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Secondary Polycythemia: Momma yensua nea ɛde ba, nea ɛkyerɛ, ne ayaresa ho ade wɔ nsɛm a ɛnyɛ den mu

Secondary Polycythemia: Momma yensua nea ɛde ba, nea ɛkyerɛ, ne ayaresa ho ade wɔ nsɛm a ɛnyɛ den mu

So ɛtɔ mmere bi a wote nka sɛ woabrɛ paa, wo ho kyere wo , na w’ani so yɛ kusuu kakra? Ɛwom sɛ yesusuw sɛ eyinom yɛ nneɛma a ɛfata de, nanso ɛtɔ mmere bi a nea enti a ɛte saa no betumi ayɛ mogya a aboaboa ano wɔ yɛn nipadua mu. Wɔfrɛ eyi Secondary Polycythemia wɔ aduruyɛ ho nyansahu mu. Mma nnsuro bere a wote saa din yi, eyi yɛ tebea a ɛntaa nsi kakra. Sɛ yɛbɛka no tiawa a, eyi kyerɛ sɛ wo nipadua no ma mogya mu nkwammoaa kɔkɔɔ pii sen sɛnea ɛsɛ sɛ ɛyɛ . Enti momma yɛnka eyi ho asɛm nkɔ akyiri, tiawa koraa.

Dɛn nti na mogya yɛ den saa? Dɛn ne nea enti a ɛte saa?

Asɛmfua "secondary" kyerɛ "nea ɛto so abien." Enti wɔde saa din no nso to saa yare yi efisɛ ɛnyɛ biribi a ɛba tẽẽ, na mmom efi aduruyɛ mu tebea foforo anaa nea ɛde ba .

Susuw ho saa kwan yi so, mogya mu nkwammoaa kɔkɔɔ de mframa pa kɔ yɛn nipadua mu ntini ahorow mu. Sɛ biribi nti amemene anaa asaabo no nya sɛnkyerɛnne bi sɛ nipadua no nnya mframa pa a ɛdɔɔso a, asaabo no yɛ hormone bi a wɔfrɛ no `Erythropoietin` anaa ` EPO` . Saa `EPO` hormone yi kɔ yɛn nnompe mu ntini mu na ɛka kyerɛ no sɛ "ɔnyɛ mogya mu nkwammoaa kɔkɔɔ pii, nipadua no nnya oxygen a ɛdɔɔso." Enti nnompe mu ntini no fi ase yɛ mogya mu nkwammoaa kɔkɔɔ foforo. Sɛ mogya mu nkwammoaa kɔkɔɔ dodow kɔ soro wɔ saa kwan yi so a, mogya no mu yɛ den nkakrankakra. Saa mogya a ayɛ den yi yɛ den sɛ ɛbɛfa mogya ntini nketenkete (`capillaries`) a ɛwɔ yɛn nipadua mu no mu. Ɛno nti na asiane a ɛwɔ tebea horow a emu yɛ den te sɛ ` stroke` mu no kɔ soro no.

Afei ma yɛnhwɛ nea enti titiriw a enti ɛte saa.

Ntease type Nhwɛso ahorow
Nneɛma a ɛde ba a ɛfa asetra kwan ho
  • Sigaretnom
  • Ɔhome a ɛyɛ den bere a wɔada esiane kɛseyɛ mmoroso nti (Obesity hypoventilation syndrome) .
  • Sɛ wɔtra mmeae a ɛkorɔn
  • Nnuru bi a wɔde yɛ nipadua a ɛyɛ den (EPO, Testosterone) ., Nnuru a wɔde yɛ anabolic) .
Ɔhome nhyehyɛe mu nyarewa
  • Ahomegye ne nna mu ahomegye (Obstructive sleep apnea) .
  • Ahurututu mu yare a enni sabea (COPD) .
  • Carbon monoxide awuduru a enni sabea
  • Ayaresa mu tebea afoforo
  • Asaabo mu yare anaa asaabo mu akisikuru
  • Akuru bi a ɛba amemene, mmerɛbo, anaa awotwaa mu
  • Komayare a enni sabea
  • Nnuru bi a wɔde yi nsu fi nipadua mu a wɔde di dwuma
  • Nsonsonoe bɛn na ɛda Primary ne Secondary Polycythemia ntam?

