Mary Rose Paradis

Update on Neonatal Septicemia

Septicemia is the second most commonly diagnosed problem in the equine neonate, superseded only by the problem of inadequate transfer of maternal antibodies. This article reviews the factors that may put a foal at high risk for developing sepsis, the diagnostic tools used to identify these animals, some of the sequelae of sepsis, and the therapeutic modalities available to the clinician.

The Effect of Geographic Location, Breed, and Pituitary Dysfunction on Seasonal Adrenocorticotropin and α-Melanocyte-Stimulating Hormone Plasma Concentrations in Horses

BACKGROUND Plasma α-melanocyte-stimulating hormone (α-MSH) and adrenocorticotropin (ACTH) concentrations in horses vary with season, confounding diagnostic testing for pituitary pars intermedia dysfunction (PPID). HYPOTHESIS The goals of this study were to determine whether seasonal variation in plasma α-MSH and ACTH concentrations in horses is influenced by geographic location, breed, or PPID. ANIMALS Healthy light breed horses residing in Florida, Massachusetts, and Finland (n = 12 per group); healthy Morgan horses (n = 13); healthy ponies (n = 9) and horses with PPID (n = 8). METHODS Monthly plasma α-MSH and ACTH concentrations were measured by radioimmunoassay. Nonlinear regression analysis was used to estimate the time of peak hormone concentrations. Mean hormone concentrations in fall and nonfall months were compared. RESULTS The fall peak plasma α-MSH concentration occurred earlier in horses residing at more northern locations. Mean seasonal α-MSH concentrations were similar in all healthy groups at all locations, but in the fall, plasma ACTH concentrations were higher in horses living in more southern locations. Plasma ACTH but not α-MSH concentrations were higher in Morgan horses compared with light breed horses from the same location. Hormone concentrations of ponies did not differ from those of horses during either season. Concentrations of both hormones were high in the fall compared with the spring in horses with PPID. CONCLUSIONS AND CLINICAL IMPORTANCE These findings suggest geographic location of residence and breed may affect the onset, amplitude, or both of the seasonal peak of pars intermedia (PI) hormones and should be considered when performing diagnostic testing for PPID. Horses with PPID maintain seasonal regulation of PI hormone output.

Demographics of health and disease in the geriatric horse.

Owners of older horses have generally owned them for a long time. They have developed a bond that is similar to that seen with companion animals. Their desire to have their animal(s) age gracefully with comfort and mobility has stirred research in the field of equine geriatric medicine. Equine geriatric medicine is to the first decade of the twenty-first century as neonatal medicine was to the 1980s. Hopefully, the demographics discussed in this article highlight area where research can be most helpful.

Tumors of the Central Nervous System

Neoplasia of the central nervous system (CNS) can be divided into two main categories: nonpituitary CNS neoplasia and pituitary adenomas. Nonpituitary CNS neoplasias are generally compressive in nature, although some are also invasive. The majority of reported CNS tumors are secondary with only a few originating from nervous tissue. Pituitary adenomas predominantly occur in the pars intermedia of the older horse. Clinical signs, diagnostic testing, and possible treatments are discussed.

Using Syndromic Surveillance to Estimate Baseline Rates for Healthcare-Associated Infections in Critical Care Units of Small Animal Referral Hospitals

BACKGROUND Expected rates of healthcare-associated infections (HCAI) have not been established in veterinary hospitals. Baseline rates are critically needed as benchmarks for quality animal care. OBJECTIVE To estimate the occurrence of events related to HCAI identified using a standardized syndromic surveillance system in small animals in critical care cases at referral hospitals. ANIMALS Weaned dogs and cats (n = 1,951) that were hospitalized in the critical care unit of referral teaching hospitals during a 12-week period. METHODS Multicenter, prospective longitudinal study. A survey was completed for all enrolled animals to record basic demographics, information about procedures and treatments that animals received, and to document the occurrence of defined nosocomial syndromes. Data were analyzed to identify risk factors associated with the occurrence of these nosocomial syndromes. RESULTS Controlling for hospital of admission, 16.3% of dogs (95% confidence intervals [CI], 14.3-18.5) and 12% of cats (95% CI, 9.3-15.5) were reported to have had ≥ 1 nosocomial syndrome occur during hospitalization. Risk factors found to have a positive association with the development of a nosocomial syndrome were longer hospital stays, placement of a urinary catheter, surgical procedures being performed, and the administration of antiulcer medications and antimicrobial drugs excluding those given perioperatively. CONCLUSIONS AND CLINICAL IMPORTANCE Syndromic surveillance systems can be successfully standardized for use across multiple hospitals to effectively collect data pertinent to HCAI rates and risk factors for occurrence.

Nutritional support: Enteral and parenteral

Abstract An ill foal presents the veterinary clinician with many diagnostic and therapeutic challenges, not the least of which is providing adequate nutrition to support health and growth. Decisions must be about when to provide nutritional intervention, how much to feed, what type of nutrition to give, and how to administer it. Intervention should occur in any foal that has a low body score or is unable or unwilling to eat on its own. Normal foals consume 25% to 30% of the body weight in mare milk per day. The sick foal may not be able to tolerate this amount; starting with 10% of its body weight over a 24-hour period may be more feasible. Mares milk is the best source of nutrition for most foals, but if the mare is agalactic or not amenable to milking, then one may need to use replacer milk. Replacer solutions should be mixed in a 10% to 15% dilution to mimic mares milk concentration. This nutrition can be administered by several different methods in regards to the individual foals needs. If it is able to suckle, then bucket feeding is the least labor-intensive method. An indwelling nasogastric tube can be placed in patients to feed foals that are unable or unwilling to nurse. Nutrition can be given as either periodic boluses or as a continuous rate infusion. Occasionally, a foal is unable to utilize enough energy from enteral feeding. In these cases, parenteral nutrition is the best way to meet the patients energy requirements.

Syndromic surveillance for evaluating the occurrence of healthcare-associated infections in equine hospitals

REASONS FOR PERFORMING STUDY Methods that can be used to estimate rates of healthcare-associated infections and other nosocomial events have not been well established for use in equine hospitals. Traditional laboratory-based surveillance is expensive and cannot be applied in all of these settings. OBJECTIVES To evaluate the use of a syndromic surveillance system for estimating rates of occurrence of healthcare-associated infections among hospitalised equine cases. STUDY DESIGN Multicentre, prospective longitudinal study. METHODS This study included weaned equids (n = 297) that were admitted for gastrointestinal disorders at one of 5 participating veterinary referral hospitals during a 12-week period in 2006. A survey form was completed by the primary clinician to summarise basic case information, procedures and treatments the horse received, and whether one or more of 7 predefined nosocomial syndromes were recognised at any point during hospitalisation. Adjusted rates of nosocomial events were estimated using Poisson regression. Risk factors associated with the risk of developing a nosocomial event were analysed using multivariable logistic regression. RESULTS Among the study population, 95 nosocomial events were reported to have occurred in 65 horses. Controlling for differences among hospitals, 19.7% (95% confidence interval, 14.5-26.7) of the study population was reported to have had at least one nosocomial event recognised during hospitalisation. The most commonly reported nosocomial syndromes that were unrelated to the reason for hospitalisation were surgical site inflammation and i.v. catheter site inflammation. CONCLUSIONS Syndromic surveillance systems can be standardised successfully for use across multiple hospitals without interfering with established organisational structures, in order to provide useful estimates of rates related to healthcare-associated infections.

Evaluation of hepatobiliary disorders in the horse.

This article addresses clinical problems that present in equine liver disease. It also discusses the variety of laboratory tests available to the clinician that can differentiate the type and degree of liver dysfunction. This is followed by a more specific discussion regarding unique features of equine bilirubin and bile acid metabolism.

Endometrial Carcinosarcoma in a Sow: An Immunohistochemical Study

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Age Effects on Blood Gas, Spirometry, Airway Reactivity, and Bronchoalveolar Lavage Fluid Cytology in Clinically Healthy Horses

Background Despite the increasing number of geriatric horses attended by veterinarians, there is a lack of understanding of aging‐related changes on the respiratory system of horses. Objective To identify aging‐related changes on the respiratory function and bronchoalveolar lavage fluid (BALF) cytology of horses. Animals Fifteen healthy young adult (2–11 years) and 16 healthy aged (≥20 years) horses. Methods The respiratory system was examined by measurement of arterial blood gases (ABG), use of respiratory inductive plethysmography (RIP) for assessment of breathing pattern and ventilatory parameters, histamine bronchoprovocation, and BALF cytology. Results No significant differences were detected with regard to values obtained by ABG or bronchoprovocation of young adult and aged healthy horses. In aged horses, there were significant differences in mean ± SD of the following parameters when compared to young horses: prolonged expiratory time (Te) measured by RIP (3.9 ± 1.5 s versus 3.0 ± 0.6 s), decreased percentage of alveolar macrophages (40.6 ± 11.3% versus 53.5 ± 9.6%), and increased percentage of lymphocytes (53.4 ± 9.5% versus 43.9 ± 11.0%). No correlations between airway reactivity and ventilatory parameters, ABG, or BALF cytology were found in this asymptomatic population. Conclusions These results suggest that aging does not cause changes in the results obtained by ABG, most RIP‐derived variables, and bronchoprovocation in the horse. A decreased percentage of macrophage and an increased percentage of lymphocytes in the BALF cytology may be expected in the asymptomatic geriatric horse and may be a result of aging.