Accuracy evaluation of two portable blood glucose meters in feline patients using whole blood samples / Avaliação da acurácia de dois glicosímetros portáteis em amostras de sangue total de pacientes felinos

ABSTRACT: Using portable blood glucose meters (PBGMs) to measure blood glucose (BG) concentration is a common procedure in veterinary practice. Our objective was to evaluate the analytical and clinical accuracy of a human PBGM (Accu-Chek Performa®), (AC) and a veterinary PBGM (GlucoCalea®), (GC) in feline patients. Central venous blood samples were collected from 48 cats at a Brazilian Veterinary teaching hospital. Two devices from each model were used and compared to a reference method (RM). Analytical accuracy was assessed according to ISO 15197:2013 requirements for human PBGMs. Data were compared using Wilcoxon's nonparametric test and represented by Bland-Altman plots. Hematocrit's effect on BG measurements was evaluated by the Spearman correlation coefficient. Clinical accuracy was determined using error grid analysis (EGA). Values of BG were significantly higher in all PBGMs compared to the RM. Although ISO's analytical accuracy requirements could not be met by any of the devices, AC meters were more accurate than GC meters. All AC measurements - but not GC ones - were within zones A and B of the EGA, meeting ISO requirements for clinical accuracy. Significant hematocrit interference was observed in all devices. Therefore, AC showed greater accuracy compared to GC using feline whole blood samples.

RESUMO: O uso de glicosímetros portáteis (GPs) para aferição da glicemia é um procedimento comum na rotina clínica veterinária. O objetivo deste trabalho é avaliar a acurácia analítica e clínica de um GP humano (Accu-Chek Performa®), (AC) e um GP veterinário (GlucoCalea®), (GC) em gatos. Amostras de sangue venoso central foram coletadas de 48 gatos atendidos em um hospital veterinário-escola no Brasil. Foram utilizados dois GPs de cada modelo e comparados a um método de referência (MR). A acurácia analítica foi avaliada de acordo com os requisitos estipulados pela ISO 15197:2013 para GPs de uso humano. Os dados foram comparados pelo teste não-paramétrico de Wilcoxon e representados em gráficos de Bland-Altman. O efeito do hematócrito sobre os valores de glicemia foi avaliado pelo coeficiente de correlação de Spearman. A acurácia clínica foi avaliada pela análise da grade de erros (AGE). Em comparação com o MR, os valores de glicemia foram maiores em todos os GPs avaliados. Nenhum deles atendeu aos requisitos da ISO quanto à acurácia analítica, mas o AC mostrou-se mais acurado que o GC. Todos os valores de glicemia obtidos pelos GPs humanos - mas não pelos GPs veterinários - estiveram dentro das zonas A e B da AGE, demonstrando acurácia clínica de acordo com as exigências da ISO. A interferência do hematócrito da amostra mostrou-se significativa em todos os aparelhos testados. Portanto, o AC apresentou maior acurácia quando comparado ao GC em amostras de sangue total em felinos.

Accuracy evaluation of two portable blood glucose meters in feline patients using whole blood samples / Avaliação da acurácia de dois glicosímetros portáteis em amostras de sangue total de pacientes felinos

Using portable blood glucose meters (PBGMs) to measure blood glucose (BG) concentration is a common procedure in veterinary practice. Our objective was to evaluate the analytical and clinical accuracy of a human PBGM (Accu-Chek Performa®), (AC) and a veterinary PBGM (GlucoCalea®), (GC) in feline patients. Central venous blood samples were collected from 48 cats at a Brazilian Veterinary teaching hospital. Two devices from each model were used and compared to a reference method (RM). Analytical accuracy was assessed according to ISO 15197:2013 requirements for human PBGMs. Data were compared using Wilcoxon's nonparametric test and represented by Bland-Altman plots. Hematocrit's effect on BG measurements was evaluated by the Spearman correlation coefficient. Clinical accuracy was determined using error grid analysis (EGA). Values of BG were significantly higher in all PBGMs compared to the RM. Although ISO's analytical accuracy requirements could not be met by any of the devices, AC meters were more accurate than GC meters. All AC measurements - but not GC ones - were within zones A and B of the EGA, meeting ISO requirements for clinical accuracy. Significant hematocrit interference was observed in all devices. Therefore, AC showed greater accuracy compared to GC using feline whole blood samples.

