Journal of Veterinary Internal Medicine最新文献

Background: Sepsis is a main contributor to calf mortality, but diagnosis is difficult.

Objectives: Develop and validate a predictive model for bacteremia in critically ill calves (CIC).

Animals: A total of 334 CIC, sampled for blood culture.

Methods: Cross-sectional study. Multivariable logistic regression and classification tree analysis on clinical, ultrasonographic, and laboratory variables were performed on a dataset including all animals. Model validation was done on 30% of the dataset. Similar statistics (except validation) were performed on a subset of the database (n = 143), in which presumed contaminants were excluded.

Results: The best performing model to predict bacteremia, taking all detected bacteria into account, included tachypnea, tachycardia, acidemia, hypoglycemia, venous hypoxemia, and hypoproteinemia. Sensitivity and specificity of this model were 70.6% and 98.0%, respectively, but decreased to 61.5% and 91.7% during model validation. The best-performing model, excluding presumed contaminants, included abnormal temperature, heart rate, absence of enteritis, hypocalcemia, and hyperlactatemia as risk factors for bacteremia. Sensitivity and specificity of this model were 71.4% and 93.9%, respectively. Both classification trees performed less well in comparison to logistic regression. The classification tree excluding presumed contaminants, featured hypoglycemia, absence of diarrhea, and hyperlactatemia as risk factors for bacteremia. Sensitivity and specificity were 39.4% and 92.7%, respectively.

Conclusions and clinical importance: Hypoglycemia, hyperlactatemia, and hypoproteinemia seem relevant in assessing bacteremia in CIC. The performance of these models based on basic clinical and blood variables remains insufficient to predict bacteremia.

Background: The presence and intensity of heart murmurs are sensitive indicators of several cardiac diseases in dogs, particularly myxomatous mitral valve disease (MMVD), but accurate interpretation requires substantial clinical expertise.

Objectives: Assess if a machine-learning algorithm can be trained to accurately detect and grade heart murmurs in dogs and detect cardiac disease in electronic stethoscope recordings.

Animals: Dogs (n = 756) with and without cardiac disease attending referral centers in the United Kingdom.

Methods: All dogs received full physical and echocardiographic examinations by a cardiologist to grade any murmurs and identify cardiac disease. A recurrent neural network algorithm, originally trained for heart murmur detection in humans, was fine-tuned on a subset of the dog data to predict the cardiologist's murmur grade from the audio recordings.

Results: The algorithm detected murmurs of any grade with a sensitivity of 87.9% (95% confidence interval [CI], 83.8%-92.1%) and a specificity of 81.7% (95% CI, 72.8%-89.0%). The predicted grade exactly matched the cardiologist's grade in 57.0% of recordings (95% CI, 52.8%-61.0%). The algorithm's prediction of loud or thrilling murmurs effectively differentiated between stage B1 and B2 preclinical MMVD (area under the curve [AUC], 0.861; 95% CI, 0.791-0.922), with a sensitivity of 81.4% (95% CI, 68.3%-93.3%) and a specificity of 73.9% (95% CI, 61.5%-84.9%).

Conclusion and clinical importance: A machine-learning algorithm trained on humans can be successfully adapted to grade heart murmurs in dogs caused by common cardiac diseases, and assist in differentiating preclinical MMVD. The model is a promising tool to enable accurate, low-cost screening in primary care.

Background: Peripheral nodal B-cell lymphomas (PNBCL) represent the most common presentation of lymphomas in dogs. Multiagent CHOP (C = cyclophosphamide, H = hydroxydaunorubicin [Doxorubicin], O = Oncovin, P = prednisolone)-based chemotherapy protocols have been widely accepted as gold standard 1st-line treatment. CHOP-25 and CHOP-19 are most commonly prescribed but have never been directly compared.

Objectives: Our primary aim was to compare outcomes of dogs diagnosed with PNBCL, treated using a 1st-line CHOP-19 or CHOP-25 protocol. A secondary objective was to determine the impact of protocol-related variables on outcomes.

Animals: Five hundred two dogs from 16 European oncology referral centers. One hundred fifty-five dogs were treated with CHOP-19 and 347 dogs with CHOP-25.

Methods: Retrospective, multicentric cohort study of dogs diagnosed with PNBCL between 2014 and 2021.

Results: The 6-month, 1-year, and median progression-free survival (PFS) were 56.5% (95% confidence interval [CI], 49.2-65.0), 14.1% (95% CI, 9.4-21.0), and 196 days (95% CI, 176-233) with CHOP-19; and 56.4% (95% CI, 51.4-61.9), 17% (95% CI, 13.4-21.6), and 209 days (95% CI, 187-224) with CHOP-25. The 1-year, 2-year and median overall survival (OS) were 36.9% (95% CI, 29.7-46.0), 13.5% (95% CI, 8.6-21.1), and 302 days (95% CI, 249-338) with CHOP-19; and 42.8% (95% CI, 37.7-48.7), 15.4% (95% CI, 11.7-20.4), and 321 days (95% CI, 293-357) with CHOP-25. No significant difference in PFS and OS was found between the 2 protocols.

Conclusions and clinical importance: Our study confirmed similar outcomes for dogs with PNBCL treated with 1st-line CHOP-19 or CHOP-25. Both protocols therefore could be used as a standard of care in future trials.

Background: The relationship between collapse and a diagnosis of hypoadrenocorticism is not well understood in dogs.

Hypothesis: To assess the prevalence of episodes of collapse in dogs screened for hypoadrenocorticism, and to assess the prevalence of confirmed hypoadrenocorticism in dogs presenting with reported collapse.

Animals: Seventy-three client-owned dogs with resting cortisol concentrations were measured and presented to a University teaching hospital for collapse.

Methods: Retrospective review of medical records of dogs at a single center.

Results: The prevalence of episodes of collapse in dogs that had a resting cortisol measurement was 73/856 (8.5%; 95% confidence interval [95% CI], 6.7%-10.6%). Resting cortisol concentration was <2 μg/dL (<55 nmol/L) in 19 dogs. Cortisol concentration after ACTH stimulation was <2 μg/dL (<55 nmol/L) in 1 of the 73 dogs in this cohort, consistent with a diagnosis of hypoadrenocorticism, giving a prevalence estimate of hypoadrenocorticism of 1.3% (95% CI, 0.15%-6.2%). In 8 dogs with an initial resting cortisol concentration <2 μg/dL (<55 nmol/L), hypoadrenocorticism was excluded based on a repeat resting cortisol concentration >2 μg/dL (>55 nmol/L). The most common diagnosis was vasovagal syncope (10/73), followed by sick sinus syndrome and third-degree atrioventricular block (2/73). The final diagnosis was unknown in 24/73 dogs.

Conclusions and clinical importance: Hypoadrenocorticism was the final diagnosis in 1 of 73 dogs presented to a teaching hospital either in a collapsed state or with a previous history of episodes of collapse. No dog presenting as cardiovascularly stable for intermittent collapse was found to have hypoadrenocorticism.

Background: Comparative pharmacokinetics and pharmacodynamics (PK/PD) of apixaban and rivaroxaban have not been studied in dogs and the propensity of these drugs to cause hypercoagulability after discontinuation is unknown.

Hypothesis: Compare the PK/PD of clinical dosing regimens of PO apixaban and rivaroxaban administered repeatedly to healthy dogs and assess the effect of abrupt drug discontinuation on coagulation.

Animals: Six University-owned, purpose-bred, middle-aged, mixed-breed dogs (4 male, 2 female).

Methods: Dogs were given apixaban or rivaroxaban PO at 0.5 mg/kg q12h for 7 days with a 14-day washout period between drugs. Plasma drug concentrations were quantitated, and anticoagulant effects were measured using clotting times, calibrated anti-Xa bioactivity assays, and measurements of thrombin generation. The potential for rebound hypercoagulability was assessed by measuring D-dimers, thrombin-antithrombin (TAT) complexes, and antithrombin activity after drug discontinuation.

Results: Plasma drug concentrations and anti-Xa bioactivities were closely correlated for both drugs, but drug concentrations varied considerably among dogs, despite consistent dose regimens. Thrombin generation variables were significantly correlated with the anti-Xa bioactivity of both drugs and no significant differences in the effects of apixaban and rivaroxaban on thrombin generation were observed. Drug discontinuation had no effect on D-dimer concentrations. The concentration of TAT complexes decreased after apixaban discontinuation and did not change after rivaroxaban discontinuation.

Conclusions and clinical importance: Repeated PO administration of apixaban or rivaroxaban to healthy dogs produced comparable anticoagulant effects measured by inhibition of thrombin formation. Rebound hypercoagulability after drug discontinuation was not observed and weaning of these drugs in clinical patients might not be necessary.

Background: Respirable mineral particles can induce lower airway inflammation, but the role they play in asthma of horses is unknown.

Objectives: Respirable mineral particles, particularly respirable silica, are an overlooked determinant of chronic lung inflammation (asthma) in horses.

Animals: Twenty-three horses from an equine hospital population: 11 moderately affected (MEA), 7 severely asthmatic (SEA), and 5 control horses free from respiratory clinical signs.

Methods: Prospective observational study. The quantity and quality of mineral particles found in bronchoalveolar lavage fluid (BALF) were characterized, with particular attention to silica content. Polarized light microscopy performed on cytospin slides identified intracellular birefringent particles as silica. Spectrometry-based analysis performed on whole BALF determined total mineral and silica percentage and concentration. Group-related differences in BALF mineral and silica load were investigated as well as associations with BALF cytology.

