The Triangle Physician March 2010

download The Triangle Physician March 2010

of 32

Transcript of The Triangle Physician March 2010

  • 8/9/2019 The Triangle Physician March 2010

    1/32

    Gi{j `m xf`{ @{{qa

    Fagx H`{ag{a>Awqgi Jrrjxqm`xpD`iia

    Xagx`me Rg`mqi[r`ma Cgkxqa{

    Ugda Fagx # Sg{kqig G{{jk`gxa{Jm Kgh`jijep{ Iagh`me Ahea

    G _ K F ? 2 7 2

  • 8/9/2019 The Triangle Physician March 2010

    2/32

    Oapjmh @lge`mgx`jm-Ujd`me `m rgxma{f`r u`xf rfp{`k`gm{

    cj jsa 12 pag{ xj o`me xfa oamac`x{

    jc o`jlah`kgi xakfmjijep xj rgx`amx{

    gjqmh xfa ujih-

  • 8/9/2019 The Triangle Physician March 2010

    3/32

    hqdafagixf-je*fagx 666,G[D,HQDA

    Hqda Fagrx Kamxar

    F`{ xagxlamxjc fagx cg`iqap`aih{ {qkka{{Hqda kgh`jije`{x Nj{arf _jea{ LH gmh

    kjiiageqa{ ga hacm`me xfa oa{x {xgxae`a{ xj fairfagx g`iqa rgx`amx{-

    Fagx cg`iqa `{ raxxp kjlljm) `{mx `x:

    Magip {`v l`ii`jm Gla`kgm{ ga i`s`me u`xf fagx g`iqaufam xfa

    fagx kgmx ghawqgxaip hj x{ njo j rqlr`me oijjh xfjqef xfa ojhp-

    Xfa ejjh mau{ { xfgx uasa {aam hglgx`k lrjsalamx{ m xfa xagx,

    lamx j fagx g`iqa `m xfa rg{x hakgha-

    Ufgx{ mau m xfa xagxlamx jc ghsgmkah fagx cg`iqa:

    Gx xfa ghsgmkah {xgeagakx`me gojqx 712222 Gla`kgm{

    lah`kgx`jm{ xpr`kgiip oakjla maakx`sa gmh fagx xgm{rigmxgx`jm {

    mjx gm jrx`jm j lj{x- Ua fgsa akamxip iagmah xfgx xfa{a rgx`amx{

    kgm oamacx eagxip jl ralgmamx lrigmxgx`jm j g iax samx`kqig

    g{{`{x has`ka &ISGH) uf`kf ujd{ xj rqlr oijjh lja ack`amxip

    xfjqef xfa ojhp-. Hqda fg{ oaam g iagh`me kamxa m xf`{ a{agkf-

    Ufgx hja{ xfa cqxqa fjih:

    @ oai`asa xfa mavx {xar `{ xfa q{a j lakfgm`kgi oijjh rqlr{ j fagx

    g`iqa rgx`amx{ agi`a `m xfa` `iima{{ xj avxamh wqgi`xp gmh pag{ j i`a-

    Gi{j ua kjqih rjxamx`giip oae`m xa{x`me {xal kaii xfagr`a{ xfgx ujqih

    rjljxa akjsap j xfa fagx gmh aljsgi j xfa rqlr-

    Ufp ujqih pjq amkjqgea fagx cg`iqa rgx`amx{ xj kjla

    xj xfa Hqda Fagx Kamxa:Gx Hqda ua fgsa g xjr,x`a rjegl> jqx{xgmh`me hjkxj{ g xagl gr,

    rjgkf kij{a kjiigojgx`jm u`xf jq kjiiageqa{ `m fagx {qeap gmh fagx

    fpxfl h`{jha{ g hah`kgx`jm xj ghsgmk`me jq dmjuiahea j fagx

    g`iqa xfjqef a{agkf gmh g rg{{`jm j qmha{xgmh`me gmh xagx`me

    xfa qm`wqa g{rakx{ j agkf rgx`amx{ h`{ag{a- Gi{j Hqda `{ jma j xfa

    sgmeqgh kamxa{ j xfa Fagx Cg`iqa _a{agkf Maxujd g kjm{jx`ql

    j `m{x`xqx`jm{ rjs`h`me `m{`efx{ `mxj mau xagxlamx{ j fagx g`iqa-

    Jmip 30 kamxa{ `m xfa Qm`xah [xgxa{ jcca ha{x`mgx`jm ISGH xfagrp cj

    ghsgmkah fagx cg`iqa- Hqda `{ jma jc xfal-

    Iagm lja gojqx xagxlamx jrx`jm{ cj fagx cg`iqa jccaah opH- _jea{ gmh f`{ kjiiageqa{) H{- L`kfgai Oig~`me) E- L`kfgai Caida)

    Gh`gm Famgmha~) Gmhau Ijhea) Kglaij L`igmj) Kf`{xjrfa

    JKjmmj) gmh A`k Saig~wqa~) op s`{`x`me jq Uao {`xa-

    H- _jea{ ra{amxah xfa{a cmh`me{ jm Mjsaloa 75 gx xfa Gla`kgm

    Fagx G{{jk`gx`jm{ [k`amx`ck [a{{`jm{ ?220-[jqka> kl{-ff{-ejs

    .

  • 8/9/2019 The Triangle Physician March 2010

    4/32

    Kjmxamx{

    FAG_X H@[AG[A>

    Awqgi Jrrjxqm`xp

    D`iia

    Lgmp ga mjx guga xfgx fagx h`{ag{a `{

    xfa Mj- 7 d`iia j ujlam gmh xfap jxam

    avra`amka g sap h`aamx gmh lja {qoxia

    {ax j {plrxjl{ xfgm lam-

    77 _GH@JIJEPJm Ogigmk`me xfa Oamax{ gmh _`{d{

    j K _gh`gx`jm Avrj{qa

    7? UJLAM[ FAGIXF G Ki`m`kgi [xqhp jm J{xajrjj{`{

    70 RFIAOJIJEP Rgx`amx{ u`xf `ah Gkfp Fagsp Iae{:

    ?2 O_G@M X_GQLG

    Og`m @mnqp g{ g Kfjm`k H`{ag{a

    ?? AIAKX_JRFP[@JIJEPIagh Avxgkx`jm

    ?; @M[Q_GMKAXa I`go`i`xp j g Mq{a

    ?8 MAU[ Uaikjla xj xfa Gag

    Asamx{ # Jrrjxqm`x`a{

    Mau gmh _aijkgxah Rgkx`ka{

    ?1 KG_H@JIJEP Ufgx Pjq [fjqih Dmju gojqx

    Ra`rfagi Gxa`gi H`{ag{a

    ?3 EJJH OQ[@MA[[Gsax`me Hgxg H`{g{xa{

    ?6 LG_DAX@MEFgsa Pjq Oaam Ogmhah:

    X_AGX@ME

    RG@MCQI [R@MA

    C_GKXQ_A[

    Rgx`amx [aiakx`jm @{ xfa Dap

    E`sam xfa kqamx kjmxjsa{p jsa saxa,

    ojrig{xpg l`m`lgiip `msg{`sa xagxlamx

    rajlah op `mxasamx`jmgi gh`jije`{x{ `m

    `mh`s`hqgi{ u`xf rg`mqi j{xajrjjx`k saxaogi

    kjlra{{`jm gkxqa{ xfgx g`i xj a{rjmh

    xj kjmsamx`jmgi lah`kgi xfagrpufgx{ g

    rgx`amx xj hj:

    KJSA_ [XJ_P

    HARG_XLAMX[

    Ugda Fagx # Sg{kqig G{{jk`gxa{>Jm Kgh`jijep{ Iagh`me Ahea

    ? Xfa Xgmeia Rfp{`k`gm y LG_KF ?272

    L G _ K F ? 2 7 2 S J I Q L A 7 @ [ [ Q A ?

    KJSA_ RFJXJ> Kamxa Ngla{ _- Cj{xa L-H- C-G-K-K- L`kfgai Ngp ^aii`mea L-H- C-G-K-K- U`ii`gl M- Maulgm L-H- Eaejp K-

    _j{a L-H- C-G-K-K- Njai Asgm [kfma`ha L-H- C-G-K-K- 7{x ju Kp{xgi Daam GMRRG _joax Iaa Njoa L-H- C-G-K-K- Kf`{x`gm M-

    E`me L-H- H`gma A- Lj`{ GKMR _gs`{f [gkfg L-H- A`k L- Ngm`{ L-H- C-G-K-K Lgxxfau [- Cjk`mg L-H- Mpig Xfjlr{jm RG,K

    Lgxaam Gdfxg L-H- N `llp Ijkdiag L-H- C-G-K-K- _gmhjirf Gamh [xgxxjm Kjjra L-H- C-G-K-K- Naap _`kfgh Hgu L-H-

    C-G-K-K- Oamngl`m E- Gxda{jm L-H- Lgp Dgxfpm Oqlegma RGK- Mjx r`kxqah Das`m _gp Kglroaii L-H- Gxfq P- Kfju L-H-

    C-G-K-K- Lgxxfau G- Fjjd L-H- Gmhau K- Djmamoae L-H- C-G-K-K- Ngla{ X`x Lgmm @@@ L-H- [glaf D- Ljogad L-H- N jfm C-_fjha{ N- L-H- Oqka Ugam Q{fa L-H- C-G-K-K- _joax O- Ua{iap @@ L-H- C-G-K-K- RFJXJ OP N@L [FGU

  • 8/9/2019 The Triangle Physician March 2010

    5/32CAO_QG_P ?272 y Xfa X`gmeia Rfp{`k`gm 71

  • 8/9/2019 The Triangle Physician March 2010

    6/32

    Ah`xj

    Lgd Ua{xrfgi lgdBx`gmeiarfp{`k`gm-kjl

    Kjmx`oqx`me Ah`xj{

    Fa`h` Daxia fa`h`Bx`gmeiarfp{`k`gm-kjl

    Lgxaam Gdfxg LH4 Kf`{ Hjgma4 Gm`i Eaf` LH4

    [xarfam R- Ijaf LH4 Gmhag [- Iqda{ LH LF[k

    CGKJE4 I`mhp LkFqxkf`m{jm LH4 Xfjlg{ I- Ra{{jm

    N- LH4 L`da _`hh`kd4 Lgd U`ama

    Rfjxjegrfp

    N`l [fgu Rfjxjegrfp n`l{fgurfjxjBagxfi`md-max

    Kagx`sa H`akxj

    Hgm Agip hgmBx`gmeiarfp{`k`gm-kjl

    Sgm Agip sgmBx`gmeiarfp{`k`gm-kjl

    Ghsax`{`me [gia{

    Kgjipm Ugixa{ kgjipmBx`gmeiarfp{`k`gm-kjl

    Mau{ gmh Kjiqlm{

    Riag{a {amh xj `mjBx`gmeiarfp{`k`gm-kjl

    Xfa X`gmeia Rfp{`k`gm `{ rqoi`{fah op

    Agip Ha{`em Ejqr

    06? X`m`xp _jgh y _gia`ef MK ?5325,8082

    [qo{k`rx`jm gxa{>

    (86-22 ra pag

    (3-01 ra `{{qa

    Ghsax`{`me gxa{ jm awqa{x

    Oqid gxa rj{xgea rg`h Xqk{jm G^ 615?3

    Asap rakgqx`jm `{ xgdam xj `m{qa xfa gkkqgkp j

    xfa gx`kia{ rqoi`{fah Xfa X`gmeia Rfp{`k`gm kgm mjx

    oa faih a{rjm{`oia j xfa jr`m`jm{ avra{{ah j

    gkx{ {qrri`ah op `x{ gqxfj{-

    Jr`m`jm avra{{ah j gkx{ {qrri`ah op `x{ gqxfj{

    ga mjx xfa a{rjm{`o`i`xp j Xfa X`gmeia Rfp{`k`gm-

    Fjuasa Xfa X`gmeia Rfp{`k`gm lgda{ mj uggmx

    xj xfa gkkqgkp j ai`go`i`xp j xf`{ `mjlgx`jm-

    Gii ghsax`{a gmh lgmqgkxqa {qrri`ah

    rfjxjegrfp u`ii aka`sa mj kjlram{gx`jm j xfa

    q{a j {qol`xxah rfjxjegrfp-

    Gmp kjrp`efx{ ga ug`sah op xfa ghsax`{a-

    Mj rgx j xf`{ rqoi`kgx`jm kgm oa arjhqkah j

    xgm{l`xxah `m gmp jl j op gmp lagm{ u`xfjqx xfau`xxam ral`{{`jm jl Xfa X`gmeia Rfp{`k`gm-

    jjd`me gx xf`{ ah`x`jm al`mh{ la j fju lqkf @ ijsa lp njo gmh rafgr{ `x u`ii

    gakx pjq {`l`igip- [`mka lp njo `{ xj am{qa `gmeia Rfp{`k`gm {xgp{ jm xfa kqxx`me

    ahea u`xf pjq lp hgp{ ga gua iiah- @ gl kjm{xgmxip {xqkd op xfa harxf j

    kjlrg{{`jm gmh kjqgea xj rq{f xfa amsaijr u`xf`m xfa ae`jm{ lah`kgi kjllqm`xp-

    Faa geg`m jq kjsa {xjp xgda{ gm m,harxf ijjd gx gm mxamgx`jmgi r`jmaaUgda Fagx #

    Sg{kqig G{{jk`gxa{- Mjx jmip `{ xf`{ rgkx`ka kqxx`me ahea gmh kjlrafam{`sa `x fg{ g {xjme

    kjllqm`xp {as`ka l`{{`jm xj rjljxa rasamx`jm gmh `x{ qmhaip`me kqixqa `{ og{ah jmeamq`ma kjlrg{{`jm j x{ rgx`amx- Ugda Fagx { gii fagx gmh `x {fju{ m ujh{ gmh gkx`jm{-

    Gi{j `m xf`{ `{{qa u`haip faih rqoi`k l`{kjmkarx`jm{ gojqx fagx h`{ag{argx`kqigip u`xf

    aegh xj eamha h`aamka{ga ojqefx xj i`efx- Rasamx`jm `{ gx xfa kqv j xf`{ lgnj

    rqoi`k fagixf `{{qa- Gmh lah`kgi rja{{`jmgi{ fgsa gm `lrjxgmx jia xj rigp `m `{d,gkxj

    `mxasamx`jm-

    Daar agh`me gmh pjqii eg`m g eagxa gugama{{ j rfiaojijep gmh xagxlamx{ j sg`kj{a

    gmh {r`ha sa`m{- L`da _`hh`kd _`hh`kd @m{qgmka Ejqr {fga{ ghs`ka jm rja{{`jmgi i`go`i`xp

    kjsagea j mq{a{- Pjqii eax xfa fagh{ qr jm xfa oa{x hgxg,ogkdqr {xgxae`a{- Pjqii gi{j eg`m

    `m{`efx `mxj xfa rjua j g akjem`~goia ogmh `m oq`ih`me ijpgixp gljme rgx`amx{ gmh

    aa`me rfp{`k`gm{-

    Uf`ia jm xfgx xjr`k kjm{`ha xfa sgiqa j ogmh`me jm xfa rgea{ j`gmeia Rfp{`k`gm- @x fg{ g

    rjuaqi agkf j lja xfgm 6222 rfp{`k`gm{ rfp{`k`gm g{{`{xgmx{ gmh fj{r`xgi {xg m Giglgmka

    Kfgxfgl Hqfgl Egms`iia Fgmaxx Njfm{xjm Iaa Ljja Mg{f Jgmea Ra{jm [glr{jm

    Sgmka Ugda Ugam Ugpma gmh U`i{jm kjqmx`a{-

    Gmh riag{a {fga pjq rgkx`ka mau{mau rfp{`k`gm{ aijkgx`jm{ jram`me{ asamx{ axk-

    @m kij{`me g fagxaix xfgmd pjq j gii pjq hj-

    Qmx`i mavx ljmxf

    Lgd Ua{xrfgi

    Ah`xj

    I

    Cjl xfa Ah`xj

    8 Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

  • 8/9/2019 The Triangle Physician March 2010

    7/32

  • 8/9/2019 The Triangle Physician March 2010

    8/32

    Cjl xfa Kjsa

    Xa rgkx`ka fg{ ojghamah oapjmh kgh`gk

    kga xj `mkiqha avrax`{a `m ra`rfagi sg{,

    kqig gmh kgjx`h gxap h`{ag{a `mkiqh`me

    xfa xagxlamx j {xjda- X`{ avxam{`jm j

    xfa rgkx`ka `{ g a{qix j xfa {`l`ig mgxqa

    j xfa h`{ag{a rjka{{a{ gmh xagxlamx

    {xgxae`a{ j lj{x xpra{ j sg{kqig h`{ag{a-

    Lgmp j xfa xakfm`wqa{ ga xgm{agoia xj

    jxfa sg{kqig oah{ oqx gii fgsa xfa` jum

    mqgmka{- Xa og{`k r`lgp gmh {akjmhgp

    rasamx`sa {xgxae`a{ ga {`l`ig- @m gkx

    xfa jsaigr j rgx`amx{ u`xf gxfaj{kiaj{`{

    `msjis`me lja xfgm jma sg{kqig xa`xjp

    `{ jsa 12 rakamx-

    RFJXJOPO_@GM[X_@KDIGMH

    Ugda Fagx# Sg{kqig G{{jk`gxa{>

    Jm Kgh`jijep{ Iagh`me Ahea

    3 Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

    Ugda Fagx # Sg{kqig G{{jk`gxa{ jqmhah `m

    7061 fg{ ejum xj oakjla ag{xam Mjxf

    Kgji`mg{ igea{x kgh`jijep rgkx`ka- @x{ejuxf `{ g aakx`jm j jqmh`me r`mk`ria{ xj

    rjs`ha xfa f`efa{x iasai j kgh`gk kga gmh

    kqxx`me,ahea xakfmjijep `m xfa ae`jm- @x{

    l`{{`jm `{ xj {asa rgx`amx{ gmh ujd u`xf xfa`

    r`lgp hjkxj{ `m xfa rasamx`jm gmh xagxlamx

    j kjlriav kgh`gk gmh sg{kqig h`{ag{a-

  • 8/9/2019 The Triangle Physician March 2010

    9/32

    jhgp ?8 kgh`jijsg{kqig {rak`gi`{x{ gx

    Ugda Fagx # Sg{kqig G{{jk`gxa{ rjs`ha

    xfa qii kjlrialamx j kgh`jijep gmh

    sg{kqig {as`ka{> ki`m`kgi kgh`jijep akfj,

    kgh`jegrfp mqkiag kgh`jijep kgh`gk

    kgxfaxa`~gx`jm `mxasamx`jmgi kgh`jijep

    aiakxjrfp{`jijep kgh`gk lgemax`k a{j,

    mgmka gme`jegrfp4 xagxlamx{ j ra`rf,

    agi sg{kqig kgjx`h gxap gmh kaaojsg{,kqig h`{ag{a{4 asam rah`gx`k `mxasamx`jmgi

    kgh`jijep-

    Gii 712 {xgc laloa{ gx

    Ugda Fagx ga `mxaegi xj jq

    avkaiiamx rgx`amx kga gmh

    {as`ka{- I`da jq hjkxj{ xfap

    kjla jl h`sa{a ogkdejqmh{

    gmh ga hah`kgxah xj {qrrjx`mexfa rfp{`k`gm{ `m xfa` hai`sap

    j xfa oa{x rj{{`oia kgh`j,

    sg{kqig kga- Ua gii xagx jq

    rgx`amx{ i`da gl`ip u`xf xfa

    qxlj{x kga gmh qmha{xgmh`me-

    Haa Hgda{

    Kf`a Jragx`me Jka

    Xa {xamexf j Ugda Fagx i`a{ `m xfaojgh gmea j {as`ka{ ua rjs`ha xfa

    avkaiiamx hjkxj{ gmh xfa kjll`xlamx xj

    avkaiiamx kga {gp{ A`k L- Ngm`{ L-H-

    C-G-K-K- g kgh`jije`{x gx Ugda Fagx{

    [l`xfaih jka- Ufgx xf`{ ejqr o`me{

    `{ xfa go`i`xp xj ujd xjeaxfa xj kjiigoj,

    gxa gmh eax `mrqx jl kjiiageqa{ ufj ga

    avrax{ `m xfa` aih{ gmh xj xgda kga j gii

    rgx`amx{ u`xf gmp kgh`jsg{kqig rjoial

    qmha jma o`e qloaiig-

    LAH@KGI IAGHA_[

    Jsa xfa pag{ agkf mau rfp{`k`gm ufj

    fg{ kjla xj xfa rgkx`ka fg{ ojqefx g mau

    {ax j {d`ii{ xj amfgmka jq kjlrafam{`sa

    kga gmh daar q{ jm xfa iagh`me ahea {gp{

    H- Ngm`{ ufj{a gag{ j avrax`{a `mkiqha

    akfjkgh`jegrfp mqkiag kgh`jijep gmh

    kgh`gk kgxfaxa`~gx`jm- @m ghh`x`jm xj

    ghsgmkah xg`m`me lj{x j xfa lah`kgi {xg

    ga ojgh kax`ah gmh lgmp ga Caiiju{ j

    xfa Gla`kgm Kjiiaea j Kgh`jijep-

    Njai [kfma`ha L-H- C-G-K-K- ug{ akq`xah

    op Ugda Fagx `m 700; gxa kjlriax`me gm

    `mxasamx`jmgi kgh`jijep aiiju{f`r gx Aljp

    Qm`sa{`xp Fj{r`xgi- @mxasamx`jmgi kgh`jijep

    {rak`gi`~a{ `m xfa rasamx`jm gmh arg` j

    gxfaj{kiajx`k gxa`a{ kg`me j g gmea j

    `{{qa{ jl gkqxa lpjkgh`gi `mgkx`jm xj

    {xgoia kfjm`k gme`mg- Fa ug{ `m{xqlamxgi `m{xgx`me xfa kjjmgp {xamx rjegl gx

    UgdaLah `mxjhqk`me xfa mau gmh mju u`haip

    gkkarxah xakfmjijep xj xfa ae`jm-

    H- [kfma`ha uamx jm xj a{xgoi`{f xfa {x

    amhjsg{kqig rjegl `m 7006 ufam xfa mau

    UgdaLah Fagx Kamxa jramah- Xa

    avrgm{`jm j gme`jrig{xp gmh {xamx`me `m

    rgx`amx{ u`xf ra`rfagi sg{kqig h`{ag{a ug{

    g mgxqgi avxam{`jm j f`{ `mxasamx`jmgi

    kgh`jijep ujd- Xa rjegl fg{ {`mka

    avrgmhah xj `mkiqha kgjx`h gxap {xamx`me

    gkqxa {xjda lgmgealamx gmh amhjsg{kqigarg` j gohjl`mgi gmh xfjgk`k gmaqp{l{-

    Magip 12 rgx`amx{ qmhauamx amhjsg{kqig

    arg` j gohjl`mgi gjx`k gmaqp{l ig{x pag

    giiju`me l`m`lgiip `msg{`sa kga xj rgx`amx{

    ufj jxfau`{a ujqih awq`a g kjlriav

    jram jragx`jm-

    X`{ rg{x Hakaloa H- [kfma`ha rajlah

    xfa {x aiakx`sa amhjsg{kqig xfjgk`k

    gmaqp{l arg` m kjiigojgx`jm u`xf kgh`j,

    xfjgk`k {qeajm Gohqi Kfgqhfp L-H- jKgr`xgi Kgh`jsg{kqig [qeap- X`{

    ghsgmkah xakfmjijep giiju{ rgx`amx{ g ag{`a

    gmh {ga grrjgkfa{ xj lgmge`me gmaqp{,

    lgi h`{ag{a {gp{ H- [kfma`ha-

    Ugda Fagx jqmh`me rgxma Ngla{ `x

    Lgmm @@@ L-H- `{ jma j xfa ujih iagha{ `m

    gh`gi gxap kgxfaxa`~gx`jm gmh `mxasamx`jm{

    gmh fair{ xg`m rfp{`k`gm{ `m xfa Qm`xah [xgxa{

    `m xfgx xakfm`wqa- _joax Iaa Njoa L-H-

    C-G-K-K- C-[-K-G-@4 N`llp Ijkdiag L-H-C-G-K-K-4 U`ii`gl M- Maulgm L-H-4 gmh

    Eaejp K- _j{a L-H- C-G-K-K- ga gii

    gkx`saip `msjisah `m xfa Ugda Fagx kgh`gk

    {xamx`me rjegl-

    Njai [kfma`ha L-H- C-G-K-K-

    LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm 5

    Ngla{ X`x Lgmm @@@ L-H- C-G-K-K-

    RFJXJOP

    O_@GM[X_@KDIGMH

  • 8/9/2019 The Triangle Physician March 2010

    10/32

    Gx gojqx xfa {gla x`la xfgx xfa Cjjh gmh

    Hqe Ghl`m`{xgx`jm grrjsah kgjx`h

    {xamx`me m ?228 _gs`{f [gkfg L-H- C-G-K-K-

    ug{ akq`xah jl Xa Kiasaigmh Ki`m`k xj

    hasaijr xfa kgjx`h {xamx`me rjegl gx

    UgdaLah- [`mka xfam lja xfgm 7222

    kgjx`h {xamx`me rjkahqa{ fgsa oaam ra,

    jlah u`xf g ia{{ xfgm 7 rakamx {xjda `{d-H- [gkfg jma j xfa gqxfj{ j xfa ojjd>

    Lgmqgi j Ra`rfagi Sg{kqig @mxasamx`jm

    gi{j fg{ fairah hasaijr ufgx fg{ oakjla

    xfa ae`jm{ igea{x ra`rfagi sg{kqig

    h`{ag{a xagxlamx rjegl gx UgdaLah

    Fagx Kamxa-

    Lgxxfau G- Fjjd L-H- nj`mah Ugda

    Fagx jl Xa Kiasaigmh Ki`m`k `m ?225 xj

    avrgmh xfa UgdaLah kjjmgp gxap

    {xamx`me rjegl- Fa gi{j ojqefx u`xf f`l

    {ji`h avrax`{a `m ra`rfagi sg{kqig

    rjkahqa{ kgjx`h {xamx`me gmh `mxgkgm`gi

    `mxasamx`jm{-

    Kf`{x`gm M- E`me L-H- C-G-K-K- gi{j

    xg`mah gx Xa Kiasaigmh Ki`m`k `m hah`kgxah

    mjm,`msg{`sa fagx `lge`me `mkiqh`me kgh`gk,

    kjlrqxah xjljegrfp gme`jegrfp gmh

    kgh`gk L_@- Fa ojqefx f`{ {d`ii{ xj Ugda

    Fagx `m ?223-

    goigx`jm g mjm,{qe`kgi xakfm`wqa j xagx`me

    gx`gi o`iigx`jm gmh a{xj`me mjlgi fpxfl-

    Ugda Fagx aiakxjrfp{`jije`{x _gmhjirf

    Kjjra L-H- C-G-K-K- {gp{ f`{ kjiiageqa{ ga

    amkjqgeah op xfa q{a j u`aia{{,ljm`xj`me

    kgrgo`i`x`a{ j `lrigmxgoia hao`iigxj{ gmh

    rgkalgda{- Uaa avrgmh me jq go`i`xp xjjiiju rgx`amx{ u`xf fagx g`iqa gmh mjx jmip

    xagx xfal oqx h`gemj{a xfal aljxaip- Xgx

    ugp ua kgm lgmgea rgx`amx kga jsa xfa rfjma

    `m{xagh j `m xfa fj{r`xgi {gp{ H- Kjjra-

    KJLLQM@XP,OG[AH KG_A

    G{ Ugda Fagx # Sg{kqig G{{jk`gxa{

    {as`ka{ fgsa avrgmhah {j xjj fg{ `x{ agkf-

    jhgp 71 Ugda Fagx ijkgx`jm{ {asa gm

    gag jl {jqxfam S`e`m`g xj lqix`ria

    ijkgx`jm{ `m ag{xam Mjxf Kgji`mg- Ugda

    Fagx{ maua{x jka `m Jvjh M-K- jram{

    `m g{{jk`gx`jm u`xf Egms`iia Lah`kgi Kamxa

    xf`{ {qlla- Xa Ejih{ojj jka `{ oa`me

    aijkgxah gkj{{ jl Ugpma Lalj`gi

    Fj{r`xgi gmh u`ii ja avrgmhah {as`ka{ gmh

    lja avgl`mgx`jm jjl{- Xa mau jka

    u`ii giiju q{ xj {aa lja rgx`amx{ gmh ja

    ghh`x`jmgi mjm`msg{`sa {as`ka{ {qkf g{

    akfjkgh`jijep mqkiag kgh`jijep {xa{{

    xa{x`me gmh ra`rfagi sg{kqig {xqh`a{

    {gp{ H- [kfma`ha-

    Xa maua{x laloa j xfa Ugda Fagx

    lah`kgi {xg `{ aiakxjrfp{`jije`{x Lgxxfau

    [- Cjk`mg L-H- jl Hqda Qm`sa{`xp

    Lah`kgi Kamxa gmh xfa Lah`kgi Qm`sa{`xp

    j [jqxf Kgji`mg- [jjm gxa nj`m`me xfa

    rgkx`ka `m ?220 H- Cjk`mg iah xfa hasai,

    jrlamx j g {rak`gi`~ah igo gx UgdaLah

    Fagx Kamxa xfgx mju rjs`ha{ xfa maua{xrjkahqa{ xj xagx gmh rjxamx`giip kqa

    gx`gi o`iigx`jm-

    Ugda Fagx{ xagl j aiakxjrfp{`jije`{x{

    ufj {rak`gi`~a m xfa {xqhp gmh xagxlamx j

    fpxfl h`{jha{ j xfa fagx `mkiqha> Das`m

    _gp Kglroaii L-H- C-G-K-K-4 _gmhjirf Kjjra

    L-H- C-G-K-K-4 gmh Ngla{ _- Cj{xa L-H-

    C-G-K-K- Xagraqx`k ljhgi`x`a{ mkiqha gmx g,

    fpxfl`k hqe xfagrp4 {qe`kgi `lrigmxgx`jm

    j rgkalgda{ kgh`jsaxa,hao`iigxj{ gmh

    a{pmkfjm`~gx`jm has`ka{4 gmh gh`jawqamkp

    6 Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

    Lgxxfau G- Fjjd L-H- Kf`{x`gm M- E`me L-H- C-G-K-K-_joax Iaa Njoa L-H- C-G-K-K- C-[-K-G-@

    _gmhjirf Kjjra L-H- C-G-K-K-

    RFJXJ[OP

    O_@GM[X_@KDIGMH

  • 8/9/2019 The Triangle Physician March 2010

    11/32

    Lgxaam Gdfxg L-H-4 Oamngl`m E- Gxda{jm

    L-H- C-G-K-K-4 Gxfq P- Kfju L-H- C-G-K-K-4

    Nj{arf L- Cgi{jma L-H- C-G-K-K-4 Gmhau K-

    Djmamoae L-H- C-G-K-K-4 _joax O- Ua{iap @@

    L-H- C-G-K-K-4 gmh L`kfgai Ngp ^aii mea L-H-

    C-G-K-K- ga gii `m{xqlamxgi `m rjs`h`me

    kga xj xfa kjllqm`xp `m ijkgx`jm{ i`da Kgp

    Kigpxjm Dm`efxhgia Iau`{oqe Mjxf Ugda

    gmh [l`xfaih- Ua ugmx xj o`me kgh`jijepkga xj xfa kjllqm`xp {j xfa kjllqm`xp

    hja{mx fgsa xj xgsai ijme h`{xgmka{ xj q{ {gp{

    H- aii`mea g jqmh`me Ugda Fagx rgxma-

    H- Ngm`{ rj`mx{ xj xfa kg{a j g 55,pag,jih

    Ki`mxjm ujlgm ufj {qaah jl

    h`~~`ma{{- [fa ug{ aaah xj H- Fjjd `m xfa

    Ugda Fagx [l`xfaih jka {gs`me fa g

    ;2,xj,82,l`mqxa h`sa xj _gia`ef-

    Gxa xa{x`me `m xfa jka {fjuah {fa fghoijkdgea{ `m ojxf makd gxa`a{ gmh g ijqh

    fagx lqlq hqa xj g fagx sgisa rjoial

    {fa ug{ {ax qr j g {rak`gi`~ah xgm{a{jrf,

    geagi akfj xa{x gmh fagx kgxfaxa`~gx`jm `m

    [l`xfaih- Xa rjkahqa{ {fjuah ojxf

    kjjmgp gxap h`{ag{a gmh g {asaa fagx

    sgisa rjoial- [qeap ug{ {kfahqiah gx

    UgdaLah ufaa H- Fjjd {x rigkah g

    {xamx `m jma j xfa rgx`amx{ makd gxa`a{

    gmh xfam aaah xfa rgx`amx j fagx sgisa

    {qeap- Op rjs`h`me {as`ka{ `m lqix`ria

    ijkgx`jm{ gx h`aamx fj{r`xgi{ ua uaa

    goia xj e`sa {qra`j {as`ka j xfa rgx`amx

    u`xf g l`m`lql j h`kqixp j fa gmh

    fa gl`ip {gp{ H- Ngm`{-

    H- ^aii`mea {gp{ lgmp j Ugda Fagx{

    aigx`jm{f`r{ u`xf aagi rfp{`k`gm{ oaegm

    u`xf xfa rgkx`ka jqmha{ {jla ?1 pag{

    gej- Ugda Fagx sgiqa{ gmh mqxqa{ `x{

    ujd`me aigx`jm{f`r{ `m xfa sg`jq{ kjl,

    lqm`x`a{- Xgx{ ufgx{ fairah oq`ih xfa

    rgkx`ka fa {gp{- @x gi{j g{{qa{ kjmx`mq`xp

    j kga- G{ {jjm g{ rgx`amx{ fgsa oaam

    xagxah j xfa` kgh`jsg{kqig rjoial{ opUgda Fagx xfap ga axqmah xj xfa kga

    j xfa` aa`me rfp{`k`gm u`xf jmej`me

    kjllqm`kgx`jm oaxuaam gii hjkxj{

    `msjisah `m xfa` kga-

    Mj- 7) Ugda Fagx fg{ giugp{

    oaam gsg`igoia) ai`goia gmh

    rjs`hah eagx avrax`{a4

    a{rjm{a j jiiju qr fg{

    oaam avkaiiamx- @x{ nq{x g eagx

    ejqr xj ujd u`xf{gp{ H- [glqaiO- LkIglo N- ufj rgkx`ka{ mxamgi lah`k`ma

    u`xf H- U`ii`gl N- [xgkdfjq{a gx Ejih{ojj

    Lah`kgi [rak`gi`{x{- Xapa aagi aigx`jm,

    {f`r xgka{ ogkd xj Ugda Fagx{ agip pag{-

    X@LA GMH AVRA_@AMKA

    JC XFA A[[AMKA

    Op s`xqa j `x{ avrax`{a {`~a gmh rjv`l`xp

    Ugda Fagx rfp{`k`gm{ fgsa oaam gx xfa

    jajmx j ghsgmka{ m kgh`gk gmh sg{kqig

    kga gx UgdaLah Fagx Kamxa `m _gia`ef

    gmh fgsa oaam `mxaegi xj `x{ {qkka{{- U`xf

    lja xfgm ?5022 xjxgi rjkahqa{ rajlah

    agkf pag `x `{ xfa oq{`a{x fagx kamxa `m

    LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm 0

    Mjxf Kgji`mg lgd`me Ugda Fagx #

    Sg{kqig xfa oq{`a{x kgh`jijep rgkx`ka-

    H- [kfma`ha rj`mx{ xj Ugda Fagx{ rgx`k`rg,

    x`jm `m UgdaLah{ [AL@ &[,[aelamx

    A,Aiasgx`jm L,Lpjkgh`gi @,@mgkx`jm)

    rjegl ha{`emah xj gkf`asa xfa mgx`jmgi

    hjj,xj,ogiijjm x`la {xgmhgh j jram`me

    gm `mgkx,aigxah gxap `m qmha 02 l`mqxa{-Xa Kjha [AL@ rjegl ojg{x{ gm gsagea

    hjj,xj,ogiijjm x`la j 11 l`mqxa{- Xa

    [AL@ xagl `{ gkx`sgxah g{ {jjm g{ xfa

    alaeamkp lah`kgi xakfm`k`gm agkfa{ xfa

    rgx`amx `m xfa aih gmh xgda{ gm ADE uf`kf

    `{ {amx xj xfa UgdaLah Alaeamkp

    Hargxlamx xj oa gmgip~ah- @ gm gkqxa

    lpjkgh`gi `mgkx`jm `{ {q{rakxah g {rak`gi

    kgh`gk xagl rarga{ j xfa rgx`amx{

    g`sgi gmh giax{ xfa jm,kgii `mxasamx`jmgi

    kgh`jije`{x-

    X`{ rg{x pag Ugda Fagx rfp{`k`gm{

    gkf`asah g 722 rakamx {qkka{{ `m agkf`me

    xfa 02,l`mqxa ejgi lagm`me xfgx g rgx`amx

    avra`amk`me g fagx gxxgkd kgm kjqmx jm

    aka`s`me xfa oa{x kga rj{{`oia {gp{ H-

    [kfma`ha- Ufgx ua hj `{ i`a kfgme`me mjx

    jmip i`a {gs`me-

    H- [kfma`ha rj`mx{ xj g kjlri`kgxah kg{a

    akamxip `msjis`me g 17,pag,jih lgm ufj

    g`sah gx xfa fj{r`xgi fgs`me g fagx gxxgkd-

    U`xf xfa Kjha [AL@ xagl aghp xfa lgm

    ug{ xgdam h`akxip jl xfa gloqigmka xj

    xfa kgxfaxa`~gx`jm igo- Xa rgx`amx{ fagx

    H- E`me agh`me g KX gme`jegl j xfa fagx-

    RFJXJOP

    O_@GM[X_@KDIGMH

  • 8/9/2019 The Triangle Physician March 2010

    12/32

    aragxahip {xjrrah gmh fgh xj oa hao`iigxah

    73 x`la{- Xa oijkdah gxap ug{ jramah u`xf`m

    ;2 l`mqxa{ j g`sgi gmh gxaugh xfa rgx`amx

    ug{ xgm{aah xj xfa kjjmgp kga qm`x-

    Ufam hai`sa`me xfa ejjh mau{ xj xfa gl`ip

    H- [kfma`ha akgii{ mjx`me xfgx jmip xfa

    rgx`amx{ pjqme hgqefxa gmh fa egmhljxfauaa `m xfa ug`x`me jjl- Fa kgla xj iagm

    xfa e`i{ ljxfa fgh h`ah j kgmka ig{x

    pag gmh op {gs`me xfa rgx`amx fa gi{j fgh

    rasamxah xfa kf`ih jl oakjl`me gm jrfgm-

    Xa lj{x augh`me rgx j jq ujd rjogoip

    j gii j q{ `{ xfa `lrgkx ua lgda j rgx`amx{

    gmh xfa` gl`i`a{ {gp{ H- [kfma`ha-

    RA_@RFA_GI SG[KQIG_ GMH

    KA_AO_JSG[KQIG_ R@JMAA_[

    Ua ga avrgmh`me xfa jmx`a{ gx ojxf amh{

    j xfa ojhp `m xfa og`m gmh `m xfa aax

    {gp{ H- [gkfg-

    Ghsgmka{ `m a{xj`me oijjh ju xj xfa iae{

    gmh aax ga {gs`me iae{ xfgx ujqih fgsa oaam

    glrqxgxah sa j 72 pag{ gej fa {gp{- Xa

    xakfmjijep q{a{ g kjlo`mgx`jm j ogiijjm{

    {xamx{ ig{a{ gmh gxfaakxjlp has`ka{ xj ej

    `mxj xfa {lgii gxa`a{ oaiju xfa dmaa gmh

    `mxj xfa aax- Rjkahqa{ xfgx a{qix `m i`lo

    {gisgea a{qix `m g hglgx`k `lrjsalamx `m

    wqgi`xp j i`a-

    H{- [gkfg gmh Fjjd gi{j fairah iagh xfa

    hasaijrlamx j Ugda Kjqmxp{ {x gkqxa

    `mxasamx`jmgi {xjda rjegl gx UgdaLah

    Fagx Kamxa uf`kf `{ xfa jmip Nj`mx

    Kjll`{{`jm,kax`ah r`lgp {xjda kamxa

    `m Ugda Kjqmxp- Qmx`i akamxip {xjda kjqihjmip oa xagxah op e`s`me kijx,h`{{jis`me

    geamx{ `mxgsamjq{ip kgiiah xfjlojip{`{-

    U`xf CHG grrjsgi Ugda Fagx rfp{`k`gm{

    ga mju goia xj aljsa kijx{ h`akxip jl

    xfa og`m jxam u`xf hglgx`k ki`m`kgi

    a{qix{- @x{ sap kqxx`me ahea- Mj jma ai{a

    `m Ugda Kjqmxp `{ hj`me xf`{ gmh xfaa ga

    jmip g fgmhqi j kamxa{ j xf`{ d`mh `m xfa

    kjqmxp {gp{ H- [gkfg-

    Fa akgii{ xfa kg{a ig{x Lgkf j g ;5,pag,jih ujlgm ufj fgh hai`saah xu`m{ op

    K,{akx`jm xuj uaad{ r`j- [fa g`sah gx

    UgdaLah kjlriaxaip rggip~ah jm fa iax

    {`ha gxa {qa`me g {xjda jm xfa `efx {`ha

    j fa og`m- Hq`me gm a`efx,fjq rjkahqa

    H- [gkfg aljsah gii xfa oijjh kijx{ gmh

    xfa ujlgm lgha g kjlriaxa akjsap-

    jhgp fa kgii{ xfa kg{a g kgaa {xgmhjqx-

    Fgh `mxgsamjq{ xfjlojipx`k geamx{ oaam

    ghl`m`{xaah xfa jqxkjla lgp mjx fgsa

    oaam {j {qkka{{qi-

    Asapxf`me ua hj `m jq rgkx`ka `{ hjma `m

    gm as`hamka,og{ah ugp j g{ rgx j ki`m`kgi

    x`gi{ {gp{ H- [gkfg- Xa rfp{`k`gm{ ufj

    ga hj`me xfa{a rjkahqa{ ga sap uaii,

    xg`mah- Xap ga iagha{ `m xfa` aih

    mgx`jmgiip gmh `mxamgx`jmgiip gmh xfap o`me

    xfgx avrax`{a xj xfa gag- Xap ga `msjisah

    72 Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

    `m gmh iagh mqlajq{ kqxx`me,ahea ki`m`kgi

    x`gi{ j mau has`ka{ hqe{ gmh rjxjkji{-

    KJLLQM@XP KJLL@XLAMX

    Ugda Fagx # Sg{kqig G{{jk`gxa{ kgh`ji,

    je`{x{ ga `msjisah `m xfa kjllqm`xp {as,

    `me jm ojgh{ gmh kjll`xxaa{ {ragd`me gx

    kjllqm`xp jql{ gmh rjljx`me ejjh

    kgh`jsg{kqig fagixf j gii-

    Jm [gxqhgp Cao- ?5 xfa rgkx`ka u`ii nj`m

    UgdaLah Fagx Kamxa `m fj{x`me xfa xf

    gmmqgi kgh`jsg{kqig ahqkgx`jm {plrj{`ql

    xj {fga `mjlgx`jm jm ghsgmka{ `m kgh`jijep

    gmh fagx*sg{kqig kga u`xf gm alrfg{`{ jm

    rasamx`jm- X`{ pag{ Fagixf Kga `m Asjiq,

    x`jm> Jrrjxqm`x`a{ gmh Kfgiiamea{ j xfa

    Kgh`jsg{kqig Rgx`amx u`ii {fah i`efx jm fagixf

    kga ajl- Xa {plrj{`ql u`ii oa jl 6>;2

    g-l- xj ;>81 r-l- gx UgdaLah Fagx KamxaKjmaamka Kamxa- @x `{ jram xj gii lah`kgi

    rja{{`jmgi{- Kgii &070) ;12,6185 j haxg`i{-

    Cj xfa` wqgi`xp j i`a kjmx`oqx`jm{ xfa

    kgh`jije`{x{ gx Ugda Fagx fgsa ujm

    mqlajq{ gkkjigha{ gmh gugh{- uj fgsa

    oaam mglah Fagixf Kga Faja{ op Xa

    `gmeia Oq{`ma{{ Njqmgi H- [gkfg `m ?220

    gmh H- Ngm`{ `m ?225- H{- Lgmm gmh Ngm`{

    uaa {aiakxah op Xa `gmeia Oq{`ma{{

    Njqmgi gmh Oa{x Hjkxj{ @mk- g{ xuj j xfaOa{x Hjkxj{ `m Gla`kg j ?220,?272-

    Ngm`{ aakx{ jm gii xfa augh{ j f`{ kgii`me>

    oa`me g rgx j xfa lah`kgi kjllqm`xp gmh

    xfa kjllqm`xp g{ g ufjia4 fair`me rgx`amx{

    ujd jm rasamx`me fagx h`{ag{a4 fair`me

    rajria jkq{ jm {xgp`me fagixfp4 daar`me g

    rj{`x`sa gxx`xqha asam `m xfa gka j {a`jq{

    `iima{{ j g h`{goi`me lah`kgi kjmh`x`jm4 gmh

    giiju`me rajria xj {xgp fagixfp gmh gkx`sa-

    _gs`{f [gkfg L-H- C-G-K-K-

    Kf`{xp Ljja R-G- lgd`me jqmh{ gx UgdaLah

    RFJX

    JOPN@L[

    FGU

    RFJXJOP

    O_@GM[X_@KDIGMH

  • 8/9/2019 The Triangle Physician March 2010

    13/32

    Jm Ogigmk`me xfaOamacx{ gmh _`{d{ jKX _gh`gx`jm Avrj{qa

    Jsa xfa rg{x ?1 pag{ kjlrqxah xjljegrfp &K) {kgm{

    fgsa oakjla jma j xfa lj{x rjuaqi xjji{ `m lah`k`ma- _akamx

    mau{ fjuasa fg{ f`efi`efxah rjxamx`gi fagixf `{d{ jl gh`gx`jm

    avrj{qa g{{jk`gxah u`xf K- Jma {xqhp rjnakxah g {`~agoia mqloa

    j mau kgmka{ xfgx kjqih g`{a jl gii K {xqh`a{ rajlah `m

    xfa Q-[- `m ?225-&7) Gmjxfa jqmh g u`ha sg`gx`jm `m gh`gx`jm hj{a{

    j kjlljm K avgl{-&?) Gi{j `m xfa

    faghi`ma{> gigl`me `m{xgmka{ j f`ef

    gh`gx`jm jsaavrj{qa jl K {kgm{-&;)

    Pa{ jq lah`kgi kjllqm`xp{fjqih oa kjmkamah- Uf`ia ua fgsa

    akjem`~ah xfa rjxamx`gi `{d{ j K

    avgl{ j pag{ xfa mau mqloa{

    aakx g algdgoia `mkag{ah q{a j

    xf`{ avxalaip sgiqgoia h`gemj{x`k xjji-

    Op {jla a{x`lgxa{ 5? l`ii`jm K {kgm{

    uaa rajlah `m ?225 `m xfa Q[-&7)

    Iax{ alaloa xuj dap rj`mx{-

    [xgx`{x`kgiip gm `mh`s`hqgi{ ra{qlah

    `mkag{ah `{d j kgmka jl jma K

    j asam g fgmhqi `{ sap iju- Gmhuf`ia jsaq{a gmh jsaavrj{qa ga

    giugp{ kjmkam{ xf`{ hgxg lq{x oa

    ua`efah geg`m{x ufgx lgp fgrram xj g

    rgx`amx fa j {fa hja{ mjx fgsa g K {kgm- @{ xfa rjrqigx`jm gx igea

    oaxxa j j uj{a j: Ua hjmx pax fgsa gm gm{ua-

    Jq kfgiiamea xfam `{ xj q{a K lj{x grrjr`gxaip uf`ia

    l`m`l`~`me xfa `{d `x `lrj{a{- Gx Ugda _gh`jijep ua grrjgkf xf {

    jm g sg`axp j jmx{-

    Ugda _gh`jijep alrijp{ {x`meamx hj{a ahqkx`jm eq`hai`ma{ j

    ghqix gmh rah`gx`k K avgl{4 jq rjxjkji{ fgsa oaam uaii oaiju

    akjllamhah iasai{ j {jla x`la- @x `{ k`x`kgi xfgx kf`iham mjx

    aka`sa ghqix hj{a{ gmh Ugda _gh`jijep rgx`k`rgxa{ `m xfa @lgea

    Eamxip `m`x`gx`sa {rjm{jah op xfa Gii`gmka j _gh`gx`jm [gaxp `m

    Rah`gx`k @lge`me-

    Ua gi{j ga rjgkx`sa `m {qeea{x`me gixamgx`sa ljhgi`x`a{ xj

    gsj`h gh`gx`jm gixjeaxfa- Xa mqloa j `mh`kgx`jm{ j uf`kf

    L_@ gmh qixg{jqmh lgp oa q{ah kjmx`mqa{ xj eju `mkiqh`me lj{x

    h`{ag{a{ j xfa gohjl`mgi jegm {p{xal{-

    Xq{ ua rqx eagx {xjkd `m fair`me ki`m`k`gm{ {aiakx xfa lj{x

    grrjr`gxa lge`me xj l`m`l`~a avrj{qa gmh agkf Ugda _gh`jijep

    {qo{rak`gixp {akx`jm lg`mxg`m{ g kjm{qixgx`jm fjxi`ma j xf`{

    rqrj{a- Jq gmmqgi _gh`jijep jhgp {al`mg jram xj gii rfp{`k`gm{

    op Xfjlg{ I- Ra{{jm N- LHH`akxj _gh`gx`jm [gcaxp Rjegl{ Ugda _gh`jijep

    _aaamka{>

    7) Oa`mexjm ha Ejm~ia~ G Lgfa{f L D`l D,R ax gi- Rjnakxah kgmka `{d{ jl kjlrqxah

    xjljegrf`k {kgm{ rajlah m xfa Qm`xah [xgxa{ m ?225- Gkf @mxam Lah- ?2204 730&??)> ?257,?255-

    ?) [l`xf,O`mhlgm _ I`r{jm N Lgkq{ _ ax gi- _gh`gx`jm hj{a g{{jk`gxah u`xf kjlljm kjlrqxah

    xjljegrfp avgl`mgx`jm{ gmh xfa g{{jk`gxah i`ax`la gxx`oqxgoia `{d j kgmka- Gkf @mxam Lah-

    ?2204 730&??)> ?256,?263-

    ;) Mau Cjkq{ jm Hgmea{ j KX [kgm{- Njmgxfgm IgRjjd- KO[ Asam`me Mau{- 78 Hak ?220- Gkka{{ah75 Ngm ?272 gx fxxr>**uuu-ko{mau{-kjl*{xj`a{*?220*7?*78*asam`memau{*lg`m1050;;?-{fxli-

    `mxjhqka {xgxa,j,xfa,gx `lge`me gmh rjs`ha eq`hgmka jm grrjr`gxa

    jha`me- Jq uao {`xa kg`a{ g i`md xj xfa Gla`kgm Kjiiaea j

    _gh`jijep{ lj{x kqamx GK_ Grrjr`gxama{{ K`xa`g-

    Avra`amka gmh avrax`{a ga s`xgi xj l`m`l`~`me avrj{qa- Gii

    Ugda _gh`jijep jqxrgx`amx ijkgx`jm{ fgsa g gh`jije`{x jm {`xa gmh 722

    rakamx j xakfmjije`{x{ ga K kax`ah op xfa Gla`kgm _ae`{xp

    j _gh`jije`k akfmjije`{x{- X`{ kgi`oa

    j kga rjs`ha{ g lqix`xqha j oamax{-

    Jma avglria { xfa ujd,qr j g rgx`amx

    jqmh xj fgsa gm `mk`hamxgi lg{{ jm gkfa{x v,gp- U`xf g gh`jije`{x jm {`xa

    xfa K xakfmjije`{x kgm g{d f`l j fa

    xj hama xfa gag xj oa {kgmmah- @ xfa

    {q{rakx mjhqia `{ `m xfa qrra rgx j

    xfa iqme g {kgm j g xf`h j g fgi j

    xfa iqme jxam u`ii giiju g h`gemj{`{-

    @m ghh`x`jm xj xfa gojsa ua

    ahqka avrj{qa xj oag{x gmh xfpj`h

    x`{{qa op q{`me o`{lqxf {f`aih`me- Jq

    K {kgmma{ qx`i`~a hj{a ljhqigx`jm g

    agxqa xfgx hpmgl`kgiip lag{qa{ ojhpham{`xp hq`me xfa {kgm gmh hakag{a{

    xfa hj{a haramh`me jm xfa ham{`xp j

    ojma `x lq{x ramaxgxa- Ua gi{j akjh

    xfa hj{a j agkf {kgm `m xfa rgx`amx{ ralgmamx kfgx-

    Oaf`mh xfa {kama{ rgx j lp l`{{`jm `{ xj jegm`~a gmh lg`mxg`m

    {gaxp rjxjkji{ gmh jsa{aa xfa `ejjq{ Gla`kgm Kjiiaea j

    _gh`jijep K {kgmma kax`kgx`jm rjegl- Gii {kgmma{ `m jq

    jqxrgx`amx jka{ ga kax`ah j fgsa kax`kgx`jm qmhaugp g{ `{ xfa

    kg{a j jq xuj maua{x {kgmma{- Ua sap kij{aip gmh kjmx`mqjq{ip

    ljm`xj {axx`me{ gmh jqxrqx-

    Jsagii ua oai`asa `x{ ag{jmgoia xj kjmkiqha xfgx xfa gh`gx`jm

    rgx`amx{ aka`sa jl K {kgm{ hja{ rj{a g {lgii oqx agi `{d jma

    xfgx u`ii {i`efxip `mkag{a u`xf agkf ghh`x`jmgi {kgm- U`xf kga xgdam

    gx asap iasai xf`{ `{d kgm oa l`m`l`~ah- Xgx oa`me {g`h K alg`m{

    jma j jq lj{x a{{amx`gi h`gemj{x`k xjji{ xj asgiqgxa gmh jiiju g

    eagx mqloa j lah`kgi kjmh`x`jm{-

    _gh`jijep

    LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm 77

  • 8/9/2019 The Triangle Physician March 2010

    14/327? Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

    Ujlam{ Fagixf

    Ojma fagixf `{ gm `lrjxgmx kjmkam j ujlam- Xarjoial j j{xajrjj{`{ gakx{ grrjv`lgxaip ;2! j

    rj{xlamjrgq{gi ujlam gmh 82! j xfj{a ujlam u`ii

    {q{xg`m jma j lja gkxqa{ `m xfa` i`ax`la-&7 ?)

    Xa ujihu`ha rasgiamka j j{xajrjj{`{ lgda{ `x g

    {a`jq{ rqoi`k fagixf kjmkam u`xf a{x`lgxa{ j jsa

    ?22 l`ii`jm rajria ujihu`ha kqamxip {qa`me jl

    xf`{ h`{ag{a-&;) @m xfa Q[ gijma j{xajrjj{`{ j

    j{xajram`g u`ii gakx jsa 82 l`ii`jm Gla`kgm{ gmh

    a{qix `m lja xfgm 7-1 l`ii`jm ge`i`xp gkxqa{ ra pag-

    Lj{x ujlam dmju xfgx j{xajrjj{`{ `{ g rjoial `msjis`me ojma pax lgmp hj mjx akjem`~a

    xfa lgmp `{d{ gkxj{ j j{xajrjj{`{- Xa{a kgm oa h`s`hah `mxj ? h`aamx kgxaej`a{> jma

    xfgx `{ `mharamhamx j ojma l`magi ham{`xp gmh jma xfgx `{ haramhamx jm ojma l`magi

    ham{`xp- Xa {rak`k `{d{ gkxj{ xfgx ga `mharamhamxj ojma l`magi ham{`xp `mkiqha> gea

    ras`jq{ ge`i`xp gkxqa lgxamgi f`{xjp j f`r gkxqa eiqkjkjx`kj`h xfagrp kqamx

    {ljd`me gikjfji `mxgda faqlgxj`h gxf`x`{ iju ojhp lg{{ `mhav gmh gii{- Xa {rak`k `{d{

    gkxj{ xfgx ga haramhamxjm ojma l`magi ham{`xp `mkiqha> qmxagxah fprjejmgh`{l lgigo,

    {jrx`jm amhjk`ma h`{ag{a kfjm`k amgi

    g`iqa kfjm`k i`sa h`{ag{a KJRH lljo`i`xp

    gmh kaxg`m hqe{ &`mkiqh`me gjlgxg{a

    `mf`o`xj{ gmhjeam har`sgx`jm xfagrp)- J

    xfa{a `{d gkxj{ lj{x j q{ akjem`~a xfgx

    gea { jma j xfa iagh`me `{d gkxj{ fjuasa x

    `{ `lrjxgmx xj agi`~a xfgx asam pjqme ujlam

    kgm hasaijr j{xajram`g gmh j{xajrjj{`{-

    Jq {xg `{ jkq{ah jm ojma fagixf gmh fg{

    oaam jxqmgxa xj oae`m g CHG ki`m`kgi x`gi jm

    j{xajrjj{`{- Xa lj{x kjlljm lah`kgx`jm{

    j j{xajrjj{`{ ga xfa o`{rfj{rfjmgxa{ {qkf

    g{ giamhjmgxa j kijhjmgxa j `ogmhjmgxa-

    X`{ kig{{ j hqe rasamx{ ojma a{jr,

    x`jm4 ufaag{ as`hamka fg{ alaeah xfgx g

    mau xpra j hqe uf`kf `{ gmgoji`k j fair{

    ojma eju lgp fair xagx j{xajrjj{`{-

    Jq @_O grrjsah kjm{amx jl j jq

    ki`m`kgi {xqhp jm j{xajrjj{`{ { rj{xah jm jq

    uao{`xa gx uuu-kuuk-kjl gmh xfa @_O

    grrjsah gh j jq ki`m`kgi {xqhp jm j{xaj,

    rjj{`{ `{ {fjum jm xfa mavx rgea>

    G Ki`m`kgi [xqhp jm

    J{xajrjj{`{

  • 8/9/2019 The Triangle Physician March 2010

    15/32LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm 7;

    op Gmhag [- Iqda{LH LF[k CGKJE

    H- Iqda{ aka`sah fa

    ogkfaij{ haeaa `m ai`e`jm

    jl Hqda Qm`sa{`xp &7066)

    jiijuah op g kjlo`mah

    lah`kgi haeaa gmh lg{xa{

    haeaa { {xgx`{x`k{ jl Hqda

    &7008)- [fa kjlriaxah fa

    Jo*Epm a{`hamkp gx xfa QMK &7006)- Hq`me fa 72 pag{ jm

    gkqixp gx Hqda Qm`sa{`xp {fa kj,jqmhah gmh {asah g{ xfa

    H`akxj j Epmakjijep j xfa Ujlam{ Falj{xg{`{ gmh Xfjloj{`{

    yKi`m`k gx Hqda- H- Iqda{ iax fa gkghal`k rj{`x`jm gx Hqda `m

    ?225 xj oae`m Kgji`mg Ujlam{ _a{agkf gmh Uaiima{{ Kamxa&KU_UK) gmh xj oakjla Cjqmha gmh Kfg` j xfa Jo*Epm

    Gii`gmka- Rfjma> &070) ?17,0??;- uuu-kuuk-kjl

    Ufgx { g Ki`m`kgi _a{agkf [xqhp:

    Ki`m`kgi a{agkf {xqh`a{ xp xj gm{ua {rak`k

    wqa{x`jm gojqx `msa{x`egx`jmgi {xqhp hqe{-

    G mau `msa{x`egx`jmgi hqe lq{x ej xfjqef

    {asagi rfg{a{ j ki`m`kgi a{agkf xfa {xqhp

    hqe kjqih igxa oa gsg`igoia xj xfa rqoi`k-

    G ki`m`kgi a{agkf {xqhp rgx`k`rgmx ujd{u`xf g a{agkf xagl xfgx `mkiqha{ hjkxj{

    mq{a{ gmh {jlax`la{ {jk`gi ujda{ gmh

    jxfa fagixf kga rja{{`jmgi{- Xa rgx`k`rgmx{

    gmh {xqhp xagl{ kjll`xlamx { `lrjxgmx xj

    fair laax xfa jonakx`sa{ j xfa a{agkf {xqhp-

    Rgx`k`rgx`me `m ki`m`kgi a{agkf `{ gm

    `lrjxgmx hak`{`jm gmh {fjqih oa xfjqefx

    xfjqef kgaqiip- Pjq {fjqih masa aai pjq

    fgsa xj xgda rgx `m g ki`m`kgi a{agkf {xqhp-

    @ pjq hj rgx`k`rgxa pjq u`ii oa aa xj

    u`xfhgu jl xfa {xqhp gx gmp x`la j gmp

    ag{jm- Pjq u`ii daar xfa `efx xfa {gla

    jqx`ma lah`kgi kga pjq aka`sah oaja

    {xqhp rgx`k`rgx`jm- Pjq {xqhp hjkxj u`iih`{kq{{ gmp jxfa xagxlamx xfgx lgp oa

    fairqi xj pjq-

    Fju Hj @ Wqgi`p:

    Pjq lgp wqgi`p j xf`{ {xqhp ` pjq>

    Ga algia gmh 81 xj 61 pag{ j gea

    Fgsa mjx fgh g ra`jh `m gx iag{x 1 pag{

    Fgsa xgdam jgi lah`kgx`jm xj xagx pjq

    j{xajrjj{`{ j ; pag{ j lja

    Fgsa xgdam giamhjmgxa xfagrp j xfa

    rg{x 7 pag j lja

    @ pjq wqgi`p pjq u`ii aka`sa {xqhp,aigxah

    kga {xqhp lah`kgx`jm gmh ojma l`magi

    ham{`xp xa{x`me &xj g{{a{{ ojma fagixf) gx mj

    kfgea-

    Ufgx xj Avrakx

    [xqhp rgx`k`rgmx{ u`ii oa g{dah xj s`{`x g

    a{agkf {`xa 0 x`la{ jsa g ?,pag ra`jh-

    Rgx`k`rgmx{ u`ii fgsa ojma l`magi ham{`xp

    xa{x`me oijjh hgum gx agkf s`{`x gmh u`ii

    oa g{dah xj xgda xfa {xqhp hqe jmka g hgp-

    @m kjmkiq{`jm gixfjqef ua ja {qkf ki`m`kgi

    x`gi{jq jkq{ `{ jm ujlam{ fagixf- Uaja gii jrx`jm{ mkiqh`me hamx`p`me xfa lj{x

    kjmsam`amx ijkgx`jm j ojma ham{`xp

    asgiqgx`jm{ j xfa ujlam ua {aa- J{xajrjj{`{

    `{ g fagixf `{{qa xfgx {fjqih xj oa ghha{{ah

    op fagixfkga rjs`ha{- Oaxxa lgmgealamx

    j xfa h`{ag{a u`ii a{qix `m `lrjsah jqxkjla{

    j jq rgx`amx{ xfjqef ahqkx`jm{ `m ojxf

    ljo`h`xp gmh ljxgi`xp- Jq {xg `{ hasjxah

    xj kjlo`m`me jq ki`m`kgi avrax`{a gmh jq

    `mxaa{x `m f`ef wqgi`xp a{agkf xj rjs`ha g

    gmea j jrx`jm{ j jq rgx`amx{-

    _aaamka{>

    &7) 7- Laixjm @@@ I Kf`{kf`iia{ AG Kjjra K Igma GU _`e{ OI>

    Ra{rakx`sa> Fju lgmp ujlam fgsa j{xajrjj{`{: N Ojma L`ma _a{

    700?45> 7221,72

    &?) _gmhaii G [glojjd RM Mqpam XS Igr{ap F Njma{ E Daiip RN

    A`{lgm NG- H`akx ki`m`kgi uaiga kj{x{ j j{xajrjjx`k gkxqa{ `m

    aihaip lam gmh ujlam- J{xajrjj{`{ @mx 700141>8?5,;?

    &;) Kjjra K- Kglr`jm E Laixjm IN ;h- F`r gkxqa{ `m xfa aihaip>

    g ujih,u`ha rjnakx`jm- J{xajrjj{`{ @mx- 700? Mjs4?&3)> ?61,0-

  • 8/9/2019 The Triangle Physician March 2010

    16/32

    Fagx H`{ag{a>Fagx H`{ag{a

    AwqgiJrrjxqm`xpD`iia

    Lj{x j q{ ga gl`i`g u`xf xfa kig{{`k fagx

    gxxgkd {plrxjl{ xfa ljs`a fagx gxxgkd

    ufaa g l`hhia,geah lgm {qhhamip kiqxkfa{

    f`{ kfa{x kjlrig`m`me j

    kq{f`me kfa{x rg`m gmh

    rg`m gh`gx`me hjum xfa

    iax gl-

    Ufgx lgmp ga mjx guga

    j `{ xfgx fagx h`{ag{a `{ xfa Mj- 7 d`iia j

    ujlam gmh xfap jxam avra`amka g sap

    h`aamx gmh lja {qoxia {ax j {plrxjl{-

    @m gkx lgmp fagx gxxgkd{ `m ujlam {xgx{ijuip u`xf l`ih rg`m j h`{kjljx- Ujl,

    am lgp gi{j ra{amx u`xf {plrxjl{ {qkf

    g{ mgq{ag gx`eqa ngu j makd rg`m xfgx

    ga jxam jsaijjdah op rgx`amx{ gmh l`{,

    h`gemj{ah op rfp{`k`gm{ g{ oa`me aigxah xj

    {xa{{ j jxfa `iima{{a{-

    Rfp{`k`gm{ mq{a{ gmh jxfa fagixfkga rj,

    s`ha{ ufj kga j ujlam maah xj oa guga

    j {jla gxgi gkx{- Kgh`jsg{kqig h`{ag{a{

    &KSH) a{rak`giip kjjmgp fagx h`{ag{agmh {xjda ga xfa iagh`me kgq{a{ j hagxf

    `m ujlam `m xfa Qm`xah [xgxa{- Xap kig`l

    lja algia i`sa{ xfgm xfa mavx sa kgq{a{

    j hagxf kjlo`mah-

    Kjm{`ha xfa gkx{>

    Magip ;5 rakamx j gii algia hagxf{ `m

    xfa Qm`xah [xgxa{ jkkq jl KSH-

    Xa hagxf gxa hqa xj KSH `{ f`efa `m

    oigkd ujlam xfgm `m uf`xa ujlam-

    Jma `m ?-5 algia{ ufj h`a h`a j fagx h`{ag{a {xjda gmh jxfa

    kgh`jsg{kqig h`{ag{a kjlrgah u`xf jma `m ;2 ufj h`a j oag{x

    kgmka-

    Ujlam ufj fgsa fagx gxxgkd{ ga lja i`daip xfgm lam xj h`a

    jl xfal u`xf`m g au uaad{-

    L`{rakarx`jm{ {x`ii av`{x xfgx KSH `{ mjx g agi rjoial j ujlam-

    @m ?221 lja xfgm ;3 l`ii`jm Gla`kgm ujlam uaa gea 11 j jiha-

    Xa `{d j kgh`jsg{kqig h`{ag{a `mkag{a{ u`xf gea gmh xfgx{ jma

    ag{jm `x{ `lrjxgmx xj g`{a gugama{{ j xf`{ lgnj rqoi`k fagixf

    `{{qa rgx`kqigip j jiha ujlam-

    Rfp{`k`gm{ kgm xgda gm g{{ax`sa jia `m `{d gkxj `mxasamx`jm

    gmh `m gkdmjuiahe`me eamha h`aamka{

    `m xfa xagxlamx j KSH `m ujlam-

    _a{agkf {fju{ xfgx rasamx`jm j `{d

    gkxj{ j kgh`jsg{,

    kqig h`{ag{a `{ xfa oa{x

    rgkx`kgi {jiqx`jm- fa

    kfgiiamea `{ xj kjllq,

    m`kgxa xj pjq rgx`amx{

    xfa `lrjxgmka j xgd`me rasamx`sa {xar{

    jm gm asaphgp og{`{-

    Lqkf gxxamx`jm fg{ oaam h`akxah xjugh g

    oaxxa grrak`gx`jm j xfa `mqamka j eamhajm kgh`jsg{kqig `{d gmh lgmgealamx

    oqx `lrjxgmx egr{ `m dmjuiahea alg`m-

    _akamx hasaijrlamx{ `m kgh`jsg{kqig

    a{agkf qmhjqoxahip u`ii fgsa g {`em`kgmx

    `lrgkx jm rasamx`jm ki`m`kgi kga gmh jqx,

    kjla{ j ujlam gmh u`ii rjs`ha h`akx`jm

    j qxqa ujd- Ar`hal`jije`kgi {xqh`a{ gmh

    gmhjl`~ah ki`m`kgi x`gi{ rjs`ha kjlraii`me

    as`hamka xfgx kjjmgp fagx h`{ag{a { igeaip

    rasamxgoia- Xaaja rasamx`jm j `{d

    gkxj{ j kgh`jsg{kqig h`{ag{a `{ gm`lrjxgmx rgkx`kgi {jiqx`jm j ujlam-

    @{ x eamha h`aamka

    j eamha o`g{:

    Rjogoip {jla j ojxf- [asagi gkxj{ lgp

    avrig`m xfa grrgamx h`{rg`xp `m xagxlamx

    j lam gmh ujlam>

    @m xfa rg{x lgmp j xfa lgnj kgh`jsg{,

    kqig a{agkf {xqh`a{ uaa kjmhqkxah jm

    lam- _a{qix{ j kqamx ki`m`kgi {xqh`a{ lgp

    fair kig`p xfa eamha h`aamka{ xfgx gakx rgxfjrfp{`jijep

    h`gemj{`{ gmh xagxlamx j ujlam u`xf fagx h`{ag{a-

    Ki`m`k`gm{ gmh rgx`amx{ jxam gxx`oqxa kfa{x rg`m{ `m ujlam xj

    mjmkgh`gk kgq{a{ iagh`me xj l`{`mxaraxgx`jm j xfa` kjmh`x`jm-

    Ujlam lgp fgsa g eagxa xamhamkp xfgm lam xj fgsa gxpr`kgi

    kfa{x rg`m j xj kjlrig`m j gohjl`mgi rg`m h`kqixp oagxf`me

    &hp{rmag) mgq{ag gmh qmavrig`mah gx`eqa-

    Ujlam lgp gsj`h j haigp {aad`me lah`kgi kga rafgr{ rgxip

    hqa xj ham`gi j xfa` igkd j gugama{{ j ojxf xpr`kgi gmh gxpr`kgi

    fagx gxxgkd {plrxjl{-

    [`mka ujlam xamh xj fgsa fagx gxxgkd{ igxa `m i`a xfgm lam hj

    xfap jxam fgsa jxfa h`{ag{a{ &{qkf g{ gxf`x`{ j j{xajrjj{`{)

    78 Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

  • 8/9/2019 The Triangle Physician March 2010

    17/32

    xfgx kgm lg{d fagx gxxgkd {plrxjl{- Gea gmh xfa lja ghsgmkah

    {xgea j kjjmgp fagx h`{ag{a `m ujlam kgm gakx xfa xagxlamx

    jrx`jm{ gsg`igoia xj rfp{`k`gm{ g{ uaii g{ xfa eagxa ljxgi`xp j

    ujlam gxa fagx gxxgkd{-

    [jla h`gemj{x`k xa{x{ gmh rjkahqa{ lgp mjx oa g{ gkkqgxa

    `m ujlam {j rfp{`k`gm{ lgp gsj`h q{`me xfal- Xgx lagm{ xfa

    h`{ag{a rjka{{ a{qix`me `m g fagx gxxgkd j {xjda lgp mjx oa

    haxakxah `m ujlam qmx`i igxa u`xf lja {a`jq{ kjm{awqamka{-

    Xa avak`{a {xa{{ xa{x j {xa{{ AKE lgp oa ia{{ gkkqgxa `m

    ujlam- Cj avglria `m pjqme ujlam u`xf g iju i`dai`fjjh j

    kjjmgp fagx h`{ag{a gm avak`{a {xa{{ xa{x lgp e`sa g gi{a

    rj{`x`sa a{qix- @m kjmxg{x {`meia,sa{{ai fagx h`{ag{a uf`kf

    `{ lja kjlljm `m ujlam xfgm `m

    lam lgp mjx oa r`kdah qr jm g jqx`ma

    xaghl`ii xa{x-

    Mjm`msg{`sa gmh ia{{ `msg{`sa h`gemj{x`k

    xa{x{ xfgx ga lja rak`{a xamh xj oa

    lja avram{`sa- Xa{a `mkiqha xfgii`ql

    {a{xgl`o` j akfjkgh`jegrf`k {xa{{xa{x{- fa rah`kx`sa sgiqa gmh kj{x,

    aakx`sama{{ j maua xakfmjije`a{ {qkf

    g{ aiakxjm,oagl kjlrqxah xjljegrfp

    &AOK) ga mjx uaii hamah-

    Oakgq{a xfa mqloa j ujlam ufj ga

    jiha gmh gx `{d `m xfa rjrqigx`jm `{ eju`me

    h`gemj{`me gmh xagx`me fagx h`{ag{a {xjda

    gmh jxfa kgh`jsg{kqig h`{ag{a{ `{ s`xgi-

    Ki`m`k`gm{ lq{x gkx xj rasamx xfa{a h`{ag{a{

    oaja ugm`me {`em{ grrag j g fagx gxxgkd

    jkkq{- Rasamx`jm gmh kjmxji j `{d gkxj{

    lq{x {xgx ufam g ujlgm `{ pjqme gmh

    kjmx`mqa xfjqefjqx fa i`a-

    Hj ki`m`k`gm{ rjs`ha

    awqgi jrrjxqm`xp lah`kgi kga

    xj rgx`amx{:

    Xjqef xfa {`xqgx`jm `{ `lrjs`me a{agkf

    {qeea{x{ xfgx aua ujlam xfgm lam u`xf

    {q{rakxah gkqxa fagx gxxgkd {plrxjl{

    ga aaah j mjm`msg{`sa xa{x{ gmhaua ujlam xfgm lam ufj xa{x rj{`x`sa j fagx h`{ag{a ga

    akjllamhah j qxfa xa{x`me gmh xagxlamx- Oakgq{a j xfa

    f`ef gxgi`xp gxa g{{jk`gxah u`xf {x fagx gxxgkd{ `m ujlam `x `{

    `lrjxgmx xj asgiqgxa ujlam u`xf {q{rakxah fagx gxxgkd{ rjlrxip

    kgaqiip gmh kjlriaxaip-

    @x { asam lja lrjxgmx xj alrfg{`~a rasamx`jm xfjqef ahqkx`jm

    j `{d{- H`{kq{{`me g rgx`amx{ `{d gkxj{ gmh hasaijr`me g rigm

    xjeaxfa xj ghha{{ xfal `{ gm `lrjxgmx {xar `m fair`me rgx`amx{

    xgda kjmxji j xfa` fagx fagixf- _`{d gkxj{ {qkf g{ joa{`xp j

    jsaua`efx f`ef kfjia{xaji f`ef oijjh ra{{qa h`goaxa{ rjj

    mqx`x`jm gikjfji kjm{qlrx`jm rfp{`kgi `mgkx`s`xp gmh {ljd`me kgm

    oa kjmxjiiah-

    Gugama{{ j gkxj{ {qkf g{ `mkag{`me gea gka gmh faah`xp xfgx

    kgmmjx oa kjmxjiiah `{ k`x`kgi- Gojqx jq jqx j sa rajria ufj h`a

    j kjjmgp fagx h`{ag{a ga gea 31 j jiha- Gx jiha gea{ ujlam

    ufj fgsa fagx gxxgkd{ ga lja i`daip xfgm lam ga xj h`a jl xfal

    u`xf`m g au uaad{-

    Faah`xp gmh gka ga rafgr{ {jla j xfa {xjmea{x mh`kgxj{ j `{d-

    Kf`iham j rgamx{ u`xf fagx h`{ag{a ga lja i`daip xj hasaijr `x

    xfal{aisa{- Ujlam jxam g{{qla xfgx asam xfjqef xfa lam `m xfa`

    gl`ip fgsa {qaah fagx h`{ag{a xfap ga

    mjx gx `{d- G`kgm Gla`kgm{ fgsa g f`efa

    rakamxgea j fpraxam{`jm xfgm uf`xa{ gmh

    xfa` `{d j fagx h`{ag{a `{ eagxa-

    Fju hj @ amfgmka

    rgx`amx kjlri`gmka:

    [xqh`a{ fgsa {fjum xfgx jmip gojqx jma,

    xf`h j ai`e`oia rgx`amx{ kjmx`mqa `{d gkxj

    `mxasamx`jm{ jsa xfa ijme xal- Fjuasa

    hgxg gi{j {fju xfgx xf`{ rjrjx`jm kgm oa

    {`em`kgmxip `mkag{ah op g xagl grrjgkf-

    Ufam fagixfkga rja{{`jmgi{ `mkiqh`me

    rfp{`k`gm{ mq{a{ h`ax`x`gm{ jxfa ki`m`k`gm{

    gmh fagixf ahqkgxj{ lgmgea `{d ahqkx`jm

    xfagrp u`xf jiiju,qr laxfjh{ {qkf g{

    jka j ki`m`k s`{`x{ gmh xaiarfjma kjmxgkx

    rgx`amx kjlri`gmka `{ amfgmkah-

    Ujlam ga iagm`me lja gojqx fagx

    h`{ag{a mju xfgm asa oaja gmh fgsa oaam

    xjih xj xgid u`xf xfa` fagixfkga rjs`ha{

    gojqx hasaijr`me gm aakx`sa fagx h`{ag{a

    rasamx`jm rigm- @ ujlam dmju xfa`

    mqloa{ gmh g{{a{{ xfa` `{d{ mju xfap kgm

    ujd u`xf pjq xj {`em`kgmxip ahqka xfa`

    kfgmka{ j eaxx`me fagx h`{ag{a xjljju

    mavx pag j ;2 pag{ jl mju-

    Nj`m xfa Ljsalamx

    Nj`m xfa Ej _ah j Ujlam ljsalamx xj kjmmakx u`xf kjiiageqa{

    gmh rgx`amx{ mgx`jmu`ha ufj {fga pjq kjll`xlamx xj rasamx

    fagx h`{ag{a- _ae`{xa mju gx Ej_ahCjUjlam-je*rja{{`jmgi{

    gmh {aa fju pjq kgm fair ujlam i`sa ijmea gmh {xjmea-

    Fagixfkga rjs`ha{ kgm gi{j xgda ghsgmxgea j Gla`kgm Fagx

    G{{jk`gx`jm a{jqka{ {qkf g{ rja{{`jmgi njqmgi{ xagxlamx

    eq`hai`ma{ rgx`amx ahqkgx`jm xjji{ gmh xfa igxa{x `m a{agkf gx

    fxxr>**lp-gla`kgmfagx-je*rja{{`jmgi-

    Fagx GxxgkdUgm`me [`em{

    Kfa{x h`{kjljx- Lj{x fagx gxxgkd{

    `msjisa h`{kjljx `m xfa kamxa j xfa kfa{x

    xfgx ig{x{ lja xfgm g au l`mqxa{ j xfgx

    eja{ gugp gmh kjla{ ogkd- @x kgm aai i`da

    qmkjljxgoia ra{{qa {wqaa~`me qiima{{

    j rg`m-

    H`{kjljx `m jxfa gag{ j xfa

    qrra ojhp- [plrxjl{ kgm `mkiqha rg`m

    j h`{kjljx `m jma j ojxf gl{ xfa ogkd

    makd ngu j {xjlgkf-

    [fjxma{{ j oagxf u`xf j u`xfjqx

    kfa{x h`{kjljx-

    Jxfa {`em{ lgp `mkiqha oagd`me jqx `m g

    kjih {uagx mgq{ag j i`efxfaghahma{{

    G{ u`xf lam ujlam{ lj{x kjlljm fagx

    gxxgkd {plrxjl `{ kfa{x rg`m j h`{kjlcjx-

    Oqx ujlam ga {jlaufgx lja i`daip xfgm

    lam xj avra`amka {jla jc xfa jxfa kjlljm

    {plrxjl{ rgx`kqigip {fjxma{{ jc oagxf

    mgq{ag*sjl`x`me gmh ogkd j ngu rg`m-

    LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm 71

  • 8/9/2019 The Triangle Physician March 2010

    18/32

    Rgx`amx [aiakx`jm @{ Dap `mXagx`me Rg`mqi[r`ma Cgkxqa{

    _gh`jijep

    73 Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

    [jk`axp j @mxasamx`jmgi _gh`jijep {qrrjx{ ghh`x`jmgi {k`amx`ck {xqh`a{ cefx{ maegx`sa

    ogkdig{f jl xuj kjmxjsa{`gi {xqh`a{ xfgx kjlrgah saxaojrig{xp xj rigkaoj xfgx

    rj{{`oip rigka{ rgx`amx{ u`xf j{xajrjj{`{ `m najrghp j ij{`me oamack`gi xagxlamx-

    E`sam xfa kqamx kjmxjsa{p jsa saxaojrig{xpgl`m`lgiip `msg{`sa xagxlamx rajlah op `mxasamx`jmgi

    gh`jije`{x{ `m `mh`s`hqgi{ u`xf rg`mqi j{xajrjjx`k

    saxaogi kjlra{{`jm gkxqa{ xfgx g`i xj a{rjmh

    xj kjmsamx`jmgi lah`kgi xfagrpufgx{

    g rgx`amx xj hj: q{x pjq lah`kgi

    xagl xj hak`ha ` pjq ga gm

    grrjr`gxa kgmh`hgxa j

    saxaojrig{xp gmh xq{x xfa

    avra`amka j fqmhah{

    j xfjq{gmh{ j jxfa

    rgx amx{ ufj fgsa qmha

    ejma xfa {r`ma xagx,

    lamx {qkka{{qiip gmh

    aka`sah i`a,`lrjs`me

    aakx{ {gp{ xfa [jk`axp j

    @mxasamx`jmgi _gh`jijep-

    Fqmhah{ j xfjq{gmh{j rgx`amx{ fgsa eagxip

    oamaxah jl saxaojrig{xp

    u`xf gilj{x kjlriaxa a{jiqx`jm j

    xfa` rg`m4 xam{ j xfjq{gmh{ haramhamx

    jm `mxgsamjq{ mgkjx`k{ fgsa oaam h`{kfgeah jl

    xfa fj{r`xgi s`xqgiip rg`m, gmh hqe,aa jiiju`me xfa`

    xagxlamx mjxah [@_ Ra{`hamx O`gm C- [xg`mdam L-H-

    C[@_ ufj ara{amx{ xfa mgx`jmgi jegm`~gx`jm j magip

    8122 hjkxj{ {k`amx`{x{ gmh gii`ah fagixf rja{{`jmgi{

    hah`kgxah xj `lrjs`me fagixf kga xfjqef l`m`lgiip`msg{`sa xagxlamx{- Oaja xagxlamx lgmp j xfa{a

    j{xajrjjx`k rgx`amx{ ga `m kjm{xgmx rg`m gmh kgmmjx

    lgmgea asaphgp gkx`s`x`a{- Lgmp ga kjmmah xj

    oah j qr xj {`v uaad{- Xa{a ga xfa

    rajria ua fair4 u`xf saxaojrig{xp

    xfap kgm ej fjla `m jma xj

    xuj hgp{- Kgmh`hgxa{ j xfa

    rjkahqa ga xfj{a ufj

    fgsa g`iah xj a{rjmh xj

    kjmsamx`jmgi lah`kgi

    xagxlamx &{qkf g{ a{x

    gmgiea{`k{ gmh mgkjx`k

    hqe{)- Saxaojrig{xp

    kgm e`sa rgx`amx{ xfa`

    i sa{ ogkd {g`h [xg`mdam

    ra{`hamx j xfa @lge`me

    Maxujd j _fjha @{igmh gmhkfg` j xfa h`gemj{x`k lge`me

    hargxlamx gx _jea U`ii`gl{

    Lah`kgi Kamxa `m Rjs`hamka _-@-

    @mxasamx`jmgi gh`jije`{x{ fgsa xfa k`x`kgi

    {d`ii{ m lge`me gmh rgx`amx kga xfgx lgda xfal avrax{

    gx haxal`m`me uf`kf rgx`amx{ ga xfa lj{x grrjr`gxa

    kgmh`hgxa{ xj aka`sa xfa xagxlamx fa ghhah-

    @lgea> @m saxaojrig{xp g maahia gojqx xfa u`hxf j g kjkdxg`i {xgu `{ `m{axah xfjqef xfa

    {d`m `mxj xfa gkxqah ojma- G ojma kalamx `{ `mnakxah- Xfa kalamx fgham{ {xgo`i`~a{ xfaojma gmh rasamx{ qxfa kjiigr{a- Xf`{ {xjr{ xfa rg`m kgq{ah op ojma qoo`me geg`m{x ojma-

  • 8/9/2019 The Triangle Physician March 2010

    19/32

    uj {xqh`a{ rqoi`{fah `m xfa Mau

    Ameigmh Njqmgi j Lah`k`ma `m Gqeq{x

    uaa xfa {x ki`m`kgi x`gi{ xj xa{x saxaoj,

    rig{xp geg`m{x g rigkaoj gmh lgmp avrax{

    uaa {xqmmah op xfa a{qix{ xfgx {qeea{xah

    xfgx rgx`amx{ ejx awqgi gljqmx{ j ljha{x

    rg`m ai`a ufaxfa xfap ejx saxaojrig{xp

    ufaa lah`kgi,egha ojma kalamx `{ `mnakxah

    `mxj ojdam saxaoga j g hqllp `mnakx`jm-[@_ {qrrjx{ xfa q{a j saxaogi gqelamxgx`jm

    &saxaojrig{xp gmh dprfjrig{xp) j rgx`amx{ u`xf

    rg`mqi kjlra{{`jm gkxqa{- @m ghh`x`jm [@_

    {qrrjx{ xfa lrjxgmx jia j a{agkf aegh`me xfa

    jia j saxaogi gqelamxgx`jm oqx ua {fjqih xgda

    mjxa xfgx `x `{ `mkag{`meip kiag xfgx xfa{a {xqh`a{ h`h

    mjx xaii xfa ufjia {xjp {g`h [xg`mdam- Xa ejqr{

    j rgx`amx{ {xqh`ah gmh xfa gmgip{`{ g`{ah g{ lgmp

    wqa{x`jm{ g{ uaa gm{uaah fa {g`h- Og{ah jm xfa MANL

    mh`me{ xfa {jk`axp akjllamhah xfgx `mxasamx`jmgi

    gh`jije`{x{ `mjl rgx`amx{ j xfa {xqh`a{ kjmxjsa{`gia{qix{ hq`me kjm{qixgx`jm- Xa {xqh`a{ haljm{xgxa

    xfa `lrjxgmka j haogxa gmh `ejjq{ gmgip{`{ j gii hgxg

    r`j xj q{f`me xj kjmkiq{`jm{- Ua lq{x kij{aip ljm`xj

    xamh{ m saxaojrig{xp a{agkf- Xaa u`ii oa ghh`x`jmgi

    {xqh`a{ gx [@_{ Gmmqgi [k`amx`k Laax`me m Lgkf xfgx

    u`ii rjs`ha mau ra{rakx`sa jm xfa gjalamx`jmah

    {xqh`a{ gmh agl jq ra{rakx`sa xfgx saxaojrig{xp

    rjs`ha{ ijme,xal gmh gr`h rg`m ai`a j grrjr`,

    gxaip {aiakxah rgx`amx{ {g`h [xg`mdam-

    Ua ga kjmkamah gojqx xfa rj{{`o`i`xp xfgx

    `m{qgmka kjsagea lgp oa u`xfhgum j

    saxaojrig{xp gmh rj{{`oip dprfjrig{xp oakgq{a

    j xfa kjmxjsa{p eamagxah op xfa xuj MANL

    {xqh`a{ {g`h [xg`mdam- @ xfgx jkkq{ gkka{{ xj

    xfa{a rjkahqa{ ujqih oa i`l`xah xj rgx`amx{

    amjiiah `m grrjsah x`gi{ iags`me lgmp

    rgx`amx{ `m {asaa rg`m u`xfjqx g {jiqx`jm-

    [@_ `{ daar`me g ugxkfqi apa jm xf`{ xj

    rjxakx rgx`amx{ gkka{{ xj lah`kgi

    xagxlamx- [@_ u`ii kjmx`mqa xj {asa

    g{ g iagha m qxqa x`gi{ j saxaoj,

    rig{xp xfgx lgp kjml j kjmxgh`kx

    xfa{a {xqh`a{ j lgp `hamx`p {qo{ax{

    j rgx`amx{ lja i`daip xj oamax

    jl saxaogi gqelamxgx`jm

    mjxah xfa [@_ ra{`hamx-

    [@_ laloa gmh saxaoj,

    rig{xp avrax N- Das`m LkEgu

    L-H- C[@_ geaa{- Uf`ia ua

    uaikjla xfa xuj {xqh`a{ op

    a{agkfa{ Hgs`h C- Dgiila{ L-H- gmh _gkfaiia

    Oqkfo`mha Rf-H- xj xfa ojhp j i`xagxqa

    jm xf`{ xakfm`wqa xfa a{qix{ j xfa{a x`gi{

    ga h`{kjhgmx u`xf ra{jmgi avra`amka gmh

    lja xfgm 71 pag{ j gkkqlqigxah lah`kgi

    i`xagxqa a{rjq{`me xfa oamax{ j saxa,

    ojrig{xp {g`h LkEgu {akx`jm fagh

    `mxasamx`jmgi gh`jijep gx _`sa{`ha

    _gh`jijep gmh @mxasamx`jmgi G{{jk`gxa{`m Kjiqloq{ Jf`j- [@_ akjem`~a{ xfa

    sgiqa j gmhjl`~ah kjmxjiiah x`gi{

    gmh as`hamka,og{ah lah`k`ma4 fjuasa

    xfa uagdma{{ `m xfa {xqh`a{ gmh xfa

    haeaa j h`{kjhgmka oaxuaam

    xfa jqxkjla{ j xfa{a {xqh`a{ r`j

    {xqh`a{ gmh avra`amka {qeea{x

    xfgx `x `{ ralgxqagmh rj{{`oip

    `mkjakx xj kjmkiqha xfgx

    saxaojrig{xp { mj oaxxa xfgm g

    kjmxji {fgl rjkahqa fa mjxah-

    K`x`k`{l{ j ojxf {xqh`a{

    `mkiqha xfa {lgii mqloa{ j

    rgx`amx{ xagxah4 xfa {lgii ra,

    kamxgea j ai e`oia rgx`amx{ ufj

    uaa gkxqgiip amjiiah `m xfa x`gi4

    `mkiq{`jm j rgx`amx{ u`xf l iha

    haeaa{ j rg`m gmh h`{go i xp xfgm

    ga q{qgiip xagxah `m g xpr`kgi

    rgkx ka4 xfa {lgii gljqmx j kalamx

    `mnakxah4 xagxlamx j rgx`amx{ u`xf

    kfjm`k kjlra{{`jm gkxqa{4 xfa

    `mkjlriaxa q{a j L_@ j K xj

    kjml xfgx xfa gkxqa ug{ xfa i daip

    {jqka j rg`m4 gmh xfa f`ef gxa j kj{{,

    jsa jl rigkaoj xj saxaojrig{xp `m jma

    j xfa {xqh`a{ avrig`mah LkEgu-

    K`x`k`{l fg{ gi{j kjla jl jma j

    xfa {xqh`a{ msa{x`egxj{- U`ii`gl Kigd L-H-

    [x- Eajea R`sgxa Fj{r`xgi [phmap Gq{xgi`ggm `msa{x`egxj u`xf xfa Dgiila{ {xqhp {g`h fa

    aeghah xfgx {xqhp g{ lagm`meia{{- @m ghh`x`jm fa

    kgiiah xfa Oqkfo`mha {xqhp g q{f xj nqhelamx jm

    {k`amka,og{ah lah`k`ma u`xfjqx grrip`me {k`amx`k

    xakfm`wqa `m grrg`{`me xfa {xqh`a{ `m kjllamx{

    rj{xah xj xfa Gxf`x`{ jhgp Uao {`xa- Kigd mjxah

    mqlajq{ igu{ `m xfa {xqh`a{ `mh`kgx`me xfap fgh

    `mgrrjr`gxa rgx`amx {aiakx`jm xa`oia akq`xlamx gmh

    {aiakx`jm o`g{ u`xf xfa lgnj`xp mjx jiijuah-

    LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm 75

    &kjmx`mqah jm mavx rgea)gea

    [JK

    J

    JKJ

    *

  • 8/9/2019 The Triangle Physician March 2010

    20/3276 Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

    J{xajrjj{`{ xfa lj{x kjlljm

    xpra j ojma h`{ag{a `{ kfggkxa`~ah

    op iju ojma lg{{ gmh {xqkxqgi haxa,

    `jgx`jm j xfa ojma a{qix`me `m gm `m,

    kag{ah {q{karx`o`i`xp xj gkxqa{- J{,

    xajrjj{`{ gakx{ 72 l`ii`jm Gla`kgm{

    gmh `{ a{rjm{`oia j 522222 saxaogigkxqa{ agkf pag- Lqix`ria saxaogi

    gkxqa{ kgm a{qix `m kfjm`k rg`m gmh

    h`{go`i`xp ij{{ j mharamhamka {xjjrah

    rj{xqa gmh kjlra{{`jm j xfa iqme{

    gmh {xjlgkf-

    Saxaojrig{xp g l`m`lgiip `msg{`sa

    xagxlamx rajlah op `mxasamx`jmgi

    gh`jije`{x{ qmha `lge`me eq`hgmka

    {xgo`i`~a{ kjiigr{ah saxaog u`xf xfa

    `mnakx`jm j lah`kgi,egha ojma kalamx`mxj xfa {r`ma- X`{ ahqka{ rg`m gmh

    kgm rasamx qxfa kjiigr{a j xfa sa,

    xaog xfaaop rasamx`me xfa fa`efx ij{{

    gmh {r`ma kqsgxqa kjlljmip {aam g{

    g a{qix j j{xajrjj{`{- Saxaojrig{xp

    ufam q{ah grrjr`gxaip `m gkkjhgmka

    u`xf a{xgoi`{fah rgkx`ka {xgmhgh{ op

    avrax rjs`ha{ hglgx`kgiip lrjsa{

    ogkd rg`m u`xf`m fjq{ j xfa rjkahqa

    rjs`ha{ ijme,xal rg`m ai`a gmh fg{ g

    iju kjlri`kgx`jm gxa g{ haljm{xgxah

    `m lqix`ria {xqh`a{- Ua lq{x mjx q{f

    xj mau kjmkiq{`jm{ a{rak`giip og{ah jm

    xfa{a akamx kjmxjsa{`gi {xqh`a{{g`h

    LkEgu-

    Lja mjlgx`jm gojqx xfa [jk`axp

    j @mxasamx`jmgi _gh`jijep `mxasam,x`jmgi gh`jije`{x{ gmh saxaojrig{xp

    kgm oa jqmh jmi`ma gx uuu-[@_uao-

    je- [@_{ _a{agkf _arjx`me [xgmhgh{

    j Rakqxgmajq{ Saxaogi Gqelamxg,

    x`jm uaa rqoi`{fah akamxip `m xfa

    Njqmgi j Sg{kqig gmh @mxasamx`jmgi

    _gh`jijep g{ gm ghh`x`jmgi aaamka j

    rfp{`k`gm{- [@_{ Kjllamxgp jm Sa,

    xaojrig{xp gmh xfa Gqeq{x [xqh`a{ `m

    xfa Mau Ameigmh Njqmgi j Lah`k`ma {

    gi{j gsg`igoia jm xfa {jk`axp{ Uao {`xa-

  • 8/9/2019 The Triangle Physician March 2010

    21/32

    Rgx`amx{u`xfX`ah Gkfp

    Fagsp Iae{:

