Untangling the stranglehold through mathematical modelling of Streptococcus equi subspecies equi transmission

Strangles, a disease caused by infection with Streptococccus equi subspecies equi (S. equi), is endemic worldwide and one of the most frequently diagnosed infectious diseases of horses. Recent work has improved our knowledge of key parameters of transmission dynamics, but important knowledge gaps remain. Our aim was to apply mathematical modelling of S. equi transmission dynamics to prioritise future research areas, and add precision to estimates of transmission parameters thereby improving understanding of S. equi epidemiology and quantifying the control effort required. A compartmental deterministic model was constructed. Parameter values were estimated from current literature wherever possible. We assessed the sensitivity of estimates for the basic reproduction number on the population scale to varying assumptions for the unknown or uncertain parameters of: (mean) duration of carriership (1∕γC), relative infectiousness of carriers (f), proportion of infections that result in carriership (p), and (mean) duration of immunity after natural infection (1∕γR). Available incidence and (sero-)prevalence data were compared to model outputs to improve point estimates and ranges for these currently unknown or uncertain transmission-related parameters. The required vaccination coverage of an ideal vaccine to prevent major outbreaks under a range of control scenarios was estimated, and compared available data on existing vaccines. The relative infectiousness of carriers (as compared to acutely ill horses) and the duration of carriership were identified as key knowledge gaps. Deterministic compartmental simulations, combined with seroprevalence data, suggest that 0.05 Collapse

Key Words

• Epidemiology
• Infectious disease modelling
• Streptococcus equi

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Effect of speed and water depth on limb and back kinematics in Thoroughbred horses walking on a water treadmill

Water treadmill (WT) exercise may induce limb and back kinematics that meet specific training and rehabilitation goals. The study aimed to investigate the effects of walk speed, at different water depths (WDs), on limb and back kinematics of six Thoroughbreds exercising on a WT. Horses walked at 2.8/4.3/5.5/6.0 km/h (i.e. 0.8/1.2/1.5/1.7 m/s) at dry, metacarpophalangeal and carpal WD. Videography captured limb movement in the sagittal plane. Motion-capture measured thoracolumbosacral flexion-extension (FE), and lateral bend (LB) ranges of movement (ROM) using skin surface markers on the sixth, tenth, thirteenth, eighteenth thoracic, third and fifth lumbar, and third sacral spinous processes. Inertial-motion-sensors measured poll, withers and pelvic displacements. Following preliminary univariable analyses, multivariable mixed-effects linear-regression analyses were used to examine the relationship between speed, WD and each outcome variable (P < 0.05). Peak metacarpophalangeal, carpal and tarsal joint flexion increased with speed (P ≤ 0.002) and depth combined (P 0.001) while peak metatarsophalangeal flexion increased with WD only (P 0.001). Thoracolumbar FE-ROM between T10 and L3 and hindlimb retraction was increased by speed and WD combined (P 0.001). Hindlimb protraction was increased by speed (P 0.001) while hindlimb retraction was increased by speed and WD combined (P 0.001). Dorsoventral poll displacement was increased by speed (P 0.001) and carpal WD (P = 0.013), craniocaudal poll displacement was increased by speed and WD combined (P 0.001). Pelvic (tubera coxae and sacrum) dorsoventral displacements increased with speed and WD combined (P 0.001). Understanding the effects of speed and WD on limb, back and pelvic kinematics will improve decision making relating to dry and WT exercise within training.

The efficacy, safety and acceptability of emergency embedded Psychiatry Assessment and Planning Units: An evaluation of Psychiatry Assessment and Planning Units in close proximity to their associated emergency departments

OBJECTIVE

To determine the efficacy, safety and acceptability as well as the patient demographics of three newly developed emergency department-embedded Psychiatric Assessment and Planning Units located in Metropolitan Melbourne at Austin, Peninsula and Eastern Health Services.

METHODS

The evaluation reviewed a 12-month period of service activity from 1 September 2017 to 31 August 2018, when all three Psychiatric Assessment and Planning Units services were operational. A 12-month period from 1 September 2014 to 31 August 2015 was compared as the pre-Psychiatric Assessment and Planning Units period. Mixed qualitative and quantitative methods were used. This included semi-structured interviews of 30 Psychiatric Assessment and Planning Units patients and 30 emergency department staff (10 of each for all 3 sites), patient survey, statistical analysis of Client Management Interface data for the emergency department and related Psychiatric Assessment and Planning Units as well as audit of RISKMAN registers.

RESULTS

There were 365 Austin, 567 Eastern and 791 Peninsula Psychiatric Assessment and Planning Units admissions. Psychiatric Assessment and Planning Units were generally well accepted by patients and emergency department staff, relatively safe, operating within the Key Performance Indicators with mixed effect on emergency department flow. Austin emergency department processing times improved post-Psychiatric Assessment and Planning Units (4 hours 57 minutes to 4 hours 19 minutes; p < 0.001) while deteriorating at Eastern and Peninsula. Adjustment Disorder and Depression and Borderline Personality Disorder were the most common admission diagnoses. While the Psychiatric Assessment and Planning Units had mixed utility on emergency department processing times, they appear to serve a demographic not previously accommodated in traditional emergency department psychiatry models.

CONCLUSION

The emergency department-embedded Psychiatric Assessment and Planning Unit model of care appears effective on some measures, safe and acceptable to patients and staff. The Psychiatric Assessment and Planning Units seem to service a group not previously accommodated in traditional emergency psychiatry models.

Identification of modifiable factors associated with owner-reported equine laminitis in Britain using a web-based cohort study approach

Background

Equine laminitis is a complex disease that manifests as pain and lameness in the feet, often with debilitating consequences. There is a paucity of data that accounts for the multifactorial nature of laminitis and considers time-varying covariates that may be associated with disease development; particularly those that are modifiable and present potential interventions. A previous case-control study identified a number of novel, modifiable factors associated with laminitis which warranted further investigation and corroboration. The aim of this study was to identify factors associated with equine laminitis in horses/ponies in Great Britain (GB) using a prospective, web-based cohort study design, with particular interest in evaluating modifiable factors previously identified in the case-control study.

Results

Self-selected horse/pony owners in GB submitted initial baseline and follow-up health and management questionnaires for 1070 horses/ponies between August 2014 and December 2016. The enrolled horses/ponies contributed 1068 horse-years at risk with a median of 38 days between questionnaire submissions. Owners reported 123 owner-recognised and/or veterinary-diagnosed episodes of active laminitis using a previously-validated laminitis reporting form. Multivariable Cox regression modelling identified 16 risk/protective factors associated with laminitis development. In keeping with the previous case-control study, a prior history of laminitis (particularly non-veterinary-diagnosed episodes), soreness after shoeing/trimming and weight gain were associated with higher rates of laminitis. There is now strong evidence that these risk factors should be used to guide future recommendations in disease prevention. Factors with some prior evidence of association included breed, steroidal anti-inflammatory administration, transport and worming. The modifiable factors amongst these should be the focus of future laminitis studies. The remainder of the identified factors relating to health, turnout and grazing management and feeding are novel, and require further investigation to explore their relationship with laminitis and their applicability as potential interventions.

Conclusions

This study has demonstrated a temporal relationship between a number of horse- and management-level factors and laminitis, identifying potential interventions and important risk groups for which these interventions would be of particular importance. These results serve as a sound evidence-base towards the development of strategic recommendations for the horse/pony-owning population to reduce the rate of laminitis in GB.

Electronic supplementary material

The online version of this article (10.1186/s12917-019-1798-8) contains supplementary material, which is available to authorized users.

Incidence and clinical signs of owner-reported equine laminitis in a cohort of horses and ponies in Great Britain

BACKGROUND

Previous robust epidemiological studies of equine laminitis have utilised only veterinary-diagnosed episodes of disease, potentially underestimating true disease frequency.

