Download - Diabetic Nephropathy Case Study
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AVX DG@Y AN KFXEY EADDFJFHaraljgl Eity$ Fgstfrl Ugkgr
@IGHFPIE LFRMXARGPMY
G Egsf Utu`y
Rrfsfltf` ta tmf Ngeudty anRgrgkf`iegd @fpgrtkflt anAur Dg`y an Kfrey Eaddfjf
Il pgrtigd nudniddkflt an tmf rfquirfkfltsnar tmf @fjrff Hgemfdar an Ueiflef il Lursilj
Uuhkittf` hy?
Hgogra$ Lgrkif JgyHgdhg`g$ Kgrihftm
Hgdais$ Og`f Erfsid`gHgsg`g$ Cgrdg Kgf
Hgtudg$ Kgf MgzfdylEgl`i`a$ Gdgil Oal
Dga$ Kgry OayDik$ Ogl Kiemgfd ^ileflt
Acghgygsmi$ GiArgdf$ Kfdizg
Kgrem 8=$ 8229
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ILPXA@VEPIAL
Mistary
@ighftie lfpmrapgtmy -lfpmrapgtig `ighftieg)$ gdsa clawl gs Cikkfdstifd+
Zidsal syl`rakf gl` iltfregpiddgry jdakfrudalfpmritis$ is g prajrfssivf ci`lfy
`isfgsf egusf` hy gljiapgtmy an egpiddgrifs il tmf ci`lfy jdakfrudi, It is
emgrgetfrizf` hy lfpmratie syl`rakf gl` la`udgr jdakfrudasedfrasis, It is `uf ta
daljstgl`ilj `ighftfs kfdditus$ gl` is g prikf egusf nar `igdysis il kgly Zfstfrl
eaultrifs,
@iseavfrf` hy Hritism pmysieigl Edinnar` Zidsal -792>+799:) gl` Jfrkgl+
harl Gkfriegl pmysieigl Rgud Cikkfdstifd -7922+79:2) gl` wgs puhdismf` nar
tmf nirst tikf il 795>,
Egusfs
Pmf fxget egusf an `ighftie lfpmrapgtmy is ulclawl$ hut it is hfdifvf` tmgt
ulealtraddf` mijm hdaa` sujgr dfg`s ta tmf `fvfdapkflt an ci`lfy `gkgjf, Il
sakf egsfs$ yaur jflfs ar ngkidy mistary kgy gdsa pdgy g radf, Lat gdd pfrsals
witm `ighftfs `fvfdap tmis eal`itial,
Fgem ci`lfy is kg`f an mul`rf`s an tmausgl`s an nidtfrilj ulits egddf`
lfpmrals, Fgem lfpmral mgs g edustfr an tily hdaa` vfssfds egddf` g jdakfrudus,
Pajftmfr tmfsf strueturfs mfdp rfkavf wgstf nrak tmf ha`y, Paa kuem hdaa`
sujgr egl `gkgjf tmfsf strueturfs$ egusilj tmfk ta tmiecfl gl` hfeakf
segrrf`, Udawdy$ avfr tikf$ karf gl` karf hdaa` vfssfds grf `fstrayf`, Pmf
ci`lfy strueturfs hfjil ta dfgc gl` pratfil -gdhukil) hfjils ta pgss ilta tmf
urilf,
Rfrsals witm `ighftfs wma mgvf tmf naddawilj risc ngetars grf karf dicfdy
ta fvfdap tmis eal`itial?
Gnriegl Gkfriegl$ Mispglie$ ar Gkfriegl Il`igl arijil
Ngkidy mistary an ci`lfy `isfgsf ar mijm hdaa` prfssurf
Raar ealtrad an hdaa` prfssurf
Raar ealtrad an hdaa` sujgrs
Pypf 7 `ighftfs hfnarf gjf 82Ukacilj
@ighftie lfpmrapgtmy jflfrgddy jafs gdalj witm atmfr `ighftfs
eakpdiegtials iledu`ilj mijm hdaa` prfssurf$ rftilapgtmy$ gl` hdaa` vfssfd
emgljfs,
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Rrfvgdflef gl` Ilei`flef Xgtf
@ighftfs mgs hfeakf tmf prikgry egusf an fl`+stgjf rflgd `isfgsf
-FUX@)$ gl` tmf ilei`flef an typf 8 `ighftfs kfdditus ealtilufs ta jraw il tmf
Vlitf` Utgtfs gl` ward`wi`f, Gppraxikgtfdy 00& an lfw pgtiflts fltfrilj
`igdysis il tmf Vlitf` Utgtfs grf `ighfties, Fgrdy `igjlasis an `ighftfs gl` fgrdy
iltfrvfltial grf eritiegd il prfvfltilj tmf larkgd prajrfssial ta rflgd ngidurf sffl
il kgly typf 7 gl` g sijlinieglt pfrefltgjf an typf 8 `ighfties,
Il tmf Vlitf` Utgtfs$ gppraxikgtfdy 82,= kiddial pfapdf$ ar :,2& an tmf
papudgtial$ grf fstikgtf` ta mgvf `ighftfs$ witm g jrawilj ilei`flef, Xaujmdy
alf tmir` an tmis papudgtial$ >,8 kiddial$ is fstikgtf` ta hf ul`igjlasf` witm typf8 `ighftfs, Pmf prfvgdflef an `ighftfs is mijmfr il efrtgil rgeigd gl` ftmlie
jraups$ gnnfetilj gppraxikgtfdy 75& an Gnriegl Gkfriegls$ 9,6& an Mispglies$
gl` 76& an Lgtivf Gkfriegls$ prikgridy witm typf 8 `ighftfs,Gppraxikgtfdy 82&
ta 52& an gdd `ighfties widd `fvfdap fvi`flef an lfpmrapgtmy$ gdtmaujm g mijmfr
pfrefltgjf an typf 7 pgtiflts prajrfss ta FUX@,
Fpi`fkiadajy
Pmf syl`rakf egl hf sffl il pgtiflts witm emralie `ighftfs -76 yfgrs ar
karf gntfr alsft)$ sa pgtiflts grf usugddy an ad`fr gjf -hftwffl 62 gl` :2 yfgrs
ad`), Pmf `isfgsf is prajrfssivf gl` kgy egusf `fgtm twa ar tmrff yfgrs gntfr
tmf ilitigd dfsials$ gl` is karf nrfquflt il kfl, @ighftie lfpmrapgtmy is tmf kast
eakkal egusf an emralie ci`lfy ngidurf gl` fl`+stgjf ci`lfy `isfgsf il tmf
Vlitf` Utgtfs, Rfapdf witm hatm typf 7 gl` typf 8 `ighftfs grf gt risc, Pmf risc is
mijmfr in hdaa`+jdueasf dfvfds grf paardy ealtraddf`, Nurtmfr$ alef lfpmrapgtmy
`fvfdaps$ tmf jrfgtfst rgtf an prajrfssial is sffl il pgtiflts witm paar ealtrad antmfir hdaa` prfssurf, Gdsa pfapdf witm mijm emadfstfrad dfvfd il tmfir hdaa` mgvf
kuem karf risc tmgl atmfrs,
Uijls . Uykptaks
Fgrdy sijls gl` sykptaks an ci`lfy `isfgsf il pgtiflts witm `ighftfs grf
typiegddy ulusugd, Mawfvfr$ g vgst grrgy an sijls gl` sykptaks distf` hfdaw kgy
kglinfst wmfl ci`lfy `isfgsf mgs prajrfssf`?
Uwfddilj$ usugddy graul` tmf fyfs il tmf karliljs3 dgtfr$ jflfrgd ha`y
swfddilj kgy rfsudt$ suem gs swfddilj an tmf dfjs
Nagky gppfgrglef ar fxefssivf nratmilj an tmf urilf
Vliltfltialgd wfijmt jgil -nrak ndui` geeukudgtial)
Ngtijuf
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Nrfquflt mieeups
Jflfrgd idd nffdilj
Jflfrgdizf` itemilj
Mfg`gemf
Lgusfg gl` vakitilj
Raar gppftitf
Zfgclfss$ pgdflfss$ gl` glfkig
Glcdf gl` dfj swfddilj$ dfj ergkps
Jailj ta tmf hgtmraak karf antfl gt lijmt
Mijm hdaa` prfssurf
Pfsts gl` `igjlasis
Dghargtary tfsts tmgt kgy hf `alf iledu`f?
HVL -Hdaa` Vrfg Litrajfl)
Ufruk erfgtililf
Pmf dfvfds an tmfsf tfsts widd ilerfgsf gs ci`lfy `gkgjf
jfts warsf, Atmfr dghargtary tfsts tmgt kgy hf `alf iledu`f?
80+maur urilf pratfil
Hdaa` dfvfds an pmaspmarus$ egdeiuk$ hiegrhalgtf$ gl` patgssiuk
Mfkajdahil
Mfkgtaerit
Rratfil fdfetrapmarfsis + urilf
Xf` hdaa` efdd -XHE) eault
Eakpdiegtials
Rassihdf eakpdiegtials iledu`f?
mypajdyefkig -nrak `ferfgsf` fxerftial an ilsudil)
rgpi`dy prajrfssilj emralie ci`lfy ngidurf
fl`+stgjf ci`lfy `isfgsf
mypfrcgdfkig
sfvfrf mypfrtflsial
eakpdiegtials an mfka`igdysis
eakpdiegtials an ci`lfy trglspdglt
eafxistflef an atmfr `ighftfs eakpdiegtials
pfritalitis -in pfritalfgd igdysis usf`)
ilerfgsf` ilnfetials
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Prfgtkflts gl` `rujs
Pmf jagds an trfgtkflt grf ta cffp tmf ci`lfy `isfgsf nrak jfttilj warsf
gl` prfvflt eakpdiegtials, Pmis ilvadvfs cffpilj tmf hdaa` prfssurf ul`fr
ealtrad -ul`fr 752!=2), Ealtraddilj mijm hdaa` prfssurf is tmf kast fnnfetivf wgy
an sdawilj ci`lfy `gkgjf nrak `ighftie lfpmrapgtmy,
Pmf `aetar kgy prfserihf tmf naddawilj kf`ieilfs ta dawfr tmf hdaa`
prfssurf?
Gljiatflsil+ealvfrtilj flzykf -GEF) ilmihitars
Gljiatflsil rfefptar hdaecfrs -GXHs)
Pmfsf `rujs mfdp rf`uef tmf gkault an pratfil il tmf urilf, Kgly stu`ifsmgvf sujjfstf` tmgt g eakhilgtial an tmfsf twa typfs an `rujs kgy hf hfst,
It is gdsa vfry ikpartglt ta ealtrad dipi` dfvfds$ kgiltgil g mfgdtmy wfijmt$
gl` fljgjf il rfjudgr pmysiegd getivity,
Edasfdy kalitar tmf hdaa` sujgr dfvfds, @ailj sa kgy mfdp sdaw `awl
ci`lfy `gkgjf$ fspfeigddy il tmf vfry fgrdy stgjfs an tmf `isfgsf, Emgljf
`ift ta mfdp ealtrad hdaa` sujgr,
Pmf `aetar kgy gdsa prfserihf kf`iegtials ta mfdp ealtrad tmf hdaa`
sujgr, @asgjf an kf`ieilf kgy lff` ta hf g`oustf` nrak tikf ta tikf, Gs
ci`lfy ngidurf jfts warsf$ aur ha`y rfkavfs dfss ilsudil$ sa skgddfr `asfs
kgy hf lff`f` ta ealtrad jdueasf dfvfds,
Vrilgry trget gl` atmfr ilnfetials grf eakkal gl` egl hf trfgtf` witm
gppraprigtf gltihiaties,
@igdysis kgy hf lfefssgry alef fl`+stgjf rflgd `isfgsf `fvfdaps, Gt tmis
stgjf$ g ci`lfy trglspdglt kust hf ealsi`frf`, Glatmfr aptial nar pgtiflts
witm typf 7 `ighftfs is g eakhilf` ci`lfy+pglerfgs trglspdglt,
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RGPIFLPU RXANIDF
I, ^IPGD ILNAXKGPIAL
LGKF? Krs, G,
G@@XFUU? Juiugl$ Fgstfrl Ugkgr
GJF? >9 yfgrs ad`
UF]? Nfkgdf
MFIJMP? 6 Nt,
ZFIJMP? 6= Cj
LGPIALGDIPY? Nidipila
XFDIJIAL? Xakgl Egtmadie
HIXPM@GY? Oulf 88$ 7959
UPGPVU? Kgrrif`
AEEVRGPIAL? Mausfwinf
G@KIUUIAL @GPF? Kgrem 28$ 8229
XAAK LA? Nfkgdf Kf`iegd Zgr`
HF@ LA? 6GPPFL@ILJ RMYUIEIGL? @rg, Kyrlg @igz
EMIFN EAKRDGILP? Fgsy ngtijghidity$ Emfst gl` hgec pgil
ILNAXKGLP? Rgtiflt itsfdn
II, EDILIEGD GUUFUUKFLP
Mistary a n Rrfsflt Iddlfss
Al tmf 8l` `gy an Kgrem 8229 gt graul` 5 il tmf gntfrlaal$ tmf
pgtiflt wgs ealnilf` gt Fgstfrl Ugkgr Rravileigd Maspitgd witm g emifn
eakpdgilt an fgsy ngtijghidity$ hgec pgil gl` swfddilj an hatm dfjs gl`
ngef gl` gl g`kittilj `igjlasis an `ighftie lfpmrapgtmy witm sfvfrf
glfkig,
G wffc RPE tmf pgtiflt sunnfrf` emfst pgil$ `izzilfss gl`
eaujm wmidf smf wgs `ailj mausfmad` emarfs -Uwffpilj$ wgsmilj
edatmfs$ fte,), Pmfrfgntfr$ smf taac g pgil rfdifvfr kf`iegtial ta fgsf
tmf pgil gl` g hglyas gppdyilj it ulta mfr emfst, Mfr sdffpilj pgttfrl
wgs gdsa gnnfetf` gs smf eaud` lat sdffp wfdd,
Mawfvfr$ fgsy ngtijghidity$ hgec pgil gl` swfddilj an mfr hatm
dfjs . ngef warsfl mfr eal`itial, Pmus$ prakptf` mfr ngkidy ta ealnilf
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mfr gt Nfdipf Ghrija Kfkarigd Maspitgd$ Juiugl$ Fgstfrl Ugkgr al tmf
8=tm `gy an Nfhrugry 8229,
Ufvfrgd tfst -hdaa` emfkistry . urilgdysis) mg` hffl kg`f gl`
smf wgs `igjlasf` witm @ighftie Lfpmrapgtmy witm sfvfrf glfkig,
Egptrapid 86 kj UD 7tgh hi` . nurasfki`f wgs jivfl gs mfr ilitigd
trfgtkflt, Mawfvfr$ mfr eal`itial pfrsistf` gl` smf `i` lat rfspal` ta
kf`iegtial gl` trfgtkflt jivfl ta mfr wmidf smf wgs ealnilf` al tmf
sgi` maspitgd, Pmus$ smf wgs rfnfrrf` hy mfr `aetar ta Fgstfrl Ugkgr
Rravileigd Maspitgd nar nurtmfr fxgkilgtial gl` trfgtkflt,
Rgst Kf`iegd Mistary
Uakftikf il 7990$ gs rfegddf` hy tmf pgtiflt$ smf wgs
`igjlasf` witm @ighftfs Kfdditus Pypf 8 hy g privgtf Kf`iegd @aetar,
@igkieral wgs jivfl gs mfr kf`iegtial nar mfr fvfry`gy kgiltflglef
hut smf ngidf` ta naddaw tmf @aetars ar`fr, Dgst yfgr al tmf kaltm an
Aetahfr smf wgs ealnilf` gt F^XKE `uf ta swfddilj an mfr hatm dfjs
gl` wgs `igjlasf` witm @ighftie Lfpmrapgtmy, Mfr eal`itial wgs
tfkpargridy rfdifvf, Pmus$ mfr pmysieigl pfrkittf` mfr ta ja makf, La
gly surjfry mgs hffl `alf `urilj mfr yauljfr yfgrs,
Rsyemasaeigd Mistary
Krs, G is gl fdfkfltgry jrg`ugtf nrak Juiugl Lgtialgd Mijm
Uemaad$ ulnartulgtfdy$ smf mgvflt nilismf` mfr sfeal`gry dfvfd, Mfr
ngtmfr `if` witm la clawl egusf gt mfr gjf an 50$ wmidf mfr katmfr
sueeukhf` ta @K gt mfr gjf an 08, Umf kgrrif` gt tmf gjf an 88$ gl`hdfssf` witm > emid`rfl$ 5 an wmak grf hays gl` 5 wfrf jirds, Hut 5 an
wmiem grf `fg`$ 7 hay gl` 8 jirds, Vpal rfegdd an Krs, G$ gt 7 y,a mis
sal `if` hfegusf an kfgsdfs$ gdsa mfr `gujmtfr gt tmf sgkf gjf `if`
hfegusf an tmf sgkf `isfgsf, Mfr atmfr `gujmtfr `if` `uf ta dfucfkig
gt tmf gjf an 80$ hut mgvf kgrrif` gt tmf gjf an 82 gl` hdfssf` witm 8
emid`rfl, Mfr 0tm gl` aldy ulkgrrif` sal rfkgils il tmfir mausf gt tmf
prapfr an Juiugl$ gl` tmf atmfr 8 gdrfg`y mgvf tmfir awl ngkidy,
Krs, G mgs g skgdd sgri+sgri starf wmfrf smf spfl`s kast an mfr
tikf, Pmis starf is tmfrf prikgry sauref an ileakf, Umfs nal` an fgtilj
swfft naa`s,
Umf is g skacfr$ smf hfjil skacilj il mfr yauljfr yfgrs, Umf
egl ealsukf 5 stiecs il g `gy oust gntfr fgtilj mfr kfgds, Umf gdsa
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`rilcs tuhg gl` hffr aeegsialgddy, Mawfvfr smf quittf` skacilj `uf
ta ighftfs kfdditus,
Flviralkfltgd Mistary
Krs, G gl` mfr mushgl` divfs il Hrjy, Hgrha$ Juiugl Fgstfrl
Ugkgr, Pmfy prfnfr ta stgy tmfrf$ wmfrf il nget tmfy mgvf tmfir mausf
il tmf prapfr an Juiugl, G sgri+sgri starf is il tmfir nralt ygr`$ tmis
cffps mfr husy fvfry `gy,
Nruit trffs grf visihdf il tmfir vieility, Zgtfr suppdifs nar
`rilcilj$ eaacilj$ wgsmilj grf tgcfl nrak g eakkulgd ngueft lfgr tmf
rivfr$ 82 kftfrs gwgy nrak tmf eaknart raak,
Naa` prfpgrgtial is usugddy `alf hy mfr, Pmfy usugddy starf tmfir
naa` il tmf rfnrijfrgtar, Pmfy mgvf g pgid ndusm typf taidft daegtf` gt tmf
hgec an tmfir mausf, Pmfy tmraw tmfir jgrhgjf il tmfir eakpast pit
daegtf` gt tmfir hgecygr`,
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NGKIDY MFGDPM MIUPAXY
DFJFL@?
@K + @ighftfs KfdditusMpl + MypfrtflsialGss + Gstmkg
Ksd + KfgsdfsD + DfucfkigK!N + Kgdf!Nfkgdf
Katmfr
-#) @K
@fefgsf`
Ngtmfr
Vlclawl @isfgsf
@fefgsf`
7st
Emid`
-N)
6tm
Emid`
-N)
0tm
Emid`
-K)
8l`
Emid`
-K)
5r`
Emid`
-N)
@K
Mpl
7st
Emid`
-N)
6tm
Emid`
-K)
@fefgsf`
Ksd
8l`
Emid`
-K)
0tm
Emid`
-K)
5r`
Emid`
-N)
@fefgsf`
D
>tm
Emid`
-N)
@fefgsf`
Ksd
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Rgttfrls an Nuletialilj
Rgttfrl HfnarfIddlfss
@uriljIddlfss
@uriljMaspitgdizgtial
Glgdysis
FgtiljRgttfrl
+ Rrfnfrsvfjftghdfs$nism gl`sakftikfskfgt,
+ Pypiegdnaa` iltgcfealsists anrief gl`
vigl`,+ rfstrietial
wgs kg`fgs ar`frf`hy tmf`aetar wgyhgec 7990wmfl smfwgs`igjlasf`w! @K 8
+ 5!0 eup anrief gl`vigl`ealsukf`
+ Xfstrietialwgs kg`fhut ngidf` tanaddaw
+ +rfstrietial almijm il sa`iuk$mijm il hatmsgturgtf` ngtgl` tatgd ngt$mijm ilegrhamy`rgtfs,
+ +`ift mijm ilegdeiuk$
patgssiuk gl`kgjlfsiukwgs ar`frf`,
+
+ Fgtiljpgttfrl mgshfflka`inif``uf taiddlfss,
@rilciljRgttfrl
+Mfr typiegdwgtfr!ndui`iltgcf isusugddy 6 > jdgssfspfr `gy,
+smf `rilcs 0ta > jdgssfsan wgtfr pfr`gy,
+smf `rilcs 7jdgss an wgtfrg `gy
+@rilcilj anwgtfr mgshffl`ferfgsf``uf ta mfreal`itial
FdikilgtialRgttfrl
+ Fdikilgtfsalef g `gy$usugddy iltmf karlilj
+ @fnfegtfstwief gwffc,
+ Nrfquflturilgtial
+ @fnfegtfs alefg `gy,
+ Vrilgtfs 6tikfs g `gy
+ Fdikilgtialpgttfrl mgshfflgdtfrf` `ufta mfr
eal`itial
UdffpiljRgttfrl
+ Vsugddysdffpsgraul` 9 ar72 il tmffvfliljgl` wgcfsup graul`6 gk al gtypiegd `gy,
+ Udffp gtgraul` 6 : pk gl`wgcfs upgraul` 0 > gk
+ Vsugddy gwgcf + Udffpiljpgttfrl mgshffliltfrruptf``uf ta tmfrfeflteal`itial
UaeigdRgttfrl
+ Umf is g
nrifl`dypfrsal,
+ @rilcstuhg gl`is g skacfr
+ Vsugddy
stgys gtmakf
+ Xfnrgilnrak`rilciljtuhg gl`Ukacilj,
+ Eakkuliegtial
ta mis rfdgtivfgl` atmfrpfapdf mgshffl dikitf`,
+ Uaeigd
pgttfrl mgshfflgdtfrf` `ufta mfreal`itial,
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XF^IFZ AN UYUPFKU
Jflfrgd Uurvfy? upal gssfsskflt$ tmf pgtiflt wgs sffl al hf` ealseiaus,
^!U? P ; 5:,:E3 R ;9= hpk3 XX ;80 epk3 HR ;7=2!92 kkMj,
Rmysiegd Gssfsskflt
Uystfk Utrue turfs Larkgd Nil`iljs Xfkgrcs
Iltfjukfltgry
Uizf$ smgpf .
sykkftry
Mfg
Rrfsflef an la udfs .kgssfs
UegdpMgir
Pmieclfss!tmillfssPfxturf
Gkault
FyfhrawsFyfs
Fyfdi sFyfdgsmfs
Ealouletivg
Fxtfrlgd LasfLasf
Guriedf eadarFgrs
UizfRasitial
EadarUcil
Eurvgturf . gljdf
Lgids
EadarPfxturf
Egpiddgry rfnidd
Xaul f $ skaatm scudd
ealtaurUkaatm$ ulinarkealsistfley$ghsflef an la udfsar kgssfs
Fvfldy istrihutf mgirPmiec mgirUidcy$ rfsidiflt mgir^grighdf
Mgir fvfldy istrihutf`
Ucil iltget sagrFqugddy istrihutf`
Prglspgrflt . smily
Uykkftrie . strgijmt
Eadar sgkf gs ngeigd scil
NirkUykkftrie pasitial
La segr
La dfsials
Vlinark il grfgsfxpasf ta tmf sul
Ealvfx eurvgturf .gljdf 7>2
Mijmdy vgseudgr . pilcUkaatm tfxturf
Larkgd il sizf$
raul f $Ghsflef anla udf arkgssfs$skaatm scudd,
Fvfldyistrihutf mgir
Pmiec mgirUidcy$ rfsidifltmgir
^grighdf
Uykkftriegddygdijlf`
Ucil iltgetFqugddy
istrihutf`Prglspgrflt .smily
Uykkftriegd glstrgijmt$ largilgjf,
Eadar sgkf gsngeigd scil
NirkUykkftriegd
Uegr latf alhatm dfjs
Dfsials latf alhatm dfjs
Vlinarkf ilgrfgs fxpasfta tmf sul
Ealvfx ileurvgturf
RgdfUkaatm
Ahtgilf uriljal mfremid maa yfgrs
@uf ta glfkig
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Lfec kusedfsLfec
UcilDawfr Fxtrfkitifs
Rrakpt rfturl an pilc arusugd eadar -5 sfe,)
Fqugd il sizf$ mfg`efltfrf`
La f fkg
Rrakpt rfturl tausugd eadar -5
sfe,)Fqugd il sizf$mfg efltfrf
F fkg al hatmdfjs-Rittilj f fkg an86,0 kk)
@uf ta ci lfyngidurf
Xfspirgtary
XXEmfst
Hrfgtmilj Rgttfrl
Uferftials
76+82 epkWuit$ rmytmkie .
fnnartdfss
rfspirgtialLalf
80 epk@ysplie
Lalf
Hfe, anferfgsf A8
egrryilj XHE il
vitgd arjgls suemgs tmf duljs
Egr`iavgseudgr
Rfripmfrgd RudsfRgdpgtials
UcilRfripmfrgd Rfrnusial
Nudd pgdpgtials
Ucil eadar pilcUcil tfkpfrgturf lat
fxefssivfdy wgrk aread
Nudd pgdpgtials
RgdfUcil tfkpfrgturflarkgd
@uf ta glfkig
Jgstrailtfstilgd
Dips
Kautm
Juks
Pfftm
Paljuf
UcilGh akfl
RgdpgtialDijmt pgdpgtial
@ffp Rgdpgtial
Rilc . kaist
Ukaatm . smily
58 g`udt tfftm
Efltrgd pasitial .skaatm
Vlhdfkismf scil .
ulinark il eadar
La tfl frlfss3 rfdgxfgh akfl witmskaatm$ ealsistflttflsial
La tfl frlfss
@ry dips$ sdijmtdypgdf
Udijmtdy `grc ileadar
Ileakpdftfflturfs
Efltrgd pasitial
Vlhdfkismf
scil glulinarkf ileadarLatftfl frlfss glmypfrsfltivityal DDWDaegdizf`tfl frlfss alDDW
@uf ta rylfssan kueasgddililj hfe , smfwgs ysplie@uf ta skacilj
@uf ta ci lfyikpgirkflt
@uf ta ci lfyikpgirkflt
JVP
RgdpgtialHdg fr
Rfreussial
Lat Rgdpghdf
@uddlfss witm nudd hdg``fr
@istfl f gl
pgdpghdf gsskaatm$ raul $tflsf kgssDgrjf udd grfgs
@uf ta urilgry
rftfltial
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GLGPAKY GL@ RMYUIADAJY
PMF FL@AEXILF UYUPFK
Pmf lfrvaus systfk sfl`s fdfetriegd kfssgjfs ta ealtrad gl` eaar`ilgtf
tmf ha`y, Pmf fl`aerilf systfk mgs g sikidgr oah$ hut usfs emfkiegds ta
eakkuliegtf, Pmfsf emfkiegds grf clawl gs markalfs, G markalf is g
spfeinie kfssfljfr kadfeudf syltmfsizf` gl` sferftf` hy g jraup an spfeigdizf`
efdds egddf` gl fl`aerilf jdgl`, Pmfsf jdgl`s grf `uetdfss$ wmiem kfgls tmgt
tmfir sferftials -markalfs) grf rfdfgsf` `irfetdy ilta tmf hdaa`strfgk gl` trgvfd
ta fdsfwmfrf il tmf ha`y ta tgrjft arjgls$ upal wmiem tmfy get,
Nuletial
Pmf Fl`aerilf systfk is gl ilnarkgtial sijlgd systfk kuem dicf tmf
lfrvaus systfk, Mawfvfr$ tmf lfrvaus systfk usfs lfrvfs ta eal`uet
ilnarkgtial$ wmfrfgs tmf fl`aerilf systfk kgildy usfs hdaa` vfssfds gs
ilnarkgtial emgllfds, Jdgl`s daegtf` il kgly rfjials an tmf ha`y rfdfgsf ilta
tmf hdaa`strfgk spfeinie emfkiegd kfssfljfrs egddf` markalfs, Markalfsrfjudgtf tmf kgly gl` vgrif` nuletials an gl arjglisk$ f,j,$ kaa`$ jrawtm gl`
`fvfdapkflt$ tissuf nuletial$ gl` kftghadisk$ gs wfdd gs sfl`ilj kfssgjfs gl`
getilj al tmfk,
Xadf il `isfgsf
@isfgsfs an tmf fl`aerilf systfk grf eakkal$ iledu`ilj `isfgsfs suem
gs `ighftfs kfdditus$ tmyrai` `isfgsf$ gl` ahfsity, Fl`aerilf `isfgsf is
emgrgetfrisf` hy `ysrfjudgtf` markalf rfdfgsf -g pra`uetivf Rituitgry
g`flakg)$ ilgppraprigtf rfspalsf ta sijlgddilj -Mypatmyrai`isk)$ dgec ar
`fstruetial an g jdgl` -@ighftfs kfdditus typf 7$ `ikilismf` frytmrapaifsis il
Emralie rflgd ngidurf)$ ar strueturgd fldgrjfkflt il g eritiegd sitf suem gs tmf lfec
-Paxie kudtila`udgr jaitrf), Mypanuletial an fl`aerilf jdgl`s egl aeeur gs rfsudt
an dass an rfsfrvf$ mypasferftial$ gjflfsis$ gtrapmy$ ar getivf `fstruetial,
Mypfrnuletial egl aeeur gs rfsudt an mypfrsferftial$ dass an supprfssial$
mypfrpdgstie$ ar lfapdgstie emgljf$ ar mypfrstikudgtial,
Fl`aerilapgtmifs grf edgssinif` gs prikgry$ sfeal`gry$ ar tfrtigry, Rrikgry
fl`aerilf `isfgsf ilmihits tmf getial an `awlstrfgk jdgl`s, Pfrtigry fl`aerilf
`isfgsf is gssaeigtf` witm `ysnuletial an tmf mypatmgdgkus gl` its rfdfgsilj
markalfs,
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Eglefr egl aeeur il fl`aerilf jdgl`s$ suem gs tmf tmyrai`$ gl` markalfs
mgvf hffl ikpdiegtf` il sijlgddilj `istglt tissufs ta pradinfrgtf$ nar fxgkpdf tmf
Fstrajfl rfefptar mgs hffl smawl ta hf ilvadvf` il efrtgil hrfgst eglefrs,
Fl`aerilf$ Rgrgerilf$ gl` gutaerilf sijlgddilj mgvf gdd hffl ikpdiegtf` il
pradinfrgtial$ alf an tmf rfquirf` stfps an aleajflfsis,
Jdgl`s an tmf Mukgl Fl`aerilf Uystfk
Markalfs sferftf` hy tmf kgil Fl`aerilf Jdgl`s
Jdgl` Markalf-s) Uferftf` Nuletial-s) an Markalfs
Rituitgry Pmf pituitgry jdgl` is g skgdd avgd fl`aerilf jdgl` tmgt difs gt tmf
hgsf an tmf hrgil, It is sakftikfs egddf` tmf kgstfr jdgl` an tmf
ha`y, Pmis pgrt an tmf hrgil ealsists an tmrff dahfs egddf`
(gltfriar($ (iltfriar( gl` (pastfriar(,
Rastfriar Axytaeil Utikudgtfs utfrilf ealtrgetialgl` hrfgst ealtrgetial narkidc rfdfgsf,
Glti +@iurft ie Utikudgtfs rf+ghsarptial an
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Markalf -G@M)$gdsa clawl gs
*vgsaprfssil*
wgtfr nrak ci`lfy tuhudfs,
Mypa+
egusfs @ighftfsIlsipi`us -dgrjf gkaults anurilf pra`uef`),
Gltfr iar Rradgetil -RXD) Rra`uetial an hrfgst kidc-warcs il kfl taa),
Mukgl JrawtmMarkalf -MJM) +
Jrawtm
Mypa
+ @wgrnisk
Mypfr
+Jijgltisk
Pmyrai` UtikudgtiljMarkalf -PMU)
Utikudgtfs tmf tmyrai` tarfdfgsf tmyraxil,
G`rflaeartieatrapmie Markalf -GEPM) +
Utikudgtfs tmf g`rflgd eartfxta pra`uef?
Eartieastfrai`s
+kilfrgdeartieai`s
+jdueaeartieai`s
+eartisad-lgturgd glti+ilndgkkgtary)
+gl`rajfls$f,j,ge`astfralf,
DutfiliziljMarkalf -DM)
Hriljs ghaut avudgtial gl`kgiltgils tmf earpus dutfuk,
Naddiedf UtikudgtiljMarkalf -NUM)
Utikudgtfsjrawtm!`fvfdapkflt anJrggnil naddiedfs -; g kgturfnaddiedf il tmf avgry priar taavudgtial$ ealtgililj g dgrjf
ndui`+niddf` egvity tmgt `istfl`stmf surngef an tmf avgry) algpprax, 8= `gy eyedf,
Kfdglil UtikudgtiljMarkalf -KUM)
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Jalg`atrapmils + Ufeal`gry sfxugdemgrgetfristies,
Iltfrstitigd EfddUtikudgtiljMarkalf -IEUM)
Zarcs al tmf sfkilinfraustuhudfs il tmf tfstfs tapra`uef spfrk wmiem tgcf87 `gys ta kgturf,-In lat fogeudgtf` witmil 87`gys$ tmf spfrk grf rf+ghsarhf` hgec ilta tmf ha`y,)
Rilfgd G pfg+sizf` kgss an lfrvf tissuf gttgemf` hy g stgdc ta tmfpastfriar wgdd an tmf tmir` vfltriedf an tmf hrgil$ `ffp hftwffl tmfefrfhrgd mfkispmfrfs gt tmf hgec an tmf scudd,
Kfdgtalil G markalf pra`uef` hy tmfpilfgd jdgl` il `grclfss hut latil hrijmt dijmt,
Kfdgtalil rfefptars il tmf hrgilrfget ta tmis markalf gl`sylemralizf tmf ha`y ta tmf 80maur `gy!lijmt rmytmk$ tmusilnarkilj tmf hrgil wmfl it is `gygl` wmfl it is lijmt,
Kfdgtalil is `frivf` nraksfrgtalil$ witm wmiem it warcs tarfjudgtf tmf sdffp eyedf,
Pmyrai`Jdgl`
Daegtf` il tmf gltfriar pgrt an tmf lfec il tmf ki`dilf, It ealsistsan twa dgtfrgd dahfs dyilj al fgem si`f an tmf tmyrai` egrtidgjf-G`gk*s gppdf) gl` eallfetf` hy g hgl` an tissuf egddf` tmfistmkus,
Pmyraxil Ealefrlf` witm tmf HgsgdKftghadie Xgtf -HKX)$ wmiem istmf gkault an flfrjy tmf ha`yusfs$ oust ta tiec avfr,
Mypfr+Pmyrai`isk ; avfr+getivftmyrai` ; PmyrataxieasisUykptaks? ilerfgsf il HKX3ilerfgsf il mfgrt+rgtf3 dass anwfijmt3 mypfr+getivity3 ilsaklige3
`fvfdaps hudjilj fyfs `uf tageeukudgtial an ndui` hfmil` tmffyf3 kgy `fvfdap Jaitrf3 passihdfdilc witm Gttfltial @fnieit @isar`fr,
Mypa+Pmyrai`isk
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Uykptaks3 `ferfgsf il HKX3wfijmt jgil3 dftmgrjy3 scil hfeakfs
`ry gl` punny3 mgir hfeakfs tmilgl` hrittdf,Egusfs? @frhysmirf Lfec-arijilgddy `uf ta ilsunnieiflt ia`ilfil tmf said il @frhysmirf)$ Jrgvfs@isfgsf$ gl` Erftilisk -; kftgdgl` sfxugd `fvfdapkflt ikgpgirf`$in aeeurs il emid`rfl),
Egdeitalil Vptgcf an egdeiuk ta half,
Rgrgtmyrai` Jdgl`
Ukgdd jdgl`s an tmf fl`aerilf systfk wmiem grf daegtf` hfmil`tmf tmyrai`, Pmfrf grf naur pgrgtmyrai` jdgl`s wmiem grf larkgddyghaut tmf sizf an g pfg,
Rgrgtmarkalf Gssaeigtf` witm tmf jrawtm ankusedf gl` half,
@istrihutial an egdeiuk gl`pmaspmgtf il tmf ha`y,
Mypfr+ Egusfs trglsnfr an egdeiuk
nrak tmf halfs ta tmf hdaa`3 halfshfeakf nrgjidf . fgsidy hracfl3astfaparasis,-Rgrgtmarkalf getivity is ilmihitf`hy afstrajfl,)
Mypa+
Dawfrs hdaa` egdeiuk dfvfds$egusilj tftgly -wmiem kgy hftrfgtf` hy ilofetials an tmfmarkalf)3 daw egdeiuk dfvfds ilscfdftgd kusedf -wmiem kgy egusf
ergkps),
Pmykus Pmf tmykus jdgl` is daegtf` strg``df` gerass tmf trgemfg .hralemi il tmf uppfr tmargx -g hi+dahf` arjgl il tmf raat an tmflfec$ ghavf gl` il nralt an tmf mfgrt),Pmf tmykus -g jdgl` gssaeigtf` witm tmf ikkulf systfk)$ isfledasf` il g egpsudf gl` `ivi`f` iltfrlgddy hy erass+wgdds iltakgly dahudfs -nudd an P+dykpmaeytfs),
Pmykasil Getivgtfs tmf ikkulf systfk hygetivgtilj tmf P+Efdds -P+Ciddfr
Efdds3 P+Mfdpfr Efdds3 P+KfkaryEfdds),
P+Dykpmaeytfs Pmf tmykus ealsists an dahudfsnudd an P+dykpmaeytfs -wmitfhdaa` efdds gssaeigtf` witm
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gltiha`y pra`uetial),
P+dykpmaeytfs kijrgtf nrak tmfhalf kgrraw ta tmf tmykus$wmfrf tmfy kgturf gl``innfrfltigtf ultid getivgtf` hygltijfls,
Rglerfgs Pmf mukgl pglerfgs wfijms gppraxikgtfdy =2 jrgks$ mgsraujmdy ealnijurgtial an gl ilvfrtf` skacfr*s pipf$ gl` issitugtf` il tmf uppfr gh`akfl, Pmf mfg` an tmf pglerfgs-fquivgdflt ta tmf hawd an tmf pipf) is ikkf`igtfdy g`ogeflt ta tmf`ua`fluk$ wmidf its ha`y gl` tgid fxtfl` gerass tmf ki`dilf
lfgrdy ta tmf spdffl,
Isdfts anDgljfrmgl
Daegtf` witmil tmf pglerfgs, Ealtgils jraups an hatm Gdpmg+ gl`Hftg+ efdds,
Hftg Efdds Ilsudil Ealvfrsial an jdueasf tajdyeajfl,
Efddudgr up+tgcf an Jdueasf,
Ealvfrsial an fxefss jdueasf tangt,
Mypa+
Uykptaks? Hdaa` jdueasf dfvfdsrisf -mypfrjdyegfkig), Jdueasf isfxerftf` ilta tmf urilf -jdyeasurig)+ wmiem ilerfgsfs dfvfds anurilgtial$ egusilj `fmy`rgtial,
Gs jdueasf dfvfds il tmf hdaa`ilerfgsf$ ngt gl` pratfil grfhracfl+`awl nar flfrjy, Eakg gl``fgtm kgy naddaw in tmf sykptaksgrf lat trfgtf`,
egusfs @ighftfs Kfdditus?
GdpmgEfdds
Jduegjal Ealvfrsial an jdyeajfl tajdueasf,
G`rflgdJdgl`s
Pmf g`rflgd jdgl`s grf argljf+eadarf` fl`aerilf w!e grfdaegtf` al tmf tap an hatm ci`lfys ,
G`rflgdil-Fpilfpmrilf)
Rrfpgrfs tmf ha`y nar (nrijmt$ nijmtar ndijmt( gl` mgs kgly fnnfets?
Getial an mfgrt ilerfgsf`,
Xgtf gl` `fptm an hrfgtmilj
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ilerfgsf`,
Kftghadie rgtf ilerfgsf`,
Naref an kuseudgr ealtrgetialikpravfs,
Alsft an kuseudgr ngtijuf`fdgyf`,
Hdaa` suppdy ta tmf hdg``fr gl`iltfstilfs rf`uef`$ tmfirkuseudgr wgdds rfdgx$ tmfspmiletfrs ealtrget,
Larg`rflgdil -Larfpilfpmrilf)
Uikidgr fnnfets ta g`rflgdil?
Ealstrietial an skgdd hdaa`vfssfds dfg`ilj ta ilerfgsf ilhdaa` prfssurf,
Ilerfgsf` hdaa` ndaw tmraujm tmfearalgry grtfrifs gl` sdawilj anmfgrt rgtf,
Ilerfgsf il rgtf gl` `fptm anhrfgtmilj,
Xfdgxgtial an tmf skaatm kusedfil tmf iltfstilgd wgdds,
Avgrifs Pmf avgrifs grf pgir an nfkgdf rfpra`uetivf arjgls, Pmfy grfdaegtf` il tmf pfdvis$ alf al fgem si`f an tmf utfrus,
fstrajfl Hrfgc+`awl an tmf utfrilf wgdd,
Rrajfstfralf Huid`s up gl` kgiltgils tmfutfrus wgdd nar fkhf``ilj annfrtidizf` fjj,
Gssaeigtf` witm sfeal`grysfxugd emgrgetfristies$ f,j, ha`ymgir$ hrfgst fldgrjfkflt$emgljfs il pmysiegd ha`y,
Pfstfs Pwa jdgl`s suspfl`f` witmil g sge an scil egddf` seratuk, Pmfy
grf eakpasf` an g dgrjf lukhfr an sfkilinfraus tuhudfs
Pfstastfralf @fvfdapkflt gl` nuletial ankgdf sfx arjgls,
Ufeal`gry sfxugdemgrgetfristies, f,j, ha`y mgir$
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kusedf `fvfdapkflt$ vaiefemgljf,
Pmf Fl`aerilf Rglerfgs
Pmf pglerfgs mausfs twa `istiletdy `innfrflt tissufs, Pmf hudc an its kgss
is fxaerilf tissuf gl` gssaeigtf` `uets$ wmiem pra`uef gl gdcgdilf ndui` dag`f`
witm `ijfstivf flzykfs wmiem is `fdivfrf` ta tmf skgdd iltfstilf ta ngeiditgtf
`ijfstial an naa`stunns, Uegttfrf` tmraujmaut tmf fxaerilf tissuf grf sfvfrgd
mul`rf` tmausgl` edustfrs an fl`aerilf efdds wmiem pra`uef tmf markalfs
ilsudil gl` jduegjal$ pdus g nfw atmfr markalfs,Ilsudil gl` jduegjal grf eritiegd pgrtieipglts il jdueasf makfastgsis gl`
sfrvf gs geutf rfjudgtars an hdaa` jdueasf ealefltrgtial, Nrak g kf`iegd
pfrspfetivf$ ilsudil il pgrtieudgr is flarkausdy ikpartglt + g `fnieifley il ilsudil
ar `fnieits il ilsudil rfspalsivflfss dfg` ta tmf `isfgsf `ighftfs kfdditus,
Pmf pglerfgs is gl fdaljgtf` arjgl lfstdf` lfxt ta tmf nirst pgrt an tmf
skgdd iltfstilf, Pmf fl`aerilf pglerfgs rfnfrs ta tmasf efdds witmil tmf pglerfgs
tmgt syltmfsizf gl` sferftf markalfs,
Pmf fl`aerilf partial an tmf pglerfgs tgcfs tmf nark an kgly skgdd
edustfrs an efdds egddf` isdfts an Dgljfrmgls ar$ karf sikpdy$ isdfts, Mukgls mgvf
raujmdy alf kiddial isdfts, Il stgl`gr` mistadajiegd sfetials an tmf pglerfgs$ isdfts
grf sffl gs rfdgtivfdy pgdf+stgililj jraups an efdds fkhf``f` il g sfg an `grcfr+
stgililj fxaerilf tissuf,
Rglerfgtie isdfts mausf tmrff kgoar efdd typfs$ fgem an wmiem pra`uefs g
`innfrflt fl`aerilf pra`uet?
Gdpmg efdds -G efdds) sferftf tmf markalf jduegjal,
Hftg efdds -H efdds) pra`uef ilsudil gl` grf tmf kast ghul`glt an tmf isdft
efdds,
@fdtg efdds -@ efdds) sferftf tmf markalf sakgtastgtil$ wmiem is gdsa
pra`uef` hy g lukhfr an atmfr fl`aerilf efdds il tmf ha`y,
Iltfrfstiljdy$ tmf `innfrflt efdd typfs witmil gl isdft grf lat rgl`akdy
`istrihutf` + hftg efdds aeeupy tmf efltrgd partial an tmf isdft gl` grf surraul`f`
hy g (ril`( an gdpmg gl` `fdtg efdds, Gsi`f nrak tmf ilsudil$ jduegjal gl`
sakgtastgtil$ g lukhfr an atmfr (kilar( markalfs mgvf hffl i`fltinif` gs
pra`uets an pglerfgtie isdfts efdds,
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Isdfts grf riemdy vgseudgrizf`$ gddawilj tmfir sferftf` markalfs rfg`y
geefss ta tmf eireudgtial, Gdtmaujm isdfts eakprisf aldy 7+8& an tmf kgss an tmf
pglerfgs$ tmfy rfefivf ghaut 72 ta 76& an tmf pglerfgtie hdaa` ndaw,
G``itialgddy$ tmfy grf illfrvgtf` hy pgrgsykpgtmftie gl` sykpgtmftie lfurals$
gl` lfrvaus sijlgds edfgrdy ka`udgtf sferftial an ilsudil gl` jduegjal,
PMF VXILGXY UYUPFK
Pmf urilgry systfk ealsists an twa ci`lfys$ twa urftfrs$ tmf urilgry
hdg``fr$ gl` tmf urftmrg, Pmf narkgtial an urilf is tmf nuletial an tmf ci`lfys$
gl` tmf rfst an tmf systfk is rfspalsihdf nar fdikilgtilj tmf urilf,Ha`y efdds pra`uef wgstf pra`uets suem gs urfg$ erfgtililf$ gl`
gkkalig$ wmiem kust hf rfkavf` nrak tmf hdaa` hfnarf tmfy geeukudgtf ta
taxie dfvfds, Gs tmf ci`lfys nark urilf ta fxerftf tmfsf wgstf pra`uets$ tmfy gdsa
geeakpdism sfvfrgd atmfr ikpartglt nuletials?
7, Xfjudgtial an tmf vadukf an hdaa` hy fxerftial ar ealsfrvgtial an wgtfr
8, Xfjudgtial an tmf fdfetradytf ealtflt an tmf hdaa` hy tmf fxerftial ar
ealsfrvgtial an kilfrgds
5, Xfjudgtial an tmf gei`hgsf hgdglef an tmf hdaa` hy fxerftial ar
ealsfrvgtial an ials suem gs MQ ials ar MEA5Q ials
0, Xfjudgtial an gdd an tmf ghavf il tissuf ndui`
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Ci`lfys
Mgs g miduk nar pgssgjf an
+ 8 -pgirf`), Pmf dfnt is mijmfr tmgl tmf rijmt `uf ta tmf prfsflef an tmf
divfr,
7, rflgd grtfry
8, rflgd vfil
5, urftfr
0, lfrvfs
is daegtf` rftrapfritalfgd, It is fkhf``f` il ngt, Pmis ngtty pauem ealsists
an 5 dgyfrs?
7, Xflgd egpsudf + illfrkast dgyfr, Is stralj gl` nihraus, It isgttgemf` ta tmf ci`lfy, It nuletials ta prfvflt ilnfetial,
8, G`ipasf egpsudf + sfeal` dgyfr, Is g pratfetivf dgyfr,
5, Xflgd ngseig + tmir` dgyfr, Is g suppartivf dgyfr, It glemars tmf
ci`lfy ta tmf pfritalfuk gl` tmf gh`akilgd wgdd,
Ci`lfy strueturf
7, Autfr eartfx + kgly egpiddgrifs
Mgs twa dgyfrs
8, illfr kf`uddg + kgly hdaa` vfssfds gl` tuhudfs
g, rflgd pyrgki`s + tuhudfs -tips ; rflgd pgpiddg)
h, rflgd eadukls + sfpgrgtf pyrgki`s, Prglskit hdaa` vfssfds
Lfpmral
+ tmf nuletialgd ulit an tmf ci`lfy, It nuletials ta pra`uef urilf, It is
kg`f up an kgly tuhudfs gl` tmfir gssaeigtf` hdaa` vfssfds, Pmfrf grf avfr 7
kiddial lfpmrals
Jdakfrudus
+ G tunt an egpiddgrifs witm nflfstrgtials
Jdakfrudgr -Hawkgl*s) egpsudf + surraul`s tmf jdakfrudus, Pajftmfr tmfy nark
tmf rflgd earpusedf, Pmf fpitmfdiuk an tmf jdakfrudgr egpiddgrifs ealtgils parfs
egddf` nflfstrgf, Pmfsf gddaw nidtrgtf hut LAP pratfils ta pgss nrak tmf hdaa` ilta
tmf jdakfrudgr egpsudf, Pmf jdakfrudgr egpsudf mgs g pgriftgd gl` g visefrgd
dgyfr, Pmf pgriftgd dgyfr
Pmf visefrgd dgyfr is kg`f up an mijmdy spfeigdizf` efdds egddf` pa`aeytfs, Pmfsf
efdds mgvf naat praefssfs -pf`iefds) wmiem dilf tmf hgsfkflt kfkhrglf an tmf
jdakfrudus, Hftwffl tmf naat praefssfs wf sff nidtrgtial sdits wmiem gddaw tmf
nidtrgtf ta pgss ilta tmf egpsudgr spgef,
is nar strueturf aldy gl` `afs lat pdgy g radf il nidtrgtial,
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Rraxikgd ealvadutf` tuhudf
+ Mfrf wf sff euhai`gd efdds witm g hrusm har`fr
-kieraviddi) Pmfsf efdds rfsarh suhstglefs nrak tmf nidtrgtf gs wfdd gs sferftf
suhstglefs ilta tmf nidtrgtf, Pmf kieraviddi jrfgtdy ilerfgsf tmf ghidity ta rfsarh
wgtfr,
Daap an Mfldf
+ mgs hatm gsefl`ilj gl` `fsefl`ilj dikhs
@fsefl`ilj dikh
+ -tmil sfjkflt) is sikpdf squgkaus fpitmfdiuk gl` is mijmdy
pfrkfghdf ta wgtfr,
Gsefl`ilj dikh
+ -tmiec sfjkflt) tmf fpitmfdiuk is euhai`gd ar fvfl daw
eaduklgr,
@istgd ealvadutf` tuhudf
7, iltfregdgtf` efdds -euhai`gd witm kieraviddi) + tmfsf nuletial il gei`!hgsf
hgdglef an tmf hdaa`,
+ mfrf tmf efdds grf euhai`gd gl` tmillfr tmgl tmasf sffl
il tmf praxikgd ealvadutf` tuhudf, Pmis smaws tmgt tmfsf efdds pdgy g radf il
sferftilj suhstglefs ilta tmf nidtrgtf rgtmfr tmgl rfkavilj suhstglefs nrak it,
Mfrf wf gdsa sff twa efdd typfs?
8, prileipgd efdds - la kieraviddi) + tmfsf nuletial il ha`y Lg# gl` wgtfr
hgdglef,
Eaddfetilj `uet
+ Lat g pgrt an tmf Lfpmral, Pmf `istgd ealvadutf` tuhudfs
eallfet ta eaddfetilj `uets, Rgssfs tmraujm tmf rflgd pyrgki`s gl` fl`s gt tmf
rflgd pgpiddgf wmfrf it fkptifs ilta g kilar egdyx,
Pwa typfs an Lfpmrals?
7, Eartiegd lfpmrals? tmfsf kgcf up =6& an aur lfpmrals, Zitm tmf
fxefptial an tmf tip an tmf daap an Mfldf tmfsf lfpmrals grf daegtf` il
tmf rflgd eartfx,
8, Ouxtgkf`uddgry lfpmrals? mfrf tmf rflgd earpusedfs grf daegtf` il tmf
eartfx$ yft vfry lfgr tmf eartfx+kf`uddg ouletial,
Hdaa` suppdy + rflgd grtfrifs nff` ilta sfjkfltgd grtfrifs$ wmiem turl iltailtfrdahgr grtfrifs -il rflgd eadukls) wmiem nff` ilta greugtf grtfrifs -hrglemf`
aut gt tmf dfvfd hftwffl tmf eartfx gl` kf`uddg), Iltfrdahudgr grtfrifs hrglem ann
an tmf greugtf grtfrifs gl` rul aut ilta tmf eartfx, Nrak tmfsf hrglem tmf gnnfrflt
grtfriadfs wmiem hrilj hdaa` ta tmf jdakfrudi -hdaa` nidtrgtf fltfrs tmf urilgry
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tuhudfs), Hdaa` dfgvilj tmf jdakfrudus fltfrs gl fnnfrflt grtfriadf wmiem tgcfs
tmf hdaa` ta pfrituhudgr egpiddgrifs graul` tmf ealvadutf` tuhudfs AX vgsg rfetg
surraul`ilj tmf gsefl`ilj gl` `fsefl`ilj dikhs an Mfldf, Gt tmis pailt tmf hdaa`
fltfrs vfils tmgt pgrgddfd tmf grtfrifs, Pmgt is$ iltfrdahudgr vfils ta greugtf vfils
ta iltfrdahgr vfils ta rflgd vfils ta tmf I^E,
Vrftfrs
+ grf rftrapfritalfgd gl` pgirf`, + fltfr tmf urilgry hdg``fr
Pmf wgdd an tmf urftfr mgs 5 dgyfrs -tulies)
7, illfr kueasg
8,
+ ealtiluaus witm tmf dililj an tmf urilgry hdg``fr, It mgs
trglsitialgd fpitmfdiuk tmgt sferftfs g pratfetivf kueaus -duhriegtial)
ki``df dgyfr
5,
+ Kuseudgris, It mgs gl illfr daljitu`ilgd gl` autfr eireudgr
dgyfr an skaatm kusedf,
Autfr dgyfr
+ nihraus eagt kg`f an daasf EP, Pmis eagt eavfrs tmf
urftfr gl` glemars it il pdgef,
Vrilgry hdg``fr
+ stargjf hgj nar urilf, It is daegtf` hfmil` tmf puhie sykpmysis
yft il nralt an tmf rfetuk il kgdfs gl` il nralt an tmf utfrus il nfkgdfs,
Pmf wgdd mgs 0 dgyfrs?
7, Kuseag
8,
+ illfrkast dgyfr, Mgs trglsitialgd fpitmfdiuk, Zidd nil` kgly
nad`s -rujfg) fxefpt il tmf grfg clawl gs tmf trijalf, Pmis is g
trigljudgr grfg `fkgregtf` hy tmrff pailts$ tmf twa apfliljs an tmf
urftfrs gl` tmf fxit pailt nar tmf urftmrg,
Uuhkueasg
5,
+ supparts tmf kueasg
Kuseudgris + mgs tmrff dgyfrs egddf` `ftrusar
0,
kusedf, Pmis kusedf
mfdps ta nark tmf iltfrlgd urftmrgd spmiletfr,
Ufrasg
+ autfrkast dgyfr, It is naul` aldy al tmf supfriar surngef an tmf
hdg``fr, It is getugddy g ealtilugtial an tmf pfritalfuk,
Vrftmrg
kgdf + daljfr, Ealsists an tmrff rfjials
+ nfkgdf + smart, Gpprax, 0 ek dalj
7, prastgtie urftmrg
8,
+ pgssfs tmraujm tmf prastgtf jdgl`
kfkhrglaus urftmrg5,
+ pgssfs tmraujm tmf VJ `igpmrgjkRflidf -spaljy) urftmrg
+ pgssfs tmf dfljtm an tmf pflis,
Vrftmrgd wgdd +Pmf ilsi`f an tmf wgdd is dilf` hy kueaus kfkhrglf surraul`f` hy
g tmiec dgyfr an skaatm kusedf, Zf gdsa sff urftmrgd jdgl`s wmiem sferftf
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kueaus ilta tmf urftmrgd eglgd, Pmfrf is gl fxtfrlgd urftmrgd spmiletfr wmiem is
eakpasf` an vadultgry scfdftgd kusedf,
Kieturitial
+ urilgtial$ wmiem is g rfndfx getial, Utrftem rfefptars getivgtf tmf
`ftrusar kusedf gl` rfdgx tmf iltfrlgd urftmrgd spmiletfr, Pmf fxtfrlgd urftmrgd
spmiletfr is ul`fr vadultgry ealtrad gntfr gpprax, 8 yfgrs an gjf, Pmis mgs ta `a
witm jrawtm an tmf spilgd ear` gl` gppraprigtf lfrvfs,
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@K PYRF 8Dfss sflsitivity an tissuf ta ilsudil
Ikpgirf` utidizgtial an ilsudil .
jdueasf
Ilghidity an jdueasf ta pflftrgtf tmf
efdd
Efdd stgrvgtia l Mypfrjdy efkig
Ilerfgsf` pdgskg askadgdity a n
jdueasf
Jdueasf spidd ta rflgd tuhudfs
-Jdueasurig)
Jdueasf gttrgets wgtfr
Fxefssivf Vrilgtial -Radyurig)
Pmf efdd widd smrilc!`fmy`rgtf`
Fxefssivf tmirst -Rady`ipsig)
Ilerfgsf` hgsgd mfpgtie jdu easf
pra`uetial
Utikudgtf hrgil
-Mypatmgdgkus) t a fgt
Fxefssivf mu ljfr
-Radypmgjig)
Emralie fdfvgtial an
hdaa` jdueasf
Hrfgc`awl an ngts
-Dypadysis)
Mypfrdipi`fkig
Nrff ngtty gei`s
Gtm fras edfra sis
Mypfrtflsial
`ferfgsf hdaa` p frnusialan suppdy ta vitgd arjgls
@ighftie Xftilapgtmy
Ikpgirf` ikkulf nuletial
@ighftie Lfurapgtmy
Ilnfetial
Uu``fl visial emgljfs Lukhlfss . tiljdilj il tmf
dawfr fxtrfkitifs
Zfijmt dass
Rrf`ispasilj
Ngetar
Mfrf itgry
Dinf Utydf
Ad gjf
Rrfeipitgtilj
Ngetar
Jflfs
Ahfsity
>9 yrs ad
@ighftie Lfpmrapgtmy
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LFRMXARGPMY
Fgrdy jdakfrudgr mfka`ylgkie
emgljfs
Mypfrnidtrgtial . Mypfrpfrnusial
@ysnuletial an gutarfjudgtary
rfspalsf
Kieragdhukilurig
Ilerfgsf grtfrigd idgtial
Ilerfgsf` kfssgljigd efdd
kgtrix pra`uetial
Ilerfgsf` iltrgjdakfrudgr
prfssurf
Ilerfgsf` fxtrgefddudgr
kgtrix `fpasitial .
kfssgljigd mypfrtrapm y
Fxpglsial an kfssgljigd
grfg
Rrf`ispasilj
Ngetar
Dalj Utgl ilj @KAd Gjf
Rrfeipitgtilj
Ngetar
76yrs>9 yrs adMypfrtflsialMypfrjdyefkig
@ferfgsf` jdakfrudgr
nidtrgtial rgtf
Xf`uetial an tmf surngef
grfg nar n idtrgtial
Kgrcs tmf hfjill ilj an
rflgd ngidurf
@ferfgsf` jdakfrudgr
nidtrgtial
Ilerfgsf` sa`iuk
erfgtililfIlerfgsf HVL
Mypftrapmy an rfkgililj
lfpmrals
Ilghidity ta ealefltrgtf
urilf
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Nurtmfr dass an lfpmral nuletial
Dass an lalfxerftary rflgd
nuletial
Ngidurf ta pra`uef
frytmrapaiftil
Dass an fxerftary rflgd
nuletial
Glfki g$ pgdd ar$
wfgclfss$ ngtiju f
Ikkulf isturhglefs
Ilnfetial
@ferfgsf` sa` iuk
rfghsarptial il tuhudf
Zgtfr rftfltial
F`fkg
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DGHAXGPAXY PFUPU . XFUVDPU
Eakpdftf Hdaa` Eault
G eakpdftf h daa` eault -EHE)$ gdsa clawl gs nudd hdaa` eault -NHE) ar
nudd hdaa` fxgk -NHF) ar hdaa` pglfd$ is g tfst rfqufstf` hy g `aetar ar atmfr
kf`iegd pranfssialgd tmgt jivfs ilnarkgtial ghaut tmf efdds il g pgtiflt*s hdaa`, G
dgh tfemlieigl -`ipdakg mad`fr) ar tfemladajist -hgemfdar mad`fr) pfrnarks tmf
rfqufstf` tfstilj gl` pravi`fs tmf rfqufstilj Kf`iegd Rranfssialgd witm tmf
rfsudts an tmf EHE, G EHE is gdsa clawl gs g (mfkajrgk(,
G eakpdftf hdaa` eault widd larkgddy iledu`f?
Xf` efdds
Patgd rf` hdaa` efdds
+ Pmf lukhfr an rf` efdds is jivfl gs gl ghsadutf
lukhfr pfr ditrf,
Mfkajdahil
+ Pmf gkault an mfkajdahil il tmf hdaa`$ fxprfssf` il jrgks
pfr feiditrf, -Daw mfkajdahil is egddf` glfkig,)
Mfkgtaerit ar pgecf` efdd vadukf -RE^)
Xf` hdaa` efdd il`iefs
+ Pmis is tmf nrgetial an wmadfhdaa` vadukf tmgt ealsists an rf` hdaa` efdds,
Kfgl earpuseudgr vadukf -KE^)
nfktaditrfs
+ tmf gvfrgjf vadukf an
tmf rf` efdds$ kfgsurf` il ,Glfkig is edgssinif`
gs kieraeytie arkgeraeytie hgsf` al wmftmfr tmis vgduf is
ghavf ar hfdaw tmf fxpfetf` larkgd rgljf, Atmfr eal`itials
tmgt egl gnnfet KE^ iledu`f tmgdgssfkig gl` rftieudaeytasis,
Kfgl earpuseudgr mfkajdahil -KEM)
+ tmf gvfrgjf gkault
an mfkajdahil pfr rf` hdaa` efdd$ il pieajrgks,
Kfgl earpuseudgr mfkajdahil ealefltrgtial -KEME)
+ tmf
gvfrgjf ealefltrgtial an mfkajdahil il tmf efdds,
Xf` hdaa` efdd `istrihutial wi`tm -X@Z)
+ g kfgsurf an tmf vgrigtial an tmf
XHE papudgtial
Zmitf efdds
Patgd wmitf hdaa` efdds + Gdd tmf wmitf efdd typfs grf jivfl gs g pfrefltgjf
gl` gs gl ghsadutf lukhfr pfr ditrf,
G eakpdftf hdaa` eault witm `innfrfltigd widd gdsa iledu`f?
http://en.wikipedia.org/wiki/Femtolitrehttp://en.wikipedia.org/wiki/Femtolitrehttp://en.wikipedia.org/wiki/Anemiahttp://en.wikipedia.org/wiki/Microcytic_anemiahttp://en.wikipedia.org/wiki/Macrocytic_anemiahttp://en.wikipedia.org/wiki/Thalassemiahttp://en.wikipedia.org/wiki/Reticulocytehttp://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobinhttp://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobinhttp://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobinhttp://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobin_concentrationhttp://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobin_concentrationhttp://en.wikipedia.org/wiki/Picogramhttp://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobin_concentrationhttp://en.wikipedia.org/wiki/Red_blood_cell_distribution_widthhttp://en.wikipedia.org/wiki/Red_blood_cell_distribution_widthhttp://en.wikipedia.org/wiki/Red_blood_cell_distribution_widthhttp://en.wikipedia.org/wiki/White_blood_cellshttp://en.wikipedia.org/wiki/White_blood_cellshttp://en.wikipedia.org/wiki/Red_blood_cell_distribution_widthhttp://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobin_concentrationhttp://en.wikipedia.org/wiki/Picogramhttp://en.wikipedia.org/wiki/Mean_corpuscular_hemoglobinhttp://en.wikipedia.org/wiki/Reticulocytehttp://en.wikipedia.org/wiki/Thalassemiahttp://en.wikipedia.org/wiki/Macrocytic_anemiahttp://en.wikipedia.org/wiki/Microcytic_anemiahttp://en.wikipedia.org/wiki/Anemiahttp://en.wikipedia.org/wiki/Femtolitre -
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Lfutrapmid jrgludaeytfs + Kgy il`iegtf hgetfrigd ilnfetial, Kgy gdsa hf
rgisf` il geutf virgd ilnfetials,Hfegusf an tmf sfjkfltf` gppfgrglef an
tmf luedfus$ lfutrapmids grf sakftikfs rfnfrrf` ta gs (sfjs,( Pmf luedfus
an dfss kgturf lfutrapmids is lat sfjkfltf`$ hut mgs g hgl` ar ra`+dicf
smgpf, Dfss kgturf lfutrapmids + tmasf tmgt mgvf rfefltdy hffl rfdfgsf`
nrak tmf half kgrraw ilta tmf hdaa`strfgk + grf clawl gs (hgl`s( ar
(stghs(, Utgh is g Jfrkgl tfrk nar ra`,
Dykpmaeytfs + Mijmfr witm sakf virgd ilnfetials suem gs jdgl`udgr nfvfr
gl`, Gdsa rgisf` il dykpmaeytie dfucgfkig EDD, Egl hf `ferfgsf` hy MI^
ilnfetial, Il g`udts$ dykpmaeytfs grf tmf sfeal` kast eakkal ZHE typfgntfr lfutrapmids, Il yaulj emid`rfl ul`fr gjf =$ dykpmaeytfs grf karf
eakkal tmgl lfutrapmids,
Kalaeytfs + Kgy hf rgisf` il hgetfrigd ilnfetial$ tuhfreudasis$ kgdgrig$
Xaecy Kaultgil spattf` nfvfr$ kalaeytie dfucfkig$ emralie udefrgtivf
eaditis gl` rfjialgd fltfritis
Fasilapmid jrgludaeytfs + Ilerfgsf` il pgrgsitie ilnfetials$ gstmkg$ ar
gddfrjie rfgetial,
Hgsapmid jrgludaeytfs + Kgy hf ilerfgsf` il half kgrraw rfdgtf`
eal`itials suem gs dfucfkig an dykpmakg,
Rdgtfdfts
Rdgtfdft lukhfrs grf jivfl$ gs wfdd gs ilnarkgtial ghaut tmfir sizf gl` tmf
rgljf an sizfs il tmf hdaa`,
http://en.wikipedia.org/wiki/Neutrophil_granulocytehttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Glandular_feverhttp://en.wikipedia.org/wiki/CLLhttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/Eosinophil_granulocytehttp://en.wikipedia.org/wiki/Parasitehttp://en.wikipedia.org/wiki/Basophil_granulocytehttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/Basophil_granulocytehttp://en.wikipedia.org/wiki/Parasitehttp://en.wikipedia.org/wiki/Eosinophil_granulocytehttp://en.wikipedia.org/wiki/Monocytehttp://en.wikipedia.org/wiki/CLLhttp://en.wikipedia.org/wiki/Glandular_feverhttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Lymphocytehttp://en.wikipedia.org/wiki/Bacteriahttp://en.wikipedia.org/wiki/Neutrophil_granulocyte -
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@gy Larkgd ^gdufs Xfsudt Xfkgrcs il`iegtialsEdiliegd
Uijlinieglef
Nfh,8=$8229
Dfueaeytfs La,EalfG`udt?6+72 x729!D
:,7 x729!D
Larkgd Pa i`fltinylarkgd hdaa`efdds ta`igjlasf`hdaa``isfgsf
@inn, Efdd Eault
Ufjkfltfrs?
2,>6+2,=6
Dykpmaeytfs?2,76+2,56
MfkajdahilKgss Ealf?
78,2+70,2 j!D
Mfkgtaerit2,5:+2,0:
2,92
2,72
>,2 j!D
2,7=
Ilerfgsf`
@ferfgsf`
@ferfgsf`
@ferfgsf`
^itgd il`igjlasiljgl`
trfgtkflt anmfkarrmgjie`isfgsf
Kfgsurfstmf gkaultanmfkajdahil
il tmf hdaa`
Kfgsurf anXHE naul`il tmf hdaa`$stgtf` gs gpfrefltgjfan tmf tatgdhdaa`vadukf
+prfsflef anilnfetial
+glfkig
+glfkig gl` mfgrt`isfgsf
+glfkig
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Ediliegd Emfkistry
@gy Larkgd ^gdufs Xfsudt Xfkgrcs il`iegtialsEdiliegd
Uijlinieglef
Kgrem,8$8229
Mjt=2+782 kj!`D
Hdaa` Vrie Gei`8,>+>,2 kj!`D
Hdaa` VrfgLitrajfl7,:+=,5 kkad!D
UfrukErfgtililf2,6+7,8 kj!`d
822kj!`D
9,2
kj!`D
7>,5kkad!D
9,=kj!`D
Ilerfgsf`
Ilerfgsf`
Ilerfgsf`
Ilerfgsf`
Pa`ftfrkilftmf dfvfd anhdaa` sujgril tmf hdaa`
Rra`uet an
kftghadiskan pratfilprfsflt iltmf hdaa` .fxerftf` iltmf urilf
Pmf gkaultan litrajflil tmf hdaa`
il tmf narkan urfg
Kfgsurfstmf gkaultan erfgtililfil tmf hdaa`
-#) @K
Jaut
@ighftielfpmrapgtmy
@ighftielfpmrapgtmy
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Vrilgdysis
G urilgdysis is g jraup an kglugd gl`!ar gutakgtf` qugditgtivf gl` sfki+
qugltitgtivf tfsts pfrnarkf` al g urilf sgkpdf, G rautilf urilgdysis usugddy
iledu`fs tmf naddawilj tfsts? eadar$ trglspgrfley$ spfeinie jrgvity$ pM$ pratfil$
jdueasf$ cftalfs$ hdaa`$ hidiruhil$ litritf$ urahidilajfl$ gl` dfucaeytf fstfrgsf,
Uakf dghargtarifs iledu`f g kieraseapie fxgkilgtial an urilgry sf`ikflt witm gdd
rautilf urilgdysis tfsts, In lat$ it is eustakgry ta pfrnark tmf kieraseapie fxgk$ in
trglspgrfley$ jdueasf$ pratfil$ hdaa`$ litritf$ ar dfucaeytf fstfrgsf is ghlarkgd,
Rurpasf
Xautilf urilgdysfs grf pfrnarkf` nar sfvfrgd rfgsals?
jflfrgd mfgdtm serfflilj ta ftfet rflgd gl` kftghadie isfgsfs
`igjlasis an isfgsfs ar isar`frs an tmf ci`lfys ar urilgry trget
kalitarilj an pgtiflts witm `ighftfs
Il g``itial$ qugltitgtivf urilgdysis tfsts kgy hf pfrnarkf` ta mfdp
`igjlasf kgly spfeinie `isar`frs$ suem gs fl`aerilf `isfgsfs$ hdg``fr eglefr$
astfaparasis$ gl` parpmyrigs -g jraup an `isar`frs egusf` hy emfkiegdikhgdglef), Wugltitgtivf glgdysis antfl rfquirfs tmf usf an g tikf` urilf sgkpdf,
Pmf urilgry kieragdhukil tfst kfgsurfs tmf rgtf an gdhukil fxerftial il tmf urilf
usilj dghargtary tfsts, Pmis tfst is usf` ta kalitar tmf ci`lfy nuletial an pfrsals
witm `ighftfs kfdditus, Il `ighfties$ tmf fxerftial an jrfgtfr tmgl 822 j!kD
gdhukil is prf`ietivf an ikpfl`ilj ci`lfy isfgsf,
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@gy Larkgd ^gdufs Xfsudt Xfkgrcs il`iegtialsEdiliegd
Uijlinieglef
Nfh, 8=$8229
EadarGkhfr yfddaw
PrglspgrfleyEdfgr
Jrgvity7,226+7,252
pM:,56+:,06Gvf? >,2
Gdhukil
Jdueasf 2 arlat prfsflt
Hdaa` latprfsflt
yfddaw
turhi`
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Il`iegtial anurilfealefltrgtial
ar gkault ansadutfsprfsflt iltmf urilf,
Pa `ftfrkilftmf rfdgtivfgei`ity gl`gdcgdility anurilf gl`gssfss tmf
ediflts gei`+hgsf` stgtus,
Pa `ftfrkilftmf gkaultan pratfilhfilj dast iltmf urilf
Ikpartglttfst an
`ighftie gl`atmfr`isar`fr
Pa `ftfrkilftmf prfsflefan hdaa` iltmf urilf
@fhris$ hgetfrigsf`ikflt
Ilerfgsf gei`itywitm rflgd tuhudgrgei`asis trget
ilnfetial
Gei ity$ VPI
Gdhukilurig
Mijm hdaa`jdueasf dfvfd
VPI gl` @ighftielfpmrapgtmy
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@gy Larkgd ^gdufs Xfsudt Xfkgrcs il`iegtialsEdiliegd
Uijlinieglef
Kgr, 5$8229
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Rrfsflef anhdaa` efdds
Il`iegtial anurilfealefltrgtial
ar gkault ansadutfsprfsflt iltmf urilf,
Pa `ftfrkilftmf rfdgtivfgei`ity gl`gdcgdility anurilf gl`gssfss tmf
ediflts gei`+hgsf` stgtus,
Pa `ftfrkilftmf gkaultan pratfilhfilj dast iltmf urilf
Ikpartglttfst an
`ighftie gl`atmfr`isar`fr
Il`iegtf tmfegusf anilnfetial
Pa `ftfrkilfpratfilurig .mijm pratifl
@fhris$ hgetfrigsf`ikflt
Ilerfgsf gei`itywitm rflgd tuhudgrgei`asis trget
ilnfetial
Gei ity$ VPI
Gdhukilurig
Mijm hdaa`jdueasf dfvfd
Rrfsflef anilnfetial
Rratflurig
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Jflfrie Lgkf-Hrgl` Lgkf)
Egtfjary Getial Lursilj Ealsi`frgtial Rgtiflt Pfgemilj Ealtrgil`iegtial
Jdiedgzi`f
-@igkieral)RrfjlgleyEgtfjary E
Mfdps ta dawfr hdaa`jdueasf hystikudgtilj tmfrfdfgsf an ilsudilnrak tmf pglerfgs,
G`kilistfr witm naa`ta `ferfgsf JIPirritgtial gl` prfvfltmypajdyefkig,
Ilstruet tmf pgtiflt latta tgcf gdeamadiehfvfrgjfs hfegusf it
egl dfg` ta sfvfrfmypajdyefkierfgetial,
Gssfss pgtiflt narsijls an `fprfssialtmraujmaut tmftmfrgpy,
Umaud` hf ilnarkf`tmgt pradaljf` usfkgy dfg` ta`fpfl`flef,
Umaud` lat hf usf` il@K eakpdiegtf` hygei`asis$ cftagei`asisar eakg$ ar il pgtifltwitm g mistary anrfpfgtf` fpisa`fs ancftagei asis ar eakg,
Jdipizi`f
-Jdueatrad)RrfjlgleyEgtfjary E
Hdaa` jdueasfdawfrilj `ruj ansudnalydurfg edgss,
Ghlarkgd hdaa`jdueasf dfvfds `uriljprfjlgley grfgssaeigtf` witm gmijmfr ilei`flef anealjflitgdghlarkgditifs,
Gvai` atmfrkf`iegtialsfspfeigddy gspiril gl`gdeamad,
Umaud` hf ilnark anpatfltigd risc gl`g`vgltgjfs anJdueatrad gl` angdtfrlgtivf ka`f antmfrgpy, Pmfy smaud`gdsa hf ilnarkf`ghaut tmf `iftgryilstruetials an grfjudgr fxfreisfprajrgk gl` anrfjudgr tfstilj an urilf
gl` ar hdaa` sujgr, In mypajdyefkig
aeeurs tgcf g jdgss anargljf ouief$ 8+5 tspan sujgr$ malfy ar
Umaud` lat hf jivfl tapgtiflt witm clawlmypfrsflsitivity ta tmf`ruj,
Umaud` lat hf jivfl tapgtiflt witm @K typf 7$`ighftie cftagei`asiswitm ar witmaut eakg,
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earl syrup `issadvf ilwgtfr,
Dgetudasf
-Rartgdge)RrfjlgleyEgtfjary H
Ilerfgsf M8A ealtfltgl` santfls mf staad,
Dawfrs tmf pM an tmfeadal,
Gssfss pgtiflt nargh`akilgd `istfltial$prfsflef an hawfdsaul`s$ gl` larkgdpgttfrl an hawfdnuletial,
Fnnfets grf sffl il
80+0= maurs @a lat sfdn kf`iegtf
witm glatmfr dgxgtivfhfegusf an sdawalsft,
Latiny @aetar in`igrrmfg pfrsists narkarf tmgl 80 mrs,$eaud` hf g sijl anavfr`asf gl` kg`fnar kf` g`oustkflt,
F`uegtf pgtiflt tmgttmis `ruj is usf`egutiausdy il @K$prfjlgley$ dgetgtial$ar emid`rfl,
Fxefssivf arpradaljf` usf kgy
dfg` ta `fpfl`flef,
smaud` lat hf jivfl tapgtiflt al daw jgdgetasf pgtiflt,
Akfprgzadf
-Dgsfe)RrfjlgleyEgtfjary H
Hil`s ta gl flzykfal jgstrie pgriftgdefdds il tmf prfsflefan gei`ie pM$prfvfltilj tmf nilgdtrglspart an my`rajflials ilta tmf jgstriedukfl,
G`kilistfr hfnarfkfgds, Egutial pgtifltta swgddaw egpsudfswmadf+lat ta apfl$emfw$ ar erusm tmfk,
Grrgljf nar nurtmfrfvgdugtial an pgtifltgntfr = wc an tmfrgpy
nar jgstrarfndux`isar`frs3 latiltfl`f` narkgiltflglef tmfrgpy,
G`kilistfr gltgei`s
Ilstruet pgtiflt ta tgcfkf`iegtial gs irfetf`nar tmf nudd eaursf antmfrgpy$ fvfl innffdilj hfttfr,
Kgy egusf aeegsialgd`rawsilfss an`izzilfss,
G`visf pgtiflt tagvai` gdeamad pra`uetsealtgililj gspiril$ tmiskgy egusf JIirritgtial,
Umaud` lat hf jivfl tapgtiflt witm clawlmypfrsflsitivity,
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witm akfprgzadf$ inlff`f`,
G`visf pgtiflt tarfpart alsft an hdgectgrry staad$ `igrrmfggl` pfrsistfltmfg`gemf,
Kftaedapraki`f
-rfjdgl)RrfjlgleyEgtfjary H
Hdaec `apgkilfrfefptars ilemfkarfefptartrijjfr zalf il ELU
Utikudglts katidity antmf uppfr JI trget$gl` geefdfrgtfsjgstrie fkpty,
Gssfss pgtiflt narlgusfg gl` vakitilj$gh`akilgd `istfltial$gl` hawfd saul`s
priar ta gl` naddawiljg`kilistrgtial, Gssfss pgtiflt nar
sijls an `fprfssialtmraujmaut tmftmfrgpy,
Ilstruet pgtiflt ta tgcfkftaedapraki`ffxgetdy gs irfetf`,
G`visf pgtiflt ta
gvai` ealeurrflt usfan gdeamad gl` atmfrELU `fprfssglts$wmidf tgcilj tmiskf`iegtial
Pmis kf`iegtial kgyegusf `rawsilfss$egutial pgtiflt ta
gvai` `rivilj ar atmfrgetivitifs rfquiriljgdfrtlfss ultidrfspalsf takf`iegtial is clawl,
Mypfrsflsitivity$mfkkarrmgjf$ mistaryan sfizurfs `isar`frs$pgrcilsals `isfgsf,
Xgliti`ilf
-_gltge)RrfjlgleyEgtfjary H
Ilmihits tmf getial anmistgkilf gt tmf M8rfefptar sitf daegtf`prikgridy il jgstriepgriftgd efdds,
Gssfss pgtifltrautilfdy nar fpijgstriear gh`akilgd pgil gl`rglc ar aeeudt hdaa` iltmf staad$ fkfsis arjgstrie gspirgtf,
Fleaurgjf pgtiflt taquit skacilj$ ar gtdfgst lat ta skacfgntfr dgst `asf an tmf`gy,
Ilnark pgtiflt tmgt
ilerfgsf ndui` gl`nihfr iltgcf gl`fxfreisf kgykilikizf ealstipgtial,
Mypfrsflsitivity$ sakfargd diqui`s ealtgilgdeamad gl` smaud` hfgvai`f` il pgtifltswitm clawl tadfrglef,
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Upiraladgetalf
-Gd`getalf@iurfties -patgssiuk Upgrilj)
Egusf dass an sa`iukhiegrhalgtf gl`egdeiuk wmidf sgviljpatgssiuk gl`my`rajfl ials,
Gltgjalizfsgd`astfralf il tmf`istgd tuhudfs$ilerfgsilj sa`iuk
gl` wgtfr fxerftial,
Kalitar I.A rgtiasgl` `gidy wfijmt`urilj tmfrgpy,
In kf`iegtials is jivflgs gl g`oulet tagltimypfrtflsivftmfrgpy$ kalitar HRhfnarf g`kilistfrilj,
Kalitar rfspalsf an
U!Ux an mypacgdfkig-wfgclfss$ ngtijuf$grrmytmkigs$ padyurig$gl` pady`ipsig),
Pa flmglefghsarptial$ jivf `rujwitm kfgds,
Rratfet `ruj nrakdijmt,
Kalitar fd`frdypgtiflts edasfdy$ wmagrf susefptihdf tafxefssivf iurfsis,
Ilstruet pgtiflt ta tgcf`ruj il tmf karlilj taprfvflt lff` taurilgtf gt lijmt,
Pa prfvflt sfriausmypfrcgdfkig$ wgrlpgtiflt ta gvai`fxefssivf iljfstial anpatgssiuk+riem naa`s$
sgdts suhstitutfs gl`patgssiuksuppdfkflts,
Egutial pgtiflt lat tapfrnark mgzgr`ausgetivitifs in g`vfrsfrfgetials aeeurs,
Ealtrgil`iegtf` ilpgtiflt mypfrsflsitivfta `ruj gl` il tmasfwitm glurig$ geutf arprajrfssivf rflgdilsunnifley$ armypfrcgdfkig,
Efnuraxikf
-_ilgefn)Ufeal`+jflfrgtialefpmgdasparilsGlti+ilnfetivfs
Ilmihits efdd+wgddsyltmfsis$ prakatiljaskatie ilstghidity$usugddy hgetfriei`gd,
Hfnarf jivilj `ruj$gsc pgtiflt in mf arsmf is gddfrjie tapflieiddils arefpmgdasparils,
Nar IK usf$ ilofet ilta
g dgrjf kusedf$ suemgs tmf jdutfuskgxikus ar tmf si`fan tmf tmijm,
Ghsarptial ar argd`ruj is flmglef` hy
Pfdd pgtiflt ta tgcf`ruj gs prfserihf`$fvfl gntfr mf!smfnffds hfttfr,
Ilstruet pgtiflt ta tgcfargd nark witm naa`,
In pgtiflt mgs `innieudtyswgddawilj tghdfts,Umaw mfr!mik maw ta`issadvf ar erusmtghdfts, Hut wgrkmik!mfr tmf hittfr tgstf
Ealtrgil`iegtial ilpgtiflts mypfrsflsitivfta `ruj ar atmfrefpmgdasparils,
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naa`, Pghdfts kgy hf
erusmf`$ in ghsadutfdylfefssgry$ narpgtiflts wma egltswgddaw tghdfts,
is mgr` ta kgsc fvflwitm naa`,
Pfdd pgtiflt ta smgcfsuspflsial wfddhfnarf kfgsurilj`asf,
G`visf pgtifltrfefivilj `ruj I,^, tarfpart `iseaknart gt
I,^, ilsfrtial sitf,
Nurasfki`f-Dgsix)
Daap `iurftie Ilmihits sa`iuk gl`emari`f rfghsarptialgt tmf praxikgd gl``istgd tuhudfs gl` tmfgsefl`ilj daap anmfldf,
Pa prfvflt laeturig$jivf R,A, gl` IKprfpgrgtials il tmfkarlilj, Jivf sfeal``asf il fgrdygntfrlaal,
Kalitar wfijmt $ HR$gl` pudsf rgtfrautilfdy witm dalj+tfrk usf gl` `uriljrgpi` ifrfsis,
Kalitar ndui` iltgcfgl` autput gl`fdfetradytf$ HVL gl`egrhal `iaxi`f dfvfds
nrfqufltdy, Zgtem nar sijls an
mypacgdfkig$ suem gskusedf wfgclfss gl`ergkps,
G`visf pgtiflt ta tgcf`ruj witm naa` taprfvflt JI upsft$ gl`ta tgcf `ruj ilkarlilj ta prfvfltlff` ta urilgtf gtlijmt,
Ilnark pgtiflt anpassihdf lff` narpatgssiuk arkgjlfsiuksuppdfkflts,
Ilstruet pgtiflt taealsudt mfgdtm egrfpranfssialgd rfjgr`ilj
g `ift mijm ilpatgssiuk,
Ealtrgil`iegtf` ilpgtiflts mypfrsflsitivfta `ruj gl` il tmasfwitm glurig,
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Kftapradad
-Daprfsar)Hftg hdaecfrsGltigljilgds$gltimypfrtflsivfs
G sfdfetivf hftghdaecfr tmgtsfdfetivfdy hdaecshftg rfefptars3`ferfgsfs egr`igeautput$ pfripmfrgdrfsistglef$ gl`egr`ige axyjflealsukptial3 gl`
`fprfssfs rfllilsferftial,
Gdwgys emfecpgtiflts gpiegd pudsfrgtf hfnarf jivilj`ruj,
Kalitar jdueasf dfvfdedasfdy hfegusf `rujkgscs eakkal U!Uxan mypajdyefkig,
Kalitar HR nrfqufltdy3
`ruj kgscs eakkalU!Ux an smaec, Kalitar I.A autput
rgtias gl` `gidywfijmt,
Ilstruet pgtiflt ta tgcf`ruj gs fxgetdy gsprfserihf` gl` witmkfgds,
Pfdd pgtiflt ta gdfrtprfserihfr in smartlfssan hrfgtm aeeurs,
Ilstruet pgtiflt lat tastap `ruj su``fldy
hut hatiny prfserihfrghaut ulpdfgsgltg`vfrsf rfgetials,
Ealtrgil`iegtf` ilpgtiflts mypfrsflsitivfta `ruj ar atmfr hftghdaecfrs,
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LVXUILJ EGXF RDGL
GUUFUUKFLP LUJ, @IGJLAUFU XGPIALGDF F]RFEPF@ AVPEAKF LUJ, ILPFX FLPIAL XGPIALGDF F GD VGPIAL
Uuhofetivf?
+ gla gwdgcgmilujg mfl ljggc dgwgs gsvfrhgdizf hy tmfpgtiflt
Ahofetivf?!U?
+ P ? 5:,:E+ RX ? 9= HRK+ XX ? 80 ERK+ HR ? 7=2!92 kkMj
Zfijmt ? 68 cj -prf+iddlfss)6= cj - urilj
maspitgdizgtial)
Ilgeeurgtf naddaw tmraujm anilstruetial
Nrfquflt gscilj ghaut mfreal itial
frhgdizilj ilgeeurgtfilnarkgtial
Clawdf`jf `fnieitrfjgr`ilj eal`itial$prajlasis$ trfgtkflt$ sfdnegrf gl` `isemgrjf lff`srfdgtf` ta ulngkidigritywitm ilnarkgtialrfsaurefs gs kglinfstf`hy nrfquflt gscilj anqufstials rfjgr`ilj@ighftfs Lfpmrapgtmy,
+Ghsflef ar fnieifley aneajlitivf ilnarkgtial rfdgtf`ta spfeinie tapie, -Judgliec$ft, Gd)+Ilnarkgtial kust hf tgujmtta pt, witm @L il ar fr tagddgy glxifty$ prfvflteakpdiegtials gl it kgysfrvf gs gl appartulity nardfgrlilj sfdn kglgjfkfltscidds, -@afljfs$ ft,gd)
Gntfr gl maur an mfgdtm
tfgemilj al fssfltigd
fdfkflts rfjgr ilj
eal itial$ prajlasis$
trfgtkflt$ sfdn egrf gl
isemgrjf lff s$ tmf pgtifltwidd hf ghdf ta vfrhgdizf
ul frstgl ilj an eal itial !
isfgsf praefss$ prajlasis
. trfgtkflt3 i fltiny
rfdgtialsmip an sijl !
sykptaks ta tmf isfgsf
praefss gl earrfdgtf
sykptaks witm egusgtivf
ngetars3 gl ilitigtf
lfefssgry dinfstydf emgljfs
gl pgrtieipgtf il trfgtkflt
rfjikfl,
Il fpfl flt7),Erfgtf gl flviralkflt antrust hy distflilj taealefrls$ hfilj gvgidghdf
8),@iseuss isfgsf praefss$prajlasis$ gl prfeipitgtiljngetars,
5),@iseuss iftgry pdgldikitilj iltgcf an sujgr$ ngt$sgdt$ gdeamad gl fgtiljeakpdfx egrhamy rgtfsspfeigddy tmasf mijm il nihfrgl wgys ta fgd witm kfgdsautsi f tmf makf,0),Fleaurgjf pgtiflt taahsfrvf emgrgetfristies anurilf gl gkault!nrfqufleyan autput,6),@iseuss getivity rfstrietialgl jrg ugd rfsukptial anfsirf getivity, Fleaurgjf
usf an flfrjy+sgvilj$rfdgxgtial$ gl ivfrsialgdtfemliqufs,
>),Xfeakkfl semf udiljgetivitifs witm g fqugtf rfstpfria s,
7),Xgppart an rfspfet lffta hf fstghdismf hfnarf tmfpgtiflt widd hf widdilj ta tgcfpgrt il tmf dfgrlilj praefss,-@afljfs$ ft,gd)8),Rravi f clawdf jf hgsfal wmiem tmf pt, egl kgcfilnarkf emaiefs,-@afljfs$ ft,gd)5),G`fqugtf lutritial islfefssgry ta prakatfmfgdilj!tissuf rfjflfrgtialwmidf g mfrflef tarfstrietials kgy prfvflteakpdiegtials0),Emgljfs kgy rfndfetgdtfrgtials il rflgdnuletial!lff nar igdysis,-@afljfs$ ft,gd)6),Rgtiflt witm GXN kgylff ta rfstriet getivitygl !ar kgy nffd wfgc nar glfxtfl f pfria urilj
dfljtmy rfeavfry pmgsf$rfquirilj kfgsurfs taealsfrvf flfrjy glrf uef harf ak !fprfssial, -@afljfs$ ft,gd)
>),Rrfvflts fxefssivfngtijuf gl ealsfrvfsflfrjy nar mfgdilj$ tissufrfjflfrgtial, -@afljfs)
Gntfr gl maur an mfgdtm
tfgemilj al fssfltigd
fdfkflts rfjgr ilj tmf
isfgsf$ tmf pgtiflt
vfrhgdizf ul frstgl ilj an
eal itial ! isfgsf praefss$prajlasis . trfgtkflt3
i fltinif rfdgtialsmip an sijl
! sykptaks ta tmf isfgsf
praefss gl earrfdgtf
sykptaks witm egusgtivf
ngetars3 gl ilitigtf`
lfefssgry dinfstydf emgljfs
gl pgrtieipgtfs il trfgtkflt
rfjikfl,
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LVXUILJ EGXF RDGL
GUUFUUKFLP LUJ, @IGJLAUFU XGPIALGDF F]RFEPF@ AVPEAKF LUJ, ILPFX FLPIAL XGPIALGDF F GD VGPIAL
Uuhofetivf?
+ lgmuhgj it gc sicigs vfrhgdizf hytmf pgtiflt
Ahofetivf?!U?
+ P ? 5:,: E+ RX ? 9= HRK+ XX ? 80 ERK+ HR ? 7=2!92 kkMj
Zfijmt ? 68 cj -prf+iddlfss)6= cj - urilj
maspitgdizgtial)
flaus istflsialJflfrgdizf f fkgXfpart an ngtijuf$ wfgclfss
gl ha y kgdgisfRittilj F fkg -86,0 kk)Xfstdfsslfss
Ndui` vadukf fxefssrfdgtf` ta eakprakisfrfjudgtary kfemglisk-rflgd ngidurf) gsfvi`flef` hy vflaus`istflsial$ jflfrgdizf`f`fkg$ ngtijuf$ wfgclfss$ha`y kgdgisf$rfstdfsslfss gl` pittiljf`fkg -86,0 kk),
+Ci lfy ngidurf ferfgsfsci lfys ghidity ta fxerftfsgdt il tmf urilf, Pmus$ tmfgkault an sgdt il tmf ha yilerfgsfs$ w!e egusfs tmfha y ta rftgil wgtfr .ferfgsf urilf autput,
Gntfr = maurs an ndui`
rfstrietials$ g`kilistfrilj
kf iegtials- iurfties .
gltimypfrtflsivf) gs
il iegtf $ tmf pgtiflt widd
fxpfriflef larkgd nduihgdglef$ ispdgy gppraprigtf
urilgry autput witm spfeinie
jrgvity !dghargtary stu ifs
lfgr larkgd$ stghdf wfijmt
gl ghsflef an f fkg
Il fpfl flt7),Xfear geeurgtf iltgcfgl autput -I!A),
@fpfl flt8),G kilistfr!rfstriet ndui gsil iegtf ,
5),G`kilistfr kf iegtial gsil iegtf -@iurfties),
Gltimypfrtflsivf
Il fpfl flt
0),Zfijm gidy gt sgkf tikfan gy$ al sgkf segdf$ witmsgkf fquipkflt gledatmilj,6),Gssfss scil$ ngef$fpfl flt grfgs nar f fkg,
7),Geeurgtf I!A is lfefssgrynar ftfrkililj rflgdnuletial gl nduirfpdgefkflt lff s glrf`ueilj risc an nduiavfrdag ,
8),Ndui kglgjfkflt isusugddy egdeudgtf ta rfpdgefautput nrak gdd saurefs glfstikgtf ilsflsihdf dassfs,5),Jivfl fgrdy il adijuriepmgsf an rflgd ngidurf il glfnnart ta ealvfrt laladijuriepmgsf$ ndusm tmf tuhudgrdukfl an fhris glprakatf urilf vadukf,Kgyhf jivfl ta trfgtmypfrtflsial hyeaultfrgetilj fnnfets anrflgd hdaa` ndaw gl !areireudgtilj vadukf avfrdag
0),@gidy ha y wfijmt is hfstkalitar an ndui stgtus,
6),F fkg aeeurs ilfpfl flt tissufs an tmf
ha y, -f,j, mgl s$ nfft$dukhasgergd grfg), Rgtifltegl jgil up ta 72 dhs -0,6
Pmf jagd wgs kft3 pgtiflt
mgs ispdgyf !fxpfriflef
larkgd ndui hgdglef$
gppraprigtf urilgry autput
witm spfeinie jrgvity
!dghargtary stu ifs lfgrlarkgd$ stghdf wfijmt gl
ghsflef an f fkg gntfr =
maurs an ndui rfstrietials$
g kilistfrilj kf iegtial
- iurfties .
gltimypfrtflsivf) gs
il iegtf ,
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>),Rdgl argd nduirfpdgefkflt witm pgtiflt$witmil kudtipdf rfstrietials,
cjs) an ndui hfnarf pittiljf fkg is ftfetf ,>),Mfdps kilikizfsharf ak an dikitf emaiefsgl rf uefs sflsf an`fprivgtial gl tmirst,
,
-
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GUUFUUKFLP LUJ, @IGJLAUFU XGPIALGDF F]RFEPF@ AVPEAKF LUJ, ILPFX FLPIAL XGPIALGDF F GD VGPIAL
Uuhofetivf?
+ kgimg kgtgkhgdgl gc mghad i imgl gc tuma gsvfrhgdizf hy tmfpt,
Ahofetivf?!U?
+ P ? 5:,:E+ RX ? 9= HRK+ XX ? 80 ERK+ HR ? 7=2!92 kkMj
Zfijmt ? 68 cj -prf+iddlfss)6= cj - urilj
iddlfss)
Mijm Jdueasf dfvfd XHU hymjt?25!28!29 ? 822 kj! dDfsials latf al hatm dfjs
Larkgd gduf?MJP ? =2 772 kj! d
Mijm risc nar ikpgirf` scil
iltfjrity rfdgtf` ta gdtfrf`
sflsgtial sfeal`gry ta
`isfgsf praefss gs
fvi`flef` hy mijm
jdueasf dfvfds an MJP?
822 kj!`d3 gl` dfsials
latf` al hatm dfjs
+Pmf risc an ilnfetialfdfvgtfs tmf mijmfr tmfJdueasf dfvfd an g pfrsalwitm ighftfs, Pmis is dgrjfdyhfegusf3 Mijm hdaa sujgregusfs tmf dass an sflsgtial-lfurapgtmy) gl ikpf fseireudgtial tmraujmaut tmfha y -spfeigddy tmf nfft),@ikilismf sflsgtial egliltfrnfrf witm tmf ha ysiloury wgrlilj systfk$ pgil,Pmus$ Ukgdd euts$ ghrgsialsgl atmfr scil gdtfrgtialskgy ja ullatief glhfeakf ilnfetf , -Zadnf$ D,),
Gntfr naddawilj g 5 gy
sfrifs an mfgdtm tfgemiljs
al tmf prfvfltivf kfgsurfs$
tmf pt, widd kgiltgil iltget
scil$ i fltiny risc ngetars gl
fkalstrgtf
hfmgviars!tfemliqufs tmgt
prfvflts scil hrfgc awl,
Il fpfl flt?7),Gltieipgtf gl usfprfvfltivf kfgsurfs il ptswma grf gt risc nar scilhrfgc awl$ suem gs glyalfwma is tmil$ ahfsf$ gjilj$ ar`fhiditgtf ,
8),Kgiltgil striet scilmyjiflf$ usilj kid $lal ftfrjflt sagp -in gly)$ryilj jfltdy gl
tmaraujmdy$ gl duhriegtiljwitm datial ar fkaddiflt,
5),Kgssgjf halyprakilflef jfltdy witmdatial ar erfgk,
0),Ilspfet scil surngef!nad sgl haly prakilflefs
7),@feuhitus udefrs grfinnieudt ta mfgd$ gl`
prfvfltial is tmf hfsttrfgtkflt, -@afljfs$ ft,gd)
8),G`gidy hgtm Is usugddy latlfefssgry il fr frdypgtiflts hfegusf tmfrf isgtrapy an sfhgefaus glswfgt jdgl s$ gl hgtmiljkgy erfgtf ry+scilprahdfks, Mawfvfr$ gsfpi frkis tmils witm gjf$edfglsilj gl usf anduhrieglts is lff f ta cffpscil sant!pdighdf gl pratfetsusefptihdf scil nrakhrfgc awl, -@afljfs$ ft,gd)
5),Flmglefs eireudgtial tatissufs$ ilerfgsfs vgseudgrtalf$ gl rf uefs tissuff fkg, -ealtrgil iegtf in
grfg pilc!rf $ gs efddudgrgkgjf kgy aeeur,) Jfltdf
kgssgjf graul grfg kgystikudgtf eireudgtial taikpgirf tissufs, -@afljfs$ft,gd)
0),Ucil hrfgc awl eglaeeur quiecdy witm patfltigd
Rgtiflts scil rfkgilsiltget$ gs fvi flef hy larf lfss avfr halyprakilflefs gl egpiddgryrfnidd dfss tmgl > sfeal savfr grfgs an rf lfss gntfrnaddawilj g 5 gy sfrifs anmfgdtm tfgemiljs al tmfprfvfltivf kfgsurfs,
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rautilfdy, Ilerfgsfprfvfltivf kfgsurfs wmflrf flf grfgs grf latief ,
6),Eal uet mfgdtm tfgemiljal prfvfltivf egrf narighftfs+naat rfdgtf
eakpdiegtials suem gs3
+Zgsm rfsi ugd dikh witmkid sagp gl wgtfr$ tmflrilsf gl pgt ry, @a tmis gtdfgst alef g gy3 a it karfantfl in yau swfgt g dat argrf trfgtilj g rgsm arilnfetial,
+@a lat usf gdeamad+hgsfdatials al yaur scil
+@a lat usf taa kuemsantflilj datial3 usf oustflaujm ta prfvflt ry scil,
+Kgiltgil g jaa prastmftienit gt gdd tikfs
nar ilnfetial . lferasis$passihdy ilvadvilj kusedfgl half, Pmfrf isilerfgsf risc anrf`lfss!irritgtial graul`dfjs uf ta fdgstie hgl s ilg udt igpfrs!ilealtilflefpg s, -@afljfs$ ft,gd)
6),Pmf kast nrfquflt rfgsalnar maspitgdizgtial ilpfrsals witm ighftfs is ufta prahdfks witm tmfir nfft,Pmfsf eaud hf prfvfltftmraujm sikpdf prfvfltivfnaat egrf, -Zadnf$ D,)
+ta cffp scil sant!pdighdfgl pratfet susefptihdf scilnrak hrfgc awl, -@afljfs$ft,gd)
+it kgy egusf tmf scil ta rygl ergec$ ilerfgsilj tmfemglef an ilnfetial, -Zadnf$
D,)
+usilj taa kuem santfliljdatial kgy egusf scilirritgtial, -Zadnf$ D,)
+ta kgiltgil earrfetgdijlkflt gl saecft nit,
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+Emfec nfft gidy glikkf igtfdy egrf nar skgddeuts ar hdistfr
+Fgt g hgdglef ift$ rilcg fqugtf wgtfr fgem gygl fxfreisf rfjudgrdy
@fpfl flt+Dikit rilcilj hfvfrgjfswmiem ealtgils egnnfilf
+ cffp hdaa prfssurf ul frealtrad
>),Kalitar gl kgiltgiljdueasf dfvfds gt larkgdrgljf -=2+722 kj! d),
:),G`kilistfr lutritialgdsuppdfkflts gl vitgkilsgs il iegtf`
Mgvilj tmf rijmt nit widd mfdprfdifvf prfssurf spats glsarflfss, -Zadnf$ D,)
+kast prahdfks nar ighftieshfjils witm skgdd sarfs altmf scil dicf ergpfs glhdistfrs, -Zadnf$ D,)
+stgyilj nit gl mfgdtmy widdealtrihutf ta avfrgddighftfs ealtrad, Fxfreisf
ilerfgsfs hdaa ndaw glilsudil sflsitivity, -Zadnf$ D,)
+ rilcilj egnnfilf hfvfrgjfsegl ealstriet hdaa vfssfdsgl kgy ealtrihutf taeireudgtial prahdfks, -Zadnf$D,)
+Mijm HR egl egusfeireudgtary prahdfks il tmfnfft, -Zadnf$ D,)
>),Cffpilj il rgljf gs antflgs passihdf widd rgkgtiegddyrf`uef risc an sfriaus
eakpdiegtials nrakighftfs, -Zadnf$ D,)
:, Gi s il mfgdilj ! efddudgrrfjflfrgtial, -@afljfs$ft,gd)
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LVXUILJ EGXF RDGL
GUUFUUKFLP LUJ, @IGJLAUFU XGPIALGDF F]RFEPF@ AVPEAKF LUJ, ILPFX FLPIAL XGPIALGDF F GD VGPIAL
Uuhofetivf?
+ kgduyg pirkf it gcpgjghgt gsvfrhgdizf hy tmfpgtiflt
Ahofetivf?!U?
+ P ? 5:,:E+ RX ? 9= HRK+ XX ? 80 ERK+ HR ? 7=2!92 kkMj
Zfijmt ? 68 cj -prf+iddlfss)6= cj - urilj
iddlfss)
Ufvfrf GlfkigZfgclfssRgddarXfstdfsslfss
Mijm Jdueasf dfvfd XHU hymjt?
25!28!29 ? 822 kj! d
Larkgd gduf?MJP ? :2 722 kj! d
Ngtijuf rfdgtf` ta`ferfgsf` kftghadieflfrjy pra`uetial gsfvi`flef` hy wfgclfss$rfstdfsslfss$ pgddar$sfvfrf glfkig . mijmjdueasf dfvfd XHU an mjt?822 kj!`d,
+Ngtijuf is g nffdilj antirf lfss$ fxmgustial$ ardgec an flfrjy, It nffds kid dyngtijuf hfegusf anavfrwarc$ paar sdffp$ warry$harf ak$ ar dgec anfxfreisf, Gly iddlfss$ suemgs g ead ar tmf ndu$ kgyegusf ngtijuf$ wmiem usugddyjafs gwgy gs tmf iddlfssedfgrs up, G strfssnudfkatialgd situgtial kgy gdsaegusf ngtijuf, Pmis typf anngtijuf usugddy edfgrs upwmfl tmf strfss is rfdifvf ,Kgly prfseriptial gllalprfseriptial kf ieilfsegl gdsa egusf ngtijuf, Itkgy hf egusf hy g karfsfriaus mfgdtm prahdfk$suem gs? Kftghadieisar frs$ suem gs ighftfs$
il wmiem sujgr -jdueasf)rfkgils il tmf hdaa rgtmfr
tmgl fltfrilj tmf ha ysefdds ta hf usf nar flfrjy,-ZfhK@)
Gntfr g `gy an pravi iljgdtfrlgtf getivitifs witmpfria s an rfst gluliltfrruptf sdffps$ tmfediflt widd ikpravf sunnieifltflfrjy ta eakpdftf fsirfdijmt getivitifs,
Il fpfl flt7),@iseuss witm pt, tmf lff`nar getivity, Rdgl semf udfwitm pt, gl i fltinygetivitifs tmgt dfg ta ngtijuf,
8),Gssfss pgtiflts ghidity tapfrnark larkgd tgscs!latilj rfparts an wfgclfss$ngtijuf$ gl innieudtygeeakpdismilj tgsc
5),Gdtfrlgtf getivity w!pfria s an rfst !uliltfrruptf sdffp,
0),Kalitar pudsf$ rfspirgtaryrgtf gl HR hfnarf!gntfrgetivity,
6),@iseuss wgys anealsfrvilj flfrjy wmidfhgtmilj$ trglsnfrrilj$ gl saal,
>),Ilerfgsf pt, pgrtieipgtialil G@Ds gs tadfrgtf ,
7),F uegtial kgy pravi fkativgtial ta ilerfgsfgetivity dfvfd fvfl tmaujm pt,kgy nffd taa wfgc ilitigddy,-Judgliec$ ft, Gd)8),Ilnduflefs emaief aniltfrvfltials! lff fgssistglef, -Judgliec$ ft,Gd)
5),Rrfvflts fxefssivfngtijuf, -Judgliec$ ft, Gd)
0),Il iegtfs pmysiadajiedfvfds tadfrglef, -Judgliec$ft, Gd)
6),Rt, widd hf ghdf tageeakpdism karf witm gferfgsf fxpfl iturf an
flfrjy,
>),Ilerfgsfs ealni flefdfvfd!sfdn+fstffk gs wfdd gstadfrglef dfvfd, -Judgliec$ft, Gd)
Rgtiflt vfrhgdizf mgviljsunnieiflt flfrjy taeakpdftf `fsirf getivitifsgntfr g `gy an pravi iljgdtfrlgtf getivitifs witmpfria s an rfst gluliltfrruptf sdffps,
http://www.webmd.com/hw-popup/stresshttp://www.webmd.com/hw-popup/medications-that-can-cause-weakness-or-fatiguehttp://www.webmd.com/hw-popup/diabeteshttp://www.webmd.com/hw-popup/diabeteshttp://www.webmd.com/hw-popup/medications-that-can-cause-weakness-or-fatiguehttp://www.webmd.com/hw-popup/stress -
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LVXUILJ EGXF RDGL
GUUFUUKFLP LUJ, @IGJLAUFU XGPIALGDF F]RFEPF@ AVPEAKF LUJ, ILPFX FLPIAL XGPIALGDF F GD VGPIAL
Uuhofetivf?
+ gjsuh gc ukghgtljg kgtutukhg gcgs vfrhgdizf hytmf pgtiflt
Ahofetivf?!U?
+ P ? 5:,:E+ RX ? 9= HRK+ XX ? 80 ERK+ HR ? 7=2!92 kkMj
Zfijmt ? 68 cj -prf+iddlfss)6= cj - urilj
iddlfss)RgddarEmfst pgilXfstdfsslfssNgtijufJflfrgdizf f fkg latfRittilj f fkg latfFdfvgtial il HVL -7>,5kkad!dEgpiddgry rfnidd < 5 sfes
Mijm Jdueasf dfvfd XHU hymjt?25!28!29 ? 822 kj! d
Larkgd gduf?MJP ? :2 722 kj! dHVL? 7,:+=,5 kkad!d
@ferfgsf` tissufpfrnusial rfdgtf` tapfripmfrgd vgsa+aeedusialan hdaa` vfssfdssfeal`gry ta `isfgsfpraefss gs fvi`flef` hyemfst pgil$ rfstdfsslfss$
pgddar $ ngtijuf$ jflfrgdizff`fkg$ fdfvgtial il HVL-7>,5 kkad!d$ egpiddgryrfnidd < 5 sfes gl` HR an7=2!92 kkMj
Aeedusial an pfripmfrgdhdaa vfssfds widd gdtfr ndawan hdaa ta pfrnusf tmfinnfrflt efdds an tmf ha y,
-mttp?!!www,fdsfvifr,eak)
Gntfr 0 maurs anikpdfkfltilj kfgsurfs tarf uef vgseudgr rfsistglefgl ikpravf tissufpfrnusial?+jivilj gltimypfrtflsivfrujs
+kgiltgil ndui gl iftgrysa iuk rfstrietials+kgiltgil pmysiegd gl
fkatialgd rfsttmf pgtiflt hdaa prfssurfwidd ferfgsf nrak 7=2!92kkMj ta 752!=2,
Il fpfl flt7),Jivf gltimypfrtflsivfrujs$ iurfties gs
prfserihf ,
@fpfl flt8),Kalitar hdaa prfssurffvfry 0 maurs,
5),Ikpdfkflt kfgsurfs tarf uef vgseudgr rfsistglefgl ikpravf tissufpfrnusial?+Kgiltgil ndui gl iftgrysa iuk rfstrietials
+@iseaurgjf iltgcf aneannff$ tfg$ eadgs$ gl`emaeadgtf$ wmiem grf mijm ilegnnfilf+ iseaurgjf skacilj
+kgiltgil pmysiegd glfkatialgd rfst,
0), Flsurf g fqugtf ndui
iltgcf uldfss ealtrgil iegtf
7),G wi f rgljf ankf iegtials is gvgidghdf nartrfgtkflt? vgsa idgtars$hftg+hdaecfrs$ glgljiatflsilajfl+ealvfrtiljflzykf -GEF) ilmihitar,
8),Pa claws tmf hgsf dilf anHR,
5),
+ta rf`uef ndui rftfltial$wmiem ealtrihutfs tamypfrtflsial,+egnnfilf stikudgtfssykpgtmftie lfrvaus systfk
+egusfs vgsaealstrietialgl ealtrihutfs taferfgsfs tissuf
axyjflgtial hy rf ueilj A8gvgidghidity
+sf gtivfs egl hf usf tarf uef strfss glgssaeigtf vgsaealstrietial,0), adukf fpdftialflmglefs patfley anmypfrtflsivf rujs gl gdsarf uefs pfrnusial taci lfys,
Gntfr 0 maurs an trfgtkflt
tmf jagd wgs kft$ tmf
pgtiflt hdaa prfssurf wgs
ferfgsf nrak 7=2!92
kkMj ta 752!=2,
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LVXUILJ EGXF RDGL
GUUFUUKFLP LUJ, @IGJLAUFU XGPIALGDF F]RFEPF@ AVPEAKF LUJ, ILPFX FLPIAL XGPIALGDF F GD VGPIAL
Uuhofetivf?
+ kgduyg pirkf it gcpgjghgt gsvfrhgdizf hy tmfpgtiflt
Ahofetivf?!U?
+ P ? 5:,:E+ RX ? 9= HRK+ XX ? 80 ERK+ HR ? 7=2!92 kkMj
Zfijmt ? 68 cj -prf+iddlfss)6= cj - urilj
iddlfss)
NgtijufUfvfrf GlfkigZfgclfssRgddarXfstdfsslfssFxfrtialgdiseaknart! ysplfg
Mijm Jdueasf dfvfd XHU hymjt?25!28!29 ? 822 kj! d
Larkgd gduf?MJP ? :2 722 kj! d
Ge tiv ity il tadfr glefrfdgtf` ta ikhgdglefhftwffl axyjfl suppdygl` `fkgl` gs fvi`flef`hy wfgclfss$rfstdfsslfss$ ngtijuf$pgddar$ sfvfrf glfkig .mijm j dueasf dfvfd XHU anmjt? 822 kj!`d,
+hfegusf an ikilismfaxyjfl+egrryilj egpgeity antmf rf hdaa efdds$ tmusrfsudtf ta ilsunnieifltpmysiadajiegd flfrjy tafl urf ar eakpdftf rfquirfar `fsirf `gidy getivitifs,-mttp?!!clad,jaajdf,eak!c!emgrdfs+paddgec!smartlfss+an+hrfgtm!zqx dNXk!so7DgG%)
Umart tfrk?Gntfr = maurs an eakpdftfhf rfst witm fdfvgtf MAHgl ikpdfkfltilj flfrjysgvilj tfemliquf$ tmfpgtiflt widd rfpart glilerfgsf il getivity tadfrglefiledu ilj getivitifs an `gidydivilj$ `fkalstrgtf gferfgsf il pmysiadajiegd
sijls an iltadfrglef glispdgy dghargtary vgdufs
witmil geefptghdf rgljf,
Dalj tfrk?Gntfr kaltms an lursiljiltfrvfltials tmf pgtiflt isnrff nrak wfgclfss gl riscan eakpdiegtials mgs hfflprfvfltf ,
Il fpfl flt7),Gssfss pgtiflts tapfrnark larkgd tgsc argetivitifs an gidy divilj,8),Fdfvgtf mfg an hf gstadfrgtf ,
5),I fltiny ar ikpdfkfltflfrjy sgvilj tfemliquf dicfsittilj wmidf ailj g tgsc,
0),Xfeakkfl quitfgtkaspmfrf$ hf rfst inil iegtf ,
6),Latf emgljfs ilhgdglef!jgit isturhglefsgl kusedf wfgclfss,
>),Rravi f ar rfeakkflgssistglef witm getivitifs argkhudgtial gs lfefssgry$gddawilj pgtiflt ta a gskuem gs passihdf,
:),Rdgl getivity prajrfssialwitm pgtiflt$ iledu iljgetivitifs tmgt tmf pgtifltvifws fssfltigd,
7),Ilnduflefs emaief aniltfrvfltials ar lff fgssistglef,8),Flmglefs dulj fxpglsialta kgxikizf axyjflgtial narefddudgr uptgcf,5),Fleaurgjf pgtiflt ta ags kuem gs passihdf$ wmidfealsfrvilj dikitf flfrjy .prfvfltilj ngtijuf,0),Xfeakkfl quitfgtkaspmfrf$ hf rfst inil iegtf ,
6),Kgy il iegtfslfuradajiegd emgljfsgnnfetilj pgtiflt sgnfty arrisc an iloury,>),Flmglefs rfst ta dawfrha ys axyjfl rfquirfkfltsgl rf uef strgil al tmfmfgrt gl duljs,
:),Gdtmaujm mfdp kgyhflfefssgry$ sfdn fstffk isflmglef wmfl pgtifltafs sakf tmiljs nar sfdn,
Rrakatfs jrg ugd rfturl talarkgd getivity dfvfd gl`ikpravf kusedf talf arstgkilg witmaut ul ufngtijuf,
Pmf pgtiflt rfvfgdf glilerfgsf il getivitytadfrglef$ fkalstrgtilj grf`uetial il pmysiadajiegdsijls an iltadfrglef gldghargtary vgdufs witmillarkgd rgljf gntfr = maursan eakpdftf hf rfst witmfdfvgtf MAH glikpdfkfltilj flfrjy sgviljtfemliquf,
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Eaddghargtivf?=),Kalitar dgh stu ifs Mh$Met$ . XHE eault,
=),I fltinifs `fnieifleifs ilXHE eakpalflts gnnfetiljaxyjfl trglspart .trfgtkflt lff s arrfspalsf ta tmfrgpy,
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LVXUILJ EGXF RDGL
GUUFUUKFLP LUJ, @IGJLAUFU XGPIALGDF F]RFEPF@ AVPEAKF LUJ, ILPFX FLPIAL XGPIALGDF F GD VGPIAL
Ahofetivf?!U?
+ P ? 5:,:E+ RX ? 9= HRK+ XX ? 80 ERK+ HR ? 7=2!92 kkMj
Zfijmt ? 68 cj -prf+iddlfss)6= cj - urilj
iddlfss)
@ysplfg@ferfgsf an urilf autput
862 eeJflfrgdizf f fkgRittilj f fkg al dawfr
fxtrfkitifsXfstdfsslfss@rihhdilj an urilf
Mijm Jdueasf dfvfd XHU hymjt?25!28!29 ? 822 kj! d
Larkgd gduf?MJP ? :2 722 kj! dVrilf Autput-g udt) ? 7822+7622 ee! gy
Gd tfrf` nd ui` .fdfetradytfs hgdglefrfdgtf` ta urilgryrftfltial gs fvi`flef` hy`ysplfg$ `ferfgsf anurilf autput 862 ee$jflfrgdizf` f`fkg$ pittilj
f`fkg al dawfrfxtrfkitifs$ rfstdfsslfss$`rihhdilj an urilf
Pmf pra uetial an gl
ghlarkgddy skgdd vadukf an
urilf is g rfsudt an ci lfy
ngidurf,
Xflgd ngidurf
@ferfgsf hdaa ndaw taci lfy
@ferfgsf pfrnusial ilci lfy
@ferfgsf urilgry autput
Vrilgry rftfltial
Umart tfrk?Gntfr = maurs an trfgtkflt?fleaurgjilj ediflt ta vaifvfry 8+0 maurs gl wmflurjf is latf $ tmf pgtifltwidd hf ghdf ta ilerfgsf urilfautput ta gt dfgst 7622 ee,
Dalj tfrk?Gt tmf fl` an maspitgdizgtialtmf pgtiflt widd hf ghdf tamgvf g larkgd urilf autputgl vai ilj pgttfrl,
Il fpfl flt7),Gssfss tmf egusf anferfgsf urilgry autput,
8),Fleaurgjf ediflt ta vaifvfry 8+0 maurs gl wmflurjf is latf ,
5),@ftfrkilf tmf ilitigd ndui s
gl fdfetradytfs dfvfd
0),Kalitar I!A maurdy,
@fpfl flt6),Rfreuss!pgdpgtfsuprgpuhie grfg
>),Ahsfrvf sijl glsykptaks an ndui glfdfetradytfs ikhgdglef suemgs ysplfg gl emgljfs ilFEJ,
7),Pa hf ghdf ta gppdy tmfprapfr tmfrgpfutie rfjikfl,
8),Kgy kilikizfs urilgryrftfltial!avfr istfltial antmf hdg` fr,
5),Ufrvfs gs hgsfdilf narprajrfss,
0),Pa ftfrkilf tmfprajrfss an tmf isfgsf,
6),G istfl`f hdg `fr eglhf nfdt il tmf suprgpuhiegrfg,>),Pa hf ghdf ta prfvfltnurtmfr eakpdiegtial glg kilistfr prapfrtmfrgpfutie rfjikfl,
Jagd pgrtigddy kft3 pgtifltpgssf aut urilf gt dfgst522 ee
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LVXUILJ EGXF RDGL
GUUFUUKFLP LUJ, @IGJLAUFU XGPIALGDF F]RFEPF@ AVPEAKF LUJ, ILPFX FLPIAL XGPIALGDF F GD VGPIAL
Uuhofetivf?
+ sgl+a gwdg gcmil kgtgtgkhgdkgimg lgm il ljggc sgcit gsvfrhgdizf hy tmfpgtiflt
Ahofetivf?!U?
+ P ? 5:,:E+ RX ? 9= HRK+ XX ? 80 ERK+ HR ? 7=2!92 kkMj
Zfijmt ? 68 cj -prf+iddlfss)6= cj - urilj
maspitgdizgtial)
Nrfquflt gscilj ghaut mfreal itial
ZfgclfssEalnusial@istrfssf
Ilerfgsf hdaa prfssurfNfgrnudXfstdfsslfssNffdiljs an mfdpdfsslfss .
iseaknartNarjftnudlfssUdffp prahdfks
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7/23/2019 Diabetic Nephropathy Case Study
54/61
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