Comparison of sedation with dexmedetomidine administered subcutaneously at 2 different locations on the head in dogs.

Objective: This study aimed to compare the sedative effects of dexmedetomidine administered to dogs subcutaneously (SC) at the Governing Vessel 20 (GV20) acupuncture point and at another point on the head. Animals and procedure: Ten client-owned dogs were included. Dogs were sedated 2 times, 14 d apart, with 200 µg/m2 of dexmedetomidine, SC, at GV20 and at a point at the base of the ear (SC-head). The sedation was assessed with a sedation scale and a Dynamic and Interactive Visual Analogue Scale (DIVAS). The ease of performing radiographic studies, physiological parameters, and adverse events were recorded. Statistical linear mixed-effect models (ANOVA) were applied. Statistical significance was set at P < 0.05. Results: The time to sedation and sedation scores were similar for both groups. The level of sedation achieved was adequate to perform orthopedic radiographs for 9/10 (90%) cases in the GV20 group and 8/10 (80%) cases in the SC-head group. Heart and respiratory rates decreased significantly over time in both groups (P < 0.001). Adverse events were infrequent and self-limiting. Conclusion: Our study provides evidence that SC administration of dexmedetomidine on the head, at the GV20 point or at the base of the ear, is easy and provides a sufficient level of sedation to obtain orthopedic radiographs in dogs.

Comparaison de la sédation avec de la dexmédétomidine administrée par voie sous-cutanée à deux sites différents sur la tête de chiens. Objectif: Cette étude a pour but de comparer les effets sédatifs de la dexmédétomidine administrée par voie sous-cutanée (SC) au point d'acupuncture VG20 et à un autre point sur la tête, non lié à la relaxation/sédation, chez le chien. Animaux et procédure: Dix chiens de clients ont été inclus dans cette étude clinique, prospective, croisée, randomisée et à l'aveugle. Les chiens ont été sédatés deux fois, à 14 jours d'intervalle, avec une injection de 200 µg/m2 de dexmédétomidine sous-cutanée au point d'acupuncture VG20 et à un autre point sur la tête, à la base de l'oreille (SC-tête). La durée et la qualité de la sédation ont été évaluées avec une échelle de sédation et une échelle analogue visuelle dynamique et interactive (DIVAS). La facilité de réaliser des études radiographiques, les paramètres physiologiques et les effets secondaires ont été enregistrés. Des modèles statistiques linéaires à effet mixte (ANOVA) ont été réalisés. Les résultats étaient considérés comme significatifs quand P < 0,05. Résultats: Le temps nécessaire pour atteindre un niveau de sédation adéquat et les scores de sédation étaient comparables entre les deux groupes. Le niveau de sédation était adéquat pour réaliser des radiographies orthopédiques chez 9/10 (90 %) des cas dans le groupe VG20 et 8/10 (80 %) des cas dans le groupe SC-tête. Les fréquences cardiaque et respiratoire diminuaient significativement dans le temps pour les 2 groupes (P < 0,001). Les effets indésirables étaient peu fréquents et auto-limitants. Conclusion: Notre étude suggère que l'administration sous-cutanée de dexmédétomidine sur la tête, que ce soit au point VG20 ou à la base de l'oreille, est facile et permet d'obtenir un niveau de sédation suffisant pour réaliser des radiographies orthopédiques chez des chiens sains.(Traduit par les auteurs).

Piloting a city health adaptation typology with data from climate-engaged cities: Toward identification of an urban health adaptation gap.

Climate change has important population health impacts, and cities are often on the frontlines. However, health is reported to be less active in climate adaptation than other sectors. To contribute to better understanding urban health adaptation efforts and identifying gaps we developed a City Climate Health Adaptation Typology and tested it with adaptation actions of 106 large world cities (population > 1 million) reported to a major publicly-available adaptation database. We found two-thirds of actions of these 'active adapter' cities were health-associated. Half were health information activities (e.g., hazard mapping, early warnings); and nearly one-third addressed climate-relevant health determinants in the urban built environment (e.g., green space). Forty percent of cities were in low- or middle-income countries. Our proposed typology provides a systematic framework for monitoring and comparing city health adaptation actions. Reported city actions are suggestive of increasing depth and breadth of urban health-associated adaptation. However, even among these adaptation-engaged cities, a health adaptation gap was apparent in key climate health services (e.g., mental health), and in climate-related public health governance and capacity building. The COVID-19 pandemic has demonstrated pressing need for strong public health institutions. We recommend better integration of public health agencies into local climate action planning, enhanced modes of collaboration between health and non-health agencies and with non-governmental actors, and strengthening of city public health adaptive capacity including through networking.

Excellent long-term clinical outcome in a young athletic dog following surgical complications of a comminuted patellar fracture and patellar ligament rupture.

A 1-year-old athletic golden retriever dog was presented for a non-weight-bearing right pelvic limb lameness that occurred during a canicross race. Orthopedic examination revealed pain and inflammation of the right stifle joint. Radiographs showed a traumatic comminuted patellar fracture. Surgery was elected and a midsubstance patellar ligament rupture was also identified. Surgical management consisted of a combination of techniques for patellar fracture fixation and primary patellar ligament reconstruction. All orthopedic implants were removed secondary to implant failure. Postoperative 20-month radiographic follow-up revealed patella alta and non-union of the fracture. However, an excellent clinical outcome was achieved with a complete return to a high activity level. Key clinical message: Surgical stabilization of patellar fractures is usually a significant challenge. A return to apparent normal limb function was achieved in this dog suffering complex patellar fracture with concomitant patellar ligament rupture despite postoperative fracture non-union.

Excellents résultats cliniques à long terme chez un jeune chien athlétique suite à des complications chirurgicales d'une fracture patellaire comminutive et d'une rupture du ligament patellaire. Un golden retriever athlétique âgé d'un an a été présenté pour une boiterie de suppression d'appui du membre pelvien droit survenue lors d'une course de canicourse. L'examen orthopédique a révélé une douleur et une inflammation du grasset droit. Les radiographies ont montré une fracture patellaire comminutive traumatique. Une chirurgie a été recommandée et une rupture du ligament patellaire à son tiers moyen a également été identifiée. La prise en charge chirurgicale consistait en une combinaison de techniques pour réaliser la réduction de la fracture patellaire et la reconstruction primaire du ligament patellaire. Tous les implants orthopédiques ont été retirés suite à des complications associées au matériel d'ostéosynthèse. Le suivi radiographique postopératoire à 20 mois a révélé une patella alta et une nonunion de la fracture. Un excellent résultat clinique a cependant été obtenu avec un retour complet à un niveau d'activité physique élevé.Message clinique clé :Les fractures patellaires sont rares chez le chien et la stabilisation chirurgicale est généralement un défi important. Selon les auteurs, seuls quelques rapports cliniques avec des suivis à court et moyen terme sont disponibles dans la littérature. Un retour à une fonction apparemment normale du membre a été obtenu chez ce patient souffrant d'une fracture patellaire complexe avec rupture concomitante du ligament patellaire malgré la non-union de la fracture en postopératoire.(Traduit par Dre Dominique Gagnon).

Uretero-Cutaneous Fistula and Renal Abscessation as a Complication of Ureteral Stenting in a Dog.

An 11 yr old female spayed shih tzu was referred for treatment of left ureterolithiasis with complete obstruction of the left ureter and pyonephrosis. A ureteral stent was placed surgically to relieve the obstruction and pyonephrosis was treated with antibiotics. Three and a half years following stent placement, the patient developed an abscess on the left flank with chronic purulent discharge. Diagnostic imaging confirmed the presence of a left uretero-cutaneous fistula and renal abscess. A left ureteronephrectomy was performed. The dog was euthanatized 4 mo later for cardiac insufficiency unresponsive to medical treatment. This is the first report of a uretero-cutaneous fistula and renal abscessation as a complication of ureteral stenting in a dog.

A canine-specific anti-nerve growth factor antibody alleviates pain and improves mobility and function in dogs with degenerative joint disease-associated pain.

BACKGROUND: There is a critical need for proven drugs other than non-steroidal anti-inflammatory drugs for treatment of degenerative joint disease (DJD) pain in dogs. Antibodies against nerve growth factor (NGF) are analgesic in rodent models and in humans with DJD. This pilot study aimed to evaluate the efficacy of a novel caninised anti-NGF antibody (NV-01) for the treatment of DJD pain in dogs. In a randomized, parallel group, stratified, double masked, placebo controlled, proof of principle clinical pilot study design, 26 dogs with DJD received NV-01 (200 mcg/kg IV) or placebo on day 0 (D0). In addition to objective accelerometry measures, owners completed clinical metrology instruments (Client-Specific Outcome Measures [CSOM], Canine Brief Pain Inventory [CBPI] and Liverpool Osteoarthritis in Dogs Index [LOAD]) on D0, D14 and D28. CBPI subscales (pain severity [PS] and pain interference [PI]), CSOM and LOAD scores were evaluated within and between groups for change over time. Recognized success/failure criteria were applied and success compared between groups. RESULTS: CBPI PS and PI scores significantly improved in the NV-01 group (PS: D0-14, P = 0.012 and D0-28, P = 0.019; PI: D0-14, P = 0.012 and D0-28, P = 0.032) but not in the placebo group. CSOM scores showed similar patterns with a significant difference between within-group changes at D14 and D28 (P = 0.038 and P = 0.009, respectively), and significantly more successes at D28 (P = 0.047). LOAD scores significantly improved in the NV-01 group (D0-14, P = 0.004 and D0-28, P = 0.002) but not in the placebo group. There were significant differences between the groups for change in LOAD score at D14 (P = 0.014) and D28 (P = 0.033). No side effects were noted. Activity in the NV-01 group increased over the study period compared to placebo (P = 0.063) and the difference between the groups for change in activity over the time period 9am-5pm (8 hours) was significant (P = 0.006). CONCLUSIONS: These pilot data demonstrate a positive analgesic effect of anti-NGF antibody in dogs suffering from chronic pain. The magnitude of the effect appeared identical to that expected with an NSAID.

Effects of Transfixation Pin Positioning on the Biomechanical Properties of Acrylic External Skeletal Fixators in a Fracture Gap Model.

OBJECTIVE: The aim of this study was to evaluate the biomechanical effects of transfixation pin positioning in acrylic columns of external skeletal fixators (ESF). STUDY DESIGN: Twenty-four type I acrylic ESF were built simulating a fracture gap-model. Transfixation pins were placed centric (n = 12) or eccentric at » of the column diameter (n = 12) in the acrylic columns. Six constructs from each group were subjected to axial compression and four-point bending tests. Stiffness, yield load and mode of failure were recorded. RESULTS: Stiffness was not influenced by centring (p = 0.373), but it was higher in four-point bending than in axial compression (p < 0.001). Pin positioning had no influence on the yield (p = 0.535) and failure loads (p = 0.715) in axial compression, nor on the yield load in bending (p = 0.135). Eccentric pin positioning decreased failure loads by 28% in bending (p < 0.001). CONCLUSION: Eccentric position of transfixation pins within the acrylic columns alters the biomechanical properties of type I ESF constructs. While acrylic offers several advantages, when forming the columns, frame strength will be optimized if pins are centrally located.

A disposable, canister-free negative-pressure wound therapy device proves feasible, but of inferior efficacy to conventional therapies for treating cutaneous wounds in dogs.

OBJECTIVE: To assess the feasibility of a canister-free negative-pressure wound therapy (NPWT) device (PICO™ 1.6, Smith & Nephew Medical Ltd) and evaluate its effect on early phases of wound healing in canine experimental cutaneous wounds. ANIMALS: 5 adult spayed female research Beagles. PROCEDURES: In a pilot experimental study, 1 full-thickness 2-cm X 2-cm cutaneous wound was surgically created on each hemithorax in each dog. Wounds were treated with either NPWT or a conventional wound dressing for 14 days. Bandage changes and wound evaluations were done at 7 time points. First macroscopic appearance of granulation tissue, smoothness of granulation tissue, and percentages of wound contraction and epithelialization were compared between treatments. Wounds were sampled at 3 time points for histopathologic analyses and semiquantitative scoring. RESULTS: NPWT dressings were well tolerated by all dogs. Complete seal of the dressing required the application of adhesive spray, and maintenance of the vacuum lessened over time. Self-limiting skin irritations appeared in all dogs and hampered the attainment of negative pressure. Granulation tissue developed faster and was more abundant in control wounds. Wound contraction, epithelialization, and fibroblast proliferation were greater in control wounds at the end of the study. CLINICAL RELEVANCE: This canister-free NPWT device is feasible but problematic in maintaining a vacuum, requiring frequent revisions of the dressing. Further studies are necessary to evaluate the effect of this device on early phases of wound healing. Its benefits in wound healing remain unknown.

Evaluation of functional outcome after BFX total hip replacement using a pressure sensitive walkway.

OBJECTIVE: To evaluate stance phase limb use after cementless (BFX) total hip replacement (THR) in dogs and to relate postoperative radiographic variables to static bodyweight distribution after surgery. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=35) that had THR. METHODS: THR was performed using the BFX THR technique. Postoperative pain management regimens were similar for all dogs. Standing bodyweight distribution (%BW(distrib)) was measured using a pressure sensitive walkway and radiographs made before surgery and at 3, 6, and 12 months after surgery. Repeated measures models (with backwards-stepping to obtain the final model) were used for statistical analysis. RESULTS: Temporally, %BW(distrib) to the operated limb increased (P<.0001; normal by 3 months) and decreased to the unoperated limb (P=.0001) and also increased to the pelvic limbs and decreased to the thoracic limbs. %BW(distrib) to the unoperated limb was significantly less than the operated limb at 3, 6, and 12 months after surgery. Postoperative canal fill and femur flare were significantly negatively correlated with change in %BW(distrib) (estimate=-0.24, P=.0413). CONCLUSION: BFX THR results in normal %BW(distrib) to the operated limb by 3 months after surgery. A greater fill of the proximal femur may be associated with a suboptimal outcome. CLINICAL RELEVANCE: BFX THR normalizes standing bodyweight distribution dogs with hip osteoarthritis. Objective evaluation of THR outcome and radiographic features may reveal factors that could be improved through changes in prosthesis design or surgical technique.

Cross-sectional study of the prevalence of radiographic degenerative joint disease in domesticated cats.

OBJECTIVE: To determine the prevalence of radiographic signs of degenerative joint disease (DJD) in a randomly selected sample of domestic cats. STUDY DESIGN: Prospective observational study. ANIMALS: Client-owned cats. METHODS: Cats (n=100) from a single practice and equally distributed across 4 age groups (0-5; 5-10; 10-15, and 15-20 years old) were randomly selected (regardless of heath status) and sedated for orthogonal radiographic projections of all joints and the spine. Quasi-Poisson regression analysis was used to investigate the relationship between patient demographics, blood biochemistry, hematologic and urine analysis variables, and DJD severity. RESULTS: Most (92%) cats had radiographic evidence of DJD; 91% had at least 1 site of appendicular DJD and 55% had > or = 1 site of axial column DJD. Affected joints in descending order of frequency were hip, stifle, tarsus, and elbow. The thoracic segment of the spine was more frequently affected than the lumbosacral segment. Although many variables were significantly associated with DJD, when variables were combined, only the association between age and DJD was significant (P<.0001). For each 1-year increase in cat age, the expected total DJD score increases by an estimated 13.6% (95% confidence interval: 10.6%, 16.8%). CONCLUSION: Radiographically visible DJD is very common in domesticated cats, even in young animals and is strongly associated with age. CLINICAL RELEVANCE: DJD is a common disease of domesticated cats that requires further investigation of its associated clinical signs.

Meniscal mineralization in domestic cats.

OBJECTIVE: To (1) determine prevalence of radiographically detectable meniscal mineralization in domestic cats and (2) to evaluate the association between meniscal mineralization and degenerative joint disease (DJD). STUDY DESIGN: Prospective study. ANIMALS: Client-owned cats (n=100) and 30 feline cadavers. METHODS: Randomly selected client-owned cats were used to determine the prevalence of meniscal mineralization. Stifles from feline cadavers were used to evaluate the relationship between meniscal mineralization (using high-resolution X-ray), radiographic DJD, and cartilage damage. Menisci were evaluated histologically. RESULTS: Forty-six percent of the client-owned cats had meniscal mineralization detected in 1 or both stifles. Pain scores were not significantly different between stifles with meniscal mineralization and those with no radiographic pathology (P=.38). Thirty-four of 57 cadaver stifles had meniscal mineralization, which was always located in the cranial horn of the medial meniscus. Percentage mineralization of the menisci was significantly correlated with the cartilage damage score of the medial femoral (r(2)=0.6; P<.0001) and tibial (r(2)=0.5; P<.0001) condyles as well as with the total joint cartilage damage (r(2)=0.36; P<.0001) score and DJD score (r(2)=0.8; P<.0001). CONCLUSION: Meniscal mineralization is a common condition in domestic cats and seems to indicate medial compartment DJD. CLINICAL RELEVANCE: Clinical significance of meniscal mineralization is uncertain. Further work is needed to determine if the meniscal mineralization is a cause, or a consequence of joint degeneration.

Transvaginal uterine evisceration during labor in a Bengal queen.

CASE SUMMARY: A 2.5-year-old Bengal queen was admitted with a 12-h history of a mass protruding from the vulva during labor. At that time, three healthy kittens had already been delivered. Physical examination identified the mass as a portion of the uterus that was eviscerated without eversion of the mucosa. Exploratory laparotomy revealed a vaginal vault rupture with a large portion of the uterus herniated through the tear and eviscerated through the vulva. Ovariohysterectomy was performed, and a dead fetus was removed with the uterus. Reconstruction of the vaginal rupture required careful dissection and urethral catheterization. The queen recovered without complications. RELEVANCE AND NOVEL INFORMATION: Uterine evisceration through a vaginal tear is a very rare condition that sometimes is erroneously referred to as 'prolapse'. Uterine prolapse and uterine evisceration may have similar presenting signs; however, proper identification and surgical correction is key when the uterus is eviscerated. This case highlights the importance of differentiating these two conditions and of rapid identification and surgical intervention for successful patient survival.

Chylous ascites associated with abdominal trauma and intestinal resection-anastomosis in a pet ferret (Mustela putorius furo).

CASE DESCRIPTION A 10-week-old 0.73-kg (1.6-lb) castrated male domestic ferret (Mustela putorius furo) was referred for exploratory laparotomy because of pneumoperitoneum and possible septic peritonitis after being bitten by the owner's dog. CLINICAL FINDINGS Abdominal exploration revealed a large laceration of the duodenum, tears of the jejunal mesentery, and 2 small tears in the abdominal wall. Chylous abdominal effusion developed 48 hours after surgery. TREATMENT AND OUTCOME Postoperative care included supportive treatment, analgesia, and antimicrobials. An abdominal drain was placed during the laparotomy and enabled monitoring of abdominal fluid production. Enteral feeding was provided through an esophagostomy tube. The chylous fluid production rapidly decreased after treatment with octreotide was initiated, and the ferret improved. Chyloabdomen resolved after 8 days of hospitalization and medical treatment. CLINICAL RELEVANCE Findings suggested that chylous ascites can potentially develop secondary to blunt abdominal trauma in ferrets. In this ferret, chyloabdomen was successfully treated with octreotide administration and abdominal drainage.

Comparison of thermal and mechanical quantitative sensory testing in client-owned dogs with chronic naturally occurring pain and normal dogs.

Detecting dogs with central sensitization (CS) secondary to chronic pain is hampered by the current inability to measure this condition. The current study aimed to use quantitative sensory testing (QST) to measure (CS) in normal dogs and dogs with painful degenerative joint disease (DJD). It was hypothesized that QST would differ between these two groups of animals. Mechanical and thermal sensory thresholds obtained in animals with DJD-associated pain on two time points 28 days apart were compared with those of normal dogs. Values of sensory thresholds in DJD dogs obtained 28 days after the first evaluation were significantly lower than the results on the first day of evaluation but no differences were found when these results were compared with those of normal dogs. In conclusion, whether QST is different between dogs with chronic pain and normal dogs needs further investigation using a larger group of animals and age, weight and sex matched groups.

Feasibility and repeatability of cold and mechanical quantitative sensory testing in normal dogs.

Feasibility and inter-session repeatability of cold and mechanical quantitative sensory testing (QST) were assessed in 24 normal dogs. Cold thermal latencies were evaluated using a thermal probe (0°C) applied to three pelvic limb sites. Mechanical thresholds were measured using an electronic von Frey anesthesiometer (EVF) and a blunt-probed pressure algometer (PA) applied to the dorsal aspect of the metatarsus. All QST trials were performed with dogs in lateral recumbency. Collection of cold QST data was easy (feasible) in 19/24 (79%) dogs. However, only 18.4%, 18.9% and 13.2% of cold QST trials elicited a response at the medial tibia, third digital pad and plantar metatarsal regions, respectively. Collection of mechanical QST data was easy (feasible) in 20/24 (83%) dogs for both EVF and PA. At consecutive sampling times, approximately 2 weeks apart, the average EVF sensory thresholds were 414 ± 186 g and 379 ± 166 g, respectively, and the average PA sensory thresholds were 1089 ± 414 g and 1028 ± 331 g, respectively. There was no significant difference in inter-session or inter-limb threshold values for either mechanical QST device. The cold QST protocol in this study was achievable, but did not provide consistently quantifiable results. Both mechanical QST devices tested provided repeatable, reliable sensory threshold measurements in normal, client-owned dogs. These findings contribute to the validation of the EVF and PA as tools to obtain repeated QST data over time in dogs to assess somatosensory processing changes.

Evaluation of the clinical use of tepoxalin and meloxicam in cats.

Medical records where tepoxalin (Zubrin) or meloxicam (Metacam) were prescribed in cats were reviewed and data extracted. Comparisons were performed for exploring changes between pre- and post-non-steroidal anti-inflammatory drug course laboratory tests. Seventy-nine medical records fit the inclusion criteria (n = 57 and n = 22, tepoxalin and meloxicam, respectively). The median dosages administered were 13 and 0.029 mg/kg(/)day (tepoxalin and meloxicam, respectively). Median prescription durations were 11 (2-919) and 93 (4-1814) days for tepoxalin and meloxicam, respectively. Suspected adverse events were reported for tepoxalin (9%, 5/57 cats) and meloxicam (18%, 4/22 cats) a median of 774 and 448 days, respectively, after the prescription started. For cats prescribed meloxicam, there were several statistically significant changes for serum biochemistry and hematology parameters, but median values were within normal limits. These valuable clinical data suggest that tepoxalin and meloxicam are well tolerated in the clinical setting at the doses prescribed in this study.

Radiographic evaluation of feline appendicular degenerative joint disease vs. Macroscopic appearance of articular cartilage.

Degenerative joint disease (DJD) is common in domesticated cats. Our purpose was to describe how radiographic findings thought to indicate feline DJD relate to macroscopic cartilage degeneration in appendicular joints. Thirty adult cats euthanized for reasons unrelated to this study were evaluated. Orthogonal digital radiographs of the elbow, tarsus, stifle, and coxofemoral joints were evaluated for the presence of DJD. The same joints were dissected for visual inspection of changes indicative of DJD and macroscopic cartilage damage was graded using a Total Cartilage Damage Score. When considering all joints, there was statistically significant fair correlation between cartilage damage and the presence of osteophytes and joint-associated mineralizations, and the subjective radiographic DJD score. Most correlations were statistically significant when looking at the different joints individually, but only the correlation between the presence of osteophytes and the subjective radiographic DJD score with the presence of cartilage damage in the elbow and coxofemoral joints had a value above 0.4 (moderate correlation). The joints most likely to have cartilage damage without radiographic evidence of DJD are the stifle (71% of radiographically normal joints) followed by the coxofemoral joint (57%), elbow (57%), and tarsal joint (46%). Our data support radiographic findings not relating well to cartilage degeneration, and that other modalities should be evaluated to aid in making a diagnosis of feline DJD.