Ese Langerhans Cell Histiocytosis (LCH) ni iki? Ese umwana wawe ari mu kaga?

Ese wigeze wumva Langerhans Cell Histiocytosis, cyangwa icyo twita LCH mu magambo ahinnye? Wenda izina rirumvikana nk'iry'urujijo kandi riteye ubwoba. Ariko mu by'ukuri, iyi ni indwara idakunze kugaragara cyane yibasira abana bacu bato, cyane cyane abana bavutse n'abana bari munsi y'imyaka 15. Rero ntugahangayike, reka tubiganireho mu buryo bworoshye, mu rurimi rwa Sinhala ushobora kumva neza, mu buryo burambuye, nk'aho uri kuganira n'inshuti yawe magara.

Mu by'ukuri (LCH) ni iki?

Mu magambo make, (LCH) ni indwara ibaho iyo umubiri w'umwana ufite uturemangingo twinshi twa Langerhans, ubwoko bw'uturemangingo twihariye mu budahangarwa bw'umubiri wacu. Utu turemangingo twa Langerhans mu by'ukuri ni ubwoko bw'uturemangingo tw'amaraso twera. Inshingano yatwo nyamukuru ni ukurwanya mikorobe zinjira mu mubiri wacu zikaturinda indwara.

Izi selile zisanzwe ziboneka mu mibiri yacu yose, cyane cyane mu ruhu, mu bihaha, mu mitsi, mu musemburo w'amagufwa, mu muhogo no mu mwijima. Ariko, mu gihe cy'indwara ya (LCH), izi selile za Langerhans zirundanya cyane ahantu hamwe cyangwa henshi. Iyo ibi bibaye, izi ngingo zishobora kwangirika kandi hagatera ibisebe.

Uburyo iyi ndwara igenda ihinduka bitewe n'umuntu ku giti cye. Hari abana bakira burundu iyi ndwara iyo bavuwe neza. Igitangaje ni uko rimwe na rimwe, cyane cyane iyo ifata uruhu gusa, ishobora koroherwa nta buvuzi. Ariko, iyo iyi ndwara (LCH) igize ingaruka ku ngingo z'ingenzi nk'umusemburo w'amagufwa y'umwana, urwagashya cyangwa umwijima, hashobora kuba ngombwa ko havurwa cyane.

Ese kanseri (LCH) ni yo?

Iki ni ikibazo abantu benshi bibaza. Mu by’ukuri, abashakashatsi benshi bafata LCH nk'indwara ya kanseri, ni ukuvuga ingirangingo. Ariko, bamwe mu bahanga muri iki gihe bayifata nk'indwara iterwa n'ububyimbirwe. Ariko, abaganga b'inzobere mu kuvura kanseri n'indwara z'amaraso. Hari igihe imiti ya kanseri, nka chimiotherapie, ikoreshwa no kuvura iyo ndwara.

Ni nde urebwa cyane n'iki kibazo (LCH)?

LCH ikunze kugaragara mu bana bavutse n'abana bari hagati y'imyaka 1 na 15. LCH ku bantu bakuru ni gake cyane, ariko ntabwo ari ikintu kidashoboka.

Ibi ni ibisanzwe gute?

Dukurikije imibare, umwana umwe cyangwa babiri muri buri mwana uvuka miliyoni bibasirwa na LCH buri mwaka. Nanone, abana bagera kuri batanu muri buri miliyoni bari munsi y'imyaka 15 barabibasirwa. Bityo rero urabona ko iyi ari indwara idasanzwe.

Ni ibihe bimenyetso bya (LCH)?

Ibimenyetso bya LCH biratandukanye cyane bitewe n'umuntu ku giti cye. Bishobora gufata igice kimwe cy'umubiri, cyangwa bigafata ibice byinshi. Bityo rero, ibimenyetso biterwa n'igice cy'umubiri w'umwana cyafashwe.

Niba amagufwa yafashwe:

Hafi 80% by'abana bafite LCH bagira ibisebe mu igufwa rimwe cyangwa menshi. Ni iki gishobora kubitera?

