Insuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamiento
14 páginas : gráficas, fotografías
- Autores:
-
Alfonso Castañeda, Valentina
- Tipo de recurso:
- Trabajo de grado de pregrado
- Fecha de publicación:
- 2020
- Institución:
- Universidad de Ciencias Aplicadas y Ambientales U.D.C.A
- Repositorio:
- Repositorio Institucional UDCA
- Idioma:
- spa
- OAI Identifier:
- oai:repository.udca.edu.co:11158/3724
- Acceso en línea:
- https://repository.udca.edu.co/handle/11158/3724
- Palabra clave:
- Insuficiencia Hepática
Preparaciones Farmacéuticas
Ictericia
Metronidazol
Metadoxina
- Rights
- openAccess
- License
- Derechos Reservados - Universidad de Ciencias Aplicadas y Ambientales
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Insuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamiento |
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Insuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamiento |
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Insuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamiento Insuficiencia Hepática Preparaciones Farmacéuticas Ictericia Metronidazol Metadoxina |
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Insuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamiento |
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Insuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamiento |
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Insuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamiento |
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Insuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamiento |
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Insuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamiento |
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Alfonso Castañeda, Valentina |
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Leal García, Marco Giovanni, dir. |
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Alfonso Castañeda, Valentina |
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Insuficiencia Hepática Preparaciones Farmacéuticas Ictericia Metronidazol Metadoxina |
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Insuficiencia Hepática Preparaciones Farmacéuticas Ictericia Metronidazol Metadoxina |
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14 páginas : gráficas, fotografías |
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2020 |
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2020-12-09T16:15:18Z |
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2020-12 |
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Trabajo de grado - Pregrado |
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Bermúdez Duarte, P. M., & Rivera Rojas, J. A. (2019). Encuesta sobre el uso de la metadoxina en hepatopatías de pequeños animales en Colombia. Revista de Medicina Veterinaria, 1(37), 35–41. https://doi.org/10.19052/mv.vol1.is s37.4 11. Cortada, M. (2006). Cytotoxicity And P-Glycoprotein In Treatment With Nitroimidazoles. Theoria, vol. 15, núm. 2. Couto, G. (2010). Medicina Interna de Pequeños Animales. Cuarta edición. Elsevier España, S.L. Guzmán, V. (2006). El citocromo P450 y la respuesta terapéutica a los antimaláricos, Rev Panam Salud Publica/Pan Am J Public Health 19(1),19(1), 9–22 Idrovo. (2003). Encefalopatía hepática, Rev Colomb Gastroenterol 18(3), 163–167 Kotacherry. T, Balakumaran. L, Mathew. P, Prasad. M, Prabhakar. B, Sood. A, Singh. S, Rao. N, Zargar. S, Bignamini. A. (2014) Metadoxine Versus Placebo for the Treatment of Non-alcoholic Steatohepatitis: A Randomized Controlled Trial, Journal of Clinical and Experimental Hepatology, Volume 4, Issue 2, Pages 94-100, ISSN 0973-6883, https://doi.org/10.1016/j.jceh.2014. 03.041 (http://www.sciencedirect.com/science/article/pii/S097368831400218 7) Lawrence, Y. A. (2016). L a b o r a t o r y Ev a l u a t i o n o f the Liver Hepatic enzymes Bile acids Bilirubin Liver disease Ammonia. Veterinary Clinics of NA: Small Animal Practice. https://doi.org/10.1016/j.cvsm.201 6.11.005 Molina, V. M., & Pacheco, C. (2016). Manejo terapéutico de lipidosis hepática felina por Mycoplasma haemofelis. CES Medicina Veterinaria y Zootecnia, 11(2), 103–114. https://doi.org/10.21615/cesmvz.1 1.2.8 Murray, R. K. (2010). Harper Bioquímica Ilustrada. Ed. McGrawHill. Page 621. Otero, R. M. (2002). Hepatotoxicidad por fármacos, (60). Revista Española de Reumatología Suplementos, Volumen 1, Número 1. .Ruiz, J. (2001). Factores fisiológicos que modifican la acción de los fármacos en medicina veterinaria, Rev Col Cienc Pec Vol. 14: 1, 200114, 36–48. Sumano, H. (2006). Farmacología Veterinaria. 3 Ed. McGraw-Hill. Tejada, F. (2010). Hepatotoxicidad por Fármacos, 3(3), Rev Clín Med Fam 2010; 3 (–191. Thawley, V. (2016). Acute Liver Injury and F a i l u re Liver jury Liver failure Hepatic encephalopathy Coagulopathy. Veterinary Clinics of NA: Small Animal Practice. https://doi.org/10.1016/j.cvsm.201 6.11.010 Webster, C. R. L. (2016). H e m o s t a t i c D i s o rd e r s Associated with Hepatobiliary Disease Coagulation Liver Portal vein thrombosis Hyperfibrinolysis Hemorrhage. Veterinary Clinics of NA: Small Animal Practice. https://doi.org/10.1016/j.cvsm.201 6.11.009 |
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Facultad de Ciencias Agropecuarias |
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Medicina Veterinaria |
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Leal García, Marco Giovanni, dir.Alfonso Castañeda, Valentina2020-12-09T16:15:18Z2020-12-09T16:15:18Z2020-12https://repository.udca.edu.co/handle/11158/372414 páginas : gráficas, fotografíasThe present work describes the case of an 11-year-old male canine of the Jack Russell breed that was treated at Novavet Veterinary Clinic. Anamnesis: jaundice, recurrent vomiting, traces of blood in the feces and depressed attitude. Clinical and Laboratory Findings: Pain at abdominal palpation, generalized jaundice, hemogram results were; leukocytosis with granulocytosis and decreased hematocrit; blood chemistry with elevated ALT and ALP levels. Abdominal ultrasound was performed showing hepatomegaly, mixed pattern and dilated hepatic vessels, gallbladder with content and presence of hyperechoic structures suggestive of bile sludge, splenomegaly, uniform granular texture and dilated splenic vessels. In partial urine haematuria, bilirubinuria, were reported. proteinuria and the presence of leukocytes, and Giardia cysts were found in feces. Therapeutic Approach: Treatment was established with Ondansetron, Ampicillin + Sulbactam, Lactulose and N-acetylcystein, Heel Therapy (Nuxeel, Ubichinon, Traumeel, Echinacea), Vitamin K1 and Antifib and antioxidant (Metadoxine). Conclusions: There is a wide variety of drugs that have the capacity to cause liver failure, even though they are considered safe and used in daily practice. A correct management and therapeutic plan is the key to a successful recovery.El presente trabajo describe el caso de un canino macho, de raza Jack Russell Terrier de 11 años que fue atendido en la Clínica Veterinaria Novavet. Anamnesis: Ictericia, vómitos recurrentes, trazas de sangre en la materia fecal y actitud deprimida. Hallazgos Clínicos y de Laboratorio: Dolor a la palpación abdominal, ictericia generalizada, hemograma evidenció leucocitosis con granulocitosis y hematocrito disminuido; química sanguínea con niveles de ALT y ALP aumentados; se realizó ecografía abdominal donde se evidencia hepatomegalia, patrón mixto y vasos hepáticos dilatados, vesícula biliar con contenido y presencia de estructuras hiperecoicas sugerentes de lodo biliar, esplenomegalia, textura granular uniforme y vasos esplénicos dilatados y parcial de orina donde se reportó hematuria, bilirrubinuria, proteinuria y presencia de leucocitos y en el coprológico se hallan quistes de Giardia. Aproximación Terapéutica: Se instauró tratamiento con Ondansetrón, Ampicilina+ Sulbactam, Lactulosa y N-acetilcistein, Terapia de Heel (Nuxeel, Ubichinon,Traumeel, Echinacea), Vitamina K1, y Antifibrótico y antioxidante (Metadoxina). Conclusiones: Existe una amplia variedad de fármacos que tienen la capacidad de generar insuficiencia hepática, aun siendo considerados como seguros y utilizados en la práctica diaria. Un correcto diagnóstico, manejo y plan terapéutico, es la clave de una recuperación exitosa.Incluye bibliografíaPregradoMédico(a) Veterinarioapplication/pdfspaBogotá : Universidad de Ciencias Aplicadas y Ambientales, 2020Facultad de Ciencias AgropecuariasMedicina VeterinariaDerechos Reservados - Universidad de Ciencias Aplicadas y Ambientaleshttps://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccessAtribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)http://purl.org/coar/access_right/c_abf2https://creativecommons.org/licenses/by-nc-sa/4.0/Insuficiencia HepáticaPreparaciones FarmacéuticasIctericiaMetronidazolMetadoxinaInsuficiencia hepática inducida por fármacos: reporte de caso, manejo general y tratamientoTrabajo de grado - Pregradohttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesisinfo:eu-repo/semantics/publishedVersionTexthttp://purl.org/redcol/resource_type/TPhttp://purl.org/coar/version/c_970fb48d4fbd8a85Bermúdez Duarte, P. M., & Rivera Rojas, J. A. (2019). Encuesta sobre el uso de la metadoxina en hepatopatías de pequeños animales en Colombia. Revista de Medicina Veterinaria, 1(37), 35–41. https://doi.org/10.19052/mv.vol1.is s37.4 11.Cortada, M. (2006). Cytotoxicity And P-Glycoprotein In Treatment With Nitroimidazoles. Theoria, vol. 15, núm. 2.Couto, G. (2010). Medicina Interna de Pequeños Animales. Cuarta edición. Elsevier España, S.L.Guzmán, V. (2006). El citocromo P450 y la respuesta terapéutica a los antimaláricos, Rev Panam Salud Publica/Pan Am J Public Health 19(1),19(1), 9–22Idrovo. (2003). Encefalopatía hepática, Rev Colomb Gastroenterol 18(3), 163–167Kotacherry. T, Balakumaran. L, Mathew. P, Prasad. M, Prabhakar. B, Sood. A, Singh. S, Rao. N, Zargar. S, Bignamini. A. (2014) Metadoxine Versus Placebo for the Treatment of Non-alcoholic Steatohepatitis: A Randomized Controlled Trial, Journal of Clinical and Experimental Hepatology, Volume 4, Issue 2, Pages 94-100, ISSN 0973-6883, https://doi.org/10.1016/j.jceh.2014. 03.041 (http://www.sciencedirect.com/science/article/pii/S097368831400218 7)Lawrence, Y. A. (2016). L a b o r a t o r y Ev a l u a t i o n o f the Liver Hepatic enzymes Bile acids Bilirubin Liver disease Ammonia. Veterinary Clinics of NA: Small Animal Practice. https://doi.org/10.1016/j.cvsm.201 6.11.005Molina, V. M., & Pacheco, C. (2016). Manejo terapéutico de lipidosis hepática felina por Mycoplasma haemofelis. CES Medicina Veterinaria y Zootecnia, 11(2), 103–114. https://doi.org/10.21615/cesmvz.1 1.2.8Murray, R. K. (2010). Harper Bioquímica Ilustrada. Ed. McGrawHill. Page 621.Otero, R. M. (2002). Hepatotoxicidad por fármacos, (60). Revista Española de Reumatología Suplementos, Volumen 1, Número 1..Ruiz, J. (2001). Factores fisiológicos que modifican la acción de los fármacos en medicina veterinaria, Rev Col Cienc Pec Vol. 14: 1, 200114, 36–48.Sumano, H. (2006). Farmacología Veterinaria. 3 Ed. McGraw-Hill.Tejada, F. (2010). Hepatotoxicidad por Fármacos, 3(3), Rev Clín Med Fam 2010; 3 (–191.Thawley, V. (2016). Acute Liver Injury and F a i l u re Liver jury Liver failure Hepatic encephalopathy Coagulopathy. Veterinary Clinics of NA: Small Animal Practice. https://doi.org/10.1016/j.cvsm.201 6.11.010Webster, C. R. L. (2016). H e m o s t a t i c D i s o rd e r s Associated with Hepatobiliary Disease Coagulation Liver Portal vein thrombosis Hyperfibrinolysis Hemorrhage. 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en las Obras Colectivas;
b.	Distribuir copias o fonogramas de las Obras, exhibirlas públicamente, ejecutarlas públicamente y/o ponerlas a disposición pública, incluyéndolas como incorporadas en Obras Colectivas, según corresponda;
c.	Distribuir copias de las Obras Derivadas que se generen, exhibirlas públicamente, ejecutarlas públicamente y/o ponerlas a disposición pública.
Los derechos mencionados anteriormente pueden ser ejercidos en todos los medios y formatos, actualmente conocidos o que se inventen en el futuro. Los derechos antes mencionados incluyen el derecho a realizar dichas modificaciones en la medida que sean técnicamente necesarias para ejercer los derechos en otro medio o formatos, pero de otra manera usted no está autorizado para realizar obras derivadas.Todos los derechos no otorgados expresamente por el Licenciante quedan por este medio reservados, incluyendo pero sin limitarse a aquellos que se mencionan en las secciones 4(d) y 4(e).
4. Restricciones.
La licencia otorgada en la anterior Sección 3 está expresamente sujeta y limitada por las siguientes restricciones:
a.	Usted puede distribuir, exhibir públicamente, ejecutar públicamente, o poner a disposición pública la Obra sólo bajo las condiciones de esta Licencia, y Usted debe incluir una copia de esta licencia o del Identificador Universal de Recursos de la misma con cada copia de la Obra que distribuya, exhiba públicamente, ejecute públicamente o ponga a disposición pública. No es posible ofrecer o imponer ninguna condición sobre la Obra que altere o limite las condiciones de esta Licencia o el ejercicio de los derechos de los destinatarios otorgados en este documento. No es posible sublicenciar la Obra. Usted debe mantener intactos todos los avisos que hagan referencia a esta Licencia y a la cláusula de limitación de garantías. Usted no puede distribuir, exhibir públicamente, ejecutar públicamente, o poner a disposición pública la Obra con alguna medida tecnológica que controle el acceso o la utilización de ella de una forma que sea inconsistente con las condiciones de esta Licencia. Lo anterior se aplica a la Obra incorporada a una Obra Colectiva, pero esto no exige que la Obra Colectiva aparte de la obra misma quede sujeta a las condiciones de esta Licencia. Si Usted crea una Obra Colectiva, previo aviso de cualquier Licenciante debe, en la medida de lo posible, eliminar de la Obra Colectiva cualquier referencia a dicho Licenciante o al Autor Original, según lo solicitado por el Licenciante y conforme lo exige la cláusula 4(c).
b.	Usted no puede ejercer ninguno de los derechos que le han sido otorgados en la Sección 3 precedente de modo que estén principalmente destinados o directamente dirigidos a conseguir un provecho comercial o una compensación monetaria privada. El intercambio de la Obra por otras obras protegidas por derechos de autor, ya sea a través de un sistema para compartir archivos digitales (digital file-sharing) o de cualquier otra manera no será considerado como estar destinado principalmente o dirigido directamente a conseguir un provecho comercial o una compensación monetaria privada, siempre que no se realice un pago mediante una compensación monetaria en relación con el intercambio de obras protegidas por el derecho de autor.
c.	Si usted distribuye, exhibe públicamente, ejecuta públicamente o ejecuta públicamente en forma digital la Obra o cualquier Obra Derivada u Obra Colectiva, Usted debe mantener intacta toda la información de derecho de autor de la Obra y proporcionar, de forma razonable según el medio o manera que Usted esté utilizando: (i) el nombre del Autor Original si está provisto (o seudónimo, si fuere aplicable), y/o (ii) el nombre de la parte o las partes que el Autor Original y/o el Licenciante hubieren designado para la atribución (v.g., un instituto patrocinador, editorial, publicación) en la información de los derechos de autor del Licenciante, términos de servicios o de otras formas razonables; el título de la Obra si está provisto; en la medida de lo razonablemente factible y, si está provisto, el Identificador Uniforme de Recursos (Uniform Resource Identifier) que el Licenciante especifica para ser asociado con la Obra, salvo que tal URI no se refiera a la nota sobre los derechos de autor o a la información sobre el licenciamiento de la Obra; y en el caso de una Obra Derivada, atribuir el crédito identificando el uso de la Obra en la Obra Derivada (v.g., "Traducción Francesa de la Obra del Autor Original," o "Guión Cinematográfico basado en la Obra original del Autor Original"). Tal crédito puede ser implementado de cualquier forma razonable; en el caso, sin embargo, de Obras Derivadas u Obras Colectivas, tal crédito aparecerá, como mínimo, donde aparece el crédito de cualquier otro autor comparable y de una manera, al menos, tan destacada como el crédito de otro autor comparable.
d.	Para evitar toda confusión, el Licenciante aclara que, cuando la obra es una composición musical:
i.	Regalías por interpretación y ejecución bajo licencias generales. El Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública o la ejecución pública digital de la obra y de recolectar, sea individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), las regalías por la ejecución pública o por la ejecución pública digital de la obra (por ejemplo Webcast) licenciada bajo licencias generales, si la interpretación o ejecución de la obra está primordialmente orientada por o dirigida a la obtención de una ventaja comercial o una compensación monetaria privada.
ii.	Regalías por Fonogramas. El Licenciante se reserva el derecho exclusivo de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), una agencia de derechos musicales o algún agente designado, las regalías por cualquier fonograma que Usted cree a partir de la obra (“versión cover”) y distribuya, en los términos del régimen de derechos de autor, si la creación o distribución de esa versión cover está primordialmente destinada o dirigida a obtener una ventaja comercial o una compensación monetaria privada.
e.	Gestión de Derechos de Autor sobre Interpretaciones y Ejecuciones Digitales (WebCasting). Para evitar toda confusión, el Licenciante aclara que, cuando la obra sea un fonograma, el Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública digital de la obra (por ejemplo, webcast) y de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, Acinpro), las regalías por la ejecución pública digital de la obra (por ejemplo, webcast), sujeta a las disposiciones aplicables del régimen de Derecho de Autor, si esta ejecución pública digital está primordialmente dirigida a obtener una ventaja comercial o una compensación monetaria privada.
5. Representaciones, Garantías y Limitaciones de Responsabilidad.
A MENOS QUE LAS PARTES LO ACORDARAN DE OTRA FORMA POR ESCRITO, EL LICENCIANTE OFRECE LA OBRA (EN EL ESTADO EN EL QUE SE ENCUENTRA) “TAL CUAL”, SIN BRINDAR GARANTÍAS DE CLASE ALGUNA RESPECTO DE LA OBRA, YA SEA EXPRESA, IMPLÍCITA, LEGAL O CUALQUIERA OTRA, INCLUYENDO, SIN LIMITARSE A ELLAS, GARANTÍAS DE TITULARIDAD, COMERCIABILIDAD, ADAPTABILIDAD O ADECUACIÓN A PROPÓSITO DETERMINADO, AUSENCIA DE INFRACCIÓN, DE AUSENCIA DE DEFECTOS LATENTES O DE OTRO TIPO, O LA PRESENCIA O AUSENCIA DE ERRORES, SEAN O NO DESCUBRIBLES (PUEDAN O NO SER ESTOS DESCUBIERTOS). ALGUNAS JURISDICCIONES NO PERMITEN LA EXCLUSIÓN DE GARANTÍAS IMPLÍCITAS, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.
