Ethical and evidential considerations on the use of novel therapies in veterinary practice

Novel therapies may be necessary both in the interests of the individual animal and in the advancement of veterinary science. However, special consideration is necessary to safeguard the welfare of the animals, ensure fully informed consent from the owner, determine the procedure's value in other cases and appropriately disseminate results. This article reviews ethical and evidential considerations raised when novel therapies are undertaken in veterinary practice, based on a series of committee meetings and intervening discussions held between members of the British Small Animal Veterinary Association Scientific Committee and Officers (2010-2011). The aim of this article is to encourage the advancement of novel veterinary therapies while safeguarding the welfare of animals.

Respiratory syncytial virus infection in children hospitalised with acute lower respiratory tract infection

BACKGROUND

Data are lacking on respiratory syncytial virus. (RSV) respiratory tract infections in children from developing countries.

OBJECTIVE

To determine the importance of RSV as a cause of acute lower respiratory tract infection (ALRTI) in Cape Town children.

METHODS

Children younger than 2 years of age admitted to hospital with ALRTI over a 15-month period from 1 June 1995 to 31 August 1996 were studied prospectively. Sociodemographic data, risk factors for severe RSV disease, clinical signs, diagnosis and hospital course were documented. A nasopharyngeal aspirate (NPA) for detection of RSV by enzyme immunoassay (EIA) was obtained in all cases. The NPA of every fifth child was sent for viral culture.

RESULTS

A total of 1,288 patients (60% male, 40% female) with a median age (25th-75th percentile) of 6 months (2-11 months) was enrolled; 32.4 had one or more risk factors for severe RSV infection. Pneumonia was diagnosed in 62.2%, bronchiolitis in 20.6%, laryngotracheobronchitis (LTB) in 8% and other respiratory illnesses in 9.2%. Mild disease, requiring admission to an overnight ward, was documented in 38.1%, while 48.9% and 13% respectively had moderate and severe disease requiring admission to a general ward and intensive care unit (ICU). Supplemental oxygen and mechanical ventilation were required by 68.9% and 8.5% of patients, respectively. The median duration of hospital stay was 5 days (range 1-10 days). RSV EIA was positive in 16.4% of cases, and there was no difference in detection rates according to diagnosis. Viral culture performed in 162 of the 1,288 study patients (12.6%) grew RSV in 11.7% of cases, adenovirus in 3.7%, para-influenza virus type 3 in 2.5% and influenza B virus in 0.6%. Patients who tested RSV EIA-positive did not significantly differ from those who tested negative with regard to demographic variables, clinical diagnoses, risk factors for RSV or length of hospitalisation. The only significant difference noted was the presence of hyperinflation, which occurred in 70.1% of EIA-positive patients compared with 57.1% of those testing negative (P = 0.0005). The mortality rate (2%) was similar for both groups.

CONCLUSION

This study indicates that RSV is an important cause of hospitalisation in infants and young children with ALRTI. Distinguishing RSV from other ALRTIs is difficult because of similarity in clinical presentation among children.

Training inspiratory resistance in Duchenne dystrophy using adapted computer games

Computer games were modified to encourage respiratory effort by two groups of patients with Duchenne muscular dystrophy. One group trained during the first six months of the study, the other during the second six months. Inspiratory effort was increased by their having to breathe through a mask to both start and continue the games. Pulmonary function tests were done at the beginning of the trial and six, 12 and 18 months later, when forced vital capacity, respiratory muscle endurance and strength were measured. Although there were some individual improvements, over-all the results were not statistically significant.

Respiratory muscle training in Duchenne muscular dystrophy

Eighteen boys with Duchenne muscular dystrophy were entered into trials to assess the effects of specific ventilatory strength and endurance training programmes. The findings showed an improvement in ventilatory muscle endurance but not in strength as a result of specific respiratory muscle training. The clinical significance of these findings is uncertain, however, and needs further evaluation.

A simplified procedure for the analysis of cholesterol, phospholipids and bile salts in human bile

Cholesterol, total bile salts and phospholipids have been measured on alcoholic extracts from human bile-rich duodenal contents. Folch extraction before phospholipid assay was found to be unnecessary and, unless fresh samples are used, it is liable to give misleadingly low values. Removal of bile pigment before measuring cholesterol was unnecessary because this estimation was done by gas-liquid chromatography. The methods described provide a simple, reproducible analysis of bile lipids.

Bran and bile: time-course of changes in normal young men given a standard dose

Twelve healthy young men added bran 15 g twice daily to their diet and underwent aspiration of bile-rich duodenal contents at 0, 1, 2, 4 and 6 weeks. In the 6-week sample, but not earlier, there was a significant decrease in deoxycholate and increase in chenodeoxycholate. Bile was unsaturated with cholesterol at the beginning and remained so throughout. The delay in the action of bran may be because it reduces the formation of deoxycholate in the colon and does not merely impede its absorption.

Fluctuations of serum and bile lipid concentrations during the menstrual cycle

We measured fasting serum and bile lipid concentrations at three intervals during the normal menstrual cycles of 11 healthy women not taking oral contraceptives. In nine of them cholesterol saturation of bile, and therefore presumably the risk of developing gall stones, was higher nine days after midcycle than at the end of menstruation. This change in bile cholesterol saturation was preceded by a significant fall in serum lipid concentrations: during the nine days after mid-cycle serum triglyceride and cholesterol concentrations fell in nine and eight of the 11 women respectively. Changes in the composition of serum and biliary lipids during the menstrual cycle are presumably due to a direct effect of sex hormones on the liver.