Use of human intravenous immunoglobulin for the treatment of 12 dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia.

OBJECTIVES: To evaluate the safety and efficacy of human intravenous immunoglobulin in dogs with newly diagnosed malignancy and presumed secondary immune-mediated thrombocytopenia. MATERIALS AND METHODS: Twelve client-owned dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia were prospectively enrolled to receive a single infusion of human intravenous immunoglobulin at a dose of 0.5 to 1 mg/kg intravenous over 8 hours. A complete treatment response was defined as a platelet estimation of ≥40,000 platelets/µL within 24 hours and a partial response within 48 hours from the completion of human intravenous immunoglobulin infusion. No treatment response was defined as a platelet estimation remaining <40,000 platelets/µL over 48 hours from the completion of the human intravenous immunoglobulin infusion. This pilot study had a prospective, open-label, uncontrolled design. RESULTS: Out of the 12 enrolled dogs, seven completed the study. A complete treatment response to human intravenous immunoglobulin was identified in one lymphoma dog and a partial response was noted in another lymphoma dog. The remaining 10 dogs had no response to human intravenous immunoglobulin. No clinically relevant adverse reactions to human intravenous immunoglobulin occurred in any of the 12 initially enrolled dogs during the infusion and over a 3-month follow-up period for the seven surviving dogs. CLINICAL SIGNIFICANCE: The results of this study suggest that the use of human intravenous immunoglobulin in dogs with newly diagnosed malignant disease and presumed secondary immune-mediated thrombocytopenia appears safe, but not effective for the treatment of thrombocytopenia. Larger multi-centre, prospective, double-blinded, placebo-controlled, outcome-based, malignancy-specific studies are needed to further evaluate these preliminary findings.

[Symptomatic osteosynthesis in calcaneal fracture: implant colonization as a cause of pain]. / Osteosíntesis sintomática en fractura de calcáneo: colonización de implante como causa del dolor.

Calcaneal fracture is unusual and carries high costs at long term because its associated morbidity. Surgical treatment of this fracture by extended lateral approach has risks like wound healing up to 20%. One of the causes of chronic pain is subtalar arthropathy, but it is important to rule out other causes as implant associated infection. The aim of this study is to demonstrate the presence of germs in the implant through extraction, sonication and culture. Cases with evident infection, subtalar arthropathy, non union or subtalar fusion concomitant surgery were excluded. The data includes open fracture history, wound healing complication, time between surgeries, cause to implant extraction and cultures results. A positive culture rate of 33.3% was obtained. We consider it is important to have in mind the implant associated infection as a cause of pain in these patients, with the aim to study microbiologically each case and choose the right strategy of treatment.

La fractura de calcáneo es poco frecuente y tiene altos costos asociados a largo plazo por su morbilidad asociada. El tratamiento quirúrgico de estas fracturas mediante la vía de abordaje lateral extendido tiene riesgos de complicación de herida quirúrgica que pueden superar 20%. Dentro de las causas del dolor secuelar, la más frecuente es la artropatía subtalar, pero se deben descartar otras como la infección asociada al implante. El objetivo de este estudio es determinar la presencia de gérmenes en el implante mediante su extracción, sonicación y cultivo. Se excluyeron los casos con clínica de infección, artropatía subtalar, seudoartrosis y cirugía de artrodesis subastragalina concomitante. Se registró antecedente de fractura expuesta, complicación de herida operatoria, tiempo entre cirugías, motivo de la ablación del implante y resultados de cultivos con los gérmenes identificados. Se obtuvo una tasa de cultivos positivos de 33.3%. Consideramos que es importante tener en cuenta la infección asociada al implante como causa del dolor en este tipo de pacientes, con el fin de estudiar microbiológicamente los casos y entregar el tratamiento adecuado cuando corresponda.

Osteosíntesis sintomática en fractura de calcáneo: colonización de implante como causa del dolor / Symptomatic osteosynthesis in calcaneal fracture: implant colonization as a cause of pain

Resumen: La fractura de calcáneo es poco frecuente y tiene altos costos asociados a largo plazo por su morbilidad asociada. El tratamiento quirúrgico de estas fracturas mediante la vía de abordaje lateral extendido tiene riesgos de complicación de herida quirúrgica que pueden superar 20%. Dentro de las causas del dolor secuelar, la más frecuente es la artropatía subtalar, pero se deben descartar otras como la infección asociada al implante. El objetivo de este estudio es determinar la presencia de gérmenes en el implante mediante su extracción, sonicación y cultivo. Se excluyeron los casos con clínica de infección, artropatía subtalar, seudoartrosis y cirugía de artrodesis subastragalina concomitante. Se registró antecedente de fractura expuesta, complicación de herida operatoria, tiempo entre cirugías, motivo de la ablación del implante y resultados de cultivos con los gérmenes identificados. Se obtuvo una tasa de cultivos positivos de 33.3%. Consideramos que es importante tener en cuenta la infección asociada al implante como causa del dolor en este tipo de pacientes, con el fin de estudiar microbiológicamente los casos y entregar el tratamiento adecuado cuando corresponda.

Abstract: Calcaneal fracture is unusual and carries high costs at long term because its associated morbidity. Surgical treatment of this fracture by extended lateral approach has risks like wound healing up to 20%. One of the causes of chronic pain is subtalar arthropathy, but it is important to rule out other causes as implant associated infection. The aim of this study is to demonstrate the presence of germs in the implant through extraction, sonication and culture. Cases with evident infection, subtalar arthropathy, non union or subtalar fusion concomitant surgery were excluded. The data includes open fracture history, wound healing complication, time between surgeries, cause to implant extraction and cultures results. A positive culture rate of 33.3% was obtained. We consider it is important to have in mind the implant associated infection as a cause of pain in these patients, with the aim to study microbiologically each case and choose the right strategy of treatment.

Treatment of refractory sino-nasal aspergillosis with posaconazole and terbinafine in 10 dogs.

OBJECTIVES: To determine the safety and efficacy of posaconazole and terbinafine for the treatment of naturally occurring sino-nasal aspergillosis in dogs refractory to conventional topical and systemic treatment. MATERIALS AND METHODS: Ten client-owned dogs with sino-nasal aspergillosis and not responsive to conventional treatments were prospectively enrolled to receive a dose of 5 mg/kg posaconazole orally every 12 hours for six months. All dogs were concurrently treated with doses of 30 mg/kg terbinafine orally every 12 hours and 5 mg/kg doxycycline orally every 12 hours for 6 to 18 months. RESULTS: All 10 enrolled dogs completed the study. The treatment response was defined as complete clinical remission (n=7) or partial clinical remission (n=3). Two dogs relapsed after cessation of combination therapy. All dogs lived more than one year after starting combination therapy and eight dogs are alive at the time of writing. No clinically relevant adverse reactions or increases in hepatic enzyme activity occurred during the combination therapy. CLINICAL SIGNIFICANCE: The results of this study suggest that this combination therapy appears safe and well-tolerated for the treatment of refractory sino-nasal aspergillosis in dogs. Long-term survival is possible with prolonged treatment, but relapse is possible. Larger prospective studies are warranted to further evaluate these preliminary findings.

Multi-scale analysis of simulated proton and alpha irradiation.

This article presents the results of the simulated irradiation with protons and alpha particles of two different geometrical models, representing a cell nucleus and its chromatin content. The characteristics of the energy deposition are studied at both micrometric and nanometric length scales. In particular, the stochastic distributions of the quantities associated with the total energy deposit in the micrometric volume are derived and compared with the physical characteristics of the clusters of energy deposits. An innovative multi-scale correlation method is introduced and tested against the simulations' data. This new approach links the two relevant length scales exploiting the differences in the kinetic energy spectra of the secondary electrons produced by the primary particles. The characteristics of the energy deposition of the electrons in the chosen material are determined in the first instance. Few free parameters of the model, linking the electrons energy deposits with the total energy deposit of the primary particles, can be used for summarising the characteristic of the irradiation with the chosen radiation quality at the two different length scales.

