Misc. Articles Flashcards

Question

Detection of nephrocalcinosis using ultrasonography, micro-computed tomography, and histopathology in cats - Tang 2024 (JVIM)

Answer 1

US - absent 3, suspected 3, present 5. Macro-VN:KT - .001%, .001%, and .019%. Macro-AN:KT - 0.08%, 0.30%, 1.47%. Histo VK-micro-AN:KT - 0.21%, 2.85%, and 4.56%. Histo AR-micro-AN:KT - 1.73%, 5.82%, and 8.9%. Strong correlation b/t macroscopic + microscopic nephrocalcinosis. **AUS-diagnosed nephrocalcinosis correlates well w/ macroscopic and microscopic nephrocalcinosis at necropsy despite time separation.**

Answer 2

US nephrocalcinosis in 61% CKD cats (81% in hypercalcemic). Higher iCa (OR 1.27), phosphate (1.16), Cr (1.29), and ALT (2.08) were nephrocalcinosis risk factors. Rate of change in FGF-23 differed sig. b/t groups - CKD and nephrocalcinosis cats had inc. Cr (.03) and phosphate (.06) and dec. BW (.02). **Nephrocalcinosis prevalent in CKD cats, esp. hypercalcemic. Appears associated w/ CKD prog.**

Answer 3

< 18 months. Breeds - FBs (22.8%), Pugs (8%), MBD (5.4%), and EB (4.9%). Vertebral malformation (18.8%), arachnoid diverticulum (12.5%), fracture (9.8%), AA-I (8.0%), and osseous-assosciated cervical spondylomyelopathy (7.6%). IVD - 4.5%. VM associated w/ younger, screw-tailed, and Pug breeds w/ no pain. SAD associated w/ screw-tailed and Pug breeds w/ no pain. IVD associated w/ older, screw-tailed and Pug breeds w/ shorter duration of CS. **DDX for dogs < 18 months should differ from older dogs, with IVD not the most common cause in younger.**

Answer 4

FQs most freq. prescribed WHO-CIA class in dogs (32.9%) and cats (42.7%). No carbapenems, dihydrofolate reductase inhibitors/sulfonamides, or polymyxins. No cats prescribed aminoglycosides or amphenicols. Institutional guidelines followed in 57.8% cases. Most freq. causes of nonadherence were failure to perform C+S (46%) and unnecessary use of higher tier (43%). C+S more freq. performed after guideline institution (59.7% vs 46.8%). **Adherence remained poor despite inc. C+S. No changes in freq. of confirmed infections, positive cultures, or AMD resistance b/t time periods.**

Answer 5

Median vinc dose for both groups (<15 kg and >15 kg) was 0.6 mg/m2. 17 neutropenia episodes (12.3%) w/ no diff. in freq. or grade b/t groups. 30 substage A dogs (29.4%) experienced GI SFX but statistical comparison could not be performed d/t use of GI supportive meds. 7 instances of hospitalization (5%) and risk of hospitalization did not differ b/t groups. **Vincristine dosed ~ 0.6 mg/m2 did not inc. risk of hematologic SFX in dogs < 15 kg.**

Answer 6

27 HN0, 19 HN1, 37 HN2, and 11 HN3 SLN. 13 (2 HN0, 4 HN2, and 7 HN3) received adjuvant chemo. Kiupel high grade, inc. number of SLN, and lymphocentrums associated w/ higher HN classes. 5 dogs died from MCT-related causes: 1 low-grade (HN0) and 1 SQ (HN3) had local relapse, 2 high-grade had distant relapse (HN3-HN0), and 1 developed disease prog. from de novo SQ MCT. No nodal relapse. 14 dogs developed de novo MCTs. **Low grade/low-risk MCT w/ nonpalpable and normal sized LN have favorable outcome independently from HN. Result should be considered strictly related to successful SLN detection guided pre- and intraoperative by radiopharmaceutical markers.**

Answer 7

No sig. diff. in demographic characteristics b/t 2 groups (BC < 6 and > 6). High COR had sig. lower response to chemotherapy, PFS, and OS compared w/ normal COR group. ALP sig. higher in high COR group. Adrenal gland size sig. larger in high COR group. No sig. diff. in rate of P-gp-positive cells b/t 2 groups, but rate of GCR-pos cells sig. lower in high COR group. **Measurement of serum COR may serve as prognostic factor and evaluation index (hypothesized high COR downreg. glucocorticoid receptor and dec. sensitivity to chemo.**

