Syndromic surveillance in companion animals utilizing electronic medical records data: development and proof of concept.

In an effort to recognize and address communicable and point-source epidemics in dog and cat populations, this project created a near real-time syndromic surveillance system devoted to companion animal health in the United States. With over 150 million owned pets in the US, the development of such a system is timely in light of previous epidemics due to various causes that were only recognized in retrospect. The goal of this study was to develop epidemiologic and statistical methods for veterinary hospital-based surveillance, and to demonstrate its efficacy by detection of simulated foodborne outbreaks using a database of over 700 hospitals. Data transfer protocols were established via a secure file transfer protocol site, and a data repository was constructed predominantly utilizing open-source software. The daily proportion of patients with a given clinical or laboratory finding was contrasted with an equivalent average proportion from a historical comparison period, allowing construction of the proportionate diagnostic outcome ratio and its confidence interval for recognizing aberrant heath events. A five-tiered alert system was used to facilitate daily assessment of almost 2,000 statistical analyses. Two simulated outbreak scenarios were created by independent experts, blinded to study investigators, and embedded in the 2010 medical records. Both outbreaks were detected almost immediately by the alert system, accurately detecting species affected using relevant clinical and laboratory findings, and ages involved. Besides demonstrating proof-in-concept of using veterinary hospital databases to detect aberrant events in space and time, this research can be extended to conducting post-detection etiologic investigations utilizing exposure information in the medical record.

Use of a meal challenge test to estimate peak postprandial triglyceride concentrations in dogs.

OBJECTIVE: To develop a standardized meal challenge test by assessing associations between food-withheld preprandial (ie, fasting) and postprandial triglyceride concentrations, determining the most appropriate sampling time to detect the peak concentration (highest postprandial concentration), and estimating reference intervals for fasting and postprandial concentrations in healthy dogs. ANIMALS: 12 lean healthy mixed-breed dogs. PROCEDURES: Dogs were fed a dry commercially available diet (fat, 31% metabolizable energy) for 3 weeks. After food was withheld for 23 to 24 hours, plasma triglyceride concentrations were measured 1 and 0.083 hours before and 1, 2, 3, 4, 5, 6, 9, and 12 hours after feeding of a standardized challenge meal (median amount eaten, 63 kcal/kg [127 kcal/kg°.75]). Correlation and agreement between concentrations at peak and other time points were assessed by use of correlation coefficients and Bland-Altman limits of agreement. Reference intervals were calculated by use of a robust method. RESULTS: Fasting and peak triglyceride concentrations were not closely associated. The highest concentration among samples obtained 2, 5, and 6 hours after meal consumption had closest agreement with peak concentration. In 5 of 12 dogs, concentrations 12 hours after eating were still significantly above baseline concentration (mean of each dog's fasting concentrations). CONCLUSIONS AND CLINICAL RELEVANCE: Fasting triglyceride concentration could not be used to accurately predict peak concentration. When estimating peak concentration, multiple samples should be collected 2, 5, and 6 hours after consumption of a standardized meal. Food may need to be withheld for > 12 hours when assessing fasting concentrations in healthy dogs.

Effects of dietary modification in dogs with early chronic valvular disease.

BACKGROUND: The potential benefits of nutritional modification in early canine cardiac disease are not known. HYPOTHESIS: We hypothesized that echocardiographic, neuroendocrine, and nutritional variables will differ between dogs with asymptomatic chronic valvular disease (CVD) and healthy controls, and that a moderately reduced sodium diet enriched with antioxidants, n-3 fatty acids, taurine, carnitine, and arginine will alter these variables in dogs with CVD. METHODS: Echocardiography was performed and blood was collected. After baseline comparison with healthy controls, all dogs with CVD were fed a low-sodium run-in diet for 4 weeks, reevaluated, and then randomized to receive either the cardiac diet or a placebo diet for 4 weeks. RESULTS: At baseline, dogs with CVD (n = 29) had significantly lower circulating sodium, chloride, arginine, and methionine concentrations and higher plasma concentrations of atrial natriuretic peptide compared to healthy controls. In dogs with CVD, plasma aldosterone concentration and heart rate increased significantly after 4 weeks of eating the run-in diet. The cardiac diet group (n = 14) had larger increases in levels of cholesterol (P = .001), triglycerides (P = .02), eicosapentaenoic acid (P < .001), docosahexaenoic acid (P < .001), total omega-3 fatty acids (P < .001), vitamin C (P = 0.04), alpha-tocopherol (P < .001), and gamma-tocopherol (P < .001) compared to the placebo diet group (n = 15). The cardiac diet group also had larger reductions in maximal left-atrial dimension (P = .003), left-ventricular internal dimension in diastole (P = .03), and weight-based maximal left-atrial dimension (P = .03). CONCLUSIONS AND CLINICAL IMPORTANCE: Observed changes in both blood variables and echocardiographic measurements warrant additional studies on dietary modifications in dogs with early CVD.

Survival of cats with naturally occurring chronic renal failure is related to severity of proteinuria.

BACKGROUND: Tubulointerstitial kidney disease is a common cause of illness and death in pet cats and is typically not associated with overt proteinuria. HYPOTHESIS: Proteinuria would be independently related to survival in cats with renal failure, with or without hypertension. ANIMALS: The study included 136 client-owned cats; 28 apparently normal, 14 hypertensive but not azotemic, 66 azotemic but not hypertensive, and 28 both hypertensive and azotemic. METHODS: Cox's proportional hazards model was used to determine the influence of initial plasma creatinine concentration, proteinuria (urine protein-to-creatinine ratio or albumin-to-creatinine ratio), age, and systemic hypertension on the risk of death or euthanasia during the follow-up period. Multivariable linear regression was used to determine the relation between severity of proteinuria and predictive variables, including age, plasma creatinine concentration, systolic blood pressure, sex, and urine specific gravity. RESULTS: Plasma creatinine concentration and proteinuria were very highly related to survival. The hazard ratio (95% confidence intervals) for death or euthanasia was 2.9 (1.4-6.3) and 4.0 (2.0-8.0) for urine protein-to-creatinine ratio 0.2-0.4 and >0.4, respectively, compared with the baseline group with a urine protein-to-creatinine ratio of <0.2 and were 2.4 (1.2-4.8) and 4.9 (2.3-10.2) for an albumin-to-creatinine ratio of 30-82 mg/g and <82 mg/g, respectively, compared with a baseline group with albumin-to-creatinine ratio of <30 mg/g. Treated hypertensive cats did not have reduced survival, although systolic blood pressure, together with plasma creatinine concentration was positively related to the magnitude of proteinuria. CONCLUSIONS AND CLINICAL IMPORTANCE: Despite the relatively low concentrations of proteinuria typical of chronic renal disease in cats, this measurement is of prognostic significance.

Dietary constituents are able to play a beneficial role in canine epidermal barrier function.

Epidermal barrier function is a critical attribute of mammalian skin. The barrier is responsible for preventing skin-associated pathologies through controlling egress of water and preventing ingress of environmental agents. Maintaining the quality and integrity of the epidermal barrier is therefore of considerable importance. Structurally, the barrier is composed of two main parts, the corneocytes and the intercellular lamellar lipid. The epidermal lamellar lipid comprises mainly ceramides, sterols and fatty acids. Twenty-seven nutritional components were screened for their ability to upregulate epidermal lipid synthesis. Seven of the 27 nutritional components (pantothenate, choline, nicotinamide, histidine, proline, pyridoxine and inositol) were subsequently retested using an in vitro transepidermal diffusion experimental model, providing a functional assessment of barrier properties. Ultimately, the best performing five nutrients were fed to dogs at supplemented concentrations in a 12-week feeding study. Barrier function was measured using transepidermal water loss (TEWL). It was found that a combination of pantothenate, choline, nicotinamide, histidine and inositol, when fed at supplemented concentrations, was able to significantly reduce TEWL in dogs after 9 weeks.

