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Transcript

SOCIAL,
ECOLOGICAL
& CLINICAL
PEDIATRICS
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ISSN 1987-9865
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33124
119
TBILISI
TBILISI
socialuri
pediatriis
dacvis fondi
Canasaxidan bavSvs ufleba aqvs iyos daculi
mTavari redaqtori
medicinis mecnierebaTa doqtori, profesori, akademikosi-mdivani
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ÃÄÃÀÈÀ, ÁÀÅÛÅÈÀ ÃÀ ÌÏÆÀÒÃÈÀ ãÀÍÌÒÈÄËÏÁÀÆÄ ÆÒÖÍÅÀ ÃÀ ÌÀÈÉ ÓÏÝÉÀËÖÒÉ ÐÉÒÏÁÄÁÉÓ
ÃÀÝÅÀ – ÊÄÈÉËÛÏÁÉËÖÒÉ ÌÉÓÉÀ ÓÏÝÉÀËÖÒÉ ÐÄÃÉÀÔÒÉÉÓ ÃÀÝÅÉÓ ×ÏÍÃÉÓ ÖÌÈÀÅÒÄÓÉ ÌÀÌÏÞÒÀÅÄÁÄËÉ ÙÄÒÞÉ ÃÀ ÖÌÏÊËÄÓ ÅÀÃÀÛÉ ÃÀÌÊÅÉÃÒÄÁÖËÉ ÀÅÔÏÒÉÔÄÔÉÓ ßÉÍÀÐÉÒÏÁÀÀ;
×ÏÍÃÛÉ ÌÏÙÅÀßÄ ÌÄÃÉÝÉÍÉÓÀ ÃÀ ÌÄÝÍÉÄÒÄÁÉÓ ÓáÅÀÃÀÓá×À Ó×ÄÒÏÓ ÈÅÀËÓÀÜÉÍÏ ßÀÒÌÏÌÀÃÂÄÍËÄÁÉ ÓÉÓÔÄÌÀÔÖÒÀÃ ÀÔÀÒÄÁÄÍ ÌÏÓÀáËÄÏÁÉÓ ÓÏÝÉÀËÖÒÉ ÖÆÒÖÍÅÄËÚÏ×ÉÓÀ ÃÀ ÓÀÌÄÃÉÝÉÍÏ
ÃÀáÌÀÒÄÁÉÓ ÓÀØÅÄËÌÏØÌÄÃÏ ÀØÝÉÄÁÓ;
„ãÀÍÓÀÙÉ ÏãÀáÉ ÃÀ ãÀÍÌÒÈÄËÉ ÈÀÏÁÀ“; „ÌÏÌÀÅÀËÉ ÃÄÃÏÁÉÓÈÅÉÓ ÌÏÌÆÀÃÄÁÖËÉ ØÀËÉ“
– ÀÌ ÃÄÅÉÆÉÈ áÄËÌÞÙÅÀÍÄËÏÁÓ ×ÏÍÃÉ, ÒÏÌËÉÓ ÓÀØÌÉÀÍÏÁÀÈÀ ÍÖÓáÀÛÉÀ:
– ÓÀÌÊÖÒÍÀËÏ ÐÒÏ×ÉËÀØÔÉÊÖÒÉ ÂÀÓÉÍãÅÄÁÉ
– ØÀËÀØÉÓ ÓÀÌ ßÀÌÚÅÀÍ ÊËÉÍÉÊÀÛÉ ÈÅÄÛÉ ÄÒÈãÄÒÀÃÉ Ö×ÀÓÏ ÌÏÌÓÀáÖÒÄÁÉÓ ÃÀÊÀÍÏÍÄÁÀ
– ÁÀÅÛÅÈÀ ¹3 ÐÏËÉÊËÉÍÉÊÉÓÀ ÃÀ ÃÄÃÀÈÀ ÃÀ ÁÀÅÛÅÈÀ ÓÀÃÉÀÂÍÏÓÔÉÊÏ ÝÄÍÔÒÛÉ ßÀÌÚÅÀÍ
ÓÐÄÝÉÀËÉÓÔÈÀ ÊÏÍÓÖËÔÀÝÉÄÁÉ;
×ÏÍÃÉ ÀÔÀÒÄÁÓ ÓÀÄÒÈÀÛÏÒÉÓÏ ÊÏÍ×ÄÒÄÍÝÉÄÁÓ: „ãÀÍÌÒÈÄËÉ ÁÀÅÛÅÉ – ÌÛÅÉÃÏÁÉÀÍÉ
ÊÀÅÊÀÓÉÀ“, „ÜÀÍÀÓÀáÉÃÀÍ ÁÀÅÛÅÓ ÀØÅÓ Ö×ËÄÁÀ ÉÚÏÓ ÃÀÝÖËÉ“, „ÃÙÄÅÀÍÃÄËÉ ÄÊÏÍÏÌÉÊÖÒÉ ÌÉÌÀÒÈÖËÄÁÀÍÉ ÐÄÃÉÀÔÒÉÀÛÉ ÃÀ ÌÉÓÉ ÐÄÒÓÐÄØÔÉÅÀ“, „ÁÀÅÛÅÈÀ ÌÊÖÒÍÀËÏÁÀ XXI ÓÀÖÊÖÍÄÛÉ“,
„ÁÀÅÛÅÈÀ ÊÅÄÁÀ XXI ÓÀÖÊÖÍÄÛÉ“, „ÐÄÃÉÀÔÒÉÉÓ ÀØÔÖÀËÖÒÉ ÓÀÊÉÈáÄÁÉ“.
ÌÉÌÃÉÍÀÒÄÏÁÓ ÌÖÛÀÏÁÀ ÛÄÌÃÄÂ ÐÒÏÂÒÀÌÄÁÆÄ ×ÀÒÌÀÝÄÅÔÖËÉ ÐÒÏÂÒÀÌÀ „GG“, „ÁÀÅÛÅÈÀ
ÊÅÄÁÀ“, ÏÒÈÏÐÄÃÉÖËÉ ÓÊÏËÀ „ÉÌÖÍÏ-ÂÄÍÄÔÉÊÖÒÉ ÝÄÍÔÒÉ ÃÀ ÃÙÄÍÀÊË ÀáÀËÛÏÁÉËÈÀÈÅÉÓ
– Ö×ÀÓÏ ÐÄÒÉÍÀÔÀËÖÒÉ ÝÄÍÔÒÉ, ÄÐÉÃÄÌÉËÏÂÉÖÒÉ ÐÒÏÂÒÀÌÄÁÉ ÃÀ ÓáÅÀ;
×ÏÍÃÌÀ ÛÄØÌÍÀ ÐÉÒÅÄËÉ ØÀÒÈÖËÉ ÊÅÄÁÉÈÉ ÃÀÍÀÌÀÔÄÁÉ ÀÐÉÅÉÔÉ ÀÐÉÊÏÒÉ, ÀÐÉÐÉÍÉ, ÀÐÉÐÉÊÍÏ ÃÀ ÄÊÏËÏÂÉÖÒÀÃ ÓÖ×ÈÀ ÌÀÔÏÍÉÆÉÒÄÁÄËÉ ÓÀÓÌÄËÉ „ÉÅÄÒÉÖËÉ“;
×ÏÍÃÉÓ ÐÒÏÂÒÀÌÄÁÛÉ ÌÏÍÀßÉËÄÏÁÉÓ ÌÓÖÒÅÄËÄÁÉ ÃÀÖÊÀÅÛÉÒÃÉÈ ÓÏÝÉÀËÖÒÉ ÐÄÃÉÀÔÒÉÉÓ ÃÀÝÅÉÓ ×ÏÍÃÉÓ ÂÀÌÂÄÏÁÀÓ.
ÈØÅÄÍ ÂÄÍÉàÄÁÀÈ ÐÒÉÏÒÉÔÄÔÉ, ÂÀáÃÄÈ ×ÏÍÃÉÓ ÈÀÍÀÃÀÌ×ÖÞÍÄÁÄËÉ ÃÀ
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Tbilisi, Lublianas q. #21; Tel: 47-04-01;
E-mail: [email protected], [email protected]
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saerTaSoriso fondi `msoflio usafrTxoeba da bavSvi~.
INTERNACIONAL FUND THE WORLD SECURITY AND CHILD
saqarTvelos socialuri pediatriis fondi
GEORJIAN SOCIAL PEDIATRICS PROTECTION FUND
samedicino-socialuri mecnierebis interkontinentaluri
samedicino-socialuri pediatriis seqcia (departamenti)
SOCIAL PEDIATRICS DEPARTAMENT OF INTERKONTINENTAL
ACADEMY OF MEDICAL-SOCIAL SCIENSES (IAMSS)
evromecnierebis saqarTvelos erovnuli seqcia
EUROSCIENCE OF GEORJIAN NACIONAL CECTION
`Canasaxidan bavSvs aqvs ufleba iyos daculi~.
CHILDRENS RIGHTS MUST BE DEFENDENED SINCE EMBRUO
socialuri, ekologiuri da
klinikuri pediatria
№ 15-10-9
SOCIAL, ECOLOGICAL & CLINICAL PEDIATRICS
gamodis eqvs TveSi erTxel
Tbilisi
2013
Tbilisi
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Dr. Louise-Anne McNutt USA. Professor of Albany Wiversity.
Fabio Rasiro Abenave, Plastic Surceon V.a Savola 72,00/98
Italy Rora F.Abenavoli 6 sriceteain.II
Claudic gaflone Italy.
E-mail: [email protected]. www.Claudiogaflone.com
Jllia m.yemets md. pr. d/ukraina/www.Casho.org.ua
Prof. Dr. Claudia
Head of Department of Bioethics Wiesemann /Germany/ and
Hictory of Medicine University of Coetinger
socialuri, ekologiuri
da klinikuri pediatria
6
teqinformis qarTul
referatul JurnalSi
asaxuli gamocemaTa
CamonaTvali
1. bavSvTa kardiologia
2. gaenaTis macne
3. eqsperimentuli da klinikuri medicina
4. Tbilisis saxelmwifo
samedicino universitetis
samecniero SromaTa krebuli
5. kavkasiis saerTaSoriso
universitetis macne
6. kardiologia da Sinagani medicina
7. kritikul mdgomareobaTa da katastrofaTa medicina
8. mecniereba da teqnologiebi
9. rentgenologiis da radiologiis macne
www.tech.caucasus.net
mTavari
dagvikavSirdiT
teqinformi
saitis ruka
qarTuli bmulebi
10. saqarTvelos mecnierebaTa erovnuli akademiis
macne, biomedicinis seria
11. saqarTvelos mecnierebaTa erovnuli akademiis
moambe
12. saqarTvelos pediatri
•
•
•
•
•
•
•
•
•
Cvens Sesaxeb
saqmianoba
struqturaTanamSromlebi
resursebi
momsaxureba
gamocemebi
RonisZiebebi
partniorebi
vakansiebi
qarTuli referatuli Jurnali
8 (20), 2012
nomerSi asaxul gamocemaTa CamonaTvali
Tematuri rubrikebi
avtorTa saZiebeli
sagnobrivi saZiebeli
13. saqarTvelos respiraciuli Jurnali
14. saqarTvelos samedicino siaxleni
15. saqarTvelos samecniero siaxleebi, saerTaSoriso
samecniero Jurnali
16. saqarTvelos teqnikuri
universitetis Sromebi
17. socialuri, ekologiuri da klinikuri pediatria
18. suxiSvilis universitetis saerTaSoriso sa mecniero konferenciis „Tanamedrove aqtualuri samecniero sakiTxebi“ masalebi
19. suxiSvilis universitetis samecniero SromaTa
krebuli
2013 weli
2013 weli
7
8
sarCevi
CONTENTS
socialuri pediatriis dacvis fondis pres-relizi
The Social Pediatric Protection Fund.............................................. 8
`siRaribe da janmrTeloba“
“Poverty and Health” ............................................................................. 67
qvelmoqmedeba......................................................................................... 14
plazmuri nakadis klinikuri gamoyenebisa da nawolebis simZimis prognozul-analogiuri skalis
Sefasebis pirveli gamocdileba kritikul avadmyofebSi
New Steps in Critical Care Medicine - the plasma
eradiation....................................................................................................... 70
XXVII konferencia............................................................................ 18
evromecnierebis saqarTvelos erovnuli
seqcia axalgazrdoba aqtiurdeba.................................... 20
saqarTvelo: ganviTarebis gzebi
Georgia: Ways of Development......................................................... 22
saWiro codna da resursi TiToeuli bavSvis uflebis realizaciisaTvis (kanonebSi Sesworeba damatebebisaTvis) da marTlac, `Canasaxidan bavSvs ufleba aqvs iyos daculi~.
Needed knowledge and resources to represent children’s all
rights in the Law codex of Georgia (Child has right to be
defended since embryo) ......................................................................... 25
didi funqcia – mZime tvirTi
Great Function - Hard ........................................................................... 29
samedicino mecniereba saqarTveloSi (sad varT da
saiT miviltviT)
Medical Sciences in Georgia (where are we now
and where are we going to) .................................................................. 34
bavSvTa da mozardTa asakis seqsualuri darRvevebis sakiTxisaTvis
Knowledge and attention about the disorder of child
and adult sexuality.................................................................................... 36
pediatriuli marTvis prioritetebi da maTi ganviTarebis perspeqtivebi saqarTveloSi
Priorities of Pediatric Managements and The Perspective
of Their Development in Georgia..................................................... 42
àbortis problema“
“Problem of Abortion”........................................................................... 45
ra unda gakeTdes bavSvTa da mozardTa jandacvis
gaumjobesebisTvis (pirovnuli Sexeduleba)
What needs to be done to improve healthcare
of children and adolescents(personal views) .............................. 47
imunuri sistemis mdgomareoba da misi koreqcia apivitiT euTireoiduli Ciyvis dros
Immune system and Euthyroid goiter........................................... 49
valeologia, rogorc `janmrTelobis medicina~
Valeology of “health medicine” ......................................................... 52
sportsmenTa da orsulTa kvebis racionSi „api puris“ aucilebloba
Importance of Including “Apipuri” in Sportsmen
and Pregnant......................................................................................................... 54
èqimisa da pacientis urTierTobis princi pebi“
Principles of Doctor-Patients relations.......................................... 62
daavadebis paTogenezisa da sanogenezis sistemuri
analizi
Systemic analysis of Patho- and Sanogenenis............................ 64
Информатиывность антропофизиологического подхода в диагностике недостаточности артериального кровообращения
нижних конечностей
Informativeness Of The Anthropophysiological Approach
In Diagnosing The Arterial Blood Flow Failure Of
The Lower Limbs...................................................................................... 75
qirurgiuli sefsisis mkurnaloba
Treating Surgical Sepsis ........................................................................ 78
mitoqondriuli dnm-i da adamianis eTnikuri warmoSoba
Mitochondrial DNA and Ethnic Lineage ..................................... 83
imunuri homeostazi TimomegaliiT mimdinare bronqopnevmoniebis dros bavSvebSi apihepatiT mkurnalobis fonze
Immunological testimonies among the children with
bronchopnewmonia diseases associatied with thymomegalia
disease treated with Apihepati ........................................................... 84
kalaTburTelTa mdgomareoba „api puris“ kvebis racionSi CarTvamde (kvlevis I etapi).
Status of Basketballers before Adding Àpipuri” into
Food Ration (First step of Research) ............................................. 86
monozigotur tyupebSi niSan-TvisebaTa gansxvavebis
zogierTi Taviseburebani
Some peculiarities of different traits in monozygotic twins............ 89
epidermuli zrdis faqtoris Eeqspresia adamianis
endometriumis hi perplaziisa da karcinomis dros
Epidermal Growth Factor Expression in Endometrial
Hyperplasia and Carcinoma............................................................... 91
leikocitozis warmoSobis meqanizmebi klinikur
praqtikaSi
Theory and mechanisms of leukocytosis in clinical practice........... 95
XXIX samecniero-praqtikuli konferenciaze miRebuli rezolucia:K`kvebis obieqtebi, mwarmoeblebTan erTad aqtiurad Caebnen moZraobaSi `jansaRi
kveba bavSvebs” sruldeba.
29th Scientific-Practical Conference- Resolution: Food producers and their retailers should join “healthy food
for children”................................................................................................. 98
saqarTvelos mean-ginekologTa da perinatologTa
asociaciis prezidentis profesor paliko kintraias cxovrebis gza ............................................................................ 99
gaxseneba ................................................................................................... 100
2013 weli
9
socialuri pediatriis
dacvis fondis pres-relizi
aqciebSi monawileoben: gamoCenili qarTveli pediatrebi. mimdinareobs avadmyofTa laboratoriuli da instrumentuli kvleva da
sxva. urigdebaT medikamentebi. CautardaT
ramdenime aTeuli saswrafo operacia. aTobiT avadmyofs Cautarda ufaso gamokvleva
da mkurnaloba sxvadasxva wamyvan klinikebSi.
07.01.98 -07.02.99 ww. Tbilisi. gaisinja 9200
bavSvi. 23-24.01.99 w. aRmosavleT saqarTvelo.
centri - q. Telavi. gaisinja 3500-ze meti bavSvi.
12-13-14.02.99 Tbilisi televiziis muSakTaTvis Ria karis dRe; gaisinja 100-mde bavSvi da daurigdaT medikamentebi. dedaTa da
bav-SvTa sadiagnostiko centrSi da agreTve
qalaqis sxvadasxva poliklinikebSi Camoyalibda maRalkvalificiur profesor-maswavlebelTa ufaso konsultaciebi kviraSi erTjer.
qalaqis wamyvan pediatriul klinikebSi
tardeba maRalkvalificiur profesor-maswavlebelTa ufaso konsultaciebi TveSi erTjer.
aqciebSi sxvadasxva profiliT monawileobdnen:
1. kanisa da vensneulebaTa instituti
2. parazitologiis samecniero-kvleviTi
instituti da sxv.
dawyebulia munisa da tilis sawinaaRmdego profilaqtikuri RonisZiebebi da mkurnalobis etapi. aseve darigdeba Sesabamisi medikamentebi.
daibeWda da gavrcelda munisa da ti-lis
sawinaaRmdego Sesabamisi ufaso samaxsovroebi.
12-13-14.03.99 w. eqspedicia foTsa da aba-SaSi.
13.03.99 w. q. foTi. gaisinja 950 bavSvi. daurigdaT medikamentebi. 13-14.03.99 w. q. abaSa
da abaSis raioni (s. qedisi, s. marani da sxv.)
29-30.01.-07-08.99 w. gaisinja 4400 bavSvi,daurigdaT medikamentebi.
23-24-25.08.99 w. Catarda ufaso laboratoriuli da instrumentuli kvleva. q. xobi da
q. zugdidi daurigdaT munisa da tilis sawinaaRmdego wamlebi.
04.04.99 w. eqspedicia fasanaurSi kompleqsurad gaisinja 400ze meti bavSvi.
07.05.99 w. eqspedicia guriis regionSi. q.
lanCxuTi CautardaT ufaso laboratoriuli da instrumentuli kvleva, daurigdaT medikamentebi.
2013 weli
18.05.99 w. Catarda gasinjvebi q. rusTav-Si (gaisinja 250-ze meti bavSvi, darigda medikamentebi).
22.06.99 w. Catarda gasinjvebi sagarejoSi
(gaisinja 250-ze meti bavSvi, darigda medikamentebi).
13-14.08.99 w. Coxatauri (gaisinja 1500-mde
bavSvi).
15.08.99 w. baxmaro (gaisinja 2000-ze meti
bavSvidamsvenebeli) zRvis donidan 2050 m.
16.08.99 w. eqspedicia gadavida baxmarodan
aWaris maRalmTian raionebSi (sul gaisinja
750-ze meti bavSvi) zRvis donidan 2300-2400 m.
17.09.99 w. Catarda kompleqsuri gamokvlevebi Tbilisis upatrono bavSvTa saxlSi.
16.10.99 w. Catarda gasinjvebi duSeTSi (gaisinja 200-mde bavSvi, darigda medikamentebi).
2000 weli
26.02.2000 w. q. gori gaisinja 500-ze meti
bavSvi, darigda medikamentebi.
23.03.2000 w. axalgori. gaisinja 30 bavSvi.
01.04.2000 w. marneulis r-ni sof. weraqvi
gakeTda sisxlis saerTo analizi, instrumentuli gamokvlevebi - eqoskopia, encefalograma da sxva. sul gaisinja 1500 bav-Svi da
momvleli.
15.04.2000 w. gurjaani kompleqsuri gasinjvebi, gaisinja 1200-mde bavSvi darigda medikamentebi.
29.04.2000 w. q. rusTavi (kostavas #6) gaisinja 300-mde bavSvi.
05-06-07-2000 w. gasinjulia avWalis koloniis bavSvebi.
20.07-28.07.2000 w. wyneTis bavSvTa saxlSi
gasinjulia 60 bavSvi.
21-22-23.07.2000 w. abaSis r-ni sof. sakie-Tisa da samtrediis r-nis aRsazrdelTa skolis bavSvTa gasinjvebi.
7-8.08.2000 w. baxmaro-beSumi gaisinja 1925
bavSvi.
2001 weli
15.03.2001 w. gaisinja da kompleqsuri gamokvleva Cautarda rusTavis azotis qarxnis Tanam-SromelTa bavSvebs.
23.06.2001 w. gaisinja da kompleqsuri gamokvleva Cautarda rusTavis azotis qarxnis
Tanam-SromelTa bavSvebs.
14-15-16.09.2001 w. baRdadis r-ni sof. sairme,
wiTelxevi, roxi, obCa, xani, zegani,saqraula.
gaisinja 2500 bavSvi.
10
2002 weli
10.03.2002 w. axalgori gaisinja 250 bavSvi.
20.04.2002 w. siRnaRis r-ni gaisinja 450 bavSvi.
23-24-25-26.2002 w. xulo (aWara) sapatriarqosTan erTad gaisinja 600 bavSvi da 100 mozrdili.
27-28-29.06.2002 w. q. Tbilisi 20 - mozrdilTa poliklinika, 10 -bavSvTa poliklinika, 11
-bavSvTa poliklinika gaisinja 400 bavSvi.
16-17-18-19.07.2002 w. kodoris xeoba (afxazeTi) gaisinja 250 bavSvi. 3-4-5-6.2002 w. mTa-TuSeTi. diklo, omalo, Senaqo. gaisinja 200 bavSvi.
2003 weli
5.03.2003 w. samcxe-javaxeTi gaisinja 1250
bavSvi.
17.04.2003 w. werovani gaisinja 450 bavSvi.
20.05.2003 w. borjomi gaisinja 870 bavSvi.
25.06.2003 w. mTa-TuSeTi gaisinja 320 bav-Svi.
30.07.2003 w. baxmaro gaisinja 630 bavSvi.
20.08.2003 w. zestafoni gaisinja 210 bavS
vi. 2008 weli I socialuri,ekologiuri da
klinikuri pediatria 7.09.2003 w. zugdidi gaisinja 290 bavSvi. 15.10.2003 w. raWa gaisinja 170
bavSvi. 18.10.2003 w. dmanisi gaisinja 180 bavSvi.
2004 weli
marti-aprili-maisi: kaspi, gurjaani, Telavi, axmeta, lagodexi, siRnaRi, bodbe, aspinZa,
axalcixe, borjomi, Tbilisi, zestafoni, xaragauli, WiaTura gaisinja 1728 bavSvi.
10.05.2008 marneuli gaisinja 300 bavSvi.
17.05.2008 duSeTi gaisinja 450 bavSvi.
18.05.2008 axaSeni gaisinja 250 bavSvi.
2005 weli
marneulis regionSi, gaisinja 700 bavSvi
da 800 mozrdili.
18 ivlisi kaspi 450 bavSvi.
8 oqtomberi mcxeTis raioni 300 bavSvi.
14-15-16 oqtomberi lentexi 850 bavSvi da
200 mozardi.
2006 weli
2006 wlis 18 Tebervals klinikaSi Catarda Ria karis dRe. gaisinja mxatvarTa kavSiris 20 ojaxi.
martSi Ria karis dRe. gaisinja ltolvilTa 100-ze meti bavSvi.
aprilSi saguramoSi elCebis monawileobiT Catarda aqcia.
31 maiss q. rusTavSi gaisinja 450 bavSvi.
1-2 ivniss Tssu-Si Catarda Ria karis dRe.
gaisinja 400 bavSvi.
maT CautardaT konsultacia da kliniko
laboratoriuli gamokvlevebi.
9-10 ivniss kaspis raionSi Catarda gasvliTi gasinjvebi. (gaisinja 300 bavSvi.
1 ivliss cxinvalis raionSi omSi monawileTa 500 bavSvi gaisinja. seqtember-oqtomberSi gaisinja 120 bavSvi.
noemberSi gaisinja JurnalistTa 100-200
ojaxi.
2007 weli
marneuli. ufaso konsultacia Cautarda
110 bavSvs. gamovlindnen sqolioziT daavadebuli bavSvebi. gadaecaT espanderebi da meToduri rekomendaciebi samkurnalo fizkulturis Sesaxeb.
duSeTi. kansultacia Cautarda 280 bavSvs.
axaSeni. kansultacia Cautarda 85 bavSvs
2008 weli
1 ivnisi – Ria karis DdRe (gaisinja 200
bavSvi)
2 ivnisi Teddy bear (gaisinja 300 bavSvi)
14 ivnisi axmeta (qaqucoba - gaisinja 450
bavSvi, romelTac CautardaT Semdegi gamokvlevebi muclis Rrus eqoskopia, ekg da sxva.
darigda Sesabamis medikametebi
27 ivnisi – saqarTvelos seqciis aRdgena
20 agvisto – Stop Russia/ igoeTis aqcia
1 seqtemberi – Stop Russia/ Tbilisi jaWvis
aqcia
4 oqtomberi Ria karis DdRe konsultacia,
gamokvlevebi: muclis Rrus eqoskopia, ekg da
sxva. Sedga mxatvrebis da xelvnebis moRvaweebis master-klasi bavSvebisTvis
6 dekemberi bergmanis klinikaSi ufasod
gaisinja 110 bavSvi, romelTac CautardaT Semdegi gamokvlevebi muclis Rrus eqoskopia,
ekg da sxva. darigda Sesabamis medikametebi
2009 weli
13.06 xaSuri gaisinja 750 bavSvi.
26.12 barisaxo 80 bavSvi.
dRemde aqciebSi sul gasinjulia 92750
bavSvi da aTasobiT xanSiSesuli. saqvelmoqmedo aqciebi grZeldeba.
2010 weli
4 ivlisi – Ria karis omSi daRupulTa
ojaxis wevrebi (gaisinja 50 bavSvi)
10 ivlisi – karaleTi. gaisinja 200 bavSvi
da daurigdaT medikamentebi.
4 noemberi – wminda keTilmsaxuri mefe
Tamaris skola pansionis bavSvebi. gaisinja
50 bavSvi.
3-4 dekemberi – gaisinja sporcmeni 400 bavSvi.
2011 weli
1 ivnisi – gaisinja 200 bavSvi
24 dekemberi – gaisinja 200 bavSvi
2012 weli
1 ivnisi – gaisinja 250 bavSvi
27.07 _ Telavi, 11.08 _ karaleTi
22 dekemberi – gaisinja 250 bavSvi
dRemde aqciebSi sul gaisinja 93 727 bavSvi
da aTasobiT xanSiSesuli. saqvelmoqmedo aqciebi grZeldeba.
2013 weli
socialuri pediatriis dacvis fondis
mier Catarebulia konferenciebi da
simpoziumebi
I konferencia ~CvenTan erTad irwmune ukeTesi momavlis realoba~
01.VI.99
II konferencia ~janmrTeli bavSvi mSvidobiani kavkasia~
25.XII.99
III konferencia ~dRevandeli ekonomikuri
mimarTulebani pediatriaSi da misi perspeqtiva~
XXI saukunis pediatria -invalidobis
profilaqtikis medicinad unda iqces.
01.VI.2000
IV konferencia ~Canasaxidan bavSvis ufleba unda iyos daculi~
27.III.2001
Sexvedra saxalxo damcvelis ofisSi ~arasrulwlovani damnaSaveebi,maTi uflebebi
da realoba~
01.06.2001
V(XIX) konferencia ~miZRvnili bavSvTa
dacvis saerTaSoriso dRisadmi~
30.03.99 01.06.2000 01.06.2001
~bavSvTa mkurnaloba XXI saukuneSi~ simpoziumi #1,@#2, #5
23.04.99 01.06.2000
~bavSvTa kveba XXI saukuneSi~ simpoziumi
#1,@#2
20.05.99 01.06.2000
“orTopediuli skola” simpoziumi #1,@#2
17.12.99 “mukoviscidozis diagnostikisa da
mkurnalobis sakiTxebi”
01.06.2000
axalgazrda pediatrTa XVIII konferencia
28.02.2001 erToblivi samecniero konferencia ~respiratorul daavadebaTa Terapiis aqtualuri sakiTxebi pediatriaSi~.
01.06.2001 ~Canasaxidan bavSvs ufleba aqvs
iyos daculi~ simpoziumi #1
01.06.2001 ~bavSvi,mozardi da ojaxuri Zaladoba~ simpoziumi #1
01.06.2001 ~Canasaxidan bavSvs ufleba aqvs
iyos daculi~
simpoziumi #1
13.02.2002 ~adamianis genomis proeqti~
10.03.2002 axalgori. matonizirebeli sasmeli ~lomisis~ prezentacia.
6.11.2002 saerTaSoriso konferencia Temaze:
“mukoviscidoziT da nivTierebaTa cvlis
konstituciuri moSlilobiT daavadebulTa
samedicino da socialuri problemebi”.
7.11.2002. saerTaSoriso konferencia Temaze: “Tandayolili infeqciebis Tanamedrove
apeqtebi”.
4. 04. 2003 pediatriis aqtualuri sakiTxebi. IX konferencia.
2013 weli
11
1.06.2003 I internet-konferencia (X samecniero-praqtikuli konferencia) socialuri pediatriis dacvis fondi ufasod uSvebs da
arigebs gazeTs ~socialuri pediatria~ da
Jurnals “socialuri, ekologiuri da klinikuri pediatria” (Suqdeba socialuri, samedicino, pedagogiuri, fsiqologiuri, fsiqiatriuli, religiuri da sxva aqtualuri da problemuri sakiTxebi)
19.12.2003. saqarTvelos bavSvTa kardi
ologTa II kongresi.
1.06.2004. II saerTaSoriso internet-konferencia. pediatriis aqtualuri sakiTxebi
22.10.2004. konferencia Temaze: ,,pediatriis
aqtualuri sakiTxebi”, romelic eZ-Rvneboda
socialuri pediatriis prezidentis, genetikosis viqtor moroSkinis naTel xsovnas.
1.06.2005 pediatriis aqtualuri sakiTxebi
XIV konferencia.
9.09.2005 Tbilisi, merioti II saerTaSoriso
konferencia ~janmrTeli bavSvi mSvidobiani
kavkasia~.
1.06.2006. socialuri pediatriis dacvis
fondis XIV konferencia ~pediatriis aqtualuri sakiTxebi~.
12.12.2006. axalgazrda pediatrTa XV konferencia. 07.12.2007. spdf XVI konferencia.
kardiologTa III kongresi.
2008 weli
2 ivnisi socialuri pediatriis XVIII konferencia
6.10.2008 gorSi gasvliTi simpoziumi _ parlametis jandacvis komiteti (oTar ToiZe) +
sabWos wevrebi. devnilTa higienis sakiTxebis
mogvareba
07.10.08 konferencia “bavSvis da mozardis”
kardiologiuri seqcia (Tbilisi)
20.12.08 socialuri pediatriis dacvis fondis da ESMNS erToblivi me-2 konferencia(Tbilisi)
23.12.08 ESMNS humanitaruli departamentis
konferencia (Tbilisi)
24.12.08 konferencia “rwmena da codna”
ilia II-is monawilebiT (Tbilisi)
1-2 ivnisi 2009 XX konferencia
18 dekemberi 2009 XXI konferencia.
2010 weli
01.06.10 spdf-is XXII da saqarTvelos
eqTanTa II konferencia.
03.12.10 prof. i. kvaWaZis 85 wlisadmi miZRvnili saiubileo konferencia.
2011 weli
01.06.10 spdf-is XXVI konferencia.
23.12.10 spdf-is XXVII konferencia.
2012 weli
01.06.10 spdf-is XXVIII konferencia.
21-22.12.10 spdf-is XXIX konferencia.
12
T h e S o c i a l P e d i a t r i c P ro t e c t i o n F u n d
Date of Foundation: 30.09.1998
Date and Number Of Registration: #147 9.10. 1998w
Address:Tbilisi, Ljubljana 21, 0154
Tel.: 995 593337154
E-mail: [email protected]; [email protected]
Contact: Prof. George Chakhunashvili
Job of Contact: Chairman of The Board
Branches of Fund: Mtskheta; Kutaisi; Gori.; Abasha.; Batumi.; Sagarejo; Gurjaani; Telavi; Tchiatura; Zugdidi; Territory of Operation: Georgia (eu)
Aim Social Pediatric Protection Fund is to execute programs
of social pediatric development and maintain rights and healthcare of Children, Mothers and Adolescents. Fund has great organizational experience, technical equipment and skilled members. Most of the members are Professors at TSMU, who have
clinical and educational experience of 15-20 years and were one
of the first, Before the independence, to read lectures about congenital infections, sexually transmitted diseases and prevention
of HIV. Fund is also cooperating with physicians, psychologists,
Lawyer (who operate in field of social assistance) and Public
figures. By the joint forces of all the people above said SPPF
is able to hold free medical examinations, juridicial consultations, charity events, informational lectures about healthy
way of life, congenital infection, HIV, Social subjects and etc.
Since 1997 more than 93.000 Children and Hundreds of older people have been medically for free in the framework of
charity events.
Before Independence, The active members of SPPF and their
consortium in 1980-1990 examined above 124 000 Children,
all over Georgia.
ACTIVITIES
From 1992 to 1998 was periodically holding humanitarian examinations. From 1998 with the help of Social Pediatrics
Protection Fund started charity activities, in which Georgian
pediatrists were participating. Activities included: Instrumental and laboratory research of patients in different regions of
Georgia, Medical gifts, several funded emergency operations.
07.01.98 – 07.02.99 Tbilisi, - over 9200 children were examined.
23-24.01.99 East Georgia, - over 3500 children were examined.
12-13-14.02.99 Tbilisi, - over 100 children were examined and
gifted medicines. Free consultations by professors were held by
Mother and Child Diagnostic Centre and other hospitals once a
week, consultations in leading pediatric clinics of the city once in
a month. In these activities were also participating: 1. Institute of
skin and vein 2.Scientific Institute of Parasitology and others.
12-13-14.03.99 expedition in Poti and Abasha (Qedisi, Marani and other), - 950 children were examined and gifted medicines.
29-30. 01-07.08.99 – 4400 children were examined and gifted medicines.
23-24-25.08.99 KhobiandZugdidi, - Free instrumental
and laboratory examinations were funded. Also medicines
against louse and itch were given.
04.04.99 - Expedition in Pasanauri – over 400 children were
examined.
07.05.99 – Expedition in Lanchkhuti – Free instrumental and
laboratory examinations were held and medicines were gifted.
18.05.99 Rustavi, - 250 children were examined and gifted medicines.
22.06.99 Sagarejo, - 250 children were examined and gifted medicines.
13-14.08.99 Chokhatauri, - over 1500 children were examined.
15.08.99 Bakhmaro, - over 2000 children were examined.
16.08.99 Adjara high-mountain regions, - over 750 children were examined.
17.08.99 Tbilisi, – Examinations in Homeless children house.
16.10.99 Dusheti region, - over 200 children were examined and gifted medicines.
2000.
26.02.2000 Gori, - over 500 children were examined. Different medicines were given out.
23.03.2000 Axalgori, - 30 children were examined.
01.04.2000 Marneuli region (Werakvi), - General blood analysis, instrumental examinations – echoscopy, encephalography were done. Over 1500 children were examined.
15.04.2000 Gurjaani, - 1200 children were examined, medicines were given out.
29.04.2000 Rustavi, - 300 children were examined.
05.06.2000 – Children from Avchala colony were examined.
20-28.07.2000 – Children in Tskhneti Orphanage were examined.
21-22-23.07.2000 – Examinations in Abasha and Samtredia region.
7-8.08. 2000, Bakhmaro-Beshumi – 1925 children were examined.
2001.
15.03.2001. Children of employees of Rustavi Nitrogen Factory were examined.
23.06.2001. Children of employees of Rustavi Nitrogen Factory were examined.
14-15-16.09.2001 Baghdati region (Sairme,Witelkhevi,Rokhi,Ochba,Xani,Zegani,Saqraula) – over 2500 children were examined.
2002.
10.03.2002 Axalgori, - 250 children were examined.
20-04.2002 Sighnaghi, - 450 children examined.
23-24-25-26.05.2002 Khulo, - 600 children and 100 adults
were examined with the help of Patriarchy.
27-28-29.06.2002 Tbilisi, - 400 children were examined in
different Hospitals.
16-17-18-19.07.2002 KodorisKheoba, - 250 children were
treated.
3-4-5-6.08.2000 Tusheti (Dikolo,Omalo,Shenaqo) – 200
children were treated.
2003.
05.03.2003 Samtskhe-Javakheti, - 1250 children were examined.
17.04.2003 Werovani, - 450 children were examined.
20.05.2003 Borjomi, - 870 children were examined.
25.06.2003 Mta-Tusheti, - 320 children were examined.
30.07.2003 Bakhmaro, - 630 children were examined.
20.08.2003 Zestaponi, - 210 children were examined.
07.09.2003 Racha, - 170 children were examined.
18.102003 Dmanisi, - 180 children were examined.
2004.
March, April, May – Kaspi, Gurjaani, Telavi, Akhmeta, Lagodekhi, Sighnaghi, Bodbe, Aspindza, Axaltsikhe, Borjomi, Tbilisi, Zestaponi, Kharagauli, Chiatura – over 1728 children were
examined. In different regions (Zugdidi, Khulo, Khelvacharui,
Qeda, Lanchkhuti, OzurgetiIngiri), SPPF held charity activities with the help of Patriarchy – over 2400 children were examined and medicines were given out.
2013 weli
2005.
Marneuli region – 700 children and 80 adults were examined.
18th of July, Kaspi – 450 children were examined.
8th of October, Mtskheta – 300 children were examined.
14-15-16th of October, Lentekhi – 850 children and 250
adults were examined.
2006.
18th of February –20 Painter Union families were examined.
March – over 100 refugee children were examined.
April – Charity activities were held by ambassadors in Guria.
31th of May – 450 children were examined in Rustavi.
1-2th of June - Open door day in TSMU, 400 children were
examined. They were held free consultations and laboratory
examinations.
9-10th of June, Kaspi - 300 children were examined.
1th of July, Ckhinvali region – 500 children of war participants were examined. In September-October – 120 children.
In November – over 200 of Journalist’s families were examined.
2007.
Marneuli – Free consultations for 100 children. Childrens
with Scoliosis were shown. They got espander gifts and were
recommended how to treat scoliosis.
Dusheti – 250 children were examined.
Akhalsheni–85 children were held consultations.
9-10th of June, Kaspi – 300 children were examined.
1th of July, Ckhinvali region – 500 children of war participants were examined. In September-October – 120 children.
In November – over 200 of Journalist’s families were examined.
2008.
1st of June – Open door day (200 children were examined).
2nd of June – Teddy bear (300 children examined).
14th of June, Akhmeta (QaQucoba) - 450 children were examined and gifted medicines. Also examinations like echoscopy of abdominal cavity and ECG were held.
13
27th of June – restoration of Georgian Section.
20th of August - STOP RUSSIA (meeting at Igoeti)
1st of September, Tbilisi – STOP RUSSIA (meeting of chain)
4th of October – free consultations and examinations. Painters and artists master classes were held.
6th of December – 110 children were examined in Bergman
Clinics with echoscopy of abdominal cavity, ECG and other.
2009.
13.06.2009, Khashuri – 750 children were examined.
26.12.2009, Barisakho – 80 children were examined.
2010.
4th of July – Open door day for family members of war victims (50 children were examined).
10th of July, Karaleti – 200 children were examined and
medicines were given out.
4th of November – St. King Tamar orphanage children were
examined.
3-4th of December,Tbilisi– 400 sportsmen children were
examined.
2011.
1st of June,Tbilisi – 200 children were examined.
24th of December,Tbilisi – 200 children were examined.
2012.
1st of June,Tbilisi – 350 children were examined.
22th of December,Tbilisi – 250 children were examined.
Since 1997 more than 93.000 Children and Hundreds of older people have been medically for free in the framework of
charity events.
Before Independence, The active members of SPPF and their
consortium in 1980-1990 examined above 124 000 Children,
all over Georgia.
SIMPOSIUMS AND CONFERENCES HELD BY THE SOCIAL PEDIATRIC PROTECTION FUND:
1992. First pediatric cardiology conference – “believe the
reality of better future”.
01.06.1999. II conference – “Healthy child & peaceful
Caucasus”.
25.12.1999. III conference – “Today’s economic directions
in pediatric and its perspective”. XXI century Pediatrics should
be the start of invalid prophylaxis.
01.06.2000. IV conference – “Child must have right to be
protected since embryo”.
27.03.2001. Meeting in ombudsman’s office – “Under aged
criminals, their rights and reality”.
01.06.2001. V conference dedicated to Children Protection
National Day.
32.03.1999. 01.06.2000. 01.06.2001
“Child treatment in XXI century”
23.04.1999. 01.06.2000
“Child treatment in XXI century”
“Orthopedic school”
17.12.1999. Mucoviszidose treatment and diagnostics.
01.06.2000. Young Pediatrists XVIII conference.
28.02.2001. Urgent questions of Therapy of respiratory diseases in pediatrics.
01.06.2001. “Child has right to be protected since embryo”.
01.06.2001. “Child, adult and family violence”.
13.02.2002. “Human genome project”.
10.03.2002. Akhalgori, - Presentationof toner drink “Lomisi”.
06.11.2002. National Conference: Medical and social
problems of people who suffer from mucoviszidose and metabolism disorder.
2013 weli
07.11.2002. “Contemporary aspects of inborn diseases”.
04.04.2003. “Urgent pediatric questions” (IX conference).
01.06.2003. Internet conference (X conference) – Social Pediatrics Protection Fund gave out journals and magazines called
“Social Pediatrics” (In which is written about social, medical, pedagogic, psychological, religious and other urgent problems).
19.12.2003. Second Georgian Cardiology Congress.
22.10.2004. “Urgent Pediatric questions” dedicated to SPPF
president, Victor Moroshkin.
01.06.2004. Second National Internet Conference.
01.06.2005. Urgent Pediatric questions.
09.09.2005. Tbilisi Marriot, - Second National Conference “Healthy child & Peaceful Caucasus”.
1st of June, 2006. – SPPF conference. XXIII Congress of
Young Pediatrists League.
31.05.2007. III congress of Pediatric Cardiology.
07.12.2007. SPDF XVII conference.
07.10.2008. Conference – “Section of child and adult”.
20.12.2008. SPPF and ESMNS second conference.
12.06.2009. SPPF XX conference.
01.06.10. Second conference of Georgian surgeons and
XXII conference of Tsalka.
03.12.2010. Conference dedicated to I. Kvachadze 85th anniversary.
01.06.2011. SPPF XXVI conference.
23-24.12.2011. SPPF XXVII conference.
01.06.2012. IV congress of Pediatric Cardiology.SPPF
XXVIII conference.
21-22.12.2012. SPPF XXIX conference
14
qvelmoqmedeba
- 2000-2004 ww.
2013 weli
15
saqvelmoqmedo aqcia rusTavsa da samtrediaSi
saqvelmoqmedo aqciebi
marneulSi, duSeTSi da
axaSenSi
Tbilisis saxelmwifo
samedicino universitetis
teritoriaze 2008 wlis 2
ivniss moewyo bavSvTa karavi
Teddy V
euz Hospit
al
(T
Veuz
Hospital
al), romelSic
monawileoba miiRes
universitetis studentebma
saqvelmoqmedo
aqcia
xaSurSi 2009
2013 weli
saqvelmoqmedo aqcia
qaqucoba 2008
16
saqvelmoqmedo aqcia barisaxo 2009
saqvelmoqmedo aqcia kalaTburTelebis gasinjva 2010
saqvelmoqmedo aqcia karaleTi 2010
saqvelmoqmedo aqcia omis monawileTa ojaxebisa da wminda keTilmsaxuri mefe
Tamaris skola pansionis bavSvebi (dekanozi mirian samxaraZe) gasinjva 2010
2010 wlis Ria karis dRe 04.XII sporcmenebTan
2013 weli
17
2011
wlis
1
ivniss
konferenciis organizatorebsa da afxazeTis jandacvis saministros iniciativiT
bavSvTa dacvis dRes mieZRvna bavSvTa saqvelmoqmedo konsultaciebi, romelic Catarda bavSvTa axal klinikaSi da gaisinja
200-mde bavSvi.agreTve moewyo afxazeTidan
afxaz bavSvTa namuSevrebis naxatebis gamofena da maT gadaecaT sertifikatebi.
2011
wlis
1
ivniss
saqvelmoqmedo
aqcia 24.12.2011.
bavSvTa axal
klinikaSi
(gaisinja 200-ze
meti bavSvi)
01.06.12. Tbilisi
27.07.12. Telavi
11.08.12. karaleTi
2013 weli
pativcemulo kolegebo,
2012 wlis 21-22 dekembers Cveni qveynis pediatrebi, socialuri pediatriis dacvis fondis warmomadgenlebi, dedaqalaqis klinikis warmomadgenlebi,
mecnierebi, sazogado moRvaweebi, Seikribnen konferenciaze,romelic tradiciulad Catarda Tssu-is saaqto darbazSi.
konferncia Tbilisis saxelmwifo samedicino universitetis, saqarTvelos
humanitaruli da saxelovnebo mecnierebaTa akademiis, socialuri pediatriis dacvis fondis, Tbilisis saxelmwifo samedicino universitetis, bavSvTa
axali klinikis, gestozebis Svilobili samedicino daxmarebis saerTaSoriso organizaciis, samedicino-socialuri mecnierebis interkontinentaluri
akademiis, saqarTvelos bavSvTa kardiologTa asociaciis, saqarTvelos sabunebismetyvelo mecnierebaTa akademiis, saqarTvelos eqimTa asociaciis, saqarTvelos meddaTa asociaciis, aliansi koalicia damoukidebeli cxovreba `moZraoba afxazeTisaTvis’’, saqarTvelos
axalgazrda pediatrTa ligis, sruliad saqarTvelos qalTa kongresis, eqimTa uflebebis dacvis asociaciis, saqarTvelos samedicino specialistebis asociaciis, evropis medikos studentTa asociaciis, saqarTvelos pediatrTa akademiis, saqarTvelos bavSvTa qirurgTa aso-
Ria werili kolegebs
ciaciis, dedaTa da bavSvTa janmrTelobis centris, saqarTvelos sportis departamentis, saqarTvelos pediatrTa asociaciis, Tssu studenturi TviTmmarTvelobis, Tssu studentTa samecniero
sabWos mier iyo organizebuli.
konferenciaze miRebuli iqna:
yoveli wlis 1 ivniss dedaTa da bavSvTa mzrunvelobis mxardasaWerad gamocxaddes samedicino dawesebulebebSi
sayoveTaoYRia karis dRe.
arsebuli informaciebi SeZlebisdagvarad vrceldeba. Cveni survilia, rac
SeiZleba metma samedicino dawesebulebebma miiRos am saqvelmoqmedo aqciaSi
monawileoba da igi gaxdes tradiciuli
(ra Tqma unda aqciaSi monawileoba nebayoflobiTia).
winaswar gixdiT madlobas
amdenad, 1 ivnisis aqciaSi monawileobis survili gamoTqva:
Tbilisi
– ir. ciciSvilis sax. bavSvTa axali
klinika
– pediatriis instituti
– sadiagnostiko centri 444
– kardiologiis instituti
aWaris regioni
– baTumi
– qobuleTi
gori
– S.p.s. `gormedi“
– saaq.saz. ìavnana“goris dedaTa da
bavSvTa centri
Telavi
bavSvTa janmrTelobis centri
quTaisi
q. quTaisis dedaTa da bavSvTa samkurnalo diagnostikuri centri, janmrTelobis
imedia kidev mravali organizacia
Caebmeba am saqvelmoqmedo aqciaSi da
igi iqneba yovelwliuri da gaxdeba tradiciuli.
didi madloba masSi yvela monawiles,
imedia momavalSi Caebmeba farmacevtuli
firmebi da biznesis warmomadgenlebi.
konferenciis orgkomiteti
18
XXVIII konferencia
,,Canasaxidan bavSvs ufleba aqvs iyos daculi”
,,bavSvTa usafrTxoeba mecnierebis gziT”
,,socialuri pediatria da bavSvTa usafrTxoeba”
saqarTvelos bavSvTa kardiologia
IV samecniero-praqtikuli konferencia
(pres relizi)
2012 wlis 1 ivniss Cveni
qveynis pediatrebi, socialuri pediatriis dacvis fondis
warmomadgenlebi, dedaqalaqis
klinikis warmomadgenlebi,
mecnierebi, sazogado moRvaweebi, Seikribnen konferenciaze,romelic tradiciulad Catarda Tssu-is saaqto darbazSi.
konferncia Tbilisis
saxelmwifo samedicino
universitetis, saqarTvelos humanitaruli da saxelovnebo mecnierebaTa
akademiis, socialuri pediatriis dacvis fondis,
Tbilisis saxelmwifo samedicino universitetis,
bavSvTa axali klinikis,
gestozebis Svilobili
samedicino daxmarebis saerTaSoriso organizaciis, samedicino-socialuri mecnierebis interkontinentaluri
akademiis, saqarTvelos bavSvTa kardiologTa asociaciis, saqarTvelos sabunebis-
metyvelo mecnierebaTa akademiis, saqarTvelos eqimTa
asociaciis, saqarTvelos meddaTa asociaciis, aliansi koalicia damoukidebeli cxovreba `moZraoba afxazeTisaT-
vis’’, saqarTvelos axalgazrda pediatrTa ligis, sruliad saqarTvelos qalTa
kongresis, eqimTa uflebebis
dacvis asociaciis, saqarTvelos samedicino specialistebis asociaciis, evropis me-
dikos studentTa asociaciis, saqarTvelos pediatrTa
akademiis, saqarTvelos bavSvTa qirurgTa asociaciis, dedaTa da bavSvTa janmrTelobis centris, saqarTvelos
sportis departamentis,
saqarTvelos pediatrTa
asociaciis, Tssu studenturi TviTmmarTvelobis,
Tssu studentTa samecniero sabWos mier iyo organizebuli.
konfernciis Tavmjdomareebi: profesorebi:
giorgi CaxunaSvili,
irakli ciciSvili, avTandil kvezereli-kopaZe, vaniko CxaiZe igor doliZe, yaraman faRava, ramaz
kutubiZe.
plenaruli sxdomebis reJimSi Catarda sami sxdoma:
konferencias miesalma mama
adami, Tssu vice-reqtori-daviT WavWaniZe,saqarTvelos
qalTa kongresis prezidenti, qalbatoni lia kiknaZe,
2013 weli
profesori paata kervaliSvili (saqarTvelos sabunebismetyvelo mecnierebaTa akademiis prezidenti), v.cxomeliZe, nino moroSkina (msoflio banki) da sxv.
socialuri pediatriis
dacvis fondis prezidentma
profesorma g. CaxunaSvilma
madlierebis sigeli gadasca profesor aleqsi xoWavas ojaxs; xolo qebis sigelebi Tssu profesors vaJa
gvanvelaZes,med.doqtors
margo gogiaSvils,med.doqtors manana Wi paSvils.
konferencias eswrebodnen
socialuri pediatriis dacvis fondis warmomadgenlebi,
mowveuli pediatrebi dedaqalaqis klinikebidan, mecnierebi, sazogado moRvaweebi,
sportsmenebi, mwvrTvnelebi. konferenciaze daregistrirda 295 delegati. maT gadaecaT sertifikatebi.
konferenciis pirvel plenarul sxdomaze warmodgenili moxsenebebi exeboda arsebul aqtualur problemebs. kerZod,
_ medicinis doqtorma d. CaxunaSvilma da k.CaxunaSvilma warmoadgina moxseneba: `
evromecnierebis qarTuli
erovnuli seqciis axalgazrduli departamentis ganvlili muSaobis Sedegebi’’
-sxvadasxva daavadebbebis
Taviseburebani 2-6 wlis bavSvTa asakSi _ profesorTa
da ucxoel _ qarTvel studentTa jgufi (Tssu)
_ ÙNICEF – WFP-is erToblivi proeqtebi” – g.lomTaZe (Tsu)
_ `sainformacioteqnologiebisrolimozardiscxovrebaSi” – g.sanikiZe (pu)
_ genuri inpritingis Tavisebureba prof.m.Wi paSvili
(Tssu)
,meore plenaruli sxdoma mieZRvna bavSvTakardiologia IV samecniero-praqtikuli konferencias Tavmjdomareebi: profesorebi i. ciciSvili, g. CaxunaSvili, av. vezereli-kopaZe, v.CxaiZe i. doliZe, y. faRava, r. kutubiZe
warmodgenili iyo leqciebi da moxsenebebi:
1. `bavSvTa da mozardTagul-sisxlZarRvTasistemis-
2013 weli
Tanamedrove marTva kardiorevmatologiur paTologiaTa dros~ _ saqarTvelosbavSvTa kardiologia asociaciis prezidenti: m.m.d. sr.
profesori g. CaxunaSvili
(Tbilisi)
2 àWaris regionis kardio-revmatologiuri problemebis Tanamedrove marTva”. Avant Group _ baTumisdedaTa da bavSvTa janmrTelobis dacvis respublikuri
centris pediatriuli departamentis ufrosiT. surmaniZe da kardiorevmatologimed.doq. m.ServaSiZe (baTumi)
3. `kardiointervalografiis roli Tanamedrove prevenciul bavSvTa kardiologiaSi” _ med. doqtorin.jobava (Tbilisi)
4 àriTmiebis medikamenturi da aramedikametozuri mkurnaloba bavSvTa asakSi
q.quTaisis d/b samkurnalo
diagnostikuri centri.Mm.xecuriani (quTaisi)
5 “axalSobilTa kardiomiopaTia” m.m.d.sr.prof. g. CaxunaSvili, m.d. n.jobava,
m.d.sr.prof.i.favleniSvili,
m..d.asoc.prof.goTua(Tbilisi)
6. aTerosklerozis ganviTarebis riskis jgufebi
bavSvTa asakSi, diagnostika, prevencia(momzadebulia
amerikis gulis asociaciis masalebis mixedviT)
m.d.asist.prof. T.kutubiZe
(Tbilisi)
7. `wyali _ bavSvis janmrTeli sicocxlis akvani da
gul-sisxlZarRvTa sistema”
m.m.d.prof.ig. doliZe (Tbilisi)
8. `mikronutrientebis deficitis koregireba gulsisZarRvTa sistemis daavadebebis mkurnalobis dros”
m.d.prof.
d.zarnaZe,
m.d.prof. i. zarnaZe (Tbilisi)
9 `sistemuri wiTeli mgluras dros gul-sisxlZarRvTa sistemis dazianeba” g.CaxunaSvili, n.jobava, k.CaxunaSvili, a.bliaZe (Tbilisi)
10. `glikozirebis Tandayolili moSla (CDG)” T.miqelaZe (Tbilisi)
11. `xSirad moavade bavSvebis imunuri statusi da
g.s.s.-is mdgomareoba imudo-
nisa da
-19 mkurnalobis
fonze“ m.d.n.TofuriZe, n.badriaSvili (Tbilisi)
konferenciisas gaimarTa
vromecnierebis saqarTvelos
erovnuli seqciis morigi
sxdoma..
konferenciaze gaimarTa aqtualur sakiTxebze kamaTi, sadac gamomsvlelebma daafiqsires TavianTi poziciebi.
bolos miRebuli iqna rezolucia:
evromecnierebis saqarTvelos erovnuli seqciis 20122016 wlebis strategiuli
gegma gadiodes masSi axalgazrdobis mecnierebaSi CarTvis mkveTri matebisaken da
19
muSavebuli grZelvadiani
gegmis mixedviT.
yvela Rone ixmaros, acnobos
samTavrobo struqturebs da
gaagrZelos Tavisi saorganizacio saqmianoba. raTa
saqarTveloSi Catardes 2016
wlis an 2018 wlis evromecnierebis forumi.
3. socialuri pediatriis
dacvis fondma da bavSvTa
kardiologTa asociaciam gaagrZelos aqtiuri muSaoba
miRebuli rezoluciebis Sesabamisad, amasTan erTad
2015wlis 1 vnisisaTvis izrunos bavSvTa kardiologTa V konferenciis Casatareblad.
4. Mmomzaddes saqarTvelos eqTanTa III konferencia.A
5. Yyoveli wlis 1 ivniss
dedaTa da bavSvTa mzrunvelobis mxardasaWerad gamocxaddes samedicino dawesebulebebSi sayoveTaoYRia
karis dRe.
6. Kkvebis obieqtebi, mwarmoeblebTan erTad aqtiurad
Caebnen moZraobaSi `jansaRi
kveba BbavSvebs”
7. gazeTis `socialuri pediatria” da Jurnalebis `socialuri, ekologiuri da
klinikuri pediatriis” da
”bavSvTa kardiologiis” axali nomrebis
-is
da WWW. esgns.org veb.gverdze ganTavsebisa da maTgan referirebad JurnalebSi statiebis gamoqveynebis strategiis gaaqtiveba.
8. arasamTavrobo organizaciebis samTavroboebTan
erTad erToblivad dawesebuli medicinaSi òqros stetoskopisa~ da òqros lancetis” varskvlavis mflobeli dasaxeldes (Tu aseTi
kandidatura SeirCeva msurvelTagan)Seqmnili komisiis
mier araugvianes 2013w-is 1
ivnisisa.
miRebul iqna
gadawyvetilebebi
1. evromecnierebis saqarTvelos erovnulma seqciam
gaagrZelos Tavisi saorganizacio saqmianoba arsebuli gamgeobiT 2016 wlamde
da masve daevalos Tavmjdomaris axali vadiT arCeva.
2. evromecnierebis saqarTvelos erovnulma seqciam
P.S. aRsaniSnavia, rom amave dRes Sedga eqim rezo sordias poeziis (krebulebis _
`siyvarulis dabadeba~ da
`laqsad getyvi~) warmatebuli prezenTacia;
xolo meore dRes 02.06.12.
konferenciis organizatorebis iniciativiT Catarda saqvelmoqmedo konsultaciebi,
da gaisinja 200-mde bavSvi.
daevalos evromecnierebis
saqarTvelos erovnuli seqciis axalgazrdul departments maszed metad ganaxorcielos aqtiuri muSaoba Se-
20
evromecnierebis saqarTvelos erovnuli seqcia
axalgazrdoba aqtiurdeba
2012 wlis 1ivniss ESGNS-is konferenciaze TbilisSi warmodgenili iyo SemuSavebuli da damtkicemuli rezoluciis mixedviT, evromecnierebis saqarTvelos erovnuli
seqciis axalgazrduli departamentis (Tavmjdomare medicinis doqtori d.CaxunaSvili) grZelvadiani gegmis mixedviT 6 Tvis angariSi. romelic emyareboda maT ZiriTad strategias:
1. saqarTveloSi mecnierebis popularizacia:
1.1. Tbilisis udides universitetebTan kavSiris gamyareba
1.2. samecniero muSakebisaTvis (35
wels qveviT) sakvlevi masalebis, literaturuli da statistikuri monacemebis xelmisawvdomobis gazrda/
gaadvileba.
1.3. sxvadasxva profilis samecniero muSakebis dakompleqtebiT proeqtebis grantze.
1.4. saqarTvelos universitetebTan
erTad samecniero konferenciis Catareba, romelzec axalgazrda mecnierebi waradgenen TavianT naSromebs. am konferencias unda qondes
konkursis saxec.
2. ucxour qveynebTan urTierTo-
ba:
2.1. qarTuli samecniero naSromebis ucxour, avtoritetul JurnalebSi dabeWvdisTvis Setana. qarTuli
mecnierebis popularizacia msoflio
asparezze.
2.2. ucxo qveynebis axalgazrda mecnierebTan qarTveli axalazrda mecnierebis dakavSireba, informaciis
gacvla.
2.3. saqarTveloSi 1.4 punqtis ganxorcielebis Semdeg, amave formatSi ucxo qveyenbis CarTva.
3. mecnierTa axal da Zvel Taobebs Soris arsebuli problemebis
gadaWris gzebis monaxva
3.1. axalgarda mecnierTa kavSiris
Seqmna, romleSic warmodegnili iqnebian stundetebi, bakalavrebi, magisrebi, doqtorantebi, filosofiis doqtorebi da profesorebi.
3.2. maT erTmaneTSi informaciis
gacvla, problemebis garCeva da maTi gadaWris gzebis moZieba daevalebaT.
3.3. am kavSiris dasvknebis da problemebis miwodeba sxvadasxva samecniero wresa da organizaciaSi.
redaqcia ulocavs qarTvel mecnierebs
Rirseul sagranto programaSi gamarjvebas:
STEP 2012 ‘From Idea to the Market”
Innovation Forum
December 3, 2012
(Holiday INN Tbilisi; 1, 26 May Square; Tbilisi, Georgia)
Project Title: NeoOligos - Designing and synthesis of oligonucleotides
Science Team PI: George Kamkamidze
Institution/Organization: Georgian Maternal and Child Care Union
Project Title: Apipuri - Bread enriched with Amino acids, Minerals
and Vitamins
Science Team PI: George Chakhunashvili
Institution/Organization: Social Pediatric Protection Fund
Company partner: JSC ‘Ifqli”
2013 weli
socialuri pediatriis dacvis fondis warmomadgeneli a.S.S-Si vaniko cxomeliZe aqtiur monawileobas yovelTvis axerxebs 1 ivnisis konferenciebSi,
romelic aTeuli wlebia eZRvneba bavSvTa dacvis
dRes, ase iyo amJamadac 2012 wels.
STEP 2012 `FROM IDEA TO THE MARKET”
INNOVATION FORUM
December 3, 2012
(Holiday INN Tbilisi;
1, 26 May Square; Tbilisi, Georgia)
STEP 2012 ìdeidan bazramde~
sainovacio forumi
3 dekemberi, 2012
(sastumro `Holiday INN Tbilisi~;
26 maisis moedani, N1: Tbilisi, saqarTvelo)
àpi puri~ - aminomJavebiT, vitaminebiTa da mineralebiT
gamdidrebuli puri
Apipuri - Bread enriched with Amino acids, Minerals and Vitamins
2013 weli
21
The representative of the Social Pediatrics Protection Fund
in U.S.A. Vaniko Cxomelidze is always participating actively
in conferences which are held 1st of January, which is dedicated
to Child Protection Day for many years already, and so it was
this year in 2012.
22
originaluri statiebi
paata kervaliSvili
saqarTvelos sabunebismeTyvelo mecnierebaTa akademiis prezidenti
biografiuli cnoba
daibada 1949 wels TbilisSi. daamTavra Tbilisis I skola, saqarTvelos politeqnikuri institutis sainJinro-fizikuri fakulteti, moskovis
ucxo
enaTa institutis inglisuri enis fakulteti, moskovis
institut “giredmetis” aspirantura da sxva.
moRvaweobda ssrk saSualo
manqanaTmSeneblobis saministros (ssrk atomuri energiis
saxelmwifo komiteti) sxvadasxva samecniero-teqnologiur
centrebSi: soxumis fizikateqnikuri instituti; stabiBIOGRAPHICAL INFORMATION
PaataKervalishvili
Professor, Doctor of Sciences and
Dr.-Eng. Paata J. Kervalishvili(born 1949) is full Professor at department of
Physics within Georgian Technical University, as well as Professor of faculty
of exact and natural sciences of Tbilisi
State University.
From 1970 until 1992 Prof. Kervalishvili was researcher and Director in
luri izotopebis instituti;
instituti “giredmeti”; i. kurCatovis atomuri energiis instituti, sadac xelmZRvanelobda samecniero da samrewve lo-teq no lo gi ur Te mebs,
proeqtebsa da saxelmwifo
programebs.
1984-wlidan igi saqareTvelos teqnikuri universitetis profesoria, xolo 2000
wlidan Tbilisis saxelmwifo
universitetis mowveuli profesori.
1989 wlidan profesorisa da
samcniero proeqtebisa da programebis xelmZRvanelis rangSi igi moRvaweobda ssrk-s, evropisa da aSS-s universitetebsa da samecniero centrebSi.
1979 wels mas institut giredmetSi mieniWa teqnikur mecnierebaTa kandidatis, xolo
1985 wels i. kurCatovis atomuri energiis institutSi fizika-maTematikis mecnierebaTa
doqtoris xarisxebi. 1981 wels
p. kervaliSvils mieniWa ufrosi mecnieri muSakis, 1989 wels
ki profesoris samecniero wodebebi.
prof. kervaliSvili 350-mde
samecniero statiis, wignis, gamogonebis, moxsenebis avtoria.
misi Sromebi dastambulia
msoflios mowinave gamocemebSi. rigi misi gamogonebebisa danergilia sxvadasxva warmoebaSi.P
p. kervaliSvili ramdenime
ssrk da saerTaSoriso prestiJuli premiisa da jildos
mflobelia. igi aris saqarTvelos sainJinro, ekologiuri
da sabunebismetyvelo mecnierebebis akademiebis, niu-iorkis
mecnierebaTa akademiis, ruseTis sabunebismetyvelo mecnierebaTa akademiis wevri da
sxva.
sxvadasxva dros igi iyo
ruseTis atomuri energiis
saministros, i. kurCatovis
institutis, ssrk mecnierebaTa akademiis, natos samecniero-teqnologiuri sabWoebis
wevri, ramdenime evropuli
organizaciis wevri da eqsperti da mravali sxva. amJamad prof. kervaliSvili aris
evroxmelTaSuazRvis xelovnebisa da mecnierebi akademiis prezidenti, saqarTvelos
sabunebismetyvelo mecnierebaTa akademiis prezidenti,
evrokomisiis, iuneskosa da
sxva saerTaSoriso organizaciebis saeqsperto sabWoebis
wevri.
diffe rent re se arch and tec h no logy
centers within the Middle Machinery
Ministry (State Committee for Atomic Energy) of former USSR main
body of the Soviet atomic energy
and weapon industry. In 1994 – 1999,
after one year in Parliament of Georgia he worked in government of Georgiaas one of the leaders of the State
Committee for Science and Technology and Ministry of Economy of
Georgia.
A condensed matter physicist with
Technical University Diploma, Dr. Kervalishvili has served in several directions
of physics and technology such as: condensed matter, molecular and quantumphysics, nuclear and laser technologies,
novel materials, sensory systems, energy and information technologies. He is
author of more then 350 scientific publications, books, manuals, and inventions.
Prof. Kervalishvili is a member of
more then 10 top level academies and
2013 weli
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research councils and among them:
full member of American, European,
Russian and Georgian scientific academies, Georgian Engineering academy and other distinguish organizations. Currently he is the President of
Georgian Academy of Natural Sciences and President of Euro Mediterranean Academy of Arts and Sci ences.
More then 20 prestigious prizes
and state orders award Dr. Kervalishvili.
As a Director and coordinator of several World Bank, EU, ISTC, etc. projects and Chairman of International
Forums and Conferences, as well as Professor of some well known European
and AmericanUniversities he has the wide international experience.
P. Kervalishvili received his B.S. and
M.S. in solid state physics from GeorgianTechnicalUniversity. The Research
and technological Centre “Institute Giredmet” awarded him the title of Ph. D., and
Dr.-Eng. in 1978, and Soviet atomic
centre “Kurchatov Institute” – degree of
Doctor of physics and mathematics
(1984). He got USSRProfessorState title in 1989.
misi xelmZRvanelobiT daculia ramdenime aTeuli samagistro, sakandidato da sadoqtoro disertacia, ganxorci e le bu lia sa er Ta So ri so
proeqtebi da programebi, (maT
Soris aSS-s, natos, evrokavSiris da sxva organizaciebis 50de proeqti).
Cvens qveyanaSi bolo ramdenime TveSi ganviTarebulma
movlenebma kidev ufro mkveTrad daanaxa saqarTvelos mosaxleobas, rom qveynis marTvasa da ganviTarebaSi arsebobs
seriozuli problemebi, romelTa gadawveta moiTxovs arsebuli inteleqtualuri resursis srul gamoyenebas. gamoikveTa Cveni qveynis ganviTarebis saWirboroto sakiTxebis
Rrma strategiuli damuSavebisa da maTi cxovrebaSi gatarebis taqtikuri problemebisa
da teqnologiuri meTodebis
swori da drouli warmarTvis
aucilebloba. sazRvargareTuli da Cveni gamocdilebac
gvkarnaxobs, rom albaT erTaderTi marTebuli gamosavali
arsebuli mdgomareobidan moqmedebebis swori prioritetebisa da kargi gegmebis arsebobaa.
saqarTvelos miznebidan gamomdinare qveynis strategiul
amocanas inovaciuri da codnaze dafuZnebli ekonomikis
ganviTareba warmoadgens. mxriv
nebismieri mimarTulebis sainovacio saqmianoba emyareba
mecnierebis, teqnologiebisa
da mrewvelobis winmswreb ganviTarebasa da miRebuli Sedegebis farTo gamoyenebas cxovrebis yvela sferoSi.
codnaze damyarebuli ekonomikuri winsvlis erT-erT
mTavari amZravi mosaxleobis
maRalteqnologiur biznesSi
aqtiuri CarTvaa. gansakuTrebiT ki maRalteqnologiuri
mcire da saSualo zomis sawarmoebis saqmianobaSi. amas
Zalian daexmareba: samecnierokvleviTi da sawarmoo organizaciebis erToblivi saqmianoba; saxelmwifo dawesebulebebis mier sainovacio saqmianobis aqtiuri danergva Tavisi
moRvaweobis yvela mimarTulebiT da am saqmianobis daxmarebis saxelmwifo sistemis Seqmna; sainovacio teqnologiebis
saerTaSoriso, integrirebuli
marTvis sitemis Camoyalibeba
da danergva.
nebismieri marTvis saTaveSi
yovelTvis Zevs erTi mTavari
sakiTxi – ra aris subeqtis mizani, risken miiswrafvis igi?
dadgenilia, rom miznis (miznebis) formulirebis procesi
win uswrebs marTvis proceduras da amitomac didad gansazRvravs mas.
magaliTad, Tu Cven mTavarsa
da erTaderT mizans tranzitul-turistuli qveynis Seqmna warmoadgens, maSin marTvis
obieqtad iseTi ti pis xelisufleba unda warmovidginoT,
romelic ZiriTadad Seqmnis
aseTi amocanis gadawyvetisaTvis aucilebel marTvis
struqturebs. xolo Tu Cven
mTavari mizani maRalteqnologiuri, inteleqtualuri saxelmwifos Seqmnaa, maSin marTvis obieqtis ganviTarebis maregulirebeli parametrebis
ricxvi izrdeba da amasTan erTad icvleba qmedebebis mimarTulebebi. sxvanairad, Tu mxolod tranzituli amocanebis
gadawyvetisaTvis saWiroa garkveuli ti pis energetikulsatransporto-telesakomunikacio infrastruqtura, TviTkmari qveynisaTvis cota ufro
sxva energetika, transporti da
kavSirgabmuloba gamogvadgeba.
yvelaferi es Tavidanve unda
iyos gaTvaliswinebuli samTavrobo da sxva saxelmwifo
marTvis struqturebis Seqmnis
dros.
aseve unda iyos dalagebuli
ga naT le bis pri o ri te tu li
amocanebic. magaliTad,Ywrfivi
kavSirebi: ganaTleba-mecniereba-industria; ganaTlebamecniereba-janmrTelobis dacva; ganaTleba-mecniereba-xelovneba da sxva.
aq gansakuTrebiT unda aRiniSnos is garemoeba, rom Tu
zogad-politikuri sistemebis
funqcionirebis elementebi
CvenSi garkveulad cnobilia,
saxelmwifoebrivi marTvis iseTi mniSvnelovani blokis, rogoricaa sameurneo-ekonomikuri politikis gamtarebeli
sa re gu la cio sam sa xu re bis
saqmianobis gaZRola, maTi moqmedebis princi pebis Camoyalibeba da danergva sawyis
stadiaSi imyofeba.
saxelmwifo marTvaSi centraluri funqcia mis mTavrobas miuZRvis. TviT sruliad
Tavisufali sabazro ekonomikis pirobebSic ki ekonomikuri organizmi saWiroebs marTvasa da kontrols, rasakvirvelia marTvis ierarqiuli mdgenelis seriozuli SemcirebiT. es ki niSnavs, rom mTavroba sxvadasxva Tavisuflebis
xarisxis mqone sistemebSi ubralod sxvadasxvanairad unda
2013 weli
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atarebdes sameurneo marTvis
politikas – ufro zogadad, an
ufro konkretulad.
am da sxva mniSvnelovani parametrebis gaTvaliswinebiT
marTvis samTavrobo rgoli
Tanamedrove msoflio ganviTarebis etapze unda iyos Zalzed operabeluri anu moqnili,
sakmaod mcire, advilad gadawyobadi. aseTi varianti sapirispiroa ierarqiul princi pebze awyobili samTavrobo
struqturebisa (sabWoTa kavSiri, sxva socialisturi qveynebi, gansakuTrebiT diqtatoruli reJimebi).
rogorc ukanaskneli wlebis
msoflio gamocdilebam calsaxad daadastura qveynis Tanamedrove efeqturi saxelmwifoebrivi marTvis gansaxorcieleblad aucilebel pirobas
sainformacio – sakomunikacio
teqnologiebis winmswrebi ganviTareba warmoadgens. iseve
rogorc, am da sxva e. w. cifruli ekonomikis sabazo teqnologiebis gansaviTareblad
saWiroa saxelmwifoSi samTavrobo marTvis efeqturi
teqnologia arsebobdes. unda
aRiniSnos, rom satelekomunikacio da sainformacio teqnikuri saSualebebisa da maTi
programuli uzrunvelyofis
metad swrafi winsvla ganapirobebs iseTi eleqtronuli
infrastruqturis arsebobas,
romelic revoluciurad gardaqmnis adamianis saqmianobis
yvela mimarTulebis funqcionirebis wesebsa da teqnologiebs da gansazRvravs gundurinteleqtualuri saqmianobis
efeqturobis mkveTr zrdas.
cifruli ekonomikis ganviTareba emyareba ra sainformacio da sakomunikacio teqnologiasa da teqnikas Tavis
mxriv safuZvelia e.w. sainformacio sazogadoebis (yovelmxriv informirebuli sazogadoebis) warmoqmnisa, romelic
aucilebeli pirobaa, rogorc
demokratiuli, samoqalaqo sazogadoebis Camoyalibebis, ise-
ve misi mdgradi ganviTarebis
da stabiluri funqcionirebis.
axali, codnaze dafuZnebuli
ekonomikis ganviTarebam ganapiroba Tanamedrove efeqturi
sam Tav ro bo struq tu re bis
warmoSoba, romelTa marTva
aseve eyrdnoba eleqtronuli
komunikaciis Tanamedrove teqnologiur saSualebebs, rac
uzrunvelyos qveynis, regionaluri da munici paluri mTavrobebis mWidro TanamSromlobas sazogadoebriv, kerZo da
arasamTavrobo organizaciebTan, da rac mTavaria, sazogadoebis yvela didsa Tu patara jgufTan.
saqarTveloSic uaxloes momavalSiPpirvel prioritetad
sainformacio da sakomunikacio teqnologiebis SeqmnaganviTareba rCeba. Semdeg modis: eleqtroenergiis warmoeba da distribucia, umaRlesi
xarisxis da ekologiurad
sufTa kvebis produqtebis
warmoeba, mecnierebatevadi da
maRalteqnologiuri produqciis Seqmna da maTi mcireseriuli industria; Tanamedrove
mrewveloba samamulo mineraluri resursebis bazaze da
sxva. rasakvirvelia, amasTan erTad da winmswrebi tempebiT
unda Seiqmnas mdgradi da
efeqturad moqmedi infrastuqtura: energetika – transporti – kavSirgabmuloba da
aseve mSeneblobis Tanamedrove industria, rac Cveni qveynis
mowinave, ekonomikurad damoukidebel, inteleqtualur-teqnologiur saxelmwifod Camoyalibebis mTavari garantia
unda gaxdes.
aRiniSnos, rom ukanasknel
wlebSi saqarTvlos xelisuflebis
mier energiulad xorcieldeba reforma mecnierebisa da
teqnologiebis politikisa da
marTvis mimarTulebiT, romelic miuxedavad mravali xarvezisa mTlianobaSi dadebiTad unda Sefasdes. gadadgmulia garkveuli nabijebi qar-
Tuli mecnierebisa da teqnikis
integraciis gansasaxorcieleblad evropulsa, da saerTod, dasavlur sivrceSi.
amasTan erTad, mecnierebisa
da mrewvelobis saerTaSoriso
integraciaze orientireuli
aucilebeli reformebi xSirad tardeba zedapirulad,
rac iwvevs did kargvebs samecniero-teqnologiuri da inovaciuri saqmianobis yvela sferoSi. Aar aris gamokveTili
prioritetebi mecnierebaSi,
teqnologiur ganviTarebaSi,
umaRles ganaTlebaSi. ar arsebobs sistemuri inovaciuri
politika. arc mecnierebaSi,
arc teqnikaSi da arc mrewvelobaSi ar aris Camoyalibebuli strategiuli gegmebi regionaluri da saerTaSoriso mimarTebiT. es problemebi Zalian swrafad unda aRmoifxvras,
risi miRwevac SesaZlebelia
qarTveli mecnierebisa da mecnier-organizatorebis aqtiuri
CarTviT qveynis marTvis procesebSi, gansakuTrebiT ki gadawyvetilebaTa damuSavebisa
da miRebis sakiTxebSi.
saqarTvelos sabunebismetyvelo mecnierebaTa akademia, romelic amJamad aerTianebs 60mde msoflioSi cnobil mecniers maTematikis, fizikis, qimiis,
informatikis, geologiis da
sxva disciplinebSi gamoTqvams
mzadyofnas mTeli Tavisi codna da gamocdileba moaxmaros
Tanamedrove qarTuli saxelmwifos Camoyalibebas da misi
mdgradi ganviTarebis strategiuli da taqtikuri gegmebis
Seqmnasa da ganxorcielebas.
gvinda gamovxatoT Cveni
Rrma rwmena imisa, rom:
XXI saukuneSi saqarTvelo
gaxdeba sainovacio saqmianobis qveyana – qarTveli eri ki
Tavisi adamianuri resursebiT
erT-erTi sarTaSoriso lideri mecnierebisa da teqnologiebis da Sesabamisad codnaze dafuZnebuli sazogadoebis
ganviTarebaSi.
Tbilisi, 2013 wlis ianvari
2013 weli
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reziume
p. kervaliSvili
saqarTvelos sabunebismeTyvelo mecnierebaTa akademiა
Cvens qveyanaSi bolo ramdenime TveSi ganviTarebulma movlenebma kidev ufro mkveTrad daanaxa saqarTvelos mosaxleobas, rom qveynis marTvasa da ganviTarebaSi arsebobs seriozuli
problemebi, romelTa gadawveta moiTxovs arsebuli inteleqtualuri resursis srul gamoyenebas.
saqarTvelos sabunebismetyvelo mecnierebaTa akademia, romelic amJamad aerTianebs 60-mde
msoflioSi cnobil mecniers maTematikis, fizikis, qimiis, informatikis, geologiis da sxva disci plinebSi gamoTqvams mzadyofnas mTeli Tavisi codna da gamocdileba moaxmaros Tanamedrove qarTuli saxelmwifos Camoyalibebas da misi mdgradi ganviTarebis strategiuli da taqtikuri gegmebis Seqmnasa da ganxorcielebas.
gvinda gamovxatoT Cveni Rrma rwmena imisa, rom:
XXI saukuneSi saqarTvelo gaxdeba sainovacio saqmianobis qveyana – qarTveli eri ki Tavisi adamianuri resursebiT erT-erTi sarTaSoriso lideri mecnierebisa da teqnologiebis
da Sesabamisad codnaze dafuZnebuli sazogadoebis ganviTarebaSi.
SUMMARY
GEORGIA: WAYS OF DEVELOPMENT
P. KERVALISHVILI
Georgian Academy of Natural Sciences
Recent events that occurred in our country showed Georgian nation once again that for governing and development of
the country has serious problems, that could only be solved by using existing intellectual resource.
Georgian Academy of Natural Sciences, that united around 60 famous scientists from various field (Maths, Physics, Chemistry etc.), is ready to share all his opinions and views about sustainable development of Georgia and creating strategies
and ways to execute them.
Our academy believes that in 21st century Georgia will be one of the lead innovators and its scientists are going to be
among other leading scientists of the world and they will help developing Georgian society.
saWiro codna da resursi TiToeuli bavSvis
uflebis realizaciisaTvis
(kanonebSi Sesworeba damatebebisaTvis)
da marTlac, ,,Canasaxidan bavSvs ufleba aqvs iyos daculi"
g. CaxunaSvili
bavSvTa uflebebi uzrunvelyofs bavSvebis sicocxlis
SenarCunebas, maT ganviTarebasa da keTildReobas.
bavSvebi ibadebian Tavisufalni da yvela adamianuri
uflebis mqoneni. es aris bavSvis uflebaTa konvenciis, adamianis uflebaTa saerTaSoriso xelSekrulebis ZiriTadi
winamZRvari, romelic gardaqmnis bavSvebisa da maTi ojaxe2013 weli
bis cxovrebas mTel msoflioSi.1,2,12
„bavSvis uflebaTa konvencia“, romelsac gaeros generalurma asambleam erTxmad dauWira mxari 1989 wels msoflio masStabis iuridiuli dokumentia. saqarTveloSi am konven ci is ra ti fi ci re ba 1994
wlis 21 aprils moxda da aiRo
valdebuleba Seasrulos konvenciis debulebani – saxelm-
26
wifos upirvelesi sazrunavi unda iyos 18 wlamde asakis bavSvebis dacva da maTze zrunva.
bavSvis uflebaTa konveciis ZalaSi Sesvlidan dRemde bavSvebis dacvis saqmeSi miRweulia
progresi. gadaidga mniSvnelovani nabijebi. SemuSavda axali kanonmdebloba, ufro daxvewili saerTaSoriso normebiT, rogoric aris bavSvis uflebaTa konvenciis damatebiTi oqmebi
bavSvebiT vaWrobis, bavSvTa prostituciisa da
pornografiis, SeiaraRebul konfiqtebSi bavSvTa gamoyenebis Sesaxeb.umniSvnelovanesia bavSvTa uflebebi konfliqtis zonebSi da ar SemiZlia ar Sevexo mas saqarTvelos magaliTze.
sabWoTa kavSiris daSlam da Tavisuflebis
dabrunebam saqarTvelos mosaxleobas moutana politikuri areuloba, samoqalaqo omi da
ekonomikis rRveva. samxreT oseTsa da afxazeTSi konfliqtebisa da separatistuli moZraobebis Sedegad adgili hqonda mZvinvare brZolebsa da iZulebiTi migraciis procesebs. dReisaTvis, rogorc cnobilia afxazeTsa da samxreT oseTs okupirebulia ruseTis mier da
marTaven de facto marionetuli separatistuli
mTavrobebi, romlebsac saerTaSoriso Tanamegobroba ar cnobs. sagulisxmoa, rom janmrTelobasTan, kvebasTan, ganaTlebasTan, agreTve, bavSvebis dacvasa da ganviTarebasTan dakavSirebuli problemebi okupirebuli ruseTis mier zonebSi ufro mkveTrad aris gamoxatuli,
vidre saqarTvelos danarCen nawilebSi. saerTaSoriso Tanamegobrobam umjobesia metad gaafarToos sakuTari roli am zonebSi bavSvTa uflebebis dacvis saqmeSi.
da marTlac, `Canasaxidan bavSvs ufleba aqvs
iyos daculi~.
dReisaTvis aRiniSneba bavSvTa da mozardTa sportSi Cabmis intensiobis mateba.umniSvnelovanesia, romamJamad mimdinareobs sportis. medicinisada ganaTlebis erTiani mecnieruli marTvisganxorcielebis
etapi (administraciuli marTvis optimizacia-aRsaniSnavia, rom am procecebSi aqtiuradaa CarTuli arasamTavrobo organizaciebi). A
aqtiobis Seneleba ar iqneba, arc SeiZleba, dro ar iTmens;
amdenad, aucilebelia ufro mWidro da metiurTierTTanamSromloba, rogorc jandacvis,sportis, ganaTlebisa da mecnierebis, aseve
sxva saministroebTan, raTa bavSvTa mdgomareoba saqarTveloSi efeqturad gaumjobesdes.
samedicino dargis profesionalebi valdebulni arian gansazRvron bavSvebis aRqmisa da
gagebis unari, raTa maTi Sexedulebebi gaTvaliswinebuli iyos gadawyetilebis miRebisas
da mkurnalobaze Tanxmobis gacxadebis dros.
samedicino dargis profesionalebi unda TanamSromlobdnen rogorc bavSvebTan, aseve
maT mSoblebTan da isini srulad unda iyvnen
CarTulni SemoTavazebuli mkurnalobis da samedicino gadawyvetilebis miRebis procesSi.
„bavSvis uflebaTa konvencia“ ratificirebulia da Sesulia ZalaSi saqarTvelos mTavrobis mier 1994 wlis 2 ivniss.
saqarTvelos kanonmdeblobaSi asaxulia
bavSvis uflebebis dacvis meqanizmebi samedicino dawesebulebebSi, saqarTvelos kanonSi
„pacientis uflebebis Sesaxeb“ Tavi VIII aregulirebs arasrulwlovanTa uflebebs samedicino momsaxurebis procesSi.
saqarTvelo jer kidev erT-erT bolo adgilzea centraluri da aRmosavleT evropisa
da dsT-s qveynebs Soris socialuri danaxarjebis mxriv. Sesabamisad, kvlav rCeba mniSvnelovani gamowvevebi, rac momdevno xuTi wlis
ganmavlobaSi unda gadaiWras, Tu gvsurs, davicvaT bavSvis uflebaTa konvenciis debulebebi
da 2015 wlamde mivaRwioT aTaswleulis ganviTarebis miznebsa da aTaswleulis deklaraciiT gaTvaliswinebul xedvebs.
unda gavixseno Cvens mier Sesrulebuli proeqti da misi daskvnebi,romelic dResac ar kargavs aqtualobas:
With the support of UNICEF(in 2001-2) we have fulfilled a project “Social-psychological, medical-prophylactic and
rehabilitation measures of children and adults in Penitentiary
Institutions”, one of the main goals of which was the study
of drug addiction and toxemia problems in above mentioned
contingent.
Data of clinical-laboratory and instrumental investigation in 417 children and adults have been analyzed. Questionnaire for Darvy and Bass aggression investigation, Shind test,
Loosher colour test were used which permit to create a perfect “psychological portrait” of under age criminals with recommendations having proper practical significance. In future the latter will be a basis fo(r creation of behavioral prophylactic model having a harmful influence on the society and
on themselves.
Results of investigations carried out were analyzed by means of modern computer programs, involving psychological
test-questionnaires and drawings in crayons.
Analysis of data obtained has shown that:
1. In children and adults of such category we deal with yet
unformed person, subjected to definite changes.
2. While considering obtained results the I, II and III necessary stages were outlined, where:
The I stage stipulates pretrial period.
The II stage stipulates measures to be taken during trial.
The III stage – after being sentenced.
Most children formally refuse the fact of smoking, hashish and glue tasting, but it is not true. The majority of them
before the arrest used different toxic substances (glue, petroleum), which need a great attention at the I-II-III stages.
Thus, investigations carried out have shown that there is
a necessity of taking prophylactic measures against toxemia
and drug addiction in children and adults in order to avoid formation of groups of persons committing a criminal offence.
msoflios mraval qveyanaSi metad mniSvnelovani gaxda bavSvisa da ojaxis keTildReobisa da janmrTelobisTvis bavSvis uflebebis mxardaWera. siRaribis zrdam da garemo
faqtorebma Secvala bavSvTa avadobisa da sikvdilobis struqtura. globalizaciis proces2013 weli
ma gansazRvra politikis wonasworoba, gadawyvetilebis traeqtoria adamianuri da sazogadoebrivi ganviTarebisaTvis.10,14,17
socialuri xasiaTis cvlilebebi moiTxovs
janmrTelobis konceftualizacias da axali
gzebis Ziebas bavSvTa keTildReobis gasaumjobeseblad. saWiro xdeba bavSvTa jandacvis
profesionalebis funqciebis radikaluri
cvlilebebi, raTa maTi qmedeba iyos warmatebuli da Sesaferisi bavSvTa da ojaxTa keTildReobasa da janmrTelobasTan.7,8,9,10,13
uflebebze dayrdnobili gancxadeba, romelic jandacvas miesadageba uzrunvelyofs
iseT samuSao gegmas, realur strategiebsa da
unars romelic SeiZleba gamoyenebuli iyos
profesionalebis mier samedicino momsaxurebisa da bavSvTa dacvisaTvis. bavSvTa janmrTelobasTan dakavSirebuli uflebebi efuZneba oTx ZiriTad komponents, rogoricaa:
sicocxle - bavSvebs aqvT sicocxlisa da gadarCenis ufleba, samedicino momsaxurebiT sargeblobis, wyliTa da sanitaruli sistemebiT
usafrTxod sargeblobis ufleba;
ganviTareba - bavSvebs aqvT ganaTlebis, individualuri ganviTarebis, gonebriv da fizikur SesaZleblobaTa gamovlenis ufleba;
dacva – bavSvebs aqvT ufleba daculni iyvnen nebismieri diskriminaciisa da eqspluataciisagan, omisa da gaWirvebisagan;
monawileoba - bavSvebs aqvT ufleba gaaCndeT
sakuTari azri, Tavisuflad gamoxaton Tavisi
Sexedulebebi, miiRon sasurveli informacia.
„bavSvis uflebaTa konvencia“, awesebs ra saerTo standartebs msoflios yvela qveynisaTvis, amasTanave iTvaliswinebs saxelmwifoTaTvis damaxasiaTebel kulturalur, socialur, ekonomikur da politikur realobebs, raTa TiToeul qveyanas konvenciis debulebebis
optimalurad ganxorcielebis SesaZlebloba
hqondes.
adamianis uflebebi janmrTelobis dacvis
sferoSi
adamianis uflebebi janmrTelobis dacvis
sferoSi or ZiriTad kategoriad iyofa: socialuri uflebebi, romelic moicavs, samedicino momsaxurebis finansur da teritoriul
xelmisawvdomobas, Tanabar xelmisawvdomobas
diskriminaciis gareSe da samedicino momsaxurebis xarisxs. es ukanaskneli gulisxmobs samedicino momsaxurebis adeqvatur xarisxs, (dignostikis, mkurnalobis, reabilitaciis meTodebis adeqvaturobas) da pacientis usafrTxoebas. xolo individuri uflebebia: informaciis miRebis ufleba, informirebuli gadawyvetilebis miRebis ufleba (informirebuli Tanxmoba), konfidencialoba da piradi cxovrebis
xelSeuxebloba, meore azris moZiebis da samedicino personalisa da samedicino dawesebulebis arCevis ufleba.2
iqedan gamomdinare, rom saqarTvelos bavSvebis erT meoTxedze meti siRaribeSi cxovrobs,
2013 weli
27
socialuri dacvis sferoSi mimdinare reformebs gadamwyveti mniSvneloba eniWeba.magaliTad,
aucilebelia Tanasworobaze orientirebuli
skolamdeli ganaTlebis sfero, radgan uRaribes ojaxebSi mcxovrebi xuTi wlis asakis bavSvebi dRes naklebi albaTobiT dadian skolamdeli ganaTlebis dawesebulebebSi, vidre maTi
Tanatolebi SeZlebuli ojaxebidan.mozardebSi jansaRi cxovrebis stilis damkvidreba,
sportis, jansaRi kvebisa da gunduri muSaobis
Rirebulebebis popularizaciis gziT.
janmrTelobis dacvis sferoSi saqarTvelos
kanonmdeblobas safuZvlad udevs saerTaSoriso dokumentebi. saxelmwifo politikis princi pad aris gacxadebuli adamianis uflebaTa
da TavisuflebaTa xelSeuvaloba (saqarTvelos kanoni „janmrTelobis dacvis Sesaxeb“,
muxli 4), rasac Tanabari pasuxismgeblobiT unda icavdes eqimi, eqTani da sxva samedicino personali. samedicino saqmianobis mizania adamianisaTvis janmrTelobis SenarCuneba, misi
janmrTelobis dacva da aRdgena, misTvis tanjvis Semsubuqeba (saqarTvelos kanoni „janmrTelobis dacvis Sesaxeb“, muxli 27).
skolamdeli aRzrdis ganaTlebaze.saerTaSoriso kvlevebiT dasturdeba, rom bavSvebi, romlebic CarTulebi arian skolamdeli ganaTlebis sistemaSi, ufro karg akademiur moswrebas
avlenen skolaSi, anu ukeTesad swavloben, im
bavSvebTan SedarebiT, romlebsac ar miuRiaT
skolamdeli ganaTleba.Tu Cven gvinda, rom saSualo ganaTlebis xarisxi gavaumjobesoT, investicia skolamdel ganaTlebaSi unda CavdoT,
raTa uzrunvelvyoT bavSvebis swavla sabavSvo baRebSi — skolamdeli aRzrdis dawesebulebebSi.
erT-erTi mniSvnelovani rekomendacia swored skolamdel ganaTlebas exeba — visurvebdiT, 2015 wlisTvis, saqarTveloSi, bavSvebis 80%
iyos CarTuli skolamdeli aRzrdis dawesebulebebSi. merwmuneT, es iqneba yvelaze kargi
investicia, romelsac qveyana ganaxorcielebs.
amdenad, saWoro da aucilebelia ufro
mWidro da meti TanamSromloba rogorc jandacvis,sportis, ganaTlebisa da mecnierebis, aseve sxva saministroebTan, raTa bavSvTa mdgomareoba saqarTveloSi efeqturad gaumjobesdes.
moiZebneba saWiro codna da resursi TiToeuli bavSvis uflebis realizaciisaTvis. bavSvTa uflebebi uzrunvelyofs bavSvebis sicocxlis SenarCunebas, maT ganviTarebasa da keTildReobas.amis gareSe SeuZlebelia iseTi
qveynis mSenebloba, romelic aTaswleulis deklaraciiTaa gaTvaliswinebuli — qveynisa, sadac sufevs mSvidoba, Tanasworoba, usafrTxoeba, daculi garemo, mokled — bavSvebisadmi keTilganwyobili saqarTvelo.
aqedan gamomdinare aucilebaa bavSvTa uflebebis dacvis kuTxiT arsebul kanonebSi
moxdes Sesworeba damatebani an moxdes axali
interpretaciiT:
28
kanoni – `Canasaxidan bavSvs ufleba aqvs iyos daculi”
kanoni – `Seiqmnas medicinis, sportisa da ganaTlebis erTiani mecnieruli marTvis erovnuli koncefcia _ janmrTel Taobebze zrunva“
kanoni – `skolebSi da baga-baRebSi saeqimo
saqmianobis amoqmedeba - maTi aucilebloba saganmanaTleblo da skolamdeli dawesebulebebis serTificirebisas”.
kanoni _ `valeologia (sanologia-samedicino mimarTuleba), rogorc axali disci plinaTaSoriso samecniero-pedagogiuri mimarTuleba”.
eTxovos:
- jandacvis saministros:
saeqimo kabinetis struqturis gansazRvra
gzamkvlevTa Seqmna
specialistTa gadamzadebisa da momzadebis uSualo Sesruleba (arasamTavrobo organizaciebTan erTad)
saeqimo saqmianobis monitoringi
- sportis saministros:
specialistebis moTxovnis gansazRvra
sportis eqimebis
fizioTerapevtebis
meTodistebis da a.S.
- ganaTlebis saministros:
specialistTa gadamzadebisa da momzadebis uSualo strategiis Seqmna.
skolebsa da baga-baRebSi saeqimo saqmianobis aRdgena.
eTxovos saqarTvelos parlamentis Sesabamis komitetebsa da aRmasrulebel organoebs
proeqtSi erToblivi Cabmis aucileblobiT gamowveuli erTiani mmarTvelobiTi sainiciativo jgufis Seqmna, romelic bolomde miiyvans
rTulad Sesasrulebel saorganizacio saqmianobas
Semdegi etapia:
1. proeqtSi erToblivi Cabmis aucileblobiT gamowveuli erTiani mmarTvelobiTi sainiciativo jgufis Seqmna, romelic ganaxorcielebs da uzrunvelyofs Zalzed rTulad warsamarT saorganizacio saqmianobas
2. strategiis gansaxorcielebeli programebis Seqmna, ganxilva da umokles vadaSi maTi
Sesruleba
1. asborneide, katarina krauze, alanrosas.
ekonomikuri, socialuri da kulturuli uflebebi, saxelmZRvanelomeoreganaxlebuligamocema; Tbilisi, 2006 w.gv.202-226
2. bavSvisuflebaTakonvencia. Semoklebuliversia. www
3. oTargerzmava. sazogadoebrivijandacvadamenejmenti, saxelmZRvanelostudentebisada-
eqimebisatvis, meoTxeSesworebulidaganaxlebuligamocema, Tbilisis, 2008 w, gv.183-195
4. saqarTveloskanoni `pacientisuflebebisSesaxeb”
5. saqarTveloskanoni `saeqimosaqmianobisSesaxeb”
6. saqarTveloskanoni `janmrTelobisdacvisSesaxeb”
7. Brenda A. LeFrancois. Children’s Participation Rights:
Voicing Opinions in Inpatient Care; Child and Adolescent
Mental Health Volume 12, No. 2, 2007, pp. 94–97
8. Convention on the Rights of the Child.UNGA Resolution 44/25. Available at: http://www.unhchr.ch/html/menu3/b/k2crc.htm or http://www.unicef.org/crc/index.html.
Accessed March 15, 2007
9. Children’s Rights and Child Health.;Pediatric Education
in Community and Office Settings (Starter Kit for Community Preceptors) by Jeffrey Goldhagen, MD, MPH, FAAP http
10. CRED-PRO Status Report — Addendum Child Rights
Curriculum for Health Professionals, 2008
11. Gerison Landsdown. Implementing Children’s rights
and health, Arch.Dis.Child. 2000;286-288
12. International Covenant on Economic, Social and
Cultural Rights.UNGA Resolution 2200A (XXI) 1976.
Available at: http://www.unhchr.ch/html/menu3/b/a_cescr.htm.
Accessed March 15, 2007
13. Lenk C; Radenbach K; Dahl M; Wiesemann C
Non-therapeutic research with minors: how do chairpersons of German research ethics committees decide? Journal
of medical ethics 2004;30(1):85-7.
14. Redress-international covenant on civil and political
rights. UNGA Resolution 2200A (XXI). Available at:
http://www.redress.org. Accessed March 15, 2007
15. Rodriguez-Garcia R, Akhter MN. Human rights: the
foundation of public health practice. Am J Public Health.
2000;90:693–694
16. To ward equ ity in child he alth.Pediatrics.
2003;112(suppl):701–722
17. T.Waterston, J. Goldhagen. Why children’s rights are
central to international Child health. Arch. Dis. Child.
2007;92;17618.G.Chakhunashvili,N.Kandelaki -Children and security:
“Child has the right to be defended from birth” NATO science for peance and seurity series E: Human and societal Dynamics – vol.37 complexity and Security – 2008 Chap.126.
p. 405-410www.iospress.nl
19. Sustainable development and child security. /G.
Chakhunashvili, I. Phavlenishvili /. Social,
Ecological and Clinical Pediatrics. – 2011. - #13-8-7. - pp.
25-46. – geo.; abs.: geo., eng.
20. CaxunaSvili g. medicinis mecniereba da aucilebeli gza XXI saukuneSi misi ganviTarebisaken “Canasaxidan bavSvs ufleba aqvs iyos daculi” socialuri, ekologiuri da klinikuri
pediatria. - Tbilisi, 2009. - N11-6-5. - gv.54-60
www.google.com/search?q=bavSvTa+dacvis+kanoni+
jandacvis+Sesaxeb
www.google.com/search?q= i.manjaviZe+kanoni
www.google.com/search?q=Canasaxidan+bavSvs+ufleba+aqvs+iyos+daculi
2013 weli
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reziume
saWiro codna da resursi TiToeuli bavSvis uflebis
realizaciisaTvis
(kanonebSi Sesworeba damatebebisaTvis)
da marTlac, `Canasaxidan bavSvs ufleba aqvs iyos daculi~.
g. CaxunaSvili
socoaluri pediatriis dacvis fondi
Sromis mizaniakanonebSiSesworebadamatebebisaTvis`Canasaxidan bavSvs ufleba aqvs iyos daculi~
.bavSvTa uflebebis dacvis kuTxiT arsebul kanonebSi moxdes Sesworeba damatebani an moxdes axali interpretaciiT:
kanoni – `CanasaxidanbavSvsuflebaaqvsiyosdaculi”
kanoni – `Seiqmnas medicinis, sportisa da ganaTlebis erTiani mecnieruli marTvis erovnuli koncefcia _ janmrTel Taobebze zrunva “
kanoni – `skolebSi da baga-baRebSi saeqimo saqmianobis amoqmedeba _ maTi aucilebloba saganmanaTleblo da skolamdeli dawesebulebebis serTificirebisas”.
kanoni _ `valeologia (sanologia-samedicino mimarTuleba), rogorc axali disci plinaTaSoriso samecniero-pedagogiuri mimarTuleba”.
SUMMARY
NEEDED KNOWLEDGE AND RESOURCES TO REPRESENT
CHILDREN’S ALL RIGHTS IN THE LAW CODEX OF GEORGIA
(CHILD HAS RIGHT TO BE DEFENDED SINCE EMBRYO)
G. CHAKHUNASHVILI
To ensure reflection of all rights that children have following changes, amendements and adding should be done.
Law – “Children has right to be defended since embryo”
Law – “United national concept- taking care of healthy generation by creating united governance of Sports, Medicine
and Education”
Law - “All schools and kindergartens should have properly taught and certificated doctors or nurses”
Law – “Valeology (sinology- medical branch) as a new interdisciplinary scientific field”.
murman TavdiSvili,
kritikosi, rusTvelologi, filologiis doqtori,
niko nikolaZis premiis luareati saqarTvelos humanitarul
da saxelovnebo mecnierebaTa akademiis akademikosi
droc iyo da saWiroebac moiTxovda, Seqmniliyo am ti pis
wigni, Tanamedrove naazrevi, romelic istoriuli faqtebis faqizi gaanalizebis Sedegad mogvawvdida qarTuli ideis srulyofil saxels, dagvexmareboda
samive droSi mcxovrebi iveriis istoriuli misiis garkvevaSi. da ai, amgvari gamokvlevac
gaCnda. apolon silagaZis „qarTuli idea“ mravalmxriv saintereso narkvevia. sakiTxi, TiTqosda, isedac naTelia: qarTveli eris mTeli murmali da Wa2013 weli
panwyveta miwyiv iqiTken iyo mimarTuli, raTa sakuTari meoba
SeenarCunebina. eg azri avtors
amgvarad Camouyalibebia: „mTeli Cveni istoria, romelic
eris sulieri mdgomareobis saxes warmoadgens, aris – radganac mas damoukideblobis mdgomareobaca hqonda da damoukideblobis dakargvisac – suverenobis ideis gansaxorcieleblad gaSlili erTiani, ganuwyveteli brZolis fronti“ /a.silagaZe, qarTuli idea, 2010, 50/.
aseTia zogadi deklaracia,
30
SiSveli ganacxadi, oRond ra
didi Zalisxmevaa saWiro, ra
didi patriotizmi da oflismRvreli Sroma, raTa eg mosazreba mwyobrad daasabuTo da
liton sityvad ar dagrCes.
rogorc yvelafridana Cans,
am mxriv avtors Tavi ar Seurcxvenia.
winasve gamicxadian:
naSromi ikiTxeba cxoveli
interesiT, SeiZleba metaforulad aseca vTqvaT, – rogorc
leqsi.
teqsts Ta na mim dev ru lad
mivyveT da alag–alag Cveni SeniSvnebi da mosazrebebic gamovTqvaT.
moazrovnes didxans ufiqria, istoriuli faqtebi erTmaneTisaTvis Seupirispirebia
da misula daskvnamde: „saqarTvelo aris im eris qveyana, romelic iyo da aris suverenuli
eri“/7/. amis gasaTvalsaCinoeblad dasmulia kiTxva: „ramdenia kidev amJamad iseTi eri, romelsac amdeni aTaswleulis
ganmavlobaSi sxvadasxva formiT dRemde SenarCunebuli aqvs
saxelmwifoebrioba?“ da iqve
naCvenebia, rom amnair naciebs
Soris /rogoric erTob cotaa/
aris saqarTvelo /7/.
Tavisi konceptualuri debulebebis dasazusteblad moazrovne TiTqmis yovelTvis poulobs mwerlobis klasikosTa
ilaTian naTqvamebs, frTian aforizmebs, mxatvrul figurebs
da amiT saTqmels ufro mkafiod warmogviCens. roca imaze
msjelobs, rom iveria „mudmivad
iyo da aris damoukideblobis
dauTrgunveli survilis mqone
da damoukideblobisaTvis mebrZoli eri, romlis erovnuli
TviTSegneba yovelTvis cocxalia“ /8/, iqve moyvanilia literaturuli samtkici: „sjobs
monobaSi gadidkacebuls Tavisuflebis ZebnaSi mkvdari“.
marTalia, imis SeniSvna araa
Zneli, rom am erma „ar dakarga ena, rwmena, kultura, teritoria, saxelmwifoebrioba da,
rogorc suverenuli erTeuli,
ar gaiTqvifa arcerT did masaSi – arc sparselebSi, arc
berZnebSi, arc arabebSi, arc
skviTebSi, arc rusebSi“, magram
saamisod moxmobili sabuTebi
da gergiliani msjeloba namdvilad sayuradReboa. yoveli-
ve amas ki agvirgvinebs didfasi dakvirveba: „qarTvelobas
yovelTvis surda qarTveloba
/„grigalTa, mexTa, quxilT Soris qarTvlad gazrdili“/...
sxvanair mdgomareobaSi igi
arasodes yofila. sxvanair
perspeqtivas Seguebuli eri
aris arasuverenuli eri“ /8–9/.
avtorma mSvenivrad icis:
qveynis damoukideblobas ZiriTadad ori safrTxe emuqreba:
garegani da Sinagani. isini
garkveulwilad erTmaneTs apirobeben kidec. gareSemotevebis Sedegad qveyana zogjer
kargavda damoukideblobas,
Tumca arc maSin izRudavdao
TviTmyofadobas da maSin qveynierebas evlineboda vasalur
mdgomareobaSi myof damoukidebel xalxad /11/.
wignSi arcerTi met–naklebad mniSvnelovani erovnuli
movlena da faqti araa miviwyebuli, rac sakiTxis garkvevas
waadgeboda. aseTia, magaliTad,
is, rom farsman meores romaelebma TavianTi imperiis dedaqalaqSi uzarmazari Zegli
auges /12/. neba–uneblieT gagondeba stalinis uzarmazari Zeglebi sabWoTa imperiisa da misi dominioni qveynebis qalaqebSi. aseTive faqtia farnavazis
reformebi /13/, oRond administraciul–kulturul RonisZiebebSi damwerlobis /anbanis/ Setana gadaWarbebul Tavisufal azrovnebad mimaCnia.
saqme isaa, rom „mwignobrobis“
Seqmna yovelTvis rodi niSnavs
anbanis /damwerlobis/ Seqmnas.
mwignobroba aqvT frangebs, ingliselebs, germanelebs, oRond
sakuTari anbani /damwerloba/
– ara! savaraudoa, rom farnavazis mier mwignobrobis dawinaureba xdeboda im ori enis meSveobiT, romlebzedac ubnobda
qriste – es gaxlavT arameuli
da ZvelberZnuli. SemTxveviTi
arc is garemoeba unda iyos,
rom Cveni welTaRricxvis I saukunis Zegli armazis bilingva swored am damwerlobebiT
aris Sesrulebuli.
aseve mniSvnelovan istoriul faqtTa wyebaSia moqceuli
aRmosavleTi da dasavleTi saqarTvelos sxvadasxva imperiis gavlenis sferoebad gamocxadeba /V–VI saukuneebi/.
marjved aris ganzogadebuli
is faqti, rom gorgasali sparselebis winaaRmdeg omSi daiRupa, xolo gubaz meore bizantielebma imsxverples /15/.
faqtebis moxmobisa da maTi
faqizi analizis Sedegad miRebulia is ucnauri daskvna, romelic yvelaze uwin akakim gamoTqva. jer avtors movusminoT, mermed – akakis: „VIII – IX saukuneebis mijnaze ramdenime suverenuli qarTuli politikuri erTeuli damkvidrda – tao–klarjeTi, kaxeTi, hereTi, egris–afxazeTi;
qarTveloba ar danebebula – igi
kvlav damoukidebeli iyo“ /17/.
avtoris azris mdinarebis
qveteqsti erTob gamWvirvalea: swored is gvSvelida, rac
xels gviSlida gaerTianebaSi
– daqsaqsuloba da calkeul
damoukidebel, suverenul erTeulTa arseboba.
sagulisxmoa, rom eg ucnauri
azri pirvelma akakim gamoTqva
– saqarTvelo gadaarCina swored iman, rom erTiani da monoliTuri saxelmwifo arasodes
yofilao. aRmosavleTi rom damoukideblobas kargavda, maSin
saqarTvelo Tavs dasavleTs
afarebda; Tu dasavleTs emuqreboda severenitetis dakargvis
safrTxe, maSin aRmosavleTi swevda moazrovne organos – Tavis – rolsao. ai, rogor aris
yovelive es gadmocemuli:
„saqarTvelos ZvelaT WirSi
gamagreba da sruliad amoufxvreloba am sxva–da–sxva ferobis brali iyo. rodesac mteri
saqarTvelos erT romelsame
kuTxes miadgeboda da daipyrobda erT romelsame nawils,
maSin qarTveloba meore kuTxeSi, meore mxareSi gadadioda, iq
ifaravda Tavs da iq Zlierdeboda; mosul mters erTi romelime droTagani wlisa udga,
imave dros qarTvelebs oTxive
dro xelT eWiraT – dabla, barSi, sicxe udgaT, maRla, mTaSi, yinva iyo; ase, amgvaraT bunebis wyalobiT SeunaxavT Tavi; arasodes ar yofilan erTsa da imave dros erTianaT dapyrobili“
/akaki wereTeli, IV, 1990, gv. 264/.
rogorc iTqva, erTob ucnauri da saintereso debadia!
apolon silagaZis wignSi
amas mosdevs msjeloba umTavres sakiTxze: arabTa okupaciis Sedegad zogi xalxi da samefo mTlianad gaqra, xalxTa
2013 weli
meore nawili asimilirda, dakarga sakuTari meoba/mentaloba/. am zewolas mxolod orma
erma /qarTvelebma da somxebma/ gauZleso /17/.
aq suli iqiTken miiwevs, avtors mokrZalebiT SevTavazo
am faqtis axsna: xom ar gamoiwvia es iman, rom am or ers hqonda atomur iaraRze mZlavri
iaraRi – sakuTari damwerloba?
saqme is aris, rom damwerloba da erTiani sametyvelo
ena kir-duRabze umtkicesad
acementebs ers da am dros imdeni mniSvneloba aRar eniWeba teritoriisa da xalxis nawilis okupacias. cnobierebisa da erTgvari uCinari enobrivi dinebis meoxebiT eri mainc inarCunebs erTianobas.
aqve moyvanilia sayuradRebo
faqti: oTxas wels Tbilisi
arabebs epyraT da Tbilisis
saamiro arsebobda. miuxedavad
imisa, rom SegviZlia gavixsenoT
Tifliselis nisbiT moRvawe
araerTi piri /Tundac hubaiS
Tifliseli/, mainc, miuxedavad
amisa, arabebma Cvens garemoSi
ver Seqmnes muslimuri kultura, iseTi kultura, istoriaSi
rom darCeboda /17/. arada, aseTi ram sxvagan moxdao /moyvanilia espaneTis magaliTi/.
aqve me TviTon momyavs meore mkafio magaliTi, TiTqmis
paradigmuli faqti.
XII sa u ku ne Si spar su li
kulturis simZlavris gamoisobiT TiTqmis yvela Suaaziur da mcireaziul qveyanaSi
gavrcelda sparsulenovani
literatura. sparsuli enis
sitkboman bevr ucxoels asurva musikobani. sparsuli metyveleba da kilo mZlavri nabijebiT gamoemarTa kavkasiiskenac. man iolad gadalaxa azerbaijani da aq Seiqmna azerbaijanel avtorTa sparsulenovani poezia /xayani, nizami ganjevi.../; zed saqarTvelos sazRvarTan akvivlda sparsuli baiaTi Tu yandreuli leqsi,
oRond qarTuli samanebi mainc
ver gadmolaxa; Tumca ki rusTveli msoflio mniSvnelobis
aRmosavluri triadis gamouklebel–gamoucalkevebeli wevria /firdousi, nizami, rusTveli/, mainc igi qarTul enaze qmnida; Tumca ki ideebi, saxeebi,
terminebi, sityvebi uxvad ises2013 weli
xa qarTulma poeziam, is mainc
erovnul niadagze darCa da sakuTari mentaloba ar daukargavs. mgonia, aq gadamwyveti
roli iman Seasrula, rom qarTvelebsa da somxebs sakuTari
ori gi na lu ri
dam wer lo ba
gvqonda. TviT Teimuraz pirvelic ki, romeli acxadebda –
sparsuli enis sitkboman gamxada poetado, Tumca ki Temebs,
ideebs, saxeebs uxvad sesxulobda, mxolod qarTuli enis
bazaze qmnida da azrovnebda.
wignis me–18 gverdze gaSlilma msjelobam kvlav gamaxsena akaki da misi „ucnauri“
mosazreba. mkvlevari brZanebs: roca centrs gauWirda
suverenobis SenarCuneba, „Cvenma winaprebma moqmedebaTa centri samxreTSi, tao–klarjeTSi, gadaitanes – grigol xanZTeli, aSot kurapalati“.
da aq avtori xmarobs, Cemi azriT, erTob Rrmaazrovan da saniSno termins TviTdajerebuli:
Cveni eri ara oden ibrZoda damoukideblobisaTvis, aramed am
aspeqtiT erTgvar TviTdajerebulobasac amJRavnebdao /18/.
vinc yuradRebiT Cahkvirvebia
qarTul xasiaTs, termini aSkarad eniazeba. miuxedavad amdeni teritoriisa da xalxis dakargvisa, rac meoce-ocdameerTe
saukuneebSi ganvicadeT, qarTveli kacis suverenuli Tavdajerebuloba /erTi SexedviT, TiTqosda sasaciloc ki/ faqtia.
me, filologs, dia momwons
giorgi merCulis cnobili
formulis – „qarTlad friadi
queyanai aRiracxebis“ – avtoriseuli gaazreba. aq mweralio
„araviTar adgils ar uTmobs
antiarabul /da antiislamur/
ganwyobas da mTlianad antibizantiur ideazea agebuli“ /19/.
mec ase mgonia.
951 wlisaTvis imdenad aRarafrad miaCnia giorgi merCules arabuli safrTxe, rom ukve yu radRe bas amax vi lebs
qristianul mosasxamSi gamowyobil bizantiur safrTxeze. am mxriv sagulisxmoa
formulis bolo nawili, romelzedac mkvlevarebi ratomRac yuradRebas ar amaxvileben. aq naTqvamia: dRemde qarTul eklesiebSi SemorCenilia berZnuli moTani „kvirie
eleison“. saWiroa igi iTarg-
31
mnos da qarTulad ase iTqvas:
an „ufalo, wyaloba yav!“ anda
„ufalo, Segviwyalen!“.
suverenobis SesanarCuneblad
gaSlil brZolaSi qarTvelebs
monRolTa mZlavrobis epoqaSi
arc saqarTvelo dauTmiaT, arc
bagrationTa dinastiis upiratesoba, arca teritoriebi, arc
iuridiuli da arc faqtobrivi
suvereniteti /20/, Semdgom mokled moyvanilia Temur lengis
mravalgzis SemoWris istoria
da naCvenebia: „es iyo samxedro
gamarjvebulis zavi sulierad
da politikurad gamarjvebul
erTan“. amas iqve mohyveba erTgvari ganzogadeba: „suverenobis
SenarCunebis gzaze saqarTvelo
araviTar msxverpls ar erideboda – arc adamianurs, arca sxvas, maT Soris prognozirebad
samxedro marcxsac“ /21/.
marTebuli da, amave dros, didfasi, Tanac erTob aqtualuria
faqtebis siRrmiseuli analizidan gamomdinare daskvna: Cvens
istoriul sazRvrebSi „Cven viyaviT mkvidri eri da vqmnidiT
saxelmwifoebriobasac da kulturasac. sxva aseTi mkvidri eri,
romelsac igive SeeZlo, aq ar
arsebobda; sxva mxolod an Cven
gverdiT iyo warmodgenili mcire tomis saxiT da mTlianad
CvenTan integrirdeboda“ /26/.
amgvar mcire warmonaqmnebs Cvens
teritoriaze araTu kultura,
TviT ubralo sakancelario
dokumentic ar SeuqmniaTo.
da isev akaki!
misi saxeba amJamad ukve
29–e gverdze SemogvanaTebs.
exeba ra XV saukunis aqeTa ambebs, avtori brZanebs: „Cveni
daqucmacebuli arseboba isev
da isev emsaxureboda Cveni
erovnuli da saxelmwifoebrivi suverenobis SenarCunebaze
zrunvas“.
kidev erTi sagulisxmiero
dakvirveba: mxolod qarTl–kaxeTsa da imereTs hqondaT samefos statusi, yvela sxvas –
samTavrosi da eg imitom, rom
amaTi liderebi bagrationebi
iyvneno. amas mosdevs mosalodneli daskvna: daSlilma
saqarTvelom mainc SeinarCuna
ara oden bagrationTa dinastia, aramed maTi meTaurobiT
Seqmnili erTiani suverenuli
samefos erTguleba. „is, rasac
bagrationebi ar marTavdnen,
32
ierarqiulad ufro dabal safexurze iyo dayenebuli“ /30/.
yovelive amas ki mosdevs SesaniSnavi formula, romelic Tavisi arsiT akakis ideis erTgvari ganviTareba da dasruleba gaxlavT: „Cven verTiandebodiT Cveni suverenuli arsebobisTvis, Cven daqucmacebulad vcxovrobdiT Cveni suverenuli arsebobisaTvis; CvenTvis gaerTianebac suverenitetis forma iyo da daSlil mdgomareobaSi yofnac“ /31/.
Cemi azriT, am wignis arsebobas marto eg formulac ki gaamarTlebda.
suverenitetis SenarCunebis
gzaze Cven mier gadaxdili zogi omi Tu brZola winaswar
ganwiruli iyo. es icodnen
xelmZRvanelebmac, oRond mainc ibrZodnen. es gaxldaT, Cemi terminiT, e.w. „CvenebiTi
omi“. amgvar faqtebad avtors
moyvanili hyavs giorgi pirvelis moqmedeba basili keisrisa da giorgi saakaZis gamosvla Sah–abasis winaaRmdeg /35/.
da aq uneblieT TavSi gagielvebs azri: don kixoti sikvdilis win sanCo pansas ukanasknel darigebas aZlevs, aswavlis: devebsa da avsulebs
imitom ki ar vebrZodi, rom maTi usaTuo damarcxebisa mwamda, aramed im mizniT, raTa xalxisaTvis meCvenebina, rom imaT
winaaRmdeg saWiroa xmisa da
xmlis amoRebao.
momdevno Rirebuli debadi
isaa, rom suverenobisaTvis brZolaSi Cabmuli iyo ara mxolod samxedro, aramed sazogadoebis yvela fena, mTeli eri.
Semdgom gatarebulia idea:
XIX saukuneSi, rodesac daikarga politikuri suvereniteti,
win wamoiwia kulturuli avtonomiis /suverenitetis/ idea.
ganxorcielda k.gamsaxurdias
formula: roca eri politikur diqtaturas kargavs, man
kulturuli diqtatura unda
daamyaroso. swored amgvari
diqtaturis saukeTeso nimuSia
qarTvel TergdaleulTa moRvaweoba. ase rom, „XIX saukune...
ar iyo amovardnili Cveni arsebobis mTavari ideis – suverenobis dacvis istoriidan;
igi ar wyvetda jaWvs“ /48/. swored amis Sedegi gaxldaT is,
rom „saukunis dasasrulisaT-
vis saqarTvelos faqtobrivad
hqonda avtonomia imperiis farglebSi, SeiZleba iTqvas, rom
moqmedebda mTavroba ilia WavWavaZis meTaurobiT“ /51/.
bolos, calkeul garkveul
faqtTa analizis safuZvelze,
mocemulia debuleba, rom Cvenma xalxma istoriis ganmavlobaSi SeinarCunao mebrZoli
eris statusi.
vfiqrob, aw ki droa ara mokrZalebiT, aramed Tamamad ganvacxado: aRniSnulis mizezi
jer mterma ar icis, radgan ar
icis arc moyvarem – es gaxlavT Ta vi se bu ri ato mu ri
iaraRi, anu originaluri damwerloba, da mis safuZvelze
Camoyalibebuli originaluri kultura.
eg iaraRi /aba, sxva raRa, Tu
ara es!/ warmatebiT moqmedebda
sabWoTa imperiis xanaSiac. f.s.
kapica /araqarTveli/ aRiarebda:
„mravali aTwleulis ganmavlobaSi saqarTvelo gaxldaT erTi yvelaze damoukidebeli respublika sabWoTa kavSiris SemadgenlobaSi“ /54/. amis sabuTad moyvanilia cnobili faqtebi: arc erT sxva sabWoTa respublikas ara hqonia ise boboqari 1921–24 wlebi; arc erT ers
1978 wels sakuTari enis statusi ise mZlavrad ar daucavs, rogorc saqarTvelos; arc erT
ers ara hqonia ise mZlavri saukunovani skola da universiteti /axla rom saakaSvilma daSala/, rogoric Cven; arc erT
ers ara hqonia ise TviTmyofadi kultura, rogorc Cven /55/.
kidev ufro „ucnauri“ is
gaxldaT, rom 1990 wlis martSi saqarTvelos umaRlesma
sabWom /sabWoTa organom/ 1921
wels saqarTveloSi wiTeli
armiis Semosvlas misca agresiis kvalifikacia, gaauqma 1921
wlis Semdgomi yvela ZiriTadi sakanonmdeblo aqti. „es
uni ka lu ri ga dawy ve ti le ba
imas niSnavda, rom saqarTvelos
sabWoTa xelisuflebam Tavisi
wvlili Seitana damoukideblobis aRdgenis saqmeSi“ /56/.
ase rom, „damoukideblobisaTvis erTxel da samudamod
gaSlili erTiani da ganuwyveteli fronti... moqmedebda sabWoTa wlebSic“ /57/.
sxvadasxva saintereso msjelobis Semdgom avtors Tamamad
Semoaqvs axali termini, viTarca Zvelis ganviTareba – kategoriuli suverenobis idea /69/.
yovelive amas ganapirobebda
qarTveli kacis mier imis Segnebac, rom mis samSoblos hqonda specifikuri da gansakuTrebuli geopolitikuri mdgomareoba, rom saqarTvelo araoden
aRmosavleT–dasavleTis mijnaa, aramed, amave dros, samyaroTa Sexvedris adgilic“ /71/. am
mZime funqcias ganapirobebda
is faqtori, rom mas unda erTmaneTTan daekavSirebina da moerigebina saxelmwifoebrioba –
ganuviTarebeli CrdiloeTi da
saxelmwifoebrioba ganviTarebuli samxreTi; meore mxriv,
qristianul da muslimur kulturaTa dialogSi Cabmuliyo.
maS, qveyanas hqonda da aqvs didi saerTaSoriso funqcia.
Cemi azriT, momavlis dakargva warsulis dakargvasac moaswavebs. SeiZleba warsuli dakargo, oRond momavali gqondes. am
SemTxvevaSi isini erTmaneTze sabediswerod ar aris damokidebuli, magram, Tu momavali ara gaqvs,
warsulsac avtomaturad kargav.
avtori grZnobs amas da
qarTveli eris mier suverenobaze gansakuTrebul zrunvas
rom qarTuli ideis mTavar azrad acxadebs, wres ar gadadis.
amitomac Tua, frTxilad acxadebs: suverenobaze gansakuTrebuli zrunva uSualod aris
dakavSirebuli qarTul Soreul warsulsa da aseve Soreul qarTul momavalTano /79/.
eris misiis sferoSi Semoaqvs
mkvlevars qarTuli enis misia,
misi roli da misi arsis gageba; samarTlianad msjelobs
qarTul–baskur enobriv protoiberiul erTobaze da iqve
miniSnebulia qarTvelTa da
baskTa mebrZoli sulis erTianobasa da am brZolis cecxlisa da alis safuZvelze /82–83/.
qarTuli enis im funqciaze,
im rolze, romelic unikaluria, saubaria 92– 93–e gverdebze. aq umniSvnelovanesia debadi: qarTvelma tomebma ar isurves cal–calke enis statusi da
erToblivad Seqmnes erTi saliteraturo ena erTi damwerlobiT. es niSnavs, rom maT isurves erT erad yofna da ase
zrunva suverenobaze erTiani
qarTuli ideis safuZvelze /93/.
2013 weli
roca patriotizmi wres gadadis, igi mJavdeba. Cveni avtori
wres ar gadadis da saqarTvelos msoflio mesianizmis ideas Tavs ar axvevs. samagierod,
sabuTianad msjelobs imaze,
rom imTaviTve gvqonda sakuTari adgili da funqcia. SesaZloa, es iyoso „SuaSi yofnis
funqcia“ /99/. kargi iqneboda, aq
avtors mogoneboda viqtor nozaZis cnobili debadi, misi
pirvelive wignis winasityvaobaSi moyvanili: qarTvelebi Suala xalxia. marTalia, pirvelaRmomCenTa Soris ar aris, oRond
arc momxmarebel ers warmoadgens. igi warmatebiT iTvisebda
mowinave erebis aRmoCenebs da
sakuTar darjakSi atarebda, sakuTar erovnul damRas adebdao. iqve aRiarebulia: „qarTuli suverenobis idea sakuTar
funqciaze zrunvas gulisxmobs“ /100/ da, amave dros, „am
ideaSi Tavidanve da TavisTavad
gaazrebulia sxvaTa suverenobis aRiareba da kategoriuli
uaryofa sxvaTa – yvelas – suverenobis Selaxvisa“ /107/.
Zalian saxamsoa, rom qarTuli idea gamoricxavs erovnuli
teritoriebis meqanikur zrdas
/111/. am ideis praqtikuli ganxorcielebis magaliTad saxavs
daviT aRmaSenebels /112 – 113/.
saboloo daskvna, romelic
mwerals gamoaqvs, gamoxatulia
sxartad: „Cven viyaviT, Cven
33
varT, Cven viqnebiT!“ /121/. eg
qarTuli idea vrclad, gaSlilad da mxatvrulad gamoxatulia jer kidev giorgi leoniZis „yivCaRis paemanSi“, romelic, samwuxarod, mkvlevarebs
dRemde mcdarad aqvT gaazrebuli. aq siyvarulis yovliswamlekav grZnobas xedaven da
mxedvelobidan ekargebaT mTavari – teqstSi ganviTarebulia iveriis ukvdavebis idea:
yvela momxduri, yvela saxis
yivCaRi moispoba, aRigveba pirisagan miwisa, xolo iveria iyo,
aris da iqneba; qsanzed, aragvzed hyvaoda xodabunebi da
kvlavac ayvavdeba; qarTveli
lamazmani adrec axelebda
vaJkacebs da kvlavac gaaxelebs; qarTveli adrec raindobda da kvlavac iraindebs –
colis, ojaxis, qveynis Rirsebas daicavs...
warsulze imdeni ar unda
ilaparako, rom awmyo dagengres
da momavali Tvalsa da xels
Sua gagiqres. apolon silagaZe im ti pis moazrovnea, romelsac aranakleb ainteresebs
qveynis momavali. am momavals
ki, eWvi araa, didmniSvnelovnad
gansazRvravs ruseTTan Cveni
samomavlo urTierToba. amitomac Tua, avtori maxvil mzeras
aqeTkenac gadmoatarebs: wignSi sakmaod SefarviT naCvenebia
Semdegi: Tu qarTuli idea mcire, kompaqtur, sakuTar terito-
riebze gaSlil saxelmwifosa
da misi suverenitetis dacvas
gulisxmobs, sxvagvaria rusuli
idea: „zedidi saxelmwifo ruseTis arsebobis formaa. igi an
iqneba didi, an saerTod aRar
iqneba. arsebobis sxva forma
mas ar gaaCnia“ /145/.
faqtobrivad am aforizmiT
mTavrdeba naSromis mTavari
ideuri rkali. aris, ra Tqma
unda, ise „wvrilmani“ miTiTebebi, rogoricaa, magaliTad,
es: „saqarTvelos unda axsovdes, rom mis gadarCenaSi Tavis
droze ruseTsac miuZRvis Tavisi wvlili“ /151/, agreTve
ruseTTan urTierTobaSi Cven
mier daSvebuli Secdomebis
Sesaxeb msjeloba /141/.
yovelive es naSroms obieqturobis SuqiT anaTebs da damajereblobasa hmatebs.
werili gamigrZelda.
ufro mokled da sxartad gamoxatva im uzarmazari ideisa
da misi dasabuTebisa ver SevZeli, magram Tavs ase vinugeSeb:
tolstois erTi qalbatoni
gadaekida, gnebavT Tu ara, sami sityviT miTxariT, ris gamoxatvas apirebdiT mravaltomiani „omiTa da zaviTao“?
pasuxi marTlac mokle gamodga:
mag saTqmelis sami sityviT
gamoxatva rom SemZleboda, pirobas gaZlevT, mets arc gamoviyenebdio.
reziume
m. TavdiSvili,
saqarTvelos humanitarul da saxelovnebo mecnierebaTa akademia
murman TavdiSvili ganixilavs rofesor apolon silagaZis wigns „qarTuli idea“ (2010); gamoyofs naSromis calkeul saintereso adgilebs,uCvenebs,rom mkvlevari zustad iyenebs da
iTvaliswinebs istoriul,socialur da literaturul masalebs,romlebze dayrdnobiTac gvixatavs qarTveli kacis bunebas, qarTveli xalxis arsebiT miswrafebas. saboloo daskvna logikuri gamodis:“ saqarTvelo aris im eris qvyana,romelic iyo da aris suveneruli eri“ da
es exeba im droebsac,roca mas garegnulad damoukidebloba warTmeuli hqonda.
SUMMARY
GREAT FUNCTION - HARD
M.TAVDISHVILI
Georgian Academy of natural and art sciences
MurmanTavadishvili discusses book of professor Apolon Silagadze called “Georgian Idea” (2010); He points out several interesting moments of the book and shows us that the author foresees and uses historical, cultural and literary stuff.
Based on these qualities, he is describing human nature and aspiration of Georgian men. Conclusion is logical: “Georgia
is the country, that is and was sovereign nation” and it also includes the time, when liberty was outwardly taken.
2013 weli
34
samedicino mecniereba saqarTveloSi
(sad varT da saiT miviltviT)
yaraman faRava, profesori
qarTul samedicino mecnierebas SesaniSnavi tradiciebi gaaCnia. Rogoria amJamindeli mdgomareoba? Zneli saTqmelia. saWiroa garkveuli “inventarizacia”, ramdeni eweva samecniero aqtivobas medicinaSi, publikaciebis raodenoba, citirebis indeqsi, patentebis ricxvi,
inovaciuri teqnologiebis danergva da a.S.
amasTanave es gazomva ar unda atarebdes erTxelobriv xasiaTs, monitoringia saWiro da is
mogvcems Sesabamisi tendenciebis gansazRvris
SesaZleblobas. Sefaseba sindikatorebis SerCeva esaWiroeba, albaT gareSe auditicaa saWiro. Calkeuli mecnieris reitingis dadgenac
ar iqneboda urigo. SesaZlebelia saerTaSoriso servisebis gamoyenebac, magaliTad ResearchGate-is.
ase Ti az ric ar se bobs, gvWir de ba ki sa me dicino mecniereba, iqneb jobia visargebloT
sa er Ta So ri so ga id la i ne biT da ar Se viq m naT prob le me bi, mi Tuf ro rom mec ni e re ba
fufunebaa, didi finansuri resursebi esaWiro e ba.
amasTanave isicaa gasaTvaliswinebeli, rom
dResdReobiT msoflio or nawiladaa gayofili - ganviTarebul da ganviTarebad qveynebad. maT Soris ufskrulia da igi kiar
mcirdeba, aramed sul ufro Rrmavdeba. cnobilia, rom mecniereba ZiriTadSi ganviTarebuli qveynebis prerogativaa. ase rom, Tu gvinda dasavluri, evroatlanturi sivrcis nawili gavxdeT, standartebs unda SevesabamebodeT. Nebismieri qmedebis warmatebuli rom
iyos, codnazeundaiyosdamyarebuli. nebismierikvleva, miT ufro samecniero, codnis mopovebis saukeTeso saSualebaa. ZalzesainteresosaerTaSorisosazogadoebaarsebobs – samedicino gadawyvetilebis miRebisa, diagnozisa da prognosis safuZvlebis kvlevas emsaxureba. Mecniereba zogjer ekonomiuri Semosavlis wyarocaa. mecnierebas rom eweva pirovneba, inteleqtualurad acizrdeba, amitomac aSS-sa da evropaSi miRebulia, rom kvlevebSi aramarto profesionalebi iyon Cabmuli, aramed studentebica da praqtikosi eqimebic. Samedicino umaRlesi skolis kurikulumebiserT-erTi aucilebeli nawilia kvleviTi komponenti. Codnis gayidva – ucxoelebis swavleba – qveynis prestiJis amaRlebisa da ekonomiuri keTildReobis saSualebaa.
Esec kidev erTi mizezia saimisod, rom samedicino universitetSi samecniero kvleva stimulirebuli iqnas, samecniero literaturis
xelmisawvdomoba unda amaRldes. miTufro,
rom saTanado SedegiTviT universitetis reitingsac gazrdis.
Mecnierebis miznobrivi finansirebis sistema (e.w.grantebi) sayovelTaodaa miRebuli. mainc, ar iqneboda urigo biujeturi regularuli dafinansebis nawilobriv mainc rom aRdgeniliyo. Mecnierebis sponsorobisTvis raRacsagadasaxado SeRavaTebi unda iyos SemoRebuli biznesisaTvis.
medicina, pirvelyovlisa, gamoyenebiTi dargia, magram fundamentur samecniero kvlevasac
unda mieqces saTanado yuradReba. pediatriaSi garda uSualod klinikuri da epidemiologiurisa, kvlevebi asakobrivi fiziologiaSi,
ganviTarebis fiziologiaSic unda xorcieldebodes.
mecniereba, samedicino mecnierebis CaTvliT erovnuli siamayisa da sakuTari Tavis rwmenis ganviTarebas uwyobs xels. Patriotuli
muxti ganasakuTrebiT Zalumia pediatriaSi, bavSvTa asakis fiziologiis CaTvliT. Momavali
Taobis srulyofili TviTrealizacia xom Cveni xvalindeli dRis gabrwyinvalebis safuZvelia.
Tanamedrove mecniereba, rogorc wesi, multicentrulia. Mcire qveynebis resursi araa
2013 weli
sakmarisi. Amitomac saerTaSoriso TanamSromlobaa saWiro, saerTaSoriso konsorciumebSi Cabmaaa ucilebeli. Kidev ufro metad unda iyos gamoyenebuli Cveni ucxoeTSi moRvawe Tanamemamuleebis samecniero da pirovnuli
potenciali.
samedicino mecnierebis popularizacia da,
pirvel rigSi, jansaRad cxovrebis wesis danergvis xelSewyobanebis mieri mkvlevaris, ragind saCino regaliebiT iyos Semkuli, sapatio
movaleobaa.
nebismier doneze – studentebisTvis, axalgazrda da Zvelgazrda mecnierebisTvis permanentuli konkursebis Catareba kidev erTi saSualebaa samecniero aqtivobis gasaZliereblad. Disertaciebis dacvis drosac upriani iqneboda xarisxis aRmniSvneli tradiciuli Suasaukuneebis evropuli maxasiaTeblebis gamoyeneba – rites, cum laude da a.S. saerTod mimaCnia,
rom samecniero cxovreba unda duRdes, konferenciebi, simpoziumebi, SromaTa krebulebis momzadeba, samecniero Jurnalebis gamocema – esaucilebelia.
medicinaSi, rogorc wesi, mravalavtoriani statiebi ibeWdeba, sasurveli iqneboda
TviToeuli avtoris piradi Rvawlis gamoyofa.
samecniero xarisxebis uaryofas Znelia daeTanxmo, raRac kompromisze unda SevjerdeT,
albaT. Zalian momwons germaniis universitetebis sistema, romlis Tanaxmadac habilitacia (mecnierebaTa doqtoris xarisxis analogi) eniWeba mkvlevars, romlis mier drois garkveul periodSi gamoqveynebuli publikacie-
35
bis reitinguli jami (gamoiTvleba imis mixedviT, Tu ra impaqt-faqtoris mqone JurnalSi
gamoqveynda statia) Dadgenil zRvars miaRwevs.
aradoqsalurad JRers, samecniero aqtivobis
Sefaseba SeiZleba eqsport-importsac Sedardes. Aravin davobs importis aucileblobaze,
magram mainc ufro mniSvnelovnad samecniero
eqsporti mesaxeba, ra gaqvs gareT gasatani da
gamosaCeni – esaa mTavari.
misasalmebelia, rom Cvens universitetSi samecniero muSaobis meTodikas aswavlian, winad
xom es absoluturad ugulvelyofili iyo. Samedicino ganaTlebis samecniero safuZvlebi,
esec mniSvnelovan wilad ucxo xilia CvenTvis, saTanado Zalisxmevaa saWiro am mimarTulebiT.
xSirad Camogvdian ucxoeli eqimebi, yvelafers akvirdebian, aRWurvilobas, profesiul
dones; amave dros imasac kiTxuloben, ra samecniero kvlevas awarmoebTo.
obeliis premiis laureates germanulenovan Sveicariel mwerals herman heses SesaniSnavi romani aqvs dawerili – `minis burTulakebi TTamaSi”. aRwerilia pedagogiur provinciad wodebuli kastalia. Misi macxovreblebi mxolod akademiur – saswavlo-pedagogiur
da samecniero saqmianobas ewevian da amiT qveynis da saerTod civilizaciis progress emsaxurebian. Samedicino mecnierebas, miT ufro pediatrias aqvs damatebiT Zalze mniSvnelovani amocana – xeli Seuwyos xalxis janmrTelobas, mzardi Taobis srulyofilad ganviTarebas.
reziume
samedicino mecniereba saqarTveloSi
(sad varT da saiT miviltviT)
y.faRava
Tbilisis sax.samedicino universiteti
qarTul samedicino mecnierebas SesaniSnavi tradiciebi gaaCnia. samedicino mecnierebas, miT
ufro pediatrias aqvs damatebiT Zalze mniSvnelovani amocana – xeli Seuwyos xalxis janmrTelobas, mzardi Taobis srulyofilad ganviTarebas.
SUMMARY
MEDICAL SCIENCES IN GEORGIA
(WHERE ARE WE NOW AND WHERE ARE WE GOING TO)
K.PAGAVA, TSMU
Georgian medical science has great tradition. Medical sciences and especially pediatrics has very important goal to
ensure healthiness of people and normal development of new generation.
2013 weli
36
bavSvTa da mozardTa asakis seqsualuri
darRvevebis sakiTxisaTvis
a. labartyava
iv.javaxiSvilis sax.Tbilisis saxelmwifo universiteti
bavSvTa da mozardTa asakis
seqsualuri darRvevebis sakiTxis codna da misdami saTanado yuradReba mniSvnelovania sazogadoebisaTvis. swored, aRniSnulma ganapiroba am
sakiTxis wamoweva.
Ta na med ro ve seq so lo gia
swrafad viTardeba. kapulaciuri ciklis neirohumoraluri
Semadgeneli yvelaze adre
formirdeba. am Semadgnelis
funqcionaluri aqtivoba gamovlkindeba embrionalur periodSi.
Sekaveba an sxva gadaxra mis
formirebasa da funqcionirebaSi embrionalur an pubertatul periodSi mRavndeba da
axdens gavlenas sxva yvela Semadgenlis formirebasa da
funqcionirebaze.
morfologiur sawyisad neirohumoraluri Semadgenlisa
aris tvinis Rrma nawili da
endokrinuli jirkvlebis sistema.
neirohumoraluri Semadgenlis klinikuri fiziologia
iyofa sam nawilad:
1) limfuri sistemis umaRlesi fena- ganayofiereba.
2) hi poTalamur-hi pofizaruli fena, Sinagani sekreciis
jirkvlebis sistema.
3) limbiko-retikularuli
kompleqsi awesrigebs Sinagan
da garegan signals da uSua-
lod monawileobs qcevis yvela saxeze, formaze. SeiZleba
gamovyoT ori qvesistema: energetikuli aqtivobis da informatiuli done. am ori qvesistemis mowesrigebuli muSaoba
gansazRvravs zogadad funqcionalur dones organizmis
moTxovnilebis Sesabamisad
konkretul situaciaSi.
hi poTalamo-hi pofizaruli
kompleqsis roli sasqeso funqciis uzrunvelyofaSi.
hi poTalamusi, hi pofizi. relizing-faqtori, inhibitori
stimulatori damTrgunveli
faqtori. luTeohormoni, foli ku lo mas ti mu li re be li
hormoni.
hi pofizis wina wili advilad ziandeba sxvadasxva daavadebebiT an dazianebebiT.
folikulomastmulirebeli
hormoni iZleva morfogeneciur
efeqts. astimulirebs folikulis zrdasa da ganviTarebas,
saTesleSi iwvevs sertolis
ujredis proliferacias da
spermatogenuri epiTelis warmoqmnas rac aucilebelia spermatogenezis aqtivaciisaTvis.
efeqtis gamomJRavnebisaTvis aucilebelia mcire odenobis luTeohormoni da testos te ro ni. mniS v ne lo va nia
adeno hi pofizis hormonis,prolaqtinis hormonis moqmedeba.
biWebSi pirveli cvlilebebi gonadotropinebis gamoyofis xdeba 10-13 wlis asakSi.
fmp koncentracia Tavidan matulobs. momatebulia l.h. Semadgenloba sisxlSi rac iwvevs testosteronis gamomuSavebis swraf zrdas da meoradi saqeso niSnebis gamoCenas.
miuxedavad imisa rom 17
wlis asakisaTvis gonadotropinebis koncentracia maRalia, testosteronis gamoyofa
sakmaod dabalia mozrdil mamakacTan sedarebiT, rac miuTiTebs saTeslis Senelebuli
momwifebaze hi pofizis gonadotropul funqciasTan Seda-
rebiT.
asakobrivi cvlilebebi hi poTalamusSi aris zogadi paTogenezuri meqanizmi siberisa da mivyavarT aramxolod
reproduqciuli homeostazis
moSlasTan.
S.s. periferiuli jirkvlebis da zogierTi mediatori
hormonis roli sasqeso funqciis uzrunvelyofaSi
humoraluri regulaciis meqanizmi Sedgeba urTierTdakavSirebuli rgolebisagan: marTva, sinTezi, sekrecia, deponireba, gadatana, metabolizmi, gamoyofa, Sedegi.
mamakacebSi neirohomoraluri Semadgenlobis semiotika
seqsualurobis Camoyalibebis ZiriTadi etapebi damokidebulia neirohomoralur uzrunvelyofaze da sva Semadgenelze kapulatiuri ciklisa,
pu ber ta ci is dam Tav re bi sas
obieqturi simptomebi praqtikulad ucvleleli rCeba.
1) seqsualurobis gamovlinebis asakobrivi maCveneblis
cvla: a) naadrevi, mZime, SeCerebuli, an arqona iseTi komponentebisa, rogoricaa libido.
pirveli eakulaciis droSi
gadaxra.
2) urogenitaluri aparatis
formirebis darRveva:
a) gonadebis formirebis
anomalia (anorxizmi, monorxizmi, kri ptorqizmi, saTesleTa hi poplazia)
b) sasqeso asos formirebis
darRveva (hi pospadia, ispalia,
mikrogenitosomia, fimozi)
g) winamdebare jirkvlis hi poplazia
3) meoradi saqeso niSnebi Camouyalibebloba: a) morfogramis Secvla b) Tmianobis darRveva, savneboze, sxeulze da
Tavze
g) atonia, naoWis ar qona da
depigmentacia saTesle parkis.
maRali xma.
2013 weli
neirohumoraluri Semadgenlobis moSlis semiotika qalebSi
menarxe, menstrualuri cikli, orsulobis dadgomis dro,
orsulobis da mSobiarobis
mimdinareoba, meoradi sasqeso
niSnebis gamovlineba, sasqeso
organoebis ganviTareba da
mdgomareoba, sarZeve jirkvlebis ganviTareba, antropologiuri gamokvlevis monacemebi.
bavSvobidan SeiZleba gagrZeldes qalobaSi.
2) homoseqsualuri realizacia gamoixateba moferebaSi, sinazeSi, amxanagTan an maswavlebelTan Sexeba.
3) Segnebuli Secvla (imitacia), socialurad dauSvebeli
kontaqtisa biWebTan: saubari
axlo megobrebTan erotiul
Temebze, romanebis garCeva, filmebi, erToblivi fantazireba
da gaTamaSeba da erotiulad
Seferadebuli situaciis da
homoseqsualuri realizacia.
(erotikis TamaSi, heteroseqsualuri partnioris nacvlad,
realur homoseqsualurze, rac
ar ganixileba arc ufrosebis
arc megobrebis mier).
seqsologiuri gamokvlevis
monacemebi:
sqesobrivi momwifeba 8-9 weli. 8-10 wlidan morcxvoba da
survili mowonebis. 10 w. mowoneba gadaizrdeba pirvel SeyvarebaSi, romelic rogorc wesi upasuxoa da Semoifargleba dardiT da fantazirebiT.
erotuli komponenti damokidebulia sqesobrivi ganviTarebis tempze. libidos gamovlena SeiZleba ganviTardes:
sruli izolacia biWebisgan,
dedis gavlena an sufTa megobruli, Tanabari damokidebuleba biWebTan, biWuri agresia.
am SemTxvevaSi ar aris bunebrivi realizacia, arc platonuli da arc erotiuli
libidosi. platonuri kompoziciis relizacia (werilebi,
paemani, mzrunveloba, gacileba,
yvavilebi da sxva).
heteroseqsualurad mimarTuli erotiuli gatacebis
realizacia: 13 wlis asakSi
umetesobas aqvs paemani, 15 wlisas uyvardebaT da aqvT peitingi. asakis matebasTan erTad matulobs erotiuli realizaciis sixSire da isaxeba misaReblobis diapazoni.
vidre erotiuli libido
damokidebulia mxolod hormonebze, jer ar CarTula da ar
aris erotiuli fantazireba.
Tu CarTulia da misi realizeba igvianebs socialuri faqtoris gamo, SesaZlebelia gaukuRmarTebuli Senacvleba:
1) erotiuli ocneba sinamdvilis gauTvaliswineblobiT
neirohumoraluri Semadgenlobis moSla
1) sqesis diferencirebis
darRveva (genetikuri aparati
da fermentebi)
2) kapulatiuri ciklis neirohumoraluri Semadgenlobis moSla mamakacebSi
3) neirohumoraluri Semadgenlobis moSla qalebSi
sqesis biologiuri gansxvaveba ganisazRvreba sasqeso
qromosomebis nakrebiT, romelic yalibdeba zigotaSi dedis da mamis gametebis SerwymiT. qalis gameta kvercxujredi Seicavs iqs promosomas, mamakacis spermatozoidi an iqs
an igrek qromosomas.
amrigad sasqeso qromosoma
an iqs-iqs an igrek-iqsi. embrionis sqesi jer kidev sxva niSnebis ar arsebobisas warmoadgens qromosomebis nakrebs genetikuri sqesi.
honaduri sqesi ganisazRvreba sasqeso jirkvlebiT, romelsac aqvs gametogenuri da hormonaluri funqcia, damaxasiaTebeli mocemuli sqesisaTvis.
sasqeso hormonebis biosinTezis procesSi warmoiqmneba
ZiriTadi sasqeso hormoni:
testosteroni, estrogeni da
progesteroni.
biosinTezis Tavisebureba
ayalibebs hormonalur sqess.
sasqeso jirkvlebis gavleniT
yalibdeba morfologiuri an
somaturi sqesi.
magaliTad 45 x karioti piT
ara aqvs meore sasqeso qromosoma, aseTi arseba usqesoa. mas
yve la ni Sa ni vlin de ba
sawyisi androgenuli ukmarisobisas (prepubertati an pubertati). Tu is mJRavndeba pubertaciis dasrulebis Semdeg, gvaqvs asTenia, saTeslis
turgoris gaqroba.
2013 weli
37
miakuTvneben qalurs. kide ufro gasakviria gonadebis sufTa agenezia. mamrobiTi karioti piT 46 xy.
genetikurad es mamakacia,
Tumca hormonaluri komponentebiT subieqti usqesoa.
mamakacebi 47 xxy genetikurad orsqesiania.
sakvercxeebis disgeneziis
sindromi
arCeven or formas, arafunqciuri sakvercxeebiT, aRnagoba pubertatul asakamde normaluria. pubertatul asakSi
sarZeve jirkvlebi ar viTardeba. sakvercxe pataraa da
funqciurad arasrulyofili.
meore forma aris funqcionirebadi sakvercxeebiT. vlindeba pubertatul asakSi. viTardeba amenorea, meoradi sasqeso niSnebi arasakmarisad
viTardeba, aqvs unayofoba, adreuli klimaqsi.
gonadebis funqcionaluri paTologiis embriogenetikur darRvevas miekuTvneba arasruli
maskulinizaciis sindromi. karioti pi 46 xy saTesle jirkvali
gamoxatulia garRveul saTesle
parkSi an sazardulis arxSi.
Sinagani sasqeso organoebi
mamrobiTia, saTesle danamati,
Teslis gammtani sadinari, saTesle buStukebi.
winamdebare jirkvali umetes SemTxvevaSi ar isinjeba.
qalis Sinagani organoebi ar
arsebobs. gareTa sasqeso organoebi naklebad gamoxatulia
maskulinizaciiT.
ZiriTadi mizezi aris androgenebis mgrZnobelobis daqveiTeba. arCeven androgenitalur
da pevnuxoidalur formebs.
gestikularuli feminizaciis sindromi
daavadeba memkvidreobiTia,
gadaecema qalisagan. genetikuri sqesi mamrobiTia. 46 xy. fenoti pi qaluri. fsiqoseqsualuri mimarTuleba qalis. saTesle ganlagebulia muclis
RruSi, gapobil saTesle parkSi an sazarduli arxSi. gareTa sasqeso organoebi qaluria.
arCeven am daavadebis or
formas: sruli klasikuri da
meore arasruli forma, aweuli mgrZnobelobiT androgenebisadmi.
38
rokicanski - kiustneris
sindromi
es aris saSos da saSvilosnos Tandayolili aplazia,
karioti pi 46 xx. sakvercxe
normalurad funqcionirebs,
gareTa sasqeso sfero qaluria. pubertatul asakSi menstruacia ar aris.
qirurgiuli Carevis Semdeg
(xelovnuri saSos Seqmna) sqesobrivi cxovreba Cveulebriv
mimdinareobs Tumca unayofoebi arian.
Tandayolili androgenitaluri sindromi
es genetikurad ganpirobebuli daavadebaa. am dros xdeba
fermentuli sistemis ukmarisobis ganviTareba. Tirkmelzeda
jirkvlis qerqi am dros gamoyofs ZiriTadad androgenebs.
viriluri forma: damokidebuli androgenebze. solicerirebuli forma (debre-fibigeris sindromi): damokidebulia fermentebis ufro Rrma
deficitze. hi pertonuli forma: 11 beta hidroqsilazis deficitis dros.
penisis magvari klitori,
ureTris da saSos erTiani naprali, saTesle parkis magvari
didi sasircxvo bageebi, naadrevi sqesobrivi da fizikuri
ganviTareba orive sqesSi.
Tandayolili adreno-genitaluri sindromi
aris qalur-genetikuri da
honaduri sqesiT. nayofis Tirkmelzeda jirkvali gamoyofs
didi raodenobiT androgenebs,
nayofi ibadeba gareTa sasqeso
organoebiT, romelic axlosaa
mamrobiTTan. saTelsle ar
isinjeba magram miakuTvneben
mamrobiT sqess, romelSic is
SemdgomSi aRizrdeba.
diagnostirebis Semdeg dgeba
sakiTxi sqesis Secvlaze an operaciaze. 15-20 wlis asakSi xSiria
TviTmkvlelobebi. sqesi unda
Seicvalos 3 wlamde, uares SemTvxvevaSi 7 wlamde. mSobiaroba
viwro menjis gamo operaciulia.
Tandayolili adreno-genitaluri sindromi mamakacebSi
biWebSi SeiniSneba naadrevi
sasqeso da fizikuri ganviTareba, izoseqsualuri ti piT. 35 wlisas uCndeba Tmianoba. 8
TerTmeti wlis asakSi sasqeso
sfero iseTive aqvs rogorc
mamakacebs.
12 wlis Semdeg zrda Cerdeba, 16 wlisas Zvlovani asaki Seesabameba zrdasrulisas. aReniSneba Tirkmelzeda jirkvlis
ormxrivi hi perplazia, momatebulia 17 ketosteroidebis gamoyofa SardiT. avadmyofebi eqims
mimarTaven dabali tanis da unayofobis gamo. aReniSnebaT oligospermia an abospermia.
sqesis arCeva rTuli sakiTxia, saWiroa specializebuli stacionari, seqsopaTologis, fsiqiartis, urologis, ginekologis konsultacia.
neiro humoraluri Semadgenlis moSla mamakacebSi
sasqeso funqcis moSla mamakacebSi tvinis nawilis paTologiisas neiro humoraluri SemadgenliT. tvinis lokaluri kerovani dazianebam SeiZleba gamoiwvios sasqeso
organoebis funqciebis darRvevebi.
kalmanis sindromi - luTeohormonis da filikulomastimulirebeli hormonis ikmarisoba. axasiaTebs hi posmia an
anosmia, ‘’kurdRlis tuCi’’,
‘’mglis xaxa’’, feradi sibrmave,
siyrue, fsiqiuri ganviTarebis Seferxeba, sindaqtilia,
Tirkmlis funqciis darRveva
da sxva.
hi pofizis funqciis moSla
- iwvevs: 1). panhi popituitarizms. viTardeba sasqeso sistemis da fizikuri ganviTarebis CamorCena.
2). hi pofizaluri nanizmi iZleva zrdaSi CamorCenas, isini unayofoebi arian da ganuviTarebeli aqvT sasqeso organoebi.
3). hi pogonadizmi - xasiaTdeba gareTa da SigniTa sasqeso organoebis ganuviTareblobiT da meoradi saqeso
niSnebis ararsebobiT. arCeven
embrionalur, pubertaciulamdel da pubertaciis Semdgom
gonadizms.
em b ri o na lu ri vlin de ba
anorxizmis, kri ptorxizmis an
klainfelteris sindromis saxiT. embrionalur hi pogonadizms mivyavarT hermafroditizmamde. postpubertaciul
formas axasiaTebs moradi sas-
qeso niSnebis gaqroba. organoTa (sasqeso) atrofiiT da maTi funqciis moSliT. saTesleebis dazianeba sqesobriv
momwifebamde ganapirobebs ‘’saWurisis sindroms’’.
pubertatul periodSi ganviTarebuli hi pogonadizmi, travma, kastracia, simsivne da sxva.
misi gamoxatuleba damokidebu li da a va de bis dawye bis
asakze. gamoirCevian maRali
taniT, sxeulis aRnagoba araproporciulia, kidurebi SedarebiT grZelia, kunTTa tonusi sustad ganviTarebulia.
kanqveSa cximi qaluri ti pisaa.
zogierTs aqvs ginekomastia.
kri ptorqizmi _ roca erTi,
an orive sasqeso jirkvali ar
aris Camosuli parkSi. naadrevad dabadebul axalSobilebSi iTvleba fiziologiurad.
arCeven kei ptorqizmis erTmxriv an ormxriv muclis da sazardulis formas. paTologiuri cvlilebebi saTesle jirkvlebSi or wlamde asakSi ar
SeimCneva.
distrofia vlindeba 5 wlidan. 10 wlis asakidan mcirdeba 17 ketosteroidis gamoyofa SardSi, gansakuTrebis ormxrivi kri ptorqizmis dros,
rac metyvelebs androgenuli
funqciis daqveiTebaze. pacientebs darRveuli aqvT reproduqciuli funqcia, mxolod aT
procents aqvs spermatozoidebi.
klainferteris sindromi Tandayolili daavadebaa, romelic xasiaTdeba saWurisis
poporciebiT, ginekomastiiT,
hopigonadizmiT da azospermiiT. avadmyofebs aqvT zedmeti
iqs qromosoma dedis an mamis
gametogenezSi. arCeven: 1). normaluri mamakacis garegmoba
ginekomastiiT, 2). normaluri
mamakacis garegnnoba ginekomastiis gareSe, 3). saWurisis
garegnoba, ginekomastiis arqona an susutad gamoxatuliT, 4).
mkveTri saWurisoba ginekomastiiT. xSirad eqims mimarTaven unayofobis gamo.
seqsualuri darRveva Tirkmelzeda jirkvlis funqciis
moSlisas
1). Tirkmelzeda jirkvlis
qronikuli ukmarisoba (adisonis daavadeba)
2013 weli
2). icenko-kuSingis daavadeba
3). (kortikosteroma, glaukosteroma) kuSingis sindromi
4). kortikoestroma (mafenizirebeli simsivne)
seqsualuri darRveva farisebri jirkvlis daavadebis
dros
1). Tireotoqsikozi
2). hi pTireozi
sasqeso funqciis darRveva
Saqriani diabetis dros
RviZlis funqciis darRveva
da sasqeso sfero
pubertaciuli ganviTarebis
tempis moSlis sindromi
arCeven:
1). aCqarebuli pubertaciuli ganviTareba (naadrevi) SedarebiT advilad gamosacnobia. etiologiaSi didi mniSvneloba eniWeba infeqciurtoqsikur zemoqmedebas, travmas, simsivnes da memkvidreobiT
faqtors. arCeven WeSmarit: a)
konstitucionalur anu idiopaTiurs b) cerebralur formas da crus: a) Tirkmelzeda
jirkvlis geneziT b) gonaduri geneziT g) egzogenuri (medikamentozuri geneziT).
WeS ma ri ti pu ber ta ci u li
ganviTarebis tempis moSla
viTardeba hi pofizis gonadotropuli hormonis sekreciis darRveviT, ris Sedegadac
hi poTalamusi- hi pofizi - gonadebis cvlis Seferxeba iwvevs sqesobrivi ganviTarebis
darRvevas. crus dros, gonadotropuli hormonebis naadrevi sekrecia ar viTardeba da
gaZlierebuli gamoyofa sasqeso hormonebisa romelsac gamoimuSavens Tirkmelzeda jirkvali an simsivne, ar Seesabameba normalur prepubertaciul an pubertacul periods,
gonadebi rCebian infantilurebi da ar funqcionireben.
gogonebSi SeiZleba iyos
hetero da izo seqsualuri gamovlinebebi, biWebSi mxolo
izoseqsualuri. damaxasiaTebelia meoradi sasqeso niSnebis
adreuli Camoyalibeba, dawyebuli dabadebidan gansakuTrebiT 4-5 wlis asakSi. biWebSi
TvalSisacemia sasqeso asos
gadideba. gogonebSi sarZeve
jirkvlebis ganviTareba da
genitaluri sisxldena. fsiqi2013 weli
uri ganviTarebis mxriv aRiniSneba oligofrenia, inteleqtualuri ukmarisoba, susti msjeloba, sityvaTa maragis
siRaribe.
am fonze zogierTs aqvs
kargi musikaluri smena, midrekileba msjelobisaken. emociurad an ugrZnobelni arian an
agznebulebi, feTqebadi agresiiT, isteriiT, darRveuli aqvT
Termoregulacia.
es pacientebi sainteresoa
sasamarTlo samedicino eqspertizis kuTxiT.
hi pofizis funqciis moSla
da sqesobrivi darRveva:
1). hi popituitarizmi
- mSobiarobis Semdgomi hi popituitarizmi (Sixanis sindromi)
- simondsis daavadeba
2). hi popituitarizmi
persistirebuli laqtoreaamenoreis sindromi
sakvercxis funqciis moSlasTan dakavSirebuli seqsualuri darRveva
arCeven centralur da periferiuls, hi poTalamus-hi pofizis da sakvercxis.
sakvercxis paTologia Seicavs:
1. prepubertaciuli anovarias (sakvercxis funqciis gamovardna sabavSvo asakSi) mivyevarT fenoti pis darRvevamde
da aseqsualobamde.
2. postpubertaciuli hi poovarizmi (meoradi anovaria)
qirurgiuli kastraciis Semdeg da axasiaTebs seqsualuri
funqciis moSla.
3. sakvercxis ukmarisoba
mozrdil asakSi
4. sakvercxis ukmarisoba
klimaqterul asakSi.
Stain-leventilis sindromi
- hi perandrogenuli disfunqcia sakvercxis misi anovulaciuri mdgomareobisas. avadoba
mJRavndeba pubertatul periodSi, roca aqtivdeba sakvercxis funqcia. zogjer aRiniSneba sarZeve jirkvlebis ganviTarebaSi CamorCena, klitoris
hi pertrofia. sakvercxeebi gadidebulia, saSvilosno dapataravebulia. arenoblastoma - gamomdinareobs mamakacuri elementebiT qalur gonadebSi, xdeba nebismier asakSi, sisxlSi mo-
39
matebulia testosteroni da
mkurnaloba operaciulia.
seqsualuri darRvevebi Tirkmelzeda jirkvlis funqciis
darRvevisas:
1. kuSingis sindromi
2. androsteroma, hormonalurad aqtiuri simsivnea, romelic gamoyofs androgenebs
da gvxvdeba axalgazrdebSi.
qalebSi SeimCneva maskulinizacia, hirsutizmi, gameloteba
hi perTireozi - moSlilia
menstrualuri cikli, daqveiTebuli sqesobrivi ltolva.
naadrevi sqesobrivi ganviTarebis sindromi:
amaSi Sedis Tandayolili
adrenogenitaluri sindromi,
qaluri genetikuri da gonaduri sqesiT xasiaTdeba. naadrevi sqesobrivi ganviTarebis
cerebraluri forma SeiZleba
iyos kerovani an zogadi.
kerovanisaTvis damaxasiaTebelia uxeSi nevrologiuri
darRveva siTxis dinamikis
moSliT, hi pertenzia, hidrocefalia da sxva. etiologiaSi
wamyvania samSobiaro travma,
intranataluri paTologia.
sqesobrivi ganviTarebis Sekavebis sindromi
meoradi sasqeso niSnebis
ganuviTarebloba, menstruaciis arqona 15 wlis asakSi. arCeven or formas:
1. centraluri warmoSobis
Sekaveba (kostitucionaluri),
damaxasiaTebelia gviani menarxe, menstrualuri da reproduqciuli fraqcia, dedis an
debis mxriv, rac miuTiTebs hi poTalamur ukmarisobaze. am
dros gvaqvs maRali aRnagoba,
maRali fexebi, menjis Semcireba, meoradi sasqeso niSnebi CamorCeba ganviTarebaSi.
2. sakvercxeebis genezis Sekaveba. am formis dros axlo
naTesavebSi darRveva ar aReniSneba, magram anamnezSi xSiria
wiTela da epidemiuri parotiti. meoradi sasqeso niSnebi ganuviTarebelia. gansakuTrebiT
sarZeve jirkvlebi, gulmkerdi
didia, Semcirebulia menjis
zomebi. saSvilosno da sakvercxeebi hi poplaziuria. hormonebis gamoyofa momatebulia,
vidre centraluris dros. ad-
40
re dasmuli diagnozi da mkurnaloba karg Sedegs iZleva.
seqsualurobis Camoyalibebis ZiriTadi etapebi
ada mi a nis in di vi du a lur
ganviTarebaSi SeiZleba gamovyoT asakobrivi jgufebi seqsualurobis CamoyalibebaSi da
dinamikaSi.
1. parapubertaluri - (1-7w)
roca yalibdeba sqesobrivi
TviTSegneba, ganviTarebis pirveli ti pi.
2. prepubertaciuli periodi
- (13w) sqesobrivi qcevis arCeva da stereoti pis formireba
(fsiqosocialuri ganviTarebis meore etapi)
3. pubertaciuli periodi (12-18w) organizmis seqsualuri
ganviTarebis yvelaze Zlieri
periodi, romlis drosac xdeba sqesobrivi momwifeba, yalibdeba platonuri, erotiuli da
sawyisi faza seqsualuri libidosi. es aris fsiqoseqsualuri ganviTarebis mesame ti pi.
4. seqsualuri Camoyalibebis
gardamavali periodi - (16-26w)
es aris ukanaskneli stadia mesame etapisa (seqsualuri libidos Camoyalibeba).
5. momwifebuli seqsualobis
periodi - (26-35w) gamoirCeva
regularuli sqesobrivi cxovrebiT mudmiv partniorTan.
pirobiT fiziologiuri xazi
sqesobrivi aqtivobisa.
6. inovulaciuri periodi (57-75w) sqesobrivi aqtivobis
daqveiTeba, intresebis Sesusteba, libidos regresiiT.
fsiqoseqsualuri orientaciis Camoyalibeba - 12-26 wlis
asakSi iyweba da aRwevs maqsimums endokrinuli sistemis
funqcionireba. individualuri
temperamentis da xasiaTis
afuZvelze yalibdeba pirovneba. xdebasakuTari mdgomareobis gadaxedva ojaxSi da sazogadoebaSi.
muSavdeba sakuTari msoflmxedveloba, viTardeba umaRlesi emociebi. damokidebuleba
sqesTa Soris simamace da sinaze. mozardis Caketilobisas
SeiZleba Seiqmnas sasurveli
niadagi seqsualuri Camoyalibebis darRvisaTvis, rasac
xels uwyobs mizanmimarTuli
sqesobrivi aRzrdis arqona.
mesame etapis maxasiaTebelia
fsiqoseqsualuri orientaciis
formireba.
fsiqosocialuri ganviTarebis tempis da drois moSla
Sekaveba (retardacia). SedarebiT xSiri variantia fsiqoseqsualuri ganviTarebis moSlaSi. somatogenuri Sekaveba
dakavSirebulia sqesobrivi
ganviTarebis CamorCenasTan.
isini mZime dsa Znelad samarTavia, aqvT biologiuri safuZveli.
fsiqogenuri Sekaveba ganpirobebulia fsiqikis moSliT.
somaturi da sqesobrivi momwifeba xdeba swored da Seesabameba asaks. fsiqopaTiis damamuxruWebeli moqmedeba iwyebs
gamovlinebas fsiqoseqsualuri orientaciis Camoyalibebis
dros. ufro adre da Rrmad
deformirdeba seqsualobis
dadgoma.
sociogenuri Sekaveba fsiqoseqsualuri ganviTarebisa gamowveulia araswori sqesobrivi aRzrdiT.
naadrevi fsiqoseqsualuri
ganviTareba gamoixateba seqsualobis adre CamoyalibebaSi,
romelic uswrebs asakobriv
da sqesobrivimomwifebis normebs. ZiriTadi mizezebia somaturi, fsiqiuri da mikro socialuri.
es procesi ar eqvemdebareba Terapiul koreqcias.
fsiqoseqsualuri ganviTarebis gadaxra - sqesobrivi
TviT Seg ne bis moS la, auto
identifikacia, transseqsualizmi. miuxedavad gonadebis
swori Camoyalibebisa, urognitaluri traqtis da meoradi
sasqeso niSnebis ganviTarebisa, dabejiTebiT mikuTvneba mowinaaRmdege sqesisadmi, aris
transseqsualizmi.
aseTi bavSvebi irqmeven sawinaaRmdego sqesis saxels, iTxoven dauZaxon biWi an gogo. isini aRweven Caicvan sawinaaRmdego sqesis tansacmeli. maTi
cxovreba savsea tragizmiT.
surT daamtkicon Tavisi ‘’me’’.
Seicvalon sqesi. es paTologia
klinikurad mJRavndeba 5 wlamde. bavSvebi cdiloben ganamtkicon Tavisi roli mowinaaR-
mdege sqesSi, maT ver warmoudgeniaT iuridiuli, socialuri
da samedicino Sedegebi.
mwvaved aRiqvaven sasqeso niSnebis ganviTarebas. gogonebs
awuxebT sarZeve jirkvlebis
gadideba, biWebs sasqeso asos
zrda. transseqsualebis umetesoba sqesobriv kontaqts amyarebs Tavisive sapasporto sqesTan. 20-21 wlis asakidan sqesis
Seclva gaZnelebulia socialuri motiviT. saWroa aramarTo
sqesis Secvla, aramed sacxovrebeli adgilis Secvla, sabuTebis gamocvla da ase Semdeg.
sqesobrivi qcevis stereoti pis moSla - transformacia
qcevaSi formirdeba meore sqesisaTvis damaxasiaTebeli CvevebiT, swori sqesobrivi kuTvnilebis miuxedavad.
sqesobrivi ltolvis Camoyalibebis dros am mozardebSi arsebobs homoseqsualuri
gatacebis saSiSroeba. xSirad
SeiniSneba interseqsualuri
tansacmlis xmareba. gogonebs
ar adardebs Tavisi sqesis damokidebuleba, urTierToba. ar
SeuZliaT gai pranWon, ar aqvT
qaluroba. rasac isini abraleben ‘’Sinaberoba’’-s.
transformacia gamoixateba
agreTve sqesobrivi urTierTobis adre dawyebaSi. sqesobrivi urTierTobisas iswrafian
ufrosi asakisaken. transformaciis mqone mamakacebi ufro
advilad eguebian garemos socialuradac da sqesobrivadac.
hi perroluri qceva _ momatebuli xazgasma sasqeso rolisa. misTvis damaxasiaTebelia aramyari, zogjer isteroiduli aqcentacia da fsiqopaTia. sadizmi mamakacebSi da mazoxizmi qalebSi. sadizmis
elementebi adreul bavSvobaSi gadaizrdeba seqsualur
parafiliaSi. agresiuloba SeiZleba CaiTvalos sqesobriv
ltolvaSi mozardis an Wabukis, gansakuTrebiT maSin roca
realizacia gaZnelebulia da
gadadis fantaziorobaSi.
am bavSvebSi dasaSvebia sxva
saxec. sqesobrivi ltolva
gadainacvlebs ufro adreul
asakSi da gaxdeba agresiuli
sadisturi. am meqanizs gavs paTologiuri mazoxisturi per2013 weli
versiuli meqanizmi. romlis
sa fuZ ve li ara de dob ri vi
zrunva, aramed piriqiT, zedmeti yuradReba, fereba da ase
Semdeg. mozardebSi SeiniSneba
TanatolebSi Cxubi, Tambaqo,
alkoholi, narkotiki.
SeiniSneba aseve antisocialuri saqcieli, sadisturi cema, sastiki saqcieli umcrosebis, zogjer ki Tanatolebis
da cxovelebis mimarT.
fsiqosocialuri orientaciis moSla _ cnobilia rogorc sqesobrivi garyvnileba,
seqsualuri perversia, parafilia. ltolvaSi CarTulia umwifari saqcieli bavSvur da
mozard asakSi. arCeven tranzistorul, SenacvlebiT parafilias, roca ar aris saSualeba sqesobrivi ltolvis
realizaciisa.
perversia inacvlebs ufro
adreul asakisaken, mas axasiaTebs polimorfizmi, mJRavndebian 6-10 wlis asakSi. SeiZleba ganviTardes Secdenisas an
fsiqiuri daavadebebisas.
fsiqopaTebs axasiaTebT vuairezmi, pedofilia, fetiSizmi,
cxovelebTan urTierToba, narcizmi.
narcisizmi _ (autoerotizmi, automonoseqsualizmi, autofilia) Tavis Tavisadmi mimarTuli sqesobrivi ltolva.
sakuTari sxeuliT tkboba, gataceba. romelsac Tan axlavs
sqesobrivi aRgzneba. mniSvne-
41
loba aqvs Tanatolebisagan
izolacias. roca Seswavlis
obieqti marto sakuTari sxeulia. sarkeSi aTvalierebs sakuTar Tavs, sasqeso organoebs,
iRebs suraTebs gaSiSvlebuli.
yvela gamovlenas axlavs
aRgzneba, masturbacia gantvirTvisaTvis.
nekrofilia _ bavSvebSi orgazmi orive sqesTan dakavSirebulia SiSTan da saSiSroebasTan. bavSvi TviTon midis saSiSroebis gancdamde wignis
kiTxviT an filmis cqeriT. iSviaTad nekrofilebi Cadian
mkvlelobas da Semdeg amyareben gvamTan urTierTobas.
eqsqibicionizmi _ sasqeso
orgamoebis gaSiSvlebis survili amaTu im sqesTan. xdeba
mamakacebSi.
pedofilia _ ltolva bavSvebisaken. SeiniSneba mozardebSi, romelbic ver amyareben urTierTobas TanatolebTan.
skopofilia _ miyuradebis
ltolva. sqesobrivi aqtis an
SerCeuli sqesis gaSiSvlebis.
pornografiiT gataceba.
efebofilia _ sqesobrivi
ltolva mozardebTan da saymawvilis asakTan.
fetiSizmi _ (idolizmi, simvolizmi) garkveuli fetiSis
ayvana saTayvaneblad da sqesobrivi ltolva misdami. fetiSis sagani SeiZleba iyos nebismieri nivTi. is gvxvdeba mamakacebSi. ltolva dakavSirebuli siamovnebasTan SeiniSneba bavSvebSi. subieqti cdilobs maqsimaluri sqesobrivi
aRgznebis miRwevas.
homoseqsualizmi _ sqesobrivi ltolva Tavissave sqesTan. homoseqsualuri TamaSebi
gvxvdeba bavSvebSi, maqsimaluri aqtivoba modis fsiqoseqsualuri orientaciis Camoyalibebisas.
darRvevebis 5% mimarTulia
bavSvebisken, 45% mozardebisken, 45% mozrdilebisaken da
5% xanSiSesulebisaken.
zo o fi lia _ sqe sob ri vi
ltolva cxovelebisadmi da
siamovnebis miReba maTTvan
kavSiriT. ZiriTdad SeiniSneba mamakacebSi. sofleli mozardebi imyofebian zoofilur kontaqtSi. is matulobs
15-dan 25 wlamde. qalebSi ZiriTadad SeiniSneba Sinaur ZaRlebTan da katebTan.
vaginizmi _ es aris fsiqikuri darRveva qalebSi. am dros
xdeba saSos da menjis kunTebis krunCxviTi SekumSva, rac
xels uSlis sqesobriv cxovrebas.
amgvarad, bavSvTa da mozardTa asakis seqsualuri darRvevebis ganxilva da sakiTxis
codna mniSvnelovania.
reziume
bavSvTa da mozardTa asakis seqsualuri darRvevebis
sakiTxisaTvis
a.labartyava
iv.javaxiSvilis sax.Tbilisis saxelmwifo universiteti
bavSvTa da mozardTa asakis seqsualuri darRvevebis sakiTxis codna da misdami saTanado
yuradReba mniSvnelovania sazogadoebisaTvis. swored, aRniSnulma ganapiroba am sakiTxis wamoweva da misi SromaSi ganxilva.
SUMMARY
KNOWLEDGE AND ATTENTION ABOUT THE DISORDER
OF CHILD AND ADULT SEXUALITY
A.LABARTKAVA, (TSU)
Knowledge and attention about the disorder of child and adult sexuality is very important for society. That’s why this
question is conditioned to be discussed in labour.
2013 weli
42
pediatriuli marTvis prioritetebi da
maTi ganviTarebis perspeqtivebisaqarTveloSi
a. kvezereli-kopaZe
asociaciis prezidenti
yvelasaTvis cnobilia saqarTvelos saxelmwifos mZime socialur-ekonomikuri mdgomareoba, rac xels uwyobs mosaxleobisa da kerZod
bavSvTa asakis janmrTelobis mdgomareobis
sagrZnob gauaresebas. janmrTlobisa da socialur sferoSi uaxloes momavalSi gamoyofili dafinanseba jer kidev ver aRwevs im parametrebs romliTac SesaZlebeli iqneba jandacvis yvela dargis erToblivad dakmayofileba.
saqarTvelos pediatriuli samsaxuri mudmivi yuradRebis qveS imyofeboda saxelmwifos
mier, Tumca dRs garkveuli mizezebis gamo is
amas moklebulia. Tbilisis saxelmwifo samedicino institutSi daixura pediatriuli
fakulteti, pediatriis instituti mTlianad
daiSala da gauTanabrda Cveulebriv bavSvTa
stacionars, maSin rodesac es dawesebuleba
mTeli respublikis baziT axorcielebda saorganizacio, meTodologiur, samecniero da
kadrebis aRzrdis saqmes.
saqarTvelos jandacvis saministroSi daixura dedaTa da bavSvTa departamenti, romelic
koordinirebas uwevda pediatriul samsaxurs,
gegmavda da nergavda misTvis saWiro prioritetul mimarTulebebs. aman ki gamoiwvia garkveuli negatiuri movlenebi am dargis ganviTarebaSi. jandacvis sferoSi gatarebuli
reformebis Rrma analizma dagvanaxa, rom:
1. pediatriul samsaxurSi avadmyofTa raodenoba gacilebiT metia arsebul sawolebis
raodenobasTan SdarebiT.
2. mouSave samedicino personalis raodenoba CamorCeba saWiro normativs.
3. Tanxebi gamoyofili biujetidan da sadazRvevo kompaniebidan sakmarisi ar aris avadmyofTa samkurnalod, dawesebulebis SenaxvisTvis da eqimebis Sromis asanazRaureblad.
am disbalansis Sedegad saxezea:
1. samedicino momsaxurebis dabali xarisxi
2. samedicino personalis dabali anazRaureba
3. samedicino dawesebulebebis mwiri maerialur-teqnikuri baza
4. samedicino mosaxurebis dabali xelmisawvdomoba.
warmodgenili situaciuri analizi, romelic
asaxavs amJamad arsebul pediatriuli samsaxuris sferos, mTlianad miuTiTebs mis aradamakmayofilebel mdgomareobaze. yovelive amas
dReisaTvis emateba saqarTveloSi arsebuli genofondis tragikuli Semcireba, romelic uaryofiTi niSniT aris warmodgenili.
bunberivia pirvel rigSi masze did zemoqmedebas axdens mosaxleobis socialur-ekonomikuri mdgomareoba, xSri ganqorwinebebi da
ojaxis dangreva, ltolvilTa gausaZlisi pirobebi, pensionerTa didi armia, Sinaberebis didi ricxvi da qveynidan mravalricxovani mosaxleobis masiuri emigracia.
yovelive zemo aRniSnuli Zlier indikators
warmoadgens genofondis Semcirebis procesebis ganviTarebaSi.
saqarTvelos pediatriuli samsaxuri Tavisi
dRevandeli mdgomareobiT mkveTrad CamorCeba
msoflios mraval mowinave qveyanas. amis magaliTia iseTi statistikuri maCvenebeli, rogoricaa bavSvTa sikvdilianoba. Tu SevadarebT am
monacemebs ramdenime qveynis magaliTze davrwmundebiT rom gansxvaveba sagrZnoblad didia:
5 wlamde bavSvTa sikvdilianoba 2010 w. janmrTelobis saministros monacemebiT:
saqarTvelo
germania
somxeTi
azerbaijani
22
4
20
39
1 wlamdebavSvTa sikvdilianoba 2010 w. janmrTelobis saministros monacemebiT:
saqarTvelo
germania
somxeTi
azerbaijani
24
4
18
46
aRniSnuli sikvdilianobis maCveneblebSi metad
didi adgili ukavia dRenaklul bavSvebs (50%).
dRes msoflios mravali kompetenturi organizaciis mier dadgenilia, rom bavSvisa da mozardis janmrTelobis mdgomareoba da dRegrZeloba damokidebulia 4 faqtorze: a) genetika da garemo 8-10% (Cvens mier naklebad marTvadi), b) cxovrebis wesi 49% g) janmrTelobis dacva 8-10%.
bavSvTa janmrTelobis mdgomareobaze moqmedi uaryofiTi faqtorebia arsebuli socialur-ekonomikuri mdgomareoba da pirveladi
jandacvisa da hospitaluri seqtoris urTierT arakoordinirebuli muSaoba. pirveladi
2013 weli
jandacvis ojaxis eqimebi xSirad ver sazRvraven vin datovon saxlSi samkurnalod da vin
gagzavnon stacionarSi.
stacionarSi moxvedril avadmyof bavSvs ki
3-4 dReSi odnavi gaumjobesebiTanave xSirad weren saxlSi, imis miuxedavad rom didi dro
sWirdeba bavSvis srul gamojanmrTlebas. deda ar aqcevs amas yuradRebas da kvlav agzavnis bavSvs sabavSvo baRSi, sadac mas xvdeba axali virusul-respiraciuli infeqciebi da mas
ewyeba daavadebis axali cikli, romelic SemdgomSi SeiZleba mZime daavadebebSi gadaizardos an moxdes procesis qronizacia.
ai erTerTi mizezi xSirad moavade bavSvTa jgufebis Seqmnisa. gakvirvebas iwvevs is faqtic rom
Tu aseTi bavSvi meored moxvda stacionarSi 3
dRis Semdeg, mis mSoblebs mTlianad axdevineben
mkurnalobis safasurs.
metad arasaxarbielo mdgomareobaa dRes sabavSvo baRebSi da sajaro skolebSi respiraciuli
virusuli infeqciebis gavrcelebasTan dakavSirebiT da rac mTavaria araviTari profilaqtikuri RonisZiebebis gatarebas am mxriv adgili ara
aqvs. pedagogiuri personali kategoriulad ewinaaRmdegeba gacdenebs da avadmyofi bavSvebi iZulebuli arian iaron skolaSi da baRSi.
metad savalalod migvaCnia is faqti, rom
dRes saqarTvelos jandacvam sruliad daiviwya profilaqtikuri medicinis doqtrina da
mTlianad gadavida mxolod avadmofTa mkurnalobis saqmeze. amas xeli Seuwyo kerZo holdingebisa da sxva kerZo pediatriuli dawesebulebebis farTo qselis gaCenam saqarTveloSi, romlebic mTlianad gadarTuli arian samkurnalo saqmeze da profilaqtikur RonisZiebebs nakleb yuradRebas aqceven.
mravali uaryofiTi faqtoris gaCenis gamo,
rac xels uSlis pediatriuli dargis ganvitarebas, dauSveblad migvaCnia biznesis farTo masStabebiT danergva jandacvis sistemaSi da gansakuTrebiT pediatriul samsaxurSi.
dReisaTvis naklebad kontrolirebadia saqarTvelos regionebSi arsebuli pediatriuli
samsaxuris mdgomareoba, maT Soris axlad aSenebul samkurnalo-profilaqtikur dawesebulebebSi. rogor arian isini materialur-teqnikuri xaziT momaragebuli da momsaxurebis
romel dones miekuTvnebian. aris Tu ara raime cvlilebebi ukeTesobisken pirveladi jandacvis da hospitalur sferoSi.
referaluri sistemis monacemebiT Tu vimsjelebT, xSiria avadmyofTa dagvianebuli gadmoyvana respublikis centralur stacionarebSi, es ki sworad organizebuli muSaobis did
nakls warmoadgens.
metad savalalo mdgomareobaSia dRes pediatriis dargSi mecnieruli kadrebis aRzrdis sakiTxic. axalgazrda medikosebs gauqraT interesi mecnierebisadmi, radgan sakvalifikacio Sromis Sesruleba doqturanturis xaziT didi Tanxebis gaRebas moiTxovs. swored amitom aris, rom
Tbilisis saxelmwifo samedicino universitetSi medicinis doqtoris xarisxis mosapoveblad
weliwadSi erTeuli sabWos sxdomebi imarTeba.
2013 weli
43
movlenebis ganviTarebis amgvarad gagrZelebis
SemTxvevaSi, mokle xamSi TiTqmis aRar gveyoleba medicinis xarisxis doqtorebi da axalgazrda kadrebis aRmzrdeli pedagogebi.
amrigad warmogidgineT uSualod Cemi xedva
dRevandeli saqarTvelos pediatriuli samsaxuris mdgomareobis Sesaxeb da bunebrivia daismis
kiTxva: ra RonisZiebebis gatarebaa saWiro arsebuli mdgomareobis gamosasworeblad?
dRevandeli qveynis socialur-ekonomikuri
mdgomareobidan gamomdinare, jandacvis sistemisTvis gamoyofili SedarebiT mwiri biujeti gvaiZulebs ganvsazRvroT yvelaze prioritetuli mimarTuleba, romelic nakleb danaxarjebs moiTxovs da swraf reagirebas moaxdens bavSvTa samedicino momsaxurebis gaumjobesebis saqmeSi.
aseT prioritetul mimarTulebad Cven dRes
migvaCnia perinataluri da neonataluri samsaxurebis swrafi gaumjobeseba da maTi srulyofa.
dReisaTvis arsebuli materialur-teqnikuri resursebi uklebliv unda moxmardes medicinis am
prioritetul mimarTulebas. radgan uaRresad aqtualuria antenataluri periodis nayofis marTvis, daavadebaTa profilaqtikisa da mkurnalobis im meTodebis danergva, romlebic dRes mTel
msoflioSi rutinul xasiaTs atarebs, xolo saqarTvelos samSobiaro saxlebSi, erTeul gamonaklisis garda, maTi danergva ver xorcieldeba.
‘’keTilsaimedo starti’’ anu gansakuTrebuli
zrunva da kontroli nayofisa da axalSobilis
ganviTarebaze pre da post natalur periodebSi da mas didi roli miekuTvneba momavali Taobis harmoniuli aRzrdisa da misi pirovnebis Camoyalibebis etapobriv ganviTareabaSi.
Tundac aviRoT nayofisa da axalSobilis hi poqsiuri procesebi, romelic iwvevs mozardTa deviaciur qcevebs. 76% mozardebisa romelTac gadatanili aqvT perinataluriiSemiuri daavadeba,
midrekili arian narkomaniisa da toqsikomaniisadmi. zogierTi perinataluri paTologia 82% SemTxvevaSi ayalibebs mozardTa Soris qurdobis da
sisxlis samarTlis damnaSave pirovnebis qcevebs.
adreuli asakis bavSvTa genetikur stigmebs Soris gul-sisxlZarRvTa sistemis dazianeba maRali maCvenebliT xasiaTdeba. gulis sistemuri gadaxrebi aris sawyisi wyaro mozrdilobis periodSi gulis iSemiuri daavadebebis ganviTarebisTvis. antenatalur periodSi adreuli asakis diagnostikas udidesi mniSvneloba eniWeba.
magaiTad sanayofe wylebis Seswavlis saSualebiT 4% SemTxvevaSi SesaZlebelia distres sindromis prognozireba nayofis dabadebis Semdeg.
aseve adreuli gamokvlevebi utyuaria sxvadasxva siyviTleebis dasadgenad da hi perbilirubinuli encefalitebis prevenciis SesaCereblad.
saqarTvelos pediatriuli samsaxuris dRevandeli mdgomareobis gamosworebas metad Sromatevadi samuSaos Catareba dasWirdeba. mxolod
jandacvis saministros ZalisxmeviT ki am mdgomareobis gamosworeba TiTqmis SeuZlebelia, Tu
amsaqmeSi ar CaerTo mTlianad saqarTvelos pediatriuli sazogadoeba da misi wamyvani birTvi dargobrivi asociaciebi.
dReisTvis saqarTveloSi pediatriis dargiT
44
3 ZriTadi asociacia moqmedebs: saqarTelos pediatrTa asocoasia, 80 wlis muSaobis gamocdilebiT, saqarTvelos pediatriuli akademia,
romelic Camoyalibda 4 wlis win da socialuri pediatriis dacvis fondi, daarsebuli 1997
wels.
dargobrivi asociaciebis areboba da maTi margi qmedebis koeficienti mTeli msoflios magaliTze didi xania rac cnobilia, mxolod saqarTveloSi maTi roli SedarebiT dakninebulia.
globaluri problemebis gadawyvetaSi didi rolis Sesruleba SeuZlia pediatriis instituts,
romelsac dRes dakarguli aqvs Tavis muSaobis
gankuTvnili statusi da gaTanabrebulia Cveulebriv bavSvTa stacionarTan.
reorganizaciis SemTxvevaSi igi SeZlebs Camoyalibdes lider pediatriul centrad, romelic qveynis masStabiT standartizaciis doneze gauwevs xelmZRvanelobas pediatriuli
samsaxuris mraval profilur mimarTulebas,
iseve rogorc amas axorcielebda 50 wlis ganmavlobaSi.
saqarTvelos dRevandeli pediatriuli samsaxuris marTvisa da ganviTarebis mizniT, saWirod
migvaCnia Semdegi RonisZiebebis gatareba:
antenataluri periodis nayofis daavadebaTa
profilaqtikisa da mkurnalobis im meTodebis danergva, romlebis dReisTvis mTel msoflioSi rutinulsaSualebad miiCneva. da saqarTvelos samSobiaro saxlebSi naklebad gamoiyeneba.
perinataluri centrebis Camoyalibeba saqarTveloSi (Tbilisi, quTaisi, baTumi, zugdidi, Telavi)
referaluri sitemebis gafarToeba da srulyofa
jandacvis sainformacio sistemis da statistikuri samsaxuris gaZliereba da srulyofa
uwyveti samedicino ganaTlebis sistematizireba da eqimTa sertificirebisa da licenzirebis daxvewa.
sayovelTao samedicino dazRvevis ganviTareba da srulyofa.
bavSvTa daavadebaTa gaidlainebisa da protokolebis damuSaveba da maTi danergva samkurnalo profilaqtikur dawesebulebebSi.
saqarTveloSi sakuTari bavSvTa kvebis
produqtebis Seqmna da maTi teqnologiuri
procesebis qarxnuli wesiT gamoSveba.
saqarTveloSi mosaxleobis siRaribis miRma arsebuli bavSvTa kontigentisaTvis gaixsnas qveynis masStabiT 3 munici paluri bavSvTa
stacionari.
respublikis regionebSiaSenebuli axal
samkurnalo-profilaqtikuri dawesebulebebs
unda mekuTvnos kategoriebi da amis Sesatyvisad dauyovnebliv daudgindeT muSaobis uflebamosilobis kroteriumebi.
dazustdes ra donezea regionebSi pediatriuli samsaxuris saqmianoba da ra princi pebiT regulirdeba igi.
jandacvis organoebis mier gamaxvildes
yuradReba pediatriaSi samecniero-kvleviTi
saqmianobis ganviTarebaze da doqtorantTa
ricxvis gazrdaze.
ganxorcieldes pediatriis institutis reorganizacia raTa misi profesiuli kadrebis
gamoyenebiT ganxorcieldes mravali orgamizaciuli sakiTxis damuSaveba da misi pediatriul praqtikaSi danergva.
reziume
pediatriuli marTvis prioritetebi da maTi ganviTarebis
perspeqtivebi saqarTveloSi
a. kvezereli-kopaZe
saqarTvelos pediatrTa asociacia
yvelasaTvis cnobilia saqarTvelos saxelmwifos mZime socialur-ekonomikuri mdgomareoba, rac xels uwyobs mosaxleobisa da kerZod bavSvTa asakis janmrTelobis mdgomareobis sagrZnob gauaresebas. janmrTlobisa da socialur sferoSi uaxloes momavalSi gamoyofili dafinanseba jer kidev ver aRwevs im parametrebs romliTac SesaZlebeli iqneba jandacvis yvela dargis erToblivad dakmayofileba.
saqarTvelos dRevandeli pediatriuli samsaxuris marTvisa da ganviTarebis mizniT SemuSavebulia RonisZiebebis gatarebis gegma.
SUMMARY
PRIORITIES OF PEDIATRIC MANAGEMENTS AND
THE PERSPECTIVE OF THEIR DEVELOPMENT IN GEORGIA
KVEZERELI-KOPADZE
Georgian Pediatricians Association
Everyone is familiar with Georgia’s hard social and economic state, which encourages worsening the health status of
the population, especially children.
The finances that are spent in Healthcare and Social field still cannot ensure that every field of medicine is equally satisfied.
The association has developed managing plan of pediatric field.
2013 weli
45
àbortis problema~
(iv. javaxiSvilis saxelobis Tbilisis saxelmwifo universiteti,
sazogadoebrivi jandacvis samagistro programa).
T. maxaraZe
iv. javaxiSvilis saxelobis Tbilisis saxelmwifo universiteti
aborti arisNorsulobisNnaadreviNSewyvetaNdaNsaSvilosnodanNnayofis gamoZevebaNorsulobisN22NkvirisNSesrulebamde. aborti SeiZlebaNiyosNspontanuriNanu TavisTavadi da xelovnuri. TviTneburi aborti arNarisNdamokidebuliNorsulisNsurvilzeNdaNgamowveuliaNjanmrTelobisNmdgomareobisNsxvadasxvaNdarRveviT. xelovnuri aborti
arisNorsulobisNxelovnuriNSewyvetaNorsulisNsurvilis,
NjanmrTelobisNmdgomareobisNanNsxvaNmizezisNgamo.
aborts didi zianis motana
SeuZlia qalis janmrTelobisTvis. igi: — asustebs organizmis damcvelobiT unars da
xSirad amwvavebs sasqeso organoebis anTebiT daavadebebs;
_ SeiZleba gaxdes uSvilobis,
TviTneburi abortebis, garTulebuli orsulobis da mSobiarobis mizezi – SeiZleba gaxdes hormonuli moSlilobebisa da menstrualuri ciklis
darRvevis mizezi; – xels
uwyobs sarZeve jirkvlebis
kibos ganviTarebas; – xSirad
aris qalis naadrevad daberebis da klimaqsis mizezi. – rogorc fsiqologiuri travma,
SeiZleba gaxdes nevrozebisa
da fsiqikis sxvadasxva ti pis
aSlilobis mizezi. – SeiZleba gaxdes wyvilis sqesobrivi
uTanxmoebisa da SemdgomSi
2013 weli
seriozuli ojaxuri konfliqtis mizezi amrigad, aborti uaryofiT zegavlenas axdens ara mxolod qalze, aramedNmisNojaxsaNdaNmTlianadNsazogadoebazec.
yovelwliurad msoflioSo
abortis Sedegad iRupeba 70
000 qali
ukanasknel aTwleulSi mecnierebis eTikis im mraval
problemaTagan, romelic sazogadoebis gansakuTrebul interessa da vnebaTaRelvas iwvevs,
yvelaze mwvave abortis sakiTxia. sazogadoebrivi azri
mkveTrad polarizebulia.
abortis momxreebis azriT,
sakiTxi ase unda davayenoT: SeiZleba Tu ara qali vaiZuloT
ataros arasasurveli nayofi
sakuTari janmrTelobisa da
sicocxlis fasadac ki~? es qalis uflebaa da misi arCevania
ataros TuNaraNCasaxuliNnayofiNanNgaikeTos aborti.
abor tis mo wi na aR m de ge ni
mTavar aqcents imaze akeTeben,
rom embrions, nayofs sicocxlis iseTive ufleba aqvs, rogorc yvela adamians. xelovnuri aborti _ es adamianuri arsebis sicocxlis xelyofaa, e.
i. mkvleloba da rogor SeiZleba visaubroT `mkvlelobis
uflebis~ Sesaxeb?
gansakuTrebuli Tema (ramac
unda aaRelvos abortis momxreebi, Tumca mas ZiriTadad mo-
winaaRmdegeni wamoWrian xolme), grZnobs Tu ara nayofi tkivils? samecniero TvalsazrisiT es sakmaod rTuli sakiTxia, radgan tkivili fsiqofiziologiuri fenomenia. 1997
wels samuSao jgufma, romelic
didi britaneTis meanobisa da
ginekologiis samefo kolejma Camoayaliba, gamoaqveyna moxseneba `nayofis cnobiereba~. es
moxseneba, romelic literaturis dawvrilebiT analizs
efuZneba, amasTanave exeba sakiTxs, TuNraNasakidanNSeigrZnobsNtkivilsNnayofi.
aRniSnulia, rom ganviTarebis ocdamesame kviras nayofs
aRmoaCndeba refleqtoruli
reaqciebi, mxolod mavne (zianis momtan) stimulebze. periferiuli nervebis, zurgis tvinis, tvinis Rrus, Tavis tvinis
qerqisa da Talamusis struqturuli integracia, rac nebas
gvaZlevs visaubroT nayofis
SegrZnebaze, iwyeba arauadres
orsulobis ocdameeqvse kvirisa. orsulobis Sewyvetis procedurebis Catarebisas, Tu nayofi 24 kviraze meti asakisaa,
rekomendebulia gautkivarebis Catareba an sedatiuri saSualebebis gamoyeneba. amasTanave, moxsenebaSi gamoyofilia
sfe ro e bi, rom le bic Sem d gomNSeswavlasNmoiTxovs.
NNabortis mowinaaRmdegeni
eqimebs samarTlianad sayveduroben, rom gviani abortebis Catarebisas isini ar iyeneben nayofis gautkivarebis saSualebebs. mxedvelobaSia misaRebi, rom yvela dokumentSi, romlebic cxovelebze biosamedicino eqsperimentebis Catarebis
normebs exeba, pirvel rigSi
aRniSnulia gautkivarebis aucilebloba. Tuki mivubrundebiT sabWoTa kavSiris jandacvis meTodur rekomendaciebs _
òrsulobis xelovnuri Sewyvetis operaciis gautkivareba~
(1988 w), sakiTxs nayofis gautkivarebis Sesaxeb aq ver Sex-
46
vdebiT. rekomendaciebSi mxolod orsul qalzea saubari.
abortis Catarebisas eqimebis mier sakuTari momsaxureobis reklamireba damkvidrebuli praqtikaa. abortis mowinaaRmdegeni samarTlianad adanaSauleben eqimebs, visTvisac
aborti momgebiani biznesia.
isini xSir SemTxvevaSi aranair informacias ar awvdian sasowarkveTil qalebs, romlebic sruli SesaZlebelia gauazreblad dgamdnen am nabijs.
didi emociuri Zala aqvs nayofis ganviTarebis Sesaxeb
embriologiur monacemebs, romlebsac abortis mowinaaRmdegeni iyeneben saagitaciod: nayofs guliscema ewyeba Casaxvidan meCvidmete dRes, ocdameerTe dRes mas gaaCnia sisxlis
mimoqcevis Caketili sistema, meormoce dRes SeiZleba SevniSnoT tvinis eleqtruli impulsebi, meeqvse-meSvide kviras nayofi damoukidebel moZraobas
iwyebs, merve kviras ki _ TiTis
lokvas, meTerTmete _ meTormete kviras igi aqtiurad sunTqavs garemomcvel wylebSi da
a. S. aqve unda gaesvas xazi sami faqtis gansakuTrebul mniSvnelobas: guliscemis dawyebas
da damoukidebeli sunTqvis da
tvinis eleqtronuli aqtivobis gaCenas. M msgavsi argumentebisa da aseve samomavlo Sedegebze adeqvaturi informaciis miwodebis safuZvelze, sruliad SesaZlebelia qalma SecvalosNTavisiNgadawyvetileba.
rac Seexeba religiis damokidebulebas __ marTlmadidebeli zneobriobis pirveli
mcneba siyvarulia. aborti aris
siyvarulis mcnebis darRveva,
amasTan, TviT misi adamianuri
siRrmiseuli arsis _ dedis mier Svilis mokvlis gamo. aseTi
midgoma ukompromisod gmobs
nayofis gamodevnas, aTanabrebs
ra dedis mucelSi myof Canasaxs cocxal adamianur arsebasTan, romlis mkvleloba Zveli aRTqmis mcnebis _ àr kac
kla~ darRvevaa da axali aRTqmis siyvarulis mcnebis darRvevac. Mmagram mainc arsebobs
kiTxvebi: ra saWiroa siRaribis
gamravleba? rogor moviqceT,
Tu orsuloba Zaladobis Sedegia? ra vqnaT, Tu fexmZimedaa 13
wlis gogona? Tu dedisTvis
orsulobis gagrZeleba sicocxlesTan SeuTavsebelia da
sxv. moskoveli dekanozi dimitri smirnovi TanamimdevrobiT
aanalizebs ra `rTul~ sakiTxebs abortTan dakavSirebiT da
ar eTanxmeba abortis aranair
gamarTlebas. Tvlis ra nebismier xelovnur aborts mkvlelobad da ar uSvebs araviTar
kompromiss. igi ambobs: `xom bunebrivia deda daiRupos mSobiarobisas. Tu gogona garyvnilia da ase iqceva, man, bunebrivia, unda ataros Tavisi jvari
(unda daisajos), rogorc sakuTari qcevis Sedegi: xSirad gaupatiurebisas TviTon dazaralebulia damnaSave _ gamomwvevi Cacmulobis, qcevis, gaufrTxileblobis, ufrosebis daujereblobisNdaNa. NS. Ngamo~.
qarTuli marTlmadidebluri eklesiis pozicias abortTan dakavSirebiT kargad gamoxatavs RvTisSoblis taZrad
miyvanebis taZris winamZRvari
dekanozi miqael botkoveli: _
`gavixsenoT, ra sityvebiT mimarTa ufalma mkvlel kaens: `xmai
sisxlisa Zmisa Senisa RaRadebs
Cuenda momarT queyaniT~ (dab.
4, 10). udanaSaulo bavSvebis
sisxli abelis sisxliviT cas
SeRaRadebs. mkvlelebi mxolod saukuno cxovrebaSi rodi isjebian, isini sazRaurs amqveynadac iReben. gasvrili sindisi yvelaze mTavars _ sulier simSvides _ arTmevs adamians. mxolod sinanuliT ZaluZs
sulsNmisiNdabruneba.
rac Seexeba sakanonmdeblo
bazas evropaSi, is SeiZleba pirobiTad oTx mimarTulebad
daiyos:
1. yvelaze liberaluri kanoniT nebadarTulia àborti TxovniT~ (qveynebis patara jgufi).
2. sakmaod Tavisufali kanonebi nebas iZleva Catardes
aborti mravalricxovani samedicino da socialuri maCveneblis mixedviT (eqvs qveyanaSi: inglisi, ungreTi, islandia,
kviprosi, luqsemburgi, fineTi).
3. sakmaod mkacri kanonebi
abortis nebas iZleva mxolod
garkveuli garemoebis dros: qalis fizikuri an fsiqikuri
janmrTelobis mZime mdgomareoba, nayofis inkurabeluri defeqtebis, gaupatiurebisa da
incestis SemTxveva (espaneTi,
portugalia da Sveicaria).
4. Zalian mkacria kanonebi,
romlebic an saerTod krZalavs
abortebs an nebas rTavs gamonaklis SemTxvevebSi, roca orsuloba safrTxes uqmnis qalis
sicocxles (CrdiloeT irlandia, axlo warsulamde _ irlandiis respublika da malta).
saqarTvelos kanoniT `janmrTelobis dacvis Sesaxeb~ saqarTvelos yvela moqalaqes
ufleba aqvs Tavad gansazRvros Svilebis raodenoba da
maTi dabadebis dro. saxelmwifo uzrunvelyofs dedis uflebebs reproduqciis sferoSi (muxli 140). kontraceptivebis warmoeba, importi da gavrceleba unda moxdes janmrTelobis dacvis saministros
mier dadgenili wesiT.
qalTa janmrTelobis gaumjobeseba abortebis Semcirebis gziT saxelmwifos prioritetuli amocanaa. orsulobis
nebayoflobiTi Sewyveta nebadarTulia:
mxolod licenzirebuli
samedicino dawesebulebebSi
licenzirebul eqimebis mier;
Tu fexmZimoba saqarTvelos kanonmdeblobiT gansazRvrul vadaze naklebi xangrZlivobisaa;
Tu orsuls eqimma Cautara winaswari gasaubreba da gasaubrebidan operaciamde gasulia kanonmdeblobiT dadgenili mosafiqrebeli vada. gasaubrebis dros eqimma upiratesoba nayofis sicocxlis dacvas unda mianiWos, arCevani qalis prerogativaa (muxli 142).
abortis sawinaaRmdego propaganda da saganmanaTleblo
muSaoba saxelmwifosa da sazogadoebis movaleobaa. abortis reklama akrZalulia saqarTvelos kanonmdeblobiT.
gansazRvrul vadaze meti xangrZlivobis orsulobis SemTxvevaSi aborti nebadarTulia
mxolod samedicino da socialuri Cvenebebis mixedviT.
literatura:
bela mamulaSvilis `bioeTika”
saqarTvelos kanoni janmrTelobis dacvis Sesaxeb
wikipedia. org
mkurnali. ge
parliament. ge
moh. gov. ge
2013 weli
47
reziume
àbortis problema“
T. maxaraZe
aborti uaryofiT zegavlenas axdens ara mxolod qalze, aramed misNojaxsaNdaNmTlianad
sazogadoebazec. am saziano gadawyvetilebis miRebaSi didi wvlili miuZRviT eqimebs, visTvisac aborti momgebiani biznesia. isini xSir SemTxvevaSi aranair informacias ar awvdian sasowarkveTil qalebs, romlebic sruli SesaZlebelia gauazreblad dgamdnen am nabijs.
damajerebeli argumentebis, aseve samomavlo Sedegebze adeqvaturi informaciis miwodebis
safuZvelze, SesaZlebelia qalma Secvalos Tavisi gadawyvetileba da gadaarCinos kidev erTi axali sicocxle.
SUMMARY
“PROBLEM OF ABORTION”
T. MAKHARADZE, I. Javakhishvili TSU
Abortion has negative influence not only on a woman, but its family and society itself. Medical doctors, many of
whom see this as their financial interests, have huge part in making this destructive decision. In quite a lot of cases,
They do not give full information to desperate women, who then make this step without knowing the effects of those action.
Convincing arguments and adequete information may change women’s decision and save one more life.
bavSvTa da mozardTa jandacva qveynis erTerT umniSvnelovanes prioritetad moisazreba. RonisZiebaTa SemuSavebisTvis profesionalTa azris Sejerebaa saWiro, rac Semdeg
unda waredginos sakanonmdeblo da aRmasrulebel organoebs, gadawyvetilebis mimRebebs.
vimedovneb, rom Cemi personaluri Sexedulebebis gamoqveyneba xels Seuwyobs saTanado
diskusiis dawyebas.
pirvel rigSi, vfiqrob upriani iqneboda
`bavSvTa da mozardTa janmrTelobisa da ganviTarebis” mdgomareobis Sesaxeb momzaddes
krebuli, romelSic asaxuli iqneba ukanaskneli 10-20 wlis ganmavlobaSi yvela epidemiologiuri kvlevis Sedegebi da xelT arsebuli statistikuri monacebi, saWiroebis
SemTxvevaSi SesaZlebeli iqneboda saeqsperto mosazrebebis moyvanac, aramkafio logikis princi pebis mixedviT formalizirebuli.
Semdeg ki garkveuli periodulobiT (5 weliwadSi erTxel) unda tardebodes `bavSvTa da
mozardTa janmrTelobisa da ganviTarebis”
mdgomareobis Sefaseba èvropuli strategi2013 weli
is” Sesabamisi dokumentebis mixedviT. Semdegi nabiji iqneboda am monacemebis Sedareba
saerTaSoriso maCveneblebTan, yvelaze mniSvnelovani indikatorebis SerCeva, am indikatorebis mopovebis strategiis SemuSaveba, saTanado kvlevebis stimulacia, samizne indikatorebis dadgena.
saqarTveloSi bavSvTa da mozardTa janmrTelobis gaumjobesebisaken mimarTuli
ramdenime saxelmwifo programa muSaobs, aris
sadazRvevo programebis paketebic. mravali
saerTaSoriso da arasamTavrobo organizaciis Zalisxmevacaa gasaTvaliswinebeli. samwuxarod, ara marto mosaxleoba, eqimebic naklebad arian garkveuli imaSi, Tu ra keTdeba realurad, ra saxis daxmarebaa aris xelmisawvdomi. miT ufro absoluturad ucnobia
warsuli proeqtebis Sedegebi. vfiqrob, aucilebelia, gamWvirvalobisa da sajaroobis
gazrda, aseve retrospeqtuli auditis Catareba.
tradiciulad, bavSvTa da mozardTa jandacvasa da ganviTarebaze msjelobisas Sem-
48
deg mimarTulebebs ganixilaven: deda da axalSobili, kveba, infeqciuri daavadebebi, fizikuri garemo, mozardTa janmrTeloba, travmebi da Zaladoba, fsiqosocialuri ganviTareba da fsiqikuri janmrTeloba, unarSezRuduli da qronikuli daavadebebis mqone bavSvebi da mozardebi. cxadia, saTanado yuradReba unda eqceodes uxSires daavadebebsac, mniSvnelovan wilad igi daavadebaTa integraluri marTvis programiT ifareba. saerTod, ufro farTod unda inergebodes janmo-s mier mowodebuli sxva programebic:
axalSobilebisTvis keTilganwyobili klinika, bavSvTa ganviTareba, bavSvTa dacva, mozardebisadmi keTilganwyobili samedicino daxmareba; aseve jansaRi skolebis iniciativa. aqve mivuTiTebdi, rom skolas da bavSvTa jandacvas Soris kavSiri ufro metad unda iyos
ganmtkicebuli.
yvelaze aqtualurad ganaTleba mesaxeba,
aq vgulisxmob rogorc profesiul momzadebas, di plomamdels da postdi plomurs, uwyveti ganaTlebis CaTvliT, saSualo samedicino rgolis, pedagogebis, paramedikosebi, yvelasi, visac saqme aqvs bavSvebsa da mozardebTan, da, cxadia, mosaxleobis (rogorc mSoblebis, aseve bavSvebisa da mozardebis) ganaTlebas. saWiroa indikatorebis SemuSaveba da
mudmivi monitoringi. jansaRad cxovrebis wesis danergva, romelsac samwuxarod, naklebi yuradReba eqceva. ganaTlebis procesSi
moviazreb xarisxis samsaxuris aqtivizaciasac. aucilebelad mimaCnia aseve gaidlainebis adaptacia da, kidev ufro ukeTesi, maTi xelmisawvdomobis gazrda referaluri
da we se bu le be bis Ta nam S rom le bis T vis ma inc.
udidesi mniSvneloba aqvs organizacias,
gansakuTrebiT roca saqme exeba rTul da iSviaT daavadebebs. mosaxleobac da profesionalebic unda erkveodnen sad da ra donis
maRalkvalificiuri samedicino daxmarebaa
xelmisawvdomi. ufro metic, yvela samedicino dawesebuleba, sasurvelia, ranJirebuli
iyos pediatriis sxvadasxva subspecialobaSi kvalifikaciis mxriv. aqve aRvniSnavdi, rom
ganviTarebul qveynebSi mzardi yuradReba eqceva e. w. ìSviaT daavadebebs”. Sesabamisad,
aucilebelia, rogorc pirveli nabiji mainc,
bavSvebsa da mozardebSi ìSviaTi daavadebebis” sainformacio-referaluri centris organizacia. igive exeba qronikuli daavadebebis mqone da unarSezRuduli bavSvebisaTvis
specializirebuli da amave dros, efeqturi
holisturi daxmarebis uzrunvelyofac. kidev
erTxel unda gadaixedos, albaT, unarSezRu-
dulobis kriteriumebi, qronikuli daavadebebis, unarSezRudulobis gamomwvevi daavadebebis /mdgomareobebis, qveynisTvis aqtualuri iSviaTi daavadebebis nusxa. mudmiv yuradRebas Txoulobs e. w. oboli wamlebis
xelmisawvdomobac.
neonatologiis problematikaSi xazs gavusvamdi Semdegs – mozardebis, rogorc gogonebis aseve vaJebis janmrTelobisa da janmrTelobasTan dakavSirebuli qcevis optimizacias, rac Cemi Rrma rwmeniT, maTi momavali
Svilebis janmrTelobis gaumjobesebis umTavresi gasaRebia. meore, Zalze mniSvnelovan sakiTxad mimaCnia, reproduqciuli higienisa da ojaxis dagegmarebis optimizacia, gansakuTrebiT Tandayolili infeqciebis prevencia da drouli diagnostika, nayofze momqmedi uaryofiTi faqtorebis minimalizacia,
skriningis optimizacia.
vaqcinkontrolirebad daavadebebis winaaRmdeg imunizaciis uzrunvelyofa – esec pediatriis da sazogadoebrivi jandacvis mudmivi problemaa. sul ufro met yuradRebas iTxovs saavadmyofos Sida infeqciebis profilaqtika.
ekologiuri pediatria praqtikulad Terra
incognita-d rCeba sazogadoebisTvis.
Zalze mtkivneul problemaa mozardTa janmrTeloba. jansaRad cxovrebis wesis implementaciis praqtikulad sruli ignorireba, vera da ver moxerxda mozardTa jandacvis centris (ebis) organizacia; rac aris, ZiriTadad
usafrTxo seqsis swavlebazea gadasuli.
epidemiis saxes Rebulobs bavSvTa da mozardTa fsiqosocialuri ganviTarebis da
fsiqiuri darRvevebi. albaT specialuri
dawesebulebebis centria Sesaqmneli.
rogorc amboben, Zala erTobaSia. `gunduri” TamaSi yovelTvis ufro efeqturia. aq
gansakuTrebulad xazs gavusvamdi mas-mediisa da pacientebis mSoblebis organizaciebs.
nebismieri aqtivoba codnaze unda iyos
damyarebuli. arsebuli literaturis sistemuri da meta-analizi da Sesabamisi kvleva
am codnis mopovebis winapirobaa. mecnierebis
ugulvelyofa miuRebelia.
da, rogorc amboben, last but not least, bolo CamoTvlaSi da ara mniSvnelobis mxriv, es aris
dafinansebis sakiTxi. cxadia, amas samedicino sazogadoeba ver gadaswyvitavs, magram yvela unda davarwmunoT, Tundac presis meSveobiT, rom yvelaze patriotuli da, saboloo
angariSiT, yvelaze momgebiani investiciaa is,
rac mozardi Taobis janmrTelobis, ganviTarebisa da ganaTlebas gaumjobesebisaken
aris mimarTuli.
2013 weli
49
reziume
bavSvTa da mozardTa jandacva qveynis erT-erT umniSvnelovanes prioritetad moisazreba.
RonisZiebaTa SemuSavebisTvis profesionalTa azris Sejerebaa saWiro, rac Semdeg unda waredginos sakanonmdeblo da aRmasrulebel organoebs, gadawyvetilebis mimRebebs. vimedovneb, rom
Cemi personaluri Sexedulebebis gamoqveyneba xels Seuwyobs saTanado diskusiis dawyebas.
da, rogorc amboben, last but not least, bolo CamoTvlaSi da ara mniSvnelobis mxriv, es aris dafinansebis sakiTxi. cxadia, amas samedicino sazogadoeba ver gadaswyvitavs, magram yvela unda davarwmunoT, Tundac presis meSveobiT, rom yvelaze patriotuli da, saboloo angariSiT,
yvelaze momgebiani investiciaa is, rac mozardi Taobis janmrTelobis, ganviTarebisa da ganaTlebas gaumjobesebisaken aris mimarTuli.
SUMMARY
WHAT NEEDS TO BE DONE TO IMPROVE HEALTHCARE
OF CHILDREN AND ADOLESCENTS(PERSONAL VIEWS)
K. PAGAVA
Healthcare of children and adolescent is thought to be one of the main priorities of the state. To work out the plans various thoughts and opinions must be discussed and only after taht sent to legislative or executive government. Ihope, My
personal views will help with the start of public discussion.
And as they say, last but not the least, the financing is vitally important. This cannot be changed by only medical personnel and by using mass media we should convince people that the best investment is the one that can ensure healthy generation, with fast development and improving education.
imunuri sistemis mdgomareoba da misi
koreqcia apivitiT euTireoiduli Ciyvis dros
g. CaxunaSvili, n. Tofurize, n. badriaSvili, k. CaxunaSvili, s. Rlonti
socialuri pediatriis dacvis fondi, ir. ciciSvilis sax. pediatriuli klinika
Tanamedrove monacemebiT
imunuri da endokrinuli sistema, es ori mniSvnelovani
sistema adamianis organizmSi,
sakmaod Rrma gavlenas axdenen
urTierTze. kerZod, adamianis
organizmSi gamomuSavebul
hormonTa umravlesoba gavlenas axdens imunologiur procesebze da uzrunvelyofs maT
normalur funqcionirebas. amave drosGgaredan inducirebul garkveul hormonTa donis
cvlilebas SeuZlia orga-nizmis imunologiuri reaqtiulobis Secvla. Sedegad, warmoiSva Sexeduleba imunogenezis
endokrinul regulaciaze(1, 5, 6).
Tanamedrove etapze farTod Seiswavleba hi pofizuradrenalinuri sistemis gavlena imunogenezze da piriqiT
farisebri jirkvlis zemoqmedeba imunologiur reaqtiulobaze. gamokvlevebiT dadgenilia: rom limfocitebis
proliferaciis intensivoba,
2013 weli
Sefasebuli H3-TimidiniT, sakmaod mWidrod da dadebiTad
korelirebs periferiul sisxlSi farisebri jirkvlis
hormonebis SemcvelobasTan;
aseve Tireoideqtomiis Semdeg aRiniSneba Timusis humoruli faqtoris sinTezis intensivobis da misi sisxlSi
gadmosrolis Semcireba;
amasTanave Tireostatikebis
Seyvanisas adgili aqvs farisebri jirkvlis funqciuri aqtivobis daqveiTebas, rac ganapirobebs Timocitebis destruqciis gaaqtivebas. Yyovelive
zemoTqmuli Timusisa da farisebri jirkvlis urTierTkavSiris maCvenebelia(2, 3, 8, 10, ).
garda amisa, farisebri jirkvali miekuTvneba e. w. `bariers
iqiTa” qsovilebs, vinaidan is
embriogenezis procesSi limfoidur qsovilTan ar kontaqtirebs. Aam Taviseburebis gamo
is sxva organoebTan SedarebiT
ufro xSirad ziandeba autoi-
munuri procesebiT, antiTireoiduli autoantisxeulebiTa
da imunuri kompleqsebiT.
Mmravalricxovani gamokvlevebiT dadasturebulia, rom
Tireoiduli paTologiis mravali formis dros SeiZleba
ganviTardes imunuri darRvevebi da piriqiT, autoimunuri paTologiebis dros yvelaze
xSirad swored farisebri jirkvali ziandeba. kerZod, toqsiuri CiyviTa da hi poTireoziT
daavadebulTa imunuri statusis Seswavlisas aRiniSna mniSvnelovani cvlilebebi ujreduli imunitetis mxriv, romelic daavadebebis klinikur
mimdinareobasTan korelirebda.
farisebri jirkvlis preparatebiT (Tireoidini) Tandayolili
hi poTireozis postoperaciuli mkurnaloba ki imunomakoregirebel efeqts iZleoda(1, 4, 9).
Aamgvarad, zemoaRniSnuli gamokvlevebi gviCvenebs, rom imunuri da endokrinuli sisteme-
50
bi mWidro urTierTkavSirSia, xels uwyobs azotovani balan- ba manCinis radialuri imunodiromelSic mniSvnelovani roli sis SenarCunebasa da organizmis fuziis meTodiT(12), farisebri
farisebr jirkvals eniWeba.
zrda-ganviTarebas; àpiviti” bi- jirkvlis hormonebis_ TiroqsiAam TvalsazrisiT, perspeqti- ologiuri stimulatoria, rome- nisa(T4) da triidTiro-ninis(T3)
ulia apivitis CarTva euTire- lic zedmiwevniT zemoqmedebs koncentracia radio-imunologioiduli Ciyvis mkurnalobis sasqeso hormonebze, igi maRal- uri meTodiT.
kompleqsSi.
potenciuria
energetikuli
miRebuli masalis statistipirveli qarTuli natura- TvalsazrisiTac.
kuri damuSaveba ganxorcielluri danamati, romelic mTliàpiviti” samedicino da bio- da kompiuteruli programa
anad akmayofilebs saerTaSori- logiuri disciplinebis speci- SPSS paketiT.
so standartebis yvelaze mkacr alistTa azriT-mokle droSi iwpacientTa 25%(14)-s aReniSnekriteriumebs da maT Soris um- vevs sxvadasxva intensivobis boda farisebri jirkvlis I xaTavress-usafrTxoebas, socia- etiologiis paTologiuri pro- risxis hi perplazia, 55%(36)-s II
luri pediatriis fondis samec- cesis Sesustebas an alagebas. xarisxis da 20%(10)-s ki III xaniero-kvleviTi sawarmo `GGW”- apivitis gamoyeneba weliwadSi risxis hi perplazia. eqogenuros mier Seqmnili kvebiTi danama- ramdenimejer, yoveli axali se- ba 5 SemTxvevaSi iyo daqveiTebuti àpiviti” warmoadgens.
zonis dawyebis win, rekomendire- li, danarCen SemTxvevaSi normis
igi bunebrivi maRalxarisxo- bulia aramxolod avadmyofebi- farglebSi, kista an kvanZi ar
vani koncentrirebuli da bio- saTvis, aramed nebismieri asakis dafiqsirebula.
logiurad aqtiuri kvebiTi da gansxvavebuli sqesis janmTeCatarebulma gamokvlevebma
produqtia, romelic Seicavs li adamianebisTvisac. ar aris mi- gviCvena, rom euTireoiduli Ciycocxali organizmis Senebis, zanSewonili misi miReba gvian viT daavadebulebs axasiaTebganviTarebisa da sicocxli- saRamos an Zilis win.
daT sisxlis SratSi TiroqsisaTvis aucilebel yvela nivTiSromis mizans warmoadgenda nisa da triiodTironinis konerebas: cilebs, cximebs, naxSir- Segveswavla ujreduli da humo- centraciis Semcireba. Ees cvliwylebs, vitaminebs A, B1, B2, B5, B6, ruli imunitetisa da farisebri lebebi korelirebda farisebri
C, E, D, PP folis mJava da sxva. jirkvlis funqcia euTireoidu- jirkvlis hi perplaziis xarisaminomJavebs, vanils, lizins, li CiyviT daavadebulebSi. gag- xTan da Sesabamisad Tiroqsinileicins, glulaminis mJavas, vesazRvra urTierTdamokidebu- sa da triiodTironinis Semcvesaitits da a. S. sul maT oc- leba ujredul imunitetsa da loba sisxlis SratSi yvelaze
daor saxeobas. aseve, glukozid farisebri jirkvlis hormonebis dabali iyo III xarisxis hi perrutins, zrdis hormons da sxva. dones Soris.
plaziis dros(cxrili #1).
apivitis ZiriTad masas futimunuri statusis SeswavliMmasala da meTodebi: Cveni
kris mier Segrovebuli produq- dakvirvebebis qveS inyofeboda sas euTireoiduli CiyviT daatis naxevarfabrikati Seadgens. euTireoiduli CiyviT daavadebu- vadebulebSi ujreduli imunimis (“apivitis”) gamoyenebas ud- li 60 pacienti. maTgan 40 qali tetis mxriv aReniSneboda CD3
didesi mniSvneloba aqvs janm- da 20 mamakaci, pacientTa saSua- da CD8 limfocitebis procenTeli organizmis cxovelqmede- lo asaki iyo 36+-12; AAA
tuli raodenobis Semcireba,
bis normalurad mimdinareobisakontrolo jgufs DSeadgen- imunomaregulirebeli subpopusaTvis. àpivitis” erT-erTi Zi- da imave asakis praqtikulad jan- laciebis gamoxatuli disbariTadi komponentia rutivi, ro- mrTeli 25 mozrdili.
lansi CD4/CD8 koeficientis
melic xels uwyobs kapilarefarisebri jirkvlis gamokv- gazrdiT, humoruli imunitetis
bis kedlebis rezistentobas da leva tardeboda ultrabgeriTi mxriv adgili hqonda B-limfoaumjobesebs gulis muSaobas.
skanirebiT (aparatiT sonilain- citebis procentli raodenobiis awesrigebs vitaminebis, ami- si). periferiuli sisxlis T-lim- sa da sisxlis SratSi samive
nomJavebis da mikroelementebis focitebi da maT imunomareguli- klasis imunoglobulinebis IgG,
cvlas, Jangva-aRdgeniT proce- rebeli subpopulaciebi isazR- IgA, IgM-is Semcvelobis matebas.
sebs; aZlierebs qsovilis mier vreboda monoklonuri antisxe- es maCveneblebi farisebri jirJangbadis utilizacias da Sede- ulebiT (CD3+, CD4+, CD8+), B- kvlis III xarisxis hi perplazigad zrdis gonebriv da fizikur limfocitebis procenuli rao- is dros ufro mkveTrad iyo
Sromisunarianobas; uzrunvel- denoba komplementuri rozetkis darRveuli, vidre II xarisxis hi yofs organizmis zrdisa da gan- warmoqmnis meTodiT(7), sisxlis perplaziis dros, I xarisxis
viTarebis procesebs; gaaCnia SratSi IgG, IgA, IgM-is Semcvelo- hi perplaziis dros ki imunoloimunomodulaciuri, imucxrili #1
nomastimulirebeli da
Tiroqsinisa da triiodTironinis koncentracia sisxlis SratSi
antimikrobuli TvisebeeuTireoiduli Ciyvis dros
bi; aumjobesebs reproduqciuli sistemis funqcionirebas; aZlierebs
eqstremaluri da stresuli faqtorebisadmi
organizmis adaptaciis
unars da mis dacviT meqanizmebs. preparatSi Semavali aminomJavebi advilad aTvisebadia, rac
2013 weli
giuri maCveneblebi Nnormidan
umniSvnelod iyo gadaxrili.
imunitetis T da B sistemaSi
mimdinare cvlilebebsa da farisebri jirkvlis hormonebis
dones Soris korelaciuri
urTierTkavSiris Seswavlam
gviCvena, rom Tiroqsinisa da
triidoTironinis koncentraciis daqveiTeba sarwmunod
korelirebda imunologiuri
maCveneblebis cvlilebebTan.
euTireoiduli Ciyvis mkurnalobisas Tiroqsinis koncentraciis momatebisa da normasTan miaxloebisas T_limfocitebis raodenoba matulobda, daavadeba
advilad emorCileboda mkurnalobas da drois ufro mokle
SualedSi dgeboda gankurneba.
amgvarad, euTireoiduli Ciyvis dros ZiriTadi imunologiuri maCveneblebia sisxlSi
CD3, CD8 procentuli raodenobis Semcireba, B-limfocitebis
procentuli raodenobisa da
IgG, IgA, IgM-imunoglobulinebis Semcvelobis momateba. imunologiur Zvrebs Tan axlavs
sisxlis SratSi Tiroqsinisa
(T4) da triidTironinis(T3)
koncentraciis daqveiTeba.
yovelive zemoT aRniSnulidan
SegviZlia davaskvnaT, rom `farisebri jirkvali _ Timusi” warmoadgens mankier wres: darRvevebi imunur sistemaSi ganpirobebs
farisebri jirkvlis funqciis
cvlilebebs da piriqiT.
miRebuli monacemebi saSualebas gvaZlevs gavwioT Semdegi rekomendaciebi:
farisebri jirkvlis paTologiis dros Seswavlili iqnas
imunuri statusi.
mizanSewonilad migvaCnia
euTireoiduli Ciyvis mkurnalobaSi apivitisgamoyeneba, romelic xels Seuwyobs imunuri homeostazis normalizebas da dadebiT zegavlenas moaxdens daavadebis mimdinareobaze.
literatura:
Быков В. Л. //,, Иммунитет, воспаления, эндокринная система,, СТ-Петербург
2012г. С-27-30 //
Буйдина Т. А. Побединцева М. В. /,,
Опыт раннего использования тиреоидных гормонов у пациентов с оперирован-
51
ной шитовидной железой,, Матерялы IV
международного конгресса эндокринологов. СТ-Петербург 2011г. С-276/
Насонов Е. Л. //,, Функция шитовидной железы и аутоимунные нарушения,, Тер. Архив 2009 №5 с. 38-42//
Иллек Я. Ю., Зайцева Г. А., Смердов
В. Л., //,, Иммунологическая реактивность и функция щитовидной железы
при острой пневмонии у детей с тимомегалией. ` Реф журн. Клиническ. Иммун. И аллерг. 2008г. Ст. 28//
Энгельгардт Н. В. /`Имуннологические аспекты биологии развития” М.
2010 с92-106/
Byron M. A. Mowat A. J. //Am. Rheum.
Diseases 2010 sol m85N4 p174-177//
Bianco A. PatricR. /Wussenrweig Exp.
Med. 1970 132-702-720/
Daro et all//Clin. Exp. Immunol. 2008
v93 N3 p430-435//
Gabriel E. M. Btrgert E. M. et
all//Germline polymprphismof codon 727of
Human Thyroidstimulatinghormone receptoris associatedwith toxic multinodular
goiter//J. Clin. Endokrin. Metab.
2011vol94p3328-3335//
Gon K. L. Wang F. A. // Am. Rheum. Diseases 2009 sol m99N2 p201-204//
Key words Immune system, Euthyroid
goiter, Apivit
reziume
imunuri sistemis mdgomareoba da misi koreqcia apivitiT
euTireoiduli Ciyvis dros
vlevis mizani iyo, gamokvleuliyo farisebri jirkvlis da humoruli-ujreduli imunuri
sistemis funqcia euTiroiduli Ciyvisas. Kvleva catarda 60 pacientze, euTiroiduli CiyviT,
romelTac cautardaT ultrabgeriTi kvlevebi da Tlimfocitebis da misi subpopulaciis gamokvlevebi (CD3, CD4, CD8), ganisazRvra b limfocitebis done, IgG, IgA, Ig M, sisxlis Sratis analizi da Tiroiduli hormonebis done (Tiroqsini, triiodTironini)
Sedegebma aCvena, ujreduli imuniteti gacilebiT ufro metad azienebs farisebr jirkvals
euTiroiduli Ciyvisas, vidre humoruli imuniteti. ganisazRvra dramatuli kleba CD3, CD8 limfocitebis da b limfocitebis, imunoglobulin G, A da M is mateba. gamovlinda, Tiroiduli hormonebis kleba sisxlis SratSi.
kvlevis mixedviT, imunuri sistemis roli euTiroiduli Ciyvisas mniSvnelovania da saWiroebs Seswavlas, iseve rogorc hormonebis raodenobis gansazRvra.
SUMMARY
IMMUNE SYSTEM AND EUTHYROID GOITER
The aim of the study was to investigate function of thyroid glands as well as cellural and humoral immune system in patients
with Euthyroid goiter. The investigation was carried out on 60 patients with Euthyroid goiter who underwent Ultrasonography of the thyroid glands, who also were studed on T- lymphocytes and its subpopulations CD3, CD4, CD8, the percentage
levels of B lymphocytes, Ig G, Ig A, Ig M, testomonies in serum of blood, concentration of thyroid hormones T4 and T3.
The resuls show that, the cell’s immun system damages more hevier then hummor immun status during Euthyroid goiter. There was detected dramatic decrease of CD3 and CD8 lymphocytes, and increase of levels of B lymphocytes, Ig G, Ig
A, Ig M. Changes in Immune system are accompanied by decrease of thyroid hormones T4 and T3 level in serum of blood.
Based on our study we can conclude that studding Immune system is important in patients with thyroid gland pathology, as well as studing thyroid gland hormones T4 and T3 in the patients with autoimmune diseases.
2013 weli
52
valeologia (sanologia-samedicino
mimarTuleba), rogorc `janmrTelobis medicina”
i. doliZe, g. CaxunaSvili
Tbilisis saxelmwifo samedicino universiteti
valeologia, rogorc axali disci plinaTaSoriso samecniero-pedagogiuri mimarTuleba
warmoiSva ruseTSi gasuli saukunis 80-ian
wlebSi. swored maSin profesorma i. brexmanma mogvawoda termini `valeologia”, rogorc
àdamianis janmrTelobis” aRmniSvneli. 1987
wels man gamoaqveyna pirveli monografia im
problemaze, romelSic moyvanilia mtkicebuleba, rom mecniereba janmrTelobaze unda iyos
integrirebuli fizikuri kulturis Teoriisa da praqtikis da sxva mecnierebaTa miRwevebTan erTad [2].
valeologiis ganviTarebas xeli Seuwyo mediko-biologiuri mimarTulebis gamoCenil
mecnierTa da praqtikosebis Sromebma klasikur medicinaSi, fiziologiaSi, higienaSi, sanologiaSi, genetikaSi da sxv., romelTa samecniero koncefciebma xeli Seuwyo valeologias,
rogorc integraluri mecnierebis CamoyalebebaSi [4].
dRes arsebuli (“Zveli”) jandacvis sistemis modelis arsi aris brZola daavadebebTan
da ara janmrTelobis SenarCunebasTan. is mTeli rigi mizezebis ZalisxmeviT yvelaze metad
gaxda samkurnalo, viwro specializaciis hospitaluri dargi da Tavisi arsiT Camoyalibda, rogorc mecniereba daavadebis Sesaxeb. es,
Tavis mxriv, aisaxa did samedicino enciklopediaSic (“medicina-erTi uZvelesTagani mecnierebaa, romlis mizania adamianTa daavadebebis
Tavidan acileba da mkurnaloba”), sadac saerTod ar aris naxsenebi sityva: `janmrTeloba”.
Mamas miaqcia yuradReba didma fiziologma ivane pavlovma, roca 1903 wlis aprilSi madridis
saerTaSoriso samedicino kongresze aRniSna:
`samwuxarod, Cven dRemde ar gagvaCnia organizmis ZiriTadi funqciis aRmniSvneli-Sinagani da
gareTa garemos gamawonasworebeli sufTa samedicino termini”.
jandacvis sistemis organizaciuli xarvezebi qmnis mraval gaugebrobebs, rogorc mosaxleobaSi, ise qveynis samTavrobo struqturebSi, rac uSlis xels qveynis konstituciiT dacul nebismieri adamianis janmrTelobis SenarCunebis uflebamosilebas. jandacvis saxelmwifroebrivi struqturebi dRevandeli gadmosaxedidan upiratesad gadatvirTulia uimedod
miSvebuli mravalricxovani socialuri problemebiT da radikalurad unargareSea mosaxleobis janmrTelobis xarisxis gasaumjobeseblad. am savalalo mdgomareobidan gamomdinare saWiroa mosaxleobis janmrTelobis dac-
vis mizniT SemuSavdes adeqvaturi saxelmwifoebrivi strategia da misi marTvis berketebi.
es moTxovna istoriuli aucileblobiT aris
ganpirovnebuli, radgan Tanamedrove jandacvis
sistema ver Caewera saxelmwifoebriv struqturaSi, radgan moSlili marTvis sistemis fonze decentralizebulia misi mravaldargobrivi ekonomika.
medicina, miuxedavad profesiuli maRali donisa ver gvaZlevs amomwurav pasuxs konkretul
SekiTvebze: ratom ganicdis rRvevas adamianis
janmrTeloba da ratom ver xerxdeba daavadebis mkurnalobisa da nawilobrivi reabilitaciis Semdgom janmrTelobis sruli aRdgena.
amis mizezad unda CaiTvalos saxelmwifoebrivi uyuradReboba janmrTeli mosaxleobis
SenarCunebisaTvis da amasTan, jandacvis sistema mTlianad gadarTulia avadmyofTa problemebze da isic destruqciuli midgomiT. mosaxleobis janmrTelobis xarisxi jer kidev
ar ganixileba qveynis ZiriTad faseulobad da
amasTan, Tanamedrove medicinas zemoTaRniSnuli mizeziT dRemde ar gaaCnia `janmrTeli adamianis organizmis fsiqofizikuri modeli”,
romlis gadasinjva yovelwliurad unda xdebodes, radgan gareTa garemos, teqnocivilizaciisa da sxva faqtorebis zemoqmedebiT progresulad icvleba adamianis homeostazi. normis dadgenas ki udidesi mniSvneloba gaaCnia
diferencirebul diagnostikaSi, radgan janmrTelobis parametrebidan unda xdebodes paTologiuri gadaxrebis xarisxobrivi Tu raodenobrivi maCveneblebis aTvla, rac obieqturad Seuwyobs xels swor diagnostikasa da
mkurnalobas. amis ugulvelyofa aris mizezi
imisa, rom gaxSirda farulad mimdinare garTulebebi organizmis sxvadasxva organoebSi
da sistemebSi, ramac gazarda gadaudebeli qirurgiuli daavadebebis nusxa da sicocxlisaTvis saSiSi prognozi. amiT qirurgia aRmoCnda `gafurCqvnis fazaSi” maSin, roca Terapia
ganicdis `Wknobis” process. es TvaliT SesamCnevi faqti uyuradRebod rCeba saxelmwifoebrivi struqturebis mier, rac progresulad
zrdis e. w. `civilizaciis daavadebebs”, qronikul paTologiebs, invalidobisa da sikvdilianobis maCveneblebs. saxelmwifos struqturebi reklamirebas ki ar unda ukeTebdes saavadmyofoebis momravlebas, aramed unda zrunavdes mosaxleobis janmrTelobaze da am mizniT sportul-gamajansaRebeli centrebis gaxsnaze. eris sijansaRe unda iyos saxelmwifo2013 weli
ebrivi prioriteti da jandacvis sistema unda zrunavdes am mimarTulebiT.
Cvens planetaze mimdinare kataklizmebma da
ucnobi daavadebebis momravlebam kidev erTxel dagvarwmuna Tanamedrove civilizaciis
TviTmkvlelobis acilebis WeSmaritebaSi da
nebismieri adamianis sakuTari janmrTelobis
SenarCunebisaTvis pasiuri moqmedebidan aqtiur moqmedebaze gadasvlis aucileblobaSi.
mravali dargis specialistisaTvis jer kidev gaazrebuli ar aris valeologiis mecnieruli azrovnebis masStaburoba. Tanamedrove valeologia iTvlis janmrTelobis 100-ze
met ganmartebas, xolo saboloo variantad miCneulia jandacvis msoflio organizaciis
debuleba, sadac janmrTeloba ganixileba,
rogorc adamianis fizikuri, sulieri da socialuri keTildReoba. Tanamedrove civilizaciis pirobebSi janmrTeli adamianis problema unda gaxdes samedicino kvlevis obieqti da eqimebma `daavadebis istoriis” garda, unda daiwyos `janmrTelobis istoriis” Sedgena, rac saSualebas mogvcems SeviswavloT adamianis fsiqofizikuri SesaZleblobebi axal
garemo pirobebTan da cxovrebis wesTan Seguebis xarisxis gaTvaliswinebiT. janmrTeli
adamianis organizmis wonasworobidan gamoyvana Zalze Znelia, radgan mas sakmarisad aqvs
ganviTarebuli dacviT-kompensatoruli meqanizmebi, Tumc es usazRvro ar aris. adamianis
organizmis bioenergetikuli rezervebi adre
Tu gvian SeiZleba gamoifitos da gamovlindes daavadebisaTvis damaxasiaTebeli klinikuri niSnebi, rac mizandasaxul, droul koreqcias saWiroebs. es ki eqimisagan moiTxovs janmrTeli adamianis fsiqofizikuri modelis
klinikur codnas da Sesabamis kvlevis meTodologias, rac mas ar gaaCnia. amis gamo, is avadmyofs iSviaTad kurnavs da garkveulwilad iTvleba eqimi-specialistis momzadebis seriozul xarvezad.
klasikuri medicina, miuxedavad didi warmatebebisa, jer kidev srulyofili ar aris. valeologia, rogorc adamianis kvlevis mecniereba ganixileba, rogorc bioenergo-informaciuli sistema, romelic sami qvesistemisagan:
sulieri, fsiqiuri da fizikurisagan Sedgeba.
samwuxarod, eqimis SesaZleblobebi zemoqmedeba moaxdinos adamianis sulier sferoze
mkveTrad SezRudulia, radgan klasikuri medicina am sferoSi gansxvavebiT aRmosavluri medicinisagan sagrZnoblad CamorCenilia, radgan
ara aqvs saTanado gamocdileba da Sesabamisi codna.
dRevandeli jandacvis sistemis funqcionirebis ZiriTadi nakli aris aramarto finansuri deficiti, aramed mcdari SexedulebebibrZola daavadebebTan da ara janmrTeli adamianis janmrTelobis dacva, adamianis organizmSi mxolod fizikuri sxeulis aRiareba da
2013 weli
53
ufro faqizi struqturebis (biovelebis) uaryofa, rac gansakuTrebul zians ayenebs adamianis janmrTelobas.
Tanamedrove jandacvis sistema gadaudeblad
moiTxovs adamianis janmrTelobis xarisxis Sefasebis eqspres-diagnostikis meTodis SemuSavebas, romelsac SeeZleba holistikuri midgomiT srulfasovnad Seafasos yvela sistemis
funqcionirebis xarisxi drois mcire monakveTSi (samedicino teqnikis inJiner-gamomgoneblebs
jandacvis samsaxurisaTvis aseTi aparati jer
ar SeuqmniaT). amasTan, unda aRiniSnos, rom aseTi aparatebi arsebobs da isini warmatebulad
gamoiyeneba samedicino praqtikaSi [3, 5]. Cven,
sportsmenebis (moWidaveebis, mZleosnebis) janmrTelobis xarisxis dasadgenad gamoviyeneT
airganmuxtviTi vizualizaciis kompiuterizebuli meTodis or variant: kamera da beotomografia [1, 6]. sportsmenebis organizmis
talRuri modelebis analizma grafikuli gamosaxulebebiT gamoavlina janmrTelobis
darRveva sportsmenebis 70-80 procentSi, romelic moiTxovda gadaudebel reabilitaciuri
RonisZiebebis Catarebas. es ki migviTiTebs imaze, Tu ramdenad mniSvnelovania janmrTelobis
xarisxis dadgena da misi kontroli sportsmenebis fsiqofizikur momzadebaSi.
amrigad, saxelmwifoebrivi jandacvis sistema ver uzrunvelyofs mosaxleobis janmrTelobis dacvas da princi pulad iTxovs am socialuri institutis demontaJs damoukidebeli samsaxurebis SeqmniT: calke- avadmyofebisaTvis da calke janmrTeli adamianebisaTvis.
aqedan gamomdinare, valeologia unda ganvixiloT, rogorc `janmrTelobis medicina”, romelic xels Seuwyobs pirovnebisa da ojaxis keTildReobas, gazrdis qveynis SromiT potencials, kulturis dones da a. S.
literatura
doliZe i. sportuli valeologia – zogadi valeologiis ganviTarebis safuZveli // saqarTvelos ganaTlebis mecnierebaTa akademiis moambe, #9, Tbilisi, 2006, 150-153.
Брехман Н. И. Валеология – Наука о здоровье, М., 2001.
206 с.
Коротков К. Г., Струков Е. Ю., Ширков Д. М. Метод
газоразрядной визуализации (ГРВ) в практике врача-исследователя, Санкт-Петербург, 2003. 102 с.
Петрушина В. А., Петрушин Н. В. Валеология –
Учебн. пос., М., 2002. 186 с.
Шадури М. И., Чичинадзе Г. К. Работа с программным-аппаратным комплексом «ГРВ-камера» по методике М. Шадури (БЭО-томография) // Вестник Северо-Западного отделения медико-технических наук Р. Ф. под
ред. К. Г. Короткова – СПб: Агенство «РДК-принт», 2001,
119-137.
Dolidze I. D., Kakhabrishvili Z. G., Ganelidze G, D. Valeometric Approach To Determining Psychophysical Fitness
of Wrestlers. / 4 Th International Baltic Congress on Sports
Medicine 2005, Riga, Latvia, p. 20.
54
reziume
valeologia, rogorc «janmrTelobis medicina»
i. doliZe, g. CaxunaSvili
Tanamedrove jandacvis sistemaSi valeologiuri codnis integrireba eqimebis, pedagogebis
da fsiqologebis mxridan xels Seuwyobs janmrTeli adamianis fsiqofizikuri modelis Seqmnas, rac unda iyos dafuZnebuli janmrTelobis holistikuri diagnostikis axal meTodologiaze da valeologia ganvixiloT, rogorc `janmrTelobis medicinis” safuZveli.
SUMMARY
VALEOLOGY OF “HEALTH MEDICINE”
I. DOLIDZE G. CHAKHUNASHVILI
Tbilisi State Medical University
In modern public health system the integration of valeological knowledge into doctors, psychologist, pedagogical psychologist, from theirs side will promote the creation of healthy person’s psychophysical model. The model will be based on
a holistic methodology of diagnostics. In the article is considered valeology as basis of the `health medicine”
sportsmenTa da orsulTa kvebis
racionSi „api puris“ aucilebloba
g. CaxunaSvili, n. badriaSvili, m. TofuriZe, n. jobava,
k. CaxunaSvili, z. fxalaZe, ir. kalsndia, d. CaxunaSvili
socialuri pediatriis dacvis fondi, ir. ciciSvilis sax. pediatriuli klinika,
Tbilisis sax. samedicino universiteti
sakvebi produqti àpi puri”.
gamdidrebulia janmTelobisaTvis aucilebeli aminomJavebiT, vitaminebiT da mineralebiT. axali teqnologiiT damzadebuli puri saqarTveloSi
Seamcirebs masiurad gavrcelebul vitaminebis, aminomJavebis
da mikroelementebis deficitiT gamowveul daavadebebs. saqarTveloSi puris moxmareba
sakmarisze ufro maRalia. samwuxarod, dReisTvis saqarTveloSi puri ZiriTadad iseTi fqvilisgan cxveba, romelic mikronutrientebis Semcvelobis
erovnul standartebs ar Seesabameba. puri asakis, sqesis damoxmarebis sixSiris mixedviT
unikaluri produqtia; izrdeba premialuri jansaRi produqtis wili; etapobrivad xdeba bazris segmentacia SefuTvis, dizainis xarisxis da moxmarebis gamartivebis mixedviT.
bazarze gaizarda adgilobrivad warmoebuli xorblis fqvilisagan damzadebuli puris
jamuri simZlavre. gaizarda
moTxovnileba vitaminebiT da
mineralebiT gamdidrebul purze. sadReisod bazarze arsebu-
li vitaminebiT da mineralebiT
gamdidrebuli pureulis raodenoba da Semadgenloba ver
akmayofilebs moTxovnilebas.
Catarebuli kvlevis Sedegebis
mixedviT zogadad dadginda,
rom puris nimuSebis mxolod
24. 9 % iyo Sesabamisad fortificirebuli, rac ar aris sakmarisi mosaxleobaSi mikronutrientebis deficitis SemcirebisTvis. Cveni teqnologiiT
damzadebuli puri, gamdidrebuli janmTelobisaTvis aucilebeli aminomJavebiT, vitaminebiT
da mineralebiT unikaluri da
maRalmoTxovnadia. Cven gamaokvlevebze dayrdnobiT àpi puri“-s momxmarebeli mosaxleobis farTo fenaa. specifiurad
ki, ZiriTadi myidveli da momxmarebeli - bavSvi, xandazmuli
adamiani da sportsmenia. vinaidan, polideficits yvela zemetad aRniSnuli kategoria ganicdis.
exla ganvixiloT prospeqtulad aminomJavebi, vitaminebi
da mineralebi:
ra aris aminomJavebi?
aminomJava (Amino Acid) - organuli naerTia, romelic ci-
lebisda kunTovani qsovilebis
samSeneblo masalas Seadgens.
adamianis organizmSi aminomJavebs bevri mniSvnelovani funqcia ekisrebaT - isini gamoiyenebian organizmis zrdis, aRdgenis, gaZlierebisaTvis, hormonebis, antisxeulebis da fermentebis gamomuSavebisaTvis.
garda amisa, aminomJavebi kargia varjiSis Semdgomfi zikuri
da fsiqologiuri tonusis asamaRleblad, kanqveSa cximis
katabolizmisaTvis da tvinis
inteleqtualuri moqmedebisaTvisac ki. sul 21 saxisaminomJava arsebobs, maT Soris 9
e. w. Seucvlels uwodeben,
radgan organizms maTi damoukideblad sinTezireba ar SeuZliaT, danarCeni aminomJavebi
ki Secvlads warmoadgenen.
aminomJavebis mniSvneloba
da sargebeli bodbildingSi
didixania mecnierulad dadasturebuli faqtia. datvirTuli varjiSis dros organizmi met energias iTxovs,
romlis wyaroc kunTovani qsovilebi xdeba. kunTebis katabolizmi (daSla) bodbilderis yvelaze didi mteria - is
2013 weli
iwvevs mtkivneul SegrZnebebs,
krunCxviT movlenebs da travmis gamowvevac ki SeuZliaT.
amis mizezi ki organizmSi
mimdinare glukoneogenezis procesia, rodesac xdeba glukozis warmoqmna aranaxSirwylovani wyaroebidan - aminomJavebi kunTovan qsovilebs gamoeyofian da RviZlSi gadaitanebian, sadac glukozad gardaiqmnebian. saSualo intensivobis datvirTvis drosac ki
daaxloebiT aminomJavebis 80%is moixmareba xdeba. kunTebis
katabolizmis Tavidan acilebisaTvis aminomJavebis swrafi
da Seuferxebeli miwodeba
organizmisTvis aucilebelia.
aminomJavebia sevesaWiroa
gamoSrobis an wonaSi klebis
periodSi kunTebis SenarCunebisaTvis. bodibildingSi gansakuTrebiT mniSvnelovania
BCAA aminomJavebis kompleqsi,
romelic kunTovaniqsovilis
35% Seadgens, aqvs maRali biologiuri efeqturoba da calke formiT gamoiSveba.
aminomJavebis daxasiaTeba
Seucvleli aminomJavebi (Essential Amino Acids):
va li ni
(Valine)
erT-erTi mTavari komponentia qsovilebis zrdisa da sinTezisaTvis. mTavari wyaro
cxoveluri produqtebia. Catarebulma laboratiulma kvlevebma aCvena, rom valini zrdis
kunTebis koordinacias da amcirebs mgrZnobelobas tkivilis, sicivis da sicxis mimarT.
histidini (Histidine) - xels uwyobs qsovilebis zrdas
da aRdgenas. mas didi raodenobiT Seicavs hemoglobini, gamoiyeneba revmatiuli arTritebis, alergiis, wylulis da
anemiis mkurnalobisas. histidinis ukmarisoba SeiZleba smenis daqveiTebis gamomwvevi
mizezi gaxdes.
izoleicini (Isoleucine) - moi poveba yvela srulfasovani cilis Semcvel produqtSi - saqonlis xorci, qaTmis xorci, Tevzi, kvercxi, rZis produqtebi.
le i ci ni
(Leucine)
aseve moi poveba yvela srulfasovani cilis Semcvel produqtSi - saqonlis xorci, qaTmis xorci, Tevzi, kvercxi, rZis
produqtebi. aucilebelia ara
mxolod proteinis sinTezi2013 weli
saTvis, aramed imunuri sistemis gaZlierebisaTvisac.
lizini (Lysine) - Seicavs yveli, Tevzi. erTerTi mTavari
komponentia karnitinis gamosamuSaveblad. uzrunvelyofs
kalciumis saTanado aTvisebas,
monawileobs kolagenis warmoqmnaSi (risganac Semdgom xrtilebi da SemaerTebeli qsovilebi formirdeba), aqtiurad
monawileobs antisxeulebis,
hormonebis da fermentebis
warmoqmnaSi. ukanasknelma kvlevebma aCvena, rom lizinia
umjobesebs ra sakvebi nivTierebebis balanss, xels uwyobs herpesTan brZolas. misi ukmarisoba SeiZleba daRlilobiT, koncentraciis daqveiTebiT, gaRizianebadobiT, Tvalis sisxlZarRvebis dazianebiT, Tmis cveniT, anemiiT da reproduqciul sferoSi problemebiT gamovlindes.
metionini (Methionine) - misiwyaroa: marcvleuli, Txileuli. mniSvnelovani roli
ukavia cximebis da cilebis metabolizmSi, organizms isasevecisteinis gamosamuSaveblad esaWiroeba. aris sulfatis
ZiriTadi mimwodebeli, romelic Tavis mxriv Tmebis, kanis
da frCxilebis formirebaSi
monawileobs; aZlierebs lecitinis aTvisebas RviZlis mier daxels uwyobs qolesterinis donis dawevas; amcirebs
cximebis dones RviZlSi, icavs Tirkmelebs, monawileobs
organizmidan mZime metalebis gamodevnaSi; aregulirebs amiakis warmoqmnas da asufTavebs misgan Sards, rac amcirebs Sardis buStze datvirTvas; xels uwyobs Tmis zrdas.
Tre o ni ni
(Thre o ni ne)
kolagenis, elastinis da kbilis minanqris Semadgeneli nawili; monawileobs RviZlSi
cximis dagrovebis winaaRmdeg brZolaSi; uzrunvelyofs saWmlis momnelebeli sistemis da kuWnawlavis traqtis
normalur moqmedebas; monawileobs metabolizmis da aTvisebisprocesebSi.
tri ptofani (Tryptophan) monawileobs niacinis (vitamini В) daserotoninis sinTezSi;
bunebrivi relaqsanti, ebrZvis uZilobas, depresias, aumjobesebs ganwyobas, xels uwyobs SakikTan brZolas, aZliereb-
55
s imunur sistemas, amcirebs arteriebis da guliskunTebis spazmebis risks, lizinTan erTad dabla swevs qolesterinis dones.
fenilalanini (Phenylalanine)
- organizmis mier tirozinis
da sami mniSvnelovani hormonis - epinerfinis, norepinerfinis da tiroqsinis warmoqmnaSi monawileobs. uzrunvelyofs karg ganwyobas, amcirebs madas, moqmedebs rogorc antidepresanti da aumjobesebs
mexsierebas.
Sec v la di
a mi nom Ja ve bi
(Nonessential Amino Acids):
alanini (Alanine) - energiis
mniSvnelovani wyaroa kunTovani qsovilebis, Tavis tvinis da
centraluri nervuli sistemisaTvis; aZlierebs imunur sistemas antisxeulebis gamomuSavebis gziT; aqtiurad monawileobs Saqris da sxva organuli mJavebis metabolizmSi.
arginini (Arginine) - anelebs kibos da simsivnis ganviTarebas. asufTavebs RviZls, xels uwyobs zrdis hormonis gamoyofas, aZlierebs imunur
sistemas, xels uwyobs spermis
gamomuSavebas, sasargebloa
Tirkmelebis travmebis da
darRvevebis mkurnalobisaTvis. aucilebelia proteinis
sinTezisaTvis. argininis arseboba organizmSi xels uwyobs kunTovani masis zrdas da
cximovani maragebis Semcirebas. kargia RviZlis daavadebebis, magaliTad cerozis mkurnalobisas. araa rekomendirebuli orsulebisTvis da meZuZuri dedebisaTvis.
asparagini (Asparagine) - monawileobs organizmidan centraluri nervuli sistemisaTvis mavne nivTierebis amiakis gamodevnaSi. ukanaskneli periodis kvlevebma aCvena,
rom asparaginis mJavadaRlilobis mimarT rezistantulobas zrdis.
glutamini (Glutamine) - mniSvnelovania Saqris donis normalizebisaTvis, tvinis qmedunarianobis asamaRleblad, impotenciis mkurnalobisaTvis,
alkoholizmis mkurnalobisaTvis, ebrZvis daRlilobas,
tvinis funqciasTan dakavSirebul daavadebebs - epilefsias,
Sizofrenias da ubralod Se-
56
nelebul reaqciebs, saWiroa
kuWis wylulis mkurnalobisas da janmrTeli saWmlis
momnelebeli traqtis formirebisaTvis. tvinSi gadamuSavdeba glutaminis mJavad, romelic aucilebelia tvinis funqcionirebisaTvis. gamoyenebis
dros unda ganvasxvavoT glutaminis mJava glutaminisgan,
radgan es prepatarebi moqmedebiT erTmaneTis gangansxvavdeba. glutaminis mJava Tavis tvinis bunebriv „sawvavad“ iTvleba, aumjobesebs gonebriv
SesaZleblobebs.
glicini (Glycine) - aqtiurad monawileobs axali ujredebis Camoyalibebis procesis
JangbadiT uzrunvelyofaSi.
mniSvnelovani funqcia aqvs
hormonebis gamomuSavebis procesSi, romlebic pasuxismgeblebi arian imunur sistemaze.
karnitini (Carnitine) - karnitini monawileobs cximis mJavebis grZeli jaWvis Seqmnis da
maT organizmidan gamodevnis procesSi. RviZli da Tirkmelebi gamoimuSaveben karnitins
ori sxva aminomJavisagan - lizinis da metioninisgan. karnitini organizms xorcis da rZis produqtebis saSualebiT
miewodeba. ganasxvaveben ramdenime ti pis karnitins. D- karnitini saSiSia, radgan amcirebs
organizmis mier karnitinis
damoukideblad gamomuSavebis
unars. L- karnitini am mxriv
naklebad saxifaTod iTvleba.
cximovani maragebis zrdis procesis Seferxebis unaris
gamo L- karnitini mniSvnelovania wonis klebisaTvis da gulis daavadebebis riskis Sesamcireblad. organizmi karnitins gamoimuSavebs mxolod
sakmarisi raodenobis lizinis,
rkinis da B19 da B69 enzimebis arsebobis dros. karnitinis
deficitis mimarT vegetarianelebi ufro mgrZnobiareebi arian, radgan maT racionSi SedarebiT mcirea lizini. karnitini aseve amaRlebs antioqsidantebis C da E vitaminebis efeqturobas. iTvleba, rom cximis
Sedegiani utilizaciisaTvis
karnitinis dRiuri norma unda
1500 miligrams Seadgendes.
ornitini (Ornithine) - xels
uwyobs zrdis hormonis gamomuSavebas, romelic l-argininis da l-karnitinis kombinaci-
aSi nivTierebaTa cvlis procesSi Warbi cximis meorad gamoyenebas astimulirebs. aucilebelia RviZlis da imunuri
sistemis funqcionirebisaTvis.
prolini (Proline) - aucilebelia xrtilebis da saxsrebis gamarTuli funqcionirebisaTvis, aseve monawileobs gulis kunTebis muSaobasa da
gaZlierebaSi.
serini (Serine) - monawileobs RviZlis da kunTebis mier glikogenis maragis SeqmnaSi. aZlierebs imunur sistemas, uzrunvelyofs mas antisxeulebiT, nervuli boWkoebis garSemo qmnis cximis „SaliTebs“.
taurini (Taurine) - astabilurebs membranebis aRgznebadobas, rac mniSvnelovania epilefsiuri Setevebis kontrolisaTvis. mniSvnelovania mravali bioqimiuri cvlilebis
kontrolisaTvis, romelsac
adgili aqvs daberebis procesSi. monawileobs organizmis
Tavisufali radikalebisagan
gaTavisuflebis procesSi.
tirozini (Tyrosine) - pirobiTad Seucvladi aminomJavaa,
sinTezirdeba organizmis mier arasakmarisi raodenobiT.
organizmis mier fenilalaninis nacvlad cilebis sinTezisaTvis gamoiyeneba. misi wyaroa rZe, xorci, Tevzi. tvini tirozins norepinerfinis gamosamuSaveblad moixmars, romelic amaRlebs mentalur tonuss.
cistini (Cysteine) - pirobiTad Seucvladi aminomJavaa,
sinTezirdeba organizmis mier arasakmarisi raodenobiT.
Tu racionSi sakamrisi raodenobis cisteinia, organizms
SeuZlia is metioninis nacvlad gamoiyenos cilebis gamosamuSaveblad. cistinis wyaroa
- xorci, Tevzi, soio, xorbali,
Svria. cistini kvebis mrewvelobaSi rogorc antioqsidants gamoiyeneben mza produqtebSi C vitaminis SesanarCuneblad.
aminomJavebis efeqti
- energiis wyaro - aminomJavebis metabolizmi sxva meTodiT xdeba naxSirwylebisagan
gansxvavebiT, amitom organizms varjiSis dros SeuZlia gacilebiT didi energiis miReba, Tu aminomJavebis depo Sevsebuli iqneba.
- cilebis sinTezis daCqareba - aminomJavebi axdenen anaboluri hormonis - insulinis
sekreciis stimulacias da aaqtiurebs mTOR-s (cila, romelic aregulirebs ujredebis
zrdas da dayofas), romlebic
Tavis mxriv kunTebis zrdis
damaCqarebeli meqanizmi.
- katabolizmis Seferxeba aminomJavebs gamokveTili antikataboluri moqmedeba axasiaTebT, romelic gansakuTrebiT
aucilebelia varjiSis Semgdeg, wonis klebis an gamoSrobis procesSi.
- cximis wva - aminomJavebi
xels uwyoben cximebis wvas
mTOR-s saSualebiTa di pocitebSi leptinis eqspresiis xarjze.
ra gansxvavebaa aminomJavebsa da proteinebs Soris
rogorc vTqviT proteini
Sedgeba igive aminomJavebisagan,
amitom xSirad dgeba kiTxva, ra
gansxvavebaa aminomJavebsa da proteinebsSoris, romlis miReba jobia da Tu SeiZleba maTi
SeTavseba? am kiTxvaze pasuxis
gasacemad unda ganvasxvavoT
am SenaerTebis struqtura.
proteini es aris aminomJavebisagan Sedgenili konstruqcia,
xolo aminomavebs Soris arsebobs qimiuri kavSirebi, romelTa daSlaa saWiro maT asaTviseblad. aminomJavebi ki Tavisufali anpeptiduri saxiT (risganac Sedgeba sportuli kvebis produqtebi) ukve daSlili a ad vi la d a saT vi se bel
formad. aqedan gamomdinare,
aminomJavebis da proteinebismiRebisdrogansxvavebulia.
ra aris vitaminebi?
vitaminebi da mineralebi sasicocxlo da ucilebeli elementebia, romelTa miReba mxolod sakvebi produqtebis,
sakvebi da sportuli danamatebis saSualebiT aris SesaZlebeli. am elementebs xSirad
rogorc „mikronutrientebs“
ise moixsenieben, radgan vitaminebi da mineralebi organizms SedarebiT mcire raodenobiT esaWiroeba, vidre cilebi,
cximebi da naxSirwylebi.
vitaminebi
vitaminebi es aris organuli
nivTierebebi, romlebic aucilebelia adamianis organizmis y2013 weli
vela sasicocxlo biologiuri funqciis uzrunvelsayofad. Cvens organizms ar SeuZlia maTi damoukideblad gamomuSaveba da vitaminebis ZiriTad nawils sakvebis saSualebiT vRebulobT, xolo maTi nawili Cvens organizmSi sinTezirdeba. vitaminebi ar warmoadgenen energiis wyaros, Tumca
isini aucilebelia sxvadasxva
sasicocxlo procesis normaluri mimdinareobisaTvis: sisxlis da Zvlovani ujredebis
warmoqnisaTvis, kbilebisa da
kanisTvis, nervuli impulsebis gadacemisaTvis, imunuri
sistemis funqcionirebisaTvis,
vitaminebi aseve aqtiurad monawileoben nivTierebaTa cvlaSi.
vitaminebi iyofa or jgufad: wyalSi da cximSi xsnad
vitaminebad. wyalSi xsnad vitaminebs miekuTvnebian B jgufis yvela vitamini da vitamini C, aseve foliumis mJava, niacini (РР), biotini (Н). xolo
cximSi xsnad vitaminebs - retinoli (A), kalciferoli (D),
E da K vitaminebi.
vitamini A da D organizms ar
miewodebian damoukidebeli saxiT, isini Semdgom sinTezirdebian. arsebobs mcdari mosazreba, TiTqos vitaminebs mxolod
xilisa da bostneulis saSualebiT viRebT. realurad ki mcenareuli sakvebi Cven mxolod
C vitaminiT, foliumis mJaviT, K
vitaminiT da karotiniT (A vitaminis provitamini) gvamaragebs,
saidanac nivTierebaTa cvlis procesSi A vitamini gamomuSvdeba. B jgufis vitaminebs cxoveluri warmoSobis sakvebi Seicavs, D vitamins ki Tevzi da zRvis produqtebi. amitom adamianis kveba mravalferovani unda
iyos, rom sakmarisi raodenobis
vitaminebis miwodeba moxdes
organizmisaTvis.
erTi an meti vitaminis deficits SeuZlia im fiziologiuri procesebis darRveva, romelzec is aris pasuxismgebeli. garda amisa, organizmSi vitaminebis qronikul ukmarisobas zogierTi daavadebebis
gamwvaveba SeuZlia.
mineraluri nivTierebebi
sakveb produqtebTan erTad
organizms garda vitaminebisa,
mineraluri nivTierebebic miewodeba. vitaminebis msgavsad
2013 weli
arc mineralebs aqvT energetikuli faseuloba, Tumca organizms maT gareSe arseboba ar
SeuZlia. mineralebi monawileoben Cveni Zvlovani qsovilebis formirebaSi, mniSvnelovan
rols TamaSoben nivTierebaTa
cvlaSi da uzrunvelyofen
nor ma lur sa si co cocx lo
funqciebs. mineralebis ZiriTadi nawili organizmis Zvlovan qsovilebSi an sxvadasxva
Txevad garemoSia koncentrirebuli. organizmidan mineralebis gamodevna bunebrivi gziT xdeba da amitom aucilebelia maTi mudmivad ganaxleba da Sevseba.
mineralebs mikro da makroelementebad hyofen. makroelementebia: gogirdi, fosfori,
qlori, magniumi, natriumi. maTorganizmi sakmarisad didi
raodenobiT Seicavs da SeiZleba ramdenime aseul miligrams
Seadgendes sxeulis 100 gramze.
am mineralebis gareSe arseboba SeuZlebelia. isini aqtiurad monawileoben cvlis procesebSi da uzrunvelyofen Cveni organoebis da sistemis
normalur funqcionirebas. es
makroelementebi Cveni ujredebis Semadgenel nawils warmoadgenen. makroelementebis Semcveloba Cvens organizmSi umniSvneloa. makroelementebia rkina, marganeci, TuTia, spilenZi, kobalti, ftori, qromi, iodi,
selenidasxv. sul mecnierebi
janmrTelobisaTvis aucilebel 25 mikroelements iTvlian.
dadgenilia, rom fermentebis didi nawili aqtiuri moqmedebas mxolod organizmSia
maTuimmineralis arsebobisas
iwyebs. maTi monawileobis gareSe cvlis procesebi ar aqtiurdeba. isini monawileoben
sisxlis warmoqmnis da Sededebis procesebSi, uzrunvelyofen mJava-tutovan balanss,
qmnian vitaminebis asaTviseblad saWiro garemos, monawileoben Zvlovani da sxva qsovilebis formirebaSi, asruleben
mniSvnelovan rols gul-sisxlZarRvTa da nervuli sistemis normalur funqcionirebaSi, monawileoben saWmlis gadamuSvebis procesSi. faqtiurad, organizmis yvela sasicocxlo procesia maT uimmineralebis monawileobis saSualebiT mimdinareobs.
57
vitaminebis da mineralebis
deficiti
SeiZleba iTqvas, rom praqtikulad verc erTi Cvengani ver iRebs sakmarisi raodenobiT
vi ta mi neb sa da mi ne ra leb s
dRevandel racionSi arsebuli produqtebis saSualebiT,
rac sxvadaxva faqtorebiTaa
gamowveuli. xSir SemTxvevaSi,
niadagi damuSavebulia didi
raodenobi sasuqebisa da qimikatebis saSualebiT, rac miwis im sakvebi nivTierebebisgan
gamofitvas iwvevs, romelic
aucilebelia vitaminebiT da
mineralebiT srulyofilad
gamdidrebuli mcenareuli produqtebis misaRebad.
aseve mniSvneloba aqvs niadags, romelzec gamozrdilia
xili da bostneuli, radgan
rogorc kvlevebi aCvenebs sxvadasxva regionebSi moyvanil
erTi da igive produqts SeiZleba sxvadasxva sakvebi faseuloba gaaCndes, magaliTad produqtis erTi partia sakmarisi raodenobiT rkinas Seicavdes, xolo sxva regionSi moyvanil igive produqtSi ki minimaluri iyo misi Semcveloba.
bevri vitamini da minerali
im momentidan iwyeben daSlas,
rac daikrifeba. maTi Senaxvis
xangrZlivi periodis ganmavlobaSi ki sakvebi faseuloba mniSvnelovnad iwevs qveviT. sasargeblo nivTierebebis darCenili nawili produqtis sakvebad momzadebis procesSi kvlav zemoqmedebas ganicdis da
nadgurdeba. ase, rom realurad
Cvens racionSi vitaminebiTa
da mineralebiT sakmaod gaRaribebuli produqti xvdeba.
yuradsaRebia, rom vitaminebis da mineralebis deficiti
xSirad Tavs iCens dietis dacvis dros, radgan kaloriebis
raodenobis Semcirebas Tan
erTad mcirdeba sasargeblo
nivTierebebis raodenoba.
aseT dros, janmrTelobisa
da organizmis sasicocxlo
sistemis normaluri funqcionirebisaTvis aucilebeli xdeba vitaminebisa da mineralebis
Semcveli specialuri da namatebis miReba.
vitaminebi da mineralebi
bodibildingSi
rogorc praqtika gviCvenebs,
bodibildingSi, fitnes Sida s-
58
portis sxva saxeobebSi SeuZlebelia warmatebuli Sedegebis miReba vitaminebis da mineralebis danamatebis gamoyenebis gareSe. swori kvebis da sistematiuri varjiSis miuxedavad, sportsmenebs xSirad uxdebaT „platosefeqtTan“ (Sedegebis erT maCvenebelze gayinva)
Sejaxeba, rogorc kunTovani
masis zrdis, aseve cxi mis fenebis Semcirebis procesSi.
amis mizezi ki SesaZlebelia
mineralebis da vitaminebis
deficiti iyos, radgan organizmi sakvebi produqtebidan
ver Rebulobs maT saWiro raodenobas, da es maSin, rodesac aTletizmiT da bodibildingiT dakavebuli adamianebis organizms vitaminebis da mine ra le bi s uf ro ma Ra li
moTxovnileba gaaCnia, vidre naklebad aqtiuri cxovrebiT dakavebul adamianebs.
aRniSnul faqtorebi ganapirobebs vitaminebis da mineralebis danamatebis miRebis aucileblobas. saWiroa arCevani
gakeTdes swored da optimalur kompleqsze. vitaminebis
da mineralebis kompleqsis
xarisxi matricebis mixedviT
ganisazRvreba, romelic saSualebas aZlevs nivTierebas
garkveuli siswrafiT da kombinaciiT gamoTavisufldes,
rac misi aTvisebis efeqts ganapirobebs. garda amisa, sportiT da bodibildingiT varjiSis dros icvleba organizmis
moTxovnilebebi: erTi ti pis
vitaminebze saWiroeba 20%-iT
izrdeba, xolo sxva zeki 100%iT. amitom aTletebs specializirebuli kompleqsebis SeZena
esaWiroebaT, romelic varjiSis dros organizmis specifiuri moTxovnilebebis mixedviTaa Seqmnili. vitaminebis da
mineralebis miReba saWiroa
rogorc kunTovani masis da Zalovani maCveneblebis zrdis dros, aseve reliefze muSaobis
da wonaSi klebis dros.
miRebis wesebi
daicaviT mwarmoeblis rekomendaciebi. miiReT kompleqsi 12 Tvis ganmavlobaSi, Semdegi 1
Tvis periodSi ki Sualedi gaakeTeT. mudmivi miReba araa rekomendirebuli, radgan organizms uqveiTdeba sakvebidan rTulad misaRwevi vitaminebis
aTvisebis unari. aseve mcirdeba vitaminebis sinTezi organizms SigniT. kompleqsis miRebis periodizacia organizmis
janmrTel mdgomareobas da
tolerantobis ganviTarebis
profilaqtikas uzrunvelyofs.
calkeuli vitaminebis aRwera
vitamini A (retnoli) – misi wyaro acxoveluri warmoSobis produqtebi. aseve is
warmoiqmneba organizmis mier
beta-karotinis saSualebiT,
romelsac xili da bostneuli
Seicavs. is ukeTesad aiTviseba cximTan erTad. A vitamini
aZlierebs imunitets, uzrunvelyofs kanis, kbilebis, Zvlebis, Tmebis janmrTelobas. Zalian mniSvnelovania mxedvelobisaTvis.
vitaminis ukmarisobis SemTxvevaSi viTardeba „qaTmis
sibrmave“, kanis da Tmis simSrale, gamonayari, wonis kleba,
uZiloba.
vitaminis hi pervitaminozis
simptomebi deficitis simptomebs waagavs. misi siWarbe iwvevs Tavis tkivils, frCxilebis da Tmis mtvrevas, saxsrebSi tkivils.
dRiuri norma: 900mkgr.
dRiuri norma bodibildingSi: 1200mkgr.
vitamini B2 (tiamini) – aumjobesebs nervuli sistemis
muSaobas, dadebiTad moqmedebs kunTebis funqcionirebaze,
aregulirebs aminomJavebis da
naxSirwylebvis cvlas, uzrunvelyofs RviZlis da kuWnawlavis muSaobas, aZlierebs imunitets.
B1-is deficitis simptomebia uZiloba, Tavis tkivili, nervuli aSliloba, gul-sisxlZarRvTa daavadeba, mexsierebis
gauareseba, kunTebis sisuste.
tiaminis xangrZlivi ukmarisoba iwvevs nervuli sistemis daavadeba beribers.
B1 naklebad toqsikuria da
misi siWarbe iSviaTad vlindeba. B1-is xangrZlivi hi pervitaminozi iwvevs Tirkmelebis da
RviZlis funqciis darRvevas.
iSviaT SemTxvevaSi iwvevs alergias.
B1 vitamins Seicavs RerRili, marcvleuli, mSrali safuari, brinjis CenCo, xorbali,
Svriis RerRili, araqisi, bos-
tneulis umetesoba, qato, Roris da xbos xorci, kvecxi, rZe.
dRiuri norma: 1, 5mgr.
dRiuri norma bodibildingSi: 10-20mgr.
vitamini B2 (riboflavini) –
gavlenas axdens ujredebis zrdasa da aRdgenaze, Sedis
fermentebis SemadgenlobaSi,
romlebic mniSvnelovan gavlenas axdenen qsovilebSi mimdinare da Jangvis reaqciebSi dacilebis, cximebis da naxSirwylebis cvlis regulaciaSi.
aucilebelia Tvalebis normaluri funqciisaTvis. riboflavins iyeneben wylulebis
da xangrZlivad Seuxorcebeli
Wrilobebis, kuWnawlavis funqciis darRvevebis mkurnalobisaTvis da a. S. saWiroa kanis,
frCxilebis, Tmebis janmrTelobisaTvis.
riboflavinis ukmarisoba vlindeba madis daqveiTebaSi,
wonis klebiT, sisustiT, Tavis
tkiviliT, mxedvelobis problemiT, tuCis kuTxeSi napralebis gaCeniT da dermatitiT.
B2 Seicavs rZe, RviZli, Tirkmelebi, safuari, mwvane furcliani bostneuli, pomidori, askili, kombosto, kvercxi.
dRiuri norma: 1, 8mgr.
vitamini B3 (PP) (niacini) monawileobs cximisa da Saqrisgan energiis warmoqmnaSi.
aferxebs gul-sisxlZarRvTa
daavadebebis ganviTarebas, aregulirebs sisxlSi qolesterinis dones, amcirebs trigliceridebis dones, romlebic
axdenen hi pertoniis da diabetis ganviTarebis provocirebas, monawileobs kuWis wvenis
warmoqmnaSi da sakvebis gadatanis procesebSi, uzrunvelyofs nervuli sistemis normalur funqcionirebas. erTaderTi vitaminia romelic monawileobas iRebs organizmis
hormonaluri fonis formirebaSi. tiroqsini, insulini, kortizoli, testosteroni, estrogeni, progesteroni gamomuSavdeba PP vitaminismonawileobiT.
B3-isukmarisobis simptomebia nervuli aSliloba, diarea,
uZiloba, madis dakargva, saWmlis mounelebloba, sisuste
kunTebSi, tkivili kidurebSi.
2013 weli
B3-is siWarbe vlindeba saxis, kisris, mkerdis kanis siwiTliT da simxurvalis SegrZnebiT. B3-is wyaroa: qaTmis
xorci, RviZli da Tirkmelebi,
yveli, Tevzi, kvercxi, araqisi,
soko, mwvane muxudo, kartofili, barda, safuari.
dRiuri norma: 20mgr.
dRiuri norma bodibildingSi: 50mgr.
vitamini B5 (pantotenismJava)
- mis gareSe ar xdeba cximovani mJavebis da Jangva da biosinTezi, li pidebis, steroiduli hormonebis da hemoglobinis sinTezi. gamoiyeneba arTritis, gul-sisxlZarRvTa daavadebebis da alergiis samkurnalod. is saWiroa sxva vitaminebis asaTviseblad da imunuri sistemis normaluri
funqcionirebisaTvis.
B5-is deficiti iSviaTad
warmoiSoba da ZiriTadad wvrili nawlavis daavadebebis,
antibiotikebiT xangrZivi mkurnalobis an stresis Sedegia.
misi ukmarisoba vlindeba dermatitiT, Tmis defigmentaciiT,
madis dakargviT da nervuli
sistemis mZime daavadebebiT.
B5-is siWarbe naklebad savaraudoa, misi didi dozebiT miRebis SemTxvevaSic ki, radgan
is advilad gamoidevneba organizmidan.
B5 vitaminis is wyaroa: RviZli, safuari, kvercxisgulidamcenareebismwvanenawilebi, garda amisa B5 sinTezirdeba nawlavebis mikrofloraSic.
dRiuri norma: 5mgr.
I15mgr.
vitamini B6 (piridoqsini) - aZlierebs imunitets, amcirebs
infarqtis, insultis, aTerosklerozis ganviTarebis safrTxes, aregulirebs arteriul
wnevas. monawileobs aminomJavebis, cilebis da cximebis cvlaSi, sisxlis warmoqmnis procesSi, amaRlebs tvinis muSaobis efeqturobas, aumjobesebs mexsierebas. uzrunvelyofs RviZis normalur funqcionirebas.
B6-is deficiti vlindeba
dermatitiT, mexsierebis da yuradRebis gauaresebiT, Tavis tkiviliT, anemiis ganviTarebiT,
madis dakargviT, nervuli sistemis darRveviT.
2013 weli
B6-is siWarbes SeuZlia alergiuli reaqciis gamovlena da sisxlis mimoqcevis darRveva.
B6-iswyaroa: gaRvivebuli marcvleuli, Txili, ispanaxi, kartofili, kombosto, stafilo,
lobio, marwyvi, limoni, forToxali, RviZli, kvercxi, Tevzi.
dRiuri norma: 2mgr.
vitamini B9 (foliumis mJava)
- aregulirebs sisxlis warmoqmnis procesebs, monawileobs hemoglobinis sinTezSi, amcirebs sisxlSi qolesterinis
dones. aferxebs aTerosklerozis daanemiis ganviTarebas.
aregulirebs nervuli sistemis funqcias, amaRlebs stresebis mimarT mdgradobas. aumjobesebs kuW-nawlavis da RviZlis funqcionirebas.
B9-is deficiti vlindeba
Tavis tkiviliT, sisustiT,
swrafi daRliT, cudi mexsierebiT, gaRizianebadobiT, uZilobiT. hi povitzminozis seriozuli SemTxvevebis dros ki
xdeba wonis dakargva, viTardeba anemia, paranoia.
B9-is didi dozebiT xangrZlivi miRebis periodSi mcirdeba sisxlSi B12-is koncentraciis done, SeiZleba gamowveuli iqna sanoreqsia an Zilis
darRveva.
B9-is wyaroa: kombosto, ispanaxi, parkosnebi, salaTi, mwvane
muxudo, lobio, mwvane xaxvi,
Warxali, stafilo, pomidori,
uxeSad daqucmacebuli fqvili, RviZli, Tirkmelebi, yveli,
xizilala, xaWo, safuari.
vitamini B12 (cianokobalamini)
- mTavar rols TamaSobs nervebis mielinis garsis CamoyalibebaSi daicavs maT daSlisagan. B12, iseve rogorc B9 monawileobs cximebis da naxSirwylebis cvlaSi, aseve sisxlis
warmoqmnis procesSi daaferxebs sisxlnaklulobis ganviTarebas. B12 mniSvnelovania B9is swori moqmedebisaTvis, aseve nukleinis mJavebis - genetikuri masalis warmoebisaTvis.
B12-is deficitis simptomebia:
Tavbrusxveva, daRliloba, dep-
59
resia, gul-sisxlZarRvTa sistemis da kuW-nawlavis moqmedebis darRveva, anemia. B12-is xangrZlivi ukmarisoba iwvevs
zurgis tvinis da nervuli
sistemis moSlas.
B12-is hi pervitaminozis specifiuri simptomebi araa dafiqsirebuli. Tumca arsebobs monacemebi intoqsikaciis
SemTxvevebSi kanze gamonayaris gamovlinebis.
B12-is wyaroa: guli, Tirkmelebi, RviZli, xamanwkebi, zRvis
produqtebi, Tevzi, yveli, kvercxis guli. mcenareuli sakvebi B12-s praqtikulad ar Seicavs.
dRiuri norma bodibildingSi: 10-50mkgr.
vitamini C (askorbinismJava)
- uzrunvelyofs kbilebis,
RrZilebis da Zvlovani qsovilebis janmrTelobas, aumjobesebs rkinis da kalcis aTvisebas, is adamianis organizmisTvis aucilebel antioqsidantad iTvleba. zrdis imunitets,
exmareba organizms daavadebebis dainfeqciebis winaaRmdeg
brZolaSi, Wrilobebis moSuSebasa da operaciebis Semdeg aRdgenaSi. garda amisa, vitamini
C saWiroa kolagenis sinTezisTvis, romelic monawileobs qsovilebis formirebaSi.
vitamini C-sSeicavscitrusebi, nesvi, briuselis da yvavilovani kombosto, Svimocxari,
bulgaruli wiwaka, marwyvi,
pomidori, vaSli, gargari, atami, askili, RviZli da Tirkmelebi.
vitamini D (kalciferoli) aregulirebs adamianis organizmSi kalcis da fosforis
dones. aRniSnuli vitamini
organizmis mier sinTezirdeba
mzis sxivebis saSualebiT.
aferxebs kibos ujredebs zrdas, uzrunvelyofs Zvlebis
normalur zrdasa da ganviTarebas, xels uSlis osteoporozis, arTritis da raqitis ganviTarebas, amcirebs aTerosklerozis da diabetis risks. D vitaminis dididoziT deficiti
zrdis zemoaRniSnuli daavadebebis ganviTarebis risks, mci-
60
re deficiti iwvevs mxedvelobis gauaresebas, wonis da madis dakargvas, uZilobas.
D vitamins aqvs organizmSi
dagrovebis unari, amitom SesaZlebelia toqsikuri mowamvla. SeiZleba gamovlindes krunCxvebi, maRali wneva, Zlieri tkivili mucelsa da kunTebSi, gulisreva, ariTmia. D vitaminis did da xangrZliv dozas SeuZlia gamoiwvios guliT an Tirkmelebis ukmarisobiT
sikvdili. amitom samedicino
kontrolis gare Seumjobesia am jgufis vitaminebis miRebis ganTavis Sekaveba.
vitamini E (tokoferoli) Zlieri antioqsidantia, ris gamoc kargad ebrZvis Tavisufal radikalebs, romlebic
iwveven sxvadasxva paTologiebs da xels uSlis organizmSi kancerogenebis warmoqmnas.
kargia qsovilebis regeneraciisaTvis da amcirebs travmebis
Semdeg nawiburebis warmoqmnis albaTobas. uzrunvelyofs
kunTebis normalur funqcionirebas, xsnis fexebSi krunCxvas, zrdis amtanobas.
E vitaminis deficitis niSnebia kunTebis distrofia, gulis da reproduqciuli funqciis darRveva, sisxlnakluloba.
E vitamini sakmaod aratoqsikuria, misi WarbidoziT xangrZlivad miRebis SemTxvevaSi
SeiZleba gamovlindes diarea,
gulisreva, meteorizmi, maRali
wneva.
E vitaminis wyaroa: mzesumziris, soios, simindis araqisis zeTi, oraguli, RviZli, stafilo, Svria, ispanaxi. E vitaminis asaTviseblad saWiroa seleni da TuTia, xolo comeuli da tkbileuli, piriqiT mis aTvsebas aferxebs.
vitamini F (omega-3, omega-6)
– xels uSlis qolesterinis
arteriebSi daleqvas; mniSvnelovan rols TamaSobs osteoqondrozis, radikulitis, revmatiuli paTologiebis mkurnalobaSi, aregulirebs li pi-
dur cvlas da sisxlis miwodebas, uzrunvelyofs qsovilebis kvebas. xels uwyobs wonis
daklebas, wvavs najer cximebs.
F vitaminis nakleboba iwvevs imunuri sistemis darRvevas,
mxedvelobis problemas, qolesterinis donis awevas, gulis daavadebebs, Tmebis dakanis xarisxis gafuWebas, gamonayaris da alergiuli reaqciebis gamovlenas.
F vitaminis moqmedebis gasaZliereblad rekomendirebulia misi antioqsidantebTan erTad miReba, aseve B6 vitaminTan
daTuTiasTan erTad. Tavis mxriv F vitamini aZlierebs A, B,
D, E vitaminebis moqmedebas, xolo snaxSirwylebis didi raodenobiT moxmareba ki piriqiT asustebs F vitaminis aTvisebas.
F vitaminis ZiriTadi wyaroa: zeiTunis, seliszeTi, Tevzis qoni, zogierTi mcenaris
kurkebi, gamomSrali zili, araqisi, soio, nuSi, avokado.
dRiuri norma: 1mgr.
TuTia (Zinc) - Sedis bevri
fermentis SemadgenlobaSi, saWiroa testosteronis gamosamuSaveblad.
wyaroa: xorblis marcvali,
rZis produqtebi.
calkeuli mineralebis aRwera
kaliumi (Potassium) - sistemuri eleqtroliti, aucilebelia yvela ujredebis funqcionirebisaTvis, monawileobs
ATP cvlaSi.
wyaroa: parkosnebi, kartofili, pomidori, banani.
rkina (Iron) - Sedis proteinebis da fermentebis SemadgenlobaSi, monawileobs Jangbadis gadatanaSi.
wyaroa: xorci, Tevzi, kvercxi, Sedis bevri mcenaris SemadgenlobaSi, Tumca iqidan
rTulad aiTviseba.
dRiuri norma: 8mgr.
qlori (Chlorine) - aucilebelia kuWSi marilovani mJavis
produqciisaTvis, monawileobs ujredis mier Sewovis funqciaSi.
wyaroa: sufris marili
manganumi (Manganese) - zogierTi fermentis ko-faqtori.
dRiurinorma: 2, 3mgr.
natriumi (Sodium) - sistemuri eleqtroliti, monawileobs
ATP cvlaSi, urTierTqmedebs
kaliumTanerTad.
wyaroa: sufris marili
kalciumi (Calcium) - aucilebelia kunTebis, gulis dasaWmlis momnelebeli sistemis
muSaobisaTvis, amagrebs Zvlebs, uzrunvelyofs sisxlis
elementebis funqcias.
wyaroa: rZis produqtebi,
Tevzis konservi (Zvlovani na-
wilebi), mwvanili, Txili, Tesli.
fosfori (Phosphorus) - fosforis 85% Seicavs Zvlebi,
fosfori aseve aucilebelia
energetikuli procesebis mimdinareobisaTvis (monawileobs ATP cvlaSi)
wyaroa: zRvis produqtebi,
kvercxi, rZis produqtebi.
magniumi (Magnesium) - monawileobs ATP cvlaSi, uzrunvelyofs Zvlebis simtkices, Sedis fermentebis SemadgenlobaSi.
wyaroa: kvercxi, mwvanili,
parkosnebi, pomidori, wiwibura,
Txili, soio, kakao.
spilenZi (Copper) - monawileobs damJangav-aRdgeniT reaqciebSi.
wyaroa: Txili, kvercxi, RviZli, rZis produqtebi
iodi (Iodine) - saWiroa farisebri jirkvlisnormaluri
funqcionirebisaTvis, Sedis misi hormonebisSemadgenlobaSi.
wyaroa: zRvis produqtebi,
zRvis kombosto, kvercxi, iodizirebuli marili.
seleniumi (Selenium) - antioqsidanti.
2013 weli
61
sadReRamiso moTxovnileba vitaminebze sxvadasxva asakobrivi jgufisaTvis
verboten, Jun 6 2007, 11:07
molibdeni (Molybdenum) SedisfermentebiskompleqsSi.
vitaminebis ZiriTad wyaros sakvebi warmoadgens. sakveb ra ci on Si vi ta mi ne bis
genlobaze (mag. naxSirwylebis siWarbis pirobebSiorganizms esaWiroebameti B1, B2 da
C vitamini), Senaxvis vadasa
da formaze, sakvebis teqnologiur damuSavebaze, kvebis
Cvevebze da sxv.
sainteresoa da sayuradReboa S. p. s. `puris” - „api puris“ Semadgenloba:
Sem c ve lo ba ic v le ba s x va dasxva mizezis zegavleniT
da damokidebulia produqtis saxeobaze, sakvebis Semad-
daskvna: yovelive zemo aRniSnuli ganapirobebs sportsmenTa da orsulTa kvebis ra-
cionSi S. p. s. `puris” - „api puris“ aucileblobas.
literatura:
1. G. Chakhunashvili, N. Kandelaki
-Children and security: `Child has the
right to be defended from birth” NATO
science for peance and seurity
series E: Human and societal Dynamics – vol. 37 complexity and Security –
2008 Chap. 126. p. 405-410www. iospress. nl
2. Sustainable development and child
security. /G. Chakhunashvili, I. Phavlenishvili /. Social,
Ecological and Clinical Pediatrics. –
2011. - #13-8-7. - pp. 25-46. – geo. ; abs.
: geo., eng.
3. CaxunaSvilig. medicinis
mecnierebadaa ucilebeli gza
XXI saukuneSi misi ganviTarebisaken `Canasaxidan bavSvs
ufleba aqvs iyos daculi”socialuri, ekologiuridaklinikuri pediatria. - Tbilisi, 2009.
- N11-6-5. - gv. 54-60
4. Daro et all//Clin. Exp. Immunol.
2008 v93 N3 p430-435//
5. Gabriel E. M. Btrgert E. M. et
all//Germline polymprphismof codon
727of Human Thyroidstimulatinghormone receptoris associatedwith toxic
multinodular goiter//J. Clin. Endokrin.
Metab. 2011vol94p3328-3335//
Gon K. L. Wang F. A. // Am. Rheum.
Diseases 2009 sol m99N2 p201-204//
fexmZime da meZuZuri qalebis sadReRamiso moTxovnileba vitaminebze
2013 weli
62
reziume
sportsmenTa da orsulTa kvebis racionSi
„api puris“ aucilebloba
g. CaxunaSvili, n. badriaSvili, m. TofuriZe, n. jobava, k. CaxunaSvili,
z. fxalaZe, ir. kalndia, d. CaxunaSvili, S. iusupovi
socialuri pediatriis dacvis fondi, ir. ciciSvilis sax. pediatriuli klinika,
Tbilisis sax. samedicino universiteti, S. p. s. `puri“
sakvebi produqti àpi puri”. gamdidrebulia janmTelobisaTvis aucilebeli aminomJavebiT, vitaminebiT da mineralebiT. axali teqnologiiT damzadebuli puri saqarTveloSi Seamcirebs masiurad gavrcelebul vitaminebis, aminomJavebis da mikroelementebis deficitiT gamowveul daavadebebs. saqarTveloSi puris moxmarebasakmarisze ufro maRalia. yovelive zemo aRniSnuli ganapirobebs sportsmenTa da orsulTa kvebis racionSi S. p. s. `puris” - „api puris“ aucileblobas.
SUMMARY
IMPORTANCE OF INCLUDING “APIPURI”
IN SPORTSMEN AND PREGNANT
G. CHAKHUNASHVILI, N. BADRIASHVILI, M. TOPURIDZE, N. JOBAVA, K. CHAKHUNASHVILI, Z.
FKHALADZE, I. KALANDIA, D. CHAKHUNASHVILI, S. YUSUPOV
SPPF, Children’s New Hospital After I. Tsitsishvili, TSMU, LLC `puri”
“Apipuri” is enriched with minerals, amino acids and vitamins, all the micronutrients needed for normal function of the
organism. The new technology pf baking bread is aimed to reduce widespread micronutrients deficiencies, as the Bread
is affordable almost by whole population. All above said, confirms that “Apipuri” produced by LLC `puri” is likely to be
in food ration of sportsmen.
,,eqimisa da pacientis urTierTobis principebi"
T. maxaraZe
eqimisa da pacientis urTierToba warmoadgens samedicino praqtikisa da Sesabamisad samedicino eTikis qvakuTxeds.
ukve 15 saukunis ganmavlobaSi eqimebi deben
fics, imis Sesaxeb, rom isini upiratesobas sakuTar interesebze metad mianiWeben pacientTa interesebs.
garkveul wilad hi pokrates ideebi dResac
aqtualuria, Tumca eqimisa da pacientis urTierTobis zogierTi eTikuri aspeqti kardinalurad Secvlilia.
1949 wels msoflio samedicino asociaciis mier miRebuli iqna`samedicino eTikis saerTaSoriso kodeqsi’’, NromelSic samedicino profesiuli eTikis princi pebi da zneobrivi normebi ufro farTod aisaxa, vidre hi pokrates ficSi. teqstSi gaCnda iseTi terminebi, rogoricaaèqimis
valdebulebebi”`, avadmyofis uflebebi’’ da sxva.
swored adamianis uflebebis ideologiis
konteqstSi aRmocenda pacientTa uflebebis
cneba da avadmyofis avtonomiis koncepcia.
tradiciuli saeqimo eTikis ZiriTadi Tema eqimisa da pacientis urTierTobis sakiTxia, da pirveladi am urTierTobebSi eqimis avtoritetia.
samedicino eTikas wminda korporaciuli xasiaTi gaaCnda, is ganixilavda eqims, rogorc
erTaderT moralur subieqts, romelsac gaaCnda gavlena pacientze. pacienti am SemTxvevaSi urTierTobebis pasiuri mxared aRiqmeboda, romelic ar Rebulobda monawileobas misTvis sasicocxlod mniSvnelovani gadawyvetilebis miRebaSi. TviT terminic`pacient’’ laTinuri sityvaa da niSnavs pasiurs. arc ise Soreul warsulSi eqims gaaCnda sruli ufleba da is valdebulic iyo TviTon SeerCia da
erTpirovnulad mieRoOgadawyvetileba pacientis mkurnalobis taqtikis Sesaxeb. eqims ar
esaWiroeboda pacientisagan informirebuli
Tanxmobis aReba. dRes pacienti eqimTan erTad
Rebulobs monawileobas gadawyvetilebis miRebaSi. rogorc vxedavT, droTa ganmavlobaSi urTierTobebma,, eqimi-pacienti’’ evolucia
ganicada.
tradiciuli samedicino eTikiT urTierToba Semofargluli iyo urTierTobiT or mxares Soris: eqimsa da pacients Soris. dRes eqimma SezRuduli samedicino resursebis gadanawilebis pirobebSi unda gaiTvaliswinos sazogadoebaSi arsebuli moTxovnilebebic. Y
eqimi pasuxismgebeli iyo mxolod sakuTari
Tavisa da kolegebis winaSe. dRes eqimi pasuxismgebelia pacientis da mesame mxaris-saavad2013 weli
myofoebis, samedicino licenziis da maregulirebeli xelisuflebis, da zogjer sasamarTlos winaSec ki.
droTa ganmavlobaSi cvlileba ganicada eqimis statusma sazogadoebaSi. Tu pacientebi
usityvod asrulebdnen eqimis nebismier miTiTebas da daniSnulebas, dRes pacintebi eqimebisgan moiTxoven ganmartebebsa da mkveTr argumentebs mkurnalobis taqtikaSi ama Tu im gadawyvetilebis miRebis Taobaze.
Aaqedan gamomdinare, SesaZlebelia visaubroT
eqimis statusis Sesustebaze. eqimTa umravlesoba grZnobs, rom maT mimarT pativiscema iseTi aRar aris, rogoric es adre iyo.
zogierT qveyanaSi jandacvaze kontroli eqimebidan menejerebisa da biurokratebis xelSi
gadavida, romlebic eqimebs ganixilaven ufro
rogorc dabrkolebas, vidre partniorebs reformebis procesSi. pacientebi, romlebic odesRac
usityvod asrulebdnen eqimis daniSnulebas, dRes
eqimisagan iTxoven maTi rekomendaciebis dasabuTebas, Tuki eqimis mier gacemuli daniSnuleba gansxvavdeba sxva eqimis rekomendaciebisagan
an internetSi moZiebuli masalisagan. zogierTi procedurebi adre mxolod eqimebis prerogativa iyo, dRes maT teqnikuri specialistebi,
eqTnebi an paramedikosebi asruleben.
dRes bevr adamians miaCnia, rom isini TviTon
uzrunvelyofen samedicino momsaxurebas sakuTari TavisTvis, xolo eqimis roli Semoifargleba konsultantis an instruqtoris roliT.
miuxedavaT eqimis statusis mimdinare cvlilebisa, medicina kvlav profesiaa, romelsac
mniSvnelovnad afaseben daavadebuli adamianebi, romelTac maTi momsaxureba esaWiroebaT.
Mmiuxedavad yvelafrisa, mainc Seucvlelia eqimis roli jandacvis sistemaSi, im pacientTa zrunvis procesSi romlebic saWiroeben samecidino
daxmarebas. samyarosa da sazogadoebis nebismieri cvlilebebis fonze eqimi iyo, aris da iqneba medicinis sabazo Rirebulebebis (TanagrZnoba, kompetenturoba, damoukidebloba) damcveli. es
Rirebulebebi adamianis fundamentur uflebebTan erTad warmoadgenen bioeTikis safuZvlebs.
samedicino eTika gansxvavdeba yvela sxva sferoSi gamoyenebuli eTikisagan imiTac, rom misi
gaJRereba xdeba Riad ficSi, romlis magaliTs
warmoadgens msoflio samedicino asociaciis Jenevis deklaracia) da/an kodeqsSi. ficebi da kodeqsebi SesaZlebelia iyos gansxvavebuli sxvadasxva qveyanaSi an Tundac erTi qveynis farglebSi, magram maT aqvT bevri saerTo maxasiaTebeli, maT Soris: eqimis piroba pativi sces pacientis interesebs sakuTar interesebze metad,
ar gauwios diskriminacia pacientebs sqesis, religiis an sxva maxasiaTeblebis mixedviT, daicvas konfidencialoba da gauwios samedicino
daxmareba yvelas, visac es esaWiroeba.
rogorc ukve avRniSneT, ukanaskneli wlebis
ganmavlobaSi kanonmdeblobaSi da eTikaSi uaryofilia eqimisa da pacientis tradiciuli paternaluri modeli, romlis drosac eqimi iRebda gadawyvetilebas, xolo pacienti mas asrulebda. magram vinaidan pacientTa did nawils ar
aqvs unari an ar surT miiRon gadawyvetileba
2013 weli
63
maT mkurnalobasTan mimarTebaSi, pacientis avtonomiis princi pi xSirad problemuri xdeba.
ara nakleb rTulia urTierTobaTa sxva aspeqtebi, magaliTad eqimis valdebuleba- uzrunvelyos pacientis monacemebis konfidencialoba- samedicino Canawerebis kompiuteruli damuSavebisa da samedicino momsaxurebis regulirebis epoqaSi an eqimis sicocxlis SenarCunebis movaleoba sikvdilis daCqarebis Txovnis SemTxvevaSi
bioeTikis Seswavlis obieqti, swored, pacientisa da medikosis urTierTobis moraluri mxarea. bioeTikis umTavresi princi pi isaa, rom medikosisa da pacientis urTierTobis safuZvelSi adamianis aragasxvisebadi ufleba da TiToeulis Rirsebis pativiscema devs. pacientma, romelTanac eqims urTierToba uxdeba, SeiZleba ganicados mZime tanjva, ris gamoc, man SeiZleba àdamianuri saxec ki dakargos~; igi SeiZleba iyos
Camoyalibebuli loTi an narkomani, gonebrivad
arasrulfasovani, saSiSi damnaSave; is SeiZleba iyos mZimed daSavebuli, ugonod myofi, sikvdilis piras misuli, WuWyiani da a. S... ufro metic, eqimebs zogjer Sexeba aqvT micvalebulis
sxeulTan an arsebebTan, romlebic adamianur sicocxles mxolod perspeqtivaSi SeiZenen. yvela
am, iseve rogorc mraval sxva, aranakleb mZime situaciebSi, medikosma ar unda daiviwyos, rom adamiani, usulo sagnisagan an TviT yvelaze maRalganviTarebuli cxovelisagan gansxvavebiT, gansakuTrebul mopyrobas imsaxurebs; adamiani, miuxedavad misi socialuri statusis, Rvawlis, finansuri an sxva SesaZleblobebisa, adamianuri
Rirsebis matarebelia.
rac Seexeba adamianis uflebebs, aq upirveles
yovlisa, unda dasaxeldes yoveli maTganis ufleba–aRiarebuli iyos pirovnebad da ara sxvaTa miznebis ganxorcielebis saSualebad. aseve
TiToeulis moraluri valdebulebaa pirovnebad aRiaros sxva adamiani. Tu eqimsa da pacients Soris RirebulebaTa da interesTa konfliqti warmoiSva, rac sruliad bunebrivia, maSin,
bioeTikis poziciebidan gamomdinare, misi gadaWris erTaderT misaReb saSualebad situaciis
Ria, patiosani ganxilva iTvleba. aucilebelia,
dainteresebul mxareTa mxriv, gonivruli argumentebis Zieba sakuTar poziciaTa dasacavad, oponentis miukerZoebeli gagebis survili da bolos, urTierTmisaRebi gadawyvetilebis moZebna.
uwyebrivi, profesiuli da iZulebis sxva formis magier, rac jandacvis sferoSi socialuri
urTierTobebisTvis aris damaxasiaTebeli, bioeTika iswrafvis wamoWras dialogis strategia
romelic Tanxmobis Ziebisaken iqneba mimarTuli.
gamoyenebuli literatura:
nino CixlaZe _ `bioeTika da samedicino samarTali”
bela mamulaSvili- `bioeTika”
msoflio samedicino asociacia- `samedicino eTikis saxelmZRvanelo”
,, Four models of the physician-patient relationship”
–Ezekiel J. Emanuel, MD, PhD, Linda L. Emanuel MD, PhD.
,, The Doctor–Patient Relationship” Challenges, Oppor1
2
tunities, and Strategies, MD, MHSA, MA and., MD
Patient-Doctor Relationships
64
reziume
èqimisa da pacientis urTierTobis principebi“
T. maxaraZe
eqimisa da pacientis urTierToba warmoadgens samedicino praqtikisa da Sesabamisad samedicino eTikis qvakuTxeds.
samyarosa da sazogadoebis nebismieri cvlilebebis fonze eqimi iyo, aris da iqneba medicinis
sabazo Rirebulebebis (TanagrZnoba, kompetenturoba, damoukidebloba) damcveli. es Rirebulebebi adamianis fundamentur uflebebTan erTad warmoadgenen bioeTikis safuZvlebs. bioeTika iswrafvis wamoWras dialogis strategia romelic Tanxmobis Ziebisaken iqneba mimarTuli.
SUMMARY
PRINCIPLES OF DOCTOR-PATIENTS RELATIONS
T. MAKHARADZE, TSU
Relation between doctor and a patient is a foundation of medical ethics.
Despite a lot of changes in society, Doctor was and will be defender of basic value of medicine (competency, independence, empathy). Those values are basis of bioethics together with humans fundamental rights. Bioethics is rushing to bring
up strategies of dialogue, which will be aimed towards Consent.
daavadebis paTogenezisa da sanogenezis sistemuri analizi
ig. doliZe, g. CaxunaSvili
adamianis daavadebis arsidan
gamomdinare, rogorc dialeqtikurad mimdinare fiziologiuri
procesi, profesorma s. pavlenkom wamoayena debuleba imis Sesaxeb, rom nebismieri daavadebis
mimdinareobaSi wamyvania ara
mxolod paTogenezi (daavadebis
ganviTarebis meqanizmi), aramed
masSi aqtiurad monawile sanogenezic (organizmis dacviT_SeguebiTi meqanizmebis kompleqsi),
romelTa urTierTzemoqmedebazea damokidebuli daavadebis
gamosavali da janmrTelobis
xarisxi. samwuxarod, qarTul medicinaSi ar mimdinareobs ganxilvebi iseTi nozologiuri xasiaTis sakiTxebisa, rogoricaa
paTogenezi da gansakuTrebiT
sanogenezi. sxvaTa Soris, isini
mWidrodaa dakavSirebuli erTmaneTTan Tanamedrove Teoriuli da praqtikuli medicinis Zalze mniSvnelovani da perspeqtiuli problemebis gadawyvetSi da sagrZnoblad ganapirobebs maTi Semdgomi ganviTarebis
perspeqtivas.
paTogenezi _ organizmis
TviTregulaciis darRvevis dinamikuri kompleqsia, romelic viTardeba funqciuri an struqturuli dazianebis Sedegad Sesabamisi refleqtoruli aparatebis zeWarbi gaRizianebis Sedegad. Aam ganmartebiT gamoyofen
or yvelaze arsebiT, erTmaneTTan uwyvetad dakavSirebul paTogenezis elementebs: a) organizmis TviTregulaciis darRvevas da b) organizmis refleqtoruli aparatebis dazianebas,
rac eqims saSualebas aZlevs mizanmimarTulad Seiswavlos meqanizmebi aramarto paTogenezis, aramed sanogenezisac, romelTa zemoqmedebas SeuZlia daavadebis ganviTarebis sxvadasxva
etapze Seasustos an ukuganaviTaros paTologiuri procesi.
paTogenetikuri da sanogenetikuri reaqciebis intensivoba da xarisxi erTi daavadebis
mimdinareobis SemTxvevaSi, SeiZleba sagrZnoblad Seicvalos erTi procesis meoreSi
gadasvliT. amitom, Tanamedrove medicinaSi sanogenezsa
da paTogenezs Soris arsebuli urTierTdamokidebulebis
Ses wav la un da ika veb des
erT_erT mTavar adgils.
SesaZlebelia, mravali mecnieris mier gamoxatuli arasakmarisi interesi paTogenezisa da
sanogenezis urTierTdamokidebulebis sistemuri Seswavlisadmi, garkveulwilad aixsneba am
fiziologiuri reaqciebis mkafio warmodgenis uqonlobiT.
Nnaklebad cnobilia maT Soris
arsebuli msgavsebebi da gansxvavebebi, da agreTve maTTan da-
kavSirebuli Tanamedrove medicinis aqtualuri amocanebis gadawyvetis SesaZleblobebi. Mmecnierebis umetesoba daavadebis
ganviTarebis analizisas Cveulebriv ar iziarebs paTogeneturi da sanogeneturi xasiaTis
efeqtebsa da meqanizmebs. Yyvelaze xSirad am sapirispiro, urTierTsawinaaRmdego procesebis mimdinareobas aerTianeben
daavadebis paTogenezis erT cnebaSi. zogjer kidevac uaryofen
paTogenezisa da sanogenezis
damoukidebelad Seswavlas, TiTqosda isini warmoadgens erTian ganuyofel process. amgvari
midgoma zogierTi avtoris mxridan miuTiTebs maT mcdar Teoriul_praqtikul Sexedulebaze,
rac dakavSirebulia nebismieri
daavadebisas Sinagani meqanizmebisa da kanonzomierebebis intimuri xasiaTis Taviseburebebis
codnis arsebul deficitTan.
sxvaTa Soris daavadebis
paTogenezi, am terminis sayovelTaod aRiarebuli gagebiT, mxolod im sakiTxebs moicavs, rac dakavSirebulia ama
Tu im fiziologiuri meqanizmebis dazianebasTan, rac gamowveulia zeWarbi gamRizianeblis zemoqmedebiT. warmoqmnili funqciur_morfologiuri
`msxvreva” am SemTxvevaSi warmoadgens avadmyofuri proce2013 weli
sis ganviTarebis wamyvan faqtors.
paTogenezis codna, e. i. daavadebis warmoSobisa da ganviTarebis gzebis meqanizmebis amoqmedeba, uSualod dakavSirebulia
romelime fiziologiuri aparatebis dazianebaze, romelsac
udavoa, gaaCnia gansakuTrebuli
Teoriuli da praqtikuli mniSvneloba, radgan eqims aZlevs
farTo SesaZleblobas dasabuTebulad umkurnalos an Tavidan
aicilos daavadeba. amasTan, daavadebis procesis ganviTarebisa
da klinikuri gamovlinebis rTuli dinamika ganpirobebulia
aramarto Sesabamisi organizmuli aparatebis `msxvreviT”,aramed
aucilebeli sanogeneturi efeqtebis CarTviT, e. i. rigi dacviTfiziologiuri reaqciebis amoqmedebiT, romelic mimarTulia
organizmSi dazianebuli funqciebis aRdgenisaTvis an CanacvlebisaTvis, xolo es ki avadmyofis
daavadebidan gamosvlas _ gamojanmrTelebas niSnavs.
paTogenezsa da sanogenezs
Soris brZola gansazRvravs
Ddaavadebis xarisxobriv da raodenobriv Taviseburebebs, misi
ganviTarebis dinamikas, da agreTve daavadebis ama Tu im gamosavals: gajansaRebas an sikvdils.
Aamgvarad, metad aucilebelia Seswavlili iqnes aramarto
`msxvrevis” elementebi, aramed
organizmSi ganviTarebuli rTuli dacviT_SeguebiTi reaqciebis Taviseburebani, romlis
dros irTveba sxvadasxvagvari
sanogeneturi meqanizmebi.
sanogenezis problemis jer
kidev naklebad Seswavlil mizezTa gamo, gansakuTrebuli yuradReba unda mivaqcioT da vuzrunvelyoT mizanmimarTuli
kvlevebi specialurad SemuSavebuli meToduri midgomebiT, rac
mogvcems SesaZleblobas gamovavlinoT misi eqsperimentuli
da klinikuri mimdinareobis Taviseburebani.
sanogenezi gansxvavebiT gamojanmrTelebisa da kompensatoruli reaqciebisa, aris naklebad
specifiuri procesi, romelSic
monawileobas iRebs dacviT-SeguebiTi reaqciebis meqanizmebi,
metaboluri, gamomyofi, imunuri,
reproduqtuli xasiaTis kompleqsebi, riTac xorcieldeba
konkretuli organizmis mizanmimarTuli brZola daavadebis
winaaRmdeg. sanogeneturi ti pis
2013 weli
reaqciebi dakavSirebulia organizmis sawyis mdgomareobasTan,
asaxavs ra misi zogadi reaqtiulobis xarisxs da SeiZleba
warmoiSvas ara marto gamoxatuli paTologiis dros, aramed im
SemTxvevebSic, roca zeWarbi gamRizianebeli organizmSi jer kidev ar iwvevs SesamCnev avadmyofur efeqts. paTogenuri faqtoris zemoqmedebisas sanogenezis
meqanizmebi pirvel rigSi miemarTeba `mtris ukugdebisaTvis”, amitom maTi srulyofisa da aqtiurobis xarisxi gansazRvravs
imis SesaZleblobas, rom konkretuli individi ar daavaddes an
SemdgomSi avad gaxdes.
Tanamedrove klinikis interesebi daJinebulad moiTxovs sanogenezis problemis yovelmxriv Seswavlas. eqimis mniSvnelovani amocanaa _ aramarto aRkveTos organizmSi arsebuli
`msxvrevebi” an Seasustos maTi
paTogenuri zemoqmedeba ama Tu
im funqciur moqmedebaze, aramed
(zogjer is yvelaze mTavaria)
SeinarCunos da SesaZleblobebis mixedviT gaaqtiuros avadmyofis sanogeneturi reaqciebi.
sanogenezis arsisa da ZiriTadi
meqanizmebis dadgenis gareSe
SeuZlebelia medicinis Teoriisa da praqtikis Semdgomi nayofieri ganviTareba.
sanogenezis SeswavlisaTvis
seriozul winaaRmdegobas warmoadgens saqmis teqnikuri mxare.
mocemuli problemisadmi saTanado uyuradRebobiT dRemde
ar damuSavebula specialuri meToduri xerxebi sanogeneturi
procesebis
eqsperimentuli
kvlevebisaTvis. sanogeneturi
reaqciebi yvelaze gamoxatuli
formiT Cveulebrivad vlindeba
organizmis iseTi gansakuTrebuli mdgomareobebisas, rogoricaa, magaliTad, xangrZlivi iZulebiTi umoZraoba, sensibilizacia, uwonoba, vibraciuli efeqti
da a. S. sanogenezis sxvadasxva
mxareebis Seswavlis meTodebis
damuSaveba upirvelesad unda
iyos dakavSirebuli konkretuli
eqstremaluri mdgomareobebis
TaviseburebasTan. sanogenezis
meqanizmebis obieqturi meToduri SesaZleblobebis gamoyeneba moiTxovs mravali avadmyofuri procesis sxvadasxva fazis
Rrma eqsperimentul analizs, romelic unda iyos ganxiluli dinamikaSi. amasTan, sanogeneturi
efeqti moiTxovs mizanmimarTul
65
Seswavlas, rogorc daavadebis
paTogenezTan erTianobaSi, aseve
misgan gancalkavebiT, damoukidebeli procesis saxiT, romelsac
gaaCnia mravalmxrivi dacviT-adaptaciuri xasiaTi.
Tu sanogenezis problemas
eqsperimentatorebisa da klinicistebis mxridan mieqceva saTanado yuradReba, maSin saqmis meToduri mxare ar warmoadgens
did siZneleebs, problema sworad iqneba gadawyvetili da medicinis mecnierebisa da praqtikis winaSe gaixsneba codnis
axali horizontebi.
koncefcia sanogenezze SeiZleba gaxdes daavadebis ganviTarebis rTuli dinamikis Semdgomi Semecnebis safuZveli, rogorc mTliani procesisa. Aase magaliTad: 1. janmrTelobas gansazRvravs sanogenetikuri meqanizmebis sakmarisi funqciuri aqtivoba da maTi kompleqsebis harmoniuli Serwyma; 2. daavadebiswina mdgomareoba, rogorc janmrTelobis daavadebaSi gadasvlis stadia warmoiSoba romelime sanogeneturi meqanizmebis
jgufis an maTi kompleqsebis funqciuri aqtivobis daqveiTebiT,
rac ganapirobebs maTi koordinaciis moSlas; 3. Tu paTogenuri gamRizianeblis Zala aRmoCndeba sakmarisi, xolo gareTa garemos pirobebi gaxdeba xelSemwyobi, maSin daavadebiswina mdgomareobis fonze organizmSi ganviTardeba rigi sanogeneturi meqanizmebis `msxvreva” da maTi kompleqsebis dezorganizacia, rac
SemdgomSi gamoiwvevs daavadebas;
4. sanogeneturi meqanizmebis paTogeneturze prevalireba gansazRvravs organizmis daavadebidan gamosvlis dinamikasa da gamojanmrTelebis xarisxs; 5. paTogeneturi meqanizmebis funqciuri
prevalireba sanogeneturze gansazRvravs daavadebis damZimebasa da organizmis sikvdils.
mecnierebas, romelic Seiswavlis zegamRizianeblebis zemoqmedebisas organizmis reaqtiulobis, homeostazis SenarCunebisa da darRveuli funqciebis
mizanmimarTul meqanizmebs warmoadgens sanologia (samedicino mimarTulebis valeologia),
romlis safuZvelia sanogenezis
fiziologiuri procesi _ paTologiuri fiziologiis ganviTarebis pirdapiri Sedegi.
sanologia iseve, rogorc paTologiuri fiziologia, unda
66
iswavlebodes umaRles samedicino saswavleblebSi, radgan janmrTelobis SenarCunebasa da daavadebulis gankurnebaSi didi
roli eniWeba dacviT-SeguebiTi
meqanizmebis droul da efeqtur
gamoyenebas, rac mimarTuli unda
iyos organizmSi darRveuli fiziologiuri procesebis, organizmis Semgueblobisa da Sromisunarianobis aRsadgenad. daavadebis mimdinareobis procesSi aqtiurad monawileoben rogorc
paTogenezuri, aseve sanogenezuri mimarTulebis fiziologiuri reaqciebi. daavadebis mkurnalobisas eqimis movaleobas Seadgens droulad Seafasos da gansazRvros, organizmSi mimdinare
Tu romeli fiziologiuri reaqcia unda gaaZlieros an daTrgunos. cnobilia, rom medicina
Tavisi arsiT ZiriTadad sam
amocanas wyvets: es aris adamianis janmrTelobis ganmtkiceba,
daavadebebis Tavidan acileba da
avadmyofobidan gajansaReba. saxelmwifoebrivi jandacvis sistema YTavisi organizaciuli
funqciis Sesasruleblad mTlianad gadarTulia avadmyofTa
mkurnalobasTan dakavSirebuli
amocanebis gadasawyvetad da
isic destruqciuli, daubalansebeli midgomiT. Tu mxolod am
strategiiT ixelmZRvanelebs
jandacvis struqturebi,maSin mosaxleobis janmrTelobis ganmtkiceba da sicocxlis gaxangrZliveba miuRwevel ocnebad darCeba. Cvens qveyanaSi saxelmwifo-
ebrivi zrunvis qveS unda damkvidrdes jansaRi cxovrebis wesis princi pebi, Seiqmnas gamajansaRebeli centrebis farTo qseli, dainergos saganmanaTleblo
sistemaSi mozardebis samedicino kontroli da a. S. imis gamo, rom jandacvis socialuri
instituti ver uzruvelyofs
mosaxleobis janmrTelobis
dacvas, princi pulad moiTxovs
am sistemis demontaJs damoukidebeli samsaxurebis SeqmniT:
calke _ avadmyofebisaTvis da
calke janmrTeli adamianebisaTvis. Uunda gvaxsovdes, rom
adamianebis janmrTeloba bavSvobis periodidan iwyeba da misi rezervebi amouwuravi rodia,
umetesobas is bavSvobaSi arasakmarisad aqvs mobilizebuli,
momwifebul asakSi es `rezervebi” TvlemsG da yovelive amis
gamo advilad qreba sibereSi.
Aamrigad, daavadebis paTogenezisa da sanogenezis sistemurma
analizma ganapiroba Tanamedrove medicinaSi sistemuri midgomis gamoyenebis mizanSewoniloba, ramac mizandasaxulad moiTxova rogorc paTogeneturi,
aseve sanogeneturi Terapiis
farTo gamoyenebisa da srulyofis aucilebloba. sanologiis
mecnierulma ideologiam stimulireba misca janmarTvis ganviTarebis process da misma praqtikaSi damkvidrebam xeli unda
Seuwyos medicinis paTocentristuli mimarTulebis princi pebis rRvevas. Ees ki ganapiro-
bebs janmrTelobis kriteriumebis SemuSavebis aucileblobas
da mosaxleobaSi jansaRi cxovrebis wesis damkvidrebas. janmarTva unda gadaiqces sanologiis ZiriTad strategiad.
literatura:
i. doliZe _ valeologia,
rogorc `janmrTelobis medicina”\\saqarTvelos samedicino
Jurnali, 2009, 2, 146 _ 148;
i. doliZe _ reabilitologisa da valeologiis adgili
janmarTvis sistemaSi da klinikuri medicina, 2010, # 4, 80 _ 82
i. doliZe, g. CaxunaSvilijanmrTelobis marTvis princi pebi skolis asakis bavSvebSi \\ socialuri, ekologiuri
da klinikuri pediatria, 2011,
#13_8_7, 67_68
i. doliZe _ sanologia _
janmrTelobis marTvis fundamenturi moZRvreba\\ eqsperimentuli da klinikuri medicina,
2011, #2, 12 _ 17
i. doliZe _ samkurnalo pedagogikis roli samedicino valeologiaSi\\ saqarTvelos ganaTlebis mecnierebaTa akademiis moambe, 2012, #12, 173 _ 176
i. doliZe, g. CaxunaSvili –
janmrTelobis marTvis princi pebi skolis asakis bavSvebSi \\ saqarTvelos ganaTlebis
mecnierebaTa akademiis moambe,
2012, # 12, 188 _ 190
С. М. Павленко – Патогенез и саногенез болезни\\ Терапевтический
архив, 1965, т. 37, №3, 115 – 119
Г. Л. Апанасенко – Медицинская
Валеология, К., `Здоровье `, 1998.
reziume
daavadebis paTogenezisa da sanogenezis sistemuri analizi
ig. doliZe, g. CaxunaSvili
daavadebis paTogenezisa da sanogenezis sistemurma analizma Tanamedrove medicinaSi ganapiroba sistemuri midgomis mizanSewoniloba, ramac mizandasaxulad moiTxova rogorc paTogeneturi,
aseve sanogeneturi Terapiis farTo gamoyenebisa da srulyofis aucilebloba. sanologiis mecnierulma ideologiam stimulireba misca janmarTvis ganviTarebis process da misma praqtikaSi
damkvidrebam xeli unda Seuwyos medicinis paTocentristuli mimarTulebis princi pebis rRvevas.
Ees ki ganapirobebs janmrTelobis kriteriumebis SemuSavebis aucileblobas da mosaxleobaSi jansaRi cxovrebis wesis damkvidrebas. janmarTva unda gadaiqces sanologiis ZiriTad strategiad.
SUMMARY
SYSTEMIC ANALYSIS OF PATHO- AND SANOGENENIS
I. DOLIDZE, G. CHAKHUNASHVILI
Georgian academy humanitarian and art sciences
Systemic analysis of patho and sanogenesis of a disease determined that sanogeneric therapies need to be polished. Development of sanology must change the vector of general medicine towards developing sanogeneric and prophylactic vectors, rather than pathogenetic. This leads to following problem, that new criterias of healthiness need to be worked out and
healthy way of life myst be advertised among the people. Sanology must be the main strategy for the healthcare ministry.
