Influencia del Regimen MYPE Tributario (RMT) en el desarrollo empresarial de las empresas de transporte público en la provincia de Cajamarca 2018

La presente investigación se justifica en la necesidad de generar conocimientos tributarios, formalidad y desarrollo empresarial en las empresas dedicadas al rubro transporte público en el distrito de Cajamarca - Perú. Se sustenta en el concepto que en el Perú la economía está sostenida por pequeñas empresas cuyos tributos contribuyen significativamente a la captación de ingresos para el erario nacional. El estudio tiene como objeto determinar de qué manera la nueva reforma tributaria (Régimen MYPE), que otorga flexibilidad en el pago del impuesto a la renta y beneficios tributarios influyeron en el desarrollo empresarial en las empresas del rubro transporte público en el distrito de Cajamarca durante el año 2018. Metodológicamente se realizará una investigación con enfoque cuantitativo, de alcance descriptivo correlacional y se utilizará el diseño transversal. Se investigará respecto a la población de empresas dedicadas al rubro transporte público en la Provincia de Cajamarca cuya información se obtendrá de SUNAT Cajamarca; para la determinación de la muestra se aplicará una fórmula estadística para poblaciones finitas la misma que permitirá definir una muestra representativa de la población. Para la obtención de la información se utilizará la técnica de encuesta cuyo instrumento de toma de información será un cuestionario con varias preguntas dirigidas a una muestra de la población. Finalmente, los datos serán tabulados e ingresados al programa Excel o SPSS para el análisis correspondiente

Sistema de costos de producción de semillas y rentabilidad en la Estación Experimental Agraria Baños del Inca, Cajamarca, períodos 2018-2020

La presente investigación buscó determinar la relación entre el sistema de costos de producción de semillas y la rentabilidad en la Estación Experimental Agraria Baños del Inca (EEABI), período 2018-2020; se consideró un enfoque cuantitativo, tipo aplicada, de alcance correlacional, corte longitudinal y con diseño no experimental. La muestra estuvo conformada por el estado de situación financiera, estado de resultados, reportes de ventas y costos. Se utilizó el método inductivo deductivo, con la técnica de análisis documental. Para el análisis de datos se utilizó el software Excel y el programa SPSS. Los resultados evidencian que la mano de obra directa tiene una variación porcentual de 11%, la materia prima directa 5% y los CIFs 6%; respecto al costo total hubo variación de 45%; asimismo, el sistema de costeo de producción presentó mayor desembolso en el rubro materia prima y generó 15% de margen neto de utilidad en relación al periodo anterior. Se obtuvo un ROA y un ROI de 5.25% y un Margen Neto de 90%. En conclusión, existe una relación inversa y significativa entre el sistema de costos de producción de semillas y la rentabilidad en la EEABI comprobado mediante el coeficiente de Pearson = -0.866; p = 0.033

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Demora quirúrgica como factor de riesgo de morbilidad perioperatoria por artroplastia parcial en fractura de cuello femoral del adulto mayor en HINDAC de Lima durante el periodo enero 2009 a diciembre 2013

Evaluar si la demora quirúrgica es factor de riesgo para morbilidad perioperatoria en ancianos con fractura de cuello femoral del Hospital Nacional Daniel Alcides Carrión. Material y Métodos: Se llevó a cabo un estudio de tipo, analítico, observacional, retrospectivo, de casos y controles. La población de estudio estuvo constituida por 87 adultos mayores con fractura de cuello femoral según criterios de inclusión y exclusión establecidos distribuidos en dos grupos: con y sin morbilidad perioperatoria Resultados: La frecuencia de demora quirúrgica en los pacientes con y sin morbilidad perioperatoria fue de 55% y 31% respectivamente. El odss ratio de demora quirúrgica en relación a morbilidad perioperatoria fue de 2.73 (p<0.05). Conclusiones: La demora quirúrgica es factor de riesgo para morbilidad perioperatoria en adultos mayores con fractura de cuello femoral en el Hospital Nacional Daniel Alcides Carrión. No se apreciaron diferencias significativas respecto a edad, condición de género y procedencia entre ambos grupos de estudio.Evaluate if surgical delayed is a risk factor to perioperative morbility at older age patients with hip fracture at Daniel Alcides Carrion National Hospital. Methods: Was conduced a analitic, observational, retrospective, cases and controls The study population was conformed for 87 older age patients with hip fracture inclusion and exclusion criteries distributed in 2 groups: with or without perioperative morbility. Results: The frequency of surgical delayed between with and without perioperative morbility were 55% y 31% respectively. Surgical delayed odss ratio related to perioperative morbility was 2.73 (p<0.05). Conclusions: Surgical delayed is a risk factor to perioperative morbility at older age patients with hip fracture at Daniel Alcides Carrion National Hospital. No stadistical significative differences was observed between both of groups related to age, sex or procedence.Tesi

Epstein-Barr virus infection-associated hemophagocytic lymphohistiocytosis

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome characterized by uncontrolled immune activation. There is an aberrant activation of lym-phocytes and macrophages that results in hypercytokinemia. We aim to describe a case of secondary HLH due to primary Epstein-Barr virus (EBV) infection. A Hispanic 28-year-old man presented with sore throat and fatigue for one week. He was diagnosed with mononucleosis and discharged and was treated according to the currently available treatment. HLH is treated by diminishing the inflammation by myelosuppressive and immunosuppressive therapy. EBV infection-associated HLH is a rare disease with high mortality. It is crucial to think about it when facing a patient with fever, cytopenia, hepatosplenomegaly, and high levels of ferritin. Despite medical treatment, the patient died from multiorgan failure

Primary cutaneous B-cell lymphoma-leg type in a young adult with HIV: a case report

Primary cutaneous B-cell lymphoma is a very rare entity. Skin lesions mainly occur on the lower extremities. Sheets of immunoblasts and centroblasts are characteristic findings at histologic examination. This case report highlights diagnostic and therapeutic strategies for primary cutaneous B-Cell lymphoma-leg type