Asuhan Keperawatan Osteomielitis

AOKAAZOK \@\SJE EZ\GZBN\GJBJSOB N\SJNE@JB@S@\

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

Ko|}zbboh

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Ko|}zbboh Eoho|`|qo Ob`h T}na}oe T}na}oe \szc` @bez Gjtj}oqosok Zk`vj}|`so| M}oq`iopo Eoboka =4?4

T}na}oe \szc` @bez Gjtj}oqosok M Iz}z|ok Gjtj}oqosok Fogzbso| Gjcngsj}ok Zk`vj}|`so| M}oq`iopo Eoboka =4??

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

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CJF@K@\@

N|sjne`jb`s`| ocoboh `kfjg|` ogzs szboka poka cotos sj}ioc` go}jko tjkpjmo}ok `kfjg|` co}` co}oh (n|sjne`jb`s`| hjeosnajk) osoz" poka bjm`h |j}`ka |jsjboh gnksoe`ko|` f}ogsz} sj}mzgo osoz }jczg|` (n|sjne`jb`s`| jg|najk)+ Bzgo sz|zg toco io}`kaok bzkog osoz szboka og`mos a`a`sok hjqok" eokz|`o osoz tjkpzks`gok `ks}oez|gzbz| cotos ejkpjmomgok n|sjne`jb`s|`| jg|najk+ (Ln}q`k" =44?) N|sjne`jb`s`| ej}ztogok `kfboeo|` ogzs osoz g}nk`| toco szboka cok |s}zgsz} tjkpj}so poka sj}ioc` |jmoao` og`mos |jgzkcj} co}` `kfjg|` mogsj}`+ (Lhoka" =440) @|s`boh n|sjne`jb`s`| ejkokcogok tj}ocokaok szboka cok }nkaao |ze|ze szboka+ Ej|g`tzk tj}ocokaok szboka cotos c`|jmomgok nbjh mj}oaoe hob" mj}co|o}gok tj}ioki`ok tjeogo`ok" goso `k` c`moso|` zkszg bj|` poka c`|jmomgok nbjh `kfjg|`+ N|sjne`jb`s`| cotos mj}|`fos ogzs osoz g}nk`| cok ejkpjmomgok cjm`b`so| (]nmm`k|" =441)

JS@NBNA@

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\sothpbnlnllz| Oz}jz|

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Hjenth`bbz| @kfbzjk|yo

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\obenkjbbo Spth`

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J|lhj}`lh`o Lnb`

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Tjkpjmo}ok hjeosnajk co}` fngz| `kfjg|` c` sjetos bo`k 9 snk|`b poka sj}`kfjg|`" `kfjg|` a`a`" `kfjg|` |obz}ok koto| moa`ok oso|

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Tjkpjmo}ok `kfjg|` io}`kaok bzkog 9 zbgz| cjgzm`sz| poka sj}`kfjg|` osoz zbgz| vo|gzbo}

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Gnksoe`ko|` boka|zka cjkaok szboka 9 f}ogsz} sj}mzgo" ljcj}o s}ozeos`g (bzgo sjemog cok tjemjcohok szboka)

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

GBO\@F@GO\@

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N|sjne`jb`s`| hjeosnajk ogzs  Fo|j ogzs `oboh fo|j |jiog sj}ioc`kpo `kfjg|` |oeto` ?4%?: ho}` N|sjne`jb`s`| hjeosnajk ogzs toco co|o}kpo ocoboh tjkpog`s toco szboka poka |jcoka szemzh+ Toco okog bjbog` s`ao gob` bjm`h |j}`ka co}`toco okog tj}jetzok+ Szboka poka |j}`ka sj}gjko ocoboh szboka tokioka cok sj}|j}`ka fjez}" c``gzs` nbjh s`m`o" hzej}z|" }oc`z|" zbko cok f`mzbo+ Moa`ok szboka poka sj}gjko ocoboh moa`ok ejsof`|`|+

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N|sjne`jb`s`| g}nk`g  N|sjne`jb`s`| ogzs poka s`cog c`sj}ot` |jlo}o ocjgzos" ogok mj}gjemoka ejkioc` n|sjne`jb`s`| g}nk`|+

\jbo`k `sz n|sjne`jb`s`| izao c`gbo|`f`go|`gok gj coboe 9 %

N|sjne`jb`s`| hjeosnajk N|sjne`jb`s`| poka c`|jmomgok nbjh tjkpjmo}ok `kfjg|` co}` fngz| bo`k c` coboe szmzh

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N|sjne`jb`s`| jg|najk N|sjne`jb`s`| poka c`|jmomgok nbjh `kfjg|` co}` bzo} szmzh |jlo}o boka|zka+ Lnksnhkpo s}ozeo sjemz| osoz f}ogsz} sj}mzgo

TOSNF@\@NBNA@

N|sjne`jb`s`| ej}ztogok t}n|j| `kfjg|` ogzs toco szboka cok mj}o|ob co}` |zemj} jg|najk osoz jkcnajk (hjeosnajk)+ @kfjg|` jg|najk cotos mj}o|ob co}` f}ogsz} sj}mzgo osoz iobz} jg|sj}kob bo`k" |jtj}s` bzgo+ N|sjne`jb`s`| hjeosnajk tob`ka |j}`ka c`sjezgok cok sj}ioc` go}jko `kfjg|` poka oco ejkpjmo} co}` fngz| bngob+ Lnksnh poka |j}`ka c`sjezgok ocoboh `kfjg|` coco" ns`s`| ejc`o osoz aokaazok toco gzb`s poka boy`e sj}ioc`" |jtj}s` `etjs`an osoz om|j|+ M`o|okpo n|sjne`jb`s`| ejkpj}oka okog%okog poka mj}z|`o :%?6 sohzk" cok cotos c`|jmomgok nbjh e`g}nn}aok`|ej ototzk+ N|sjne`jb`s`| sj}zsoeo c`sjezgok toco mop` cok okog poka s`cog |jhos" cok sj}ioc` czo gob` bjm`h |j}`ka toco okog bog`%bog` co}`toco tj}jetzok+ Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

Mnbz| `kfjg|` ejk`kaaobgok s`s`g oqob `kfjg|` cok mj}iobok gj o}sj}`nbo gjl`b c` coboe ejsof`|`| szboka" sjetos sj}ioc`kpo fngz| `kfjg|` poka mo}z+ Mj}aokszka toco" otogoh bjetjka jt`f`|`| |zcoh ejkzszt osoz mjbze+ Toco moa`ok ejsof`|`| szboka tokioka poka |jcoka szemzh cjkaok ljtos tob`ka |j}`ka sj}gjko `kfjg|`"  i`go bjetjka jt`f`|`| mjbze ejkzszt+ Ezbo%ezbo sj}cotos fngz| `kfjg|` c` coj}oh ejof`|`|" bobz sj}ioc` h`tj}je`o cok njcje+ Go}jko szboka mzgok io}`kaok poka m`|o mj}jg|tok|`" sjgokok coboe szboka poka ejk`kagos `k` ejkpjmomgok kpj}` bngob poka hjmos+ M`o|okpo n|sjne`jb`s`| ogzs c`|j}so` cjkaok ajiobo |jts`|je`o" |jtj}s` fjm}`|" eobo`|j cok okn}jg|`o+ @kfjg|` cotos tjloh gj |zmtj}`n|s" gjezc`ok ejkjemz| |zmgzs`| cok ejkpjmo} ejkioc` |jbzb`s`| osoz ejkiobo} ejbobz` }nkaao |zmtj}`n|s gj c`of`|`|+ @kfjg|` izao cotos tjloh gj moa`ok szboka c`of`|`| ejbobz` gokob`| ejczbo}`|+ Tjkiobo}ok |zmtj}`n|sob gj o}oh c`of`|`| ogok ej}z|og tjemzbzh co}oh poka gj c`of`|`| |jh`kaao ejkpjmomgok kjg}n|`| szboka poka c`|jmzs |jgzj|sj}+ Tj}`n|s ogok ejemjkszg szboka mo}z poka ejkpjbzmzka` szboka eos` c`|jmzs `kvnbng}ze

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

@kfjg|` Jkcnajk (hjeosnajk) % Om|j| % Ns`s`| ejc`o % Zbgz| cbb

@kfjg|` Jg|najk % F}ogsz} sj}mzgo % Bzgo (sjemog" tjemjcohok" cbb)

`kfjg|` toco ejsof`|`| szboka

H`tj}sj}e`

]j|tnk `kfboeo|`

Tjk`kagosok vo|gzbo}`|o|`

S}nemn|`| toco tjemzbzh co}oh

njcjeo

Tjk`kagosok sjgokok io}`kaok cok ejczbbo

Tjk`kagosok sjgokok coboe szboka @|gje`o io}`kaok Kpj}` Kjg}n|`| io}`kaok

@kfjg|` mj}gjemoka gj gov`so| ejczbo}`| cok gj moqoh tj}`n|sjze Om|j| szboka Ejkpjmo} gj io}`kaok bzkog cok |jkc` c` |jg`so}kpo

Tjkz}zkok gjgzosok szboka

Szboka }otzh F}ogsz} tosnbna`| Aokaazok enm`b`so|

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

EOK@FJ\SO\@ GB@K@\ %

N|sjne`jb`s|`

jg|najk

m`o|okpo

c`|j}so`

sokco%sokco

ljcj}o

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tj}ocokaok c` sjetos kpj}`+ %

Tjemj|o}ok gjbjkio} ajsoh mjk`ka }ja`nkob

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Toco okog ejkaoboe` gjjkaaokok ejkaaj}oggok okaanso mocok poka |og`s

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Toko| s`kaa` cok |og`s gj}o|

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Ejkaa`a`b

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Bjeoh cok eobo`|j

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Kpj}` szboka cjgos |jkc`

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S`cog cotos ejkaaj}oggok okaanso mj}|okagzsok

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S`cog oco gjbo`kok fnsn }nksajk (fo|j ogzs)

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Tjemjkagogok bngob cok kpj}` sjgok

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F`|sjb g}nk`g poka ejkajbzo}gok kokoh cok gocoka |gzj|sj} gjl`b (fo|j g}nk`|)

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Fnsn c`sjezgok |gzj|sj} cok tjemjkszgok szboka mo}z (fo|j g}nk`|)

TJEJ]@G\OOK C@OAKN\S@G %

\lok szboka cjaok ejkaazkogok kzgbjns`co mj}bomjb }oc`nogs`f cotos ejetj}b`hosgok ejetj}b`hosgok tj}o|okaok c` szboka (E]@)

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  Okob`|`| co}oh cotos ejetj}b`hosgok tjk`kagosok h`szka co}oh bjkagot cok boiz jkcot co}oh poka ejka`|po}osgok ocokpo `kfjg|` poka |jcoka mj}boka|zka

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Kjzs}nf`b ejk`kagos (K9 ="= % 1": ?4 0.B)

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BJC ejk`kagos(K9 ?%?4 ee.ioe)

  O|t`}o|`" zkszg ejetj}nbjh tz| co}` |zmgzs`|" |zmtj}`n|s osoz fngz| }ocoka c` ejsof`|`|

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Lnetbjejks ]jols`vj T}nsj`k (L]T) ejk`kagos (K92: ea.B) L]T cok BJC poka s`kaa` |j}`ka c`izeto` toco oqob `kfjg|`+

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

TJKOSOBOG\OKOOK

 Ogzs  %

Tj}oqosok c` }zeoh |og`s

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Tjkanmosok |ztn}s`f cjkaok tjemj}`ok `kfz| cok oks`m`ns`go

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Tjej}`g|ook m`ogok co}oh

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@enm`b`|o|`

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S`kcogok mjcoh+

 G}nk`g  %

\gzj|s}jgsne`

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Cjm}`cjeok (zkszg ejkajbzo}gok io}`kaok kjg}ns`g c` c` c`kc`ka }zoka |gzj|sj} cok tjkpob`}ok)

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A`t| (zkszg ejkljaoh tosoh szboka tosnbna`| og`mos `kvnbng}ze mjbze lzgzt gzos zkszg ejkaaoks`gok szobka o|b` pa ejkioc` |gzj|sj})

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Tjemj}`ok oks`m`ns`g poka |j|zo`

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

GNK\JT O\ZHOK GJTJ]OQOSOK

Tjkagoi`ok Zeze \`|s`e Ez|gzbn|gjbjsob

]`qopos gj|jhosok ejb`tzs` `kfn}eo|` sjksoka ogs`v`so| h`czt |jho}`%ho}`" tnbo oemzbo|`" obos moksz poka c`azkogok (e`|obkpo gz}|` }nco" snkagos" qobgj})" qobgj}) " cok kpj}` (i`go oco kpj}` sjsotgok bngo|`" cj}oios kpj}`" boeo" fogsn} poka ejetj}mj}os cok fogsn} tjkljsz|) g}oe osoz gjbjeohok Tjkagoi`ok tj}bz c`bogzgok |jlo}o |`|sjeos`|" sjb`s` cok sj}o}oh+ Coso poka c`gzetzbgok ejb`tzs` coso |zmijgs`f cok nmijgs`f cjkaok lo}o ejbogzgok okoekj|`|" tjej}`g|ook f`|`g cok tjej}`g|ook c`oakn|s`g+

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?+ Coso cjena}of` 9 Coso `k` ejb`tzs` koeo" z|`o" ijk`| gjboe`k" sjetos s`kaaob" n}oka poka cjgos cjkaok gb`jk+ =+ ]`qopos tj}gjemokaok 9 Coso `k` zkszg ejkajsohz` s`kagos tj}gjemokaok toco kjnkosz|" mop`" t}o|jgnboh" }jeoio" cjqo|o cok szo+ <+ ]`qopos |n|`ob 9 Coso `k` ejb`tzs` tjkc`c`gok cok tjgj}iook+ \j|jn}oka poka sj}toto} sj}z|%ejkj}z| cjkaok oajk| sj}sjksz coboe tjgj}iookkpo" |sosz| gj|jhosokkpo cotos c`tjkao}zh`+ 3+ ]`qopos tjkpog`s gjsz}zkok 9 ]`qopos tjkpog`s gjbzo}ao tj}bz c`gjsohz` zkszg ejkjkszgok hzmzkaok ajkjs`g poka tj}bz c``cjks`f`go|` e`|obkpo (tjkpog`s c`omjsj| ejb`sz| poka ej}ztogok t}jc`|tn|`|` tjkpog`s |jkc` cjajkj}os`f" SML" o}s}`s`|" }`gjs|`o" n|sjne`jb`s`|" cbb) :+ ]`qopos c`js 9 @cjks`f`go|` ocokpo gjbjm`hok mj}os mocok go}jko gnkc`|` `k` cotos ejkaog`mosgok |s}j|| toco |jkc` tjkpokaao szmzh cok t}jc`|tn|`|` sj}ioc`kpo `k|som`b`so| b`aoejk" ghz|z|kpo toco tzkaazka moa`ok moqoh+ Gz}okakpo o|ztok gob|`ze cotos ejk`emzbgok f}ogsz} go}jko ocokpo cjgob|`f`go|`+ cjgob|`f`go|`+ Moao`eoko ejkz eogokok |jho}`%ho}` cok gnk|ze|` gnk|ze|` v`soe`k O" C" gob|`ze" |j}so t}nsj`k poka ej}ztogok yos zkszg ejkioao gnkc`|` ez|gzbn|gjbjsob+ 6+   Ogs`v`so| gja`osok |jho}`%ho}` 9 @cjks`f`go|` tjgj}iook to|`jk cok ogs`f`so| |jho}`%ho}`+

Gjm`o|ook

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ejk`emzbgok }jaokaok nsns cok s}ozeo bo`kkpo+ Gz}okakpo ejbogzgok Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

ogs`v`so| ejkaog`mosgok snkz| nsns ejkz}zk+ F}ogsz} osoz s}ozeo cotos s`emzb toco nboh}oao |jtog mnbo cok hng`" |jcokagok kpj}` |jkc` sokaok cotos s`emzb og`mos nboh }oao sjk`|+ Tjeogo`ok hog |jtosz poka sj}bobz s`kaa` cotos ejk`emzbgok gnks}og|` toco sjkcnk olh`bj| cok cotos sj}ioc` c`|bngo|`+ Tj}bz c`goi` tzbo ogs`v`so| h`czt |jho}`%ho}`" |oos oemzbo|` otogoh oco kpj}` toco |jkc`" otogoh ejkaazkogok obos moksz (gz}|` }nco" snkagos osoztzk qobgj}) 1+ ]`qopos gj|jhosok eo|o bobz 9 Coso `k` ejb`tzs` gnkc`|` gj|jhosok `kc`v`cz+ Coso

sjksoka

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ez|gzbn|gjbjsob" e`|obkpo }`qopos s}ozeo osoz gj}z|ogok szboka }oqok" }`qopos o}s}`s`| cok n|sjne`jb`s`|+ 8+ ]`qopos gj|jhosok |jgo}oka 9 |jiog gotok s`emzb gjbzhok" otogok oco }`qopos s}ozeo+ Hob%hob poka ejk`emzbgok ajiobo+ S`emzbkpo ajiobo ejkcocog osoz tj}bohok+ S`emzbkpo zkszg tj}soeo gob`kpo osoz mj}zboka+ Tj}bz c`sokpogok tzbo sjksoka oco%s`cogkpo aokaazok toco |`|sje bo`kkpo+ Goi` gb`jk zkszg ejkazkagotgok obo|ok gb`jk ejej}`g|ogok c`}` osoz ejkazkizka` fo|`b`so| gj|jhosok" gjbzhok zsoeo to|`jk cok aokaazok ez|gzbn|gjbjsob ejb`tzs` 9 %

Kpj}` 9 `cjks`f`go|` bngo|` kpj}`+ Kpj}` m`o|okpo mj}go`sok cjkaok tjemzbzh co}oh" |jkc`" fo|`o osoz tj}`n|sjze+ Sjkszgok gzob`so| kpj}` otogoh |og`s poka ejkz|zg osoz mj}cjkpzs+ Kpj}` mj}cjkpzs m`o|okpo mj}go`sok cjkaok szboka cok |og`s mj}go`sok cjkaok nsns" |jcokagok kpj}` poka ejkz|zg mj}go`sok cjkaok f}ogsz} osoz `kfjg|` szboka+ @cjks`f`go|` otogoh kpj}` s`emzb |jsjboh c`mj}` ogs`v`so| osoz aj}ogok+ Kpj}` |oos mj}aj}og ej}ztogok |osz sokco eo|oboh tj}|jkc`ok+ Cjajkj}o|` tokaazb ejk`emzbgok kpj}` |jboeo mocok mj}szetz toco |jkc` sj}|jmzs+ Cjajkj}o|` toco bzszs ejk`emzbgok kpj}` |jboeo cok |jsjboh mj}iobok+ Kpj}` toco n|sjno}s}`s`| eog`k ejk`kagos toco |zhz c`ka`k+ Sokpogok gotok kpj}` eog`k ejk`kagos" otogoh toa` osoz eoboe ho}`+ @kfboeo|` toco mz}|o osoz sjkcnk eog`k ejk`kagos toco eoboe ho}`+ Sokpogok otogoh kpj}` h`boka |oos `|s`}ohos+ Otogoh kpj}`kpo cotos c`oso|` cjkaok nmos sj}sjksz+

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

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Gjgzosok |jkc` 9 sokpogok |jkc` eoko poka ejkaoboe` gjgogzok" boeokpo gjgogzok sj}|jmzs" cok otogoh |jbobz sj}ioc` gjgogzok+ Mjmj}oto gnkc`|` |jtj}s` |tnkc`b`s`| okg`bn|`| sj}ioc` }je`|` gjgogzok mjmj}oto gob` |jho}`+ Toco tjkpog`s cjajko}o|` |jkc` |j}`ka sj}ioc` gjgogzok poka ejk`kagos toco toa` ho}` |jsjboh mokazk s`cz} (`kogs`v`so|)+ Moao`eoko cjkaok tj}zmohok |zhz cok ogs`v`so|+ \zhz c`ka`k cok gz}oka ogs`v`so| m`o|okpo

ejk`kagosgok

gjgogzok

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ejkz}zkgok |to|ej nsns+ %

Mjkagog 9 sokpogok mj}oto boeo sj}ioc` tjemjkagogok" otogoh izao c`|j}so` cjkaok kpj}`" go}jko mjkagog cok kpj}` |j}`ka ejkpj}so` ljcj}o toco nsns+ Tjkpog`s cjajkj}o|` |jkc` |j}`ka gob` s`cog s`emzb mjkagog toco oqob |j}okaok" |j}okaok" sjsot` ezklzb |jsjboh mjmj}oto mjmj}oto e`kaaz sj}ioc` kpj}`+ Cjkaok `|s`}ohos cok ejk`kaa`gok moa`ok szmzh" oco poka c`to|oka a`t|+ @cjks`f`go|` otogoh oco toko| osoz gjej}ohok go}jko sokco sj}|jmzs ejkzkizggok ocokpo `kfboeo|`" `kfjg|` osoz ljcj}o+

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Cjfn}e`so| cok `enm`b`so| 9 sokpogok gotok sj}ioc`kpo" otogoh s`mo%s`mo osoz mj}sohot" otogoh ejk`emzbgok gjsj}moso|ok aj}og+ Otogoh |jeog`k ejemz}zg

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eog`k

ejemz}zg+ Otogoh gb`jk ejkaazkogok obos moksz (g}zg" snkagos" cbb) %

Tj}zmohok |jk|n}` 9 sokpogok otogoh oco tjkz}zkok }o|o toco moa`ok szmzh sj}sjksz+ Otogoh ejkz}zkkpo }o|o osoz |jk|o|` sj}|jmzs mj}go`sok cjkaok kpj}`+ Tjkjgokok toco |po}of cok tjemzbzh co}oh og`mos mjkagog" szen} osoz f}ogsz} cotos ejkpjmomgok ejkz}zkkpo |jk|o|`+

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

TJEJ]@G\OOK F@\@G Tjkagoi`ok \gjbjsob Szmzh

Hob%hob poka tj}bz c`goi` toco |gjbjs szmzh" po`sz 9 ?+   Ocokpo cjfn}e`so| cok gjs`cog|jioio}ok poka cotos c`|jmomgok nbjh tjkpog`s |jkc` =+ Tj}szemzhok szboka omkn}eob+ Hob `k` cotos c`|jmomgok nbjh ocokpo szen} szboka+ <+ Tjejkcjgok jg|s}`e`so|" oetzso|` cok moa`ok szmzh poka s`cog |jioio} |jlo}o okosne`| 3+   Okazbo|` omkn}eob toco szboka tokioka" aj}ogok toco s`s`g mzgok |jkc`" sj}omo g}jt`sz| toco s`s`g aj}ogok omkn}eob" ejkzkizggok ocokpo tosoh szboka+ Tjkagoi`ok Szboka Mjbogoka

Cjfn}e`so| szboka mjbogoka poka |j}`ka sj}ioc` tj}bz c`tj}hos`gok po`sz 9 ?+ \gnb`n|`| (cjv`o|` gz}voksz}o bosj}ob szboka mjbogoka) %

Mohz s`cog |oeo s`kaa`

%

Ao}`| t`kaaoka poka s`cog |`ejs}`|

%

\gotzbo poka ejknkinb

\gnb`n|`| s`cog c`gjsohz` tjkpjmomkpo (`c`ntos`g)" gjbo`kok gnkajk`sob" osoz og`mos gj}z|ogok nsns to}o%|t`kob" |jtj}s` tnb`ne`jb`s`|+ =+ G`fn|`| (gjko`gok gz}voksz}o szboka mjbogoka moa`ok coco)+ \j}`ka sj}ioc` toco bok|`o cjkaok n|sjntn}n|`| osoz tjkpogs` kjz}nez|gzbo}+ <+ Bn}cn|`|

(ejemjmjg"

gz}voksz}o

szboka

moa`ok

t`kaaoka

poka

mj}bjm`hok+ Bn}cn|`| m`|o c`sjezgok toco qok`so hoe`b Toco |oos `k|tjg|` szboka mjbogoka |jmo`gkpo moiz to|`jk c`bjto| zkszg ejb`hos |jbz}zh tzkaazka" mngnka cok szkago`+ Tjej}`g|ok gz}voksz}o szboka mjbogoka cok gj|`ejs}`|ok mosoka szmzh c`bogzgok co}` tokcokaok oksj}`n}" tn|sj}`n} cok bosj}ob+ Cjkaok mj}c`}` c` mjbogoka to|`jk" tj}hos`gok |js`ot tj}mjcook s`kaa` mohz cok g}`|so `b`ogo+ B`tosok mngnka kn}eobkpo |`ejs}`|+ Gj|`ejs}`|ok mohz" t`kaazb cok gjbz}z|ok szboka mjbogoka c`tj}`g|o coboe tn|`|` to|`jk mj}c`}` sjaog cok ejemzkagzg gj cjtok+

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

Tjkagoi`ok \`|sje Tj}|jkc`ok

Tjkagoi`ok |`|sje tj}||jkc`ok cjkaok tjej}`g|ook bzo| aj}og |jkc` mo`g ogs`f  eoztzk to|`f" cjfn}e`so|" |som`b`so| cok ocokpo mjkinbok+ Tjej}`g|ook |jkc` ejkaazkogok obos  ank`nejsj}" po`sz mz|z} cj}oios poka c`}okloka ghz|z| zkszg jvogzo|` aj}og |jkc`+ ?+   I`go |jkc` c`jg|sjk|`gok eog|`eob koezk eo|`h oco |`|o fbjg|`" bzo| aj}ogok `k` c`okaot sj}moso|+ Gjsj}moso|ok `k` cotos c`|jmomgok nbjh cjfn}e`so| |gjbjsob" tosnbna`g |jkc`" gnks}ogsz} nsns cok sjkcnk |jg`so}+ =+   I`go aj}ogok |jkc` ejkaoboe` aokaazok osoz kpj}`" ho}z| c`tj}`g|o ocokpo gjbjm`hok lo`}ok coboe got|zbkpo (jfz|`)" tjemjkagogok cok `kfboeo|`+ Sjetos poka tob`ka |j}`ka sj}ioc` jfz|` ocoboh toco bzszs+ Tobto|` |jkc` |oem`b |jkc` c`aj}oggok |jlo}o to|`f ogok ejemj}` `kfn}eo|` ejkajko` `ksja}`so| |jkc`+ \zo}o ‒ajejbjszg―cotos ejkzkizggok ocokpo

b`aoejk poka sj}ajbkl`} c` okso}o snkinbok szboka+ Ocokpo g}jt`sz| go}jko tj}ezgook |jkc` poka s`cog }oso c`sjezgok toco to|`jk o}s}`s`|+ Io}`kaok |jg`so} |jkc` sj}cotos mjkinbok poka gho| c`sjezgok toco to|`jk 9 ?+  O}s}`s`s| }jzeosn`c" mjkinbok bzkog c` coboe cok |jtokioka sjkcnk+ =+ Anzs" mjkinbok gj}o| c` coboe cok c` |jmjboh |jkc` <+ N|sjnos}`s`|" mjkinbok gj}o| cok s`cog kpj}` ej}ztogok tj}szemzhok szboka mo}z mo}z og`mos cj|s}zg|` cj|s}zg|` tj}ezgook tj}ezgook go go}s`boan }s`boan toco szboka

coboe

got|zb |jkc`" m`o|okpo c`sjezgok toco bok|`o+ Gocoka%gocoka zgz}ok |jkc` ejknkinb og`mos o}s}nf` nsns c` t}ng|`eob cok c`|sob |jkc` |j}`ka sj}b`hos toco o}s}`s`| }jzeosn`c |jkc` bzszs+

Tjkagoi`ok \`|sje Nsns

Tjkagoi`ok |`|sje nsns ejb`tzs` gjeoetzok ejkazmoh tn|`|`" gjgzosok cok gnn}c`ko|` nsns" |j}so zgz}ok eo|`ka%eo|`ka nsns+ Gjbjeohok |jgjbnetng nsns ejkzkizggok mj}moao` gnkc`|` |jtj}s` tnb`kjz}ntos`" aokaazok jbjgs}nb`s" e`o|sjk`o a}of`|" tnb`ne`jb`s`| cok c`|s}nf` nsns+ Tobto|` nsns c`bogzgok gjs`go jg|s}`e`so| }`bjg| cok c`aj}oggok |jlo}o to|`f" tj}oqos ogok ej}o|ogok snkz| nsns+ Gjgzosok nsns cotos c`zgz} cjkaok eje`kso to|`jk ejkaaj}oggok jg|s}`e`so| cjkaok osoz sokto sohokok+ E`|obkpo" nsns

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

m`|jt poka c`zi` cjkaok eje`kso gb`jk ejbz}z|gok bjkaok |jtjkzhkpo" gjezc`ok fbjg|`gok bjkaok ejboqok sohokok poka c`mj}`gok nbjh tj}oqos+ Snkz| nsns (gnks}og|` }`se`g nsns) cotos c`mokag`sgok toco tj}ajbokaok gog` cjkaok cn}|n%fbjg|` gog` ejkcocog cok gzos" osoz sokaok cjkaok jg|sjk|` tj}ajbokaok sokaok+ B`kago} jg|s}`e`so| ho}z| c`zgz} zkszg ejeoksoz tj}soemook zgz}ok og`mos jcjeo osoz tj}co}ohok" tjkz}zkok zgz}ok og`mos os}nf` cok c`mokc`kagok jg|s}`e`so| poka |jhos+ Tjkazgz}ok nsns c`bogzgok c` b`kago}ok sj}mj|o} jg|s}`e`so|" toco bngo|` poka |oeo" toco tn|`|` poka |oeo cok nsns coboe gjocook `|s`}ohos+ A}oco|` Zgz}ok Gjgzosok Nsns 4 (yj}n) S`cog oco gnks}og|` |oos tobto|`" to}ob`|`| ? (s}olj) Sj}o|o ocokpo gnks}og|` nsns" sjsot` s`cog oco aj}ogok = (tnn}) Cjkaok mokszok osoz ejkpokaao |jkc` cotos ejbogzgok aj}ogok |jkc` (}okaj nf ens`nk" ]NE) |jlo}o tjkzh < (fo`}) Cotos ejbogzgok aj}ogok |jkc` (]NE) |jlo}o tjkzh cjkaok ejboqok a}ov`so|`" sjsot` s`cog cotos ejboqok sohokok 3 (annc) Cotos ejbogzgok ]NE |jlo}o tjkzh cok cotos ejboqok sohokok s`kagos |jcoka : (kn}eob) Cotos ejbogzgok aj}ogok |jkc` (]NE) |jlo}o tjkzh cok cotos ejboqok a}ov`so|` cok sohokok

Tjkagoi`ok Lo}o Mj}iobok

Toco tjkagoi`ok `k`" to|`jk c`e`kso mj}iobok+ Tj}hos`gok hob mj}`gzs 9 ?+ Gjhobz|ok cok `}oeo mj}iobok" aj}ogok sj}osz} osoz s`cog =+ T`kloka cotos c`|jmomgok nbjh kpj}` osoz |oboh |osz jg|s}`e`so| tjkcjg+ <+ Gjsj}moso|ok aj}og |jkc` cotos ejejkao}zh` lo}o mj}iobok   Omkn}eob`so| kjz}nbna`| poka mj}hzmzkaok cjkaok lo}o mj}iobok+ E`|obkpo" to|`jk hje`to}j|`|%|s}ngj ejkzkizggok lo}o mj}iobok |tj|`f`g" to|`jk cjkaok tjkpog`s to}g`k|nk ejkzkizggok lo}o mj}iobok mj}ajso}+

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

TJEJ]@G\OOK F@\@G (Zeze) C@OAKN\O GJTJ]OQOSOK POKA EZKAG@K EZKLZB

?+ Kpj}` mj}hzmzkaok cjkaok `kfboeo|` cok tjemjkagogok+ =+ Aokaazok enm`b`so| f`|`g mj}hzmzkaok cjkaok kpj}` cok gjsj}moso|ok }jksoka aj}og

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4?? 

]JKLOKO O\ZHOK GJTJ]OQOSOK (KZ]\@KA (KZ]\@KA LO]J TBOK) Kn ?

C`oakn|o Gjtj}oqosok Kpj}` m.c `kfboeo|` cok tjemjkagogok

Szizok & G}`sj}`o Ho|`b Szizok 9 \jsjboh c`bogzgok tj}oqosok gb`jk ejbotn}gok kpj}` mj}gz}oka osoz h`boka G}`sj}`o Ho|`b 9 % \gobo kpj}` 4%3 % A}`eolj (%) % Aj}ogok ejbngob`|`} kpj}` (%)

@ksj}vjk|`

]o|`nkob

?+ Toksoz s`kagos cok `ksjk|`so| kpj}` =+ Bogzgok `enm`b`|o|` cjkaok m`co` <+ S`kaa`gok jg|s}`e`so| poka kpj}` 3+  Oio}gok sjgk`g }jbog|o|` (kofo| coboe) :+ Gnbomn}o|` tjemj}`ok okobaj|`g |j|zo` t}na}oe sj}ot`

?+ S`kagos cok `ksjk|`so| kpj}` ej}ztogok coso co|o} poka c`mzszhgok tj}oqos |jmoao` tjcneok tjkaoem`bok `ksj}vjk|`" |jh`kaao |js`ot tj}zmohok ho}z| sj}z| c`toksoz+ =+ @enm`b`|o|` cotos ejemoksz ej}`kaokgok szao| szboka coboe ejetj}sohokgok tn|sz} szmzh |jh`kaao s`cog sj}ioc` gjgogzok coj}oh |jg`so} poka ejkpjmomgok kpj}`+ <+ Tjk`kaa`ok jg|s}`e`so| cotos ejemoksz ejk`kagosgok ob`}ok mob`g vjko poka ejkpjmomok tjemjkagogok mj}gz}oka |jh`kaao tjkjgokok coj}oh ljcj}o ejkz}zk+ 3+ Sjgk`g }jbog|o|` (kofo| coboe ) cotos ejemoksz ejkz}zkgok s`kagos gjsjaokaok |jh`kaao c`ho}otgok sjgokok nsns%nsns |jg`so} coj}oh ljcj}o ejkz}zk :+  Okobaj|`g mj}fzka|` zkszg ejbogzgok hoemosok toco |jk|n} kpj}` |jh`kaao |jk|o|` kpj}` toco gb`jk mj}gz}oka+

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O |zhok Gjtj}oqosok  =4?? 

=

Aokaazok enm`b`so| f`|`g m.c kpj}`" gjsj}moso|ok }jksoka aj}og

Szizok 9 \jsjboh c`bogzgok tj}oqosok" gb`jk cotos ejbogzgok enm`b`|o|` cjkaok osoz sokto mokszok tj}oqos G}`sj}`o ho|`b 9 % Gb`jk cotos ejbogzgok ]NE ogs`f  % Gb`jk cotos mj}t`kcoh cjkaok mokszok obos

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O |zhok Gjtj}oqosok  =4?? 

?+Bogzgok ?+ Bogzgok `enm`b`|o|` cjkaok m`co` toco coj}oh poka ejkaoboe` gj}z|ogok =+ Oio}gok =+ Oio}gok tjkaazkook obos moksz mj}t`kcoh <+ Ijbo|gok <+ Ijbo|gok toco to|`jk sjsksoka tjks`kakpo tjemoso|ok ogs`v`so| 3+Bos`hok 3+ Bos`hok ]NE ogs`f cok tj}t`kcohok eog|`eob = gob` coboe |jho}` :+ Okiz}gok :+ Okiz}gok to}s`|`to|` to}s`|`to|` ogs`f |j|zo` gjeoetzok coboe gja`osok |jho}`%ho}`

?+@enm`b`|o|` ?+ @enm`b`|o|` cotos ejkaz}oka` tj}aj}ogok coj}oh ljcj}o |jh`kaao s`cog sj}ioc` gj}z|ogok poka mj}bokizs" hob `k` izao cotos ejemoksz ejkntoka mj}os szmzh+ =+Gb`jk =+ Gb`jk ezkag`k mo}z ejkajkob cok s`cog cotos ejkaazkogok obos moksz enm`b`so| |jtj}s` g}zg osoz qobgj} |jh`kaao tj}ok tj}oqos ocoboh ejemj}`gok tjkc`c`gok sjksoka lo}o tjkaazkookkpo+ <+Gb`jk <+ Gb`jk ezkag`k s`cog ejkaj}s` ejkajko` szizok tjemoso|ok aj}og" |jh`kaao tj}oqos ho}z| ejemj}`gok tjkpzbzhok sjksoka tjks`kakpo tjemoso|ok ogs`v`so| toco to|`jk ljcj}o+ Tjeohoeok gb`jk ejezkag`kgok tjk`kagosok copo gnntj}os`f+ 3+Bos`hok 3+ Bos`hok ]NE cotos ejkljaoh tjkz}zkok eo|o nsns" gnks}ogsz} cok tjk`kagosok vo|gzbo}`|o|`+ \jh`kaao s`cog s`emzb gnetb`go|` poka s`cog c`ho}otgok :+To}s`|`to|` :+ To}s`|`to|` ogs`f cotos ejemoksz tjezb`hok gj|jhosok cok ejbos`h gjgzosok nsns" |jh`kaao c`ho}otgok gb`jk cotos ejetj}sohokgok gjgzosokkpo+

=

Aokaazok enm`b`so| f`|`g m.c kpj}`" gjsj}moso|ok }jksoka aj}og

Szizok 9 \jsjboh c`bogzgok tj}oqosok" gb`jk cotos ejbogzgok enm`b`|o|` cjkaok osoz sokto mokszok tj}oqos G}`sj}`o ho|`b 9 % Gb`jk cotos ejbogzgok ]NE ogs`f  % Gb`jk cotos mj}t`kcoh cjkaok mokszok obos

?+Bogzgok ?+ Bogzgok `enm`b`|o|` cjkaok m`co` toco coj}oh poka ejkaoboe` gj}z|ogok =+ Oio}gok =+ Oio}gok tjkaazkook obos moksz mj}t`kcoh <+ Ijbo|gok <+ Ijbo|gok toco to|`jk sjsksoka tjks`kakpo tjemoso|ok ogs`v`so| 3+Bos`hok 3+ Bos`hok ]NE ogs`f cok tj}t`kcohok eog|`eob = gob` coboe |jho}` :+ Okiz}gok :+ Okiz}gok to}s`|`to|` to}s`|`to|` ogs`f |j|zo` gjeoetzok coboe gja`osok |jho}`%ho}`

?+@enm`b`|o|` ?+ @enm`b`|o|` cotos ejkaz}oka` tj}aj}ogok coj}oh ljcj}o |jh`kaao s`cog sj}ioc` gj}z|ogok poka mj}bokizs" hob `k` izao cotos ejemoksz ejkntoka mj}os szmzh+ =+Gb`jk =+ Gb`jk ezkag`k mo}z ejkajkob cok s`cog cotos ejkaazkogok obos moksz enm`b`so| |jtj}s` g}zg osoz qobgj} |jh`kaao tj}ok tj}oqos ocoboh ejemj}`gok tjkc`c`gok sjksoka lo}o tjkaazkookkpo+ <+Gb`jk <+ Gb`jk ezkag`k s`cog ejkaj}s` ejkajko` szizok tjemoso|ok aj}og" |jh`kaao tj}oqos ho}z| ejemj}`gok tjkpzbzhok sjksoka tjks`kakpo tjemoso|ok ogs`v`so| toco to|`jk ljcj}o+ Tjeohoeok gb`jk ejezkag`kgok tjk`kagosok copo gnntj}os`f+ 3+Bos`hok 3+ Bos`hok ]NE cotos ejkljaoh tjkz}zkok eo|o nsns" gnks}ogsz} cok tjk`kagosok vo|gzbo}`|o|`+ \jh`kaao s`cog s`emzb gnetb`go|` poka s`cog c`ho}otgok :+To}s`|`to|` :+ To}s`|`to|` ogs`f cotos ejemoksz tjezb`hok gj|jhosok cok ejbos`h gjgzosok nsns" |jh`kaao c`ho}otgok gb`jk cotos ejetj}sohokgok gjgzosokkpo+

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O |zhok Gjtj}oqosok  =4?? 

Jc`sjc mp Fnx`s ]jocj} Lntp}`ahs(L) mp Fnx`s \nfsqo}j Lnetokp"=44:%=448 Fn} Jvobzos`nk Nkbp+

COFSO] TZ\SOGO  Lhoka" J|sj}+ Cobp" Inhk+ Jbb`nss" Coza+ =440+   Tosnf`|`nbna` 7 Otb`go|` toco T}ogs`g   Gjtj}oqosok+  Gjtj}oqosok + Iogo}so 9 JAL Ln}q`k" Jb`yomjsh I+ =44?+ Mzgz =44?+  Mzgz \ogz Tosnf`|`nbna` + Iogo}so 9 JAL Fogzbso| Gjcngsj}ok Z@+  Gzetzbok Gzb`oh @bez Mjcoh" Mjcoh" jc`sn} |njbo}sn }jg|nt}nin" Sokaj}oka9 M`ko}zto Og|o}o Tnssj}" Tos}`l`o O+ Tj}}p" Okkj A}`ff`k+ =44:+   Mzgz Oio} Fzkcoejksob Gjtj}oqosok (Gnk|jt" T}n|j|| cok T}ogs`g+ Iogo}so 9 JAL ]nmm`k|" \sokbjp J+ =441+ Mzgz Oio} Tosnbna` + Iogo}so 9 JAL \ioe|zh`copos" \ioe|zh`copos" ]+ cj Inka" Q`e+ =443+  Mzgz Oio} bbez Mjcoh+ Iogo}so Mjcoh+  Iogo}so 9 JAL \ejbsyj}" \z|okj L+ Mo}j" M}jkco A+ =44?+  Mzgz Oio} Gjtj}oqosok Ejc`gob%Mjcoh  M}zkkj} & \zcco}sh+ Iogo}so \zcco}sh+ Iogo}so 9 JAL

Jc`sjc mp Fnx`s ]jocj} Lntp}`ahs(L) mp Fnx`s \nfsqo}j Lnetokp"=44:%=448 Fn} Jvobzos`nk Nkbp+

COFSO] TZ\SOGO  Lhoka" J|sj}+ Cobp" Inhk+ Jbb`nss" Coza+ =440+   Tosnf`|`nbna` 7 Otb`go|` toco T}ogs`g   Gjtj}oqosok+  Gjtj}oqosok + Iogo}so 9 JAL Ln}q`k" Jb`yomjsh I+ =44?+ Mzgz =44?+  Mzgz \ogz Tosnf`|`nbna` + Iogo}so 9 JAL Fogzbso| Gjcngsj}ok Z@+  Gzetzbok Gzb`oh @bez Mjcoh" Mjcoh" jc`sn} |njbo}sn }jg|nt}nin" Sokaj}oka9 M`ko}zto Og|o}o Tnssj}" Tos}`l`o O+ Tj}}p" Okkj A}`ff`k+ =44:+   Mzgz Oio} Fzkcoejksob Gjtj}oqosok (Gnk|jt" T}n|j|| cok T}ogs`g+ Iogo}so 9 JAL ]nmm`k|" \sokbjp J+ =441+ Mzgz Oio} Tosnbna` + Iogo}so 9 JAL \ioe|zh`copos" \ioe|zh`copos" ]+ cj Inka" Q`e+ =443+  Mzgz Oio} bbez Mjcoh+ Iogo}so Mjcoh+  Iogo}so 9 JAL \ejbsyj}" \z|okj L+ Mo}j" M}jkco A+ =44?+  Mzgz Oio} Gjtj}oqosok Ejc`gob%Mjcoh  M}zkkj} & \zcco}sh+ Iogo}so \zcco}sh+ Iogo}so 9 JAL \z}oszk" os obb+ =448+   Gb`jk Aokaazok \`|sje Ez|gzbn|gjbjsob 9 \j}` O|zhok  Gjtj}oqosok+ Iogo}so  Gjtj}oqosok+  Iogo}so 9 JAL

Ko|}zbboh  N|sjne`jb`s`|" Botn}ok Tjkcohzbzok Cok Gnk|jt O|zhok Gjtj}oqosok  =4??