Le Service Européen pour l’action Extérieure á l’heure de son épreuve : Une contribution tenforcée de l’UE au maintien de la paix ?

Cet article a pour objet de s’intéresser à l’impact que la mise en place d’un nouvel organe comme le Service Européen pour l’Action Extérieure, extrêmement original et innovateur du point de vue institutionnel, pourrait avoir à court et moyen terme sur la capacité de l’UE pour décoller défnitivement en tant qu’acteur majeur et partenaire vraiment crédible dans le domaine du maintien de la paix. Le moment semble opportun pour le faire dans la mesure où, après quelques quatre ans d’existence et une fois surmontés un certain nombre de teething problems, un processus de réflexion sur les faiblesses et potentialités du SEAE est en cours au sein du système institutionnel de l’UE en vue d’une éventuelle révision de sa Décision de base.En este trabajo se propone un análisis del impacto que la creación y puesta en funcionamiento de un nuevo órgano tan original e innovador desde el punto de vista institucional como el Servicio Europeo de Acción Exterior podría ejercer, a corto y medio plazo, sobre la capacidad de la UE para afanzarse como actor realmente signifcativo y socio internacional creíble en el campo del mantenimiento de la paz. El momento parece oportuno para ello en la medida en que, tras cuatro años de existencia y una vez superado un buen número de difcultades iniciales, se ha abierto un proceso de reflexión sobre las defciencias y potencialidades del SEAE que podría conducir a una revisión de su Decisión fundacional.This paper aims to analyse the impact that the setup and functioning of a new body, as original and innovative from an institutional point of view as the European External Action Service, could have in the consolidation of the EU’s position as a signifcant and reliable international partner in peacekeeping, both in the short and medium terms. This timing appears appropriate to do so insofar as, after four years of existence and having overcome a signifcant number of teething problems, a reflection process on the weaknesses and potentialities of the EEAS is currently in place and could eventually lead to a review of its founding Decision

Le Service Européen pour l’action Extérieure á l’heure de son épreuve: Une contribution renforcée de l’UE au maintien de la paix ?

External Action European Service in practice: An EU’s enhanced contribution in peacekeeping? Abstract. This paper aims to analyse the impact that the setup and functioning of a new body, as original and innovative from an institutional point of view as the European External Action Service, could have in the consolidation of the EU’s position as a significant and reliable international partner in peacekeeping, both in the short and medium terms. This timing appears appropriate to do so insofar as, after four years of existence and having overcome a significant number of teething problems, a refl ection process on the weaknesses and potentialities of the EEAS is currently in place and could eventually lead to a review of its founding Decision. Keywords: CSDP Missions, EU External Action, European External Action Service (EEAS), EU Delegations, EU High Representative, Peacekeeping.El Servicio Europeo de Acción Exterior en la práctica: ¿una contribución reforzada de la UE en el mantenimiento de la Paz? Resumen. En este trabajo se propone un análisis del impacto que la creación y puesta en funcionamiento de un nuevo órgano tan original e innovador desde el punto de vista institucional como el Servicio Europeo de Acción Exterior podría ejercer, a corto y medio plazo, sobre la capacidad de la UE para afianzarse como actor realmente significativo y socio internacional creíble en el campo del mantenimiento de la paz. El momento parece oportuno para ello en la medida en que, tras cuatro años de existencia y una vez superado un buen número de dificultades iniciales, se ha abierto un proceso de reflexión sobre las deficiencias y potencialidades del SEAE que podría conducir a una revisión de su Decisión fundacional. Palabras clave: Acción exterior de la UE, Alto Representante de la UE, Delegaciones de la UE, Mantenimiento de la paz, Operaciones de gestión de crisis, Servicio Europeo de Acción Exterior (SEAE).  Résumé. Cet article a pour objet de s’intéresser à l’impact que la mise en place d’un nouvel organe comme le Service Européen pour l’Action Extérieure, extrêmement original et innovateur du point de vue institutionnel, pourrait avoir à court et moyen terme sur la capacité de l’UE pour décoller défi nitivement en tant qu’acteur majeur et partenaire vraiment crédible dans le domaine du maintien de la paix. Le moment semble opportun pour le faire dans la mesure où, après quelques quatre ans d’existence et une fois surmontés un certain nombre de teething problems, un processus de réflexion sur les faiblesses et potentialités du SEAE est en cours au sein du système institutionnel de l’UE en vue d’une éventuelle révision de sa Décision de base. Mots clés : Action extérieure de l’UE, Délégations de l’UE, Haut représentant de l’UE, Maintien de la paix, Missions de gestion de crises, Service Européen pour l’Action Extérieure(SEAE)

El Brexit y la Unión Europea: panorama de problemáticas 2016-2019

Texto de la conferencia pronunciada el 22 de julio de 2019 en el Palacio de los Gobernadores de San Roque, durante el Curso «Gibraltar y Campo de Gibraltar, afrontando las consecuencias del ‘Brexit’», celebrado en San Roque y Gibraltar, en el marco de los XXXIX Cursos de la Universidad de Cádiz en San Roque, 22, 23 y 24 de Julio de 2019

Anti-TNF-a therapy in refractory uveitis associated with sarcoidosis: multicenter study of 17 patients