Nutrient intake and urine composition in calcium oxalate stone-forming dogs: comparison with healthy dogs and impact of dietary modification.

Nutrient intake and urine composition were analyzed in calcium oxalate (CaOx)stone-forming and healthy control dogs to identify factors that contribute to CaOx urolithiasis. Stone-forming dogs had significantly lower intake of sodium, calcium, potassium, and phosphorus and significantly higher urinary calcium and oxalate concentrations, calcium excretion, and CaOx relative supersaturation (RSS). Feeding a diet used in the treatment of canine lower urinary tract disease for 1 month was associated with increased intake of moisture, sodium, and fat; reduced intake of potassium and calcium; and decreased urinary calcium and oxalate concentrations, calcium excretion, and CaOx RSS. No clinical signs of disease recurrence were observed in the stone-forming dogs when the diet was fed for an additional 11 months. The results suggest that hypercalciuria and hyperoxaluria contribute to the formation of CaOx uroliths in dogs and show that dietary modifications can alter this process.

Evaluation of dietary patterns in dogs with cardiac disease.

OBJECTIVE: To determine the dietary patterns and intake of nutrients of concern in dogs with cardiac disease. DESIGN: Prospective study. ANIMALS: 82 dogs with dilated cardiomyopathy (DCM) or chronic valvular disease. PROCEDURE: Owners of dogs were contacted and given a standardized telephone questionnaire regarding diet and a 24-hour food recall to determine daily intake of calories, protein, fat, sodium, potassium, and magnesium. RESULTS: Among the 82 dogs, 71% had no congestive heart failure (CHF), and 29% had CHF or a history of CHF. Sixty-one percent of dogs had concurrent diseases. Anorexia was or had been evident in 34% of dogs and was significantly more common in the CHF group and in dogs with DCM. Most dogs (92%) received some treats and table food, with a median percentage of daily calories from treats of 19% (range, 0% to 100%). Most owners (57%) that administered pills used human or pet foods for pill administration. Most dogs ate more than the Association of American Feed Control Officials (AAFCO) minimum values for fat and protein. Daily sodium intake varied from 14 to 384 mg/100 kcal, compared with the AAFCO minimum of 17 mg/100 kcal. A median of 25% of total daily sodium came from treats and table food (range, 0% to 100%). Dogs with CHF ate significantly more sodium, compared with dogs with no CHF. CONCLUSIONS AND CLINICAL RELEVANCE: Dietary intake for dogs with cardiac disease is highly variable and often not optimal.

Prevalence of systolic hypertension in cats with chronic renal failure at initial evaluation.

OBJECTIVE: To determine prevalence of systolic hypertension and associated risk factors in cats with chronic renal failure evaluated in first-opinion practice. DESIGN: Prospective study. ANIMALS: 103 cats with chronic renal failure. PROCEDURE: Systolic arterial blood pressure (SABP) was measured with a noninvasive Doppler technique, and cats that had SABP > 175 mm Hg on 2 occasions or that had SABP > 175 mm Hg and compatible ocular lesions were classified as hypertensive. Information from the history (previous treatment for hyperthyroidism, age), physical examination (sex, body weight), routine plasma biochemical analyses (creatinine, cholesterol, potassium, sodium, chloride, and calcium concentrations), and thyroid status were evaluated as potential risk factors for systolic hypertension. Variables associated with systolic hypertension were evaluated by use of logistic regression. RESULTS: 20 (19.4%; 95% confidence interval, 13 to 28%) cats had systolic hypertension. Plasma potassium concentration was significantly and inversely associated with systolic hypertension. CONCLUSIONS AND CLINICAL RELEVANCE: Prevalence of systolic hypertension, although clinically important, was lower than that reported previously. The cause of the inverse association between systolic hypertension and plasma potassium concentration is not yet known.

Predicting the crystallization potential of urine from cats and dogs with respect to calcium oxalate and magnesium ammonium phosphate (struvite).

