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3. KG 2 UW E- LEARNING DECEMBER SESSION 3
Quiz by POOJA VERMA
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âHe guards our houseÂ
Painter
Security GuardÂ
Chef
âName the tool a security guard uses ?Â
stethoscopeÂ
whisker
batonÂ
He guards our houseÂ
Name the tool a security guard uses ?Â
What does the security guard wear ?Â
Which tool does a tailor use ?Â
Who protects us from thief ? or who is missing in the pictureÂ

What is the responsibility of a security guard ?Â
KG 2 FEBRUARY'22 WEEK-3 SESSION-5 UW E LEARNING - QUIZ ON- LIVING & NON LIVING THINGS
KG 2 MATH E -LEARNING -SESSION-3 SUBTRACTION OF DOUBLE DIGIT SUMS -31ST OCT-4TH NOV'21
KG 2 HINDI SESSION 7 WEEK 3
2 kg unit 4 lesson 3 expressions
Animal Rights and Diet Success Criteria I can explain key terms which describe the type of diets people have I can explain the advantages and disadvantages of different types of diet Animal Rights and Diet Match up the terms with the meaning Term Meaning Omnivore - eats fish but no other type of meat Vegetarian - eats most types of meat and vegetables Pescetarian - doesnât eat any products that come from animals Vegan - doesnât eat meat but will eat dairy products like milk Place the different diets on a spectrum All meat No animal products at all Vegetarian Vegan Omnivore Pescetarian Omnivore Omnivore Most people in the UK are omnivores Match the countries with the amount of meat eaten per person per year Country Meat per person per year India 9.9 kg USA 4.4 kg Bangladesh 120 kg UK 111.5kg Nepal 84.2 kg Australia 4 kg Numeracy How much meat is consumed in the UK per year? (Amount of meat eaten X the UK population) 2. How much meat is consumed in Bangladesh per year? (Amount of meat eaten X the Bangladesh population) Country Meat per person per year USA 120 kg Australia 111.5kg UK 84.2 kg Nepal 9.9 kg India 4.4 kg Bangladesh 4 kg UK â 64 million Bangladesh â 165 million http://www.telegraph.co.uk/travel/maps-and-graphics/world-according-to-meat-consumption/ 7 Why do people eat meat? Discuss Tradition (their family has always done it) Culture (celebrations) Taste Convenience Nutrients such as B12, protein and iron Consumption of meat is rising across developing countries because higher incomes generally mean more meat eating. Pescetarian "Yeah, I'm a vegetarian." "But that looks like fish you're eating." "Oh yeah, I eat fish.â An estimated 5% - 6% of people in the UK are pescetarians. How many people is this? Approx. 3.6 million Calculation â 66,000,000 /100 x 5.5 = 3,630,000 9 Which group is cuter? Animals Fish 10 People often donât feel as much love for fish as they do for fluffy, cute mammals. The may think fish donât feel pain. They may be fussy. They think fish isnât meat. Not farmed as much as mammals; can be wild. To get nutrients they wouldnât get from just vegetables and grains. (Omega 3 is in plants but in higher concentrations in oily fish) Why are people pescetarians? https://www.vegsoc.org/sslpage.aspx?pid=753 http://articles.mercola.com/omega-3.aspx Fish â In a perfect world, fish can provide you all the omega-3s you need. Unfortunately, the vast majority of the fish supply is now heavily tainted with industrial toxins and pollutants, such as heavy metals which include mercury, lead, arsenic, and cadmium, PCBs, and radioactive poisons. These toxins make eating fish no longer recommended. 11 Vegetarianism Vegetarians will not eat any meat or product that comes from the slaughter of animals e.g. gelatine. About 3% of the UK population are vegetarian. How many people is this? 1.9 million 12 Why are people vegetarian? They donât like the idea that animals are killed so they can eat Health reasons Donât like meat Brought up vegetarian Environmental reasons Religious reasons (e.g. some Buddhist, Hindus) Watch the following clip twice. The second time, write down the fact which surprises you the most. https://www.youtube.com/watch?v=VW6wfpHFdaI The World Health Organization has classified processed meats â including ham, salami, sausages and hot dogs â as a Group 1 carcinogen (same as smoking/alcohol) which means that there is strong evidence that processed meats cause cancer. Red meat, such as beef, lamb and pork has been classified as a 'probable' cause of cancer. 13 Veganism Not just a diet Around 1% of the population of UK are vegans. A vegan is described by the Vegan Society as âa philosophy and way of living which seeks to excludeâas far as is possible and practicableâall forms of exploitation of, and cruelty to, animals for food, clothing or any other purpose; and by extension, promotes the development and use of animal-free alternatives for the benefit of humans, animals and the environment. In dietary terms it denotes the practice of dispensing with all products derived wholly or partly from animalsâ Why are people vegan? Why are people vegan? James Aspey: https://www.youtube.com/watch?v=a22XxXP3nU8 Warning: some of the content in this video clip may upset some viewers from 7:14 â 8:11 https://www.youtube.com/watch?v=BtqXeym7H8A Why are people vegan? âDonât want bad karmaâ Feel healthier Reduce chances of diseases. Example heart disease. Donât want to exploit animals Believe in animal rights Sustainability Environment Create a Table of Pros & Cons of Veganism Pros â Cons - Create a Table of Pros & Cons of Veganism Pros Cons No animals have died for you to eat Some people think it is healthier Help the environment Fewer antibiotics/chemicals that are given to some animals Makes you feel good No vitamin B12 so have to supplement Harder to find food at shops or restaurants May be harder to get enough iron May be more expensive to get substitute meats Judged by family and friends Could put farmers out of business Group Work Source 1 Summarise it in your jotter Explain what the source is/what it says What does it suggest? What is your opinion? Feedback to rest of class https://www.youtube.com/watch?v=SYyjel5VuHg Farmerâs Poem
MATERI PERKULIAHAN Sub-CPMK 1.7 Mampu menghitung performa produksi (IP, FCR) dan melakukan Analisis Usaha Broiler per satu siklus produksi 1. IDENTITAS MATERI Mata Kuliah : Produksi Ternak Potong Unggas Komersil Pokok Bahasan : Evaluasi Performa Produksi dan Analisis Usaha Broiler Sub-CPMK : 1.7 Capaian Pembelajaran : Mahasiswa mampu: Menjelaskan parameter performa produksi broiler. Menghitung Feed Conversion Ratio (FCR). Menghitung Indeks Performa (IP). Menganalisis hasil performa produksi dalam satu siklus pemeliharaan. Menyusun analisis usaha broiler per satu siklus produksi. Menarik kesimpulan kelayakan usaha berdasarkan hasil teknis dan ekonomis. ________________________________________ 2. TUJUAN PEMBELAJARAN Setelah mengikuti perkuliahan ini, mahasiswa diharapkan mampu: Memahami konsep dasar evaluasi performa broiler. Mengidentifikasi data teknis yang dibutuhkan dalam perhitungan performa. Menghitung mortalitas, deplesi, bobot badan rata-rata, FCR, dan IP. Menghitung biaya produksi, penerimaan, keuntungan, dan efisiensi usaha broiler. Menganalisis hubungan antara performa teknis dengan hasil ekonomi usaha. ________________________________________ 3. DESKRIPSI MATERI Dalam usaha broiler modern, keberhasilan produksi tidak hanya diukur dari bobot panen, tetapi juga dari efisiensi penggunaan pakan, tingkat kematian, umur panen, serta keuntungan yang diperoleh per siklus. Oleh karena itu, diperlukan kemampuan untuk menghitung parameter teknis produksi seperti FCR dan IP, serta mengaitkannya dengan analisis usaha agar dapat diketahui apakah usaha berjalan efisien dan menguntungkan. ________________________________________ 4. POKOK-POKOK MATERI A. Konsep Dasar Evaluasi Performa Produksi Broiler 1. Pengertian Performa Produksi Performa produksi broiler adalah gambaran tingkat keberhasilan pemeliharaan ayam broiler selama satu periode/siklus pemeliharaan yang dinilai dari indikator teknis tertentu. 2. Parameter Utama Performa Produksi Parameter yang umum digunakan meliputi: Populasi awal DOC Jumlah ayam hidup saat panen Mortalitas (%) Deplesi (%) Umur panen (hari) Bobot badan rata-rata panen (kg/ekor) Total konsumsi pakan (kg) Feed Conversion Ratio (FCR) Indeks Performa (IP) ________________________________________ B. Parameter Teknis dan Rumus Perhitungan ________________________________________ 1. Mortalitas (%) Pengertian: Persentase ayam yang mati selama masa pemeliharaan. Rumus: "Mortalitas (%)"="Jumlah ayam mati" /"Populasi awal" Ă100 Contoh: Populasi awal = 5.000 ekor Ayam mati = 150 ekor "Mortalitas"=150/5000Ă100=3% ________________________________________ 2. Deplesi (%) Pengertian: Persentase pengurangan populasi akibat kematian dan afkir/culling. Rumus: "Deplesi (%)"="Ayam mati + ayam afkir" /"Populasi awal" Ă100 Jika tidak ada afkir, maka deplesi = mortalitas. ________________________________________ 3. Persentase Ayam Hidup / Livability (%) Rumus: "Livability (%)"="Jumlah ayam panen" /"Populasi awal" Ă100 atau "Livability (%)"=100-"Deplesi (%)" ________________________________________ 4. Bobot Badan Rata-Rata Panen Rumus: "Bobot rata-rata (kg/ekor)"="Total bobot panen (kg)" /"Jumlah ayam panen (ekor)" ________________________________________ 5. Feed Conversion Ratio (FCR) Pengertian: FCR adalah rasio jumlah pakan yang dikonsumsi terhadap pertambahan bobot hidup atau bobot hidup yang dihasilkan. Rumus praktis broiler: "FCR"="Total konsumsi pakan (kg)" /"Total bobot hidup panen (kg)" Interpretasi: Semakin rendah nilai FCR, semakin efisien penggunaan pakan. Contoh: Total pakan = 16.000 kg Total bobot panen = 9.600 kg "FCR"=16.000/9.600=1,67 Interpretasi: Untuk menghasilkan 1 kg bobot hidup, dibutuhkan 1,67 kg pakan. ________________________________________ 6. Indeks Performa (IP) Pengertian: IP adalah indikator gabungan untuk menilai performa pemeliharaan broiler berdasarkan: daya hidup, bobot badan, umur panen, efisiensi pakan. Rumus umum IP: "IP"=("Livability (%)" Ă"Bobot rata-rata (kg)" )/("Umur panen (hari)" Ă"FCR" )Ă100 Contoh: Livability = 97% Bobot rata-rata = 2,0 kg Umur panen = 35 hari FCR = 1,67 "IP"=(97Ă2,0)/(35Ă1,67)Ă100 "IP"=194/58,45Ă100=331,9 Jadi, IP = 331,9 ________________________________________ C. Interpretasi Nilai FCR dan IP 1. Interpretasi FCR < 1,50 = sangat efisien 1,50 â 1,65 = efisien/baik 1,66 â 1,80 = cukup > 1,80 = kurang efisien Catatan: Nilai ini dapat berbeda tergantung strain, umur panen, sistem kandang, musim, dan standar perusahaan. ________________________________________ 2. Interpretasi IP (umum) > 400 = sangat baik / Ů
Ů
تاز 351 â 400 = baik 301 â 350 = cukup baik 251 â 300 = sedang < 250 = kurang Dalam praktik kemitraan, IP sering menjadi dasar evaluasi bonus performa. ________________________________________ 5. HUBUNGAN PARAMETER TEKNIS DENGAN KINERJA USAHA Performa teknis sangat menentukan keuntungan usaha broiler: FCR naik â biaya pakan meningkat â laba turun Mortalitas naik â ayam panen berkurang â penerimaan turun Bobot panen rendah â total kg jual turun â omzet turun Umur panen terlalu lama â biaya operasional naik â efisiensi turun IP tinggi â menunjukkan usaha lebih efisien dan berpotensi lebih menguntungkan ________________________________________ 6. ANALISIS USAHA BROILER PER SATU SIKLUS PRODUKSI A. Pengertian Analisis Usaha Analisis usaha broiler adalah perhitungan ekonomi untuk mengetahui: total biaya produksi, total penerimaan, pendapatan/keuntungan, efisiensi usaha, kelayakan usaha per satu siklus pemeliharaan. ________________________________________ B. Komponen Biaya Produksi 1. Biaya Tetap (Fixed Cost) Biaya yang relatif tidak berubah dalam satu siklus, misalnya: Penyusutan kandang Penyusutan peralatan Pajak/sewa lahan (jika dihitung) Bunga modal tetap (opsional) 2. Biaya Variabel (Variable Cost) Biaya yang berubah sesuai jumlah populasi, misalnya: DOC Pakan Obat, vitamin, vaksin (OVK) Sekam/litter Gas/LPG/bahan bakar brooder Listrik dan air Tenaga kerja Desinfektan dan sanitasi Biaya panen/angkut Biaya lain-lain operasional Catatan penting: Pada usaha broiler, pakan biasanya menyumbang 60â70% dari total biaya produksi. ________________________________________ 7. RUMUS ANALISIS USAHA 1. Total Biaya Produksi (TC) "TC"="Biaya Tetap"+"Biaya Variabel" ________________________________________ 2. Total Penerimaan (TR) Jika dijual berdasarkan bobot hidup: "TR"="Total bobot panen (kg)"Ă"Harga jual per kg" Jika ada penerimaan tambahan: "TR total"="Penjualan ayam"+"Penjualan kotoran"+"Penjualan karung pakan/bekas" ________________________________________ 3. Keuntungan / Pendapatan (Ď) Ď="TR"-"TC" ________________________________________ 4. R/C Ratio R/C="TR" /"TC" Kriteria: R/C > 1 â usaha menguntungkan R/C = 1 â impas R/C < 1 â usaha merugi ________________________________________ 5. B/C Ratio (opsional) B/C=("TR" -"TC" )/"TC" ________________________________________ 6. Harga Pokok Produksi (HPP) "HPP per kg"="Total biaya produksi" /"Total bobot panen (kg)" Interpretasi: Jika harga jual > HPP â usaha berpotensi untung. FAKTOR-FAKTOR YANG MEMPENGARUHI FCR, IP, DAN KEUNTUNGAN A. Faktor Teknis Kualitas DOC Mutu pakan Program brooding Kepadatan kandang Ventilasi dan suhu kandang Kualitas air minum Program vaksinasi dan biosekuriti Manajemen litter Ketepatan waktu panen B. Faktor Ekonomi Harga DOC Harga pakan Harga jual ayam hidup Biaya tenaga kerja Biaya energi (gas/listrik) Sistem usaha (mandiri vs kemitraan) STRATEGI MENINGKATKAN PERFORMA DAN KEUNTUNGAN Gunakan DOC berkualitas dan seragam Laksanakan brooding secara optimal (0â14 hari sangat krusial) Pastikan feed intake dan water intake normal Terapkan biosekuriti ketat Kurangi feed wastage Pantau bobot badan mingguan Lakukan culling selektif Tentukan umur panen berdasarkan kombinasi FCR, bobot, dan harga pasar Evaluasi performa tiap siklus dengan pencatatan lengkap Gunakan data historis untuk perbaikan keputusan produksi RANGKUMAN MATERI FCR menunjukkan efisiensi penggunaan pakan. Semakin kecil FCR, semakin baik. IP adalah indikator gabungan performa broiler yang mempertimbangkan: daya hidup, bobot panen, umur panen, efisiensi pakan. Analisis usaha broiler harus mengintegrasikan: aspek teknis (FCR, IP, mortalitas, bobot panen) aspek ekonomi (biaya, penerimaan, laba, R/C, HPP) Usaha broiler dinilai baik apabila: FCR efisien, mortalitas rendah, IP tinggi, HPP lebih rendah dari harga jual, R/C ratio > 1. PENUTUP Kemampuan menghitung FCR, IP, dan melakukan analisis usaha broiler per satu siklus produksi merupakan kompetensi penting dalam manajemen produksi broiler modern. Mahasiswa tidak hanya dituntut memahami teori, tetapi juga harus mampu membaca data produksi, melakukan perhitungan secara akurat, dan mengambil keputusan manajerial berbasis hasil analisis teknis-ekonomis. REFERENSI SINGKAT (untuk bahan ajar/RPS) North, M.O., & Bell, D.D. Commercial Chicken Production Manual. Leeson, S., & Summers, J.D. Commercial Poultry Nutrition. Bell, D.D., & Weaver, W.D. Commercial Chicken Meat and Egg Production. Saputra, dkk. Literatur manajemen broiler modern dan analisis usaha ternak unggas. Standar teknis perusahaan integrator/kemitraan broiler (CP, Japfa, Malindo, dll.) untuk benchmarking FCR dan IP.
Lo sai che cos'è il fast fashion con fast fashion? Si intende quel settore dell'abbigliamento che realizza abiti a prezzi super ridotti e che lancia nuove collezioni di continuo pensate proprio per essere usate poco, il tutto sembra figo, no? Vestiti nuovi ogni volta che vuoi. Non è figo, ogni anno nel mondo vengono prodotti oltre 80 miliardi di capi d'abbigliamento e sulla terra siamo 8 miliardi e dopo il brevissimo periodo in cui vengono utilizzati tre capi su quattro finiscono in discarica o vengono inceneriti e soltanto un quarto viene riciclato Si stima che in un anno una persona compri circa 15 kg di vestiti. Eppure la sensazione è quella di non aver mai in mente da mettere e questo è esattamente quello che l'industria del fast fashion vuole. Lo sai che per produrre una t-shirt ci vogliono circa 3.900 litri di acqua l'equivalente di quello che beve una persona in cinque anni, un capo d'abbigliamento ha un impatto sull'ambiente in ogni fase della sua produzione, dalla produzione delle fibre, all'assemblaggio dal trasporto allo smaltimento, ma come è possibile che un top un prodotto che è stato coltivato come fibra trasformato in filato cucito dall'altra parte del mondo tinto confezionare e spedito costi meno di un panino? La risposta è semplice materie prime scadenti a basso costo abbinate quasi sempre allo sfruttamento dei lavoratori, la maggior parte dei capi di abbigliamento fast fashion viene prodotta in paesi come bangladesh, vietnam cambogia, spesso le condizioni di lavoro in questi paesi sono terribili e i diritti umani vengono calpestati, se paghiamo un top 7,95 significa che qualcun altro ha pagato il prezzo al posto nostro. Riassumendo il fast fashion nè non è sostenibile e probabilmente non ci rende piÚ felici, ma l'abbigliamento è anche un modo per esprimere la propria personalità e creatività quindi ecco alcuni consigli. 1 comprare meno e curare meglio certo spendere tanto per una maglietta ci sembra assurdo ma ricordiamoci che una t-shirt a 4 euro probabilmente durerà poco o niente e soprattutto siamo sicuri di averne bisogno di 10? 2 scegliere bene i marchi alcuni siti possono aiutarti a scoprire nuovi brand etici e sostenibili e magari anche nuovi stili 3 riutilizzare e riparare, scambiamo i vestiti che non usiamo piÚ quelle amiche quegli amici oppure vendiamoli sui mercatini online, ma soprattutto non buttiamoli appena salta un bottone, proviamo piuttosto a ripararli Come ultimo consiglio resiste l'impulso da shopping compulsivo, la maggior parte degli acquisti, soprattutto online in periodo di saldi vengono fatti d'impulso, fermati un momento e pensa a tutto ciò che quel vestito rappresenta, come è stato fatto, chi lo ha creato quanto ha inquinato e chiediti se ti serve davvero e ora che sai riconoscerlo cosa ne pensi del fast fashion?
[t comes from the GREEK name "Epilepsia" which means "taking hold of or seizing". - It is a disorder characterized by: recurrent seizures. SEIZURES R ectment transient attacks of: R epresent: R esult from: ASSOCIATED WITH: somatic, psychic, or, autonomic clinical featmes. clinical features of abnormally hyperexcitable cortical neurons. paroxvsmal and excessive electrical neuronal discharges. EEG changes & may be disturbance of consciousness. same causes of convulsions 1. Idiopathic epile~ ⢠It is the commonest cause. no cause can be detected ( 65 % ) ⢠It may be associated with positive family history in some cases. ⢠It starts in the l st & 2nd decades in the form of: -- Grand ma! epilepsy. Petit mal epilepsy. Myoclonic epilepsy. Atonic seizures. 2. Secondary epilepsy A. Local causes in the brain: l. Congenital: 2. Traumatic: cerebral palsy. a cause can be detected cerebral contusion or laceration. 3. Inflammatory: 4. Neoplastic: 5. Degenerative: 6. Vascular: encephalitis, brain tumours. mening1t1s, presenile dementia. brain abscess. stroke (especially hemon-hagic), hypertensive encephalopathy. B. General causes with secondary effects on the brain: I. Toxic: 2. Iatrogenic: 3. Metabolic: 4. Endocrinal: 5. Organ failure: 6. Heart disease: 7. Nutritional: - Alcohol, cocaine, lead. - Lidocaine, INH. - j glucose & ! glucose. - Hypoparathyroidism. - Hepatic failme. - Adam's Stoke's attacks. - Pellagra. - Botulism, tetanus. - Ambilhar, Amphetamine, Aminophylline. - j Ca & ! Ca. - Hype1thyroid crisis. - Renal failure. - Fallot's tetralogy. - j Na & ! Na. - Vitamin B6 deficiency. 8. Physical: 9. HYSTERICAL. - High fevers. - Heat stroke. 136 137 CLINICAL PICTURE 1. GENERALISED SEIZURES " Excessive electrical discharges from cortical neurons in BOTH hemispheres simultaneously " I. II. 1. Grand Mal Epile~: 1. Pre-ictal stage "attacks of tonic-clonic convulsions " (aura) It is a warning sign of a coming attack. It may be: ⢠Somatic: ⢠Psychic: ⢠Autonomic: 2. Ictal stage Myoclonus, Hallucinations. Tachycardia, (seizure) Sudden loss of consciousness: Parasthesias. Sweating. for seconds to minutes. -- Tonic phase (few seconds) o The UL & LL: o o o o The HEAD: The JAWS: CYANOSIS: are extended. is retracted to one side & the eye balls rolled up. are firmly clenched, with biting of the TONGUE. due to impaired respiration. There may be incontinence of urine. Clonic phase (few minutes) o The UL & LL: o The HEAD: 3. Post-ictal stage - It may be: ⢠Somatic: ⢠Psychic: ⢠Autonomic: Drug of choice: contract & relax repeatedly & rapidly. jerks forcibly. (sequelae) Todd's paralysis(< 24 hours, due to neuronal exhaustion). Confusion. Vomiting. Carbamazepine (Tegretol) or Phenytoin (Epanutin) Petit Mal Epilepsy: "attacks of loss of consciousness " " Absence " It starts in childhood & improves at puberty & usually disappears at the age of 20. 2. It is NOT PRECEEDED by aura & NOT FOLLOWED by sequelae. 3. It is usually PRECIPITATED by: hyperventilation 4. It is characterized by: or photic stimulation. sudden loss of consciousness of short duration (few seconds). 5. It may be associated with: ⢠High frequency ( 50 attacks / day). ⢠Falling to the ground without warning. ⢠Jerky movements of the head & UL Drug of choice: (myoclonic petit mal). Valproate (Depakine) or Succinimide (Zarontin) 137 138 Ill. M oclonic Seizures: "attacks of involuntary clonic movements " - It is characterized by: sudden, jerky, shock-like INVOLUNTARY muscle contraction. ⢠The jerks are bilateral contractions, mainly of the shoulders and arms. ⢠However, some patients repmtjerking in the lower limbs, trunk, or head. - It may be of 2 types: - Occurs singly ⢠Simple: ⢠As a pait of: I Drug of choice: IV. Atonic seizures: (no loss of consciousness). - Grand mal epilepsy (aura). - Petit mal epilepsy. Valproate (Depakine) or Clonazepam (Rivotril) I - Transient attacks of brief loss of postural tone, often resulting in falls and injuries. 2. PARTIAL SEIZURES "Excessive electrical discharges from cmtical neurons in a ce1tain area in ONE hemisphere" A. Simple seizures: " No disturbance in consciousness " - The CP depends on the site of the hyperexcitable neurones in the cerebral cortex, whether in: "Motor area or Senso,y areas". 1. Motor fits: ⢠Focal fits: ⢠Motor jacksonian fits: 2. General Sensory fits: ⢠Focal fits: ⢠Sensory jacksonian fits: 3. Special Senso1y fits: ⢠Visual hallucinations: ⢠Auditory hallucinations: ⢠Olfactory hallucinations: B. Complex seizures: - SITE: movement of part of a limb or the whole limb. movement of one side of the body (see before). parasthesia of part of a limb or the whole limb. parasthesia of one side of the body (see before). irritation of the visual sensory area. irritation of the auditory sensory area. initation of the uncus. " disturbance in consciousness " The hyperexcitable neurons are in the Temporal lobe "Temporal lobe epilepsy". - DURATION: The seizure lasts few seconds to few minutes. - The seizure starts with A ura, followed by A bsence, Automatism, Amnesia: 1. 2. 3. 4. A ura: A bsence: Automatism: A mnesia: Olfactory hallucinations, Deja-vu phenomenon, Sensation of fear. Absent patient with staring eyes (with no response to conversation). Involuntary Purposeless acts: motor ( eg, lip smacking, chewing) or verbal. No recalling of the seizure. 