Download - Case Presentation - Acute Gastroentiritis
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7/21/2019 Case Presentation - Acute Gastroentiritis
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HKP\A@ZNPHAK
Tj, draup 7 am Cjvjc HHH sjnthak 7, fgvj nfasjk tfhs ngsj ta dghk ekawcj`dj gk`
ta mgohchgrhzj hk `hsjgsj pranjss, jthacady, ogkhmjstgthaks gk` ogkgdjojkts glaut
ojtglachn gctjrgthak tfgt ngusj sjhzurjs. Tj gcsa wgkt ta hopravj aur ekawcj`dj gk`
sehccs hk `jgchkd whtf hk`hvh`ugcs whtf tfhs ehk` am `hsjgsj, jspjnhgccy hk prjvjkthkd tfj
annurrjknj am jphsa`js am sjhzurjs gk` hts naopchngthak. Aur pgthjkt .!. hs g " yjgrs
ac` ogcj wfa hs `hgdkasj` am gnutj dgstrajktjrhths whtf sjhzurjs.
#h`y, $. %&'7&( )gstrajktjrhths hs gk hkmjnthak am tfj dut. Ht ngusjs `hgrrfjg, gk`
ogy gcsa ngusj vaohthkd, tuooy pghk gk` atfjr syoptaos. Hk oast ngsjs tfj hkmjnthak
ncjgrs whtfhk g mjw `gys, lut saojthojs tgejs cakdjr. #fj oghk rhse hs `jfy`rgthak. #fj
oghk trjgtojkt hs rjfy`rgthak, jknaurgdj tfj nfhc` ta jgt gs karogccy gs passhlcj.
!gky nfhc`rjk fgvj oarj tfgk akj jphsa`j hk g yjgr. #fj sjvjrhty ngk rgkdj
mrao g ohc` tuooy upsjt mar g `gy ar twa whtf saoj ohc` `hgrrfjg, ta sjvjrj `hgrrfjg
gk` vaohthkd mar sjvjrgc `gys ar cakdjr. !gky vhrusjs, lgntjrhg gk` atfjr ohnraljs
%djros( ngk ngusj dgstrajktjrhths.
*ctfaudf amtjk naksh`jrj` g ljkhdk `hsjgsj, gnutj dgstrajktjrhths rjoghks g
og+ar ngusj am oarlh`hty gk` oartgchty hk nfhc`rjk grauk` tfj warc` gnnaukthkd mar 7."
ohcchak `jgtfs gkkugccy hk nfhc`rjk yaukdjr tfgk - yjgrs, ar raudfcy 7- am gcc nfhc`
`jgtfs. *s tfj `hsjgsj sjvjrhty `jpjk`s ak tfj `jdrjj am mcuh` cass, gnnurgtjcy
gssjsshkd `jfy`rgthak stgtus rjoghks g nrunhgc stjp hk prjvjkthkd oartgchty.
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Hk oast nfhc`rjk, tfj syoptaos grj ohc` gk` tfjy tjk` ta djt ljttjr whtfhk g mjw
`gys. Hm vaohthkd annurs, ht amtjk cgsts akcy g `gy ar sa, lut saojthojs cakdjr. hgrrfjg
amtjk nakthkujs gmtjr tfj vaohthkd staps gk` naooakcy cgsts mar ljtwjjk - ta < `gys.
>chdftcy caasj staacs ogy pjrshst mar g wjje ar sa murtfjr ljmarj g karogc pgttjrk
rjturks. >aojthojs tfj syoptaos cgst cakdjr.
*rohk, jt.gc %&''aojthojs gmjlrhcj sjhzurjs
fgvj ljjk ekawk ta annur hk gssanhgthak whtf `jfy rgthak, jcjntracytj holgcgknj,
fypadcynjohg ar fypangcngjohg gk` naopchngtj` gnutj dgstrajktjrhths0 fawjvjr tfj
annurrjknj am gmjlrhcj sjhzurjs `urhkd vhrgc dgstrajktjrhths whtfaut `jfy rgthak ar
jcjntracytj holgcgknj fgs gcsa ljjk rjpartj`.
>jhzurj hs ljchjvj` ta gmmjnt 7 ta & am tfj papucgthak0 gppra:hogtjcy & ohcchak
pjapcj fgvj ljjk `hgdkasj` whtf tfhs `hsar`jr %Chpphknatt Thcchgos = Thcehks &''
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H. @JOAD\GRFHN @GPGG. Hkhthgcs am Nchjkts Kgoj4 .!. @gtj am G`ohsshak9 gkugry
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3j akcy dat 7 `asj am L$), 7 `asj 3jpg L, & `asjs am 2#, akj `asj am
A2N gk` !jgscjs vgnnhkj. #fj pgthjkt `h`k8t jknauktjr gky gnnh`jkts ar mgcc tfus
fj `h`k8t fgvj gky mrgnturj hk tfj pgst, `ajsk8t fgvj gky gccjrdy gk` mhrst thoj ta
sjje oj`hngc ngrj. *nnar`hkd ta 2ulchn 3jgctf 6urshkd, g nfhc` hs sgh` ta lj @5uccy
Hooukhzj` $fhc J wfjk g nfhc` rjnjhvjs akj `asj am L$), " `asjs am A2N whtf gk
hktjrvgc ljtwjjk `asjs am wjjes, " `asjs am 2# whtf gk hktjrvgc ljtwjjk `asjs
am wjjes, " `asjs am 3G2* L whtf M wjjes hktjrvgc mrao 7st`asj ta &k``asj gk` ;
wjjes hktjrvgc mrao &k``asj ta "r``asj.
2gthjkt !8s oatfjr ncghoj` tfgt fj `h` j:pjrhjknj naooak hcckjssjs chej
mjvjr, naudf gk` nac`s. #fj pgthjkt fg` g nfhnejkpa: wfjk fj wgs 7 yjgr ac` gk`
ojgscjs wfjk fj wgs ; oaktfs. >fj ncghoj` tfgt pgthjkt ! fgs ka ekawk
gccjrdhjs hk maa`s gk` hk oj`hngthaks. #fjy `h`k8t rjcy tfgt ounf hk avjr tfj nauktjr
`ruds ljngusj mar fjr ht whcc +ust ogej oarj `jpjk`jkt hk syktfjthn rjoj`hjs gk`
sfj ncghoj` tfgt sfj usugccy usjs cgduk`h gk` arjdgka gs fjrlgc oj`hnhkj. *csa,
fj hs kat tgehkd gky vhtgohks. #wa `gys prhar ta g`ohsshak tfj pgthjkt j:pjrhjknj`
`hgrrfjg, fj `jmjngtjs tfrhnj g `gy whtf yjccawhsf wgtjry staac, ka sach phjnjs,
jkthrjcy ch?uh` whtf sjjk wfhtj pgrgshthn waros gk` gnnaopgkhj` ly gl`aohkgc pghk.
2gthjkt .! gcsa vaohts nfgrgntjrhzj` ly yjccawhsf ch?uh` `hsnfgrdj jvjry thoj fj
wgs mj` ly fhs oatfjr. 3hs oatfjr gcsa ncghoj` tfgt hk tfjhr mgohcy, tfjrj grj ka
fhstary am fjrj`htgry `hsjgsjs sunf gs `hgljtjs gk` fypjrtjkshak. #fj pgthjkt `h`k8t
jknauktjr gky gnnh`jkts ar mgcc tfus fj `h`k8t fgvj gky mrgnturj hk tfj pgst. 2gthjkt
!8s oatfjr ncghoj` tfgt ht hs fhs mhrst thoj ta lj fasphtgchzj`.
]. FJ\J@A- MGOHCHGC FH^PA\X
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Hktjrprjtgthak9
#fj djkadrgo hs g phntarhgc `hspcgy am pgthjkt8s .!8s mgohcy rjcgthaksfhp gk`
oj hngc fhstary. Ht sfaws tfj tfrjjDdjkjrgthak mgohcy am tfj pgthjkt. #fj `hgdrgo
hkncu`js tfj nurrjkt gdjs gk` nurrjkt fjgctf stgtus am jgnf mgohcy ojoljr mrao tfj
tfrjj djkjrgthak mrao tfj pgthjkt.
#fj pgtjrkgc gk` ogtjrkgc sh`j am tfj pgthjkt hk latf am fjr drgk`pgrjkts wjrj
`jg` lut tfj oatfjr wgs kat surj mar tfj j:gnt ngusj am fjr `jgtf.
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Hk >jnak` )jkjrgthak, oast am tfj mgohcy ojoljrs wjrj gchvj gk` wjcc. #fjy
`ak8t fgvj gky `hsjgsjs tfgt wjrj fjrj`htgry.
5ar tfj tfhr` djkjrgthak, fhs ac`jr shstjr `hj` hk tfj &''1 ljngusj am sjpshs.
+H. @J+J,AROJKPG, FH'PA\-
Jrh Jrhsaks Rs%$!asa$hgc @j"jca)ojkt P!jar%
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ljdhks ta hohtgtj pgrjkts `ahkd
fausjfac` nfarjs. @!gfhchd shygkd
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ekaws fhs awk kgoj gk` gcrjg`y
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#fj nfhc` fgs ta cjgrk ta
naktrac fhs ar fjr la`hcy kjj`s.
*nnar`hkd ta tfj pgthjkt8s oatfjr,
@Fgpgd kgtgtgj a kghhfh shyg
kgdgsgsglh shyg sg gehk gt
shkgsgogfgk eaJ. 3hs pgrjkts
uthchzj prghsj gk` rjwgr`s mar
ushkd tfj tahcjt.
*jgk Rhgjts Nakhth"j @j"jca)ojkt P!jar%
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'tgj ')j$hmh$ Pgs/s2J"h`jk$js am Ohcjstakj
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prjtjk` pcgy lut sthcc struddcj
whtf cadhn gk` tgehkd tfj pahkt
am vhjw am atfjr pjapcj.
*nnar hkd ta fhs oatfjr, @!gfhchd
shyg ogehpgdcgra ohksgk
ogcgwge yukd hogdhkgthak khyg.
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*nnar hkd ta fhs oatfjr, tfj
pgthjkt fgs g wh`j hogdhkgthak,
chejs ta `hsnavjr kjw tfhkds. 3j
hs stgrthkd ta ljnaoj nurhaus hk
saojtfhkd fj sjjs, chejs ta
?ujsthak gk` hkvjsthdgtj kjw
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jcsj, sunf gs prjtjk`hkd g lraao
hs g farsj, g la: hs g tglcj gk` g
phjnj am pgpjr hs ljhkd pcgtj. 3j
pcgys whtf tfj atfjrs gk` nrjgtjs
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rjprjsjktgthakgc tfaudfts gk`
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,g#rjk$j 7a!c
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gmmjnthak gk` gppravgc0 mar
atfjr gnthaks, pgrjkts snac`
gk` cgljc tfj ljfgvhar
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stgdj ta prghsj g ta``cjr mar
`ahkd wfgt fj ar sfj fgs
ljjk gsej` ta `a.
gnthaks. >fj vjrlgchzj`, @Fgpgd
kgohohcht shygkd ogdcglg rhk
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shkgsglhfgk ea cgkd shygkd
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shyg lhlhdygk ea shyg kd
prjoya. !hksgk tgtgfhohe cgkd
shyg. 2jra ogy odg grgw rhkd
kgdpupuohcht shyg gt kgdDhhyge.
+HH. DA\@AK' >> &ZKNPHAKG, FJG,PF RGPPJ\K'
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>fj ncghoj` tfgt tfj pgthjkt `h` j:pjrhjknj naooak hcckjssjs chej mjvjr,
naudf gk` nac`s. *t tfj gdj am 7 tfj pgthjkt staps `rhkehkd ohce lut hkstjg` fj hs
`rhkehkd nammjj. 3hs oatfjr ncghoj` tfgt wfjkjvjr fj dat shne, tfjy `h`k8t gcrjg`y
tgej fho ta tfj fasphtgc ljngusj am cgne am oakjy. #fjy grj ushkd fjrlgc
oj`hnhkjs mar oj`hngthaks chej arjdgka gk` cgduk`h. #fjy rgtfjr prjmjr fjrlgc
oj hnhkjs gs g rjoj`y wfjkjvjr fj dat shne. #fj pgthjkt hs kat tgehkd gky
vhtgohks.
*t prjsjkt, tfj oatfjr pjrnjhvjs tfgt tfj djkjrgc fjgctf am fhs sak wgs
naopraohsj`. #fj oatfjr ncghoj` tfgt ht hs tfj mhrst thoj tfgt tfj pgthjkt fg` g
sjrhaus nak`hthak gk` fasphtgchzj` mar gcoast " wjjes.
. Kut$+t+akg#-Ojtg!a#+, Rgttj$k
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*nnar`hkd ta fhs oatfjr, tfj pgthjkt usj` ta lrjgstmjj` tfjk fj stgrtj`
`rhkehkd maroucgtj` ohce gt 7 yjgr ac`. *nnar`hkd ta fhs oatfjr, fj chejs ta rhke
nammjj0 fj stgrtj` `rhkehkd wfjk fj wgs 7 yjgr ac` ljngusj saojthojs tfjy
wjrj kat glcj ta purnfgsj ohce. 3j usj` ta jgt mruhts, vjdjtglcjs, ojgt, gk` rhnj
`ghcy. 3j gtj tfrjj thojs g `gy gk` tfgt hkncu`js lrjgemgst, cuknf, gk` `hkkjr. 3hs
typhngc `ghcy mcuh` hktgej hs "D dcgssjs am wgtjr. #fj saurnj am tfjhr wgtjr ngoj
mrao tfj mgunjt gk` `h`k8t lahc ht. #fj pgthjkt gcsa jgts whtf lgrj fgk` whtfaut
wgsfhkd ht gmtjr pcgyhkd hk tfj mgro.
Tfjk fj wgs fasphtgchzj`, tfj pgthjkt fg` cass gppjthtj gk` cgne am
hktjrjst ak jgthkd, gk` saojthojs fj +ust usugccy gtj lrjg` gk` nammjj mar tfj
wfacj `gy. 3hs oatfjr gcsa ncghoj` tfgt wfjkjvjr fj jgts fj su``jkcy vaohts
whtf yjccawhsf `hsnfgrdj. pak pfyshngc j:gohkgthak, tfjrj grj " `jktgc ngrhjs4 7
gt tfj cjmt cawjr oacgr, 7 hk rhdft cawjr oacgr gk` 7 hk prjoacgr. #fj pgthjkt `h`k8t
tgej gky vhtgohks ar suppcjojkts.
#fj pgthjkt `ajsk8t fgvj gky pralcjo ak nfjwhkd gk` swgccawhkd. 3j
gcsa fg` `ry sehk gk` paar sehk turdar wfhnf hk`hngtjs `jfy`rgthak. *nnar hkd ta
tfj `antar8s ar`jr fj hs oghktghkj` ak mjj` whtf >*2. 3j gcsa `jnrjgsjs la`y
wjhdft mrao 77ed ta 7'ed gs tgejk upak pfyshngc j:gohkgthak. #fj pgthjkt fgs
gk HN hkmushak am -H!L sacuthak hk -''oc, rjducgtj` gt ;D1 uddts ak fhs cjmt
ojtgngrpgc vjhk. Ht hk hngtj` mar tfj oghktjkgknj am mcuh` gk` jcjntracytjs
jspjnhgccy ta pgthjkts wfa kjj` ngcarhjs gk` fy`rgthak. #fj HN chkj wgs hkmushkd
wjcc gk` ka ghr gk` lgne mcaw sjjk.
N. J#+o+kgt+ak
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Ljmarj fasphtgchzgthak, gnnar`hkd ta pgthjkt8s oatfjr fj usj` ta `jmjngtj
rjducgrcy mar glaut " thojs g wjje. #fj mjngc nfgrgntjrhsthn wgs lrawk hk nacar,
schdftcy samt whtf sjpgrgtj` cuops whtf sjohsach` tj:turj. 3j `ajs kat fgvj gky
`hmmhnucty ar pralcjos hk naktracchkd gk` hkmaros fjr oatfjr wfjk ta urhkgtj gk`
`jmjngtj. 3j urhkgtjs " ta thojs `ghcy whtf chdft yjccaw hk nacar. *nnar`hkd ta
5uk`gojktgcs am 6urshkd
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fhs mrhjk` gk` shlchkd jvjry `gy. Tfjk fj hs gt faoj, fj usugccy wgtnfjs
tjcjvhshak ljmarj dahkd ta scjjp. Ljngusj fj hs sthcc yaukd fj `ajsk8t fgvj gky
maro am j:jrnhsjs.
Tfjk fj wgs fasphtgchzj`, fj mjct vjry wjge gk` thrj` `uj ta j:njss
vaohts gk` `jmjngthkd. 3j caaes pgcj gk` cjtfgrdhn. 3hs pfyshngc gnthvhty cjssjks
gk` fj gcwgys tjk`s ta scjjp mar naksjrvgthak am fhs jkjrdy. *csa, fj kjj`s
gsshstgknj wfjkjvjr dahkd ta tfj lgtfraao ar jvjk stgk`hkd up hk prjvjkthkd
gnnh`jkts jspjnhgccy mgcc.
#fj pgthjkt gcsa ljnaoj hrrhtglcj gk` nrhjs mrj?ujktcy jspjnhgccy wfjk fj
sjjs g pjrsak `rjssj` hk wfhtj ukhmaro gk` `ahkd tfj rauk`s wfhnf hs us,
stu`jkt kursjs gk` tfj rjdhstjrj` kursjs ht wgs ngccj` Tfhtj $agt *k:hjty. >trjss
gk` gk:hjty pcgy g fudj racj hk tfj `jvjcapojkt am wfhtj nagt syk`raoj. Hm yau
fg` g lg` j:pjrhjknj whtf oj`hngc `hgdkashs gk` trjgtojkt hk yaur nfhc`faa`, ht8s
vjry passhlcj tfgt kaw yau grj sulnaksnhauscy gmrgh` am gcc `antars ljngusj tfjy
rjohk` yau am yaur pgst trguog. Hk tfj kj:t mjw `gys tfj pgthjkt sfaws ka
hktjrjst hk pcgyhkd, fj ljnaoj oarj hrrhtglcj gk` wjge.
7gt0 Hk`j: am Hk`j)jk`jk$j hk G$th"hthjs am @ghc% ,h"hk
*nthvhthjs Hk`jpjk`jknj %7(jpjk`jknj %'(
Lgtfhkd '@rjsshkd '
Pahcjthkd 'Prgksmjrrhkd 'bbNakthkjknj '
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Mjj`hkd 'PAPGC
RAHKP^9'
Hktjrprjtgthak9
#fj pgthjkt wgs muccy `jpjk`jkt ta fhs oatfjr. 3j sjjes duh`gknj
gk` gsshstgknj whtf fhs oatfjr.
J. ^#jj*-\jst
*nnar`hkd ta tfj pgthjkt8s oatfjr, ! gcoast spjk`s fhs wfacj `gy
scjjphkd. 3j usugccy wgejs up M go gk` scjjps 7' po. #fj `urgthak am fhs scjjp
hs +ust jkaudf mar fhs `jvjcapojkt. urhkd spgrj thoj, sfj spjk`s ht ly pcgyhkd
whtf fhs mrhjk`s gk` naushks gk` fj gcwgys tgej gk gmtjrkaak kgp mrao 7& po ta
po.
urhkd fasphtgchzgthak, tfj oatfjr ncghoj` tfgt fj `ajsk8t fgvj gky
jkaudf scjjp jspjnhgccy wfjk tfj kursjs wjrj `ahkd tfjhr rauk`s gk` tgehkd vhtgc
shdks. #fj pgthjkt usugccy scjjps - faurs mar jvjkhkd tfjk fgs g kgp mar & faurs
hk tfj gmtjrkaak. 3hs scjjphkd `hsturlgknjs wjrj fhs gl`aohkgc pghk gk` fat
raao tjopjrgturj. Ljmarj dahkd ta scjjp fj gcwgys prgyj` gs fhs oatfjr
tjgnfjs fho.
3hs oatfjr stgtj` tfgt fj gcwgys sohcjs gmtjr wgehkd ukchej kaw tfgt fj
usugccy nrhjs wfjk fj wgejs up gk` wfjk fjr oatfjr cjgvjs fho wfhcj fj wgs
sthcc scjjphkd. #fj oast naomartglcj scjjphkd pashthak am 2gthjkt .! wgs sh`j
cyhkd pashthak whtf 7 phccaw ak tfj fjg` gk` `ajsk8t wgkt g lcgkejt.
M. Na&k+t+vj / Rj$,j*tug#
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Ljmarj fasphtgchzgthak, pgthjkt ! fgs ka pralcjo hk sojcc, vhshak gk`
fjgrhkd jvjk tfaudf fj wgs j:pasj` ak cau` kahsj gt tfjhr faojs. 3j hs g vjry
pcgymuc pjrsak gk` vjry mrhjk`cy whtf atfjrs.
2gthjkt .! jgshcy manusjs gttjkthak jspjnhgccy wfjk fj wgtnfjs
tjcjvhshak. 3j ngk gcsa jgshcy rjojoljr kgojs, pcgnjs gk` kuoljrs. 3j ngk
gcsa maccaw gk` uk`jrstgk` `hrjnthaks.
urhkd fasphtgchzgthak gk` upak tfaraudf pfyshngc j:gohkgthak, 2gthjkt
! fgs ka pralcjo whtf fhs fjgrhkd, sojcc gk` whtf fhs vhshak lut fg` nfgkdjs hk
tgstj am maa`s gs jvh`jknj` ly cass am gppjthtj gk` nfaashkd g vhgk`. #fj pgthjkt
fg` j:pjrhjknj` pghk hk tfj gl`aojk gk` sfaws dugr hkd ljfgvhar gk`
hrrhtglhchty.
D. ^j#2-Rj$,j*t+ak - ^j#2-,ak,j*t Rgttj$k
#fj pgthjkt hs " yjgrs ac`, nurrjktcy j:pjrhjknhkd pghk gk` wgs kat glcj ta
sgy gkytfhkd glaut fhosjcm. *s stgtj` ly tfj oatfjr, pgthjkt .! gs g nfjjrmuc,
kgudfty, g cavhkd sak gk` lratfjr. Ljmarj fasphtgchzgthak, fj wgs glcj ta dghk
trust ta gkyakj lut wfjk fj wgs stgrtj` ta g`ohttj`, fj jgshcy djts hrrhtgtj`
ljngusj am tfj golhgknj hk tfj fasphtgc gs wjcc gs wfjk tfj kursj `ahkd tfjhr
rauk`s ljngusj fj ngkkat rjst wjcc. #fj oatfjr gcsa ncghoj` tfgt sfj ekjw tfgt
tfj pgthjkt8s fjgctf wgs tfjk naopraohsj` gk` wgs kat glcj ta pcgy chej ljmarj.
7" / 2 g d j
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F. \a#j \j#gt+aksf+*
2gthjkt ! hs tfj yaukdjst goakd tfj nfhc`rjk am fhs pgrjkts. 3j chvjs
whtf fhs cavhkd pgrjkt gk` shlchkd. *nnar hkd ta fhs oatfjr, fj gcwgys ogejs
tfjo fgppy wfjkjvjr fj sohcjs gk` gcwgys pcgyhkd whtf fhs ac`jr lratfjrs. 3hs
pgrjkts usugccy vhsht gk` tgej daa` ngrj am fho ljngusj tfjy sgh` tfgt tfjhr nfhc`
wgs vjry hopartgkt ta tfjo. #fj pjrsak wfa spjk`s cakd pjrha` am thoj whtf tfj
pgthjkt hs fhs oatfjr gk` ht hs jvh`jknj` tfgt tfj pgthjkt hs rjnjhvhkd jkaudf ngrj
gk` cavj.
urhkd tfj hktjrvhjw fhs pgrjkts wgs tatgccy warryhkd glaut tfj pgthjkt8s
nak`hthak. Ht sjjos tfgt tfjy rjgccy ngrj hk tfjhr yaukdjst nfhc`. #fjy ogkgdj tfj
pgthjkt ly dhvhkd gk j:trg ngrj ta fjcp fho rjnavjr ly fhs hcckjss. *s am kaw, tfjhr
hknaoj wgs kat jkaudf mar tfj fasphtgc j:pjksjs, ljngusj fhs mgtfjr8s +al wgs
hksummhnhjkt mar tfjhr `ghcy chmj. #fjy trust )a` tfgt tfjhr sak whcc lj fjgcj`.
H. ]g#uj / j#+j2 Rgttj$k
*nnar hkd ta fhs oatfjr, 2gthjkt ! wgs lgpthzj` gs 9aogk $gtfachn gk`
jvjry >uk`gy tfjy wjkt ta nfurnf whtf fhs mgohcy. 3j prgnthnjs prgyhkd ljmarj
scjjphkd gt khdft. 3hs oatfjr sgh` tfgt )a` fjcps tfjo ta djt tfraudf whtf tfjhr
pralcjos hk chmj. 9jchdhak mar tfjo wgs vjry hopartgkt. #fjy trust gk` dghk strjkdtf
ly )a`. #fjy ljchjvj` tfgt tfjhr sak whcc lj fjgcj` saoj`gy.
urhkd fasphtgchzgthak, 2gthjkt ! hs kat gnthvj hk dahkd ta nfurnf ljngusj fj
hs sthcc hk fasphtgc gk` tfj pgthjkt kjj`s dugr`hgk. jsphtj am ht, fhs oatfjr gk`
7 / 2 g d j
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pgthjkt .! wjrj sthcc prgyhkd mar fhs mgst rjnavjry. Hk tjros am oj`hngc gppragnfjs,
fhs oatfjr rjchjs hkta tfj fjrlgc oj`hnhkjs gk` ncghoj` tfgt sfj `ajsk8t rjcy taa
ounf ak tfj avjr tfj nauktjr `ruds. #fjy gcsa ljchjvj hk ?ugne `antars gk`
ljchjvj` hk supjrsththaus gs jvh`jknj` ly djtthkd tfj fjhdft am tfj pgthjkt wfhcj fj
wgs scjjphkd lut tfj oatfjr rj+jntj` ljngusj sfj ljchjvjs tfgt ht hs chej djtthkd tfj
shzj am tfj nammhk. *s g stu`jkt kursj, wj uk`jrstgk` gk` rjspjntj` tfjhr nucturj gk`
ljchjms.
Hk tfj kjgr muturj, tfjy wgkt tfjhr nfhc` ta ljnaoj sunnjssmuc gk` mhkhsfj` fhs
stu`hjs saoj`gy. #fj oast hopartgkt tfhkds hk tfjhr chmj wjrj 2gthjkt .! gk` tfjhr
mgohcy.
+HHH. NAOR\JFJK'H+J RF-'HNG, J=GOHKGPHAK
G. +htgc 'hks
*gk(gr% 468 46>
PHOJ
Pjo)jrgt(rj \gtj
/5N2
R(csj \gtj
/
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` Fjh!t9 1; noj 3jh!t977 ed
La`% Ogss Hk`j:9
&aro(cg9 /Lgsj ak ONK ?t!
j`. 1BB&ar %jgrs ac`9 La%2LOHTjhdft %ed( E >tgturj %no( E >tgturj %no( : 7',''' Ar Tjhdft %cl( E >tgturj %hk( E >tgturj %hk( : tgturj %no( E >tgturj %no( : 7',''' 77 ed E 1; no E 1; no E : 7','''LOH >>.? ar (k`jr ka(rhs!
N. DJKJ\G, GRRJG\GKNJ9
2gthjkt ! djkjrgccy caaes pgcj gk` cjtfgrdhn. #fj la`y wgs chdft luhct whtf sogcc
+ahkt gk` fhs ousncj wgs cjgk. 5cgnnh`hty wgs jvh`jkt whtf tfj pgthjkt gk` wgs kat
rjcg:j`. #fj sehk wgs ncjgk, kghcs wjrj kjgt. 3j fgs ka ukusugc la`y gk` lrjgtf a`ar.
2gthjkt ! fgs naoprjfjkshlcj tfaudfts gk` fhs vahnj ngk lj fjgr` hk oa`jrgtj
pgnj.
7M / 2 g d j
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Nj)!gca$g(`gc Gssjssojkt
/Lgsj` ak t!j N!hc`rjk +grhgthaks2
7< / 2 g d j
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@. Nj)!gca$g(`gc Gssjssojkt9
/Lgsj` ak t!j N!hc`rjk +grhgthaks2
La`% Rgrt
J:gohkj`
Karogc &hk`hk G$t(gc &hk`hk Nchkh$gc 'hkhmh$gk$j
HKPJDZOJKPG\- '-'PJO
^7+kehk nacar rgkdjs
mrao pgcj wfhtj
whtf phke, yjccaw,
ar achvj takjs ta
`gre lrawk ar
lcgne.
H4 Ksehk nacar hs
lrawk
Kmcusfj` sehk
Hkspjnthak rjvjgcs jvjkcy
nacarj` sehk takjs, whtfaut
ukusugc `hsnacargthaks.
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt
>ogcc goaukt am ojcgkhk
grj naooak hk wfhtjr sehks,
wfhcj cgrdj goaukts am
ojcgkhk grj naooak hk
achvj gk` `grejr sehks.
$gratjkj gnnaukts mar g
yjccaw ngst.
*lkarogc mhk`hkd4 5cusfj`
sehk `uj ta hknrjgsj la`y
tjopjrgturj.
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a`ar, O6a strakd a`ar
sfauc` lj jvh`jkt.
H4 Kka strakd
a`ar
Kpramusj
swjgthkd
*nnar`hkd ta 3jgctf =
2fyshngc *ssjssojkt hk
6urshkd ly 8*ohna gk`
Lgrlgrhta tfgt Ohgpfarjshs
%pramusj swjgthkd( annurs
`urhkd j:jrthak, pghk, gk`
joathakgc strjss.
OC*L4 Hknrjgsj cjvjc am
$rjgthkhkj hk 77M.-1uoacEC
ngusj `jfy`rgthak ar
hkg`j?ugtj wgtjr hktgej
sunf gs swjgthkd ngk ngusj
lcaa` naknjktrgthak gk`
rj`unj` lcaa` mcaw hk tfj
eh`kjys. nrjgthkhkj whcchknrjgsj.
gk` cjshaks. Osehk sfauc` lj
cjshak mrjj.
H4 Kwhtf cjshaks hk
tfj latf cawjr
j:trjohthjs
Kwhtf htnfhkjss
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt
fgvhkd cjshaks hk tfj sehk
wgs `uj ta hksjnt lhtjs.
2gcpgtj mar
tjopjrgturj,
O>ehk hs karogccy
wgro tjopjrgturj.
2g4 K wgro ta
taunf
K"ehk phknfjs
jgshcy gk`
hooj`hgtjcy
rjturks ta htsarhdhkgc pashthak.
2g4 Kpaar sehk
turdar
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt sehk
hs kat ?uhnecy g rjturk taarhdhkgc sfgpj gmtjr ljhkd
phknfj`. 2aar sehk turdar
hk`hngtjs `jfy`rgthak.
OC*L>4 * cawjrDtfgkDkarogc
cjvjc am nfcarh`j %;;.-
ooacEC( hs ngccj`
71 / 2 g d j
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fypanfcarjohg. Ht ogy lj
`uj ta jfy`rgthak.
Djfy`rgthakar g`hjtfhdf
hk pratjhk ngk ogej yaur
L6 cjvjc fhdfjr %&".&'EC(.
D * cawjrDtfgkDkarogc cjvjc
am nfcarh`j %;;.- ooacEC( hs
ngccj` fypanfcarjohg. Ht
ogy lj `uj ta jfy`rgthak.
gk` j`jog. O>ehk rjlauk`s
gk` `ajs kat
rjoghk hk`jktj`
wfjk prjssurj hs
rjcjgsj`.
2g4 Kka j`jog *nnar hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak hs
*lsjknj am j`jog ogy
hk`hngtj g `jsnjkt sehk
nak`hthak.Fg+$ncjrg hs
wfhtj.H4 hrhs gk` tfj
puphcs.
O2uphcs grj j?ugc,
rauk`, gk`
rjgnthvj ta chdft
gk`
gnnaooa`gthak
%2G99C*(.
H4 Kj?ugc
K rjgnthvj ta
chdft gk`
gnnaooa`gthak
Kkarogc gk`
j?ugc hk shzj
KhrhsDrauk`, mcgt,
gk` jvjkcy
nacarj`
KpuphcD rauk`whtf rjducgr
lar`jr, hs
njktrj` hk hrhs.
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt tfj
hrhs hs typhngccy rauk`, mcgt,
gk` jvjkcy nacarj`. #fj
puphc, rauk` whtf g rjducgr
lar`jr, hs njktrj` ak tfj hrhs.
5hkgccy hkspjnt
tfj jyjlraw gk`
jyjcgsfjs.
OGyjlraws
sfauc` lj
syoojtrhn hk
H4 Kjvjkcy
`hstrhlutj`
Kjyjlraws
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt tfj
&" / 2 g d j
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sfgpj gk`
oavjojkt. #fjy
sfauc` kat ojjt
hk oh`chkj.
OGyjcgsfjs
sfauc` lj jvjkcy
`hstrhlutj` gk`
nurcj` autwgr`.
`ajs kat ojjt hk
tfj oh`chkj
Ksyoojtrhn hk
sfgpj gk`
oavjojkt.
jyjlraws sfauc` lj
syoojtrhn hk sfgpj gk`
oavjojkt.
Jg$s gk Fjg$+k&
H4 gu$+,#jsmar
nacar, syoojtry
gk` pashthak
O#fj jgrs grj
jvjkcy nacarj`. Ht
hs j?ugc hk shzj
lhcgtjrgccy.
H4 Kgurhncj gchdks
whtf tfj narkjr am
jgnf jyj
K lhcgtjrgccy
j?ugc hk shzj
Knacar hsnakshstjkt whtf
mgnhgc nacar
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt tfj
nacar, pashthak gk` tfj
syoojtry am tfj jgrs sfauc`
lj h`jkthngc gk` ukhmarocynacarj`. #fj gchdkojkt am
tfj gurhncj ogej strghdft ta
tfj narkjr am tfj jyj.
4 jtj$kg# ,gkg#
mar njruojk
O* sogcc goaukt
am a`arcjss
njruojk hs tfj
akcy `hsnfgrdj
karogccy prjsjkt.
H4 K6arogc
goaukt am
yjccawhsf
njruojk upak
gssjssojkt hk
fjr jgr.
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt tfjrj
sfauc` lj ka j:njsshvj
njruojk.
5aucDsojcchkd, sthney, yjccaw
`hsnfgrdjRathths j:tjrkg arhopgntj` marjhdk la`y.
cjshaks, pus ar
lcaa`
O#fj ngkgc wgccs
sfauc` lj phke
gk` soaatf gk`
whtfaut ka`ucjs.
H4 Kka cjshaks,
pus ar lcaa`
prjsjkt gs sjjk
whtf tfj usj am
pjkchdft.
Kka `hsnfgrdj
prjsjkt
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt kakD
gppjgrgknj am cjshaks gk`
lcaa` hs karogc. Lcaa`y,
purucjkt `hsnfgrdjRathths
oj`hg whtf rupturj`
tyopgkhn ojolrgkj.
24 gu$+,#jsmartj:turj, jcgsthnhty
gk` grjgs am
tjk`jrkjss
O#fj sehk hssoaatf whtf ka
cjshaks, cuops, ar
ka`ucjs. 6arogccy
tfj gurhncj hs kat
tjk`jr.
2g4 K#fj gurhncjsgrj soaatf. Ht hs
saojwfgt jcgsthn
Kka
tjk`jrkjss
*nnar`hkd ta Tjlljr =Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt g
pghkmuc gurhncj hs gssanhgtj`
whtf athths j:tjrkg ar g past
gurhnucgr nyst.
Kasj gk ^+kusjs.
& / 2 g d j
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H4 kasj `jvhgthak
hk sfgpj, shzj,
nacar, mcgrhkd,
`hsnfgrdj
O $acar hs tfj
sgoj gs tfj rjst
am tfj mgnj0 tfj
kgsgc strunturj hs
soaatf gk`
syoojtrhn.
H4 K#fj kasj hs
syoojtrhnE hs hk
oh`chkj am tfj
mgnj.
K $acar hs tfj
sgoj gs tfj
mgnj. K6a mcgrhkd
%rj`kjss( ar
`hsnfgrdj
prjsjkt
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt tfj
nacar hk j:tjrkgc kasj hs
sgoj gs tfj rjst am tfj mgnj0
tfj kgsgc strunturj hs
soaatf gk` syoojtrhn.
Ljngusj, 5cgrhkd ar
`hsnfgrdjs hs gk glkarogc
shdks.
4 kgsg# ou,asg
mar rj`kjss,
swjcchkd, drawtf
ar `hsnfgrdj
O #fj kgsgc
ounasg hs `gre
phke, oahst, gk`
mrjj am j:u`gtjs.
#fj kgsgc sjptuohs hktgnt gk` mrjj
am ucnjrs ar
pjrmargthaks.
H4 K6a rj`kjss,
swjcchkd, ar
`hsnfgrdjs am
kgsgc ounasg.
Kphke hk nacar
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt tfj
kgsgc ounasg hs `gre phke,
oahst, gk` mrjj am j:u`gtjs.#fj kgsgc sjptuo hs hktgnt
gk` mrjj am ucnjr ar
pjrmargthaks.
G:njsshvj gnnuoucgthak am
ounus sjnrjthak rjsucts ta
nac`s.
2gcpgtj tfj
shkusjs hk ac`jr
nfhc`rjk hm
shkushths hssuspjntj`.
O6a tjk`jrkjss
pgcpgtj` avjr
shkusjs.
2g4 Kka
tjk`jrkjss
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt hm
tfjrj hs g tjk`jr shkusjssuddjst shkushths.
Oautf gk Pf$agt
H4 #+*sgk`
o($a(s
ojo
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L6 cjvjc fhdfjr %&".&'EC(.
D * cawjrDtfgkDkarogc cjvjc
am nfcarh`j %;;.- ooacEC( hs
ngccj` fypanfcarjohg. Ht
ogy lj `uj ta jfy`rgthak.
4 tjjtfmar
gchdkojkt, cass,
`jktgc mhcchkds gk`
ngrhjs.
Ojnh`aus tjjtf
ljdhk ta `jvjcap
ljtwjjk gk` M
oaktfs0 gcsa &'
jrupt ly "M
oaktfs0 tjjtf
ljdhk ta mgcc aut
grauk` M yjgrs,
wfjk pjrogkjkt
taatf jrupthak gk`pradrjssjs ukthc
gcc "& fgvj
jruptj`.
H4 K" jktgc
ngrhjs, 7 gt tfj
cjmt cawjr oacgr
gk` 7 hk rhdft
cawjr oacgr0 7 hk
prjoacgr
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r` j`hthak tfgt
taatf `jngy %ngrhjs( ogy
gppjgr gs lrawk `ats ar
navjr oarj j:tjkshvj grjgs
am nfjwhkd surmgnj. * nfgcey
wfhtj grjg hk tfj taatf
surmgnj hs g ngvhty tfgt whcc
turk `grejr whtf thoj.
4 &uosmar
lcjj`hkd, nacar,
rjtrgnthak,
cjshaks, swjcchkd
O )uos grj phke,
oahst, gk` mhro
whtf thdft ogrdhks
ta tfj taatf. O6a
cjshaks ar
ogssjs.
H4 K phkehsf duos,
whtfaut tfj
prjsjknj am
lcjj`hkd,
cjshaks, swjcchkd,
ar duo rjtrgnthak
gs alsjrvj`.
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt 9j`,
swaccjk duos tfgt lcjj`
jgshcy grj sjjk hk dhkdhvhths,
snurvy %vhtgohk $
`jmhnhjkny(, gk` cjuejohg.9jnj`hkd rj` duos whtf
cass am tjjtf grj sjjk hk
pjrha`akthths. Ht hs glkarogc
hk yaukdjr nchjkts.
4 tak&ujmar
pashthak, nacar =
tj:turj
O #akduj sfauc`
lj phke, oahst, g
oa`jrgtj shzj
whtf pgphccgj
prjsjkt, gk`
syoojtrhn hkpashthak.
H4 K takduj wgs
phke hk nacar whtf
wfhtj nacargthak,
oahst, gk`
syoojtrhn.
K#fjrj hs gprjsjknj am
pgphccgj ak ht.
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt
goakd passhlcj
glkarogchthjs grj `jjp
cakdhtu`hkgc mhssurjs sjjk hk`jfy`rgthak0 g lcgne takduj
hk`hngthvj am lhsoutf
ta:hnhty4 lcgne, fghry takduj0
g soaatf, rj``hsf, sfhky
takduj whtfaut pgphccgj
hk`hngthvj am khgnhk ar L7&
&M / 2 g d j
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`jmhnhjknhjs, njrtghk gkjohg,
gk` gkthkjapcgsthn tfjrgpy.
oavjojkt O #fj takduj
ammjr strakd
rjshstgknj.
H4 K takduj
oavjs wfjk
hkstrunthkd tfj
pgthjkt ta oavj
ht.
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt
jnrjgsj` takduj strjkdtf
ogy annur whtf g `jmjnt am
tfj WHH nrgkhgc kjrvj
%fypadcassgc( ar whtf g sfart
mrjkucuo tfgt chohts oathak.
4 *g#gtjsmar
nacar, sfgpj,
tj:turj, prjsjknj
am laky
praohkjknjs
O #fj fgr` pgcgtj
hs pgcj ar wfhthsf
whtf mhro,
trgksvjrsj rudgj.
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DDphkehsf gk`
soaatf
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pgcgtjDDD mhro gk`
fgs tfj prjsjknj
am trgksvjrsj
rudgj.
*nnar`hkd ta Tjlljr =
Fjccjy 3jgctf *ssjssojkt hk
6urshkd "r`j`hthak tfgt *
ngk`h`gc hkmjnthak ogy
gppjgr gs tfhne wfhtj
pcg?ujs ak tfj fgr` pgcgtj.
4 uvu#gmar
pashthak =
oalhchty
O #fj uvucg hs g
mcjsfcy, sach`
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tfj oh`chkj.
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ar j:u`gtjs mraouvucg gk`
syoojtrhn
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samt pgcgtj.
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syoojtrhn gk`
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sgyhkd @gggfJ.
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Fjccjy 3jgctf *ssjssojkt hk
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pgcgtj mghcs ta rhsj gk` uvucg
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hk`hngtjs whtf nrgkhgc kjrvj
W %vgdus( pgrgcyshs.
6atj tfj
nak`hthak am tfj
tfragt gk` takshcs
O#akshcs grj
jgshcy sjjk ly
gdj M wfjk tfjy
hknrjgsj ta g`uct
`hojkshaks.
H4 K#akshcs grj
karogccy phke
gk` syoojtrhn.
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cjshaks.
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6urshkd "r`j`hthak tfgt tfj
latf takshcs grj mauk`
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6urshkd "r`j`hthak tfgt g
systachn fjgvj hm ogy
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&< / 2 g d j
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ht `raps ta tfj -tf.
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tfj oh`ncgvhnucgr
chkj %!$C( ukthc
gdj .
ar vhlrgthaks grj
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am gpj:
jkcgrdjojkt. *phngc pucsj
tfgt hs kat hk prapjr cangthak
mar gdj ogy hk`hngtj
ngr`haoyapgtfy,
pkjuoatfarg:, ar
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am tfj gphngc
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rjsthkd rgtjs vgry
whtf tfj gdj am
tfj nfhc`4
& yjgrs ta 7'
yjgrs4
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&'7(
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rjsakgknj hs tfj
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jchnhtj` hk yaukd
nfhc`rjk.
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6urshkd "r`j`hthak tfgt ht hs
6arogc `uj ta tfj tfhkkjss
am tfj nfjst wgccR#fhs
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wgccs.
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yjgrs am gdj,
tfj gl`aojk hs
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suphkj pashthak
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gl`aojk hk`hngtjs am
ogckutrhthak.
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jvh`jkt
fjrkhgthak am tfj
uolhchnus.
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6urshkd "r`j`hthak tfgt tfj
olhchnus hs shohcgr sehk
takj ta tfj surrauk`hkd hk
gl`aojk whtf jvjkcy
phkehsf. *k` ht hs hk tfj
&1 / 2 g d j
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oh`chkj gt cgtjrgc chkj.
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sauk`s prjsjkt
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drawcs. Lruht hs kat karogccy
fjgr`.
2gcpgtj
gl`aojk mar
samtkjss ar
fgr`kjss.
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ta pgcpgthak gk`
whtfaut ogssjs ar
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K ka
tjk`jrkjss
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pgcpgtj
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ta pgcpgthak gk` whtfaut
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gdj am tfj pgthjkt.
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hk sogcc nfhc`rjk.
2g4 Krhkgry
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ogy hk`hngtj am urhkgry
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g ogss.
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cjshaks.
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katj`.
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rgsfjs.
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6urshkd "r`
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`gre lrawk,
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Hm tfjrj hs rj`kjss, j`jog,
gk` tjk`jrkjss ht hk`hngtjs
am ogsthths.
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`jpjk`hkd ak tfj
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ka cjshaks grj
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mrjj hs 6arogc whtf tfj gdj
am tfj pgthjkt.
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gk` tjstjs.
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am cjshaks.
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6urshkd "r` j`hthak tfgt
cjshak mrjj, j?ugc hk shzj,
soaatf, oalhcj, gk` tjstjs
"7 / 2 g d j
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cjmt tjsthncj
usugccy cawjr tfgk
tfj rhdft.
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hk shzj, soaatf,
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ogssjs.
snratuo
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pgcpgtj
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mrjj am ogssjs
grj pgcpglcj hk snratuo hs
karogc whtf tfj gdj am tfj
pgthjkt.
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grjg mar fjrkhgs.
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fjrkhgs grj
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lucdj hk tfj
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lj katj`.
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pashthakhkd am tfj
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j:trjohthjs
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fgvhkd g cjshaks hk tfj sehk
hs glkarogc `uj ta hksjnt
lhtjs.
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jvh`jkt am ka swjcchkd gk`
ka j`jog prjsjkt whtf daa`
oavjojkt gk` gchdkojkt.
"& / 2 g d j
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cakd g:hs, gk` hs
usugccy ngusj` ly
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pasturj hs katj`.
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rgkdj am oathak,
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ar tjk`jrkjss.
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6urshkd "r`j`hthak tfgt
j?ugc lhcgtjrgccy hk ousncj
shzj gk` strjkdtf hs 6arogc
whtf tfj gdj am tfj pgthjkt.
"" / 2 g d j
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#fj fjoadcalhk oacjnucj mhccs up tfj rj` lcaa` njccs. Ht ngrrhjs a:ydjk gk` dhvjs tfj
lcaa` njcc hts rj` nacar. #fj fjoadcalhk tjst ojgsurjs tfj goaukt am fjoadcalhk hk
lcaa` gk` hs g daa` ojgsurj am tfj lcaa`^s glhchty ta ngrry a:ydjk tfraudfaut tfj la`y.
* caw fjoadcalhk naukt hs g naooakcy sjjk lcaa` tjst rjsuct. Hk ogky ngsjs, g caw
fjoadcalhk naukt hs akcy schdftcy cawjr tfgk karogc, hsk^t naksh`jrj` shdkhmhngkt gk`
ngusjs ka syoptaos. * caw fjoadcalhk naukt ngk gcsa lj ngusj` ly gk glkarogchty ar
`hsjgsj. Hk tfjsj shtugthaks, g caw fjoadcalhk naukt hs rjmjrrj` ta gs gkjohg
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jstrunthak am rj` lcaa` njccs
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caw sa`huo cjvjcs, rjsucts wfjk tfj la`y
casjs oarj sa`huo tfgk wgtjr, jspjnhgccy hk
ngsjs am sjvjrj vaohthkd gk` `hgrrfjg.
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nakmushak gk` cjtfgrdy
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; / 2 g d j
http://www.webmd.com/hepatitis/liverhttp://www.webmd.com/hw-popup/heart-failure-8021http://www.webmd.com/hw-popup/heart-failure-8021http://www.webmd.com/hw-popup/dehydrationhttp://www.webmd.com/diet/old-diet-tochttp://www.webmd.com/hepatitis/liverhttp://www.webmd.com/hw-popup/heart-failure-8021http://www.webmd.com/hw-popup/dehydrationhttp://www.webmd.com/diet/old-diet-toc -
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*jE(k(o9#fhs hs tfj oh`sjnthak am tfj hktjsthkj, nakkjnthkd tfj
`ua`jkuo ta tfj hcjuo. Ht naktghks tfj pchngj nhrnucgrjs, gk` vhcchtfgt
hknrjgsj tfj surmgnj grjg am tfhs pgrt am tfj )H #rgnt. 2ra`unts am `hdjsthak
%sudgrs, gohka gnh`s, gk` mgtty gnh`s( grj glsarlj` hkta tfj lcaa`strjgofjrj.
Hcj(o93gs vhcchshohcgr ta tfj +j+ukuo, gk` glsarls oghkcy vhtgohk
L7&gk` lhcj gnh`s, gs wjcc gs gky atfjr rjoghkhkd kutrhjkts.
,grj Hktjsthkj93gs tfrjj pgrts4
Ngj$(o9#fj vjrohmaro gppjk`h:hs gttgnfj` ta tfj ngjnuo.
Nacak9Hkncu`js tfj gsnjk`hkd nacak,trgksvjrsj nacak,`jsnjk`hkd
nacakgk`
'hoah` &cj:(rj9#fj oghk muknthak am tfj $acak hs ta glsarl
wgtjr, lut ht gcsa naktghks lgntjrhgtfgt pra`unj
ljkjmhnhgc vhtgohkschej vhtgohk F.
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Gkgc $gkgc9 #fj tjrohkgc pgrt am tfj cgrdj hktjsthkj.
RF-'HA,AD-
#fj thoj tgejk mar maa` ar atfjr hkdjstj` al+jnts ta trgksht tfraudf tfj
dgstrahktjsthkgc trgnt vgrhjs `jpjk`hkd ak ogky mgntars, lut raudfcy, ht tgejs cjss tfgk
gk faur gmtjr g ojgc mar -' am staognf naktjkts ta jopty hkta tfj hktjsthkjs gk` tatgcjoptyhkd am tfj staognf tgejs grauk` & faurs. >ulsj?ujktcy, -' joptyhkd am tfj
sogcc hktjsthkj tgejs 7 ta & faurs. 5hkgccy, trgksht tfraudf tfj nacak tgejs 7& ta -' faurs
whtf wh`j vgrhgthak ljtwjjk hk`hvh`ugcs.
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Hoo(kj m(k$thak
#fj dgstrahktjsthkgc trgnt hs gcsa g praohkjkt pgrt am tfj hooukj systjo. #fj
surmgnj grjg am tfj `hdjsthvj trgnt hs jsthogtj` ta lj tfj surmgnj grjg am g maatlgcc mhjc`.
Thtf sunf g cgrdj j:pasurj, tfj hooukj systjo oust ware fgr` ta prjvjkt pgtfadjks
mrao jktjrhkd hkta lcaa` gk` cyopf.#fj caw p3%rgkdhkd mrao 7 ta ( am tfj staognf hs mgtgc mar
ogky ohnraardgkhsostfgt jktjr ht. >hohcgrcy, ounus%naktghkhkd Hd*gkthla`hjs(
kjutrgchzjs ogky am tfjsj ohnraardgkhsos. Atfjr mgntars hk tfj )H trgnt fjcp whtf
hooukj muknthak gs wjcc, hkncu`hkd jkzyojshksgchvggk` lhcj. Gkzyojssunf gs
$yp"*, gcakd whtf tfj gkthpartjr gnthvhthjs, gcsa grj hkstruojktgc hk tfj hktjsthkj^s racj
am `jta:hmhngthak am gkthdjksgk` :jkalhathns, sunf gs `ruds, hkvacvj` hk mhrst pgss
ojtglachso.
3jgctfDjkfgknhkd hktjsthkgc lgntjrhgsjrvj ta prjvjkt tfj avjrdrawtf am
patjkthgccy fgromuc lgntjrhghk tfj dut. #fjsj twa typjs am lgntjrhg naopjtj mar spgnj
gk` Vmaa`,V gs tfjrj grj chohtj` rjsaurnjs whtfhk tfj hktjsthkgc trgnt. * rgtha am ;'D;-
ljkjmhnhgc ta 7-D&' patjkthgccy fgromuc lgntjrhg djkjrgccy hs naksh`jrj` karogc whtfhktfj hktjsthkjs. !hnraardgkhsos gcsa grj ejpt gt lgy ly gk j:tjkshvj hooukj systjo
naoprhshkd tfj dutDgssanhgtj` cyopfah` thssuj%)*C#(.
L\GHK
#fj lrghk hs akj am tfj oast naopcj: gk` ogdkhmhnjkt ardgks hk tfj fuogk la`y.
Aur lrghk dhvjs us gwgrjkjss am aursjcvjs gk` am aur jkvhrakojkt, pranjsshkd g
nakstgkt strjgo am sjksary `gtg. Ht naktracs aur ousncj oavjojkts, tfj sjnrjthaks am
aur dcgk`s, gk` jvjk aur lrjgtfhkd gk` hktjrkgc tjopjrgturj. Gvjry nrjgthvj tfaudft,mjjchkd, gk` pcgk hs `jvjcapj` ly aur lrghk. #fj lrghk8s kjuraks rjnar` tfj ojoary am
jvjry jvjkt hk aur chvjs.
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#fjrj grj `hmmjrjkt wgys am `hvh`hkd tfj lrghk gkgtaohngccy hkta rjdhaks. Cjt8s usjg naooak ojtfa` gk` `hvh`j tfj lrghk hkta tfrjj oghk rjdhaks lgsj` ak jolryakhn`jvjcapojkt4 tfj marjlrghk, oh`lrghk gk` fhk`lrghk. k`jr tfjsj `hvhshaks4
#fj marj
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mar hktjdrgthkd gk` pranjsshkd hkmarogthak `jchvjrj` ta tfj lrghk ly sjksary kjuraks.Hktjrkjuraks sjk` shdkgcs ta oatar kjuraks, wfhnf ngrry shdkgcs ta ousncjs gk` dcgk`s.
Kju$a+g8ar dchgc njccs, gnt gs tfj fjcpjr njccs am tfj lrghk0 tfjy suppart gk`pratjnt tfj kjuraks. Hk tfj lrghk tfjrj grj maur typjs am dchgc njccs4 gstranytjs,
achda`jk`ranytjs, ohnradchg, gk` jpjk`yogc njccs.
Gst$a,ytjspratjnt kjuraks ly mhctjrhkd kutrhjkts aut am tfj lcaa` gk` prjvjkthkd
nfjohngcs gk` pgtfadjks mrao cjgvhkd tfj ngphccgrhjs am tfj lrghk.
A#+&ajk$a,ytjswrgp tfj g:aks am kjuraks hk tfj lrghk ta pra`unj tfj
hksucgthak ekawk gs oyjchk. !yjchkgtj` g:aks trgksoht kjrvj shdkgcs ounf mgstjr tfgkukoyjchkgtj` g:aks, sa achda`jk`ranytjs gnnjcjrgtj tfj naooukhngthak spjj` am tfjlrghk.
O+,$a+ggnt ounf chej wfhtj lcaa` njccs ly gttgnehkd gk` `jstrayhkd pgtfadjks
tfgt hkvg`j tfj lrghk.
J*jkyog# ,j##s chkj tfj ngphccgrhjs am tfj nfarah` pcj:usjs gk` mhctjr lcaa`
pcgsog ta pra`unj njrjlrasphkgc mcuh`.#fj thssuj am tfj lrghk ngk lj lraejk `awk hkta twa og+ar ncgssjs4 drgy ogttjr gk`wfhtj ogttjr.
0$gy ogttj$hs og`j am oastcy ukoyjchkgtj` kjuraks, oast am wfhnf grj
hktjrkjuraks. #fj drgy ogttjr rjdhaks grj tfj grjgs am kjrvj nakkjnthaks gk`pranjsshkd.
:f+tj ogttj$hs og`j am oastcy oyjchkgtj` kjuraks tfgt nakkjnt tfj rjdhaks am
drgy ogttjr ta jgnf atfjr gk` ta tfj rjst am tfj la`y. !yjchkgtj` kjuraks trgksoht kjrvjshdkgcs ounf mgstjr tfgk ukoyjchkgtj` g:aks `a. #fj wfhtj ogttjr gnts gs tfjhkmarogthak fhdfwgy am tfj lrghk ta spjj` tfj nakkjnthaks ljtwjjk `hstgkt pgrts am tfjlrghk gk` la`y.
FHK@L\GHK /\FAOLJKNJRFG,AK2
Lrghkstjo $akkjnthkd tfj lrghk ta tfj sphkgc nar`, tfj lrghkstjo hs tfj oast hkmjrhar parthakam aur lrghk. !gky am tfj oast lgshn survhvgc muknthaks am tfj lrghk grj naktraccj` ly tfjlrghkstjo.
#fj lrghkstjo hs og`j am tfrjj rjdhaks4 tfj oj`uccg alcakdgtg, tfj paks, gk`tfj oh`lrghk. * kjtDchej strunturj am oh:j` drgy gk` wfhtj ogttjr ekawk gs tfj rjthnucgr
marogthak hs mauk` hk gcc tfrjj rjdhaks am tfj lrghkstjo. #fj rjthnucgr marogthak naktracsousncj takj hk tfj la`y gk` gnts gs tfj swhtnf ljtwjjk naksnhauskjss gk` scjjp hk tfjlrghk.
#fj oju##g a!#ak>ghs g raudfcy nychk`rhngc ogss am kjrvaus thssuj tfgtnakkjnts ta tfj sphkgc nar` ak hts hkmjrhar lar`jr gk` ta tfj paks ak hts supjrhar lar`jr.#fj oj`uccg naktghks oastcy wfhtj ogttjr tfgt ngrrhjs kjrvj shdkgcs gsnjk`hkd hkta tfjlrghk gk` `jsnjk`hkd hkta tfj sphkgc nar`. Thtfhk tfj oj`uccg grj sjvjrgc rjdhaks amdrgy ogttjr tfgt pranjss hkvacuktgry la`y muknthaks rjcgtj` ta faojastgshs. #fj
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ngr`havgsnucgr njktjr am tfj oj`uccg oakhtars lcaa` prjssurj gk` a:ydjk cjvjcs gk`rjducgtjs fjgrt rgtj ta pravh`j summhnhjkt a:ydjk suppchjs ta tfj la`y8s thssujs. #fjoj`uccgry rfytfohnhty njktjr naktracs tfj rgtj am lrjgtfhkd ta pravh`j a:ydjk ta tfjla`y. Naohthkd, skjjzhkd, naudfhkd, gk` swgccawhkd rjmcj:js grj naar`hkgtj` hk tfhsrjdhak am tfj lrghk gs wjcc.
#fj*akshs tfj rjdhak am tfj lrghkstjo mauk` supjrhar ta tfj oj`uccg alcakdgtg,hkmjrhar ta tfj oh`lrghk, gk` gktjrhar ta tfj njrjljccuo. #adjtfjr whtf tfj njrjljccuo, htmaros wfgt hs ngccj` tfj !jtjknjpfgcak. *laut gk hknf cakd gk` saojwfgt cgrdjr gk`wh`jr tfgk tfj oj`uccg, tfj paks gnts gs tfj lrh`dj mar kjrvj shdkgcs trgvjchkd ta gk`mrao tfj njrjljccuo gk` ngrrhjs shdkgcs ljtwjjk tfj supjrhar rjdhaks am tfj lrghk gk`tfj oj`uccg gk` sphkgc nar`.
Njrj
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&A\JL\GHK /R\A'JKNJRFG,AK2
@hjk$j)!gcak >upjrhar gk` gktjrhar ta tfj oh`lrghk hs tfj rjdhak ekawk gs tfj hktjrlrghk, ar`hjknjpfgcak. #fj tfgcgous, fypatfgcgous, gk` phkjgc dcgk`s ogej up tfj og+ar
rjdhaks am tfj `hjknjpfgcak.
#fj tfg#gousnakshsts am g pghr am avgc ogssjs am drgy ogttjr hkmjrhar ta tfj
cgtjrgc vjktrhncjs gk` surrauk`hkd tfj tfhr` vjktrhncj. >jksary kjuraks jktjrhkd tfj lrghkmrao tfj pjrhpfjrgc kjrvaus systjo maro rjcgys whtf kjuraks hk tfj tfgcgous tfgtnakthkuj ak ta tfj njrjlrgc nartj:. Hk tfhs wgy tfj tfgcgous gnts chej tfj swhtnflagr`apjrgtar am tfj lrghk ly rauthkd sjksary hkputs ta tfj narrjnt rjdhaks am tfj njrjlrgcnartj:. #fj tfgcgous fgs gk hopartgkt racj hk cjgrkhkd ly rauthkd sjksary hkmarogthakhkta pranjsshkd gk` ojoary njktjrs am tfj njrjlruo.
#fj fy*atfg#goushs g rjdhak am tfj lrghk cangtj` hkmjrhar ta tfj tfgcgous gk`
supjrhar ta tfj phtuhtgry dcgk`. #fj fypatfgcgous gnts gs tfj lrghk8s naktrac njktjr mar
la`y tjopjrgturj, fukdjr, tfhrst, lcaa` prjssurj, fjgrt rgtj, gk` tfj pra`unthak amfaroakjs. Hk rjspaksj ta nfgkdjs hk tfj nak`hthak am tfj la`y `jtjntj` ly sjksaryrjnjptars, tfj fypatfgcgous sjk`s shdkgcs ta dcgk`s, soaatf ousncjs, gk` tfj fjgrt tanauktjrgnt tfjsj nfgkdjs. 5ar j:gopcj, hk rjspaksj ta hknrjgsjs hk la`y tjopjrgturj,tfj fypatfgcgous sthoucgtjs tfj sjnrjthak am swjgt ly swjgt dcgk`s hk tfj sehk. #fjfypatfgcgous gcsa sjk`s shdkgcs ta tfj njrjlrgc nartj: ta pra`unj tfj mjjchkds amfukdjr gk` tfhrst wfjk tfj la`y hs cgnehkd maa` ar wgtjr. #fjsj shdkgcs sthoucgtj tfjnaksnhaus ohk` ta sjje aut maa` ar wgtjr ta narrjnt tfhs shtugthak. #fj fypatfgcgousgcsa `hrjntcy naktracs tfj phtuhtgry dcgk` ly pra`unhkd faroakjs. >aoj am tfjsjfaroakjs, sunf gs a:ytanhk gk` gkth hurjthn faroakj, grj pra`unj` hk tfjfypatfgcgous gk` starj` hk tfj pastjrhar phtuhtgry dcgk`. Atfjr far