In-hospital medical management of feline urethral obstruction: A review of recent clinical research.

Evidence-based medical practice requires that clinical research be conducted to help guide veterinary recommendations. Unfortunately, clinical research on the treatment of feline urethral obstruction (UO) is limited. Over the past decade, a body of clinically relevant scientific literature related to the in-hospital management of feline UO has been published. This review of the literature from December 2007 to February 2019 encompasses management options, stabilization, anesthetic considerations, unblocking procedures, urinary bladder lavage, intravesical treatments, post-obstructive diuresis, urinary catheter management, catheter-associated bacterial complications, and oral medications. Studies are briefly summarized with respect to their main findings and limitations. Common recurring limitations observed include small sample sizes leading to insufficient power and potential type II errors, lack of standardized treatment protocols, and assessment of multiple inter-related confounding variables. The authors' intent is for this article to inform practitioners and inspire future clinical research initiatives which address these limitations, possibly with large-scale multicenter studies, standardized treatment protocols, and multivariate regression modeling.

Gestion médicale en hôpital d'obstruction urétrale féline : Revue descriptive de la recherche clinique. La pratique médicale factuelle nécessite que de la recherche clinique soit menée afin d'aider à guider les recommandations vétérinaires. Malheureusement, la recherche clinique sur le traitement de l'obstruction urétrale féline (UO) est limitée. Au cours de la dernière décennie, un ensemble de publications cliniques scientifiquement pertinentes à la gestion en hôpital d'UO féline a été publié. Cette recension de la littérature de décembre 2007 à février 2019 incluait les options de gestion, la stabilisation, les considérations anesthésiques, les procédures de déblocage, le lavage de la vessie urinaire, les traitements intravésical, la diurèse post-traitement, la gestion des cathéters urinaires, les complications bactériennes associées aux cathéters et les médications orales. Les études sont résumées brièvement en lien avec leurs trouvailles principales et leurs limitations. Les limitations récurrentes observées fréquemment incluaient les petites tailles d'échantillonnage entrainant une puissance insuffisante et des erreurs de type II potentielles, un manque de standardisation des protocoles de traitement et l'évaluation de multiples variables confondantes interreliées. L'intention des auteurs est que le présent article informe les praticiens et inspire de futures initiatives de recherche clinique qui vise ces limitations, possiblement avec des études multicentres de grande envergure, des protocoles de traitement standardisés et de la modélisation de régression multivariée.(Traduit par Dr Serge Messier).

The association between serial point-of-care test results and hospitalization time in canine parvovirus infection (2003-2015).

The objectives of this study were to describe serial point-of-care test results in dogs infected with canine parvovirus (CPV), highlight clinicopathologic abnormalities at various timepoints, and investigate their association with the duration of hospitalization. Two-hundred and four dogs positive for CPV at the Western College of Veterinary Medicine between 2003 and 2015 were included. Data were recorded pertaining to emergency panel and venous blood gas tests at presentation, and every 12 hours thereafter (+/- 4 hours) for the first 72 hours of hospitalization. Common persistent abnormalities included hypoproteinemia, acidosis, hyponatremia, hypochloremia, hyperkalemia, and hyperbicarbonatemia. Ionized hypocalcemia was associated with a longer duration of hospitalization and mild hyperkalemia was associated with a shorter duration of hospitalization (P < 0.05). This study suggests that the use of point-of-care tests for in-hospital monitoring may provide insight into CPV case complexity and predict total hospitalization times.

Association entre les résultats des tests au point de service et la durée de l'hospitalisation pour l'infection par le parvovirus canin (2003­2015). Les objectifs de cette étude consistaient à décrire les résultats des tests au point de service chez les chiens infectés par le parvovirus canin (CPV), à souligner les anomalies clinico-pathologiques à divers moments et à étudier leur association avec la durée d'hospitalisation. Deux cent quatre chiens positifs pour le CPV au Western College of Veterinary Medicine entre 2003 et 2015 ont été inclus. Des données ont été consignées en lien avec le panel d'urgence et les tests de gaz du sang veineux à la présentation et toutes les 12 heures par la suite (+/− 4 heures) pour les 72 premières heures d'hospitalisation. Les anomalies persistantes communes incluaient l'hypoprotéinémie, l'acidose, l'hyponatrémie, l'hypochlorémie, l'hyperkaliémie et l'hyperbicarbonatémie. L'hypocalcémie inonisée était associée à une plus longue durée d'hospitalisation et une légère hyperkaliémie était associée à une plus courte durée d'hospitalisation (P < 0,05). Cette étude suggère que l'usage des tests au point de service pour la surveillance à l'hôpital peut fournir de l'information à propos de la complexité des cas de CPV et prédire la durée totale d'hospitalisation.(Traduit par Isabelle Vallières).

Brucella canis: An update on research and clinical management.

In Canada, Brucella canis remains a potentially devastating infectious agent that is still considered uncommon, despite the increasing international movement of dogs. There may be a growing risk to the Canadian canine population due to a reliance on outdated seroprevalence studies and the lack of federal regulation. With the complex diagnostic and management challenges associated with Brucella canis, a One Health approach is necessary to address the need for ongoing research, including updating canine and human seroprevalence rates in Canada, elucidating the pathogenesis, and determining the most appropriate treatment and prevention strategies. Clinical management decisions are often complicated by currently available treatment protocols, and health risks to both canine and human populations. This article integrates recent research focusing on the pathogenesis, diagnosis, and treatment of Brucella canis, and outlines current clinical management approaches.

Brucella canis:mise à jour sur la recherche et la gestion clinique. La brucellose canine, causée par un agent infectieux important et potentiellement dévastateur, est toujours considérée rare au Canada malgré l'arrivée croissante de chiens provenant de régions ayant une prévalence supérieure de l'infection par Brucella canis. Il y a un risque grandissant pour la population canine canadienne parce que l'on se fie à des études de séroprévalence désuètes et qu'il existe une absence de règlements fédéraux. En raison des défis complexes liés au diagnostic et à la gestion de Brucella canis, l'approche Une seule santé est nécessaire afin d'aborder le besoin de poursuivre la recherche, y compris la mise à jour des taux de séroprévalence canine et humaine au Canada, la clarification de la pathogénèse, la définition de l'éventail potentiel de manifestations cliniques et la détermination du traitement et des stratégies de prévention les plus appropriés. Les décisions de gestion clinique sont souvent compliquées par les protocoles de traitement actuellement disponibles et les risques pour la santé des populations canine et humaine. Cet article intègre de la recherche récente portant sur la pathogénèse, le diagnostic et le traitement de Brucella canis et présente les approches de gestion clinique actuelles.(Traduit par Isabelle Vallières).

Online survey to determine client perceptions of feline chronic lower airway disease management: response to therapy, side effects and challenges encountered.

OBJECTIVES: The first aim of this survey was to report client experiences associated with the administration of common medications, particularly glucocorticoids and bronchodilators, in managing cats with feline lower airway disease (FLAD). The second aim was to ascertain client perception of response to treatment and level of satisfaction. METHODS: This was a prospective cross-sectional study. An online survey was distributed worldwide to cat owners caring for cats with a chronic cough. Only cats reported to have FLAD were included. RESULTS: A total of 153 complete responses describing cats with FLAD were analyzed. Glucocorticoids and bronchodilators were the predominantly prescribed therapeutics for 140/153 (92%) and 80/153 (52%) of FLAD cats, respectively. Oral and inhalant administration routes were reported most commonly: glucocorticoids (64% oral and 75% inhalant) and bronchodilators (21% oral and 88% inhalant). A review of how air quality could be improved was conducted for 54% of cats. Almost half (43%) of owners reported adverse effects secondary to glucocorticoid administration, the most frequent being polyphagia (26%) and polydipsia (21%). Only 10% of owners reported bronchodilator-associated side effects, with restlessness (9%) being the most common. Difficulties giving glucocorticoid or bronchodilator tablets orally were reported for 33% and 71% of owners, respectively. Glucocorticoid or bronchodilator inhalant therapies were difficult to administer for 28% and 31% of owners, respectively. Frequency and severity of coughing were significantly lower after at least 2 months of treatment, with median numerical input on a slider scale (0-100) of 48 and 42 before, and 10 and 7 after treatment, respectively (P <0.0001). Median numerical input of owner satisfaction was 83%. CONCLUSIONS AND RELEVANCE: Despite significant improvements in client-reported responses to treatment, challenges associated with the administration of medications and their adverse effects still exist. Promoting awareness of client experiences can facilitate appropriate follow-up, guidance and empathy to further optimize outcomes.

Prognostic indicators at presentation for canine parvoviral enteritis: 322 cases (2001-2018).

OBJECTIVE: To evaluate clinicopathological prognostic indicators associated with survival based on hematology and serum biochemistry profile findings at presentation of dogs with canine parvoviral enteritis (CPE). Secondary objectives were to describe the signalment, history, physical examination findings, and progression of disease while in hospital and correlate them to survival. DESIGN: Retrospective study from medical records of dogs diagnosed with CPE between 2001 and 2018. SETTING: University teaching hospital. ANIMALS: Three hundred twenty-two dogs diagnosed with CPE that received in-hospital treatment. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 322 hospitalized dogs, 294 dogs (91%) survived infection with a median hospitalization time of 79 hours. Multivariable analysis showed that glucose (P = 0.04), total magnesium (P = 0.011), and the dichotomized variable of a low HCT (P = 0.033) on presentation were significantly associated with survival. For every 1 mmol/L (18 mg/dL) decrease in glucose concentration, cases had 1.85 lower odds of survival. For every 0.1 mmol/L (0.2 mEq/L) increase in total magnesium concentration, cases had 2.50 lower odds of survival. Cases with a low HCT had 10.69 lower odds of survival. On univariable analyses, non-survivors had a lower median body weight (P = 0.006) and presented more commonly for diarrhea (P = 0.015). At least 1 episode of diarrhea (P = 0.003) and hematochezia or melena (P < 0.001) in hospital were negatively associated with outcome, in addition to the persistence of diarrhea (P = 0.026) and hyporexia (P = 0.018) in hospital for 5 to 6 days. CONCLUSIONS: Survival rates of 91% were achieved with in-hospital treatment in this cohort of dogs. Negative biochemical prognostic indicators affecting survival include a low HCT, decreased blood glucose concentrations, and increased total serum magnesium concentrations at presentation.

Effects of dexmedetomidine on glucose homeostasis in healthy cats.

OBJECTIVES: Alpha(α)2-agonist administration has been documented to increase blood glucose concentrations in many species. The aim of this study was to further describe the effect of dexmedetomidine on glucose and its regulatory hormones in healthy cats. METHODS: A randomized crossover study using eight healthy cats with a 14 day washout period was used to assess the effect of dexmedetomidine (10 µg/kg IV) and saline on glucose, cortisol, insulin, glucagon and non-esterified fatty acid (NEFA) concentrations at 0, 20, 60, 120 and 180 mins post-administration. Glucose:insulin ratios were calculated for each time point. RESULTS: Within the dexmedetomidine group, significant differences (P <0.05) were detected: increased median (range) blood glucose concentrations at 60 mins (11.55 mmol/l [5.9-16.6 mmol/l]) and 120 mins (12.0 mmol/l [6.1-13.8 mmol/l]) compared with baseline (6.05 mmol/l [4.8-13.3 mmol/l]); decreased glucagon concentrations at 120 mins (3.8 pmol/l [2.7-8.8 pmol/l]) and 180 mins (4.7 pmol/l [2.1-8.2 pmol/l]) compared with baseline (11.85 pmol/l [8.3-17.2 pmol/l]); decreased NEFA concentrations at 60 mins (0.281 mmol/l [0.041-1.357 mmol/l]) and 120 mins (0.415 mmol/l [0.035-1.356 mmol/l]) compared with baseline (0.937 mmol/l [0.677-1.482 mmol/l]); and significantly larger (P <0.05) glucose:insulin ratios at 60 mins compared with baseline. Insulin and cortisol concentrations were not significantly changed after dexmedetomidine administration. CONCLUSIONS AND RELEVANCE: Feline practitioners should be aware of the endocrine effects associated with the use of α2-agonists, particularly when interpreting blood glucose concentrations. The transient effects of dexmedetomidine on glucose homeostasis are unlikely to significantly affect clinical practice.

A possible new inherited myopathy in a young Labrador retriever.

A 5-month-old, male, Labrador retriever was evaluated for progressive weakness and muscle atrophy. Histologic evaluation of fresh frozen muscle revealed distinct cytoarchitectural changes and central mitochondrial accumulations indistinguishable from those found in the inherited myopathy described in Great Danes. Multiple male littermates and half-siblings were similarly affected.