13 Oct 2021
Alex Gough MA, VetMB, CertSAM, CertVC, PGCert(Neuroimaging), MRCVS presents the latest companion animal research in this latest column from Vet Times.
Alex Gough
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Good theoretical reasons exist for why spironolactone should be beneficial in the treatment of congestive heart failure (CHF).
The renin-angiotensin-aldosterone system (RAAS) is chronically activated in CHF, which is harmful in the long term. Spironolactone is a mineralocorticoid receptor antagonist and can help reduce the deleterious effects of the RAAS system in CHF. However, clinical evidence of beneficial effects in dogs is sparse.
Coffman et al1 performed a positive controlled-double-blind, multicentre trial to assess whether spironolactone is safe and beneficial in the treatment of CHF caused by myxomatous mitral valve disease (MMVD). In total, 569 dogs with MMVD and CHF were included in the trial and randomised to treatment with furosemide, benazepril and spironolactone, or furosemide and benazepril without spironolactone.
The primary endpoint was defined as death, euthanasia, recurrence of pulmonary oedema, a need for non-authorised cardiac drugs or a high furosemide dose, by day 360. Significantly fewer dogs treated with spironolactone reached the endpoint by day 360 than those that did not. Adverse events were rare and no difference between the two groups was evident.
The authors noted the combination of spironolactone and benazepril is safe and more effective than benazepril alone in the treatment of CHF caused by MMVD in dogs.
Gall bladder mucoceles are commonly encountered in dogs, sometimes incidentally discovered at abdominal ultrasound, and with the potential to cause a variety of complications including biliary obstruction and rupture with consequent bile peritonitis. However, limited information is available on how this condition affects the coagulation status in dogs.
Pavlick et al2 performed a prospective study of 23 dogs that had gall bladder mucocele discovered on ultrasound. Urinalysis and blood tests for haematological and coagulation parameters were taken from these cases.
A total of 83% of dogs showed evidence of hypercoagulability on thromboelastography. Protein C, fibrinogen, platelet count and D-dimers were frequently elevated. Activated partial thromboplastin time was prolonged in 41% and low von Willebrand’s factor activity was found in 24%.
The authors noted these results suggest a complex state of haemostasis exists in dogs with gall bladder mucoceles.
Vitamin D supplementation is important in certain endocrine diseases and in the case of dietary deficiency. However, multiple forms of vitamin D are available for oral supplementation.
Backus and Foster3 performed a study to compare the effects of dietary supplementation of 25-hydroxyvitamin D3 and vitamin D3 on indicators of vitamin D status in healthy dogs.
A total of 13 adult dogs were included in the study and 20 commercial dog foods were also tested for 25(OH)D3.
Six dogs were fed a diet that was deliberately manufactured to be low in vitamin D and were supplemented with vitamin D2, plus varying doses of 25(OH)D3 in a crossover trial. Another crossover trial was conducted in seven dogs receiving a diet formulated with vitamin D3 or 25(OH)D3 supplementation.
Serum/plasma concentrations of vitamin D metabolites were analysed at various timepoints; 25(OH)D3 was found to be low or undetectable in the commercial diets evaluated.
In the trial with low dietary vitamin D, vitamin D2 increased circulating concentrations of 25-hydroxyvitamin D2, but not 24R,25-dihydroxyvitamin D2.
In the trial with the diet supplemented with vitamin D, circulating 25(OH)D3 concentration increased after being fed either diet. It was estimated the potency of 25(OH)D3 supplementation was five times that of vitamin D3.
No adverse effects or vitamin D excess was noted in either trial.
Piroxicam is an NSAID that is often recommended as treatment for cancer. Like all NSAIDs, piroxicam can be associated with gastrointestinal side effects.
Shaevitz et al4 performed a prospective, randomised, double-blinded clinical trial to evaluate whether prophylactic omeprazole or famotidine reduced the incidence and severity of gastrointestinal side effects of piroxicam.
In total, 39 dogs with cancer and no history of gastrointestinal disease that were being treated with piroxicam as the sole agent were included in the study. Dogs were divided into groups to receive famotidine, omeprazole or placebo.
A higher frequency of gastrointestinal side effects was noted in the omeprazole and famotidine groups than the placebo group, and a higher severity of side effects was noted in the omeprazole group than the placebo group.
The authors noted these drugs are not helpful in reducing gastrointestinal side effects from piroxicam in dogs with cancer and, in fact, can make things worse.
Periodontal disease is one of the most common conditions diagnosed in primary care veterinary practice. Evidence exists to show breed predispositions affect the incidence of the disease.
Wallis et al5 performed a huge retrospective study involving more than three million pet records to ascertain which sizes and breeds of dog are most commonly diagnosed with periodontitis. A total of 60 breeds of dogs attending a chain of veterinary hospitals in the US were included in the study.
Most breeds that were frequently diagnosed with periodontal disease were classified as extra small (less than 6.5kg), small (6.5kg to 9kg) or medium-small (9kg to 15kg).
Extra small breeds were five times more likely to suffer from periodontitis than giant breeds (more than 25kg). Age, being overweight and time since last dental prophylaxis were also associated with increased risk of periodontitis.
Antibiotic-resistant bacteria are a serious threat to human and animal health, with carbapenem-resistant Enterobacteriaceae (CRE) being one of the most serious. Few reports of this bacterium in companion animals exists, so Lavigne et al6 performed a case-control study to describe CRE in a tertiary veterinary hospital in the US.
A total of 15 CRE cases were matched 1:2 with culture negative controls. Using logistic regression, associations between the disease, and exposure to various procedures and services was evaluated.
The CRE patients had a 12.8 odds ratio of being exposed to the anaesthesia service and an odds ratio of 4 for being exposed to the surgery service compared to non-cases. Endotracheal intubation gave rise to an odds ratio of 10.
The authors recommended that veterinary hospitals are aware of the risk of transmission of this bacterium – especially in cases requiring placement of an endotracheal tube.
Abdominal ultrasonography is routinely used in cases of suspected acute pancreatitis, but its sensitivity and utility has been questioned.
Gori et al7 reported the findings of abdominal ultrasonography in 37 client-owned dogs with acute pancreatitis during the first two days of hospitalisation.
Canine pancreatic lipase (cPL) concentrations were measured at hospital admission. Ultrasonographic findings were classified as mild, moderate or severe. In total, 24 out 37 dogs had ultrasonographic signs of acute pancreatitis at admission, and a further 10 had positive signs within 2 days of hospitalisation. A total of three dogs were negative for ultrasonographic signs of acute pancreatitis, but had markedly elevated cPL concentrations.
Severe ultrasound findings were associated with a higher risk of death. The authors recommended repeated ultrasound examinations of dogs hospitalised with signs of acute pancreatitis are performed.
