Diagnostic findings in sinonasal aspergillosis in dogs in the United Kingdom: 475 cases (2011-2021)

OBJECTIVES

To describe the diagnostic tests used and their comparative performance in dogs diagnosed with sinonasal aspergillosis in the United Kingdom. A secondary objective was to describe the signalment, clinical findings and common clinicopathologic abnormalities in sinonasal aspergillosis.

MATERIALS AND METHODS

A multi-centre retrospective survey was performed involving 23 referral centres in the United Kingdom to identify dogs diagnosed with sinonasal aspergillosis from January 2011 to December 2021. Dogs were included if fungal plaques were seen during rhinoscopy or if ancillary testing (via histopathology, culture, cytology, serology or PCR) was positive and other differential diagnoses were excluded.

RESULTS

A total of 662 cases were entered into the database across the 23 referral centres. Four hundred and seventy-five cases met the study inclusion criteria. Of these, 419 dogs had fungal plaques and compatible clinical signs. Fungal plaques were not seen in 56 dogs with turbinate destruction that had compatible clinical signs and a positive ancillary test result. Ancillary diagnostics were performed in 312 of 419 (74%) dogs with observed fungal plaques permitting calculation of sensitivity of cytology as 67%, fungal culture 59%, histopathology 47% and PCR 71%.

CLINICAL SIGNIFICANCE

The sensitivities of ancillary diagnostics in this study were lower than previously reported challenging the clinical utility of such tests in sinonasal aspergillosis. Treatment and management decisions should be based on a combination of diagnostics including imaging findings, visual inspection, and ancillary testing, rather than ancillary tests alone.

Gall bladder ejection fractions in dogs investigated for chronic altered appetite: 14 cases (2015-2017)

OBJECTIVES

To determine if gall bladder dysmotility occurs in dogs investigated for chronic altered appetite and to determine if gall bladder dysmotility warrants further investigation as a contributing factor to altered appetite.

MATERIALS AND METHODS

Case series of dogs investigated for chronic gastrointestinal disease. Gastrointestinal clinical signs were assessed before and after a 6-week hydrolysed protein diet. Gall bladder ejection fractions were determined at the end of the 6-week hydrolysed protein diet as part of an investigation that included a full blood cell count, biochemistry, abdominal X-rays and ultrasound. The gall bladder ejections fraction results of dogs with normal appetite were compared to dogs with general inappetence and dogs with diurnal inappetence in the morning.

RESULTS

In this retrospective case series of 14 dogs, altered appetite was the most frequent and persistent clinical sign associated with chronic gastrointestinal disease. Nine dogs had suboptimal gall bladder function and this occurred in dogs with, and without, gravity-dependent biliary sludge. Gall bladder function and volumes of dogs in this study were comparable to those of dogs with nongravity-dependent gall bladder sludge or gall bladder mucoceles in other studies. There was an observable difference in gall bladder ejection fractions between groups defined by appetite but no statistically significant difference was present. Small sample sizes meant the effect size was large.

CLINICAL SIGNIFICANCE

Gall bladder dysmotility and distension can occur in the absence of gall bladder sludge and mucocoeles in younger dogs. Gall bladder dysmotility requires further investigation as a potential contributing factor to altered appetite in dogs.

Clinical characteristics and histology of cholecystectomised dogs with nongravity-dependent biliary sludge: 16 cases (2014-2019)

OBJECTIVES

To report the available histology, biochemistry and clinical progression of dogs without classic overt biliary tract signs that underwent cholecystectomy for nongravity-dependent biliary sludge.

MATERIALS AND METHODS

Case series of client-owned dogs for which a cholecystectomy was performed for nongravity-dependent biliary sludge. In six dogs, for which nongravity-dependent biliary sludge filled less than half of gall bladder volume, gall bladder ejection fractions were measured. Available histology, biochemistry, presenting clinical signs and post-surgical clinical progression were reported.

