Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
2. AETIOLOGY
• Almost always rheumatic in origin.
• In older people it can be caused by heavy
calcification of mitral valve apparatus.
• Congenital mitral valve stenosis.
• SLE,rheumatoid arthritis,left atrial myxoma.
• Pure MS occurs in 40% of all patients with RHD and
a h/o RF.
3.
4. PATHOPHYSIOLOGY
Fusion of mitral commisures
↓
restricted opening of mitral valve
↓
“fish mouth” shape of mitral valve orifice
Thickening, fusion and shortening of the chordae or papillary
muscles ,valvular cusps become rigid
↓
funnel-shaped change of valve apparatus
5.
6.
7. PATHOPHYSIOLOGY
• In rheumatic mitral stenosis, the mitral valve orifice is slowly
diminished by fibrosis,& calcification.
• Normal area of mitral valve is 4-6 cm2
• Reduced to <2cm2.
• Flow of blood from LA to LV is restricted.
• Left atrial pressure rises.
• Leads to pulmonary venous congestion & breathlessness.
• Dilatation & hypertrophy of LA.
8.
9. Effect of elevated LAP on pulmonary circulation
• The elevated LAP in turn raises pulmonary venous and
capillary pressures (PVP, PCP).
LAP↑ → PVP↑→ PCP↑→ Exertional Dyspnea
Lung compliance↓
Pulmonary hypertension results from:
• 1. Passive backward transmission of the elevated LAP.
• 2. Reactive pulmonary arteriolar constriction, which
presumably is triggered by left atrial and pulmonary venous
hypertension,
• 3. Organic obliterative changes in the pulmonary vascular
bed, which may be considered to be a complication of
longstanding and severe MS.
10. Pulmonary HTN leads to
• Right ventricular hypertrophy and dilatation.
• Tricuspid regurgitation.
• Right heart failure.
Atrial fibrillation due to progressive dilatation of LA
is very common.
13. SIGNS
• Malar flush with pinched and blue facies.
• Atrial fibrillation
• Pulmonary edema,effusions(raised pulmonary
capillary pressure).
AUSCULTATION
Loud first heart sound,opening snap.
Mid diastolic murmur.
Crepitation
14. INVESTIGATION
Electrocardiography (ECG)
• P wave suggests Left atrial enlargement
• Mitral valve P wave
• P-wave duration in lead II ＞ 0.12 s
• P wave upright in lead V1
• QRS complex usually normal
• Right ventricular hypertrophy :tall R waves in V1-V3.
• Arrhythmia.
• Premature atrial contraction → atrial fibrillation
15. X-RAY
• straightening of left upper border of heart.
• Prominence of main pulmonary arteries.
• Posterior displacement of oesophagus by
enlarged LA.
19. MANAGEMENT
• Penicillin prophylaxis for secondary prevention of RF for at
risk patients.
• Restrict sodium intake, and take oral diuretics.
• Beta blockers.
• CCB-verapamil,diltiazem.
• Digitalis glycoside to reduce ventricular rate in patient with
AF.
• Warfarin.
20. CRITERIA FOR MITRAL
VALVULOPLASTY
• SIGNIFICANT SYMPTOMS
• ISLOTED MITRAL STENOSIS
• NO (OR TRIVIAL) MITRAL REGURGITATION
• MOBILE,NON CALCIFIED VALVE ON ECHO
• LA FREE OF THROMBUS
