Support Grows for WSAVA Campaign to Secure Global Access to Veterinary Therapeutics

Medicine bottles17757322_1357464287609589_4350987275167613409_nThe World Veterinary Association (WVA), the Federation of Veterinarians of Europe (FVE) and the Federation of Companion Animal Francophone Veterinary Associations (FAFVAC) have all thrown their weight behind a campaign led by the World Small Animal Veterinary Association (WSAVA) to secure equal access to veterinary therapeutics for veterinarians around the world.  Ten WSAVA member associations have also endorsed it.

The WSAVA’s new Therapeutics Guidelines Group (TGG), which spearheads the campaign, has also appointed its first Chair, Dr Luca Guardabassi DVM, PhD, ECVPH.  Dr Guardabassi is Professor of One Health Antimicrobial Resistance at the University of Copenhagen, Denmark.

In a survey of its members conducted by the WSAVA during 2016-2017, 75% of respondents confirmed that that problems in accessing veterinary medical products hampered their ability to meet the needs of their patients and 20% assessed the impact of this issue as resulting in a severe restriction on their ability to provide a high level of care.

Dr Olatunji Nasir, Medical Director and CEO of the Truthmiles Animal Hospital in south west Nigeria, one of the countries affected, explained: “We face a Herculean task in trying access everything from basic medical consumables, such as syringes and needles, right up to veterinary drugs. Registration fees are very high because they are the equivalent of what is charged for human drugs despite the fact that the volume used is much lower.  The process of registering a new drug can also take up to 36 months which feeds demand for sub-standard products which are smuggled into the country.  The procedures for importing drugs are also cumbersome and impractical.”

The WSAVA launched its campaign earlier this year to tackle these problems and is calling on all of its member associations to endorse its Position Statement on the issue and to support its campaign. It is also calling on other veterinary associations to become co-signatories of the Position Statement.

 

Commenting, Dr Luca Guardabassi said: “Difficulty in accessing therapeutics to treat patients is a critical issue for companion animal veterinarians in many parts of the world.  It causes huge frustration and means that many thousands – probably millions – of animals do not receive optimum care.  It’s a situation which requires urgent change and we are determined to bring this about.

“We’re delighted that so many veterinary associations are supporting our campaign and are now preparing for a high-level summit meeting which will be held during WSAVA World Congress in Singapore in September.  At this meeting, we will bring together stakeholders from around the world to discuss the issues and recommend practical solutions.”

The WSAVA represents more than 200,000 veterinarians worldwide through its 105 member associations and works to enhance standards of clinical care for companion animals.  Its core activities include the development of WSAVA Global Guidelines in key areas of veterinary practice and lobbying on important issues affecting companion animal care worldwide.

Note to editors:

The following veterinary associations are co-signatories of the WSAVA’s Position Statement on therapeutic access:

  • Commonwealth Veterinary Association
  • FAFVAC
  • FVE
  • Federation of Asian Veterinary Associations
  • Federation of Asian Small Animal Veterinary Associations
  • Federation of European Companion Animal Veterinary Associations
  • Federacion Iberoamericana de Asociaciones Veterinarias de Animales de Compania
  • HealthforAnimals
  • World Veterinary Association

The following WSAVA member associations have endorsed its Position Statement on therapeutic access:

  • Estonian Small Animal Veterinary Association
  • Federation of Small Animal Practitioners Association, India
  • Ghana Private Veterinary Surgeons Association
  • Hellenic Companion Animal Veterinary Society
  • Kenyan Small Companion Animal Association
  • The Netherlands Association of Companion Animal Medicine
  • North American Veterinary Congress
  • The Philippines Animal Hospital Association

The Polish Small Animal Veterinary Association

Nutritional management of canine atopic dermatitis

Author: H.P. Meyer, DVM, PhD, Dipl-ECVIM-CA

Director, Professional & Veterinary Affairs, Hill’s Pet Nutrition

 

Co-author: Iveta Becvarova, DVM, MS, Dipl-ACVN

Director, Global Academic & Professional Affairs, Hill’s Pet Nutrition

 

 

 

Introduction

It has long been accepted that canine atopic dermatitis (CAD), much like human atopic dermatitis is underpinned by dysfunction of the patients’ adaptive immune response. Specifically, inappropriate production of immunoglobulins and activation of an inflammatory response as a result of sensitisation to environmental allergens. However, newer research into the pathophysiology of the condition has also discovered an important deficiency in the skin of patients with CAD. It has been suggested that dogs have reduced skin barrier function allowing increased allergen permeation (1). These two mechanisms are not mutually exclusive and it is possible that both play a role in the development of atopy. The abnormal presence of allergens that have permeated the epidermis may be a potential trigger for cell sensitisation during development of CAD.

 

Structural changes in the skin of atopic dogs are notably a reduction in the intercellular lipid layer with disorganised lipid lamellae (1). Studies also show differences in the barrier function of skin in atopic and non-atopic patients (2). Transepidermal water loss (TEWL) has been used as a measure of skin barrier function to demonstrate this effect. A study using an experimental model of CAD showed increased TEWL assumed to be as a result of altered skin barrier function in patients with an experimental model of atopy (2). This finding has also been noted in dogs with naturally occurring AD (3). Importantly, in both of these studies the changes in barrier function could be measured in both lesional and non lesional skin.

 

This improved understanding of affected skin barrier function whether cause or consequence is highly relevant to the management of CAD. These deficiencies have been shown to be present both in lesional and non lesional skin and structural changes are constant and present both during and between episodes of clinical signs. The International Task Force on Canine Atopic Dermatitis (4) has recommended a gold standard approach to management of CAD, which is to use more aggressive therapy for periods of clinical signs or atopic flares in addition to long-term maintenance therapy between flares that aims to reduce the incidence and severity of clinical episodes. One of the big considerations for clinicians when selecting such long-term management therapies for CAD patients is interventions with mild or no side effects. Use of carefully selected nutrients that can support the skin and coat could fit this brief.  Considering the importance of maintaining barrier function as well as tempering the inflammatory response to allergens there are nutrients that may play an important role in these areas of recent interest.

Nutrients of interest in CAD

There are two nutrients to consider that can be utilised for their effects on cell sensitisation and cell activation during the induction and effector phases of CAD. The first is the use of egg, which has multiple potential benefits, including antioxidant and immunomodulatory properties (5,6). The immunomodulatory benefit of egg has been explored in skin sensitisation in dogs (7). Three groups of dogs were exposed to a novel antigen (keyhole limpet hemocyanin (KLH) in weeks 9 and 11 of a controlled food trial. The three groups were a control food, the control food and prednisone (at 2.2mg/kg bodyweight orally per day) and a food containing egg. An intradermal skin test (with KLH) was performed at week 12 and the results were as follows: both the prednisone treated group and the egg fed group had statistically significant reductions in the immediate and delayed-type (cell-mediated) hypersensitivity reactions  compared to the control group. This response was similar between the egg and prednisone groups. These results support the findings that egg have immunomodulating properties (5,6), in particular in reducing allergen-induced hypersensitivity reactions. This nutrient may be of use when considering a food for patients with CAD.

