Bayesian Decision Analysis: An Underutilized Tool in Veterinary Medicine.

Bayesian inference and decision analysis can be used to identify the most probable differential diagnosis and use those probabilities to identify the best choice of diagnostic or treatment among several alternatives. In this retrospective case analysis, we surveyed three experts on the prior probability of several differential diagnoses, given the signalment and history of a ferret presenting for lethargy and anorexia, and the conditional probability of different clinical findings (physical, bloodwork, imaging, etc.), given a diagnosis. Using these data and utility estimates provided by other clinicians, we constructed a decision tree to retrospectively identify the optimal treatment choice between exploratory laparotomy and medical management. We identified medical management as the optimal choice, in contrast to the original clinical team which performed an exploratory laparotomy. We discuss the potential cognitive biases of the original clinical team. We also discuss the strengths, e.g., shared decision making, and limitations of a Bayesian decision analysis in the veterinary clinic. Bayesian decision analysis can be a useful tool for retrospective case analysis and prospective decision making, especially for deciding on invasive interventions or end-of-life care. The dissimilarity of expert-derived probability estimates makes Bayesian decision analysis somewhat challenging to apply, particularly in wide-ranging specialties like zoological medicine.

Respiratory Disorders in Ferrets.

Ferrets are susceptible to many disorders affecting the respiratory tract including both primary diseases and diseases of other body systems secondarily affecting the respiratory tract. Some primary respiratory diseases are shared with other mammal species including humans; potentially zoonotic diseases include important pathogens such as influenza and SARS-CoV-2. Other diseases include infections (bacterial, parasitic, and fungal) and neoplasia. A thorough workup is important to identify exact causes in order to formulate a treatment plan. Infectious diseases include bacterial, fungal, parasitic, and viral.

End-of-Life Decisions: Palliative Care, Hospice, and Euthanasia for Exotic Animals.

A great deal of attention has been directed toward developing better options for palliative care and hospice, and improving euthanasia techniques in all species. Euthanasia of exotic pets is technically more difficult because of anatomic differences and small patient size. Traditional intravenous euthanasia techniques in conscious patients are stressful and should generally be avoided in exotic pets; simple intramuscular administration of high dosages of anesthetics followed by delivery of euthanasia solutions is preferred. Options for mammals, birds, and reptiles are presented.

Disease Overview of the Urinary Tract in Exotic Companion Mammals and Tips on Clinical Management.

Diseases of the urinary tract are reviewed, covering infectious (bacterial, viral, parasitic), degenerative, congenital, metabolic, nutritional, neoplastic, obstructive, and toxic causes. Some clinical presentations and diagnostic procedures are described for ferrets, rabbits, guinea pigs, hamsters, mice, rats, chinchillas, hedgehogs, and sugar gliders, as well as therapies.

Ischemia/reperfusion injury in male guinea pigs: An efficient model to investigate myocardial damage in cardiovascular complications.

Myocardial ischemia/reperfusion (I/R) injury is the major problem that aggravates cardiac damage. Several established animal models fail to explain the similarity in disease mechanism and progression as seen in humans; whereas guinea pig shows high similarity in cardiovascular parameters. Hence, current study is aimed to develop an animal model using guinea pigs that may best correlate with disease mechanism of human myocardial I/R injury. Male guinea pigs were randomized into three groups: normal diet (ND), high fat diet (HFD) and sham; fed with respective diets for 90 days. Myocardial infarction (MI) was induced by ligating left anterior descending artery (LAD) for 30 min followed by 24 h and 7 days of reperfusion in ND and HFD groups. Electrocardiogram (ECG) showed the alterations in electrical conduction during myocardial I/R injury. Elevated levels of lactate dehydrogenase (LDH) and creatine kinase-MB ((CK-MB)) were higher in HFD compared to ND. Inflammatory markers such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were up-regulated in I/R injury animals compared to sham. Fold change of these protein expression levels were higher in HFD compared to ND. Elevated lipid profile and increased aortic wall thickness in HFD animals depicts the risk of developing cardiovascular complications. ECG analysis strongly confirmed MI through changes in sinus rhythm that are reflected in infarcted tissue as verified through TTC staining. Thus the combination of HFD followed by I/R injury proved to be an efficient model to study pathophysiology of myocardial I/R injury with minimal tissue damage and surgical mortality.

Four cases of iridociliary tumors in domestic rabbits (Oryctolagus Cuniculus).

