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Key Clinical Message Drug‐induced acute pancreatitis is a potentially ignored diagnosis that must be precisely valued. Drug‐induced acute pancreatitis can be considered the third common cause of acute pancreatitis after ruling out alcohol and gallstones. Levofloxacin belongs to a class of fluoroquinolone antibiotics used for treating various infections. Besides photosensitivity and liver toxicity, levofloxacin can induce acute pancreatitis, although rarely described. We highlight a case of acute pancreatitis in a female induced by levofloxacin. She presented with typical signs and symptoms of acute pancreatitis and had been taking levofloxacin for urinary tract infections for the last 3 days. After ruling out all other possible causes, her clinical picture, laboratory results, and imaging findings confirmed acute pancreatitis induced by levofloxacin.

Abstract Most commonly caused by trauma, basal skull fractures present with a range of clinical signs. These include periorbital ecchymosis, as seen in this case, as well as rhinorrhea, otorrhoea and post‐mastoid ecchymosis. Suspected cases must be managed with appropriate imaging and medical or surgical treatment as indicated.

The commensal bacteria that are present in our body since infancy are known to play a role in metabolism, in health as well as disease. Diabetes is a growing epidemic, and a long-term solution that targets the disease at the molecular level is yet to be developed. In this article, we have reviewed the link between the body’s microbiota and disturbed glucose metabolism, as well as the reasons for bacterial dysbiosis and the mechanisms by which it causes inflammation. The link between dysbiosis and diabetes is convincing, particularly since probiotics have been shown to be of some benefit in normalising disturbed metabolism in diabetes patients. Probiotics have recently been found to have a wide application in diseases such as autoimmune, inflammatory, and allergic conditions. The efficacy of probiotics in diabetes has been proven by their ability to lower fasting glucose and insulin levels in a preclinical setting as well as in human trials. However, there is heterogeneity in these studies, including the species used, probiotic dosage, and the magnitude of efficacy. Based on the robust understanding of the benefits of probiotics in diabetes at the cellular level, in both animal studies and clinical trials, combined with their excellent tolerability, probiotics should be explored for their application in clinics.

Being able to prepare a diagnostic blood smear for evaluation is an essential skill for veterinary practitioners. While this basic technique can be demonstrated via videos or illustrations, it can only be learned through practice and with feedback. With the necessity for virtual learning experiences during the COVID-19 pandemic, a model was developed and paired with an online module to facilitate at home instruction and practice of blood smear preparation. Materials for the simulated blood included water, corn starch, and gel-based food coloring. Students were supplied a kit that, in addition to the simulated blood, included slides, Kimwipes®, microhematocrit tubes, a disposable pipette, a cleaning cloth, and disposable gloves. The module includes an introduction to making blood smears, an explanation of simulation kit contents, a demonstration video, and a reflection component. The simulation experience was developed for a short course with 12 students, and the required clinical pathology course, which has 100 students. Overall, the model is cost-effective, and students felt that the activity was useful to practice making blood smears and provided a good introduction and useful explanation of the overall technique in a virtual/ distance learning environment.

There is a concern over long-term retention of knowledge in professional programs. The goal of this study was to evaluate the retention of veterinary clinical pathology knowledge between the fourth-semester and fourth-year clinical pathology courses. We hypothesize that students will forget a significant amount of content area knowledge between the fourth semester and fourth year in the Doctor of Veterinary Medicine (DVM) program. We further hypothesize that a review of material during the fourth-year clinical pathology rotation will help students rebuild existing knowledge and increase performance on specific test questions, between T2 (rotation pre-test) and T3 (rotation post-test). Initial mastery of course material was assessed via a 94-item multiple-choice final exam (T1) given in the semester 4 clinical pathology course. Retention of course material from semester 4 to year 4 was assessed via a 55-item multiple-choice pre-test, administered at the start of the clinical pathology rotation in year 4 while learning/mastery during the clinical rotation was assessed via a 55-item multiple-choice post-test, administered at the end of each clinical pathology rotation. In this study, evidence of knowledge retention between semester 4 and year 4 was 55.5%. There is a small increase in the measure of knowledge gain from the beginning to the end of the rotation. As an added benefit, we were able to use identified trends for retention of knowledge within specific subject areas as a mechanism to evaluate the effectiveness of our course and reallocate additional instructional time to topics with poorer retention.

It is recommended that institutions develop academic conduct policies to help preserve academic integrity, enforce compliance, and aid in legal defensibility. These policies should also articulate reasonable consequences for persons found in violation. The problem, however, is that all academic misconduct offenses are not created equal, and determining reasonable consequences for these violations can be particularly challenging due to their subjective nature. Thus, the purpose of this study was to introduce a novel method for more objectively determining reasonable sanctions for several academic misconduct offenses of varying degrees of severity. We utilized a variation of the Bookmark procedure, a popular standard-setting technique used primarily by psychometricians in high-stakes testing environments, to investigate empirical survey data and develop policy recommendations. We encourage others to use this procedure, where appropriate, to identify appropriate cut scores and ranges to aid in policy development across a variety of contexts.

Many medical and professional programs implement policies that prohibit students from asking questions during examinations. The reasoning behind these policies remains unclear to some, as there is a lack of literature addressing this topic. The purpose of this article is to present the rationale behind such policies and to discuss why these policies may help promote fairness and preserve score validity.

Objective: Clinical and research usefulness of articles can depend on image quality. This study addressed whether scans of figures in black and white (B&W), grayscale, or color, or portable document format (PDF) to tagged image file format (TIFF) conversions as provided by interlibrary loan or document delivery were viewed as acceptable or useful by radiologists or pathologists., Methods: Residency coordinators selected eighteen figures from studies from radiology, clinical pathology, and anatomic pathology journals. With original PDF controls, each figure was prepared in three or four experimental conditions: PDF conversion to TIFF, and scans from print in B&W, grayscale, and color. Twelve independent observers indicated whether they could identify the features and whether the image quality was acceptable. They also ranked all the experimental conditions of each figure in terms of usefulness., Results: Of 982 assessments of 87 anatomic pathology, 83 clinical pathology, and 77 radiology images, 471 (48%) were unidentifiable. Unidentifiability of originals (4%) and conversions (10%) was low. For scans, unidentifiability ranged from 53% for color, to 74% for grayscale, to 97% for B&W. Of 987 responses about acceptability (n=405), 41% were said to be unacceptable, 97% of B&W, 66% of grayscale, 41% of color, and 1% of conversions. Hypothesized order (original, conversion, color, grayscale, B&W) matched 67% of rankings (n=215)., Conclusions: PDF to TIFF conversion provided acceptable content. Color images are rarely useful in grayscale (12%) or B&W (less than 1%). Acceptability of grayscale scans of noncolor originals was 52%. Digital originals are needed for most images. Print images in color or grayscale should be scanned using those modalities.

Objective: To determine the frequency of clinically relevant abnormalities missed by failure to perform a blood smear evaluation in a specific subset of dogs receiving chemotherapy and to compare automated and manual neutrophil counts in the same population., Design: Retrospective case series., Animals: 50 dogs receiving chemotherapy with a total nucleated cell count > 4,000 nucleated cells/μL., Procedures: 50 blood smears were evaluated for abnormalities that have strong potential to change the medical plan for a patient: presence of blast cells, band neutrophils, nucleated RBCs, toxic change, hemoparasites, schistocytes, and spherocytes. Automated and manual neutrophil counts were compared., Results: Blood smears from 10 (20%) patients had ≥ 1 abnormalities. Blast cells were identified on 4 (8%) blood smears, increased nucleated RBCs were identified on 5 (10%), and very mild toxic change was identified on 2 (4%). Correlation coefficient of the neutrophil counts was 0.96. Analysis revealed a slight bias between the automated and manual neutrophil counts (mean ± SD difference, -0.43 × 10(3)/μL ± 1.10 × 10(3)/μL)., Conclusions and Clinical Relevance: In this series of patients, neutrophil count correlation was very good. Clinically relevant abnormalities were found on 20% of the blood smears. An automated CBC appears to be accurate for neutrophil counts, but a microscopic examination of the corresponding blood smear is still recommended; further studies are needed to determine whether the detection or frequency of these abnormalities would differ dependent on chemotherapy protocol, neoplastic disease, and decision thresholds used by the oncologist in the ordering of a CBC without a blood smear evaluation.

Background: Thrombocytosis has been associated with various conditions, including inflammation, neoplasia, iron deficiency, splenectomy, and drug administration., Objective: The aim of this study was to characterize diseases and conditions associated with thrombocytosis in dogs., Methods: In this retrospective study, dogs with thrombocytosis (platelet count > 600 × 10(3) /μL) and complete medical records during a 1-year period were included, and breed, sex, age, CBC results, alkaline phosphatase and gamma-glutamyltransferase activities in some dogs, administration of glucocorticoids or vincristine, and primary diagnosis were evaluated., Results: Thrombocytosis was found in 240 of 5342 dogs (4.6%), and 165 (3.1%) met inclusion criteria. Thrombocytosis was secondary in all dogs, and underlying diseases and conditions (n,%) were neoplasia (56, 33.9%), inflammation (55, 33.3%), miscellaneous disorders (26, 15.8%), neoplasia plus a second disease (13, 7.9%), endocrine diseases (8, 4.8%), and multiple diseases (7, 4.2%). In dogs with neoplasia, carcinomas (24) and round cell neoplasms (20), especially lymphoma and mast cell tumor, were the most frequent tumors. Inflammatory disorders consisted of immune-mediated disorders (11), neurologic diseases (8), infectious diseases (6), allergic disease (5), orthopedic diseases (4), gastrointestinal diseases (4), and miscellaneous conditions (17). Of the 165 dogs, 73 (44.2%) had received glucocorticoids (55) or vincristine (18) Marked (850-969 × 10(3) platelets/μL) or extreme ( ≥ 970 × 10(3) platelets/μL) thrombocytosis occurred in 24 (14.5%) dogs; 12 (50.0%) had neoplasia. Thromboembolism occurred in 13 (7.9%) dogs., Conclusions: Thrombocytosis in dogs occurred most frequently secondary to neoplastic and inflammatory diseases and was commonly associated with glucocorticoid and vincristine administration. Thromboembolic complications occurred in a small number of patients. Marked or extreme thrombocytosis was more likely to occur with neoplasia than with other conditions., (© 2012 American Society for Veterinary Clinical Pathology.)

Background: Degree of polychromasia and reticulocyte counts are commonly used in veterinary medicine to evaluate response to anemia. The quantitative association between these 2 measurements has not been evaluated., Objective: The aim of this retrospective study was to compare automated reticulocyte percents and counts with those of polychromatophilic cells on blood films from dogs., Methods: Blood films and medical records from 30 clinically healthy dogs and 60 anemic dogs were evaluated. Manual percentage of polychromatophilic cells (MPP) was determined by counting cells in 10 1000× fields, and automated reticulocyte percentage (ARP) was measured using an ADVIA 120 hematology analyzer; absolute polychromatophilic cell and reticulocyte counts were then calculated. Degree of polychromasia, estimated as slight, mild, moderate, marked was documented. Percentages and absolute counts of polychromatophilic cells and reticulocytes were compared using least squares regression and Pearson's correlation coefficients., Results: The reference interval for MPP in healthy dogs was 0.21-0.26%. Correlation between MPP and ARP was highest when all levels were considered (n = 60, r = .98, P < .0001), strong when ARP was > 5% (n = 20, r = .91, P < .0001), and poor when ARP was 1-2% (n = 20, r = .35, P < .0001). Results were similar for comparisons of absolute reticulocyte and polychromatophilic cell counts, with the best correlation found when all levels of counts were analyzed together (r = .96) and for automated reticulocyte counts > 150,000/μL (r = .94). Correlation of estimates of polychromasia with ARP was good (r = .83)., Conclusion: In anemic dogs MPP can be used for assessment of regeneration, especially in dogs with higher levels of ARP. Standard quantification of reticulocytes is more accurate in dogs with lesser degrees of regeneration., (© 2012 American Society for Veterinary Clinical Pathology.)

