Mechanizm limitacji prawa do wolności uzewnętrzniania przekonań religijnych w międzynarodowym systemie ochrony praw człowieka ze szczególnym uwzględnieniem kontekstu europejskiego

Artykuł 18 Powszechnej Deklaracji Praw Człowieka stanowi, że prawo do wolności myśli, sumienia i religii obejmuje (obok swobody zmiany religii i przekonań) prawo do uzewnętrzniania swojej religii lub przekonań. W budowanym po II wojnie światowej międzynarodowym systemie ochrony praw człowieka zadaniem Deklaracji było proklamowanie praw człowieka jako standardu międzynarodowego, a tym samym wskazanie podstawowych treści samego pojęcia praw człowieka użytego w Karcie Narodów Zjednoczonych. Analogiczne do treści art. 18 Deklaracji prawo do uzewnętrzniania przekonań religijnych uznane jest w art. 9 Konwencji o Ochronie Praw Człowieka i Podstawowych Wolności, art. 18 Międzynarodowego Paktu Praw Obywatelskich i Politycznych oraz w art. 10 Karty Praw Podstawowych Unii Europejskiej – traktatowych aktach normatywnych praw człowieka, mających znaczenie dla europejskiego rozumienia standardu ochrony w zakresie prawa do uzewnętrzniania religii lub przekonań na poziomie ponadpaństwowym i regionalnym. Ustępy drugie Konwencji i Paktu zawierają klauzule limitacyjne, dopuszczające ograniczenie wolności uzewnętrzniania przekonań religijnych. Karta przejmuje z Konwencji – choć nie bez zastrzeżeń – zakres chronionych praw, a przez to również mechanizmy limitacyjne. W niniejszym opracowaniu zastosowano metodę dogmatyczno-prawną. Dążąc do przyczynienia się do lepszego rozumienia praktycznoprawnych konsekwencji realizacji teoretycznych założeń klauzul limitacyjnych w – istotnych z europejskiego punktu widzenia – przepisach traktatowych chroniących wolność uzewnętrzniania przekonań religijnych, Autor omawia odnośne przepisy Konwencji, Paktu i Karty, analizując warunki prawnej dopuszczalności limitacji prawa do uzewnętrzniania przekonań religijnych na gruncie omawianych aktów prawa międzynarodowego

Arrhythmic mitral valve prolapse in 2023: Evidence-based update

Patients with mitral valve prolapse (MVP) may develop ventricular arrhythmias, ranging from premature ventricular contractions through more complex non-sustained ventricular tachycardia to sustained life-threatening ventricular arrhythmias. The prevalence of MVP in autopsy series of young adults who died suddenly has been estimated to be between 4% and 7%. Thus, “arrhythmic MVP” has been reported as an underappreciated cause of sudden cardiac death, leading to a renewed interest in the study of this association. The term “arrhythmic MVP” refers to a small subset of patients who have, in the absence of any other arrhythmic substrate, MVP, with or without mitral annular disjunction, and frequent or complex ventricular arrhythmias. Our understanding of their coexistence in terms of contemporary management and prognosis is still incomplete. While literature regarding the arrhythmic MVP may be contrasting despite recent consensus document, the present review summarizes the relevant evidence concerning the diagnostic approach, prognostic implications, and targeted therapies for MVP-related ventricular arrhythmias. We also summarize recent data supporting left ventricular remodeling, which complicates the coexistence of MVP with ventricular arrhythmias. As the evidence for a putative link between MVP-associated ventricular arrhythmias and sudden cardiac death is scarce and based on scant and retrospective data, risk prediction remains a challenge. Thus, we aimed at listing potential risk factors from available seminal reports for further use in a more reliable prediction model that requires additional prospective data. Finally, we summarize evidence and guidelines on targeted therapies of ventricular arrhythmias in the setting of MVP, including implantable cardioverter defibrillators and catheter ablation. Our review highlights current knowledge gaps and provides an action plan for structured research on the pathophysiological genesis, diagnosis, prognostic impact, and optimal management of patients with arrhythmic MVP

Arrhythmias in Patients With Valvular Heart Disease: Gaps in Knowledge and the Way Forward.

peer reviewedThe prevalence of both organic valvular heart disease (VHD) and cardiac arrhythmias is high in the general population, and their coexistence is common. Both VHD and arrhythmias in the elderly lead to an elevated risk of hospitalization and use of health services. However, the relationships of the two conditions is not fully understood and our understanding of their coexistence in terms of contemporary management and prognosis is still limited. VHD-induced left ventricular dysfunction/hypertrophy and left atrial dilation lead to both atrial and ventricular arrhythmias. On the other hand, arrhythmias can be considered as an independent condition resulting from a coexisting ischemic or non-ischemic substrate or idiopathic ectopy. Both atrial and ventricular VHD-induced arrhythmias may contribute to clinical worsening and be a turning point in the natural history of VHD. Symptoms developed in patients with VHD are not specific and may be attributable to hemodynamical consequences of valve disease but also to other cardiac conditions including arrhythmias which are notably prevalent in this population. The issue how to distinguish symptoms related to VHD from those related to atrial fibrillation (AF) during decision making process remains challenging. Moreover, AF is a traditional limit of echocardiography and an important source of errors in assessment of the severity of VHD. Despite recent progress in understanding the pathophysiology and prognosis of postoperative AF, many questions remain regarding its prevention and management. Furthermore, life-threatening ventricular arrhythmias can predispose patients with VHD to sudden cardiac death. Evidence for a putative link between arrhythmias and outcome in VHD is growing but available data on targeted therapies for VHD-related arrhythmias, including monitoring and catheter ablation, is scarce. Despite growing evidences, more research focused on the prognosis and optimal management of VHD-related arrhythmias is still required. We aimed to review the current evidence and identify gaps in knowledge about the prevalence, prognostic considerations, and treatment of atrial and ventricular arrhythmias in common subtypes of organic VHD

Characteristics, management, and outcomes of patients with multiple native valvular heart disease: a substudy of the EURObservational Research Programme Valvular Heart Disease II Survey

Aims To assess the characteristics, management, and survival of patients with multiple native valvular heart disease (VHD). Methods and results Among the 5087 patients with >= 1 severe left-sided native VHD included in the EURObservational VHD II Survey (maximum 3-month recruitment period per centre between January and August 2017 with a 6-month follow-up), 3571 had a single left-sided VHD (Group A, 70.2%), 363 had one severe left-sided VHD with moderate VHD of the other ipsilateral valve (Group B, 7.1%), and 1153 patients (22.7%) had >= 2 severe native VHDs (left-sided and/or tricuspid regurgitation, Group C). Patients with multiple VHD (Groups B and C) were more often women, had greater congestive heart failure (CHF) and comorbidity, higher left atrial volumes and pulmonary pressures, and lower ejection fraction than Group A patients (all P <= 0.01). During the index hospitalization, 36.7% of Group A (n = 1312), 26.7% of Group B (n = 97), and 32.7% of Group C (n = 377) underwent valvular intervention (P < 0.001). Six-month survival was better for Group A than for Group B or C (both P < 0.001), even after adjustment for age, sex, body mass index, and Charlson index [hazard ratio (HR) 95% confidence interval (CI) 1.62 (1.10-2.38) vs. Group B and HR 95% CI 1.72 (1.32-2.25) vs. Group C]. Groups B and C had more CHF at 6 months than Group A (both P < 0.001). Factors associated with mortality in Group C were age, CHF, and comorbidity (all P < 0.010). Conclusion Multiple VHD is common, encountered in nearly 30% of patients with left-sided native VHD, and associated with greater cardiac damage and leads to higher mortality and more heart failure at 6 months than single VHD, yet with lower rates of surgery

Effect of natalizumab on disease progression in secondary progressive multiple sclerosis (ASCEND). a phase 3, randomised, double-blind, placebo-controlled trial with an open-label extension