OBJECTIVES

To estimate the incidence of, and describe clinical signs associated with, owner-reported active laminitis in horses/ponies, using both veterinary-diagnosed and nonveterinary-diagnosed episodes.

STUDY DESIGN

Prospective cohort.

METHODS

Data were collected from horse/pony owners in Great Britain between August 2014 and December 2016 using a web-based application. The incidence of owner-reported laminitis was estimated using both first incident and repeat episodes reported during the study period via a previously validated laminitis reporting form. Owner-reported clinical signs present in these episodes were recorded.

RESULTS

A total of 1070 horses/ponies contributed 1068 horse-years at risk (HYAR) and 123 active laminitis episodes were reported in 97 animals. Sixty-two of these episodes (50.4%, 95% confidence interval [CI] 41.6, 59.2%) were veterinary-diagnosed and 75.3% (CI 66.7, 83.8%; n = 73) of horses/ponies reported to have laminitis during the study had a previous laminitis history. Overall owner-reported first episode incidence was 9.6 episodes (CI 7.8, 11.7)/100 HYAR, whereas incidence including repeat episodes was 11.5 episodes (CI 9.7, 13.7)/100 HYAR. Laminitis occurred throughout the year with no significant differences between seasonal incidence estimates. Incidence was highest in Connemara and New Forest and lowest in Draught and Cob breed categories. The most prevalent owner-reported clinical signs (≥70%) were difficulty turning and a short/stilted or lame walk. Laminitis was reported in all limbs, however; both forelimbs were most commonly affected (62.9%, CI 54.1, 71.7%; n = 73/116).

MAIN LIMITATIONS

Self-selection enrolment of participants may limit generalisability of the findings.

CONCLUSIONS

Laminitis remains a considerable year-round welfare issue of horses and ponies, with frequency estimates utilising owner-reported data more representative of the true impact of the disease. The clinical signs reported by horse/pony owners were reflective of those previously described by veterinary surgeons.

Streptococcus equi Infections in Horses: Guidelines for Treatment, Control, and Prevention of Strangles-Revised Consensus Statement

This consensus statement update reflects our current published knowledge and opinion about clinical signs, pathogenesis, epidemiology, treatment, complications, and control of strangles. This updated statement emphasizes varying presentations in the context of existing underlying immunity and carrier states of strangles in the transmission of disease. The statement redefines the “gold standard” for detection of possible infection and reviews the new technologies available in polymerase chain reaction diagnosis and serology and their use in outbreak control and prevention. We reiterate the importance of judicious use of antibiotics in horses with strangles. This updated consensus statement reviews current vaccine technology and the importance of linking vaccination with currently advocated disease control and prevention programs to facilitate the eradication of endemic infections while safely maintaining herd immunity. Differentiation between immune responses to primary and repeated exposure of subclinically infected animals and responses induced by vaccination is also addressed.

Short-Term and Long-Term Physical Effects of Exposure to CS Spray

CS gas (2-chlorobenzylidene malonitrile) is widely used in an incapacitant spray that causes intense lacrimation, blepharospasm and burning sensations in the throat and nose. Questions have been raised about its safety. We obtained information on short-term and long-term symptoms, and performed ear, nose and throat examinations and respirometry at 8–10 months, in 34 young adults who had been exposed to CS spray in a confined space during a confrontation with police. The group was subdivided into those who had been sprayed directly on the face ( n=10) and those exposed indirectly.

At one hour, all but 2 individuals still had symptoms; respiratory and oral symptoms were significantly more prevalent in the directly exposed group. At one month, only oral symptoms were significantly more prevalent. At 8–10 months, symptoms were still reported but there were no differences between the groups and clinical examinations revealed no specific abnormalities.

There was no convincing evidence of long-term physical sequelae from exposure to CS spray.

Equine atypical myopathy in the UK: Epidemiological characteristics of cases reported from 2011 to 2015 and factors associated with survival

BACKGROUND

Equine atypical myopathy (AM) is a toxic rhabdomyolysis associated with ingestion of hypoglycin A, derived typically in Europe, from Acer pseudoplatanus tree. Despite the wide distribution of this tree species in the UK, the number of cases reported annually varies, and there has been an apparent increase in prevalence in recent years. Although AM was first recognised in the UK, epidemiological studies have never been conducted focused solely on this country.

OBJECTIVES

To describe the spatiotemporal distribution, presentation, treatment and outcome of AM cases reported in the UK.

STUDY DESIGN

Retrospective case series.

METHODS

British AM cases reported to the atypical myopathy alert website, between 2011 and 2015 were included (n = 224). Data were obtained via standardised epidemiological questionnaires from owners and veterinarians. Factors associated with survival were assessed using logistic regression.

RESULTS

Most cases reported were from England (87.9%). Survival was 38.6% (n = 73/189). Clinical factors associated with reduced odds of survival included, hypothermia (odds ratio [OR] 0.18; 95% confidence interval [CI] 0.06-0.57; P = 0.01), bladder distension (OR 0.11; CI 0.02-0.59; P = 0.01), tachycardia (OR 0.97; CI 0.94-0.99; P = 0.04) and serum creatine kinase activity >100,000 IU/L (OR 0.17; CI 0.04-0.68; P = 0.01) in the univariable analysis as well as recumbency. The latter was the only sign retained in multivariable analysis (OR = 0.19; CI 0.06-0.62; P = 0.006). Administration of vitamins during the disease was associated with survival (OR 3.75; CI 1.21-11.57; P = 0.02).

MAIN LIMITATIONS

Reporting cases to the Atypical Myopathy Alert Group is voluntary; therefore, under-reporting will result in underestimation of AM cases; furthermore, direct owner-reporting could have introduced misdiagnosis bias.

CONCLUSION

Some areas of the UK reported AM cases more commonly. Clinical signs such as recumbency, rectal temperature, distended bladder and serum creatine kinase activity might be useful prognostic indicators though should be considered in the context of the clinical picture. Treatment with vitamins increases odds of survival.

Deafness in a Young Musician: A Case of Missed Diagnosis

Hearing loss in a young adult can be devastating and prompt diagnosis and treatment of the cause are vital. This case report is of a young musician presenting to the ENT surgeons with deafness and a lower motor neurone facial nerve palsy which was given a presumptive diagnosis of infective pathology but subsequent investigations indicated this was an uncommon presentation of Wegener's Granulomatosis. Treatment involved systemic Cyclophosphamide followed by steroids and Azathioprine. Two years after commencing therapy the disease remains under control but the patient is left with bilateral hearing aids and a grade 3 facial nerve palsy. Diagnosis and treatment of this multi-system disease are discussed.

Polarisation of equine pregnancy outcome associated with a maternal MHC class I allele: Preliminary evidence

Identification of risk factors which are associated with severe clinical signs can assist in the management of disease outbreaks and indicate future research areas. Pregnancy loss during late gestation in the mare compromises welfare, reduces fecundity and has financial implications for horse owners. This retrospective study focussed on the identification of risk factors associated with pregnancy loss among 46 Thoroughbred mares on a single British stud farm, with some but not all losses involving equid herpesvirus-1 (EHV-1) infection. In a sub-group of 30 mares, association between pregnancy loss and the presence of five common Thoroughbred horse haplotypes of the equine Major Histocompatibility Complex (MHC) was assessed. This involved development of sequence specific, reverse transcriptase polymerase chain reactions and in several mares, measurement of cytotoxic T lymphocyte activity. Of the 46 mares, 10 suffered late gestation pregnancy loss or neonatal foal death, five of which were EHV-1 positive. Maternal factors including age, parity, number of EHV-1 specific vaccinations and the number of days between final vaccination and foaling or abortion were not significantly associated with pregnancy loss. In contrast, a statistically significant association between the presence of the MHC class I B2 allele and pregnancy loss was identified, regardless of the fetus/foal's EHV-1 status (p=0.002). In conclusion, this study demonstrated a significantly positive association between pregnancy loss in Thoroughbred mares and a specific MHC class I allele in the mother. This association requires independent validation and further investigation of the mechanism by which the mare's genetic background contributes to pregnancy outcome.

