Las propiedades incorporales en el entorno digital y el derecho de la competencia

La presente Tesis, sobre Las Propiedades Incorporales en el Entorno Digital y el Derecho de la Competencia, es un estudio de investigación, realizado a partir de mis inquietudes profesionales como Abogado, al haberme enfrentado a cuestiones, tanto de propiedad intelectual, como de propiedad industrial -sustancialmente patentes- en el entorno digital, que siempre han acabado involucrando otras cuestiones, en el ámbito del Derecho de la Competencia. La Tesis parte de la deformación del derecho de autor, en el mundo globalizado, hasta el punto de convertirlo en un Derecho de grandes corporaciones, sobre todo en la sociedad tecnológica, donde juegan importantes mecanismos de dependencia global, a partir de cuestiones geoestratégicas, que tradicionalmente han servido a los intereses de los EE.UU. y ahora también de China, y a sus grandes conglomerados empresariales tecnocapitalistas, como son las FAANG y las BAT..

Predicting high risk of exacerbations in bronchiectasis: the E-FACED score

BACKGROUND: Although the FACED score has demonstrated a great prognostic capacity in bronchiectasis, it does not include the number or severity of exacerbations as a separate variable, which is important in the natural history of these patients. OBJECTIVE: Construction and external validation of a new index, the E-FACED, to evaluate the predictive capacity of exacerbations and mortality. METHODS: The new score was constructed on the basis of the complete cohort for the construction of the original FACED score, while the external validation was undertaken with six cohorts from three countries (Brazil, Argentina, and Chile). The main outcome was the number of annual exacerbations/hospitalizations, with all-cause and respiratory-related deaths as the secondary outcomes. A statistical evaluation comprised the relative weight and ideal cut-off point for the number or severity of the exacerbations and was incorporated into the FACED score (E-FACED). The results obtained after the application of FACED and E-FACED were compared in both the cohorts. RESULTS: A total of 1,470 patients with bronchiectasis (819 from the construction cohorts and 651 from the external validation cohorts) were followed up for 5 years after diagnosis. The best cut-off point was at least two exacerbations in the previous year (two additional points), meaning that the E-FACED has nine points of growing severity. E-FACED presented an excellent prognostic capacity for exacerbations (areas under the receiver operating characteristic curve: 0.82 for at least two exacerbations in 1 year and 0.87 for at least one hospitalization in 1 year) that was statistically better than that of the FACED score (0.72 and 0.78, P<0.05, respectively). The predictive capacities for all-cause and respiratory mortality were 0.87 and 0.86, respectively, with both being similar to those of the FACED. CONCLUSION: E-FACED score significantly increases the FACED capacity to predict future yearly exacerbations while maintaining the score’s simplicity and prognostic capacity for death

Inhaled Colistimethate Sodium in the Management of Patients with Bronchiectasis Infected by Pseudomonas aeruginosa: A Narrative Review of Current Evidence

International guidelines on the treatment of bronchiectasis indicate that the use of inhaled antibiotics is effective, especially in symptomatic chronic bronchial infection (CBI) due to Pseudomonas aeruginosa (PA). To date, however, no such treatment has been approved by regulatory agencies. Of the inhaled antibiotics on the market, colistimethate sodium (colistin) is one of the most used in many countries, either in its nebulized presentation or as dry powder. Among the characteristics of this antibiotic, it is worth noting that its main target is the lipopolysaccharide in the outer membrane of the cell wall of gram-negative bacteria and that it has a low rate of resistance to PA (<1%). Most observational studies have shown that the use of colistin in patients with bronchiectasis and CBI due to PA results in a decrease in both the number and severity of exacerbations, an improvement in quality of life, a decrease in sputum volume and purulence, and a high rate of PA eradication, although there are no clear differences with respect to other inhaled antibiotics. However, the lack of randomized clinical trials (RCT) with positive results for its main variable (exacerbations) in an intention-to-treat analysis has prevented its approval by regulatory agencies as a formal indication for use in bronchiectasis. The PROMIS program, made up of two RCT with identical methodology, is currently underway. The first of these RCT (already concluded) has demonstrated a clearly positive effect on the group randomized to colistin in its main variable (number of annual exacerbations), while the results of the second are still pending. This review presents exhaustive information on the pharmacological and microbiological characteristics of colistin, the results of the studies carried out to date, and the future challenges associated with this treatment

Características asmáticas en pacientes fumadores con enfisema avanzado

Objetivos: La mayoría de los neumólogos asumen que el asma crónica y el enfisema asociado al fumar difieren tanto en su origen como en el tipo de inflamación, pero es difícil que se estudie a individuos que presenten simultáneamente ambos procesos. Nosotros pretendemos averiguar mediante un análisis prospectivo si una porción de pacientes fumadores con enfisema avanzado tienen un perfil asmático, lo que supondría un solapamiento de ambas entidades. Pacientes y método: Se estudió a una población de 23 fumadores afectados de obstrucción moderada a grave al flujo aéreo y con criterios radiológicos de enfisema avanzado. Se analizó en todos los pacientes el perfil asmático definido mediante 5 características: respuesta aguda positiva a broncodilatadores, eosinofilia en sangre periférica, eosinófilos en esputo significativos, IgE sérica total significativa e IgE específica positiva a alergenos comunes y hongos. Se consideró presente el perfil asmático si se daban en un paciente tres o más de las características citadas. El análisis estadístico se hizo construyendo intervalos de confianza sobre los casos positivos totales para estimar la proporción poblacional. Resultados: De los 23 pacientes, en 21 se pudo analizar al menos 4 de las características. De los 21 pacientes, 10 (48%) presentaban un perfil asmático, es decir, tenían tres o más de las características antes señaladas. Este dato supone una proporción positiva de la presencia de características asmáticas de entre el 17,6 y el 79,6% de la población analizada con enfisema avanzado, con un intervalo de confianza del 99,9% de probabilidad. Conclusiones: En el enfisema asociado en principio al hábito de fumar se podría admitir que al menos un 17,6% de los pacientes presentan un perfil asmático evidente, lo que supone un alto grado de solapamiento entre asma y enfisema del fumador, y por eso no se desmiente la teoría holandesa sobre el origen común de las enfermedades obstructivas crónicas que sostiene una base inicial de sensibilización alérgica e hiperreactividad bronquial e influencias diversas, como el humo de tabaco, en la evolución final a largo plazo