Background: Although several disease-modifying treatments are available for relapsing multiple sclerosis, treatment effects have been more modest in progressive multiple sclerosis and have been observed particularly in actively relapsing subgroups or those with lesion activity on imaging. We sought to assess whether natalizumab slows disease progression in secondary progressive multiple sclerosis, independent of relapses. Methods: ASCEND was a phase 3, randomised, double-blind, placebo-controlled trial (part 1) with an optional 2 year open-label extension (part 2). Enrolled patients aged 18–58 years were natalizumab-naive and had secondary progressive multiple sclerosis for 2 years or more, disability progression unrelated to relapses in the previous year, and Expanded Disability Status Scale (EDSS) scores of 3·0–6·5. In part 1, patients from 163 sites in 17 countries were randomly assigned (1:1) to receive 300 mg intravenous natalizumab or placebo every 4 weeks for 2 years. Patients were stratified by site and by EDSS score (3·0–5·5 vs 6·0–6·5). Patients completing part 1 could enrol in part 2, in which all patients received natalizumab every 4 weeks until the end of the study. Throughout both parts, patients and staff were masked to the treatment received in part 1. The primary outcome in part 1 was the proportion of patients with sustained disability progression, assessed by one or more of three measures: the EDSS, Timed 25-Foot Walk (T25FW), and 9-Hole Peg Test (9HPT). The primary outcome in part 2 was the incidence of adverse events and serious adverse events. Efficacy and safety analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01416181. Findings: Between Sept 13, 2011, and July 16, 2015, 889 patients were randomly assigned (n=440 to the natalizumab group, n=449 to the placebo group). In part 1, 195 (44%) of 439 natalizumab-treated patients and 214 (48%) of 448 placebo-treated patients had confirmed disability progression (odds ratio [OR] 0·86; 95% CI 0·66–1·13; p=0·287). No treatment effect was observed on the EDSS (OR 1·06, 95% CI 0·74–1·53; nominal p=0·753) or the T25FW (0·98, 0·74–1·30; nominal p=0·914) components of the primary outcome. However, natalizumab treatment reduced 9HPT progression (OR 0·56, 95% CI 0·40–0·80; nominal p=0·001). In part 1, 100 (22%) placebo-treated and 90 (20%) natalizumab-treated patients had serious adverse events. In part 2, 291 natalizumab-continuing patients and 274 natalizumab-naive patients received natalizumab (median follow-up 160 weeks [range 108–221]). Serious adverse events occurred in 39 (13%) patients continuing natalizumab and in 24 (9%) patients initiating natalizumab. Two deaths occurred in part 1, neither of which was considered related to study treatment. No progressive multifocal leukoencephalopathy occurred. Interpretation: Natalizumab treatment for secondary progressive multiple sclerosis did not reduce progression on the primary multicomponent disability endpoint in part 1, but it did reduce progression on its upper-limb component. Longer-term trials are needed to assess whether treatment of secondary progressive multiple sclerosis might produce benefits on additional disability components. Funding: Biogen

INSTITUTIONALISATION OF THE RIGHT-CONSCIENCE CONFLICT AS A CONTEMPORARY CHALLENGE FOR THE CONTINENTAL LAW SYSTEMS

Najmocniejszą odsłoną znanego ze starożytności konfliktu sumienie – prawo stanowione stały się, powodujące ogromne rozterki moralne, wydarzenia w XX wieku, będące efektami oburzających etycznie decyzji politycznych czy normatywnych, podejmowanych np. przez nazistów czy Sowietów. Rozliczenie tych decyzji i ich skutków po II wojnie światowej przez społeczność międzynarodową dało impuls do budowania w duchu iusnaturalizmu międzynarodowego – w założeniu efektywnego – systemu praw człowieka. System ten, respektując wolność sumienia, w znanej triadzie wolności myśli sumienia i wyznania (religii), sprzyjał również pozytywnemu uznaniu prawa do sprzeciwu sumienia jako prawa człowieka. Uznanie prawa do sprzeciwu sumienia przebiegało od pozytywno-prawnego uznania wolności sumienia, poprzez teoretycznoprawne wyodrębnienie prawa do sprzeciwu sumienia, aż do uznania tego prawa w instytucji prawnej, nazywanej klauzulą sumienia, która ma postać przepisu dopuszczającego możliwość niewykonania jakiegoś działania ze względu na tzw. motywy sumienia. Tak rozumiany proces stopniowego uznawania prawa do sprzeciwu sumienia w porządku prawnym określamy w niniejszym opracowaniu sformułowaniem „instytucjonalizacja konfliktu prawo – sumienie”. Instytucjonalizacja ta przyjmuje różne formy i nie zawsze prowadzi do zapewnienia wystarczającej ochrony prawnej osobom chcącym skorzystać ze swojego prawa do sprzeciwu sumienia. Zawsze jednak prawne uznanie możliwości niezastosowania obowiązującego prawa ze względu na sprzeciw sumienia generuje wiele wyzwań dla spójności systemu prawnego. W niniejszej pracy, w której zastosowano metodę dogmatyczno-prawną, wyznaczono zadanie badawcze polegające na odpowiedzi na pytanie: Jakie wyzwania dla systemów prawnych continental law wynikają z instytucjonalizacji konfliktu prawo – sumienie? Artykuł podzielony został na dwie części, podejmujące analizę odpowiednio teoretycznoprawnych i praktycznoprawnych konsekwencji instytucjonalizacji konfliktu prawo – sumienie oraz wynikających z nich współcześnie wyzwań dla systemów prawnych continental law.The strongest version of the conscience-statutory law conflict, known from antiquity, is found in the events of the twentieth century. The effects of ethically outrageous political or normative decisions made, for example, by the Nazis or the Soviets, caused huge moral dilemmas. The international community’s account for these decisions and their consequences after World War II inspired the building of a system of human rights in the spirit of international iusnaturalism. This system, respecting the freedom of conscience in the well-known triad of freedom of thought, conscience, and religion, also favoured the positive recognition of the human right to conscientious objection. Recognition of the right to conscientious objection ran from the positive and legal recognition of the freedom of conscience, through the theoretical and legal separation of the right to conscientious objection, to the recognition of this right in a legal institution, known as the conscience clause, which takes the form of a provision allowing the possibility of failure to perform an action due to the so-called motives of conscience. The process of gradual recognition of the right to conscientious objection in the legal order, understood in this way, is defined in this study by the term “institutionalisation of the right-conscience conflict”. This institutionalisation takes various forms and does not always lead to the provision of sufficient legal protection to those wishing to exercise their right to conscientious objection. However, legal recognition of the possibility of non-application of the law in force due to conscientious objection always generates a number of challenges for the coherence of the legal system. In this work, a research task was undertaken using the dogmatic-legal method to answer the question which challenges for the legal systems of Continental law result from the institutionalisation of the law-conscience conflict? The article is divided into two parts, analysing the theoretical-legal and practical-legal consequences of the institutionalisation of the right-conscience conflict and the resulting challenges for the legal systems of Continental law