Determinación de humedad en harina precocida de maíz blanco utilizando un horno de microondas doméstico / Determination of moisture in flour precooked white corn using a domestic microwave oven

El contenido de humedad es un parámetro de principal interés entre los índices que regulan la calidad de granos, cereales y sus derivados. Los métodos oficiales para determinar la humedad (AOAC 32.1.03, ISO 6540:1980, NTC 2227:86 y COVENIN 2135:96) tienen la desventaja de consumir mucho tiempo en la determinación porque  requieren la desecación de la muestra en estufa. En este trabajo se compara el método propuesto de secado de la muestra de maíz blanco en un horno doméstico de microondas contra el método rápido convencional de termobalanza infrarrojo y los métodos de referencia oficiales AOAC (32.1.03) y COVENIN (2135:96). Se determinaron las condiciones de análisis: tamaño de muestra, tipo de recipiente, distribución de la muestra, condiciones de operación usando un microondas doméstico de 700 W de potencia, así como el secado en uno o varios pasos. Entre el método propuesto y el método de referencia no se encontraron diferencias estadísticamente significativas a p<0,05; el tiempo de secado se redujo de varias horas a pocos minutos: 4 min con 90% de potencia. Como se puede  concluir que es factible la determinación de humedad por volatilización en una matriz de harina precocida de maíz blanco usando un horno de microondas doméstico.

The moisture content is a primary parameter between indices governing the quality of grains, cereals and cereal products. The official methods for determining moisture (AOAC 32.1.03, ISO 6540: 1980, NTC 2227: 86 COVENIN 2135: 96) have the disadvantage of to be time consuming that require drying oven method. The aim in this paper was compare the proposed method of drying sample of white corn with domestic microwave oven against conventional rapid method of infrared thermobalance and official reference methods AOAC 32.1.03 method and COVENIN 2135:96. Sample size, vessel kind, sample container distribution,   operations conditions using domestic 700 W microwave and also analysis employed to one or more drying steps were determined. Between the proposed and the reference method not statistically significant differences were found at P <0.05; drying time was reduced from several hours to a few minutes: 4 min at 90% power. It can be concluded that the determination of moisture by volatilization in a matrix of precooked white corn flour using a domestic microwave oven is feasible.

RBE-LET relationship for proton and alpha irradiations studied with a nanodosimetric approach.

Relative Biological Effectiveness (RBE) values are used to characterise the biological efficiency of different radiation qualities relative to photon irradiations. The RBE-high linear energy transfer (LET) relation for ion irradiations presents general features that the authors propose to look at using a nanometric description of the energy deposition of these ion irradiations (protons and alphas of different energies). In this work, the simulation of the energy transfer points in the tracks was made by Monte Carlo method using the Geant4-DNA processes and a nanometric description of the target of interest for studying biological effects, the DNA molecule. Results were obtained concerning the sensitive volume to be considered for direct DNA clustered damages that could be related to late biological effects.

A retrospective evaluation of doxorubicin-based chemotherapy for dogs with right atrial masses and pericardial effusion.

OBJECTIVE: To report the outcome of doxorubicin-based chemotherapy as the sole treatment for dogs with echocardiographically identified right atrial masses and pericardial effusion. METHODS: A retrospective study of case records of dogs with right atrial masses treated with doxorubicin. Dogs were excluded from the study if they had any type of surgery performed such as pericardiectomy or right atrial mass resection, or if their chemotherapy protocol did not include doxorubicin. The data collected included signalment, history, physical examination findings, diagnostic test results and long-term survival. RESULTS: Dogs with right atrial masses and pericardial effusion that received doxorubicin-based chemotherapy alone had a median survival of 139 · 5 days (range 2 to 302 days). Chemotherapy side effects were frequent but mild. CLINICAL SIGNIFICANCE: Doxorubicin-based chemotherapy alone appears to be a viable treatment option for dogs with echocardiographically identified right atrial masses and pericardial effusion.

Treatment of five haemodynamically stable dogs with immune-mediated thrombocytopenia using mycophenolate mofetil as single agent.

Five dogs were presumptively diagnosed with immune-mediated thrombocytopenia. As they had all been chronically treated with non-steroidal anti-inflammatory drugs, administration of immunosuppressive doses of corticosteroids was considered contraindicated. Non-steroidal anti-inflammatory drugs were temporarily discontinued in all the dogs and mycophenolate mofetil was introduced as first-line single immunomodulatory therapy. This treatment protocol resulted in complete remission of immune-mediated thrombocytopenia in all the dogs, and mycophenolate mofetil was discontinued after several months of therapy in four of the five dogs with no relapses, even when non-steroidal anti-inflammatory drug administration was resumed. The remaining dog required continued mycophenolate mofetil therapy to avoid relapse. One dog experienced diarrhoea, and another dog had diarrhoea and decreased appetite.

Hand hygiene practices of veterinary support staff in small animal private practice.

OBJECTIVE: To evaluate the hand hygiene (HH) practices among veterinary technicians (VT) and veterinary support staff (VSS) in small animal private practice. METHODS: This was a prospective questionnaire-based study involving 182 VT and VSS from 18 small animal hospitals in the USA. Questions asked included gender, number of animals handled per work shift, frequency of hand washing, reason for not washing more frequently, most common available hand washing agent, education regarding the importance of HH and frequency of ring wearing. RESULTS: Less than half of the respondents [76 of 182 (41·7%)] reported washing their hands regularly between handling patients and 154 of 182 (85·6%) believed they should have washed more frequently. The most commonly employed HH agent was hand soap [154 of 182 (84·6%)] and the most common reason cited for not washing more frequently was being too busy [132 of 182 (72·5%)]. Only 96 of 182 (52·7%) respondents were educated by doctors at their hospital regarding the importance of HH. CLINICAL SIGNIFICANCE: The HH practices among VT and VSS in small animal private practice is poor. Hand soap was the most commonly employed agent among respondents in this study. Education of VT and VSS regarding the importance of HH requires improvement.

A prospective study of clopidogrel therapy in dogs with primary immune-mediated hemolytic anemia.

BACKGROUND: A major cause of death in dogs with primary immune-mediated hemolytic anemia (pIMHA) is thrombotic disease. Ultralow-dose aspirin (ULDA) is commonly used to prevent thrombosis in dogs with pIMHA; however, the efficacy of antiplatelet agents in dogs with pIMHA is unknown. HYPOTHESIS: The use of clopidogrel (CL), alone or in combination with ULDA, would improve survival to discharge and at 90 days without important adverse effects compared with ULDA alone in dogs with pIMHA treated with standard immunosuppressive therapy. ANIMALS: Twenty-four client-owned dogs with pIMHA. METHODS: Prospective, positive-controlled, unmasked clinical trial with dogs randomized in 3 treatment groups to receive PO ULDA or CL or both. RESULTS: There was no identifiable adverse reaction, evidence of hemorrhage, or increase in transfusion requirements associated with CL therapy, either alone or combined with ULDA, compared with ULDA alone. There was no significant difference between treatment groups with respect to survival to discharge and at 90 days. CONCLUSIONS AND CLINICAL IMPORTANCE: This study suggests that CL therapy, alone or in combination with ULDA, was safe and had similar short-term survival compared with ULDA alone in a small group of dogs with pIMHA able to tolerate oral medications and treated with standard immunosuppressive treatment.

A prospective, randomized, double-blinded, placebo-controlled study of human intravenous immunoglobulin for the acute management of presumptive primary immune-mediated thrombocytopenia in dogs.

BACKGROUND: Immune-mediated thrombocytopenia (IMT) is a common hematologic disorder in dogs. Human intravenous immunoglobulin (hIVIG) may have a beneficial effect in canine IMT. HYPOTHESIS: A single hIVIG infusion (0.5 g/kg) in dogs with presumed primary IMT (pIMT) is a safe adjunctive emergency treatment to accelerate platelet count recovery and shorten hospitalization time without increasing the cost of patient care. ANIMALS: Eighteen client-owned dogs with a presumptive diagnosis of pIMT. METHODS: Prospective, randomized, double-blinded, placebo-controlled clinical trial. RESULTS: There were no identifiable immediate or delayed adverse reactions associated with hIVIG administration over a 6-month period. The median platelet count recovery time for the hIVIG group was 3.5 days (mean + or - SD: 3.7 + or - 1.3 days; range, 2-7 days) and 7.5 days (mean + or - SD: 7.8 + or - 3.9 days; range, 3-12 days) for the placebo group. The median duration of hospitalization for hIVIG group was 4 days (mean + or - SD: 4.2 + or - 0.4 days; range, 2-8 days) and 8 days (mean + or - SD: 8.3 + or - 0.6 days; range, 4-12 days) for the placebo group. There was no significant difference between groups with respect to expense of initial patient care, whereas significant reduction in platelet count recovery time (P= .018) and duration of hospitalization (P= .027) were detected in the hIVIG group. CONCLUSIONS AND CLINICAL IMPORTANCE: Compared with corticosteroids alone, adjunctive emergency therapy of a single hIVIG infusion was safe and associated with a significant reduction in platelet count recovery time and duration of hospitalization without increasing the expense of medical care in a small group of dogs with presumed pIMT.

Increased fetal nuchal translucency thickness at 10-14 weeks: is screening for maternal-fetal infection necessary?

OBJECTIVE: To investigate the relation between increased fetal nuchal translucency thickness at 10-14 weeks of gestation and maternal-fetal infection. DESIGN: Prospective study. SETTING: Harris Birthright Research Centre for Fetal Medicine. POPULATION: Four hundred and twenty-six chromosomally normal pregnancies with increased fetal nuchal translucency thickness at 10-14 weeks of gestation and 63 with 'unexplained' second or third trimester fetal nuchal oedema or hydrops. METHODS: Maternal serum infection screening and investigations for fetal infection in those with evidence of recent maternal infection. MAIN OUTCOME MEASURES: Maternal and fetal infection. RESULTS: Evidence of recent maternal infection was present in six of the 426 pregnancies (1.4%) with increased fetal nuchal translucency thickness at 10-14 weeks, but in all cases a healthy infant was born with no evidence of infection. In contrast, 'unexplained' second or third-trimester fetal hydrops was associated with maternal infection in six of the pregnancies (9.5%) and in all cases there was evidence of fetal infection. CONCLUSIONS: Maternal-fetal infection is one of the causes of second or third trimester nuchal oedema or fetal hydrops. In contrast, the presence of increased nuchal translucency in the first trimester is not a marker of either maternal or fetal infection.

Intraamniotic surfactant for prevention of neonatal respiratory distress syndrome (IRDS): rationale and personal experience.

OBJECTIVE: To evaluate the efficacy of intramniotic instillation of supplementary surfactant for the prophylaxis of neonatal IRDS in an emergency obstetric setting. STUDY DESIGN: Supplementary natural surfactant (SS) was administered intra-amniotically (80 mg in 1 ml) under ultrasound guidance in the proximity of the fetal nostrils and mouth in six pregnant women at 24-32 weeks gestation, with immature amniotic fluid indices of fetal lung maturity, and whose delivery was imminent because of severe fetal distress, deteriorating maternal conditions, or refractory vaginal bleeding. The administration of SS was preceded by IV aminophylline to the mother (a bolus of 240 mg over 10 min, and a maintenance dose of 0.02-0.1 mg kg-1 min-1) in order to elicit sustained fetal breathing movements. RESULTS: The clinical conditions of the six newborn infants were good with no respiratory problems in four cases, and with mild IRDS in the remaining two, which, however, resolved uneventfully. CONCLUSIONS: It is suggested that this prophylactic approach has a great potential for becoming a reliable option for the antenatal prevention of IRDS.

Evaluation of drug counselor training: a pilot study.

A pilot evaluation study was conducted to explore the impact of a training course aimed at helping drug counselors establish effective therapeutic relationships with their clients. Counselor abilities to reflect accurate empathy, sensitivity to client values and attitudes, and use of specified problem-solving techniques were measured before and after training through counselor self-ratings and ratings of counselor behaviors provided by clients and supervisors. The preliminary findings reveal a trend toward improved drug counselor functioning along these dimensions following training. However, the findings also suggest that the greatest impact of training may be a shift in drug counselor self-perceptions toward more confidence in their own capability to establish effective therapeutic relationships.