Seroprevalence and factors associated with equine herpesvirus type 1 and 4 in Spanish Purebred horses in Spain

Equine herpesvirus type 1 (EHV-1) and type 4 (EHV-4) have a worldwide distribution and cause respiratory disease, abortion, neonatal death and myeloencephalopathy in susceptible horses. Given the scarcity of serological EHV-1/EHV-4 data in Spain, the objective of this cross-sectional study was to estimate the seroprevalence of EHV-1/EHV-4 and to identify potential horse-level and stud farm-level factors associated with EHV-1/EHV-4 in the breeding Spanish Purebred (SP) horse population in central Spain. Serum samples from 334 SP unvaccinated horses, collected between September 2011 and November 2013 at 30 stud farms, were tested using a commercially available EHV-1/EHV-4 antibody ELISA and seroneutralisation as the World Organisation for Animal Health reference confirmation test. Data on factors putatively associated with seropositivity to EHV-1/EHV-4 were collected via a questionnaire and examined using logistic regression analysis. EHV-1/EHV-4 seroprevalence in the SP breeding population in central Spain, standardised for the sex distribution of the reference horse population, was 53.9 per cent (95 per cent confidence interval 44.0 per cent to 63.8 per cent). Increasing age, southern location of the stud farm, temperate climate during the summer, and a smaller surface area used for breeding activities in the farm were associated with increased odds for EHV-1/EHV-4 seropositivity, whereas EHV-1/EHV-4 vaccination of other resident horses and separation of breeding mares from youngsters were protective factors.

Decision-tree analysis of clinical data to aid diagnostic reasoning for equine laminitis: a cross-sectional study

The objective of this cross-sectional study was to compare the prevalence of selected clinical signs in laminitis cases and non-laminitic but lame controls to evaluate their capability to discriminate laminitis from other causes of lameness. Participating veterinary practitioners completed a checklist of laminitis-associated clinical signs identified by literature review. Cases were defined as horses/ponies with veterinary-diagnosed, clinically apparent laminitis; controls were horses/ponies with any lameness other than laminitis. Associations were tested by logistic regression with adjusted odds ratios (ORs) and 95% confidence intervals, with veterinary practice as an a priori fixed effect. Multivariable analysis using graphical classification tree-based statistical models linked laminitis prevalence with specific combinations of clinical signs. Data were collected for 588 cases and 201 controls. Five clinical signs had a difference in prevalence of greater than +50 per cent: 'reluctance to walk' (OR 4.4), 'short, stilted gait at walk' (OR 9.4), 'difficulty turning' (OR 16.9), 'shifting weight' (OR 17.7) and 'increased digital pulse' (OR 13.2) (all P<0.001). 'Bilateral forelimb lameness' was the best discriminator; 92 per cent of animals with this clinical sign had laminitis (OR 40.5, P<0.001). If, in addition, horses/ponies had an 'increased digital pulse', 99 per cent were identified as laminitis. 'Presence of a flat/convex sole' also significantly enhanced clinical diagnosis discrimination (OR 15.5, P<0.001). This is the first epidemiological laminitis study to use decision-tree analysis, providing the first evidence base for evaluating clinical signs to differentially diagnose laminitis from other causes of lameness. Improved evaluation of the clinical signs displayed by laminitic animals examined by first-opinion practitioners will lead to equine welfare improvements.

Infectious risk factors and clinical indicators for tracheal mucus in British National Hunt racehorses

REASONS FOR PERFORMING STUDY

Many studies of respiratory disease in racehorses have focused on a combination of increased tracheal mucus and airway neutrophilia. Examination of each component separately should provide further insight into this condition.

OBJECTIVES

To identify infectious risk factors for endoscopically visible tracheal mucus in National Hunt racehorses.

STUDY DESIGN

A 2 year prospective longitudinal study.

METHODS

Monthly quantitative bacteriological examinations of tracheal wash samples and viral serological examinations were conducted. Risk factors for 'small amounts of mucus' (mucus score = 1/3) and 'increased mucus' (score ≥2/3) were identified.

RESULTS

There were increased odds of small amounts of mucus when both Streptococcus zooepidemicus and nonhaemolytic streptococci (NHS) were isolated (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.5-4.6; P<0.001) but not when either species was isolated in the absence of the other. Increased odds of increased mucus were associated with the isolation of either S. zooepidemicus (OR 5.6; 95% CI 1.2-25.9; P = 0.03) or NHS (OR 3.7; 95% CI 1.2-11.6; P = 0.02), with an increased effect when both were isolated together (OR 12.5; 95% CI 3.7-41.6; P<0.001). Approximately 6-fold increased odds of small amounts of mucus were associated with the first 3 months in training (OR 6.3; 95% CI 2.0-19.4; P<0.001) and 3-fold increased odds of increased mucus associated with the first 6 months in training (OR 2.9; 95% CI 1.3-6.4; P = 0.01). Coughing at exercise and increased serous nasal discharge were specific but insensitive indicators of increased mucus.

CONCLUSIONS

Associations with S. zooepidemicus corroborate previous research, but an independent effect of NHS has not previously been reported. The possibility that there are individual pathogenic species within this group should be considered. Further work is required to identify S. zooepidemicus subtypes and NHS species associated with disease. Closer monitoring of the respiratory health of horses entering training for the first time is likely to be valuable.

Next-generation transcriptome profiling reveals insights into genetic factors contributing to growth differences and temperature adaptation in Australian populations of barramundi (Lates calcarifer)

Identification of genetically-regulated adaptation in fish is a precursor to understanding how populations will respond to future climate induced stressors like temperature. Australian populations of barramundi (Lates calcarifer) show strong evidence of local adaptation to temperature. However, the phenotypic consequences of this adaptation are unknown and the genetic mechanisms underlying this response are poorly understood. In the current study, two populations of barramundi from temperature extremes of the species Australian distribution were communally reared at cool (22°C), control (28°C) and hot (36°C) water temperatures for 3.5months. Southern populations of barramundi originating from a cooler environment grew significantly faster at 22°C than northern populations of warm adapted barramundi. However, no difference in population growth was present at either 28°C or 36°C. The underlying transcriptome profile of barramundi was examined via Illumina mRNA deep sequencing to determine the major contributing gene categories giving rise to phenotypic differences in barramundi population growth. Gene ontology (GO) analysis revealed enrichment in categories relating to the regulation of peptidase activity as well as microtubule, cytoplasmic and cellular metabolic based processes. Further analysis of the GO category "microtubule based process" with associated genes from the "response to stress" category revealed an apparent re-organization of cytoskeletal elements in response to an induced cold stress in northern barramundi reared at 22°C, when compared with northern barramundi reared at 36°C. Between southern barramundi and northern barramundi reared at 36°C, an analysis of the "endopeptidase inhibitor activity" GO category in conjunction with stress genes indicated a suppression of the complement system in southern barramundi along with an increase in the cellular stress response. The results of the present study show that southern populations of barramundi exhibit underlying molecular adaptation to cooler water temperatures, but still retain a tolerance for warm water temperatures. Furthermore, GO profiling has revealed groups of genes that underlie population differences in temperature tolerance as a means to prioritize the analysis of differential gene expression in studies of local adaptation in the future.

What can mathematical models bring to the control of equine influenza?

Mathematical modelling of infectious disease is increasingly regarded as an important tool in the development of disease prevention and control measures. This article brings together key findings from various modelling studies conducted over the past 10 years that are of relevance to those on the front line of the battle against equine influenza.

