Olina obubonero buno? Ka twogere ku bulwadde bwa Cushing Syndrome!

Wali owuliddeko ku bulwadde bwa Cushing Syndrome? Erinnya lino liyinza okuba nga lipya katono gy’oli. Mu ngeri ennyangu, mbeera ebaawo ng’emibiri gyaffe gifulumya obusimu obuyitiridde obuyitibwa cortisol . Abantu abamu era bakiyita hypercortisolism. "Syndrome" kwe kukungaanya obubonero obujja awamu. Oyinza okuba nga wali olabye abantu abamu bwe bakiyita obulwadde bwa Cushing.

Kale ono cortisol kye ki?

Cortisol busimu bwa steroid mu mibiri gyaffe. Tutera okukiyita "obusimu bwa situleesi" kubanga bwe tuba ku situleesi, emibiri gyaffe gifulumya ekirungo kya cortisol ekiwera. Mu biseera bino, cortisol atuyamba:

• Omutima gwo gweyongera okukuba.
• Puleesa yo yeeyongera.
• Afuga ssukaali mu musaayi.
• Afuga okussa.
• Ayongera okusika omuguwa mu binywa.

Tekikoma awo, naye bwe tuba ku situleesi, cortisol era eyamba okuggala okumala akaseera enkola ezitali zeetaagisa mu mubiri gwaffe mu kiseera ekyo, okugeza, enkola y’okugaaya emmere n’enkola y’okuzaala.

Cortisol busimu bukulu nnyo eri emibiri gyaffe. Cortisol yeetaagibwa nnyo mu bintu bino:

• Kuuma puleesa.
• Okutereeza ssukaali mu musaayi.
• Okukendeeza ku kuzimba.
• Zimba ebijjukizo.
• Fuga okussa kwo.
• Kuuma bbalansi y’omunnyo mu mubiri.
• Emmere gye tulya gifuule amaanyi.

Emiwendo gya cortisol gifugibwa endwadde entonotono bbiri waggulu w’ensigo zaffe, endwadde z’ekibumba, endwadde z’ekibumba mu bwongo, ne hypothalamus, esangibwa waggulu w’endwadde z’ekibumba.

Obulwadde bwa Cushing butera kuva ku kizimba . Kino kiyinza okubaawo mu ngeri bbiri enkulu:

• Endogenous: Kino kitegeeza nti mbeera ereetebwa cortisol, ekolebwa mu mibiri gyaffe.
• Exogenous: Kino kitegeeza nti embeera eva ku nsonga ez’ebweru ng’ekizibu ky’eddagala erimu erimira okujjanjaba embeera endala ez’obujjanjabi.

Ani asinga okulwala obulwadde bwa Cushing Syndrome?

Obulwadde bwa Cushing businga kubeera mu baana, abavubuka abakulu n’abantu abakulu. Businga kubeera mu bantu abali wakati w’emyaka 25 ne 50. Abantu abamira eddagala eririmu ekirungo kya cortisol (okugeza eddagala eriweweeza ku bulwadde bwa asima n’endwadde z’enkizi) bali mu bulabe bwa maanyi okufuna embeera eno. Abantu nga 70% abalina obulwadde bwa Cushing’s syndrome bakyala ate 30% basajja.

Embeera eno ya bulijjo etya?

Cushing’s syndrome is a very rare condition , ekwata abantu wakati wa 40 ne 70 ku bukadde buli mwaka.

Njawulo ki eriwo wakati w’obulwadde bwa Cushing Syndrome n’obulwadde bwa Cushing?

Obulwadde bwa Cushing kika kya Cushing’s syndrome. Kiva ku kizimba ekitali kya bulabe mu nseke y’omubiri (pituitary gland). Ekizimba kino kifulumya obusimu bungi nnyo obuyitibwa ACTH (adrenocorticotropic hormone) . Kino kireetera endwadde z’ekibumba okufulumya ekirungo kya cortisol ekisusse.

Ku abo abalina obulwadde bwa Cushing, abantu abakulu abasoba mu 70% ate abaana n’abavubuka abakulu wakati wa 60% ne 70% balina obulwadde bwa Cushing obw’ekika kino.

Abasawo ba ngeri ki abajjanjaba obulwadde bwa Cushing Syndrome?

