Atorvastatin, sold under the brand name Lipitor among others, is a statin medication used to prevent cardiovascular disease in those at high risk and treat abnormal lipid levels. For the prevention of cardiovascular disease, statins are a first-line treatment, it is taken by mouth. Common side effects include joint pain, heartburn and muscle pains. Serious side effects may include rhabdomyolysis, liver problems, diabetes. Use during pregnancy may harm the baby. Like all statins, atorvastatin works by inhibiting HMG-CoA reductase, an enzyme found in the liver that plays a role in producing cholesterol. Atorvastatin was patented in 1986, approved for medical use in the United States in 1996, it is available as a generic medication. In the United States, the wholesale cost per month is about US$3.80 as of 2018. In the United Kingdom, it costs the NHS about £0.70 per month as of 2018. In 2017, it was the second most prescribed medication in the United States, with more than 104 million prescriptions.
The primary uses of atorvastatin is for the treatment of dyslipidemia and the prevention of cardiovascular disease: Hypercholesterolemia and mixed dyslipidemia to reduce total cholesterol, LDL-C, apo-B, triglycerides levels, CRP as well as increase HDL levels. Heterozygous familial hypercholesterolemia in children Homozygous familial hypercholesterolemia Hypertriglyceridemia Primary dysbetalipoproteinemia Combined hyperlipidemia Primary prevention of heart attack and need for revascularization procedures in people who have risk factors such as age, high blood pressure, low HDL-C, a family history of early heart disease, but have not yet developed evidence of coronary artery disease. Secondary prevention of myocardial infarction, unstable angina, revascularization in people with established coronary artery disease. Myocardial infarction and stroke prevention in people with type II diabetesStudies suggest that high-dose statin therapy may play a plaque-stabilizing role in people with acute coronary syndrome and thrombotic stroke.
Statins, including atorvastatin, have a small beneficial effect on preventing the loss of kidney function and on reducing loss of protein in urine in people with cardiovascular disease. Statins, including atorvastatin, before heart surgery does not prevent acute kidney injury. There is tentative evidence that statins such as atorvastatin may decrease the risk of contrast-induced nephropathy. Atorvastatin may be used in combination with bile acid sequestrants and ezetimibe to increase the reduction in cholesterol levels. However, it is not recommended to combine statin medication treatment with certain other cholesterol-lowering medications fibrates, because this may increase the risk of myopathy-related adverse effects. While many statin medications should be administered at bedtime for optimal effect, atorvastatin can be dosed at any time of day, as long as it is continually dosed once daily at the same time. Geriatric: Plasma concentrations of atorvastatin in healthy elderly subjects are higher than those in young adults, clinical data suggests a greater degree of LDL-lowering at any dose for people in the population as compared to young adults.
Pediatric: Pharmacokinetic data is not available for this population. Gender: Plasma concentrations are higher in women than in men, but there is no clinically significant difference in the extent of LDL reduction between men and women. Kidney impairment: Kidney disease has no influence on plasma concentrations of atorvastatin and dosing need not be adjusted in these people. Hemodialysis: Hemodialysis will not alter medication levels or change clinical effect of atorvastatin. Hepatic impairment: In people with chronic alcoholic liver disease, levels of atorvastatin may be increased depending upon the extent of liver disease. Active liver disease: cholestasis, hepatic encephalopathy and jaundice Unexplained elevations in AST or ALT levels Pregnancy: Atorvastatin may cause fetal harm by affecting serum cholesterol and triglyceride levels, which are essential for fetal development. Breastfeeding: Small amounts of other statin medications have been found to pass into breast milk, although atorvastatin has not been studied, specifically.
Due to risk of disrupting a breastfeeding infant's metabolism of lipids, atorvastatin is not regarded as compatible with breastfeeding. Markedly elevated CPK levels or if a myopathy is suspected or diagnosed after dosing of atorvastatin has begun. Atorvastatin may cause rhabdomyolysis, it may be serious leading to acute kidney injury due to myoglobinuria. If rhabdomyolysis is suspected or diagnosed, atorvastatin therapy should be discontinued immediately; the likelihood of developing a myopathy is increased by the co-administration of cyclosporine, fibric acid derivatives, erythromycin and azole antifungals. Type 2 diabetes mellitus, an uncommon class effect of all statins. Myopathy with elevation of creatine kinase and rhabdomyolysis are the most serious side effects, occurring at a rate of 2.3 to 9.1 per 10,000 person-years among people taking atorvastatin. As mentioned atorvastatin should be discontinued if this occurs. Persistent liver enzyme abnormalities occurred in 0.7% of people who received atorvastatin in clinical trials.
It is recommended that hepatic function be assessed with laboratory tests before beginning atorvastatin treatment and repeated as clinically indicated thereafter. If evidence of serious liver injury occurs while a person is taking atorvastatin, it should be discontinued and not restarted until the etiology of the person's liver dysfunction is defined
In mathematics, equality is a relationship between two quantities or, more two mathematical expressions, asserting that the quantities have the same value, or that the expressions represent the same mathematical object. The equality between A and B is written A = B, pronounced A equals B; the symbol "=" is called an "equals sign". For example: x = y means that y denote the same object. 2 = x 2 + 2 x + 1 means. This may be interpreted by saying that the two sides of the equals sign represent the same function. = if and only if P ⇔ Q. This assertion, which uses set-builder notation, means that, if the elements satisfying the property P are the same as the elements satisfying Q the two uses of the set-builder notation define the same set; this property expressed as "two sets that have the same elements are equal." It is one of the usual axioms of set theory, called Axiom of extensionality. The etymology of the word is from the Latin aequālis from aequus. Substitution property: For any quantities a and b and any expression F, if a = b F = F.
Some specific examples of this are: For any real numbers a, b, c, if a = b a + c = b + c. Reflexive property: For any quantity a, a = a. Symmetric property: For any quantities a and b, if a = b b = a. Transitive property: For any quantities a, b, c, if a = b and b = c a = c; these three properties make equality an equivalence relation. They were included among the Peano axioms for natural numbers. Although the symmetric and transitive properties are seen as fundamental, they can be deduced from substitution and reflexive properties; when A and B are not specified or depend on some variables, equality is a proposition, which may be true for some values and false for some other values. Equality is a binary relation or, in other words, a two-argument predicate, which may produce a truth value from its arguments. In computer programming, its computation from two expressions is known as comparison; when A and B may be viewed as functions of some variables A = B means that A and B define the same function.
Such an equality of functions is sometimes called an identity. An example is 2 = x2 + 2x + 1. Sometimes, but not always, an identity is written with a triple bar: 2 ≡ x2 + 2x + 1. An equation is a problem of finding values of some variables, called unknowns, for which the specified equality is true. Equation may refer to an equality relation, satisfied only for the values of the variables that one is interested in. For example, x2 + y2 = 1 is the equation of the unit circle. There is no standard notation that distinguishes an equation from an identity or other use of the equality relation: a reader has to guess an appropriate interpretation from the semantics of expressions and the context. An identity is asserted to be true for all values of variables in a given domain. An "equation" may sometimes mean an identity, but more it specifies a subset of the variable space to be the subset where the equation is true. In some cases, one may consider as equal two mathematical objects that are only equivalent for the properties that are considered.
In the case of geometry, this is where two geometric shapes are said to be equal when one may be moved to coincide with the other. The word congruence is used for this kind of equality. There are some logic systems; this reflects the undecidability of the equality of two real numbers defined by formulas involving the integers, the basic arithmetic operations, the logarithm and the exponential function. In other words, there cannot exist any algorithm for deciding such an equality; the binary relation "is equal" between real numbers or other things if more defined, is not transitive. However, equality everywhere is transitive. Viewed as a relation, equality is the archetype of the more general concept of an equivalence relation on a set: those binary relations that are reflexive and transitive; the identity relation is an equivalence relation. Conversely, let R be an equivalence relation, let us denote by xR the equivalence class of x, consisting of all elements z such that x R z; the relation x R y is equivalent with the equality xR = yR.
It follows that equality is the finest equivalence relation on any set S in the sense that it is the relation that has the smallest equivalence classes. In some contexts, equality is distinguished from equiv
Razvan Preotu is a Canadian chess Grandmaster. Preotu is the son of Rene and Gabriela Preotu, who came to Canada from Romania in 1998; the family settled in Toronto, moved to nearby Burlington, Ontario in 2003. Razvan graduated from Dr. Frank J. Hayden Secondary School in the summer of 2017 and is studying computer science at The University of Texas at Dallas, he is a member of the university chess team. Razvan's first coach was his father Rene, a class B / Category II player, a FIDE chess Arbiter, his first organized tournament was at age seven—the Grade 2 Chess'n Math Association event in Toronto, in 2007. Razvan studied with a Hamilton, Ontario resident, he began to work online with Romanian Grandmaster George-Gabriel Grigore. Upon Grigore's retirement from coaching chess, Razvan worked with another Romanian GM Gergely Szabo, until summer 2016. Razvan won the Canadian Chess Challenge three consecutive times, for his grade 8, grade 9, grade 10 years, in 2013, 2014, 2015; this annual event, organized by the Chess'n Math Association, is Canada's national grade school championship, bringing together all of the provincial champions.
Upon attaining a FIDE rating of 2300, Razvan was awarded the FIDE Master title in 2013, at age 14. Razvan scored his first International Master norm at the 2013 North American Open in Las Vegas, he earned his first win over a Grandmaster when he defeated Bator Sambuev, a Canadian Olympic team member, at the 2013 Guelph Pro-Am. He made his second IM norm at the 2014 World Open at Virginia, he attained his third and final required IM norm at the 2014 U. S. Masters, was awarded the title by FIDE that year, as his FIDE rating had topped 2400. Razvan achieved his second GM norm in St Louis, Missouri, he made his final required GM norm at the 2016 World Open in Philadelphia. One final step still remained before he could formally be awarded the GM title: the minimum 2500 rating, Razvan completed this with his draw against GM Gata Kamsky in round five of the 2016 Washington, D. C. International. Razvan was granted the GM title during the 2016 FIDE Congress at Baku, Azerbaijan, in early September, 2016, becoming the second youngest Canadian-born GM.
Razvan played board one for Canada at the 2014 World Youth U16 Olympiad. He won the U16 Canadian title in 2015, placed sixth at the 2015 World Youth Chess Championship for U16. Razvan won the championship at the 2016 Calgary International, ahead of five GMs, becoming the first Canadian to win this title outright, he won the 2018 Quebec Open with an undefeated 7.5/9, including wins over 2nd and 4th place GMs Edouard and Mikhalevskyi. As of August 1, 2018, Razvan is the #2 ranked Canadian for national rating, behind GM Anton Kovalyov. Razvan will be playing for Team Canada at the 2018 Chess Olympiad, Georgia He has written articles for Chess Canada magazine, released a book. Michael Song, Razvan Preotu, Foreword by Evgeny Bareev. 2017. The Chess Attacker's Handbook. Gambit Publications. ISBN 978-1911465164 Razvan Preotu blog website
Popcorn chicken is a dish consisting of small, bite-sized pieces of chicken that have been breaded and fried, was developed by KFC. Popcorn chicken was invented by food technologist Gene Gagliardi, it was test-marketed in the United States from March 1992, had been launched nationwide by September 1992. It has been periodically available in KFC outlets, it was re-introduced in the US in 1998, again in 2001. It was re-introduced once again in 2015, under the name "KFC Popcorn Nuggets", it is still available in the UK, Australia and New Zealand. As of 2018 it is available in the Netherlands and in France and Italy since 2019; the product is targeted at young adults. Taiwanese popcorn chicken uses different seasonings. List of deep fried foods
San Felice is a Roman Catholic church in the town of Massa Martana, province of Perugia, Italy. The church is dedicated to the town patron saint, said to have been the bishop and martyr during the persecutions by Emperors Diocletian and Maximinian. While the church was erected by medieval times, the present structure has undergone many re-edifications; the church was damaged during the second world war. The façade with stone blocks has a baroque belltower rising from the cornice; the interior has a single nave surrounded by large pilasters. The main altarpiece depicts the Madonna with Blessed Ruggero, St Felix, Santa Rita and St Pope Pius V by Giacinto Boccanera. On the wall to the left of the entrance are two 16th-century frescoes depicting a Crucifixion and an Enthroned Virgin and Child with Saints Roch and Ambrosius. There are 15th-century frescoes including a Virgin and Child with St Sebastian and St Bernardino da Siena
The clapper rail is a member of the rail family, Rallidae. The taxonomy for this species is confusing and still being determined; the Ridgway's rail and the mangrove rail have been split. Furthermore, some taxonomists consider that the King rail and Aztec rail should be considered within this group, as those birds look similar and the birds are known to interbreed where they share territories; the clapper rail is found along the Atlantic coasts of the eastern U. S. Gulf of Mexico, eastern Mexico, some Caribbean islands, south through eastern Central America, as well at several inland locales. Populations are stable on the East Coast of the U. S. although the numbers of this bird have declined due to habitat loss. Clapper rails are saltmarsh specialists, are mobile across their range, with females showing weak philopatry and a lack of philopatry in males. Named subspecies of the clapper rail include: Rallus c. belizensis—Ycacos clapper rail. S. Gulf Coasts of southwest Alabama through Texas, of Tamaulipas.
Rallus c. scottii Rallus c. waynei The clapper rail is a chicken-sized bird that flies. It is grayish brown with a noticeable white patch under the tail, its bill curves downwards. These birds eat crustaceans, aquatic insects, small fish, they search for food while walking, sometimes probing with their long bills, in shallow water or mud. The twig nest is placed low in mangrove roots, 3-7 purple-spotted buff eggs are laid. Rails by Taylor and van Perlo, ISBN 90-74345-20-4 Clapper rail bird sound