So wo mmerɛbo da asiane mu? Biribiara a ɛfa mmerɛbo mu akisikuru ho wɔ nsɛm a ɛnyɛ den mu

Mmɛn yɛ akwaa a ɛho hia paa wɔ yɛn nipadua mu, ɛnte saa? Ɛte sɛ adwumayɛbea ketewaa bi wɔ yɛn nipadua mu. Nanso saa mmerɛbo yi nso tumi nya nyarewa. Ɛtɔ da bi a woate nsɛm te sɛ "mmerɛboɔ no yɛ den", "mmerɛboɔ no asɛe". Wɔfrɛ tebea a emu yɛ den a ɛte saa no biako sɛ mmerɛbo mu yare. Momma yɛnka eyi ho asɛm nkɔ akyiri kakra nnɛ, efisɛ ɛho hia yiye sɛ yehu eyi.

Momma yenni kan nhwɛ nea mmerɛbo mu akisikuru yɛ.

Sɛ yɛbɛka no tiawa a, mmerɛbo mu yare yɛ tebea a mmerɛbo no asɛe bere tenten na wɔde akuru ntini asi mmerɛbo mu nkwammoaa a ɛte apɔw ananmu . Sɛnea akuru ba yɛn honam ani bere a yɛwɔ kuru no, sɛ ɔfe kɔ so wɔ mmerɛbo no mu, anaa nea yɛfrɛ no hepatitis , saa akuru yi ba bere a mmerɛbo no bɔ mmɔden sɛ ɛbɛsa ne ho no. Nanso sɛ saa akuru yi boaboa ano a, mmerɛbo no ntumi nyɛ adwuma yiye. Eyi ne ade a etwa to a mmerɛbo no di huammɔ nkakrankakra ( mrɛbo no di huammɔ a enni sabea ).

So akisikuru no fã ahorow wɔ hɔ?

Yiw, cirrhosis nyɛ biribi a ɛba mpofirim. Ɛkɔ so nkakrankakra, bere kɔ so no.

• Mfiase (Compensated Cirrhosis): Saa bere yi de, wo mmerɛbo dwumadi so tew kakra, nanso wo nipadua no yɛ nsakrae ma ɛne no hyia, enti ebia worenhu sɛnkyerɛnne titiriw biara. Ebia worenhu mpo.
• Akyiri yi fã (Decompensated Cirrhosis): .Bere a mmerɛbo no sɛe kɛse no, mmerɛbo no dwumadi so tew kɛse. Ɛno ne bere a wufi ase hu sɛnkyerɛnne ahorow a emu da hɔ. Eyi yɛ aniberesɛm kɛse kakra.

Dɛn na ɛba mmerɛbo ne nipadua no so esiane akisikuru nti?

Saa akuru a ɛwɔ mmerɛbo no mu yi siw mogya ne mframa pa a ɛsen fa mmerɛbo no mu no kwan. Dɛn na ɛba saa bere no?

• Tumi a mmerɛbo no tumi tew mogya no ho, yɛ aduannuru ho adwuma, na ɛsepa awuduru no so tew.
• Bile ne mogya mu protein ahorow a ɛho hia a mmerɛbo no yɛ no so tew.
• Saa akuru yi tumi mia mogya ntini a ɛwɔ mmerɛbo no mu no. Titiriw bere a wɔahyɛ ntini a ɛho hia te sɛ portal vein system no mu den a, tebea bi a wɔfrɛ no portal hypertension betumi aba. Eyi nso yɛ nea efi cirrhosis mu ba a anibere wom.

Cirrhosis abu so dɛn?

Cirrhosis yɛ yare a abu so kakra. Wobu no sɛ ade titiriw a ɛde ayaresabea ne owu ba, titiriw wɔ mfinimfini mfe akyi. Nea enti a ɛte saa ne sɛ ɛrenya nkɔanim ntɛmntɛm. Sɛ nhwɛso no, wɔ United States no, wɔka sɛ mpanyimfo bɛyɛ 0.25% ne mpanyimfo a wɔadi fi mfe 45 kosi 54 bɛyɛ 0.50% wɔ akisikuru. Wontumi mmu tebea yi adewa wɔ Sri Lanka. Cirrhosis yɛ akwahosan ho haw kɛse wɔ wiase nyinaa.

Dɛn ne mmerɛbo mu yare a ɛma obi ho kyere no ho sɛnkyerɛnne?

Cirrhosis ho sɛnkyerɛnne gyina sɛnea yare no mu yɛ den so. Wɔ mfiase no, ebia yare no ho sɛnkyerɛnne biara nni hɔ koraa. Anaasɛ ebia sɛnkyerɛnne kakraa bi pɛ na ɛwɔ hɔ a emu nna hɔ a ɛte sɛ nyarewa afoforo. Nsɛnkyerɛnne no da adi kɛse bere a mmerɛbo no dwumadi so tew no. Sɛ nhwɛso no, sɛnkyerɛnne ahorow bi wɔ hɔ a ɛda adi bere a bile nsen yiye na ɛboaboa ano wɔ nipadua no afã afoforo no.

Dɛn ne sɛnkyerɛnne a edi kan a ɛkyerɛ sɛ obi anya akisikuru?

Wɔ mfiase no, ebia wubehu sɛnkyerɛnne ahorow te sɛ:

• Akisikuru anaasɛ aduan ho akɔnnɔ a ɛyera .
• Ɔbrɛ , ɔbrɛ.
• Malaise yɛ nkate a ɛkɔ so wɔ ɔkwan a ɛkɔ akyiri so sɛ ne ho nyɛ no dɛ.
• Ɛyaw a ɛba yafunu no atifi, titiriw wɔ nifa so.
• Spider angiomas yɛ mogya ntini a ɛte sɛ akɔre ntaban a ɛwɔ honam ani.
• Nsateaa a ɛyɛ kɔkɔɔ (palmar erythema).

Dɛn ne sɛnkyerɛnne ahorow a ɛwɔ hɔ bere a yare no kɔ so no?

Wobetumi akyekyɛ sɛnkyerɛnne ahorow a ɛda adi bere a cirrhosis kɔ so no mu abien: sɛnkyerɛnne ahorow a efi mmerɛbo no dwumadi a ɛso tew mu ba ne sɛnkyerɛnne ahorow a efi portal hypertension mu ba.

Nsɛnkyerɛnne a efi mmerɛbo no dwumadi a ɛso tew mu ba:

• Wɔfrɛ honam ani hwɛbea ne aniwa a ɛyɛ kɔkɔɔ no jaundice.
• Wora a ɛyɛ wo yaw (Pruritus) (a ɛnyɛ akisikuru a emu da hɔ).
• Nsu a ɛyɛ tumm ne nsu a ɛyɛ hare.
• Nnuan a wɔyam, titiriw wɔ nnuan a srade wom ho.
• Srade nketenkete kɔkɔɔ a ɛwɔ honam ani anaa aniwa so a ɛda adi.
• Mu duru a ɛso tew a wontumi nkyerɛkyerɛ mu ne ntini a wɔsɛe no.
• Nkɛntɛnso a ɛwɔ amemene no dwumadi so (Hepatic Encephalopathy) – te sɛ nkae a ɛyera, adwene mu naayɛ, ne adwene mu nsakrae.
• Motor dysfunction – twitwiw, wosow.
• Nneɛma a ɛnkɔ so pɛpɛɛpɛ wɔ mmea brayɛ mu.
• Nufu a ɛyɛ kɛse ne mmadwoa a ɛtwetwe wɔ mmarima mu.

Nsɛnkyerɛnne a Portal Hypertension de ba:

• Yafunu a ɛho ayɛ kurukuruwa, nsu a ɛtwetwe (ascites).
• Nsa, nan, nan ne/anaasɛ anim a ɛho ahonhon (edema).
• Mogya a ɛbɛtɔ ne akuru a ɛnyɛ den (coagulopathy).
• Mogya a wɔfe anaa mogya a wɔde fa nsu mu.
• Nsu a ɛba no so tew (ebia efi asaabo a entumi nyɛ adwuma yiye bere tenten).
• Ɔhome a ɛyɛ den (ebia efi ɔhome a entumi nyɛ adwuma yiye a enni sabea).

Dɛn na ɛde mmerɛbo mu yare ba?

Cirrhosis yɛ tebea a ɛma mmerɛbo no mu akuru nkakrankakra a ɔfe a enni sabea de ba. Yare biara a ɛma mmerɛbo mu hyew bere tenten (mrɛbo mu yare a enni sabea) betumi ama obi anya mmerɛbo mu yare. Nneɛma atitiriw a ɛde ba no bi ne:

• Hepatitis a nsa de ba: Mmerɛbo a ɛsɛe esiane nsa a wɔnom boro so bere tenten nti. Ɛwom sɛ nsa na ɛtaa ma obi nya akisikuru de, nanso nneɛma pii wɔ hɔ a ɛnyɛ nsa.
• Non-alcoholic steatohepatitis (NASH): Ɔsɛe a enni sabea a srade a ɛboro so wɔ mmerɛbo no mu de ba . Nneɛma a ɛma nipadua no yɛ adwuma te sɛ srade a ɛdɔɔso wɔ mogya mu, asikre a ɛdɔɔso wɔ mogya mu (te sɛ asikreyare), ne mogya mmoroso na ɛde ba.
• Hepatitis C a enni sabea: Hepatitis C yɛ ɔyare mmoawa a efi ɔyare mmoawa mu. Wɔ nnipa pii fam no, ɛbɛyɛ tebea a enni sabea. Mprempren wobetumi de nnuru a ekum ɔyare mmoawa asa. Nanso nnipa pii nnim sɛ wɔwɔ bi.
• Hepatitis B a enni sabea: Hepatitis B nso yɛ ɔyare mmoawa. Wɔ nnipa kakraa bi mu no, ebetumi abɛyɛ nea enni sabea. Sɛ saa a, ɛyɛ nkwa nna nyinaa. Ayaresa wɔ hɔ, nanso wontumi nsa koraa.

Nneɛma bi nso wɔ hɔ a enti ɛntaa nsi:

• Autoimmune biliary disease: Nyarewa bi a nipadua no tumi ko tia nyarewa betumi ama mmerɛbo no ayɛ hyew bere tenten. Nhwɛso ahorow bi ne hepatitis a nipadua no tumi ko tia nyarewa, biliary cholangitis titiriw, ne sclerosing cholangitis titiriw.
• Awosu mu nyarewa: Awosu mu nyarewa bi betumi asɛe mmerɛbo denam awuduru a ɛma ɛdɔɔso wɔ mmerɛbo no mu no so. Nhwɛso ahorow bi ne glycogen a wɔkora so yare, cystic fibrosis, ne Wilson yare.
• Hepatitis a awuduru wom: Sɛ obi de ne ho hyɛ nneɛma bi a atwa yɛn ho ahyia mu bere tenten anaasɛ nnuru bi a wɔkɔ so de di dwuma (nnuru a wɔde kum ɛyaw a wɔtɔn mpo) a, ebetumi asɛe mmerɛbo no.
• Koma ne ntini mu yare: Nyarewa a ɛma mogya boaboa ano wɔ mmerɛbo no mu (te sɛ koma a ɛyɛ mmerɛw) anaa nyarewa a ɛmma mogya nkɔ mmerɛbo no mu (te sɛ ischemia a enni sabea) nso betumi asɛe mmerɛbo no.

Hena na ɔwɔ asiane kɛse mu ma tebea yi?

Ebia wobɛkɔ asiane kɛse mu sɛ wubenya mmerɛbo mu yare sɛ:

• Sɛ woadi boro mfe 50 a.
• Sɛ wowɔ abakɔsɛm a ɛfa asanom bebree ho a.
• Sɛ wowɔ hepatitis yare mmoawa a enni sabea a.
• Sɛ wowɔ metabolic syndrome ( i.e., tebea horow te sɛ mu duru boro so, mogya mmoroso, asikre a ɛwɔ mogya mu, ne srade a ɛkɔ soro a wɔaka abom).

Dɛn ne nsɛnnennen a ɛwɔ cirrhosis mu?

Nneɛma bɔne pii wɔ hɔ a cirrhosis ne portal hypertension de ba.

Nsɛnnennen a ɛtaa ba:

• Sɛ obi te nka sɛ ɔyare, ɔbrɛ, na n’adwene mu ayɛ kusuu esiane awuduru a ɛboaboa ano wɔ nipadua no mu nti.
• Nkwammoaa a ɛko tia nyarewa a ɛso tew, akuru a ɛkyɛ.
• Nsu a ɛretu fi mogya ntini mu a ɛho ahonhon.
• Hormone a ɛnkari pɛ ne nea enni mu.
• Nnuan a wɔyam, aduannuru a wɔmfa nni dwuma yiye, ne aduan pa a wonnya nni.
• Amemene no dwumadi mu ɔhaw nketenkete ne ɔhaw ahorow a ɛba wɔ ntini a ɛhwɛ so ho.

