bluuebunny/crossref_metadata_2025 huggingface dataset:
Rationale Behind State Aid Control over Tax Incentives
Authors: Xu Diheng
Published: April 2022

EU State aid draws international attention recent years due to its application to fiscal measures granted by Member States to multinational enterprises. It has triggered discussions on the reasonableness of applying State aid law to tax measures. This article aims to explore the fundamental rationale behind EU State aid and its application to tax incentives. By going back to basics, this article contributes to a clearer picture on reasons for the State aid control over tax incentives. Governments tend to use fiscal State aid measures to achieve policy goals and tax incentives could realize the goals since they do bring beneficial effects. However, considering efficiency and equity in the internal market, tax incentives can cause harmful effects as well. It is necessary for State aid law to regulate the harmful effects of tax incentives, therefore guaranteeing the level playing field in the internal market.
What Can We Learn About the Application of the as Efficient Competitor Test in Fidelity Rebate Cases from the Recent US Case Law?
Authors: Marinova Miroslava
Published: April 2022

It is accepted that the treatment of fidelity rebates is one of the most controversial topics in European Union competition law. It remains an outstanding issue despite the clear position of the Court of Justice in both the Intel and Post Danmark II judgments to depart from the strict form-based approach and to endorse an approach based on an evaluation of the possible anticompetitive effects of fidelity rebates. In particular, it remains unclear whether a price-cost test should be deployed. The conditions when a price-cost test should be applied to fidelity rebates as opposed to alternative approaches is a central issue in recent US case law of fidelity rebates and associated scholarly debate. This article examines the academic debate in US and compares the treatment of fidelity rebates on both sides of the Atlantic in an attempt to clarify under which circumstances a price-cost test should be used as a tool to determine anticompetitive effects of fidelity rebates and how this clarification can be translated into concrete lessons for European caselaw. It reveals that the economic theory of raising rival’s cost explains that the assessment of a strategy to exclude an as efficient competitor does not require a price-cost test.
Do Pay-for-Delay Agreements Promote Innovation?: The Effects Across Innovation Cycles
Authors: de Barsy Laureen
Published: April 2022

Since the first EU case in 2013, pay-for-delay agreements have been considered a restriction of competition by object under Article 101 TFEU. However, according to parties to these agreements, the harm caused to consumers can be balanced out by efficiencies in terms of increased incentives to innovate. The aim of this thesis is to assess this efficiency argument by studying the effect of pay-fordelay agreements on innovation. It appears from the analysis that this effect partly depends on the innovation cycle it relates to: either first-generation innovation or subsequent innovation. 

The impact on first-generation innovation is studied sequentially, by reference to the literature, for three dimensions of innovation: returns on innovation, R&D investments and the innovative output. We conclude that first-generation innovation is either promoted or nonaffected.

Subsequent innovation is then studied from both a theoretical and an empirical point of view. The theoretical analysis focuses on two distinct issues: the incentives for first-generation innovators to invest in an improved version of their patented invention, and the ability of follow-on innovators to use existing knowledge. Based on this theoretical analysis, we put forward the revocation of a patent as a proxy for pay-for-delay agreements. We further use this assumption to design an empirical model whose objective is to estimate these agreements’ effect on innovation. We conclude that second-generation innovation is either unaffected or hindered.
Cultural and Political Forces in the Criminalization of Cartels: A Case Study on the Chilean Experience
Authors: Muraca Chiara
Published: April 2022

Despite the increasing number of countries opting for a criminal antitrust enforcement, outside the US, the implementation of criminal penalties has been quite deficient. Among the main arguments provided by the relevant literature to explain such deficiency, in addition to the procedural obstacles, there is a belief that the criminalization of cartels is often the product of a top-down process led by transnational enforcement interests rather than domestic bottom up pressures. And, as such, it bears the original sin of missing the required enforcement culture and support of the decisive stakeholders. Against this background, the present article provides an empirical investigation exploring the law making processes that led to the criminalization of cartels in Chile. We observe that, when the policy decision is highly politicized, i.e. the consensus building motive is predominant, even if the decision making is not driven by transnational interests but by purely domestic pressures, a regulatory populism might still overcome important balancing policy considerations, with the risk of jeopardizing the results’ effectiveness.
Interim Judicial Protection Against Publication of Confidential Information in Commission Antitrust Decisions
Authors: Iannuccelli Paolo
Published: April 2022

The publication, in the name of transparency, of Commission decisions finding infringements of EU competition law is a powerful tool for enhancing the private enforcement of Articles 101 and 102 of the Treaty on the Functioning of the European Union (‘TFEU’). Before publishing those decisions, the Commission must nonetheless be careful to afford ‘very special protection’ to the legitimate interest of the undertakings concerned in the protection of their business secrets and other confidential information. When preparing the non-confidential version of the decision to be published, the Commission involves those undertakings, which have the right to object and, where they consider it appropriate, to refer the matter to the Hearing Officer, whose decisions may in turn be challenged before the EU Courts. In such cases, interim relief is essential to safeguard the undertakings’ right to the protection of confidential information, as well as their right to effective judicial protection. The recent case law of both EU Courts on interim protection in this context is marked by a high degree of technicality and struggles to adapt the ordinary interpretation of the conditions required for the granting of interim measures to the specificities of this kind of case. This article examines several rather complex interlocutory orders in an attempt to extract the logic behind them.
Competition Damages Claims in Ireland: The Damages Directive Improves the Irish System Though Obstacles Remain
Authors: McCarthy Alan
Published: April 2022

The Damages Directive and the implementing Irish legislation apply to infringements of EU (and Irish) competition law that occurred on or after 27 December 2016. Irish litigation rules were already well developed but the Directive will augment and add to the Irish rules on disclosure, the effect of national decisions on competition law, limitation periods, joint and several liability, quantification of harm, passing-on of overcharges and consensual dispute resolution. However, obstacles remain to bringing competition damages claims in Ireland. In particular, the absence of any class action system and litigation funding coupled with the lack of any real history of such claims will limit the ability to bring such actions in Ireland.
Bid Rigging Analysis and Relevant Provisions in the Serbian Legislation
Authors: Jokovic Slavica
Published: April 2022

The article reviews the main characteristics of bid rigging in public procurement regarding some forms, objectives and consequences, as well as various features of the industry, products and services that tend to facilitate collusion in public tenders. This article also describes the most common indicators of bid rigging in order to detect and prevent anticompetitive collusion.

 

For the purpose of this analysis, the common definition of bid rigging and some practical examples are included in order to elaborate effective measures for its detection and prevention.

Taking into consideration that certain public procurement rules may support bid rigging by lessening competition, this article gives an overview of the Law on Public Procurement in Serbia. It outlines relevant provisions that should boost competition and stimulate participation of potential bidders in the public procurement process. Some incentives concerning participation of small and medium enterprises in public procurement are examined, as well as certain new provisions aimed at increasing transparency, promoting integrity and preventing corruption in public procurement.

This article also emphasizes the role of the Commission for Protection of Competition in fighting against bid rigging in public procurement. It includes examination based on legislative framework and empirical data of the Commission for Protection of Competition, that performs the activities in accordance with the Law on Protection of Competition. Some examples of bid rigging cases in Serbia are examined, as well.

Finally, concluding remarks and recommendations are included.
Access to the File in Competition Proceedings Before the European Commission
Authors: Wils Wouter P. J. , Abbott Henry
Published: April 2022

This article deals with access to the file in competition proceedings conducted by the European Commission for the enforcement of Articles 101 and 102 of the Treaty on the Functioning of the European Union (TFEU) (antitrust proceedings) and merger control proceedings under the EU Merger Regulation.
Competition Law and IP Rights: Not So Complementary: Time for Re-alignment of the Goals?
Authors: Schmidt Hedvig
Published: April 2022

This article argues through a US/EU comparative assessment of the intellectual property (IP) law goals and competition law goals that whilst the overarching goals of competition law and IP rights to enhance overall economic welfare are still complementary, internal conflicts within the two legal spheres are jeopardizing the achievement of these goals.

Within the IP laws the private/public reward/incentive to innovate equilibrium is now being tilted in favour of private interests due to recent developments in terms of rapid innovation in digital economy markets and technologies coupled with an expansion of IP rights and increase in patents grants and their width.

This has a knock-on effect on the application of the competition rules as a second-tier regulator of IP rights. However, the competition rules also face its own battle in keeping up with the fast-developing digital economy, the concerns regarding Big Data and online platforms raising questions about the sustainability of the ‘consumer welfare’ framework as an optimal standard to ensure effective competition in these markets.

Consequently, there is a danger that the competition rules and the IP rights will be out of quilter, risking stifling of innovation and harm to consumer welfare, unless adjustment is made within the two legal spheres.
The Anti-Competitive Effect of Price Controls: Study of the Indian Pharmaceutical Industry
Authors: Reddy Lokesh Rhea
Published: April 2022

The objective behind imposing price controls on essential medicines is to ensure that the masses have access to these essential goods and services without prejudice. However, the prices of these medicines have significantly increased under price controls, defeating the purpose of the ceilings’ implementation. In this article, the author examines the reasons behind these price increases. In particular, the article examines whether price ceilings facilitate collusion in the pharmaceutical market of India. The scope of examination considers the effect of the ceiling on prices both before and after it was implemented. This is important because prices become significantly higher in a cartelized market, thereby preventing the masses from being able to access essential, life-saving medicines.

After examining studies of individual drugs and common market tendencies, the author concluded that price ceilings do facilitate anti-competitive practices. This is due to the marketbased price ceilings providing a focal point for tacit collusion. This is especially true in pharmaceutical markets with market-based price ceilings due to the presence of strong intermediary association and monitoring, evidence of communication, and underutilization of capacity. Similar collusive behaviour has been observed in markets across China, the United States, and the United Kingdom. At the end of the article, suggestions to mitigate the effects of price ceilings and prevent the consumers from being harmed further have been enumerated.

