Línea jurisprudencial. La prueba indiciaria en el proceso de simulación

El tema de la prueba indiciaria ha tenido una importancia muy especial frente a los procesos de simulación de contratos, debido a que las partes que intervienen en la celebración de los actos jurídicos simulados buscan dar la apariencia de verdad a lo que no es. La jurisprudencia de la Corte Suprema de Justicia, unida a las normas legales imperantes en un momento determinado, han ido señalando el camino que debe seguir el juez (jueza) al momento de valorar la prueba indiciaria obrante en el proceso, con el fin de desentrañar la verdad. Bajo la vigencia del Código Judicial (Ley 105 de 1931), y rigiendo el sistema probatorio denominado “tarifa legal de prueba”, la jurisprudencia de la Corte Suprema de Justicia – Sala de Casación Civil señaló que no es el número de indicios lo concluyente para llegar a una decisión final, basta un solo indicio siempre y cuando éste sea necesario. Las características de este indicio único necesario eran de gravedad y precisión suficientes para formar el convencimiento del fallador (falladora). En vigencia del actual C.P.C. y frente al sistema de valoración de la prueba denominado “sana crítica racional”, ha señalado la Corte Suprema de Justicia, -en jurisprudencia que se ha hecho pacífica-, que se debe efectuar el análisis de los diferentes indicios y luego concordar estos con las pruebas directas que aparecen en el expediente; siendo necesario valorar individualmente cada uno de los medios de prueba y después integrarlos en conjunto para decidir en relación con la simulación

Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER); Agencia Española del Medicamento; Consejería de Salud de Andalucía.Background & Aims: Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period. Methods: Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected. Results: A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974-0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994-0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged ≥65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy's law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%). Conclusions: AST elevation at onset is a strong predictor of poor outcome and should be routinely assessed in DILI evaluation. Mortality is higher in older patients with hepatocellular damage and patients with underlying hepatic conditions. The Spanish DILI Registry is a valuable tool in the identification of causative drugs, clinical signatures and prognostic risk factors in DILI and can aid physicians in DILI characterisation and management. Lay summary: Clinical information on drug-induced liver injury (DILI) collected from enrolled patients in the Spanish DILI Registry can guide physicians in the decision-making process. We have found that older patients with hepatocellular type liver injury and patients with additional liver conditions are at a higher risk of mortality. The type of liver injury, patient sex and analytical values of aspartate aminotransferase and total bilirubin can also help predict clinical outcomes