Nsɛnnennen a emu yɛ den a ebetumi de nkwa ato asiane mu:

• Yafunu mu nsunsuanso ne yafunu mu mogya a ɛtɔ.
• Mmoawa a ɛma obi nya peritonitis a ɛba ara kwa.
• Asaabo a entumi nyɛ adwuma yiye (Hepatorenal syndrome).
• Ɔhome a entumi nyɛ adwuma yiye (Hepatopulmonary syndrome).
• mmerɛbo a entumi nyɛ adwuma yiye.
• mmerɛbo mu kokoram.

Ɔkwan bɛn so na wohu sɛ mmerɛbo mu yare a ɛma mogya tu?

Oduruyɛfo bi bedi kan ahwɛ wo nipadua mu ahwɛ sɛ ebia wowɔ cirrhosis ho sɛnkyerɛnne bi anaa. Wobebisa wo nsɛm afa bere a wo yare no ho sɛnkyerɛnne no fii ase ne sɛ ebia bere kɔ so no asesa anaa. Wobebisa w’ayaresa ho abakɔsɛm nso, nnuru, nhabannuru, ne nnuru a wode ka aduan ho a wonom, w’aduan, ne w’asetra kwan ho asɛm. Wɔbɛhwehwɛ mmerɛbo mu yare anaa mmerɛbo a asɛe ho sɛnkyerɛnne.

Ɛno ansa na wɔbɛyɛ aduruyɛ mu nhwehwɛmu de ahu sɛ ebia akisikuru wɔ hɔ anaa. Ebia eyinom bi ne:

• Mogya mu nhwehwɛmu:Mmerɛbo dwumadi ho nhwehwɛmu betumi ada mmerɛbo mu yare ne mmerɛbo a entumi nyɛ adwuma yiye ho sɛnkyerɛnne adi. Eyinom susuw nneɛma te sɛ mmerɛbo mu enzymes, protein, ne bilirubin dodow. Mogya mu nhwehwɛmu nso betumi akyerɛ nneɛma te sɛ mogya a ɛtwetwe so tew.
• Mfonini a wɔde yɛ nhwehwɛmu: Nhwehwɛmu te sɛ yafunu mu ultrasound, CT scan, anaa MRI betumi akyerɛ mmerɛbo no kɛse, ne nsusuwii, ne ne tebea. Mfoninitwa sɔhwɛ titiriw bi a wɔfrɛ no elastography betumi asusuw sɛnea mmerɛbo no mu yɛ den anaasɛ ɛyɛ fibrosis.
• Berɛbo mu nipadua mu nhwehwɛmu: Eyi yɛ adeyɛ ketewaa bi. Wogye ntini ketewaa bi fi mmerɛbo no mu na wɔhwehwɛ mu wɔ aduruyɛdan mu. Wɔtaa de ade a ɛwɔ tokuru na fa saa nhwɛsode yi. Ɛwom sɛ ɛnyɛ bere nyinaa na ɛho hia de, nanso nipadua mu nhwehwɛmu betumi aboa ma wɔahu sɛ obi anya akisikuru na ebia wɔahu nea ɛde ba.

So wobetumi adan mmerɛbo mu yare a ɛma mogya tu no anaasɛ wɔasa no yare?

Nanso, wobetumi asiw cirrhosis a ɛkɔ so no ano anaasɛ wobedi so . Egyina nea ɛde yare no bae, sɛnea wobetumi asa no yiye, ne sɛnea woyɛ w’ade yiye wɔ ayaresa ho no so.

Ɔkwan bɛn so na nnuruyɛfo sa akisikuru?

Nea ɛka aduru a wɔde sa cirrhosis ho ne:

• Sɛ ɛbɛyɛ yiye a, di nea ɛde yare no ba no so (tew ɔsɛe no so anaa gyae).
• Nsakrae a ɛnyɛ den wɔ aduan ne asetra mu na ama wɔatew nhyɛso a ɛba mmerɛbo so no so.
• Nsɛnnennen a ɛwɔ cirrhosis mu a wɔbɛhwɛ so anaasɛ wɔbɛhwehwɛ mu .
• Sɛ́ ɔkwan a etwa to no, mmerɛbo a wɔde bɛma obi foforo .

