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-------------------------

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ryDjyif/

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]]tJ'gaMumifYaygYAsm/ Renal Failure (ausmufuyfysufpD;jcif;)0ifNyDxifw,f/ Urine Output

(qD;txGuf)enf;w,f}}

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r&bl;/ cGJ&pdwf&rS axmwmr[kwfvm;}}



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xifw,f}}

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NyKH;½TifpGm ESKwfqufvdkufonf/

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oufaZmfEdkif tenf;i,f ½Suftrf;um ...

]][m aqm&D;}}

acgif;u qHyifrsm;udk vufESpfzufjzifY aemufjyefodrf;onf/

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cifOD;EG,fu tNyKH;jzifY ajym&if; olrvufxJu *smuiftusÐudk oufaZmfEkdifokdY vSrf;ay;onf/

xdktay;t,ludk rl,mu rsufcHk;av;jr§ifYvsuf pl;prf;Munfh Munfhavonf/

]]rl,mvnf; a&mufaew,faemf/ vm? udk,fwdkY auY(pf)udk oGm;Munfhvdkuf&atmif}}



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]]q&m? Renal Failture 0ifNyDvdkY xifovm;}}

]]uRefawmfawmY xifwmyJ rr}}

]]Septicaemia (ydk;qdyfysHUjcif;)aMumifY jzpfEdkifw,f}}

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rl,mwifu apmapmu olrajymcJYonfrsm;ESifY vHk;0rqdkifpGm ...

]]rl,mvnf; vlem½SifawGudk ½Sif;jyxm;ygw,f rr/ rrudk,fwdkif 0ifay;xm;wmrdkY

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rl,mwif&JU pum;rsm;udk em;axmif&if; oufaZmfEdkif tHYtm;oifYrdonf/ trsKd;orD;awGrsm;

wwfvnf;wwfEdkifMuw,f/ odkYaomf trsKd;orD;wpfOD;yifjzpfaom rrEG,furl tawG;awGu ta0;rSm

½Sdaeovdk aq;½kH0if;xJodkY vSrf;ai;Munfh&if; ½kwfw&ufvdk ...

]]Blood Urea vkyfMunfhvdkufao;vm;}}

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aoG;xJu "mwfcGJprf;oyfawGU½SdEdkifonfh ppfaq;csufudk ar;cJYjcif;yif/

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ESKwfcrf;ESifY yg;jyifrsm; nHhoufpGm ajyajyav; eDjref;aecJYonf/ acgif;pGyfqG,fwmtyg; teufa&mif

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olwpfa,mufvdk xGm;jrifYuspfvspfaom udk,fae[efESifY jrefrmqefqef ,Ofaus;vSyaom rsufESm

tquftpyfu xl;jcm;qGJaqmifrSK ½SdaecJYonf xif\/ xdkrsufESmav; tawG;euf[ef rSKef&Daeonfudk

oufaZmfEdkif pdwfraumif;rd/ nu vlemtajctaeu raumif;cJYbl;av/



rl,mwifu olr\ vdkufavsmaompum;udk wHkYjyefjcif;rjyK? ukdoufaZmfEdkifbufodkY vSnfhí

pum;ajymvdkufaom cifOD;EG,fudk rausrvnf ½Sdaerdonf/ udkoufaZmfEdkifurl ...

]]uRefawmfu Surgeon awGxuf Surgery udk ydkpdwf0ifpm;w,f}}

olUoabmxm; ajymjycJYwm rl,mMum;vdkuf&avonf/

udk,fwdkif cGJpdwfukoxm;aom vlemudk tcsdefrSef *½kwpdkufMunfh&jcif;u q&m0efwpfa,muf

twGuf vdktyfaom tavYtxwpfckygyJ/ wpfNyKdifwnf;rSm tjcm;vlemawGtwGufvnf; tcsdef

ay;wwf&rnfav/ OD;jrarmifudk cGJpdwfNyD;onfhaemufydkif; EG,f 0gY('f)xJ a&mufvmvQif oufaZmfEdkif

½Sdraewwfay/

]]vSvSapma&? OD;oufaZmfEdkif awGUrdvm;}}

]]a&mufNyD rr/ OD;jrarmif tcef;xJrSm}}

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rMunfhcif cGJpdwfNyD;p vlemrsm;udk cifOD;EG,f MunfhavY½SdNrJ/ cGJpdwfNyD;aom vlemu ½SpfOD;½Sdaeonf/

tao;pm;cGJpdwfvlemrsm;udk vlemaqmifxJrSm ydkYxm;&\/ ta&;BuD;vlemtjzpf½Sdaeao;aom OD;jrarmif

tcef;odkY cifOD;EG,f t&if0ifcJYonf/ oufaZmfEdkifudk vlem&JU ukwifay:rSm xdkifprf;oyfvdkY awGU&onf/

vlemukwifay:wGif rxdkiftyfpGm xdkifvsuf EG,f awGUoGm;cJYí tenf;i,ftrf;pGm ...

]]rr Round awmYrvm;/ uRefawmfvnf; apmao;ovm;vdkY pçrxm;rdao;wm}}

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vlemtajctaeudk a':cifOD;EG,f em;axmifaecJYonf/ olUpum;qHk;rS ...

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ajym&if; jznf;nif;nifom jyefvnfprf;oyfav\/ oufaZmfEdkif\ awGU½Sdxm;csufrsm;udk jyefvnf

twnfjyKMunfhjcif;ygyJ/ wpfcsdefvHk; owdaumif;aeaom tbdk;u cifOD;EG,fudk avoH,JY,JYjzifY ...



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vSygNyD}}

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olYudk OD;jrarmif tcef;xJrSm xm;cJY&awmYrnf/

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raeYu 0gY('f)xJrSm oufaZmfEdkifESifY rratrDwdkY ajymaecJYwm EG,f Mum;cJYao;onf/

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]]'Dv vcsKyfvkyfNyD;NyDvm; oufaZmfEdkif}}

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tcef;xJodkY ola&mufoGm;awmYonf/ pwifcGJpdwfonfhnrSpí n*sLwD qufwdkuf,l&if; aq;½kHrSm

vmtdyfapmifYay;aecJYwm oHk;&ufqufwdkuf½SdcJYNyD/ cifOD;EG,f awG;&if; acgif;cg,rf;vdkufrdav\/

cGJpdwfNyD;onfh wwd,ajrmufaeY eHeufapmapmwGif OD;jrarmifudk cifOD;EG,fwdkY qHk;½SKH;vdkuf

&onf/ EG,fwdkY pí cGJpdwfukopOfuyif arQmfvifYcsufenf;yg;pGmjzifY pGefYcJYMujcif;yif/ cGJpdwfrSKu

atmifjrifcJYawmY arQmfvifYcsufxm;rdvmcJYMujyefonf/ BuKd;pm;NyD;rSawmY yifyef;&usKd;vnf; eyfvdk

Muonf/ OD;jrarmif rdom;pkESifYtwl aq;½kHrS NyKH;aysmfpGm qif;oGm;EdkifzdkYyJ &nfrSef;arQmfvifYum



tpGrf;ukef BuKd;pm;cJYMuonfygyJ/ wu,fawmY cifOD;EG,f\ cGJpdwfvlemrsm;rSm wdrf;yg;cJonf/

OD;jrarmif aemufuscJYonfuG,f/

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ukd,fyl½Sdef aMumufrufzG,f jrifYwufaeonfhMum;uyif ua,mifuwrf;ESifYa&mvdkY ...

]]uRefawmfYaMumifY tm;vHk;yifyef;aeNyD}} tm;empum; qdkwwfonf/ olu jyefESpfodrfYay;

wwfonfu cifOD;EG,fwdkYudk qkdYeifYapavonf/

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xdkaeY eHeufig;em&DrSm OD;jrarmif uG,fvGefonfhowif; cifOD;EG,fxHodkY ydkUvTwftaMumif;Mum;

apolrSmvnf; oludk,fwdkif jzpfav\/ &ifcGJ cGJpdwfppfaq;rSK jyKvkyfMunfhzdkY cifOD;EG,fu olYudk jyefí

wm0efay;cJYonf/ aoqHk;&jcif; taMumif;t&if;rSef aocsm&efay/ vlem½Sifrsm;u cGifYjyKygYrvm;

[kawmY cifOD;EG,f xifxm;rdav\/ xifonfhtwdkif;yif jzpfvmcJYonf/ oufaZmfEdkif pma&;taMumif;

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oufaZmfEdkif awmif;yefpum;udk Mum;cJY&onf/ EG,f pdwfysufoGm;rdcJYonf/ rl,m&JUpum;udk jyefMum;

&pOfuxuf tcH&qdk;cJYonf/ bmudkrS jyKjyifr,lvdkawmYbJ jzpfcsifovdk jzpfygap xm;vdkufcsifpdwf

0ifrdonf/ oDa&wmu oufaZmfEdkif xGufcJYvQif cGJpdwfvlemaqmifudk EG,fESifYtwl vSnfhvnf

Munfhaprnf pdwful;xm;rd\/ ol ypöu© tajctaerS xGufajy;ykef;a½SmifaecJYpOf aq;½HkrSm b,fvdk

ta&;ay:vlemawGa&mufcJYNyD; EG,fwdkY ukoay;cJYMuwm? cGJpdwfrSKuRrf;usifaom q&m0efwpfa,mufudk

tjcm;vlemawGu vdktyfpGm apmifYqdkif;aeao;wm ajymjyzdkY EG,f pdwful;xm;rdonf/ tckawmY EG,f

pdwfysufNyD/ udk,fYudk &ifqdkifajymwmr[kwfaom tMum;pum;wpfcktwGuf tmCmwjzifY EG,fu wrif

auY(pf)rsm;rsm; wifay;cJYonfwJYvm;/ awmfawmf tawG;aumif;wJY OD;aESmufyJ/

EG,f olYudk wnfNidrfpGm NyKH;ESKwfqufonf/ ol jyefvnfNyKH;cJYayr,fY olUtNyKH;u tiftm;r½Sd/

ol rsufESmraumif;½Hkomru tenf;i,f EGrf;e,faeyHk&onf/ ol cGJpdwf&onfh cGJpdwfrSKrsm;u tcuf

tcJ r½SdEdkif/ odkYaomf tm½Hkpdkufcsdef rsm;cJYvQif EGrf;e,fvmrSmyif/ NyD; wpfcsdefvHk;&yfvsuf tvkyfvkyfcJY

&onf/ tm½Hkpl;pdkuf&vGef;í acR;awG pD;usaeYm wpfudk,fvHk;vnf; awmifYwif;aecJYrnf/ Operation

List qGJaom EG,fvnf; enf;enf;vGefoGm;onf xifyg\/

]]tcke auY(pf)u bmauY(pf)vJ rr}}

]]tdkwDzGifYzdkY rvdkygbl;/ Amoebic Hepatitis (0rf;udkufydk;aMumifY tonf;a&mifa&m*g)yg}}

]]awmfao;wmaygYAsm}}

olUtNyKH;u apmapmav;u tdkwDxJrSm jrifcJY&ovdk aygYyg;jcif;r½Sd/ aeygOD;av/ aemufqHk;

auY(pf)r0ifcif cifOD;EG,fudk awmif;yefpum;qdkpOfu oufaZmfEdkif onfrQ rsufESmrysufcJYao;wm

trSwf&onf/ EG,f wpfckckudk od½Sdum ...



]]rif;udk rratrDu ajymjyvdkufNyDvm; oufaZmfEdkif}}

]]ajymvdkufw,f rrEG,f/ The operation is successful but the patient is dead

qdkwm}}

olUtoHwdk;wdk;u tufuGJaecJYonf/ rl,mhpum;u oufaZmfEdkifudk rsm;pGmxdcdkufapcJY

vdrfYrnf/ EG,f oufaZmfEdkifudk em;vnfvdkufrdav\/ ESpfodrfYay;vdkpGm ...

]]uG,f&mrSm ajymwJYpum;udk udk,fwdkY rwHkYjyefMuygpdkYeJYvm;}}

EG,fu ajymcJYvQif ol rsufESmrSKefrSKefESifYyif ...

]][kwfuJY}}[k qdkcJYonf/ olUrsufESmiHkYiHkYudk Munfhum EG,f pdwfajymif;rdvsuf ...

]]udk,fYtcef;rSm cP xdkif&atmifav}}

cGJpdwfuko trsKd;orD;ESifY trsKd;om;vlemaqmifMum;wGif q&m0ef?q&mr *sLwDcef; ½Sdonf/

xdktcef;ESifY rsufESmcsif;qdkifrSm cifOD;EG,f\ tcef;ay/ em;aecef;vnf;jzpf? vlemvnf;Munfhaom

tvkyfcef; jzpfav\/ oufaZmfEdkif vdkuf0ifvmcJYonf/ EG,fwpfa,mufwnf; ½SdaecsdefuvGJvQif

t0if0 cef;qD;tenf;i,f yGifY[xm;apNrJudk oufaZmfEdkifvnf; owdxm;rdonf/ EG,fYtcef;xJ

0ifcJYwdkif; ol 0ifNyD;onfESifY cef;qD;pudk pkodrf;zGifY[vdkufwwfonf/ jyefxGufvQif cef;qD;udk

jyefapYxm;wwfcJYavonf/ oufaZmfEdkif EG,fYpm;yGJa½SUu xdkifcHkwGif 0ifvmxdkifcJYonf/

]]oufaZmfEdkif 'DaeY yifyef;oGm;w,f xifw,f}}

]]ryifyef;ygbl; rr/ &ygw,f}}

]]udk,fvnf; vGefoGm;ygw,f/ udk,f&nf½G,fwmuawmY wpfrsKd;yg}}

]]bmudkvJ/ uRefawmf em;rvnfbl;}}

oufaZmfEdkif olrudk tawG;cufpGm Munfh\/ cifOD;EG,f NidrfoufpOf;pm;aerdonf/ vlem

wpfa,mufwnf;twGuf cHpm;aeaom olYudk 0gY('f)xJu vlemawGtaMumif; ajymjyazsmif;zszdkY

jzpfayr,fY olrtaMumif;ESifY,SOfí ½dk;½dk;yif ajymjyzdkY EG,fqHk;jzwfrdonf/ ckcsdefrSm 'gyJ txda&mufqHk;

jzpfawmYr,f/ cifOD;EG,f olYudk bmaMumifY auY(pf)rsm;pGm 0ifcdkif;cJYwmvJ/

]]OD;jrarmiftwGuf oufaZmfEdkif pdwfxdcdkufaew,fqdkwm udk,f &dyfrdygw,f/ 'DtwGuf

ajzazsmufEdkifzdkY vdkw,fav/ udk,fawGUxm;wJY taumif;qHk;ukxHk; rif;udk ay;MunfhrdcJYwmyg}}

oufaZmfEdkifu olrudk cyfawGawG ai;MunfhaeqJ/



]]udk,feJY ol tqifrajyMuwJYtcsdefrSm udk,fu Surgical Ward rSm A.S aygY/ First

Assistant u udk,fY&JU q&m&if;yJ/ q&mu tJ'DvdktcsdefrSm udk,fYudkn§mNyD; bmrSrcdkif;cJYawmYbl;/

oludk,fwdkifyJ vkyfawmYwm/ ukd,f q&mYudk oGm;awGUcJYw,f/ ]uRefr vHk;0tem;r½Sd tvkyfvkyfyg&ap}

qdkNyD;awmY aq;½HkrSm aeYa&mnyg *sLwDawG 0ifcJYw,f/ oDa&wmxJu rxGufbJ vmorQauY(pf)

'dkifcHcGJw,f/ arYaq; Training vnf;&atmif ,lvdkufw,f/ oli,fcsif;awG½SdwJY 'yfz&ifukdoGm;NyD;

OG vnf; 0ifcJYw,f/ 'DvdkeJY udk,fYudk,fudk tem;ray;bJ tvkyfawGvkyfcJYwm/ arYwefoa½GU arYxm;

vdkufEdkifNyD; tcsdefwdkwdkeJY yHkrSeftajctaeudk jyefa&mufvmEdkifcJYw,f/ udk,fYtwGufawmY 'Denf;u

rqdk;bl;yJ/ Training awGvnf; trsm;BuD;&cJYw,f}}

oufaZmfEdkif tHYMopGm em;axmifaerd\/ rrEG,fpum;udk Mum;&wm olUaoG;rnf;nKdnKdawGudk

eD&JoefYpifvmapovdkay/ aoG;awG Munfvifum tawG;awGvnf; Munfvifvmaponf xifrd\/ rr

EG,fxHrS olYudk,fa&;udk,fwm onfwpfBudrf yxrqHk; Mum;&onfyJ jzpf\/ cgwdkif; Mum;aeYsvdk ...

]q&m xl;cRefwm? BuKd;pm;pepfuswm? om;awGtay: cspfjrwfEdk;vSwm}awG r[kwfcJY/ olr

ESKwfrS olrb0 avmu"Hudk yxrqHk; Mum;&jcif;ay/

]]ukd,fYwkef;uvdk tvkyfawGeJY ukpm;&if aysmufvG,frvm;vdkY 'DaeY auY(pf)rsm;rsm; cGJcdkif;vdkuf

rdwmyg/ oufaZmfEdkifeJY udk,f cH,lcsufcsif; wpfoabmwnf; r½SdEdkifwm rpOf;pm;rdvdkufbl;/

udk,fYbufu vGefoGm;cJYygw,f}}

]]rrEG,f rvGefygbl;/ uRefawmf rvkyfEdkifwmawG rw&m;cdkif;wmrS r[kwfbJ/ tJ'Dvkd tvkyf

vkyfae&awmY arYarYaysmufaysmuf jzpfaecJYwmvnf; wu,fygyJ}}

]]udk,f vGefoGm;cJYvdkYyJ rif;u awmif;yefcJYwm r[kwfbl;vm;/ opfyifatmufrSm ay;½SifYawG

cGJypfvdkufr,fvdkY Mum;&wkef;u udk,fjzifY NyKH;awmifNyKH;rdao;wm/ rif;pum;u oabmusp&m

