Under pressure: A survey of Canadian veterinarians in the diagnosis and treatment of feline hypertension.

Objectives: The objectives of this study were to explore feline hypertension diagnostics and treatment practices among Canadian veterinarians and to identify barriers to recommending blood pressure monitoring in senior (> 7 y) feline wellness patients. Procedure: An online survey was developed and circulated by CommuniVET using email and social media. Results: A total of 114 Canadian veterinarians completed the survey. Most respondents indicated that they either do not recommend (n = 45; 39.5%) or occasionally recommend (n = 47; 41.2%) blood pressure monitoring in senior (> 7 y) feline wellness examinations. The most frequently reported barriers to recommending a blood pressure evaluation were the difficulty in interpreting results in stressed patients (n = 87; 76.3%), time involved in obtaining blood pressure (n = 73; 64.0%), and cost to the owner (n = 54; 47.4%). When faced with a patient diagnosed with a comorbidity commonly associated with hypertension, most respondents indicated that they always recommend (n = 38; 33.3%) or frequently recommend (n = 27; 23.7%) blood pressure monitoring. Most veterinarians' first line treatment for hypertension was amlodipine for primary (n = 81; 71.1%) and secondary (n = 39; 34.2%) hypertension. Conclusion: Most veterinarians did not routinely recommend blood pressure evaluation during senior feline wellness examinations. Although the frequency of recommendation for blood pressure monitoring appeared to be better in patients diagnosed with a comorbidity associated with hypertension, there was a substantial shortfall. Clinical relevance: This study identified the most common barriers to recommending blood pressure monitoring in senior feline wellness examinations. Normalizing blood pressure monitoring as part of a routine examination in senior feline patients may lead to increased intervention for hypertension and improved outcomes.

Sous pression : Une enquête auprès des vétérinaires canadiens sur le diagnostic et le traitement de l'hypertension féline. Objectifs: Les objectifs de cette étude étaient d'explorer les diagnostics et les pratiques de traitement de l'hypertension féline chez les vétérinaires canadiens et d'identifier les obstacles à la recommandation de la surveillance de la tension artérielle chez les patients félins âgés (> 7 ans). Procédure: Une enquête en ligne a été développée et diffusée par CommuniVET par courriel et sur les réseaux sociaux. Résultats: Au total, 114 vétérinaires canadiens ont répondu au sondage. La plupart des répondants ont indiqué qu'ils ne recommandaient pas (n = 45; 39,5 %) ou recommandaient occasionnellement (n = 47; 41,2 %) la surveillance de la tension artérielle lors des examens de santé des félins âgés (> 7 ans). Les obstacles les plus fréquemment signalés à la recommandation d'une évaluation de la tension artérielle étaient la difficulté d'interpréter les résultats chez les patients stressés (n = 87; 76,3 %), le temps nécessaire pour obtenir la tension artérielle (n = 73; 64,0 %) et le coût pour le propriétaire (n = 54; 47,4 %). Face à un patient diagnostiqué avec une comorbidité couramment associée à l'hypertension, la plupart des répondants indiquent recommander toujours (n = 38; 33,3 %) ou fréquemment (n = 27; 23,7 %) une surveillance de la pression artérielle. Le traitement de première intention de la plupart des vétérinaires contre l'hypertension était l'amlodipine pour l'hypertension primaire (n = 81; 71,1 %) et secondaire (n = 39; 34,2 %). Conclusion: La plupart des vétérinaires ne recommandent pas systématiquement l'évaluation de la pression artérielle lors des examens de santé des félins seniors. Bien que la fréquence de recommandation de la surveillance de la pression artérielle semble meilleure chez les patients diagnostiqués avec une comorbidité associée à l'hypertension, il y avait un manque à gagner important. Pertinence clinique: Cette étude a identifié les obstacles les plus courants à la recommandation d'une surveillance de la pression artérielle lors des examens de santé des félins seniors. La normalisation de la surveillance de la pression artérielle dans le cadre d'un examen de routine chez les patients félins âgés peut entraîner une intervention accrue pour l'hypertension et de meilleurs résultats.(Traduit par Dr Serge Messier).

Surface and Air Contamination With Severe Acute Respiratory Syndrome Coronavirus 2 From Hospitalized Coronavirus Disease 2019 Patients in Toronto, Canada, March-May 2020.

BACKGROUND: We determined the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in air and on surfaces in rooms of patients hospitalized with coronavirus disease 2019 (COVID-19) and investigated patient characteristics associated with SARS-CoV-2 environmental contamination. METHODS: Nasopharyngeal swabs, surface, and air samples were collected from the rooms of 78 inpatients with COVID-19 at 6 acute care hospitals in Toronto from March to May 2020. Samples were tested for SARS-CoV-2 ribonucleic acid (RNA), cultured to determine potential infectivity, and whole viral genomes were sequenced. Association between patient factors and detection of SARS-CoV-2 RNA in surface samples were investigated. RESULTS: Severe acute respiratory syndrome coronavirus 2 RNA was detected from surfaces (125 of 474 samples; 42 of 78 patients) and air (3 of 146 samples; 3 of 45 patients); 17% (6 of 36) of surface samples from 3 patients yielded viable virus. Viral sequences from nasopharyngeal and surface samples clustered by patient. Multivariable analysis indicated hypoxia at admission, polymerase chain reaction-positive nasopharyngeal swab (cycle threshold of ≤30) on or after surface sampling date, higher Charlson comorbidity score, and shorter time from onset of illness to sampling date were significantly associated with detection of SARS-CoV-2 RNA in surface samples. CONCLUSIONS: The infrequent recovery of infectious SARS-CoV-2 virus from the environment suggests that the risk to healthcare workers from air and near-patient surfaces in acute care hospital wards is likely limited.

Sensitivity of Nasopharyngeal Swabs and Saliva for the Detection of Severe Acute Respiratory Syndrome Coronavirus 2.

We enrolled 91 consecutive inpatients with COVID-19 at 6 hospitals in Toronto, Canada, and tested 1 nasopharyngeal swab/saliva sample pair from each patient using real-time RT-PCR for severe acute respiratory syndrome coronavirus 2. Sensitivity was 89% for nasopharyngeal swabs and 72% for saliva (P = .02). Difference in sensitivity was greatest for sample pairs collected later in illness.

Influenza virus RNA recovered from droplets and droplet nuclei emitted by adults in an acute care setting.

Transmission in hospital settings of seasonal influenza viruses and novel agents such as the Middle East respiratory syndrome coronavirus (MERS-CoV) is well-described but poorly understood. The characterization of potentially infectious bio-aerosols in the healthcare setting remains an important yet ill-defined factor in the transmission of respiratory viruses. Empiric data describing the distribution of bio-aerosols enable discernment of potential exposure risk to respiratory viruses. We sought to determine the distribution of influenza virus RNA emitted into the air by participants with laboratory-confirmed influenza, and whether these emissions had the potential to reach healthcare workers' breathing zones. Two-stage cyclone bio-aerosol samplers from the Centers for Disease Control and Prevention - National Institute for Occupational Safety and Health were placed 0.5-1.0 m (near field) and 2.1-2.5 m (far field) from infected patient participants, as well as in the corridor immediately outside their rooms. In addition, healthcare worker participants providing care to infected participants were recruited to wear a polytetrafluoroethylene (PTFE) filter cassette in their breathing zones. Viral RNA was detected from the air emitted by 37.5% of the 16 participants infected with influenza virus and distributed both in near and far fields and in all tested particle sizes (<1 µm, 1-4 µm, and >4 µm). Viral RNA was recovered in droplet nuclei and beyond 1 m from naturally-infected participants in the healthcare setting and from the breathing zone of one healthcare worker. There was no correlation between patient participant nasal viral load and recovery of viral RNA from the air, and we did not identify any significant association between RNA detection from the air and patient demographics or clinical presentation. A more substantial study is required to identify patient determinants of virus emission into the air and delineate implications for evidence-based policy for prevention and control.

