Journal of Veterinary Internal Medicine最新文献

Background: Flash glucose monitoring systems (FGMS; FreeStyle Libre) are useful devices for managing diabetic patients. The FGMS is reportedly accurate for diabetic dogs with hyperglycemia and euglycemia but might underestimate glucose concentrations during hypoglycemia.

Hypothesis/objectives: Assess the frequency of low and high interstitial glucose (IG) concentrations recorded in healthy, nondiabetic dogs using FGMS.

Animals: Twenty-three hospital employee-owned dogs.

Methods: Prospective, observational study. The FGMS was placed on all dogs to record ≥488 readings each over up to 14 days. Interstitial glucose concentrations were analyzed to identify the frequency of low, normal, and high IG concentrations. Descriptive statistics were calculated, and comparisons between demographic cohorts were performed.

Results: During monitoring, 73.7% (14/19) of participants had at least one low IG concentration (<70 mg/dL), whereas 26.3% (5/19) had at least one high IG concentration (>180 mg/dL). The mean (±SD) percentage of low and high IG concentrations per dog was 2.8 ± 4.3% and 0.8 ± 2.2%, respectively. Markedly decreased IG (<55 mg/dL) and markedly increased (>250 mg/dL) IG concentrations occurred in 63.2% (12/19) and 10.5% (2/19) of dogs, respectively. The frequency of low IG concentrations in dogs weighing 2.5-20.5 kg (2.2%; interquartile range [IQR], 1.1-5.0) was higher (P = .02) than in dogs weighing 20.6-41.4 kg (0.1%; IQR, 0.0-0.7%); the median difference was 2.1% (95% confidence interval, 0.6-10.1).

Conclusions and clinical importance: Low and high IG concentrations were recorded in healthy, nondiabetic dogs, providing a context for interpreting FGMS results in diabetic dogs.

Background: Platelet surface-associated immunoglobulin (PSAIG) occurs in thrombocytopenic dogs with vector-borne diseases and immune thrombocytopenia (ITP) and may be associated with thrombocytopenia severity and inflammatory markers, including neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios (NLR, PLR).

Hypothesis/objectives: Assess associations between PSAIG positivity, hematologic parameters, thrombocytopenia severity, and vector-borne status in thrombocytopenic dogs.

Animals: Sixty-nine client-owned thrombocytopenic dogs (<200 × 103/μL) were enrolled between June 2022 and June 2023.

Methods: Dogs were prospectively enrolled. Platelet surface-associated immunoglobulin was measured using flow cytometry. Vector-borne pathogens were assessed by serology (Ehrlichia spp., Anaplasma spp., Borrelia burgdorferi, Dirofilaria immitis) and PCR for Ehrlichia canis. Hematologic parameters were compared between PSAIG groups (Mann-Whitney U), and associations tested by univariable logistic regression.

Results: Dogs positive for PSAIG (n = 16) had lower median automated platelet counts (16.5 × 103/μL; interquartile range [IQR]: 8.25-40.75) than PSAIG-negative dogs (n = 53; 64 × 103/μL; IQR: 25.0-92.5; P = .001), with similarly lower manual platelet counts (48 × 103/μL; IQR: 20-86 vs 96 × 103/μL; IQR: 55-138; P = .01) and automated PLR (7.14; IQR: 3.30-15.28 vs 21.82; IQR: 9.42-38.99; P = .01). In logistic regression, PSAIG positivity was associated with lower platelet counts and automated PLR, E. canis PCR positivity, and Anaplasma seropositivity, with the strongest association for concurrent E. canis PCR and Anaplasma seropositivity (odds ratio [OR]; 15.3; 95% confidence interval [CI]: 2.69-86.99; P = .002).

Conclusions and clinical importance: Lower platelet counts and automated PLR were associated with PSAIG positivity in thrombocytopenic dogs. Associations between PSAIG, E. canis infection, and co-exposure to Anaplasma spp. support immune-mediated platelet destruction in infected dogs.

