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ojaxuri xmelTaSuazRvis cxeleba (oxc)

ra daavadebaa?
oxc – genetikuri daavadebaa, romelsac axasiaTebs cxelebis ganmeorebiTi Setevebi, mimdinare muclis da/an gulmkerdis tkiviliTa da/an saxsrebis SeSupebiTa da tkiviliT. avaddebian ZiriTadad xmelTaSua zRvis auzisa da Sua aRmosavleTis qveynebis mkvidrni (ebraelebi, Turqebi, arabebi, somxebi).

ramdenad xSiria?
maRali riskis populaciaSi daavadebis sixSirea daaxloebiT 1-3 yovel 1000 adamianze. msoflios danarCen nawilSi is iSviaTia. amave dros, Sesabamisi genis aRmoCenis Semdeg is meti sixSiriT diagnoscirdeba im populaciebSi, romelSic iSviaTad iyo miCneuli, magaliTad italielebSi, berZnebsa da amerikelebSi.
pacientTa 90%-s daavadeba 20 wlamde asakSi ewyeba, maTgan naxevarze mets - sicocxlis pirvel dekadaSi. vaJebSi igi gogonebTan SedarebiT odnav ufro xSiria (Sefardeba 13:10-zea).

ra aris daavadebis gamomwvevi mizezi?
oxc – genetikuri daavadebaa. daavadebis ganviTarebaze pasuxismgebeli genia MEFV, romlis meSveobiTac xdeba anTebis SemzRudavi cilis kodireba. Te aRniSnuli geni mutacias ganicdis, rogorc oxc-is SemTxvevaSi, igi veRar asrulebs adeqvatur maregulirebel funqcias, ris gamoc pacientebi cxelebis Setevebs ganicdian.
amJamad mimdinareobs kvleva sxva genebis gamosavlenad, romelic, SesaZlebelia, aRniSnuli daavadebis ganviTarebaSi monawileobs.

memkvidreobiT gadadis?
igi gadaecema memkvidreobiT autosomur-recesiuli gziT (sqesTan SeWidulobis gareSe). aRniSnuli tipiT gadacema niSnavs, rom ganviTarebisaTvis saWiroa ori mutaciuri genis arseboba, erTi dedisagan, xolo meore mamis mxridan (mtarebels aqvs mxolod erTi mutaciuri geni, magram daavadebuli ar aris). daavadeba aRiniSneba xolme ojaxsa da naTesaobaSi, magaliTad, ded-mamiSvilebSi, biZaSvilebSi, biZasa da deida-mamidaSi da sxva ufro Soreul naTesavebSi. amave dros, rogorc es dakvirvebaTa SedarebiT mcire jgufSia naxuli, Tu erT-erT mSobels aqvs oxc, xolo meore paTologiuri genis mtarebelia, 50%-iani riskia, rom oridan Svilidan erTi daavaddeba.

ratom daavadda Cemi Svili? SeiZleba am daavadebis Tavidan acileba?
bavSvi daavadebulia imitom, rom mas aqvs is genebi, romelic oxc-s ganapirobebs. mniSvnelovania vicodeT, rom sisxliT naTesauri qorwineba zrdis imis risks, rom ori mtarebeli erTmaneTs Sexvdes. pacientebis daaxloebiT erT meoTxed erT sagvartomo xes miekuTvnebian (erTi winapris STamomavlebi arian). swored maRali riskis populaciis warmomadgenel individumebma Tavi unda Seikavon sisxliT naTesauri qorwinebisagan.

gadamdebia?
ara, is ar aris gadamdebi.

rogoria ZiriTadi simptomebi?
mTavari niSnebia morecidive cxeleba, romelsac Tan axlavs muclis, gulmkerdis an saxsrebis tkivili. abdominaluri simptomebi yvelaze xSiria, gvxvdeba pacientebis daaxloebiT 90%-Si, Setevebi gulmkerdis tkiviliT 20-40%-Si gvxvdeba, xolo saxsrebis tkivili - 50-60%-Si.
Cveulebriv bavSvebi uCivian muclis tkiviliTa da cxelebiT mimdinare ganmeorebad Setevebs. Tumca zogierTs sxva tipis Setevebi SeiZleba hqondes, zogjer Sereuli xasiaTis, magaliTad muclisa da gulmkerdis tkivili, an gulmkerdis tkivili da saxsrebis anTeba. es gamovlinebebi 1-4 dRes grZeldeba da TavisiT gaivlis. Setevis bolosTvis bavSvebi absoluturad ganikurnebian da SetevaTa Soris SualedebSi Tavs absoluturad jansaRad grZoben. zogjer Setevebi imdenad Zlieria, rom pacienti an ojaxi eqims mimarTaven. gansakuTrebiT mZime abdominaluri sindromis arsebobisas daavadebas zogjer apendicitad miiCneven xolme, ris gamoc pacientebs arasaWiro qirurgiuli operacia - apendeqtomia ukeTdebaT.
amave dros, zogierTi Seteva, erTsa da imave pacientebSic ki, imdenad msubuqad mimdinareobs, rom SeiZleba martiv abdominalur distresad Sefasdes. es aris erT-erTi mizezTagani, rac aseT avadmyofebSi diagnozis dasmas aZnelebs. muclis tkivilis dros bavSvs Cveulebriv yabzoba aqvs, tkivilis gaqrobis Sedeg mas xanmokle periodisaTvis ganavlis gaTxeleba enacvleba.
bavSvs erTi Setevis dros SeiZleba Zalian maRali sicxe hqondes, meores dros ki sxeulis temperaturis odnavi matulobdes.
tkivili gulmkerdis areSi Cveulebriv calmxrivia, igi SeiZleba imdenad Zlieri iyos, rom Rrmad sunTqva gauWirdes. es ramdenime dReSi gaivlis raime narCeni movlenebis gareSe. Cveulebriv Setevis dros erTi saxsari ziandeba (monoarTriti), rogorc wesi muxlisa an koW-wvivis. saxsari SeiZleba imdenad iyos Sesiebuli da mtkivneuli, rom bavSvma siaruli ver SeZlos. pacientTa daaxloebiT erT mesameds dazianebuli saxsris garSemo eriTematozuli mowiTalo gamonayari uviTardeba. saxsrebis dazianebiT mimdinare Setevebis xangrZlivoba ufro metia, vidre sxva klinikuri gamovlinebebiT mimdinare Setevebisa.
simptomebis srul alagebas 4 dRidan 2 kviramde vada esaWiroeba. zogierT bavSvSi daavadebis erTaderTi gamovlineba SeiZleba iyos saxsr(eb)is morecidive tkivili da SeSupeba, rasac SecdomiT revmatiul cxelebad an iuvenilur revmatoidul arTritad miiCneven xolme.
saxsrebis CarTviT mimdinare SemTxvevebis daaxloebiT 5-10%-Si procesi SeiZleba qronikulSi gadaizardos da Seuqcevadi cvlilebebi gamoiwvios.
oxc-sTvis damaxasiaTebelia wiTeli qaris msgavsi mowiTalo feris gamonayari, Cveulebriv qvemo kidurebsa da saxsrebis midamoSi vlindeba. zogierTi bavSvi uCivis fexis tkivils, rac Zalian Semawuxebelia.
Setevebis uiSviaTes formebs miekuTvneba ganmeorebiTi perikarditi (gulis perangis anTeba), mioziti (kunTebis anTeba), meningiti da orqiti (saTesleebis anTeba).
oxc-iT daavadebul bavSvebSi SedarebiT ufro xSirad gvxvdeba daavadebebi, romelsac sisxlZarRvebis anTeba (vaskuliti) axasiaTebs, mag. Sonlain-henoxis purpura da kvanZovani poliarteriti.
aranamkurnalebi oxc-is yvelazi mniSvnelovani garTuleba amiloidozis ganviTarebaa.
amiloidi specifiuri cilovani nivTierebaa, romelic lagdeba garkveul organoebSi, rogoricaa Tirkmlebi, nawlavebi, kani, guli da iwvevs am organoTa funqciis TandaTanobiT darRvevas, gansakuTrebiT Tirkmelebisas. amiloidozis ganviTareba ar aris specifiuri oxc-Tvis, igi SeiZleba sxva arasaTanadod namkurnalebi qronikuli anTebiTi daavadebebis garTulebas warmoadgendes. aseTebs miekuTvneba revmatoiduli arTriti, iuveniluri qronikuli arTriti, tuberkulozi. amiloidis nawlavsa an TirkmelSi diagnozis gasaRebia.
kolxicinis (ix. “medikamentozuri mkurnaloba”) adeqvaturi doziT miReba bavSvebs am garTulebis ganviTarebisgan icavs.

