Cultural tourism experiences focus on both traditional cultural attractions and contemporary culture or local ways of life. Younger tourists, known as Generation Y, are interested in exciting cultural experiences. Future tourists will seek diverse cultural experiences when traveling. Destinations should use their cultural resources to create holistic tourism experiences, package cultural components together, and showcase local culture to all tourists, not just those interested in culture, in order to improve destination image and visitors' memories.
This document contains personal and professional details about Ehab Mohamed Abd Elgawad Manse. It includes his contact information, education history, and extensive work experience in quality control and validation roles over 15 years at various pharmaceutical companies in Egypt. His experience includes microbiological testing, equipment qualification, process validation, and assisting in obtaining GMP certification from European regulatory agencies.
Ahhh.... It's a pain ... right !! I can tell you exactly, why the above happens. Stay with me!!
On a circuit, fabricated on silicon, there are trillions of wires packed in a small area, something like below, and as me and you demand for higher speed and huge number of applications, poor engineers [:(] try to pack even more devices and wires in that tiny area
This document from the American Academy of Pediatrics provides guidelines on neonatal hypoglycemia. It states that hypoglycemia is common in healthy neonates in the first few hours after birth. The signs are non-specific and the Whipple triad must be fulfilled to attribute signs to hypoglycemia. Infants at risk include those that are small or large for gestational age, infants of diabetic mothers, or late-preterm. At risk infants should be screened in the first few hours and through multiple feed-fast cycles. Management includes a glucose bolus or continuous infusion to maintain plasma glucose between 40-50mg/dL.
Cultural tourism experiences focus on both traditional cultural attractions and contemporary culture or local ways of life. Younger tourists, known as Generation Y, are interested in exciting cultural experiences. Future tourists will seek diverse cultural experiences when traveling. Destinations should use their cultural resources to create holistic tourism experiences, package cultural components together, and showcase local culture to all tourists, not just those interested in culture, in order to improve destination image and visitors' memories.
This document contains personal and professional details about Ehab Mohamed Abd Elgawad Manse. It includes his contact information, education history, and extensive work experience in quality control and validation roles over 15 years at various pharmaceutical companies in Egypt. His experience includes microbiological testing, equipment qualification, process validation, and assisting in obtaining GMP certification from European regulatory agencies.
Ahhh.... It's a pain ... right !! I can tell you exactly, why the above happens. Stay with me!!
On a circuit, fabricated on silicon, there are trillions of wires packed in a small area, something like below, and as me and you demand for higher speed and huge number of applications, poor engineers [:(] try to pack even more devices and wires in that tiny area
This document from the American Academy of Pediatrics provides guidelines on neonatal hypoglycemia. It states that hypoglycemia is common in healthy neonates in the first few hours after birth. The signs are non-specific and the Whipple triad must be fulfilled to attribute signs to hypoglycemia. Infants at risk include those that are small or large for gestational age, infants of diabetic mothers, or late-preterm. At risk infants should be screened in the first few hours and through multiple feed-fast cycles. Management includes a glucose bolus or continuous infusion to maintain plasma glucose between 40-50mg/dL.
This document outlines a systematic approach to interpreting electrocardiograms (ECGs). It begins with an overview of ECG fundamentals, including the cardiac conduction system and the 12 ECG leads. It then covers normal ECG morphology and a 6-step scheme for ECG interpretation. The 6 steps are: 1) analyze rhythm, rate, and regularity, 2) determine axis, 3) examine P and PR intervals, 4) analyze the QRS complex, 5) check for abnormalities. The document aims to provide guidance on interpreting ECGs and detecting major cardiac abnormalities.
Metabolic liver disease presenting with cholestasis talk anshu srivastavaSanjeev Kumar
This document discusses metabolic liver disease presenting with cholestasis. It begins by defining cholestasis and describing the differences between intrahepatic and extrahepatic cholestasis. In neonates, a metabolic etiology is often the cause of cholestasis and can include conditions like galactosemia or tyrosinemia. The document then examines various etiologies of cholestasis across different age groups. It provides details on progressive familial intrahepatic cholestasis (PFIC), benign recurrent intrahepatic cholestasis (BRIC), and intrahepatic cholestasis of pregnancy. The document emphasizes the importance of early identification of treatable metabolic causes of chole
investigations and management of obstructive jaundice secondary to stone diseaseErum Khateeb
This document discusses the investigation and management of obstructive jaundice secondary to gallstone disease. It defines obstructive jaundice and describes the typical symptoms and signs. Common causes include gallstones, tumors, and strictures. Investigations include blood tests, ultrasound, CT, MRI/MRCP, ERCP and intraoperative cholangiography. Treatment involves correcting dehydration and coagulopathy conservatively or surgically removing gallstones via ERCP or open surgery. ERCP methods for extracting large or impacted stones include lithotripsy techniques.
This document provides an overview of the management of obstructive jaundice. It begins with definitions and classifications of jaundice. Obstructive jaundice can be intrahepatic or extrahepatic in origin. Common causes of intrahepatic cholestasis include viral hepatitis, alcoholic hepatitis, and drug toxicity. Extrahepatic obstructions are often due to choledocholithiasis (gallstones in the common bile duct), tumors, or strictures. Diagnostic imaging includes ultrasound, MRCP, ERCP, and intraoperative cholangiography. Treatment depends on whether the obstruction is pre-operative or discovered during cholecystectomy, and may involve ERCP, laparoscopic or open CBD exploration, or
This document outlines a systematic approach to interpreting electrocardiograms (ECGs). It begins with an overview of ECG fundamentals, including the cardiac conduction system and the 12 ECG leads. It then covers normal ECG morphology and a 6-step scheme for ECG interpretation. The 6 steps are: 1) analyze rhythm, rate, and regularity, 2) determine axis, 3) examine P and PR intervals, 4) analyze the QRS complex, 5) check for abnormalities. The document aims to provide guidance on interpreting ECGs and detecting major cardiac abnormalities.
Metabolic liver disease presenting with cholestasis talk anshu srivastavaSanjeev Kumar
This document discusses metabolic liver disease presenting with cholestasis. It begins by defining cholestasis and describing the differences between intrahepatic and extrahepatic cholestasis. In neonates, a metabolic etiology is often the cause of cholestasis and can include conditions like galactosemia or tyrosinemia. The document then examines various etiologies of cholestasis across different age groups. It provides details on progressive familial intrahepatic cholestasis (PFIC), benign recurrent intrahepatic cholestasis (BRIC), and intrahepatic cholestasis of pregnancy. The document emphasizes the importance of early identification of treatable metabolic causes of chole
investigations and management of obstructive jaundice secondary to stone diseaseErum Khateeb
This document discusses the investigation and management of obstructive jaundice secondary to gallstone disease. It defines obstructive jaundice and describes the typical symptoms and signs. Common causes include gallstones, tumors, and strictures. Investigations include blood tests, ultrasound, CT, MRI/MRCP, ERCP and intraoperative cholangiography. Treatment involves correcting dehydration and coagulopathy conservatively or surgically removing gallstones via ERCP or open surgery. ERCP methods for extracting large or impacted stones include lithotripsy techniques.
This document provides an overview of the management of obstructive jaundice. It begins with definitions and classifications of jaundice. Obstructive jaundice can be intrahepatic or extrahepatic in origin. Common causes of intrahepatic cholestasis include viral hepatitis, alcoholic hepatitis, and drug toxicity. Extrahepatic obstructions are often due to choledocholithiasis (gallstones in the common bile duct), tumors, or strictures. Diagnostic imaging includes ultrasound, MRCP, ERCP, and intraoperative cholangiography. Treatment depends on whether the obstruction is pre-operative or discovered during cholecystectomy, and may involve ERCP, laparoscopic or open CBD exploration, or