Clinical Canine And Feline Reproduction: Evidence Based Answers
Mina Spartin
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A retrospective study was used to analyse canine pyometra cases in Segar Veterinary Hospital, Kuala Lumpur, Malaysia from May 2012 to May 2016 and to investigate the relationship between pyometra and breed and age of dogs. The study was done through secondary collection of data from ambulatoirs of pyometra cases which were diagnosed based on anamnesis, examination of clinical signs and ultrasonography and/or radiography. The data collected includes breed categorised into small, medium, and large breeds, whereas the age are categorised into puppies, adulthood and geriatric. The data was then analysed with tree classification analysis and CATPCA (Principal Components Analysis for Categorical Data) analysis using SPSS program. A total of 80 cases of pyometra were recovered from female dog patients over the study period. Small breed dogs at 72.5% (n=58) and geriatric dogs at 62.5% (n=50) had the highest percentage of pyometra. The breeds Mongreal, German Shepard Dog, Mini Schnauzer, Silky Terrier, Toy Poodle, Beagle, Chow Chow, Golden Retriever, Rottweiler, Cocker Spaniel, White Terrier, Siberian Husky, and Pekingese aged older than 5.5 years had 100% from 37 cases of open-cervix pyometra. Geriatric and small breed dogs are inclined to have open-cervix pyometra. However adult and medium or large breed dogs have a higher possibility to have closed-cervix pyometra. These results serve to highlight the importance of public awareness regarding canine pyometra and further researches are needed to find out the effects of hormone therapy, frequency of births, and the bacteria present in uterus with pyometra.
Clinical Canine and Feline Reproduction: Evidence Based Answers
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Tube feeding is a common procedure in neonatology. In humans, tube misplacement reportedly occurs in up to 59% of all cases and may lead to perforation in 1.1% of preterm intubated neonates. While numerous studies on optimal tube placement have been performed in human neonates, current recommendations on tube feeding in canine and feline neonatology are based, at best, on studies performed in adult animals. Herein, we aimed to test ultrasonography as a tool to verify tube placement in puppies and kittens and to compare different anatomical predictive markers used in human, canine and feline neonates.
Studies on live canine and feline neonates concerning proper tube feeding placement are lacking, likely due to the dearth of ethical methods to analyze tube placement and its complications. To provide new insights into tube feeding management in canine and feline neonates, we used deceased kittens and puppies, accepting that the absence of muscular tone and fragility of the stomach wall may somewhat bias the results. This study demonstrated that in a clinical setting, appropriate placement of the tube can be performed quickly using ultrasonography: stomach wall deformation and stomach volume were accurately visualized, even without clipping hairs. Although no difference was found between frozen and fresh puppies, further validation is required in live animals to confirm these results.
Ultrasonography is a reliable tool for correct gastric tube placement in canine and feline neonates. However, whenever ultrasonography is not available, the proposed weight-based formula is a good option for choosing the correct length of tube insertion. In addition to the possible complications of tube feeding, it is important to be aware of the reduced stomach capacity in less-than-one-day-old neonates. Additional studies are required to assess regurgitation risks with respect to esophageal versus gastric intubation in canine and feline neonates.
As identified in the AHRQ-sponsored clinical evidence review, the overall evidence base for the effectiveness and risks of long-term opioid therapy is low in quality per the GRADE criteria. Thus, contextual evidence is needed to provide information about the benefits and harms of nonpharmacologic and nonopioid pharmacologic therapy and the epidemiology of opioid pain medication overdose and inform the recommendations. Further, as elucidated by the GRADE Working Group, supplemental information on clinician and patient values and preferences and resource allocation can inform judgments of benefits and harms and be helpful for translating the evidence into recommendations. CDC conducted a contextual evidence review to supplement the clinical evidence review based on systematic searches of the literature. The review focused on the following four areas: effectiveness of nonpharmacologic and nonopioid pharmacologic treatments; benefits and harms related to opioid therapy (including additional studies not included in the clinical evidence review such as studies that evaluated outcomes at any duration or used observational study designs related to specific opioid pain medications, high-dose opioid therapy, co-prescription of opioids with other controlled substances, duration of opioid use, special populations, risk stratification/mitigation approaches, and effectiveness of treatments for addressing potential harms of opioid therapy); clinician and patient values and preferences; and resource allocation. CDC constructed narrative summaries of this contextual evidence and used the information to support the clinical recommendations. More details on methods for the contextual evidence review are provided in the Contextual Evidence Review ( ).
Complete methods and data for the 2014 AHRQ report, upon which this updated systematic review is based, have been published previously (14,52). Study authors developed the protocol using a standardized process (53) with input from experts and the public and registered the protocol in the PROSPERO database (54). For the 2014 AHRQ report, a research librarian searched MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, PsycINFO, and CINAHL for English-language articles published January 2008 through August 2014, using search terms for opioid therapy, specific opioids, chronic pain, and comparative study designs. Also included were relevant studies from an earlier review (10) in which searches were conducted without a date restriction, reference lists were reviewed, and ClinicalTrials.gov was searched. CDC updated the AHRQ literature search using the same search strategies as in the original review including studies published before April, 2015. Seven additional studies met inclusion criteria and were added to the review. CDC used the GRADE approach outlined in the ACIP Handbook for Developing Evidence-Based Recommendations (47) to rate the quality of evidence for the full body of evidence (evidence from the 2014 AHRQ review plus the update) for each clinical question. Evidence was categorized into the following types: type 1 (randomized clinical trials or overwhelming evidence from observational studies), type 2 (randomized clinical trials with important limitations, or exceptionally strong evidence from observational studies), type 3 (observational studies, or randomized clinical trials with notable limitations), or type 4 (clinical experience and observations, observational studies with important limitations, or randomized clinical trials with several major limitations). When no studies were present, evidence was considered to be insufficient. Per GRADE methods, type of evidence was categorized by study design as well as a function of limitations in study design or implementation, imprecision of estimates, variability in findings, indirectness of evidence, publication bias, magnitude of treatment effects, dose-response gradient, and constellation of plausible biases that could change effects. Results were synthesized qualitatively, highlighting new evidence identified during the update process. Meta-analysis was not attempted due to the small numbers of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of the studies. More detailed information about data sources and searches, study selection, data extraction and quality assessment, data synthesis, and update search yield and new evidence for the current review is provided in the Clinical Evidence Review ( ).
The GRADE evidence summary with type of evidence ratings for the five clinical questions for the current evidence review are outlined ( Table 1). This summary is based on studies included in the AHRQ 2014 review (35 studies) plus additional studies identified in the updated search (seven studies). Additional details on findings from the original review are provided in the full 2014 AHRQ report (14,52). Full details on the clinical evidence review findings supporting this guideline are provided in the Clinical Evidence Review ( ).
Detailed information about contextual evidence data sources and searches, inclusion criteria, study selection, and data extraction and synthesis are provided in the Contextual Evidence Review ( ). In brief, CDC conducted systematic literature searches to identify original studies, systematic reviews, and clinical guidelines, depending on the topic being searched. CDC also solicited publication referrals from subject matter experts. Given the need for a rapid review process, grey literature (e.g., literature by academia, organizations, or government in the forms of reports, documents, or proceedings not published by commercial publishers) was not systematically searched. Database sources, including MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, varied by topic. Multiple reviewers scanned study abstracts identified through the database searches and extracted relevant studies for review. CDC constructed narrative summaries and tables based on relevant articles that met inclusion criteria, which are provided in the Contextual Evidence Review ( ).