Konke Odinga Ukukwazi Ngokwelapha Kwamuva Kwe-Psoriasis

-Delile

• I-biologics entsha
• I-Risankizumab-rzaa (Skyrizi)
• I-Certolizumab pegol (Cimzia)
• I-Tildrakizumab-asmn (Ilumya)
• I-Guselkumab (Tremfya)
• I-Brodalumab (Siliq)
• I-Ixekizumab (Taltz)
• Ama-biosimilars
• Ama-biosimilars kuya ku-adalimumab (Humira)
• Ama-biosimilars to etanercept (Enbrel)
• Ama-biosimilars kuya ku-infliximab (i-Remicade)
• Izindlela zokwelashwa ezintsha
• I-halobetasol propionate-tazarotene lotion, 0.01% / 0.045% (iDuobrii)
• Igwebu leHalobetasol propionate, 0.05% (Lexette)
• I-lotion ye-Halobetasol propionate, 0.01% (Bryhali)
• Isifutho seBetamethasone dipropionate, 0.05% (Sernivo)
• Imithi emisha yezingane
• Igwebu leCalcipotriene, 0.005% (iSorilux)
• Igwebu leCalcipotriene-betamethasone dipropionate, 0.005% / 0.064% (Enstilar)
• Ukumiswa okwesikhashana kweCalcipotriene-betamethasone dipropionate, 0.005% / 0.064% (Taclonex)
• I-Ustekinumab (Stelara)
• I-Etanercept (Enbrel)
• Ezinye izindlela zokwelashwa zisondela ekwamukelweni
• Bimekizumab
• Ukhilimu weCalcipotriene-betamethasone dipropionate, 0.005% / 0.064% (Wynzora)
• Ama-JAK inhibitors
• Ukudla okudlela endlini

Abaphenyi bafunde okuningi kakhulu eminyakeni yamuva mayelana ne-psoriasis nendima edlalwa amasosha omzimba kulesi simo. Lokhu okutholakele okusha kuholele ekwelashweni okuphephile, okubhekiswe kakhulu, nokusebenza ngempumelelo kwe-psoriasis.

Yize kukhona konke ukwelashwa okutholakalayo, ucwaningo lukhombisa ukuthi abantu abaningi abathola ukwelashwa kwe-psoriasis abanelisekile ngokwelashwa kwabo noma baneliseke ngesizotha kuphela.

Uma ufuna ukushintsha imishanguzo ngoba eyakho yamanje ayisasebenzi noma unemiphumela engemihle, kuwumqondo omuhle ukufunda okuningi ngangokunokwenzeka ngezinketho zakamuva.

I-biologics entsha

I-biologics yenziwa ngezinto ezitholakala ezintweni eziphilayo, njengamaprotheni, ushukela, noma ama-nucleic acid. Kanye emzimbeni, le mithi ivimba ingxenye yesistimu yomzimba enomthelela ezimpawu zakho ze-psoriasis.

I-Biologics iphazamisa lokhu okulandelayo:

• i-tumor necrosis factor alpha (TNF-alpha), okuyi-protein ekhuthaza ukuvuvukala emzimbeni
• T amaseli, angamaseli amhlophe egazi
• ama-interleukin, angama-cytokines (amaprotheni amancane okuvuvukala) abandakanyeka ku-psoriasis

Lokhu kuphazamiseka kusiza ukunciphisa ukuvuvukala.

I-Risankizumab-rzaa (Skyrizi)

I-Risankizumab-rzaa (Skyrizi) yamukelwa yi-Food and Drug Administration (FDA) ngo-Ephreli 2019.

Kuhloselwe abantu abane-plaque psoriasis elinganiselayo kuya kwelinzima abangabakhokhelwa i-phototherapy (i-light therapy) noma i-systemic (body-wide) therapy.

ISkyrizi isebenza ngokuvimba isenzo se-interleukin-23 (IL-23).

Umthamo ngamunye uqukethe imijovo emibili engaphansi (ngaphansi kwesikhumba). Imithamo emibili yokuqala ihlukaniswe amasonto ama-4. Okunye kunikezwa kanye ezinyangeni ezintathu.

