Advances in Clinical Voice Quality Analysis with VOXplot.

BACKGROUND: The assessment of voice quality can be evaluated perceptually with standard clinical practice, also including acoustic evaluation of digital voice recordings to validate and further interpret perceptual judgments. The goal of the present study was to determine the strongest acoustic voice quality parameters for perceived hoarseness and breathiness when analyzing the sustained vowel [a:] using a new clinical acoustic tool, the VOXplot software. METHODS: A total of 218 voice samples of individuals with and without voice disorders were applied to perceptual and acoustic analyses. Overall, 13 single acoustic parameters were included to determine validity aspects in relation to perceptions of hoarseness and breathiness. RESULTS: Four single acoustic measures could be clearly associated with perceptions of hoarseness or breathiness. For hoarseness, the harmonics-to-noise ratio (HNR) and pitch perturbation quotient with a smoothing factor of five periods (PPQ5), and, for breathiness, the smoothed cepstral peak prominence (CPPS) and the glottal-to-noise excitation ratio (GNE) were shown to be highly valid, with a significant difference being demonstrated for each of the other perceptual voice quality aspects. CONCLUSIONS: Two acoustic measures, the HNR and the PPQ5, were both strongly associated with perceptions of hoarseness and were able to discriminate hoarseness from breathiness with good confidence. Two other acoustic measures, the CPPS and the GNE, were both strongly associated with perceptions of breathiness and were able to discriminate breathiness from hoarseness with good confidence.

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.

Clinical tolerance of dexamethasone in New Zealand white rabbits.

Rabbits have been a popular pet and research species world-wide. In many clinical and research situations, controlling inflammation is necessary for the health of these animals. One of the first drugs commonly employed in veterinary medicine to suppress inflammatory responses is corticosteroids. Unfortunately, steroid use in rabbits is not universally accepted as they are perceived, based on their potent immunosuppressant activity, to negatively impact quality of life. This is may be due, in part, to the lack of well-developed dosing protocols in these animals. This study evaluated the impact of a 5-day IM dexamethasone (Dex, 0.5 mg/kg) protocol on the immunity and clinical health of the New Zealand rabbit. Through two experiments separated by a 10-day washout period, experiment 1 comprised 5-days of dosing with bleedings on day 0, 3, 5 and 7, where experiment 2 consisted of 5-days of dosing with bleedings on day 0, 3 and 5. Animals were monitored twice daily for changes in clinical health. Hematology, T cell subset phenotype, leukocyte cell cycle, histopathology, phagocytosis and oxidative formation were evaluated. Consistent with other species, 5-day dosing with Dex suppressed leukocytes, in particular the T cells (p ≤ 0.003). Interestingly, rabbits failed to show any adverse clinical signs throughout the entire study. This would imply that a 5-day IM Dex (0.5 mg/kg) dosing protocol is well tolerated by New Zealand white rabbits and could be used in rabbits suffering from inflammatory conditions or disease as long as the animal's immune status is closely monitored.

Investigation for correction formulas on the basis of packed cell volume for blood glucose concentration measurements obtained with portable glucometers when used in rabbits.

OBJECTIVE: To determine effects of PCV on blood glucose (BG) concentration measurements obtained with a human portable blood glucometer (HPBG) and a veterinary portable blood glucometer (VPBG) on canine (cVPBG) and feline (fVPBG) settings (test methods) when used in rabbits and to develop correction formulas to mitigate effects of PCV on such measurements. SAMPLE: 48 resuspended blood samples with known PVCs (range, 0% [plasma] to 92% [plasma and packed RBCs]) from 6 healthy research rabbits (experimental sample set) and 252 historic measurements of BG concentration and PCV in 84 client-owned rabbits evaluated at a veterinary hospital (validation data set). PROCEDURES: Duplicate measurements of BG concentration with each test method and of PCV were obtained for each sample in the experimental sample set, and the mean results for each variable for each test method and sample were compared with results from a clinical laboratory analyzer (reference method) used to determine the true BG concentration for each sample. Mean ± SD differences in measurements between the reference and test methods were calculated. Linear regression and modified Clarke error grid analysis were used to develop correction formulas for the test methods given known PCVs, and these formulas were evaluated on the validation data set with linear regression and a modified Clarke error grid. RESULTS: Blood glucose concentrations were falsely low for cVPBG and fVPBG used on samples with PCV < 31% and were falsely high for all test methods used on samples with PCV > 43%. Compared with original measurements, formula-corrected measurements overall had better agreement with reference method measurements for the experimental sample set; however, only the formula-corrected HPBG measurements had improved agreement for the validation data set. CONCLUSIONS AND CLINICAL RELEVANCE: Findings indicated that, in rabbits, HPBG measurements had improved accuracy with the use of the correction formula HPBG measurement of BG concentration + ([0.75 × PCV] - 15); however, the correction formulas did not improve the accuracy of VPBG measurements, and we believe that neither the cVPBG nor fVPBG should be used in rabbits.

