Effect of a pharmacologically induced decrease in core temperature in rats resuscitated from cardiac arrest.

AIM: Hypothermia is recommended by international guidelines for treatment of unconscious survivors of cardiac arrest to improve neurologic outcomes. However, temperature management is often underutilized because it may be difficult to implement. The present study evaluated the efficacy of pharmacologically induced hypothermia on survival and neurological outcome in rats resuscitated from cardiac arrest. METHODS: Cardiac arrest was induced for 10 min in 120 rats. Sixty-one rats were resuscitated and randomized to normothermia, physical cooling or pharmacological hypothermia 5 min after resuscitation. Pharmacological hypothermia rats received a combination of ethanol, vasopressin and lidocaine (HBN-1). Physical hypothermia rats were cooled with intravenous iced saline and cooling pads. Rats in the pharmacological hypothermia group received HBN-1 at ambient temperature (20 °C). Normothermic rats were maintained at 37.3 ± 0.2 °C. RESULTS: HBN-1 (p < 0.0001) shortened the time (85 ± 71 min) to target temperature (33.5 °C) versus physical hypothermia (247 ± 142 min). The duration of hypothermia was 17.0 ± 6.8h in the HBN-1 group and 17.3 ± 7.5h in the physical hypothermia group (p = 0.918). Survival (p = 0.034), neurological deficit scores (p < 0.0001) and Morris Water Maze performance after resuscitation (p = 0.041) was improved in the HBN-1 versus the normothermic group. HBN-1 improved survival and early neurological outcome compared to the physical hypothermia group while there was no significant difference in performance in the Morris water maze. CONCLUSION: HBN-1 induced rapid and prolonged hypothermia improved survival with good neurological outcomes after cardiac arrest suggesting that pharmacologically induced regulated hypothermia may provide a practical alternative to physical cooling.

Variation in the use of 12-lead electrocardiography for patients with chest pain by emergency medical services in North Carolina.

BACKGROUND: Prehospital 12-lead electrocardiography (ECG) is critical to timely STEMI care although its use remains inconsistent. Previous studies to identify reasons for failure to obtain a prehospital ECG have generally only focused on individual emergency medical service (EMS) systems in urban areas. Our study objective was to identify patient, geographic, and EMS agency-related factors associated with failure to perform a prehospital ECG across a statewide geography. METHODS AND RESULTS: We analyzed data from the Prehospital Medical Information System (PreMIS) in North Carolina from January 2008 to November 2010 for patients >30 years of age who used EMS and had a prehospital chief complaint of chest pain. Among 3.1 million EMS encounters, 134 350 patients met study criteria. From 2008-2010, 82 311 (61%) persons with chest pain received a prehospital ECG; utilization increased from 55% in 2008 to 65% in 2010 (trend P<0.001). Utilization by health referral region ranged from 22.9% to 74.2% and was lowest in rural areas. Men were more likely than women to have an ECG performed (63.0% vs 61.3%, adjusted RR 1.02, 95% CI 1.01 to 1.04). The certification-level of the EMS provider (paramedic vsbasic/intermediate) and system-level ECG equipment availability were the strongest predictors of ECG utilization. Persons in an ambulance with a certified paramedic were significantly more likely to receive a prehospital ECG than nonparamedics (RR 2.15, 95% CI 1.55, 2.99). CONCLUSIONS: Across a large geographic area prehospital ECG use increased significantly, although important quality improvement opportunities remain. Increasing ECG availability and improving EMS certification and training levels are needed to improve overall care and reduce rural-urban treatment differences.

Detection of herbicides in the urine of pet dogs following home lawn chemical application.

Exposure to herbicide-treated lawns has been associated with significantly higher bladder cancer risk in dogs. This work was performed to further characterize lawn chemical exposures in dogs, and to determine environmental factors associated with chemical residence time on grass. In addition to concern for canine health, a strong justification for the work was that dogs may serve as sentinels for potentially harmful environmental exposures in humans. Experimentally, herbicides [2,4-dichlorophenoxyacetic acid (2,4-D), 4-chloro-2-methylphenoxypropionic acid (MCPP), dicamba] were applied to grass plots under different conditions (e.g., green, dry brown, wet, and recently mowed grass). Chemicals in dislodgeable residues were measured by LC-MS at 0.17, 1, 24, 48, 72 h post treatment. In a separate study, 2,4-D, MCPP, and dithiopyr concentrations were measured in the urine of dogs and in dislodgeable grass residues in households that applied or did not apply chemicals in the preceding 48 h. Chemicals were measured at 0, 24, and 48 h post application in treated households and at time 0 in untreated control households. Residence times of 2,4-D, MCPP, and dicamba were significantly prolonged (P<0.05) on dry brown grass compared to green grass. Chemicals were detected in the urine of dogs in 14 of 25 households before lawn treatment, in 19 of 25 households after lawn treatment, and in 4 of 8 untreated households. Chemicals were commonly detected in grass residues from treated lawns, and from untreated lawns suggesting chemical drift from nearby treated areas. Thus dogs could be exposed to chemicals through contact with their own lawn (treated or contaminated through drift) or through contact with other grassy areas if they travel. The length of time to restrict a dog's access to treated lawns following treatment remains to be defined. Further study is indicated to assess the risks of herbicide exposure in humans and dogs.

Dog ownership, functional ability, and walking in community-dwelling older adults.

BACKGROUND: Regular walking improves overall health and functional ability of older adults, yet most are sedentary. Dog ownership/pet responsibility may increase walking in older adults. Goals of this study were to identify factors that influence older adult walking and compare physical activity, functional ability and psychosocial characteristics by dog ownership status. METHODS: In this cross-sectional study, older adults (65-95 years of age, n = 1091) completed and returned questionnaires via postal mail. Measures included: Physical Activity Scale for the Elderly, Physical Functioning Questionnaire and Theory of Planned Behavior Questionnaire. RESULTS: Dog owner/dog walkers (n = 77) reported significantly (P < .05) more total walking, walking frequency, leisure and total physical activity and higher total functional ability than dog owner/nondog walkers (n = 83) and nondog owners (n = 931). Dog owner/nondog walkers reported lower intention and perceived behavioral control and a less positive attitude than dog owner/dog walkers (P < .05). CONCLUSIONS: Dog owner/ dog walkers were significantly different than the nondog walker groups in nearly every study variable. Many dog owners (48.1%) reported walking their dogs regularly and the dog owner/dog walkers participated in nearly 50% more total walking than the 2 nondog walking groups, suggesting that pet obligation may provide a purposeful activity that motivates some older dog owners to walk.

Development and validation of a prioritization rule for obtaining an immediate 12-lead electrocardiogram in the emergency department to identify ST-elevation myocardial infarction.

BACKGROUND: Current guidelines recommend an immediate (eg, <10 minutes) 12-lead electrocardiogram (ECG) to identify ST-elevation myocardial infarction (STEMI) among patients presenting to the emergency department (ED) with chest pain. Yet, one third of all patients with myocardial infarction do not have chest pain. Our objective was to develop a practical approach to identify patients, especially those without chest pain, who require an immediate ECG in the ED to identify STEMI. METHODS: An ECG prioritization rule was derived and validated using classification and regression tree analysis among >3 million ED visits to 107 EDs from 2007 to 2008. RESULTS: The final study population included 3,575,178 ED patient visits; of these, 6,464 (0.18%) were diagnosed with STEMI. Overall, 1,413 (21.9%) of patients with STEMI did not present to the ED with chest pain. Major predictors of those requiring an immediate ECG in the ED included age ≥30 years with chest pain; age ≥50 years with shortness of breath, altered mental status, upper extremity pain, syncope, or generalized weakness; and those with age ≥80 years with abdominal pain or nausea/vomiting. When the ECG prioritization rule was applied to a validation sample, it had a sensitivity of 91.9% (95% CI 90.9%-92.8%) for STEMI and a negative predictive value 99.98% (95% CI 99.98%-99.98%). CONCLUSION: A simple ECG prioritization rule based on age and presenting symptoms in the ED can identify patients during triage who are at high risk for STEMI and therefore should receive an immediate 12-lead ECG, often before they are seen by a physician.

Association between chronic azotemic kidney disease and the severity of periodontal disease in dogs.

Naturally occurring periodontal disease affects >75% of dogs and has been associated with cardiac lesions and presumptive endocarditis. However, the relationships between periodontal disease and chronic kidney disease (CKD) in dogs have not been studied. In a retrospective longitudinal study the incidence of azotemic CKD was compared between a cohort of 164,706 dogs with periodontal disease and a cohort of age-matched dogs with no periodontal disease from a national primary care practice. These dogs contributed 415,971 dog-years of follow-up from 2002 to 2008. Hazard ratios and 95% confidence intervals from Cox regression were used to compare the incidence of azotemic CKD in dogs with stage 1, 2, or 3/4 periodontal disease to dogs with no periodontal disease. The hazard ratio for azotemic CKD increased with increasing severity of periodontal disease (stage 1 hazard ratio=1.8, 95% confidence interval: 1.6, 2.1; stage 2 hazard ratio=2.0, 95% confidence interval: 1.7, 2.3; stage 3/4 hazard ratio=2.7, 95% confidence interval: 2.3, 3.0; P(trend)=<0.0001) after adjustment for age, gender, neuter status, breed, body weight, number of hospital visits, and dental procedures. Increasing severity of periodontal disease was also associated with serum creatinine >1.4 mg/dl and blood urea nitrogen >36 mg/dl, independent of a veterinarian's clinical diagnosis of CKD.

Perspective: The case for research justice: inclusion of patients with limited English proficiency in clinical research.

Persons with limited English proficiency (LEP) constitute a growing portion of the U.S. population, yet they are underrepresented in clinical research. This inherently limits the societal benefits of the research and its generalizability to ethnic populations living in the United States. To illustrate the complexity associated with including LEP participants in clinical research, the authors critically evaluated LEP consent requirements posted on the Web sites of 134 academic health centers in March 2008. They found wide variability with regard to consent policies and striking interinstitutional differences in posted IRB policies and attitudes toward consent of LEP patients in research. The authors argue this variation highlights competing concerns between autonomy and justice. Outcomes-based justice requires inclusion of LEP patients in the research, yet the consent process is often resource-intensive and complex. The authors suggest that more uniform and specific guidance from federal agencies for enrollment of LEP patients in clinical research be established and that this guidance explicitly recalibrate the current balance between autonomy and justice. Investigators and institutional review boards should also develop streamlined best practices to reduce unnecessary effort and expense associated with recruitment of LEP individuals. LEP individuals should have fair access to clinical research in order to fully realize individual and societal benefits of their participation and to ensure the generalizability of scientific discovery.

Disease progression in hemodynamically stable patients presenting to the emergency department with sepsis.

BACKGROUND: Aggressive diagnosis and treatment of patients presenting to the emergency department (ED) with septic shock has been shown to reduce mortality. To enhance the ability to intervene in patients with lesser illness severity, a better understanding of the natural history of the early progression from simple infection to more severe illness is needed. OBJECTIVES: The objectives were to 1) describe the clinical presentation of ED sepsis, including types of infection and causative microorganisms, and 2) determine the incidence, patient characteristics, and mortality associated with early progression to septic shock among ED patients with infection. METHODS: This was a multicenter study of adult ED patients with sepsis but no evidence of shock. Multivariable logistic regression was used to identify patient factors for early progression to shock and its association with 30-day mortality. RESULTS: Of 472 patients not in shock at ED presentation (systolic blood pressure > 90 mm Hg and lactate < 4 mmol/L), 84 (17.8%) progressed to shock within 72 hours. Independent factors associated with early progression to shock included older age, female sex, hyperthermia, anemia, comorbid lung disease, and vascular access device infection. Early progression to shock (vs. no progression) was associated with higher 30-day mortality (13.1% vs. 3.1%, odds ratio [OR] = 4.72, 95% confidence interval [CI] = 2.01 to 11.1; p < or = 0.001). Among 379 patients with uncomplicated sepsis (i.e., no evidence of shock or any end-organ dysfunction), 86 (22.7%) progressed to severe sepsis or shock within 72 hours of hospital admission. CONCLUSIONS: A significant portion of ED patients with less severe sepsis progress to severe sepsis or shock within 72 hours. Additional diagnostic approaches are needed to risk stratify and more effectively treat ED patients with sepsis.

Increased rate of central venous catheterization procedures in community EDs.

OBJECTIVE: Central venous catheterization (CVC) is integral to the emergency department (ED) treatment of critically ill patients, such as those receiving early goal-directed therapy for severe sepsis. No previous studies have described the overall use of CVC in community EDs. The objective of this study was to estimate the overall frequency and temporal trends in CVC use in a sample of patients visiting community EDs. METHODS: This was a retrospective observational study of 2.97 million patient visits at 28 community EDs (range of annual visits, 10 837-110 136) from January 2004 to February 2008. Data were obtained from a community-based research consortium. Central venous catheterization procedures were aggregated at the hospital level for each study year. Trends in CVC use were evaluated using linear regression. RESULTS: Three thousand four hundred eighty-nine patient visits (0.12% of all ED patient visits) had a CVC procedure performed in the ED. The overall rate of CVC procedures per 1000 ED patient visits increased from 0.87 (95% confidence interval [CI(95%)], 0.80-0.95) in 2004 to 1.62 (CI(95%), 1.38-1.91) procedures in 2008 (P value for trend = .003). There was wide variability in the frequency of CVC procedures performed among EDs, ranging from a low of 0.27 (CI(95%), 0.18-0.42) to a high of 7.58 (CI(95%), 6.27-9.17) procedures per 1000 ED visits. The CVC procedure rates were lower in the 8 rural EDs (0.99 CVCs per 1000 ED patient visits [CI(95%), 0.91-1.07] compared with the 20 urban EDs (1.22 CVCs [CI(95%), 1.18-1.27]; P < .001). An increasing rate of CVC procedures during the study period was observed in urban EDs (0.84-1.94 CVCs per 1000 ED patient visits; P value for trend = .005) but not in rural EDs (1.1-0.93; P value for trend = .41) during the study period. CONCLUSION: The overall rate of CVC increased from 2004 to 2008. However, there was a wide variation among Eds, and the CVC rate was lower in rural compared with urban EDs. The increase in CVC use in urban EDs may reflect more intensive therapy in the management of ED patients with acute illness or injury. Future efforts are needed to optimize best practices for the use of CVC in community ED practices and to characterize factors responsible for urban rural differences in the rate of CVC procedures.

The North Carolina EMS Data System: a comprehensive integrated emergency medical services quality improvement program.

BACKGROUND: The EMS Agenda for the Future describes emergency medical services (EMS) as the intersection between public health, public safety, and health care. The most comprehensive method to describe, evaluate, and optimize these systems of care is using a state EMS data system. A centralized EMS data system can be a valuable tool to identify, evaluate, target, and improve EMS service delivery and patient care. Significant barriers, however, still exist to the standardization of EMS data systems and infrastructure nationally. Indeed, there is no comprehensive measurement of EMS service delivery or patient volume at the national level. OBJECTIVE: In this article, we describe the successful development of a fully integrated, statewide EMS data system for quality improvement of EMS service delivery and patient care in North Carolina. The article also provides a platform for linking EMS with emergency physicians, other health care providers, and public health agencies responsible for planning, disease surveillance, and disaster preparedness. RESULTS AND CONCLUSION: The North Carolina EMS Data System represents the successful development of a large, fully integrated, comprehensive statewide EMS database and quality improvement effort. The North Carolina EMS Data System applications include the Prehospital Medical Information System (PreMIS), the Credentialing Information System (CIS), the State Medical Asset Resource Tracking Tool (SMARTT), and the EMS Performance Improvement Toolkits. The system provides a quality and performance improvement program consistent with the idealized EMS design described in the EMS Agenda for the Future. The program has already achieved significant improvements in the quality of EMS service delivery, patient care, and integrated systems of care. Consistent with the goals of the 2007 Institute of Medicine's recommendations for EMS, the linkage of the North Carolina EMS Data System with other health care registries has created an environment that can evaluate larger systems of care and ultimate patient outcomes.

Evaluation of the risk of endocarditis and other cardiovascular events on the basis of the severity of periodontal disease in dogs.

OBJECTIVE: To test the hypothesis that increased severity of periodontal disease in dogs is associated with an increased risk of cardiovascular-related events, such as endocarditis and cardiomyopathy, as well as markers of inflammation. DESIGN: Historical cohort observational study. SAMPLE POPULATION: 59,296 dogs with a history of periodontal disease (periodontal cohort), of which 23,043 had stage 1 disease, 20,732 had stage 2 disease, and 15,521 had stage 3 disease; and an age-matched comparison group of 59,296 dogs with no history of periodontal disease (nonperiodontal cohort). PROCEDURES: Cox proportional hazard regression models were used to estimate the risk of cardiovascular-related diagnoses and examination findings in dogs as a function of the stage of periodontal disease (1, 2, or 3 or no periodontal disease) over time while controlling for the effect of potential confounding factors. RESULTS: Significant associations were detected between the severity of periodontal disease and the subsequent risk of cardiovascular-related conditions, such as endocarditis and cardiomyopathy, but not between the severity of periodontal disease and the risk of a variety of other common noncardiovascular-related conditions. CONCLUSIONS AND CLINICAL RELEVANCE: The findings of this observational study, similar to epidemiologic studies in humans, suggested that periodontal disease was associated with cardiovascular-related conditions, such as endocarditis and cardiomyopathy. Chronic inflammation is probably an important mechanism connecting bacterial flora in the oral cavity of dogs with systemic disease. Canine health may be improved if veterinarians and pet owners place a higher priority on routine dental care.

Noninvasive prediction of prostatic DNA damage by oxidative stress challenge of peripheral blood lymphocytes.

To move closer to the goal of individualized risk prediction for prostate cancer, we used an in vivo canine model to evaluate whether the susceptibility of peripheral blood lymphocytes (PBLs) to oxidative stress-induced DNA damage could identify those individuals with the highest prostatic DNA damage. This hypothesis was tested in a population of 69 elderly male beagle dogs after they had completed a 7-month randomized feeding trial to achieve the broad range of dietary selenium status observed in U.S. men. The alkaline Comet assay was used to directly compare the extent of DNA damage in PBLs with prostatic DNA damage in each dog. Using stepwise logistic regression, the sensitivity of PBLs to oxidative stress challenge with hydrogen peroxide (H(2)O(2)) predicted dogs in the highest tertile of prostatic DNA damage. Dogs with PBLs highly sensitive to H(2)O(2) were 7.6 times [95% confidence interval (95% CI), 1.5-38.3] more likely to have high prostatic DNA damage than those in the H(2)O(2)-resistant group. This risk stratification was observed in multivariate analysis that considered other factors that might influence DNA damage, such as age, toenail selenium concentration, and serum testosterone concentration. Our data show that the sensitivity of PBLs to oxidative stress challenge, but not endogenous DNA damage in PBLs, provides a noninvasive surrogate marker for prostatic DNA damage. These findings lend support to the concept that oxidative stress contributes to genotoxic damage, and that oxidative stress challenge may stratify men for prostate cancer risk.

Adverse events after vaccine administration in cats: 2,560 cases (2002-2005).

OBJECTIVE: To determine the incidence of vaccine-associated adverse events (VAAEs) diagnosed within 30 days of vaccination in cats and characterize risk factors for their occurrence. DESIGN: Retrospective cohort study. ANIMALS: 496,189 cats vaccinated at 329 hospitals. PROCEDURES: Electronic records were searched for VAAEs that occurred after vaccine administration classified by practitioners as nonspecific vaccine reaction, allergic reaction, urticaria, shock, or anaphylaxis. Clinical signs and treatments were reviewed. The association between potential risk factors and a VAAE occurrence was estimated via multivariate logistic regression. RESULTS: 2,560 VAAEs were associated with administration of 1,258,712 doses of vaccine to 496,189 cats (51.6 VAAEs/10,000 cats vaccinated). The risk of a VAAE significantly increased as the number of vaccines administered per office visit increased. Risk was greatest for cats approximately 1 year old; overall risk was greater for neutered versus sexually intact cats. Lethargy with or without fever was the most commonly diagnosed VAAE. No localized reactions recorded in the 30-day period were subsequently diagnosed as neoplasia when followed for 1 to 2 years. CONCLUSIONS AND CLINICAL RELEVANCE: Although overall VAAE rates were low, young adult neutered cats that received multiple vaccines per office visit were at the greatest risk of a VAAE within 30 days after vaccination. Veterinarians should incorporate these findings into risk communications and limit the number of vaccinations administered concurrently to cats.

Physical activity and function in older adults: theory of planned behavior.

OBJECTIVE: To assess the theory of planned behavior (TPB) and TPB with functional ability to explain intention and self-reported physical activity (PA) behavior of older adults. METHODS: A survey was mailed to 2056 retirees from a large Midwestern university. RESULTS: Structural equation modeling revealed that the TPB plus functional ability explained an additional 11% variance than the TPB alone in older adult PA and functional ability was the best predictor of PA (beta = .53, P<.05). CONCLUSIONS: Functional ability appears to be an important predictor of PA behavior and should be included when designing PA programs for older adults.

Blastomycosis in indoor cats: suburban Chicago, Illinois, USA.

Blastomyces dermatitidis, the etiologic agent of blastomycosis, a potentially life-threatening systemic mycosis of humans and animals, is acquired from a yet incompletely defined environmental niche. There is controversy regarding the potential for contact with the fungus in or near one's home, particularly in urban areas. We investigated an outbreak of blastomycosis among five urban, indoor cats diagnosed at three veterinary clinics March 3-July 13, 2005, in suburban Chicago, Illinois, by owner interviews, site visits, environmental cultures for B. dermatitidis, GIS analysis, and analysis of local weather data. There were no environmental exposures common to the five cats that lived a median of 300 m from nearest body of water, in homes on a loam soil. Closest and farthest case home sites were 3.4 and 26.1 km, respectively. All cats were confined indoors except one cat that averaged 15 min/week in his backyard and was exposed to excavation. B. dermatitidis was not isolated from any of 60 environmental samples. The annualized incidence rate March through July 2005 among 6,761 cats in these practices was 178/100,000, compared to none in the previous 4 years, and 0.14/100,000 cat visits from a nationwide animal hospital registry. Precipitation January through June 2005 was 9.30 versus period mean of 14.05 +/- 1.69 inches the previous 4 years (P = 0.01). Circumstantial evidence suggests acquisition of B. dermatitidis from the home site environment in five cats. Relative drought may have contributed to an apparent outbreak of blastomycosis in this urban locale.

Lack of association between repeated vaccination and thyroiditis in laboratory Beagles.

BACKGROUND: Intensive vaccination protocols have been suggested as partially responsible for an increased prevalence of autoimmune diseases in dogs in recent years. The aim of this study was to determine whether repeated routine vaccination in dogs is associated with an increased prevalence of thyroiditis. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a prospective experimental study with 20 healthy purpose-bred Beagles. Five dogs were vaccinated with a multivalent vaccine and a rabies vaccine. Five dogs received only the multivalent vaccine, and 5 dogs received only the rabies vaccine. Five dogs were unvaccinated controls. The multivalent vaccine was administered at 8, 10, 12, 16, 20, 26, and 52 weeks of age and every 6 months thereafter. The rabies vaccine was administered at 16 and 52 weeks of age and then once a year. Blood samples were collected 1 week before euthanasia for evaluation of thyroid profiles and measurement of antibodies directed against canine thyroglobulin. Dogs were euthanized at 5.5 years of age, and the thyroid glands were evaluated histopathologically. Thyroiditis was present in 8 of 20 (40%) dogs at postmortem examination. No association was found between a dog being vaccinated and the prevalence of thyroiditis at postmortem examination. However, the power of the study to detect such an association was low because of the unexpected high prevalence of thyroiditis in the unvaccinated control dogs. Thyroid function tests were abnormal in 2 of 8 dogs with thyroiditis but were normal in all dogs without thyroiditis. CONCLUSIONS/SIGNIFICANCE: There was no evidence to support an association between routine vaccination and thyroiditis at postmortem examination in beagle dogs after repeated vaccination.

Evaluation of surgical treatment for signs of acute abdominal pain in draft horses: 72 cases (1983-2002).

