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Brooks MB, Goggs R, Frye AH, Armato J, Forman M, Hertl J, Koch M, Loftus JP, Lucy J, Mattison B, Merriam J, Shropshire S, Van Vertloo L, Viall A, LeVine DN. A prospective cohort study to identify clinical diagnostic and prognostic markers of primary immune thrombocytopenia in dogs. J Vet Intern Med 2024; 38:1022-1034. [PMID: 38205735 PMCID: PMC10937499 DOI: 10.1111/jvim.16985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Primary immune thrombocytopenia (pITP) in dogs presents a diagnostic challenge, and clinical markers of severity are lacking. OBJECTIVES Identify clinicopathologic features that differentiate pITP from secondary ITP (sITP) and markers related to bleeding severity, transfusion, and survival of dogs with pITP. ANIMALS Ninety-eight thrombocytopenic dogs (58 pITP and 40 sITP). METHODS Client-owned dogs with platelet counts <50 000/μL were enrolled in a prospective, multi-institution cohort study. History and treatment information, through a maximum of 7 days, was recorded on standard data forms. Bleeding severity was scored daily using a bleeding assessment tool (DOGiBAT). At-admission blood samples were collected for CBC, biochemistry, C-reactive protein concentration, and coagulation panels, and to measure platelet surface-associated immunoglobulin G (PSAIg) and expression of platelet membrane proteins and phospholipids. Dogs with evidence of coincident disease were classified as sITP. RESULTS No definitive pITP diagnostic test was found. However, pITP cases were characterized by lower platelet counts, D dimer concentrations, and platelet membrane protein expression than sITP cases. Differentiation between pITP and sITP was further enhanced using logistic regression modeling combining patient sex, coagulation profile, platelet count, D dimer, and PSAIg. A second model of pITP severity indicated that low hematocrit and high BUN concentration were associated with non-survival. Low hematocrit at admission, but not platelet count or DOGiBAT score, was associated with transfusion. CONCLUSIONS AND CLINICAL IMPORTANCE Pending validation studies, models constructed from at-admission clinicopathologic findings may improve differentiation of pITP from sITP and identify the most severe pITP cases at the time of presentation.
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Affiliation(s)
- Marjory B. Brooks
- Population Medicine & Diagnostic SciencesCornell University, 240 Farrier RoadIthaca, New York 14853USA
| | - Robert Goggs
- Clinical Sciences, C3‐502D Clinical Programs CenterCornell University, 930 Campus RoadIthaca, New York 14853‐0001USA
| | - Amelia H. Frye
- Population Medicine & Diagnostic SciencesCornell University, 240 Farrier RoadIthaca, New York 14853USA
| | - Jessica Armato
- Internal MedicineCornell University Veterinary SpecialistsStamfordConnecticutUSA
| | - Marnin Forman
- Internal MedicineCornell University Veterinary SpecialistsStamfordConnecticutUSA
| | - Julia Hertl
- Population Medicine & Diagnostic SciencesCornell University, 240 Farrier RoadIthaca, New York 14853USA
| | - Michael Koch
- Veterinary Internal Medicine ConsultingRochesterNew YorkUSA
| | - John P. Loftus
- Clinical SciencesCollege of Veterinary Medicine, Cornell University, 930 Campus RoadIthaca, New York 14853USA
| | - John Lucy
- Internal Medicine, Oradell Animal HospitalParamusNew JerseyUSA
| | - Brandi Mattison
- Arizona Veterinary Emergency & Critical Care CenterPeoriaArizonaUSA
| | - Julia Merriam
- Blue Pearl Pet Hospital NorthfieldNorthfieldIllinoisUSA
| | | | - Laura Van Vertloo
- Veterinary Clinical SciencesCollege of Veterinary Medicine, Iowa State UniversityAmesIowaUSA
| | - Austin Viall
- Department of Pathology, Microbiology and ImmunologyUniversity of California, DavisDavisCaliforniaUSA
| | - Dana N. LeVine
- Veterinary Clinical SciencesCollege of Veterinary Medicine, Auburn University, 1600 S 16th StAuburn, Alabama 36849USA
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Williams M, Shropshire S, Chornarm N, Brewer M, Hawley J, Khorsand M, Lappin M. Effects of canine influenza infection and DA2PP vaccination on the development of platelet-associated immunoglobulins and platelet counts in dogs. Vet Clin Pathol 2024; 53:47-56. [PMID: 38433107 DOI: 10.1111/vcp.13333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is commonly associated with platelet-associated immunoglobulins (PAIg). Demonstration of PAIg can help determine etiologies for thrombocytopenia. In humans, ITP and thrombocytopenia have been associated with various vaccinations and influenza infections, respectively. OBJECTIVES We aimed to evaluate platelet counts and PAIg in research dogs with H3N2 and in research and client-owned dogs routinely vaccinated for distemper, adenovirus-2, parainfluenza, and parvovirus (DA2PP). The hypotheses were that H3N2 infection but not DA2PP vaccination would decrease platelet counts, and neither would result in the detection of PAIg. METHODS Three pilot studies. Platelet counts and PAIg, measured by direct flow cytometry as %IgG, were evaluated in eight research Beagles following experimental infection with H3N2 (experiment 1), nine research Beagles vaccinated for DA2PP (experiment 2), and thirty client-owned dogs vaccinated for DA2PP (experiment 3). All animals were considered healthy at the start of the experiments. RESULTS Transient, self-resolving decreases in platelet counts and increases in %IgG occurred following H3N2 infection, and one dog became thrombocytopenic and positive for PAIg. Following DA2PP vaccination, %IgG increased in research and client-owned dogs, but only one dog was considered positive for PAIg with a concurrent increase in platelet count. Mean PAIg increased from baseline in client-owned dogs following vaccination. CONCLUSIONS Transient PAIg and thrombocytopenia can occur following H3N2 infection, while routine vaccination for DA2PP in this group of dogs was not associated with the development of thrombocytopenia or clinically relevant formation of PAIg.
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Affiliation(s)
- Maggie Williams
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Sarah Shropshire
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Nida Chornarm
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Melissa Brewer
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Jennifer Hawley
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Matthew Khorsand
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Michael Lappin
- Department of Clinical Sciences, Center for Companion Animal Studies, Colorado State University, Fort Collins, Colorado, USA
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Ogrodny AJ, Mani R, Schmid SM, Gould EN, Fellman CL, DeStefano I, Shropshire S, Haines JM, Bolton TA, Jablonski SA, Jess N, Cridge H. Multi-institutional retrospective study investigating blood culture protocols and test positivity in 701 dogs. Front Vet Sci 2023; 10:1301018. [PMID: 38152597 PMCID: PMC10752604 DOI: 10.3389/fvets.2023.1301018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Objectives (i) To determine the influence of specimen collection protocol (timing and specimen quantity), primary disease process, and pre-existing antimicrobial or immunosuppressive therapy on blood culture (BC) positivity and (ii) To determine agreement between urine culture and BC results. Animals 701 client-owned dogs. Methods Multi-institutional retrospective study (2019-2022). Mixed-effect logistic regression was used to determine whether primary disease process, the number of BCs, or the timing of specimen collection was associated with BC positivity. Prediction plots were generated. Associations between urine culture and BC results were performed using logistic regression. Results Dogs with a positive urine culture were more likely to have a positive BC (OR: 4.36, 95% CI: 2.12-8.97, p = 0.003). Dogs that had three BC specimens had the greatest odds of obtaining a positive BC result (adjusted predictive value: 0.44, 95% CI: 0.21-0.70), although this was not significant. Isolates from 38.5% of dogs with a positive BC had resistance to ≥3 antimicrobial classes. The timing between specimen collection had no significant association with BC positivity. Pre-existing antibiotic or immunosuppressive therapy had no significant association with BC positivity. Clinical relevance Dogs with a positive urine culture were more likely to have a positive BC result.
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Affiliation(s)
- Andrzej J. Ogrodny
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Rinosh Mani
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, United States
| | - Sarah M. Schmid
- Department of Medical Sciences, College of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Emily N. Gould
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, School of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Claire L. Fellman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Ian DeStefano
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Sarah Shropshire
- Department of Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Jillian M. Haines
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - Timothy A. Bolton
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
| | - Sara A. Jablonski
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - Nicole Jess
- Center for Statistical Training and Consulting, Michigan State University, East Lansing, MI, United States
| | - Harry Cridge
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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Cˇerná P, Botts MM, Williams M, Aboellail TA, Shropshire S. Fanconi syndrome with hepatorenal karyomegaly in a young Sphynx cat. JFMS Open Rep 2023; 9:20551169231190611. [PMID: 37810577 PMCID: PMC10559701 DOI: 10.1177/20551169231190611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Case summary A 3-year-old male neutered Sphynx cat was referred for history of chronically increased liver enzymes and lower urinary tract signs that were first reported when the cat was 5 months old. Urine metabolic profile revealed increased amino aciduria and glucosuria despite normoglycemia, suggesting Fanconi syndrome. Urine sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed a banding pattern suggestive of primary tubular damage. Serial blood work showed non-regenerative normocytic normochromic anemia, persistently elevated liver enzymes, worsening azotemia and progressive hyperchloremic metabolic acidosis. Ultrasound revealed irregular kidneys and bilaterally hyperechoic cortices and medullae with a loss of normal corticomedullary distinction. Laparoscopic kidney biopsy revealed a moderate-to-severe chronic interstitial fibrosis with chronic lymphoplasmacytic inflammation, tubular degeneration and atrophy, mild glomerulosclerosis and mild large vascular amyloidosis. Tubular epithelial cell karyomegaly was multifocally evident throughout the kidney. The liver had moderate diffuse zone 1 hepatocellular atrophy, periportal fibrosis, biliary hyperplasia, mild perisinusoidal amyloidosis and hepatocyte karyomegaly in zones 2 and 3. The patient continued to decline and developed polyuria, polydipsia, lethargy and hyporexia irrespective of rigorous management, which failed to curtail the progressive anemia and azotemia. The patient was euthanized 8 months from the onset of clinical signs. Relevance and novel information Fanconi syndrome in cats is a rare condition, with most reports occurring secondary to chlorambucil treatment. This is the first known case of Fanconi syndrome occurring with concurrent hepatorenal epithelial karyomegaly in a young Sphynx cat.
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Affiliation(s)
- Petra Cˇerná
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Michaela M Botts
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Maggie Williams
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Tawfik A Aboellail
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Sarah Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Wang Z, Daniels JB, Lappin M, Aboellail T, Shropshire S. Sino-orbital aspergillosis with obstructive cervical lymphadenopathy in a cat caused by Aspergillus viridinutans complex. JFMS Open Rep 2023; 9:20551169231181863. [PMID: 37434987 PMCID: PMC10331201 DOI: 10.1177/20551169231181863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Case summary This report describes an indoor-only cat with a rare form of sino-orbital aspergillosis (SOA) with cervical lymphadenopathy causing local obstruction. Extensive work-up on initial presentation failed to identify the underlying etiology and the diagnosis was not determined until the disease progressed during a prolonged course of glucocorticoid therapy. Relevance and novel information SOA caused by Aspergillus viridinutans complex is increasingly recognized as a significant cause of mortality in cats in recent years, with most cases reported in Australia, Europe and Asia. Feline SOA carries a poor prognosis owing to its invasive nature and resistance to antifungal therapy. This case demonstrates the importance of clinical awareness of SOA as a differential for cats with chronic nasal signs and exophthalmos in the USA. Moreover, it demonstrates a rare form of presentation and potential difficulty in achieving a correct diagnosis.
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Affiliation(s)
- Zhe Wang
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Joshua B Daniels
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Michael Lappin
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Tawfik Aboellail
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA
| | - Sarah Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Nelson V, Downey A, Summers S, Shropshire S. Prevalence of signs of lower urinary tract disease and positive urine culture in dogs with diabetes mellitus: A retrospective study. Vet Med (Auckl) 2023; 37:550-555. [PMID: 36708199 DOI: 10.1111/jvim.16634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND No recent studies have evaluated the association between clinical signs of lower urinary tract disease (LUTD) and positive urine culture in dogs with diabetes mellitus. OBJECTIVE Determine the prevalence of subclinical bacteriuria (ie, positive urine culture without signs of LUTD) in dogs with diabetes mellitus. ANIMALS One hundred seven dogs with diabetes mellitus were evaluated at a university veterinary hospital. METHODS Retrospective study evaluating diabetic dogs with a single sample paired urinalysis and urine culture. Relationship between the presence of signs of LUTD, pyuria, and bacteriuria and urine culture results were compared using Fisher exact testing. RESULTS Fifteen dogs (14%) had a positive urine culture via cystocentesis or free catch, of which 8 (53%) had pyuria, and 4 (27%) had signs of LUTD. Of the 88 dogs (82%) without signs of LUTD, 11 (13%) had a positive culture. A significant association was found between a positive urine culture and pyuria (OR infinity; 95% CI 20.34-infinity, P < .00001) and bacteriuria (OR infinity; 95% CI 164.4-infinity, P < .00001). No association was found between urine culture results and signs of LUTD (OR 1.87; 95% CI 0.59-6.85, P = .46). CONCLUSION AND CLINICAL IMPORTANCE Subclinical bacteriuria occurred in this cohort of dogs, and our findings reinforce the recommendation that urine cultures should not be routinely performed in diabetic dogs particularly if pyuria and bacteriuria are absent.
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Affiliation(s)
- Valerie Nelson
- Colorado State University Veterinary Teaching Hospital, Fort Collins, Colorado, USA
| | - Amy Downey
- Davis Veterinary Medical Teaching Hospital, University of California, Davis, California, USA
| | - Stacie Summers
- Oregon State University Veterinary Teaching Hospital, Corvallis, Oregon, USA
| | - Sarah Shropshire
- Colorado State University Veterinary Teaching Hospital, Fort Collins, Colorado, USA
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Ames MK, Vaden SL, Atkins CE, Palerme J, Langston CE, Grauer GF, Shropshire S, Bove C, Webb T. Prevalence of aldosterone breakthrough in dogs receiving renin‐angiotensin system inhibitors for proteinuric chronic kidney disease. J Vet Intern Med 2022; 36:2088-2097. [DOI: 10.1111/jvim.16573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marisa K. Ames
- Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USA
| | - Shelly L. Vaden
- Department of Clinical Sciences North Carolina State University College of Veterinary Medicine Raleigh North Carolina USA
| | - Clarke E. Atkins
- Department of Clinical Sciences North Carolina State University College of Veterinary Medicine Raleigh North Carolina USA
| | - Jean‐Sebastien Palerme
- Department of Veterinary Clinical Sciences Iowa State University College of Veterinary Medicine Ames Iowa USA
| | - Catherine E. Langston
- Department of Veterinary Clinical Sciences The Ohio State University College of Veterinary Medicine Columbus Ohio USA
| | - Gregory F. Grauer
- Department of Clinical Sciences Kansas State University College of Veterinary Medicine Manhattan Kansas USA
| | - Sarah Shropshire
- Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USA
| | - Christina Bove
- Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USA
| | - Tracy Webb
- Department of Clinical Sciences Colorado State University College of Veterinary Medicine and Biomedical Sciences Fort Collins Colorado USA
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Siu K, Diaz A, Chadwick A, Keys D, Shropshire S, Summers SC. Urine bacterial culture growth and association with urine sedimentation and clinical findings in cats with acute kidney injury. J Feline Med Surg 2022; 24:e295-e301. [PMID: 35748789 PMCID: PMC10812317 DOI: 10.1177/1098612x221105309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study was to determine the ability of a urinalysis and lower urinary tract signs (LUTS) to predict urine culture results in cats with AKI. METHODS Ninety-seven cats with AKI were included in this study. This was a retrospective, observational study. Medical records from 2008 to 2018 were reviewed to identify cats with AKI that had a paired urinalysis and urine bacterial culture. The sensitivity, specificity, positive predictive value and negative predictive values of microscopic bacteriuria, pyuria, hematuria and the presence of LUTS for predicting urine culture results was calculated. RESULTS Thirty-two percent of cats (n = 31) had a positive urine culture. Of these, 28 (90%) had bacteriuria, 21 (68%) had pyuria, 13 (42%) had hematuria and 10 (32%) had LUTS. Of the 42 cats without hematuria or pyuria, seven had a positive urine culture (17%). Bacteriuria had a high sensitivity (90%) and specificity (92%) for predicting urine culture bacterial growth. The absence of bacteriuria had a high negative predictive value for no bacterial growth (95%). The odds of a positive urine culture were increased with bacteriuria (odds ratio [OR] 114, 95% confidence interval [CI] 29-621; P <0.001), pyuria (OR 21, 95% CI 7-70; P <0.001) and LUTS (OR 5, 95% CI 1.7-16; P = 0.004). Hematuria was not associated with a positive culture (sensitivity 42%, specificity 52%). CONCLUSIONS AND RELEVANCE Microscopic bacteriuria and pyuria on urine sediment evaluation and LUTS can be helpful for predicting bacterial culture results in cats with AKI and in settings where submitting a urine culture may not be financially feasible.
