A Multicentre Epidemiologic Study of Sudden and Unexpected Death in Adult Cats and Dogs in Australia.

Sudden and unexpected death (SUD) is a common reason for animals to undergo post-mortem examination. There is limited literature examining the causes of SUD in cats and dogs, and no research specific to Australia. The purpose of this study was to investigate the epidemiology and pathology of SUD in cats and dogs in a multicentric study across Australia. Retrospective post-mortem reports of SUD in cats and dogs were obtained from four veterinary schools in Australia distributed across four states. The frequency of SUD between institutes ranged from 2.1% to 6.5%. Dogs composed the majority of the study population (76%), and males outnumbered females, particularly in the feline subpopulation. After necropsy, 37% of SUD remained cause unknown, the largest category in both cats and dogs. When cause was identified, cardiovascular disease was most common in both species, followed by gastrointestinal disease in dogs, and trauma in cats. In dogs, multinomial logistic regression identified age as a risk factor significantly associated with the four largest categories of SUD. This study identified causes of SUD in Australian cats and dogs, including novel causes not previously reported. Further, this study revealed a higher rate of unsolved SUD in Australia than can be found in the literature from other countries.

Pre-hospital emergency cricothyrotomy in dogs part 2: Airway sealing and ventilation using cricothyrotomy tubes.

Cricothyrotomy (CTT) has been recommended for use in the pre-hospital setting for military working dogs and Operational K9s during airway emergencies. Although the CTT can establish a patent airway for spontaneous ventilation, the ability to seal the airway and provide positive pressure ventilation (PPV) using tubes designed for humans has not been determined. Using various CTT tubes placed in cadaver dog airways, this study aimed to determine: (1) Whether the tube cuff could create a functional airway seal with safe intra-cuff pressures; (2) The magnitude of delivered tidal volume (TV) loss during a standard breath to assess the possibility of delivering an adequate tidal volume with a bag-valve device (BVM); (3) The best performing tubes for either test; (4) The reasons behind the findings using observations from upper airway endoscopy, dissection, and measurements. Cadaver dogs of similar weights to MWD and Operational K9 breeds had various CTT tubes placed including three from commercial kits, a standard endotracheal tube, and a tracheostomy tube. The minimum occlusive volume technique was used to inflate the tube cuff and a pressure ≤ 48 cm H2O with an adequate seal was considered successful. Individual TVs were calculated for each dog and added to the volume lost during delivery of a standard breath from an ICU ventilator. Endoscopy and airway dissection were performed to assess the relationship between tubes cuffs and the airway. The tubes from the CTT kits performed poorly with regards to producing an airway seal with the H&H tube failing to seal the airway all tests. Tracheal dimensions were significantly associated with successful airway sealing (P = 0.0004). Tidal volume loss could be compensated using a BVM in 34/35 tests with the H&H tube in cadaver 8 the only to fail. Tracheal airway sealing is influenced by airway anatomy when tube cuffs are inflated to a target pressure and larger tubes do not always provide a better seal. The CTT tubes tested have the potential to facilitate ventilation with a BVM under the conditions set in this study. The 8.0 mm endotracheal tube performed the best and the H&H the worst in both tests.

Antimicrobials in dog-to-dog bite wounds: A retrospective study of 1526 dog bite events (1999-2019).

BACKGROUND: Although dog-to-dog bite wounds (DBW) are common, few studies worldwide have evaluated antimicrobial usage patterns or appropriateness of use. OBJECTIVES: Report frequency and results of DBW cultures, including antimicrobial susceptibility patterns. Determine the most commonly prescribed antimicrobials and their appropriateness for the treatment of DBW, and if antimicrobial importance is associated with wound severity, clinic type or year. ANIMALS: One thousand five hundred twenty-six dog bite events involving 1436 dogs presenting with DBW from 3 Australian university clinics from 1999 to 2019. METHODS: Retrospective study. Medical records were reviewed for presenting signs, culture and susceptibility testing, antimicrobial treatment, and outcome. A partial proportional odds model was used to determine if use of higher importance antimicrobials was associated with wound severity, clinic, or year. RESULTS: Antimicrobials were prescribed in 88.1% (1344/1526) of DBW. Amoxicillin-clavulanic acid was prescribed in 73.4% (1121/1526) of dogs, followed by first-generation cephalosporins, 18.1% (277/1526). Of a total of 1647 antimicrobial prescriptions, underdosing occurred in 13.4% for AMC (220/1647) and 26.1% (81/310) of dogs prescribed first generation cephalosporins. There was an association between the increased use of high-importance antimicrobials and wound severity (P < .001), antimicrobial polytherapy (P < .001) and year (P < .001). The odds of the clinic with specialists prescribing high-importance antimicrobials compared to those of medium importance for DBW was 82% less than that of a semi-rural, mixed and general practice. Culture and susceptibility (C&S) testing was performed in 1.8% of dogs. CONCLUSION AND CLINICAL IMPORTANCE: Empirical use of amoxicillin-clavulanic acid was common for DBW. Increasing wound severity was associated with greater use of high-importance antimicrobials. While C&S testing was rarely performed, routine susceptibility profiles are recommended to optimize antimicrobial stewardship.

Pulmonary Histopathology in Cats and Dogs with Fatal Tick Paralysis.

The objective of this study was to evaluate critically the nature and prevalence of histological pulmonary lesions in dogs and cats that had died or were euthanized because of tick paralysis. A retrospective and prospective case study of 11 cats and 23 dogs was carried out. Retrospective cases were gathered from the Veterinary Laboratory Services database at The University of Queensland (UQ). Prospective cases were provided by Veterinary Specialist Services and UQ VETs Small Animal Hospital. Lung and other tissue samples were collected for histopathological analysis. All tick intoxicated animals demonstrated evidence of pulmonary parenchymal changes: alveolar oedema, interstitial and alveolar congestion and alveolar fibrin exudation. Eleven of 23 (48%) dogs exhibited mild to severe bronchopneumonia. A lower rate (18%) of bronchopneumonia was found in cats, with one case of aspiration pneumonia. A novel pulmonary histological grading scheme was developed to evaluate the correlation between clinical presentation and histopathological changes. Novel extrapulmonary lesions in cats included hepatic necrosis and acute renal tubular necrosis attributed to hypoxia. We concluded that both dogs and cats with high clinical grade tick paralysis are extremely likely to have pulmonary pathology. High-protein oedema and fibrin exudation are predicted to be present in most cases of canine and feline tick paralysis.

Untangling interactions between Bitis vipers and their prey using coagulotoxicity against diverse vertebrate plasmas.

Venom is a key evolutionary innovation which plays a primary role in prey subjugation by venomous snakes. However, while there is a growing body of literature indicating the composition and activity of snake venoms is under strong natural selection driven by differences in prey physiology, the majority of studies have historically focussed on the activity of snake venoms with regards only towards human or mammalian physiologies. This study aimed to use clotting assays measuring both time and strength of clotting to characterise the coagulotoxic activity of venoms from a taxonomically, morphologically, and ecologically diverse range of Bitis spp. of viperid snakes upon the plasma of model species: amphibian (Cane Toad, Rhinella marina); lizard (Blue-tongue Skink, Tiliqua scincoides); avian (Domestic Chicken, Gallus gallus); and rodent (Brown Rat, Rattus norvegicus). Significant variation in coagulotoxic activity across the different plasmas was observed between species and compared to the known affects upon human plasma. Bitis caudalis was notable in being active on all four plasmas, but in extremely divergent manners: accelerating clotting times and producing strong, stable clots upon amphibian plasma (consistent with true procoagulation); accelerating clotting time but producing weak, unstable clots upon lizard plasma (consistent with pseudo-procoagulation); delaying avian clotting time beyond machine maximum reading time (strong anticoagulation consistent with either inhibition of clotting enzymes or total destruction of fibrinogen, or both); and delaying clotting of rodent plasma (consistent with inhibition of clotting enzymes) and with only weak clots formed (consistent with destruction of fibrinogen). In contrast, the sister species B. peringueyi and B. schneideri displayed activity only upon the lizard plasma, slightly accelerating the clotting times to produce weak, unstable clots (consistent with pseudo-procoagulation). The other dwarf species, B. cornuta, displayed strong anticoagulation upon avian and rodent plasmas, delaying clotting beyond the machine maximum reading time (strong anticoagulation consistent with either inhibition of clotting enzymes or total destruction of fibrinogen, or both). In contrast, the giant species studied (B. gabonica) showed only a very weak pseudo-procoagulant activity upon lizard plasma. The wide range of variation seen within this study highlights the importance of studying venom activity on relevant models when making conclusions about the ecological role of venoms and the extreme limitation in extrapolating animal results to predict potential human clinical effects.

