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Silver KI, Patkar S, Mazcko C, Berger EP, Beck JA, LeBlanc AK. Patterns of metastatic progression and association with clinical outcomes in canine osteosarcoma: A necropsy study of 83 dogs. Vet Comp Oncol 2023; 21:646-655. [PMID: 37592810 PMCID: PMC10842475 DOI: 10.1111/vco.12927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023]
Abstract
Osteosarcoma is a highly metastatic primary bone tumour that occurs spontaneously in both pet dogs and humans. Patterns of metastasis to organs beyond the most common site (lung) are poorly characterised and it is unknown whether specific associations between patterns of metastatic progression and patient features exist. This retrospective study characterised the necropsy findings of 83 dogs receiving standardised therapy and clinical monitoring in a prospective clinical trial setting to document patterns of metastasis and correlate outcomes with these patterns and other patient and tumour-specific factors. A total of 20 different sites of metastasis were documented, with lung as the most common site, followed by bone, kidney, liver, and heart. Two distinct clusters of dogs were identified based on patterns of metastasis. There was no significant association between site of enrollment, trial arm, sex, serum alkaline phosphatase (ALP) activity, or tumour location and clinical outcomes. A second cancer type was identified at necropsy in 10 dogs (10/83; 12%). These data showcase the extensive nature of osteosarcoma metastasis beyond the lung and provide a benchmark for clinical monitoring of the disease. Further, this study provides insight into transcriptional features of primary tumours that may relate to a propensity for osteosarcoma metastasis to specific organs and tissues.
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Affiliation(s)
- K I Silver
- Comparative Oncology Program, Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - S Patkar
- Artificial Intelligence Resource, Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - C Mazcko
- Comparative Oncology Program, Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - E P Berger
- Frederick National Laboratory for Cancer Research in the Comparative Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - J A Beck
- Comparative Oncology Program, Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - A K LeBlanc
- Comparative Oncology Program, Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
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2
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Hugen S, Ankringa N, Robben JH, Valtolina C. Assessment of misdiagnosis in small animal intensive care patients using the Modified Goldman criteria. Vet Q 2023; 43:1-8. [PMID: 37401620 PMCID: PMC10506425 DOI: 10.1080/01652176.2023.2233584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/10/2023] [Accepted: 07/01/2023] [Indexed: 07/05/2023] Open
Abstract
The postmortem examination can be used as a means of quality control for clinical diagnoses. A retrospective study on 300 dogs and cats that had been admitted to a small animal intensive care unit was performed comparing the clinical and postmortem findings, using the Modified Goldman criteria. All patient files were reevaluated for clinical diagnoses and all postmortem material was reevaluated for pathological diagnoses. After this, the Modified Goldman criteria were applied to score the discrepancies between them, and factors associated with the occurrence of an undiagnosed major unexpected finding were analyzed. The postmortem examination revealed additional findings in 65% of the cases. Major discrepancies, defined as those affecting treatment and possibly outcome of the patient, were present in 21.3% of the cases. The most frequently missed diagnoses detected at necropsy were pneumonia of various etiologies, meningitis/meningoencephalitis, myocarditis and generalized vasculitis. A shorter ICU stay was associated with increased odds of a major discrepancy. Conditions affecting the urinary or gastrointestinal system were negatively associated with major discrepancy.
