DISLIPIDEMIA DIABÉTICA

RESUMENLas enfermedades cardiovasculares constituyen la principal causa de morbimortalidad en los pacientes diabéticos y uno de los principales factores de riesgo son las dislipidemias. Estos pacientes presentan un patrón de alteraciones lipídicas caracterizadas por elevación moderada del colesterol LDL, con aumento de las partículas de LDL densas y pequeñas, incremento de triglicéridos y reducción del colesterol HDL (dislipidemia aterogénica).Las diversas guías de manejo de dislipidemias coinciden en que la reducción del colesterol LDL, es el principal objetivo terapéutico en estos pacientes. Así entonces, las intervenciones terapéuticas deben considerar, además de las modificaciones del estilo de vida, el uso de estatinas como droga de primera elección. Diversos estudios han evidenciado la gran efectividad de las estatinas en la reducción de eventos cardiovasculares en pacientes diabéticos. Sin embargo, en muchos casos es necesario el uso de otros fármacos asociados, principalmente ezetimibe y algunos fibratos con el fin de optimizar los niveles de lípidos plasmáticos y reducir el riesgo cardiovascular residual.SUMMARYCardiovascular diseases are the main cause of morbi-mortality in diabetic patients and the dyslipidemias are one of the main risk factors. Diabetic patients exhibit different lipid abnormalities including increase of LDL cholesterol, with predominance of small dense LDL particles, increase of triglycerides and low HDL-cholesterol plasma levels.Different lipid guidelines have established that LDL cholesterol is the primary therapeutic target for diabetic patients. Therefore, in addition to lifestyle modifications, statins are the first line drug in these patients, and several studies have shown the effectiveness of statins in reduction of cardiovascular events in these patients. Nevertheless, in several cases, it is necessary to associate additional drugs, including ezetimibe and/or fibrates in order to optimize the lipid levels and reduce the cardiovascular residual risk

Lo último en diagnóstico y tratamiento de la obesidad: ¿Hay lugar aún para la terapia conservadora?

Indexación: ScieloIn Chile and other countries the actual prevalence of obesity is reaching 30% in selected populations (low income women). Nowadays bariatric surgery appears to be the treatment of choice. However, it is only indicated in selected patients and is not the first line treatment, since it does not prevent or reduce the appearance of this condition, a crucial challenge in its clinical management. The contemporary medical management of obesity should include changes in lifestyle habits and diet together with a behavioral therapy. However, this optimal management requires a multidisciplinary team. A challenge for contemporary medicine is to design efficient interventional strategies to change lifestyles among the obese. These interventions are the only way to reduce the adverse health consequences of obesity.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000600015&nrm=is

Un acercamiento exploratorio en torno a la Universidad y siglo XXI: asignatura insignia para la formación integral de los discentes, desde la visión institucional y la mirada estudiantil

The present article, it is an exploratory approximation concerning University and 21st century ensued from the first stage of an investigation of path that is realized on the part of a group of teachers specialists in the subject matter, which aim was to know the perception of the students of the subject “emblem” named University and 21st century, for his integral formation. The reflections about the new subject, arise in this first phase as an approximation from the study of perception applied to the discentes that there deposited with the new reform curricular during the schedule of courses 2013-A to the University Economic Center of Sciences Administrative officers (CUCEA) of the University of Guadalajara (UDEG). In the UDEG, was considered to be pertinent the incorporation of a subject “emblem” that should offer to the university community a condition of belonging; a critical vision before problematic in the local as global area; a critical thought; the development of intellectual, academic tools and of investigation; a planeación and exploration of his life and profession; as well as the construction of his university identity, which allows that they should manage to identify the values and symbols, the aspirations and longings, the customs and traditions, the daily practices and the social commitments, which from every diversified being converge towards a common end. Under these ambitious intentions, there arises the Course-workshop of “ University and 21st century “ in a modality presencial enriched (with the platform Moodle), that must not be conceived as the panacea, but as the opportunity for that the university community had waited for fungir as catharsis of those absent turns in his universitary education. The way, it is complex and the uncertain future, but with a wide and pertinent vision of what is wanted and expects from our university and from the university students, it will manage to construct what the company of the 21st century needs.El presente artículo es un acercamiento exploratorio en torno a Universidad y Siglo XXI, resultado de la primera etapa de una investigación de trayectoria que se realiza por parte de un grupo de profesores especialistas en la temática, cuyo objetivo fue conocer la percepción de los estudiantes de la asignatura “insignia” denominada Universidad y Siglo XXI, para su formación integral. Las reflexiones alrededor de la nueva asignatura, surgen en esta primera fase como un acercamiento a partir del estudio de percepción aplicado a los discentes que ingresaron con la nueva reforma curricular durante el calendario escolar 2013-A al Centro Universitario de Ciencias Económico Administrativas (CUCEA) de la Universidad de Guadalajara (UDEG). En la UDEG, se consideró pertinente la incorporación de una asignatura “insignia” que brinde a la comunidad universitaria un estado de pertenencia; una visión crítica ante problemáticas en el ámbito local como global; un pensamiento crítico; el desarrollo de herramientas intelectuales, académicas y de investigación; una planeación y prospección de su vida y profesión; así como la construcción de su identidad universitaria, que permita que logren identificar los valores y símbolos, las aspiraciones y anhelos, las costumbres y tradiciones, las prácticas cotidianas y los compromisos sociales, que desde cada ser diversificado convergen hacia un fin común. Bajo estos ambiciosos propósitos, surge el Curso-Taller de “Universidad y Siglo XXI” en una modalidad presencial enriquecida (con la plataforma Moodle), que no debe concebirse como la panacea, sino como la oportunidad que la comunidad universitaria había esperado para fungir como catarsis de aquellos recovecos ausentes en su formación universitaria. El camino es complejo y el futuro incierto, pero con una visión amplia y pertinente de lo que se quiere y espera de nuestra universidad y de los universitarios, se llegará a construir lo que la sociedad del siglo XXI necesita.

Phenotypical, Clinical, and Molecular Aspects of Adults and Children With Homozygous Familial Hypercholesterolemia in Iberoamerica

