Comparison of rapid immunoassays for rupture of fetal membranes.

BACKGROUND: Rupture of membranes (ROM) before the onset of uterine contractions, particularly in pregnancies less than 37 weeks gestational age, is a common diagnostic problem in obstetrical practice. Timely detection of ROM is vital to support gestational age-specific interventions to optimize perinatal outcomes and minimize the risk of serious complications such as preterm delivery, fetal distress and maternal/fetal infections. Rapid bedside immunoassay tests designed to detect amniotic fluid proteins in cervicovaginal fluids have emerged as valuable clinical tools to provide timely ROM diagnosis. METHODS: In this prospective observational study, two commercially-available immunoassay tests (ROM Plus®, AmniSure®) were evaluated concurrently in 111 pregnant women who presented with the chief complaint of ROM. Immunoassay results were compared to clinical parameters for determining ROM via comprehensive, retrospective clinical chart review. Diagnostic performance characteristics were calculated including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. RESULTS: Overall, diagnostic performance characteristics were robust and similar between ROM Plus® and AmniSure®, respectively: sensitivity (96.4 and 89.3%), specificity (98.8 and 100%), PPV (96.4 and 100%), NPV (98.8% and 96.5) and accuracy (98.2 and 97.3%). For term patients (≥37 weeks gestation), the sensitivities were 93.8 and 81.3% and specificities were 97.1 and 100% for ROM Plus® and AmniSure®, respectively. For preterm patients (<37 weeks gestation), both immunoassay tests provided exact concordance with clinical confirmation of ROM resulting in 100% diagnostic accuracy. CONCLUSIONS: Both rapid immunoassay tests provided similarly excellent diagnostic accuracy for the rapid detection of ROM with only two discrepant results for ROM Plus® and three discrepant results for AmniSure® compared to clinical confirmation. The findings from this study recommend these tests for pregnant women presenting with suspected ROM to guide correct clinical management decisions to improve obstetrical and neonatal outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02208011 (1 August 2014).

SCID dogs: similar transplant potential but distinct intra-uterine growth defects and premature replicative senescence compared with SCID mice.

We have previously described DNA-dependent protein kinase (DNA-PKcs) mutations in horses and dogs that result in deficits in V(D)J recombination, DNA repair, and SCID. In this paper, we document substantial developmental growth defects in DNA-PKcs-deficient dogs that are not apparent in SCID mice. Fibroblast cell strains derived from either fetal or adult SCID dogs proliferate poorly in culture and undergo premature replicative senescence, somewhat reminiscent of cells derived from Ku-deficient mice. A limited number of animals have been immune reconstituted (by bone marrow transplantation) so that they can be maintained in a normal environment for long periods. Several of these animals have developed conditions associated with premature ageing at 2-3 years of age, roughly 20% of their expected lifespan. These conditions include intestinal malabsorption and primary neural cell neoplasia. These results suggest that DNA-PKcs deficiency is not tolerated equally in all species, perhaps providing insight into why DNA-PKcs deficiency has not been observed in humans. Finally, this study demonstrates the feasibility of maintaining SCID dogs for extended periods of time and documents their utility for bone marrow transplantation studies and as hosts for the propagation of xenografts. In sum, SCID dogs may present researchers with new possibilities for the development of animal models of human disease.

Effect of semen in urine specimens on urine protein concentration determined by means of dipstick analysis.

OBJECTIVE: To determine the effect of semen in urine specimens on urine protein concentration measured by means of dipstick analysis. SAMPLE POPULATION: 14 urine samples from 3 adult castrated male dogs and 14 semen samples from 7 adult sexually intact male dogs. PROCEDURES: Serial dilutions of the whole ejaculate or spermatozoa-free seminal fluid in urine were created, and unaltered and diluted urine samples were analyzed by means of a commercially available dipstick; pH and specific gravity of the samples were also measured. Spermatozoa and WBC counts of the semen samples and protein concentration of the seminal fluid were determined. RESULTS: Protein concentrations determined by means of dipstick analysis of urine samples to which whole ejaculate (dilutions of 1:1, 1:2, 1:16, 1:64, and 1:256) or seminal fluid (dilutions of 1:1, 1:2, 1:16, and 1:64) had been added were significantly higher than concentrations in unaltered urine samples. All 13 samples to which whole ejaculate was added at a dilution of 1:2 and 10 of 12 samples to which seminal fluid was added at a dilution of 1:2 were positive for blood on dipstick analysis. There was no significant linear correlation between spermatozoa or WBC count of the semen sample and protein concentration of the spermatozoa-free seminal fluid. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that regardless of whether spermatozoa were present, semen contamination could result in false-positive results for protein and blood during dipstick analysis of urine samples from sexually intact male dogs.

