Cholestyramine treatment in two dogs with presumptive bile acid diarrhoea: a case report

Background: In people, bile acid diarrhoea is a prevalent complication of Crohn’s disease and diarrhoea- associated irritable bowel syndrome. Affected patients typically respond to bile acid sequestrants, such as cholestyramine, but human gastroenterologists often fail to recognize bile acid diarrhoea. Consequently, bile acid diarrhoea is regarded as an underrecognized and undertreated condition in human medicine. Due to lack of diagnostic tools, clinical response to bile acid sequestrants is often used to confirm a diagnosis of bile acid diarrhoea in people. Several recent studies have shown that bile acid dysmetabolism also occurs in dogs with chronic enteropathies. It has further been shown that dogs with chronic enteropathies have significantly decreased expression of a bile acid transport protein in the ileum compared to healthy dogs, which correlates with faecal bile acid dysmetabolism. Consequently, in spite of the lack of reports in the literature, bile acid diarrhoea is likely to exist in dogs as well. Case descriptions: Two dogs, an 8-year old Rottweiler and a 4.5-year old Siberian Husky were evaluated for chronic watery diarrhoea. Neither dog responded to dietary trials, probiotics, cyclosporine, faecal microbial transplantations or metronidazole. One of the dogs responded to high daily doses of corticosteroids, which were however associated with unacceptable side effects. The other dog was refractory to all standard treatment protocols, including cyclosporine and corticosteroids. Since none of the dogs responded satisfactorily to standard treatment or modulation of the intestinal microbiome, a suspicion of possible bile acid diarrhoea was raised. Treatment with cholestyramine, a bile acid sequestrant was initiated and resulted in marked improvement of faecal consistency, frequency of defecation and activity level in both dogs. Conclusion: This report presents two dogs with presumed bile acid diarrhoea that were successfully treated with cholestyramine. Therefore, bile acid diarrhoea should be considered as a possible diagnosis in dogs with treatment-refractory chronic diarrhoea. Keywords: Bile acids, Diarrhoea, Dog, CholestyraminePeer reviewe

Investment Decisions by Individuals and Groups in \u27Sunk Cost\u27 Situations: The Potential Impact of Shared Representations

Past research has shown that individuals prefer to continue investing resources into a failing endeavor once a considerable investment has been made, even when abandoning the project would be more rational economically. This phenomenon has been labeled the sunk cost effect (Arkes & Blumer, 1985). Since investment decisions are often made by groups, we compared individual and group propensities for falling prey to the sunk cost effect. we also varied whether or not individuals and groups needed to justify their investment decision to a superior. Both individuals and groups showed the sunk cost effect. Group process analyses showed that error-prone majorities were more powerful than more rational minorities. In addition, group decisions seemed to be a function of two competing task representations--one favoring the sunk cost interpretation and the other favoring economic rationality

Sprachliche Integration: mittelalterliche Ortsnamen im Kontaktgebiet des Kantons St. Gallen

The article deals with toponyms in the canton of St. Gallen in Switzerland with regard to language contact. Since the emergence of the Romance language in late antiquity (3rd-6th century AD) and until the Germanisation in the early Middle Ages (ca. from the 9th century until ca. the 14th century) St. Gallen has functioned in an interaction of two languages: Old Romansh and Old High German. This sequence can still be identified in a considerable number of toponyms. Here we want, first, to show how Romansh toponyms were transferred to Swiss German and, second, to discuss the methodological challenges facing toponymists when dealing with names in contact areas. Based on the categorization of Nicolaisen (1996) various types of adaptational processes such as translations, analogical re-formation and re-interpretation are illustrated and discussed using names and historical name data from the database «Flurnamen des Kantons St. Gallen». Two important categories in this regard are phonological adaptation and morphological translation. Finally, the study offers an insight into how toponomastics in an ancient contact area can help to reconstruct an extinct language, i.e. Old Romansh.

Caregivers’ Incongruence: Emotional Strain in Caring For Persons With Stroke

Purpose:Guided by Friedemann\u27s framework, the purpose of this study was to examine the dimensions of new family caregivers’ emotional strain in caring for persons with stroke. Method: Seventy-three caregivers who were new to that role participated in an interview every 2 weeks for a year as part of a NIH project. Of these caregivers, 36 participants were randomly assigned and had access to a Web-based intervention and its e-mail discussion. In this secondary data analysis, 2,148 e-mail discussion messages plus 2,455 narrative interview entries were used to examine dimensions of caregivers’ emotional strain. Rigorous content analysis was applied to these data. Results: The majority of these caregivers were white women with an average of 55 years who cared for spouses. Three themes emerged from these data: (1) being worried, (2) running on empty, and (3) losing self. Discussion: Caregivers worried about themselves and their care recipient, sharing feelings of being just “plain tired.” The caregivers felt that their lives were lost to giving care. They described in detail the emotional strain that they felt, as they took on new roles in caring for the person with stroke. Conclusion: This study informs nurses about new family caregivers’ emotional strain, or incongruence in Friedemann\u27s terms, from their viewpoint and provides direction for supportive education interactions

Male Spouses of Women Physicians: Communication, Compromise, and Carving Out Time

As the numbers of female physicians continue to grow, fewer medical marriages are comprised of the traditional dyad of male physician and stay - at - home wife. The “two - career family” is an increasingly frequent state for both male and female physicians’ families, and dual - doctor marriages are on the rise. This qualitative study explored the contemporary medical marriage from the perspective of male spouses of female physicians. In 2010, we conducted semi - structured, in - depth interviews with nine spouses of internal medicine resident and faculty physicians. Interviewers queried work - home balance, career choices, and support networks. We used an interpretive, inductive, iterative approach to thematically analyze interview transcripts and develop broad, consensus - derived themes. A conceptual framework based on three major themes emerged: “A time for us? Really?”, “Supporting and protecting her, sometimes at my expense,’” and “Hers is a career, mine is a job.” This framework described the inflexibility of physicians’ time and its impact on spousal time, career development, and choices. Having a set time for synchronizing schedules, frequent verbal support, and shared decision - making were seen a s important by the husbands of female, full - time physicians. This exploratory study examined the contemporary medical marriage from the male spouse’s perspective and highlights specific strategies for success. Keywords: Academic Medicine, Gender, Career, Qualitative Research, Work - Life Balance, Medical Marriag

Effects of oral cobalamin supplementation on serum cobalamin concentrations in dogs with exocrine pancreatic insufficiency: A pilot study

The objective of this retrospective study was to evaluate serum cobalamin concentrations before and after oral cobalamin supplementation in dogs with low serum cobalamin concentrations and exocrine pancreatic insufficiency (EPI). Eighteen dogs with serum trypsin-like immunoreactivities between <1.0-2.7 μg/L (reference interval, 5.2-35 μg/L) and serum cobalamin concentrations ≤350 ng/L (reference interval, 244-959 ng/L) were enrolled. All dogs were treated with oral cyanocobalamin according to a previously described protocol (0.25-1.0 mg daily, depending on bodyweight). Median (range) serum cobalamin concentrations at inclusion was 188 ng/L (<111-350 ng/L), which increased significantly to 1000 ng/L (794-2385 ng/L; P < 0.001) after cobalamin supplementation for 19-199 days (median, 41 days). Oral cobalamin supplementation is a potential alternative to parenteral supplementation in dogs with EPI.The objective of this retrospective study was to evaluate serum cobalamin concentrations before and after oral cobalamin supplementation in dogs with low serum cobalamin concentrations and exocrine pancreatic insufficiency (EPI). Eighteen dogs with serum trypsin-like immunoreactivities between < 1.0-2.7 mu g/L (reference interval, 5.2-35 mu g/L) and serum cobalamin concentrations < 350 ng/L (reference interval, 244-959 ng/L) were enrolled. All dogs were treated with oral cyanocobalamin according to a previously described protocol (0.25-1.0 mg daily, depending on bodyweight). Median (range) serum cobalamin concentrations at inclusion was 188 ng/L (< 111-350 ng/L), which increased significantly to 1000 ng/L (794-2385 ng/L; P < 0.001) after cobalamin supplementation for 19-199 days (median, 41 days). Oral cobalamin supplementation is a potential alternative to parenteral supplementation in dogs with EPI.Peer reviewe

The fecal microbiome in dogs with acute diarrhea and idiopathic inflammatory bowel disease.

Recent molecular studies have revealed a highly complex bacterial assembly in the canine intestinal tract. There is mounting evidence that microbes play an important role in the pathogenesis of acute and chronic enteropathies of dogs, including idiopathic inflammatory bowel disease (IBD). The aim of this study was to characterize the bacterial microbiota in dogs with various gastrointestinal disorders. Fecal samples from healthy dogs (n = 32), dogs with acute non-hemorrhagic diarrhea (NHD; n = 12), dogs with acute hemorrhagic diarrhea (AHD; n = 13), and dogs with active (n = 9) and therapeutically controlled idiopathic IBD (n = 10) were analyzed by 454-pyrosequencing of the 16S rRNA gene and qPCR assays. Dogs with acute diarrhea, especially those with AHD, had the most profound alterations in their microbiome, as significant separations were observed on PCoA plots of unweighted Unifrac distances. Dogs with AHD had significant decreases in Blautia, Ruminococcaceae including Faecalibacterium, and Turicibacter spp., and significant increases in genus Sutterella and Clostridium perfringens when compared to healthy dogs. No significant separation on PCoA plots was observed for the dogs with IBD. Faecalibacterium spp. and Fusobacteria were, however, decreased in the dogs with clinically active IBD, but increased during time periods of clinically insignificant IBD, as defined by a clinical IBD activity index (CIBDAI). Results of this study revealed a bacterial dysbiosis in fecal samples of dogs with various GI disorders. The observed changes in the microbiome differed between acute and chronic disease states. The bacterial groups that were commonly decreased during diarrhea are considered to be important short-chain fatty acid producers and may be important for canine intestinal health. Future studies should correlate these observed phylogenetic differences with functional changes in the intestinal microbiome of dogs with defined disease phenotypes