Ukuthi yini iGranulomatosis nge-Polyangiitis? Izimpawu, Izimbangela, & Ukwelashwa

I-Granulomatosis nge-polyangiitis iyisimo esingavamile sezifo ezingapheli lapho isimiso sakho sokugcina impilo sihlasele ngokungalungile imithambo yegazi enempilo emzimbeni wakho. Lokhu kubangela ukuvuvukala emithambe yegazi emincane nephakathi, okungathinta amalungu amaningi kuhlanganise amaphaphu akho, izinso, amasayinasi, nezinye izingxenye zomzimba wakho.

Ungase uzwe odokotela bebiza lesi simo ngokuthi i-Wegener's granulomatosis, nakuba umphakathi wezokwelapha manje usebenzisa igama elisha. Nakuba kuzwakala kuyinkimbinkimbi futhi kuyesabekayo, ukuqonda ukuthi kwenzekani emzimbeni wakho kungakusiza uzizwe ulungile futhi unamandla okusebenzisana neqembu lakho lokunakekelwa kwezempilo.

Ukuthi yini iGranulomatosis nge-Polyangiitis?

I-Granulomatosis nge-polyangiitis kwenzeka lapho isimiso sakho sokugcina impilo sidala ukuvuvukala odongeni lwemithambo yegazi. Cabanga ngakho njengesimiso sakho sokuvikela umzimba siyadida futhi sihlasele imithambo ehambisa igazi ezingxenyeni zomzimba wakho.

Lokhu kuvuvukala kudala amaqembu amancane amaseli okugcina impilo abizwa ngama-granulomas, okuyilapho lesi simo sithola khona igama. La ma-granulomas angakha ezingxenyeni zomzimba ezihlukahlukene, kodwa ngokuvamile athinta uhlelo lwakho lokuphefumula nezinso.

Lesi simo ngokuvamile sithuthuka kubantu abadala abaneminyaka engama-40 kuya kwengu-60, nakuba singase senzeke kunoma iyiphi iminyaka. Sithinta amadoda nabesifazane ngokulinganayo futhi senzeka kuwo wonke amaqembu ezizwe, nakuba sivame kakhulu kubantu abavela eYurophu enyakatho.

Ziyini Izimpawu zeGranulomatosis nge-Polyangiitis?

Izimpawu ozibonayo ziyahluka kuye ngokuthi yiziphi izingxenye zomzimba ezithintekile, futhi ngokuvamile zithuthuka kancane kancane ezinyangeni ezimbalwa noma eziminyakeni esikhundleni sokuvela ngokuzumayo. Abantu abaningi ekuqaleni bayaphambanisa izimpawu zokuqala ngokubanda okuqhubekayo noma ukutheleleka kwamasayinasi.

Nawa izimpawu ezivamile ongaziqaphela:

• Ikhala elide noma evaliwe elingaphuli ngokwelashwa okuvamile
• Ukuphuma kwegazi kwasekhala noma ukubopha ngaphakathi ekhaleni lakho
• Ubuhlungu besayinasi nokucindezela okuzwakala kuhlukile kunokuthi izinkinga zesayinasi eziqhelekile
• Ikhala elide elingase likhiphe i-sputum ebomvu legazi
• Ukuthandeka komoya ngesikhathi semisebenzi evamile
• Ubuhlungu noma ukungakhululeki kwesifuba
• Ukukhathala okungaphuli ngokuphumula
• Ubuhlungu bezingxenye zomzimba nokukhula, ikakhulukazi ezingxenyeni zomzimba ezinkulu
• Ukuvuvukala okungachazeki okuza futhi kuye
• Ukwehla kobunzima okungachazeki

Njengoba lesi simo siqhubeka, ungase uthole izimpawu ezinkulu ezibonisa ukuhileleka kwezinso. Lokhu kungafaka ukushintsha kombala wesisu sakho, ukukhula ezinyaweni zakho noma ebusweni, nokucindezela kwegazi okuphezulu.

Ngokungavamile, abanye abantu baba nezifo zesikhumba, amehlo abomvu noma ubuhlungu, izinkinga zokuzwa, noma ukungathandeki nokukhahlela ezandleni nasezinyaweni zabo. Lezi zimpawu zenzeka lapho ukuvuvukala kuthinta imithambo yegazi kulezi zindawo.

Yini ebangela iGranulomatosis nge-Polyangiitis?

Imbangela eqondile ye-granulomatosis nge-polyangiitis ayiqondakali ngokuphelele, kodwa abacwaningi bakholelwa ukuthi ivela ekuxubeni kwezinto ezivela ezifundweni zezinto eziphilayo nezinto ezikhuthazayo zasemhlabeni. Isimiso sakho sokugcina impilo ngokuyisisekelo siyaphambana futhi siqala ukuhlasele imithambo yegazi yakho.

Osayensi baye baqaphela izinto eziningana ezingase zifake isandla ekuthuthukiseni lesi simo:

• Ukukhethwa kwezinto eziphilayo - amajini athile angase akwenze ube sengozini enkulu
• Izinto ezikhuthazayo zasemhlabeni njengezifo, ikakhulukazi izifo zokuphefumula
• Ukuvezwa ezimweni ezithile zezinto ezinobuthi, nakuba izinto ezikhuthazayo ezithile zingachazeki ngokucacile
• Impendulo yokugcina impilo lapho umzimba wakho ukhiqiza ama-antibodies ngokumelene nezingxenye zomzimba wakho

Abantu abaningi abanesimo esinjalo bane-antibodies ebizwa nge-ANCA (ama-anti-neutrophil cytoplasmic antibodies) egazini labo. Lezi antibodies ziqondisa amaprotheni ezinye i-white blood cells, zibangela ukuvuvukala nokubhujiswa kwezicubu.

Kubalulekile ukuqonda ukuthi lesi simo asiwumkhuhlane, futhi awenzanga lutho ukubangela. Akuxhunyaniswanga nokukhetha indlela yokuphila noma into obungayivikela.

Nini Okufanele Ubone Udokotela ngeGranulomatosis nge-Polyangiitis?

Kufanele uxhumane nodokotela wakho uma unezimpawu eziqhubekayo ezingaphuli ngokwelashwa okuvamile, ikakhulukazi uma zihlale isikhathi esingaphezu kwamasonto ambalwa. Ukuxilongwa kwasekuqaleni nokwelashwa kubalulekile ekuvinjeni izinkinga ezinkulu.

Funani ukunakekelwa kwezokwelapha ngokushesha uma uhlangabezana nanoma yiziphi izimpawu ezinkulu:

• Ukukhokha igazi noma i-sputum ebomvu legazi
• Ukuthandeka komoya okukhulu noma ubunzima bokuthandeka komoya
• Ukushintsha kombono ngokuzumayo noma ubuhlungu lwamehlo
• Unyaweni omnyama noma ophethe igazi
• Ubuthakathaka obukhulu noma ukungathandeki ezingxenyeni zomzimba
• Ubuhlungu noma ukucindezela kwesifuba
• Izimpawu zezinkinga zezinso njengokukhula ebusweni, ezandleni, noma ezinyaweni

Ungalindi uma izimpawu eziningi zenzeka ndawonye, ngisho noma ngayinye ibonakala iphansi ngokwayo. Ukuhlanganiswa kwezimpawu zokuphefumula, izinso, nezimpawu ezijwayelekile kungaba yinto ebalulekile.

Khumbula ukuthi izimpawu zokuqala ngokuvamile zifana nezinye izimo eziqhelekile njengokubanda noma ukutheleleka kwamasayinasi. Kodwa-ke, uma lezi zimpawu ziqhubeka isikhathi eside kunokulindelekile noma zibonakala zinkulu kakhulu, kufanele ukuxoxe nodokotela wakho.

Ziyini Izinto Ezingase Zikhulise Ingozi yeGranulomatosis nge-Polyangiitis?

Nakuba noma ubani angaba nalesi simo, izinto ezithile zingase zikhulise amathuba akho okuthuthukisa i-granulomatosis nge-polyangiitis. Ukuqonda lezi zinto ezingase zikhulise ingozi kungakusiza uhlale uqaphele izimpawu ezingase zivele.

Izinto eziyinhloko ezingase zikhulise ingozi zihlanganisa:

• Iminyaka - ngokuvamile ithinta abantu abadala abaneminyaka engama-40 kuya kwengu-60
• Ubuzwe - ivame kakhulu kubantu abavela eYurophu enyakatho
• Umlando womndeni - ukuba nezihlobo ezinezimo zokugcina impilo kungase kukhulise ingozi kancane
• Indawo yomhlaba - amanani aphezulu ezindawo zaseNyakatho nezindawo zasemakhaya
• Izifo zokuphefumula zangaphambili - ucwaningo oluthile luphakamisa ukuxhumana okungenzeka
• Ukuvezwa othulini lwesilika - ukuvezwa emsebenzini kungaba yinto eyingozi

Ukuba nalezi zinto ezingase zikhulise ingozi akusho ukuthi uzoba nalesi simo ngokuqinisekile. Abantu abaningi abanezinto eziningi ezingase zikhulise ingozi abazitholi i-granulomatosis nge-polyangiitis, kanti abanye abangenazo izinto ezingase zikhulise ingozi ebonakalayo bayayithola.

Lesi simo sithinta amadoda nabesifazane ngokulinganayo, futhi nakuba sivame kakhulu kubantu abathile, singase senzeke kubantu banoma yiluphi ubuzwe. Izigameko eziningi zibonakala zingezona ezivela emindenini.

Ziyini Izinkinga Ezingase Zenzeke ngeGranulomatosis nge-Polyangiitis?

Ngaphandle kokwelashwa okufanele, i-granulomatosis nge-polyangiitis ingabangela izinkinga ezinkulu njengoba ukuvuvukala kubhubhisa imithambo yegazi namalungu. Kodwa-ke, ngokuxilongwa kwasekuqaleni nokwelashwa okufanele, izinkinga eziningi zingavikeleka noma ziphathwe kahle.

Izinkinga ezivamile zithinta lezi zindawo zomzimba wakho:

• Ukubhujiswa kwezinso - kungathuthukela ekwehleni kwesikhumba sezinso uma kungenakwelashwa
• Ukukhula kwamaphaphu - kungabangela ubunzima bokuthandeka komoya obuhlala njalo
• Ukwehliswa kokuzwa - kusuka ekuvuvukaleni okuthinta indlebe yangaphakathi
• Izinkinga zombono - kuhlanganise ukufuna amehlo okuvela ekuhilelekeni kwamehlo
• Izinkinga zenhliziyo - kuhlanganise ukuvuvukala kwemisipha yenhliziyo
• Ukubhujiswa kwama-nerve - kubangela ukungathandeki, ukukhahlela, noma ubuthakathaka
• Ukukhula kwesikhumba - kusuka ekuvuvukaleni kwemithambo yegazi esikhuneni
• Ukukhula okungavamile kwasekhala - kusuka ekubhujisweni kwe-cartilage ekuhilelekeni okukhulu kwasekhala

Izinkinga zezinso ziphakathi kwezinkulu kakhulu, njengoba zingase zithuthuke ngokuthula ngaphandle kwezimpawu ezicacile kuze kube yilapho ukubhujiswa okukhulu sekwenzeke. Kungakho ukulandelela okuvamile ngokuhlola igazi ne-urine kubalulekile kangaka.

Ngokungavamile, abanye abantu bangase babe nezinkinga ezithinta ubuchopho, kuhlanganise nokushaya noma ukubamba, nakuba lokhu kungavamile. Izindaba ezinhle ukuthi ngokwelashwa okufanele, abantu abaningi bangagwema lezi zinkinga ezinkulu futhi bahlale benempilo enhle.

Ukuthi iGranulomatosis nge-Polyangiitis Ixilongwe Kanjani?

Ukuxilonga i-granulomatosis nge-polyangiitis kungaba inselele ngoba izimpawu zayo ngokuvamile zifana nezinye izimo eziqhelekile. Udokotela wakho uzosebenzisa ukuhlanganiswa kokuhlola nokuhlolwa ukuze afinyelele ekuxilongweni okuchaneka.

Inqubo yokuxilonga ngokuvamile ihlanganisa izinyathelo eziningana. Okokuqala, udokotela wakho uzothatha umlando wezokwelapha ophelele futhi enze ukuhlolwa komzimba, agxile ohlelweni lwakho lokuphefumula, izinso, nanoma yiziphi izingxenye zomzimba ezithintekile.

Ukuhlola igazi kudlala indima ebalulekile ekuxilongweni. Udokotela wakho uzohlola ama-ANCA antibodies, akhona cishe ku-80-90% yabantu abanesimo esinjalo. Bazobheka futhi izimpawu zokuvuvukala nezinhlungu zokusebenza kwezinso.

Izifundo zokuthola izithombe zisiza udokotela wakho ukubona izingxenye zomzimba ezithintekile. Lokhu kungafaka i-X-rays yesifuba noma i-CT scans ukuhlola amaphaphu akho, ne-sinus CT scans ukuhlola ukuvuvukala emizileni yakho yasekhala nasemasayinasini.

Ezimeni eziningi, udokotela wakho uzokhuthaza i-tissue biopsy ukuze aqinisekise ukuxilongwa. Lokhu kuhilela ukuthatha isampula encane yesicubu esithintekile, ngokuvamile ekhaleni lakho, amaphaphu, noma izinso, ukuze ubone ama-granulomas ahambisanayo ngaphansi komkhiqizo.

Ukuhlola i-urine kubalulekile ekutholeni ukuhileleka kwezinso, ngisho noma ungenazo izimpawu ezicacile. Udokotela wakho uzohlola iprotheni, igazi, noma amaseli angavamile angase abonise ukubhujiswa kwezinso.

Ukuthi iGranulomatosis nge-Polyangiitis Iwela Kanjani?

Ukuphatha i-granulomatosis nge-polyangiitis kugxile ekulawuleni ukuvuvukala nasekuvinjeni ukubhujiswa kwamalungu. Izindaba ezinhle ukuthi ngokwelashwa okufanele, abantu abaningi bangafinyelela ekuphumuleni futhi bahlale benempilo enhle.

Uhlelo lwakho lokwelashwa ngokuvamile luzoba nezinyathelo ezimbili. Isinyathelo sokuqala siqonde ekulawuleni ngokushesha ukuvuvukala okusebenzayo nokuletha isifo ekuphumuleni. Isinyathelo sesibili sigxile ekuhlaliseni ukuphumula nasekuvinjeni ukubuyela kwesifo.

Phakathi nesinyathelo sokuqala sokwelashwa, udokotela wakho cishe uzokubhalela imithi enamandla ukuze ucindezele isimiso sakho sokugcina impilo:

• Ama-corticosteroids afana ne-prednisone ukuze unciphise ukuvuvukala ngokushesha
• Imithi yokucindezela isimiso sokugcina impilo efana ne-cyclophosphamide noma i-rituximab
• Ukuphatha okuhlanganisiwe okwenzelwe izimpawu zakho ezithile nokuhileleka kwamalungu

Uma isimo sakho sesikuphumule, uzoshintshela emithini yokugcina. Lokhu kungafaka i-methotrexate, i-azathioprine, noma i-rituximab ngamanani aphansi ukuze uvikele isimo ekubuyeleni.

Iqembu lakho lokwelashwa lingase lihlanganise ochwepheshe abaningi abasebenza ndawonye. Ungase ubona udokotela we-rheumatologist ngokuphatha isifo sonke, udokotela we-nephrologist uma izinso zakho zithintekile, nodokotela we-pulmonologist ngokubandakanyeka kwamaphaphu.

Ukulandelela okuvamile kubalulekile kulo lonke ukwelashwa. Udokotela wakho uzolandelela impendulo yakho ngokuhlola igazi, izifundo zokuthola izithombe, nokuhlolwa komzimba ukuze alungise imithi njengoba kudingeka futhi abheke imiphumela emibi.

Ukuthi Ungathatha Kanjani Ukwelashwa Ekhaya Ngesikhathi SeGranulomatosis nge-Polyangiitis?

Nakuba ukwelashwa kwezokwelapha kubalulekile, kunezinto eziningana ongazenza ekhaya ukuze usekele impilo yakho futhi ulawule izimpawu. Lezi zindlela zisebenza ndawonye nemithi yakho ebhaliwe, hhayi esikhundleni sayo.

Ukukhathalela impilo yakho yonke kuba yinto ebalulekile kakhulu lapho uphatha lesi simo. Gxila ekudleni ukudla okuhlanzekile okugcwele izondlo ukuze usekele isimiso sakho sokugcina impilo futhi usize umzimba wakho ukubhekana nemiphumela emibi yokwelashwa.

Nawa amanye amaqhinga okuhlanza ekhaya awusizo:

• Thola ukuphumula okwanele - zama ukuthola amahora angu-7-9 okulala okuhle ubusuku ngalunye
• Hlala uthambile ngokuphuza amanzi amaningi usuku lonke
• Sebenzisa i-humidifier ukuze ugcine imizila yasekhala ibe manzi futhi ibe lula
• Yenza umsebenzi olula njengoba kuvunyelwe udokotela wakho ukuze ugcine amandla
• Gwema ukubhema nokubhema okusecondhand, okungase kubangele izimpawu zokuphefumula zibe zimbi
• Sebenzisa i-saline nasal rinses ukuze usize ngezimpawu zesayinasi
• Thatha imithi ngokuqondile njengoba kubhaliwe, ngisho noma uzizwa kangcono

Ukuphatha ukucindezeleka nakho kubalulekile, njengoba ukucindezeleka kungase kukhuthaze ukubuyela kwesifo. Cabanga ngezindlela zokuphumula njengokuphefumula okujulile, ukuzindla, noma i-yoga olula uma udokotela wakho evuma.

Gcina uqaphele izimpawu zakho encwadini. Lokhu kungakusiza wena neqembu lakho lokunakekelwa kwezempilo ukubona izindlela noma izimpawu zokuqala zokubuyela kwesifo, okuvumela ukulungiswa kokwelashwa ngokushesha uma kudingeka.

Ukuthi Kufanele Uzilungiselele Kanjani Ukuya Kulodokotela?

Ukulungiselela ukuya kwakho kudokotela kungakusiza ukwenze kakhulu isikhathi sakho nodokotela wakho futhi kuqinisekise ukuthi uthola ulwazi nokukhathalela okudingayo. Ukulungiselela okuhle kuholela ezingxoxweni ezisebenzayo ngesimo sakho.

Ngaphambi kokubona udokotela, bhala zonke izimpawu zakho, kuhlanganise nokuthi zaqala nini nokuthi zishintshe kanjani ngokuhamba kwesikhathi. Faka imininingwane mayelana nalokho okwenza kube ngcono noma kube zimbi, nanoma yiziphi izindlela ozibonile.

Letha uhlu oluphelele lwemithi yonke oyithathayo, kuhlanganise nemithi ebhaliwe, imithi yokuthengwa ngaphandle komthetho, kanye nezinye izinto. Faka amanani nokuthi uthatha ngayinye kangaki.

Lungisa imibuzo yakho kusengaphambili ukuze ungakhohlwa izinto ezibalulekile ngesikhathi sokubona udokotela:

• Yiziphi izivivinyo engizidingayo, futhi zizosisholani?
• Ziyini izinketho zokwelashwa kwami ​​kanye nemiphumela emibi engase ibe khona?
• Sizolandelela kanjani isimo sami ngokuhamba kwesikhathi?
• Ziyiphi izimpawu okufanele zingenze ngixhumane nawe ngokushesha?
• Ingabe kunezinto engingazigwema noma ngizishintshe?
• Lokhu simo singase sithinte kanjani impilo yami yansuku zonke nomsebenzi wami?

Cabanga ukuletha umngani noma ilungu lomndeni omethembayo ekuhlanganyeleni kwakho. Bangakusiza ukukhumbula ulwazi olubalulekile futhi banikeze ukwesekwa ngokomzwelo ngesikhathi esingase sibe yisikhathi esicindezelayo.

Butha noma yiziphi izincwadi zezokwelapha zangaphambili, imiphumela yokuhlola, noma izifundo zokuthola izithombe ezingase zihambisane nezimpawu zakho zamanje. Lolu lwazi lungasiza udokotela wakho ukuthi athole isithombe esiphelele somlando wakho wezempilo.

Yini Eyinhloko Okufanele Uyikhumbule NgeGranulomatosis nge-Polyangiitis?

I-Granulomatosis nge-polyangiitis iyisimo esinzima kodwa esiphatheka sezifo ezingapheli ezithinta imithambo yegazi kulo lonke umzimba wakho. Nakuba kungase kubonakale kuyinkimbinkimbi ekuqaleni, ukuqonda isimo sakho kukwenza ube namandla okusebenzisana kahle neqembu lakho lokunakekelwa kwezempilo.

Into ebaluleke kakhulu okumele uyikhumbule ukuthi ukuxilongwa kwasekuqaleni nokwelashwa kwenza umehluko omkhulu emiphumeleni. Ngokunakekelwa kwezokwelapha okufanele, abantu abaningi abanesimo esinjalo bangafinyelela ekuphumuleni futhi bahlale benempilo enhle.