Background: Benchmarking small animal antimicrobial use is limited by lack of data on factors associated with prescribing of antimicrobial medications.

Hypothesis/objectives: To identify factors associated with prescription of antimicrobial drugs (PAD) in dogs receiving outpatient care.

Animals: Nine thousand six hundred eighty-five dogs with 19 597 outpatient visits.

Methods: Electronic medical record data from dogs receiving outpatient care at a veterinary teaching hospital in 2022 were retrospectively analyzed. Study outcomes were receipt of any systemic PAD at the visit, and receipt of "Watch" or "Reserve" (WR) PAD using World Health Organization (WHO) Access-Watch-Reserve (AWaRe) classification. Multivariable models including independent variables related to signalment, hospital service, and pet owner sociodemographic factors were built using generalized estimating equations yielding odds ratios (ORs) with 95% CIs.

Results: Approximately 10% of outpatient visit records (1871/19 597) were associated with ≥ 1 PAD. Factors significantly associated with prescription of antimicrobials included age, male sex, intact status, hospital service visited, visit duration, diagnostics performed, lower estimated owner income, visit date, and prescriber training level. Factors most strongly affecting odds of receiving any PAD were hospital service visited (OR 0.08 [0.05-0.13] to 1.55 [1.18-2.05] for visits to services other than emergency) and having urine culture performed (OR 4.32 [3.06-6.08]). Factors most strongly affecting odds of receiving WHO-WR PAD were higher total count of discrete PAD during visit (OR 10.1 [6.41-15.8]) and undergoing computed tomography or magnetic resonance imaging during the visit (OR 3.41 [1.50-7.76]).

Conclusions and clinical importance: This evaluation of companion animal prescribing practices supports facility-level monitoring and development of normalized antimicrobial use benchmarks and One Health antimicrobial stewardship efforts.

Background: The frequency, characteristics, and relationship with performance of arrhythmias occurring during high-intensity exercise in Thoroughbred racehorses remain poorly understood.

Hypothesis/objectives: Describe the frequency, characteristics, and association with subsequent race performance of arrhythmias occurring during intense exercise.

Animals: Seventy-one racehorses competing in races sanctioned by the Hong Kong Jockey Club.

Methods: Risk-based case-control study. Single-lead ECGs were recorded during high-intensity trials using wearable devices. Ectopic depolarizations identified during warm-up, maximal exercise, and fast and slow recovery were characterized by frequency and morphology. Horses with ECG recordings obtained before a race were included. Race performance was classified as poor (finishing in the last 3 positions) or good (finishing in the first 3 positions). Associations between ECG variables and race performance were assessed using odds ratios.

Results: A total of 405 ECGs were recorded within 21 days before 1 or more race starts (82 poor- and 142 good-performance starts). Arrhythmias were detected in 73% and 81% of ECGs preceding good and poor performances, respectively. Ectopic beats during maximal exercise occurred in 57% of ECGs before good and in 70% before poor performances. The odds of performing poorly increased with each additional ectopic beat (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.04-1.28; P = .01), and horses with any ectopic beat were nearly twice as likely to underperform (OR, 1.8; 95% CI, 0.86-3.81; P = .02).

Conclusions and clinical importance: Ectopic beats are common and adversely associated with athletic performance. Electrocardiographic monitoring during intense exertion might enable detection of clinically important arrhythmias.

Background: There is an association between inflammation and glycemic control (GC), β-cell function (BCF), and insulin resistance (IR) in humans.

Hypothesis/objectives: To assess the association between acute phase reaction (APR) (indicating inflammation) and markers reflecting GC, BCF, IR, and the presence of comorbidities in diabetic cats.

Animals: Serial serum samples from 69 diabetic cats, treated with long-acting insulin or long-acting insulin in combination with long-acting exenatide at a single study center from 2013 to 2018.

Methods: In this retrospective study, acute phase proteins (APPs), serum amyloid A (SAA), α-1-acid glycoprotein (AGP), and haptoglobin (Hp) were measured. Quality of GC (based on fructosamine), BCF test results, IR measures, and the presence of comorbidities from 4 study visits (enrolment, months 1, 3, and 6) were included. Mixed effects modeling, principal component analysis, and χ2-test were used to assess associations.

