Wybrane zagadnienia dotyczące eutanazji zwierząt: Część I – Niwelowanie cierpienia

Renesansowa myśl Francisa Bacona na temat łagodzenia cierpienia u pacjentów przyczyniła się do powstania pojęcia eutanazji i jego ewolucji na przestrzeni wieków wraz z podążającą za nią zmianą postaw moralnych i etycznych w medycynie ludzkiej i weterynaryjnej. W XXI wieku trwa spór na temat legalizacji eutanazji u ludzi terminalnie chorych. Z drugiej strony – poprawie ulega jakość i ilość środków nakładanych na opiekę paliatywną. Różne grupy społeczne próbują uzasadnić celowość eutanazji lub nie dopuścić do jej zalegalizowania (Gielen et al. 2009; Łużyński 2011). W świecie zwierząt eutanazję cechuje chęć zniwelowania cierpienia u osobników wyniszczonych bądź w skrajnych przypadkach zagrażających życiu ludzi i innych zwierząt. W obu sytuacjach motywy eutanazji mają uzasadnienie znajdujące się w polskim prawie w tym w Konstytucji RP.Francis Bacon’s renaissance idea of alleviating the suffering of patients contributed to the creation of the concept of euthanasia and its evolution over the ages with the following change of moral and ethical attitudes in human and veterinary medicine. In the 21’st century there is an ongoing controversy around the legalisation of euthanasia in people terminally ill. On the other hand the quality and quantity of measures imposed on palliative care are improving. Various social groups are trying to justify purposefulness of euthanasia or not to allow to its legalization (Gielen et al. 2009; Łużyński 2011). In world of animals euthanasia is characterized by the willingness of alleviating suffering in devastated animals or in extreme cases threatening the life of people and other animals. In both cases motives of euthanasia can be justified by Polish law including the Constitution of the Republic of Poland

DIAGNOSTIC APPLICATION OF MULTIROW COMPUTED TOMOGRAPHY OF THE HIP JOINT OF JAPANESE QUAILS (COTURNIX JAPONICA)

ABSTRACT The morphological assessment of selected parts of the hindlimb of Japanese quails (Temminck & Schlegel, 1849), with particular emphasis on hip joint structures, was performed, using a 128-row scanner (GE Optima Aquilion, Toshiba, Japan). Eight dead 3-month-old Japanese quails were evaluated. During intravital examination of those birds, no hindlimb abnormalities or locomotion disorders were detected. Bird body, which hip joints and other structures of hindlimbs were studied, was examined in posterioranterior position. The following hip joint structures, on both sides, were assessed in this study: hip joint gap width, acetabulum width, femoral head diameter, and femoral shaft width. The applied imaging method allowed accurate assessment of the selected structures. There was low variability between left and right hindlimbs and among individuals. Modern imaging techniques, such as multirow computed tomography (MCT) allows quick intravital assessment of normal and pathological structures of poultry bones and joints

Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Background: Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial. Methods: NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy. Findings: Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk of recurrent ischaemic stroke between rivaroxaban and aspirin (hazard ratio [HR] 0·54; 95% CI 0·22–1·36), and the risk was similar for those without known PFO (1·06; 0·84–1·33; pinteraction=0·18). The risks of major bleeding with rivaroxaban versus aspirin were similar in patients with PFO detected (HR 2·05; 95% CI 0·51–8·18) and in those without PFO detected (HR 2·82; 95% CI 1·69–4·70; pinteraction=0·68). The random-effects meta-analysis combined data from NAVIGATE ESUS with data from two previous trials (PICSS and CLOSE) and yielded a summary odds ratio of 0·48 (95% CI 0·24–0·96; p=0·04) for ischaemic stroke in favour of anticoagulation, without evidence of heterogeneity. Interpretation: Among patients with ESUS who have PFO, anticoagulation might reduce the risk of recurrent stroke by about half, although substantial imprecision remains. Dedicated trials of anticoagulation versus antiplatelet therapy or PFO closure, or both, are warranted. Funding: Bayer and Janssen