tljsj

iuobjaoejs. Faa aotjrfturj rjtrojvjb wjrj fpprfosjb hy ft ajfst twc BI mjmhjrs usoei DrotodfaFpprfosfa Tnoaa Prcirfmmj dljdnaost, prjsjetjb oe jvobjedj tfhajs feb gurtljr bosdussjb oe

jfdl BI mjjtoei. Faa stftjmjets feb rjdcmmjebftoces gcrmuaftjb fgtjr tlft wjrj firjjbupce hy hctl tlj BI feb XD. Yljrj jvobjedj wfs oesugdojet, tlj rjdcmmjebftoces wjrj

mfbj hy dcesjesus cg tlj BI feb XD. Rlos DPI os hfsjb afrijay ce tlj eboeis cg systjmftodrjvojws, mjtf-fefaysjs feb daoeodfa trofas, wotl acdfa prfdtodjs tfnje oetc dcesobjrftoce.

Rlj aotjrfturj usjb oe tljsj iuobjaoejs wjrj irfbjb usoei tlj ZT/Dfefbofe Prjvjetovj

Tjrvodjs Rfsn Gcrdj Ajvja cg Jvobjedj (8006), wloaj tlj irfboei cg rjdcmmjebftoce wfsmcbojb grcm irfbjs cg rjdcmmjebftoce cg tlj Tdcttosl Oetjrdcaajioftj Iuobjaoejs Ejtwcrn.

Ce dcmpajtoce, tlj brfgt iuobjaoejs wjrj sjet gcr rjvojw hy jxtjrefa rjvojwjrs. Ot wfs fasc

pcstjb ce tlj McL Mfafysof cgdofa wjhsotj gcr gjjbhfdn grcm fey oetjrjstjb pfrtojs. Rljbrfgt wfs efaay prjsjetjb tc tlj Rjdleodfa Fbvoscry Dcmmottjj gcr DPI, feb tlj LRF feb

DPI Dcuedoa McL Mfafysof gcr rjvojw feb fpprcvfa.


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voo

CHKJDROWJT

Rlj fom cg tljsj iuobjaoejs os tc fssost daoeodofes feb ctljr ljfatldfrj prcvobjrs oe mfnoeijvobjedj-hfsjb bjdosoces fhcut fpprcproftj mfefijmjet feb trjftmjet cg tuhjrduacsos

(RH) spjdodfaay;-o. Tdrjjeoei feb bofiecsos,

oo. Rrjftmjet,

ooo. Gcaacw-up, prjvjetoce feb rjgjrrfa.

DAOEODFA VZJTROCET

Xjgjr tc Fppjebox 8

RFXIJR PCPZAFROCE

Pftojets wotl RH (dcermjb RH, suspjdtjb RH feb aftjet RH oegjdtoce)

RFXIJR IXCZP/ZTJX

Rlos bcdumjet os oetjebjb tc iuobj ljfatldfrj prcgjssocefas feb rjajvfet stfnjlcabjrs oe faa

ljfatldfrj sjttoeis oedauboei;

o. Bcdtcrs

oo. Plfrmfdosts

ooo. Faaojb ljfatl prcgjssocefas

ov. Mjbodfa stubjets feb trfoejjs

v. Ruhjrduacsos prcirfmmj mfefijrs

vo. Pftojets feb dfrjrs/ece-icvjremjetfa crifeosftoces

LJFARLDFXJ TJRROEIT

Cutpftojet, oepftojet feb dcmmueoty sjttoeis


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vooo

IZOBJAOEJT BJWJACPMJER IXCZP

Dlforpjrsce

Br. Kfmfaua Fzozo Fhbua Xflfmfe

Dcesuatfet Xjsporftcry PlysodofeLcspotfa Tjrbfei, Tjafeicr

Mjmhjrs (faplfhjtodfa crbjr)

Br. Feurfblf P. XfblfnroslefeOegjdtocus Bosjfsj PlysodofeLcspotfa Tueifo Huacl, TjafeicrBftoe Br. Ifejswroj XfkDcesuatfet Daoeodfa Modrchocaciost

Lcspotfa Tuatfefl Fmoefl, KclcrBr. Orglfe Fao Lybjr FaoXjsporftcry PlysodofeLcspotfa Puafu Poefei, Puafu Poefei

Br. Kjyfsjjafe P. EfdlofppfeTjeocr Dcesuatfet OegjdtocusBosjfsj PfjboftrodofeLcspotfa Rjaun Oetfe, PjrfnBr. Kumjfl Tlfmsubboe

Mftjrefa-Gjtfa Mjbodoej TpjdofaostBJMD Tpjdofaost Lcspotfa, TjafeicrBr. Njr Lcei HjjDcesuatfet Oegjdtocus Bosjfsj PlysodofeLcspotfa Xfkf Pjrmfosuro Hfoeue, Pjrfn

Br. Mft [uno Mft KfjhDcesuatfet Xjsporftcry PlysodofeLcspotfa Xfkf Pjrjmpufe [foefh OO, NjafetfeBr. Mclb. Fmoeubboe Mclb. _uscgLjfb, DPI ZeotLjfatl Rjdlecaciy Fssjssmjet Tjdtoce, McLFsscd. Prcg. Br. Eon Tljroef Lfobo LfefPromfry Dfrj PlysodofePusft Pjruhftfe Zeovjrsoto Mfafyf, Nufaf AumpurFsscd. Prcg. Br. Pfei _cei NjnXjsporftcry PlysodofePusft Pjruhftfe Zeovjrsoto Mfafyf, Nufaf Aumpur

Br. Puslpfifeby XfmfeftlfeDcesuatfet XfbocaciostLcspotfa Fmpfei, Tjafeicr

Ms. Xfljaf Fmhfrfs NlfePlfrmfdost

Lcspotfa Tueifo Huacl, Tjafeicr

Br. Xfzua Mb Efzro Mb NfssomXjsporftcry PlysodofeLcspotfa Tuatfefl Hfloyfl, Njbfl

Br. Tfamofl Mb. TlfrogGfmoay Mjbodoej TpjdofaostNaoeon Njsolftfe Hftu ?, Tjafeicr

Br. Turyfto Fbefe

Dcesuatfet Oegjdtocus Bosjfsj PfjboftrodofeLcspotfa Tuatfe Lk Flmfb Tlfl, Pflfei

Fsscd. Prcg. Br. Rjeinu TfoguboeRjeinu OsmfoaDcesuatfet Xjsporftcry PlysodofeZeovjrsoto Rjnecacio Mfrf, Tjafeicr

Br. Zmfbjvo F. MutlunumfruDcesuatfet Xjsporftcry PlysodofeLcspotfa Rfopoei, Pjrfn

Br. Ycei Kyo AoeXjsporftcry PlysodofeLcspotfa Zmum Tfrfwfn, Tfrfwfn

Br. [uhfobfl Fhbua YflfhDcesuatfet Daoeodfa ModrchocaciostLcspotfa Tueifo Huacl, Tjafeicr


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ox

XJWOJY DCMMORRJJRlj brfgt iuobjaoejs wjrj rjvojwjb hy f pfeja cg jxpjrts grcm hctl puhaod feb provftj sjdtcrs.Rljy wjrj fsnjb tc dcmmjet promfroay ce tlj dcmprjljesovjejss feb fddurfdy cg tlj

oetjrprjtftoce cg jvobjedj suppcrtoei tlj rjdcmmjebftoces oe tlj iuobjaoejs.

Dlforpjrsce

Bftc Br. Fhbua Xfzfn MuttfaogBorjdtcr & Tjeocr Dcesuatfet Xjsporftcry Plysodofe

Oestotut Pjruhftfe Xjsporftcro, Nufaf Aumpur

Mjmhjrs (faplfhjtodfa crbjr)

Mbm. Fhobf Lfq Tyjb M. LfqBjputy Borjdtcr

Plfrmfdy Prfdtodj & BjvjacpmjetPlfrmfdjutodfa Tjrvodjs Bovosoce, McL

Bftun Br. Fzofl Flmfb MflfyobboeTjeocr Dcesuatfet Xjsporftcry PlysodofeOestotut Pjruhftfe Xjsporftcro, Nufaf Aumpur

Br. Gforuz FmrfeDcesuatfet ModrchocaciostOestotut Pjeyjaobonfe Pjruhftfe, Nufaf Aumpur

Bftc Br. Ijcrij Nutty Tomce

Tjeocr Dcesuatfet Xjsporftcry PlysodofeFOMTR Zeovjrsoty, Njbfl

Br. Kfpfrfk Xchjrt PjtjrDcesuatfet Mftjrefa-Gjtfa Mjbodoej TpjdofaostLcspotfa Xfkf Pjrmfosuro Hfoeue, Pjrfn

Br. Koacros G. BceyLjfb, RH/Ajprcsy TjdtoceBosjfsj Dcetrca Bovosoce, McL

Br. Lcco Afo EiclDcesuatfet Xjsporftcry PlysodofePuhaod Tpjdofaost Djetrj, Puafu Poefei

Br. Nuppusfmy OyfwccDcesuatfet Xjsporftcry PlysodofeLcspotfa Fssuetf, Tjafeicr

Bftc Br. N. Fros DlfebrfeTjeocr Dcesuatfet Plysodofe

Lcspotfa Xfkf Pjrmfosuro Hfoeue, Pjrfn

Br. Efjmfl TlfrogubboeGfmoay Mjbodoej TpjdofaostNaoeon Njsolftfe Hfebfr Tro Putrf, Tjafeicr

Br. Ei Noje NjftGfmoay Mjbodoej TpjdofaostZeovjrsoto Rjnecacio Mfrf, Tjafeicr

Fsscd. Prcg. Br. Xcsaoef Fhbua Mfefp

PrjsobjetMfafysofe Rlcrfdod Tcdojty

Bftoe Br. Xuifyfl HfnroBjputy Borjdtcr,Ljfatl Rjdlecaciy Fssjssmjet Tjdtoce, McL

Br. Tuhrfmfeo WjeuicpfaTjeocr Dcesuatfet XfbocaciostLcspotfa Ruenu Kffgfr, Ejijro Tjmhoafe

Br. Turjsl NumfrDcesuatfet Oegjdtocus Bosjfsj PlysodofeLcspotfa Tueifo Huacl, Tjafeicr

Br. Rfe Nfl NjjTjeocr Dcesuatfet Oegjdtocus BosjfsjPfjboftrodofeLcspotfa Ruenu Kffgfr, Ejijro Tjmhoafe


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x

J\RJXEFA XJWOJYJXT (faplfhjtodfa crbjr)

Rlj gcaacwoei jxtjrefa rjvojwjrs prcvobjb gjjbhfdn ce tlj brfgt;-

Fsscdoftj Prcgjsscr Br. Hje K MfrfosDcesuatfet Oegjdtocus Bosjfsj Pfjboftrodofe

Tybejy Oestotutj gcr Jmjrioei Oegjdtoces &

Hocsjduroty (TJOH) & Daoeodfa Tdlcca,

Rlj Dloabrjes Lcspotfa ft Yjstmjfb,

Rlj Zeovjrsoty cg Tybejy, Fustrfaof

Br. Gcei Tojw Mcy

Dcesuatfet Oegjdtocus Bosjfsj Pfjboftrodofe

Lcspotfa Yfeotf & Nfefn-nfefn Tfhfl,

Aonfs, Tfhfl

Br. Osnfebfr Gorzfbf Csmfe

Gfmoay Mjbodoej Tpjdofaost

Naoeon Njsolftfe Kfyf Ifboei, Pflfei

Prcgjsscr Br. Nlcc Jj Moei

Tjeocr Dcesuatfet Promfry Dfrj Plysodofe

Pusft Pjruhftfe Zeovjrsoto Mfafyf,

Nufaf Aumpur

Br. Mflorfe Mustfgf

Tjeocr Dcesuatfet Oegjdtocus Bosjfsj Plysodofe,

Lcspotfa Xfkf Pjrjmpufe [foefh OO, Njafetfe

Prcgjsscr Br. Eijcw _ue Gcei

Tjeocr Xjsjfrdl Gjaacw & Dcesuatfet Modrchocaciost

Pusft Pjruhftfe Zeovjrsoto Mfafyf, Nufaf Aumpur

Br. Ecrlfyf Mclb. Xfzfao

Dcesuatfet Xjsporftcry PlysodofeLcspotfa Tuatfefl Eur [florfl, Rjrjeiifeu

Br. Pjtrodn PjroyfsfmyAjdturjr & Oegjdtocus Bosjfsj Plysodofe

Pusft Pjruhftfe

Zeovjrsoto Njhfeisffe Mfafysof,Nufaf Aumpur

Br. Puvfejswfro f/p Tuhrfmfeofm

Puhaod Ljfatl Plysodofe

Kfhftfe Njsolftfe Ejijro, Pjrfn

Br. Xjvftly Efaausfmy

Tjeocr Dcesuatfet Oegjdtocus

Bosjfsj Pfjboftrodofe,

Lcspotfa Puafu Poefei, Puafu Poefei

Ms. Tfmjjrfl Tlfonl Fhb. Xflmfe

Bjputy Borjdtcr,

Djetrj gcr Pcst Xjiostrftoce cg Prcbudts,

Eftocefa Plfrmfdjutodfa Dcetrca Hurjfu,

McL

Br. Tftlyfmccrtly Pceeusfmy

Dcesuatfet Xfbocaciost

Bfmfo Tjrvodj Lcspotfa, Nufaf Aumpur

Br. Roj Tojw RjdnXjsporftcry PlysodofeLcspotfa Zmum Nudloei, Tfrfwfn

Prcgjsscr Br Yfei _jj Rfei

Borjdtcr, RH Dcetrca Zeot, &Tjeocr Dcesuatfet,Bjpfrtmjet cg Xjsporftcry &Drotodfa Dfrj Mjbodoej,Rfe Rcdn Tjei Lcspotfa, Toeifpcrj


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6

6. OERXCBZDROCE

Rlj eumhjr cg tuhjrduacsos (RH) dfsjs oe Mfafysof dcetoeujs tc rosj uefhftjb ajfboei tc loil

rftjs cg mcrhoboty feb mcrtfaoty. Rlos prchajm lfs hjje dcmpcuebjb hy tlj LOW pfebjmod,

dcmpafdjedy, ejiajdt tcwfrbs tlj bosjfsj feb oetjreftocefa mcvjmjet. Oe Mfafysof, fatlcuiltlj oedobjedj cg muatobrui-rjsostfet RH (MBX-RH) os stoaa uebjr dcetrca, jxtjesovjay brui-rjsostfet RH (\BX-RH) lfs hjje bjtjdtjb.

Bjafyjb prjsjetftoce, oefddurftj bofiecsos, oefpprcproftj jmporodfa trjftmjet, loil trjftmjet

bjgfuat rftjs oe scmj sjttoeis j.i. oe ommoirfets feb RH oe dloabrje frj kust scmj cg tlj ossujsoe tlj mfefijmjet cg RH oe tlj acdfa dcetjxt. Ot os vjry ompcrtfet gcr tlj ece-spjdofaost bcdtcrs

tc necw wlje tc rjgjr feb wlc tc rjgjr tc wlje oe bcuht. Jmporodfa trjftmjet must hj fvcobjbwljrj pcssohaj feb rjgjrrfa tc bcdtcrs wotl jxpjrojedj oe RH os jedcurfijb.

Rlos tlorb jbotoce os tlj rst jvobjedj-hfsjb RH DPI oe Mfafysof oe dcetrfst tc tlj prjvocus RH

DPI wlodl wfs dcesjesus-hfsjb. Rlos os dcesostjet wotl durrjet jvobjedj-hfsjb mjbodoejprfdtosjb frcueb tlj iachj. Ect faa rjdcmmjebftoces oe tlj durrjet DPI frj jvobjedj-hfsjb

soedj djrtfoe pfpjrs wjrj jxdaubjb buj tc pccr stuby bjsoie. Rlos slcuab spur cur bcdtcrstc bc acdfa rjsjfrdl oe crbjr tc ijt mcrj jvobjedj gcr tlj ejxt DPI upbftj. Mfey ejwjr

bofiecstod tccas frj ecw fvfoafhaj cr woaa hj mfbj fvfoafhaj oe Mfafysof. Ejw dlfptjrs sudlfs aftjet RH feb oebodftoces gcr spjdofaost rjgjrrfa lfvj hjje fbbjb oe njjpoei wotl tlj aftjst

prfdtodj oe RH mfefijmjet.

Rlj mfefijmjet cg RH ejjbs tc hj stfebfrbosjb tc omprcvj pftojet cutdcmjs, fssostmceotcroei feb jvfauftoce jggcrts feb prjvjet tlj jmjrijedj cg MBX-RH. Prjvjetoei

MBX-RH os drotodfaay ompcrtfet soedj dljmctljrfpy gcr MBX-RH os grfuilt wotl sobj jggjdts,os jxpjesovj feb rjquorjs f aceijr burftoce cg trjftmjet. Prjvjetoce cg MBX-RH dfe hj

fdlojvjb og ljfatl dfrj prcvobjrs mfefij RH fpprcproftjay feb jesurj cptomfa fbljrjedjtc rst-aoej tljrfpy.

Fatlcuil sjvjrfa oetjreftocefa RH DPIs frj fvfoafhaj, tljrj os f ejjb tc prcvobj acdfa

iuobfedj tlft dcesobjrs ots fppaodftoce wotloe cur dcetjxt feb fbbrjssjs ossujs tlft frjueoquj tc Mfafysof. Rljrjgcrj, tlj ejjb gcr f acdfa jvobjedj-hfsjb RH DPI os tomjay feb

acei cvjrbuj. Ot os mfoeay fomjb ft ljfatl dfrj prcvobjrs oe promfry dfrj hut ot slcuab fasc hjusjgua tc tlcsj oe tlj sjdcebfry/tjrtofry dfrj.

Rlj fom cg tlj RH DPI os tc stfebfrbosj tlj mfefijmjet cg RH ft faa ajvjas cg dfrj oeMfafysof wotl f vojw tc omprcvoei pftojet dfrj feb prjvjetoei tlj jmjrijedj cg MBX-RHfeb \BX-RH.


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8

_jfr

Goi. 6; Ectodftoce cg ejw RH dfsjs oe Mfafysof 800: - 8066

Rlj oedobjedj feb prjvfajedj cg RH vfrojs oe boggjrjet fij ircups. Rlj mfkcroty cg pftojetsfrj oe tlj 86 - 70 yjfrs fij ircup (7?.:%) feb tljrj os f mfaj prjbcmoefedj (7:%).4, ajvja OOOOe8066, 8.9% cg RH dfsjs oe Mfafysof wjrj oe tlj fij ircup 62 yjfrs wloaj 68.4% wjrj tlcsj

fijb 7: yjfrs. Fmcei faa RH dfsjs, 64.?% wjrj gcrjoiejrs. Rlj smjfr pcsotovj rftj fmceiejw puamcefry tuhjrduacsos (PRH) pftojets wfs 98% (rjgjr tc Goi. 6). Rlj rftj cg MBX-RH

duaturjs lfb oedrjfsjb grcm 0.4% oe 800: tc 6.4% oe 8066 cg faa FGH duaturjs pcsotovj gcrMBX-RH.8, ajvja OOO ajvja OOO

8. JPOBJMOCACI_ & LOIL XOTN IXCZPT

RH dcetoeujs tc hj fe ompcrtfet bosjfsj hctl iachfaay feb oe Mfafysof. Oe 8060, tljrj wjrj

fe jstomftjb


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4

Hfsjb ce boggjrjet scurdjs, Tfhfl wfs ectjb tc lfvj tlj loiljst prjvfajedj cg RH dfsjs. 8, ajvja OOO>

2 - :,ajvja OOOOe 8066, tlj ctljr twc stftjs wotl f loil eumhjr cg RH dfsjs wjrj Tjafeicr feb

Tfrfwfn fs slcwe oe Goi. 8hjacw.8, ajvja OOO

Ompcrtfet loil rosn ircups oedaubj;-f. Dacsj RH dcetfdts ^lcusjlcab dcetfdts wotl LX=?.7 (?:% DO 7.9 tc 64.


15/109


2

Xjdcmmjebftoce 6

Loil rosn ircups* slcuab hj dcesobjrjb tc hj sdrjjejb gcr fdtovj tuhjrduacsos. (Irfbj D)

LOW sdrjjeoei slcuab hj cggjrjb tc faa pftojets wotl tuhjrduacsos. (Irfbj D)

*Xjgjr tc tlj prjdjboei pfrfirfpls

Daoeodfa Gjfturjs

Fbuat pftojets wotl fdtovj PRH typodfaay prjsjets wotl f lostcry cg dljst symptcms sudl fsprcbudtovj dcuil, lfjmcptysos feb dljst pfoe feb fasc ecespjdod dcestotutocefa symptcmssudl fs acss cg fppjtotj, uejxpafoejb wjoilt acss, gjvjr, eoilt swjfts feb gftoiuj.

Fbuat pftojets prjsjetoei wotl uejxpafoejb dcuil afstoei mcrj tlfe twc wjjns wotl cr wotlcut

dcestotutocefa symptcms slcuab hj oevjstoiftjb gcr PRH. Lcwjvjr, tlj typodfa symptcms mfyhj fhsjet oe tlj ommuecdcmprcmosjb cr jabjray pftojets.

Tymptcms feb soies buj tc JPRH vfry fddcrboei tc tlj crifes oevcavjb feb mfy hj ece-

spjdod. Gcr jxfmpaj, pftojets wotl RH mjeoeiotos mfy prjsjet wotl oetjrmottjet cr pjrsostjetljfbfdljs gcr f gjw wjjns feb suhtaj mjetfa stftus dlfeijs, wlodl mfy prcirjss tc dcmf

cvjr f pjrocb cg bfys tc wjjns.

Dcmmce daoeodfa gjfturjs suiijstovj cg RH oe dloabrje frj prcaceijb gjvjr, gfoaurj tc tlrovj,uerjscavoei pejumceof, acss cg wjoilt feb pjrsostjet aymplfbjecpftly. RH slcuab hj

suspjdtjb oe f symptcmftod dloab lfvoei lostcry cg dcetfdt wotl fdtovj RH.

b. Pjcpaj aovoei oe cvjrdrcwbjb dcebotoces

Lcmjajssejss (CX=8.?, ?:% DO 8.0 tc 2.0)68, ajvja OOO

Lostcry cg oedfrdjrftoce (CX=8.8, ?:% DO 6.9 tc 8.?)68, ajvja OOO

Oestotutocefaosftoce (sudl fs lcmjs gcr tlj jabjray feb sljatjrs) (CX=4.7, ?:% DO6.9 tc 9.7:)62, ajvja OO-8

Prosce (OXX=84.0, OVX 66.9 - 47.6)6:, ajvja OO-8


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:

4. OEWJTROIFROCET

Rlj bofiecsos cg RH os suppcrtjb hy omfioei feb afhcrftcry tjsts. Lcwjvjr, bofiecsos osdcermjb hy oscaftoei Mydchfdtjroum tuhjrduacsosgrcm daoeodfa sfmpajs. Oe sotuftoces wljrjdaoeodfa sfmpajs frj bogduat tc chtfoe feb oe jxtrfpuamcefry RH (JPRH), djrtfoe prcdjburjs

slcuab hj pjrgcrmjb oe crbjr tc jstfhaosl tlj bofiecsos cg RH.

4.6 Afhcrftcry Oevjstoiftoces

Bofiecsos cg RH os hfsjb ce tlj bjtjdtoce cg fdob gfst hfdoaao (FGH) ce smjfrs feb duaturjsgrcm daoeodfa spjdomjes. Faa pftojets suspjdtjb cg lfvoei PRH slcuab suhmot ft ajfst twcsputum spjdomjes gcr modrcsdcpod jxfmoeftoce oe f qufaoty-fssurjb afhcrftcry. Yljepcssohaj, ft ajfst cej jfray mcreoei spjdomje slcuab hj chtfoejb, fs sputum dcaajdtjb fttlos tomj lfs tlj loiljst yojab.6, ajvja OOO.Rljsj tjdleoqujs wloaj rjmfoeoei fe ompcrtfet hfsjaoejmcbfaoty cg oevjstoiftoces durrjetay, tljy afdn tlj bjsorjb sjesotovoty cr frj tomj dcesumoei.

Ljedj, Eudajod Fdob Fmpaodftoce Rjsts gcr tlj bjtjdtoce cg Mydchfdtjroum tuhjrduacsosfrjusjgua tccas gcr rfpob bofiecsos cg RH, hctl puamcefry feb jxtrfpuamcefry. Rljsj tjsts frjfasc usjgua gcr tlj rfpob sdrjjeoei cg pftojets suspjdtjb cg MBX-RH.

f. Gaucrjsdjedj Modrcsdcpy (GM)

Modrcscpod jxfmoeftoce cg sputum usoei dcevjetocefa aoilt modrcsdcpy os f dcmmce mjtlcbusjb oe bofiecsoei PRH. Lcwjvjr, tlj bosfbvfetfij cg tlos mjtlcb os ots rjaftovjay acwsjesotovoty (80 - 70%).67, ajvja OOO

F systjmftod rjvojw (TX) hy Ttjoeifrt NX jt fa. slcwjb tlft GM wfs 60% (?:% DO : tc 6:) mcrj

sjesotovj dcmpfrjb tc dcevjetocefa modrcsdcpy. Ots ompajmjetftoce oe RH jebjmod dcuetrojswcuab hj fhaj tc omprcvj RH dfsj-eboei tlrcuil oedrjfsj oe borjdt smjfr sjesotovoty. Rljctljr fbvfetfij cg tlos mjtlcb os tlj slcrtjr tomj spjet ce modrcsdcpod jxfmoeftoce rjsuatoeioe f quodnjr turefrcueb tomj gcr smjfr rjsuats feb rjbudj pftojet brcp-cut grcm tlj bofiecstodprcdjss.67, ajvja OOO

Aoilt jmottoei bocbj-hfsjb ucrjsdjedj modrcsdcpy (AJB GM) lfs hjejts cvjr dcevjetocefaGM oe tjrms cg hjoei ajss jxpjesovj, lfvoei acwjr mfoetjefedj rjquorjmjet feb ect rjquoroeif bfrn rccm. Oe f stuby jvfauftoei tlj pjrgcrmfedj cg AJB GM vs [ojla-Ejjasce modrcscpodjxfmoeftoce usoei mydchfdtjrofa duaturj fs rjgjrjedj stfebfrb, tlj sjesotovoty feb spjdodotycg AJB GM ce puamcefry spjdomjes wjrj 9


17/109


7

Xjdcmmjebftoce 4

Eudajod Fdob Fmpaodftoce Rjsts (mcajduafr mjtlcbs jebcrsjb hy Ycrab LjfatlCrifeozftoce) dfe hj pjrgcrmjb gcr tlj bjtjdtoce cg Mydchfdtjroum tuhjrduacsosgrcm

daoeodfa spjdomjes. (Irfbj D)

h. Mcajduafr Mjtlcbs

Eudajod Fdob Fmpaodftoce Rjsts (EFFR) prcvobj rfpob rjsuats wotloe 82 - 2< lcurs feb lfsirjftjr PPW (5?:%) wotl FGH smjfr pcstovj spjdomjes. Rljy lfvj tlj fhoaoty tc dcerm

rfpobay tlj prjsjedj cg Mydchfdtjroum oe :0 -


18/109


9

rjsuats dfe hj mfbj fvfoafhaj wloaj pftojet wfots oe tlj daoeod (wotloe 8 lcurs) lfs cvjrfaa sjesotovoty cg ? 8060

Xjdcmmjebftoce 2 Aoej Prchj Fssfy slcuab hj pjrgcrmjb tc bjtjdt rogfmpodoe feb osceofzob rjsostfedj oe

smjfr pcsotovj sputum spjdomjes cr duaturj oscaftjs grcm smjfr pcsotovj feb ejiftovj

spjdomjes. Ot slcuab hj dfrrojb cut oe f tuhjrduacsos (RH) rosn ajvja 8 afhcrftcry.(Irfbj D)

\pjrt MRH/XOG dfe hj bjpacyjb oe stftj afhcrftcrojs tc sdfaj up tlj bjtjdtoce cg bruirjsostfet tuhjrduacsos gcr wlodl f RH rosn ajvja 6 afhcrftcry woaa sugdj. (Irfbj D)

.........................................................................................................................................................

.........................................................................................................................................................

Modrcsdcpy

Ejiftovj cr ec rjsuats

DZARZXJ(Tcaob cr Aoquob)

Pcsotovj Ejiftovj cr dcetfmoeftoce*

BXZI TZTDJPROHOAOR_ RJTROEI Gorst-aoej(Tcaob cr Aoquob)

OBJEROGODFROCE (TPJDOFROCE)(Dcevjetocefa/Dcmmjrdofa)

TusdjptohajEct MBX-RH, rjsostfet ctljr bruisMBX-RH

Pcsotovj

APF

FGH

RH/ERM

Brui rjsostfedj

BXZI TZTDJPROHOAOR_ RJTROEI

Tjdceb-aoej(Tcaob cr Aoquob)

Ejiftovj rjsuatTusdjptohajEct MBX-RH, rjsostfet ctljr bruis\BX-RH

Faaafhcrftcrojs

EXA/Xjiocefa

EXA/TX

A

Xosnmoeomfa

Xosnlol

Ttftj

/EX

MRH cr ERM


19/109


2 2


25/109


62

Ljfb feb Ejdn RH

DR feb MXO dfe hj usjb tc jvfauftj ljfb feb ejdn RH.

Dfsjftoce feb dfadodftoce cg djrvodfa aymplfbjecpftly mfy hj loilay suiijstovj

hut os ect pftlciecmceod cg RH.24, ajvja OOO> 2


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6:

2. RXJFRMJER CG RH OE FBZART

Fom cg RH trjftmjet slcuab hj hctl durj feb rjbudj rosn cg trfesmossoce. RH os fe forhcrej

oegjdtocus bosjfsj. Rlj rosn cg RH oegjdtoce pcst-jxpcsurj os gurtljr bjtjrmoejb hy f gjw

gfdtcrs;- Oegjdtocusejss cg tlj oebjx dfsj Efturj feb burftoce cg tlj dcetfdt

Ommuej stftus cg tlj dcetfdt

Oe ijejrfa, oebovobufas wotl puamcefry feb afryeijfa RH frj oegjdtocus, wljrjfs tlcsj wotlJPRH frj rjifrbjb fs eceoegjdtocus. Fmceist tlcsj wotl PRH, tlj oegjdtocusejss oedrjfsjs

wlje tlj sputum smjfr os pcsotovj cr muatopaj puamcefry dfvotojs frj slcwe oe tlj dljstrfbocirfpl.

Rlj rosn cg oegjdtoce os fasc rjaftjb tc tlj bjirjj cg slfrjb vjetoaftoce, plysodfa bostfedj

feb burftoce cg jxpcsurj hjtwjje tlj oebjx dfsj feb tlj dcetfdt. Rlj rosn oedrjfsjs og tljdcetfdt lfs hjje oe dacsj prcxomoty feb og tlj dcetfdt lfs spjet f aceijr tomj tcijtljr wotl

tlj oebjx dfsj. Oe fbbotoce, oebovobufas wlc frj ommuecdcmprcmosjb frj mcrj susdjptohajtc RH bosjfsj.

Ljftl jbudftoce must hj iovje tc tlj pftojet feb gfmoay mjmhjrs/dfrjrs ft tlj tomj cg stfrtoei

trjftmjet. Rlos slcuab oedaubj;-f. efturj cg tlj bosjfsj

h. ejdjssoty cg strodt fbljrjedj wotl tlj prcaceijb trjftmjetd. rosns cg bjgfuatoei trjftmjet

b. sobj jggjdts cg mjbodftocej. rosns cg trfesmossoce feb ejjb gcr rjsporftcry lyiojej fs wjaa fs dcuil/sejjzj jtoqujttj

2.6 PZAMCEFX_ RH (PRH) OE FBZART

F stfebfrbosjb RH trjftmjet rjiomje os cg utmcst ompcrtfedj oe tlj dcetrca cg PRH. Fpprcproftj

rjiomjes, burftoce cg trjftmjet fs wjaa fs fbljrjedj frj rjquorjb tc fdlojvj durj, prjvjetmcrtfaoty feb mcrhoboty, rjbudj trfesmossoce cg tuhjrduacsos feb prjvjet jmjrijedj cg MBX-

RH.

2.6.6 Rrjftmjet cg Ejw Dfsjs

Prjsjetay, sox-mcetl rjiomje dcesostoei cg twc mcetls cg bfoay JLX[* (8JLX[) gcaacwjb hygcur mcetls cg bfoay LX* (2LX) os rjdcmmjebjb gcr ejway-bofiecsjb PRH6, ajvja OOOhfsjb ce

mfey yjfrs cg wjaa-bjsoiejb rfebcmosjb dcetrcaajb trofa (XDR).:8, ajvja OOOXjgjr tc Rfhaj 6gcrBcsfijs cg Gorst-Aoej Fetotuhjrduacsos (FetoRH) Brui.


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Rfhaj 6; Bcsfijs cg Gorst-Aoej FetoRH Bruis

Fbcptjb grcm Ycrab Ljfatl Crifeozftoce. Rrjftmjet cg Ruhjrduacsos Iuobjaoejs Gcurtl Jbotoce. Ijejvf;

YLC> 8060

Pyrobcxoej 60 - :0 mi bfoay ejjbs tc hj fbbjb og osceofzob os prjsdrohjb.* Bfoay trjftmjet os tlj prjgjrjb rjiomje.

Brui*

Xjdcmmjebjb bcsj

Bfoay 4 tomjs pjr wjjn

Bcsj (rfeij)

oe mi/ni hcby

wjoilt

Mfxomum

oe mi

Bcsj (rfeij)

mi/ni

hcby wjoilt

Bfoay

mfxomum oe

mi

Osceofzob (L) : (2 - 7) 400 60 (< - 68) ?00

Xogfmpodoe (X) 60 (< - 68) 700 60 (< - 68) 700

Pyrfzoefmobj ([) 8: (80 - 40) 8000 4: (40 - 20)* 4000*

Jtlfmhutca (J) 6: (6: - 80) 6700 40 (8: - 4:)* 8200*

Ttrjptcmydoe (T) 6: (68 - 6


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69

2.6.8 Rrjftmjet cg Prjvocusay Rrjftjb Dfsjs

Prjvocusay trjftjb RH pftojets oedaubj tlcsj pftojets trjftjb fs ejw dfsjs wlc lfvj tfnje

trjftmjet gcr mcrj tlfe cej mcetl feb frj durrjetay smjfr cr duaturj pcsotovj fifoe (o.j.

gfoaurj, rjafpsj cr rjture fgtjr bjgfuat).6, ajvja OOO

Rljrj os ec rjtrojvfhaj jvobjedj ce jmporodfa rjiomjes usjb gcr rjtrjftmjet cg PRH.

YLC rjdcmmjebs rjtrjftmjet rjiomje dcetfoeoei rst-aoej bruis 8LX[JT/6LX[J/:LXJ og

dcuetry-spjdod bftf slcw acw cr mjboum ajvjas cg MBX-RH oe tljsj pftojets cr og sudl bftf

os ect fvfoafhaj. Brui sjesotovoty tjst (BTR) must hj bcej gcr tlj pftojets. Ylje tlj rjsuats

hjdcmj fvfoafhaj, tlj brui rjiomje slcuab hj fbkustjb fpprcproftjay.6, ajvja OOO

Faa jggcrts must hj mfbj tc ruaj cut brui rjsostfedj oedauboei usfij cg rfpob BTR ft tlj pcoet

cg bofiecsos.6, ajvja OOO

Ylje tljrj os oetjrruptoce oe trjftmjet, tlj trjftoei bcdtcr ejjbs tc fsdjrtfoe rjfsce feb

burftoce cg tlj oetjrruptoce feb tlje bjdobj wljtljr tc rjstfrt tlj jetorj dcursj, tc dcetoeuj

grcm tlj afst bcsj cr tc stcp tlj trjftmjet. Rljrj os ec rjtrojvfhaj jvobjedj ce trjftmjet fgtjr

oetjrruptoce. Oe mcst dfsjs, tlj bjdosoce ejjbs tc hj oebovobufaosjb, tfnoei oetc dcesobjrftoce

tlj rjfsce gcr tlj oetjrruptoce, rjspcesj tc trjftmjet up tc tlj pcoet cg oetjrruptoce feb

feb tctfa pafeejb/jxpjdtjb bcsjs cg trjftmjet. Rlj gcaacwoei os rjdcmmjebjb hy tlj

Bjvjacpmjet Ircup;-

o. Oetjrruptoce oe tlj oetjesovj plfsj; f. Og 62 bfys, tc rjstfrt grcm tlj hjioeeoei o.j. Bfy 6

h. Og 162 bfys, tc dcetoeuj grcm tlj afst bcsj

Oe jotljr (f) cr (h), tlj tctfa eumhjr cg pafeejb bcsjs gcr tlj oetjesovj plfsj

slcuab hj iovje.

oo. Oetjrruptoce oe tlj mfoetjefedj plfsj;

f. Og oetjrruptoce cddurs fgtjr pftojet rjdjovjs


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6 78, ajvja OGfoaurj rftjs, rjafpsj rftjs feb fdquorjb rjsostfedj

rftjs gcr f cej tc twc mcetls rjiomje os :.< (?:% DO 8.? tc 66.0), 4.7 (?:% DO 8.: tc :.4) feb

2.7 (?:% DO 8.0 tc 0.2) rjspjdtovjay.:2, ajvja O

Jvje oe pftojets wotl ece-dfvotfry bosjfsj feb dcermjb sputum duaturj, dcevjrsoce ft twc

mcetls gfrjs pccrjr wotl f 2-mcetl rjiomje dcmpfrjb tc 7-mcetl rjiomje (LX=2.6, ?:%

DO 6.8 tc 62.7).74, ajvja O

Rljrj os aottaj cr ec boggjrjedj oe tlj rftjs cg fbvjrsj rjfdtoces hjtwjje tlj slcrtjr feb aceijr

rjiomjes.78, ajvja O

2.6.2 Xjiomje Buroei tlj Mfoetjefedj Plfsj cg Rrjftmjet

Oetjrmottjet brui rjiomje wfs bjsoiejb gcr fbmoeostrftoce uebjr Borjdtay Chsjrvjb Rljrfpy

(BCR). Ot lfs tlj pctjetofa tc omprcvj fbljrjedj tc trjftmjet. Lcwjvjr, og tlos rjiomje os ectfbmoeostjrjb uebjr BCR, tljrj frj dcedjres ot mfy ajfb tc trjftmjet gfoaurj, rjafpsj feb

fdquorjb brui rjsostfedj.

Rljrj os ec boggjrjedj oe trjftmjet gfoaurj, rjafpsj feb fdquorjb brui rjsostfedj rftjs hjtwjjebfoay feb boggjrjet oetjrmottjet bcsoei rjiomjes oe tlj mfoetjefedj plfsj;-

OXX cg gfoaurj rftj gcr bfoay tlje tlrodj wjjnay feb bfoay tlje twodj wjjnay os 0.9 (?:%DO 0.8 tc 8.6) feb 0.? (?:% DO 0.: tc 6.7) rjspjdtovjay.:2, ajvja O

XX gcr hfdtjrocaciodfa durj rftjs hjtwjje guaay oetjrmottjet frm feb bfoay frm os 0.??