• Kubyimba cyangwa ikibyimba bishobora kuvuka mu bice nko mu gahanga, mu magufwa akikije amaso, mu magufwa yo mu matwi, mu magufwa y'umusaya, mu maguru, mu mugongo, mu matako, cyangwa mu mbavu. Uku kubyimba gushobora kubabaza cyangwa kugashira.
• Umutwe.
• Kubabara mu ijosi cyangwa mu mugongo.
• Kuvunika kw'imitsi.
• Kugorwa no kugenda.
• Kunanirwa.

Ku ruhu:

Ibisebe bikunze kugaragara nk'ibimenyetso by'uruhu (LCH).

• Ku bana bato, uduheri gisa n'ingofero y'umwana wo mu mutwe dushobora kugaragara ku mutwe.
• Ku bana bakuru n'abantu bakuru, bishobora gutera uduheri duto dusa n'uduheri.
• Ibi bisebe bishobora no kugaragara ku bindi bice by'umubiri (ku muhogo, ku maboko, mu kwaha, mu gifu, mu mugongo, mu gituza). Bishobora kubabaza, kubyimbirwa, cyangwa gukomera.
• Hari abana bashobora kugira uduheri dutose.
• Ibintu nko guhindura ibara, gukomera, cyangwa gukuraho inzara nabyo bishobora kubaho.

Ku bijyanye n'umunwa:

Ibimenyetso bishobora kugaragara mu kanwa birimo:

• Kurekura amenyo cyangwa kuyatakaza.
• Iryinyo ryakuwe.
• Kubyimba kw'ishinya.
• Ibisebe ku minwa, ku rurimi, imbere mu matama, cyangwa hejuru y'umunwa.

Ibijyanye n'umwijima cyangwa imyakura:

Iyo izi ngingo zifashwe, ibimenyetso nka:

• Kubyimba inda bitewe no kwiyongera k'umwijima cyangwa urwagashya.
• Ibara ry'umuhondo ku ruhu n'umweru by'amaso (jaundice).
• Kuryarya.
• Umunaniro.
• Gukomereka cyangwa kuva amaraso byoroshye.

Iyo umwongo w'amagufwa wagize ingaruka:

Umwongo w'amagufwa niho uturemangingo tw'amaraso dukorerwa. Iyo ugize ikibazo:

• Kubura amaraso, uruhu rwerurutse, umunaniro, no kubura ubushake bwo kurya bitewe no kugabanuka k'uturemangingo dutukura tw'amaraso.
• Kwandura indwara zikunze kugaragara no kugira umuriro bitewe n'uturemangingo tw'umweru duke mu maraso.
• Gukomereka cyangwa kuva amaraso byoroshye bitewe n'uko platelets nkeya zigaragara.

Sisitemu y'imisemburo (Sisitemu y'imisemburo - Imisemburo):

LCH ishobora kugira ingaruka ku misemburo y'umwana, ari naho imisemburo ikorerwa, nka pituitary gland na tiroyide.

• Iyo igitsina cya pituitary cyagize ikibazo: inyota ikabije (polydipsia) no kwihagarika kenshi (bita diyabete insipidus), kunanirwa gukura, ubwangavu bukiri kare cyangwa butinze, no kwiyongera ibiro.
• Iyo tiroyide ifashwe: kubyimba kwa tiroyide, ibimenyetso byo kugabanuka k'imisemburo ya tiroyide (hypothyroidism), no kugorwa no guhumeka.

Ku bijyanye n'amatwi:

• Udukoko dukunze kwandura mu matwi.
• Amazi ava mu matwi.
• Umutuku.
• Uduheri dushyuha.
• Kubabara ugutwi.
• Kubura amatwi.

Ku bijyanye n'amaso:

• Amaso abyimbye.
• Kubyimba hejuru y'amaso.
• Ibibazo byo kutabona neza.

Utunyangingo tw'imitsi:

• Utunyangingo tw’imitsi tubyimba kandi tubabaza mu ijosi, mu kwaha no mu kibuno.

Uturemangingo tw'imitsi two hagati:

Ibi bivuze ko ubwonko n'umugongo bifatwa n'ingaruka.

• Umutwe.
• Kuzungera.
• Kuruka.
• Inyota ikabije.
• Kwihagarika inkari kenshi.
• Kugorwa no kugenda.
• Gutakaza uburinganire.
• Kudashobora kugenzura imigendere y'umubiri (ataxia).
• Kugorwa no kuvuga cyangwa kubona.
• Indwara zo mu mutwe.
• Impinduka mu myitwarire no mu kwibuka.