In vitro comparison of plain radiography, double-contrast cystography, ultrasonography, and computed tomography for estimation of cystolith size.

OBJECTIVE: To compare accuracy of estimates of cystolith size obtained by means of plain radiography, double-contrast cystography, ultrasonography, and computed tomography. SAMPLE POPULATION: 30 canine cystoliths ranging from 1 to 11 mm in diameter with various mineral compositions. PROCEDURES: A bladder phantom model was created by filling a rubber balloon with saline (1% NaCl) solution and positioning it on top of a 2% gelatin cushion at the bottom of a water-filled 4-quart container. Cystoliths were individually placed in the bladder phantom and imaged by each of the 4 techniques. For each image, cystolith size was measured by 2 radiologists with computerized calipers, and size estimates were compared with actual cystolith size. RESULTS: Mean cystolith size estimates obtained by means of radiography, cystography, and computed tomography did not differ significantly from each other. However, for ultrasonographic images, mean +/- SD difference between actual and estimated cystolith size (2.95 +/- 0.73 mm) was significantly higher than mean difference for radiographic, cystographic, and computed tomographic images. For ultrasonography, mean +/- SD percentage overestimation in cystolith size was 68.4 +/- 51.5%. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that measurements of cystolith size obtained by means of ultrasonography may overestimate the true size. This suggests that cystolith size estimates obtained by means of ultrasonography should be interpreted with caution whenever cystolith size may influence patient management.

Investigation and characterization of Brucella canis infections in pet-quality dogs and associated human exposures during a 2007-2016 outbreak in Michigan.

OBJECTIVE To estimate Brucella canis seropositivity rates for purebred dogs being bred by noncommercial breeders, describe epidemiological findings in infected commercial dog-production facilities, and characterize B canis infection in pet dogs and the risk to human health. DESIGN Retrospective descriptive study. SAMPLE 2,799 canine specimens submitted to the Michigan State University Veterinary Diagnostic Laboratory for B canis testing and records of B canis reports provided to the Michigan Department of Agriculture and Rural Development from 2007 through 2016. PROCEDURES Results of B canis laboratory tests and epidemiological findings for reported cases of B canis were reviewed and summarized. Federal and state public health officials were interviewed regarding human B canis infection. State veterinarians were interviewed regarding canine brucellosis reporting and control procedures. RESULTS Estimated B canis seropositivity was 0.4% among purebred Michigan dogs owned by noncommercial breeders. Infection was confirmed in dogs from 17 commercial dog-production facilities, 3 shelters, and 1 rescue agency. Estimated infection prevalence in production facilities ranged from 2 of 22 (9%) to 5 of 6 (83%). Transfer of infected dogs involved 22 Michigan counties and 11 states. Seven of 20 privately owned infected dogs had diskospondylitis; I also had uveitis. Fifty-three veterinary hospital or diagnostic laboratory personnel had inadvertent exposure to the pathogen. Brucella canis was isolated from 1 commercial production facility owner. CONCLUSIONS AND CLINICAL RELEVANCE B canis was uncommon in purebred dogs being bred by noncommercial breeders but endemic in Michigan commercial facilities producing dogs destined to become household pets. Infected pet dogs caused human B canis exposure, and several pet dogs had debilitating disease not associated with the reproductive system.

Implementing Interventions Aimed at Reducing Rates of Cesarean Birth.

Increased incidence of both nulliparous, term, singleton, vertex and overall cesarean birth rates has warranted close monitoring and scrutiny by various health care associations and by individual obstetric facilities and providers of obstetric care. Concerted efforts to reduce rates of nonmedically indicated cesarean birth have resulted in the development and implementation of comprehensive action plans aimed at effecting reductions and enhancing overall obstetric quality care. Here we describe how a multidisciplinary team at our hospital developed and implemented interventions aimed at reducing rates of cesarean birth.

Systemic manifestations of Cuterebra infection in dogs and cats: 42 cases (2000-2014).

OBJECTIVE To document clinical signs in cats and dogs with Cuterebra infection, determine the outcome of infected animals, and determine whether Yorkshire Terriers were more commonly affected than other breeds of dogs. DESIGN Retrospective case series. ANIMALS 22 cats and 20 dogs with Cuterebra infection. PROCEDURES Medical records of dogs and cats with Cuterebra infection were reviewed for signalment, history, clinical and laboratory findings, treatment, duration of hospitalization, and outcome. RESULTS Most (16/20 [80%]) of the dogs weighed ≤ 4.5 kg (10 lb), and Yorkshire Terriers were overrepresented (8/20 [40%]), compared with dogs of other breeds. Ten (50%) dogs and 3 (14%) cats had systemic inflammatory response syndrome at the time of initial evaluation, and 8 (40%) dogs but none of the cats had disseminated intravascular coagulation. The overall mortality rate was 17% (7/42), but was higher for dogs (6/20 [30%]) than cats (1/22 [4.5%]). All 6 dogs that died weighed ≤ 4.5 kg and had systemic inflammatory response syndrome, disseminated intravascular coagulation, or both. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that Cuterebra infection can cause severe systemic illness in small-breed dogs. Yorkshire Terriers were more commonly affected than were dogs of other breeds and, subjectively at least, appeared to be more likely to develop severe systemic illness.

Serum alkaline phosphatase activity in Scottish Terriers versus dogs of other breeds.

OBJECTIVE: To determine whether Scottish Terriers have higher serum alkaline phosphatase (ALP) activities and a higher prevalence of diseases commonly associated with high serum ALP activity than do dogs of other breeds. DESIGN: Retrospective case-control study. ANIMALS: 85 Scottish Terriers and 340 age-matched control dogs that were not Scottish Terriers. PROCEDURE: Medical records were reviewed, and data for year of evaluation, age, sex, breed, serum ALP activity, and final diagnosis were recorded. RESULTS: Scottish Terriers had a significantly higher mean serum ALP activity than did control dogs (1,520 U/L vs 306 U/L). Regardless of breed, dogs that had a disease commonly associated with high serum ALP activity had a significantly higher mean serum ALP activity than did dogs without such diseases (1,304 U/L vs 427 U/L). Scottish Terriers were 2.4 times as likely to have a disease commonly associated with high serum ALP activity than were control dogs, but Scottish Terriers with diseases commonly associated with high serum ALP activity had a significantly higher mean ALP activity than did control dogs with such diseases (2,073 U/L vs 909 U/L), and Scottish Terriers without such diseases had a significantly higher mean serum ALP activity than did control dogs without such diseases (1,349 U/L vs 228 U/L). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that Scottish Terriers have higher serum ALP activities than do dogs of other breeds. Although Scottish Terriers also have a higher prevalence of diseases associated with high serum ALP activity, this alone did not explain the higher mean serum ALP activity in the breed.

Assessment of the dark-adaptation time required for recovery of electroretinographic responses in dogs after fundus photography and indirect ophthalmoscopy.

