Kurapa, Zvinokonzera, Kuongororwa, uye Kusarudza Kwemhuri
Chikoro chekutanga chisina kukwana (POI) ndicho chikonzero chinokonzera kusakwana kwevakadzi . Izvo zvinozivikanwa sekukundikana kwemaawa masikati, vakadzi vane POI havaiti nguva dzose uye havagoni kubata nemazai avo. Kubudirira kunobatsira kurapa kurapa ndeye IVF neii kana mubereki wemukomana.
Vakadzi vane POI vanoona zviratidzo zvekuchipatara uye dzimwe nguva zviratidzo zvekuenda kumwedzi vasati vava nemakore makumi mana.
(Avhareji yemakore ekupera kwemwedzi iri pakati pe 48 ne55.) Chirwere ichi chinogonawo kutumidzwa se hypergonadotropic hypogonadism (HH) kana kuti primary hypogonadism.
POI haisi kuenda kumwedzi. Kunyange zvazvo chirwere chacho chaimbove chinonziwo "nguva isati yasvika," zita iri harina kururama.
Vakadzi avo vakayambuka kunonoka havakwanisi kuwana nguva, havagoni kuvhara, uye havagone kutora mazai avo.
Vakadzi vane POI vanogona kuvhara uye dzimwe nguva vanogona kudzoka nguva yekuenda kumwedzi (kunyange makore mushure mekuongororwa). Uyezve, kubata nemazai avo pachavo hazvibviri zvachose. (Zvimwe pamusoro apa iri pasi apa.)
Chirongwa chekutanga chekuvhara mahara hachisi chikonzero chinowanzokonzera kusava nekushaya simba, asi hachisi chakanaka kana. Ngozi yekuongororwa inowedzera nezera:
- 1 mu1000 vakadzi vane makore 15 kusvika ku29 vanorwara vane POI
- 1 muna 250 kuvakadzi vane makore 30 kusvika ku35
- 1 mu100 kune vakadzi vane makore 35 kusvika ku40
Kuwana kuongororwa kwekutanga kwekuvhara mavari kunogona kuparadza.
Apo chiremba wako achikuudza kuti matambudziko ako ekuva nemwana ane ruzivo rwakafanana newe haunzwisisike, iwe unganzwa uchinetseka, wakatsamwa, uye wakasuruvara zvikuru. Iwe unogona kunzwa uchinzwa uye usisina tariro. Pakutanga, unganzwa uchinetseka kana uchinetseka.
Aya ndiwo manzwiro anowanzofanira kuva nawo .
Kana iwe wakagamuchira ichi kuongororwa, tapota svika kune rubatsiro.
A
Taura nachiremba wako, chiremba anozivikanwa nehutachiona , uye, kana zvichibvira, boka rekubatsira kusakwanisa, saka unogona kushungurudzika uye kunyatsoongorora zvaunogona kuita.
Ne nguva yekuporesa, zvinokwanisika kuva noupenyu hwakazara uye hunofadza nehukuru hwekuvhara mavari.
Sei Zvakaoma Kuziva Nekutanga Ovarian Kusakwana?
Mavhai emukadzi mukuru akwegura ane makumi ezviuru zve follicles . Mune follicle imwe neimwe ingangove yai . Chero bedzi chikamu chezana che follicles iyi ichagara ichikura, ichizadza, uye inogona kuva mubereki.
Zvakasikwa uye zvakajairika kuti follicles dzideredze nenguva.
Muchikamu, mwana ane utano akaberekwa anoberekwa nemaawa anopfuura mamiriyoni. Asi panguva yaanosvika pakuyaruka, achange ava pasi kusvika 300 000 chete.
Zvinowanzoitawo kuti mapurisa apedze kurega kupindura zvinobudirira kune mahomoni anokonzera mazai ekukura uye ovulation. Ichi ndicho chinokonzera kusununguka kwezera , uye nei vakadzi vane makore makumi mana nemasere vasingakwanisi kubata pamuviri kupfuura mukadzi wemakore makumi matatu.
Zvisinei, kuvakadzi vane hutano husina kukwana, mavhavhao avo haashandi sezvinodiwa.
Mazai mazai angave ane mashoma mashoma kupfuura izvo zvingatarisirwa kumudzimai wavo.
Vanorral follicle count (nzira yekuenzanisa nhamba yakazara yeiyo yakawanikwa follicles mu mavha mavari) ichave yakaderera.
