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1.
BMC Vet Res ; 17(1): 222, 2021 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-34154584

RESUMO

BACKGROUND: Vestibular syndrome is often accompanied by nausea. Drugs currently approved for its treatment have been developed to stop vomiting but not nausea. The efficacy of 5-HT3 receptor antagonists to reduce nausea has been described for chemotherapy, but not for nausea secondary to vestibular disorders. METHODS: Sixteen dogs with vestibular syndrome-associated nausea were included in the open-label, multicentre study. The intensity of nausea-like behaviour was analysed before ondansetron administration (0.5 mg/kg i.v.) and 2 h afterwards, using a validated 5-point-scale. The occurrence and frequency of salivation, lip licking, restlessness, vocalisation, lethargy, and vomiting were assessed. RESULTS: All dogs initially showed signs of nausea, whereas only 31% showed vomitus. The intensity of nausea was significantly reduced in all dogs (p ≤ 0.0001) 2 h after ondansetron administration, including the clinical signs of nausea analysed in 11 dogs (salivation [p = 0.0078], lip licking [p = 0.0078], restlessness [p = 0.0039], and lethargy [p = 0.0078]) except for vocalisation (p > 0.9999). CONCLUSIONS: The results provide preliminary evidence of the potential benefit of ondansetron in the treatment of nausea, which was present in all examined dogs. Vomiting was only observed in 5 dogs indicating that nausea can occur separately and should not be perceived only as a preceding stimulation of the vomiting centre.


Assuntos
Náusea/veterinária , Ondansetron/uso terapêutico , Doenças Vestibulares/veterinária , Administração Intravenosa/veterinária , Animais , Antieméticos/administração & dosagem , Antieméticos/uso terapêutico , Cães , Náusea/tratamento farmacológico , Ondansetron/administração & dosagem , Doenças Vestibulares/tratamento farmacológico , Vômito/tratamento farmacológico , Vômito/veterinária
2.
J Vet Pharmacol Ther ; 41(1): 28-38, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28736817

RESUMO

A calf tissue cage model was used to study the pharmacokinetics (PK) and pharmacodynamics (PD) of oxytetracycline in serum, inflamed (exudate) and noninflamed (transudate) tissue cage fluids. After intramuscular administration, the PK was characterized by a long mean residence time of 28.3 hr. Based on minimum inhibitory concentrations (MICs) for six isolates each of Mannheimia haemolytica and Pasteurella multocida, measured in serum, integration of in vivo PK and in vitro PD data established area under serum concentration-time curve (AUC0-∞ )/MIC ratios of 30.0 and 24.3 hr for M. haemolytica and P. multocida, respectively. Corresponding AUC0-∞ /MIC ratios based on MICs in broth were 656 and 745 hr, respectively. PK-PD modelling of in vitro bacterial time-kill curves for oxytetracycline in serum established mean AUC0-24 hr /MIC ratios for 3log10 decrease in bacterial count of 27.5 hr (M. haemolytica) and 60.9 hr (P. multocida). Monte Carlo simulations predicted target attainment rate (TAR) dosages. Based on the potency of oxytetracycline in serum, the predicted 50% TAR single doses required to achieve a bacteriostatic action covering 48-hr periods were 197 mg/kg (M. haemolytica) and 314 mg/kg (P. multocida), respectively, against susceptible populations. Dosages based on the potency of oxytetracycline in broth were 25- and 27-fold lower (7.8 and 11.5 mg/kg) for M. haemolytica and P. multocida, respectively.


Assuntos
Antibacterianos/farmacocinética , Mannheimia haemolytica/efeitos dos fármacos , Oxitetraciclina/farmacocinética , Infecções por Pasteurella/veterinária , Pasteurella multocida/efeitos dos fármacos , Pneumonia Enzoótica dos Bezerros/tratamento farmacológico , Animais , Antibacterianos/administração & dosagem , Antibacterianos/sangue , Antibacterianos/farmacologia , Carga Bacteriana/efeitos dos fármacos , Carga Bacteriana/veterinária , Bovinos , Feminino , Injeções Intramusculares/veterinária , Testes de Sensibilidade Microbiana/veterinária , Oxitetraciclina/administração & dosagem , Oxitetraciclina/sangue , Oxitetraciclina/farmacologia , Infecções por Pasteurella/tratamento farmacológico
3.
J Vet Pharmacol Ther ; 41(2): 171-183, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29226975

RESUMO

A common feature of human and veterinary pharmacokinetics is the importance of identifying and quantifying the key determinants of between-patient variability in drug disposition and effects. Some of these attributes are already well known to the field of human pharmacology such as bodyweight, age, or sex, while others are more specific to veterinary medicine, such as species, breed, and social behavior. Identification of these attributes has the potential to allow a better and more tailored use of therapeutic drugs both in companion and food-producing animals. Nonlinear mixed effects (NLME) have been purposely designed to characterize the sources of variability in drug disposition and response. The NLME approach can be used to explore the impact of population-associated variables on the relationship between drug administration, systemic exposure, and the levels of drug residues in tissues. The latter, while different from the method used by the US Food and Drug Administration for setting official withdrawal times (WT) can also be beneficial for estimating WT of approved animal drug products when used in an extralabel manner. Finally, NLME can also prove useful to optimize dosing schedules, or to analyze sparse data collected in situations where intensive blood collection is technically challenging, as in small animal species presenting limited blood volume such as poultry and fish.


Assuntos
Modelos Teóricos , Dinâmica não Linear , Farmacocinética , Doenças dos Animais/tratamento farmacológico , Animais
4.
J Vet Pharmacol Ther ; 40(5): 505-516, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28090673

RESUMO

Pharmacokinetic-pharmacodynamic (PK/PD) integration and modelling were used to predict dosage schedules of oxytetracycline for two pig pneumonia pathogens, Actinobacillus pleuropneumoniae and Pasteurella multocida. Minimum inhibitory concentration (MIC) and mutant prevention concentration (MPC) were determined in broth and porcine serum. PK/PD integration established ratios of average concentration over 48 h (Cav0-48 h )/MIC of 5.87 and 0.27 µg/mL (P. multocida) and 0.70 and 0.85 µg/mL (A. pleuropneumoniae) for broth and serum MICs, respectively. PK/PD modelling of in vitro time-kill curves established broth and serum breakpoint values for area under curve (AUC0-24 h )/MIC for three levels of inhibition of growth, bacteriostasis and 3 and 4 log10 reductions in bacterial count. Doses were then predicted for each pathogen, based on Monte Carlo simulations, for: (i) bacteriostatic and bactericidal levels of kill; (ii) 50% and 90% target attainment rates (TAR); and (iii) single dosing and daily dosing at steady-state. For 90% TAR, predicted daily doses at steady-state for bactericidal actions were 1123 mg/kg (P. multocida) and 43 mg/kg (A. pleuropneumoniae) based on serum MICs. Lower TARs were predicted from broth MIC data; corresponding dose estimates were 95 mg/kg (P. multocida) and 34 mg/kg (A. pleuropneumoniae).


Assuntos
Actinobacillus pleuropneumoniae/efeitos dos fármacos , Antibacterianos/farmacocinética , Oxitetraciclina/farmacocinética , Pasteurella multocida/efeitos dos fármacos , Pneumonia/veterinária , Actinobacillus pleuropneumoniae/crescimento & desenvolvimento , Animais , Antibacterianos/farmacologia , Relação Dose-Resposta a Droga , Testes de Sensibilidade Microbiana , Oxitetraciclina/farmacologia , Pasteurella multocida/crescimento & desenvolvimento , Pneumonia/tratamento farmacológico , Suínos
5.
J Vet Pharmacol Ther ; 40(5): 419-428, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27891615

RESUMO

The antimicrobial properties of tulathromycin were investigated for M. haemolytica and P. multocida. Three in vitro indices of antimicrobial activity, minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and time-kill curves, were established for six isolates of each organism. Each index was measured in two growth media: Mueller-Hinton broth (MHB) and calf serum. It was shown that MICs and MBCs were markedly lower in serum than in MHB. MHB:serum ratios for MIC were 47:1 (M. haemolytica) and 53:1 (P. multocida). For both serum and MHB, adjustment of pH led to greater potency at alkaline compared to acid pH. Tulathromycin MIC was influenced by size of inoculum count, being 4.0- to 7.7-fold greater for high compared to low initial counts. It was concluded that for the purpose of determining dosages for therapeutic use, pharmacodynamic data for tulathromycin should be derived in biological fluids such as serum. It is hypothesized that in vitro measurement of MIC in broth, conducted according to internationally recommended standards, may be misleading as a basis for estimating the in vivo potency of tulathromycin.


Assuntos
Antibacterianos/farmacologia , Dissacarídeos/farmacologia , Compostos Heterocíclicos/farmacologia , Mannheimia haemolytica/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Pasteurella multocida/efeitos dos fármacos , Animais , Bovinos , Meios de Cultura , Mannheimia haemolytica/crescimento & desenvolvimento , Pasteurella multocida/crescimento & desenvolvimento
6.
J Vet Pharmacol Ther ; 40(1): 16-27, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27501187

RESUMO

The pharmacokinetic (PK) profile of tulathromycin, administered to calves subcutaneously at the dosage of 2.5 mg/kg, was established in serum, inflamed (exudate), and noninflamed (transudate) fluids in a tissue cage model. The PK profile of tulathromycin was also established in pneumonic calves. For Mannheimia haemolytica and Pasteurella multocida, tulathromycin minimum inhibitory concentrations (MIC) were approximately 50 times lower in calf serum than in Mueller-Hinton broth. The breakpoint value of the PK/pharmacodynamic (PD) index (AUC(0-24 h) /MIC) to achieve a bactericidal effect was estimated from in vitro time-kill studies to be approximately 24 h for M. haemolytica and P. multocida. A population model was developed from healthy and pneumonic calves and, using Monte Carlo simulations, PK/PD cutoffs required for the development of antimicrobial susceptibility testing (AST) were determined. The population distributions of tulathromycin doses were established by Monte Carlo computation (MCC). The computation predicted a target attainment rate (TAR) for a tulathromycin dosage of 2.5 mg/kg of 66% for M. haemolytica and 87% for P. multocida. The findings indicate that free tulathromycin concentrations in serum suffice to explain the efficacy of single-dose tulathromycin in clinical use, and that a dosage regimen can be computed for tulathromycin using classical PK/PD concepts.


Assuntos
Antibacterianos/administração & dosagem , Dissacarídeos/administração & dosagem , Compostos Heterocíclicos/administração & dosagem , Animais , Animais Recém-Nascidos , Antibacterianos/análise , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/veterinária , Bovinos , Doenças dos Bovinos/tratamento farmacológico , Dissacarídeos/análise , Dissacarídeos/farmacocinética , Dissacarídeos/uso terapêutico , Exsudatos e Transudatos/química , Feminino , Compostos Heterocíclicos/análise , Compostos Heterocíclicos/farmacocinética , Compostos Heterocíclicos/uso terapêutico , Injeções Subcutâneas/veterinária
7.
BMC Vet Res ; 11: 296, 2015 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-26634699