aumif;vdkYav/ tJ'DtmCmweJY auY(pf)awG trsm;BuD; cGJcdkif;cJYwm r[kwfygbl;}}

oufaZmfEdkifu olUqHyifrsm;udk vufjzifY aemufjyefoyfonf/

]][m? aoygawmYAsm/ tm;vHk; ½SKyfukefNyD/ tJ'gvnf; ya,m*yJ/ uRefawmf olrsm;ajymwm

em;a,mifNyD; rrEG,fudk ajymvdkufrdwm/ wu,fvGefwmu uRefawmfyg}}

a,mufsm;wpfa,mufrdkYom xkdya,m*&JUtrnfudk rajymbJxm;&onf/ rrEG,fvnf; tHMo

oGm;[ef jrif&\/

]]aMomf 'Dvdkvm;/ rratrD ajymjycJYwJY ya,m*eJY ukrÜPDwpfckwnf;xGufrsm;vm;}}

rrEG,fvnf; em;vnfvmcJY[ef MunfvifaygYyg;aom tNyKH;av;wpfck xifvmcJYonf/

]]taotcsmaygY}}



odkYaomf xdkya,m*aMumifYyif rrEG,fESifY ol udk,fa&;udk,fwmqefaom pum;awGudk rarQmf

vifYbJ ajymrdMuNyD/ ydkvdkY&if;ESD;aEG;axG;vm&onf/ oufaZmfEdkif acgif;armYí &,farmaerdcJYonf/

olUpdwfawG tMunfvifqHk; jzpfcJYNyD/ rrEG,fuvnf; jznf;jznf;omom &,farmav\/

]]'gqdk&if rif; reufjzef *sLwDvmawmYrSm r[kwfbl;/ 0gY('f)xJrSm Ill case awG

trsm;BuD;uGm/ udk,fvnf; wcsKdUwav ykcHk;ajymif; wm0efay;csifw,f/ ykcHk;anmif;vSNyD}}

rrEG,f&JU cyfnnf;nnf; ½Tef;jyufaom tajymudk oufaZmfEdkifu &,farm&if; ...

]]vmrSm rr/ uRefawmf vmcJYrSmyg}}

uwday;onf/ nae 4-em&D xdk;cJYNyD jzpf\/ cifOD;EG,fa&m oufaZmfEdkifyg tdrfjyefMuzdkY

jyifonf/

]]uRefawmf jyefawmYr,f rr}}

]]aumif;NyDav/ aMomf? cP oufaZmfEdkif}}

rrEG,fu owd&vdkufovdk olUpmtkyfMum;rSm n§yfxm;aom ypönf;av;wpfckudk xkwf,l

cJYonf/ 'Hk;ysH½kyfem&Dav;/ cvkwfESdyfvdkufrS 'Hk;ysHtzHk;av; yGifY[um 'Hk;ysHwufoHav;ESifYtwl em&DESifY

rdepf ay:vmaom uav;ywfem&Dav;/ em&Dav; toHrjrnfawmYwm MumNyD/ oufaZmfEdkifodkY urf;ay;

cJYonf/

]]OD;udk ay;vdkufygwJY/ nDol ay;oGm;wm/ toH jyifcdkif;jyefNyD xifw,f/ olauseyfatmif cP

,lxm;NyD; jyifr&bl;qdkNyD; jyefay;vdkufaygYuGm/ nDolu 'DvdkyJ olUupm;p&mt½kyfawGeJY vlwumudk

vdkuf½SKyfawmYwmyJ}}

oufaZmfEdkif em&Dav;udk tenf;i,f pdwfvSKyf½Sm;rdpGm vSrf;,lcJYonf/ onfem&Dav;u

nDol&JU cifrifrSKESifY ,HkMunfrSK jy,k*fav;wpfckay/

]]nDola&? ukd,feJY qm*sifMum;rSm aemufqdk&if b,fvdk txifvGJrSKawGrS r½Sdap&awmYbl;

qdkwm ukd,fuwday;ygw,f}}

em&Dydkif½Sifav;odkY oufaZmfEdkifpdwfxJu wdkifwnfuwday;aerdav\/

wpfywf MumjrifYoGm;cJYonf/

aemufwpfBudrf cGJpdwf&ufjzpfaom Ak'¨[l;aeYodkY a&mufvmcJYonf/ Operation List wGif

tBuD;pm;cGJpdwfrSK oHk;ckESifY tao;pm;cGJpdwfrSKav;ck wifxm;cJYonf/ qm*sif a':cifOD;EG,fu tBuD;pm;



cGJpdwfrSK ESpfck? a':rl,mu tao;pm;cGJpdwfrSK ESpfckESifY usefcGJpdwfrSKrsm;u oufaZmfEdkif ½Sif;&rnfh

auY(pf)rsm;ay/ qm*sif\ vufaxmufcGJpdwfoltjzpfvnf; oufaZmfEdkif 0ifay;&rnf/

yxrqHk;vlemrSm abvHk;tBuD;BuD; ½SdaecJYonf/ xdkabvHk;udk cGJxkwf&rSm jzpfonf/ yxrqHk;

vlemjzpfí q&mOD;atmifjrifyg xHk;pHtwdkif; ½SdaecJYonf/ qm*sif\ jrefqefoGufvuf enf;pepfus

vSaom vufrsm;u vlem&JUvuf0Jbuf Adkuftay:jcrf; abvHk;ae&mwGif cGJpdwf"m;&m pay;vdkufpOf

oDa&wmwHcg;u ½kwfw&uf yGifYoGm;cJYonf/ tvkyfvkyfaeolawG taESmifYt,SufrjzpfzkdY wHcg;udk

*½kwpdkuf toHrjrnfatmif zGifYMuydwfMuavY½SdNrJjzpfaom cifOD;EG,f\ cGJpdwfaqmifwGif xdkodkY

tMurf;ywrf; vSKyf½Sm;wwfolrSm wpfOD;om ½Sdavonf/ olawmY rjzpfEdkifao;[k xifxm;vsuf

pdwftaESmifYt,SufjzpfpGm armfMunfhrdvQif 0ifvmolu xdkwpfOD;yifjzpfaom a'gufwm,OfrsKd;ay/

toH0gBuD;jzifY ...

