El confuso límite entre el deber de información del precio dispuesto por el estatuto del consumidor y el precio sugerido

El presente escrito pretende mostrar la problemática existente entre el deber de información que tienen los proveedores, derivado del Estatuto del Consumidor, en cuanto al precio que deben indicarles a los consumidores; y el precio sugerido que es presentado publicitariamente. Lo anterior, teniendo en cuenta de un lado que el precio que se le indica al consumidor debe ser el precio total, y por otra parte, que el precio sugerido no puede resultar obligatorio en virtud de la normativa referente a la protección de la libre competencia. Tomando como base la dicotomía planteada el documento procura indicar cuál es el límite y correcta aplicación de cada una de las normas, teniendo en cuenta que los receptores reales de la información correspondiente al precio sugerido son tanto consumidores como proveedores.This text aims to showcase the existent quandary between the information duty that providers have, derived from the Consumer Protection Statute, regarding the price that must be indicated to the consumer; and the suggested price that is advertised. The aforementioned, keeping in mind that on one hand, the price that is indicated to the consumer must be the total price, and on the other hand, that the suggested price cannot be held as binding in virtue of the normative protecting free competition. Based on this dichotomy, the text seeks to show the limit and proper application of each of the norms, considering that the real receivers of the information regarding suggested prices are both the consumers and the providers.Especialista en Derecho ComercialEspecializació

Clinical profile, treatment and predictors during the first COVID-19 wave: a population-based registry analysis from Castile and Leon hospitals

Producción CientíficaThe first wave of the COVID-19 pandemic collapsed the hospitals in Castile and Leon (Spain). An analysis of the clinical characteristics, drug therapies and principal outcome predictors in the COVID-19 hospitalized patients from 1 March to 31 May 2020 is presented through a population-based registry study. Hospital stay variables, ventilation mode data and clinical outcomes were observed. In Castile and Leon hospitals, 7307 COVID-19 patients were admitted, with 57.05% being male and a median of 76 years. The mortality rate was 24.43%, with a high incidence of severe acute respiratory syndrome (SARS) (14.03%) and acute kidney injury (AKI) (10.87%). The most used medicines were antibiotics (90.83%), antimalarials (42.63%), steroids (44.37%) and antivirals, such as lopinavir/ritonavir (42.63%). The use of tocilizumab (9.37%) and anti-SIRS (systemic inflammatory response syndrome) medicines (7.34%) were remarkable. Fundamentally, death occurred more likely over 65 years of age (OR: 9.05). In addition, the need for ventilation was associated with a higher probability of death (OR: 3.59), SARS (OR: 5.14) and AKI (OR: 2.31). The drug-use pattern had been modified throughout the COVID-19 first wave. Multiple factors, such as age, gender and the need for mechanical ventilation, were related to the worst evolution prognosis of the disease.Gerencia Regional de Salud - (Proyecto GRS COVID 10/A/20

El Pueblo y la Ley: La reelección como conflicto en Paraguay, Ecuador y Bolivia (2016-2018)

En este trabajo se analiza la reelección presidencial como conflicto político a través de los casos de Paraguay, Ecuador y Bolivia. La discusión sobre la reelección que se ha dado a la luz de los acontecimientos ocurridos en Suramérica en los últimos años se ha centrado en una dimensión normativa del fenómeno, lo que demanda una reflexión que contemple otras dimensiones. El objetivo del trabajo es conceptualizar el fenómeno de la reelección presidencial como conflicto político y analizar los tres casos señalados identificando sus singularidades políticas y profundizando en los conflictos generados por el debate sobre la reelección en cada país. Con este fin, se ha aplicado la metodología de estudio de caso con parámetros comunes para interpretar de forma comparativa las tres coyunturas estudiada

Nosocomial Vs. Community-Acquired Infective Endocarditis in Spain: Location, Trends, Clinical Presentation, Etiology, and Survival in the 21st Century

Major changes have occurred in the epidemiology and etiology of infective endocarditis (IE). Nevertheless, the differences between nosocomial infective endocarditis (NIE) and community-acquired infective endocarditis (CIE) have not been addressed in a population-based study. We conducted a retrospective, nationwide, temporal trend study from 1997 to 2014 analyzing the epidemiology, clinical, geographical, meteorological characteristics of patients diagnosed with IE in Spain, to distinguish NIE from CIE. Among 25,952 patients with IE (62.2 ± 18·6 years; 65.9% men), 45.9% had NIE. The incidence of IE increased from 2.83 to 3.73 due to the NIE incidence increment with a decline in CIE. Patients with NIE were older (63.8 years vs. 60.8 years, p < 0·001), presented a higher Charlson index (1.22 vs. 1.03, p < 0.001), a greater history of implanted cardiac devices (8.7% vs. 4.6%, p < 0.001), and higher mortality (31.5% vs. 21.7%, p < 0.001). The most frequent microorganism for both NIE and CIE was Staphylococcus (p < 0.001), and the North reported a higher incidence (p < 0.001). Risk factors of mortality for NIE were age, Charlson index, hemodialysis, shock, heart failure, and stroke. Risk factors for CIE included female sex, renal disease, and cardiac-device carriers. The etiology of IE shifted from community origins to mostly nosocomial-associated infections. Higher morbidity, mortality, and poorer outcomes are associated with NIE.This research received no external funding. The authors thank Consejería de Educación, Junta de Castilla y León, Spain (reference: VA161G18), for covering the publication charges of this article.S