RESUMO

BACKGROUND: The role of cyclooxygenase(COX)-1 and COX-2 in the saluretic and renin-angiotensin responses to loop diuretics in the cat is unknown. We propose in vivo characterisation of isoform roles in a furosemide model by administering non-steroidal anti-inflammatory drugs (NSAIDs) with differing selectivity profiles: robenacoxib (COX-2 selective) and ketoprofen (COX-1 selective). RESULTS: In this four period crossover study, we compared the effect of four treatments: placebo, robenacoxib once or twice daily and ketoprofen once daily concomitantly with furosemide in seven healthy cats. For each period, urine and blood samples were collected at baseline and within 48 h of treatment starting. Plasma renin activity (PRA), plasma and urinary aldosterone concentrations, glomerular filtration rate (GFR) and 24 h urinary volumes, electrolytes and eicosanoids (PGE2, 6-keto-PGF1α, TxB2), renal injury biomarker excretions [N-acetyl-beta-D-glucosaminidase (NAG) and Gamma-Glutamyltransferase] were measured. Urine volume (24 h) and urinary sodium, chloride and calcium excretions increased from baseline with all treatments. Plasma creatinine increased with all treatments except placebo, whereas GFR was significantly decreased from baseline only with ketoprofen. PRA increased significantly with placebo and once daily robenacoxib and the increase was significantly higher with placebo compared to ketoprofen (10.5 ± 4.4 vs 4.9 ± 5.0 ng ml(-1) h(-1)). Urinary aldosterone excretion increased with all treatments but this increase was inhibited by 75 % with ketoprofen and 65 % with once daily robenacoxib compared to placebo. Urinary PGE2 excretion decreased with all treatments and excretion was significantly lower with ketoprofen compared to placebo. Urinary TxB2 excretion was significantly increased from baseline only with placebo. NAG increased from baseline with all treatments. Immunohistochemistry on post-mortem renal specimens, obtained from a different group of cats that died naturally of non-renal causes, suggested constitutive COX-1 and COX-2 co-localization in many renal structures including the macula densa (MD). CONCLUSIONS: These data suggest that both COX-1 and COX-2 could generate the signal from the MD to the renin secreting cells in cats exposed to furosemide. Co-localization of COX isoenzymes in MD cells supports the functional data reported here.


Assuntos
Ciclo-Oxigenase 1/metabolismo , Ciclo-Oxigenase 2/metabolismo , Difenilamina/análogos & derivados , Furosemida/toxicidade , Cetoprofeno/farmacologia , Rim/efeitos dos fármacos , Fenilacetatos/farmacologia , Animais , Gatos , Estudos Cross-Over , Ciclo-Oxigenase 1/genética , Ciclo-Oxigenase 2/genética , Inibidores de Ciclo-Oxigenase/administração & dosagem , Inibidores de Ciclo-Oxigenase/farmacologia , Difenilamina/administração & dosagem , Difenilamina/farmacologia , Eicosanoides/urina , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Regulação Enzimológica da Expressão Gênica/fisiologia , Taxa de Filtração Glomerular/efeitos dos fármacos , Taxa de Filtração Glomerular/veterinária , Cetoprofeno/administração & dosagem , Rim/enzimologia , Rim/metabolismo , Fenilacetatos/administração & dosagem , Isoformas de Proteínas , Transporte Proteico , Renina/sangue , Renina/metabolismo
8.
J Vet Pharmacol Ther ; 38(1): 1-14, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25413929

RESUMO

Mavacoxib is a novel nonsteroidal anti-inflammatory drug (NSAID), with a preferential action on the cyclooxygenase (COX)-2 isoform of COX and a long duration of action. It is classified chemically as a member of the sulphonamide subgroup of coxibs. Mavacoxib is highly lipid but very poorly water soluble. In the dog, the pharmacokinetic (PK) profile comprises very slow body clearance, long elimination half-life and a relatively large distribution volume. Biotransformation and renal excretion are very limited, and elimination occurs primarily by biliary secretion and excretion of unchanged drug in faeces. The PK profile of mavacoxib differs quantitatively between young healthy dogs (Beagles and mongrels) and clinical cases with osteoarthritis (OA). In OA dogs, mavacoxib exhibits a much longer terminal half-life, associated principally with their greater median body weight compared with dogs used in preclinical studies. There is also some evidence of breed differences and a small effect of age on mavacoxib PK in the OA canine population. The pharmacodynamics (PD) of mavacoxib has been established: (i) in whole blood assays at the molecular level (inhibition of COX-1 and COX-2 isoforms); (ii) in preclinical models of inflammation and pain; and (iii) in clinical OA subjects treated with mavacoxib. The dosage schedule of mavacoxib for clinical use has been determined by owner and veterinary clinical assessments and is supported by integration of PK and PD preclinical data with clinical responses in canine disease models and in dogs with naturally occurring OA. The dosage regimen has been further confirmed by correlating levels of inhibition of COX isoforms in in vitro whole blood assays with plasma concentrations of mavacoxib achieved in OA dogs. In addition to the specific properties of mavacoxib, some general aspects of the PK and PD of other agents of the NSAID group, together with pathophysiological and clinical aspects of OA, are reviewed, as a basis for correlating with the safety and efficacy of mavacoxib in therapeutic use. Integration of PK and PD data suggests that the recommended dosage regimen of 2 mg/kg bw once for 14 days, followed by administration at monthly intervals, is optimal from both efficacy and safety perspectives and is further confirmed by clinical field studies.


Assuntos
Anti-Inflamatórios não Esteroides/farmacocinética , Anti-Inflamatórios não Esteroides/uso terapêutico , Doenças do Cão/tratamento farmacológico , Pirazóis/farmacocinética , Pirazóis/uso terapêutico , Animais , Anti-Inflamatórios não Esteroides/efeitos adversos , Cães , Pirazóis/efeitos adversos
9.
J Vet Pharmacol Ther ; 38(5): 457-70, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25669418

RESUMO

The antimicrobial properties of amoxicillin were determined for the bovine respiratory tract pathogens, Mannheima haemolytica and Pasteurella multocida. Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and time-kill curves were established. Pharmacokinetic (PK)/pharmacodynamic (PD) modelling of the time-kill data, based on the sigmoidal Emax equation, generated parameters for three levels of efficacy, namely bacteriostatic, bactericidal (3log10 reduction) and 4log10 reduction in bacterial counts. For these levels, mean AUC(0-24 h) /MIC serum values for M. haemolytica were 29.1, 57.3 and 71.5 h, respectively, and corresponding values for P. multocida were 28.1, 44.9 and 59.5 h. Amoxicillin PK was determined in calf serum, inflamed (exudate) and noninflamed (transudate) tissue cage fluids, after intramuscular administration of a depot formulation at a dosage of 15 mg/kg. Mean residence times were 16.5 (serum), 29.6 (exudate) and 29.0 h (transudate). Based on serum MICs, integration of in vivo PK and in vitro PD data established maximum concentration (Cmax )/MIC ratios of 13.9:1 and 25.2:1, area under concentration-time curve (AUC0-∞ )/MIC ratios of 179 and 325 h and T>MIC of 40.3 and 57.6 h for P. multocida and M. haemolytica, respectively. Monte Carlo simulations for a 90% target attainment rate predicted single dose to achieve bacteriostatic and bactericidal actions over 48 h of 17.7 and 28.3 mg/kg (M. haemolytica) and 17.7 and 34.9 mg/kg (P. multocida).


Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Doenças dos Bovinos/tratamento farmacológico , Mannheimia haemolytica/efeitos dos fármacos , Infecções por Pasteurella/veterinária , Pasteurella multocida/efeitos dos fármacos , Pneumonia Enzoótica dos Bezerros/tratamento farmacológico , Amoxicilina/administração & dosagem , Amoxicilina/farmacocinética , Animais , Animais Recém-Nascidos , Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Bovinos , Doenças dos Bovinos/microbiologia , Preparações de Ação Retardada , Feminino , Injeções Intramusculares/veterinária , Testes de Sensibilidade Microbiana/veterinária , Infecções por Pasteurella/tratamento farmacológico , Infecções por Pasteurella/microbiologia , Pneumonia Enzoótica dos Bezerros/microbiologia
10.
J Vet Pharmacol Ther ; 37(4): 354-66, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24628410

RESUMO

Robenacoxib and ketoprofen are acidic nonsteroidal anti-inflammatory drugs (NSAIDs). Both are licensed for once daily administration in the cat, despite having short blood half-lives. This study reports the pharmacokinetic/pharmacodynamic (PK/PD) modelling of each drug in a feline model of inflammation. Eight cats were enrolled in a randomized, controlled, three-period cross-over study. In each period, sterile inflammation was induced by the injection of carrageenan into a subcutaneously implanted tissue cage, immediately before the subcutaneous injection of robenacoxib (2 mg/kg), ketoprofen (2 mg/kg) or placebo. Blood samples were taken for the determination of drug and serum thromboxane (Tx)B2 concentrations (measuring COX-1 activity). Tissue cage exudate samples were obtained for drug and prostaglandin (PG)E2 concentrations (measuring COX-2 activity). Individual animal pharmacokinetic and pharmacodynamic parameters for COX-1 and COX-2 inhibition were generated by PK/PD modelling. S(+) ketoprofen clearance scaled by bioavailability (CL/F) was 0.114 L/kg/h (elimination half-life = 1.62 h). For robenacoxib, blood CL/F was 0.684 L/kg/h (elimination half-life = 1.13 h). Exudate elimination half-lives were 25.9 and 41.5 h for S(+) ketoprofen and robenacoxib, respectively. Both drugs reduced exudate PGE2 concentration significantly between 6 and 36 h. Ketoprofen significantly suppressed (>97%) serum TxB2 between 4 min and 24 h, whereas suppression was mild and transient with robenacoxib. In vivo IC50 COX-1/IC50 COX-2 ratios were 66.9:1 for robenacoxib and 1:107 for S(+) ketoprofen. The carboxylic acid nature of both drugs may contribute to the prolonged COX-2 inhibition in exudate, despite short half-lives in blood.


Assuntos
Doenças do Gato/induzido quimicamente , Difenilamina/análogos & derivados , Inflamação/tratamento farmacológico , Cetoprofeno/farmacologia , Cetoprofeno/farmacocinética , Fenilacetatos/farmacologia , Fenilacetatos/farmacocinética , Animais , Anti-Inflamatórios não Esteroides/sangue , Anti-Inflamatórios não Esteroides/química , Anti-Inflamatórios não Esteroides/farmacocinética , Anti-Inflamatórios não Esteroides/farmacologia , Carragenina/toxicidade , Doenças do Gato/tratamento farmacológico , Gatos , Cultura em Câmaras de Difusão , Difenilamina/sangue , Difenilamina/química , Difenilamina/farmacocinética , Difenilamina/farmacologia , Feminino , Cetoprofeno/sangue , Cetoprofeno/química , Masculino , Estrutura Molecular , Fenilacetatos/sangue , Fenilacetatos/química
11.
J Vet Pharmacol Ther ; 37(3): 231-42, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24341543

RESUMO

Florfenicol was administered subcutaneously to 10 calves at a dose of 40 mg/kg. Pharmacokinetic-pharmacodynamic (PK-PD) integration and modelling of the data were undertaken using a tissue cage model, which allowed comparison of microbial growth inhibition profiles in three fluids, serum, exudate and transudate. Terminal half-lives were relatively long, so that florfenicol concentrations were well maintained in all three fluids. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration were determined in vitro for six strains each of the calf pneumonia pathogens, Mannhemia haemolytica and Pasteurella multocida. An PK-PD integration for three serum indices provided mean values for P. multocida and M. haemolytica, respectively, of 12.6 and 10.4 for Cmax /MIC, 183 and 152 h for AUC0-24 h /MIC and 78 and 76 h for T>MIC. Average florfenicol concentrations in serum exceeded 4 × MIC and 1.5 × MIC for the periods 0-24 and 48-72 h, respectively. Ex vivo growth inhibition curves for M. haemolytica and P. multocida demonstrated a rapid (with 8 h of exposure) and marked (6 log10 reduction in bacterial count or greater) killing response, suggesting a concentration-dependent killing action. During 24-h incubation periods, inhibition of growth to a bacteriostatic level or greater was maintained in serum samples collected up to 96 h and in transudate and exudate samples harvested up to 120 h. Based on the sigmoidal Emax relationship, PK-PD modelling of the ex vivo time-kill data provided AUC0-24 h /MIC serum values for three levels of growth inhibition, bacteriostatic, bactericidal and 4 log10 decrease in bacterial count; mean values were, respectively, 8.2, 26.6 and 39.0 h for M. haemolytica and 7.6, 18.1 and 25.0 h for P. multocida. Similar values were obtained for transudate and exudate. Based on pharmacokinetic and PK-PD modelled data obtained in this study and scientific literature values for MIC distributions, Monte Carlo simulations over 100 000 trials were undertaken to predict once daily dosages of florfenicol required to provide 50% and 90% target attainment rates for three levels of growth inhibition, namely, bacteriostasis, bactericidal action and 4 log10 reduction in bacterial count.


Assuntos
Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Bovinos/metabolismo , Tianfenicol/análogos & derivados , Animais , Antibacterianos/administração & dosagem , Antibacterianos/química , Área Sob a Curva , Bovinos/sangue , Exsudatos e Transudatos/química , Feminino , Meia-Vida , Injeções Subcutâneas , Mannheimia haemolytica/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Modelos Biológicos , Pasteurella multocida/efeitos dos fármacos , Tianfenicol/administração & dosagem , Tianfenicol/química , Tianfenicol/farmacocinética , Tianfenicol/uso terapêutico
12.
Vet J ; 305: 106136, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38759725

RESUMO

The Pharmacokinetic/Pharmacodynamic (PK/PD) relationship of antimicrobial drugs (AMD) for surgical prophylaxis has been poorly studied, hampering evidence-based decision making around AMD dosing and timing. Our objective is to use PK/PD principles to inform (1) the timing of administration and (2) the interval for re-administration of AMD used peri-operatively in dogs. Raw plasma concentrations of cefazolin, cefuroxime, cefalexin, amoxicillin and ampicillin were retrieved from original intravenous studies performed in dogs. E. coli and methicillin-susceptible staphylococci were identified as possible intraoperative contaminants and their epidemiological cut-offs (ECOFF) were retrieved from the EUCAST database. Individual PK data were refitted with non-linear mixed effect models (Phoenix®). We performed Monte Carlo simulation to compute i) the 95th percentile of time of peak concentration in the peripheral compartment (informing timing between administration and first incision) and ii) the duration for which at least 90% of dogs maintain a free plasma concentration above ECOFF (informing timing of re-administration: 1.5-4 h). Cefazolin (22-25 mg/kg), cefuroxime (20 mg/kg), cefalexin (15 mg/kg) and amoxicillin (16.7 mg/kg) reached peak peripheral concentrations within 30 min, but ampicillin (20 mg/kg) required 82 min, respectively. For methicillin-susceptible staphylococci, cefazolin and cefuroxime require re-administration every 2 h, whereas cefalexin and both amoxicillin and ampicillin can be readministered every 3 and 4 h, respectively. For E. coli, only cefazolin provided adequate perioperative coverage with 2-hourly administration, where cefuroxime and cefalexin failed uniformly. Alternatively, ampicillin and amoxicillin (critically ill dogs) may cover E. coli contaminations, but only if readministered every 1.5 h. These PK-derived conclusions provide a rationale for perioperative AMD administration timing.


Assuntos
Antibacterianos , Antibioticoprofilaxia , beta-Lactamas , Cães , Animais , Antibacterianos/farmacocinética , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/veterinária , beta-Lactamas/farmacocinética , beta-Lactamas/administração & dosagem , Doenças do Cão/prevenção & controle , Doenças do Cão/tratamento farmacológico , Infecção da Ferida Cirúrgica/veterinária , Infecção da Ferida Cirúrgica/prevenção & controle , Escherichia coli/efeitos dos fármacos , Método de Monte Carlo
13.
Vet J ; 304: 106101, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38490359

RESUMO

Surgical antimicrobial prophylaxis (SAP) is widely used to reduce the risk of surgical site infections (SSI), but there is uncertainty as to what the proportion of SSI reduction is. Therefore, it is difficult for surgeons to properly weigh the costs, risks and benefits for individual patients when deciding on the use of SAP, making it challenging to promote antimicrobial stewardship in primary practice settings. The objective of this study was to map the veterinary evidence focused on assessing the effect of SAP on SSI development and in order to identify surgical procedures with some research evidence and possible knowledge gaps. In October 2021 and December 2022, Scopus, CAB Abstracts, Web of Science Core Collection, Embase and MEDLINE were systematically searched. Double blinded screening of records was performed to identify studies in companion animals that reported on the use of SAP and SSI rates. Comparative data were available from 34 out of 39123 records screened including: eight randomised controlled trials (RCT), 23 cohort studies (seven prospective and 16 retrospective) and three retrospective case series representing 12476 dogs and cats in total. Extracted data described peri- or post-operative SAP in nine, and 25 studies, respectively. In the eight RCTs evaluating SAP in companion animals, surgical procedure coverage was skewed towards orthopaedic stifle surgeries in referral settings and there was large variation in SAP protocols, SSI definitions and follow-up periods. More standardized data collection and agreement of SSI definitions is needed to build stronger evidence for optimized patient care.


Assuntos
Anti-Infecciosos , Doenças do Gato , Doenças do Cão , Humanos , Animais , Gatos , Cães , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/veterinária , Antibioticoprofilaxia/métodos , Animais de Estimação , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/veterinária , Infecção da Ferida Cirúrgica/tratamento farmacológico , Anti-Infecciosos/uso terapêutico , Doenças do Gato/tratamento farmacológico , Doenças do Gato/prevenção & controle , Doenças do Cão/tratamento farmacológico , Doenças do Cão/prevenção & controle , Doenças do Cão/cirurgia
14.
J Vet Pharmacol Ther ; 2013 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-23713757

RESUMO

The Animal Health Modeling & Simulation Society (AHM&S) is a newly founded association (2012) that aims to promote the development, application, and dissemination of modeling and simulation techniques in the field of Veterinary Pharmacology and Toxicology. The association is co-chaired by Pr. Johan Gabrielsson (Europe), Pr. Jim Riviere (USA), and secretary Dr. Jonathan Mochel (Switzerland). This short communication aims at presenting the membership, rationale and objectives of this group.