]]*Gwfarmeif;Asm;/ oDa&wma';qdkawmY tm;vHk; oDa&wmxJrSmyJ ½Sdr,fqkdNyD; vmcJYwm}}

]]a[m? q&m,pfrsKd;/ av,mOfysHoHvnf; rMum;vdkufygvm;}}

]]i,fcspfuav;eJY cGJvdkuf&vdkY xifw,f/ q&m,pf 0vmw,f}}

]]jyefvmawmYr,f Mum;uwnf;u usKyfwdkYu arQmfaewmygawmf/ rsufcHk;av;awG

wvSKyfvSKyfeJY}}

tdkwDxJrSm 0rf;yef;wom ESKwfqufoHawG qlnHoGm;cJYonf/

]]q&m bmeJYvmcJYovJ/ &xm;qdkufcsdefvnf; r[kwfygbl;}}

]]uRefawmf num;BuKHeJY vdkufcJYwmyg q&mBuD;/ q&mBuD; aeaumif;w,faemf}}

]]aumif;ygw,fAsm}}

]]OD;,OfrsKd;BuD; *sLwD0ifawmYr,f r[kwfvm;/ rl,mwdkYjzifY wpfa,mufwpfvJ *sLwDqif;ae

&wm/ oluawmY NidrfYaewmaygYav}}

]]uRefawmfwdkY&JU av'Da'gufwmav; aeaumif;w,faemf/ ydkacsmydkvSvdkYygvm;/ twdk;eJY

*sKwDawG ydk0ifay;zkdY jyefvmwmygAsm}}

wdwfqdwfpGm tvkyfvkyfaeMuolESpfOD;rSm cifOD;EG,fESifY oufaZmfEdkifom/

a'gufwm,OfrsKd;u owdjyKrdoGm;cJYonf/ oufaZmfEdkifudk vSrf;vdkY ...

]][m? New A.S a&mufaewmxifw,f/ olwdkYajymwmawG r,HkeJYaemf oli,fcsif;}}



oufaZmfEdkifu ESmacgif;pnf;txufrS ausmfMunfhum OD;,OfrsKd;udk tuJcwfonf/

oufaZmfEdkifxuf touft½G,fa&m vkyfoufyg BuD;yHk&onf/ tom;nKdnKd? qHyifu vnfukyfxd

t½Snf/ t&yfu 5-ay? 6-vufrcefY½Sdrnf/ wkwfwkwfcdkifcdkif jzpf\/ rsufvHk;rsm;u oabmoum,

aumif;r,fYyHk/ ESKwfcrf;xlrsm;uawmY avmuBuD;udk oa&mfcsifyHkjzifY &,farmvdkufvQif

ESKwfcrf;zsm;wpfzufu aumYwufoGm;wwfavonf/ oufaZmfEdkif rsufvHk;rsm;rSwpfqifYom olYudk

todtrSwfjyK NyKH;ESKwfquf&av\/

]]a[Y}}

rrEG,fu olYudk pdwfr½Snfovdk vSrf;owday;rS ol aoG;aMumudkifxm;onhf n§yfuav;udk

rçay;jzpfonf/ xdkn§yfatmufrSm rdxm;aom aoG;aMumav;udk tyfcsnfESifY csnfypfzdkY rrEG,fu olYudk

apmifYae&avonf/ olu a'gufwmOD;,OfrsKd;udk pdwf0ifwpm; ai;MunfhaerdcJYonfav/

]]a':cifOD;EG,fa&m t&iftwdkif;ygyJvm; cifAsm}}

rrEG,f pdwftaESmifYt,Suf jzpfoGm;cJYonfudk oufaZmfEdkif cHpm;odaecJYonf/ OD;,OfrsKd;\

toH us,favmifpGm xGufay:vmwdkif; rrEG,f\ vSKyf½Sm;aeaom vufrsm;u odom½Hkav; wHkYrvdk

jzpfoGm;Muonf/ onfwpfBudrfrl OD;,OfrsKd;\ toHu nifom,Ofaus;vSí wrifjyKjyif,lxm;ovm;

xif&onf/

]]t&iftwdkif;yJvm;qdkwm bmudk ar;wmygvJ OD;,OfrsKd;}}

rrEG,fu oHrSefjzifY armfrMunfhbJ jyefar;cJYonf/

OD;,OfrsKd;u ESKwfcrf;zsm; wpfzufaumYaom tNyKH;jzifY ...

]]t&ifwkef;uvdkyJ usef;cHYomvdkY rmygovm;/ tvkyftudkifrsm;a&m tqifajyygovm;/

bmnmbmnm ygovm;aygYAsm}}

]]bmnmbmnm ygovm;u ygcJYao;w,f/ q&m,pfwdkYuawmYav}}

aemfatrDu 0ifajymcJYonf/ rrEG,fu pdwfajzavQmY[efjzifY jznf;jznf;omom &,farm

avonf/

]]t&ufuawmY jzwfvdkY&csif&r,f/ i,fusifYuawmY azsmufvdkYr&EdkifawmYygbl; xifw,faemf

q&mBuD; }}

]][kwfw,f/ tJ'gajymrvdkYyJ a':cifOD;EG,f/ uRefawmf t&uf jywfoGm;NyDaemf/ tm;vHk;udk

aMunmwm/ uRefawmYftonf;av; rBuKdufwJYtvkyfudk uRefawmf vHk;0 rvkyfawmYygbl;/ olwdkY

uRefawmfYudk q&m,pfvdkY ac:aeao;wmudkawmY wm;jrpfay;&vdrfYr,f xifw,f q&mBuD;}}



q&m OD;,OfrsKd;u vpmrJYcGifY quf,lNyD; t&ufaMumifY tonf;a&mifa0'emudk tonf;toef

cHvdkuf&ao;onf/ Mum;zl;xm;\/ &efukef tonf;a&m*g txl;ukXmerSm vtwefMum aq;cGifYjzifY

aeYm ukocJY&onf/ Munfh&yHkuawmY tom;ta&rsm; vwfqwfpdkjynf uspfvspfum t&ufawmY

jywfvmyHk&av\/

]]ac:&rSmyJ/ q&mu ,yufvufeJY r,pf&&if &aumufeJY &pfaeOD;rSmyJ}}

aemfatrDu qdkav\/

a'gufwm,OfrsKd;u cGJpdwfrSKvufaxmuftjzpf 0ifaeaom oufaZmfEdkif&JU aemufbufodkY

vm&yfum cGJpdwfrSKudk pD;rdk;í MunfhcJYonf/

]]aMomf? Splenectomy vm;/ awmrSmwkef;uawmY vkyf&ygYAsm/ opfyifay:u vdrfYuswmwdkY?

vSnf;eif;wmwdkY? abxdqdk&if uGJa&mqdkwm tJ'gaygY/ rav;&D;,m;abqdk&if xdwmeJYuGJNyD/

tonf;toef xkwfzdkYom jyifayawmY}}

olUpum;rS aeí olUtawGUtBuKHudk oufaZmfEdkif cefYrSef;rdav\/

]]tJ'Dvdkdk Splenic Rupture (abvHk;uGJjcif;)aMumifY toufu,fzdkY ta&;ay: xkkwf&wmeJY

Hypersplenism (a&m*gaMumifY abvHk;BuD;jcif;)aMumifY touf½Snf½Snfae&zdkY xkwf&wmu

enf;pepfrSmawmY enf;enf;uGmjcm;wmaygYav}}

q&mBuD; OD;atmifjrifu 0ifajymcJYav\/

]][m? [kwfygw,f q&mBuD;/ uRefawmfwdkYvdk a&mifpHkq&m0efeJY wpfa&mifwnf;jc,fwJY

qm*sifYvuf&mcsif;uawmY b,fwlEdkifygYrvJ/ uRefawmf q&mBuD;a½SUrSm 0efcHcsuf trSwfwpf

pay;aeNyDaemf rratrD}}

onfpum;rsm;u rratrDudk r[kwfbJ a':cifOD;EG,fokdY &nf½G,faeaMumif; oufaZmfEdkifyif

odrdvmcJYonf/ rrEG,fESifY q&mOD;,OfrsKd;Mum;u y#dyu©udkvnf; em;vnfvmrdovdk ½SdcJYonf/

a'gufwmOD;,OfrsKd;udkrl oufaZmfEdkif cifrifoabmusrdonf/ avmuBuD;udk oa&mfvdk[ef ESKwfcrf;zsm;

wpfzufwnf; NyKH;wwfaom OD;,OfrsKd;wGif pdwfaumif;raemaumif;av;awmY ½SdvdrfYrnf/ olYudk

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ayr,fY a,musfm;awGudk ½GHUpdwf wpf0uf? emMunf;pdwf wpf0ufjzifY ½Sdaeavrnfhol/ b,fawmYrSvnf;

tcefYoifY tqifajyMuvdrfYrnf rxif/

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wpfa,muf tjzpfodkY vsifjrefpGm a&muf½SdvmcJYonf/ oufaZmfEdkif *sLwDnrSm EG,f tdyf&mu x&aom

tBudrf enf;vmcJYonf/ ta&;ay: cGJpdwfcef;zGifYzkdYvdkonfhtcg OD;atmifjrifESifY qm*sifEG,fYudk

oufaZmfEdkifu taMumif;Mum;NrJ jzpfonf/ olUtaMumif;Mum;pmrSm ½Sif;½Sif;vif;vif;½Sdonf/

olUqHk;jzwfcsufrsm; wdusrSefuefonf/ oltultnDac:cJYvQif EG,fyg yg0ifulnD cGJpdwfay;&aom

tcuftcJauY(pf)rsKd; jzpfwm aocsmvSayonf/



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taMumif;jyefa&;wwfonf/ oufaZmfEdkifrSm cGJpdwfq&m0eftjzpf aq;½HkrSmae&vQif aysmfydkufaeav\/

armifarmifat;? MuLMuLESifY oufaZmfEdkif uGmjcm;csufyif/ armifarmifat;u uav;txl;ukjzpfcsifum

MuLMuLuawmY taxGaxGa&m*gukq&m0eftjzpfyJ aeawmYr,f qdkcJYav\/ cGJpdwftxl;uk jzpfvdkaom

oufaZmfEdkif\ BuKd;pm;rSKu ydkcJYavonf/

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uRefawmfu aeYwpf0uf Off &OD;r,f/ rrEG,fu r&bl;av}}

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vmcJYonf/

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ruRrf;íay/ onftwGuf rl,mYudk EG,f tjypfrqdkyg/ aq;½HkoufrSm "m;rudkifEdkifaom trsKd;om;

q&m0efrsm;yif EG,f BuKHzl;\/ jynfolUusef;rma&;? ausmif;usef;rma&; ponfrSm wm0efuscJYí

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½Sdonfav/ rl,murS ruRrf;usifayr,fY BuKd;pm;csifao;onf/

olr taMumif;Mum;pma&;&if olr t*Fvdyfvdk ta&;tom;u ½SKyfaxG;um yGifYyGifYvif;vif;

r½Sd/ EG,fYudk today;½Hk taMumif;Mum;wmvm;? EG,fvmMunfhNyD; cGJpdwfzdkY qHk;jzwfay;&rSmvm;?

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usawmY tajctaeu qdk;csifqdk;aernf/ vlemtwGufa&m EG,fYtwGufyg raumif;/

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jyifvQif ...

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trlt&mjzifY ol ajymwwfonf/ EG,f jyeftdyfvdkY raysmfYwaysmfrSm ...

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pmtkyfav;udkifí a&mufvmwwfNyD/ pmtkyfxJrSm emY(pf)av; wpfa,mufa,mufu t*Fvdyfvdka&m?

jrefrmvdka&m a&mausmfa&;xm;aom taMumif;Mum;pmav; ygav\/



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Operation udk vmMunfhay;yg/ Patient u Shock &csifovdkvdk jzpfaeygw,f½SifY}}

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uRefawmf aemufwpfcg vdkrSyJ ...}}

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a':cifOD;EG,fu reufudkvnf; 0gY('f)xJvm&OD;r,f/ reufjzefn ta&;ay:eJY aq;½Hkrvm&bl;vnf;

rajymEdkifbl;/ at;Asm? qm*sifqdkwm odyfyifyef;w,faemf}}[k EG,fajym&rnfhpum;awG olyJ ajymoGm;

wwfavonf/ ol ynmjyaerSef;odvsuf EG,fu bmrS jyefrajymombJ ½SdaecJYonf/ EG,f vlem

prf;oyfMunfhNyD; qm*sifudk rvdktyfbJac:? ynm½Sd ESdyfpufwm[k EG,fu pGyfpGJcJYvQif onfudpöu

BuD;us,foGm;rnf/ cJGpdwfukwifxufu arYaq;ray;&ao;aom vlemMum;vQif pdwftm;i,fcJYrnf/

olUtoufudk ESif;tyfNyD; cGJpdwfukocHr,fYqJqJrSm qm*sifvmMunfhay;&vdkY rausrcsrf; pum;rsm;

cJYonf xifcJYvQif .../

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pum;rsKd; Mum;zl;&awmYw,f/ atmfya&;½Sif;uvnf; tjyifu apmifYay;&wm rajymeJY/ txJrSmawmif

udk,fwdkifcGJ&wm r[kwfbJ ul&&if odyfysif;zdkYaumif;wm/ udk,fwdkif qm*sifvkyfNyD; cGJvdkufcsif

ao;w,f/ NyD;awmY tdyfa&;vnf;ysuf ...}}

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b,fawmYrS jyefajymrSmvnf;r[kwf/ OD;,OfrsKd; &pfaeonfudk olu Mum;rS taecufaewwfavonf/

]]rrEG,fudk,fpm; uRefawmf Surgical Ward u A.S wpfa,muftaeeJY oGm;Munfhay;vdkYrsm;

&rvm;/ rrEG,fu uRefawmfYudk oGm;Munfhay;zdkY vTJvdkufr,fqdk&ifaygY}}

]]'gayr,fY olu qm*sifudk,fwdkif vmMunfhygvdkY ac:wwfwm/ udk,f tdyf&muvnf; Ekd;NyD;NyD/

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cGJae&if; udk,fYudk vSrf;ac:awmY oDa&wmzGifYwmawmY qm*sifodoifYw,fvdkY ajymvnf;ajymrda&m

udk,fwdkYqufqHa&;u tqdk;qHk; jzpfoGm;awmYwmyJ/ udk,fu csKyfudkifcsifwJYoabm r[kwfygbl;/

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olawmfwmvnf; awmfygw,f/ 'gayr,fY wwfp&m rusefbl;awmY b,f[kwfrvJ/ udk,fawmif rvkyf

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udk,fYudk ac:aeawmYwm}}

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av\/

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EG,f pmudk qHk;atmifrzwfawmYbJ tenf;i,f pdwfwdkrdpGm aq;½HkodkY vmcJYonf/ raeYnuyif

tlusNyD; jyefrwufEdkifaom ta&;ay:vlemwpfa,mufudk EG,fESifY rl,m cGJpdwfcJYMu&ao;onf/

OD;,OfrsKd; rodwmvnf; r[kwf/

EG,fa&mufawmY vlemu cGJpdwfukwifxufrSm a&mufaecJYNyD/ oDa&wm\ qifem;½GufwHcg;?

jcifqefumwHcg;wdkYudk wGef;zGifY0ifoGm;vQif ...

]]aMomf? qm*sif a&mufcJYNyDaemf/ wu,fawmY Appendicectomy twGuf a':cifOD;EG,fukd

c:wm uRefawmf odyftm;emrdygw,fAsm/ 'grsKd;u awmaq;½Hkav;rSmawmif bmwpfckrS rvkyfEdkifbl;

xm;/ q&m0efwpfa,mufwnf;yJ ½SdOD;/ Appendicectomy uawmY tedrfYqHk;vkyfEdkif&r,fY udpö

uav;yg}}

EG,f a'goESifY ajymjzpfEdkifonfh pum;awGudk oluyJ ajymaejyefNyD/ EG,f olYudk tav;*½k

rxm;bJ olUaemufrSm &yfvmonfh oufaZmfEdkifudkom ESKwfqufvdkufonf/

]]oufaZmfEdkifyg a&mufaewmvm;}}



]][kwfw,f rrEG,f/ ay;½SifYu vGefcJYwJY oHk;vpvHk; Dysentery (0rf;udkufa&m*g)

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½Sdcsif½Sdaer,f/ tpfudku ajymvdkY uRefawmfvnf; tawGUtBuKH&atmif vdkufMunfhwmyg}}

]][kwfygw,f a':cifOD;EG,f/ tJ'gaMumifYyJ uRefawmf a':cifOD;EG,fudk ac:&wmyg}}

EG,f bmrSrajymombJ ykcHk;om wGefYrd&avonf/

cGJpdwfukwifxufu vlemudk vSrf;MunfhawmY trsKd;orD;wpfOD;rdkY EG,f pdwf0ifpm;oGm;rdonf/

vlemtrsKd;orD;&JU cGJpdwfcef;0if0wfpHk aemufuGJtusÐudk tay:odkY vSefwifvdkufNyD; t0wfrJY 0rf;Adkuf

jyifudk cifOD;EG,fu ...

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wpfcsuf prf;Munfhonf/ tltwufa&mifwmawmY aocsmvSavonf/

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avmufudk MumcJYygw,f}}

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]][kwfygw,f}}

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cGJay;ygvdrfYr,f}}

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toHxGuf&,favonf/

cifOD;EG,f em;aecef;qDodkY xGufcJYonf/ ukwifay:rSm rem;&ao;rD cGJpdwfrSKrpao;í yGifY[

aeqJ cGJpdwfcef;xJrS OD;,OfrsKd;&JU toH0gBuD;u vdkufvmcJYonf/



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tJ'D i½kwfapY? yJykyfapY? qD;apYawGu tltwufuav;rSm oGm;ydwfqdkYawmY tltwufu a&mifa&m/

cGJ&a&mAsm;/ 0rf;udkufwmvnf; tJ'Dvdk rdef;ryDyD udk,fBuKduf&ifNyD;&if? vrf;ab;ra½Smif bmra½Smif

avQmufpm;vdkY 0rf;udkufa&m*gvnf; &wmAsm;}}

]][kwfygw,fawmf? [kwfygw,f/ a,musfm;usawmY tltwufra&mifMuwmusvdkY}}

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oufaZmfEdkif&JU &,farmoHoJYoJYudk Mum;&avonf/

cifOD;EG,f ukwifxufrSm ausmqefYvdkY vSJrdav\/ nu tdyfa&;vnf;ysufonfrdkY cP

arS;idkufoGm;rd\/ todpdwfwpfrsKd;jzifY EG,f rsufvHk;rsm; zsufueJ zGifYrdonf/ EG,fYacgif;&if;em;u

0g;yufvufukvm;xkdifwGif 0ifvmxdkifvkdufaom oufaZmfEdkifudk awGU&onf/

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wifyg;ausmfaom EG,fYqHyifudk vufwpfzufjzifY odrf;,l&if; xxdkifvdkufcJYonf/ vSJtdyfcJY&if

qHyifawGudkyg avQmYajzvdkpGm acgif;u qHn§yfudk jzKwfxm;rdNrJ jzpfonf/ tck EG,fYqHn§yfav;udk

½kwfw&uf ½SmrawGU/ vufwpfzufu qHyifawGudk odrf;udkifxm;NrJ/ vufwpfzufjzifY acgif;tHk;udk

rçMunfhrdpOf acgif;&if;pm;yGJay:u qHn§yfuvpfudk oufaZmfEdkifu vSrf;,lay;av\/ EG,fYpdwfxJrSm

onftjyKtrludk uoduatmuf jzpfoGm;rdcJYayr,fY bmrS rjzpfovdk ...

]]Appendix udk jzKwfvdkufNyDvm;}}[k ar;cJYonf/

aemufwpfBudrf onfvdkrjzpfap&/ EG,fYudk,fEG,f pdwfxJu owday;rdonf/ oufaZmfEdkif

uvnf; bmrSrjzpfovdk/ onfvdk qHn§yfuvpf ½Smay;cJY&wJY tBudrfawG olUb0rSm axmifcsD

½SdcJYovdkjzifY ...

]]&awmYr,f rr/ Colon u Pelvic eH&HwpfavQmufvHk; uyfaew,f/ Appendix udk qGJ,lvdkY

&vdkY awmfao;wm/ a&wGif;xJrSm vkyf&ovdkyJ/ tay:udk vHk;0 rçvdkYr&bl;/ tm;vHk; uyfaew,f}}

cGJpdwfvlem&JU tltwuftaMumif;udkyJ ajymjycJYavonf/

]]tJ'g rr jyefvdkufawmYrvm;/ uRefawmf vmajymwmyg/ uRefawmfeJY avay;&if; cGJae&awmY

q&m rrEG,fudk &pfzdkY arYaeNyDav/ jyefoGm;&if ol odvdkufrSm r[kwfygbl;/ aemufudkvnf; rrEG,f

ta,mifvmjyNyD; jyefoGm;vdkuf/ uRefawmf usefcJYay;r,fav}}



EG,f oufaZmfEdkif&JU tBuHtpnfudk &,farmrdav\/

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]][m? aqm&D; rr/ uRefawmf ...}}

oufaZmfEdkif rsufESmysufavonf/

]]xm;ygav/ udk,fem;vnfygw,f/ udk,f olYudk aocsmESKwfqufNyD;rS jyefrSmyg}}

cifOD;EG,f NyKH;&,fajym&if; oDa&wmxJ 0ifcJYav\/

olr 0ifcJYyHku b,folYudkrS taESmifYt,Sufrjzpf/ nifomvSí cGJpdwfcHkrSm acgif;csif;qdkif

cGJaeolrsm; rodvdkuf/ oufaZmfEdkifu olraemufrS 0ifvdkufvmcJYonf/

]]*Gwfbdkif? cGJcGmMuygpdkY Appendix av;a&}}

EG,f teD;a&mufonfESifY tltwufav;udk xkwfvdkufcsdef BuKHBuKdufaeay\/

av;vufravmuf ½Snfvsm;aumufauGUNyD; wpfcsdefr[kwf wpfcsdefrSm ol 'ku©ay;rSm aocsmaecJYonf/

]]Appendix &oGm;NyDyJ/ q&m odyfBuKd;pm;vdkuf&yHkawmif ray:bl;}}

cifOD;EG,f&JU pum;oHu El;nHhodrfarGUaecJYonf/

q&m,OfrsKd;u armfMunfhpOf csD;usL;[ef NyKH;cJYao;\/

]]oufaZmfEdkifu ajymw,f/ Colon u awmufavQmuf uyfaewmqdk/ 'grsKd; uRefr

q&mwpfa,muf vkyfwmawmif Colon udk "m;xdoGm;vdkY tawmf avmoGm;ao;w,f/

uGef*&ufusLav;½Sif;yg q&m}}

cifOD;EG,f\ rarQmfvifYaom csD;usL;pum;aMumifY q&m,OfrsKd; tenf;i,f tae&

cufoGm;[ef½Sd\/

]][kwfuJY? a':cifOD;EG,f/ vmapmifYay;wm aus;Zl;trsm;BuD;wifygw,f/ tm;vnf;emygw,f

cifAsm}}

onfwpfBudrfrl wu,fyif OD;,OfrsKd; tm;empdwf0ifrdí ajymyHk&av\/

]]'gqdk uRefr oGm;awmYr,f}}



]]aumif;ygNyD cifAsm}}

cifOD;EG,f cg;½dk;xHkaq;aMumifY cg;atmufydkif; cGJpdwfaeonfudk remusif? rodjim;vnf; owd

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ajym&if; ESpfodrfYcJY&avonf/

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EG,fu cg;cg;oD;oD; jiif;onf/



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ararYbufu avQmYcJY&avonf/

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onmodyJ/ ynmodqdkwm t&d,mrSmrS ½SdEdkifwm}}

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ae&onf/

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Mum;w,f}}

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twGif;rSmyif ...

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arar &,farmavonf/

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aeonf/ EG,fuJYodkYyif toHat;aq;pGm ...

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xdkif&mu xonf/

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qm*sifcifOD;EG,fr[kwfbJ tjcm;trsKd;om;qm*sifwpfOD;ESifYom BuKHBuKdufcJYvQif b,frQ tcGifYtvrf;

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wpfcku tNcm;olawG&JU b0udkvnf; xdcdkufepfemapcJYonfhtwGuf EG,f 0rf;enf;aMuuGJ&ygonf/

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