daavadeba yvela bavSvSi Tanabrad mimdinareobs?
ara, bavSvebSi igi sxvadasxvanairad mimdinareobs. ufro metic, Setevebis tipi, xangrZlivoba da simZime erTsa da imave avadmyofSic ki gansxvavebulia.

gansxvavdeba Tu ara daavadeba bavSvebsa da mozrdilebSi?
ZiriTadad oxc-is mimdinareoba bavSvebsa da mozrdilebSi msgavsia. Tumca arTriti da mioziti bavSvTa asakSi ufro xSirad gvsvdeba, asakis matebasTan erTad iSviaTdeba. orqiti ufro mozardebSi vlindeba, vidre zrdasrul mamakacebSi. oxc-is dawyebis asakic mniSvnelovania. amiloidozis riski ufro maRalia aranamkurnaleb pacientebSi daavadebis adre dawyebisas.

rogor diagnostirdeba?
oxc-is diagnozis dasasmelad raime specifiuri sadiagnostiko saSualeba ar arsebobs. Semdegi midgomebia rekomendirebuli:
a) eWvis mitana klinikuri gamovlinebebis arsebobisas: daavadeba SeiZleba vivaraudoT mxolod im SemTxvevaSi Tu bavSvma sul cota sami Seteva gadaitana. detalur anamnezSi gaTvaliswinebuli unda iyos eTnikuri kuTvnileba, msgavsi Civilebisa an Tirkmlis ukmarisobis arseboba naTesavebSi.
b) mSoblebs unda vTxovoT detalurad aRweron wina Seteva.
g) midevneba: bavSvi, oxc-ze saeWvo, Txoulobs guldasmiT dakvirvebas manam, sanam diagnozi sabolood daismebodes. meTvalyureobis periodSi Setevis dros bavSvi guldasmiT unda gaisinjos da gaukeTdes zogierTi sisxlis analizi anTebis dasadgenad.
Cveulebriv kvlevis Sedegebi Setevis dros dadebiTia, Setevis moxsnis Semdeg ki normas an normasTan miaxloebul mdgomareobas ubrundeba. daavadebis am stadiaSi diagnozis dasasmelad specialuri kriteriumebia SemuSavebuli.
sxvadasxva mizezis gamo Setevis dros bavSvis naxva yovelTvis ar aris SesaZlebeli. amitom mSoblebs Txoven awarmoon dRiuri da aRweron ra xdeba am dros. maT aseve SeuZliaT gamoiyenon adgilobrivi laboratoria sisxlis gamokvlevebis Casatareblad.
g) kolxiciniT mkurnalobis Sedegi: bavSvebs, romelTac aqvT iseTi klinikur-laboratoriuli monacemebi, romelic oxc-s diagnozis maRal albaTobaze miuTiTebs, daaxloebiT 6 Tvis manZilze eZlevaT kolxicini Sesabamisi pasuxis Sesafaseblad. Tu pacients aqvs oxc, Setevebi an sul ar eqneba, an maTi ricxvi, simZime da xangrZlivoba mniSvnelovnad Semcirdeba.
mxolod mas Semdeg, rac zemod aRniSnuli gakeTdeba, SeiZleba daisvas saboloo diagnozi da pavients daeniSnos kolxiciniT mkurnaloba mTeli sicocxlis manZilze.
vinaidan oxc-is dros organoTa sxvadasxva ziandeba, diagnozis dasmasa da, Sesabamisad. mkurnalobis ganxorcielebaSi sxvadasxva specialisti monawileobs: pediatri, bavSvTa an zogadi revmatologi, nefrologi (Tirkmlis daavadebebis specialisti), gastroenterologi.
d) genetikuri analizi: ukanasknel wlebSi pacientebs SeiZleba Cautardes specialuri genetikuri gamokvleva mutaciuri genis gamosavlenad, romelic, rogorc fiqroben, am daavadebis ganviTarebaze pasuxismgebelia.
daavadebis klinikuri diagnozi dasturdeba, Tu pacienti ori mutaciuri genis mtarebelia, TiToeuli mSoblisgan TiTosi. Tumca am droisaTvis aRwerili mutaciebi oxc-iT daavadebulTa daaxloebiT 70-80%-Sia aRmoCenili. es imaze miuTiTebs, rom arian oxc-iT daavadebulebi mutaciuri genis gareSe.
swored amitom oxc-s diagnozis dasma jerac klinikur gansjas eyrdnoba. genetikuri kvleva yvela centrsa da qveyanaSi xelmisawvdomi ar aris.
cxeleba da muclis tkivili bavSvTa asakSi yvelaze xSiri Civilebia. amitomac am diagnozis dasma maRali riskis mqone populaciaSic ki Znelia. ramdenime weli midis xolme imaze, rom daavadeba gamocnobil iqnas. diagnozis aseTi dagvianeba ki Zalze mniSvnelovania, vinaidan aranamkurnaleb pacientebSi amiloidozis ganviTarebis riski izrdeba.
arsebobs ramdenime daavadeba, romelsac cxelebis, muclisa da saxsrebis tkivilis Setevebi axasiaTebs. maTi umravlesoba genetikuria, SeiZleba ramdenime davasaxeloT. eseni arian mevalonatkinazasTan asocirebuli perioduli cxelebis sindromi (maps) (sinonimia hiperimunoglobulin D sindromi, hids), simsivnis nekrozis faqtoris (snf) receptorTan asocirebuli perioduli sindromi (sraps), perioduli cxeleba aftozuri stomatitiT, faringitiT, adenitiT (pcafa), bexCetis daavadeba, Muckle-Wells-is sindromi (daavadeba), Cvil bavSvTa qronikuli nevrologiuri, kanis da saxsrovani (Cbqnks) sindromi. maT aqvT oxc-sTan saerTo klinikuri niSnebi, amave drois ganirCevian klinikuri da laboratoriuli maxasiaTeblebiT.

