QCM: Si six cent scies scient six cent cyprès:

chaque scie peut scier un cyprès

il y a six cent six cyprès, ou si près

six cent six scies scieront forcément six cent six cyprès

il y a six cent six scies, ou si près

INSERTION DE DOCUMENT: D'après le document:

52% des fils de cadres deviennent cadres

52% des cadres ont un père cadre

Il y a 52 000 cadres qui sont fils de cadres

Initiation a Zzish

refreshment (n): (small amounts of food and drink ( Refreshments will be available during the interval.) stimulant (n): a substance which temporarily arouses physiological or organic activity ( Caffeine is a natural stimulant .) reinforcement (n): the act of making sth stronger / (plural) soldiers sent to join an army to make it stronger ( Constructors have been hired to add reinforcement to the foundations of the old bridge.) initiative (n): the ability to make decisions without waiting to be told what to do (Being a successful entrepreneur requires one to have great initiative.) inhibition (n): a shy or nervous feeling that stops you from expressing your real feelings (She drinks alcohol at parties to get over her inhibitions.) initiation (n): a ceremony, ritual, test, or period of instruction with which a new member is admitted to an organization or office (The initiation period for new employees lasts approximately six weeks.) initial (n): the first letter of a name, esp. when used to represent a name (Do you know what Ms Rowling's initials, J and K, stand for?) concise (adj): short and clear, expressing what needs to be said without unnecessary words (She gave a concise overview of the points she was about to make in her speech. ) direct (adj): happening or done without involving other people, actions, etc. in between ( You will only be hired if you have direct experience in this field.) devious (adj): not straightforward, sincere and honest about your intentions or motives; shifty (They came up with a devious plan to overthrow the chairman of the company.) circuitous (adj): not straight or direct (The professor gave a circuitous explanation confusing his students.) diluted (adj): (of a liquid) made weaker or less pure by being mixed with sth else( Orange squash should be diluted with water before it is served.) delicate (adj): easily hurt or destroyed.( This silk shirt is too delicate to put in the washing machine.) desolate (adj): extremely sad and feeling lonely. (After the death of his wife he led a desolate life.) diffused (adj): widely spread or scattered; not concentrated/ wordy ( He spoke in such a diffused manner that it was impossible to take notes on his lecture.) might (n): the power, force, or influence held by a person or group (The captive struggled with all of his might and managed to free himself of the chains.) plot (n): a secret plan made by several people to do sth that is wrong, harmful or not legal, esp. to do damage to a person or a government / a storyline ( The plot of the forthcoming Harry Potter book has yet to be revealed.) glaze (n): a thin clear liquid put on objects before they are finished, to give them a shiny surface ( She mixed sugar and lemon to make the glaze of the cake.) plight (n): an unpleasant condition, esp. serious, sad or difficult one ( Last night's documentary dealt with the plight of political asylum seekers.) comprise (v): to consist of be composed of( The final exam is comprised of three parts.)

[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.

Iniciación a la multiplicación

L'invitation - Offrir à boire et à manger

Bibliography A list of works cited or otherwise relevant to a subject or other work. Bildungsroman A German word referring to a novel structured as a series of events that take place as the hero travels in quest of a goal. Bombast Inflated, pretentious language used for trivial subjects. Burlesque A work of literature meant to ridicule a subject; a grotesque imitation . Cacophony Grating, inharmonious sounds. Caesura A pause somewhere in the middle of a verse, often (but not always) marked by punctuation . Canon The works considered most important in a national literature or period; works widely read and studied . Caricature A grotesque likeness of striking qualities in persons and things . Carpe Diem Literally, "seize the day"; enjoy life while you can, a common theme in literature. Catharsis A cleansing of the spirit brought about by the pity and terror of a dramatic tragedy.

What is an official invitation letter? The companies write a letter of invitation-business when they host business visitors from abroad or from the same region or country. The business visitors can be investors; potential buyers may be conference visitors, business partners, employees of any company, or mere individuals who come for training at the company’s facilities. If a company is inviting any visitor, a representative of that company must write the letter. Also, the firms must have some specific people who would sign the invitation letters. These letters are very much precise, only containing the necessary information. The invitation letter should state the name of the business organization they represent and their relationship to the host (e.g., distributor, regional sales reps, etc.). The letter should articulate the planned dates of travel, and must be formatted professionally. What is a personal invitation letter? A Personal invitation letter is a letter one writes to invite people to a party or a social gathering at a very personal level. It is a formal request asking for the person’s presence at the event that is going to take place. All the relevant details regarding the event like the reason, date, time and venue and the dress code, if any, must be provided in the invitation letters. This will keep the guests informed, and they will feel happy to attend the event. The style and tone of the letter would depend upon the relationship between the sender and receiver. Through the letter, you should be able to make the receiver feel that you highly value his/her presence at the party or the event. A personal invitation letter can be written to invite a person to a birthday party, wedding, conference, meeting, dinner, etc. Before writing the letter, make sure you have a list of people whom you would like to invite to the party or the event. How to Write an Invitation Letter Writing an invitation letter becomes easy and swift once you get through the tips and the format of the invitation letter provided below. Usually block, semi-block or a modified block format is used for official invitation letters. The important aspects of any invitation letters are date, time, salutations and closing. For more advice refer to the tips provided. Tips for Invitation Letter Writing ● Organize the Matter – Before you draft an invitation letter ensure that you have all the required material. This material refers to a list of the people to be invited, sequential order of the events, timings of the events, special guest, official documents, photocopies and any other required item. Some items may also need to be attached along with the letter, keep them alongside. Refer to these as and when required. All the relevant documents will help you in drafting the letter. ● Drafting – You don’t just write a letter straightway and post it. It has to be reviewed and finalized. One of these processes is drafting. Drafting ensures that your mistakes and their rectification aren’t passed on to the invitation itself. Make all the mistakes in the draft itself. Drafting an invitation letter is important as sometimes we may make mistakes that we are not able to see but they are visible to others. One may require a draft to be approved by seniors before it is finalized. A second opinion from a friend or peer etc. may be required as well to determine certain things. ● Politeness – You don’t need to be told that you have to use polite language while writing an invitation letter, why would you be rude when sending an invitation? True, but you have to remind yourself of certain manners and etiquettes required of an invitation. Your invitation is your initiative, not the recipients so you need to be gracious. Always begin the letter with a welcome note instead of straightforward information of the invitation. Words of respect and gratitude are symbols of courtesy and politeness, always expressing your gratitude in the beginning and the end of the letter. ● Positive Tone – The gesture of welcome and gratitude themselves are positive points of an invitation letter. Apart from these, gestures of appreciation and anticipation are other positive points which can persuade a guest to attend the event. When you show your appreciation and anticipation towards the recipient through your words, it is an acknowledgement of his importance and thereby a positive approach. Towards this effect two tenses are used within the invitation letter, the present and the future. The present tense conveys information about the event and the future tense conveys an anticipated presence of the guest. ● Offer Assistance – An invitation being the responsibility of the sender, the assistance to the recipient by default becomes a responsibility of the host. The more facilities you provide the better the chances of someone’s attendance. You can offer pick up and drop services, accommodation, meals, provide them contact numbers in case you are not present at the venue and other required assistance. Relevant facts like date, time and venue of the event in the beginning itself is itself assisting. These assistances encourage a positive response from the invitees. ● Special Instructions – Some occasions require special instructions for the guests. These instructions can be: 1. Dress code 2. Road or route map 3. Purpose of the occasion – birthday, honor, anniversary etc. 4. Return gift 5. Response or confirmation to the invitation 6. Attire and items required for the guest to bring 7. No eatables allowed 8. Entrance only by invitation 9. 2 people per pass 10. No weapons allowed ● Length of the Matter – A simple invitation letter will only contain only the relevant facts. A simple invitation letter features an introduction which allows the sender to introduce themselves and or the organization they represent. A simple background of the individual or company is enough. Though invitations are meant to be concise and straightforward, it isn’t necessary. You can vary the length as per your need and requirement. Wedding and party invitation letters are not lengthy as compared to visit and certain personal invitation letters. ● Using Letterhead – As a rule official Invitation letters require a letterhead. Letterhead represents the sender and its inclusion is authority established. If you have a pre printed letterhead then use that. Personal Invitation letters don’t require letterheads and one can use it as per one’s desire. ● Gesture of Appreciation – Next, the appreciation for the guest to attend an activity or event must be shown. This can be completed with a formal note, stating that you look forward to seeing the individual at the event. ● Don’t forget the Enclosure – Some requests require certain documents to be attached; these can be the photocopies of documents like agreements, hard copies of email received, earlier correspondence, receipts, warranty etc. Keep original copies of all your letters, faxes, e-mails, and other related documents. ● Closing the Letter – Start the letter with Gratitude and end it with the same. It is a professional and social courtesy. At the end of your last paragraph is written, a complimentary close of the likes of ‘Sincerely’, ‘Thank you’, ‘Truly’ is essential. Close the letter by restating your appreciation and gratitude. ● Proofreading – Check for - awkward phrases, grammatical errors, incomplete sentences and spelling mistakes. Fix them with appropriate punctuation and remove dull or lifeless sentences and replace them with clever phrasing, poetry or a themed approach. This is the final step; the draft will be reviewed and revised before it acquires a proper form. Read it aloud to yourself to figure out mistakes which are missed out in writing. ● Inform in Advance – Invitation letters need to be sent in advance. Try to send the invitation letter two weeks or more in advance. The recipient needs to know in advance so that they can adjust their schedules, book tickets or make other arrangements which are essential.

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