Historical and Legal Context and Significance… of Selected Roman Public Law Institutions of the Early Principate Described in Canonical Gospels of the New Testament

The article analyses the issues in question by means of a method used in the legal sciences which in the Polish methodology is called “the historical and legal method.” It involves presentation and analysis of selected legal institutions and of their evolution in time. The following issues—identified across the pages of the Gospel—are analysed in this article: political and systemic context of evangelical events (section 1), the role of censuses in the implementation of Roman administrative and systemic principles (section 2), Roman tax law in the context of tax burdens resting on residents of Judea (section 3) and the Roman judicial procedure in the context of the trial of Jesus (section 4). In the summary the author answers the research question asked in the introduction: to what degree does the historical and legal significance of selected institutions of Roman law, inspired by the description of these institutions in canonical gospels of the New Testament, determine the contemporary understanding of the gospels themselves

Overcoming challenges in the management of arrhythmogenic right ventricular cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy (ARVC) appears in most patients to be an inherited disease characterized by fibrofatty replacement of myocytes extending from the epicardium to the endocardium in the right ventricle. The disease process results in life‑threatening ventricular arrhythmias and ventricular dysfunction. In the absence of a gold‑standard diagnostic test and despite the progress in imaging techniques, ARVC is often misdiagnosed and earlier detection of the disease is challenging. Preprocedural identification and localization of the substrate can be determined from the analysis of surface electrocardiography and cardiac magnetic resonance imaging. Typically, perivalvular arrhythmogenic substrate, defined by electroanatomic mapping, is present and can be isolated to the epicardium. Ablation targets are further identified with activation, entrainment, and local electrogram abnormalities based on detailed electroanatomic mapping. Extensive combined endo / epicardial ablation performed in experienced centers is frequently required to prevent ventricular tachycardia (VT). Catheter ablation significantly reduces recurrences of VT, appropriate implantable cardioverter‑defibrillator shocks, and the use of antiarrhythmic drugs and cardiac transplant as a management strategy for refractory arrhythmias is rarely required. Progression of the disease is poorly understood and may require a distinct triggering mechanism. Biventricular involvement is more common than previously recognized. However, left ventricular involvement leading to significant terminal heart failure is fortunately uncommon and left ventricular tachycardias are also infrequent. Many questions remain regarding prevention and management of coexisting tricuspid valve regurgitation, atrial arrhythmias, and intracardiac thrombosis. Although data on genotype‑phenotype correlations is growing, long‑term follow‑up studies of families with ARVC are still lacking. Ongoing research will contribute to better understanding of this pathological condition