Differential coagulotoxic and neurotoxic venom activity from species of the arboreal viperid snake genus Bothriechis (palm-pitvipers).

The viperid snake genus Bothriechis consists of eleven species distributed among Central and South America, living across low and high-altitude habitats. Despite Bothriechis envenomations being prominent across the Central and South American region, the functional effects of Bothriechis venoms are poorly understood. Thus, the aim of this study was to investigate the coagulotoxic and neurotoxic activities of Bothriechis venoms to fill this knowledge gap. Coagulotoxic investigations revealed Bothriechis nigroviridis and B. schlegelii to have pseudo-procoagulant venom activity, forming weak clots that rapidly break down, thereby depleting fibrinogen levels and thus contributing to a net anticoagulant state. While one sample of B. lateralis also showed weaker pseudo-procoagulant activity, directly clotting fibrinogen, two samples of B. lateralis venom were anticoagulant through the inhibition of thrombin and factor Xa activity. Differential efficacy of PoliVal-ICP antivenom was also observed, with the pseudo-procoagulant effect of B. nigroviridis venom poorly neutralised, despite this same activity in the venom of B. schlegelii being effectively neutralised. Significant specificity of these fibrinogen cleaving toxins was also observed, with no activity upon model amphibian, avian, lizard or rodent plasma observed. However, upon avian plasma the venom of B. nigroviridis exerted a complete anticoagulant effect, in contrast to the pseudo-procoagulant effect seen on human plasma. Neurotoxic investigations revealed B. schlegelii to be unique among the genus in having potent binding to the orthosteric site of the alpha-1 postsynaptic nicotinic acetylcholine receptor (with B. lateralis having a weaker but still discernible effect). This represents the first identification of postsynaptic nAChR neurotoxic activity for Bothriechis. In conclusion this study identifies notable differential activity within the coagulotoxic and postsynaptic neurotoxic activity of Bothriechis venoms, supporting previous research, and highlights the need for further studies with respect to antivenom efficacy as well as coagulotoxin specificity for Bothriechis venoms.

A Proposed Guideline for Performance of Emergency Surgical Airways in Small Animals: Analysis of Five Unsuccessfully Managed Cannot Intubate, Cannot Oxygenate Cases.

Objective-To describe three dogs and two cats diagnosed with a cannot intubate, cannot oxygenate (CICO) condition, and discuss the appropriateness and timing of emergency front-of-neck airway access (eFONA). The authors aim to increase awareness of CICO events and effective management strategies, which may result in faster airway access and improve patient outcomes. Case series summary-Three dogs and two cats could not be easily intubated resulting in the inability to deliver oxygen and contributing to their death. Emergency front-of-neck airway access was attempted in three cases, it could not be performed in one when indicated, and it was not considered in managing another. Conclusions-This is the first report of small animals suffering CICO emergencies and tracheostomy attempts without a concurrently secured airway. Cannot intubate, cannot oxygenate events and eFONA attempts were managed sub-optimally in all cases, which likely contributed to the poor outcomes. Rapid diagnosis of CICO and early eFONA using appropriate techniques has the potential to improve the management of difficult airways in small animals.

A VetCompass Australia Study of Antimicrobial Use in Dog-to-Dog Bite Wounds (1998-2018).

Although dog-to-dog bite wounds (DBW) are a common presentation to veterinary clinics, antimicrobial prescribing habits of Australian clinics have not been reported. This study determined the frequency and results of DBW cultures; antimicrobial selection; and importance class of antimicrobials prescribed relative to wound severity, geographic location, or year. A systematic sample of 72,507 patient records was retrieved from the VetCompass Australia database. Records for 1713 dog bite events involving 1655 dogs were reviewed for presenting signs, results of culture and susceptibility testing (C&S), antimicrobial treatment, geographical location, and outcome. A crossed random effects multivariable logistic regression model was used to determine if antimicrobial importance was associated with wound severity, year, and location, and to assess the differences in antimicrobial prescription between geographical locations, clinics, and veterinarians. Antimicrobials were prescribed in 86.1% of DBW. Amoxicillin-clavulanic acid was prescribed in 70% (1202/1713) with underdosing in 15.8% (191/1202). High-importance antimicrobial use was associated with wound severity (p < 0.001), year category (p = 0.007), and surgery (p = 0.03). C&S testing was recorded as having been performed in only one case. Differences in individual veterinarian prescribing habits were stronger than the clinic culture, suggesting that education utilizing clinic-wide antimicrobial guidelines may aid in improving antimicrobial stewardship.

Acute cerebral compression caused by an epidural hematoma associated with cryptococcosis in a dog.

OBJECTIVE: To describe acute cerebral compression caused by an epidural hematoma (EDH) in a dog with cryptococcal infection. CASE SUMMARY: An 18-month-old neutered male Neapolitan Mastiff was found comatose with no preceding clinical signs apart from a mild forelimb lameness. A CT scan of the head revealed a lesion within the right caudal nasal cavity that traversed the cribriform plate in addition to a right epidural lesion resulting in compression of the right cerebrum. Assessment of brain death was made based on the presence of coma, apnea, and absence of brain stem reflexes and included assessment of the vestibulo-ocular reflex. Postmortem identified a large EDH causing marked compression of the right frontal lobe. A nasal biopsy cultured Cryptococcus gattii. NEW OR UNIQUE INFORMATION PROVIDED: EDH formation in a dog secondary to cryptococcosis has not been previously reported. This is also the first time a caloric vestibulo-ocular reflex assessment has been reported in a dog.

Prehospital Emergency Cricothyrotomy in Dogs Part 1: Experiences With Commercial Cricothyrotomy Kits.

The surgical cricothyrotomy (CTT) has been recommended for emergency front of neck airway access (eFONA) during a cannot intubate, cannot oxygenate scenario for military working dogs (MWD) and civilian law enforcement working dogs (operational K9s). In prehospital and austere environments, combat medics and emergency medical service providers are expected to administer emergency medical care to working dogs and may only have emergency airway kits designed for humans at their disposal. The objective of this article is to provide a detailed description of the application of such devices in cadaver dogs and highlight potential alterations to manufacturer guidelines required for successful tube placement. The kits evaluated included the Portex® PCK, Melker universal cricothyrotomy kit and H&H® emergency cricothyrotomy kit. A novel technique for awake cricothyrotomy in the dog is also described, which can also be considered for in-hospital use, together with the open surgical method described for the H&H® kit. To the authors' knowledge, this is the first publication documenting and providing instruction on the application of commercial cricothyrotomy kits in dogs.

Pathology of Fatal Australian Black Snake (Pseudechis sp) Envenomation in Two Adult Dogs.

Black snakes (Pseudechis spp) are a genus of venomous Australian elapid snakes that can cause major clinical envenomation in companion animals, which may be fatal, even with appropriate antivenom treatment. Despite its clinical significance, there is little published information on the pathology of black snake envenomation. We report the gross and microscopic lesions associated with black snake envenomation in two dogs, one with a definitive immunological species identification of red-bellied black snake (RBBS; Pseudechis porphyriacus), the other with a black snake immunotype on a venom detection kit. Both dogs were located in a geographical area where the RBBS is found. The prominent gross findings in both cases included icterus, localized facial oedema in the region of the presumed bite wound, pigmenturia and multicavitary serosanguineous effusions. Histopathology of the confirmed RBBS case revealed acute renal tubular necrosis with haemosiderosis, marked splenic haemosiderosis and centrilobular to midzonal hepatocellular necrosis with severe cholestasis. Defining the spectrum of lesions of elapid snake envenomation improves understanding of the pathogenesis, which may lead to improved patient outcomes and post-mortem diagnosis.

