Journal of Veterinary Internal Medicine最新文献

Background: Episodic ataxias (EAs) are a rare group of paroxysmal movement disorders (PMD) described in human medicine with only one suspected case described in veterinary literature.

Hypothesis/objectives: This study aimed to provide clinical description of a suspected primary EA in working Cocker Spaniel (WCS) dogs.

Animals: Seven WCS dogs with suspected primary EA.

Methods: Descriptive, retrospecitve, multicenter study. Clinical signs, video footage, investigations, treatment, and outcome were reviewed. Owners of affected dogs were invited to complete a questionnaire.

Results: The mean age at clinical onset was 4 months. Signs were acute and included episodic body swaying, titubation, cerebellar ataxia, wide-base stance, and hypermetria, all while mentation remained unaltered. Neither autonomic nor vestibular signs nor hyperkinetic movements were observed. Duration of episodes ranged from 30 minutes up to 24 hours, and their frequency varied from weekly to once every 5 months. When investigations were performed, results revealed no abnormalities except for 1 dog that had increased gluten antibody titers. None of the dogs deteriorated, and in dogs with available follow-up (5/7) the frequency of episodes decreased or completely resolved, from which the majority (4/5) received gluten-free diet.

Conclusion and clinical importance: A novel PMD was identified in young WCS, manifesting as EA. The condition is suspected to have a primary (genetic) etiology, although the cause of this manifestation has not yet been identified. Episodic ataxia in our WCS had a good prognosis. Veterinarians must be aware of this presentation, and further investigations are needed to determine the origin of the clinical signs.

Background: Hyperthyroid cats that are azotemic and hypothyroid after surgical or medical treatment have poor outcomes, and supplementation with levothyroxine (LT4) improves survival. However, the effect of LT4 supplementation on survival of nonazotemic, hypothyroid radioiodine (RI)-treated hyperthyroid cats is unknown.

Hypothesis: Radioiodine treated hyperthyroid cats with iatrogenic hypothyroidism or azotemia have shorter survival times than euthyroid, nonazotemic cats and supplementation of LT4 improves survival times of hypothyroid cats.

Animals: One hundred seventeen RI treated hyperthyroid cats.

Methods: Prospective cohort study. Radioiodine treated cats were screened for azotemia and iatrogenic hypothyroidism using TSH stimulation test; LT4 supplementation was offered to all hypothyroid cats with decision to treat based on owner preference. The log rank test was used to compare survival times between groups, and the Mann-Whitney U test was used to compare age and renal variables. Data are presented as median [range].

Results: Euthyroid azotemic cats (934 [759-2035] days) and nonsupplemented hypothyroid cats (azotemic and nonazotemic combined, 1232 [238-2363] days) had shorter survival times than euthyroid nonazotemic cats (1616 [663-3369] days, P = .003 and P = .002, respectively). Levothyroxine supplemented hypothyroid nonazotemic cats had longer survival times than nonsupplemented hypothyroid nonazotemic cats (1037 [300-2401] days vs 768 [34-1014] days; P = .027). Levothyroxine supplementation was not associated with prolonged survival times in hypothyroid azotemic cats vs nonsupplemented hypothyroid azotemic cats (771 [718-1558] days vs 152 [82-1852] days, respectively, P = .991).

Conclusions and clinical importance: Levothyroxine supplementation in nonazotemic cats with iatrogenic hypothyroidism (diagnosed based on TSH stimulation test results) improved survival times, although randomized controlled trials are needed.

Background: Evaluating the size of the pulmonary artery (PA) is key for the echocardiographic assessment of pulmonary hypertension (PH) in dogs.

Hypothesis/objectives: To compare the diagnostic accuracy of the main PA (MPA) and right PA (RPA) sizes for the echocardiographic detection of PH in dogs, and to evaluate differences between precapillary and postcapillary PH dogs.

Animals: Four hundred four dogs; 136 controls and 268 with PH.

Methods: Prospective, multicenter, observational study. The MPA, maximum and minimum RPA diameter were normalized to body weight (MPA_N, RPAmax_N, and RPAmin_N). The MPA was also indexed to the ascending aorta (MPA/AO), while the RPA size was indexed to the aortic annulus (RPAmax/Aod and RPAmin/Aod). The right pulmonary artery distensibility index (RPADi) was also calculated. The diagnostic accuracy of PA parameters for PH was assessed through the receiver operating characteristic curve analysis and area under the curve (AUC). Measurement variability was assessed trough the coefficient of variation (CV).

Results: The RPADi, RPAmin_N, and RPAmin/Aod showed similar diagnostic accuracy for the detection of PH (AUC = 0.975, AUC = 0.971, and AUC = 0.953, respectively), higher than MPA/AO (AUC = 0.926), MPA_N (AUC = 0.880), RPAmax_N (AUC = 0.814), and RPAmax/Aod (AUC = 0.803; P < .05). Aside from RPAmax variables, no differences were found between precapillary and postcapillary PH. RPA size parameters showed lower CVs in comparison to MPA/AO and RPADi.

Conclusions and clinical importance: Although MPA/AO showed an excellent sensitivity and specificity for the detection of PH, the RPAmin exhibited a higher diagnostic accuracy and less measurement variability, thus could represent a new useful parameter for the detection of PH in dogs.

Background: Oxidative injury occurs in septic people, but the role of oxidative stress and antioxidants has rarely been evaluated in foals.

Objectives/hypothesis: To measure reactive oxygen species (ROS), biomarkers of oxidative injury, and antioxidants in neonatal foals. We hypothesized that ill foals would have higher blood concentrations of ROS and biomarkers of oxidative injury and lower concentrations of antioxidants compared to healthy foals.

Animals: Seventy-two hospitalized and 21 healthy neonatal foals.

Methods: Prospective cohort study. Reactive oxygen species (hydrogen peroxide [H₂O₂]), biomarkers of oxidative injury (malondialdehyde [MDA], protein carbonyl), and antioxidants (superoxide dismutase [SOD], catalase [CAT], glutathione, and glutathione reductase [GR] and peroxidase [GPx]) were measured from foals at admission. Measured variables were compared between healthy and ill foals using a 1-way ANOVA by Tukey's multiple comparisons test.

Results: Ill foals (n = 51) had significantly higher mean concentrations of H₂O₂ (healthy 2.6 ± 1.4 nmol/mL, ill 6.8 ± 4.6 L nmol/mL; 95% CI), MDA (healthy 31.2 ± 14.4 nmol/mL, ill 114.3 ± 94.0 nmol/mL; 95% CI), and protein carbonyl (healthy 0.07 ± 0.01 nmol/mg protein, ill 0.12 ± 0.02 nmol/mg protein, 95% CI). Significant lower CAT (healthy 0.4 ± 0.3 mU/mg protein, ill 0.02 ± 0.02 mU/mg protein, 95% CI), glutathione (healthy 238.5 ± 101.9 μg/mL, ill 110.7 ± 37.8 μg/mL, 95% CI; P < .0001), GR (healthy 1.6 ± 1.8 mU/mg protein, ill 0.4 ± 0.5 mU/mg protein, 95% CI), and GPx (healthy 0.01 ± 0.003 mU/mg protein, ill 0.007 ± 0.002 mU/mg protein, 95% CI) were also noted.

Conclusions and clinical importance: Oxidative stress and lower antioxidant concentrations occur in ill and bacteremic neonatal foals. These variables should be considered during the treatment of ill foals.

Background: Left ventricular (LV) volumes can be calculated from various linear, monoplane, and multiplane echocardiographic methods, and the same method can be applied to different imaging views. However, these methods and their variations have not been comprehensively evaluated against real-time 3-dimensional echocardiography (RT3D).

Hypothesis/objectives: To identify the LV volumetric approaches that produce the least bias and the best agreement with RT3D, and to assess interoperator reproducibility between an experienced and an inexperienced operator.

Animals: Fifty-nine client-owned dogs with myxomatous mitral valve disease (38 Stage B1, 13 Stage B2, 8 Stages C/D) received echocardiograms, with a subset of 28 dogs (14 Stage B1, 10 Stage B2, 4 Stages C/D) imaged by 2 operators.

Methods: Prospective method comparison study. Body weight-indexed end-diastolic and end-systolic LV volumes using linear methods in long- and short-axis views (Teichholz, cube, modified cube), monoplane methods in right parasternal and left apical views (area-length and Simpson's method of discs), biplane Simpson's method of discs, and real-time triplane (RT3P) were compared against RT3D.

Results: The RT3P method exhibited no bias and demonstrated the highest agreement with RT3D. The linear methods showed significant bias and lower agreements for end-diastolic volumes, end-systolic volumes, or both. Volumes derived from different imaging views using the same method showed poor agreement. Both RT3P and RT3D methods demonstrated poor interoperator reproducibility.

Conclusions and clinical importance: Incorporating additional dimensions improves bias and agreement in LV volume quantification, but comprehensive clinical experience with RT3P and RT3D is needed to improve consistency across all operators.

Background: Understanding of equine herpesvirus-1 (EHV-1) myeloencephalopathy (EHM) is complicated by disparities among studies.

Objective: Compare clinical findings and outcome in horses involved in 2 recent EHM outbreaks.

Animals: Twenty-five and 10 horses affected during 2 natural EHM outbreaks were admitted to a veterinary teaching hospital (VTH) in 2021 and 2023, respectively.

Methods: Data collected from the VTH and surveys completed by riders and horse owners were analyzed retrospectively.

Results: No risk factors associated with EHM development showed significant differences between the outbreaks; both outbreaks were caused by A2254/N752 strains. Treatments administered for EHM were not significantly different, whereas the duration was longer in 2021 for flunixin meglumine (P = .01) and dimethyl sulfoxide (P < .001). In 2021, more horses required hospitalization (P = .02), and fatality rate was 32%, whereas in 2023, no patient died. Hospitalization duration was longer in 2021 than in 2023 (P = .06) and 11.7% of horses from 2021 returned to competition within 6 months, whereas 100% in 2023 did (P < .001). Ataxia grade upon admission was equivalent in 2021 and 2023, but factors related to poor prognosis, such as simultaneous development of urinary and vascular complications, occurred in 2021 but not in 2023 (P = .01).

Conclusions and clinical importance: Two EHM outbreaks caused by the A2254/N752 strain differed in disease severity. Urinary complications and systemic signs of vasculitis were important clinical variables associated with prognosis. Systemic complications in horses with EHM lead to a worse prognosis.

Background: Clinical characteristics of cervical hydrated nucleus pulposus extrusion (HNPE) in dogs compared to other causes of cervical myelopathy are not well described.

Hypothesis/objectives: To evaluate for clinical characteristics and mechanical ventilation likelihood associated with HNPE compared to other causes of cervical myelopathy.

Animals: Three hundred seventy-seven client-owned dogs from 2010 to 2022. Cases included 46 HNPE, 192 IVDE (intervertebral disc extrusion), 30 FCEM (fibrocartilaginous embolic myelopathy), 66 CSM (cervical spondylomyelopathy), and 43 neoplasia.

Methods: Retrospective study with record review and bivariate analyses. Dogs with signs of cervical myelopathy and an MRI diagnosis of HNPE, IVDE, FCEM, CSM, or neoplasia were included.

Results: When compared to dogs with other cervical myelopathies, dogs with HNPE were more likely to be older and of lower weight (median age 10 vs 8 years, P < .001; median weight 9.1 vs 20.2 kg, P < .001), be nonambulatory (89% vs 54%, P < .001), have signs of central cord syndrome (35% vs 16%, P = .002), and have nonlateralizing signs of myelopathy (65% vs 48%, P = .029). When compared to dogs with IVDE, dogs with HNPE were more likely to present with lower pain scores (30% vs 15% nonpainful, P = .002), and require mechanical ventilation (4/46 HNPE, 2/192 IVDE; odds ratio [OR] 9.0, 95% confidence interval [CI] 1.6-51.0).

Conclusions and clinical importance: Compared to dogs with other cervical myelopathies, dogs with HNPE have differences in clinical characteristics, presentation and likelihood of requiring mechanical ventilation. These differences are important to consider for case management.

Background: Nephrocalcinosis is a common pathological finding in cats with chronic kidney disease and nephrolithiasis. Understanding its pathogenesis may identify future therapeutic targets.

Hypothesis: Nephrocalcinosis is associated with expression of an osteogenic phenotype.

Animals: Kidneys with medullary mineralization were obtained from 18 cats (10 with and 8 without nephroliths) undergoing necropsy.

Methods: Cross-sectional study. Microradiography and histopathology (modified von Kossa stain) were used to confirm parenchymal mineralization. Immunohistochemistry for 5 osteogenic markers was performed to determine their co-localization with nephrocalcinosis. The proportion of kidneys with stronger immunointensity in mineralized versus non-mineralized regions was analyzed using 1-tailed sign tests. The proportion of kidneys with co-localization of nephrocalcinosis and each marker was compared between kidneys with and without nephroliths using Fisher's exact tests.

Results: Nephrocalcinosis co-localized with osteopontin immunoreactivity in all 18 cats (100%) and with osteocalcin in 12 cats (67%). Both osteogenic markers had stronger immunointensity in mineralized regions compared with non-mineralized regions. Limited co-localization was observed with other markers: bone morphogenic protein-2 in 2 kidneys (both with nephroliths) and tissue non-specific alkaline phosphatase in 1 kidney (without nephroliths); runt-related transcription factor-2 was undetected. No statistically significant differences were found in the co-localization of nephrocalcinosis with osteogenic proteins between kidneys with and without nephroliths.

Conclusions and clinical importance: Expression of osteogenic proteins in areas of nephrocalcinosis indicates that nephrocalcinosis is associated with the development of an osteogenic phenotype. Targeting these processes could offer a novel approach to prevent nephrolithiasis at its origin.

Background: Dogs with hepatocutaneous syndrome (HCS) have marked plasma hypoaminoacidemia, but its occurrence in dogs with chronic liver diseases not associated with HCS (non-HCS CLD) is unknown.

Objectives: To determine if plasma hypoaminoacidemia occurs in dogs with non-HCS CLD, compare plasma amino acid (PAA) profiles between dogs with non-HCS CLD and HCS, and define a sensitive and specific PAA pattern for diagnosing HCS.

Animals: Data were collected from client-owned dogs, a prospective cohort of 32 with CLD and 1 with HCS, and a retrospective cohort of 7 with HCS.

Methods: Prospective study. Dogs with chronic serum liver enzyme increases were recruited after hepatic biopsy. Plasma amino acid profiles were measured using high-performance liquid chromatography. Plasma amino acid concentrations were compared between dogs with non-HCS CLD and HCS. Regression analysis was performed to identify a unique PAA pattern for HCS diagnosis.

Results: Twelve dogs each with vacuolar hepatopathy or chronic hepatitis and 8 dogs with congenital disorders (primary hypoplasia of the portal vein or ductal plate malformations) were enrolled. Compared to non-HCS CLD dogs, HCS dogs had significantly lower plasma concentrations of several amino acids. Regression analysis revealed that glutamine, glycine, citrulline, arginine, and proline concentrations less than 30% of the mean reference value had 100% sensitivity, specificity for diagnosing HCS.

Conclusions and clinical importance: Generalized plasma hypoaminoacidemia does not accompany non-HCS CLD. Concentrations of 5 specific amino acids less than 30% of the mean reference value can serve as a noninvasive biomarker for diagnosing HCS.

Background: Videocapsule endoscopy (VCE) is a valuable tool for investigating gastrointestinal (GI) diseases in dogs. Its use is not recommended in dogs ≤4.3 kg, because of risks of GI endoscopic capsule (EC) retention and bowel obstruction.

Objectives: Describe the feasibility and complications of VCE in dogs ≤7 kg.

Animals: Twenty-six client-owned dogs.

Methods: Retrospective study describing the signalment, previous GI imaging, indications, findings, and complications of canine VCE studies submitted to Infiniti Medical between March 2020 and January 2023.

Results: The median weight and age of dogs was 5.6 kg (range, 3-7) and 8.8 years (range, 1-16), respectively. Two capsules were administered endoscopically into the duodenum (1) and stomach (1). Sixteen out of 26 (62%, 95% CI, 40.51-79.70) dogs that underwent VCE had incomplete studies. Of the 24 capsules administered per os, 15 led to incomplete studies (battery died in the stomach (14), EC was vomited (1)). Body weight <5 kg significantly increased the risk of an incomplete study (OR: 3.67, 95% CI, 1.56-inf, P = .0074). Median esophageal, gastric, and small bowel transit time were 5 seconds (range, 1-180), 240 minutes (range, 17-335), and 73.5 minutes (range, 5-168), respectively. All 10 dogs with overt GI bleeding had a possible origin identified with VCE. Complications were limited to vomiting (1/26, 3.85%, 95% CI, 0-11.20).

Conclusions and clinical importance: Videocapsule endoscopy is a safe and informative procedure even when performed in dogs as small as 3 kg. However, weighing <5 kg increases the risk of incomplete studies.