Ese umwana wawe afite ikibazo cy'imikurire y'ubwonko? Menya ibijyanye na Holoprosencephaly (HPE)

Amagambo ntashobora gusobanura ibyishimo n'urukundo twumva iyo turebye uruhinja ruvutse, si byo se? Ariko rimwe na rimwe, abana bacu bashobora kuza muri iyi si bafite ibibazo by'ubuzima tudategereje. Uyu munsi, tugiye kuvuga ku kibazo cyo kuvukana kitoroshye, ariko tugomba kumenya.

Holoprosencephaly (HPE) ni iki?

Mu magambo make, Holoprosencephaly, izwi kandi nka HPE, ni indwara ivukana umwana akiri mu nda. Iyi ni indwara ivuka. Muri iyi ndwara, ubwonko bw'umwana uri mu nda ntibutandukana neza mu bice by'iburyo n'ibumoso uko bugenda bukura. Ese wari uzi ko ubwonko bwacu busanzwe bugabanyijemo ibice bibiri by'ingenzi, igice cy'iburyo n'igice cy'ibumoso. Ibi bice bibiri bifitanye isano kandi bigahana amakuru binyuze mu mugozi w'imitsi witwa corpus callosum. Nanone, buri gice cy'imitsi gigabanyijemo ibindi bice, nk'igice cy'imbere, igice cy'imbere, igice cy'imbere, igice cy'imbere, n'igice cy'imbere.

Uku gutandukanya ubwonko mo ibice ni ingenzi cyane. Kubera ko uku gutandukanya bifasha ubwonko gutunganya amakuru menshi icyarimwe no gukora ibikorwa bitandukanye. Nk'uko bimeze kuri `(HPE)`, iyo uku gutandukanya kutabayeho mu gihe ubwonko buri gukura neza, bishobora guteza ibibazo byinshi bijyanye n'umubiri n'imitsi.

Iyi ndwara, yitwa ‘HPE’, ibaho mu gihe umwana akiri muto akura. Ibi bivuze ko ishobora no kuba mbere yuko umenya ko utwite. Hari ubwoko butandukanye bwa holoprosencephaly, kandi uburemere bwabyo n'ibimenyetso byabyo biratandukanye. Uburyo iyi ndwara igira ingaruka kuri buri mwana nabwo bushobora gutandukana.

Ni ubuhe bwoko bw'ingenzi bwa holoprosencephaly (HPE)?

Hari ubwoko butatu bw'ingenzi bwa holoprosencephaly (HPE). Reka tubirebe dukurikije uko bikurikirana, uhereye kuri bwinshi kugeza kuri buke:

Alobar holoprosencephaly

Ubu ni bwo bwoko bukabije cyane . Ikibaho hano ni uko ubwonko bw'umwana ukiri mu nda budatandukana na gato mu bice bibiri by'umubiri. Ingaruka zabyo ni uko imiterere iri hagati y'ubwonko n'isura irabura, kandi utwobo tw'ubwonko turahurira hamwe. Hamwe n'ibi, hagaragara ubumuga bukomeye mu maso. Akenshi, abana bafite ubwo bwoko bwa `(HPE)` bavuka bapfuye cyangwa bagapfa nyuma gato yo kuvuka.

Semilobar holoprosencephaly

Muri ubu bwoko, ubwonko bw'umwana uri mu nda bugabanyijemo ibice bibiri gusa . Ibi bibaho kubera ko uruhande rw'ibumoso rw'ubwonko rufatanye n'uruhande rw'iburyo mu bice byitwa "frontal lobes" na "parietal lobes". Nanone, umurongo utandukanya hagati y'uruhande rw'iburyo n'ibumoso rw'ubwonko, "interhemispheric fissure," uba inyuma y'ubwonko gusa.

Lobar holoprosencephaly

Muri ubu bwoko, ubwonko bw'umwana uri mu nda bugabanyijemo ibice bibiri by'imbere., ariko ntabwo bitandukanyije burundu. Nubwo hari ibice bibiri by'umubiri (iburyo n'ibumoso), ibice by'umubiri by'ubwonko bifatanye muri "cortex" y'imbere. Ubu ni bwo bwoko bwa ``(HPE)`` buto cyane .