138 139 3. PARTIAL SEIZURES ~ GENERALISED SEIZURES " Partial seizures may spread to involve the whole brain .- secondarily generalised seizures " . HY-sterical epilepsY ⢠Usually: ⢠The cause: ⢠Incidence: young neurotic Sj2 . psychological & there is no organic lesion. usually occurs in the presence of people. ⢠It is associated with: ⢠EEG: ⢠It is not associated with: normal. ⢠Missed ttt. ⢠Menses. ⢠Alkalosis. anxiety, palpitaion & hyperventilation. tongue biting or incontinence of urine. ⢠Alcohol use & Drug abuse ( e.g. cocaine ). ⢠S timulation by photons & Hyperventilation. ⢠S leep deprivation & Stress & sudden withdrawal of antiepileptic drngs. INVESTIGATIONS 1. EEG: ⢠It is the most specific test for epilepsy because it records the electrical activity of the brain. ⢠It shows specific pattern: 2. LOCAL INVESTIGATIONS: "Epilepsy waves". "CT & MRI of the brain" ⢠To identify or exclude a LOCAL CAUSE of seizures in the brain. 3. GENERAL INVESTIGATIONS: "Laboratory investigations" ⢠To search for a GENERAL CAUSE of seizures, e.g. blood glucose. 139 140 TREATMENT A. General Measures: 1. 2. Moderation of the patient's physical activity. A void the precipitating factors ( Alcohol, hyperventilation, photic stimulation ...... ). 3. A ketogenic diet is encouraged because it will induce acidosis: - Acidosis is beneficial as it raises the threshold of stimulation of the brain cells. B. Specific Treatment: 2. 1. Treatment of the cause in secondary epilepsy. Anti-epileptic drugs: a) Always sta1t with one drug, then add another drug if there is no response. b) Always stop the drugs ONLY if: ⢠The patient stays free of symptoms for at least 2 years. ⢠The patient has a normal EEG. 3. Side effects of Anti-epileptic drugs: I . Skin rash. 2. 3. Bone marrow depression. Ataxia. Drug 1. Barbiturates (Pbenonobarbitone) 2. Hydantoin (Epanutin) 3. Carbamazepine 4. Clonazepam 5. Valproate 6. Succinamide ANTI-EPILEPTIC DRUGS NEW ANTI-EPILEPTIC DRUGS - These drugs are new dtugs that may be used in resistant seizures. 1. Lamotrigine: 200 - 400 mg/ day. 2. Felbamate: 3. Gabapentin: 400- 800 mg/ day. 600 - 1200 mg/ day. \ " General rules for use ": Dose 100-600 mg I day 100-600 mg / day 200-600 mg I day 2-6 mg I day 500-1500 mg I day 500-1000 mg / day Best indicated - Broad spectrum. - Not for petit mal. - Grand mal. - Motor Jacksonian fits. - Grand mal. - Motor Jacksonian fits. - Complex seizures. - Not for petit ma!. - Myoclonic. - Grand mat. - Broad spectrum. - Petit mat. 140 141 STATUS EPILEPTICUS DEFINITION - A medical emergency: 1. Repeated attacks of generalized convulsions, with lack of recove,y of consciousness, 2. Persistent attack of seizure lasting for at least 30 minutes. OR, - If the convulsions are not stopped rapidly, coma deepens & death may occur due to: heart failure or respiratory failure or brain damage or hyperpyrexia. - The most common causes are: sudden withdrawal of anti-epileptic drugs & stroke. TREATMENT A. General Measures: l. Take care of: " ABC " ⢠Place the patient on the ground, to guard against falling from bed. ⢠Mouth gag & 02 inhalation ( endo-tracheal intubation may be needed). ⢠Record the vital signs regularly. 2. Take a sample of: - Venous blood: for the level of: - A.tierial blood: for the level of: 3. a nti-epileptic drugs, a lcohol. pH, p0 2, pC02, HC0 3. Give cerebral dehydrating measures: e.g. Frusemide, cone. Mannitol, Dexamethazone. B. Specific Treatment: - Phenytoin with diazepam (or clonazepam) immediately: 1. Phenytoin: 2. Diazepam: Clonazepam: seizures recur: 15 mg I Kg slow infusion. 5 mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 20 mg. OR: 2 mg slowly IV, to be repeated after 5 minutes if maximum dose: 6 mg. - If seizures persist after 20 min. of Phenytoin & diazepam: 3. PHENOBARBITONE: - In resistant cases: 200 mg infusion. 4. GENERAL ANAESTHESIA: may be used.