15.
J Small Anim Pract ; 64(10): 626-634, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37340896

RESUMO

OBJECTIVES: Amoxicillin/clavulanate is the most commonly used oral antimicrobial drug in companion animals. The objective of the study was to detect types and frequency of deficits in the quality of veterinary oral formulations of amoxicillin/clavulanate in various countries. MATERIALS AND METHODS: In a prospective study with purposive sampling, amoxicillin/clavulanate tablet formulations for canine use were collected in four countries (wholesalers or veterinary practice) and shipped to a central bioanalytical laboratory. Twenty-four samples were collected from the UK (nine), Malaysia (nine), Serbia (four) and Thailand (two), yielding 18 different formulations (10 veterinary). Packaging inspection, tablet disintegration and content assay were conducted (validated high-performance liquid chromatography with ultra-violet detection); content was acceptable when within the 90% to 120% pre-specified range (US Pharmacopeia). RESULTS: Secondary packaging was present for 13 of 24 samples and primary packaging integrity was verified for all but one sample. Amoxicillin trihydrate/potassium clavulanate label ratio was 4:1, except for three formulations (2:1). Tablet dose strength ranged from 250 to 625 mg. All formulations contained both analytes. For amoxicillin, two of 24 samples were out of specification with 72.8% (Malaysia) and 82.3% (Thailand) of labelled content. For clavulanate, four of 24 samples were out of specification with 46.9% (Serbia), 79.0% (UK), 84.3% (Serbia) and 86.5% (Thailand) of labelled content. One formulation (Thailand) failed for both analytes. CLINICAL SIGNIFICANCE: Antimicrobial formulations of substandard quality have negative consequences for efficacy in patients and potentially promote antimicrobial resistance. There was evidence of substandard formulations in all countries, not only for amoxicillin but especially for clavulanate; this could compromise equitable access to acceptable quality essential veterinary medicines worldwide.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio , Anti-Infecciosos , Animais , Cães , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Malásia , Sérvia , Tailândia , Estudos Prospectivos , Amoxicilina , Ácido Clavulânico/uso terapêutico , Comprimidos , Reino Unido , Antibacterianos/uso terapêutico
16.
J Vet Pharmacol Ther ; 35(3): 239-48, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21781136

RESUMO

Four cylindrical silicon tissue cages (TC, internal volume: 6.7 ± 0.11 cm(3)) were inserted subcutaneously in 29 young healthy cats. A mild inflammatory reaction was induced by intracaveal injection of 1 mL of a 2%λ-carrageenan solution. TC exudate was subsequently sampled at predetermined times (up to 120 h) to measure exudate leucocyte counts and the concentrations of protein and eicosanoids. TC remained in situ for 9-10 months and were well tolerated. Leucocyte counts peaked at 34 h (50.1 ± 57.6 × 10(3) cells/mm(3) ) and returned towards baseline after 72 h. Protein concentration increased from 26.2 ± 2.7 g/L to a peak of 35.9 ± 6.0 g/L at 12 h before returning to baseline at 48 h. Exudate prostaglandin (PG)E(2) concentration peaked at 24 h (11.7 ± 13.7 ng/mL) and returned to baseline by 120 h. Repeated collection of fluid from noninjected cages did not increase transudate PGE(2). Ketoprofen (2 mg/kg, subcutaneously) suppressed exudate PGE(2) at 24 h. The carrageenan-stimulated TC model is an ethical and novel means of investigating soft tissue inflammation in the cat, in which exudate PGE(2) acts as surrogate marker of cyclooxygenase-2 activity. This model will facilitate the investigation of in vivo pharmacokinetics and pharmacodynamics of anti-inflammatory drugs in this species.


Assuntos
Doenças do Gato/induzido quimicamente , Cultura em Câmaras de Difusão/veterinária , Modelos Animais de Doenças , Inflamação/veterinária , Doença Aguda , Animais , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Carragenina/farmacologia , Doenças do Gato/etiologia , Doenças do Gato/imunologia , Gatos , Dinoprostona/análise , Exsudatos e Transudatos/química , Inflamação/induzido quimicamente , Inflamação/tratamento farmacológico , Inflamação/imunologia , Injeções Subcutâneas , Contagem de Leucócitos/veterinária , Silício
17.
J Vet Pharmacol Ther ; 35(1): 19-32, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21767277

RESUMO

Robenacoxib is a novel nonsteroidal anti-inflammatory drug developed for use in cats. It is a highly selective COX-2 inhibitor. Results from previous feline studies showed that, despite a short half-life in blood, the effect of robenacoxib persisted for 24 h in clinical studies. A tissue cage model of acute inflammation was used to determine robenacoxib's pharmacokinetics and its ex vivo and in vivo selectivity for COX-1 and COX-2 using serum TxB(2) and exudate PGE(2) as surrogate markers for enzyme activity, respectively. After intravenous, subcutaneous and oral administration (2 mg/kg), the clearance of robenacoxib from blood was rapid (0.54-0.71 L·h/kg). The mean residence time (MRT) in blood was short (0.4, 1.9 and 3.3 h after intravenous, subcutaneous and oral administration, respectively), but in exudate MRT was approximately 24 h regardless of the route of administration. Robenacoxib inhibition of COX-1 in blood was transient, occurring only at high concentrations, but inhibition of COX-2 in exudate persisted to 24 h. The potency ratio (IC(50) COX-1: IC(50) COX-2) was 171:1, and slopes of the concentration-effect relationship were 1.36 and 1.12 for COX-1 and COX-2, respectively. These data highlight the enzymatic selectivity and inflamed tissue selectivity of robenacoxib and support the current recommendation of once-daily administration.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Anti-Inflamatórios não Esteroides/farmacocinética , Difenilamina/análogos & derivados , Inflamação/tratamento farmacológico , Fenilacetatos/farmacologia , Fenilacetatos/farmacocinética , Animais , Anti-Inflamatórios não Esteroides/sangue , Área Sob a Curva , Doenças do Gato/sangue , Doenças do Gato/tratamento farmacológico , Doenças do Gato/metabolismo , Gatos , Estudos Cross-Over , Cultura em Câmaras de Difusão , Dinoprostona/sangue , Dinoprostona/metabolismo , Difenilamina/sangue , Difenilamina/farmacocinética , Difenilamina/farmacologia , Feminino , Meia-Vida , Masculino , Fenilacetatos/sangue , Prostaglandinas/sangue , Tromboxano B2/sangue , Tromboxano B2/metabolismo
18.
Lab Anim ; 56(6): 540-549, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35850552

RESUMO

The objective of this study was to describe prolonged surgical anaesthesia and recovery in fire salamanders (Salamandra salamandra) using tricaine methanesulfonate (MS-222). A total of 14 salamanders were anaesthetised for electromyography wire implantation. Sodium bicarbonate buffered solutions (0.5-4 g l-1) of MS-222 were prepared (adjusted to pH 7.0). Anaesthesia was induced by partial immersion in pre-oxygenated 3 g l-1 solution for 20 min. Buprenorphine (0.5 mg kg-1) was administered subcutaneously. During microsurgery, heart rate (HR), solution pH and temperature were recorded. Reflectance pulse oximeter (SpO2) (Masimo Rad-57) was recorded in two salamanders. Anaesthetic plane and MS-222 pH stability (pH 7.6) were maintained by renewing administration of oxygenated MS-222 solution (0.5-3 g l-1) onto swabs that partially covered the body. Recovery started at the end of surgery (MS-222 0 g l-1). Postoperatively, salamanders were given oral meloxicam (0.2 mg kg-1). Mean time for loss of righting reflex during induction was 13.7 ± 2.2 min. Duration of anaesthesia and time to recovery were 111 ± 24.2 and 31 ± 10.3 min, respectively. Due to complications, two salamanders did not recover. Baseline HR was 67.4 ± 34.5 beats/min, and it decreased significantly until recovery (p ≤ 0.0001). In two salamanders, baseline SpO2 was 85.5% ± 14.5, SpO2 during surgery was 61% ± 6.4, improving to 80.5% ± 2.1 on recovery.In conclusion, prolonged recovery anaesthesia is achievable with MS-222 dilutions in salamander. Reflectance SpO2 could prove valuable during immersion anaesthesia.


Assuntos
Anestesia , Salamandra , Animais , Aminobenzoatos , Anestesia/métodos , Mesilatos
19.
Integr Org Biol ; 2(1): obaa015, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33791558

RESUMO

Salamanders and newts (urodeles) are often used as a model system to elucidate the evolution of tetrapod locomotion. Studies range from detailed descriptions of musculoskeletal anatomy and segment kinematics, to bone loading mechanics and inferring central pattern generators. A further area of interest has been in vivo muscle activity patterns, measured through electromyography (EMG). However, most prior EMG work has primarily focused on muscles of the forelimb or hindlimb in specific species or the axial system in others. Here we present data on forelimb, hindlimb, and epaxial muscle activity patterns in one species, Salamandra salamandra, during steady state walking. The data are calibrated to limb stride cycle events (stance phase, swing phase), allowing direct comparisons to homologous muscle activation patterns recorded for other walking tetrapods (e.g., lizards, alligators, turtles, mammals). Results demonstrate that Salamandra has similar walking kinematics and muscle activity patterns to other urodele species, but that interspecies variation does exist. In the forelimb, both the m. dorsalis scapulae and m. latissimus dorsi are active for 80% of the forelimb swing phase, while the m. anconaeus humeralis lateralis is active at the swing-stance phase transition and continues through 86% of the stance phase. In the hindlimb, both the m. puboischiofemoralis internus and m. extensor iliotibialis anterior are active for 30% of the hindlimb swing phase, while the m. caudofemoralis is active 65% through the swing phase and remains active for most of the stance phase. With respect to the axial system, both the anterior and posterior m. dorsalis trunci display two activation bursts, a pattern consistent with stabilization and rotation of the pectoral and pelvic girdles. In support of previous assertions, comparison of Salamandra muscle activity timings to other walking tetrapods revealed broad-scale similarities, potentially indicating conservation of some aspects of neuromuscular function across tetrapods. Our data provide the foundation for building and testing dynamic simulations of fire salamander locomotor biomechanics to better understand musculoskeletal function. They could also be applied to future musculoskeletal simulations of extinct species to explore the evolution of tetrapod locomotion across deep-time.


Padrones de actividad muscular epaxial y apendicular durante la cursorialidad de la salamandra-de-fuego, Salamandra salamandra Las salamandras y los tritones (urodelos) son utilizados con frecuencia como un sistema modelo para dilucidar la evolución de la locomoción en los tetrápodos. Los estudios previos varían de descripciones detalladas de la anatomía musculoesquelética y cinemática de los segmentos del cuerpo, a la mecánica de la capacidad de soporte de carga estructural ósea y la generación de padrones centrales. Otra área de interés ha sido los padrones de actividad muscular in vivo, medidos por electromiografía (EMG). Sin embargo, la mayoría de los trabajos anteriores con EMG se han centrado principalmente en los músculos de los miembros anteriores o posteriores en especies específicas o en el sistema axial de otras. En este trabajo, presentamos datos sobre los padrones de actividad muscular en los músculos de los miembros anteriores, posteriores y de la musculatura epaxial en una especie, Salamandra salamandra, durante la marcha continua. Los datos se calibran para los períodos del ciclo de caminar de los miembros (fase de soporte, fase de movimiento), lo que permite comparaciones directas con padrones de activación muscular homólogos registrados para otros tetrápodos cursoriales (por ejemplo, lagartos, caimanes, tortugas y mamíferos). Los resultados demuestran que Salamandra tiene padrones de cinemática cursorial y actividad muscular similares a otras especies de urodelos, pero con variación interespecífica. En los miembros anteriores, ambos los m. dorsalis scapulae y m. latissimus dorsi están activos en 80% de la fase de movimiento del miembro anterior, mientras que el m. anconaeus humeralis lateralis se activa en la transición de la fase de movimiento-soporte y permanece activo en 86% de la fase de soporte. En los miembros posteriores, ambos m. puboischiofemoralis internus y m. extensor iliotibialis anterior están activos en 30% de la fase de movimiento de los miembros posteriores, mientras que el m. caudofemoralis está activo durante el 65% de la fase de movimiento, permaneciendo activo durante la mayor parte de la fase de soporte. Con respecto al sistema axial, las porciones anterior y posterior del m. dorsalis trunci exhibe dos períodos de activación, un padrón consistente con la estabilización y rotación de la cintura pélvica y pectoral. Como sugirido anteriormente, la comparación de los tiempos de actividad muscular de Salamandra con otros tetrápodos cursoriales reveló similitudes en gran escala, lo que podría indicar la conservación de algunos aspectos de la función neuromuscular entre los tetrápodos. Nuestros datos proporcionan una base para la construcción y prueba de simulaciones dinámicas de la biomecánica locomotora de salamandras-de-fuego para comprender mejor las funciones musculoesqueléticas. Nuestros resultados también se pueden aplicar a futuras simulaciones musculoesqueléticas de especies extintas para explorar la evolución de la locomoción de tetrápodos en el tiempo profundo.