6. Limitación de responsabilidad.
A MENOS QUE LO EXIJA EXPRESAMENTE LA LEY APLICABLE, EL LICENCIANTE NO SERÁ RESPONSABLE ANTE USTED POR DAÑO ALGUNO, SEA POR RESPONSABILIDAD EXTRACONTRACTUAL, PRECONTRACTUAL O CONTRACTUAL, OBJETIVA O SUBJETIVA, SE TRATE DE DAÑOS MORALES O PATRIMONIALES, DIRECTOS O INDIRECTOS, PREVISTOS O IMPREVISTOS PRODUCIDOS POR EL USO DE ESTA LICENCIA O DE LA OBRA, AUN CUANDO EL LICENCIANTE HAYA SIDO ADVERTIDO DE LA POSIBILIDAD DE DICHOS DAÑOS. ALGUNAS LEYES NO PERMITEN LA EXCLUSIÓN DE CIERTA RESPONSABILIDAD, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.
7. Término.
a.	Esta Licencia y los derechos otorgados en virtud de ella terminarán automáticamente si Usted infringe alguna condición establecida en ella. Sin embargo, los individuos o entidades que han recibido Obras Derivadas o Colectivas de Usted de conformidad con esta Licencia, no verán terminadas sus licencias, siempre que estos individuos o entidades sigan cumpliendo íntegramente las condiciones de estas licencias. Las Secciones 1, 2, 5, 6, 7, y 8 subsistirán a cualquier terminación de esta Licencia.
b.	Sujeta a las condiciones y términos anteriores, la licencia otorgada aquí es perpetua (durante el período de vigencia de los derechos de autor de la obra). No obstante lo anterior, el Licenciante se reserva el derecho a publicar y/o estrenar la Obra bajo condiciones de licencia diferentes o a dejar de distribuirla en los términos de esta Licencia en cualquier momento; en el entendido, sin embargo, que esa elección no servirá para revocar esta licencia o que deba ser otorgada , bajo los términos de esta licencia), y esta licencia continuará en pleno vigor y efecto a menos que sea terminada como se expresa atrás. La Licencia revocada continuará siendo plenamente vigente y efectiva si no se le da término en las condiciones indicadas anteriormente.
8. Varios.
a.	Cada vez que Usted distribuya o ponga a disposición pública la Obra o una Obra Colectiva, el Licenciante ofrecerá al destinatario una licencia en los mismos términos y condiciones que la licencia otorgada a Usted bajo esta Licencia.
b.	Si alguna disposición de esta Licencia resulta invalidada o no exigible, según la legislación vigente, esto no afectará ni la validez ni la aplicabilidad del resto de condiciones de esta Licencia y, sin acción adicional por parte de los sujetos de este acuerdo, aquélla se entenderá reformada lo mínimo necesario para hacer que dicha disposición sea válida y exigible.
c.	Ningún término o disposición de esta Licencia se estimará renunciada y ninguna violación de ella será consentida a menos que esa renuncia o consentimiento sea otorgado por escrito y firmado por la parte que renuncie o consienta.
d.	Esta Licencia refleja el acuerdo pleno entre las partes respecto a la Obra aquí licenciada. No hay arreglos, acuerdos o declaraciones respecto a la Obra que no estén especificados en este documento. El Licenciante no se verá limitado por ninguna disposición adicional que pueda surgir en alguna comunicación emanada de Usted. Esta Licencia no puede ser modificada sin el consentimiento mutuo por escrito del Licenciante y Usted.

 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