A multiple-session mesotherapy protocol for the management of hip osteoarthritis in police working dogs.

OBJECTIVE: To describe the effect of a mesotherapy protocol in dogs with osteoarthritis. ANIMALS: 30 dogs. PROCEDURES: Dogs were randomly assigned to a control (CG; n = 10) or a mesotherapy group (MG; 20). CG received meloxicam for 70 days. MG was treated with a combination of lidocaine, piroxicam, and thiocolchicoside, injected in intradermal points. Seven treatment sessions were conducted. Response to treatment was measured with different instruments: the Canine Brief Pain Inventory (divided into Pain Interference Score [PIS] and Pain Severity Score [PSS]), Liverpool Osteoarthritis in Dogs (LOAD), and Canine Orthopedic Index (COI; divided into function, gait, stiffness, and quality of life), at time 0 (T0), +15 days, +30 days, +60 days, and +90 days after T0. At each time point, the results of the 2 groups with each instrument were analyzed with the Wilcoxon signed ranks test, P < .05. Kaplan-Meier estimators were compared with the Breslow test. RESULTS: Dogs had a mean age of 6.9 ± 2.7 years and a body weight of 31.0 ± 6.4 kg. Hip osteoarthritis was classified as mild (n = 9), moderate (17), or severe (4). No differences were found at T0. Better results were observed in MG at +15 days (P < .01 for PSS and PIS, P = .03 for function), +30 days (P = .01 for PIS and LOAD, P = .03 for PSS, and P = .04 for function, gait, and COI), +60 days (P < .01 for PSS and PIS, P = .01 for LOAD, and P = .02 for function), and +90 days (P = .01 for PSS and PIS, P = .03 for LOAD, and P = .04 for function). Kaplan-Meier estimators showed MG had longer periods with better results than CG in various scores. CLINICAL RELEVANCE: This mesotherapy protocol reduced pain scores and other clinical metrology instrument scores lasting for longer periods.

Clinical comparison of two techniques of brachial plexus block for forelimb surgery in dogs.

The objective of this study was to compare two different local anaesthesia techniques for intraoperative analgesia in dogs undergoing surgical procedures distal to the mid humeral diaphysis. Thirty-two dogs were divided into two groups: the US group received an ultrasound-guided brachial plexus block at the level of the first rib and the N group received a neurostimulation-guided paravertebral brachial plexus block. Ropivacaine 0.75% at 1.5mg/kg was injected in each case. Dogs were monitored during the surgical procedure, and rescue analgesia was administered whenever the heart rate, respiratory rate or blood pressure increased more than 20% from the basal values. Success rate was defined as no need for rescue analgesia during surgery and complete blockade of the operated leg evaluated just after anaesthesia recovery. Complications were also recorded. Data was analysed using Fisher exact and Mann/Whitney tests. Success rate was observed in 14/16 (87%) dogs and in 12/16 (75%) dogs in the US and N groups, respectively (P=0.65). Complications recorded were hypotension in three cases (US group, n=1; N group, n=2) and Horner's syndrome in three cases (US group, n=1; N group, n=2; P=0.65). Both techniques were found to provide good level of analgesia that allowed performing the orthopaedic procedures from the mid humeral diaphysis and distal in the limb, without the need for further analgesia.

Gait analysis in French bulldogs with and without vertebral kyphosis.

The study objective was to compare temporal-spatial and kinetic gait variables in neurologically normal French bulldogs with and without vertebral kyphosis. French bulldogs presented to a dedicated brachycephalic clinic were prospectively enrolled. All dogs underwent general physical, orthopaedic, and neurological examination prior to study inclusion. The presence of vertebral kyphosis was evaluated by computed tomography and kyphosis was defined as a Cobb angle exceeding 10°. Gait variables were collected using a pressure-sensitive GAITRite walkway with GAITFour software and included measurement of total pressure index (TPI) defined as the sum of peak pressure values recorded from each activated sensor by a paw during mat contact. Fifteen French bulldogs with (n=8) and without kyphosis (n=7) were included. Cobb angle in kyphotic dogs ranged from 14.9° to 39.5°. Univariate analyses were initially performed to examine the association between kyphosis and 16 gait variables. When those variables found to be associated (P<0.2) were taken forward into multivariate generalised linear mixed models (accounting for dog, velocity and side), kyphosis had a significant effect upon TPI of the forelimbs and TPI symmetry ratio (P<0.05); however, the size of these effects was small. Although vertebral kyphosis is rarely associated with neurological deficits, it was associated with subtle alterations in kinetic gait variables (TPI forelimbs and TPI symmetry ratio). Further studies are needed to evaluate the clinical importance of altered gait variables in French bulldogs with kyphosis.

Effectiveness of slow motion video compared to real time video in improving the accuracy and consistency of subjective gait analysis in dogs.

Objective measures of canine gait quality via force plates, pressure mats or kinematic analysis are considered superior to subjective gait assessment (SGA). Despite research demonstrating that SGA does not accurately detect subtle lameness, it remains the most commonly performed diagnostic test for detecting lameness in dogs. This is largely because the financial, temporal and spatial requirements for existing objective gait analysis equipment makes this technology impractical for use in general practice. The utility of slow motion video as a potential tool to augment SGA is currently untested. To evaluate a more accessible way to overcome the limitations of SGA, a slow motion video study was undertaken. Three experienced veterinarians reviewed video footage of 30 dogs, 15 with a diagnosis of primary limb lameness based on history and physical examination, and 15 with no indication of limb lameness based on history and physical examination. Four different videos were made for each dog, demonstrating each dog walking and trotting in real time, and then again walking and trotting in 50% slow motion. For each video, the veterinary raters assessed both the degree of lameness, and which limb(s) they felt represented the source of the lameness. Spearman's rho, Cramer's V, and t-tests were performed to determine if slow motion video increased either the accuracy or consistency of raters' SGA relative to real time video. Raters demonstrated no significant increase in consistency or accuracy in their SGA of slow motion video relative to real time video. Based on these findings, slow motion video does not increase the consistency or accuracy of SGA values. Further research is required to determine if slow motion video will benefit SGA in other ways.

Recogida de orina en el lactante febril para el diagnóstico de la infección urinaria en Urgencias / Collection of urine in febrile infants for diagnosis of urinary tract infection in the Emergencies’ room

Introducción: la infección del tracto urinario (ITU) es una enfermedad frecuente en niños. Resulta fundamental una adecuada recogida de orina para evitar falsos positivos, minimizando procedimientos invasivos. La recogida de orina al acecho es una técnica incruenta, con baja tasa de contaminación, por lo que se estableció como método de elección al actualizar nuestro protocolo clínico. Material y métodos: estudio prospectivo longitudinal descriptivo y analítico, realizado en el Servicio de Urgencias de un hospital terciario, en dos periodos, antes y después de la actualización del protocolo. Se analizaron: edad, sexo, tiempo en Urgencias, método de recogida, sedimento y cultivo de orina y diagnóstico, en pacientes febriles menores de tres años. Resultados: hubo 140 pacientes en 2012 y 180 en 2011, sin diferencias en distribución por sexo y edad. Las medias etarias fueron 12 y 14 meses respectivamente. El 35,7% se recogieron por acecho en 2012, frente al 7,8% de 2011 (p<0,001). En 2011 fueron necesarias más confirmaciones: 20,5% frente a 10,7% en 2012. No hubo diferencias significativas en el número de sospechas de ITU ni en el de muestras contaminadas en ambos años. Tampoco entre las muestras recogidas por acecho o sondaje en 2012. El tiempo medio de estancia en Urgencias en 2011 fue 221 minutos, siendo 190 en 2012 (p<0,05). Conclusiones: la recogida de orina mediante el acecho constituye un método sencillo y no invasivo, que generalmente no precisa confirmación, por lo que reduce el tiempo de espera en el Servicio de Urgencias. No se ha objetivado un aumento de falsos diagnósticos de ITU en pacientes con muestra recogida por acecho (AU)

Introduction: urinary tract infection (UTI) in children is a common process. It is essential to find an adequate method to collect urine, to avoid false positives, minimizing invasive procedures. Clean catch urine (CCU) is a noninvasive technique, with low contamination rate, so it has been established as the recommended method for urine collection to update our clinical protocol. Material and methods: a prospective longitudinal descriptive and analytical study was conducted in a tertiary hospital in the Emergencies’ room (ER) in two periods, before and after the update protocol. Age, sex, time in the ER, collection method, sediment and urine culture and diagnosis in febrile patients <3 years were analyzed. Results: there were 140 patients in 2012 and 180 in 2011, with no differences in age and sex distribution. The mean ages were 12 and 14 months respectively. 35.7% of the samples were collected by CCU in 2012, compared to 7.8% in 2011 (p<0.001). In 2011 more confirmations of urine analysis were necessary: 20.5% vs. 10.7% in 2012. There were no significant differences between the number of suspected UTI or the contaminated samples in both years. Neither did between samples collected by catheterization or CCU in 2012. The average length of stay in the ER in 2011 was 221 minutes, while 190 in 2012 (p<0.05). Conclusions: urine collection by CCU is a simple and noninvasive method, which usually does not require confirmation, thereby reducing the wait time in the ER. There has not been an objectified increased of false diagnosis of UTI in patients with sample collected by CCU (AU)

