No abstract

No abstract

N-of-1 data are unavoidable in zoological medicine. Accordingly, zoological medicine clinicians and investigators need research techniques that can make use of these data. This article reviews two methodologies for using both observational and experimental N-of-1 data: 1) systematic reviews and meta-analyses of case reports and 2) prospective N-of-1 trials. Systematic reviews of case reports and other observational evidence are formal, unbiased summaries of clinical characteristics of a particular disease-taxon combination. They offer advantages to narrative reviews by minimizing omission of relevant articles, thereby reducing the potential for mischaracterization of the literature. Meta-analyses are extensions of systematic reviews that quantitatively synthesize the data from the included articles. While valuable, systematic reviews and meta-analyses of case reports can have limited interpretations due to publication bias and confounding present in their source materials. In contrast to case reports, N-of-1 trials are prospective study designs that allow clinicians to make strong inferences about the effect of an intervention in a particular patient. They are double-blinded, single patient, multi-crossover studies that are of particular value in fields where it is difficult to recruit sufficient patients for conventional randomized control trials (RCTs), such as zoological medicine. Because they require multiple crossover periods, N-of-1 trials are ideal for evaluating short-acting interventions in patients with somewhat stable chronic diseases, such as osteoarthritis. More complex than conventional therapeutic trials, N-of-1 trials require prior consideration of how to achieve blinding, appropriate placebo controls, quantitative primary outcomes, analysis methods, and ethical approval. Aggregation of N-of-1 trials allows estimation of the average treatment effect across the population with fewer participants than a conventional RCT. While systematic reviews and meta-analyses of case reports can be used to synthesize the observational N-of-1 data already in existence, N-of-1 trials offer an exciting way to prospectively generate strong evidence that will be useful for evidence-based decision-making.

No abstract

An estimated 29-year-old male, desert tortoise ( Gopherus agassizii ) under professional care presented for endoscopic liver biopsies as part of a diagnostic work-up for recurrent, profound anemia and hypoalbuminemia. Suspected cystoliths were identified during endoscopy but were not visible on contemporary radiographs. Dual-energy computed tomography (DECT) imaging confirmed the presence of a large urate urolith filling the majority of the bladder. Due to the recent clinical illness, the tortoise was considered a poor surgical candidate. Medical management consisting of urinary alkalinization with potassium citrate, vibration therapy, and daily warm water soaks was elected. Following institution of medical therapies, the tortoise began passing pieces of urate stone that were 0.25-2.0cm in diameter during daily soaks. A recheck DECT scan at two months indicated the urolith was approximately 1/3 the initial size, suggesting medical therapy was effectively treating the urolith. Unfortunately, after five months of medical therapy, the stone had increased in size again on the follow-up DECT scan. This case report suggests that medical management may be a potential option for large urate cystoliths in desert tortoises, though more research is needed to further refine effective therapeutics for such cases. The use of dual-energy CT imaging was essential in this case as it enabled confirmation of stone presence, identification of urolith composition, and monitoring of response to therapy.