Comparison of endoscopic endotracheal intubation and the v-gel supraglottic airway device for spontaneously ventilating New Zealand white rabbits undergoing ovariohysterectomy.

BACKGROUND: Due to the technical difficulties with endotracheal intubation of rabbits, a prospective, randomised, controlled study was performed to compare a rabbit-specific supraglottic airway device (SGAD), the v-gel, with endoscopic endotracheal intubation (EEI) in spontaneously breathing rabbits undergoing ovariohysterectomy. METHODS: Fourteen adult female New Zealand white rabbits were randomly allocated to one of two groups based on the method of airway establishment: EEI or v-gel SGAD. Anaesthesia was induced with ketamine and xylazine and maintained using isoflurane in 100 per cent oxygen. Comparisons were made between groups based on placement time of endotracheal tube/SGAD, number of attempts and adjustments, the necessity to increase isoflurane concentrations to maintain a surgical plane of anaesthesia, arterial blood gas values, gross laryngeal evaluation, and laryngotracheal histopathology. RESULTS: Both techniques resulted in elevated arterial pCO2 levels, but the v-gel was associated with more elevated pCO2 in comparison with EEI (P=0.045). Airway trauma was histologically present but clinically negligible in both groups, with no statistically significant differences observed between techniques (P>0.05). Placement time of the v-gel was significantly faster (P=0.003) and required less technical skill than EEI, but was more easily displaced when changing the animal's position (P=0.004). CONCLUSION: The v-gel is a practical alternative to EEI for securing the airway of healthy spontaneously ventilating rabbits, provided a capnograph is utilised to ensure continuous placement. Both airway techniques appear safe and effective with few complications, as long as intermittent positive pressure ventilation can be employed to correct hypercapnia.

Technological Advances in Wound Treatment of Exotic Pets.

Although most research about the use of technological advances for wound healing was performed in laboratory animals but oriented to human medicine, recent technological advances allowed its application not only to small animals but also to exotic pets. This article reviews the literature available about some of these techniques (negative wound pressure therapy, photobiomodulation [laser therapy], electrical stimulation therapy, therapeutic ultrasonography, hyperbaric oxygen therapy), and other advances in wound management (skin expanders, xenografts, and bioengineered autologous skin substitutes) in exotic pet species.

Novel ultrasound assisted suture anchor system using the BoneWelding® technology yields a comparable primary stability in osteopenic and healthy human humeri as a benchmark anchor.

INTRODUCTION: The aim of this biomechanical study was to evaluate the primary stability of the SportWelding® Sombrero 3.6 mm suture anchor system in osteopenic and healthy cadaveric humeri. METHODS: The Sombrero® and BioCorkscrew® anchors were deployed in 8 osteopenic and 4 healthy cadaver humeri after the bone mineral density (BMD) measurements of the 32 specimens. Both anchors were loaded with a USP Nr. 2 FiberWire® suture. An established cyclic testing protocol was performed. The maximum failure load (Fmax), the system displacement and the modes of failure were recorded. RESULTS: The Fmax and system displacement of the Sombrero® in osteopenic and healthy humeri was equivalent to the Bio-Corkscrew® benchmark anchor; there were no significant differences in the maximum failure loads and system displacement values. Only anchor and suture dislocations were observed; suture ruptures did not occur. CONCLUSION: This study shows that the Sombrero® yields similar maximum failure loads and system displacement values as the established Bio-Corkscrew® benchmark anchor. The primary stability of the Sombrero® and Bio-Corkscrew® seems to be independent of the bone mineral quality. This relatively small-sized polymer anchor is independent of the BMD and may be an alternative to established suture anchors in rotator cuff repair.

Effects of intravenous administration of lidocaine and buprenorphine on gastrointestinal tract motility and signs of pain in New Zealand White rabbits after ovariohysterectomy.

OBJECTIVE To compare analgesic and gastrointestinal effects of lidocaine and buprenorphine administered to rabbits undergoing ovariohysterectomy. ANIMALS Fourteen 12-month-old female New Zealand White rabbits. PROCEDURES Rabbits were assigned to 2 treatment groups (7 rabbits/group). One group received buprenorphine (0.06 mg/kg, IV, q 8 h for 2 days), and the other received lidocaine (continuous rate infusion [CRI] at 100 µg/kg/min for 2 days). Variables, including food and water consumption, fecal output, glucose and cortisol concentrations, and behaviors while in exercise pens, were recorded. RESULTS Rabbits receiving a lidocaine CRI had significantly higher gastrointestinal motility, food intake, and fecal output and significantly lower glucose concentrations, compared with results for rabbits receiving buprenorphine. Rabbits receiving lidocaine also had a higher number of normal behaviors (eg, sprawling, traveling, and frolicking) after surgery, compared with behaviors such as crouching and sitting that were seen more commonly in rabbits receiving buprenorphine. Both groups had significant weight loss after surgery. Pain scores did not differ significantly between treatment groups. Significant decreases in heart rate and respiratory rate were observed on the day of surgery, compared with values before and after surgery. Rabbits in the lidocaine group had significantly overall lower heart rates than did rabbits in the buprenorphine group. CONCLUSIONS AND CLINICAL RELEVANCE A CRI of lidocaine to rabbits provided better postoperative outcomes with respect to fecal output, food intake, and glucose concentrations. Thus, lidocaine appeared to be a suitable alternative to buprenorphine for alleviating postoperative pain with minimal risk of anorexia and gastrointestinal ileus.

BAYLISASCARIS PROCYONIS LARVA MIGRANS IN TWO CAPTIVE NORTH AMERICAN BEAVERS (CASTOR CANADENSIS).

Baylisascaris procyonis larva migrans was diagnosed in two North American beavers ( Castor canadensis ) belonging to a zoological park in Clarke County, Georgia. Both beavers presented with neurological signs. One beaver died naturally and despite attempted treatment, the other beaver was euthanatized because of severe clinical signs and poor prognosis. Histologic evaluation of the beavers revealed evidence of parasitic migration characterized by several lesions, including eosinophilic granulomas in various organs, as well as necrotizing eosinophilic and lymphoplasmacytic to granulomatous polioencephalitis, leukoencephalitis and cervical leukomyelitis. This represents the first confirmed case of B. procyonis larva migrans in beaver and the first non-raccoon ( Procyon lotor ) host in the southeastern United States. This report highlights the need for clinicians and diagnosticians to consider baylisascariasis in animals with compatible clinical signs. Preventative measures should be considered for captive animals, because early diagnosis of B. procyonis is challenging, and treatment is often unrewarding.

Reproductive Medicine in Guinea Pigs, Chinchillas and Degus.

Guinea pigs, chinchillas, and degus are hystricomorph rodents originating from South America. They are commonly presented as exotic pets in veterinary practice. Reviewing the anatomy and physiology of their reproductive tract helps to offer better client education about preventive medicine and helps to act faster in emergency situations. Choosing the right anesthetic protocol helps to prevent complications. This article should aid as a guideline on the most common reproductive problems of these 3 species and help in making decisions regarding the best treatment options.

The immunomodulatory effects of a commercial antiviral homeopathic compound in C57BL/6 mice, pre and post vaccine challenge.

Homeopathic remedies have been selectively employed in human medicine since Hahneman introduced the concept in 1828. While the use of homeopathy is regionally popular in both human and veterinary medicine, there is still a significant lack of scientific evidence supporting its efficacy. This is likely due to an absence of studies evaluating the mechanism of action of these compounds. Engystol® an FDA-approved antiviral agent, is a popular homeopathic commercial product. In select in vivo and in vitro observational studies, the drug showed a measureable innate immune therapeutic efficacy. The focus of the present study was to evaluate the innate and adaptive immunomodulatory effects of oral Engystol(®) (1 or 10 tablets/L water consumed), prior to and post antigenic challenge in a mouse model with a well-characterized and clinically measureable immune system. We first evaluated the murine immune response when oral Engystol(®) was given alone for 28days. Mice were then challenged with an antigen-specific H5N1 HA vaccine while on Engystol(®) for an additional 33days. Serum and supernatants from cultured splenic lymphocytes were collected and screened with a 32-cytokine panel. Serum vaccine epitope-specific IgG titers plus T cell and B cell phenotypes from splenic tissue were also evaluated. Preliminary results showed that Engystol(®) alone did not alter immunity; however, upon vaccine challenge, Engystol(®) decreased CD4(+)/CD8(+) ratios, altered select cytokines/chemokines, and anti-H5N1 HA IgG titers were increased in the 10 tablet/L group. Collectively, these data suggest that Engystol(®) can modulate immunity upon antigenic challenge.

FOCUSED ASSESSMENT WITH SONOGRAPHY AS AN AID FOR THE DIAGNOSIS OF GASTROINTESTINAL PERFORATION IN A BOBCAT ( FELIS RUFUS ).

A 10-yr-old female spayed bobcat (Felis rufus) presented with a 3-day history of lethargy, anorexia, and two episodes of vomiting. An emergency field visit was scheduled to perform abdominal radiography and ultrasonography. The bobcat was assessed to be approximately 5-10% dehydrated, on the basis of decreased skin turgor and tacky mucous membranes. Free peritoneal gas, reduced abdominal serosal detail, and an abnormal-appearing right-sided intestinal segment were identified in the abdominal radiographs. However, the emergency field clinicians were not knowledgeable of these abnormalities, because the radiographs could not be processed in the field. During an initial complete abdominal ultrasound evaluation, a nondependent hyperechoic interface with reverberation artifact suggestive of intestinal or free gas and focal intestinal changes indicative of marked enteritis or peritonitis were identified. Free peritoneal fluid was not present on initial examination. In a focused abdominal sonography for trauma (FAST) scan, made after subcutaneous fluid administration, a small volume of anechoic free fluid was present in the peritoneal space. With ultrasound guidance, the fluid was aspirated and appeared grossly turbid. This fluid was subsequently confirmed as septic suppurative effusion, secondary to a foreign body-associated intestinal perforation. The use of a FAST scan is well described in human medicine, and to a limited degree in veterinary literature. This case represents a novel application of FAST scanning in an emergency field setting in a nontraumatized patient. This case report illustrates the utility of the FAST scan in yielding critical clinical information after fluid resuscitation in a zoological setting.

Endocrine tumours in the guinea pig.

Functional endocrine tumours have long been thought to be rare in guinea pigs, although conditions such as hyperthyroidism and hyperadrenocorticism have been documented with increasing frequency so the prevalence of hormonal disorders may have been underestimated. Both the clinical signs and diagnosis of hyperthyroidism in guinea pigs appear to be very similar to those described in feline hyperthyroidism, and methimazole has been proven to be a practical therapy option. Hyperadrenocorticism has been confirmed in several guinea pigs with an adrenocorticotropic hormone stimulation test using saliva as a non-invasive sample matrix; trilostane has been successfully used to treat a guinea pig with hyperadrenocorticism. Insulinomas have only rarely been documented in guinea pigs and one animal was effectively treated with diazoxide.

Use of a Nitinol Wire Stent for Management of Severe Tracheal Stenosis in an Eclectus Parrot (Eclectus roratus).

A 25-year-old, female eclectus parrot (Eclectus roratus) presented for dyspnea 3 weeks after anesthesia and surgery for egg yolk coelomitis. Radiography, computed tomography, and tracheoscopy revealed multiple tracheal strictures spanning a length of 2.6 cm in the mid to distal trachea. Histopathologic examination revealed mild fibrosis, inflammation, and hyperplasia consistent with acquired tracheal strictures. Tracheal resection was not considered possible because of the length of the affected trachea. The strictures were resected endoscopically, and repeated balloon dilation under fluoroscopic guidance over the course of 10 months resulted in immediate but unsustained improvement. Computed tomography was used to measure the stenotic area. A 4 × 36-mm, custom-made, nitinol wire stent was inserted into the trachea under fluoroscopic guidance. After stent placement, intermittent episodes of mild to moderate dyspnea continued, and these responded to nebulization with a combination of saline, acetylcysteine, and dexamethasone. Multiple attempts to wean the patient off nebulization therapy and to switch to a corticosteroid-free combination were unsuccessful. The parrot eventually developed complications, was euthanatized, and necropsy was performed. Histologically, the tracheal mucosa had widespread erosion to ulceration, with accumulation of intraluminal exudate and bacteria, severe degeneration of skeletal muscle and tracheal rings, prominent fibrosis, and mild to moderate, submucosal inflammation. Clinicopathologic findings in this case suggested tracheomalacia, which has not been previously described in birds. Custom-made tracheal stents can be used for severe tracheal stenosis in birds when tracheal resection and anastomosis is not possible. Complications of tracheal stent placement in birds may include tracheitis and tracheomalacia. To our knowledge, this is the first report of tracheal stent placement in an avian species.

Diagnostic quality of percutaneous fine-needle aspirates and laparoscopic biopsy specimens of the liver in rabbits (Oryctolagus cuniculus).

OBJECTIVE: To evaluate diagnostic quality of liver percutaneous ultrasound-guided fine-needle aspirates and laparoscopic biopsy specimens of rabbits (Oryctolagus cuniculus). DESIGN: Prospective descriptive study. ANIMALS: 7 healthy adult rabbits. PROCEDURES: 3 to 5 liver fine-needle aspirates were obtained with a 22-gauge needle under ultrasound guidance in anesthetized rabbits. Liver biopsy specimens were also obtained with 1.7-mm (n = 2) or 3.0-mm (1) biopsy forceps by direct laparoscopic observation. Fine-needle aspirates were cytologically evaluated on a scale from 0 (suboptimal specimen) to 3 (optimal specimen) for cellularity, cell distribution, cell preservation, cell morphology, and blood contamination. Biopsy specimens were histologically evaluated on a scale from 0 (optimal specimen) to 5 (suboptimal specimen) for artifactual changes; numbers of portal triads and central veins were quantified. RESULTS: Aspirates were moderately to highly cellular (mean, 2.54) with good cell distribution (mean, 2.56), good cell preservation (mean, 2.20), and moderate blood contamination (mean, 1.04). The 1.7-mm biopsy specimens had a mean score of 1.3 for artifactual changes and contained a mean of 0.6 portal triads and 1.6 central veins/biopsy specimen. The 3.0-mm liver biopsy specimens had a mean score of 2.7 for artifactual changes, with a mean of 4.0 portal triads and 4.14 central veins/biopsy specimen. All but one 3.0-mm liver biopsy specimen had ≥ 1 portal triad suitable for histologic evaluation, and all had ≥ 1 central vein; in contrast, only half of the 1.7-mm liver biopsy specimens had a discernible portal triad or central vein. CONCLUSIONS AND CLINICAL RELEVANCE: For histologic evaluation, advantages of obtaining 3.0-mm liver biopsy specimens, compared with 1.7-mm liver biopsy specimens or fine-needle aspirates, should be considered in rabbits with suspected liver disease.

Prescription diets for rabbits.

Dietary management can be used with drug therapy for the successful treatment of many diseases. Therapeutic nutrition is well-recognized in dogs and cats and is beginning to increase among other pet species, including rabbits. The nutritional component of some rabbit diseases (eg, urolithiasis) is not completely understood, and the clinician should evaluate the use of prescription diets based on the scientific literature and individual needs. Long-term feeding trials are needed to further evaluate the efficacy of prescription diets in rabbits. Prescription diets are available for selected diseases in rabbits, including diets for immediate-term, short-term, and long-term management.

Antemortem Diagnosis and Successful Treatment of Pulmonary Candidiasis in a Sun Conure (Aratinga solstitialis).

An adult male sun conure (Aratinga solstitialis) was evaluated because of lethargy, ruffled feathers, and decreased appetite. Physical examination revealed hypothermia, dehydration, dyspnea, and crop distention. Results of a complete blood cell count revealed a marked inflammatory leukogram, and cytologic examination of a crop swab sample identified gram-negative bacilli and occasional yeast organisms. Radiographs demonstrated an opaque, ill-defined, soft tissue structure in the caudal coelom just cranial to the renogonadal silhouette, loss of serosal detail, and splenomegaly. Endoscopic examination revealed a pale, granuloma-like structure within the caudal aspect of the left lung, splenomegaly, and an enlarged proventriculus. Intraoperative cytologic examination of a biopsy sample of the lesion demonstrated yeast organisms, and a subsequent culture of the biopsy sample revealed Candida albicans . The bird was treated intraoperatively with intralesional amphotericin B. Postoperative treatment consisted of meloxicam, trimethoprim sulfa, amphotericin B by nebulization, and systemic itraconazole and fluconazole. The bird made a complete recovery, was discontinued from all medications, and has remained asymptomatic for 6 months. Although rare, pulmonary candidiasis should be on the list of differential diagnoses for any respiratory infection in birds. Endoscopic biopsy, cytology, and fungal culture were valuable in making the diagnosis.