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ABSTRACT
Key words: In vitro, Aoueous neem extract, Deltamethrin against, Sarcoptes scabiei var. cuniculi.
INTRODUCTION
There is extensive evidence of the activity of the
pyrethroids, such as deltamethrin, pyrethin,
Sarcoptic mange belongs to the family
cypermethrin and tetramethrin, when they are used as
sarcoptidae and it’s a highly contagious and
topical pesticides. Deltamethrin is a pyrethroid with
burrowing parasite (Walton and Currie, 2007).
strong insecticidal activity and photo-stability and
Sarcoptes scabiei is an important rabbit ectoparasite
low mammalian toxicity and acts on the insect’s
because of the possibility of zoonotic infection
central nervous system to give a rapid knockdown. It
(Harrenstien et al., 1995) and considerable losses in
brings acaricidal and repellent effects against ticks,
weight, productivity, wool, and fiber quality.
mites and biting insects, thus providing protection
from the transmission of diseases (Mehlhorn et al.,
In Egypt, mange (Sarcoptes and Psorptic) in rabbits is 2011).
considered to be second to coccidiosis importance,
with high losses. Sarcoptes scabiei var. cuniculi
In general, many of the chemical acaracides have
causes mange infestation in rabbits, affecting their
limitations such as resistance (Currie et al., 2004) and
nose, feet, and areas around the genitalia, resulting in
toxicity (O’Brien 1999), environmental
hypertensive reaction, body weight loss, and death
contamination, and persistence (Halley et al., 1993;
(Saha and Mukherjee 1998). S. scabiei can be
O’Brien 1999). Such side effects of chemical
difficult to eliminate in rabbits compared to other
acaricides have prompted a search for new
domestic animals (Aiello et al., 1998).
alternatives (Khater et al., 2013a, b).
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experimentally infested with 50 mites (Larvae). The (Duncan, 1955) using SPSS, a computer software
infestation was carried out on the dorsal area (4X2 (SPSS, 2009).
cm) after scratching the fur. One month post-
infestaotion, the second group was not treated and
taken into account as the positive control group. The RESULTS
third group was treated topically with deltamethrin
(DMT) 0.005 % solution, once every three days for AEN (40 %) was highly efficacious against S. scabiei
three consecutive weeks. Finally, the fourth group var. cuniculi larvae as 100 % mortality was reached
was treated topically with 25 % AEN (the 24 h PT. On the other hand, all mites treated with
concentration which showed lethal concentration 99 AEN (20 %) and DMT (0.005 %) died 48 h PT
(LC99) value 48 h post-treatment, PT) every 3 days (Table 1). The lethal values of AEN (LC50, LC90,
for three consecutive weeks, according to Haussain LC95, and LC99) were 7.65, 14.97, 18.11, and 25.88
(2002). %, respectively, 48 h PT (Table 2). Lesion scoring in
DMT (0.005%) and AEN (25%) treated groups were
Clinical score value descriptions significantly decreased (P < 0.05), reaching 0.21 and
Index scoring of lesions was described weekly 0.41, respectively, when compared with that of
according Jensen et al. (2002) as follows: 0=no positive control group (4.08), 42 days PT (Table 3).
lesion; 1=mild lesion-small visible mange body lesion
(diameter, 0-4 cm), no bloody skin injuries, good Rabbits infested with S. scabiei var. cuniculi adult
overall body condition, only occasional ebbing; and not treated (positive control group) showed
2=moderate lesion-medium-sized visible mange body sarcoptic mange on the nose. The affected regions
lesion (diameter, 4-8 cm), no bloody skin injuries, showed scales, alopecia, and scale formation. Rabbits
good overall body condition, more sequent rubbing; showed pruritis and were intermittently scratching the
3=severe lesion-severe body mange skin lesion, area with front paws. Later, hemorrhagic crusts with
bloody skin injuries due to rubbing, reduced overall Assures developed, even becoming eroded in places.
body condition; 4=chronic lesion-thick asbestos-like Rabbits showed minor signs of recovery. In contrast,
scab in the body, bloody skin injuries due to rubbing, rabbits treated with AEN exhibited improvement of
marked reduced overall body condition. Skin clinical signs during the experiment, no inflammation
scrapings were taken from the part of the lesions was observed, and showed absence of macroscopic
bordering healthy tissue by scraping the infested lesions on the nose, and legs after 42 days PT. Similar
areas. The number of live mites (larvae, nymphs, and results had been reported for the DMT-treated group.
adults) on each rabbit was counted on the 14 th, 28th,
and 42th day PT.
Twenty-eight days PT, the reduction percentages of
mites infesting rabbits were 93.07 % and 92.81 % for
Biochemical analyses DMT and AEN, respectively. However, complete
Blood samples were taken from the ear veins of five mite reduction was reached at 42 days PT (Table 4).
rabbits per group two times, 28 and 42 days PT, to Rabbits treated with AEN did not show signs of
separate the serum, which was stored at -20 °C until restlessness or irritation, respiratory signs, or
used for estimating the activity of serum alanine inflammation on the eye and/or skin at the time of
aminotransferase (ALT) and aspartate application or afterwards.
aminotransferase (AST) (Varliy, 1974), cholesterol
(Flegg, 1973), creatinine (Henry, 1974), total protein
(Domas, 1975), albumin (Dogmas, 1971), and Regarding biochemical analyses at 42 days PT, the
globulin. levels of AST and total cholesterol of rabbits infested
with S. scabiei var. cuniculi and not treated (positive
control group) were significantly increased (P < 0.05)
Rabbit performance than those of rabbits of the negative control group and
The body weight and cumulative body weight gain of those treated with DMT (0.005%) or AEN (25%)
rabbits were recoded 14, 28, and 42 days PT. (Table 5). On the other hand, the levels of total
protein, albumin, and globulin of positive control
Statistical analysis group were significantly decreased (P < 0.05) when
In bioassay tests, probit analysis was done on compared with the corresponding values of other
mortality data (Finney, 1971) using a computer groups (Table 6). The body weight and cumulative
program (Biostat, 2009) to calculate the lethal body weight gain of rabbits treated with AEN were
concentration (LC) and lethal time (LT) values. The significantly increased (P < 0.05) when compared
biological data were subjected to analysis of variance with such values of positive control group & those
(ANOVA) with Duncan’s multiple range test treated with DMT (0.005%), on 28 and 42 days PT
(Table 7).
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Table 1: In vitro mortality percentage of S. scabiei var. cuniculi larvae after treatment with different
concentrations of aqueous extract of neem and the recommended dose of deltamethrin.
Table 2: In vitro sensitivity of S. scabiei var. cuniculi larvae to aqueous extract of neem with determination of its
effective lethal time against the mites. (Mean ±SEM).
24 48 72
Table 3: Index scoring of S. scabiei var. cuniculi adult infested rabbits after treatment with aqueous extract of
neem and deltamethrin. (Mean ±SEM).
Days post-treatment
7 14 21 28 35 42
-ve control 0.00 ±0.00 b 0.00 ±0.00 c 0.00 ±0.00 c 0.00 ±0.00 c 0.00±0.00 b 0.00 ±0.00 b
+ve control 2.04 ±0.01a 2.65 ±0.12 a 3.47 ±0.21 a 3.67 ±0.24 a 3.88 ±0.24 a 4.08 ±0.24 a
DMT 1.65 ±0.02 a 1.65 ±0.03 b 1.44 ±0.05 b 1.24 ±0.07 b 0.41 ±0.24 b 0.21 ±0.24 b
AEN 1.71 ±0.04 a 1.85 ±0.07 b 1.65 ±0.06 b 1.44 ±0.08 b 0.62 ±0.24 b 0.41 ±0.24 b
SEM=stander error of mean. -ve control: negative control (not infested & not treated); +ve control: positive control (Infested
& not treated); DMT: infested and treated with deltamethrin locally (0.005%); AEN= infested and treated with aqueous
extract of neem locally (25%). a-c Mean values within a column followed by different lowercase letters were significantly
different (P ≤ 0.05). Index scores according to Jensen et al. (2002).
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Table 4: Reduction percentage of live mite on the infested rabbits after treatment with aqueous extract of neem
and deltamethrin.
Days post-treatment
14 28 42
+ve control 98.70 ±1.04a 0.00 137.00 ±1.03 a 0.00 182.11 ±4.36 a 0.00
DMT 35.35 ±2.32b 64.18 9.50 ±1.06 b 93.07 0.00 ±1.03 b 100.00
AEN 39.55 ±2.24b 59.93 9.85 ±1.02 b 92.81 1.56 ±1.07 b 99.14
M= mean number of live mites (larvae, nymphs & adults). SEM=stander error of mean. R% = Reduction percentage. -ve
control: negative control (not infested & not treated); +ve control: positive control (Infested & not treated); DMT: infested
and treated with deltamethrin locally (0.005%); AEN= infested and treated with aqueous extract of neem locally (25%).
a-c
Mean values within a column followed by different lowercase letters were significantly different (P ≤ 0.05).
Table 5: Some serum biochemical parameters in rabbits treated with crude aqueous extract of neem or
deltamethrin. (Mean ± SEM).
28 42 28 42 28 42 28 42
-ve
control 40.23 ±2.81 b 39.55 ±2.15 b 35.61 ±2.47 a 36.57 ±2.17 a 1.25 ±0.01 a 1.37 ±0.04 a 58.43 ±3.72 b 60.32 ±3.63 b
+ve
control 63.12 ±3.22 a 72.45 ±4.52 a 40.12 ±1.72 a 40.83 ±2.84 a 0.96 ±0.02 a 1.18 ±0.01 a 72.62 ±4.83 a 76.54 ±3.77 a
DMT 41.28 ±1.72 b 38.73 ±1.88 b 38.48 ±2.64 a 38.96 ±1.46 a 1.15 ±0.01 a 1.31 ±0.06 a 59.46 ±3.44 b 61.45 ±4.14 b
AEN 42.19 ±2.52 b 37.85 ±2.62 b 39.53 ±1.42 a 40.11 ±1.89 a 0.98 ±0.06 a 1.22 ±0.05 a 60.24 ±3.64 b 58.78 ±3.43 b
AST: Aspartate aminotransferase; ALT: Alanine transaminase; SEM: stander error of mean; -ve control: negative control
(not infested & not treated); +ve control: positive control (Infested & not treated); DMT: infested and treated with
deltamethrin locally (0.005%); AEN= infested and treated with aqueous extract of neem locally (25%).
a-b
Mean values within a column followed by different lowercase letters were significantly different (P ≤ 0.05).
Table 6: Serum total protein, albumin, and globulin in rabbits treated with crude aqueous extract of neem or
deltamethrin. (Mean ± SEM).
28 42 28 42 28 42
-ve control 5.82 ±0.08 a 5.94 ±0.12 a 3.12 ±0.12 a 3.32 ±0.06 a 2.70 ±0.08 a 2.62 ±0.11 a
+ve control 4.46 ±0.14 c 4.16 ±0.25 b 2.31 ±0.07 c 2.12 ±0.03 b 2.15 ±0.17 c 2.04 ±0.08 b
DMT 5.24 ±0.26 b 5.73 ±0.17 a 2.87 ±0.02 b 3.43 ±0.02 a 2.37 ±0.13 b 2.30 ±0.07 a
AEN 5.55 ±0.31 a 5.89 ±0.27 a 2.98 ±0.10 a 3.36 ±0.05 a 2.57 ±0.07 a 2.53 ±0.13 a
SEM: stander error of mean; -ve control: negative control (not infested & not treated); +ve control: positive control (Infested
& not treated); DMT: infested and treated with deltamethrin locally (0.005%); AEN= infested and treated with aqueous
extract of neem locally (25%). a-c Mean values within a column followed by different lowercase letters were significantly
different (P ≤ 0.05).
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Table 7: Body weight and body weight gain in rabbits treated with aqueous extract of neem or deltamethrin.
(Mean ± SEM).