Uhambo lwakho nalesi simo luzoba oluhlukile, futhi izinhlelo zokwelashwa zenzelwe izidingo zakho ezithile nezimpawu. Hlala uhileleke ekunakekelweni kwakho, buza imibuzo, futhi ungangabazi ukuxhumana neqembu lakho lokunakekelwa kwezempilo uma kukhona ukukhathazeka.

Khumbula ukuthi ukuphatha lesi simo kuyilwimi phakathi kwakho neqembu lakho lezokwelapha. Ngokuhlala unolwazi, ulandela uhlelo lwakho lokwelashwa, futhi uhlale uxhumana nodokotela bakho, uthatha izinyathelo ezibalulekile ekutholeni umphumela omuhle kakhulu.

Imibuzo Evamile Ebuzwayo NgeGranulomatosis nge-Polyangiitis

Ingabe i-granulomatosis nge-polyangiitis iyaphulileka?

Nakuba ayikho impumuzo eqinisekile, i-granulomatosis nge-polyangiitis iyakwelashwa kakhulu. Abantu abaningi bangafinyelela ekuphumuleni isikhathi eside ngemithi efanele nokulandelela. Abantu abaningi baphila impilo evamile, esebenzayo lapho isimo sabo silawulwa kahle. Okubalulekile ukuxilongwa kwasekuqaleni nokwelashwa okuqhubekayo ukuvimbela ukubhujiswa kwamalungu.

Ukwelashwa kuvame ukuphela isikhathi esingakanani?

Ukwelashwa ngokuvamile kwenzeka ngezigaba ezimbili. Ukwelashwa okuqine kokuqala ukuze kufinyelelwe ekuphumuleni ngokuvamile kuhlala izinyanga ezingu-3-6. Ngemva kwalokho, cishe uzodinga ukwelashwa okuqhubekayo iminyaka eminingana ukuze uvikele ukubuyela kwesifo. Abanye abantu ekugcineni bangase bakwazi ukunciphisa noma ukuyeka imithi, kanti abanye badinga ukwelashwa isikhathi eside. Udokotela wakho uzosebenza nawe ukuze uthole isikhathi esifushane sokusebenza sokwelashwa.

Ngikwazi yini ukuphila impilo evamile ngalesi simo?

Yebo, abantu abaningi abane-granulomatosis nge-polyangiitis baphila impilo egcwele, esebenzayo. Nakuba uzodinga ukulandelela okuvamile kwezokwelapha futhi ungase udinga ukwenza izinguquko zendlela yokuphila, imisebenzi eminingi yansuku zonke isasebenza. Abantu abaningi baqhubeka besebenza, behamba, futhi bajabulela imisebenzi yabo yokuhlala. Okubalulekile ukulandela uhlelo lwakho lokwelashwa futhi uhlale uxhumana neqembu lakho lokunakekelwa kwezempilo.

Ingabe kukhona ukudla engingakugwema ngenkathi ngithatha imithi yokwelashwa?

Imithi ethile esetshenziswa ukwelapha lesi simo ingase idinge ukunakekelwa kokudla. Isibonelo, uma uthatha ama-corticosteroids, ungase udinga ukulinganisela i-sodium futhi wandise ukudla kwe-calcium. Imithi yokucindezela isimiso sokugcina impilo ingase idinge ukugwema ukudla okuthile okungase kukhulise ingozi yokutheleleka. Udokotela wakho noma umqeqeshi wokudla obhalisiwe angakunika isiqondiso esithile esisekelwe emithini yakho nasesimweni sakho sempilo sonke.

Kufanele ngenzeni uma ngicabanga ukuthi ngibuyela esimweni sami?

Xhumana nodokotela wakho ngokushesha uma uqaphela izimpawu ezibuyayo noma ezimbi, ikakhulukazi izinkinga zokuphefumula, ukushintsha kwe-urine, noma izimpawu ezintsha. Ungalindi ukubona uma izimpawu ziyaphulile. Ukwelashwa kwasekuqaleni kokubuyela kwesifo kungavimbela izinkinga ezinkulu futhi ngokuvamile kudinga ukwelashwa okungaphansi kunokulinda kuze kube yilapho izimpawu zibe zimbi.