PICO Question In bovines undergoing caesarean section does the use of synthetic absorbable uterine sutures compared with catgut result in less uterine tissue reactions? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Three studies were critically appraised. Two were non-randomised controlled trials and one was a randomised controlled trial. Strength of evidence Weak. Outcomes reported One study found no difference in the incidence of uterine adhesions between plain catgut and polyglactin 910. Two other studies, which were both conducted on the same group of animals using chromic catgut and polyglycolic acid (PGA), demonstrated a lower incidence and severity of uterine adhesions, as well as reduced histopathological indicators of uterine tissue damage, with polyglycolic acid sutures compared to chromic catgut. Conclusion There is limited evidence concerning the difference in uterine tissue reactions caused when using catgut or a synthetic uterine suture material in bovine caesarean surgeries. The lack of comparability between the relevant studies in terms of population characteristics and type of suture material used (chromic and plain catgut) does not allow a clear conclusion to be made. In addition, uterine adhesion formation is likely to be multifactorial and there is no overall clear indication that the use of synthetic absorbable suture materials is superior in terms of reduced uterine tissue reactions. There are several other papers of interest which may provide further evidence, but these are not available in English and are therefore outside the scope of this Knowledge Summary.
PICO Question In cats with traumatic brain injury, is hypertonic saline more effective than Lactated Ringer’s Solution (LRS), when measuring neurological recovery? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Zero. Strength of evidence Zero. Outcomes reported Both hypertonic saline and LRS have been successfully used in the management of traumatic brain injuries in cats. There is not enough evidence to recommend one treatment over the other and they should be chosen with consideration of the individual after assessing patient status. Conclusion In cats with traumatic brain injury, there is not enough evidence to say that hypertonic saline is more effective than LRS when measuring short-term neurological response with an improved Modified Glasgow Coma Score.
PICO Question In canine patients with infectious systemic inflammatory response syndrome (SIRS), how do increased levels of High Mobility Group Box 1 (HMGB1) protein, compared to low levels, relate to mortality outcomes? Clinical bottom line Category of research Prognosis. Number and type of study designs reviewed Three studies were critically reviewed. All three studies were prospective observational studies. Strength of evidence Weak. Outcomes reported All three studies included in this Knowledge Summary evaluated canine patients with SIRS, encompassing both infectious and non-infectious causes. The second and third paper both found a significant association between elevated serum HMGB1 levels and increased mortality in dogs with SIRS. The first paper, while focusing specifically on infectious SIRS, did not find a statistically significant correlation between HMGB1 levels and mortality, although HMGB1 levels were elevated in SIRS cases compared to healthy controls. Variability in the timing of HMGB1 measurements, along with differences in study design, population heterogeneity, and small sample sizes, may have contributed to inconsistencies in the findings. Overall, the evidence suggests a potential association between higher HMGB1 levels and increased mortality in dogs with SIRS, but further standardised research is needed to strengthen this conclusion. Conclusion While two studies identified an association between elevated HMGB1 and mortality, the findings are inconclusive. The strength of evidence is restricted by diagnostic and methodological limitations, making for weak quality evidence overall. Future research should prioritise standardised measurement timing, larger and more homogeneous populations, and explore HMGB1’s role in disease progression to fully establish its utility as a prognostic marker in canine SIRS.
Question In cats with eosinophilic airway inflammation does cyproheptadine compared with no treatment result in a reduction in severity of clinical signs? Clinical bottom line The category of research question was: Treatment. The number and type of study designs that were critically appraised were: Four studies were evaluated: the first was a randomised, blinded, placebo-controlled, crossover study, the second was a randomised crossover study, the third was a non-randomised, controlled study, and the fourth a non-randomised, controlled study. Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation: Moderate. The outcomes reported are summarised as follows… In two of the four studies it was found that cyproheptadine was not useful in resolving the symptoms of feline airway inflammation. The third study showed that the concentration of cyproheptadine that completely blocked contractile effects of serotonin did not successfully cause a significant effect on contraction caused by muscarinic stimulation. The fourth study provided evidence that cyproheptadine could reduce serotonin-induced bronchoconstriction. In view of the strength of evidence and the outcomes from the studies the following conclusion is made… There is no current evidence to support that cyproheptadine monotherapy has any immediate benefit over no treatment for feline eosinophilic airway inflammation, and its use is not supported for this indication.
PICO Question In dogs diagnosed with canine transmissible venereal tumour (CTVT), does treatment with vincristine combined with ivermectin, compared to treatment with vincristine alone, lead to improved clinical outcomes? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Two randomised controlled trials. Strength of evidence Weak. Outcomes reported The studies collectively indicate that the combination of vincristine and ivermectin may be an effective and well-tolerated treatment for CTVT, with potential advantages over vincristine alone. One study demonstrated a statistically significant reduction in the number of treatment sessions for tumour remission, although methodological limitations and the absence of long-term follow-up limit the evidence. The other study observed comparable treatment efficacy across groups and a trend toward improved tolerability, despite the presence of cytomorphologically resistant types in the combination group; however, these differences were not statistically significant. Conclusion Ivermectin, a synthetic avermectin, may augment the action of vincristine when used for the treatment of CTVT. This may reduce the duration of therapy, lessen side effects, minimise recurrence and in turn reduce the animal’s suffering. Overall, the evidence to support this is assessed as weak.
