Veterinary Clinical Digest Summary

Chemotherapeutic drugs are the backbone of treatment of many neoplasms, but they have the potential for serious adverse events. One of these is the damage that certain drugs can cause if there is extravasation during administration. However, the literature on this complication is sparse. This retrospective descriptive study aimed to evaluate episodes of extravasation in dogs and cats. Twenty dogs and three cats were included in the study. Doxorubicin was the most common extravasated drug with nine cases, followed by carboplatin with five cases. All the cases of carboplatin extravasation were of moderate to severe seriousness and all required surgical debridement. The severity of adverse events was more variable for doxorubicin, but in two cases amputation was recommended, one of these being euthanased instead. Five cases of vinca alkaloid and one case of rabacfosadine extravasation resulted in moderately severe adverse events, which could be managed as outpatients. Extravasations with mitoxantrone and dacarbazine resulted in no observed adverse effects. 30% of cases in which there was extravasation experienced this complication during the first chemotherapy treatment.

Most cases of extravasation had no, mild or moderate adverse effects, but carboplatin should now be considered as a vesicant.

Veterinary Clinical Digest Summary

Generalised tremor is a feature of several neurological and metabolic diseases, but there is little data on the condition. This retrospective study included 198 dogs with generalised tremors in which a definitive or presumed diagnosis of the underlying cause was made, and aimed to describe the signs, associated diseases and clinical features of the condition and underlying disease. The most common diseases found were intoxication, which accounted for 46% of cases and idiopathic generalised tremor syndrome (IGTS), accounting for 25%. Meningoencephalitis of unknown origin (MUO), degenerative encephalopathies, hypo- and hypercalcaemia and hypoglycaemia were other conditions found to be associated with generalised tremors. Dogs that had IGTS tended to be younger and female and had an acute, progressive, lateralising presentation. Dogs with intoxication tended to be male, young to middle aged, with a hyperacute, non-progressive, symmetric presentation. Intoxication was often accompanied by signs of behavioural changes, hypersalivation, hyperaesthesia, abnormal mentation and mydriasis, while dogs with IGTS often exhibited inappetence and vestibulocerebellar signs. It was more common in IGTS than intoxication for tremors to be the only clinical sign. Only dogs with intoxication improved within 48 hours unless corticosteroids were given.

Intoxication and idiopathic generalised tremor syndrome are the most common diagnoses for generalised tremor syndrome. Different clinical features may help clinicians diagnose the underlying condition.

Veterinary Clinical Digest Summary

Prebiotics, probiotics and synbiotics (a combination of the two) are commonly used in cats, but their efficacy is uncertain. This systematic review aimed to evaluate whether these types of treatments are effective in the prevention and treatment of gastroenteropathies, and whether they reduce the gastrointestinal adverse effects of antibiotic administration in cats. Twenty reports were included in the study, which had an unclear or a low risk of bias. The evidence discovered was insufficient to draw firm conclusions, but five of the seven probiotic trials showed evidence of improvement of faecal consistency. Synbiotics were not found to be effective in reducing antibiotic-associated vomiting in a meta-analysis of 32 cats, but the certainty of the finding was very low. A meta-analysis of 34 cats suggested with low certainty that probiotics could reduce the Bacillota/Actinomycetota ratio. Probiotics were found to improve the immune system of young cats and to increase the butyric acid concentration.

More research is needed into the efficacy of biotic supplementation, especially in at-risk groups and sick cats.

Veterinary Clinical Digest Summary

Gastrostomy tubes can be used to bypass the oesophagus and allow long term nutritional support. This retrospective study aimed to assess the frequency of complications during hospitalisation associated with the tubes, the survival to discharge and the association between complications and the primary disease and blood protein levels. 133 dogs with surgically placed gastrostomy tubes were included in the study. Nine dogs, around 7%, had a complication associated with the tube, with stoma infection/inflammation being the most common adverse event. These were managed with topical therapy only. One case had a gastrointestinal leakage which caused septic peritonitis. No association was found between the primary disease, serum albumin or plasma total protein levels and complications. No mortality resulted from gastrostomy tube complications.

The authors note that there is a low complication frequency with the use of gastrostomy tubes in dogs, and that surgically placed gastrostomy tubes can be useful for nutritional support in patients undergoing abdominal surgery.

Veterinary Clinical Digest Summary

Feline oral squamous cell carcinomas (FOSCC) are the most frequently encountered oral neoplasia in cats. They tend to be highly locally invasive and rapid growing. Current effective treatments are limited. This retrospective cohort study aimed to report the prognosis and complications of cats that underwent total glosso-mandibulectomy (TGM) for the treatment of FOSCC. 20 cats with histopathologically confirmed FOSCC that were treated with TGM were included in the study. 12 cats had mandibular FOSCC and 8 had a glossal location. All cases were treated with a simultaneous percutaneous endoscopic gastrostomy. 90% of cases had post-operative complications, with 11 cats having swelling of the incision and three cases requiring prolonged tracheal intubation to manage airway obstruction. 10 cats became anaemic, with 2 cats needing blood transfusions. There was no immediate post-operative mortality. The overall survival time was 533 days, while one and two year survival rates were 50% and 48% respectively. Only histopathological margins were associated with survival and progression free interval. Lifelong feeding via gastrostomy tube was required, as well as home care such as removing secretions from palate and throat.

Cats undergoing TGM for oral squamous cell carcinoma had an extended survival time, but had serious complications and a need for lifelong homecare.

Veterinary Clinical Digest Summary

Atopic dermatitis is a common immune-mediated skin condition in dogs that can be hard to control. Multimodal treatments may be required, including immunosuppressants. This controlled clinical trial aimed to assess the effectiveness, safety and cost of oclacitinib and prednisolone in dogs with atopic dermatitis. 23 dogs with atopic dermatitis were included in the study. One group received prednisolone once daily for seven days, then alternating oclacitinib and prednisolone for a further seven weeks. The second group received oclacitinib only for eight weeks. Validated scales were used to assess clinical signs. Both groups had significant reductions in clinical signs and there was no significant difference between the severity of clinical signs in the two groups at the later time periods.  Two dogs had polyuria and polydipsia and three had polyphagia in the prednisolone and oclacitinib group, but these resolved by day fourteen. In the oclacitinib-only group one dog had polyphagia and two had self-limiting vomiting.

The authors note that the combination of prednisolone and oclacitinib was effective at managing pruritus and inflammation at a considerably lower cost than oclacitinib alone.

Veterinary Clinical Digest Summary

Raw meat based diets (RMBDs) have become increasingly popular in recent years, despite an almost complete absence of quality evidence suggesting a benefit and a rising number of reports of adverse events associated with the practice. This study aimed to assess the general public's knowledge and use of pet foods, especially with respect to RMBDs. An anonymous cross-sectional web-based surgery was performed in Spain for this purpose. 712 replies were received, of which 47% were familiar with RMBDs and 6% used them. Dogs were more than twice as likely to be fed a raw meat diet than cats. 66% of respondents who were familiar with RMBDs believed the diets had benefits, but 96% recognised there was a possibility of disadvantages such as risk to pets and concern over handling the diets. Around a quarter of owners who fed their pets RMDBs lived with people with reduced immune function. Confidence in veterinary advice was lower in owners who fed these diets.

Despite the potential limitations of questionnaire studies such as response bias, the authors note that this study highlights the need for vets to be more proactive in communication to clients regarding pet nutrition.

Veterinary Clinical Digest Summary

Para-aminopropiophenone (PAPP) is increasingly used in New Zealand and Australia as a bait for vertebrates. Domestic dogs are prone to intoxication due to their indiscriminate eating habits. This paper reports a case series of thirteen dogs in which PAPP toxicity was the likely diagnosis, based on regional exposure and historical and clinicopathological findings. Acute collapse, vomiting and cyanotic or brown mucuous membranes were commonly noted in these cases, and marker beads associated with the bait was identified in the stomach contents of two dogs. All dogs were treated with intravenous methylene blue. Higher doses of methylene blue were associated with a more rapid decline in methaemoglobin concentrations. 77% of cases survived to hospital discharge with a mean hospitalisation time of 1.6 days.

The authors note that this case series aids with the knowledge of the clinical presentation and treatment of PAPP toxicity in dogs. The prognosis is fair.