natgillin/translations-raw huggingface dataset:
Recurrent UTIs are common among young, healthy women, even though they generally have anatomically and physiologically normal urinary tracts (Hooton 2001).
Ponavljajoče se okužbe sečil so pogoste pri mladih, zdravih ženskah, čeprav imajo na splošno anatomsko in fiziološko normalna sečila (Hooton, 2001).
Vaginal rinsing with povidone iodine can provide rapid relieve of symptoms but does not provide long-term cure of the bacterial loads.
Izpiranje nožnice s povidon-jodom lahko hitro lajša simptome, vendar ne zagotavlja dolgoročnega zmanjšanja količine bakterij.
Local antibiotics most suitable are preferably non-absorbed and broad spectrum, especially covering enteric gram-positive and gram-negative aerobes, like kanamycin.
Najbolj primerni lokalni antibiotiki so neabsorbirani in s širokim spektrom, zlasti s pokrivanjem enteričnih grampozitivnih in gramnegativnih aerobov, kot je kanamicin.
Antibiotic prophylaxis is not recommended for most travellers (CDC 2017; Hill et al 2006; Public Health Agency of Canada 2015; Riddle et al 2016).
Profilaksa z antibiotiki za večino popotnikov ni priporočljiva (CDC, 2017; Hill et al, 2006; Public Health Agency of Canada, 2015; Riddle et al, 2016).
Relevant stakeholders, including academia and MAHs, are encouraged to perform further research that would further characterise these disabling adverse drug reactions.
Ustrezne zainteresirane strani, vključno z akademiki in imetniki dovoljenja za promet z zdravilom, se spodbuja, da opravijo dodatne raziskave, ki bi še bolj opisale te onesposobljajoče neželene učinke zdravil.
The benefit-risk balance remains positive and its incremental change does not warrant any amendment to the indication.
Razmerje med tveganji in koristmi ostaja pozitivno, zato njegova naraščajoča sprememba ne upravičuje nobenih sprememb indikacij.
(1) too broad and encompass too many medical entities in terms of the scientific evidence available for (fluoro)quinolone benefit/risk assessment, in view of the Guideline on the evaluation of medicinal products indicated for treatment of bacterial infections (CPMP/EWP/558/95 rev 2) and in relation to the (sub) indications mentioned in categories 1, 2 or 3 above.
(1) preveč široke in vključujejo preveč medicinskih izrazov glede na znanstvene dokaze, ki so na voljo za oceno koristi in tveganj uporabe (fluoro)kinolonov, ob upoštevanju Smernic o vrednotenju zdravil z indikacijo za zdravljenje bakterijskih okužb (CPMP/EWP/558/95, rev 2) in v zvezi s (pod)indikacijami, navedenimi v kategorijah 1, 2 ali 3 zgoraj.
In EU, the indication of meningitis is only authorised for pefloxacin.
V EU je indikacija meningitisa odobrena samo za pefloksacin.
Infective endocarditis is a severe and life-threatening disease associated with high mortality.
Infektivni endokarditis je huda in smrtno nevarna bolezen, povezana z visoko smrtnostjo.
Category 2: indications to be restricted
Kategorija 2: indikacije, ki jih je treba omejiti
The later ones (starting with norfloxacin) possess an increasingly broader spectrum of activity; they are fluorinated at C-6 carbon of their basic ring structure, hence so-called fluoroquinolones.
Novejše spojine (začenši z norfloksacinom) imajo vedno širši spekter delovanja; so fluorirane na ogljiku C-6 v strukturi osnovnega obroča, zato jih imenujemo fluorokinoloni.
These indications shall be amended.
Te indikacije se spremenijo.
Based on the available data, approximately 90% cases of pharyngitis and 70% cases of tonsillitis in adults and children are of viral origin (Zoorob et al 2012).
Na podlagi razpoložljivih podatkov je znano, da približno 90 % primerov faringitisa in 70 % primerov tonzilitisa pri odraslih in otrocih povzročijo virusi (Zoorob et al., 2012).
Urethritis and cervicitis
Uretritis in cervicitis
In the EU, the indication endocarditis is approved exclusively for pefloxacin.
Indikacija endokarditisa je v EU odobrena izključno za pefloksacin.
While these ADRs are already included in the EU product information of quinolones and fluoroquinolones, the severity and persistence of these known ADRs has not yet been systematically evaluated in the EU.
Čeprav so ti neželeni učinki že vključeni v informacije o zdravilu za kinolone in fluorokinolone v EU, resnost in trajanje znanih neželenih učinkov v EU še nista bila sistematično ovrednotena.
The recommendation for the restriction to last line is based on the below:
Priporočilo za omejitev na zdravilo zadnje izbire temelji na naslednjem:
In addition, pefloxacin has low urinary excretion (34% of pefloxacin dose including its active metabolite norfloxacin) (Naber 2001).
Poleg tega ima pefloksacin majhno izločanje skozi sečila (34 % odmerka pefloksacina, vključno z njegovim aktivnim presnovkom norfloksacinom) (Naber 2001).
(Fluoro)quinolones are sometimes recommended in the initial treatment of serious and/or complicated cases of aerobic vaginitis (i.e. to control acute symptoms in severe cases such as staphylococcal or macular streptococcal vaginitis).
(Fluoro)kinoloni se včasih priporočajo pri začetnem zdravljenju resnih in/ali zapletenih primerov aerobnega vaginitisa (npr. za obvladovanje akutnih simptomov v hudih primerih, kot sta stafilokokni ali makularni streptokokni vaginitis).
While the efficacy of topical antibacterial therapy was confirmed in clinical trials, the use of systemic therapy is questionable (Freedman 1978; Yelland 1993; Cannon 1970) and should be limited to persistent otitis externa or local or systemic spread of the infection (Sander 2001).
Medtem ko je bila učinkovitost topične antibiotične terapije potrjena v kliničnih preskušanjih, je uporaba sistemske terapije vprašljiva (Freedman 1978; Yelland 1993; Cannon 1970), zato jo moramo omejiti na trdovratno vnetje zunanjega ušesa ali lokalno ali sistemsko širjenje okužbe (Sander 2001).
In cases with Candida present on microscopy or culture, antifungals must be tried first, in order to see if other treatment is still needed.
Kadar je na mikroskopiji ali v kulturi prisotna glivica Candida, je treba najprej preizkusiti zdravila proti glivicam, da bi ugotovili, ali je potrebno tudi drugačno zdravljenje.
Almost 95% of MOE cases reported in the literature are attributed to Pseudomonas aeruginosa (Bovo et al. 2012).
Skoraj 95 % primerov MOE, navedenih v literaturi, je določenih Pseudomonas aeruginosa (Bovo et al., 2012).
According to the European Association of Urology (EAU) guideline (Bonkat et al 2017), prevention of uncomplicated rUTIs includes counselling and behavioural modifications.
V skladu s smernicami Evropske zveze za urologijo (EAU) (Bonkat et al., 2017) preprečevanje nezapletenih ponavljajočih se okužb sečil obsega svetovanje in spremembe vedenja.
Pefloxacin antimicrobial activity against bacterial strains relevant for this indication is low (Hoogkamp-Korstanje 1997).
Protimikrobno delovanje pefloksacina proti bakterijam, pomembnim pri tej indikaciji, je slabo (Hoogkamp-Korstanje 1997).
There is no avalaible data establishing efficacy in this clinical setting.
V teh kliničnih okoliščinah ni nobenih razpoložljivih podatkov o učinkovitosti.
(Fluoro)quinolones have not been extensively studied for the treatment of acute bacterial meningitis and therefore there is only sparse data available regarding the use of pefloxacin in patients with meningitis that do not allow establishing efficacy.
(Fluoro)kinoloni niso bili obsežno raziskani za zdravljenje akutnega bakterijskega meningitisa, zato je na voljo malo podatkov o uporabi pefloksacina pri bolnikih z meningitisom, ki ne omogočajo ugotavljanja učinkovitosti.
Septicaemia is a severe and life-threatening disease associated with high mortality.
Septikemija je huda in smrtno nevarna bolezen, povezana z visoko smrtnostjo.
Indeed, the PRAC could not identify any solid evidence on the efficacy of (fluoro)quinolone use in this indication.
Pravzaprav odbor PRAC ni mogel najti trdnih dokazov o učinkovitosti (fluoro)kinolonov pri tej indikaciji.
It should be noted that pefloxacin has a poor antimicrobial activity against P. aeruginosa, thus, the benefit is very limited.
Opozoriti je treba, da ima pefloksacin slabo protimikrobno delovanje proti bakteriji P. aeruginosa in je korist zelo omejena.
Acute bacterial rhinosinusitis (ABS)
Akutni bakterijski rinosinuzitis (ABS)
Fluoroquinolones and quinolones (hereinafter ‘(fluoro)quinolones') are a class of synthetic antibacterial agents that have been used in clinical practice since 1961.
Fluorokinoloni in kinoloni (v nadaljnjem besedilu: (fluoro)kinoloni) spadajo v razred sintetičnih protibakterijskih učinkovin, ki se v klinični praksi uporabljajo od leta 1961 dalje.
Apart from that, the available data shows a poor antimicrobial activity of pefloxacin against Pseudomonas (King and Phillips 1986) and no updated susceptibility data on pefloxacin are available as the European Committee on Antimicrobial Susceptibility Testing (EUCAST) has not defined clinical breakpoints for pefloxacin (http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Rationale_documents/Ciproflo xacin_rationale_1.9.pdf).
Razen tega razpoložljivi podatki kažejo na slabo protimikrobno delovanje pefloksacina proti rodu Pseudomonas (King in Phillips, 1986), na voljo pa tudi ni nobenih posodobljenih podatkov o občutljivosti za pefloksacin, saj Evropski odbor za preverjanje protimikrobne občutljivosti (EUCAST) ni opredelil kliničnih mejnih koncentracij za pefloksacin (http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Rationale_documents/Ciproflo xacin_rationale_1.9.pdf).
Table 5 - Category 4 indications to be reworded according to accurate medical terms
Preglednica 5 - indikacije kategorije 4, ki jih je treba preoblikovati z natančnimi medicinskimi izrazi
Streptococcus species have only moderate sensitivity to pefloxacin, with MIC90 values ranging from 3.1 to 32 mg/L (Gonzalez JP, Henwood JM.
Vrste Streptococcus imajo zmerno občutljivost za pefloksacin, pri čemer znaša vrednost MIK90 od 3,1 do 32 mg/l (Gonzalez JP, Henwood JM (Gonzalez JP, Henwood JM.
The pathogens associated with pyelonephritis consists mainly of E. coli (75% to 95%), with occasional other species of Enterobacteriaceae, such as P. mirabilis and K. pneumoniae, and of Staphylococci.
Povzročitelji, povezani s pielonefritisom, so predvsem bakterija E. coli (od 75 % do 95 %), občasno pa tudi druge enterobakterijske vrste, kot sta P. mirabilis in K. pneumoniae, ter stafilokoki.
Rhinosinusitis is a group of disorders characterized by inflammation of the mucosa of the nose and the paranasal sinuses.
Rinosinuzitis je skupina bolezni, za katera je značilno vnetje sluznice nosu in paranazalnih sinusov.
The earliest substances of this class (starting with nalidixic acid) are non-fluorinated, possess only a narrow spectrum of activity against Gram-negative bacteria and have generally been replaced in clinical practices by more recent antibiotics.
Prve spojine v tem razredu (začenši z nalidiksno kislino) so nefluorirane, imajo le ozek spekter delovanja proti gramnegativnim bakterijam in so jih v klinični praksi na splošno nadomestili novejši antibiotiki.
These substances inhibit synthesis of bacterial DNA via binding to intracellular topoisomerase enzymes and forming drug-enzyme-DNA complexes.
Te snovi zavirajo sintezo bakterijske DNK tako, da se vežejo na znotrajcelične encime topoizomeraze in oblikujejo komplekse zdravilo-encim-DNK.
• Category 2: The newly identified safety concern necessitates a restriction of (fluoro)quinolone use in these indications.
• Kategorija 2: novo ugotovljeni zadržek glede varnosti zahteva omejitev uporabe (fluoro)kinolona pri teh indikacijah.
The therapy should be targeted to the primary infection taking into account PK/PD characteristics of the treatment and site of the infection.
Zdravljenje je treba usmeriti v primarno okužbo ob upoštevanju značilnosti farmakokinetike/farmakodinamike zdravljenja in mesta okužbe.
Infectious laryngitis is mostly a self-limiting viral disease (caused by parainfluenza, rhinovirus, influenza and adenovirus) that does not respond to antibiotic therapy (Higgins, 1974).
Infektivni laringitis je virusna okužba, ki večinoma izzveni sama od sebe (povzročajo ga virusi parainfluence, rinovirus, virus gripe in adenovirus) in se ne odziva na zdravljenje z antibiotiki (Higgins, 1974).
For these indications, the recommendation for the deletion of the indication is based on the below:
Priporočilo za brisanje teh indikacij temelji na naslednjem:
Group B streptococci (GBS), Escherichia coli, Staphylococcus aureus and Enterococcus faecalis are the organisms most frequently associated with Aerobic Vagnitis (Rampersaud et al 2012).
Streptokoki skupine B, Escherichia coli, Staphylococcus aureus in Enterococcus faecalis, so organizmi, ki so najpogosteje povezani z aerobnim vaginitisom (Rampersaud et al, 2012).
Thus, the current role of pefloxacin for the management of bacterial prostatitis and the benefit of using pefloxacin to treat these infections is unknown.
Torej sta trenutna vloga pefloksacina za zdravljenje bakterijskega prostatitisa in korist uporabe pefloksacina za zdravljenje teh okužb neznani.
Table 4 - Category 4 indications that are considered too broad
Preglednica 4 - indikacije kategorije 4, ki so preširoke
(Fluoro)quinolones do not sufficiently cover the spectrum of pathogens which are commonly identified in patients with pharyngitis and/or tonsillitis.
(Fluoro)kinoloni ne pokrivajo zadostno spektra povzročiteljev, ki so pogosto ugotovljeni pri bolnikih s faringitisom in/ali tonzilitisom.
• Category 1: The newly identified nature of the safety concerns does not substantially modify the existing benefit/risk balance and no change to the indication is warranted.
• Kategorija 1: novo opredeljena narava zadržkov glede varnosti ne spreminja bistveno obstoječega razmerja med tveganji in koristmi, zato sprememba indikacije ni upravičena.
Furthermore, for pefloxacin PRAC considered that some of the indications mentioned above in Table 1 should be removed as below:
Poleg tega je za pefloksacin menil, da je treba nekatere od zgoraj navedenih indikacij v preglednici 1 odstraniti, kot je navedeno spodaj:
Reviewed European guidelines do not discuss an option of non-antibacterial therapy of urinary tract infections.
Pregledane evropske smernice ne razpravljajo o možnostih zdravljenja okužb sečil brez antibiotikov.
Vaginal infections (AV)
Okužbe nožnice (AV)
The poor pefloxacin antimicrobial activity against indication specific pathogen precludes its use in this indication as there is a high risk of inadequate coverage and resistance development.
Slabo protimikrobno delovanje pefloksacina proti določenemu povzročitelju pri indikaciji izključuje njegovo uporabo pri tej indikaciji, ker obstaja veliko tveganje za neustrezno pokritost in pojav odpornosti.
The research should focus on current gaps and uncertainties in knowledge, including but not exclusive to, risk factors associated with these specific ADRs, treatments for the ADRs, identification of possible biomarkers to predict these ADRs and underlying mechanisms of action that could lead to the respective reactions.
Raziskave bi se morale osredotočiti na trenutne vrzeli in negotovosti v znanju, med drugim tudi na dejavnike tveganja, povezane z navedenimi neželenimi učinki, zdravljenja neželenih učinkov, določitev morebitnih bioloških označevalcev za napovedovanje teh neželenih učinkov in temeljne mehanizme delovanja, ki vodijo do navedenih učinkov.
In these infections complicated course as well as high level of the resistant pathogens should be expected.
Pri teh okužbah je treba pričakovati zapleten potek in visoko pogostnost odpornih povzročiteljev.
Furthermore, activity of ofloxacin against relevant pathogens is too limited to justify use in nosocomial pneumonia.
Poleg tega je delovanje ofloksacina proti zadevnim povzročiteljem preveč omejeno, da bi upravičilo njegovo uporabo pri bolnišnični pljučnici.
The benefit of systemic antibiotic prophylaxis in general in the clean-contaminated ear surgery is currently not sufficiently substantiated and the benefit over topical antibiotics is not proven.