RESULTS

Sixteen dogs were included in this retrospective case series. No dogs met the histological criteria for gall bladder mucocoeles or had histological evidence of primary hepatitis or cholangitis. Biochemistry was normal for 11 dogs. Hypercholesterolaemia was not noted in any dog. Twelve dogs had cholecystitis (11 lymphoplasmacytic, one neutrophilic) and nine dogs had biliary mucosal hyperplasia. Thirteen dogs had enteritis (12 lymphoplasmacytic, one eosinophilic) and nine dogs had reactive hepatitis (eight lymphoplasmacytic, one neutrophilic). All six dogs with nongravity-dependent biliary sludge that filled less than half of gall bladder volume had sub-optimal gall bladder function. Presenting clinical signs, including diurnal inappetence in the morning and exercise intolerance, resolved in 86% (12/14) of dogs after cholecystectomy and clinical improvement was noted in 81% (13/16) of dogs overall.

CLINICAL SIGNIFICANCE

Duodenal inflammation could potentially impact gall bladder dysmotility in dogs with nongravity-dependent biliary sludge. Furthermore, diurnal inappetence in the morning and exercise intolerance could indicate symptomatic gall bladder disease in dogs with NDBS and can potentially precede more obvious systemic clinical signs associated with gall bladder mucocoeles.

Bacterial Cholangitis, Cholecystitis, or both in Dogs

Background

Bacterial cholangitis and cholecystitis are rarely reported, poorly characterized diseases in the dog.

Objectives

To characterize the clinical features of these conditions.

Animals

Twenty‐seven client‐owned dogs with bacterial cholangitis, cholecystitis, or both.

Methods

Multicenter, retrospective cases series of dogs with bacterial cholangitis, cholecystitis, or both, presenting January 2000 to June 2011 to 4 Veterinary Schools in Ireland/United Kingdom. Interrogation of hospital databases identified all cases with the inclusion criteria; histopathologically confirmed cholangitis or cholecystitis and bile culture/cytology results supporting a bacterial etiology.

Results

Twenty‐seven dogs met the inclusion criteria with approximately 460 hepatitis cases documented over the same study period. Typical clinical pathology findings were increases in liver enzyme activities (25/26), hyperbilirubinemia (20/26), and an inflammatory leukogram (21/24). Ultrasound findings, although nonspecific, aided decision‐making in 25/26 cases. The most frequent hepatobiliary bacterial isolates were Escherichia coli (n = 17; 16 cases), Enterococcus spp. (n = 8; 6 cases), and Clostridium spp. (n = 5; 5 cases). Antimicrobial resistance was an important feature of aerobic isolates; 10/16 E. coli isolates resistant to 3 or more antimicrobial classes. Biliary tract rupture complicated nearly one third of cases, associated with significant mortality (4/8). Discharged dogs had a guarded to fair prognosis; 17/18 alive at 2 months, although 5/10 re‐evaluated had persistent liver enzyme elevation 2–12 months later.

Conclusion and Clinical Significance

Bacterial cholangitis and cholecystitis occur more frequently than suggested by current literature and should be considered in dogs presenting with jaundice and fever, abdominal pain, or an inflammatory leukogram or with ultrasonographic evidence of gallbladder abnormalities.

Effect of heart failure on dipeptidyl peptidase IV activity in plasma of dogs

BACKGROUND

In congestive heart failure (HF), plasma B-type natriuretic peptide (BNP) seems devoid of biological effectiveness. BNP(1-32) could be truncated into BNP(3-32) by dipeptidyl peptidase IV (DPP4), and BNP(3-32) has reduced biological activities.

HYPOTHESIS

Increased DPP4 activity is associated with pathophysiology of HF.

ANIMALS

One hundred twenty-eight client-owned dogs and 9 experimental Beagles from the Clinical Veterinary Unit of the University of Liège.

METHODS

We prospectively measured plasma DPP4 activity in 5 groups of dogs: normal growing dogs (n = 21), normal adult dogs (n = 60), healthy Beagle (n = 9), dogs with myxomatous mitral valve disease (n = 35), and dogs with dilated cardiomyopathy (n = 12). The final diagnosis and the severity of HF were determined by Doppler echocardiography. Plasma DPP4 activity was measured kinetically by a fluorimetric method.

RESULTS

In growing dogs, DPP4 activity was higher than in adults (P < .001) and inversely correlated with age (r = -0.57, P < .01). In adults, DPP4 activity increased linearly with body weight (r = 0.39, P < .01), but there was no influence of age or sex. No effect of the circadian rhythm was noted. DPP4 activity was significantly higher in HF ISACHC I (16.3 ± 1.14 U/L) compared with healthy adults (12.4 ± 0.65 U/L, P < .05) and HF ISACHC III (11.0 ± 1.50 U/L, P < .05). Mean DPP4 activity in ISACHC II was 15.1 ± 1.4 U/L.

CONCLUSION AND CLINICAL IMPORTANCE

We did not find evidence that plasma DPP4 activity is responsible for the "BNP resistance" in overt congestive HF, but it may be implicated in early stages.

[Current role of hormone replacement therapy in the prevention of postmenopausal osteoporosis: gynecologic point of view]

Hormonal Replacement Therapy (HRT) of the menopause has already proved to be effective in preventing bone loss and reducing the risk of fractures in postmenopausal women. Up until 2002, HRT was widely proposed and prescribed by French practitioners, in particular with regard to the prevention of osteoporosis. The results of two major studies, one American, the Women's Health Initiative (WHI) Study, and the other British, the Million Women Study (MWS), published in July 2002 and August 2003, have called into question the hitherto favourable benefits/risks ratio of HRT after finding an increased incidence of breast cancer and heart disease amongst women undergoing this treatment. Following these studies, the European and French health authorities have issued new recommendations regulating and restricting the use of HRT with a drastic restriction on the indications for its use in the prevention of osteoporosis. These new recommendations are the subject of controversy and pose new problems for practitioners.

[Reality of menopausal hormone replacement therapy by French gynaecologists: OCEANIDES, a transversal and longitudinal national epidemiology study]

OBJECTIVE

To describe the initiation of hormone replacement therapy (HRT) in standard gynaecological practice in France, and to assess treatment adherence factors at 1 year follow-up.

MATERIALS AND METHODS

Six hundred and nineteen gynaecologists distributed on the French territory and 1428 menopausal women were included in a transversal then longitudinal epidemiology study run over a period of 1 year. They filled out a questionnaire specially made for the purpose. All patients underwent patch HRT.

RESULTS

One year after initiation of HRT, 1161 patients completed the study; 959 (82.6%) were still under HRT, and 202 (17.4%) had stopped altogether. Very few differences were found between those patients continuing with and those having stopped HRT. The two groups were comparable for the whole range of their own socio-demographic characteristics and for the demographic characteristics and medical practice of their gynaecologists. It had, however, more often been for renewal of an ongoing treatment that the patients who later ceased HRT had come to the consultation at which HRT was initiated, and these patients had less often enquired about the sexual benefits of HRT.

DISCUSSION AND CONCLUSIONS

Adherence to physician-initiated patch HRT was good at 1 year follow-up. This result may be related to the quality of care provided by the gynaecologists, who listened to their patients, explained the treatment, and initiated personalised low-dose regimens, which they adapted to the patients' needs.

Identification and antimicrobial susceptibility testing of clinical isolates of nonfermenting gram-negative bacteria by the Phoenix Automated Microbiology System

The Phoenix Automated Microbiology System (Becton Dickinson, Sparks, MD) was evaluated for its ability to identify nonfermenting gram-negative pathogens and measure their drug susceptibility. Isolates producing rare extended-spectrum beta-lactamases (PER-1, IMP-2, VIM-1, and VIM-2) were included in the study. Species identification was compared to that given by the ATB System (bio-Mérieux, Marcy l'Etoile, France), whereas susceptibility results were compared to those produced by a reference broth microdilution test (panels manufactured by Pasco Laboratories, Becton Dickinson). The Phoenix system consistently identified all isolates of Pseudomonas aeruginosa (n = 55) and Stenotrophomonas maltophilia (n = 28), while in other cases species agreement was obtained for 47/53 isolates (Acinetobacter baumannii, 29/31; Pseudomonas putida, 10/11; Burkholderia cepacia, 6/7; and Pseudomonas fluorescens, 2/4). Overall, the Phoenix and ATB systems gave equal results in 130/136 cases (95.6%). For two isolates, consistent identification was obtained at the genus level, thus bringing the cumulative agreement to 97.1%. MIC values (interpreted according to NCCLS guidelines) gave essential and categorical agreement in 94.2% and 93.1% of cases, respectively. Minor and major errors were 5.1% and 5.2%, respectively. No very major errors were produced. The mean time to results (TTR) for the Phoenix system was 14.8 +/- 1.6 h (mean +/- SD), with the shortest TTR being observedfor A. baumannii (13.0 +/- 1.8 h) and the longest one for P. aeruginosa (15.6 +/- 1.2 h). In conclusion, the Phoenix system performed rapidly and correctly in the identification of clinical isolates of important opportunistic pathogens and in measuring their susceptibility to antipseudomonal drugs.

Epidemiology of bloodstream infections and time to detection of positive blood cultures: an evaluation of the automated BacT/Alert and BACTEC 9240 systems

Data of 3,097 blood culture sets processed with the BacT/Alert system in 1997 were compared to those of 3,158 blood culture sets processed with BACTEC 9240 in 1999. Agents responsible for bloodstream infections (BSI) were detected in 15.9% and 20.0% of blood cultures in 1997 and 1999, respectively. The incidence of BSI was 9.3 (1997) vs. 11.3 (1999) per 1,000 admissions. In both years, S. aureus was the most frequent isolate, followed by E. coli. Overall, the mean detection time (MDT) obtained with the BACTEC 9240 was significantly shorter than that of the BacT/Alert. Significant MDT differences were found for all organisms, except for Enterobacteriaceae (12.7 vs. 10.6 h). With both systems, over 95% positive samples were detected within 3 days, indicating that a 4-day incubation protocol may disclose most BSI agents. Thus, the added speed of the BACTEC 9240 allowed a particularly fast clinical management of septic patients.

Efficacy and tolerability of a low-dose of Oesclim (25 mcg daily) in the management of symptomatic menopausal women: a French open-label study

OBJECTIVE

To establish the proportion of symptomatic postmenopausal women, whose HRT treatment is initiated on Oesclim 25, who can be satisfactorily maintained on this low dose after two months.

STUDY DESIGN AND PATIENTS

This was an open-label, multicentre, non-comparative, four-month treatment study. Treatment was initiated with Oesclim 25 (17 beta-oestradiol transdermal patch, 25 mcg/day). Dosage could be increased to Oesclim 50 if required after two months, according to clinical evaluation. Sequential treatment with an oral progestagen was also given for > or = 12 days/month in all non-hysterectomised women. A total of 1465 women were included in the study.

RESULTS

82.3% (CI: 80.1-84.4) of patients remained on Oesclim 25 across the whole study. The mean number of hot flushes was reduced similarly by 93% and 94% at month 4 in the Oesclim 25 group and Oesclim 50 group, respectively. However, at month 2 the decrease in hot flushes and other menopausal symptoms was less marked until the dose was adjusted, in patients switching to Oesclim 50. In a global evaluation, 97.5% of the investigators and 95.7% of the patients rated the overall efficacy of the treatment as good/very good. Overall, treatment initiated at a low dose was well tolerated throughout the study, with a trend showing Oesclim 25 as being better tolerated than Oesclim 50.

CONCLUSION

Oesclim low dose (25 mcg) can effectively reduce symptoms in most postmenopausal women with a very satisfactory level of tolerability. The risk/benefit ratio observed is probably one key reason for good patient compliance.

[Variability of bone response to hormone replacement therapy]

Bone response to hormone replacement therapy (HRT) was assessed in a retrospective longitudinal study. 115 women started on HRT for the first time and 252 controls underwent initial densitometric evaluation (spine and femur) and a second evaluation on average 29 months later. Patients were classified as post-menopausal or perimenopausal according to whether they had had more or less than 6 months amenorrhea. Oral or non-oral 17-beta estradiol was used at the dose generally accepted to be skeletally protective. In the post-menopausal group, prescription of HRT was followed by spinal and femoral bone gain (+ 2.85% and + 1.06% per year respectively). There was no bone gain with HRT in the peri-menopausal women, but the stability seen contrasted greatly with the very marked bone loss found in controls (spine - 3.09% per year and femur - 1.78% per year). Lumbar densitometric variations were correlated, at least in the post-menopausal group, with those in the femur, but the amplitude of femoral variations was half that of the spine. Body mass index (BMI) was not found to be a predictive factor of bone response to HRT in this group, but the time since the menopause and initial densitometric results were. For the spine, the % of subjects losing their bone mass in response to the start of HRT, nil in the post-menopausal group, was 16% in peri-menopausal women. The % of good responders increased from 8% peri-menopausally to more than 59% 2 years after the menopause. The response in the femur appeared to be very different, with 20% good responders and a % of stable subjects similar to that of the control group. Femoral variations and the existence regarding the spine of a group showing no or only a poor response to HRT would be in favor of densitometric monitoring when initial bone mass is low.

[Value of standardized Ginkgo biloba extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome]

The efficacy of standardized Ginkgo biloba extract (EGb 761) in treating congestive symptoms of premenstrual syndrome (PMS) was evaluated in a controlled multicentric double blind study versus placebo. The population studied was a group of 165 women aged between 18 to 45, in genital activity period, suffering since 3 cycles from congestive premenstrual troubles during at least 7 days per cycle. The characteristics of patients and PMS were the same in both groups (EGb 761 and placebo). The observation of one menstrual cycle confirmed the diagnosis of PMS. Then, during the 2 following cycles, each patient received either EGb 761 or placebo from the 16th day of the first cycle till the 5th day of the next cycle. A double evaluation of the symptoms was realized by the patient using a daily rating scale (auto-evaluation), by the practitioner during visits at the premenstrual phase before and after the two cycles treatment. From 165 patients included, 143 observations were available. With a good acceptability, EGb 761 was effective against the congestive symptoms of PMS, particularly breast symptoms with a statistical significance between EGb 761 and placebo. Neuropsychological symptoms were also improved. EGb 761 is an alternative of interest to therapeutics already used in treating PMS or can be associated without any inconvenience.

[Inadequate corpus luteum function in benign breast-diseases (author's transl)]

The amount of progesterone and estradiol secreted by human corpus luteum depends upon an adequate release of FSH and LH by pituitary gland during follicular phase and ovulation. In this paper, plasma determination of progesterone and estradiol were carried out in 109 women with benign breast disease during the luteal phase of their menstrual cycle. Results obtained were compared with those observed in 25 normal women studied in the same conditions. In women with benign breast disease, the curve of daily progesterone concentrations during luteal phase was lower than that of normal women. The progesterone peak at 5th day of luteal phase was only 8,1 +/- 3.8 ng/ml instead of 17.2 +/- 3.5 ng/ml in normal women. No significative difference was observed concerning plasma estradiol between patients and normal women. These results indicate that women with benign breast disease have an inadequate corpus luteum function which may be the result of disorder of ovulation. Pathophysiological implications resulting from this observation are discussed.