3 research outputs found
The impact of cuff size and the presence of medical staff during blood pressure measurement in dogs : evaluated by HDO-dedicated software
SAMMANFATTNING
VidhĂ„llandet av normalt blodtryck Ă€r en essentiell funktion hos bĂ„de mĂ€nniskor och djur. BlodtrycksmĂ€tning pĂ„ djur utförs idag mer Ă€n nĂ„gonsin men att diagnostisera ett sant avvikande vĂ€rde Ă€r inte helt enkelt. Den sĂ„ kallade âwhite-coat-effektenâ (WCE) kan orsaka ett högt blodtryck p.g.a. exempelvis stress. I litteraturen framkommer att Ă€ven kuffstorlek Ă€r vĂ€sentlig vid indirekt blodtrycksmĂ€tning. Ett mĂ„l med studien var att se om en WCE kan minskas genom att djurĂ€garen fĂ„r mĂ€ta blodtrycket ensam i rummet. Ett annat syfte med studien var att undersöka om det föreligger en skillnad mellan mĂ€tvĂ€rden dĂ„ tvĂ„ olika kuffstorlekar anvĂ€nds, tillhörande senaste tekniken inom oscillometri, high definition oscillometry (HDO). Vid alla blodtrycksmĂ€tningar sammankopplades HDO-systemet med en tillhörande mjukvara för att utvĂ€rdera dess anvĂ€ndarvĂ€nlighet.
I studien medverkade totalt 31 hundar. Blodtrycket mÀttes i tre omgÄngar hos varje hund. Operatören anvÀnde tvÄ olika kuffstorlekar i tvÄ omgÄngar och djurÀgaren mÀtte blodtrycket ensam en omgÄng. Ett blodtrycksmedelvÀrde berÀknades vid varje mÀtomgÄng, utifrÄn de fem mest trovÀrdiga mÀtvÀrdena.
Resultatet visade att den större och bredare kuffen uppmÀtte ett signifikant lÀgre tryck med en genomsnittlig skillnad pÄ 6,8 mmHg. Hundarnas blodtryck var signifikant lÀgre dÄ djurÀgaren mÀtte det ensam. Den genomsnittliga skillnaden var 5,8 mmHg. Vid 79 av 82 mÀtomgÄngar registrerade mjukvaran mÀtningarna. Nya blodtrycksmedelvÀrden, som berÀknades utifrÄn analys av mjukvaran, jÀmfördes med de medelvÀrden som berÀknats innan mjukvaran anvÀndes till hjÀlp. Vid fem av 79 mÀtomgÄngar (6 %) översteg skillnaden i berÀknat medelvÀrde 10 mmHg. Dessa fall Àr dÀrmed av möjlig klinisk betydelse.
UtifrÄn studiens resultat drogs slutsatserna att valet av kuffstorlek vid blodtrycksmÀtning med HDO hos hund troligen inte spelar nÄgon avgörande roll för bedömning av patienten. Det kan vara fördelaktigt att lÄta djurÀgaren mÀta blodtrycket sjÀlv pÄ sin hund för att minska en eventuell WCE. Det Àr sannolikt inte alltid nödvÀndigt att rutinmÀssigt anvÀnda mjukvaran vid en blodtrycksmÀtning för avgöra om mÀtningen Àr korrekt samt överensstÀmmande med verkligheten. Mjukvaran kan dock bidra med kompletterande information i specifika fall, till exempel vid tidsbrist eller hos djur som har svÄrt att vara stilla.SUMMARY
Maintenance of normal blood pressure is an essential function in both humans and animals. Blood pressure measurement is today practiced more than ever in animals but, it can be difficult to diagnose a true abnormal value. The so called âwhite coat effectâ (WCE) can cause a high blood pressure due to stress/anxiety. According to previous studies, cuff size is essential during indirect blood pressure measurement. One purpose of this study was to evaluate if a WCE can be reduced by having the owner measure their dogsâ blood pressure alone in the room. Another purpose of the study was to investigate if there was a significant difference in the measured blood pressure when using two different cuff sizes belonging to the latest oscillometric system, high definition oscillometry (HDO). During each measurement the HDO was connected to a software in order to evaluate its user friendliness.
In total, 31 dogs were included in the study. Blood pressure was measured in three sets in each dog. Medical staff were using two different cuff sizes in two sets and one third set were performed by the owner alone. During each set of measuring, a mean blood pressure value was calculated using the five most reliable values.