ra mniSvneloba aqvs laboratoriul gamokvlevebs?
a) sisxlis gamokvlevebi:
rogorc zemodaa aRniSnuli, laboratoriuli testebi metad mniSvnelovania oxc-is diagnozis dasasmelad. testebi - eriTrocitebis daleqvis siCqaris, C-reaqtiuli cilis, sisxlis TeTri ujredebis (leikocitebis) raodenobisa da fibrinogenis koncentraciis gansazRvrisaTvis iniSneba Setevis dros anTebis xarisxis dasadgenad.
mas Semdeg, rac bavSvis mdgomareoba gaumjobesdeba, am testebs imeoreben, raTa daadginon maCveneblebi normaluri an normasTan miaxloebuli Tu gaxda. avadmyofTa mesamedSi adgili aqvs maT normalizacias, SemTxvevaTa or mesamedSi ki gadaxrebi Tumca mniSvnelovnad mcirdeba, mainc normis zeda zRvars mcired aRemateba.
sisxlis mcire raodenobaa saWiro agreTve genetikuri analizis Casatareblad. bavSvebi, romelTac daniSnuli aqvT kolxicini mTeli cxovrebis manZilze, monitoringis mizniT weliwadSi orjer unda abarebdnen sisxlsa da Sards analizis Casatareblad.
b) Sardis gamokvlevebi: Sardi isinjeba masSi cilisa da sisxlis wiTeli ujredebis (eriTrocitebis) arsebobaze. es SeiZleba iyos droebiTi gardamavali cvlilebebi Setevis dros. magram amiloidozis dros SardSi cila mudmivadaa. eqimma sifrTxile unda gamoiCinos da daniSnos gamokvlevebi, raTa daadginos Sardis mxriv cvlilebebi amiloidiziT Tu aris ganpirobebuli. damatebiTi gamokvlevebi moicavs SardiT cilis danakargis raodenobriv gansazRvras, swori nawlavisa an Tirkmlis biofsiis gakeTebas.
g) swori nawlavis an Tirkmlis biofsia: swori nawlavis biofsia niSnavs am organodan mcire odenobiT qsovilis aRebas, es metad advilad gansaxorcielebadia. Tu swori nawlavis biofsiiT amiloidozi ar gamovlinda, diagnozis dasadastureblad aucilebelia Tirkmlis biofsiis gakeTeba. am gamokvlevis Casatareblad bavSvi saavadmyofoSi unda moTavsdes. miRebuli qsovili SeiRebeba da Semdeg mas mikroskopiT Seiswavlian masSi amiloidis CanarTebis, depozitebis aRmosaCenad.