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Affiliation(s)
- Sanne Hugen
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | - Nynke Ankringa
- Department of Biomolecular Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - Joris Henricus Robben
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
| | - Chiara Valtolina
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, The Netherlands
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3
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Rafalko JM, Kruglyak KM, McCleary-Wheeler AL, Goyal V, Phelps-Dunn A, Wong LK, Warren CD, Brandstetter G, Rosentel MC, DiMarzio L, McLennan LM, O’Kell AL, Cohen TA, Grosu DS, Chibuk J, Tsui DWY, Chorny I, Flory A. Age at cancer diagnosis by breed, weight, sex, and cancer type in a cohort of more than 3,000 dogs: Determining the optimal age to initiate cancer screening in canine patients. PLoS One 2023; 18:e0280795. [PMID: 36724177 PMCID: PMC9891508 DOI: 10.1371/journal.pone.0280795] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023] Open
Abstract
The goal of cancer screening is to detect disease at an early stage when treatment may be more effective. Cancer screening in dogs has relied upon annual physical examinations and routine laboratory tests, which are largely inadequate for detecting preclinical disease. With the introduction of non-invasive liquid biopsy cancer detection methods, the discussion is shifting from how to screen dogs for cancer to when to screen dogs for cancer. To address this question, we analyzed data from 3,452 cancer-diagnosed dogs to determine the age at which dogs of certain breeds and weights are typically diagnosed with cancer. In our study population, the median age at cancer diagnosis was 8.8 years, with males diagnosed at younger ages than females, and neutered dogs diagnosed at significantly later ages than intact dogs. Overall, weight was inversely correlated with age at cancer diagnosis, and purebred dogs were diagnosed at significantly younger ages than mixed-breed dogs. For breeds represented by ≥10 dogs, a breed-based median age at diagnosis was calculated. A weight-based linear regression model was developed to predict the median age at diagnosis for breeds represented by ≤10 dogs and for mixed-breed dogs. Our findings, combined with findings from previous studies which established a long duration of the preclinical phase of cancer development in dogs, suggest that it might be reasonable to consider annual cancer screening starting 2 years prior to the median age at cancer diagnosis for dogs of similar breed or weight. This logic would support a general recommendation to start cancer screening for all dogs at the age of 7, and as early as age 4 for breeds with a lower median age at cancer diagnosis, in order to increase the likelihood of early detection and treatment.
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Affiliation(s)
- Jill M. Rafalko
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
- * E-mail:
| | - Kristina M. Kruglyak
- Information Technology & Bioinformatics, PetDx, La Jolla, California, United States of America
| | | | - Vidit Goyal
- Information Technology & Bioinformatics, PetDx, La Jolla, California, United States of America
| | - Ashley Phelps-Dunn
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Lilian K. Wong
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Chelsea D. Warren
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Gina Brandstetter
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Michelle C. Rosentel
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Lauren DiMarzio
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Lisa M. McLennan
- Clinical Studies, PetDx, La Jolla, California, United States of America
| | - Allison L. O’Kell
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Todd A. Cohen
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Daniel S. Grosu
- Chief Executive Officer, PetDx, La Jolla, California, United States of America
| | - Jason Chibuk
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
| | - Dana W. Y. Tsui
- Research & Development, PetDx, La Jolla, California, United States of America
| | - Ilya Chorny
- Information Technology & Bioinformatics, PetDx, La Jolla, California, United States of America
| | - Andi Flory
- Medical & Clinical Affairs, PetDx, La Jolla, California, United States of America
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4
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Kent MS, Karchemskiy S, Culp WTN, Lejeune AT, Pesavento PA, Toedebusch C, Brady R, Rebhun R. Longevity and mortality in cats: A single institution necropsy study of 3108 cases (1989-2019). PLoS One 2022; 17:e0278199. [PMID: 36580443 PMCID: PMC9799304 DOI: 10.1371/journal.pone.0278199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/13/2022] [Indexed: 12/30/2022] Open
Abstract
Client-owned cats who underwent a post-mortem examination (n = 3,108) at a veterinary medical teaching hospital between 1989 and 2019 were studied to determine longevity and factors affecting mortality. Demographic factors, environmental factors, age, and causes of death were assessed. Sexes included 5.66% intact females, 39.86% spayed females, 6.95% intact males and 47.49% neutered males. 84.2% were mixed breed cats. Age at death was known for 2,974 cases with a median of 9.07 years. Cancer was the most common pathophysiologic cause of death (35.81%) and was identified in 41.3% of cats. When categorized by organ system, mortality was most attributed to multiorgan/systemic (21.72%). Renal histologic abnormalities were noted in 62.84% of cats but was considered the primary cause of death in only 13.06% of cats. Intact female and male cats had significantly shorter lifespans than their spayed or neutered counterparts. FeLV positive status was associated with decreased longevity (P<0.0001) while FIV status was not. This study reports on risk factors associated with mortality and highlights areas of research that may contribute to improved lifespan in cats.
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Affiliation(s)
- Michael S. Kent
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States of America
- * E-mail:
| | - Sophie Karchemskiy
- William T. Prichard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States of America
| | - William T. N. Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States of America
| | - Amandine T. Lejeune
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States of America
| | - Patricia A. Pesavento
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States of America
| | - Christine Toedebusch
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States of America
| | - Rachel Brady
- William T. Prichard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States of America
| | - Robert Rebhun
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States of America
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5
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Flückiger K, Richter H, Hilbe M, Martinez HS, Kircher PR, Geissbühler U, Dennler M. VetVirtopsy by CT and MRI–Complementing conventional necropsy. FORENSIC IMAGING 2022. [DOI: 10.1016/j.fri.2022.200517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Huenerfauth E, Nessler J, Erath J, Tipold A. Probable Sudden Unexpected Death in Dogs With Epilepsy (pSUDED). Front Vet Sci 2021; 8:600307. [PMID: 33987215 PMCID: PMC8112544 DOI: 10.3389/fvets.2021.600307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
Sudden unexpected death in human epileptic patients (SUDEP) is defined as death related to recurrent unprovoked seizures, death occurring unexpectedly, and suddenly in a patient with reasonable state of health, without an obvious medical cause of death, trauma, asphyxia, or intractable status epilepticus, and in post mortem examination no obvious reason for death can be found. “Probable SUDEP” (pSUDEP) is defined as SUDEP not confirmed pathologically. The adapted abbreviation for dogs is used in the following: “pSUDED” (probable sudden unexpected death in dogs with epilepsy). The aim of the present monocentric retrospective study using an online questionnaire was to evaluate the occurrence of pSUDED. Data of canine patients presented with seizures between 01/1998 and 05/2018 were retrospectively analyzed and classified according to their etiology (n = 1,503). Owners were contacted by telephone to participate in answering a validated questionnaire. A total of 509 owners were reached, and 373 owners completed the questionnaire. In addition to signalement (e.g., breed), special attention was paid to the frequency and presentation of seizures and seizures in the context of death. Fifty-one percent (191/373) of the dogs were dead at the endpoint of the study. A large proportion of the dogs was euthanized (149/191) because of seizure severity or health problems unrelated to seizures. Idiopathic epilepsy (IE) was diagnosed in 19/34 dogs which died unexpectedly. Of these seven animals had to be excluded for further investigation of pSUDED because of status epilepticus or aspiration pneumonia as a result of the seizures. In 12 dogs with IE the last seizure event occurred between 6 h and ~3 months before death. pSUDED was suspected in these dogs and an occurrence rate of 4.5–10% was calculated. pSUDED appears in a similar occurrence rate as human SUDEP and should be considered as a possible complication in epileptic dogs. The results of this study suggest that dogs with IE but especially those with brachycephalic syndrome and cluster seizures have an increased risk to die of pSUDED. Owners of dogs with seizures should be educated about the risk of sudden death in dogs with epilepsy.
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Affiliation(s)
- Enrice Huenerfauth
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Jasmin Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Johannes Erath
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
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7
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Schertenleib TI, Pospischil A, Hässig M, Kircher PR, Hilbe M. Comparison of Clinical and Pathological Diagnoses in Cats and Dogs. J Comp Pathol 2017; 156:217-234. [PMID: 28233522 DOI: 10.1016/j.jcpa.2017.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 12/19/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
The comparison of clinical ante-mortem and pathological post-mortem diagnoses is a prerequisite for quality control, but is rarely done in veterinary medicine. This study reports the occurrence and concurrence of clinical and pathological diagnoses linked to death in 1,000 cats and 1,000 dogs examined and subjected to necropsy examination at the University of Zurich, Switzerland. Potential factors influencing the correlation between diagnoses were examined retrospectively. In 5.8% of cats and 5.2% of dogs no diagnosis was made; in 2.6% and 3.8% of cases only a clinical, and in 17.8% and 11.2%, respectively, only a pathological diagnosis was available. Of the 73.8% of cats and 79.8% of dogs with both diagnoses present, 38.3% and 36.2% were in agreement, while there was disagreement in 17.9% and 16.0%, respectively. The remaining cases (43.8% and 47.8%) had different levels of further diagnostic procedures following necropsy examination. In both species, the manner of death, the clinical discipline submitting the animal for necropsy examination and the quality of the necropsy submission request, as well as the timespan between death and necropsy examination in dogs, proved to influence the concurrence between diagnoses. In contrast, the organ system affected and the type of disease entity were, for both species, the most influential factors in the concurrence of diagnoses. Therefore, in veterinary medicine, even in times of improving diagnostic abilities, necropsy examination still reveals important information for quality control and education.
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Affiliation(s)
- T I Schertenleib
- Institute of Veterinary Pathology, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland
| | - A Pospischil
- Institute of Veterinary Pathology, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland
| | - M Hässig
- Department of Farm Animals, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland
| | - P R Kircher
- Department of Small Animals, Division of Diagnostic Imaging, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland
| | - M Hilbe
- Institute of Veterinary Pathology, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, Zürich, Switzerland.
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8
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Watson E, Heng HG. FORENSIC RADIOLOGY AND IMAGING FOR VETERINARY RADIOLOGISTS. Vet Radiol Ultrasound 2017; 58:245-258. [PMID: 28233422 DOI: 10.1111/vru.12484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 12/12/2022] Open
Abstract
Imaging studies are often of evidentiary value in medicolegal investigations involving animals and the role of the veterinary radiologist is to interpret those images for courts as an expert or opinion witness. With progressing interest in prosecuting animal crimes and strengthening of penalties for crimes against animals, the participation of veterinary radiologists in medicolegal investigations is expected to increase. Veterinary radiologists who are aware of radiographic and imaging signs that result in animal suffering, abuse, or neglect; knowledgeable in ways radiology and imaging may support cause of death determinations; conversant in postmortem imaging; comfortable discussing mechanisms and timing of blunt or sharp force and projectile trauma in imaging; and prepared to identify mimics of abuse can assist court participants in understanding imaging evidence. The goal of this commentary review is to familiarize veterinary radiologists with the forensic radiology and imaging literature and with the advantages and disadvantages of various imaging modalities utilized in forensic investigations. Another goal is to provide background information for future research studies in veterinary forensic radiology and imaging.
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Affiliation(s)
- Elizabeth Watson
- Department of Pathology, Immunology, and Laboratory Medicine, Veterinary Forensic Sciences, University of Florida College of Medicine, Gainesville, FL, 32610
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, Purdue University, 625 Harrison Street, West Lafayette, IN, 47907
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9
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Wäsle K, Pospischil A, Hässig M, Gerspach C, Hilbe M. The Post-mortem Examination in Ruminants and its Possible Benefit to Ruminant Clinical Medicine. J Comp Pathol 2017; 156:202-216. [DOI: 10.1016/j.jcpa.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 12/19/2016] [Accepted: 01/11/2017] [Indexed: 11/26/2022]
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10
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Abstract
In research studies using rats or mice, the cause of death is often not evaluated or reported. An analysis of the causes of death is particularly valuable for aging and carcinogenesis studies. Comparing causes of death among the study groups is often an important adjunct to the biochemical, molecular, clinical, and histopathologic findings. The methods for evaluating causes of death, contributing causes of death, and comorbidities have been suggested in several publications. Surprisingly, in important mouse aging studies, causes of death are often not reported. Cause-of-death assignment in preclinical rodent model aging research suffers from a lack of a standardized approach and an understanding of the value that it can add to longevity and interventional studies. While assigning single cause of death may facilitate data analysis, defining and publishing data on contributing causes (comorbidities) provides more information on associated underlying chronic conditions and health span in mouse models. This article reviews factors that affect determination of cause of death and the methods for evaluating causes of death and comorbidities. The proposed systematic pathology analysis includes assigning cause of death and comorbidities to define total disease burden. The combination of pathology with in vivo data will fully characterize the effect of tested interventions on multiple chronic diseases and health span of aging mice with improved translation to human aging and age-associated lesions.
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Affiliation(s)
- J M Snyder
- Department of Comparative Medicine and Comparative Pathology Program, University of Washington, Seattle, WA, USA
| | - J M Ward
- Global VetPathology, Montgomery Village, MD, USA
| | - P M Treuting
- Department of Comparative Medicine and Comparative Pathology Program, University of Washington, Seattle, WA, USA
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11
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O′Neill DG, Church DB, McGreevy PD, Thomson PC, Brodbelt DC. Prevalence of disorders recorded in dogs attending primary-care veterinary practices in England. PLoS One 2014; 9:e90501. [PMID: 24594665 PMCID: PMC3942437 DOI: 10.1371/journal.pone.0090501] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/03/2014] [Indexed: 01/17/2023] Open
Abstract
Purebred dog health is thought to be compromised by an increasing occurence of inherited diseases but inadequate prevalence data on common disorders have hampered efforts to prioritise health reforms. Analysis of primary veterinary practice clinical data has been proposed for reliable estimation of disorder prevalence in dogs. Electronic patient record (EPR) data were collected on 148,741 dogs attending 93 clinics across central and south-eastern England. Analysis in detail of a random sample of EPRs relating to 3,884 dogs from 89 clinics identified the most frequently recorded disorders as otitis externa (prevalence 10.2%, 95% CI: 9.1-11.3), periodontal disease (9.3%, 95% CI: 8.3-10.3) and anal sac impaction (7.1%, 95% CI: 6.1-8.1). Using syndromic classification, the most prevalent body location affected was the head-and-neck (32.8%, 95% CI: 30.7-34.9), the most prevalent organ system affected was the integument (36.3%, 95% CI: 33.9-38.6) and the most prevalent pathophysiologic process diagnosed was inflammation (32.1%, 95% CI: 29.8-34.3). Among the twenty most-frequently recorded disorders, purebred dogs had a significantly higher prevalence compared with crossbreds for three: otitis externa (P = 0.001), obesity (P = 0.006) and skin mass lesion (P = 0.033), and popular breeds differed significantly from each other in their prevalence for five: periodontal disease (P = 0.002), overgrown nails (P = 0.004), degenerative joint disease (P = 0.005), obesity (P = 0.001) and lipoma (P = 0.003). These results fill a crucial data gap in disorder prevalence information and assist with disorder prioritisation. The results suggest that, for maximal impact, breeding reforms should target commonly-diagnosed complex disorders that are amenable to genetic improvement and should place special focus on at-risk breeds. Future studies evaluating disorder severity and duration will augment the usefulness of the disorder prevalence information reported herein.
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Affiliation(s)
- Dan G. O′Neill
- Veterinary Epidemiology, Economics and Public Health, Royal Veterinary College, London, United Kingdom
| | - David B. Church
- Small Animal Medicine and Surgery Group, Royal Veterinary College, London, United Kingdom
| | - Paul D. McGreevy
- Faculty of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - Peter C. Thomson
- Faculty of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - Dave C. Brodbelt
- Veterinary Epidemiology, Economics and Public Health, Royal Veterinary College, London, United Kingdom
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12
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