Sensitivity of midturbinate versus nasopharyngeal swabs for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

To compare sensitivity of specimens for COVID-19 diagnosis, we tested 151 nasopharyngeal/midturbinate swab pairs from 117 COVID-19 inpatients using reverse-transcriptase polymerase chain reaction (RT-PCR). Sensitivity was 94% for nasopharyngeal and 75% for midturbinate swabs (P = .0001). In 88 nasopharyngeal/midturbinate pairs with matched saliva, sensitivity was 86% for nasopharyngeal swabs and 88% for combined midturbinate swabs/saliva.

Severity of coronavirus respiratory tract infections in adults admitted to acute care in Toronto, Ontario.

BACKGROUND: The World Health Organization has highlighted the need for improved surveillance and understanding of the health burden imposed by non-influenza RNA respiratory viruses. Human coronaviruses (CoVs) are a major cause of respiratory and gastrointestinal tract infections with associated morbidity and mortality. OBJECTIVES: The objective of our study was to characterize the epidemiology of CoVs in our tertiary care centre, and identify clinical correlates of disease severity. STUDY DESIGN: A cross-sectional study was performed of 226 patients admitted with confirmed CoV respiratory tract infection between 2010 and 2016. Variables consistent with a severe disease burden were evaluated including symptoms, length of stay, intensive care unit (ICU) admission and mortality. RESULTS: CoVs represented 11.3% of all positive respiratory virus samples and OC43 was the most commonly identified CoV. The majority of infections were community-associated while 21.6% were considered nosocomial. The average length of stay was 11.8 days with 17.3% of patients requiring ICU admission and an all-cause mortality of 7%. In a multivariate model, female gender and smoking were associated with increased likelihood of admission to ICU or death. CONCLUSION: This study highlights the significant burden of CoVs and justifies the need for surveillance in the acute care setting.

Bioaerosol and surface sampling for the surveillance of influenza A virus in swine.

Influenza A virus in swine is of significant importance to human and veterinary public health. Environmental sampling techniques that prove practical would enhance surveillance for influenza viruses in swine. The primary objective of this study was to demonstrate the feasibility of bioaerosol and surface sampling for the detection of influenza virus in swine barns with a secondary objective of piloting a mobile application for data collection. Sampling was conducted at a large swine operation between July 2016 and August 2017. Swine oral fluids and surface swabs were collected from multiple rooms. Room-level air samples were collected using four bioaerosol samplers: a low volume polytetrafluoroethylene (PTFE) filter sampler, the National Institute for Occupational Safety and Health's low volume cyclone sampler, a 2-stage Andersen impactor and/or one high volume cyclonic sampler. Samples were analysed using quantitative RT-PCR. Data and results were reported using a mobile data application. Eighty-nine composite oral fluid samples, 70 surface swabs and 122 bioaerosol samples were analysed. Detection rates for influenza virus RNA in swine barn samples were 71.1% for oral fluids, 70.8% for surface swabs and 71.1% for the PTFE sampler. Analysis revealed a statistically significant relationship between the results of the PTFE sampler and the surface swabs with oral fluid results (p < 0.001 and p < 0.01 respectively). In addition, both the PTFE sampler (p < 0.01) and surface swabs (p = 0.03) significantly correlated with, and predicted oral fluid results. Bioaerosol sampling using PTFE samplers is an effective hands-off approach for detecting influenza virus activity among swine. Further study is required for the implementation of this approach for surveillance and risk assessment of circulating influenza viruses of swine origin. In addition, mobile data collection stands to be an invaluable tool in the field by allowing secure, real-time reporting of sample collection and results.