Methylene blue pa kukumbukira ndi kuika maganizo: zimene mayesero a anthu anayeza

Pepala la kafukufuku la 2023 lokhudza methylene blue ndi ubongo wa munthu wamoyo limayamba mfundo yake ndi chiganizo chimene tsopano chimabwerezedwa m'mawunikidwe, m'mavidiyo, ndi pamasamba a zinthu zogulitsidwa: mankhwalawa “anasonyezedwanso kuti amawongolera magwiridwe a kuganiza, kuphunzira ndi kukumbukira mwa anthu komanso nyama zoyesedwa, mogwirizana ndi kuchuluka kwa mlingo.”

Mbali ya chiganizochi yokhudza nyama ndi yosavuta kuchirikiza. Mbali yokhudza anthu imadalira mayesero ochepa, ndipo kuwawerenga kumasiyanitsa zimene mawu akuti “magwiridwe a kuganiza” akutanthauza. Kufufuza kwa nkhaniyi kunapeza maphunziro asanu a anthu amene anali ndi muyeso womaliza wokhudza kuganiza kapena zithunzi za ubongo, komanso mayesero atatu a opaleshoni amene anayeza magwiridwe a kuganiza. Mayesero amodzi a akuluakulu athanzi anapeza kukumbukira kwabwino, koma kusinthaku sikunakhalebe kofunika poyerekezera magulu.

Mitundu inayi ya zotsatira mwa anthu nthawi zambiri imatengedwa ngati chinthu chimodzi

Mukawerenga tebulo limeneli kuchokera pamwamba mpaka pansi, chitsanzo chake chimaoneka. Maphunziro amene anali ndi muyeso weniweni wa magwiridwe a kuganiza ndi aja a opaleshoni, ndipo anagwiritsa ntchito mankhwala operekedwa mumtsempha wa magazi kwa odwala amene anapatsidwa mankhwala ogonetsa. Maphunziro a anthu athanzi odzipereka anayeza zizindikiro za ubongo m'malo mwa kuganiza.

Zimene mayesero a akuluakulu athanzi a 2016 anapeza

Kafukufuku wa anthu amene amatchulidwa kwambiri anapatsa akuluakulu athanzi 26 mlingo umodzi wa 280 mg wa pakamwa, pafupifupi 4 mg/kg, kapena kapsulo ya placebo yodzazidwa ndi FD&C blue no. 2 kuti zonse ziwiri zioneke zofanana. Anthuwo anajambulidwa zithunzi za ubongo asanapatsidwe mlingowo ndiponso patatha ola limodzi, akuchita ntchito yoyesa kukhala tcheru ndi kuyankha mwachangu ku chizindikiro chooneka chosavuta, komanso ntchito yofananitsa chithunzi ndi chimene anaona kale pambuyo podikira, yomwe ndi mayeso a kukumbukira zinthu zooneka kwa nthawi yochepa.

Mayankho a ubongo anasintha. Methylene blue inawonjezera chizindikiro m'zigawo za insular cortex za mbali zonse ziwiri pa ntchito ya kuika maganizo (Z = 2.9 to 3.4, P = .01 to .008), komanso m'zigawo za prefrontal, parietal, ndi occipital pa ntchito ya kukumbukira (Z = 2.9 to 4.2, P = .03 to .0003).

Zotsatira za machitidwe a anthu ndi mbali imene imafupikitsidwa kwambiri pofotokozanso kafukufukuyu.

1. Nthawi yoyankha sinakhale yabwino. Gulu la placebo linachoka pa 230 kufika pa 220 milliseconds. Gulu la methylene blue linachoka pa 230 kufika pa 230 milliseconds. Kuyerekezera magulu kunapereka F = 0.65, P = .43.
2. Mayankho olondola pokumbukira anawonjezeka pafupifupi 7% mkati mwa gulu lopatsidwa mankhwalawa, P = .01 poyerekezera zotsatira za gululo zisanachitike ndi zitachitika.
3. 7% imeneyo sinakhalebe yofunika pa mayeso oyerekezera magulu. Kuyerekezera kusintha kwa mayankho olondola pogwiritsa ntchito miyeso yobwerezedwa kunapereka F = 2.96, P = .09.

