Momma yensua ɔhaw ahorow bi a ɛwɔ wo nipadua no ntini nhyehyɛe mu ho ade? - a ɛyɛ Endocrine Neoplasia (MEN) a ɛwɔ nipadua no mu pii .

Yɛn nipadua te sɛ afiri a ɛyɛ nwonwa, ɛnte saa? Sɛ afiri yi bɛyɛ adwuma yiye a, ɛsɛ sɛ ɔfã biara bom yɛ adwuma na ɛyɛ biako yiye. Nhyehyɛe bi a ɛho hia yiye wɔ yɛn nipadua mu, na wɔfrɛ no endocrine system . Ntini a ɛwɔ nhyehyɛe yi mu no yɛ nkwaadɔm a ɛhwɛ yɛn nipadua mu dwumadi pii so. Nanso, ɛtɔ mmere bi a nhyehyɛe yi betumi asɛe. Ɛnnɛ yɛrebɛka tebea bi a ɛntaa nsi nanso ɛho hia yiye a ɛsɛ sɛ yɛma yɛn ani da hɔ ho asɛm. Ɛno ne Multiple Endocrine Neoplasia , a wɔsan frɛ no `(MEN)` tiawa.

Enti dɛn ne saa endocrine nhyehyɛe yi?

Sɛ yɛbɛka no tiawa a, yɛn endocrine nhyehyɛe no yɛ ntini ne akwaa ahorow a ɛwɔ yɛn nipadua mu a ɛyɛ nhama. Eyinom na ɛma wonya nnuru a wɔfrɛ no hormone na ɛma ɛkɔ mogya no mu. Fa saa hormone ahorow yi sɛ abɔfo nketewa a wɔde nkrasɛm kɔ yɛn nipadua mu. Saa nkrasɛm yi kyerɛ yɛn akwaa, honam ani, ne yɛn ntini nea ɛsɛ sɛ yɛyɛ ne bere a ɛsɛ sɛ yɛyɛ.

Ntini ne akwaa atitiriw pii wɔ hɔ a ɛyɛ yɛn endocrine nhyehyɛe no dea:

• Hypothalamus: Eyi wɔ yɛn amemene no ase. Ɛhwɛ nneɛma pii so wɔ endocrine nhyehyɛe no mu.
• Pituitary gland: Saa ntini ketewa yi a ɛne hypothalamus wɔ abusuabɔ no ma nkwaadɔm a ɛhwɛ ntini afoforo pii so, a thyroid gland, adrenal glands, ovaries, ne testicles ka ho.
• Thyroid: Saa ntini a ɛte sɛ ntontom a ɛwɔ kɔn anim yi na ɛhwɛ sɛnea yɛn nipadua no yɛ adwuma, na ɛno ne sɛnea yɛde ahoɔden a efi aduan a yedi mu no di dwuma.
• Parathyroid ntini: Saa ntini nketewa anan yi a mpɛn pii no ɛbɛn thyroid ntini no na ɛhwɛ calcium ne phosphorus dodow a ɛwɔ yɛn nipadua mu no so.
• Adrenal glands: Saa ntini abien yi a ɛwɔ asaabo atifi no na ɛhwɛ nipadua no mu nneɛma a ɛsakra, mogya mmoroso, nna mu nkɔso, ne adwennwen ho mmuae so.
• Pineal gland: Saa gland yi na ɛyɛ hormone melatonin na ɛhwɛ yɛn nna kyinhyia so.
• Pancreas: Ɛha na wɔyɛ insulin. Ɛho hia yiye ma nipadua mu nneɛma a ɛsakra ne asikre a ɛwɔ mogya mu no sohwɛ. Ɛyɛ yɛn aduan mu nneɛma nso fã.
• Ovaries: Ɛha na wɔyɛ mmea nna mu nkwaadɔm a wɔfrɛ no estrogen, progesterone, ne testosterone.
• Testes: Bere a ɛyɛ mmadwoa wɔ mmarima mu no, wɔyɛ hormone testosterone nso wɔ ha.

Enti dɛn ne Multiple Endocrine Neoplasia (MEN)?

Multiple Endocrine Neoplasia (MEN) is a rare genetic condition in which tumors develop in more than one of the glands and tissues of the endocrine system, which we discussed earlier. Ɛtɔ mmere bi a, saa akisikuru yi tumi dan kokoram.

Saa `(MEN)` tebea yi ahorow atitiriw abien na ɛwɔ hɔ:

1. Multiple endocrine neoplasia type 1 (MEN type 1): Eyi yɛ tebea a ɛma akisikuru pii nyin wɔ endocrine nhyehyɛe no ntini ahorow mu. Wɔsan frɛ eyi MEN-1 ne Wermer yare.

2. Multiple endocrine neoplasia type 2 (MEN type 2): Eyi yɛ awosu mu kokoram tebea a ɛka ntini ahorow pii. Nnipa a wɔwɔ MEN2 no nya thyroid kokoram bi a wɔfrɛ no medullary thyroid cancer (MTC) . Asiane kɛse nso wɔ hɔ sɛ wobenya akisikuru wɔ endocrine nhyehyɛe no ntini afoforo mu. Wɔsan frɛ eyi MEN-2 ne Sipple syndrome.

Adɛn nti na saa `(MEN)` tebea yi ba?

Saa `(MEN)` ahorow abien yi nyinaa fi nsakrae a ɛba yɛn awosu mu nkwaadɔm mu , kyerɛ sɛ, nkwaadɔm mu nsakrae . Fa no sɛ yɛn nipadua no wɔ biribi te sɛ akwankyerɛ nhoma, kyerɛ sɛ, awosu mu nkwaadɔm. Sɛ nkyerɛwde biako mpo a ɛwɔ akwankyerɛ nhoma yi mu no yɛ mfomso, kyerɛ sɛ, sɛ wɔsakra awosu mu abɔde bi a, nipadua no dwumadi ahorow bi betumi asɛe.

• (MEN type 1) no fi nkwaadɔm mu nsakrae a ɛba `MEN1` awosu mu abɔde mu . Saa `MEN1` awosu mu abɔde yi yɛ awosu mu abɔde a esiw akisikuru ano . Ɛne sɛ, awosu mu abɔde a ɛboa ma nkwammoaa mu mpaapaemu na esiw akisikuru ano. Sɛ saa awosu mu abɔde yi anyɛ adwuma yiye a, nkwammoaa bi betumi anyin a wontumi nni so na wɔayɛ akisikuru.
• (MEN type 2) no fi nkwaadɔm mu nsakrae a ɛba `RET` awosu mu abɔde mu . Saa `RET` gene yi yɛ gene a ɛne kokoram nkɔso wɔ abusuabɔ. Sɛ wɔsakra saa awosu mu abɔde yi a, nkwammoaa a ɛwɔ akwaa ne ntini ahorow bi mu no nyin a wontumi nni so na ɛyɛ akisikuru.

Wobetumi anya awosu mu nsakrae yi afi awofo hɔ anaasɛ ebetumi aba kwa bere a awotwaa no nyin no. Sɛ ɔwofoɔ baako wɔ MEN a, ɛbɛyɛ sɛ abofra bɛnya bi.

Momma yensua pii fa `(MEN)` type 1 (`MEN type 1`) ho.

Nnipa a wɔwɔ MEN type 1 no nya akisikuru wɔ endocrine nhyehyɛe no ntini pii mu. Mmeae a ɛtaa ka no ne:

• Parathyroid ntini: Eyi ne nea abu so sen biara.
• Gastroenteropancreatic tract: Eyi kyerɛ sɛ akisikuru betumi ayɛ dwensɔtwaa, yafunu, ne aduan mu nneɛma afoforo te sɛ duodenum.
• Pituitary ntini a ɛwɔ nipadua no mu.

Mpɛn pii no, akuru a ɛba bere a MEN type 1 no ba no nyɛ kokoram (ɛnyɛ bɔne) . Nanso, akuru bi betumi ayɛ kokoram (a ɛyɛ hu).Etumi nso trɛw (metastasize) kɔ nipadua no afã afoforo. Ntini a ɛwɔ akisikuru no taa yi hormone pii kɔ mogya no mu. Eyi na ɛde sɛnkyerɛnne ahorow ne akwahosan ho haw ahorow ba.

Nnuruyɛfo ahu akisikuru ahorow bɛboro 20 a ɛwɔ nipadua no mu ne nea enni nipadua no mu wɔ nnipa a wɔwɔ MEN type 1. Akisikuru ahorow afoforo wɔ hɔ a ɛntaa nsi, te sɛ:

• Neuroendocrine tumors a ɛba wɔ thymus (ntini a ɛwɔ koko mu) ne bronchi (mframa kwan a ɛwɔ ahurututu mu) mu.
• Adrenocortical tumors ba wɔ adrenal ntini no akyi fã no mu.
• Srade a ɛyɛ kurukuruwa (Lipomas) a ɛba honam ani.
• Nufu mu kokoram.
• Akisikuru te sɛ meningiomas ne ependymomas a ebetumi aba amemene anaa akyi berɛmo mu.

Dɛn ne `(MEN type 1)` ho sɛnkyerɛnne?

MEN type 1 ho sɛnkyerɛnne betumi ayɛ soronko kɛse wɔ onipa biara ho. Egyina ntini ahorow a ɛka ne hormone dodow a ɛyɛ so. Ebia nnipa binom rennya yare no ho sɛnkyerɛnne biara koraa, afoforo nso betumi anya yare no ho sɛnkyerɛnne a emu nyɛ den, na ebinom nso betumi anya yare no ho sɛnkyerɛnne a emu yɛ den, a ɛde wɔn nkwa mpo to asiane mu. Nsɛnkyerɛnne no betumi ayɛ soronko wɔ onipa biara mu, mpo wɔ abusua koro mu, mpo wɔ mmanoma ntam.

Momma yɛnhwɛ akisikuru ahorow atitiriw no bi ne ne sɛnkyerɛnne ahorow a ɛbata ho:

• Esiane ɔhaw ahorow a ɛwɔ parathyroid ntini no mu (hyperparathyroidism) nti:

Nnipa a wɔwɔ `(MEN type 1)` no mu 90% nya saa tebea yi bere a wɔadi mfe 50. Wɔ eyi mu no, parathyroid ntini no yɛ adwuma boro so.

• Nsɛnkyerɛnne a emu nyɛ den: nkwaa mu yaw, ntini mu mmerɛwyɛ, ɔbrɛ, adwenemhaw, ɛyɛ den sɛ wode w’adwene besi biribi so, aduan ho akɔnnɔ a ɛyera.
• Nsɛnkyerɛnne a emu yɛ den: akisikuru, ɔfe, adwene a ɛyɛ basaa, werɛ fi, sukɔm dodo ne nsu a ɔtaa to, akisikuru, nnompe mu yaw.

• Esiane akisikuru a ɛwɔ dwensɔtwaa ne dwensɔtwaa ketewa no fã a edi kan (Gastrinomas) nti:

Mpanyimfo a wɔwɔ MEN type 1 no mu bɛyɛ 40% nya akisikuru a wɔfrɛ no gastrinomas. Eyinom ma wonya hormone bi a wɔfrɛ no gastrin, na ɛma yafunu no yɛ acid pii dodo.

• Nsɛnkyerɛnne: Yafunu mu yaw, akisikuru, komayare (acid reflux), yafunu mu akuru (peptic ulcers).
• Akisikuru foforo a wohu wɔ saa kuw yi mu ne insulinoma . Eyi ma insulin ba, na ebetumi ama asikre a ɛwɔ mogya mu no so atew (hypoglycemia).
• Nsɛnkyerɛnne: adwene a ɛyɛ basaa, ahopopo, fifiri, ɔkɔm a ɛboro so, ahomegye a enni mu, koma a ɛbɔ ntɛmntɛm, n’ani a ɛsakra bere tiaa bi.

• Esiane akisikuru a ɛwɔ pituitary (prolactinomas) nti:

Nnipa a wɔwɔ MEN type 1 no mu bɛyɛ 25% nya pituitary tumors. Nea ɛtaa ba ne prolactinomas a ɛma hormone prolactin .

• Nsɛnkyerɛnne a ɛwɔ mmea mu: brayɛ a ɛnkɔ so pɛpɛɛpɛ anaasɛ brayɛ a wogyae (amenorrhea), ɛyɛ den sɛ wobenyinsɛn mmofra, nufusu a efi nufusu mu bere a wonnyinsɛn anaasɛ wɔmma nufu (galactorrhea), nna ho akɔnnɔ a ɛso tew.
• Nsɛnkyerɛnne a ɛwɔ mmarima mu: Ɔbarima ne ɔbea nna ho akɔnnɔ a ɛso tew esiane testosterone dodow a ɛso tew, ɔbarima ne ɔbea nna a ɛnyɛ den (ED), ne mmofra a ɛyɛ den sɛ wobenyinsɛn nti.
• Sɛ akuru no yɛ kɛse a: tiyɛ, akisikuru/fefe, anisoadehu sesa (anisoadehu mmɔho abien, afã a wohu no so tew).

