Serum vitamin D metabolite and acute-phase protein concentrations are frequently abnormal in a cohort of hospitalized dogs and cats

OBJECTIVE

To determine whether serum 25-hydroxyvitamin D (25[OH]D) and 1,25-dihydroxyvitamin D (1,25[OH]2D) concentrations are associated with survival and negatively correlate with acute-phase protein (APP) concentrations in ill dogs and cats admitted to nursing care units.

ANIMALS

Client-owned dogs (n = 79) and cats (16) admitted to 2 academic veterinary hospital nursing care units.

METHODS

A prospective cohort study was conducted between August 12, 2019, and October 26, 2021. A diagnostic laboratory measured 25(OH)D, 1,25(OH)2D, and haptoglobin (HPT) in dogs and cats; C-reactive protein (CRP) in dogs; and serum amyloid A (SAA) in cats. Serum was collected within 12 hours of admission. Illness severity (acute patient physiologic and laboratory evaluation [APPLEfast]) scores and survival data were recorded.

RESULTS

Serum 25(OH)D concentrations were in the deficient range for 22 of 79 dogs and 2 of 16 cats. There were no associations between serum analyte concentrations (25[OH]D, 1,25[OH]2D, and APP) or APPLEfast score and survival in dogs or cats. In dogs, HPT was negatively correlated with 25(OH)D (P = .002; r = -0.34) and 1,25(OH)2D (P = .012; r = -0.28), while CRP was positively correlated with HPT (P = .001; r = 0.32) and APPLEfast score (P = .014; r = 0.16). In cats, 1,25(OH)2D was negatively correlated with APPLEfast scores (P = .055; r = -0.49) and SAA was positively correlated with HPT (P = .002; r = 0.73).

CLINICAL RELEVANCE

Serum 25(OH)D or 1,25(OH)2D was not associated with survival in our hospitalized patient population. Relationships between APP and serum vitamin D metabolites with APPLEfast scores in cats warrant further investigation as illness severity biomarkers.

Disseminated Aspergillus citrinoterreus and concurrent localized dermal phaeohyphomycosis in an immunosuppressed dog

Key Clinical message

We report on a dog with immune-mediated hemolytic anemia (IMHA) treated with immunomodulatory therapy that developed phaeohyphomycosis and Aspergillus citrinoterreus infections. This is the first reported case of A. citrinoterreus in dogs. It details cytological and microbiological findings leading to diagnosis and highlights the importance of investigating new lesions in immunocompromised patients.

Abstract

A 5-year-old Staffordshire terrier mix treated with immunosuppressive therapy for IMHA was diagnosed with concurrent disseminated A. citrinoterreus and localized Curvularia lunata infections. This case highlights the potential development of multiple concurrent opportunistic fungal infections and is the first reported case of A. citrinoterreus infection in a dog.

ChatGPT and Artificial Intelligence in Medical Writing: Concerns and Ethical Considerations

Artificial intelligence (AI) language generation models, such as ChatGPT, have the potential to revolutionize the field of medical writing and other natural language processing (NLP) tasks. It is crucial to consider the ethical concerns that come with their use. These include bias, misinformation, privacy, lack of transparency, job displacement, stifling creativity, plagiarism, authorship, and dependence. Therefore, it is essential to develop strategies to understand and address these concerns. Important techniques include common bias and misinformation detection, ensuring privacy, providing transparency, and being mindful of the impact on employment. The AI-generated text must be critically reviewed by medical experts to validate the output generated by these models before being used in any clinical or medical context. By considering these ethical concerns and taking appropriate measures, we can ensure that the benefits of these powerful tools are maximized while minimizing any potential harm. This article focuses on the implications of AI assistants in medical writing and hopes to provide insight into the perceived rapid rate of technological progression from a historical and ethical perspective.

Hyperkalemic periodic paralysis with paramyotonia and the anaesthetic implications

Hyperkalemic periodic paralysis (HyperKPP) is a rare disease with significant anaesthetic implications. We compare two perioperative courses in the same patient. The first surgery resulted in paralysis and a protracted hospitalisation, while the second surgery resulted in a same-day discharge. Various anaesthetic techniques may be used; however, clear communication surrounding optimisation both for home medications (eg, continuing potassium wasting diuretics) and avoidance of triggering medications (primarily: depolarising neuromuscular blockers), along with thermoregulation and glucose management plans, is critical and best performed early by an anaesthetic precare clinic. Our cases highlight the physiological underpinnings in managing patients with HyperKPP.

Bilateral Dorsomedial Prefrontal Cortex rTMS for Tinnitus Treatment: A Successful Case

We present a successful tinnitus treatment case with intensity and distress reduction in a patient subjected to bilateral 10 Hz repetitive transcranial magnetic stimulation (rTMS) to the dorsomedial prefrontal cortex (DMPFC). Subjective tinnitus is the perception of sound in the ears or head when no corresponding external stimulus exists. Approximately 1%-2% of the population report severe tinnitus with daily life impairment. Sham-controlled studies have revealed benefits using rTMS in tinnitus, although the improvement is moderate or temporary, indicating the need for new strategies. Evidence that the DMPFC is important in tinnitus pathophysiology makes this area a promising target. A 51-year-old male patient with a 4-year history of treatment-resistant moderate bilateral tinnitus was treated with 20 sessions of bilateral 10 Hz DMPFC rTMS. The patient showed important reduction and sustained 4-month response in tinnitus loudness and annoyance, 24 point drop in tinnitus handicap inventory, visual analog scale reduction to zero, and tinnitus loudness of 1 dB compared to baseline 15 dB. Tinnitus treatment is challenging and new alternatives are needed. To our knowledge, this is the first report using rTMS to the DMPFC for tinnitus. In this protocol, important and sustained reduction of tinnitus annoyance and loudness was obtained. This outcome of the case suggests that this approach is promising for treating tinnitus and is worth further investigation.