Prednost sistemske antibiotične profilakse na splošno pri ušesnem kirurškem posegu na čistemkontaminiranem območju ni zadostno utemeljena, koristi pred topičnimi antibiotiki pa niso dokazane.
• Core elements of a direct healthcare professional communication were agreed, together with the timelines for its distribution.
• Dogovorili so se o bistvenih delih neposrednih sporočil za zdravstvene delavce in časovnih okvirih za njihovo razširjanje;
Furthermore, the terminology ‘Infection of cerebrospinal fluid' is considered by the PRAC to be incorrect from a medical perspective.
Poleg tega je odbor PRAC obravnaval izraz „okužba likvorja“ in menil, da je z medicinskega vidika nepravilen.
In case of atypical sexually transmitted pathogens, such as Mycoplasma hominis and Chlamydia trachomatis or Ureaplasma urealyticum, pefloxacin antimicrobial activity is low (Gonzales and Henwood 1989).
V primeru atipičnih spolno prenosljivih povzročiteljev, kot so Mycoplasma hominis in Chlamydia trachomatis ali Ureaplasma urealyticum, je protimikrobno delovanje pefloksacina slabo (Gonzales in Henwood, 1989).
In majority of cases, otitis externa is caused by bacterial infection (Dibb 1991; Rosenfeld et al. 2014), however, also other causative agents such as fungal infection or non-infectious dermatologic processes should be considered.
Večinoma je vnetje zunanjega ušesa posledica bakterijske okužbe (Dibb 1991; Rosenfeld et al. 2014), vendar je treba upoštevati tudi druge povzročitelje, kot so glivična okužba in neinfektivni dermatološki procesi.
Table 1 - Category 1 indications: no modification of the indications
Preglednica 1 - indikacije kategorije 1: brez sprememb indikacij
AV requires a treatment based on microscopy findings and a combined local treatment with any of the following may yield the best results: antibiotic (infectious component), steroids (inflammatory component) and/or oestrogen (atrophy component).
Okužbe nožnice zahtevajo zdravljenje, ki temelji na ugotovitvah mikroskopije, kombinirano lokalno zdravljenje s katerim koli od spodaj navedenih snovi pa lahko privede do najboljših rezultatov: antibiotik (infektivna komponenta), steroidi (vnetna komponenta) in/ali estrogen (komponenta atrofije).
However, lack of symptoms relief and risk of complications (specifically pyelonephritis) have been found to be higher in non-antibiotic group.
Vendar je bilo ugotovljeno, da sta bila nejemanje zdravil za olajšanje simptomov in tveganje za zaplete (zlasti za pojav pielonefritisa) pogostejša v skupini, ki ni prejemala antibiotika.
Category 1: no modification of the indications
Kategorija 1: brez sprememb indikacij
The agent used for peri-procedural prophylaxis should ideally not be one that may be required for treatment of infections.
Zdravilo, ki se uporablja za profilakso pred posegom, v najboljšem primeru ne bi smelo biti takšno, ki je potrebno za zdravljenje okužb.
For these indications, the (fluoro)quinolones medicinal products should be used only when it is considered inappropriate to use other antibacterial agents that are commonly recommended for the treatment of these infections.
Pri teh indikacijah je treba zdravila s (fluoro)kinoloni uporabljati le, če se šteje, da ni primerno uporabljati drugih protibakterijskih zdravil, ki se običajno priporočajo za zdravljenje okužb.
The risk/benefit balance of (fluoro)quinolone use in septicaemia as stated is considered negative and the indication should be deleted.
Razmerje med tveganji in koristmi uporabe (fluoro)kinolonov pri septikemiji je, kot je navedeno, negativno, zato je treba indikacijo izbrisati.
Malignant otitis externa (MOE), also known as necrotizing otitis externa, is a severe invasive bacterial infection that involves the external auditory canal and skull base.
Maligno vnetje zunanjega ušesa (MOE, malignant otitis externa), poimenovano tudi nekrotizirajoče vnetje zunanjega ušesa, je huda invazivna bakterijska okužba, ki zajame zunanji slušni kanal in lobanjsko dno.
Category 3: deletion of indications
Kategorija 3: brisanje indikacij
Latter colonisations are frequent, but inflammatory infection rare, the use of oral antibiotics in women with AV is discouraged (Donders et al 2015; Wang et al. 2016).
Poznejše kolonizacije so pogoste, vendar je vnetna okužba redka, uporaba peroralnih antibiotikov pri ženskah z okužbo nožnice se ne priporoča (Donders et al., 2015; Wang et al., 2016).
Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catharralis were isolated from sputum samples in up to 45% of patients with acute bronchitis (Macfarlane et al. 1993) but their role is difficult to distinguish because of potential oropharyngeal colonization in healthy individuals (Laurenzi et al. 1961; Smith and Lockwood 1986).
Iz izmečkov bolnikov z akutnim bronhitisom so v do 45 % primerov osamili bakterije Streptococcus pneumoniae, Haemophilus influenzae in Moraxella catharralis (Macfarlane et al., 1993), vendar je njihova vloga težko razlikovati, saj se lahko pri zdravih posameznikih (Laurenzi et al.; Smith and Lockwood 1986) pojavi orofaringealna kolonizacija.
Considering the limited benefit and in view of the overall risk related to the use of these medicinal products including the risk of long-lasting, disabling and potentially irreversible reactions, the benefit-risk balance of these medicinal products is negative.
Glede na omejeno korist in splošno tveganje, povezano z uporabo teh zdravil, vključno s tveganjem za dolgotrajne, onesposobljajoče in možne nepopravljive neželene učinke, je razmerje med tveganji in koristmi uporabe teh zdravil negativno.
The MAHs should justify the dosage recommendation and consider appropriate PK/PD data in support of the indication.
Imetniki dovoljenja za promet z zdravilom bi morali utemeljiti priporočila za odmerjanje in upoštevati ustrezne podatke farmakokinetike/farmakodinamike v podporo indikaciji.
Prophylaxis of invasive infections due to Neisseria meningitidis Inhalation anthrax (post-exposure prophylaxis and curative treatment) Infection in immunocompromised patients
Profilaksa invazivnih okužb zaradi bakterije Neisseria meningitidis Inhalacijski antraks (poekspozicijska profilaksa in kurativno zdravljenje) Okužba pri imunsko oslabljenih bolnikih
Acute otitis externa is a cellulitis of the ear canal skin and sub-dermis, with acute inflammation and variable oedema.
Akutno vnetje zunanjega ušesa je celulitis kože ušesnega kanala in podkožja z akutnim vnetjem in spremenljivim edemom.
The role of pefloxacin in the treatment of bacterial prostatitis is considered as not being demonstrated.
Šteje se, da vloga pefloksacina pri zdravljenju bakterijskega prostatitisa ni dokazana.
Generally, the most bronchial infections are of viral origin.
Bronhialne okužbe večinoma povzročajo virusi.
Pneumonia due to Gram-negative bacteria
Pljučnica zaradi gramnegativnih bakterij
The poor antimicrobial activity of pefloxacin to Pseudomonas aeruginosa precludes from its use in nosocomial pneumonia where P. aeruginosa is a frequent pathogen.
Slabo protimikrobno delovanje pefloksacina na Pseudomonas aeruginosa onemogoča njegovo uporabo pri bolnišnični pljučnici, pri kateri je P. aeruginosa pogost povzročitelj.
• Category 3: The newly identified safety concern changes benefit risk to negative and these indications shall be deleted.
• Kategorija 3: novo ugotovljeni zadržek glede varnosti spreminja razmerje med tveganji in koristmi v negativno, zato bodo te indikacije izbrisane.
The benefit-risk balance is therefore negative and the indication should be deleted.
Razmerje med tveganji in koristmi je zato negativno, indikacijo pa je treba izbrisati.
Preoperative preparations for chronic cholesteatomatous otitis and chronic otitis spreading to bone
Predoperativne priprave pri kroničnem holestatskem otitisu in kroničnem otitisu, ki se širi na kost
Infection of cerebrospinal fluid Endocarditis
Okužba likvorja Endokarditis
Overall, the benefit-risk balance in the indication of acute exacerbation of chronic bronchitis and COPD is considered positive only in patients who have no alternative treatment options.
Na splošno je razmerje med tveganji in koristmi pri indikaciji akutnega poslabšanja kroničnega bronhitisa in KOPB pozitivno le pri bolnikih, ki nimajo nadomestnih možnosti zdravljenja.