    Ebia woate `Primary Polycythemia` ho asɛm nso. Ɛwom sɛ saa abien yi te sɛ nea ɛte saa de, nanso nsonsonoe kɛse da abien no ntam.

    Sɛ yɛbɛka no tiawa a, yɛn nnompe mu ntini te sɛ adwumayɛbea bi a wɔyɛ mogya mu nkwammoaa.

    • Primary Polycythemia: Eyi ne bere a adwumayɛbea no ankasa (nnompe mu ntini) no ankasa yɛ mogya mu nkwammoaa kɔkɔɔ pii dodo, a abɔnten so sɛnkyerɛnne biara nni mu. Eyi taa fi awosu mu nsakrae (`mutation`).
    • Secondary Polycythemia: Ɛha yi, adwumayɛbea (nnompe mu ntini) reyɛ adwuma yiye. Nanso, esiane nsɛnkyerɛnne a ɛnteɛ anaasɛ ɛho nhia a efi abɔnten (e.g., efi asaabo mu) a ɛka kyerɛ no sɛ "ɔnyɛ pii" nti, ɛma mogya mu nkwammoaa kɔkɔɔ pii dodo.

    Sɛnea ɛbɛyɛ na wɔahu nsonsonoe a ɛda abien no ntam no, nnuruyɛfo sɔ awosu mu abɔde bi a wɔfrɛ no `JAK2` hwɛ. Nnipa pii a wɔwɔ `Primary Polycythemia` yɛ `positive` nhwehwɛmu wɔ saa gene yi ho. Nanso, eyi nsi wɔ `Secondary Polycythemia` mu.

    Dɛn ne tebea yi ho sɛnkyerɛnne?

    Mogya a ɛtwetwe no ho sɛnkyerɛnne betumi ayɛ soronko wɔ onipa biara ho. Ebia nnipa binom rennya yare no ho sɛnkyerɛnne biara koraa. Nanso, eyinom ne sɛnkyerɛnne ahorow a ɛtaa ba.

    • Ɔbrɛ
    • Tipaeɛ
    • Adwene a ɛyɛ basaa
    • Anisoadehu a ɛyɛ kusuu
    • Anorexia a ɛma obi nya aduan
    • Mmerewa a ɛba nipadua no mu
    • Adwene mu adwene a wɔde si biribi so a ɛso tew

    Nea ɛho hia no, ɛnyɛ mogya a ɛtɔ nkutoo na ɛde saa sɛnkyerɛnne ahorow yi ba. Nsɛnkyerɛnne afoforo (ɔfe, ahome a ɛyɛ tiaa) nso betumi aba esiane nea ɛde ba nti (e.g., ahurututu mu yare).

    Sɛ nhwɛso no, sɛ nea ɛde ba ne `Sleep Apnea` a, wubetumi anya nna a ɛboro so awiabere na woabɔ ahurututu anadwo.

    Wobɛyɛ dɛn ahu eyi, Oduruyɛfo?

    Sɛ woka saa sɛnkyerɛnne ahorow yi kyerɛ wo duruyɛfo a, ade a edi kan a ɔbɛyɛ ne sɛ obebisa wo w’ayaresa ho abakɔsɛm nyinaa ho asɛm. Ɛne sɛ, sɛ wonom sigaret a, so wo mu duru so atew nnansa yi, so woafe, wo moma so ayɛ wo den, ɛyɛ den sɛ wobɛhome, anaasɛ woafe anadwo . Obebisa nso sɛ ebia obi wɔ w’abusua mu anya saa tebea horow yi anaa.

    Afei, wɔyɛ nipadua mu nhwehwɛmu na sɛ ɛho hia a, wɔkamfo kyerɛ sɛ wɔnyɛ nhwehwɛmu pii te sɛ:

    • Mogya mu nhwehwɛmu: Hwɛ mogya mu nkwammoaa kɔkɔɔ dodow, EPO hormone dodow, ne mogya mu oxygen dodow (wobetumi de Arterial Blood Gas - ABG ayɛ eyi).
    • ECG (Electrocardiogram): Hwɛ sɛnea koma no yɛ adwuma.
    • Mfoniniyɛ mu Nhwehwɛmu: Koko mu X-ray, CT scan, anaa ultrasound scan betumi ahwɛ sɛ koma, mmerɛbo, anaa akyi berɛmo mu ahonhon anaa.