    Lgmp rgx`amx{ xf`md xfa` iae {plrxjl{ ga

    jl ge`me rjj rfp{`kgi kjmh`x`jm j nq{x

    ijme fgh hgp{- @m gkx lj{x rgx`amx{rfp{`k`gm{ gmh jxfa rjs`ha{ hjmx asam

    dmju iae {plrxjl{ kjqih oa kgq{ah op

    samjq{ h`{ag{a j qmfagixfp k`kqigx`jm `m

    xfa` iae sa`m{- Rgx`amx{ hjmx xaii xfa`

    rfp{`k`gm oakgq{a xfap q{qgiip gamx g{dah

    gojqx xfa {plrxjl{ gmh lj{x rgx`amx{ hjmx

    agi`~a xfa` iae {plrxjl{ kjqih oa g lah`kgi

    rjoial ag{`ip xagxgoia gmh kjsaah op lj{x

    `m{qgmka rigm{ `mkiqh`me Lah`kga- [ghip

    lgmp rgx`amx{ ga {qa`me qmmaka{{g`ip-

    Ufgx { Rfiaojijep:

    Rfiaojijep `{ jma j xfa maua{x akjem`~ah

    aih{ j lah`k`ma gmh `{ hah`kgxah xj xfa

    h`gemj{`{ xagxlamx gmh {xqhp j sa`m h`{ag{a

    uf`kf gc`kx{ 62 l`ii`jm Gla`kgm{ j

    grrjv`lgxaip ?2! j xfa ghqix rjrqigx`jm-

    Rfiaojijep xagx{ ojxf xfa lah`kgi &samjq{

    `m{qk`amkp) gmh kj{lax`k &{r`ha sa`m{)

    g{rakx{ j samjq{ h`{ag{a- @ g lah`kgi rjoial

    lj{x `m{qgmka kjlrgm`a{ `mkiqh`me

    Lah`kga u`ii kjsa xfa asgiqgx`jm{ gmh

    xagxlamx{-

    Samjq{ h`{jha{ h`gemj{ah gmh xagxah op

    Rfiaojije`{x `mkiqha> kfjm`k samjq{ `m{q,

    k`amkp sg`kj{a sa`m{ {r`ha sa`m{ samjq{ iae

    qika{ kjmeam`xgi samjq{ gomjlgi`x`a{

    samjq{ xfjlojaloji`{l gmh jxfa h`{jha{

    j samjq{ j`e`m-

    H`gemj{x`k asgiqgx`jm `mkiqha{ F#R gmh

    hqriav qixg{jqmh- Hqriav qixg{jqmh { q{qgiip

    rajlah `m xfa jka op g {rak`gi`~ah

    xakfm`k`gm gmh `{ kjm{`haah xfa ejih

    {xgmhgh xj asgiqgxa samjq{ `m{qk`amkp-

    Q{`me hqriav qixg{jqmh xfa xakfm`k`gm

    asgiqgxa{ xfa ju j oijjh `m xfa iae sa`m{

    gmh lgr{ xfa sa`m{-

    Mjlgiip iae sa`m{ fgsa qmkx`jmgi jma ugp

    ju sgisa{ xj daar oijjh ju`me geg`m{x

    egs`xp xjugh{ xfa fagx- @ xfa{a ju sgisa{

    ga haakx`sa go{amx j jxfa kjmh`x`jm{ ga

    ra{amx oijjh ju{ axjegha j ogkdugh{

    hjum xfa iae kgq{`me samjq{ kjmea{x`jm

    gmh `mkag{ah samjq{ ra{{qa-

    f`{ samjq{ kjmea{x`jm gmh

    fpraxam{`jm ga qix`lgxaip

    a{rjm{`oia j lj{x j xfa {plrxjl{ gmh

    rfp{`kgi mh`me{ j kfjm`k samjq{

    `m{qk`amkp uf`kf mkiqha> iae h`{kjljx

    kglr`me xamhama{{ oqm`me xfjoo`me

    {uaii`me sg`kj{a sa`m{ {d`m kfgmea{ gmh

    asamxqgi samjq{ qika{-

    agxlamx{ ga q{qgiip {fjx jqxrgx`amx

    jka rjkahqa{ jkq{ah jm kij{`me

    qmfagixfp sa`m{ u`xf a`xfa amhjsamjq{ ig{a

    goigx`jm gmh*j {kiajxfagrp &`mnakx`jm{-)Oqie`me sg`kj{a sa`m{ ga q{qgiip avxgkxah

    s`g l`kj rfiaoakxjlp- _akjsap x`la `{

    o`a gmh rgx`amx{ q{qgiip axqm xj mjlgi

    gkx`s`x`a{ xfa {gla j jiiju`me hgp- Ugxkf g

    {fjx `mjlgx`jmgi hsh jm jq uao{`xa xj

    iagm lja gojqx xfa{a jka rjkahqa{ gx

    uuu-kgji`mgsa`mkamxa-kjl

    @ pjq fgsa gmp wqa{x`jm{ gojqx Rfiaojijep riag{a hj

    mjx fa{`xgxa xj kjmxgkx la gx xfa Kgji`mg Sa`m Kamxa

    I`mhp LkFqxkf`{jm LH &070) 821,8?22

    i`mhpBkgji`mgsa`mkamxa-kjl Ua ga kjll`xxah xjahqkgx`me xfa kjllqm`xp ojxf rfp{`k`gm{ gmh rgx`amx{

    gmh ga fgrrp xj hj g {fjx ra{amxgx`jm m pjq jcka-

    LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm 70

    op I`mhp LkFqxkf`m{jm LHI`mhp LkFqxkf`m{jm oaegm xg`m`me u`xf mjxgoia rfp{`k`gm{

    `m xfa `aih j Rfiaojijep `{x gx Hqda Qm`sa{`xp g{ gm

    jo{asgx`jmgi aiiju u`xf H- Kpmxf`g [fjxaii kf`a j

    sg{kqig {qeap gx Hqda- [qo{awqamxip H- LkFqxkf`{jm

    kjlriaxah gm avxamhah ki`m`kgi rakarxj{f`r u`xf H- Njfm

    Lgq`aiij aiiju j xfa Gla`kgm Kjiiaea j Rfiaojijep

    gmh mgx`jmgiip dmjum ahqkgxj m xfa `aih- [fa gi{j xg`mah

    u`xf H- Njfm D`mei{ap `m O`l`mefgl Gigoglg gmjxfa

    mgx`jmgiip dmjum rfiaojije`{x- R`j xj fa `mxaa{x m sg`kj{a

    sa`m{ Kgji`mg Sa`m Kamxa [jqxfrj`mx-

    [plrxjl{ jSamjq{ Iae

    gmdia {uaii`me

    iae {uaii`me

    x`ah

    gkfp

    fagsp

    rg`mqi

    rq`x`a{

    xfjoo`me

    kglr`me

    oqm`me

    {x`me`me

    mqloma{{

    a{xia{{ iae{

    Rfiaojijep

  • 8/9/2019 The Triangle Physician March 2010

    22/32?2 Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

    Og`m gqlg

    Kig{{`p`me

    Og`m @mnqpg{g Kfrjm`kH`{ag{a

    xj {qkf {`kdma{{- &F- Dai{j ra{jmgi kjl,

    lqm`kgx`jm Nqma ;2 ?226)- Ufam grri`ah xj

    O@ xf`{ ham`x`jm `lri`a{ xfgx O@ `{ g

    jma,x`la `iima{{ xfgx fg{ g oae`mm`me gmh g

    a{jiqx`jm- Uf`ia xf`{ `{ xfa kg{a j lgmp

    `mh`s`hqgi{ ufj {q{xg`m g O@ `x `{ mjx xfa kg{a

    j wq`xa g au- X`{ `{ ufp `x `{

    `lragx`sa xfgx xfa lah`kgi

    `m{qgmka `mhq{xp) lah`kgi

    kjllqm`xp) gmh xfa kjllq,

    m`xp,gx,igea) qmha{xgmh XO@

    g{ g h`{ag{a {xgxa xfgx `{

    rjea{{`sa m xfgx) jsa x`la) x

    fg{ haiaxa`jq{ acakx{ jm jxfa

    jegm {p{xal{-

    [k`amx`k hgxg av`{x xfgx {qrrjx{ xfa gkx

    xfgx ma`xfa gm gkqxa O@ mj g kfjm`k O@

    `{ g {xgx`k rjka{{ xfgx g O@ `lrgkx{ lqi,

    x`ria jegm {p{xal{ `{ h`{ag{a,kgq{gx`sa gmh

    h`{ag{a, gkkaiagx`sa- Kig{{`kgx`jm j O@

    g{ xfa oae`mm`me j g h`{ag{a rjka{{ ujqih

    gk`i`xgxa xagxlamx g{ jqxi`mah j xfa qii

    kjmx`mqql j kga uf`kf {fjqih oa rg`h j

    op lah`kgi `m{qa{ gmh lgmgeah jm g rg

    u`xf jxfa h`{ag{a{-

    Ha{r`xa xfa gkx xfgx `mh`s`hqgi{ u`xf g O@

    ufj {qs`sa xfa gkqxa asamx hj mjx h`a j

    ---g XO@ `lrgkx{ lqix`ria jegm {p{xal{) `{

    h`{ag{a,kgq{gx`sa) gmh h`{ag{a,gkkaiagx`sa-

    @lri`k`x `m xfa mjlamkigxqa gqlgx`k Og`m

    @mnqp &O@) `{ xfa mjx`jm xfgx xgqlg xj xfa

    og`m `{ xfa a{qix j gm `mnqp gmh xfgx xfa

    `mnqp u`ii fagi- Lah`kgi kjmh`x`jm{ xfgx ga

    aaah xj g{ `mnq`a{ lj{x jxam fgsa g

    ra{k`oah rjxjkji j xagxlamx xfgx gilj{xgiugp{ a{qix{ m {`em`kgmx `lrjsalamx gmh

    rj{{`oip g kqa- Fjuasa xf`{ `{ mjx xfa kg{a

    u`xf O@-

    Op `x{ sap mgxqa agkf O@ fg{ `x{ jum qm`wqa

    {`emgxqa uf`kf u`ii lgm`a{x g{ jma j j g

    kjm{xaiigx`jm j maqjije`kgi aakx{- Uf`ia

    lgmp j xfa 7-8 l`ii`jm O@{ {q{xg`mah

    gmmqgiip `m xfa Q-[- ga `mhaah `mnq`a{ jl

    uf`kf agkf rgx`amx akjsa{ j `{ kqah jsa

    7?1222 j xfa{a ga ralgmamx gmh `mkqgoia-

    Cj xfa{a O@{ xfa kig{{`kgx`jm j h`{ag{a

    `{ lja grrjr`gxa xfgm xfgx j `mnqp-

    H`{ag{a `{ hamah `m xfaCaa Jmi`ma

    H`kx`jmgp g{ ara{amx`me g has`gx`jm jl

    j `mxaqrx`jm j xfa mjlgi {xqkxqa j

    qmkx`jm j gmp ojhp rgx jegm j {p{xal xfgx

    `{ lgm`a{xah op g kfggkxa`{x`k {ax j

    {plrxjl{ gmh {`em{ gmh ufj{a ax`jijep

    rgxfjijep gmh rjemj{`{ lgp oa dmjum j

    qmdmjum- Gmh xfa a{qix{ j g O@ kgm oa

    ha{k`oah `m xfa{a xal{-

    gda xfa {x rfg{a j xfa ham`x`jm> g

    has`gx`jm jl j `mxaqrx`jm j xfa mjlgi

    {xqkxqa j qmkx`jm j gmp ojhp rgx jegm

    j {p{xal Xa a{qix{ j g O@ hj kgq{a

    xfa{a xf`me{ xj gakx xfa `mh`s`hqgi{ og`m

    gmh maqjije`kgi {p{xal- Xa mavx rgx {xgxa{

    xfgx xfa{a has`gx`jm{ gmh `mxaqrx`jm{ ga

    lgm`a{x op g kfggkxa`{x`k {ax j {plrxjl{

    gmh {`em{ uf`kf grri`a{ xj xfa kjm{xaiigx`jm

    j {plrxjl{ g{{jk`gxah u`xf g O@- Xa

    ham`x`jm kjmkiqha{ u`xf ufj{a ax`jijep

    rgxfjijep gmh rjemj{`{ lgp oa dmjum j

    qmdmjum uf`kf {ragd{ xj xfa rjea{{`sa

    h`{ag{a rjka{{ `m`x`gxah op g O@-

    @m eamagi xfa m{qgmka mhq{xp q{a{ xfa xal

    {`kdma{{ gxfa xfgm h`{ag{a xj ha{k`oa O@-

    [`kdma{{ `{ hamah op jma lah`kgi `m{qgmka

    `mhq{xp rjs`ha g{> `iima{{ h`{ag{a j

    kjmh`x`jm j g kjsaah ra{jm- [`kdma{{ mkiqha{

    gmp kjlri`kgx`jm{ j akqamka{ xfgx aigxa

  • 8/9/2019 The Triangle Physician March 2010

    23/32LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm ?7

    xfa` og`m `mnqp ra {a O@ `{ g h`{ag{a-

    Xaa ga lgmp {`l`ig avglria{ `m xfa aih

    j lah`k`ma- Kfjm`k d`hmap h`{ag{a `{ gm

    `mharamhamx `{d gkxj j kgh`jsg{kqig

    h`{ag{a- Rgx`amx{ u`xf kfjm`k d`hmap h`{ag{a

    ga lja i`daip xj h`a j kgh`jsg{kqig h`{ag{a

    xfgm amh,{xgea amgi g`iqa- Rgx`amx{ hj mjx

    {qkkqlo xj G@H[- Xap h`a jl jxfa h`{ag{a{{qkf g{ rmaqljm`g kgq{ah op xfa G@H[ h`{ag{a-

    Gmh `mhaah h`{ag{a{ kgm oa kgq{ah op avxamgi

    jka{ {qkf g{ `mnq`a{- Gm `mh`s`hqgi {q{xg`m`me

    g {asaa kfal`kgi oqm xj xfa iqme{ u`ii hasaijr

    kfjm`k iqme h`{ag{a xfgx lgp xfam kgq{a j

    gkkaiagxa kg h`gk h`{ag{a- Gixfjqef xfa

    rfamjlamjm `{ mjx kiagip qmha{xjjh

    jiiju`me kfaljxfagrp lgmp rgx`amx{ lgp

    hasaijr h`{goi`me rjoial{ u`xf laljp

    gxxamx jm lqix`,xg{d`me gmh jxfa hjlg`m{

    j kjem`x`sa qmkx`jm dmjum g{ kfalj og`m-

    @m g ?228 {xqhp jm ljxgi`xp jma pag rj{x O@

    gljme ?756 `mh`s`hqgi{ u`xf g ljhagxa,xj,

    {asaa O@ `x ug{ arjxah xfgx `mh`s`hqgi{

    u`xf g O@ uaa xu`ka g{ i`daip xj h`a g{ g {`l`ig

    mjm,og`m,`mnqah kjfjx gmh fgh g i`a

    avrakxgmkp ahqkx`jm j {asam pag{- Cjiiju,qr

    {xqh`a{ jm kgq{a{ j hagxf asagiah xfgx

    `mh`s`hqgi{ {qs`s`me lja xfgm jma pag u`xf

    g O@ ga ;5 x`la{ lja i`daip xj h`a jl

    {a`~qa{ 7? x`la{ lja i`daip xj h`a jl

    {arx`kal`g jq x`la{ lja i`daip xj h`a jl

    rmaqljm`g gmh xfaa x`la{ lja i`daip xj

    h`a jl jxfa a{r`gxjp kjmh`x`jm{ xfgm g

    lgxkfah kjfjx jl xfa eamagi rjrqigx`jm-

    Xa eagxa{x rjrjx`jm j hagxf{ `m xfa {xqhp

    ?0 rakamxug{ jl k`kqigxjp rjoial{-

    [asagi maqjije`k h`{jha{ ga

    g{{jk`gxah u`xf XO@ gii j uf`kf ra{amx

    g iasai j h`{go`i`xp u`xf sgp`me haeaa{ j

    {asa`xp- O@ `{ g lgnj kgq{a jar`iar{p

    gkkjqmx`me j sa rakamx j gii ar`iar{p `m

    xfa eamagi rjrqigx`jm- S`{qgi h`{xqogmka{

    ga kjlljm u`xf O@ g{ ga {iaar h`{,

    xqogmka{gmh fpra{jlm`g-O@ kgm oa g

    `{d gkxj j xfa hasaijrlamx jGi~fa`la{

    h`{ag{a- @x gi{j kgm kgq{a Kfjm`k

    Xgqlgx`k Amkarfgijrgxfp &KXA)-

    G ljhagxa,xj,{asaa O@ `{ g{{jk`gxah u`xf

    g fj{x jmaqjamhjk`ma h`{jha{

    `mkiqh`me fprjr`xq`xg`{l> kjx`{ji hak`amkp

    ejuxf fjljma &EF) hak`amkp*`m{qk`amkp4

    fprjxfpj`h`{l4 gmh ejmghjxjr`m

    hack`amkp- Agkf j xfa{a h`{jha{ fg{

    maegx`sa aakx{ g{{jk`gxah u`xf xfal gmh iagh{

    xj g rjea{{`sa h`{ag{a rjka{{-

    @mkjmx`mamka ojxf j xfa oighha gmh

    ojuai kgm awqamxip jkkq u`xf O@- O@ gi{jkgq{a{ {avqgi hp{qmkx`jm- Ghh`x`jmgiip

    `x kgq{a{ lq{kqij{daiaxgi hp{qmkx`jm

    `mkiqh`me {rgkx`k`xp uf`kf awq`a{ i`a,ijme

    xagxlamx gmh g f`ef `mk`hamka j gkxqa{ xfgx

    rigka{ xfa `mh`s`hqgi gx `{d j faxajxjr`k

    j{{`ckgx`jm &FJ) uf`kf lgp mjx hasaijr

    j g{ ijme g{ xfaa ljmxf{ rj{x `mnqp-

    @x `{ k`x`kgi xj mjxa xfgx r{pkf`gx`k

    h`{ag{a gmh r{pkfjije`kgi hack`x{ ga

    gljme xfa lj{x h`{goi`me kjm{awqamka{ j

    O@- Xa jsarufail`me lgnjr`xp jc mh`s`hqgi{

    ufj {qs`sa g ljhagxa,xj,{asaa O@ ga iax

    u`xf {`em`kgmx ijme,xal maqjoafgs`jgi

    kjm{awqamka{- @m ghh`x`jm xj xfa geea{,

    {`jm kjmq{`jm gmh ge`xgx`jm {aam `m

    xfa gkqxa {xgea{ O@ `{ g{{jk`gxah u`xf gm

    `mkag{ah `{d j hasaijr`me mqlajq{

    r{pkf`gx`k h`{ag{a{ `mkiqh`me jo{a{{`sa

    kjlrqi{`sa h`{jha{ gmv`axp

    h`{jha{ r{pkfjx`k h`{jha{ ljjh

    h`{jha{ gmh lgnj hara{{`jm-

    op Oamx Lg{ai LHRa{`hamx gmh Lah`kgi H`akxj Xgm{`x`jmgi Iagm`me Kamxa Egisa{xjm Xavg{4

