Ukuthi yini i-Primary Sclerosing Cholangitis? Izimpawu, Izimbangela, kanye Nokwelashwa

I-Primary sclerosing cholangitis (PSC) yisifo sesibindi esingapheli esibangela ukuvuvukala nokwenzakala kwe-bile ducts ngaphakathi nangaphandle kwesibindi sakho. Lezi ducts ngokuvamile zithwala i-bile evela esibindini sakho ziye esibindini sakho esincane ukuze zisize ekuqothuleni amafutha, kodwa i-PSC iyazilimaza kancane kancane ngokuhamba kwesikhathi.

Cabanga nge-bile ducts yakho njengenqwaba yemibhobho ephuma i-bile esibindini sakho. Uma i-PSC ithuthuka, le mibhobho iyakuvuvukala, ibe ne-scarring, futhi ibe mncintisana, okwenza kube nzima i-bile ukuba igeleze kahle. Lokhu kuqongelela kwe-bile kungalimaza ekugcineni isibindi sakho futhi kube yimbangela yezinhlungu ezinkulu uma kungelashwa.

Ziyini izimpawu ze-Primary Sclerosing Cholangitis?

Abantu abaningi abane-PSC abanawo ama-symptom ezigabeni zokuqala, kungakho leli simo sivame ukungabonakali iminyaka eminingi. Uma izimpawu zivele, ngokuvamile zithuthuka kancane njengoba i-bile ducts ilimalala kakhulu.

Izimpawu ezivamile ongaziqaphela zihlanganisa:

• Ukukhathala okuqhubekayo okungaphuli ngokuphumula
• Ukukroba kwesikhumba (pruritus) okungaba nzima futhi kuhlanganise yonke indawo
• Ukukhanya kwesikhumba namehlo (jaundice)
• Ubuhlungu besisu, ikakhulukazi endaweni engaphezulu ngakwesokudla
• Umyisa omnyama kanye nezisu ezimhlophe
• Ukulahlekelwa isisindo okungachazeki
• Ukuqina nokuthandaza ngesikhathi sezigaba zokutheleleka

Ukukroba kungaba yinkinga kakhulu futhi kuvame ukuba sibi ebusuku. Abanye abantu bakucacisa njengokuzwa sengathi abakwazi ukukroba ngokwanele ukuze bathole impumuzo. Lokhu kwenzeka ngoba ama-bile salts aqongelela esikhuneni sakho uma i-bile ingakwazi ukubeka kahle.

Njengoba i-PSC ithuthuka, ungase ube nezimpawu ezihlobene nezinhlungu zesibindi, njengokuqongelela kwamanzi esiswini sakho, ukungabaza, noma ukulula ukweluleka nokopha.

Ziyini izinhlobo ze-Primary Sclerosing Cholangitis?

I-PSC ngokuvamile ihlukaniswe ngezinhlobo ezimbili eziyinhloko ngokusekelwe ekutheni yiziphi i-bile ducts ezithintekayo. Ukuqonda lezi zinhlobo kusiza udokotela wakho ukuthi anqume indlela engcono yokwelapha nokubikezela ukuthi isifo singathuthuka kanjani.

I-Large duct PSC ithonya i-bile ducts eziyinhloko ezingabonwa ekuhlolweni kwezithombe njenge-MRCP (magnetic resonance cholangiopancreatography). Lena yiyona ndlela evamile, emelela cishe u-90% wezimangalo. Abantu abane-large duct PSC ngokuvamile baba nokuvela okuvamile kwe-bile ducts ecindezelekile ne-dilated ebukeka njenge-“beads on a string” ezithombeni.

I-Small duct PSC ithonya kuphela i-bile ducts encane ngaphakathi kwesibindi esingabonakali ekuhlolweni kwezithombe okuvamile. Leli fomu liqondaniswe nge-liver biopsy futhi liyaqhubeka kancane kunaleli large duct PSC. Noma kunjalo, abanye abantu abane-small duct PSC bangase ekugcineni bathuthukise izinguquko ezinkulu zabo ducts.

Kunenye inguquko engavamile ebizwa nge-PSC ene-autoimmune hepatitis overlap syndrome, lapho unezimpawu zombili izimo. Lo mhlangano udinga izindlela zokwelapha ezikhethekile eziphatha zombili izifo.

Yini ebangela i-Primary Sclerosing Cholangitis?

Imbangela eqondile ye-PSC ayaziwa, kodwa abacwaningi bakholelwa ukuthi ivela ekuhlanganiseni kokuthambekela kwezakhiwo kanye nezici zemvelo. I-immune system yakho ibonakala ihlasela i-bile ducts yakho, ibangele ukuvuvukala nokwenzakala okuqondisa leli simo.

Izici eziningi zingase zinikezele ekuthuthukiseni kwe-PSC:

• Izici zezakhiwo - ama-gene athile akwenza ube sengozini kakhulu
• Ukusebenza okungalungile kwe-autoimmune - i-immune system yakho ihlasela izicubu eziphilile
• Ukutheleleka kwe-bacteria e-bile ducts
• Izinto eziyingozi ezilimaza amaseli e-bile duct
• Ukuhlanganiswa okungalungile kwe-bile acid
• Izinkinga ze-blood vessel ezithinta ukunikezwa kwegazi kwe-bile duct

Ubuhlobo obuqinile kakhulu buhambisana nesifo esivuvukalayo sesibindi, ikakhulukazi i-ulcerative colitis. Cishe u-70-80% yabantu abane-PSC banesifo sesibindi, yize uxhumano phakathi kwalezi zimo lungaqondakali ngokuphelele. Ukuba nesifo sesibindi akusho ukuthi uzokuthuthukisa ngokuqinisekile i-PSC, kodwa kukwandisa ingozi yakho.

Ezinye izimbangela ezingavamile ze-secondary sclerosing cholangitis zingafana ne-PSC, kuhlanganise imithi ethile, ukutheleleka, noma ukulimala kwe-bile duct ekuhlinzweni. Noma kunjalo, i-primary sclerosing cholangitis yangempela ithuthuka ngaphandle kwanoma iyiphi imbangela yangaphandle eyaziwayo.

Nini okufanele ubona udokotela nge-Primary Sclerosing Cholangitis?

Kufanele uxhumane nodokotela wakho uma uhlangabezana nezimpawu eziqhubekayo ezingase zibonise izinkinga zesibindi. Ukutholwa kwangaphambi kwesikhathi nokwelashwa kungasiza ekuthuthukiseni ukuqhubeka kwesifo nokuvimbela izinkinga.

Funani ukunakekelwa kwezokwelapha ngokushesha uma uqaphela:

• Ukukhanya kwesikhumba sakho noma ama-whites amehlo akho
• Ukukroba okukhulu, okuqhubekayo ngaphandle kwesizathu esicacile sesikhumba
• Umyisa omnyama ohlangene nezisu ezimhlophe
• Ukukhathala okuqhubekayo okuhlanganisa nemisebenzi yansuku zonke
• Ubuhlungu besisu obungachazeki, ikakhulukazi endaweni engaphezulu ngakwesokudla
• Ukulahlekelwa isisindo okungachazeki

Uma usuvele unesifo sesibindi esivuvukalayo, ukulandelela njalo i-PSC kubalulekile njengoba lezi zimo zivame ukwenzeka ndawonye. I-gastroenterologist yakho ingase ikucele ukuhlolwa okuqhubekayo kwesibindi kanye nezifundo zezithombe.

Funani ukunakekelwa okusheshayo kwezimo eziphuthumayo uma uthuthukisa ukuqina, ukuthandaza, nobuhlungu besisu ndawonye, njengoba lokhu kungase kubonise ukutheleleka okukhulu kwe-bile duct okuthiwa yi-cholangitis okudinga ukwelashwa okusheshayo.

Ziyini izici zengozi ze-Primary Sclerosing Cholangitis?

Izici eziningi zingakwandisa amathuba akho okuthuthukisa i-PSC, yize ukuba nalezi zici zengozi akusho ukuthi uzothola isifo. Ukuqonda ingozi yakho kungasiza ekutholeni kwangaphambi kwesikhathi nokubhekwa.

Izici zengozi ezibaluleke kakhulu zihlanganisa:

• Ukuba nesifo sesibindi esivuvukalayo, ikakhulukazi i-ulcerative colitis
• Ukuba owesilisa - amadoda athinteka kabili kunabesifazane
• Iminyaka phakathi kweminyaka engu-30-50, yize ingase ibe khona kunoma iyiphi iminyaka
• Ubuzwe baseYurophu yaseNyakatho noma iScandinavia
• Umlando womndeni we-PSC noma ezinye izifo ze-autoimmune
• Ukuba namamaki athile e-genetic njenge-HLA-B8 ne-HLA-DR3

Ezinye izici zengozi ezingavamile zihlanganisa ukuba nezinye izimo ze-autoimmune njenge-autoimmune hepatitis, isifo se-thyroid, noma isifo se-celiac. Kungase kube nezici zemvelo esingaziqondi ngokuphelele.

Ngokuthakazelisayo, ukubhema kubonakala kunomphumela ovikela i-PSC kubantu abane-ulcerative colitis, yize odokotela bengakuncomi ukubhema ngenxa yezinye izingozi eziningi zempilo.

Ziyini izinkinga ezingase zenzeke ze-Primary Sclerosing Cholangitis?

I-PSC ingabangela izinkinga eziningi ezinkulu njengoba isifo siqhubeka futhi i-bile duct scarring ibe sibi. Ukuba uqaphele lezi zinto ezingase zenzeke kusiza wena neqembu lakho lokunakekelwa kwezokwelapha ukulandelela izimpawu zezexwayiso nokungenela kwangaphambi kwesikhathi uma kudingeka.

Izinkinga ezivamile zihlanganisa:

• I-Liver cirrhosis nokuhluleka kwesibindi ekugcineni
• I-Portal hypertension eholela esibindini esikhulu nokopha kwe-variceal
• Ukutheleleka okuphindaphindayo kwe-bacteria ye-bile ducts (cholangitis)
• Ama-bile duct stones akha ngenxa yokugeleza okungalungile kwe-bile
• Ukungahlangani kwamandla ama-vitamin (A, D, E, K)
• I-Osteoporosis evela ekungabi khona kwe-vitamin D nasesifweni sesibindi

Enye yezinto ezinkulu kakhulu ukukhathazeka yi-cholangiocarcinoma, uhlobo lomdlavuza we-bile duct oluthuthuka cishe ku-10-15% yabantu abane-PSC. Lo mdlavuza ngokuvamile kunzima ukuwuthola kwangaphambi kwesikhathi, kungakho ukulandelela njalo ngezithombe nezivivinyo zegazi kubaluleke kangaka.

Abantu abane-PSC nesifo sesibindi esivuvukalayo banengozi enkulu yomdlavuza we-colorectal, okudinga ukuhlolwa okuvamile kwe-colonoscopy. Ngaphezu kwalokho, ingozi yomdlavuza we-gallbladder ikhuphuke, yize le nkinga ingavamile.

Izindaba ezinhle ukuthi izinkinga eziningi zingavikeleka noma ziphathwe kahle ngokunakekelwa kwezokwelapha okuhle nokubhekwa. Imihlangano yokulandelela njalo iyasiza ekutholeni izinkinga kwangaphambi kwesikhathi lapho zilawuleka kakhulu.

I-Primary Sclerosing Cholangitis ihlonishwa kanjani?

Ukuhlonishwa kwe-PSC ngokuvamile kuhilela ukuhlanganiswa kwezivivinyo zegazi, izifundo zezithombe, futhi ngezinye izikhathi ukukhethwa kwezicubu. Udokotela wakho uzobheka izibonelo ezifanele ze-bile duct changes kanye ne-laboratory abnormalities ethile.

Inkqubo yokuxilonga ngokuvamile iqala ngezilingo zegazi ezihlola umsebenzi wesibindi sakho. Amazinga aphezulu e-alkaline phosphatase ne-bilirubin yizinto ezivamile, kanye nezinye i-liver enzymes. Udokotela wakho angase futhi ahlole ama-antibodies athile, yize lawa angabi khona njalo e-PSC.

Ivivinyo eliyinhloko lezithombe yi-MRCP (magnetic resonance cholangiopancreatography), enikeza izithombe eziningiliziwe ze-bile ducts yakho ngaphandle kokudinga izinqubo ezinamandla. Leli vivinyo lingabonisa ukubonakala okuvamile kwe-“beads on a string” kwe-bile ducts ecindezelekile ne-dilated okusikisela i-PSC.

Kwezinye izimo, udokotela wakho angase akukhuthaze i-ERCP (endoscopic retrograde cholangiopancreatography), ehilela ukufaka umbo obobukhulu obuncane emlonyeni wakho ukuze uhlole ngokuqondile i-bile ducts. Le nqubo ingasetshenziswa futhi ekuthatheni izibonelo zezicubu noma ekuqedeni izinqubo.

Uma i-small duct PSC ithandwa, i-liver biopsy ingase idingeke njengoba i-ducts ethintekayo incintisana kakhulu ukubonwa ezithombeni. I-biopsy ingabonisa ukuvuvukala nokwenzakala eduze kwe-bile ducts encane ngaphakathi kwesicubu sesibindi.

Yini ukwelashwa kwe-Primary Sclerosing Cholangitis?

Okwamanje, ayikho indlela yokwelapha i-PSC, kodwa izindlela ezahlukene zokwelapha zingasiza ekulawuleni izimpawu, ekuthuthukiseni ukuqhubeka kwesifo, nokuvimbela izinkinga. Uhlelo lwakho lokwelapha luzokwenziwa ngokwezimo zakho ezikhethekile futhi lungase luthuthuke njengoba isimo sakho sishintsha.

Izindlela eziyinhloko zokwelapha zihlanganisa:

• I-Ursodeoxycholic acid (UDCA) ukuthuthukisa ukugeleza kwe-bile nokunciphisa ukuvuvukala kwesibindi
• Imithi yokulawula ukukroba, njenge-cholestyramine noma i-rifampin
• Ama-antibiotics okutheleleka kwe-bile duct
• Ama-vitamin supplements, ikakhulukazi ama-vitamin afanele amafutha A, D, E, ne-K
• Izinqubo ze-endoscopic zokuvula i-bile ducts ecindezelekile
• Ukwelashwa kwesifo sesibindi esivuvukalayo esingaphansi uma sikho

Ngokukroba okukhulu, udokotela wakho angase anikeze imithi efana nama-antihistamines, ama-antidepressants, noma imithi ekhethekile esiza ekuqothuleni ama-bile acids esistim yakho. Abanye abantu bathola impumuzo nge-UV light therapy noma i-plasmapheresis ezimweni eziqine kakhulu.

Uma uthuthukisa i-bile duct strictures (ukuncishiswa okukhulu), ukwandiswa kwe-endoscopic balloon noma ukufakwa kwe-stent kungasiza ekubuyiseni ukugeleza kwe-bile. Lezi zinqubo ngokuvamile zenziwa ngesikhathi se-ERCP futhi kungase kudingeke ziphindwe njalo.

Ngokwesifo esiqine kakhulu esine-liver failure, ukutshalwa kwesibindi kungase kudingeke. I-PSC ingenye yezinto eziyinhloko zokutshalwa kwesibindi, futhi le nqubo ngokuvamile inezimpumelelo ezinhle kubantu abaneli simo.

Indlela yokuphatha i-Primary Sclerosing Cholangitis ekhaya?

Ngenkathi ukwelashwa kwezokwelapha kubalulekile, kunezinto eziningi ongazenza ekhaya ukuze usekele impilo yakho futhi uthuthukise ikhwalithi yempilo yakho nge-PSC. Lezi zindlela zokunakekela ngokwakho zisebenza kangcono uma zihlanganiswe nokunakekelwa okuvamile kwezokwelapha.

Gxila ekuqondeni ukudla okuhle njengoba i-PSC ingase ihlanganise ukufunwa kwamafutha nokufunwa kwama-vitamin. Dlala ukudla okuhlanganisiwe okunama-fruits, imifino, namaprotheni ahlanzekile. Ungase udinge ukunciphisa ukufunwa kwamafutha uma unezinkinga ekuqothuleni, futhi udokotela wakho angase akukhuthaze ama-medium-chain triglyceride supplements.

Ukuthatha ama-vitamin supplements akho aqokiwe njalo kubalulekile, ikakhulukazi ama-vitamin afanele amafutha. Abantu abaningi abane-PSC bathuthukisa ukungabi khona okungabangela izinkinga emathamini, izinkinga zombono, nokuphulukiswa okungalungile kwezindawo uma kungelashwa.

Ukulawula ukukroba ekhaya, zama ukugcina isikhumba sakho sinomswakama ngama-lotions angenamphunga, uthathe izimbobo ezibandayo nge-oatmeal noma i-baking soda, futhi ugqoke izingubo eziphumule, eziphefumula. Gcina iinzipho zakho zimfushane ukuze unciphise ukulimala kwesikhumba ngokukroba.

Hlala usesikhathini ngazo zonke izilingo ezinconywayo, kuhlanganise ne-colonoscopies uma unesifo sesibindi futhi ukulandelela njalo izithombe ukuze uqaphele izinkinga. Gwema utshwala ngokuphelele, njengoba kungalimaza kakhulu isibindi, futhi uqaphele imithi yokuthengwa ngaphandle kokubonisana nodokotela engase ithonye isibindi sakho.

Kufanele ulungiselele kanjani i-appointment yakho yodokotela?

Ukulungiselela kahle i-appointments yakho kusiza ukuqinisekisa ukuthi uthola inani elikhulu lesikhathi sakho neqembu lakho lokunakekelwa kwezokwelapha. Ukulungiselela okuhle kusiza futhi udokotela wakho ukuba enze izinqumo ezilwemi ngokunakekelwa kwakho.

Ngaphambi kwe-appointment yakho, yenza uhlu lwazo zonke izimpawu zakho zamanje, kuhlanganise nokuthi zaqala nini nokuthi zishintshe kanjani ngokuhamba kwesikhathi. Qaphela noma yiziphi izibonelo ozibonile, njengokuthi ukukroba kubi yini ngezikhathi ezithile zosuku noma uma ukukhathala kuphumula ngokuphumula.

Letha uhlu oluphelele lwazo zonke imithi, ama-supplements, nemikhiqizo yokuthengwa ngaphandle kokubonisana nodokotela oyithathayo, kuhlanganise ne-dosages. Buthana futhi noma yiziphi iziphumo zezivivinyo zakamuva, imibiko yezithombe, noma amarekhodi avela kwabanye abahlinzeki bezempilo abaye bahileleka ekunakekelweni kwakho.

Bhala imibuzo ofuna ukuyibuza udokotela wakho. Lokhu kungase kuhlanganise ukukhathazeka ngokulawulwa kwezimpawu, izindlela zokwelapha, ukuguqulwa kwesitayela sempilo, noma okumele ukulindele njengoba isimo sakho siqhubeka. Ungakhathazeki ngokubuza imibuzo eminingi kakhulu - iqembu lakho lokunakekelwa kwezokwelapha lifuna ukukusiza uqonde isimo sakho.

Cabanga ngokuletha ilungu lomndeni noma umngani othembekile ukukusiza ukuba ukhumbule ulwazi oluqakathekile oluxoxwe ngesikhathi se-appointment. Bangase futhi banikeze ukwesekwa ngokomzwelo futhi basize ekuvikeleni izidingo zakho uma kudingeka.

Iyini into ebaluleke kakhulu nge-Primary Sclerosing Cholangitis?

I-PSC yisimo esinzima kodwa esilawuleka esidinga ukunakekelwa okuqhubekayo kwezokwelapha nokuguqulwa kwesitayela sempilo. Ngenkathi okwamanje kungekho ukwelashwa, abantu abaningi abane-PSC baphila impilo egcwele, enenjongo ngokwelashwa okuhle nokubhekwa.

Ukutholwa kwangaphambi kwesikhathi nokwelashwa kungathuthukisa kakhulu umbono wakho nekhalithi yempilo. Okubalulekile ukusebenzisana eduze neqembu lokunakekelwa kwezokwelapha eliqeqeshwe ekulawuleni i-PSC, ukuhlala uqine ngokwelashwa nokubhekwa, nokuthatha indima ephambili ekunakekelweni kwakho.

Khumbula ukuthi i-PSC ithonya wonke umuntu ngokuhlukile. Abanye abantu bane-disease eyaqhubeka kancane ehlala iqinile iminyaka eminingi, ngenkathi abanye bengase badinge ukungenelela okukhulu. Uhambo lwakho lomuntu siqu luzoba oluhlukile, futhi uhlelo lwakho lokwelapha kufanele lubeka izidingo zakho ezikhethekile nezimo.

Hlala unethemba futhi uqonde. Ucwaningo ngezindlela zokwelapha i-PSC luyaqhubeka luthuthuka, futhi kukhona izindlela ezintsha zokwelapha ezithuthukiswayo ezingase zinikeze izinketho ezinhle ngokwengeziwe esikhathini esizayo. Gxila kulokho ongakulawula namuhla ngenkathi usebenzisana neqembu lakho lokunakekelwa kwezokwelapha ukucwangcisa kusasa.

Imibuzo evamile ebuzwayo nge-Primary Sclerosing Cholangitis

Q1. Ingabe i-Primary Sclerosing Cholangitis iyefa?

I-PSC ayidluliselwa ngqo njengezinye izifo zezakhiwo, kodwa kubonakala sengathi kunengxenye yezakhiwo ekwandisa ukuthambekela. Ukuba nelungu lomndeni eline-PSC noma ezinye izifo ze-autoimmune kungase kukwandisa kancane ingozi yakho, kodwa abantu abaningi abane-PSC abanamalungu omndeni athintekayo. Amamaki athile e-genetic avame kakhulu kubantu abane-PSC, kodwa ukuba nalezi zibonelo akusho ukuthi uzothuthukisa isifo.

Q2. Ingabe ukuguqulwa kokudla kungasiza nge-Primary Sclerosing Cholangitis?

Ngenkathi ukuguqulwa kokudla kungelaphi noma kuyeke ukukhula kwe-PSC, ukudla okuhle kubalulekile ekulawuleni izimpawu nokuvimbela izinkinga. Ungase udinge ukunciphisa ukufunwa kwamafutha uma unezinkinga ekuqothuleni, futhi ukudla ama-vitamin supplements afanele amafutha kuvame ukudingeka. Abanye abantu bathola ukuthi ukugwema utshwala ngokuphelele nokudla ukudla okuncane, okuvamile kusiza ekulawuleni izimpawu. Sebenzani neqembu lakho lokunakekelwa kwezokwelapha noma umhlengikazi wokudla oqeqeshwe ezifweni zesibindi ukwenza uhlelo lokudla olusebenza ngawe.

Q3. I-Primary Sclerosing Cholangitis iqhubeka ngokushesha kangakanani?

Ukuqhubeka kwe-PSC kuyahluka kakhulu kumuntu ngamunye. Abanye abantu bane-disease eyaqhubeka kancane ehlala iqinile iminyaka eminingi, ngenkathi abanye bengase baqhubeke ngokushesha ngezinkinga njenge-cirrhosis. Izici ezingase zithinte ukuqhubeka zihlanganisa iminyaka yakho yokuqala, ukuthi unesifo sesibindi esivuvukalayo yini, nokuthi uphendula kangcono ekuwelapheni. Ukulandelela njalo kusiza iqembu lakho lokunakekelwa kwezokwelapha ukulandelela ukuqhubeka kwakho komuntu siqu nokwenza izinguquko ekuwelapheni ngokufanele.

Q4. Ingabe i-Primary Sclerosing Cholangitis ingangena ekuphumuleni?

I-PSC ngokuvamile ayihlali iphela ngokuphelele njengezinye izifo ze-autoimmune. Noma kunjalo, isifo singase sihlale siqinile isikhathi eside, futhi izimpawu zingase zithuthuke ngokwelashwa. Abanye abantu bahlangabezana nezinkathi lapho isimo sabo sibonakala sihlala noma siphumula kancane, kodwa izinguquko ze-bile duct ezingezansi ngokuvamile ziyaqhubeka. Umgomo wokwelapha ukunciphisa ukuqhubeka, ukulawula izimpawu, nokuvimbela izinkinga kunokufinyelela ekuphumuleni.

Q5. Iyini ithemba lokuphila nge-Primary Sclerosing Cholangitis?

It hemba lokuphila nge-PSC liyahluka kakhulu ngokusekelwe ezintweni ezifana neminyaka yokuqala, ubukhulu besifo, impendulo ekuwelapheni, nokuthi izinkinga zithuthuka yini. Abantu abaningi abane-PSC baphila amashumi eminyaka ngemuva kokuxilongwa, ikakhulukazi uma isifo sibanjwe kwangaphambi kwesikhathi futhi silawulwa kahle. Isikhathi esimaphakathi kusukela ekutholweni kuya ekuthuthukiseni kwesibindi noma ezinhlungwini ezinkulu ngokuvamile iminyaka engu-10-20, kodwa abanye abantu abafinyeleli kuleli phuzu. Gxila ekusebenzeni neqembu lakho lokunakekelwa kwezokwelapha ukuthuthukisa ukunakekelwa kwakho komuntu siqu kunokukhathazeka ngezibalo ezingase zingasebenzi esimweni sakho esithile.