Answer 8

No sig. diff. in LVIDDN and LA:Ao b/t CKCS w/ or w/o syringomyelia. CKCS w/ symptomatic syringomyelia had sig. smaller LVIDDN (1.45) and LA:Ao (1.20) compared to CKCS w/ asymptomatic syringomyelia (1.60 and 1.40) and without syringomyelia (0.24 and 0.3). **Association b/t MMVD + SM not confirmed in this cohort of CKCS, indicating that MMVD + SM do not co-segregate. CKCS w/ symptomatic SM had smaller LV and atrial size compared to other groups.**

Answer 9

Amlodipine associated w/ inc. markers of plasma renin (med. 44% increase), angiotensin I (59% increase), angiotensin II (56% increase), angiotensin IV (42% increase), and angiotensin 1-7 (38% increase). **In healthy cats, amlodipine resulted in nonspecific activation of both classical and alternative RAAS pathways.**

Answer 10

Confirmed or likely hypothyroid - 38.2%, 48%, 55.9%. Hypothyroidism suspected but not confirmed - 5.9%, 22.6%, 11.8%. Hypothyroidism considered unlikely - 3.9%, 22.6%, 13.7%. No reason to suspect hypothyroidism - 52%, 6.9%, 18.6%. Clinician 1, 2, and 3 considered levothyroxine not indicated in 58.5%, 52.9%, and 45.1% respectively. **Support concern that hypothyroidism overly and incorrectly diagnosed in first opinion practice, and that thyroid function testing should be performed only in those dogs w/ high pretest probability of disease.**

Answer 11

Median time to HPA axis recovery ~ 3 days (2-133 days). Dose and duration of treatment not correlated w/ timing of HPA recovery. ALT and ALP sig. correlated w/ post-ACTH cortisol conc. (r = -0.34 and -0.31). Endogenous ACTH sig. correlated with pre (r = 0.72) and post-ACTH cortisol conc (r = 0.35). Timing of HPA recovery not diff. for dogs with EOD tapering vs those that did not. **Most dogs experienced HPA recovery w/in a few days but 2/20 required > 8 weeks.**

Answer 12

No sig. diff. for hospitalization time (57 h DEX vs 48 h HC) nor case fatality (2/28 in DEX and 0/11 in HC) nor # of electrolyte measurements (DEX 4.5 vs HC 4). No sig. diff. b/t groups in time to normalization of Na (DEX 16 h vs HC 33 h), K (DEX 16 h vs HC 17 h), or Na:K (DEX 26 h vs HC 17 h). **No diff. in outcomes for dogs in adrenal crisis treated with either DEX boluses or HC CRI.**

Answer 13

LC-MS/MS method showed good linearity (r2 = 0.99) and precision (CoV < 10%) w/ RI 8.0 - 14.0 mcg/dL. Median SDMA were 9.4 using LC-MS/MS and 12.0 using ELISA. Both methods sig. diff. w/ mean diff. 2.2 mcg/dL. RI for older dogs for LC-MS/MS was 4.4 - 15.0, and for ELISA was 6.4 - 17.4. **ELISA provided sig. higher SDMA conc. compared to validated LC-MS/MS, indicating need for device or assay-specific RI. Obtained age-specific RI for SDMA considerably higher in older dogs compared to general lab RI.**

Answer 14

6 clusters - primary HTG dispersed among 4 clusters. 1 cluster had highest intensities for triglyceride-rich lipoproteins and LDL fractions and also included 4 dogs with secondary HTG. Two clusters had mod. high TRL fraction intensities and low-to-intermed. LDL intensities. Fourth cluster had high LDL but variable TRL fraction intensities with equal # NTG and mild HTG dogs. Final 2 clusters only NTG dogs w/ low TRL intensities and low-to-intermed. LDL intensities. Clusters did not appear driven by diff. in clinical data. **Spectrum of lipoprotein phenotypes w/in Mini Schnauzers that cannot be predicted by triglyceride conc. alone. Lipoprotein profiling might be useful to determine if subtypes have diff. origins, clinical consequences, and response to TX.**

Answer 15

29/824 (3.5%) with hyperglycemia developed ITDM, including 3/824 (0.4%) with mod. hyperglycemia > 144 and 2/824 (0.2%) with marked hyperglycemia > 200. Among dogs that eventually needed insulin, no assoc. b/t degree of hyperglycemia and time interval b/t documentation of hyperglycemia and diagnosis of ITDM. Logistic regression determined that BGC not sig. assoc. w/ ITDM. **Most dogs w/ randomly identified hyperglycemia did not develop need for exogenous insulin. Other criteria could be required to augment definition of overt DM in non-insulin TX dogs (prev. suggested BG > 144).**

Answer 16

cPLI > 400 - median CRP (111.9), MCAI (10), and OH (4/10). cPLI < 400 - median CRP (58), MCAI (6), and OH (6/10). Not sig. diff. b/t groups. 4/5 in cPLI < 400 had HX of susp. panc. cPLI + MCAI rapidly dec. in dogs w/ baseline cPLI > 400, whereas US evidence of panc. persisted for longer. **US evidence of panc. in absence of clinical or biochemical abnormalities may represent resolving injury rather than active disease.**

Answer 17

8 miRNAs sig. diff. in dogs w/ panc. 4 mapped to canine genome (221, 222, 23a, 205). 3 mapped to murine genome (484, 6240, 101a-3p). 1 mapped to human genome (1290). Expression in dogs w/ panc. was higher for 7 and lower for 101a-3p. Qiagen IPA demonstrated a number of diff. expressed miRNA involved in common panc. inflamm. pathway. **Sig. diff. expressed miRNA represent promising candidates for further validation as diagnostic biomarkers for canine panc.**

Answer 18

Med. age ~ 5.4 years. 30% DSH + 12% DLH; most prevalent pedigree were Ragdolls (25%), Exotic Shorthair (10%), and Persian (8%). Med. duration CS ~ 90 days - weight loss (60%), hyporexia (55%), vomiting (37%), lethargy (35%), diarrhea (27%). Masses in SI (32%), stomach (27%), ICJ (15%), colon (10%), LN (8%), and mesentery (8%). 15% had > 1 mass. Eosinophilia - 50%. HypoAlb - 28%. Surgery - 37%. Steroids - 98%. Survival not diff. b/t surgery or medical therapy alone. Survival - 88%. **Important DDX for ab masses in cats, and has much better prog. than previously reported.**

Answer 19

No definitive diagnostic test. pITP had lower PLT, D-dimers, and PLT membrane protein expression than sITP. Diff. further enhanced using logistic regression modeling - second model of pITP severity indicated low HCT and high BUN associated w/ non-survival. Low HCT at admission but not PLT or DOGiBAT associated w/ transfusion. **Pending validation studies, models constructed from at-admission clinicopathologic findings may improve diff. of pITP/sITP and ID most severe pITP cases at presentation.**

Answer 20

Relapse rates at 12 months diff. sig. b/t disease groups. Higher rate for IMPA (35%) vs IMHA (11%) or ITP (11%). At 24 months - IMPA (41%), IMHA (18%), and ITP (23%). 90% IMPA relapses occurred in first ~ 12 months compared for 56% for IMHA and 50% for ITP. Vaccine admin. not associated w/ relapse. **Risk of IMPA relapse highest in first year, w/ higher relapse rate than IMHA/ITP. Role of vaccine in relapse remains unclear.**

Answer 21

Median TBili 1.73. Biliary obstruction in 7.9% with median TBili 9.69. Diff. sig. from those w/o obstruction (median 1.51). Optimal TBili cutoff 3.86 - TBili > 3.86 had Se 94.1%, Sp 82.4%.. As age inc. odds of BO inc. sig. (OR 1.20). **Severity of hyperbilirubinemia has potential to predict likelihood of BO and to discriminate from cats that may or may not need SX at suggested cutoff > 3.86. Alongside TBili, age also useful when assessing for likelihood of BO in cat presented w/ hyperbilirubinemia.**

Answer 22

73% survived to DX. 81% of survivors alive > 30 days and 75% alive at 6 months. Sig. higher in nonsurvivors - # body systems affected and median maxBili (21 vs 1.9). No sig. diff. in median maxBUN or maxCr. **Regardless of azotemia severity, dogs w/ AKI-L receiving RRT have good survival rate to discharge. # of body systems and hyperbilirubinemia may be associated w/ worse outcomes.**

Answer 23

Pos. mod. corr. b/t UPCR and DUR. Not influenced by active urine sediment, glucosuria, or urine pH. For canine samples w/ UPCR > 0.5, DUR 1.4 had Se 89%, Sp 83%, PPV 96%, NPV 63%. For feline samples w/ UPCR > 0.4, DUR 2.1 had Se 70%, Sp 100%, PPV 100%, NPV 75%. **DUR can be reliable method for ID of proteinuria, but given poor NPV should not be used for exclusion of proteinuric patients.**

Answer 24

UAG inversely correlated w/ UACR in healthy cats (r = -0.40) but not in cats w/ CKD (r = -0.15). A sig. diff. found b/t UAG in healthy cats and those w/ CKD. **UAG cannot be used as substitute for UACR in cats. Clinical relevance of UAG diff. b/t healthy cats + those w/ CKD remains unknown.**

Misc. Articles Flashcards

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