Search

En esta tesis se ofrece un estudio del fenómeno de la sucesión de empresas en las administraciones públicas y su proyección en el empleo público. Se realiza un estudio de la normativa vigente a la luz de la jurisprudencia nacional y comunitaria y de la doctrina actualmente existente. En este estudio se pone manifiesto la colisión de ordenamientos jurídicos entre el derecho laboral y el derecho administrativo cuando se produce una proceso de reinternalización o reestructuración de un servicio público y es de aplicación lo previsto en el artículo 44 del Estatuto de los Trabajadores y la Directiva 2001/23/CE, que constituye una garantía para la estabilidad en el empleo y la aplicación de los principios constitucionales de igualdad, mérito y capacidad.Ha sido la jurisprudencia española la que ha intentado configurar una solución de compromiso a los fenómenos de reinternalización y reestructuración del sector público mediante la utilización de la figura del personal laboral indefinido no fijo para la integración del personal proveniente de una contrata, concesión o entidad del sector público. Sin embargo, esta es una figura de construcción jurisprudencial que no fue creada para la sucesión de empresas cuando en ella interviene una Administración Pública, sino para sanar la contratación temporal en fraude de ley en el ámbito de las Administraciones Públicas por el abuso en la temporalidad del personal laboral, en particular por entidades locales y comunidades autónomas, por lo que resulta una figura insatisfactoria para resolver los problemas que suceden con la integración del personal que proviene de una entidad que no tiene la consideración de administración pública.Se propone al respecto la teoría de los círculos concéntricos de la integración del personal en la que lo determinante no es tanto la denominación del personal que se integra como el estatuto jurídico de este personal y la vida administrativa que le espera una vez integrados en la administración pública que ha recuperado el servicio público previamente externalizado. Finalmente se efectúa una propuesta de lege ferenda como el fin de completar la transposición de la Directiva 2001/23/CE al artículo 44 del Estatuto de los Trabajadores.

Staphylococcus aureus est une bactérie commensale retrouvée chez environ 30 % des individus sains dont elle colonise la peau et la muqueuse nasale. Cependant, c’est également une bactérie pathogène opportuniste responsable d’infections diverses telles que orgelet, ostéomyélite, endocardite, ou encore septicémie en envahissant un grand nombre de tissus et d’organes. Cette bactérie est capable de s’adapter à des conditions hostiles et variées, telles que carence nutritive et stress osmotique, oxydant, ou thermique, ainsi qu’à la réponse immunitaire de l’hôte, car elle produit une grande diversité de facteurs de virulence. La synthèse de ces facteurs est finement régulée par des protéines et des ARN régulateurs majoritairement non codants, souvent désignés par l’abréviation sARN (dérivée de l’anglais, small RNA). Les facteurs de transcription et les systèmes à deux composants contrôlent l’expression des gènes impliqués non seulement dans le métabolisme, mais aussi dans la réponse au stress et la virulence [1]. Par exemple, la protéine du contrôle catabolique (carbon catabolite control protein A, CcpA) a un rôle essentiel dans le choix de la source carbonée en régulant le métabolisme central de la bactérie ainsi que la virulence [2, 3]. CcpA se fixe à une séquence promotrice spécifique appelée cre (catabolite-responsive element), qui est très conservée chez les bactéries à Gram positif [2]. Quant aux sARN, ils interagissent principalement avec leurs ARN messagers (ARNm) cibles. L’hybridation peut conduire à la stabilisation/ déstabilisation de l’ARNm ou à l’activation/répression de sa traduction [4]. Nous avons montré que la transcription du sARN RsaI (RNA Staphylococcus aureus I) est réprimée par CcpA en présence de glucose [5]. L’induction de la synthèse de RsaI signale que la concentration en glucose diminue dans le milieu extracellulaire et que la croissance des bactéries est ralentie. En interagissant avec ses ARNm cibles ou d’autres sARN, il permet à la population bactérienne de modifier son métabolisme lorsque la source carbonée primaire est consommée.

Background and importance From the beginning of the COVID-19 pandemic, tocilizumab has been positioned as an effective drug to treat cytokine release syndrome, which causes acute respiratory distress in patients with SARS-CoV2 pneumonia Throughout these months, clinical protocols have been developed that improve the effectiveness, introducing it at the onset of symptoms Aim and objectives To evaluate if the change in criteria for treatment with tocilizumab between the first and second waves of the COVID-19 pandemic, introducing it at the onset of symptoms, led to an improvement in its effectiveness Material and methods A retrospective observational study was conducted between 3 March 2020 and 15 October 2020 in patients with COVID-19 confirmed by PCR, treated with tocilizumab in a first level hospital Demographic, clinical and pharmacotherapeutic data were collected from electronic medical records To compare the effectiveness of treatment between the first COVID-19 wave (3 March to 31 May 2020) and the second COVID-19 wave (31 May to 15 October), we collected for each patient: days from admission to tocilizumab administration, oxygen therapy requirement, ICU stay, hospital stay and survival Differences between quantitative and qualitative variables were analysed, applying the Student's t test and the χ2 test (p≤0 005) Statistical analysis was performed with SPSS22 0 Results 167 patients (131 men), average age 58 9±12 6 years, were included During the first wave, tocilizumab was administered to 100 patients Days (average) until administration was 5±4 4 Length of hospital stay was 22 9±15 9 days 39 0% of patients needed a stay in the ICU Distribution of patients according to requirement for oxygen therapy: 48% high flow (HF) oxygen delivery systems, 19% low flow (LF) oxygen delivery systems and 31% with invasive mechanical ventilation Two patients did not require oxygen therapy The mortality rate was 28% During the second wave, tocilizumab was administered to 67 Days (average) until administration was 2 ±2 2 Length (average) of hospital admission was 13 1±10 4 days 10 1% of patients needed a stay in the ICU Distribution of patients according to requirement for oxygen therapy: 11 6% HF and 88 4% LF The mortality rate was 11 6% We found statistically significant differences in length of hospital stay and mortality rate between the two groups Conclusion and relevance The study showed that early administration of tocilizumab increased survival, decreased ICU income and shortened hospital stay A limitation of our study was the lack of comparison between inflammatory parameters before and after administration Further studies are needed

Background and importance Nutritional management in the intensive care unit (ICU) of patients with COVID-19 can influence their recovery Several guides about nutritional support have appeared in the past few months Aim and objectives To assess the appropriateness of nutritional management for COVID-19 patients in the ICU requiring invasive mechanical ventilation (IMV) through compliance with the recommendations of the Spanish Society for Intensive Care (SEMICYUC), the European Society for Clinical Nutrition and Metabolism (ESPEN) and the American Society for Parenteral and Enteral Nutrition (ASPEN) Material and methods An observational retrospective study was conducted between 2 March and 13 May 2020 Patient data were taken from the clinical records Demographic variables were age and sex;clinical variables were days until the start of artificial nutrition (AN), duration and type of enteral (EN) or parenteral nutrition (PN), body mass index (BMI), calorie intake/kg/day, protein/kg/day on the first and fifth days, increase in markers of hepatic cholestasis when duration of NP was >14 days, length of ICU stay and death Results 41 patients were included, 75 6%(n=31) men, and average age was 59 6±12,2 years Median time to start of AN was 1 (0-6) day 34 1% (n=14) of patients were obese, of whom 21% (n=3) were morbidly obese (average BMI 44 86±6 4) Average total kcal/kg/day and protein/kg/day on the first and fifth days of nutrition were 21 9±7 5 kcal/kg/day and 1 35±0 6 g protein/kg/day and 23 5±9 8 kcal/kg/day and 1 9±3 2 g protein/kg/day, respectively Only 17% (n=7) started AN with EN, which was hypercaloric/hyperproteic (n=3) and normocaloric/normoproteic (n=4) At any time during hospital stay, 97 5% of patients had PN with a median of 14 5 (2-52) days 20 people had PN >14 days Alkaline phosphatase remained increased for 11 of them with a median of 13 (3-38) days Direct bilirubin was elevated in all patients 34 patients died and 26 remained on PN until the day they died Conclusion and relevance During the first day, AN accomplished the recommendations (20 kcal/kg/day and 1 2-1 3 g protein/kg/day) On the fifth day, total kilocalories did not achieve the recommended values (25 kcal/kg/day), although protein/kg/day was higher than the guidelines (1 5 kcal/kg/ day) The reason might be the increasing protein request of these patients High doses of muscle relaxants could prevent proper functionality of digestive tube and low use of EN It may be important to discuss the suitability of maintenance of AN for patients with a short life expectancy