Ubwoko bwa Interhemisphere yo Hagati (MIH)

Uretse ubwo bwoko butatu bw'ingenzi, hari ubwoko bwa kane bwitwa Middle Interhemispheric (MIH). Aha niho ubwonko bw'umwana uri mu nda buhurizwa hamwe hagati.

Ni irihe tandukaniro riri hagati ya hydranencephaly na holoprosencephaly?

Ushobora kwitiranya aya mazina abiri. Hydranencephaly na holoprosencephaly byombi ni ubusembwa bw'umwana uvukana bugira ingaruka ku bwonko bwe, ariko hari itandukaniro hagati y'ayo mazina yombi.

Hydranencephaly ni ukubura igice cy'ubwonko bw'umwana wawe. Iyi ni indwara idakunze kugaragara yitwa hydrocephalus (umutwe w'amazi). Abana bafite iyi ndwara akenshi bagira umutwe munini.

Ariko, Holoprosencephaly ni igihe ubwonko budatandukana neza mu bice by'umubiri by'iburyo n'ibumoso mu gihe cy'ibaruka ry'umwana uri mu nda. Urabyumva iryo tandukaniro?

Iyi ndwara ifata bande? Ni ku rugero rungana iki?

Holoprosencephaly (HPE) ni indwara ifata abana bakiri mu nda. Akenshi ibaho mu cyumweru cya kabiri n'icya gatatu cy'imikurire y'umwana uri mu nda. Ibi bivuze ko akenshi mbere yuko umenya ko utwite.

Abashakashatsi bavuga ko holoprosencephaly yibasira umwana umwe kuri 250 mu gihe cyo gutangira gutwita (icyumweru cya kabiri n'icya gatatu cyo gutwita). Ariko, inyinshi muri izi nda zirangira zikuyemo inda cyangwa zigapfa.

Bityo rero, holoprosencephaly ni indwara idakunze kugaragara ku bana bavutse ari bazima, ikaba ibaho ku bana bagera ku 1 mu bana 16.000 bavutse ari bazima.

Ni ibihe bimenyetso bya holoprosencephaly (HPE)?

Kubera ko hari ubwoko butandukanye bwa holoprosencephaly (HPE), ubukana n'ibimenyetso bishobora gutandukana cyane. Ibi bivuze ko ibi bimenyetso bishobora gutandukana bitewe n'umwana umwe.

Ibimenyetso bisanzwe

Ibimenyetso bikunze kugaragara ku bijyanye na HPE birimo:

• Gutinda mu iterambere.
• Ubumuga bwo mu mutwe.
• Indwara y'igicuri n'indwara zo mu mutwe.
• Kugira umutwe muto (microcephaly).
• Kugira umutwe munini (macrocephaly).
• Amazi menshi yiyongera mu bwonko (hydrocephalus).
• Ibitagenda neza mu maso .
• Ibitagenda neza mu menyo (urugero, kugira incisor imwe yo hagati).
• Umunwa upfutse cyangwa upfutse.
• Kugorwa no kugenzura ubushyuhe bw'umubiri, umuvuduko w'umutima, no guhumeka.
• Kugorwa no kurya.

Ibiranga Alobar HPE

Ubu ni bwo bwoko bukabije cyane, bityo ibimenyetso bikaba bikomeye kurushaho:

• Kugira ijisho rimwe (cyclopia), kugira amaso yegeranye cyane (ethmocephaly), cyangwa kutagira amaso na gato (anophthalmia).
• Kugira utuntu duto cyane tw'amaso (microphthalmia) n'izuru rimeze nk'umuyoboro (proboscis).
• Izuru rirambuye rifite amaso yegereye (orbital hypotelorism) cyangwa umunwa upfutse hagati y'umunwa (median cleft lip) cyangwa impande zombi (bilateral cleft lip).

Ibiranga Semilobar HPE

• Amaso yegeranye cyane (hypotelorism yo mu kirere), imboni nto cyane z'amaso (microphthalmia), cyangwa ijisho rimwe cyangwa menshi (anophthalmia).
• Kurekura ikiraro n'isonga ry'izuru.
• Izuru rimwe.
• Umunwa ugabanya iminwa hagati cyangwa iminwa ibiri igabanya iminwa.
• Akanwa gacitse.

Ibiranga Lobar HPE

Ubu ni bwo bwoko budakabije cyane, ariko ushobora kubona ibimenyetso bikurikira:

• Umunwa upfukirana impande zombi.
• Imbere y'amaso.
• Izuru rirambuye cyangwa ryaguye.

Iyi ndwara, yitwa holoprosencephaly, ishobora no kuba mu bigize indwara zitandukanye za gene. Buri ndwara ifite ibimenyetso byayo byihariye.

Ni iki gitera holoprosencephaly (HPE)?

Ubusanzwe, ubwonko bw'umwana uri mu nda bugabanyukamo ibice bibiri mu ntangiriro y'imikurire. Holoprosencephaly (HPE) ibaho iyo igice cy'imbere cy'ubwonko, prosencephalon, kidatandukanye neza mu bice by'iburyo n'ibumoso. Ni ukuvuga ko aho kugira ngo impande z'ibumoso n'iburyo by'igice cy'imbere cy'ubwonko zitandukanye burundu, haba hari isano idasanzwe hagati y'ibyo byombi.

By’umwihariko, holoprosencephaly ishobora guterwa na:

• Impinduka mu miterere y'uturemangingo (mutations) ziba muri za genes zigera kuri 14 zitandukanye .
• Ubusembwa bwa chromosome .
• Hari indwara zimwe na zimwe ziterwa n'uturemangingo .

Ariko, mu bihe byinshi, abaganga ntibashobora kubona impamvu nyayo.

Impinduka mu ngirabuzimafatizo

Impinduka mu miterere y’uturemangingo ni impinduka mu ruhererekane rwa ADN yawe. Uru ruhererekane rwa ADN ruha uturemangingo twawe amakuru dukeneye kugira ngo dukore imirimo yatwo. Rero, niba igice cy’uruhererekane rwa ADN kitaruzura cyangwa cyangiritse, ushobora kugira ibimenyetso by’indwara y’uturemangingo.

Umwana ashobora kuragwa ihinduka ry’uturemangingo ry’umubiri riturutse ku mubyeyi umwe cyangwa bombi, bitewe n’uburyo ihinduka ry’umubiri ryandujwe. Ariko, hari n’ihinduka ry’umubiri ribaho ku buryo butunguranye, bivuze ko nta muntu n’umwe mu bagize umuryango ufite amateka y’ihinduka ry’umubiri.

Abahanga mu bya siyansi bahuje impinduka mu ngirabuzimafatizo zikurikira n’iyi ndwara (HPE):

• `SHH`
• `SIX3`
• `TGIF1`
• `ZIC2`
• `PTCH1`
• `FOXH1`
• `'NODAL''
• `CDON`
• `FGF8`
• `GLI2`

Izi mpinduka zituma utunyangingo (genes) na poroteyine zikora bidakora neza. Ibi nibyo bigira ingaruka ku mikurire y'ubwonko bw'umwana uri mu nda bikanatera holoprosencephaly.

Ibitagenda neza mu mikorere ya chromosome

Twese dufite chromosomes 46 mu turemangingo twacu, zitondetse mu matsinda 23. Izi chromosomes zitwara ADN yacu. Mu magambo make, zikubiyemo amabwiriza y'uko imibiri yacu ikura kandi igakora. Duhabwa seti imwe ya chromosomes kuri mama wacu n'indi imwe kuri data.

Hafi kimwe cya gatatu cy'abana bavukanye holoprosencephaly bafite ikibazo cya chromosome. Ikibazo cya chromosome gikunze kugaragara cyane kuri HPE ni ukuba hari kopi eshatu za chromosome 13, izwi nka trisomiya 13. Trisomiya 18 (kopi eshatu za chromosome 18) na triploidy (kuba hari chromosome 69 mu karemangingo aho kuba 46 bisanzwe) nabyo bishobora gutera HPE.

Indwara z'uturemangingo

Hari igihe holoprosencephaly ishobora kubaho nk'igice cy'indwara zimwe na zimwe ziterwa n'uturemangingo zitera izindi ngorane z'ubuvuzi uretse HPE.

Zimwe mu ndwara z’uturemangingo zifitanye isano na HPE ni izi:

• `(Hartsfield syndrome)`
• `(Kallman syndrome ya kabiri)`
• `(Indwara ya Steinfeld)`
• `(Sindrome ya Smith-Lemli-Opitz)`
• `(Stromme syndrome)`

Ni gute holoprosencephaly (HPE) ipimwa?