Omusawo wo ow’enjawulo ajja kukusindika ew’omusawo omukugu ayitibwa omusawo w’endwadde z’omu lubuto okuzuula n’okujjanjaba embeera eno.

Obulwadde bwa Cushing Syndrome busobola okutta omuntu?

Yee, obulwadde bwa Cushing’s Syndrome buyinza okutta omuntu singa tebujjanjabwa bulungi. Singa tebujjanjabwa, omuwendo guno ogwa cortisol omungi (hypercortisolism) guyinza okuvaako ebizibu by’obulamu eby’enjawulo. Okugeza nga:

• Yinfekisoni
• Okuzimba omusaayi naddala mu mawuggwe n’amagulu
• Ennaku
• Omutima okulwala
• Okweyongera omugejjo
• Obuzibu mu kujjukira oba okukaluubirirwa okussaayo omwoyo
• Puleesa oba kolesterol omungi
• Amagumba agamenyese
• Ssukaali ow’ekika eky’okubiri, ssukaali nga tannabaawo, oba glucose mu kisiibo akendedde

Singa obulwadde bwa Cushing tebujjanjabwa, buyinza n’okuviirako omuntu okufa.

Biki ebivaako obulwadde bwa Cushing Syndrome?

Obulwadde bwa Cushing buva ku bungi bwa cortisol mu mubiri. Waliwo ensonga eziwerako eziyinza okuvaako kino:

• Okukozesa eddagala lya Glucocorticoid: Eddagala lya Glucocorticoid (okugeza, prednisone) likozesebwa okujjanjaba asima atawona, endwadde z’enkizi, lupus, sarcoidosis, n’endwadde endala nnyingi ez’abaserikale b’omubiri ezireeta okuzimba okutambula obutasalako. Okumira eddagala lino okumala ebbanga eddene kiyinza okuleeta "iatrogenic" oba exogenous Cushing syndrome. Ekigambo "iatrogenic" kitegeeza nti ekintu ekirala kiva ku bujjanjabi.
• Ebizimba by’omu lubuto: Obulwadde bwa Cushing ( nga tobaliddeemu iatrogenic Cushing syndrome) buva ku bizimba by’omu lubuto ebikola ennyo ACTH, obusimu obugamba endwadde z’ekibumba okukola cortisol, era bukosa abantu 8 ku buli 10. Ekika kino kiyitibwa obulwadde bwa Cushing.
• Ebizimba by’ekibumba: Ekizimba ekikula waggulu ku nseke z’ekibumba kiyinza okukola ekirungo kya cortisol ekisusse. Bino bitera kuba bizimba ebitali bya bulabe. Wabula oluusi ekizimba kino kiyinza okuba kookolo w’ekibumba (adrenal cortical carcinoma), ekika kya kookolo w’ekibumba ekitali kya bulijjo nnyo.
• Ebizimba by’amawuggwe, olubuto, thyroid ne thymus: ACTH bw’ekolebwa ebizimba ebiri ebweru w’endwadde z’omu lubuto, eyitibwa ectopic ACTH syndrome. Ebizimba bino bitera kuba bya bulabe. Ku bino ebisinga okubeerawo ye kookolo w’amawuggwe ow’obutoffaali obutono.

Obulwadde bwa Cushing Syndrome buva ku nsikirano?

Ebiseera ebisinga, nedda . Emisango egisinga egy’obulwadde bwa Cushing si gya nsikirano.

Bubonero ki obulaga obulwadde bwa Cushing Syndrome?

Ng’oggyeeko obubonero obukwata ku bulwadde bwa Cushing, waliwo n’obubonero obuyinza okuba obw’enjawulo mu mbeera endala nnyingi. Si buli muntu nti ajja kuba n’obubonero bwe bumu. Buno bwe bubonero obuyinza okulabika:

• Okugejja amangu mu maaso (abamu kino bakiyita "feesi y'omwezi"), ekitundu ky'olubuto, emabega w'ensingo (abamu kino bakiyita "buffalo hump"), n'ekifuba.
• Feesi emmyufu, eyeetooloovu.
• Ebiwundu bitwala ekiseera okuwona.
• Puleesa (puleesa).
• Enviiri ezisukkiridde okukula mu maaso, mu bulago, mu kifuba, mu lubuto, mu mabeere, n’ebisambi, oba enviiri okugwa (ekiwalaata).
• Ekirwadde ekya sukaali.

Obubonero obulala buyinza okuli:

• Okulabika kw’obubonero obuwanvuwa obwa kakobe mu kitundu ky’olubuto.
• Okunyiga emikono n’ebigere okwangu.
• Obunafu obw’awamu n’obukoowu.
• Okulaba okuzibu n’okuziyira.
• Obunafu bw’ebinywa n’okukendeera kw’ebitundu by’omubiri.
• Obwagazi bukyuka n’obutakola bulungi mu basajja.
• Okulemererwa okukula mu baana.

Obulwadde bwa Cushing Syndrome bumala bbanga ki?

Obulwadde bwa Cushing bwe bumala ebbanga ki kisinziira ku ngeri gy’okwatamu obujjanjabi. Abantu abasinga abalina eddagala lya cortisol eringi (hypercortisolism) bawona oluvannyuma lwa wiiki ntono nga bajjanjabiddwa.

Obulwadde bwa Cushing Syndrome buleeta obuzibu mu kussa?

Nedda.Okussa obubi si kabonero akalaga obulwadde bwa Cushing.

Obulwadde bwa Cushing Syndrome buleeta obulwadde bw’amagumba?

Yee. Obulwadde bwa Cushing’s syndrome buyinza okuvaako amagumba okunafuwa. Kino kiyinza okuvaako okumenya naddala ng’embeera eno omaze ebbanga ng’olina. Amagumba amanafu nago gayinza okuvaako obulumi.

Obulwadde bwa Cushing Syndrome buleeta obulwadde bwa hypokalemia?

Hypokalemia mbeera nga potassium mu musaayi gwo mutono. Embeera eno esobola okubaawo singa oba olina obulwadde bwa Cushing.

Obulwadde bwa Cushing Syndrome buzuulibwa butya?

Singa omusawo wo atebereza nti cortisol mungi (hypercortisolism), waliwo ebiragiro by’agenda okugoberera. Bajja kubuuza ebibuuzo, bakutwale ebyafaayo byo eby’obujjanjabi, bakole okukeberebwa omubiri, n’oluvannyuma balagira okukeberebwa mu laabu. Era bayinza okukulondoola okumala ekiseera.

Obulwadde bwa Cushing oluusi buyinza okuba obw’akakodyo katono okuzuula. Bw’ogamba omusawo wo nti okooye era ng’ogenda weeyongera okugejja, ayinza obutalowooza mangu ku bulwadde bwa Cushing. Kino kiri bwe kityo kubanga obubonero buno butera kubeera mu ndwadde nnyingi ez’enjawulo.

Ate era, obulwadde bwa Cushing oluusi buyinza okutabulwa n’obulwadde bwa polycystic ovary syndrome oba metabolic syndrome . Omusawo wo ajja kwetaaga okugoba embeera endala okusobola okuzuula obulwadde.

Bikebere ki ebikolebwa okuzuula obulwadde bwa Cushing Syndrome?

Omusawo wo ayinza okukola ebimu ku bigezo bino:

• Okukebera cortisol mu musulo okumala essaawa 24: Okukebera kuno kupima obungi bwa cortisol mu musulo gwo mu micrograms (mcg). Omusawo ajja kukusaba okukung’aanya omusulo gwo mu bbanga lya ssaawa 24.
• Okukebera cortisol mu malusu mu ttumbi: Mu budde obwa bulijjo, emiwendo gya cortisol giba wansi nnyo ekiro. Okukebera kuno kukebera emiwendo gya cortisol wakati w’essaawa 11 ne 12 ez’oku makya. Bw’oba ​​olina obulwadde bwa Cushing, emiwendo gya cortisol gyo gijja kuba waggulu mu ngeri etaali ya bulijjo mu kiseera ekyo.
• Okukebera okuziyiza eddagala lya dexamethasone erya dose entono:Dexamethasone ddagala erifaananako ne cortisol. Ku kukebera kuno, omira miligiraamu emu (mg) ey’eddagala lino mu kamwa ekiro, olwo emiwendo gyo egya cortisol ne gipimibwa wakati w’essaawa 8 ne 9 ez’oku makya. Bw’oba ​​olina obulwadde bwa Cushing, emiwendo gya cortisol gyo gijja kuba mingi.
• Okukebera omusaayi: Okukebera omusaayi kupima omuwendo gwa ACTH mu musaayi gwo. Singa ACTH eba wansi, oyinza okuba n’ekizimba mu kibumba. Singa omutindo guba gwa bulijjo oba nga guli waggulu, oyinza okuba n’ekizimba mu pituitary oba ekizimba eky’ebweru w’olubuto.
• Okukebera okuziyiza eddagala lya dexamethasone erya ddoozi ennene: Kino kifaananako n’okukebera okuziyiza eddagala lya dexamethasone erya ddoozi entono, naye ddoozi ya miligiraamu 8 mu kifo kya 1. Okukebera kuno kutera okukolebwa oluvannyuma lw’okukebera kwa ddoozi entono okulaga nti cortisol eri waggulu ku makya ate ng’okukeberebwa mu musaayi kulaga nti ACTH eri waggulu mu musaayi. Okukebera kuno kuyinza okuyamba okuzuula ekivaako obulwadde bwa Cushing. Kiyinza okuyamba okwawula wakati w’ekizimba ekiyitibwa pituitary adenoma (era ekimanyiddwa nga Cushing’s disease) n’ekizimba awalala mu mubiri gwo (nga mu mawuggwe).

Omusawo bw’amala okukakasa nti olina obulwadde bwa Cushing, ekiddako kwe kumanya ekibuleeta. Emirundi egisinga, kiyinza okuba eddagala oba ekizimba. Bw’oba ​​omira eddagala lya glucocorticoids, ekyo kirabika kye kivaako, n’olwekyo omusawo ayinza okukendeeza ku ddoozi yo. Bw’oba ​​tomira ddagala lya glucocorticoids, kiyinza okulaga nti waliwo ekizimba mu nseke zo ez’omu kibumba, mu nseke z’omu lubuto oba awalala. Omusawo ayinza okukuwa amagezi okunoonyereza ku bifaananyi nga bino okuyamba okuzuula ekizimba:

• CAT scan (CT scan) oba MRI olubuto: Omusawo ayinza okukola CT scan oba MRI okulaba oba olina ekizimba mu nseke zo ez’omu kibumba. Sikaani zino ziyinza okukolebwa nga zirina enjawulo mu misuwa (IV contrast) oba nga tezirina. Ebigezo bino bikwata nnyo okuzuula ebizimba by’omu kibumba.
• Okukuba ebifaananyi mu magineeti (MRI) mu nseke:MRI ekubisa ebifaananyi by’endwadde yo ey’omu lubuto okunoonya ekizimba. Mu mbeera ezimu, MRI si kuzuula bulwadde mu bujjuvu. Abantu nga 50% abalina obulwadde bwa Cushing balina MRI "eya bulijjo", ate 10% bayinza okuba n'ebizimba ebitali bikwatagana na bulwadde buno.
• Bilateral inferior petrosal sinus sampling (BIPPS): Okukebera kuno kuzuula ensibuko y’okufulumya ACTH. ACTH n’obusimu obulala obuyitibwa pituitary hormones bufuluma okuva mu pituitary gland ne buyingira mu musaayi. Omusawo omukugu mu by’okukuba ebifaananyi (interventional radiologist) akola okukebera kuno ng’ayita mu misuwa ebiri egiyitibwa inferior petrosal sinuses. Omuwendo gw’obutuufu bw’okugezesebwa kuno buli wakati wa 95% ne 98%.
• CT scan chest: Singa omusawo wo ateebereza nti waliwo ekizimba ekiri ebweru w’olubuto, ayinza okulagira CT scan y’ekifuba okukebera oba kookolo w’amawuggwe ayinza okubaawo.

Obulwadde bwa Cushing Syndrome bujjanjabwa butya?

Ekika ky’obujjanjabi kisinziira ku kivaako ekirungo kya cortisol okubeera ekinene. Bw’oba ​​omira eddagala lya glucocorticoids, omusawo wo ajja kukendeeza ku ddoozi yo oba okukuwa eddagala eritali lya glucocorticoids.

Singa obulwadde bwa Cushing buva ku kizimba, omusawo ayinza okukuwa amagezi okulongoosebwa oba obujjanjabi obw’amasannyalaze.

Ekirala omusawo akuwa eddagala erikendeeza ku kukola cortisol, gamba nga ketoconazole. Oyinza okwetaaga okukolagana n’abasawo ab’enjawulo abawerako okujjanjaba ekizimba n’obubonero bw’obulwadde bwa Cushing.

• Obujjanjabi bw’eddagala: Singa ekizimba kiba kya kookolo era nga kisaasaanidde mu bitundu by’omubiri ebirala, kiyinza okwetaagisa okukozesa eddagala. Kakasa nti oyogera n’omusawo wo ku bizibu byonna ebiyinza okuvaamu.
• Eddagala: Okwongerako eddagala erikendeeza ku cortisol oba okuggyawo eddagala eriyinza okuvaako obulwadde bwa Cushing’s Syndrome.
• Radiation: Ekizimba mu pituitary kiyinza obutalongoosebwa. Mu mbeera ng’ezo, oyinza okumala wiiki mukaaga ng’olina obujjanjabi obw’amasannyalaze. Kiyinza okutwala emyaka omuwendo gwa cortisol okudda mu mbeera eya bulijjo. Yogerako n’omusawo wo ku bizibu byonna ebiyinza okuvaamu.
• Okuloongoosa:Okulongoosa okuggyawo ebizimba by’omu lubuto, ebizimba by’omu kibumba, n’ebizimba eby’ebweru w’olubuto kivaamu bulungi, naye ojja kwetaaga okumanyiira emiwendo gya cortisol emipya, egya wansi. Mu kiseera kino, oyinza okwetaaga okumira eddagala lya cortisol mu ngeri y’empeke za hydrocortisone. Ojja kusobola okulekera awo okumira eddagala lino oluvannyuma lw’emyezi 6 ku 18. Ebiseera ebisinga, oluvannyuma lw’okulongoosebwa mu ngeri ya laparoscopic, ojja kusobola okuva mu ddwaaliro mu lunaku lumu oba bbiri.

Singa obulwadde bwa Cushing bujjanjabwa bulungi, kiyinza okutwala wonna okuva ku myezi 2 okutuuka ku 18 okuwona. Sigala ng’okwatagana nnyo n’omusawo wo mu kiseera kino n’okusingawo.

Kiki kye nsuubira singa mba nnina obulwadde bwa Cushing Syndrome?

Omusawo wo asobola era alina okujjanjaba obulwadde bwa Cushing. Singa tebujjanjabwa, kiyinza okutta omuntu. Laba omusawo amangu ddala nga bwe kisoboka okuteesa n’omusawo ku bubonero bwo.

Obulwadde bwa Cushing Syndrome busobola okweyongera?

Obulwadde bwa Cushing buyinza okweyongera singa tebujjanjabwa bulungi. Sigala ng’okwatagana n’omusawo wo era mutegeeze ku bubonero bwonna obupya, obubonero obweyongera oba obuzibu obulala bwonna.

Nnyinza ntya okukendeeza oba okuziyiza obulabe bw’obulwadde bwa Cushing Syndrome?

Omubiri gwo gwetaaga eddagala lya cortisol buli kiseera. Okwetaaga okusobola okusigala ng’okola. Kifuga okussa kwo, emmere gy’olya kifuula amaanyi, kitereeza ssukaali mu musaayi, kikuyamba okukola ku situleesi n’okukola bingi. Cortisol si mulabe wa mubiri gwo, naye okumuyitirira si kirungi. Wabula tosobola kubeera nga tolina cortisol.

Bw’oba ​​omira eddagala lya glucocorticoids oba steroids, omusawo wo alondere bulungi emiwendo gya cortisol gyo. Ebyembi, tewali ngeri yonna gye tuyinza kuziyiza kizimba kuleeta obulwadde bwa Cushing’s Syndrome (hypercortisolism).

Okubeera n’obulwadde bwa Cushing Syndrome kiri kitya?

Okubeera n’obulwadde bwa Cushing kiyinza okuba ekizibu, naye tekiteekwa kuba mbeera eyinza okutta omuntu. Waliwo abasawo abatendeke okukuyamba, era waliwo n’obujjanjabi. Enzijanjaba zino zitera okuwonya obulwadde bwa Cushing n’okulongoosa obubonero bw’obungi bwa cortisol (hypercortisolism).

