Kasmat Hiperleukositosis Ama

 

@gpiei Xtm. Vijhia @isus @glithia, ……. Judh 3?3?

Vijhia @isus @glithia

Iai` dgdi`h egania mhpgrdgu`kshtkshs IDD ee ILD, gphsti`shs

gt fiusi tgrsian`i

gt fiusi trklckshtkpgahi,

iaglhi

akrlkshth` akrlk`rklh` gt fiusi pgreirimia, tgrsian`i IDD ee ILD eia nhzh cih` 

Kdgm : Ihsyi Bh`rhtili Iehtyi

_glchlchan : er. Lumillie Shzi, VpI(@), L.@gs er. Vgptha ^hehrgtaiah, VpI(@), L.@gs

__EV HDLW @GVGMIUIA IAI@  BI@WDUIV @GEK@UGSIA WAV / SVWE Er. LKG^ISEH VWSI@ISUI 3?3?

9

 

H.

_gaeimuduia

Dgu`gl Dgu `glhi hi ieidim ieidim `gniai `gniaisia sia sgd eirim eirim yian yian cgrisid cgrisid eirh eirh sulsul sulsul tudian. tudia n. I`ut dhlbkcdisth` dhlbkcdisth` dgu`glhi dgu`glhi (IDD) (IDD) lgrupi`ia lgrupi`ia 6?-5?% `gniaisia `gniaisia mglitkdknh mglit kdknh piei iai`, egania hashegash hashegash 7/9??.??? 7/9??.??? iai` pgr timua piei ushi ehci ehciwi wim m 97 timu timua. a. _iei _iei dgu`g dgu`glh lhii i` i`ut ut,, `g `gji jieh ehia ia IDD IDD lgaf lgafip ipih ih =3 =3%, %, sgeian`ia ILD lgafipih 9=%. IDD dgchm sgrhan piei dgdi`h. _iei IDD rhsh`k thannh (MS) eipit ehtgatu`ia eirh ahdih prknaksth`ayi yihtu tgreipit  cgcgripi bi`tkr rhsh`k ehciwim hah: juldim dgu`ksht iwid i wid dgchm eirh 7?.???/ud, ushi 4 9= cudia itiu 1 9? timua, timua, bgakthp eirh hluakbgak hluakbgakthphan thphan lgauaju`` lgauaju``ia ia sgd C litur, jgahs `gdilha dgdi`h, thei` cgrgspka sgtgdim > mirh pglcgrhia  prgeahska ehludih.Irtrhths dgu`glhi tgrjieh piei 7% pishga IDD piei iai`, eia sgrhan eheipit`ia `gtgrdilcitia ehinakshs.9,3,6,5,7,2,> Mhpgrdg Mhp grdgu`k u`kshtk shtkshs shs ehegbh ehegbhahs ahs`ia `ia sgcini sgcinihh juldim juldim dgu`ks dgu`ksht ht eirim eirim tgph tgph lgdgchmh 9??.???/ud. lgdgchmh 9??.???/ud. Vhaerkl Vhaerkl tulkr dhshs ieidim suitu `gieiia `gieiia glgrngash glgrngash ka`kdknh yian ehsgcic`ia kdgm pganmiafuria tulkr sgfiri spkatia liupua sgtgdim pglcgrhia `glktgriph. Mishd pganmiafuria sgd cgrupi hatri sgdudgr  iahka, `ithka, prkeu` lgtickdh` prktgha eia isil au`dgit i`ia lisu` `g eidil eid il shr`udi shr`udish sh eirim. eirim. Mishd-m Mishd-mish ishdd hah ehg`s` ehg`s`rgsh rgsh`ia `ia kdgm kdgm nhajid nhajid,, mith mith eia ehbi ehbink nksh shtk tksh shss kdgm kdgm sh shstg stgl l rgth` rgth`ud udkg kgae aekt ktgdh gdhid id,, ai ailu lua a pg pgah ahan an`i `iti tia a yi yian an  cgrdgchmia i`ia tgrjieh jh`i shstgl g`s`rgsh tgrniannu mhanni thlcud ngjiding ngji jidi di VUD VUD cg cgru rupi pi mhpg mhpgr` r`id idgl glhi hi,, mhpk`i mhp k`idsgl dsglhi. hi.

mh mhpg pgrbk rbksbi sbitg tglh lhi, i, mh mhpg pgru rurh rhsgl sglhi hi ei eia a

=,8

  @kaehs @kaehshh hah ehtglu`i ehtglu`ia a piei piei 8-96% 8-96% iai` iai` egania egania IDD.

Juldim dgu`ksht eirim tgph piei iwid ehinakshs IDD sgcinih bi`tkr pgathan  pgagatuia prknakshs pishga, pgaygcic thannhayi ian`i rgdips, eia rgaeimayi ian`i `gshatisia pishga IDD. @klpdh`ish @klpdh`ish mhpgrdgu`k mhpgrdgu`kshtkshs shtkshs eipit tgrjieh tgrjieh shaerkl dhshs tulkr tgrutili piei IDD. Uitidi`siai shaerkl dhshs tulkr  yihtu egania mherish ieg`uit sgrti `krg`sh `gdihaia lgtickdh` yian iei. Vidim situ situ `klp `klpdh dh`i `ish sh eirh eirh sh shae aerk rkl l dhsh dhshss tu tulk lkrr yi yiht htu u tg tgrj rjie ieha hayi yi I@H I@H yi yian an ehtglu`ia piei 57% shaerkl dhshs tulkr. I@H i`ia lgaygcic`ia kvgrdkie fihria fih ria eh`irga eh`irgai`i i`ia a niannu niannuia ia piei piei g`s`rg g`s`rgsh sh urha, urha, juni juni `irgai `irgai `gdiha `gdihaia ia lgtickdh`, eia habhdtrish sgd tulkr piei nhajid, yian i`ia cgri`mhr egania  8,9?,99,93

ninid aipis. Iaidhshs rgtrkspg`thb tgrmieip >33 egwisi eia iai`-iai` eheipit`ia 6>% 6>% piei piei pish pishga ga AMD, AMD, IDD IDD 62% 62% ei eia a ILD ILD 3> 3>%. %. _i _iei ei pi pish shga ga yi yian an lganidilh shaerkl hah, 57% lganidilh I@H, 37% lglgrdu`ia ehidhshs eia 3

 

97% lgahannid `irgai `klpdh`ish VUD.= Uujuia sijhia `isus `glithia hah ieidim uatu` lgaehs`ush`ia ehinakshs, `gluan`haia pgaygcic `glithia, sgrti pgangdkdiia `isus iai`  egania dgu`glhi i`ut egania mhpgrdgu`kshtkshs, `klpdh`ish mhpgrdgu`kshtkshs, gphsti`shs gt fiusi trklckshtkpgahi fiusi trklckshtkpgahi sgrti `gdihaia mglkstishs yian eipit tgrjieh  piei dgu`glhi.

6

 

HH.

@isus

Vgkrian iai` dgdi`h cgrhahshid U ushi 96 timua egania cgrit cieia 7? `n, thannh cieia 9>3 fl, tgreibtir sgcinih pishga SV Er. Lkgwireh egania aklkr rgnhstrish ?97?5668. _ishga lgrupi`ia ruju`ia eirh SVWE Ckykdidh egania `gdumia lhlhsia. Glpit lhannu sgcgdul lisu` rulim si`ht pishga eh`gdum`ia aygrh eh sgdurum pgrsgaehia, aygrh mhdian thlcud, aygrh cgr`urian sgtgdim lhaul kcit  pganurian aygrh, `gluehia luafud `glcidh, aygrh thei` ehpganirumh i`thbhtis. i` thbhtis. _ishga lishm eipit cgri`thbhtis sgpgrth chisi (cgrjidia, cgrliha egania tglia sgciyiayi), cgr`kluah`ish egania cih`. Eui cgdis jil sgcgdul lisu` rulim si`ht si` ht pishga pishga lgangd lgangdum`i um`iapgr apgreir eirimia imia mheuan mheuan ludih ludih `gduir `gduir lgagtg lgagtgs. s. Kdgm Kdgm kria kriant ntui ui pi pish shga ga ehci ehciwi wi `g SVWE SVWE Ckykd Ckykdid idhh ei eia a eh ehlk lkaek aek`` ``ia. ia. _ishg _ishga a ehdi`u`ia pglgrh`siia dickritkrhul piei tiannid 69 Lgh 3?3? egania mishd Mc 2,5 n/ed, n/ed, mglitk mglitkfrh frhtt 9=%, 9=%, dgu`ks dgu`ksht ht =8.98?/ =8.98?/uD, uD, trk trklck lcksht sht 9?.???/ 9?.???/uD, uD, grhtrksht 3 juti/uD, LFR =7,5 bD, LFM 6?,> pn, LFMF 67,8 n/ed, _U 3?,7 egth`,, HAS 9,7=, I_UU 6>,9 egth`, egth` egth`, aitrhul aitrhul 963 llkd/D, llkd/D, `idhul `idhul 6,8 llkd/D, `dkrhei 9?? llkd/D. _iei siit pgriwitia eh rulim si`ht sgcgdulayi, pishga lgaeip lga eipit` it`ia ia triasb triasbush ush eirim eirim trklck trklcksht sht sgciayi sgciayi` ` 9? `iatka `iatkan n eia ehcgrh ehcgrh tilpka mheuan uatu` lganmgath`ia pgreirimia. @irgai `gtgrcitisia siriai ei eia a pris prisir iria iai, i, pishg pishga a `g `glu lueh ehia ia eh ehru ruju ju` ` `g HN HNE E SVWE SVWE Er Er.. Lkgw Lkgwir ireh eh Vuri`irti. _iei siit eh HNE SVWE Er. Lkgwireh Vuri`irti pishga sieir pgaum, eipit eip it cgr`kl cgr`kluah uah`is `ish, h, thei` thei` eglil, eglil, thei` thei` luatim luatim,, th thei` ei` sgsi` sgsi` aipis, aipis, eia lishm lis hm tgrpis tgrpisian ian tilpka tilpka mheuan, mheuan, egania egania rglcgs rglcgs eirim. eirim. @gduir @gduir eirim eirim eirh eirh mheuan sgcgdim `iaia. Lhlhsia thei` cgrmgath egania lgag`ia mheuan, eirim lgrim sgnir sgciayi` sg`htir 3? ff. _ishga lgani`u sgcgdulayi lgankrg`  mheuan. _iei pishga thei` eheipit`ia eglil dili, thei` eheipit`ia cgajkdia eh cieia cieia pishga pishga,, thei` thei` eheipi eheipit`i t`ia a citu` citu` dili dili liupua liupua sgsi`. sgsi`. Li` Li`ia ia eia lhaul pishga lishm cih`. CI@ eia CIC pishga thei` iei `gdumia. _ishga sgcgdulayi pgraim `katrkd `g pkdh`dhah` mglitkka`kdknh iai` piei cudia Lgh 3?3? 3?3 ? egania egania ehinak ehinakshs shs chshtk chshtkpgah pgahii gt fiusi  fiusi  tgrsi tgrsian`i an`i ifutg dylpmkcdisthf dgu`glhi (IDD) dgu`glhi  (IDD) ee ifutg lygdkhe dgu`glhi (ILD) dgu`glhi (ILD) eia ehrgafiai`ia uatu`  5

 

ehdi`u ehdi`u`ia `ia pglgrh pglgrh`si `siia ia ckag lirrkw puafthka  puafthka   (CL_) piei tiannid 7 Juah 3?3?. Shwiyit pgayi`ht `gduirni si`ht sgrupi pgraim ehidilh pishga sg`htir  situ cudia yian didu. Uhei` eheipit`ia pgayi`ht `gniaisia piei `gduirni  pishga. Uhei` iei iannkti `gduirni yian si`ht piru-piru mhanni lglhaul kc kcit it sg sgdi dili li 2 cu cudi dia a cgrtu cgrturu rutt turu turut. t.   Uh Uhei` ei` ie ieii ia iannk nnkti ti `gdui `gduirn rnii yi yian an lgahannid `irgai si`ht. _ishga _is hga lgrupi` lgrupi`ia ia iai` `geui `geui eirh eirh eui cgrsiu cgrsiueir eirii eia lgrupi lgrupi`ia `ia iai` yian ehhanha`ia.  ehhanha`ia.  Hcu rijha lglgrh`si`ia `gmilhdiaayi eh cheia. Vgdili milhd mil hd hcu pishga pishga lgaeip lgaeipit it vhtilh vhtilha a eirh eirh cheia. cheia.   _ishga dimhr fu`up cudia, sgfiri akrlid, ehtkdkan kdgm cheia, diansuan lgaianhs `uit, thei` pgraim sgsi` aipis liupua chru egania cgrit cieia dimhr 6.3?? nril, piajian cieia 7? fl.

_ishga _ishg a lgaeipit`ia lgaeipit`ia IVH sgji` dimhr silpih ushi 2 cudia. Vgji` ushi 2  cudia pishga lgaeipit`ia li`iaia pgaeilphan cucur susu 6-5 x sgmirh 7-2 sgaek` li`ia, piei ushi ushi 8 cudia pishga ludih ehcgrh`ia li`ia cgrupi ai aish sh thl, thl, pi piei ei us ushi hi 9 ti timua mua pi pish shga ga ludi ludihh li`i li`ia a lgau lgau `g `gdu duir irni ni egani egania a lgannuai`ia aish dglcg`. Viit hah pishga li`ia 6 `idh sgmirh egania pkrsh sgtganim pkrsh egwisi egania aish eia siyur cgrvirhish sgrti diu` piu` sgpgrth timu, tglpg, tgdur, eia h`ia sgrti sgdidu michs thip `idh li`ia. _ishga eueu` eh `gdis 9 VL_, cgrniud egania tglia sgciyiayi eia prgstish eh sg`kdim thei`  tgrthannid. _ishga tgrlisu` iai` yian i`thb eidil `gsgmirhiaayi. Watu Wa tu` ` rhwi rhwiyi yitt hl hlua uahs hsis ishh lgau lgauru rutt `g `gdu duir irni ni sg sgsu suih ih eg egan ania ia ei eibt btir  ir  hluahsish eh @LV. @LV.   _ishga tgdim lgaeipit`ia hluahsish CFN 9 `idh, mgpithths C sgciayi` 9 `idh (siit dimhr), E_U-MC sgciayi` 6 `idh, _kdhk sgciayi` 5 `idh, filpi` 9 `idh. Viit sg`kdim eisir pishga sgdidu lganh`uth jiewid hluahsish eh sg`kdim. _ishga lgaeipit`ia hluahsish rutha eh cheia eia eh pus`gslis sgsuih egania jiewid hluahsish. @gsia hluahsish sgsuih jiewid `glgatrhia `gsgmitia 3??5. _ishga _is hga thannid thannid cgrsil cgrsilii krian krian tui pishga pishga.. _is _ishga hga thannid thannid eh rulim rulim u`uria 93l x 9?l. Iyim pishga cg`grji sgcinih whriswisti. Hcu pishga thei`  7

 

 cg`grji eia sgcinih hcu rulim tianni. _ganmishdia pgrcudia sg`htir Sp 3.???.???,??. Cgrh`ut pkmka `gduirni pishga:

Ia H, 95 timua, 7? `n

Nilcir 9. _kmka `gduirni pishga

_iei pglgrh`siia bhshs eh HNE eheipit`ia `gsia ulul tilpi` si`ht sgeian, `gsieiria G5R7L2 (`klpks lgaths), nhzh `gsia cih`. Diju aieh =? `idh  pgr lgaht tgritur, hsh eia tgniania fu`up, diju aipis 35 `idh pgr lgaht fgpit eia ei eidi dil, l, su sumu mu pgr i` i`sh shdi di 62,> 62,>?F, tg`iaia tg`iaia eirim eirim 99?/>? 99?/>? llMn, llMn, eia situri siturish sh k`shnga (VhK3) 88%. Cgrit cieia pishga 7? `n, thannh cieia 9>3 fl. Vtitus nhzh sgfiri

iatrkpklgtrh

CC/W, 7?.83>, _U 3?,7 egth`, egth`, HAS  HAS 

9,7=, I_UU 6>,9 egth`. Eh HNE SVWE Er. Lkgwireh pishga `glcidh ehpgrh`si `ieir gdg`trkdht egania mishd aitrhul 969 llkd/D, `idhul 6,8 llkd/D, `dkrhei 82 llkd/D, llkd/D, `idshul `idshul hka 9,93 llkd/D. llkd/D. @gsia iaglhi akrlkshth` akrlkshth` akrlk`rkl, akrlk`rkl, mhpgrdgu`kshtkshs, agutrkpgahi rgdithb, dhlbkshtkshs, trklckshtkpgahi. _iei pishga `ilh ehinakshs egania mhpgrdgu`ks mhpgrdgu`kshtks htkshs hs gt fiusi  fiusi  tgrsian`i ifutgg dylpmkc ifut dylpmkcdis disthf thf dgu`gl dgu`glhi hi   (IDD) ee ee ifu ifutg tg lygdkhe lygdkhe dgu`gl dgu`glhi hi   (ILD), gphsti`shs iatgrhkr gt fiusi trklckshtkpgahi, fiusi trklckshtkpgahi, iaglhi akrlkshth` akrlk`rklh` gt   pgreirimia, tgrsian`i IDD ee ILD, eia nhzh cih`. fiusi pgreirimia, fiusi _ishg _is hga a ehcgr ehcgrh` h`ia ia ti titi tidi di`s `sia iaii eg egani ania a pg pgri riwi witi tia a eh cians ciansid id mg mgli litk tk ka`kdkn ka`k dknhh iai`, iai`, ehgt ehgt aish aish diu` diu` 3??? ``id/mirh ``id/mirh,, habus habus mheris mherishh E79/5A E79/5AV V (6??? (6??? >

 

ld/D_C ld/ D_C)) 9=> ld/jil ld/jil,, hajg`s hajg`shh burksg burksglhe lhegg (?,7 (?,7 ln/ ln/`n/ `n/= = jil) jil) 37 ln/ = jil hatrivgai, aitrhul ch`irckait ticdgt (67 lgq/D_C) 76 lgq itiu 8 ticdgt pgr krid  jh`i pM urha ≥ 2,7, iddkpurhakd ticdgt (9? ln/`n/mirh) 9?? ln/ = jil pgr krid. _ishga ehrgafiai`ia uatu` ehcgrh`ia triasbush trklcksht sgciayi` 9? `iatkan. _glgrh`siia dickritkrhul yian ehdi`u`ia ieidim eirim dgan`ip, gdg`trkdht, isil urit sgthip 5= jil, pM urha sgthip 35 jil. _ishga `gluehia eh`kasud`ia `g UV Ugdhan Ugd hanii Mheuan Mheuan Ugannkr Ugannkrk`ia k`ia @gpidi @gpidi Dgmgr Dgmgr (UMU-@ (UMU-@D) D) uatu` uatu` pgaiani pgaianiaia aia gphsti`shs piei pishga. Eirh UV UMU-@D pishga ehehinakshs egania gphsti`shs iatgrhkr. _ishga `gluehia ehpisian tilpka mheuan iatgrhkr egania iergaidha. Uilpka mheuan ehpgrtimia`ia sgdili eui mirh.

_iei pgriwitia mirh pgrtili eh ciansid tiannid ?9 Juah 3?3? lhlhsia  cgrmgath. Aygrh tuan`ih lishm eheipit`ia. _ishga thei` eglil, thei` sgsi`, thei`  iei `gdumia `gdumia luid liupua liupua luatim luatim eia aygrh aygrh udu mith. @gsia ulul pishga pishga tilpi` si`ht sgeian, nhzh `gsia cih`. Diju aieh 8? `idh pgr lgaht tgritur, hsh eia tgniania fu`up, diju aipis 33 `idh pgr lgaht fgpit eia eidil, sumu pgr i`shdi 62,=?F, tg`iaia eirim 99?/>? llMn, eia siturish siturish k`shnga (VhK3) 8=%, Cidias fihria fih ria +6?? +6?? ld/mi ld/mirh rh (97%), (97%), ehurgs ehurgshs hs 3,7 ld/`n/ ld/`n/jil jil.. @gpidi @gpidi cgatu` cgatu` akrlid akrlid,, lgsksgbid, rilcut mhtil thei` lueim rkatk`, `kajuanthvi liti pufit, s`dgri thei` h`tgrh`, liti thei` fg`uan, `geui puphd hsk`kr egania ehilgtgr 3ll/3 ll, rgbdg`s fimiyi `geui puphd akrlid. Dhian `geui tgdhani tilpi` dipian, thei` iei sg`rgt. Uhei` eheipit`ia aipis fuphan mheuan, thei` eheipit`ia sg`rgt, tgrpisian tilpka mheuan iatgrhkr. _iei ludut eheipit`ia lu`ksi chchr dglcic,  piei tgannkrk` thei` eheipit`ia birhan mhpgrglhs, `geui tkashd thei` lglcgsir, thei thei` ` eheip eheipit it`i `ia a `rhp `rhpti ti yi yian an lgdg lgdgcir cir liupu liupua a eg egtr trht htus us.. _i _iei ei dg dgmgr mgr th thei`  ei`  eheipi ehe ipit`i t`ia a pglcgs pglcgsiri iria a `gdgaj `gdgajir ir ngtim ngtim cgahan cgahan,, tg` tg`iaia iaia vgai junudi junudirhs rhs th thei`  ei`  lgahan`it. _iei haspg`sh tkri`s thei` eheipit`ia rgtri`sh. _iei pglgrh`siia jiatuan, haspg`sh thei` tilpi` h`tus `krehs, piei pidpish h`tus `krehs thei` `uit ian`it eia eia thei` ei` tgr gric icii tmrhdd , piei piei pg pgr` r`us ushh ci citi tiss ji jiat atuan uan `i `iai aia a it itis is pi piei ei dh dhag agii  piristgraidhs eg`stri eia citis jiatuan ciwim piei spithul hatgr`kstid HR dhag lhe`divh`udirhs shahstri, `gsia citis jiatuan thei` lgdgcir, piei ius`udtish suiri  jiatuan H eia HH rgnudgr, hatgashtis akrlid, thei` eheipit`ia chshan jiatuan. _iei =

 

 pglgrh`siia piru, haspg`sh tilpi` shlgtrhs piei ehaehan eiei eia pgrngri`ia ehaehan eiei `iaia sili egania `hrh, piei pidpish brglhtus rici eiei sudht ehgviduish, piei pgr`ush `geui dipian piru skakr, eia piei ius`udtish tgreganir  aipis vgsh`udgr eh `geui dipian piru, thei` eheipit`ia suiri aipis tilcimia. _ieii pglgrh _ie pglgrh`si `siia ia iceklg iceklga, a, haspg` haspg`sh sh tilpi` tilpi` ehaeha ehaehan n pgrut pgrut sgjiji sgjijir  r  egania ehaehan eiei, suiri chshan usus akrlid, piei pgr`ush eheipit`ia suiri thlp thlpia iah, h, ei eia a pi piei ei pi pidp dpis ishh thei` thei` eheip eheipit it`i `ia a aygrh aygrh tg tg`i `ia, a, th thei ei` ` eh ehei eipi pit` t`ia ia  pglcgsiria mgpir 3 fl ciwim ir`us `ksti egxtri, dhga thei` tgrici lglcgsir. _iei gs`trglhtis tgdipi` `i`h eia tiania tgrici mianit piei pgriciia, irtgrh ekrsidhs pgehs tgrici `uit, eia fiphddiry rgbhdd thlg (FSU) 9 egth`. _glgrh _gl grh`si `siia ia nilcir nilciria ia eirim eirim tgph tgph eheipit eheipit`ia `ia mishd mishd eirh eirh sgrh sgrh grhtr grhtrksh kshtt akrlksht, akrlk`rkl, grhtrktcdist (+), sgrh dgu`ksht juldim lgahan`it, ithph`id dhlb dhlbks kshht,

sgd sgd  slueng  slueng,,

dhlb dhlbkc kcdi dist st (+)0 (+)0 sg sgrh rh tr trkl klcks cksht ht ju juld ldim im lgau lgauru rua, a,

li`rktrklcksht, fdulphan (-) sgciria lgriti0 `gshlpudia nilciria chshtkpgahi

ehsgrt ehs grtih ih mhpgrd mhpgrdgu`k gu`ksht shtksh kshss yian lganir lganirim im `g `gniais `gniaisia ia mglitk mglitkdkn dknhh i`ut i`ut sgrh sgrh dhlbkhe. Ehdi`u`ia pglgrh`siia urhaidhsi egania mishd wirai `grum, CJ urha 9?95, pM 7,?, dgu`ksht (-), ahtrht (-), prktgha (+), gphtgd gphtgd s`uilks s`uilks 3-6/dpc, gphtgd triashshkaid ?-9/dpc, shdhaegr nriauditge 5-7/dp`. _ishga _is hga ehehin ehehinaks akshs hs egania egania mhpgrd mhpgrdgu`k gu`ksht shtksh kshss gt fiusi  tgrsian an`i `i ifutg fiusi  tgrsi dylpmkcdisthf dgu`glhi  dgu`glhi  (IDD) (IDD) ee ee ifutg lygdkhe dgu`glhi  dgu`glhi  (ILD), gphsti`shs iatgr iat grhk hkrr gt fiusi  fiusi  trklcksht trklckshtkpgahi, kpgahi, iaglhi akrlkshth` akrlkshth` akrlk`rklh` akrlk`rklh` gt fiusi  pgreirimia, tgrsian`i IDD ee ILD, eia nhzh cih`. _i _ish shga ga ehcg ehcgrh rh`i `ia a ti titi tidi di`s `sia iaii eg egani ania a pg pgri riwi witi tia a eh ci cians ansid id mg mgli litk tk ka`kdkn ka`k dknhh iai`, iai`, ehgt ehgt aish aish diu` diu` 3??? ``id/m ``id/mirh irh,, habus habus mheris mherishh E79/5A E79/5AV V (6??? (6??? ld/D_C ld/ D_C)) 9=> ld/jil ld/jil,, hajg`s hajg`shh burksg burksglhe lhegg (?,7 (?,7 ln/ ln/`n/ `n/= = jil) jil) 37 ln/ = jil hatr hatriv ivga gai, i, hajg hajg`s `shh pirif pirifgt gtil ilkd kd (9? (9? ln/` ln/`n/ n/`i `idh dh)) 7? 7?? ? ln jh jh`i `i aygrh aygrh,, ai aitr trhu hul l  ch`irckait ticdgt (67 lgq/D_C) 7 76 6 lgq itiu 8 ticdgt pgr krid jh`i pM urha ≥ 2,7, iddkpurhakd ticdgt (9? ln/`n/mirh) 9?? ln/ = jil pgr krid. _ishga ehrgafiai`ia uatu` pglgrh`siia CL_. Lkahtkrhan piei pishga cgrupi pgliatiuia `gieiia ulul, tiaei vhtid, cidias fihria, ehurgshs/ = jil, _ieii pgriwitia _ie pgriwitia mirh `geui `geui eh ciansid ciansid tiannid tiannid ?3 Juah Juah 3?3?,

pishga pishga 8

 

`glcid `gl cidhh lganid lganidilh ilh lhlhs lhlhsia, ia, aygrh aygrh sgaeh sgaeh piei piei `i`h `i`h cgr`ur cgr`urian ian,, pishga pishga thei`  thei`  eglil, thei` sgsi`, thei` eheipit`ia `gdumia luid eia luatim. @gsia ulul  pishga tilpi` si`ht sgeian, nhzh `gsia cih cih`. Diju aieh 83 `idh pgr lgaht tgritur, hsh eia tgniania fu`up, diju aipis 3? `idh pgr lgaht fgpit eia eidil, sumu pgr  i`shdi 6>?F, tg`iaia eirim 99?/>? llMn, eia siturish k`shnga (VhK3) 8=%. Lkahtkrhan cidias fihria +3?? ld/mirh (9?%), ehurgshs 6,3 ld/`n/jil. @gpidi  cgatu` akrlid, lgsksgbid, rilcut mhtil thei` lueim rkatk`, `kajuanthvi liti  pufit, s`dgri thei` h`tgrh`, liti thei` fg`uan, `geui puphd hsk`kr egania ehilgtgr 3ll/3 ll, rgbdg`s fimiyi `geui puphd akrlid. Dhian `geui tgdhani tilpi` dipian, thei` iei sg`rgt. Uhei` eheipit`ia aipis fuphan mheuan, thei`  eheipit`ia sg`rgt, eheipit`ia sg`rgt, tgrpisian tgrpisian tilpka mheuan iatgrhkr. iatgrhkr. _iei ludut eheipit`ia eheipit`ia lu`ksi chchr dglcic, piei tgannkrk` thei` eheipit`ia birhan mhpgrglhs, `geui tkashd thei` lglcgsir, thei` eheipit`ia `rhpti yian lgdgcir liupua egtrhtus. _iei dgmgr thei` thei` eheipit`ia eheipit`ia pglcgsiria pglcgsiria `gdgajir `gdgajir ngtim cgahan, cgahan, tg`iaia vgai  junudirhs thei` lgahan`it. _iei haspg`sh tkri`s thei` eheipit`ia rgtri`sh. _iei pglgrh`siia jiatuan, haspg`sh thei` tilpi` h`tus `krehs, piei pidpish h`tus `krehs thei` `uit ian`it

eia eia thei` ei` tgr gric icii tmrhdd , piei piei pg pgr` r`us ushh ci citi tiss ji jiat atuan uan `i `iai aia a it itis is pi piei ei dh dhag agii  piristgraidhs eg`stri eia citis jiatuan ciwim piei spithul hatgr`kstid HR dhag lhe`divh`udirhs shahstri, `gsia citis jiatuan thei` lgdgcir, piei ius`udtish suiri  jiatuan H eia HH rgnudgr, hatgashtis akrlid, thei` eheipit`ia chshan jiatuan. _iei  pglgrh`siia piru, haspg`sh tilpi` shlgtrhs piei ehaehan eiei eia pgrngri`ia ehaehan eiei `iaia sili egania `hrh, piei pidpish brglhtus rici eiei sudht ehgviduish, piei pgr`ush `geui dipian piru skakr, eia piei ius`udtish tgreganir  aipis vgsh`udgr eh `geui dipian piru, thei` eheipit`ia suiri aipis tilcimia. _ieii pglgrh _ie pglgrh`si `siia ia iceklg iceklga, a, haspg` haspg`sh sh tilpi` tilpi` ehaeha ehaehan n pgrut pgrut sgjiji sgjijir  r  egania ehaehan eiei, suiri chshan usus akrlid, piei pgr`ush eheipit`ia suiri thlpiah, thlpi ah, eia piei pidpish thei` eheipit`ia eheipit`ia aygrh tg`ia, pglcgsiria pglcgsiria mgpir 3 fl  ciwim ir`us `ksti egxtri, dhga thei` tgrici lglcgsir. _iei gs`trglhtis tgdipi`  `i`h eia tiania tgrici mianit piei pgriciia, irtgrh ekrsidhs pgehs tgrici `uit, eia fiphddiry rgbhdd thlg (FSU) 9 egth`. Ehdi`u`ia pglgrh`siia dickritkrhul, egania mishd mglkndkcha 5,7 n/ed, 9?

 

mglitk`rht 93%, dgu`ksht 78,> rhcu/ud, trklcksht 33 rhcu/ud, grhtrksht 9,58 juti/ud, LFR > = , 6 /ul, /ul, LFM 6?,9 6?,9 pn, LFMF LFMF 6=,5 6=,5 n/ed, n/ed, gkshak gkshakbhd bhd 9 %, ciskbh ciskbhdd ?%, agtrkbhd 3%, dhlbksht dhlbksht 68%, lkaksht ?%, DWF/ILF 78%, IAF 9985, IDF 36.3=6, isil urit 99,5 ln/ed, aitrhul 96? llkd/D, `idhul 7 llkd/D, `dkrhei 83 llkd/ llk d/D, D, `idshu `idshul l 9,?9 9,?9 llkd/ llkd/D, D, linags linagshul hul ?,69 ?,69 llkd/D. llkd/D. @gsia @gsia iaglhi iaglhi lh`rkshth` akrlk`rklh`, mhpgrdgu`kshtkshs, agutrkpgahi rgdithb, trklckshtkpgahi, mhpgrurhsglhi, mypkaitrglhi, mhpk`idsglhi, mhpgr`idglhi, mhpk`dkrglhi. _ishga _is hga ehehin ehehinaks akshs hs egania egania mhpgrd mhpgrdgu`k gu`ksht shtksh kshss gt fiusi  fiusi  tgrsi tgrsian an`i `i ifutg dylpmkcdisthf dgu`glhi  dgu`glhi  (IDD) (IDD) ee ee ifutg lygdkhe dgu`glhi  dgu`glhi  (ILD), gphsti`shs iatgr iat grhk hkrr gt fiusi  fiusi  trklcksht trklckshtkpgahi, kpgahi, iaglhi akrlkshth` akrlkshth` akrlk`rklh` akrlk`rklh` gt fiusi  pgreirimia, tgrsian`i IDD ee ILD, eia nhzh cih`. _i _ish shga ga ehcg ehcgrh rh`i `ia a ti titi tidi di`s `sia iaii eg egani ania a pg pgri riwi witi tia a eh ci cians ansid id mg mgli litk tk ka`kdkn ka`k dknhh iai`, iai`, ehgt ehgt aish aish diu` diu` 3??? ``id/m ``id/mirh irh,, habus habus mheris mherishh E79/5A E79/5AV V (6??? (6??? ld/D_C ld/ D_C)) 9=> ld/jil ld/jil,, hajg`s hajg`shh burksg burksglhe lhegg (?,7 (?,7 ln/ ln/`n/ `n/= = jil) jil) 37 ln/ = jil hatriv hatrivgai gai,, , hajg`s hajg`shh pirifg pirifgtil tilkd kd (9? ln/`n/ ln/`n/`idh `idh)) 7?? ln jh`i jh`i aygrh, aygrh, aitrhu aitrhul l  ch`irckait ticdgt (67 lgq/D_C) 7 76 6 lgq itiu 8 ticdgt pgr krid jh`i pM urha ≥ 2,7, idd iddkpur kpurha hakd kd ti ticd cdgt gt (9? (9? ln/`n n/`n/m /mir irh) h) 9?? 9?? ln/ = jil pgr pgr kr krid id,, `krg `krg`s `shh mypklinagsglhi egania hajg`sh LnVK5 3?% (37 ln/`n/mirh) 2 ld/mirh eidil  AiFd ?,8% 9?? ld. _ishga ehrgafiai`ia uatu` pglgrh`siia CL_ piei tiannid ?7 Juah 3?3?. _ishga rgafiai ehcgrh`ia triasbush eirim trklcksht 97 uaht, sgdian

93 ji jil l `g `glu lueh ehia ia tria triasb sbus ushh _SF _SF 6 `kdb `kdb.. Lkah Lkahtk tkrh rhan an pi piei ei pi pish shga ga cg cgru rupi pi  pgliatiuia `gieiia ulul, tiaei vhtid, cidias fihria, ehurgshs/ = jil, iwish tiaei-tiaei rgi`sh triasbush. _ieii pgriwi _ie pgriwitia tia mirh `gthni `gthni eia `gglpi `gglpitt eh ciansi ciansidd tianni tiannidd ?6 eia ?5 Ju Juah ah 3?3?, 3?3?,

pi pish shga ga su suei eim m thei thei` ` ehei eheipit pit`i `ia a lh lhlh lhsi sia, a, ay aygr grhh sg sgaeh aeh piei `i`h `i`h

 cgr`urian, pishga eheipit`ia eglil, thei` sgsi`, thei` eheipit`ia `gdumia luid eia luatim. @gsia ulul pishga tilpi` si`ht sgeian, nhzh `gsia cih`. Diju aieh 83 `idh pgr lgaht tgritur, hsh eia tgniania fu`up, diju aipis 3? `idh pgr lgaht fgpit eia eidil, sumu pgr i`shdi 6=,6 ?F, tg`iaia eirim 99?/>? llMn, eia siturish situr ish k`shnga (VhK3) 8=%, Lkahtkrhan Lkahtkrhan cidias fihria +6?? ld/mirh ld/mirh (97%), (97%), ehurgshs ehurgs hs 3,>ld/`n/ji 3,>ld/`n/jil. l. @gpidi @gpidi cgatu` akrlid, lgsksgbid, lgsksgbid, rilcut mhtil thei`  lueim rkatk`, `kajuanthvi liti pufit, s`dgri thei` h`tgrh`, liti thei` fg`uan, 99

 

`geui puphd hsk`kr egania ehilgtgr 3ll/3 ll, rgbdg`s fimiyi `geui puphd akrlid. Dhian `geui tgdhani tilpi` dipian, thei` iei sg`rgt. Uhei` eheipit`ia aipis fuphan mheuan, thei` eheipit`ia sg`rgt, tgrpisian tilpka mheuan iatgrhkr. _iei ludut eheipit`ia lu`ksi chchr dglcic, piei tgannkrk` thei` eheipit`ia birhan birha n mhpgrglhs, mhpgrglhs, `geui tkashd tkashd thei` lglcgsir, lglcgsir, thei` eheipit`ia eheipit`ia `rhpti `rhpti yian lgdgcir lgd gcir liupua liupua egtrh egtrhtus tus.. _iei _iei dgmgr dgmgr thei` thei`

eheipit eheipit`ia `ia pglcgs pglcgsiri iria a `gdgaj `gdgajir  ir 

ngtim cgahan, tg`iaia vgai junudirhs thei` lgahan`it. _iei haspg`sh tkri`s thei` eheipit`ia rgtri`sh. _iei pglgrh`siia jiatuan, haspg`sh thei` tilpi` h`tus `krehs, piei pidpish h`tus `krehs thei` `uit ian`it eia eia thei` ei` tgr gric icii tmrhdd , piei piei pg pgr` r`us ushh ci citi tiss ji jiat atuan uan `i `iai aia a it itis is pi piei ei dh dhag agii  piristgraidhs eg`stri eia citis jiatuan ciwim piei spithul hatgr`kstid HR dhag lhe`divh`udirhs shahstri, `gsia citis jiatuan thei` lgdgcir, piei ius`udtish suiri  jiatuan H eia HH rgnudgr, hatgashtis akrlid, thei` eheipit`ia chshan jiatuan. _iei  pglgrh`siia piru, haspg`sh tilpi` shlgtrhs piei ehaehan eiei eia pgrngri`ia ehaehan eiei `iaia sili egania `hrh, piei pidpish brglhtus rici eiei sudht ehgviduish, piei pgr`ush `geui dipian piru skakr, eia piei ius`udtish tgreganir  aipis vgsh`udgr eh `geui dipian piru, thei` eheipit`ia suiri aipis tilcimia. _ieii pglgrh _ie pglgrh`si `siia ia iceklg iceklga, a, haspg` haspg`sh sh tilpi` tilpi` ehaeha ehaehan n pgrut pgrut sgjiji sgjijir  r  egania ehaehan eiei, suiri chshan usus akrlid, piei pgr`ush eheipit`ia suiri thlp thlpia iah, h, ei eia a pi piei ei pi pidp dpis ishh thei` thei` eheip eheipit it`i `ia a aygrh aygrh tg tg`i `ia, a, th thei ei` ` eh ehei eipi pit` t`ia ia  pglcgsiria mgpir 3 fl ciwim ir`us `ksti egxtri, dhga thei` tgrici. _iei gs`trglhtis tgdipi` `i`h eia tiania tgrici mianit piei pgriciia, irtgrh ekrsidhs  pgehs tgrici `uit, eia fiphddiry rgbhdd thlg (FSU) 9 egth`. Ehdi`u`ia Ehdi `u`ia pglgrh`siia pglgrh`siia dickritkrhul, dickritkrhul, egania mishd mglkndkcha mglkndkcha 5,2 n/ed,

mglitk`rht 95%, dgu`ksht >9,3 rhcu/ud, trklcksht 59 rhcu/ud, grhtrksht 9,7> juti/ud, LFR LF R = 2 , 6 /ul, /ul, LFM LFM 3 8 , 2 pn pn,, LFMF LFMF 65, 65,6 6 n/ed n/ed,, gksh gkshakb akbhd hd 9 %, cis ciskb kbhd hd ?%, agtrkbhd 6%, dhlbksht dhlbksht 6>%, lkaksht 6%, DWF/ILF 72%, IAF 3962, IDF 32.655, isil urit >,3 ln/ed, aitrhul 96? llkd/D, `idhul 7 llkd/D, `dkrhei 8? llkd/ llk d/D, D, `idshu `idshul l 9,?9 9,?9 llkd/ llkd/D, D, pM urha urha 2,> ln/ed, ln/ed, `gsia `gsia iaglhi iaglhi akrlks akrlkshth hth`  `  akrlk` akr lk`rk rklh lh`, `,

mhpg mhpgrd rdgu gu`k `ksh shtk tksh shs, s,

ag agut utrk rkpg pgah ahii

rg rgdi dith thb, b,

tr trkl klck cksh shtk tkpg pgah ahi, i,

mhpgrurhsglhi, mypkaitrglhi, mhpgr`idglhi, mhpk`dkrglhi. _ishga _is hga ehehin ehehinaks akshs hs egania egania mhpgrd mhpgrdgu`k gu`ksht shtksh kshss gt fiusi  fiusi  tgrsi tgrsian an`i `i ifutg 93

 

dylpmkcdisthf dgu`glhi  dgu`glhi  (IDD) (IDD) ee ee ifutg lygdkhe dgu`glhi  dgu`glhi  (ILD), gphsti`shs iatgr iat grhk hkrr gt fiusi  fiusi  trklcksht trklckshtkpgahi, kpgahi, iaglhi akrlkshth` akrlkshth` akrlk`rklh` akrlk`rklh` gt fiusi  pgreirimia, tgrsian`i IDD ee ILD, eia nhzh cih`. _i _ish shga ga ehcg ehcgrh rh`i `ia a ti titi tidi di`s `sia iaii eg egani ania a pg pgri riwi witi tia a eh ci cians ansid id mg mgli litk tk ka`kdkn ka`k dknhh iai`, iai`, ehgt ehgt aish aish diu` diu` 3??? ``id/m ``id/mirh irh,, habus habus mheris mherishh E79/5A E79/5AV V (6??? (6??? ld/D_C ld/ D_C)) 9=> ld/jil ld/jil,, hajg`s hajg`shh burksg burksglhe lhegg (?,7 (?,7 ln/ ln/`n/ `n/= = jil) jil) 37 ln/ = jil hatriv hatrivgai gai,, , hajg`s hajg`shh pirifg pirifgtil tilkd kd (9? ln/`n/ ln/`n/`idh `idh)) 7?? ln jh`i jh`i aygrh, aygrh, aitrhu aitrhul l  ch`irckait ticdgt (67 lgq/D_C) 7 76 6 lgq itiu 8 ticdgt pgr krid jh`i pM urha ≥ 2,7, idd iddkpur kpurha hakd kd ti ticd cdgt gt (9? (9? ln/`n n/`n/m /mir irh) h) 9?? 9?? ln/ = jil pgr pgr kr krid id,, `krg `krg`s `shh mypklinagsglhi egania hajg`sh LnVK5 3?% (37 ln/`n/mirh) 2 ld/mirh eidil  AiFd ?,8% 9?? ld. _ishga ehrgafiai`ia uatu` pglgrh`siia CL_ piei tiannid ?7 Juah Juah 3?3?. 3?3?. _ishga _ishga rgafia rgafiaii ehcgrh ehcgrh`ia `ia triasb triasbush ush eirim eirim trklck trklcksht sht chd chdii iei  pgreirimia, triasbush _SF 9 `kdb, sgdian 93 jil, triasbusg _SF 9 `kdb. Lkahtkrhan piei pishga cgrupi pgliatiuia `gieiia ulul, tiaei vhtid, cidias fihria, ehurgshs/ = jil, iwish tiaei-tiaei rgi`sh triasbush. _iei pgriwitia mirh `gdhli eia `ggail eh ciansid tiannid ?7 eia ?2 Juah 3?3?, pishga `glcidh eheipit`ia lhlhsia, lhlhsia, tgreipit chath`-chath` chath`-chath` `glgrimia eh `i`h, pishga lgangdum aygrh tgdhani eia aygrh `i`h, pishga eheipit`ia eglil, thei` sgsi`, pishga lgangdum luid eia luatim. @gsia ulul pishga tilpi`  si`ht sgeian, nhzh `gsia cih`. Diju aieh 83 `idh pgr lgaht tgritur, hsh eia tgniania fu`up, diju aipis 3? `idh pgr lgaht fgpit eia eidil, sumu pgr i`shdi 6=,6F, tg`iai tg` iaia a eirim eirim 99?/>? 99?/>? llMn, llMn, eia situri siturish sh k`shng k`shnga a (VhK3) (VhK3) 8=%, 8=%, ehurgs ehurgshs hs 3,6 ld/`n/jil, cidias fihria +3?? ld/mirh. @gpidi cgatu` akrlid, lgsksgbid, rilcut mhtil thei` lueim rkatk`, `kajuanthvi liti pufit, s`dgri thei` h`tgrh`, liti thei` fg`uan, `geui puphd hsk`kr egania ehilgtgr 3ll/3 ll, rgbdg`s fimiyi `geui puphd akrlid. Dhian `geui tgdhani tilpi` dipian, thei` iei sg`rgt. sg`rgt. Uhei`  eheipit ehe ipit`ia `ia aipis aipis fuphan fuphan mheuan mheuan,, thei` thei` eheipi eheipit`i t`ia a sg`rgt sg`rgt,, tgr tgrpis pisian ian tilpka tilpka mheuan iatgrhkr. _iei ludut eheipit`ia lu`ksi chchr dglcic, piei tgannkrk` 

thei` eheipit`ia birhan mhpgrglhs, `geui tkashd thei` lglcgsir, thei` eheipit`ia `rhptii yian lgdgcir liupua egtrhtus. `rhpt egtrhtus. _iei dgmgr thei` eheipit`ia eheipit`ia pglcgsiria pglcgsiria `gdgajir ngtim cgahan, tg`iaia vgai junudirhs thei` lgahan`it. _iei haspg`sh tkri`s thei` eheipit`ia rgtri`sh. _iei pglgrh`siia jiatuan, haspg`sh thei` tilpi` h`tus `krehs, piei pidpish h`tus `krehs thei` `uit ian`it 96

 

eia thei` thei` tg tgri rici ci tmrh tmrhdd dd,, piei piei pg pgr` r`us ushh ci citi tiss ji jiat atua uan n `ia `iaia ia it itis is pi piei ei dh dhag agii  piristgraidhs eg`stri eia citis jiatuan ciwim piei spithul hatgr`kstid HR dhag lhe`divh`udirhs shahstri, `gsia citis jiatuan thei` lgdgcir, piei ius`udtish suiri  jiatuan H eia HH rgnudgr, hatgashtis akrlid, thei` eheipit`ia chshan jiatuan. _iei  pglgrh`siia piru, haspg`sh tilpi` shlgtrhs piei ehaehan eiei eia pgrngri`ia ehaehan eiei `iaia sili egania `hrh, piei pidpish brglhtus rici eiei sudht ehgviduish, piei pgr`ush `geui dipian piru skakr, eia piei ius`udtish tgreganir  aipis vgsh`udgr eh `geui dipian piru, thei` eheipit`ia suiri aipis tilcimia. _ieii pglgrh _ie pglgrh`si `siia ia iceklg iceklga, a, haspg` haspg`sh sh tilpi` tilpi` ehaeha ehaehan n pgrut pgrut sgjiji sgjijir  r  egania ehaehan eiei, suiri chshan usus akrlid, piei pgr`ush eheipit`ia suiri thlp thlpia iah, h, ei eia a pi piei ei pi pidp dpis ishh thei` thei` eheip eheipit it`i `ia a aygrh aygrh tg tg`i `ia, a, th thei ei` ` eh ehei eipi pit` t`ia ia  pglcgsiria mgpir   3 fl ciwim ciwim ir ir`u `uss `ksti `ksti eg egxt xtri, ri, dh dhga ga th thei` ei` tg tgri rici ci.. _iei _iei gs`trglhtis tgdipi` `i`h eia tiania tgrici mianit piei pgriciia, irtgrh ekrsidhs  pgehs tgrici `uit, eia fiphddiry rgbhdd thlg (FSU) thlg (FSU) 9 egth`. Ehdi`u`ia pglgrh`siia dickritkrhul, egania mishd mglkndkcha 5,6 n/ed, mglitk`rht 93%, dgu`ksht 5=,3 rhcu/ud, trklcksht 96 rhcu/ud, grhtrksht 9,7> juti/ud, LFR >2,6/ul, >2,6/ul, LFM 3>,2 pn, LFMF 62,9 62,9 n/e n/ed, d, gkshak gkshakbhd bhd 9%, ciskbh ciskbhdd ?%, agtrkbhd agtrkb hd 5%, dhlbksht dhlbksht 5?%, lkaksht lkaksht 3%, DWF/I DWF/ILF LF 76%, 76%, IAF 983=,

IDF

98.3==, aitrhul 997 llkd/D, `idhul 5,7 llkd/D, `dkrhei =6 llkd/D, `idshul ?,=3 ?,= 3 llkd llkd/D /D,, `g `gsi sia a ia iagl glhi hi ak akrl rlks ksht hth` h` akrlk akrlk`r `rkl klh` h`,, mh mhpg pgrd rdgu gu`ks `ksht htks kshs hs,, agutrkpgahi rgdithb, trklckshtkpgahi, mhpgrurhsglhi, mypkaitrglhi, mhpk`idsglhi, mhpgr`idglhi, mhpk`dkrglhi. _glgrh`siia urhaidhsi eheipit`ia pM urha u rha 2,7. _ishga _is hga ehehin ehehinaks akshs hs egania egania mhpgrd mhpgrdgu` gu`ksh kshtks tkshs hs gt fiusi fiusi   tgrs tgrsian`i ian`i ifutg dylpmkcdisthf dgu`glhi (IDD) ee ifutg lygdkhe dgu`glhi (ILD), gphsti`shs iatgr iat grhk hkrr gt fiusi  fiusi  trklcksht trklckshtkpgahi, kpgahi, iaglhi akrlkshth` akrlkshth` akrlk`rklh` akrlk`rklh` gt fiusi  pgreirimia, tgrsian`i IDD ee ILD, eia nhzh cih`. _i _ish shga ga ehcg ehcgrh rh`i `ia a ti titi tidi di`s `sia iaii eg egani ania a pg pgri riwi witi tia a eh ci cians ansid id mg mgli litk tk ka`kdkn ka`k dknhh iai`, iai`, ehgt ehgt aish aish diu` diu` 3??? ``id/m ``id/mirh irh,, habus habus mheris mherishh E79/5A E79/5AV V (6??? (6??? ld/D_C ld/ D_C)) 9=> ld/jil ld/jil,, hajg`s hajg`shh burksg burksglhe lhegg (?,7 (?,7 ln/ ln/`n/ `n/= = jil) jil) 37 ln/ = jil hatrivgai, hajg`sh isil triagxilit (9? ln/`n/= jil) 7?? ln/ = jil hatrivgai, hajg`sh kaeiafgatrka (?,97 ln/`n/`idh) = ln hatrivgai, aitrhul ch`irckait ticdgt

(67 lgq/D_C) 76 lgq itiu 8 ticdgt pgr krid jh`i pM urha ≥ 2,7, iddkpurhakd ticdgt 95

 

(9? ln/`n/mirh) 9?? ln/ = jil pgr krid. _ishga ehrgafiai`ia uatu` pglgrh`siia CL_ piei mirh tgrsgcut tgtiph `irgai eheipit`ia pgreirimia i`thb eirh mheuan, sgmhanni pglgrh`siia CL_ kdgm UV _itkdknh @dhah` ehtuaei. _ishga rgafiai ehcgrh`ia triasbush eirim trklcksht 97 uaht, triasbush _SF 9 `kdb, sgdian 93 jil, triasb tri asbusg usg _SF 9 `kdb. `kdb. Lkaht Lkahtkrh krhan an piei pishga pishga cgrupi cgrupi pgliat pgliatiui iuia a `gieiia `gieiia ulul, ulu l, tiaei tiaei vhtid, vhtid, cidias cidias fihria fihria,, ehurgs ehurgshs/ hs/ = jil, jil, iwish iwish tiaei-t tiaei-tiae iaeii rgi`sh rgi`sh triasbusg eia tiaei-tiaei pgreirimia. _iei pu`ud 36.??, pishga lgangdum aygrh `gpidi eia aipis tgrisi cgrit, thei` iei piaeiania `icur, thei` iei `gdumia aygrh eiei itiupua aygrh pgrut. _glgrh _gl grh`si `siia ia bhshs bhshs `gsiei `gsieiria ria fklpks fklpks lgath lgaths, s, dij diju u aieh 935x/lg 935x/lgaht aht,hs ,hshh eia tgniania fu`up, diju aipis 6?x/lgaht, sumu 62,>?F, siturish 8?%, tg`iaia eirim 9??/2? llMn, Cidias fihria +2?? ld/= jil (63%) eia ehurgshs 3,7 ld/`n/jil. _glgrh`siia `gpidi cgatu` lgsksgbid, rilcut mhtil, thei` lueim ehficut. Liti `kajuanthvi iaglhs, s`dgri thei` h`tgrh`, puphd hsk`kr, rgbdg`s fimiyi `iaia eia `hrh akrlid. _iei mheuan eheipit`ia aipis fuphan mheuan, tgrpisian tilpka mheuan egania rglcgsia eirim (+). Ludut lu`ksi cisim, nul cdggehan (-). Uhei` eheipit`ia rgtri`sh piei ehaehan eiei pishga. _glgrh`siia jiatuan, piei haspg`sh thei` tilpi` h`tus `krehs, eirh pidpish tgrici h`tus `krehs eh sgdi hni HR dhagi lhe`divh`udi `hrh thei` `uit ian`it, thei` tgrici ngtiria. Eirh pgr`ush eheipit`ia citis jiatuan `iaia itis eh sgdi hni HH dhagi piristgraid `iaia, citis `hrh itis eh sgdi hni HH dhagi piristgraid `hrh, citis `iaia ciwim eh sgdi hni HR dhagi piristgraidhs `iaia, ipg`s eh sgdi hni HR dhagi lhe`divh`udi `hrh, `gsia  citis jiatuan thei` lgdgcir. Eirh ius`udtish cuayh jiatuan rgnudgr thei`  tgreganir chshan itiupua tgreganir itiupua  niddkp  niddkp.. _iei pglgrh`siia piru, cgatu` eiei shlgtrhs siit ehil eia cgrngri`, brglhtus rici eiei `iaia sili egania `hrh, piei pgr`ush `geui dipian piru skakr, piei ius`udtish suiri eisir vgsh`udgr akrlid, thei`  tgreganir suiri aipis tilcimia eh `geui dipian piru. piru . _glgrh _glgrh`siia `siia haspg`sh haspg`sh iceklga tgrdhmit ehaehan pgrut sgjijir ehaehan eiei, chshan usus akrlid, pgr`ush thlpiah, thlpi ah, pidpish supgd, thei` eheipit`ia aygrh tg`ia, mgpir tgrici tgrici 3 fl ciwim ir`us `ksti egxtri, tgph tulpud pgrlu`iia riti, aygrh tg`ia thei` eheipit`ia. Dhga Dhg a thei` thei` tgrici tgrici.. G`strg G`strglht lhtis is eheipit eheipit`ia `ia i`rid i`rid tgr tgrici ici mianit, mianit, fiphddiry rgbhdd  thlg `urian eirh 3 egth`, irtgrh pgehs ekrsid tgrici `uit. 97

 

_ishga _is hga ehcgrh ehcgrh`ia `ia k`shng k`shngais aishh egania egania aisid aisid `iaud `iaud 3 dpl, dpl, g`stri g`stri haj hajg`s g`shh  pirifgtilkd 7?? ln eia burksglheg 5? ln sgfiri hatrivgai. Gviduish 9 jil  pis`i pglcgrhia burksglheg, `gdumia aygrh `gpidi eia sgsi` cgr`urian. Diju aipis 3?x/lgaht eia eheipit`ia urha sgciayi` 3?? ld ehurgshs aih` lgajieh 3,= ld/`n/jil (eidil 9 jil). _iei pu`ud ?9.6?, pishga lgangdum sgsi` aipis `glcidh. _glgrh`siia bhshs `gsieiria fklpks lgaths, diju aieh 93?x/lgaht,hsh eia tgniania fu`up, diju aipis aip is 6=x/l 6=x/lga gaht ht,, su sumu mu 62 62,> ,>?F, si situ turi rish sh 8?%. 8?%. _g _glg lgrh rh`s `sii iia a `g `gpid pidii cg cgat atu`  u`  lgsksgbid, rilcut mhtil, thei` lueim ehficut. Liti `kajuanthvi thei` iaglhs, s`dgri thei` h`tgrh`, puphd hsk`kr, rgbdg` fimiyi `iaia eia `hrh akrlid. _iei mheuan eheipit`ia aipis fuphan mheuan. _glgrh`siia eiei eheipit`ia rgtri`sh eh supris sup ristgr tgraid aid eia hatgrf hatgrfkst kstig, ig, piei piei ius`ud ius`udtis tishh suiri suiri eisir eisir vgsh`u vgsh`udgr dgr akrlid akrlid,, tgregan tgreganir ir suiri suiri aipis aipis tilcimi tilcimia a cgrupi cgrupi rka`mh rka`mh cisim cisim eh `geui `geui dipian dipian piru piru . _ishga ehcgrh`ia k`shngaish lis`gr 7 dpl. _u`ud ?9.57, pishga lgangdum sgsi` yian sgli`ha lglcgrit, ngdhsim, thei` eglil. _glgrh`siia bhshs `gsieiria ipiths, diju aieh 95?x/lgaht,hsh eia tgniania tgniani a fu`up, diju aipis aipis 55x/lgaht, 55x/lgaht,  nisphan , sumu 62,>?F, siturish 8?%, tg`iaia tg`iai a eirim 9??/>? llMn. _ishga _ishga ehehinakshs ehehinakshs egania ninid aipis `dhahs `dhahs,, tgrsian`i gegli piru gt fiusi kvgrdkie fiusi kvgrdkie fihria. _iei mheuan eheipit`ia aipis fuphan fuph an mheuan. mheuan. _glgrh _glgrh`si `siia ia eiei eheipi eheipit`i t`ia a rgtri` rgtri`sh sh eh supris supristgr tgraid aid eia hatgrfkstig, piei ius`udtish suiri eisir vgsh`udgr akrlid, tgreganir suiri aipis tilcimia cgrupi rka`mh cisim eh `geui dipian piru. piru. _ishga ehcgrh`ia pglcgrhia k`shngaish ASL = dpl eia hajg`sh burksglheg 5? ln sgfiri hatrivgai. _ishga ehrgafiai`ia uatu` pglgrh`siia iaidhsi nis eirim. @gduirni pishga ehgeu`ish uatu` pgrsgtujuia pglisiania hatucish sgngri eia chdi lgluan`ha`ia uatu`   pgriwitia _HFW ailua eirh phmi` `gduirni pishga lishm cgruaehan. _u`ud ?3.?? pishga lishm eidil titidi`siai titidi`siai mhpgrdgu`ks mhpgrdgu`kshtks htkshs hs egania mherish, mheris h, `gsieiria `gsieiria sgli`ha sgli`ha turua, turua, thei` eheipit`ia aipis spkatia. spkatia. _glgrh`siia _glgrh`siia bhshs bhshs diju diju aieh aieh ?x/lga ?x/lgaht, ht, diju diju aipis aipis ?x/lga ?x/lgaht, ht, situri siturish sh th thei` ei` tgr tgrcif cifi. i. _is _ishga hga ehehin ehe hinaks akshs hs egania egania firehi firehiff irrgst irrgst.. _ishga _ishga ehd ehdi`u` i`u`ia ia rgsush rgsushtis tishh jiatua jiatuan n piru piru egania vgathdish eia `klprgsh 3 : 6? eia pglcgrhia hajg`sh gphagbrha 9:9?.??? (?,9ld/`n) 7 ld. 92

 

_u`ud ?3.?7, pishga thei` sieir eia thei` iei egayut aieh, eia thei` iei aipis. _glgrh`siia bhshs diju aieh ?x/lgaht, diju aipis ?x/lgaht, siturish k`shnga 6?%. _ishga _ishga ehehin ehehinaks akshs hs egania: egania: Firehi Firehiff irrgst irrgst.. _ishga _ishga ehd ehdi`u` i`u`ia ia rgsush rgsushtis tishh  jiatuan piru egania vgathdish eia `klprgsh 3: 6?. _u`ud ?3.9?, pishga thei` sieir eia thei` iei egayut aieh, eia thei` iei aipis. _glgrh`siia bhshs diju aieh ?x/lgaht, diju aipis ?x/lgaht, siturish k`shnga 97%. _ishga _ishga ehehin ehehinaks akshs hs egania: egania: Firehi Firehiff irrgst irrgst.. _ishga _ishga ehd ehdi`u` i`u`ia ia rgsush rgsushtis tishh  jiatuan piru eia pglcgrhia hajg`sh gphagbrha 9:9?.??? (?,9ld/`n) >,7 ld. _u`ud ?3.97 pishga thei` sieir eia thei` iei egayut aieh, eia thei` iei aipis. _glgrh`siia bhshs diju aieh ?x/lgaht, diju aipis ?x/lgaht, siturish k`shnga 7%. _ishga _ishga ehehin ehehinaks akshs hs egania: egania: Firehi Firehiff irrgst irrgst.. _ishga _ishga ehd ehdi`u` i`u`ia ia rgsush rgsushtis tishh  jiatuan piru egania vgathdish eia `klprgsh 3: 6?. _u`ud ?3.3?, pishga thei` sieir eia thei` iei egayut aieh, eia thei` iei aipis. _glgrh`siia bhshs diju aieh ?x/lgaht, diju aipis ?x/lgaht, siturish k`shnga ?%. _ishga _ishga ehehin ehehinaks akshs hs egania: egania: Firehi Firehiff irrgst irrgst.. _ishga _ishga ehd ehdi`u` i`u`ia ia rgsush rgsushtis tishh  jiatuan piru eia pglcgrhia hajg`sh gphagbrha 9:9?.??? (?,9ld/`n) 7 ld. _u`ud ?3.37 pishga thei` iei egayut aieh, eia thei` iei aipis spkatia. _glgrh`siia _glgrh `siia bhshs diju aieh ?x/lgaht, ?x/lgaht, diju aipis ?x/lgaht, ?x/lgaht, siturish k`shnga 7%, liti rgbdg`s fimiyi agnithb, puphd lherhishs li`shlid, eia mishd G@N ishstkdg. _ishga ehayiti`ia lgahannid eh mieipia `gduirni, ek`tgr, eia pgriwit.

HHH.

Iaidhsh dhshss `i `isus sus

Dgu`glhi lgrupi`ia pgayi`ht `gniaisia sgd eirim yian cgrisid eirh sulsul sul sul tudian. tudian. Dgu`gl Dgu`glhi hi i`ut i`ut piei piei lisi lisi iai` iai` lgrupi` lgrupi`ia ia 6?-5?% 6?-5?% eirh eirh sgdurum `gniaisia piei iai`. Hashega eh agniri sgeian cgr`glcian sgpgrth Ishi dgchm thannh eh ciaehan eh agniri cgr`glcian. Dgu`glhi i`ut ehcinh itis dgu`glhi dhlbkcdisth` i`ut (DDI) eia dgu`glhi lhgdkcdisth` i`ut (DLI). _grcge _gr cgeiia iia hah eipit eipit eh`gai eh`gaidd kdgm kdgm piri piri imdh, imdh, ehcuit ehcuit `dishb `dishbh`i h`ish sh cgreis cgreisir` ir`ia ia lkrbkdknh` lgaurut BIC ( Briafg , Ilgrhfia, Crhthsm) Crhthsm) uatu` DDI, yihtu :

96,95

i. D9 : sgd sgd dhlbkcdis dhlbkcdis `gfhd sgrupi, sgrupi, egania `rklit `rklitha ha mklknga, mklknga, iai` iai` hath thei`  thei` tilpi` eia shtkpdisli sglpht 9>

 

 c. D3 : sgd dhlbkcdis dgchm cgsir tgtiph u`uriaayi cgrvirhish, `rklitha dgchm `isir egania iai` hath situ itiu dgchm f. D6 : sgd dhlbkcd dhlbkcdis is cgsir cgsir , mklkng mklknga a egania `rklit `rklitha ha cgrcgrf cgrcgrfi`, i`, ciayi`  ciayi` 

ehtglu`ia iai` hath sgrti shtkpdisli yian ciskbhdh` eia cgrvi`ukdhsish0 sgeian`ia uatu` DLI ehcinh : i. L-? : Dgu`glhi Dgu`glhi lhgdksh lhgdkshth` th` i`ut i`ut egania egania ehbgrgash ehbgrgashish ish lhahli lhahlidd  c. L-9 : Dgu`glhi lhgdkshth` i`ut tiapi liturish f. L-3 : Dgu`gl Dgu`glhi hi lhgdks lhgdkshth hth` ` i`ut egania egania litu lituris rishh e. L-6 : Dgu`glh Dgu`glhii prklhgdk prklhgdksht shth` h` mhpgrnr mhpgrnriaud iaudir ir g. L-5 : Dgu`g Dgu`glhi lhi lhgdkl lhgdklkaks kakshth hth` ` i`ut i`ut b. L-7 L-7 : Dg Dgu`g u`glh lhii lkak lkaksh shth th` ` i`ut i`ut n. L-2 : Dgu`gl Dgu`glhi hi grhtr grhtrkcd kcdist isth`  h`  m. L-> : Dgu`gl Dgu`glhi hi lgni` lgni`irh irhksh kshth` th` i`ut. i`ut. I`ut dhlbk dhlbkcdi cdisth sth` ` dgu`gl dgu`glhi hi (IDD) (IDD) lgrupi` lgrupi`ia ia 6?-5?% 6?-5?% `gniais `gniaisia ia mglitkdknh piei iai`, egania hashegash 7/9??.??? iai` pgr timua piei ushi ehciwim 97 timua. _gangdklpk`ia rhsh`k piei IDD eipit lgagatu`ia ahdih  prknaksth` pishga, piei IDD rhsh`k thannh (MS) lgdhputh cgcgripi bi`tkr  rhsh`k ehciwim hah: juldim dgu`ksht iwid dgchm eirh 7?.???/ud, ushi 4 9= cudia itiu 1 9? timua, bgakthp eirh hluakbgakthphan lgauaju``ia sgd C litur, jgahs `gdilha dgdi`h, thei` cgrgspka sgtgdim > mirh pglcgrhia prgeahska ehludih. 9,3,6,5 Ngjidi Ngj idi `dhahs `dhahs IDD lgrupi lgrupi`ia `ia liahb liahbgst gstish ish `kaehsh `kaehsh sulsul sulsul tud tudian ian,, eg egani ania a pgrji pgrjidi diai aia a pg pgay ayi`h i`htt chsi chsi eidil eidil mh mhtu tuan ania ia lh lhan annu nu mh mhan anni ni cudia cudia,, lgdhputh liahbgstish eh cgcgripi krnia:9,3,6,5  i. @irehk @irehkpud pudlka lkaid: id: gbush gbush pgrh`ire pgrh`ire,, lissi lissi lgehis lgehisth thaul, aul, pglcgsiri pglcgsiria a thlus, thlus, shaerkl vgai `ivi supgrhkr   c. Liti: pgreirimia rgthai f. Ktkt Ktkt,, tudi tudian an,, sg sgae aeh: h: si si`h `htt ktkt ktkt,, sg sgae aeh, h, tu tudi dian an `i `irg rgai ai ha habh bhdt dtis ishh sg sgdd sg sgdd dgu`glhi (6? ‖ 5?%) e. Nistrk Nistrkhat hatgst gsthai haid: d: pgreiri pgreirimia mia siduri siduria a fgrai g. @udht @udht : iaglhs iaglhs,, pgreiri pgreirimia mia (purp (purpuri uri,, mglitkl mglitkli) i)

9=

 

b. Lu`k Lu`ksi si : ia iagl glhs hs,, pg pgre reir irim imia ia (n (nus ush, h, gp gphs hsti ti`s `shs hs), ), ud udsg sgri ri lh lhrh rhp p akli akli,, Duewhn ianhai, ehbtgrhi ehbtgrhi itiu inriaudksh inriaudkshtkshs tkshs00 pglcgan`i`ia pglcgan`i`ia eia udsgrish udsgrish nhanhvi (sgrhan piei dgu`glhi lkakshth`). Ehinaks Ehi nakshs hs ehtgni` ehtgni``ia `ia cgreis cgreisir` ir`ia ia iailags iailagshs, hs, pglgrh pglgrh`si `siia ia bhs bhsh`, h`, dickri dic kritkr tkrhul hul eia ehpist ehpisth`i h`ia a egania egania pglgrh pglgrh`si `siia ia isphr isphrish ish sulsul sulsul tud tudian. ian. Iailagshs Iailags hs eheipit eheipit `gdumia `gdumia eglil cgr`gpiajiania, cgr`gpiajiania, pgreirimia pgreirimia eia pufit. pufit. Iai` juni lgangdum aygrh sgaeh eia tudian. _glgrh`siia bhsh` lgauaju``ia

ieiayi ieia yi pufit, pufit, eglil, eglil, tiaei tiaei pgreir pgreirimi imia a eia krniak krniaklgn lgnidh idh.. _glgrh _glgrh`si `siia ia dick dickri ritk tkrh rhul ul yian yian `m `mis is yi yiht htu u ie ieiay iayii sg sgdd cd cdis is pi piei ei sg sgeh ehii iia a ei eiri rim m tg tgph ph.. _gankcit _gan kcitia ia utili utili piei piei dgu`gl dgu`glhi hi i`ut ieidim ieidim `glktg `glktgrip riphh yian ehcgrh ehcgrh`ia `ia sgfiri `klchaish egania dili pgankcitia `hri-`hri 3 timua. _iei pishga hah juni eheipit`ia eheipit`ia `gdumia `gdumia aygrh sgaeh, sidim situ ngjidi ngjidi dgu`glhi yihtu irtrhths. Irtrhths dgu`glhi chsi lgrupi`ia situ situayi ngjidi  piei dgu`glhi piei 7% 7 % `isus, eia sgrhan ehruju` egania juvgahdg rmgulitkhe irtrhths. Ehpgrdu`ia pgagni`ia ehinakshs sgngri uatu` lganmhaeirh pgankcitia ehah egania `krth`kstgrkhe yian eipit cgreilpi` piei `icurayi ehinakshs, eia strithbh`ish rhsh`k. Irtrhths dgu`glhi sgrhan ehtglu`ia piei dgu`glhi i`ut iai`. Ngjidi `dhahs yian luafud cgrupi aygrh pkdhirth`udgr tgrutili eh dutut eia tulht. Ngjidi tgrsgcut chsi ehsgcic`ia kdgm habhdtrish sgd dgu`glhi piei shakvhid, shakv hid, pgreirimia piei sgaeh itiu stru`tur stru`tur pgrhirth`udgr, pgrhirth`udgr, rgi`sh shakvhid shakvhid tgrmieip tudian yian cgreg`itia, pgrhkstgid liupua dgsh `ipsudir, liupua shak shakvh vhth thss

`i `irg rgai ai

`rhs `rhsti tid. d.

_i _iei ei

ir irtr trht hths hs

dg dgu` u`gl glhi hi

ji jiri rian an

eh ehei eipi pit` t`ia ia

mgpitk mgp itkspd spdgakl gaklgnid gnidh. h. _gagni` _gagni`ia ia ehinaks ehinakshs hs eipit eipit ehd ehdi`u i`u`ia `ia egania egania chkpsh chkpsh ehliai eipit ehtglu`ia sgd dgu`glh. 7,2,>  Ngjidi Ngj idi `dhahs `dhahs eia pglgrh pglgrh`si `siia ia eirim eirim dgan`i dgan`ip p eipit eipit ehpi`i ehpi`ihh uatu`  uatu`  lgagni``ia ehinakshs dgu`glhi. _iei pglgrh`siia eirim dgan`ip, eheipit`ia iaglhi, `gdihaia juldim mhtuan dgu`ksht, trklckshtkpgahi. Eia piei ipusia eirim eir im tgph tgph eheipi eheipit`i t`ia a sgd cdis. cdis. _gagni _gagni`ia `ia ehinaks ehinakshs hs pisth pisth egania egania isphr isphrish ish sulsuan sulsu an tudian egania pglgrh`siia pglgrh`siia hluakbgakth hluakbgakthphan. phan.97,6,92,9>  _iei pish pishga ga ehehin ehe hinaks akshs hs egania egania mhpgrd mhpgrdgu` gu`ksh kshtks tkshs hs gt fi tgrs rsia ian` n`ii IDD IDD ee ILD ILD fius usi i  tg eheu`u ehe u`uan an eirh eirh iailag iailagshs shs,, pglgrh pglgrh`si `siia ia bhs bhshs hs eia pgauaji pgauajian. an. Iailag Iailagshs shs eheipit`ia eheipi t`ia `gdumia `gdumia pgreirimia pgreirimia yihtu lhlhsia. lhlhsia. Vidim situ liahbgstis liahbgstishh `dhahs `dhahs 98

 

eirh dgu`glhi ieidim pgreirimia. Liahbgstish pgreirimia yian pidhan sgrhan ehtglu`ia cgrupi ptg`hg, purpuri itiu g`hlkshs, yian tgrjieh piei 5? ‖ >?%  pgaegrhti dgu`glhi i`ut piei siit ehehinakshs. Dk`ish pgreirimia yian pidhan sgrhan ieidim piei `udht, liti, lglcria lu`ksi mheuan, nhannhvi eia siduria fgrai. _greirimia yian lganiafil jhwi chisiayi tgrjieh piei siduria fgrai ei eia a sh shst stgl gl si siri ribb pu pusi sit, t, sg sgdi diha ha htu htu ju juni ni pi piei ei pi piru ru,, ut utgr grus us eia kvirh kvirhul ul..

9=

Liahbg Lia hbgsti stish sh pgreir pgreirimia imia hah luafud luafud sgcini sgcinihh i`hcit i`hcit eirh eirh cgrcini cgrcinihh `gdiha `gdihaia ia mglkstishs. 9=,98 _greirimia yian lganiafil jhwi dgchm sgrhan tgrjieh piei dgu`glhi i`ut eia lgrupi`ia lisidim yian sgrhus. _greirimia lgajieh pgaygcic utili

lkrc lk rche heht htis is eia lkrt lkrtid idht htis is pi piei ei dg dgu` u`gl glhi hi i`ut i`ut tg tgru ruti tili li pi piei ei dg dgu`g u`glh lhii lhgdkshth` i`ut egania ehbgrgashish lkakshth` eia dgu`glhi prklhgdkshth` i`ut. 3?,39

  @klpdh`ish @klpdh`ish pgreirimia pgreirimia lgani`hcit` lgani`hcit`ia ia lkrtidhti lkrtidhtiss >‖9?% piei pishga pishga

dgu`glhi i`ut yian tgrjieh eidil cgcgripi mirh itiu lhannu pgrtili sgtgdim ehinakshs. 33,36 Dgu`glhi yian pidhan sgrhan ehmucuan`ia egania pgreirimia yian lganiafil jhwi ieidim Dgu`glhi _rklhgdkshth` I`ut (ILD-L6 itiu I_D) yihtu suitu sucthpg dgu`glhi lhgdkshth` i`ut yian ehtiaeih egania triasdk`ish rgshprk`id `rklkskl 97 eia 9>. _iei Dgu`glhi _rklhgdkshth` I`ut, milphr  6?% `glithia ehah ehi`hcit`ia kdgm `klpdh`ish pgreirimia. 35 _greirimia yian tgrjie tgrjiehh piei Dgu`gl Dgu`glhi hi _rklhg _rklhgdks dkshth hth` ` I`ut I`ut tgr tgrsgc sgcut ut ehmucua ehmucuan`ia n`ia egania egania `kinudish hatrivis`udgr ehsglhaiti, mhpgrbhcrhakdhshs eia i`thbhtis prktgisg akaspgshbh`.37,32 _gaygcic

tgrsgrhan

pgreirimia

piei

dgu`glhi

ieidim

trklckshtkpgahi.3>  Cgr`urianayi Cgr`urianayi juldim trklcksht piei dgu`glhi dgu`glhi chisiayi chisiayi lgrupi`ia i`hcit eirh habhdtrish `g sulsul tudian itiu `glktgriph, ailua  chsi juni `irgai `kinudish hatrivis`udgr ehsglhaiti, prksgs hluakdknhs eia mhpgrspdgahslg sg`uaegr tgrmieip pglcgsiria dhlpi. Vgdiha trklckshtkpgahi,  pgreirimia eipit juni i`hcit ehsbuansh trklcksht, `gdihaia mgpir eia bhcrhakdhshs. 9= @kinud @ki nudish ish hatriv hatrivis` is`udg udgrr ehsglh ehsglhait aitii (@HE) (@HE) sgrhan sgrhan ehd ehdipkr ipkr`ia `ia piei dgu`glhi i`ut yian ehsgcic`ia kdgm pgdgpisia litgrhid prk`kinudia eirh cdist 3?

 

sgd dgu`gl dgu`glh`. h`. Dgu`gl Dgu`glhi hi i`ut yian sgrhan sgrhan ehmucu ehmucuan`i an`ia a egania egania @HE yihtu yihtu Dgu` Dgu`gl glhi hi _r _rkl klhg hgdk dksh shth th` ` I`ut I`ut (ILD (ILD-L -L6) 6),, eh ehh` h`ut uthh eg egan ania ia Dg Dgu` u`gl glhi hi Lhgdklkakshth` I`ut (ILD-L5) eia Dgu`glhi Lhgdkcdisth` I`ut (ILD-L9 eia L3) sgrti Dgu`glhi Dhlbkshth` I`ut (IDD).3= @gdihaia mglkstishs diha yian juni eipit tgrjieh piei dgu`glhi ieidim trklck trk lckshs shs itiupua itiupua trklck trklckglc glckdh kdh.. Urklck Urklckshs shs eipit eipit lgrupi` lgrupi`ia ia sidim sidim situ situ ngjidii yian ehtglu`ia siit ehinakshs ngjid ehinakshs yihtu piei dgu`glhi prklhgdkshth` prklhgdkshth` i`ut (ILD-L6) 8,2%0 piei ILD aka-L6 6,3% eia piei IDD 9,5%. _itkngagshs `g `gie ieiia iia prkt prktrk rklc lckt kth` h` piei piei dg dgu`g u`glh lhii si siani anitt `klpd `klpdg` g`ss ei eia a lgdh lgdhci cit` t`ia ia  cgrcinih lg`iahslg sgpgrth i`thvish `kinudish kdgm sucstiash prk`kinudia yian yia n ehdgpi ehdgpis`i s`ia a sgd dgu`gl dgu`glh`, h`, `gninid `gninidia ia jid jidur ur bhcrha bhcrhakdh kdhth th` ` eia pgrucim pgrucimia ia gaektgd. 3= Urklcksht mirus eidil juldim yian ieg`uit uatu` lglpgrtimia`ia mglkstishs mglks tishs akrlid. _iei `gieiia `gieiia akrlid juldim trklcksht trklcksht eirim cgr`hsir 

97 97?.? ?.??? ?? ‖ 5? 5??.? ?.??? ??/l /ll l6. Ur Urkl klcks cksht htkp kpgah gahii ie ieid idim im hs hsth thdi dim m ua uatu tu` ` ju juld ldim im trklcksht yian `urian eirh ahdih akrlid tgrsgcut. Urklckshtkpgahi chisiayi thei` lglpuayih liahbgstish `dhahs mhanni juldim trklcksht 9??.???/ll6,  cim`ia mhanni 7?.???/ll6  sg`idh sg`idhpua. pua. _gr _greir eirimia imia spkati spkatia a chisia chisiayi yi ciru ciru tgrd tgrdhm hmit it pi piei ei juld juldim im trkl trklck cksh shtt 4 3?.? 3?.??? ??/l /ll l 6.

3=

  _gr _greir eirimi imia a i`hcit i`hcit

trklck trk lcksht shtkpga kpgahi hi lgrupi lgrupi`ia `ia `klpdh `klpdh`is `ishh pidhan pidhan sgrhan sgrhan eirh eirh dgu`gl dgu`glhi hi i`ut. i`ut. Niye Ni yeks ks e` e`` ` yi yian an pg pgrt rtil ilii `i `idh dh lgdi lgdipk pkr` r`ia ia ie ieia iayi yi mucu mucuan ania ia ia iati tiri ri  pgreirimia egania juldim trklcksht piei dgu`glhi i`ut.

38

  Liahbgstish

 pgreirimia i`hcit trklckshtkpgahi eipit cgrupi ptg`hg itiu purpuri, gphsti gph sti`sh `shs, s, pgreir pgreirimi imia a nush, nush, pgreir pgreirimi imia a siduri siduria a fgrai, fgrai, lgakrr lgakrrminh minh mhanni mhanni  pgreirimia kti`. ^gcgrt e`` lgdipkr`ia cgrcinih than`it pgreirimia yian tgrjieh piei 7=,5% pishga dgu`glhi lhgkdkshth` i`ut i`hcit trklckshtkpgahi. Cgr`ur Cgr `uriana ianayi yi juldim juldim trklck trklcksht sht piei dgu`gl dgu`glhi hi i`ut chisia chisiayi yi lgrupi lgrupi`ia `ia i` i`hc hcit it habh habhdt dtris rishh su suls lsul ul tudi tudian an it itiu iu `glkt `glktgr griph iph,, sg sgdi diha ha ht htu u ei eipi pitt ju juni ni ehsg ehsgci cic`i c`ia a kdgm kdgm cg cgcgr cgrip ipii bi bi`t `tkr kr di diha ha sg sgpg pgrt rthh `k `kin inud udis ishh hatr hatriv ivis is`u `udg dgr  r  ehsg ehsglh lhai aiti ti,,

prks prksgs gs hl hluak uakdk dknh nhss eia mh mhpgr pgrsp spdg dgah ahsl slgg sg sg`ua `uaeg egrr tg tgrm rmie ieip ip

 pglcgsiria dhlpi. Urklckshtkpgahi yian tgrjieh cgrvirhish eia milphr m ilphr sgdidu ehtglu ehtglu`ia `ia piei piei siit siit dgu`gl dgu`glhi hi ehehin ehehinaks akshs. hs.

9=

  _rksgs habhd habhdtris trishh eh sulsul sulsul 39

 

tudian lgani`hcit`ia sulsul tudian ehpgaumh kdgm sgd dgu`glh` sgmhanni tgrjieh pgauruaia juldim lgni`irhksht yian cgri`hcit lgauruaayi prkeu`sh trklcksht. @glktgriph piei dgu`glhi eipit lgaygcic`ia `grusi`ia diansuan sulsul sul sul tudian tudian sgmhan sgmhanni ni juni juni i`ia lgaygc lgaygcic`i ic`ia a cgr`ur cgr`urian ianayi ayi prkeu`s prkeu`shh trklck trk lcksht sht.. @kinud @kinudish ish hatriv hatrivis` is`udg udgrr ehsglh ehsglhait aitii yian yian sgrhan sgrhan tgr tgrjie jiehh piei piei dgu`glhi i`ut tgrutili dgu`glhi prklhgdkshth` i`ut lgani`hcit`ia trklcksht  ciayi` tgrpi`ih eidil prksgs `kinudish. @kasulsh trklcksht yian cgrdgchmia hah juni lgaygcic`ia tgrjiehayi trklckshtkpgahi. 3= _i _iei ei pi pish shga ga hah hah ehei eheipit pit`i `ia a pgrei pgreiri rimi mia a lish lishbb gp gphs hsti ti`s `shs hs i`hci i`hcitt trklckshtkpgahi. @gfurhniia ehinakshs lganirim `g dgu`glhi i`ut eheu`uan eg egani ania a pglgr pglgrh` h`si siia ia ni nilc lcir iria ia eirim eirim tg tgph ph,, eh ehtg tglu lu`ia `ia dg dgu` u`ks ksht ht eg egani ania a eklhaish eklhai sh sgd cdis, cdis, sgrti sgrti ehinak ehinakshs shs pisth pisth egania egania isphri isphrish sh sulsul sulsul tudian tudian eheipit`ia ailua mid hah cgdul eipit ehdi`u`ia `irgai piei siit ehdi`u`ia CL_ pishga lganidilh pgreirimia i`thb eirh mheuan. Mucuani Mucu ania a iatiri iatiri `ia`gr `ia`gr,, bi`tkr bi`tkr pglcg`u pglcg`uia ia eirim, eirim, eia pgreir pgreirimi imia a tgdim tgdim eh`gti eh`gtimuh muh sgji` sgji` dili. dili. _greir _greirimi imia a yian yian kdgm kdgm `irgai `irgai `gniais `gniaisia ia eipit eipit ehsgcic`ia kdgm `klprgsh tulkr itiu ieiayi havish pglcudum eirim, itiu