Matenda a shuga

Matenda a shuga a m'thupi ndi chithokomiro cha ziwalo zomwe zimatsogolera ku kusowa kwa madzi m'thupi komanso kusowa kwa madzi amchere wamchere. Matendawa amayankha bwino chithandizo, koma amayambitsa zovuta. Matenda a shuga ndi matenda omwe anthu ambiri amawadziwa. Kwenikweni, chidziwitsochi chikugwirizana ndi momwe mungapewere matenda osautsa awa. Izi zimangotanthauza mtundu umodzi wokha wa matenda ashuga. Pochita izi, pali matenda osiyanasiyana osiyanasiyana omwe amabwera chifukwa cha kuyamwa ndi kugwiritsa ntchito shuga. Chimodzi mwa izo ndi matenda a shuga a impso.

Ntchito zofunikira kwambiri mthupi zimaphatikizapo ma excretory, ndiko kuti, kuthekera kwa impso kuchotsa zinthu zomaliza za metabolic m'magazi, madzi ochulukirapo, michere mu mawonekedwe a yankho la creatinine, uric acid, phenols, amines ndi zinthu zina. Pophwanya ntchitoyi, zinthu zomwe zimayenera kuchotsedwa zimadziunjikira ndikubwerera m'magazi, pang'onopang'ono poizoni chamoyo chonse, osati impso yokha.

Mbali yofunika kwambiri ya impso ndikuthekera kwina kuzama ndikuwonjezera mkodzo, kutengera zosowa za thupi. Ndi chifukwa cha izi kuti kuchuluka kwa zinthu zosiyanasiyana komanso kuchuluka kwa madzi kumasiyana kwambiri kutengera nthawi ya tsiku, ntchito, kutentha kwa thupi, ndi zina zambiri. Mwachidziwikire, kulephera kugwira ntchito imeneyi kumabweretsa mitundu yambiri ya kuledzera.

Matenda osiyanasiyana omwe amaphatikizidwa ndi kuponderezana kwa ntchito ya excretory amagwirizanitsidwa ndikuti mayamwidwe ndikuchotsa mokhudzana ndi chinthu china chake chimakonda kuperewera. Ndi matenda amtunduwu omwe matenda a shuga a impso amakhudzana nawo.

Zizindikiro za matendawa zimawonekera pokhapokha ngati mavuto a shuga ndi madzi atayika kwambiri. Mwanthawi yofatsa, kuchuluka kwa shuga m'magazi kumakhalabe kwabwinobwino, kulolerana kwachilengedwe kumakhala kwabwinobwino kapena kuchepetsedwa, ndiye kuti, matendawa sakhudzanso kuyamwa kwa shuga m'zakudya. Nthawi zina matenda a shuga a impso amakhala "pafupi" ndi shuga. Matenda amafanirana, koma osalunjika, m'malo mwake amakhudza kakulidwe ka wina ndi mnzake kuposa kukwiya.

Choopsa chachikulu ndikutayika kwa madzimadzi ndikupanga hypokalemia, yomwe, pamapeto pake, imabweretsa kuwonongeka kwa madzi amchere wamchere. Kuphatikiza apo, kuchepa kwa chakudya chamafuta sikuloledwa kukhalabe ndi mphamvu zamagetsi.

Matendawa sikuti ndi matenda wamba, koma amathanso kubereka - cholowa chamitundu ina. Pazaka ndi ukazi, matendawa "samangidwa".

Mu ana, kubadwa kwawonekedwe kumawonekera kale pa masabata atatu a moyo. Chizindikiro ndichakuti khanda limakonda madzi mkaka wa amayi ndipo limataya msanga. Mawonekedwe osabereka, ngati akulu, ali ndi zizindikiro zopanda pake, ngakhale zotsatira zake zimakhala zowononga kwambiri. Nthawi zambiri matenda amatsimikiziridwa ngakhale mwana atayamba kutsalira pomakula ndi m'maganizo.

Fomu yotsalira yochepera siziwonjezera zovuta zapakhomo. Odwala achikulire sangathe kulosera za matenda awo kwazaka zambiri.

Ngati njira zamatenda zomwezo zimamveka bwino, ndiye kuti sizoyambitsa kwenikweni.

Malingaliro amakono amalongosola kuchepa kwa shuga m'magazi motere:

Ndi aimpso a glucosuria a mtundu A, kuchuluka kwa ma tubules ochulukirapo kumachepa komweko, komwe kumapangitsa kuti shuga athe.
Kutha kwa kayendedwe kayendedwe palokha motsutsana ndi kuzungulira kwa membrane. Umboni ndiwakuti gawo la glucose kudzera mu nembanemba limalumikizidwa ndi mayendedwe a sodium. Kusambitsa yotsirizira, motero, kumayambitsa kuchotsedwa kwa shuga.
Kuchepetsa kubwezeretsa kwa nembanizo zomwe zikuyang'anitsidwa ndi lumbu ya mabubu - glucose samasungidwa ndi nembanemba.
Kuchepa kwa magwiridwe antchito a nembanemba a shuga.

Mtundu wina wa matenda ashuga (shuga insipidus) ndi matenda a shuga. Amaphatikizidwa ndi kulowetsedwa kwa sodium, komwe kumapangitsa kuti pakhale kuchotsetseka kwa hyponatremia, ndiko kuti, kuphwanya mulingo wamadzi wamchere.

Zomwe zimayambitsa matendawa zimaphunziridwa bwino:

Matenda opatsirana ngati chifuwa chachikulu, chimfine.
The matenda a hypothalamus, zikubweretsa zosagwira mu kapangidwe ka mankhwala antidiuretic - vasopressin. Zitha kukhala zatsopano kapena zopezedwa.
Zowonongeka ku ubongo, mwanjira ina kapena zina zomwe zimakhudza ntchito pokodza - kuvulala, zotupa, kugwira ntchito.
Matenda a Autoimmune omwe machitidwe a calcium amawukiridwa.

Mu kanema wonena za zomwe zimayambitsa matenda a shuga

Pali mitundu iwiri yayikulu yamatendawa: matenda ashuga komanso matenda amchere amchere. Ngakhale zovuta zili zamtundu womwewo, kusiyana komwe kuli pakati pawo ndikofunikira.

Shuga - glycosuria, ndiko kuti, kusakwanira kwa shuga, komwe kumapangitsa kuti atulutsidwe mkodzo. Potengera momwe matenda a shuga akuphwere, matendawa sakudziwika, chifukwa mankhwalawa - kuchotsa shuga, ndikulipira shuga wambiri m'magazi. Komabe, kuphwanya kumeneku, komabe, kumayambitsa kuvala mwachangu kwa ma nephrons, popeza amagwira ntchito mopitirira muyeso.

Pali mitundu iwiri:

lembedwe A - Logwirizana ndi kuwonongeka kwa mphamvu ya masanjidwe ofunikira,
mtundu B - kuphwanya kayendedwe ka shuga kumawonedwa kokha mu gawo la nephrons, pomwe gawo linalo likugwira ntchito yowonjezera.

Pogwirizana ndi mapangidwe a mapangidwe a matendawa, aimpso a glucosuria amagawidwa ku pulayimale ndi sekondale:

yoyamba - yolumikizidwa ndi kusowa kwa tubular kukomoka,
yachiwiri - zotsatira za zomwe zidapezeka. Izi zimaphatikizapo nephrosis, glomerulonephritis, matenda a Girke, ndi zina zambiri.

Kuphatikiza apo, taganizirani za impso ndi glucosuria:

Fomu lamkati - limalumikizidwa ndi shuga wotsekemera pamlingo wa impso, mu ma tubular system, komanso chifukwa cha kusokonezeka kwa mayendedwe a shuga m'maselo.
Zowonjezera zimapangidwa mothandizidwa ndi zinthu zakunja. Amasiyana ndi impso chifukwa chakuti kuchuluka kwamkodzo kwamkodzo kumagwirizana ndi kuwonjezeka kwa shuga m'magazi.

Pali mitundu ingapo yolumikizidwa yomwe imayambitsa kuphwanya:

matenda ashuga - amagwirizana ndi matenda a shuga, nthawi zambiri amtundu woyamba. Shuga mumkodzo amawonekera ngakhale ndikuwonjezera pang'ono m'madzi a m'magazi. Kusowa kwa glucose mkodzo ndi chizindikiro chosasangalatsa, chifukwa chikuwonetsa kulephera kwa thupi kuchita zosefera chilichonse,
wapakati - wogwirizana ndi kuwonongeka kwa ubongo. Amayambitsa ndi encephalitis, meningitis, stroke, kutaya mtima chifukwa cha kuvulala ndi zina,
kapamba - ndizakanthawi, kumayambitsa matenda kuphwanya kwa ntchito kapamba. Pambuyo pochotsa zotupa, glucosuria amazimiririka,
endocrine - imalumikizidwa ndi kuchuluka kapena kusowa kwa mahomoni. Chomwe chimatha kukhala matenda oyamba onse - pheochromocytoma, acromegaly, ndi kugwiritsa ntchito mankhwala - ACTH, cortisol, etc.
Hyperthermia imakhalanso mkhalidwe wosakhalitsa womwe umayambitsidwa ndi malungo, womwe umayambitsa kuchepa mphamvu kwa thupi ndi hypokalemia.

