La estructura tributaria del Paraguay: presión fiscal baja, inestable y sesgada hacia impruestos indirectos sobre el consumo

Metadados do trabalho de conclusão de curso: La estructura tributaria del Paraguay: presión fiscal baja, inestable y sesgada hacia impruestos indirectos sobre el consumo, pela/o discente: Juan Pablo Mendez Orue, sob orientação: Rodrigo Luiz Medeiros da Silva do Centro de Economia e Sociedade, curso de Ciências Econômicas - Economia, Integração e Desenvolvimento da Universidade Federal da Integração Latino-Americana (UNILA), no Repositório Institucional da Unila (RI-UNILA).La estructura tributaria del Paraguay: presión fiscal baja, inestable y sesgada hacia impruestos indirectos sobre el consum

El Turismo en la Triple Frontera como un Factor en la Construcción y Representación del Imaginario Latinoamericano

Anais do II Encontro de Iniciação Científica e de Extensão da Unila - Sessão de Relações Internacionais I - 03/07/13 – 13h30 às 18h30 - Unila-PTI - Bloco 09 – Espaço 01 – Sala 02Desde el abordaje del turismo en una regi ́on fronteriza, d ́onde existen una gran diversidad cultural, como por ejemplo en la triple frontera, compartida entre los pa ́ ıses de Argentina, Brasil y Paraguay, se destacan los valores de una exuberante riqueza cultural y una gran cantidad de espacios e intercambios que van m ́as all ́a de lo econ ́omico y comercial. Las grandes transfor- maciones de las ciudades que la conforman entre ellas la construcci ́ on de la Represa de Itaip ́ u, una de las obras de ingenier ́ ıa de gran envergadura en la producci ́ on de energ ́ ıa limpia, y pai- sajes naturales como las Cataratas del rio Iguaz ́ u, nombrada por la Unesco, Patrimonio de la Humanidad y adem ́as considerada como una de las siete maravillas del mundo, han contribuido en la urbanizaci ́on y explotaci ́on tur ́ ıstica, en la b ́ usqueda de estrategias para unificar esta zona fronteriza como una sola, por medio de im ́agenes y propagandas con la idea de crear armon ́ ıa entre la diversidad cultural existente, integr ́andolas paulatinamente cada vez m ́as con mayor dinamismo. As ́ ı, partimos del turismo como una actividad que no s ́ olo se centra en el desarrollo, sino, que se convierte al mismo tiempo en un mecanismo o estrategia pol ́ ıtica en la construcci ́ on de un espaci ́o que da nacimiento a nuevas identidades por medio de representaciones ideol ́ ogicas que contraponen diferencias y pretenden legitimar un imaginario u ́ nico de percepci ́on de los que habitan el lugar y de los que la visitan, como un espejo regional cultural de una identidad particular latinoamericana, aunque compartida.Universidade Federal da Integração Latino-Americana (UNILA

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients