Control interno y la gestión de tesorería en la empresa Tigre Perú – Lurín 2017

Este trabajo de investigación tuvo como objetivo principal determinar la relación de control interno y la gestión de tesorería en la empresa Tigre Perú – Lurín 2016, lo cual implicó la búsqueda de fuentes de información científicas para la realización de esta. La población está conformada por 30 personas que trabajan en el área. Como instrumento el cuestionario estuvo compuesto por 30 preguntas en medición de escala de Likert, luego los resultados fueron procesados, analizados mediante el programa estadístico IMB SPSS 20, a través de ellos se logró medir el nivel de confiabilidad mediante el Alfa de Cronbach, asimismo para medir el nivel de correlación de las variables se usó la prueba de correlación de Spearman y por último se analizaron e interpretaron los gráficos estadísticos obtenidos. Se obtuvo resultados significativos que si existe relación entre control interno y gestión de tesorería en la empresa

Postoperative complications after pancreatoduodenectomy for malignancy: results from the Recurrence After Whipple’s (RAW) study

Postoperative complications; Pancreatoduodenectomy; RecurrenceComplicaciones postoperatorias; Pancreatoduodenectomía; RecurrenciaComplicacions postoperatòries; Pancreatoduodenectomia; RecurrènciaBackground Pancreatoduodenectomy (PD) is associated with significant postoperative morbidity. Surgeons should have a sound understanding of the potential complications for consenting and benchmarking purposes. Furthermore, preoperative identification of high-risk patients can guide patient selection and potentially allow for targeted prehabilitation and/or individualized treatment regimens. Using a large multicentre cohort, this study aimed to calculate the incidence of all PD complications and identify risk factors. Method Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective cohort study of PD outcomes (29 centres from 8 countries, 2012–2015). The incidence and severity of all complications was recorded and potential risk factors for morbidity, major morbidity (Clavien–Dindo grade > IIIa), postoperative pancreatic fistula (POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were investigated. Results Among the 1348 included patients, overall morbidity, major morbidity, POPF, PPH and perioperative death affected 53 per cent (n = 720), 17 per cent (n = 228), 8 per cent (n = 108), 6 per cent (n = 84) and 4 per cent (n = 53), respectively. Following multivariable tests, a high BMI (P = 0.007), an ASA grade > II (P II patients were at increased risk of major morbidity (P < 0.0001), and a raised BMI correlated with a greater risk of POPF (P = 0.001). Conclusion In this multicentre study of PD outcomes, an ASA grade > II was a risk factor for major morbidity and a high BMI was a risk factor for POPF. Patients who are preoperatively identified to be high risk may benefit from targeted prehabilitation or individualized treatment regimens

Muerte social en el leprocomio Mariano Estrella de la ciudad de Cuenca entre los años 1946-1991

La lepra, es una enfermedad que ha sido sin lugar a dudas, causa de estigmas y rechazo en quien la poseía. Los primeros casos en el Ecuador se dan con la llegada de los colonizadores en el siglo XVI. Durante la Real Audiencia de Quito, se perseguía, rechazaba y desterraba a los hansenianos. En el siglo XIX se empezaron a crear leprocomios en las principales ciudades del país. En Cuenca, se fundó el “Lazareto de Miraflores” que después pasó a llamarse “Mariano Estrella”. Por tal motivo, se analizarán los acontecimientos que dieron paso a la muerte social en el enfermo de lepra del Mariano Estrella, entre los años 1946 y 1991. Es importante enmarcar esta investigación entre estos años, ya que, en 1946 todos los hansenianos de Cuenca regresaron al lazareto, después de haber permanecido catorce años en Quito. En 1991, gracias a los avances médicos, se erradicó la lepra en el país y se clausuró el lazareto de Cuenca. Para este estudio se utilizarán fuentes primarias: archivos, periódicos, entrevistas, etc., y fuentes secundarias: libros, artículos e investigaciones médicas. Todo esto permitirá evidenciar que el estigma, segregación y rechazo, dio paso a la muerte social a la que fueron condenados.Leprosy is a disease that has undoubtedly been a cause of stigma and rejection for those who had it. The first cases in Ecuador occurred with the arrival of the colonizers in the sixteenth century. During the time of Real Audiencia de Quito, people with Hansen’s disease were pursued, rejected, and banished. In the nineteenth century, leprosaria were established in the main cities of the country. In Cuenca, "Lazareto de Miraflores" leprosarium was founded, which was later renamed "Mariano Estrella." For this reason, this study will analyze the events that led to the social death of the leprosy patients at Mariano Estrella between the years 1946 and 1991. It's essential to frame this investigation within these years since, in 1946, all people with Hansen’s disease from Cuenca returned to the leprosarium after having spent fourteen years in Quito. In 1991, thanks to medical advances, leprosy was eradicated in the country, and the leprosarium in Cuenca was closed. This study will use primary sources such as archives, newspapers, interviews, etc., and secondary sources such as books, articles, and medical research. All of these will demonstrate that the stigma, segregation, and rejection led to the social death to which these people were condemned.0000-0001-7026-689

