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Ce travail présent le développement d’une formulation exergétique réduite au sillage, adaptée à l’analyse aérodynamique de configurations ayant un fort couplage aéro-propulsif. Cette formulation est basée sur le travail d’Arntz (formulation exergétique utilisant un plan de sondage de taille infinie qui est bien adaptée pour l’analyse des simulations aérodynamique computationnelles par CFD) et combinée avec des méthodes classiques de champ lointain afin de réduire la zone d’étude au sillage. L’intérêt de cette réduction de la zone d’étude est double : d’un part, cela autorise une validation expérimentale de l’étude aéro-propulsif. D’autre part, cette réduction au sillage offre une compréhension très puissante de la physique et permet aussi de décomposer tous les mécanismes de génération de pertes aérodynamique. Ainsi, cette décomposition permet d’établir une comptabilité des phénomènes aéro-propulsifs pour des configurations avion complexes, ayant un fort couplage, ce qui est très outil pour le design d’un avion.La deuxième partie de la thèse vise à récolter des donnés expérimentaux (essais en soufflerie) d’une configuration avion type multifan, ayant un très fort couplage aéro-propulsif. Une maquette simplifiée de cet avion a été testée, tout en réalisant des mesures de sillage par PIV et sonde cinq trous, ainsi que des mesures de balance. Cette base de données a été utilisée pour valider expérimentalement la nouvelle formulation exergétique. Aussi, elle a été utilisé pour établir une modèle aéro-propulsif en utilisant une analyse aérodynamique classique, suivi d’une analyse exergétique complémentaire qui a fourni information de design très outil et qu’aucune méthode existante permet de le faire. This work presents the development of a wake-reduced exergy formulation suited for the aerodynamic analysis of close-coupled aero-propulsive aircraft configurations. It is based on the original work from Arntz (Exergy formulation requiring an infinite survey plane, that is well suited for the analysis of computational aerodynamic simulations by CFD), combined with several far-field methods in order to reduce the computation region to the wake. The interest behind the wake reduction is twofold: on one hand, it allows an experimental verification of the aero-propulsive assessment by the exergy method (by performing wake measurements in a wing tunnel testing). One the other hand, and even more important, this wake-reduction procedure provides a powerful insight into the physics and allows performing a breakdown of all the loss-generating mechanisms. This deeper breakdown enables a more comprehensive bookkeeping of the aero-propulsive phenomena involved in complex cases, which is key for design purposes.The second part of the PhD work aimed to gather experimental data (wind tunnel testing) of a highly-coupled aero-propulsive configuration: the Multifan aircraft. A simplified model was tested and its wake was measured by PIV and 5HP, along with balance data. Then, an experimental verification of the new wake-reduced formulation was carried out. Finally, the experimental data was exploited to build an aero-propulsive model of this complex configuration by using classical aerodynamic analysis. Then, this model was re-analyzed by using the new wake-reduced exergy formulation, revealing additional key information that couldn’t be obtained by other means, thereby showing the power of the method.

This paper shows the application of the aerodynamics exergy analysis preliminary formulation developed for unsteady flows for adiabatic and fixed bodies under low subsonic flow conditions (no shock-waves). The numerical implementation for URANS CFD cases of the presented formulation is explained. The test case is a circular cylinder in vortex shedding regime at Reynolds number 140, at low subsonic flow, with no movement with respect to the reference frame. The validation of the developed formulation is done by comparing the drag coefficient computed by the presented unsteady exergy formulation versus the near field drag coefficient taken as reference.

In 2020, ISAE-SUPAERO has released the first version of Epsilon: an open source tool for the aerodynamic analysis of CFD data with Paraview [1]. Several methods were available: near-field, far-field, Lamb vector and exergy. In the original release, CFD data could be fully analyzed but the analysis of wind tunnel data was very limited. That is why a development effort was undertaken in order to improve the posttreatment capabilities of wind tunnel data. Several tools were created to properly perform an aerodynamic analysis from PIV and 5HP data. These developments were implemented and verified in a recent wind tunnel campaign and the resulting feedback was used to perform a further upgrade to the software. The resulting new version of Epsilon is released to the public along with this conference paper.

The aerodynamic analysis by the exergy method is a powerful approach which allows establishing the theoretical limits of the aerodynamic performance of a given body, based on an aero-thermodynamic approach. The most used formulation is the Arntz’s method [1], which is well suited for the analysis of CFD data. This formulation was widely applied and validated for plenty of test cases but all of them were high-aspect ratio configurations. Then, the objective of this work is to study a test case with low aspect ratio: a delta wing with 74° of sweep angle, which is characterized by extreme flow features like strong vortices. It was found that the exergy formulation behaves well even under such challenging conditions. However, the related extreme flowfield allows identifying some hard points like the wake-reduced exergy analysis of the vortex breakdown, the impact of the solver setting on the final assessment, the viscous anergy generation, among other topics.

El presente trabajo de investigación tiene como objetivo caracterizar la telegestión educativa en los Institutos de Educación Superior Tecnológicos Públicos de la Dirección Regional de Educación de Lima Provincias, 2020. Este estudio es realizado por la actual coyuntura que está pasando el país del servicio educativo no presencial o remoto y el mundo como también ver la caracterización bondades y debilidades de los institutos en los diversos contextos de la región Lima provincias. La investigación obedece a un tipo de investigación de enfoque cuantitativo, de tipo básica, el diseño es no experimental – por lo que se aplica un método transversal – y busca caracterizar la variable de estudio; la variable telegestión educativa. La población estuvo conformada por 235 docentes y directivos. Se utilizó como instrumento de investigación el cuestionario. La validez de contenido del instrumento se tuvo a través del juicio de expertos, los cuales determinaron su validez de ser aplicable; y el valor de confiabilidad del instrumento se halló a través de la prueba de Alfa de Cronbach, lo cual dio como resultado de coeficiente de 0,982 para el cuestionario de telegestión educativa, el resultado indica el índice de muy alta confiabilidad Los resultados indican que el nivel de telegestión educativa en los Institutos Superiores Tecnológicos de Lima Provincias es alto 69.59%, moderado en 29.73% y bajo en 0.68%. estos resultados evidencian que la telegestión educativa en los Institutos Superiores Tecnológicos de Lima Provincias presenta un nivel alto. Ate Escuela de Posgrado Gestión y Calidad Educativa

Business in the restaurant sector in Peru are increasing, this implies that companies seek to optimize their processes to provide a better quality service to their customers. Restaurant.pe is a company that provides its clients with software focused on the administration and operation of the premises, providing information remotely and in real time to the owners. Being a growing Start-up, Restaurant.pe did not have defined areas or processes, which generated loss of information through the contact channels for its customers, causing them to make the decision to abandon the service provided by the company, generating losses in monthly billing. For this reason, to identify the recurring reasons that led clients to make that decision, methods such as the Ishikawa diagram were used, generating the creation of new control tools such as inspection, installation and customer monitoring checklist, among others. These tools allowed Restaurant.pe to carry out a restructuring of processes in the support and customer service areas respectively, thereby increasing customer retention in the company and improving its monthly billing. Los negocios del sector restaurante en el Perú son cada vez mayores, esto implica que las empresas busquen optimizar sus procesos para otorgar un servicio de mejor calidad a sus clientes. Restaurant.pe es una empresa que brinda a sus clientes un software enfocado en la administración y operatividad de los locales, otorgando información de manera remota y en tiempo real a los dueños. Al ser una Start up en crecimiento, Restaurant.pe no contaba con áreas ni procesos definidos, lo que le generaba pérdida de información a través de los canales de contacto para con sus clientes, haciendo que estos tomen la decisión de abandonar el servicio brindado por la empresa, generando pérdidas en la facturación mensual. Por tal razón para identificar los motivos recurrentes que llevaban a los clientes a tomar esa decisión se utilizaron métodos como el diagrama Ishikawa, generando la creación de nuevas herramientas de control como checklist de inspección, instalación y seguimiento a los clientes entre otros. Estas herramientas permitían a Restaurant.pe realizar una reestructuración de procesos en el área de soporte y de atención al cliente respectivamente, logrando con ello incrementar la retención de clientes en la empresa y mejorar su facturación mensual.

The aerodynamic analysis by the exergy method is reviewed. The existing formulations are analyzed for an external flow test case (NACA 0012 airfoil). This lead to the detection of some discrepancies between the CFD-based formulation and the wind-tunnel-based formulation, as well as other inconsistencies. Hence, a new harmonized formulation (based on the original Arntz’s work [1]) is proposed, providing consistent results for both, CFD and wind-tunnel approaches.

Artículo de grado El proyecto tiene como fin responder acertadamente al déficit de equipamientos del sector de Fontibón, complementado con la renovación urbana del Centro Fundacional por medio de la inclusión de adultos mayores a través de un equipamento que responda a sus necesidades de esparcimiento dentro del espacio urbano formulado. Pregrado Arquitecto INTRODUCCIÓN 1. METODOLOGÍA 2. RESULTADOS 3. DISCUSIÓN 4. CONCLUSIÓN REFERENCIAS

This paper presents the open source code called “Epsilon”. It is a tool suited for the aerodynamic analysis of CFD and wind tunnel data by using the exergy method. Other methods are also provided (near-field, far-field, Lamb vector). The architecture of the code is presented as well as a qualitative description of the analysis capabilities provided by the tool. Some reference test cases are presented and an accuracy assessment of the exergy analysis is performed. The software is released to the public along with this conference paper.

This paper aims to provide a prediction method for the transverse exergy of the wing’s trailing vortices. It relates the transverse exergy at each point of the entire downstream survey plane to the vorticity inside the wake. This allows reducing the survey area to the wake region only, leading to a useful expression for the calculation of the transverse exergy from wind tunnel measurements. The proposed equation offers a significant improvement respect to the Maskell method especially at high-angle of attack condition. CFD analyses of a NACA 0012 rectangular wing at subsonic and transonic conditions were used as test cases to present the concept.

La capacidad de almacenamiento del tejido adiposo es limitada y determinada genéticamente, así, hay individuos delgados con poca capacidad de almacenamiento que tienen marcadores metabólicos alterados (hiperinsulinismo, hiperglucemia, dislipidemia, esteatosis hepática, etc.), y otros sujetos con gran capacidad de almacenamiento que incrementan su peso hasta llegar a obesidad mórbida y sin embargo tienen marcadores metabólicos normales. A medida que el tejido adiposo se va acercando a su máxima capacidad de almacenamiento, el adipocito se va haciendo menos sensible a la insulina, para evitar su muerte por apoptosis debido al acúmulo excesivo de triglicéridos (TG). El grado de insulino-resistencia (IR) del tejido adiposo y el tiempo que dure determina tres situaciones diferentes. Una inicial donde el individuo incrementa su peso. La segunda en la cual el individuo mantiene su peso constante, ya que la cantidad de TG almacenados es igual a la cantidad que se hidrolizan. Y la tercera, cuando la IR es permanente, se desencadena la Diabetes Mellitus tipo 2 (DM2) que cursa con pérdida de peso y marcadores metabólicos alterados. La IR del tejido adiposo incrementa los ácidos grasos libres circulantes y estos tienen tres destinos: en el tejido hepático se acumulan causando esteatosis; la célula beta pancreática sufre apoptosis y disminuye la síntesis y secreción de insulina; y el músculo esquelético desarrolla IR para protegerse de una acumulación anormal de glucógeno que conllevaría a degeneración y muerte de la célula muscular. En este artículo se explican las modificaciones moleculares que estos órganos utilizan para mantener su indemnidad. The storage capacity of adipose tissue is limited and determined genetically, so there are thin people with small storage capacity that have altered metabolic markers (hyperinsulinemia, hyperglycemia, dyslipidemia, hepatic steatosis, etc.), and other people with large storage capacity that are able to increase weight until becoming morbidly obese and yet have normal metabolic markers. As adipose tissue approaches its maximum storage capacity, the adipocyte becomes less sensitive to insulin, to avoid death by apoptosis due to excessive accumulation of triglycerides (TG). The degree of insulin resistance (IR) in the adipose tissue and its duration determines three different situations. First of all, the patient increases weight. Second, the patient remains in a constant weight, since the amount of stored TG equals the amount that is hydrolyzed. And finally, when the IR is permanent, Type 2 Diabetes Mellitus (DM2) develops, causing weight loss and altered metabolic markers. Adipose tissue IR increases circulating free fatty acids, which have three destinations: liver, where they accumulate causing steatosis; pancreatic beta cell, which undergoes apoptosis and decreases synthesis and secretion of insulin; and skeletal muscle which develops IR to protect itself against an abnormal accumulation of glycogen that would lead to degeneration and death of the muscle cell. This article explains the molecular modifications that these organs use to maintain their indemnity. 20-28 mvillalobos1380@gmail.com miguelaguir@gmail.com climacoc@hotmail.com Cuatrimestral

O presente trabalho tem como objetivo estudar escoamentos de tornados e sua ação sobre corpos imersos empregando ferramentas numéricas da Engenharia do Vento Computacional (EVC). Os tornados constituem-se atualmente em uma das causas de desastres naturais no Brasil, especialmente nas regiões sul e sudeste do país, como também em alguns países vizinhos. Os efeitos gerados são geralmente localizados e de curta duração, podendo ser devastadores dependendo da escala do tornado. Tais características dificultam a realização de estudos detalhados a partir de eventos reais, o que levou ao desenvolvimento de modelos experimentais e numéricos. A abordagem numérica é utilizada neste trabalho para a simulação de tornados, a qual se baseia nas equações de Navier-Stokes e na equação de conservação de massa, considerando a hipótese de pseudo-compressibilidade e condições isotérmicas. Para escoamentos com turbulência utiliza-se a Simulação Direta de Grandes Escalas com o modelo clássico de Smagorinsky para as escalas inferiores à resolução da malha (Large Eddy Simulation ou LES em inglês). A discretização das equações fundamentais do escoamento se realiza com um esquema explícito de dois passos de Taylor-Galerkin, onde o Método dos Elementos Finitos é empregado na discretização espacial utilizando-se o elemento hexaédrico trilinear isoparamétrico com um ponto de integração e controle de modos espúrios Na presença de corpos imersos que se movem para simular os deslocamentos dos tornados, o escoamento é descrito cinematicamente através de uma formulação Arbitrária Lagrangeana-Euleriana (ALE) que inclui um esquema de movimento de malha. Tornados são reproduzidos através da simulação numérica de dispositivos experimentais e do Modelo de Vórtice Combinado de Rankine (RCVM). Exemplos clássicos da Dinâmica dos Fluidos Computacional são apresentados inicialmente para a verificação das ferramentas numéricas implementadas. Finalmente, problemas envolvendo tornados móveis e estacionários são analisados, incluindo sua ação sobre corpos imersos. Nos modelos baseados em experimentos, a variação da relação de redemoinho determinou os diferentes padrões de escoamento observados no laboratório. Nos exemplos de modelo de vórtice, quando o tornado impactou o corpo imerso gerou picos de forças em todas as direções e, após a passar pelo mesmo, produziu uma alteração significativa na estrutura do vórtice. Analyses of tornado flows and its action on immersed bodies using numerical tools of Computational Wind Engineering (CWE) are the main aims of the present work. Tornadoes are currently one of the causes of natural disasters in Brazil, occurring more frequently in the southern and southeastern regions of the country, as well as in some neighboring countries. Effects are usually localized, presenting a short time interval, which can be devastating depending on the scale of the tornado. These characteristics difficult to carry out detailed studies based on real events, leading to the development of experimental and numerical models. The numerical approach is used in this work for the simulation of tornadoes, which is based on the Navier-Stokes equations and the mass conservation equation, considering the hypothesis of pseudo-compressibility and isothermal conditions. For turbulent flows, Large Eddy Simulation (LES) is used with the classical Smagorinsky model for sub-grid scales Discretization is performed the explicit two-step Taylor-Galerkin scheme, where the Finite Element Method is used in spatial discretization using isoparametric trilinear hexahedral elements with one-point quadrature and hourglass control. In the presence of immersed bodies that are moving in order to simulate translating tornadoes, the flow is kinematically described through a Lagrangian-Eulerian Arbitrary (ALE) formulation, which includes a mesh motion scheme. Tornadoes are reproduced using numerical simulation of experimental devices and the Rankine Combined Vortex Model (RCVM). Classical examples of Computational Fluid Dynamics are presented initially for the verification of the numerical tools implemented here. Finally, problems involving moving and stationary tornadoes are analyzed, including their actions on immersed bodies. For models based on experiments, the variation of the swirl ratio determined the different flow patterns observed in the laboratory. In the vortex model examples, when the tornado impacted on the immersed body, peaks of forces were generated in all directions and, after passing over it, a significant change in the structure of the vortex was produced.

Objetivo: Dar a conocer una presentación atípica de dislipidemia mixta severa en población pediátrica y su abordaje diagnóstico y terapéutico. Caso Clínico: Escolar femenina de 7 años de edad, quien es referida por presentar suero lactescente, evidenciado al realizarle pruebas de laboratorio. Examen físico: talla, peso e índice de masa corporal en percentil 50, hepatomegalia palpable no dolorosa. Paraclínicos de ingreso: glucemia 114 mg/dl, colesterol: 166 mg/dl y triglicéridos: 1200 mg/ dl. Electroforesis: se evidencia VLDL y quilomicrones. Se hace diagnóstico de hiperlipoproteinemia tipo V, se inicia tratamiento con modificación de estilo de vida y ácidos omega 3, 1500 mg/día. Persisten niveles elevados de triglicéridos y aumenta el colesterol, por lo que se omite el omega 3 y se indica tratamiento con ezetimiba 10 mg y ciprofibrato 50 mg diarios. El estudio genético evidenció una variante intrónica G/C en el intrón 7 para el gen de PPAR?, correlacionándose con un riesgo elevado de hipertrigliceridemia y mutación del exón 4 del gen del receptor de LDL, por lo que se modifica el diagnóstico a dislipidemia mixta con elevación de VLDL, quilomicrones y LDL. La evolución actual ha sido satisfactoria. Conclusión: Las hiperlipidemias primarias son un grupo de patologías con frecuencia variables de acuerdo a los diferentes fenotipos presentes. El diagnóstico diferencial es importante para descartar una causa secundaria. La electroforesis y el estudio genético orientan al diagnóstico, y el tratamiento debe ser individualizado dependiendo de la clínica del paciente, los niveles de lípidos plasmáticos y los factores de riesgos asociados. Objective: To present an atypical presentation of severe mixed dyslipidemia in the pediatric population and its diagnostic and therapeutic approach. Case Report: Female 7-year-old is referred because of presenting lactescent serum, evidenced by laboratory tests. Physical exam: height, weight and body mass index in the 50th percentile, painless palpable hepatomegaly. Initial paraclinical: glucose 114 mg/dl, cholesterol 166 mg/dl and triglycerides 1200 mg/dl. Electrophoresis: evidence of VLDL and chylomicrons. Hyperlipoproteinemia type V diagnosis is made; treatment is initiated with lifestyle modification and omega 3 fatty acids, 1500 mg/day. However, given the persistence of high levels of triglycerides and cholesterol, the omega 3 fatty acids is omitted and treatment with ezetimibe 10 mg and ciprofibrate 50 mg daily, is indicated. Genetic studies revealed an intronic variant G/C in intron 7 for gene PPAR?, correlated with a high risk of hypertriglyceridemia, and a mutation of exon 4 of gene LDL receptor; for this reason, the diagnosis is modified to mixed dyslipidemia, with elevated VLDL, LDL and chylomicron. The current evolution has been satisfactory. Conclusions: Primary hyperlipidemia is a group of diseases with variable frequency according to the different phenotypes present. The differential diagnosis is important to exclude a secondary cause. Electrophoresis and genetic study guide the diagnosis. Treatment should be individualized depending on the clinical findings of the patient, plasma lipid levels, and associated risk factors. 205-216 seileehung@hotmail.com paolimariela@hotmail.com

168-179 miguelaguir@gmail.com Cuatrimestral

157-167 miguelaguir@gmail.com Cuatrimestral

Objetivo: El objetivo es dar a conocer un caso de Síndrome de Williams-Beuren (SWB). Caso Clínico: Lactante mayor, masculino de 1 año de edad, quien es remitido a la Unidad de Endocrinología del Instituto Autónomo Hospital Universitario de los Andes por presentar hipotonía y retraso en el desarrollo psicomotor. El examen físico reveló peso de 8,300 Kg (P10), talla de 75 cm (P50), potencial genético de talla de 176±10 cm. Normocéfalo, con dismorfia facial caracterizada por frente amplia, nariz corta y ancha, leve oblicuidad palpebral y epicántica, iris marrón estrellado, filtrum largo, mandíbula pequeña, labios prominentes y probable microdoncia. Además, se auscultó soplo sistólico eyectivo en foco pulmonar y el examen neurológico evidenció hipotonía troncal, leve y armónica, así como déficit de atención. El ultrasonido de tiroides reportó leve hipoplasia de la glándula, y el perfil tiroideo fue compatible con un hipotiroidismo subclínico. El estudio hemodinámico demostró la presencia de estenosis múltiple de arterias pulmonares y de ramas periféricas. Conclusiones: El paciente fue diagnosticado con SWB debido a la coexistencia de estenosis múltiple de arterias pulmonares y de ramas periféricas así como a las características faciales propias de este trastorno. Se estima que la frecuencia de este síndrome es de 1 por cada 7.500 nacidos vivos, pudiendo ser de aparición esporádica y ocurre por deleción en 7q11.23. El hipotiroidismo subclínico constituye una de las alteraciones endocrinológicas más frecuentemente encontradas en estos pacientes y se asocia a hipoplasia de la glándula tiroides. Objective: To divulge a case of Williams-Beuren Syndrome (WBS). Clinical case: Toddler, male, 1-year old, referred to the Endrocrinology Unit of the Mérida, Venezuela Los Andes University Hospital for presenting hypotonia and psychomotor retardation. At clinical examination he exhibited:weight: 8.3 kg (P10); height: 75 cm (P50); size genetic potential: 176±10 cm; normocephalic, with facial dysmorphia characterized by broad forehead, short and wide nasal bridge, slight palpebral and epicanthic obliquity, brown starry iris, long philtrum, small jaw, bulging lips and probable microdontism. Systolic ejection murmur in pulmonic root. Neurological examination evinced slight and harmonic truncal hypotonia and attention deficit. Ultrasound reported mild thyroid hypoplasia, thyroid profile being compatible with subclinical hypothyroidism. Hemodynamic monitoring confirmed multiple stenosis of pulmonary arteries and peripheral branches. Conclusion: Patient was diagnosed with WBS because of main branch and peripheral pulmonary artery stenosis concurrent with facial demeanor typical of this disorder. Its occurrence, likely sporadic and due to 7q11.23 deletion, attends one in 7500 live births. Subclinical hypothyroidism, associated to thyroid hypoplasia, is one of the most frequent endocrinological alterations found in these patients. 26-30 marcoslimamedical@hotmail.com Cuatrimestral

La Prolactina (PRL) es una hormona de naturaleza proteica sintetizada y secretada en la hipófisis anterior. Esta hormona presenta un amplio espectro de acciones biológicas siendo su principal función la estimulación de la glándula mamaria durante la lactancia. La hiperprolactinemia es el desorden hormonal hipofisario observado con mayor frecuencia en la práctica clínica. Existen condiciones fisiológicas y patológicas que pueden producir una elevación de la PRL. Las causas patológicas incluyen condiciones propias de la adenohipófisis, alteración de la conexión hipotálamo/hipofisaria y desórdenes sistémicos que condicionan un aumento en las concentraciones séricas de PRL. Los Prolactinomas constituyen el tumor pituitario más común y una de las principales causas de hiperprolactinemia. La causa más frecuente de hiperprolactinemia de origen no tumoral se debe al uso de fármacos en especial los neurolépticos/antipsicóticos. La galactorrea y la disfunción en la esfera reproductiva constituyen los marcadores clínicos de la hiperprolactinemia no fisiológica, sin embargo, un grupo de pacientes puede permanecer asintomático. Dependiendo de la causa y las consecuencias de la hiperprolactinemia un grupo de pacientes requerirá tratamiento. La causa desencadenante, edad, sexo y etapa reproductiva deben ser considerados al momento de la elección de la opción terapéutica. En el presente artículo, basados en niveles de evidencia científica y la experiencia clínica de la Unidad de Endocrinologí a del IAHULA, se describe el enfoque diagnóstico y terapéutico de esta alteración en diferentes grupos clínicos. Prolactin is a proteic hormone which is synthetized and secreted by the anterior hypophysis. This hormone has a broad spectrum of biological actions, but its main fuction is to stimulate mammary glands to induce milk production. Hyperprolactinemia is a hypohysis disorder which is frequently observed in the clinical practice. There are physiologic and pathologic conditions associated with the elevated production of PRL. The most common causes for pathological conditions include defects in the gland, alterations in the hypophysis/ hypothalamus conections and systemic disorders which precipitate elevated levels of serum PRL. The most frequent cause of non-tumoral hyperprolactinemia is due to medication side effects, specially antipsychotics and neuroleptic drugs. Galactorrhea and dysfunction of the reproductive axis are the main clinical markers of non- physiologic hyperprolactinemia, yet most patients may be asymtomatic. According to the cause and the clinical consequences some patients will require treatment for hyperprolactinemia. The triggering conditions, such as age, gender, and reproductive stage, must be taken into account when treatment is being considered. The present article, based on levels of scientific evidence and clinical experience in the Unit of Endocrinology, IAHULA, describes the diagnostic and therapeutic approach needed to handle such cases. 26-38 miguelaguir@gmail.com Cuatrimestral

La Diabetes Mellitus Tipo 1 (DM1) es una de las patologías más estudiadas en la actualidad, no solo por el aumento de su incidencia, sino también por su aparición a edades cada vez más tempranas. La DM1 es una enfermedad autoinmune de una alta complejidad genética y donde la susceptibilidad a factores ambientales parece jugar un papel preponderante. Elementos como parto por cesárea, deficiencia de vitamina D, exposición temprana a proteínas de la leche de vaca, exposición limitada a microorganismos durante la infancia y el incremento en la incidencia de obesidad infantil han sido relacionados con el desarrollo de esta entidad, convergiendo todos estos factores en un punto clave: la pérdida de la tolerancia inmunológica intestinal y la participación de células T auto-reactivas en pacientes susceptibles. Por su parte, la leche materna ofrece una serie de factores de crecimiento, inmunológicos, e incluso insulina, que son capaces de inducir una respuesta tolerogénica en el microambiente intestinal con la subsecuente disminución de la autoinmunidad. En esta revisión se expondrá la evidencia y los mecanismos fisiopatológicos propuestos por medio de los cuales los elementos mencionados desencadenarían una alteración de la inmunomodulación intestinal y un incremento en la predisposición al desarrollo de DM1. Type 1 Diabetes Mellitus (T1DM) is one of the most studied pathologies to date, not only due to the elevating incidence but also because it is being diagnosed at even earlier ages. T1DM is an autoimmune disease with a very complex genetic background where environmental factors seem to play a very important triggering role. Elements like cesarean section, vitamin D deficiency, early exposure to cow milk proteins, limited exposure to microorganisms during infancy, and the increase of childhood obesity have been related to the development of this disease, converging all the factors into one key feature: loss of intestinal immunological tolerance and the participation of auto-reactive T cells from a susceptible patient. On the other hand, breast milk offers a series of growth and immunological factors, even insulin, which are able to induce a tolerogenic response in the intestinal microenvironment, lowering the probability of any autoimmune phenomena. The following review will expose evidence of the pathophysiological mechanisms involved in each environmental element associated with intestinal immunomodulation and the increase risk of T1DM. 122-135 miguelaguir@gmail.com Cuatrimestral