 

The other important nutrient group to consider are polyphenols, which are sourced from plant ingredients such as green tea, herbs and green vegetables. Polyphenols do also have strong  antioxidant properties. Antioxidants are beneficial in foods for patients with CAD as it is a markedly inflammatory condition. Supplementation can support the patient’s own antioxidant defences in the face of free radical cellular injury caused by inflammation. Polyphenols, like egg, have also been shown to have specific effects tempering cell-mediated immune responses. Notably, they may inhibit antigen presentation, T cell cytokine release, B cell IgE production and mast cell degranulation (8-13). Use of these ingredients in pilot feeding studies of botanicals, containing polyphenols and antioxidants, in CAD has yielded reductions in levels of IL-31, IL-12p40 and other cytokines as well as reduced itching, hair loss and erythema (14).

Image 1. Fast and simple completion of the CADESI-4 skin scoring for CAD in the ‘Atopy Index’ APP developed by Hill’s. Download in your phone’s APP store .

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Following the identification of impaired barrier function in patients with CAD, studies have been conducted to identify nutrients to support the skin barrier. A key area has been to target the deficiencies noted in the intercellular lipid layer. A major component of this layer is ceramide; lower ceramide levels have been identified in the stratum corneum (SC) of patients with CAD compared to normal dogs (15,16). Oral supplementation of polyunsaturated fatty acids  (PUFAs) appears to support improvement in at least some of these structural changes. One study found supplementation of AD dogs with PUFAs resulted in increased ceramide content in the SC and improved organisation of lamellae in the SC to be comparable to that of normal dogs (17).

PUFAs have been widely trialed in both research and clinically as a management strategy for CAD for their anti-inflammatory effect and to nourish the skin and coat. The benefits of using PUFAs as an anti-inflammatory are through a reduction in production of pro-inflammatory eicosanoids and a reduction in stimulation of inflammatory cells. (18). This effect is largely mediated through Ω-3 PUFAs in contrast to the epidermal barrier support described above which is considered to be a factor of total Ω-6 intake.

 

This requirement for both Ω-3 and Ω-6 fatty acids can complicate the interpretation of research findings in relation to PUFAs. Further work is required to completely understand PUFAs in this regard. From the current literature it is advisable to consider both the level of Ω-3 and Ω-6 PUFAs and their ratio to one another for optimum support. A low Ω-6 to Ω-3 ratio is considered anti-inflammatory, with an inclusion of sufficient total Ω-6 for skin barrier support. For this reason their inclusion in a complete food rather than supplementation on top of the patient’s own food will give better control.

 

To complete the review of nutrients there are also macro and micro nutrients that can be added to the food and optimised for skin and coat support. These nutrients are applicable to all dogs not just patients with CAD. Protein, vitamins A and E, Ω-3 and Ω-6 fatty acids, zinc and copper all contribute to maintenance and repair of skin and coat. These benefits are well described in more detail in nutrition texts (19).

Figure 1. Median (range) dermatological scores in 20 dogs with CAD at baseline and at 4 and 8 weeks after being put on a dietetic food indicated for CAD. * p<0.05 vs. baseline.

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To assess the holistic impact of the discussed nutrients a study was conducted using a food indicated for patients with CAD. The food is a complete canine food optimised for skin support to include zinc, copper, antioxidant vitamins E and C and also containing egg, polyphenols and supplemented with both Ω-3 and 6 PUFAs. The study was constructed as an open label non-controlled feeding study of adult dogs with pre-existing AD. Patients were included on the basis of presenting with 5 or more of Favrot’s criteria for the diagnosis of AD (20). The dogs could be maintained during the study on standard therapy for AD including allergen avoidance, allergen-specific immunotherapy, symptomatic anti-inflammatory therapy and antimicrobial therapy as long as drugs, doses, and frequency of administration remained constant from the time of previous food administration through to completion of the study . Dogs were excluded on the basis of untreated infectious or parasitic dermatitis or concurrent skin or major systemic conditions. Also dogs were excluded if they had been fed with either food or supplements with high levels of Ω-3 fatty acids in the 12 weeks preceding the study. Dogs using oclacitinib were also excluded from the study.

 

The owners were instructed to feed the dogs the food exclusively for 8 weeks and discontinue all any homeopathic remedies and other supplements. The dogs were assessed at 0, 4 and 8 weeks and at each assessment the attending vet completed a dermatological evaluation based on the Canine Atopic Dermatitis Extent and Severity Index (CADESI) (21) and owners completed an evaluation form at each visit and gave their opinion on their dog’s quality of life, skin and coat appearance, and food acceptance. The CADESI-4 scoring system is an important tool to provide an objective assessment of the situation and to monitor progress. Hill’s has developed a simple in-clinic APP to facilitate CADESI-4 scoring completion, storage and visualisation to the pet owner. It can be downloaded via your app store on your mobile phone (Image 1).

 

20 dogs were included in the data analysis, 28 dogs were excluded prior to this due to various medication and supplement changes or missing data and 3 were excluded due to food refusal. For the analysed patient group both mean BCS and mean weight were stable during the study.  The results shown below show the median dermatological scores for the dogs decreased significantly at both 4 and 8 weeks when compared to the baseline (Fig 1).

 

Owner assessments also showed significant improvements at the end of the study compared to baseline in the following categories: scratching, licking, scratching of ears, disruption to the family redness of skin and overall condition of skin and hair coat  (Fig 2).

Figure 2. Owner assessments (Least square mean (range); Scale from 0 (not present) – 10 (always present) of various skin parameters in 20 dogs with CAD at baseline and at 4 and 8 weeks after being put on a dietetic food indicated  for CAD. * p<0.05  vs. baseline

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Overall food acceptance was good with 90% of dogs eating the food for the entire study duration. Many dogs had to be excluded due to medication changes. The number that started and stopped medication was almost equal during the study removing selection bias towards milder or more severe cases.  This results suggest use of these nutrients in a complete food shows improvement from both an owner perspective and in reducing dermatological scores for patients. The application of a food designed for use in patients with AD to reduce the inflammatory response, support skin barrier function and optimise skin and coat health could be considered as part of a multimodal approach to managing the patient with AD. Particularly considering that nutrition can be used simply on a daily basis both during and between clinical flares with no adverse effects to the patient.

 

C2 FRACTURE AND CENTRAL CORD SYNDROME

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Dr Svetoslav Penchev

United Veterinary Clinic 

Varna, Bulgaria

 

 

 

 

Case is about a 6 months , male  cocker spaniel named  Michael.Michael was brought in the clinic from another city in very bad candition.The owners report for a trauma in cervical region.Radiography and neurological examinations were made. Results revealed –Tetraplegie and atalnto-axial instability.It was made a CBCT on cervical region.The image show C2-Fracture .3

 

 

 

 

 

 

 

 

Michael C2 fr et CCS 9Michael C2 fr et CCS 5Michael C2 fr et CCS 6Michael C2 fr et CCS 4Michael C2 fr et CCS 2It was maked a surgary to stabilize  cervical spine. Ten days after surgery Michael starts moving the pelvic limbs first and tries to stand on them. Twenty one days after surgary Micheal start to moving and thoracic limb  , but  have ataxia and destroys proprioception on his  four leg. Michael`s  recovery begin first with the hind limbs and then with the thoracic limbs .In human literature, the symptom in which the thoracic limb is in a dysfunctional state with minimal to no deficit in the pelvic limbs has been referred to as CCS (Central Cord Syndrome ). The spinal cords that travel to the pelvic limbs are minimally affected because the lesion is centralized in the cervical region, which only affects the thoracic limbs. In general, CCS has a good prognosis for functional recovery and its common etiology is traumatic disease in human medicine. CCS treatments with nonsurgical management include cervical spine restriction with a neck collar, rehabilitation followed by physical therapy and occupational therapy. Surgical management is provided for patients who cannot be treated by conservative management alone.

 

Michael C2 fr et CCS 10Michael C2 fr et CCS 8Michael C2 fr et CCS 11Michael C2 fr et CCS 12Michael C2 fr et CCS 13

Diagnosis and therapeutic management in a a dog with severe cardiac dilatation associated with complex arrhythmias – A case report.

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Dr Vasile Vulpe

33023039_1831545640221964_5476404995450470400_n

Dr Andrei Baisan

Radu Andrei BAISAN, Vasile VULPE

Clinics Department, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine “Ion Ionescu de la Brad”, Iași, Romania

Baisan.andrei_mv@yahoo.com

Cardiac dilatation is a common finding in dogs with heart disease. Chronic myocardial stress and volume overload are the main reasons for cardiac remodeling. These changes are encountered in most of chronic diseases such as dilated cardiomyopathy, mitral valve disease or congenital disease that develop volume overload. Cardiac dilatation should not be confused with dilated cardiomyopathy (DCM), which is known to be a myocardial disease induced by several specific factors such as genetic or familial predispositions. In the absence of specific signs, such as mitral valve degeneration or congenital heart diseases, cardiac dilatation should be carefully evaluated and additional tests must be performed before deciding the diagnosis and therapy. In veterinary medicine, there is insufficient data regarding the differential diagnosis of cardiac dilatation when specific sins are absent.

The aim of this paper is to report and discuss a patient with congestive heart failure due to severe cardiac dilatation associated with multiple arrhythmias and to describe the diagnostic protocol, therapy and evolution of the disease.

Case presentation

An eleven years male, German Shorthaired Pointer dog, weighing 38 kg, was referred for a second opinion to our Cardiology Service from the Teaching Hospital of the Veterinary Faculty of Iași, because of chronic abdominal fluid accumulation, severe effort intolerance and weight loss for the past few months. The dog was receiving cardiac therapy assigned by the referring clinician and consisted of pimobendane (Vetmedin® Boehringer Ingelheim), 0.25 mg/kg P.O. BID and furosemide (Furosoral, Artesan Pharma GmbH & Co.), 2 mg/kg P.O. BID. The owner reported that the dog had been treated for Babesia canis for four times in the past few years.

During the first visit, the dog was subjected for complete cardiologic examination consisting of physical examination, five minutes six leads electrocardiography (PolySpectrum veterinary device), blood pressure measurement (Vet-HDO blood pressure device), cardiac ultrasonography (Logiq V5, General Electric), cardio-thoracic radiography (Intermedical Basic 4006 X-ray machine and Examion X-CR smart digital developing machine) and biochemical and CBC blood analyses as previously described [1-4].

Physical examination showed pink mucosal membranes, with a CRT of 3 seconds, abdominal distension, breathlessness, with a normal respiratory rate (28 bpm), strong and arrhythmic cardiac beats, without precordial thrill. The palpation of the femoral artery revealed weak asynchronous arterial pulse. Auscultation revealed an arrhythmic rhythm and III/VI systolic plateau left apical murmur. Auscultation of the lungs revealed crackles in both sides of the caudal lung lobes.

Electrocardiography revealed an arrhythmic rhythm with a median heart rate of 130 bpm, with more types of arrhythmias present over the five minutes ECG tracing. The predominant rhythm was accelerated idioventricular rhythm, with a heart rate of 168 bpm, interrupted by runs of supraventricular tachycardia, with a heart rate of 240 bpm and sinus tachycardia with a heart rate of 165 bpm (Fig no 1).

Fig no 1

Fig 1. Six leads ECG at 50 mm/sec and 5 mm/mV of an eleven years old dog with signs of congestive heart failure. The main rhythm is represented by an accelerated idioventricular rhythm (black arrowhead), with a heart rate of 168 bpm, interrupted by left ventricular premature complexes (red arrowhead) and fusion beats (star)

Fig no 2

Fig 2. Six leads ECG at 50 mm/sec and 5 mm/mV of the same dog with signs of congestive heart failure. Sequences of supraventricular rhythm are visible, with a heart rate of 240 bpm and sparse sinus complexes (star); also, one left ventricular premature complex is present on the tracing (diamond) and junctional beats with retro-conducted P’-waves (arrow);

Fig no 3-1

Fig 3. Six leads ECG at 50 mm/sec and 5 mm/mV of the same dog with signs of congestive heart failure. An atrial beat is present with a small P-wave (star), followed by 3 RBBB aspect complexes and a fusion beat. The black horizontal arrow marks the beginning and the end of fast supraventricular tachycardia consistent with atrial fibrillation, followed by another fusion beat (diamond);

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

There were also present runs o junctional beats with a retro-conducted P-wave. Between these sequences of arrhythmias, there were present 25 left ventricular premature complexes, with the same morphology, with a negative polarity in DII, DIII, and aVF and positive polarity aVR and aVL. These complexes had a length of 120 msec and a tall, opposed T-wave. Multiple fusion beats were also present (Fig no 2 and 3).

 

 

 

 

 

 

 

 

 

 

 

 

The blood pressure measurement was performed with a D1 cuff placed on the tail and simultaneous recording of the pulsating-wave graphic. However, measurements of the blood pressure were not accurate due to the differences in the pulsating wave.

Fig no 6

Fig nr. 6 Echocardiographic M-mode in right parasternal short axis view through the papillary muscles of the left ventricle of the same dog with signs of congestive heart failure. Arrhythmic contractions of the left ventricle are visible. The free wall and septum appear thinned and the ventricular cavity is enlarged in both systole and diastole. The measurements were performed when the rhythm was supraventricular. The shortening (SF%) and ejection (EF%) fractions are within normal limits.

figg 4

Fig 4

figg 5

Fig 5

Cardiac ultrasonography revealed severe left ventricular dilatation during systole (39.6 mm 95%CI 15.8-17.18 mm) and diastole (64.2 mm, 95% CI 37.64-39.1 mm), with thinned interventricular septum and ventricular free wall and severe left atrial dilatation, with a LA/Ao ratio of 2.54 (normal upper limit 1.6). Also, the left auricular cavity was visibly enlarged. The mitral valve was thin with normal echoic appearance and abnormal motion due to the hemodynamic changes induced by the underlying arrhythmia and a regurgitating jet was observed by color doppler. The left ventricle systolic function was within normal limit, when assessed during supraventricular rhythm (SF%=38, EF%=67). The pulmonary and aortic flow were laminar, within normal ranges. There were no signs of pulmonary hypertension. The pericardium was normal, without fluid accumulation (Fig no 4-6).

Fig nr. 4 Echocardiographic left parasternal long axis apical four chamber view of an eleven years old dog with signs of congestive heart failure. The LA and LV are visible enlarged and the mitral valve leaflets appear normal. LV-left ventricle; LA-left atrium; RV-right ventricle; RA-right atrium;

Fig nr. 5 Echocardiographic right parasternal long axis oblique four chamber view optimized for the left atrium of the same dog with signs of congestive heart failure. The LA and Lau appear visible enlarged. LV-left ventricle; LA-left atrium; LAu-left auricle

 

xray

Fig nr. 7 Left lateral chest radiography of an eleven years old dog with signs of congestive heart failure. The cardiac silhouette is visibly enlarged with dorsal displacement of the trachea and a perihilar pulmonary interstitial and alveolar pattern is visible extending in the caudal lung lobes. A round radiopaque mass is visible on the lower cranial abdomen

A left lateral thoracic X-ray was available for examination and revealed severe cardiomegaly, with a VHS of 13.3v. The trachea was dorsally displaced and a perihilar pulmonary interstitial and alveolar pattern was visible in the caudal lung lobes consistent with moderate cardiogenic pulmonary edema. A round radiopaque area was present over the gallbladder topography and a gallbladder stone was suspected (Fig no 7).

 

Blood biochemical analyses were within normal ranges except a moderate hypoalbuminemia (2.5 g/dL normal ranges 2.6-4 g/dL) and moderate increased alanine aminotransferase (58 UI/L, normal ranges 8-57 UI/L). Cell blood count was within normal ranges.

The diagnosis consisted of idiopathic dilated cardiomyopathy with supraventricular and ventricular arrhythmias. The current therapy was maintained and amiodarone (Amiodaronă LPH, LABORMED PHARMA S.A.), was added as following: 15 mg/kg P.O. BID for 7 days, followed by 7.5 mg/kg P.O. BID for the next seven days and 7.5 mg/kg P.O. QD for the next fourteen days. The dog was released from the hospital the same day with effort and salt restriction. The reevaluation was scheduled after 2 weeks if no event required a sooner visit.

Three weeks later, the owner called for a reevaluation. The medication was administered according to recommendation and no events were observed during this period. aA significant improvement in the quality of life of the patient was reported.

The dog was alert and active during physical examination, with pink mucosal membranes, CRT of 3 seconds, moderate decreased respiratory rate (36 bpm) and effort, and a less distended abdomen. Palpation of the thorax revealed a strong cardiac beat and the arterial pulse was synchronous with the cardiac beat. Cardiac auscultation showed rhythmic rhythm, with a heart rate of 114 bpm and III/VI systolic plateau left apical murmur.

Fig no 8

Fig 8. Six leads ECG at 50 mm/sec and 5 mm/mV of the same dog with signs of congestive heart failure, performed during reevaluation, 3 weeks later. The predominance of sinus rhythm is visible, with a heart rate of 115 bpm, interrupted by one right ventricular premature complex (star) and one supraventricular complex (arrowhead);

The five minutes six lead ECG tracing revealed a predominant sinus rhythm, interrupted by 107 single supraventricular complexes and only one right ventricular premature complex with positive polarity in DII, DIII and aVF and negative in DI, aVR and aVL. No sequences of supraventricular tachycardia or accelerated idioventricular rhythm were present on the five minutes tracing. The abnormalities in morphology of the sinus beats revealed a mitral P-wave (78 msec), increased amplitude of the R-wave (3.34 mV) and increased length of the QRS complex (91 msec) (Fig no 8).

 

There were no improvements seen during the echocardiographic examination. The owners were instructed to administer the therapy with pimobendane and furosemide continuously and amiodarone until the end of protocol. Eight weeks after the first examination, owners reported by telephone that the patient is alive and the quality of life remained improved.

Discussions

Dilated cardiomyopathy (DCM) can occur as a primary cardiomyopathy such as genetic, or familial DCM [5], or secondary to myocardial stress, such as drug- or toxin-induced, infiltrative, ischaemic, metabolic, nutritional, or inflammatory myocardial diseases [6]. In both cases, DCM is expressed through a disease of the myocardium associated with ventricular systolic and diastolic dysfunction and development of congestive heart failure [5]. According to ESVC Taskforce for Dilated Cardiomyopathy, 2003, scoring system, the score in this dog was above 6 points, which is consistent with the presence of DCM  [5]. The left ventricular internal diameter in both systole and diastole were above the 95% CI based on the regression formula [7], the sphericity index was under the lowest recommended limit and left atrial enlargement was present. However, there were some changes that did not seem to be associated with primary DCM. The shortening and ejection fraction were within normal ranges and the large range of arrhythmias was not consistent with specific morphologic and rhythm changes in primary DCM. It has been suggested that atrial fibrillation is the most common arrhythmia in dogs with DCM and also, increased number of ventricular premature complexes may have diagnostic value [5, 8]. Nevertheless, it must be considered that the dog was treated with positive inotropic medication which may have influenced the systolic function of the heart. Another unexpected result was the intense positive response to arrhythmic therapy. Amiodarone is an antiarrhythmic agent with primarily class 3 action, but also potent class one. This agent prolongs the action potential duration and the effective refractory period in all cardiac tissues. It is recommended in dogs with ventricular arrhythmias and has also been used to convert atrial fibrillation to sinus rhythm [9].

The differential diagnosis for cardiac dilatation should include secondary DCM due to cardio-toxicosis, drug-induced, metabolic or nutritional factors, chronic myocarditis or tachycardia-induced cardiomyopathy (TIC). Secondary DCM is difficult to diagnose due to the multiple factors of environment and microclimate. A large series of pathogens have been reported to induce chronic myocarditis, including canine babesiosis [10-15]. However, in most studies, the etiological diagnosis was reached through histopathological examination of the cardiac tissue after patient’s death [16]. Considering the four episodes of clinical manifestation of canine babesiosis in this patient, cardiac enlargement may be related to this. Tachycardia-induced cardiomyopathy is characterized by cardiac dilatation and systolic and diastolic dysfunction due to long-term increased heart rate, however these changes may be easily confused with DCM. Clinical studies in human medicine have suggested that the left ventricle internal diameter and volume are significantly smaller in patients with TIC than in those with DCM [17]. Another difference between the two pathologies is that the ventricle remodeling during TIC may benefit from partial or total reversibility once the arrhythmia control is achieved [18]. In the patient discussed in this paper, we observed a significant improvement in controlling the rhythm and heart rate after the antiarrhythmic therapy but not in the cardiac remodeling. It remains unclear whether the arrhythmias were induced by the myocardial structural changes during the progression of heart remodeling or if the dilatation was induced by a chronic supraventricular tachyarrhythmia which later developed ventricular complexes and accelerated idioventricular rhythm.

Conclusions

Dilated cardiomyopathy is a common cardiac disease in large breed dogs, however differential diagnosis must be considered when cardiac dilatation is present, in the absence of any certain factors. The dog from this report had cardiac dilatation associated with severe arrhythmia. Although an etiologic diagnosis could not be established, we succeeded to improve the quality of life by controlling the heart rate and the rhythm.

The reference list is available at baisan.andrei_mv@yahoo.com

Multimodal treatment approach to canine oral malignant melanoma: a clinical case

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Dr Ana Nemec

Ana Nemec, DVM, PhD, Dipl. AVDC, Dipl. EVDC; Ana Rejec, DVM, PhD, Resident, Veterinary dentistry

 

Animal Hospital Postojna, Cesta v Staro vas 20, 6230 Postojna, Slovenia

 

Case history and clinical signs

Fig. 1

Figure 1: Amelanotic malignant melanoma affecting right rostral maxilla in a 4-year-old female German shepherd at presentation.

A 4-year-old 30-kg female spayed German shepherd was presented due to rapidly growing rostral maxillary mass. At presentation, the proliferative mass, located around right maxillary third incisor and canine tooth was ulcerated and bleeding (Fig. 1). The patient was otherwise healthy with physical exam findings, CBC and biochemistry all within normal limits. Staging options were discussed and the client elected computed tomography (CT) of the head and neck as well as chest CT together with biopsy of the lesion and an abdominal ultrasound.

 

Imaging and histopathology findings

Fig. 2

Figure 2: A CT image taken at the level of maxillary canine teeth at presentation. Note an invasive lesion occupying majority of the right nasal cavity and crossing the midline

Pre- and post-contrast CT images revealed an invasive lesion, located primarily around the maxillary canine tooth and extending from the right maxillary second  incisor tooth to the mesial root of the right maxillary second premolar tooth, occupying majority of the right nasal cavity and crossing the midline (Fig. 2). CT of the neck and chest revealed no metastatic disease to the regional lymph nodes and lungs, and abdominal ultrasound was also within normal limits.

Histopathology of the lesion revealed spindle-cell neoplasm, with differential diagnoses being fibrosarcoma or spindle-cell amelanotic melanoma, and further immunohistochemistry using Melan A and PNL-2 antibodies was performed and was suggestive of amelanotic melanoma.

A stage III (with no detectable metastasis based on the diagnostics performed) amelanotic melanoma was diagnosed.

 

Treatment and follow-up

Fig. 3

Figure 3: With the dog under general anaesthesia in dorsal recumbency an incision is planned to remove the tumor with narrow margins (“debulking surgery”).

Fig. 4

Figure 4: Once the right rostral maxilla and left incisive bone are en-block removed together with the tumor, hemostasis is achieved by ligation of major palatine arteries. Note macroscopically-visible tumor remnants in the right nasal cavity.

Fig. 5

Figure 5: Immediate post-operative photograph of the 4 years old dog with OMM.

Due to an extensive involvement of the nasal cavity, wide resection was impossible to achieve without significantly impairing the cosmetic appearance and function of the animal, and the client elected palliative-intent extended unilateral rostral maxillectomy to reduce tumor burden (Figs. 3-5), followed by a course of adjuvant hypo-fractionated radiotherapy of the surgical area (6 x 6 Gy twice weekly) 3 weeks after the surgery (Figs. 6-9).

 

 

 

 

 

 

 

 

 

 

Fig. 6

Figure 6: Three weeks post surgery the mucosal flaps have healed and any remaining sutures are removed to minimize irritation and inflammation before radiation therapy is initiated

Fig. 7a

Figures 7: Radiotherapy is performed 3 weeks after surgical resection of amelanotic malignant melanoma with the dog under general anesthesia. Note a lead plate positioned in the mouth to prevent irradiation (exit dose) of the healthy mandibles. A bolus is used on the maxilla to achieve optimal dose distribution in the irradiation field.

Fig. 8

Figure 8: Radiation therapy technologist adjusting the patient and equipment to correctly apply the radiation treatment plan.

Fig. 9

Figure 9: Acute side affects of radiotherapy (radiomucosititis) 2 weeks after completion of radiotherapy, which diminished with supportive antibiotic, local antiseptic and anti-inflammatory treatment.

Melanoma vaccine treatment (4-dose, biweekly protocol, then boosters in 6-month intervals) was added to the treatment protocol as an immunotherapy approach to multimodal treatment approach. At all re-checks, the patient was clinically healthy and the most recent re-check head and neck and chest CT revealed no metastases 5 years after the diagnosis (Fig. 10). Fig. 7b

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discussion

Fig. 10b

Figure 10: 5-year follow up – no clinical nor CT evidence of local tumor recurrence

Malignant melanoma (OMM) is the most common nonodontogenic oral tumour in dogs. Clinical signs may vary greatly; the tumour is not necessarily pigmented (black). Histopathological diagnostics may be complicated as a tumour may present as amelanotic variant and/or as epithelioid-cell OMM, spindle-cell OMM or mixed-cell OMM. Therefore, immunohistochemistry is often needed to determine the diagnosis. OMM is locally invasive, with 50% of tumours being associated with surrounding bone invasion. Metastases are also common: in 74% of cases, OMM metastasise in regional lymph nodes and in up to 92% of cases in the lungs.

Hence, before any treatment is attempted, a patient with an OMM needs to be properly staged. To evaluate local disease, tumor location is noted and the lesion measured. Diagnostic imaging of the local lesion should include pre- and post-contrast CT of the head, as skull radiographs and/or intraoral dental radiographs will underestimate the extent of the lesion and especially invasion of maxillary tumor into adjacent structures. Magnetic resonance imaging (MRI) can also be considered and PET/CT is becoming available in veterinary medicine as well.

Evaluation of regional lymph nodes may be challenging. Although palpation of the mandibular lymph nodes should be routinely performed, it needs to be realized, that 40% of palpably normal lymph nodes contain metastases. Fine needle aspiration of the regional lymph nodes may be helpful, but reaching the main draining center of the head – retropharyngeal lymph nodes – requires ultrasound-guided approach. Also, it has recently been described, that consensus between cytology and histopathology for staging of lymph nodes in patients with melanocytic neoplasms is poor, and negative result does not rule out metastases. Evaluation of size and contrast-enhancement pattern on post-contrast CT images can be very helpful in evaluating regional lymph nodes for metastases, and PET/CT is also very promising. Excisional biopsy of the lymph nodes is debatable, as complete staging requires removal of all lymph nodes of the head and neck. Excisional biopsy of the sentinel lymph node – technique which is well developed in human medicine – is the goal and determination of the sentinel node will hopefully become easier with advanced imaging techniques.

Staging is completed with evaluation of distant organs for possible metastatic disease, where chest CT is much more sensitive to diagnose pulmonary metastases compared to thoracic radiographs. Full body CT may be recommended, if involvement of abdominal organs is suspected, which is rare in cases of canine OMM, and abdominal ultrasound is usually performed.

Once the stage of the OMM is determined, the treatment approach(es) and prognosis can be discussed with the client. It is worth mentioning here, that scientific data on treatment outcomes for specific stage OMM, especially when several treatment approaches are combined, are scarce. Hence, proper communication with the client is extremely important to present as much as possible information and keep realistic expectations. Generally, prognosis for animals, especially if the tumour arises from dentate areas, is guarded due to early and common metastases. Dogs with small OMM (smaller than 2 cm in diameter, stage I) located rostrally and those without metastases, have the best prognosis. With radical tumour resection (tumour with associated 1 cm of healthy tissues as determined by CT) median survival time was reported to be 723 days and related to tumor stage. It has also been reported, that even incomplete tumour resection (dirty margins) increases survival time. When complete resection cannot be achieved (as was expected in the presented case), or the client declines surgical treatment, or when surgery has resulted in incomplete removal of the tumor, or when regional metastases are present, other treatment options exist, although some studies questioned the benefits of adjuvant therapies. When recommending an adjuvant treatment, most commonly suggested is radiation therapy, which can also be the sole treatment for OMM (local and regional disease). The outcome of radiation therapy depends, as with surgery, on the stage of the tumor as well as on the radiation protocol; most commonly hypo-fractionated radiation protocols are recommended and, when used as a sole treatment of OMM, can result in median survival times a bit shorter than those achieved with surgical treatment. Acute side effects, such as radiomucositis are common, expected and usually resolve with supportive treatment, while late life-threatening side effects, such as osteoradionecrosis or secondary tumors, are rare, but need to be discussed with the client in advance, especially when long-term survival of irradiated patients is expected.

OMM is considered poorly responsive to chemotherapy, but is a highly immunogenic tumor. Although the exact immune mechanisms are not completely understood and are likely individually-specific, several immunotherapy and/or gene-electrotransfer therapy approaches have been suggested for canine OMM patients. Most (clinical) research has been performed on a canine melanoma vaccine (xenogeneic plasmid DNA with a cDNA insert encoding human tyrosinase), which has been shown to be safe, but data on its’ efficacy are conflicting. Although it remains unclear, what (if any) role melanoma vaccine and other treatments played in the prevention of metastatic disease in the case described in this report, it is important to realize, that the outcome of canine OMM treatment may not neccessary be poor. In addition, new multimodal approaches are being developed to treat canine OMM and are changing this disease with historically poor outocme into a chronic disease, at least in selected cases.Fig. 10a

 

Clinical study at Animal Hospital Postojna

At Animal Hospital Postojna we recently began a study titled “Evaluation of immune system response to hypo-fractionated radiotherapy in canine non-operable oral, cutaneous or digital melanoma’ together with the Oncovet Clinical Research Centre in France. The study aims to evaluate immune system response to hypo-fractionated radiotherapy in canine non-operable oral, cutaneous, or digital melanoma and to assess the ability of this therapy to improve the response to immunotherapy in combined treatment. With the client’s agreement, we include dogs (males and females) with malignant melanoma when the tumour cannot be surgically removed, either due to its localisation preventing the recommended wide excision, or the client’s refusal to approve such a procedure. In that case, hypo-fractionated radiotherapy remains the preferred treatment. If you or anyone you know are interested in participating in the study and would like to know more about the study protocol and obligations, risks and potential constraints as well as benefits that we offer if you decide to participate, please, contact us at info@ahp.si

 

 

2018 Hill’s Global Symposium on ageing pets

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Over 5,000 viewers at 24-hour educational live-stream
connecting veterinarians around the world

 

Lisbon (April 28, 2018) – The number of veterinary professionals viewing the 24-hour educational live-stream of Hill’s Global Symposium 2018 has exceeded five thousand three hundred unique viewers worldwide, in addition to some 200 veterinarians who travelled from over 35 countries to attend the symposium in person. In total, they viewed over 7,500 hours of quality continuing education.

 

We are very proud of this achievement for our first-ever global live event in the veterinary sector,’ commented Dr Jolle Kirpensteijn, Chief Professional Veterinary Officer at Hill’s US. ‘It is a particularly fitting result as today we are celebrating World Veterinary Day.’

 

Thanks to the great attendance, Hill’s will donate £10,000 (approximately €11,300 / U$13,800) to Dogs for Goods a UK-based charity that trains and provides accredited assistance dogs to people with physical or mental disabilities.

 

The unique 24-hour educational live-stream allowed veterinarians and veterinary students anywhere in the world to join the conference directly from the comfort of their clinic or home.

 

In addition, the symposium will be made available for on-demand content between June 1, 2018, and May 31, 2019. Registered veterinarians will be able to view and review all recordings in the website.

 

The theme of this year’s Global Symposium was ‘Adventures of Ageing: Early Chronic Kidney Disease & Growing Older.’ Veterinarians are treating an ever-increasing number of elderly dogs and cats, many of whose lives have been prolonged through advances in veterinary medicine. ‘Helping these animals age healthily is a rapidly growing area of practice and one in which nutrition plays a key role,’ stressed Dr Iveta Becvarova, Director of Global Academic and Professional Affairs at Hill’s Pet Nutrition, and organizer of this year’s event.

Newsletter on the conference named Recent advances in dog and cat oncology, 13-14th of April 2018

29663580_408766522919304_655278454_nEsteemed colleagues,

Between the 13th and 14th of April, in Iasi, the Ramada Hotel hosted the conference named Recent advances in dog and cat oncology, organized by the Romanian Association of Veterinary Diagnostic Imaging (ARDIV). ARDIV organized this event in partnership with the Neurovet Association, Altius, Purina, Liamed, Synevovet, MSD Animal Health and Neologis.

The chosen topic was a particular, highly specialized one, and the scientific schedule was concentrated, comprising aspects starting with the clinical and diagnostic ones and ending with aspects related to pathologic anatomy, cytology and histology. Internationally up-to-date information was provided with regard to chemotherapy and radiotherapy. Papers were presented on the technique of tumoral specimen sampling, conditioning and expedition to specialized laboratories, as well as on topics frequently encountered in practice, such as the tumoral prostatic syndrome in dog and the multimodal approach of mammary tumors in the bitch and queen cat.

