An i-autologous stem cell transplant lunyango olumandla apho isigulana sifumana ezaso iiseli ezisisiqu emva. Oku kwahlukile xa ufumana iiseli zesiqu zomnye umntu (umxhasi), ezibizwa ngokuba yi- i-allogeneic stem cell transplant.
Isishwankathelo sofakelo lwe-autologous stem cell
I-autologous stem cell transplant ingachazwa njenge hlangula unyango. Iiseli ze-autologous stem zilawulwa njengento yokuhlangula amajoni omzimba. 'I-Autologous' ligama elisemthethweni lento evela kubuqu, ngokuchaseneyo nento evela komnye umntu. Kwi-autologous stem cell transplant, iiseli ezitshintshiweyo ziiseli zesigulana zibuyiselwa kuzo.
Isizathu sokuba igama lokuhlangula lingasetyenziselwa ukuchaza i-autologous stem cell transplant, kungenxa yokuba xa i-lymphoma ingaphenduli kunyango, okanye ibuyele ngokuqhubekayo emva konyango amanyathelo anamandla afunekayo ukuzama ukuphelisa i-lymphoma kube kanye. Oku kubandakanya iidosi eziphezulu kakhulu chemotherapy.
La mayeza aphezulu kakhulu aya kubulala amajoni omzimba (kubandakanywa ne-lymphoma). Nangona kunjalo, imiphumo yolo nyango lunzima luthetha ukuba amajoni omzimba akayi kukwazi ukuphinda aphile ngokwawo, iiseli ze-autologous stem zibonelela ngohlangulo lwamajoni omzimba owonakeleyo kwaye ancede ukuba abuyele kwaye asebenze.
Injongo yokutshintshwa kwe-stem cell
Kukho izizathu ezininzi zokuba izigulane ze-lymphoma zingadinga ukutshintshwa kweeseli ze-stem kuquka:
- Ukunyanga izigulane ze-lymphoma ezixolelweyo, kodwa 'zinomngcipheko omkhulu' wokubuya kwe-lymphoma
- I-lymphoma ibuyile emva konyango lokuqala olusemgangathweni, ngoko ke ichemotherapy eqatha (eyomelele) isetyenziselwa ukubabuyisela kuxolelo (akukho sifo sibonwayo)
- I-lymphoma i-refractory (ayikaphenduli ngokupheleleyo) kunyango oluqhelekileyo lodidi lokuqala ngenjongo yokufumana uxolelo.
I-Autologous (iiseli ezizezakho) i-stem cell transplant
Ukuba iiseli ze-autologous stem bezingalawulwa, amajoni omzimba anokuba buthathaka kakhulu ukuba angalwa naluphi na usulelo. Oku kuthetha ukuba usulelo olulula oluthe amajoni omzimba awomeleleyo aluqapheli, lunokukhokelela kusulelo olubeka ubomi esichengeni kunye nokufa.
Inkqubo ye-autologous stem cell transplant
UGq Amit Khot, ugqirha weHaematologist kunye nogqirha wofakelo lomongo wethambo
Peter MacCallum Cancer Centre kunye nesibhedlele saseRoyal Melbourne
- Ukulungiselela: oku kubandakanya unyango oluthile lokunciphisa i-lymphoma (oku kunokubandakanya ukuya kwii-2 iidosi ze-chemotherapy). Olunye unyango lwenziwa ukuvuselela umongo wethambo ukuvelisa iiseli ezaneleyo zokuqokelela.
- Ukuqokelelwa kweeseli zesiqu: Le yinkqubo yokuvuna i-stem cells, eyenziwa ngokubanzi ngomatshini we-apheresis onceda ukuhluza iiseli ze-stem kwigazi elijikelezayo. Iiseli ze-stem zifakwe emkhenkceni kwaye zigcinwe kude kube yimini yokubuyisela kwakhona.
- Unyango lokulungisa: le yichemotherapy elawulwa ngamadosi aphezulu kakhulu ukuphelisa yonke i-lymphoma
- Ukuvuselelwa kweeseli ze-stem: lwakuba lwenziwe unyango lwedosi ephezulu, iiseli zesilonda zesigulana ebeziqokelelwe ngaphambili, zibuyiselwa kumsinga wegazi.
- Engraftment: le yinkqubo apho iiseli ezibuyiselweyo zihlala emzimbeni kwaye zonyuse amajoni omzimba, ukuyihlangula kwi-neutropenia ende.
