Intra- and Inter-observer Variability of Computed Tomographic Measurements of the Prostate Gland in Neutered Dogs.

The purpose of this study was to evaluate the intra- and inter-observer variability of computed tomographic measurements of linear prostate dimensions in neutered dogs without signs of prostatic disease, to determine potential associations between prostatic parameters and body weight or age and to provide reference ranges. Length, width and height of the prostate gland were measured in 62 neutered dogs with no signs of prostatic disease by three observers with different levels of training. Statistically significant positive associations were found between all prostatic parameters and body weight and between all prostatic parameters and age at castration, but not with age. Formulae allowing the calculation of the expected values for prostatic parameters based on body weight are provided [length = 15.3 + body weight (BW) × 0.3; height = 9.7 + BW × 0.16; width = 9.5 + BW × 0.2]. These may represent a useful tool for computed tomographic evaluation of the size of the prostate in neutered dogs. Subjective evaluations of the morphological appearance of the prostate gland are also provided.

Use of Readily Accessible Inflammatory Markers to Predict Diabetic Kidney Disease.

Diabetic kidney disease is a common complication of type 1 and type 2 diabetes and is the primary cause of end-stage renal disease in developed countries. Early detection of diabetic kidney disease will facilitate early intervention aimed at reducing the rate of progression to end-stage renal disease. Diabetic kidney disease has been traditionally classified based on the presence of albuminuria. More recently estimated glomerular filtration rate has also been incorporated into the staging of diabetic kidney disease. While albuminuric diabetic kidney disease is well described, the phenotype of non-albuminuric diabetic kidney disease is now widely accepted. An association between markers of inflammation and diabetic kidney disease has previously been demonstrated. Effector molecules of the innate immune system including C-reactive protein, interleukin-6, and tumor necrosis factor-α are increased in patients with diabetic kidney disease. Furthermore, renal infiltration of neutrophils, macrophages, and lymphocytes are observed in renal biopsies of patients with diabetic kidney disease. Similarly high serum neutrophil and low serum lymphocyte counts have been shown to be associated with diabetic kidney disease. The neutrophil-lymphocyte ratio is considered a robust measure of systemic inflammation and is associated with the presence of inflammatory conditions including the metabolic syndrome and insulin resistance. Cross-sectional studies have demonstrated a link between high levels of the above inflammatory biomarkers and diabetic kidney disease. Further longitudinal studies will be required to determine if these readily available inflammatory biomarkers can accurately predict the presence and prognosis of diabetic kidney disease, above and beyond albuminuria, and estimated glomerular filtration rate.

Treating Gastritis, Peptic Ulcer Disease, and Dyspepsia in the Emergency Department: The Feasibility and Patient-Reported Outcomes of Testing and Treating for Helicobacter pylori Infection.

STUDY OBJECTIVE: Helicobacter pylori infection is a known cause of gastritis, dyspepsia, and peptic ulcer disease. Testing for infection is indicated in high-prevalence outpatient settings. The objective of this prospective cohort study is to examine the feasibility of a test-and-treat strategy in the emergency department (ED) setting. METHODS: During a 13-month period at an academic ED, symptomatic patients underwent a point-of-care urea breath test (BreathID; Exalenz Bioscience Inc., Modiin, Israel) during the ED visit. Research assistants abstracted treatment information from the electronic medical record. Patients who tested positive were prescribed triple-therapy medication. All enrollees were telephoned 2 weeks after the index ED visit to ascertain symptom resolution and treatment compliance. H pylori-positive subjects were asked to return to the ED for retest. Risk differences in patient and clinical characteristics were compared by H pylori infection status, and a paired t test was used to estimate differences in pain resolution at the ED visit and follow-up. RESULTS: Of the 465 symptomatic patients, 271 were eligible and 212 enrolled and were tested for H pylori. Forty-nine patients (23%) (95% confidence interval [CI] 18% to 30%) had a positive result, 33 of 49 (67%) (95% CI 53% to 79%) self-reported receiving the medication as prescribed at follow-up, 23 of 49 (47%) (95% CI 34% to 61%) were retested, and 20 of 49 (41%) (95% CI 28% to 55%) had a negative result. There was a significant reduction in pain severity, regardless of H pylori infection status. CONCLUSION: A test-and-treat strategy is feasible in the ED setting and could benefit symptomatic patients.