The two days abounded in scientifically relevant content, benefitting from the high appreciation of the participants towards the connections established by the organizers and speakers with the area of imaging, among others.

National speakers were involved, such as Assoc. Prof. Alexandru Diaconescu (FMV Bucuresti), Lect. Dan Cranganu (FMV Bucuresti), Dr. Claudiu Gal (FMV Bucuresti), and from Spain, Prof. Ana Isabel Raya Bermudez (FMV Cordoba), all of whom have our gratitude for the highly practical presentations and the relevant data.

Participation at the event was rewarded by the College of Romanian Veterinarians with 50 points for participants and 100 points for speakers; at the end of the second day of the event, the participants were awarded the participation diplomas.

The organizing committee considers that the chosen topics were relevant and necessary for the continuing formation of veterinary practitioners, given that the final feedback (provided by survey, with an average score of 4.5 out of 5) was indeed a positive one.

We would also like to point out that this event was the first of its kind (tumoral disease) to take place in Iasi and in the Moldavian region.

The organizing committee has duly noted the ideas of the participants for future application and undertakes it to satisfy these requirements in the future scientific events in the field of veterinary imaging and related areas.

Together on the path of imaging,

ARDIV

The feline nematode parasite Troglostrongylus brevior has been found in cats of Cyprus

17522718_10210771628620689_8401590001954170847_nDr Demetra Sofroniu

Cyprus

 

Cat is one of the most popular pets all over the world with an estimated population number of over 74 millions. In Cyprus, an island of the Mediterrenean Sea, there is a large cat population. Although, for many decades, there is a worldwide intense research activity regarding the parasitesof cats, no research on the parasites of the intestinal and respiratory tract of cats in Cyprus have been conducted until recently.

However, in 2017, a study entitled “Occurrence and zoonotic potential of endoparasites in cats of Cyprus and a new distribution area for Troglostrongylus brevior” has been published in the scientific journal Parasitology Research [Parasitol Res. 2017, 116(12):3429-3435. doi:10.1007/s00436-017-5651-3]

The aim of this study was to investigate the occurrence of pulmonary and intestinal parasites of cats in Cyprus, in order to fill in the gap of relevant information in this area of Europe. A total of 185 cats from 5 districts of Cyprus were included. Individual faecal samples of 48 exclusively indoor living cats and 137 cats with outdoor access were examined by classical parasitological methods. The morphological identification of lungworm larvae was confirmed by PCR.

Parasites were found in 66 cats (35.7%) i.e. Toxocara cati (12%), Cystoisospora rivolta (12%), Joyeuxiella/Diplopylidium spp. (7%), Giardia spp. (6.5%), Troglostrongylus brevior (5%), Cystoisospora felis (2.5%), Aelurostrongylus abstrusus (2%), Taenia spp. (0.5%), Dipylidium caninum (0.5%). Mixed infections were found in 18 cats (9.7%). Parasites were found in 4 of 48 indoor cats and in 61 of 137 cats with outdoor access.Troglo d

This study showed that a high percentage (35.7%) of cats in Cyprus are infected by intestinal or pulmonary parasites, some of which may have an impact on human health (i.e. Toxocara cati, Dipylidium caninum, Giardia spp.). Furthermore, cats who had outdoor access were more likely to be infected, while cats who had received an antiparasitic treatment in the last 6 months were less likely to be infected.

In addition, this study revealed that T. brevior, a respiratory nematode of felids, is presenting on the island. Until recently, T. brevior was considered a parasite of wild felids. However, in recent years, it has been found that domestic cat is also a host for this parasite in some areas. More precisely, T. brevior has been found before in Italy, Spain, Greece and Bulgaria. This study render Cyprus the easternmost distribution border of this parasite in Europe to date. As infection of this parasite in young cats are more likely to be severe and life threatening, there is an acute scientific interest for T. brevior.

More research on T.brevior is expected the next years. Interestingly, the life cycle is not fully described and there is evidence of vertical transmission that needs further confirmation and clarification. It is thus important, thet the veterinary practinioners keep a vigilant eye on the correct and timely diagnosis of troglostrongylosis.IMG_1961 IMG_2006

Brachycephalics-Anaesthesia and Intensive Care particularities

 

10455370_1662135347386201_2573188422215976094_nDr Ruxandra Costea, PhD

Bucharest, Romania

 

 

Brachycephalics are patients that are prone to the increase in the superior airways’ resistance, with the decrease of the airflow at the level of the nose or mouth, which implies higher risks and complications associated with anaesthesia.

The acute obstruction of the superior airways can manifest itself consequently to the overheating syndrome (excessive heat, excessive humidity, after physical effort, hyperthermia), post-detubation or as the worsening of a chronic obstruction.Presentation5

The overheating syndrome is represented by the the body’s incapacity to dissipate the accumulated heat and can manifest clinically through hyperthermia (> 41° C), dysfunctions of the central nervous system, the activation of the inflammatory mechanisms, hemostasis disorders and initiation of the systemic inflammatory response syndrome (SIRS). The physiopathological cascade can evolve through multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), disseminated intravascular coagulation (DIC).

The risk factors for the triggering of the overheating syndrome are represented by any anterior episodes, obesity, breed (brachycephalics, Golden Retriever, Labrador), elevated ambiental temperatures and humidity,  poor acclimatization, low resistance to physical effort.29425659_10211461064425220_967441903115042816_o

Hyperthermia can generate cerebral hypoperfusion, neuronal necrosis, vascular lesions, cerebral edema, haemorrhages, multifocal vascular thromboses. The clinical signs can be spontaneous haemorrhages (petechiae, hematemesis, hematochezia).DIC can appear anytime during the first 24 hours after the incident (close monitoring). Hyperthermia can trigger oxidative stress mechanisms, which can act at gastrointestinal level through intestinal ischemia, cytoskeleton relaxation, increase in intestinal permeability and finally, bacterial translocation. Temperature control is essential for the limitation of clinical manifestations (tachypnea, tachycardia, vasodilation, massive haemorrhagic diarrhea and hematemesis coagulopathies, miocardial hypoperfusion, lactic acidosis, electrolitic disturbances, cardiac arrhythmias, stupor, convulsions, exitus). The patient will have to be cooled simultaneously with the administration of  fluids for the control of tissular perfusion and hydroelectrolytic disorders. Crystalloid isotonic fluids will be administered, supplementing, if needed, with colloid boluses, depending on the hydration state, cardiovascular potential and the electrolytic status of the patient. The therapy will continue without interruptions until the patient is stable. In severe cases, it is necessary to start the antimicrobial therapy for restricting the endotoxemia and preventing sepsis ( broad-spectrum antibiotics). The therapy will be completed with gastrointestinal protectors, H2 antagonists (famotidine) and proton pump inhibitors (pantoprazole). Continuous monitoring throughout the therapy is mandatory, because the patients need re-evaluation and consequent adaptation of the therapy.

The key points in the therapeutical management of the overheating syndrome are:

  • Oxygen supplementation
  • Sedation, general anaesthesia
  • Temperature control
  • Control of the tissular perfusion and of the acid-base and hydroelectrolytic disorders
  • Correction of homeostasis disorders
  • Maintenance of the renal function
  • Blood glucose monitoring
  • Antimicrobial therapyPurpose:  Presentation4 

    Oxygen supplementation is necessary when the patient first shows up ( starting with the triage phase) in the case of acute respiratory distress syndrome (ARDS), noncardiogenic pulmonary edema or laryngeal edema. Brachycephalics in thermal shock exhibit compensatory hyperventilation or can’t oxygenate themselves enough, consequently to respiratory insufficiency, with high respiratory effort, hyperthermia, muscular exhaustion and, finally, respiratory arrest! The immediate control of hypoxemia initially requires oxygenation through noninvasive methods, followed, if needed, by additional invasive procedures (general anaesthesia with endotracheal intubation, nasal oxygenation catheter, tracheal catheter, tracheotomy/ tracheostomy). High air flow devices can be used for oxygenation (>15l /min.)- oxygen tent/cage, AMBU-bag or low flow devices(<6l/min.)-mask, nasal oxygenation tube, endotracheal probe, tracheal catheter.29388957_10211461064265216_3957696742744391680_n 29425012_10211461064385219_3239167496015577088_n

    Assisted ventilation is recommended either in case of hypercapnia (PaC O2 >60 mmHg) or severe hypoxemia (PaC O2 <80 mmHg or SpO2 <90%) with persistent cyanosis despite having oxygenation levels reaching 100%.Possible complications regarding mechanic ventilation are correlated to the accidental disconnection of the patient, device failures, barotrauma, atelectasis or oxygen toxicity.

    Brachycephalics are NOT the best candidates for „a simple sedation”, requiring, in most cases, general anaesthesia protocols. Given the fact that all anaesthetics affect the respiratory function through central depression or through muscle relaxation, a continuous monitoring is necessary, from premedication to the patient waking up from anaesthesia.Presentation1

    Preanaesthetic evaluation will be cautiosly approached, in order to reduce the perioperative mortality, by tracing and evaluating the risks and by adjusting the perioperative protocols. The patients will be premedicated in order to reduce stress, anxiety, agitation, this also leading to a decrease of the doses that are necessary for maintenance. For critical patients, premedication can be excluded, but analgesia must be maintained! A minimal contention is recommended, without a muzzle! For brachycephalics, preoperative preoxygenation is mandatory. For induction, the lowest propofol doses will be slowly administered intravenously. (1.0 mg/kg slowly injected intravenously for the first 15 seconds, then another 1.5-2 mg/kg until reaching the desired effect). The administration of propofol in rapid bolus causes apnea, bradycardia, hypotension and respiratory depression. Propofol reduces the cerebral metabolism, the cerebral blood flow and the intracranial pressure, also alleviating the effects of the hypoxic lesions, and inhibiting lipid peroxidation, having an antioxidative action.

    The endotracheal intubation of the brachycephalics must be done with care. It is hard to anticipate the dimension of the trachea by the size of the patients, because they often  have hypoplastic tracheas. Anaesthesia is maintained gaseously, ensuring the efficient ventilation of the patient.  For avoiding regurgitation, the patients will be positioned slighly forward, with the anterior extremity lifted at . Inhalation anaesthesia protocols can be carried out, if needed, at the same time with the administration of opioids (bolus or CRI) or with locoregional anaesthesia techniques (blockages, infiltrations, epidural etc.).29496194_10211461064545223_8396511414134505472_n

    Secondary effects can appear at high doses of opioids (dysphoria, bradycardia, respiratory depression). For ensuring the polymodal analgesia, opioids, NSAIDs and local anaesthetics can be administred.

    Managing the hemostasis disturbances implies the stabilization of the coagulation system, the administration of fresh frozen plasma or anticoagulants, for preventing thromboses.

     

    Maintaining the renal function is possible in the case of patients suffering from thermal shock through maintaining the perfusion and oxygenation of the kidney. Hypovolemia and dehydration will determine the arterial tension and the cardiac output to lower, leading to the decrease of the renal perfusion ( renal ischemia). Lowering the oxygenation at renal level will favor the triggering of acute renal insufficiency. Consequent rhabdomyolysis and myoglobulinemia will damage the kidney even more. If the urine output is low (<1ml/kg/h) even after fluidotherapy, furosemide and/or mannitol can be administered. Mannitol (osmotic diuretic) will reduce the water content of the neuronal cells, will increase the reanl perfusion and diuresis. Furosemide can be administered at 15 minutes after the administration of mannitol. An option for hyperhydration, uremia or different electrolytic imbalances is represented by hemodialysis.

     

    Monitoring the glycemia is very important for critical patients, because the ones that are hypoglycemic have a hard time compensating!

     

    A particular situation is represented by the acute obstruction of the superior airways after detubation. The muscles of the superior airways, which are relaxed post anaesthesia, can favor the appearance of acute obstructions at brachycephalic breeds, together with the inflammation of the larynx and the pharynx, especially after the specific correctional surgical procedures. That is the reason why it is recommended to postpone these patients’ extubation for as long as possible after anaesthesia and to supplement their oxygenation through noninvasive methods (nasal oxygenation probes, prongs, oxygen cage), until they have completely recovered from it. Since the risk of complications is high, it is good to be prepared for a possible reintubation or even for invasive oxygenation methods (trecheotomy, trecheostomy).

     

SAVAB Congress 2018 and how Balkans were part of it!

congrestasVets on the Balkans has got 2 free registrations with accommodation from SAVAB (Small Animal Veterinary Association of Belgium) this year. It was a huge gesture to our region and our journal. They support the willing and desire of the veterianrians from East Europe to grow and improve their knowledge.

 

 

‘ The CATalogue’ cats, cats and more cats,  in Wemmel ( near to Brussels) was on 9th to 10th of March this year.

They had as speakers: Hans Kooistra, Gerry Polton, Penny Watson, Pascale Smets , Sara Van Cauwelaert .

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bty

 

 

 

 

 

 

 

 

 

One of the vets, Dr Yordan Yordanov, who was able to be there, share with us:

 

 

“I am grateful for the opportunity to visit the Belgian congress for small animals, I am extremely impressed by the high level of lectures, the hospitality of the organizers Anne Kriegel, Bob Prossmasms and Mark Vanghelwell, and the good organization of the event. I’ve made many new acquaintances, and I hope other colleagues like me will discover the benefits of SAVAB.”

 

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After something like this we are strongly believe that hand by hands we all be better and we live in a wonderful world. We would like to express our gratitude to SAVAB for such a great opportunity and you should know that you are big part of our Balkan family!

 

THANK YOU SAVAB and Dr Ann Criel!!!banner catalogue