Fil: Alves, Ana Catarina. Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa; Portugal.Fil: Alonso, Rodrigo. Center for Advanced Metabolic Medicine and Nutrition, Santiago; Chile.Fil: Diaz-Diaz, José Luís. Hospital Universitario A Coruña. Department of Internal Medicine; España.Fil: Medeiros, Ana Margarida. Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa; Portugal.Fil: Jannes, Cinthia E. University of São Paulo. Medical School. Hospital São Paulo. Heart Institute (InCor); Brasil.Fil: Merchan, Alonso. Fundación Clinica SHAIO, Cardiología, Bogotá; Colombia.Fil: Vasques-Cardenas, Norma A. Universidad Autónoma de Guadalajara. Facultad de Medicina Zapopan; México.Fil: Cuevas, Ada. Center for Advanced Metabolic Medicine and Nutrition, Santiago; Chile.Fil: Chacra, Ana Paula. University of São Paulo. Medical School. Hospital São Paulo. Heart Institute (InCor); Brasil.Fil: Krieger, Jose E. University of São Paulo. Medical School. Hospital São Paulo. Heart Institute (InCor); Brasil.Fil: Arroyo, Raquel. Fundación Hipercolesterolemia Familiar, Madrid; España.Fil: Arrieta, Francisco. Hospital Ramón y Cajal. Departamento de Endocrinología, Madrid; España.Fil: Schreier, Laura. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica, Laboratorio de Lípidos y Aterosclerosis; Argentina.Fil: Corral, Pablo. Universidad FASTA. Facultad de Medicina. Cátedra Farmacología e Investigación, Mar del Plata; Argentina.Fil: Bañares, Virginia. ANLIS Dr.C.G.Malbrán. Centro Nacional de Genética Médica. Departamento de Genética Experimental; Argentina.Fil: Araujo, Maria B. Hospital Garrahan. Servicio de Nutrición; Argentina.Fil: Bustos, Paula. Universidad de Concepción. Facultad de Farmacia; Chile.Fil: Asenjo, Sylvia. Universidad de Concepción. Facultad de Medicina; Chile.Fil: Stoll, Mario. Programa GENYCO, Laboratorio de Genética Molecular. Comisión Honoraria de Salud Cardiovascular, Montevideo; Uruguay.Fil: Dell'Oca, Nicolás. Programa GENYCO, Laboratorio de Genética Molecular. Comisión Honoraria de Salud Cardiovascular, Montevideo; Uruguay.Fil: Reyes, Maria. Fundación Cardiovascular de Colombia. Cardiología; Bogotá.Fil: Ressia, Andrés. Fundación Cardiovascular de Colombia. Cardiología; Bogotá.Fil: Campo, Rafael. Instituto Mexicano del Seguro Social. Centro de Investigación Biomédica del Occidente, Guadalajara; México.Fil: Magaña-Torres, Maria T. Instituto Nacional de Ciencias Médicas y Nutrición. Unidad de Investigación de Enfermedades Metabólicas; México.Fil: Metha, Roopa. Instituto Nacional de Ciencias Médicas y Nutrición. Unidad de Investigación de Enfermedades Metabólicas; México.Fil: Aguilar-Salinas, Carlos A. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Departamento de Endocrinología y Metabolismo. Secretaría de la Defensa Nacional. Unidad de Especialidades Médicas. Servicio de Endocrinología; México.Fil: Ceballos-Macias, José J. Pontificia Universidad Javerina. Facultad de Medicina. Departamento de Medicina Interna, Bogotá; Colombia.Fil: Ruiz Morales, Álvaro J. Pontificia Universidad Javerina. Facultad de Medicina. Departamento de Medicina Interna, Bogotá; Colombia.Fil: Mata, Pedro. Fundación Hipercolesterolemia Familiar, Madrid; España.Fil: Bourbon, Mafalda. Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa; Portugal.Fil: Santos, Raul D. University of São Paulo. Medical School. Hospital São Paulo. Heart Institute (InCor); Brasil.OBJECTIVE: Characterize homozygous familial hypercholesterolemia (HoFH) individuals from Iberoamerica. APPROACH AND RESULTS: In a cross-sectional retrospective evaluation 134 individuals with a HoFH phenotype, 71 adults (age 39.3±15.8 years, 38.0% males), and 63 children (age 8.8±4.0 years, 50.8% males) were studied. Genetic characterization was available in 129 (96%). The majority (91%) were true homozygotes (true HoFH, n=79, 43.0% children, 46.8% males) or compound heterozygotes (compound heterozygous familial hypercholesterolemia, n=39, 51.3% children, 46.2% males) with putative pathogenic variants in the LDLR. True HoFH due to LDLR variants had higher total (P=0.015) and LDL (low-density lipoprotein)-cholesterol (P=0.008) compared with compound heterozygous familial hypercholesterolemia. Children with true HoFH (n=34) tended to be diagnosed earlier (P=0.051) and had a greater frequency of xanthomas (P=0.016) than those with compound heterozygous familial hypercholesterolemia (n=20). Previous major cardiovascular events were present in 25 (48%) of 52 children (missing information in 2 cases), and in 43 (67%) of 64 adults with LDLR variants. Children who are true HoFH had higher frequency of major cardiovascular events (P=0.02), coronary heart (P=0.013), and aortic/supra-aortic valve diseases (P=0.022) than compound heterozygous familial hypercholesterolemia. In adults, no differences were observed in major cardiovascular events according to type of LDLR variant. From 118 subjects with LDLR variants, 76 (64%) had 2 likely pathogenic or pathogenic variants. In 89 subjects with 2 LDLR variants, those with at least one null allele were younger (P=0.003) and had a greater frequency of major cardiovascular events (P=0.038) occurring at an earlier age (P=0.001). CONCLUSIONS: There was a high frequency of cardiovascular disease even in children. Phenotype and cardiovascular complications were heterogeneous and associated with the type of molecular defect

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI