Monthly Journal Round-Up - February 2018

Thanks as always to Lara Brunori DVM CertAVP MRCVS

Clinical practice review:

  • Humm, K. and Cortellini, S. (2018) ‘Abdominal trauma in dogs: management’. In Practice 40(1) , pp.2-10
  • Humm, K. and Cortellini, S. (2018) ‘Investigating and managing abdominal trauma in dogs’. Veterinary Record, 182(8), pp. 228-229

Clinical studies:

Prospective:

  • Vilar, J.M. et al. (2018) ‘Comparison of 3 anesthetic protocols for the elective cesarean- section in the dog: Effects on the bitch and the newborn puppies’. Animal Reproduction Science, doi: 10.1016/j.anireprosci.2018.01.007 (Early view)
  • Hiratzka, J. et al. ‘Incidence of hospital-acquired anemia in hospitalized dogs and cats’. Journal of the American Veterinary Medical Association, 252(5), pp.  560-564
  • Pereira, G.Q. et al. ‘Fecal microbiota transplantation in canine parvovirus infection’. Journal of Veterinary Internal Medicine, doi: 10.1111/jvim.15072 (Early view)
  • Cridge, H. Et al. ‘Evaluation of SNAP cPL, Spec cPL, VetScan cPL Rapid Test, and Precision PSL Assays for the diagnosis of clinical pancreatitis in dogs’. Journal of Veterinary Internal Medicine, doi: 10.1111/jvim.15039 (Early view)
  • Budsberg, S.C. et al. (2018) ‘Lack of effectiveness of tramadol hydrochloride for treatment of pain and joint dysfunction in dogs with chronic osteoarthritis’ Journal of the American Veterinary Medical Association, 252(4), pp. 427-432
  • Guedes et al. ‘Evaluation of tramadol for treatment of osteoarthritis in geriatric cats’. Journal of the American Veterinary Medical Association, 252(5), pp.  565-571

Retrospective:

  • Hopper, K. et al. ‘An online survey of small animal veterinarians regarding current fluid therapy practices in dogs and cats’. Journal of the American Veterinary Medical Association, 252(5), pp. 553-559

Case report: 

  • Biddick, A.A. et al. (2018) ‘A serious adverse event secondary to rapid intravenous levetiracetam injection in a dog’. Journal of Veterinary Emergency and Critical Care, doi: 10.1111/vec.12693 (Early view)

Research study:

McCarthy et al. (2018) ‘Investigation of the HotDog patient warming system: detection of thermal gradients’. Journal of Small Animal Practice, doi: 10.1111/jsap.12816 (Early view)

For a copy of any of the papers mentioned in this post (personal education purposes only), including details of the scoring system, please email lara.brunori@gmail.com.

Pick of the Month

Evaluation of SNAP cPL, Spec cPL, VetScan cPL, Rapid Test and Precision PSL assays for the diagnosis of clinical pancreatitis in dogs

Cridge, H. et al. (2018) Journal of Veterinary Internal Medicine, doi: 10.1111/jvim.15039
 
Pancreatitis is a common differential diagnosis for patients presented with non-specific gastrointestinal signs. Traditional lipase and amylase enzyme assays have been proven unreliable for reaching a definitive diagnosis of pancreatitis. 

Recently a number of new lipase-based diagnostic assays have been developed in order to improve diagnostic accuracy.

This study evaluated 4 lipase-based assays:

  • 1) Quantitative ELISA Spec cPL
  • 2) Point of care qualitative SNAP cPL
  • 3) Semiquantitative point of care VetScan cPL Rapid
  • 4) Colorimetric DGGR-based Precision PSL.

The authors calculated and compared sensitivity and specificity of each test and assessed the level of agreement between assay results and clinical findings. 

A total of 50 dogs were prospectively enrolled in the study. These were client-owned dogs presented at an emergency clinic with at least one of the following clinical signs: anorexia, lethargy, vomiting, diarrhoea or abdominal pain. All dogs underwent full clinical examination, haemtology, biochemistry and abdominal ultrasound. Sonography was consistently performed or at least reviewed by the same board-certified imaging specialist.

For each dog, a blood sample was obtained and all the 4 assays run. At the same time, a panel of internal medicine specialists reviewed the patient’s history, clinical signs, basic blood results, ultrasound report and assigned a score reflecting the likelihood of these being consistent with a final diagnosis of clinical pancreatitis. 

Main findings:

  • Overall there was a high level of agreement amongst internists
  • 54% of dogs presented a clinical picture poorly indicative for pancreatitis (score 0), 22% were considered to have an equivocal clinical presentation (score 1), 24% had clinical signs highly consistent with pancreatitis (score 2)
  • Sensitivity and specificity of the 4 lipase assay were evaluated using the internists’ scoring system as the diagnostic ‘golden standard’. Two values for sensitivity and specificity were obtained for each test. The first considering equivocal clinical presentations (score 1) as positives and the second considering them as negatives. All assays performed better under the second assumption.
  • A good to excellent agreement was found within the 4 diagnostic assays
  • Only a moderate level of agreement was noted between diagnostic assays and internists’ scores
  • No single assay had high enough diagnostic specificity to conclusively diagnose pancreatitis
  • Precision PSL test showed the poorest performance both in terms of sensitivity/ specificity values and level of agreement with the other assays. This might be due to the fact that this is a DGGR-based test which is non-specific for pancreatic lipase. 

Study limitations: 

  • Wide inclusion criteria which might have caused inadequate population selection and affected the assays’ evaluation
  • Recruiting an emergency-only population might have selected more severe presentations
  • The diagnostic “golden standard” considered in this study was a clinical score rather than the more widely accepted histopathology assessment

Conclusions: 

A combination of signalment, physical examination, laboratory tests and abdominal ultrasound examination should be appraised before reaching a definitive diagnosis of clinical pancreatitis in dogs.

This is in-line with several previous studies demonstrating how assays’ results can vary depending on multiple factors, often unrelated to the presence of clinical pancreatitis. 

For example dogs with upper gastrointestinal obstruction were found to have high pancreatic lipase concentration at Spec cPL test (Trehy et al., 2014). Increased values at Spec cPL and positives at SNAP cPL tests were obtained in dogs with hyperadrenocorticism and no signs of clinical pancreatitis (Mawby et al., 2014). More recently a relationship between IVDD and high Spec cPLi values has also been established (Schueler, 2018).

Furthermore, subclinical pancreatitis has a role in producing positive assays’ results without a clearly defined clinical significance (Newman et al., 2004).

References: 

Mawby , D.I. et al. (2014) ‘Canine pancreatic-specific lipase concentrations in clinically healthy dogs and dogs with naturally occurring hyperadrenocorticism’. Journal of Veterinary Internal Medicine, 28(4), pp. 1244–1250.

Newman, S.J et al. (2004) ‘Localization of pancreatic inflammation and necrosis in dogs’. Journal of Veterinary Internal Medicine, 18(4), pp.488–493.

Schueler, R.O. et al. (2018) ‘Canine pancreatic lipase immunoreactivity concentration associated with intervertebral disk disease in 84 dogs’. Journal of Small Animal Practice, doi: 10.1111/jsap.12818

Trehy M.R., et al. (2014) ‘Serum pancreas-specific lipase concentrations in dogs with upper gastrointestinal foreign bodies’. Journal of Veterinary Internal Medicine, 28(2), pp. 711–744. 28. 

For a copy of any of the papers mentioned in this post (personal education purposes only), including details of the scoring system, please email lara.brunori@gmail.com.

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