Producci?n y exportaci?n de lim?n Fino 49 cultivado en Huaura (Regi?n Lima) : plan de internacionalizaci?n para la empresa Agropecuaria San Ram?n

El lim?n amarillo (Citrus lim?n) es un producto inel?stico que se comercializa en todo el mundo, centrando su consumo en el Hemisferio Norte en forma de fruta fresca e industrializada, la comercializaci?n del Lim?n fino 49 en fresco hacia Europa por ASR Trading, brazo comercial de ASR Agr?cola se centrar? en la ventana comercial de Julio a Setiembre, teniendo como driver operativo, el manejo agr?cola, las operaciones log?sticas t?cticas y comercializaciones directas en la entrega de un tipo de lim?n amarillo Premium que cumpla las caracter?sticas organol?pticas requeridas por Alemania como mercado objetivo por la tasa de consumo de limones en los ?ltimos a?os, mejores precios, estabilidad econ?mico, pol?tica y comercial, ofertando a precios por encima del 80% de la temporada de invierno debido a la nula oferta de Espa?a, su principal abastecedor y la poca oferta de los pa?ses del Hemisferio Sur, principalmente Sud?frica y Chile, que aprovechan estos meses para posicionar su fruta. La oferta de limones amarillo por parte de Per? tendr? como gu?a la cadena agroexportadora de lima Tah?ti, reconociendo los factores claves de ?xito, cuellos de botella y los paradigmas claves para generar valor y posicionarse con un producto nuevo en la canasta agroexportadora peruana

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Producción y exportación de limón Fino 49 cultivado en Huaura (Región Lima) : plan de internacionalización para la empresa Agropecuaria San Ramón

El limón amarillo (Citrus limón) es un producto inelástico que se comercializa en todo el mundo, centrando su consumo en el Hemisferio Norte en forma de fruta fresca e industrializada, la comercialización del Limón fino 49 en fresco hacia Europa por ASR Trading, brazo comercial de ASR Agrícola se centrará en la ventana comercial de Julio a Setiembre, teniendo como driver operativo, el manejo agrícola, las operaciones logísticas tácticas y comercializaciones directas en la entrega de un tipo de limón amarillo Premium que cumpla las características organolépticas requeridas por Alemania como mercado objetivo por la tasa de consumo de limones en los últimos años, mejores precios, estabilidad económico, política y comercial, ofertando a precios por encima del 80% de la temporada de invierno debido a la nula oferta de España, su principal abastecedor y la poca oferta de los países del Hemisferio Sur, principalmente Sudáfrica y Chile, que aprovechan estos meses para posicionar su fruta. La oferta de limones amarillo por parte de Perú tendrá como guía la cadena agroexportadora de lima Tahíti, reconociendo los factores claves de éxito, cuellos de botella y los paradigmas claves para generar valor y posicionarse con un producto nuevo en la canasta agroexportadora peruana

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc