Steroid-responsive meningitis-arteritis (SRMA) is a relatively common immune-mediated disease usually affecting young dogs, which, as its name suggests, responds well to steroid treatment. However, the length of treatment required is uncertain.
Six months is usually recommended in order to avoid relapse from withdrawing treatment too quickly, but this can lead to significant adverse effects from the medication.
Rose et al1 performed a prospective randomised study to assess whether remission and relapse rates were different if steroids were given for six weeks or six months. Forty-four cases were included in the study and were followed for 12 months. All cases responded well to treatment.
30% of cases on the six-month protocol relapsed, compared to 38% on the six-week protocol. No significant difference was reported in the incidence:relapse ratio between the two groups.
The authors concluded that a short, six-week protocol can be used to treat SRMA, which should lead to a reduction in adverse effects from treatment.
Effect of three compounds on CKD
Chronic kidney disease (CKD) is a common condition of older dogs and cats, but treatment options are limited.
Fucoidan is a polysaccharide extracted from brown algae, and fucoxanthin is a carotenoid that is also abundant in brown algae. L-carnitine is an amino-acid obtained from dietary sources or synthesised in the liver and kidney. All three of them have a variety of reno-protective properties, such as anti-inflammatory and anti-fibrotic effects. However, their effect on CKD has not been evaluated.
Hong et al2 performed a retrospective study of 50 dogs, 28 of which received the three compounds, and 22 were controls. A significant difference was noted between serum urea and creatinine concentrations after six months, but no difference in electrolytes.
The authors concluded that this combination of supplements has a reno-protective effect that might delay the progression of CKD if used as an adjuvant treatment.
LDDST result patterns
The low-dose dexamethasone suppression test (LDDST) is often used in the diagnosis of hyperadrenocorticism in dogs.
Rebelo et al3 performed a retrospective cross-sectional study to assess the frequency of different patterns of LDDST findings in patients, with clinical and laboratory findings suggestive of hyperadrenocorticism.
One hundred and twenty-eight dogs were included in the study, and their LDDST results were classified according to the various patterns (with proportion observed in brackets) of complete suppression (39%), lack of suppression (31%), partial suppression (14%), escape (10%) and inverse patterns (6%
Clinical signs, serum alkaline phosphatase (ALP), urine specific gravity (USG) and adrenal ultrasound findings were also recorded.
No association was found between the LDDST pattern and the clinical signs, ALP, USG or ultrasound findings.
In all the cases where complete suppression or an inverse pattern was found, a diagnosis of hyperadrenocorticism was excluded by the attending veterinarian. The diagnosis was also excluded without further testing in some of the cases that showed escape, a lack of suppression or a partial suppression.
The authors concluded that the clinical significance of LDDST patterns – especially escape and inverse patterns – are often misinterpreted by clinicians, and hyperadrenocorticism may be inappropriately excluded.
Efficacy and safety of amiodarone and sotalol
Amiodarone and sotalol are frequently used to treat ventricular and supraventricular tachyarrhythmias in dogs (VT; SVT). However, little published evidence exists on their efficacy and safety.
Romito et al4 performed a retrospective study of 64 dogs to examine the use of amiodarone or sotalol as a first-line treatment in dogs with VT or SVT. Treatment of VT was considered to be efficacious if the Lown-Wolf grade (a grading system for ventricular arrhythmias) decreased to less than five, or a reduction of at least 85% was recorded in the number of ventricular premature complexes on Holter monitoring.
Efficacy of SVT was judged by cardioversion or a decrease in mean heart rate to less than 140 beats per minute. Both amiodarone and sotalol were found to be efficacious in both the treatment of VT (86% and 90% of cases, responding respectively) and SVT (75% and 71% of cases, responding respectively). Clinically important adverse effects were noted in less than 10% of cases for both drugs.
The authors concluded that amiodarone and sotalol are both generally effective and safe in the treatment of tachyarrhythmias.
Tick paralysis and ocular issues
In certain parts of the world, tick paralysis is a common condition caused by a reaction to the saliva of the tick Ixodes holocyclus. Among other issues, this can cause ocular problems because of the loss of the palpebral reflex.
Reynolds et al5 performed a retrospective cohort study of 102 dogs and 100 cats that had been previously hospitalised because of tick paralysis. 23% of dogs developed corneal ulceration during hospitalisation, which was strongly associated with an ipsilateral loss of the palpebral reflex. The need for mechanical ventilation and a cranial location of the tick were also associated with ulceration.
28.4% of hospitalised dogs had an incomplete palpebral reflex, which was associated with lower bodyweight. A strong association between complete loss of palpebral reflex and mortality was noted.
Corneal ulcers occurred in 10% of cats, which was also associated with loss of palpebral reflex, but a complete loss of the reflex was not associated with mortality in this species.
The authors noted that corneal ulcers and loss of palpebral reflexes are common in dogs and cats hospitalised for tick paralysis.
Bacterial isolates and infection prevention in a hospital
Infection prevention and control (IPC) is of increasing importance in human and veterinary medicine in light of the increase in antimicrobial resistance.
Sasaoka et al6 performed a retrospective longitudinal study to describe the changes in bacterial isolates and drug resistance after an IPC programme was instituted in a hospital.
Changes instituted included forming an IPC task force, education and improvement in infrastructure. The number of total and multi-drug resistant isolates decreased after institution of the programme, and the COVID-19 pandemic did not affect the changes. Self-reported hand hygiene practices improved.
The authors concluded that instituting an IPC programme can reduce bacterial isolates including those with multi-drug resistance in the long term.
Emesis induction in small animals
Institution of emesis is often required in small animal medicine, usually because of ingestion of a toxin or other undesirable matter. However, it is not always possible to achieve emesis with chemical methods.
Chan et al7 performed a prospective randomised study to assess whether the use of abdominal thrusts in combination with intravenous apomorphine could improve the success rate of emesis induction.
Thirty-one dogs that had been prescribed emesis by the attending clinician were included in the study. Each was given intravenous apomorphine and then randomised to either receive abdominal thrusts or no physical intervention. All 14 dogs that received apomorphine and abdominal thrusts had emesis induced successfully, compared to 77% that had apomorphine only.
The authors noted that abdominal thrusts may aid in the induction of emesis in cases where it is not contraindicated.
- Use of some of the drugs mentioned in this article is under the veterinary medicine cascade.
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