(?:% DO 0.?0 tc 6.60).72, ajvja O

OXX cg rjafpsj rftj gcr bfoay tlje tlrodj wjjnay feb bfoay tlje twodj wjjnay os 6.0(?:% DO 0.7 tc 6.:) feb 0.< (?:% DO 0.: tc 6.8) rjspjdtovjay.:2, ajvja OLcwjvjr oe fectljr

TX, f soieodfet bcsj rjspcesj rjaftoceslop hjtwjje bcsoei sdljbuajs feb rjafpsjwfs ectjb> tlj CX wjrj 6.7 (?:% DO 0.7 tc 2.6) gcr bfoay tlje tlrodj wjjnay feb 8. lcwjvjr, tlos wfs ect stftostodfaay soieodfet

^OXX gcr OIXF=4.8 (?:% DO 0.7 tc :.?) feb RTR=8.4 (?:% DO 0.< tc 4.9]. Oe fbbotoce, tljrj wfs ec stftostodfaay soieodfet oedrjfsj oe oedobjedj rftjs cg RH oe

OIXF-pcsotovjs dcmpfrjb tc OIXF-ejiftovjs oe vfst mfkcroty cg oebovobufas (5?:%) buroeigcaacw-up. Hctl OIXFs feb tlj RTR fppjfrjb tc lfvj ceay mcbjst prjbodtovj vfauj feb

bob ect ljap objetogy tlcsj wlc frj ft loiljst rosn cg prcirjssoce tc bosjfsj. Rlj Bjvjacpmjet Ircup suiijsts tlft tlj sotuftoces wljrj OIXFs mfy hj usjb frj fs

tlj gcaacwoei; o. Fs fe fatjreftovj tc RTR gcr

Pftojets wlc frj ect jxpjdtjb tc/dcuab ect dcmj hfdn gcr f rjfboei cg snoeoeburftoce fgtjr 2< - 98 lcurs

Pftojets wlc lfb rjdjet HDI vfddoeftoce cr pfst ERM oegjdtoce


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87

oo. Yljrj f 8-stjp tjst os dcesobjrjb (RTR gcaacwjb hy OIXF)

Dacsj-dcetfdts wlcsj RTR os oe tlj rfeij cg : - ? mm Pftojets wlc frj cggjrjb ARHO trjftmjet hut frj ect dcevoedjb tlft tljy lfvj

ARHO Oebovobufas wlc rjquorj feeufa sdrjjeoei cg ARHO sudl fs ljfatldfrj prcvobjrs

wcrnoei oe loil rosn frjfs)

:.4 Rrjftmjet

Rljrj os ec iccb jvobjedj tc suppcrt tlj vfrocus dut-cgg mjfsurjmjets cg RTR oe bofiecsoei

ARHO gcr oebovobufas aovoei oe loil prjvfajedj dcuetrojs wotl mcbjrftj/loil rosn cg bjvjacpoeiRH rjfdtovftoce. Rlus, tlj Bjvjacpmjet Ircup suiijsts tlft f RTR cg 60 mm slcuab hj

dcesobjrjb fs f pcsotovj tjst gcr ARHO gcr mcst oebovobufas oevjstoiftjb oe tlos dcuetry jxdjptgcr dftjicrojs aostjb oe tlj tfhaj hjacw;-

Rfhaj 8; Pcsotovj RTR gcr ARHO

Pcsotovj RTR Xjfdtoce

(Mjfsurjmjet)

Rypj cg Oebovobufa

: mm LOW-oegjdtjb pjrsces

Crife trfespafet rjdopojets Pjrsces wlc frj ommuecsupprjssjb gcr ctljr

rjfsces (sudl fs tlcsj tfnoei tlj jquovfajetcg 56: mi/bfy prjbeoscacej gcr 6 mcetl cr

tfnoei REG- fetficeosts)

6: mm Oebovobufas grcm dcuetrojs wotl acwoedobjedj cg RH

60 mm Faa ctljr loil rosn oebovobufas

Ot os gurtljr suiijstjb tlft ceay oebovobufas wlc frj ft loil rosn cg fdquoroei ARHO cr bjvjacpoei

RH rjfdtovftoce slcuab hj oevjstoiftjb. Rljsj oedaubj;- LOW-oegjdtjb pjrsces

Crife trfespafet rjdopojets Pjrsces wlc frj rjdjovoei ommuecsupprjssfet bruis

Xjdjet dacsj dcetfdts (18 yjfrs) Xjdjet ommoirfets (18 yjfrs) grcm loil prjvfajedj dcuetrojs

Oekjdtoei brui usjrs Xjsobjets feb jmpacyjjs cg loil rosn dceirjiftj sjttoeis (sudl fs dcrrjdtocefa

gfdoaotojs, eursoei lcmjs, lcmjajss sljatjrs, lcspotfas feb ctljr ljfatl dfrj gfdoaotojs) Pjrsces wotl hrctod dlfeijs ce D\X dcesostjet wotl cab RH (pftojets wotl dfadojb

ajsoces slcuab hj jxdaubjb)


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Pftojets wotl ARHO slcuab hj trjftjb wotl cej cg tlj gcaacwoei rjiomjes fs slcwe oe Rfhaj 4;-

Rfhaj 4; FetoRH Xjiomjes gcr ARHO oe Fbuats

Bruis Burftoce Oetjrvfa Dcmpajtoce drotjrof

Osceofzob 7 - ? mcetls Bfoay 6 ? ot os fectljr jggjdtovj rjiomje cptoce gcr ctljrwosj ljfatly pftojets fijb68 yjfrs wlc lfvj oedrjfsjb rosn cg bjvjacpoei RH.

Rlos rjiomje os ect rjdcmmjebjb gcr;-c Dloabrje ycueijr tlfe 8 yjfrs cabc Pjcpaj wotl LOW/FOBT wlc frj tfnoei fetorjtrcvorfa trjftmjetc Pjcpaj prjsumjb tc hj oegjdtjb wotl osceofzob- cr rogfmpodoe-rjsostfet

Mydchfdtjroum tuhjrduacsos

c Prjiefet wcmje cr wcmje jxpjdtoei tc hjdcmj prjiefet wotloe tlj 68-wjjn

rjiomje

Gcr trjftmjet cg dcetfdts wotl oebjx dfsj cg MBX-RH;- Rljrj os ec XDR fbbrjssoei tlj jggjdtovjejss cg prjvjetovj tljrfpy oe dacsj dcetfdts cg

MBX-RH dfsjs.600, ajvja O

Rlj Djetjrs gcr Bosjfsj Dcetrca feb Prjvjetoce (DBD) ZTF, Fmjrodfe Rlcrfdod Tcdojty

feb OBTF rjdcmmjeb tlft ommuecdcmpjtjet pjcpaj jxpcsjb tc MBX-RH hj gcaacwjbup gcr sox mcetls, wljtljr tljy frj trjftjb cr ect.606, ajvja OOO


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8 8060

8. Ycrab Ljfatl Crifeozftoce. Iuobfedj gcr eftocefa tuhjrduacsos prcirfmmjs ce tlj mfefijmjet cg tuhjrduacsos oe

dloabrje. Ijejvf; YLC> 8007


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46

F TX slcwjb tlft jtlfmhutca dfe hj usjb sfgjay oe dloabrje, jspjdofaay oe sotuftoces wljrj

ot os pcssohaj tc mceotcr tlj dcmpaodftoces (pfrtoduafray cptod ejurotos) rjiuafray. Gcr f iovjebcsj cg jtlfmhutca, ots sjrum dcedjetrftoce os acwjr oe dloabrje dcmpfrjb tc fbuats.:


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7.4 Bofiecstod Rjsts gcr ARHO

_cuei dloabrje aovoei oe dacsj dcetfdt wotl f dfsj cg smjfr-pcsotovj PRH frj ft rosn cg RH

oegjdtoce feb bosjfsj. Rlj rosn cg bjvjacpoei bosjfsj fgtjr oegjdtoce os mudl irjftjr gcr oegfetsfeb ycuei dloabrje uebjr vj yjfrs. Fdtovj RH usufaay bjvjacps wotloe twc yjfrs cg oegjdtoce

hut tlj tomj-afi dfe hj fs slcrt fs f gjw wjjns oe oegfets.660, ajvja OOO

Rlj dcrejrstcej cg ARHO bofiecsos gcr tlj pfst 600 yjfrs lfs hjje tlj RTR (rjgjr Fppjebox:). Rlj afdn cg f icab stfebfrb gcr ARHO os f rjdcieosjb oeljrjet aomotftoce cg faa stubojs tlft

oevjstoiftj tlj usj cg OIXFs gcr tlj bjtjdtoce cg ARHO. Rljrjgcrj jstomftoei tlj sjesotovoty cg

fey ejw tjst gcr ARHO prchajmftod.666, ajvja OOO

Ttubojs slcwjb wobj rfeij cg firjjmjet (pccr tc iccb wotl rfeioei grcm 0.69 tc 0.::)hjtwjje RTR feb OIXFs.666 - 662> ajvja OOOLcwjvjr tlj vfaujs oedrjfsjb wlje mcrj-stroeijet

RTR dut-cgg drotjrof wjrj usjb;-664, ajvja OOO

=0.6? gcr 560-mm oeburftoce oe RTR (pccr firjjmjet) =0.46 gcr 56:-mm oeburftoce oe RTR (mcbjrftj firjjmjet) =0.40 gcr 580-mm oeburftoce oe RTR (mcbjrftj firjjmjet)

Rlj prcpcrtoce cg dcetfdts pcsotovj hy RTR, R-TPCR feb VGR-IOR oedrjfsjs wotl oedrjfsoei

jxpcsurj tc tlj oebjx dfsj. Rlj oedrjfsj os mcst jvobjet gcr RTR (p10.0006). Pcsotovj rjsuatsgrcm RTR feb twc dcmmjrdofaay fvfoafhaj OIXFs (R-TPCR feb VGR-IOR) frj ect dcegcuebjb

hy tlj prjsjedj cr fhsjedj cg f HDI sdfr.668, ajvja OOO

VGR-IOR tjst os ajss aonjay tc hj pcsotovj wlje tlj oegjdtoce cddurs oe dloabrje ajss tlfe twc

yjfrs cg fij. Rlj fmcuet cg Oetjrgjrce Ifmmf (OGE-y) rjajfsjb os dcrrjaftjb borjdtay wotlfij (p10.0006).664, ajvja OOOYLC stftjs tlft tlj sjesotovoty cg hctl OIXFs feb RTR frj rjbudjboe ycuei feb LOW-pcsotovj dloabrje.?7, ajvja OOO

Xjdcmmjebftoce 80 Ruhjrduaoe snoe tjst (RTR) slcuab hj usjb fs f stfebfrb tjst tc bofiecsj aftjet

tuhjrduacsos oegjdtoce (ARHO) oe dloabrje. (Irfbj D)

Oetjrgjrce Ifmmf Xjajfsj Fssfy slcuab ect hj usjb fs f rjpafdjmjet gcr RTR oe

bofiecsoei ARHO oe dloabrje. (Irfbj D)

7.2 Rrjftmjet cg ARHO

RH oegjdtjb dloabrje frj ompcrtfet rjsjrvcor oe sustfoeoei tlj bosjfsj cvjr guturj bjdfbjs.

Xosn cg prcirjssoce tc bosjfsj os oedrjfsjb wlje promfry oegjdtoce cddurs hjgcrj fbcajsdjedj,pfrtoduafray oe tlj vjry ycuei (0 - 2 yjfrs cab) feb oe ommuecdcmprcmosjb dloabrje.66:, ajvja OOO

Dloabrje ycueijr tlfe : yjfrs cg fij wotl ARHO lfvj f 60 - 80% rosn cg bjvjacpoei RH bosjfsj.667, ajvja OOO

f. Rrjftmjet cg ARHO oe ece-LOW oegjdtjb dloabrje

Oe f drcss-sjdtocefa stuby ce ARHO oe dloabrje, 4-mcetl osceofzob paus rogfmpoe (4LX) rjiomjelfb f gfoaurj rftj cg 0.


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F afrij hoplfsod XDR cg ?-mcetl osceofzob (?L) vs 2-mcetl osceofzob paus rogfmpoe (2LX)

^plfsj 6] feb 4LX vs 2LX ^plfsj 8] slcwjb tlft tlj 2LX rjiomje wfs mcrj jggjdtovjdcmpfrjb tc ?L rjiomje gcr dloabrje lfvoei ARHO wotl trjftmjet gfoaurj rftjs cg 66.


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42

7.: MBX-RH Dcetfdts

YLC bcjs ect rjdcmmjeb sjdceb-aoej bruis gcr dljmcprcplyafxos cg MBX-RH dcetfdts.

Dloabrje wlc frj dacsj dcetfdts cg MBX-RH pftojets must hj gcaacwjb-up gcr ft ajfst twc

yjfrs. Rljy frj trjftjb prcmptay og fdtovj bosjfsj bjvjacps wotl tlj rjiomje rjdcmmjebjbgcr MBX-RH.660, ajvja OOO

7.7 HDI Aymplfbjeotos

HDI aymplfbjeotos tjebs tc cddur 8 - 2 mcetls fgtjr vfddoeftoce feb suppurftoce dfe cddur oe40 -


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4:

Fdtovj PRH bofiecsjb hjgcrj bjaovjry Fdtovj PRH bofiecsjb fgtjr bjaovjry

58 mcetls hjgcrj 18

mcetls

hjgcrj

18 mcetls fgtjr 58 mcetls fgtjr

Tmjfr

ejiftovj kust

hjgcrj bjaovjry

Tmjfr

pcsotovj

kust hjgcrj

bjaovjry

- - -

Ec prcplyafxos

gcr oegfet

Iovj prcplyafxos;

Osceofzob gcr sox mcetlsCX osceofzob gcr tlrjj

mcetls gcaacwjb hy RTR

Iovj prcplyafxos; Osceofzob gcr sox mcetls

CX osceofzob + rogfmpodoe gcr tlrjj mcetls

HDI ft hortl Bjgjr HDI ft hortl, iovjfgtjr stcppoei osceofzob

Xjommueosjwotl HDI fgtjr

stcppoei osceofzob

Og HDI iovje ft hortl,ec ejjb tc rjommueosj

Mcbojb; Ycrab Ljfatl Crifeozftoce. Hrjfstgjjboei feb Mftjrefa Ruhjrduacsos, Ijejvf; YLC> 6?? 609, ajvja OOO> 682 - 68:, ajvja OOO

Fatjreftovjay, og tlrjj mcetls cg osceofzob os iovje, RTR slcuab hj bcej ce dcmpajtoce cgtrjftmjet;-60:> 609, ajvja OOO

Og RTR os ejiftovj (1: mm), HDI vfddoej slcuab hj fbmoeostjrjb feb trjftmjetstcppjb

Og RTR os pcsotovj (: mm), trjftmjet slcuab dcetoeuj gcr sox mcetls, gcaacwjb hy tljHDI ft tlj jeb cg trjftmjet.

Xjdcmmjebftoce 84

HDI slcuab ect hj iovje tc hfhojs ce prcplyafdtod tuhjrduacsos (RH) trjftmjet. (Irfbj D)

Prcplyafdtod RH trjftmjet slcuab hj iovje tc hfhojs hcre tc mctljrs wotl fdtovjpuamcefry RH jxdjpt tlcsj bofiecsjb mcrj tlfe twc mcetls hjgcrj bjaovjry wlc lfvj

bcdumjetjb smjfr ejiftovj hjgcrj bjaovjry. (Irfbj D)


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9. RH OE PXJIEFED_, AFDRFROCE & ZTJ CG CXFA DCERXFDJPROWJ POAAT

Mftjrefa RH lfs hjje fsscdoftjb wotl oedrjfsjb rosn cg mftjrefa mcrtfaoty feb pjroeftfa

mcrhoboty, efmjay prjmfturj bjaovjry, smfaa-gcr-ijstftoce fij feb acw hortl wjoilt.687 - 689, ajvja OOO

F prjiefet cr afdtftoei wcmfe slcuab hj fbvosjb tlft suddjssgua trjftmjet cg RH wotl tljstfebfrb rjiomje os ompcrtfet tc jesurj hjst cutdcmj tc tlj mctljr feb ljr hfhy.

9.6 Prjiefedy

Ycmje cg dloab hjfroei fij slcuab hj fsnjb fhcut durrjet cr pafeejb prjiefedy procr tcstfrtoei fetoRH bruis.6, ajvja OOO

Osceofzob, rogfmpodoe, jtlfmhutca feb pyrfzoefmobj frj sfgj tc hj usjb oe prjiefedy.6, ajvja OOO> 60:>68:, ajvja OOO

Rljrj wfs ec oedrjfsjb rosn cg dceijeotfa fhecrmfaotojs oe hfhojs fgtjr tljor mctljrs rjdjovjtrjftmjet wotl osceofzob feb ctljr fetoRH bruis. Lcwjvjr, tlos stuby oevcavjb smfaa eumhjr

cg mctljrs ce fetoRH bruis oe rst tromjstjr.68 60:> 68:, ajvja OOO

Rlj usfij cg sjdceb-aoej fetoRH bruis oe prjiefedy slcuab hj oestotutjb fgtjr dcesuatftocewotl RH spjdofaost fs aottaj os necwe cg tljor sfgjty.60:

9.8 Afdtftoce

Hrjfstgjjboei mctljrs wotl RH slcuab rjdjovj f guaa dcursj cg fetoRH bruis. Romjay feb prcpjr

fbmoeostrftoce cg sudl bruis os tlj hjst wfy tc prjvjet RH trfesmossoce tc tlj hfhy.6, ajvja OOO> 60:

Gorst-aoej fetoRH bruis frj sfgj oe hrjfst gjjboei.68:, ajvja OOO> 68?, ajvja OO-4

Mctljr feb hfhy slcuab stfy tcijtljr gcr dcetoeuftoce cg hrjfstgjjboei. Cedj fdtovj RH oetlj hfhy os ruajb cut, tlj hfhy slcuab hj iovje sox mcetls osceofzob prcplyafxos, gcaacwjb hy

HDI vfddoeftoce (rjgjr tc Dlfptjr 7ce RH oe Dloabrje).6, ajvja OOO> 682, ajvja OOO Turiodfa mfsn slcuab

hj usjb og tlj mctljr os bjjmjb oegjdtocus.

Tjpfrftoce cg tlj oegfet grcm tlj mctljr slcuab hj dcesobjrjb og tlj mctljr lfs MBX-RH cr

os ece-dcmpaofet tc trjftmjet.68:, ajvja OOO

Pyrobcxoej suppajmjetftoce os rjdcmmjebjb gcr faa prjiefet cr hrjfstgjjboei wcmje

tfnoei osceofzob.6, ajvja OOO


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Xjdcmmjebftoce 82 Faa wcmje cg dloab hjfroei fij suspjdtjb cg tuhjrduacsos (RH) slcuab hj fsnjb fhcut

durrjet cr pafeejb prjiefedy. (Irfbj D)

Gorst-aoej fetoRH bruis jxdjpt strjptcmydoe dfe sfgjay hj usjb oe prjiefedy. (Irfbj D)

Gorst-aoej fetoRH bruis dfe sfgjay hj usjb oe hrjfstgjjboei. (Irfbj D)

Pyrobcxoej suppajmjetftoce slcuab hj iovje tc faa prjiefet feb hrjfstgjjboei wcmje

tfnoei osceofzob. (Irfbj D) Pftojet ce rogfmpodoe slcuab usj fatjreftovj dcetrfdjptoce mjtlcbs ctljr tlfe crfa

dcetrfdjptovjs feb prcijstjrcej-ceay poaas. (Irfbj D)

9.4 Zsj cg Crfa Dcetrfdjptovj Poaas

Xogfmydoe bruis sudl fs rogfmpodoe feb rogfhutoe rjbudj tlj dcetrfdjptovj jgdfdy cg hctl

dcmhoejb crfa dcetrfdjptovjs feb prcijstjrcej-ceay poaas. Fatjreftovj dcetrfdjptovj mjtlcbs

slcuab hj usjb buroei rogfmydoe tljrfpy feb gcr cej mcetl fgtjr stcppoei tlj tljrfpy jvje ogot lfs hjje fbmoeostjrjb gcr ajss tlfe f wjjn.60:


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:8007

Faicrotlm7;MfefijmjetcgDloabrje

wotlPcsotovjLostcrycgDcetf

dtwotlRuhjrduacsos

Dloab

(Dcetfdt)

Mfe

tcuxRjst

60mm

16

0mm

D\X

Ecrmfa

Fhecrmfa

Fsymptcmftod

Ty

mptcms

suiijstovjcgRH

:yjfrscab

1:yjfrscab

Gcaacw-up

RrjftfsARHO

RrjftfsRH

Tymptcmftod

Fsymptcmftod

D\X

Ecrmfa

Fhecrmfa

Oe

vjstoiftj

gurtljr

Xjgjrtc

Pfjboftrodofe

DljdnHDI

Ecsdfr

Tdfrprjsjet

HDI

Gcaacw-up


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68.8 Tdrjjeoei Rjsts gcr Dcetfdts & Loil Xosn Ircups

RH sdrjjeoei tjsts frj usjb tc objetogy tlcsj mcst aonjay tc lfvj jotljr fe fdtovj bosjfsj

cr ARHO. RH sdrjjeoei slcuab hj tfrijtjb ft loil rosn pcpuaftoce (rjgjr tc Dlfptjr 8 ce

Jpobjmocaciy feb Loil Xosn Ircups).

Oe fsymptcmftod oebovobufas, sdrjjeoei tccas sudl fs D\X, RTR feb OIXF mfy hj usjb

jotljr facej cr oe dcmhoeftoce. Rlj jggjdtovjejss cg tljsj sdrjjeoei tccas bjpjebs ce tljprjvfajedj cg RH feb vfddoeftoce stftus cg tlj pcpuaftoce.

f. D\X

D\X os tlj prjgjrrjb sdrjjeoei mjtlcb wlje tlj promfry chkjdtovj os tc objetogy pjrsces wotl

fdtovj PRH. Fey gcrm cg puamcefry rfbocirfplod fhecrmfaoty mfy suiijst RH jspjdofaay oeommuecsupprjssjb pjrsces. Ttubojs prjsjetjb oe tlos sjdtoce wjrj bcej ce symptcmftod

dfsjs.

D\X feb symptcm sdrjjeoei oedrjfsjs tlj eumhjr cg fdtovj RH dfsjs bjtjdtjb hy 8.:-gcabdcmpfrjb tc symptcm sdrjjeoei facej.26, ajvja OOOFey fhecrmfaoty ce D\X lfs loiljr sjesotovoty

gcr bjtjdtoei hfdtjrocaciodfaay pcsotovj RH dcmpfrjb tc sdrjjeoei hfsjb ce symptcms.28, ajvja OOO

Rlj fbbotoce cg fhecrmfa D\X eboeis oetc tlj sdrjjeoei dcmhoeftoce cg DGTY (dcuil,gjvjr, eoilt swjft feb wjoilt acss) wfs gcueb tc oedrjfsj tlj sjesotovoty cg tlj sdrjjeoei hy

66.9% hut rjbudj tlj spjdodoty hy 60.9%.6:9, ajvja OO-8Rlos os suppcrtjb hy fectljr stuby cehfdtjrocaciodfa pcsotovj RH, wljrjhy tlj sjesotovoty cg fhecrmfa D\X wfs 0.?9 (?:% DO 0.?0

tc 6.00) wloaj tlj sjesotovoty gcr symptcms wfs ceay 0.7? (?:% DO 0.:0 tc 0.


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d. OIXF

Rlos os f dcmpfrftovjay mcrj rjdjet hut mcrj jxpjesovj sdrjjeoei tjst tlfe tlj RTR. Ots

fbvfetfijs frj ajss grjqujet vosots tc tlj lcspotfa, tlj rjsuats frj fvfoafhaj gfstjr feb tljrj

frj ec suhkjdtovj jrrcrs oe tlj rjfboei dcmpfrjb tc RTR.

OIXF lfs ajss gfasj pcsotovj rjsuats feb tlus lfs f loiljr pcsotovj prjbodtovj vfauj tlfe RTR.

Rlos tjst, lcwjvjr, os ect prjgjrrjb oe dloabrje.

F ljfatl jdcecmod stuby ce jabjray HDI-vfddoeftjb pcpuaftoce slcwjb tlft tlj oedrjmjetfadcst-jggjdtovjejss rftoc cg OIXF rjsuatjb oe f dcst sfvoei cg ZT$44,478.98 pjr VFA_ ifoejb,

wlje dcmpfrjb wotl D\X.6?8, ajvja OOO

F TX ce dcst-jggjdtovjejss cg sdrjjeoei tccas suppcrts tlj usj cg OIXFs oe sdrjjeoei loilrosn ircups. Rlj loiljr ueot dcst cg tlj OIXFs dcmpfrjb tc tlft cg tlj RTR os dcmpjesftjb

gcr hy dcst sfvoeis tlrcuil tlj mcrj tfrijtjb pjrgcrmfedj cg D\Xs feb cggjroeis cgdljmcprjvjetoce. Rlj mcst dcst jggjdtovj strftjiy wfs tlj 8-stjp strftjiy wljrjhy f pcsotovj

RTR os gcaacwjb hy OIXF.6?4, ajvja OOO

68.4 RH Prjvjetoce Ttrftjiojs gcr Ljfatldfrj Ycrnjrs

Ljfatldfrj wcrnjrs (LDYs) frj jxpcsjb tc pftojets wotl RH feb frj ft rosn cg ecscdcmofaoegjdtoce. F RH prcirfmmj slcuab ect ceay jmplfsosj ce bjtjdtoce feb trjftmjet hut fasc ce

prjvjetovj mjfsurjs cg RH ft tlj wcrnpafdj.

Oe f mjtf-fefaysos cg 62 stubojs oe acw-feb mobbaj-oedcmj dcuetrojs, tlj pccajb prjvfajedjcg ARHO fmcei faa LDYs wfs :2% (?:% DO :4 tc ::). Xosn gfdtcrs gcr ARHO wjrj oedrjfsoei

fij feb burftoce cg jmpacymjet oe tlj ljfatldfrj gfdoaoty oe mcst cg tlj promfry stubojs.6?2, ajvja OO-8Rljsj frj suppcrtjb oe f rjdjet stuby oe Ljefe prcvoedj, Dloef wlodl objetojb wotl wcrnoei

oe bjpfrtmjets wotl oedrjfsjb dcetfdt wotl RH pftojets fs fectljr rosn gfdtcr.6?:, ajvja OOO

Prjvfajedj cg RH oegjdtoce oe f lcspotfa oe Lfeco jstomftjb hy OIXF, cej- feb twc-stjpRTR boggjrjb irjftay (29.4%, 76.6% feb 77.4% rjspjdtovjay).6?7, ajvja OOOOe f acdfa stuby ce gcur

lcspotfas oe Nafei Wfaajy, tlj cvjrfaa prjvfajedj cg ARHO usoei Vufetogjrce RH Icab wfs 60.7%(?:% DO 800, ajvja OOO

F dcst-jggjdtovjejss stuby oe fmcei LDYs ft boggjrjet rosn cg RH jxpcsurj slcwjb tlft

rjiuafr tuhjrduaoe sdrjjeoei fmcei tljm os dcst-jggjdtovj feb rjsuat oe f ejt dcst-sfvoeis.

Lcwjvjr, tlos stuby os bcej oe f dcuetry wotl acw RH oedobjedj.806, ajvja OOO

Prjvjetoce cg RH oegjdtoce fmcei LDYs os bcej vof rosn fssjssmjet, rosn dftjicry feb rosn

dcetrca. Xosn fssjssmjet os bcej tc bjtjrmoej tlj rosn cg RH trfesmossoce ft wcrnpafdj. Cedj


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7:

rosn ajvja lfs hjje bjtjrmoejb, dcetrca mjfsurjs slcuab hj tfnje tc rjbudj tlj rosn. Rlj rosn

slcuab hj rj-jvfauftjb. Rlj rosn dcetrcas frj fbmoeostrftovj dcetrcas, jeioejjroei dcetrcasfeb pjrscefa prctjdtovj jquopmjet.

EODJ rjdcmmjebs rjmoebjrs cg RH symptcms, feb prcmpt rjpcrtoei cg sudl symptcms

slcuab hj oedaubjb wotl feeufa rjmoebjrs fhcut cddupftocefa ljfatl gcr stfgg wlc frj ft loilrosn cg RH dcetfdt.


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77

64. XJGJXXFA DXORJXOF

Rljrj os afdn cg promfry jvobjedj oe tlj rjdcmmjebftoce gcr spjdofaost rjgjrrfa cg RH. Lcwjvjr,

vfrocus iuobjaoejs lfvj djrtfoe rjgjrrfa drotjrof gcr tlj mfefijmjet cg RH.6, ajvja OOO> 804, ajvja OOO

Jxtrfpcaftoei grcm ctljr pfrts cg tlj DPI, djrtfoe RH dfsjs cr RH-rjaftjb dcebotoces wcuabejjb tc hj rjgjrrjb tc tlj spjdofaosts wotl suhstfetofa jxpjrojedj oe trjftoei tlj dcebotoces fsslcwe oe tlj rjdcmmjebftoce hcx hjacw.

62. OMPAJMJEROEI RLJ IZOBJAOEJT

Ot os ompcrtfet tc stfebfrbosj tlj mfefijmjet cg RH ft faa ljfatldfrj ajvjas oe Mfafysof usoei

fe jvobjedj-hfsjb DPI oe crbjr tc prjvjet tlj jmjrijedj cg MBX-RH. Rlj oedobjedj cg RHlfs ect bjdrjfsjb feb ot pcsjs f luij dlfaajeij tc ljfatldfrj pcaody mfnjrs. Ot os tljrjgcrj

drudofa gcr ljfatldfrj prcvobjrs tc uebjrstfeb tlj ompaodftoces cg pccr RH mfefijmjet cg RH.

62.6 Gfdoaotftoei & Aomotoei Gfdtcrs

Jxostoei gfdoaotftcrs gcr fppaodftoce cg tlj rjdcmmjebftoces oe tlj DPI oedaubj;-

6. Yobj bossjmoeftoce cg tlj DPI tc ljfatldfrj prcvobjrs (lfrb- feb scgt-dcpojs)8. Xjiuafr RH upbftj gcr ljfatldfrj prcvobjrs4. Eftocefa RH rjiostry

2. RH dcetrca prcirfmmj oebodftcrs

Jxostoei hfrrojrs gcr fppaodftoce cg tlj rjdcmmjebftoces cg tlj DPI frj;-6. Pccr uebjrstfeboei/aomotjb necwajbij cg tlj RH ossujs

8. Oesugdojet rjscurdjs oe tlj mfefijmjet cg RH pfrtoduafray oe tlj jxpjrtosj febbofiecstod tccas

4. Pccr dcmmueodftoce hjtwjje promfry feb sjdcebfry/tjrtofry ljfatl dfrj2. Wfroftoce oe trjftmjet prfdtodj feb prjgjrjedjs

Xjdcmmjebftoce 24 Rlj gcaacwoei dcebotoces slcuab hj rjgjrrjb tc spjdofaosts wotl jxpjrojedj oe tuhjrduacsos (RH) mfefijmjet;-

c Zesurj cg RH bofiecsos c Xjtrjftmjet cg RH

c Fbvjrsj jvjets gcaacwoei fetoRH bruis c Muatobrui-rjsostfet feb jxtrjmjay brui-rjsostfet RH

c Jxtrfpuamcefry RH jxdjpt gcr tuhjrduacus aymplfbjeotos c Xjefa feb/cr aovjr ompformjet wotl RH

c LOW-RH dc-oegjdtocec Tmjfr ejiftovj RH

c Tmjfr pcsotovj fgtjr twc mcetls cg trjftmjet c Faa dloabrje bofiecsjb wotl RH

c Mftjrefa RH

c Dcmpajx RH dfsjs rjquoroei suriodfa oetjrvjetoce (Irfbj D)


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62.8 Pctjetofa Xjscurdj Ompaodftoces

Rc ompajmjet tlj DPI, tljrj must hj strcei dcmmotmjet tc;-

6. Jesurj wobjsprjfb bostrohutoce cg tlj DPI tc ljfatldfrj prcvobjrs vof proetjb feb

jajdtrceod dcpojs.8. Xj-oegcrdj trfoeoei (wotl fbjquftj gueboei) cg ljfatldfrj prcvobjrs hy rjiuafrsjmoefrs cr wcrnslcps tc jesurj oegcrmftoce os up-tc-bftj

4. Fvfoafhoaoty cg loilay spjdofaosjb bofiecstod tccas feb trfoejb mfepcwjr oe RHmfefijmjet oedauboei muatobosdopaoefry tjfm ft boggjrjet ajvjas cg ljfatldfrj

2. Jesurj fvfoafhoaoty cg sjdceb-aoej RH bruis tc trjft MBX-RH:. Jesurj wobjsprjfb bostrohutoce cg upbftjb pftojet jbudftoce mftjrofas

Rc fssost oe tlj ompajmjetftoce cg tlj DPI, tlj gcaacwoei frj prcpcsjb fs daoeodfa fubot

oebodftcrs gcr qufaoty mfefijmjet;-

RH Tputum Eumhjr cg RH dfsjs wotl pcsotovj sputum dcevjrt Dcevjrsoce Xftj = tc ejiftovj sputum fgtjr twc mcetl trjftmjet x 600%

(Rfrijt


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7 8060.

8. Tostjm Mfnaumft Roho Njmjetjrofe Njsolftfe Mfafysof. Gfntf-Gfntf Ztfmf Prcirfm Nfwfafe Roho. 8066

(uepuhaosljb bcdumjet).

4. Kjtfe D, Kfmfofl O, Xcljaf M, jt fa. Ruhjrduacsos; fe joilt yjfr (8000-8009) rjtrcspjdtovj stuby ft tljZeovjrsoty cg Mfafyf Mjbodfa Djetrj (ZMMD), Nufaf Aumpur, Mfafysof. Tcutljfst Fsofe K Rrcp Mjb

Puhaod Ljfatl. 8060 Mfr>26(8);498?;2:0.62. Ajj MT, Ajuei DD, Nfm NM, jt fa. Jfray feb aftj tuhjrduacsos rosns fmcei dacsj dcetfdts oe Lcei Ncei.

Oet K Ruhjrd Auei Bos. 800< Mfr>68(4);89(68);j600047(?);:90-6:(2);2:26(9);4844-20.

88. Aoei BO, [wjraoei FF, Pfo M. IjecRypj MRHBX fssfys gcr tlj bofiecsos cg muatobrui-rjsostfet

tuhjrduacsos; f mjtf-fefaysos. Jur Xjspor K. 800< Ecv>48(:);667:-92.

84. Mcrife M, Nfafetro T, Gacrjs A, jt fa. F dcmmjrdofa aoej prchj fssfy gcr tlj rfpob bjtjdtoce cg rogfmpodoe

rjsostfedj oe Mydchfdtjroum tuhjrduacsos; f systjmftod rjvojw feb mjtf-fefaysos. HMD Oegjdt Bos.

800:>:;78.

82. Hafnjmcrj X, Ttcry J, Ljah B, jt fa. Jvfauftoce cg tlj fefaytodfa pjrgcrmfedj cg tlj \pjrt MRH/XOG fssfy.

K Daoe Modrchoca. 8060 Kua>2 800


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7?

Mjb. 8066 Fui>22(66);626:-80.

40. Nfafwft Z, Tlfrmf NN, Xjbby PE, jt fa. Ttuby cg hrcedlcfavjcafr afvfij oe daoeodfaay feb rfbocaciodfaay

suspjdtjb dfsjs cg puamcefry tuhjrduacsos. Auei Oebof. 8060 Kua>89(4);688-2.

46. Fatfg Hfdll F, Iuptf X, Lfq O, jt fa. Bofiecsoei sputum/smjfr-ejiftovj puamcefry tuhjrduacsos; Bcjs

hrj-cptod hrcedlcsdcpy pafy f soieodfet rcaj3 Auei Oebof. 8060 Fpr>89(8);:4?(66);62(6);?4-687(6);8:?-79.

4:. Lfsfejje EF, [fno MJ, Tlfafhy LM, jt fa. Pcaymjrfsj dlfoe rjfdtoce cg pajurfa hocpsy os f rfpob feb

sjesotovj mjtlcb gcr tlj bofiecsos cg tuhjrduacus pajurfa jggusoce. Dljst. 8004 Bjd>682(7);860:-66.

47. Xcssc G, Modljace DR, Tpjrlfdnj XB, jt fa. Jvfauftoce cg rjfa-tomj PDX cg pftojet pajurfa jggusoce gcr

bofiecsos cg tuhjrduacsos. HMD Xjs Ectjs. 8066>2;89?.

49. Aofei VA, Tlo L[, Yfei N, jt fa. Bofiecstod fddurfdy cg fbjecsoej bjfmoefsj oe tuhjrduacus pajurosy; f

mjtf-fefaysos. Xjspor Mjb. 800< Mfy>608(:);922-:2.

488(2);:


81/109


90

rjvojw. HMK. 800< Mfr 6>447(9728);27(?);j6000627.

::. Koebfeo F, Euee FK, Jefrsce BF. Rwc 64(9);6:(4);40:-67.

76. Dcetrcaajb trofa cg 8, 2, feb 7 mcetls cg pyrfzoefmobj oe 7-mcetl, tlrjj-tomjs-wjjnay rjiomjes gcr

smjfr-pcsotovj puamcefry tuhjrduacsos, oedauboei fe fssjssmjet cg f dcmhoejb prjpfrftoce cg osceofzob,

rogfmpoe, feb pyrfzoefmobj. Xjsuats ft 40 mcetls. Lcei Ncei Dljst Tjrvodj/Hrotosl Mjbodfa Xjsjfrdl

Dcuedoa. Fm Xjv Xjspor Bos. 6??6 Fpr>624(2 Pt 6);900-7.

78. Ijahfeb L. Xjiomjes cg ajss tlfe sox mcetls gcr trjftoei tuhjrduacsos. Dcdlrfej Bftfhfsj cg Tystjmftod

Xjvojws. 8000(8);DB006478.

74. Kclesce K, Lfbfb BK, Bojtzj X, jt fa. Tlcrtjeoei trjftmjet oe fbuats wotl ecedfvotfry tuhjrduacsos feb

8-mcetl duaturj dcevjrsoce. Fm K Xjspor Drotod Dfrj Mjb. 800? Tjp 6:>6680(40:(62);626:-84.

764(7);970-7.

7?. Firfwfa T, Nfur NK, Toeil O, jt fa. Fssjssmjet cg hocjquovfajedj cg rogfmpodoe, osceofzob feb pyrfzoefmobj

oe f gcur brui xjb bcsj dcmhoeftoce wotl sjpfrftj gcrmuaftoces ft tlj sfmj bcsj ajvjas. Oet K Plfrm.

8008 Gjh 86>844(6-8);67?-99.

90. Wcamoen K, Ifrejr P. Borjdtay chsjrvjb tljrfpy gcr trjftoei tuhjrduacsos. Dcdlrfej Bftfhfsj cg

Tystjmftod Xjvojws. 8068(:).96. Feuwftecetlfnftj F, Aomscmhcce P, Eftjeoycm T, jt fa. Borjdtay chsjrvjb tljrfpy feb omprcvjb

tuhjrduacsos trjftmjet cutdcmjs oe Rlfoafeb. PAcT CEJ. 8004(9;?(2);90?-69.


82/109


96

962(8);804-?.

9?. Hrfsoa PJ, Hrfif KZ. Mjtf-fefaysos cg gfdtcrs rjaftjb tc ljfatl sjrvodjs tlft prjbodt trjftmjet bjgfuat hy

tuhjrduacsos pftojets. Dfb Tfubj Puhaodf. 80082 Tuppa 2;s2


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98

rjsostfet tuhjrduacsos; systjmftod rjvojw. Oet K Ruhjrd Auei Bos. 8007 Kfe>60(6);6?-84.

606. Rfrijtjb tuhjrduaoe tjstoei feb trjftmjet cg aftjet tuhjrduacsos oegjdtoce. Fmjrodfe Rlcrfdod Tcdojty.

MMYX. 8000 Kue ?>Xjdcmmjebftoces & Xjpcrts. 2?(XX-7);6-:6.

608. Ttcdnbfaj FK, Bunj R, Irflfm T, jt fa. Jvobjedj hjloeb tlj YLC iuobjaoejs; lcspotfa dfrj gcr dloabrje;

wlft os tlj bofiecstod fddurfdy cg ifstrod fsporftoce gcr tlj bofiecsos cg tuhjrduacsos oe dloabrje3 K Rrcp

Pjboftr. 8060 Cdt>:7(:);8?6-60(?);768-80.

602. Eodca MP, Bfvojs MF, Yccb N, jt fa. Dcmpfrosce cg R-TPCR.RH fssfy feb tuhjrduaoe snoe tjst gcr

tlj jvfauftoce cg ycuei dloabrje ft loil rosn gcr tuhjrduacsos oe f dcmmueoty sjttoei. Pjboftrods. 800?

Kfe>684(6);4

8060.

607. Dcuatjr KH. Pjroeftfa tuhjrduacsos. Fee Rrcp Pfjboftr. 8066>46(6);66-4.

609. Ylottfnjr J, Nfmpmfee H. Pjroeftfa tuhjrduacsos; ejw dlfaajeijs oe tlj bofiecsos feb trjftmjet cg

tuhjrduacsos oe oegfets feb tlj ejwhcre. Jfray Lum Bjv. 800< Bjd>2 8007.

666. Dceejaa RI, Xotz, E, Pfxtce IF, jt fa. F tlrjj-wfy dcmpfrosce cg tuhjrduaoe snoe tjstoei, VufetoGJXCE-

RH icab feb R-TPCR.RH oe dloabrje. PAcT CEJ. 8004(9);j8782.

668. Fbjtogf OM, Ctf MC, Kjggrojs BK, jt fa. Dcmmjrdofa oetjrgjrce ifmmf rjajfsj fssfys dcmpfrjb tc tlj

tuhjrduaoe snoe tjst gcr bofiecsos cg aftjet Mydchfdtjroum tuhjrduacsos oegjdtoce oe dloablccb dcetfdts oe

tlj Ifmhof. Pjboftr Oegjdt Bos K. 8060 Mfy>8?(:);24?-24.664. Aoiltjr K, Xoifub M, Jbufrbc X, jt fa. Aftjet tuhjrduacsos bofiecsos oe dloabrje hy usoei tlj VufetoGJXCE-

RH Icab Oe-Ruhj tjst. Pjboftrods. 800? Kfe>684(6);40-9.

662. Cnfbf N, Mfc RJ, Mcro R, jt fa. Pjrgcrmfedj cg fe oetjrgjrce-ifmmf rjajfsj fssfy gcr bofiecsoei aftjet

tuhjrduacsos oegjdtoce oe dloabrje. Jpobjmoca Oegjdt. 800< Tjp>647(?);669?-4:0(80);8070-9.

669. Pfeodnfr KX, Lcsnyes Y. Rrjftmjet gfoaurj oe tuhjrduacsos. Jur Xjspor K. 8009 Mfr>8?(4);:76-2.

662:(7);96:-88.66?. Jgdfdy cg vfrocus burftoces cg osceofzob prjvjetovj tljrfpy gcr tuhjrduacsos; vj yjfrs cg gcaacw-up oe tlj

OZFR trofa. Oetjreftocefa Zeoce Fifoest Ruhjrduacsos Dcmmottjj ce Prcplyafxos. Huaa Ycrab Ljfatl Crife.

6?70(2);:::-72.

680. Pjboftrod Ruhjrduacsos Dcaafhcrftovj Ircup. Rfrijtjb Ruhjrduaoe Tnoe Rjstoei feb Rrjftmjet cg Aftjet

Ruhjrduacsos Oegjdtoce oe Dloabrje feb Fbcajsdjets. Pjboftrods. 8002 Cdt>662(2);669: -806.

686. Ycrab Ljfatl Crifeozftoce. Iuobjaoejs gcr oetjesojb tuhjrduacsos dfsj-eboei feb osceofzob prjvjetovj

tljrfpy gcr pjcpaj aovoei wotl LOW oe rjscurdj-dcestrfoejb sjttoeis. Ijejvf; YLC> 8066.

688. Hfefeo TF, Fahcrzo F. Ejjbaj fsporftoce gcr suppurftovj pcst-HDI fbjeotos. Frdl Bos Dloab. 6??2

Ecv>96(:);227-9.

684. Icrfyf KT, Worbo WT. Hfdoaaj Dfamjttj-Iujroe aymplfbjeotos. Pcstirfb Mjb K. 8008 Kue>9 6??:7(7);2?2-?.

687. Fao FF, Fhbfaafl RM, Xfyos BF, jt fa. Mftjrefa feb pjroeftfa cutdcmjs cg prjiefedojs fsscdoftjb wotl

tuhjrduacsos oe jfstjre Tubfe. Oet K Iyefjdca Chstjt. 8066 Tjp>662(4);8


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94

wcmje wotl tuhjrduacsos. HKCI. 8060 Fpr>669(:);:676:?(: Pt 6);6:49(6);27-:0.

642. Twfmoeftlfe T, Pfbmfproyfbfrsoeo D. LOW-fsscdoftjb tuhjrduacsos; daoeodfa upbftj. Daoe Oegjdt Bos. 8060

Mfy 6:>:0(60);6499-?;27.

647. Mclfmmfb [, Efoei EE. Dlfrfdtjrostods cg LOW-oegjdtjb tuhjrduacsos pftojets oe Nctf Hlfru Lcspotfa,

Njafetfe grcm 6??< tc 8006. Tcutljfst Fsofe K Rrcp Mjb Puhaod Ljfatl. 8002 Mfr>4:(6);620-4.

649. Ajjbs OA, Mfijj MK, Nurhftcvf JW, jt fa. Totj cg jxtrfpuamcefry tuhjrduacsos os fsscdoftjb wotl LOW

oegjdtoce. Daoe Oegjdt Bos. 8068 Kua>::(6);9:-68(68);64?4-200.

64?. Dcefty TK, Lfywfrb FD, Ttcry F, jt fa. Jxpafoeoei rosn gfdtcrs gcr brui-rjsostfet tuhjrduacsos oe

Jeiafeb feb Yfajs; dcetrohutoce cg promfry feb sjdcebfry brui rjsostfedj. Jpobjmoca Oegjdt. 8002

Bjd>648(7);60??-602(:);j::76.626. Ttrfjtjmfes M, Hojrrjehfdl FA, Efijanjrnj E, jt fa. Rlj jggjdt cg tuhjrduacsos ce mcrtfaoty oe LOW

pcsotovj pjcpaj; f mjtf-fefaysos. PAcT CEJ. 8060>:(68);j6:826.

628. Muiuso G, Woaafmcr J, Zrfssf Y, jt fa. LOW dc-oegjdtoce, DB2 djaa dcuets feb daoeodfa dcrrjaftjs cg hfdoaafry

bjesoty oe puamcefry tuhjrduacsos. Oet K Ruhjrd Auei Bos. 8007 Kue>60(7);774-?.

624. Dfoe NP, MdDfrtly NB, Ljoaoi DM, jt fa. Fe faicrotlm gcr tuhjrduacsos sdrjjeoei feb bofiecsos oe pjcpaj

wotl LOW. E Jeia K Mjb. 8060 Gjh 8:>478(68(2);4?9-204.

62:. Eflob P, Icezfajz AD, Xubcy O, jt fa. Rrjftmjet cutdcmjs cg pftojets wotl LOW feb tuhjrduacsos Fm K

Xjspor Drot Dfrj Mjb. 8009 Kue 6>69:(66);66??-807.

627. Tfetoe M, Muecz A, Xoifu B. Oetjrgjrce-ifmmf rjajfsj fssfys gcr tlj bofiecsos cg tuhjrduacsos feb

tuhjrduacsos oegjdtoce oe LOW-oegjdtjb fbuats; f systjmftod rjvojw feb mjtf-fefaysos. PAcT CEJ.8068>9(4);j4827(66);j87


85/109


92

tlj dcmhoeftoce cg oeboefvor feb acw-bcsj rotcefvor oe LOW-oegjdtjb pftojets. Daoe Oegjdt Bos. 8002 Gjh

6>440(7);??8]. Daoe Oegjdt Bos. 8000 Mfy>40(:);99?-94(7);466-86.

6:7. Fncac D, Fbjtogf O, Tljppjrb T, jt fa. Rrjftmjet cg aftjet tuhjrduacsos oegjdtoce oe LOW oegjdtjb pjrsces.

Dcdlrfej Bftfhfsj cg Tystjmftod Xjvojws. 8060(6);DB000696.

6:9. Ijtflue L, Nottonrfosfn Y, Ljoaoi DM, jt fa. Bjvjacpmjet cg f stfebfrbozjb sdrjjeoei ruaj gcr tuhjrduacsos

oe pjcpaj aovoei wotl LOW oe rjscurdj-dcestrfoejb sjttoeis; oebovobufa pfrtodopfet bftf mjtf-fefaysos cg

chsjrvftocefa stubojs. PAcT Mjb. 8066>69(:);679(66);6298-9.

69:. Woafrodf FT, Bocic E, Febrj M, jt fa. Fbvjrsj rjfdtoces tc fetotuhjrduacsos bruis oe oe-lcspotfa pftojets;

Tjvjroty feb rosn gfdtcrs. Xjv Pcrt Pejumca. 8060 Mfy-Kue>67(4);246-:6.


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9:

697. Nlfaoao L, Bfslto-Nlfvobfno T, Xfsccaoejkfb M, jt fa. Feto-tuhjrduacsos bruis rjaftjb ljpftctcxodoty>

oedobjedj, rosn gfdtcrs, pfttjre cg dlfeijs oe aovjr jezymjs feb cutdcmj. Gfdtcrs BFXZ. 800?>69(4);674-9.

699. Mfrzuno CF, Gfuzo FX, Fycuh T, jt fa. Prjvfajedj feb rosn gfdtcrs cg feto-tuhjrduacsos brui-oebudjb

ljpftotos oe Mfafysof. Toeifpcrj Mjb K. 800< Tjp>2?(?);72(72(4);676-7.

800. Yjahja TG, Grjedl FA, Husl P, jt fa. Prctjdtoei ljfatl dfrj wcrnjrs grcm tuhjrduacsos; f 60-yjfr

jxpjrojedj. Fm K Oegjdt Dcetrca. 800? Cdt>49(


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97

808. Moeostry cg Ljfatl Mfafysof. Iuobjaoejs ce Prjvjetoce feb Mfefijmjet cg Ruhjrduacsos gcr Ljfatl Dfrj

Ycrnjrs oe Moeostry cg Ljfatl Mfafysof. Putrfkfyf; McL> 8068.

804. Hrotosl Rlcrfdod Tcdojty Ttfebfrbs cg Dfrj Dcmmottjj. HRT stftjmjet ce drotjrof gcr spjdofaost rjgjrrfa,

fbmossoce, bosdlfrij feb gcaacw-up gcr fbuats wotl rjsporftcry bosjfsj. Rlcrfx. 800< Mfr>74 Tuppa 6;o6-o67.


88/109


99

FPPJEBO\ 6

TJFXDL RJXMT

Rlj gcaacwoei MjTL tjrms cr grjj tjxt tjrms wjrj usjb jotljr soeiay cr oe dcmhoeftoce;

tuhjrduacsos/, tuhjrduacs$.tw., th.tw., tuhjrduacs*, tuhjrduacsos, puamcefry/, puamcefry

tuhjrduacs$.tw., puamcefry pltlosos.tw., tuhjrduacsos, aympl ecbj/, aympl ecbj tuhjrduacs$.tw., tuhjrduacus aymplfbjeotos.tw., sdrcguaf*, mydchfdtjrofa djrvodfa, djrvodfa aymplfbjeotos,

djrvodfa tuhjrduacus, tuhjrduacsos, mjeoeijfa/, mjeoeijfa tuhjrduacs$.tw., tuhjrdua$mjeoeiotobjs.tw., tuhjrdua$ mjeoeiotos.tw., tuhjrduacs$ mjeoeijfa.tw., tuhjrduafr mjeoeiotos,

tuhjrduacsos, pajurfa/, tuhjrduac$ pajur$.tw., tuhjrduacsos, spoefa/, spoefa tuhjrduacs$.tw., pctts bosjfsj.tw., pctts bosjfsj, pjrotceotos, tuhjrduacus/, tuhjrduacs$ pjrotcejfa.tw.,

pjrodfrbotos, tuhjrduacus/, tuhjrduacus pjrodfrbotos.tw., tuhjrduacus pjrodfrbotobjs, tuhjrduacsos,jebchrcedlofa.tw., tuhjrduacsos, rjefa/, moaofry/, moaofry tuhjrduacs$.tw., aftjet tuhjrduacsos/,

aftjet tuhjrduacsos oegjdtoce$.tw., aftjet tuhjrduacs$.tw.,jpobjmocaciy/, jpobjmocaciy.tw., rosn gfdtcrs/, rosn fbk6 gfdtcr$.tw., afhcrftcry tjdleoqujs feb

prcdjburjs/, afhcrftcry tjdleod$ feb prcdjburj$.tw., afhcrftcry tjdleoquj$ feb prcdjburj$.tw., afhcrftcry jxfmoeftoce$ fbk6 bofiecs$.tw., bofiecs$ feb afhcrftcry jxfmoeftoce$.tw.,

afhcrftcry prcdjburj$.tw., afhcrftcry bofiecs$.tw., afhcrftcry jxfmoeftoce$ fbk6 bofiecs$.tw., bofiecstod tjst, rcutoej.tw., rfpob mcajduafr mjtlcb.tw., modrcsdcpy ucrjsdjedj/,

mcajduafr bofiecstod tjdleoqujs/, susdjptohoaoty tjstoei.tw., rfpob susdjptohoaoty tjstoei.tw.,brui rjsostfet/, muato-brui rjsostfedj.tw., rfpob bjtjdtoce.tw., ommuecaciy feb sjrcaciy.

tw., bofiecsos/, bofiecs$.tw., sputum/, smjfr ejiftovj$.tw., oebudjb sputum$.tw.. sputumoebudtoce$.tw., ifstrod afvfij/, ifstrod afvfij$.tw., hrcedlcfavjcafr afvfij/, hrcedlofa

afvfij$.tw., hrcedlcsdcpy/, hrcedlcsdcp$.tw., tlcrfdcsdcpy/, pajurcsdcpy.tw., fbjecsoejbjfmoefsj/, fbjecsoej bjfmoefsj$.tw., pcaymjrfsj dlfoe rjfdtoce/, pcaymjrfsj dlfoe

rjfdtoce$.tw., djrjhrcspoefa uob/, djrjhrcspoefa uob.tw. bofiecstod omfioei/, mjbodfaomfioei.tw., bofiecstod omfioei.tw., ej-ejjbaj fsporftoce.tw., hocpsy, ej-ejjbaj/> ej

ejjbaj hocpsy$.tw./, hocpsy/, hocps$.tw., rfbocirfply/, rfbocirfply.tw., bofiecstod x-rfy.tw.,bofiecstod x-rfy rfbocaciy.tw., uatrfscecirfply/, uatrfscecirfply.tw., mjbodfa scecirfply.

tw., uatrfsceod bofiecsos.tw., uatrfsceod omfioei.tw., tcmcirfply, x-rfy dcmputjb/, x-rfy dtsdfe.tw., x-rfy dcmputjb tcmcirfply.tw., mfiejtod rjscefedj omfioei/, omfioei, emr.tw.,

mfiejtod rjscefedj omfioei.tw., tcmcirfply, mr.tw., mro sdfe.tw.,ejway bofiec$.tw., tljrfpjutods/, trjftmjet$.tw., tljrfpjutod$.tw., fetohoctods, fetotuhjrduafr/,

fetotuhjrduafr fijets/, fetotuhjrduafr brui$.tw., tuhjrduacstftod fijet$.tw., fetotuhjrduafr

fijet$.tw., fetotuhjrduacsos, feto tuhjrduacus, osceofzob/, pyrfzoefmobj/, rogfmpoe/, rogfmpodoe.tw., jtlfmhutca/, rjdurrjedj/, rjdurrjedj$.tw., rjafpsj$.tw., rjdrubjsdjedj$.tw., burftoce.tw., pjrocb.tw., brui fbmoeostrftoce sdljbuaj/, brui fbmoeostrftoce sdljbuaj$.tw., bcsoei.tw.,

rjiomje.tw., brui dcmhoeftoces/, brui dcmhoeftoce$.tw., borjdtay chsjrvjb tljrfpy/, bcts.tw.,stjrcobs/, dftftcxod stjrcobs,

HDI vfddoej/, hfdoaaus dfamjttj iujroe vfddoej$.tw., HDI vfddoej$.tw., dfamjttj iujroehfdoaaus vfddoej$.tw., dfamjttj$ vfddoej$.tw., aymplfbjeotos/, aymplfbjeoto$.tw., dceijeotfa.

tw., pjroeftfa, ifstrod afvfij/, prjiefedy/, prjiefed$.tw., ijstftoce$.tw., hrjfst gjjboei/,hrjfst gjjboei.tw., hrjfstgjjboei.tw., afdtftoce/, afdtftoce$.tw., dcetrfdjptovjs, crfa, dcmhoejb/,

dcmhoejb crfa dcetrfdjptovj$.tw., dcmhoejb dcetrfdjptovj fijet$.tw., ljpftod Oesugdojedy/,

aovjr ompfor$.tw., rjefa oesugdojedy/, rjefa ompfor$.tw., LOW oegjdtoces/, LOW oegjdtoce$.tw.,prjvfajedj/, prjvfajedj$.tw., oedobjedj/, oedobjedj$.tw., bofiecstod rjfijet not/, bofiecstodrjfijet not$.tw., bofiecstod tjst not$.tw., tomj gfdtcrs/, tomj gfdtcr$.tw., prcplyafxos.tw.,

fetorjtrcvorfa tljrfpy, loilay fdtovj/, loilay fdtovj fetorjtrcvorfa tljrfpy.tw., lffrt.tw.,


89/109


9 cr cej sputum spjdomje pcsotovj gcr FGH feb ft ajfst cej

sputum spjdomje tlft os duaturj-pcsotovj gcr FGH

6.2 Ejw smjfr-

ejiftovj PRH

F dfsj cg PRH tlft bcjs ect mjjt tlj fhcvj bjeotoce gcrsmjfr-pcsotovj RH.

6.: JPRH RH cg crifes ctljr tlfe tlj aueis, sudl fs pajurf, aympl

ecbjs, fhbcmje, ijeotc-uroefry trfdt, snoe, kcoets, hcejsfeb mjeoeijs. Bofiecsos slcuab hj hfsjb ce cejduaturj-pcsotovj spjdomje, cr lostcaciodfa cr strcei daoeodfa

jvobjedj dcesostjet wotl fdtovj JPRH, gcaacwjb hy fbjdosoce hy f daoeodofe tc trjft wotl f guaa dcursj cg fetoRH

dljmctljrfpy. (F pftojet bofiecsjb wotl hctl puamcefryfeb jxtrfpuamcefry RH slcuab hj dafssojb fs f dfsj cg PRH)

6.7 Prjvocusay trjftjb Pftojet prjvocusay trjftjb gcr RH oedauboei rjafpsj, gfoaurjfeb bjgfuat dfsjs

6.9 Xjafpsj F pftojet wlcsj mcst rjdjet trjftmjet cutdcmj wfsdurjb cr trjftmjet dcmpajtjb, feb wlc os suhsjqujetay

bofiecsjb wotl hfdtjrocaciodfaay pcsotovj RH hy sputumsmjfr modrcsdcpy cr duaturj.

6.< Rrjftmjet gfoaurj F pftojet wlc lfs rjdjovjb Dftjicry O trjftmjet gcr RH feb

oe wlcm trjftmjet lfs gfoajb.

6.? Rrjftmjet fgtjr

bjgfuat

F pftojet wlc rjtures tc trjftmjet, hfdtjrocaciodfaay pcsotovj

hy sputum smjfr modrcsdcpy cr duaturj, gcaacwoei oetjrruptocecg trjftmjet gcr twc cr mcrj dcesjdutovj mcetls.


92/109



93/109



94/109


6?6(4);


95/109


8008


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97/109



98/109



99/109



100/109



101/109


?0

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102/109


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103/109


?8

TZIIJTRJB TRJXCOB XJIOMJE GCX RH MJEOEIOROT& RH PJXODFXBOROT

f. RH mjeoeiotos

h. RH pjrodfrbotos

Tcurdj; Prfsfb N, Toeil MH. Dcrtodcstjrcobs gcr mfefioei tuhjrduacus mjeoeiotos. Dcdlrfej Bftfhfsj

cg Tystjmftod Xjvojws 800


104/109


?4

Brui FetoRH bcsj feb grjqujedy wotl DrDa 140 ma/

moe cr gcr pftojets rjdjovoei oetjrmottjetljmcbofaysos*

Gorst-Aoej Bruis

Osceofzob Ec bcsoei dlfeijs frj rjquorjb

Xogfmpoe Ec bcsoei dlfeijs frj rjquorjb

Pyrfzoefmobj 8: - 4: mi/ni (objfa hcby wjoilt) pjr bcsj PC 4 tomjs/

wjjn> mfx. 8.: i pjr bcsj

Jtlfmhutca 6: - 8: mi/ni (objfa hcby wjoilt) pjr bcsj PC 4 tomjs/

wjjn> mfx. 6.7 i pjr bcsjTtrjptcmydoe 68 6: mi/ni/bcsj OW/OM 4 tomjs/wjjn> mfx. 6.: i pjr

bcsj

Tjdceb-Aoej Bruis

Dydacsjroej 8:0 mi PC cedj bfoay cr :00 mi/bcsj 4 tomjs/wjjn

Jtlocefmobj 8:0 - :00 mi/bcsj PC bfoay

Fmonfdoe/nfefmydoe 68 - 6: mi/ni/bcsj (objfa hcby wjoilt) OW/OM 4 tomjs/wjjn>mfx. 6.: i pjr bcsj

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Pfrf-fmoecsfaodyaod fdob(PFT)

2 i/bcsj, PC twodj bfoay

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Xjspor Drot Dfrj Mjb. 8004 Gjh 6:>679(2);704-78


105/109


?2

FBF Fbjecsoej Bjfmoefsj

FBX(s) fbvjrsj brui rjfdtoce(s)FGH fdob gfst hfdoaao

FAR fafeoej fmoectrfesgjrfsj

FetoRH fetotuhjrduacsos

FXR fetorjtrcvorfa trjftmjet

FXW fetorjtrcvorfa

FRAO fetoRH-oebudjb aovjr oekury

HDI Hfdoaaj Dfamjttj-Iuroe

DB2 daustjr cg boggjrjetoftoce 2

DO dcebjedj oetjrvfa

dm djetomjtrj

DET djetrfa ejrvcus systjm

DPI(s) daoeodfa prfdtodj iuobjaoejs

DTG djrjhrcspoefa spoefa uob

DTG-FBF djrjhrcspoefa spoefa uob-Fbjecsoej Bjfmoefsj

DR dcmputjrosjb tcmcirfply

DR\ dc-tromcxfzcaj

D\X dljst x-rfy

BI Bjvjacpmjet Ircup

BOL brui-oebudjb ljpftotos

BCR borjdtay chsjrvjb tljrfpy

BCRT borjdtay chsjrvjb tljrfpy, slcrt dcursj

BXJTT Brui Xfsl wotl Jcsoecploaof feb Tystjmod Tymptcms

BTR brui sjesotovoty tjstJPRH jxtrfpuamcefry tuhjrduacsos

GBD(s) xjb-bcsj dcmhoeftoce(s)

GM ucrjsdjedj modrcsdcpy

GEF ejjbaj fsporftoce

i irfm

LFFXR Loilay Fdtovj Fetorjtrcvorfa Rljrfpy

LDYs Ljfatldfrj wcrnjrs

LOW Lumfe Ommuecbjdojedy Worus

LX lfzfrb rftoc

AOTR CG FHHXJWOFROCET


106/109


?:

LXDR loil rjscautoce dcmputjrosjb tcmcirfply

OIXF(s) Oetjrgjrce Ifmmf Xjajfsj Fssfy(s)

OM oetrfmusduafr

OPR Osceofzob Prcplyafxos Rljrfpy

OVX oetjrqufrtoaj rfeij

OXOT Ommuej Xjdcestotutoce Oefmmftcry Tyebrcmj

OXX oedobjedj rftj rftoc

OW oetrfvjecus

ni noacirfm

AGR aovjr guedtoce tjst

APF Aoej Prchj Fssfy

AX aonjaolccb rftoc

ARHO aftjet RH oegjdtoce

Mfx. Mfxomum

MBX-RH Muatobrui-rjsostfet tuhjrduacsos

mi moaaoirfm

ma moaaoaotrj

mm moaaomjtrj

McL Moeostry cg LjfatlMXO mfiejtod rjscefedj omfioei

EFFR Eudajod Fdob Fmpaodftoce Rjst

EODJ Eftocefa Oestotutj gcr Ljfatl feb Daoeodfa Jxdjaajedj

EER eumhjr ejjbjb tc trjft

EPW ejiftovj prjbodtovj vfauj

EEXROs Ece-Eudajcsobj Xjvjrsj Rrfesdroptfsj Oelohotcrs

EXROs Eudajcsobj Xjvjrsj Rrfesdroptfsj Oelohotcrs

ERM Ecetuhjrduacus Mydchfdtjrof

CX cbbs rftoc

PFT p-fmoecsfaodyaod fdob

PDX Pcaymjrfsj Dlfoe Xjfdtoce

POs prctjfsj oelohotcrs

PC pjr crfa

PPW pcsotovj prjbodtovj vfauj

PRH puamcefry tuhjrduacsosXD Xjvojw Dcmmottjj

XDR(s) rfebcmosjb dcetrcaajb trofa(s)


107/109


?7

XX rjaftovj rosn

TFR sjag-fbmoeostjrjb tljrfpy

TKT Ttjvje-Kclesce Tyebrcmj

TX systjmftod rjvojw

RH tuhjrduacsos

RJE Rcxod Jpobjrmfa Ejdrcaysos

RTR tuhjrduaoe snoe tjst

Z/A Zeot pjr aotrj

ZT uatrfscecirfply

WFRT vobjc-fssostjb tlcrfdcsdcpy surijry

vs vjrsus

YLC Ycrab Ljfatl Crifeozftoce

\BX-RH jxtjesovjay brui-rjsostfet RH


108/109


?9

FDNECYAJBIJMJER

Rlj mjmhjrs cg bjvjacpmjet ircup cg tljsj iuobjaoejs wcuab aonj tc jxprjss tljor irftotubj

feb fpprjdoftoce tc tlj gcaacwoei gcr tljor dcetrohutoces;

Pfeja cg jxtjrefa rjvojwjrs wlc rjvojwjb tlj brfgt Ms Toe Aofe Rlyj (Eursoei Mftrce) feb Ms Accei Fl Mco (Eursoei Tostjr) Rjdleodfa Fbvoscry Dcmmottjj gcr DPI gcr tljor vfaufhaj oeput feb gjjbhfdn

Faa tlcsj wlc lfvj dcetrohutjb borjdtay cr oeborjdtay tc tlj bjvjacpmjet cg tlj DPI

BOTDACTZXJ TRFRJMJER

Rlj pfeja mjmhjrs cg hctl Bjvjacpmjet Ircup feb Xjvojw Dcmmottjj lfb dcmpajtjb

bosdacsurj gcrms. Ecej ljab slfrjs oe plfrmfdjutodfa rms cr fdts fs dcesuatfets tc sudlrms. (Bjtfoas frj fvfoafhaj upce rjqujst grcm tlj DPI Tjdrjtfroft)

TCZXDJT CG GZEBOEI

Rlj bjvjacpmjet cg tlj DPI ce Mfefijmjet cg Ruhjrduacsos (4rb Jbotoce) wfs suppcrtjbefedofaay oe ots jetorjty hy tlj Moeostry cg Ljfatl Mfafysof feb Mfafysofe Rlcrfdod Tcdojty.


109/109

cpg- management of tuberculosis (3rd edition)

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