To describe misoprostol pharmacokinetics and anti-inflammatory efficacy when administered orally or per rectum in endotoxin-challenged horses.6 healthy geldings.A randomized 3-treatment crossover design was performed with a minimum washout period of 28 days between treatment arms. Prior to endotoxin challenge (lipopolysaccharide, 30 ng/kg IV over 30 minutes), horses received misoprostol (5 µg/kg once) per os (M-PO) or per rectum (M-PR) or water as control (CON). Clinical parameters were evaluated and blood samples obtained to measure plasma misoprostol free acid concentration, leukocyte counts, and tumor necrosis factor-α (TNFα) and interleukin 6 (IL-6) leukocyte gene expression and serum concentrations.In the M-PO treatment arm, maximum plasma concentration and area under the concentration-versus-time curve (mean ± SD) were higher (5,209 ± 3,487 pg/mL and 17,998,254 ± 13,194,420 h·pg/mL, respectively) and median (interquartile range) time to maximum concentration (25 min [18 to 34 min]) was longer than in the M-PR treatment arm (854 ± 855 pg/mL; 644,960 ± 558,866 h·pg/mL; 3 min [3 to 3.5 min]). Significant differences in clinical parameters, leukocyte counts, and TNFα or IL-6 gene expression or serum protein concentration were not detected. Downregulation of relative gene expression was appreciated for individual horses in the M-PO and M-PR treatment arms at select time points.Considerable variability in measured parameters was detected among horses within and between treatment arms. Misoprostol absorption and systemic exposure after PO administration differed from previous reports in horses not administered LPS. Investigation of multidose administration of misoprostol is warranted to better evaluate efficacy as an anti-inflammatory therapeutic.
Abstract Objective: To describe the clinical manifestations and response to management of opioid dysphoria in 3 dogs. Case summary: Three dogs being managed for post‐operative pain were evaluated. All 3 dogs had been managed with various opioids including morphine, hydromorphone, and fentanyl following the surgical procedure. The 3 dogs exhibited vocalization that did not respond to interaction and did not change with administration of analgesic and anxiolytic agents. The dogs were treated with naloxone and, within 5 minutes of its administration, ceased vocalizing, and became aware and interactive with their environment. Further pain management consisted of non‐steroidal anti‐inflammatory medications, alpha‐2 (α 2 ) receptor agonists or the partial μ‐receptor opioid agonist, buprenorphine. New and unique information provided: Vocalization and lack of response to interaction with humans are clinical signs which can be seen in dogs with opioid dysphoria, and generally are not responsive to analgesics or sedation. Reversal with naloxone results in rapid resolution of vocalization and opioid‐induced dysphoria.
Abstract Background Dobutamine is used to treat hypotension in isoflurane‐anaesthetised horses but may produce arrhythmias. Halothane is a volatile anaesthetic that was, historically, widely used in horses, but in one study, 56 of 200 halothane‐anaesthetised horses (28%) developed arrhythmias after dobutamine administration. Although isoflurane has largely replaced halothane, it is unknown how isoflurane and dobutamine interact in the development of arrhythmias. Methods The medical records of horses undergoing general anaesthesia at the University of Georgia Veterinary Teaching Hospital in 2015 were reviewed retrospectively. Cases were selected if isoflurane was used as the maintenance inhalant anaesthetic agent and dobutamine was administered for the treatment of hypotension. Any instances of arrhythmia occurring following dobutamine administration were recorded. Results Arrhythmia occurred after dobutamine administration in six out of a total of 148 horses (4.0%). Limitations The retrospective nature of this study and the fact that the horses were anaesthetised at a single institution might limit the extent to which the findings can be ge. Conclusion Compared to halothane, isoflurane has a much lower incidence of arrhythmia when used with dobutamine. However, a larger‐scale study is needed to identify risk factors associated with horses developing an arrhythmia induced by isoflurane in combination with dobutamine.
Veterinary students’ accuracy, confidence, and time required to diagnose bacterial sepsis in fluid cytology samples was evaluated using two different slide preparation methods: direct smears and cytocentrifuged concentrated preparations. We hypothesized veterinary students would diagnose fluids as septic on concentrated preparations more accurately and quickly than on direct smears. Thirty third- and fourth-year students who had previously participated in a clinical pathology course completed a survey regarding general cytology experience and reviewed 40 randomized Romanowsky-stained slides via microscopy. Slides consisted of 10 septic and 10 non-septic samples with matched direct and concentrated slides, prepared from fluids from dogs, cats, and a horse. Participants’ slide evaluation time, diagnosis, confidence, and slide photographs of areas considered septic were recorded. No difference in diagnostic accuracy between direct and concentrated samples was identified (area under the curve: 57% for both preparations, p = 0.77), although students agreed with pathologist-determined diagnoses more often when viewing concentrated samples ( M = 63%, SD = 11% for concentrated; M = 56%, SD = 21% for direct, p = .012). A positive relationship existed between accuracy of diagnosis ( R 2 = .59) and senior status ( p = .002), comfort interpreting cytology slides ( p < .03), and if the student had taken the senior pathology rotation ( p = .02). Only 38% (121/319) of participant photographs correctly identified sepsis. Under experimental conditions, concentrated preparations did not increase the accuracy of veterinary students’ bacterial sepsis diagnosis; however, since accuracy did increase with cytology experience and comfort level, additional pre-clinical and clinical cytology training may benefit students before entering practice.
As part of the process of developing a decision aid for carpal tunnel syndrome (CTS) according to the Ottawa Decision Support Framework, we were interested in the level of 'decisional conflict' of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.One-hundred-twenty-three observers of the Science of Variation Group (SOVG) and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ) and the Patient Doctor Relationship Questionnaire (PDRQ-9).On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons. Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one's goals in spite of pain), and higher PDRQ (relationship between patient and doctor). Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America.Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.
To document the admission systolic blood pressure (SBP), heart rate (HR), and modified Glasgow coma scale (MGCS) score in dogs with and without brain herniation and to determine their relationship with brain herniation.Retrospective study between 2010 and 2019.University veterinary teaching hospital.Fifty-four client-owned dogs with brain herniation and 40 client-owned dogs as a control group, as determined on magnetic resonance imaging.None.SBP, HR, MGCS score, and outcome were extracted from medical records. MGCS score was retrospectively calculated based on initial neurological examination in dogs with adequate available information. Dogs with brain herniation had a significantly higher SBP (P = 0.0078), greater SBP-HR difference (P = 0.0006), and lower MGCS score (P < 0.0001) compared to control dogs. A cutoff value of an SBP ≥ 178 mm Hg, SBP-HR ≥ 60, and MGCS score ≤ 14 each provides a specificity of 90%-98%. A combination of an SBP > 140 mm Hg and HR < 80/min provided 24% sensitivity and 100% specificity to diagnose dogs with brain herniation (P < 0.0001).A high SBP, a greater difference between SBP and HR, a combination of higher SBP and lower HR, and a low MGCS score were associated with brain herniation in dogs presenting with neurological signs upon admission. Early recognition of these abnormalities may help veterinarians to suspect brain herniation and determine timely treatment.