I-stem cell transplant yindlela yonyango olunzulu kwaye kukho izibhedlele ezikhethiweyo kuphela e-Australia ezinokubonelela ngolu nyango. Ke ngoko, kwezinye iimeko kunokuthetha ukufudukela kwizixeko ezikhulu apho isibhedlele soqhaqho-fakelo sikhoyo.
Kungathatha iinyanga ezininzi kwaye ngamanye amaxesha neminyaka ukuba amajoni omzimba aphinde aphile ngokupheleleyo emva kokufakelwa kwe-autologous. Uninzi lwabantu abafumana i-autologous stem cell transplant baya kuba sesibhedlele kangangeeveki ezi-3 ukuya kwezi-6 ngokomndilili. Ngokuqhelekileyo bangeniswa esibhedlele kwiintsuku ezimbalwa phambi koSuku lokuTshintshela (usuku iiseli zibuyiselwa kwakhona) kwaye bahlala esibhedlele de amajoni abo omzimba abuyele kwinqanaba elikhuselekileyo.
Ukulungiselela
Ukukhokelela kwi-stem cell transplant, kukho amalungiselelo afunekayo. Ufakelo ngalunye lwahlukile, iqela lakho lokutshintshela kufuneka likulungiselele yonke into. Amanye amalungiselelo anokuquka:
Ukufakwa komgca osembindini
Ukuba isigulane asinalo umgca ophakathi, ngoko ke umntu uya kufakwa ngaphambi kokutshintshwa. Umgca osembindini unokuba yi-PICC (i-peripherally efakwe phakathi kwe-catheter) okanye inokuba yi-CVL (umgca we-venous ophakathi). Ugqirha uya kuthatha isigqibo sokuba yeyiphi umgca ophakathi olungele isigulane.
Umgca ophakathi unika indlela yokuba izigulane zifumane amayeza amaninzi ahlukeneyo ngexesha elinye. Izigulana ngokubanzi zifuna amayeza amaninzi awohlukeneyo kunye novavanyo lwegazi ngexesha lofakelo kwaye umgca osembindini unceda abongikazi ukulawula ukhathalelo lwesigulana.
Chemotherapy
I-chemotherapy yedosi ephezulu ihlala ilawulwa njengenxalenye yenkqubo yokutshintshwa. Idosi ephezulu yechemotherapy ibizwa ngokuba unyango lokulungisa. Ngaphandle kwedosi ephezulu yechemotherapy, ezinye izigulana zidinga ichemotherapy yokuhlangula. Unyango lwe-Salvage xa i-lymphoma inobudlova kwaye idinga ukuncitshiswa ngaphambi kokuba yonke inkqubo yokutshintshwa iqhube phambili. Igama kunqanda ivela ekuzameni ukuhlenga umzimba kwi-lymphoma.
Ukufuduswa kunyango
Zizibhedlele ezithile kuphela ngaphakathi eOstreliya ezikwaziyo ukwenza utyando lwe-stem cell. Ngenxa yoku, izigulane kunokufuneka zifuduke ukusuka kumakhaya azo ziye kwindawo ekufutshane nesibhedlele. Ezinye izibhedlele zoqhaqho-fakelo zinendawo yokuhlala yezigulane esinokuhlala kuyo isigulane kunye nomkhathaleli.
Ukugcinwa kokuchuma
Utyando lwe-stem cell lunokuba nefuthe kumandla okuba nabantwana. Kubalulekile ukuba izigulane zixoxe ngeendlela ezikhoyo zokulondoloza ukuchuma. Ukuba awukabi nabo abantwana okanye ufuna ukuqhubeka nosapho lwakho kungcono uthethe neqela lezonyango malunga nokuchuma phambi kokuba unyango luqale.
USteve wafunyaniswa ene-mantle cell lymphoma ngo-2010. USteve uye wasinda kwi-autologous kunye ne-allogeneic stem cell transplant. Eli libali likaSteve.
Iingcebiso ezisebenzayo zokulungiselela ukutshintshwa
Ukuba ne-stem cell transplant kudla ngokubandakanya ukuhlala ixesha elide esibhedlele. Kunokuba luncedo ukupakisha ezinye zezi zinto:
- Izibini ezininzi zeempahla ezithambileyo, ezitofotofo okanye zokulala kunye nempahla yangaphantsi eninzi
- Ibhrashi yamazinyo (ethambileyo), intlama yamazinyo, isepha, isiqholo esithambileyo, isiqhumiso esithambileyo
- Umqamelo ongowakho (uhlambe ushushu umqamelo kunye naziphi na iingubo zobuqu/uziphose iiragi phambi kokuba ulaliswe esibhedlele – zihlambe zishushu ukunciphisa iintsholongwane njengoko amajoni akho omzimba aya kuba sesichengeni kakhulu).
- I-Slippers okanye izicathulo ezikhululekile kunye neninzi yeeperesi zeekawusi
- Izinto zobuqu zokuqaqambisa igumbi esibhedlele (ifoto yabantu obathandayo)
- Izinto zokuzonwabisa njengeencwadi, iimagazini, amagama anqamlezayo, i-iPad/laptop/tablet. Isibhedlele sinokudika kakhulu ukuba awunanto yokwenza.
- Ikhalenda yokugcina umkhondo womhla, ukulaliswa esibhedlele ixesha elide kunokuphazamisa yonke imihla kunye.
Ukuqokelelwa kweeseli ze-stem
Ukuqokelelwa kweeseli zegazi zeperipheral
Ingqokelela ye-peripheral stem cell yingqokelela yeeseli ukusuka kumsinga wegazi weperipheral.
Ukukhokelela ekuqokeleleni kweeseli ze-stem cell, uninzi lwezigulane zifumana inaliti yento yokukhula. Izinto zokukhula zikhuthaza ukuveliswa kweeseli ze-stem. Oku kunceda ii-stem cells zihambe ukusuka kumongo wethambo, ziye egazini, zilungele ukuqokelelwa.
Iiseli ze-stem ziqokelelwa ngenkqubo eyaziwa ngokuba yi-apheresis. Umatshini we-apheresis usetyenziselwa ukuqokelela emva koko kwahlula iiseli ze-stem kwigazi liphela.
Ngaphambi kokuqokelela i-stem cell uya kufumana i-chemotherapy, ukunciphisa okanye ukuphelisa i-lymphoma ngaphambi kokuqokelela.
Iiseli ze-stem eziqokelelweyo ziyakhenkcezwa kwaye zigcinwe de ube ukulungele ukuba ziphinde zifakwe okanye zitshintshwe. . Ezi seli stem ziya kunyibilika ngoko nangoko phambi kokuba ziphinde zifakwe, ngokubanzi ecaleni kwebhedi.
Isebenza njani i-apheresis
Umatshini we-apheresis wahlula iinxalenye ezahlukeneyo zegazi. Ikwenza oku ngokwahlula iiseli ezaneleyo ezifunekayo kufakelo. I-Apheresis ibandakanya ukufaka i-cannula (inaliti / i-catheter) kwi-vein enkulu engalweni okanye i-vascath (umgca okhethekileyo ophakathi). I-cannula okanye i-vascath inceda ukuhamba kwegazi ngaphandle komzimba kunye ne-apheresis machine.
Umtshini ke wohlula iiseli zestem zibe yingxowa yokuqokelela. Emva kokuba igazi lihambile kwisigaba sokuqokelelwa kweeseli. Ibuyela emzimbeni. Le nkqubo ithatha iiyure ezininzi (malunga ne-2 - 4 iiyure). Ingqokelela ye-Apheresis iphinda-phinda kangangeentsuku ezininzi de umthamo wokuqokelela okanye iiseli zesikhondo ezaneleyo ziqokelelwe.
Ukuqokelelwa kwe-peripheral stem cell akubangeli naziphi na iintlungu eziqhubekayo. Kukho ukungakhululeki kwinaliti (i-cannula okanye i-vascath) efakwe kwi-vein. Kusenokubakho 'intlungu yethambo' ethambileyo ngenxa yeenaliti zohlobo lokukhula. Le ntlungu ilawulwa kakuhle ngeparacetamol yomlomo. I-Apheresis yeyona ndlela iqhelekileyo yokuqokelela iiseli ze-stem namhlanje.
Unyango lwemeko
Unyango lwe-conditioning yi-chemotherapy yedosi ephezulu elawulwa kwiintsuku ezikhokelela kufakelo. Unyango lwe-conditioning yi-chemotherapy kwaye ngamanye amaxesha unyango lwe-radiation lunikezelwa ngokudibeneyo. Iinjongo ezimbini zonyango lwemeko zezi:
- Ukubulala i-lymphoma eninzi kangangoko kunokwenzeka
- Ukunciphisa inani le-stem cell
Kukho indibaniselwano ezininzi ezahlukeneyo zechemotherapy kunye nonyango lweradiation olunokuthi lusetyenziswe kwiinkqubo zokumisela. Iqela lonyango liya kuthatha isigqibo sokuba yeyiphi i-conditioning regime ilungele isigulane. Oku kuya kuxhomekeka kwi-lymphoma subtype, imbali yonyango kunye nezinye izinto ezizimeleyo ezifana nobudala, impilo jikelele kunye nokufaneleka.
