Academic performance in Jamaican children with sickle cell disease.

OBJECTIVE: Children with sickle cell disease (SCD) are at risk for neurocognitive deficits that can affect school performance, and psychosocial functioning. The aim of this study was to assess the academic performance of school-aged children with SCD in Jamaica compared to their school peers. METHOD: A cross-sectional survey of academic performance was done in a group of children 11 to 13 years of age, using a standardized state administered examination, the Grade Six Achievement Test (GSAT), covering 5 subjects. Scores were obtained from the Ministry of Education (MOE) for eligible children with SCD, as well as mean scores with standard deviation for unaffected classmates by gender. Socio-demographic and clinical data were obtained from our sickle cell clinic database and an interview administered questionnaire. RESULTS: Sixty-four children satisfied eligibility criteria. Children with SCD had lower percentage scores and significantly lower mean z-scores for 4 of 5 subjects (p < 0.05). Males had significantly lower mean z-scores compared with females. Thirty-seven children (57.8%) were classified as underperformers. Haemoglobin level was a significant predictor of subject score rank. CONCLUSION: Children with SCD in Jamaica perform worse in standardized school examinations than their class peers with boys being particularly vulnerable.

Postmortem evaluation of renal tubular vacuolization in critically ill dogs.

OBJECTIVE: To describe the frequency of renal tubular vacuolization (RTV) as a surrogate of osmotic nephrosis and assess hyperosmolar agents as predictors of RTV severity. DESIGN: Retrospective study (February 2004-October 2014). SETTING: Veterinary teaching hospital. ANIMALS: Fifty-three client-owned, critically ill dogs that had a postmortem examination. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The frequency, severity, and location of RTV were determined in small group of critically ill dogs postmortem. Logistic regression was performed to assess cumulative 6% HES (670/0.75) and mannitol dose as predictors for RTV severity with presenting serum creatinine concentration, cumulative furosemide dose, and duration of hospitalization as covariates. RTV was noted in 45 (85%) of 53 critically ill dogs and was most commonly located to the medullary rays (68%). Cumulative 6% HES (670/0.75) dose (P = 0.009) and presenting serum creatinine concentration (P = 0.027) were significant predictors of RTV severity. For every 1 mL/kg increase in 6% HES (670/0.75) dose that a dog received, there was 1.6% increased chance of having more severe RTV (OR 1.016; 95% CI 1.004-1.029). In addition, for every 88.4 µmol/L (1 mg/dL) increase in presenting serum creatinine, there was a 22.7% increased chance of having more severe RTV (OR 1.227; 95% CI 1.023-1.472). Cumulative mannitol (P = 0.548) and furosemide (P = 0.136) doses were not significant predictors of RTV severity. CONCLUSION: In a small group of critically ill dogs, there was a high frequency of RTV identified on postmortem examination. Administration of 6% HES (670/0.75) and presenting serum creatinine concentration were significant predictors of RTV severity. Larger prospective studies are needed to determine the etiology and significance of RTV in dogs.

Further characterization of computed tomographic and clinical features for staging and prognosis of idiopathic pulmonary fibrosis in West Highland white terriers.

Idiopathic pulmonary fibrosis is an interstitial lung disease of unknown etiology resulting in progressive interstitial fibrosis, with a known predilection in West Highland white terriers. In humans, computed tomography (CT) is a standard method for providing diagnostic and prognostic information, and plays a major role in the idiopathic pulmonary fibrosis staging process. Objectives of this retrospective, analytical, cross-sectional study were to establish descriptive criteria for reporting CT findings and test correlations among CT, clinical findings and survival time in West Highland white terriers with idiopathic pulmonary fibrosis. Inclusion criteria for affected West Highland white terriers were a diagnosis of idiopathic pulmonary fibrosis and available CT, bronchoscopy, bronchoalveolar lavage, echocardiography, and routine blood analysis findings. Clinically normal West Highland white terriers were recruited for the control group. Survival times were recorded for affected dogs. The main CT lung pattern and clinical data were blindly and separately graded as mild, moderate, or severe. Twenty-one West Highland white terriers with idiopathic pulmonary fibrosis and 11 control West Highland white terriers were included. The severity of pulmonary CT findings was positively correlated with severity of clinical signs (ρ = 0.48, P = 0.029) and negatively associated with survival time after diagnosis (ρ = -0.56, P = 0.025). Affected dogs had higher lung attenuation (median: -563 Hounsfield Units (HU)) than control dogs (median: -761 HU), (P < 0.001). The most common CT characteristics were ground-glass pattern (16/21) considered as a mild degree of severity, and focal reticular and mosaic ground-glass patterns (10/21) considered as a moderate degree of severity. Findings supported the use of thoracic CT as a method for characterizing idiopathic pulmonary fibrosis in West Highland white terriers and providing prognostic information for owners.

Retrospective comparison of thromboelastography results to postmortem evidence of thrombosis in critically ill dogs: 39 cases (2005-2010).

OBJECTIVE: To determine whether there is an association between thromboelastography (TEG) data and necropsy evidence of thrombosis in a cohort of critically ill dogs. DESIGN: Retrospective study (2005-2010). SETTING: University teaching hospital. ANIMALS: Thirty-nine client-owned critically ill dogs for which TEG was performed within 7 days of complete necropsy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thrombi were found in 26 (67%) dogs. Spayed females (n = 20) were significantly more likely to have thrombosis (P = 0.0127). No significant association was found between presence of thrombosis and any TEG parameter, the calculated coagulation index, results of coagulation testing, type of vascular access, or clinical diagnosis. D-dimers were significantly higher in dogs with thrombosis (P = 0.0207) and a weak positive correlation was found between D-dimer value and number of sites of thrombosis (ρ = 0.18, P = 0.0045). Dogs with WBC > 16 × 10(3) /µL were more likely to have thrombosis compared to others (odds ratio 5.56, 95% confidence interval 1.2-25.7, P = 0.025). CONCLUSIONS: This study found no association between any TEG parameter and the presence of thrombosis on postmortem examination.

Impact of a Comprehensive Sickle Cell Center on Early Childhood Mortality in a Developing Country: The Jamaican Experience.

OBJECTIVE: To compare mortality in children <5 years of age with sickle cell disease (SCD) in Jamaica, a resource-limited country, diagnosed by newborn screening and managed in a comprehensive care facility, to that of the general population. STUDY DESIGN: The study was carried out at the Sickle Cell Unit in Kingston, Jamaica. We determined the status (dead/alive) at age 5 years in a cohort of 548 children with SCD diagnosed by newborn screening and managed at the Sickle Cell Unit during the period November 1995 to December 2009. The standardized mortality ratio was calculated using World Health Organization life tables for reference mortality. RESULTS: Eight deaths (1.5%) occurred in children <5 years of age during the study period. The mean age at death was 2.0 ± 1.5 years. The overall mortality incidence in children <5 years of age was 3.1 (95% CI 1.6, 6.2) per 1000 person-years with a standardized mortality ratio of 0.52 (95% CI 0.3, 1.0). CONCLUSIONS: Mortality in children <5 years of age with SCD diagnosed at birth and managed at a comprehensive care clinic in Jamaica is equivalent to that of the general population. Children with SCD, a highly vulnerable population, can be effectively managed, even in resource-limited environments.

Organ dysfunction and mortality risk factors in severe canine bite wound trauma.

OBJECTIVE: To identify mortality risk factors, determine mortality rate, and to describe the treatment, incidence, and type of organ dysfunction in dogs with severe bite wounds. DESIGN: Retrospective case study from 2000 to 2009. SETTING: University veterinary teaching hospital. ANIMALS: Ninety-four dogs admitted to the intensive care unit (ICU) with bite wounds. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In all dogs, physical parameters, diagnostic testing, surgery and anesthesia timing, and treatment details were recorded at presentation and during ICU hospitalization. The overall mortality rate was 15%. A majority of dogs (68%) were <10 kg. A majority of the wounds (53%) yielded no growth on bacterial culture. Prolonged time from admission to anesthesia was associated with a need for longer postoperative ICU hospitalization (P = 0.0099). Prolonged anesthesia time was associated with mortality (P = 0.0044). Systemic inflammatory response syndrome (SIRS) occurred in 54.3% of dogs and multiple organ dysfunction syndrome (MODS) occurred in 27.7% of dogs. The presence of SIRS was significantly associated with mortality (P = 0.01), with a mortality rate of 24% in dogs that developed SIRS. MODS was associated with risk of mortality (P < 0.001) with a mortality rate of 67% in dogs with dysfunction of 4 or more organs. Dogs with dysfunction of 1 organ system had a mortality rate of 9%. The body system most commonly affected was the respiratory system (37%). Cardiovascular dysfunction was highly predictive of mortality (odds ratio [OR]: 29). CONCLUSIONS: Patients with extensive bite wounds have a significant risk of developing severe secondary complications such as SIRS, disseminated intravascular coagulopathy, and MODS. Longer time to anesthesia was associated with a longer recovery and longer anesthetic times were associated with mortality, disseminated intravascular coagulopathy, and MODS. Injury to the respiratory system was most commonly encountered and mortality increased with cardiovascular injury, MODS, and SIRS.

Updates on pulmonary function testing in small animals.

This article focuses on the most commonly used tests of pulmonary function in companion animals, including tests of pulmonary mechanics as well as of gas exchange in the lungs.

Partial resolution of hypoplastic trachea in six english bulldog puppies with bronchopneumonia.

Six English bulldog and nine nonbrachycephalic puppies with bronchopneumonia and radiographs were evaluated. Relative size of the trachea was measured by the tracheal diameter (TD) and the thoracic inlet distance (TI), expressed as a ratio (TD:TI). At diagnosis of bronchopneumonia, there was a significant difference between the median TD:TI of the bulldog puppies (0.07; range, 0.06-0.09) and that of the nonbrachycephalic puppies (0.14; range, 0.11-0.25; P=0.0004). At the same time, there was also a significant difference between the mean TD:TI of bulldog puppies (0.07±0.01) and that of nonbrachycephalic puppies (0.15±0.05; P=0.002). Follow-up radiographs showed significant increases in TD:TI ratio in all six bulldogs (median TD:TI = 0.14; range, 0.12-0.18; P=0.03 and mean TD:TI = 0.15±0.02; P=0.0007), whereas the ratio did not change significantly in the nonbrachycephalic control group (median TD:TI = 0.17; range, 0.14-0.22; P=0.10 and mean TD:TI = 0.18±0.03; P=0.06). Tracheal hypoplasia in some brachycephalic dogs might partially or completely resolve with growth to mature body size.

Accuracy of a continuous glucose monitoring system in dogs and cats with diabetic ketoacidosis.

OBJECTIVE: (1) To determine the ability of a continuous interstitial glucose monitoring system (CGMS) to accurately estimate blood glucose (BG) in dogs and cats with diabetic ketoacidosis. (2) To determine the effect of perfusion, hydration, body condition score, severity of ketosis, and frequency of calibration on the accuracy of the CGMS. DESIGN: Prospective study. SETTING: University Teaching Hospital. ANIMALS: Thirteen dogs and 11 cats diagnosed with diabetic ketoacidosis were enrolled in the study within 24 hours of presentation. INTERVENTIONS: Once BG dropped below 22.2 mmol/L (400 mg/dL), a sterile flexible glucose sensor was placed aseptically in the interstitial space and attached to the continuous glucose monitoring device for estimation of the interstitial glucose every 5 minutes. MEASUREMENTS AND MAIN RESULTS: BG measurements were taken with a portable BG meter every 2-4 hours at the discretion of the primary clinician and compared with CGMS glucose measurements. The CGMS estimates of BG and BG measured on the glucometer were strongly associated regardless of calibration frequency (calibration every 8 h: r=0.86, P<0.001; calibration every 12 h: r=0.85, P<0.001). Evaluation of this data using both the Clarke and Consensus error grids showed that 96.7% and 99% of the CGMS readings, respectively, were deemed clinically acceptable (Zones A and B errors). Interpatient variability in the accuracy of the CGMS glucose measurements was found but was not associated with body condition, perfusion, or degree of ketosis. A weak association between hydration status of the patient as assessed with the visual analog scale and absolute percent error (Spearman's rank correlation, rho=-0.079, 95% CI=-0.15 to -0.01, P=0.03) was found, with the device being more accurate in the more hydrated patients. CONCLUSIONS: The CGMS provides clinically accurate estimates of BG in patients with diabetic ketoacidosis.

Case-control study to evaluate risk factors for the development of sepsis (neutropenia and fever) in dogs receiving chemotherapy.

OBJECTIVE-To identify risk factors for development of sepsis in dogs treated with chemotherapeutics and to evaluate the impact of sepsis on outcome. DESIGN-Case-control study. ANIMALS-Client-owned dogs with various cancers undergoing standard chemotherapeutic treatment at the University of Pennsylvania veterinary hospital. PROCEDURES-39 dogs with sepsis (cases) were identified through a search of the medical record database. Controls (n = 77) were randomly selected from dogs admitted during the same time period. Variables analyzed included patient demographics, tumor type, stage, remission status, treatment phase, chemotherapeutics used, and outcome. RESULTS-Dogs that weighed less and dogs with lymphoma were significantly more likely to become septic, compared with larger dogs or dogs with solid tumors. Septic dogs were also significantly more likely to have received doxorubicin (odds ratio [OR], 12.5; 95% confidence interval [CI], 2.4 to 66.0) or vincristine (OR, 9.0; 95% CI, 1.6 to 52.0) than controls. Of the 39 cases, 28 (71.8%) were in the induction phase of their protocol, and 19 of 39 (48.7%) became septic after receiving the chemotherapeutic drug for the first time. Median survival time of the cases (253 days) was not significantly different from that of the controls (371 days). CONCLUSIONS AND CLINICAL RELEVANCE-Dogs that weighed less were at increased risk for chemotherapy-induced sepsis. Tumor type and chemotherapeutic drug used were also important risk factors. These results may lead to the implementation of prophylactic measures, especially when doxorubicin or vincristine is used in the induction phase in small dogs with lymphoma.

Antimicrobial therapy and aerobic bacteriologic culture patterns in canine intensive care unit patients: 74 dogs (January-June 2006).

OBJECTIVE: Describe antimicrobial therapy and aerobic bacteriologic culture patterns in canine intensive care unit (ICU) patients in a university hospital. DESIGN: Retrospective descriptive. SETTING: A tertiary university referral hospital. ANIMALS: Seventy-four canine ICU patients. INTERVENTIONS: From January to June 2006 patient antimicrobial use, minimum inhibitory concentration (MIC) results, and clinical data were recorded. Appropriate antimicrobial use was analyzed relative to the time of culture submission and MIC results. MEASUREMENTS AND MAIN RESULTS: Mean+/-SD age was 7.2+/-4.2 years. Median (range) length of ICU and hospital stays were 3 days (1-25 d) and 4 days (1-27 d), respectively. A total of 106 cultures were submitted; 47 of 106 (44%) cultures were positive for 70 isolates, including Escherichia coli (16/70 [23%]), Staphylococcus intermedius (7/70 [10%]), and Acinetobacter baumannii (5/70 [7%]). A multidrug resistant pattern occurred in 19 of 70 (27%) isolates, and was significantly more likely after 48 hours of hospitalization (P<0.001). Antimicrobials were administered before culture submission in 42 of 74 dogs (57%) and included enrofloxacin (23/42 [55%]), ampicillin (20/42 [48%]), and amoxicillin/clavulanic acid (8/42 [19%]). Antimicrobial choices were appropriate 19% of the time. While pending culture results, antimicrobials were administered to 67 of 72 (94%) dogs remaining alive, and were appropriate 75% of the time. The most common antimicrobials administered while awaiting culture results were ampicillin (52/67 [78%]), enrofloxacin (49/67 [73%]), and amikacin (9/67 [13%]). Post-MIC antimicrobials were appropriate 89% of the time. Of 45 dogs remaining alive, 17 (37%) continued to receive antimicrobials despite negative cultures. CONCLUSIONS: Antimicrobial use was extensive in this patient population, but when available, MIC results were used to guide antimicrobial therapy. Many patients with negative cultures continued to receive antimicrobial therapy. Multidrug resistant bacteria were more likely in cultures taken after 48 hours of hospitalization.

Incidence of and risk factors for postoperative pneumonia in dogs anesthetized for diagnosis or treatment of intervertebral disk disease.

OBJECTIVE: To determine incidence of and risk factors for postoperative pneumonia in dogs anesthetized for diagnosis or treatment of intervertebral disk disease (IVDD). DESIGN: Retrospective case-control study. ANIMALS: 707 dogs that underwent general anesthesia for the diagnosis or treatment of IVDD between 1992 and 1996 or between 2002 and 2006. PROCEDURES: Postoperative pneumonia was diagnosed if compatible clinical signs (cough or hypoxemia) and radiographic abnormalities (alveolar infiltrates) developed within 48 hours after anesthesia. To identify risk factors for postoperative pneumonia, findings for dogs that developed postoperative pneumonia between 2002 and 2006 were compared with findings for a randomly selected control group of unaffected dogs from the same population. RESULTS: There were no significant differences in age, breed, body weight, sex, location of IVDD, or survival rate between the 2 time periods, but there were significant differences in the use of magnetic resonance imaging, computed tomography, and hemilaminectomy and in the percentage of dogs that developed postoperative pneumonia in the later (4.6%) versus the earlier (0.6%) years. Significant risk factors for postoperative pneumonia included preanesthetic tetraparesis, cervical lesions, undergoing magnetic resonance imaging, undergoing > 1 anesthetic procedure, longer duration of anesthesia, and postanesthetic vomiting or regurgitation. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that at this institution, the incidence of postoperative pneumonia in dogs anesthetized for diagnosis or treatment of IVDD had increased in recent years.

Relationship between Doppler blood pressure and survival or response to treatment in critically ill cats: 83 cases (2003-2004).

OBJECTIVE: To evaluate the relationship between Doppler blood pressure (DBP) and survival or response to treatment in critically ill cats. DESIGN: Retrospective case series. ANIMALS: 83 cats. PROCEDURES: Medical records from cats admitted to the intensive care unit with at least 2 recorded DBP measurements were included in the study. Hypotension was defined as 1 or more DBP measurements d 90 mm Hg. Change in blood pressure, survival to hospital discharge, heart rate, rectal temperature, PCV, plasma pH, serum ionized calcium concentration, disease process, body weight, age, duration of hospitalization, and catecholamine treatment were also evaluated. RESULTS: 39 cats were included in the hypotensive group, and 44 were consistently normotensive. Overall survival rate was 53% (44/83), with a significantly higher mortality rate in the hypotensive group (64% vs 32%). Among other variables, only low rectal temperature and low PCV were significantly associated with hypotension. Hypotensive cats with an increase in blood pressure of >or=20 mm Hg during hospitalization were more likely to survive to discharge (mortality rate, 69% vs 17%). CONCLUSIONS AND CLINICAL RELEVANCE: Hypotensive cats had increased mortality rate with lower rectal temperatures and lower PCV, compared with normotensive critically ill cats. The implications of these findings with regard to treatment remain to be elucidated, but addressing these abnormalities may be appropriate.

Community-acquired infectious pneumonia in puppies: 65 cases (1993-2002).

OBJECTIVE: To identify causative organisms, treatment, outcome, and prognosis for dogs < 1 year old with community-acquired infectious pneumonia. DESIGN: Retrospective case series. ANIMALS: 65 dogs. PROCEDURES: Dogs were considered to have community-acquired infectious pneumonia if they had clinical signs of primary respiratory tract disease in conjunction with radiographic evidence of alveolar disease and positive results following bacterial culture of tracheal wash fluid. RESULTS: Most dogs were hypoxemic at the time of initial examination, with pulmonary function becoming worse during the first few days of hospitalization before improving; 57 (88%) dogs survived to discharge. Bordetella bronchiseptica was isolated from tracheal wash fluid from 32 (49%) dogs, and other organisms, predominantly gram-negative enteric bacteria, were isolated from the other 33 (51%). Dogs with Bordetella pneumonia were significantly younger (median, 14 vs 21 weeks), were significantly more likely to have been obtained from a pet store (19/31 vs 7/32), had been owned for a significantly shorter time prior to the onset of illness (median, 18 vs 90 days), had significantly higher PvCO2 values at initial examination (median, 48.7 vs 41.3 mm Hg), were significantly more likely to receive supplemental oxygen (25/32 vs 16/33), and had significantly longer hospitalization times (mean, 7.2 vs 4.9 days) than did dogs with pneumonia caused by any other organism. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that a type of community-acquired infectious pneumonia could be identified in dogs < 1 year old, with disease being more severe in dogs with Bordetella pneumonia than in dogs with pneumonia caused by other bacterial organisms.

Treatment of severe adverse cutaneous drug reactions with human intravenous immunoglobulin in two dogs.

Severe adverse cutaneous reactions were documented in two dogs with acute skin lesions and systemic signs after exposure to several oral and injectable drugs. Because of the high morbidity and mortality rates of many severe cutaneous drug reactions and a poor response to supportive care, wound management, and conventional immunosuppressive therapy, human intravenous immunoglobulin (IVIG) was infused on 2 consecutive days (1 g/kg per day) after informed consent was received. Human IVIG, with supportive care, resulted in rapid resolution of dermatological and systemic signs in both dogs; this treatment may be considered in other cases of severe cutaneous drug reactions.

Indications for and outcome of positive-pressure ventilation in cats: 53 cases (1993-2002).

OBJECTIVE: To determine indications for and outcomes of positive-pressure ventilation (PPV) in cats, document ventilator management, and identify factors associated with outcome. DESIGN: Retrospective study. ANIMALS: 53 cats that underwent PPV. PROCEDURE: Information on signalment, history, concurrent diseases, clinical findings, results of venous blood gas analyses and clinicopathologic testing, treatment, ventilator settings, and outcome was retrieved from the medical records. Data for cats that survived were compared with data for cats that died or were euthanatized while undergoing PPV RESULTS: PPV was initiated for management of respiratory failure (36 cats [68%]), cardiac arrest (9 [17%]), neurologic impairment (6 [11%]), and nonresponsive hypotension (2 [4%]). Eight cats (15%) survived, 19 (36%) died, and 26 (49%) were euthanatized while undergoing PPV. Cats that survived had a longer duration of ventilation than did those that died or were euthanatized and had a significantly higher incidence of ventilator-associated pneumonia. Signalment and ventilator settings were not associated with outcome. Cats that had no clinical evidence of pulmonary disease but required PPV because of primary neurologic disease had a higher survival rate (2/6) than did cats that required PPV because of respiratory failure (5/36), cardiac arrest (1/9), or nonresponsive hypotension (0/2). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the survival rate for cats requiring PPV may be lower than reported survival rates for dogs. Death was attributable to progressive respiratory failure, non-responsive hypotension, kidney failure, or neurologic impairment.

Underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis: 51 cases (1990-2001).

OBJECTIVE: To determine the underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis and identify differences between cats that survived following treatment and cats that did not survive despite treatment. DESIGN: Retrospective study. ANIMALS: 51 cats with septic peritonitis. PROCEDURE: Medical records were reviewed for clinical findings; results of clinicopathologic testing, microbial culture, and radiography; diagnosis; treatment; and outcome. RESULTS: Signs of pain during palpation of the abdomen were reported for only 29 of 47 (62%) cats. Eight (16%) cats had relative bradycardia (heart rate < 140 beats/min). The most commonly isolated organisms included Escherichia coli, Enterococcus spp, and Clostridium spp. The most common cause of peritonitis was gastrointestinal tract leakage (24 cats). No definitive source could be identified in 7 cats. Treatment, including exploratory surgery, was pursued in 23 cats, of which 16 (70%) survived and were discharged. There were no significant differences between survivors and nonsurvivors in regard to heart rate, age, rectal temperature, serum lactate concentration, WBC count, PCV, blood glucose concentration, or serum albumin concentration. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that clinicopathologic abnormalities and outcome in cats with septic peritonitis are similar to those reported for dogs. However, certain features may be unique, including an absence of signs of pain during abdominal palpation, relative bradycardia, and apparent spontaneous peritonitis in some cats.