Diagnosis and Treatment of Snake Envenomation in Dogs in Queensland, Australia.

Australia has some of the most venous snakes in the world, and envenomations of domestic dogs are common, but clinical signs as well as the diagnostic procedures and treatments of snake envenomations are poorly described. Therefore, we invited veterinary clinics in the state of Queensland, Australia, to provide detailed data on snake envenomation cases in dogs. A total of 230 cases were reported from 19 veterinary hospitals, with an average of 12.1 dogs per clinic, per year. Detailed case data were provided from 20 dogs-of these, 65.0% (13/20) were envenomated during the daytime, with collapse and paresis being the most common signs reported by owners. The median time between the onset of clinical signs and admission to the veterinary hospital was 60 min. Clinical signs were the sole diagnostic modality utilised by veterinarians in 30.0% (6/20) of cases. Activated clotting time was the most common diagnostic procedure conducted, while snake venom detection kits (SVDK) were only used in 15.0% (3/20) of cases. Of the dogs that received antivenom (85.0%, 17/20), the tiger/multibrown combination (3000 units tiger/4000 units brown) was predominately (13/17) provided. Three of the 17 dogs that received antivenom (17.6%) died or were euthanised. About 82.4% (14/17) of the dogs treated with antivenom, but only 33.3% (1/3) of the dogs not treated with antivenom, recovered (p = 0.140). Overall, veterinarians relied frequently on medical history, clinical signs, and diagnostic tests other than the SVDK and, thus, most likely, administered snake envenomation treatment based on their clinical experience.

Cricothyrotomy Is Faster Than Tracheostomy for Emergency Front-of-Neck Airway Access in Dogs.

Objectives: In novice final year veterinary students, we sought to: (1) compare the procedure time between a novel cricothyrotomy (CTT) technique and an abbreviated tracheostomy (TT) technique in canine cadavers, (2) assess the success rate of each procedure, (3) assess the complication rate of each procedure via a damage score, (4) evaluate the technical difficulty of each procedure and (5) determine the preferred procedure of study participants for emergency front-of-neck access. Materials and Methods: A prospective, cross-over, block randomised trial was performed, where veterinary students completed CTT and TT procedures on cadaver dogs. Eight students were recruited and performed 32 procedures on 16 dogs. A generalised estimating equation approach to modelling the procedure times was used. Results: The procedure time was significantly faster for the CTT than the TT technique, on average (p < 0.001). The mean time taken to complete the CTT technique was 49.6 s (95% CI: 29.5-69.6) faster on average, with a mean CTT time of less than half that of the TT. When taking into account the attempt number, the procedure time for a CTT was 66.4 s (95% CI: 38.9-93.9) faster than TT for the first attempt, and for the second attempt, this was 32.7 s (95% CI: 15.2-50.2) faster, on average. The success rate for both procedures was 100% and there was no difference detected in the damage or difficulty scores (P = 0.13 and 0.08, respectively). Seven of eight participants preferred the CTT. Clinical Significance: CTT warrants consideration as the primary option for emergency front-of-neck airway access for dogs.

Pseudohypoadrenocorticism in a Siberian Husky with Trichuris vulpis Infection.

An entire male Siberian Husky presented for diarrhoea, weakness, inappetence, and collapse following a six-day period of illness. On clinical examination the dog displayed vasoconstrictive circulatory shock, dehydration, and melena. Laboratory tests revealed a marked hyponatraemia, hyperkalaemia, and a decreased sodium/potassium ratio of ≤ 12.4. The baseline and poststimulation serum cortisol concentrations were markedly elevated following adrenocorticotropin hormone (ACTH) stimulation test, yielding 712 nmol/L and 706 nmol/L, respectively. The elevated cortisol concentration excluded hypoadrenocorticism. A concurrent Trichuris vulpis (whipworm) infection was also identified. The dog was treated with supportive care including fenbendazole and recovered uneventfully. The final diagnosis was Trichuris vulpis infection with secondary pseudohypoadrenocorticism. This case report further supports a previous observation that the Siberian Husky breed may have an increased sensitivity to infection with Trichuris vulpis and development of pseudohypoadrenocorticism.

Successful Treatment of Transient Central Diabetes Insipidus following Traumatic Brain Injury in a Dog.

An 11-year-old female spayed Maltese presented comatose, half an hour after vehicular trauma, and was treated for traumatic brain injury and pulmonary contusions. The dog developed severe hypernatremia within six hours of presentation, which responded poorly to the administration of five percent dextrose in water. As central diabetes insipidus was suspected, desmopressin was trialled and resolution of hypernatremia was achieved six days later. Transient trauma-induced central diabetes insipidus has been described previously in two dogs; in the first, serum sodium concentrations were evaluated three days after injury and the other developed hypernatremia seven days after injury. To the authors' knowledge, this is the first report of rapid onset, transient, and trauma-induced central diabetes insipidus in a dog that encompasses the complete clinical progression of the syndrome from shortly after injury through to resolution.

A pilot study evaluating the utility of a novel tube cricothyrotomy technique in providing ventilation in small animals using a live porcine model.

BACKGROUND: Tube cricothyrotomy has been suggested as a first-choice for emergency surgical airway access in small animals, rather than the more commonly accepted procedures of tracheotomy and needle cricothyrotomy. METHODS: A small pilot study of tube cricothyrotomy in a live porcine model was conducted to evaluate this method. The technique was modified to permit the use of commonly available equipment and ease of application. Following ethics approval, a tube cricothyrotomy was performed on 9 live pigs. The endpoints were the efficacy of ventilation through the tube as measured by end-tidal carbon dioxide, successful placement of the tube and the time taken for placement. RESULTS: Of the nine pigs, eight had a tube placed successfully, with the median procedure time being 111.5 seconds (range: 35-240 seconds). After 10 mins, the mean end-tidal carbon dioxide was 58.3 mmHg (95% CI: 55.2-61.3 mmHg), with a range of 54-64 mmHg. Tube cricothyrotomy holds promise as a means of rapidly obtaining tracheal access in small animals and temporarily sustaining ventilation in an emergency. CONCLUSION: Further detailed investigation is warranted to assess the use of this technique in the small animal emergency setting.

Use of big data in the surveillance of veterinary diseases: early detection of tick paralysis in companion animals.

BACKGROUND: Tick paralysis, resultant from envenomation by the scrub-tick Ixodes holocyclus, is a serious threat for small companion animals in the eastern coast of Australia. We hypothesise that surveillance systems that are built on Internet search queries may provide a more timely indication of high-risk periods more effectively than current approaches. METHODS: Monthly tick paralysis notifications in dogs and cats across Australia and the states of Queensland (QLD) and New South Wales (NSW) were retrieved from Disease WatchDog surveillance system for the period 2011-2013. Internet search terms related to tick paralysis in small companion animals were identified using Google Correlate, and corresponding search frequency metrics were downloaded from Google Trends. Spearman's rank correlations and time series cross correlations were performed to assess which Google search terms lead or are synchronous with tick paralysis notifications. RESULTS: Metrics data were available for 24 relevant search terms at national level, 16 for QLD and 18 for NSW, and they were all significantly correlated with tick paralysis notifications (P < 0.05). Among those terms, 70.8, 56.3 and 50 % showed strong Spearman's correlations, at national level, for QLD, and for NSW respectively, and cross correlation analyses identified searches which lead notifications at national or state levels. CONCLUSION: This study demonstrates that Internet search metrics can be used to monitor the occurrence of tick paralysis in companion animals, which would facilitate early detection of high-risk periods for tick paralysis cases. This study constitutes the first application of the rapidly emerging field of Internet-based surveillance to veterinary science.

Validation of the Intensive Care National Audit and Research Centre Scoring System in a UK Adult Cardiac Surgery Population.

OBJECTIVE: The Intensive Care National Audit and Research Centre (ICNARC) scoring system was conceived in 2007, utilizing 12 physiologic variables taken from the first 24 hours of adult admissions to the general intensive care unit (ICU) to predict in-hospital mortality. The authors aimed to evaluate the ICNARC score in predicting mortality in cardiac surgical patients compared to established cardiac risk models such as logistic EuroSCORE as well as to the Acute Physiology and Chronic Health Evaluation (APACHE) II. DESIGN: Retrospective analysis of data collected prospectively. SETTING: Single-center study in a cardiac intensive care in a regional cardiothoracic center. PARTICIPANTS: Patients undergoing cardiac surgery between January 2010 and June 2012. METHODS: A total of 1,646 patients were scored preoperatively using the logistic EuroSCORE and postoperatively using ICNARC and APACHE II. Data for comparison of scoring systems are presented as area under the receiver operating characteristic curve. MEASUREMENTS AND MAIN RESULTS: The mean age at surgery was 67 years±10.1. The mortality from all cardiac surgery was 3.2%. The mean logistic EuroSCORE was 7.31±10.13, the mean ICNARC score was 13.42±5.055, while the mean APACHE II score was 6.32±7.731. The c-indices for logistic EuroSCORE, ICNARC, and APACHE II were 0.801, 0.847 and 0.648, respectively. CONCLUSION: The authors have, for the first time, validated the ICNARC score as a useful predictor of postoperative mortality in adult cardiac surgical patients. This could have implications for postoperative management, focusing the utilization of resources as well as a method to measure and compare performance in the cardiothoracic ICU.

Diagnostic accuracy of the SNAP and Spec canine pancreatic lipase tests for pancreatitis in dogs presenting with clinical signs of acute abdominal disease.

OBJECTIVES: To (i) assess the clinical diagnostic accuracy of SNAP canine pancreatic lipase (cPL) and specific canine pancreatic lipase (Spec cPL) and (ii) assess the agreement of an abnormal test result between SNAP cPL and Spec cPL in dogs presenting with acute abdominal disease. DESIGN: Prospective observational cohort study. SETTING: University teaching hospital emergency center. ANIMALS: Thirty-eight client-owned dogs that presented with acute abdominal disease, with a known final diagnosis between March 2009 and April 2010. Dogs were retrospectively assigned into 2 groups, dogs with acute pancreatitis (AP) (Group 1) and dogs without AP (Group 2). INTERVENTIONS: Paired serum samples obtained within 24 hours of presentation were analyzed using the SNAP cPL test and Spec cPL assay. MEASUREMENTS AND RESULTS: SNAP cPL clinical sensitivity and specificity was 82% (9/11 dogs of group 1) and 59% (16/27 dogs of group 2), respectively. Spec cPL clinical sensitivity and specificity was 70% (7/10 dogs of group 1) and 77% (20/26 dogs of group 2), respectively. Accuracy of the SNAP and Spec cPL for a clinical diagnosis of pancreatitis was found to be 66% and 75%, respectively. Agreement between a positive SNAP (cPL ≥ 200 µg/L) and a clinical diagnosis pancreatitis resulted in κ = 0.33. Agreement between an increased Spec (cPL ≥ 400 µg/L) and a clinical diagnosis of pancreatitis resulted in a κ = 0.43. The agreement between SNAP and Spec cPL (cPL ≥ 200 µg/L) for the entire cohort resulted in κ = 0.78. CONCLUSION: SNAP cPL and Spec cPL results may provide a "false positive" diagnosis of pancreatitis in up to 40% of dogs presenting with acute abdominal disease. There is good overall agreement between SNAP cPL and Spec cPL; however, there were 4/38 dogs with positive SNAP cPL and "normal" Spec cPL.

Use of intravenous lipid therapy in three cases of feline permethrin toxicosis.

OBJECTIVE: To describe the use of intravenous lipid emulsion (IVLE) as an adjunctive therapy in 3 cats with permethrin toxicosis. CASE SERIES SUMMARY: Three cats with permethrin toxicosis were treated with IVLE in addition to the current accepted treatment regime. All 3 cats demonstrated a subjective rapid clinical improvement after the administration of IVLE, with no adverse reactions observed. NEW OR UNIQUE INFORMATION PROVIDED: This is the first reported use of IVLE for feline permethrin toxicosis, with encouraging results. A possible reduction in costs associated with treatment may contribute to a reduction in euthanasia. Further investigation of the use of IVLEs in permethrin toxicosis is warranted.