Spontaneously occurring ocular neoplasia is rarely reported in rabbits. This case series presents four cases of rabbits diagnosed with iridociliary tumors, which have not been previously reported in this species. Major pathological findings include epithelial tumors affecting the anterior uvea with variable pigmentation and basement membrane formation. Follow-up information was only available for two cases, but neither showed evidence of metastasis, suggesting that the prognosis for these tumors in rabbits, as in other species, may be very good.

Reproductive Disorders of Marsupials.

Marsupial reproduction differs significantly in anatomy and physiology from that of placental mammals. The gastrointestinal and urogenital tracts empty into a cloaca. Reproductive parameters include gestation and pouch time, as the fetus develops outside of the uterus. Captive marsupials discussed include sugar gliders), short-tailed opossums, Virginia opossums, and Tammar and Bennett's wallabies. Common disease conditions include joey eviction, pouch infections, mastitis, metritis, prostatitis, penile necrosis, and neoplasia. Common surgeries include penile amputation, castration, and ovario-vaginal-hysterectomy or ovario-hysterectomy. Therapeutics used for these conditions are presented.

Anatomy and Disorders of the Oral Cavity of Miscellaneous Exotic Companion Mammals.

Unusual mammalian species such as the hedgehog, sugar glider, and miniature pig are encountered with increasing frequency in exotic companion medicine. Disease of the oral cavity can occur in any species; although occasionally encountered in exotic mammalian species, it is rarely described in the literature. Anatomy and dentition vary significantly; diagnosis and treatment are often extrapolated from that known in other species. The best-documented disease of the oral cavity in this group of species is oral neoplasia in the hedgehog.

Elodontoma in Two Guinea Pigs.

Elodontoma was diagnosed in two pet guinea pigs, one involving a maxillary premolar tooth and the other affecting a mandibular incisor tooth. Diagnostic imaging, including radiographs, computed tomography, and oral endoscopy was performed in order to quantify dental disease. Diagnostic imaging was also used to guide treatment of acquired dental disease, which included intraoral restoration of normal occlusal plane and tooth extraction using an extraoral approach. These are the first histologically confirmed cases of elodontoma in guinea pigs.

Monoclonal hyperglobulinemia in lymphosarcoma in a cockatiel (Nymphicus hollandicus) and a blue and gold macaw (Ara ararauna).

A 15-yr-old cockatiel (Nymphicus hollandicus) presented with decreased activity and appetite. A presumptive diagnosis of lymphoproliferative disease was made because of a monoclonal band observed on plasma protein electrophoresis. The owner declined further diagnostics or treatment, and the bird died 2 yr later. In a second case, a 4-yr-old blue and gold macaw (Ara ararauna) presented with lethargy and anorexia. Despite supportive treatment, the bird died 7 days later. Blood studies also demonstrated a monoclonal band on plasma protein electrophoresis. The histologic review of tissues from both birds found extensive neoplastic lymphoplasmocytic cells in the liver and supported a diagnosis of lymphosarcoma.

Diagnostic imaging of the respiratory system in exotic companion mammals.

The level of care for smaller companion mammals has increased significantly during the past few years. Today, exotic companion mammals are acknowledged as a specific area of zoologic medicine. Owner demands for a higher level of care is increasing dramatically. Because most of these patients are small (less than 2 kg), this represents a great challenge, in particular for the field of diagnostic imaging. This article reviews the 5 main diagnostic imaging modalities currently available for investigation of the respiratory system of exotic companion mammals: radiography, ultrasonography, endoscopy, computed tomography, and magnetic resonance.

Updates and advanced therapies for gastrointestinal stasis in rabbits.

Gastrointestinal stasis is currently a vaguely defined term for decreased gastrointestinal motility. The term gastric stasis syndrome was previously proposed, but falls short of an accurate description, as in many cases portions of the gastrointestinal tract other than the stomach are affected. The term rabbit gastrointestinal syndrome (RGIS) defines a complex of clinical signs, symptoms, and concurrent pathologic conditions affecting the digestive apparatus of the rabbit. When ill rabbits present for examination it is important to determine if RGIS is present and if so, begin treatment and a diagnostic workup to determine underlying contributing factors. Identification of underlying cause is often difficult; many rabbits present with evidence of RGIS whereby attempts to identify an underlying cause are unfruitful. In many cases, these rabbits respond positively to supportive therapy including fluids, hand feeding, and motility-enhancing drugs.

Care of the geriatric rabbit.

The average life span reported in laboratory and lay literature for the domestic rabbit is 5 to 10 years. The author and other veterinarians are now regularly seeing rabbits living to 9 or 10 years, the oldest reported in the author's practice being 14 years. Rabbits are herbivorous prey species with continually growing (elodont) teeth. This feature allows the geriatric rabbit to possess teeth that are essentially "new", a distinct advantage over geriatric carnivores. Expanded longevity, while generally desirable, necessarily accompanies an increase in geriatric disorders. This article examines the spectrum of disease that can affect the geriatric rabbit as well as crucial factors concerning the clinical management of the animal up to the end of its life. An improved understanding of geriatric disorders in pet rabbits allows early recognition and the opportunity to improve quality of life.

The Leicester Model of Interprofessional education: developing, delivering and learning from student voices for 10 years.

There are few sustained interprofessional learning opportunities in practice which engage the whole cohort of health and social care students across a region, the Leicester Model of Interprofessional Education is such an example. Since 1995 the Leicester Model has evolved to enable health and social care students to learn about the complexities of delivering multi-agency care in a range of health and social care settings. The learning environment is situated at the front line of service delivery. The education model takes students through a cycle of learning and applies a problem-solving, experiential learning approach which promotes deep learning. Follow-up data indicates that deep learning is achieved. This paper describes the original setting and presents the evaluation outcomes of the Leicester Model's "Health in the Community" course, which is delivered in city-centre communities, where inequalities in health are greatest. It traces a ten-year trajectory of interprofessional student group evaluations which helped shape this learning experience. Year-on-year positive student outcomes indicate the potential of the model to motivate and prepare future professionals for team working. Its sustainability has been achieved through ensuring the integration of education research in the development process, engagement of practitioners who value the student contributions to team working, placing patients central to the learning experience and establishing working partnerships between Higher Education Institutions, local health and social care organizations and the voluntary sector.

Bacterial and parasitic diseases of rabbits.

Bacterial disease is common in pet rabbits; parasitic disease occurs as well but at a much lower frequency. Of these, bacterial diseases of the respiratory tract and dental structures are seen most commonly in practice. Successful treatment depends on positive diagnosis of the disease process and causative agent. This article focuses on the more common bacterial and parasitic diseases encountered in clinical practice.

Mycobacteriosis in companion psittacine birds: a review.

Mycobacteriosis has long been recognized as a disease of companion psittacine birds. In this review, the signalment, clinical signs of disease, and diagnosis of mycobacteriosis in psittacine birds are presented. Although treatment of birds with mycobacteriosis is controversial, therapeutic protocols for use in psittacine birds have been developed based on protocols used in humans. Results of recent studies indicate that mycobacteriosis in psittacine birds is unlikely to represent a significant health risk for humans. However, the potential for zoonotic disease must be considered, especially if persons who are immunocompromised are in contact with an infected bird.

Malignant melanoma in a zebra finch (Taeniopygia guttata): cytologic, histologic, and ultrastructural characteristics.

An approximately 3-year-old adult male zebra finch (Taeniopygia guttata) was diagnosed with malignant melanoma. The large darkly pigmented tumor was located in the coelom, extended from the apex of the heart to the cloaca, and was adherent to the intestines and the ventriculus. Dark small masses (likely metastases) were observed in the lungs. Cytologically, the neoplasm consisted mainly of round to oval cells with brown or pale blue to blue-brown pigment. Lesser numbers of cells were stellate to dendritic with abundant amounts of brown pigment granules or were markedly pleomorphic with variable amounts of pigment. Histologically, the tumor consisted of dense sheets and aggregates of infiltrative melanocytes that were negative for S-100 and Melan A. A few cells were consistent with "signet-ring" melanocytes. Melanocytes examined by electron microscopy contained typical structures, mainly premelanosomes and melanosomes, of this cell type. However, melanocytes with marked pleomorphism also contained intracytoplasmic aggregates of filaments, consistent with previously reported ultrastructural findings in signet-ring or rhabdoid melanoma of nonavian species.

Emergency and critical care of pet birds.

Critically ill birds must be assessed accurately and provided with immediate supportive care. This article reviews the assessment and diagnostics required for evaluating the critical avian patient. The most common emergencies seen in pet birds are discussed. Diagnostics and treatments protocols are provided to help direct the practitioner toward a complete recovery.