Uyewo, mazai avo uye mapirlicles haazopindure zvakakwana kumahomoni anorehwa kukurudzira kusveta kweii nekuvhunga. Mavhaiyo anogonawo kukundikana kubudisa maitiro akaenzana eesrogen.
Ichi ndicho chikonzero kubereka zvinodhaka hazvisi izvo zvinobudirira kuvakadzi vane POI.
Kuita zvinodhaka zvinongoshanda chete kana pane zvikwata zvakakwana zvemukati maevoes kuti zvikurudzirwe uye kana iyo follicles inopindura kana ichinge yakasvikiswa mavhomoni anowedzera.
MuPPOI, follicles "haigoni" kana kuti kwete kunyatsopindura mishonga yekubereka.
Clomid kana gonadotropin zvinowanzokundikana kukurudzira mazai ehutano kukura kana kuvhuvhuta.
Kunyange kana zvingakonzera kuvhara mazai, mazai angave akaipa. Izvi zvinokonzera kubereka nekuita pamuviri zvishoma.
Zviratidzo zveNheyo yeOvarian Insufficiency
Chirwere chekutanga chisina kukwana inoratidzira chirwere. Zvimwe zviitiko zvePPI zvakanyanya kudarika vamwe.
Izvi zvinorevawo kuti vakadzi vachave nezviratidzo zvakasiyana-siyana zvezviratidzo.
Chiratidzo chinowanzovhiringidza nguva dzisiri. Vakadzi vane POI vanogona
- Usava nenguva (amenorrhea)
- Iva nenguva dzinouya nguva dzose (kupfuura mazuva makumi matatu nerimwe)
- Iva nemisi inouya isiri yakasiyana (inopesana nemamwe mazuva mashomanana kubva pamwedzi kusvika pamwedzi)
- Iva nemwedzi usina kukodzera kubuda kumwedzi (kunyanya kupenya nguva kana kuonekwa)
Izvi zvinogonawo kuti mukadzi ane POI aende asina nguva yekuenda kumwedzi kwemakore, uye pakarepo anotanga kuenda kumwedzi zvakare.
Vamwe, asi kwete vose, vakadzi vane POI vanoona zviratidzo kubva pasi maestrogen mazinga. Zviratidzo izvi zvinogona kuva nguva dzose kana kuuya uye kuenda.
Zviratidzo izvi zvinogona kusanganisira:
- Zvinorwadza zvepabonde
- Vaginal dryness
- Low libido
- Kupisa kunopisa uye / kana usiku kunopika
- Kunyunyuta kana kuoma kurara
- Kuora mwoyo uye / kana kuzvidya mwoyo
Kana iwe uine maitiro asina kukwana, asi hauna zviratidzo zvepasi zveestrogen, zvinoreva here kuti hauna POI?
Kwete hazvo.
Pakati pe50 ne75 muzana yevakadzi vane POI vachatsvaira uye vasunungure estrogen dzimwe nguva.
(Izvi zvakasiyana nemudzimai akapfuura nepamuviri chaiyo.Kubva kwekupera kwemwedzi, ovulation uye pre-menopause levels estrogen hazviitiki zvachose.)
Zvisinei, usati washushikana, pane dzakawanda zvinokonzera kukanganisa kana kusipo .
Pasi pe10 muzana yevakadzi vane kuzora vachaonekwa kuti vane POI.
Zvimwe zvikonzero zvinowanzoitika zvekuvhiringidza kusina kuvhara zvinosanganisira polycystic ovarian syndrome (PCOS) , hyperprolactinemia, uye kuberekwa kwehupenzi hunobata .
Kuedza Kunobereka uye Kuita Kuongororwa Kwepamuviri Ovarian Kusakwana
Kuongororwa kwekutanga kwemaawa ovarian kusakwana hakugoni kuitwa pazviratidzo chete.
Pane zvimwe zvinokonzera kusagadzikana maitiro uye pasi maitiro eestrogen, kunze kwekutanga kwekuvhara maitiro.
Chiremba wako anogona kuraira zviyero zvinotevera asati aongororwa:
- Chirwere chepamuviri (kusimbisa izvi hachisi chikonzero nguva dzako dzamira)
- FSH mazinga (achange ari pakugumira mumiriri nePPI)
- Estradiol (estrogen) mazinga (kazhinji anowanikwa pasi nevakadzi vane POI, asi kwete nguva dzose)
- AMH (kuongororongedza maitiro evanhu vakawanda)
- Prolactin (kutonga kunze hyperprolactinemia)
- Antral follicle count (an ultrasound, uyewo kuongorora ovarian reserves)
- Clomid dambudziko test (kuti uone kuti mavhai ako anopindura sei pamishonga yekubereka)
Kana maFSH ako akasiyana nekusingaperi uye mune menopausal range, chiremba wako angangodzokorora kuedza kwe mwedzi gare gare kuti asimbise.
Kana zviitiko zvikadzoka, uye iwe uri nemakore makumi mana kana anoduku, chiremba wako anogona kukufungidzira iwe nePPI.
Chii Chinokonzera Kukura KwemaOvarian Kusakwana?
Kune vazhinji vevakadzi vane POI, hazvingazivikanwe chii chakaita kuti chirwere chacho chivepo.
Chirwere chekutanga chekuvhara mahara chinosanganiswa nehuwandu hwezvirwere zvekudzivirira muviri, kusanganisira dry-eye syndrome, rheumatoid arthritis, uye lupus. Zvisinei, iyo yakabatana sei haisi pachena.
Zvimwe zviitiko zvePPO zvinokonzerwa nekuchinja kwemajini. Kusuruvara-X uye Turner syndrome kunogona kukonzera POI.
Kunyange zvakadaro, kutsvakurudza kwemashoko matsva kwakawana kuti vazhinji vanenge makumi maviri kusvika ku25 kubva muzana emhosva dzePPI vanogona kukonzerwa nemararamiro (zvinosanganisira Fragile-X uye Turner syndrome.)
Ichi chichiri muzvikamu zvekutanga zvekutsvakurudza, saka kuongorora kwakajeka kwakanyanya kusati kwawanikwa. Mune ramangwana, zvisinei, kuongororwa kwemazwi kunogona kukwanisa kuwedzera avo vari pangozi.
Zvichigoverwa kuti zvinokonzerwa nehutano, hazvishamisi kuti nhoroondo yemhuri yekutanga yekuvhara mavari inowanikwa mu10 kusvika ku15 muzana yematambudziko.
Hazvizivikanwe kana vakadzi vane hutachiwana hwekutanga hunozvarwa vasina mazai mashoma kana kana kubereka kwavo kuchikwira nokukurumidza.
Kunyanya kusagadzikana kwemaawa kunogona kukonzerwa nemishonga.
Mimwe mishonga yekenza, kusanganisira chemotherapy, radiation, uye chirwere, inogona kutungamirira ku POI.
Kunyanya kusagadzikana kwemavariya inoitika nguva pfupi mushure mekurapa inozivikanwa sekukundikana kwemaovarian.
Zvakakosha kuziva kuti kuderedza kubereka shure kwekurapa kenza hakusi nguva dzose. Zvingave kuti kubereka kwako kuchadzoka zvishoma kana zvizere kuchaenderana nezera rako pawakagamuchira kurapwa kwekenza uye mishonga yekenza yakashandiswa sei.
Kana iwe wakabatwa nechirwere chekenza, uye iwe usati watanga kenza mishonga, taura nachiremba wako nezvekuchengetedza kubereka kwako. Inogona kuve yakakonzera kusunungura mazai ako kana mavari mavara .
Kuchengetwa kwehutano hweChe Primary Ovarian Kusakwana
Iyo yakanakisisa uye inongowanikwa chete yekurapa kusarudzwa kwevakadzi vane hutachiona hwekutanga husingawaniki ndeye IVF neii kana mubereki wemukomana.
Kana kuwedzera ku POI pane uterine zvinetso, mumwe munhu anokwanisa kudiwawo kutakura pamuviri. Asi izvi hazvisi zvisizvo.
Evha kana mubereki wemukomana angangodaro anove anozivikanwa anopa-shamwari kana nhengo yemhuri-asi kazhinji, mupiro haazivi. Kereke yako yekubereka inogona kukubatsira kuti uwane mazai evha, kana iwe unogona kushanda nebhenji rezai kana sangano.
Anopa mucheche angave akarongeka kuburikidza nekliniki yako yekubereka kana sangano.