Kusintha mkati mwa gulu limodzi pamene kusiyana kwa kusintha pakati pa magulu sikofunika malinga ndi ziwerengero ndi chizindikiro cha zotsatira zimene zingakhale zenizeni kapena kungokhala kusiyanasiyana mwangozi. Mawu omaliza a pepalalo ndi ochepa moyenerera: zotsatirazo “zimachirikiza lingaliro lakuti methylene blue imawongolera kukumbukira” ndipo zimapereka maziko a mayesero am'tsogolo. Maziko si zotsatira zotsimikizidwa. Kuwunika kwathu kwa umboni wonse wa anthu kumatsata zimene zamangidwa pa maziko amenewa kuyambira pamenepo.

Zimene mayesowo amayezadi

Palibe chida mwa zimenezi chimene chimayeza “kukumbukira” kapena “kuika maganizo” monga mmene wowerenga amatanthauzira. Chilichonse chimafuna kuti munthu achite ntchito inayake ndipo chimapereka mphambu pa yankho lake; malire a chidacho ndi amenenso amakhala malire a chilichonse chimene chimanenedwa potengera zotsatira zake.

Choncho zotsatira zingakhale zolimba malinga ndi ziwerengero koma zikhale ndi tanthauzo lochepa. Nthawi yoyankha yosasintha imasonyeza kuti kuzindikira chizindikiro sikunafulumire; sikutanthauza kuti kukumbukira zimene zinaphunzitsidwa sikungakhale kwabwino. Mphambu yabwino pa mayeso ofananitsa chithunzi pambuyo podikira imatanthauza kuti chithunzicho chinazindikiridwa molondola nthawi zambiri; sizitanthauza kuti munthuyo adzakumbukira dzina mawa. Kalozera wa mmene kafukufuku wa nyama amayezera kukumbukira amatsata kusiyana kumeneku kudzera m'mayeso a njira zopotapota ndi kuzindikira zinthu amene ali maziko a zonena zambiri.

Kafukufuku wotsagana nawo sanalembe mphambu zilizonse

Pulogalamu yomweyo ya kafukufuku inafalitsa kuwunika kwachiwiri kuchokera pa nthawi yomweyo yolembera anthu, ku yunivesite yomweyo, pogwiritsa ntchito mlingo womwewo ndi placebo yomweyo, koma ulendo uno ikuyang'ana kulumikizana kwa zigawo za ubongo uli pa mpumulo. Anthu 28 analembetsedwa; kuwunika kwa zithunzi kunagwiritsa ntchito pafupifupi 13 mpaka 15 pa gulu lililonse.

Methylene blue inali yogwirizana ndi kuchepa kwa kuyenda kwa magazi mu ubongo m'gulu la zigawo zokhudza kuona ndi kuzindikira malo, komanso kulumikizana kwamphamvu kwa zigawo zingapo ubongo uli pa mpumulo, kuphatikizapo hippocampus ya kumanzere ndi cerebellum ya kumanja. Zonsezi ndi zochititsa chidwi zokhudza mmene magulu a zigawo za ubongo amagwirira ntchito. Palibe mwa ziwirizi chimene ndi zotsatira za kukumbukira, ndipo pepalalo limanenanso lokha kuti: “Kusowa kwa mphambu za machitidwe mu kafukufukuyu ndi malire enanso.”

Malipoti awiri ochokera ku gulu limodzi, nthawi imodzi yolembera anthu, ndi mlingo umodzi ndi mayesero amodzi, osati awiri. Umboni wa zithunzi za ubongo wa anthu wokhudza phindu pa kuganiza sunabwerezedwe ndi ofufuza odziyimira pawokha.

Kafukufuku wodziyimira pawokha anapeza kusintha kosiyana

Muyezo wodziyimira pawokha unachokera ku gulu lina ndipo unagwiritsa ntchito njira ina yoperekera mankhwalawa. Singh ndi anzake anapatsa akazi athanzi asanu ndi atatu mankhwala kudzera mumtsempha wa magazi: placebo ndi methylene blue ya 0.5 ndi 1 mg/kg pamasiku osiyana, kenako anayeza kuyenda kwa magazi mu ubongo, kuchotsedwa kwa okosijeni m'magazi, ndi liwiro limene ubongo umagwiritsa ntchito okosijeni.