Initial body Days post-treatment
weight
14 28 42
Body weight cBody gain Body weight cBody gain Body weight cBody gain
a
-ve 761.5 ±25.2
1062.6 ±21.7 a 301.1 ±14.2 a 1350.4 ±26.4 a 588.9 ±10.4 a 1660.7 ±32.4 a 899.2 ±13.3 a
control
+ve 755.7 ±17.3 a
965.0 ±15.2 b 209.3 ±13.5 b 1160.3 ±23.8 d 404.6 ±8.7 d 1375.4 ±43.3 d 619.7 ±16.4 c
control
DMT 755.4 ±16.3 a 970.4 ±24.5 b 215.0 ±17.7 b 1255.7 ±43.2 c 500.0 ±11.5 c 1570.3 ±26.5 c 814.9 ±24.7 b
AEN 756.3 ±28.5 a 967.2 ±28.3 b 210.9 ±14.3 b 1262.5 ±31.4 b 506.0 ±13.2 b 1632.2 ±33.7 b 875.9 ±17.9 a
SEM: stander error of mean; cBody gain: Cumulative body gain; -ve control: negative control (not infested & not treated);
+ve control: positive control (Infested & not treated); DMT: infested and treated with deltamethrin locally (0.005%); AEN=
infested and treated with aqueous extract of neem locally (25%). a-d Mean values within a column followed by different
lowercase letters were significantly different (P ≤ 0.05).
Botanicals could be an environment-friendly solution Our in vivo trial indicated that rabbits infested with S.
(Khater, 2013; Seddiek et al., 2013). Our in vitro scabiei var. cuniculi adult and not treated showed
study signposted that 20 % AEN generated 68.75 and mange infestations on the nose, and legs with minor
100.00 % mortality of S. scabiei var. cuniculi larvae signs of recovery. On the contrary, rabbits treated
after 24 and 48 h, respectively. AEN comprised good with DMT and AEN exhibited improvement of
effect against sarcoptic mite larvae in vitro as the clinical signs during the experiment. The reduction
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percentage of S. scabiei mites on rabbits was 100 and Biochemical analyses indicated that no significant
99 % after treatment with DMT and AEN for 42 days difference of serum AST and total cholesterol in
PT, respectively, which was represented clinically by rabbits treated with DMT or AEN when compared
the absence of macroscopic lesions. Likewise, neem with those values in negative control group (rabbits
oil had been reported to induce recovery of mange not infested and not treated). While, infested and not
affecting other animals, such as sheep (Hirudkar treated rabbits (positive control) showed a significant
et al., 1997; Tabassam et al., 2008) and dog (Abdel- increase of serum AST and total cholesterol. Such
Ghaffar et al., 2008a). Neem ointment (5 %) was results were in agreement with those mentioned for
effective against ear canker of rabbits, psoroptes rabbits (Seddiek et al., 2013), layer chickens (Buim
cuniculi (Joshi et al., 2000). Moreover, neem induced et al., 2013) and cattle (Hussein et al., 2008).
an effective in vivo control of the poultry mite, However, these results were in disagreement with
Dermanyssus gallinae (Lundh et al., 2005; Abdel- those obtained for goat (Kumar et al., 2010).
Ghaffar et al., 2008b; Locher et al., 2010a, b). Ogbuewu et al., (2010a) reported that neem leaf
meal-based diets decreased the serum cholesterol
Similar to DMT, our in vivo data indicated that neem level in rabbit bucks. Serum ALT & creatinine
extract completely cured mange in rabbits. Similarly, showed no significant difference in all treated groups.
the undiluted neem oil killed all S. scabiei var. Our study revealed that, AEN-treated group did not
cuniculi larvae and was significantly higher than show any significant difference in serum total protein,
pyrethrins, but not significantly different from albumin and globulin when compared with negative
avermectin (Du et al., 2007). Crude aqueous control group. These results were in disagreement
methanol extract of neem seed kernel (20 %) was with those obtained for rabbits (Seddiek et al., 2013).
found as effective as ivermectin against sarcoptic On the other hand, rabbits infested and not treated
mange infesting sheep under field conditions (positive control) showed a significant decreased in
(Tabassam et al., 2008). serum total protein, albumin, and globulin when
compared with the corresponding values of other
Regarding index scoring, the index scores of rabbits groups. This result similar to that obtained for rabbit
infested with S. scabiei var. cuniculi and treated with (Seddiek et al., 2013) and cattle (Hussein et al.,
DMT or AEN were significantly decreased when 2008).
compared with those of the infested and non-treated
ones (positive control group). Equivalent In our study, AEN could be considered as safe
improvement of lesion scoring was reported for neem because it had no side effect on the liver and kidney
as an acaricide against mange in dog (Abdel-Ghaffar of the treated rabbits. Our data pointed out to the
et al., 2008a) and sheep (Tabassam et al., 2008). hepato- and renal- protective effects of the neem
extract. Similar results were reported by Khalifa et al.
The pesticidal activity of neem oil is generally (1998) as they found that water suspension of dried
thought to be due to the tetranortriterpenoid and leaves of A. indica was hepatoprotective in rabbits
azadirachtin (Isman et al., 1990). Azadirachtin infected with Eimeria stiedae, and also by Ezz- Din
induces feeding and oviposition deterrence, growth et al. (2011) who found that the use of A. indica leaf
inhibition, and fertility & fitness reductions extract was a promising renal and hepatoprotective
(Schmutterer 1990). Azadirachtin is a natural plant agent in rats due to its antioxidant effect and
defense chemical affecting feeding through normalization of impaired kidney and liver Unction
chemoreception (primary anti-feedancy) that consists activities.
in the blockage of the input from receptors that
normally respond to phagostimulants or from the Regarding growth performance of rabbits in the
stimulation of specific deterrent cells or both present study, the body weight and cumulative body
(Chapman 1974; Dethier 1982) and through a weight gain of rabbits in the infested and non-treated
reduction in food intake due to toxic effects if group were significantly decreased compared to
consumed (secondary antifeedancy), where food values of the treated groups. The body weight and
intake is reduced after the application of azadirachtin cumulative body weight gain of rabbits treated with
in ways which bypass the mouth part chemoreceptors. AEN were significantly increased when compared
In addition, Azadirachtin has growth regulatory with such values of positive control group and those
effects on larval insects like disruption of molting, treated with DMT (0.005%), on 28 and 42 days PT.
growth inhibition, and malformation, which may Similar results were reported (Bawa et al., 2007;
contribute to mortality. This is attributed to a Ogbuewu et al., 2010a, b and Seddiek et al., 2013).
disruption of endocrine events such as the down While this result was in disagreement with that
regulation of hemolymph ecdysteroid level through obtained for rabbits fed leaf meal (15 %) for 16
the blockage of release of the prothoracicotropic weeks. the rabbits did not show any deleterious
hormone from the brain-corpus cardiacum complex effects on body weight gain (Ogbuewu et al., 2010b).
or to a delay in the appearance of the last ecdysteroid
peak showing complete molt inhibition (Mordue and AEN was found safe for rabbits, as indicated by
Blackwell 1993). biochemical analyses in the present study. There are
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Assiut Vet. Med. J. Vol. 61 No. 145 April 2015
no skin irritations or restlessness during the time of indica) seeds on performance of young rabbits.
application and afterwards. Similar results had been Pakistan j Nutr 6(3): 212-216.
reported (Tabassam et al., 2008; Schmahl et al., Ben Slima, A.; Ben Abdallah, F.; Keskes-Ammar, L.;
2010). Along with the economic benefits, additional Mallek, Z.; El Feki, A. and Gdoura, R. (2012):
advantages of using neem pesticides are that they "Embryonic Exposure to Dimethoate and/or
have low environmental persistence (Sundaram and Deltamethrin Impairs Sexual Development
Curry 1994), do not induce resistance readily in and Programs Reproductive Success in Adult
insects (Feng and Isman 1995; Jacobson 1995), and Male Offspring Mice." Andrologia 44 Suppl 1:
are relatively nontoxic to mammals (Jacobson 1995; 661-666.
Larson 1989) and non-target organisms Biswas, KI.; Chattopadhyay, A.; Banerijee, YA. and
(Condor_Golec 2007). Bandopadhyay, U. (2002): Biological
activities and medicinal properties of neem
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vivo acaricidal efficiency similar to that of DMT. It BioStat (2009): 5.8.3.0. Statistical software.
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No significant signs of side effects or adverse Buim Marcos Roberto; Andreia Mauruto Chernaki
reactions were noticed throughout the study. These Leffer; Claudia Del Fava; Helenice de Souza
data provide a platform for the development of Spinosa; Rachel Santos Bueno and Silvana
environment-friendly, non-toxic, non-accumulating Lima Górniak (2013): The First Report about
medicines against acariasis, which could be carried Allopsoroptoides galli n. g., n. sp (Acari:
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AEN could be suitable as a promising alternative Hens: Hematological, Serum Chemistry, and
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ACKNOWLEDGMENT by phytophagus insects-a review. Bull Ent Res
64: 339-363.
The authors thank Prof. Dr. Hanem F. Khater,
Cóndor_Golec, AF. (2007): Effect of neem
professor of parasitology, faculty of Vet. Medicine,
(Azadirachta indica A. Juss) insecticides on
Benha Univ. Egypt, for her support and advice.
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فعالَة المستخلص المائٌ لىثات الىََم والدلتامَثرٍه ضد ُدلم الجرب (ساركوتتس سكاتَاى فاركووَكوالً)
فٌ األراوة المعدٍة معملَا
علي مذمد مذمد أدمد ،شاكر صدٍق عثد الردمه ،مٌ عثمان مذمد عثد الفتاح ،سامخ عثد المىعم مذمد األلفٌ
Email: alimohamed312@yahoo.com Assiut University web-site: www.aun.edu.eg
ذٓذف ْزِ انذساعح نًعشفح ذأثٛش انًغرخهض انًائ ٙنُثاخ انُٛٛى كًؼاد نحُهــى اندــشب .أٔلا :خــاسج اندغى -عه ٙأؽثــاق ترــش٘
( )in-vitroذى اعرخذاو 5ذشكٛضاخ يٍ انًغرخهض انًائ ٙنُثاخ انُٛٛى (ٔ ،)40 ،30 ،20 ،10 ،5كزنك اعرخذو انذنرايٛثش ٍٚترشكٛض
(ٔ ،)%0.005انًدًٕعح انؼاتطح اعرخذو فٓٛا انًاء انًمطش فمؾ .ذى ٔػع عذد ٚ 20شلح ( )Larvaeف ٙكم ؽثك ترش٘ عهٔ ٙسلح
ذششٛح ْٔزا نكم ذشكٛض يغرخذو .ذى حغاب َغثح انٕفٛاخ ٔانٕلد انالصو نهٕفاِ يٍ كم ذشكٛض .ثاَٛاا :عهٗ األساَة انًظاتح يعًهٛاا
تطفٛم خشب انغاسكٕترظ عكاتٛاٖ فاسكَٕٛكٕل٘ ( .)in-vivoأخشٚد ْزِ انذساعح عهٗ 40أسَة َٕٛصٚالَذ٘ أتٛغٔ .لغًد
األساَة إنٗ أستعح يدًٕعاخ يرغأٚح تكم يدًٕعح 10أساَة .انًدًٕعح األٔن ٙاعرخذيد كؼاتطح عانثح نهردشتحٔ ،تالٙ
انًدًٕعاخ ذى إطاترٓا يعًهٛا ا تطفٛم خشب انغاسكٕترظ عكاتٛاٖ ڤاسكَٕٛكٕل٘ تًعذل 50ؽفٛم كايم انرطٕس عه ٙيغاحح 4عى
ؽٕل 2ٔ ،عى عشع عه ٙظٓش األسَة تعذ إصانح انشعش يٍ ْزِ انًُطمح /أسَةٔ ،ذى يعاندرٓا تعذ شٓش يٍ اإلطاتح انًعًهٛح.
