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and cushions set in rows,
iyo barkimooyin la safay.
Ultimo aggiornamento 2014-07-03
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and cushions arrayed in rows,
iyo barkimooyin la safay.
Ultimo aggiornamento 2014-07-03
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10 20 30 40 50 60 70 80 90 100
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by those who range themselves in rows;
(waxaan ku dhaartay) malaa'igta safan.
Ultimo aggiornamento 2014-07-03
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and your lord comes with the angels in rows,
eebe iyo malaguna la yimaaddo amarkiisa malaa'igtoo safan.
Ultimo aggiornamento 2014-07-03
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by those [angels] lined up in rows
(waxaan ku dhaartay) malaa'igta safan.
Ultimo aggiornamento 2014-07-03
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and when your lord appears with rows upon rows of angels,
eebe iyo malaguna la yimaaddo amarkiisa malaa'igtoo safan.
Ultimo aggiornamento 2014-07-03
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"and we are truly those who stand in rows,
waana safannahay (cibaado darteed).
Ultimo aggiornamento 2014-07-03
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verily we range ourselves in rows (as humble servants)
waana safannahay (cibaado darteed).
Ultimo aggiornamento 2014-07-03
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north america and middle east retailers saw a 50–60% drop.
tan sidoo kale waxaa ka dhashay 33-43% oo ah hoos dhaca saxmada goobaha dukaamaysiga ee maarso marka loo eego febraayo.
Ultimo aggiornamento 2020-08-25
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by those (angels) ranged in ranks (or rows).
(waxaan ku dhaartay) malaa'igta safan.
Ultimo aggiornamento 2014-07-03
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by 23 march, iran was experiencing 50 new cases every hour and one new death every ten minutes due to coronavirus.
sida laga soo xigtay madaxda hay'ada caafimaadka aduunka, in ay jirin karaan kiisas shanjeer ka badan gudaha iran marka loo eego waxaa lasoo sheegay.
Ultimo aggiornamento 2020-08-25
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the epidemic started in wuhan, china, and quickly spread throughout the entire country and to near 50 others all over the world.
xanuunka safmareenku wuxuu ka bilawday wuhan, shiinaha, wuxuna si dhakhsa ah ugu faafay dalka oo dhan iyo in ku dhaw 50 kale oo daafaha caalamka ah.
Ultimo aggiornamento 2020-08-25
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the day that the spirit and the angels will stand in rows, they will not speak except for one whom the most merciful permits, and he will say what is correct.
maalinta jibriil iyo malaa'igtu saf istaagi wax hadli ma jiro ruux eebe idmo mooyee oo hadal xaq ah ku hadla.
Ultimo aggiornamento 2014-07-03
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according to dr meerjady, two cases were aged above 60, two between 51 and 60, and one 41-50 years old.
iyadoo laga soo xiganayo dr meerjady, laba kiisas ayay da'doodu ka waynayd 60, laba u dhaxeeya 51 iyo 60, iyo mid 41-50 sano jir ah.
Ultimo aggiornamento 2020-08-25
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acknowledgment ................................................................................................................... i table of contents .................................................................................................................. ii chapter one: shock ............................................................................................................. 1 introduction ................................................................................................. 1 classification .............................................................................................. 1 patho physiology of shock ......................................................................... 2 management of shock ................................................................................ 3 complications of shock .............................................................................. 4 chapter two: fluid and electolytes ..................................................................................... 5 introduction ................................................................................................. 5 normal distribution of body fluids .............................................................. 5 disturbances of fluid and electrolytes ........................................................ 7 acid – base balance ................................................................................... 12 review questions ....................................................................................... 15 references .................................................................................................. 16 chapter three: blood transfusion ....................................................................................... 17 indications for blood transfusion ............................................................... 17 compatibility tests ...................................................................................... 17 component therapy ................................................................................... 18 review questions ....................................................................................... 21 references .................................................................................................. 22 chapter four: pre-operative and post-operative care ...................................................... 23 introduction ................................................................................................. 23 general consideration ............................................................................... 23 assessment and minimization of surgical risks ........................................ 24 post-operative care, complications and their treatment ......................... 26 post operative intestinal obstruction ......................................................... 31 hematoma, abscess and seromas ............................................................ 33 review questions ....................................................................................... 34 references .................................................................................................. 35 chapter five: aseptic and antisepic techniques ................................................................ 36 introduction ................................................................................................. 36 choice of antiseptic ................................................................................... 37 review questions ....................................................................................... 41 references .................................................................................................. 42 chapter six: suture materials and suturing ......................................................................... 43 types of suture materials ........................................................................... 43 suturing techniques ................................................................................... 44 iii chapter seven: wounds- wound healing and care ........................................................... 47 introduction ................................................................................................. 47 wound healing ............................................................................................ 47 wound assessment and classification ....................................................... 49 wound management ................................................................................... 50 crush and avulsion wounds ....................................................................... 53 wound complications ................................................................................. 55 review questions ....................................................................................... 57 key to the review questions ..................................................................... 59 references .................................................................................................. 60 chapter eight: surgical infections ........................................................................................ 61 introduction ................................................................................................. 61 classification .............................................................................................. 62 pathogenesis .............................................................................................. 62 specific types of infections ........................................................................ 64 review questions ....................................................................................... 73 key to the review questions ..................................................................... 75 references .................................................................................................. 76 chapter nine: trauma .......................................................................................................... 77 introduction ................................................................................................. 77 treatment priorities ..................................................................................... 78 road traffic accidents ................................................................................ 79 firearm injuries ........................................................................................... 80 burn injuries ......................................................................................... 81 review questions ....................................................................................... 84 references .................................................................................................. 85 head and spinal injuries ............................................................................ 86 head injury .................................................................................................. 86 brain injuries ............................................................................................... 87 spinal cord injuries ..................................................................................... 90 review questions ....................................................................................... 92 references .................................................................................................. 93 chapter ten: orthopedic surgery ........................................................................................ 94 introduction ................................................................................................. 94 infections of bones and joints .................................................................... 94 fractures ..................................................................................................... 97 dislocations ................................................................................................. 102 amputations ................................................................................................ 103 review questions ....................................................................................... 105 references .................................................................................................. 106 chapter eleven: anesthesia................................................................................................. 107 pre-anesthetic patient evaluation and preparation .................................... 107 iv cardiopulmonary resuscitation .................................................................. 111 systemic (general) anesthesia .................................................................. 115 regional anesthesia ................................................................................... 118 review questions ....................................................................................... 124 references .................................................................................................. 125 systemic surgery chapter one: the thyroid gland ......................................................................................... 126 thyroid enlargement: goiter ....................................................................... 126 neoplasms of the thyroid ........................................................................... 130 review questions ....................................................................................... 132 references .................................................................................................. 133 chapter two: the breast ..................................................................................................... 134 introduction ................................................................................................. 134 anatomy ..................................................................................................... 134 breast lumps .............................................................................................. 135 carcinoma of the breast ............................................................................. 137 review questions ....................................................................................... 140 references .................................................................................................. 141 chapter three: the chest ................................................................................................... 142 introduction ................................................................................................. 142 upper airway obstruction ........................................................................... 142 tracheostomy ............................................................................................. 143 chest injuries .............................................................................................. 146 pneumothorax ............................................................................................. 149 hemothorax ................................................................................................. 149 tube thoracostomy (chest tube) .............................................................. 150 empyema and lung abscess ..................................................................... 152 lung abscess .............................................................................................. 154 review questions ....................................................................................... 156 references .................................................................................................. 157 chapter four: gastrointestinal tract .................................................................................... 158 introduction ................................................................................................. 158 upper gastrointestinal bleeding ................................................................. 159 colorectal tumors ....................................................................................... 164 common perianal conditions ..................................................................... 166 anal fissure (fissure in ano) .................................................................... 170 hemorrhoids (piles) .................................................................................... 171 references .................................................................................................. 175 acute abdomen ........................................................................................... 176 intestinal obstruction .................................................................................. 177 sigmoid volvulus ......................................................................................... 179 v appendicitis ................................................................................................. 180 peritonitis .................................................................................................... 183 hepato biliary diseases .............................................................................. 185 hydatid cyst of the liver ............................................................................. 187 diseases of gall bladder and biliary tree .................................................. 189 obstructive jaundice................................................................................... 193 review questions ....................................................................................... 197 abdominal wall hernias ............................................................................. 198 introduction ................................................................................................. 198 risk factors for abdominal wall hernia development ............................... 199 specific types of hernia ............................................................................. 200 review questions ....................................................................................... 204 references .................................................................................................. 205 stomach and duodenum ............................................................................ 206 introduction ................................................................................................. 206 peptic ulcer disease ................................................................................... 206 gastric cancer ............................................................................................ 211 review questions ....................................................................................... 213 dysphagia ............................................................................................. 214 introduction ................................................................................................. 214 dysphagia ................................................................................................... 214 carcinoma of the esophagus...................................................................... 215 review questions ....................................................................................... 218 references .................................................................................................. 219 chapter five: urology .......................................................................................................... 220 introduction ................................................................................................. 220 urinary symptoms and investigations of urinary tract problems .............. 220 acute renal failure (anuria/oliguria) ......................................................... 222 disorder of the kidneys and ureters ........................................................... 223 urinary tract infection ................................................................................. 224 renal tuberculosis ..................................................................................... 226 urinary bladder ........................................................................................... 230 bladder cancer ........................................................................................... 231 benign prostatic hyperplasia ...................................................................... 231 the urethra and penis ................................................................................ 233 urethral stricture ......................................................................................... 234 review questions ....................................................................................... 238 references .................................................................................................. 239 1 chapter one shock learning objectives at the end of this chapter, each student should be able to: • state the clinical definition of shock • list the chief characteristics and causes of all types of shock • describe the clinical symptoms and signs that are indicative of shock • list the immediate treatment measures to prevent complications introduction shock is a life-threatening condition which occurs when the circulatory system fails to deliver oxygen and nutrients to the body tissues and becomes unable to remove waste products from the body. it is a descriptive term based on the symptoms and signs secondary to one or more of a wide range of problems. if not recognized and corrected as early as possible, shock may rapidly progress to an irreversible state with subsequent multi-organ failure and death. definition shock is defined as a pathological state causing inadequate oxygen delivery to the peripheral tissues and resulting in lactic acidosis, cellular hypoxia and disruption of normal metabolic condition. classification shock is generally classified into three major categories: 1. hypovolemic shock 2. cardiogenic shock 3. distributive shock distributive shock is further subdivided into three subgroups: a. septic shock b. neurogenic shock c. anaphylactic shock hypovolemic shock is present when marked reduction in oxygen delivery results from diminished cardiac output secondary to inadequate vascular volume. in general, it results from loss of fluid from circulation, either directly or indirectly. 2 e.g. ▪ hemorrhage loss of plasma due to burns loss of water and electrolytes in diarrhea third space loss (internal fluid shift into inflammatory exudates in the peritoneum, such as in pancreatitis.) cardiogenic shock is present when there is severe reduction in oxygen delivery secondary to impaired cardiac function. usually it is due to myocardial infarction or pericardial tamponade. septic shock (vasogenic shock) develops as a result of the systemic effect of infection. it is the result of a septicemia with endotoxin and exotoxin release by gram-negative and gram-positive bacteria. despite normal or increased cardiac output and oxygen delivery, cellular oxygen consumption is less than normal due to impaired extraction as a result of impaired metabolism. neurogenic shock results primarily from the disruption of the sympathetic nervous system which may be due to pain or loss of sympathetic tone, as in spinal cord injuries. patho physiology of shock shock stimulates a physiologic response. this circulatory response to hypotension is to cons
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