A survey on Shar Pei autoinflammatory disease in the United Kingdom

OBJECTIVES

To characterise the fever episodes attributed to Shar Pei autoinflammatory disease and to identify common diagnostic and management strategies in the United Kingdom. A secondary objective was to determine risk factors associated with Shar Pei autoinflammatory disease fever episodes.

METHODS

A retrospective survey was performed to characterise episodes of Shar Pei autoinflammatory disease fever and to identify commonly used treatments in affected dogs. Clinical data were collected from owners and veterinarians. Frequencies of previously proposed risk factors (skin thickness and folding, muzzle conformation) and comorbid conditions were compared between dogs that had exhibited fever episodes consistent with Shar Pei autoinflammatory disease and those who had not.

RESULTS

At least one episode of fever attributed to Shar Pei autoinflammatory disease was reported in 52 of 106 (49%) Shar Pei. Nine other dogs had fever episodes consistent with Shar Pei autoinflammatory disease reported by their owners but not by veterinarians. Median rectal temperature at presentation for Shar Pei autoinflammatory disease fever was 40.1°C [104.2°F] (39.9 to 41.3°C [103.8 to 106.3°F]) and owners reported associated hyporexia (n=33, 63%) and vomiting (n=8, 15%) more frequently than veterinary records (n=22, 42% and n=0, 0%, respectively). The median number of veterinary appointments for Shar Pei autoinflammatory disease was two per dog (1 to 15) while owners reported a median of four episodes per dog per year. None of the assessed phenotypic variants or comorbidities were significantly associated with exhibiting Shar Pei autoinflammatory disease fever episodes.

CLINICAL SIGNIFICANCE

Episodes of Shar Pei autoinflammatory disease fever were reported approximately twice as frequently by owners compared to veterinary records, suggesting the burden of this condition may be underestimated by veterinarians. Specific risk factors for Shar Pei autoinflammatory disease fever were not identified.

Antibiotic therapy in dogs and cats in general practise in the United Kingdom before referral

OBJECTIVES

To describe antibiotic prescription by veterinarians in general practises in the United Kingdom before referral and analyse if UK antibiotic stewardship guidelines were followed.

MATERIALS AND METHODS

The clinical records from dogs and cats referred to the Internal Medicine and Oncology departments of two referral hospitals were retrospectively reviewed.

RESULTS

There were 917 cases included, of which 486 (53.0%) had been prescribed antibiotics for the presentation they were subsequently referred for. Bacterial culture or cytology to guide antibiotic prescription had been performed in 43 of 486 (8.8%) and nine of 486 cases (1.8%) respectively. In four cases, both cytology and culture were performed. For those animals who had received antibiotics, 344 of 486 (70.8%) prescriptions did not comply with UK antibiotic stewardship guidelines. Following investigations at a referral centre, a bacterial aetiology was found or suspected in 17.9% of the cases that received antibiotics.

CLINICAL SIGNIFICANCE

Use of diagnostics, including culture and cytology, to prove or determine the likelihood of a bacterial aetiology was infrequently performed before referral and may have contributed to overprescription of antibiotics. Encouraging veterinarians to undertake appropriate diagnostics, in combination with education around compliance with antibiotic stewardship guidelines, might reduce antibiotic prescription.

Paclitaxel with or without trametinib or pazopanib in advanced wild-type BRAF melanoma (PACMEL): a multicentre, open-label, randomised, controlled phase II trial

BACKGROUND

Advanced melanoma treatments often rely on immunotherapy or targeting mutations, with few treatment options for wild-type BRAF (BRAF-wt) melanoma. However, the mitogen-activated protein kinase pathway is activated in most melanoma, including BRAF-wt. We assessed whether inhibiting this pathway by adding kinase inhibitors trametinib or pazopanib to paclitaxel chemotherapy improved outcomes in patients with advanced BRAF-wt melanoma in a phase II, randomised and open-label trial.

PATIENTS AND METHODS

Patients were randomised (1 : 1 : 1) to paclitaxel alone or with trametinib or pazopanib. Paclitaxel was given for a maximum of six cycles, while 2 mg trametinib and 800 mg pazopanib were administered orally once daily until disease progression or unacceptable toxicity. Participants and investigators were unblinded. The primary end point was progression-free survival (PFS). Key secondary end points included overall survival (OS) and objective response rate (ORR).

RESULTS

Participants were randomised to paclitaxel alone (n = 38), paclitaxel and trametinib (n = 36), or paclitaxel and pazopanib (n = 37). Adding trametinib significantly improved 6-month PFS [time ratio (TR), 1.47; 90% confidence interval (CI) 1.08-2.01, P = 0.04] and ORR (42% versus 13%; P = 0.01) but had no effect on OS (P = 0.25). Adding pazopanib did not benefit 6-month PFS; (TR 1.36; 90% CI 0.96-1.93; P = 0.14), ORR, or OS. Toxicity increased in both combination arms.

CONCLUSION

In this phase II trial, adding trametinib to paclitaxel chemotherapy for BRAF-wt melanoma improved PFS and substantially increased ORR but did not impact OS.This study was registered with the EU Clinical Trials Register, EudraCT number 2011-002545-35, and with the ISRCTN registry, number 43327231.

Pasireotide Long-Acting Release Treatment for Diabetic Cats with Underlying Hypersomatotropism

BACKGROUND

Long-term medical management of hypersomatotropism (HS) in cats has proved unrewarding. Pasireotide, a novel somatostatin analogue, decreases serum insulin-like growth factor 1 (IGF-1) and improves insulin sensitivity in cats with HS when administered as a short-acting preparation.

OBJECTIVES

Assess once-monthly administration of long-acting pasireotide (pasireotide LAR) for treatment of cats with HS.

ANIMALS

Fourteen cats with HS, diagnosed based on diabetes mellitus, pituitary enlargement, and serum IGF-1 > 1000 ng/mL.

METHODS

Uncontrolled, prospective cohort study. Cats received pasireotide LAR (6-8 mg/kg SC) once monthly for 6 months. Fructosamine and IGF-1 concentrations, and 12-hour blood glucose curves (BGCs) were assessed at baseline and then monthly. Product of fructosamine concentration and insulin dose was calculated as an indicator of insulin resistance (Insulin Resistance Index). Linear mixed-effects modeling assessed for significant change in fructosamine, IGF-1, mean blood glucose (MBG) of BGCs, insulin dose (U/kg) and Insulin Resistance Index.

RESULTS

Eight cats completed the trial. Three cats entered diabetic remission. Median IGF-1 (baseline: 1962 ng/mL [range 1051-2000 ng/mL]; month 6: 1253 ng/mL [524-1987 ng/mL]; P < .001) and median Insulin Resistance Index (baseline: 812 μmolU/L kg [173-3565 μmolU/L kg]; month 6: 135 μmolU/L kg [0-443 μmolU/L kg]; P = .001) decreased significantly. No significant change was found in mean fructosamine (baseline: 494 ± 127 μmol/L; month 6: 319 ± 113.3 μmol/L; P = .07) or MBG (baseline: 347.7 ± 111.0 mg/dL; month 6: 319.5 ± 113.3 mg/dL; P = .11), despite a significant decrease in median insulin dose (baseline: 1.5 [0.4-5.2] U/kg; 6 months: 0.3 [0.0-1.4] U/kg; P < .001). Adverse events included diarrhea (n = 11), hypoglycemia (n = 5), and worsening polyphagia (n = 2).

CONCLUSIONS AND CLINICAL IMPORTANCE

Pasireotide LAR is the first drug to show potential as a long-term management option for cats with HS.

Neuronal responses to turtle head rotation in vitro

Extracellular recordings were made during vestibular stimulation from an in vitro turtle brain stem in which the temporal bones remained attached. Under visual control, microelectrodes were slowly advanced into the vestibular nucleus (VN) while we rotated the brain and searched for a single isolated unit whose spike activity was modulated by the lateral semicircular canals. In some experiments, responses were shown to be due to stimulation of the lateral canals, either by positioning the brains in forward or backward pitch during horizontal rotation or by plugging the vertical canals with wax. VN neurons usually had low spontaneous activity and rectified sinusoidal responses to sinusoidal stimulation. Spike response histograms were averaged from many stimulus cycles and were then fit to a sine function. The fitted phase and amplitude parameters were plotted relative to stimulus frequency and amplitude. The sample of VN cells were quite heterogeneous. Using stimuli at 1 Hz, however, each cell's response phase was weakly correlated with the slope of the plots of response amplitude versus frequency so that a cell could be categorized as sensitive to velocity or acceleration and as sensitive to ipsiversive or contraversive rotation, depending on whether its phase was near -180 degrees, -90 degrees, 0 degrees, or 90 degrees, and whether the gain exceeded 0.4 spikes/s per degrees/s. The properties of these VN cells suggest that there is substantial complexity in the vestibular responses at this first site of central vestibular processing. These data are compared to that of other species where such vestibular signals play an important role in oculomotor and spinal reflexes.

Episodic postoperative oxygen desaturation: the value of added oxygen

Six patients were studied following general anaesthesia for cholecystectomy or hip replacement. Intravenous morphine was given for postoperative pain relief. Continuous measurements were made of breathing pattern and arterial oxygen saturation for a 12-hour period postoperatively. The effect of breathing either air or 28% oxygen for alternate 2-hour periods was examined. There was no significant effect of oxygen on the number of periods of central apnoea, obstructive apnoea or partial upper airways obstruction. The number of episodes of decreases in oxygen saturation to below 80%, associated with these breathing disturbances, was reduced from 59 to zero by the administration of oxygen. There was a gradual improvement in oxygenation whilst breathing air during the 12-hour postoperative period. The administration of oxygen had a beneficial effect on average arterial oxygen saturation.