Accuracy of differences in blood and peritoneal glucose to differentiate between septic and non-septic peritonitis in horses.

Difference in blood and peritoneal glucose (DBPG) is used in clinical practice to support a diagnosis of septic peritonitis in horses. It is inexpensive, easy and rapid to perform. The aim of this study was to evaluate the accuracy of the DBPG to differentiate between septic and non-septic peritonitis in horses. Blood and peritoneal fluids were harvested from suspected animals. Plasma and peritoneal glucose levels, total nucleated cell count, direct microscopic and microbiological examinations of the peritoneal fluid were evaluated. Using DBPG levels, the animals were classified into two groups: difference ≥ 50 mg/dL (positive test) and difference < 50 mg/dL (negative test). Positive microbiological examination and/or presence of bacteria in direct microscopic examination was used as a gold standard to detect septic peritonitis. The accuracy parameters analysed were: sensitivity, specificity, and positive/negative predictive values, for which the results were respectively: 0.23, 0.91, 0.60 and 0.67. Due to poor accuracy, other cut-off margins and peritoneal glucose concentrations were evaluated. The test was considered most accurate when the DBPG was zero with sensitivity, specificity, and positive/negative predictive values of 0.85, 0.82, 0.73, 0.90 respectively. Peritoneal glucose concentrations alone were not a reliable feature to detect peritonitis. DBPG ≥50 mg/dL, widely used for the diagnosis of septic peritonitis, does not have a good accuracy and the DBPG = 0 has a better accuracy for detecting the disease.

Association of intraperitoneal ceftriaxone, intravenous gentamicin and oral metronidazole in the treatment of an abdominal abscess and peritonitis in a horse: case report / Associação da ceftriaxona intraperitoneal, gentamicina intravenosa e do metronidazol oral no tratamento de abscesso abdominal e peritonite em equino: relato de um caso

Medical management of abdominal abscesses in horses requires prolonged antibiotic therapy and presents varied success rates. A 6-year-old male horse with a history of colic and multiple abdominal punctures to relieve gas was attended. At admission, tachycardia, tachypnea, hyperthermia, mucosal congestion, dehydration, and rigid gait were observed. The association of physical examination, laboratory and ultrasonographic findings allowed the diagnoses of peritonitis and abdominal abscess. Supporting treatment plus broad spectrum antibiotic therapy was performed: daily intraperitoneal ceftriaxone (25 mg/kg, 7 days); daily intravenous gentamicin (6.6 mg/kg, 7 days); per os metronidazole three times a day (15 mg/kg 12 days), followed by the same dose twice a day (15 mg/kg 33 days), totaling 45 days of treatment. Plasma fibrinogen and ultrasonographic examination were the most effective tools to evaluate abscess evolution. There was normalization of the physical examination 24 h after beginning the treatment, consecutive regression of the nucleated cell count in the peritoneal fluid, and regression of plasma fibrinogen and size of the abscess. On the 10th treatment day, the animal was discharged from the hospital, maintaining oral therapy with metronidazole every 12 h (15 mg / kg). When the animal returned on the 30th day, an abscess size regression was observed. However, there was no resolution, and therapy with metronidazole was maintained. On the 45th day of treatment, a new hospital evaluation was performed, where the abscess resolved, and metronidazole was suspended. It is highlighted that the therapeutic association used in the treatment of abdominal infection and abscess resulted in a rapid clinical response.(AU)

O tratamento conservativo dos abscessos abdominais em equinos requer antibioticoterapia prolongada e apresenta variadas taxas de sucesso. Foi atendido um cavalo de seis anos de idade, com histórico de cólica e múltiplas punções abdominais por agulha para esvaziamento de gás. Na admissão, foram observados taquicardia, taquipnéia, hipertermia, congestão mucosa, desidratação e marcha rígida. A associação do exame físico, achados laboratoriais e ultrassonográficos permitiu o diagnóstico de peritonite e abscesso abdominal. Foi realizado tratamento suporte e antibioticoterapia de amplo espectro: ceftriaxona intraperitoneal diária (25 mg/kg, 7 dias); gentamicina intravenosa diária (6,6 mg/kg, 7 dias); metronidazol oral três vezes ao dia (15 mg/kg, 12 dias), seguido de mesma dose duas vezes ao dia, por mais 33 dias, totalizando 45 dias de tratamento. O fibrinogênio plasmático e o exame ultrassonográfico foram os recursos mais eficazes para a avaliação da evolução do abscesso. Após 24 horas do início do tratamento foi constatada a normalização do exame fisico, regressão progressiva da contagem de células nucleadas no líquido peritoneal, do fibrinogênio plasmático e do tamanho do abscesso. No 10° dia de tratamento o animal recebeu alta hospitalar, mantendo-se a terapia oral com metronidazol a cada 12 horas (15 mg/Kg). Em retorno, ao 30° dia, observou-se regressão do tamanho do abscesso, entretanto, não houve resolução, tendo sido mantida a terapia com metronidazol. No 45º dia de tratamento, realizou-se nova avaliação hospitalar, onde foi observada a resolução do abscesso e a admnistração do metronidazol foi suspensa. Destaca-se, que a associação terapêutica utilizada no tratamento de infecção abdominal e abscesso resultou em rápida resposta clínica.(AU)

Adjuvant intraperitoneal ceftriaxone in the treatment of septic peritonitis in horses.

BACKGROUND: Intraperitoneal administration of ceftriaxone maintains therapeutic abdominal concentrations for 24 hours in healthy horses. Therefore, it is a possible treatment for septic peritonitis. The aim of this study was to evaluate the efficacy of ceftriaxone as an adjuvant treatment in horses with septic peritonitis. METHODS: Twenty-six horses with clinical signs, sonography and/or laboratory findings of septic peritonitis were included. Peritoneal fluid was collected for microbiological culture and in vitro microbial sensitivity profile assessment. Daily intraperitoneal administration of ceftriaxone (25 mg/kg) was initiated with supportive and systemic antimicrobial treatment. The animals were divided into three groups: group 1-gastrointestinal tract injuries and abdominal surgery (excluding perforations/ruptures); group 2-not related to changes in the gastrointestinal tract; group 3-secondary to intestinal rupture and/or faeces contamination. RESULTS: The mean success rate of the treatment was 77 per cent (20/26 animals), with success rates of 84.6 per cent in group 1; 87.5 per cent, group 2; and 40 per cent, group 3. CONCLUSIONS: This is the first study to report adjuvant intraperitoneal treatment ceftriaxone for septic peritonitis in horses and indicates that this treatment can successfully treat septic peritonitis in horses.

Experimental skin wound treatment with Copaifera langsdorffii Desf Kuntze (Leguminosae) extract and oil-resin in horses / Tratamento experimental de feridas cutâneas com extrato e óleo resina de Copaifera langsdorffii Desf Kuntze (Leguminosae) em equinos

Copaifera langsdorffii is a Brazilian native plant that is used for wound healing or as an anti-inflammatory agent. Non-healing wounds are an important health problem, particularly in horses, because they can cause the animal invalidity or even lead to death. In addition, horses respond to skin wounds with chronic inflammatory response and intense wound granulation, thereby delaying the healing process. By this way, our aim was to evaluate the healing potential of Copaifera langsdorffii hydroalcoholic extract (HE) and oil-resin creams (OR) in horse skin wounds. Four wounds were performed bilaterally in the lumbar region of six horses with a 2 cm punch and treated daily with the respective treatments: saline solution, vehicle, 10% HE creams or 10% OR cream. Daily planimetry analyses were performed to measure the wound area and clinical parameters. In four different experimental periods (3, 7, 14 and 21 d), wound biopsies were removed and used for microscopic analyses. SS wounds presented a significant small area at day 3 and 7, OR wounds presented significant small area in comparison with HE at 14 d, and no significant difference was observed between treatments at 21 d. A better microscopic and clinical healing activity of HE and OR was identified in comparison with the controls. The OR group showed better healing quality, specifically after 7 d of treatment. Therefore, Copaifera langsdorffii formulations demonstrated their wound healing potential in horse skin lesions, exhibiting an improvement of the macro- and microscopic parameters.(AU)

Copaifera langsdorffii é uma planta nativa brasileira usada para cicatrização de feridas e como agente anti-inflamatório. As feridas que não cicatrizam são um importante problema de saúde em equinos, devido à possibilidade de afastamento da carreira atlética ou até mesmo levar à morte. Além disso, os cavalos respondem às feridas com resposta inflamatória crônica e intensa granulação, atrasando o processo cicatricial. Dessa forma, o presente trabalho avaliou o potencial do extrato hidroalcoólico (EH) e cremes de óleo resina (OR) de Copaifera langsdorffii em feridas cutâneas de equinos. Quatro feridas de 2 cm foram realizadas bilateralmente na região lombar de seis equinos e tratadas diariamente com: solução salina, veículo, creme EH 10% ou creme OR 10%. Diariamente foi efetuada a análise macroscópica das feridas e planimetria para mensurar a área da ferida. Em quatro períodos experimentais diferentes (3, 7, 14 e 21 dias), as biópsias foram realizadas e utilizadas para análises microscópicas. As análises microscópica e clínica indicaram melhor resposta cicatricial nas feridas tratadas com HE e OR em comparação com os controles. O grupo OR apresentou melhor qualidade de cicatrização, especificamente após sete dias de tratamento. Portanto, as formulações de Copaifera langsdorffiiutilizadas apresentaram potencial de cicatrização de feridas em lesões de pele de cavalo, exibindo uma melhora nos parâmetros macro e microscópicos.(AU)

Glossopharyngeal and vagus neuropathy associated to stylopharyngeus muscle compression in horse guttural pouch ­ case report / Neuropatia do glossofaringeo e vago associada à compressão pelo musculo estilofaringeo em bolsa gutural de equino ­ relato de caso

Neuropathies of pharyngeal branches of glossopharyngeal and vagus are often associated with guttural pouches diseases; however, these branches of injury due to stylopharyngeus muscle compression are not reported. A case was reported of a quarter horse mare, 8 years old, 450 kg, presenting dyspnea and respiratory noise associated with weight loss. Clinical examination observed mixed dyspnea, tachycardia, dysphagia, sialorrhea, lung crackles and submandibular and parotid lymphadenopathy. Endoscopic exam showed right arytenoid chondritis, nasopharyngeal collapse, generalized larynx edema and dorsal displacement of the soft palate. Right guttural pouch evaluation showed swelling in the origin of stylopharyngeus muscle with consequent compression of the XII, X and IX cranial nerves. Tracheotomy, systemic treatment with corticosteroids, beta lactams and aminoglycosides antibiotics were performed. No resolution was observed and, after 16 days, the animal showed clinical worsening, developed pleuropneumonia, uveitis, severe sepsis, acute renal failure and was euthanized. The mixed neuropathy resulted in rapid clinical deterioration of the animal, due to the difficulty in swallowing and consequent associated respiratory processes. This report emphasizes the importance of evaluating stylopharyngeus muscle origin in cases of nasopharyngeal collapse associated with dysphagia in horses, given the possibility that structural changes in this muscle can result in laryngeal neuropathy.(AU)

As neuropatias do glossofaríngeo e vago são frequentemente associadas com enfermidade das bolsas guturais. A ocorrência desta lesão secundária a compressão pelo músculo estilofaríngeo não é reportada. Relata-se o caso de uma égua quarto de milha, 8 anos de idade, 450 kg, apresentando dispneia, ruído respiratório e perda de peso. No exame clínico observou-se dispnéia mista, taquicardia, disfagia, sialorréia, crepitação pulmonar e linfadenopatia submandibular e parotídea. Ao exame endoscópico identificou-se condrite aritenóide direita, colapso nasofaríngeo, edema generalizado da laringe e deslocamento dorsal do palato mole. Na avaliação da bolsa gutural direita identificou-se aumento de volume na origem do músculo estilofaríngeo com consequente compressão dos nervos cranianos XII, X e IX. Foi realizada traqueotomia, tratamento sistêmico com corticosteróides e antibióticos. Nenhuma resolução foi observada, após 16 dias o animal apresentou piora clínica, pleuropneumonia, uveíte, sepse grave, insuficiência renal aguda e foi submetido à eutanásia. A neuropatia mista resultou em rápida deterioração clínica do animal, devido à dificuldade de deglutição e processos respiratórios associados. Salienta-se a importância de se avaliar a origem do músculo estilofaríngeo em casos de colapso nasofaríngeo associado a disfagia em cavalos, dada a possibilidade de que alterações estruturais nesse músculo possam resultar em neuropatia laríngea.(AU)

Refinement and partial validation of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in horses.