2013 weli
67
`siRaribe da janmrTeloba~
T. maxaraZe
`siRaribe adamianis mdgomareobaa, romelic xasiaTdeba
resursebis, SesaZleblobebis,
arCevanis, usafrTxoebisa da
uflebis dakargviT, rac aucilebelia cxovrebis adeqvaturi pirobebis da sxva samoqalaqo, kulturuli, ekonomikuri, politikuri da socialuri
uflebebis dasakmayofileblad”
kargi janmrTeloba socialuri da ekonomikuri ganviTarebis umniSvnelovanesi resursia, janmrTelobasa da mdgrad ganviTarebas Soris mWidro kavSiri arsebobs. janmrTelobis cneba mravalfaqtorulia da garda biologiurisa,
is socialur, kulturul, ekonomikur da politikur elementebsac moicavs, rac Tavis
mxriv, adamianis janmrTelobaze pozitiur an negatiur zemoqmedebas axdens.
adamianis janmrTeloba keTildReobis mraval faqtorTan mWidrod aris dakavSirebuli, esenia: kvebis racioni,
cxovrebis wesi, samedicino
momsaxurebisadmi xelmisawvdomoba da sxv. aq udidesi roli socialur-ekonomikur determinantebs eniWeba, radganac
swored isini moqmedebsNriskis
faqtorTa mimarT mgrZnobelobis doneze. sakvanZo ki
iseTi parametrebia, rogoricaa
Semosavali, ganaTlebis done
da dasaqmeba. es sami determinantiNerTmaneTTan garkveul
kavSirSia, Tumca TiToeuli
maTgani mosaxleobis socialur-ekonomikuri statusis sxvadasxva aspeqts asaxavs. am
faqtorebs Soris arsebuli
urTierTobebi Zalian rTulia da maT udidesi zegavlenis moxdena SeuZliaT mosaxleobis janmrTelobaze. sxvadasxva faqtorebis wili avadobis tvirTSi mocemulia
cxrilSi:
jan m r Te li ar Se iZ le ba
iyos adamiani, romelic ar
avad m yo fobs, mag ram imavdroulad iZulebulia iSimSilos, ganicdides xarisxiani
wylis naklebobas, arNhqondes
saxl-kari da a. S. dResdReobiT msoflioSi mcxovrebi 6
miliardze metiNadamianidan 1
miliardi siRaribis zRvars
miRma cxovrobs, 3 miliardi moixmars dReSiN1 aSS dolarze
nak lebs, 3 mi li ar di saT vis
xelmisawvdomi ar aris sufTa
sasmeli wyali, 2 miliardi sa-
avadobis tvirTis determinantebi
wyaro: Determinants of the burden of disease in the European Union, Stockholm,
National Institute of Public Health, 1997.
2013 weli
erTod ver moixmars eleqtroenergias. ar SeiZleba janmrTeladNCaiTvalos is sazogadoeba da mTlianad mosaxleoba,
sadac farTodaa gavrcelebuliNnarkomania, alkoholizmi,
mosaxleobisaTvis miuwvdomelia saTanado ganaTleba, Tanamedrove sakomunikacio saSualebebi, samedicino daxmareba.
yve la ze mo Ca moT v li liNda
sxva mravali faqtori xels
uwyobs rogorc calkeuli pirovnebis dasnebovnebas, iseNmosaxleobaSi daavadebaTa gavrcelebas, rac kidev ufro amZimebs saerTo situacias. mosaxleobis janmrTeloba sazogadoebis ganviTarebis ZiriTadi pirobaa daNamaveNdrosNmisi
moqmedebisNsabolooNSedegi.
siRaribe globaluri movlenaa, romlis daZleva xorcieldeba zedmiwevniT neli tempebiT. dReisaTvis 1, 1 miliardi adamiani, anu msoflios
mosaxleobis meeqvsedi, ganicdis ukidures siRaribes, isini
arian Ratakebi RaribTa Soris
da cxovrobenNganviTarebad
qveynebSi. ukiduresad Raribebi (1, 1 miliardi adamiani) da
Raribebi (1, 5Nmiliardi adamiani) Nmsoflios mosaxleobis
40%-s Seadgenen. yovelwliurad 8 milionze meti adamiani
kvdeba im mizeziT, rom arian
Zalian Raribebi da ara aqvTNelementaruli sa me di ci no
daxmarebisadmi ekonomikuri
xelmisawvdomoba. planetis umdidresTa 20%-isa da uRaribesTa 20%-is Semosavlebis Sefardeba 1960 wels iyo 30:1, 1991
wels 61:1, 1994 wels 78:1 da 2004
wels 150:1.
siRaribesTan asocirebuli
daavadebebis umetesoba aris
infeqciuri daavadebebi- Sidsi, malaria, tuberkulozi, diarea da a. S. es daavadebebi da-
68
bal SemosavlebTan, sufTa
wylisa daNsanitariisNnaklebobasTan, sakvebis arasrulfasovan moxmarebasTan, samedicino daxmarebaze xelmisawvdomobis ararsebobasTan aris
da kav Si re bu li. gen de ru li
diskriminaciiT, asakiT, rasiT,
religiiT, eTnikuri jgufiT,
seqsualuriNda geografiuli
faqtorebiT gamowveuli uTanasworoba mTavrdeba siRaribiT. siRaribe, jandacvaSi uTanasworoba da usamarTloba
Rrmad aisaxeba adamianebze
daNisini infeqciuri riskebisadmi, daavadebebisa da dazianebebisadmi mowyvladni xdebian. arsebobs siRaribis sarwmuno korelacia ara marto
in feq ci ur, ara med fsi qi kurNdaavadebebTanac. miuxedavad imisa, rom simdidre ar
aris fsiqikuri janmrTelobisNaucilebeli winapiroba
da arc siRaribe aris am daavadebaTa aucilebeli gamomwveviNmizezi, arsebobs mosazreba, rom siRaribe aris determinanti da cudi fsiqikuri
janmrTelobis Sedegic.
siRaribe ukve aRar Tavsdeba nacionalur sazRvrebSi, is
globaluri gaxda da narkoti-
kebis, daavadebebis, garemos dabinZurebis, migraciis, terorizmis da politikuri arastabilurobis saxiT gadakveTs
sazRvrebs.
siRaribis dayofa
regionebis mixedviT
ukanasknel aTwleulSi msoflioSi mimdinare globaluri procesebis fonze saqarTveloSi, iseve rogorc evropisa da centraluri aziis regionis gardamavali ekonomikis
qveynebSi, aRiniSna siRaribis
donis mniSvnelovani zrda.
mTliani Sida produqtis axlandeli moculoba mniSvnelovnad CamorCeba gardamaval
periodamdeNarsebuls, rac ZiriTadad politikur, ekonomikur da sazogadoebriv cxovrebaSiNmomxdarma cvlilebebma
ganapiroba.
`siRaribis globalizaciis” gamo 2000 wlis seqtemberSi ga e ros me-8 ple na rul
sxdomaze, 193 saxelmwifosa da
mTavrobis meTaurma da 23 saer Ta So ri so or ga ni za ci is
xelmZRvanelma miiRes àTaswleulis deklaracia”, romelSic Camoyalibebulia msofli-
avadobis tvirTi mosaxleobis mdidar da Rarib jgufebSi
os mSvidobis, usafrTxoebis
da ganviTarebis sakiTxebi, agreTve warmodgenilia garemos dacvis, adamianis uflebebis dacvisa da efeqtiani saxelmwifo marTvis princi pebi.
DdeklaraciaSi gansazRvrulia aTaswleulis ganviTarebis 8 mizani, romelic 2015
wlamde siRaribisa da misi gamomwvevi mizezebisa da gamovlinebebis daZlevis farTomasStabian parogramas warmoadgens. TiToeuli miznisaTvis
SemuSavebulia konkretuli
amocanebi, maTi SefasebisaTvis
SerCeulia SesabamisiNindikatorebi.
qveyanaSi siRaribis masStabis Sesafaseblad aucilebalia saarsebo minimumis dadgena, romelic Sromisunariani
asakis adamianis arsebobisTvis
saWiro minimaluri samomxmareblo kalaTis Rirebulebas
warmoadgens. Eekonomikuri mdgomareobis gaTvaliswinebiT,
sxvadasxva qveyanaSi, rogorc
samomxmareblo kalaTis Semadgenloba, ise misi Rirebuleba
da aqedan gamomdinare, saarsebo minimumicNsxvadasxvanairia.
2002 wlis mdgomareobiT saqar T ve lo Si ofi ci a lu rad
dadgenili saarsebo minimumiT
(TveSi 124 lari ) ar iyo uzrunvelyofili mosaxleobis
48%, amasTan ukiduresi siRaribis zRvars qve moT m yof Ta
(vinc TveSi 50-55 larze naklebs moixmarda) xvedriTiNwili 14%-s Seadgenda.
siRaribis done 2004 wels
52%-s, xolo 2005 wels - 57, 7%s Seadgenda (statistikis departamentis monacemebi). 20042005 wlebSi aRiniSneboda rogorc siRaribis siRrmis, ise
simwvavis mateba saarsebo minimumis mimarT, rac Raribi mosaxleobis siRaribis zRvris
donidan daSorebis wilis zrdas da Rarib ojaxTa Soris
uTanasworobis gaRrmavebas
aRniSnavda.
jan m r Te lo bis msof lio
organizaciis monacemebiT, 5
wlamde asakis bavSvTa Soris
mokvdaobis 10, 5 milioni SemTx2013 weli
vevidan 97% ganviTarebad qveynebze modis da umetesoba
pnevmoniiTa da diareiT aris
gamowveuli; 2 mln bavSvis
sikvdilis Tavidan acileba
SesaZlebeli iqneboda vaqcinaciis farTod danergviT; yovelwliurad 585 000 axalgazrda qali iRupeba orsulobis
an mSobiarobis dros (evropaSi - 1400-dan erTi, aziaSi - 65dan erTi, xolo afrikaSi - 16dan erTi). cudi janmrTeloba
da siRaribe erTmaneTTan mizez-Sedegobrivad aris dakavSirebuli. es niSnavs, rom avadmyofi adamianisTvis arsebobs
gaRaribebis ufro meti SesaZlebloba, xolo Raribebi avadmyofobisa da invalidobis mimarT ufro mowyvlad jgufs
ganekuTvnebian. cudi janmrTeloba da janmrTelobaze gaRebuli xarjebi Rarib mosaxleobas mZime tvirTadNawveba da
`SeZlebulTa” mniSvnelovan
nawilsac gardamavali siRaribisken ubiZgebs.
siRaribe qalaqad da soflad mniSvnelovnad gansxvavebul movlenas warmoadgens. siRaribe qalaqad ZiriTadad
aras rul fa so van kve bas Tan
aris dakavSirebuli, rac saerTo jamSi ufro mwvave da Rrma
siRaribis maCvenebelia. soflad ki siRaribe kvebas iSviaT SemTxvevaSi ukavSirdeba,
Tumca es mxolod im faqtiTaa
ganpirobebuli, rom soflad
kvebis produqtebis moxmarebas
ZiriTadad sakuTari warmoebis
sursaTi gansazRvravs. soflad mosaxleobis umTavres
problemas fuladi resursebis deficiti da infrastruqturis arasakmarisi ganviTareba ganapirobebs, rac Sesabamisad momsaxurebis ZiriTad saxeebze xelmisawvdomobas amcirebs.
siRaribis donis erT-erTi
yvelaze mniSvnelovani ganmsazRvreli faqtori aris umuSevroba. rac ufro metia SinameurneobaSi umuSevari wevrebi, miT ufro metia aseTi Sinameurneobebis siRaribis zRvars miRma moxvedris riski.
siRaribis zRvars miRma myofi
Sinameurneobebis TiTqmis 40%Si arcerTi wevri ar aris dasaqmebuli. Raribi Sinameurneobebis TiTqmis 45%-Si erT momuSaves saSualod 2 an meti
suli hyavs sarCeni Tavis CaTvliT. SinameurneobebSi, romelTa yvela wevri umuSevaria,
siRaribis done saSualoze
TiTqmis 3-jer maRalia.
69
jan m r Te lo bis msof lio
organizaciis monacemebiT, rogorc umuSevroba, ise samuSaos dakargvis SiSi uaryofiTad moqmedebs janmrTelobaze, zrdis fsiqologiuri darRvevebisa da suicidebis risks,
ganurCevlad adamianis ganaTlebis donisa da sacxovreblis sakuTrebisa.
amrigad, saqarTveloSi amJamad arsebuli socialur-ekonomikuri mdgomareoba jerjerobiT optimizmis safuZvels ar iZleva. «Raribi eri
janmrTeli ver iqneba» _ sayovelTaod cnobili es gamonaTqvami zedmiwevniT sworad asaxavs qveyanaSi mosaxleobis
janmrTelobis mxriv Seqmnil
viTarebas, razec metyveleben
kidevac zemoaRniSnuli monacemebi. aqedan gamomdinare, metad aucilebeli da aqtualuria qveyanaSi siRaribis daZlevis amocanis gadaWra.
gamoyenebuli literatura:
http://www. greenadvocacy. net/photos/7424-National%20Report%202005.
pdf
http://www. who. int/hdp/poverty/en/
http://whiteband. caucasus. net
http://www. cdc. gov/dhdsp/maps/sd_poverty_2004. htm
reziume
`siRaribe da janmrTeloba“
T. maxaraZe
mosaxleobis janmrTeloba sazogadoebis ganviTarebis ZiriTadi pirobaa da amave dros misi
moqmedebis saboloo Sedegi. cudi janmrTeloba da siRaribe erTmaneTTan mizez-Sedegobrivad aris dakavSirebuli. es niSnavs, rom avadmyofi adamianisTvis arsebobs gaRaribebis ufro meti SesaZlebloba, xolo Raribebi avadmyofobisa da invalidobis mimarT ufro mowyvlad jgufs ganekuTvnebian. cudi janmrTeloba da janmrTelobaze gaRebuli xarjebi Rarib
mosaxleobas mZime tvirTadNawveba da `SeZlebulTa” mniSvnelovan nawilsac gardamavali siRaribisken ubiZgebs. amitom metad aucilebeli da aqtualuria qveyanaSi siRaribis daZlevis
amocanis gadaWra, vinaidan «Raribi eri janmrTeli ver iqneba»
SUMMARY
“POVERTY AND HEALTH”
T. MAKHARADZE, TSU
Healthy population is the basis of social development and at the same time its’ final result. Bad health condition and
poverty are almost always linked together. This means that unhealthy person can easily be converted to poor and poor people are more likely to catch various disease or inabilities. Bad health and finances spent in healthcare facilities are heavy
burden not for only poor but even for the people above average income. That is why it is vitally important for our country to solve the problem of poverty, otherwise, `poor nation will never be healthy”.
2013 weli
70
plazmuri nakadis klinikuri gamoyenebisa da nawolebis
simZimis prognozul-analogiuri skalis Sefasebis
pirveli gamocdileba kritikul avadmyofebSi
z. xelaZe, s. jaiani, b. cucqiriZe, n. kviciani, g. CaxunaSvili, d. CaxunaSvili
kritikuli mdgomareobebis medicinis instituti,
respublikuri sefsisis sawinaaRmdego centri, Tbilisi, saqarTvelo
problemis aqtualoba.
nawolebi - distrofiuli wylulovan-nefrozuli procesebia, isini uviTardebaT xangrZlivad sawolSi myof dasustebul avadmyofebs, romlebsac ar aqvT moZraobis saSualeba da miekuTvneba kritikul mdgomareobaSi
myof avadmyofTa mkurnalobis procesSi erTerT yvelaze gavrcelebul problemas, gansakuTrebiT xSirad - nevrologiuri profilis
avadmyofSi. nawolebis warmoqmnaSi xangrZlivad mwoliare mdgomareobaSi myofi avadmyofebisaTvis aucilebelia damatebiTi faqtorebi,
romlebic aucilebelia maTi ganviTarebisaTvis. maT miekuTvneba organizmis damcvelobiTi Zalebis daqveiTebiT mimdinare mZime daavadebebis arseboba, ris gamoc qsovilTa regeneraciis unari mcirdeba. yvelaze xSirad nawolebi uviTardebaT avadmyofebs insultiT,
dambliT da xerxemlisa da zurgis tvinis
travmebiT da gamowveuli arian, rogorc meqanikuri faqtorebiT (e. w. egzogenuri), romelsac mivyavarT qsovilebis danekrozebisaken, aseve endogenuri faqtorebiT, romelTa ganviTareba ganisazRvreba organizmis cxovelqmedebis darRveviT (qsovilTa neirotrofikuli
cvlilebebi).
dRemde nawolebis ganviTarebis sixSire, personalis mier avadmyofis swori marTvis miuxedavad, rCeba maRali. kerZod, nawolebi aRiniSneba 40-ze met SemTxvevaSi yovel 100 000 mosaxleze. aRniSnuli daavadeba uviTardebaT
asakovan pirebs, romelTac 65%-Si aReniSnebaT
barZayis yelis motexiloba, im pacientTa 30%s, romlebic moTavsebuli arian intensiuri Terapiis blokSi, avadmyofTa 60%-s, romelTac
aReniSnebaT tetraplegia. nawolebis ganviTarebis sixSire pacientebSi, romelTac gadaitanes xerxemal-zurgis tvinis travma aRwevs 4060%-s, xolo zogierTi avtoris monacemebiT
zurgis tvinis dazianebisas 80%-sac ki. amasTan nawolis garTulebis ganviTarebis albaToba iseTebi rogoricaa tkivili, depresia, infeqciebi (abscesebi, septiuri arTritebi, baqteriemiebi, sefsisi) gvxvdeba avadmyofTa 20-30%Si. xangrZlivi Seuxorcebeli nawolebis SemTxvevaSi viTardeba osteomieliti, xolo detaluri gamosavlis riski izrdeba 4-5-jer.
Cvens qveyanaSi aRniSnul problemas ufro meti mniSvneloba aqvs, es dakavSirebulia imasTan, rom nawolebi analogiuri kategoriis
avadmyofebs emarTebaT sarwmunod xSirad uC-
ndebaT ra ifi woliT reJimSi myof mZime avadmyofebs. aseTi avadmyofebis 50-60%-s aqvT IIIIV xarisxis nawolebi.
nawolebis mkurnaloba sakmaod xangrZlivi
da ZviradRirebuli procesia. zogierTi avtoris monacemebiT aseTi avadmtofebis mkurnalobis Rirebuleba evropisa da aziis zogierT
qveyanaSi meryeobs 10000-dan 40000 amerikul dolaramde. operaciuli mkurnalobis SemTxvevebi es cifri izrdeba ramodenimejer, amasTan
aRiniSneba operaciis Semdgomi garTulebebis
da letalobis maRali procenti. saSualod,
operaciis Semdgomi nawolebis mxolod 50-75%
xorcdeba pirveladad, danarCen SemTxvevebSi
aucilebelia damatebiTi, sakmaod xangrZlivi
konservatiuli Terapia an ganmeorebiTi operacia. amis gamo msoflios wamyvan klinikebSi, romlebic dakavebuli arian am problemiT,
operacia utardebaT mxolod avadmtofTa 2030%-s, ZiriTadad es arian pacientebi IV xarisxis nawolebiT. operacias win uZRvis xangrZlivi momzadeba, romelic grZeldeba 2-3 Tvidan
1 wlamde. II da III xarisxis nawolebis mkurnaloba konservatiulia. saqarTveloSi operaciuli mkurnaloba gamoiyeneba iSviaTad, operirdeba avadmyofTa daaxloebiT 10%, danarCeni pacientebis mkurnaloba konservatiulia.
amasTan nawolebis mkurnalobis axal perspeqtivebs xsnis plazmuri gamosxivebis komponentebis gamoyeneba (sakuTriv plazmuri nakadi, ozoni, ultraiisferi gamosxiveba da azotis oqsidi). eqsperimentuli da klinikuri kvlevebis zogierTma monacemebma gviCvena, rom plazmuri nakadis gamoyeneba saSualebas iZleva swrafad, efeqturad da xarisxianad Seasrulos hemostazi,
saimedod gauwios Wrilobis zedapirs hermetizireba, moacilos nekrozulad Secvlili qsovilebi, gaakeTos Wrilobis sterilizeba. aseve
gamovlenili iqna ozonis da ultraiisferi sxivebis gamoxatuli baqteriociduli moqmedeba da
azotis oqsidis biomastimulirebeli efeqti.
kvlevis mizani.
kvlevis mizans warmoadgenda Cvens mier SemuSavebuli skalis gamoyeneba da praqtikaSi
danergva nawolebis simZimis, mkurnalobis Semdgomi taqtikisa da prognozis garkvevis mizniT, agreTve nawolebiT garTulebuli kritikuli avadmyofebis mkurnalobis Sedegebis gaumjobesebis SesaZlebloba plazmuri nakadis
kompleqsur mkurnalobaSi gamoyenebis dros.
2013 weli
kvlevis Sedegebi.
Cvens mier Sedgenil da SemuSavebul iqna nawolebis axali klasifikacia balebis mixedviT. masSi gaTvaliswinebulia nawolebisa da
pacientis mdgomareobis mTeli rigi mniSvnelovani kriteriumebi. es klasifikacia gvexmareba ganvsazRvroT nawolebis simZmis zogadi suraTi da SevafasoT igi ara marto stadiebis,
aramed lokalizaciis, xasiaTis, siRrmis, farTobisa da nawolebis ganviTarebis xelSemwyobi damatebiTi faqtorebis mixedviT. es saSualebas gvaZlevs ganisazRvros nawolebiani
Wrilobis mdgomareobisa da qirurgiuli operaciebisaTvis mzadebis kriteriumebi, dadgindes nawolebis mdgomareba, agreTve gakontroldes avadmyofis mkurnalobis swori taqtikisa da efeqturobis SerCeva.
nawolebis simZmis Sefasebis prognozul-analogiuri skala:
avadmyofis simZimis Sefaseba:
1 qula - damakmayofilebeli.
2 qula - saSualo simZimis (sasicocxlo
funqciebis kompensireba).
3 qula - mZime (sasicocxlo funqciebis xangrZlivi kompensireba).
4 qula - ukiduresad mZime (kritikuli mdgomareoba).
5 qula - terminaluri.
nawolebis ganciTarebis xelSemwyobi damatebiTi faqtorebi:
1 qula - sisxlis mimoqcevis adgilobrivi
darRveva.
2 qula - Saqriani diabei, gadatanili operaciebi.
3 qula - sefsisi, onkologiuri darRvevebi.
4 qula - tvinis darRvevebi.
5 qula - spinaluri darRvevebi.
nawolebis dayofa lokalizaciis mixedviT:
1 qula - erTu qveda kiduri.
2 qula - orive qveda kiduri.
3 qula - kudusuni, dundulo, menji.
4 qula - beWi, mxari.
5 qula - Tavi.
nawolebiani Wrilobis xasiaTi:
1 qula - danawibureba da epiTelizacia.
2 qula - granulacia.
3 qula - serozuli gamonadeni.
4 qula - mSrali nekrozi.
5 qula - sveli nekrozi.
nawolebis siRrmis Sefaseba:
1 qula - gafermkrTaleba, silurje, adgilobrivi hi poTermia.
2 qula - buStukebis arseboba, adgilobrivi hi peremia, SeSupeba.
3 qula - wylulis formireba, romelic ar
vrceldeba kanis qveS.
4 qula - nekrozi, romelic vrceldeba kanis
qveS, magram ar aRwevs Zvlebs.
5 qula - mekrozi, romelic aRwevs Zvlisazrdelas da Zvlebs.
nawolebis farTobis saerTo daxasiaTeba:
1 qula - 10 sm-ze naklebi.
2 qula - 10-20 sm.
2013 weli
71
3 qula - 20-35 sm.
4 qula - 35-50 sm.
5 qula - 50 sm-ze meti.
qulebis saerTo minimaluri raodenoba - 6.
qulebis saerTo maqsimaluri raodenoba - 30.
aRniSnuli skala dResdReisobiT aprobirebulia Cvens institutSi samkurnalod myof 103
avadmyofze. miRebuli monacemebi saSualebas
iZleva skalis gamoyenebiT rekomendirebul iqnas nawolebiani Wrilobebis saoperaciod
momzadebis aucileblobisa da mzadebis gansazRvrisaTvis. am mizniT, Cveni monacemebiT, yvelaze misaRebad iTvleba qulebis saerTo raodenobis 15-dan 22-mde Sualedi. ufro maRali
cifrebi miuTiTebs adgilobrivi paTologiuri procesisa da zogadi mdgomareobis gamoxatul simZimeze, rac saWiroebs avadmyofis operaciisaTvis damatebiT momzadebas. qulebis saerTo raodenoba 15-ze dabla miuTiTebs konservatiuli mkurnalobis meTodis upiratesobaze.
aseve warmodgenilia mniSvnelovnad skalis
gamoyeneba prognozirebis mizniT, agreTve
mkurnalobis mimdinareobis drouli koregirebisaTvis. 22-is zeviT prognozi gvesaxeba saeWvod, xolo 26-ze da maRla - ukiduresad arakeTilsaimedod. mkurnalobis procesSi 10-12
dRis ganmavlobaSi dadebiTi dinamikis ararsebobsas, rekomendirebulia mkurnalobis koreqciis Catareba antibiotikebis daniSvniT (an
SecvliT), dezintoqsikaciuri Terapia, imunomodulatorebis daniSvna, samkurnalo fizkulturis damatebiTi Catareba, fizioTerapiuli
mkurnaloba, oqsigenoTerapia, vitaminoTerapia
da a. S.
miRebuli Sedegebi safuZvels iZleva mocemuli skala CavTvaloT sakmaod obieqturad da
praqtikul saqmianobaSi moxerxebulad da rekomendacia gavuwioT mis aprovacias avadmyofTa nawolebis profilaqtikasa da mkurnalobisas kritikul medicinaSi.
yvela avadmyofs utardebodaT kritikuli
medicinis institutSi miRebuli standartuli
kvleva da mkurnaloba, aseve planimetriuli
kvleva da fotometria. maT utardebodaT,
plazmuri nakadis gamoyenebiT, nawolebis kompleqsuri mkurnaloba, xolo Cvenebebis mixedviT - nekreqtomia, plazmuri nekreqtomiis meTodikis CaTvliT.
profilaqtikis mizniT, imisaTvis, rom yvela
Cveni pacientisTvis SegvenarCunebina kani janmrTel mdgomareobaSi utardebodaT Sesabamisi kveba (sakvebi unda Seicavdes ara nakleb
20%-isa cilas), vitamin „c’’-s preparatebis CarTviT (500mg 2-jer dReSi) da siTxe (Tu ar arsebobda SezRudva avadmyofi iRebda aranakleb
1, 5l dReSi), datenianebul kans vaSrobdiT, xolo mSrals - vatenianebdiT, SesaZleblobis mixedviT avadmyofs vuwyobdiT haeris abazanebs
dReSi ramodenimejer, Tu avadmyofi Tavisi mdgomareobiT iZleoda amis saSualebas vabru-
72
nebdiT gverdze. pacientis umoZraobis SemTxvevaSi mis mdebareobas vcvlidiT yoveli 2 saaTis Semdeg. TviTeuli nawolebiani avadmyofi uzrunvelyofili iyo drekadi gasaberi
leibiT (sisqiT aranakleb 1, 5sm. ). kudusunis
qveS vadebdiT rezinis gasaber rgols, romelzec Camocmuli iyo baliSis piri, xolo umoZrao xelebisa da fexebis qveS vaTavsebdiT toprakebs, romlebic avsebuli iyo specialuri SemavseblebiT an tiloTi. yoveldRiurad kans
vuzeldiT qafuris spirtiT, Tbili wyliT an
madenzificirebeli xsnariT dasvelebuli pirsaxociT, kani iwmindeboda pirsaxociT. gaSrobis Semdeg kanis problemur adgilebs vayridiT talks. hi peremiis SemTxvevaSi kanis zedapirs vasxivebdiT plazmuri sxivebis ganfokusirebuli nakadiT.
ZiriTad #1jgufSi (53 pacienti) damatebiT
kompleqsur mkurnalobaSi gamoiyeneboda nawolebis dasxiveba plazmuri nakadiT. meTodika
reJimSi „plazmuri dasxiveba“ efuZneboda 5 (33
pacienti) an 10 (20 pacienti) xanmokle, yoveldRiur ganfokusirebul dasxivebas plazmuri
nakadiT nawolebiani Wrilobis gavrcelebis
zonebSi, 5-7wuTis ganmavlobaSi, 10-15sm-is daSorebiT kanis zedapiridan. plazmuri nakadis
daxris kuTxe Wrilobis zedapiris sibrtyesTan Seadgenda 30-45 graduss. manZili saqSenidan qsovilebamde Seadgenda 40-dan 60mm-mde.
plazmuri sxivis temperatura kanis zedapirze iyo uxifaTo da Seadgenda 40-42 graduss
C-iT, TviTon meTodika ar saWiroebda winaswar
momzadebas da ar iyo damokidebuli avadmyofis mdgomareobis simZimeze. plazmuri nakadi
„plazmuri aorTqlebis“ reJimSi gamoiyeneboda Semdegi meTodikiT: Wrilobis zedapiris kidis paralelurad edeboda nestiani, steriluri, dolbandis safeni, raTa daculi yofiliyo Termuli dazianebisagan Wrilobis kideebi Wrilobis zedapiridan areklili maRaltemperaturuli Semobrunebuli turbulenturi nakadebiT. 30-45 gradusiani daxriT TandaTanobiT da wriuli moZraobiT Wrilobis zedapiris garSemo 5-15 mm-is manZilze tardeboda misi damuSaveba. nekrozuli qsovilebis moSorebis Semdeg Wrilobis zedapirs vamuSavebdiT
plazmuri skalpeliT, romlis zemoqmedebiT
elviseburad orTqldeboda darCenili sicocxlisuunaro qsovilebi da eqsudati, amasTan adgili hqonda koagulacias da hemostazs. damuSavebis Semdeg Wrilobis zedapiri praqtikulad xdeboda steriluri. aRniSnuli mani pulaciebis Catarebis dro varirebda 5-8 wuTis
SualedSi.
gamoyenebuli iyo nawolebis mkurnalobis
sqemebi, romlebic moicavda paTogenezis yvela
rgols. aRniSnuli sqemebi nawolebiani Wrilobis adgilobriv mkurnalobasTan erTad aucileblad moicavda qirurgiul damuSavebas
plazmuri nakadiT. tardeboda gadaxvevebi da
sxva mani pulaciebi, romlis drosac avadmyof-
Ta nawolisaTvis aucilebel komponents warmoadgenda midamos dasxiveba plazmuri komponentebiT. agreTve tardeboda avadmyofTa saerTo mkurnaloba zogadad miRebuli meTodikebiT, rogoricaa infuziur-dezintoqsikaciuri, antibaqteriuli, imunoTerapiuli, fizioTerapiuli, samkurnalo fizkulturis, biologiurad aqtiur wertilze zogadmastimulirebeli zemoqmedebis da a. S. meTodebi.
#2 sakontrolo jgufSi (50 pacienti) Wrilobis dasufTaveba xdeboda momakvdavi qsovilebis mocilebiT, ris Semdeg igi ixureboda kaliumis 1%-iani permanganatis xsnariT dasvelebuli steriluri safeniT. naxvevs cvlidnen aranakleb 2-jer dReSi. Semdeg gadadiodnen dolbandis safenebze, romlebic Wrilobas
edeboda Semdgomi fiqsaciiT viSnevskis malamos an sxva preparatebis gamoyenebiT, isini aCqareben reparaciul procesebs nela mimdinare granulaciuri da maepiTelizirebeli Wrilobebis dros („levomikoli“, „levosini“, qacvis zeTi da sxva). nawolze meoradi infeqciis TandarTvisas gamoiyeneboda antisepriuri
da antibaqteriuli saSualebebi: boris mJava,
wyalbadis 3%-iani zeJangi, malamoebi „levomikali“ da „levosini“. WrilobisaTvis sveli pirobebis Sesaqmnelad gamoiyeneboda alginatebi, Wrilobebis safenebisa da fxvnilebis saxiT Sesavsebad, xolo hidrokoloiduri naxvevebi misi gawmendisa da daxurvis mizniT.
kvlevis Sedegebi. #1 jgufSi uSualod
plazmiT damuSavebis Semdgom Wrilobis zedapiri mniSvnelovnad gasufTavda, mikrobuli moTesva Semcirda ramdenjerme. plazmiT damuSavebis Semdgom pirvelive dRe-RameSi pacientTa 80%-s aReniSneboda TviTSegrZnebis gaumjobeseba, SeumcirdaT tkivili Wrilobis areSi,
rac plazmuri nakadis maanesTezirebeli efeqtiT ganisazRvreba. #2 jgufSi TviTSegrZneba da tkivilis Semcireba Wrilobis areSi aReniSnaT mxolod pacientTa 30-35%-s, danarCenebs
SeunarCundaT intensiuri tkivili, adgilobrivi garTulebebi mxolod 1-2 erTeuliT.
#1 jgufis pacientTa 80%-s 3-4 dRe-Ramis ganmavlobaSi gaugrZeldaT mdgomareobis subieqturi gaumjobeseba, sxeulis temperaturuli maCvenebeli Semcirda saSualod 0, 8-0, 90±0, 20С-iT.
mniSvnelovnad daqveiTda leikocitebis maCvenebeli periferiul sisxlSi (11, 9±1, 1*109/l) da
intoqsikaciisa limfocitaruli indeqsi (3, 0±0, 3).
#2 jgufSi,imave periodSi,mdgomareoba gaumjobesda pacientTa 45%-Si, temperaturis saSualo maCvenebeli Semcirda daaxloebiT 0, 4-0, 50±0, 20С-iT.
leikocitebis maCvenebeli sisxlSi Semcirda
da gaxda (13, 1±0, 6*109/l) da intoqsikaciis limfocitaruli indeqsi ki (3, 5±0, 3).
me-5-7 dRe-Rameze #1 jgufis pacientTa 60%ze metis mdgomareoba fasdeboda rogorc damakmayofilebeli, danarCenebisa ki, rogorc saSualo simZimis. sxeulis temperaturuli maCvenebeku varirebda 37, 40±0, 20С-is farglebSi, into2013 weli
qsikaciis limfocitaruli indeqsi progresulad mcirdeboda 2, 5±0, 2-mde. gaumjobesda
sisxlSi leikocitebis maCvenebeli (saS. 8, 2±1,
1* 109/л). amasTanave SemTxvevaTa 30%-is Wrilobis gamonadenSi mikroorganizmebis zrda ar xdeboda. #2 jgufSi avadmyofTa 40%-is mdgomareoba fasdeboda rogorc SedarebiT damakmayofilebeli, 50%-isa rogorc saSualo simZimis,
xolo 10%-is - rogorc mZime. intoqsikaciis
limfocitaruli indeqsi #1 jgufTan SedarebiT
daqveiTda mcirediT (2, 8±0, 3-mde), igive iTqmis
leikocitarul maCvenebelze (saS. maCvenebeli
gaxda 9, 8±0, 8*109/l); sxeulis temperatura iyo
37, 70±0, 30С-is farglebSi. amasTanace SemTxvevaTa mxolod 5%-s ar aReniSneboda mikroorganizmTa zrda.
me-7-10 dRe-Ramis periodSi #1 jgufSi pacientTa 75%-is mdgomareoba fasdeboda, rogorc
SedarebiT damakmayofilebeli. organizmis temperaturuli maCveneblebi mcirdeboda 37, 00±0, 20СiT. intoqsikaciis leikocitaruli indeqsi
mcirdeboda 2, 0 ±0, 2-mde. periferiul sisxlSi
leikocitaruli maCveneblis done Semcirdeboda 7, 5±0, 6*109/l-mde. organizmis temperatura normalizda 70%-ze met pacientSi. Semcirda infiltracia, Wrilobis kideebi gamkvrivda, Wrilobebi praqtikulad mTlianad gaiwminda. #2 jgufSi daSavebulTa 55%-is mdgomareoba fasdeboda rogorc Sedarebis damakmayofilebeli. intoqsikaciis limpicitarul indeqsis maCvenebeli da leikocitozis done #1
jgufTan SedarebiT mcirdebodaSedarebiT
nela, organizmis temperatura normalizda
daSavebulTa 30%-Si. zomierad mcirdeboda infiltracia, Wrilobis kideebi mkvrivdeboda da
iwmindeboda. baqteriologiuri kvlevebisas
xSirad vlindeboda Sereuli mikroflora
stafilokokuri, Cirqovani da sokovani kulturebis siWarbiT.
„plazmuri dasxivebis“ reJimis gamoyenebam
inficirebuli nawolebis zedapirdze migviyvana moulodnel Sedegamde. dasawyisSi plazmuri dasxiveba gamoiyeneboda mxolod Wrilobbis zedapiris damatebiTi gamoSrobis mizniT,
xolo mogvianebiT SemCneul iqna, rom „plazmuri moberva“-s gaaCnia aramarto gamoSrobis,
aramed ufro metad biostimulatoruli efeqti. Wrilobis mimdinareobis procesis maCveneblebi miuTiTeben, rom Wrilobis defeqtis dinamiuri plazmuri dasxiveba sisxlZarRvovani
darRvevebis fonze xels uwyobda mikrobuli
moTesvianobis donis da qveiTebis 2-4 rigirs,
mikrofloris saxeobisa da Stamebisagan damoukideblad. pirveli 2-3 dasxivebis Semdegac ki
mniSvnelovnad qveiTdeboda Wrilobebis areSi tkivilebis intensivoba, xolo 4-5-is Semdeg
maT zedapirze Cndeboda granulaciis erTeuli fokusebi, romlebic 1-2 dRis Semdeg erTiandeboda kunZulebad. erTdroulad granulaciebis zedapirze Cndeboda epiTeluri qsovi2013 weli
73
lis ubnebi. damaxasiaTebelia, rom Wrilobis
epiTelizacia rig SemTxevebSi xSirad iwyeboda ara napirebidan, aramed centridan wvrili
kerebis, xidebis an radialuri bilikebis saxiT. procesis aseTi mimdinareoba, zogadad miRebul meTodebTan SedarebiT, uzrunvelyofda wylulovani defeqtis swraf Sexorcebas.
Cvens mier dadgenil iqna, rom plazmuri nakadis gamoyeneba kidurebis Wrilobebis mkurnalobaSi saSualebas iZleva ufro swrafad
gaiwmindos Wriloba paTogenuri makroflorisagan, plazmuri sxivebis maRaltemperaturuli
ultraiisferi gamosxivebisa da ozonis baqteriociduli zemoqmedebis gamo. plazmuri nakadis gamoyeneba saSualebas iZleva umravles
SemTxvevaSi miviRoT Wrilobis praqtikulad
steriluri zedapiri, danarCen SemTxvevebSi mikrobebis koncentracia bevrad maRalia „kritikul“ donesTan SedarebiT. Catarebulma kvlevebma saSualeba mogvca migveRo sarwmuno Sedegebi, romlebic amtkiceben plazmuri nakadis
gamoyenebis mizanSewonilobis Wrilobebis
sterilizaciisa da Cirqovani garTulebebis
ganviTarebis aRkveTis mizniT.
daskvnebi. aqedan gamomdinare, nawolebis kompleqsuri mkurnaloba kritikul avadmyofebSi, romelic moicavs Wrilobis zedapiris damuSavebis da dasxivebis plazmisa da misi komponentebis (ozoni, ultraiisferi sxivebim
azotis oqsidi) daxmarebiT, saSualebas iZleva miviRoT gamoxatuli dadebiTi efeqti. amave dros mcirdeba mkurnalobis saSualo vadebi 20-30%-iT, SeimCneva WrilobaSi regeneraciuli procesebis ufro intensiuri mimdinareoba, mdgomareoba ufro iSiaTad rTuldeba
sefsisiT, umjobesdeba (maT Soris postoperaciuli tkivilebis Semcirebis xarjze) operaciis Semdgomi periodis mimdinareoba da funqciis adreuli aRdgena xdeba SesaZlebeli. nawolebis mkurnalobis axali meTodika plazmuri nakadis gamoyenebiT saSualebas gvaZlevs
movaxdinoT nawolebis garTulebebis profilaqtika ufro maRali xarisxiT da agreTve ukve ganviTarebuli nawolebis efeqturi mkurnaloba. Wrilobis zedapirebis damuSaveba rekomendirebulia reJimebiT „koagulacia“ da
„plazmuri dasxiveba“.
literatura
1. Басков А. В. Хирургическое лечение пролежней у
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спинальных больных: Дис.... канд. мед. наук. – М.,
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при лечении хронических гнойных ран». Конференция
«Сепсис». Тбилиси. 1999, стр. 8-9.
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4. Климиашвили А. Д. Профилактика и лечение пролежней // Русский медицинский журнал. – 2004. – № 12.
– С. 40-45.
5. Мусалатов Х. А., Елизаров М. Н., Насридинов М.
А. Лечение пролежней у больных с повреждением позвоночника и спинного мозга // Медицинская помощь. – 2002.
– № 3. – С. 22-28.
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Новые возможности лечения трофических язв, ран кожи
и мягких тканей, пролежней и свищей // Provisorum. – Т.
1, № 4. – С. 30—33.
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– С. 32—35.
8. Цуцкиридзе Б. Н. Применение плазменных потоков
при боевых повреждениях конечностей. Дисс. акад. ст.
доктора медицины. – 2007. – 163 с.
9. Цуцкиридзе Б. Н. Джаиани С. В., Мгалоблишвили
Г. И. Применение плазменных потоков в хирургической
обработке гнойно-септических осложнений при повреждениях конечностей // Georgian Medical News. – 2007.
– № 6. – С. 19 – 22.
9. Fowler E., Papen J. C. // Decubitus. – 1991. – Vol. 4.
№ 3. – P. 47-53.
10. Yarcony G. M., Hememann A. W. Spinal Cord Injury.
– 1995. – P. 100-119.
11. Kheladze Z. «New Steps in Critical Care Medicine».
Critical car medicine institute, Tbilisi, 1998, 215 p.
reziume
plazmuri nakadis klinikuri gamoyenebisa da nawolebis
simZimis prognozul-analogiuri skalis Sefasebis
pirveli gamocdileba kritikul avadmyofebSi
z. xelaZe, s. jaiani, b. cucqiriZe, n. kviciani, g. CaxunaSvili, d. CaxunaSvili
kritikuli mdgomareobebis medicinis instituti, respublikuri
sefsisis sawinaaRmdego centri, Tbilisi, saqarTvelo
avtorebis mier SemuSavebulia kritikuli medicinis avadmyofebisaTvis nawolebis Sefasebis
axali prognozul-analogiuri skala. gamoyenebuli iqna 6 yvelaze mniSvnelovani prognozuli kriteriumebi, romelTa mixedviTac nawolebiani Wrilobebis mqone avadmyofebis Sefaseba xdeboda. axali skala exmareba ganisazRvros nawolebis simZimis zogadi suraTi da Sefasdes nawolebi ara marto misi stadiebis, aramed lokalizaciis, xasiaTis, siRrmis, farTobisa da nawolebis ganviTarebis xelSemwyobi damatebiTi faqtorebis mixedviT. es saSualebas iZleva ganisazRvros nawolebis mzadebis kriteriumebi qirurgiuli operaciebisaTvis, dazustdes nawolebis adgilmdebareoba. miRebuli monacemebi saSualebas iZleva rekomendirebul iqnas skalis
gamoyeneba nawolebiani Wrilobis operaciuli mkurnalobis aucileblobisa da mzadyofnis gansazRvrisaTvis, mkurnalobis mimdinareobis drouli koreqciisaTvis da prognozis mizniT.
avtorebi warmodgenil statiaSi, 103 nawolebian kritikul avadmyofis mkurnalobis gamocdilebaze dayrdnobiT, gvTavazoben mkurnalobis axal meTodikas, romelic dafuZnebulia plazmuri gamosxivebis gamoyenebaze. aRniSnuli kategoriis avadmyofebis kompleqsuri mkurnaloba, moicavs plazmuri nakadis gamoyenebiT Wrilobis zedapiris damuSavebas da dasxivebas, rac
sarwmunod aumjobesebs mkurnalobis Sedegebs, amcirebs garTulebebis raodenobas, amcirebs
mkurnalobis saSualo vadebs. miRebuli Sedegebi, saSualebas iZleva farTod iyos rekomendirebuli mocemuli meTodika nawolebiT garTulebuli avadmyofebis mkurnalobisas.
sakvanZo sityvebi: nawoli, kritikuli mdgomareobebi, prognozul-analogiuri skala, plazma.
SUMMARY
NEW STEPS IN CRITICAL CARE MEDICINE - THE PLASMA ERADIATION
Z. KHELADZE, S. JAIANI, B. TSUTSKIRIDZE, N. KVITSIANI,
G. CHAKHUNASHVILI, D. CHAKHUNASHVILI
Institute of Critical Care Medicine, Anti-Sepsis Republican Centre, Tbilisi, Georgia
The new prognostic-analogue scale of rating the bedsores of the critically ill patients was ellaborated by authors. 6 most
important prognostic criterions were used, by which the patients with the bedsore wounds were evaulated. The new scale
aids in defining the general picture of the bedsore and rate the bedsores not only by its’ stages, but also with determining
localization, character, depth, area and the additional factors that favor the development of the bedsores. The above mentioned gives the possibility to determine the preparation criterions for the surgical operations, to ascertain the exact localization of the bedsore. The achieved results give the opportunity to recommend using of this scale to determine the necessity
and readiness of the surgical treatment of the bedsore wound, for timely correction and prognosis of the treatment course.
In this article, the authors, based on the treating experience of the critically ill 103 patients with bedsore wounds, offer
the new method of treatment, which is based on using the plasma eradiation. The complex treatment of the above mentioned category of patients includes treating and irradiating the surface of the wound with the plasma flow, which significantly improves the results of treatment, lowers the numbers of complications and shortens the general dates of treatment. Achieved
results, give us the possibility to widely recommend this method for treating the patients with bedsore complications.
Keywords: bedsore, critical condition, prognostic-analogue scale, plasma.
2013 weli
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ИНФОРМАТИЫВНОСТЬ АНТРОПОФИЗИОЛОГИЧЕСКОГО
ПОДХОДА В ДИАГНОСТИКЕ НЕДОСТАТОЧНОСТИ
АРТЕРИАЛЬНОГО КРОВООБРАЩЕНИЯ НИЖНИХ КОНЕЧНОСТЕЙ
БАГРИЙ А., ДИЛЕНЯН Л., БЕЛКАНИЯ Г., ПУХАЛЬСКАЯ Л.,
ГВИНДЖИЛИЯ И., МАТИАШВИЛИ Э., ДЖАЯНИ С.
Винницкий национальный медицинский университет, Украина; Нижегородская медицинская академия,
Россия; Лаборатория медицинских экспертных систем «Антропос Системс Лэб. », Винница, Украина;
Варшавский медицинский университет, Польша; Лечебно-оздоровительный центр «АНТРОПОС»,
Тбилиси, Грузия; Институт критической медицины, Тбилиси, Грузия
ВВЕДЕНИЕ.
Состояние здоровья человека определяется многими факторами, но в первую очередь оно лимитируется состоянием его основных физиологических систем, среди которых
ведущее место принадлежит сердечно-сосудистой системе
(ССС). Именно она, первая из начинающих свое функционирование еще при внутриутробном развитии организма,
обеспечивает адаптивные возможности, а, в конечном счете, и жизнеспособность организма в целом на всех этапах
его развития и существования.
Поэтому неслучайно врожденные дефекты развития ССС
или ее заболевания, а также возрастные и инволютивные
процессы и «сцепленные» со старением состояния и заболевания наиболее существенно, чем аналогичные состояния других систем, ограничивают адаптивные возможности и продолжительность жизни организма. Ярким подтверждением тому является и структура нозологического профиля человека и причин смерти, по которой ведущее место
принадлежит, как известно, именно сердечно-сосудистым
заболеваниям.
Успешное развитие превентивного направления в современной медицине, включая информационную поддержку здоровья, требует новых методологических подходов в разработке диагностических средств во всем диапазоне соматического состояния организма: здоровье–нездоровье–болезнь. Это
предъявляет определенные требования к диагностической чувствительности таких средств, особенно при оценке состояния
ССС, как системы базового обеспечения любого соматического состояния организма и здоровья в целом.
В качестве такого подхода предлагается антропофизиологическое представление об актуальности и адекватности
для человека, как прямоходящего существа, системно связанной мультипараметровой характеристики ССС не только в стандартно практикуемого в диагностике положении
теле лежа, но и в наиболее типичных для человека условиях
жизнедеятельности в вертикальном положении тела –
стоя, сидя, при ходьбе. Это позволяет охватить полное информационной пространство (лежа и стоя) состояния
больного и здорового человека. При этом адекватность и объективность оценки кровообращения обеспечивается не только связанной по позным условиям стоя - лежа, но и по основным гемодинамическим механизмам (объем–емкость–насос–кровоток) и отделам ССС оценкой центрального и периферического кровообращения.
Целью работы являетсяобоснование диагностической информативности антропофизиологического подхода в клинической практике при такой типичной для человека нозологии как облитерирующий эндартериит (недостаточность артериального кровообращения нижних конечностей).
МАТЕРИАЛ И МЕТОДЫ.
Исследования были проведены в рамках клинических испытаний [1]на базе отделений сосудистой хирургии Варшавского и Каунасского медицинских университетов разработанной на основе антропофизиологического подхода диаг2013 weli
ностической системы и ее аппаратно-программной реализации в виде компьютерного комплекса АНТРОПОС-CAVASCREEN (Лаборатория медицинских экспертных систем,
г. Винница, Украина; Институт медицинских технологий и
приборостроения, г. Забже, Польша).
Клиническую группу составили больные (мужчины и
женщины) с облитерирующим эндартериитом (артериосклерозом) с разной степенью нарушения проходимости артериальных сосудов (n=126), контрольную одновозрастную
группу составили женщины и мужчины (n=233) без клинических проявлений (диагноза) нарушений артериального
кровообращения нижних конечностей. Онтогенетический
анализ проявляемости (в % по возрастным выборкам) циркуляторных синдромов по артериальному кровообращению
нижних конечностей(ишемии, гиперрезистивности сосудов)
проведен по общей базе данных по следующим возрастным
группам: до 5 лет (n=4), 6-7 лет (n=5), 8-21 год (n=297), 2235 лет (n=326), 36-60 лет (n=598) и старше 60 лет (n=578).
Возрастные группы выделялись соответственно критическим периодам формирования онтогенетической адаптации
к гравитации в условиях прямохождения [2, 3].
Больные клинической группы обследовались по стандартному унифицированному протоколу, который включал в себя
полное клиническое обследование с использованием рентгеноконтрастной и компьютерной ангиографии, ультразвуковой дуплексной допплерографии. Состояние артериального
кровообращения пациентов контрольной группы оценивалось
клиническими методами без использования ангиографии.
У всех больных и здоровых лиц проводилось комплексное реографическое исследование состояния ССС с
использованием стандартных технических характеристик
приборного оборудования (аналогичных тетраполярному
реографу типа РПГ2-02). Оригинальной схемы наложения
токовых и потенциальныхэлектродов (рис. 1). Определенной последовательности позных условий регистрации импедансных эквивалентов гемодинамических параметров –
исследование сначала проводилось в положении стоя, а затем через 15-20 минут пребывания в положении лежа [4].
С данными клинических исследований сопоставлялась
проявляемость циркуляторных синдромов недостаточности
артериального кровотока, которые диагностировались по
амплитуде дифференциальной реограммы(показатель артериального притока (АП)) соответствующего сегмента тела:
таз-бедро (слева и справа) и голени (левая и правая). Циркуляторный синдром недостаточности артериального кровообращения диагностировался при величине АПменьше
нижнего нормативного предела по диагностической шкале. Синдром повышения сосудистого сопротивления и гиперрезистивности артериальных сосудов оценивался по показателям артериального импеданса. Он определялся по соотношению параметров центральной гемодинамики –
ударного объема сердца (УОС), ударного индекса сердца
(УИ) и среднего артериального давления (АДср. ) с величиной АП по соответствующему сегменту тела: по режиму давления – АДср/АП, насосному режиму – УОС/АП и УИ/АП,
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а также по режиму перфузии АДср×УИ/АП. Циркуляторный синдром гиперрезистивности артериальных сосудов
диагностировался при величинахэтих показателей больше
верхнего нормативного предела. Оценка используемых гемодинамических показателей проводилась по положению
стоя и лежа с учетом их соотношения – стоя/лежа с использованием стандартных методов непараметрического статистического анализа[5, 6].
РЕЗУЛЬТАТЫ И ИХ ОБСУЖДЕНИЕ.
Проведенный анализ показал высокую сопоставимость
результатов оценки состояния кровообращения нижних конечностей, полученных стандартными (референтными) клиническими и инструментальными методами, и с использованием диагностической системы АНТРОПОС-CAVASCREEN. Для повышения надежности определения диагностической информативности сопоставление проводилось
не по проявляемости циркуляторного синдрома недостаточности артериального кровообращения (ишемии) по тому или
иному сегменту (таз-бедро или голени) одноименной (левой или правой) нижней конечности, а по каждому из 4-х
сегментов – таз-бедро (слева, справа) и голень (слева и справа). Таким образом, выборка сосудистых сегментов сопоставления по клинической группе составила n=489, а по
контрольной группе n=1060. В 99% случаев отмечалось совпадение диагностических заключений по идентификации
недостаточности артериального кровообращения нижних
конечностей по клинической выборке пациентов с облитерирующим эндартериитом или артериосклерозом (рис. 2).
Такое информационное соответствие свидетельствует о высокой диагностической чувствительности представляемой диагностической системы.
Важным результатом, явилось заметное расхождение в
диагностике по контрольной группе. Совпадение результатов клинических исследований по стандартному протоколу и по АНТРОПОС-CAVASCREEN было в 74% – по обоим методам не отмечено нарушений артериального кровообращения по нижним конечностям. В отличие от протокольных клинических исследований, которые стандартно
проводятся в положении лежа, при диагностике с использованием АНТРОПОС-CAVASCREEN гемодинамические
синдромы недостаточности артериального кровообращения
в положении лежа обнаруживались по разным отделам нижних конечностей (таз-бедро или голень, слева или справа)
от 18% до 26% случаев. Но что особенно важно – от 31%
и до 44% случаев эти синдромы выявлялись именно в положении тела стоя. Фактически это и есть реальный объем группы риска лиц с начальными состояниями развития
сосудистой патологии, которые скрыты от стандартных клинических исследований уже в силу просто ограниченного
диагностического пространства проведением исследования
в стандартных условиях положения тела лежа.
Полученные данные свидетельствуют о более высокой
диагностической чувствительности и полноте исследований с использованием АНТРОПОС-CAVASCREEN, а также об особой актуальности проведения диагностики в положении тела стоя. Еще более убедительным обоснованием этому являются данные по онтогенетической динамике проявления недостаточности артериального кровообращения нижних конечностей, полученные на выборке из 1808
лиц (мужчин и женщин) в возрасте от 3 и до 94 лет (рис.
3, верхняя часть рисунка).
По старшим возрастным группам (36-60 лет и старше) при
диагностике в положении лежа стандартными методами и
с использованием АНТРОПОС-CAVASCREEN отмечается
практическое совпадение диагностического вывода. Однако в положении тела стоя отмечается четкое и достоверное
выявления гемодинамического синдрома недостаточности
артериального кровообращения нижних конечностей.
Еще более выразительно это выглядит, если учитывать
не только синдром артериальной недостаточности, но и
гемодинамический синдром, не выявляемый в клинике
сосудистой хирургии при стандартных методах инструментальной диагностики, повышение сосудистого сопротивления и гиперрезистивности артериальных сосудов.
Это такое циркуляторное состояния, которое, с одной стороны, явно ограничивает адаптивные возможности периферического кровообращения; а с другой стороны,
предшествует развитию клинически выраженной сосудистой патологии, включая недостаточность артериального кровообращения.
На представленном рисунке 3 (нижняя часть) хорошо видно, что при такой интегральной диагностической характеристике достоверно увеличивается количество и диагностируемых состояний уже по положению тела лежа, но особенно выразительно по положению тела стоя. С позиций превентивной медицины особенно важна высокая диагностическая чувствительность исследований с использованием
именно антропофизиологически ориентированной диагностической системы АНТРОПОС–CAVASCREEN на всех
остальных возрастных выборках до 35 лет – как в положении тела лежа, так и, особенно, стоя. Из данных представленных на рис. 3 хорошо видно, как проявляемость циркуляторных синдромов ограниченности и недостаточности
артериального кровообращения по нижним конечностям распространяется на период детства. Именно на тот возрастной этап, на протяжении которого формируется ростовая
адаптация к гравитационному (гидростатическому) фактору кровообращения [2, 3]. Данное обстоятельство представляется особо важным, учитывая актуальность сосудистой
патологии нижних конечностей у человека (облитерирующий эндартериит и артериосклероз, варикозная болезнь и
др. ), как по заболеваемости, так и по фатальности ее протекания [7]. В связи с этим и имеющимися другими данными [8, 9]представляется целесообразным все же обозначить
значение гравитационного фактора кровообращения для человека, как прямоходящего существа, как антропогенетической основы формирования нарушений кровообращения
нижних конечностей.
Для проведенного нами исследования именно данная патология (разные формы и степень окклюзии артериальных
сосудов) была использована и в связи с наиболее четко отработанным алгоритмом референтных методов клинической
и инструментальной диагностики, включая и возможность дополнительной верификации диагноза во время оперативного пособия. Однако, при этом следует отметить, что
в диагностической практике именно при данной патологии,
за редким исключением [8, 9], ориентируются на состояние
кровообращения, в том числе и нижних конечностей, в условиях горизонтального положения тела лежа.
ЗАКЛЮЧЕНИЕ
Полученные результаты свидетельствуют о том, что использование антропофизиологического подхода в системной оценке состояния кровообращения позволяет осуществлять раннюю диагностику циркуляторных состояний,
которые лежат в основе недостаточности артериального кровообращения. Причем, задолго до формирования уже клинически выраженных проявлений такой недостаточности. В свою очередь, это позволяет объективно выявить донозологический этап данной сосудистой патологии и сдержать практически всегда фатальное ее развитие.
Дальнейшее развитие на основе антропофизиологического подхода средств диагностики, ориентированных не
только на больных людей, а на весь диапазон соматических
состояний, актуально как для методического обеспечения
превентивной медицины, так и институций поддержки здоровья в целом.
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РЕЗЮМЕ
ИНФОРМАТИЫВНОСТЬ АНТРОПОФИЗИОЛОГИЧЕСКОГО ПОДХОДА
В ДИАГНОСТИКЕ НЕДОСТАТОЧНОСТИ АРТЕРИАЛЬНОГО
КРОВООБРАЩЕНИЯ НИЖНИХ КОНЕЧНОСТЕЙ
БАГРИЙ А., ДИЛЕНЯН Л., БЕЛКАНИЯ Г., ПУХАЛЬСКАЯ Л.,
ГВИНДЖИЛИЯ И., МАТИАШВИЛИ Э., ДЖАЯНИ С.
Сопоставлены оценки состояния артериального кровообращения нижних конечностей у больных с облитерирующим эндартериитом (артериосклерозом), полученные стандартными клиническими и инструментальными методами в традиционных для таких исследований условиях положения тела пациентов лежа, с антропофизиологической
оценкой состояния кровообращения в положениях тела стоя и лежа. Показано, что проявляемость циркуляторных синдромов ограниченности и недостаточности артериального кровообращения по клинической и контрольной группам
пациентов, а также по всем возрастным выборкам была достоверно более высокой в положении стоя.
Ключевые слова: антропофизиологический подход, облитерирующий эндартериит, артериальное кровообращение, диагностика.
SUMMARY
INFORMATIVENESS OF THE ANTHROPOPHYSIOLOGICAL APPROACH IN DIAGNOSING
THE ARTERIAL BLOOD FLOW FAILURE OF THE LOWER LIMBS
BAGRI A., DILENIAN L., BELKANIA G., PUKHALSKAYA L., GVINJILIA I., MATIASHVILI E., JAIANI S.
The evaluations, of the condition of the arterial blood flow of the lower limbs in the patients with the obliterating endarteritis (arteriosclerosis), were obtainted using standard clinical and instrumental methods. The position of the patients’ body was lying which is traditional for these kind of researches. The anthrophysiological evalutaion of the condition of the blood flow was exceuted in the lying
and standing position. It was shown, that the appearance of the circulatory syndromes of the restrictions and failures of the arterial blood flow, both in the case and control and also by all age groups, it was more trustworthily high while standing.
Keywords: anthropophysiological approach, obliterating endarteritis, arterial blood flow, diagnostics.
Рис. 1. Схема тетраполярного наложения
электродов токовых (I)
и потенциальных
электродов для проведения реографической
регистрации гемодинамических параметров.
Обозначения по
связанной системе потенциальных электродов: Ц – голова, ГР –
грудь, Ж – живот, Т-Б
– таз-бедро, Г – голень;
п – справа, л – слева.
АД – манжеточное измерение артериального давления, ЭКГ –
электрокардиограмма.
Рис. 2. Соответствие диагностического заключения по CAVASCREEN клиническому диагнозу недостаточности артериального кровообращения нижних конечностей у пациентов с окклюзиями артериальных сосудов и у пациентов контрольной выборки (без окклюзий сосудов).
На диаграммах: цифры слева – совпадение, справа – расхождение заключения и диагноза.
Рис. 3. Возрастная проявляемость (в %) недостаточности артериального кровообращения нижних конечностей по
общей выборке людей (мужчины и женщины) в возрасте от 3 и до 94 лет (n = 1808).
Фигурками обозначены позные условия (стоя, лежа), в которых проводились исследования. Остальные обозначения на рисунке.
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qi rur gi u li sef si sis mkur na lo ba
s. jaiani, b. cucqiriZe, d. CaxunaSvili, g. CaxunaSvili, n. kviciani
respublikuri sefsisis sawinaaRmdego centri,
kritikuli medicinis instituti, Tbilisi, saqarTvelo
problemis aqtualoba.
Cirqovan-septiuri daavadebebis diagnostika da mkurnaloba – qirurgis erTerTi gadauWreli da rTuli problemaa.
misi aqtualoba dakavSirebulia Cirqovani garTulebebis
farTod gavrcelebasTan, rasac ganapirobebs operaciuli
Carevebis moculobebi, antibiotikorezistentuli mikrofloris mkveTri zrda da mravalmxrioba, aseve pacientebis
imunobiologiuri reaqtiulobis darRvevebi.
qirurgTa msofli kongresze aRniSnul iyo, rom ukanasknel aTwledSi Cirqovan-septiurma daavadebebma msoflioSi mniSvnelovnad imata, calkeul regionebSi ki wina wlebTan SedarebiT 2-jer, 4-jer da
ufro metjerac.
avtorTa monacemebiT daaxloebiT avadmyofTa 30-40%, qirurgiuli paTologiiT, stacionarSi imyofebian Cirqovanseptiuri daavadebebiT.
aradamakmayofilebeli rCeba qirurgiuli avadmyofebis,
romelTac Cirqovan-septiuri
daavadebebi aReniSnebaT, mkurnaloba. maRalia letaloba,
romelic sefsisiT daavadebulebebSi Seadgens 60-70%-s.
qirurgiuli pacientebi Cirqovan-septiuri daavadebebiT,
saWiroeben xangrZliv da ZviradRi re bul mkur na lo bas.
avadmyofebis mkurnaloba, romelTac aReniSnebaT daCirqebebi, 10-jer ufro Zviria vidre
im qirurgiuli avadmyofebisa,
romelTac ar aqvT Cirqovani
garTulebebi.
monacemebi zogierTi Cirqovan-septiuri daavadebebis diagnostikisa da klinikuri mimdinareobis Sesaxeb literaturaSi sakmaod winaaRmdegobrivia, mravali mniSvnelovani
sakiTxi ki gadauWreli.
praqtikuli TvalsazrisiT
Cirqovani infeqciis adreuli
diagnostirebis mxriv siZneleebi kidev rCeba. is mdgomare-
obs imaSi, rom Cirqovani procesi mimdinareobs ZiriTadi
daavadebis fonze, ufro xSirad – gadatanili operaciuli
Carevis fonze da praqtikosi
eqimisaTvis xSirad Znelia ganisazRvros mocemuli garTulebis dasawyisi.
qirurgiuli avadmyofebis
Cirqovan-septiuri daavadebebis
dawyebis sxvadasxva aspeqtebis
Seswavla warmoadgens Tanamedrove qirurgTa erTerT aqtualur problemas.
gadauWrelirCeba sakiTxi
sxva das x va
lo ka li za ci is
Cirqovani procesisa da operaciuli Carevis moculobisa da
miTumetes eWvi sefsisis dawyebis Sesaxeb.
adreuli gamovlena da baqteriologiuri etiologiis
dazustebac ki ver icavs avadmyofs sicocxlis safrTxisagan.
dasnebovnebis meqanizmisa
da Cirqovan-septiuri garTulebebis ganviTarebis Seswavla agreTve warmoadgens klinikuri qirurgiis mniSvnelovan amocanas, romelic moiTxovs Semdgom dazustebas.
konservatiuli mkurnalobis meTodis SerCevis pronci pi, operaciuli Carevis moculoba, operaciis Semdgomi periodis warmarTva, gansakuTrebiT ki anaerobuli da Sereuli etiologiis SemTxvevaSi
saWiroeben mniSvnelovan daxvewas.
kvlevis masala da meTodebi.
Cven mier Seswavlili iyo
2875 SemTxveva avadmyofebisa
sxvadasxva qirurgiuli paTologiiT, romlebic mkurnalobdnen akad. v. boWoriSvilis saxelobis sefsissawinaaRmdego
centris qirurgiuli infeqciis ganyofilebaSi. maT Soris
488 avadmyofs hqonda qirurgiuli sefsisi (16, 9%), swored am
avadmyofebma Seadgina Cveni
kvlevis safuZveli. mamakacebi
iyo 137 (40%), qalebi – 291 (60%).
avadmyofebi gayofil iyvnen
2 jgufad paTologiis saxeobis
mixedviT: peritonitis (179) da
pacientebi rbili qsovilebis
Cirqovani daavadebebiT (309).
peritonitis jgufSi iyo 71
mamakacebi (39, 7%), 108 (60, 3%) qali. unda aRiniSnos, rom gavrcelebuli peritoniti aRiniSna 86 avadmyofSi, mamakacebi da qalebi am jgufSi iyvnen
daaxloebiT Tanabari raodenobiT (45 mamakaci da 41 qali).
sxva suraTi aRiniSna SemosazRvruli peritonitis SemTxvevaSi (93 pacienti) – mamakaci iyo 27, 9% da 72, 1% qali. es
albaT unda aixsnas imiT, rom
SemosazRvruli peritonitis
dros xSirad adgili hqonda
ginekologiuri warmoSobis
muclis Rrus Cirqovan dazianebas.
rbili qsovilebis Cirqovani paTologiisas 309 pacientidan Segvxvda 40, 8% (126) mamakaci da 59, 2% (183) qali.
avadmyofebi rbili da jirkvlovani qsovilis paTologiiT gvxvdeboda SemTxvevaTa 63,
3%-Si, peritonitiT – 36, 7%-Si.
Cvens mier gamosakvlevi 488 pacientidan gavrcelebul peritonits adgili gqonda 17, 6%Si, SemosazRvruli - 19, 1%-Si,
qveda kidurebis Cirqovani daavadebebi – 17, 4%-Si, maT Soris
aRniSnuli lokalizaciis anaerobuli dazianebis process
adgili hqonda 26 SemTxvevaSi
(qveda kidurebis paTologiis
mqone avadmyofTa mTliani raodenobis 30, 5%-s), dundulos
midamos abscess adgili hqonda pacientTa 14, 7%-Si, maT Soris anaerobuli dazianeba
aReniSneboda 12 avadmyofs (16,
9% dundulos midamos Cirqova ni da a va de be bis sa er To
ricxvidan), rbili qsovilebis
anaerobulma dazianebam Seadgina avadmyofTa saerTo raodenobis 7, 8%.
ZiriTad kontingents Seadgenda 20-39 wlis qirurgiuli
sefsisiT daavadebuli axal2013 weli
gazrdebi (64, 5%), ufro asakovani adamianebi (60 wlis da meti) Seadgenda – 5, 7%-s, magram
daavadebis mimdinareobis simZimis mixedviT maT ekavaT mowinave pozicia. am asakobriv
jgufSi letalurma gamosavalma Seadgina 4%.
Cirqovan-septiuri daavadebebis ganviTarebis mizezs warmoadgenda pirveladi-Cirqovani Wrilobebi (22, 3%), operaciis Semdgomi Wrilobebi (41, 4%),
pos t t rav ma tu li Cir qo va ni
Wrilobebi (36, 3%).
yvela avadmyofs, Sesabamisi
paTologiis mixedviT, CautardaT qirurgiuli mani pulacia.
obieqturi informaciis misaRebad pacientis organoebisa da sistemebis mdgomareobas,
Cirqovani procesis dinamikis,
srulfasovani mkurnalobis,
agreTve qirurgiuli sefsisiT
avadmyofTa mkurnalobis meTodebis efeqturi gamoyenebis
sakiTxTa gadawyvetis Sesaxeb,
Cvens mier SemuSavebul iqna
diagnostikuri da kliniko-laboratoriuli kvlevebis kompleqsi.
anamnezis Segrovebis dros
gamoyenebuli iyo specialurad SemuSavebuli ruqa, romelmac mniSvnelovnad Seamsubuqa pirvelad dokumentaciaze muSaoba. gansakuTrebuli
yuradReba eqceoda ciebis xangrZlivobas, gamosayenebeli
mkurnalobis meTodebs, Cirqovani procesis dinamikas.
yvela avadmyofs ganesazRvraT sisxlis maCveneblebi (sisxlis saerTo analizi, bioqimiuri, imunologiuri, koagulaciuri), Seswavlili iyo intoqsikaciis leikocitaruli indeqsis cvlileba (ili), neitrofilur-limfocitaruli indeqsi (n/l), sisxlis osmosuroba.
aseve yvela avadmyofs Cautarda sisxlis baqteriologiuri, Wrilobidan gamonaJonis,
Cirqovani midamos, eqsudatis
gamokvleva. Seswavlili iyo
antibiotikogramebi.
ru ti nu li
fi zi ka lu ri
kvlevis Semdeg yvela avadmyofi isinjeboda SesaxvevSi Cirqovani dazianebis simZimis gansazRvrisaTvis, saWiroebis SemTxvevaSi tardeboda Wrilobis
pirveladi qirurgiuli damuSaveba, xolo pacientTa nawili
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cxrili #1.
muSaobis dros gamoyenebuli mkurnalobis originaluri meTodebi.
gadaiyvaneboda saoperacioSi,
Cvenebis mixedviT qirurgiuli
CarevisaTvis (xSirad – sasicocxlod).
488 avadmyofidan daiRupa 101
pacienti. saSualo letaloba
Seadgenda – 20, 6%-s. peritonitiT avadmyofebSi letaloba
iyo 18% (179-dan 32 pacienti),
xolo rbili qsovilebis Cirqovani dazianebiT avadmyofebSi – letaloba iyo 22, 4% (309dan 69 pacienti).
erTi SexedviT rbili qsovilebis Cirqovani dazianebis
SemTxvevaSi, gaugebaria avadmyofTa ufro maRali letaloba, vidre pacientebSi romelTac aReniSnebodaT peritoniti. magram yvelaferi gasagebi
gaxdeba Tu mivuTiTebT rom
rbili qsovilebis Cirqovani
dazianebis dros adgili hqonda anaerobul flegmonebs,
xSirad gvxvdeboda dekompensirebuli diabetis SemTxvevebi,
am paTologiis dros ki daavadeba mimdinareobs ufro mZimed da iZleva maRal letalobas. aqve unda aRiniSnos,
rom letalobis yvela SemTxvevaSi, Seucvlelad diagnostirebul iyo sefsisi, e. i. adgili hqonda infeqciis generalizacias.
qirurgiuli mkurnalobis
Cveulebriv meTodebTan erTad
muSaobis procesSi gamoyenebuli iyo Wrilobebis adgilobrivi mkurnalobis originaluri meTodebi (cxrili #1).
Cirqovan-septiuri avadmyofebis mkurnaloba iyo mravalferovani, rac ganpirobebuli
iyo faqtorTa simravliT, romlebic Seadgendnen aRniSnuli
paTologias. avadmyofis mdgomareobis uecari damZimeba, romelsac mivyavarT procesis
SeuqcevadobasTan, saWiroebs
gadaudebel samkurnalo RonisZiebebs. rogorc klinikurma praqtikam gviCvena, mkurnalobis Sedegebi damokidebulia mis droul dasawyisze.
CvenTvis mniSvnelovani iyo
praqtikosi eqimebisaTvis Segveqmna samkurnalo RonisZiebebis programa, romelic aucilebelia qirurgiuli sefsis
mqone avadmyofis srulyofili
etiopaTogenezuri mkurnalobisaTvis.
Cvens naSromSi miviCnieT aucileblad da mizandasaxulad,
rom avadmyofTa mkurnalobis
dros gasatarebeli RonisZiebebi dagveyo jgufebad:
Cirqovani da metastazuri
kerebis adgilobrivi mkurnaloba:
qirurgiuli mkurnalobis
tradiciuli meTodebi (Wrilobis pirveladi qirurgiuli damuSaveba, gaxsna, sanacia, Cirqovani midamos drenireba da sxva);
aratradiciuli meTodebi:
plazmuri da lazeruli
skalpelebis gamoyeneba.
geg mi u ri re la pa ra to mia
(“elva”) peritonitis dros.
sorbciuli qsovilebis gamoyeneba.
Cirqovan-septiuri daavadebebis mqone avadmyofebis zogadi mkurnaloba:
antibaqteriuli Terapia;
imunomakoreqtirebeli Terapia;
g) antikoagulanturi Terapia;
d) antifermentuli Terapia;
e) eqstrakoronaluri detoqsikacia.
rogorc warmodgenili monacemebidan Cans, Cvens mier mowodebuli samkurnalo programa,
qirurgiuli sefsisiT daavadebulTa samkurnalod, Tavis
arsenalSi moicavs yvela arsebuli Tanamedrove mkurna-
80
lobis meTods, rasac mivyavarT
mkurnalobis Sedegebis gaumjobesebisaken da aRniSnuli
profilis avadmyofTa letalobis Semcirebisaken.
#2 cxrilSi naCvenebia operaciuli Carevis sxvadasxva
saxeoba, romlebic utardebodaT pacientebs Cirqovan-septiuri daavadebebiT.
centrSi Semosvlamde, pirveladi da meoradi (metastazuri) kerebis gamo, avadmyofTa
umravlesoba ramodenimejer
iyvnen operirebuli (2-5-jer).
rig SemTxvevebSi Cven iZulebuli viyaviT qirurgiuli operacia Cagvetarebina im defeqtebis salikvidaciod, romlebic daSvebuli iyo mkurnalobis wina etapze.
Cirqovani infeqciis kerebis
reviziam TiTqmis SemTxvevaTa
2/3-Si gamoavlina praqtikulad erTnairidefeqtebi: patara ganakveTi, arasakmarisi drenirebis gamo bevri Cirqis Semcveli Rru, nekrotizirebuli
qsovilis Semcveli Cirqovani
Rrus kedlebi, Cirqovanis nekrotizirebuli fskeri, e. w.
`jibeebis” msgavsiCirqgrova.
361 SemTxvevaSi (73, 9%) avadmyofebi stacionarSi Semodiodnen WrilobaSi tamoponebiT,
romlebic maTSi xangrZlivi
yofnis gamo, qmnidnen Cirqovani Rrudan Cirqis gamodinebis
sawinaaRmdegod Seqmnil xelovnur dabrkolebas. xSirad
tamponebs ematebodaT rezinis
milebi an rezinis xelTaTmanebis zolebi, romelTa gamoyenebac aseve ver asrulebda
Tavis pirdapir funqcias –
Cirqovani Rrus drenirebis.
moyvanili monacemebi ar arian SerCeuli, isini warmoadgenen umravlesi zogadi profilis qirurgiuli stacionarebis ti piur defeqtebs. isini kidev erTxel gviCveneben
Cirqovani paTologiebis mqone
pacientebis specializirebul
stacionarSi mkurnalobis aucileblobaze, miTumetes, rom
dResdReobiT Cirqovani infeqciis gauvnebelyofisaTvis
mxolod erTi an ori meTodis
gamoyenebac ki yovelTvis ar
SeiZleba iyos warmatebuli.
dRes dRe o biT pir ve la di
Cirqovani keris tradiciuli
meTodebiT likvidaciisas kar-
gi Sedegebi SeiZleba iqnas miRebuli mxolod Semdeg princi pze dayrdnobiT: Wriloba
rac SeiZleba adreul periodSi unda daeqvemdebaros radikalur qirurgiul mokveTas,
aucilebelia SesaZleblobebis mixedviT amokveTili iyos
yvela arasicocxlisundariani qsovili.
operaciuli Careva unda
warmoebdes narkozis qveS, raTa operaciaSi gamoiricxos aqtiuri avadmyofis faqtori (avadmyofi tkivilze reaqciis
gamo xels uSlis warmoebul
operacias), zogadi gautkivareba erTdroulad xels uwyobs
pirveladi CareviT ganxorcieldes metastazuri kerebis qirurgiuli damuSaveba.
SemdgomSi Cirqovani Wrilobis qirurgiuli damuSavebis Semdeg aucilebelia uzrunvelyofili iyos misi sakmarisi drenireba. Cven, 157
avadmyofzerbili qsovilebis
Cirqovani WrilobebiT, ganvaxor ci e leT mi si na ka du ri
drenireba kargi klinikuri
SedegiT. Wrilobebis nakaduri
amorecxvis sistema sakmaod
martivi da efeqturia. Wrilobis nakaduri amorecxva saSualebas iZleva misi qirurgiuli damuSavebis Semdeg Wriloba daixuros nakeriT.
im SemTxvevaSi Tu rigi mizezebis gamo avadmyofs ar Cautarda Wrilobis nakaduri
amorecxva, gamoviyeneT Wrilobis tamponireba da wyalSi
xsnad fuZeze damzadebuli
malamosnaxvevi.
magram rig SemTxvevebSi, gansakuTrebiT anaerobuli infeqciis arsebobis dros, mocemuli
meTodi (Wrilobis qirurgiuli
damuSaveba da drenireba) yovelTvis ar aris srulfasovani, radganac anaerobul gamomwvevebze aucilebelia ramdenadme sxvagvari zemoqmedeba. aRniSnulma siZneleebma Cven migviyvana mkurnalobis axali meTodebis SemuSavebamde, kerZod,
plazmuri skalpelis gamoyenebiT ozonisa da plazmuri ultraiisferi nakadis gamoyenebamde, romelic SemuSavebulida
danergilia Cveni monawileobiT. am drois manZilze ganxorcielebulia operaciuli Careva 118 avadmyofze.
peritonitebis dros plazmuri skalpeli gamoyenebuli
iyo 6 SemTxvevaSi, rbili qsovilebis Cirqovani dazianebis
dros ki – 112 SemTxvevaSi.
Cvens mier gamoyenebuli iyo
plazmuri nakadis iseTi Taviseburebebi, rogoricaa didi
koncentraciis ozonis, romelic saqSenidan wnevis qveS gamodis, da plazmis warmoSobisas mkvrivi ultraiisferi konis gamoyofa.
peritonitis dros Cvens mier gamoyenebuli iyo muclis
midamos dasxiveba ozoniTa
da plazmis ultraiisferi
koniT 6 avadmyofze operaciis dros, xolo 4 SemTxvevaSi
– dagegmili relaparatomiisas
(“elva”-is gamoyenebisas). baqteriologiurma kontrolma peritonealur SigTavsze mogvca Semdegi Sedegebi: plazmu-
cxrili #2.
qirurgiuli operaciebis saxeobebi, romlebic utardebodaT avadmyofebs.
2013 weli
ri nakadiT damuSavebas mivyavdiT mikroorganizmebis mkveTri Semcirebisaken 1ml eqsudatSi. Tu dasxivebamde mikrobebis raodenoba Seadgenda
107-108, proceduris Semdeg iyo
– 103-104 1 gram qsovilze gadaangariSebiT, amasTan Semcirebas adgili hqonda erTjeradi dasxivebisas.
gegmiuri relaparatomiebis
dros muclis midamos dasxiveba xsnarebiT mis amorecxvasTan
erTad iZleoda kidev ufro
mniSvnelovan efeqts. mikroorganizmebis koncentraciis Sefasebisas plazmuri nakadis gamoyenebis gareSe SemCneuli iyo,
rom mkurnalobas kargi klinikuri efeqtis drosac ki muclis midamos moTesvianoba Seadgenda 106-105 1 gram qsovilze.
plazmuri skalpelis gamoyeneba rbili qsovilebis Cirqovani daavadebebis dros iyo sakmaod farTe. rogorc cxrilidan Cans, yvelaze xSirad plazmuri skalpeliT operirebul
iyvnen avadmyofebi qveda kidurebis Cirqovan-septiuri daavadebebis jgufSi (33, 9%). unda
aRiniSnos, rom plazmuri nakadiT damuSavebisas, gamoiyeneboda misi Termuli efeqti Cirqovan qsovilze terfis, wvivisa da
barZayis flegmonebisas.
SesaZlebeli iyo ukvepirvelive mani pulaciebis dros
Segveqmna aseptiuri garemo,
gamogveSro Wriloba, malamoebisa da xsnarebis gamoyenebis
gareSe `mSrali” meTodiT warmarTuliyo mkurnaloba. magram
unda aRiniSnos, rom mani pulacia unda Catardes dRe-RameSi
2-3 gr. Cven CavatareT `mSrali”
meTodiT aRniSnuli mkurnaloba sxvadasxva lokalizaciis
paTologiiT 35 avadmyofze da
arc erT SemTxvevaSi ar iyo
arasaimedo Sedegi, Wrilobebi
pirvelive seansis Semdeg xdeboda mSrali da 2-3 dRis ganmavlobaSi iwmindeboda.
Cvens mi er ga mo ye ne bu li
plazmuri skalpeli, gansakuTrebiT misi ozonisa da ultraiisferi komponentebi rbili
qsovilebis anaerobuli dazianebis samkurnalod.
Cven gamoviyeneT Wrilobis
gaxsnis Semdeg mis centrSi
damuSaveba 14 avadmyofze ana2013 weli
erobuli infeqciiT, romelTac
aReniSnebodaT celulitTan
SeuRlebuli fasciti.
dazianeba yvela avadmyofSi
lokalizdeboda dundulos
midamoSi, barZayisaken gavrcelebiT. yvela pacients saswrafod utardebodaT farTo ganakveTi dunduloze da barZayze da zi a ne bu li qso vi lis
mTliani amokveTiT. saoperacio ma gi da ze va ta reb diT
plazmuri skalpelis saSualebiT Wrilobis pirvel dasxivebas imis gamo, rom ozone da
ultraiisferi sxivebi vrceldebian 10-15 sm-is manZilze, Wrilobis kideebis amoweviT SesaZlebeli aim qsovilebis
dasxiveba, romlebic ganlagebulia sakmaod Rrmad.
farTod gaxsnili da damuSavebuli anaerobuli Wrilobebis Sexorceba mimdinareobs
sakmaod swrafad, daaxloebiT
1, 5-jer ufro Cqara vidre analogiuri avadmyofebis Cveulebrivi mkurnalobis dros.
CO2 _ lazeriT mkurnalobisas dasxivebis 5-6 seansis Semdeg Wriloba iwmindeboda nekrozuli qsovilisagan, Cirqovani gamonadeni mniSvnelovnad
mcirdeboda 71% SemTxvevaSi,
rogorc peritonitis, aseve
rbili qsovilebis Cirqovani
dazianebis dros Wrilobis
gamonadenis naTesSi mikroflora mniSvnelovnad Semcirda (109-108-dan 104-103-mde qsovilis TiToeul gramze).
helium-neonis lazeris daxmarebiT mkurnalobis dros
aRiniSneboda ufro swrafi
granulireba Wrilobis daaxloebiT 1, 5 gr im avadmyofTan
SedarebiT, romelTac ar utardebodaT dasxiveba.
amgvarad, lazeruli teqnikis
gamoyeneba qirurgiuli sefsisiT daavadebuli avadmyofebis
mkurnalobis dros (lazeris
naxSirorJangisa da helium-neonis saxeobebi) saSualebas iZleva mniSvnelovnad gafarTovdes qirurgiuli mkurnalobis
SesaZleblobebi aRniSnuli paTologiis dros da gaumjobesdes misi Sedegebi.
dagegmili relaparatomia
gamoyenebuli iyo 14 avadmyofis SemTxvevaSi difuzuri peritonitiT, 11-s aReniSnaT Cir-
81
qovani peritonitis, 3-s – fibrozuli. avadmyofebi operirebuli iyvnen pirveli operaciidan 4-6 dRis Semdeg. unda
aRiniSnos, rom 5 avadmyofis muclis Rrus amorecxva utardebodaT 4 dRis ganmavlobaSi, 7s – 6 dRis, xolo 3-s – 8 dRis
ganmavlobaSi.
5 avadmyofs CautardaT dasxiveba dagegmili relaparatomiis SemTxvevaSi plazmuri
skalpelis ozonisa da ultraiisferi komponentebiT kargi klinikuri efeqtiT (mikrobuli floris Semcireba qsovilis 1 gramze 107-108-dan 103104-mde).
dagegmili relaparatomiebi
aucilebelia gamoyenebul iqnas difuzuri peritonitebiT
avad m yo fe bis
kom p leq sur
mkurnalobaSi, agreTve dagvianebuli hospitalizaciis, peritonitis progresirebuli mimdinareobis, mravlobiTi nawlavSua Cirqovani procesebis
dros.
Cveni azriT meTodi sakmaod
martivia, efeqturi, saSualebas
iZleva muclis Rrus damatebiTi operaciuli gaxsnis gareSe ganxorcieldes mudmivi
kontroli masze, Cirqovani
SigTavsisagan gawmenda xarisxiania, agreTve xorcieldeba
amorecxvasTan erTad sxva mani pulaciebi, mag., plazmuri nakadiT dasxiveba baqteriociduli mizniT.
Cven gamoviyeneT krioqirurgiuli danadgari 4 avadmyofze rbili qsovilebis Cirqovani dazianebiT, ZiriTadSi (3
SemTxveva) qveda kidurebze.
sicivis zemoqmedebiT barZayis
flegmonis dros, misi Cveulebrivi gziT gaxsnisas, 3-5 wuTis
ganmavlobaSi xangamoSvebiT
vacivebdiT da vyinavdiT Cirqovani procesiT yvelaze ufro dazianebul adgilebs. aseTi mani pulacia tardeboda 3
dRis ganmavlobaSi. aRniSnuli
iyo, rom paTologiuri qsovilebis gayinvis zonebSi ufro
swrafad xdeboda arasicocxli su na ri a ni
qso vi lo va ni
fragmentebis mocileba.
Cirqovan-septiuri daavadebiT 63 avadmyofis mkurnaloba
CavatareT sorbciuli meTodis
daxmarebiT (sorbenti-AUVM).
11 maTganSi adgili hqonda pe-
82
ritonitis, 52-Si rbili qsovilebis Cirqovan daavadebebs.
sorbciuli meTodis gamoyeneba (kerZod, qsovili-AUVM)
xels uwyoben Cirqovani Wrilobis adreul gawmendas. yvelaze ufro gamoxatuli klinikuri efeqti sorbentis gamoyenebisas gamovlindeba operaciuli Carevidan pirvel saaTebSi, romelic mimarTulia
pirveladi an metastazuri
Cirqovani keris moSorebisaken.
Sedegebi.
arc erTi laboratoriuli,
instrumentuli da kvlevis
sxva meTodi TavisTavad ar iZleva saSualebas saimedod gamovlindes sefsisis sawyisi
niSnebi, rac aucileblobas
qmnis Seiqmnas programebi Tanamedrove diagnostikuri SesaZleblobebis gaTvaliswinebiT saerTo Cirqovani infeqciis sawyisi periodis ganviTare-
bis dasabuTebulad gamovlinebisaTvis.
sefsisis simZimis xarisxis
saboloo diagnostika Cirqovani infeqciiT avadmyofebSi
efuZneba kliniko-laboratoriuli monacemebis kompleqss,
romelic saSualebas iZleva
Sefasdes paTologiuri procesis siRrme, sadac wamyvani adgili rCeba daavadebis klinikur suraTs.
Cirqovan-septiuri daavadebebiT pacientebis samkurnalo
programaSi, qirurgiuli mkurnalobis tradiciul meTodebTan erTad, aucilebelia CaerTos Zemoqmedebis axali saSualebebi, rogoricaa lazeruli da krioqirurgia, sorbciuli meTodi, programirebuli
laparatomia, eqstrakorporaluri detoqsikaciis meTodebi (plazmoferezi, hemosorbcia, qsenosplenoperfuzia).
plazmuri qirurgiuli da-
nadgaris gamoyeneba saSualebas iZleva daCqardes Wrilobis Sexorcebis vadebi misi
iseTi Tvisebebis dadebiTi zemoqmedebis xarjze, rogoricaa
plazmuri nakadis siTburi
efeqti, agreTve misi ultraiisferi da ozonuri komponentebi.
operirebis plazmuri meTodi saSualebas iZleva gaZlierdes samkurnalo efeqti Cirqovani infeqciiT avadmyofebis
kompleqsur mkurnalobaSi da
miRweul iqna dadebiTi Sedegi wina etapebze daSvebuli
arasruli mkurnalobis SemTxvevebSic ki.
kompleqsuri mkurnalobis
programa Cirqovan-septiuri
daavadebebiT pacientebSi, axali aratradiciuli meTodebis
gamoyenebiT saSualebas iZleva Semcirdes mkurnlobis xangrZlivoba, xolo letaloba
Semcirdes 20, 6%-mde.
reziume
qirurgiuli sefsisis mkurnaloba
s. jaiani, b. cucqiriZe, d. CaxunaSvili, g. CaxunaSvili, n. kviciani
respublikuri sefsisis sawinaaRmdego centri,
kritikuli medicinis instituti, Tbilisi, saqarTvelo
Cirqovan-septiuri daavadebebis diagnostika da mkurnaloba qirurgis erTerTi gadauWreli da rTuli problemaa. misi aqtualoba dakavSirebulia Cirqovani garTulebebis farTod
gavrcelebasTan, rasac ganapirobebs operaciuli Carevebis moculobebi, antibiotikorezistentuli mikrofloris mkveTri zrda da mravalmxrioba, aseve pacientebis imunobiologiuri reaqtiulobis darRvevebi. avtorebis mier SemoTavazebuli plazmuri qirurgiuli danadgaris
gamoyeneba saSualebas iZleva daCqardes Wrilobis Sexorcebis vadebi misi iseTi Tvisebebis
dadebiTi zemoqmedebis xarjze, rogoricaa plazmuri nakadis siTburi efeqti, agreTve misi ultraiisferi da ozonuri komponentebi.
Cvens mier SemoTavazebuli operirebis plazmuri meTodi saSualebas iZleva gaZlierdes samkurnalo efeqti Cirqovani infeqciiT avadmyofebis kompleqsur mkurnalobaSi da miRweul iqna dadebiTi Sedegi wina etapebze daSvebuli arasruli mkurnalobis SemTxvevebSic ki. miRebuli Sedegebi iZleva saSualebas mocemuli meTodikis gamoyeneba rekomendirebul iqnas aRniSnuli garTulebebis mqone pacientebSi.
sakvanZo sityvebi: sefsisi, kritikuli mdgomareoba, plazma.
SUMMARY
TREATING SURGICAL SEPSIS
JAIANI S., TSUTSKIRIDZE B., CHAKHUNASHVILI D., CHAKHUNASHVILI G., KVITSIANI N.
Anti-Sepsis Republican Centre, Institute of Critical Care Medicine, Tbilisi, Georgia
The treatment and diagnostics of purulent-septic diseases is one of the most unsolved and tough problems of surgery.
Its’ actuality is related to the spreading of the purulent complications, which caused the numbers of the surgeries and the
antibioticoresistent microflora to increase, as well as the disfunctions of the patients’ imunobiological reactions. The authors offer using the plasma-surgical device, which gives the opportunity to hasten the cicatrization dates of the wound using its’ possitive effects such as thermal effect of the plasma flow and the ultraviole and ozone components.
The proposed plasma method of surgery makes it possible to improve the treating effect of the patients with purulent
infection and the possitive results were achieved even at the early stages of using this method. The achieved results gives
us the possibility to recommend using this method for treating the patients with the above mentioned complications.
Keywords: sepsis, critical condition, plasma.
2013 weli
83
m. WipaSvili, e. abzianiZe, c. gigineiSvili, e. imnaZe
molekuluri da samedicino genetikis departamenti
yoveli organizmis bioqimiuri procesebis
mniSvnelovani nawili mimdinareobs mitoqondriebis matriqsze, sadac Jangva-fosforilirebis Sedegad warmoiqmneba ATP-i, romelic SemdgomSi transfirmirdeba meqanikur, bioeleqtrikul da sxva saxis energiaSi. mitoqondroaSi mimdinare procesebi ganapirobeben organizmis metabolizmis dones. paTologiuri procesebis gamomJRavnebis xarisxi damokidebulia
saTanado organos qsovilebis JangbadiT da energiiT momaragebis doneze.
eriTrocitebis da keratinocitebis garda
mitoqondriebi gaaCnia yvela ujreds. citoplazmaSi maTi lokalizacia ganapirobebs mitoqondriuli dnm-is damemkvidrebis unikalurobis - dediseul memkvidreobas, replikaciur
segregacias da heteroplazmias.
mitoqondroebis genomis Taviseburebas warmoadgens mutagenezis ufro didi sixSire - 6-17jer birTvulTan SedarebiT. aseve, cnobilia, mitoqondriuli darRvevebis polisindromuli xasiaTi (nervuli, kunTovani da sxva sistemebis patologiur procesSi CarTviT), gviani eqspresia,
progredientuli mimdinareoba antici paciiT.
mitoqondriuli dnm-is gaSifra moxda 1981
wels kembrijis molekuluri kvlevebis centrSi frederik sangeris, pol bergis da
uolter gilbertis laboratoriaSi.
mitoqondriuli genomis genetikur polimorfizms uzrunvelyofs heteroplazmia, romelic
mimdinareobs, rogorc somatur ujredebSi, aseve - kvercxujredebSi. amis gamo mitoqondriebi warmoadgenen maRalpolimorful informatul genetikur sistemebs, rac gemoiyeneba
evoluciur da kriminalur kvlevebSi.
mitoqondriuli genomis geografiuli korelacia pirvelad dadgenil iqna duglas uolesis laboratorioaSi, sadac Catarda mitoqnodriuli dnm-is restriqtiuli analizi 5 eTnikur
jgufSi. alan uilsonis mier dadgonda nukleotiduri Tanamimdevroba, calkeuli mutaciebis
warmoSobis dro. kvlevebis Sedegad dadginda
Tanamedrove adamianis mitoqondriuli dnm-is
yvela ti pebis minaTesaveba „afrikul evasTan“.
es mtkicdeda dRes bevri paleontologiuri monacemebiT, maT Soris Cvens teritoriazec.
dadgenilia, rom Tanamedrove adamianis haplojgufebis umravlesoba kontinent _ specifiuria.
saqaris negroiduli misaxleobis 70% miekuTvneba mitoqondriuli dnm-is _ jgufs, sadac identurobis damamtkicebelia mutacia 3. 592 mukleotidTa wyvilebis poziciaSi. adamianis genetikuri daSoreba moxda TandaTan: - 110 aTasi wlis
win gamoeyo negroiduli rasa, monRoloedebis da
evropelebis daSoreba ki - 40 – 50 wlis win.
aRmosavleT aziaSi da cimbirSi aRmoCenilia
mutaciebi mitoqondriuli xazebis 55%-Si or
poziciaSi. aqedan 50% miekuTvneba aziuri war2013 weli
moSobis mosaxleobas. am genetikuri informaciis mxolod 2% da misi calkeuli derivatebi aRiniSneboba evropul populaciaSi. zogadad evropul da aziur mosaxleobaSi ar aRniSneba haplojgufebis informaciis intensiuri Sereva (mxolod 5 %). Sua aziis kontaqtur
teritoriebze ki aRiniSneba, rogorc evropuli, aseve aziuri mit-dnm-is haplojgufebi.
amerikis aborigenul mosaxleobaSi aRniSneba aziuri warmomamvlobis 4 haplojgufi, rac
amtkocebs amerikis mosaxleobis warmoSobis
cimbiris eTnosebis genetikur safuZvelze. mogvianebiT aRmoCenili erT-erTi haplojgufi miuTiTebs evropuli komponentis arsebobazec.
1998 wels m. riCarsma daadgina evropielebis
5 ZiriTadi haplojgufi tranziciebiT edentur
poziciebSi.
ukrainelebis polulacia genetikurad ganekuTvneba iseT subklasters, romelic axlos
aris serbebTan, germanelebTan, moldovelebTan,
qorvatebTan da CexebTan. aRniSnuli subbkalsterSi gaerTianebulia centraluri da aRmosavleTis evropielebi, romelTa winaprebi
gadmosaxldnen evropaSi aziidan da samxreTi
ruseTidan.
ukrainuli populaciis mitoqondriuli dnmis klasterizacia miuTiTebs imaze, rom mit-dnmis ti pebis umravlesoba miekuTvneba evropuli
warmoSobis haploti pebs. magram, maT Soris moi poveba aziuri komponentic.
rac Seexeba Cven polulacias, ra Tqma unda,
dRes mtkicdeba Cveni naTesavoba saerTo genetikur winaparTan - „afrikul evasTan“. regionebis mixedviT Catarebuli kvlevebis mixedviT,
romlebsacatarebdnen londonis da izraelis
universitetebis mecnierTa jgufebi, aRmoCnda,
rom aRmosavleTi saqarTvelos populaciebSi
aRiniSneboda aziuri warmomavlobis haploti pebi (iranelebTan da TurqebTan asocierebuli).
svaneTis da afxazeTis polulaciebSi aRiniSneba mit-dnm-is haploti pebi, romlebic aziuri
wamoSobisaaa da, amave dros, axlos aris daRestnur da adiRenur populaciebTan. dasavleT saqarTvelos populaciaSi ki Warbobs evropuli
mitoqondriuli dnm-is ti pebi. Tumca unda aRiniSnos, rom, zogadad, qarTvelTa yvela populaciaSi meti raodenobiT aris armoCenili evropuli warmoSobis mit-dnm-is hapliti pebi.
literatura:
1. „samedicino genetika“ - e. greCaninova, r.
bogatirova, a. volosoveci. kievi, gamomcemloba „medicina“, 2010
2. „samedicino genetika“ - n. boCkovi. moskovi, gamomcemloba „akademia“, 2007
3. „genebi da genomebi“ - m. sangeri, p. bergi, 1998
4. „samedicino genetika“ - m. Wi paSvili, n. moroSkina, e. imnaZe, c. gigineiSvili, gamomcemloba „tori“, 2011.
84
reziume
m. WipaSvili, e. abzianiZe, c. gigineiSvili, e. imnaZe
molekuluri da samedicino genetikis departamenti
mitoqondriuli dnm-is polimorfizmebi miuTiTebs adamianTa populaciebis eTnikur da geografiul wamomavlobaze.
SUMMARY
MITOCHONDRIAL DNA AND ETHNIC LINEAGE
M. TCHIPASHVILI, E. ABZIANIDZE, TS. GIGINEISHVILI, E. IMNADZE
Department of Molecular and Medical DNA
The polymorphism of the mitochondrial DNA explains the ethnic and geographical origins of human populations.
imunuri homeostazi TimomegaliiT
mimdinare bronqopnevmoniebis dros bavSvebSi
apihepatiT mkurnalobis fonze
g. CaxunaSvili, n. Tofurize, n. badriaSvili, k. CaxunaSvili
adaptaciuri meqanizmebis
ganviTarebasa da reaqtulobis
CamoyalibebaSi Timuss mniSvnelovani adgili uWiravs (1. 2).
Timusisa da misi mikrogaremos gavleniT Zvlis tvinis Rerovani ujredebi transformirdeba T-limfocitebad, romlebic migrireben periferiul
organoebsa da qsovilebSi, da
anxorcieleben imunologiur
zedamxedvelobas(4, 7, 8).
avtorTa monacemebiT, sakmaod
didia Timomegaliis, rogorc
premorbiduli fonis gavlena
pnevmoniebis mimdinareobasa da
gamosavalze. Timomegaliis
dros hormonalur homeostazSi gamovlenili funqciuri cvlilebebi, ganapirobebs organizmis adaptaciuri SesaZleblobebis darRvevas, gansakuTrebiT stresuli situaciis dros,
rac am bavSvebze diferencirebuli dakvirvebis aucileblobaze metyvelebs(3, 5, 6, 9).
Aam TvalsazrisiT, perspeqtiulia apihepatis CarTva TimomegaliiT mimdinare bronqopnevmoniebis mkurnalobis kompleqsSi.
apihepati warmoadgens bunebriv, naturalur mcenareul
komponentTa jams: wiwvovanis
eqstraqtis, futkrisa da yurZnis produqtebis nazavs, romelic Seicavs: aminomJavebis 22
saxeobas20% proteins albuminebis saxiT, vitaminebs (A, B1, B2,
B5, B6, C, D, PP, E, K, folis mjava), biotins, rutins, beta-sitosterins (fosfoterini), mikroelementebs(Fe, Ca, Mg, Zn, Cu,
F), glikozidebs, qlorofils,
cximovan mJavebs.
is zrdis organizmis fizikur da gonebriv Sromisunarianobas; awesrigebs vitaminebis,
aminomJavebis da mikroelementebis cvlas, Jangva-aRdgeniT
procesebs; preparatSi Semavali aminomJavebi advilad aTvisebadia, rac xels uwyobs azotovani balansis SenarCunebas
da uzrunvelyofs organizmis
zrdisa da ganviTarebis procesebs; gaaCnia imunomodulaciuri, imunomastimulirebeli
da antimikrobuli Tvisebebi;
mocemuli Sromis mizans
warmoadgenda Segveswavla imunologiuri
maCveneblebis dinamika TimomegaliiT Mmimdinare bronqopnevmoniebis
dros bavSvebSi apihepatiT
mkurnalobis fonze.
Mmasala da meTodebi:
Cvens mier gamokvleul iqna
erTi Tvidan 3 wlamde asakis
Timomegaliis fonze mimdinare
bronqopnevmoniiT daavadebuli
45 bavSvi, aqedan 33%-s (15 avadm-
yofs) aRiniSneboda daavadebis
mZime, xolo 67%-s (30 bavSvs) saSualo simZimis mimdinareoba.
sakontrolo jgufi warmodgenili iyo erT wlamde
asakis praqtikulad janmrTeli 20 bavSviT.
Bbronqopnevmoniis diagnozi
daisva anamnezuri, klinikurlaboratoriuli da rentgenologiuri monacemebis safuZvelze. Timomegaliis diagnozis dasabuTeba xdeboda klinikur-rentgenologiuri monacemebis Sedegad.
avadmyofebi dayofilni iyvnen or jgufad:
I jgufi _ TimomegaliiT
mimdinare bronqopnevmoniis
diagnoziT hospitalizirebuli 20 pacienti, sadac tardeboda bazisuri mkurnaloba.
II jgufi _ TimomegaliiT
mimdinare bronqopnevmoniis
diagnozis mqone 25 avadmyofi,
sadac bazisuri mkurnalobis
kompleqsSi CarTuli iyo apihepati - sqemiT 1/3 abi samjer
dReSi. mkurnalobis kursi Seadgenda 20 dRes.
mkurnalobamde da mkurnalobis Semdeg tardeboda imunuri statusis Sefaseba: periferiuli sisxlis T-limfocitebi da misi subpopulaciebis
procentuli raodenoba Seiswavleboda CD3, CD4, CD8 monok2013 weli
lonuri antisxeulebiT, B- limfocitebis procentuli raodenoba _ komplementuri rozetkebis warmoqmnis meTodiT(6).
sisxlis SratSi G, A, M imunologiebi – manCinis radialuri
imunodifuziis meTodiT(7).
Kklinikur efeqturobas afasebdnen Semdegi kriteriumebiT:
gamojanmrTeleba-daavadebis
yvela simptomis gaqroba, gaumjobeseba – simptomebis mniSvnelovani Semcireba da efeqtis
ar arseboba –simptomebis SenarCuneba anda maTi momateba.
mkurnalobis efeqturoba aseve fasdeboda misi gavleniT
daavadebis mimdinareobis simZimesa da xangrZlivobaze.
jgufebs Soris gansxvavebis
Sefasebas vaxdendiT raodanobrivi maCveneblebisaTvis
stiudentis koeficientiT (t>1,
96; p< 0, 05) xolo xarisxobrivi maCveneblebisaTvis ckriteriumiT (Pearson). (c>3, 84, p<0, 05), maTematikuri uzrunvelyofa
ganxorcielda programebis paketis SPSS 11-5-is gamoyenebiT.
miRebuli masalis statistikuri damuSaveba ganxorcielda kompiuteruli programa
SPSS paketiT.
gamokvlevis Sedegebi da maTi ganxilva:
I jgufis avadmyofebidan(20)
bronqopnevmoniis mwvave mimdinareoba aReniSneboda 8(40%)-s,
gaxangrZlivebuli 12(60%) pacients.
II jgufSi (25) daavadebis mwvave mimdinareobiT hospitalizebuli iyo 16(64%) pacienti,
gaxangrZlivebuli mimdinareobiT – 9(36%).
klinikuri dakvirvebisa da
gamokvlevis Sedegebis analizma gviCvena, rom adreuli
asakis bavSvebSi TimomegaliiT
mimdinare bronqopnevmoni-isaTvis damaxasiaTebelia saSualo
da mZime xarisxiT gamoxatuli
sunTqvis ukmarisoba, gamoxatuli obstruqciuli sindromi,
anTebiTi procesis gaxangrZlivebisaken midrekileba, imunodeficituri mdgomareobis
Camoyalibeba. K
kerZod, Timomegaliis fonze
mimdinare bronqopnevmoniebis
dros mwvave periodSi aRiniSneboda CD3-limfocitebis (TsaerTo), CD4- helperebis procentuli raodenobisa da imunologiuri indeqsis CD4/CD3
2013 weli
85
cxrili#1
imunologiuri maCveneblebi, TimomegaliiT mimdinare bronqopnevmoniebis dros bavSvebSi, apihepatiT mkurnalobis fonze. M+m
Semcireba, humoruli imunitetis mxriv darRvevebi SedarebiT naklebad iyo gamoxatuli:
adgili hqonda B-limfocitebis procentuli raodenobisa
da sisxlis SratSi samive
klasis imunoglobulinebis
koncentraciis daqveiTebas.
gamokvlevis Sedegebis analizma gviCvena, rom mkurnalobaSi api pulmos CarTvam moaxdena imunomodulaciuri zemoqmedeba, rac gamoixata Tlimfocitebisa(CD3) da T-helperebis(CD4) procentuli raodenobis momatebiTa da T-supresorebis(CD8) SemcirebiT im
pacientebSi, romelTac CD3 и
CD4 limfocitebis raodenoba
daqveiTebuli hqondaT. kompleqsuri mkurnalobis gavleniT limfocitebis procentuli raodenoba ar icvleboda im bavSvebSi, romelTacN es
maCveneblebi normaSi hqondaT.
Hhumoruli
imu ni te tis
mxriv, kompleqsur mkurnalobaSi apihepatis CarTvis fonze,
aRiniSna B-limfocitebis procentuli raodenobisa da sisxlis SratSi samive klasis
imunoglobulinebis koncentraciis momateba.
imunologiuri maCveneblebis dinamika apihepatiT mkurnalobis fonze mocemulia
cxrilSi #1.
rogorc cxrilidan Cans,
imunuri maCveneblebis dadebiTi dinamika ufro mniSvnelovnad gamoxatuli iyo avadmyofTa im jgufSi, sadac mkurnalobis kompleqsSi CarTuli
iyo apihepati.
bronqopnevmoniis kompleqsuri mkurnalobis Semdeg, II
jgufis avadmyofebSi, aRiniSneboda imunologiuri maCveneblebis gaumjobeseba. gansakuTrebiT mniSvnelovania CD4- helperebis procentuli raodeno-
bisa da imunologiuri indeqsis momateba, agerTve humoruli imunitetis maCveneblebis
dadebiTi dinamika, rac gamoixata B -limfocitebis procentuli raodenobasa da Sratismieri imunoglobulinebis G, A,
M koncentraciis matebiT.
amgvarad, miRebuli monacemebi gviCvenebs rom
Timomegaliis fonze mimdinare bronqopnevmoniis dros
aRiniSneboda darRvevebi imunuri homeostazis mxriv, rac
gamoixateboda ujreduli imunitetis Rrma, xolo humoruli
imunitetis SedarebiT naklebi
cvlilebebiT.
brnqopnevmonia Timomegaliis fonze mimdinareobda ufro
mZimed, saSualo da mZime xarisxiT gamoxatuli sunTqvis ukmarisobiT, gamoxatuli obstruqciuli sindromiT, anTebiTi procesis gaxangrZlivebisaken midrekilebiT, imunodeficituri mdgomareobis fonze.
imunologiuri maCveneblebi, Timomegaliis fonze mimdinare bronqopnevmoniis dros,
ar koregirdeboda kompleqsuri Terapiis fonze.
Mkurnalobis kom p leq s Si
apihepatis CarTvam ganapiroba
imunologiuri maCveneblebis
gaumjobeseba;
Sedegad, mizanSewonilad migvaCnia TimomegaliiT mimdinare
bronqopnevmoniebis mkurnalobaSi apihepatis gamoyeneba, romelic xels Seuwyobs imunuri
homeostazis normalizebas da
dadebiT zegavlenas moaxdens
daavadebis mimdinareobaze.
literatura:
m. dumbaZe /òrganizmis araspecifiuri da specifiuri imunoaqtivoba bronqopulmonuri daavadebebis dros adreul asakis
bavSvebSi” T. s. s. u. SromaTa
86
krebuli XXXVII_2005w. /
Караулов А. В. ,, Иммунотерапия респираторных заболевании М. 2011 с. 19.
Иллек Я. Ю., Зайцева Г. А., Смердов В. Л., /,, Иммунологическая реактивность и функция щитовидной
железы при острой пневмонии у детей с тимомегалией. `2011
Реброва О. Ю. / Статистический
анализ медицинских данных. -Москва: Медия Сфера. - 2010. – 312с/
Энгельгардт Н. В. /`Имуннологические аспекты биологии развития”
М. 2009 с92-106/
Чернушенко Е. Ф. / `местный иммунитет при заболеваниях легких”
Реф журн. Клиническ. Иммун. И
аллерг. 2010г. Ст. 28/
Чихрадзе М. В. / `Клинико-иммунологическая характеристика больних схроническим бронхитам в динамике имуннореабилитации. `
Автореферат 1999г.
Чернушенко Е. Ф.. / `местный иммунитет при заболеваниях легких”
Реф журн. Клиническ. Иммун. И
аллерг. 2010г. Ст. 28/
Boanco A. PatricR. /Wussenrweig
Exp. Med. 2008 132-702-720/
Key words: thymomegalia, bronchopnewmonia, children, Immunological, Apihepati;
reziume
imunuri homeostazi TimomegaliiT mimdinare bronqopnevmoniebis
dros bavSvebSi apihepatiT mkurnalobis fonze
g. CaxunaSvili, n. Tofurize, n. badriaSvili, k. CaxunaSvili
kvlevis mizani iyo, aRmogveCina xerxi, romliTac adreul asakSi bavSvebSi avicilebT bronqopnevmoniur daavadebebs.
SeviswavleT T-limfociebi da misi subpopulaciebi CD3, CD4, CD8, antisxeulebi, b limfocitis done, IgG, IgM, IgA–s doneebi.
kvlevis mizani iyo humorul da ujreduli imunuri sistemis mdgomareobis Seswavla bavSvebSi.
Sedegebma gviCvena, rom ujreduli imunuri sistema did deficits ganicdis bronqopnevmoniis dros.
gamoviyeneT preparati apihepati, imunomodulatori, romelmac sxva preparatebtan erTad kombinaciaSi humoruli da ujreduli imunuri sistemis brZolis unarianoba gacilebiT gazarda.
SUMMARY
IMMUNOLOGICAL TESTIMONIES AMONG THE CHILDREN WITH
BRONCHOPNEWMONIA DISEASES ASSOCIATIED WITH THYMOMEGALIA
DISEASE TREATED WITH APIHEPATI
G. CHAKHUNASHVILI, N. TOPURIDZE, N. BADRIASHVILI, K. CHAKHUNASHVILI,
SPPF, Childrens New Clinic After I. tsitsishvili
The aim of our trail research the immune system among the children of early age with bronchopneumonia.
We studied T- lymphocytes and its subpopulations CD3, CD4, CD8, antibodies.
The percentage levels of B lymphocytes, The Ig G, Ig A, Ig M, testomonies in serum of blood.
The aim of our theme is the study the cell and hummoral immune system among the children of early age. Given results
show us that cell immune system is more damaged during bronchopneumonia. We used immune modulating – apihepati.
The results showed that Apihepati combined with basic treatment significantly enhances cellular as well as hummoral
Immune status of the patients with bronchopneumonia diseases.
kalaTburTelTa mdgomareoba „apipuris“ kvebis racionSi CarTvamde
(kvle vis I eta pi)
g. CaxunaSvili, n. badriaSvili, m. TofuriZe, n. jobava,
k. CaxunaSvili, ir. kalsndiaz. fxalaZe, d. CaxunaSvili
(socialuri pediatiis dacvis fondi, saqarTvelos bavSvTa kardiologTa asociacia,
Tmilisis sax. samedicino universireti)
dReisaTvis umniSvnelovanesia sportsmenTa
kvebis sakiTxi.
organizmis fizikuri ganviTareba ganisazRvreba rogorc adamianis organizmis morfofunqciuri Taviseburebebis cvlilebaTa rTuli
procesi. is emorCileba biologiur kanonebs
da asaxavs zrdisa da ganviTarebis zogad kanonzomierebebs.
varjiSis procesis intensifikacia(2, 3) da organizmis sistematiuri gadatvirTva iwvevs
struqturuli, fiziologiuri da sxa rezervebis Semcirebas(1, 5). didi fizikuri datvirTva
gazrdil moTxovnebs uyenebs organizms, spotsmenebSi deficituri mdgomareoba iCens Tavs,
rasac SeiZleba Tan axldes funqciuri rezervebis amowurva, adaptaciis uaryofiTi efeqtebi da janmrTelobis darRveva (4, 7, 9, 11). amdenad, sportuli medicinis umniSvnelovanes
problemas mwvave da qronikuli gadaZabva da
misi profilaqtika warmoadgens. swored aminom2013 weli
87
cxrili #1 JavebiTa da vitaminebiT gamdidrebulkalaTburTelTa anTropometruli, fizikuri da funqciuri ma „api purma“ SeiZleba Seasrulos
maCveneblebis analizi „api puris“ miRebamde
mniSvnelovani roli sportsmenTa rea-
bilitaciaSi energiis aRsadgenad, polideficituri mdgomareobebis, fizikuri
da gonebrivi gadaRlis dros. (6, 8, 10).
aminomJavebiTa da vitaminebiT gamdidrebuli energetikuli „api puris“ gamoyeneba aumjobesebs sportsmenTa Sromisunarianobas, afarTovebs adaptaciuri
meqanizmebs savarjiSo da saSejibro pirobebisadmi; aCqarebs aRdgeniT procesebs intensiuri fizikuri datvirTvis
Semdeg; amdenad interess iwvevs adaptaciis uaryofiTi efeqtebis Tavidan
asacileblad aminomJavebiT gamdidrebuli „api puris“ moqmedebis Seswavla.
mizani: kalaTburTelTa funqciuri mdgomareobis Sefaseba maRali fizikuri
datvirTvis pirobebSi da aminomJavebiT
gamdidrebuli „api puris“ Seswavlis
pirveli etapi mozard sportsmenTa reabilitaciaSi. masala da meTodebi: samuSaos safuZvlad daedo 12-dan 18 wlamde
asakis 100 kalaTburTelis fizikuri ganviTarebis maCveneblebis gamokvlevis Sedegebi „api puris“ moqmedebamde.
CarTvis kriteriumebi: damakmayofilebeli socialur-ekonomiuri pirobebi, damakmayofilebeli da kargi sportuli Sedegebi.
sakontrolod aRebuli iyo igive monacemebis 50 kalaTburTeli, romelTac
ar eZleodaT aRniSnuli „api puri~. Catarda randomizebuli Ria kontrolirebadi kvleva 6 Tvis ganmavlobaSi.
Seswavlil iqna Semdegi maxasiaTeblebi: ramden dRes varjiSobs kviraSi, ramden saaTs varjiSobs dReSi, ganwyoba
varjiSis Semdeg, aqvs Tu ara gadaRla
da gadaZabva, gulis SekumSvaTa sixSire,
sunTqvis Sekvris dro, zogadi mdgomareoba, simaRle mjdomare da fexze dgomisas; welis, gulmkerdis, mxrebis, kidurebis garSemoweriloba, pulsi, arteriuli
wneva sistoluri da diastoluri, datvirTvamde da datvirTvis Semdeg, am maCveneblebis mixedviT gamoTvlil iqna
Semdegi sportuli indeqsebi: sisxlis
mimoqcevis sistoluri da wuTobrivi moculobebi (lilienistradisa da canderis formulebi), sisxlis mimoqcevis efeqturobis koeficienti, ketles indeqsi(simaRlisa da wonis Tanafardoba), minuvries indeqsi (sxeulisa da fexebis sigrZeTa Tanafardoba), pinies indeqsi.
raodenobrivi maCveneblebis sarwmunobis Sefasebas vaxdendiT stiudentis
kriteriumiT (t), xarisxovanis χ2kriteriumiT, jgufebs Soris Sedarebas
Pearson-iT. gansxvaveba iTvleboda sarwmunod, Tu t>1, 96 p<0, 05 da c>3, 84, p<0, 05
(10, 11). maTematikuri uzrunvelyofa
ganxorcielda programebis paketis
SPSS 11-5 –is gamoyenebiT.
2013 weli
88
kvlevis Sedegebi da maTi ganxilva:
kvlevis pirvel etapze SeviswavleT kalaTburTelTa anTropometruli, fizikuri da funqciuri maxasiaTeblebi „api puris“ miRebamde. (cxr#1)
vinaidan arsebobs Sroma (G. Chakhunashvili; N.
Badriashvili; M. Topuridze;
N. Jobava;K. Chakhunashvili „Assessment of Anthropological, Physical and Functional Indices in Sportsmen Receiving
During the Training „ (11), romelSic aRniSnulia,
sasmelis ìveriuli fitos” miRebis Semdeg,
(romlis Semadgenlobac TiTqmis `pi puris“
analogiuria) aRiniSna sxeulis wonis; simaRlis; mxris da gulmkerdis sagitaluri da
frontaluri diametris sarwmuno momateba.
aseve sarwmunod gaumjobesda fizikuri da
funqciuri maCveneblebi.
sasmelis miRebis Semdeg adgili hqonda sunTqvis sixSiris da pulsuri wnevis momatebas;
agreTve datvirTvis Semdeg gulis SekumSvaTa
sixSiris, saSualo wnevis Semcirebas; garda amisa gaumjobesda iseTi funqciuri monacemebi
rogoricaa sunTqviTi indeqsebi (Stanges sinji; genCis sinji) rufies indeqsi, amtanobis koeficienti, sisxlis mimoqcevis sistoluri da
wuTobrivi moculobebi (lilienistradisa da
canderis formulebi), gauaresda sisxlis mimoqcevis efeqturobis koeficienti.
igive maCveneblebis Sedarebam sakontrolo
jgufSi (romelsac ar eZleoda sasmeli ìveriuli fito”) 3 Tvis Semdeg arsebiTi gansxvaveba ar aRiniSneba.
3 Tvis Semdeg im jgufSi, romelsac ar eZleoda sasmeli, wonis, simaRlis, mxris da gulmkerdis diametris, mxris da winamxris garSemowerilobis maCveneblebis mixedviT raime
mkveTri cvlileba(sarwmuno mateba) ar aRiniSneboda, sasmeli ìveriuli fito” sjgufisagan
gansxvavebiT gaizarda mxolod datvirTvis
Semdeg sunTqvis da pulsis sixSireebi.
Yyovelive zemo aRniSnulis gamo aucilebelia
kvlevebi gafaraTovdes àpi puris” sportsmenebSi kvebis racionSi Setanis Semdeg da mieces maT
Sesabamisi interpretaciiT rekomendaciebi.
literatura:
Флетчер Р., Флетчер С. Вагнер Э. Клиническая эпидемиология(основы доказательной медицины). Москва: Медиасфера – 2008. - 345c
Гайятт Г., Ренни Д. Путеводитель читателя медицинской
литературы – Принципы клинической практики, основанной на доказанном. Издательство. Медия Сфера. –М. 2003
11. Assessment of anthropological, physical and functional indices in sportsmen (basketball players) against the background of high physical loading.
Chakhunashvili G, Jobava N, Guchashvili M, Chakhunashvili K, Gogilashvili T, Shvangiradze M, Pagava K.
Georgian Med News. 2011 Jul-Aug;(196-197):12-8.
reziume
kalaTburTelTa mdgomareoba „api puris“ kvebis racionSi CarTvamde
(kvlevis I etapi).
g. CaxunaSvili, n. badriaSvili, m. TofuriZe, n. jobava, k. CaxunaSvili,
ir. kalsndiaz. fxalaZe, d. CaxunaSvili
(socialuri pediatiis dacvis fondi, saqarTvelos bavSvTa kardiologTa asociacia,
Tmilisis sax. samedicino universireti)
dReisaTvis umniSvnelovanesia sportsmenTa kvebis sakiTxi. organizmis fizikuri ganviTareba ganisazRvreba rogorc adamianis organizmis morfofunqciuri Taviseburebebis cvlilebaTa rTuli procesi. is emorCileba biologiur kanonebs da asaxavs zrdisa da ganviTarebis zogad kanonzomierebebs.
mizani: kalaTburTelTa funqciuri mdgomareobis Sefaseba maRali fizikuri datvirTvis pirobebSi da aminomJavebiT gamdidrebuli „api puris“ Seswavlis pirveli etapi mozard sportsmenTa reabilitaciaSi.
masala da meTodebi: samuSaos safuZvlad daedo 12-dan 18 wlamde asakis 100 kalaTburTelis fizikuri ganviTarebis maCveneblebis gamokvlevis Sedegebi „api puris“ moqmedebamde.
daskvna: Yyovelive zemo aRniSnulis gamo aucilebelia kvlevebi gafaraTovdes àpi puris” sportsmenebSi kvebis racionSi Setanis Semdeg da mieces maT Sesabamisi interpretaciiT rekomendaciebi.
SUMMARY
STATUS OF BASKETBALLERS BEFORE ADDING ÀPIPURI” INTO FOOD RATION
(FIRST STEP OF RESEARCH)
G. CHAKHUNASHVILI, N. BADRIASHVILI, M. TOPURIDZE, N. JOBAVA, K. CHAKHUNASHVILI,
I. KALANDIA, Z. FKHALAZDE, D. CHAKHUNASHVILI
(Social Pediatric Protection Fund, Association Of Georgian Pediatric Cardiology, TSMU)
Nutrition of Sportsmen is quite actual subject these days. Physical development of human body is hard morphological
process. Its growth depends on biological processes.
Aim: Evaluation of basketball players’ functional state under stress, before they start receiving Àpipuri”.
Methods: The research had been done on 100 basketball players of age 12-18 by evaluating their development, before adding Àpipuri” into their ration.
Conclusion : The research needs to continue after adding “Apipuri” into their ration and the functional state needs to
be evaluated again and compared to previous results.
2013 weli
89
monozigotur tyupebSi niSan-TvisebaTa
gansxvavebis zogierTi Taviseburebani
d. cxomeliZe, m. abisonaSvili, b. ruxaZe, d. CaxunaSvili, v. ozaSvili
Cveni kvlevis mizani iyo
dagvedgina postnatalur periodSi monozigotur tyupiscalebs Soris iseTi niSan-Tvisebebis mixedviT gansxvaveba.
rogoricaa wona, simaRle, temperatura, kanis Seferiloba,
Tavis. Sublis, cxvirisa da yuris forma, saxis sigrZe, sxeulze xalis arseboba. amave dros
SevecadeT yuradReba gagvemaxvilebina adamianis ganviTarebis iseT etapebze, rogoricaa
kbilebis amosvla da siarulis dawyeba.
sul Cvens eqsperimentebSi
monawileobda 18 wyvili monozigoturi tyupi(aqedan 8 wyvili mamrobiTi sqesis da 10 mdedrobiTi ) miRebul SedegebSi gansakuTrebiT mniSvnelovnad miviCnieT Semdegi garemoebebi:
1) 5 monozigoturi wyvilidan TiToeulSi erTerT tyupiscals aucileblad gaaCnda
xali saxeze, rac rogorc
mSoblebisaTvis, aseve tyupebis
naTesavebisa da axloblebisaTvis maTi erTmaneTisagan
garCevis erTerT mniSvnelovan
saSualebas warmoadgenda. Tumca sxva monozigotur wyvilSi xali orives gaaCnda da am
niSniT maTi identifikacia SeuZlebeli iyo. darCenil 12
wyvilSi saxeze xalis arseboba ar SeiniSneboda, magram
tyupebis dedebi yovelTvis
axerxebdnen Svilebis gansxvavebas iseTi niSnebiT rogoricaa sxeulis zoma, Tavis forma, saxis sigrZe, kanis Seferiloba, Tvalebis feri, yurisa da cxviris 50%
forma, an Tundac sxve- 45%
bisTvis naklebad Sesam- 40%
Cnevi sxva niSniT, ix. 35%
30%
sur. 1
2) kvlevis Semdgom 25%
etapze Cven erTmaneTs 20%
SevadareT TiToeuli 15%
tyupiscalis dabadebi- 10%
sas dafiqsirebuli wo- 5%
na da miviReT, rom meo- 0%
2013 weli
sur. 1
red dabadebuli tyupiscalis
wona Warbobda pirvels, Tumca
arc Tu ise iSviaTad maTi wonebi erTmaneTs emTxveoda. ix.
sur. N2
3) rac Seexeba pirveli kbilis amosvlas da siarulis
Tanabaria
17%
meore
tyupiscalis
metia 50%
pirveli
tyupiscalis
metia 33%
sur. 2. wonaTa sxvaoba
dawyebas am mxriv monozigoturi tyupebis did umravlesobaSi pirveli tyupiscali inarCunebda sagrZnob upiratesobas. ix. sur.N3
4) erT-erT monozigotur
wyvilSi (gogonebi) meore tyupis cals aR mo aC n da me sa me
aras ru lad gan vi Ta re bu li
sarZeve jirkvali, romelic
iyo memkvidreobiT miRebuli
rudimenti mamisagan. amave monozigotur wyvilSi dafiqsirda temperaturaTa sxvaoba
pirvelad dabadebul tyupiscalsa da meore tyupiscals
Soris. pirvel tyupiscals
mudmivad hqonda temperatura
– 36, 8 xolo meores –36, 4
5) rac Seexeba sxva niSnebs,
diskonkordantoba SeiniSneboda tyupebis simaRleSic(ZiriTadad 1–2 santimetris farglebSi) magram am niSan-Tvisebis mixedviT arcerT tyupiscals ar gaaCnda upiratesoba,
zogjer meore tyupiscali
iyo 1 sm–iT maRali da zogjer
pirveli, Tumca Tanabari simaRlec ramodenimejer dafiqsirda.
6) rac Seexeba saxis sigrZes, aq erT SemTxvevaSi sxvaobam tyupiscalebs Soris 6 milimetrsac ki miaRwia. xolo
sxva SemTxvevebSi gansxvaveba
iyo 1, 2 an 3 milimetri. aqedan
gamomdinare, Cven gavakeTeT
daskvna, rom namdvilad SemTxveviT ar xdeboda, rom erTerTi monozigoturi tyupebis
deda, romlis Svilebi Zalian
gavdnen erTmaneTs maT swored
saxis sigrZis mixedviT ansxvavebda, maSin roca ucxo TvalisaTvis es erTi SexedviT „advilad SesamCnevi“ gansxvaveba(romelic am SemTxvevaSi 3 mm
SekiTxva dedas: romels amouvida
pirvelad kbili?
pirvel tyupiscals
meore tyupiscals
ar maxsovs
SekiTxva
dedas:
romelma
gaiara
pirvelad?
A. pirvelma
tyupiscalma
B. ar maxsovs
pirvel tyupiscals
meore tyupiscals
ar maxsovs
sur. 3.