Tacit Collusion, Signalling, Cartelization, Pharmaceutical, India, Focal Point, Price Control, Ceiling, Market-based, Price-fixing
Disclosure in European Competition Litigation Through the Lens of US Discovery
Authors: Ruster Andreas , Massow Sebastian Von
Published: April 2022

The disclosure regime introduced by the EU Damages Directive is largely unprecedented in many EU Member States. Its implementation raises a number of thorny questions for both legal scholarship and practice. This contribution proposes a comparative analysis of Germany’s implementation through the lens of US discovery as a means of exposing issues, testing weaknesses, and exploring potential solutions. While the US certainly does not get everything right, it has grappled with questions of disclosure for decades. This wealth of experience and case law provides a rich vein for European (civil law) legislators and practitioners alike to mine. To this end, we analyse the key uncertainties that persist in Germany’s implementation: from the conditions and costs of disclosure, to the protections against disclosure, and the consequences of a breach. Each step of the way the US model serves as a preface to the German approach, providing context for a critical comparative analysis. We conclude with practical recommendations for the future.

Disclosure, Discovery, Damages Directive, Comparative Law, European Law, German Law, US Law, Litigation Hold, Legal Privilege, Principle of Effectiveness
Remedying The Mischief Created By E-Commerce Entities In India
Authors: Udhwani Mayank
Published: April 2022

E-commerce entities like Flipkart and Amazon have been alleged to be in violation of the laws governing foreign direct investment [‘FDI’] in India. Additionally, the business model adopted by them appears to be in contravention of the Competition Act, 2002. On 26 December 2018, the Department for Promotion of Industry and Internal Trade [‘DPIIT’] had issued Press Note 2 (2018 Series) which introduced a series of changes in the FDI norms in the e-commerce sector. (These changes have been incorporated in the FDI Policy vide Foreign Exchange Management (Transfer or Issue of Security by a Person Resident outside India) (Fifth Amendment) Regulations, 2019, dated 31 January 2019, Notification No.FEMA.20(R) (6)/2019-RB, available at, https://rbi.org.in/Scripts/BS_FemaNotifications.aspx?Id=11496 [Last accessed on: 21 April 2020].) The Press Note was purportedly introduced to protect the interest of small and medium sized enterprises in India. In this article, the author argues that the changes which are introduced by the Press Note go against the very purpose of their introduction as it leaves every stakeholder in a worse off situation by allowing easy circumvention. After highlighting the issues arising from amendments introduced by the Press Note in Part I of this article, the author delineates the anti-competitive nature of the business model of the e-commerce entities in Part II of this article. The author proposes that the appropriate method to remedy the problem surrounding the e-commerce sector would have been to make the appropriate amendments under Competition Act, 2002 rather than to opt for the FDI route.

Foreign Direct Investment, Competition Law, Foreign Exchange Law, Amazon, Flipkart, e-commerce entities, private equity, anti-competitive practices, circumvention of FDI norms, India
EU Merger Control After CK Telecoms UK Investments v. Commission
Authors: Monti Giorgio
Published: April 2022

The General Court’s judgment in CK Telecoms is of major importance. On matters of substance, the Court explains for the first time how to apply the substantial impediment of effective competition (SIEC) test to mergers which do not create or strengthen a dominant position. The judgment calls into question certain aspects of the Horizontal Merger Guidelines. On matters of procedure, the Court sets out the standard of proof in merger control and reveals itself willing to examine the Commission decision in depth. However, it is argued that the Court’s disagreement with the decision is not always expressed convincingly. This episode reveals the need for the Commission to explain its theory of harm more clearly and the need for the General Court to explain its conclusions more fully. The legislator may see this episode as an occasion to consider the suitability of assessing mergers based on the application of ever more complex economic analysis.

EU Merger Regulation, judicial review, SIEC test, close competitors, standard of proof, efficiency, telecommunications, more economic approach, UPP test, oligopoly.
Who Is the Dominant Actor Under the US Merger Regulation?
Authors: Truong Hieu Trong
Published: April 2022

The US appears to lean towards the model of unconcentrated and distributed competition regulation agencies, instead of a single concentrated one. Aside from the states and private litigants, in practice, this model mainly runs through the Department of Justice (DOJ), via its Antitrust Division, and the Federal Trade Commission (FTC)’s enforcement. Traditionally, under developments of the regulatory approach, the ‘quasi-judicial’ FTC could be understood to be a cornerstone of US antitrust law, particularly in its practical enforcement. However, it appears that the DOJ contributes far more policies on the specific regulation of mergers as well as consumption of merger remedies. By analysing the US model of ‘inter-agency competition’ under perspectives of merger control, this writing leads to proof that the DOJ is a dominant actor to some extent. More significantly, the DOJ’s performances partially bring the FTC and others to the uniformity of stipulated mergers as well as approved remedy fashions.

Merger regulation, merger remedies, merger guidelines, DOJ, FTC, clearance process, Sherman Act, Clayton Act, HSR Act, US antitrust.
Predatory Pricing and Platform Competition in India
Authors: Agrawal Akanshha
Published: April 2022

Predatory pricing has been a concern since the inception of competition policy. Scholars from different schools have large disagreements about it, with some arguing that predation does not exist to others considering it a legitimate threat to competition. As predatory pricing theory is largely concerned with price cost test, the issue is further complicated while looking at two sided platforms. Due to network effects, the value of the platform for the users changes with the number of users on the network. Therefore, the price of services is influenced by multiplicity of factors rather than just the cost of the service.The aim of the paper is to note such economic theory and apply this in the Indian jurisprudence on predatory pricing. Part I of the paper provides a non-technical introduction to the economics of two-sided platforms. It explains the rationale behind below cost pricing and critiques the usage of a price cost test for determining predation in case of two-sided platforms. Part II touches on the international regulation of predatory pricing and establishes the context for the Indian jurisprudence. Part III discusses the Indian jurisprudence surrounding predatory pricing. This elaborates on the legislative history and the judicial decisions concerning predatory pricing and platform competition in India. This part argues that the Indian jurisprudence has completely disregarded the economic theory of predation in case of two-sided platforms and the adjudications are merely based on a price cost test.

Predatory Pricing, India, CCI, Competition Law, Chicago School, Game Theory, Uber, Deep Discounting, Predatory Pricing Theory, Abuse of Dominance
Inability-to-Pay Fine Reductions in European Cartel Cases
Authors: Kokkoris Ioannis , Gabison Garry , Pahari Nandini
Published: April 2022

The European Commission can consider ‘the economic and social context’ of cartel members when imposing fines. This article investigates the process behind the inability-to-pay fine reductions. These fine reductions are rare and its process opaque. This article looks at the European Commission opinions and the case law to shed some light on the process. This article also collects data on companies involved. We found that 18.3% of applicants were granted some reduction. Applicants behave as expected: companies that are more likely to become insolvent are more likely to apply for a fine reduction. But the European Commission does not grant fine reduction based on insolvency propensity. These results show the importance of transparency to avoid further waste of resources in applying and investigating fine reduction claims.

Inability to Pay, Fine Reduction, Cartel, European Commission
Innovation: An Antitrust Trojan Horse?
Authors: Aron Shaurya
Published: April 2022

Innovation is regarded as the spearhead of consumer benefit in a competitive market. However, a strategy of predatory innovation presents the innovator with a shower of opportunities to close down the market and drive out competitors, thereby directly affecting consumer sovereignty. An inquiry into the relationship between innovation and market structures is not only important to assess the impact of such forms of the market on innovative activities, but also for a well-founded and evidenced framing of principles of antitrust laws in respect of Intellectual Property Rights (‘IPRs’). Therefore, this article makes a case for the legal recognition, across jurisdictions including India, of predatory innovation in the context of high-tech markets to uphold the objectives of the antitrust regime, i.e., consumer welfare. The article traces the progressive steps taken by developed jurisdiction in this context and highlights how a similar approach could be adopted by India, fitting its current framework.

This article, firstly, discusses the impact the market structure has on the motives and incentives for a manufacturer to innovate; secondly, brings forward the anti-competitive nature of predatory innovation in high tech markets; thirdly, advocates for the need for legal recognition of the conduct of Predatory Innovation while noting the counterarguments; lastly, concludes with identifying the effects of recognizing Predatory Innovation as anticompetitive conduct.

Innovation, Predatory, Market Structures, Monopoly, Intellectual Property Rights, India, High-tech Markets, Interoperability, Platforms, Network Effects
The Role of Regulation in EU Competition Law Assessment
Authors: Dunne Niamh
Published: April 2022

The relationship between competition law and regulation is a perennial question in competition policy. This article considers what happens when we apply competition law within markets already subject to a degree of alternative regulatory intervention – and, more specifically, how the presence of regulation can inform the antitrust assessment exercise. First, it asks why we might need, but also be reluctant, to apply competition law to market problems arising in regulated sectors. It then examines the potential impact of regulation within the task of competition law assessment from three overlapping perspectives: (1) where regulation forms an integral part of the ‘legal and economic context’; (2) where a regulatory standard is applied to set the boundaries of competition on the merits; and (3) where competition intervention functions as a means of ‘course correction’ to the underlying regulatory regime.

EU competition law, regulation, State action, regulatory gaming, data protection
El método de escenarios en la estimación de resultados electorales. Una aplicación al caso de Castilla y León / Using the Scenario Method for Predicting Electoral Results: The Case of Castilla y León
Authors: Alaminos Chica Antonio
Published: April 2022

Esta investigación aplica la metodología de escenarios a la estimación electoral. Para ello se sistematizan a partir de dos parámetros, el efecto del tiempo y la incorporación de incertidumbre, los modelos de estimación demoscópica más habituales en España. La combinación de los dos parámetros configura un conjunto de escenarios que permite conocer estructuras y patrones electorales existentes en la opinión pública, así como efectuar un análisis de sensibilidad y robustez de las estimaciones del apoyo electoral a los partidos. Aplicado empíricamente por el CIS a las elecciones autonómicas de Castilla y León con finalidad diagnóstica, se observa la existencia de singularidades provinciales en el ajuste de modelos, así como la elevada sensibilidad de sus estimaciones según la interacción entre los parámetros definidos por las dinámicas de cambio y la incertidumbre.
Perkembangan Dan Pola Literatur Maqāṣid Syarīʿah Di Malaysia: Analisis Sistematik
Authors: Baharuddin Ahmad Syukran , Abdull Rahim Aiman , Wan Ismail Wan Abdul Fattah , Abdul Mutalib Lukman , Roslan Siti Robiatun Addawiyah , Ruskam Aminuddin
Published: April 2022

Maqasid al-Shariah is a branch of knowledge based on al-quran and al-sunnah. Intellectual discourses related to maqasid al-shariah are seen to be increasing with the support given by the government in Malaysia. Among the indicators used to show the level of preparation of academics member in Malaysia regarding the discourse of Maqāsid Al-Shariʿah is through re-observation of the existence of literature and writing journal articles that have been published. Through the writing of journal articles, it indirectly proves the existence of serious revelations, discourses and studies on the concept of Maqāsid Al-Shariʿah among academics. This qualitative study analyzes the development status of Maqāsid Al-Shariʿah in Malaysia based on the writings and publications that have been done. This study uses the PRISMA methodology with the scope of data stored on the web www.scopus.com  and http://myjurnal.my which brings together thousands of scholarly writings in the world. The final screening results found that a total of 296 articles related to Maqasid al-Shariah have been published in various fields. Writing patterns are also analyzed to see the writing tendencies of academics in this field. This study is expected to be a guide to further research, especially novice researchers.
 
Abstrak
Maqāṣid Syariah merupakan cabang ilmu yang berasaskan al-quran dan al-sunnah. Wacana-wacana intelek berkaitan Maqāṣid Syariah dilihat semakin bertambah dengan sokongan yang diberikan oleh pihak pemerintah di Malaysia. Antara indikator yang digunakan bagi menunjukkan tahap persediaan ahli akademik di Malaysia berkenaan wacana Maqāsid Syariah ini ialah melalui pemerhatian semula terhadap kewujudan literatur dan penulisan artikel jurnal yang telah diterbitkan. Melalui penulisan artikel jurnal, ia secara tidak langsung membuktikan wujudnya pendedahan, wacana dan kajian yang serius berkenaan konsep Maqāsid Syariah dalam kalangan ahli akademik. Kajian kualitatif ini menganalisis status perkembangan Maqāsid Syariah di Malaysia berdasarkan penulisan dan penerbitan yang telah dilakukan. Kajian ini menggunakan metodologi PRISMA dengan skop data simpanan di web www.scopus.com dan http://myjurnal.my yang menghimpunkan ribuan penulisan ilmiah di dunia. Hasil tapisan akhir mendapati sebanyak 296 artikel berkaitan Maqāṣid Syariah telah diterbitkan dalam pelbagai bidang. Pola-pola penulisan juga dianalisis bagi melihat kecenderungan penulisan para akademia dalam bidang ini. Kajian ini diharapkan dapat menjadi panduan kepada penyelidikan seterusnya terutama penyelidik novis.
Desnutrición en pacientes oncológicos hospitalizados en el Centro Médico Docente La Trinidad en agosto-septiembre 2017
Authors: Alzuru Luisa , Mantellini Isabella
Published: April 2022

Todos los individuos con deficiencias de macro y micronutrientes necesarios para el mantenimiento y la reparación de tejidos cursan con desnutrición. El reconocimiento y tratamiento precoz de desnutrición en los centros de salud es un tema de cuidado principal. Los pacientes hospitalizados cursan con aumento del metabolismo basal y producción de energía para favorecer la curación. La desnutrición hospitalaria es un problema importante a nivel mundial, ya que se ha reportado que 50% de los pacientes hospitalizados presentan algún tipo de déficit nutricional. Esto se traduce en aumento de la morbi-mortalidad principalmente por aumento de las complicaciones. En el paciente oncológico hospitalizado se conjugan múltiples factores por los que puede aparecer desnutrición, entre ellos escaso aporte de nutrientes, alteración de la digestión y aumento de las necesidades. Se ha reportado 40-80% de malnutrición en los pacientes con cáncer, por lo que es importante diagnosticar y de ser necesario, solicitar intervención nutricional en estos pacientes con el fin de disminuir la morbimortalidad y mejorar la calidad de atención. El presente trabajo de investigación buscó determinar el estado nutricional de los pacientes hospitalizados en el Centro Médico Docente La Trinidad de Agosto-Septiembre 2017 utilizando la Valoración Global Subjetiva Generada por el Paciente como método diagnóstico. Comprobando las hipótesis, se encontró malnutrición moderada a severa (o riesgo de padecerla) en 87% de una muestra de 15 pacientes. Así mismo, se determinó que el 100% de la muestra ameritaba intervención nutricional o farmacológica por su oncólogo y un especialista en nutrición.
Influencia del bloqueo ecodirigido del nervio pudendo para disminuir el dolor posterior a cirugía anorrectal
Authors: Chuquitaype John , Pappe Peter , Angarita Luis , Martínez-Millán Sergio
Published: April 2022

Introducción: El bloqueo bilateral del nervio pudendo mediante ultrasonido podría ofrecer adecuada analgesia postoperatoria luego de la cirugía anorrectal. Objetivo: Evaluar la influencia del bloqueo bilateral del nervio pudendo ecodirigido en la disminución del dolor de pacientes de cirugía anorrectal, durante el periodo comprendido desde Febrero del 2017 hasta Octubre del 2017. Métodos: Estudio experimental, prospectivo, con asignación al azar, donde se evaluó el dolor postoperatorio. Se determinaron dos grupos de pacientes a quienes luego de cirugía para patología anorrectal benigna se les realizó bloqueo bilateral del nervio pudendo ecodirigido (grupo experimental) o mediante relaciones topográficas (grupo control). El dolor postoperatorio se evaluó mediante la escala visual análoga del dolor al momento de egresar de quirófano, a las 24 horas y con la primera defecación. Resultados: Se evaluaron 12 pacientes, seis para cada grupo,  66,67%  mujeres y 33,33% hombres, con promedio de edad de 42,92 años. Al analizar la escala del dolor como una variable del tipo cualitativo ordinal (severidad) y comparando la proporción dentro de cada valor se observó que el 66,67% del grupo experimental no presento dolor al momento del egreso de quirófano, comparado con el 33,33% del grupo control.  Conclusiones: El bloqueo del nervio pudendo ecodirigido es un procedimiento que disminuye el dolor postoperatorio.
Rehabilitación estética de dientes primarios: Reporte de dos Casos
Authors: Sotillo Gómez Virgina , Martínez Vásquez María Gabriela , Medina Díaz A. Carolina
Published: April 2022

La caries dental perjudica el  desarrollo  integral  del  niño ya que en casos avanzados produce dolor, muerte pulpar, infecciones periapicales o pérdida dental ocasionando problemas estéticos y funcionales. Siendo así, el tratamiento endodóntico y rehabilitador  fundamental. El objetivo de este trabajo es exponer dos casos clínicos de rehabilitación compleja, en pacientes con caries de infancia temprana severa, utilizando técnicas endodónticas y restauradoras, con coronas de resina nano híbrida, forma de celuloide y acero inoxidable.  Presentación de casos: Se describen dos casos clínicos de pacientes preescolares de 21  y 36 meses, sin antecedentes médicos relevantes, diagnosticadas con caries infancia temprana, lesiones de caries activas severas, abscesos dentoalveolares y destrucción de la corona clínica. Bajo anestesia general en ambiente hospitalario, se realizó rehabilitación que incluyó pulpectomías obturadas con pasta de hidróxido de calcio yodoformada, para el sector anterior colocación de pernos intraconducto, reconstrucción con coronas de resina nano híbridas y coronas de resina con formas de celuloide. Para el sector posterior coronas de acero inoxidable, restauraciones directas de vidrio ionomérico reforzado, resina compuesta y sellante de fosas y fisuras. El seguimiento al mes y a los tres meses de tratamiento, demostró correcto adaptado marginal de las coronas sin inflamación gingival, correcta función y estética. Fueron reforzados hábitos de higiene y realizadas recomendaciones de dieta. Conclusión: La reconstrucción de  dientes primarios, mediante la realización de tratamientos endodónticos y restauradores incluyendo rehabilitación estética de incisivos primarios, demuestran un resultado positivo en pacientes de corta edad, preservando la dentición primaria y devolviendo estética y función.
Caracterización clínico-epidemiológica de pacientes con hiperprolactinemia y adenomas hipofisiarios productores de prolactina
Authors: Isea Sofía , Vilela María Elena , Aure Gestne , Camperos Paul
Published: April 2022

La hiperprolactinemia es un diagnóstico frecuente en la consulta de endocrinología y   de los adenomas hipofisarios los prolactinomas son el subtipo más frecuente causantes de hiperprolactinemia. Se revisó pacientes con hiperprolactinemia idiopática y prolactinomas evaluados en el servicio de endocrinología del Centro Médico Docente La Trinidad. Se realizó un estudio descriptivo, retrospectivo, de carácter observacional en el que se explorararon posibles relaciones estadísticamente significativas, entre la presencia de hiperprolactinemia idiopática versus tumores hipofisiario (prolactinoma) e hiperprolactinemia y características demográficas o de presentación  y presentació clínica. Se encontró:  predominio de hiperprolactinemia en el sexo femenino, con una proporción de 4:2, pacientes con prolactinomas la proporción fue 3 mujeres por cada hombre afectado, el promedio de edad al momento del diagnóstico en las mujeres resultó 37 años y 45 años en los hombres. Los prolactinomas eran responsables de la hiperprolactinemia en un 67.44 %, siendo los microadenomas los tumores más frecuentes con un 68,9 %. Los macroadenomas se presentaron en 9 pacientes (31,03 %) de los cuales 8 fueron tratados con neurocirugía. Las manifestaciones clínicas y comorbilidades en los 43 pacientes con hiperprolactinemia principales fueron trastornos menstruales, dislipidemia y sobrepeso. La concentración media de prolactina estuvo directamente relacionada con las dimensiones de los tumores. Por último, se observó que la totalidad de los pacientes recibió tratamiento con cabergolina y 8 ameritaron neurocirugía, presentando déficits secuelares más inherentes al tumor que a la cirugía.
Bloqueo capsular versus bloqueo IPACK: Comparación en el manejo del dolor en pacientes con reemplazo total de rodilla
Authors: García Hernández Julio Alfonso , Maloni Franco Cordivani
Published: April 2022

El reemplazo total de rodilla (RTR) es un procedimiento quirúrgico, indicado en pacientes que presentan osteoartrosis severa (grado III - IV) de la articulación. Se han desarrollado diversas técnicas de analgesia para disminuir el dolor en el RTR. Objetivo: Evaluar la eficacia del bloqueo capsular versus bloqueo por infiltración entre la arteria poplítea y la cápsula de la rodilla (IPACK) en el manejo del dolor en pacientes tratados con RTR. Materiales y métodos: Se realizó un estudio observacional, analítico, de cohorte prospectivo, durante 10 meses, en 20 pacientes con artrosis severa de rodilla, corroborada por estudio de imágenes. A 10 pacientes se les aplicó el bloqueo IPACK guiado bajo ecografía con levobupivacaína y a los otros 10 pacientes se les aplicó el IPACK con la mezcla de Ranawat luego del cementado de la prótesis durante el acto quirúrgico. En un segundo tiempo, a las 24 y 48 horas del postoperatorio se aplicó un instrumento de evaluación para determinar la funcionalidad de la rodilla considerando los grados de flexión y el nivel de analgesia mediante la escala visual análoga del dolor (EVA). Resultados: No se presentaron diferencias significativas entre ambas técnicas anestésicas, sin embargo los grados de flexión con el bloqueo capsular fueron más altos con respecto al bloqueo IPACK así mismo que con la escala visual análoga del dolor. Conclusión: Los dos bloqueos resultan ser eficientes para el manejo del dolor postoperatorio en pacientes con reemplazo articular de rodilla.
Prevalencia de malformaciones congénitas fetales detectadas mediante ultrasonido
Authors: Fontaines Rattia Flor María , Cáceres Gelvis Marcos
Published: April 2022

Introducción: La ecografía obstétrica constituye una herramienta indispensable en la evaluación rutinaria de la consulta prenatal, en el diagnóstico de gestaciones múltiples, trastorno en el crecimiento fetal, anomalías placentarias y errores en la estimación de la edad gestacional. Objetivo: Describir y conocer la prevalencia de malformaciones congénitas diagnosticadas por ultrasonido en el servicio de Obstetricia del Centro Médico Docente la Trinidad. Métodos: Se realizó un estudio observacional, descriptivo de tipo retrospectivo. La población estuvo conformada por pacientes que acudieron al servicio de Obstetricia y Ginecología para el diagnóstico prenatal, que hayan presentado diagnostico ecográfico de alguna malformación fetal, en el periodo comprendido enero de 2011 junio 2021. Resultados: Se incluyeron a 58 pacientes embarazadas, la edad gestacional promedio fue de 15,9,5 ± 4,5 semanas, el estrato socioeconómico II fue del 94,6%. Las malformaciones cardíacas fueron las más frecuentes en el 25,9%, seguido de las del sistema nervioso central y abdomen con 24,1% cada uno. Al especificar las patologías, la translucencia nucal fue la más frecuente (19,0%), seguido de la ectasia renal/dilatación pielocalicial/hidronefrosis (12,1%). Conclusión: Las malformaciomes congénitas más prevalente fueron las cardíacas. Los resultados resaltan la importancia de establecer una vigilancia epidemiológica continua que permita un diagnóstico temprano y tratamiento oportuno de las malformaciones congénitas.
Cáncer Sincrónico Ginecológico: Experiencia en la consulta de ginecología oncológica del Servicio de Cirugía de CMDLT.
Authors: Aranguren Tuarez Carmen María , Mijares Briñez Alirio José , Suarez González Carmen María
Published: April 2022

Introducción: El cáncer sincrónico ginecológico corresponde a neoplasias que se presentan en un mismo paciente, simultánea o sucesivamente. La sincronicidad de cáncer mas frecuente reportada es la de endometrio-ovario sin embargo esta entidad clínica pude aparecer en cuello uterino- ovario, cuello uterino-endometrio; puede ser doble o triple e inclusive sincrónico de ovario in situ. Objetivo: Demostrar la experiencia en cuanto al diagnóstico y manejo del cáncer sincrónico ginecológico en la consulta de ginecología oncológica del servicio de cirugía del Centro Médico Docente La Trinidad. Materiales y métodos: Se realizó un estudio observacional descriptivo tipo serie de casos. La población estuvo conformada por 3854 pacientes con diagnóstico de cáncer ginecológico, de ello se seleccionaron 350 historias con diagnóstico de cáncer ginecológico con 2 neoplasias en diferente localización corporal, que acudieron a consulta de Ginecología Oncológica en el Centro Médico Docente La Trinidad desde 2000-2020. Resultados: Se evaluaron 350 historias de pacientes con diagnóstico de cáncer ginecológico con 2 neoplasias en diferente localización corporal, de las cuales según los criterios de exclusión se diagnosticaron 4 casos con cáncer sincrónico representando esto el 1,1 % de frecuencia en la consulta. Conclusión: El diagnóstico de cáncer sincrónico siempre debe ser considerado en todas las pacientes cuando presentan algún tipo de cáncer ginecológico, ya que esta condición es cada vez más frecuente, se corrobora que la supervivencia y el tiempo libre de recaída de la enfermedad dependerá del correcto estadiaje de cada uno de los canceres por separado de los estudios de imágenes.
The Impact of Website Design and Customer Support on Customer Experience and Its Relation to Fintech Adoption Intention in Saudi Arabia
Authors: Alothman Afnan Ibrahim , Al-Meshal Soad Abdullah
Published: April 2022

Very little research has been conducted on customer experience (CE) in fintech to date, especially in the Kingdom of Saudi Arabia. The purpose of this paper is to study the impact of website design (WD) and customer support (CS) on CE and its relation to fintech adoption intention (AI) in Saudi Arabia. Data was gathered from 296 individuals by means of a survey. After checking the validity and reliability of the results, structural equation modeling was used to test the hypotheses. The results showed that WD and CS have a significant positive impact on CE. Also, WD and CE positively influence AI in fintech, while CS does not have a direct relation. Furthermore, CE mediates both WD and CS with AI. This paper provides further conceptual understanding of antecedents and consequences of CE in fintech. Practitioners in the fintech sector could benefit from results in achieving long-term goals. There are some limitations in the study that suggest the need for further studies.
Improving the outcomes for pregnancies in the context of kidney disease
Authors:   ”Carol Davila” University of Medicine and Pharmacy, Bucharest,  Romania  Elias Emergency Hospital, Bucharest, Romania, Zvanca Mona , Petca Aida ,   ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Elias Emergency Hospital, Bucharest, Romania, Balta Oana ,   Elias Emergency Hospital, Bucharest, Romania, Bot Mihaela ,   ”Carol Davila” University of Medicine and Pharmacy, Bucharest,  Romania   Elias Emergency Hospital, Bucharest, Romania, Mehedintu Claudia ,   ”Carol Davila” University of Medicine and Pharmacy, Bucharest,  Romania   Malaxa Clinical Hospital, Bucharest, Romania, Maru Nicoleta ,   ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Petcu Razvan ,   ”Carol Davila” University of Medicine and Pharmacy, Bucharest,  Romania   ”Prof. Dr. Th. Burghele” Clinical Hospital, Bucharest, Romania
Published: April 2022

Renal disease in pregnancy is a rare pathology, but it raises several problems in terms of normal pregnancy evolution. Among pregnant women with renal injury, the rate of complications such as spontaneous abortion, preeclampsia, hypertension, intrauterine growth restriction, premature birth, fetal and neonatal mortality are much higher. For a good understanding of the pathology and a correct management of pregnant women with renal disease, it is necessary to know the normal pregnancy changes and the differentiation of chronic kidney disease from the acute injuries occurring during pregnancy. It is useful to ensure counseling prior to conception and to perform all prophylactic measures in order to prevent pregnancy complications and subsequent decline in renal function in all cases of pregnant women with chronic renal insufficiency. Treatment of acute renal failure in pregnancy involves therapy of the underlying condition that caused renal injury, prevention of irreversible kidney injury and pre-vention of maternal and fetal secondary complications. Monitoring carefully this cate-gory of pregnant women, although additional risks strike, often results in favorabl pregnancy evolution.
Differential diagnosis in case of overdose of antiepileptic treatment. Clinical case
Authors:   University of Medicine and Pharmacy “Carol Davila”, Bucharest, Tudosie Mihail S. , Caragea Genica ,   Military Medical Research Center, Bucuresti, Romania, Radu Ana D. ,   National Forensic Institute, Bucharest, Romania, Danescu Ilenuta L. ,   ICU II Toxicology, Clinical Emergency Hospital, Bucharest
Published: April 2022

Acute drug-related acute intoxications or suicidal ideation following overdose with anticonvulsants may cause major morbidity, in many cases requiring intensive care and prolonged periods of hospitalization. The case of a 35-year-old patient known for a history of epilepsy with phenobarbital and carbamazepine treatment is brought to the Emergency Unit by transfer from another hospital in a comatose state with insufficient respiratory performance, bilateral active mydriasis. From the family members' claims, the patient discontinued treatment with phenobarbital two weeks ago. Following interdisciplinary examination, hospitalization in the Neurology Department with the diagnosis of epileptic status is decided. Due to the progressive aggravation of acute respiratory insufficiency, the ventilator support is constituted. Since the biological samples related to probability diagnosis and cerebral imaging were not conclusive, toxicological samples were collected. The GC/MS analytical toxicology screening in urine reveals the presence of carbamazepine and phenobarbital and their plasma levels (5.92 and 92.3 mg/l) as determined by the FPIA method indicate an overdose of phenobarbital therapy. The patient is taken over by the Department of Clinical Toxicology where specific intensive care measures are applied. Clinical evolution is favorable. The psychiatric examination highlights the depressive idea, suicidal ideas, and uselessness. The suicide attempt is confirmed. It also presents a review of the main information about acute poisoning with anticonvulsants, but also about the analytical laboratory methods that bring precious information in establishing the diagnosis of certainty.