Beneficial effects of paricalcitol on cardiac dysfunction and remodelling in a model of established heart failure

The synthetic vitamin D3 analogue paricalcitol acts as a selective activator of the vitamin D receptor (VDR). While there is evidence for cardioprotective effects of paricalcitol associated with the VDR pathway, less information is available about the structural and functional cardiac effects of paricalcitol on established heart failure (HF) and particularly its effects on associated electrophysiological or Ca2+ handling remodelling. EXPERIMENTAL APPROACH: We used a murine model of transverse aortic constriction (TAC) to study the effect of paricalcitol on established HF. Treatment was initiated 4 weeks after surgery over five consecutive weeks, and mice were sacrificed 9 weeks after surgery. Cardiac MRI (CMRI) was performed 4 and 9 weeks after surgery. Hearts were used for biochemical and histological studies and to isolate ventricular myocytes for electrophysiological and calcium imaging studies. KEY RESULTS: CMRI analysis revealed that, compared with vehicle, paricalcitol treatment prevented the progression of ventricular dilation and hypertrophy after TAC and halted the corresponding decline in ejection fraction. These beneficial effects were related to the attenuation of intracellular Ca2+ mishandling remodelling, antifibrotic and antihypertrophic effects and potentially antiarrhythmic effects by preventing the reduction of K+ current density and the long QT, JT and TpTe intervals observed in HF animals. CONCLUSION AND IMPLICATIONS: The results suggest that paricalcitol treatment in established HF hampers disease progression and improves adverse electrophysiological and Ca2+ handling remodelling, attenuating the vulnerability to HF-associated ventricular arrhythmias. Paricalcitol may emerge as a potential therapeutic option in the treatment of HFThis work was supported by the Spanish Ministry of Economy and Competitiveness (SAF2014- 57190R, SAF2017-84777-R), ISCIII (PI17/01093 and PI17/01344), European Regional Development Fund (FEDER), Sociedad Española de Cardiología (SEC), and CIBER-CV, a network funded by ISCIII. MF-V is a Miguel Servet II researcher of ISCIII (MSII16/00047 Carlos III Health Institute). GR-H is a Miguel Servet I researcher of ISCIII (CP15/00129 Carlos III Health Institute). MT is a predoctoral fellow of the Spanish Ministry of Science, Innovation and Universities (FPU-17/06135

Intraoperative PaO2 is not related to the development of surgical site infections after major cardiac surgery

Producción CientíficaBackground: The perioperative use of high inspired oxygen fraction (FIO2) for preventing surgical site infections (SSIs) has demonstrated a reduction in their incidence in some types of surgery however there exist some discrepancies in this respect. The aim of this study was to analyze the relationship between PaO2 values and SSIs in cardiac patients. Methods: We designed a prospective study in which 1,024 patients undergoing cardiac surgery were analyzed. Results: SSIs were observed in 5.3% of patients. There was not significant difference in mortality at 30 days between patients with and without SSIs. In the uni and multivariate analysis no differences in function of the inspired oxygen fraction administrated were observed. Conclusions: We observed that the PaO2 in adult cardiac surgery patients was not related to SSI rate

IFNL3 rs12980275 Polymorphism Predicts Septic Shock-Related Death in Patients Undergoing Major Surgery: A Retrospective Study

