Factors related to longevity and mortality of dogs in Italy

Besides its translational value, an improved understanding of dog longevity and mortality is necessary to guide health management decisions, breed selection, and improve dog welfare. In order to analyse the lifespan of dogs in Italy, identify the most common causes of death, and evaluate possible risk factors, anonymised medical records were collected from 9 veterinary teaching hospitals and 2 public health institutions. Data regarding breed, sex, neuter status, age, diagnosis, and mechanism of death were retrieved. Cause of death (COD) was classified by pathophysiologic process (PP) and organ system (OS). Of the 4957 dogs that died between 2004 and 2020 included in the study, 2920 (59.0%) were purebred, 2293 (46.2%) were female, 3005 (60.6%) were intact, 2883 (58.2%) were euthanised. Overall median longevity was 10.0 years. Median longevity was significantly longer for crossbreds, females, neutered dogs, and small-sized breeds. The breeds with the highest median age at death were the Yorkshire terrier, English cocker spaniel, West Highland white terrier, Italian volpino, and Shih Tzu, whilst the American bulldog, English bulldog, American pit bull terrier, Bernese mountain dog and the Maremma and the Abruzzes sheepdog had the lowest median age at death. The most frequent COD by PP was neoplasia (34.0%), which occurred more frequently in large breeds, namely German shepherd, Labrador retriever and Boxer. Degenerative diseases mostly affected small-sized dogs like Miniature pinscher and Dachshund. Regarding the OS involved, diseases of the renal/urinary system were most frequently responsible for COD (15.0%), prevalently degenerative and inflammatory/infectious. Substantial variation in median longevity according to causes of death by PP and OS was observed. These data are relevant for breeders, veterinary practitioners, and owners, to assist breed selection, facilitate early diagnosis, guide choice when purchasing a purebred dog and making health management decisions, and ultimately improve dog welfare.

An Association between Pancreatic and Cholestatic Biliary Disorders in Dogs

Canine chronic biliary tree disease (CBTD) is a suspected risk factor for pancreatic injury. The aim of this study was to evaluate the frequency and features of pancreatic involvement in canine CBTD, and their relationship with hyperlipemia and its severity. CBTD was defined as the increase in at least two of ALP, GGT, total bilirubin, cholesterol, and a biliary tree abnormal abdominal ultrasound (graded mild to severe). Pancreatic ultrasound appearance was recorded and classified as acute/chronic. Dogs were divided into a PBD group (pancreatic and biliary disease) and BD group (only biliary tree disease). PBD group was subgraded into a "pancreatic injury" and "pancreatitis" group. Eighty-one dogs were retrospectively included: 56 in the PBD group and 25 in the BD group. Of the PBD group, 20 had pancreatitis (15 chronic and 5 dogs acute). US score was mild in 64 dogs and moderate in 17 dogs, and it was not associated with evidence of pancreopathy. Sixty-six dogs had hyperlipemia (mild = 27 dogs; moderate-to-severe = 39 dogs) and no association with pancreopathy was found. Pancreatic injury was more frequent than pancreatitis in CBTD dogs. Although both acute and chronic pancreatic injury may be present, chronic forms were more frequent. Pancreatic injury should be considered in CBTD patients due its possible clinical significance.

Intestinal Microbiome in Dogs with Chronic Hepatobiliary Disease: Can We Talk about the Gut-Liver Axis?

The gut-liver axis represents a current topic in human medicine. Extensive research investigates the gut microbiome (GM) modifications in relation to various kinds of chronic hepatobiliary diseases (CHD), with many mechanisms and therapeutical implications recognized. Those aspects in veterinary medicine are still quite unexplored. The aim of the present study was to evaluate GM in dogs diagnosed with CD. Comparison among CHD dogs were made considering some clinical and biochemical variables (lipemia and alanine-aminotransferase activities), presence of cholestasis or endocrine disorders, diet). Sixty-five dogs were prospectively enrolled with clinical and hematobiochemical evaluation and 16S-RNA GM sequencing assessed. Dogs that received antibiotics and/or pre/pro/symbiotics administration were excluded. Deeper GM alteration was observed between dogs with or without ultrasonographic and biochemical cholestatic CHD. Cholestasis was associated with a decrease in several bacterial taxa, including Clostridium hiranonis, Fusobacterium, Megamonas, Ruminococcus faecis, Turicibacter, and higher levels of Escherichia/Shigella and Serratia. Thus, the alteration in bile flow and composition, typical of cholestasis, may directly affect the local intestinal microbial environment. For the management of dogs with CHD and especially cholestatic CHD, clinicians should be aware that gut-liver interaction may lead to dysbiosis.

Retrospective Evaluation of Gastrointestinal Signs in Hypothyroid Dogs

Few observations about gastrointestinal (GI) signs in hypothyroid dogs (hypo-T dogs) are available. We aimed to evaluate the prevalence and characteristics of concurrent GI signs in hypo-T dogs, describe clinicopathological, hepato-intestinal ultrasound findings in hypo-T dogs, investigate changes in GI signs after thyroid replacement therapy (THRT). Medical records of suspected hypo-T dogs from two hospitals were retrospectively reviewed. The inclusion criteria were: (1) having symptoms and clinicopathological abnormalities related to hypothyroidism (i.e., mild anemia, hyperlipemia); (2) not being affected by systemic acute disease; (3) not having received any treatment affecting thyroid axis. Hypothyroidism had to be confirmed using low fT4 or TT4 with high TSH and/or inadequate TSH-stimulation test response; otherwise, dogs were assigned to a euthyroid group. Clinical history, GI signs, hematobiochemical parameters, and abdominal ultrasound findings were recorded. Hypo-T dogs were assigned to the GI group (at least 2 GI signs) and not-GI group (1 or no GI signs). Follow-up information 3-5 weeks after THRT was recorded. In total, 110 medical records were screened: 31 dogs were hypo-T, and 79 were euthyroid. Hypo-T dogs showed a higher prevalence of GI signs (44%), especially constipation and diarrhea (p = 0.03 and p = 0.001), than euthyroid dogs (24%) (p = 0.04). Among hypo-T dogs, no difference in hematological parameters between GI and non-GI groups was found. Hypo-T dogs had a higher prevalence of gallbladder alterations than euthyroid dogs (20/25; 80% and 32/61; 52% p = 0.04). The hypo-T GI group showed a significant improvement in the GI signs after THRT (p < 0.0001). Specific investigation for concurrent GI diseases in hypo-T dogs was lacking; however, improvement in GI signs following THRT supports this association between GI signs and hypothyroidism.

Linguatula serrata (Pentastomida: Linguatulidae) infection in a paucisymptomatic greyhound imported from Romania to Italy: A case report and literature overview

Background

Linguatula serrata is a pentastomid zoonotic parasite with worldwide distribution. Although some cases of L. serrata infection have been reported in dogs, the epidemiology of this parasite remains largely unknown in developed countries. In recent years, canine linguatulosis has been repeatedly linked to cases of imported infections. This study aims to focus attention on this uncommon parasite through the presentation of a case report and an overview of the literature.

Case Description

A 1-year-old intact female Borzoi imported from Romania to Italy sneezed spontaneously a worm-like parasite specimen. Morphological and molecular diagnosis identified the parasite as a female of the zoonotic pentastomid L. serrata (so-called European tongue worm) that lives in the nasopharyngeal tract of canids. Eggs of Linguatula were detected in the feces. Molecular identification (99%-100% homology) was based on DNA extraction, polymerase chain reaction of a 700-bp fragment of the mitochondrial cytochrome c oxidase subunit I gene, and alignment with BLAST analysis. Due to the possibility of other adult or juvenile specimens of the parasite still occurring in the dog, a treatment attempt with a combination of febantel/pyrantel/praziquantel was made. No parasite eggs were detected in fecal samples after the drug was administered. Endoscopy confirmed the absence of adult parasites and slight pathological changes. A follow-up examination conducted 3 months after the treatment did not reveal any clinical and laboratory abnormalities.

Conclusion

Linguatula serrata appears to be currently prevalent in some European countries, but there are no recent extensive studies on the prevalence of canine linguatulosis, so the parasite frequently remains undetected and unreported in dogs as the diagnosis is often overlooked. Parasites not commonly found such as L. serrata can become increasingly prevalent and may be detected in imported dogs. Therefore, veterinarians must be aware of the possible presence of uncommon and exotic pathogens in these dogs, be able to recognize the relevant clinical signs, and diagnose the infection quickly. This will improve the prognosis in individual dogs, reduces the risk of possible public health implications, and reduces the risk of uncommon and exotic pathogens establishing new endemic foci.

Fractional excretion of electrolytes and neutrophil gelatinase-associated lipocalin as early biomarkers of acute kidney injury in dogs with acute pancreatitis

OBJECTIVES

To determine if fractional excretion of urinary electrolytes and neutrophil gelatinase-associated lipocalin could detect different degrees of kidney injury in dogs with naturally occurring acute pancreatitis.