Zonse zitatu zinachepa. Kuyenda kwa magazi mu ubongo wonse kunatsika pafupifupi 8% pa milingo yonse iwiri, ndipo liwiro la kugwiritsa ntchito okosijeni linachepa kwambiri malinga ndi ziwerengero. Olembawo anali atayembekezera kuwonjezeka ndipo anafotokoza mosapita m'mbali kusintha kosiyanako, akupereka zifukwa ziwiri: milingoyi ili pamene zotsatira za methylene blue zimasintha kuchokera pa kulimbikitsa ntchito kupita pa kuiletsa, ndipo ubongo wathanzi ungakhale ndi mwayi wochepa wowongoleredwa.

Kusintha kosiyanaku ndi chifukwa chake kutanthauzira mankhwalawa kuti “wochuluka ndi wabwino kwambiri” sikugwira ntchito. Kalozera wa hormesis amafotokoza mmene mzere wa zotsatira umapindirira; milingo imene kafukufukuyu amafotokoza kuti imawongolera ntchito ndi 0.5 mpaka 4 mg/kg, ndipo mapepala amene amagwiritsa ntchito milingoyo amanena kuti pamwamba pa 10 mg/kg zotsatira zimasintha n'kupita mbali ina.

Muyezo wa magwiridwe a kuganiza umene unasinthadi ndi kusokonezeka kwa maganizo pambuyo pa opaleshoni

Kusokonezeka mwadzidzidzi kwa maganizo, kapena delirium, kumayamba mkati mwa maola kapena masiku, nthawi zambiri mwa anthu okalamba pambuyo pa opaleshoni yaikulu. Sikufanana ndi kukumbukira kumene kuli makiyi, koma kumayesedwa ndi zida zotsimikizidwa kuti n'zoyenera, ndipo ndi zotsatira zokhudza magwiridwe a kuganiza.

Mayesero atatu ogawa anthu m'magulu mwachisawawa ayesa ngati mlingo woperekedwa mumtsempha wa magazi panthawi ya opaleshoni umachepetsa vutoli.

Mayesero a 2021 anafotokozanso kuti kusagwira bwino ntchito koyambirira kwa kuganiza pambuyo pa opaleshoni pa tsiku lachisanu ndi chiwiri kunatsika kuchokera pa 40.2% kufika pa 16.1% (OR 0.30, 95% CI 0.16 to 0.57, P < .001). Kuwunika kophatikiza mayesero atatuwa kwa 2026, komwe kunaphatikiza odwala 779, kunapeza chiŵerengero chophatikizidwa cha mwayi wa vutoli cha 0.35 (95% CI 0.23 to 0.53), popanda kusiyanasiyana kofunika malinga ndi ziwerengero pakati pa maphunzirowo.

Zotsatirazi ndi zazikulu malinga ndi miyezo ya chithandizo cha nthawi yozungulira opaleshoni, koma zinabweranso ndi mavuto. M'mayesero a kusintha mfundo, malungo pambuyo pa opaleshoni anali ochuluka m'gulu lopatsidwa mankhwalawa, 16.5% poyerekezera ndi 7.4% (P = .039). Kuyambira pamenepo, mayesero a kapamba ndi a kusintha mfundo ayambitsa makalata opita kwa mkonzi amene afalitsidwa. Izi zimachitika pamene zotsatira zikuyamba kusintha machitidwe a chithandizo, ndiponso ndi chizindikiro chakuti tsatanetsatane akuwunikidwa.

Palinso umboni wina woti uganiziridwe. Kuwunika kophatikiza ndi kuyerekezera njira zambiri kwa 2026 mu The BMJ kunaphatikiza mayesero 158 ndi odwala 41,084 kuti kusankhe mankhwala malinga ndi mmene amatetezera ku kusokonezeka kwa maganizo. Kunasankha dexmedetomidine kukhala yodalirika kwambiri, pamodzi ndi corticosteroids, mankhwala oyambitsa ma receptor a melatonin, parecoxib, olanzapine, ndi insulin yoperekedwa m'mphuno. Methylene blue sinali m'gulu la njira zimene kuwunikako kunatchula.

Chifukwa chake kupambana m'chipinda cha opaleshoni sikutanthauza kupambana pa kuphunzira

Pali kusiyana kunayi pakati pa zochitikazi.