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Affiliation(s)
- Kenneth Siu
- Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Amanda Diaz
- Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - Deborah Keys
- Kaleidoscope Statistical Consulting, Athens, GA, USA
| | - Sarah Shropshire
- Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Fuller A, Černá P, Jost H, Williams M, Shropshire S, Lappin MR. Histoplasma capsulatum, Toxoplasma gondii, Bartonella henselae and Bartonella clarridgeiae coinfections in an indoor-only Siamese cat. JFMS Open Rep 2022. [DOI: 10.1177/20551169221118553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 6-year-old male castrated Siamese cat was referred for acute-onset blindness and mydriasis. Physical examination revealed serous retinal detachment with panuveitis and systemic hypertension. Abdominal ultrasound showed suspected dilation of the cisterna chyli and abdominal lymphadenopathy. Aspirates of mesenteric lymph nodes revealed intrahistiocytic yeast organisms with mild-to-moderate pyogranulomatous inflammation. Fungal culture and ITS1 sequencing of the lymph node aspirates confirmed infection with Histoplasma capsulatum. PCR performed on whole blood was positive for Bartonella henselae and Bartonella clarridgeiae, and Toxoplasma gondii IgG and IgM antibodies were detected in serum. The cat was prescribed prednisolone (0.5 mg/kg PO q24h), itraconazole (10 mg/kg PO q24h), clindamycin (13 mg/kg PO q12h), amlodipine (0.625 mg PO q24h), prednisolone acetate 1% drops (q6h) and ophthalmic lubricant for both eyes (q6h). The cat was doing well at home after 2 weeks of prednisolone, itraconazole and clindamycin administration, and no abnormalities were detected on repeat abdominal ultrasound 3 months later. The retinal detachment showed mild-to-moderate improvement at that time, but vision was not regained. Relevance and novel information This is the first report of coinfection of H capsulatum, T gondii, B henselae and B clarridgeiae in an indoor-only cat living in a H capsulatum non-enzootic area with no known travel history.
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Affiliation(s)
- Alexandra Fuller
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Petra Černá
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Haley Jost
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Maggie Williams
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sarah Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Michael R Lappin
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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Gagnon AL, Scansen BA, Olver C, Shropshire S, Hess A, Orton EC. Phase I clinical trial of an antithrombotic drug protocol combining apixaban and clopidogrel in dogs. J Vet Cardiol 2021; 36:105-114. [PMID: 34192609 DOI: 10.1016/j.jvc.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Combining an antiplatelet drug, clopidogrel, with the direct oral Factor Xa inhibitor, apixaban, could provide an effective antithrombotic strategy in dogs. Thus, a limited 3 + 3 phase I dose-escalation clinical trial in healthy dogs was conducted to evaluate bleeding (primary end-point) and pharmacodynamic (PD)/pharmacokinetic (PK) parameters (secondary end-point). ANIMALS Eleven beagle dogs, median body weight 10.2 kg (9.7-10.9 kg), were enrolled. METHODS Four doses of apixaban (three dogs/dose) administered for eight days. Clopidogrel dose was fixed at 18.75 mg per os (PO) q 24 h with escalation of apixaban dose at 5 mg PO q 12 h, 5 mg PO q 8 h, 10 mg PO q 12 h, and 10 mg PO q 8 h. Laboratory testing included fecal occult blood, coagulation parameters, Factor X activity, apixaban concentration, platelet aggregometry, and thromboelastography on days 1, 3, and 8. RESULTS Evidence of bleeding was not observed at any dosage. Dose-dependent changes in PD/PK parameters between baseline and 3 h post-medication were observed including a prolongation of prothrombin time, a prolongation of activated partial thromboplastin time, a decrease of Factor X activity level, and increased apixaban concentration. CONCLUSIONS The combination of apixaban at a dosage range of approximately 0.5 mg/kg PO q 12 h to 1 mg/kg PO q 8 h and clopidogrel at approximately 1.8 mg/kg PO q 24 h did not cause bleeding over a one-week period in healthy dogs. Clinically relevant changes in PD/PK data occur at all dosage levels. This study provides a starting point for longer-term clinical trials to determine safety and efficacy.
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Affiliation(s)
- A L Gagnon
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - B A Scansen
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - C Olver
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, 80523, USA
| | - S Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - A Hess
- Department of Statistics, Colorado State University, Fort Collins, CO, 80523, USA
| | - E C Orton
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO, 80523, USA.
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Shropshire S, Dow S, Lappin M. Detection and dynamics of anti-platelet antibodies in thrombocytopenic dogs with and without idiopathic immune thrombocytopenia. J Vet Intern Med 2020; 34:700-709. [PMID: 32072705 PMCID: PMC7096660 DOI: 10.1111/jvim.15737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 02/05/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Antiplatelet antibodies are detected in multiple diseases including primary immune thrombocytopenia (ITP). Dynamics of how these antibodies change over time in ITP is unknown in dogs. HYPOTHESIS/OBJECTIVES Antiplatelet antibodies (APA) will be detected in thrombocytopenic dogs with multiple etiologies and dynamics of APA in dogs with ITP can be used to evaluate response to treatment and relapse. Determine APA at the time of diagnosis in thrombocytopenic dogs and serially in primary ITP dogs. ANIMALS Seventy-nine thrombocytopenic dogs and 28 primary ITP dogs. METHODS Direct flow cytometry was performed in thrombocytopenic dogs at initial evaluation and serially in suspected primary ITP dogs. In primary ITP dogs, a 2-tailed Fisher's exact test was performed comparing survival to discharge between dogs with and without melena and to relate response to treatment and relapse to changes in APA and platelet count (repeated measures analysis, Spearman correlation). RESULTS Twenty percent (16/79) of thrombocytopenic non-ITP dogs with infectious, neoplastic, or other diseases and all primary ITP dogs were positive for APA. Melena at initial evaluation was associated with decreased survival to discharge (odds ratio 0.06; P = .01). Persistence of APA was not associated with response to treatment, but recurrence of antibodies was associated with relapse (odds ratio 205.0; P < .01). There was no difference in percentage of APA or platelet count at initial diagnosis between dogs that did or did not respond to treatment. CONCLUSIONS AND CLINICAL IMPORTANCE Serial monitoring of APA in dogs with primary ITP appeared beneficial for determining relapse of disease.
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Affiliation(s)
| | - Steven Dow
- Colorado State University, Fort Collins, Colorado
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Shropshire S, Johnson T, Olver C. Platelet aggregometry testing during aspirin or clopidogrel treatment and measurement of clopidogrel metabolite concentrations in dogs with protein-losing nephropathy. J Vet Intern Med 2020; 34:710-718. [PMID: 31981378 PMCID: PMC7096639 DOI: 10.1111/jvim.15694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022] Open
Abstract
Background Dogs with protein‐losing nephropathy (PLN) are treated with antiplatelet drugs for thromboprophylaxis but no standardized method exists to measure drug response. It is also unknown if clopidogrel metabolite concentrations [CM] differ between healthy and PLN dogs. Objectives Assess response to aspirin or clopidogrel in PLN dogs using platelet aggregometry (PA) and compare [CM] between healthy and PLN dogs. Animals Six healthy and 14 PLN dogs. Methods Platelet aggregometry using adenosine diphosphate (ADP), arachidonic acid (AA), and saline was performed in healthy dogs at baseline and 1‐week postclopidogrel administration to identify responders or nonresponders. A decrease of ≥60% for ADP or ≥30% for AA at 1 or 3 hours postpill was used to define a responder. At 1 and 3 hours postclopidogrel, [CM] and PA were measured in healthy and PLN dogs. Platelet aggregometry was performed in PLN dogs at baseline, 1, 6, and 12 weeks after clopidogrel or aspirin administration. Results In PLN dogs receiving clopidogrel, PA differed from baseline at all time points for ADP but not for AA at any time point. Most dogs responded at 1 or both time points except for 1 dog that showed no response. For PLN dogs receiving aspirin, no differences from baseline were observed at any time point for either ADP or AA. No differences in [CM] were found at either time point between healthy and PLN dogs. Conclusions and Clinical Importance Platelet aggregometry may represent an objective method to evaluate response to clopidogrel or aspirin treatment and PLN dogs appear to metabolize clopidogrel similarly to healthy dogs.
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Affiliation(s)
- Sarah Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
| | - Tyler Johnson
- North Carolina State University, Raleigh, North Carolina
| | - Christine Olver
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado
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Shropshire S, Dow S, Lappin M. Validation of a clinically applicable flow cytometric assay for the detection of immunoglobulin associated platelets in dogs. Vet Immunol Immunopathol 2018; 202:109-114. [PMID: 30078583 DOI: 10.1016/j.vetimm.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 12/12/2022]
Abstract
Thrombocytopenia is commonly encountered in veterinary practice when evaluating canine patients. It can occur in infectious, neoplastic, inflammatory, toxic, and immune-mediated conditions. Elucidating the underlying cause for thrombocytopenia can therefore represent a challenge to veterinary practitioners. Additionally, determination of whether an immune process could be contributing to a patient's thrombocytopenia is important for refining differentials and enhancing understanding of a particular disease process. A possible candidate test for the development of a clinically applicable assay in dogs is flow cytometry. Therefore, the purpose of this study was to develop a clinically applicable direct and indirect flow cytometric assay for the detection of canine immunoglobulin associated platelets. Direct and indirect flow cytometry was performed in nine healthy beagles and twelve client-owned thrombocytopenic dogs at four time points: fresh and after 24, 48, and 72 h of storage at 4 °C. For healthy dogs, there was no significant difference between fresh and 24 and 48 h samples but there was a significant difference between fresh and 72 h samples. There was no significant difference between fresh and 24, 48, or 72 h samples in the thrombocytopenic dogs. A cut-off value of ≤ 10% antibody binding was defined to differentiate negative and positive classifications and was determined by serial direct flow evaluations in a healthy dog. Based on this cut-off value, healthy and thrombocytopenic dogs were consistently categorized at every time point. The average intra-assay coefficient of variation for the thrombocytopenic dogs was 4.32%. The indirect flow cytometric methods evaluated herein did not provide reliable or repeatable results in healthy or thrombocytopenic dogs. Direct flow cytometry represents a potentially clinically useful test for the detection of immunoglobulin associated platelets in dogs that can be processed and evaluated within a realistic amount of time which would allow for testing in a larger number of patients. Based on the findings from this study using our protocols, indirect flow cytometry was not clinically applicable in dogs.
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Affiliation(s)
- Sarah Shropshire
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO, USA.
| | - Steven Dow
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO, USA
| | - Michael Lappin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO, USA
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Shropshire S, Olver C, Lappin M. Characteristics of hemostasis during experimental Ehrlichia canis infection. J Vet Intern Med 2018; 32:1334-1342. [PMID: 29704268 PMCID: PMC6060328 DOI: 10.1111/jvim.15130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/09/2018] [Accepted: 03/07/2018] [Indexed: 12/20/2022] Open
Abstract
Background Ehrlichia canis infection in dogs can cause thrombocytopenia and clinical evidence of bleeding. It is unknown why some dogs show signs of bleeding whereas others do not despite clinically relevant thrombocytopenia. Hypothesis/Objectives Activated platelets, decreased fibrinolysis or both mitigate bleeding tendency. Assess standard hemostatic variables, platelet dynamics, and specialized coagulation testing in dogs experimentally infected with E. canis to evaluate this clinical discrepancy. Animals Four healthy laboratory beagles. Methods Dogs were given blood infected with E. canis IV. Platelet indices of activation, platelet aggregometry, antiplatelet antibodies (percent IgG), complete coagulation panel, and thromboelastography (TEG) were measured before inoculation and on weeks 1‐8. Dogs were treated with doxycycline at approximately 5 mg/kg PO q12h between weeks 3 and 4 (day 24). For each variable, 1‐way repeated measures analysis (1‐way ANOVA) with post‐hoc analysis was performed with statistical significance set at P < .05. Results Dogs had significantly lower platelet counts, evidence of activated platelets, and antiplatelet antibodies during E. canis infection. Dogs also appeared hypercoagulable and hypofibrinolytic using TEG as compared with baseline, changes that persisted for variable amounts of time after doxycycline administration. No overt signs of bleeding were noted during the study. Conclusions and Clinical Importance Activated platelets and a hypercoagulable, hypofibrinolytic state could explain the lack of a bleeding phenotype in some dogs despite clinically relevant thrombocytopenia. Findings from our pilot study indicate that additional studies are warranted.
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Affiliation(s)
- Sarah Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, CO
| | - Christine Olver
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, CO
| | - Michael Lappin
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, CO
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Shropshire S, Quimby J, Cerda R. Comparison of Single, Averaged, and Pooled Urine Protein:Creatinine Ratios in Proteinuric Dogs Undergoing Medical Treatment. J Vet Intern Med 2017; 32:288-294. [PMID: 29171088 PMCID: PMC5787151 DOI: 10.1111/jvim.14872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/02/2017] [Accepted: 10/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background Monitoring urine protein:creatinine ratios (UPC) in dogs with protein‐losing nephropathy (PLN) is challenging because of day‐to‐day variation in UPC results. Hypothesis/Objectives Determine whether single, averaged, or pooled samples from PLN dogs receiving medical treatment yield comparable UPCs, regardless of degree of proteinuria. Animals Twenty‐five client‐owned PLN dogs receiving medical treatment. Methods UPC ratios were prospectively measured in each dog utilizing 3 methods: single in‐hospital sample (day 3), average sample (days 1–3), and pooled sample (equal pooling of urine from days 1–3). Bland‐Altman analysis was performed to evaluate agreement between methods for all dogs, as well as in subgroups of dogs (UPC ≤4 or UPC >4). Results For all dogs, Bland‐Altman log‐transformed 95% limits of agreement were −0.07–0.18 (single versus pooled UPC), −0.06–0.16 (single versus average UPC), and −0.06–0.04 (pooled versus average UPC). For dogs with UPC ≤4, Bland‐Altman 95% limits of agreement were −0.42–0.82 (single versus pooled UPC), −0.38–0.76 (single versus average UPC), and −0.27–0.25 (pooled versus average UPC). For dogs with UPC >4, Bland‐Altman 95% limits of agreement were −0.17–2.4 (single versus pooled UPC), −0.40–2.2 (single versus average UPC), and −0.85–0.43 (pooled versus average UPC). Conclusions and Clinical Importance UPC ratios from all methods were comparable in PLN dogs receiving medical treatment. In PLN dogs with UPC >4, more variability between methods exists likely because of higher in‐hospital results, but whether this finding is clinically relevant is unknown.
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Affiliation(s)
| | - J Quimby
- Colorado State University, Fort Collins, CO
| | - R Cerda
- Arapahoe Animal Hospital, Boulder, CO
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Shropshire S. What's a Guy To Do?: Contraceptive Responsibility, Confronting Masculinity, and the History of Vasectomy in Canada. Can Bull Med Hist 2014; 31:161-182. [PMID: 28155350 DOI: 10.3138/cbmh.31.2.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite the growing popularity of vasectomy in recent years, historians have largely ignored the history of the procedure. The current article provides a preliminary examination of voluntary male sterilization in Canada and, in so doing, challenges the gendered paradigm scholars have often applied to the history of contraception. State-sponsored Medicare and late decriminalization of contraception are discussed as factors that slowed widespread adoption of vasectomy in Canada while evolving surgical techniques are highlighted for their role in increasing acceptability of the procedure. The article explores how evolving definitions of hegemonic masculinity have both hindered and encouraged acceptance of vasectomy over time.
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Shropshire S. E-commerce: a quick guide to online shopping. CIN Plus 2000; 3:12, 10, 4. [PMID: 10890852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Shropshire S, Nicoll L. VoIP and Internet telephony. CIN Plus 1999; 2:10-2. [PMID: 10890854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Shropshire S. Not so lovely spam. CIN Plus 1999; 2:12, 11. [PMID: 10890847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- S Shropshire
- College of Nursing, University of Southern Maine, Portland, USA
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Shropshire S. Search engines on the information superhighway. CIN Plus 1998; 1:16. [PMID: 10890844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Shropshire S. How do you cite a Web site? CIN Plus 1998; 1:2, 9. [PMID: 10890842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Murray RH, Shropshire S. Effect of atropine on circulatory responses to lower body negative pressure and vasodepressor syncope. Aerosp Med 1970; 41:717-22. [PMID: 4912272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Haley R, Shropshire S, Markand ON, Crout JR, Kaplan NM, Eigenbrodt EH. Clinico-pathologic conference. Tex Med 1970; 66:82-92. [PMID: 5436619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Shropshire S, Kilman WJ, Blomquist GC, Smiley JD, Jasin HE, Fallis BD, Eigenbrodt EH. Clinicopathologic conference. Tex Med 1969; 65:62-7. [PMID: 5384680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Shropshire S, Dowell AR, McCally M, Pohl SA, Bowles GL. Changes in acid-base balance induced by 100 percent gradient headward acceleration. Aerosp Med 1969; 40:237-42. [PMID: 4975973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Murray RH, Shropshire S, Thompson L. Attempted acclimatization by vigorous exercise during periodic exposure to simulated altitude. J Sports Med Phys Fitness 1968; 8:135-42. [PMID: 5724114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Dowell AR, Shropshire S, McCally M. Ventilation and pulmonary gas exchange during headward (+Gz) gradient acceleration. Aerosp Med 1968; 39:926-34. [PMID: 5672460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Murray RH, Shropshire S, Thompson L. Attempted acclimatization by vigorous exercise during periodic exposures to simulated altitude. AMRL-TR-67-114. AMRL TR 1967:1-11. [PMID: 5302881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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