Insulinorresistencia en mujeres eutiroideas con nódulos tiroideos: estudio de casos y controles

Objective. To establish the association between insulin resistance and thyroid nodules in euthyroid women from Metropolitan Lima. Methods. Study in euthyroid women, 20 to 70 years of age: 32 cases (with thyroid nodules) and 32 controls (without thyroid nodules), by ultrasound of the thyroid, negative anti-thyroid antibodies, and adequate urinary iodine excretion (EUI), matched by age and BMI, treated in the Almenara-EsSalud care network. Using a clinical record, age and anthropometric parameters were recorded. Was measured: glucose, basal insulin (IB), and insulin resistance (IR) using the homeostatic model (HOMAIR≥2.97). EUI was detected by spectrophotometer at 420 nm, it was considered adequate between 100-300 ug/L. For the statistical analysis, the student’s t-test, Chi-square test, Fisher’s exact test, and Odds Ratio adjusted for age and abdominal obesity were used, considering a statistically significant p &lt;0.05. Results: Significant differences were observed in the means between the group of cases and controls in fasting glucose, IB, HOMA-IR (4.3 vs 2.5, p &lt;0.05), and EUI levels were lower in the group of cases (167.2 vs 228.3 ug/L p &lt;0.001). IR was more frequent in the case group than in the control group (82.3% vs 28.1%; p &lt;0.001). The Odds Ratio was 14.8 (95% CI: 3.4-65.1). Conclusion: In this study, a significant association was found between the presence of thyroid nodules and insulin resistance in euthyroid adult women residing in an iodine-sufficient region.Objetivo. Establecer la asociación entre insulinorresistencia y nódulos tiroideos en mujeres eutiroideas residentes de Lima Metropolitana. Métodos. Estudio en mujeres eutiroideas, de 20 a 70 años de edad: 32 casos (con nódulos tiroideos) y 32 controles (sin nódulos tiroideos), por ecografía tiroidea, anticuerpos anti tiroideos negativos y excreción de yodo urinario (EUI) adecuado, pareados por edad e IMC, atendidos en la Red Asistencial Almenara EsSalud. Mediante una ficha clínica se registró la edad y parámetros antropométricos. Se midió: glucosa, insulina basal (IB), e insulinorresistencia (IR) mediante el modelo homeostático (HOMA-IR≥2,97). EUI fue detectada por espectrofotómetro a 420 nm, se consideró adecuado entre 100-300 ug/L. Para el análisis estadístico se utilizó la prueba t de student, la prueba Chi2, la prueba exacta de Fisher y Odds Ratio ajustado por edad y obesidad abdominal, considerándose un p&lt;0,05 estadísticamente significativo. Resultados. Se observó diferencias significativas de los promedios entre el grupo de casos y controles en la glucosa en ayunas, IB, HOMA-IR (4,3 vs 2,5, p &lt;0,05), y los niveles de EUI fueron menores en el grupo de casos comparados con los controles (167,2 vs 228,3 ug/L, p &lt;0,001). La IR fue más frecuente en el grupo de casos que en el grupo control (82,3% vs 28,1%; p &lt;0,001). El Odds Ratio fue 14,8 (95% IC: 3,4-65,1). Conclusión. En este estudio se encontró una significativa asociación entre la presencia de nódulos tiroideos e insulinorresistencia en mujeres adultas eutiroideas residentes de unaregión yodo suficiente

The additive value of CA19.9 monitoring in a pancreatic cyst surveillance program

Pancreatic cysts; Surgical intervention; SurveillanceQuists pancreàtics; Intervenció quirúrgica; VigilànciaQuistes pancreáticos; Intervención quirúrgica; VigilanciaBackground Surveillance of pancreatic cysts focuses on the detection of (mostly morphologic) features warranting surgery. European guidelines consider elevated CA19.9 as a relative indication for surgery. We aimed to evaluate the role of CA19.9 monitoring for early detection and management in a cyst surveillance population. Methods The PACYFIC-registry is a prospective collaboration that investigates the yield of pancreatic cyst surveillance performed at the discretion of the treating physician. We included participants for whom at least one serum CA19.9 value was determined by a minimum follow-up of 12 months. Results Of 1865 PACYFIC participants, 685 met the inclusion criteria for this study (mean age 67 years, SD 10; 61% female). During a median follow-up of 25 months (IQR 24, 1966 visits), 29 participants developed high-grade dysplasia (HGD) or pancreatic cancer. At baseline, CA19.9 ranged from 1 to 591 kU/L (median 10 kU/L [IQR 14]), and was elevated (≥37 kU/L) in 64 participants (9%). During 191 of 1966 visits (10%), an elevated CA19.9 was detected, and these visits more often led to an intensified follow-up (42%) than those without an elevated CA19.9 (27%; p < 0.001). An elevated CA19.9 was the sole reason for surgery in five participants with benign disease (10%). The baseline CA19.9 value was (as continuous or dichotomous variable at the 37 kU/L threshold) not independently associated with HGD or pancreatic cancer development, whilst a CA19.9 of ≥ 133 kU/L was (HR 3.8, 95% CI 1.1–13, p = 0.03). Conclusions In this pancreatic cyst surveillance cohort, CA19.9 monitoring caused substantial harm by shortening surveillance intervals (and performance of unnecessary surgery). The current CA19.9 cutoff was not predictive of HGD and pancreatic cancer, whereas a higher cutoff may decrease false-positive values. The role of CA19.9 monitoring should be critically appraised prior to implementation in surveillance programs and guidelines

Pancreatic metastases from renal cell carcinoma: postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID)

Metastases; Pancreatectomy; Renal cell carcinomaMetástasis; Pancreatectomía; Carcinoma de células renalesMetàstasis; Pancreatectomia; Carcinoma de cèl·lules renalsBackground: Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. Methods: Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. Results: The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). Conclusions: Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival

Benchmarking of robotic and laparoscopic spleen-preserving distal pancreatectomy by using two different methods

Benchmarking; PancreatectomyBenchmarking; PancreatectomiaBenchmarking; PancreatectomíaBackground Benchmarking is an important tool for quality comparison and improvement. However, no benchmark values are available for minimally invasive spleen-preserving distal pancreatectomy, either laparoscopically or robotically assisted. The aim of this study was to establish benchmarks for these techniques using two different methods. Methods Data from patients undergoing laparoscopically or robotically assisted spleen-preserving distal pancreatectomy were extracted from a multicentre database (2006–2019). Benchmarks for 10 outcomes were calculated using the Achievable Benchmark of Care (ABC) and best-patient-in-best-centre methods. Results Overall, 951 laparoscopically assisted (77.3 per cent) and 279 robotically assisted (22.7 per cent) procedures were included. Using the ABC method, the benchmarks for laparoscopically assisted and robotically assisted spleen-preserving distal pancreatectomy respectively were: 150 and 207 min for duration of operation, 55 and 100 ml for blood loss, 3.5 and 1.7 per cent for conversion, 0 and 1.7 per cent for failure to preserve the spleen, 27.3 and 34.0 per cent for overall morbidity, 5.1 and 3.3 per cent for major morbidity, 3.6 and 7.1 per cent for pancreatic fistula grade B/C, 5 and 6 days for duration of hospital stay, 2.9 and 5.4 per cent for readmissions, and 0 and 0 per cent for 90-day mortality. Best-patient-in-best-centre methodology revealed milder benchmark cut-offs for laparoscopically and robotically assisted procedures, with operating times of 254 and 262.5 min, blood loss of 150 and 195 ml, conversion rates of 5.8 and 8.2 per cent, rates of failure to salvage spleen of 29.9 and 27.3 per cent, overall morbidity rates of 62.7 and 55.7 per cent, major morbidity rates of 20.4 and 14 per cent, POPF B/C rates of 23.8 and 24.2 per cent, duration of hospital stay of 8 and 8 days, readmission rates of 20 and 15.1 per cent, and 90-day mortality rates of 0 and 0 per cent respectively. Conclusion Two benchmark methods for minimally invasive distal pancreatectomy produced different values, and should be interpreted and applied differently

Robot-Assisted Versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer: An International, Retrospective, Cohort Study

Distal pancreatectomy; Pancreatic cancerPancreatectomia distal; Càncer de pàncreesPancreatectomía distal; Cáncer de páncreasBackground Robot-assisted distal pancreatectomy (RDP) is increasingly used as an alternative to laparoscopic distal pancreatectomy (LDP) in patients with resectable pancreatic cancer but comparative multicenter studies confirming the safety and efficacy of RDP are lacking. Methods An international, multicenter, retrospective, cohort study, including consecutive patients undergoing RDP and LDP for resectable pancreatic cancer in 33 experienced centers from 11 countries (2010–2019). The primary outcome was R0-resection. Secondary outcomes included lymph node yield, major complications, conversion rate, and overall survival. Results In total, 542 patients after minimally invasive distal pancreatectomy were included: 103 RDP (19%) and 439 LDP (81%). The R0-resection rate was comparable (75.7% RDP vs. 69.3% LDP, p = 0.404). RDP was associated with longer operative time (290 vs. 240 min, p < 0.001), more vascular resections (7.6% vs. 2.7%, p = 0.030), lower conversion rate (4.9% vs. 17.3%, p = 0.001), more major complications (26.2% vs. 16.3%, p = 0.019), improved lymph node yield (18 vs. 16, p = 0.021), and longer hospital stay (10 vs. 8 days, p = 0.001). The 90-day mortality (1.9% vs. 0.7%, p = 0.268) and overall survival (median 28 vs. 31 months, p = 0.599) did not differ significantly between RDP and LDP, respectively. Conclusions In selected patients with resectable pancreatic cancer, RDP and LDP provide a comparable R0-resection rate and overall survival in experienced centers. Although the lymph node yield and conversion rate appeared favorable after RDP, LDP was associated with shorter operating time, less major complications, and shorter hospital stay. The specific benefits associated with each approach should be confirmed by multicenter, randomized trials

Radiofrequency ablation and chemotherapy versus chemotherapy alone for locally advanced pancreatic cancer (PELICAN): study protocol for a randomized controlled trial

Quimioteràpia; Càncer de pàncrees localment avançat; Ablació per radiofreqüènciaQuimioterapia; Cáncer de páncreas localmente avanzado; Ablación por radiofrecuenciaChemotherapy; Locally advanced pancreatic cancer; Radiofrequency ablationBackground Approximately 80% of patients with locally advanced pancreatic cancer (LAPC) are treated with chemotherapy, of whom approximately 10% undergo a resection. Cohort studies investigating local tumor ablation with radiofrequency ablation (RFA) have reported a promising overall survival of 26–34 months when given in a multimodal setting. However, randomized controlled trials (RCTs) investigating the effect of RFA in combination with chemotherapy in patients with LAPC are lacking. Methods The “Pancreatic Locally Advanced Unresectable Cancer Ablation” (PELICAN) trial is an international multicenter superiority RCT, initiated by the Dutch Pancreatic Cancer Group (DPCG). All patients with LAPC according to DPCG criteria, who start with FOLFIRINOX or (nab-paclitaxel/)gemcitabine, are screened for eligibility. Restaging is performed after completion of four cycles of FOLFIRINOX or two cycles of (nab-paclitaxel/)gemcitabine (i.e., 2 months of treatment), and the results are assessed within a nationwide online expert panel. Eligible patients with RECIST stable disease or objective response, in whom resection is not feasible, are randomized to RFA followed by chemotherapy or chemotherapy alone. In total, 228 patients will be included in 16 centers in The Netherlands and four other European centers. The primary endpoint is overall survival. Secondary endpoints include progression-free survival, RECIST response, CA 19.9 and CEA response, toxicity, quality of life, pain, costs, and immunomodulatory effects of RFA. Discussion The PELICAN RCT aims to assess whether the combination of chemotherapy and RFA improves the overall survival when compared to chemotherapy alone, in patients with LAPC with no progression of disease following 2 months of systemic treatment.Olympus Netherlands BV supported the investigator-initiated PELICAN trial with material support by providing the RFA generators and electrodes for the study. They did not have and will not have any influence on the trial design, data collection, interpretation of the data, manuscript development, or decision to publish. Furthermore, the study protocol has undergone full external peer review and received a data management and monitoring grant from the Dutch Cancer Society (grant number 2014-7244)

Implementación de un plan de auditoría Interna con enfoque en riesgos y su influencia en los controles al proceso de cobranzas en una empresa de distribución de energía eléctrica en el año 2018

El presente trabajo de investigación titulado “Implementación de un Plan de auditoría interna con enfoque en riesgos y su influencia en los controles al proceso de cobranzas en una empresa de distribución de energía eléctrica en el año 2018”, tuvo como objetivo principal, determinar la influencia de la implementación de un plan de auditoría interna con enfoque en riesgos, en el contexto de un cambio del sistema de cobranza y considerando que dicho cambio no ha sido considerado en el plan de auditoría vigente, por lo cual, la propensión a que los riesgos puedan materializarse y perjudicar los objetivos de la empresa, se incrementaban. Asimismo, debido a su participación en el mercado de valores, la empresa puede incurrir en afectaciones al cumplimiento del Código de Buen Gobierno Corporativo publicado por la Superintendencia del Mercado de Valores. Así también, se realizó un caso práctico que denota una propuesta de solución a los problemas que afronta la empresa en la actualidad, y puede ser aplicado a empresas con características y/o dificultades similares.Campus Lima Centr