Ganizirani izi:

Alimentary - ndizotsatira zakudya ndi mafuta ochulukirapo. Amawonedwa patatha mphindi 30 atatha kudya ndikusowa pambuyo maola 4-5. Chitha kukhala chifukwa chomwa ma glucocorticoids,
zam'maganizo - zimagwirizanitsidwa ndi zokumana nazo zamphamvu chifukwa chovulala, kugwedezeka, magazi. Zimaphatikizidwanso ndi glucocorticoids, koma mwachilengedwe cokha: mahomoni amapangidwa thupi likagwirizana ndi nkhawa.
glucosuria pa nthawi yoyembekezera - nthawi zambiri imapangidwa mu semester yachitatu ndipo imazimiririka pambuyo pobereka. Ngati kuchuluka kwa shuga mu mkodzo kuli kotsika, palibe njira zapadera zomwe zimatengedwa. Mkulu wa glucose akakwera kwambiri ndipo amawonekera mwadongosolo, chithandizo ndikofunikira.

Mulingo wamchere wamchere m'thupi nthawi zambiri umaperekedwa ndi chiŵerengero china cha sodium ndi potaziyamu. Kufanana kumakonzedwa kudzera mu ntchito ya impso ndi mahomoni. Mwachitsanzo, pakuwonjezeka kwa kuchuluka kwa sodium m'magazi, kupanga timadzi tambiri timagazi tamadontha, ndipo ma ayoni a sodium amachotsedwa mu mkodzo kuti abwezeretse kuchuluka kwa potaziyamu ndi sodium. Ndi kuchepa kwa sodium ndende, aldosterone imapangidwa mwachangu.

Sodium reabsorption imachitika mu aimpso tubules. Aldosterone imakhudza ma mineralocorticoid receptors, omwe, nawonso, amathandizira kupanga mayendedwe a sodium. Wotsirizirayo amachotsekera kudzera mu lumen ya tubule ndipo amachotsedwa ndi mkodzo.

Matenda a shuga a reine a shuga a impso amapezeka pamene kuzindikira kwa aimpso a babu a aldosterone kumachepa. Chifukwa chake, thupi silingayankhe mokwanira pakulimbikitsidwa kwa aldosterone. Zotsatira zake, sodium ikupitilizidwa, kuchuluka kwake kwamkodzo kumawonjezeka kwambiri - nthawi 15-20.

Kutsika kwamphamvu kwa sodium ions kumabweretsa kuchepa kwakukulu kwa madzimadzi, kuphwanya kayendedwe kamadzi amchere ndipo ndizomwe zimayambitsa kwambiri ma pathologies. Pa maziko awa - kusowa kwamadzi, shuga wa mchere ndikuphatikiza ndi shuga.

Pali matenda obadwa nawo omwe amayambitsidwa ndi matenda ashuga:

kobadwa nako - kumalumikizidwa ndi ma pathologies mu chitukuko cha tubular system, amapezeka adakali aang'ono kwambiri,
zopezeka - zimawonekera chifukwa cha matenda opatsirana - chifuwa chachikulu, kuwonongeka kwa ubongo - meningitis, kuvulala, kuwonongeka kwa mtima ndi zina. Makinawo amatha kuphatikizidwa ndi onse aldosterone ndi vasopressin.

Ngati matenda ashuga amagwirizanitsidwa ndi kusokonekera kwa mahomoni a antidiuretic, ndiye kuti amatha kupangidwa ndi ma cell awiri.

Malinga ndi izi, pali mitundu iwiri yamatenda:

chapakati - olumikizidwa ndi kusowa kwa ma antidiuretic mahomoni, omwe pazifukwa zina satulutsa mu hypothalamus. Potere, madzi samamwe, chifukwa impso sizilandira chizindikiro chofananira,
nephrogenic shuga insipidus - amagwirizana ndi kutayika kwa zolandilira za maselo a aimpso tubules. Nthawi yomweyo, vasopressin amapangidwa, koma chiwalo sichimayankha.

Matenda a shuga amapezeka kawirikawiri kwa odwala a zaka zazing'ono - mpaka zaka 30. Ngati sanachiritsidwe, matendawa amakula msanga.

Mu ana, matendawa amawonekera ndendende, nthawi zina mawonekedwe a khunyu. Zizindikiro zake zili limodzi ndi kutentha thupi.

Zizindikiro zake

Chithunzi cha matenda ashuga chimatengera kuuma, chomwe chimayambitsa matendawa komanso chikhalidwe chake. Matenda awo am'madzi komanso ludzu lalikulu komanso mkodzo wambiri womwe umayamba motsutsana ndi maziko awa ndiofala.

Kugwiritsa ntchito njira yopatsira ena zinthu zina kumakhala kokwanira. Chifukwa chake, pa glucose, chizolowezi ndicho 8.9-10 mmol / l m'magazi. Pa ndende imeneyi, shuga amabwezeretsedwera m'magazi.

Pamwamba pa mulingo uno, katundu pa tubules ndi wochuluka, ndipo shuga wambiri amamuthira. Mtengo womwe glucose imaleka kumilidwa kwathunthu umatchedwa "cholowera impso." Kwa anthu osiyanasiyana, mtengo wofunikira kwambiri umakhala wosiyana, koma nthawi zambiri umagwera pamtundu wofotokozedwayo.
Mwa amayi apakati, cholowa mu semester yachitatu chimachepa, komwe nthawi zambiri kumayambitsa kuwoneka kwa shuga mkodzo.

Mwa mwana, "cholumikizira impso" ndi 10,45-12, 65 mmol / L.

Nthawi yachilengedwe yokhudza mkodzo m'magazi ndende ya 1.7 mmol / L. Ngati mupitilira kuchuluka kwa oposa 2.8 mmol / l, mutha kulankhula molimba mtima za matendawa.

Ndi mawonekedwe ofatsa, palibe zizindikiro. Ana ang'onoang'ono amatha kuchepa thupi, kapena, kuchepa thupi, kuchepa kwa chakudya.

Zizindikiro zamankhwala zimawonekera pokhapokha madzi am'mimba komanso kuwonongeka kwakukulu kwa shuga:

kufooka ndi chizungulire,
anjala, yomwe nthawi zambiri imaphatikizidwa ndi kusowa kwa chakudya - mukufuna kudya, koma "chidutswa sichimakwiya ',
kusokonezeka kwa kukumbukira, kutsika kwa malingaliro komwe kumalumikizidwa ndi kufa ndi njala,
polyuria - malita 3-4 patsiku.

Zizindikiro izi zimayenderana ndi zizindikiro za hypoglycemia, zomwe zimapangitsa kuzindikira kukhala kovuta.

Kuchulukana kwambiri komanso pafupipafupi kumawonetsa bwino matendawa - polyuria, yomwe imadziwoneka yowoneka bwino komanso kusokonezeka kwambiri kwaimpso.

Kuphwanya malire amchere wamchere ndikofunikira kwambiri kwa moyo wabwinobwino, kotero kusintha kwake kumakhudza thanzi mwachangu kwambiri.

Zomwe zikuluzikulu ndi izi:

polyuria - ndipo kwakukulu, malita 5-2,
ludzu losalekeza, pamene thupi limayesetsa kubwezeretsa zinthu,
kukomoka kwamikodzo, makamaka usiku. Mothandizidwa ndi katundu wotere, chikhodzodzo chimakula ndikugwira ntchito molimbika,
Kuchepetsa thupi - chizindikiro ichi chimatchulidwa makamaka mwa ana,
khungu louma, malovu osasamba,
malungo
mseru kusanza, kugwidwa ndi njala ndi kusowa kudya, kudzimbidwa.

Zizindikiro zimayamba pang'onopang'ono, koma osapatsidwa chithandizo, pitani patsogolo mwachangu. Kuphatikiza apo, katundu wotere amakhudza zochita za mtima, zomwe zimapangitsa kuti magazi azithamanga.
Mu ana aang'ono, Zizindikiro zimakhala zowawa kwambiri:

Gawo lodziwika bwino la matendawa ndi lodium kwambiri kwamikodzo sodium - 15-20 nthawi zambiri kuposa kale. Kuti adziwe, kuyezetsa magazi m'magazi amtunduwu amathandizira kupatula kulephera kwa impso.
Chizindikiro chodziwika bwino cha matenda a shuga a impso omwe ali pakati pake ndi otsika kwambiri mahomoni a antidiuretic - vasopressin. Hormoni imadziunjikira mu tchire lachiberekera ndipo imachotsedwako ngati pakufunika. Ndi kuwonongeka kwa ubongo, matenda a autoimmune kapena kukomoka kwa hypothalamic, vasopressin sichipangidwire kuchuluka kofunikira. Zotsatira zake, makina amakankhira oyamwa amawonongeka, omwe amatsogolera ku polyuria.

Yang'anani kuchuluka kwa vasopressin pogwiritsa ntchito mayeso owuma.

Zizindikiro ndi mankhwala a shuga insipidus

Zizindikiro

Ndikofunikira kuyeserera kosiyanitsa kuti mudziwitse kuzindikira koyenera. Ngakhale kuzindikirika kwathunthu kwa zizindikiro, zovuta zimatha kukhala ndi mawonekedwe osiyanasiyana komanso zoyambitsa.

Kuti muchite izi, kusanthula kosiyanasiyana kosiyanasiyana kumayikidwa:

Choyamba, kachulukidwe ndi osmolarity kwamikodzo amatsimikiza - uku ndi kuwunika kofala.
Kuyesa kwamwazi wamagazi ndi urinalysis kumakupatsani mwayi wokhazikitsa kuchuluka kwa potaziyamu, sodium ndi zinthu zina komanso kuchuluka kwake mu plasma ndi mkodzo.
Ngati mukukayika glucosuria, kuyezetsa magazi ndi mkodzo wa shuga kumachitika. Koma ngati mayeso ololera wa glucose akuwonetsa zotsatira zake, ndiye kuti kuchuluka kwa shuga mkodzo kuyenera kuyezedwa kangapo. Kupsinjika, zolimbitsa thupi, zomwe zimapangidwira chakudya chamadzulo - zonsezi zimakhudzana ndikuchotsa shuga. Kutengera kuyeserera kwamkodzo kamodzi kwa glucose, simungathe kuzindikira.
Ngati mchere wamtundu wa shuga umakayikiridwa motsutsana ndi maziko a kusapezeka kwa mahomoni antidiuretic, kuyesedwa kouma kumachitika. Wodwala moyang'aniridwa ndi dokotala kwa maola 8-24 samamwa madzi. Ola lililonse, mkodzo umatengedwa kuti uwunikidwe: kachulukidwe kamatsimikiziridwa ndi kupanikizika kwa osmotic komanso kuchuluka kwa sodium mu mkodzo. Wodwalayo amalemedwa nthawi zonse. Kuyesedwa kumamalizidwa pambuyo pa nthawi yoyikika kapena ngati wodwala wataya zoposa 5% ya kulemera, mulingo wa sodium mu mkodzo wafika 3 mmol / L kapena kupitirira, ndipo kachulukidwe ndi osmolarity amakhalabe otsika.

Zotsatira zoyesazi zimatsimikizira mtundu wapakati wa matenda a shuga a impso, ndiko kuti, motsutsana ndi maziko omwe kulibe vasopressin.

Ngati zotsatirazi ndizosiyana, ndiye kuti matenda ena amathandizanso kuzindikira matenda am'mimba kapena polydipsia:

Chiyeso chachiwiri cholekanitsa matenda ashuga amchere ndikuwunika minirin. Kuyesedwa kumachitika molingana ndi Zimnitsky musanagwiritse ntchito mankhwalawa komanso pambuyo pake. Ngati mankhwalawa ali othandiza, ndiye kuti kuchuluka kwa mkodzo kumawonjezeka, ndipo kuchuluka kwake pambuyo pa kutsika kumachepa, ndiye kuti matenda a shuga a hypothalamic atha kupezeka.
Kuyesa kwa biochemical pamilandu iyi ndikofunikira: malinga ndi kuchuluka kwa vasopressin m'magazi, matenda a shuga apakati komanso a nephrogenic amagawidwa. Poyamba, mulingo wa vasopressin umatsitsidwa, chachiwiri - umakhala wambiri.

