Yintoni? Intombazana encinci enentshukumo ezibukhali nezishukumisayo

Wamkelekile, Kathryn.

UDkt. Kathryn Yang: Enkosi ngokundibona, Hugo

UGqr. Hugo Morales Briceno: Kumnandi kakhulu. Ngoku ukuze ndilungiselele abaphulaphuli bethu, ndingathanda ukuqala ngokufunda imbali yeklinikhi [00:01:00], ndize ndifumane iingcinga zakho ngeentetho ngaphambi kokuba ndingene kuvavanyo. Ngoku, le yintombazana eneminyaka eli-15 ubudala eyayiqhelekile ngaphambili eyabonakalisa iimpawu eziqala kancinci kwiiveki ezimbalwa.

Iimpawu, uchaze, yayikukushukuma kwemilenze engasentla okushukumayo okwakukho xa ephumle kwaye kusebenza. Kwisithuba senyanga enye, zonke iimpawu zakhe ziye zanda kweli tyala, kwaye nokuhamba kwakhe kuyaphazamiseka. Xa ebuzwa imibuzo ethile, iimpawu zakhe ziye zavela emva kwesifo somkhuhlane.

Nangona kunjalo, asinazo iinkcukacha malunga nobunzima besi sifo esinjalo esinomkhuhlane. Imbali yakhe yezonyango yayingathetheki, kwaye wayengasebenzisi mayeza. Ngoku, ukuba siqala ngale nto, Kathryn, emva kokuva indlela echazwe ngayo kwiklinikhi, yintoni eza engqondweni yakho malunga neziphumo ezinokwenzeka [00:02:00]?

UGqr. Kathryn Yang: Ewe, ndicinga ukuba ngumbuzo omhle, kwaye ndicinga ukuba ukuqala ngokubanzi. Ukucinga nje ngesiqu ngokubanzi, kubalulekile ukugxininisa ukuba le yintombazana eneminyaka eli-15 ubudala eyayiqhelekile ngaphambili. Ndicinga ukuba xa siqala kamva ukwakha umahluko, kuyanceda ukwahlulahlula ngokweebhakethi into oyicingayo kunye nesizathu sakho esisisiseko.

Isini sisenokuba yinto esicinga ngayo ngokukodwa xa kufikwa kweli tyala. Ngoko ke, ukukhumbula oko. Ukwehla kweempawu kubonisa uhlobo oluthile lomfanekiso ongaphantsi. Ngoko ke, into ekufuneka sicinge ngayo xa sicinga ngeepateni ze-syndromes okanye i-etiology ethile.

Kwaye ndicinga ukuba eyona nto ibalulekileyo iza kwenzeka xa sicinga ngovavanyo. Ngoko ke ngoku, inkcazo yeentshukumo zakhe yile ntshukumo yamalungu angasentla eshukumayo xa ephumle kwaye eshukuma, kwaye ayicaci kangako. Ibonisa ukuba kusenokwenzeka ukuba yi-hyperkinetic, kuba sicinga nge-movement disorder, i-hyperkinetic movement disorder.

Kodwa phantsi kwelo gama libanzi, kukho izinto ezininzi ezahlukeneyo [00:03:00] esinokuzikhomba. Ngoko ke omnye umbuzo obalulekileyo kamva kukuchaza ukuba yintoni na into ephambili. Kwaye olu hlobo lwembali yokuqhubela phambili kunye nokubandakanya ukuhamba kwakhe kuya kuba yinto ekufuneka ikhunjulwe, kunye nesiganeko esibangela isifo esibangelwa yifiva, kuba usulelo kunye nohlobo lokuphazamiseka kokuhamba emva kokosuleleka lunokuba yinto eqhelekileyo kwaye kukho izinto ezahlukeneyo kuluhlu lwethu lomahluko. Kodwa ngokubanzi, kusashiya imibuzo emininzi evulekileyo, kwaye ndicinga ukuba sidibanisa kakuhle ekucingeni ngevidiyo ezayo kunye nophando esiza kulujonga.

UGqr. Hugo Morales Briceno: Ndiyavuma. Imbali ikuxelela ukuba kukho into eyenzekileyo kancinci kancinci, kwaye okufunyenweyo kuya kuba luncedo kakhulu ukuqonda okwenzekayo. Ngoku, ndiza kukunika uvavanyo lweklinikhi, ndize ndikucele uchaze imbonakalo yevidiyo endikubonise yona.

Ngoku, xa wayehlolwa, wayephaphile, egxile, kodwa iMini-Mental State Exam yafumana amanqaku ali-18, ilahlekelwa ngamanqaku kwingqwalasela. Kodwa ulwimi lwakhe kunye nentetho yakhe zagcinwa. Amandla okunyakaza kunye neempendulo zaziqhelekile, kunye nemvakalelo. Kwakungekho i-ataxia yelungu eliphezulu ngokwenkcazo, kodwa-- kwaye iziphumo eziphambili yayikukuba esi sigulana sasinale ntshukumo ixhaphakileyo.

Ngoku kwividiyo ubona ntoni? Ukuba ubunokuxelela abaphulaphuli into oyijongileyo kwaye ucinga ukuba kwenzeka ntoni?

UDkt. Kathryn Yang: Ewe. Ndijonge nje ividiyo njengoko sithetha ukuze ndisibonise indlela esiphila ngayo, kodwa le yintombazana eselula. Ilele ebhedini yesibhedlele. Ivukile kwaye ilandela umyalelo ngokufanelekileyo. Kodwa ungabona kwasekuqaleni ukuba kukho iimpawu ezimbalwa eziphawulekayo.

Ngoko ke inxalenye yokuqala isezingalweni zakhe. Ngoko ke ndicinga ukuba umvavanyi umcela ukuba aphakamise iingalo zakhe ngendlela ethile. Kwaye xa esenza loo nto, kukho ezi ntshukumo ziqhubekayo, ezibonakala ngathi ziintshukumo eziguquguqukayo ezingalweni zombini. [00:05:00] azinyamalali nangaliphi na ixesha lovavanyo, kodwa ukwaphakamisa ingalo yakhe kulo lonke uviwo.

Ngoko ke xa unesimo sengqondo esifanelekileyo, kukho le ntshukumo ibangela i-hyperkinetic. Ukuba bendinokuyibona le nto, eyona nto iphambili endingayibiza ngokuba yi-myoclonus. Ndicinga ukuba ufika apho ngokukhawuleza emva kovavanyo olusecaleni kwebhedi kuba iintshukumo ziyaxhathisa. Zenzeka oko kwachazwa xa uphumle kwaye usebenza kwaye zenziwa ngokubanzi.

Ngoko ke, kamva kuvavanyo, ungabona ukuba nazo zibandakanya iinyawo zakhe, ngoko ke amalungu akhe asezantsi nawo ayachaphazeleka. Kwaye ndicinga ukuba uhlobo oluthile lweperile kubafundi kukuba olu hlobo lokuphikisana, ukungcangcazela, umzekelo, okuhlala kuvakala ngesingqisho kwaye kushukuma kufutshane nelungu.

Oku ku-arrhythmic. Kwenzeka ngequbuliso kakhulu. Kufana nokukhwankqiswa. Ngoko ke ndicinga ukuba i-myoclonus ingaba yinto ephambili engqondweni. Esinye isiphumo seklinikhi esibonakalayo kukuhamba kwamehlo akhe.

Ngoko ke xa umjonga [00:06:00] ebhedini, uhleli apho, kodwa unezi zinto zibonakala ngathi ziintshukumo zamehlo ezingaqhelekanga, ezikhawulezayo, nezijolise kwicala elinye.

Kwaye olo hlobo lwenkcazo ngamanye amaxesha lusikhokelela kwinto ebizwa ngokuba yi-opsoclonus. I-Opsoclonus idla ngokungazikhetheli, idibana, ijikeleza ngeendlela ezininzi kwaye yenzeka ngasemva ngaphandle kojongano oluqhelekileyo lwe-intersaccadic olukunceda ukwahlula oku kolunye uhlobo lwentshukumo yamehlo, olunokuthi ngamanye amaxesha lubonakale lufana kancinci olubizwa ngokuba yi-ocular flutter.

Kodwa oko kudla ngokuba ngokuthe tye kuphela. Kwaye kuyahlula oku kwi-nystagmus, apho-eyona inesigaba esicothayo esilandelwa sisigaba sokulungisa ngokukhawuleza. Ngoko ke ezi ntshukumo zamehlo azisiso isigaba esicothayo okanye ixesha lokuphumla. Ziyaphithizela kakhulu. Zikumacala onke, kwaye ziyaqhubeka kuyo yonke ividiyo.

UGqr. Hugo Morales Briceno: Ewe. Kodwa inkcazo osinike yona kukuba ujongeka ene-syndromic kakhulu kunye nendibaniselwano ye-generalized myoclonus kunye ne-opsoclonus, nto leyo eyahlukileyo kakhulu. Kwaye ndicinga ukuba [00:07:00] njengabafundi bokuqala be-neurology kunye nabafundi abahlala apho, abazange bayibone i-myoclonus kulula ukuyibhidanisa nezinye izinto kuba, i-nystagmus ine-quick phases kunye ne-slow phases, inecala elahlukileyo, kodwa le nkcazo osinike yona icacile kakhulu kwi-opsoclonus, ngoko akukho mathandabuzo ukuba le yi-syndrome.

Ngoku, kwinkonzo yakho, ungathetha njani nabo ngasemva, njengoko usikhankanyile? Unesifo esibuhlungu, kukho isifo somkhuhlane, uze ufumane i-opsoclonus myoclonus. Ungathanda ukuphanda njani esi sigulana?

UGqr. Kathryn Yang: Ngoko ke ndicinga ngaphambi kokuba ndicinge ngovavanyo olongezelelweyo, njengoko uthe kukho uhlobo oluthile lwenkcazo ye-syndromic apha ehambelana nento ebizwa ngokuba yi-- Ngoko ke xa ndicinga-- xa sicinga nge-opsoclonus myoclonus i-ataxia ethile yokuhamba, kunye ne-encephalopathy encinci enovavanyo oluncinci lwengqondo kumntu okwishumi elivisayo owayephilile ngaphambili, sicinga ngento ebizwa ngokuba yi-opsoclonus myoclonus ataxia syndrome, okanye i-OMAS.

Kukho isiteketiso esidala sale nto. Yayibizwa ngokuba ngamehlo okudanisa, iinyawo zokudanisa. Kwaye ndicinga ukuba kuyanceda ukuyibeka ngolu hlobo. Ngoko ke ngokwembono yokuxilonga, ukuba kukho iimpawu ezintathu kwezine, ngoko ke i-opsoclonus, i-ataxia okanye i-myoclonus, utshintsho lokuziphatha okanye ukuphazamiseka kokulala, kwaye kamva siza kuxoxa ngezizathu ezisisiseko ezifana ne-neuroblastoma.

Ukuba kukho ezintathu kwezi mpawu zine, olu xilongo lunokwenziwa. Kwaye luchaza ngakumbi isifo. Ndicinga ukuba wakuba ufumene olo phawu, kufuneka sicinge ngalo, yintoni ebangela oku? Yintoni enokubangela ezi mpawu? Kwaye ke ndicinga ukuba olo hlobo lukhokelela kuvavanyo oluzinikeleyo.

Ndicinga ukuba ukuba besinokusondela kwesi sigulana sisecaleni kwebhedi, umbuzo omnye onokuthi uwuphendule kukuba, ngamanye amaxesha i-myoclonus inokuba nesifo sokuwa, ngoko ke umahluko phakathi kwe-myoclonus [00:09:00] ivela kwi-cortex okanye kwi-cortical myoclonus xa ithelekiswa ne-subcortical nangaphezulu kuba oko kuya kutshintsha indlela osebenza ngayo kodwa neendlela zakho zonyango.

Ngoko ke loo nto isenokuba yinto yokuqala onokuyicinga. Kodwa ndingaqala ngaloo nto ndize ndicinge ukuba ukuvavanya i-myoclonus, ngakumbi ukwenza into ebizwa ngokuba yi-EMG, kuba ngamanye amaxesha i-EMG morphology inokukunika ulwazi oluthile.

UGqr. Hugo Morales Briceno: Ndineziphumo ezithile kuwe. Ngoko ke isigulana sanikwa i-electroencephalogram eyayixelwe ukuba iqhelekile. Sasine-polymyography eyayibonisa olu qhushumbo oluphezulu olungaphantsi kwe-milliseconds ezilikhulu. Kwaye i-EEG, i-EMG jerk ivaliwe, kwakungekho nxulunyaniso okanye unxulunyaniso lwe-cortical kwi-jerks nto leyo ethetha ukuba aziveli kwi-cortex, ubuncinci.

Olunye uphando olubalulekileyo kukuba i-MRI yobuchopho bakhe yayiqhelekile kwaye uphando olucwangcisiweyo nalo lwaluqhelekile. Kwakungekho zinkcazo [00:10:00] zokungasebenzi kakuhle kwesibindi, iingxaki zezintso. Kwaye i-CSF ibonise ukuba iiseli ezimbini zeproteni ezingama-48 ziphezulu kancinci kwi-glucose eqhelekileyo.

Kwaye wayenophando nge-CT esiswini kunye nesifuba, nto leyo eyaxelwa ukuba yayiqhelekile. Ucinga ngale nto, ungathanda ukuqhubeka njani nolunye uphando?

UGqr. Kathryn Yang: Ewe. Ngoko ke ndicinga ukushwankathela uphando olwenziweyo ukuza kuthi ga ngoku. Ngoko ke ndicinga ukuba oko sikuxelelwa yi-EEG kunye ne-EEG EMG kukuba ezi azizo-seizures. Ngoko ke yinto esiyikhuphe ngaphandle. I-EEG iqhelekile kwaye akukho nxibelelwano lokwenyani. Ikwakuxelela ngokuqinisekileyo ukuba akukho nxibelelwano phakathi kwe-EMG kunye ne-EEG ngokwayo kunye nezi ntshukumo zifana ne-jerk-like okanye i-myoclonus.

Imo ye-EMG ikuxelela kancinci malunga nokuba izinto zinokufumaneka phi. I-Cortical myoclonus [00:11:00] idla ngokuvelisa ukuqhuma okufutshane kakhulu kwindawo ethile ukusuka kwi-10 ukuya kwi-50-milliseconds. Esikubonayo kolu phando, kolu phando kukuqhuma kwe-polyphasic phantsi kwe-100 milliseconds, okude kancinci, kodwa kuhambelana ngcono kakhulu nephethini eveliswe yi-subcortical.

Ngoko ke ndicinga ukuba yinto esinokuyisusa koku. I-MRI yobuchopho iyasiqinisekisa kuba ayibonisi zizilonda zesakhiwo. Ngoko ke amaxesha amaninzi sicinga ngotshintsho kwi-basal ganglia okanye imifanekiso yokudumba okanye ukuba ucinga ngotshintsho lwe-ataxia kwi-cerebellum, oko kusenokuba kuchaza ezinye zezi mpawu, kwaye i-MRI yobuchopho ayimangalisi.

Njengoko ukhankanyile, uphando lwakhe lwenkqubo alubonisanga nto, kwaye i-CSF yakhe, nangona ibonakalisa iiseli ezimbini, ayibonakali kakuhle. Ngoko ke kwakhona ayibonisi i-lymphocytic pleocytosis yokwenyani kwaye i-CT abdo/chest njengenqaku lokuqala ayimangalisi. Ngoko ke ndicinga ukuba xa sicinga ngokwandisa iimvavanyo zethu, [00:12:00] ngakumbi kule meko yeklinikhi apho sicinga ukuba lo ngumfanekiso we-OMAS.

Ndicinga ukuba ukucwangcisa uvavanyo olwandisiweyo lube ziibhakethi ezintathu. Ngoko ke ndicinga ukuba kubalulekile kwi-OMAS ukuvavanya ithumba kungaba yibhakethi enye. Eyesibini ingaba kukuvavanya i-autoimmune kunye ne-antibody, ngakumbi. Kuze kube kukuvavanya okwesithathu okusulelayo kwaye kwividiyo, le ntombazana ibonakala ngathi ivela kuhlobo oluthile lwemvelaphi yase-Southeast Asia olunokuthi ugxile kulo ngakumbi.

Ukuphonononga nganye nganye ngokweenkcukacha ezithe vetshe. Ngoko ke ndicinga ukuba kwisikrini sethumba, esi sisiqendu ongenakusiphosa kwi-OMAS, ngoko ke inani elibalulekileyo lezigulane ezincinci, ingakumbi imbangela ye-OMAS yi-paraneoplastic. Nangona isifuba se-CT kunye nesisu ziqhelekile, oko akwanele ngokwako.

Ezinye iziko zikhetha ukuqala nge-MRI yomzimba wonke kwaye ndicinga ukuba umgangatho olungileyo wokufumanisa into esiyifunayo ngokusisiseko, okuyi-neuroblastoma yi-MRI yomzimba wonke okwangoku. Kodwa kukwakho nee-biomarkers onokuzivavanya, ngoko ke i-catecholamine yomchamo, ii-metabolites HVA, kunye ne-VMA ngokubanzi kulula ukuzithumela.

Zidla ngokuba zincinci kancinci. Kodwa ndicinga ukuba kufanelekile ukuba uzithumele kunye nophando lwakho oluseleyo. Kwaye ke i-MIBG synscintigraphy iluncedo nakwezinye iimeko, kunzima kancinci ukufikelela kuyo, kodwa ngokwesiqhelo olu luvavanyo olunokusetyenziswa ukukhangela iintlobo ze-tumor.

Kumabhinqa asemva kokufikisa, uhlala ufuna ukugxila kwimifanekiso ye-pelvic ukuze ukhangele i-teratomas yesibeleko. Nokuba unesikrini esingalunganga kwaye iimpawu ziyaqhubeka, kubalulekile ukuphinda imifanekiso ngokwembono esebenzayo. Ukuze uqhubeke nokukhangela loo mthombo kwaye uwukhuphe ngokupheleleyo, kuba unendlela eyahlukileyo yonyango.

Ibhakethi yesibini, eyi-autoimmune [00:14:00] kunye nee-paraneoplastic antibodies. Ngoko ke ndicinga ukuba ukuthumela iphaneli yee-serum kunye nee-CSF antibodies ezifana, i-mimic ephambili yi-NMDAR okanye i-anti-NMDA receptor encephalitis, ngoko ke ukuthumela i-anti-NMDAR, i-anti-GABA kunye ne-anti-GAD 65. Ezi zezinye zee-antibodies esizicingayo ngamanye amaxesha.

Kukho uluhlu lwezinye izinto ekufuneka zifakwe kuloo ngqokelela. Kodwa i-OMAS ene-antibody negative ixhaphakile, iphaneli ene-negative ayisoloko isusa isifo. Kwaye ndicinga ukuba ukuchukumisa ngokukhawuleza kwibhakethi yesithathu, okusulelayo nokudumba, kuba wayenesifo esicacileyo se-febrile ngaphambi kokuba afumane isifo, ngoko ke ndijonga i-viral serologies kunye ne-PCR, kwaye emva koko kuxhomekeke kwijografi kunye nembali yokuvezwa, ndicinga ngosulelo oluthile ngononophelo.

UGqr. Hugo Morales Briceno: Ewe. Ndicinga ukuba bubulumko kakhulu ukwahlulahlula ngaloo ndlela. Ukhangela imvelaphi enonyango oluthile. Nangona kukho [00:15:00] ezinye iindlela apho baya kubona i-opsoclonus myoclonus baze baqalise unyango lwe-steroids kunye ne-IV okanye batshintshele kunyango olunzima ngakumbi. Kodwa ukuba uyazi i-etiology kunye ne-pathophysiology esisiseko, inokukunceda ukuba ujolise okanye ulungelelanise unyango ngokukodwa.

Kodwa ezo zingongoma ziluncedo kakhulu. Ngoku ndiza kukunika iziphumo. Ngoko ke esi sigulana senze olu phando sinombono wokukhupha i-neuroblastoma, nangona sasingenalo uvavanyo oluthile lwaloo nto. Kodwa sasinephaneli ye-limbic encephalitis ebonisa i-CASPR2 antibody. Njengoko ubusitsho, le yayinencasa yokuzikhusela komzimba ngenxa yendlela ebonakala ngayo.

Into engaqhelekanga kweli tyala kukuba ii-antibodies ze-CASPR2 ezine-opsoclonus myoclonus aziqhelekanga okanye aziqhelekanga. Ukuba ndithetha inyani, bendingalindela ukuba esi sigulana sibe ne-NMDA receptor encephalitis okanye ii-antibodies ze-GABA receptor okanye ii-antibodies ze-glutamate receptor. Kwanee-antibodies ze-glutamate receptor.

[00:16:00] Kodwa le yimeko eyayikhethekile ngendlela eyayinayo le antibody ye-CASPR2. Kwaye ndicinga ukuba ukujonga nje emva xa ndibona le meko bubukho be-myoclonus, eyakunika incasa eninzi ye-autoimmune. Wanyangwa nge-IVIG kunye nee-steroids ngaphakathi apho babenokukhululwa ngokupheleleyo.

Kwaye ndicinga ukuba i-OMS inesizathu esibanzi kakhulu. Ujonga kwiincwadi ozibonayo uluhlu kunye noluhlu lwe-autoimmune olufunyenweyo. Ngamanye amaxesha ubona i-paraneoplastic engena-antibody yokwenyani, kodwa inxulumene nje nethumba, kwaye ngamanye amaxesha awunayo i-antibody.

Kukho izifundo ezibonisa ukuba uhlola i-antibody ethile, uninzi alunayo loo nto. Ziimeko ezimbalwa kakhulu. Ndicinga ukuba umyalezo ophambili, njengoko usitsho, yi-syndrome. Ukuba uyayiqonda le syndrome, uyazi apho kufuneka uye khona ngokweephando [00:17:00] kunye nonyango.

Ubusithi i-opsoclonus myoclonus xa kujongwa i-neuroblastoma, ingaba ifana nobuntwana, ubuntwana, ngokungafaniyo nokufikisa, okanye ungayifumana-- ngokuqinisekileyo ingena ekufikiseni ekupheleni kwexesha?

UGqr. Kathryn Yang: Kulungile. Ewe, ndicinga ukuba ugxininisa ingongoma ephambili kuba uhlobo oluqhelekileyo lwe-OMAS ludla ngokuba lolwabantu abancinci, yiyo loo nto, xa sicinga ngale meko, i-15 leminyaka ikwicala labantu abadala. Ihlala ingaphandle kwefestile enxulumene ne-neuroblastoma yiyo loo nto sicinga ngomahluko obanzi kakhulu.

Ndicinga ukuba uhlobo lweenkqubo ezilawulwa zii-antibody lunokubonakala kwiintlobo ngeentlobo zeengxaki zokuhamba. Ngoko ke ndicinga ukuba le yimeko enomdla kakhulu ebonisa ukuba kufuneka sikhumbule ezo mpawu ziqhelekileyo. Ndingathi andikaze ndibone umfanekiso wesifo se-antibody ye-CASPR2.

Ndicinga ukuba xa ndikhumbula oko ndikufundayo, ndidla ngokuba ndimdala kakhulu kwaye ndibe ngabantu abahlukileyo koko sikubonayo kule nkcazo [00:18:00]. Ngokwesiqhelo, yimeko yabantu abadala. Ngoko ke ndizibuza ukuba yingakho na kuthotho lwamatyala abantwana, mhlawumbi babonakala bahlukile kancinci koko kudla ngokuchazwa.

Kwaye uchanekile, asikokunxibelelana okuqhelekileyo ne-OMAS, kodwa kuyathakazelisa ukuva ukuba nayo inokuba njalo.

UDkt. Hugo Morales Briceno: Ewe. Kulungile. Kwaye enkosi kakhulu ngokusinika indlela yakho yokwenza i-opsoclonus myoclonus. Ndicinga ukuba le ngxoxo iza kuba luncedo kakhulu koogqirha abaphulaphule i-podcast ukuze bazi indlela yokujongana, ukuchonga, kunye nokugxila kunyango olusekelwe kwisizathu. Kodwa ndingathanda ukukubulela kwakhona, Kathryn, ngokuba yinxalenye ye-podcast.

UDkt. Kathryn Yang: Enkosi kakhulu, Hugo. Kwaye ndingathi kukho izixhobo ezintle kakhulu kubafundi abanomdla wokufunda okungakumbi ngale nto. Kukho isikhokelo esihle kakhulu se-OMS samazwe ngamazwe sowama-2022. Sibhalwe nguRossor, ROSSOR kunye nabanye oogxa bakhe kwi-neuroimmunology kunye ne-[00:19:00] neuroinflammation journal.

Ngoko ke kwabo banomdla ndingacebisa ukuba nabo bayifunde loo nto.

UDkt. Hugo Morales Briceno: Igqibelele. Nam ndiza kuyijonga loo nto.

UDkt. Kathryn Yang: Ewe.

UDkt. Hugo Morales Briceno: Kulungile. Enkosi kubaphulaphuli, kwaye ndinethemba lokukubona kwi-podcast yethu elandelayo.

UGqr. Kathryn Yang: Iyamangalisa. Enkosi, Hugo.