Results: Intracellular birefringent particles were increased in SEA vs MEA (median [interquartile range, IQR]), 12 [7] vs 4 [5] particles/30 high power fields [hpf], respectively; P = .01) and vs controls (4 [2] particles/30 hpf; P = .02). Total mineral concentration in BALF was similar between the groups studied, whereas silica concentration and percentage were increased in SEA vs MEA (1758 [887] particles/mL and 20 [10]% vs 867 [662] particles/mL and 8 [6]%; P = .009 and P = .001) and control group (355 [330] particles/mL and 6 [3]%; P = .0003 and P = .002). Silica load in BALF was associated with BALF neutrophilia in MEA and SEA.

Conclusions and clinical importance: Respirable silica is associated with neutrophilic lower airway inflammation in horses and might contribute to asthma development.

Background: Information regarding response rate to tigilanol tiglate for mast cell tumors in dogs is limited.

Objectives: Report the response rate and durability of tigilanol tiglate intratumoral treatment in dogs with mast cell tumors presented to veterinary oncologists.

Animals: One hundred forty-nine dogs; 151 individual tumors.

Methods: Multicenter, retrospective survey-based study. Veterinary oncologists subscribed to the American College of Veterinary Internal Medicine (ACVIM) oncology listserv were solicited for information from dogs treated with tigilanol tiglate. An electronic survey was used to collect information at initial treatment, 1 month and 1 year after treatment.

Results: Most tumors were cutaneous, occurred on the limbs and were cytologically low grade. Seventy-five percent of dogs achieved a complete response after 1 dose of tigilanol tiglate 1 month after treatment. This response was durable at 1 year in 64% of dogs for which data were available (n = 88). Wound formation, an expectation after treatment, occurred after a median of 7 days (range, 1-91 days), with a median wound area of 4.71 cm² (range, 0.09-100 cm²). Wounds took a median of 30 days to heal completely (range, 14-154 days). A moderate association between tumor volume and wound size was confirmed.

Conclusions and clinical importance: Tigilanol tiglate is an effective local treatment option for mast cell tumors in dogs with a predictable clinical course and response. Because of the unique mode of action and clinical course, client education and careful case selection is necessary before electing tigilanol tiglate for local treatment.

Background: Gabapentin is often administered PO for preappointment or in-hospital anxiolysis in cats. A previous study reported mild changes on the neurologic examination after administration.

Objectives: Investigate the effects of gabapentin on anxiety, sedation, compliance, and neurologic examination in 2 age groups of cats.

Animals: Thirty-one young cats and 12 geriatric cats perceived by their owners to be healthy and neurologically normal.

Methods: Prospective double-blinded clinical crossover study. Assessment of baseline sedation and anxiety was performed before initial neurologic examinations and after gabapentin administration (100 mg/cat). Assessments were repeated 90 to 120 minutes after administration. Ease of handling pregabapentin and postgabapentin was assessed in the younger cats. All examinations were performed by a board-certified veterinary neurologist and scoring of examinations was performed by a different, masked board-certified neurologist.

Results: Sixteen cats (50%) in the younger cohort and 6 cats (50%) in the geriatric cohort exhibited an increase in their overall neurologic examination score postgabapentin administration, mainly through new or progressive postural reaction deficits and gait changes. Anxiety and sedation scores were significantly changed in the geriatric population (P < .01, P = .004, respectively); however, only sedation scores were significantly increased in the younger cats after gabapentin administration (P = .004).

Conclusions and clinical importance: All study participants showed mild neurologic changes after gabapentin administration, most markedly noted in the geriatric population. Dose reduction of gabapentin for preappointment anxiolysis and neurologic examination in geriatric patients should be considered.

Background: Feline blood transfusion is required for the treatment of various illnesses in cats, and the safety of donor cats is vital. Donor adverse reactions can include cardiorespiratory, venepuncture-related, and behavioral abnormalities.

Hypothesis/objectives: To describe a large number of feline blood donation events and document use of sedation and anxiolysis, record volume of blood collected and describe the frequency, type, and risk factors for, adverse reactions.

Animals: The study included 7812 individual cats and 29 201 donation events at a blood banking center over 5 years.

Methods: Retrospective analysis of donation event records with signalment, donation volume, sedation status, donation number, and adverse reactions (acute and caregiver reported) recorded. Risk factors for adverse reactions were examined by stratifying data according to groups exposed to relevant predictors and calculating odds ratios with 95% and 99% confidence intervals (CIs).

Results: Adverse reactions were uncommon (0.29%, 2.88/1000 donor events) and most commonly were cardiorespiratory (0.08%, 0.75/1000 donor events) or behavioral (0.06%, 0.62/1000 donor events). The only risk factor significantly associated with adverse reactions was conscious donation, with conscious donors 4.4 times more likely to have an adverse reaction (95% CI, 2.5-7.9, P ≤ .0001).

Conclusions and clinical importance: Feline blood donation is associated with a low rate of adverse reactions. Sedation should be considered to reduce adverse reactions, and the environment and interactions optimized to reduce donor stress. Caregiver education on care postdonation could reduce behavioral adverse reactions.