Veterinary Clinical Digest Summary

The Schirmer Tear Test (STT) diagnostic test is important for ophthalmologists and general practitioners to assess aqueous tear production. This study aimed to assess whether different results are obtained when the eyelids are open or closed. Thirty dogs - fifteen brachycephalic Shih Tzus and fifteen non-brachycephalic Labrador Retrievers - were included in the study. Each dog underwent two sessions of STT testing thirty minutes apart, with eyelids closed and open, with the order randomised. A survey was also performed to ascertain which technique ophthalmologists preferred. The STT values were significantly higher in the closed eyes for both breeds. In six cases where the eyelids were open, the STT strips were dislodged, but there were no instances of dislodgement in dogs with closed eyelids. The results of the survey of ophthalmologists were fairly evenly split between a preference for eyes closed, eyes open, or “never paid attention, sometimes open, sometimes closed.” The authors note that since it makes a significant difference whether the eyes are open or closed during STT testing, it is important that practitioners are consistent when applying the test.

STT results are higher when the eyelids are closed. Practitioners should consistently use the same technique when monitoring STT trends.

Veterinary Clinical Digest Summary

Although canine distemper virus (CDV) is encountered uncommonly in most areas of the UK due to the success of vaccination, significant reservoirs exist worldwide, both in dogs and other carnivores. This systematic review aimed to find studies that detected and sequenced CDV in Carnivora hosts. 160 published papers were included. 93.7% of host species belonged to the suborder Caniformia, with 75.2% Canidae, 9.7% Mustelidae and 7.6%  Procyonidae (the family which includes racoons). 6.1% of host species were of the suborder Feliformia, mostly wild Felidae. The authors list the genotypes most commonly detected, with the America-1 and Europe/South America-1 being the most widely distributed worldwide. The authors note that there is a very wide variety of hosts that can harbour CDV. However, 40% of cases were detected in domestic dogs and 30% in the red fox. There was evidence of constant spillover infections where domestic and wild hosts shared habitats.

Canine Distemper Virus remains common worldwide, and has a large variety of host reservoirs domestic and wild.

Veterinary Clinical Digest Summary

Another disease that is well-controlled by vaccination, although not to the same extent as CDV, is leptospirosis. This study aimed to examine risk factors for infection with Leptospira in dogs in New South Wales, Australia. Seventy-nine clinical cases of canine leptospirosis and sixteen healthy dogs that were seropositive to Leptospira were included in the study, and were compared to 394 healthy, seronegative controls from at-risk areas. A questionnaire was used to investigate factors that might contribute to acquiring the disease. Rat contact was found to increase the risk of clinical disease and seropositivity roughly fourfold. Herding dogs and Terriers were at greatly increased risk compared to other breeds, as were young adults compared to other ages. However, frequenting dog parks decreased the risk of contracting leptospirosis. The authors recommend environmental sampling to identify reservoirs of infection. Measures to reduce risk involve reducing contact with reservoir hosts and contaminated environments and improving pest control.

Terriers, herding dogs and dogs exposed to rats had an increased risk of leptospirosis.

Veterinary Clinical Digest Summary

Acute haemorrhagic diarrhoea syndrome (AHDS) is a disease of dogs characterised by sudden onset vomiting and haemorrhagic diarrhoea. The aetiology is uncertain but may involve bacterial or immune-mediated factors. This  retrospective study aimed to report the occurrence of neutropenia in dogs with this condition and assess whether this has an impact on survival. 54 dogs with suspected AHDS were included in the study. 52% of cases had neutropenia at presentation or during the course of the disease. 17% of dogs did not survive. 8 out of 28 dogs that had neutropenia did not survive, while only one dog without neutropenia did not survive. Dogs with neutropenia were more likely to fulfil the criteria for Systemic Inflammatory Response Syndrome (SIRS). However, there was no difference in hospitalisation length between neutropenic and nonneutropenic dogs. The authors conclude that neutropenia is common in dogs with AHDS, and that it is significantly associated with nonsurvival.