Nea ɛho hia: Ɛnyɛ obiara na obenya yare no ho sɛnkyerɛnne koro. Saa nsɛm a wɔahyehyɛ yi nyɛ nea edi mũ. Nkuruwankuruwa afoforo pii wɔ hɔ a ebetumi aba wɔ MEN type 1 mu.

Momma yɛnsua `(MEN)` type 2 (`MEN type 2`) nso ho ade.

Obiara a ɔwɔ MEN type 2 no nya thyroid kokoram bi a wɔfrɛ no medullary thyroid cancer (MTC) . Saa kokoram yi ba wɔ nkwammoaa soronko bi a ɛwɔ thyroid ntini no mu a wɔfrɛ no C nkwammoaa mu. Saa nkwammoaa yi yɛ hormone bi a wɔfrɛ no calcitonin. MTC betumi atrɛw akɔ ntini a ɛma mogya tu ne akwaa afoforo mu. Ayaresa titiriw ne oprehyɛn a wɔde yi thyroid ntini no (thyroidectomy).

Afei nso, nnipa a wɔwɔ `(MEN type 2)` betumi anya tebea horow a edidi so yi mu biako anaa abien no nyinaa:

• Pheochromocytoma: Eyi yɛ akisikuru a ɛntaa nsi a ɛba wɔ adrenal glands biako anaa abien no nyinaa mfinimfini (adrenal medulla). Mpɛn pii no, eyinom nyɛ kokoram. Bɛyɛ 10%-15% betumi abɛyɛ kokoram na atrɛw.
• Hyperparathyroidism: Mogya mu calcium dodow kɔ soro esiane parathyroid hormone (PTH) a parathyroid ntini no yɛ dodo nti.

Dɛn ne `(MEN type 2)` ho sɛnkyerɛnne?

Nsɛnkyerɛnne a ɛwɔ ha nso yɛ soronko. Mpɛn pii no, hormone ahorow a kokoram (MTC) ne akisikuru binom de ba a ɛdɔɔso na ɛde yare no ho sɛnkyerɛnne ahorow ba.

• Nsɛnkyerɛnne a ɛkyerɛ sɛ obi anya kokoram a ɛwɔ medullary thyroid (MTC):
• Akuru a ɛwɔ kɔn anim, kɔn mu yaw, nne a ɛsakra (ɛyɛ den), ɔfe, ɛyɛ den sɛ ɔbɛmene, ɛyɛ den sɛ ɔbɛhome.

• Nsɛnkyerɛnne a Pheochromocytoma de ba: (ɛba wɔ bɛyɛ 50% mu) .
• Bere a saa akisikuru yi ma nkwaadɔm te sɛ adrenaline dɔɔso dodo nkutoo na ɛkyerɛ yare no. Akisikuru bi ntumi nnya hormone na ebia ɛrenna sɛnkyerɛnne biara adi.
• Nsɛnkyerɛnne a ɛtaa ba (a ɛtaa ba na ɛkɔ wɔ akɔmfosɛm mu): mogya mmoroso (hypertension), tiyɛ, fifiri a ɛboro so a ntease biara nnim, koma a ɛbɔ ntɛmntɛm anaasɛ ɛnteɛ, wosow.

• Nsɛnkyerɛnne a efi hyperparathyroidism mu ba:
• Sɛnea ɛte wɔ `(MEN type 1)` mu no, sɛnkyerɛnne ahorow te sɛ nkwaa mu yaw, ntini mu mmerɛwyɛ, ɔbrɛ, adwenemhaw, ɛyɛ den sɛ wode w’adwene besi biribi so, aduan ho akɔnnɔ a ɛyera, akisikuru, ɔfe, sukɔm a ɛdɔɔso ne nsu a wɔtaa tow, akisikuru, ne nnompe mu yaw betumi aba.

Hena na obetumi anya saa `(MEN)` tebea yi? Ɛtaa ba dɛn?

Tebea `(MEN)` betumi aka mmarima ne mmea nyinaa pɛpɛɛpɛ. Mfeɛ a tebea `(MEN type 1)` da adi no gu ahodoɔ kɛseɛ. Wɔahu sɛ ɛwɔ mmofra a wɔadi mfe 8 pɛ ne mpanyimfo a wɔadi mfe 80 mu.

`(MEN)` yɛ tebea a ɛntaa nsi .

• `(MEN type 1)` ka nnipa bɛyɛ 30,000 biara mu biako.
• `(MEN type 2)` ka nnipa bɛyɛ 35,000 biara mu biako.

