Impacto financiero del impuesto del 2% sobre los ingresos en las microempresas aplicado al sector comercial de la provincia de Pichincha en el contexto del COVID- 19

El 31 de diciembre de 2019 fue publicada la Ley Orgánica de Simplificación y Progresividad Tributaria en el Registro Oficial No. 111, dentro de la cual fue definido el impuesto del 2% sobre los ingresos brutos de las microempresas, con el objetivo de facilitar la forma de tributar de los microempresarios. La finalidad de esta investigación es conocer si existió un impacto financiero causado por este impuesto en las sociedades designadas por el Servicio de Rentas Internas (SRI) como microempresas del sector comercial de Pichincha, para esto se realizó un análisis de los principales indicadores financieros de liquidez, actividad, solvencia y rentabilidad, efectuando comparaciones entre los años 2019 y 2020; se utilizó además el método de revisión documental de artículos, noticias y leyes relacionadas al tema, y se realizaron entrevistas a actores clave para complementar la información numérica y estadística. Se pudo concluir de este modo, que el impacto de este impuesto fue negativo para la mayoría de las microempresas, especialmente para aquellas que obtuvieron pérdidas que se acentuaron debido a la crisis económica por el COVID-19, provocando un mayor endeudamiento, menor rotación de los inventarios, rentabilidad baja y una fuerte incertidumbre, tanto por el desconocimiento de la ley, como por la competencia de los negocios informales. Se demostró también que el papel del Estado es fundamental, pues a través de la política tributaria que promueva, puede afectar de gran manera, no solo a las empresas a las que van dirigidas las reformas sino también a toda la economía nacional.On December 31, 2019, the Organic Law of Tax Simplification and Progressivity was published in the Official Gazette No. 111, within which the 2% tax on gross income of microenterprises was defined, with the objective of facilitating the way micro entrepreneurs pay taxes. The purpose of this research is to know if there was a financial impact caused by this tax on companies designated as microenterprises in the commercial sector of Pichincha, for this an analysis of the main financial indicators of liquidity, activity, solvency and profitability was performed, making comparisons between the years 2019 and 2020; the method of documentary review of articles, news and laws related to the subject was also used, and interviews were conducted with key actors to complement the numerical and statistical information. It was thus possible to conclude that the impact of this tax was negative for most microenterprises, especially for those that obtained losses that were accentuated due to the economic crisis caused by COVID-19, causing higher indebtedness, lower inventory turnover, low profitability, and strong uncertainty, both due to the lack of knowledge of the law, as well as competition from informal businesses. It was also demonstrated that the role of the State is fundamental, since through the tax policy it promotes, it can greatly affect not only the companies targeted by the reforms, but also Financial the entire national economy.Contador Público AuditorCuenc

Current treatment of difficult airway: a practical review of advanced techniques for airway management

The airway by definition is a conduit through which the air passes; or it is the route by which the air travels from the nose or mouth to the lungs. An exhaustive review was performed with the available literature using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2009 to 2021. The search criteria were formulated to identify reports related to difficult airway management. To allow controlled ventilation, the airway must meet two characteristics in priority order, be permeable and airtight. In assessing risk, in addition to looking for predictors of difficult airway, it was important to understand the global clinical circumstances. Faced with a patient with a difficult airway, decision-making must be agile and correct since any decision can modify the clinical outcome

Transfusion related acute lung injury-TRALI: a review

Acute pulmonary damage caused by transfusion is characterized by the sudden onset of respiratory distress in newly transfused patients within 6 hours after the transfusion, bilateral infiltrative changes in chest X-ray, PaO2/FIO2 <300 mmHg, absence of other risk factors for acute lung injury and absence of signs suggesting cardiogenic origin of pulmonary edema. Being one of the most serious complications of blood transfusion, plasma is the most involved factor, although all blood components can cause it, and is caused by antigen reactions/leukocyte antibody and lipid activity with ability to modify the biological response on primitive leukocytes. The diagnosis is based on the integration of clinical, radiological and gasometric elements, ruling out the rest of the possible causes of acute lung injury. Its differential diagnosis should include hemodynamic overload, anaphylactic reaction, bacterial contamination of transfused blood products and transfusion hemolytic reaction. The treatment is supportive measures based on the needs and does not differ from the treatment of acute lung injury secondary to other etiologies, severe cases require endotracheal intubation and mechanical ventilation while the non-severe can be managed with oxygen therapy

Pelvic limb reconstruction failed by propeller flap resolved with microsurgery

Reconstruction of lower limb defects is a constant challenge for surgeons, the etiology of the defect can be very variable from diabetic ulcers, traffic accidents, fall from height, oncological resections and many others. Free flaps have always been an important option because it has great results in complex reconstructions in lower limbs, it is a microvascular technique, so it has a higher level of complexity. This technique is usually reserved for extensive perilesional wide defects. On the other hand, the propeller flap, which is considered less invasive and easier as it does not involve microvascular surgery. An 18-year-old patient who had a fracture of the right tibial pylon due to a 7-meter drop, who after orthopedic treatment had a defect with exposure of ostesynthesis material of 3 cm in circumference in the medial malleolus. This defect was first managed with a propeller flap complicated with necrosis at 48 hours which was treated with sub atmospheric pressure system for 5 days and later with an ultra-thin anterolateral flap of the pelvic limb. Complete pedicled propeller flap failure is very rare but, because necrosis develops distally, even partial necrosis can expose bone, tendons, or other tissue. Some surgeons consider that propeller flap placement is risky in this location, especially the distal third of the lower leg a prefer to use free flaps. Whenever any pelvic member reconstruction plan fails in the distal third, the best and safest is the use of microsurgery even with the failure of a previous micro vascular flap

Postoperative analgesia in total knee arthroplasty

Total knee arthroplasty is commonly performed in patients with end-stage osteoarthritis or rheumatic knee arthritis to relieve joint pain, increase mobility, and improve quality of life. Despite advances in surgical techniques, postoperative pain management in these types of patients is still deficient. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to total knee replacement and pain management. Pain after total knee arthroplasty has been shown to involve both peripheral and central pain pathways, which is why various postoperative pain management strategies are currently applied, including patient-controlled analgesia, continuous peripheral nerve blocks, or single injection or local infiltration analgesia. Today local techniques such as periarticular injections are becoming more common in total knee replacement due to their effectiveness in controlling pain without causing muscle weakness. The development of minimally invasive techniques associated with multimodal and preventive analgesia improves recovery rates and early rehabilitation in patients undergoing total knee arthroplasty, reducing in-hospital costs, risk of complications, and improving patient satisfaction with chronic osteoarthropathy.

The neurobiology of splitbrain crayfish

Background: They crayfish brain is segmented into two symmetrical hemiganglia. Normally both hemiganglia are in direct communication through a series of well-defined neural bridges that cross de midline to form reciprocal cross connections.Methods: An original study was carried out in the Department of Physiology of the Faculty of Medicine, UNAM during the period from August 2019 to August 2020. 13 Crayfish Procambarus clarkii weighing between 1g to 30g were used. Each eyestalk of the animals was tied to a displacement transducer coupled with a polygraph so that optomotor or electrical activity was bilaterally recorded. The separation of the right from the left hemiganglia from the cerebral or supraesophageal ganglion was performed with a sagittal section, splitbrain (SB).Results: The normal photo motor reflex in crayfish eye is measured as a gradual decrease in the ERG amplitude. During tactile stimulation, the visual activation of both eyestalks in normal crayfish leads to a highly regular bilateral activity. The regular activity can only be altered by disturbing the mechanoreceptors located in the shell surrounding the eyestalks.Conclusions: The procedure presented in this article provides unique characteristics for the study of the nervous system such as a detailed response of the bilateral optomotor reflex

Chronic venous insufficiency: a review

Chronic venous insufficiency (CVI) comprises a complete spectrum of morphological and functional abnormalities of the venous system1 including any long-term functional and morphological alteration. CVI accounts for several abnormalities of the venous system. It is a highly prevalent disease that causes serious economic consequences, a decrease in the quality of life and can lead to serious complications. An exhaustive review was performed with the available literature, using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2004 to 2021. The search criteria were formulated to identify reports related to chronic venous insufficiency. The pathophysiology of chronic venous insufficiency begins with chronic venous hypertension and the dilation of the vessel, this leads to a series of pathological changes in the venous wall and surrounding tissues, in advanced stages of CVI, skin lesions are associated with an increased proliferation of skin capillaries and microcirculatory abnormalities that may be the result of an altered level of factors responsible for the angiogenic response, such as vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2) and angiostatin. In this review, updates on pathophysiology, clinic, diagnosis, classification and treatment of this disease are analyzed, with special emphasis on therapeutic options. Chronic venous insufficiency is a disease that affects the patient at several levels, mainly diminishing his/her quality of life. Currently there are various treatments ranging from habit modifications, pharmacological, to endovenous and surgical treatment.

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance