Eficiencia del control interno en las microempresas: una revisión sistemática de la literatura científica de los últimos 10 años

RESUMEN El control interno se basa en la necesidad de poder controlar las diferentes operaciones que tienen las empresas para generar sus ingresos, también se podría decir que surge de la necesidad de accionar activamente a disminuir los riesgos significativamente los cuales se encentran afectando de forma directa o indirectamente a los distintos tipos de organizaciones y sin importar en las condiciones que se encuentren. Por ello para las empresas en un problema el no saber cómo aplicar un sistema de control interno. Debido a esto es que el objetivo de la presente investigación es realizar una búsqueda sistemática de las características de los artículos científicos y aplicativos publicados en revistas y bibliotecas nacionales e internacionales sobre control interno en las MYPES. La búsqueda se realizó en las bases de datos Scielo, Redalyc, Scopus y a través de google y google académico utilizando combinaciones de diferentes palabras claves relacionadas al tema seleccionado, para esto dicho análisis estuvo conformado por 71 artículos, en dichos estudios destaca la necesidad de incorporar controles internos a las empresas y los beneficios de poder aplicarlos correctamente. Debido a inconsistencias presentadas los artículos estudiados como reportes y sustentos bibliográficos en la utilización de instrumentos, motivo por el cual, se puede afirmar que los estudios no cumplen en su totalidad con los estándares de publicación propuestos por la American Psychological Association

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

Cuantificacion de niveles de INF-Á - IL-13 y celulas T CD4+, CD8+ en pacientes con leishmaniasis tegumentaria con falla terapéutica

Objectives: is a study of the immune status, quantifying the Th1 cytokine profile (IFN-ã) and Th2 (IL-13) and CD3 + T cells, CD4 + and CD8 + as variables that can provide information on the link and / or association therapeutic failure. Methods: we quantified the levels of INF-ã, IL-13, CD4 + and CD8 + in three study groups: a) patients with LT and therapeutic failure (RESISTANT), b) Treated patients who responded to treatment successfully (SENSITIVE ) c) healthy patients (CONTROL GROUP). Results: the results indicate that the specific immune response of resistant and sensitive patients is polarized toward the TH1 response and values of CD4 + T lymphocytes and CD8 + were below normal values in the three groups. The levels of IFN-ã production was higher than IL-13, being more pronounced in patients resistant to sensitive in response to Leishmania Ag, the typing of the strains that were isolated from patients resistant identified: Leishmania brasiliensis and guayanensis Leishmania. Conclusions: regarding treatment failure resistant patients, would also be involved factors related to the parasite and other extrinsic factors to the host.se realiza un estudio del estatus inmunologico, cuantificando el perfil de citoquinas Th1 (INF-Á) y Th2 (IL-13) y celulas T CD3+, CD4+ y CD8+ como variables que puedan brindar informacion sobre el vinculo y/o asociacion a la falla terapeutica. Metodos: se cuantifico los niveles de INF-Á , IL-13, CD4 + y CD8+ en tres grupos de estudio: a) Pacientes con LT y falla terapeutica (RESISTENTES), b) Pacientes tratados que respondieron al tratamiento de forma exitosa (SENSIBLES) c) Pacientes sanos (GRUPO CONTROL). Resultados: los resultados indican, que la respuesta especifica inmune de los pacientes Resistentes y Sensibles esta polarizada hacia la respuesta TH1 y los valores de los Linfocitos T CD4+ y CD8+ estaban por debajo de los valores normales en los tres grupos de estudio. Los niveles de produccion de INF- Á fue mayor que la IL-13, siendo mas pronunciada en pacientes Resistentes que Sensibles en respuesta al Ag de Leishmania, la tipificacion de las cepas que fueron aisladas de los pacientes resistentes, identificaron a: Leishmania brasiliensis y Leishmania guayanensis. Conclusiones: en relacion a la falla terapeutica de los pacientes resistentes, estarian tambien involucrados los factores relacionados al parasito y otros factores extrinsecos al huesped

Rol de anticuerpos anti-Toxoplasma gondii en la activación de la respuesta inmune en mujeres embarazadas.

Objectives: the study aimed to evaluate in vitro the role of anti T. gondiiin activating immune responses in pregnant women. Methods: the study was performed with peripheral blood mononuclear cells (PBMC) of pregnant women with chronic toxoplasmosis (n = 15) were stimulated in the presence and absence of autologous plasma (PA) (anti T. gondii antibody). Results: the data show that in PBMC stimulated in the absence of autologous plasma there is increased cell proliferation (P < 0.05) than cells in the presence of autologous plasma. Levels of IFN- ã produced in both conditions (PA and SBF) were similar. Comparing the production of IFN- ã vs IL - 10 shows increased production of Th1 cytokines. Conclusions: in general, our results suggest that the antibodies present in autologous plasma modulate the immune response in pregnant women with chronic toxoplasmosis, such that the immune system does not exacerbate or inhibit this specific response. The presence of antibodies to T. gondii not affecting IFN- ã production in pregnant women with chronic toxoplasmosis, but if cell proliferation.Objetivos: el estudio tuvo como objetivo evaluar in vitro el rol de anticuerpos anti T. gondii en la activacion de la respuesta inmune en mujeres embarazadas. Metodos: el estudio se realizo con celulas mononucleares de sangre periferica (PBMC) de mujeres embarazadas con toxoplasmosis cronica (n=15) que fueron estimuladas en presencia y ausencia de plasma autologo (PA) (anticuerpos anti T. gondii). Resultados: los datos muestran que en PBMC estimuladas en ausencia de plasma autologo existe mayor proliferacion celular (P<0.05) que celulas en presencia de plasma autologo. Niveles de IFN-�Á producidos en ambas condiciones (PA y SBF) fueron similares. Comparando la produccion de IFN-�Á vs IL-10 muestra mayor produccion de citoquinas Th1. Conclusiones: en general nuestros resultados sugieren que los anticuerpos presentes en el plasma autologo modulan la respuesta inmune en mujeres embarazadas con toxoplasmosis cronica, de tal modo que el sistema inmune no exacerbe o inhiba esta respuesta especifica. La presencia de anticuerpos anti T. gondii no influyen en produccion de IFN-�Á en mujeres embarazadas con toxoplasmosis cronica, pero si en la proliferacion celular

Intralesional Meglumine Antimoniate: Safe, Feasible and Effective Therapy for Cutaneous Leishmaniasis in Bolivia

The standard of care for cutaneous leishmaniasis includes the intramuscular/intravenous administration of pentavalent antimonials that are toxic and poorly tolerated. Primary health care usually lacks trained health staff for the diagnosis and treatment of leishmaniasis in Cochabamba Bolivia. Taking these aspects into account, a Bolivian consortium set out to explore the intralesional administration of meglumine antimoniate to treat cutaneous leishmaniasis during primary care under programmatic conditions. A four-step strategy consisting of clinical training for intralesional treatment and the promotion and periodic follow-up of health staff was carried out. The training process was applied in situ to personnel of nine primary health care centres. The intralesional treatment was applied five times every other day. Clinical follow-up after six-months of treatment showed a 77% healing proportion and 5% of therapeutic failure among 152 enrolled patients. The drug volume used in the intralesional procedure was on average 1.7 mL/ulcer treated. In conclusion, the strategy used was successful and effective, accomplishing a healing proportion similar to the long standardized treatment with a reduced time of administration, no severe side effects, and it is feasible to conduct by trained health staff. Our study supports the current PAHO/WHO recommendation for the intralesional administration of pentavalent antimonials for the treatment of cutaneous leishmaniasis