I-DaxibotulinumtoxinA ye-dystonia yomlomo wesibeleko

UNjingalwazi uLuxman Bahru: Enkosi ngokuba nathi. 

UDkt. Todd Gross: Ewe, enkosi ngokuba nathi. 

UGqr. Sara Schaefer: Ngoko ke ukuqala nje imvelaphi encinci apha. Uphononongo lwakho lujonge ityhefu entsha ye-botulinum, i-DaxibotulinumtoxinA okanye i-DAXI okanye [00:01:00] Daxxify ngamafutshane kunyango lwe-cervical dystonia. Sinezinye iityhefu ezine ze-botulinum ezisetyenziswa rhoqo kwizonyango kunyango lweengxaki zokuhamba, kubandakanya i-Botox, i-Xeomin, i-BioBlock, kunye ne-Dysport.

Ungayichaza kuqala imfuneko engafezekiswanga yonyango lwe-cervical dystonia nge-chemodenervation, Dr. Bahroo?

UDkt. Laxman Bahroo: Ngokuqinisekileyo. Njengoko sineemveliso ezininzi zetyhefu ye-botulinum ezithengiswayo, nganye kuzo inomda kwiiveki ezili-12.

Umntu akanakukwazi ukujova ngaphantsi kweeveki ezili-12. Nokuba sele kudlule iiveki ezili-12, sinabantu abanesiphumo se-yo-yo, kwaye ngokuxhomekeke kuncwadi, ukuya kuthi ga kwi-80% yabantu baya kuba nexesha elingaphantsi ukususela kwixesha abajova ngalo ukuya kwixesha abafumana iingenelo zeeveki ezimbalwa. Kwaye ngaphambi kwelo thuba leeveki ezili-12, baya kuba nokuyeka, kwaye njengoko abantu abaninzi bebonile, baya kufumana impendulo yeeveki ezisibhozo ukuya kwezili-10 zenzuzo nokuba ngaphakathi kweveki ezili-12.

I-Daxibotulinumtoxin inengxaki engafezekiswayo elungisekayo ngokunika impendulo ende, kwaye siza kuthetha ngaloo nto [00:02:00] kwelo nqaku kwaye ngethemba kulo lonke eli podcast. 

UGqr. Sara Schaefer: Ewe. Mhlawumbi uza kungena kancinci kule nto, Gqr. Gross, ngombuzo olandelayo, othi, iDAXI ifana okanye yahluke njani ngokweekhemikhali kwezinye iityhefu zebotulinum ezisetyenziswayo?

UDkt. Todd Gross: Ewe. Ngoko ke kukho izinto ezintathu apha. Okokuqala, iDaxxify yenziwe kusetyenziswa i-150 kilodalton neurotoxin molecule engenazo iiproteni ezincedisayo. Phakathi kwezo, iityhefu ze-botulinum ezivunyiweyo ukuba zisetyenziswe kwi-cervical dystonia, kukho uluhlu. Ezinye zine-150 kilodalton molecule, ezinye zine-variable ukuya kuthi ga kwi-500 kilodalton, kwaye ezinye zine-900 kilodalton.

 Ngaphezulu kwe-150, ubona ukufakwa kweeproteni ezincedisayo. Okwesibini, iDaxxify yenziwe ngepeptide etshajelwe kakuhle, esetyenziselwa ukuzinzisa. Kwaye njengoko sixoxile kwiphepha, ipeptide ibopha ngombane kwi-neurotoxin eyintloko. Oku kuboniswe ukuba kuphucula ukubopha kwetyhefu [00:03:00] kumphezulu we-neuronal, kwaye yonyusa ukuqhekeka kwe-SNAP 25 ngendlela exhomekeke kwidosi.

Kwaye ekugqibeleni, iDaxxify ayisebenzisi i-albumin ye-serum yomntu kwifomyula yayo, njengoko kunjalo nakwezinye iirobhothi ezivunyiweyo. Ukususa i-HSA kuthintela umngcipheko wokudluliselwa kwentsholongwane okunokuhambisana nokusetyenziswa kwe-HSA kwinkqubo yokwenziwa. Kukwakhokelela kwinto, ehlala ixesha elide kubushushu begumbi.

UGqr. Sara Schaefer: Owu, inomdla. Ngoko ke loo nto isenokuba yindlela efanelekileyo kumaNgqina kaYehova, umzekelo, angakwaziyo ukusebenzisa ezinye iityhefu ze-botulinum okanye akhetha ukungasebenzisi ngenxa yeenkolelo zawo zonqulo ngokutofwa ngezinye izinto zabantu, akunjalo? 

UDkt. Todd Gross: Ngokuqinisekileyo. 

UGqr. Sara Schaefer: Ngowama-2023, iDaxxify yavunywa yi-FDA e-United States kunyango lwe-cervical dystonia emva kokuba iimvavanyo zeklinikhi zibonise ukusebenza kakuhle kunye nenzuzo ende xa kuthelekiswa nobude bexesha elibikwe kwezinye iityhefu, njengoko ukhankanyile, uGqr. Bahroo. [00:04:00] Ungathetha ngokufutshane ngezo zilingo zangaphambili ezakhokelela ekuvunyweni kwe-FDA kunye nesishwankathelo nje esifutshane seenkqubo zabo kunye noko bakufumanisileyo okwakhokelela ekuvunyweni kwemvelaphi ephepheni lakho? 

UDkt. Laxman Bahroo: Ngokuqinisekileyo. Ngoko ke bekukho iimvavanyo ezimbini ezazikwisigaba sesithathu ezakhokelela ekuvunyweni. Elokuqala yayiyi-ASPEN-1.

Yayiluvavanyo olulawulwa yi-placebo oluqhutywa ngokungacwangciswanga, olulandela ngenaliti enye, ukuya kuthi ga kwiiveki ezingama-36, kwaye iidosi zaziyi-placebo daxibotulinumtoxin iiyunithi ezili-125 kunye neeyunithi ezingama-250. Kwaye ngokusisiseko, isiphumo yayikukubona inzuzo xa kuthelekiswa ne-placebo kwezo dosi zombini. Ngoku, ewe, into enomdla yayikukuba zombini zibonise inzuzo, iziganeko ezibi eziphantsi ngokwe-dysphasia okanye ubuthathaka bemisipha, kwaza kwalandela ulwandiso lweleyibhile evulekileyo, olulandele abantu ukuya kuthi ga kunyaka.

Idosi yathiwa tyaba yaya kuthi ga kwiiyunithi ezingama-300, kwaye kwakhona, inxalenye yokhuseleko lwedatha yabonwa kwakhona, yaphindwa njengoko sasibona oko sikubonileyo nge-ASPEN-1. Kwaye ezo zizifundo ezimbini ezikhokelele ekuvunyweni. Kakade ke, ilebheli ngokwe [00:05:00] ye-FDA, idosi ephezulu ikwiiyunithi ezingama-250 ngokusekelwe kuvavanyo lolawulo lwe-placebo, hayi ilebheli evulekileyo yeeyunithi ezingama-300.

UGqr. Sara Schaefer: Ewe, siza kuthetha ngaloo nto kamva. Ngoko ke sithethe nge-US FDA kunye nokuvunywa kwayo. Ungathetha ngokusetyenziswa kweDaxxify kunye nokuvunywa kwayo ukuba isetyenziswe ngaphandle kwe-United States njengoko injalo namhlanje, Gqr. Gross? 

UDkt. Todd Gross: Ngokuqinisekileyo. Kwaye njengoko utshilo, ngoko ke iDaxxify ivunyiwe kwiimpawu ezimbini eMelika.

Yavunywa njenge-dermatological symptomatic, glabellar lines, ngo-2022 kunye ne-cervical dystonia ngo-2023. Ukususela ngoko, yavunywa zombini ezo symptomatic eTshayina ngo-2024 kunye ne-Australia zombini ezi symptomatic ngo-2024.

UGqr. Sara Schaefer: Kwaye uluqhube njani uphando lwakho kwaye ufumene ntoni kuphando lwakho, Gqr. Bahroo? 

UDkt. Laxman Bahroo: Ngoko ke inkqubo yamava okujonga kwangaphambili yayiyindlela yokuba abantu bafumane amava okwenyani ngayo ngaphandle kwesehlo sovavanyo, esasilivavanyo olubalulekileyo lwesigaba sesithathu.

Iingcali ezili-16 [00:06:00] zikhethwe ngokusekelwe kwiindlela zokuphazamiseka kwentshukumo, ngokusekelwe kumava abo ngetyhefu ye-botulinum. Izigulane ezingama-234 zizonke zabhaliswa, ukuya kuthi ga kwimijikelo emithathu. Asinguye wonke umntu owafikelela kwimijikelo emithathu, kodwa imijikelo emithathu. Kwaye ke, injongo ephambili yayikukubhalisa izigulane ezazinengxaki yokudinwa.

Kwaye malunga nama-88% abantu babenetyhefu ye-botulinum, i-12% yayingenalwazi. Uninzi lwabantu ababenetyhefu ngaphambili, malunga nekota ezintathu, babeneempawu zokuqaqamba ngaphambi kweeveki ezili-12. Malunga ne-15% bathi bayonwabile ngonyango lwabo lwangaphambili, kodwa kwakhona, ikota ezintathu zabantu babeneempawu zokuqaqamba.

Ngaphambi koko, zaziziswa, kwaye kwabo bantu babekhe bachaphazeleka yi-botulinum toxin ngaphambili, idosi yabo yokuqala ephakathi yayimalunga neeyunithi ezingama-244. Ngoko ke yayikwicala eliphezulu ledatha ye-Aspen, kodwa kwakhona, ngaphakathi kolo luhlu. Kwaye emva koko kumjikelo ngamnye, phakathi komjikelo wokuqala nomjikelo wesibini, zazifakwa i-titration kwaye zafakwa i-titration kwakhona.

Kwaye sifumene amaqela amabini ahlukeneyo abantu [00:07:00] abanyangelwe iimpawu zokuphumelela xa kuthelekiswa nabantu abanyangelwe ukugcinwa kweempawu ngokuzinzileyo. Umyinge woluhlu lwemithamo yayiyi-244 kumjikelo wokuqala, i-294 kumjikelo wesibini, kunye ne-315, kunye nedosi ephakathi yayimalunga neeyunithi ezingama-300.

Ngoko ke oko kwakuhambelana nophando lwe-Aspen open label. Ngoku, njengoko benditshilo, bekukho amaqela amabini, njengoko benditshilo. Amaqela abekwe ngaphezulu kancinci abekwe phantsi kuba ayeneempawu eziphumayo ngaphambi komjikelo olandelayo wenaliti. Kwelinye icala, abantu abagcina inzuzo yabo babenikwe phantsi kancinci. 

UGqr. Sara Schaefer: Kwaye ukhankanye iidosi eziphakathi kumjikelo ngamnye.

Kwaye ndiphawule xa ndifunda uphando lwakho ukuba uninzi lwezigulane ezinamava eBotox zazinonyango apho amanani ayedlula uphando lokuqala kwaye kwezinye iimeko ayedlula kakhulu. Ndichanekile na ukuba ezinye zezi zigulane zafumana iiyunithi ezingama-800 zokujova? Kwaye uphando lokuqala, njengoko ukhankanyile, yayiziiyunithi ezili-125 okanye ezingama-250 [00:08:00], emva koko

ukuya kuthi ga kwi-300 kuphando olulandelayo. Kwaye - iMedicare eMelika, izikhokelo zabo zichaza idosi ephezulu ye-250. Ngoko ke ungathetha ngaloo nto, amava okwenyani ngokuchasene noko kuvunyiweyo kwaye oko kunokuchaphazela njani ukhathalelo? 

UDkt. Laxman Bahroo: Owu, ngokuqinisekileyo. Kwaye ndicinga ukuba kukho izinto ezimbini kule nto.

Okokuqala, yile nto siyifumanayo kuphando lwehlabathi lokwenyani. Kwezi zifundo zenziwayo ezizizifundo ezibalulekileyo zesigaba sesithathu, uyazi, iidosi aziguquki, inani leenaliti aliguquki ngoko ke awunakuguquguquka kakhulu. Njengoko umntu othile wakha wathi kum kamnandi kakhulu, "ikhaya ohlala kulo likhaya lamava okwenyani."

Ezi zifundo zikhaya abakubonisa lona ngaphambi kokuba uthenge elo khaya apho yonke into yenziwe kakuhle. Nangona libukeka lihle kwaye licocekile, alisebenzi kubomi bokwenyani nakwimisebenzi yokwenyani. Ngoku, ewe, besinabo abantu abafumene iidosi eziphezulu. Bambalwa kakhulu, kodwa nangona kunjalo, abanye abantu bafumana iiyunithi zedosi eziphezulu, kwaye ngokuqinisekileyo babenyangwa nge-toxin ye-botulinum ephezulu ngamava angaphambili.

Ukongeza, babeneempawu eziphawulekayo [00:09:00]. Ngoko ke baqale besebenzisa isiseko esiphezulu, baya nakwisiseko esiphezulu. Kodwa yiloo nto esiyizuzayo kumava okwenyani, ukuba kukho abantu abangaqhelekanga kunye nabantu abane-cervical dystonia enzima abadla ngokufuna iidosi eziphezulu ezidlula nayiphi na ileyibhile yemveliso. 

UDkt. Todd Gross: Kwaye ukuba ndingakwazi ukwandisa mhlawumbi kancinci kwidatha efunyenweyo njengoko ubutshilo, uvavanyo olubalulekileyo luhlolisise iiyunithi ezili-125 kunye nama-250.

Ngeenjongo zomthetho, ezo zenzelwe ukuxhasa ukuvunywa, nto leyo abayenzileyo kakuhle. Njengoko uGqr. Bahroo etshilo, xa usiya kwiklinikhi, unokubona indlela eyahlukileyo yokuziphatha. Iziphumo kwiprogram yokujonga kwangaphambili, njengoko utshilo, yayingama-300.

Uninzi lwezigulane belukwinqanaba eliphantsi kakhulu kuloo nto. Kwaye sibona ngokwe-titration ukuba izigulane ezininzi zifikelele kwidosi ezinzileyo kumjikelo wesibini okanye wesithathu. Enyanisweni, uGqr. Bahroo uthe ukunyuka ukusuka kumjikelo wesibini ukuya kowesithathu bekuncinci kakhulu kunokuba bekunjalo ukusuka kowokuqala ukuya kowesibini.

Oku ngokucacileyo kubonisa iimfuno zomntu ngamnye zezigulane. Abanye abaguli [00:10:00] bafuna okungakumbi, abanye abaguli bafuna okuncinci, kwaye abaguli abakhethwe kuba beneempawu zokuphazamiseka okanye abasebenzisa idosi ephezulu yetyhefu ngaphambili banokugqibela befuna iidosi eziphezulu zeDaxxify. 

UGqr. Sara Schaefer: Ngoku sifikelela kwiziphumo ebezingalindelekanga, nto leyo ebaluleke kakhulu ukuthetha ngayo kulo naluphi na uvavanyo lweyeza.

Kuzo zombini izifundo zobhaliso kunye nephepha leengcebiso zeklinikhi, uxela amazinga eziganeko ezimbi ezibalulekileyo ezifana ne-dysphasia kunye nobuthathaka bemisipha obubonakala buphantsi xa kuthelekiswa namazinga axeliweyo kwezinye ii-neurotoxins ezivunyiweyo. Nangona kunjalo, ewe, ukuba ityhefu ihlala ixesha elide, kukho ithuba lokuba ezo ziphumo zibe zimbi zihlale ixesha elide kuyo nayiphi na imijikelo yenaliti.

Ithini ingcaciso yakho ngale nto, kwaye ucinga ukuba olu phando luchaphazela njani izigqibo zonyango kwimisebenzi yeklinikhi? 

UDkt. Laxman Bahroo: Ndiza kuqala ndithathe loo nto kwaye mhlawumbi uGqr. Gross angabuya nenguqulelo eyahlukileyo yale nto. Ngoko ke ukuba uyijonga, njengoko utshilo, iziganeko ezimbi bezincinci, zeziphi iziganeko ezimbi esizibonileyo, [00:11:00] ubuthathaka bubonwe malunga ne-2% ngaphezulu kancinci, ndicinga ukuba yi-2.4 ngqo.

I-Dysphasia ibonwe kwi-.3 kwaye njengoko kukhankanyiwe, iidosi kwiimeko ezininzi zazibekwe ngaphezulu kweedosi ze-ASPEN-1 kunye ne-Aspen OLE. Ndicinga ukuba le yiyo eyenza i-daxibotulinumtoxin ibe yodwa ngaloo ndlela kuba ine-peptide ebizwa ngokuba yi-RT004, eyi-peptide eyenzelwe ukugubungela i-neurotoxin ye-botulinum toxin core, kodwa yenzelwe ukuyilinganisa kufutshane ne-membrane, i-membrane ene-negative charged ene-peptide ene-positive charged.

Ivumela ukusasazeka okuncinci ngaphandle kwaloo ndawo. Ndicinga ukuba oko kuyenza yahluke kuba une-neurotoxin eninzi efunxwayo, ungaphumi kwindawo ofakwe kuyo inaliti uye kwiindawo esingafuni ukungena kuzo, kwaye ngenxa yoko ubona iingxaki ezimbalwa malunga nokusasazeka, njengobuthathaka okanye i-dysphasia.

Yiyo loo ngcaciso endiyicingileyo malunga nesizathu sokuba sibone loo nto. Njengoko umthamo usanda kulandelana, asifumananga ziphumo ebezingalindelekanga ezingakumbi ngaxeshanye. 

UDkt. Todd Gross: Ewe, ndicinga ukuba yimpendulo elungileyo kakhulu leyo. Ndingangeza nje ukuba oko kwabonwa kwinkqubo yokuphonononga [00:12:00] kwakuhambelana kakhulu noko sikubonileyo kuvavanyo olubalulekileyo kunye nophando oluvulekileyo olwalandela, olwalungamazinga e-dysphagia awayephakathi kwe-1.6 kunye ne-3.8%, kuxhomekeke kwiqela lonyango, kunye namazinga obuthathaka bemisipha angama-4.8 kunye ne-2.3% kumaqela omabini onyango.

Kwaye xa sangena kwindlela yokwenyani yokwenza unyango, sabona ukuba loo manani ayefana kakhulu. 

UGqr. Sara Schaefer: Kakade ke, ezi ayizozilingo zokujongana ubuso nobuso, ngoko ke kufuneka wongeze i-asterisk kancinci koku. Kodwa kuyathakazelisa, ngakumbi ngohlobo lwenkcazo yamakhemikhali oyinike yona, uGqr. Bahroo, ukuba kutheni kusenokwenzeka ukuba iziphumo ebezingalindelekanga zinokulinganiselwa ngakumbi ngale tyhefu ye-botulinum. Ke ngoko kwabo bagqirha abanokuba bephulaphule oku kunye noDaxxify abanomdla abanokuba becinga ngokutshintsha izigulane zabo zeziphi iingcebiso ezisebenzayo onazo kubo ngokwemigaqo...

Ukhankanye kwiphepha lakho ulwazi oluthile malunga nee-ratios kunye ne-intervals. Ukhankanye uGqr. Bahroo, ukuba abanye oogqirha [00:13:00] obafunde kuphando lwakho bagqibe ekubeni banyange izigulana ngaphambi kokuba ziqale ukuncipha kwenzuzo yazo yeempawu, ngelixa abanye berhoxa ngenxa yokuncipha kwenzuzo yeempawu.

Ukwazi oko ukwaziyo, zeziphi izinto oza kuzisebenzisa kwisigulana esitsha kwindawo yakho yokusebenza? 

UDkt. Laxman Bahroo: Zininzi izinto ekufuneka zichazwe, kwaye ndicinga ukuba ezo zingongoma zifanelekileyo kakhulu. Masithi ekuqaleni, siqale malunga nomlinganiselo we-one-to-one phakathi kwe-daxi kunye ne-onabot.

Uninzi lwezigulane zethu ezazinamava ngaphambili zazisebenzisa i-onabot. Ngoko ke saqala ngomntu ngamnye. Ngoku, ngokwendalo, ndiza kukuxelela ukuba kukho ii-injectors ezili-16 ezahlukeneyo ezineedosi ezili-16 ezahlukeneyo, kodwa sasisondelelene kakhulu noko. Ngoku, izigulane ezingenangqondo, ewe, zaqaliswa ngedosi ephantsi kuba kwakungekho rekhodi yangaphambili yokuba idosi yazo yayiyintoni.

Njengoko bekufanele ukuba ube njalo kwizigulana ezingazi nto kwiklasi yamayeza, besisoloko sigcina imithetho. Ngezigulana ezazinamava ngakumbi, nangona zazingazi nto kwi-DAXI, besikhululekile kancinci kuloo dosi. Kwaye ewe, i-titration yasilungisa. Kwaye ngexesha le-titration, siye saya kwi-[00:14:00] saya kwi-1.4 kweso sithuba sedosi.

Ngoku, into eyabangela oku yayilixesha lokurhoxa. Ngoku, ixesha lokurhoxa linomdla kuba amava ethu angaphambili phantse kuzo zonke ezinye iityhefu ze-botulinum yayiziiveki ezili-12, kwaye ukhetha abantu, njengoko benditshilo, abangaphezu kwama-80 ekhulwini kubo abaye baphelelwa ngamandla ngaphambi kokuba bathathe idosi elandelayo.

Ngoko ke, siwubeka phi umhla wokubuyela umva? Oku bekuyinto nje yokuqikelela kuthi. Ekuqaleni, sonke sakubeka malunga nexesha leeveki ezili-12, ezili-13. Ngoku, imeko eyayinzima yayikukuba izigulane ezininzi zaziqhuba kakuhle, kwaye le yingxaki elungileyo ukuba nayo, kodwa zaziqhuba kakuhle. Ngoku, ukuba isigulana sihleli phambi kwakho kwaye sifuna ukugonywa, ukuba senze umzamo wokungena, rhoqo, asiyi kuthanda ukuhamba size sibuye emva kweeveki ezimbini, ezintathu.

Uninzi lwezo zigulana zathi, "Kulungile, ndiza kungena ndize ndihlatywe nangona ndigcina inzuzo yam ngelo xesha." Yayilulo olunye uluvo. Ezinye zezigulane zam kunye nabo bonke abanye, ukusuka kwi-16 practices nabo benza into efanayo. Babebiza iveki okanye ezimbini ngaphambili baze bahambise idinga emva kweeveki ezimbalwa [00:15:00].

Ngoko ke bekukho into engaziwayo malunga nokuba lo mjikelo wokuqala uza kuthatha ixesha elingakanani. Besilindele iiveki ezili-14, iiveki ezili-16, kodwa izigulane bezingaqinisekanga kuba zizigulana ezineempawu zokuqhambuka. Siqhele ukuba ezi zigulane zibe neempawu zokuqhambuka, ngoko ke bekunzima ukufumana ngaloo ndlela.

Kwakukho olunye utshintsho esalufumanisayo. Xa inkqubo yokujonga kwangaphambili yaqala, yaqala ngasekupheleni kwehlobo, ekuqaleni kwekwindla. Xa ujonge ukuba iiveki ezili-12 ukuya kwezili-13 ziphelile, elo lixesha leeholide. Idlanzana lezigulana lafika ngaphambi kwexesha leeholide kuba lalisazi ukuba phakathi kweeshedyuli zababoneleli, iishedyuli zabo, basenokuba baphume inyanga yonke.

Uloyiko lwabo, kwaye oku koko bakutshoyo abaninzi kum nakwabanye ababoneleli ngeenkonzo, kukuba uloyiko lwalukukuba, "Kuthekani ukuba kwiiveki ezimbini ezizayo ndiqala ukudinwa ndize ndingakwazi ukuza ezinye iiveki ezine? Emva koko ndiza kuba lusizi." Ngoko ke abantu abakumjikelo wokuqala bangena, nangona babezinzile kwimilinganiselo yokugcinwa, ukuze banikwe inaliti.

Ngoku, umjikelo wesibini, njengoko ubona, uphuhlise ixesha elide kancinci, kwaye bakwazile ukungena ixesha elide. Okokuqala, babeqhele ukufumana impendulo kwaye bakwazile ukuqiniseka ngakumbi ukuba baza kufumana impendulo ende [00:16:00]. Ukongeza, siwabeke phantsi amagama lawo aneempawu zokuphumelela ukuze bakwazi ukufumana impendulo ende.

Ngoko ke kukho izinto ezingaqhelekanga apho. Indlela endingayiguqula ngayo ngokwendlela esebenza ngayo, ndingaqalisa kufutshane nedosi yabo. Ukuba bakwi-Onabot, kufutshane nedosi leyo, ndisazi kakuhle ukuba ndiza kuyinciphisa. Beka ulindelo lokuba ixesha lethu eliqhelekileyo lokuvavanya idosi limalunga neeveki ezili-16. Kwaye malunga nendlela izigulane ezikhetha ukuza ngayo oko kuxhomekeke kwisigulana, kumboneleli.

Sikholelwa ukuba, ixesha lokusebenzisa idosi ye-daxi likunika ukuguquguquka. Kusenokuba kukho abantu abasenokufuna ukugonywa rhoqo ngenxa yeendleko okanye umgama okanye bakhetha nje ukugonywa kancinci, kunye nabanye abantu abanokuthi, "Hayi, ndifuna ulawulo olugqibeleleyo, ngoko ke ndiza kusondela kakhulu kuloo mzuzu ukuze ndingabi nampumelelo."

Kwaye bubuhle bokuba ngumjovi, ngokoluvo lwam, kukuba unokuba nomtsalane ofanayo kwizigulana zombini ngokuxhomekeke kwinto abafuna ukuyizisa kuyo. Kukubona iglasi igcwele isiqingatha kwaye ingenanto isiqingatha. 

UGqr. Sara Schaefer: Ewe, ndicinga ngezigulane ezithile kwicandelo lam lonyango eziya kuwela kuzo zonke ezo ndidi.

UDkt. Laxman Bahroo: Ewe. 

UGqr. Sara Schaefer: [00:17:00] Ngaba kukho na amazwi okuvala avela kuni? 

UDkt. Todd Gross: Ndingathanda ukuthatha eli thuba ukunibulela ngesimemo sokuvela kwi-podcast nize nixoxe ngeli nqaku. Kwaye ndifuna ukubulela abaphandi abaninike ulwazi ngalo. 

Uyazi, njengoko sasilungiselela ukutshintsha ukusuka ekuvunyweni ukuya ekuthengisweni, kwakubaluleke kakhulu ukufumana izimvo zabo.

Kwaye, sikholelwa ukuba le yindlela esebenzayo kakhulu yokufudukela kwishishini kunye nokufumana la mava kwangethuba.

UDkt. Laxman Bahroo: Kwicala lam uluvo lwam lokugqibela lungaba kukuba siyonwabele kakhulu i-preview experience. Siyonwabele ukujonga i-ASPEN kunye nedatha yolwandiso lwe-open-label kwaye sibone apho idatha ingayi...

yayiluhlobo oluthile lwencwadi yesikhokelo okanye isikhokelo, size emva koko sisebenzise loo ncwadi yesikhokelo kwaye silungisa kakuhle kwaye siphucula izakhono zethu zokujova kunye nomthamo womthamo. Kwaye ndiza kukuxelela, uninzi lwethu lwafumana umthamo kwaye lwaluneendlela ezahlukeneyo zokucinga ngayo, kodwa ekugqibeleni, zonke izixhobo zokujova zidibene ngeengcinga ezithile ezisisiseko.

Ngoko ke bekumnandi kuthi ukuthetha nabanye abajovayo kulo lonke ilizwe, sixoxe ngeengcebiso zendlela esijongana ngayo [00:18:00] into ethile, sifundana. Kwaye njengoko nawuphi na umjovayo angakuxelela, omnye umjovayo uhlala efunda komnye umjovayo kwaye uyazuza kuyo. Ngoko ke ndicinga ukuba ekugqibeleni, oku kuncede ekufundeni kwethu ngetyhefu ye-botulinum ehlala ixesha elide.

Izigulane zethu ezazikwazi ukufumana ityhefu ye-botulinum, nokuba yayiyingxaki yeendleko kubo okanye yexesha elide, kwaye zazuza kunyango olwaluntsha kunye nenyaniso yokuba zazikwazi ukufumana imijikelo emininzi yonyango ukuze zikwazi ukunciphisa nokulungisa ulawulo lwazo lwe-cervical dystonia.

Ngoko ke enkosi kakhulu ngokundinceda. 

UGqr. Sara Schaefer: Ndiyawuthanda lo mbono wokuvala. Asingobantu abazimele bodwa. Kufuneka sithethe omnye nomnye, akunjalo? 

UDkt. Laxman Bahroo: Ngokuqinisekileyo. 

UGqr. Sara Schaefer: Kuhle kakhulu. Kulungile. Enkosi ngokujoyina nathi namhlanje. 

UDkt. Todd Gross: Enkosi. 

UDkt. Laxman Bahroo: Enkosi kakhulu. [00:19:00]