Dogs with and without lymphoma have undergone hematopoietic cell transplantation in a research setting for decades. North Carolina State University is currently treating dogs with B- and T-cell lymphoma in a clinical setting with autologous peripheral blood progenitor cell transplants, using peripheral blood CD34+ progenitor cells harvested using an apheresis machine. Complete blood counts were performed daily for 15 to 19 days posttransplantation to monitor peripheral blood cell nadirs and subsequent CD34+ cell engraftment. This study documents the hematologic toxicities of total body irradiation in 10 dogs and the subsequent recovery of the affected cell lines after peripheral blood progenitor cell transplant, indicating successful CD34+ engraftment. All peripheral blood cell lines, excluding red blood cells, experienced grade 4 toxicities. All dogs had ≥ 500 neutrophils/μl by day 12, while thrombocytopenia persisted for many weeks. All dogs were clinically normal at discharge.

Awareness of student learning-style preferences is important for several reasons. Understanding differences in learning styles permits instructors to design course materials that allow all types of learners to absorb and process information. Students who know their own learning style are better able to help themselves in courses taught in a non-preferred method by developing study strategies in line with their preferred learning method. We used the Felder and Solomon Index of Learning Styles to assess the learning-style profiles of 150 veterinary students in three consecutive years. Students were predominantly active (56.7%), sensing (79.3%), visual (76.7%), and sequential (69.3%). Most were balanced on the active-reflective (59.3%) and global-sequential (50%) dimensions, and 61.3% and 54% were moderately to strongly sensing and visual, respectively. Small but significant numbers of students were moderately to strongly intuitive (8.7%), verbal (13%), and global (12%). The most common patterns were active-sensing-visual-sequential (26%), reflective-sensing-visual-sequential (19.3%), active-sensing-visual-global (8.7%), and active-sensing-verbal-sequential (8.7%). Although most students (65.3%) were balanced on one to two dimensions, 77.3% had one or more strong preferences. Our results show that although people have dominant learning-style preference and patterns, they have significant minor preferences and patterns across all dimensions with moderate to strong preferences on each scale. These results indicate that a balanced approach to teaching is essential to allow all students to learn optimally.

A 5-year-old neutered male Cavalier King Charles Spaniel was evaluated for a 3-week history of progressive paresis. The dog had been receiving potassium citrate capsules to acidify urine for the past 2 years because of an earlier history of urolithiasis. Results of neurologic examination, spinal cord radiography, and magnetic resonance imaging of the skull and spinal cord revealed no lesions that could have accounted for the neurologic signs. The main abnormalities on a clinical chemistry profile were marked hyperchloremia (179 mmol/L, reference interval 108-122 mmol/L) and an anion gap of -50.4 mmol/L (reference interval 16.3-28.6 mmol/L). Because of the severe hyperchloremia, serum bromide concentration was measured (400 mg/dL; toxic concentration >150 mg/dL; some dogs may tolerate up to 300 mg/dL). Analysis of the potassium citrate capsules, which had been compounded at a local pharmacy, yielded a mean bromide concentration of 239 mg/capsule. Administration of the capsules was discontinued and there was rapid resolution of the dog's neurologic signs. This case of extreme bromide toxicity, which apparently resulted from inadvertent use of bromide instead of citrate at the pharmacy, illustrates the importance of knowing common interferents with analyte methodologies and of pursing logical additional diagnostic tests based on clinical and laboratory evidence, even when a patient's history appears to rule out a potential etiology.