انًدًٕعح انثاَٛح اعرخذيد كؼاتؾ يٕخة (يظاتح يعًهٛا ا تاندشب ٔغٛش يعاندح) .انًدًٕعح انثانثح يظاتح ٔيعاندح يٕػعٛا ا
تًحهٕل انذنرايٛثش 50( )0.005%( ٍٚيهٛدشاو دنرايٛثش/ٍٚنرش ياء) يشج كم ثالثح أٚاو نًذج 3أعاتٛع يررانٛح .انًدًٕعح انشاتعح يظاتح
ٔذى يعاندرٓا يٕػعٛا ا تانًغرخهض انًائ ٙنُثاخ انُٛٛى ( )% 20يشج كم ثالثح أٚا او نًذج 3أعاتٛع يررانٛح .ذى فحض ذأثٛش انًغرخهض
انًائ ٙنُثاخ انُٛٛى خاسج اندغى انح )in-vitro( ٙعهٗ ؽفٛم اندشب (عاسكٕترظ عكاتٛاٖ ڤاسكَٕٛكٕل٘)ٔ .كزنك ذى فحض اندغى
نرمٛٛى دسخح اإلطاتح ( )index scoresاعثٕعٛا ا تعذ انعالج ٔحرٗ َٓاٚح انردشتح .ذى ذحذٚذ عذد حهى اندشب عهٗ األساَة انًظاتح
ٔانًعاندح عُذ ٕٚ 42 ،22 ،14و تعذ انعالج .كًا ذى ذغدٛم يعاٛٚش انًُٕ (ٔصٌ اندغى ٔٔصٌ اندغى انًكرغة) لثم انعذٔ٘ يثاششج ثى
كم ٕٚ 14و حرٗ َٓاٚح انردشتحٔ .ذى عًم انفحٕص انثٕٛكًٛٛائٛح ف ٙانٕٛو 42 ٔ 22تعذ انعالج يرًثهح ف ٙلٛاط يغرٕٖ كم يٍ
,ALT, ASTانكٕنٛغرٛشٔل ،انكشٚاذ ،ٍُٛٛانثشٔذ ٍٛانكهٗ ،األنثٕٛئ ٍٛاندهٕتٛه ٍٛف ٙيظم انذؤ .لذ أظٓشخ َرائح انذساعح ،أٔلا :خاسج
اندغى انح )in-vitro( ٙأٌ انًغرخهض انًائ ٙنُثاخ انُٛٛى نّ كفاءج عالخٛح عانٛح ترشكٛضٔ % 40 ،30,20رنك يٍ خالل لرهّ ألكثش يٍ % 65يٍ
ؽفٛم خشب انغاسكٕترظ عكاتٛاٖ خالل 24عاعح .ثاَٛا ا :كًا أظٓشخ انُرائح تعذ ٕٚ 42و يٍ انعالج أٌ انًغرخهض انًائ ٙنُثاخ انُٛٛى ٚمهم يٍ
دسخح اإلطاتح (ٔ ،)index scoresكزنك ٚمهم عذد حهى اندشب تعذ انعالج تكفاءج .% 100ثانثا انرحهٛم انثٕٛكًٛٛائ :ٙأظٓشخ َرائح انرحانٛم
انثٕٛكًٛٛائٛح أٌ انًغرخهض انًائ ٙنُثاخ انُٛٛى لذ اعاد كافح انمٛاعاخ انثٕٛكًٛٛائح ((ٔ )ALT, ASTيغرٕٚاخ انكٕنٛغرشٔلٔ ،انكشٚاذ ،ٍُٛٛانثشٔذٍٛ
انكهٔ ٙاألنثٕئ ،ٍٛاندهٕتٕٛن ٍٛتًظم انذو) إنٗ يعادنرٓا انطثٛعٛح ،عُذ انٕٛو 42ٔ ،28تعذ انعالج .أظٓش انًغرخهض انًائ ٙنُثاخ انُٛٛى صٚادج فٙ
ٔصٌ اندغىٔٔ ،صٌ اندغى انًكرغة تًماسَح تاألساَة انًظاتح تحُهى اندشبَ .غرخهض يٍ ْزِ انذساعح أٌ انًغرخهض انًائ ٙنُثاخ انُٛٛى نّ كفاءج
عالخٛح ف ٙانحالخ انًظاتح تدشب انغاسكٕترظ عكاتٛاٖ ف ٙاألساَةٚٔ ،عذ تذٚالا فعالا ٔأيُا ا عٍ األدٔٚح انكًٛأٚح راخ اٜثاس انداَثٛح.
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