Obulwadde bwa Cushing buyinza okukuleetera okufuna ebizibu ebimu mu nneewulira n’embeera z’abantu. Abantu abamu bayinza okukwatibwa ensonyi olw’enviiri okugwa, enviiri okukula ennyo, ne/oba okugejja mu maaso n’emabega w’ensingo. "Moon face" ne "buffalo hump" biyinza okukuleetera okulowooza emirundi ebiri ku kwetaba mu mbeera z'embeera z'abantu. Ekiseera bwe kigenda kiyitawo, obujjanjabi busobola okuyamba okulongoosa obubonero buno. Obulwadde bwa Cushing era busobola okuvaako okwennyamira n’endwadde endala ez’obwongo. Bwe kiba kyetaagisa, laba omusawo akubudaabudibwa n’omusawo w’eby’omutwe akuwe eddagala okukuyamba okukola ku bikolwa by’enneewulira olw’omuwendo gwa cortisol omungi (hypercortisolism).

Ddi lwe nnina okulaba omusawo?

Laba omusawo bw’oba ​​olina obubonero buno obw’obulwadde bwa Cushing:

Obubonero obukwata abakyala mu ngeri ey’enjawulo:

• Enviiri empya oba ezisukkiridde okukula mu maaso.
• Enkyukakyuka mu kwegomba okwegatta.
• Enkyukakyuka mu nkola y’okugenda mu nsonga.

Obubonero obukwata buli muntu:

• Okugejja amangu mu maaso (abamu kino bakiyita "feesi y'omwezi"), ekitundu ky'olubuto, emabega w'ensingo (abamu kino bakiyita "buffalo hump"), n'ekifuba.
• Feesi emmyufu, eyeetooloovu.
• Puleesa (puleesa).
• Enviiri ezisusse okukula mu maaso, mu bulago, mu kifuba, mu lubuto n’ebisambi.
• Ekirwadde ekya sukaali.
• Embalabe empya oba ezisukkiridde.
• Okulabika kw’obubonero obuwanvuwa obwa kakobe mu kitundu ky’olubuto.
• Okunyiga emikono n’ebigere okwangu.
• Obunafu obw’awamu n’obukoowu.
• Okulaba okuzibu n’okuziyira.
• Ebiwundu bitwala ekiseera okuwona.
• Obunafu bw’ebinywa.

Bibuuzo ki bye nnina okubuuza omusawo wange?

• Eddagala ki lye nsobola okumira okuyamba ku bulwadde bwange obwa Cushing?
• Waliwo dduyiro ze nsobola okukola okuyamba ebinywa byange ebinafu?
• Waliwo eddagala lyonna eriyinza okusiigibwa okuyamba ku bubonero bw’okugolola?
• Nsaana okulaba omusawo omukugu mu bulwadde bwa Cushing Syndrome?
• Nneetaaga okulekera awo okumira eddagala lyonna lye nmira mu kiseera kino?
• Bujjanjabi ki obusinga okunkwatako?
• Waliwo enkola endala ez’okuziyiza ze nsaanidde okukola?

Obulwadde bwa Cushing buyinza okuba embeera enzibu okukolako. Kiyinza okuvaako okunafuwa, puleesa n’okukoowa. Obujjanjabi ng’okulongoosa, eddagala, obujjanjabi obw’amasannyalaze, n’obujjanjabi obw’eddagala buyinza okuba obuzibu. Naye zisaanira, kubanga singa omuntu afuna obujjanjabi obutuufu, obulwadde bwa Cushing busobola okuwona.

Mu bufunze (Obubaka Obutwala Awaka)

Obulwadde bwa Cushing’s syndrome buva ku busimu obuyitibwa cortisol okweyongera mu mubiri gwaffe. Kino tekitera kubaawo katono, naye...Singa kizuulibwa era ne kijjanjabwa obulungi, kisobola okuwona . Kikulu nnyo okugenda mu basawo amagezi bw’oba ​​olina obubonero ng’okuzimba mu maaso, okugejja, enviiri ezisusse okukula, oba puleesa. Enkola z’obujjanjabi zaawukana okusinziira ku kivaako. Kale yogerako n’omusawo wo ku buli kimu era ogoberere amagezi ge. Jjukira nti toli wekka, era obuyambi bubaawo.

` Cushing's Syndrome, cortisol, obusimu, endwadde z'ekibumba, endwadde z'omu lubuto, ACTH, obubonero, obujjanjabi, omusawo w'endwadde z'omu lubuto