The SEISICAT study: a pilot study assessing efficacy and safety of spironolactone in cats with congestive heart failure secondary to cardiomyopathy.

INTRODUCTION: The pathophysiology of heart failure involves activation of several neurohormonal systems including the renin-angiotensin-aldosterone system. The mineralocorticoid receptor antagonist spironolactone has been shown to be beneficial in humans and dogs with heart failure. The objective of this pilot study was to investigate the efficacy and safety of spironolactone in cats with heart failure secondary to cardiomyopathy already treated with furosemide and an angiotensin-converting enzyme inhibitor. ANIMALS: Twenty cats with heart failure due to cardiomyopathy. METHODS: The study was a double-blind, randomised, placebo-controlled, multicentre clinical study assessing the effect of spironolactone on survival and clinical parameters in cats with heart failure due to cardiomyopathy. The primary end point was mortality, defined as death (spontaneous or by euthanasia) due to cardiac causes. RESULTS: Twenty cats were enrolled: 9 in the spironolactone group and 11 in the placebo group of which 56% (5/9) and 0% (0/11) completed the 15-month period respectively. At inclusion, differences in systemic blood pressure, body condition score, electrocardiographic abnormalities and LA/Ao ratio suggested that disease may be less severe in the spironolactone group. Twenty-two percent (2/9) of cats in the spironolactone group and 82% (9/11) in the control group reached the primary end point (Fisher's exact test, p = 0.0216). No safety issues were identified in either group. CONCLUSIONS: This study suggests that spironolactone is well tolerated, and preliminary results support further investigation to evaluate the efficacy of spironolactone in the treatment of cats with cardiac failure due to cardiomyopathy.

Owner observations regarding cat scratching behavior: an internet-based survey.

OBJECTIVES: This study was performed to examine aspects of the cat, environment and scratching post that might influence scratching behavior, in an effort to determine how inappropriate scratching behavior might be refocused on acceptable targets. METHODS: An internet survey, posted on several public websites, gathered details about scratching behavior, as described by owners in their home environments, from 4331 respondents over a 4 month period. Responses from 39 different countries were analyzed, mostly from the USA, Canada and the UK. RESULTS: Owners offered traditionally recommended scratching substrates including rope, cardboard, carpet and wood. Rope was most frequently used when offered, although carpet was offered most commonly. Most owners provided at least one scratching post; cats scratched the preferred substrate more often when the post was a simple upright type or a cat tree with two or more levels and at least 3 ft high. Narrower posts (base width ⩽3 ft) were used more often than wider posts (base width ⩾5 ft). Intact or neutered cats (males and females) were as likely to scratch inappropriately, and inappropriate scratching decreased with age. Geriatric cats between the ages of 10 and 14 years preferred carpet substrate most frequently; all other ages preferred rope first. Inappropriate scratching decreased as the different types/styles of posts increased in the home. Inappropriate scratching did not increase if the number of cats or dogs increased in the household. Declawed cats were preventatively declawed most often to prevent household item destruction. CONCLUSIONS AND RELEVANCE: Although cats can have individual preferences, our data provide a starting point for veterinarians recommending scratching posts to clients.

[Influence of age on characteristics of cutaneous vasculitis: a series of 132 patients]. / Influence de l'âge sur les caractéristiques des purpuras vasculaires: 132 patients.

OBJECTIVES: Age onset of cutaneous vasculitis may influence clinical manifestations and outcome of this condition. However, to date, no authors have analyzed characteristics of cutaneous vasculitis, especially causes, in elderly patients (≥ 65 years). METHODS: The aims of this retrospective study were to compare clinical and biochemical characteristics as well as causes of cutaneous vasculitis between elderly patients (n=58) and younger subjects (n=74). RESULTS: Median time onset between first clinical symptoms and diagnosis of cutaneous vasculitis was similar between elderly and younger (15 vs 10 days; P=0.39). Clinical characteristics did not differ between the 2 groups. The following biochemical parameters were more frequently found in elderly patients: higher median levels of erythrocyte sedimentation rate (44 vs 28 mm/h; P=0.006), urea (8 vs 5 mmol/L; P<0.0001), creatininemia (92 vs 74 µmol/L; P=0.004), and lower values of serum protein (P=0.023). The more common causes of cutaneous vasculitis in elderly patients were as follows: infections (n=24), drugs (n=12), systemic vasculitides (n=8) and cancer (n=8); only cancer-associated cutaneous vasculitis was more frequently observed in elderly patients (P=0.02). CONCLUSION: Our study suggests that age onset of cutaneous vasculitis may influence causes of cutaneous vasculitis, as cancer were more common in elderly patients. Moreover, infectious manifestations were different in elderly patients (urinary and pulmonary infections) compared to younger patients (otorhinolaryngeal infections). In essence, our data underline that the search for cancer should be performed in elderly patients exhibiting cutaneous vasculitis.