    Ɛnam nhwehwɛmu ahorow yi so na oduruyɛfo no hu nea ɛde tebea yi ba ankasa.

    Dɛn ne ayaresa ahorow a wɔde sa eyi?

    Nea eye sen biara wɔ eyi ho ne sɛ wobetumi asa polycythemia a ɛto so abien denam tebea a ɛde mogya no yɛɛ kɛse a wobehu na wɔasa so .

    Botae titiriw a ɛwɔ ayaresa mu ne sɛ wobeyi nea ɛde mogya no ba no afi hɔ.

    • Nea ɛde ba no ntini a wɔsa:
    • Sɛ woyɛ obi a ɔnom sigaret a: Ɛho hia sɛ wugyae sigaretnom. Oduruyɛfo no de afotu ne nnuru a ɛho hia bɛma wɔ eyi ho.
    • Sɛ efi kɛseyɛ mmoroso a: Wɔbɛtu wo fo sɛ sesa w’asetra kwan, teɛteɛ w’apɔw mu, na wo mu duru so tew.
    • Sɛ wowɔ ahurututu mu yare te sɛ COPD a: Oxygen a ɛmma mframa nkɔ fam no betumi aboa ma oxygen dodow asan aba nipadua no mu.
    • Sɛ efi akisikuru a: Wobetumi asa tebea yi koraa denam oprehyɛn a wɔde beyi akisikuru no so.
    • Ayaresa a wɔde ma yare no ho sɛnkyerɛnne ahorow no so tew:
    • Phlebotomy: Eyi te sɛ mogya a wɔde ma no. Woyi mogya bɛyɛ pint fã anaa pint biako fi ntini bi mu, na ɛma mogya mu nkwammoaa kɔkɔɔ dodow so tew na ɛma mogya no yɛ teateaa. Eyi ma wonya ahotɔ ntɛmntɛm fi sɛnkyerɛnne ahorow te sɛ tiyɛ ne adwenemhaw ho.
    • Nnuru: Ebia wo duruyɛfo bɛkyerɛw nnuru te sɛ aspirin na ama ɛyaw no so atew, ne nnuru a ekum histamine ama sɛnkyerɛnne ahorow te sɛ ɛyaw.

    Ɛyɛ abasamtu sɛ wubehu tebea foforo ho ade bere a woredi biako ho dwuma no. Nanso kae sɛ, tebea horow a ɛde `Secondary Polycythemia` ba no mu dodow no ara yɛ nea wonim no yiye na ɛwɔ ayaresa ahorow bi. Enti, sɛ wɔsa nea ɛde ba no yiye a, mpɛn pii no, tebea yi rennya wo nkwa nna so nkɛntɛnso.

    Nkrasɛm a Wɔde Kɔ Fie

    • Secondary polycythemia yɛ bere a nipadua no mogya mu nkwammoaa kɔkɔɔ no dɔɔso na mogya no yɛ kɛse esiane aduruyɛ tebea foforo nti.
    • Eyi nyɛ hwee sɛ nnompe mu ntini mu sintɔ.
    • Sigaretnom, kɛseyɛ mmoroso, ahurututu mu yare, ne komayare yɛ nneɛma atitiriw a ɛde eyi ba no bi.
    • Botae titiriw a ɛwɔ ayaresa mu ne sɛ wɔbɛsa tebea a ɛda adi a ɛma mogya no yɛɛ den no.
    • Sɛ wowɔ sɛnkyerɛnne ahorow te sɛ ɔbrɛ a ɛkɔ so, tiyɛ, anaa adwenemhaw a, hwɛ hu sɛ wo ne wo duruyɛfo bɛkasa afa ho.

    Mogya a ɛtwetwe, Secondary Polycythemia, Mogya mu nkwammoaa kɔkɔɔ, Erythropoietin, COPD, Mogya a ɛtwetwe, Nsɛnkyerɛnne
    ⚠️ Important: The medical articles and information on Nirogi Lanka are for general awareness only, and are by no means a substitute for professional medical advice, diagnosis, or treatment. For any medical problem you have, consult a qualified physician immediately.

    💬 Comments (0)

    Wɔnnya nyɛɛ nsɛm biara. Fa wo nsɛm no ka ho wɔ ha nea edi kan.

