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Background Clostridium difficile infection (CDI) is a leading cause of hospital-associated infections. Antibiotic stewardship, environmental disinfection, and reduction of transmission via health care workers are the major modes of CDI prevention within hospitals. Methods The aim of this study was to evaluate the role of the environment in the spread of CDI within hospital rooms. Bed tracing of positive-CDI inpatients was performed to detect the strength of association to specific rooms. Environmental cultures were conducted to identify adequacy of environmental C difficile (CD) spores. Whole-genome sequencing was performed to evaluate the degree of CD relatedness. Results Bed tracing performed for 211 CDI patients showed a limited list of high-burden rooms. Environmental cultures for surfaces disinfected with a sporicidal agent were almost entirely negative, whereas the floors were positive for CDI in 15% of the studied patient rooms. Whole-genome sequencing did not detect any close genetic relatedness. Conclusions Unlike in an outbreak setting, bed tracing did not yield conclusive results of room reservoirs. The C diff Banana Broth culture was inexpensive, sensitive, and easy to incubate under aerobic conditions. Sporicidal disinfectants were effective in eliminating CD from the environment. CD spores were found on floors and hard-to-clean surfaces.

Background Interprofessional education strategies are becoming more prevalent as nursing schools integrate interprofessional practice activities into their curricula. Purpose This paper presents the results of a federally funded project to deliver online interprofessional education to nursing students on screening for alcohol and substance use in rural areas, in which their perceptions about interprofessional education were measured. Methods A quasi-experimental within-subjects repeated measures design was utilized. Students in the bachelor or associate degree program were recruited from two rural nursing schools. A demographic questionnaire, Alcohol and Alcohol Problems Questionnaire, Drug and Drug Problems Questionnaire, and Interprofessional Education Perception Scale were utilized. General linear modeling was used to determine changes in these measurements over time. Data collection was performed at pretraining, posttraining, and following an online interprofessional dialogue. Results The study consisted of 89 nursing students. The participants were 87% female (n = 77/89) and 91% white (n = 81/89); their mean age was 24.9 years (standard deviation = 10.36). Analysis of evaluation questionnaires demonstrated increased levels of confidence in working with patients who consume alcohol or other drugs and on certain aspects of interprofessional education. Conclusion Online interprofessional preservice education holds the potential to positively increase nursing students’ confidence in working with patients and to increase their interprofessional practice.

Staphylococcus pseudintermedius is a major opportunistic bacterial pathogen and the leading cause of pyoderma in dogs. In canines it is also often associated with infections of the urinary system and wounds and occasionally infects people. Widespread antimicrobial resistance has made the development of alternative treatments a high priority. The development of a staphylococcal vaccine, however, has proven challenging. Identification of virulence factors that inhibit phagocytosis and avoid innate immunity may play a significant role in preventing or treating infection with S. pseudintermedius. In this study, we identified a putative 5'-nucleotidase provisionally named SpAdsA, a S. pseudintermedius cell- wall protein encoded by SpAdsA. SpAdsA shares approximately 52% identity with the orthologous protein of Staphylococcus aureus and 14.8% identity with that of Streptococcus suis type2. It catalyzes the dephosphorylation of adenosine triphosphate and attenuation of this enzyme with critical amino acid substitutions nearly eliminated its hydrolytic activity. Exogenous adenosine inhibited phagocytosis of S. pseudintermedius by canine neutrophils and monocytes. Conversely, the addition of SpAdsA inhibitor or A2A adenosine receptor antagonist impaired the capacity of S. pseudintermedius to escape from killing by phagocytic cells. The neutralizing ability of canine antibody produced against SpAdsA-M was determined. Taken together, these results suggest that SpAdsA likely plays an important role in S. pseudintermedius virulence and that attenuated SpAdsA may be a good candidate for inclusion in a vaccine against S. pseudintermedius.

People living with HIV (PLWH) who use drugs and alcohol are particularly likely to experience gaps across the HIV care continuum. People with co-occurring HIV and a substance use disorder face significant challenges in treatment. Substance use is well-known to be linked to important health behaviors and outcomes including adherence to antiretroviral and treatment, immunosuppression, and sexual risk behaviors. This chapter provides a review of the impact of substance use in PLWH and the role of motivational interviewing as part of an integrated approach to care of PLWH with co-occurring substance use disorders. The chapter concludes with a case example to illustrate the role that motivational interviewing can play the care of PLWH with a co-morbidity of substance use disorder.