Padrões de atividade muscular epaxial e apendicular durante a cursorialidade da salamandra-de-fogo, Salamandra salamandra Salamandras e tritões (urodelos) são freqüentemente utilizados como um sistema modelo para elucidar a evolução da locomoção em tetrápodes. Estudos anteriores variam de descrições detalhadas da anatomia musculoesquelética e cinemática dos segmentos corporais, a mecânica da capacidade de carga estrutural óssea e geradora de padrões centrais. Uma outra área de interesse tem sido os padrões de atividade muscular in vivo, medidos por eletromiografia (EMG). No entanto, a maioria dos trabalhos anteriores de EMG concentrou-se principalmente nos músculos dos membros anteriores ou posteriores em espécies específicas ou no sistema axial de outras. Nesse trabalho, apresentamos dados sobre os padrões de atividade muscular nos membros anteriores, posteriores e musculatura epaxial em uma espécie, Salamandra salamandra, durante caminhada em modo contínuo. Os dados são calibrados para os períodos do ciclo de caminhada dos membros (fase de apoio, fase de movimento), permitindo comparações diretas com padrões de ativação muscular homólogos registrados para outros tetrápodes cursoriais (por exemplo, lagartos, jacarés, tartarugas e mamíferos). Os resultados demonstram que Salamandra possui padrões de cinemática cursorial e atividade muscular semelhantes à outras espécies de urodelos, mas com variação interespecífica. Nos membros anteriores, ambos os m. dorsalis scapulae e m. latissimus dorsi estão ativos em 80% da fase de movimento do membro anterior, enquanto o m. anconaeus humeralis lateralis é ativado na transição da fase de movimento-apoio e continua ativo em 86% da fase de apoio. Nos membros posteriores, ambos m. puboischiofemoralis internus e m. extensor iliotibialis anterior estão ativos em 30% da fase de movimento dos membros posteriores, enquanto o m. caudofemoralis está ativo por 65% da fase de movimento, permanecendo ativo na maior parte da fase de apoio. No que diz respeito ao sistema axial, as porções anterior e posterior do m. dorsalis trunci exibe dois períodos de ativação, um padrão consistente com a estabilização e rotação da cintura peitoral e pélvica. Como préviamente sugerido, a comparação dos tempos de atividade muscular de Salamandra com outros tetrápodes cursoriais revelou similaridades em larga escala, potencialmente indicando a conservação de alguns aspectos da função neuromuscular entre tetrápodes. Os nossos dados fornecem uma base para a construção e testagem de simulações dinâmicas da biomecânica locomotora de salamandras-de-fogo para se entender melhor as funções músculo-esqueléticas. Nossos resultados também podem ser aplicados a futuras simulações músculo-esqueléticas de espécies extintas para explorar a evolução da locomoção de tetrápodes no tempo profundo.

20.
Vet J ; 250: 55-62, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383420

RESUMO

Pregabalin is the first-line treatment for neuropathic pain (NeP) in humans. Dogs with Chiari-like malformation and syringomyelia (CM/SM) associated with NeP could benefit from pregabalin. The aim of this study was to evaluate the efficacy of pregabalin for NeP in dogs with CM/SM. Eight dogs with symptomatic CM/SM were included in a double-masked, randomised, crossover placebo-controlled clinical trial. All dogs received anti-inflammatory drugs as base-line treatment during placebo or pregabalin phase of 14±4 days each. Analgesic efficacy was assessed with a daily numerical rating scale (NRS) recorded by dog owners (0-10, 10=worst pain) and quantitative sensory testing at baseline, placebo and pregabalin phases. Blood samples were collected to report pregabalin exposure and to assess renal function. Daily NRS scores recorded by dog owners in the pregabalin group were lower than in the placebo group (P=0.006). Mechanical thresholds were higher with pregabalin compared to baseline or placebo (P=0.037, P<0.001). Cold latency at 15°C was prolonged on the neck and humeri with pregabalin compared to baseline (P<0.001 for both) or placebo (P=0.02, P=0.0001). Cold latency at 0°C was longer on pregabalin compared to baseline and placebo (P=0.001, P=0.004). There was no pregabalin accumulation between first and last dose. This study demonstrates the efficacy of pregabalin for the treatment of NeP due to CM/SM on daily pain scores recorded by dog owners. Pregabalin significantly reduced mechanical hyperalgesia, cold hyperalgesia (0°C) and allodynia (15°C) compared to placebo. Pregabalin was non-cumulative and well tolerated with occasional mild sedation.


Assuntos
Analgésicos/uso terapêutico , Doenças do Cão/tratamento farmacológico , Neuralgia/veterinária , Pregabalina/uso terapêutico , Siringomielia/veterinária , Animais , Malformação de Arnold-Chiari/tratamento farmacológico , Malformação de Arnold-Chiari/veterinária , Estudos Cross-Over , Cães , Método Duplo-Cego , Feminino , Hiperalgesia , Masculino , Neuralgia/tratamento farmacológico , Medição da Dor , Siringomielia/tratamento farmacológico
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