The Summary is available in Chinese – see Supporting information.

Preventive health care and owner-reported disease prevalence of horses and ponies in Great Britain

This study aimed to describe the provision of preventive health care and owner-reported disease prevalence in horses and ponies within Great Britain (GB), and to assess geographical variations in health care provision. A cross-sectional survey was conducted, using a postal questionnaire administered to a random sample of veterinary-registered owners of horses and ponies in GB (n=797). The majority of animals received regular preventive health care: 95.6% had regular hoof care; 71.3% were vaccinated for both influenza and tetanus and median time since last anthelmintic administration was 8.7 weeks. Thirty-one percent of owners indicated their animal was overweight/obese. A new health problem within the previous 7 days was reported for 7.4% of animals, 59.3% of which were veterinary-diagnosed. Thirty-two percent of animals were reported to have a long-term/recurrent condition, of which osteoarthritis (13.9%) was the most prevalent. Obesity, musculoskeletal disorders, and dermatological conditions were the most prevalent conditions affecting veterinary-registered horses/ponies.

Duration of equine influenza virus shedding and infectivity in immunised horses after experimental infection with EIV A/eq2/Richmond/1/07

Equine influenza (EI) is a major respiratory disease of horses. Recent outbreaks of EI have demonstrated the ease with which EI virus (EIV) can be transmitted internationally. This study aimed to improve our understanding of EIV shedding after infection of vaccinated horses, which would inform possible changes to current quarantine requirements. Our objectives were to compare commonly used diagnostic tests and to evaluate the relative merits of nasal and nasopharyngeal swabs for detection of EIV in vaccinated and unvaccinated ponies following EIV infection and to use these data to inform optimal quarantine procedures for the safe international movement of horses. Five ponies vaccinated against EI were infected experimentally with A/eq/Richmond/1/07 (Florida clade 2), 11 weeks after V2. Nasal and nasopharyngeal swabs were taken daily for 14 days and every 2 days for another 2 weeks. The 5 vaccinates were introduced sequentially for 48h to 3 groups of 2 naïve sentinel ponies each on days 2, 4 and 6 post-challenge respectively. Clinical signs of disease and EIV shedding were monitored for 14 days after co-mingling. EIV was detected by 3 different methods of detection (EIV nucleoprotein ELISA, EIV nucleoprotein qRT-PCR and isolation/titration in embryonated hens' eggs). Directigen™ EZ Flu A+B tests were also performed on samples from the vaccinated ponies for 6 days after infection. Results show that nasopharyngeal swabs were superior to nasal swabs, with increased frequency and amount of virus detected. The average mean duration of shedding was 6-8 days in naïve animals. All 3 sentinel groups were infected successfully with EIV after commingling with vaccinates, indicating up to 6 days of transmission. EI protection induced by vaccination is a dynamic process, naturally fluctuating and dependent on the time since last immunisation, with periods of high immunity (peak of immunity shortly after boost immunisation) and periods of susceptibility to EIV infection. This result indicates that vaccinated horses may actively transmit EIV if the immunity gap (a usual period of susceptibility between V2 and V3) is not adequately closed by immunisation. In infected sentinels EIV was detectable up to 12 days after commingling. Results also suggest that tests such as qRT-PCR may be a suitable substitute for time spent in pre-export quarantine.

Equine influenza--a global perspective

To date, equine influenza outbreaks have been reported all over the world with the exception of a small number of island nations including New Zealand and Iceland. Influenza is endemic in Europe and North America and is considered to be of potentially major economic significance to the equine industry worldwide. The importation of subclinically infected vaccinated horses, and inadequate quarantine procedures have resulted in several major outbreaks in susceptible populations for example, in Australia (2007) when more than 76,000 horses on over 10,000 properties were reported as infected. This review summarises the current understanding of, and recent research on, equine influenza, including epidemiology, pathogenesis, clinical characteristics, laboratory diagnosis, management and prevention. Recent advances in diagnostic techniques are discussed as are the merits of different vaccination regimes.

Risk factors for superficial digital flexor tendinopathy in Thoroughbred racehorses in steeplechase starts in the United Kingdom (2001-2009)

The objective of this study was to identify risk factors for superficial digital flexor (SDF) tendinopathy in Thoroughbred horses in steeplechase races in the United Kingdom. Potential risk factors for SDF tendinopathy were studied between 1st January 2001 and 31st December 2009 using a cohort study design with 648 injuries sustained in 102,894 starts. Potential risk factors were screened using univariable logistic regression prior to multivariable model building. In the final multivariable model, 12 statistically significant risk factors were identified. Variables that increased the odds of SDF tendinopathy included firmer going, increased horse age, and racing in the summer compared to other seasons. Variables that decreased the odds included having a higher official rating and the number of starts in the preceding days. Fewer and different risk factors were identified than in an equivalent model of SDF tendinopathy in hurdle racing, highlighting potential differences between these disciplines. Further collection of training and racecourse information would be beneficial and may help to explain further some of the associations identified in this study. The results will facilitate the development of strategies to improve overall safety of horses in UK steeplechase racing.

The gene expression response of the catadromous perciform barramundi Lates calcarifer to an acute heat stress

The acute heat-shock response of the tropical estuarine fish species barramundi Lates calcarifer as indicated by the expression of genes within stress (hsp 90AA, hsp 90AB, hsp 70 and hsc 70), metabolic (cisy, cco II and ldh) and growth (igf1 and mstn 1) related pathways was examined following an increase in water temperature from 28 to 36° C over 30 min. Lates calcarifer were maintained at the acute stress temperature of 36° C for 1 h before being returned to 28° C and allowed to recover at this temperature for a further 2 weeks. Muscle tissue sampling over the experimental period allowed for the expression quantification of stress, metabolic and growth-related genes via quantitative real-time polymerase chain reaction (qrt-PCR) where a robust and reliable normalization approach identified both α-tub and Rpl8 as appropriate genes for the analysis of gene expression in response to an acute heat stress. hsp90AA and hsp70 of the inducible heat-shock response pathway showed a massive up-regulation of gene expression in response to heat stress, whilst the constitutive heat-shock genes hsp90AB and hsp70 showed no change over the course of the experiment and a small increase after 2 weeks of recovery, respectively. Of the three genes representing the metabolic pathway (cisy, cco II and ldh) only cco II changed significantly showing a decrease in gene expression, which may suggest a small suppression of aerobic metabolism. igf1 of the growth pathway showed no significant differences in response to an acute heat stress, whilst mstn1 increased at the beginning of the heat stress but returned to basal levels soon after. Overall, the results demonstrate that an acute heat stress in L. calcarifer caused a significant increase in the expression of genes from the stress response pathway and a possible decrease in aerobic metabolism with only relatively minor changes to the growth pathway highlighting the hardy nature of L. calcarifer and its resilience in coping with sudden temperature changes routinely encountered within its natural environment.

Molecular epidemiology of strangles outbreaks in the UK during 2010

The sequence of the Streptococcus equi subspecies equi (S equi) M-like protein (SeM) gene was determined for 105 isolates of S equi from strangles outbreaks in the UK during 2010 and compared with previous data from 2007 to 2008. Twenty-three distinct alleles were identified, including 11 novel alleles. One allele giving rise to a putative truncated M protein was identified from the guttural pouch of an asymptomatic carrier. Allele 9 was the most prevalent, comprising 57.7 per cent of isolates, followed by allele 6 (10.3 per cent). Significant changes in allele prevalence were found between 2007, 2008 and 2010, with an increasing prevalence in SeM-9-related alleles and a corresponding decreasing prevalence in SeM-6-related alleles observed over the period (P<0.001). Geographical proximity of outbreaks caused by some uncommon alleles was apparent between 2007, 2008 and 2010.

A nationwide surveillance scheme for equine grass sickness in Great Britain: results for the period 2000-2009

REASONS FOR PERFORMING STUDY

Equine grass sickness (EGS) remains a frequently fatal disease of equids in Great Britain (GB). The first nationwide surveillance scheme for EGS was developed to obtain information on the occurrence of EGS and to help facilitate future proposed intervention studies, such as vaccine trials.

OBJECTIVES

To collect both retrospective and prospective data on cases of EGS occurring in GB since 2000 and to assess potential risk factors for categories of EGS and survival after chronic EGS.

METHODS

Prospective data were collected using a nationwide surveillance scheme for EGS that was developed and initiated in 2007. Data were collected by means of postal and online questionnaires documenting both retrospective premises-level and prospective case-level information. Data on outcomes of EGS category and survival after chronic grass sickness (CGS) were analysed using univariable logistic regression.

RESULTS

Descriptive data for 1410 EGS cases occurring in GB in the decade between the beginning of 2000 and the end of 2009 are presented. Univariable logistic regression analyses identified that CGS cases in Scotland were significantly more likely to survive than those occurring elsewhere in GB. There was no relationship between case details and the category of EGS or the outcome among CGS cases.

CONCLUSIONS

EGS affected equids throughout England, Scotland and Wales. Although an overall average of 141 cases were reported to the nationwide surveillance scheme annually, this number of cases was not consistent between years. Around 50% of CGS cases survived, although regional differences in survival rates existed, probably due to variation in expertise of care and/or disease severity.

POTENTIAL RELEVANCE

This study provides information on the spatiotemporal occurrence of EGS in GB during the last decade. Data from the nationwide surveillance scheme can be used in developing protocols for future intervention studies such as Clostridium botulinum vaccine trials.

Descriptive results from a longitudinal study of airway inflammation in British National Hunt racehorses

REASONS FOR PERFORMING STUDY

Rates of airway inflammation in young racehorses decrease with time but it is not clear whether this is associated with increasing age or time exposed to the training environment. The structure of the British National Hunt (NH) population allowed closer examination of this relationship.

OBJECTIVES

To compare rates of inflammatory airway disease diagnosed by tracheal sampling (trIAD), and its components, in NH racehorses by age and training history and with published rates in young racehorses.

METHODS

A prospective, longitudinal study was conducted on 5 NH yards over 2 years. Period sample prevalences of nasal discharge, tracheal mucus, airway neutrophilia and trIAD (defined by a combination of tracheal mucus and airway neutrophilia) were estimated and compared between horses with different ages and time in training.

RESULTS

Horses new to training had twice the odds of visible tracheal mucus as ex-flat trained horses (OR 2.0; 95% CI: 1.4-2.8; P<0.001) but no significantly increased odds of airway neutrophilia (OR 1.3; 95% CI: 0.8-1.9; P = 0.3) and inconclusive evidence of increased odds of trIAD (OR 1.8; CI: 0.9-3.5; P = 0.08). However, a lower median time in training was significantly associated with the presence of visible mucus (P<0.001), increased mucus (P = 0.005) and trIAD (P = 0.03). No disease measure varied significantly with age.

CONCLUSIONS

Tracheal mucus and trIAD, but not neutrophilia detected in tracheal wash samples, were less prevalent in horses that had been exposed to the training environment for longer, explaining previously reported associations with age.

POTENTIAL RELEVANCE

Neutrophil proportion in tracheal wash samples is not as useful a clinical tool as measures of visible tracheal mucus for identifying horses requiring treatment or changes in management. The inclusion of tracheal wash neutrophils in the assessment of equine airways, or at least their relative weighting in definitions of trIAD, should be re-evaluated.

Community-based participatory approach to reduce breast cancer disparities in south Dallas

BACKGROUND

South Dallas experiences significant disparities in breast cancer mortality, with a high proportion of stage III and IV diagnoses. To address these rates, the Dallas Cancer Disparities Community Research Coalition created an educational intervention to promote breast health and early detection efforts.

OBJECTIVES

The goals of the intervention were to increase (a) knowledge regarding the chief contributing factors for breast cancer, (b) awareness of the importance of screening for early detection, and (c) the proportion of women who have engaged in appropriate breast cancer screening practices.

METHODS

Eligibility criteria for this nonrandomized, controlled trial included women age 40 and older, English-speaking, and having no personal history of cancer. Control participants received written breast health educational materials. Intervention participants attended 8 weekly sessions that included interactive educational materials, cooking demonstrations, and discussions emphasizing primary and secondary breast cancer prevention. All study participants completed a 1-hour survey at baseline and 4 months later.

RESULTS

There were 59 women were enrolled in the intervention and 60 in the control group. At follow-up, after controlling for baseline mammography status, women in the intervention group were 10.4 times more likely (95% confidence interval [CI], 2.9-36.4) to have received a screening mammogram in the last year compared with the control group. Intervention participants demonstrated statistically significantly higher rates of breast self-examination (odds ratio [OR], 3.0; 95% CI, 1.0-8.6) and breast cancer knowledge (p=.003).

CONCLUSION

Lessons learned from this community-based participatory research (CBPR) study can be used to create sustainable cancer disparity reduction models that can be replicated in similar communities.

Preliminary Investigation of the Dosimetric Properties of 'RadGel'

A preliminary investigation into the efficacy of a new 3D dosimetry material, RadGel™, for verification of radiation therapy dose distributions is presented. Small volumes of RadGel™ were found to exhibit a linear, reproducible response to dose. A gradual increase in optical-density (OD) with time was observed, suggesting scanning should be completed within 18 hours to keep a linear correlation of R(2) > 0.99. A larger 10 cm diameter volume of RadGel™ was irradiated with a rotationally symmetric "spoke" plan designed to rigorously evaluate scanner/dosimeter combined performance. The dosimeter was imaged with the Duke Mid-sized Optical-CT Scanner (DMOS). Promising OD and corresponding dose maps were obtained. Edge artefacts were observed and are suspected to be exacerbated by the particular container used in this early study. Further studies will evaluate new containers and methods for refractive matching at the gel-container-fluid interface.

Making use of equine population demography for disease control purposes: preliminary observations on the difficulties of counting and locating horses in Great Britain

Detailed knowledge of horse populations can better facilitate effective control of equine diseases. Preliminary studies were undertaken to ascertain the type of information held on the UK's National Equine Database (NED) and to determine the geographical resolution at which mandatorily recorded owner addresses might be a suitable proxy for predicting horse locations. Results indicated that relatively few UK passport-issuing organisations requested details of where horses were kept in addition to owner address details. Examination of data on 1440 horses held on an Animal Health Trust syndromic surveillance database showed that 90% of them were kept within 10 km of their owners. While owner location may provide an indication of where most horses are kept, further work is also needed to evaluate the usefulness of NED as an epidemiological resource in future equine disease control measures.

Molecular characterisation of 'strangles' outbreaks in the UK: the use of M-protein typing of Streptococcus equi ssp. equi

REASONS FOR PERFORMING STUDY

Strangles is the most commonly diagnosed and important infectious disease of horses worldwide. Very little is known about the temporo-spatial and molecular epidemiology of strangles. The disease is not notifiable in the UK and there are few published data on the geographical locations of outbreaks.

OBJECTIVE

To investigate whether typing of a surface protein (SeM) of Streptococcus equi ssp. equi (S. equi), the causative agent of strangles, is a useful epidemiological tool.

METHODS

The variable region of the SeM gene was amplified from 145 isolates of S. equi by PCR and sequenced. Different SeM gene alleles were assigned based on the SeM database, grouped into phylogenetic clusters using split decomposition analysis and plotted against the submitting veterinary practices.