BACKGROUND: Quantification of pain plays a vital role in the diagnosis and management of pain in animals. In order to refine and validate an acute pain scale for horses a prospective, randomized, blinded study was conducted. Twenty-four client owned adult horses were recruited and allocated to one of four following groups: anaesthesia only (GA); pre-emptive analgesia and anaesthesia (GAA,); anaesthesia, castration and postoperative analgesia (GC); or pre-emptive analgesia, anaesthesia and castration (GCA). One investigator, unaware of the treatment group, assessed all horses at time-points before and after intervention and completed the pain scale. Videos were also obtained at these time-points and were evaluated by a further four blinded evaluators who also completed the scale. The data were used to investigate the relevance, specificity, criterion validity and inter- and intra-observer reliability of each item on the pain scale, and to evaluate construct validity and responsiveness of the scale. RESULTS: Construct validity was demonstrated by the observed differences in scores between the groups, four hours after anaesthetic recovery and before administration of systemic analgesia in the GC group. Inter- and intra-observer reliability for the items was only satisfactory. Subsequently the pain scale was refined, based on results for relevance, specificity and total item correlation. CONCLUSIONS: Scale refinement and exclusion of items that did not meet predefined requirements generated a selection of relevant pain behaviours in horses. After further validation for reliability, these may be used to evaluate pain under clinical and experimental conditions.

Peritoneal reactivity evaluation in horses subjected to experimental small colon enterotomy and treated with subcutaneous heparin.

Heparin is routinely administered in postoperative abdominal surgery aiming to prevent adhesions formation; however, there is no consensus indicating its effectiveness. This study evaluated the effect of heparin on peritoneal reactivity after abdominal surgery, through the association between peritoneal fluid features and ultrasonographic and laparoscopic examination. Ten adult horses were used: control group (CG) and treated group (TG). Both groups underwent laparotomy and small colon enterotomy. TG received subcutaneous heparin at 150 IU/kg every 12 hours for 5 days. The animals underwent ultrasonography and peritoneal fluid examination prior to enterotomy (M0) 12 hours (M1), 1 day (M2), 2 days (M3), 4 days (M4), 6 days (M5), 10 days (M6), and 14 days after enterotomy (M7) with laparoscopic examination being performed on the fifth postoperative day. Peritoneal inflammatory response was observed in both groups. The peritoneal fluid of TG animals showed higher echogenicity during heparin therapy. No inflammatory difference was observed between groups through peritoneal fluid features, except for the higher D-dimer concentration in CG. On laparoscopy, slightly diffuse peritoneal reactivity for both groups was observed, being higher for TG. Laparoscopy and ultrasonography association allowed detailed access to the abdominal cavity. Ultrasonography assessed the diffuse peritoneal inflammation, and laparoscopy allowed the detailed analysis of the segments. No gross beneficial reactions resulting from the use of heparin on peritoneal reactivity were observed; however, it was observed by D-dimer evaluation that the TG had less fibrin deposition, which is directly related to a lower rate of abdominal adhesions formation.

Peritoneal response to abdominal surgery: the role of equine abdominal adhesions and current prophylactic strategies.

Intra-abdominal adhesions constitute a significant clinical and surgical problem that can lead to complications such as pain and bowel occlusion or subocclusion. These adhesions are frustrating and potentially fatal, representing a major postoperative complication in abdominal surgery. It is estimated that 32% of horses undergoing laparotomy will present clinical symptoms due to adhesions, but the true prevalence is not known because a large proportion of animals with postoperative recurrent colics are medically treated or submitted to euthanasia without necropsy. Adhesions are highly cellular, vascularized, dynamic structures that are influenced by complex signaling mechanisms. Understanding their pathogenesis could assist in applying better therapeutic strategies and in developing more effective antiadhesion products. Currently, there are no definitive strategies that prevent adhesion formation, and it is difficult to interpret the results of existing studies due to nonstandardization of an induction model and evaluation of their severity. The best clinical results have been obtained from using minimally traumatic surgical techniques, anti-inflammatory agents, antimicrobials, anticoagulants, and mechanical separation of serosal surfaces by viscous intraperitoneal solutions or physical barriers. This paper aims to review adhesion formation pathogenesis, guide the understanding of major products and drugs used to inhibit adhesion formation, and address their effectiveness in the equine species.

O treinamento nos valores da V200, FCpico e distância percorrida de cavalos da raça Árabe e Crioula / Training in V200, HRpeak and worked distance values in Arabian and Criollo horses

Avaliou-se o efeito do treinamento em esteira sobre a velocidade na qual a frequência cardíaca (FC) atinge o valor de 200 batimentos por minuto (V200), frequência cardíaca pico (FCpico) e sobre a distância percorrida em duas raças de equinos com aptidões diferentes. Para tanto, foram utilizados cinco equinos adultos da raça Árabe (GA) e cinco da raça Crioula (GC), submetidos ao teste padrão de exercício progressivo (TPEP) com inclinação da esteira de 6%, velocidade inicial de 1,8m s-1 por 5 minutos, fases a 4m s-1 por 3 minutos, a 6m s-1 por 2 minutos e fases a 8m s-1, 9m s-1, 10m s-1 e 11m s-1 por 1 minuto cada, até os cavalos não acompanharem a velocidade da esteira, mesmo sendo estimulados. A V200 de cada cavalo foi determinada através da regressão linear da FC versus a velocidade antes (M0) e após o treinamento (M1). O consumo máximo de oxigênio (VO2max) individual foi determinado para o cálculo da carga de trabalho nas nove semanas de treinamento, sendo cinco semanas com a carga de 35% VO2max, duas a 50% VO2max e duas a 100% VO2max. Os exercícios foram realizados uma vez por dia, cinco dias por semana e com inclinação de 6%. A média da V200 antes do treinamento (M0) foi 7,4±0,5 e 7,4±1,2m s-1, para o GA e GC, respectivamente, e após o treinamento (M1) foi 7,8±0,8 e 7,0±0,7m s-1, para o GA e GC, respectivamente. A média da FCpico no M0 foi 221,6±9,0 e 207,4±7,3bpm para o GA e GC, respectivamente, e no M1 foi 226,0±8,4 e 215,0±7,7bpm, para o GA e GC, respectivamente. A distância percorrida em metros no M0 foi de 3.391,0±252,0 e 2.446,0±96,3m para o GA e GC respectivamente, e no M1 foi de 3.850,8±462,2 e 2.698,6±335,8m para o GA e GC, respectivamente. Para a V200, não foram observadas diferenças significativas entre os grupos (P=0,4643) e os momentos (P=1,0). Para a FCpico, houve diferença estatística entre os grupos (P=0,0064), mas não entre os momentos (P=0,1348) . Para a distância percorrida, houve diferença estatística entre os grupos (P=0,0002) e entre os momentos (P=0,0092). Provavelmente, o treinamento condicionou os equinos a antecipar o exercício quando encaminhados à esteira, elevando a FC e influenciando nos valores da V200. Conclui-se que a V200 foi ineficaz para a constatação de diferenças no desempenho atlético entre as duas raças e para avaliação do efeito do treinamento em esteira. Demonstrando a necessidade da associação de outros índices de desempenho como a distância percorrida para assegurar a devida interpretação do efeito de programas de treinamento sobre o desempenho de equinos em testes físicos de exercício.

The effects of a training program on V200, HRpeak and worked distance were evaluated in two horse breeds with distinct aptitudes. Five Arabian (GA) and five Crioulo (GC’) adult horses were subjected to incremental exercise tests on a 6% slope, which consisted of 5 minutes at 1.8m s-1, 3 minutes at 4m s-1, 2 minutes at 6m s-1, then 1 minute steps at 8m s-1, 9m s-1, 10m s-1 and 11m s-1 or until the horse could not keep up the speed even being encouraged. V200 was achieved through linear regression analyses of heart rate vs. speed. Individual maximum oxygen uptake (VO2máx) was determined to establish speed during 9 weeks of training, being 35% of the VO2máx for 5 weeks, 50% for 2 weeks, and 100% for two additional weeks. Horses were exercised once a day, for 5 days a week, on a 6% slope. Mean V200 before training (M0) was 7.4±0.5m s-1 and 7.4±1.,2m s-1, for GA and GC, respectively, and after training (M1) was 7.8±0.8m s-1 and 7.0±0.7m s-1, for GA and GC, respectively. Mean HRpeak at M0 was 221.6±9.0 and 207.4±7.3 for GA and GC, respectively, and 226.0±8.4 and 215.0±7.7 at M1,for GA and GC respectively. Worked distance at M0 was 3391.0±252.0 and 2446.0±96.3 for GA e GC respectively, and at M1 was 3850.8±462.2 and 2698.6±335.8 for GA and GC respectively. No significant differences were observed between groups (P=0.4643) or moments (P=1.0) for V200. To HRpeak. there was statistical difference only between groups (P=0.0064). For the index of the distance traveled there was statistical difference between groups (P=0.0002) and moments (P=0.0092). Training probably conditioned horses to anticipate exercise when taken to the treadmill, therefore increasing heart rate and being an influence on V200 values. V200 was considered ineffective to assess differences in athletic performance between breeds and to evaluate the effect of treadmill training. Therefore it is necessary to associate other performance indicators as the distance to ensure appropriate interpretation of training effect programs on equine performance.