Effect of common sedation agents on feline splenic size determined via ultrasonography

AIMS

To evaluate the effect of IM administration of three sedative drugs, acepromazine, alfaxalone and dexmedetomidine, in combination with morphine, on the size of the feline spleen using ultrasonography.

METHODS

Twenty-four client-owned cats undergoing elective de-sexing or minor procedures were recruited for a focused ultrasonographic examination of the spleen prior to and at 10, 20 and 30 minutes following administration of one of three randomly assigned IM sedation protocols: 0.05 mg/kg acepromazine (ACE group), 3 mg/kg alfaxalone (ALF group), or 10 μg/kg dexmedetomidine (DEX group), in combination with 0.5 mg/kg morphine. B-mode images of the spleen were collected and measured following a standardised protocol. Cardiorespiratory parameters and sedation score were also recorded. Mean thickness of the head, body and tail of the spleen for each group at 10, 20 and 30 minutes after drug administration was compared to baseline.

RESULTS

Mean splenic thickness increased over time in the ACE group (thickness of body at T0 = 8.9 (SE 2.1) mm and at T30 = 10.5 (SE 2.0) mm; p = 0.001) and the ALF group (thickness of body at T0 = 8.8 (SE 1.0) mm and at T30 = 10.3 (SE 1.7) mm; p = 0.022) but not in the DEX group (thickness of body at T0 = 8.6 mm (1.2) and at T30 = 8.9 mm (0.6); p = 0.67). Mean arterial blood pressure in the DEX group was significantly higher than in the other groups (p = 0.002). Sedation scores in the DEX group were consistently high for the entire period. However, the sedation score in the ACE group increased over 30 minutes (p = 0.007). Sedation score in the ALF group was highest at 10 minutes but gradually decreased over the following 20 minutes (p = 0.003).

CONCLUSIONS

Sedation with IM dexmedetomidine and morphine did not change splenic size, whereas acepromazine or alfaxalone and morphine increased it regardless of the degree of sedation.

CLINICAL RELEVANCE

Where splenomegaly is identified in a cat sedated with acepromazine or alfaxalone, the effects of the sedation protocol could be considered as a possible cause.

Vaccine Effectiveness during Outbreak of COVID-19 Alpha (B.1.1.7) Variant in Men's Correctional Facility, United States

In April 2021, a COVID-19 outbreak occurred at a correctional facility in rural Virginia, USA. Eighty-four infections were identified among 854 incarcerated persons by facilitywide testing with reverse transcription quantitative PCR (qRT-PCR). We used whole-genome sequencing to link all infections to 2 employees infected with the B.1.1.7α (UK) variant. The relative risk comparing unvaccinated to fully vaccinated persons (mRNA-1273 [Moderna, https://www.modernatx.com]) was 7.8 (95% CI 4.8–12.7), corresponding to a vaccine effectiveness of 87.1% (95% CI 79.0%–92.1%). Average qRT-PCR cycle threshold values were lower, suggesting higher viral loads, among unvaccinated infected than vaccinated cases for the nucleocapsid, envelope, and spike genes. Vaccination was highly effective at preventing SARS-CoV-2 infection in this high-risk setting. This approach can be applied to similar settings to estimate vaccine effectiveness as variants emerge to guide public health strategies during the ongoing pandemic.

Barriers associated with mandatory influenza vaccination policies for healthcare workers: an integrative review

BACKGROUND

Uptake of influenza vaccination reduces staff absenteeism as well as mortality of patients and healthcare workers (HCWs); however, adherence of HCWs to annual influenza vaccination is poor and some healthcare facilities are now considering mandatory influenza vaccination policies.

AIM

The purpose of this study was to identify the perceived and reported barriers to the implementation of a mandatory influenza vaccination policy for HCWs.

METHODS

An integrative review of the literature was conducted. Databases including CINAHL, Cochrane Library, Medline and PubMed were searched using key terms. The quality of papers was assessed utilising the Standard Quality Assessment Criteria for Evaluating Primary Research papers for a Variety of Fields which consisted of 10 questions with a possible total score of 20. PRISMA guidelines were used to report the search outcomes.

RESULTS

A total of 68 papers were identified from the database search. Seven papers were relevant, following screening. The quality scores of these were in the range of 15-20. A number of barriers are reported to prevent the effective implementation of mandatory influenza vaccination policies including ethical and legal considerations, logistics, healthcare burden, leadership and management, and human factors such as HCWs' perspectives.

CONCLUSIONS

By comprehensively identifying these, barriers can be addressed to allow effective implementation of such policies in healthcare facilities to ensure improved outcomes. The results of the review indicated the need for further research to ensure that barriers are addressed cohesively.

Traumatic spinal cord injury and psychological impact: a cross-sectional analysis of coping strategies

Many studies have suggested a relationship between coping strategies used to deal with stressors and levels of psychological well-being. To explore this further the current study examined such relationships in people who have sustained a spinal cord injury. Measures of psychological impact and coping strategies were taken from those in their sixth week post-injury (N = 41) and those between four and seven years post-injury (N = 30). The results were analysed using stepwise multiple regression. This provided a number of models containing coping strategies that accounted for a certain proportion of the variance in each of the psychological impact variables. While the results help to identify specific coping strategies associated with better adjustment, they also highlight the need to adopt a longitudinal approach in the investigation of psychological responses to spinal cord injury.

Effects of tooth function on adjacent alveolar bone and Sharpey's fibers of the rat periodontium

There is little information about the effects of short-term non-hypo-, and hyperfunction of teeth on the 1) mineralization patterns of intrinsic and extrinsic (Sharpey's) fibers and 2) mean number and diameter of Sharpey's fibers of adjacent alveolar bone. The mineral density of intrinsic and Sharpey's fibers and the size and number of Sharpey's fibers could indicate the relative strength of the attachment of a tooth to bone in various functional situations. In the present study, non- and hypofunctional situations were created by selective extraction of right molar teeth of the rat; the contralateral teeth were placed in hyperfunction by the surgery. In non- and hypofunctionals, intrinsic and Sharpey's fibers of the crestal third of the alveolus were less densely mineralized than in hyperfunctionals or untreated controls. Mean Sharpey's fiber diameters were significantly greater and their mean number/unit area significantly less in non- than in hypo- or hyperfunctionals or untreated controls (P less than 0.001). Mean Sharpey's fiber diameters in hyperfunctionals were significantly less than in untreated controls (P less than 0.05). Hypofunction ameliorated the effects of nonfunction on mean diameter and number of Sharpey's fibers, but had little effect on the density of mineralization of either the intrinsic or Sharpey's fibers of the alveolus, suggesting that their mineralization may be controlled by factors other than occlusal forces from the adjacent teeth. Thus changes in the stress/strain environment within the periodontium, coincident to altered occlusal function of the adjacent teeth, rapidly affects the morphology of intrinsic and Sharpey's fibers of alveolar bone and ensures that adequate tooth support is maintained in the new functional situation.

Exaggerated phosphaturic response to circulating parathyroid hormone in patients with familial X-linked hypophosphatemic rickets

To determine whether the phosphaturic response to circulating parathyroid hormone (PTH) is exaggerated in patients with familial x-linked hypophosphatemic vitamin D-resistant rickets (FHR), we examined the phosphaturic response to parathyroid extract (PTE) (administered intravenously in the posthypercalcemic state) in two unrelated adult hemizygotes with FHR. In these two patients whose plasma concentration of PTH was normal (determined by radioimmunoassay). neither vitamin D nor phosphate therapy had been given during the past 10 yr. Two normal men and a hypophosphatemic man with intestinal malabsorption, hypocalcemia, and osteomalacia served as control subjects. In all subjects, calcium gluconate was adminstered intravenously from 6 p.m. to 12 midnight at a rate that maintained the concentration of serum calcium at 13-15 mg/100 ml during the administration of calcium. When normocalcemia had recurred the next morning, and the plasma PTH concentration and urinary excretion of cyclic 3', 5'-AMP were reduced. PTE was administered intravenously at successively increasing rates of 0.1, 0.4, and 0.8 U/kg per h, each rate lasting 90 min. Minutes after the initiation of PTE in the affected hemizygotes, fractional excretion of filtered phosphate increased from negligible values to values strikingly greater than those of similarly studied control subjects and plateaued at strikingly greater values throughout further administration of PTE. This phenomenon of exaggerated phosphaturia could not be attributed to volume expansion, decreases in serum concentration of calcium during the study, differences in percent of administered calcium retained, or hemodynamic changes. Only the phosphaturic response to PTE appeared to be exaggerated. At any cumulative dose of PTE, urinary excretion of cyclic 3', 5'-AMP in the hemizogytes was indistinguishable from that of control subjects. The findings in this study suggest that in patients with FHR, circulating PTH is required for the genetically transmitted abnormality to be physiologically expressed as a reduction in net renal reabsorption of phosphate, and that this physiological expression of the genetic abnormality is expressed fully at normal or nearly normal circulating levels of PTH.