Iva nehanya zvikuru nekutengeserana kwepaIndaneti uye unopa mazai evha kana embryo. Kune vanhu kunze uko vanotarisa kuvanetsa vabereki pasina mari yavo.
IVF ine maii evha inobudirira kwazvo. Chaizvoizvo, mazai evha IVF ane zvakanakisisa zvakakosha yehutano hwehutano hwe IVF .
Chimwe chidzidzo chakawana kuti vakadzi vakagumisa katatu IVF mavheekiti nemazai emapairo vaiva nemikana ye90 muzana yekubata kubudirira.
Mari inokanganisa chikuru kune egg donor IVF.
Imwe mutsva inopa egg donor cycle inogona kuva pakati pe $ 25,000 kusvika 35,000. Paunofunga kuti iwe unoda kuita maitiro akawanda, mari inogona kukurumidza kukura.
Kushandisa mazai akaomeswa kubva kubhangi rezhi kunogona kunge zvishoma kudhura, sezvinokwanisa "kugoverana" mazai evha nemumwe murume nemudzimai. Imwe nzira yekuderedza mari ndeyekuziva-mupi, semu shamwari kana nhengo yemhuri.
Zvisinei, kutenderera kunogona kunge kuchiri mu $ 15,000 kusvika ku20,000.
Embryo donor IVF haina kunyanya kudhura, uye kunyange inodhura kudarika IVF yakawanda.
Maererano neRIVOLVE, mavhareji embryo vanoendesa muchechi yekubereka inodhura pakati pe $ 2 500 ne4000.
Zvisinei, mari iyo haisanganisi mutemo uye inoda kurapwa kwepfungwa. Mari iyo inogona kunge iri yakakwirira kana yakarongeka kuburikidza nesangano.
Kubudirira kwehuwandu hwembairo embryo kunosiyana zvikuru. Ichabva pane kliniki yekubereka, mamiriro ekuberekwa kwemurume nemudzimai avo vakapa mazamu, uye chero zvipi zveuviri zvinogona kunge zviri kutamba iwe.
Kuita sarudzo yekushandisa mazai kana mubereki wemukomana kunogona kuva nemweya uye kwakaoma. Kubvuma iwe unogona kunge usingakwanise kuva nevana rinogona kukuvadza.
Kusarudza mucheche wemubereki kunoreva kuti iwe nemumwe wako hamuzovi nehutano hwemwana. Nekupa mazai, iwe pachaga hauzove wakabatana nehutano.
Kupa mazano nemumwe muongorori ane ruzivo rwekubereka hakusi kungokurudzirwa chete asiwo inotarisirwa nekliniki zhinji vasati vatanga kutapwa.
Ndinokwanisa Kuwana Mucheche Maiki Angu? Ndichati Ndida Kushandisa Egg Donor?
Vakadzi vakapfuura nemukenza mutsva vangakwanisa kushandisa mazai avo kana mazai kana vakatora matanho ekuchengetedza kubereka kwavo vasati vatapwa. Izvozvo zvingave zvakasanganisira mazai evha (vitrification) , mavhiri echinhu chinopisa, kana embryo cryopreservation.
Uyezve, vamwe vakadzi vanoona maPI mushure mekurapa kwekenza vanogona kunge vane ovarian basa kudzoka.
Kana uri kuedza kubata pamuviri mushure mekenza, taura nachiremba wako pamusoro pezvaunogona kuita.
Kana iwe usati wapinda kuburikidza nekuberekwa kwekuberekwa usati watanga kuziva, kubata nemazai ako pachako hazvigoneki.
Zvisinei, hazvibviri.
Kutsvakurudza kwakawana kuti 5 kusvika ku10 muzana yevakadzi vanoonekwa kuti vane hutano husina kukwana hunoenda pakuva nemimba, dzimwe nguva pakarepo.
Izvi zvinogona kuitika kana pasina mishonga inobereka. Inoratidzikawo kuti inowanzoonekwa kune vakadzi vanotambira hormone therapy (inoreva kutarisa zviratidzo zvepasi-estrogen zvePPI.)
Vamwe vakadzi vanopinda mukuregererwa kwenguva pfupi uye vanogona kunge vane mazai avo anotanga kushanda zvakare. Vanogona kunge vane nguva yekuenda kumwedzi vachidzoka mushure memakore emakore asina kukwana kana kusipo.
Hazvanzwisisikwi nei vamwe vakadzi vachienda mukuregererwa kana kuti vachifungidzira uye vamwe havaiti.
Chiremba wako haakwanisi kufanotaura kana izvi zvichange zviri mamiriro ako. Kana iwe uchida chaizvo kuva nemwana, uchifunga kuti iwe uchawira muhope 5 kusvika ku10 muboka haisi chirongwa chakanaka.
Kune uchapupu hwekuti vamwe vakadzi vane POI vanogona kukwezva uye kuvata pamuviri nemazai avo pachavo kana vakagamuchira isrogen therapy mushure mekushandisa kushandiswa kwemishonga yekushandisa.
Kutsvakurudza pamusoro penzira iyi-estrogen therapy inoteverwa nemishonga ne gonadotropins-iyo yakawana migumisiro yakavhenganiswa.
Kunyange zvazvo zvidzidzo zvishomanana zvakawana kubudirira, vamwe havana.
Ramba uchifunga kuti kubudirira kwemitambo yemishonga inobereka, IUI , kana IVF ne mazai ako pachako akaderera zvikuru.
Zvichipa mari yekurapa, pamwe nekushungurudzika kwepfungwa dzisingabatsiri kutora mishonga yokurapa, kufamba zvakananga kune IVF nevana vanozvipa kana mazai angave akachenjera kupfuura ose.
Zvechokwadi, tora pfungwa yechipiri. Usapinda zvakananga kuVIV neine mazai evha pasina kubvunza kune vanopfuura chiremba.
Zvisinei, iwewo hausi kuda kuparadza mari nemafungiro emweya pane kurapwa kusingaiti kubudirira.
Cherechedza: kana iwe usingadi kutora pamuviri, uye iwe une POI, iwe haufaniri kuvimba nemaitiro ekuzvidzivirira kuberekwa nguva dzose (kana kushaya chirwere chekuberekwa) nokuda kwekubata pamuviri. Kurapa kwepamuviri mapiritsi hauna kuongororwa kuvakadzi vane chirwere ichi.
Vakadzi vane POI vakave nemimba pamuviri wemishonga yekuberekwa uye pamishonga yehomoni.
Kana iwe uchida kudzivisa kubata pamuviri, nzira yekudzivirira kana chipiniti chinogona kunge chiri nani.
Zvimwe Zvimwe Zvingasarudzwa kunze kweHertility Treatment
Kunyange zvazvo IVF ine mazai kana mubereki ari mucheche inogona kunge yakakosha yekurapa kusarudzwa, haisi iwe chete wekuvakwa kwemhuri.
Vamwe vakaroorana vanosarudza kutsvaga kuberekwa kana kuberekera vana. Vanogona kufunga nezvekugadziriswa kubva pakutanga, kana kuti kuenda kumagamuchirwe kana kurapa kuchikundikana.
- 15 Nzira Dzokuita Kusiyanisa Muhupenyu hweMwana
- 8 Zvikonzero Zvisingateereri Kubereka Kurapa kana IVF
Kusarudza hupenyu husina hanya nevana ndiyo imwe nzira.
Mupi wezano anogona kukubatsira kuti uone zvose zvaunosarudza, saka iwe unogona kuita chisarudzo chine ruzivo.
Zvimwe (Kwete-Fertility) Kuedzwa Pashure pekuongororwa kwePPI
POI inosanganiswa nemamwe matambudziko ehutano. Nokuda kwechikonzero ichi, chiremba wako anogona kuraira zvakare kuedza, kusanganisira:
Kuyera kwepfupa test : Lowestrogen levels inokuisa pangozi ye osteoporosis. Utachiona hweHormone, kudya kwakagadzikana, uye kuyerwa kuita basa kunogona kuderedza ngozi yako.
Karyotype uye genetic test : Zvimwe zviitiko zvePPI zvinokonzerwa nekuchinja kwemagetsi. Vamwe vakadzi vanogona kunge vane X-chromosome imwe chete pane mbiri.
Kuongorora maitiro evanhu vanogona kuongororawo FMR1, iyo inobatanidza neFragile X syndrome uye POI.
Utachiona hweHyroid : Vakadzi vane POI vari panjodzi yekusawirirana kwekemikari. Ichokwadi, pakati pe14 ne27 muzana yevakadzi vane POI vachavawo nehotera yakadzika.
Cortisol yepamusoro kana corticotropin (ACTH) kukurudzira kuedza : Vakadzi vane POI vari pangozi yezvinetso zvegrenal gland.
Kutsvakurudza kwakawana kuti vanenge 3 muzana yevakadzi vane hutano husina kukwana hunova nechirwere cheAdisonison.
Kuongororwa kwekuzvidzivirira : Kusvikira 20 kubva muzana yevakadzi vane POI vachawana dzimwe zvirwere zvekudzivirira zvirwere.
Vakadzi vane hutano husina kukwana hunoita kuti vanhu vakawanda vave nezvinetso zvehutano zvezvehutano, asi hazvipi zvaunotarisana nazvo.
Sezvo nguva dzose, taura nechiremba wako kana une mibvunzo kana zvinetso.
Utano Hwepanyama uye Hwepfungwa Pashure pekuongororwa kwePPI
Vakadzi vane pasi vaserojeni mazinga vari pangozi yakakura yepfungwa yemwoyo, zvinetso zvepabonde ( kusanganisira kurara kunotambudza ), uye osteoporosis.
Chimwe chinogona kurapwa chiremba wako angakurudzira kuti ihomoni inotsiva-shandiswa. Kazhinji kusanganiswa kweesrogen uye progesterone, izvi zvinogona kubvisa zvimwe zvezviratidzo zvako uye zvinogona kuderedza ngozi yako ye osteoporosis.
Utachiona hweHormone hunogonawo kubatsira nemoto unopisa uye mafungiro akaderera anoshamwaridzana nechepasi isrogen.
Mishonga inongowanzoenderera mberi kusvikira pavhareji yemakore ekuguma kwemwedzi, apo zvingave zvakajairika kuva nesorogen yakaderera.
- Estrogen Therapy ye "Kutanga Kuenda Kwokutanga"
Sezvakaitwa nemishonga yose, kune njodzi dzinogona kuitika uye dzinobatsira.
Hapana anonyatsoziva kuti njodzi dzenguva refu ndeipi yekurapa kwehomoni (kana kusaita hutachiona kurapwa) mune vakadzi vane POI.
Kurukurai nzira dzenyu dzekurapa nechiremba wenyu.
Vakadzi vane nheyo yepamusoro yevarivha inogonawo kuora mwoyo uye / kana kushungurudzika .
Ichi chikamu pamusana pezvikamu zvepasi zvinonzi estrogen, asi zvakare, kuongororwa uye kukonzera kusununguka kunogonawo kukonzera kushungurudzika mupfungwa . Kana pane dambudziko remadonal kana kuti thyroid, izvi zvinogona kukonzera kuora mwoyo.
Kurayira kwakakurudzirwa zvikuru. Imwe nyanzvi yekurapa, kunyanya inozivikanwa nehuperetility, inogona kukubatsira kuti utsungirire chirwere ichi uye uite zvisarudzo zvakajeka pamusoro pekugadzirisa kwemhuri yako sarudzo.
Anopesana nechisimba anogonawo kubatsira. Usafungidzira kuti haugoni kutora imwe kana uri kuedza kubata pamuviri. Ichi ndicho chinhu chaunokurukura nachiremba wako wekubereka, chiremba wekubatsira vana, uye mutungamiri.
> Sources:
> Embryo Donation: Myth and Facts. BATSIRA: National Infertility Association. Yakasvika musi waJuly 27, 2016.
> Nelson, Lawrence M. Clinical Zviratidzo uye Kuongorora kweSpontaneous Primary Ovarian Insufficiency (Kutadza kusati kwasvika Ovarian). UptoDate.com.
> Nelson, Lawrence M; Calis, Karim Anton. "Kutungamira kweSpanish Primary Ovarian Insufficiency (Kusapera kweOvarian kusati yasvika). "UptoDate.com.
> Nelson LM. Primary Primary Ovarian Insufficiency. The New England Journal of Medicine. 2009; 360 (6): 606-614. doi: 10.1056 / NEJMcp0808697.
> Qin Y1, Jiao X1, Simpson JL2, Chen ZJ3. "Genetics of Primary Ovarian Insufficiency: Nyaya Dzakakurumbira uye Mikana." Hum Kudzorerwa . 2015-Nov-Dec; 21 (6): 787-808. doi: 10.1093 / humupd / dmv036. Epub 2015 Aug 4.