OBJECTIVE: To determine whether heavy (> or = 680 kg [> or = 1,500 lb]) draft horses undergoing surgical treatment for acute signs of abdominal pain were at a greater risk for anesthetic and postoperative complications and lower postoperative survival rates than light (< 680 kg) draft horses. DESIGN: Retrospective case series. ANIMALS: 72 draft horses. PROCEDURES: Medical records of draft horses that underwent exploratory celiotomy for signs of acute abdominal pain from October 1983 to December 2002 were reviewed. Medical records of draft horses in which a celiotomy was performed for correction of reproductive abnormalities were not included in the study. RESULTS: When compared with light draft horses, heavy draft horses had longer durations of anesthesia, more postoperative complications, and lower survival rates. Seventy-six percent of horses that recovered from anesthesia had postoperative complications. Postoperative complications associated with low survival rates included myopathy and neuropathy, ileus, diarrhea, and endotoxemia. All horses with postoperative myopathy and neuropathy died or were euthanized. The short-term survival rate for horses that recovered from anesthesia was 60%. Horses undergoing small intestinal surgery had a worse prognosis for short-term survival than those undergoing large intestinal surgery. The survival rate for horses for which long-term (> 1 year) follow-up information was available was 50%. CONCLUSIONS AND CLINICAL RELEVANCE: Draft horses weighing > 680 kg that underwent surgery because of acute signs of abdominal pain had longer durations of anesthesia, more postoperative complications, and higher mortality rates than draft horses weighing < 680 kg.

Prevalence and risk factors for Giardia and coccidia species of pet cats in 2003-2004.

Prevalence and risk factors for feline coccidia and Giardia species infections were estimated for cats visiting 434 Banfield hospitals in 40 states in 2003-2004. Evaluated were 631,021 cats making 1,456,712 office visits (encounters) and having 211,105 fecal examinations. The overall fecal prevalences of coccidia and Giardia species were 1.4% and 0.58%, respectively. Cats at increased risk of coccidia infection were under 4 years of age, intact, and seen during the summer, fall, and spring months compared to winter. Cats at increased risk of Giardia species infection were under 4 years of age. Those at decreased risk were mixed breed and seen during the summer, fall, and spring. The highest regional risk of coccidia and Giardia species infection was for cats in the East South Central region and Mountain region, respectively, compared to the South Pacific region.

Canine leptospirosis, United States, 2002-2004.

The proportion of positive Leptospira microscopic agglutination tests for 23,005 dogs significantly increased from 2002 to 2004 (p < 0.002) regardless of the positive cutoff titer used and was highest (p < 0.05) for serovars Autumnalis and Grippotyphosa. The strongest positive serologic correlation (r = 0.72) was between serovars Autumnalis and Pomona.

Estimated prevalence of nematode parasitism among pet cats in the United States.

OBJECTIVE: To estimate prevalences of roundworm, hookworm, and whipworm infections in pet cats in the United States and identify risk factors for parasitism. DESIGN: Retrospective period prevalence survey. STUDY POPULATION: 356,086 cats examined at 359 private veterinary hospitals during 2003. PROCEDURE: Electronic medical records were searched to identify cats for which fecal flotation tests had been performed and to determine proportions of test results positive for roundworms, hookworms, and whipworms. Potential risk factors for roundworm and hookworm infection were identified by means of multivariate logistic regression analysis. RESULTS: A total of 80,278 tests were performed on fecal samples from 66,819 cats. Calculated prevalences of roundworm, hookworm, and whipworm infection were 2.92%, 0.63%, and 0.031%, respectively. Age, reproductive status, breed, and season were significant risk factors for roundworm infection, with cats < 4 years old; sexually intact cats; mixed-breed cats; and cats examined during the summer, fall, or winter more likely to be infected. Age, reproductive status, and season were significant risk factors for hookworm infection, with cats < 1 year old, sexually intact cats, and cats examined during the summer more likely to be infected. Regional differences in prevalences of roundworm and hookworm infection were found. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that prevalences of nematode infections among pet cats in the United States may be lower than previously suspected on the basis of prevalences reported among cats in humane shelters and those reported in more geographically focused studies.