Nhwehwɛmufo binom gye di sɛ ebia nnipa dodow ankasa a wɔwɔ saa tebea horow yi bɛdɔɔso esiane sɛ wɔanhu yare no yiye anaasɛ wɔanhu wɔn yiye nti.

Ɔkwan bɛn so na nnuruyɛfo hu tebea no `(MEN)`? (Nyare a Wɔahu) .

Tebea `(MEN)` a wobehu no betumi ayɛ den kakra, efisɛ ɛka ntini ahorow.

• `(MEN type 1)` ho nkyerɛkyerɛmu:

Wɔtaa hu sɛ obi anya MEN type 1 sɛ anyɛ yiye koraa no ɔwɔ endocrine akisikuru atitiriw abiɛsa a yɛaka ho asɛm wɔ atifi hɔ no mu abien (parathyroid akisikuru, pituitary akisikuru, ne/anaasɛ yafunu mu akisikuru), anaasɛ sɛ ɔwɔ saa akisikuru no mu biako na abusua muni bi wɔ MEN type 1 a.

• Sɔhwɛ ahorow:
• Mogya mu nhwehwɛmu: Hwɛ sɛ hormone ahorow bi (e.g. parathyroid hormone (PTH), calcium) dɔɔso anaa.
• Mfoniniyɛ mu sɔhwɛ ahorow: Eyinom betumi aboa ma wɔahu mmeae a akuru wɔ, te sɛ CT scan (computed tomography scan) anaa MRI (magnetic resonance imaging scan).
• Awosu mu nhwehwɛmu: Ɛhwɛ sɛ nsakrae bi aba `MEN1` awosu mu abɔde mu.

• `(MEN type 2)` ho nkyerɛkyerɛmu:

Sɛ obi wɔ MEN type 2 sɛ ɔwɔ medullary thyroid cancer (MTC) a pheochromocytoma ne/anaasɛ hyperplasia anaa adenoma a ɛwɔ parathyroid ntini mu ka ho a.

• Sɔhwɛ ahorow:
• Mogya mu nhwehwɛmu: Hwɛ sɛnea hormone dodow te sɛ calcitonin (ma MTC), parathyroid hormone (PTH), ne catecholamines (ma pheochromocytoma).
• Mfoniniyɛ nhwehwɛmu: Wɔde `CT scan` anaa `MRI scan` na edi dwuma.
• Awosu mu nhwehwɛmu: Ɛhwɛ sɛ nsakrae bi aba `RET` awosu mu abɔde mu.

Dɛn ne ayaresa a wɔde ma `(MEN)`?

MEN ayaresa gyina endocrine ntini ne akwaa ahorow a ɛka no so koraa. Mpɛn pii no, ɛfa nnuruyɛfo kuw a wɔyɛ adwuma ahorow pii, a wɔn a wɔyɛ endocrinologists , oprehyɛn ho animdefo , ne oncologists ka ho.

Ebia ayaresa ahorow pii wɔ hɔ a wobetumi apaw:

• Nnuru: Di yare no ho sɛnkyerɛnne so na tew nkɛntɛnso a nkwaadɔm a ɛboro so de ba no so.
• Oprehyɛn: Yi akisikuru no anaa ntini a ɛka no nyinaa (e.g., thyroid ntini no).
• Hormone replacement therapy: Sɛ wɔyɛ oprehyɛn yi endocrine gland bi a, wɔde hormone a ɛde ba no kɔ abɔnten.
• Kokoram ayaresa: Sɛ kokoram no atrɛw akɔ mmeae afoforo (a ɛkɔ mmeae afoforo) a, ayaresa te sɛ nnuru a wɔde sa yare ne mframa a wɔde sa yare .

Esiane sɛ `(MEN)` ɔyarefo biara yɛ soronko nti, ayaresa nhyehyɛe a ɛyɛ adwuma ma obiara no yɛ soronko. Nsuro sɛ wo ne wo duruyɛfo bɛkasa afa ayaresa a eye ma wo ho.

So wobetumi asa `(MEN)` yare koraa? So wobetumi asiw ano?

Awerɛhosɛm ne sɛ, mprempren aduru biara nni hɔ a wɔde sa tebea `(MEN)` no. Nanso, wobetumi adi ho dwuma . Nnuruyɛfo de oprehyɛn anaa nnuru sa nsakrae a ɛba ntini biara mu no sɛnea ɛfata saa bere no.

Ɛntumi nsiw `(MEN)` nkɔsoɔ ano, ɛfiri sɛ awosuo mu nsakraeɛ na ɛde ba. Wobetumi anya awosu mu nsakrae yi afi awofo hɔ anaasɛ ɛba kwa wɔ awotwaa no mu.

Nanso, sɛ wɔahu sɛ abusua muni bi a ɔbɛn no (ɔwofo, onua) anya MEN a, ɛho hia sɛ wo ne wo duruyɛfo kasa fa awosu mu nhwehwɛmu a wɔyɛ ma MEN ho. Saa a wobɛyɛ no betumi aboa ma woahu akisikuru ntɛm sɛ wowɔ tebea no a.

Sɛ wo ne `(MEN)` te a, dɛn na ɛba? (Nkɔmhyɛ) .

Nkɔmhyɛ a ɛfa MEN ho no gyina nneɛma pii so:

• Sɛnea wohuu `(MEN)` ntɛmntɛm.
• Endocrine glands bɛn na ɛka?
• Sɛ́ ebia akisikuru no yɛ kokoram anaasɛ ɛnte saa.
• Ayaresa ko a wɔde di dwuma.
• Sɛ́ ebia kokoram akisikuru atrɛw akɔ nipadua no afã afoforo (a akɔ mmeae afoforo) na wɔfrɛ no.

Sɛ wɔahu sɛ wowɔ MEN a, wo duruyɛfo betumi ama wo adwene a eye sen biara wɔ w’ayaresa ne ɔkwan a wobɛfa so akɔ w’anim no ho.

Bere a ɛsɛ sɛ wokɔ oduruyɛfo nkyɛn ne nsɛm a ɛho hia a ɛsɛ sɛ wobisa

Sɛ wɔahu sɛ wowɔ MEN a, ɛho behia sɛ wokɔ wo duruyɛfo nkyɛn daa na wahwɛ wo tebea no na wahwɛ ahu sɛ w’ayaresa no reyɛ adwuma yiye.

Afei nso, sɛ abusua muni bi a ɔbɛn w’abusua mu bi wɔ `(MEN)` a, wo ne wo duruyɛfo nkasa mfa awosu mu nhwehwɛmu ho, sɛnea yɛadi kan aka no.

Sɛ wowɔ `(MEN)` a, ebetumi aboa sɛ wubebisa wo duruyɛfo nsɛm te sɛ eyinom:

• `(MEN)` bɛn na mewɔ?
• Ɔkwan bɛn so na (MMAN) ka me nipadua?
• Nsɛnkyerɛnne bɛn na ɛsɛ sɛ mehwɛ yiye?
• Ayaresa ahorow bɛn na mewɔ?
• Dɛn ne mfaso ne ɔhaw ahorow a ɛwɔ akwan horow a wɔfa so sa yare no so?
• Bere tenten ahe na egye ansa na ayaresa no ayɛ yiye?
• So ɛsɛ sɛ wɔsɔ m’abusua mufo a aka no hwɛ sɛ ebia (MEN) anaa?

Nea etwa to no, nneɛma a ɛsɛ sɛ wokae (Take-Home Message) .

Multiple endocrine neoplasia (MEN) yɛ tebea a ɛntaa nsi. Afei nso, esiane sɛ MEN tumi de sɛnkyerɛnne ahorow pii ba na ɛnyɛ obiara tebea yɛ pɛ nti, ɛtɔ mmere bi a ebetumi ayɛ den sɛ wubehu sɛ wowɔ bi anaa.

Sɛ wunya sɛnkyerɛnne foforo biara a ɛhaw wo, anaasɛ wuhu nsakrae bi wɔ wo nipadua mu a, ade a eye sen biara a ɛsɛ sɛ woyɛ ne sɛ wobɛkɔ oduruyɛfo nkyɛn.

Ɛwom sɛ `(MEN)` nsɛm bi ba kwa de, nanso ebetumi atu mmirika wɔ mmusua mu nso. Sɛ w'abusuafoɔ a wɔbɛn wo no mu baako wɔ `(MEN)` a, ɛho hia paa sɛ wobɛyɛ awosuo mu nhwehwɛmu de ahunu sɛ wowɔ asiane mu anaa. Wo ne wo duruyɛfoɔ nkasa fa nsɛmmisa biara a wowɔ fa asiane a ɛwɔ hɔ sɛ wobɛnya `(MEN)` ho. Wɔwɔ hɔ sɛ wɔbɛboa wo. Nsuro, nsuro, na nsuro sɛ wobɛbisa nsɛm.

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