MATERIALS AND METHODS

We included dogs with acute pancreatitis. Dogs with a history of kidney disease, urinary tract infection, dogs which received potentially nephrotoxic drugs and dogs managed with haemodialysis were excluded. Acute kidney injury was diagnosed if there was an acute onset of clinical signs, haemato-chemical results compatible with acute kidney injury. Students or staff-owned dogs were selected to build the healthy group.

RESULTS

The study population was composed of 53 dogs: acute pancreatitis with AKI (n=15), acute pancreatitis alone (n=23), and healthy dogs (n=15). In dogs with acute pancreatitis and AKI, all the FEs of urine electrolytes were significantly higher than dogs with acute pancreatitis alone and healthy ones. Dogs with acute pancreatitis alone had higher uNGAL/uCr than healthy dogs (median 54 ng/mg vs. 0.1 ng/mg) and lower compared to AP-AKI patients (54 ng/mg vs 209 ng/mg). Some fractional excretion of electrolytes are increased acute kidney injury dogs, however their role in the early detection of renal injury in acute pancreatitis dogs remains doubtful. On the contrary, urinary neutrophil gelatinase-associated lipocalin had higher concentrations in dogs with acute pancreatitis with or without acute kidney injury compared to healthy controls, suggesting that it may be used as an early marker of renal tubular damage in acute pancreatitis dogs.

Serum Bicarbonate Deficiency in Dogs with Acute and Chronic Kidney Disease

Serum bicarbonate deficiency is a disorder frequently found in human patients with acute (AKI) and chronic (CKD) kidney disease, due to abnormalities in kidney generation and reabsorption of bicarbonate. Although alkali supplementation is usually performed in both humans and veterinary CKD patients, data regarding the frequency of bicarbonate disorders in AKI and CKD dogs are scarce. The aim of the present study is to assess the frequency and the severity of bicarbonate deficiency of dogs affected by AKI, acute chronic kidney disease (ACKD), and CKD, and to investigate its possible association with the IRIS grade/stage as well as with disorders of calcium phosphate metabolism. A retrospective evaluation of the serum biochemical panels of all dogs with diagnoses of AKI, ACKD, and CKD referred to the nephrology and urology service of the Veterinary Teaching Hospital of the University of Pisa, between January 2014 and January 2022, was performed. Bicarbonate deficiency was defined as serum bicarbonate < 22 mmol/L and classified as moderate (between 18 and 22 mmol/L) or severe (<18 mmol/L). Serum bicarbonate deficiency was found in 397/521 dogs (76%), of which 142/397 (36%) showed moderate deficiency, and 255/397 (64%) severe deficiency. Dogs with AKI and ACKD showed a significantly higher frequency of bicarbonate deficiency (p = 0.004) and severe forms compared to CKD dogs (p = 0.02). In AKI and ACKD dogs, a negative linear correlation was found between serum bicarbonate and serum creatinine, urea, and phosphate. The frequency of bicarbonate deficiency was higher in the later stages of the disease in both AKI (p = 0.01), ACKD (p = 0.0003), and CKD dogs (p = 0.009). Dogs with serum CaxP ≥ 70 mg²/dL² showed a higher frequency of bicarbonate deficiency (p = 0.01) and showed severe forms (p = 0.01) compared to dogs with CaxP < 70 mg²/dL². Serum bicarbonate deficiency seems to be a very frequent disorder in both AKI, ACKD, and CKD dogs, with an increasing frequency and severity in more advanced stages of kidney disease. The higher frequency and severity of bicarbonate deficiency in AKI and ACKD may be caused by a more severe and sudden loss of kidney function, or extra-renal factors. Finally, the association between frequency and severity of bicarbonate deficiency and abnormal CaxP may suggest a potential connection between metabolic acidosis and bone mineral disorders.

Ultrasonographic appearance and possible clinical relevance of hyperechoic foci of mineralization in the canine intrahepatic biliary tree

Background

The evidence of mineralizations in the canine liver is usually considered an incidental finding of unclear clinical significance, frequently observed in small-size old dogs.

Aim

To describe the ultrasound features of intrahepatic biliary tree foci of mineralization, to assess their clinical relevance and their possible relationship with other gastrointestinal pathological disorders.

Methods

A retrospective analysis evaluating the database of canine patients admitted to two referral veterinary centers we carried out. All dogs under study underwent an abdominal ultrasound examination in which intrahepatic biliary tree mineralization was found. Clinical and anamnestic data of the included dogs were reviewed.

Results

Approximatively 90% of the patients showed ultrasonographic abnormalities regarding the biliary system, and over 85% presented ultrasonographic abnormalities of the hepatic parenchyma. In 81.2% of dogs, ultrasonographic anomalies in the digestive tract were observed. In approximately half of our patients, we evidenced increased liver enzymes (alkaline phosphatase, alanine aminotransferase, and gamma-glutamyl transferase). At the clinical evaluation, 84.4% (23 out of 32 dogs) of patients showed signs of gastrointestinal disease that persisted for over 3 months.

Conclusion

The presence of intrahepatic biliary tree mineralizations is an unusual and frequently incidental finding that could be related to a bile stasis condition, a chronic inflammatory disease involving the biliary system and the hepatic parenchyma, and it could be associated with a liver-gut axis alteration.

The erythrocyte sedimentation rate (ESR) in canine inflammation

The clinical application of the erythrocyte sedimentation rate (ESR) assay is challenging due to its long processing time. However, in 2020 a new automated instrument for veterinary ESR was released and validated. This study sought: (1) to refine the proposed reference range (reference interval, RI) for canine ESR; (2) to compare the ESR values of healthy and sick dogs; and (3) to correlate ESR with other inflammatory markers such as C-reactive protein (CRP), fibrinogen, albumin:globulin ratio (A/G), and neutrophil-to-lymphocyte ratio (NLR); and also (4) to study ESR behavior across illnesses of varying durations. A prospective cohort study of 396 client-owned dogs (n = 120 healthy and n = 276 sick dogs) was conducted. Animals with a full clinical evaluation, complete hematobiochemical profile and a final diagnosis were included. ESR was performed according to manufacturer's instructions using the same 1 mL K3-EDTA tube used for the complete blood count. The RI was established at 1-8 mm/h in 14 min. Sick dogs had a significantly faster ESR (median 10 mm/h) than healthy dogs (median 1 mm/h; P < 0.0001). ESR was positively correlated with NLR (r = 0.36), CRP (r = 0.18) and fibrinogen (r = 0.56) and negatively correlated with A/G (r = -0.37). Dogs with an acute-on-chronic disease had the highest ESR values (median 17 mm/h) compared with either acute (median 11 mm/h; P < 0.001) or chronic diseases (median 7 mm/h; P = 0.001). ESR was confirmed as a reliable canine inflammatory marker, positively correlating with the main inflammatory markers in dogs and significantly different between sick and healthy dogs. The ESR assay appears useful especially in dogs with an acute clinical presentation, with or without an underlying chronic condition.

Electronic Package Leaflets for Vaccines: What Are People’s Perceptions in Italy?

In Italy, the paper package leaflet (PPL) is the official document that is approved by the Italian Medicines Agency (AIFA) for each medicine. PPLs of all medicines, including vaccines, are freely available online by accessing the AIFA website. To investigate people’s attitudes toward possible access to the PPLs of vaccines and the acceptability of switching to an electronic package leaflet (e-leaflet) in the future, we surveyed three target groups (pregnant women, young parents, and older people) in Italy, via an online survey. We collected 321 questionnaires from the cohorts, which comprised 104 pregnant women, 105 young parents, and 112 older people. The results indicate in all target groups that health care professionals (HCPs) do not usually offer the vaccine PPL during the vaccination session: only about 10.7% of respondents receive the PPL without asking for it, with pregnant women receiving it the most frequently. The acceptance rate for switching from a PPL to an e-leaflet is fairly high in all target groups (76.9% in pregnant women, 81.9% in young parents, and 66.1% in the elderly), especially if the option exists to request a paper print, to make sure that people with a low level of digital skills can access the PPL information as well. HCPs have an important role in ensuring access to the PPLs of vaccines. HCPs should be trained to inform their patients about the different options for accessing the PPLs (as well as online access) to increase their patients’ knowledge and satisfaction.

Urinary Cytology: Potential Role in Canine Urinary Tract Infections

The diagnosis of urinary tract infections (UTIs) requires a concomitant evaluation of clinical signs and urine culture, which is of fundamental to start an appropriate antibiotic treatment. Several factors, such as subclinical bacteriuria or pre-analytical errors, may make the interpretation of urine culture difficult. The aim of the study was to evaluate the association between the finding of neutrophils and bacteria in unstained and stained canine urine sediment and the presence of clinical signs and positive urine culture. Urine samples from 35 dogs with clinical signs of UTI and 55 asymptomatic dogs with risk factors for UTI were prospectively collected by cystocentesis, divided into three aliquots, and submitted for: (1) physical and chemical Dipstick analysis and unstained urinary sediment (casts, crystals, bacteria, leucocytes, cells, parasites); (2) stained urinary sediment (extra/intracellular bacteria, degenerated and non-degenerated neutrophils); (3) qualitative and quantitative urine culture and antimicrobial sensitivity-test. The association between unstained and stained findings of urinary sediment and urine culture was tested. Sensibility, specificity, and positive/negative predictive values in diagnosing positive urine cultures of bacteria at unstained and stained evaluation were compared. Both wet-mount bacteriuria and the cytological presence of intracellular and extracellular bacteria, neutrophils, and degenerated neutrophils were successively associated with positive urine culture (p < 0.001). The presence of intracellular bacteria was the only independent predictor of positive urine culture. Total bacterial count did not differ significantly between symptomatic and asymptomatic dogs. Detection of extracellular and intracellular bacteriuria at stained urinary sediment significantly improved the sensibility of predicting positive urine culture. Cytologic evaluation of urinary sediment may be helpful in detecting signs of active inflammation, thus enhancing the clinical relevance of a positive urine culture.

Serum protein electrophoresis in 26 dogs with chronic hepatitis

Serum protein electrophoresis (SPE) shows the distribution of protein fractions, helping clinicians to characterize some pathologic processes. Information is lacking in the literature about SPE alterations in dogs with chronic hepatitis (CH). Our aim was to describe SPE alterations in canine CH, to compare SPE results to histologic scores, and to study SPE trends during follow-up. We reviewed retrospectively case data from dogs with a histologic diagnosis of CH. Only cases with SPE, CBC, and serum chemistry results available were included. Dogs were divided into subgroups based on histologic necroinflammatory activity (A) and fibrosis (F) scores (groups A0-1 and A>1; groups F<2 and F≥2). We included 26 dogs; 15 had follow-up SPE. The most common SPE alterations at admission were hypoalbuminemia (n = 16), increases in α1-globulins (n = 11), γ-globulins (n = 11), α2-globulins (n = 8), β2-globulins (n = 7), and β1-globulins (n = 6), and decreased albumin:globulin (A:G) ratios (n = 20). Four of 11 dogs had β-γ bridging. Groups with higher A and F scores had higher β2-globulins. Eleven of 15 dogs with a post-treatment SPE had a decrease in γ-globulins and increase in A:G ratio compared to their T0, although there was no statistically significant difference. Although further studies are warranted, SPE may be useful for monitoring canine CH.

Alterations of selected serum biochemical and urinary parameters in dogs with chronic enteropathy

Background:

No specific study on concurrent nephropathy has been conducted in dogs with chronic enteropathy (CE), except for soft-coated Wheaten Terriers. Moreover, limited information exists regarding the urinary profile in dogs with CE.

Aim:

To describe, compare, and discuss the alterations in selected serum biochemical and urinary parameters in dogs with CE.

Methods:

Multicentric retrospective study on dogs with CE diagnosed after exclusion of extra-gastrointestinal diseases. In addition, dogs with azotemia and lower urinary tract diseases were excluded. Information on canine chronic enteropathy clinical activity index (CCECAI) score, muscular condition score (MCS), presence of glycosuria, proteinuria [urine protein-to-creatinine (UPC) ratio > 0.5], and/or cylindruria (>1–2 casts/hpf) at diagnosis were gleaned from the medical records. Dogs were retrospectively classified as food-responsive enteropathy, immunosuppressant-responsive enteropathy, or nonresponsive enteropathy based on the presence of gastrointestinal histological inflammation and the treatment response. In addition, based on the serum albumin concentration (ALB), dogs were classified as having protein-losing enteropathy (PLE).

Results:

Ninety CE dogs were included. Fifty-two dogs had mild-to-severely decreased MCS and 38 dogs showed altered urinary parameters. No significant associations were found between CCECAI and altered urinary parameters. No significant association was found between PLE dogs and altered urinary parameters. PLE dogs showed higher prevalence of proteinuria than non-PLE dogs (p = 0.03; OR = 2.8; 95% CI = 1–6.8).

Conclusion:

Despite the presence of altered urinary profile in dogs with CE, further studies are needed to explore a possible link between gastrointestinal and renal inflammation.

Health Literacy and COVID-19 preventive behaviours in during the Lock-Down Phase in Tuscany (Italy)

 

In the first COVID-19 pandemic period, when no vaccines were available, individual behaviours were essential for controlling the spread of the virus. In this context of rapidly changing guidance, emerging new evidence, fake news and misinformation, there have been new challenges for health literacy (HL). This study explored whether guidance-compliant healthy behaviours were associated with HL in individuals who have performed essential activities (public employees and volunteers of the Civil Protection) during the lock-down period in the Province of Prato, Italy. Items on knowledge, attitudes and practices (KAP) towards COVID-19 preventive measures and COVID-19 risk perception, along with the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6), were collected using a self-administered structured questionnaire. In May 2020, 751 responses were collected; respondents were mostly males (59%), younger than 65 years old (83.5%), with sufficient HL (56%), and never smokers (54.2%). Most of the items related to the KAP towards COVID-19 preventive measures were significantly correlated with the HLS-EU-Q6 score in the total sample. In the multiple linear model, HL results to be a predictor of both a better self-reported knowledge of COVID-19 preventive measures (beta 0.32 for sufficient HL, 0.11 for problematic HL, 1.00 for inadequate HL) and a higher score of attitude towards the importance of COVID-19 preventive measures (beta 0.33 for sufficient HL, 0.17 for problematic HL, 1.00 for inadequate HL), while it has no role in predicting a higher risk perception. These findings can be useful to understand the importance of HL in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

Key messages

Lower levels of Health Literacy predict poor COVID-19 related knowledge and a worse attitudes towards the importance of COVID-19 preventive measures. Health Literacy may be an important factor in promoting guidance-compliant healthy behaviours and in helping people to understand the rapidly changing public health messages and then act accordingly.

Evaluation of diagnostic and prognostic usefulness of abdominal ultrasonography in dogs with clinical signs of acute pancreatitis

OBJECTIVE

To report abdominal ultrasonography (AUS) findings in dogs with clinical signs of acute pancreatitis (AP) during the first 2 days of hospitalization and to compare AUS findings with severity of disease and mortality rate.

ANIMALS

37 client-owned dogs with clinical signs of AP.

PROCEDURES

Dogs suspected of having AP with complete medical records, AUS examinations performed throughout the first 2 days of hospitalization, and available frozen surplus serum samples for quantitative measurement of canine pancreatic lipase (cPL) concentrations at hospital admission met the criteria for study inclusion. Dogs were grouped as AUS+ or AUS- on the basis of positive or negative findings for AP on AUS, respectively. Abdominal ultrasonography findings of AP were stratified (as mild, moderate, or severe) by use of an AUS severity index, and a canine acute pancreatitis severity score was calculated.

RESULTS

24 of 37 (64.8%) dogs had AUS findings of AP at hospital admission, whereas 10 had positive findings for AP on AUS within 2 days of hospitalization. Three (8%) dogs were AUS- but had serum cPL concentrations > 400 μg/L (ie, values considered diagnostic for AP). On the AUS severity index, 5 of 34 (14.7%) AUS+ dogs had mild findings, 18 (52.9%) AUS+ dogs had moderate findings, and 11 (32.4%) AUS+ dogs had severe findings. Severe findings were associated with a higher risk of death than mild and moderate findings. A significant association was found between canine acute pancreatitis severity scores and mortality rates.

CONCLUSIONS AND CLINICAL RELEVANCE

For dogs with clinical signs of AP, repeated AUS examinations during hospitalization should be performed, severe findings on the AUS severity index may indicate an increased risk of death, and serum cPL concentrations may increase earlier than findings on AUS of AP.

Immunosuppressant-Responsive Enteropathy and Non-Responsive Enteropathy in Dogs: Prognostic Factors, Short- and Long-Term Follow Up

Simple Summary

Chronic intestinal inflammation in dogs is a challenging disease to manage. Most studies about prognostic factors and follow-up data are only available for small populations or with short-term follow-up. The aim of this study of 165 dogs with chronic intestinal inflammation was to identify clinical and haematological factors associated with mortality, clinical response and relapse, with long-term follow-up. Nine per cent of dogs did not respond to therapy at 1 month follow-up. Most dogs with chronic intestinal inflammation had a good clinical course in most cases, and the non-response or relapse rate was 9–11%. A reduction of body condition (loss of weight), lower serum albumin concentration and presence of lacteal dilatation on intestinal histology at diagnosis were identified as factors associated with a decreased response rate, higher mortality and lower chance of achieving long-term remission.