The objective of this study was to validate two programs (SUPERSAT and EQUIL 2) for calculation of calcium oxalate (CaOx) and magnesium ammonium phosphate (struvite; MAP) relative supersaturation (RSS) in dog and cat urine. Healthy adult cats (n = 10) and dogs (n = 9) were fed standard diets for a 3-wk period. Urine was collected (24 h, dogs; 48 h, cats) and filtered, and the pH was measured. A 20-mL aliquot was titrated to pH 2 and frozen for analysis. Additional aliquots were incubated with 1 g seed crystals at 38 degrees C; CaOx for 24 h (cat) and 2, 6 and 9 d (dog); MAP for 48 h (dog) and 6 d (cat). Samples were analyzed for 10 substances. RSS was calculated using EQUIL 2 and SUPERSAT. CaOx RSS (SUPERSAT): dog urine was initially supersaturated, whereas cat urine was undersaturated with the diets used. Cat urine reached the solubility product (K(sp)), (RSS = 1) after 24-h incubation, whereas dog urine was still approaching K(sp) at 9 d. MAP RSS (SUPERSAT): urine from both species was undersaturated and increased toward K(sp) during incubation. Final RSS values were compared for both programs. SUPERSAT resulted in values close to 1 for both CaOx and MAP; EQUIL 2 gave similar values for CaOx RSS, although MAP RSS values were considerably higher than 1. In conclusion, EQUIL 2 and SUPERSAT both calculated reasonably accurate RSS values for CaOx, whereas only SUPERSAT provided an accurate measure of MAP RSS.

An open prospective investigation into aetiology in a group of cats with suspected allergic skin disease.

Abstract This prospective study evaluated the cause(s) of dermatitis in a series of cats with signs suggestive of allergic skin disease. Twenty cases completed the díagnostic evaluation, which included intradermal skin testing, a rigorous flea-control programme, and a 4-month stabilization period on a restricted protein source commercial diet, followed by rechallenge with the cat's original diet. The most common final díagnoses included flea allergic dermatitis (seven cases), and flea allergic dermatitis together with atopy (seven cases). Three additional cases which did not complete the study were also considered to be atopic. No cases were considered to be primarily associated with food hypersensitivity, an observation supporting previous data indicating this to be a rare cause of allergic skin disease in the cat. These observations emphasize the value of a rigorous flea-control programme as part of the management of many cases of feline allergic dermatitis. Résumé Une étude étiologique prospective a été réalisée dans une population de chats suspects de dermites allergiques. Des tests cutanés intradermiques ont été réalisés ainsi qu'un contrôle antipuce rigoureux et un régime d'élimination, faisant appel à une alimentation du commerce restreinte en protéines pendant 4 mois, suivi par une réintroduction de l'alimentation initiale du chat. Le díagnostic le plus fréquent est la Dermite par Allergie à la Piqûres de Puce (DAPP) (7 cas), une DAPP associée à une atopie (7 cas). Trois cas supplémentaires sont atopiques. Aucun cas n'est en rapport avec seulement une allergie alimentaire. Cette observation montre que l'allergie alimentaire est une cause rare de dermite allergique chez le chat. Ces observations confirment par ailleurs l'intérêt d'un contrôle antipuce rigoureux dans la gestion thérapeutique des dermites allergiques du chat. [O'Dair, H.A., Markwell, P.J., Maskell, I.E. An open prospective investigation into aetiology in a group of cats with suspected allergic skin disease (Etude étiologique prospective ouverte dans une population de chats suspects de dermite allergiques). Veterinary Dermatology 1996; 7: 193-202.] Resumen Este estudio prospective evalúa la(s) causa(s) de dermatitis en un grupo de gatos con sintomas sugestivos de dermatosis alérgica. Se evaluó el díagnóstico de veinte casos, incluyendo pruebas cutáneas intradérmicas, programa riguroso de control de pulgas y un periodo de cuatro meses de estabilización con una dieta comercial con fuente de proteina restringida, seguido de una re-exposición a la dieta original del gato. El díagnóstico final más frecuente fue de dermatitis alérgica a las pulgas (siete casos) y dermatitis alérgica a las pulgas con atopia (siete casos). Tres casos más que no completaron el estudio fueron también considerados atópicos. Ninguno de los casos fue considerado estar principalmente asociado a una hipersensibilidad alimentaria, lo que apoya hallazgos previos indicativos de que este tipo de hipersensibilidad es poco frecuente en el gato. Estos hallazgos resaltan la importancia de un programa rigurosos de control de pulgas en el protocolo de manejo de muchos casos de dermatitis alérgica felina. [O'Dair, H.A., Markwell, P.J., Maskell, I.E. An open prospective investigation into aetiology in a group of cats with suspected allergic skin disease (Investigacion prospectiva abierta de la etiologia en un grupo de gatos sospechosos de dermatosis alérgica). Veterinary Dermatology 1996; 7: 193-202.] Zusammenfassung Diese prospektive Untersuchung wertete die Fälle von Dermatitis bei einer Reihe von Katzen aus, die Symptome aufwiesen, welche auf eine allergische Hautkrankheit deuteten. Zwanzig Fälle wiesen eine vollständige díagnostische Untersuchung äuf, die intradermale Hauttests, striktes Flohbekämpfungsprogramm und eine viermonatige Stabilisierungsphase mit einer kommerziellen Diät mit begrenzten Eiweißquellen, gefolgt von einer Provokation mit dem bisher üblichen Katzenfutter, beinhaltete. Die häufigste endgültige Diagnose bestand in Flohbißdermatitis (sieben Fälle) und Flohbißdermatitis zusammen mit Atopie (sieben Fälle). Drei weitere Fälle durchliefen die Studie nicht vollständig, wurden aber als atopisch angesehen. Kein Fall wurde primär in Verbindug mit Futtermittelhypersensibilität gesehen, eine Beobachtung, die frühere Daten unterstützt, die dies als seltene Ursache bei allergischen Hautkrankheiten der Katze nennt. Diese Beobachtungen betonen die Bedeutung des genauen Flohbekämpfungsprogramms als Teil des Management vieler Fälle von allergischen Hautkrankheiten bei der Katze. [O'Dair, H.A., Markwell, P.J., Maskell, I.E. An open prospective investigation into aetiology in a group of cats with suspected allergic skin disease (Offene prospektive Untersuchung über die Ätiologie bei einer Gruppe von Katzen mit Verdacht auf allergische Hautkrankheiten). Veterinary Dermatology 1996; 7: 193-202.].

The mineral composition of nails in normal dogs and comparison with shed nails in canine idiopathic onychomadesis.

Abstract The mineral analyses of nails from 32 normal dogs were determined by atomic absorption spectrophotometry or colorimetrically. Data were compared with the mineral analyses of nails from 21 cases of idiopathic canine onychomadesis. German Shepherd dogs were significantly over represented (P < 0.005) in the affected group compared with a reference hospital population. Significant increases in the concentration of calcium (P < 0.05), potassium (P < 0.05), sodium (P < 0.0005) and phosphorus (P < 0.05) were found in nails from affected dogs compared with nails from normal animals. The mineral composition of nails from affected German Shepherd dogs was significantly different from that of affected non-German Shepherd dogs. Normal ranges for the mineral concentrations of normal canine nail are presented for the first time. The different composition of nails from affected German Shepherd dogs compared with nails from other breeds suggests a different aetiology to the onychomadesis, although the cause of the problem remains speculative. Résumé- Des analyses d'ongles de 32 chiens sains ont été déterminées par spectrophotométrie d'absorption atomique ou colométrie. Celles-ci ont été comparées avec celles d'ongles de 21 chiens à onychomadèse idiopathique. Les Bergers allemands sont surreprésentés (P < 0,005) dans le groupe de chiens malades, comparativement à la population de référence. Des augmentations significatives de la concentration de calcium (P < 0,05), de potassium (P < 0,05), de sodium (P < 0,005) et de phosphore (P < 0,05) sont notées dans les ongles des Bergers allemands à onychomadèse idiopathique, par rapport à celles des ongles des chiens atteints, mais non de race Berger allemand. Des valeurs usuelles des concentrations minérales des ongles du chien sont présentées pour la première fois. La composition différente des ongles des Bergers allemands affectés comparéeà celle des ongles des autres races affectées suggère une étiologie différente de l'onychomadèse dans cette race, bien que la cause reste encore imprècise. [Harvey, R. G., Markwell, P. J. The mineral composition of nails in normal dogs and comparison with shed nails in canine idiopathic onychomadesis (Composition minérale des ongles de chiens sains et comparaison avec celle des ongles provenant de chiens à onychomadèse idiopathique). Veterinary Dermatology 1996; 7: 29-34.] Resumen El análisis mineral de las uñas de 32 perros normales se determinó por espectrofotometría atómica de absorción o colorimétricamente. La información se comparó con los análisis de 21 casos de onicomadesis idiopática canina. Los perros Pastor Aleman estaban significativamente sobrerepresentados (P < 0.005) en el grupo afectado comparado con la población de un hospital de referencia. Se encontraron aumentos significativos en la concentración de calcio (P < 0.05), potasio (P < 0.00005) y fósforo (P < 0.05) en la población afectada, comparado con uñas de animales normales. La composicón mineral de uñas de perros Pastor Alemán afectados fue significativamente distinta de la de los perros no Pastor Alemán afectados. Se presenta por primera vez los valores de las concentración mineral de las uñas normales en el perro. La composición distinta de las uñas de perros Pastor Alemán afectados comparadda con uñas de otras razas sugiere una etiología distinta de la onicomadesis, aunque la causa del problema continúa siendo motivo de especulación. [Harvey, R. G., Markwell, P. J. The mineral composition of nails in normal dogs and comparison with shed nails in canine idiopathic onychomadesis (Composición mineral de las uñas de perros normales comparada con la uñas eliminadas en la onicomadesis idiopática canina). Veterinary Dermatology 1996; 7: 29-34.] Zusammenfassung- Die Mineralstoffanalyse der Krallen von 32 gesunden Hunden wurde mit Atomabsorptionsspektrometrie oder Kolorimetrie durchgeführt. Die Daten wurden mit Mineralstoffanalysen von Krallen aus 21 Fällen von idiopathischer kaniner Onychomadesis verglichen. Deutsche Schäferhunde waren signifikant überrepräsentiert (P < 0,005) in der betroffenen Gruppen im Vergleich zur einer Referenzpopulation der Klinik. Signifikante Anstiege in der Konzentration von Kalzium (P < 0,05), Kalium (P < 0,05), Natrium (P < 0,0005) und Phosphor (P < 0,05) wurden in den Krallen der betroffener Hunde im Vergleich zu denen gesunder gefunden. Die Mineralstoffzusammensetzung der Krallen betroffener Deutscher Schäferhunde unterschied sich signifikant von der betroffener Hunde anderer Rassen. Referenzbereiche für die Mineralstoffkonzentrationen gesunder Hundekrallen werden erstmalig vorgestellt. Die verschiedene Zusammensetzung der Krallen betroffener Deutscher Schäferhunde im Vergleich zu den Krallen anderer Rassen legt eine unterschiedliche Ätiologie der Onychomadesis nahe, obwohl die Ursache der Störung spekulativ bleibt. [Harvey, R. G., Markwell, P. J. The mineral composition of nails in normal dogs and comparison with shed nails in canine idiopathic onychomadesis (Die Mineralstoffzusammensetzung der krallen gesunder Hunde im Verleich zu abgesto ßenen Krallen bei kaniner idiopathischer Onychomadesis). Veterinary Dermatology 1996; 7: 29-34.].