Red Blood Cell Distribution Width, Hematology, and Serum Biochemistry in Dogs with Echocardiographically Estimated Precapillary and Postcapillary Pulmonary Arterial Hypertension

Background: Red blood cell distribution width (RDW) is a quantitative measurement of anisocytosis. RDW has prognostic value in humans with different cardiovascular and systemic disorders, but few studies have investigated this biomarker in dogs. Objectives: To compare the RDW in dogs with precapillary and postcapillary pulmonary hypertension (PH) and a control population of dogs and to correlate RDW with demographic, echocardiographic, and laboratory variables. Animals: One hundred and twenty-seven client-owned dogs including 19 healthy dogs, 82 dogs with myxomatous mitral valve disease (50 dogs without PH and 32 dogs with postcapillary PH), and 26 dogs with precapillary PH. Methods: Prospective study. Dogs were allocated to groups according to clinical and echocardiographic evaluation. RDW and selected laboratory and echocardiographic variables were compared among dog groups. Associations between RDW and demographic, laboratory, and echocardiographic variables were analyzed using correlation and multiple regression analysis. Results: Median RDW in dogs with precapillary PH (13.8%, interquartile range 13.2\ue2\u80\u9314.9%) and postcapillary PH (13.7, 13.2\ue2\u80\u9314.7%) was significantly increased compared to healthy dogs (13.3, 12.3\ue2\u80\u9313.7%; P <.05 for both comparisons), but only dogs with severe PH had significantly increased RDW compared to dogs without PH (P <.05). Peak tricuspid regurgitation pressure gradient was significantly associated with increased RDW (rho = 0.263, P =.007). Serum urea concentration, hematocrit, age, and white blood cell number were significantly associated with RDW in the multivariate analysis. Conclusions and Clinical Importance: Underlying pathophysiologic processes associated with PH instead of severity of PH are likely responsible for increased RDW in dogs with PH

Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement

OBJECTIVES There is a growing understanding of the complexity of interplay between renal and cardiovascular systems in both health and disease. The medical profession has adopted the term "cardiorenal syndrome" (CRS) to describe the pathophysiological relationship between the kidney and heart in disease. CRS has yet to be formally defined and described by the veterinary profession and its existence and importance in dogs and cats warrant investigation. The CRS Consensus Group, comprising nine veterinary cardiologists and seven nephrologists from Europe and North America, sought to achieve consensus around the definition, pathophysiology, diagnosis and management of dogs and cats with "cardiovascular-renal disorders" (CvRD). To this end, the Delphi formal methodology for defining/building consensus and defining guidelines was utilised. METHODS Following a literature review, 13 candidate statements regarding CvRD in dogs and cats were tested for consensus, using a modified Delphi method. As a new area of interest, well-designed studies, specific to CRS/CvRD, are lacking, particularly in dogs and cats. Hence, while scientific justification of all the recommendations was sought and used when available, recommendations were largely reliant on theory, expert opinion, small clinical studies and extrapolation from data derived from other species. RESULTS Of the 13 statements, 11 achieved consensus and 2 did not. The modified Delphi approach worked well to achieve consensus in an objective manner and to develop initial guidelines for CvRD. DISCUSSION The resultant manuscript describes consensus statements for the definition, classification, diagnosis and management strategies for veterinary patients with CvRD, with an emphasis on the pathological interplay between the two organ systems. By formulating consensus statements regarding CvRD in veterinary medicine, the authors hope to stimulate interest in and advancement of the understanding and management of CvRD in dogs and cats. The use of a formalised method for consensus and guideline development should be considered for other topics in veterinary medicine

Expression of Fibroblast Activation Protein in lungs of dogs with idiopathic pulmonary fibrosis and dogs with lung cancer

peer reviewedCanine Idiopathic Pulmonary Fibrosis (CIPF) is a progressive fibrotic interstitial lung disease of unknown aetiology, affecting predominantly the West Highland White Terrier (WHWT) breed. Currently, there is no curative treatment option available. Fibroblast Activation Protein (FAP) is a cell surface protease usually absent from normal tissue but specifically expressed in areas of active tissue remodelling such as in fibroblast foci in human idiopathic pulmonary fibrosis. In humans, it is also upregulated in various types of cancers, either in cancer-associated fibroblasts (CAFs), in cancer cells or in both, depending on the tumour type. The aim of this study was to assess the expression and localization of FAP in the lungs of WHWTs affected with CIPF, in comparison with WHWTs with healthy lungs and dogs with lung cancer. Post-mortem formalin-fixed lung biopsies prepared from WHWTs with CIPF (n=17, age from 10 to 15y), control WHWTs exempt from lung disease (n=4, age from 11 to 15y) and dogs from various breeds with lung cancer (n=8, age from 8 to 14y) were retrospectively used. Included lung neoplasia were adenocarcinomas (n=6), histiocytic sarcoma (n=1) and metastasized mammary adenocarcinoma (n=1). Immunohistochemistry (IHC) was performed using a rabbit anti-human FAP monoclonal antibody (#ab207178). An IHC staining index (absent, low, moderate or high) was attributed according to the percentage of positive cells combined with the staining intensity. FAP was identified in the lungs of 16 out of 17 (94%) WHWTs with CIPF (IHC index high, moderate, or low in respectively 10, 4 and 2 dogs), 2 out of 4 (50%) WHWTs with healthy lungs (1 of each moderate and low), and 7 out of 8 (88%) dogs with lung cancer (high and moderate in respectively 6 and 1 dogs). FAP was expressed by fibroblasts in areas of active fibrosis in CIPF and by CAFs (all types of cancer) and cancer cells (adenocarcinomas only, n=5) in lung tumours. Results of this study showed that FAP is moderately to markedly expressed by fibroblasts in most dogs affected with either CIPF or lung cancer. Accordingly, FAP should be considered as an interesting potential therapeutic target for both diseases and should encourage further studies in the future. The expression of FAP in healthy lungs of WHWTs should be further investigated, particularly in comparison with FAP expression in dogs from other breeds, as it might serve as an indicator of early fibrosis

Serum 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D in dogs with sinonasal aspergillosis

peer reviewedSinonasal aspergillosis (SNA) is a common cause of chronic nasal disease with a still poorly understood pathophysiology and which remains a challenge to treat. There is increasing evidence that vitamin D plays a role in both innate and adaptative immunity. A preliminary retrospective study showed that serum 25-hydroxyvitamin D concentration, measured by high performance liquid chromatography (HPLC), was significantly lower in dogs affected with SNA compared to healthy dogs. Objectives of this prospective study were 1) to compare serum 25(OH)D and 24,25(OH)2D concentrations in dogs with SNA to healthy control dogs and dogs with lymphoplasmacytic rhinitis (LPR) or nasal neoplasia; and 2) to determine if serum 25(OH)D and 24,25(OH)2D concentrations in dogs with SNA change from the time of diagnosis to when a cure is achieved. Twenty dogs with a novel diagnosis of SNA, 12 healthy control dogs, 9 dogs with LPR, 10 dogs with nasal neoplasia were included. Nine dogs with SNA were available for follow up until cure. Serum vitamin D concentrations were measured by liquid chromatography tandem mass spectrometry (LC-MS/MS) and compared: 1) among the different groups using a One-way ANOVA and 2) from diagnosis to cure with a paired t-test (significant p-value <0,05 for both tests). The vitamin D metabolite ratio (VMR) was calculated by dividing the 25(OH)D by the 24,25(OH)2D concentration. Serum 25(OH)D and 24,25(OH)2D were lower in dogs with SNA at the time of diagnosis (mean ± standard deviation = 23.5 ± 7,1 ng/ml – 10,5 ± 4,2 ng/ml, respectively) than in healthy dogs (34,1 ± 7,5 ng/ml; p=0,017 - 18,2 ± 5.4 ng/ml; p = 0,005) while there was no difference between healthy and dogs with tumor (27,8 ± 10,9 ng/ml – 15,4 ± 6,5 ng/ml) or LPR (27,4 ± 13,7 ng/ml – 14,3 ± 8,7 ng/ml). There was no significant difference in serum 25(OH)D and 24,25(OH)2D between dogs with SNA at the time of diagnosis and dogs achieving cure. The VMR was higher in SNA dogs (2,4 ± 0,7) than in control dogs (1,9 ± 0,3; p=0,031 t-test), indicating a decreased catabolic clearance of vitamin D in SNA dogs. These results further support the rationale that vitamin D could play a role in dogs with SNA as it does in human with aspergillosis. Whether hypovitaminosis D could contribute to the development of SNA or if oral supplementation could be a beneficial adjunctive therapy in affected dogs is unknown and warrants future investigations

Use of two-dimensional speckle tracking echocardiography to assess left ventricular systolic function in dogs with systemic inflammatory response syndrome

SIRS is a clinical syndrome caused by systemic inflammation of infectious or non-infectious origin. SIRS is characterized by an endogenous cascade of interleukins and others inflammatory mediators such as TNF-α IL-6 and IL-1 which are responsible to the myocardial depression during systemic inflammation. Conventional echocardiographic indices of LV systolic function such as Fractional Shortening (FS%) and Ejection Fraction (EF%) are not sensitive enough to detect mild or early systolic dysfunction in dogs suffering from SIRS. Speckle-Tracking Echocardiography (STE) is a new echocardiographic technique that allows an objective and quantitative evaluation of global and regional myocardial function through the analysis of the motion of speckles that are created by the interaction of ultrasonic beams and the myocardium during the 2D exam. In the present study we tested the hypothesis that 2D-STE may detect LV systolic dysfunction, not diagnosed by conventional echocardiography, in dogs with SIRS. 17 dogs with evidence of SIRS and 17 healthy dogs as a control group were included in this prospective study. At the time of Veterinary Teaching Hospital admission each dog was submitted to standard 2D, M-mode, Doppler and 2D Speckle Tracking echocardiography to assess systolic function. Furthermore, blood samples were obtained for the measurements of cTnI and CRP serum levels. To assess the intraobserver within-day and between-day variability of the 2D-STE acquisition and measurements we performed a study of variability on 5 healthy dogs belonging to the control group. The results showed that the 2D-STE had low intraobserver variability and that the LV Global Longitudinal Peak Strain of endomyocardial layer (ENDO GLPS) and the STE-derived Ejection Fraction (EF%) were lower in the SIRS group than in the control group. On the contrary, standard 2D and M-Mode indices of systolic function such as EF%, FS% weren’t significantly different between the two groups. We didn’t find significant correlation between CRP serum levels and 2D-STE variables and between cTnI and ENDO GLPS. Our study demonstrated that 2D-STE was more sensitive than standard echocardiography in detecting early or mild to moderate myocardial dysfunction, not detected by conventional echocardiography, in a population of dogs with SIRS

Thoracic radiography and oxidative stress indices in heartworm affected dogs

Aim: The aim was to study the pathomorphological changes through thoracic radiography and status of oxidative stress parameters in heartworm affected dogs in Odisha. Materials and Methods: A total of 16 dogs with clinically established diagnosis of dirofilariasis by wet blood smear and modified Knott’s test and equal numbers of dogs as control were included in this study. The present study was conducted in heartworm affected dogs to see the pathomorphological changes through thoracic radiography. Similarly, the evaluation was undertaken for observing any alterations in oxidative stress status in affected as well as non-affected, but healthy control dogs by adopting standard procedure. Results: Thoracic radiography revealed cardiac enlargement, round heart appearance suggestive of right ventricular hypertrophy, tortuous pulmonary artery and darkening of lungs. Alterations in oxidative stress indices showed a significant rise of lipid peroxidase activity, non-significant rise of superoxide dismutase and a significant although reverse trend for catalase levels in affected dogs in comparison to Dirofilaria negative control but apparently healthy dogs. Conclusions: Radiographic changes, as well as alterations in oxidative stress parameters, may not be diagnostic for heartworm infection, but useful for detecting heartworm disease, assessing severity and evaluating cardiopulmonary parenchyma changes and gives a fair idea about the degree of severity of the disease. It aids as contributing factors in disease pathogenesis

Use of the short form glasgow composite measure pain scale in the assessment of canine patients presenting in shock

Dissertação de Mestrado Integrado em Medicina VeterináriaThe short form of Glasgow Composite Measure Pain Scale (CMPS-SF), a previously validated decision-making tool is increasingly used in practice for the assessment of pain in dogs. However, few studies have considered the application of a pain scoring system in patients presenting in emergency situations. This study aimed to evaluate if pain scoring with the Glasgow CMPS-SF was effective in identifying pain in patients in shock. A prospective study (November 2014 to January 2015), within a first opinion and specialty intensive care service was developed. A total of 31 client-owned dogs (16 females and 15 males) that presented as primary emergencies or transfers. When admitted to the study, all dogs were examined by a veterinarian or registered veterinary nurse. Patients were classified and grouped as Shock (S) or Not Shock (NS) on basis of their shock index (SI). The shock status was defined a priori if the SI was higher than 1.0. Regardless of group, all patients had their pain assessed with the Glasgow CMPS-SF and by a Board Eligible Internist or a Emergency and Critical Care specialist, blinded to both pain score and SI values. Dogs in shock numbered 18/31 dogs within the not shock group numbered 13/31. Mean age of dogs in the S group was 4.6 years (0.2 – 10) and in the NS group was 8.3 years (1 – 16); a significant difference existed in age between groups (p-value<0.05). Median pain score of the S group was 5 (0 – 17) and on the NS group was 3 (1 – 15). There was no significant difference on pain scores between the groups (p-value>0.05) and between the clinicians’ perception of pain between groups (p-value>0.05). A significant difference was present between pain scores and the clinicians’ opinion on pain (p-value=0.014), including within the shock group (p-value=0.0021). Cohen’s kappa statistic within the shock group was 0.47, which can be interpreted as weak to moderate agreement between the Glasgow CMPS-SF and the clinician opinion on pain. Within the NS group the differences between the pain scores and the clinician’ opinion on pain were not statistically significant (p-value>0.05). These results do not support an acceptable agreement between the Glasgow CMPS-SF and an experienced veterinarians evaluation of pain in patients presenting in shock. Therefore, further investigation into the relevance of the used pain assessment tool in emergency and shock patients is recommended before use in the objective monitoring of this subset of patients.RESUMO - USO DA FORMA ABREVIADA DA ESCALA COMPOSTA DA DOR DE GLASGOW EM CÃES COM APRESENTAÇÃO DE CHOQUE - O reconhecimento e avaliação de dor em doentes veterinários pode ser desafiante, especialmente nos que se encontram em estado crítico. A já validada forma abreviada da Escala Composta da Dor de Glasgow (CMPS-SF) é, cada vez, mais utilizada em ambiente clínico na avaliação da dor aguda em cães. Contudo, poucos estudos têm considerado a aplicação de um sistema de avaliação de dor em doentes que se apresentam em situação de emergência. Foi desenvolvido um estudo experimental com o propósito de avaliar se a pontuação obtida com a CMPS-SF seria capaz de identificar dor em doentes que se apresentassem em choque. O estudo prospetivo desenvolveu-se numa clínica de primeira opinião e com serviço de cuidados intensivos (entre Novembro de 2014 e Janeiro de 2015). Foram incluídos no estudo 31 cães, admitidos em situação de emergência ou como referências, tendo sido examinados por um médico veterinário ou uma enfermeira veterinária. Os doentes foram classificados como estando em choque (S) ou não (NS) com base no seu índice de choque (IC). O estado de choque foi definido quando IC>1.0. Todos os doentes foram avaliados quanto à dor pela utilização da CMPS-SF e através de um exame físico realizado por um candidato a Internista ou um especialista em Emergências e Cuidados Intensivos, desconhecedores da pontuação obtida com a escala de CMPS-SF e do IC. O nível de significância estabelecido foi de 0.05. O grupo de cães em choque incluiu 18 cães e o grupo de não choque incluiu 13. A idade média dos animais no grupo S foi de 4.6 anos e no grupo NS foi de 8.3. As diferenças de idade observadas entre os grupos foram consideradas estatisticamente significativas (pvalue< 0.05). A pontuação média de dor no grupo S foi 5 e no grupo N.S. foi 3. As diferenças observadas na pontuação de dor entre os dois grupos grupos não foi considerada significativa (p-value>0.05). A perceção da dor pelos médicos veterinários nos dois grupos também não foi considerada significativa (p-value>0.05). Considerou-se significativa a diferença observada entre as pontuações de dor e a perceção de dor dos médicos veterinários (p-value=0.014), incluíndo no grupo S (p-value=0.0021). No grupo S, a concordância entre métodos foi de 0.47, interpretada como fraca a moderada. Face aos resultados obtidos, sugerem-se mais estudos relativos à precisão da utilização de escalas de dor em doentes que se apresentem em emergência e em condições de choque, antes que estas escalas possam ser recomendadas neste tipo de doentes