[Digitization in Swiss veterinary practices]. / Stand der Digitalisierung in Schweizer Tierarztpraxen.

INTRODUCTION: Data on the digitization in Swiss veterinary practices and clinics were collected in a survey from June 2017 to the end of December 2017. Data of 171 practices contributed to the survey. Animal records were filed in 96.5% with a practice management program. Nine out of ten practices operate an x-ray machine whereof 70% digitally record the radiographs. While a moderate diversity of practice management systems is used, numerous different radiographic recording, archiving and viewing systems are utilized. Data exchange with other practices and owners preferably takes place via e-mail, followed by upload servers and digital data carriers. Data protection receives less attention in veterinary medicine than in comparison to human medicine. A protected data exchange platform coupled with AMICUS and ANIS is under construction via standardized DICOM (https://www.dicomstandard.org/current/) and HL7 (https://www.hl7.org/) interfaces.

INTRODUCTION: De juin 2017 à fin décembre 2017, des données relative à la digitalisation ont été collectées dans le cadre d'une enquête auprès de cabinets et cliniques vétérinaires suisses. Au total, 171 pratiques ont participé à l'enquête. 96,5% conservent les antécédents du patient avec un programme de gestion. Neuf cabinets sur dix utilisent un appareil à rayons X, dont 70% enregistrent numériquement les images. Bien que la variété des systèmes de gestion soit modérée, elle est riche en ce qui concerne l'enregistrement, l'archivage et la visualisation des images. L'échange de données avec d'autres pratiques et propriétaires se fait de préférence par courrier électronique, suivi de serveurs de téléchargement et de supports de données numériques. En comparaison avec la médecine humaine, la protection des données a beaucoup moins d'importance en médecine vétérinaire. Afin de pouvoir effectuer l'échange de données numériques de manière pratique, une plate-forme d'échange de données sécurisée couplée à AMICUS et à ANIS via DICOM normalisé (https://www.dicomstandard.org/current/) et HL7 (https://www.hl7.org/) est en construction.

[AntibioticScout.ch: A decision supporting tool for antimicrobial stewardship: application to companion animal medicine]. / AntibioticScout.ch: Eine Entscheidungshilfe für den umsichtigen Einsatz von antimikrobiellen Wirkstoffen: Anwendung in der Kleintiermedizin.

INTRODUCTION: Bacterial resistances to antimicrobial drugs pose serious public health challenges. The observed increase of resistances is attributed to the uncontrolled, massive and often unnecessary administration of antibiotics both in human and veterinary medicine. To support the responsible use of antimicrobials in animals and help veterinarians selecting the most suitable antimicrobial drugs, we developed the AntibioticScout.ch as a comprehensive decision supporting tool providing online access to the current knowledge of rational antibiotic prescription practices. User-friendly search functions allow for the fast and efficient retrieval of information that is structured in this database by animal species, organ systems and therapeutic indications. In addition, an online form allows to report treatment failures in order to identify problematic cases as well as ensuing risks and take appropriate mitigation measures. The present report describes the workflow of this decision support system applied to the prudent use of antimicrobials in companion animal medicine.

INTRODUCTION: Les résistances bactériennes face aux substances antimicrobiennes placent le système de santé face à de grands défis. L'augmentation des résistances est attribuée à une utilisation mal dirigée, massive et souvent inutile d'antibiotiques tant en médecine humaine qu'en médecine vétérinaire. Afin d'encourager une utilisation responsable des substances antimicrobiennes en médecine vétérinaire et pour soutenir les vétérinaires lors du choix de l'antibiotique adapté, on a créé, avec AntibioticScout. ch, une aide à la décision de grande envergure qui permet de recourir à chaque instant aux principes de prescription reconnus de la médecine fondée sur les faits (Evidence Based Medicine). La banque de données est structurée par espèces animales, systèmes d'organes et indications et un moteur de recherche intuitif garantit de trouver rapidement et efficacement les informations. D'autre part un formulaire en ligne pour l'annonce d'une inefficacité est proposé afin de reconnaitre les cas à problèmes et les risques en vue d'améliorer l'aide au diagnostic. La présente contribution pour but de démontrer l'utilisation d'AntibioticScout pour un usage prudent des antibiotiques en médecine des petits animaux.

Intestinal epidermoid cyst in a cat.

A 3-year-old cat was presented with anorexia and vomiting. Palpation revealed a caudal abdominal mass. Ultrasound and explorative abdominal surgery revealed a cystic mass in the jejunum. Histopathologic findings were consistent with an epidermoid cyst. The cyst was likely of congenital origin, since the cat had not undergone previous abdominal surgery, and gradually grew to reach a size that caused intestinal obstruction. Extrapolating from findings in people, intestinal epidermoid cysts are considered benign with a good long-term prognosis when completely excised.

[Diabetes remission in cats: a review]. / Diabetes-Remission bei der Katze: Ein Überblick.

Remission from diabetes is seen in 25 - 50 % of cats during the first months of therapy. The likelihood of remission is higher in old cats and cats with normal cholesterol than in young cats and cats with increased cholesterol. The results of an ongoing study indicate that initial intravenous insulin therapy has positive effects on remission rates and quality of metabolic control.

Comparison of a continuous glucose monitoring system with a portable blood glucose meter to determine insulin dose in cats with diabetes mellitus.

BACKGROUND: The continuous glucose monitoring system (CGMS) Guardian REAL-Time(®) allows the generation of very detailed glucose profiles in cats. The performance of CGMS to generate short-term glucose profiles to evaluate treatment response has not been yet evaluated in diabetic cats. HYPOTHESIS: Analysis of glucose profiles generated using the CGMS produces insulin dose recommendations that differ from those of profiles generated using the portable blood glucose meter (PBGM) in diabetic cats. ANIMALS: Thirteen client-owned diabetic cats. METHODS: Prospective, observational study. Simultaneous glucose profiles were generated over an 8-10 hour period using the CGMS, blood glucose concentration was measured every 2 hours with the PBGM. Profiles were submitted to three internal medicine specialists who used them to determine the insulin dose. Differences between insulin doses deduced from paired profiles were compared. Percentages of nadirs recorded with the CGMS that were lower, higher, or equal to those derived with the PBGM were calculated. RESULTS: Twenty-one paired glucose profiles were obtained. There was no difference of insulin doses based on CGMS and PBGM profiles (median 0 U; range: -1 to +0.5). Treatment decisions did not differ among investigators. Compared with the observed PBGM nadir, the CGMS nadir was lower, higher, or equal in 17, 2, and 2 of 21 cases, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Adjustments in insulin dose based on glucose profiles generated with the CGMS are similar to those based on the PBGM. The common occurrence of lower nadirs recorded with the CGMS suggests that this device detects hypoglycemic periods that are not identified with the PBGM.

Remission of diabetes mellitus in cats cannot be predicted by the arginine stimulation test.

BACKGROUND: Cats with diabetes mellitus frequently achieve clinical remission, suggesting residual ß-cell function. Responsiveness of ß-cells to arginine persists the longest during diabetes progression, making the intravenous arginine stimulation test (IVAST) a useful tool to assess residual insulin and glucagon secretion. HYPOTHESIS: Diabetic cats with and without remission will have different arginine-induced insulin or glucagon response. ANIMALS: Seventeen cats with diabetes, 7 healthy cats. METHODS: Blood samples collected on admission and during subsequent IVAST. Glucose, insulin, and glucagon were measured. Response to IVAST was assessed by calculating the insulin and glucagon area under the curve (AUC) and the AUC glucagon-to-insulin ratio. Diabetic cats were treated with insulin and were followed for 18 weeks. Remission was defined as normoglycemia and disappearance of clinical signs of diabetes for ≥4 weeks, without requiring insulin. RESULTS: Seven diabetic cats (41%) achieved remission. On admission, blood glucose concentration was significantly lower in cats with remission (median, 389 mg/dL; range, 342-536 mg/dL) than in those without remission (median, 506 mg/dL; range, 266-738 mg/dL). After IVAST, diabetic cats with remission had higher AUC glucagon-to-insulin ratios (median, 61; range, 34-852) than did cats without remission (median, 26; range, 20-498); glucose, insulin, and glucagon AUCs were not different. Diabetic cats had lower insulin AUC than did healthy cats but comparable glucagon AUC. CONCLUSIONS AND CLINICAL IMPORTANCE: Diabetic cats with and without remission have similar arginine-stimulated insulin secretion on admission. Although cats with remission had lower blood glucose concentrations and higher AUC glucagon-to-insulin ratios, large overlap between groups prevents use of these parameters in clinical practice.

[Natural infection with Angiostrongylus vasorum: characterisation of 3 dogs with pulmonary hypertension]. / Natürliche Angiostrongylus vasorum Infektion: Charakterisierung des Krankheitsbildes bei drei Hunden mit pulmonärer Hypertonie.

Pulmonary hypertension (PH), together with its accompanying clinical signs and underlying causes, e.g. pulmonary thrombosis, are more and more recognized as an important clinical entity also in dogs. This article characterizes the clinical picture of 3 dogs with PH caused by natural infection with Angiostrongylus vasorum. All 3 dogs were of small breeds ( < 10 kg), the age at the time of diagnosis was 1, 2 and 11 years. Clinically, dyspnea and exercise intolerance were the predominating signs, 2 dogs developed hemoptysis, 1 dog developed right sided congestive heart failure. Severe arterial hypoxemia (PaO2 41 - 53 mmHg) reflected the severity of pulmonary parenchymal and vascular damage. Severe hyperglobulinemia (59 und 88 g/l) in two dogs implicated a long lasting infection. Anthelmintic treatment in 2 dogs resulted in quick clinical, radiographic and echocardiographic normalization. PH is the consequence of multiple causes and pathomechanisms, and the recognition of PH is primarily of differential diagnostic relevance. Prognosis and therapy in cases with PH mainly depend on the underlying cause, rather than on the PH and on its degree.

[Infectious canine hepatitis in 4 dogs in Switzerland]. / Hepatitis contagiosa canis Infektion bei 4 Hunden in der Schweiz.

Infectious canine hepatitis in 4 Dogs in Switzerland. Four dogs presented with nonspecific symptoms of lethargy, vomiting, diarrhea, fever and weakness. Laboratory results were consistent with hepatopathy and disseminated intravascular coagulation. Three dogs died, one survived. In the three deceased dogs, a diagnosis of infectious canine hepatitis (ICH) was made based on histological findings and positive immunhistochemistry results for canine adenovirus-1 (CAV-1). In the surviving dog, an antemortem diagnosis of ICH was determined via positive polymerase chain reaction results from blood, occular, nasal and preputial discharge as well as from urine. Since the introduction of widespread vaccination, the incidence of CAV-1 infection in dogs is low. However, the disease has not been eradicated and should be considered when clinical signs consistent with ICH are present.

Evaluation of a novel real-time continuous glucose-monitoring system for use in cats.

BACKGROUND: The Guardian REAL-Time is a continuous glucose-monitoring system (CGMS) recently developed to provide instantaneous interstitial glucose concentrations; the system does not require a monitor being fixed to the animal. HYPOTHESIS: The CGMS provides accurate and reproducible real-time readings of glucose concentration in cats. ANIMALS: Thirty-two diabetic cats, 2 cats with suspected insulinoma, and 5 healthy cats. METHODS: Prospective, observational study. CGMS accuracy was compared with a reference glucose meter at normal, high, and low blood glucose concentrations using error grid analysis. Reading variability of 2 simultaneously used CGMS was determined in diabetic cats by calculating correlation and percentage of concordance of paired data at different glycemic ranges. The time interval between increasing glycemia and a rise in interstitial fluid glucose measured by the CGMS was assessed in healthy cats receiving glucose IV; the time point of maximal increase in interstitial glucose concentrations was calculated. RESULTS: The CGMS was 100, 96.1, and 91.0% accurate at normal, high, and low blood glucose concentrations. Measurements deviated from reference by -12.7 +/- 70.5 mg/dL at normal, -12.1 +/- 141.5 mg/dL at high, and -1.9 +/- 40.9 mg/dL at low glucose concentrations. Overall, paired CGMS readings correlated significantly (r = 0.95, P < .0001) and concordance was 95.7%. The median delay after IV administration of glucose to an increase in interstitial glucose was 11.4 minutes (range: 8.8-19.7 minutes). CONCLUSIONS AND CLINICAL IMPORTANCE: Although some readings substantially deviated from reference values, the CGMS yields reproducible results, is clinically accurate in cats with hyperglycemia and euglycemia, and is slightly less accurate if blood glucose concentrations are low. Rapidly increasing interstitial glucose after a glycemic rise suggests that the CGMS is suitable for real-time measurement under clinical conditions.

Evaluation of a new portable glucose meter designed for the use in cats.

Portable blood glucose meters (PBGMs) are useful in the management of diabetes mellitus in cats. In the present study we compared the performance of two PBGMs: the AlphaTRAK (Abbott Animal Health, Maidenhead, England) specifically developed for dogs and cats, and the Ascensia ELITE (Bayer HealthCare, Zurich, Switzerland) developed for humans. Quality parameters, including precision and accuracy, were better for the AlphaTRAK meter compared to Ascensia ELITE. While the AlphaTRAK meter results did not differ from the reference method, results from the Ascensia ELITE were significantly (P<0.001) lower. The superior performance of the AlphaTRAK meter supports its use to monitor blood glucose levels in cats.

Remission of diabetes mellitus in cats with diabetic ketoacidosis.

BACKGROUND: Diabetic ketoacidosis (DKA) has long been considered a key clinical feature of type-1 diabetes mellitus (DM) in humans although. An increasing number of cases of ketoacidosis have been reported in people with type-2 DM. HYPOTHESIS/OBJECTIVES: Cats initially diagnosed with DKA can achieve remission from diabetes. Cats with DKA and diabetic remission are more likely to have been administered glucocorticoids before diagnosis. ANIMALS: Twelve cats with DKA and 7 cats with uncomplicated DM. METHODS: Retrospective case review. Medical records of cats presenting with DKA or DM were evaluated. Diabetic remission was defined as being clinically unremarkable for at least 1 month after insulin withdrawal. The cats were assigned to 1 of 3 groups: (1) cats with DKA and diabetic remission; (2) cats with DKA without diabetic remission; and (3) cats with DM and diabetic remission. RESULTS: Seven cats with DKA had remission from diabetes. These cats had significantly higher concentrations of leukocytes and segmented neutrophils, and significantly lower concentrations of eosinophils in blood and had pancreatic disease more often than did cats with uncomplicated DM and diabetic remission. With regard to pretreatment, 3/7 cats in group 1, 1/5 cats in group 2, and 1/7 cats in group 3 had been treated with glucocorticoids. CONCLUSIONS AND CLINICAL IMPORTANCE: Remission of DM in cats presenting with DKA is possible. Cats with DKA and remission have more components of a stress leucogram, pancreatic disease, and seemed to be treated more often with glucocorticoids than cats with uncomplicated DM and diabetic remission.

Evaluation of IGF-1 levels in cats with transient and permanent diabetes mellitus.

It was investigated if IGF-1 levels in cats which experience diabetic remission (i.e. transient diabetes mellitus) differ from those in cats with permanent disease. Thirteen of 32 diabetic cats showed remission within 16 weeks after initiating insulin therapy, 19 cats continued to need insulin therapy. IGF-1 concentrations were measured before (t(0)), 1-3 (t(1)) and 4-8 (t(2)) weeks after initiating insulin therapy. No difference in IGF-1 levels was found between cats with transient and permanent diabetes at any point in time. In both groups of cats IGF-1 concentrations were significantly lower compared to those of controls before insulin administration. After starting insulin therapy IGF-1 increased significantly in both groups. In cats with transient diabetes IGF-1 levels were not different from controls already at t(1), whereas in cats with permanent diabetes it took until t(2). Although IGF-1 levels seem to normalize faster in cats with transient diabetes mellitus, measurement is not helpful to predict the course of the disease.