Efectividad de la entrevista motivacional en la atención fisioterápica de los trastornos musculoesqueléticos de la espalda / Effectiveness of the motivational interview in the physiotherapy care of musculoskeletal disorders of the back: A quasi-experimental study

Objetivo: Evaluar la efectividad de la entrevista motivacional (EM) junto al tratamiento fisioterapéutico habitual en pacientes con trastornos musculoesqueléticos (TME) de la espalda en atención primaria (AP). Métodos: Estudio cuasiexperimental en pacientes que iniciaron su tratamiento en el año 2020 en una unidad de fisioterapia tras diagnóstico médico de TME en la espalda, con seguimiento prospectivo de 2grupos con actuación terapéutica: grupo experimental (GE) y grupo de control (GC). Se empleó la EM solo en el GE. A ambos grupos se les entrevistó telefónicamente a los 3y 6meses de finalizar el tratamiento fisioterápico, preguntando por el cumplimiento de pautas domiciliarias y por la percepción subjetiva del estado de salud (escala de Barthel). Se ajustaron modelos de regresión lineales (coeficiente de regresión, IC del 95%) y logísticos (OR, IC del 95%). Resultados: La población de estudio fue de 154 personas (76,6% mujeres). La salud percibida fue significativamente mejor (p<0,001) en el GE que en el GC, tanto a los 3meses de seguimiento (7,4 versus 5,0, respectivamente) como a los 6(7,1 versus 4,6, respectivamente). Hubo una fuerte asociación entre percepción de salud y cumplimiento (coeficiente de regresión 3,0 [IC del 95%=2,5-3,4]). La asociación entre la EM y el cumplimiento terapéutico se mantuvo tras ajustes multivariados (OR a 6meses=383,6 [IC del 95% = 31,0-4.742,4]). Conclusiones: la incorporación de la EM como complemento de los tratamientos de fisioterapia es una herramienta factible y efectiva para mejorar el cumplimiento de las pautas domiciliarias y la percepción subjetiva de salud. (AU)

Objective: To evaluate the effectiveness of motivational interviewing (MI) combined with the usual physiotherapy treatment in patients with back musculoskeletal disorders (MSD) in primary care (PC). Methods: Quasi-experimental study with 2groups with therapeutic action (control group and experimental group) and prospective follow-up, in a physiotherapy unit in PC, in patients who began their treatment in 2020, with a medical diagnosis of MSD in the back. MI was used only in the face-to-face visits of the experimental group. Both groups were interviewed by telephone about 3and 6months after finishing the physiotherapy treatment. For this purpose, the Barthel scale was used for the subjective perception of the state of health, and the scale of compliance with home guidelines. Linear (regression coefficient, 95% CI) and logistic (OR, 95% CI) regression models were fitted. Results: The study population was 154 people (76.6% women). Perceived health was significantly better (P<.001) in the experimental group than in the control group, both at 3(7.4 versus 5.0, respectively) and at 6months of follow-up (7.1 versus 4.6, respectively). There was a strong association between perceived health and compliance (regression coefficient 3.0 [95% CI=2.5–3.4]). The strong association between MI and treatment adherence was maintained after multivariate adjustments (6-month OR=383.6 [95% CI 31.0–4742.4]). Conclusions: MI is a feasible and effective complement to physiotherapy treatments to improve compliance with home recommendations and subjective perception of health. (AU)

Seguimiento de los pacientes con diabetes tipo 2 durante la pandemia por COVID-19: un estudio multicéntrico en Atención Primaria / Follow-up of patients with type 2 diabetes during the COVID-19 pandemic: A multicentre study in Primary Care

Antecedentes La pandemia de COVID-19 obligó a tomar medidas que implicaban la desatención a los pacientes con diabetes tipo 2 (DM2). Objetivos Explorar la repercusión de la discontinuidad asistencial sobre los pacientes con DM2. Diseño Estudio observacional retrospectivo multicéntrico. Emplazamiento Cinco centros de atención primaria (AP), que no tenían protocolo de actuación específica para ellos, durante 2020 y 2021. Participantes Pacientes con DM2 en Tenerife, Islas Canarias, España. Mediciones principales De las historias clínicas se extrajeron el sexo y la edad, las variables de seguimiento del programa de detección y control de la enfermedad vascular ateroesclerótica (pEVA), de cumplimiento de los objetivos de control y frecuentación al médico de familia y enfermera comunitaria. Resultados Se incluyó a 3.543 pacientes, 1.772 (50%) mujeres, de ellos 2.204 (62%) mayores de 65 años. La gran mayoría de actividades registradas y objetivos de control disminuyeron en 2020, recuperándose en 2021 sin alcanzar los niveles de 2019. En 2020 aumentaron las consultas telefónicas y disminuyeron las presenciales, tendencia mantenida en 2021 para las telefónicas. Las mujeres y los mayores de 65 años presentaron mayor frecuentación, más registros de actividades y logros de objetivos de control en la mayoría de los parámetros. Conclusiones La pandemia supuso una sobrecarga de la AP que ha afectado a la atención de los pacientes con DM2, que no ha logrado restablecerse a los niveles prepandémicos. Los hombres jóvenes conforman la diana de priorización de esta atención. Las medidas antipandémicas han aumentado la consulta telefónica, un recurso que debe potenciarse (AU)

Background The COVID-19 pandemic meant measures had to be taken that implied the neglect of patients with type 2 diabetes (T2D). Objectives to explore the impact of care discontinuity on patients with T2D in Primary Care (PC) centres, who did not have a specific action protocol for them, during 2020 and 2021. Design Multicenter retrospective observational study. Participants Patients with T2D in Tenerife, Canary Islands, Spain. Main Measurements Sex and age, follow-up variables of atherosclerotic vascular disease detection and control programme (pEVA), compliance with the control objectives and visits to the family practitioner and community nurse were extracted from their medical records. Results 3,543 participants took part in the study, 1,772 (50%) women, 2,204 (62%) of whom were older than 65 years of age. The vast majority of registered activities and control objectives decreased in 2020, recovering in 2021 without reaching 2019 levels. In 2020, telephone consultations increased and in-person consultations decreased, a trend that remained unchanged in 2021 for telephone consultations. Women and those over 65 years of age presented higher frequentation, more activity records and achievement of control objectives in most of the parameters. Conclusions The pandemic caused an overload in the PCs that affected the care of patients with T2D, which has not returned to pre-pandemic levels. Young men are the target for prioritization of this care. Anti-pandemic measures have led to an increase in telephone consultations, a resource that should be strengthened (AU)

[Follow-up of patients with type 2 diabetes during the COVID-19 pandemic: A multicentre study in Primary Care]. / Seguimiento de los pacientes con diabetes tipo 2 durante la pandemia por COVID-19: un estudio multicéntrico en Atención Primaria.

BACKGROUND: The COVID-19 pandemic meant measures had to be taken that implied the neglect of patients with type 2 diabetes (T2D). OBJECTIVES: to explore the impact of care discontinuity on patients with T2D in Primary Care (PC) centres, who did not have a specific action protocol for them, during 2020 and 2021. DESIGN: Multicenter retrospective observational study. PARTICIPANTS: Patients with T2D in Tenerife, Canary Islands, Spain. MAIN MEASUREMENTS: Sex and age, follow-up variables of atherosclerotic vascular disease detection and control programme (pEVA), compliance with the control objectives and visits to the family practitioner and community nurse were extracted from their medical records. RESULTS: 3,543 participants took part in the study, 1,772 (50%) women, 2,204 (62%) of whom were older than 65 years of age. The vast majority of registered activities and control objectives decreased in 2020, recovering in 2021 without reaching 2019 levels. In 2020, telephone consultations increased and in-person consultations decreased, a trend that remained unchanged in 2021 for telephone consultations. Women and those over 65 years of age presented higher frequentation, more activity records and achievement of control objectives in most of the parameters. CONCLUSIONS: The pandemic caused an overload in the PCs that affected the care of patients with T2D, which has not returned to pre-pandemic levels. Young men are the target for prioritization of this care. Anti-pandemic measures have led to an increase in telephone consultations, a resource that should be strengthened.

Implementation of a Blended Learning Module to Teach Handling, Restraint, and Physical Examination of Cats in Undergraduate Veterinary Training.

Cats can be easily stressed in a clinical (training) setting and may show unpredictable reactions and patterns of defensive aggression. This can be a complicating factor in undergraduate veterinary training. Inexperienced veterinary students can evoke defensive feline behavior that negatively affects learning outcomes and animal welfare. As a result, restraint techniques and physical examination of cats was hardly practiced in pre-clinical training at Utrecht University. To overcome this, a new blended learning module was developed using a lecture on feline behavior; e-learning modules about feline behavior, handling, restraint, and physical examination skills; and redesigned practical sessions in which live animals and manikins were used. The aim of this study was to investigate how students' perceptions of competence and confidence changed regarding feline behavior, handling, restraint, and physical examination skills after the new module was implemented. Questionnaires were used for quantitative analysis, and focus groups were used for qualitative analysis. The results show that compared with students who followed the standard module, students who participated in the blended learning module scored higher in feeling confident with handling animals, feeling competent to perform physical examination on cats, and ability to assess whether a cat is stressed. Students with less experience with cats were more likely to show improvement in assessing a cat's stress level than students who had much experience with cats. The results demonstrate that the blended learning module improves students' learning outcomes regarding feline skills training and adds to reduction, refinement, and replacement of the use of live cats.

Quality of life in dogs with idiopathic epilepsy and their owners with an emphasis on breed-A pilot study.

Epilepsy in dogs is a common chronic and serious disorder and may have an impact on the quality of life of the owners as well as the dogs themselves. The aim of this pilot study was to investigate the QoL score of dogs suffering from idiopathic epilepsy and their owners and if possible, investigate whether a breed specific difference exists. Owners, either Dutch or Belgium, were asked to participate in a web based SurveyMonkey questionnaire. A total of 402 questionnaires representing 402 dogs with epilepsy were suitable for further analysis. Of the 402 dogs, 253 were males and 149 were females. Ninety-nine different breeds were represented. Fourteen breeds (177 dogs in total) were used to calculate breed specific scores; Australian Shepherd (n = 8), Beagle (n = 7), Belgian Tervuren dog (n = 9), Belgian Groenendaeler dog (n = 8), Border Collie (n = 38), Chihuahua (n = 9), Dachshund (n = 13), Drentsche Patrijshond (a Dutch partridge dog) (n = 14), French Bulldog (n = 12), Golden Retriever (n = 17), Labrador Retriever (n = 18), and Rottweiler (n = 12). For the Border Collie, there was a statistically significant correlation between "epilepsy related death," the severity of the seizures (p < 0.001) and cluster seizures (p < 0.001). The quality of life of the Border Collie was scored lower compared to all other dogs (p = 0.02). There were three breeds that had a minimal decrease in the overall quality of life score compared to all other dogs: the Chihuahua (p = 0.03), Dachshund (p = 0.001), and Golden retriever (p = 0.01). The score for "caring for my epileptic dog decreases my own QoL" was high for the Border Collie, Boxer, French Bulldog, and Rottweiler, but was only found to be statistically significantly higher in the Border Collie (p = 0.01). Scores for the Golden Retriever (p = 0.04) and Labrador (p = 0.006) were lower. In conclusion, this study reports breed specific quality of life scores of dogs with epilepsy and their owners, and underlines that breed by itself, is also an important factor when managing epilepsy in dogs.

Exposición a pesticidas como factor de riesgo para enfermedad de Parkinson: un estudio caso-control en el municipio de San Juan Nepomuceno (Bolívar) / Exposure to pesticides as a risk factor for Parkinson's disease: a case-control study in San Juan Nepomuceno town (Bolivar)

La enfermedad de Parkinson es el segundo trastorno neurodegenerativo más común después de la enfermedad de Alzheimer, afectando la calidad de vida, no sólo de la persona que lo padece, sino también la de su entorno familiar. Se ha sugerido la interacción entre la susceptibilidad genética con un 10 % y la exposición a factores ambientales en un 90 %; considerando los pesticidas como un factor de riesgo potencialmente alto debido a su toxicidad y efectos neurodegenerativos. San Juan Nepomuceno es un municipio cuya principal actividad económica es la agricultura y la ganadería; prácticas que requieren el uso de pesticidas como paraquat, glifosato, aminas y picloram; exponiendo de esta manera a los campesinos y otros habitantes del municipio a este tipo de sustancias. Este estudio de investigación tiene como objetivo principal determinar la relación entre la exposición a pesticidas y la prevalencia de enfermedad de Parkinson en el municipio de San Juan Nepomuceno, Bolívar; mediante un diseño epidemiológico observacional analítico de casos y controles. De esta manera, se busca reforzar las medidas preventivas sobre el uso de pesticidas para disminuir la incidencia y prevalencia de enfermedad de Parkinson

Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease, affecting the quality of life, not only of the person who suffers it, but also to their family surroundings. The interaction between genetic susceptibility with 10% and exposure to environmental factors by 90% has been suggested; considering pesticides as a potentially high risk factor due to its toxicity and neurodegenerative effects. San Juan Nepomuceno is a municipality whose main economic activity is agriculture and livestock; activities that require the use of pesticides such as paraquat, glyphosate, amines, picloram; exposing in this way, the farmers and other habitants of the municipality to this type of substances. The main objective of this research study is to determine the relationship between exposure to pesticides and the prevalence of Parkinson's disease in the municipality of San Juan Nepomuceno, Bolívar; considering an epidemiological observational analytical design of cases and controls. In this way, it seeks to strengthen preventive measures on the use of pesticides to reduce the incidence and prevalence of Parkinson's disease

Meat quality in relation to swine well-being after transport and during lairage at the slaughterhouse.

Cortisol and corticosterone in saliva were evaluated as pig stress biomarkers, using pig genotype (Duroc, L62 or Pietrain) and lairage time in the slaughterhouse (0, 2.0, 4.0 or 6.0 h) as controlled variables. Although some pigs were found to be carriers of stress susceptibility, all were healthy heterozygous individuals. Pre-slaughter transport increased cortisol levels in saliva above 3.0 µg/L (medium stress), and 4.0 h of lairage in the slaughterhouse raised them above 6.0 µg/L, whereas corticosterone concentrations exceeded 4 µg/L, which are suggestive of high stress. The highest cortisol levels were detected in the Duroc genotype. Other factors such as food deprivation, background noise, the presence of a large number of animals waiting to be slaughtered, mixing with unfamiliar animals or recent mixing of genders may also influence stress. Corticosterone proved a reliable indicator of high stress only. Meat quality from the pig breeds studied was not affected by lairage in the slaughterhouse for up to 6.0 h.

Core@shell, Au@TiOx nanoparticles by gas phase synthesis.

Herein, gas phase synthesis and characterization of multifunctional core@shell, Au@TiOx nanoparticles have been reported. The nanoparticles were produced via a one-step process using a multiple-ion cluster source under a controlled environment that guaranteed the purity of the nanoparticles. The growth of the Au cores (6 nm diameter) is stopped when they pass through the Ti plasma where they are covered by an ultra-thin (1 nm thick) and homogeneous titanium shell that is oxidized in-flight before the soft-landing of the nanoparticles. The Au cores were found to be highly crystalline with icosahedral (44%) and decahedral (66%) structures, whereas the shell, mainly composed of TiO2 (79%), was not ordered. The highly electrical insulating behaviour of the titanium oxide shell was confirmed by the charging effect produced during X-ray photoemission spectroscopy.

Effect of rumen-protected niacin on lipid metabolism, oxidative stress, and performance of transition dairy cows.

The objective of this study was to evaluate the effect of a rumen-protected niacin product (RPN; 65% nicotinic acid; NiaShure, Balchem Corp., New Hampton, NY) on lipid metabolism, oxidative stress, and performance of transition dairy cows. Thirty nonlactating multiparous Holstein cows in late gestation were paired according to expected calving date and randomly assigned to 12 g/cow per day of RPN product or to an unsupplemented control (CON) diet. Treatment diets were fed from 21 d before expected calving through 21 d after parturition. Blood samples were taken on d -21, -14, -7, 1, 7, 14, and 21 relative to calving for plasma nonesterified fatty acid (NEFA), ß-hydroxybutyrate (BHBA), glucose, and superoxide dismutase (SOD) analyses. Liver samples were taken by biopsy on d 1 and 21 relative to calving for triglyceride (TG) analysis. Data were analyzed for a randomized complete block design with repeated measures. Pre- and postpartum dry matter intake, milk yield, and protein were unaffected by treatment. Milk fat percentage (5.08 vs. 4.44%) and somatic cell score (3.93 vs. 2.48) were reduced for RPN. Treatment × time interactions were observed for energy-corrected milk (ECM) and fat-corrected milk (FCM) yields; RPN reduced ECM and FCM yields by 8.5 and 8.9 kg/cow per day, respectively, in the first week of lactation. Although body weight and condition score decreased during the experimental period, no differences due to treatment were observed. However, calculated postpartum energy balance tended to be improved for RPN because of the reduction in ECM yield. Time and treatment × time effects were observed for plasma NEFA. On d 1 postpartum, NEFA reached 1,138±80 µEq/L for CON compared with 698±80 µEq/L for RPN. Cows supplemented with RPN tended to have lower plasma NEFA concentrations than CON cows on d 7 and 14 postpartum. Plasma BHBA, glucose, and SOD and liver TG concentrations were unaffected by treatment. In conclusion, supplementation with 12 g/cow per day of the RPN product provided a bioavailable source of niacin that modified lipid metabolism but did not affect milk yield over the first 3 wk of lactation or oxidative stress of transition dairy cows.

Influence of a reduced-starch diet with or without exogenous amylase on lactation performance by dairy cows.

The objective of this trial was to determine lactation performance responses in high-producing dairy cows to a reduced-starch versus a normal-starch diet and to the addition of exogenous amylase to the reduced-starch diet. Forty-five multiparous Holstein cows, 68±29 d in milk and 696±62 kg of body weight (BW) at trial initiation, were randomly assigned to 1 of 3 treatments in a completely randomized design; a 2-wk covariate adjustment period with cows fed the normal-starch diet was followed by a 10-wk treatment period with cows fed their assigned treatment diets. The normal-starch total mixed ration did not contain exogenous amylase (NS-). The reduced-starch diets, formulated by partially replacing corn grain and soybean meal with whole cottonseed and wheat middlings, were fed without (RS-) and with (RS+) exogenous amylase addition to the total mixed ration. All diets contained 50% forage and 19.8% forage neutral detergent fiber (dry matter basis). Starch and neutral detergent fiber concentrations averaged 27.0 and 30.9%, 22.1 and 35.0%, and 21.2 and 35.3% (dry matter basis) for the NS-, RS-, and RS+ diets, respectively. Expressed as a percentage of BW, dry matter intake was greater for cows fed RS- than for cows fed NS- or RS+. Intake of neutral detergent fiber ranged from 1.09 to 1.30% of BW among the treatments, with that of RS- being 21% greater than that of NS-. Milk yield tended to be greater for cows fed NS- compared with the RS diets. Milk fat content and yield were unaffected by treatment. Milk protein content and yield were greater for cows fed NS- compared with the RS diets. Concentrations of milk urea nitrogen were greater for cows fed RS diets compared with the NS- diet. Body weight, BW change, and body condition score were unaffected by treatment. Feed conversion (kg of milk/kg of dry matter intake) was 10% greater on average for cows fed NS- than for cows fed the RS diets, and tended to be 6% greater for cows fed RS+ compared with RS-. Feeding a reduced-starch diet formulated by partially replacing corn grain and soybean meal with a wheat middlings and whole cottonseed mixture compared with a normal-starch diet without addition of exogenous amylase to either diet reduced milk and component-corrected feed conversions. Addition of exogenous amylase to a reduced-starch diet was of minimal benefit in this study.

Adenohypophyseal function in dogs with primary hypothyroidism and nonthyroidal illness.

BACKGROUND: A recent study of dogs with induced primary hypothyroidism (PH) demonstrated that thyroid hormone deficiency leads to loss of thyrotropin (TSH) hypersecretion, hypersomatotropism, hypoprolactinemia, and pituitary enlargement with large vacuolated "thyroid deficiency" cells that double-stained for growth hormone (GH) and TSH, indicative of transdifferentiation of somatotropes to thyrosomatropes. HYPOTHESIS: Similar functional changes in adenohypophyseal function occur in dogs with spontaneous PH as do in dogs with induced PH, but not in dogs with nonthyroidal illness (NTI). ANIMALS: Fourteen dogs with spontaneous PH and 13 dogs with NTI. METHODS: Adenohypophyseal function was investigated by combined intravenous administration of 4 hypophysiotropic releasing hormones (4RH test), followed by measurement of plasma concentrations of ACTH, GH, luteinizing hormone (LH), prolactin (PRL), and TSH. In the PH dogs this test was repeated after 4 and 12 weeks of thyroxine treatment. RESULTS: In 6 PH dogs, the basal TSH concentration was within the reference range. In the PH dogs, the TSH concentrations did not increase with the 4RH test. However, TSH concentrations increased significantly in the NTI dogs. Basal and stimulated GH and PRL concentrations indicated reversible hypersomatotropism and hyperprolactinemia in the PH dogs, but not in the NTI dogs. Basal and stimulated LH and ACTH concentrations did not differ between groups. CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs with spontaneous PH hypersecrete GH but have little or no TSH hypersecretion. Development of hyperprolactinemia (and possible galactorrhea) in dogs with PH seems to occur only in sexually intact bitches. In this group of dogs with NTI, basal and stimulated plasma adenohypophyseal hormone concentrations were not altered.

Functional and morphological changes in the adenohypophysis of dogs with induced primary hypothyroidism: loss of TSH hypersecretion, hypersomatotropism, hypoprolactinemia, and pituitary enlargement with transdifferentiation.

From case studies in humans it is known that primary hypothyroidism (PH) may be associated with morphological and functional changes of the pituitary. There is no insight into the time scale of these changes. In this study, seven beagle dogs were followed up for 3 years after the induction of primary hypothyroidism. Three of these dogs were followed up for another 1.5 years while receiving l-thyroxine. Adenohypophyseal function was investigated at 2-month intervals with the combined intravenous injection of CRH, GHRH, GnRH, and TRH, and measurement of the plasma concentrations of ACTH, GH, LH, PRL, and TSH. In addition, after 2 years of hypothyroidism a single TRH-stimulation test and a somatostatin test were performed, with measurements of the same pituitary hormones. Every 6 months the pituitary gland was visualized by computed tomography (CT). Induction of PH led to high plasma TSH concentrations for a few months, where after concentrations gradually declined to values no longer significantly different from pre-PH values. A blunted response to stimulation of TSH release preceded this decline. Basal plasma GH concentrations increased during PH and there was a paradoxical hyperresponsiveness to TRH stimulation. Basal GH concentrations remained elevated and returned only to low values during l-thyroxine treatment. Basal PRL concentrations decreased significantly during PH and normalized after several months of l-thyroxine treatment. The pituitary gland became enlarged in all dogs. Histomorphology and immunohistochemical studies in 4 dogs, after 3 years of PH, revealed thyrotroph hyperplasia, large vacuolated thyroid deficiency cells, and decreased numbers of mammotrophs. Several cells stained for both GH and TSH. In conclusion, with time PH led to a loss of the TSH response to low T4 concentrations, hypersecretion of GH, and hyposecretion of PRL. The enlarged pituitaries were characterized by thyrotroph hyperplasia, large vacuolated thyroid deficiency cells, and double-staining cells, which are indicative of transdifferentiation.

Thyrotropin-releasing hormone-induced growth hormone secretion in dogs with primary hypothyroidism.

Primary hypothyroidism in dogs is associated with increased release of growth hormone (GH). In search for an explanation we investigated the effect of intravenous administration of thyrotropin-releasing hormone (TRH, 10 microg/kg body weight) on GH release in 10 dogs with primary hypothyroidism and 6 healthy control dogs. The hypothyroid dogs had a medical history and physical changes compatible with hypothyroidism and were included in the study on the basis of the following criteria: plasma thyroxine concentration < 2 nmol/l and plasma thyrotropin (TSH) concentration > 1 microg/l. In addition, (99m)TcO(4)(-) uptake during thyroid scintigraphy was low or absent. TRH administration caused plasma TSH concentrations to rise significantly in the control dogs, but not in the hypothyroid dogs. In the dogs with primary hypothyroidism, the mean basal plasma GH concentration was relatively high (2.3+/-0.5 microg/l) and increased significantly (P=0.001) 10 and 20 min after injection of TRH (to 11.9+/-3.5 and 9.8+/-2.7 microg/l, respectively). In the control dogs, the mean basal plasma GH concentration was 1.3+/-0.1 microg/l and did not increase significantly after TRH administration. We conclude that, in contrast to healthy control dogs, primary hypothyroid dogs respond to TRH administration with a significant increase in the plasma GH concentration, possibly as a result of transdifferentiation of somatotropic pituitary cells to thyrosomatotropes.

Assessment of thyroid function in dogs with low plasma thyroxine concentration.

BACKGROUND: Differentiation between hypothyroidism and nonthyroidal illness in dogs poses specific problems, because plasma total thyroxine (TT4) concentrations are often low in nonthyroidal illness, and plasma thyroid stimulating hormone (TSH) concentrations are frequently not high in primary hypothyroidism. HYPOTHESIS: The serum concentrations of the common basal biochemical variables (TT4, freeT4 [fT4], and TSH) overlap between dogs with hypothyroidism and dogs with nonthyroidal illness, but, with stimulation tests and quantitative measurement of thyroidal 99mTcO4(-) uptake, differentiation will be possible. ANIMALS: In 30 dogs with low plasma TT4 concentration, the final diagnosis was based upon histopathologic examination of thyroid tissue obtained by biopsy. Fourteen dogs had primary hypothyroidism, and 13 dogs had nonthyroidal illness. Two dogs had secondary hypothyroidism, and 1 dog had metastatic thyroid cancer. METHODS: The diagnostic value was assessed for (1) plasma concentrations of TT4, fT4, and TSH; (2) TSH-stimulation test; (3) plasma TSH concentration after stimulation with TSH-releasing hormone (TRH); (4) occurrence of thyroglobulin antibodies (TgAbs); and (5) thyroidal 99mTcO4(-) uptake. RESULTS: Plasma concentrations of TT4, fT4, TSH, and the hormone pairs TT4/TSH and fT4/TSH overlapped in the 2 groups, whereas, with TgAbs, there was 1 false-negative result. Results of the TSH- and TRH-stimulation tests did not meet earlier established diagnostic criteria, overlapped, or both. With a quantitative measurement of thyroidal 99mTcO4(-) uptake, there was no overlap between dogs with primary hypothyroidism and dogs with nonthyroidal illness. CONCLUSIONS AND CLINICAL IMPORTANCE: The results of this study confirm earlier observations that, in dogs, accurate biochemical diagnosis of primary hypothyroidism poses specific problems. Previous studies, in which the TSH-stimulation test was used as the "gold standard" for the diagnosis of hypothyroidism may have suffered from misclassification. Quantitative measurement of thyroidal 99mTcO- uptake has the highest discriminatory power with regard to the differentiation between primary hypothyroidism and nonthyroidal illness.

Utilización de la eritropoyetina en la prevención de transfusiones en radio-quimioterapia concurrente de tumores avanzados de cabeza y cuello / Use of eryihropoietin for the prevention of transfusions in concurrent radio-chemotherapy of advanced head and neck tumors

Propósito: valorar si la utilización de eritropoyetina es capaz de evitar las transfusiones en nuestro protocolo de radioquimioterapia concurrente en tumores avanzados de cabeza y cuello. Material y métodos: en 1996 iniciamos un esquema de radioquimioterapia concurrente con inhalación de carbogeno en tumores avanzados de cabeza y cuello. Inicialmente decidimos transfundir si el nivel de hemoglobina bajaba de 11 gr/dl. Tras tratar a los primeros 21 pacientes y debido al alto número de transfusiones requeridas, comenzamos a utilizar eritropoyetina cuando el nivel de hemoglobina caía por debajo de 13 gr/dl. (10.000U, 3 veces por semana).Resultados: tras evaluar 56 pacientes se constató que fue preciso transfundir a 5 de los primeros 21 pacientes (anemia tratada con transfusiones). En los siguientes 36 pacientes (anemia tratada con eritropoyetina) no fue necesario transfundir a ninguno. Conclusiones: la utilización de la eritropoyetina según describimos es capaz de evitar las transfusiones en nuestro esquema de radioquimioterapia concurrente (AU)

Hyperfractionated chemoradiation with carbogen breathing, with or without erythropoietin: a stepwise developed treatment schedule for advanced head-and-neck cancer.

PURPOSE: To investigate the influence of carbogen breathing on chemoradiation and the effects of erythropoietin on transfusions. METHODS AND MATERIALS: From March 1996 to April 2000, 42 (4 Stage III and 38 Stage IV) patients with head and neck cancer were treated with a twice-a-day hyperfractionated schedule. Each fraction consisted of 5 mg/m(2) of carboplatin plus 115 cGy with carbogen breathing. Treatment was given 5 days per week up to total doses of 350 mg/m(2) of carboplatin plus 8050 cGy in 7 weeks. Anemia was treated either by transfusion or by erythropoietin. RESULTS: Forty-one patients tolerated the treatment as scheduled. All patients tolerated the planned radiation dose. Five transfusions were given in the first group, but no transfusion was needed in the erythropoietin group. Local toxicities remained at the level expected with irradiation alone. Chemotherapy toxicity was moderate. Forty-two complete responses were achieved. At two years actuarial local control, cause-specific survival and overall survival are respectively 85%, 69%, and 68%. At four years estimated probabilities of local control, cause-specific survival and overall survival are also 85%, 69%, and 68%. CONCLUSIONS: These results compare favorably with those of most reported studies. The addition of carbogen breathing appears to improve the results of chemoradiation alone. Erythropoietin therapy avoided transfusions.

Primary hypothyroidism in dogs is associated with elevated GH release.

The pulsatile secretion patterns of GH were investigated in seven beagle bitches by collecting blood samples every 10 min for 6 h during euthyroidism and 1.5 years after induction of primary hypothyroidism. Hypothyroidism was induced by surgical removal of the thyroid gland and subsequent destruction of any remnant thyroid tissue by oral administration of sodium [(131)I]iodide. Some of the physical changes observed in the dogs with primary hypothyroidism mimicked those of acromegaly. During both euthyroidism and hypothyroidism GH was secreted in a pulsatile fashion. The mean (+/-s.e.m. ) basal plasma GH concentration was significantly higher (P=0.003) in the hypothyroid state (4.1+/-1.6 microg/l) than in the euthyroid state (1.2+/-0.4 microg/l). Likewise, the mean area under the curve (AUC) for GH above the zero-level during hypothyroidism (27.0+/-10.0 microg/lx6 h) was significantly higher (P=0.004) than that during euthyroidism (11.7+/-2.0 microg/l x 6 h). The mean AUC for GH above the baseline was significantly lower (P=0.008) during hypothyroidism (2.4+/-0.8 microg/l x 6 h) than during euthyroidism (4.5+/-1.8 microg/lx6 h), whereas there was no significant difference in GH pulse frequency. The mean plasma IGF-I level was significantly higher (P<0.01) in the hypothyroid state (169+/-45 microg/l) than in the euthyroid (97+/-15 microg/l). The results of this study demonstrate that primary hypothyroidism in dogs is associated with elevated basal GH secretion and less GH secreted in pulses. This elevated GH secretion has endocrine significance as illustrated by elevated plasma IGF-I levels and some physical changes mimicking acromegaly. It is discussed that the increased GH release in hypothyroid dogs may be the result of the absence of a response element for thyroid hormone within the canine pituitary GH gene and alterations in supra-pituitary regulation.

Secretion pattern of thyroid-stimulating hormone in dogs during euthyroidism and hypothyroidism.

In as many as one third of dogs with primary hypothyroidism a plasma thyrotropin (TSH) concentration within the reference range for euthyroid dogs is found. To determine whether this is due to fluctuations in the release of TSH, the plasma profiles of TSH were analyzed in 7 beagle bitches by collecting blood samples every 10 min for 6 hr, both before and after induction of primary hypothyroidism. After induction of primary hypothyroidism, a 37-fold increase in mean basal plasma TSH concentration and a 34-fold increase in mean area under the curve for TSH were found. Analysis by the Pulsar program demonstrated pulsatile secretion of TSH in the hypothyroid state, characterized by relatively low amplitude pulses (mean [+/-SEM]) amplitude 41 +/- 3% of basal plasma TSH level) and a mean pulse frequency of 2.0 +/- 0.5 pulses/6 hr. In the euthyroid state, significant TSH pulses were identified in only 2 dogs. The mean basal plasma TSH level correlated positively (r = 0.84) with the mean amplitude of the TSH pulses, and correlated negatively (r = -0.88) with the TSH pulse frequency. The results of this study demonstrate pulsatile secretion of TSH in dogs during hypothyroidism and only small fluctuations in plasma TSH concentrations during euthyroidism. The findings also suggest that the low TSH values occasionally found in dogs with spontaneous primary hypothyroidism may in some cases in part be the result of ultradian fluctuations.

Thrombosis of the portal vein in a miniature schnauzer.

A miniature schnauzer with a history of apathy, anorexia and jaundice was presented to the Utrecht University Clinic for Companion Animals. Abnormal laboratory findings included highly increased levels of total bile acids and alkaline phosphatase, and hyponatraemia. Abdominal ultrasonography revealed that the right side of the liver was enlarged and the left side was small, together with a thrombus in the portal vein. Biopsies from the right side of the liver demonstrated subacute to chronic active hepatitis, for which the dog was treated with prednisolone (1 mg/kg/day for four weeks). No improvement was observed and the owner requested euthanasia. At necropsy the left lobes of the liver were found to be small and firm, while the right lobes were large and soft. There were two thrombi in the portal vein. Microscopic examination revealed chronic active hepatitis and cirrhosis.

Chemotherapy as a part of each treatment fraction in a twice-a-day hyperfractionated schedule: a new chemoradiotherapy approach for advanced head and neck cancer.

BACKGROUND: Using chemotherapy as a part of each treatment fraction remains unexplored. This study integrates the concomitant administration of carboplatin with hyperfractionated irradiation by optimizing chemopotentiation through carboplatin administration with each irradiation fraction. METHODS: From February 1993 to August 1996, 52 patients with advanced head and neck cancer were treated on a twice-a-day chemoradiotherapy schedule. Each fraction consisted of 115 cGy preceded by 5 mg/m2 of carboplatin. Treatment was given 5 days a week up to total doses of 350 mg/m2 of carboplatin + 8050 cGy in 7 weeks. RESULTS: All (100%) of patients tolerated the treatment (83% as scheduled). Acute and late toxicities were moderate. Rates of 96% complete response (CR) and 4% partial response (PR) were achieved. At 52 months, local control and cause-specific survival rates are 72% and 59%, respectively. Nodal control rate is 95%. CONCLUSION: These results show potential for improvement upon hyperfractionated radiotherapy alone and compare favorably with those of most reported trials.