Use of the larger and wider cuff resulted in a significantly lower blood pressure with a mean difference of 6,8 mmHg. A significantly lower blood pressure was also obtained when the owner measured alone. The mean difference was 5,8 mmHg. In total, 79 out of 82 measuring sets were recorded by the software. The mean blood pressure values that were calculated, from each measuring set, both before and after analysis of the software, were compared to each other. In five out of 79 measuring sets (6 %), the difference in calculated mean blood pressure exceeded 10 mmHg, which may potentially be of clinical importance.
According to this study, the cuff size when using HDO for blood pressure measurement in dogs probably has little impact on the evaluation of the patient. A suspected WCE can be decreased by allowing the owner to measure the blood pressure alone in the room. The use of HDO-software is probably not always essential in order to decide whether blood pressure measurements are correctly performed by the HDO. The software can, however, contribute with valuable information in some specifi
Chromogranin A
SAMMANFATTNING
För att fÄ fram en prognos nÀr ett djur uppsöker vÄrd finns det idag olika metoder. Inga Àr dock perfekta och dÀrför forskas det pÄ biomarkörer som ska kunna berÀtta mer om en individs allmÀntillstÄnd. En biomarkör ska objektivt fungera som en indikator för normala biologiska processer, patogena processer eller farmakologiska responser efter en terapeutisk ÄtgÀrd. Chromogranin A (CgA) Àr en molekyl vars egenskaper och funktion undersökts mycket, bland annat dess potential som biomarkör vid olika tillstÄnd. FÄ djurstudier finns men humanstudier demonstrerar att CgA-koncentrationer exempelvis ökar vid olika sjukdomstillstÄnd; sÄsom hjÀrtsjukdomar, brÀnnskador och hos patienter med neuroendokrina tumörer. Vidare ses förhöjda koncentrationer Àven vid andra tillstÄnd; sÄsom högintensiv trÀning och psykologisk stress. Syftet med denna litteraturstudie Àr dÀrför att undersöka CgA:s egenskaper och funktion. Det ska Àven utredas vid vilka situationer CgA-koncentrationer ökar och vad detta kan indikera. Har CgA potential som en prognostisk biomarkör och gÀller det i sÄ fall Àven hos hund?
Chromogranin A upptÀcktes Är 1967 och ingÄr i familjen Graniner som Àr en grupp sura, lösliga och sekretoriska proteiner. CgA finns i neuroendokrina celler i hela kroppen varifrÄn den frisÀtts genom exocytos tillsammans med respektive vÀvnads hormon/er eller verksamma substanser. Detta gÀller Àven för hund och hos dem har man, som hos mÀnniska, Àven funnit att neuroendokrina tumörer innehÄller CgA.
Chromogranin A frisĂ€tts bland annat frĂ„n sympatiska nervĂ€ndar och chromaffinceller i binjuremĂ€rgen tillsammans med adrenalin och noradrenalin. Dessa Ă€r transmittorsubstanser i sympatiska nervsystemet (SNS) som aktiveras vid sĂ„ kallade âfright-fight-flight-situationerâ. I flera studier ses förhöjda CgA-koncentrationer i takt med ökad sympatikusaktivitet, som vid hjĂ€rtstillestĂ„nd, hypoglykemi (Ă€ven hund) eller psykologisk stress, vilket tyder pĂ„ att CgA kan fungera som ett mĂ„tt pĂ„ sympatisk aktivitet. Denna koncentrationsökning Ă€r Ă€ven nĂ„got som kan pĂ„verka resultaten vid mĂ€tning av CgA-koncentrationer vid andra tillstĂ„nd. Hos patienter med neuroendokrina tumörer ses Ă€ven allmĂ€nt förhöjda CgA-koncentrationer. Dessutom har förhöjda koncentrationer Chromogranin A visats kunna ge en prognos angĂ„ende tumörstorlek samt om metastasering skett hos patienter med neuroendokrina tumörer. Utöver detta har CgA Ă€ven kopplats samman med mortalitet och sĂ€mre prognos hos hjĂ€rtsjuka samt allvarligt sjuka patienter.
Hos mÀnniska verkar alltsÄ CgA besitta mÄnga av de egenskaper som definierar en biomarkör och har dessutom uppvisat potential som en prognostisk sÄdan vid olika tillstÄnd. Molekylen Àr dessutom stabil och kan mÀtas i blod eller saliv hos bÄde mÀnniska och hund. Det finns Àven studier som talar för att hundars CgA pÄ flera sÀtt liknar mÀnniskans. Men trots de mÄnga humanstudier som talar för CgA:s potential som prognostisk biomarkör kan inga paralleller dras till hund. För detta krÀvs mer forskning och dÀrmed klara bevis avseende just denna art. För att ha klinisk betydelse Àr det Àven viktigt att utreda huruvida CgA tillför nÄgot mer Àn de idag vedertagna prognostiska hjÀlpmedlen.SUMMARY
Today there are several possible methods to rapidly assess a prognosis when an animal is ill. However, none of these methods are perfect which is why scientists are constantly looking for biomarkers capable of telling us more about an individualâs general condition. A biomarker should objectively work as an indicator for normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. Chromogranin A is a molecule whose properties and functions has been investigated extensively, for example its potential as a biomarker. There are few animal studies done, however, human studies has shown that CgA-concentrations increase at several medical conditions; e.g. heart diseases, burn injuries and patients with neuroendocrine tumours. Moreover, CgA is elevated in other situations as well; for example high-intensity exercise and psychological stress. Therefore, the purpose of this study is to investigate CgA:s properties and function. Moreover, to analyse in which situations CgA is elevated and what this could indicate. Does CgA have the potential of a prognostic biomarker and, in that case, does this also apply for dogs?
Chromogranin A was found in 1967 and is a member of the Granin family, a group of acidic, soluble secretory proteins. CgA is distributed in neuroendocrine cells from which it is secreted by exocytosis together with hormones of that tissue. The same is true for dogs and studies has shown that neuroendocrine tumours of dogs, as in humans, contain CgA.
For instance, CgA is released from sympathetic nerve endings and chromaffin cells in the adrenal medulla along with epinephrine and norepinephrine. These are transmitter substances in the sympathetic nervous system (SNS) which is activated in so-called âfright-fight-flight-situationsâ. In several studies CgA-concentrations are elevated along with increased sympathetic activity; e.g. in cardiac arrest, hypoglycemia or psychological stress, which suggests that CgA could be an indicator of sympathetic activity. Something to consider about this increase is that it could interfere with the results when measuring CgA for other reasons. In patients with neuroendocrine neoplasia CgA is also elevated in general. Furthermore, elevated concentrations of CgA has been able to give a prognosis regarding tumour size and if metastasis occur in patients with neuroendocrine tumours. Moreover, CgA have been associated with mortality and poor prognosis in patients with heart diseases and severely ill patients.
In humans CgA seems to possess many features defining a biomarker and has also presented potential as a prognostic biomarker in several situations. This molecule is stable and measurable in blood or saliva in both humans and dogs. There are also studies demonstrating several similarities between human and canine CgA. However, even though CgA has a potential as a prognostic biomarker in humans, this cannot yet be said for dogs. More research and consequently evidence considering dogs and their CgA are required first. Another important question to be answered is whether CgA contributes to something more than the traditional prognostic methods already do
Impact of equipment and handling on systolic blood pressure measurements in conscious dogs in an animal hospital environment
Background Situational hypertension and differences between devices complicate interpretations of systolic blood pressure (SBP) measurements in dogs.Hypothesis/Objectives To evaluate if time point of in-clinic SBP measurement, type of oscillometric device, and operator affect SBP measurements in conscious dogs.Animals Sixty-seven privately owned dogs with or without chronic kidney disease, divided into 2 study samples (A and B).Methods Cross-sectional diagnostic study. In part A, SBP measurements in dogs were performed using 2 different devices (HDO and petMap) after acclimatization at 3 standardized time points during a clinical visit. In part B, SBP measurements (HDO) were performed in dogs by a trained final year veterinary student and by the owner alone, at the same occasion.Results For all dogs, there was no difference in mean SBP (mSBP) among the 3 time points for HDO (P = .12) or petMAP (P = .67). However, intraindividual mSBP differences of up to 60 mm Hg between time points were documented. Mean SBP obtained with petMAP was on average 14 (95% CI: 8-20) mm Hg higher than mSBP obtained with HDO, and this difference increased with increasing SBP. Mean SBP measurements obtained by the trained student were 7 (95% CI: 2-11) mm Hg higher than mSBP measurements obtained by the owner.Conclusions and Clinical Importance According to the results of this study, time point of in-clinic SBP measurement in dogs is of minor importance, and instructing owners to perform measurements might reduce suspected situational hypertension. Differences in mSBP measured with HDO and petMAP underscore the need for validation of BP devices used clinically