Imiphumela emibi ye-Skyrizi yile:

• izifo eziphezulu zokuphefumula
• ukusabela endaweni yomjovo
• ikhanda
• ukukhathala
• izifo zokukhunta

I-Certolizumab pegol (Cimzia)

I-FDA igunyaze i-certolizumab pegol (i-Cimzia) njengokwelashwa kwe-psoriasis ngoMeyi 2018. Ngaphambilini bekuvunyelwe ukwelapha izimo ezifana nesifo sikaCrohn nesifo samathambo i-psoriatic (PsA).

UCimzia uphatha i-plaque psoriasis elinganiselayo nenzima kubantu abakhethelwa ukuthola i-phototherapy noma i-systemic therapy. Isebenza ngokukhomba iphrotheni i-TNF-alpha.

Isidakamizwa sinikezwa njengemijovo emibili engaphansi kwesinye isonto.

Imiphumela emibi kakhulu ye-Cimzia yile:

• izifo eziphezulu zomgudu wokuphefumula
• ukuqubuka
• izifo ezithinta umchamo (UTIs)

I-Tildrakizumab-asmn (Ilumya)

I-Tildrakizumab-asmn (Ilumya) yamukelwa yi-FDA ngoMashi 2018. Isetshenziselwa ukwelapha i-plaque psoriasis kubantu abadala abafuna ukhetho lwe-phototherapy noma i-systemic therapy.

Isidakamizwa sisebenza ngokuvimba i-IL-23.

I-Ilumya inikezwa njengemijovo engaphansi. Imijovo emibili yokuqala yehlukaniswe amasonto ama-4. Kusukela lapho kuya phambili, imijovo inikezwa izinyanga ezi-3 zihlukene.

Imiphumela emibi ye-Ilumya yile:

• ukusabela endaweni yomjovo
• izifo eziphezulu zokuphefumula
• isifo sohudo

I-Guselkumab (Tremfya)

I-Guselkumab (Tremfya) yamukelwa yi-FDA ngoJulayi 2017. Isetshenziselwa ukwelapha i-plaque psoriasis elinganiselayo kuya kwelinzima kubantu futhi abangabaqokelwe ukuthola i-phototherapy noma i-systemic therapy.

I-Tremfya yayiyi-biologic yokuqala ukukhomba i-IL-23.

Imithamo yokuqala yokuqala emibili inikezwa amasonto ama-4 ahlukene. Ngemuva kwalokho, iTremfya inikezwa njengomjovo ongaphansi komhlaba njalo emavikini ayisishiyagalombili.

Imiphumela emibi ejwayelekile ifaka phakathi:

• ikhanda
• izifo eziphezulu zokuphefumula
• ukusabela endaweni yomjovo
• ubuhlungu obuhlangene
• isifo sohudo
• umkhuhlane wesisu

I-Brodalumab (Siliq)

I-Brodalumab (Siliq) yamukelwa yi-FDA ngoFebhuwari 2017. Yenzelwe abantu abahlangabezana nale mibandela elandelayo:

• ube ne-plaque psoriasis ephakathi nendawo
• abazongenela ukhetho lwe-phototherapy noma i-systemic therapy
• i-psoriasis yabo ayiphenduli kwezinye izindlela zokwelapha ezihlelekile

Isebenza ngokubophezela kumamukeli we-IL-17. Indlela ye-IL-17 idlala indima ekuvuvukeni futhi ibandakanyekile ekwakhiweni kwamapuleti e-psoriasis.

Ekuvivinyweni komtholampilo, ababambiqhaza abaphathwe noSiliq babenamathuba amaningi kunalabo abathola i-placebo ukuba babe nesikhumba esathathwa njengesicacile noma esicishe sicace.

I-Siliq iphathwa njengomjovo. Uma udokotela wakho ekunika umuthi, uzothola umjovo owodwa ngesonto emavikini amathathu okuqala. Ngemuva kwalokho, uzothola umjovo owodwa njalo emavikini amabili.

Njengamanye ama-biologics, i-Siliq yandisa ubungozi bokutheleleka. Ilebuli yalesi sidakamizwa inesixwayiso sebhokisi elimnyama ngengozi ephezulu yemicabango yokuzibulala nokuziphatha.

Abantu abanomlando wokuzibulala noma ukucindezeleka kufanele babhekwe lapho bethatha i-brodalumab.

I-Ixekizumab (Taltz)

I-Ixekizumab (Taltz) yamukelwa yi-FDA ngoMashi 2016 ukwelapha abantu abadala abane-psoriasis elinganiselayo. Yenzelwe abantu ababhekelwa i-phototherapy, i-systemic therapy, noma bobabili.

I-Taltz ihlose iphrotheni IL-17A.

Kungumuthi ojojowe. Uzothola imijovo emibili ngosuku lwakho lokuqala, imijovo njalo emavikini ama-2 ezinyangeni ezi-3 ezizayo, nokujova njalo emavikini ama-4 ngempatho yakho esele.

Ukuvunyelwa kwakususelwa kwimiphumela yezifundo eziningi zemitholampilo ezinengqikithi yabahlanganyeli be-3,866. Kulezo zifundo, iningi labantu elisebenzisa umuthi lifinyelele isikhumba ebesicacile noma esicishe sicace.

Imiphumela emibi ejwayelekile ye-Taltz ifaka:

• izifo eziphezulu zokuphefumula
• ukusabela endaweni yomjovo
• izifo zokukhunta

Ama-biosimilars

Ama-biosimilars akuzona izimpendulo eziqondile ze-biologics. Esikhundleni salokho, zenzelwe ukubuyela emuva ukuze zikhiqize imiphumela efanayo ne-biologics.

Njengemithi ejwayelekile, ama-biosimilars enziwa lapho i-biologic yasekuqaleni iphuma patent. Inzuzo yama-biosimilars ukuthi imvamisa ibiza kancane kakhulu kunomkhiqizo wokuqala.

Ama-biosimilars we-psoriasis afaka okulandelayo:

Ama-biosimilars kuya ku-adalimumab (Humira)

• i-adalimumab-adaz (Hyrimoz)
• i-adalimumab-adbm (Cyltezo)
• i-adalimumab-afzb (Abrilada)
• adalimumab-atto (Amjevita)
• adalimumab-bwwd (Hadlima)

Ama-biosimilars to etanercept (Enbrel)

• i-etanercept-szzs (i-Erelzi)
• I-etanercept-ykro (Eticovo)

Ama-biosimilars kuya ku-infliximab (i-Remicade)

• infliximab-abda (i-Renflexis)
• i-infliximab-axxq (Avsola)
• i-infliximab-dyyb (i-Inflectra)

I-Remicade biosimilar Inflectra yayiyi-psoriasis biosimilar yokuqala ukuthola ukuvunywa kwe-FDA. Kwakungo-Ephreli 2016.

I-Inflectra ne-Renflexis, enye i-Remicade biosimilar, iyona kuphela etholakalayo manje ukuthengwa e-United States. Lokhu ikakhulukazi kungenxa yokuthi amalungelo obunikazi aphethwe ngabakhiqizi be-biologics abakaphelelwa yisikhathi.

Izindlela zokwelashwa ezintsha

Ukwelashwa ngezihloko, noma okugcobayo esikhunjeni sakho, imvamisa kuyindlela yokuqala yokwelashwa odokotela abayincomela i-psoriasis. Zisebenza ngokunciphisa ukuvuvukala futhi zinciphise ukukhiqizwa kwamaseli esikhumba okweqile.

I-halobetasol propionate-tazarotene lotion, 0.01% / 0.045% (iDuobrii)

Ngo-Ephreli 2019, i-FDA igunyaze i-halobetasol propionate-tazarotene lotion, amaphesenti angu-0.01 / amaphesenti ayi-0.045 (iDuobrii) ekwelapheni i-plaque psoriasis kubantu abadala.

I-Duobrii iyi-lotion yokuqala yokuhlanganisa i-corticosteroid (halobetasol propionate) ne-retinoid (tazarotene). I-corticosteroid elwa nokuvuvukala isula izingcwecwe, kuyilapho i-vitamin A-based retinoid ikhawulela ukukhula okweqile kwamaseli esikhumba.

I-Duobrii isetshenziswa kanye ngosuku ezindaweni ezithintekile zesikhumba.

Imiphumela emibi kakhulu yilena:

• ubuhlungu esizeni sokufaka isicelo
• ukuqubuka
• folliculitis, noma izinwele zezinwele ezivuthayo
• ukugqoka isikhumba lapho kufakwa khona i-lotion
• ukukhishwa, noma ukukhetha isikhumba

Igwebu leHalobetasol propionate, 0.05% (Lexette)

Igobolondo leHalobetasol propionate, u-0.05% yi-corticosteroid eyisihloko i-FDA eyaqala ukuyivuma, njengejenerikhi, ngoMeyi 2018. Ngo-Ephreli 2019, yatholakala ngaphansi kwegama lomkhiqizo iLexette.

Isetshenziselwa ukwelapha i-plaque psoriasis kubantu abadala. Inhloso yalo ukusula isikhumba.

Kabili ngosuku, igwebu lisetshenziswa ungqimba oluncane futhi lihlikihlizwe esikhunjeni. ILexette ingasetshenziswa kuze kube amasonto ama-2.

Imiphumela emibi kakhulu yeLexette ubuhlungu esizeni sokufaka isicelo kanye nekhanda.

I-lotion ye-Halobetasol propionate, 0.01% (Bryhali)

I-Halobetasol propionate lotion, amaphesenti angu-0.01 (uBryhali) avunywa yi-FDA ngoNovemba 2018. Yenzelwe abantu abadala abane-plaque psoriasis.

Ezinye zezimpawu ezisiza ukubhekana nazo yilezi:

• ukoma
• ukuqhuma
• ukuvuvukala
• uqweqwe lokwakha

UBryhali usetshenziswa nsuku zonke. I-lotion ingasetshenziswa kuze kube amasonto ayi-8.

Imiphumela emibi kakhulu ifaka phakathi:

• evuthayo
• ukuhlaba
• ukulunywa
• ukoma
• izifo eziphezulu zomgudu wokuphefumula
• ushukela ophakeme wegazi

Isifutho seBetamethasone dipropionate, 0.05% (Sernivo)

NgoFebhuwari 2016, i-FDA yavuma i-betamethasone dipropionate spray, u-0.05 wamaphesenti (Sernivo). Lesi sihloko siphatha i-plaque psoriasis emnene kuya kokulingene kubantu abaneminyaka eyi-18 nangaphezulu.

ISernivo isiza ukuqeda izimpawu ze-psoriasis njengokulunywa, ukuqhuma, nokubomvu.

Ufafaza lo muthi we-corticosteroid esikhunjeni kabili ngosuku bese uwugcoba ngobumnene. Ungasetshenziswa kuze kube amasonto amane.

Imiphumela emibi kakhulu yilena:

• ukulunywa
• evuthayo
• ukuhlaba
• ubuhlungu esizeni sokufaka isicelo
• ukuqeda isikhumba

Imithi emisha yezingane

Izidakamizwa ezimbalwa ze-psoriasis ezazitholakala kuphela kubantu abadala zisanda kuvunywa yi-FDA ukuthi ziphathe nezingane.

Igwebu leCalcipotriene, 0.005% (iSorilux)

Ngo-2019, i-FDA yandisa ukuvunyelwa kwayo kohlobo lwevithamini D olubizwa nge-calcipotriene foam, u-0.005% (iSorilux). Isetshenziselwa ukwelashwa kwe-plaque psoriasis yekhanda nomzimba.

NgoMeyi, ithole imvume yokusetshenziswa ezinganeni ezineminyaka engu-12 kuya kwengu-17 ubudala. NgoNovemba olandelayo, kwavunywa ukwelapha i-plaque psoriasis yesikhumba somzimba nomzimba ezinganeni ezineminyaka yobudala eyi-4 ubudala.

I-Sorilux isiza ukukhula kancane kwamaseli esikhumba okungajwayelekile ku-psoriasis. Lesi sigwebu sisetshenziswa ezindaweni ezithintekile zesikhumba kabili ngosuku kuze kube amasonto ayi-8. Uma izimpawu zingathuthuki ngemuva kwamasonto ayisishiyagalombili, thintana nodokotela wakho.

Imiphumela emibi ejwayelekile ukubomvu nobuhlungu esizeni sokufaka isicelo.

Igwebu leCalcipotriene-betamethasone dipropionate, 0.005% / 0.064% (Enstilar)

NgoJulayi 2019, i-FDA ivume igwebu le-calcipotriene-betamethasone dipropionate, amaphesenti angu-0.005 / amaphesenti ayi-0.064 (i-Enstilar) ukuze isetshenziswe kwintsha phakathi kweminyaka eyi-12 nengu-17 ubudala. Yenzelwe abantu abane-plaque psoriasis.

ICalcipotriene inciphisa ukukhula kwamaseli esikhumba, kuyilapho i-betamethasone dipropionate isiza ukunciphisa ukuvuvukala.

I-foam isetshenziswa nsuku zonke kuze kube amasonto ama-4.

Imiphumela emibi kakhulu ifaka phakathi:

• ukulunywa
• folliculitis
• ukuqubuka ngamaqhubu abomvu aphakanyisiwe noma isifuba
• i-psoriasis eya iba yimbi

Ukumiswa okwesikhashana kweCalcipotriene-betamethasone dipropionate, 0.005% / 0.064% (Taclonex)

NgoJulayi 2019, ukumiswa kwe-calcipotriene-betamethasone dipropionate topical, amaphesenti angu-0.005 / amaphesenti ayi-0.064 (Taclonex) nayo yagunyazwa yi-FDA ukuthi isetshenziswe ezinganeni ezineminyaka engu-12 kuya kwengu-17 ezine-plaque psoriasis yomzimba.

Ukumiswa ngokwezihloko kwakukade kuvunyelwe i-FDA kubantwana abaneminyaka engu-12 kuya kwengu-17 abane-plaque psoriasis yesikhumba. Umuthi weTaclonex phambilini wawukade uvunyelwe yi-FDA kubantu abasha kanye nabantu abadala abane-plaque psoriasis.

Ukumiswa kwe-Taclonex topical kusetshenziswa nsuku zonke kuze kube amasonto ayi-8. Kubantwana abaneminyaka engu-12 kuya kwengu-17, isilinganiso esiphezulu samasonto onke singama-gramu angama-60 (g). Isilinganiso esiphezulu samasonto onke sabantu abadala singu-100 g.

Imiphumela emibi kakhulu ifaka phakathi:

• ukulunywa
• evuthayo
• ukucasuka
• ububomvu
• folliculitis

I-Ustekinumab (Stelara)

Ngo-Okthoba 2017, i-FDA yavuma i-ustekinumab (Stelara) yentsha eneminyaka eyi-12 nangaphezulu.Ingasetshenziselwa abantu abasha abane-plaque psoriasis elinganiselayo nelinzima ababhekelwa ukuthola i-phototherapy noma i-systemic therapy.

Ukugunyazwa kwenzeke ngemuva kocwaningo lwango-2015 oluthola ukuthi umuthi usule isikhumba kakhulu ngemuva kwezinyanga ezintathu. Ngokuya kwesikhumba nokuphepha, imiphumela ibifana naleyo ebonwa kubantu abadala.

UStelara uvimba amaprotheni amabili ayisihluthulelo senqubo yokuvuvukala, i-IL-12 ne-IL-23.

Inikezwa njengomjovo ongaphansi. Umthamo usekelwe kusisindo somzimba:

• Intsha enesisindo esingaphansi kwamakhilogremu angama-60 (amakhilogremu ayi-132) ithola ama-milligram angu-0.75 (mg) ngekhilogremu ngalinye lesisindo.
• Intsha enesisindo esiphakathi kuka-60 kg (132 lbs.) Kanye no-100 kg (220 lbs.) Ithola umthamo we-45-mg.
• Intsha enesisindo esingaphezu kwe-100 kg (220 lbs.) Ithola i-90 mg, okuyisilinganiso esilinganiselwe sabantu abadala abanesisindo esifanayo.

Imithamo emibili yokuqala inikezwa amasonto ama-4 ahlukene. Ngemuva kwalokho, umuthi unikezwa kanye ezinyangeni ezintathu.

Imiphumela emibi kakhulu yilena:

• imikhuhlane nezinye izifo ezingaphezulu zokuphefumula
• ikhanda
• ukukhathala

I-Etanercept (Enbrel)

NgoNovemba 2016, i-FDA yavuma i-etanercept (i-Enbrel) ukwelapha i-plaque psoriasis engapheli ezinganeni ezineminyaka engu-4 kuye kwengu-17 ubudala abazongenela i-phototherapy noma i-systemic therapy.

U-Enbrel uvunyelwe ukwelapha abantu abadala abane-plaque psoriasis kusukela ngo-2004 nokwelapha izingane ezine-juvenile idiopathic arthritis (JIA) kusukela ngo-1999.

Lesi sidakamizwa esinomjovo sisebenza ngokunciphisa umsebenzi we-TNF-alpha.