Mayeso ena atha kutumizidwa:

MRI - kupatula zotupa mu ubongo zomwe zimayika mavuto pa hypothalamus,
aimpso parenchyma biopsy - ndi shuga wa mchere palibe kusintha kwachilendo mosiyana ndi kulephera kwa impso.

Mu kanema wothandizira matenda a shuga insipidus:

Njira zopangira shuga ndi shuga zamchere ndizosiyana kwambiri. Chithandizo, ndiye, chilibe chochita.

Ndi glucosuria

Matenda a shuga sikhala ngati matenda odziyimira pawokha. Nthawi zambiri, njira ya mankhwalawa imachepetsedwa kuthandizira matenda oyamba - zovuta za endocrine, kapamba ndi zina zotero.

Mwanjira yofatsa, glucosuria sifunikira chithandizo chilichonse, koma milingo ya mkodzo iyenera kuyang'aniridwa.

M'mavuto akulu, amayamba kulandira chithandizo chamankhwala. Cholinga chake ndikuchepetsa kuchuluka kwa glucose kukhala kwabwinobwino.

Kuti muchite izi, gwiritsani ntchito:

ACE zoletsa, kuchepa kwa magazi - quinapril, Captopril,
angiotensin-2 receptor blockers - valsartan, condesartan. Amalembedwa ngati zoletsa za ACE zikupangika pazifukwa zina,
sulodexide ndi mankhwala omwe amabwezeretsa mulingo woyenera wa membrane wapansi.

Glucosuria imafuna zakudya zinazake, zomwe nthawi zambiri zimalimbikitsidwa kwa odwala omwe ali ndi matenda ashuga, koma osakhala okhwimitsa zinthu.

Matenda a shuga

Njira yochizira matenda ashuga amchere ndi cholinga chobwezeretsanso mchere wamchere. M'malo mwake, kubwezeretsa mulingo wa sodium m'magazi. Kuti muchite izi, njira ya sodium imayambitsidwa kuti mukwaniritse ndende yomwe mukufuna.

Zina zotsala zamankhwala zimatengera kuzindikira:

Mankhwalawa matenda am'mimba a shuga a pakati, mankhwalawa amagwiritsidwa ntchito omwe ali analogue ya vasopressin: desmopressin, minirin, adiuretin.
Ndi mtundu wa shuga wa nephrogenic, desmopressin siyothandiza. Pochiritsa, ma prostaglandin zoletsa amalembera: ibuprofen, aspirin, indomethacin. Maziko a maphunzirowa ndi thiazide diuretics.

Zakudya zimatsika pang'ono kuti muchepetse kapena ngakhale kuthetsa mchere. Panthawi ya chithandizo ndikuchira, maziko azakudya ayenera kukhala zipatso, ndiwo zamasamba ndi mkaka. Njira yakumwa sizikhala ndi malire.

Kuchiza ana sikusiyana kwambiri. Maziko ake ndi othandizira m'malo mwake ndi fanizo la ma antidiuretic mahomoni. Nthawi zambiri amakhala desmopressin.

Mlingo ndi mtundu wa magwiritsidwe ake amatsimikiziridwa ndi dokotala potengera momwe wodwalayo alili. Palibe zovomerezeka pano.
Mu vidiyo yokhudza matenda a shuga:

Zoneneratu ndi Zovuta

Kuzindikiritsa kwa odwala omwe ali ndi matenda a shuga a impso ndikwabwino, ngakhale mutapita kukaonana ndi dokotala. Glucosuria, makamaka, siwopseza moyo, ngakhale imatha kupititsa patsogolo chitukuko cha matenda ashuga.

Matenda a shuga a impso nawonso amachiritsidwa mosavuta pochotsa matenda oyambitsidwa.

Pochiza ana, ndikofunikira kudziwa matendawa nthawi, chifukwa mitundu yake yambiri imayambitsa kuchedwa. Zoneneratu ndizabwino. Komabe, popanga matenda ngati awa, ana ayenera kuyang'aniridwa ndi a chipatala: kamodzi miyezi itatu, khungu lowuma, ludzu limayang'aniridwa, diuresis imayang'aniridwa, ndikukula kwakuthupi ndi kwamaganizidwe kumayang'aniridwa. Onetsetsani kuti mukuyendera katswiri wa zamitsempha ndi opaleshoni.

Matenda a shuga ndi matenda omwe amatha kuthandizidwa moyenera ndipo safuna kuti moyo wawo usinthe. Komabe, malingaliro a adotolo ndi a zaumoyo ayenera kutsatiridwa.