In vitro secretion of matrix metalloprotease 9 is a prognostic marker in childhood acute lymphoblastic leukemia.

Matrix metalloproteases (MMPs) are endopeptidases involved in tumor cell invasion. Childhood acute lymphoblastic leukemia (ALL) is characterized by its capacity to infiltrate different organs. We analyzed the expression of MMP-2, -9, -14 and TIMP-1 and -2 in a prospective study on 86 children with newly diagnosed ALL (73 B- and 13 T-lineage) and 9 children at relapse with B-ALL. Membrane-bound and intracytoplasmic MMPs and TIMPs were analyzed by flow cytometry, and secreted MMPs were quantified by ELISA. In patients at relapse, MMP-14 was present in a greater proportion of the B-ALL cell population than at diagnosis. In patients with peripheral infiltration, intracytoplasmic MMP-9 was significantly higher than in patients without infiltration. ROC curve and Kaplan-Meier curve analysis showed that a high secretion of MMP-9 (>2450 pg/ml/10(6) cells) was associated with a lower overall survival rate, suggesting that the secretion of MMP-9 is an independent prognostic factor in childhood B-ALL.

ELISA testing of anti-desmoglein 1 and 3 antibodies in the management of pemphigus.

OBJECTIVE: To assess the predictive value of anti-desmoglein (Dsg) 1 and anti-Dsg3 antibody (Ab) enzyme-linked immunosorbent assay (ELISA) values for the occurrence of relapses in pemphigus. DESIGN: Retrospective study. SETTING: Dermatology departments from 13 university hospitals in France. Patients The study population comprised 26 patients with typical clinical, histologic, and immunofluorescence findings of pemphigus, who were followed up over a 17-month period. MAIN OUTCOME MEASURES: Serial anti-Dsg1 and anti-Dsg3 Ab ELISA values were recorded during the patients' follow-up examinations and correlated with the occurrence of skin and/or mucosal relapses. RESULTS: A significant reduction of anti-Dsg1 (P < .001) and anti-Dsg3 (P < .001) Ab ELISA values was observed in serum samples from patients with pemphigus foliaceus or pemphigus vulgaris after the initial treatment. During the long-term follow-up, anti-Dsg1 Ab ELISA values correlated with the course of skin lesions (P = .03); the 20 U/mL cutoff for the anti-Dsg1 Ab ELISA value provided a 79% positive and an 84% negative predictive value for the occurrence of cutaneous relapses. No correlation was observed between anti-Dsg3 Ab ELISA values and the course of mucosal lesions (P = .13). Anti-Dsg3 Ab ELISA values higher than the 14-U/mL cutoff were observed in 5 of the 5 patients with relapse and in 10 of the 13 patients with ongoing mucosal remission, providing a 100% sensitivity but a poor specificity of 23%. A cutoff value of 130 U/mL for anti-Dsg3 Abs was calculated based on the receiver operating characteristics curve and provided an 84% positive and an 81% negative predictive value. CONCLUSIONS: Anti-Dsg1 Ab ELISA values are more closely correlated than anti-Dsg3 Ab ELISA values with the course of the disease in patients with pemphigus vulgaris or pemphigus foliaceus. This should be taken into account for the management of patients with pemphigus.

Risk factors of vitamin K antagonist overcoagulation. A case-control study in unselected patients referred to an emergency department.

The aims of this case-control study were to identify in vitamin K antagonist (VKA)-treated unselected patients, factors associated with international normalised ratio (INR) values: (i) greater than 6.0.; and (ii) ranging from 4.0 to 6.0 complicated with bleeding. We also assessed VKA-related morbidity in these patients. During a two-month period, 4,188 consecutive and unselected patients were referred to our Emergency Department. At admission, the medical records of each patient and two age- and sex-matched controls were reviewed for: both duration and indication of VKA therapy, previous medical history of VKA-related haemorrhage, underlying co-morbidities, concomitant medications other than VKA, duration of hospitalization and deaths' causes. Of these 4,188 subjects, 50 case-patients (1.19%) were identified; both case-patients and controls did not differ as regards indications and patterns of VKA therapy. Interestingly, two-thirds of case-patients were women, suggesting that female gender may be a risk factor of VKA over-coagulation onset. We identified the following risk factors of VKA over-coagulation: previous medical history of INR levels over therapeutic range, therapy with antibiotics, amiodarone and proton pump inhibitors, as well as fever. A total of 88% of case-patients were hospitalized; mean duration of patients' hospitalization was seven days [range: 1-56 days]; no patient died from major bleeding. Our study underscores that it is of utmost importance to consider the strength of indication before starting VKA therapy, as this therapy has been responsible for as high as 1.19% of admissions in unselected subjects referred to an Emergency Department. Our data therefore suggest that internists should be aware of VKA-related high morbidity, particularly in situations at risk of VKA over-coagulation.