Abaganga bakunze gusuzuma indwara ya holoprosencephaly (HPE), cyane cyane indwara zikomeye, mbere yuko umwana avuka, bakoresheje ultrasound scan mbere yo kuvuka. Iyi ndwara ishobora kandi gupimwa mbere yo kuvuka hakoreshejwe MRI y'umwana uri mu nda (Magnetic Resonance Imaging).

Nubwo ibi bizamini byo gupima umwana mbere yo kubyara bishobora kugaragaza HPE, HPE ikunze gusuzumwa umwana amaze kuvuka , iyo hatangiye kugaragara ibibazo byo mu maso cyangwa ibibazo byo mu bwonko. Hanyuma hakorwa ibizamini byo gupima umutwe kugira ngo byemezwe ko ari indwara.

Abana bafite ubwoko bworoheje cyane bwa holoprosencephaly bashobora kutamenyekana kugeza bagejeje ku mwaka umwe. Muri ibyo bihe, gutinda mu mikurire bishobora kuba ikimenyetso cy'uko hashobora kuba hari ikibazo mu mitsi. Abaganga bazategeka ko ibizamini byo gupima ubwonko.

Ibipimo byo gusuzuma indwara

Abaganga bakoresha ibizamini bikurikira byo gusuzuma indwara ya holoprosencephaly nyuma yo kuvuka k'umwana:

• Ultrasound yo mu mutwe: Ultrasound (izwi kandi nka sonography) ni ikizamini cyo gufata amashusho kidababaza kandi kidatera indwara gikoresha amajwi menshi kugira ngo gikore amashusho cyangwa amashusho y’ingingo nk’ingingo z’imbere cyangwa imiyoboro y’amaraso.
• Isuzuma ry'ubwonko rya MRI (magnetic resonance imaging):Gupima MRI nabyo ni ikizamini kidasaba ububabare. Bishobora kwerekana neza imiterere n'ingingo mu bwonko bw'umwana wawe. MRI ikoresha rukuruzi nini, imiraba ya radiyo, na mudasobwa. Ntikoresha imirasire ya X (imirasire).
• Gupima umutwe hakoreshejwe ikoranabuhanga rya CT (CT scan): Gupima umutwe hakoreshejwe ikoranabuhanga rya CT ni ikizamini gikoresha imirasire ya X na mudasobwa kugira ngo hakorwe amashusho menshi y’igice cy’umubiri kiri gusuzumwa mu buryo bwa 3D (muri iki gihe, umutwe n’ubwonko by’umwana wawe).

Niba bishoboka, abaganga bazakora inyigo za ADN, harimo gusesengura chromosomes, gupima cytogenetike na molekile, kugira ngo bamenye impamvu nyayo ya HPE.

Niba ibizamini bya genetike bigaragaza ikibazo cya chromosome cyangwa genetike kijyanye na holoprosencephaly, muganga wawe ashobora kukugira inama yo gushaka inama ku genetike niba uteganya kubyara undi mwana.

Ni ubuhe buryo bwo kuvura indwara ya holoprosencephaly (HPE)?

Ikibabaje ni uko ubu nta muti cyangwa uburyo bukomeye bwo kuvura indwara ya holoprosencephaly (HPE) ihari. Ahubwo, abaganga bavura buri mwana HPE bitewe n'ibimenyetso bye byihariye. Ibi bivuze ko uburyo bwo kuvura butandukanye bitewe n'umwana.

Ubu buvuzi bushobora gusaba imbaraga zihuriweho n'itsinda ry'inzobere zitandukanye, harimo:

• Abaganga b'abana
• Abaganga b'indwara z'imitsi
• Abaganga b'indwara z'imitsi
• Abaganga b'inzobere mu kubaga pulasitiki
• Abavuzi b'inzobere mu by'ubuzima n'imitsi
• Itsinda ryita ku barwayi ba palliative
• Itsinda ryita ku bibazo bikomeye

Abantu nk'abo bashobora kuba barimo.