Results: Glycemic control, BCF, and IR improved over the study period. There was no association between the quality of GC and the concentration of any of the 3 APPs (SAA: P = .35; AGP: P = .59; Hp: P = .1), nor an association between APR and fructosamine concentration (P = .35), BCF or IR measures (all P > .05). β-cell function was strongly associated with GC (P < .001; odds ratio 0.27; 95% CI, 0.14-0.51), but IR or APR were not. Acute phase reaction was not associated with comorbidities (P = .13).

Conclusions and clinical importance: Our data suggest that inflammatory state does not predict poor GC assessed by serum fructosamine concentration in diabetic cats, but BCF is an important determinant of GC.

Background: Therapeutic strategies are needed to treat immune-mediated diseases in dogs. Human intravenous immunoglobulin (hIVIG), approved to treat inflammatory diseases in humans, has been used in dogs with some success in some immune-mediated hematologic and dermatologic disorders. However, cost, supply issues, and safety concerns have limited studies in dogs.

Hypothesis/objectives: Evaluate the feasibility of swine immunoglobulin G (SwIgG) in healthy dogs as a replacement for hIVIG.

Animals: Three healthy female beagles.

Methods: Swine IgG purified by column chromatography and injected SC into beagle dogs with or without intradermal injections at predetermined time points. The dogs were observed for up to 3 weeks with blood collected for clinical chemistry, hematology, and cytokine analysis. Clinical monitoring included heart rate, temperature, and respiratory rate.

Results: Injection of 1 dose (1 g/kg) of SwIgG resulted in vomiting after injection that resolved with treatment; no other clinical signs were observed over the 3-week period. One beagle that received a single dose of 0.2 g/kg SwIgG had a reaction and was removed from the second trial. The third beagle received 3 serial doses of 0.5 g/kg SwIgG with no adverse reaction throughout the 3-week period. Clinical chemistry in all dogs indicated slight increase in creatine kinase activity, C-reactive protein concentration, and aspartate aminotransferase activity which returned to normal by day 7 postinjection.

Conclusions and clinical importance: It is feasible to use SwIgG in dogs and additional studies to investigate its use as an adjunctive treatment for immune-mediated disorders are warranted.

Background: Risk of recurrent lower urinary tract infection and bacterial prostatitis (BP) after prostate artery embolization in dogs diagnosed with concurrent BP and prostatic carcinoma (PC) is unknown.

Hypothesis/objectives: To report short- and long-term outcomes of dogs with PC and BP undergoing prostatic artery embolization (PAE).

Animals: Six clients owned dogs with a concurrent diagnoses of BP and PC that subsequently underwent PAE and had a minimum follow-up of 4 months after PAE.

Methods: Medical records of 6 dogs diagnosed with PC and BP and treated with PAE were retrospectively reviewed. Physical exams, clinicopathologic and imaging results, procedural details, and short- and long-term outcome data were evaluated.

Results: Prostatic carcinoma was diagnosed via imaging findings (6/6), cadet-B-Raf protein (BRAF) testing (3/6), ultrasound-guided aspirates (2/6), and cystoscopic biopsy (1/6). BP was diagnosed based on clinical signs (6/6), imaging (6/6), urinalysis and positive urine culture (6/6), and concurrent positive prostatic wash cultures (2/6). All dogs received antibiotics based on urine culture and sensitivity testing (UCS) for a median of 7 weeks (range 2-13) before PAE. Two dogs had positive UCS at the time of PAE. One dog developed a prostatic abscess and 2/6 had positive UCS after PAE. Median survival was 13 months (4.5-17), and no dog died from infection.

Conclusions and clinical importance: Urinary tract infection, BP, or a combination of both occurred in a minority of dogs undergoing PAE in this cohort and were not life-limiting complications. In dogs, concurrent BP and PC should not prevent treatment with PAE.