Infección por Eikenella corrodens tras mordedura humana / Eikenella corrodens infection after a human bite

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¿Enfermedad de Kawasaki sin fiebre? / Kawasaki disease without fever?

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Prevalence of dental enamel defects in celiac patients with deciduous dentition: a pilot study.

OBJECTIVE: To describe the prevalence of unspecific and systematic enamel defects in children with deciduous dentition diagnosed with celiac disease compared with a control group. STUDY DESIGN: Thirty children (mean age 3.6 yrs) diagnosed with celiac disease and a reference group (n = 30; mean age 3.8 yrs) were studied to determine the prevalence of enamel defects. Both groups had complete deciduous dentition. Unspecific and systematic enamel defects were evaluated according to Aine criteria. RESULTS: Enamel defects were detected in 83.3% of the celiac children versus 53.3% of the control children (P = .025). The corresponding figures for symmetric defects were 73.3% and 23.3% (P < .001), respectively. The most frequent defect severity classification was Aine grade 1. Dental enamel defects were most frequently detected in deciduous molars (45.1%), followed by deciduous incisors. CONCLUSIONS: This study showed significantly more systematic enamel defects in children with celiac disease and deciduous dentition compared with a control group in the same stage of dentition. Dental examination of these defects may be useful to alert for this disease.

Beta-tricalcium phosphate as a synthetic cancellous bone graft in veterinary orthopaedics: a retrospective study of 13 clinical cases.

The clinical use of beta-tricalcium phosphate (beta-TCP) as a synthetic cancellous bone graft in veterinary orthopaedics is herein reported. The retrospective study was based on 13 clinical cases belonging to 11 dogs and one cat. The weights of the dogs ranged from 3.4 to 48 kg. One female cat weighing 3.5 kg completed the study. The clinical cases were six arthrodeses (four carpal, two tarsal), one hypertrophic non-union (femur), one atrophic non-union (metacarpal bones) and five long-bone fractures (two femurs, one tibia, two radii) possessing subcritical-sized bone defects. The beta-TCP used in this study was presented as irregular interconnected- porous granules and was placed in the bone defects after mixing it with fresh blood. Bone healing was achieved at between eight and 12 weeks in all clinical cases except for the case of the chronic atrophic nonunion in which only one of the four metacarpal bones healed. In the 12 successful cases, the bone defect grafted with beta-TCP showed a radiological bone ingrowth of 100% (10 cases), 90% (one case) and 75% (one case). The complete lack of tissue adverse effects in our series, and the good defect healing, allows us to hypothesise that beta-TCP can be successfully used as a synthetic bone graft in bone defects with good local biological conditions and where osteoconduction is especially needed for assuring a structural scaffold for new-bone ingrowth. When, in addition to osteoconduction, osteoinduction and osteogenesis are necessary for defect healing, the fresh cancellous bone graft remains the gold standard in veterinary orthopaedics.

Actitudes y conocimientos de los auxiliares de ayuda a domicilio en relación con la salud oral de los mayores a su cargo / Attitudes and knowledge of home help auxiliaries about oral health in the elderly

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Multiple cartilaginous exostosis in a Golden Retriever cross-bred puppy. Clinical, radiographic and backscattered scanning microscopy findings.