C. meore
tyupiscalma
90
aRwevda) ucxo TvalisTvis SeumCneveli iyo.
amrigad, rogorc vxedavT,
monozigotur tyupebSi didi
msgavsebis miuxedavad tyupiscalebs Soris bevri ganmasxvavebeli niSan–Tvisebac arsebobs. zogi maTgani SedarebiT
advili gamosacnobia (vTqvaT
xalis arseboba saxeze an yuris bibilos gansxvavebuli
forma), magram im SemTxvevebSic
ki, rodesac tyupiscalebs Soris konkordantoba Zalian didi iyo, tyupebis dedebi mainc
iolad axerxebdnen maTi erTmaneTisagan gansxvavebas. Tumca
isic unda iTqvas, rom sxva oja-
xebis monozigoturi tyupebSi
gansxvavebis povna maTTvis iseTive problema aRmoCnda, rogorc sxva adamianebisaTvis..
da bolos, Cvens mier nanaxi
mutacia – mesame ganuviTarebeli sarZeve jirkvali erTerTi
tyupiscalis epigastriumis
areSi sainteresoa im mxrivac,
rom tyupis–cals es uCveulo
ru di men tu li ni Sa ni ma mis
mxridan gadaeca da ara dedidan, rac kidev erTxel miuTiTebs imaze, rom tyupebis biologiis Rrmad SeswavlaSi
sxva mniSvnelovan biologiur
movlenebTan erTad didi mniSvneloba eniWeba rogorc saku-
Tar organizmSi, aseve maT
mSoblebSi mimdinare epigenetikur procesebs, gansakuTrebiT ki genomur impritings.
literatura
Mathew W, Dykens E. M————
-“Genetics of childhood disorders”,
2010
Alberts and at all—“Molecular Biology of the cell” 2006
Nino Khvitia, G. Shatirishvili—‘Medical Biology” 2011
M. Chipashvili, E. Imnadze———
-“Secret of Genomic impriting and reality”
SOCIAL, ECOLOGICAL AND
CLINICAL PEDIATRICS -20012,
TBILISI
reziume
monozigotur tyupebSi niSan-TvisebaTa gansxvavebis
zogierTi Taviseburebani
d. cxomeliZe, m. abisonaSvili, b. ruxaZe, d. CaxunaSvili, v. ozaSvili
kvlevis mizani iyo dagvedgina postnatalur periodSi monozigotur tyupiscalebs Soris
iseTi niSan –Tvisebebis mixedviT gansxvaveba. rogoricaa wona, simaRle, temperatura, kanis Seferiloba, Tavis. Sublis, cxvirisa da yuris forma, saxis sigrZe, sxeulze xalis arseboba. amave dros SevecadeT yuradReba gagvemaxvilebina adamianis ganviTarebis iseT etapebze, rogoricaa kbilebis amosvla da siarulis dawyeba.
monozigotur tyupebSi didi msgavsebis miuxedavad tyupiscalebs Soris bevri ganmasxvavebeli niSan–Tvisebac arsebobs. zogi maTgani SedarebiT advili gamosacnobia (vTqvaT xalis arseboba saxeze an yuris bibilos gansxvavebuli forma), magram im SemTxvevebSic ki, rodesac tyupiscalebs Soris konkordantoba Zalian didi iyo, tyupebis dedebi mainc iolad axerxebdnen maTi erTmaneTisagan gansxvavebas. Tumca isic unda iTqvas, rom sxva ojaxebis monozigoturi tyupebSi gansxvavebis povna maTTvis iseTive problema aRmoCnda, rogorc sxva adamianebisaTvis.
nanaxi mutacia–mesame ganuviTarebeli sarZeve jirkvali erTerTi tyupiscalis epigastriumis areSi sainteresoa im mxrivac, rom tyupis–cals es uCveulo rudimentuli niSani mamis
mxridan gadaeca da ara dedidan, rac kidev erTxel miuTiTebs imaze, rom tyupebis biologiis Rrmad SeswavlaSi sxva mniSvnelovan biologiur movlenebTan erTad didi mniSvneloba eniWeba rogorc sakuTar organizmSi, aseve maT mSoblebSi mimdinare epigenetikur procesebs, gansakuTrebiT ki genomur impritings.
SUMMARY
SOME PECULIARITIES OF DIFFERENT TRAITS IN
MONOZYGOTIC TWINS
D. TSKHOMELIDZE, M. ABISONASHVILI, B. RUKHADZE, D. CHAKHUNASHVILI, V. OZASHVILI
(TSMU)
The aim of our research was to find the differences between single monozygotic twins by different signs, for example
weight at birth, height, form of head, nose, ear, length of face, color of skin, developing birth mark on the body and so on.
At the same time we established one strange rule for monozygotic twins: The first one (who was born first) more often
begins walking earlier compared to the second one and the same process was going on with first teeth appearing. To consider problems of epigenetics and genomic impriting in future we have to find some interesting exceptions:
1 ) The single monozygotic twin(girl) with an undeveloped lachrymal gland was located in the epigastric area of the
body and it was inherited to daughter from father.
2) We established that some single twins are different from each other by length of face(maximum in our case was- 6
mm) and the mother of these twins can distinguish between them by this sign. But at the same time she is unable to catch
the difference between the other monozygotic twins.
2013 weli
91
epidermuli zrdis faqtoris eqspresia adamianis
endometriumis hiperplaziisa da karcinomis dros
n. ZnelaSvili a. mariamiZe d. kasraZe a. TavarTqilaZe
daviT tvildianis saxelobis samedicino universiteti paTologiis departamenti
epidermuli zrdis faqtori 1962 wels iqna
gamoyofili. mraval sxva efeqtTan erTad epidermuli zrdis faqtori (EGF) aaqtivebs sakvercxis granulozuri ujredebis proliferacias da aferxebs maT diferenciacias, aseve Trgunavs maTSi progesteronis, estradiolis da inhibinis promocias; is aaqtivebs placentis kultivirebuli trofoblastis ujredebis proliferacias, magram ara maT diferenciacias; aseve is aCqarebs embrionis ganviTarebas; is xels
uwyobs sarZeve jirkvlis ujredebis proliferacias da aferxebs maT diferenciacias; aseve epidermuli zrdis faqtori gavlenas axdens
saSvilosnos endometriumze. mas SeuZlia iyos
sinergizmSi estradiolTan /7/, estrogeni astimulirebs EGF-is sinTezs endometriumSi /5/. rac
metia estrogenis Semcveloba plamaSi, miT metadaa gamoxatuli endometriumis proliferacia, izrdeba epidermuli zrdis faqtoris aqtivobac da misi receptorebis eqspresiac /5/.
Tumca EGF-s SeuZlia imoqmedos damoukidebladac /7/ da awarmoos epiTeluri ujredebis
zrdis stimulacia /7/. EGF riskis matarebelia
simsivneebis paTogenezSi, Sesabamisad – misi receptoris daTrgunva Seamcirebs simsivneebis
ganviTarebis SesaZleblobas. EGFr -is maRali
done endometriumis karcinomebSi korelaciaSia histologiurad cud diferenciaciasTan,
- dabaldiferenciaciasTan /12/.
CvenTvis saintereso iyo epidermuli zrdis
faqtoris eqspresiis Seswavla endometriumis
hi perplaziissa da karcinomis SemTxvevaSi.
klinikurad da morfologiurad SeviswavleT 45 pacienti, maT Soris iyo reproduqciuli asakisa (27-45 ww) 27 pacienti, romelTac
aReniSneboda menstrualuri ciklis darRveva, gamovlenili menometroragiiT; aseve – preklimaqteruli asakis 8 pacienti, araregularuli menstrualuri cikliT da disfunqciuri
sisxldenebiT (klinikuri kvlevebiT (endovaginaluri eqoskopia) dadiagnozda endometriumis hi perplazia, rac vlindeboda metroragiiT) da 10 pacienti postmeonopauzuri periodis sisxldeniT.
morfologiuri kvlevisTvis masala miRebuli iqna endometriumidan gamonafxekis saxiT.
vawarmoeT histologiuri da imunohistoqimiuri kvlevebi.
morfologiuri masalis fiqsacia moxda 4%
neitralur buferul formalinSi, 24 sT ganmavlobaSi da Semdgom Cayalibebul iqna parafinSi. 4 mkm-is sisqis anaTlebi davakariT polyL-lysine–iT dafarul minebze. anaTalebis nawili SevRebeT hematoqsiliniT da eoziniT
2013 weli
(H&E) _ histologiuri preparatebis misaRebad.
imunohistoqimiuri kvlevisTvis pirvelad anitisxeulad gamoyenebuli iqna anti-EGFR (Novocastra; Leica biosystems Newcastle ltd, UK). movaxdineT
anaTlebis deparafinizacia da 3% hidrogenperoqsidaziT davamuSaveT (10 wT) - endogenuri
peroqsidazis blokirebisaTvis. antigenis aRdgena vawarmoeT 0. 01MM citratul buferSi da
gavaciveT 20 wT-s ganmavlobaSi. Semdeg gavrecxeT trifosfatur buferSi (Tbs) (5 wT). movaxdineT inkubacia protein blokiT 5 wT-is
ganmavlobaSi. gavrecxeT Tbs-Si (2 x5 wT). vawarmoeT inkubacia anti-EGFR, ganzavebiT 1:50, 60 wuTis ganmavlobaSi 250C-ze. gavrecxeT Tbs-Si (2
x 5 wT). vawarmoeT inkubacia Post primary block, 30
wT-is ganmavlobaSi. gavrecxeT Tbs -Si (2 x 5 wT).
movaxdineT inkubacia Novo Link Polimer, 30 wT-is
ganmavlobaSi. gavrecxeT Tbs-Si (2 x 5 wT). peroqsidazas aqtivacia movaxdineT diaminobenzidinis samuSao xsnariT, 5 wT-s ganmavlobaSi.
gavavleT wyalSi da birTvebi SevRebeT hematoqsiliniT (5 wT).
hi perplaziis ti pis Sefaseba moxda histologiur preperatebze dayrdnobiT. ganvsazRvreT misi klinikur-morfologiuri varianti.
imunohistoqimiuri kvleviT gamovavlineT
epidermuli zrdis faqtoris SeRebvis intensivoba da misi gavrceleba. intensivoba fasdeboda: (++) intensiuri (mkveTri) SeRebva, (+) zomieri SeRebva, (+/_) susti SeRebva (Niikura at al.,
1996, mixedviT) da gamovsaxeT procentebSi. EGFisGgavreceleba dadginda pozitiuri EGF-imunoreaqtiulobis SefasebiT jirkvlovan epiTeliumSi da stromaSi /6/. miRebuli ricxobrivi monacemebi damuSavda statistikurad SPS12 –is gamoyenebiT. SedarebisTvis gamoyenebu-
sur. 1. endometriumi. martivi hiperplazia atipiis gareSe. H&EX10
92
li iqna normis miRebuli standarti (Niikura at
al., 1996, mixedviT, normul endometriumSi EGF-is
susti eqspresia vlindeba 66, 7%-Si, amasTan, gavrcelebis TvalsazrisiT, EGF-imunoreaqtiuloba pozitiuria mxolod jirkvlovan epiTeliumSi da negatiuri stromul ujredebSi).
miRebuli Sedegebi
reproduqciuli asakis 27 pacientidan 13-Si
gamovlinda endometriumis martivi hi perplazia
ati piis gareSe, kompleqsuri hi perplazia ati piis gareSe aRmoCnda 13 pacientSi, kompleqsuri hi perplazia ati piiT ki - 1 pacientSi;Ppreklimaqsuri asakis 8 pacientidan 6-Si gamovlinda martivi hi perplazia ati piis gareSe,
xolo kompleqsuri hi perplazia ati piis gareSe - 2 pacientSi. saerTo jamSi, 35 pacientidan
19-Si aRiniSna martivi hi perplazia ati piis gareSe (sur. 1), 15 pacientSi - kompleqsuri hi perplazia ati pis gareSe (sur. 2) da 1 SemTxvevaSi - kompleqsuri hi perplazia ati piiT (sur. 3).
miRebuli Sedegebis mixedviT epidermuli
zrdis faqtoris intensivoba gamovlenilia pacientebis 100%-Si. aqedan susti eqspresia (sur.
4) gamovlenilia pacientebis 42%-Si (p>0. 1)., xolo mkveTri eqspresia (sur. 5) - pacientTa 58
%-Si (p<0. 1)., amasTan, EGF-imunoreaqtiuloba nanaxi iqna endometriumis jirkvlovan epiTeliumSi rogor martivi, ise kompleqsuri hi perplaziis SemTxvevaSi.
endometriumSi martivi hi perplaziis dros
EGF vlindeba sxvadasxva intensivobiT, magram
ufro metad, anu 19-dan 11 pacientSi (57. 8%-Si)
EGF sustad vlindeba (p<0. 01); 8 pacientSi ki
(42. 1%-Si) EGF mkveTradaa gamovlenili (p<0. 1).
endometriumSi kompleqsuri hi perplaziis (ati piis gareSe) dros EGF vlindeba rogorc
susti, ise mkveTri intensivobiT: 15 pacientidan
8-Si. (53. 3%-Si) EGF gamovlinda mkveTri intensivobiT (p<0. 01), 6 pacientSi. (40 %-Si) EGF vlindeba susti intensivobiT (p<0. 1), xolo 1 pacientSi. (6, 6%-Si) - rogorc mkveTri, ise susti
intensivobiT (p>0. 1), endometiurmSi kompleqsuri hi perplaziis (ati piiT) dros ki (anu ati puri hi perplaziis dros, - marTalia, sul 1 SemTxveva gvqonda) EGF vlindeba mkveTri intensivobiT. Cvens mier gamokvleuli endometriumis
karcinomebSi ( 100%) intensivoba mkveTria.
maSasadame, sakuTari kvlevebis Sedegebis Tanaxmad, SegviZlia davaskvnaT, rom endometriumis martiv hi perplaziaSi mniSvnelovnad Warbobs EGF-is susti eqspresia, xolo kompleqsur
hi perplaziaSi – ufro metad vlindeba EGF-is
mkveTri eqspresia; amasTan, hi perplaziis simZimis mixedviT EGF-is SeRebvis intensivoba matulobs da endometriumis simsivneebSi yovelTvis vlindeba mkveTri eqspresia.
sainteresoa, am mxriv sxva avtorTa monacemebis ganxilva:
epideruli zrdis faqtori unda iyos mediatori endometriumSi estrogenis moqmedebisTvis /2/. EGF-s SeuZlia iyos sinergizmSi estradiolTan, mas damoukideblad ar ZaluZs uj-
sur. 2. endometriumi. Kkompleqsuri hiperplazia atipiis gareSe. H&E. X10
redebis proliferaciaze imoqmedos, magram estradiolTan kombinaciaSi igi maRla swevs
jirkvlebis ujredebSi gamravlebis xarisxs (
50%), rac ar xdeba stromul ujredebSi (in vivo) /1/. aseve dadgenilia, rom menstrualuri
ciklis proliferaciuli faza ZiriTadad gaSualebulia estrogeniT. estrogenis recepto-
sur. 3.
H&E X10
endometriumi. endometriumis karcinoma.
rebi mniSvnelovnad ikargeba epiTeliumze, mas
Semdeg rac progesteronis eqspozicia iwyeba
/7, 5/. aranakleb sainteresoa is faqti, rom EGFis stimulacia midis arapirdapirad estrogenis receptoris aqtivaciamde da receptoris
daRmavali mimarTulebiT (downstreem) samiznes
eqspresiamde, EGF-s SeuZlia gaaSualos epiTeluri ujredebis proliferacia endometriumSi adreuli folikuluri fazis mimdinareo-
sur. 4 pozitiuri EGF X40-imunoraqtiuloba jirkvlovan epiTeliumSi endometriumis martivi hiperplaziis (atipiis gareSe) dros, zomieri intensivoba (+).
2013 weli
93
leobdes diferenciaciaSic! - da Tu neoplazia iwyeba an kidev avTvisebiani zrda progresirebs – iqneb imitom, rom EGF cotaa, an kidev
iqneb imitomaa cota, rom rac SeiZleba `xeli
SeuSalos” neoplaziis progresias. vfiqrobT
Semdgomi kvlevebi – SratSi EGF-isa da melatoninis (anti proliferacili da antineoplaziuri efeqtebis mqone universaluri hormoni)
Semcvelobis gamosavlenad rogorc saSvilosnos lorwovani garsis hi perplaziebSi, ise simsivneebSi, naTels mohfens Cvens varauds.
sur. 5 pozitiuri EGF X40-imunoraqtiuloba jirkvlovan epiTeliumSi endometriumis kompleqsuri hiperplaziis (atipiis gareSe) dros, mkveTri mkveTri (++).
baSi - roca estradiolis done aris sazogadod Zalian dabali /7/. igive avtoris azriT,
moproliferacie endometriumSi, anu normaSi
– EGF-r-is (epidermuli zrdis faqtoris receptoris) eqspresia ufro maRalia, vidre emndometriul karcinomebSi. Tumca sxva kvlevebi
gvaCvenebs, rom EGF-r-is maRali eqspresia nanaxia xSirad endometriaul karcinomebSi /12/.
mniSvnelovania is faqti, rom endometriumSi
EGF-is moqmedebisTvis saWiroa sasqeso steroidebi, aseve - am steroidebs funqciis gaSualebisTvis sWirdebaT epidermuli zrdis faqtori /3/. simsivnur procesebSi ki, gamoTqmulia
mosazreba, rom EGF-r-is arseboba araa kavSirSi avTvisebianobis xarisxTan Tu prognozTan,
sasqeso hormonebis donesTan, estrogenebis da
progesteronis receptorebis (ER, PR) arsebobasTan. imunohistoqimiurad: EGF-r araa korelaciaSi simsivnis xarisxTan, stadiasTan, sicocxlis xangrZlivobasTn / 14 /. 10, 9 / avtorisA monacemebiT SesaZloa EGF-r-s hqondes
prognozuli mniSvneloba, Tu gaviTvaliswinebT
mosazrebas, rom EGF-r-is maRali eqspresia korelaciaSia histologiurad cud diferenciaciasTan – dabal diferenciaciasTan, Tumca
sxva kriteriumebTan (daavadebis stadia, limfur kvanZebSi invazia) ar aris korelacia. asevea endometriul sarkomebSic: dabaldiferencirebul sarkomebSi 74%-ASi aRiniSna receptoris HER1-is eqspresia (esaa igive EGF-r), xolo aradiferencirebul SemTxvevaSi - ar aRiniSneba / 13/. sainteresoa, am dros, EGF-is saSualo done plazmaSi: – igi yvelaze maRalia
saSualo diferenciaciis karcinomebSi, xolo
dabalia cudad diferencirebul karcinomebSi; maCvenebeli Zalian dabalia sarkomis 2 SemTxvevaSi /11/.
Ddabolos: sakuTari Tu sxva avtorTa monacemebze dayrdnobiT SegviZlia vivaraudoT,
rom: EGF-is dabali Semcveloba SratSic da endometriumis qsovilSic – xom ar niSnavs cud
prognozs?! gamovTqvamT mosazrebas, rom rogorc Cans, garkveul etapze – garkveul koncentraciaSi EGF-s aqvs aramarto proliferaciis ‘’daniSnuleba’’, aramed SesaZloa monawi2013 weli
literatura:
1. Blaustein A., Kurman R. J. Blaiustein’s pathology of the
female genital tract. 5thedition. – Springer, 2002. – 1391 p.
2. Haining R. E. B., Cameron I. T., van Papendorp C. et
al. Epidermal growth factor in human endometrium: proliferative effects in culture and immunocytochemical localization in normal and endometriotic tissues // Hum Reprod.
– 1991. – Vol. 6, No. 9. – P. 1200-1205
3. Ishihara S., Taketani Y., Mizuno M. Epidermal growth factor-like immunoreactivity in human endometrium // Asia
Oceania J Obstet Gynecol. – 1990. – Vol. 1, No, 2. – P. 165-168.
4. Leone M., Costanitini C., Gallo G. et al. Role of growth
factors in the human endometrium during aging. // Maturitas. – 1993. – Vol. 16, No. 1. – P. 31-38.
5. McBean J. H., Brumsted J. R., Stirewalt W. S. In vivo Estrogen Regulation of Epidermal Growth Factor Receptor in Human Endometrium // J Clin Endocrinol Metabol. –
1997. – Vol. 82, No. 5. – P. 1467- 1471.
6. Niikura H., Sasano H., Kaga K. et al. Expression of epidermal growth factor family proteins and epidermal growth
factor receptor in human endometrium // Human Pathology.
– 1996. – Vol. 27, Issue 3. – P. 282-289.
7. Santoro N. Amenorrhea: A case-Based, Clinical Guide.
– Springer, 2010. – 218 p.
8. Singer G. A., Stowitzki T., Retting I., Kimming R. Flow
cytometric detection and binding studies of human endometrial stromal cell growth factor receptor in monolayer culture: influence of progesterone // Hum Reprod. – 1998. – Vol.
4, No. 6. – P. 577-583.
9. Grimbizis G., Tsalikis T., Tzioufa V. et al. Regression of
endometrial hyperplasia after treatment with the gonadotropinreleasing hormone analogue triptorelin: a rospective study // Oxf
J Med Hum Reprod. – 1999. – Vol. 14 (2). – P. 479-484.
10. Gershtein E. S., Bocharova L. B., Ermilova V. D. et
al. Epidermal growth factor receptors and their ligands in endometrial carcinoma: correlation with clinici-morphological
factors and steroid receptors // Vopr Onkol. – 2000. – Vol. 46,
No. 2. – P. 180-186.
11. Tomaszewski J., Miturski R., Kotarski J. Concentracion og epidermal growth factor (EGF) in serum of women
with endometrial cancer // Ginekol Pol. – 1996. – Vol. 67,
No. 5. – P. 248-253.
12. Oza A. M., Eisenhauer E. A., Elit L. et al. Phase II Study
of Erlotinib in Recurrent or Metastatic Endometrial Cancer:
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P. 4319-4325.
Endometrial Stromal Sarcomas Frequently Express Epidermal Growth Factor Receptor (EGFR, HER-1): Potential
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Am J Obstet Gynecol. – 1989. – Vol. 160 No. 1. – P. 126-131
94
reziume
epidermuli zrdis faqtoris Eeqspresia adamianis endometriumis
hi perplaziisa da karcinomis dros
n. ZnelaSvili a. mariamiZe d. kasraZe a. TavarTqilaZe
daviT tvildianis saxelobis samedicino universiteti, paTologiis departamenti
epidermuli zrdis faqtoris eqspresiis intensivoba, adamianis endometriumis hi perplaziisa da
karcinomis dros, Cveni interesis sagans warmoadgens. klinikurad da morfologiurad SeviswavleT 45 pacienti; maT Soris - reproduqciuli asakisa (27-45 ww) 27 pacienti, romelTac aReniSneboda menstrualuri ciklis darRveva, gamovlenili menometroragiiT; aseve - preklimaqsuri asakis 8 pacienti, araregularuli menstrualuri cikliT da disfunqciuri sisxldenebiT da 10 pacienti postmeonopauzuri periodis sisxldeniT. klinikuri kvlevebiT (endovaginaluri eqoskopia) dadiagnozda endometriumis hi perplazia, rac vlindeboda metroragiiT morfologiuri kvlevisTvis masala miRebuli iqna endometriumidan gamonafxekis saxiT. vawarmoeT histologiuri da
imunohistoqimiuri kvlevebi. miRebuli ricxobrivi monacemebi damuSavda statistikurad programa SPSS-12–is gamoyenebiT. kvlevis Sedegebis mixedviT, epidermuli zrdis faqtoris eqspresia dadginda pacientTa 100%-Si. aqedan EGF-is susti eqspresia gamovlenilia pacientebis 42%-Si, xolo mkveTri eqspresia - pacientTa 58 %-Si; amasTan, EGF-imunoreaqtiuloba nanaxi iqna endometriumis jirkvlovan epiTeliumSi rogorc martivi, ise kompleqsuri hi perplaziis SemTxvevaSi. endometriumSi
martivi hi perplaziis dros EGF vlindeba sxvadasxva intensivobiT, magram ufro metad, anu 19-dan
11 pacientSi (57. 8%-Si) EGF vlindeba susti intensivobiT (p<0, 01); 8 pacientSi ki (42.1%-Si) EGF mkveTri intensivobiTaa gamovlinili (p<0. 1), endometriumSi kompleqsuri hi perplaziis (ati piis gareSe)
dros EGF vlindeba rogorc susti, ise mkveTri intensivobiT: 15 pacientidan 8-Si (53, 3%-Si) EGF mkveTradaa gamovlenili (p<0, 01), 6 pacientSi (40%-Si) EGF sustadAD vlindebaA(p<0, 1), xolo 1 pacientSi
(6, 6%-Si) – aRiniSneba EGF-is rogorc mkveTri, ise susti intensivoba (p>0. 01), endometiurmSi kompleqsuri hi perplaziis (ati piiT) dros ki (anu ati puri hi perplaziis dros, - marTalia, sul 1 SemTxveva gvqonda) EGF mkveTri intensivobiT vlindeba. amasTan, EGF-imunoreaqtiuloba nanaxi iqna endometriumis jirkvlovan epiTeliumSi rogor martivi, ise kompleqsuri hi perplaziis SemTxvevaSi.
kvlevis Sedegebis mixedviT SesaZloa davaskvnaT, rom endometriumis martiv hi perplaziaSi mniSvnelovnad Warbobs EGF-is susti eqspresia, xolo kompleqsur hi perplaziaSi – ufro metad vlindeba EGF-is mkveTri eqspresia; amasTan, hi perplaziis simZimis mixedviT EGF-is SeRebvis intensivoba matulobs da endometriumis karcinomaSi vlindeba mkveTri intensivoba.
sakvanZo sityvebi: epidermuli zrdis faqtori, endometriumis hi perplazia, endometriumis
karcinoma, imunohistoqimia
SUMMARY
EPIDERMAL GROWTH FACTOR EXPRESSION IN ENDOMETRIAL
HYPERPLASIA AND CARCINOMA
N. DZNELASHVILI, A. MARIAMIDZE, D. KASRADZE, A. TAVARTKILADZE
Department of Pathology, Davit Tvildiani Medical University.
Abstract.
The intensity of Epidermal Growth Factor Expression in endometrial hyperplasia and carcinoma was the focus of our
study.
35 patients have been investigated clinically and morphologically; of them 22 patients of reproductive age (27-44) had menstrual cycle disorders and diagnosed menometrorrhagia; 8 patients of preeclamptic gestational age had irregular menstrual cycle
and dysfunctional uterine bleeding;10 patients of postmenopausal period with uterine bleeding. Clinical examination (endovaginal endoscopy) revealed endometrial hyperplasia manifested by metrorrhagia; For morphological study the material was collected by endometrial scrap. Histologic and immunohistochemical studies were performed as well. The numeric data obtained were
processed statistically using the SPSS-12 program. Based on the results, expression of epidermal growth factor was diagnosed in
100% of the patients. Of them, mild EGF expression was documented in 51, 4%, while sharp EGF expression – in 48, 4% of patients. With that, EGF -immunoreactivity was observed in endometrial glandular epithelium both in simple and complex hyperplasia. In simple endometrial hyperplasia EGF was expressed with different intensity, however in most cases, i. e. in 11 out of 19
patients (57. 8%) EGF was expressed with low intensity (p>0. 01); in 8 patients (42. 1%) high intensity of EGF expression was
revealed. In complex endometrial hyperplasia EGF was expressed both with low and high intensity: in 8 patients out of 15 (53.
3%) EGF was sharply expressed (p>0. 01), 6 patients (40%) showed mild EGF expression(p>0. 01), whereas 1 patient revealed
both low and high intensity of EGF expression. In complex endometrial hyperplasia (only one case of atypical hyperplasia), EGF
was revealed with high intensity. Additionally, EGF –immunoreactivity was observed in endometrial glandular epithelium in simple and complex hyperplasia. The results of the study suggest that in complex hyperplasia mild EGF expression predominates, while sharp EGF expression is mostly typical of complex hyperplasia. At the same time, EGF staining intensity increases with the severity of hyperplasia. With endometrial carcinoma, a drastic intensity of EGF expression is observed.
Key words: Epidermal Growth Factor, Endometrial Hyperplasia, Endometrial Carcinoma, Immunohistochemistry.
2013 weli
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leikocitozis warmoSobis meqanizmebi
klinikur praqtikaSi
av. kvezereli-kopaZe, i. xizaneiSvili
pediatriis instituti, alergiisa da revmatologiis centri
leikocitebi, sisxlis TeTri ujredebi. leikocitebis normebi mozrdilebSi — 4, 0* 10—
11. 0*10/l. > 11, 0*10/l —leikocitozi. <4,
0*10/l—leikopenia.
leikocitozis warmoSobis 4 koncefcia: 1)
baqteriuli endotoqsinebi (baqteriuli li popolisaqaridebi, igive ekzogenuri pirogenebi), isini an Tavad gvevlinebian kmf-d an aqtiurad anTavisufleben maT qsovilebidan (kmf—
koloniamastimulirebeli faqtorebi — leikopoezis humoraluri stimulatorebi, uzrunvelyofs granulo, eriTro, mono, limfocituuri rigis winapari ujredebis koloniebis zrdas qsovilovan kulturaSi, gamomuSavdeba
Zvlis tvinis da sisxlis monocitebisa da makrofagebisa, aseve elenTis limfocitebSi). 2)
leikocitozis ganviTarebas iwvevs leikocitebis daSlis produqtebi, isini gvevlinebian
leikocitarul kmf — ed. 3) glukokortikoidebi, maT gareSe faqtiurad wydeba mielopoezi, isini aucilebeli nivTierebaa kmf-s gaaqtiurebisaTvis!!!!!! 4)qsovilovani ujredebisagan
ganTavisuflebuli peptidebi, igive koloniamastimulirebeli faqtorebi. mniSvnelovania
oTxive koncefcia, saWiroa gairkves, romeli meqanizmia wamyvani ama Tu im SemTxvevaSi. oTxive meqanizmi faqtiurad damokidebulebaSia erTmaneTTan.
leikocitozis ganviTarebis sqema: hi poalamusis aqtivacia hi pofizis aqtivacia Tirkmelzeda jirkvlis qerqis gaaqtiureba kortizolis pirdapiri zemoqmedeba Zvlis tvinze kmf-s damxmare moqmedeba _ granulopoezis
gaaqtiureba- neitrofiluri leikocitozi.
leikocitozis paTogenezSi CarTulia
yvela rgoli, Tumca romelime maTgani metad
aqtiurad, erTerTi rgolis amovardnas SesaZlebelia mohyves leikopoezis daTrgunva,
rac klinikur maCveneblebTan mimarTebaSi
araadeqvatur suraTs Seqmnis, praqtikosi
eqimis klinikuri azrovneba mxolod Tu
gadawyvets
daavadebis
mimdinareobas,
gamosavals, etiologias da mkurnalobis
Taviseburebebs.
reziume
leikocitozis warmoSobis meqanizmebi
klinikur praqtikaSi
av. kvezereli-kopaZe i. xizaneiSvili,
pediatriis instituti, alergiisa da revmatologiis
centri leikocitozis paTogenezSi CarTulia yvela rgoli, Tumca romelime maTgani metad
aqtiurad, erTerTi rgolis amovardnas SesaZlebelia mohyves leikopoezis daTrgunva, rac
klinikur maCveneblebTan mimarTebaSi araadeqvatur suraTs Seqmnis, praqtikosi eqimis
klinikuri azrovneba mxolod Tu gadawyvets daavadebis mimdinareobas, gamosavals, etiologias da mkurnalobis Taviseburebebs.
SUMMARY
THEORY AND MECHANISMS OF LEUKOCYTOSIS
IN CLINICAL PRACTICE
AV. KVEZERELI-KOPADZE, I. KHIZANEISHVILI
Institute of Pediatry, Center for Allergy and Rheumatology
All the above mentioned steps are involved in leukocytosis, and absence each step may inhibit process of leukopoiesis,
which will result in abnormal clinical manifestation. The outcome, etiology and treatment options are based on clinician’s
ability to correctly interpret each clinical case.
2013 weli
96
XI samecniero-praqtikuli konferenciaze miRebuli rezolucia:
,,kvebis obieqtebi, mwarmoeblebTan erTad aqtiurad Caebnen
moZraobaSi ,,jansaRi kveba BbavSvebs"” sruldeba ,,apipuri" _
aminomJavebiT, vitaminebiTa da mineralebiT gamdidrebuli puri"
k. CaxunaSvili, S. iusupovi, i. kalandia, n. jobava, n. badriaSvili,
n. TofuriZe, g. CaxunaSvili z. SaqaraSvili, k. kokaia
(socialuri pediatriis dacvis fondi, S. p. s. `puri“(Tbilisi)
yoveldRiuri da yvelasaTvis xelmisawvdomi iafiFsakvebi produqti àpi puri”. gamdidrebulia janmTelobisaTvis aucilebeli aminomJavebiT, vitaminebiT da mineralebiT. axali teqnologiiT damzadebuli puri saqarTveloSi
Seamcirebs masiurad gavrcelebul vitaminebis,
aminomJavebisdami kroelementebis deficitiT
gamowveul daavadebebs. saqarTveloSi puris
moxmareba sakmarisze ufro maRalia. samwuxarod, dReisTvissaqarTveloSi puri ZiriTadad iseTi fqvilisgan cxveba, romelic mikronutrientebis Semcvelobis erovnul standartebs ar Seesabameba. puri asakis, sqesis da moxmarebis sixSiris mixedviT unikaluri produqtia; izrdeba premialuri jansaRi produqtis
wili; etapobrivad xdeba bazris segmentacia
SefuTvis, dizainis xarisxis da moxmarebis gamartivebis mixedviT. bazarze gaizarda adgilobrivad warmoebuli xorblis fqvilisagan
damzadebuli puris jamuri simZlavre. gaizarda moTxovnileba vitaminebiT da mineralebiT
gamdidrebul purze. sadReisod bazarze arsebuli vitaminebiT da mineralebiT gamdidrebuli pureulis raodenoba da Semadgenloba ver akmayofilebs moTxovnilebas. Catarebuli kvlevis Sedegebis mixedviT zogadad dadginda,
rom puris nimuSebis mxolod 24. 9 % iyo Sesabamisad fortificirebuli, rac ar aris sakmarisi mosaxleobaSi mikronutrientebis deficitis SemcirebisTvis. Cveni teqnologiiT
damzadebuli puri, gamdidrebuli janmTelobisaTvis aucilebeli aminomJavebiT, vitaminebiT da mineralebiT unikaluri da maRalmoTxovnadia. Cven gmaokvlevebze dayrdnobiT
àpi puri“-s momxmarebeli mosaxleobis farTo
fenaa. specifiurad ki, ZiriTadi myidveli da
momxmarebeli - bavSvi, xandazmuli adamiani da
sportsmenia. vinaidan, polideficits yvelaze
metad aRniSnuli kategoria ganicdis. S. p. s.
`puri” da socialuri pediatriis dacvis fondi, winaswari analizis datestirebis Semdeg,
uzrunvelyofen puri - àpi puri”-s srul warmoebas da biologiurad aqtiuri bunebrivi danamatis suspenziis Semadgenlobis daxvewas,
licenzirebas da produqciis farTomasStabian gamoSvebas. yovelTviurad gaizrdeba puris
warmoebis moculoba da wlis bolos miaRwevs daaxloebiT 150 000 cal purs erT TveSi. gaizrdeba sawarmos Semosavlebi 15%-iT. àpiviti” mzaddeba unikaluri Tvisebebis mqone qarTuli (kavkasiuri) futkris produqtebis nazaviT. ase, rom proeqtis mTavari mizani iqneba,
DdamuSavdes da daixvewos biologiuri aqtiuri
danamatis optimaluri Semadgenloba, rac mogvcems mosaxleobaSi janmrTelobis mdgomareobis maqsimalur gaumjobesebas mikroelementebis, vitaminebis da aminmJavebis deficitis mxriv. aseve, Cveni biologiurad aqtiuri danamatis Semadgenlobis daxvewa gazrdis puris
Senaxvis vadas, rac mogvcems àpi puri”-is produqtis eqsportis saSualebas mezobel qveynebSi. SemdgomSi vapirebT àpiviti”-is suspenziaSi antiseptikuri Tvisebebis gazrdiT miviRoT
bunebrivi konservanti. romelic gamoyenebuli
iqneba sxva kvebis produqtebis warmoebaSi. momavalSi, daxvewis Semdeg, biologiurma danamatma aseve SeiZleba Caanclos sinTezuri qimiuri konservantebi, romlebiC sakmaod didi raodenobiT gamoiyeneba produqciaSi.
yoveldRiuri da yvelasaTvis xelmisawvdomi iafiFsakvebi produqti àpi puri”. gamdidrebulia janmTelobisaTvis aucilebeli aminomJavebiT, vitaminebiT da mineralebiT. igi Seamcirebs masiurad gavrcelebul vitaminebis, aminomJavebis da mikroelementebis deficitiT gamowveul daavadebebs. Mmosaxleobis farTo
fenebis kvebis racionSi sakmaodaa gavrcelebuli mikonutrientebis deficiti romelic
mravali daavadebis sawindaria. cilovan-energetikuli deficiti (zrdaSi CamorCena) bavSvTa da mozardTa asakSi, janmo-sbavSvis zrdis
standartTan (2.3%) SedarebiT, statistikurad
mniSvnelovnad aris momatebuli. Edeficituri mdgomareobaxSirad Tavs spotsmenebSic
iCens, sadac umniSvnelovanes problemas mwvave da qronikuli gadaZabva da misi profilaqtika warmoadgens. janmrTelobis msoflio organizaciis bavSvis zrdis standartis mixed2013 weli
viT zrdaSi CamorCenis nebismieri maCvenebelisagan gaSoa da Sesabamisi reagirebisa da kvebisa da janmrTelobis programis ganxorcielebis safuZvels warmoadgens. janmo-smier mier aRiarebuli unikaluri programa - yoveldRiurad yvelasaTvis xelmisawvdomi sakvebi produqtis - puris Tundac rkiniT gamdidreba,
saqarTveloSi Seamcirebs anemiiT gamowveul
daavadebebs. kvlevis Sedegebis mixedviT zogadad dadginda, rom puris nimuSebis mxolod
24,9% iyo Sesabamisad fortificirebuli, rac
ar aris sakmarisi mosaxleobaSi mikronutrientebis deficitis SemcirebisTvis. komerciul
sacxobebsa da Sinameurneobis pirobebSi puris
gamosacxobad gamoyenebuli xorblis fqvilis umetesobaa nariyorkiniT gamdidrebuli, an
arasakmaris rkinas Seicavda. amgvari mdgomareoba yvela regionSi gamovlinda. aRsaniSnavia, rom radgan rkinax Sirad sxva mikroelementebiT Sesabamisi fortifikaciis maCvenebelia da radgan qarTuli puri rkiniT ar aris
sakmarisad fortificirebuli, SegviZlia davaskvnaT, rom puri sxva elementebs, maT Soris foliumis mJavasac, arasakmarisad Seicavs. aRarafers vambob TvitaminebiT gamdidrebaze. aRniSnuli problemis gadawvetas moemsaxureba yvelasaTvis xelmisawvdomi iafi sakvebi produqtis puri - àpi puri”-s warmoeba.
yoveldRiuri da yvelasaTvis xelmisawvdomi sakvebi produqti puri, gamdidrebuli jan-
2013 weli
97
mTelobisaTvis aucilebeli aminomJavebiT, vitaminebiT da mineralebiT, saqarTveloSi Seamcirebs masiurad gavrcelebul vitaminebis, aminomJavebis da mikroelementebis deficitiT gamowveul daavadebebs, romlebic did safTxes
uqnian bavSvebs da saqarTvelos mTel mosaxleobas. àpi puri” Seicavs yvela zemoTqmul
bunebriv elements da misi moxmareba mosaxleobas uzrunvelyofs janmrTelobisTvis sakmaris vitaminebs, aminomJavebsa da mikroelementebs.
axali teqnologiiT damzadebuli puri
àpi puri”, romelic gamdidrebulia biulogiurad aqtiuri danamatiT àpivitiT” (futkris
naturaluri produqtebis nazavi), gamoirCeva
sasiamovno, specifikuri surneliT dagemoTi,
rac produqts ufro mimzidvels xdis. vinaidan mosaxleoba darwmunebulia futkris produqtebis sasargeblo TvisebebSi, produqti ufro met ndobas moi povebs momxmarebelSi.
sxva ufro Zvirad Rirebuli kvebis produqtebiT (rZis nawarmi, xorci, Tevzeuli)
preparatebiT da kvebiTi danamatebiT, romlebic Seicaven aminomJavebs, vitaminebs da mineralebs, preparatebi (Multi-tabs B-complex da
sxva), kvebiTi danamatebi) preparatebSi da kvebiT danamatebSi aminomJavebi, vitaminebi da mineralebi miRebulia sinTezuri gziT. maTgan
gansxvavebiT „apiviti“ warmoadgens bunebriv
futkris produqtebis nazavs.
98
mas Semdeg rac „apviti“-is suspenziaSi ingredientebis wilobrivi cvlilebebiT ise
rom produqts ar daekargos sasiamovno gemo
da surneli, comSi mikrobiologiuri analizis
safuZvelze miiRweva vargisianobis gazrda. adglobriv bazarTan erTad Cveni samizne gaxdeba saerTaSoriso bazaric.
puri „api puri“ romelic gamdidrebulia bunebrivi biologiurad aqturi produqtiT warmoadgens siaxles rogorc adgilobriv ise saerTaSoriso bazarze. ar arsebobs iseT purfunTuSeulis produqti romelic Seicavs erTdroulad amnomJavebs, vitamnebs da mineralebs.
saqarTveloSi pur-funTunTuSeulis mravali saxeoba iwarmoeba. Cveni konkurentebi arian is mwarmoeblebi, romlebic uSveben vitaminebiT da mineralebiT gamdidrebul purs. maTi produqcia gamdidrebulia ZiriTadad rkiniT da B- jgufis vitaminebiT. aseT sawarmoTa raodenoba mcirea da ver akmayofilebs bazris miTxovnilebas. Cvens mier warmoebuli puri - àpi puri” gamdidrebuli aminomJavebiT, vitaminebiT da mineralebiT, zemoT CamoTvlili
gamdidrebuli pureulisagan gansxvavebiT, Seicavs yvelaze srulyofil nakrebs. mxolod
mis SemadgenlobaSia erTdroulad: mniSvnelovani naxSirwylebi (fruqtoza, glukoza), aminomJavebis 22 saxeoba (valini, lizini, leicini, glutamini, cistini dasxva), vitaminebi
(A, B1, B2, B5, B6, Bcac. folici, C, D, PP, E, K fosfoterinebi, rutini (sisxlZarRvis kedlis gamamagrebeli flavinoidi) najeri da ujeri
cximovani mJavebi, mineralebi (Ca, Mg, Pp, Fe, Zn,
I, Ka, Na, Cu).
yoveldRiuri da yvelasaTvis xelmisawvdomi iafiFsakvebi produqti àpi puri”. romelc
damzadebulia axali teqnologiiT, saqarTveloSi Seamcirebs masiurad gavrcelebul vitaminebis, aminomJavebis da mikroelementebis
deficitiT gamowveul daavadebebs.
literatura:
1. G. Chakhunashvili, N. Kandelaki -Children and security: `Child has the right to be defended from birth” NATO
science for peance and seurity
series E: Human and societal Dynamics – vol. 37 complexity and Security – 2008 Chap. 126. p. 405-410www. iospress. nl
2. Sustainable development and child security. /G. Chakhunashvili, I. Phavlenishvili /. Social,
Ecological and Clinical Pediatrics. – 2011. - #13-8-7. - pp.
25-46. – geo. ; abs. : geo., eng.
3. CaxunaSvili g. medicinismecnierebadaaucilebeligza XXI saukuneSimisiganviTarebisaken
`CanasaxidanbavSvsuflebaaqvsiyosdaculi”socialuri, ekologiuridaklinikuri pediatria. Tbilisi, 2009. _N11-6-5. - gv. 54-60
4. Daro et all//Clin. Exp. Immunol. 2008 v93 N3 p430435//
5. Gabriel E. M. Btrgert E. M. et all//Germline polymprphismof codon 727of Human Thyroidstimulatinghormone
receptoris associatedwith toxic multinodular goiter//J. Clin.
Endokrin. Metab. 2011vol94p3328-3335//
Gon K. L. Wang F. A. // Am. Rheum. Diseases 2009 sol
m99N2 p201-204//
7. http://www. google. ge/#site=&source=hp&q=kveba&oq=kveba&gs_l=hp. 3... 4235. 9360. 0. 10672. 0. 0. 0.
0. 0. 0. 0. 0.. 0. 0... 0. 0... 1c. 1. 14. hp. _bCcHeo0CX8&bav
reziume
XXIX samecniero-praqtikuli konferenciaze miRebuli rezolucia:K
`kvebis obieqtebi, mwarmoeblebTan erTad aqtiurad Caebnen moZraobaSi
`jansaRi kveba BbavSvebs” sruldeba.
àpi puri“ -aminomJavebiT, vitaminebiTadamineralebiT gamdidrebuli puri“
k. CaxunaSvili, S. iusupovi, i. kalandia, n. jobava, n. badriaSvili,
n. TofuriZe, gCaxunaSvili z. SaqaraSvili, k. kokaia
(socialuri pediatriis dacvis fondi, S. p. s. `puri“(Tbilisi)
yoveldRiuri da yvelasaTvis xelmisawvdomi iafiFsakvebi produqti àpi puri”. gamdidrebulia janmTelobisaTvis aucilebeli aminomJavebiT, vitaminebiT da mineralebiT. axali teqnologiiT damzadebuli puri saqarTveloSi Seamcirebs masiurad gavrcelebulvi taminebis, aminomJavebis da mikroelementebis deficitiT gamowveul daavadebebs.
SUMMARY
29TH SCIENTIFIC-PRACTICAL CONFERENCE- RESOLUTION: FOOD PRODUCERS
AND THEIR RETAILERS SHOULD JOIN “HEALTHY FOOD FOR CHILDREN”.
APIPURI – A BREAD ENRICHED WITH MINERALS, AMINO ACIDS AND VITAMINS
K. CHAKHUNASHVILI, SH. YUSUPOV, I. KALANDIA, N. JOBAVA, N. BADRIASHVILI, N. TOPURIDZE, G.
CHAKHUNASHVILI, Z. SHAQARASHVILI, K. KOKAIA
Every day and cheap product “Apipuri” is enriched by minerals, amino acids and minerals, all the micronutrient needed for organism to maintain healthiness. Newly developed technology of baking bread will help solving problem of micronutrient deficiency.
2013 weli
99
baton paliko kintraias
redaqcia guliTadad ulocavs
dabadebis dRes
saqarTvelos mean-ginekologTa da perinatologTa
asociaciis prezidentis profesor paliko kintraias
cxovrebis gza
daibada 1933 wlis 8 dekembers q. TbilisSi
1958 wels daamTavra Tbilisis saxelmwifo samedicino institutis samkurnalo
fakulteti warCinebiT.
1958-61 ww. muSaobda TianeTis raisaavadmyofos sameano ganyofilebis gamged.
1961-63 ww. Ggaiara klinikuri ordinaturis kursi Tbilisis sax. samedicino akademiis meanoba-ginekologiis kaTedraze.
1963-66 ww. muSaobda marneulis samSobiaro saxlis
mTavar eqimad.
1964 wels daicva sakandidato disertacia Temaze:,,nayofis eleqtrokardiogramis
cvlilebebi vakuumeqstraqtorisa da sameano maSebis gamoyenebiT”.
1971 wels – sadoqtoro
disertacia,,nayofis Tavis
tvinis hi poTermia mSobiarobis dros”.
1966-2006 wlidan muSaobda Tbilisis eqimTa di plomisSemdgomi momzadebis akademiis meanoba-ginekologiis
2013 weli
kaTedraze asistentad, profesorad, kaTedris gamged.
1980-2002 wlidan - k.v.CaCavas saxelobis perinataluri medicinisa da meanoba-ginekologiis samecniero kvleviTi institutis direqtorad,
2002 wlidan dRemde institutis sameTalyureo sabWos
Tavmjdomared.
1977-86 wlebSi da 1997-2005
ww. saqarTvelos Sromis, janmrTelobisa da socialuri
dacvis saministros mTavar
mean-ginekologad.
1997-2003 wlidan Tbilisis
sax. samedicino universitetis samecniero xarisxebis
mimniWebeli saatestacio sabWos Tavmjdomare meanoba-ginekologiaSi.
1998-2005 w.w. saqarTvelos
Sromis, janmrTelobisa da
socialuri dacvis saministros eqimTa saserTifikaciosaatestacio komisiis Tavmjdomare meanoba-ginekologiaSi.
aris saqarTvelos samedicino akademiis erT-erTi damfuZnebeeli da misi namdvili wevri.
1983 wels mieniWa saqarTvelos mecnierebis damsaxurebuli moRvawis wodeba, 1985
wels saqarTvelos saxelmwifo premia sameano-ginekologiuri sefsisis sakiTxebisadmi miZRvnili samecniero SromebisaTvis.
1998 wels dajildoebulia
Rirsebis ordeniT.
1998 wels arCeulia ungreTis mean-ginekologTa samecniero sazogadoebis wevrad, 1988w. evropis mean-ginekologTa asociaciis wevrad,
1988w. amerikis mean-ginekologTa kolejis sazRvargareTel wevrad. arCeulia ramdenime saerTaSoriso Jurnalis sabWos wevrad.
2002 wels – ruseTis federaciis sabunebismetyvelo
mecnierebaTa akademiis ucxoel wevrad
sxvadasxva dros p. kintraia iyo sabWoTa kavSiris
mean-ginekologTa sazogadoebis prezidiumis wevri, ssrk
jandacvis saministros saeqsperto sabWos wevri meanoba-ginekologiaSi. ssrk medicinis mecnierebaTa akademiis saproblemo komisiis wevri da sxva.
samecniero kvlevis ZiriTadi problemebia fizikuri
da eleqtrofiziologiuri
meTodebis gamoyeneba meanobasa da ginekologiaSi diagnostikisa da mkurnalobis
mizniT. Nnayofisa da axalSobilis daavadebaTa paTogenezis Seswavla. Nnayofisa
da axalSobilis adaptaciis
centraluri saregulacio meqanizmebis Seswavla. Nnayofi
da tkivilis problema, garemo faqtorebis gavlena orsulobis mimdinareobaze da
nayofis ganviTarebaze, stresi da orsuloba.
mis mier TanaavtorebTan
erTad pirvelad SemuSavebul
iqna mSobiarobis dros nayofis pirdapiri eleqtro-kardiografiis meTodi (1961 w.)
da nayofisa da axalSobilis
kraniocerebraluri hipoTermiis meTodi (1968 w.), SemuSavebul iqna (1961-70ww) mSobiarobis dros nayofis funqciuri mdgomareobis Sefasebis
eleqtrofiziologiuri kriteriumebi, dadgenil iqna, rom
mSobiarobis dros nayofs gaaCnia tkivilis SegrZnebis avtonomiuri regulaciis unari da SemoRebul iqna nayofis autohibernaciis mcneba.
TanaavtorebTan erTad
dadgenil iqna nayofis ZilRviZilis bioriTmebis arseboba da masTan dakavSirebuli nayofis gulis moqmedebis Taviseburebani (1981 w),
pirvelad Seiqmna nayofis Tavis tvinis peptiduri ruqa,
identificirebul iqna 15 neiro peptidi da daginda, rom
antenataluri periodis dasasruls nayofis Tavis tvinis peptiderguli sistema imyofeba funqciuri aqtivobis
mdgomareobaSi, rac uzrunvelyofs nayofis Seguebas
axal pirobebTan. Aaseve pirvelad TanaavtorebTan erTad
Seswavlil iqna nayofis neiropeptidebis roli samSobiaro moqmedebis aRZvraSi da
regulaciaSi.
gamoqveynebuli aqvs 200mde samecniero Sroma. maT
Soris 14 gamogoneba. misi
xelmZRvanelobiT Sesrulebulia da daculia 40 sakandidato da 12 sadoqtoro disertacia.
1980 wlidan p. kintraia
aris saqarTvelos mean-ginekologTa sazogadoebis (xolo Semdgom mean-ginekologTa da perinatologTa asociaciis) ucvleli xelmZRvaneli. misi xelmZRvanelobiT
rogorc ginekologiis samecniero kvleviTma institutma,
aseve mean-ginekologTa sazogadoebam moi pova didi saer-
Rirseuli 80
80 weli
Rirseuli
weli
TaSoriso aRiareba. p. kintraias xelmZRvanelobiT instituts da asociacias hqonda grZelvadiani saerTaSoriso xelSekruleba iaponiis tokios universitetis, inglisis souTemptonis universitetis, germaniis haidelbergis universitetis, budapeStis eqimTa daxelovnebis institutis meanoba-ginekologiis kaTedrebTan. am xelSekrulebis farglebSi erToblivad Sesrulebuli Sromebis Sedegebi ixileboda Semajamebel saerTaSoriso konferenciebze. 1980-2003 wlebSi Catarebulia 23 aseTi konferencia da gamocemulia 23
SomaTa krebuli saqarTveloSi, ungreTSi da iaponiaSi.
aseve nayofieria p. kintraias xangrZlivi muSaoba saqarTvelos jandacvis saministros mTavar mean-ginekologad. sakmarisia aRiniSnos,
rom maSin rodesac saqarTveloSi weliwasSi 150 000 bavSvi ibadeboda, dedaTa sikvdiloba 3.5 jer Semcirda da
es iyo mTel sabWoTa kavSirSi samagaliTo maCvenebeli.
aseve didia p.kintraias damsaxureba saqarTveloSi mean-ginekologTa rogorc samecniero, aseve praqtikos eqimTa momzadebaSi da dRes saqarTvelos yvela kuTxeSi mis
mier aRzrdili mean-ginekologebi uZRvebian am urTules saqmes.
samecniero problema, romelzec muSaobs profesori
p. Kkintraia da misi xelmZRvanelobiT perinataluri medicinisa da meanoba-ginekologiis instituti aris:
1. stresi da orsuloba:
2. orsulobis dromdemiutanlobis paTogenezi da paTogenezuri mkurnalobis meTodebis SemuSaveba.
100
daviT fruiZe
(03.01. 1960 – 24.04.2013)
24 aprils Tbilisi SeZra Semzaravma ambavma: daTo
fruiZe gardaicvala!
daTos megobrebis da nacnobebis
usazRvrod didi
wrisaTvis warmoudgenelia imis dajereba,
rom aRar aris axalgazrda,
energiuli, uzomod ganaTlebuli, iumoriT savse, gamousworebeli optimisti,
axali ideebis generatori,
daxvewili Tbiliseli kaci.
daTo fruiZis wasvlam
yvela dagvasevdiana. miuxedavad imisa, rom mis cxovrebaSi iyo tragikuli epizodebic, gulistkenac, Tvi-
Ton arafers imCnevda da
aravisTvis utkenia guli
uxeSi qceviT da sityvapasuxiT. paradoqsia: misi
gaxsenebis dros Tvalebi
cremliT gvevseba, magram
uneburad gveRimeba, radgan
masTan dakavSirebuli yoveli cxovrebiseuli epizodi
aRsavsea iumoriT, oxunjobiT, enamoswrebuli sityva-pa-
viola beriSvili
Zalian Znelia masze warsul droSi saubari. is iseTi energiuli da dauRalavi iyo, yvelafrisadmi gansakuTrebuli damokidebulebiT. iyo sicicxlis moyvaruli adamiani, kargi deda,
iSviaTi qali. daxvewili, inteligenturi, maRali donis
profesionali, mecnieri da
pedagogi. mis cxovrebaSi iyo
ori mniSvnelovani etapi iyo.
erTi _ iv. beritaSvilis saxelobis fiziologiis institutis msoflioSi aRiarebuli skola, meore - Tbilisis saxelmwifo samedicino
universiteti. orive Rirseulad da warmatebulad gaiara. iSviaTia adamianebi,
romlebsac gaaCniaT Tavisi
saqmisadmi miseuli damokidebuleba. dauzareli da da-
uRalavi iyo. mxolod is rad
Rirda, rogor muSaobda is
studentebTan samecniero
wreSi. rogor uyvarda konferenciebis mowyoba da organizacia. yvelaferi unda
gaekeTebina gansakuTrebulad kargad, yovelTvis Zalian gansxvavebulad. TiTqmis mxolod amisTvis cocxlobda da arsebobda. cdilobda yoveli RonisZieba
dResaswauli yofiliyo. saerTod, sadResaswaulo situaciis Seqmna saxlSic da
gareTac misi cxovrebis kredo iyo. mas sxvanairad ar
SeeZlo. yvelaferi mis irgvliv mxolod saukeTeso unda yofiliyo. is Zalian ixarjeboda da, amitom, etyoba veRar gauZlo da gadaiwva.
Tundac is rad Rirs, rogor
ar imCnevda viola Tavis mZime avadmyofobas, rogor bolomde cdilobda sul karg
xasiaTze yofnas. dadioda
koncertebze, speqtaklebze. is
xom xelovnebis Zalian didi moyvaruli iyo. sul gegmavda sadRac wasvlas, raRacis naxvas, gakeTebas. uyvarda megobrebTan urTierToba. yvelas unawilebda Tavis sikeTes da siyvaruls...
da Semdeg, sul ramodenime
dReSi Caqra...
manana Wi paSvili
Tssu, molekuluri da
samedicino genetikis
departamentis profesori
suxiT. igi dajildovebuli iyo iumoris udidesi
niWiT.
gavixsenoT daTos biografiuli monacemebi:
daviT fruiZe daibada
03.01. 1960w.
dabadebis adgili: Tbilisi, saqarTvelo
ganaTleba: Tbilisis saxelmwifo samedicino institutis samkurnalo fakulteti 1983
medicinis doqtoris samecniero xarisxi 1989
reanimaciis ganyofilebis eqimi 1983-1990
T.s.s.i. bavSvTa qirurgiis kaTdris asistenti 1990-1995
m.iaSvilis bavSvTa
centraluri saavadmyofos kritikuli medicinis samsaxuris ufrosi 1995-2002
èqimebi sazRvrebs
gareT `samedicino koordinatori 2002-2004
saqarTvelos iusticiis saministros samedicino departamentis
mrCeveli 2004
Tbilisis saxelmwifo samedicino akademi-
staJireba wminda anas
bavSvTa saavadmyofos kritikuli medicinis departamentSi, vena, avstria 2000
saerTaSoriso treningi
Temaze: hospitalTa menejmenti 2009
profesiuli gamocdileba: bavSvTa respublikuri
saavadmyofos
is upg da adamianuri resusrsebis departamentis ufrosi 20042006
g.Jvanias saxelobis pediatriuli klinikis
direqtori 20062012
aTi weli sruldeba, rac
is CvenTan aRar aris. Zalian
male gavida dro. TiTqos es
guSin moxda. iSviaTad Semxvedria adamiani, romelsac uyvarda yvela. is didTan didi
iyo, patarasTan _ patara. arasodes ar gamigia vinmeze sayveduri eTqvas. gamousworebeli optimisti iyo, sicocxleze da Tavis saqmeze Seyvarebuli. samwuxarod, cxovreba rTuli iyo. mas mouxda ramodenime etapis gavla. es jer
pediatria iyo, Semdeg _ biologia da samedicino genetika, da, bolos _ socialuri
pediatria. gavida dro da
mxolod exla mivxvdi, ramxela saqmes akeTebda. ase megona, rom is arafers gansakuTrebuls ar akeTebda. cxovrobda ise, rogorc SeeZlo
da jeroda. yvelas exmareboda. cdilobda yvelasTvis gaenawilebina Tavisi sikeTe. keTilSobili adamiani iyo.
profesionali, inteligenti,
daxvewili pirovneba da namdvili qalaqeli... qarTveli
- moroSkini...
Zalian kargi megobari iyo.
dRemde is axsovs yvelas. mis
saflavze xSirad viRacis mitanili yvavilebi devs. pediatrebis da genetikosebis nebismier RonisZiebaze sul misi saxelis xsenebaa. zaur fxalaZes misi suraTi samsaxurSi samuSao kabinetSi ukidia,
zurab Ciqovans ki _ saxlSi
Tavisi gardacvlili Svilis
gverdze. sadac waxval, an misi megobari, an misi mowafe
gxvdeba - TbilisSi, moskovSi,
kievSi, JenevaSi. gasakviria, magram misi sikeTis madli mis
Svilebs xSirad win xvdebaT.
misi megobrebis Svilebi Cve-
viqtor
moroSkini
ni Svilebis megobrebi gaxdnen. da grZeldeba isev is siyvaruli da siTbo, rasac is
unawilebda yvelas, uSurvelad da uangarod. Zalian damaklda misi gverdiT yofna.
mis gverdiT xom ara marto
me, yvela qali qalad grZnobda Tavs. amas winad, JenevaSi
Cemma umcrosma qaliSvilma
miTxra: „ici, me bavSvobaSi mama ufro maxsovs, vidre Sen.
Sen sul samsaxurSi, gamocdebze da kvalifikaciaze iyavi wasuli, an saxlSi raRacas akeTebdi. CvenTvis naklebad iclidi. mama ki sul Cven-
gaxseneba
akademiis generaluri mdivani 2008-2012
unar-Cvevebi: inglisuri,rusuli ( Tavisuflad)
saofise kompiuteruli
programebi
cxovreba grZeldeba axla ukve daTo
fruiZis gareSe, misi
xsovna samaradJamod
darCeba misi ojaxis
wevrebis, megobrebis
da ubralod nacnobebis gulebSi.
redaqcia da
megobrebis jgufi
Tan iyo - yvelgan davyavdiT,
gvaseirnebda, gvmkurnalobda,
gadasxmebs gvikeTebda, araferze uars ar gveubneboda. sul
CvenTan iyo“. misi suli, albaT, isev sul TqvenTan aris.
is TqveniT amayobda da, albaT, iqac, sadac wavida TqveniT xarobs. kargebi gagzardeT. RmerTis madlobeli var,
rom Tavis droze studenti
gogo Sevxvdi axalgazrda
eqims, Wkvians, daxvewils, sxvebisagan Zalian gansxvavebuls,
romlisganac bevri ram viswavle _ megobroba, mimtevebloba, saqmisadmi da garSemomyofebisadmi damokidebuleba.
samwuxarod, adamianebis
wasvlis Semdeg TandaTan
xvdebi vin iyvnen isini da rogor gaklia maTi gverdze yofna. droTa ganmavlobaSi sxva
TvaliT uyureb cxovrebas da
sxvanairad afaseb yvelafers.
„, “ (rodesac gvyavs _ ver
vafasebT, dakargvisas _ vtiriT). ase yofila...
manana Wi paSvili,
Tssu, molekuluri da
samedicino genetikis
departamentis profesori
2013 weli
profesor ioseb kvaWaZis
pediatriuli skolis didi warmateba
2012 wlis 16 ivliss `Rirsebis ordeniT” dajildovdnen
profesor ioseb kvaWaZis pediatriuli skolis Rirseuli
warmomadgenlebi: profesori g. CaxunaSvili, profesori
n.uberi, am skolis aRzrdili niWieri pediatri T.miqelaZe
da endokrinologi medicinis doqtori m.gordelaZe.
kidev erTxel vulocavT qarTul pediatriul skolas
am did aRiarebas da vusurvebT saqarTvelos bavSvTa
janmrTelobis samsaxurSi arsebuli SemarTebiT mravalwlian moRvaweobas.
saqarTvelos pediatrTa akademiis prezidenti
profesori ir. ciciSvili
News
CRDF Global periodically
releases news items of general or topical interest. If you
are a member of the media
and wish to receive news
alerts, please for our mailing
list. Please direct all media inquiries to EA Dyson, 703526-2339, or email the CRDF
Global office.
Winners of STEP 2012
?From Idea to Market? Competition in Georgia Announced
Dec 11, 2012
On December 3rd, in Tbilisi, Georgia, CRDF Global?s
Science and Technology Entrepreneurship
Program
(STEP) concluded its 2012
?From Idea to Market? competition. Ten teams pitched
their ideas to the US-Georgian panel of jurors at the
Competition final event, Venture Forum, and four were
awarded one-year $24,500
grants to bring their innovations to the market.
STEP 2012 ?From Idea to
Market? competition was
open to all Georgian scientists
and technology entrepreneurs
with innovative projects that
have commercial applications
in the local, regional, and/or
international markets. The
competition and the awards
are co-funded by Shota Rustaveli National Science Foundation, and implemented in
partnership with the Georgian
Research and Development
Foundation (GRDF). STEP is
funded by the US Department
of State.
nology commercialization
and entrepreneurship.
CRDF Global congratulates all competition partici-
In addition to the monetary
awards, teams will receive individual mentoring from top
U.S. business experts in tech-
pants for their hard work and
innovative spirit, and is proud
to present the winners of this
year?s competition.
irakli
ciciSvilis
sax. bavSvTa
axali klinika
Apipuri
Team Lead:
George Chakhunashvili
In Georgia, a huge part of
society suffers from malnutrition or micronutrient deficiencies due to a lack of essential
vitamins and minerals in their
diet. Many cannot always afford to buy the fresh milk,
meat, and vegetables that provide essential micronutrients.
Recognizing, however, that
bread is a staple bought by
every Georgian family, the
team developed enriched bread
called ?Apipuri,? which delivers a complex of micronutrients unlike any other enriched
bread on the market. By purchasing the low-cost Apipuri,
the team expects consumers
will get the vitamins they need
to avoid long-term health-related financial costs they may
not be able to afford.

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Transcript

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