Şunu aradınız:: reduced berfomance (İngilizce - Somalice)

many forms of transportation reduced or shut down
magaca rasmi ah oo lagu qoro kaadhka lagu raacayo gaadiidka oo waajib ah

the mountains reduced to dust and blown away,
oo buuraha la rujiyo.

there they were defeated, and utterly reduced.
waxaana lagaga adkaaday gaaladii halkaas, waxayna noqdeen iyagoo dullaysan.

then we reduced him to the lowest of the low,
kaddibna waxaan u celinaynaa hoos (gabow dartiis).

and it destroyed everything over which it passed and reduced it to dust.
wax kasta oy martana ka dhigi wax tirtiran.

so the truth came out, and what they had wrought was reduced to naught.
waxaana sugnaaday xaqii waxaana buray waxay falayeen.

it left nothing whatever that it came up against, but reduced it to ruin and rottenness.
wax kasta oy martana ka dhigi wax tirtiran.

they did not cease to cry this until we reduced them to stubble, still and silent.
saasna kuma tagin qayladoodu intaan ka yeello, wax la shafay oo bakhtiya.

so he reduced them into pieces, except for their biggest, that they may return to it.
wuxuuna ka yeelay burbur, koodii waynaa mooye inay xaggiisa u noqdaan (inuu jajabiyey isagu).

also businesses other than food stores and pharmacies are closed, and public transport has been reduced or stopped.
dalalka uu sida xun u sameeyay oo ay ku jiraan talyaaniga, isbayn, iyo faransiiska, sidii jayna badooda loogu soo rotay janaayo, ayaa lagu soo rogay.

does he promise you that when you are dead and are reduced to dust and bones, you will be brought forth to life?
ma wuxuu idiin yaboohi markaad dhimataan ood noqotaan carro iyo lafo in laydin soo boxin.

opportunistic sampling for serology in children younger than 10 years might be limited due to the overall reduced rate of blood tests in children.
ka faa'iidaystayaasha sambala dheecaan dhiiga ee laga qaaday caruurta ka yar 10 sanno ayaa laga yaabaa in ay koobnaanto sababtoo ah hoos u dhigada guud ee heerka baadhitaanada dhiiga ee caruurta laga qaado.

(do you think) we would be paid back our due when we are dead and reduced to dust and bones?'
ma markaan dhimana oon carro noqono iyo lafo yaa nala abaalmarin.

beginning on 15 march, many businesses closed or reduced hours throughout the u.s. to try to reduce the spread of the virus.
17 maarso, safmareenka waxaa laga xaqiijiyay dhamaan 50ka gobol iyo degmada columbia. 23 maarso, waxaa lasooo sheegay in magaalada new york laga helay 10,700 kiisas oo coronavirus ah, in ka badan tirada guud ee kiisas kuuriyada koonfureed.

and they sold him for a reduced price - a few dirhams - and they were, concerning him, of those content with little.
waxayna ku gateen qiima jaban dirhamo tirsan waxayna ahaayeen kuwaan rabin.

if we so wished, we could have reduced your harvest to rubble, and you would have been left wonder-struck to exclaim:
haddaan doonno waxaan ka dhigaynaa burbur (aan wax tarin) markaasaad yaabaysaan (murugoonaysaan).

believers, do not raise your voices above the voice of the prophet and when speaking to him do not speak aloud as you speak aloud to one another, lest all your deeds are reduced to nothing without your even realising it.
kuwa xaqa rumeeyow ha ka koryeelina codkiinna codka nabiga, hana kula jahrina (qaylina) hadal sida qaarkiin qaar ugula jahro (qaylyo) si aan camalkiinnu u burin idinkoon agayn.

in patients with severe cases, the level of d-dimer, a fibrin degradation product present in the blood, was elevated, and lymphocyte count was progressively reduced.
bukaanada kiisaska khatarta ah leh, heerka d-dimmer, hoos udhaca wax soo saarka fibrin ee ku jira dhiiga , ayaa kor loo qaaday, iyo tirada dhiiga cad oo si hormar leh hoos loogu dhigay

the emergence of sars-cov-2 in central china at the end of 2019 has thrusted covs into the spotlight again and surprised us with its high transmissibility but reduced pathogenicity compared to its sister sars-cov.
soo bixitaankii sars-cov-2 ee bartamaha shiinaha dhammaadkii sanadka 2019 ayaa mar kale hoos u dhigay fursadaha covs isla markaana wuu naga yaabiyay awooddiisa gudbineed ee aadka u sareeya laakiin waxay hoos u dhigtay faafitaanka marka loo eego walaasheed sars-cov.

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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