Uburyo busanzwe bwo kuvura

Dore bumwe mu buryo bukunze gukoreshwa mu kuvura HPE:

• Imiti igabanya ubukana bw'ibicurane ikoreshwa mu gukumira, kugabanya cyangwa kurwanya ibicurane.
• Niba umwana wawe afite hydrocephalus, ashobora kuvurwa na ventriculoperitoneal (VP) shunt.
• Imiti n'ubuvuzi bw'umubiri n'ubw'akazi bishobora gufasha mu ndwara zo kwihuta nko gukomera kw'imitsi (spasticity) no kwihuta mu buryo butunguranye (dystonia).
• Kubaga iminwa n'ibikatsi cyangwa ibindi bice byo mu maso hakoreshejwe pulasitiki.
• Imiti yo kuvura ihindagurika ry'imisemburo mu gasabo k'ubwonko.
• Gufata ingamba zo kunoza imirire y'abana bafite ibibazo byo kugaburira. Urugero, kugaburira mu gifu binyuze mu muyoboro w'amaraso (gastrostomy tube - G-tube).

Ibi byose bikorwa kugira ngo umwana agire ubuzima bwiza bushoboka.

Ese holoprosencephaly (HPE) ishobora kwirindwa?

Ikibabaje ni uko holoprosencephaly (HPE) ibahoIndwara nyinshi ntizishobora kwirindwa. Ibi biterwa nuko akenshi ziterwa n'ibibazo by'uturemangingo "bihishe". Niba uteganya kubyara umwana, ni byiza kuganira na muganga wawe ku bijyanye no gupima uturemangingo kugira ngo wumve ibyago umwana wawe afite byo kugira ikibazo cy'uturemangingo cyangwa guhinduka kw'uturemangingo nk'uko byagaragajwe na HPE.

Ariko, abahanga mu bya siyansi bagaragaje ibintu bimwe na bimwe bishobora kongera amahirwe y’uko umwana uri mu nda yarwara indwara ya holoprosencephaly. Muri byo harimo:

• Kurwara diyabete: Niba wari ufite diyabete yo mu bwoko bwa 1 cyangwa 2 mbere yuko utwita, ushobora kuba ufite ibyago byinshi byo kubyara umwana ufite HPE. Ibi ntibikwiye kwitiranywa na diyabete yo mu gihe cyo gutwita, ibaho mu gihe utwite.
• Kubura folate (aside folic): Folate, ubwoko karemano bwa vitamine B9, ni ingenzi cyane ku mikurire myiza y'umwana uri mu nda, cyane cyane ubwonko n'umugongo. Kubura folate mbere no mu gihe cyo gutwita bishobora kongera ibyago byo kubyara umwana ufite HPE.
• Guhura na teratogens: Teratogens ni ibintu cyangwa ibintu biteza ibibazo mu mikurire y'umwana uri mu nda bigatera ubusembwa mu gihe avuka. Guhura na teratogens, nka ethanol (alcohol), aside retinoic, na mycotoxins (uburozi bw'ibihumyo) biva mu biribwa, bishobora kongera ibyago byo kubyara umwana ufite holoprosencephaly.

Bityo rero, ni ingenzi cyane gukurikiza ubuzima bwiza, kurya indyo yuzuye, no gukurikiza inama za muganga mu gihe cyo gutwita na mbere yo gutwita.

Ni iki gipimo cy’indwara ya holoprosencephaly (HPE)?

Uko indwara ya holoprosencephaly (HPE) ihagaze biratandukanye bitewe n'uburemere bw'iyi ndwara ndetse n'impamvu yayo.

Icyizere cy’indwara ya HPE iri hagati y’ibyiciro bibiri muri rusange ni kibi. Abana bake cyane bafite HPE iri hagati y’ibyiciro bibiri barokoka kugeza bakuze. Abana bafite HPE yoroheje kugeza ku iri hagati bakunze kubaho kugeza bakuze, ariko akenshi baba bafite ibibazo by’uburwayi bijyanye na HPE.

Abana benshi barwaye indwara ya holoprosencephaly bakenera imiti n'ubuvuzi bwa buri munsi kugira ngo birinde indwara zo mu mutwe no kuvura izindi ngorane.

Icyizere cy'ubuzima

Imyaka umuntu abayeho arwaye holoprosencephaly (HPE) iterwa n'ubwoko bwa HPE afite n'impamvu nyamukuru y'iyi ndwara.

Abana barwaye Alobar HPE (ubwoko bukomeye cyane) bakunze gupfa bavutse nyuma gato yo kuvuka cyangwa mu mezi atandatu ya mbere y'ubuzima.