Ucwaningo lwango-2016 lwezingane ezicishe zibe ngama-70 ezineminyaka engama-4 kuya kwengu-17 ubudala zithole ukuthi i-Enbrel iphephile futhi iqhubeke nokusebenza kuze kube yiminyaka emihlanu.

Isonto ngalinye, izingane nentsha zithola u-0.8 mg wesidakamizwa ngekhilogremu lesisindo somzimba wazo. Umthamo omkhulu udokotela wakho azowunquma ngu-50 mg ngesonto, okuyisilinganiso esilinganiselwe sabantu abadala.

Imiphumela emibi evame kakhulu ukusabela endaweni yokujova kanye nezifo ezingaphezulu zokuphefumula.

Ezinye izindlela zokwelashwa zisondela ekwamukelweni

Ezinye izidakamizwa zisondela ekuvunyelweni yi-FDA.

Bimekizumab

I-Bimekizumab iyisidakamizwa se-biologic esijojwayo esivivinywa njengokwelashwa kwe-plaque psoriasis engapheli. Isebenza ngokuvimba i-IL-17.

I-Bimekizumab njengamanje isesifundweni sesigaba III. Kuze kube manje, ucwaningo selukhombisile ukuthi luphephile futhi lusebenza ngempumelelo.

Esivivinyweni somtholampilo se-BE SURE, i-bimekizumab yayisebenza kangcono kune-adalimumab (Humira) ekusizeni abantu ukuthi bathole okungenani ukuthuthuka okungamaphesenti angama-90 ezikolo ezisetshenziselwa ukukala ukuqina kwezifo.

Ukhilimu weCalcipotriene-betamethasone dipropionate, 0.005% / 0.064% (Wynzora)

Ku-2019, isicelo esisha sezidakamizwa sathunyelwa ku-FDA yeWynzora. I-Wynzora ingukhilimu owenziwa kanye ngosuku ohlanganisa i-calcipotriene ne-betamethasone dipropionate.

Esifundweni sesigaba III, iWynzora ibisebenza kangcono ekususeni isikhumba ngemuva kwamasonto ayisishiyagalombili kunokumiswa kokhilimu nokhilimu weTaclonex.

I-Wynzora inethuba lokungakhethi kalula, okutholwe abahlanganyeli bocwaningo kwaba lula kakhulu.

Ama-JAK inhibitors

Ama-JAK inhibitors elinye iqembu lezidakamizwa eziguqula izifo. Basebenza ngokukhomba izindlela ezisiza umzimba ukuthi wenze amaprotheni amaningi okuvuvukala.

Sezivele zisetshenziselwe ukwelapha:

• isifo samathambo psoriatic
• isifo samathambo
• ukulunywa yizilonda emathunjini

Abambalwa basesivivinyweni sesigaba II nesigaba III se-psoriasis elinganiselayo nesibi. Ezifundelwa i-psoriasis yizidakamizwa zomlomo i-tofacitinib (Xeljanz), i-baricitinib (i-Olumiant), ne-abrocitinib. I-topical JAK inhibitor nayo iyaphenywa.

Kuze kube manje, izifundo zithole ukuthi ama-JAK inhibitors asebenza kahle nge-psoriasis. Bacishe baphephe njengezidakamizwa ze-biologic ezikhona. Enye inzuzo ukuthi ziza ngendlela yamaphilisi futhi akudingeki zinikezwe njengemijovo.

Ucwaningo olwenziwe kuze kube manje lube yisikhashana esifushane. Ucwaningo olwengeziwe luyadingeka ukwazi ukuthi ama-JAK inhibitors aqhubeka nokusebenza isikhathi eside.

Ukudla okudlela endlini

Ukuhlala unolwazi ngezindlela ezintsha zokwelapha i-psoriasis kubalulekile ekuphatheni isimo sakho.

Alukho umuthi olingana nosayizi owodwa we-psoriasis. Kungenzeka ukuthi kuzofanele uzame izindlela eziningi zokwelashwa ezahlukahlukene ngaphambi kokuba uthole eyodwa esebenza kangcono kuwe futhi engabangeli imiphumela emibi.

Okutholakele okusha ku-psoriasis kwenzeka ngaso sonke isikhathi. Qiniseka ukuthi ukhuluma nodokotela wakho ngezindlela ezintsha zokwelashwa.