OBJECTIVES: To assess anti-TNF-α therapy response in uveitis associated with sarcoidosis refractory to conventional immunosuppressive therapy. METHODS: Open-label, multicenter, retrospective study on patients with sarcoid uveitis who underwent anti-TNF-α therapy because of inadequate response to conventional therapy including corticosteroids and at least 1 systemic synthetic immunosuppressive drug. The main outcome measurements were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness, and immunosuppression load. RESULTS: A total of 17 patients (8 men; 29 affected eyes; mean ± standard deviation age 38.4 ± 16.8; range: 13-76 years) were studied. The patients had bilateral hilar lymphadenopathy (58.8%), lung parenchyma involvement (47.1%), peripheral lymph nodes (41.2%), and involvement of other organs (52.9%). Angiotensin-converting enzyme was elevated in 58.8%. The most frequent ocular pattern was bilateral chronic relapsing panuveitis. The first biologic agent used was adalimumab in 10 (58.8%) and infliximab in 7 (41.2%) cases. Infliximab 5mg/kg intravenously every 4-8 weeks and adalimumab 40mg subcutaneously every 2 weeks were the most common administration patterns. In most cases anti-TNF-α therapy was given in combination with immunosuppressive drugs. The mean duration of follow-up was 33.9 ± 17.1 months. Significant improvement was observed following anti-TNF-α therapy. Baseline results versus results at 2 years from the onset of biologic therapy were the following: the median of cells in the ocular anterior chamber [interquartile range-IQR] 0.5 [0-2] versus 0 [0-0] (p = 0.003), vitritis 0 [0-1.25] versus 0 [0-0] (p = 0.008), macular thickness (391.1 ± 58.8 versus 247 ± 40.5µm) (p = 0.028), and visual acuity 0.60 ± 0.33 versus 0.74 ± 0.27; p = 0.009. The median daily [interquartile range] dose of prednisone was also reduced from 10 [0-30]mg at the onset of the anti-TNF-α therapy to 0 [0-0]mg at 2 years (p = 0.02). Significant reduction was also achieved in the immunosuppressive load. CONCLUSION: Anti-TNF-α therapy is effective in sarcoid uveitis patients refractory to conventional immunosuppressive therapy. Infliximab and adalimumab allowed a substantial reduction in prednisone dose despite having failed standard therapy.Funding: This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from ‘‘Instituto de Salud Carlos III’’ (ISCIII) (Spain) Acknowledgments: This work was partially supported by RETICS Program, RD12/0009/0013 (RIER) from “Instituto de Salud Carlos III” (ISCIII) (Spain)

Los juicios simulados (Moot Court) como herramienta pedagógica en derecho y ciencias políticas

Memoria ID-0054. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2017-2018

Biologic Therapy in Refractory Non-Multiple Sclerosis Optic Neuritis Isolated or Associated to Immune Mediated Inflammatory Diseases. A Multicenter Study

We aimed to assess the e cacy of biologic therapy in refractory non-Multiple Sclerosis (MS) Optic Neuritis (ON), a condition more infrequent, chronic and severe than MS ON. This was an open-label multicenter study of patients with non-MS ON refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were Best Corrected Visual Acuity (BCVA) and both Macular Thickness (MT) and Retinal Nerve Fiber Layer (RNFL) using Optical Coherence Tomography (OCT). These outcome variables were assessed at baseline, 1 week, and 1, 3, 6 and 12 months after biologic therapy initiation. Remission was defined as the absence of ON symptoms and signs that lasted longer than 24 h, with or without an associated new lesion on magnetic resonance imaging with gadolinium contrast agents for at least 3 months. We studied 19 patients (11 women/8 men; mean age, 34.8 13.9 years). The underlying diseases were Bechet?s disease (n = 5), neuromyelitis optica (n = 3), systemic lupus erythematosus (n = 2), sarcoidosis (n = 1), relapsing polychondritis (n = 1) and anti-neutrophil cytoplasmic antibody -associated vasculitis (n = 1). It was idiopathic in 6 patients. The first biologic agent used in each patient was: adalimumab (n = 6), rituximab (n = 6), infliximab (n = 5) and tocilizumab (n = 2). A second immunosuppressive drug was simultaneously used in 11 patients: methotrexate (n = 11), azathioprine (n = 2), mycophenolate mofetil (n = 1) and hydroxychloroquine (n = 1). Improvement of the main outcomes was observed after 1 year of therapy when compared with baseline data: mean SD BCVA (0.8 0.3 LogMAR vs. 0.6 0.3 LogMAR; p = 0.03), mean SD RNFL (190.5 175.4 m vs. 183.4 139.5 m; p = 0.02), mean SD MT (270.7 23.2 m vs. 369.6 137.4 m; p = 0.03). Besides, the median (IQR) prednisone-dose was also reduced from 40 (10?61.5) mg/day at baseline to. 2.5 (0?5) mg/day after one year of follow-up; p = 0.001. After a mean SD follow-up of 35 months, 15 patients (78.9%) achieved ocular remission, and 2 (10.5%) experienced severe adverse events. Biologic therapy is e ective in patients with refractory non-MS ON

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