Neutropenia is common in AHDS and has prognostic significance.

Veterinary Clinical Digest Summary

Trauma is a common reason for cats to present to emergency services, especially due to incidents involving road traffic. This retrospective observational study aimed to assess whether the abdominal fluid score (AFS) in cats that had suffered trauma was of value in prognosis and in assessing the need for surgery and transfusion. 2,309 cats were included in the study, of which 148 had abdominal effusion on presentation, i.e. a positive AFS score. Cats with a positive AFS had lower plasma protein than cats without abdominal effusion, and also had a higher Animal Trauma Triage Score (ATTS). Cats with effusion were more likely to need a blood transfusion, but there was no difference in incidence of surgical intervention between cats with and without abdominal effusion. Presence of abdominal effusion was associated with higher mortality and an increased need for hospitalisation, but not length of hospitalisation.

The presence of abdominal effusion in cats that suffered from trauma was associated with higher mortality, higher need for blood transfusion and higher need for hospitalization.

Veterinary Clinical Digest Summary

Intravenous catheterisation is an essential part of medical treatment in emergency and non-emergency settings, but pain associated with the introduction of the cannula can make the procedure more challenging. This randomised controlled trial of 83 dogs and 18 cats aimed to assess whether a vapocoolant spray improved tolerance of intravenous catheterisation compared to lidocaine/prilocaine cream in dogs and cats. Subjects were randomised to have either the lidocaine/prilocaine cream applied one hour prior to catheterisation, or the vapocoolant spray immediately prior to the procedure. A blinded observer assessed a video of the procedure. There was a difference in reaction scores when the swab was applied in patients receiving the vapocoolant spray compared to the lidocaine/prilocaine cream. The vapocoolant spray also appeared to be less effective in reducing the adverse reactions to skin puncture in cats compared to the lidocaine/prilocaine cream.

There was no significant difference in adverse reactions between the two methods that aimed at improving tolerance of intravenous catheter placement, but the vapocoolant spray may be less effective than the lidocaine/prilocaine preparation in cats.

Veterinary Clinical Digest Summary

The words and terminology that clinicians use when conveying clinical information to owners can alter the reception of that information. This randomised cross-sectional study aimed to determine if canine caregivers’ treatment choices and anxiety levels were different when they were given information about papillary thyroid cancers that did or didn’t include the word cancer. 683 people were included in the study, and they ranked their preference for treatments of total thyroidectomy, active surveillance, medical therapy or radiotherapy following diagnoses reported as papillary thyroid cancer (PTC), thyroid papillary lesion (TPL) or abnormal cells (AC) in their pet. For a diagnosis of PTC, TPL or AC, 78.1%, 34.2% and 59.3% respectively reported being anxious or very anxious. Surgery as a first-choice treatment was chosen for PTC, TPL or AC by 71.8%, 39.8% and 53.8% of respondents respectively. By contrast, active surveillance was chosen by 24.5%, 57.5% and 43.9% of respondents respectively. The authors note that the terminology used when informing caregivers of a diagnosis of thyroid cancer influences both their level of anxiety and their choice of treatment.

Terminology used when presenting a diagnosis can alter client anxiety and treatment choices.

Veterinary Clinical Digest Summary

Kidney disease has many causes in dogs, but it is uncertain whether the underlying diagnosis has an effect on prognosis. This retrospective study aimed to determine the outcome for dogs with different categories of kidney disease diagnosed by biopsy. 649 dogs that had undergone biopsies to evaluate kidney disease were included in the study. The median survival time for all dogs was 608 days. Renal amyloidosis was associated with the shortest survival with a median survival time of just 76 days. However, dogs with podocytopathy, membranous glomerulonephritis (MGN), membranoproliferative glomerulonephritis (MGPN) and mixed MGN or mixed MGPN had a decreased risk of death. Increased age, serum creatine, urine protein:creatine ratio and a decreased serum albumin level were indicators of a poorer prognosis.

Diagnosis of underlying kidney disease affects prognosis, although the survival within diagnostic categories was very variable.

Veterinary Clinical Digest Summary

Why I chose this study: although this study was about equine veterinarians in the United States, retention of staff within the equine veterinary profession is becoming increasingly important in the UK.

There is a shortage of equine veterinarians. Understanding what factors are associated with job satisfaction in equine veterinarians can inform interventions to increase retention in equine medicine. The aim of this qualitative research study from semi-structured focus groups was to explore the prominent factors causing work dissatisfaction and burnout in equine veterinarians.

Thirty-seven current and former equine veterinarians across the United States were recruited via snowball and convenience sampling to answer questions on work history, work–life balance, and perceptions of equine practice. Transcripts were analysed in Delve and coded in the context of the Conservation of Resources (COR) theory. A card sorting activity was used to rank the four types of resources in the COR theory (condition, object, energy, and personal).

Condition resources were the most frequently mentioned reasons for work dissatisfaction. These included issues with discrimination or bias due to age, race/ethnicity, and gender, unpredictable and long hours, and heavy workloads. Object resources, such as equipment, were rarely mentioned. Energy resources, including pay and student loan debt, were influential, with most participants feeling that equine veterinarians are underpaid. Personal resources, such as problem-solving skills and enjoyment in helping others, improved job satisfaction.

Bottom line: The main barriers to equine veterinary retention included a lack of work–life balance, long hours, lower-than-expected pay, and issues with discrimination and bias. This study highlights areas for intervention to improve the equine veterinary field, such as higher pay, rural practice incentives, and effective diversity, equity, inclusion, and belonging (DEIB) efforts. A shift toward caseload-sharing between veterinarians could help alleviate excessive emergency on-call and burnout.

Veterinary Clinical Digest Summary

Why I chose this study: this study further validates the Equine Utrecht University Scale for Facial Assessment of Pain in Foals (EQUUS-FAP FOAL).

The aim of this prospective blinded case–control study was to extend previous pilot findings of the Equine Utrecht University Scale for Facial Assessment of Pain in Foals (EQUUS-FAP FOAL). In brief, this scale uses head movement; degree of eyelid opening; focus on environment; nostril, ear and lip position; presence of muscle fasciculations; yawning, lip smacking, moaning or teeth grinding; and grades them 0-2 to assess pain in foals out of a total of 22.

Video recordings (30–60 s) of 100 foals (38 patients and 62 controls) were collected. Videos were scored by two observers, blinded for the condition of the animals. Inter- and intra-observer agreement was tested by Intra Class Correlation (ICC) analysis. Differences between patients and controls were tested using Mann–Whitney U test, differences before and after analgesic treatment were tested with Wilcoxon signed rank test. Multilevel binomial logistic regression was performed for statistical weighting of each pain scale item. Receiver operating characteristic (ROC) analysis was performed to determine sensitivity, specificity and cut-off values.

EQUUS-FAP FOAL showed good inter- and intra-observer reliability (ICC coefficient of 0.85 and 0.90 respectively, p < 0.001). Patients had significantly higher pain scores (median score 7, IQR 5.3–7.5) compared with controls (median score 2.5, IQR 1–3, p < 0.001) and the patient pain scores decreased after analgesic treatment (median score 6.5, IQR 5–8 vs. median score 4.5, IQR 3.5–6.5, p < 0.05). Multilevel binomial logistic regression showed the relative importance of the individual scale items. Using the original scale, sensitivity and specificity were 88.2% (95% CI 76%–96%) and 87.9% (81%–98%) respectively, with an area under the ROC curve of 94.9% (92%–98%), based on a cut-off value of ≥4. These values remained similar with the weighted scale based on logistic regression output.

Bottom line: The EQUUS-FAP FOAL can be effectively used to assess acute pain in young foals.