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

Sexual life and dysfunction after maternal morbidity: A systematic review

© 2015 Andreucci et al. Background: Because there is a lack of knowledge on the long-term consequences of maternal morbidity/near miss episodes on women's sexual life and function we conducted a systematic review with the purpose of identifying the available evidence on any sexual impairment associated with complications from pregnancy and childbirth. Methods: Systematic review on aspects of women sexual life after any maternal morbidity and/or maternal near miss, during different time periods after delivery. The search was carried out until May 22nd, 2015 including studies published from 1995 to 2015. No language or study design restrictions were applied. Maternal morbidity as exposure was split into general or severe/near miss. Female sexual outcomes evaluated were dyspareunia, Female Sexual Function Index (FSFI) scores and time to resume sexual activity after childbirth. Qualitative syntheses for outcomes were provided whenever possible. Results: A total of 2,573 studies were initially identified, and 14 were included for analysis after standard selection procedures for systematic review. General morbidity was mainly related to major perineal injury (3rd or 4th degree laceration, 12 studies). A clear pattern for severity evaluation of maternal morbidity could not be distinguished, unless when a maternal near miss concept was used. Women experiencing maternal morbidity had more frequently dyspareunia and resumed sexual activity later, when compared to women without morbidity. There were no differences in FSFI scores between groups. Meta-analysis could not be performed, since included studies were too heterogeneous regarding study design, evaluation of exposure and/or outcome and time span. Conclusion: Investigation of long-term repercussions on women's sexual life aspects after maternal morbidity has been scarcely performed, however indicating worse outcomes for those experiencing morbidity. Further standardized evaluation of these conditions among maternal morbidity survivors may provide relevant information for clinical follow-up and reproductive planning for women

Troponin i perioperative trend in dogs undergoing the correction of patent ductus arteriosus : preliminary investigations

Troponin I concentration (cTnI) trend was analysed in 10 dogs undergoing the correction of patent ducts arteriosus (PDA). In 7 dogs an increased cTnI level within 24 hours from PDA closure was detected.It suggests that acute variation in left ventricle and aorta pressure and a left ventricle preload reduction, could damage myocardial cells and could cause cTnI release as consequence. cTnI was within normal values in 2 dogs, in 1 dog the highest level was found after 48 hour from PDA closure. Four dogs have already concluded the follow-up (6 months), normal cTnI levels were founded

Is it too early to recommend patent foramen ovale closure for all patients who suffer from migraine? A single-centre study

Purpose of review To evaluate the course of migraine in migraine headache patients undergoing patent foramen ovale (PFO) transcatheter closure. Background Migraine has an important impact on the quality of life, and it seems to be one of the most disabling medical illnesses. In several studies, a high prevalence of right-to-left shunt has been described in patients with migraine, especially migraine with aura. The presence of right-to-left shunt, whatever the mechanism, may be the most potent trigger of migraine attacks in both migraine with aura and migraine without aura and the main determinant of aura in migraine with aura. Methods A cohort of 42 patients (nine men/33 women; mean age 39W11.2 years), current migraineurs, underwent PFO percutaneous closure in our centre between January 2004 and December 2007. All patients rated the severity of their migraine preoperatively and 6 months postoperatively, indicating the frequency, duration, and intensity of the attacks and the occurrence of the aura in the prodromal phase, during the past 6 months, according to the migraine severity score. Results Baseline severity of migraine was higher in migraine with aura patients than in migraine without aura ones (8.8 vs. 7.5; PU0.037). The resolution of migraine was verified in 11 patients (26%) after the closure of the PFO. A reduction in the frequency of the attacks (>\u2013 50%) wa

Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta in dogs

Background: quantitative and semi-quantitative methods have been proposed for the assessment of MR severity, although all are associated with limitations. Measurement of vena contracta width (VCW) has been used in clinical practice. Objective: To measure the VCW in dogs with different levels of MR severity Animals: 279 dogs were classified according to five levels of MR severity . Methods: This was a retrospective study. EROA and regurgitant volume calculated by the PISA method, were measured and indexed to BSA. Descriptive statistic were calculated for VCW and VCW index for all categories of MR severity. Spearman\u2019s rank correlation coefficients (\u3c1s) were calculated to compare the results of the different methods (VCW and VCW index vs RV PISA, RV PISA index, EROA, EROA index), and between VCW and VCW index vs MR severity. Results: All Spearman\u2019s rank correlation coefficients were significant (p<0.001). The median values of VCW resulted of 2.9 mm (IQR 3.4-2.5) and of 4.6 mm (IQR 5.4-4.1) in the groups previously classified as mild-to-moderate and moderate-to-severe respectively. The median values of VCW index resulted of 4.4 mm/m2 (IQR=5.5-4.2) in mild-to-moderate MR and of 10.8 mm/m2 (IQR=12.8-9.4) in moderate-to-severe MR. Conclusion and Clinical Importance: This is not a validation study against any previously validated invasive gold standard, the VCW method has proved easy to employ and it might be an additional tool in quantifying disease severity, that supports, rather than replace, data coming from other techniques in daily clinical practice and research