    Ojgh Laloa Og`m @mnqp G{{jk`gx`jm jc Gla`kg

    H- Lg{ai eghqgxah jl Ijpjig Lah`kgi [kfjji `m Lgpujjh @ii`mj`{ `m 7058- Fa kjlriaxah f`{

    `mxam{f`r gmh Maqjijep a{`hamkp gx xfa Qm`sa{`xp j Xavg{ Lah`kgi Ogmkf &QXLO) gx Egisa{xjm

    Xavg{ `m 7056-

    Cjiiju`me f`{ xg`m`me H- Lg{ai a{xgoi`{fah g Maqjijep r`sgxa rgkx`ka `m Egisa{xjm gmh

    aka`sah kax``kgx`jm `m 7062 jl xfa Ojgh j R{pkf`gxp gmh Maqjijep- Fa `{ g Ki`m`kgi

    G{{`{xgmx Rja{{j `m xfa Hargxlamx{ j Maqjijep Cgl`ip Lah`k`ma @mxamgi Lah`k`ma Rfp{`kgi

    Xfagrp gmh Jkkqrgx`jmgi Xfagrp gx QXLO- Fa fg{ kjmhqkxah a{agkf gmh rqoi`{fah `m xfa

    gag j faghgkfa rg`m lgmgealamx-

    @m 700? H- Lg{ai oakgla xfa Lah`kgi H`akxj j Xfa Xgm{`x`jmgi Iagm`me Kamxa &XIK) gmh `m Ngmqgp j 7008 fa iax f`{ r`sgxa

    rgkx`ka xj oakjla xfa Ra{`hamx j xf`{ rj{x gkqxa og`m `mnqp afgo`i`xgx`jm gk`i`xp-

    H- Lg{ai `{ `m halgmh g{ gm `mxamgx`jmgi {ragda jm xfa xjr`k j Ejuxf Fjljma Hack`amkp gmh Fprjr`xq`xg`{l gmh _afgo`i`xgx`jm

    jiiju`me gm Gkwq`ah j Xgqlgx`k Og`m @mnqp-

    @mh`s`hqgi{ u`xf g O@ grrag xj fgsa f`efa

    gxa{ j hara{{`sa h`{jha{ gmv`axp h`{jha{

    gmh {qo{xgmka goq{a gmh jxam fgsa {q`k`hgi

    rigm{ {q`k`hgi oafgs`j j {q`k`ha kjlriax`jm

    `m xfa kjmxavx j xfa{a `iima{{a{-

    G XO@ kiagip lgp kgq{a hakgha{,

    ijme) gmh rj{{`oip ralgmamx)

    sqimago i`xp xj r{pkf`gx`k

    `iima{{-

    F`{xj`kgiip mh`s`hqgi{ i`s`me u`xf g og`m

    `mnqp fgsa oaam aaah xj g{ og`m `mnqp

    {qs`sj{- Rafgr{ xf`{ kjmkarx j laaip

    {xgp`me gi`sa ug{ q{ah oakgq{a g{ i`xxia g{ ;2

    pag{ gej xfa lgnj`xp j `mh`s`hqgi{ u`xf g

    ljhagxa,xj,{asaa O@ {qkkqloah {jjm

    gxa xfa` `mnqp- Rafgr{ xfa xal`mjijep ug{

    q{ah xj `lrip xfgx xfa `mh`s`hqgi jqxi`sahxfa``mnqp gmh ra{asaah ha{r`xa xfa fgh{f`r j

    xfa xgqlg-

    [qs`sj fjuasa hja{ mjx ghha{{ xfa

    agi`xp j og`m `mnqp- Kgmka{qs`sj{ ga

    {qs`sj{ oakgq{a `x `{ oai`asah xfap ga

    kqahgmh xfap `mhaah fgsa jqxi`sah xfa`

    h`{ag{a- Lgmp `mh`s`hqgi{ ufj {q{xg`m g O@

    akjsa 722 rakamx- Xap fgsa xqip {qs`sah

    xfa` `mnqp- Fjuasa `m xfa Q-[- gijma asap

    pag jsa 7?1222 `mh`s`hqgi{ ufj {q{xg`m g

    O@ oakjla h`{goiah-

    X`{ gx`kia h`{kq{{a{ jmip g {lgii rakamxgea

    j xfa kgq{a{ j h`{go`i`xp gmh xfa jmej`me gmh

    hasaijr`me lah`kgi kjmh`x`jm{ mh`s`hqgi{

    u`xf O@ gka- Ra{amxip lja xfgm 8 l`ii`jm

    `mh`s`hqgi{ `m xfa Q-[- ga h`{goiah hqa xj xfa

    lp`gh j kjm{awqamka{ j g O@- Xa` og`m

    xgqlg fg{ a{qixah `m g kjmh`x`jm xfgx `{

    h`{ag{a,kgq{gx`sa gmh h`{ag{a,gkkaiagx`sa- G{ g

    a{qix j xfa` og`m xgqlg xfa{a `mh`s`hqgi{

    mju fgsa i`a,ijme og`m `mnqp h`{ag{a-

    Kga gmh xagxlamx j og`m `mnqp h`{ag{a

    {fjqih oa a`loq{ah op lah`kgi m{qa{ gmh

    lgmgeah jm g rg u`xf gii jxfa h`{ag{a{- Jmip

    xfam u`ii xfa `mh`s`hqgi{ u`xf xf`{ h`{ag{a j

    gqlgx`k Og`m @mnqp eax xfa lah`kgi

    {qsa`iigmka {qrrjx gmh xagxlamx xfap

    ha{asa- Jmip xfam u`ii og`m `mnqp a{agkf

    aka`sa xfa qmh`me `x awq`a{- Jmip xfam u`ii

    ua oa goia xj xqip xgid gojqx mh`me g kqa-

  • 8/9/2019 The Triangle Physician March 2010

    24/32?? Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

    Jsa xfa ig{x ?2 pag{ xfaa fg{ oaam

    xalamhjq{ ejuxf `m xfa q{a j `lrigmxgoia

    has`ka j kgh`gk fpxfl lgmgealamx

    `mkiqh`me rgkalgda{ `lrigmxgoia kgh`gk

    hao`iigxj{ gmh o`samx`kqig rgkalgda{-

    Gkkjlrgmp`me xf`{ ejuxf `{ gm `mkag{`me

    `mk`hamka j iagh hp{qmkx`jm gmh has`ka,

    aigxah `makx`jm- Ghh`x`jmgiip g{ rgx`amx{ ga

    jqx`maip lrigmxah u`xf has`ka{ xfgx lgp maah

    xj oa lg`mxg`mah j hakgha{ gogmhjm`me

    hp{qmkx`jmgi iagh{ `{ oakjl`me lja gmh

    lja rjoialgx`k- Gogmhjmah iagh{ kgm iagh

    xj sa`m jkkiq{`jm j asam sgisqig hp{qmkx`jm

    gmh xfa{a rjxamx`gi kjlri`kgx`jm{ kgm oa

    glai`jgxah j gsj`hah kjlriaxaip ` xfa

    rjoialgx`k iagh{ ga avxgkxah-

    G akamx kjm{am{q{ {xgxalamx jl xfa Fagx

    _fpxfl [jk`axp kig`ah xfa `mh`kgx`jm{ cj

    xgm{samjq{ iagh avxgkx`jm- Xa{a `mh`kg,

    x`jm{ `mkiqha> 7) as`hamka jc has`ka {p{xal

    `mcakx`jm &`mkiqh me rjkdax makx`jm)?) samjq{

    {xamj{`{ j jkkiq{`jm rasamx`me gkka{{ xj

    xfa samjq{ k`kqigx`jm gmh ;) qmq{ah iagh{

    xfgx `mxacaa u`xf has`ka cqmkx`jm j

    mqloa `m avka{{ jc 8 iagh{ jm jma {`ha-

    U`xf xfa eamagi ge`me j xfa has`ka rgx`amx

    rjrqigx`jm gmh xfa `mkag{`me kjlriav`xp

    j `lrigmxgoia has`ka{ xfaa `{ gm `mkag{`me

    maah j iagh{ xj oa aljsah j arigkah-

    Jsa x`la iagh{ q{qgiip ga vah `m rigka

    op {kg x`{{qa gmh oakjla `lrj{{`oia xj

    avxgkx op {`lria xgkx`jm- Hqa xj xfa `{d

    gmh xakfm`kgi kfgiiamea{ j iagh avxgkx`jm

    lgmp rfp{`k`gm{ ufj `lrigmx has`ka{ ga

    aiqkxgmx xj avxgkx `lrigmxah iagh{- Jsa

    xfa ig{x hakgha {asagi hasaijrlamx{ fgsa

    eagxip ahqkah xfa `{d j avxgkx`jm- Xa

    og{`{ j gii j xfa{a xakfm`wqa{ `{ {x xj

    xgm{l`x iagh xgkx`jm xj xfa x`r j xfa iagh

    `m xfa fagx gxfa xfgm xj xfa gsg`igoia

    rjv`lgi amh j xfa iagh `m xfa rjkdax- X`{

    `{ gkf`asah q{`me g {xpiax xfgx ijkd{ xj xfa x`r

    j g iagh- X`{ kjqmxaxgkx`jm xj xfa x`r j

    xfa iagh { kjqriah u`xf {jla jl j {fagxf

    xfgx `{ rg{{ah jsa xfa iagh gmh q{ah xj kqx

    gugp xfa ojq{ ghfa{`jm{ xfgx v xfa iagh

    xj xfa fagx- @m `x{ {`lria{x jl xf`{ kgm

    oa gkf`asah u`xf g {`lria {fagxf gixfjqef

    {asagi xjji{ fgsa oaam hasaijrah xj g{{`{x

    `m oagd`me xfjqef ojq{ ghfa{`jm{- Xa

    lj{x kjlljm {fagxf{ qx`i`~a a`xfa ig{a

    amaep &[rakxgmax`k{) j g jxgx`me {xg`mia{{

    {xaai kqxx`me x`r &Kjjd Lah`kgi)- U`xf {qkf

    xakfm`wqa{ g {fagxf `{ ghsgmkah xfjqef

    xfa sa`m jsa iagh u`xf xfa kgrgo`i`xp j

    hai sa`me kjmxjiiah ig{a amaep j lakfgm`kgi

    h`{qrx`jm xj kqx xfjqef gmp {kg x`{{qa gmh

    aa xfa iagh jl xfa fagx- @m xf`{ ugp iagh

    avxgkx`jm u`xf g =02! {qkka{{ gxa gmh g

    ?,;! jsagii kjlri`kgx`jm gxa kgm oa gkf`asah

    u`xf jmip g 2-1! lgnj kjlri`kgx`jm gxa-

    Gmp iagh avxgkx`jm rjegl awq`a{ g

    lqix`,h`{k`ri`mgp xagl- Oa{`ha{ xfa r`lgp

    jragxj &jxam g kgh`gk aiakxjrfp{`jije`{x)

    ufj lq{x oa avra`amkah `m iagh avxgkx`jm

    gmh gi{j uaii,sa{ah `m has`ka `lrigmx`jm

    gmh lgmgealamx `x `{ k`x`kgi xj fgsa {qrrjx

    jl kgh`jxfjgk`k {qeap gmh gma{xfa{`g

    ra{jmmai gl`i`g u`xf gii rjxamx`gi

    kjlri`kgx`jm{ j iagh avxgkx`jm gmh a,`l,

    rigmxgx`jm- X`{ kjiigojgx`jm `{ k`x`kgi xj

    lg`mxg`m`me xfa {gaxp j xfa rjkahqa- Xa

    ag{jm j xf`{ `{ xfa {lgii oqx m`xa `{d j

    kgh`gk qrxqa u`xf xglrjmgha g{ xf`{ kgm

    awq`a `llah`gxa xfjgkjxjlp xj kjmxji

    faljfgea-

    G{ xfa oamax gmh qx`i`~gx`jm j kgh`gk

    `lrigmxgoia has`ka{ kjmx`mqa{ xj avrgmh x {

    k`x`kgi xfgx xfaa { {qrrjx`me kgrgo`i`xp j

    iagh avxgkx`jm- Rgx`amx{ u`xf ? j ; qmq{ah

    gogmhjmah iagh{ ufj lgp oa i`s`me u`xf

    gm `lrigmxgoia has`ka j lgmp pag{ ga gx

    qmgkkarxgoia `{d jl ijme,xal iagh

    aigxah kjlri`kgx`jm{- @x { g oaxxa xj avxgkx

    qmq{ah iagh{ agip `m xfa kjq{a ufam `x kgm

    oa gkf`asah u`xf l`m`lgi kjlri`kgx jm{- Xa

    kjl`me pag{ u`ii i`daip {aa iagh avxgkx`jm

    avrgmh jl g xagxlamx j has`ka aigxah

    `makx`jm xj gm avrgmh`me jia `m aljs`me

    hp{qmkx`jmgi j gogmhjmah iagh{-

    Aiakxjrfp{`jijep

    IaghAvxgkx`jm

    op Gm`i Eaf` LH

    Qmhaeghqgxa y Lg{{gkfq{axx{ @m{x`xqxa j Xakfmjijep 7003

    Lah`kgi [kfjji y Qm`sa{`xp j Kgi`jm`g gx [gm Cgmk`{kj ?222

    @mxamgi Lah`k`ma y Qm`sa{`xp j Kgi`jm`g gx [gm Cgmk`{kj ?22;

    Caiiju{f`r{ y Lx- [`mg` Lah`kgi Kamxa ?223 &Kgh`jsg{kqig Lah`k`ma)

    Aljp Qm`sa{`xp ?226 &Kgh`gk Aiakxjrf{`jijep)

    Kax`ckgx`jm y @mxamgi Lah`k`ma Kgh`jijep Aiakxjrfp{`jijep

    Ki`m`kgi @mxaa{x{ y Rgkalgda &`mkiqh`me o`samx`kqig) # haco`iigxj

    `lrigmxgx`jm has`ka avxgkx`jm kgxfaxa goigx`jm j [SX SX gmh gx`gi

    co`iigx`jm-

  • 8/9/2019 The Triangle Physician March 2010

    25/32LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm ?;

    Xa mq{a { g k`x`kgi xagl laloa m gmp fagixf {as`ka{ oq{`ma{{- Xa

    mq{a `{ jma j xfa dap gka{ xfgx asapjma {aa{ gx g lah`kgi rgkx`ka

    ufaxfa `x{ xfa oae`mm`me j xfa s`{`x j xfa amh j g ijme rjkahqa-

    Xa` `amhip {l`ia gmh {xaghp fgmh{ fair xfa ki`amx aai kgil gmh

    {akqa gojqx xfa rjkahqa xfap ga gojqx xj fgsa- Gmh gixfjqef xfap

    rigp {qkf g `amhip jia mq{`me rja{{`jmgi i`go`i`xp kig`l{ ga gx gm

    gii x`la f`ef-

    Qmjxqmgxaip gmp kq{xjla j gmp e`sam ag{jm kgm {qa g mq{a gx gmp

    x`la- Xa mq{a hja{mx fgsa xj oa ujme `x nq{x fgrram{- G{ u`xf gmpjma

    ai{a oa`me {qah lgda{ xfa mq{a aai alogg{{ah gmh `m{akqa gojqxf`{ j fa njo- @llah`gxaip aljx`jm{ j ag gmv`axp gmh qmkaxg`mxp

    xgda jsa-

    Ufaa hja{ xf`{ rqx g mq{a gmh ufgx kgm xfap hj xj oa rargah:

    Mq{a{ Rja{{`jmgi I`go`i`xp `{ g eagx ugp xj kgil xfa{a ag{-

    F`{xj`kgiip xfa gag{ j mq{`me xfgx fgsa oaam xfa lj{x rjma xj

    kig`l{ ga gma{xfa{`g lah`kgx`jm ghl`m`{xgx`jm l`hu`ap gmh

    ljm`xj`me jia{4 fjuasa kig`l{ xjhgp ga avrgmh`me xj gii gag{ j

    xfa aih- F`efa {xgmhgh{ j kga g`iqa xj jiiju rjkahqa gmh

    g`iqa xj hjkqlamx kjmh`x`jm{ gmh xagxlamx ga {jla j xfa o`eea{x

    kgq{a{ j igu {q`x{- Gii lah`kgi jka{ {fjqih fgsa rja{{`jmgi

    i`go`i`xp `m{qgmka j xfa` hjkxj{ gmh {xg- Fjuasa xjhgp mq{a{

    kgm eax kjsagea j xfal{aisa{ `mharamhamxip j ufgx xfa` alrijpa

    ja{- X`{ kjsagea `{ kgiiah Mq{a{ Rja{{`jmgi I`go`i`xp-

    Xaa ga xuj ugp{ g mq{a kgm rqkfg{a Rja{{`jmgi I`go`i`xp- C`{x

    `{ g {xgmh,gijma Mq{a{ I`go`i`xp rji`kp uf`kf lgmp kg`a{ ja-

    [akjmhip lgmp fjla m{qgmka kjlrgm`a{ ja Mq{a{ Rja{{`jmgi

    I`go`i`xp kjsagea g{ g `ha jm av`{x`me fjla `m{qgmka rji`k`a{-

    Fgs`me xfa `ha ghhah xj xfa fjla rji`kp `{ rjogoip xfa kfagra{x

    gmh lj{x ak`amx ugp xj fgsa xfa kjsagea ghhah gmh {x`ii e`sa mq{a{

    xfa {akq`xp xfap maah-

    Xaa ga xfaa dap xf`me{ xfgx @ akjllamh xj mq{a{ ufj ga

    ijjd`me gx rqkfg{`me xf`{ kjsagea>

    C`{x `{ xfa kjsagea jm g kig`l{ lgha og{`{ j jm gm

    jkkqamka og{`{: Xaa `{ g sap o`e gmh `lrjxgmx h`aamka-

    Kig`l{ Lgha lagm{ xfgx xfa rji`kp u`ii jmip rgp xfa kig`l ` xfa

    kig`l `{ lgha uf`ia xfa rji`kp `{ `m jka- Jkkqamka og{`{ lagm{

    xfa rji`kp u`ii rgp xfa kig`l ` xfa aj j jl`{{`jm ug{ hjma uf`ia

    xfa rji`kp ug{ `m jka- U`xf Jkkqamka og{`{ `x hja{ mjx lgxxa `

    xfa rji`kp `{ `m jka ufam xfa kig`l `{ lgha- G{ pjq kgm {aa xfaa `{

    g sap o`e h`aamka oaxuaam xfa xuj-

    [akjmhip dmju ufgx pjq kjsagea i`l`x{ lagm gmh

    ` iaegi kj{x{ ga `mkiqhah- Lgmp rji`k`a{ u`ii rgp iaegi kj{x{

    &xfa kj{x xj haamh pjq) `m ghh`x`jm xj ufgxasa xfa i`l`x{ j xfa rji`kp

    ga- Lgmp rji`k`a{ u`ii q{a g ra kig`l i`l`x gmh gm geeaegxa i`l`x- Cj

    avglria ` pjq rji`kp agh{ (7222222*(?222222 qmha xfa kjsagea

    gljqmx xfgx jxam lagm{ xfa `m{qgmka kjlrgmp u`ii rgp jqx qr xj (7

    l`ii`jm j gmp jma kig`l gmh qr xj (? l`ii`jm `m xjxgi j xfa rji`kp-

    C`mgiip hj {jla a{agkf jm xfa cmgmk`gi {xgo`i`xp

    gmh kig`l{ f`{xjp j xfa kjlrgmp ja`me pjq xfa

    kjsagea-Xaa ga lgmp `m{qgmka kjlrgm`a{ `m oq{`ma{{ xjhgpgmh pjq giugp{ ugmx xj hj oq{`ma{{ u`xf g kjlrgmp xfgx fg{ g ejjh

    arqxgx`jm gmh g {ji`h gx`me u`xf G-L- Oa{x &@ akjllamh G j

    f`efa)- @ pjq gamx {qa gojqx xfa kjlrgmp ja`me pjq kjsagea

    kjmxgkx pjq `m{qgmka geamx gmh {aa ` xfap fgsa {qeea{x`jm{-

    Rajria ga kjl`me jl gii jsa xfa kjqmxp xj aka`sa xagxlamx

    faa `m xfa `gmeia- Riag{a lgda {qa pjq ga kjsa`me pjq{ai gmh

    pjq kgaa jl h`{g{xa'

    XaI`go`i`xpj gMq{a

    @m{qgmkaop L`da _`hh`kd

    L`da _`hh`kd `{ xfa ra{`hamx j _`hh`kd @m{qgmka

    Ejqr @mk gm `mharamhamx `m{qgmka geamkp `m

    _gia`ef MK- Cj 72 pag{ L`da fg{ oaam fair`me

    rja{{`jmgi{ rjxakx xfa` g{{ax{ xfjqef

    `m{qgmka gmh cmgmk`gi rigmm`me- Xfa ljxxj j

    _`hh`kd @m{qgmka Ejqr `{ xj fair ki`amx{ rjxakx

    xfa` {xgmhgh j i`s`me op oa`me oaxxa rjxakxah

    xjhgp gmh oaxxa rargah j xjljju- _`hh`kd

    @m{qgmka Ejqr {rak`gi`~a{ `m fair`me {lgii

    oq{`ma{{ juma{ u`xf rjraxp kg{qgixp i`go`i`xp

    gmh i`a `m{qgmka rigmm`me-

  • 8/9/2019 The Triangle Physician March 2010

    26/32?8 Xfa X`gmeia Rfp{`k`gm y LG_KF ?272

    E_GKA LKKG_XFP LHGma{xfa{`jijep

    Hqda Qm`sa{`xp Fj{r`xgi{ Hqfgl

    FAGXFA_ RGHHJKD LHRah`gx`k [qeap

    Hqda H`s`{`jm j Rah`gx`k [qeap Hqfgl

    _@KFG_H _QMDIA @@@ LHGma{xfa{`jijep

    Qm`sa{`xp j Mjxf Kgji`mg Fj{r`xgi{ Kfgrai F`ii

    [XACGM@A [KFQLGMLHJrfxfgiljijep

    Hqda Apa Kamxa Hqfgl

    _GNHAAR [@MEF LHMaqjijep

    Hqda Qm`sa{`xp Lah`kgi Kamxa Hqfgl

    _PGM [XGMEA_ LHGma{xfa{`jijep

    Qm`sa{`xp j Mjxf Kgji`mg Fj{r`xgi{ Kfgrai F`ii

    A_@K [X_JXFA_ LHGma{xfa{`jijep

    _gia`ef Cgl`ip Fagixf Kga _gia`ef

    L@II@A [Q_GX@ LHJxjf`mjigpmejijep

    Hqda Qm`sa{`xp Fj{r`xgi{ Hqfgl

    R_@PGMDG QRRGI LH@mxamgi Lah`k`ma

    Kgp

    K_A@EFXJM SGQEFX LHJxjf`mjigpmejijep

    Giglgmka AMX # Cgk`gi Rig{x`k [qeap Oqi`mexjm

    KIGQH@G S@[[GEA [K_QEE[ LH@mxamgi Lah`k`ma

    Qm`sa{`xp j Mjxf Kgji`mg Fj{r`xgi{ Kfgrai F`ii

    NJ[ARF U@I[JM LHJxfjrah`k [qeap

    X`gmeia Jxfjrgah`k{ Hqfgl

    XGPIJ_ UJCCJ_H LH@mxamgi Lah`k`ma

    Qm`sa{`xp j Mjxf Kgji`mg Fj{r`xgi{ Kfgrai F`ii

    NJ_HGM PJQME LH@mxamgi Lah`k`ma

    Ugpma Lalj`gi Fj{r`xgi Ejih{ojj

    _JO@M ^AM@KD LHRah`gx`k{

    Ral`a Rah`gx`k{ [jqxfam R`ma{

    GMH_AU OGOKJKD LHCgl`ip Lah`k`ma

    Qm`sa{`xp j Mjxf Kgji`mg Fj{r`xgi{ Kfgrai F`ii

    DGXFIAAM OGIIG[ LHRah`gx`k{

    Kgp

    O_@GM O_@XX LH@mxamgi Lah`k`ma

    Hqda _gia`ef Fj{r`xgi _gia`ef

    XJHH O_JLOA_E LHGma{xfa{`jijep Rg`m Lgmgealamx

    Kfgrai F`ii

    DGIIJI KFGQHFQ_@ LHGma{xfa{`jijep

    Hqda Qm`sa{`xp Lah`kgi Kamxa Hqfgl

    [UGRMG KFGQHFQ_@ LHGma{xfa{`jijep

    Hqda Qm`sa{`xp Lah`kgi Kamxa Hqfgl

    KF@F,KFAME KFAM LHMaqjijep

    Kgojj

    HGM KJXJLGM LHR{pkf`gxp

    Hqfgl

    RF@I@R HGSAMRJ_X LHMaqjijep

    Hqda Maqjijep j _gia`ef _gia`ef

    LG_D CG[^FJI^ LHGma{xfa{`jijep

    Hqfgl

    G_G[F CJ_JQEF@ LHMaqjijep

    Hqda Qm`sa{`xp Fj{r`xgi{ Hqfgl

    RAG_I@MA E_GMX LHCgl`ip Lah`k`ma

    _gia`ef

    GMH_AU E_AAM LHEamagi [qeap

    U`i{jm

    UGPMA DAIIAP N_- LHJxfjrah`k [qeap

    Hqda Qm`sa{`xp Fj{r`xgi{ Hqfgl

    GG_JM IAMX^ LHQjije`kgi [qeap

    Qm`sa{`xp j Mjxf Kgji`mg Fj{r`xgi{ Kfgrai F`ii

    Mau{

    Gla`kgm @m{x`xqxaj Fagixfkga # C`xma{{ Jcka{6;22 Fagixf Rgd [q`xa ?77

    _gia`ef MK ?5371jcka 070,685,6?;1

    Caoqgp 1 ?272

    MGX@JMGI UAG_ _AH HGP[fju pjq {qrrjx j xfa cefx geg`m{x fagx h`{ag{a `m ujlam

    gmh xfa Gla`kgm Fagx G{{jk`gx`jm{ Ej _ah Cj Ujlam

    ljsalamx op {rjx`me pjq oa{x ah jqxcx Cao- 1xf- Cj g aa

    hjumijghgoia Uag _ah Hgp d`x s`{`x Ej_ahCjUjlam-

    je*Uag_ahHgp j kjmxgkx xfa GFG gx 070,83;,6;25-

    Caoqgp 7; ?272

    ?1XF GMM@SA_[G_PX_@GMEIA FAG_X OGII_gia`ef Kjmsamx`jm Kamxa Hjumxjum _gia`ef

    83;,6;1;

    uuu-x`gmeiafagxogii-je

    ?1xf Gmm`sa{gp asamx g`{a{ qmh{ xj {qrrjx Gla`kgm Fagx

    G{{jk`gx`jm a{agkf gmh ahqkgx`jm j fagx h`{ag{a gmh

    {xjda xfa +7 gmh +; iagh`me kgq{a{ j hagxf `m Gla`kg- Cao-

    7; ?272 jl 3 r-l- 77 r-l-

    Caoqgp 7; ?272

    OIQA NAGM OGIIXfa xf`h gmmqgi Oiqa Nagm Ogii g ujlam{ fagixf oamacx u`ii

    oa faih gx xfa [fagxjm @lra`gi jm Rgea _jgh Hqfgl MK-

    Xfa asamx hgxa `{ [gxqhgp Caoqgp 7; ?272- Nj`m xfa ha{{

    hjum{rgdia qr asamx ufaa Oiqa Nagm{ ga xfa avrakxah

    gxx`a- G {`iamx gqkx`jm h`mma gmh i`sa ogmh ga g rgx j ufgx

    pjq u`ii amnjp hq`me gm asam`me hah`kgxah xj g`{`me gugama{{

    gmh qmh{ xj rjs`ha {qe`kgi gmh lah`kgi kga xj ujlam `m Ag{x

    G`kg- Cj x`kdax j rjegl `mjlgx`jm riag{a s`{`x fxxr>**

    oiqanagmogii-lk-hqda-ahq j kgii &070) 332,?;56-

    Caoqgp ?5 ?272

    KG_H@JSG[KQIG_ H@[AG[A ?272FAGIXF KG_A @M ASJIQX@JM>JRRJ_XQM@X@A[ GMH KFGIIAMEA[ CJ_XFA KG_H@JSG[KQIG_ RGX@AMXUgdaLah Fagx Kamxa Kjmaamka Kamxa

    UgdaLah _gia`ef Kglrq{

    ;222 Mau Oam Gsamqa

    _gia`ef MK ?5372

    Nj`mxip {rjm{jah op Ugda Fagx Gmh Sg{kqig G{{jk`gxa{ gmh

    Ugda GFAK

    Xf`{ rjegl u`ii ra{amx kjlrafam{`sa m{`efx{ mxj kgh`jijep

    gmh kga j xfa rgx`amx u`xf j gx `{d j kgh`jsg{kqig

    kjmh`x`jm{- _ae`{xa jmi`ma> uuu-ugdagfak-je

    Gr`i 5 ?272

    MGX@JMGI [XG_X' UGID@ME HGPIgka qr pjq {magda{ gmh xgda g ugid xj kaiaogxa Mgx`jmgi

    [xgx' Ugid`me Hgp- Ugid`me fg{ oaam rjsam xj ijua fagx

    h`{ag{a `{d gmh `lrjsa uaiima{{- Cj aa ugid`me a{jqka{

    s`{`x [xgxUgid`meMju-je j kjmxgkx xfa GFG gx 070,83;,6;1;-

    Gr`i 73 gmh 75 ?272

    KLA> ?MH GMMQGI AL@IP OA_AMH GHQIX_AKJM[X_QKX@JM [PLRJ[@QLG kjlrafam{`sa f`r gmh dmaa kjq{a ra{amxah op Ghqix

    _akjm{xqkx`jm H`s`{`jm j Jxfjrgah`k [qeap Hqda Qm`sa{`xp

    Lah`kgi Kamxa

    Iakxqa{ jm fjx xjr`k{ `m f`r gmh dmaa gxfjrig{xp gmh i`sa

    s`haj haljm{xgx`jm{ jm xfa igxa{x jragx`sa xakfm`wqa{

    S`{`x`me rja{{j Ghjirf S- Ijlogh` LH CGK[

    C`hgp Gr`i 73 ?272 &Dmaa {a{{`jm)[gxqhgp Gr`i 75 ?272 &F`r {a{{`jm)

    Hqda Qm`sa{`xp Lah`kgi Kamxa

    _ae`{xa gmh eax lja `mjlgx`jm gx

    klaxgkda-max*HQDA*Kjq{a{-fxli

    Xf`{ gkx`s`xp fg{ oaam grrjsah j GLG R_G Kgxaejp 7 kah`x-XL

    [rjm{jah op Hqda Qm`sa{`xp [kfjji j Lah`k`ma

    Lgp 5 ?272

    X_@GMEIA EJA[ _AHCJ_ UJLAM IQMKFAJMKgoxaa Lg`jxx _gia`ef

    070,83;,6;25

    uuu-x`gmeiaeja{ah-je

    Kaiaogxa xfa rjua j ujlam xj nj`m xjeaxfa m xfa cefx geg`m{x

    xfa` Mj-7 d`iia fagx h`{ag{a- Amnjp fagx fagixf {al`mg{

    maxujd`me g fagixfp iqmkf gmh rjuaqi dapmjxa ghha{{-

    Uaikjla xj xfa Gag Asamx{ gmh Jrrjxqm`x`a{

    Mau gmh _aijkgxah Rgkx`ka{

    HQDA EAMA_GI [Q_EA_P JC _GIA@EF &xuj ijkgx`jm{)

    Hqda Lah`k`ma Rig~g;862 Ugda Cja{x _jgh [q`xa 123_gia`ef MK ?5320jcka 070,8?2,1222

  • 8/9/2019 The Triangle Physician March 2010

    27/32LG_KF ?272 y Xfa X`gmeia Rfp{`k`gm ?1

    Kgh`jijep

    Ra`rfagi

    Gxa`giH`{ag{a

    Gohjl`mgi Gjx`k Gmaqp{l &GGG)

    Hacm`x`jm>

    Gohjl`mgi gjx`k h`glaxa avkaah`me ; kl-

    Rasgiamka>

    Qr xj 7;! `m lam gmh 3! j ujlam jsa

    gea 31- _ga qmha gea 32-

    [plrxjl{>

    Lgnj`xp ga g{plrxjlgx`k- Lgp ra{amxu`xf qrxqa*{qhham hagxf &62,02! j GGG

    qrxqa{ ga gxgi)- Lgp fgsa gohjl`mgi

    rg`m j ogkd rg`m-

    _`{d Cgkxj{>

    Gea lgia eamha xjogkkj q{a gl`ip f`{xjp

    j GGG kjmmakx`sa x`{{qa h`{jha h`goaxa{

    laii`xq{ hp{i`r`hal`g-

    H`gemj{`{>

    Gohjl`mgi qixg{jqmh `{ f`efip {am{`x`sa

    gmh {rak`k-

    [kaam`me>

    Xa Q[ Rasamx`sa g{d Cjka eq`hai`ma{

    akjllamh GGG {kaam`me j>

    Lgia{ jsa gea 31 u`xf g f`{xjp j {ljd`me

    Lgia{ jsa gea 32 u`xf g gl`ip f`{xjp

    j GGG

    Xagxlamx>

    _`{d j qrxqa `mkag{a{ u`xf gmaqp{l

    {`~a- _akjllamh xagxlamx jmka GGG h`,

    glaxa = 1-1 kl j j gr`h avrgm{`jm- Jr,

    x`jm{ `mkiqha jram {qe`kgi arg` s{- amhj,

    sg{kqig {xamx egx`me-

    Kgjx`h Gxap [xamj{`{

    Rasgiamka>

    Kgjx`h gxap {xamj{`{ kgq{a{ qr xj 5! j

    gii {xjda{-

    [plrxjl{>

    Jxam g{plrxjlgx`k- Lgp fgsa {plrxjl{

    j {xjda j @G-

    H`gemj{`{>Kgjx`h hqriav qixg{jqmh `{ f`efip {am{`,

    x`sa gmh {rak`k- Jxfa ljhgi`x`a{ `mkiqha

    L_G gmh KG-

    [kaam`me>

    Gq{kqixgx`jm j kgjx`h oq`x{- Mj jia j

    {kaam`me g{plrxjlgx`k `mh`s`hqgi{-

    Xagxlamx>

    L`ih,xj,ljhagxa kgjx`h {xamj{`{>

    Gmx`rigxaiax geamx{ {xgx`m xfagrp gmx`,

    fpraxam{`sa xfagrp gmh gmmqgi kgjx`h

    hqriav j ljm`xj`me-

    [plrxjlgx`k {asaa kgjx`h {xamj{`{>

    _asg{kqig`~gx`jm { mh`kgxah u`xf kgjx`h

    amhgxaakxjlp s{- kgjx`h {xamx`me-

    G{plrxjlgx`k {asaa kgjx`h {xamj{`{>

    Kjmxjsa{`gi maah xj ua`ef `{d{ s{-

    oamax{ j asg{kqig`~gx`jm s{- lah`kgi

    xfagrp jm kg{a,op,kg{a og{`{-

    Ijua Avxal`xp

    Gxfaj{kiajx`k H`{ag{a

    [plrxjl{> Kigqh`kgx`jm avax`jmgi kgi

    xf`ef j oqxxjkd rg`m &?2,;2!) Gxpr`kgi iae

    rg`m &;2,;1!) G{plrxjlgx`k &;2!) K`x`kgi

    I`lo @{kfal`g &7,?!)Gx,_`{d Rgx`amx{

    &og{ah qrjm GKK*GFG eq`hai`ma{)>

    Gea 82,80 u`xf h`goaxa{ laii`xq{ $ jma

    jxfa `{d gkxj

    Gea 12,30 u`xf f`{xjp j {ljd`me j

    h`goaxa{ laii`xq{

    Gea 52

    [kaam`me>

    Gmdia,ogkf`gi `mhav &GO@) gx`j j oijjh

    ra{{qa lag{qalamx{ xgdam `m xfa gl{

    gmh gmdia{- GO@ 92-0 `{ gomjlgi- Gm GO@9 2-8 `mh`kgxa{ {asaa RGH- Xa GO@ xa{x `{

    f`efip {rak`k- [am{`x`s`xp lgp oa ahqkah

    `m {qonakx{ u`xf kgik`ah gxa`a{- @ ki`m`kgi

    {q{r`k`jm `{ f`ef {qeea{x qxfa asgiqgx`jm

    {qkf g{ KG L_G j gme`jegrfp-

    Xagxlamx>

    Cj l`ih,xj,ljhagxa RGH akjllamh

    geea{{`sa `{d gkxj ljh`kgx`jm avak`{a

    afgo`i`xgx`jm rjegl{ gmx`,rigxaiax geamx{

    k`ij{xg~ji- Cj {asaa RGH asg{kqig`~gx`jm

    s`g sg{kqig {qeap j rakqxgmajq{ gme`j,rig{xp*{xamx lgp oa `mh`kgxah-

    @m kjmkiq{`jm lg`mxg`m`me g f`ef mhav

    j {q{r`k`jm j RGH gmh alaloa`me

    xj {kaam rgx`amx{ `{ `lrjxgmx {`mka agip

    haxakx`jm j RGH giiju{ j agip geea{,

    {`sa lah`kgi xfagrp gmh `lrjsah

    jqxkjla{- Kgh`jsg{kqig kjm{qixgx`jm

    `{ akjllamhah j pjq gx,`{d j

    {plrxjlgx`k rgx`amx{-

    op H- Lgxaam Gdfxg

    H- Gdfxg `{ g ki`m`kgi kgh`jije`{x u`xf Ugda Fagx # Sg{kqig

    G{{jk`gxa{- Fa fg{ j`ka{ `m Kigpxjm gmh [l`xf`aih gmh

    uaikjla{ mau rgx`amx aagi{- Rfjma> &070) 060,5020-

    Alg`i> lgxaamgdfxglhBelg`i-kjl

    UfgxPjq

    [fjqihDmjuGojqx

    Ra`rfagi gxa`gi h`{ag{a &RGH) `{ gxfaj{kiajx`k h`{ag{a j xfa gxa`a{ avkiqh`me

    xfa kjjmgp gmh kaaogi gxa`a{- _`{d gkxj{ j hasaijrlamx j RGH ga {