Trimethoprim-sulfonamide: a valid antimicrobial treatment in foals?

Trimethoprim-sulfonamide (TMPS) combinations are widely used to treat a range of infectious diseases in horses, but some equine practitioners are reluctant to use them for treatment of both neonatal and older foals. Considering the emergence of increased antimicrobial resistance, the use of protected antimicrobials commonly prescribed to foals should be avoided and alternative first-line therapy considered, where appropriate. This review examines the characteristics and pharmacokinetics of TMPS and its suitability for treatment of foals. Data regarding dosage and route of administration are reported on the basis of recent publications in foals. The review intends to share significant information about the common infections that are most likely responsive to TMPS treatment in foals and, as such, where TMPS might be considered a suitable first-line therapeutic option.

Breath Alcohol Test Results in Equine Veterinarians after Performing an Abdominal Ultrasound with Ethanol.

Transcutaneous abdominal ultrasonography using alcohol saturation is used in the diagnostic workup of a variety of conditions in horses. The duration of the examination and the amount of alcohol used in each case may vary depending on several factors. The aim of this study is to describe the breath alcohol test results obtained by veterinarians performing abdominal ultrasound on horses. Six volunteers were enrolled, after written consent, and a Standardbred mare was used for the whole study protocol. Each operator performed a total of 6 ultrasounds by pouring the ethanol solution from a jar or by spray application, for a duration of 10, 30, and 60 min. An infrared breath alcohol analyzer was used immediately after completing the ultrasonography and at 5-min intervals until a negative result was obtained. Positive results were obtained for 0-60 min after the procedure. A statistically significant difference was found between the groups that used more than 1000 mL, 300-1000 mL, and less than 300 mL of ethanol. No significant differences were observed between the type of ethanol administration and the time of exposure. Based on this study, equine vets who perform ultrasound on horses can test positive at the breath alcohol test for up to 60 min following ethanol exposure.

Factors that influence owner consent for exploratory laparotomy in horses with colic in Australia and New Zealand.

BACKGROUND: Horse owners' motivators and barriers for consent to exploratory laparotomy are poorly understood. OBJECTIVES: To (1) determine the proportion of Australian and New Zealand horse owners who would consent to exploratory laparotomy and (2) identify motivators and barriers for consent. STUDY DESIGN: Cross-sectional survey. METHODS: A questionnaire was developed and distributed online. Descriptive statistics were calculated by tabulating respondents by their answers to whether they would consent to exploratory laparotomy. Univariate and multivariate analyses were used to identify variables associated with consenting to exploratory laparotomy. RESULTS: Two thousand two hundred horse owners participated with a 68.3% survey completion rate. Most were female (95.6%), and 18.7% stated they would consent to exploratory laparotomy, 55.2% would consider exploratory laparotomy and 26.1% would not consent to exploratory laparotomy being performed on their horse. Geographical location, intended use of the horse and perceptions regarding the cost and prognosis of exploratory laparotomy, as well as the previous experience of respondents significantly impacted the decision. Self-reported level of financial comfort, gender of respondents, number of horses owned and pre-existing relationship with nearest equine referral clinic did not impact the decision. Top motivators for exploratory laparotomy were high probability of survival, trust in hospital, emotional value of horse and the alternative being euthanasia. Top barriers for exploratory laparotomy were financial cost, uncertain outcome, welfare concern and age of the horse. MAIN LIMITATIONS: Self-selection bias and acquiescence in responses. CONCLUSIONS: Most respondents indicated that they would consider or consent to exploratory laparotomy. Several factors for owners to decide for exploratory laparotomy could be identified. Improved owner education regarding the positively reported survival rates for exploratory laparotomy would be beneficial.

INTRODUCTION/CONTEXTE: Les motivateurs et les obstacles derrières la décision des propriétaires d'autoriser ou pas une laparotomie exploratrice (LE) sur leurs chevaux demeurent mal compris. OBJECTIFS: (1) Déterminer la proportion des propriétaires de chevaux en Australie et Nouvelle-Zélande qui consentiraient à une LE et (2) identifier les motivateurs et obstacles contribuant à leur consentement. TYPE D'ÉTUDE: Étude transversale. MÉTHODES: Un questionnaire a été développé et distribué en ligne. Des statistiques descriptives ont été calculées en classifiant les répondants selon s'ils consentiraient ou non à une LE. Des analyses uni et multivariées ont été utilisées pour identifier les variables associées au consentement à la LE. RÉSULTATS: Deux milles deux cents propriétaires de chevaux ont participé et le taux de remplissage du sondage était de 68.3%. La majorité étaient des femmes (95.6%) et 18.7% donneraient leur consentement pour une LE, 55.2% considéraient une LE et 26.1% ne consentiraient pas à une LE pour leur cheval. La localisation géographique, la discipline du cheval et les perceptions relativement aux coûts et au pronostic pour une LE, de même que leurs expériences précédentes influenceraient la décision des participants de façon significative. La situation monétaire des participants (rapportés de leur plein gré), leur genre, le nombre de chevaux dont ils sont propriétaires et une relation pré-existante avec une clinique de référence à proximité n'influenceraient pas leur décision. Les motivateurs les plus importants pour le consentement à la LE étaient une chance de survie élevée, leur confiance envers le centre de référence, la valeur émotionnelle du cheval et les alternatives possibles à l'euthanasie. Les obstacles les plus flagrants étaient les coûts, une chance de survie incertaine, des préoccupations par rapport au bien-être du cheval et son âge. LIMITES PRINCIPALES: Biais de sélection et degré d'accord des réponses. CONCLUSIONS: La plupart des répondants consentiraient ou au moins considéraient une LE. Plusieurs facteurs influençant la décision des propriétaires ont pu être identifiés. Il est impératif pour les vétérinariares traitants d'éduquer les clients en ce qui concerne les taux de survie plus positifs suivant les laparotomies exploratrices.

Novel Board Game versus Active Case-Based Discussion to Teach Final-Year Veterinary Students the Diagnostic Approach to Clinical Cases.

Traditional lectures, where students listen passively, often do not reflect the complexity of real-life decision-making situations. Furthermore, modern students are using online devices for daily activities, and this has a challenging side effect for educators, as many people these days can only maintain their focus if topics are discussed in concise and engaging ways. For these reasons, there is growing interest in the use of games for educational purposes. The aim of this study was to introduce a board game based on the Clue game for final-year veterinary students during their practical activity in large animal medicine. This type of learning process was compared with a classical case-based discussion and evaluated via a survey delivered to the students to both test their acquired knowledge and obtain their evaluation of the activity. A total of 49 students were enrolled in this study. While the board game was evaluated significatively better than the traditional class, no statistically significant differences were observed for the answers given to questions assessing their veterinary skills. The proposed game requires few resources other than a case-based visual materials and analyses from clinical patients, a board, two dice, and some imagination to create cases at the appropriate level for students' knowledge. We conclude that this board game-based activity represents innovative techniques to teach clinical approaches in an interactive way with the same utility as a traditional class but is more enjoyable for the students.

Equine Suture Exostosis: A Review of Cases from a Multicenter Retrospective Study.

Suture exostosis is an intriguing and not uncommon pathology that has to be included in the differential diagnosis for horses with swelling of the head. Although several singular case reports have been published, no large case series is available. The aim of this study is to report a multicentric retrospective collection of suture exostosis cases. Data concerning horses with suture exostosis in the facial region were collected retrospectively. Information regarding breed, age, gender, history, imaging findings, initiated treatment, response to treatment and follow up was recorded. One hundred and five cases of various breeds were reported. Analysis revealed the cases could be grouped into four entities: 45 developed following sino-nasal surgery, 23 following trauma, seven with underlying sinus pathology and 25 idiopathic. Treatment consisted of sequestra removal, plate fixation, antimicrobial and anti-inflammatory drugs or no treatment. Whereas initial localized pain fades within few days or weeks, resolution or reduction of the swelling was obtained in most cases after 3 months to 1.5 years. The etiopathogenesis of suture exostosis seems to consist of different entities. Identification of an underlying cause, particularly the presence of a bone sequester and infection is important to speed up resolution and before concluding an idiopathic case. When performing sinusotomies, it is important to provide as little trauma as possible to the surgical site in order to prevent suture exostosis as a complication.

Surface wear in a custom manufactured temporomandibular joint prosthesis.

The wear of a novel temporomandibular joint (TMJ) prosthesis was evaluated in an animal model. The prosthesis consisted of an additively manufactured titanium alloy (Ti6 Al4 V) mandibular condyle and glenoid fossa created through selective laser melting, with a machined vitamin E-enriched ultra-high molecular weight polyethylene (UHMWPE) surface attached to the fossa. Thirteen TMJ prosthesis were implanted in sheep, six of which had condylar heads coated with HadSat® diamond-like carbon (H-DLC). Euthanasia took place after 288 days, equaling 22 years of human mastication. Linear and volumetric wear analysis of the fossa was performed by optical scanning. The condylar head surfaces were assessed by scanning electron and confocal laser microscopy. The average linear UHMWPE wear, when combined with the coated condyle, was 0.67 ± 0.28 mm (range: 0.34-1.15 mm), not significantly differing (p = .3765, t-test) from the non-coated combination average (0.88 ± 0.41 mm; range: 0.28-1.48 mm). The respective mean volumetric wear volumes were 25.29 ± 11.43 mm3 and 45.85 ± 22.01 mm3 , not significantly differing (p = .1448, t-test). Analysis of the coated condylar surface produced a mean Ra of 0.12 ± 0.04 µm and Sa of 0.69 ± 0.07 µm. The non-coated condylar surface measured a mean Ra of 0.28 ± 0.17 µm and Sa of 2.40 ± 2.08 µm. Both Sa (p = .0083, Mann-Whitney U test) and Ra (p = .0182, Mann-Whitney U test), differed significantly. The prosthesis exhibits acceptable wear resistance and addition of the H-DLC-coating significantly improved long-term condylar surface smoothness.

Neutrophil Gelatinase-Associated Lipocalin in Synovial Fluid from Horses with and without Septic Arthritis.

Neutrophil gelatinase-associated lipocalin (NGAL) has been suggested to be a highly sensitive and specific marker of joint infection in humans. The aim of the study was to investigate NGAL concentrations in synovial fluid (SF) from horses with septic synovitis, horses without septic synovitis, and horses with uncertain status. NGAL was measured in 177 admission samples obtained from 152 horses. From a subset of horses (n = 35), additional samples obtained sequentially over the course of treatment were available. Concentrations of NGAL were significantly higher in septic synovitis (n = 47 samples) than in samples classified as non-septic (n = 103) or samples with uncertain status (n = 27), with median NGAL concentrations in the three groups being 1236, 16.8, and 266.4 µg/L, respectively. NGAL discriminated nearly perfectly between septic and non-septic (area under the receiver operating characteristic curve 0.98, 95% confidence interval 0.95-1.00). The optimal cut-off value for maximal sensitivity (87.2%) and specificity (75.0%) to discriminate septic samples from those with uncertain status was 444.6 µg/L, with an area under the receiver operating characteristic curve of 0.85 (95% confidence interval 0.74-0.93). Concentrations declined over time in horses undergoing treatment. NGAL is a novel biomarker that seems to have great potential for identifying septic synovitis and for monitoring the response to treatment of synovial infection in horses.

Effect of exercise on serum neutrophil gelatinase-associated lipocalin concentration in racehorses.

Serum neutrophil gelatinase-associated lipocalin (sNGAL) is a marker of renal injury, and its concentrations are affected by inflammation. Therefore, it could serve as a useful biomarker of disease or fitness in high-level competition. However, it has not yet been determined if sNGAL concentrations are affected by exercise. The aim of this study was to determine whether concentrations of equine sNGAL were affected by 1000 m galloping as the form of exercise used in the study. Pre- and post-gallop sNGAL, serum amyloid A, and creatinine concentrations were evaluated in 14 healthy Thoroughbred racehorses. The results showed that short, high-intensity exercise did not significantly affect sNGAL concentrations in healthy horses (P = .42), and no significant difference was found in either creatinine or serum amyloid A before and after galloping (P > .05). Therefore, it was determined that sNGAL was not influenced by the type of exercise used in the study and could have the potential to be used as a routine laboratory screening tool in horses even after strenuous exercise. Future research should clarify its use in a larger population and a broader range of equine sport disciplines, including endurance-related exercise.

Perforations of tri-layer nitrile-latex and natural rubber latex gloves during ex-vivo equine intestinal anastomoses.

OBJECTIVE: To compare perforation rates between tri-layer nitrile-latex and natural rubber latex surgical gloves after single-layer end-to-end jejunojejunal anastomoses in equine cadavers. STUDY DESIGN: Prospective randomized ex-vivo study. SAMPLE POPULATION: Pairs of surgical gloves (n = 46) worn during jejunojejunal anastomoses. METHODS: Tri-layer nitrile-latex and rubber latex pairs of gloves were equally but randomly allocated to a right-handed surgeon performing 46 single-layer end-to-end jejunojejunal anastomoses on cadaveric material. Number and location of perforations were determined with the water leak test after each procedure. Ten unused pairs of both glove types were tested as controls. RESULTS: At least one perforation occurred in 41% (19/46) of the pairs of gloves. Glove perforations were present in 22% (5/23; 95% CI: 9-42) of tri-layer glove pairs and 61% (14/23; 95% CI: 41-78) of the rubber glove pairs. The odds of glove perforation were 5.6 times (p = .009, 95% CI: 1.5-20.5) lower when tri-layer rather than rubber gloves were used. The duration of procedure did not affect the risk of glove perforation (p = .679). No perforations were observed in the unused gloves. CONCLUSION: Perforations were less common when the surgeon wore tri-layer nitrile-latex gloves rather than to the natural rubber latex gloves tested in this study. CLINICAL RELEVANCE: Tri-layer nitrile-latex gloves were more resistant to perforations in experimental settings; further studies may confirm that they are also superior in a clinical setting.

Effect of three different needle holders on gastrointestinal anastomosis construction time and bursting pressure in equine jejunal segments.

BACKGROUND: Equine small intestinal resection and anastomosis is a procedure where optimizing speed, without compromising integrity, is advantageous. There are a range of different needle holders available, but little is published on the impact surgical instrumentation has on surgical technique in veterinary medicine. The objectives of this study were to investigate if the needle holder type influences the anastomosis construction time, the anastomosis bursting pressure and whether the bursting pressure is influenced by the anastomosis construction time. Single layer end-to-end jejunojejunal anastomoses were performed on jejunal segments harvested from equine cadavers. These segments were randomly allocated to four groups. Three groups based on the needle holder type that was used: 16.5 cm Frimand (Group 1), 16 cm Mayo-Hegar (Group 2) or 20.5 cm Mayo-Hegar (Group 3) needle holders. One (Group 4) as control without anastomoses. Anastomosis construction time was recorded. Bursting pressure was determined by pumping green coloured fluid progressively into the lumen whilst recording intraluminal pressures. Maximum pressure reached prior to failure was recorded as bursting pressure. Construction times and bursting pressures were compared between needle holder, and the correlation between bursting pressure and construction time was estimated. RESULTS: Construction times were not statistically different between groups (P = 0.784). Segments from Group 2 and Group 3 burst at a statistically significantly lower pressure than those from Group 4; P = 0.031 and P = 0.001 respectively. Group 4 and Group 1 were not different (P = 0.125). The mean bursting pressure was highest in Group 4 (189 ± 61.9 mmHg), followed by Group 1 (166 ± 31 mmHg) and Group 2 (156 ± 42 mmHg), with Group 3 (139 ± 34 mmHg) having the lowest mean bursting pressure. Anastomosis construction time and bursting pressure were not correlated (P = 0.792). CONCLUSIONS: The tested needle holders had a significant effect on bursting pressure, but not on anastomosis construction time. In an experimental setting, the Frimand needle holder produced anastomoses with higher bursting pressures. Further studies are required to determine clinical implications.

Lateral pterygoid muscle enthesis reconstruction in total temporomandibular joint replacement: An animal experiment with radiological correlation.

A novel total temporomandibular joint replacement (TMJR) was developed with CADskills BV (Ghent, Belgium), aiming to achieve reinsertion of the (LPM) onto a scaffold in the implant. In order to investigate the possibility of reinsertion of the LPM, an animal experiment was conducted. An in vivo sheep experiment was conducted, which involved implanting sheep with a TMJR. Clinical parameters were recorded regularly and computed tomography (CT) scan images of two randomly selected sheep per scan were made at 1, 3, and 6 months. After 9.5 months, the sheep were euthanized, and CT scans of all animals were performed in order to evaluate the LPM's enthesis. A total of 13 sheep were implanted with a TMJR. One sheep was used as a sham. Radiographs revealed four outcome types of enthesis reconstruction. In four sheep, there was no reconstruction between the implant and the LPM. In three sheep, there was a purely soft tissue connection of 0.5-0.9 mm (average 0.7 mm) between the ostectomized bony LPM insertion and the implant's lattice structure. A combination of partial bony and partial soft tissue enthesis attachment (0.3-0.5 mm, average 0.4 mm) was found in three sheep. A bony ingrowth of the enthesis into the scaffold occurred in two sheep. A secondary bony connection between the mandible and the insertion of the LPM was found in 10 of 13 sheep. Four fossa components were found to be displaced, yet TMJ function remained in these ewes. The heterotopic ossification that was seen may be a confounding factor in these results. This in vivo experiment showed promising results for improving the current approach to TMJR with the possibility of restoring the laterotrusive function. The fossa displacement was considered to be due to insufficient fixation and predominant laterotrusive force not allowing for proper osseointegration. Further optimization of the reattachment technique, scaffold position and surface area should be done, as well as trials in humans to evaluate the effect of proper revalidation.

Blood glucose and subcutaneous continuous glucose monitoring in critically ill horses: A pilot study.

This pilot prospective study reports the feasibility, management and cost of the use of a continuous glucose monitoring (CGM) system in critically ill adult horses and foals. We compared the glucose measurements obtained by the CGM device with blood glucose (BG) concentrations. Neonatal foals (0-2 weeks of age) and adult horses (> 1 year old) admitted in the period of March-May 2016 with clinical and laboratory parameters compatible with systemic inflammatory response syndrome (SIRS) were included. Glucose concentration was monitored every 4 hours on blood samples with a point-of-care (POC) glucometer and with a blood gas analyzer. A CGM system was also placed on six adults and four foals but recordings were successfully obtained only in four adults and one foal. Glucose concentrations corresponded fairly well between BG and CGM, however, there appeared to be a lag time for interstitial glucose levels. Fluctuations of glucose in the interstitial fluid did not always follow the same trend as BG. CGM identified peaks and drops that would have been missed with conventional glucose monitoring. The use of CGM system is feasible in ill horses and may provide clinically relevant information on glucose levels, but there are several challenges that need to be resolved for the system to gain more widespread usability.

A systematic review of cranioplasty material toxicity in human subjects.

PURPOSE: Local and systemic toxic reactions to implanted materials can result in morbidities. However, little is reported about cranioplasty implants. Therefore, we performed a systematic review on the toxicity of different materials used for cranioplasty implants. MATERIALS AND METHODS: A systematic search was conducted by browsing the Pubmed, Embase, and Cochrane Library databases. All human studies that identified toxic (aseptic) reactions to any types of material used as cranioplasty implants or onplants, published up to January 1, 2019, were included in the review. RESULTS: Nineteen studies were identified. Collectively, 36 patients endured some type of toxic reaction to an implanted material. Eleven studies presented several types of toxicity for PMMA cranioplasties in several tissue types. One article highlighted the risk of neurotoxicity for PMMA cranioplasty. Three articles presented toxic reactions to calcium phosphate and titanium implants. Three additional articles presented toxic reactions to PEEK, polypropylene-polyester, and polyethylene. CONCLUSION: All materials currently used for cranioplasty showed occasional toxicity and morbidities. Therefore, none can be considered completely biologically inert. We found that aseptic inflammatory reactions have been underreported in the literature due to a high incidence of infections with questionable evidence.

Complications associated with closure of the linea alba using a combination of interrupted vertical mattress and simple interrupted sutures in equine laparotomies.

OBJECTIVES: (1) Evaluate the occurrence and variables associated with incisional morbidities (IMs) after ventral median laparotomy when using interrupted vertical mattress sutures (IVMS) and (2) determine the occurrence of abdominal bandage-associated complications in horses. METHODS: Occurrence of IM and bandage-associated complications were determined after single laparotomies (SL group; n=546 horses) and repeat laparotomies (RL group: multiple laparotomies within four weeks; n=30 horses) in horses that survived ≥7 days postoperatively. Univariate analysis and multivariate logistic regression were performed to evaluate variables associated with IM. RESULTS: The IM rate was 9.52 per cent in the SL group and 33.33 per cent in the RL group. The actual infection rate was 5.31 per cent in the SL group and 26.67 per cent in the RL group. Overall, long-term clinically relevant wound complications was 1.68 per cent. After multivariate analysis, increased anaesthesia duration was associated with IM and performing an enterotomy and postoperative intravenous lidocaine administration were associated with incisional infection in the SL group; no parameter remained significant in the RL group. Bandage-related complications were recorded in 2.95 per cent of the cases. CONCLUSIONS: These results suggest that the use of IVMS for closure of the linea alba is another viable option for closure and that an abdominal bandage does not appear to cause significant complications.

Effects of intra-articular administration of lidocaine, mepivacaine, and the preservative methyl parahydroxybenzoate on synovial fluid biomarkers of horses.

OBJECTIVE: To compare the extent of inflammation and catabolic collagen response in the middle carpal joints (MCJs) of healthy horses following intra-articular injection of 2% lidocaine, 2% mepivacaine, lactated Ringer solution (LRS), or 0.1% methyl parahydroxybenzoate. ANIMALS: 17 adult horses. PROCEDURES: In the first of 2 experiments, the left middle carpal joint (MCJ) of each of 12 horses was injected with 10 mL of 2% lidocaine (n = 3), 2% mepivacaine (3), or LRS (control; 6). After a 4-week washout period, the right MCJ of the horses that received lidocaine or mepivacaine was injected with 10 mL of LRS, and the right MCJ of horses that received LRS was injected with 10 mL of 2% lidocaine (n = 3) or 2% mepivacaine (3). In experiment 2, the left MCJ of each of 5 horses was injected with 10 mL of 0.1% methyl parahydroxybenzoate. After a 48-hour washout period, the right MCJ of each horse was injected with 10 mL of LRS. Synovial fluid (SF) samples were aseptically collected before and at predetermined times after each injection. Synovial fluid WBC count, neutrophil percentage, and total protein, neutrophil myeloperoxidase, neutrophil elastase, and Coll2-1 concentrations were compared among treatments. RESULTS: Both lidocaine and mepivacaine induced SF changes indicative of inflammation and a catabolic collagen response, but the magnitude of those changes was more pronounced for lidocaine. Methyl parahydroxybenzoate did not cause any SF changes indicative of inflammation. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that mepivacaine was safer than lidocaine for intra-articular injection in horses.

B-mode and power Doppler ultrasonography of the equine suspensory ligament branches: A descriptive study on 13 horses.

Ultrasonography is routinely used to achieve the diagnosis of equine suspensory ligament desmopathy. In human medicine, power Doppler ultrasonography has also been found to be useful for the diagnosis of tendon/ligament injuries. The aim of this prospective, pilot study was to assess the presence or absence of power Doppler signal in suspensory ligament branches and compare B-mode findings with power Doppler findings in suspensory ligament branches of lame and non-lame limbs. Thirteen horses were used (eight lame horses, with lameness related to pain in the suspensory ligament branches, and five non-lame horses). Ten lame limbs and 24 sound limbs were assessed by B-mode and power Doppler ultrasonography. The severity of power Doppler signal was scored by two independent readers. The B-mode ultrasonographic examination revealed abnormalities in branches of lame limbs and in branches of sound limbs. Suspensory ligament branches that were considered normal in B-mode showed no power Doppler signal. However, power Doppler signal was detected in suspensory ligament branches that were abnormal in B-mode, both in lame and sound limbs. Power Doppler scores were subjectively higher in suspensory ligament branches of lame limbs and in branches with more severe B-mode changes. Findings supported the use of power Doppler as an adjunctive diagnostic test for lame horses with suspected suspensory desmopathy.

Retrospective evaluation of 155 adult equids and 21 foals with tetanus in Western, Northern, and Central Europe (2000-2014). Part 1: Description of history and clinical evolution.

OBJECTIVE: To describe clinical data of hospitalized adult equids and foals with tetanus. DESIGN: Multicenter retrospective study (2000-2014). SETTING: Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. ANIMALS: One hundred fifty-five adult equids (>6 months) and 21 foals (<6 months) with tetanus. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Information on geographic, annual and seasonal data, demographic- and management-related data, clinical history, clinical examination and blood analysis on admission, complications, treatments, and outcomes were described and statistically compared between adults and foals. The described cases were often young horses. In 4 adult horses, tetanus developed despite appropriate vaccination and in 2 foals despite preventive tetanus antitoxin administration at birth. Castration, hoof abscesses, and wounds were the most common entry sites for adults; umbilical cord infections and wounds for foals. Stiffness was the commonest observed initial clinical sign. Blood analyses frequently revealed an inflammatory response, hemoconcentration, muscle damage, azotemia, negative energy balance, liver damage, and electrolyte and acid base disturbances. Common complications or clinical signs developing during hospitalization included dysphagia, dyspnea, recumbency, hyperthermia, seizures, hyperlipemia, gastrointestinal impactions, dysuria, and laryngeal spasms. Cases were supported with wound debridement, antimicrobial treatment, tetanus antitoxin, muscle spasm and seizure control, analgesia, anti-inflammatory drugs, fluid therapy, and nutritional support. Mortality rates were 68.4% in adult horses and 66.7% in foals. Foals differed from adult horses with respect to months of occurrence, signalment, management-related data, potential causative events, clinical signs on admission, blood analysis, complications, and severity grades. CONCLUSIONS: This is the first study that rigorously describes a large population of equids affected by tetanus. The information provided is potentially useful to clinicians for early recognition and case management of tetanus in adult horses and foals. Tetanus affects multiple organ systems, requiring broad supportive and intensive care. Neonatal and adult tetanus in the horse should be considered as distinct syndromes, as in human medicine.

Retrospective evaluation of 155 adult equids and 21 foals with tetanus from Western, Northern, and Central Europe (2000-2014). Part 2: Prognostic assessment.

OBJECTIVE: To identify prognostic variables for adult equids and foals with tetanus. DESIGN: Multicenter retrospective study (2000-2014). SETTING: Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. ANIMALS: One hundred fifty-five adult equids and 21 foals with tetanus. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Variables from history and clinical examination were statistically compared between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors). Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and 66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and seizures during hospitalization, treatment with glycerol guaiacolate, intravenous fluids, and intravenous glucose solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft food and drinking, older age, and longer hospitalization delay. Outcome was not different between different tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved outcome and shorter hospitalization. CONCLUSIONS: Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based information related to patient management. Several prognostic indicators relate to the ability to eat or drink, and more severe clinical signs relate to poor outcome. Increasing intravenous dosages of TAT has no significant effect on outcome, but the positive trend identified may support a recommendation for high intravenous TAT dosages. Further evaluation is warranted.

Modified Thomas splint-cast combination for the management of limb fractures in small equids.

OBJECTIVE: To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC). STUDY DESIGN: Retrospective case series. ANIMALS: Client owned horses and donkeys. METHODS: Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians. RESULTS: Nine horses and 4 donkeys were identified with fractures of the tibial diaphysis (n = 4), ulna (n = 3), distal metatarsus (n = 2), proximal metacarpus (n = 1), radial diaphysis (n = 1), calcaneus (n = 1), and distal femoral physis (n = 1). Follow-up was available for 12 equids, of which 8 (67%) recovered from the fracture and became pasture sound. Six equids developed obvious external deformation of the affected limb. CONCLUSION: Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure.