Manifestations of hypertensive encephalopathy in cats.

OBJECTIVES: Hypertensive encephalopathy in cats is an important entity but is underestimated in clinical practice. This could be explained, in part, by non-specific clinical signs. The objective of this study was to characterise the clinical manifestations of hypertensive encephalopathy in cats. METHODS: Cats with systemic hypertension (SHT) recognised by routine screening, associated with underlying predisposing disease or a clinical presentation suggestive of SHT (neurological or non-neurological), were prospectively enrolled over a 2-year period. Confirmation of SHT was based on at least two sets of measurements of systolic blood pressure >160 mmHg by Doppler sphygmomanometry. RESULTS: Fifty-six hypertensive cats with a median age of 16.5 years were identified; 31 had neurological signs. In 16/31 cats, neurological abnormalities were the primary complaint. The other 15 cats were first presented to the medicine or ophthalmology service, and neurological disease was recognised based on the cat's history. The most common neurological signs were ataxia, various manifestations of seizures and altered behaviour. Individual cats also showed paresis, pleurothotonus, cervical ventroflexion, stupor and facial nerve paralysis. In 28/30 cats, retinal lesions were detected. Of these 28 cats, six presented with a primary complaint of visual deficits, and neurological signs were not the primary complaint; nine presented with non-specific medical issues, without suspicion of SHT-induced organ damage; in 13 cats, neurological issues were the primary complaint and fundic abnormalities were detected subsequently. CONCLUSIONS AND RELEVANCE: SHT is common in older cats and the brain is an important target organ; however, neurological deficits are commonly ignored in cats with SHT. Gait abnormalities, (partial) seizures and even mild behavioural changes should prompt clinicians to consider the presence of SHT. A fundic examination in cats with suspected hypertensive encephalopathy is a sensitive test to support the diagnosis.

Reversible facial nerve paralysis in a cat suspected to be associated with systemic hypertension.

CASE SUMMARY: This report describes the appearance of facial nerve paralysis in a 16-year-old hypertensive cat. MRI was helpful in visualising and characterising mesencephalic and facial nerve lesions thought to be induced by hypertension. Neurological signs rapidly resolved under antihypertensive therapy. RELEVANCE AND NOVEL INFORMATION: Systemic hypertension is an important medical condition in geriatric cats causing damage in various target organs, including the brain. Hypertensive encephalopathy is an umbrella term for a multitude of different clinical manifestations of cerebral target organ damage. Facial nerve paralysis secondary to hypertension is recognised in human medicine, particularly in children, but so far has not been reported in veterinary medicine.

Reliability of detecting fundus abnormalities associated with systemic hypertension in cats assessed by veterinarians with and without ophthalmology specialty training.

OBJECTIVES: Systemic hypertension (SHT) causes severe target organ damage (TOD) and blood pressure (BP) measurement should be routine in at-risk populations. Fundoscopy is a tool to corroborate acute clinical relevance of high BP results and to decide on immediate therapy. Not every cat with a high BP result can be examined by an ophthalmologist. The study objective was to determine the reliability of fundoscopy in cats with SHT performed by a veterinarian without ophthalmology specialty training. METHODS: Cats with suspicion of hypertensive TOD or belonging to an at-risk population for SHT with a first measurement of elevated BP >160 mmHg were enrolled. Indirect ophthalmoscopy was performed by a recent graduate veterinarian followed by a veterinary ophthalmologist. Confirmation of SHT was based on two additional sets of systolic BP measurements >160 mmHg by Doppler sphygmomanometry. RESULTS: Thirty-three cats were included. SHT was confirmed in 27 cats. SHT was detected on routine examinations in 12/27 cats; fundoscopic lesions were observed in 9/12 by the non-trained veterinarian and in 11/12 by an ophthalmologist. Nine of 27 cats were neurological patients; fundoscopic lesions were detected in 4/9 by the non-trained veterinarian and in 7/9 by an ophthalmologist. Six of 27 cats were presented for acute blindness; fundus lesions were detected in all six cats by the non-trained veterinarian and ophthalmologist. SHT was not confirmed and fundoscopic lesions were not detected by either examiner in 6/33 cats. Compared with a veterinary ophthalmologist, reliability of detecting fundus abnormalities by the non-trained veterinarian was 72% (13/18) for cats with, and 100% (6/6) for cats without, vision. CONCLUSIONS AND RELEVANCE: Fundus examination by a non-specialty trained veterinarian has reasonably high reliability for the detection of ocular TOD. Private practice veterinarians are encouraged to perform an initial fundic examination in suspected hypertensive cats.

Fermented Soy-Derived Bioactive Peptides Selected by a Molecular Docking Approach Show Antioxidant Properties Involving the Keap1/Nrf2 Pathway.

Bioactive peptides are a group of molecules with health beneficial properties, deriving from food matrices. They are protein fragments consisting of 2-20 amino acids that can be released by microbial fermentation, food processing and gastrointestinal digestion. Once hydrolyzed from their native proteins, they can have different functions including antioxidant activity, which is important for cell protection by oxidant agents. In this work, fermented soy products were digested in vitro in order to improve the release of bioactive peptides. These were extracted, purified and analyzed in vitro and in a cellular model to assess their antioxidant activity. Peptide sequences were identified by LC-MS/MS analysis and a molecular docking approach was used to predict their ability to interact with Keap1, one of the key proteins of the Keap1/Nrf2 pathway, the major system involved in redox regulation. Peptides showing a high score of interaction were selected and tested for their antioxidant properties in a cellular environment using the Caco-2 cell line and examined for their capability to defend cells against oxidative stress. Our results indicate that several of the selected peptides were indeed able to activate the Keap1/Nrf2 pathway with the consequent overexpression of antioxidant and phase II enzymes.

Identification of New Peptides from Fermented Milk Showing Antioxidant Properties: Mechanism of Action.

Due to their beneficial properties, fermented foods are considered important constituents of the human diet. They also contain bioactive peptides, health-promoting compounds studied for a wide range of effects. In this work, several antioxidant peptides extracted from fermented milk proteins were investigated. First, enriched peptide fractions were purified and analysed for their antioxidant capacity in vitro and in a cellular model. Subsequently, from the most active fractions, 23 peptides were identified by mass spectrometry MS/MS), synthesized and tested. Peptides N-15-M, E-11-F, Q-14-R and A-17-E were selected for their antioxidant effects on Caco-2 cells both in the protection against oxidative stress and inhibition of ROS production. To define their action mechanism, the activation of the Kelch-like ECH-associated protein 1/nuclear factor erythroid 2-related factor 2(Keap1/Nrf2) pathway was studied evaluating the translocation of Nrf2 from cytosol to nucleus. In cells treated with N-15-M, Q-14-R and A-17-E, a higher amount of Nrf2 was found in the nucleus with respect to the control. In addition, the three active peptides, through the activation of Keap1/Nrf2 pathway, led to overexpression and increased activity of antioxidant enzymes. Molecular docking analysis confirmed the potential ability of N-15-M, Q-14-R and A-17-E to bind Keap1, showing their destabilizing effect on Keap1/Nrf2 interaction.

Antioxidant Properties of Fermented Soy during Shelf Life.

Glycine max (soybean) is a fundamental food in human nutrition, largely utilized by the consumers, and in particular, fermented soy is mainly used. However, health benefits of the products can change during the shelf life as oxidation processes occur determining alterations of protein and lipid constituents leading to a decrease of nutritional quality. Therefore, the oxidative stability of the fermented soy during the shelf life was studied. The antioxidant potential of this product was evaluated by estimating total phenols, free radical scavenger activity using DPPH and ABTS tests, and the degree of lipid peroxidation, from I up to IX weeks. The antioxidant capacity after an initial decrease, increased again at VII-IX weeks. Lipid peroxidation was evaluated by comparing non fermented and fermented soy. The results disclosed a low amount of peroxides in the fermented soy, suggesting that fermentation brings to an improvement of the product associated to a decreased lipid peroxidation at longer times. Fractions of aqueous extract, obtained at the end of the shelf life from fermented soy, showed an enrichment in antioxidant peptides.

Insight into antioxidant properties of milk-derived bioactive peptides in vitro and in a cellular model.

Milk is a nutritionally important source of bioactive peptides with anti-inflammatory, immunomodulatory, anticancer, and antioxidant properties. These compounds can be useful as ingredients of functional food. For this reason, in the last decades, bioactive peptides attracted the interest of researchers and food companies. In this work, the results obtained with six milk-derived bioactive peptides (Y-4-R, V-6-R, V-7-K, A-10-F, R-10-M, and H-9-M) synthesized and studied for their antioxidant properties in vitro and in a cellular model, are reported. These molecules correspond to peptide fragments derived from parent compounds able to cross the apical membrane of Caco-2 cell layer and released in the basolateral compartment. In vitro, antioxidant tests such as 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) and crocin bleaching showed antioxidant activity mainly for peptides Y-4-R and V-6-R, respectively. In Caco-2 cells, peptides V-6-R, H-9-R, Y-4-R, and particularly R-10-M and V-7-K are able to prevent the decrease of viability due to oxidative stress. The latter peptide is also the most effective in protecting cells from lipid peroxidation. In conclusion, the reported hydrolyzed peptides are shown to exert the antioxidant properties both in vitro and in a cellular model.

Glucose concentrations after insulin-induced hypoglycemia and glycemic variability in healthy and diabetic cats.

BACKGROUND: Little information is available about posthypoglycemic hyperglycemia (PHH) in diabetic cats, and a causal link between hypoglycemia and subsequent hyperglycemia is not clear. Fluctuations in blood glucose concentrations might only represent high glycemic variability. HYPOTHESIS: Insulin induces PHH in healthy cats, and PHH is associated with poorly regulated diabetes and increased glycemic variability in diabetic cats. ANIMALS: Six healthy cats, 133 diabetic cats. METHODS: Insulin (protamine-zinc and degludec; 0.1-0.3 IU/kg) administered to healthy cats. Blood glucose curves were generated with portable glucose meter to determine the percentage of curves with PHH. Data from insulin-treated diabetic cats with blood glucose curves showing hypoglycemia included data of cats with and without PHH. Post-hypoglycemic hyperglycemia was defined as blood glucose concentrations <4 mmol/L followed by blood glucose concentrations >15 mmol/L within 12 hours. Glycemic variability was calculated as the standard deviation of the blood glucose concentrations. RESULTS: In healthy cats, all insulin doses caused hypoglycemia but PHH was not observed; glycemic variability did not differ between insulin preparations. Among diabetic cats with hypoglycemia, 33 (25%) had PHH. Compared with cats without PHH, their daily insulin dose was higher (1.09 ± 0.55 versus 0.65 ± 0.56 IU/kg; P < .001), serum fructosamine concentration was higher (565 ± 113 versus 430 ± 112 µmol/L; P < .001), remission was less frequent (10% versus 56%; P < .001), and glycemic variability was larger (8.1 ± 2.4 mmol/L versus 2.9 ± 2.2 mmol/L; P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE: Insulin-induced hypoglycemia did not cause PHH in healthy cats but it occurred in 25% of diabetic cats with hypoglycemia, particularly when diabetes was poorly controlled. Glycemic variability was increased in cats with PHH.

Clinical governance benchmarking issues in oncology: aggressiveness of cancer care and consumption of strong opioids. A single-center experience on measurement of quality of care.

AIMS AND BACKGROUND: The aggressiveness of cancer care near the end of life and the consumption of opioids are potential indicators of quality of care in palliative and end-of-life settings. The purpose of this article is to present a retrospective analysis regarding these themes and the adopted procedures to improve quality of care. METHODS: We evaluated all cancer patients treated and deceased during 2008 and considered those who died and received any antiblastic therapy within 14 and 30 days prior to death. Moreover, we evaluated the annual consumption of pure opioids during 2007 and 2008 in our inpatient clinic. We found that 5% and 9% of all treated patients were still receiving antiblastic treatment near the end of life within respectively 14 and 30 days prior to death (respectively 29.6% and 51.5% of deceased patients). All but 2 patients died from progressive disease, one patient died from acute myocardial infarction during chemotherapy, and one of severe sepsis after chemotherapy for non-Hodgkin lymphoma. As regards the annual consumption of strong opioids, there was a 179% increase in the use of morphine-equivalent doses of oral long-acting opioids (+228% for oxycodone) after the introduction of daily pain measurement through a numerical rating scale. CONCLUSIONS: To reduce the administration of chemotherapy near the end of life, we introduced the palliative prognostic score, to be administered to all advanced cancer patients with performance status of at least 2. To evaluate the effectiveness of analgesics and to reduce the cases of undertreatment of cancer pain, we adopted, in addition to the numerical rating scale, Cleeland's Pain Management Index. We are convinced that attempts to improve the quality of care can be achieved by the collaboration of all health professionals, patients and care givers.