ikurneba Tu ara?
diax, mas SeiZleba vumkurnaloT kolxiciniT, mTeli sicocxlis ganmavlobaSi. sinamdvileSi es Terapia ar gankurnavs, igi ufro ganmeorebiTi Setevebisa da amiloidozis Tavidan asacileblad gamoiyeneba. amave dros, wamlis Sewyvetisas Setevebi isev ganaxldeba xolme, amiloidozis riskic matulobs.

rogoria mkurnaloba?
oxc-is mkurnaloba martivia, iafi da mniSvnelovani gverdiTi efeqtebis gareSe. dResdReobiT kolxicini erTaderTi preparatia, romelic oxc-is mkurnalobaSi gamoiyeneba. rogorc ki diagnozi daismeba, wamali mTeli sicocxlis manZilze iniSneba. wamlis swored miRebisas SemTxvevaTa daaxloebiT 60%-Si Setevebi sruliad qreba, 30%-Si nawilobrivi gaumjobesebaa, efeqti ar aris 5-10%-Si.
kolxiciniT mkurnalobisas marto Setevebis kontroli ki ar xorcieldeba, aramed amiloidozis ganviTarebis riskic praqtikulad qreba. amitomac Zalze mniSvnelovania, eqimma kidev da kidev auxsnas mSobelsa da pacients Tu ramdenad aucilebelia wamali yovel dRe da daniSnuli doziT miiRos. daniSnulebis Sesruleba uaRresad mniSvnelovania. Tu mkurnalobis reJimi sruldeba, bavSvi Cveulebrivi cxovrebiT cxovrobs da misi sicocxlis mosalodneli xangrZlivoba igivea rac janmrTeli bavSvisa. mSoblebi dozas ar unda cvlidnen eqimTan konsultaciis gareSe.
kolxicinis doza uSualod Setevis dros ar unda gaizardos, es ar iqneba efeqturi. mTavaria, Seteva Tavidan aviciloT. kolxicinis sxva wamlebTan raime mniSvnelovan urTierTqmedebas adgili ara aqvs.

Catarebulia ramdenime kvleva oxc-is alternatiuli mkurnalobis Taobaze gama–interferoniT, simsivnis nekrozis faqtoris sawinaaRmdego preparatebiT, TalidomidiT. Tumca monacemebi aRniSnuli preparatebis efeqturobisa da usafrTxoebis Sesaxeb sakmarisad miCneuli ar aris.

rogoria medikamenturi mkurnalobis gverdiTi moqmedeba?
mSoblebisTvis ar aris ioli Seeguon im azrs, rom maTma Svilma wamali mudmivad unda miiRos. Cveulebriv maT awuxebT, ra potenciuri gverdiTi movlenebi SeiZleba Tan axldes kolxicinis miRebas. es wamali usafrTxoa, gverdiTi moqmedeba minimaluria da dozis Semcirebisas Cveulebriv gaivlis xolme. yvelaze xSiri gverdiTi movlena faRaraTia.
zogierTi pacienti ver egueba mocemul dozas nawlavTa xSiri moqmedebisa da siTxis didi raodenobis Semcveli ganavlis gamo. aseT SemTxvevaSi doza mcirdeba manam, sanam faRaraTi ar gaqreba. Semdeg ki nel-nela mas isev zrdian saWiro donemde misaRwevad.
sxva gverdiTi efeqtebia gulis reva, Rebineba, spastiuri xasiaTis tkivili muclis areSi. iSviaT SemTxvevebSi kunTebis sisuste viTardeba. zogjer SeiZleba Semcirdes sisxlis wiTeli da TeTri ujredebisa da Trombocitebis raodenoba, magram es cvlilebebi dozis SemcirebasTan erTad gaivlis xolme.
Cveulebrivi samkurnalo doziT wamlis gamoyenebisas spermatozoidebis raodenobis Semcireba metad iSviaTia. orsulobisa da ZuZuTi kvebis dros qalebma kolxicinis miReba ar unda Sewyviton.
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ramden xans unda grZeldebodes mkurnaloba?
es aris prevenciuli mkurnaloba mTeli sicocxlis ganmavlobaSi.

ra SeiZleba iTqvas aratradiciuli/alternatiuli mkurnalobis Sesaxeb?
aseTi Terapia ar arsebobs.

ra saxis perioduli kontrolia aucilebeli?
mkurnalobaze myof bavSvebs esaWiroebaT sisxlisa da Sardis analizis gakeTeba sul cota weliwadSi orjer.

ramden xans grZeldeba daavadeba?
igi mTeli sicocxle grZeldeba.

rogoria daavadebis grZelvadiani evolucia (prognozi)?
Tu daavadebas swored, mTeli sicocxlis ganmavlobaSi vumkurnalebT, oxc-is mqone bavSvebi normalur cxovrebas ewevian. magram, Tu diagnozi mogvianebiT daisva, mkurnalobis reJimi irRveva, amiloidozis ganviTarebis riski matulobs, rac cud prognozTanaa dakavSirebuli. bavSvebs, romelTac amiloidozi ganuviTardaT, SeiZleba Tirkmlis gadanergva dasWirdeT.
zrdaSi CamorCena oxc-is dros mniSvnelovan problemas ar warmoadgens. Tumca simaRleSi zrdis daCqareba sqesobrivi momwifebis periodSi zogierT bavSvSi mxolod kolxicinis daniSvnis dros aRiniSneba.

sruli gamojansaReba SesaZlebelia?
ara, vinaidan es daavadeba genetikuria. amave dros mTeli sicocxlis ganmavlobaSi kolxiciniT mkurnaloba pacients aZlevs SesaZleblobas icxovros normaluri cxovrebiT, SezRudvebisa da amiloidozis ganviTarebis riskis gareSe.

yoveldRiuri cxovreba
ra uaryofiTi zegavlena SeiZleba moaxdinos daavadebam bavSvisa da ojaxis yoveldRiur cxovrebaze?
bavSvi da ojaxi did gasaWirSia diagnozis dasmamde. mSoblebs xSirad uwevT Svilis saavadmyofoSi miyvana muclis, gulmkerdisa Tu saxsrebis Zlieri tkivilis gamo. zogierT bavSvs araswori diagnozis gamo arasaWiro operaciac ukeTdeba. rogorc ki diagnozi daismeba, bavSvica da ojaxic TiTqmis normalur cxovrebas ewevian. zogierTs aviwydeba kidevac, rom bavSvs oxc aqvs. es SeiZleba saxifaToc gaxdes, vinaidan amas zogjer samkurnalo reJimis darRvevamde mivyavarT.
erTaderTi problemaa mTeli sicocxlis ganmavlobaSi mkurnalobis Catarebis aucileblobasTan dakavSirebuli fsiqologiuri datvirTvaa. amis daZleva SeiZleba pacientebisa da mSoblebis saganmanaTleblo programebis meSveobiT.

ra SeiZleba iTqvas skolis Sesaxeb?
xSirma Setevebma SeiZleba skolaSi mecadineobebis gacdenis mizezi gaxdes. magram kolxiciniT mkurnalobis dawyebisTanave es ukve aRaraa mniSvnelovani problema.
maswavleblebi informirebuli unda iyon daavadebis Sesaxeb da icodnen, ra gaakeTon Setevis SemTxvevaSi.

ra SeiZleba iTqvas sportis Sesaxeb?
oxc-iT daavadebul bavSvebs, romlebic mTeli sicocxle kolxicins Rebuloben, ara aqvT SezRudva sportis nebismier saxes eweodnen. erTaderTi problema SeiZleba Seiqnas saxsris gaxangrZlivebuli anTebisas, ramac SeiZleba dazianebul saxsarSi moZraobis SezRudva gamoiwvios.

ra SeiZleba iTqvas dietis Sesaxeb?
raime specialuri dieta saWiro ar aris.

SeiZleba havam daavadebis mimdinareobaze raime zegavlena moaxdinos?
ara, ar SeiZleba.

SeiZleba bavSvs vaqcinacia Cautardes?
diax, SeiZleba.

ra SeiZleba iTqvas sqesobriv cxovrebaze, orsulobaze, Casaxvis sawinaaRmdego saSualebebze?
oxc-iT daavadebulebs hqondaT fertilobasTan dakavSirebuli problemebi kolxiciniT mkurnalobamde, kolxicinis eris dawyebidan es problema gaqra. wamals orsulobis dros unda Rebulobdnen.