Multiple cartilaginous exostosis was diagnosed in a six-month-old Golden Retriever cross-bred male with a history of forelimb lameness and isolated, but very painful, acute episodes. Physical examination revealed a right forelimb lameness with a firm, painful palpable mass on the cranial aspect of the forearm. The radiological examination showed the presence of bony masses at the humerus and radius as well as several masses in the ribs and spinous processes of the thoracic vertebrae. Based on the history and radiographic findings, multiple cartilaginous exostosis was diagnosed. Treatment with non-steroidal anti-inflammatory drugs was commenced for two weeks without any effect. Due to the lack of a response to the treatment as well as to the progressive physical deterioration of the animal, the owners requested euthanasia of the dog. Histology of the different exostoses demonstrated the presence of a hyaline cartilage cup surrounding a central area, formed mainly by bone and cartilage trabecullae. Signs of malignancy were not observed. Back-scattered scanning electron microscopy (BEI-SEM) study revealed well ordered and progressively calcified cartilage trabecullae present underneath the non-calcified cartilage cap. At a greater depth, those cartilage trabecullae became osteochondral trabecullae, and the innermost were formed exclusively by woven and lamellar bone. The histological and back-scattered electron scanning microscopy results conclude that it was a well-arranged normal endochondral ossification process that followed a centripetal pattern inside the bony mass, confirming the diagnoses of multiple cartilaginous exostoses.

Management of leishmanial osteolytic lesions in a hypothyroid dog by partial tarsal arthrodesis.

A five-year-old male boxer, previously diagnosed with leishmaniasis and hypothyroidism, had gradually become unable to bear weight on its left hindlimb. Physical examination revealed a left popliteal lymphadenopathy, mild crepitus, and severe swelling of the left tarsal joint, a radiographic examination of which revealed severe bone destruction of the talus and a periosteal reaction of the calcaneus. Laboratory findings and serological tests suggested an active leishmanial infection, and a Leishmania species was identified by direct cytology of a sample from the osteolytic area and by indirect immunohistochemistry of a bone biopsy. The dog's condition improved when it was treated with meglumine antimonate and allopurinol. Because of the large osteolytic area and the increased use of the affected leg, a partial tarsal arthrodesis was performed to prevent a fracture. Five months after the surgery, the osteolytic area had healed completely and the calcaneus periosteal reaction had disappeared.

Thromboplastin Bilbao: reproducibility and sensitivity of a Spanish thromboplastin.

Prothrombin time (PT) is the control test for oral anticoagulant therapy as well as the screening test for defects of the extrinsic pathway of coagulation. Its responsiveness to decreased extrinsic clotting factors depends on the source and type of tissue factor thromboplastin extract. In 1994, a rabbit brain thromboplastin - Thromboplastin Bilbao (TBi) - was introduced as a replacement for a human brain preparation used since 1983, with the aim of establishing a national standard. The purpose of this study was to check the reproducibility, the inter-assay/intra-assay accuracy and the stability of this reagent under temperature changes and over time. A method modified from Frei et al. [World Health Organisation Regional Publications, Eastern Mediterranean Series, Alexandria, 1995] was used for the preparation of thromboplastin extract. Thirty-five batches of human TBi were prepared from 1983 to 1988, while from 1993 to 1999 13 batches of rabbit TBi were produced. The inter-assay reproducibility of rabbit TBi exhibited a coefficient of variation (CV) of 1.07-1.57% for normal plasma and of 1.25-2.56% for anticoagulated plasma. The intra-assay CV was 0.06-1.30% for normal plasma and 1.23-2.66% for anticoagulated plasma. The stability of the reagent to temperature changes and time was also estimated, with similar results for the two thromboplastins. As a result of the Oral Anticoagulant Treatment Quality Assessment Scheme in the Basque Country, an in-house rabbit thromboplastin with good sensitivity and reproducibility was developed.

Prothrombin time quality assessment scheme in the Basque Country.

The Basque Country Quality Assessment Scheme on Oral Anticoagulant Treatment (PEEC-CAV) was first launched in 1984. This project combined prothrombin time (PT) quality controls and a new in-house standard reagent called Thromboplastin Bilbao (TBi). Originally, this reagent was of human origin, but in 1994, it was replaced by one derived from rabbit brain following WHO recommendations. Nine hospitals in the area collaborated in carrying out quality controls (a) to assess different systems of PT test performance in the Basque Country and (b) to evaluate TBi response in these controls. Evaluation over the period 1994-1999 yielded an INR coefficient of variation (CV) for the plasmas used in these controls of 8.29+/-4.18% using the laboratories' routine system (reagent and coagulometer), and 9.7+/-2.70% using TBi and the manual technique. These results were similar to those obtained in the CV of PT ratio with human brain thromboplastin from 1984 to 1988 (9.26+/-2.84%).

[Life-styles determining the oral health of adolescents in Vitoria (Gasteiz):and evaluation]. / Estilos de vida determinantes de la salud oral en adolescentes de Vitoria-Gasteiz: evaluación.

OBJECTIVE: To assess the factors determining oral health in adolescents in school at Vitoria (Gasteiz).Design. Descriptive epidemiological study. PARTICIPANTS: Randomised representative sample of 1,380 students from public and private schools. Setting. Vitoria (Gasteiz). MAIN MASUREMENTS AND RESULTS: A questionnaire on bucco-dental health was self-administered. 41.9% of the adolescents brushed their teeth three times or more a day (2.2 ( 0.98 times a day), with greater frequency in girls. 64% never used dental floss, and 30% did so only at times. 88.1% did not complement their oral hygiene with mouth-washes. Consumption of commercial cakes and pastries was 0.74 ( 1.12 times a day; and of sweets, 1.58 ( 3.15 times a day. 81.9% of the adolescents valued their mouth and dental health the same as the health of other organs of their bodies. 63.5% did not know whether any compound was added to the water as a preventive measure against dental disease; and 83.2% of those who thought something was added did not know what compound it was. 66.7% had been to the dentist during the previous year; 28.2% had not been for over a year. CONCLUSION: The oral health habits of adolescents in Vitoria (Gasteiz) show deficiencies that could be corrected through Health Education Programmes and promotion of the use of preventive dental services.

[Geographical distribution of the male/female ratio of cardiovascular mortality in Spain]. / La distribución geográfica de la razón varón/mujer de la mortalidad cardiovascular en España.

OBJECTIVES: To describe the geographic distribution of the male/female ratio (MFR) of mortality from ischaemic heart disease (IHD) and cerebrovascular disease (CVD) in 1991-1995 in Spain, and to examine wether the differences between men and women in exposure to cardiovascular risk factors could explain such distribution. METHODS: Mortality data come from National Vital Statistics. Age-adjusted mortality rates for the period 1991-1995 were calculated for IHD and CVD using the direct method, in population aged 40 to 79 years. Data on tobacco and alcohol consumption, hypertension, hypercholesterolemia, diabetes, obesity, sedentariness, and health services use come from the 1993 Spanish National Health Survey, and socioeconomic data from the 1991 Population Census. Data were analyzed by correlation and Poisson regression methods. RESULTS: MFR of mortality from IHD and CVD are higher in the provinces of the north of Spain, and are correlated negatively with mortality from IHD and CVD. This negative association is stronger for mortality in women than in men. Among the risk factors examined, only MFR of alcohol consumption showed a significant (p < 0.05) association with MFR of mortality from IHD and CVD. MFR of alcohol consumption explains 23 and 14% of the provincial variation in MFR of mortality from IHD and CVD, respectively, and showed a U shaped relationship with MFR of mortality for both diseases. CONCLUSIONS: Provinces in the north of Spain, which register the lowest cardiovascular mortality, show the highest MFR of IHD and CVD mortality, because of the lower mortality in women than in men. As derived from the dose-response relationship between MFR of IHD and CVD mortality and the MFR of alcohol consumption, a higher alcohol consumption in men could contribute to a higher MFR of cardiovascular mortality in some Spanish provinces.

Comparative study of a portable prothrombin time monitor employing three different systems in oral anticoagulant units.

The aim of this study was to evaluate the accuracy of the portable coagulometer CoaguChek (Roche Diagnostics) as a prothrombin time (PT) monitor, and to correlate capillary blood results with those of three different routine methods used for monitoring oral anticoagulant therapy (OAT): capillary, plasma and whole blood samples. Three hospitals participated in the study with a total of 235 patients on OAT. The international normalized ratio (INR) results obtained with CoaguChek were compared with those obtained using each of the routine methods. The study presents a good correlation between the PT monitor and the three methods studied: r = 0.9745 (hospital A), r = 0.9283 (hospital B), r = 0.9136 (hospital C). A simplified concordance test of the methods results in a nine-field comparison table showing concordances of 87.2, 85.7 and 68.4%, respectively. The absolute difference (mean +/- SD) between laboratory A and CoaguChek INRs was 0.0571 +/- 0.2042, with values of 0.04286 +/- 0.3906 for laboratory B and 0.6986 +/- 0.6170 for laboratory C. These results confirm that CoaguChek could be used as a new method for oral anticoagulant monitoring, and is in best agreement with the capillary blood PT system.