A review of treatment options for behavioural manifestations of clinical anxiety as a comorbidity in dogs with idiopathic epilepsy.

Psychiatric comorbidities affect a large percentage of people with epilepsy and have a detrimental impact on their quality of life. Recently, behavioural comorbidities, with similar characteristics to human psychiatric diseases, have been identified in dogs with idiopathic epilepsy. In particular, behaviours motivated by the fear-anxiety emotional system have been found to be associated with the occurrence of idiopathic epilepsy in both dogs receiving anti-epileptic drugs, and drug-naïve dogs. There has been little research into the relationship between epilepsy and behavioural signs, and even less into potential treatment protocols. The following article will review available literature from human medicine to describe the current state of knowledge about the bi-directional relationship between anxiety and epilepsy, draw parallels from reported anxiogenic and anxiolytic properties of anti-epileptic drugs and attempt to provide pharmaceutical and behavioural guidance for veterinary patients with epilepsy and comorbid anxiety.

Early-life risk factors identified for owner-reported feline overweight and obesity at around two years of age.

Obesity is considered the second most common health problem in pet cats in developed countries. This study used prospective data from a longitudinal study of pet cats ('C.L.A.W.S.', www.bristol.ac.uk/vetscience/claws) to identify early-life risk factors for feline overweight/obesity occurring at around two years of age. Data were collected via five owner-completed questionnaires (for cats aged two-six months, six months, 12 months, 18 months and two years respectively) completed between May 2011 and April 2015. Owner-reported body condition scores (BCS) of cats at age two years, assessed using images from the 9-point BCS system (Laflamme, 1997), were categorised into a dichotomous variable: overweight/obese (BCS 6-9) and not overweight (BCS 1-5) and used as the dependent variable. Of the 375 cats with owner-reported BCS, 25.3% were overweight or obese at two years of age. Multivariable logistic regression models were built using stepwise forward-selection. To account for potential hierarchical clustering due to multi-cat households two-level random intercept models were considered but clustering had no impact on the analysis. Models were compared using Wald tests. Six factors were significantly associated with overweight/obesity at two years of age: being overweight or obese at one year of age (OR=10.6, 95%CI 4.4-25.3); owner belief that BCS 7 was the ideal weight (OR=33.2, 95%CI 8.5-129.4), or that BCS represented overweight cats but they would not be concerned if their cat were classified in this category (OR=2.7, 95%CI 1.2-6.2), at questionnaire five completion; vets advising owners that the cat should lose weight, or making no comment on their weight, between one and two years of age (OR=12.1, 95%CI 3.2-44.9 and OR=3.9, 95%CI 1.5-10.3 respectively); owners giving their cat treats when they "felt happy" with them at 18 months of age (OR=2.7, 95%CI 1.0 - 7.3); feeding ≥250g wet food daily between two and six months of age (OR=2.7, 95%CI 1.2-5.9), and feeding dry food as the only or major part (>50%) of the diet at two years of age (OR=2.1, 95%CI 1.0-4.2). These findings have the potential to reduce the current high prevalence of a widespread problem by informing preventive advice, and as such improving the health and welfare of pet cats.

Risk factors for human-directed canine aggression in a referral level clinical population.

Risk factors for human-directed aggression were investigated using retrospective analysis of data from a referral-level clinical behaviour population in the UK. A sample of 200 cases involving human-directed canine aggression and 200 control cases involving no instance of human-directed aggression were selected at random from a population of 746 cases. The final model suggested that clinical cases with human-directed aggression were significantly younger than those presenting with other undesired behaviours (P=0.008) and that male dogs were 1.4 times more likely to be aggressive towards human beings than female dogs (P=0.019). Dogs were 1.7 times more likely to be aggressive towards people if they had attended more than five puppy classes than if they had never attended puppy class (P=0.015) and that dogs were 2.8 times more likely to be aggressive towards human beings if there was another dog between 0 months and 24 months of age in the home (P=0.004). These factors only account for 7 per cent to 10 per cent of the variance between the human-directed aggression population and the control population, but factors such as attendance at puppy classes and numbers of dogs in the household suggest the need for longitudinal studies to investigate temporal relationships.

Inter-dog aggression in a UK owner survey: prevalence, co-occurrence in different contexts and risk factors.

Aggression between dogs is common and can result in injury. The aims of this study were to estimate prevalence, evaluate co-occurrence with human-directed aggression, and investigate potential risk factors, using a cross-sectional convenience sample of dog owners. Aggression (barking, lunging, growling or biting) towards unfamiliar dogs was reported to currently occur, by 22 per cent of owners, and towards other dogs in the household, by 8 per cent. A low level of concordance between dog and human-directed aggression suggested most dogs were not showing aggression in multiple contexts. Aggression towards other dogs in the household was associated with increasing dog age, use of positive punishment/negative reinforcement training techniques, and attending ring-craft classes. Aggression towards other dogs on walks was associated with location of questionnaire distribution, owner age, age of dog, origin of dog, dog breed type, use of positive punishment/negative reinforcement training techniques and attending obedience classes for more than four weeks. In both, the amount of variance explained by models was low (<15 per cent), suggesting that unmeasured factors mostly accounted for differences between groups. These results suggest general characteristics of dogs and owners which contribute to intraspecific aggression, but also highlight that these are relatively minor predictors.