OBJECTIVE: To investigate the duration of dark-adaptation time required for recovery of electroretinographic responses after fundus photography or indirect ophthalmoscopy in dogs. ANIMALS: 6 dogs. PROCEDURE: Initially, scotopic-intensity series of electroretinograms (ERGs) were recorded after 20 minutes of dark adaptation. The fundus of the left eye of each dog was photographed (n = 10) or examined via indirect ophthalmoscopy for 5 minutes with moderate- (117 candela [cd]/m2) or bright-intensity (1,693 cd/m2) light; ERGs were repeated after a further 20 or 60 minutes of dark adaptation (6 procedures/dog). RESULTS: Following 20 minutes of dark adaptation after fundus photography, the b- and a-wave amplitudes were reduced in response to brighter stimuli, compared with pretest ERGs; after 60 minutes of dark adaptation, ERG amplitudes had recovered. Following 20 minutes of dark adaptation after indirect ophthalmoscopy (moderate-intensity light), significantly lower b-wave amplitudes were recorded in response to 2 of the brighter flash stimuli, compared with pretest ERGs; after 60 minutes of dark adaptation, ERG amplitudes had recovered. Following 20 minutes of dark adaptation after indirect ophthalmoscopy (bright-intensity light), all ERG amplitudes were significantly decreased and implicit times were significantly decreased at several flash intensities, compared with pretest ERGs; after 60 minutes of dark adaptation, ERG amplitudes and implicit times had returned to initial values, except for b-wave amplitudes recorded in response to dimmer stimuli. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that at least 60 minutes of dark adaptation should be allowed before ERGs are performed in dogs after fundus photography or indirect ophthalmoscopy.

Identification and characterization of an idiopathic pulmonary fibrosis-like condition in cats.

Interstitial lung diseases are a heterogeneous group of disorders with a variety of causes. In veterinary medicine, such lung diseases with a prominent fibrotic component of unknown etiology are often called idiopathic pulmonary fibrosis (IPF). In human medicine, this term is reserved for a distinct disease entity with specific histologic findings labeled as usual interstitial pneumonia (UIP). We identified 23 cats displaying histologic criteria of UIP The purpose of this retrospective study is to describe the presentation and response to therapy of these cats to better define this disease entity. All but 2 cats were middle aged to older (median 8.7 years), with no apparent sex or breed predisposition. Complaints included respiratory distress (n = 18) and cough (13). Duration of signs was less than 6 months in 17 cats. Physical-examination abnormalities included tachypnea, inspiratory or mixed inspiratory and expiratory effort, and adventitial lung sounds. No consistent hematologic or biochemical abnormalities, parasites, or positive serologic results for feline retroviruses, heartworms, or toxoplasmosis were present. Radiographic changes included dense patchy or diffuse interstitial, bronchiolar, and alveolar infiltrates. Analysis of bronchial lavage fluid revealed mild neutrophilic inflammation (n = 6) with no consistent pathogen growth. Clinical condition of 5 cats worsened after lavage. Coincident pulmonary neoplasia was identified in 6 cats. Response to therapy (corticosteroids, antibiotics, bronchodilators, and diuretics) was poor, and most cats died within days to months. Cats with histologic changes compatible with UIP had signs that mimicked many of the clinical findings of human IPF, and treatment response was similarly unrewarding.

Thyroid issues in reproduction.

Observations in people and animals demonstrate relationships between thyroid and reproductive functions. Thyroid issues of importance to small animal reproduction are twofold. First, some thyroid disorders, such as lymphocytic thyroiditis and some forms of congenital hypothyroidism, appear to be heritable. Those traits might be considered undesirable. If so, to eliminate the trait affected animals would not be selected as breeding stock. Second, thyroid disorders may adversely affect fertility, pregnancy, or neonatal health. If a causal relationship existed between thyroid and reproductive disorders, correction of one would be expected to result in resolution of the other. This is often not the case. Although animals and people with thyroid disorders may also have reproductive disorders, usually disorders other than thyroid disease are the cause of reproductive abnormalities. It appears that euthyroidism supports optimal reproductive performance, but clinically significant reproductive dysfunction is manifested only under certain uncommon conditions of thyroid disease in dogs and cats.

Perinatal considerations in the hospital disaster management process.

Nurses play a vital role in providing care to mothers and infants during a disaster, yet few are fully prepared for the challenges they will encounter under extreme conditions. The ability to provide the best possible care for families begins with understanding the perinatal issues in relation to each phase of the disaster management process. This article reviews the hospital and perinatal nursing role in the mitigation, preparedness, response, and recovery phases of disaster management.