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Hart KA, Kimura S. Pharmacologic Interventions to Immunologic and Immune-Mediated Conditions in Horses. Vet Clin North Am Equine Pract 2024; 40:307-339. [PMID: 38852015 DOI: 10.1016/j.cveq.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024] Open
Abstract
Immunomodulators can stimulate, suppress, or regulate one or many aspects of the immune response. Use of a variety of immunostimulants, immunosuppressors, and anti-inflammatory drugs are described in horses, but the evidence supporting their efficacy is variable. Corticosteroids and nonsteroidal anti-inflammatory drugs are the best characterized immunomodulators in horses, but further study is needed to fully define their ideal dosing protocols and indications and to characterize the efficacy of other immunomodulators in equine medicine.
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Affiliation(s)
- Kelsey A Hart
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, 2200 College Station Road, Athens, GA 30602, USA.
| | - Shune Kimura
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, 2200 College Station Road, Athens, GA 30602, USA
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Xue C, Segabinazzi L, Hall A, Dzikiti TB, French H, Gilbert R. A retrospective comparison of postoperative outcomes in ovariectomised jennies (Equus asinus) treated with phenylbutazone or flunixin meglumine. Equine Vet J 2024. [PMID: 38500306 DOI: 10.1111/evj.14082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Clinically, flunixin meglumine (FM) and phenylbutazone (PBZ) are preferentially selected for the treatment of visceral and musculoskeletal pain, respectively, in horses. In donkeys, there is no information to support or refute this conventional conjecture. OBJECTIVES To compare postoperative outcomes in a group of jennies treated with intravenous FM or oral PBZ. ANIMALS Fourteen jennies unilaterally ovariectomised by standing left flank laparotomy. STUDY DESIGN Retrospective cohort study. METHODS Data from medical records of ovariectomised jennies (case details, weight, non-steroidal anti-inflammatory drug [NSAID] protocol, surgery duration, operative sequence, anaesthesia protocol, physical examination findings and outcomes) were collected. From collated data, postoperative adverse events were defined as fever, tachycardia, tachypnea, inappetence, altered mentation, abnormal oral mucous membranes, bruxism, colic, incisional complications (i.e., drainage, oedema, peri-incisional emphysema and pain) and non-survival, then further divided into occurrence during the early (≤24 h) or late (>24 h) postoperative period for data analysis using R software. Chi-squared test was used to compare individual adverse events between groups (PBZ vs. FM) and moments (early vs. late). Significance was set at p ≤ 0.05. RESULTS PBZ treatment (8/14) was associated with (odds ratio, 95% confidence interval) more total (2.93, 1.97-4.36), early (3.01, 1.87-4.84) and late (2.69, 1.28-5.63) adverse events than FM treatment (6/14). Tachycardia (37.83, 2.21-646.66), tachypnoea (0.29, 0.13-0.66), altered mentation (2.78, 1.01-7.67), altered mucous membranes (18.38, 1.04-325.23), incisional oedema (44.33, 2.60-754.5) and incisional pain (47.78, 2.81-811.61) were significantly different between groups. Early adverse events significantly different between groups included tachycardia (50.2, 2.9-877.0), altered mentation (3.33, 1.08-10.29) and incisional pain (21.0, 1.2-374.5), with late adverse events being tachypnea (0.07, 0.01-0.62), incisional oedema (32.92, 1.85-584.28) and incisional pain (28.92, 1.62-515.68). Colic (2/8) and non-survival (1/8) were rare events that only occurred in the PBZ cohort and could not be further evaluated for differences. MAIN LIMITATIONS Small sample size; retrospective study; treatment bias; varied administration routes. CONCLUSIONS Oral PBZ may be inappropriate to use following abdominal surgery in donkeys. CLINICAL RELEVANCE More prospective and case-controlled studies are needed to evaluate the clinical efficacy of these two NSAIDs in donkeys.
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Affiliation(s)
- Cynthia Xue
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies
| | - Lorenzo Segabinazzi
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies
| | - Alexis Hall
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies
| | - Tarisai Brighton Dzikiti
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies
| | - Hilari French
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies
| | - Robert Gilbert
- Department of Clinical Sciences, Ross University School of Veterinary Medicine, Basseterre, St. Kitts, West Indies
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3
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Giusto G, Cerullo A, Gandini M. Anastomotic techniques for small intestinal obstruction in horses. A scoping review. Equine Vet J 2024. [PMID: 38379364 DOI: 10.1111/evj.14076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Small bowel obstruction (SBO) is a significant cause of surgery in adult horses presenting with colic pain. SBOs often require resection and anastomosis. While various techniques for intestinal anastomoses have been developed, it remains uncertain if any fully meet our clinical needs. OBJECTIVE To conduct a scoping review of publications on anastomosis techniques and outcomes for the treatment of SBO. STUDY DESIGN Scoping review. METHODS A literature review was conducted using the CAB, Web of Science, Scopus, and PubMed databases. Peer-reviewed scientific articles in English, published between 1992 and 2023, were included. A quality assessment was performed for potentially eligible articles. Experimental studies, case reports, and case series with less than five cases were excluded and relevant data on study methods and sample size were extracted and charted from remaining articles. Anastomosis type and outcome were reported for articles considered potentially eligible for meta-analysis. Articles in which only overall outcome was reported or details on type of anastomosis were not reported were excluded for the final charting. RESULTS Of 3024 articles, 210 underwent a quality assessment. The most common study designs were case reports and case series (64.3%), followed by experimental studies (17.1%). After further exclusions, 104 articles met the inclusion criteria. In only 42 articles detailed data on type of anastomosis and relative outcome were reported. A total of 23 anastomosis types were reported for the treatment of SBO, with 6 different outcomes evaluated. Both short- and long-term survival rates consistently exceed 70% for all types of anastomosis (jejuno-jejunal, jejuno-ileal, and jejunocaecal). MAIN LIMITATION Non-English language studies and conference proceedings were excluded. CONCLUSION The body of literature focused on surgical treatment for SBO exhibits low-quality evidence. Several techniques of anastomosis were described for different pathologies. However, there is a lack of homogeneity in reporting outcome for each surgical technique. Furthermore, outcomes considered varied significantly among studies and were sometimes poorly reported, although success rates are generally high. Overall, there is a need for better-structured studies on existing and commonly used techniques before comparing techniques and exploring other innovative approaches.
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Affiliation(s)
- Gessica Giusto
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Anna Cerullo
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Marco Gandini
- Department of Veterinary Sciences, University of Turin, Turin, Italy
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4
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Keen A, Shipman E. Is firocoxib as effective as flunixin meglumine in providing postoperative analgesia in horses following colic surgery? Vet Rec 2024; 194:115-116. [PMID: 38305529 DOI: 10.1002/vetr.3926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Aimee Keen
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - Emma Shipman
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
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5
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Citarella G, Heitzmann V, Ranninger E, Bettschart-Wolfensberger R. Analgesic Efficacy of Non-Steroidal Anti-Inflammatory Drug Therapy in Horses with Abdominal Pain: A Systematic Review. Animals (Basel) 2023; 13:3447. [PMID: 38003065 PMCID: PMC10668864 DOI: 10.3390/ani13223447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
This systematic review aimed to identify the evidence concerning the analgesic efficacy of non-steroidal anti-inflammatory drugs to treat abdominal pain in horses, and to establish whether one non-steroidal anti-inflammatory drug could provide better analgesia compared to others. This systematic review was conducted following the "Systematic Review Protocol for Animal Intervention Studies". Research published between 1985 and the end of May 2023 was searched, using three databases, namely, PubMed, Embase, and Scopus, using the words equine OR horse AND colic OR abdominal pain AND non-steroidal anti-inflammatory drug AND meloxicam OR flunixin meglumine OR phenylbutazone OR firocoxib OR ketoprofen. Risk of bias was assessed with the SYRCLE risk of bias tool, and level of evidence scored according to the Oxford Centre for Evidence-based Medicine. A total of 10 studies met the inclusion criteria. From those only one study judged pain with a validated pain score, and a high risk of bias was identified due to the presence of selection, performance, and "other" types of bias. Therefore, caution is required in the interpretation of results from individual studies. To date, the evidence on analgesic efficacy to determine whether one drug is more potent than another regarding the treatment of abdominal pain in horses is sparse.
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Affiliation(s)
- Gerardo Citarella
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (V.H.); (E.R.); (R.B.-W.)
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6
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Bishop RC, Wilkins PA, Kemper AM, Stewart RM, McCoy AM. Effect of Firocoxib and Flunixin Meglumine on Large Colon Mural Thickness of Healthy Horses. J Equine Vet Sci 2023; 126:104562. [PMID: 37172749 DOI: 10.1016/j.jevs.2023.104562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/27/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
Nonsteroidal anti-inflammatory drug (NSAID) administration carries risks of gastrointestinal toxicity. Selective COX-2 inhibitors ("coxibs") were designed to reduce risks of adverse effects but are still associated with gastrointestinal complications in humans. The effect of coxibs on colonic inflammation and integrity in horses is unknown. The study objective was to compare the effects of the coxib firocoxib and the nonselective NSAID flunixin meglumine on ultrasonographic indicators of colonic inflammation in healthy horses. Twelve healthy adult horses were administered flunixin meglumine (1.1 mg/kg IV q12h) and omeprazole (1 mg/kg PO q24h) for 5 days, allowed a 6-month washout period, then administered firocoxib (0.3 mg/kg PO once, then 0.1 mg/kg PO q24h for 4 days) and omeprazole. Transabdominal ultrasonographic examination and serum chemistry profiles were performed at the beginning and end of each treatment week. Colon wall thickness increased over time when horses received firocoxib (median post treatment 5.8 mm, interquartile range 2.8 mm; P < .001), but not flunixin (median 3 mm, interquartile range 1.2 mm; P = .7) and was significantly greater following firocoxib compared to flunixin (P = .003). Subjectively, colonic edema was noted more frequently following treatment with firocoxib (11/12 horses), compared to flunixin (1/12 horses). There were no clinically significant alterations in hematologic parameters after administration of either drug. The increase in colon wall thickness following treatment with the COX-2 selective NSAID firocoxib may suggest a risk of subclinical colitis in healthy horses. Monitoring colonic health when NSAIDs are used in a clinical setting is warranted.
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Affiliation(s)
- Rebecca C Bishop
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois.
| | - Pamela A Wilkins
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois
| | - Ann M Kemper
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois
| | - Ruth M Stewart
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois
| | - Annette M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois
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7
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Mercer MA, Davis JL, McKenzie HC. The Clinical Pharmacology and Therapeutic Evaluation of Non-Steroidal Anti-Inflammatory Drugs in Adult Horses. Animals (Basel) 2023; 13:ani13101597. [PMID: 37238029 DOI: 10.3390/ani13101597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
This review firstly examines the underlying pathophysiology of pain and inflammation associated with orthopedic disease and endotoxemia. Then, it reviews the clinical pharmacology (pharmacokinetics and pharmacodynamics) of both conventional and non-conventional NSAIDs in the adult horse, and finally provides an overview of different modalities to evaluate the therapeutic efficacy of NSAIDs in research.
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Affiliation(s)
- Melissa A Mercer
- Department of Biological Sciences and Pathobiology, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
| | - Jennifer L Davis
- Department of Biological Sciences and Pathobiology, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
| | - Harold C McKenzie
- Department of Large Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
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8
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Barton C, Hassel DM. Critical Care of the Colic Patient: Monitoring, Fluid Therapy, and More. Vet Clin North Am Equine Pract 2023:S0749-0739(23)00023-8. [PMID: 37169620 DOI: 10.1016/j.cveq.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
A successful outcome to management of the critical colic patient is highly dependent on how the patient is monitored and treated, particularly, in the perioperative period. In this article, we will provide an update on monitoring techniques, advances in fluid therapy, nutrition management and pharmacotherapeutic agents, inclusive of pain monitoring and management, prokinetics, and management of systemic inflammatory response syndrome and the hypercoagulable state.
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Affiliation(s)
- Charlie Barton
- Department of Clinical Sciences, Colorado State University, College of Veterinary Medicine & Biological Sciences, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - Diana M Hassel
- Department of Clinical Sciences, Colorado State University, College of Veterinary Medicine & Biological Sciences, 300 West Drake Road, Fort Collins, CO 80523, USA.
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9
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Bookbinder L, Prisk A. Updates on Diagnosis and Management of Colic in the Field and Criteria for Referral. Vet Clin North Am Equine Pract 2023:S0749-0739(23)00013-5. [PMID: 37121785 DOI: 10.1016/j.cveq.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Gastrointestinal colic is the most common primary care equine emergency and affects nearly one of four horses per year. Colic is a significant welfare concern for equine patients and a financial and emotional burden for owners. The primary care practitioner is instrumental in identifying critical cases quickly and making appropriate management recommendations to improve patient outcomes.
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Affiliation(s)
- Lauren Bookbinder
- Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, 736 Wilson Road, East Lansing, MI, USA.
| | - Amanda Prisk
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, MA, USA
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10
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Bauck AG. Basic Postoperative Care of the Equine Colic Patient. Vet Clin North Am Equine Pract 2023:S0749-0739(23)00022-6. [PMID: 37120332 DOI: 10.1016/j.cveq.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
The 3 time periods around colic surgery (preoperative, operative, and postoperative) are all critical to successful outcomes. Although much focus is often paid to the first 2 time periods, the importance of sound clinical judgment and rational decision-making in the postoperative period cannot be overstated. This article will outline the basic principles of monitoring, fluid therapy, antimicrobial therapy, analgesia, nutrition, and other therapeutics routinely used in patients following colic surgery. Discussions of the economics of colic surgery and expectations for normal return to function will also be included.
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Affiliation(s)
- Anje G Bauck
- Large Animal Surgery, Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, Gainesville, FL 32608, USA.
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11
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Urayama S, Tanaka A, Kusano K, Sato H, Muranaka M, Mita H, Nagashima T, Matsuda H. Oral Administration of Meloxicam and Flunixin Meglumine Have Similar Analgesic Effects After Lipopolysaccharide-Induced Inflammatory Response in Thoroughbred Horses. J Equine Vet Sci 2023; 121:104205. [PMID: 36586521 DOI: 10.1016/j.jevs.2022.104205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022]
Abstract
Flunixin meglumine (FM), a nonselective cyclooxygenase (COX) inhibitor, is most frequently selected for the treatment of equine systemic inflammatory response syndrome (SIRS)/endotoxemia. However, FM has considerable adverse effects on gastrointestinal function. The aims of this study were to compare the effect of meloxicam (MX), a COX-2 selective inhibitor commonly used in equine clinical practice, with FM, and to investigate the potential for clinical application in horses with SIRS/endotoxemia. Fifteen horses were divided into three groups of five and orally administered MX (0.6 mg/kg), FM (1.1 mg/kg), or saline as placebo at 30 minutes after LPS challenge. Clinical parameters, including behavioral pain scores, were recorded and blood for clinical pathological data was collected at various times from 60 minutes before to 420 minutes after LPS infusion. The pain score were significantly lower in both the MX and FM groups than in the placebo group, with no significant difference between them. Body temperature was significantly lower in the MX and FM groups than in the placebo group. Heart rates and respiratory rates, hoof wall surface temperature, and leukocyte counts changed similarly between the MX and FM groups. TNF-α and cortisol were lower in the FM group than in the MX group. The results suggest that MX suppresses the inflammatory response after LPS infusion and has an analgesic effect similar to that of FM. Given the adverse effects of nonselective COX inhibitors, clinical application of MX may be beneficial in horses with SIRS/endotoxemia.
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Affiliation(s)
- Shuntaro Urayama
- Racehorse Hospital, Ritto Training Center, Japan Racing Association (JRA), Ritto-Shi, Shiga, Japan.
| | - Akane Tanaka
- Laboratory of Comparative Animal Medicine, Division of Animal Life Science, Institute of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-Shi, Tokyo, Japan
| | - Kanichi Kusano
- Racehorse Hospital, Ritto Training Center, Japan Racing Association (JRA), Ritto-Shi, Shiga, Japan
| | - Hiroaki Sato
- Stewards Section, Ritto Training Center, JRA, Ritto-Shi, Shiga, Japan
| | - Masanori Muranaka
- Racehorse Hospital, Ritto Training Center, Japan Racing Association (JRA), Ritto-Shi, Shiga, Japan
| | - Hiroshi Mita
- Clinical Veterinary Medicine Division, Equine Research Institute, JRA, Simotsuke-Shi, Tochigi, Japan
| | - Tsuyoshi Nagashima
- Racehorse Hospital, Ritto Training Center, Japan Racing Association (JRA), Ritto-Shi, Shiga, Japan
| | - Hiroshi Matsuda
- Laboratory of Comparative Animal Medicine, Division of Animal Life Science, Institute of Agriculture, Tokyo University of Agriculture and Technology, Fuchu-Shi, Tokyo, Japan
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12
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Flood J, Stewart AJ. Non-Steroidal Anti-Inflammatory Drugs and Associated Toxicities in Horses. Animals (Basel) 2022; 12:2939. [PMID: 36359062 PMCID: PMC9655344 DOI: 10.3390/ani12212939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/22/2022] [Accepted: 10/23/2022] [Indexed: 07/30/2023] Open
Abstract
Effective pain management in horses can be a challenge despite the understanding that appropriate analgesia improves animal welfare and increases treatment success. The administration of NSAID drugs, particularly phenylbutazone and flunixin, are common practice in equine veterinary patients. Known for their analgesic and anti-inflammatory properties, NSAIDs are used for the treatment of a variety of conditions in horses, from gastrointestinal to orthopedic pain. Despite extensive usage, NSAIDs have a narrow margin of safety and the body of literature documenting the efficacy and side effects of different NSAIDs is broad. The three main side effects associated with excessive or prolonged NSAID usage in horses include gastroduodenal ulceration, right dorsal colitis (RDC) and renal papillary necrosis. The use of cyclooxygenase-2 selective NSAIDS, such as firocoxib, are theoretically safer. The aim of this paper is to review the current literature on the use and efficacy of different NSAIDs, summarise the associated side effects of NSAID usage and evaluate the current state of knowledge for the diagnosis and treatment of such toxicities.
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13
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Gandini M, Cerullo A, Franci P, Giusto G. Changes in Perioperative Antimicrobial and Anti-Inflammatory Drugs Regimens for Colic Surgery in Horses: A Single Center Report. Vet Sci 2022; 9:vetsci9100546. [PMID: 36288159 PMCID: PMC9607452 DOI: 10.3390/vetsci9100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
Simple Summary The administration of postoperative anti-inflammatory and antimicrobial drugs after colic surgery is based on an empirical approach, and for this reason, in recent years, it has been questioned. Recent guidelines recommend that antimicrobials should be administered for the shortest effective period possible. The use of non-steroidal anti-inflammatory drugs is also discussed given the side effects especially on the gastrointestinal tract. Consequently, the antimicrobial and anti-inflammatory drugs administration in horses has changed in our practice over the years to modulate therapies according to the postoperative complications that eventually arise. The description of these changes and the reasons behind them can help define an appropriate stewardship. Over the years, the administration of postoperative antibiotics has been limited, and treatments have been started only in case of complications that justified their use. As for anti-inflammatories, there was a variation of dosages of flunixin meglumine and the addition of new types of anti-inflammatories, both non-steroidal anti-inflammatory drugs and corticosteroids. These changes in prophylaxis protocols were not associated with an increase in postoperative complications. Abstract Reducing postoperative incisional infection is the main reason to administer postoperative antimicrobials (AMD) after emergency laparotomy in horses, while reducing inflammation and providing analgesia are the reasons to administer anti-inflammatory drugs (AID). The basis for postoperative AMD and AID administration is empirical and only recently has been questioned. Empirical approaches can be changed, and these changes, along with the description of their outcomes, can help produce appropriate stewardship. The aim of this study is to report the changes in AMD and AID regimens in horses undergoing emergency laparotomy at a referral teaching hospital between 2017 and 2021. Signalment, pathology, surgery, prophylactic AMD and AID administration were obtained from the medical records. Difference in AMD and AID regimens throughout the study period were also reported. In 234 postoperative records considered, ninety-two horses received prophylactic AMD, while 142 received pre-operative antimicrobials only. There was a progressive change in regimens throughout the years, increasing the number of AID molecules used. AMD and AID administration in horses has changed in our practice over the years to modulate therapies according to the postoperative complications that eventually arise. In this study, horses not receiving postoperative routine AMD treatment did not show an increased incidence of complications.
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Bishop RC, McCoy AM, Kemper AM, Stewart RM, Wilkins PA. Short-term administration of flunixin meglumine or firocoxib does not alter viscoelastic coagulation profiles in healthy horses. J Am Vet Med Assoc 2022; 260:1963-1966. [PMID: 36198050 DOI: 10.2460/javma.22.08.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of the cyclooxygenase-2-selective NSAID firocoxib, compared to the nonselective NSAID flunixin meglumine on viscoelastic coagulation parameters in healthy horses. ANIMALS 12 healthy adult mixed-breed horses. PROCEDURES Following a crossover protocol, horses were administered flunixin meglumine (1.1 mg/kg, IV, q 12 h for 5 days), allowed a 6-month washout period, and then administered firocoxib (0.3 mg/kg, PO, once, then 0.1 mg/kg, PO, q 24 h for 4 days). Omeprazole (1 mg/kg, PO, q 24 h) was administered concurrently with each NSAID. Viscoelastic coagulation profiles and traditional coagulation parameters (prothrombin time, partial thromboplastin time, and fibrinogen) were measured before and after each treatment. RESULTS Viscoelastic coagulation parameters were within reference intervals before and after both treatments. There was a statistically significant difference between treatments for amplitude at 10 minutes after clot time (P = .02) and maximum clot formation (P = .02); however, the magnitude of change was not clinically significant. CLINICAL RELEVANCE Short-term administration of flunixin meglumine and firocoxib did not result in significant alteration of viscoelastic coagulation profiles in healthy horses. However, clinicians should be aware of possible coagulopathy secondary to NSAID administration with long-term use or critical illness, and further study is indicated.
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15
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Gibbs R, Duz M, Shipman E. A survey of non‐steroidal anti‐inflammatory drug use in the post‐operative period following equine colic surgery. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rachel Gibbs
- School of Veterinary Medicine and Science University of Nottingham Leicestershire UK
| | - Marco Duz
- School of Veterinary Medicine and Science University of Nottingham Leicestershire UK
| | - Emma Shipman
- School of Veterinary Medicine and Science University of Nottingham Leicestershire UK
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Lemonnier LC, Thorin C, Meurice A, Dubus A, Touzot-Jourde G, Couroucé A, Leroux AA. Comparison of Flunixin Meglumine, Meloxicam and Ketoprofen on Mild Visceral Post-Operative Pain in Horses. Animals (Basel) 2022; 12:ani12040526. [PMID: 35203234 PMCID: PMC8868280 DOI: 10.3390/ani12040526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Pain management following surgical intervention is key. In horses, several anti-inflammatories (flunixin meglumine, meloxicam and ketoprofen) are available for the management of pain following castration. However, their analgesic efficacy remains unclear for mild visceral pain. The aim of this study was to compare the analgesic efficacy of the above-mentioned anti-inflammatory drugs, following a simple surgery (inguinal castration). Horses were administered a randomly assigned anti-inflammatory drug before and after surgery. A pain score was recorded using a previously described pain assessment scale (PASPAS) before administration, and after the first and second administrations by a senior clinician and a veterinary student. Thirty horses were evaluated, and there was no significant effect of the drug administered on the pain score. Horse welfare was not compromised regardless of drug assigned. Horses showed mild pain post-operatively, which decreased significantly within 24 h. Pain scores were significantly different when assessed by a veterinary student and a senior clinician. The authors found that the anti-inflammatory drug studied provided a similar level of analgesia for the management of mild visceral pain in horses, but that the pain scale used is not suitable for junior evaluators or, by extension, owners. Abstract The analgesic efficacy of meloxicam and ketoprofen against equine visceral pain is unclear. The aim of this study was to compare the analgesic efficacy of meloxicam (M) and ketoprofen (K) to flunixin meglumine (F) following inguinal castration. Horses undergoing inguinal castration under general anesthesia were randomly assigned F (1.1 mg/kg), M (0.6 mg/kg) or K (2.2 mg/kg) intravenously two hours pre-operatively and 24 h later. A pain score (out of 31) was recorded blindly by a senior clinician and veterinary student before NSAIDs administration (T0), and after the first (T1) and second (T2) administrations, using a modified post-abdominal surgery pain assessment scale (PASPAS). Pain was classified as mild (score ≤ 7), moderate (score = 8–14) or severe (score > 14). Thirty horses (12 F, 10 M, 8 K) aged 6.2 ± 4.9 years, mostly warmbloods, were included. Horse welfare was not compromised regardless of the drug assigned. There was no statistically significant effect of NSAIDs on pain score. Mean pain scores were significantly higher at T1 than T0 for each NSAID (F: 5.08 ± 2.50 vs. 1.58 ± 1.38 (p < 0.001); M: 4.60 ± 2.32 vs. 1.10 ± 1.20 (p < 0.001); K: 5.25 ± 1.39 vs. 1.50 ± 1.51 (p < 0.0001)) and lower at T2 than T1 for F (2.92 ± 2.423 vs. 5.08 ± 2.50 (p < 0.001)) and M (2.90 ± 1.37 vs. 4.60 ± 2.32 (p < 0.0325)). At T1, senior pain scores were significantly different than for junior (5.56 ± 0.54 vs. 3.22 ± 0.62, p = 0.005). This study indicates that meloxicam and ketoprofen provide a similar level of analgesia to flunixin meglumine for the management of mild visceral pain in horses. PASPAS is not reliable for junior evaluators.
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Affiliation(s)
- Louise C. Lemonnier
- Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France; (A.M.); (G.T.-J.); (A.C.); (A.A.L.)
- Correspondence: ; Tel.: +33-(0)2-40-68-76-64
| | - Chantal Thorin
- Nutrition PhysioPathologie et Pharmacologie, University of Nantes, Oniris, F-44000 Nantes, France;
| | - Antoine Meurice
- Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France; (A.M.); (G.T.-J.); (A.C.); (A.A.L.)
| | - Alice Dubus
- Clinique Vétérinaire de Bel Air, Allée Marcel Doret, F-41000 Blois, France;
| | - Gwenola Touzot-Jourde
- Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France; (A.M.); (G.T.-J.); (A.C.); (A.A.L.)
- UMR Inserm U1229–Regenerative Medecine and Skeleton, Department of Veterinary Clinical Sciences, University of Nantes, Oniris, F-44000 Nantes, France
| | - Anne Couroucé
- Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France; (A.M.); (G.T.-J.); (A.C.); (A.A.L.)
- Biotargen, Normandie University, Unicaen, F-14000 Caen, France
| | - Aurélia A. Leroux
- Department of Clinical Sciences, Equine Veterinary Teaching Hospital (CISCO), Oniris, Route de Gachet, F-44000 Nantes, France; (A.M.); (G.T.-J.); (A.C.); (A.A.L.)
- l’Institut du Thorax, Université de Nantes, CHU Nantes, CNRS, INSERM, F-44000 Nantes, France
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17
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Rudnick MJ, Denagamage TN, Freeman DE. Effects of age, disease, and anastomosis on short- and long-term survival after surgical correction of small intestinal strangulating diseases in 89 horses. Equine Vet J 2022; 54:1031-1038. [PMID: 35023209 DOI: 10.1111/evj.13558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 11/20/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although survival rates have been reported after small intestinal surgery for strangulating diseases in horses, none have followed survival for periods relevant to the long lifespan of horses and none have described effect of age, disease and surgical treatments over such long survival periods. OBJECTIVES To examine effects of age, disease, and type of surgery on long-term survival in horses after surgical treatment of small intestinal strangulating diseases over periods relevant to the expected lifespan of a horse. STUDY DESIGN Retrospective clinical study. METHODS Post-operative data were gathered from medical records and owner contact for 89 horses with small intestinal strangulation. Survival times from surgery to date of death or date of last follow-up were analysed by Kaplan-Meier statistics. Variables of interest were age, type of strangulating disease, and surgical correction. Cox proportional hazards regression was used to evaluate these variables. RESULTS Short-term survival was not affected by any of the variables measured. For long-term survival with Kaplan-Meier statistics, horses ≥16 years old had significantly shorter (P=0.002) median survival times (72 months; 95% C.I. 32.0-96.0) than younger horses (121.7 months; 95% C.I. 90.0-162), horses without resection had significantly longer (P=0.02) survival times (120 months; 95% C.I. 86-212) than horses that had jejunocecostomy (76.8 months; 95% C.I. 24-125), and horses with miscellaneous diseases had significantly longer (P=0.02) median survival times (161.9 months (95% C.I. 72.0-M) than horses with strangulating lipoma (79.8 months; 95% C.I. 32.0-120.0). In the multivariable Cox Proportional Hazard model, age (HR=2.67; 1.49-4.75, p<0.001) and anastomosis (HR=0.65; 0.46-0.92, P=0.02) had the most significant effect on median survival time. MAIN LIMITATIONS Limitations were small numbers in some categories, loss of cases to follow-up, owner recall failures, and lack of a control group. CONCLUSIONS The remaining lifespan of older horses at the time of surgery had the greatest effect on survival. Age could influence long-term survival studies after colic surgery, and therefore needs to be considered for survival analyses. Horses that did not require resection and anastomosis had favourable outcomes, underscoring the potential importance of early intervention to reduce the need for resection.
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Affiliation(s)
- Meredith J Rudnick
- University of Florida College of Veterinary Medicine, Department of Large Animal Clinical Sciences, PO Box 100136, Gainesville, Florida, 32610, USA
| | - Thomas N Denagamage
- University of Florida College of Veterinary Medicine, Department of Large Animal Clinical Sciences, PO Box 100136, Gainesville, Florida, 32610, USA
| | - David E Freeman
- University of Florida College of Veterinary Medicine, Department of Large Animal Clinical Sciences, PO Box 100136, Gainesville, Florida, 32610, USA
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18
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Waller P, Lomnicka I, Lucas C, Johnson S, Dirikolu L. The medication violations in racehorses at Louisiana racetracks from 2016 to 2020. Vet Med Sci 2022; 8:553-560. [PMID: 34989156 PMCID: PMC8959255 DOI: 10.1002/vms3.724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction/Background The number of publications for most common drug violations in racehorses is limited. This study reports the most common medication violations in racehorses at four major racetracks in Louisiana between 2016 and 2020. Methods During this 5‐year period, 27,237 blood samples and 25,672 urine samples collected during the course of normal race meeting activities were analysed by initial screening procedure utilizing Liquid Chromatography Mass Spectrometry (LC‐MS/MS). Following initial screening, suspect samples were subject to quantitative or semi‐ quantitative confirmation analysis by LC‐MS/MS. Results The total number of violations reported was 534 (1.01% of the total number of specimens analysed). The total number of violations reported in Thoroughbred horses was 210 while the total number of violations reported in Quarter Horses was 324. The percentage of total violations was %0.59 for all the specimens analysed in Thoroughbred horses while this percentage was %1.9 for all the specimens analysed in Quarter Horses during this 5‐year period. The most frequent violations included the overages (concentrations of permitted medications equal to or exceeding the set threshold) of clenbuterol (165 violations), non‐steroidal anti‐inflammatory drugs (NSAIDs) such as phenylbutazone (73 violations), combination of phenylbutazone with flunixin (45 violations) and muscle relaxant methocarbamol (40 violations). Discussion/Conclusions The total number of violations were relatively low during 5‐year period, but wide varieties of medications with different pharmacological actions were confirmed in performance horses in Louisiana. The most frequently reported violations in Louisiana were for permitted therapeutic medications (clenbuterol, phenylbutazone, flunixin methocarbamol) with established threshold and/or withdrawal guidelines in racehorses.
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Affiliation(s)
- Pamela Waller
- Equine Medication Surveillance Laboratory (EMSL), Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Izabela Lomnicka
- Equine Medication Surveillance Laboratory (EMSL), Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Cam Lucas
- Equine Medication Surveillance Laboratory (EMSL), Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Sara Johnson
- Equine Medication Surveillance Laboratory (EMSL), Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Levent Dirikolu
- Equine Medication Surveillance Laboratory (EMSL), Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
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19
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Geesala R, Lin YM, Zhang K, Shi XZ. Targeting Mechano-Transcription Process as Therapeutic Intervention in Gastrointestinal Disorders. Front Pharmacol 2021; 12:809350. [PMID: 34992543 PMCID: PMC8724579 DOI: 10.3389/fphar.2021.809350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022] Open
Abstract
Mechano-transcription is a process whereby mechanical stress alters gene expression. The gastrointestinal (GI) tract is composed of a series of hollow organs, often encountered by transient or persistent mechanical stress. Recent studies have revealed that persistent mechanical stress is present in obstructive, functional, and inflammatory disorders and alters gene transcription in these conditions. Mechano-transcription of inflammatory molecules, pain mediators, pro-fibrotic and growth factors has been shown to play a key role in the development of motility dysfunction, visceral hypersensitivity, inflammation, and fibrosis in the gut. In particular, mechanical stress-induced cyclooxygenase-2 (COX-2) and certain pro-inflammatory mediators in gut smooth muscle cells are responsible for motility dysfunction and inflammatory process. Mechano-transcription of pain mediators such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) may lead to visceral hypersensitivity. Emerging evidence suggests that mechanical stress in the gut also leads to up-regulation of certain proliferative and pro-fibrotic mediators such as connective tissue growth factor (CTGF) and osteopontin (OPN), which may contribute to fibrostenotic Crohn's disease. In this review, we will discuss the pathophysiological significance of mechanical stress-induced expression of pro-inflammatory molecules, pain mediators, pro-fibrotic and growth factors in obstructive, inflammatory, and functional bowel disorders. We will also evaluate potential therapeutic targets of mechano-transcription process for the management of these disorders.
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20
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Hay AN, Wagner B, Leeth CM, LeRoith T, Cecere TE, Lahmers KK, Andrews FM, Werre SR, Johnson AL, Clark CK, Pusterla N, Reed SM, Lindsay DS, Taylor S, Estell KE, Furr M, MacKay RJ, Del Piero F, Witonsky SG. Horses affected by EPM have increased sCD14 compared to healthy horses. Vet Immunol Immunopathol 2021; 242:110338. [PMID: 34717126 DOI: 10.1016/j.vetimm.2021.110338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
Equine protozoal myeloencephalitis (EPM) is a debilitating neurologic disease affecting horses across the Americas. Gaps in understanding the inflammatory immune response in EPM-affected horses create difficulties with diagnosis and treatment, subsequently negatively impacting the prognosis of affected horses. The purpose of the current study was to evaluate circulating levels of the inflammatory immune marker soluble CD14 (sCD14), in horses with EPM (n = 7) and determine if they differed from healthy neurologically normal horses (n = 6). Paired sera and cerebrospinal fluid (CSF) samples were analyzed for sCD14. Inclusion criteria for EPM horses consisted of the presence of neurologic signs consistent with EPM, Sarcocystis neurona surface antigens 2, 4/3 (SnSAG 2, 4/3) ELISA serum: CSF antibody ratio ≤ 100, and a postmortem diagnosis of EPM. Control horses were neurologically normal, healthy horses with SnSAG 2, 4/3 ELISA serum: CSF antibody ratios of > 100. Serum anti-Sarcocystis neurona antibodies indicate that healthy control horses were exposed to S. neurona but resistant to developing clinical EPM. EPM cases had significantly greater concentrations of sCD14 in CSF samples compared to control horses and increased serum sCD14 concentrations. A positive correlation between sCD14 serum and CSF concentrations was observed in EPM-affected horses but not healthy horses. Soluble CD14 is an inflammatory marker, and the study results suggest it is elevated in EPM patients. When performed in conjunction with clinical evaluation and standard antibody testing, there may be potential for sCD14 to be utilized as a correlate for EPM.
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Affiliation(s)
- Alayna N Hay
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Bettina Wagner
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - Caroline M Leeth
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Tanya LeRoith
- Department of Biomedical Sciences and Pathobiology, Virginia- Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Thomas E Cecere
- Department of Biomedical Sciences and Pathobiology, Virginia- Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Kevin K Lahmers
- Department of Biomedical Sciences and Pathobiology, Virginia- Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Frank M Andrews
- Equine Health Studies Program, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Stephen R Werre
- Department of Population Health Sciences, Virginia- Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Amy L Johnson
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, New Bolton Center, Kennett Square, PA, USA
| | | | - Nicola Pusterla
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | | | - David S Lindsay
- Department of Biomedical Sciences and Pathobiology, Virginia- Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Sandra Taylor
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Krista E Estell
- Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Leesburg, VA, USA
| | - Martin Furr
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Robert J MacKay
- Department of Large Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
| | - Fabio Del Piero
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Sharon G Witonsky
- Department of Large Animal Clinical Sciences, Virginia- Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA.
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21
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Rhodes DM, Madrigal R. Management of Colic in the Field. Vet Clin North Am Equine Pract 2021; 37:421-439. [PMID: 34243880 DOI: 10.1016/j.cveq.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Colic is one of the most frequent emergencies necessitating veterinary attention. Referral is not an option in many cases; therefore, the ability to diagnose and treat colic in an ambulatory setting is paramount. Portable imaging and point-of-care testing has improved the ability to identify lesions and assess the patient's status. In cases when field management is the only option, practitioners should be aware of the various treatment options available.
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Affiliation(s)
- Diane M Rhodes
- Loomis Basin Equine Medical Center, 2973 Penryn Road, Penryn, CA 95603, USA.
| | - Rodolfo Madrigal
- Loomis Basin Equine Medical Center, 2973 Penryn Road, Penryn, CA 95603, USA
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22
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Lawson A, Pinchbeck G. Study design synopsis: Observational study design in equine research. Equine Vet J 2021; 53:638-644. [PMID: 33719094 DOI: 10.1111/evj.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
When planning to conduct research, thorough consideration of the study design is essential to enable valid results and purposeful conclusions. A good study design will provide a strong basis for robust conclusions that can contribute to the evidence base. Conversely, a poor study design may unintentionally lead to invalid conclusions with inappropriate claims of the clinical importance. The purpose of this article is to review important aspects of observational study design, with an emphasis on observational clinical research. The value of an observational study can be manifold and the benefit of studying clinical cases can add substantial value to the evidence base and equine health and welfare, however this value will be diminished if study designs are flawed, or are inadequately reported. It is essential that clinicians have the skills to critically appraise observational studies, to determine strengths, limitations and the applicability to their clinical practice.
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Affiliation(s)
- April Lawson
- Faculty of Health and Life Sciences, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst, Neston, Cheshire, UK
| | - Gina Pinchbeck
- Faculty of Health and Life Sciences, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst, Neston, Cheshire, UK
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23
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Novel Combination of COX-2 Inhibitor and Antioxidant Therapy for Modulating Oxidative Stress Associated with Intestinal Ischemic Reperfusion Injury and Endotoxemia. Antioxidants (Basel) 2020; 9:antiox9100930. [PMID: 32998462 PMCID: PMC7601577 DOI: 10.3390/antiox9100930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023] Open
Abstract
Background: Intestinal ischemic reperfusion (I/R) injury is associated with a high mortality rate; this condition is also related to significant endotoxemia and systemic inflammation. The preservation of tissue perfusion and a sufficient blood flow are required to deliver nutrients and oxygen, preserve metabolic pathways, and eliminate waste products. Oxidative stress plays a fundamental role in intestinal I/R injury and leads to disruption of the mucosal barrier and necrosis, allowing the migration of endotoxins and luminal bacteria into the systemic circulation. In this study, we evaluated the beneficial effects of a cyclooxygenase (COX)-2 inhibitor—firocoxib—plus the antioxidant vitamin C in a rat model of intestinal I/R injury. Methods: We used a rat model of I/R injury in which the superior mesenteric artery was clamped for 30 min by a vascular clamp, and the animals were then allowed 1 h of reperfusion. Results: Our results show the importance of combined anti-inflammatory and antioxidant treatment for the prevention of intestinal I/R injury that leads to reduced systemic endotoxemia. We observed a significantly synergistic effect of firocoxib and vitamin C in reducing intestinal wall damage and oxidative stress, leading to a significant reduction of inflammation and endotoxemia. Conclusions: Our results indicate that this approach could be a new pharmacological protocol for intestinal colic or ischemic injury-induced endotoxemia.
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24
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Fogle C, Davis J, Yechuri B, Cordle K, Marshall J, Blikslager A. Ex vivo COX‐1 and COX‐2 inhibition in equine blood by phenylbutazone, flunixin meglumine, meloxicam and firocoxib: Informing clinical NSAID selection. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C. Fogle
- Department of Clinical Sciences College of Veterinary Medicine North Carolina State University Raleigh North Carolina USA
| | - J. Davis
- Department of Biomedical Sciences and Pathobiology Virginia‐Maryland College of Veterinary Medicine Blacksburg Virginia USA
| | - B. Yechuri
- University of British Columbia Vancouver British Columbia Canada
| | - K. Cordle
- Department of Molecular and Biomedical Sciences College of Veterinary Medicine North Carolina State University Raleigh North Carolina USA
| | - J. Marshall
- Weipers Centre Equine Hospital University of Glasgow Glasgow UK
| | - A. Blikslager
- Department of Clinical Sciences College of Veterinary Medicine North Carolina State University Raleigh North Carolina USA
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25
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Bowen IM, Redpath A, Dugdale A, Burford JH, Lloyd D, Watson T, Hallowell GD. BEVA primary care clinical guidelines: Analgesia. Equine Vet J 2020; 52:13-27. [PMID: 31657050 DOI: 10.1111/evj.13198] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/18/2019] [Indexed: 02/07/2023]
Abstract
Primary care guidelines provide a reference point to guide clinicians based on a systematic review of the literature, contextualised by expert clinical opinion. These guidelines develop a modification of the GRADE framework for assessment of research evidence (vetGRADE) and applied this to a range of clinical scenarios regarding use of analgesic agents. Key guidelines produced by the panel included recommendations that horses undergoing routine castration should receive intratesticular local anaesthesia irrespective of methods adopted and that horses should receive NSAIDs prior to surgery (overall certainty levels high). Butorphanol and buprenorphine should not be considered appropriate as sole analgesic for such procedures (high certainty). The panel recommend the continuation of analgesia for 3 days following castration (moderate certainty) and conclude that phenylbutazone provided superior analgesia to meloxicam and firocoxib for hoof pain/laminitis (moderate certainty), but that enhanced efficacy has not been demonstrated for joint pain. In horses with colic, flunixin and firocoxib are considered to provide more effective analgesia than meloxicam or phenylbutazone (moderate certainty). Given the risk of adverse events of all classes of analgesic, these agents should be used only under the control of a veterinary surgeon who has fully evaluated a horse and developed a therapeutic, analgesic plan that includes ongoing monitoring for such adverse events such as the development of right dorsal colitis with all classes of NSAID and spontaneous locomotor activity and potentially ileus with opiates. Finally, the panel call for the development of a single properly validated composite pain score for horses to allow accurate comparisons between medications in a robust manner.
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Affiliation(s)
- I M Bowen
- Oakham Veterinary Hospital/University of Nottingham, Sutton Bonington, Loughborough, UK
| | - A Redpath
- Oakham Veterinary Hospital/University of Nottingham, Sutton Bonington, Loughborough, UK
| | - A Dugdale
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, UK
| | - J H Burford
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Loughborough, UK
| | - D Lloyd
- ChesterGates Veterinary Specialists, Chester, UK
| | - T Watson
- Waterlane Equine Vets, Stroud, UK
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26
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Freeman DE. Letter to the Editor: Response to Dr Blikslager's letter on post‐operative reflux. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D. E. Freeman
- Department of Large Animal Clinical Sciences College of Veterinary Medicine University of Florida Gainesville Florida USA
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27
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Blikslager AT. Letter to the Editor: Post‐operative reflux – a surgeon's perspective. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. T. Blikslager
- Department of Clinical Sciences North Carolina State University Raleigh North Carolina USA
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28
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Ziegler AL, Blikslager AT. Sparing the gut: COX-2 inhibitors herald a new era for treatment of horses with surgical colic. EQUINE VET EDUC 2019; 32:611-616. [PMID: 34305336 DOI: 10.1111/eve.13189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage a wide variety of conditions in horses, including management of colic. Flunixin meglumine is by far the most commonly used drug in the control of colic pain and inflammation and has become a go-to for not only veterinarians but also horse-owners and nonmedical equine professionals. NSAID use, however, has always been controversial in critical cases due to a high risk of adverse effects associated with their potent cyclo-oxygenase (COX) inhibition. There are two important COX isoenzymes: COX-1 is generally beneficial for normal renal and gastrointestinal functions and COX-2 is associated with the pain and inflammation of disease. Newer selective NSAIDs can target COX-2-driven pathology while sparing important COX-1-driven physiology, which is of critical importance in horses with severe gastrointestinal disease. Emerging research suggests that firocoxib, a COX-2-selective NSAID labelled for use in horses, may be preferable for use in colic cases in spite of the decades-long dogma that flunixin saves lives.
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Affiliation(s)
- A L Ziegler
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - A T Blikslager
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
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29
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Ziegler AL, Fogle CA, Burke M, Blikslager AT. Letter to the Editor: Bias in statistics or bias in equine veterinary medicine? Equine Vet J 2019; 51:423. [PMID: 30811658 DOI: 10.1111/evj.13081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A L Ziegler
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - C A Fogle
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - M Burke
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - A T Blikslager
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Freeman DE. Letter to the Editor: Multicentre, blinded, randomised clinical trial comparing the use of flunixin meglumine with firocoxib in horses with small intestinal strangulating obstruction. Equine Vet J 2019; 51:422. [PMID: 30714186 DOI: 10.1111/evj.13078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D E Freeman
- University of Florida, College of Veterinary Medicine, Large Animal Clinical Sciences, Gainesville, Florida, USA
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Wright S. Highlights of recent clinically relevant papers. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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