Izigulane ezine-co-morbidities kwaye ezisengozini enkulu yokuxakeka, ngokubanzi ziya kuba nokunciphisa unyango olunamandla. Oku kubizwa ngokuba 'yi-reduced-intensity conditioning regime'. Ukunyangwa kwe-conditioning kunokuba ngamandla aphezulu okanye kuncitshiswe kakhulu. Kuzo zombini iirementi unyango lunobundlobongela. Ngenxa yoko, ezininzi iiseli eziphilileyo ziyafa kunye ne-lymphoma.
Ukwamkelwa esibhedlele kudla ngokuqala kwasekuqaleni konyango lonyango. Olunye unyango lwe-conditioning lunokwenziwa kwiikliniki zezigulane ezingalaliswanga kodwa ukwamkelwa esibhedlele kuya kwenzeka kwiintsuku ezi-1-2 phambi kofakelo. Izigulane zinokungeniswa esibhedlele naphi na ukusuka kwiiveki ezi-3 ukuya kwezi-6. Esi sisikhokelo njengoko utyando ngalunye lwahlukile kwaye ezinye izigulana ziya kufuna ukhathalelo lwezonyango ngaphezulu kweeveki ezi-6.
Kwi-lymphomas, enye yezona nkqubo zixhaphakileyo zokumisela i-chemotherapy protocol ebizwa ngokuba yi-BEAM:
- B – BCNU® okanye BCNU okanye carmustine
- E – Etoposide
- A – Ara-C okanye cytarabine
- M – Melphalan
I-BEAM ifakwa esibhedlele kwiintsuku ezi-6 phambi kokuba i-stem cells yesigulana ibuyiselwe. Amachiza anikwa ngomgca osembindini.
I-countdown yokufumana iiseli zakho ze-stem emva ziqale ukusuka kunyango lonyango losuku luqalisiwe. Usuku lwe-zero luhlala luyimini yokufunyanwa kweeseli. Umzekelo, ukuba ubufumana iprotocol yeBEAM ehamba iintsuku ezi-6, usuku lokuqala lwale protocol lubizwa ngokuba yimini –6 (minus 6). Ibala usuku ngalunye kunye nosuku lwesibini olubizwa ngokuba yi-day -5, njl., de ufike kumhla we-0 xa iiseli zesigulane zibuyiselwa.
Emva kokuba isigulana sifumene ii-stem cells, iintsuku zibala ukuya phezulu. Usuku emva kokuba iiseli zifunyenwe zibizwa ngokuba yimini +1 (kunye nenye), usuku lwesibini lusuku +2, njl.
Ukubuyisela iiseli ze-stem
Emva kokuba i-chemotherapy enzulu igqityiwe, iiseli ze-stem zibuyiselwa kwakhona. Ezi stem cells ziqala kancinci ukuvelisa iiseli zegazi ezintsha nezisempilweni. Ekugqibeleni, baya kuvelisa iiseli ezaneleyo ezinempilo ukuze ziphinde zizalise umnkantsha wethambo, zizalise lonke igazi kunye neeseli zomzimba.
Ukubuyiselwa kweeseli ze-stem yinkqubo ethe ngqo. Kuyafana nokutofelwa igazi kwaye iiseli zinikezelwa ngomgca kumgca ophakathi. Mhla ii-stem cells ziphinda zifakwe yi-"Day Zero".
Ngayo nayiphi na inkqubo yonyango, kukho umngcipheko wokusabela kwi-stem cell infusion. Kwizigulane ezininzi akukho mpendulo, kodwa abanye banokufumana:
- Ukuziva ugula okanye ugula
- Incasa embi okanye ukuvutha komlomo emlonyeni
- Igazi elonyukayo
- Ukuphendula ngokuchaseneyo
- Sulelo
Kwi-autologous (self) yofakelo, iiseli ze-stem zifakwe emkhenkceni kwaye zigcinwe ngaphambi kokuba zifakwe kwakhona. Le nkqubo yokukhenkceza iquka ukuxuba iiseli kwisithinteli. Ezinye izigulana zinokusabela kwesi sigcini kuneeseli zestem. Isiphumo esiqhelekileyo sesi sigcini kukutshintsha komphefumlo, kubangela ukuba umoya ube nevumba elimnandi.
Ukwenziwa kweeseli ze-stem
Ukungena kuxa iiseli ze-stem ezintsha ziqala ngokuthe ngcembe ukuthatha indawo njengee-primary stem cells. Oku kwenzeka ngokubanzi malunga neeveki ezi-2-3 emva kokufakwa kweeseli ze-stem.
Ngelixa ii-stem cells ezintsha zikrolwa, isigulana sisemngciphekweni omkhulu wokufumana usulelo. Izigulane ngokubanzi kufuneka zihlale esibhedlele ngeli xesha, kuba zinokugula kwaye kufuneka zifumane unyango ngokukhawuleza.
Iingxaki zokutshintshwa kwe-stem cell
Imiphumo emibi ye-conditioning chemotherapy
Izigulane kusenokwenzeka ukuba zibe neziphumo ebezingalindelekanga ukusuka kunyango lwedosi ephezulu yechemotherapy. Kukho icandelo elahlukileyo kwezona zixhaphakileyo iziphumo ebezingalindelekanga zonyango lwe-lymphoma, kuquka iingcebiso eziluncedo ngendlela yokumelana nezinye eziqhelekileyo:
- Oral Mucositis (umlomo obuhlungu)
- I-anemia (isibalo esisezantsi seeseli ezibomvu)
- I-Thrombocytopenia (inani eliphantsi leplatelet)
- Isihlunu kunye nokuhlanza
- Iingxaki zendlela yokwetyisa (urhudo okanye ukuqhina)
Umngcipheko Wosulelo
Thumela i-stem cell transplant, idosi ephezulu ye-chemotherapy iya kube ishenxise iiseli zegazi ezimhlophe ezininzi, kubandakanya iseli emhlophe yegazi ebizwa ngokuba yi-neutrophils, ebangela i-neutropenia. I-neutropenia yexesha elide ibeka izigulane emngciphekweni omkhulu kakhulu wokuphuhlisa usulelo. Usulelo lunokunyangwa, kodwa ukuba alubanjwanga kwangoko kwaye lunyangwe ngokukhawuleza lunokubeka ubomi esichengeni.
Ngelixa usesibhedlele, ngokukhawuleza emva kofakelo lwe-stem cell, iqela elinyangayo liya kuthatha amanyathelo okuthintela ukuvela kosulelo kunye nokubeka iliso elibukhali kwiimpawu zosulelo. Nangona amanyathelo amaninzi athatyathiweyo ukunciphisa umngcipheko wokufumana usulelo, uninzi lwezigulane ezine-autologous stem cell transplant ziya kufumana usulelo.
Kwiintsuku ezimbalwa zokuqala emva kofakelo kuxa izigulana zisemngciphekweni omkhulu wokufumana usulelo lwebhaktheriya olunjengosulelo lwegazi, inyumoniya, usulelo lwenkqubo yokwetyisa okanye usulelo lwesikhumba.
Kwiinyanga ezimbalwa ezizayo, izigulane zisemngciphekweni omkhulu wokufumana usulelo lwentsholongwane. Ezi inokuba ziintsholongwane ebezilele emzimbeni phambi kofakelo kwaye zinokugqabhuka xa amajoni omzimba ephantsi. Azisoloko zibangela iimpawu kodwa iimvavanyo zegazi rhoqo emva kokutshintshwa kufuneka zichonge i-flare-up yosulelo lwentsholongwane olubizwa ngokuba yi-cytomegalovirus (CMV). Ukuba iimvavanyo zegazi zibonisa ukuba i-CMV ikhona - nangaphandle kweempawu - isigulane siya kunyangwa ngamachiza e-antiviral.
Ubalo lwegazi luqala ukunyuka phakathi kweeveki ezi-2 ukuya kwezi-4 emva kofakelo lwe-autologous stem cell. Nangona kunjalo, kunokuthatha iinyanga ezininzi, okanye ngamanye amaxesha kwaneminyaka, ukuze amajoni omzimba aphinde aphile ngokupheleleyo.
Izigulana kufuneka zicetyiswe xa zigoduka ukuba zeziphi iimpawu zosulelo ekufuneka zijongwe kwaye ngubani emakuqhagamshelwane nazo xa kukho umngcipheko wosulelo okanye nayiphi na enye into ekhathaza isigulana.