O uso de glicosímetros portáteis (GPs) para aferição da glicemia é um procedimento comum na rotina clínica veterinária. O objetivo deste trabalho é avaliar a acurácia analítica e clínica de um GP humano (Accu-Chek Performa®), (AC) e um GP veterinário (GlucoCalea®), (GC) em gatos. Amostras de sangue venoso central foram coletadas de 48 gatos atendidos em um hospital veterinário-escola no Brasil. Foram utilizados dois GPs de cada modelo e comparados a um método de referência (MR). A acurácia analítica foi avaliada de acordo com os requisitos estipulados pela ISO 15197:2013 para GPs de uso humano. Os dados foram comparados pelo teste não-paramétrico de Wilcoxon e representados em gráficos de Bland-Altman. O efeito do hematócrito sobre os valores de glicemia foi avaliado pelo coeficiente de correlação de Spearman. A acurácia clínica foi avaliada pela análise da grade de erros (AGE). Em comparação com o MR, os valores de glicemia foram maiores em todos os GPs avaliados. Nenhum deles atendeu aos requisitos da ISO quanto à acurácia analítica, mas o AC mostrou-se mais acurado que o GC. Todos os valores de glicemia obtidos pelos GPs humanos - mas não pelos GPs veterinários - estiveram dentro das zonas A e B da AGE, demonstrando acurácia clínica de acordo com as exigências da ISO. A interferência do hematócrito da amostra mostrou-se significativa em todos os aparelhos testados. Portanto, o AC apresentou maior acurácia quando comparado ao GC em amostras de sangue total em felinos.

Approach to classification of cavitary effusion and comparison between manual and automatic methods for total nucleated cell count

Background: Two classifications are used to categorize cavitary effusions using total nucleated cell count (TNCC): protein concentration and pathophysiology of its formation. The aims of the present study were to evaluate the correlation between the TNCC values of cavitary effusions obtained in the automatic and the manual method, and also evaluating the classification methodology.Materials, Methods & Results: Cavitary effusions were analyzed for physical, chemical and cytological aspects, as well as manual and automatic cell counts for the correlation between the traditional methods and those suggested by Stockham & Scott. Bland-Altman regression and Spearman correlation analysis were performed. Of the total, 44 were abdominal effusions (73.3%), 15 thoracic (25%) and 1 pericardial (1.7%). According to the traditional classification, most of the effusions were classified as modified transudates (40%) and according to the classification of Stockham and Scott, as transudates poor in protein (31.7%). The correlation between cell counting techniques between pure, modified and exudate transudates was 0.94, 0.97 and 0.94, respectively, indicating an excellent correlation between the parameters (P = 0.95%).Discussion: Considering the concentration of proteins and CCNT, the effusions classified as modified transudate were mainly caused by neoplastic processes (carcinomas/adenocarcinomas), since there are several mechanisms of their formation, such as large variation of protein concentration. According to the Stockham & Scott classification a unique classification is considered for exfoliative neoplastic effusions, the variation of the protein concentration of the effusion does not alter its classification. In neoplastic effusions, classified as exudates, lymphomas were the most prevalent, and hypercellularity (approximately 150,000 cells / μL) allowed this classification.[...]

Approach to classification of cavitary effusion and comparison between manual and automatic methods for total nucleated cell count

Background: Two classifications are used to categorize cavitary effusions using total nucleated cell count (TNCC): protein concentration and pathophysiology of its formation. The aims of the present study were to evaluate the correlation between the TNCC values of cavitary effusions obtained in the automatic and the manual method, and also evaluating the classification methodology.Materials, Methods & Results: Cavitary effusions were analyzed for physical, chemical and cytological aspects, as well as manual and automatic cell counts for the correlation between the traditional methods and those suggested by Stockham & Scott. Bland-Altman regression and Spearman correlation analysis were performed. Of the total, 44 were abdominal effusions (73.3%), 15 thoracic (25%) and 1 pericardial (1.7%). According to the traditional classification, most of the effusions were classified as modified transudates (40%) and according to the classification of Stockham and Scott, as transudates poor in protein (31.7%). The correlation between cell counting techniques between pure, modified and exudate transudates was 0.94, 0.97 and 0.94, respectively, indicating an excellent correlation between the parameters (P = 0.95%).Discussion: Considering the concentration of proteins and CCNT, the effusions classified as modified transudate were mainly caused by neoplastic processes (carcinomas/adenocarcinomas), since there are several mechanisms of their formation, such as large variation of protein concentration. According to the Stockham & Scott classification a unique classification is considered for exfoliative neoplastic effusions, the variation of the protein concentration of the effusion does not alter its classification. In neoplastic effusions, classified as exudates, lymphomas were the most prevalent, and hypercellularity (approximately 150,000 cells / μL) allowed this classification.[...](AU)

Dilated cardiomyopathy in a fila brasileiro with hypothyroidism secondary to lymphocytic thyroiditis

Background: Hypothyroidism is a common disease in middle-aged purebred dogs and is characterized by reduced plasma concentrations of thyroid hormones. These hormones have important modulatory effects on myocardial chronotropism and inotropism, and when heart disease is linked to hypothyroidism, disease progression may be accelerated. Dilated cardiomyopathy (DCM) often occurs in association with hypothyroidism. However, an etiologic contribution of lower thyroid hormone concentrations towards the development and progression of DCM is still unclear. The aim of this study was to describe a case of DCM in a Fila Brasileiro dog with hypothyroidism secondary to lymphocytic thyroiditis. Case: A male, 11-year-old Fila Brasileiro dog was referred to the Division of Endocrinology and Metabolism of the Veterinary Clinical Hospital of the Universidade Federal do Rio Grande do Sul due to keratoconjunctivitis sicca, weight gain, apathy, and hyporexia. A primary diagnosis of hypothyroidism was made based on clinical features of hypothermia (37.8C), bradycardia (78 bpm) with bradysphygmia, facial myxedema, bilaterally symmetrical alopecia, and hyperpigmentation of the skin with tail involvement associated with normocytic hypochromic anemia (RBC 4.76 x106/mm3, Ht = 29% and Hb = 9.2 g/dL), reduced concentration of biphasic free T4 (0.22 ng/mL - reference value 0.62 - 3.11 ng/mL) and high level...

Dilated cardiomyopathy in a fila brasileiro with hypothyroidism secondary to lymphocytic thyroiditis

Background: Hypothyroidism is a common disease in middle-aged purebred dogs and is characterized by reduced plasma concentrations of thyroid hormones. These hormones have important modulatory effects on myocardial chronotropism and inotropism, and when heart disease is linked to hypothyroidism, disease progression may be accelerated. Dilated cardiomyopathy (DCM) often occurs in association with hypothyroidism. However, an etiologic contribution of lower thyroid hormone concentrations towards the development and progression of DCM is still unclear. The aim of this study was to describe a case of DCM in a Fila Brasileiro dog with hypothyroidism secondary to lymphocytic thyroiditis. Case: A male, 11-year-old Fila Brasileiro dog was referred to the Division of Endocrinology and Metabolism of the Veterinary Clinical Hospital of the Universidade Federal do Rio Grande do Sul due to keratoconjunctivitis sicca, weight gain, apathy, and hyporexia. A primary diagnosis of hypothyroidism was made based on clinical features of hypothermia (37.8C), bradycardia (78 bpm) with bradysphygmia, facial myxedema, bilaterally symmetrical alopecia, and hyperpigmentation of the skin with tail involvement associated with normocytic hypochromic anemia (RBC 4.76 x106/mm3, Ht = 29% and Hb = 9.2 g/dL), reduced concentration of biphasic free T4 (0.22 ng/mL - reference value 0.62 - 3.11 ng/mL) and high level...(AU)

Acidente ofídico em um cão - relato de caso / g - case report

As serpentes peçonhentas dos gêneros Bothrops (jararacas), Micrurus (corais), Crotalus (cascavéis) e Lachesis (surucucus) são as mais importantes em acidentes ofídicos no Brasil. A maior incidência destes acidentes na Medicina Veterinária é causada por serpentes do gênero Bothrops. Os cães são altamente suscetíveis a acidentes botrópicos devido ao seu comportamento curioso, e os locais comumente atingidos no ataque da serpente são o focinho e o pescoço. Cães e gatos são geralmente tratados algumas horas após a picada, quando os sintomas já são bem evidentes. Devido à atividade proteolítica, hipotensora e coagulante do veneno, o tratamento imediato é um fator decisivo para o prognóstico do paciente. O objetivo deste resumo é descrever o caso de um acidente ofídico em um cão atendido em hospital universitário.(AU)

Coagulação intravascular disseminada após parada cardíaca / Disseminated intravascular coagulation after cardiac arrest

Foi demonstrado em estudos com animais que uma ativação da coagulação sanguínea e alterações que indicam CID podem ser encontradas em leitos capilares após uma parada cardíaca e ressuscitação cardiopulmonar (RCP). Este resumo tem como objetivo relatar o caso e as alterações laboratoriais apresentadas por um cão que após uma parada cardíaca durante procedimento cirúrgico e RCP desenvolveu um quadro de CID.(AU)

Coagulação intravascular disseminada após parada cardíaca / Disseminated intravascular coagulation after cardiac arrest

Foi demonstrado em estudos com animais que uma ativação da coagulação sanguínea e alterações que indicam CID podem ser encontradas em leitos capilares após uma parada cardíaca e ressuscitação cardiopulmonar (RCP). Este resumo tem como objetivo relatar o caso e as alterações laboratoriais apresentadas por um cão que após uma parada cardíaca durante procedimento cirúrgico e RCP desenvolveu um quadro de CID.

Acidente ofídico em um cão - relato de caso / g - case report

As serpentes peçonhentas dos gêneros Bothrops (jararacas), Micrurus (corais), Crotalus (cascavéis) e Lachesis (surucucus) são as mais importantes em acidentes ofídicos no Brasil. A maior incidência destes acidentes na Medicina Veterinária é causada por serpentes do gênero Bothrops. Os cães são altamente suscetíveis a acidentes botrópicos devido ao seu comportamento curioso, e os locais comumente atingidos no ataque da serpente são o focinho e o pescoço. Cães e gatos são geralmente tratados algumas horas após a picada, quando os sintomas já são bem evidentes. Devido à atividade proteolítica, hipotensora e coagulante do veneno, o tratamento imediato é um fator decisivo para o prognóstico do paciente. O objetivo deste resumo é descrever o caso de um acidente ofídico em um cão atendido em hospital universitário.