    Fa wo nsɛm no ka ho

    Yɛsrɛ wo bu akontaa: 9 + 1 =
    Secondary Polycythemia: Momma yensua nea ɛde ba, nea ɛkyerɛ, ne ayaresa ho ade wɔ nsɛm a ɛnyɛ den mu
    Mpopoeɛ9, Obubuo, 2025

    Secondary Polycythemia: Momma yensua nea ɛde ba, nea ɛkyerɛ, ne ayaresa ho ade wɔ nsɛm a ɛnyɛ den mu

    So ɛtɔ mmere bi a wote nka sɛ woabrɛ paa, wo ho kyere wo , na w’ani so yɛ kusuu kakra? Ɛwom sɛ yesusuw sɛ eyinom yɛ nneɛma a ɛfata de, nanso ɛtɔ mmere bi a nea enti a ɛte saa no betumi ayɛ mogya a aboaboa ano wɔ yɛn nipadua mu. Wɔfrɛ eyi Secondary Polycythemia wɔ aduruyɛ ho nyansahu mu. Mma nnsuro bere a wote saa din yi, eyi yɛ tebea a ɛntaa nsi kakra. Sɛ yɛbɛka no tiawa a, eyi kyerɛ sɛ wo nipadua no ma mogya mu nkwammoaa kɔkɔɔ pii sen sɛnea ɛsɛ sɛ ɛyɛ . Enti momma yɛnka eyi ho asɛm nkɔ akyiri, tiawa koraa.

    Dɛn nti na mogya yɛ den saa? Dɛn ne nea enti a ɛte saa?

    Asɛmfua "secondary" kyerɛ "nea ɛto so abien." Enti wɔde saa din no nso to saa yare yi efisɛ ɛnyɛ biribi a ɛba tẽẽ, na mmom efi aduruyɛ mu tebea foforo anaa nea ɛde ba .

    Susuw ho saa kwan yi so, mogya mu nkwammoaa kɔkɔɔ de mframa pa kɔ yɛn nipadua mu ntini ahorow mu. Sɛ biribi nti amemene anaa asaabo no nya sɛnkyerɛnne bi sɛ nipadua no nnya mframa pa a ɛdɔɔso a, asaabo no yɛ hormone bi a wɔfrɛ no `Erythropoietin` anaa ` EPO` . Saa `EPO` hormone yi kɔ yɛn nnompe mu ntini mu na ɛka kyerɛ no sɛ "ɔnyɛ mogya mu nkwammoaa kɔkɔɔ pii, nipadua no nnya oxygen a ɛdɔɔso." Enti nnompe mu ntini no fi ase yɛ mogya mu nkwammoaa kɔkɔɔ foforo. Sɛ mogya mu nkwammoaa kɔkɔɔ dodow kɔ soro wɔ saa kwan yi so a, mogya no mu yɛ den nkakrankakra. Saa mogya a ayɛ den yi yɛ den sɛ ɛbɛfa mogya ntini nketenkete (`capillaries`) a ɛwɔ yɛn nipadua mu no mu. Ɛno nti na asiane a ɛwɔ tebea horow a emu yɛ den te sɛ ` stroke` mu no kɔ soro no.

    Afei ma yɛnhwɛ nea enti titiriw a enti ɛte saa.

    Ntease type Nhwɛso ahorow
    Nneɛma a ɛde ba a ɛfa asetra kwan ho
    • Sigaretnom
    • Ɔhome a ɛyɛ den bere a wɔada esiane kɛseyɛ mmoroso nti (Obesity hypoventilation syndrome) .
    • Sɛ wɔtra mmeae a ɛkorɔn
    • Nnuru bi a wɔde yɛ nipadua a ɛyɛ den (EPO, Testosterone) ., Nnuru a wɔde yɛ anabolic) .
    Ɔhome nhyehyɛe mu nyarewa
  • Ahomegye ne nna mu ahomegye (Obstructive sleep apnea) .
  • Ahurututu mu yare a enni sabea (COPD) .
  • Carbon monoxide awuduru a enni sabea
  • Ayaresa mu tebea afoforo
  • Asaabo mu yare anaa asaabo mu akisikuru
  • Akuru bi a ɛba amemene, mmerɛbo, anaa awotwaa mu
  • Komayare a enni sabea
  • Nnuru bi a wɔde yi nsu fi nipadua mu a wɔde di dwuma
  • Nsonsonoe bɛn na ɛda Primary ne Secondary Polycythemia ntam?

    Ebia woate `Primary Polycythemia` ho asɛm nso. Ɛwom sɛ saa abien yi te sɛ nea ɛte saa de, nanso nsonsonoe kɛse da abien no ntam.

    Sɛ yɛbɛka no tiawa a, yɛn nnompe mu ntini te sɛ adwumayɛbea bi a wɔyɛ mogya mu nkwammoaa.

    • Primary Polycythemia: Eyi ne bere a adwumayɛbea no ankasa (nnompe mu ntini) no ankasa yɛ mogya mu nkwammoaa kɔkɔɔ pii dodo, a abɔnten so sɛnkyerɛnne biara nni mu. Eyi taa fi awosu mu nsakrae (`mutation`).
    • Secondary Polycythemia: Ɛha yi, adwumayɛbea (nnompe mu ntini) reyɛ adwuma yiye. Nanso, esiane nsɛnkyerɛnne a ɛnteɛ anaasɛ ɛho nhia a efi abɔnten (e.g., efi asaabo mu) a ɛka kyerɛ no sɛ "ɔnyɛ pii" nti, ɛma mogya mu nkwammoaa kɔkɔɔ pii dodo.

    Sɛnea ɛbɛyɛ na wɔahu nsonsonoe a ɛda abien no ntam no, nnuruyɛfo sɔ awosu mu abɔde bi a wɔfrɛ no `JAK2` hwɛ. Nnipa pii a wɔwɔ `Primary Polycythemia` yɛ `positive` nhwehwɛmu wɔ saa gene yi ho. Nanso, eyi nsi wɔ `Secondary Polycythemia` mu.

    Dɛn ne tebea yi ho sɛnkyerɛnne?

    Mogya a ɛtwetwe no ho sɛnkyerɛnne betumi ayɛ soronko wɔ onipa biara ho. Ebia nnipa binom rennya yare no ho sɛnkyerɛnne biara koraa. Nanso, eyinom ne sɛnkyerɛnne ahorow a ɛtaa ba.

    • Ɔbrɛ
    • Tipaeɛ
    • Adwene a ɛyɛ basaa
    • Anisoadehu a ɛyɛ kusuu
    • Anorexia a ɛma obi nya aduan
    • Mmerewa a ɛba nipadua no mu
    • Adwene mu adwene a wɔde si biribi so a ɛso tew

    Nea ɛho hia no, ɛnyɛ mogya a ɛtɔ nkutoo na ɛde saa sɛnkyerɛnne ahorow yi ba. Nsɛnkyerɛnne afoforo (ɔfe, ahome a ɛyɛ tiaa) nso betumi aba esiane nea ɛde ba nti (e.g., ahurututu mu yare).

    Sɛ nhwɛso no, sɛ nea ɛde ba ne `Sleep Apnea` a, wubetumi anya nna a ɛboro so awiabere na woabɔ ahurututu anadwo.

    Wobɛyɛ dɛn ahu eyi, Oduruyɛfo?

    Sɛ woka saa sɛnkyerɛnne ahorow yi kyerɛ wo duruyɛfo a, ade a edi kan a ɔbɛyɛ ne sɛ obebisa wo w’ayaresa ho abakɔsɛm nyinaa ho asɛm. Ɛne sɛ, sɛ wonom sigaret a, so wo mu duru so atew nnansa yi, so woafe, wo moma so ayɛ wo den, ɛyɛ den sɛ wobɛhome, anaasɛ woafe anadwo . Obebisa nso sɛ ebia obi wɔ w’abusua mu anya saa tebea horow yi anaa.

    Afei, wɔyɛ nipadua mu nhwehwɛmu na sɛ ɛho hia a, wɔkamfo kyerɛ sɛ wɔnyɛ nhwehwɛmu pii te sɛ:

    • Mogya mu nhwehwɛmu: Hwɛ mogya mu nkwammoaa kɔkɔɔ dodow, EPO hormone dodow, ne mogya mu oxygen dodow (wobetumi de Arterial Blood Gas - ABG ayɛ eyi).
    • ECG (Electrocardiogram): Hwɛ sɛnea koma no yɛ adwuma.
    • Mfoniniyɛ mu Nhwehwɛmu: Koko mu X-ray, CT scan, anaa ultrasound scan betumi ahwɛ sɛ koma, mmerɛbo, anaa akyi berɛmo mu ahonhon anaa.

