Retrospective evaluation of the efficacy of isolating bacteria from synovial fluid in dogs with suspected septic arthritis.

OBJECTIVE: To evaluate the efficacy of synovial fluid culture in obtaining the causative organism from dogs with suspected septic arthritis. METHODS: In this retrospective evaluation, synovial fluid cytology and microbiology submissions from dogs with suspected septic arthritis from March 2007 to August 2011 were reviewed. Synovial fluid cytology consistent with joint sepsis was identified. Cultures of synovial fluid from dogs with clinical histories and abnormalities consistent with septic arthritis were used to evaluate the efficacy of bacterial isolation. RESULTS: In total, 36 dogs met the inclusion criteria. Initial aerobic cultures of joint fluid yielded bacterial growth in 44% of these dogs. All anaerobic cultures were negative. In 19% of the dogs with positive cultures, antibiotics had been administered prior to arthrocentesis compared with 10% of dogs with negative cultures. There was no association between culture efficacy and the administration of antimicrobial treatment prior to synovial fluid culture or recent surgery involving the affected joint (P=0.637 and P=0.106, respectively). CONCLUSION: Culture of synovial fluid from dogs with suspected septic arthritis has a low yield, necessitating a more effective means of identifying bacteria from suspected septic joints in dogs.

Adherence in single-parent households in a long-term asthma clinical trial.

Adherence of participants in a long-term clinical trial is necessary to assure validity of findings. This article examines adherence differences between single-parent and two-parent families in the Childhood Asthma Management Program (CAMP). Adherence was defined as the percentage of completed daily diary cards and scheduled study visits during the course of the trial. Logistic regression and ordinal logistic regression analyses were used. Children from single-parent families had a lower percentage of completed diary cards (72% vs. 84%) than two-parent families. Single-parent families were also more likely to reschedule visits (62% vs. 45%) and miss more clinic visits (23% vs. 17%) than two-parent families. Suggestions are given for study coordinators to assist participants in completing a long-term clinical trial. Many suggestions may be adapted for nurses in inpatient or outpatient settings for assisting parents of patients with chronic diseases.

Safety and application of induced sputum analysis in childhood asthma.

BACKGROUND: The value of sputum induction in pediatric asthma lies in its potential to directly and noninvasively assess airway inflammation in children, because bronchoscopy and biopsy carry some risk. The Childhood Asthma Management Program (CAMP) study was designed to evaluate the long-term effects of budesonide and nedocromil compared with placebo in children with mild to moderate asthma across 8 centers. OBJECTIVE: At the Denver CAMP site, we sought to evaluate the safety of sputum induction, to determine differences in airway inflammation between treatment groups by using induced sputum analysis, and to examine correlations between other biomarkers and sputum eosinophils. METHODS: Sputum induction was performed, and exhaled nitric oxide, circulating eosinophil counts, and serum eosinophil cationic protein were obtained at treatment discontinuation and after washout. Spirometry and a methacholine challenge were also performed according to the CAMP protocol. RESULTS: Ninety of 117 children provided an adequate sputum sample for analysis. In 9 subjects (3 nedocromil and 6 placebo), sputum induction resulted in bronchospasm. These subjects had greater disease severity, as measured by a lower median prebronchodilator FEV 1 percentage predicted (85.0% vs 96.0%; P =.024) and FEV 1 /FVC ratio (70.0% vs 79.0%; P =.0008); greater bronchodilator reversibility (16.5% vs 6.8%; P =.004); higher serum IgE (1390.0 vs 495.0 ng/mL; P =.017) and circulating eosinophil count (757.0 vs 282.0/mm 3; P =.04); greater use of prednisone (1.9 vs 0.9 courses per 100 person-years; P =.05); and greater supplemental inhaled steroid doses (85.3 vs 0 mg; P =.016). At treatment discontinuation, budesonide-treated patients had a lower median (1st, 3rd quartile) sputum percentage eosinophil (SPEos) (0.2% [0%, 1.2%] vs 0.8% [0.2%, 4.6%]; P =.03) compared with those treated with placebo; no significant difference was noted between nedocromil- and placebo-treated patients. Higher SPEos at the time of treatment discontinuation was associated with asthma worsening that required rescue prednisone (n = 23) during the washout period compared with patients who remained stable (3.6% [0.4%, 6.4%] vs 0.6% [0.2%, 3.2%] SPEos; P =.023). Finally, greater SPEos was associated with atopy, higher bronchodilator reversibility, lower FEV 1 /FVC ratio, higher exhaled nitric oxide levels, circulating eosinophils, sputum and serum eosinophil cationic protein, more prednisone courses during the treatment period, and greater asthma severity. CONCLUSIONS: Sputum induction is a relatively noninvasive and safe procedure that can provide information on eosinophilic inflammation and treatment response and is also associated with several measures of asthma control. However, this procedure still remains a research tool in asthma because of its requirements for technical expertise.

Minimizing attrition in a long-term clinical trial of pediatric asthma.

BACKGROUND: Despite increased attention focused on the need to prevent patient attrition in long-term clinical trials, high dropout rates have threatened the success of numerous studies. OBJECTIVE: To evaluate the disease, demographic, and psychological factors associated with missed visits and study dropout to help improve patient management in long-term clinical trials. METHODS: Predictors of attrition were examined within the Childhood Asthma Management Program (CAMP), a large, multicenter clinical trial that followed up 1,041 children with asthma for 4 to 6 years. RESULTS: Eighty-two percent of patients attended all study visits. The tendency to miss visits was increased among older children with milder asthma, lower intellectual and social competence, and more symptoms of behavioral problems and emotional distress. Forty-two patients who missed 3 or more visits in a row and did not attend the final visit were considered study dropouts; these patients at baseline had milder asthma; lower cognitive, academic, and social competence skills; and more family conflict and distress than found among participants who remained in the study. The 49 children who had erratic attendance but did not drop out also had lower intellectual and academic skills and less family social support. CONCLUSIONS: The 4% dropout rate in CAMP was lower than reported in any previous long-term asthma trial. The findings of milder disease, decreased psychological resources, and increased distress in problem-attendance patients can assist in identifying patients who are at risk for missed visits or dropout during the trial either to block their entry into the trial or to focus efforts at maintaining their attendance once enrolled in the trial.

Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma.

OBJECTIVE: Exhaled nitric oxide (FE(NO)) was evaluated in children with asthma after 4 to 6 years of treatment with budesonide, nedocromil, or albuterol as needed. STUDY DESIGN: FE(NO), spirometry, total eosinophil count, and serum eosinophil cationic protein levels were obtained from 118 children at the Denver site of the Childhood Asthma Management Program upon completion of treatment and after a 2- to 4-month washout. RESULTS: Budesonide-treated patients had significantly lower median (1st, 3rd quartile) FE(NO) (21.5 [13.2, 84.4] vs 62.5 [26.2, 115.0] ppb, P <.01) and eosinophil cationic protein levels (17.4 [10.1, 24.3] vs 24.0 [15.4, 33.9] mg/dL, P =.05) compared with placebo, whereas no differences were noted between nedocromil and placebo groups. After washout, FE(NO) levels were similar between the three treatments. FE(NO) levels significantly correlated with degree of bronchial hyperresponsiveness, bronchodilator reversibility, allergen skin prick tests, serum IgE, and total eosinophil count. FE(NO) levels were also higher in patients with nocturnal symptoms and in patients requiring beta-agonist use at least once weekly. CONCLUSIONS: Budesonide therapy was more effective than nedocromil in reducing FE(NO). Unfortunately, the effects of long-term budesonide were not sustained after its discontinuation. FE(NO) may be a complementary tool to current practice guidelines in assessing asthma control and medication response.

Serum ascorbic acid concentrations in previously unsupplemented greyhounds after administration of a single dose of ascorbic acid intravenously or per os.

Plasma vitamin C concentrations (mean + SD) were measured after a large (1 g) dose of vitamin C was administered orally or intravenously to each of four trained greyhounds in a randomized cross-over design. Concentrations increased (p<0.05) for 2 h but returned to baseline by 6 h after supplementation. Peak concentrations were greater (p<0.01) after intravenous than oral administration (6.1+/-1.2 vs. 0.54+/-0.23 mg/dl). This suggests that vitamin C must be administered many times daily to maintain plasma concentrations above normal.

Effect of alpha-tocopheryl acetate supplementation on vitamin E concentrations in Greyhounds before and after a race.

OBJECTIVES: To determine effect of alpha-tocopherol supplementation on serum vitamin E concentrations in Greyhounds before and after a race. ANIMALS: 8 adult racing Greyhounds. PROCEDURE: Dogs were given 2 capsules of alpha-tocopheryl acetate (total, 680 units [0.5 g]) with food that contained < or = 15 mg of vitamin E/kg each morning for 7 days. Dogs were exercised in a 30 X 30-m grass paddock for 15 minutes twice a day and raced for 500 m twice a week. Blood samples were collected before and 5 minutes after a race, before supplementation was begun, and after 7 days of supplementation. Blood and diet samples were analyzed for tocopherols and alpha-tocopheryl acetate. RESULTS: Before supplementation, serum alpha-tocopherol concentration after racing (mean +/- SD, 6.7 +/- 2.4 mg/L ) was significantly lower than before racing (12.2 +/- 3.1 mg/L). After supplementation, alpha-tocopherol concentrations were significantly higher overall, although values obtained before (26.6 +/- 5.2 mg/L) and after (29.8 +/- 3.6 mg/L) racing were not significantly different. CONCLUSIONS AND CLINICAL RELEVANCE: Supplementation with alpha-tocopheryl acetate increased serum alpha-tocopherol concentrations and eliminated the decrease in alpha-tocopherol concentration that was detected after a race, which may decrease oxidation during exercise and improve performance or recovery.

Effect of increased dietary protein and decreased dietary carbohydrate on performance and body composition in racing Greyhounds.

OBJECTIVE: To determine effects of increased dietary protein and decreased dietary carbohydrate on hematologic variables, body composition, and racing performance in Greyhounds. ANIMALS: 8 adult Greyhounds. PROCEDURE: Dogs were fed a high-protein (HP; 37% metabolizable-energy [ME] protein, 33% ME fat, 30% ME carbohydrate) or moderate-protein (MP; 24% ME protein, 33% ME fat, 43% ME carbohydrate) extruded diet for 11 weeks. Dogs subsequently were fed the other diet for 11 weeks (crossover design). Dogs raced a distance of 500 m twice weekly. Rectal temperature, hematologic variables before and after racing, plasma volume, total body water, body weight, average weekly food intake, and race times were measured at the end of each diet period. RESULTS: When dogs were fed the MP diet, compared with the HP diet, values (mean +/- SD) differed significantly for race time (32.43 +/- 0.48 vs 32.61 +/- 0.50 seconds), body weight (32.8 +/- 2.5 vs 32.2 +/- 2.9 kg), Hct before (56 +/- 4 vs 54 +/- 6%) and after (67 +/- 3 vs 64 +/- 8%) racing, and glucose (131 +/- 16 vs 151 +/- 27 mg/dl) and triglyceride (128 +/- 17 vs 104 +/- 28 mg/dl) concentrations after racing. CONCLUSIONS AND CLINICAL RELEVANCE: Greyhounds were 0.18 seconds slower (equivalent to 0.08 m/s or 2.6 m) over a distance of 500 m when fed a diet with increased protein and decreased carbohydrate. Improved performance attributed to feeding meat to racing Greyhounds apparently is not attributable to increased dietary protein and decreased dietary carbohydrate.

Effects of racing and training on serum thyroid hormone concentrations in racing Greyhounds.

OBJECTIVES: To determine the effects of racing and training on serum thyroxine (T4), triiodothyronine (T3), and thyroid stimulating hormone (TSH) concentrations in Greyhounds. ANIMALS: 9 adult racing Greyhounds. PROCEDURE: Serum thyroid hormone concentrations were measured before and 5 minutes after a race in dogs trained to race 500 m twice weekly for 6 months. Resting concentrations were measured again when these dogs had been neutered and had not raced for 3 months. Postrace concentrations were adjusted relative to albumin concentration to allow for effects of hemoconcentration. Thyroid hormone concentrations were then compared with those of clinically normal dogs of non-Greyhound breeds. RESULTS: When adjusted for hemoconcentration, total T4 concentrations increased significantly after racing and TSH concentrations decreased; however, there was no evidence of a change in free T4 or total or free T3 concentrations. Resting total T4 concentrations increased significantly when dogs had been neutered and were not in training. There was no evidence that training and neutering affected resting TSH, total or free T3, or free T4 concentrations. Resting concentrations of T3, TSH, and autoantibodies against T4, T3, and thyroglobulin were similar to those found in other breeds; however, resting free and total T4 concentrations were lower than those found in other breeds. CONCLUSIONS AND CLINICAL RELEVANCE: Except for total T4, thyroid hormone concentrations in Greyhounds are affected little by sprint racing and training. Greyhounds with low resting total and free T4 concentrations may not be hypothyroid.

Maintenance energy requirements and the effect of diet on performance of racing Greyhounds.

OBJECTIVES: To determine maintenance energy requirements and effect of diet on performance of racing Greyhounds. ANIMALS: 7 adult racing Greyhounds. PROCEDURE: Dogs were fed a higher fat and protein (HFP) or a lower fat and protein (LFP) diet for 8 weeks in a crossover design. Dogs were exercised for 15 minutes twice daily in a paddock and raced 500 m twice weekly. Blood gas, hematologic, and serum biochemical analyses were performed before and after racing, and race times were compared at the end of each diet period. RESULTS: Mean race time was significantly shorter (32.81+/-0.65 seconds vs. 33.05+/-0.71 seconds), and mean racing speed over 500 m was significantly faster (15.25+/-0.30 vs. 15.13+/-0.30 m x s(-1)) when dogs were fed the HFP diet than when they were fed the LFP diet. Diet had little or no effect on results of blood gas, hematologic, and serum biochemical analyses, except that Hct was 4% greater before and after racing when the HFP diet was fed than when the LFP diet was fed. Mean SD metabolizable energy intake from weeks 1 through 16 was 155+/-9 kcal x kg(-0.75) x d(-1). CONCLUSIONS AND CLINICAL RELEVANCE: Racing Greyhounds ran faster when fed a diet containing higher fat and protein and lower carbohydrate contents. Their maintenance metabolizable energy requirement was slightly higher than that of moderately active dogs.