Abana barenga 50% bafite semilobar cyangwa lobar HPE, kandi badafite ibindi bibazo by'ingingo, bamara nibura amezi 12.

Abana bafite HPE yoroheje akenshi bararokoka kugeza bakuze.

Niba umwana wanjye afite holoprosencephaly (HPE), ni iki nakwitega?

Ibi ni ingenzi cyane. Wibuke ko nta bana babiri bafite holoprosencephaly (HPE) bagira ingaruka zimwe. Nta buryo bwo kumenya neza uko umwana wawe azagerwaho n'ingaruka. Ikintu cyiza wakora kugira ngo witegure ahazaza ni ukuganira n'inzobere zikora ubushakashatsi zikavura holoprosencephaly. Bashobora kuguha amakuru arambuye kuri ibi.

Ni gute nakwita ku mwana wanjye ufite ikibazo cya holoprosencephaly (HPE)?

Kugira ngo ufashe umwana wawe ufite holoprosencephaly (HPE), kurikiza izi nama ziva ku baganga be:

• Tanga imiti iyo ari yo yose wahawe n'abaganga nk'uko byategetswe.
• Reba isuzuma ry'iterambere n'uburyo bwo kuvura.
• Menya neza ko witabira ubuvuzi bwose bukurikira.

Holoprosencephaly ishobora gutera ibibazo byo mu mutwe, ubwonko, cyangwa imitsi. Abana benshi barwaye HPE bafite ibibazo by'imikurire kandi bashobora gukenera ubufasha mu bikorwa bya buri munsi mu buzima bwabo bwose.

Itsinda ry'abaganga b'umwana wawe rishobora gusubiza ibibazo byawe no kuguha ubufasha. Bashobora kandi kukwereka amatsinda y'ubufasha mu gace utuyemo cyangwa kuri interineti. Wibuke ko utari wenyine.

Ni ryari nkwiye kubonana na muganga w'umwana wanjye?

Niba umwana wawe yarasanzwe arwaye indwara ya holoprosencephaly (HPE), azakenera kujya kwa muganga buri gihe kugira ngo arebe neza ko ubuvuzi bwe bukora neza kandi barebe aho iterambere rye rigeze.

Kumenya ko umwana wawe afite holoprosencephaly bishobora kugorana guhangana nabyo. Ariko menya ko utari wenyine. Hari uburyo bwinshi bwo kugufasha wowe n'umuryango wawe. Ni ngombwa kuvugana na muganga uzi neza iki kibazo. Ibi bizagufasha kumenya byinshi ku buryo umwana wawe azahura n'ingaruka n'uburyo bwo kubyitegura.

Amaherezo, ibintu byo kwibuka (Ubutumwa bwo kujyana mu rugo)

Holoprosencephaly (HPE) ni ikibazo gikomeye cyo kuvukana umwana iyo ubwonko bw'umwana budatandukanye neza mu bice bibiri biri mu nda.

• Hariho ubwoko butandukanye n'urwego rw'ubukana , bityo ibimenyetso biratandukanye bitewe n'umwana.
• Akenshi impamvu ziterwa n'uturemangingo n'ibitagenda neza mu mikurosomu bibaho, ariko rimwe na rimwe impamvu ntishobora kuboneka.
• Nubwo ishobora kumenyekana mbere yo kuvuka hakoreshejwe ultrasound cyangwa MRI, akenshi imenyekana gusa nyuma yo kuvuka.
• Nta muti wihariye uhari , ariko hari uburyo butandukanye bwo kuvura kugira ngo hagenzurwe ibimenyetso by'indwara no gufasha umwana.
• Uko ikibazo giteye biratandukana bitewe n'ubukana bw'indwara. Mu bihe byoroheje, abana bashobora kurokoka kugeza bakuze.
• Niba utwite cyangwa uteganya gusama, witondere ibintu nko kugenzura diyabete yawe no gufata aside folike.
• Ntabwo uri wenyine muri iki kibazo. Ushobora kubona ubufasha ku baganga, abajyanama, n'amatsinda y'abaterankunga. Amakuru nyayo n'ubufasha ni ingenzi cyane.

Holoprosencephaly , HPE, ibibazo by'ubwonko, ubumuga bwo kuvuka, imikurire y'umwana uri mu nda, indwara z'uturemangingo, ubusembwa bwa chromosomes, ubuzima bw'inda, ubuzima bw'umwana