Physician outreach during a pandemic: shared or collective responsibility?

In ‘Ethics of sharing medical knowledge with the community: is the physician responsible for medical outreach during a pandemic?’ Strous and Karni note that the revised physician’s pledge in the World Medical Association Declaration of Geneva obligates individual physicians to share medical knowledge, which they interpret to mean a requirement to share knowledge publicly and through outreach. In the context of the COVID-19 pandemic, Strous and Karni defend a form of medical paternalism insofar as the individual physician must reach out to communities who may not want, or know to seek out, medical advice, for reasons of public health and health equity. Strous and Karni offer a novel defence of why physicians ought to intervene even in insular communities, and they offer suggestions for how this could be done in culturally sensitive ways. Yet their view rests on an unfounded interpretation of the Geneva Declaration language. More problematically, their paper confuses shared and collective responsibility, misattributing the scope of individual physician obligations in potentially harmful ways. In response, this reply delineates between shared and collective responsibility, and suggests that to defend the obligation of medical outreach Strous and Karni propose, it is better conceptualised as a collective responsibility of the medical profession, rather than a shared responsibility of individual physicians. This interpretation rejects paternalism on the part of individual providers in favour of a more sensitive and collaborative practice of knowledge sharing between physicians and communities, and in the service of collective responsibility.

Сatalase antibodies in patients with systemic scleroderma as a diagnostic and prognostic marker of the disease

The study covered 30 apparently healthy individuals and 38 patients with systemic scleroderma. The patients gave their consent to participate in the study in accordance with the World Medical Association Declaration of Helsinki in the current (2013) version (ACR/EULAR). The donors and patients had their blood tested for catalase antibodies with immunoenzyme assay and using magnetic sorbents upon hospital admission and before discharge. It was found that the patients with systemic scleroderma had a reduced oxidase activity of catalase as well as elevated catalase antibodies, compared with the controls. We revealed a statistically significant regularity that the concentration of catalase immunoglobulins is associated with activity and course of the disease. To assess the activity of systemic scleroderma we performed a complex evaluation of two parameters: enzymatic activity and catalase antibody levels. It was established that catalase autoantibodies are mostly revealed in patients with high-activity scleroderma, subacute and acute course of the disease, and when the lungs, skin, kidneys, joints and nervous system were involved, which was conclusively confirmed by a correlation analysis. It is especially important that catalase antibodies should be revealed at early stage of the disease development; they are of especial diagnostic importance, and their changes over time may form the basis for assessing efficiency of administered therapy. The changes in biochemical activity of catalase, elevated antibody titers provide additional criteria of diagnosis in systemic scleroderma. Monitoring of these parameters in hospital settings helps to evaluate the effectiveness of administered therapy and adjust its correction, which is confirmed by inclusion of such extracorporal techniques as plasma separation into the combined treatment schedules. Studying biochemical activity of catalase and formation of catalase antibodies expands our understanding of scleroderma development and opens new avenues for research.

DIAGNOSTIC VALUE OF CERULOPLASMIN IN SYSTEMIC SCLERODERMA

Objective of study: refining immune diagnostics of systemic scleroderma through determining ceruloplasmin antibodies, its amount and enzymatic activity, as well as control of effectiveness of therapy with ceruloplasmin-based immobilized magnetocontrollable immunosorbents.Materials and methods. 30 apparently healthy individuals and 68 patients with systemic scleroderma were examined. The study included patients with referral diagnosis of systemic scleroderma who signed an informed consent. The study was performed in accordance with the principles of World Medical Association Declaration of Helsinki rev. 2013 (ACR/EULAR). All participants had their blood tested with the method of immunoenzymatic determination of antibodies to ceruloplasmin upon admission to hospital and prior to discharge.Results. It was established that patients with systemic scleroderma show reduced oxidase activity of ceruloplasmin, increased ceruloplasmin levels, as well as elevated antibodies to ceruloplasmin compared with the control group. A link between the amount of antibodies to the studied enzyme, and the activity, nature, course and stage of the disease was established. It was found that there is a reliable negative correlation between the level of ceruloplasmin antibodies, and the amount of RBCs, the hemoglobin level. For the first time a complex assessment of three parameters was employed, the parameters being the enzymatic activity, ceruloplasmin amount, and antibodies to ceruloplasmin. It was established that autoantibodies to ceruloplasmin are more often found in systemic scleroderma patients who show a high disease activity, subacute course with involvement of the liver, lungs, and with anemia. It was found that antibodies to ceruloplasmin are detected at early stages of systemic scleroderma development and can be used in timely diagnosis of the condition. It was shown that the change of parameters under study over time can serve as a basis on which to evaluate the effectiveness of administered therapy.Conclusion. Decreased enzymatic activity of ceruloplasmin, its elevated amount and increased antibodies to ceruloplasmin can be taken as additional diagnostic tools in evaluation of systemic scleroderma activity. These parameters promote a more accurate assessment of the disease activity and of the nature of the pathologic process; they can serve as an indication of a variety of clinical forms of the disease. Employing these parameters for monitoring of administered therapy in hospital settings permits a more accurate assessment of its effectiveness and making adjustments. Studying ceruloplasmin antibody formation, amount of ceruloplasmin and its biochemical activity extends the existing concept of rheumatic disease pathogeny, outlines a way forward for further research and reflects the involvement of antioxidant system in immune disorders.

World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human subjects. Reviewing the Latest Version

The World Medical Association (WMA) has developed the Declaration of Helsinki as a statement of ethical principles for medical research involving human subjects, including research on identifiable human material and data. It has undergone numerous revisions and amendments, the most recent being in Fortaleza–Brazil (2013). This new version includes various improvements and modifications which substantially easier to read, with a greater number of subsections. It is emphasized that the research ethics committee is recognized as a fundamental part of the research, the importance of disseminating research and compulsory informed consent. The Declaration of Helsinki is constantly evolving, and is arguably a document that provides the basis for the undertaking of any research. His knowledge and reading, is mandatory for all health professionals.