RESULTS

In this study 21 S. equi SeM alleles were found, including 9 previously unidentified alleles and representing 4 phylogenetic groups. S. equi containing SeM alleles 9 and 7 were the most commonly isolated and there was a high number of low frequency alleles. The occurrence of an outbreak cluster in the north-west of the UK is also reported.

CONCLUSIONS

Strangles outbreaks can be differentiated on the basis of their SeM allele sequences. The data provide further evidence of SeM mutation leading to the emergence of novel, but related SeM alleles that are geographically linked. Sequencing of the SeM gene is a useful tool for the elucidation of strangles epidemiology at a regional and a national level.

POTENTIAL RELEVANCE

This technique may allow differentiation or linkage of strangles outbreaks and as such may be an effective tool for local as well as national and international disease surveillance.

Retrospective study of predictive variables for maximal heart rate (HRmax) in horses undergoing strenuous treadmill exercise

REASONS FOR PERFORMING STUDY

Heart rate is one of the most commonly measured variables in equine exercise physiology and relative exercise intensity commonly expressed as % of maximal heart rate. A number of influences affect maximal heart rate (HRmax), including age of the horse but other factors have not been described.

OBJECTIVES

To determine if fitness, health status, gender, breed, athletic use, body mass, in addition to age, are predictive of HRmax in the horse.

METHODS

Maximal heart rate data from 328 horses which underwent treadmill exercise tests at 5 different laboratories were obtained retrospectively. Univariable linear regression analyses were performed on individual variables. Multiple linear regression analysis using a backward elimination modelling procedure was then used to relate the observed HRmax values simultaneously with different predictive variables. Variables were retained in the final regression model if they or any of their categories were significantly predictive of HRmax at P<0.05 and if there was a significant collective contribution to the model from inclusion of each variable, also at P<0.05.

RESULTS

Age, fitness status, laboratory, gender and breed/use (combined category) were all statistically significantly predictive of HRmax. Together these variables accounted for 41% of the variance in HRmax. Age alone accounted for only approximately 13% of the variation between horses in HRmax. Neither body mass nor health status were significantly predictive.

CONCLUSIONS

HRmax in the horse declines with age but is also influenced by other factors. As the factors investigated accounted for only 41% of the variation between horses, other unidentified variables with a strong influence on HRmax remain to be identified.

POTENTIAL RELEVANCE

Factors such as fitness, age, gender, breed and use need to be considered when interpreting estimates or measurements of HRmax.

Development and application of a scoring system for prognostic evaluation of equine liver biopsies

REASONS FOR PERFORMING STUDY

The study was designed to investigate the prognostic value of liver biopsy during investigation of cases of suspected liver disease in mature horses.

HYPOTHESIS

That liver biopsy is the most prognostically useful technique in common usage in the investigation of suspected liver disease.

METHODS

This study examined the prognostic value of liver biopsy during the investigation of suspected liver disease in 73 mature horses. Histopathological variables comprising fibrosis, irreversible cytopathology, inflammatory infiltration, haemosiderin accumulation and biliary hyperplasia were found to be significant predictors of nonsurvival and were used to formulate a weighted biopsy score representing a prognostically useful broad comparative index of histopathological severity. Minimum and maximum possible scores were 0 and 14 points, respectively.

RESULTS

Retrospective application of the biopsy scoring system to the study population indicated that horses with scores of 0 or 1 were equally likely to survive to 6 months with a combined mortality of 4%. Horses with biopsy scores between 2 and 6 had a combined mortality of 33% and were at a 12-fold increased risk of nonsurvival within 6 months (hazard ratio = 12.04, 95% CI 134-107.81, P = 0.026) compared to horses with a biopsy score of 0. Horses with biopsy scores between 7 and 14 had a combined mortality of 86% and were at a 46-fold increased risk of nonsurvival (hazard ratio = 46.01, 95% CI 5.92-357.5, P < 0.001) compared to horses with biopsy score 0.

CONCLUSIONS

Application of the biopsy scoring system to histopathological findings in liver biopsy specimens was very useful in predicting survival of cases of suspected liver disease.

POTENTIAL RELEVANCE

Application of the findings in this study may not be directly applicable to other case populations. However, liver biopsy appears to be the most valuable prognostic technique employed during the investigation of suspected cases of liver disease in mature horses.

Risk factors for epistaxis on British racecourses: evidence for locomotory impact-induced trauma contributing to the aetiology of exercise-induced pulmonary haemorrhage

REASONS FOR PERFORMING STUDY

The proposed biological mechanisms for exercise-induced pulmonary haemorrhage (EIPH) are many and varied. Better knowledge of risk factors should lead to achievable measures to reduce the incidence.

OBJECTIVES

To identify risk factors associated with epistaxis following racing in UK Thoroughbreds, to gain possible insights into the pathogenesis of the condition and to investigate the association between epistaxis and race finishing position.

METHODS

The association of epistaxis occurring on UK racecourses between 1996 and 1998 with a wide range of race-, horse- and start-level variables was examined in multivariable mixed effect logistic regression analyses. Four multivariable analyses were conducted, one for all race types considered collectively and one each for flat, hurdle and steeplechase race types considered separately.

RESULTS

Risk of epistaxis was significantly increased for hurdle and steeplechase race types compared to both flat and National Hunt flat races. In 3 of the 4 final models, there was a significant biological trend for increasing risk of epistaxis with increasing ground hardness ('going') and accumulated years spent racing. However, in flat races epistaxis was such a rare outcome (0.33 cases per 1000 starts) that this subset analysis had insufficient power to measure the detectable effect of 'going' as statistically significant. Horses with epistaxis were significantly more likely to have a poorer finishing position than those without blood at the nostrils.

CONCLUSIONS

Findings were consistent with the theory that locomotory impact-induced trauma contributes to exercise-induced epistaxis. Further validation of this hypothesis through application of similar methods to endoscopically visible EIPH and through biomechanical studies is warranted.

POTENTIAL RELEVANCE

Knowledge of significant risk factors should allow formulation of practical measures, such as track watering, to reduce the risks of EIPH and epistaxis in racehorses.

An evaluation of diagnostic data in comparison to the results of liver biopsies in mature horses

REASONS FOR PERFORMING STUDY

The diagnostic value of several investigative procedures commonly used during the evaluation of suspected equine hepatopathy cases has not been specifically quantified in previous studies.

HYPOTHESIS

No noninvasive procedures would clearly discriminate between horses with and without significant liver disease.

METHODS

Histopathology of biopsy samples was used as the 'gold standard' technique for definitive diagnosis of the presence or absence of significant liver disease. Clinical, ultrasonographic and clinicopathological data obtained during the investigation of 82 suspected cases of hepatopathy in mature horses were compared with the results of subsequent biopsy in order to quantify the diagnostic value of each test.

RESULTS

Of the 82 cases, 61 were confirmed to have significant liver disease and 21 were not. Only serum concentrations of gamma-glutamyltransferase (gammaGT), globulins and alkaline phosphatase (AP) were found to be significantly different between the 2 groups of horses. Clinical and ultrasonographic abnormalities were found, when present, to be good indicators of the presence of liver disease. Certain single serum biochemical tests and combinations thereof were found to have high values for sensitivity (SN), specificity (SP), positive predictive value (PPV) and/or negative predictive value (NPV), but none showed high values for all 4 parameters leading to important limitations in their practical diagnostic application. Of all serum biochemical tests studied, the PPVs of only gammaGT and globulins could be clearly improved by considering especially high positive results.

CONCLUSIONS

The single positive test results of greatest diagnostic value were presence of hepatic encephalopathy (HE), increased gammaGT, hyperglobulinaemia, hypoalbuminaemia, increased AP, increased total bile acids (TBA) and increased total bilirubin (TBil). Increased aspartate aminotransferase (AST) and increased glutamate dehydrogenase (GLDH) were also of good diagnostic value, but only when used in combination with the above tests. However, no single, combination or sequential test was able to discriminate fully between horses with and without biopsy-confirmed liver disease and reliance on the use of noninvasive tests for the prediction of the presence or absence of significant liver disease may lead to frequent diagnostic errors. Although certain positive results did reliably predict the presence of liver disease, negative test results were invariably poor predictors of the absence of liver disease.

POTENTIAL RELEVANCE

Application of the findings in this study may not be directly applicable to other case populations. However, the results may help clinicians with their selection and interpretation of appropriate test results in cases of suspected liver disease.

Electrosurgery as the sole means of haemostasis during the laparoscopic removal of pathologically enlarged ovaries in mares: a report of 55 cases

REASONS FOR PERFORMING STUDY

There is little published clinical evidence on the use of a laparoscopic approach for the removal of pathologically enlarged ovaries in standing mares.

OBJECTIVES

To show the orders of success and complication rates that can be expected if pathologically enlarged ovaries are removed from standing, sedated mares under laparoscopic guidance using only electrosurgical means of haemostasis.

METHODS

A retrospective analysis was made of 55 mares in which the removal of an enlarged ovary was attempted by applying a standard laparoscopic procedure for routine ovariectomy in standing mares including a reliance solely on one of 2 types of electrosurgical bipolar forceps with an integrated guillotine for haemostasis and transection of the ovarian pedicle. The outcomes and complications encountered were recorded. Logistic regression analysis was performed to identify the risk of any complications associated with the size of the ovary removed and the instrument used.

RESULTS

In 54 of the 55 mares, the surgery was successfully accomplished by the planned approach. In one mare there was significant intraoperative haemorrhage and this necessitated the additional use of a prosthetic haemostatic device. The only other complications encountered were post operative abdominal discomfort (n = 9), delayed incisional wound healing (n = 6) and iatrogenic uterine puncture (n = 2). One mare developed a rectal tear, but not as a direct complication of the surgical procedure. None of these prevented a long-term successful outcome.

CONCLUSIONS

The removal of pathologically enlarged ovaries (up to 30 cm diameter) from mares under standing sedation can be accomplished predictably and safely by applying the standard laparoscopic approach that is established for routine laparoscopic ovariectomy, including a reliance solely on endoscopic electrosurgery instruments for haemostasis of the ovarian pedicle.

POTENTIAL RELEVANCE

This study shows that the simple standing laparoscopic technique now favoured for routine ovariectomy can be used safely and reliably for the removal of pathologically enlarged ovaries. This promises to be of significant clinical advantage to mares so affected.

An epidemiological study of risk factors associated with the recurrence of equine grass sickness (dysautonomia) on previously affected premises

REASONS FOR PERFORMING STUDY

The reasons why equine grass sickness (EGS) recurs on premises are unknown and, consequently, practical methods for reducing the risk of recurrence are not available.

OBJECTIVES

To identify risk factors associated with recurrence of EGS on premises and to gain possible insights into the pathogenesis of the disease.

METHODS

Data on disease history and risk factors were collected by postal questionnaire from premises with EGS cases between 1st January 1997 and 31st December 2001. Data on variation in rates of recurrence of EGS for different risk factors were analysed using Poisson regression analysis.

RESULTS

Of 509 premises contacted, 305 (60%) returned useable questionnaires and 100 of these (33%) were classified as 'recurrent' premises. An overall median incidence rate for EGS of 2.1 EGS incidents/100 horses/premises/year was recorded. There was an increased rate of recurrence with higher numbers of horses, presence of younger animals, stud farms and livery/riding establishments, loam and sand soils, rearing of domestic birds and mechanical droppings removal. The rate of recurrence decreased with chalk soil, cograzing ruminants, grass cutting on pastures and removal of droppings by hand. Several statistically significant interactions were identified.

CONCLUSIONS

Many of the findings are consistent with the theory that EGS is a toxico-infectious form of botulism. Several of the significant factors identified may directly or indirectly relate to soil disturbance and consequent soil contamination of grass, thereby increasing the rate of exposure of grazing horses to Clostridium botulinum, which resides in soil.

POTENTIAL RELEVANCE

Identification of potentially modifiable risk factors may, ideally following validation in appropriately designed, controlled and randomised intervention studies, lead to practical measures to reduce the incidence of EGS on previously affected premises.

Nutritional and clinicopathological effects of post operative parenteral nutrition following small intestinal resection and anastomosis in the mature horse

REASONS FOR PERFORMING STUDY

There is an absence of data describing the nutritional requirements and nutritional status of horses following surgery for colic; furthermore, the potential effect of parenteral nutrition (PN) on improving nutritional status in such cases is unknown.

HYPOTHESIS

Post operative colic cases suffer from a potentially detrimental negative energy balance and the PN formulation developed in this study would lead to clinicopathologically detectable improvements in the subjects' nutritional status.

METHODS

Several clinicopathological variables, some known to be associated with nutritional status, were compared in 2 groups of horses in the post operative period following colic surgery; Group N (n = 15) were treated with PN and Group C (n = 15) were starved routinely.

RESULTS

Group N had significantly lower serum concentrations of triglycerides, total bilirubin, albumin and urea and significantly higher serum concentrations of glucose and insulin compared with Group C in the post operative period.

CONCLUSIONS

The control group of horses demonstrated significant clinicopathological evidence of starvation and the described PN protocol resulted in a demonstrably improved nutritional status in the treated horses.

POTENTIAL RELEVANCE

Further study is required to investigate clinical benefits and possible harmful side effects of post operative parenteral nutrition before the technique can be advocated for widespread use in practice.

Risk factors for colic in horses after general anaesthesia for MRI or nonabdominal surgery: absence of evidence of effect from perianaesthetic morphine

REASON FOR PERFORMING STUDY

Post anaesthetic colic is a recognised risk of general anaesthesia (GA), but causes are poorly understood.

OBJECTIVES

To identify risk factors for development of colic following GA for magnetic resonance imaging (MRI) or nonabdominal surgery and to test whether the use of perianaesthetic morphine was associated with an increased risk of post anaesthetic colic.

METHODS

A total of 553 anaesthetic and clinical records of 500 horses anaesthetised at the Animal Health Trust were analysed, 342 (62%) involved MRI and 211 (38%) nonabdominal, predominantly orthopaedic surgery. Multivariable logistic regression analysis was used to examine the association between post anaesthetic colic and explanatory variables, including use of perianaesthetic morphine.

RESULTS

Twenty horses (3.6%) developed colic within 7 days of GA. A significantly larger (P = 0.001) proportion of the surgical cases developed post anaesthetic colic (7.1%) compared with MRI cases (1.5%). Having controlled for the effect of MRI/surgeon, there was evidence for a significantly increased risk of colic associated with maintenance of anaesthesia with isoflurane and administration of benzyl penicillin and/or ceftiofur. A reduction in risk of colic was associated with premedication with romifidine, longer duration of anaesthesia and sedation within 2 days of GA. Perianaesthetic morphine administration was not associated with increased risk.

CONCLUSIONS

This study identified apparently novel risk factors for colic in horses following GA. Use of morphine was not found, after controlling for other MRI and surgery related risk factors, to be associated with an increased risk. The low prevalence of colic after GA and resulting low study power mean that further larger, multicentre collaborative studies are warranted to corroborate findings in this study.

POTENTIAL RELEVANCE

Better knowledge of risk factors should lead to achievable measures to reduce frequency of occurrence.

Retrospective analysis of historical, clinical, ultrasonographic, serum biochemical and haematological data in prognostic evaluation of equine liver disease

REASONS FOR PERFORMING STUDY

Results of noninvasive tests of liver disease do not always correlate with the degree of hepatic disease nor outcome of the case.

OBJECTIVE

To investigate the prognostic value of data collected using noninvasive tests during the investigation of cases of suspected liver disease in mature horses.

HYPOTHESIS

Much of the data gathered during the investigation of suspected hepatopathy cases offers little prognostic guidance and interpretation of such data can be misleading.

METHODS

The results from a range of common and noninvasive diagnostic techniques applied in 116 mature horses with suspected liver disease, were assessed for their ability to predict survival within a 6 month period.

RESULTS

A significantly poorer prognosis was found in association with clinical signs suggestive of liver disease, presence of hepatic encephalopathy, ultrasonographic abnormalities, increased serum globulins, increased total bile acids (TBA), increased alkaline phosphatase (AP), increased gamma-glutamyl transferase (gammaGT), erythrocytosis, leucocytosis, low serum albumin and low serum urea. Additional significant novel findings of interest included an association between increased plasma fibrinogen and low serum creatinine concentrations with nonsurvival in cases of liver disease, an association between raised serum concentrations of AP and gammaGT with biliary hyperplasia and also an association between hepatic fibrosis, haemosiderosis and biliary hyperplasia with ultrasonographically detected hepatic abnormalities.

CONCLUSIONS

The most useful noninvasive prognostic test in cases of suspected liver disease in mature horses is the severity of clinical signs. Other data may be of some limited prognostic value.

POTENTIAL RELEVANCE

Application of the findings in this study may not be directly applicable to other case populations. However, the findings should at least be considered when prognosis is based on similar criteria.

Control of equine influenza: scenario testing using a realistic metapopulation model of spread

We present a metapopulation model of the spread of equine influenza among thoroughbred horses parametrized with data from a 2003 outbreak in Newmarket, UK. The number of horses initially susceptible is derived from a threshold theorem and a published statistical model. Two simulated likelihood-based methods are used to find the within- and between-yard transmissions using both exponential and empirical latent and infectious periods. We demonstrate that the 2003 outbreak was largely locally driven and use the parametrized model to address important questions of control. The chance of a large epidemic is shown to be largely dependent on the size of the index yard. The impact of poor responders to vaccination is estimated under different scenarios. A small proportion of poor responders strongly influences the efficiency of vaccine policies, which increases risk further when the vaccine and infecting strains differ following antigenic drift. Finally, the use of vaccinating in the face of an outbreak is evaluated at a global and individual management group level. The benefits for an individual horse trainer are found to be substantial, although this is influenced by the behaviour of other trainers.

Patients' satisfaction with the nurse-led aural care clinic

BACKGROUND

The necessity of decreasing costs while maintaining a high standard of clinical care has led to the expansion of the role of nurses in recent years. To this end, nurse-led clinics are becoming increasingly common in otolaryngology. The aims of this cross sectional survey were to assess patients' satisfaction with this nurse-led aural care clinic.

METHOD

Patients attending this clinic were requested to fill in an anonymous questionnaire. Data was collected for 12 weeks between January and April, 2007.

RESULTS

Forty-four questionnaires were completed satisfactorily (44/50 = 88%). In response to the presenting complaint, the nurse gave verbal advice (25), discussed with a doctor (10) or arranged a doctor review (9). Forty patients were very satisfied and 4 patients were satisfied with the overall care in the clinic.

CONCLUSION

Combining medical and nursing efforts can provide efficient use of limited time resource in NHS. Nurse-led clinics are cost effective and help reduce the waiting time, for outpatient clinics.

Equine influenza vaccine containing older H3N8 strains offers protection against A/eq/South Africa/4/03 (H3N8) strain in a short-term vaccine efficacy study

REASONS FOR PERFORMING STUDY

Surveillance of equine influenza viruses has suggested that strains included in currently licensed vaccines are a poor match for those predominantly circulating in the field.

OBJECTIVE

To assess the ability of Duvaxyn IE-T Plus to provide cross protection against the newly evolved South Africa/4/03 (H3N8) strain of equine influenza virus.

METHODS

The vaccine efficacy was evaluated by challenge infection with influenza strain A/eq/South Africa/4/03 (H3N8) 2 weeks after a primary course of 2 vaccinations with Duvaxyn IE-T Plus given at a 4-week interval. The outcome of challenge in vaccinated ponies was compared with that in unvaccinated animals.

RESULTS

At the time of challenge, all vaccinated ponies had high levels of antibody to Newmarket/1/93, Newmarket/2/93 and South Africa/4/03 strains measured by single radial haemolysis. After challenge infection, there were statistically significantly decreased clinical scores and virus shedding was significantly lower in the vaccinated ponies compared to unvaccinated controls.

CONCLUSION

Two doses of Duvaxyn IE-T Plus provides good clinical and virological protection against challenge with a variant virus 2 weeks after the 2 doses of vaccine.

POTENTIAL RELEVANCE

When variant strains of equine influenza virus first emerge, booster immunisations with currently available vaccines may limit infection provided sufficiently high antibody levels are achieved, suggesting that vaccination in the face of an outbreak may be beneficial.

Evaluation of endoscopic sinus surgery by Glasgow benefit inventory

INTRODUCTION

Functional endoscopic sinus surgery is a common adjunct to medical therapy in cases of chronic rhinosinusitis and nasal polyposis.

AIM

The objective of this study was to assess patients' quality of life up to two years after endoscopic sinus surgery.

METHOD

Fifty consecutive patients attending a rhinology clinic filled in the Glasgow benefit inventory. The patients were divided into three groups according to the time period elapsed since surgery (i.e. six months, 12 months or up to two years).

RESULTS

The results showed that, generally, the Glasgow benefit inventory scores indicated a benefit from the procedure. Overall, surgery led to statistically significant improvements in both total and general scores (p < 0.05). Comparison of endoscopic sinus surgery with nasal polypectomy (plus endoscopic sinus surgery) indicated a greater benefit for polyp disease. No statistical difference was observed between the scores for females vs males or for various post-operative follow-up periods.

Evidence for transferrin allele as a host-level risk factor in naturally occurring equine respiratory disease: a preliminary study

REASONS FOR PERFORMING STUDY

Recurring respiratory infections can contribute to prolonged burdens of disease, especially in younger horses and better knowledge of factors and effective interventions, such as vaccines, should improve therapeutic and preventive strategies.

OBJECTIVES

To identify factors and infections associated with naturally occurring respiratory disease in recently weaned Welsh Mountain ponies maintained at pasture and to determine whether ponies vaccinated with an experimental inactivated bacterial vaccine had lower burdens of disease and infection compared to nonvaccinated controls. Transferrin allele, which may influence the ability of pathogenic bacteria to acquire iron, was examined specifically as a host-level risk factor.

METHODS

Twice weekly clinical evaluations and weekly microbiological samplings over a 10 week period were conducted in 29 ponies, of which 12 received an experimental bacterial vaccine, 12 received placebo and 5 were untreated. A multilevel modelling approach suitable for analysing longitudinal data containing repeated observations was used to identify factors associated with disease and to evaluate any effect from vaccination.

RESULTS

Analyses demonstrated significant variation in clinical disease between ponies that possessed different alleles of iron binding transferrin protein but no significant effect from vaccination. Of the 29 ponies monitored, 14 possessing homozygote or non-F2 heterozygote transferrin D alleles demonstrated significantly less clinical disease (P < 0.001), whereas 14 possessing the F2 transferrin allele demonstrated significantly more clinical disease (P < 0.001). These effects remained apparent even after the significant effects of tracheal bacterial isolates, clinical score the previous week and repeated observations from the same ponies were accounted for.

CONCLUSIONS AND POTENTIAL RELEVANCE

Results provide evidence for a potential genetic basis for variation in susceptibility to clinical equine respiratory disease of bacterial origin, although more work is required to corroborate this conclusion.