Clinical presentation, outcome and prognostic factors in dogs with immune-mediated haemolytic anaemia: a retrospective single-centre study of 104 cases in Ireland (2002-2020).

BACKGROUND: Immune-mediated haemolytic anaemia (IMHA) has a high mortality rate within the first weeks to months of diagnosis. Identifying dogs at increased risk of death may help guide decision-making for owners and veterinarians. Prior studies have identified several but inconsistent prognostic factors. The objectives of the study were to describe the clinical presentation and outcome of canine immune-mediated haemolytic anaemia in Ireland and to assess for independent factors associated with survival including long-term survival. Medical records from a single centre were reviewed between 2002 and 2020 to identify dogs with immune-mediated haemolytic anaemia using the American College of Veterinary Internal Medicine (ACVIM) consensus statement algorithm. Survival analysis was performed using univariable Cox proportional hazards regression models with Breslow method for ties to identify prognostic factors. RESULTS: One hundred and four cases were included. The diagnosis of immune-mediated haemolytic anaemia was classified as definitive, supportive and suspicious in 42 (40%), 50 (48%), and 12 dogs (12%) respectively. Twenty-two dogs (21%) were diagnosed with associative IMHA and 82 dogs were diagnosed with non-associative IMHA (79%). 65% of the cases received more than one immunosuppressive medication during the course of treatment. The mortality rate at one and three months was 16% (95% confidence interval [CI] 9-26) and 31% (95% CI 21-43) respectively. Excluding dogs that died within three months, the median survival time was 2664 days. The relapse rate during the follow-up period was 7%. Survival did not improve over the course of the study period. Thrombocytopenia and hyperbilirubinaemia were identified as negative prognostic indicators (Hazard ratio 2.2 and 2.5, 95% CI 1.1-4.1 and 1.1-5.6, respectively). CONCLUSIONS: Excluding dogs that died within three months, the outcome was good in dogs with non-associative immune-mediated haemolytic anaemia in Ireland. The relapse rate was low regardless of the presence of associative causes. Thrombocytopenia and hyperbilirubinaemia were the only independent negative prognostic factors. The one-month and three-month mortality rates were similar compared to prior studies and survival did not improve over time during the study period: the mortality rate of canine immune-mediated haemolytic anaemia remains high in the acute phase.

A systematic review and meta-analysis of prevalence of complications after tracheal stenting in dogs.

BACKGROUND: Stenting has become popular to treat tracheal collapse in dogs, but complications might arise and negatively affect treatment outcome. OBJECTIVES: Determine the overall prevalence of complications of tracheal stenting in dogs. METHODS: A bibliographic search was performed of publications from 2000 to 2020. Studies were assessed for quality of evidence and measured prevalence of the 8 most commonly reported complications after tracheal stenting in dogs (stent fracture, stent migration, relapsing collapse, granuloma formation, tracheobronchial infections, and early, late, and clinically relevant late cough). Random effects meta-analyses were used to estimate pooled complications prevalence. RESULTS: Fifteen studies met inclusion criteria. Cough (early: 99%; 95% confidence interval [95% CI]: 95%-100%, late: 75%; 95% CI: 63%-85%, and clinically relevant: 52%; 95% CI: 42%-61%), tracheobronchial infections (24%; 95% CI: 14%-35%), and granulomas (20%; 95% CI: 11%-30%) were common after tracheal stenting. Stent fractures (12%; 95% CI: 5%-20%), relapsing collapse (10%; 95% CI: 5%-15%), and stent migration (5%; 95% CI: 1%-9%) were less frequent. Significant heterogeneity among studies was identified for the estimated prevalence of stent fracture, granulomas, infections, and late cough. CONCLUSIONS AND CLINICAL IMPORTANCE: Tracheal stenting in dogs is associated with a high risk of coughing and a moderate risk of tracheobronchial infections and granuloma formation. Because most complications will impact a dog's quality of life, owners must be informed that tracheal stenting is a second-line procedure that does not necessarily alleviate the need for medical treatment and frequent follow-up visits. Additional studies are warranted to identify the risk factors of these complications.

Endoscopic Removal of Gastric Foreign Bodies with a Bottle Liner in 12 Dogs (2020-2023).

Endoscopy is widely used to remove gastric foreign bodies using grasping forceps and loop snares to manipulate and retrieve the foreign material. However, as not all foreign bodies can be removed using conventional endoscopic techniques, this case series describes the use of bottle liners for the removal of gastric foreign bodies in 12 dogs between 2020 and 2023. A 4 oz bottle liner (Drop-Ins) was placed at the end of the endoscope and pushed into the stomach. With the help of forceps introduced into the operating channel, the foreign body was pushed into the bottle liner. The bottle liner containing the foreign body was then extracted with the help of traction threads. The technique was used as the initial retrieval method in 5 dogs because of smooth (i.e., difficult to grasp) or sharp (i.e., that may damage the digestive tract mucosa during removal) foreign bodies and as a rescue procedure in 7 dogs. Foreign body retrieval was successful in all 12 dogs, with minor complications reported in 5 dogs (erosions and bleeding of the gastroesophageal sphincter). The use of a bottle liner represents an affordable alternative to gastrotomy when foreign bodies cannot be grasped with forceps or snares.

Treatment of recurrent hunting-associated respiratory distress episodes in 2 dogs.

Noncardiogenic pulmonary edema (NCPE) in hunting dogs is an uncommon and poorly described condition for which no preventive treatment is available. Two dogs were presented for recurrent respiratory distress strictly associated with hunting activities. Diagnosis was based on bilateral, symmetrical, interstitial-to-alveolar pattern in the caudodorsal lung fields on thoracic radiographs, exclusion of other causes, and spontaneous clinical and radiographic improvement. Considering that the pathogenesis of exercise-induced NCPE likely involves α- and ß-adrenergic overstimulation, treatment with sympathetic blockers was used in both dogs. The first dog no longer showed respiratory signs during hunting activities. However, treatment failed to prevent respiratory distress in the other dog. Based on the large number of red blood cells in the bronchoalveolar lavage fluid of the second dog, exercise-induced pulmonary hemorrhage was suspected, as described in racing horses. The loop diuretic furosemide successfully prevented further hunting-associated respiratory distress episodes in this dog.

IV Versus Myelography Computed Tomography for Thoracolumbar Intervertebral Disc Extrusion Surgical Planning in French Bulldogs.

Accurate diagnostic imaging is required for surgical planning of acute thoracolumbar intervertebral disc extrusion. However, data comparing the accuracy of conventional IV contrast-injected computed tomography (CT) and myelography CT for hemilaminectomy localization and size assessment are sparse. In this study, IV contrast-injected CT and myelography CT were performed in 48 French bulldogs presenting with acute disc herniation and compared with postsurgical CT. CT images were evaluated by three raters. IV contrast-injected CT erroneously identified the compressive lesion site significantly more often than myelography CT. The length of the compressive lesion was significantly higher using myelography CT compared with conventional CT, but this did not lead to relevant consequences on the surgical opening site length. Myelography CT should therefore be recommended when thoracolumbar disc disease is suspected and multiple compressive lesions are visualized on IV-injected CT in French bulldogs.

Long-term outcomes after arthroscopic treatment of dogs affected by osteochondrosis dissecans of the humeral trochlea, with or without medial coronoid disease: 23 cases (2012-2020).

The objective of this study was to report long-term clinical and radiographic outcomes following arthroscopic reparative treatment - flap removal, curettage, and osteostixis of subchondral bone - in dogs with humeral trochlea osteochondritis dissecans (OCD). Dogs were included in this retrospective multicenter case series if they had a computed tomography diagnostic of humeral trochlear OCD, with or without medial coronoid disease, that was treated by arthroscopic reparative technique, and a detailed follow-up at least 6 mo postoperatively. The latter included a clinical examination, assessment of lameness, measurement of the brachial circumference and elbow amplitude, International Elbow Working Group (IEWG) radiographic score, owner-completed canine brief pain inventory (CBPI) score, and visual analogue scale (VAS) rating. A generalized linear model and tests for symmetry and marginal homogeneity were used to compare data. Twenty-three dogs (30 affected elbows) were included. Long-term (median: 22 mo; range: 6 to 98 mo) postoperative lameness, CBPI, VAS, joint distension, and pain scores were significantly improved compared with the preoperative values. Long-term postoperative range of motion and brachial circumference did not reveal any significant difference between OCD-affected and unaffected elbows. Long-term IEWG scores were similar to preoperative values in 56% of elbows and had progressed by 1 grade in 44%. Long-term complications included persistent Grade-1 lameness and occurred in 23% of dogs. Long-term outcomes based on lameness and CBPI scores were considered excellent in 67% of dogs, good in 27%, and intermediate in 6%. Arthroscopic treatment is thus a suitable surgical procedure for OCD of the humeral trochlea in dogs and provides good long-term results.

Cette étude rapporte les résultats cliniques et radiographiques à long terme après un traitement arthroscopique chez des chiens atteints d'ostéochondrite disséquante (OCD) de la trochlée humérale. Les chiens inclus ont reçu un diagnostic d'OCD de la trochlée humérale par tomographie, un traitement réparateur par arthroscopie et un suivi post-opératoire d'au moins 6 mois. Ce dernier comprenant un examen clinique et orthopédique, la mesure de la circonférence brachiale et de l'amplitude du coude, le score radiographique de l'International Elbow Working Group (IEWG), le score Canine Brief Pain Inventory (CBPI) et l'échelle visuelle analogique (EVA). Un modèle linéaire généralisé et des tests de symétrie et d'homogénéité marginale ont permis de comparer les données. Vingt-trois chiens (30 coudes affectés) ont été inclus. Les scores postopératoires à long terme (médiane, 22 mois), de boiterie, de CBPI, d'EVA, de distension articulaire et de douleur étaient significativement améliorés. L'amplitude de mouvement et la circonférence brachiale postopératoires à long terme entre les coudes affectés et non affectés n'ont pas révélé de différence significative. Les scores IEWG à long terme étaient similaires aux valeurs préopératoires dans 56 % des coudes et avaient progressé d'un grade dans 44 %. Les résultats à long terme basés sur la boiterie et les scores CBPI ont été considérés comme excellents chez 67 % des chiens, bons chez 27 % et intermédiaires chez 6 %. Le traitement arthroscopique est donc une procédure chirurgicale appropriée pour l'OCD de la trochlée humérale chez le chien et donne de bons résultats à long terme.(Traduit par les auteurs).

Video telescope operating monitor-assisted surgery is equivalent to conventional surgery in treatment of cervical intervertebral disc herniation in dogs.

OBJECTIVE: To compare the use of the video telescope operating monitor (VITOM) and use of a conventional unassisted surgical method for treatment of cervical intervertebral disc herniation in dogs. ANIMALS: 39 dogs with cervical intervertebral disc disease. METHODS: Prospective study. Dogs were prospectively nonrandomly assigned to either the VITOM (n = 19) or conventional surgery (20) group depending on VITOM system availability. Signalment and preoperative neurologic status were recorded for all dogs. Preoperative and postoperative CT myelography was performed to compare intervertebral space location, spinal cord dimensions at the decompression level, ventral slot dimensions, and residual disc material. Surgical complications and postoperative neurologic outcomes were recorded. Data were compared between the 2 groups using fixed-effects or mixed-effects models to consider double reading of CT myelography images. RESULTS: No significant differences were noted between the 2 groups regarding the decompression ratio (P = .85), vertebral length body ratio (P = .13), ventral slot width ratio (P = .39), residual disc material (P = .30), and sinus bleeding (P = .12). No significant differences were found between the 2 groups regarding postoperative neurologic grade (P = .17). CLINICAL RELEVANCE: VITOM-assisted ventral slot decompression is equivalent to conventional surgery in treatment of cervical intervertebral disc herniation in dogs. The use of VITOM remains a good alternative to the conventional surgical method.

Assessment of survey radiography as a method of diagnosing bilateral laryngeal paralysis in dogs.

The gold standard for diagnosis of laryngeal paralysis is laryngoscopy under light anesthesia. This prospective analytical cross-sectional study aimed to determine whether a radiographic assessment of the larynx could be used as a non-invasive screening tool for diagnosing laryngeal paralysis in non-sedated animals, as the laryngeal ventricles may appear wider in affected animals. The laryngeal ventricles of 18 dogs with bilateral laryngeal paralysis composing the affected group and 25 non-sedated dogs presenting no respiratory abnormality composing the control group were evaluated using right lateral radiography of the larynx. Three observers measured the ratios of the maximal ventricular length and surface to the body length of the third cervical vertebra (MVL/LC3 and VS/LC3, respectively). They also subjectively assessed the ventricular shape as either normal or rounded. The most accurate criterion was found to be MVL/LC3, as the respective areas under the ROC curves were 0.96 (95% confidence interval [CI]: 0.95-0.97), 0.89 (95% CI: 0.87-0.91), 0.80 (95% CI: 0.65-0.95) for MVL/LC3, VS/LC3, and ventricular shape evaluation, respectively. Based on ROC curve analysis, two thresholds of clinical interest were set for the MVL/LC3; bilateral laryngeal paralysis was very unlikely for values < 0.3 and very likely for values > 0.5. The findings of this study support the use of lateral laryngeal radiography as a screening tool for diagnosing bilateral laryngeal paralysis. However, further diagnostic tests remain required if MVL/LC3 lies between these threshold values or if clinically indicated. Further studies are warranted to explore the use of laryngeal radiography in unilateral paralysis and other laryngeal or oropharyngeal diseases.

Suppurative spinal meningomyelitis in a dog with intra-neutrophilic cerebrospinal fluid cells Ehrlichia canis morulae.

A 2-year-old castrated male Creole Shepherd mixed dog was presented for non-ambulatory paraparesis of the pelvic limbs. The magnetic resonance imaging and cerebrospinal fluid (CSF) analysis were consistent with meningomyelitis. Positive serology for Ehrlichia canis/Ehrlichia ewingii suggested exposure to a pathogen; qPCR on the serum and the CSF confirmed active infection. Ehrlichial morulae were observed within CSF and peripheral blood polymorphonuclear neutrophils; a species-specific PCR confirmed E. canis infection. This is an interesting report of E. canis infection in a dog with morulae observed in neutrophils both in the peripheral blood and CSF.

Spinal epidural and synovial lipomatosis in a 3-year-old Eurasian dog receiving sustained steroid therapy.

This report describes a spinal cord epidural and synovial lipomatosis in a 3-year-old neutered male Eurasian dog. This dog presented for ambulatory paraparesis and was previously treated with immunosuppressive dosages of prednisolone for 2 years. Computed tomography (CT) myelography and magnetic resonnance imaging (MRI) images identified dorsal compression of the thoraco-lumbar spinal cord by hypertrophic epidural fat. Histological examination identified extensive well-differentiated mature adipose tissue in the subepithelial area of the tarsal synovium. Prednisolone is a reported predisposing factor in humans with lipomatosis.

Association between quantitative bacterial culture of bronchoalveolar lavage fluid and antibiotic requirement in dogs with lower respiratory tract signs.

BACKGROUND: Historically, positive bacterial cultures from the lower respiratory tract (LRT) have been considered clinically relevant when quantitative bacterial cultures of bronchoalveolar lavage fluid (BALF) were >1700 colony forming units (cfu)/mL. However, this threshold might not accurately predict a requirement for antibiotics. OBJECTIVES: To study whether quantitative BALF bacterial culture results were predictive of antibiotic requirement in dogs with LRT signs. ANIMALS: Thirty-three client-owned dogs. METHODS: Cross-sectional study. Dogs with positive quantitative bacterial culture of BALF were included. Dogs were divided into 2 groups, depending on whether they had a LRT infection requiring antibiotics (LRTI-RA) or LRT disease not requiring antibiotics (LRTD-NRA), based on thoracic imaging features, presence of intracellular bacteria on BALF cytology, and response to treatment. Predictive effect of cfu/mL and BALF total nucleated cell count (TNCC) on antibiotic requirement, adjusting for ongoing or prior antibiotic therapy and age, were studied using logistic regression. RESULTS: Twenty-two and 11 dogs were included in the LRTI-RA and LRTD-NRA groups, respectively. The cfu/mL was not significantly predictive of antibiotic requirement, independent of ongoing or prior antibiotic treatment and age (LRTI-RA: median, 10 000 cfu/mL; range, 10-3 × 108 ; LRTD-NRA: median, 10  000 cfu/mL; range, 250-1.3 × 109 ; P = .27). The TNCC was not significantly predictive of antibiotic requirement when only dogs with bronchial disease were considered (LRTI-RA: median, 470 cells/µL; range, 240-2260; LRTD-NRA: median, 455 cells/µL; range, 80-4990; P = .57). CONCLUSION AND CLINICAL IMPORTANCE: The cfu/mL is an inappropriate measure for determining whether antibiotics are of benefit in dogs with LRT signs.

Association of gastric lymphofollicular hyperplasia with Helicobacter-like organisms in dogs.

BACKGROUND: The relationships among gastric lymphoid follicular hyperplasia (GLFH), Helicobacter-like organisms (HLOs), and clinical signs have not been established in dogs. OBJECTIVES: To evaluate the epidemiologic, clinical, endoscopic, and histopathologic findings associated with GLFH in dogs, and determine the association of GLFH with HLOs and the French Bulldog (FB) breed. ANIMALS: Two hundred eighty-eight dogs that underwent gastroscopy between 2013 and 2016. METHODS: Retrospective, cross-sectional study. Gastric biopsy samples were reviewed and scored for inflammation and HLOs. Dogs were divided into 3 groups: group 1 (63 FBs), group 2 (45 non-FB brachycephalic dogs), and group 3 (180 nonbrachycephalic dogs). Variables were evaluated for their association with GLFH. RESULTS: Univariate analysis determined that intact males, young age, vomiting, gastroscopic findings (discoloration, hemorrhage, and ulcers), and histopathologic findings (gastric lamina propria lymphocytic infiltration and HLO score) were associated with GLFH (P ≤ .03). In the multivariate analysis, GLFH was associated with the HLO score (odds ratio [OR] > 5 for HLO scores 1-2 and >15 for HLO score of 3; P < .001), with vomiting (OR > 4; P = .01) but not with FB breed (P = .76) and age (P = .1). The HLO score was associated with younger age (P < .001). CONCLUSION AND CLINICAL IMPORTANCE: The HLO score was associated with a high GLFH score. Vomiting was associated with GLFH. Helicobacter-like organisms are highly prevalent in young dogs and GLFH is indirectly associated with this factor. Clinical relevance of the identification of GLFH and HLO remains to be determined.

Outcomes of dogs undergoing surgery for gastric dilatation volvulus after rapid versus prolonged medical stabilization.

OBJECTIVE: To compare the outcomes of dogs surgically treated for gastric dilatation volvulus (GDV) after rapid versus prolonged medical stabilization. STUDY DESIGN: Prospective cohort study, monoinstitutional. SAMPLE POPULATION: One hundred and sixty-two dogs with GDV. METHODS: Dogs presenting with a GDV were allocated to 1 of 2 groups, immediate or delayed. In the immediate group, dogs were stabilized for 90 min prior to undergoing surgery. In the delayed group, dogs underwent surgery after at least 5 h of stabilization. Medical stabilization included gastric decompression and placement of an indwelling nasogastric tube to prevent further gastric dilatation in all dogs. Short-term outcomes were compared between surgical timings by univariate and multivariate analyses. RESULTS: Dogs (n = 89) in the immediate group underwent surgery a median time of 2.1 h after presentation (range 1.9-2.5 h), whereas those in the delayed surgery group (n = 73) were operated a median time of 9.8 h (range 5.4-13.7 h) after presentation. Survival rates did not differ between dogs undergoing immediate or delayed surgery at discharge (70/89 and 60/73, respectively) or at 1 month postoperatively (68/89 and 55/73, respectively). The degree of gastric torsion was differently distributed between the 2 groups (P = .05). In the immediate group, 19, 52, and 9 dogs had a 0°, 180° and 270° gastric torsion respectively, whereas in the delayed group, 27, 32, and 5 dogs had a 0°, 180° and 270° gastric torsion respectively. Hyperlactatemia 24 h after initiation of fluid therapy was associated with an increased in-hospital mortality risk and at 1 month postoperatively. CONCLUSION: No survival benefit was detected as a result of proceeding to surgery after either a rapid or a prolonged medical stabilization. CLINICAL SIGNIFICANCE: The aggressive stabilization and monitoring protocol described here can be considered as an alternative to stabilize dogs with GDV prior to surgery within 13.7 h of presentation. Further research is required to investigate the potential risks and benefits of prolonged over rapid stabilization and to identify candidates for each approach.

Diagnostic performance of predicted ionized calcium in dogs with total hypercalcemia and total hypocalcemia.

BACKGROUND: Abnormal total calcium (tCa) values do not necessarily imply dysregulated ionized calcium. OBJECTIVES: We aimed to evaluate the diagnostic performance of predicted ionized calcium (piCa) regarding true calcium status in dogs with abnormal tCa. METHODS: This was a cross-sectional multicenter study. piCa and its prediction interval (PI) were calculated in 114 dogs, from three different hospitals, with either increased (62) or decreased tCa (52), All dogs also had ionized calcium and a biochemical profile available. The sensitivity, specificity, predictive values, and diagnostic discordance of piCa to confirm ionized hypercalcemia (iHyperCa) and ionized hypocalcemia (iHypoCa) were calculated using logistic regression analysis. RESULTS: iHyperCa was found in 28% and 66% of hyperphosphatemic and non-hyperphosphatemic dogs with tCa above the reference interval upper limit, respectively. The piCa correctly classified dogs with iHyperCa in 72.2% of those with hyperphosphatemia and 93.2% of those without hyperphosphatemia. Comparatively, elevating the tCa threshold to 12 mg/dL properly classified dogs 50% and 75% of the time in hyperphosphatemic and non-hyperphosphatemic dogs, respectively. iHypoCa was found in only 31/52 (60%) dogs with decreased tCa. The piCa correctly classified 55.2 to 100% of dogs with iHypoCa depending on the hospital. The PI demonstrated high sensitivity for iHyperCa (100%) and high specificity for both iHyperCa (100%) and iHypoCa (100%). CONCLUSIONS: Evaluating tCa alone does not reliably determine ionized calcium status. Even with hyperphosphatemia, piCa and its PI represent a reliable alternative to interpret abnormal tCa values when ionized calcium measurements are not available. However, if the tCa reference interval is notably different from 7.6 to 11.4 mg/dL, piCa values might be under/overestimated.

Complications, prognostic factors, and long-term outcomes for dogs with brachycephalic obstructive airway syndrome that underwent H-pharyngoplasty and ala-vestibuloplasty: 423 cases (2011-2017).

OBJECTIVE: To describe the H-pharyngoplasty procedure, report the outcomes of dogs with brachycephalic obstructive airway syndrome (BOAS) treated with ala-vestibuloplasty and H-pharyngoplasty with a CO2 laser, and identify prognostic factors. ANIMALS: 423 dogs. PROCEDURES: Medical records of dogs admitted for BOAS from 2011 to 2017 were reviewed. Dogs were included if they were treated with ala-vestibuloplasty and H-pharyngoplasty with a CO2 laser. Signalment, physical examination findings, grades at admission of clinical signs associated with respiratory and digestive systems, diagnostic test results, postoperative treatments, and short-term follow-up results were extracted from medical records. Long-term follow-up of > 12 months was evaluated via questionnaire. Generalized ordered logistic regression was used for bivariable and multivariable analyses. RESULTS: Overall mortality rate was 2.6%. Median duration of follow-up was 36 months (12 to 91 months), and 341 (80.6%) dog owners completed the questionnaire. Major complications included respiratory distress (2.1%), heatstroke (0.5%), and bronchopneumonia (0.5%). No dogs required revision surgery. Improvement in signs associated with the respiratory and digestive systems was reported in 72% and 34% of the dogs, respectively, and owners' satisfaction was high (97.1%). Risk of death increased by 29.8% (95% CI, 11.8% to 50.7%) for every 1-year increase in age. CONCLUSION AND CLINICAL RELEVANCE: H-pharyngoplasty was possible in all dogs with BOAS, including those previously treated with conventional surgery and was associated with low morbidity and improved respiratory and digestive signs. H-pharyngoplasty combined with ala-vestibuloplasty may be an alternative treatment for even the most severely affected dogs.

Subjective assessment of frequency distribution histograms and consequences on reference interval accuracy for small sample sizes: A computer-simulated study.

BACKGROUND: Inaccuracy in estimating reference intervals (RIs) is a problem with small sample sizes. OBJECTIVES: This study aimed to identify the most accurate statistical methods to estimate RIs based on sample size and population distribution shape. We also studied the accuracy of sample frequency distribution histograms to retrieve the original population distribution and compared strategies based on the histogram and goodness-of-fit test. METHODS: The statistical methods that best enhanced accuracy were determined for various sample sizes (n = 20-60) and population distributions (Gaussian, log-normal, and left-skewed) were determined by repeated-measures ANOVA and posthoc analyses. Frequency distribution histograms were built from 900 samples of five different sizes randomly extracted from six simulated populations. Three reviewers classified the population distributions from visual assessments of a sample histogram, and the classification error rate was calculated. RI accuracy was compared among the strategies based on the histograms and goodness-of-fit tests. RESULTS: The parametric, nonparametric, and robust methods enhanced lower reference limit estimation accuracy for Gaussian, log-normal, and left-skewed distributions, respectively. The parametric, nonparametric bootstrap, and nonparametric methods enhanced the upper limit estimation accuracy for Gaussian, log-normal, and left-skewed distributions, respectively. Regardless of sample size, sample histogram assessments properly classified the original population distribution 71% to 93.9% of the time, depending on the reviewers. In this study, the strategy based on histograms assessed by the statistician was significantly more precise and accurate than the strategy based on the goodness-of-fit test (P < 0.001). CONCLUSIONS: A strategy based on histograms might enhance the accuracy of RI estimations. However, relevant inter-reviewer variations in histogram interpretation were detected. Factors affecting inter-reviewer variations should be further explored.

Evaluation of bronchial narrowing in coughing dogs with heart murmurs using computed tomography.

BACKGROUND: The origin of cough in dogs with heart murmurs is controversial, because the cough could be primary cardiac (eg, pulmonary edema, bronchi compression by left-sided cardiomegaly) or respiratory (eg, bronchomalacia, other bronchial or bronchiolar disease, interstitial lung disease) in origin. HYPOTHESIS/OBJECTIVES: To study the association between left atrium (LA) dilatation and cardiomegaly and bronchial narrowing in coughing dogs with heart murmurs using computed tomography (CT). ANIMALS: Twenty-one client-owned coughing dogs with heart murmurs and 14 historical control dogs. METHODS: Dogs with cough and murmur were prospectively recruited over 4 months. Cervical and thoracic radiography, echocardiography, and thoracic CT were performed in enrolled dogs. Control dogs, with no disease on thoracic CT and no records of heart murmur and coughing, were gathered from the institution's computerized database. Degree of bronchial narrowing was assessed using the bronchial-to-aorta (Ao) ratio, measured by 3 radiologists blinded to the clinical findings. After identifying bronchi that were significantly narrowed in dogs with murmur compared to controls, the relationship between degree of narrowing and LA/Ao ratio (measured echocardiographically) and vertebral heart scale (VHS) measured radiographically was studied in dogs with murmur using mixed-effects regression. RESULT: Significant narrowing was identified for all left-sided bronchi and the right principal, middle, and caudal bronchi in the coughing dogs, compared with controls. Increasing LA size and VHS were significantly inversely associated with diameter for all left-sided and right-sided bronchi indicated above. CONCLUSION AND CLINICAL IMPORTANCE: Results indicate an association between LA enlargement and cardiomegaly and bronchial narrowing and support heart size-associated exacerbation of cough in dogs with murmurs.

The multivariate predictive model to estimate ionized calcium concentration from serum biochemical results in dogs: External validation.

BACKGROUND: Predicted ionized calcium (piCa) can be calculated from routine biochemistry variables using a recently developed predictive model in dogs. However, it has not been evaluated with variables measured from multiple laboratories. OBJECTIVES: We aimed to (a) externally validate piCa in dogs where biochemistry results were obtained from different analyzers, and (b) compare the diagnostic performances of piCa and total calcium (tCa). METHODS: A cross-sectional multicentric study on 138 dogs from three different hospitals was performed. The sensitivity (Sen), specificity (Spe), positive (PPV) and negative predictive values (NPV), and diagnostic discordance of piCa and tCa were calculated using logistic regression for ionized hypercalcemia and hypocalcemia. Diagnostic performance fluctuations across hospitals were also assessed. RESULTS: For ionized hypercalcemia, the Sen (81.8%), Spe (96.1%), PPV (69.2%), NPV (97.7%), and diagnostic discordance (5.1%) of piCa were not significantly different among hospitals or from those of tCa. For ionized hypocalcemia, the Sen (range: 9.7%-53.8%) and Spe (range: 95.6%-99.6%) of piCa and tCa (Sen range: 16.2%-87.8%; Spe range: 58.3%-98.1%) varied across hospitals, although to a lesser extent for piCa. The diagnostic discordances of piCa (20.3%) and tCa (25.4%) were close. The prediction interval (PI) of piCa demonstrated high Sen to screen for ionized hypercalcemia (100%) and hypocalcemia (range: 75%-93.3%), and high Spe to diagnose ionized hypercalcemia and hypocalcemia (100% for both). CONCLUSIONS: These results support the external validation of piCa in dogs. Its PI represents a notable advantage over tCa to help clinicians explore calcium-related disorders when ionized calcium cannot be readily measured.