Iziphumo zamva
Iziphumo zamva ziingxaki zempilo ezinokukhula iinyanga okanye iminyaka emva kokuba unyango lwe-lymphoma luphelile. Uninzi lwamaziko anikezela ngeenkonzo zeziphumo emva kwexesha ezibonelela ngeenkqubo zokujonga iziphumo zasemva kwexesha kwangoko. Oku kunika isigulana elona thuba lilungileyo lokunyangwa ngempumelelo ukuba kukho naziphi na iziphumo zasemva kwexesha eziphuhlayo.
Iqela lofakelo-mzimba liya kucebisa ukuba yintoni echaphazela kade izigulana ezisemngciphekweni wokuphuhla kunye nento emayenziwe ukunciphisa umngcipheko wokuphuhla. Ngolwazi oluninzi, bona 'Iziphumo zamva'
Izigulane zisenokuba semngciphekweni wokukhula emva kokutshintshwa kwe-lymphoproliferative disorder (PTLD) -i-lymphomas ezinokukhula kwizigulane ezithatha iziyobisi ze-immunosuppressant emva kokutshintshwa. Nangona kunjalo, i-PTLD inqabile kwaye izigulane ezininzi eziye zafumana ukutshintshwa aziphuhlisi i-PTLD. Iqela lofakelo-mzimba liya kuxoxa ngayo nayiphi na imingcipheko yomntu kunye nayo nayiphi na imiqondiso okanye iimpawu ekufuneka zijongwe.
Ukhathalelo lokulandela
Emva kofakelo lwe-stem cell, izigulane ziya kuqeshwa rhoqo kunye nogqirha wabo. Oku kuqeshwa kuya kuncipha njengoko ixesha lihamba kwaye kusenzeka ukuchacha. Ukulandelela kuya kuqhubeka iinyanga kunye neminyaka emva konyango, kodwa ngaphantsi nangaphantsi rhoqo njengoko ixesha lihamba. Ekugqibeleni oogqirha bofakelo-mzimba baya kuba nakho ukunika ukhathalelo olulandelayo, kugqirha wakho.
Phantse kwiinyanga ezi-3 emva kokutshintshwa, i-PET scan, i-CT scan kunye / okanye i-bone marrow aspirate (BMA) inokuyalelwa ukuba ihlole indlela yokubuyisela ngayo.
Kuqhelekile ukuba ubuyele esibhedlele ukuze ufumane unyango kwiiveki kunye neenyanga ezilandela ukutshintshwa kodwa njengoko ixesha lihamba, umngcipheko weengxaki ezinzulu ziyancipha.
Izigulana zofakelo lotshintsho zisenokwenzeka ukuba zibe neziphumo ebezingalindelekanga kunyango lwedosi ephezulu. Maxa wambi izigulane zinokuziva zingaphilanga kwaye zidiniwe kakhulu. Kubalulekile ukuthatha ixesha lokubuyisela kwi-stem cell transplant.
Iqela lezonyango kufuneka linike iingcebiso malunga nezinye izinto eziza kuqwalaselwa ngexesha lesigaba sokubuyisela.
Kwenzeka ntoni emva kokufakelwa kwe-stem cell
Ukugqiba unyango inokuba lixesha elinzima kubantu abaninzi, njengoko bebuyela ebomini emva kokutshintshwa. Abanye abantu basenokungaqali ukuziva eminye yale mingeni kangangeeveki ukuya kwiinyanga emva kokuba unyango lomhlaza lugqityiwe, njengoko beqalisa ukubonakalisa amava abo okanye bazive ngathi sele bechacha, njengoko beqalisa ukucamngca ngamava abo okanye benze. abaziva ngathi bachacha ngokukhawuleza njengoko bebefanele. Ezinye zeenkxalabo eziqhelekileyo zinokunxulumana noku:
- Zemvelo
- Ukuphila kwengqondo
- Impilo ngokweemvakalelo
- ubudlelwane
- Umsebenzi, ukufunda kunye nemisebenzi yentlalo
Impilo kunye nokuphila
Usenokuba sele uphila ngendlela esempilweni, okanye unokunqwenela ukwenza utshintsho oluqinisekileyo lwendlela yokuphila emva konyango. Ukwenza utshintsho oluncinci olunjengokutya kunye nokwandisa ukomelela kwakho kunokuphucula impilo kunye nempilo yakho kwaye kuncede umzimba wakho ukuba uphile. Zininzi izicwangciso zokuzikhathalela oko kunokukunceda ukuba uchache kunyango.