    Ɛnam nhwehwɛmu ahorow yi so na oduruyɛfo no hu nea ɛde tebea yi ba ankasa.

    Dɛn ne ayaresa ahorow a wɔde sa eyi?

    Nea eye sen biara wɔ eyi ho ne sɛ wobetumi asa polycythemia a ɛto so abien denam tebea a ɛde mogya no yɛɛ kɛse a wobehu na wɔasa so .

    Botae titiriw a ɛwɔ ayaresa mu ne sɛ wobeyi nea ɛde mogya no ba no afi hɔ.

    • Nea ɛde ba no ntini a wɔsa:
    • Sɛ woyɛ obi a ɔnom sigaret a: Ɛho hia sɛ wugyae sigaretnom. Oduruyɛfo no de afotu ne nnuru a ɛho hia bɛma wɔ eyi ho.
    • Sɛ efi kɛseyɛ mmoroso a: Wɔbɛtu wo fo sɛ sesa w’asetra kwan, teɛteɛ w’apɔw mu, na wo mu duru so tew.
    • Sɛ wowɔ ahurututu mu yare te sɛ COPD a: Oxygen a ɛmma mframa nkɔ fam no betumi aboa ma oxygen dodow asan aba nipadua no mu.
    • Sɛ efi akisikuru a: Wobetumi asa tebea yi koraa denam oprehyɛn a wɔde beyi akisikuru no so.
    • Ayaresa a wɔde ma yare no ho sɛnkyerɛnne ahorow no so tew:
    • Phlebotomy: Eyi te sɛ mogya a wɔde ma no. Woyi mogya bɛyɛ pint fã anaa pint biako fi ntini bi mu, na ɛma mogya mu nkwammoaa kɔkɔɔ dodow so tew na ɛma mogya no yɛ teateaa. Eyi ma wonya ahotɔ ntɛmntɛm fi sɛnkyerɛnne ahorow te sɛ tiyɛ ne adwenemhaw ho.
    • Nnuru: Ebia wo duruyɛfo bɛkyerɛw nnuru te sɛ aspirin na ama ɛyaw no so atew, ne nnuru a ekum histamine ama sɛnkyerɛnne ahorow te sɛ ɛyaw.

    Ɛyɛ abasamtu sɛ wubehu tebea foforo ho ade bere a woredi biako ho dwuma no. Nanso kae sɛ, tebea horow a ɛde `Secondary Polycythemia` ba no mu dodow no ara yɛ nea wonim no yiye na ɛwɔ ayaresa ahorow bi. Enti, sɛ wɔsa nea ɛde ba no yiye a, mpɛn pii no, tebea yi rennya wo nkwa nna so nkɛntɛnso.

    Nkrasɛm a Wɔde Kɔ Fie

    • Secondary polycythemia yɛ bere a nipadua no mogya mu nkwammoaa kɔkɔɔ no dɔɔso na mogya no yɛ kɛse esiane aduruyɛ tebea foforo nti.
    • Eyi nyɛ hwee sɛ nnompe mu ntini mu sintɔ.
    • Sigaretnom, kɛseyɛ mmoroso, ahurututu mu yare, ne komayare yɛ nneɛma atitiriw a ɛde eyi ba no bi.
    • Botae titiriw a ɛwɔ ayaresa mu ne sɛ wɔbɛsa tebea a ɛda adi a ɛma mogya no yɛɛ den no.
    • Sɛ wowɔ sɛnkyerɛnne ahorow te sɛ ɔbrɛ a ɛkɔ so, tiyɛ, anaa adwenemhaw a, hwɛ hu sɛ wo ne wo duruyɛfo bɛkasa afa ho.

    Mogya a ɛtwetwe, Secondary Polycythemia, Mogya mu nkwammoaa kɔkɔɔ, Erythropoietin, COPD, Mogya a ɛtwetwe, Nsɛnkyerɛnne
    ⚠️ Important: The medical articles and information on Nirogi Lanka are for general awareness only, and are by no means a substitute for professional medical advice, diagnosis, or treatment. For any medical problem you have, consult a qualified physician immediately.

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