Case Description: A 4-year-old spayed female mixed-breed dog with a history of allergic skin disease was examined because of regurgitation, coughing, and dysphagia that began 15 days after abdominal surgery for correction of gastric dilatation and volvulus., Clinical Findings: Severe diffuse esophagitis, esophageal dysmotility, and a benign esophageal stricture at the level of the base of the heart were identified via contrast videofluoroscopy and esophagoscopy. Severe diffuse eosinophilic ulcerative esophagitis was confirmed by histologic examination of esophageal biopsy specimens and cytologic evaluation of specimens obtained by use of a cytology brush. Esophageal eosinophils were evident (14% to 50% of the inflammatory cell population and > 25 eosinophils/hpf)., Treatment and Outcome: No clinical or endoscopic improvement was evident after treatment with antireflux medications, including a proton-pump inhibitor, following an initial esophageal bougienage procedure. An excellent response characterized by resolution of dysphagia and regurgitation with marked improvement of the esophageal mucosa was evident following intralesional and systemic administration of glucocorticoids, 2 additional esophageal bougienage procedures, and feeding of an elimination diet., Clinical Relevance: To our knowledge, the information reported here is the first description of eosinophilic esophagitis (EE) in a dog. Many similarities exist between the condition in the dog reported here and EE in humans. This clinical report highlights the need to consider EE as a differential diagnosis for esophagitis and esophageal strictures in dogs. When appropriate, esophageal biopsy or cytologic specimens should be obtained and examined to investigate the possibility of EE.

A 9-year-old spayed female German Shepherd dog with a history of orthopedic disease was presented to the North Carolina State University Veterinary Teaching Hospital for evaluation of recent, progressive, bilateral, hindlimb ataxia. Analysis of cisternal and lumbar cerebrospinal fluid (CSF) samples revealed normal total nucleated cell counts and a mild increase in protein concentration in the lumbar sample. In cytocentrifuged specimens of both CSF samples, aggregates of refractile, angular to irregular, pale blue to colorless, crystalline material were observed in the background. Some of the material appeared birefringent under polarized light. Differentials for the material included contrast agent, epidural anesthetics or other pharmacologic agents, or artifact introduced through sample processing, collection, or handling. Based on investigation of clinical and laboratory processes it was determined that tubes used to collect CSF in the hospital recently had been changed from additive-free glass tubes to silica-coated shatter-resistant plastic tubes (BD Vacutainer Plus serum tubes, silicone-coated, Becton Dickinson). A cytocentrifuged preparation of saline placed in a silica-coated tube contained crystalline material identical to that observed in the CSF samples; saline placed in an additive-free glass tube contained no material. In this case, we document the microscopic appearance of highly concentrated silica particles in cytocentrifuged preparations of CSF and underscore the importance of recognizing and identifying this artifact in cytologic preparations.

An adult female golden hamster (Mesocricetus auratus) developed a firm subcutaneous mass on the lateral distal right forelimb that progressed to diffuse limb enlargement accompanied by extensive cutaneous ulceration and drainage and axillary lymph node metastasis. Touch imprint cytology revealed pleomorphic neoplastic mesenchymal cells. On histology, the invasive neoplasm merged with a large subcutaneous nerve and was composed of spindle cells with a high mitotic index, and lymph node metastasis was confirmed. Histologic morphology and positive immunohistochemical staining of neoplastic cells for vimentin, S100, and neuron-specific enolase were consistent with a malignant peripheral nerve sheath tumor. Although relatively common in dogs, peripheral nerve sheath tumors had not been reported previously in hamsters.

Virtual microscopy (VM) uses a computer to view digitized slides and is comparable to using a microscope to view glass slides. This technology has been assessed in human medical education for teaching histology and histopathology, but, to the authors' knowledge, no one has evaluated its use in teaching cytopathology in veterinary medical education. We hypothesize that students will respond positively to the use of VM for viewing cytopathology preparations and that the technology can be successfully used for student assessment. To test this hypothesis, we surveyed students regarding their level of satisfaction with features of the VM system, their preference for use of VM in the curriculum, and the potential influence virtual slides may have on student study habits; student performance on a traditional cytopathology practical examination and a similar exam using VM was evaluated. Our results show that student perception of the VM system is generally very positive, with some concerns about resolution and the need for continued exposure to traditional microscopy. Within the curriculum, students indicated a preference for the option of using virtual slides for studying and take-home exercises. Overwhelmingly, students wanted either hybrid laboratory sessions or sessions using glass slides with virtual slides available for study and review. Students identified many VM test-taking features as advantageous compared with traditional glass-slide practical exams as traditionally administered. However, students indicated a strong preference for continued use of traditional microscopy for graded practical exams. Students may be more likely to study slides in preparation for practical examinations if virtual slides are available. Results also indicate that VM can be used successfully for assessment purposes, but students should receive training in using virtual slides if the technology will be used for assessment.

An 8-year-old, neutered male, domestic shorthair cat housed at the North Carolina State University, College of Veterinary Medicine, Laboratory Animal Research facility as part of a research colony was examined because of mulifocal skin lesions. The lesions consisted of patchy alopecia with mild crusting of the periauricular region, neck, and dorsum; periauricular excoriations; marked dorsal seborrhea and scaling; and generalized erythematous papules. A moderate amount of ceruminous exudate was present in both ear canals. Results of testing for feline immunodeficiency virus (FIV) were positive. An ear swab specimen and superficial and deep skin scrapings were obtained, mounted with oil on glass slides, and coverslipped for microscopic examination. Two populations of mites were observed: a large population of slender, long (approximately 200 microm), adult mites with long, tapering abdomens that comprised two-thirds of the total body length; and a smaller population of more translucent and shorter mites (approximately 100 microm) with wide, blunt abdomens that had prominent transverse ridges. The interpretation was demodicosis, with Demodex cati and D gatoi co-infection. Histologic sections of biopsies from skin lesions on the neck, dorsum, and periauricular area contained a mild perivascular and perifollicular inflammatory infiltrate composed predominantly of histiocytes, lymphocytes, and plasma cells. Diffusely within the follicular lumina and occasionally within the superficial keratin, a myriad of Demodex organisms were observed. Intrafollicular mites were compatible in appearance with D cati whereas those in the corneal layer were suggestive of D gatoi. Demodicosis is an uncommon disease of cats, and rare cases of dual infection have been documented, occasionally in FIV-infected cats. The dual infection emphasizes the importance of doing both superficial and deep skin scrapings and of recognizing the unique microscopic features of different Demodex mites.

A 7-year-old, male, castrated, Labrador Retriever with a history of pancreatitis and inflammatory bowel disease presented for vomiting and anorexia. Serum biochemistry findings were indicative of cholestasis, hepatocellular insult, and decreased hepatic function. Ultrasound examination showed sediment and gas within the gallbladder, and a diagnosis of emphysematous cholecystitis was made. Emergency gallbladder resection was performed. Cytologic examination of bile fluid collected at surgery showed a mixed population of bacteria (bactibilia) together with fungal organisms consistent with Cyniclomyces guttulatus (previously known as Saccharomycopsis guttulatus). Similar fungal organisms were seen on a fecal smear. Bacteria cultured were normal gastrointestinal flora, supporting ascending infection; the fungal organisms were interpreted as incidental. Histopathology of the gallbladder indicated active (suppurative) and chronic (lymphocytic) cholecystitis and sections of liver tissue had evidence of chronic liver disease. A positive liver culture indicated concurrent bacterial hepatitis or cholangiohepatitis. Despite supportive care, the dog continued to decline and was euthanized 30 days later. Necropsy results confirmed end stage liver disease, but an initiating cause was not found. This case highlights the role of bactibilia in the development of acute cholecystitis and the unique cytologic appearance of C guttulatus as an incidental finding in bile fluid.

Reticulocytes are anucleate immature red blood cells that contain a network of RNA, organelles, and mitochondria, which stain with supravital dyes. Both aggregate and punctate reticulocytes are present in domestic cats, and aggregate reticulocytes are used to assess the degree of regeneration in anemic dogs and cats. Multiple factors influence the degree of regenerative response to anemia. These factors include time of reticulocyte measurement, concurrent diseases, species, and ongoing therapy. Although many automated systems for reticulocyte enumeration exist, manual counts remain the gold standard in veterinary medicine.

Cytologic examination of bone marrow aspirates can provide a wealth of diagnostic information. Practitioners should not hesitate to perform bone marrow aspirates when indicated. This article is designed to assist the practitioner in the evaluation of bone marrow aspiration biopsies. The indications for marrow evaluation, methods of sample collection, sample preparation, and cytologic examination of bone marrow are discussed. Cases are provided to demonstrate accurate interpretation of bone marrow aspirates.