Ibihaha:

Indwara ya LCH y'ibihaha, indwara ikunze kwibasira ibihaha, ikunze kugaragara cyane mu bantu bakuru. Abantu banywa itabi ni bo bafite ibyago byinshi.

• Kubabara mu gituza.
• Inkorora yumye.
• Kugorwa no guhumeka.
• Gukorora amaraso.
• Kunanirwa kw'ibihaha (pneumothorax).

Uburyo bwo gutera inda:

Iyo igifu cy'umwana, amara mato, cyangwa amara manini byagize ingaruka:

• Kubabara mu gifu.
• Kuruka.
• Impiswi.
• Amaraso mu ntebe.
• Kunanirwa gukura bitewe n'imirire mibi.

Icy'ingenzi: Ibi bimenyetso bishobora guterwa n'izindi ndwara zitandukanye, atari LCH gusa. Kubwibyo, niba umwana wawe afite ibi bimenyetso, ni ngombwa gushaka inama z'abaganga vuba kugira ngo amenye neza indwara.

Ni izihe mpamvu zitera (LCH)?

Kimwe cya kabiri cy'abantu bafite LCH ni bo bafite impinduka mu mubiri (somatic mutation) muri gene yitwa BRAF. Impinduka mu mubiri (somatic mutations) ni impinduka ziba mu turemangingo tumwe na tumwe nyuma yo gusama. Ntabwo zituruka ku babyeyi, ahubwo ziba ku buryo butunguranye mu gihe cy'imikurire y'uruhinja.

Gene (BRAF) ikora poroteyine igenzura imikurire n'imikurire y'uturemangingo. Ubusanzwe, iyi poroteyine ishobora gufungurwa no kuzimwa hakurikijwe ibimenyetso bya shimi. Ariko, iyo habayeho impinduka muri iyi gene, poroteyine ihora ihagaze mu "buzima". Ibi bituma uturemangingo (LCH) dukura kandi tugacikamo ibice byinshi. Ibi nibyo bituma kwangirika kw'uturemangingo no kuvuka kwa kanseri.

Abahanga mu bya siyansi bavumbuye kandi ko impinduka mu zindi ngirabuzimafatizo nyinshi zishobora gutera iyi ndwara. Urugero, ngirabuzimafatizo (MAP2K1), (RAS), na (ARAF). Abashakashatsi bamwe bemera ko uburozi bukomoka ku bidukikije n'ubwandu bwa virusi nabyo bishobora gutera iyi ndwara.

Ni ibihe bintu bishobora gutera (LCH)?

Hari ibintu bishobora kongera ibyago by'umwana wawe byo kurwara LCH. Muri byo harimo:

• Kugira amateka y'umuryango wa LCH.
• Kugira ubwoko bw'Abanya-Hispanic (nubwo ibi bitajyanye n'igihugu cyacu, bivugwa mu masoko).
• Kunywa itabi (cyane cyane ku bantu bakuru barwaye kanseri y'ibihaha (LCH)).
• Guhura n'ibintu bimwe na bimwe byangiza ibidukikije mu gihe cyo gutwita.
• Guhura n'icyuma, granite, cyangwa ivumbi ry'ibiti ku kazi.
• Kwandura indwara mu gihe cy'uruhinja.
• Kutabona inkingo zisabwa mu bwana.

Ni izihe ngorane zishobora guterwa na (LCH)?

Abana bagera kuri 50% bafite LCH bahura n'ingorane zitandukanye bitewe n'iyi ndwara. Urugero:

• Inkovu.
• Kudindira mu mikurire.
• Ubumuga bw'imitsi n'amagufwa.
• Indwara nka diyabete (Diabetes insipidus).
• Kudahuza kw'imisemburo.
• Ubumuga bwo kutumva.
• Ingorane z'ubuzima bwo mu mutwe (nk'ihungabana, guhangayika).
• Ibibazo by'amagufwa n'ibihaha.
• Indwara ya cirrhose y'umwijima.
• Kanseri za kabiri (urugero: kanseri y'amaraso, kanseri ya kanseri ...

LCH ipimwa ite?