1. Anthu omwe anayesedwa. Mayesero analemba anthu opitirira zaka 60 amene anali kuchitidwa maopaleshoni aakulu, gulu limene linali kale pachiwopsezo chachikulu cha kusokonezeka kwa maganizo. Kuteteza ubongo wofooka ku kusokonezeka si chimodzimodzi ndi kuwongolera ubongo wogwira ntchito bwino.
2. Njira yoperekera ndi malo. Zotsatira zabwino zonse zinachokera pa mankhwala operekedwa mumtsempha wa magazi pamene odwala anali pansi pa mankhwala ogonetsa. Kapsulo imafikitsa mankhwala m'thupi mosiyana; kuyerekezera njira zoperekera kumafotokoza kuchuluka kwa mankhwala a pakamwa kumene kumafika ku ubongo.
3. Zotsatira. Kusokonezeka mwadzidzidzi kwa maganizo ndi vuto lachipatala limene ogwira ntchito zachipatala amayesa ndi zida zokonzedwa mwadongosolo. Kuika maganizo mosadukiza masana onse pogwira ntchito si chimodzimodzi, ndipo mayesero amene sangathe kubisa bwino kwa anthu kuti ali m'gulu liti adzavutika kuyeza zimenezi.
4. Njira yogwirira ntchito imene akuganiza. Mapepala a opaleshoni amati zotsatirazo zimachokera ku kuchepa kwa kutupa kwa thupi lonse ndi kusungidwa kwa chotchinga pakati pa magazi ndi ubongo, limodzi ndi kutsika kwa IL-6. Izi n'zosiyana ndi nkhani ya kusamutsa ma elekitironi m'mitochondria imene imagwiritsidwa ntchito pogulitsa phindu la kuika maganizo, ndipo umboni wa anthu umachirikiza mfundo yoyamba kwambiri kuposa yachiwiri.

Mayesero amodzi a anthu amene anapeza kukumbukira kwabwino

Mu mayesero a 2014 mu American Journal of Psychiatry, akuluakulu 42 amene anali ndi mantha aakulu a kukhala m'malo otsekedwa anapatsidwa 260 mg ya methylene blue kapena placebo nthawi yomweyo atangomaliza magawo asanu ndi limodzi a mphindi zisanu olowera m'malo otsekedwa kuti akumane ndi mantha awo. Kukumbukira malo ndi zochitika za maphunzirowo, koyesedwa patatha tsiku limodzi ndi masiku 30, kunali kwabwino m'gulu lopatsidwa mankhwalawa.

Zotsatira pa mantha zinadalira mmene gawolo linathera. Anthu amene anamaliza gawo lokumana ndi mantha awo ali ndi mantha ochepa anali ndi zotsatira zabwino patatha mwezi ngati analandira methylene blue; anthu amene magawo awo anatha moipa ankakonda kukhala ndi zotsatira zoipa kwambiri. Choncho chinthu choyandikira kwambiri mu kafukufuku wa anthu ku zotsatira zotsimikizidwa za kukumbukira ndi kukumbukira chochitika chimodzi chophunzira mu labotale, komwe kunawongoleredwa pamene mankhwalawa anaperekedwa pambuyo pa chochitikacho. Kalozera wa chithandizo chokumana ndi zimene munthu amaopa amawunika chitsanzo chimenechi.

Kumene anazifufuza koma sanazipeze

Mayesero a anthu a methylene blue ndi magwiridwe a kuganiza amene anatenga nthawi yaitali kwambiri anachitika kwa miyezi isanu ndi umodzi. Mu kafukufuku wa matenda a bipolar wogawa anthu mwachisawawa kuti alandire njira zonse ziwiri motsatizana, odwala 37 amene anali kale kumwa lamotrigine analandira 15 mg ngati mlingo woyerekezera wooneka ngati wogwira ntchito, kapena 195 mg ngati mlingo wogwira ntchito. Mphambu za kuvutika maganizo ndi nkhawa zinakhala zabwino pa mlingo wapamwamba. Lipoti la pepalalo pa magwiridwe a kuganiza lili ndi mzere umodzi: “Zotsatira za methylene blue pa zizindikiro zokhudza magwiridwe a kuganiza sizinali zofunika malinga ndi ziwerengero.”

Kapangidwe ka kafukufukuyu kanagwiritsa ntchito mankhwala enieni m'gulu loyerekezera chifukwa methylene blue imasintha mtundu wa mkodzo, ndipo olembawo anaona kuti placebo yosagwira ntchito singathe kubisa magulu. Vuto lobisa magulu limeneli limabwerezabwereza m'gawo lonse la kafukufukuyu, ndipo kalozera wa chifukwa chake n'zovuta kubisa magulu m'mayesero a methylene blue amafotokoza mmene zimakhudzira kutanthauzira zotsatira zimene zimadalira zimene munthu akunena kuti akumva.

Mayesero aakulu kwambiri a kukumbukira mwa anthu anagwiritsa ntchito mankhwala ena

Mayesero aakulu kwambiri a mankhwala a m'gulu la methylene blue pa kukumbukira anali pulogalamu ya Alzheimer's, ndipo sanagwiritse ntchito methylene blue. Anagwiritsa ntchito hydromethylthionine mesylate, mtundu wa pachimake chomwecho cha phenothiazine umene walandira ma elekitironi ndipo wakhazikitsidwa ngati mchere, wopangidwa kuti uletse kusonkhana kwa tau. Mayesero aposachedwa kwambiri a gawo la 3 analemba anthu 598 amene anali ndi kuchepa pang'ono kwa luso loganiza kapena dementia ya Alzheimer's yochepa mpaka yapakatikati m'malo 82, ndipo sanakwaniritse miyeso yawo ikuluikulu iwiri pa masabata 52. Chifukwa chofotokozedwa chili ndi phunziro: gulu loyerekezera linakhala bwino, ndipo olembawo amati izi zinachokera ku mankhwala a m'gulu loyerekezera omwewo, 4 mg ya methylthioninium chloride kawiri pa sabata, yosankhidwa ngati chopatsa mkodzo mtundu chimene chinkaganiziridwa kuti sichigwira ntchito, kuti chisunge kubisidwa kwa magulu. Kusiyana kofunika kunangooneka m'kagulu ka anthu amene anali ndi kuchepa pang'ono kwa luso loganiza, pa masabata 78 ndi 104, mu kuwunika kwa kuyamba mankhwala mochedwa. Lipoti loyambirira la gawo la 3 la pulogalamu yomweyo linapeza zotsatira zake zofunika kuchokera pa kuwunika komwe kunasinthidwa magulu asanaululidwe, poyerekezera timagulu ta anthu amene anali kulandira mankhwala amodzi okha, osagawidwa mwachisawawa. Kalozera wa mayesero a Alzheimer's amafotokoza zimene mayesero amenewo amatsimikizira.

Mmene kafukufuku woyenera kukhulupirira angakhalire

Mayesero amene angachirikize zonena za kukumbukira kapena kuika maganizo angafune akuluakulu athanzi amene alibe kale dandaulo lokhudza kuganiza, milingo yobwerezedwa kwa masabata, kuyerekezera kobisa kuti kapsulo iliyonse ndi iti, zotsatira zoyenera kuyezedwa zokhazikitsidwa pasadakhale, ndi gulu la ofufuza odziyimira pawokha. Palibe chimene chili pamndandandawu chimene n'chosayenera. Kungoti sichinachitikebe.

Ngati mukuganizabe zoigwiritsa ntchito

Mfundo ziwiri za chitetezo ziyenera kubwera patsogolo pa kukambirana kulikonse za phindu. Methylene blue imaletsa monoamine oxidase A, zomwe zimabweretsa nkhani yoigwiritsa ntchito limodzi ndi mankhwala olembedwa ndi dokotala a kuvutika maganizo ndi mankhwala ena okhudza serotonin; chodetsa nkhawa ndi serotonin syndrome, osati kungokhudzana pang'ono kwa mankhwala. Siyeneranso kugwiritsidwa ntchito mwa anthu amene ali ndi kuchepa kwa G6PD chifukwa cha kuchepa kwa magazi kobwera chifukwa cha kuwonongeka kwa maselo ofiira a magazi. Buku lofotokozera chitetezo ndi kalozera wa kukhudzana kwa mankhwala amakonzera mafunso amenewa malinga ndi magulu a mankhwala.

Ngati kukumbukira kapena kuika maganizo kwasinthadi, sitepe yoyamba si chowonjezera. Matenda a chithokomiro, kudukiza kupuma munthu ali mtulo, kuchepa kwa B12, kuvutika maganizo, ndi mankhwala angapo olembedwa ndi dokotala zimayambitsa chizindikiro chomwecho chimene anthu amagulira chowonjezera cha luso loganiza kuti achikonze, ndipo kalozera wa umboni wa chithokomiro amasonyeza mmene chifukwa chochizika chimakhalira kaŵirikaŵiri pansi pa vutolo.

Mankhwala ogwiritsidwa ntchito ndi chinthu chofunika m'maphunziro onse pamwambapa

Mlingo uliwonse wofotokozedwa pano unali kuchuluka koyezedwa kwa mankhwala odziwika bwino, ochokera kwa wopanga mankhwala a zachipatala, okhala ndi satifiketi ya kuwunika. Botolo lochokera kwa wogulitsa amene sanatsimikizidwe si chimodzimodzi. Kukwaniritsa zofunikira za kufotokozera kwa USP ndi muyezo umene wogula angauone, ndipo mankhwala osakwaniritsa zofunikirazo mwina ndi a mulingo wopangira nsalu, amene angakhale ndi zonyansa za mankhwala a organic monga Azure B, zotsalira za zosungunulira, ndi zitsulo zolemera pa milingo imene zofunikira za mankhwala a zachipatala zimakhazikitsa malire. Zimene chizindikiro cha USP chimatsimikizira ndi zimene sichimatsimikizira zimafotokoza mulingowo.

Ogulitsa ambiri amene amati mankhwala awo ayesedwa ndi bungwe lodziyimira pawokha amangoyesa zitsulo zolemera zokha ndipo amaonetsa mayeso amodziwo ngati kukwaniritsa zofunikira zonse. Blupreme imayesa zofunikira zonse za USP: kutsimikizira kuti mankhwalawo ndi amene akunenedwa, kuyera, zonyansa za organic, zotsalira za zosungunulira, zonyansa za zinthu za mankhwala, zotsalira pambuyo powotcha, malire a tizilombo, ndi endotoxins za mabakiteriya. Gulu lililonse lopangidwa limatumizidwa ndi satifiketi ya kuwunika, ndipo kuiwerenga molondola kumatanthauza kugwirizanitsa nambala ya gulu lopangidwa ndi labotale ndi botolo limene muli nalo. Palibe mwa zimenezi chimene chimapanga phindu pa magwiridwe a kuganiza, ndipo mankhwala amene sangathe kupereka zolemba zotsimikizira kuti ndi amene akunenedwa si malo oyenera oyambira kuyesa zonena.

Mfundo yomaliza

Palibe mayesero amene apatsa methylene blue kwa akuluakulu athanzi n'kusonyeza kukumbukira kapena kuika maganizo kwabwino kuposa placebo. Mayesero a 2016 anasintha zizindikiro za ubongo, anasiya nthawi yoyankha yosasintha, ndipo anapeza kusintha kwabwino pa kukumbukira kumene sikunali kofunika malinga ndi ziwerengero magulu atayerekezera. Pepala lotsagana nawo silinalembe mphambu za mayeso. Gulu lodziyimira pawokha linapeza kuti kuyenda kwa magazi ndi kugwiritsa ntchito okosijeni zinatsika, osati kukwera.

Zotsatira za magwiridwe a kuganiza mwa anthu zimene zili ndi umboni wolimba zimachokera ku opaleshoni, kumene mlingo woperekedwa mumtsempha wa magazi kwa odwala okalamba unachepetsa pafupifupi ndi theka kuchuluka kwa kusokonezeka kwa maganizo pambuyo pa opaleshoni m'mayesero atatu ndi kuwunika kophatikiza. Izi ndi zotsatira zenizeni zokhudza odwala amene akudwala kwambiri panthawiyo, ndipo kuwunika kwakukulu kwambiri kodziyimira pawokha kwa kuteteza ku kusokonezeka kwa maganizo sikunasankhe mankhwalawa kukhala apadera. Ndi zonena zochepa kwambiri kuposa zimene akugulitsa, ndipo malo ake ndi kuchipatala.

Mapu a njira zogwirira ntchito m'maselo amafotokoza zimene mankhwalawa amachita m'mitundu yoyesera ya labotale, kuwunika kwa umboni wa ADHD kumatsata funso la kuika maganizo mwa anthu amene apezeka ndi vutoli, ndipo laibulale ya kafukufuku imalemba maphunziro amene ali maziko a chilichonse chonenedwa patsamba lino.