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The Greek Alphabet.
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The Greek Renaissance [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.Rise of the Greek CivilizationTales of the Greek HeroesQuiz for fifth graders about the Greek revolution ORIGINS AND MEANING OF HISTORY When was the first time you heard the word ‘history’? History has always been with us as people. How is history referred to in your language? History is common to all ethnic groups in Ghana. All ethnic groups in Ghana describe history in their local languages. The origins and meaning of history help us understand how past events have shaped the world we live in today. By exploring these beginnings, we can trace the development of societies, cultures, and civilisations, gaining insights into the experiences, challenges, and achievements of those who came before us. Understanding history offers us a deeper connection to our heritage and a clearer perspective on the present and future. The word ‘history’ has conventional and non-conventional origins or roots. Let’s delve deeper into these two main origins of history. The Non-conventional Origin of History History is not foreign to Ghanaians; we have always owned our history. This is known as non-conventional history. Its origins can be traced to the indigenous terms used by different communities and ethnic groups in Ghana to describe “history.” The Akans use the phrase ‘abakɔsɛm’ to refer to past events. The Dagbon people call it ‘Taarihi,’ the Ewes refer to it as ‘gbedenyawo’ or ‘blemanyawo,’ the Gas say ‘blemasaji,’ and the Gonjas use the term ‘Adrashɜη.’ As you can see, history is not new to our societies. Despite the different languages, one similarity across these non-conventional descriptions is their reference to significant past events. Though the words may vary, they all carry the same meaning and understanding, showing that history has always been part of our ethnic groups. Since prehistoric times, Ghanaians have preserved their history through narratives, songs, storytelling, drum language, oaths, and dirges. These sources reflect how Ghanaians understand and value history within their respective ethnic groups. Our understanding of history is shaped by our customs, practices, and traditions, such as chieftaincy, wars, marriages, and festivals. The Conventional Origin of History The word ‘history’ comes from the Greek word ‘historia,’ which means ‘inquiry’ in English. The term became popular and widely used in the 5th century BCE/BC when people began to study history in a more rational and structured way. This was the period when Herodotus described his investigation into the past, focusing on the events that led to the Persian War. Herodotus is often called the ‘father of history’ because of his early efforts to approach the study of history in a logical and systematic manner.Organic Nomenclature. What are aliphatic compounds or aliphatic hydrocarbons? An aliphatic compound or aliphatic hydrocarbon is an organic compound containing hydrogen and carbon atoms that are usually linked together in chains that are straight. The term Aliphatic has been derived from the Greek word “Aleiphar” which translates to “fat”. It is used to describe hydrocarbons that are obtained by the chemical degradation of oils or fats. What are aliphatic compounds or aliphatic hydrocarbons? The simplest organic compounds are those composed of only two elements: carbon and hydrogen. These compounds are called hydrocarbons. Hydrocarbons are separated into two types: aliphatic hydrocarbons and aromatic hydrocarbons. Aliphatic hydrocarbons are hydrocarbons based on chains of C atoms. There are three types of aliphatic hydrocarbons: Alkanes are aliphatic hydrocarbons with only single covalent bonds. Alkenes are hydrocarbons that contain at least one C–C double bond, and alkynes are hydrocarbons that contain a C–C triple bond. Occasionally, we find an aliphatic hydrocarbon with a ring of C atoms; these hydrocarbons are called cycloalkanes (or cycloalkenes or cycloalkynes). The simplest alkanes have their C atoms bonded in a straight chain; these are called normal alkanes. They are named according to the number of C atoms in the chain. The smallest alkane is methane: molecule is three dimensional, with the H atoms in the positions of the four corners of a tetrahedron. The diagrams representing alkanes are called structural formulas because they show the structure of the molecule. As molecules get larger, structural formulas become more and more complex. One way around this is to use a condensed structural formula, which lists the formula of each C atom in the backbone of the Molecule. The condensed formulas show hydrogen atoms right next to the carbon atoms to which they are attached, as illustrated for butane: The ultimate condensed formula is a line-angle formula (or line drawing) , in which carbon atoms are implied at the corners and ends of lines, and each carbon atom is understood to be attached to enough hydrogen atoms to give each carbon atom four bonds. For example, we can represent pentane (CH3CH2CH2CH2CH3) and isopentane [(CH3)2CHCH2CH3] as follows: Unsaturated Hydocarbons: Alkenes and Alkynes Alkenes Organic compounds that contain one or more double or triple bonds between carbon atoms are described as unsaturated. Unsaturated hydrocarbons have less than the maximum number of H atoms possible. Unsaturated hydrocarbon molecules that contain one or more double bonds are called