Radiation dosimetry of the FluoroCAT scan for real-time endoscopic sinus surgery.

OBJECTIVE/HYPOTHESIS: The FluoroCAT platform of the GE InstaTrak 3500 Plus reconstructs images acquired from the GE OEC 9800 Plus fluoroscope into triplanar images which allow the surgeon to perform real-time endoscopic sinus and skull-base surgery. The radiation dosimetry for the new scanning protocol required by the FluoroCAT has not been reported. This study was designed to measure the radiation dose of a FluoroCAT scan and compare this to the dosimetry of an InstaTrak CT scan. STUDY DESIGN: Prospective study. METHODS: A standardized CT head phantom was used along with a CT ion chamber to measure radiation exposure. FluoroCAT scans were performed using the GE OEC 9800 Plus fluoroscope. Scans were performed using each of the three fluoroscopic scanning modes on the GE OEC 9800 Plus; normal fluoro, high-level fluoro, and Digital Ciné at 15 pulses per second (pps). RESULTS: The highest radiation dose was measured using Digital Ciné 15 pps. The dose measured at the center of the head phantom was 4.1 Gy while the maximum surface dose was 10.7 mGy. The center and surface radiation dose recorded from the CTDI(vol) reading on the control panel of a GE Lightspeed Plus during an InstaTrak CT scan was 85 mGy. CONCLUSIONS: Using the GE OEC 9800 Plus fluoroscope to accumulate images for the FluoroCAT platform in the InstaTrak 3500 Plus resulted in less radiation compared to an InstaTrak CT scan. This will allow multiple scans to be performed intraoperatively, giving the surgeon the opportunity to perform real-time endoscopic sinus and skull-base surgery. EBM RATING: C-4.

Endoscopic placement of spreader grafts in the nasal valve.

OBJECTIVE: Surgery to the internal nasal valve is presently approached either externally via an open rhinoplasty incision or transnasally. The endoscopic approach has become the preferred method of access to various other sinonasal conditions. The goal of this study was to evaluate 1) whether the internal nasal valve could be accessed and evaluated endoscopically and 2) whether a spreader graft placed under endoscopic visualization could widen the nasal valve area. STUDY DESIGN AND SETTING: Single-blinded study on 8 cadaveric heads. One side per head was randomly selected to be studied. The contralateral side served as the control. The nasal valve was approached endoscopically via the submucoperichondrial plane of the nasal septum with a 30-degree endoscope. After fully examining and subsequently separating the internal nasal valve, a spreader graft was placed. A blinded examiner then performed acoustic rhinometry to measure the nasal valve area as well as corroborate the position from an external approach. This data was then statistically analyzed using the paired Student t test. RESULTS: The nasal valve was easily detected endoscopically and the position of the spreader grafts was externally confirmed in all 8 specimens. The mean change of the nasal valve area on the side with the spreader grafts was 0.28 cm2. On the control side, the mean change was 0.026 cm2. This difference was statistically significant (P = 0.004). CONCLUSION: The endoscopic approach is a viable option in accessing the nasal valve. Endoscopic placement of a spreader graft has also been shown to statistically widen the nasal valve area.

Controlled trial of behavioural therapy for separation-related disorders in dogs.

A generic programme of behavioural modification for the clinical treatment of separation-related behaviours in dogs was assessed in a controlled replicated trial. After 12 weeks of treatment, 56 per cent of the owners of the treated dogs reported significant improvements in their dogs' behaviour, and a further 25 per cent reported a slight improvement. The owners' reports were generally supported by changes in the behaviour of the dogs as recorded on video when they were left alone. The majority of the untreated dogs continued to show the same degree of separation-related behaviour throughout the 12 weeks of the trial. In a supplementary set of 30 case studies, treated with a behavioural programme tailored to the specific diagnosis for each dog, all the owners reported improvements in their dogs' behaviour after 12 weeks of treatment.

Incidence of methicillin-resistant Staphylococcus aureus causing chronic rhinosinusitis.

OBJECTIVE/HYPOTHESIS: To identify the incidence of methicillin-resistant Staphylococcus aureus (MRSA) causing chronic rhinosinusitis (CRS) and identify whether antibiotic use and previous endoscopic sinus surgeries (ESS) contribute to its development. STUDY DESIGN: A retrospective case control analysis, with the control group randomly selected and matched for age and sex. METHODS: All patients undergoing an endonasal culture in a tertiary otolaryngology center between April 2001 and March 2003 for mucopurulent rhinosinusitis were identified. A chart review was undertaken to identify those patients with a positive MRSA culture result. An age- and sex-matched control group was randomly chosen, and an interview was conducted to identify antibiotic use and previous ESS. A statistical analysis on these two variables was carried out using a t test and the Wilcoxon rank-sum test. RESULTS: Two hundred eighty cultures were identified in 188 patients, and of these, 264 cultures in 173 patients met the inclusion criteria. There were 141 positive cultures and 13 positive MRSA cultures. The overall incidence of MRSA in this population was 9.22%. The mean number of antibiotic courses in the MRSA and the control groups was 33.2 and 26.7, respectively, which was not statistically significant (P =.43). The 95% confidence interval (CI) for this mean difference of 6.5 is -9.8 to 22.8. The mean number of ESS in the MRSA and control groups was 2.0 and 1.9, respectively, which was not statistically significant (P =.93). The 95% CI for this mean difference of 0.06 is -1.3 to 1.4. CONCLUSIONS: We identified a 9.22% incidence of MRSA-causing CRS. The frequency of antibiotic use and previous ESS were found not to be statistically significant causes of MRSA sinusitis. However, the 95% CI for antibiotic usage is skewed to the right, indicating a possible role for its contribution to the emergence of MRSA-causing CRS.

A study of environmental and behavioural factors that may be associated with feline idiopathic cystitis.

The cause of cystitis in many cats remains unknown. The aim of this study was to determine whether or not any environmental or behavioural factors, particularly those that could be considered potentially stressful, were associated with feline idiopathic cystitis (FIC). The questionnaire-based study involved comparing 31 cats with FIC to 24 cats in the same households that did not have cystitis. They were also compared with a control population of 125 clinically healthy cats. Compared with the live-in controls and the control population, the cats with FIC were significantly more likely to be male, overweight and pedigree. Several stress factors were found to be associated with FIC. The factor that stood out most prominently was living with another cat with which there was conflict. The findings support the hypothesis that stress may be implicated in some cases of FIC.

Aetiology of separation-related behaviour in domestic dogs.

A longitudinal study of seven litters of labrador retrievers and five litters of border collies from eight weeks to 18 months of age indicated that the majority showed some degree of potentially undesirable behaviour when separated from their owners. Its incidence was particularly high in the labrador retrievers, of which 13 of 23 showed separation-related behaviour for more than a month. Socially diverse environments experienced between six and 12 months of age were associated with a subsequent absence of separation-related behaviour. In a questionnaire survey of dog owners, separation-related behaviour was reported in 27 of 94 dogs, and a further 20 had shown the behaviour in the past. Male dogs were more likely to express separation-related behaviour currently, and females were more likely never to have displayed it. The prevalence of the behaviour was unaffected by whether the dog was pedigree or mixed breed, or whether it had been obtained from a breeder or from a rescue organisation. Combining the results of the two studies, the owners of only six of 75 dogs showing separation-related behaviour had sought assistance, and only two of the owners had sought help from veterinary surgeons.

Relationship between aggressive and avoidance behaviour by dogs and their experience in the first six months of life.

The early experiences of dogs showing signs of avoidance behaviour or aggression were compared with those of dogs from the same clinical population that did not show such behaviour. The occurrence of each behavioural sign was tested for its association with the dog's maternal environment, the environment it experienced between three and six months of age, and the age at which it had been acquired. Non-domestic maternal environments, and a lack of experience of urban environments between three and six months of age, were both significantly associated with aggression towards unfamiliar people and avoidance behaviour. Aggression during a veterinary examination was more likely in dogs from non-domestic maternal environments. There was no significant association with either environment for aggression towards familiar people, or towards dogs.

Clinical decision analysis in the treatment of acute otitis media in a child over 2 years of age.

Acute otitis media (AOM) is the most common infection diagnosed in children. In Canada and the United States, the standard of care for treatment of children over 2 years of age diagnosed with AOM is a course of antibiotics for 5 to 10 days. However, in other countries, treatment is primarily symptomatic, and antibiotics are prescribed only if symptoms fail to resolve. Clinical decision analysis is a process whereby different treatment options are assessed systematically. All clinical pathways are incorporated into a model, probabilities for each event are determined from the literature, and clinical outcomes are quantified as to the preference of patients. The decision analysis then determines the most appropriate treatment option for the disease process. For AOM in a child over 2 years of age, four treatment options were considered including observation followed by 10 days of antibiotic therapy if required for failure of symptoms to resolve, observation followed by 5 days of antibiotic therapy if required, 10 days of antibiotic therapy when the child was initially diagnosed with AOM, and 5 days of antibiotic therapy when the child was initially diagnosed with AOM. Using a clinical decision analysis model for the treatment of AOM in a child over 2 years of age, the most appropriate treatment was found to be initial observation followed by 5 days of an antibiotic if the child failed to improve spontaneously. The decision analysis model developed was designed to be free of construction bias and was found to be robust in multiple sensitivity analysis.