Muganga w'umwana wawe azabanza kubaza amateka y'ubuzima bw'umwana wawe hanyuma akore isuzuma ry'umubiri. Hanyuma, azategeka ibizamini byinshi bitewe n'ibimenyetso umwana wawe afite. Bitewe n'ibisubizo by'ibi bizamini, umwana wawe ashobora koherezwa kwa muganga w'indwara z'amaraso/kanseri w'abana, uzahuza uburyo umwana wawe avurwa kandi akamwitaho.

Ni ibihe bipimo bikorerwa kugira ngo hamenyekane indwara?

Kubera ko LCH ishobora kugira ingaruka ku bice bitandukanye by'umubiri, hakenewe ibizamini byinshi kugira ngo hamenyekane neza indwara.

• Ibipimo by'amaraso:
• Umubare wuzuye w'amaraso (CBC): Ibi bigenzura urugero rw'uturemangingo dutukura tw'amaraso, uturemangingo tw'umweru, n'uturemangingo tw'amaraso mu maraso y'umwana.
• Ibipimo bya shimi y'amaraso: Ibi bigenzura urwego rw'ibintu bimwe na bimwe birekurwa n'ingingo n'imitsi by'umubiri.
• Ibizamini by'imikorere y'umwijima: Ibi bigenzura ingano y'ibintu birekurwa n'umwijima.

• Ibipimo by'inkari:
• Isesengura ry'inkari: Isuzuma ry'inkari z'umwana rireba ingano y'uturemangingo dutukura tw'amaraso, uturemangingo tw'umweru tw'amaraso, poroteyine n'isukari.
• Ikizamini cyo kubura amazi: Iki kizamini gipima ingano y'inkari umwana anyara n'uko inkari ziba nyinshi iyo adahawe amazi.

• Isuzuma ry'ubuzima bw'umuntu:
• Isuzuma ry'umubiri: Umuganga afata icyitegererezo cy'ingingo, maze inzobere mu ndwara ikazireba ikoresheje mikorosikopi kugira ngo irebe ko hari uturemangingo twa LCH.
• Gukoresha umwobo w'amagufwa no gupima: Urushinge rw'ubusa rukoreshwa mu gukura umwobo w'amagufwa, amaraso, n'agace gato k'igufwa mu igufwa ry'ikibuno cy'umwana. Ibi kandi bisuzumwa n'inzobere mu ndwara.

• Gupima imiterere y'uturemangingo:
• Ingero y'amaraso cyangwa ingirabuzimafatizo ikoreshwa mu gusuzuma impinduka muri gene (BRAF).

• Ibizamini byo gushushanya:
• Imirasire ya X: Hafatwa amashusho y'amagufwa n'ingingo z'umubiri. Hari igihe hakorwa ubushakashatsi ku magufwa y'umubiri wose kugira ngo harebwe niba hari ibitagenda neza.
• Gupima amagufwa: Hari ikintu giterwa n'imirasire mu mitsi, hanyuma hagakoreshwa icyuma gipima amagufwa kugira ngo harebwe niba hari ibintu bidasanzwe biri mu magufwa. Ibi ntibikikoreshwa cyane.
• Gupima CT (CT scan) (computed tomography - CT scan): Umwana ahabwa amazi yihariye yo kunywa cyangwa guterwa mu mitsi, kandi amashusho arambuye afatwa mu mpande zitandukanye imbere mu mubiri.
• Isuzuma rya Positron emission tomography (PET scan): Isukari nkeya iterwa mu mitsi, hanyuma isuzuma rikagenda rizenguruka umubiri wose kugira ngo hafatwe amafoto y'aho isukari ikoreshwa. Uturemangingo turwaye tugaragara nk'aho turi urumuri kuri iri suzuma.
• Gupima MRI (Magnetic resonance imaging - MRI scan): Ikintu cyitwa gadolinium gishyirwa mu mitsi hanyuma hagafatwa amashusho menshi arambuye hakoreshejwe magnets, radio waves, na mudasobwa. Ahantu harwaye hagaragara nk'ahagaragara cyane.
• Ultrasound: Ikoresha amajwi afite ingufu nyinshi mu gukora amashusho y'imbere mu mubiri binyuze mu kugaragaza amajwi y'inyuma y'ingingo n'imitsi.

LCH ivurwa ite?

Uburyo bwo kuvura LCH buterwa n'aho uturemangingo twa LCH turi mu mubiri w'umwana ndetse niba indwara ari "ifite ibyago bike" cyangwa "ifite ibyago byinshi."

Ingingo z'umubiri zifite ibyago bike ni izi:

• Uruhu
• Igufwa
• Ibihaha
• Uduce tw'umurabyo (lymph nodes)
• Uduce tw'igifu
• Indwara y'umuyoboro w'amaraso (pituitary gland)
• Indwara ya tiroyide
• Thymus

Ingingo z'umubiri zishobora gutera ibyago byinshi ni izi:

• Umwijima
• Umugongo
• Umworo w'amagufwa
• Udutsi two mu bwonko two hagati (CNS)

Abaganga bashyira iyo ndwara mu byiciro bya "LCH" mu byiciro bibiri: "LCH ifite uburyo bumwe" na "LCH ifite uburyo bwinshi." Ibi bivuze:

• Sisitemu imwe (LCH): Uturemangingo twa LCH tuboneka mu gice kimwe gusa cy'urugingo rumwe cyangwa sisitemu imwe y'umubiri. Ubwoko bukunze kugaragara cyane ni LCH ifata amagufwa gusa.
• Uduce twinshi tw’umubiri (LCH): Hari uturemangingo mu ngingo ebyiri cyangwa nyinshi, cyangwa mu mubiri wose (LCH). Ibi ntibikunze kugaragara cyane nka bumwe mu buryo bw’umubiri (LCH).

Mu bihe bimwe na bimwe, cyane cyane ibibasira uruhu cyangwa amagufwa gusa (LCH), iyo ndwara ishobora gukemuka nta muti. Muri ibyo bihe, abaganga bazakurikirana iyo ndwara kugira ngo barebe niba igarutse cyangwa yakwirakwiriye.

Uburyo bwo kuvura (LCH):

• Uburyo bwo kuvura indwara ya steroid: Muganga wawe ashobora gukoresha imiti ya steroid, nka prednisone, cyane cyane kuri LCH y'uruhu. Iyi miti igabanya imikorere y'uturemangingo tw'amaraso twera, ibyo bikaba byanagira ingaruka ku turemangingo twa LCH.
• Kubagwa: Ibibyimba bya LCH n'ingingo zikikije bishobora gukurwaho mu buryo bwo kubaga. Uburyo bwitwa curettage bukubiyemo gukata uturemangingo twa LCH mu igufwa hakoreshejwe igikoresho gityaye, kimeze nk'ikiyiko (curette).
• Chimiotherapie: Ibi bikubiyemo guha uturemangingo twa kanseri imiti yo kutubuza gukura. Bica uturemangingo cyangwa bikatubuza kwigabanyamo ibice. Iyi miti inyurwa mu kanwa, igaterwa mu mitsi cyangwa mu mitsi, cyangwa rimwe na rimwe igasigwa ku ruhu nk'amavuta yo kwisiga.
• Ubuvuzi bushingiye ku mirasire: Imirasire ya X-ray cyangwa ubundi bwoko bw'imirasire ikoreshwa mu kwica uturemangingo twa kanseri cyangwa kuyibuza gukura no kwigabanyamo ibice.
• Ubudahangarwa bw'umubiri: Uburyo bwo gukoresha ubudahangarwa bw'umubiri bw'umwana mu kurwanya kanseri. Ubudahangarwa bw'umubiri burushaho gukomera hakoreshejwe ibintu byakozwe n'umubiri ubwawo cyangwa ibyakorewe muri laboratwari.
• Ubuvuzi bwibasiwe: Bukoresha imiti cyangwa ibindi bintu kugira ngo bumenye kandi bwibasire uturemangingo twa kanseri. Urugero, imiti yitwa BRAF ibuza uturemangingo twa kanseri ishobora kwica uturemangingo twa kanseri ibuza poroteyine zikenewe kugira ngo uturemangingo dukure. Uturemangingo twa monoclonal ni poroteyine z’ubudahangarwa bw’umubiri zikorerwa muri laboratwari.
• Gutera uturemangingo: Gutera uturemangingo dushya kugira ngo dusimbuze uturemangingo dukora amaraso twangijwe na chemotherapy.

Ese LCH ishobora kwirindwa?

LCH irashoboka cyane kwirindwa kuko iterwa n'impinduka mu miterere y'uturemangingo. Ntidushobora kugenzura bimwe mu bintu bishobora gutera ibyago, nk'amateka y'umuryango n'ubwoko. Ariko, hari ibintu bimwe na bimwe dushobora gukora:

• Nta kunywa itabi bibujijwe.
• Kwirinda imiti imwe n'imwe yangiza mu gihe utwite.
• Kubona inkingo zose zisabwa.

Ni iki gipimo cy'indwara ya (LCH)?

Uko LCH ihagaze biterwa n'ibintu byinshi:

• Ni ingingo zingahe z'umubiri cyangwa ingingo zifatwa n'ingaruka?
• Ni izihe ngingo cyangwa ingingo z'umubiri zigira ingaruka.
• Uburyo indwara yakira neza iyo ivuwe.

Muri rusange, abana bafite ubwoko bumwe bw’indwara zifata umwijima, urwagashya, cyangwa umwongo w’amagufwa (single-system) badafata umwijima, urwagashya, cyangwa umwongo w’amagufwa bagwa mu cyiciro cy’indwara zifata umwijima, urwagashya cyangwa umwongo w’amagufwa (“low risk”). Iyo bavuwe, abana bari muri iki cyiciro baba bafite amahirwe hafi 100% yo kurokoka. Ariko, iyi ndwara ishobora kongera kugaruka cyangwa igatera izindi ngorane z’igihe kirekire.

Abana barwaye kanseri y’imitsi myinshi (LCH) yibasira umwijima, urwagashya, cyangwa umwongo w’amagufwa bari mu cyiciro cy’ "ibyago byinshi".

Ni ryari umwana wanjye agomba kujya kwa muganga?

Nubwo umwana wawe yarangiza kuvurwa, muganga azakenera kujya kureba umwana wawe buri gihe. Ibi biterwa nuko ibyago byo kongera kurwara biba byinshi. Kubwibyo, umwana wawe azakenera gukurikiranwa imyaka myinshi. Muri ibi bizamini byo gukurikirana, ibizamini bimwe byakozwe igihe umwana yasuzumwaga, nka ultrasound, MRI, CT scan, na PET scan, bizakenera gusubirwamo. Muganga azakubwira inshuro ugomba kuzana umwana wawe.

Ni ibihe bibazo ngomba kubaza muganga w'umwana wanjye?

Ushobora kuba ufite ibibazo byinshi ku bijyanye n'indwara y'umwana wawe. Ni byiza kubyandika hanyuma ukabijyana kwa muganga wawe utaha. Dore bimwe mu bibazo ushobora kubaza:

• Ni gute ingirabuzimafatizo za Langerhans cell histiocytosis zigira ingaruka ku mwana wanjye?
• Ese umwana wanjye akeneye kuvurwa?
• Ni ubuhe buryo bwo kuvura buhari ku mwana wanjye?
• Ingaruka mbi z'ubuvuzi ni izihe?
• Ese umwana wanjye azakira burundu hamwe n'ubu buryo bwo kuvura?
• Ni iki kizere cy'uko indwara y'umwana wanjye izagenda?
• Ese hari amatsinda y'ubufasha ushobora gutanga inama?

Amaherezo, ubutumwa bwo kujyana mu rugo

Indwara ya Langerhans Cell Histiocytosis (LCH) ni indwara idakunze kugaragara ikunze kwibasira abana. Niba umwana wawe arimo kunyura muri ibi, ushobora kuba wumva amarangamutima menshi. Ushobora kumva ubabaye kandi utinya umwana wawe. Ushobora kuba ufite ubwoba bwinshi imbere, ariko ushobora kuba ugerageza gukomera inyuma. Amarangamutima yawe yose afite ishingiro. Ariko ibuka ko udakwiye kunyura muri uru rugendo wenyine. Itsinda ry'abaganga b'umwana wawe rizi ibyo urimo kunyuramo. Barahari kugira ngo bagufashe muri buri ntambwe, basobanukirwe uko umwana wawe amerewe, kandi baguhe imbaraga zo guhangana nabyo.

Wibuke ko gusuzuma umwana hakiri kare no kumuvura neza bishobora gutuma agira ubuzima bwiza. Ntutinye, hangana n'iki kibazo ubigiranye ubutwari.

` Histiocytosis y'ingirabuzimafatizo za Langerhans, LCH, ubuvuzi bw'abana, kanseri, impinduka mu ngirabuzimafatizo, ibimenyetso, uburyo bwo kuvura