In dogs with pituitary-dependent hypercortisolaemia, retinoic acid was shown to lower cortisol, reduce pituitary tumour size and decrease clinical signs when administered for six months. Oral vitamin A (retinol) has been used to treat various canine dermatoses in which retinoic acid has been efficacious.To determine if orally administered vitamin A lowers cortisol and reduces clinical signs in dogs with pituitary-dependent hypercortisolaemia over a five month period.Five dogs were enrolled in this study. Diagnosis of hypercortisolaemia was based on the presence of at least three clinical signs and one abnormal screening test. Diagnosis of pituitary-dependent disease was based on low dose dexamethasone suppression (LDDS) test results and symmetrical adrenal glands on ultrasound. Adrenocorticotropic hormone (ACTH) stimulation testing and adrenal ultrasound were performed at each visit. Plasma was collected at each visit and stored at -80°C for batch analysis of endogenous ACTH at conclusion of the study.Four dogs completed the study. A fifth dog died from complications of hypercortisolaemia before the third month. One dog showed improvement in clinical signs, yet there was no significant decrease in adrenal gland size or cortisol concentrations. Endogenous ACTH concentrations at the fifth month were decreased from baseline in two dogs and increased from baseline in one dog. The treatment had no adverse effects.Results from this study failed to show an improvement in clinical signs or cortisol concentration after five months of oral daily vitamin A in dogs with hypercortisolaemia.Chez les chiens avec hypercortisolémie dépendant de l’hypophyse, l’acide rétinoïque a permis une baisse de cortisol, une réduction de la taille de la tumeur hypophysaire et une diminution des signes cliniques quand administré pendant six mois. La vitamine A orale (retinol) a été utilisée pour traiter des dermatoses canines variées dans laquelle l’acide rétinoïque a été efficace.Déterminer si l’administration orale de vitamine A diminue le cortisol et réduit les signes cliniques chez les chiens avec hypercortisolémie d’origine hypophysaire sur une période de cinq mois. MATÉRIELS ET MÉTHODES: Cinq chiens ont été inclus dans cette étude. Le diagnostic d’hypercortisolémie était basé sur la présence d’au moins trois signes cliniques et une échographie abdominale. Le diagnostic de maladie liée à l’hypophyse était basé sur les résultats d’un test de freinage à la déxaméthasone dose faible (LDDS) et les glandes surrénales symétriques à l’échographie. Le plasma a été collecté à chaque visite et conservé à -80°C pour analyse par lots d’ACTH endogène à la conclusion de l’étude. RÉSULTATS: Quatre chiens ont complété l’étude. Un cinquième chien est mort de complications d’hypercortisolémie avant le troisième mois. Un chien a montré une amélioration clinique et il n’y avait pas de diminution significative de la taille des glandes surrénales ou des concentrations de cortisol. Les concentrations d’ACTH endogène au cinquième mois étaient diminuées chez deux chiens et augmentée chez un chien. Le traitement n’avait pas d’effet secondaire.Les résultats de cette étude n’ont pas pu montré d’amélioration des signes cliniques ou de concentration de cortisol après cinq mois de vitamine A orale quotidien chez les chiens avec hypercortisolémie.INTRODUCCIÓN: se ha demostrado que en perros con hipercortisolemia dependiente de la hipófisis el ácido retinoico reduce el cortisol, reduce el tamaño del tumor hipofisario y disminuye los signos clínicos cuando se administra durante seis meses. La vitamina A oral (retinol) se ha utilizado para tratar diversas dermatosis caninas en las que el ácido retinoico ha resultado eficaz. OBJETIVOS: Determinar si la vitamina A administrada por vía oral reduce el cortisol y reduce los signos clínicos en perros con hipercortisolemia dependiente de la hipófisis durante un período de cinco meses. MÉTODOS Y MATERIALES: se inscribieron cinco perros en este estudio. El diagnóstico de hipercortisolemia se basó en la presencia de al menos tres signos clínicos y una prueba de detección anormal. El diagnóstico de la enfermedad dependiente de la hipófisis se basó en los resultados de la prueba de supresión de dexametasona (LDDS) en dosis bajas y en la presencia de glándulas adrenales simétricas según la ecografía. En cada visita se realizaron pruebas de estimulación con hormona adrenocorticotrópica (ACTH) y ecografía de adrenales. El plasma se recogió en cada visita y se almacenó a -80°C para el análisis por lotes de ACTH endógena al finalizar el estudio. RESULTADOS: cuatro perros completaron el estudio. Un quinto perro murió por complicaciones de la hipercortisolemia antes del tercer mes. Un perro mostró una mejoría en los signos clínicos, sin embargo, no hubo una disminución significativa en el tamaño de las glándulas adrenales o en las concentraciones de cortisol. Las concentraciones de ACTH endógena al quinto mes disminuyeron del valor inicial en dos perros y aumentaron del el valor inicial en un perro. El tratamiento no tuvo efectos adversos. CONCLUSIONES E IMPORTANCIA CLÍNICA: los resultados de este estudio no mostraron una mejora en los signos clínicos o la concentración de cortisol después de cinco meses de vitamina A oral diaria en perros con hipercortisolemia.Bei Hunden mit einer Hypophysen-abhängigen Hypercortisolämie konnte gezeigt werden, dass Retinolsäure das Cortisol erniedrigt, die Größe des Hypophysentumors vermindert und die klinischen Zeichen verringert, wenn es sechs Monate lang verabreicht wird. Vitamin A (Retinol) per os wurde zur Behandlung verschiedener Dermatosen von Hunden eingesetzt, bei denen Retinolsäure wirksam war.Die Feststellung ob per os verabreichtes Vitamin A Cortisol vermindert und die klinischen Zeichen bei Hunden mit einer Hypophysen-abhängigen Hypercortisolämie über einen Zeitraum von fünf Monaten reduziert.Es wurden fünf Hunde in die Studie aufgenommen. Die Diagnose erfolgte aufgrund des Auftretens mindestens drei klinischer Zeichen und einem abnormalen Screening Test. Die Diagnose einer Hypophysen-abhängigen Erkrankung basierte auf den Ergebnissen eines Low Dose Dexamethason Tests (LDDS) und symmetrischer Nebennieren im Ultraschall. Bei jedem Besuch wurde ein Adrenocorticotropes Hormon (ACTH) Stimulationstest und eine Ultraschalluntersuchung der Nebennieren durchgeführt. Plasma wurde bei jedem Besuch genommen und bei -80° C gelagert, um eine Sammelanalyse von endogenem ACTH am Ende der Studie durchzuführen.Vier Hunde beendeten die Studie. Ein fünfter Hund starb aufgrund von Komplikationen durch die Hypercortisolämie vor Ende des dritten Monats. Ein Hund zeigte eine Verbesserung der klinischen Zeichen, es nahmen jedoch weder die Größe der Nebennieren im Vergleich zur Anfangsuntersuchung noch die Cortisolkonzentrationen ab. Nach dem fünften Monat waren die endogenen ACTH Konzentrationen im Vergleich zum Ausgangswert bei zwei Hunden erniedrigt und bei einem Hund erhöht. Die Behandlung zeigte keine Nebenwirkungen.Die Ergebnisse der Studie konnten nach fünf Monaten einer Vitamin A Behandlung per os bei Hunden mit einer Hypercortisolämie keine Verbesserung der klinischen Zeichen oder der Cortisolkonzentrationen zeigen.背景: 下垂体依存性高コルチゾール血症を有する犬において、レチノイン酸を 6 ヶ月間投与した場合、コルチゾール値を低下させ、下垂体腫瘍を縮小させ、臨床徴候を減少させることが示された。経口ビタミン A (レチノール) は、レチノイン酸が有効であった様々な犬の皮膚病の治療に使用されてきた。 目的: 本研究の目的は、下垂体依存性高コルチゾール血症の犬において、ビタミン A の経口投与がコルチゾール値を低下させ、臨床徴候を減少させるかどうかを 5 ヶ月間にわたって検討することであった。 材料および方法: 本研究に5 頭の犬を登録した。高コルチゾール血症の診断は、少なくとも3つの臨床徴候および少なくとも1つの異常なスクリーニング検査結果に基づいた。下垂体依存性疾患の診断は、低用量デキサメタゾン抑制 (LDDS)試験の結果および超音波検査での左右対称性副腎の有無に基づいた。副腎皮質刺激ホルモン (ACTH) 刺激試験および副腎超音波検査を各訪問時に実施した。血漿を各訪問時に採取し、研究終了時に内因性ACTHのバッチ解析のために-80℃で保存した。 結果: 4頭の犬が試験を終了した。5頭目の犬は3ヶ月目までに高コルチゾール血症の合併症で死亡した。1頭の犬は臨床症状の改善を示したが、副腎の大きさやコルチゾール濃度の有意な低下は認められなかった。5ヶ月目の内因性ACTH濃度は、2頭の犬でベースラインから低下し、1頭の犬でベースラインから上昇した。ビタミン A の経口投与による治療法には副作用はなかった。 結論および臨床的重要性: 本試験の結果は、高コルチゾール血症を有する犬において、ビタミンAを5カ月間毎日経口投与した後の臨床徴候またはコルチゾール濃度の改善を示すことができなかった。.背景: 在垂体依赖性高皮质醇血症犬中, 维A酸给药6个月后显示可降低皮质醇、减小垂体瘤体积并减少临床体征。口服维生素A (视黄醇) 已用于治疗维A酸有效的各种犬皮肤病。 目的: 确定经口给予5个月的维生素A,是否可降低垂体依赖性高皮质醇血症犬的皮质醇并减轻临床症状。 方法和材料: 本研究入组了5只犬。高皮质醇血症的诊断是基于至少存在3种临床症状和1项异常筛查试验。垂体依赖性疾病的诊断是基于低剂量地塞米松抑制(LDDS)试验结果和超声显示的对称肾上腺。在每次就诊时进行促肾上腺皮质激素(ACTH)刺激试验和肾上腺超声检查。在每次就诊时采集血浆, 并储存在-80 ℃下, 用于研究结束时内源性ACTH的批分析。 结果: 4只犬完成了研究。第5只犬在第3个月前死于高皮质醇血症并发症。1只犬显示临床症状改善, 但肾上腺大小或皮质醇浓度未显著降低。第5个月时, 2只犬的内源性ACTH浓度较基线降低, 1只犬的内源性ACTH浓度较基线升高。治疗无不良反应。 结论和临床重要性: 研究高皮质醇血症犬每日口服5个月的维生素A, 结果显示临床症状或皮质醇浓度并未改善。.Em cães com hipercortisolemia pituitária-dependente, o ácido retinoico demonstrou reduzir o cortisol, reduzir o tamanho do tumor e diminuir os sinais clínicos quando administrado por seis meses. A vitamina A (retinol) por via oral tem sido utilizada para tratar várias dermatoses caninas em que o ácido retinoico é eficaz.Determinar se a vitamina A administrada por via oral reduz o cortisol e diminui os sinais clínicos em cães com hipercortisolemia pituitária-dependente em um período de cinco meses. MÉTODOS E MATERIAIS: Cinco cães foram incluídos nesse estudo. O diagnóstico de hipercortisolemia foi baseado na presença de ao menos três sinais clínicos e um teste de triagem alterado. O diagnóstico de doença pituitária-dependente foi baseado nos resultados do teste de supressão de adrenal em baixa dose de dexametasona (LDDS) e adrenais simétricas no ultrassom. O teste de estimulação por hormônio adrenocorticotrófico (ACTH) e ultrassom de adrenal foi realizado a cada visita. O plasma foi coletado a cada visita e armazenado a -80° C para análise de ACTH endógena na conclusão do estudo.Quatro cães completaram o estudo. O quinto cão faleceu devido às complicações da hipercortisolemia antes do terceiro mês. Um cão apresentou melhora nos sinais clínicos, apesar de não haver redução significativa no tamanho da adrenal ou nas concentrações de cortisol. As concentrações de ACTH endógeno no quinto mês estavam reduzidas comparado ao tempo zero em dois cães e aumentadas em um cão. O tratamento não apresentou efeitos adversos. CONCLUSÕES E IMPORTÂNCIA CLÍNICA: Os resultados deste estudo não demonstraram melhora nos sinais clínicos ou na concentração de cortisol após cinco meses de tratamento com vitamina A por via oral em cães com hipercortisolemia.

Purpose . Interprofessional collaborative practice (IPCP) has been advocated to overcome challenges related to rural healthcare and substance abuse. The investigators evaluated the effectiveness of an online interprofessional education (IPE) program to improve health care professionals’ perceptions in treating people with substance use and identified the challenges of conducting IPE. Sample . Sample included 106 healthcare professionals (nurses, behavioral health counselors, and public health workers) from rural areas in Pennsylvania, Ohio, and West Virginia. Method. This prospective study utilized a quasi-experimental design with healthcare professionals who received a 6-hour online IPE regarding substance abuse. Measures were the Alcohol & Alcohol Problems Perception Questionnaire (AAPPQ) and the Drug & Drug Problems Perception Questionnaire (DDPPQ). Findings. Perceptions of alcohol (i.e., role adequacy and role support) and drug (i.e., role adequacy, role legitimacy, sole support, and work satisfaction) problems were improved after training (Ps < .05). Competing priorities, leadership support, technology, rural culture, and fiscal consequences were addressed as challenges during project implementation. Conclusion. The IPE program improved the participants’ attitudes and perceptions toward working with patients who struggle with substance abuse. Rural nurse managers can influence professionals in a range of clinical team settings to improve safety and quality of health care through IPCP. Challenges experienced by rural healthcare professionals can be resolved by the leadership support. Consequently, the leadership of nurse management can favorably impact patient healthcare outcomes by reinforcing IPE. DOI: http://dx.doi.org/10.14574/ojrnhc.v16i1.385

Feline inflammatory aural polyps (IP) have been reported as solitary growths, yet bilateral polyps may occur more commonly than described previously.To identify the prevalence and risk factors associated with bilateral feline IP within a population of cats evaluated at a veterinary teaching hospital over a 10 year period.Twenty-five cats with histologically confirmed IP.A retrospective study was performed by searching computerized medical records of cats seen at The University of Tennessee Veterinary Teaching Hospital from 2005 to 2015. Keywords used for the search included "feline polyp", "ventral bulla osteotomy", "inflammatory polyp ear canal" and "nasopharyngeal polyp".Cats were separated into groups with unilateral or bilateral disease. Six of 25 (24%) cats had bilateral IP. Twelve cats had computed tomography performed (four of six with bilateral IP; eight of 19 with unilateral IP). Clinical signs, history of upper respiratory infection, post-treatment complications, and IP recurrence with and without local and systemic steroid administration were studied between groups and no differences were identified. In four of six cats with bilateral disease, the second polyp was identified with advanced imaging performed at the time of referral.These findings demonstrate that bilateral IP occur more frequently than reported previously and establish a prevalence for bilateral IP. These findings also highlight the value of advanced imaging techniques in diagnosing bilateral IP.Les polypes inflammatoires naso-pharyngés (IP) du chat sont décrits comme des proliférations solitaires, pouvant être bilatérales plus fréquemment que précédemment rapportés.Identifier les facteurs de risque et la prévalence associés aux IP bilatéraux du chat au sein d’une population de chats vus à l’Hôpital d’enseignement vétérinaire de l’Université du Tennessee de 2005 à 2015. Les mots clés utilisés étaient « polype félin », « ostéotomie ventrale de la bulle », « polype inflammatoire du conduit auriculaire » et « polype naso-pahryngé ». RÉSULTATS: Les chats ont été séparés en groupes avec atteinte unilatérale ou bilatérale. Six des 25 (24%) chats avaient une atteinte bilatérale. Douze chats avaient réalisés un examen tomodensitométrique (quatre sur six avec IP bilatéral ; huit sur 19 avec IP unilatéral). Les signes cliniques, les antécédents d’infections respiratoires, les complications post-traitement, et la récidive d’IP avec et sans corticoïdes systémiques ont été étudiés entre les groupes et aucune différence n’a été identifiée. Dans quatre des six chats avec atteinte bilatérale, le deuxième polype a été identifié par imagerie au moment du référé.Ces données démontrent que l’atteinte bilatérale peut se produire plus fréquemment que précédemment rapporté et permet d’établir une prévalence pour l’IP bilatérale. Ces données mettent aussi en lumière l’importance des techniques d’imagerie pour le diagnostic de l’IP bilatéral.INTRODUCCIÓN: los pólipos inflamatorios felinos del oído (IP) se han reportado como crecimientos solitarios, aunque pólipos bilaterales pueden ocurrir con mayor frecuencia que la descrita previamente. OBJETIVOS: identificar la prevalencia y los factores de riesgo asociados con pólipos bilaterales óticos en una población de gatos evaluados en un hospital veterinario de enseñanza durante un período de 10 años. ANIMALES: veinticinco gatos con IP confirmada histológicamente. MÉTODOS Y MATERIALES: se realizó un estudio retrospectivo mediante la búsqueda en historiales médicos computerizados de gatos examinados en el Hospital de Enseñanza Veterinaria de la Universidad de Tennessee de 2005 a 2015. Las palabras clave utilizadas para la búsqueda incluyeron "pólipo felino", "osteotomía de bulla ventral", "pólipo inflamatorio canal auditivo "y" pólipo nasofaríngeo ". RESULTADOS: los gatos se separaron en grupos con enfermedad unilateral o bilateral. Seis de 25 (24%) gatos tenían IP bilateral. Doce gatos se examinaron mediante tomografía computerizada (cuatro de seis con IP bilateral; ocho de 19 con IP unilateral). Se estudiaron signos clínicos, antecedentes de infección de las vías respiratorias superiores, complicaciones posteriores al tratamiento y recurrencia de IP con y sin administración local y sistémica de esteroides entre los grupos y no se identificaron diferencias. En cuatro de seis gatos con enfermedad bilateral, el segundo pólipo se identificó con análisis avanzado de imágenes realizado en el momento de la derivación al centro especializado. CONCLUSIONES E IMPORTANCIA CLÍNICA: estos hallazgos demuestran que los pólipos bilaterales ocurren con más frecuencia de lo que se ha publicado anteriormente y establece una prevalencia de IP bilateral. Estos hallazgos también destacan la importancia de las técnicas de imagen avanzadas en el diagnóstico de la IP bilateral.Entzündliche aurale Polypen (IP) bei Katzen sind als einzelne Gewächse beschrieben, es könnten jedoch Polypen auch häufiger als bisher beschrieben bilateral auftreten.Eine Evaluierung der Prävalenz und der Risikofaktoren im Zusammenhang mit bilateralen felinen IP innerhalb der Katzenpopulation in einer Universitätsklinik über eine Periode von 10 Jahren.Fünfundzwanzig Katzen mit histologisch bestätigter IP.Eine retrospektive Studie wurde mittels Durchsicht elektronischer medizinischer Patientenkarteien von Katzen, die im Veterinary Teaching Hospital der Universität Tennessee zwischen 2005 und 2015 vorgestellt worden waren, durchgeführt. Keywords, die für die Suche Verwendung fanden, waren „feliner Polyp“, „ventrale Bullaosteotomie“, „entzündlicher Polyp Ohrkanal“ und „nasopharyngealer Polyp“.Die Katzen wurden in Gruppen mit unilateraler und bilateraler Erkrankung eingeteilt. Sechs von 25 (24%) der Katzen hatten bilaterale IP. Bei zwölf Katzen wurde eine Computertomografie durchgeführt (bei vier der sechs mit bilateraler IP; bei acht von 19 mit unilateraler IP). Klinische Zeichen, Anamnese einer oberen respiratorischen Infektion, Komplikationen nach der Behandlung, und das Wiederauftreten von IP mit und ohne lokaler und systemischer Steroidverabreichung wurde zwischen den beiden Gruppen verglichen und keine Unterschiede gefunden. Bei vier der sechs Katzen mit bilateraler Erkrankung wurde der zweite Polyp zum Zeitpunkt der Überweisung mittels fortgeschrittener bildgebender Diagnostik identifiziert.Diese Befunde zeigen, dass bilaterale IP häufiger auftreten als bisher beschrieben und zeigen eine Prävalenz für bilaterale Polypen. Diese Befunde streichen ebenfalls die Wichtigkeit von fortgeschrittener bildgebender Diagnostik bei der Diagnose bilateraler IP heraus.背景: 之前报道认为猫炎性耳息肉(IP)为单侧生长，但双侧息肉可能比之前所报道的更常见。 目的: 评估10年内在兽医教学医院的就诊猫，调查双侧猫IP的发病率和相关风险因素。 动物: 25只猫经组织学证实患有IP。 方法和材料: 2005年至2015年田纳西大学兽医教学医院的就诊猫，通过检索其电脑系统病历进行回顾性研究。检索关键词包括“猫息肉”、“腹侧大疱截骨术”、“炎性息肉耳道”和“鼻咽息肉”。 结果: 猫被分为单侧或双侧疾病组。25只猫中的6只(24%)患有双侧IP。12只猫进行了计算机断层扫描（4/6只患有双侧IP；8/19只患有单侧IP）。研究了组间临床体征、上呼吸道感染史、治疗后并发症和 IP 复发（伴和不伴局部和全身类固醇给药），未发现差异。4/6只双侧发病猫，通过转诊时进行的高级成像确定了另一侧的耳道息肉。 结论和临床重要性: 这些结果表明，双侧IP的发生频率高于既往的报道，并确定了双侧IP的发病率。这些结果也强调了高级成像技术对诊断双侧IP的重要性。.背景: 猫の炎症性耳ポリープ（IP）は孤立性成長として報告されているが、両側性ポリープは以前に説明されたよりも一般的に発生する可能性がある。 目的: 本研究の目的は、獣医教育病院で10年間にわたって評価された猫の集団内の両側性IPに関連する有病率および危険因子を特定することであった。 供試動物: 組織学的にIPが確認された25頭の猫。 材料と方法: 2005年から2015年にテネシー大学獣医教育病院で診察された猫のコンピューター化された医療記録を検索することにより、遡及的研究が行われた。検索に使用されたキーワードには、「猫ポリープ」、「腹側鼓室胞骨切り術」、「外耳道の炎症性ポリープ」および「鼻咽頭ポリープ」を含んだ。 結果: 猫は片側性または両側性の群に分けられた。 25頭の猫のうち6頭（24％）に両側性IPがあった。 12頭の猫がコンピューター断層撮影を実施した（6頭中4頭が両側IP、19頭中8頭で片側IP）。臨床的徴候、上気道感染の病歴、治療後の合併症、および局所および全身ステロイド投与の有無によるIP再発をグループ間で調査したところ、差異は確認されなかった。両側性疾患の猫6頭のうち4頭では、紹介時に高度な画像処理を行って2つ目のポリープを特定した。 結論と臨床的重要性: 本調査結果は、両側IPが以前に報告されたよりも頻繁に発生し、両側IPの有病率を確立していることを示している。これらの調査結果はまた、両側IPの診断における高度な画像技術の重要性を強調している。.Os pólipos aurais inflamatórios felinos (PI) têm sido relatados como crescimentos solitários, mas os pólipos bilaterais podem ocorrer mais comumente do que descrito anteriormente.Identificar a prevalência e os fatores de risco associados a PI felinos bilaterais em uma população de gatos atendidos em um hospital veterinário durante um período de 10 anos.Vinte e cinco gatos com PI histologicamente confirmado. MÉTODOS E MATERIAIS: Foi realizado um estudo retrospectivo, pesquisando registros médicos computadorizados de gatos atendidos no Hospital Veterinário da Universidade do Tennessee, entre 2005 e 2015. As palavras-chave utilizadas para a pesquisa incluíram “pólipo felino”, “osteotomia da bolha ventral”, “pólipo inflamatório canal auditivo ”e“ pólipo nasofaríngeo ”.Os gatos foram divididos em grupos com doença unilateral ou bilateral. Seis dos 25 (24%) gatos tiveram PI bilateral. Doze gatos realizaram tomografia computadorizada (quatro de seis com PI bilateral; oito de 19 com PI unilateral). Sinais clínicos, história de infecção respiratória superior, complicações pós-tratamento e recorrência de PI com e sem administração local e sistêmica de esteroides foram estudados entre os grupos e não foram identificadas diferenças. Em quatro dos seis gatos com doença bilateral, o segundo pólipo foi identificado com o uso de imagens avançadas realizadas no momento do encaminhamento. CONCLUSÕES E IMPORTÂNCIA CLÍNICA: Esses achados demonstram que os PI bilaterais ocorrem mais frequentemente do que o relatado anteriormente e estabelece uma prevalência para a PI bilateral. Esses achados também destacam a importância de técnicas avançadas de imagem no diagnóstico da PI bilateral.

BACKGROUND Schipperkes develop bilaterally symmetrical alopecia preceded by lightening of the hair coat not associated with systemic clinical signs. The alopecia is presumptively diagnosed as Alopecia X but has never been investigated. HYPOTHESIS/OBJECTIVES The purpose of this study was to describe clinical features, histopathological and laboratory abnormalities associated with symmetrical, noninflammatory alopecia in schipperkes. ANIMALS Three healthy and eight affected schipperkes. METHODS AND MATERIALS Complete blood count (CBC), serum chemistry panel, urinalysis (UA), urine cortisol: creatinine ratio (UCCR), total thyroxine (T4 ), free thyroxine by equilibrium dialysis (fT4 ed), thyroid stimulating hormone (TSH) and pre- and post-stimulation cortisol with sex hormone analyses were performed for all dogs. A minimum of two skin biopsy sites were sampled for histopathological evaluation. RESULTS The CBC, serum chemistry panel, UA, T4 , fT4 ed, TSH and post-ACTH cortisol concentrations were normal for all dogs. Androstenedione concentrations were increased for all dogs; two of three healthy and five of eight affected dogs had increased post-ACTH androstenedione concentrations. Estradiol concentrations were increased for all healthy and four of eight affected dogs, with post-ACTH estradiol concentrations increased for all healthy and five of eight affected dogs. Progesterone concentrations were increased for two of three healthy and four of eight affected dogs. Post-ACTH progesterone concentrations were increased for one of three healthy and four of eight affected dogs. For one of three healthy and two of eight affected dogs, 17-hydroxyprogesterone concentrations were increased; post-ACTH 17-hydroxyprogesterone concentrations were increased in three of eight affected dogs only. Histopathology results from affected dogs were consistent with hair cycle arrest. CONCLUSIONS AND CLINICAL IMPORTANCE This disorder resembles Alopecia X clinically and histologically.

Background Dermatophilus congolensis is a facultative anaerobic actinomycete that causes papular to exudative dermatitis with crusting in horses. This organism is frequently implicated as a cause of pastern dermatitis, but few data are available validating the organism's association with this disease. Hypothesis/objectives The aim of this study was to evaluate if D. congolensis is associated with pastern dermatitis in horses utilizing RT-qPCR. Animals Fifteen client-owned horses diagnosed with pastern dermatitis and eight client-owned unaffected control horses were utilized for this study. Methods A cross-sectional study was performed. History and physical examination findings were recorded, and samples were collected and tested for D. congolensis utilizing cytological evaluation and RT-qPCR. Dermatophyte culture and superficial skin scrapings were also performed. Results Ten of 15 horses with pastern dermatitis had feathered pasterns. Dermatophilus congolensis was identified by RT-qPCR from one nonfeathered horse but none with feathered pasterns. Cytological evaluation identified bacteria in all horses but failed to identify organisms resembling D. congolensis in any horse. Four of 15 horses, all feathered, were positive for Chorioptes mites. Fungal culture was negative for dermatophytes in all horses. All test results were negative for the eight control horses. Conclusions and clinical importance Dermatophilus congolensis was uncommonly associated with pastern dermatitis in horses in this population. However, chorioptic mange was commonly associated with pastern dermatitis in feathered horses and represented an important differential diagnosis for this clinical presentation.

A striking form of lymphocytic mural folliculitis is described in 6 tigers ( Panthera tigris). Clinically, all tigers exhibited regionally extensive chronic, variably waxing and waning alopecia with minimal scaling and crusting most pronounced over the head, neck, and shoulders. More severely affected tigers exhibited marked hyperpigmentation and lichenification. Pruritus was not a feature. Tigers generally lacked signs of systemic illness and clinical pathology findings were unremarkable. Histologic examination of skin biopsies revealed infiltrative lymphocytic mural folliculitis extending the length of the hair follicle. Mild epidermal lymphocytic infiltrates were frequent. The surrounding dermis was histologically unremarkable in 4 of 6 tigers or associated with mild perifollicular and periadnexal mixed inflammation in 2 of 6 tigers. The cause of the mural folliculitis was not identified, and tigers responded poorly to immunomodulatory therapy. Lymphocytic mural folliculitis might be a nonspecific hypersensitivity reaction pattern in tigers, and care should be taken to differentiate this reaction pattern from epitheliotropic T-cell lymphoma.

Bacterial infections from Staphylococcus pseudintermedius are the most common cause of skin infections (pyoderma) affecting dogs. Two component pore-forming leukocidins are a family of potent toxins secreted by staphylococci and consist of S (slow) and F (fast) components. They impair the innate immune system, the first line of defense against these pathogens. Seven different leukocidins have been characterized in Staphylococcus aureus, some of which are host and cell specific. Through genome sequencing and analysis of the S. pseudintermedius secretome using liquid chromatography mass spectrometry we identified two proteins, named "LukS-I" and "LukF-I", encoded on a degenerate prophage contained in the genome of S. pseudintermedius isolates. Phylogenetic analysis of LukS-I components in comparison to the rest of the leukocidin family showed that LukS-I was most closely related to S. intermedius LukS-I, S. aureus LukE and LukP, whereas LukF-I was most similar to S. intermedius LukF-I S. aureus gamma hemolysin subunit B. The killing effect of recombinant S. pseudintermedius LukS-I and LukF-I on canine polymorphonuclear leukocytes was determined using a flow cytometry cell permeability assay. The cytotoxic effect occurred only when the two recombinant proteins were combined. Engineered mutant versions of the two-component pore-forming leukocidins, produced through amino acids substitutions at selected points, were not cytotoxic. Anti-Luk-I produced in dogs against attenuated proteins reduced the cytotoxic effect of native canine leukotoxin which highlights the importance of Luk-I as a promising component in a vaccine against canine S. pseudintermedius infections.

Background Atypical hyperadrenocorticism (AHAC) is considered when dogs have clinical signs of hypercortisolemia with normal hyperadrenocorticism screening tests. Hypothesis/Objectives To compare cortisol concentrations and adrenal gland size among dogs with pituitary‐dependent hyperadrenocorticism (PDH), atypical hyperadrenocorticism (AHAC), and healthy controls. Animals Ten healthy dogs, 7 dogs with PDH, and 8 dogs with AHAC. Method Dogs were prospectively enrolled between November 2011 and January 2013. Dogs were diagnosed with PDH or AHAC based on clinical signs and positive screening test results (PDH) or abnormal extended adrenal hormone panel results (AHAC). Transverse adrenal gland measurements were obtained by abdominal ultrasound. Hourly mean cortisol (9 samplings), sum of hourly cortisol measurements and adrenal gland sizes were compared among the 3 groups. Results Hourly (control, 1.4 ± 0.6 μg/dL; AHAC, 2.9 ± 1.3; PDH, 4.3 ± 1.5) (mean, SD) and sum (control, 11.3 ± 3.3; AHAC, 23.2 ± 7.7; PDH, 34.7 ± 9.9) cortisol concentrations differed significantly between the controls and AHAC (P

This study investigated the expression of ion transporters involved in intestinal fluid absorption and presents evidence for developmental changes in abundance and tissue distribution of these transporters during smoltification and seawater (SW) acclimation of Atlantic salmon Salmo salar. Emphasis was placed on Na(+) , K(+) -ATPase (NKA) and Na(+) , K(+) , Cl(-) co-transporter (NKCC) isoforms, at both transcriptional and protein levels, together with transcription of chloride channel genes. The nka α1c was the dominant isoform at the transcript level in both proximal and distal intestines; also, it was the most abundant isoform expressed in the basolateral membrane of enterocytes in the proximal intestine. This isoform was also abundantly expressed in the distal intestine in the lower part of the mucosal folds. The protein expression of intestinal Nkaα1c increased during smoltification. Immunostaining was localized to the basal membrane of the enterocytes in freshwater (FW) fish, and re-distributed to a lateral position after SW entry. Two other Nka isoforms, α1a and α1b, were expressed in the intestine but were not regulated to the same extent during smoltification and subsequent SW transfer. Their localization in the intestinal wall indicates a house-keeping function in excitatory tissues. The absorptive form of the NKCC-like isoform (sub-apically located NKCC2 and/or Na(+) , Cl(-) co-transporter) increased during smoltification and further after SW transfer. The cellular distribution changed from a diffuse expression in the sub-apical regions during smoltification to clustering of the transporters closer to the apical membrane after entry to SW. Furthermore, transcript abundance indicates that the mechanisms necessary for exit of chloride ions across the basolateral membrane and into the lateral intercellular space are present in the form of one or more of three different chloride channels: cystic fibrosis transmembrane conductance regulator I and II and chloride channel 3.

Staphylococci have evolved numerous strategies to evade their hosts' immune systems. Some staphylococcal toxins target essential components of host innate immunity, one of the two main branches of the immune system. Analysis of the Staphylococcus pseudintermedius secretome using liquid chromatography mass spectrometry guided by genomic data, was used to identify an S. pseudintermedius exotoxin provisionally named SpEX. This exoprotein has low overall amino acid identity with the Staphylococcus aureus group of proteins named staphylococcal superantigen like proteins (SSLs) and staphylococcal enterotoxin- like toxin X (SEIX), but predictive modeling showed that it shares similar folds and domain architecture to these important virulence factors. In this study, we found SpEX binds to complement component C5, prevents complement mediated lysis of sensitized bovine red blood cells, kills polymorphonuclear leukocytes and monocytes and inhibits neutrophil migration at sub-lethal concentrations. A mutant version of SpEX, produced through amino acid substitution at selected positions, had diminished cytotoxicity. Anti-SpEX produced in dogs reduced the inhibitory effect of native SpEX on canine neutrophil migration and protected immune cells from the toxic effects of the native recombinant protein. These results suggest that SpEX likely plays an important role in S. pseudintermedius virulence and that attenuated SpEX may be an important candidate for inclusion in a vaccine against S. pseudintermedius infections.

Background Corns are hard protuberances that occur on the digital footpads of Greyhound dogs. The cause of these lesions is unknown and there is little information about them in the veterinary literature. We received anecdotal examples of dog to dog spread of corns suggesting an infectious cause. The aim of this study was to determine if papillomavirus (PV) is associated with Greyhound corns. Methods We examined four corns from two unrelated adult Greyhound dogs that resided in Florida and Washington, respectively, for PV by PCR. The samples were obtained by owner coring of two lesions from one dog and laser removal of two lesions from the other dog. Total nucleic acid was extracted and DNA was amplified using two PCR primer sets that have been shown to amplify a broad range of PVs from humans and animals: FAP59/ FAP64 and MY11/ MY09. The DNA sequences were compared with all sequences in GenBank. Formalin-fixed, paraffin-embedded tissue from the footpads of four dogs with other inflammatory dermatoses were also examined. Results PV DNA was amplified from all four corn lesions, while no PV DNA was amplified from other tissues. Comparison of the 444-bp sequences amplified by the MY11/ MY09 primers identified two different PVs. One showed 96% nucleotide sequence similarity with the L1 gene of canine PV type 12. The other showed 78% similarity to canine PV type 16 and, therefore, represents a novel PV. In one of the corns, infection by two of the identified PVs was found. Discussion These results suggest PV infection could be involved in the pathogenesis of corns in Greyhound dogs.

Although substance use is prevalent in the United States, the majority of people who misuse substances do not receive appropriate treatment. This paper describes, (1) an interprofessional education (IPE) program for health professionals to provide Screening Brief Intervention and Referral to Treatment to rural substance use patients, and (2) compares registered nurses' [RNs] and behavioral health professionals' [BHPs] attitudes to work with those patients and their perceptions on IPE. A data analysis of 62 RNs and 36 BHPs shows statistically significant increases in both attitudes and perceptions. This paper discusses the implications of the IPE program vis-a-vis substance use treatment.

Background Dermatophilus congolensis causes a crusting dermatitis that affects horses. Diagnosis requires the identification of the organism with cytological evaluation of crust samples. This method can lack sensitivity in chronic cases. Hypothesis/Objectives To develop a probe-based real time quantitative polymerase chain reaction (RT-qPCR) test to assist with the diagnosis of dermatophilosis in horses. Animals Twenty six privately owned horses and seven horses from a research colony were used. Methods Crust samples, collected from 14 horses with suspected dermatophilosis and 12 horses with crusting skin disease not characteristic of dermatophilosis, were evaluated by cytological evaluation and RT-qPCR; the latter was also performed on hair samples collected from seven healthy horses. Results Cytological evaluation revealed organisms consistent with Dermatophilus congolensis from nine horses with suspected dermatophilosis, with only a few organisms seen from five samples. Cytological evaluation of all other crusts was negative for Dermatophilus. Other bacterial organisms were detected on cytological evaluation from 15 samples. RT-qPCR for Dermatophilus was positive from 11 crusts, whereas all other samples were negative. Two samples were cytologically negative but RT-qPCR positive for Dermatophilus. No samples were cytologically positive but RT-qPCR negative for Dermatophilus. Conclusion Results of this study show that RT-qPCR may be a more sensitive and easier method than cytological evaluation for the diagnosis of dermatophilosis in horses.

Objective—To compare methicillin-resistant Staphylococcus pseudintermedius (MRSP) and methicillin-susceptible S pseudintermedius (MSSP) infections in dogs. Design—Multicenter case-control study. Animals—Dogs with MRSP infections were matched, by hospital, with 2 MSSP controls, with the infections occurring immediately before and after the case infection. Procedures—Signalment, historical, clinical, treatment, and outcome data were documented. Conditional logistic regression was performed. A manual stepwise backward elimination procedure was used to build the multivariable model. Results—56 case and 112 control dogs were enrolled. Pyoderma was the most common infection type in both groups. In the final multivariable model, systemic administration of antimicrobials within 30 days prior to infection was significantly associated with an MRSP versus an MSSP infection (OR, 9.9; 95% confidence interval, 3.59 to 27.53). Conclusions and Clinical Relevance—The association of prior antimicrobial administration and MRSP infection indicated the potential impact of routine antimicrobial use in veterinary medicine on antimicrobial resistance and the need for prudent use of these important drugs. Mortality rate was not significantly different between MRSP and MSSP infections; the lack of a significant difference suggested that MRSP was inherently no more virulent than MSSP, provided the infection was properly diagnosed and appropriate treatment was started. Basic concepts such as prudent antimicrobial use and early diagnosis through timely submission of appropriate culture specimens therefore can be important measures to try to reduce the impact of this pathogen.

Two camels ( Camelus dromedarius ), 3- and 4-years-old, respectively, from an eastern Tennessee wildlife farm presented with persistent weight loss and large vulvar masses. An initial biopsy of the vulvar mass of one of the camels performed by a local veterinarian showed eosinophilic dermatitis. An allergic or parasitic dermatitis was suspected. The two camels were treated with one dose of sodium iodide (66 mg/ kg, in 1.0 L of normosolR, IV) and ivermectin 1% (200 ug/kg PO). Upon presentation at the Veterinary Teaching Hospital, University of Tennessee, additional biopsies of the masses again revealed eosinophilic dermatitis. Microscopic examination of a Gomori methenamine silver (GMS)-stained section prepared from the biopsy of one of the camels revealed the presence of fungal-like hyphae of a mold which was suspected to be Pythium insidiosum . The vulvar masses were surgically debulked in both animals and sodium iodide and Pythium -immunotherapy prescribed. Pythium insidiosum was isolated in culture and hyphae elements were detected in histological sections confi rming the diagnosis of pythiosis in both animals. Despite signs of progressive healing of the vulvar surgical areas, postoperative persistent weight lost in one of the camels suggested the possibility of gastro intestinal (GI) tract pythiosis. This camel died 5 months after the fi rst onset of clinical signs and unfortunately a necropsy was not performed. The other camel responded well to the combination of surgery, iodides, and immunotherapy and has currently rejoined the other members of the herd.

In this study, we sought to obtain data from HIV/AIDS patients served in Pennsylvania's AIDS Drug Assistance Program (ADAP) in 2005, to obtain input pertaining to the access, utilization, and quality of HIV treatment. Self-reported data through a survey instrument were solicited from all 2912 adults actively enrolled in the Pennsylvania ADAP in 2005. Of the enrollees who responded, 59% reported undetectable viral load, 71% reported CD4 counts of greater than 200 cells/mm3, and 80% reported ease in accessing medical care providers. A positive relationship with clinicians was reported by 93% of respondents, 77% were compliant with treatment, and 87% received timely standard of care. Persons living with HIV/AIDS who were served by Pennsylvania ADAP report higher quality health care, improved health status, improved medication adherence, and lower emergency department/hospital services utilization.

Follicular cysts are non-neoplastic skin lesions lined by follicular epithelium. The pathogenesis of these lesions is unclear. Multiple follicular cysts occur sporadically in dogs, horses and humans and are common in sheep. Here we report multiple follicular cysts in four aged alpacas (Vicugna pacos). Based on their histological features, they are most consistent with hybrid cysts. This is the first report of multiple follicular cysts in alpacas.

It is not uncommon for a hypothyroid dog to be receiving concurrent corticosteroids. As hypothyroid dogs receiving thyroid supplement need periodic monitoring, knowledge of whether prednisone alters thyroid hormone concentrations would be useful to determine whether testing can or should be done while the dog is receiving therapy and whether dose adjustments are appropriate. In this study, the effect of short-term anti-inflammatory prednisone was determined in dogs with naturally occurring hypothyroidism. Eight adult dogs were given prednisone (1.0 mg/kg, orally) daily for 7 days and then on alternate days for 14 days. Serum total thyroxine (T(4) ), free T(4) (fT(4) ), and thyroid-stimulating hormone (TSH) were measured on days 7, 21 and 28 and compared with baseline data. Total T(4) concentrations were significantly decreased after 7 days of anti-inflammatory prednisone, but were not significantly altered from baseline on days 21 or 28. Free T(4) and TSH concentrations were not significantly altered from baseline at any point during the study. Two dogs had decreased total T(4) concentrations on day 7, which may have resulted in an alteration in thyroid supplementation. Results showed that administration of prednisone at a dosage of 1 mg/kg, orally, once daily for 7 days decreased total T(4) , while fT(4) was unchanged, suggesting that fT(4) may be less affected by daily prednisone administration. Anti-inflammatory doses of prednisone administered every other day did not interfere with thyroid hormone monitoring.

Practical relevance Food allergy is recognized as a cause of non-seasonal dermatologic disease and pruritus in cats, though its exact prevalence remains unknown. Feline food allergy can also be associated with gastrointestinal, neurologic, respiratory and behavioral components. Patient group There are no breed, sex or age predispositions for developing food allergy, though there is some evidence that the Siamese and its crosses may be at increased risk. Clinical challenges Food allergy cannot be diagnosed simply on the basis of the distribution of pruritus, and many of the dermatologic reaction patterns observed in affected cats, such as miliary dermatitis, eosinophilic granuloma complex and alopecia, may be seen in cats with flea allergy and atopy; in some cases, cats may have concurrent allergic conditions. The only way to definitively diagnose food allergy is to identify a causative food component through a food elimination trial. However, palatability and client compliance can each be a problem; specifically, many owners are unwilling to perform a provocation challenge, which is required to confirm a suspected food allergy. For cats in which the existence of a food allergy is confirmed, a suitable maintenance diet then needs to be fed for the remainder of the patient's life. Evidence base Recent literature has revealed that there is marked variability in the clinical picture, response to treatment and outcome in food-allergic cats. This article reviews published literature and highlights clinically relevant observations pertinent to feline food allergy.

Squamous cell carcinoma (SCC) is the most common malignant cutaneous and oral neoplasm of cats. Papillomavirus (PV) DNA has been identified in a proportion of feline Bowenoid in situ carcinomas (BISCs), cutaneous SCCs and a single oral SCC, but its exact role in the pathogenesis remains unknown. In humans, it has been suggested that ultraviolet (UV) light and human PV (HPV) may act as cofactors in cutaneous SCC carcinogenesis. Little is known about the influence of UV light on PV prevalence in feline cutaneous lesions, including actinic keratosis (AK). Additionally, PV prevalence in noncutaneous feline lesions, including oral SCC, is largely not known. This study aimed to determine the presence of PV in 84 cats with premalignant and invasive SCC from cutaneous and noncutaneous sites using polymerase chain reaction and to investigate an association with UV light. Papillomaviral DNA was amplified from two of 12 cases of AK, seven of 22 BISCs, nine of 39 cutaneous SCCs and two of 35 non-cutaneous SCCs. Of the PV DNA sequenced, 50% was most similar to HPV of the genus Betapapillomavirus, while the other 50% was most similar to Felis domesticus PV type 2. Exposure to UV was not associated with an increase in PV for cutaneous SCC. The results of this study suggest that in the cat, HPV DNA may be detectible within a higher percentage of squamous lesions than previously demonstrated, UV exposure may not be a confounder for PV presence, and noncutaneous lesions may have a low prevalence of PV.

Estradiol concentrations are evaluated in canine serum as part of an adrenal panel used to diagnose atypical Cushing's syndrome and other endocrine abnormalities. Estradiol concentrations are often elevated in dogs without clinical signs of hyperestrogenism, and the significance of this elevation is unknown. The purpose of this study was to estimate the variation in estradiol concentrations in normal dogs. Ten neutered male and female dogs were enrolled in the study. Blood was collected from each dog at 2 h intervals, four times during a given day. This was repeated approximately 1 (week 2) and 5 weeks later (week 6). There was no attempt for a given dog to be started at the exact time or day each week. Results showed that estradiol concentrations ranged from 44.6 to 120.3 pg/mL with a mean of 70.4 pg/mL, which is greater than the upper limit of normal for our laboratory (69 pg/mL). The mean difference between the highest and lowest concentrations for each dog was 28.8 pg/mL, with a range of 12.5-53.5 pg/mL. Mean estradiol concentrations from week 6 (63.2 pg/mL) were significantly lower than those from week 1 (71.4 pg/mL; P=0.015) and week 2 (76.5 pg/mL; P=0.0004). These data show a wide range of variability in estradiol concentration both within and between dogs and that these measurements often exceed the normal ranges established by the laboratory. Therefore, diagnosis of hyperestrogenism or atypical Cushing's syndrome based on increased estradiol concentrations should require compatible clinical presentation of hyperestrogenism together with elevated serum estradiol.

Background Cutaneous adverse food reaction (CAFR) is diagnosed by performing an elimination diet trial utilizing prescription or home-cooked diets followed by provocative challenge. Objectives To report findings of PCR analysis of a prescription vegetarian diet (RCV) for undeclared proteins of animal origin, as well as to describe its utilization for diagnosis and management of dogs suspected of having CAFR. Animals Three client-owned dogs. Methods PCR analysis of RCV for 11 mammalian species and poultry. In three dogs, clinical examination, cytology, aerobic culture (if indicated) and at least one elimination diet trial with RCV. Results In our case series, all dogs had a history of pruritus and recurrent pyoderma that resolved with infection control and an elimination diet trial. In cases 1 and 2, a diagnosis of CAFR was made following an elimination trial with RCV and provocative challenge. Case 3 had a previously confirmed diagnosis of CAFR and RCV was successfully used to maintain remission of CAFR-related signs. PCR testing of RCV was negative for 11 mammalian species and poultry. Conclusions and clinical importance The RCV diet was found not to contain any undeclared mammalian or avian proteins. In this case series, the RCV was successfully used to diagnose and maintain three dogs with CAFR.

To determine the zoonotic risk from meticillin-resistant staphylococcal species or transfer of resistance genes between dogs with pyoderma and their owners, 25 dog–owner pairs were studied. Cultures were obtained from the dog’s lesions and the owner’s nasal cavity on the initial visit. Staphylococcus isolates were identified and antimicrobial susceptibility tests were performed by the Kirby-Bauer disk diffusion method. Presence of the mecA gene was determined by PCR. Staphylococcal Cassette Chromosome (SCCmec) typing was performed by multiplex PCR. Eighteen dogs had a meticillin-resistant staphylococcal species, with meticillin-resistant S. pseudintermedius (MRSP) isolated from 15 dogs. MRSP was isolated from two owners of dogs with MRSP skin infections. Both organisms had the same susceptibility pattern and SCCmec type. MRSP was not isolated from the owners after treating both dogs for 1 month. At least one coagulase-negative Staphylococcus spp. (CoNS) was isolated from each owner, with meticillin resistance found in 16 (64%) of the isolates. The mecA gene was identified in all but two of the meticillin-resistant Staphylococcus spp. Multiplex PCR identified SCCmec type V in all MRSP. The mecA gene-possessing CoNS isolates from owners contained either SCCmec type IVa or IVc. In conclusion, MRSP colonization of owners appeared to be uncommon and transient. Human nasal carriage of meticillin-resistant CoNS was common, but the SCCmec types were different from those in the canine MRSP isolates. Owners do not appear to be at great risk of zoonotic transfer of organisms or antimicrobial resistance genes from dogs with MRSP infections, but the findings should be confirmed with a much larger cohort. Resume Afin de determiner le risque zoonotique des staphylocoques resistant a la meticilline ou le transfert de genes de resistances entre chiens atteints de pyodermites et leurs proprietaires, 25 paires de chien et leur maitre ont eteetudies. Des cultures ont ete obtenues a partir des lesions du chien et de la cavite nasale de son maitre au cours de la visite initiale. Les isolats de Staphylococcus ont ete identifies et des tests de susceptibilite antimicrobienne ont ete realises par la methode de diffusion sur disque Kirby-Bauer. La presence du gene mecA a ete determinee par PCR. Le typage du SCCmec (Staphylococcal Cassette Chromosome) a ete realise par PCR multiplexe. Dix huit chiens etaient porteurs d’especes de staphylocoques resistant a la meticilline dont 15 etaient des S. pseudointermedius (MRSP). MRSP a ete isole de deux proprietaires de deux chiens atteints d’infection a MRSP. Les deux organismes avaient les memes susceptibilites et type de SCCmec. MRSP n’a plus ete isole des proprietaires apres un mois de traitement des deux chiens. Au moins un Staphylococcus coagulase-positive (CoNS) a ete isole de chaque proprietaire avec une resistance a la meticilline dans 16 (64%) isolats. Le gene mecA a ete identifie dans tous sauf deux des Staphylococcus spp. Resistant a la meticilline. SCCmec type V a ete identifie par PCR multiplex pour tous les MRSP. Les souches CoNS porteurs du gene mecA isolees des proprietaires contenaient SCCmec de type IVa ou IVc. En conclusion, la colonisation des proprietaires par MRSP semble rare et transitoire. Le portage nasal humain de CoNS resistant a la meticilline etait frequent mais les types de SCCmecetaient differents des isolats de MRSP canins. Le transfert d’organismes ou de genes de resistance antimicrobiens de chiens atteins d’infections a MRSP a leur proprietaire n’apparait pas comme un risque majeur zoonotique mais ces resultats devraient etre confirmes par des essais sur un plus grand nombre de chiens. Resumen Para determinar el riesgo zoonotico de las especies de estafilococo resistentes a meticilina o la transferencia de genes de resistencia entre perros con pioderma y sus propietarios, 25 parejas perro-propietario fueron incluidas en este estudio. Los cultivos se obtuvieron de lesiones de perros y de la cavidad nasal de los propietarios en la visita inicial. Se identificaron aislados de Staphylococcus y la susceptibilidad antimicrobiana se evaluo por el metodo de difusion de disco de Kirby-Bauer. Se determino la presencia del gen mecA mediante PCR. El fenotipado del Cassette Cromosomal de estafilococo(SCCmec) se evaluo mediante PCR multiplex. Dieciocho perros tenian especies de estafilococos resistentes a meticilina, siendo S. pseudintermedius resistente a meticilina (MRSP) el aislado mas frecuente en 15 perros. MRSP fue aislado en dos propietarios con infecciones de la piel causadas por MRSP. Ambos organismos tenian el mismo patron de susceptibilidad y el mismo tipo de SCCmec. No se aislo MRSP de los propietarios tras tratar los perros durante un mes. Al menos un estafilococo coagulasa negativo (CoNS) se aislo de cada propietario, encontrandose resistencia a meticilina en 16 (64%) de los aislados. El gen mecA fue identificado en todos los aislados excepto en dos de las especies de estafilococos resistentes a meticilina. La PCR multiplex identifico SCCmec de tipo V en todos los aislados MRSP. Los aislados CoNS con el gen mecA de los propietarios contenian SCCmec tipo IVa o IVc. En conclusion, la colonizacion con aislados MRSP en los propietarios parece ser poco comun y transitoria. Portadores humanos de CoNS resistentes a meticilina en la cavidad nasal fueron comunes, pero los tipos de SCCmec fueron diferentes de los aislados caninos. Los propietarios no parecen estar en riesgo de transferencia zoonotica de organismos o de los genes de resistencia antimicrobiana de perros con infecciones causadas por MRSP, pero estos hallazgos deben ser confirmados en una poblacion mayor. Zusammenfassung Um das Zoonoserisiko durch Meticillin-resistente Staphylokokken Spezies oder durch den Transfer von resistenten Genen zwischen Hunden mit Pyodermie und ihren BesitzerInnen zu bestimmen, wurden 25 Hunde-BesitzerInnen Paare untersucht. Bei der ersten Vorstellung wurden Kulturen von den Hautveranderungen der Hunde und von den Nasenhohlen der BesitzerInnen genommen. Staphylokokkus Isolate wurden bestimmt und Antibiogramme mittels Disc-Diffusionsmethode nach Kirby-Bauer durchgefuhrt. Das Vorkommen des mecA Gens wurde mittels PCR bestimmt. Staphylococcal Cassette Chromosome (SCCmec) Typisierung wurde mittels multiplex PCR durchgefuhrt. Achtzehn Hunde hatten eine Meticillin-resistente Staphylokokken Spezies, wobei ein Meticillin-resistenter S. pseudointermedius (MRSP) von 15 Hunden isoliert wurde. MRSP wurde von zwei BesitzerInnen von Hunden mit MRSP Haut- Infektionen isoliert. Beide Organismen zeigten dieselbe Empfindlichkeit und denselben SCCmec Typ. Nachdem beide Hunde einen Monat lang behandelt worden waren, wurde der MRSP von den BesitzerInnen nicht mehr isoliert. Mindestens ein Koagulase-negativer Staphylokokkus (CoNS) wurde von jedem Besitzer/jeder Besitzerin isoliert, wobei eine Meticillin Resistenz bei 16 (64%) der Isolate gefunden wurde. Das mecA Gen wurde in allen auser zwei der Meticillin-resistenten Staphylokokken spp. bestimmt. Mittels Multiplex PCR wurde in allen MRSP das SCCmec Typ V identifiziert. Die CoNS Isolate von BesitzerInnen, welche das mecA Gen besasen, hatten entweder das SCCmec Typ IVa oder IVc. Zusammenfassend schien eine MRSP Kolonisierung der BesitzerInnen unublich und transient zu sein. Menschliche Trager von Meticillin-resistenten CoNS in der Nase waren haufig, aber die SCCmec Typen waren verschieden von denen der caninen MRSP Isolate. BesitzerInnen scheinen keinem grosen Zoonoserisiko durch eine Ubertragung von Organismen oder antimikrobiellen Resistenzgenen von Hunden mit MRSP Infektionen ausgesetzt zu sein, aber diese Ergebnisse sollten durch eine wesentlich grosere Gruppe bestatigt werden.

This report describes a dog that developed erythema multiforme in temporal association with administration of the sulphonamide-based anticonvulsant drug zonisamide. Similar adverse drug reactions have been associated with sulphonamide antimicrobial drugs. Caution should be exercised when prescribing this medication for dogs with known hypersensitivity to sulphonamides.

This study examines the effectiveness of HIV clinical consultation offered by the Health Resources and Services Administration (HRSA) funded AIDS Education and Training Centers (AETC) program. The study demonstrates that the consultation provided is effective and useful in providing current treatment recommendations to clinicians in the field caring for HIV-infected patients. The study also shows that individual clinicians seeking clinical consultation from AETC consultants implement the recommendations provided.

Objective—To evaluate effects of trimethoprim-sulfamethoxazole (T/SMX) on thyroid function in dogs. Animals—6 healthy euthyroid dogs. Procedure—Dogs were administered T/SMX (14.1 to 16 mg/kg, PO, q 12 h) for 3 weeks. Blood was collected weekly for 6 weeks for determination of total thyroxine (TT4), free thyroxine (fT4), and canine thyroid- stimulating hormone (cTSH) concentrations. Schirmer tear tests were performed weekly. Blood was collected for CBC prior to antimicrobial treatment and at 3 and 6 weeks. Results—5 dogs had serum TT4 concentrations equal to or less than the lower reference limit, and 4 dogs had serum fT4 less than the lower reference limit after 3 weeks of T/SMX administration; cTSH concentrations were greater than the upper reference limit in 4 dogs. All dogs had TT4 and fT4 concentrations greater than the lower reference limit after T/SMX administration was discontinued for 1 week, and cTSH concentrations were less than reference range after T/SMX administration was discontinued for 2 weeks. Two dogs developed decreased tear production, which returned to normal after discontinuing administration. Conclusions and Clinical Relevance—Results suggest that administration of T/SMX at a dosage of 14.1 to 16 mg/kg, PO, every 12 hours for 3 weeks caused decreased TT4 and fT4 concentrations and increased cTSH concentration, conditions that would be compatible with a diagnosis of hypothyroidism. Therefore, dogs should not have thyroid function evaluated while receiving this dosage of T/SMX for > 2 weeks. These results are in contrast to those of a previous study of trimethoprim- sulfadiazine. (Am J Vet Res 2005;66:256–259)

Objective—To determine the methicillin-resistant profile of staphylococcal isolates from the skin of dogs with pyoderma. Animals—90 dogs with pyoderma. Procedure—Staphylococci isolated from dogs with pyoderma were tested for susceptibility to methicillin by use of a standard disk diffusion test with oxacillin disks. The DNA extracted from the isolates was tested for the mecA gene that encodes the penicillinbinding protein 2a (PBP2a) by use of a polymerase chain reaction (PCR) assay. The expression of PBP2a was determined with a commercial latex agglutination assay. Species of staphylococcal isolates were identified by use of morphologic, biochemical, and enzymatic tests. Results—Most of the isolated staphylococci were methicillin-susceptible, coagulase-positive Staphylococcus intermedius isolates. Whereas only 2 of 57 S intermedius isolates were resistant to methicillin, approximately half of the isolates had the mecA gene and produced PBP2a. Staphylococcus schleiferi was the second most common isolate. Widespread resistance to methicillin was found among S schleiferi isolates. More coagulase-negative S schleiferi isolates were identified with mecA gene-mediated resistance to methicillin, compared with coagulase-positive S schleiferi isolates. Conclusions and Clinical Relevance—The latex agglutination assay for the detection of PBP2a expression coupled with the PCR assay for the mecA gene may provide new information about emerging antimicrobial resistance among staphylococcal isolates. (Am J Vet Res2004;65:1265–1268)

There is general agreement that nursing-led research is under-resourced with respect to funding for academic preparation and for the conduct of clinical research. All of the previous literature, however, focuses on the nursing profession as a whole and provides little insight into the capacity and resource issues for specialty practice areas such as children's nursing. This paper provides an overview of the state of paediatric nurse-led research capability, capacity and output within the limitations of the available data. The findings reveal that paediatric nursing in the UK currently has very limited capacity to conduct and utilise research in the care of children and is in a weak position to create a future workforce that has this capacity. Nurse-led research on children's health issues is urgently needed if the UK paediatric nursing workforce is to deliver the standard of care specified in the Children's National Service Framework. However, strategies for accelerating the development of research capacity and output within paediatric nursing all require targeted financial investment to build capacity. This analysis is illustrative of the need for a more detailed investigation of nursing research capacity by specialty. Key messages and action points are suggested for nurses in higher education, professional nursing organizations, doctorally prepared nurses and their employers.

The purpose of this study was to determine if there are specific steroid hormone aberrations associated with suspect endocrine alopecias in dogs in whom hypothyroidism and hyperadrenocorticism have been excluded. Steroid hormone panels submitted to the UTCVM endocrinology laboratory over a 7.5-year period (783 samples) from dogs with alopecia were reviewed. During this period, 276 dogs met the criteria for inclusion and were comprised of 54 different breeds. Approximately 73% of dogs had at least one baseline or post-ACTH stimulation steroid hormone intermediate greater than the normal range. The most frequent hormone elevation noted was for progesterone (57.6% of samples). When compared with normal dogs, oestradiol was significantly greater in Keeshond dogs and progesterone was significantly greater in Pomeranian and Siberian Husky dogs. Not all individual dogs had hormone abnormalities. Chow Chow, Samoyed and Malamute dogs had the greatest percentage of normal steroid hormone intermediates of the dogs in this study. Baseline cortisol concentrations were significantly correlated with progesterone, 17-hydroxyprogesterone (17-OHP) and androstenedione. Results of this study suggest that the pathomechanism of the alopecia, at least for some breeds, may not relate to steroid hormone intermediates and emphasizes the need for breed specific normals.

The purpose of this study was to determine if there are specific steroid hormonal aberrations associated with suspect endocrine alopecias in dogs where hypothyroidism and hyperadrenocorticism have been excluded. Steroid hormone panels submitted to the UTCVM endocrinology laboratory over a 7.5-year period (783 samples) from dogs with alopecia were reviewed. To be included in the final analysis, complete information about age, sex, neuter status and breed was required; hypothyroidism had been ruled out; and cortisol concentration post-ACTH stimulation was less than 200 ng mL−1. A total of 276 dogs met the criteria for inclusion (seven intact females, 32 intact males, 134 spayed females, 103 neutered males) and comprised of 54 different breeds. Approximately 73% of dogs had at least one steroid hormone intermediate greater than the normal range. The most frequent hormone elevation was noted in baseline and/or post-ACTH stimulation progesterone (57.9% of samples). Breeds that contained seven or more dogs were statistically compared. Only malamute dogs failed to show an increase in progesterone for any dog. When compared with normal dogs, oestradiol was significantly greater in keeshond dogs and baseline progesterone was significantly greater in pomeranians and husky breed dogs. While significant difference existed among breeds, neither baseline nor post-stimulation 17-hydroxyprogesterone differed significantly from normal values. Chow-chow and malamute dogs had the greatest percentage of dogs with completely normal steroid hormone intermediates. Results of this study suggest that the pathomechanism of the alopecia, at least for some breeds, may not relate to steroid hormone intermediates. Funded by the Companion Animal Fund, Department of Small Animal Clinical Sciences.

Staphylococcus schleiferi is a recently recognized organism with potential pathogenic implications in human and veterinary medicine. The purpose of this study was to determine the frequency of S. schleiferi in canine pyodermas and see if methicillin resistance (MR) is associated with this organism. Cultures were obtained from dogs with pyoderma over a 1-year period. It was determined if the pyoderma was a first-time or recurrent one, and if the dog was receiving antibiotics at the time of culture. Of 15 dogs with first-time pyoderma, four dogs were receiving antibiotics at the time of culture: S. schleiferi was not cultured from any dog in this group. Cultures were obtained from 27 dogs with recurrent infection that were not receiving antibiotics: S. schleiferi was cultured from five of these dogs; three of the five S. schleiferi-cultured isolates were MR. Cultures were obtained from 12 dogs with recurrent pyoderma while receiving antibiotics: S. schleiferi was cultured from nine of these dogs; eight of the nine S. schleiferi-cultured isolates were MR. Five of the 12 dogs had been cultured previously while not receiving antibiotics. Three of these dogs cultured positive for S. intermedius initially, and then -cultured; one dog cultured S. schleiferi positive both times; and one dog cultured S. schleiferi positive, then S. intermedius positive. To the authors’ knowledge, this is the first report of S. schleiferi associated with canine pyoderma. Results indicate that S. schleiferi is cultured more often from dogs with recurrent pyodermas while receiving antibiotics. MR is frequently associated with S. schleiferi. Funded by the Department of Small Animal Clinical Sciences and a grant from the Center of Excellence.

Background Mycoplasma spp. are commensal organisms found in association with the mucus membranes of all mammalian species and are implicated in bacterial infections of many different locations. Mycoplasma spp. as a primary pathogen associated with otitis media in cats has not been reported. Objectives To describe three cats with Mycoplasma infection of the middle ear associated with various underlying disease processes. Animals Three client-owned cats. Methods Clinical examination, aerobic culture of the middle ear and computed tomography or magnetic resonance imaging of the skull. Results Mycoplasma spp. were grown on aerobic culture from the middle ear of three cats. In Case 1, concurrent neoplasia of the bulla was identified. Mycoplasma alone was cultured in Case 2 and Mycoplasma was grown in addition to Bordetella in Case 3. Case 1 was euthanized, Case 2 responded to Mycoplasma targeted therapy and Case 3 responded to Bordetella targeted therapy. Conclusions and clinical importance Mycoplasma infections of the middle ear may be clinically important and require targeted treatment in some cases.

A prospective study was undertaken to compare intravenous tetracosactrin at doses of 5 microg/kg and 250 microg for diagnosing hyperadrenocorticism in dogs. Both healthy dogs and dogs with pituitary-dependent hyperadrenocorticism were evaluated with the two doses of the drug, and serum cortisol concentrations were compared at 60 minutes post-stimulation. Some of the dogs had additional samples taken at 90 and 120 minutes. For four dogs with hyperadrenocorticism, timed samples were also obtained at 150, 180 and 240 minutes post-injection. Cortisol concentrations 60 minutes after stimulation with either 5 microg/kg or 250 microg intravenous tetracosactrin were similar for both healthy dogs and dogs with hyperadrenocorticism. The lower dose can therefore be used for diagnosing hyperadrenocorticism in dogs.

Background Alopecia X is a common cause of noninflammatory alopecia in Pomeranian dogs. In the past, treatment with growth hormone injections resulted in hair regrowth in many individuals. Progesterone can induce mammary-derived growth hormone and is used to treat dogs with congenital growth hormone deficiency. Hypothesis/Objectives To determine whether progesterone induces endogenous insulin-like growth factor-1 (IGF-1) and causes hair regrowth in dogs with alopecia X. Animals Eight neutered Pomeranian dogs with alopecia X for 1–2 years. Methods In part 1, two male and three female dogs received 5 mg/kg medroxyprogesterone acetate injected subcutaneously (s.c.) every 4 weeks for a total of four injections. In part 2, one male and two female dogs received 10 mg/kg medroxyprogesterone acetate injected s.c. every 4 weeks for four injections. Dogs were monitored monthly with physical examinations and complete blood counts, chemistry panels and urinalyses. In part 3, two coated Pomeranian dogs and two normal-coated small breed dogs received two s.c. injections of 10 mg/kg medroxyprogesterone acetate. Serum was saved from each visit for IGF-1 analysis. Results In part 1, two dogs had partial hair regrowth of ~40–60%. In part 2, one dog had partial hair regrowth and one dog had complete hair regrowth 2 months after completion of the study. Unlike the normal-coated dogs, whose IGF-1 concentrations increased, the IGF-1 concentrations in alopecic and coated Pomeranian dogs were low and remained unchanged. No adverse effects were noted. Conclusions and clinical importance Results of this study showed that medroxyprogesterone injections resulted in partial hair regrowth in three and complete hair regrowth in one of eight Pomeranian dogs with alopecia X.

Background Demodex gatoi causes a pruritic dermatitis in cats. Diagnosis requires the demonstration of mites using superficial skin scrapings or faecal flotation, which can be insensitive. Hypothesis/objectives The goal of this study was to develop a molecular method to diagnose D. gatoi infection in cats and distinguish these mites from Demodex cati. Animals Fifty-three shelter cats, 11 cats from a closed research colony and 12 privately owned cats were used. Methods Demodex gatoi and D. cati were obtained from scrapings of cat skin. The 16S rRNA DNA was amplified by PCR, sequenced and compared with available Demodex sequences. Hair and skin samples were also collected for microscopic examination and DNA isolation. Results DNA sequences were obtained from D. gatoi and D. cati. qPCR with D. gatoi specific primers and probe amplified DNA isolated from D. gatoi and not D. cati. Conversely, D. cati qPCR primers and probe amplified D. cati DNA and not D. gatoi. Five of the shelter cats were positive for D. gatoi. Two of these cats were pruritic, and the other three were in contact with these cats. Only one cat was positive for D. gatoi on skin scraping but was negative for D. gatoi or D. cati DNA. Conclusion Results from this study show D. gatoi and D. cati to be distinct species. A novel qPCR test for the identification and differentiation of D. gatoi and D. cati was developed. Once optimized, this test could provide a valuable technique for the diagnosis of D. gatoi infection.