Diagnosis and treatment of canine hypoadrenocorticism

Canine hypoadrenocorticism (Addison’s disease), the ‘great pretender’ of internal medicine, is a disease that should be frequently considered as a differential diagnosis of several clinical presentations, albeit it is less commonly the actual cause of the clinical signs. Hypoadrenocorticism cannot be diagnosed on clinical signs alone and further investigations are always required. There have been some interesting new ideas about diagnostic options for this condition and new treatment options are available for both acute and chronic therapy of the condition in dogs. It is therefore pertinent to review the causes, diagnosis and treatment of hypoadrenocorticism in dogs

Management of Addison's disease in dogs

No abstract available

Validation and determination of a reference interval for Canine HbA1c using an immunoturbidimetric assay

Background: Hemoglobin A1c (HbA1c) provides a reliable measure of glycemic control over 2–3 months in human diabetes mellitus. In dogs, presence of HbA1c has been demonstrated, but there are no validated commercial assays. Objective: The purpose of the study was to validate a commercially available automated immunoturbidimetric assay for canine HbA1c and determine an RI in a hospital population. Methods: The specificity of the assay was assessed by inducing glycosylation in vitro using isolated canine hemoglobin, repeatability by measuring canine samples 5 times in succession, long term inter-assay imprecision by measuring supplied control materials, stability using samples stored at 4°C over 5 days and −20°C over 8 weeks, linearity by mixing samples of known HbA1c in differing proportions, and the effect of anticoagulants with paired samples. An RI was determined using EDTA-anticoagulated blood samples from 60 nondiabetic hospitalized animals of various ages and breeds. Hemoglobin A1c was also measured in 10 diabetic dogs. Results: The concentration of HbA1c increased proportionally with glucose concentration in vitro. For repeat measurements, the CV was 4.08% (range 1.16–6.10%). Samples were stable for 5 days at 4°C. The assay was linear within the assessed range. Heparin- and EDTA-anticoagulated blood provided comparable results. The RI for HbA1c was 9–18.5 mmol/mol. There was no apparent effect of age or breed on HbA1c. In diabetic dogs, HbA1c ranged from 14 to 48 mmol/mol. Conclusions: The assay provides a reliable method for canine HbA1c measurement with good analytic performance

Comparing treatment methods of canine hypoadrenocorticism

Management of canine hypoadrenocorticism relies on supplementation of glucocorticoids and mineralocorticoids. Although previous studies show success of both a steroid with combined activity (fludrocortisone) and steroids with separate activities (DOCP with prednisolone) in the management of canine hypoadrenocorticism, the two treatment methods had never been prospectively compared. The objective of this clinical trial was to compare fludrocortisone to DOCP with prednisolone for the management of canine hypoadrenocorticism in stable patients. A prospective, randomised, cross-over, non-blinded, non-inferiority trial was conducted. Patients were randomised into two groups: Group A received three months of treatment with the interventional product (DOCP and prednisolone) followed by three months of the control product (fludrocortisone) whilst Group B received three months of the control product followed by three months of the interventional product. Primary outcome measures were electrolyte concentrations and clinical signs at the end of each phase of the trial. Secondary outcome measures included plasma renin activity, endogenous ACTH, blood pressure and routine haematology/biochemistry results. No dogs had clinical signs of hypoadrenocorticism or hyponatraemia/hyperkalaemia at the end of the DOCP phase of the trial. Three dogs however were hyponatraemic at the end of the fludrocortisone phase of the trial, although no patients were hyperkalaemic or showed clinical signs of hypoadrenocorticism. The blood pressure was significantly higher (Paired T test; P=0.006) at the end of the DOCP phase (mean 161mmHg; SD 26.3) than at the end of the fludrocortisone phase (mean 147mmHg; SD 26.2). The neutrophil count was significantly higher (Paired T test; P=0.009) at the end of the DOCP phase (mean 7.49x10^9/L; SD 3.1) compared to the fludrocortisone phase (mean 5.81x10^9/L; SD 2.31). The urea was significantly lower (Wilcoxon Signed Rank test; P <0.001) at the end of the DOCP phase (median 5.3mmol/L; 2.9-11.7) compared to the end of the fludrocortisone phase (median 7.4mmol/L; 3.8-17.2). The creatinine was also significantly lower (Paired T test; P=0.001) at the end of the DOCP phase (mean 96umol/L; 19.2) compared to the fludrocortisone phase (mean 109umol/L 28.9). The ACTH and renin concentrations were significantly lower at the end of the DOCP phase compared to the fludrocortisone phase (Wilcoxon Signed Rank test; both P <0.001). In conclusion, DOCP with prednisolone appears to be non-inferior to fludrocortisone acetate for the management of canine hypoadrenocorticism

Use of computed tomography imaging during long-term follow-up of nine feline tuberculosis cases

Case series summary: Feline tuberculosis is an increasingly recognised potential zoonosis of cats. Treatment is challenging and prognosis can vary greatly between cases. Pulmonary infection requires extended courses of antibiotics, but methodologies for sensitively monitoring response to treatment are currently lacking. In this case series, we retrospectively examined the serial computed tomography (CT) findings in nine cats that had been diagnosed with tuberculosis. Changes in pathology (where applicable to tuberculosis) were correlated with the clinical presentation of each of the cats, the treatment protocol, and previous and contemporary diagnostic investigations. This study found that changes in CT findings during the medium- to long-term management of feline tuberculosis were highly variable between cats. The majority of cats had reduced pathology at re-examination during anti-tuberculous therapy, but pathology only resolved in a minority of cases. In some cases recurrence of pathology detected by CT imaging preceded clinical deterioration, allowing for rapid therapeutic intervention. Relevance and novel information: When considered in combination with clinical findings, CT studies can aid in decision making regarding tapering of antibiotic protocols, or reintroduction of therapy in cases of recurrence or reinfection. This series also highlights that, in some cases, persistent abnormalities can be detected by CT, so complete resolution of CT pathology should not always be a goal in the management of feline tuberculosis

Booster vaccination against SARS-CoV-2 induces potent immune responses in people with human immunodeficiency virus

Background People with human immunodeficiency virus (HIV) on antiretroviral therapy (ART) with good CD4 T-cell counts make effective immune responses following vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There are few data on longer term responses and the impact of a booster dose. Methods Adults with HIV were enrolled into a single arm open label study. Two doses of ChAdOx1 nCoV-19 were followed 12 months later by a third heterologous vaccine dose. Participants had undetectable viraemia on ART and CD4 counts >350 cells/µL. Immune responses to the ancestral strain and variants of concern were measured by anti-spike immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA), MesoScale Discovery (MSD) anti-spike platform, ACE-2 inhibition, activation induced marker (AIM) assay, and T-cell proliferation. Findings In total, 54 participants received 2 doses of ChAdOx1 nCoV-19. 43 received a third dose (42 with BNT162b2; 1 with mRNA-1273) 1 year after the first dose. After the third dose, total anti-SARS-CoV-2 spike IgG titers (MSD), ACE-2 inhibition, and IgG ELISA results were significantly higher compared to Day 182 titers (P < .0001 for all 3). SARS-CoV-2 specific CD4+ T-cell responses measured by AIM against SARS-CoV-2 S1 and S2 peptide pools were significantly increased after a third vaccine compared to 6 months after a first dose, with significant increases in proliferative CD4+ and CD8+ T-cell responses to SARS-CoV-2 S1 and S2 after boosting. Responses to Alpha, Beta, Gamma, and Delta variants were boosted, although to a lesser extent for Omicron. Conclusions In PWH receiving a third vaccine dose, there were significant increases in B- and T-cell immunity, including to known variants of concern (VOCs)

Stable population structure in Europe since the Iron Age, despite high mobility

Ancient DNA research in the past decade has revealed that European population structure changed dramatically in the prehistoric period (14,000–3000 years before present, YBP), reflecting the widespread introduction of Neolithic farmer and Bronze Age Steppe ancestries. However, little is known about how population structure changed from the historical period onward (3000 YBP - present). To address this, we collected whole genomes from 204 individuals from Europe and the Mediterranean, many of which are the first historical period genomes from their region (e.g. Armenia and France). We found that most regions show remarkable inter-individual heterogeneity. At least 7% of historical individuals carry ancestry uncommon in the region where they were sampled, some indicating cross-Mediterranean contacts. Despite this high level of mobility, overall population structure across western Eurasia is relatively stable through the historical period up to the present, mirroring geography. We show that, under standard population genetics models with local panmixia, the observed level of dispersal would lead to a collapse of population structure. Persistent population structure thus suggests a lower effective migration rate than indicated by the observed dispersal. We hypothesize that this phenomenon can be explained by extensive transient dispersal arising from drastically improved transportation networks and the Roman Empire’s mobilization of people for trade, labor, and military. This work highlights the utility of ancient DNA in elucidating finer scale human population dynamics in recent history

Canine Addison's disease: a new treatment option

No abstract available

Canine Addison's disease: a new treatment option

No abstract available