Abstract

A multicentre prospective study was performed to assess whether clinical, hematobiochemical, endoscopic and histopathological parameters were associated with mortality, clinical response and relapse of disease in short- and long-term follow-up of a total of 165 dogs with chronic inflammatory enteropathy, of which 150 had immunosuppressant responsive enteropathy (IRE), and 15 had non-responsive enteropathy (NRE) dogs. Clinical severity (CCECAI) was evaluated from presentation (T0) to 18 months (T18) from diagnosis. T0 body condition score (BCS), selected haematological parameters and endoscopic and histopathological scores were evaluated. Presence/absence of histopathological duodenal lesions was recorded. Responders were evaluated using CCECAI at T1. Relapse was evaluated from T3 to T18. Long-term responders included dogs who responded at T1 and showed no relapse. Dogs were divided into responders/non-responders, survivors/non-survivors and relapsed/non-relapsed. At T1, 15/165 dogs (9%) were considered NRE. Sixteen dogs (11%) were considered relapsed at T3, 8% at T6 and 10% at T12, and none of 96 dogs relapsed at T18. NREs showed significantly lower BCS than IREs. Non-survivors showed a significantly lower serum albumin concentration and BCS than survivors. Non-responders, relapsed or non-survivors had higher presence of lacteal dilatation compared to long-term responders. Dogs with IRE showed a good clinical course with a low relapse rate, with only a few dogs in the NRE group. Reduction of BCS, albumin and lacteal dilatation at diagnosis may be considered negative prognostic factors for response, mortality and long-term disease remission.

Detection of Anti-Erythrocyte Antibodies in Dogs with Inflammatory Bowel Disease (IBD)

Several extra-intestinal manifestations, including immune-mediated cytopenias, are reported in human inflammatory bowel disease (IBD), whereas they are poorly documented in dogs. Hypothesizing that immune-mediated subclinical anemia can occur in canine IBD, the study aim was to evaluate the erythrogram and the presence of anti-RBC antibodies in dogs with IBD. IBD was diagnosed according to the following criteria: chronic gastrointestinal signs, ruling out of extra-intestinal diseases, no improvement with diet trial, histological evidence of inflammatory infiltration, and improvement after immunosuppressant therapy. Canine Chronic Enteropathy Clinical Activity Index (CCECAI) endoscopic and histopathological scores were assessed for each dog. Twenty-five dogs were enrolled, and each dog had a CBC evaluation prior to endoscopy. The CBC was performed using laser hematology analyzer and blood smears were carefully reviewed for the presence of nucleated RBC, anisocytosis, polychromasia, and Howell-Jolly bodies. IgG and IgM anti-RBC antibodies were evaluated with flow cytometry. A high frequency of positive cases for anti-RBC antibodies in dogs with IBD (17/25 dogs) was ascertained. Approximatively 50% of dogs showed some hematologic features of RBC regeneration in addition to hematologic findings consistent with chronic inflammation. Anti-RBC antibodies and signs of erythroid regeneration may suggest possible subclinical chronic immune-mediated hemolysis that can cause anemia in dogs with IBD, together with the chronic inflammation.

Hepatic lead and copper concentrations in dogs with chronic hepatitis and their relationship with hematology, serum biochemistry, and histopathology

BACKGROUND

Although the influence of copper ([Cu]) on chronic hepatitis (CH) has been widely studied in dogs, little information is available about the accumulation of other metals.

HYPOTHESIS/OBJECTIVES

We assessed the concentration of lead ([Pb]) in the livers of dogs with CH with or without abnormal hepatic [Cu] to establish if any association existed between [Pb] and either hematologic or biochemical variables, fibrosis, necrosis and inflammation of the liver on histology.

ANIMALS

Thirty-four dogs with CH that had hepatic [Cu] and [Pb] determined.

METHODS

Retrospective review of medical records of dogs with CH and hepatic [Cu] and [Pb]. Chronic hepatitis was defined using current American College of Veterinary Internal Medicine consensus statement guidelines. Hepatic [Cu] and [Pb] were determined using square wave anodic stripping voltammetry. Dogs were divided into 2 groups based on [Cu]: <400 ppm (LoCu) and ≥400 ppm (HiCu).

RESULTS

The median [Cu] and [Pb] were 357 ppm (range, 100-7743 ppm) and 58.7 (range, 6.89-224.4 ppm), respectively. Nineteen dogs had LoCu and 15 dogs had HiCu. Median [Pb] was significantly higher in HiCu compared to LoCu dogs (P < .001). Hepatic [Pb] and [Cu] were significantly correlated (rho = 0.7; P < .001). Dogs with microcytosis had higher [Pb] than did dogs with normal red cell volume (P = .02). Hepatic [Pb] was not correlated with either necroinflammatory or fibrosis scores.

CONCLUSIONS AND CLINICAL IMPORTANCE

Although additional studies are needed to better understand the clinical role of hepatic [Pb], dogs with abnormal hepatic [Cu] may also have higher hepatic [Pb]. In addition, in dogs with high hepatic [Pb], microcytosis may be present.

Evaluation of duodenal endoscopic and histologic findings, including counts of forkhead box P3-positive regulatory T cells, in dogs with immunosuppressant-responsive enteropathy

OBJECTIVE

To prospectively evaluate the clinical and prognostic importance of duodenal endoscopic and histologic findings, including duodenal mucosal counts of forkhead box P3-positive regulatory T cells (Foxp3+ Tregs), in dogs with immunosuppressant-responsive enteropathy (IRE).

ANIMALS

57 client-owned dogs with IRE.

PROCEDURES

The canine chronic enteropathy clinical activity index (CCECAI) was used to assess each dog when IRE was diagnosed (T0) and 1, 3, 6, and 12 months later. Dogs were grouped on the basis of clinical response (responder group vs nonresponder group) and 12-month long-term outcome (responded to treatment and did not relapse [good outcome group] vs did not respond to treatment or had relapsed [bad outcome group]). At T0, dogs underwent gastrointestinal endoscopy and endoscopic biopsy, with results for variables of duodenal endoscopic and histologic evaluations scored and compared across groups.

RESULTS

At T0, the overall median CCECAI score was 7; CCECAI score was not associated with clinical response or relapse. Dogs had significantly greater odds of being in the bad outcome group (vs the good outcome group) if they had a histologic score of 3 (OR, 3.5; 95% CI, 1.09 to 11.3). No differences in the counts of Foxp3+ Tregs were detected between groups.

CONCLUSIONS AND CLINICAL RELEVANCE

In dogs with IRE, results indicated that evaluation of Foxp3+ Tregs did not have prognostic value, whereas a duodenal histologic score of 3 could be a negative prognostic factor for response and relapse, and higher severity scores for intraepithelial lymphocytes and lamina propria lymphocytes and plasma cells in duodenal biopsy samples may be negatively associated with response.

Serum Total Thyroxine Evaluation in Critically Ill Feline Patients

This retrospective case control study compared serum total thyroxine (tT4) concentrations in hospitalized critical cats (CCs) and non-hospitalized cats with non-thyroidal chronic diseases (chronic group, CG) and evaluated the relationship between the serum tT4 concentration of CCs and systemic inflammation (systemic inflammatory response syndrome (SIRS)), disease severity (Acute Patient Physiologic and Laboratory Evaluation (APPLEfast)), and prognosis. Cats with previously suspected or diagnosed thyroid disease were excluded. Serum tT4 was evaluated in surplus serum samples at the time of admission for CCs and CGs. The APPLEfast score of the CC group was calculated at admission. The systemic inflammatory response syndrome (SIRS) in CCs was determined using proposed criteria. Cats were divided into survivors and non-survivors according to the discharge outcome. Forty-nine cats were retrospectively included. Twenty-seven cats died during hospitalization. The CG group was composed of 37 cats. The CC group showed a significantly lower tT4 compared to the CG group (1.3 ± 0.7 vs. 2 ± 0.9; p < 0.0001). Among SIRS, APPLEfast, and tT4, only tT4 was associated with mortality (p = 0.04). The tT4 cut-off point for mortality was 1.65 μg/dL (sensitivity 81%, specificity 57%, odds ratio (OR) 5.6). Twenty-five cats (51%) had SIRS that was not associated with tT4. Non-thyroidal illness syndrome can occur in critically ill cats and the evaluation of tT4 in hospitalized cats could add prognostic information.

Platelet abnormalities and platelet-to-lymphocyte ratios in canine immunosuppressant-responsive and non-responsive enteropathy: A retrospective study in 41 dogs

Few studies have examined platelet alterations in dogs with chronic enteropathy. Our aim was to investigate platelet count (PLT), mean platelet volume (MPV), and platelet-to-lymphocyte ratio (PLR) in dogs diagnosed with immunosuppressant-responsive enteropathy (IRE). In this retrospective study of 41 dogs, data regarding signalment, canine chronic enteropathy clinical activity index (CCECAI), endoscopic and histopathological scores, PLT, MPV, PLR, total serum protein concentrations, albumin, and iron were collected. Clinical response and relapse were assessed with the evaluation of CCECAI over time. One month after starting therapy, dogs with >25% CCECAI reduction were considered responders. During a three-month CCECAI evaluation as part of a twelve-month follow-up, a CCECAI >3 together with a ≥2 unit increase in responder dogs was considered a relapse. PLT and PLR displayed significant negative correlation with MPV. MPV was positively correlated with total protein and albumin levels and negatively correlated with CCECAI. Three dogs were classified as non-responders, and 14 relapsed within 12 months. No differences were observed in PLT, MPV, or PLR between responding/non-responding and relapsing/non-relapsing groups. PLT, MPV, and PLR correlated with total protein, albumin, and CCECAI, confirming PLT as a potential marker, and suggesting MPV as a new marker of clinical efficacy against canine IRE.

SARS-CoV-2 Seroprevalence Survey in People Involved in Different Essential Activities during the General Lock-Down Phase in the Province of Prato (Tuscany, Italy)

Serosurveys may help to assess the transmission dynamics in high-risk groups. The aim of the study was to assess the SARS-CoV-2 antibody seroprevalence in people who had performed essential activities during the lock-down period in the Province of Prato (Italy), and to evaluate the risk of exposure to SARS-CoV-2 according to the type of service. All the workers and volunteers of the Civil Protection, employees of the municipalities, and all the staff of the Health Authority of the Province of Prato were invited to be tested with a rapid serological test. A total of 4656 participants were tested. SARS-CoV-2 antibodies were found in 138 (2.96%) cases. The seroprevalence in health care workers, in participants involved in essential support services and in those who worked from home were 4.1%, 1.4% and 1.0%, respectively. Health care workers experienced higher odds of seropositivity (OR 4.38, 95%CI 2.19–10.41) than participants who were assigned to work-from-home; no significant seropositivity differences were observed between support services and work-from-home groups. A low circulation of SARS-CoV-2 was observed among participants performing different essential activities. Findings highlighted the risk of in-hospital transmission in healthcare workers and that community support services may increase the risk of seropositivity to a limited extent in low incidence areas.

Oesophagostomy tube complications in azotaemic dogs: 139 cases (2015 to 2019)

OBJECTIVES

To retrospectively assess the rate of oesophagostomy tube-related complications in azotaemic dogs, the influence of the oesophagostomy tube (o-tube) duration and the therapeutic approach (medical versus haemodialysis) on the complication rate.

MATERIALS AND METHODS

Medical records were retrospectively reviewed in order to identify azotaemic dogswhich underwent o-tube placement. o-Tube duration (short-term versus long-term), time of o-tube change, therapeutic approach (medical versus haemodialysis), prevalence of minor (malposition, suture related, inflammation, muco-purulent discharge, abscess) and major (haemorrhage, malposition, obstruction, dislodgement, vomiting of the tube, food coming from the stoma) o-tube-related complications were extracted. Univariate and multivariate logistic regression analysis were performed to identify the risk factors for o-tube-related complications.

RESULTS

Tube-related complications were reported in 74 of 139 dogs (53%). Minor complications were reported in 66 of 74 (89%) and major complications in eight of 74 (11%). In azotaemic dogs, o-tube indwelling time (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.01 to 1.05), and the use of haemodialysis (OR 40.12; 95% CI 9.18 to 175.20) were risk factors for o-tube-related complications.

CLINICAL SIGNIFICANCE

The majority of o-tube-related complications were minor, and easily manageable, with no need of hospitalisation, tube-removal or euthanasia. In azotaemic dogs, the use of haemodialysis was strongly associated with a higher risk of o-tube-related complications, possibly as a consequence of the presence of the neck bandage.

Rapid and simultaneous electrochemical method to measure copper and lead in canine liver biopsy

The conventional analytical techniques used for the quantitative analysis of heavy metals in animal tissues are the atomic absorption spectroscopy (AAS) and the inductively-coupled plasma mass spectrometry (ICP-MS). These methods involve high cost, skilled personnel and long analysis times. Several studies have shown the applicability of electrochemical transducer coupled to disposable screen-printed electrodes (SPE) for measuring metals. The aim of the present study was to applicate and validate a simple and fast protocol for the simultaneous measurement of Cu and Pb concentrations in canine liver biopsy, coupling a simple digestion procedure with electrochemical stripping analysis. Square wave anodic stripping voltammetry (SWASV) coupled to disposable SPE was employed as fast and sensitive method for metals detection. Samples were digested with hydrogen peroxide/hydrochloric acid mixture for 1 h coupled to solid phase purification with carbon columns. Instrumental precision, digestion procedure accuracy and limits of detections were evaluated. To validate the proposed method the metal concentrations have also been determined by AAS. Instrumental precision and digestion method accuracy were less than 15.3% and 16.8% for Cu and Pb, respectively. The limits of detection were 10 and 6 mg/kg dry weight in liver samples for Cu and Pb, respectively. The results obtained by the electrochemical method are in agreement with those of the reference method. The obtained results showed a reliable approach for Cu and Pb detection simultaneously with good sensitivity, accuracy and precision. The simple sample pre-treatment together with the low cost makes this approach particularly appealing for Cu and Pb quantification for diagnostic purposes.•

Simultaneous determination of Cu and Pb concentrations in canine liver biopsy.

•

Square wave anodic stripping voltammetry (SWASV) with screen-printed electrodes (SPE) coupled to an acid digestion protocol.

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Cu and Pb were measured with a very good sensitivity and accuracy.

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Good agreement with AAS reference method.

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Low cost, fast and sensitive method for diagnostic purposes.

Ultrasonographic Monitoring in 38 Dogs with Clinically Suspected Acute Pancreatitis

Abdominal ultrasound examinations (AUEs) are commonly used in the diagnostic evaluation of canine acute pancreatitis (AP). The purpose of this retrospective study was to evaluate and monitor the ultrasonographic changes observed in dogs with clinically suspected AP on consecutive AUEs. The study population was constituted by 38 client-owned dogs hospitalized for no less than 48 h from January 2016 to December 2019. Dogs included in this study were suspected of AP based on the clinical examination and abnormal rapid specific canine pancreatic lipase test performed at admission. Dogs were submitted to two AUEs, the first on the first day of hospitalization, and the second between 40–52 h after the first one. Twelve dogs had both AUEs suggestive of AP. Fourteen dogs received an ultrasonographic diagnosis of AP exclusively on the second AUE. Twelve dogs remained negative on both the first and the second AUE. In 26 out of 38 patients the second AUE was suggestive of AP. If a patient is suspected of AP, it is advisable to carry out ultrasonographic monitoring at least within the first 52 h after admission, since ultrasonographic signs of AP may only become observable later after hospitalization.

Serum homocysteine concentration in dogs with immunosuppressant-responsive enteropathy

Background

Homocysteine (HCY) was evaluated in healthy and chronic enteropathic dogs, however no studies on dogs with immunosuppressant-responsive enteropathy are available.

Objectives

The aim was to evaluate serum HCY concentrations and its prognostic role in dogs with immunosuppressant-responsive enteropathy compared to healthy dogs.

Methods

Serum HCY concentration was statistically compared between 24 healthy dogs and 29 dogs with immunosuppressant-responsive enteropathy. Correlation analyses between serum total protein, albumin (ALB), C-reactive protein (CRP), folate and cobalamin, and serum HCY concentration were performed in immunosuppressant-responsive enteropathic dogs.

Results

The associations between serum HCY concentration and clinical, histological, endoscopic scores and follow-up were evaluated. Mean serum HCY concentration was higher in immunosuppressant-responsive enteropathic dogs compared to control dogs (30.22 ± 8.67 µmol/L vs. 5.26 ± 2.78 µmol/L; p < 0.0001). No association between serum HCY concentration and total protein, ALB, CRP, folate concentration as well as, clinical score, histological and endoscopic scores was found. A negative correlation between serum HCY concentration and cobalamin was noted (p = 0.0025, r = −0.54). No significant difference in HCY was found between responsive and non-responsive dogs or between survivors and non-survivors.

Conclusions

Although, serum HCY concentration was higher in immunosuppressant-responsive enteropathy, its prognostic value remains unclear. However, further prospective, large-scale studies are warranted to better investigate the possible prognostic role of HCY in immunosuppressant-responsive enteropathic dogs.

Are Leukocyte and Platelet Abnormalities and Complete Blood Count Ratios Potential Prognostic Markers in Canine Sepsis?

Background: Sepsis is a common disease in which early diagnosis and prognosis assessment are the main aims in order to arrange a prompt and effective treatment. Objectives: (1) To compare leukogram parameters (WBC, segmented and band neutrophils, lymphocytes, monocytes), platelet count (PLT), mean platelet volume (MPV), and some leukocyte/platelet ratio such as NLR, NBNLR, PLR, and MLR between dogs with systemic inflammatory response syndrome (SIRS) and sepsis. (2) To investigate any difference in the trend of these latter parameters between survivors and non-survivors septic dogs. Animals: 57 dogs with confirmed sepsis and 57 dogs with non-septic SIRS. Methods: A review of the medical records was conducted in order to find dogs with sepsis. Sepsis was defined as the presence of an infectious focus with fulfillment of systemic inflammatory response syndrome criteria (SIRS). Septic dogs had to have a CBC at admission and another CBC within 48 h from the previous timepoint. Purebreds with CBC breed-related abnormalities were excluded, together with dogs without confirmed sepsis and dogs with only a single CBC. NLR, NBNLR, PLR, and MLR were calculated. Univariate analysis of all blood parameters studied was assessed between SIRS and septic dogs. Generalized Estimating Equations models for repeated measures were used to test if the blood parameters studied were modified between survivors and non-survivors in the septic group. Results: Septic dogs had lower median segmented neutrophils count and NLR compared to SIRS dogs (p = 0.02 and p = 0.04, respectively). Lastly, septic dogs had a higher prevalence of toxic neutrophil than SIRS dogs (p = 0.01). We found that for a 1-unit increase of PLR and MLR, the risk of death increased by 50.5 and 60%, respectively. Conclusion and Clinical Importance: Evaluation of NLR at hospital admission may be a useful marker of inflammation, although it showed low sensitivity in differentiating SIRS and septic dogs. The monitoring of some CBC parameters, especially PLR and MLR may be useful in the establishment of prognosis in septic dogs.

Design, synthesis and biological evaluation of second-generation benzoylpiperidine derivatives as reversible monoacylglycerol lipase (MAGL) inhibitors

An interesting enzyme of the endocannabinoid system is monoacylglycerol lipase (MAGL). This enzyme, which metabolizes the endocannabinoid 2-arachidonoylglycerol (2-AG), has attracted great interest due to its involvement in several physiological and pathological processes, such as cancer progression. Experimental evidences highlighted some drawbacks associated with the use of irreversible MAGL inhibitors in vivo, therefore the research field concerning reversible inhibitors is rapidly growing. In the present manuscript, the class of benzoylpiperidine-based MAGL inhibitors was further expanded and optimized. Enzymatic assays identified some compounds in the low nanomolar range and steered molecular dynamics simulations predicted the dissociation itinerary of one of the best compounds from the enzyme, confirming the observed structure-activity relationship. Biological evaluation, including assays in intact U937 cells and competitive activity-based protein profiling experiments in mouse brain membranes, confirmed the selectivity of the selected compounds for MAGL versus other components of the endocannabinoid system. An antiproliferative ability in a panel of cancer cell lines highlighted their potential as potential anticancer agents. Future studies on the potential use of these compounds in the clinical setting are also supported by the inhibition of cell growth observed both in cancer organoids derived from high grade serous ovarian cancer patients and in pancreatic ductal adenocarcinoma primary cells, which showed genetic and histological features very similar to the primary tumors.

Neutrophil-to-Lymphocyte Ratio (NLR) in Canine Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease (IBD) is a multifactorial chronic inflammatory disorder leading to structural changes in the intestinal wall. In humans, the neutrophil-to-lymphocyte ratio (NLR) has been proposed as a promising marker of IBD. This study evaluated the possible clinical and prognostic significance of the NLR in dogs with IBD. This retrospective study enrolled 41 dogs diagnosed with IBD presented to University of Pisa from January 2017 to January 2018. For each dog, age, sex, canine chronic enteropathy clinical activity index (CCECAI), endoscopic and histopathological grading were recorded. Complete blood count, serum total protein, albumin, cholesterol, and C-reactive protein at the time of endoscopy were recorded. A control group (CG) of healthy dogs from a blood donor database was built. NLR was calculated for both IBD and CG as the ratio between absolute neutrophils and lymphocytes. Presence of crypt distension, lacteal dilation (LD), mucosal fibrosis, intraepithelial lymphocytes was recorded. Follow-up information was obtained from electronic medical records and dogs were classified as responders and non-responders based on CCECAI variation between admission and the first recheck. IRE dogs showed higher NLR compared to healthy dogs. NLR correlated negatively with total protein, albumin, and cholesterol and correlated positively with CCECAI. Dogs with LD showed higher NLR than dogs without LD. Non-responders showed higher NLR compared to responders. In conclusion, as in IBD human patients, the NLR acts as an inflammatory marker providing further information on severity of the disease and could be useful in predicting treatment response.

Evaluation of C-reactive protein/albumin ratio and its relationship with survival in dogs with acute pancreatitis

Aims: To evaluate the association between the C-reactive protein (CRP)/albumin (ALB) ratio and survival in dogs with acute pancreatitis and its use as a prognostic marker for survival. Methods: Medical records of a veterinary referral hospital in Italy were retrospectively searched for dogs that were admitted with acute pancreatitis between January 2015 and April 2019, in which the concentrations of CRP and ALB in serum were measured at admission. The CRP/ALB ratio was calculated and the time between admission and discharge or death was recorded. Mortality rates overall and for dogs that died within 2 days of admission were calculated. A univariable Cox proportional hazard model was used to assess the relationship between survival time and CRP/ALB ratio. Results: Seventy-one dogs were included in the study. Of these, 19 died within 2 days of presentation; an early mortality rate of 26.8%, while 27 died before discharge for an overall mortality rated of 38%. Dogs with higher CRP/ALB ratio had a significantly greater mortality rate than dogs with lower CRP/ALB ratio: for every 1-unit increase in CRP/ALB ratio, the hazard of death over the study period increased by 130% (hazard ratio = 2.34; 95% CI = 1.53-3.58; p < 0.001). The optimal CRP/ALB ratio cut-off point for predicting mortality was 0.56, with a sensitivity and specificity of 88.9% and 68.2%, respectively (AUC = 0.82; p < 0.001). Conclusions: As in humans, the CRP/ALB ratio, may be a promising, though not particularly specific, prognostic marker for increased risk of death in dogs with acute pancreatitis.

Pulmonary complications in dogs with acute presentation of pancreatitis

Background

In humans, respiratory complications in patients with acute pancreatitis (AP) are a common life-threatening comorbidity. Since possible lung impairment has not been individually evaluated in canine AP, the aims of the present study were to: (1) describe the prevalence, types and severity of pulmonary complications in dogs with acute presentation of AP, and (2) evaluate their association with mortality. AP diagnosis was based on compatible clinical and laboratory parameters, abnormal canine pancreatic-lipase test, and positive abdominal ultrasound within 48 h from admission. The canine acute pancreatitis severity score (CAPS) was calculated for each dog at admission. Arterial blood gas analysis and thoracic radiography were performed at admission. Thoracic radiography was classified on the basis of pulmonary pattern (normal, interstitial or alveolar) and a modified lung injury score (mLIS) was applied to the ventrodorsal projections for each dog. VetALI/VetARDS were diagnosed using current veterinary consensus. Dogs were divided into non-survivors or survivors (hospital discharge). Clinical, radiological and blood gas parameters collected at presentation were compared between survivors and non-survivors and associated with mortality.

Results

This prospective cohort study included twenty-six client-owned dogs with AP. Twelve out of twenty-six dogs (46%) died or were euthanized. At admission, thirteen dogs showed respiratory distress at physical examination, which was associated with death (P < 0.001). Radiographic abnormalities were found in twenty-one dogs: alveolar (n = 11) and interstitial pattern (n = 10). Radiographic alterations and mLIS score were both associated with death (P = 0.02 and P = 0.0023). The results of the arterial blood-gas evaluation showed that non-survivors had lower PaCO₂ and HCO₃⁻ levels, and higher A-a gradient than survivors (P = 0.0014, P = 0.019 and P = 0.004, respectively). Specifically, three dogs had aspiration pneumonia, and VetALI was diagnosed in nine dogs (34.6%), and no dogs met the criteria for VetARDS. The presence of VetALI was associated with mortality (P < 0.001).

Conclusions

As with humans, possible lung impairments, such as VetALI, should be investigated in dogs with acute presentation of pancreatitis.

Evaluation of Symmetric Dimethylarginine (SDMA) in Dogs with Acute Pancreatitis

Symmetric dimethylarginine (SDMA) is considered an important biomarker of kidney dysfunction. The aims of the study were to evaluate SDMA in dogs with acute pancreatitis (AP) and its relationship with the presence of kidney injury and mortality. A cohort study including fifty-four dogs with AP diagnosed using compatible clinical and laboratory parameters, abnormal SNAP cPL and compatible abdominal ultrasound within 48 h from admission, was conducted. Dogs with history of renal and/or urinary diseases were excluded, along with dogs exposed to nephrotoxic drugs. Serum urea and creatinine and urinary output (UO) were recorded. Acute kidney injury (AKI) was diagnosed and graded using International Renal Interest Society (IRIS) guidelines. SDMA was measured using high performance liquid chromatography. Fifty-four dogs were included and divided in non-AKI (n = 37) and AKI dogs (n = 17). Twenty-three dogs (14 non-AKI) had SDMA > 15 μg/dL. Median SDMA was higher in AKI dogs than non-AKI dogs (25.7 vs. 13.93 μg/dL; p = 0.03). Dogs with normal creatinine (AP and AKI 1 dogs) had SDMA above reference range in 38% and 33% of cases, respectively. In AKI dogs, SDMA and creatinine were positively correlated (p = 0.006 r = 0.7). SDMA was not significantly different between survivors and non-survivors. Although further studies are warranted, SDMA may be a useful tool in canine AP, as a high SDMA may be related to subclinical kidney impairment.

Evaluation of asymmetric dimethylarginine as an inflammatory and prognostic marker in dogs with acute pancreatitis

Background

Asymmetric dimethylarginine (ADMA) has been proposed as a severity marker in humans with acute pancreatitis (AP).

Objectives

To evaluate ADMA in dogs with AP compared with healthy dogs and its association with severity of disease, mortality, and indicators of the systemic inflammatory response syndrome (SIRS), including serum C‐reactive protein (CRP) concentration, WBC count, and band neutrophils.

Animals

Fifty‐four dogs with AP and a control group (CG) of 28 healthy dogs.

Methods

Cohort study including dogs with AP diagnosed using clinical and laboratory variables, abnormal canine pancreatic lipase (cPL) concentration, and compatible abdominal ultrasound examination findings performed within 48 hours of admission. Canine AP severity (CAPS) was calculated. Serum concentration of ADMA was measured using high performance liquid chromatography. Blood donor‐, staff‐, and student‐owned dogs were enrolled in the CG.

Results

Dogs with AP had higher median admission serum ADMA concentrations compared with the CG (62 versus 48.5 μg/dL; P = .003). Dogs with CAPS ≥11 had higher serum ADMA concentrations than did dogs with CAPS <11 (92 versus 54.6 μg/dL P = .009). Univariable analysis for mortality, CAPS score, band neutrophils, CRP, and ADMA were included in multivariable logistic regression, in which only ADMA was associated with mortality (P = .02). Survivors had a significant decrease in ADMA at first reevaluation compared to admission (P = .02).

Conclusions and Clinical Importance

Because serum ADMA concentrations were higher in AP dogs compared with the CG, it may have value as a biomarker in the diagnosis of AP in dogs. In addition, because ADMA was associated with mortality, it may have prognostic value.

Serum amino acid profile in 51 dogs with immunosuppressant-responsive enteropathy (IRE): a pilot study on clinical aspects and outcomes

Background

Lower levels of tryptophan (TRP) have been identified in people with inflammatory bowel disease and in dogs with protein-losing enteropathy (PLE). No data on serum amino acids (AAs) but some on plasma in canine immunosuppressant-responsive enteropathy (IRE) are available. The aim of this study is to compare serum AAs between healthy and IRE dogs, considering clinicopathological variables and follow-up.

Results

Twenty-six healthy control dogs (CD) and 51 IRE dogs were included. IRE was diagnosed after the exclusion of extra-intestinal diseases and food and antibiotic responsive enteropathies. The canine chronic enteropathy clinical activity index (CCECAI) was assessed at presentation and during the clinical follow-up. In CD and IRE dogs, 19 different serum AAs were measured. IRE dogs were classified into responders, partial responders and non-responders, based on CCECAI after 1 month, and divided into PLE and non-PLE, based on albumin level. IRE dogs showed lower L-Tyrosine (TYR), L-Phenylalanine (PHE) and TRP (p < 0.001) and higher L-Serine (SER), L-Glutamic acid (GLU), L-Arginine (p < 0.001), L-Threonine (p = 0.013), Proline (p = 0.044), L-Cysteine (p = 0.003), L-Valine (p = 0.018), L-Lysine (p = 0.01) and L-Isoleucine (p = 0.005) than CDs. PLE dogs showed lower L-Histidine (HIS) (p = 0.008), PHE (p = 0.005) and TRP (p = 0.005) than non-PLE dogs. In IRE dogs, median GLU was significantly lower in dogs with BCS 3/9 than BCS 5/9 category (p = 0.036). Total protein was positively correlated with PHE and TRP (both p = 0.031, r = 0.30) and albumin was positively correlated with HIS (p = 0.025, r = 0.31), PHE and TRP (both p = 0.001, r = 0.46). HIS (p = 0.041), PHE (p = 0.047) and TRP (p = 0.044) concentrations were significantly lower in non-responders than in responders and partial responders.

Conclusions

This study may suggest further investigation on serum, HIS, PHE, TRP and TYR as markers of intestinal disease and proposed HIS, PHE and TRP as prognostic marker for response to therapy.

The guaiac-based fecal occult blood test in healthy dogs: Evaluation of the effects of diet, and the ability of the test to detect fecal occult blood

BACKGROUND

The guaiac-based fecal occult blood test (gFOBt) has been used for human colorectal cancer screening. It can detect the fecal occult blood (FOB) in dogs after oral administration of 20 mg of hemoglobin/kg body weight of blood and is influenced by diet.

OBJECTIVES

The aims were to evaluate the effect of diet and the ability of gFOBt to detect FOB in healthy dogs after oral administration of autologous blood.

METHODS

Five healthy dogs were fed Purina Hypoallergenic (HA) and Gastrointestinal (EN) diets. Feces were tested with gFOBt before starting diets and at each defecation (hereafter referred to as fecal collection event) throughout the study period. Every 4 days, increased doses of autologous blood were administered orally. The whole blood of one dog was progressively diluted with a saline solution, and dilutions were directly tested with the gFOBt, until a negative result was found.

RESULTS

Twelve of 185 (6.5%) gFOBt were found to be positive. No associations between diet and gFOBt positivity were found. A significant association was found between the fecal collection event and gFOBt positivity (P < .001) and between doses of blood and gFOBt positivity (P = .048). The lowest dilution ensuring all positive tests was 6.5 µg_Hgb /mL.

CONCLUSIONS

The gFOBt was not influenced by either the HA or EN diets. The gFOBt positivity was associated with the dose of blood and the fecal collection event. However, caution is needed in the interpretation of results due to the lack of an association between gFOBt positivity and increasing doses of blood in the same dog.

Neutrophil-to-lymphocyte ratio, nucleated red blood cells and erythrocyte abnormalities in canine systemic inflammatory response syndrome

Systemic inflammatory response syndrome (SIRS) is the manifestation of the systemic response to an infectious or non-infectious disease. We evaluated the association between erythrocyte parameters, including nucleated red blood cells (NRBCs) and leukocyte ratios (NLR, neutrophil-to-lymphocyte ratio; BLR, band neutrophil-to-lymphocyte ratio; BLNR, band neutrophil-to-neutrophil-to-lymphocyte ratio). A review of the medical records was conducted searching SIRS dogs among those admitted to our intensive care unit and a SIRS grading was obtained based on how many criteria were fulfilled. The Acute Patient Physiology and Laboratory Evaluation (APPLE_fast) score was assessed in each dog. Survival rate was assessed 15 days after admission. Dogs with clinical and/or clinicopathological signs of hemolytic or hemorrhagic disorders were excluded. Dogs with ≥2 criteria of SIRS along with a documented underlying infectious cause were recorded as septic (32/90, 35%). A SIRS grading >2 (p = .001) and an APPLE_fast score > 25 (p = .03) were associated with mortality. Twenty-two of SIRS dogs (24%) showed circulating NRBCs. The occurrence of circulating NRBCs was associated with the mortality in SIRS groups (p = .0025). The median NLR was 11.69 and NLR was lower in septic dogs compared to non-septic ones (p = .0272). APPLE_fast, SIRS grading and circulating NRBCs may be considered as negative prognostic factors in canine SIRS. NLR could be a useful tool in dogs with SIRS, which was significantly lower in the septic group. Further prospective, large-scale studies investigating BLR and BNLR in canine SIRS are warranted.

Epidemiology of Breed-Related Mast Cell Tumour Occurrence and Prognostic Significance of Clinical Features in a Defined Population of Dogs in West-Central Italy

Canine mast cell tumours (MCTs) present a wide variety of challenging clinical behaviours in terms of predicting the prognosis and choosing appropriate treatment. This study investigated the frequency, risk, and prognostic factors of MCTs in dogs admitted to a single veterinary teaching hospital (VTH). Breed, age, sex, and sexual status in ninety-eight dogs with MCTs (MCT-group) were compared with a control group of 13,077 dogs (VTH-group) obtained from the VTH clinical database from January 2010 to January 2016. Within the MCT-group, signalment, location, size, mass number, ulceration, histopathological grading, presence of lymph node, or distant metastases were compared with each other and with the outcome. Boxers (OR 7.2), American Pit Bull Terriers (OR 5.4), French Bulldogs (OR 4.4) and Labrador Retrievers (OR 2.6) were overrepresented. The MCT-group was significantly older than the VTH-group (p < 0.0001). In comparison with the VTH group, in the MCT-group neutered dogs (OR 2.1) and spayed females (OR 2.3) were predominant compared to intact dogs and intact females, respectively. Ulceration (OR 5.2) and lymph node metastasis (OR 7.1) occurred more frequently in larger MCTs. Both ulceration and MCTs > 3 cm were highly associated with lymph node metastasis (OR 24.8). Recurrence was associated with MCT-related death (OR 10.50, p = 0.0040), and the latter was associated with shorter survival times (p = 0.0115). Dogs with MCTs > 3 cm (p = 0.0040), lymph node metastasis (p = 0.0234), or elevated WHO stage (p = 0.0158) had shorter survival times. A significantly higher frequency of MCTs was found in specific breeds, and in older and neutered dogs. MCTs > 3 cm and lymph node or distant metastases were associated with shorter survival times.

Urinalysis and Urinary GGT-to-Urinary Creatinine Ratio in Dogs with Acute Pancreatitis

In acute pancreatitis (AP), kidney injury (KI) can occur. Urinalysis and some urinary biomarkers have been proposed as prognostic tools in human AP. The aim of the study was to evaluate urinalysis and urinary GGT-to-urinary creatinine (uGGT/uCr) in canine AP and their association with possible outcomes. AP diagnosis was based on clinical and laboratory parameters, abnormal SNAP^® cPL™ test and compatible imaging. Urinary KI (uKI) was defined if dogs had urinary casts and/or proteinuria. Dogs (n = 70) were divided in survivors and non-survivors according to the 15-day outcome. Data were analyzed using statistical software. Seventy dogs were retrospectively included, of which 24 dogs (34%) died. uKI was detected in 36 dogs (37%) which was associated with mortality (p = 0.01, Odds ratio (OR) 3.9, 95% CI 1.3–11.56). Non-survivors showed higher dipstick bilirubin levels than survivors (p = 0.0022). By excluding active sediments, urine protein-to-creatinine ratio (UPC) ≥2 was associated with mortality (p = 0.001, OR 47.5, 95% CI 4–571.9). The uGGT/uCr was available in 40 dogs, although no association of this factor with any outcome was found. The UPC ≥2 can be a negative prognostic factor in canine AP and further studies on uGGT/uCr are warranted.

Acute pancreatitis and acute kidney injury in dogs

Acute pancreatitis and acute kidney injury are well-documented comorbidities in human medicine. Dogs that develop acute kidney injury during hospitalization have significantly higher mortality rates than those that do not. The aim of this study was to evaluate the prevalence of acute kidney injury in dogs with acute pancreatitis and the prognostic value of various clinicopathological parameters. Cases of acute pancreatitis presented between January 2012 and June 2016 were identified. The diagnosis of acute pancreatitis was based on two or more of the following clinical signs: abdominal pain, diarrhea, vomiting or anorexia/hyporexia, no other abdominal extra-pancreatic diseases at abdominal ultrasound, and abnormal SNAP cPL test. Diagnosis of acute kidney injury was based on the guidelines of the International Renal Interest Society. Dogs were classified into survivors and non-survivors. Serum creatinine, urea, amylase, total calcium, total cholesterol, C-reactive protein, WBC and band neutrophils were evaluated at admission. Clinical severity index was calculated at admission. Clinical and clinicopathological data were compared between survivors and non-survivors. Sixty-five dogs with acute pancreatitis were assessed. Clinical severity index≥6.5 were associated with poor outcome (P=0.0011). Serum urea and creatinine concentrations at admission were significantly lower in survivors than non-survivors (P<0.0001 and P=0.0002, respectively). Acute kidney injury was diagnosed in 17/65 dogs (26.2%) and was associated with poor outcome (P<0.0001). Oligo-anuria was associated with poor outcome (P=0.0294). Increased clinical severity index and azotemia in dogs with acute pancreatitis were associated with an increased risk of mortality. Acute kidney injury may be a comorbidity of canine acute pancreatitis. The presence of oligo-anuria is associated with poor outcome.

LARS™ in ACL reconstruction: evaluation of 60 cases with 5-year minimum follow-up

PURPOSE

The injury of anterior cruciate ligament (ACL) causes joint instability and, in the absence of adequate treatment, progressive joint deterioration, meniscal lesions and development of post-traumatic osteoarthritis.

METHODS

The purpose of this study was to evaluate the clinical, functional and radiographic outcomes and complications in a consecutive case series of 60 patients with minimum follow-up of 5 years who underwent an arthroscopic surgery for ACL reconstruction using LARS™ ligament. Patients with concomitant meniscal or chondral lesions in the same knee were excluded.

RESULTS

The subjective evaluation of the patients involved in the study (Lysholm score, IKDC score and Tegner activity level scale) shows good/excellent results. The range of movement is optimal in most patients, and pain symptoms are considered mild. A total of 31.25% of the patients did not change their lifestyle that they had before the injury. None of the patients underwent resurgery in the same knee. In 85.4% of cases, X-ray images showed no signs of osteoarthritis after ACL reconstruction.

CONCLUSIONS

Comparable with other series showed in the literature, this study assesses that the use of LARS™ in reconstruction of ACL is an excellent option for treating >40-year-old patients requesting rapid return to daily activities/sports also at the first surgery. By restoring knee stability, articular degeneration at short and medium follow-up was avoided.

[Effects of dose of erythropoiesis stimulating agents on cardiovascular outcomes, quality of life and costs of haemodialysis. the clinical evaluation of the DOSe of erythropoietins (C.E. DOSE) Trial]

BACKGROUND

Anaemia is a risk factor for death, adverse cardiovascular outcomes and poor quality of life in patients with chronic kidney disease (CKD). Erythropoietin Stimulating Agents (ESA) are the most used treatment option. In observational studies, higher haemoglobin (Hb) levels (around 11-13 g/dL) are associated with improved survival and quality of life compared to Hb levels around 9-10 g/dL. Randomized studies found that targeting higher Hb levels with ESA causes an increased risk of death, mainly due to adverse cardiovascular outcomes. It is possible that this is mediated by ESA dose rather than haemoglobin concentration, although this hypothesis has never been formally tested.

METHODS

We present the protocol of the Clinical Evaluation of the Dose of Erythropoietins (C.E. DOSE) trial, which will assess the benefits and harms of a high versus a low ESA dose therapeutic strategy for the management of anaemia of end stage kidney disease (ESKD). This is a randomized, prospective open label blinded end-point (PROBE) design trial due to enroll 900 haemodialysis patients. Patients will be randomized 1:1 to 4000 UI/week i. v. versus 18000 UI/week i. v. of epoetin alfa, beta or any other epoetin in equivalent doses. The primary outcome of the trial is a composite of cardiovascular events. In addition, quality of life and costs of these two strategies will be assessed. The study has been approved and funded by the Italian Agency of Drugs (Agenzia Italiana del Farmaco (AIFA)) within the 2006 funding plan for independent research on drugs (registered at www.clinicaltrials.gov (NCT00827021)).

Cryotherapy in the prevention of oral mucositis in patients receiving low-dose methotrexate following myeloablative allogeneic stem cell transplantation: a prospective randomized study of the Gruppo Italiano Trapianto di Midollo Osseo nurses group

Severe oral mucositis is a major cause of morbidity following allogeneic hematopoietic stem cell transplantation (AHSCT). Cryotherapy, that is, the application of ice chips on the mucosa of the oral cavity during the administration of antineoplastic agents, may reduce the incidence and severity of chemotherapy-related oral mucositis. In this multicenter randomized study, we addressed whether cryotherapy during MTX administration is effective in the prevention of severe oral mucositis in patients undergoing myeloablative AHSCT. One hundred and thirty patients undergoing myeloablative AHSCT and MTX-containing GVHD prophylaxis were enrolled and randomized to receive or not receive cryotherapy during MTX administration. The incidence of severe (grade 3-4) oral mucositis, the primary end point of the study, was comparable in patients receiving or not cryotherapy. Moreover, no difference was observed in the incidence of oral mucositis grade 2-4 and the duration of oral mucositis grade 3-4 or 2-4, or in the kinetics of mucositis over time. In univariate and multivariate analysis, severe oral mucositis correlated with TBI in the conditioning regimen and lack of folinic acid rescue following MTX administration. Thus, cryotherapy during MTX administration does not reduce severe oral mucositis in patients undergoing myeloablative allogeneic HSCT. Future studies will assess cryotherapy before allogeneic HSCT.

[Changes is Th1/Th2 balance in hemodialysis patients: effect of different membranes]

BACKGROUND

Hemodialysis (HD) patients present an immunodeficiency that is mainly related to the defect of cell-mediated immunity. We have previously shown the polarisation of T-helper cells toward the phenotype in HD treatment with cuprophan membrane. In the present study, we have examined the effect of a Vitamin E-coated dialyser (Excebrane, VE) on the activity of the two Th subsets.

METHODS

We studied 8 healthy controls and 10 patients on RDT for at least 6 months with cellulose membrane (AC), then switched to HD-VE. Blood was collected from HD patients while on treatment with AC, and after 1 year of treatment with VE. CD4+ cells were isolated from peripheral blood mononuclear cells (PBMC) by negative selection, treating PBMC with a cocktail of anti-CD8, -CD16, -CD19, -CD36 and -CD56 antibodies labelled with magnetic beads, and passing them through a magnetic field. The collected Th cells were cultured for 48 h with and without phytohemagglutinin (PHA). IFNgamma and IL-4 were measured in the supernatant using the ELISA assay.

RESULTS

The constitutive release of IL-4 by CD4+ cells was abated significantly by treatment with VE. IFNgamma released by mitogen-stimulated CD4+ recovered with VE.

CONCLUSIONS

This study demonstrates that treatment with vitamin E-coated dialyser improves the defect of PBMC function associated with cellulose membrane dialyser consisting of altered spontaneous and mitogen-stimulated cytokine release. The effects of vitamin E-coated filter, in particular the recovery of reactive IFNgamma production by Th1 cells and the restriction of spontaneous IL-4 release by Th2 cells may have clinical importance.