Nea ɛde ba no a wɔbɛsa

Wobetumi de nnuru asa mmerɛbo mu nyarewa bi. Sɛ nhwɛso no, nnuru a ekum ɔyare mmoawa betumi asa hepatitis C a enni sabea, nanso hepatitis B a enni sabea nkutoo na wobetumi adi so (ɛnyɛ nea wɔsa). Corticosteroids ne nnuru a ɛma nipadua no tumi ko tia nyarewa betumi aboa ma wɔadi nyarewa bi a nipadua no tumi ko tia nyarewa no so.

Sɛ nsa anaa awuduru foforo asɛe mmerɛbo no a, ayaresa biako pɛ ne sɛ wubeyi saa awuduru no afi w’asetra mu. Ebia ɛho behia nso sɛ nnipa binom nya nnuru a wɔde di dwuma ɔkwammɔne so ayaresa. Sɛ nneɛma a ɛnyɛ nsa (te sɛ NASH) sɛe mmerɛbo no a, ebetumi aboa.

Aduan ne asetra kwan

Sɛ biribi foforo na ɛde wo mmerɛbo mu yare no ba mpo a, nsa ne nnubɔne a epira mmerɛbo no a wobɛkwati no betumi aboa ma woabɔ wo mmerɛbo ho ban akyɛ. Saa ara na nneɛma a ɛma nipadua no yɛ adwuma no betumi ayɛ saa. Nnuruyɛfo kamfo kyerɛ sɛ obiara a ɔwɔ mmerɛbo mu yare biara nni aduan pa na ɔbɔ mmɔden sɛ obekura ne mu duru a ɛfata mu. Ebia ɛho behia nso sɛ nnipa binom nom nnuru a wɔde ka aduan ho na ama wɔadi aduannuru a wonnya nni ho dwuma.

Nsɛnnennen a ɛba ho ayaresa

Sɛ wo duruyɛfo hu sɛ wowɔ cirrhosis wie a, wɔbɛhwɛ nso sɛ ebia nneɛma bɔne a ɛtaa ba anaa. Portal hypertension ne ɔhaw a ɛtaa ba. Ɛwɔ n’ankasa nsɛnnennen nso, na emu biara hwehwɛ sɛ wɔsa no pɔtee.

Ebia wubehia nneɛma te sɛ:

• Ade ketewaa bi a wɔyɛ de siw ntini bi a mogya retu no ano.
• Mogya a wɔde ma na ama mogya mu nkwammoaa dodow asan aba.
• Asaabo mu nhwehwɛmu.
• Oxygen a wɔde sa yare.
• Paracentesis ne nnuru a ekum ɔyare mmoawa a wɔde yi nsu fi yafunu mu (ascites).
• Nnuru a ɛma obi ho yɛ hyew boa ma wɔtwe awuduru fi aduan no mu na ɛpam.

mmerɛbo mu kokoram

Hepatocellular carcinoma yɛ ɔhaw foforo a asiane wom a ɛba bere a obi anya akisikuru. Ɛnyɛ obiara a ɔwɔ mmerɛbo mu kokoram na obenya mmerɛbo mu kokoram, nanso nnipa pii a wonya mmerɛbo mu kokoram no wɔ mmerɛbo mu kokoram. Sɛ kokoram fi cirrhosis mu ba a, wobetumi de kokoram ayaresa te sɛ mframa a wɔde sa yare anaa nnuru a wɔde sa yare ama. Anaasɛ, ebia wo duruyɛfo besi gyinae sɛ mmerɛbo a wɔde bɛma obi foforo ne ɔkwan a eye sen biara.

Mmɛn a Wɔde Si Asema Mu

Nnuruyɛfo kamfo kyerɛ sɛ wɔmfa mmerɛbo foforo nsi hɔ bere a wosusuw sɛ w’akwahosan bɛsɛe bere a wɔannye wo mmerɛbo foforo no. Eyi betumi aba saa sɛ wowɔ mmerɛbo mu yare a ɛyɛ nnam, wowɔ mmerɛbo mu kokoram, ne/anaasɛ wonyɛ wo mmerɛbo mu yare no ayaresa ho biribi a. Sɛ wofata sɛ wɔma wo mmerɛbo foforo a, wɔde wo bɛto ɔman no mu nnipa a wɔtwɛn no mu.

So wobetumi asiw cirrhosis ano?

Mpɛn pii no wobetumi asiw mmerɛbo mu yare ano sɛnea ɛbɛyɛ a ɛbɛkɔ so ayɛ mmerɛbo mu yare denam nea wɔde wɔn ho bɛhyɛ mu ntɛm so . Egyina sɛ ebia wunim ne anammɔn a wubetumi atu de asiw ano so. Esiane sɛ nnipa pii nni yare no ho sɛnkyerɛnne wɔ mfiase nti, wobetumi ahu bere a wɔreyɛ akwahosan ho nhwehwɛmu daa no. Eyi ma wunya hokwan yɛ nsakrae a ɛho hia anaasɛ wufi ase sa yare.

So mmerɛbo no betumi asan ayɛ yiye bere a obi anya mmerɛbo mu yare akyi?

Sɛ wonya nya cirrhosis wie a, wo mmerɛbo no nyɛ yiye. Nanso ɛnyɛ nea ɛyɛ kɛse nso . Sɛ woda so ara wɔ sɛnkyerɛnne ahorow (compensated cirrhosis) a, wubetumi atra hɔ saa bere tiaa bi. Sɛ wubetumi agyae ɔfe a ɛde cirrhosis ba no anaasɛ wobɛtew so a, ebia yare no renkɔ so nkɔ baabi a ɛnyɛ den. Nanso ɛsɛ sɛ wohwɛ wo mmerɛbo so wo nkwa nna nyinaa.

Sɛ obi te akisikuru a ɛma obi ho kyere no a, nkwa nna bɛn na wodi?

Nkwa nna bere a obi te ase a ɔwɔ cirrhosis no gu ahorow gyina nneɛma pii so:

• Yare no mu den (wɔatua ho ka anaasɛ wɔagyae).
• Nsɛnnennen a worehyia no.
• Nkwa a wonya ne ayaresa ahorow a edi mu.
• W’akwahosan nyinaa anaasɛ sɛ ebia wowɔ nyarewa foforo biara.

Nnuruyɛfo de nkontabuo nhyehyɛe te sɛ Child-Turcotte-Pugh (CTP) nhyehyɛe ne Model for End-Stage Liver Disease (MELD) di dwuma de susuw wo tebea no ho na wɔkyerɛ baabi a wowɔ wɔ mmerɛbo a wɔde bɛma obi foforo a wɔretwɛn no mu.

Wɔ ``compensated cirrhosis`` mfiase no, nkwa nna betumi boro mfe 15. Sɛ portal hypertension ba a, ɛtew nkwa nna so esiane asiane a ɛwɔ hɔ sɛ mogya bɛtu obi wɔ ne mu nti. Sɛ wɔkyekyem pɛpɛɛpɛ a, ``decompensated cirrhosis`` nkwa nna bɛyɛ mfe ason. Saa bere yi betumi ayɛ tiaa mpo esiane nyarewa a emu yɛ den a wontumi nsa ne nsɛnnennen afoforo nti. Wɔ nnipa binom fam no, ebetumi adi mfe abien. Nanso ɛho hia sɛ yɛkae sɛ saa akontaabu ahorow yi nyɛ pɛ mma obiara.

Mɛyɛ dɛn ahwɛ me ho bere a mete mmerɛbo mu yare a ɛma mogya tu no?

Saa nneɛma yi betumi aboa ma wo mmerɛbo no nkwa nna akyɛ:

• Di nnuan a ahoɔden wom, a ɛyɛ dɛ ne protein a ɛnyɛ den .
• Kwati nsa, tawa, ne nnuru a wɔnom a wonnya nnuruyɛfo afotu sɛnea wubetumi biara.
• Fa nnuru no sɛnea wo duruyɛfo kyerɛ no nkutoo. Wo ne wo duruyɛfo nka nnuru biara a wobɛnom ho asɛm.
• Mma aduruyɛ mu nhwehwɛmu a wɔayɛ ho nhyehyɛe ne nhwehwɛmu a wɔbɛyɛ ahwɛ sɛ ebia nsɛnnennen bi wɔ hɔ no nmpa wo ti so.