Distribution of mortality patterns in cats with naturally occurring trauma: A Veterinary Committee on Trauma registry study.

A greater understanding of the prognostic variables that affect the timing of death for cats with trauma may help clinicians select treatments and monitoring plans. This study investigated the mortality rate and its distribution pattern in a large population of cats to identify variables associated with the timing of trauma-related deaths. Clinical data was retrieved from the Veterinary Committee on Trauma database to determine mortality rates and timing of deaths, defined as early death (ED; <1 day post-presentation) or delayed death (DD; ≥1 day post-presentation). Multivariable logistic regression analyses were performed to identify characteristics and interventions that best predicted timing of death. Overall mortality rate for 6703 feline trauma patients with complete records was 17.2%, with 7.6% due to natural death and 92.3% due to euthanasia. Among the subset of 543 cats with trauma that died after presentation or required euthanasia due to a grave prognosis (representing an 8.1% mortality rate), EDs were more common (71.7%) than DD and the cause of death was not significantly associated with the timing of death. Clinical pathology parameters were unable to identify animals more likely to die or to require euthanasia due to a poor prognosis during hospitalisation. Factors that were significantly different for cats with ED vs. DD included the median cumulative results for the Modified Glasgow Coma Scale (MGCS) score and the Animal Trauma Triage (ATT) score, the presence of spinal trauma, administration of blood products and undertaking surgical procedures. An increased likelihood of DD rather than ED was associated with the administration of blood products (odds ratio [OR], 3.959; P = 0.019) vs. not, performing a surgical procedure (OR, 6.055; P < 0.001) vs. not, and a cumulative MGCS of 15-17 or 18 (OR, 1.947 and 3.115; P = 0.031 and P = 0.01, respectively) vs. a cumulative MGCS ≤ 11.

Identifying drivers for user preference and acceptability of different hydro-alcoholic hand rub formulations.

BACKGROUND: In the current era, the importance of proper hand hygiene to reduce the transmission of infectious diseases has become difficult to debate. Yet, compliance rates remain low and are affected by many factors, amongst which is user acceptability of hand hygiene products. AIM: The present study aimed at investigating drivers of preference towards different hand hygiene formulations. METHODS: Three different formulations (liquid, foam and gel) of the same brand were randomly and blindly evaluated by 54 participants based on the WHO Protocol for Evaluation of Tolerability and Acceptability of Alcohol-based Handrubs. RESULTS: The majority (76%) of respondents indicated that the product formulation impacted their level of compliance with hand hygiene protocols. The preferred formulation was liquid, with 50% of participants ranking it as first choice. General product satisfaction, the product texture, the drying speed and the ease of application, were the statistically significant drivers for participants to rank a formulation as their first choice vs not ranking it as their first choice. CONCLUSIONS: When designing alcohol formulations and implementing hand hygiene protocols, understanding drivers of preference for formulations may enhance product user acceptability and therefore compliance with hand hygiene.

Colonic Health in Hospitalized Horses Treated with Non-Steroidal Anti-Inflammatory Drugs - A Preliminary Study.

Non-steroidal anti-inflammatory drugs (NSAIDs) can cause right dorsal colitis, but longitudinal clinical studies are lacking. This study investigates whether NSAID treated horses develop right dorsal colonic pathology in a clinical setting. Non-gastrointestinal hospitalized horses treated with NSAIDs >4 days, and untreated hospital-owned teaching horses and non-gastrointestinal client-owned hospitalized horses were included. All horses were monitored over time with clinical examinations (focusing on presence of colic, depression, reduced appetite, unstructured feces), ultrasonographic intestinal wall measurements, fecal occult blood tests (semi-quantitative results), and blood analysis (total protein and albumin concentrations, white blood cell and neutrophil counts). Outcomes were recorded as "ultrasonographically thickened right dorsal colon (RDC) walls", "colitis" and "right dorsal colitis". Findings over time were compared to baseline values and to control horses. Seventeen NSAID treated horses and 5 controls were included. NSAID treated horses developed thickened RDC walls (4/9), and subclinical and mild colitis (9/11) and right dorsal colitis (4/10), whereas all control horses remained healthy. The first changes were identified on treatment day 2. RDC walls of treated horses were significantly thicker compared to their own baseline values and compared to control horses. In conclusion, presumptive colon pathology was identified with a high incidence, starting early in the course of treatment, but with low severity. Appropriate monitoring should be advised throughout NSAID treatment. Additional research for noninvasive diagnostic tests for colon pathology is required.

Development of the equine gut microbiota.

Shortly after birth the mammalian gut is colonized, by a transient microbiota, highly susceptible to environment and diet, that eventually stabilizes and becomes the resident gut microbiota. In a window of opportunity during the colonization, oral tolerance is established towards resident bacteria. In this study, the development of the equine gut microbiota was investigated in ten foals from parturition until post weaning. We found great differences in the core species of the gut microbiota composition between time-matched samples on Day 7 and 20 post-partum. Between day 20 and Day 50 post-partum, we saw the gut microbiota became increasingly dominated by fiber fermenting species. After Day 50, no significant changes in species abundance were observed. Gene expression analysis of pro- and anti-inflammatory cytokines in the blood revealed no significant changes before and after weaning. In summary, relative stability of the gut microbiota was reached within 50 days post-partum and, weaning did not have a major impact on the microbial composition.

Expression of immune regulatory genes correlate with the abundance of specific Clostridiales and Verrucomicrobia species in the equine ileum and cecum.

Billions of bacteria inhabit the gastrointestinal tract. Immune-microbial cross talk is responsible for immunological homeostasis, and symbiotic microbial species induce regulatory immunity, which helps to control the inflammation levels. In this study we aimed to identify species within the equine intestinal microbiota with the potential to induce regulatory immunity. These could be future targets for preventing or treating low-grade chronic inflammation occurring as a result of intestinal microbial changes and disruption of the homeostasis. 16S rRNA gene amplicon sequencing was performed on samples of intestinal microbial content from ileum, cecum, and colon of 24 healthy horses obtained from an abattoir. Expression of genes coding for IL-6, IL-10, IL-12, IL-17, 18 s, TNFα, TGFß, and Foxp3 in the ileum and mesenteric lymph nodes was measured by qPCR. Intestinal microbiota composition was significantly different in the cecum and colon compared to the ileum, which contains large abundances of Proteobacteria. Especially members of the Clostridiales order correlated positively with the regulatory T-cell transcription factor Foxp3 and so did the phylum Verrucomicrobia. We conclude that Clostridiales and Verrucomicrobia have the potential to induce regulatory immunity and are possible targets for intestinal microbial interventions aiming at regulatory immunity improvement.

Clinical Sentinel Surveillance of Equine West Nile Fever, Spain.

West Nile fever (WNF) is a viral zoonotic infection caused by a mosquito-borne flavivirus of the Flaviviridae family. According to a comparative study, the passive surveillance of horses by equine veterinarians appeared to be the most cost-effective system in the European context of WNF. Clinical data issued from a passive epidemiosurveillance network from September 2010 to December 2011 on horses in Spain were statistically compared and used to develop a predictive diagnostic decision tree, both with the aim to improve the early clinical detection of WNF in horses. Although clinical signs were variable in horses affected by WNF, four clinical signs and the month of occurrence were identified as useful indicators to distinguish between WNF-related and WNF-unrelated cases. The signs that pointed out a presumptive diagnosis of WNF in horses were cranial nerves deficits, limb paralysis, photophobia and nasal discharge. Clinical examination of horses with neurological signs that are not vaccinated against WNV could provide important clues for the early clinical detection of WNF and therefore serve as an alert for possible human viral infections. The study of the clinical pattern of WNF in horses is of importance to enhance awareness and better understanding and to optimize surveillance designs for clinical detection of WNF in horses in advance of epidemic activity affecting humans.

Identification of methylenecyclopropyl acetic acid in serum of European horses with atypical myopathy.

REASONS FOR PERFORMING STUDY: It is hypothesised that European atypical myopathy (AM) has a similar basis as seasonal pasture myopathy in North America, which is now known to be caused by ingestion of hypoglycin A contained in seeds from the tree Acer negundo. Serum from horses with seasonal pasture myopathy contained the conjugated toxic metabolite of hypoglycin A, methylenecyclopropyl acetic acid (MCPA). STUDY DESIGN: Retrospective study on archived samples. OBJECTIVES: 1) To determine whether MCPA-carnitine was present in serum of European horses confirmed to have AM; 2) to determine whether Acer negundo or related Acer species were present on AM pastures in Europe. METHODS: Concentrations of MCPA-carnitine were analysed in banked serum samples of 17 AM horses from Europe and 3 diseased controls (tetanus, neoplasia and exertional rhabdomyolysis) using tandem mass spectrometry. Atypical myopathy was diagnosed by characteristic serum acylcarnitine profiles. Pastures of 12 AM farms were visited by experienced botanists and plant species were documented. RESULTS: Methylenecyclopropyl acetic acid-carnitine at high concentrations (20.39 ± 17.24 nmol/l; range 0.95-57.63 nmol/l; reference: <0.01 nmol/l) was identified in serum of AM but not disease controls (0.00 ± 0.00 nmol/l). Acer pseudoplatanus but not Acer negundo was present on all AM farms. CONCLUSIONS: Atypical myopathy in Europe, like seasonal pasture myopathy in North America, is highly associated with the toxic metabolite of hypoglycin A, MCPA-carnitine. This finding coupled with the presence of a tree of which seeds are known to also contain hypoglycin A indicates that ingestion of Acer pseudoplatanus is the probable cause of AM. This finding has major implications for the prevention of AM.

Traditional and quantitative assessment of acid-base and shock variables in horses with atypical myopathy.

BACKGROUND: Descriptions of acid-base disturbances in atypical myopathy (AM) are limited. OBJECTIVES: Describe and compare traditional and quantitative acid-base abnormalities and cardiovascular shock status in horses with AM at admission. ANIMALS: 34 horses with AM, 15 healthy controls. METHODS: Retrospective case-control study. Records were searched for shock variables (packed cell volume [PCV], blood urea nitrogen [BUN], heart and respiratory rate) and acid-base variables (venous blood gas analysis, electrolytes, total protein, lactate) on admission. Base excess (BE) of free water (BEfw), chloride (BEcl), total protein (BEtp), and unidentified anions (BEua), anion gap (AG), measured strong ion difference (SIDm), and concentration of total nonvolatile weak acids ([Atot]) were calculated. Acid-base classifications, using simplified strong ion model and traditional approach, and shock grades were assigned. A 2-sample Wilcoxon rank-sum test and Bonferroni correction compared variables in AM cases versus control horses. Significance was P < .05/16 for acid-base and P < .05/5 for shock variables. RESULTS: Tachycardia, tachypnea, and normal to increased PCV and BUN were common in AM cases. Respiratory, metabolic acid-base alterations, or both were mainly caused by respiratory alkalosis, lactic acidosis, and SIDm alkalosis, alone or in combination. Evaluated variables (except pH, potassium concentration, total protein, and related calculations) were significantly different (P < .001) between AM cases and control horses. The strong ion model provided a more accurate assessment than the traditional approach and identified mixed derangements. CONCLUSIONS AND CLINICAL IMPORTANCE: Acid-base derangements should be evaluated in horses with AM and this preferably with the strong ion model.

European outbreaks of atypical myopathy in grazing equids (2006-2009): spatiotemporal distribution, history and clinical features.

REASONS FOR PERFORMING STUDY: Improved understanding of the epidemiology of atypical myopathy (AM) will help to define the environmental factors that permit or support the causal agent(s) to exert toxicity. OBJECTIVES: This European survey of AM aimed to describe spatiotemporal distribution, survival, clinical signs, circumstances in which AM develops and its different expressions between countries and over time. METHODS: The spatiotemporal distribution, history and clinical features of AM cases reported to the Atypical Myopathy Alert Group from 2006 to 2009 were described. Comparisons of data from the most severely affected countries and from the large outbreaks were made with Fisher's exact and Welch's tests with Bonferroni correction. RESULTS: Of 600 suspected cases, 354 met the diagnostic criteria for confirmed or highly probable AM. The largest outbreaks occurred during the autumns of 2006 and 2009 in Belgium, France and Germany. For the first time, donkeys, zebras and old horses were affected, and clinical signs such as gastrointestinal impaction, diarrhoea, penile prolapse, buccal ulceration and renal dysfunction were observed. Affected horses spent >6 h/day on pastures that almost always contained or were surrounded by trees. The latency period was estimated at up to 4 days. Overall survival rate was 26%. Although differences between countries in affected breeds, body condition, horse management and pasture characteristics were recognised, the common presenting clinical signs and mortality were similar between countries. CONCLUSIONS AND POTENTIAL RELEVANCE: This study describes new data on case details, history and clinical course of AM that is of preventive, diagnostic and therapeutic value. However, the true impact of the findings of this study on the development of or severity of AM should be tested with case-control studies.

European outbreaks of atypical myopathy in grazing horses (2006-2009): determination of indicators for risk and prognostic factors.

REASONS FOR PERFORMING STUDY: Appropriate management of atypical myopathy (AM) requires the establishment of an accurate diagnosis and prognosis. Furthermore, preventive measures to avoid AM need to be refined. OBJECTIVES: The aims of the study were as follows: 1) to improve the diagnosis of AM; 2) to identify prognostic predictors; and 3) to refine recommended preventive measures based on indicators of risk factors. METHODS: An exploratory analysis of cases in Europe between 2006 and 2009 reported to the Atypical Myopathy Alert Group was conducted. Based on clinical data, reported cases were allocated into 2 groups: confirmed or highly probable AM (AM group; further divided into survivors and nonsurvivors); and cases with a low probability of having AM or with another final diagnosis (non-AM group). Using Welch's test and odds ratios corrected for multiple comparisons, the AM vs. non-AM groups were compared to identify indicators for diagnosis and risk factors, and survivors vs. nonsurvivors in the AM group were compared to identify prognostic factors. Sensitivity, specificity and positive and negative predictive values were calculated for specific clinical signs related to final diagnosis and outcome. RESULTS: From 600 reported cases, 354 AM cases (survival rate of 26%) and 69 non-AM cases were identified, while there were insufficient data to categorise the remainder. Variables valuable for diagnosing AM compared with similar diseases were as follows: presence of dead leaves and wood and/or trees on pastures; sloping pastures; full-time pasture access; no food supplementation; normal body condition; pigmenturia; normothermia; and congested mucous membranes. Nonsurvival was associated with recumbency, sweating, anorexia, dyspnoea, tachypnoea and/or tachycardia. Survival was associated with remaining standing most of the time, normothermia, normal mucous membranes, defaecation and vitamin and antioxidant therapy. CONCLUSIONS AND POTENTIAL RELEVANCE: This study refines the list of risk factors for AM. Clinical signs valuable for diagnosis and prognosis have been identified, enabling clinicians to improve management of AM cases.

Investigation of the best suture pattern to close a stuffed Christmas turkey.

Instructions on how to debone and stuff a turkey are available, but what is the best way to close it up? A randomised trial involving 15 turkeys was performed in order to evaluate skin disruption scores and cosmetic outcomes following the use of different suture patterns. Turkeys were deboned, stuffed and cooked according to guidelines of the US Department of Agriculture Food Safety and Inspection Services. After stuffing, they were randomly assigned to one of five closure groups: simple continuous Lembert; simple continuous Cushing; simple continuous Utrecht; simple continuous; or staples. Turkeys were cooked at 180 °C for two hours ensuring core temperature reached 75 °C. Suture line integrity was evaluated after removal of the sutures and the cosmetic aspect was graded. Before cooking, the Utrecht pattern and skin staples offered the best cosmetic result. After removal of the sutures, the skin remained intact only in the stapled group. All other suture patterns disrupted the skin after removal of the sutures, rendering the turkey less cosmetically appealing for serving. Closure of a stuffed turkey was best performed using skin staples to achieve the best cosmetic results. Using this technique you will be able to impress family and friends at a Christmas dinner, and finally show them your surgical skills.

Clinical diagnosis of West Nile Fever in Equids by classification and regression tree (CART) analysis and comparative study of clinical appearance in three European countries.

This retrospective study describes risk/protection factors for the development of clinical West Nile Fever (WNF) in equids, compares clinical presentation in three European countries, France, Italy and Hungary, and creates classification and regression trees (CART) to facilitate clinical diagnosis. The peak of WNF occurrence was observed in September whatever the country. A significant difference between Italy and France was observed in the delay between initial clinical signs and veterinary consultation. No clinical sign was significantly associated with WNF. Despite similar clinical presentations in the three countries, occurrence of hyperthermia was more frequently reported in France. Classification and regression tree demonstrated the major importance of geographical locality and month to reach a diagnosis and emphasized differences in predominant clinical signs depending on the period of detection of the suspected case (epizootic or not). However, definite diagnosis requires specific serological tests. Centralized reporting system and time-space risk mapping should be promoted in every country.

Variations of plasmatic concentrations of Insulin-like Growth Factor-I in post-pubescent horses affected with developmental osteochondral lesions.

Developmental osteochondral lesions are often encountered in the equine population and are a major cause of lameness. Different growth factors that act systemically as well as locally regulate the growth of cartilage. Among them is Insulin-like Growth Factor I that has been demonstrated to promote chondrocyte growth and differentiation and that has been shown to influence cartilage repair. The aims of this study were to investigate differences in circulating plasma levels of Insulin-like Growth Factor-I in post-pubescent horses affected with developmental osteochondral lesions compared to unaffected ones. Significantly higher values of circulating Insulin-like Growth Factor-I levels were found in the affected group (n = 82) compared to controls (n = 86). This result may still reflect an earlier imbalance in IGF-I levels from horses with developmental osteochondral lesions considering the aetiopathological link which has been made between IGF-I and the occurrence of osteochondrosis. However, other studies have shown increased expression of IGF-I after cartilage damage. The higher levels found in this study could be due to a healing response of the cartilage to the damage caused by the osteochondral lesions.

Vegetative endocarditis in equids (1994--2006).

BACKGROUND: Endocarditis is a rare heart condition with variable clinical expressions in equids. Risk factors for this disease are incompletely understood. OBJECTIVE: Describe risk factors for endocarditis in equids. ANIMALS: One hundred and fifty-three equids admitted to Liège University, 9 diagnosed with endocarditis and 144 free from endocarditis but admitted to the hospital with a differential diagnosis including this disease. METHODS: Retrospective case-control study. RESULTS: Equids with endocarditis were significantly younger (mean age = 4.84 +/- 5.74 years) than control equids (mean age = 10.8 +/- 7.73 years) (P = .01). No sex or breed predisposition was observed. Animals with hyperthermia (odds ratio [OR] = 24.4; confidence interval [CI] = 1.40-428), synovial distension (OR = 13.4; CI = 3.00-59.8), lameness (OR = 6.52; CI = 1.63-26.1), hyperglobulinemia (OR = 26.4; CI = 3.03-229), hypoalbuminemia (OR = 11.4; CI = 1.34-96.8), hyperfibrinogenemia (OR = 9.81; CI = 1.16-82.7), or leukocytosis (OR = 7.12; CI = 1.40-36.4) presented a significantly higher risk of having endocarditis than control horses. The presence of two of the clinical signs mentioned above significantly increased the probability of a diagnosis of endocarditis (P< or = .05). CONCLUSIONS AND CLINICAL IMPORTANCE: Age is associated with equine endocarditis. The diagnostic value of certain clinical signs and abnormalities in blood parameters in this disease are described.

The use of radial extracorporeal shockwave therapy in the treatment of urethral urolithiasis in the horse: a preliminary study.

BACKGROUND: Radial extracorporeal shockwave therapy (ESWT) is widely used in equine practice for the treatment of orthopedic problems. However, its original use as a lithotripsy device in human and canine urology led us to postulate that it could be used as an alternative to the surgical treatment of urethral calculi in horses. HYPOTHESIS: Radial ESWT can easily and safely fragment calculi in the distal urethra of the horse. ANIMALS: Two postmortem cases and 1 live case of obstructive urinary disease admitted at the Veterinary Teaching Hospital of Liege. METHODS: A radial shockwave device was directly applied to the urethra in an attempt to fragment calculi. An ex vivo trial was performed on the same retrieved calculi to investigate pressure settings in order to obtain complete fragmentation of the calculus. RESULTS: In all cases, radial ESWT was able to fragment the calculus partially, enabling retrieval of the remaining fragments via the urethra. Much higher pressure settings than those used for in vivo partial fragmentation were necessary to obtain complete destruction of the calculi ex vivo. CONCLUSIONS AND CLINICAL IMPORTANCE: This brief report suggests the use of radial ESWT as a safe and useful alternative to more invasive surgical management of urethral calculi in horses.

Tetanus in the equine species: a retrospective study of 31 cases.

BACKGROUND: Few studies exist about factors affecting the outcome of horses with tetanus. ANIMALS: 31 equids (30 horses and 1 donkey) with a clinical diagnosis of tetanus admitted to the Equine Clinic of the University of Liege between 1991 and 2006. The cases were divided into two groups according to the outcome (survivors and non-survivors). METHODS: The clinical data of survivors and non-survivors were compared using an ANOVA (continuous data) or a Fisher's test (discrete data). RESULTS: The survival rate was 32%. Most animals were 5 years or younger, and none had been appropriately vaccinated. The non-survivors were significantly younger than the survivors. The development of dyspnoea, recumbency, and the combination of dysphagia, dyspnoea, and recumbency was observed significantly more in the non-survivors than in the survivors. The timing of tetanus antitoxin administration (either immediately after the onset of suggestive signs or after a delay) was not different between the two groups. The time between the occurrence of a wound and the first signs ranged from 2 days to 2 months and was not significantly different between groups. All non-survivors died within 8 days of the first signs. CONCLUSIONS & CLINICAL IMPORTANCE: This study suggests that young animals are affected more often and more severely by tetanus than older animals. Dyspnoea, recumbency, and the combination of dysphagia, dyspnoea, and recumbency can be considered as indicators of a poor prognosis in equids suffering from tetanus.

The composition of the inflammatory infiltrate in three cases of polyneuritis equi.

Polyneuritis equi (PNE) is a rare neurological disease in the horse. Because of the suspicion in PNE of a T-lymphocyte mediated immune response against the myelin, the objective of this study was to determine the composition of the inflammatory infiltrate in the involved nerves of 3 horses with PNE, studied retrospectively. T-lymphocytes were demonstrated in the lesions, which suggests a T-lymphocyte mediated immune response against myelin. In addition, the presence of B-lymphocytes indicated a local production of antibodies. More research, involving a prospective study, is needed to determine whether the T-lymphocytes are cytotoxic or T-helper lymphocytes.

Emotionally charged earcons reveal affective congruency effects.

In the present study, the affective impact of earcons on stimulus classification is investigated. We show, using a picture-categorization task, that the affective connotation of earcons in major and minor mode (representing positive and negative valence, respectively) can be congruent or incongruent with response valence. Twenty participants classified pictures of animals and instruments in 256 trials, using positive and negative Yes or No responses. Together with the pictures, either a chord in major mode or minor mode was played. The affective valence of the chords either did or did not match the valence of responses. Response-time latencies show congruency effects of the matching and non matching sound and response valences, indicating that it is important to carefully investigate human-computer interfaces for potential affective congruency effects, as these can either facilitate or inhibit user performance.

Distraction affects the performance of obstacle avoidance during walking.

In this study, dual-task interference in obstacle-avoidance tasks during human walking was examined. Ten healthy young adults participated in the experiment. While they were walking on a treadmill, an obstacle suddenly fell on the treadmill in front of their left leg during either midswing, early stance, or late stance of the ipsilateral leg. Participants were instructed to avoid the obstacle, both as a single task and while they were concurrently performing a cognitive secondary task (dual task). Rates of failure, avoidance strategy, and a number of kinematic parameters were studied under both task conditions. When only a short response time was available, rates of failure on the avoidance task were larger during the dual task than during the single task. Smaller crossing swing velocities were found during the dual task as compared with those observed in the single task. The difference in crossing swing velocities was attributable to increased stiffness of the crossing swing limb. The results of the present study indicated that divided attention affects young and healthy individuals' obstacle-avoidance performance during walking.