Interferon lambda 3 (IFNL3, previously called IL-28B) is a cytokine with effects against viral and bacterial pathogens. We aimed to analyze the IFNL3 rs12980275 SNP in patients who underwent major surgery, in order to establish its relationship with susceptibility to septic shock and septic shock-related death in these patients. We performed a case-control study on 376 patients to establish the association between IFNL3 rs12980275 SNP and the susceptibility to develop septic shock. Besides, we performed a longitudinal study among 172 septic shock patients using survival analysis with one censoring point of 28-days mortality. The IFNL3 rs12980275 polymorphism was genotyped by Agena Bioscience's MassARRAY platform. IFNL3 rs12980275 polymorphism was not associated with higher susceptibility to infection and septic shock development. Regarding survival analysis, the Kaplan-Meier analysis showed that patients with IFNL3 rs12980275 AA genotype had higher survival than patients with GG genotype (p = 0.003). The Cox regression analysis adjusted by the most relevant clinical and epidemiological characteristics showed that the GG genotype (recessive model) and the presence of the G allele (additive model) were associated with higher risk of death [adjusted hazard ratio (aHR) = 2.15, p = 0.034; aHR = 1.50, p = 0.030, respectively]. In conclusion, IFNL3 rs12980275 polymorphism was associated with septic shock-related death in patients who underwent major surgery. The A allele was linked to protection, and the G allele was associated with an increased risk of death. This is a first preliminary study that suggests for the first time a role of IFNL3 polymorphisms in the prognosis of septic shock.This work has been supported by grants given by Instituto de Salud Carlos III (grant numbers PI15/01451 to ET), Gerencia de Salud, Consejería de Sanidad, Junta de Castilla y Leon (grant number GRS 463/A/10 and 773/A/13 to ET), and PFIZER (grant number CT25-ESP01-01 to SR). MJ-S and AF-R are supported by Instituto de Salud Carlos III (grant numbers CP17CIII/00007 and CP14CIII/00010, respectively).S

Effect of immunocastration on behaviour and blood parameters (cortisol and testosterone) of Holstein bulls

To evaluate the effect that immunocastration has on behaviour, testosterone and cortisol levels of feedlot Holstein bulls, 720 intact animals aged between 7 and 8 months, weighing 232±1.19 kg were randomly assigned to two treatments: immunocastration using the Bopriva vaccine and a placebo (360 animals per treatment). The bulls were slaughtered at day 239 of treatment. Animals were vaccinated on days 1, 21, 101, and 181, and on those same days testosterone levels were measured; while cortisol, glucose and creatin kinase measurements were done on day 181 and during exanguination at slaughter. Sexual, aggressive and social behaviours were evaluated and it was found that intact bulls showed a higher average of head butts, mounting, threats, flehmen sign and sniffing (P&lt;0.05), no differences were found for vocalisations, lowering of the head and grooming (P&gt;0.05). Testosterone levels in intact bulls remained at 0.47ng/mL throughout the study, however, by day 181 differences (P&lt;0.05) were observed in immunised bulls, with values of 0.22ng/mL. At slaughter, testosterone levels were 0.21 ± 0.06 ng/mL in immunocastrated bulls and 0.54 ± 0.06 ng/mL in the placebo group. The use of immunocastration with Bopriva has shown to be effective to reduce testosterone, sexual and aggressive behaviours on Holstein bulls

Gene Expression Patterns Distinguish Mortality Risk in Patients with Postsurgical Shock

Producción CientíficaNowadays, mortality rates in intensive care units are the highest of all hospital units. However, there is not a reliable prognostic system to predict the likelihood of death in patients with postsurgical shock. Thus, the aim of the present work is to obtain a gene expression signature to distinguish the low and high risk of death in postsurgical shock patients. In this sense, mRNA levels were evaluated by microarray on a discovery cohort to select the most differentially expressed genes between surviving and non-surviving groups 30 days after the operation. Selected genes were evaluated by quantitative real-time polymerase chain reaction (qPCR) in a validation cohort to validate the reliability of data. A receiver-operating characteristic analysis with the area under the curve was performed to quantify the sensitivity and specificity for gene expression levels, which were compared with predictions by established risk scales, such as acute physiology and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA). IL1R2, CD177, RETN, and OLFM4 genes were upregulated in the non-surviving group of the discovery cohort, and their predictive power was confirmed in the validation cohort. This work offers new biomarkers based on transcriptional patterns to classify the postsurgical shock patients according to low and high risk of death. The results present more accuracy than other mortality risk scores.Instituto de Salud Carlos III (grant PI15/01451)Junta de Castilla y León (grant 1255/A/16)Universidad de Valladolid - Fondo Europeo de Desarrollo Regional (grant VA321P18

CEACAM7 polymorphisms predict genetic predisposition to mortality in post-surgical septic shock patients

We carried out a retrospective exploratory study on 173 patients who underwent major surgery and developed septic shock after surgery. Our findings suggest that CEACAM7 rs1001578, rs10409040, and rs889365 polymorphisms could influence septic shock-related death in individuals who underwent major surgery.This work has been supported by grants given by Instituto de Salud Carlos III (grant number PI15/01451 to ET), “Gerencia de Salud, Consejería de Sanidad, Junta de Castilla y Leon” [grant number GRS 463/A/10 and 773/A/13 to ET], and PFIZER [grant number CT25-ESP01-01 to SR]. MAJS and AFR are supported by “Instituto de Salud Carlos III” [grant numbers CP17CIII/00007 and CP14CIII/00010, respectively]S