alkenes. Carbon atoms linked by a double bond are bound together by two bonds, one σ bond and one π bond. Double and triple bonds give rise to a different geometry around the carbon atom that participates in them, leading to important differences in molecular shape and properties. The differing geometries are responsible for the different properties of unsaturated versus saturated fats. Naming Alkenes and Alkynes Alkenes and alkynes are named in a similar fashion. The biggest difference is that when identifying the longest carbon chain, it must contain the C–C double or triple bond. Furthermore, when numbering the main chain, the double or triple bond gets the lowest possible number. This means that there may be longer or higher-numbered substituents than may be allowed if the molecule were an alkane. For example, this molecule is 2,4-dimethyl-3-heptene (note the number and the hyphens that indicate the position of the double bond). Unsaturated Hydocarbons: Alkenes and Alkynes Unsaturated Hydocarbons: Alkenes and Alkynes Alkynes Hydrocarbon molecules with one or more triple bonds are called alkynes; they make up another series of unsaturated hydrocarbons. Two carbon atoms joined by a triple bond are bound together by one σ bond and two π bonds. The sp-hybridized carbons involved in the triple bond have bond angles of 180°, giving these types of bonds a linear, rod-like shape. The simplest member of the alkyne series is ethyne, C2H2, commonly called acetylene. The Lewis structure for ethyne, a linear molecule, is: Properties of Unsaturated Hydocarbons: Alkenes and Alkynes Ethylene (the common industrial name for ethene) is a basic raw material in the production of polyethylene and other important compounds. Over 135 million tons of ethylene were produced worldwide in 2010 for use in the polymer, petrochemical, and plastic industries. Ethylene is produced industrially in a process called cracking, in which the long hydrocarbon chains in a petroleum mixture are broken into smaller molecules. Halogens can also react with alkenes and alkynes, but the reaction is different. In these cases, the halogen reacts with the C–C double or triple bond and inserts itself onto each C atom involved in the multiple bonds. This reaction is called an addition reaction. One example is Properties of Unsaturated Hydocarbons: Alkenes and Alkynes Hydrogen can also be added across a multiple bond; this reaction is called a hydrogenation reaction. In this case, however, the reaction conditions may not be mild; high pressures of H2 gas may be necessary. A platinum or palladium catalyst is usually employed to get the reaction to proceed at a reasonable pace: CH2=CH2+H2→metalcatalystCH3CH3 CH2=CH2+H2→metalcatalystCH3CH3. 'Create a quiz based on this lesson: . Tenali Rama was known for his sense of humour. In fact, King Krishnadevaraya used to enjoy his witty remarks even when they were targeted at him. Here is one such story. Scene 1 One day, an Arab horse trader visited the court of King Krishnadevaraya. He had a fine horse for the king. The (Greek/Chinese/Arab/ British) trader visited the court of King Krishnadevaraya King: All of you know that I am very fond of horses. The horses in my stable are the finest indeed! Send the trader in! I always want some rare breeds of horses from across the world to add to my man collection. Trader: Good day, Your Majesty! I have brought one of the finest horses from ArabiaI request you to see the horse. I am sure you will want him for your royal stable. King: This is indeed a magnificent creature! I wish to buy this fine horse. Trader: Your Majesty, I have two more such horses with me in Arabia and it would be my pleasure to bring them to you. Trader: You are really kind and I am sure you will like ader merchant magnificent splendid/superb King: I am so happy to hear that. I agree to buy the other two horses as well Into Trader: l am grateful for your offer and I promise to return with the other two horses within a week's time. Scene 2 Months passed, but there was no sign of the trader. Worried and anxious, the king decided to take a stroll in the garden. There, he spotted Tenali Rama sitting under a tree and scribbling something on a piece of paper. King: What are you writing on this sheet of paper, Rama? Rama: Here is the paper. You can see for yourself. It is the list of names of people who can be called 'very foolish!. Rama showed the paper to the king. It was a list of names with the king's name at the top. King: My name is always on top of the list. I do know that you respect me. On the top of the list was written— 'List of the Biggest Fools in the World! He became furious. King: How can you call your King, 'a fool?' You will have to explain it to me. Rama: lam really sorry that I had to add you as well in the list of fools. How could your Highness trust an unknown Arab horse trader, give him a huge advance, and expect him to return? ' King: What if he really comes back? Rama: If he returns with his horses after taking so much money from you, then I will put his name as the first one. So, he will be on top of the list of fools. The king realized his mistake. His anger slowly gives way to laughter. King: You are really funny, Rama. I was very unhappy, but with your witty remark, you have defused my anger and anxiety. I love your sense of humour. Rama: Dear King, you are so good to everyone! You fail to understand that you should be good to people, but should never trust strangers. The king agreed and they walked back to the palace.