Intragastric pH of foals admitted to the intensive care unit

Abstract Background Intragastric pH profiles of neonatal foals admitted to the intensive care unit (ICU) remain poorly characterized. Hypothesis/Objectives To determine intragastric pH profiles and clinical parameters associated with intragastric pH in foals admitted to the ICU. Animals Forty‐two neonatal foals admitted to the ICU and requiring placement of an indwelling nasogastric tube for nutritional management were included. Methods Intragastric pH was measured for 24 hours from the time of admission. Mean pH, % time pH <4, and % time pH >4 were determined for each foal. History, clinical findings, and clinicopathological data recorded at the time of presentation were collected. Results The mean pH of included foals was 5.5 ± 1.8. The median % time pH <4 was 6.3% (range: 0‐99). A history of placentitis was associated with greater mean pH (median 5.3 (range: 0.9‐7.8) versus median 7.2 (5.9‐11.3); P = .002) and less % time pH <4 (median 13 (0‐99.6) versus median 0.1 (0‐7.2); P = .01). Foals with diarrhea had a greater % time pH <4 (median 4.6% (0‐99) versus median 28.8% (1.4‐57.48); P = .02). Foals with a pH >4 for >50% recording time had a lower PaO2 (mean difference 25.0 mm Hg; 95% confidence interval [CI], 14.4‐35.6; P = .03) and higher PaCO2 (mean difference 14.9 mm Hg; 95% CI, 4.7‐25.2; P = .02). Surviving foals had a lower mean median hourly pH (P = .02). Conclusions and Clinical Importance Intragastric pH profiles were unpredictable and mostly >4 for >80% of the recording time. This study does not support the indiscriminate administration of acid suppressive treatment.

interobserver and intraobserver reliability of the Equine Gastric Ulceration Syndrome Council grading system (EGUC) and a novel visual analogue scale (VAS), and to assess differences between experienced and less experienced assessors.
Six observers (three specialists, three residents) graded 60 prerecorded de-identified gastroscopy videos, three times for each grading system (EGUC and VAS), using a cross-over design with at least one week between each phase of the study.
Interobserver and intraobserver reliability were estimated by calculation of Gwet's agreement coefficient (AC1), and with ordinal weights applied (AC2), for the EGUC grading system and the intraclass correlation coefficient (ICC) for the VAS.
Reliability was substantial using the EGUC system for both squamous (AC2 = 0.687) and glandular mucosa (AC2 = 0.721), and intraobserver reliability for squamous (AC2 = 0.801) and glandular mucosa (AC2 = 0.804) was substantial to excellent. Interobserver reliability was moderate for squamous mucosa (ICC = 0.635) and poor for glandular mucosa (ICC = 0.353) using the VAS. Intraobserver repeatability for squamous mucosa was moderate to good (ICC = 0.744) and moderate for glandular mucosa (ICC = 0.555). Reliability was greater for experienced observers and improved with time. The EGUC grading system had acceptable intraobserver and interobserver reliability and performed well regardless of experience. As a continuous variable, the VAS affords some advantages for statistical evaluation, and reliability can be improved with practice. These find- This study aimed to characterize short-and long-term effects of transportation, hospitalization and trimethoprim-sulfadiazine (TMS) administration on the fecal microbiome of healthy equids. In an experimental study design, fecal samples were collected from six Welsh ponies at the farm at day 0 (D0) and D13 after which they were transported to the hospital and re-sampled immediately upon arrival. The ponies were hospitalized from D13 to D27 and received TMS orally from D21 to D25. During hospitalization and the first week after discharge from the hospital fecal samples were collected daily (D13-D34) and subsequently at D41, D48, D58, D88, D119, D149, D180 and D211. Illumina Miseq 16S sequencing was performed on all samples. Species richness, α-diversity, β-diversity and species composition were compared to identify changes over time. Wilcoxon signed rank tests were used for statistical analysis. Transportation to the hospital resulted in an increase in richness (475 vs. 856; P = 0.046) and Shannon diversity index (5.678 vs. 6089; P = 0.046) which normalized within 24 h. Hospitalization alone had no significant effect on microbiome composition. TMS administration decreased richness (494 vs. 396; P = 0.046) and Shannon diversity index (5.614 vs. 5.171; P = 0.046), which normalized 2 weeks after discharge. However, the fecal microbiome composition 6 months after antimicrobial treatment differed significantly from pretreatment composition. The number of Ruminococcaceae present in the fecal microbiome was still reduced 6 months after hospitalization and antimicrobial treatment (P < 0.001). Based on this study we conclude that oral treatment with TMS has long-term effects on gut microbiome composition. Sarcoids are common in horses, but their pathogenesis is unknown.
MicroRNAs are non-coding RNAs that control cellular processes.
MicroRNA dysregulation is associated with tumor development and progression. Work on equine fibroblast cell lines (EFCL) reported bovine papillomavirus (BPV)-associated changes in microRNA expres-sion1, but the role of BPV remains controversial. The study objective was to describe changes in microRNA expression associated with BPV status in equine sarcoids.
DNA and RNA were isolated from fibroblasts dissected from formalinfixed paraffin-embedded biopsies of 19 histologically-confirmed periorbital fibroblastic sarcoids and 19 normal periorbital skin (from horses without sarcoids). Quantitative PCR detected BPV DNA presence. MicroRNA microarrays measured microRNA expression. Micro-RNAs displaying differential expression between sarcoid and normal fibroblasts were identified using t-tests. Differential expression of selected microRNAs was validated by quantitative RT-PCR.
100% of sarcoids and 50% of normal biopsies assayed contained BPV, although viral DNA was present in significantly fewer normal fibroblasts. Seventy-three microRNAs were differentially expressed between 6 sarcoids and 8 normal skin biopsies. The altered expression of miR-214, miR-103/107a, and miR-4429 was validated by RT-qPCR.
All 3 microRNAs are associated with known cancer pathogenesis pathways, and 2 of the microRNAs exhibited differential expression in the EFCL study1. MiR-4429 has not previously been reported in the horse.
MicroRNAs differentially expressed in sarcoids are associated with known cancer pathogenesis pathways, including viral carcinogenesis.
The presence of BPV in extremely low copy number in normal fibroblast populations does not preclude the possibility that BPV contributes to sarcoid pathogenesis by dysregulation of host cell microRNA expression. AKI in neonatal foals is poorly documented. The objective was to retrospectively determine AKI prevalence, and to establish and test a multimodal diagnostic approach to assess different types of azotemia on admission in hospitalized neonatal foals. Foals <14 days old with admission blood analyses were included (n = 91). NGAL was measured on stored admission serum by ELISA*. AKI prevalence was assessed based on 1) serum creatinine concentrations at 2 different cut-off values (140 and 180micromol/L) and 2) a newly proposed multimodal algorithm including creatinine, NGAL and inflammatory parameters (sepsis score and categorization, white blood cell count and serum amyloid A). The algorithm classified cases as no-AKI, non-azotemic AKI, azotemic AKI, postrenal azotemia, inflammatory postrenal azotemia and inflammatory azotemic AKI, and was assessed against medical records. Dependent on the method, AKI prevalence was 14.3-25.3%.
In 86 foals, the algorithm matched medical records and allowed foals to be categorized as no-AKI (n = 62), non-azotemic AKI (n = 6), azotemic AKI (n = 7), postrenal azotemia (n = 4), inflammatory postrenal azotemia (n = 4) and inflammatory azotemic AKI (n = 3). The algorithm never showed a medical record mismatch. However, in 5 cases no final categorization was reached; this involved postrenal azotemia and the inflammatory categories (n = 5), foals <2 days (n = 4) and having AKI based on the low cut off value for creatinine (>140micromol/L; n = 5). In conclusion, this study shows that AKI is not uncommon in neonatal foals. Furthermore, it shows the limitations to the use of creatinine concentrations. These could be partially averted by using a multimodal diagnostic approach including NGAL as proposed.
These findings suggest acetazoleamide is a potential systemic treatment in equine glaucoma.
Keyword: equine glaucoma, acetazolamide, IOP. Low-grade respiratory disease is a potential cause for reduced athletic performance. Increased intrathoracic pressure amplitude (IP) indicates impaired respiratory function but measurements at rest are insensitive diagnostics to abnormally elevated respiratory effort during exercise. A purpose-designed device (Equivent 300) for continuous telemetric measurement of IP during exercise was validated and reference ranges of exercising IP in warmblood horses were established.

Endemic flaviviruses in eastern Austria
Twenty healthy Dutch warmblood mares underwent resting IP measurements using a standard method and the Equivent. With the device in place, horses underwent a standardized lunging exercise test (four minutes trot, four minutes canter, five minutes trot, five minutes' walk) on four consecutive days. Heart rate and mean IP for each stage and ambient temperature and humidity for each session were recorded. All data were checked for normality and a mixed linear model was used to determine mean IP for each stage and the intraclass correlation coefficient (ICC) of IP for each stage with horse, SET stage, and session as explanatory variables. Reference values were calculated as mean IP ± 2SD.
The device was well tolerated by the horses. There was no significant effect of session day; the ICC for 'horses was 0.11 and the ICC for Amiodarone, a class III anti-arrhythmic drug, has been used in equine and human medicine to treat atrial fibrillation (AF). The aim of this retrospective study was to report the effect of amiodarone administered IV during transvenous electrical cardioversion (TVEC) in case of failure to restore sinus rhythm (SR) or immediate recurrence of AF (IRAF).
Data from 11 Warmblood horses with AF receiving amiodarone (5 mg/kg over 30 minutes) during the TVEC procedure were reviewed. Mean age was 9.5 years. AF duration varied from two weeks to 1.5 year. Mild, moderate or severe mitral (n = 8), tricuspid (n = 10) and aortic (n = 4) valvular regurgitations were present. Five horses had left atrial dilatation. TVEC was performed using 'Guelph' catheters (n = 5) or 'Gaeltec' catheters (n = 6). When TVEC, using energy levels of 150 to 360 J with 50 J increments, failed to restore SR (n = 7), amiodarone was administered. SR could be restored The reasons why older horses are predisposed to arterial rupture are still unclear. The aim of this study was to analyze the effect of age on the biomechanical properties of the proximal and distal aorta, common carotid artery and external iliac artery. Entire circular samples of 5-10 cm long were collected from 6 young (3-6 years) and 14 older horses (≥15 years). Vessels were mounted in a custommade water tank and gradually pressurized from 15 to 300 mmHg.
For each pressure point, longitudinal B-mode ultrasonographic images were collected for off-line measurement of arterial diameters. Rupture occurred in a minority of arteries (8.9%) at high pressures (200-300 mmHg), and mostly occurred in older horses (85.7%).
Pressure-diameter results were fitted to the arctangent model1 and pressure-area and pressure-compliance curves were constructed.
Age significantly influenced the pressure-area curves of the distal aorta (P = 0.04), common carotid artery (P < 0.001) and external iliac artery (P < 0.001). At same pressures, larger areas were found in old horses compared to young horses. Also the pressure-compliance curve of the proximal aorta was significantly influenced by age Total E2 immunoglobulins (Igs), EqHV qPCR-status and liverassociated serum biochemistry parameters were monitored weekly, until 16 weeks post-inoculation.
Three of four test ponies (75%) had an early E2 Ig-response following the second vaccine, prior to viral inoculation. E2 Igs were detected in all seven ponies following viral inoculation, until 13 to 14 weeks postinoculation. Although the early E2 Ig-response did not protect the three test ponies against EqHV-infection, these three ponies showed lower numbers of viral copies/ml serum at peak viremia and earlier clearance of the EqHV infection. Peak increases in GLDH, AST and GGT, and the return of these parameters to within reference ranges, also occurred earlier in these three ponies.
In conclusion, the E2 Ig-response to an EqHV E2 recombinant protein vaccine potentially plays a role in accelerated viral clearance and recovery after EqHV infection.
Keywords: viral hepatitis, liver, humoral immunity, antibodies A significant difference in NGAL concentration (μg/L) was found between the severe EA horses and all other groups (P < 0.001). A significant positive correlation was found between NGAL and BAL neutrophils (r = 0.6, P = <0.001).
NGAL can be used as a biomarker for horses with severe EA. NGAL is a marker of inflammation known to be in neutrophil granules. The NGAL marker was able to distingue only severe EA from healthy. The NGAL marker was unable to detect an increase in BAL mast cells, which makes it unreliable to be used as a sole biomarker as mastocytic EA subtypes would be missed. Further studies are needed to evaluate the potential for NGAL in EA.
Keywords: equine asthma, NGAL, biomarker Horses undergoing HDRB treatment1 with owner consent were enrolled in a '3 + 3 phase 1 study design' with a 26Gy starting dose, 30Gy target dose, and an increase of 1Gy for each 3-horse cohort.
Dose-limiting toxicity (DLT) was defined as grade 3 skin toxicity2. If DLT was observed, an additional 3 horses would be given the same dose. If DLTs developed in ≥1 of 6 subjects no further dose escalation was performed. If no DLTs occurred, 3 horses were administered the next dose, repeated until the target dose was achieved. Response to treatment was evaluated using the cRECIST criteria3. 21 horses were enrolled; 3 in the initial cohorts and 9 in the target cohort. The target dose was reached without DLTs. Complete resolution of disease was achieved in 86% of cases, with follow-up of 24 to 30 months. 2 horses were euthanased due to progressive disease, 1 had no response to treatment. 4 of 9 horses given 30Gy experienced grade I skin toxicity at time of treatment, late side effects occurred in 88% of cases. No grade 2 or 3 late side effects were observed.
No significant toxicity was observed at a dose of 30G, therefore an increased HDRB dose can be safely administered. Further work is required to investigate efficacy of the increased dose. The horses remained healthy during the study period. BALF neutrophil percentage was higher after the straw pellet period (3.1 ± 2.7, P = 0.001) and Peat 2 period (4.9 ± 16.2, P = 0.033) compared to Peat 1 period (1.6 ± 1.1). There was no difference between wood pellet period and Peat 1 period.

References
These preliminary results suggest that straw pellet and loosely stored peat increase airway neutrophilia detected in BALF compared to baled peat bedding. The result might be helpful in choosing bedding material for horses prone to neutrophilic airway inflammation. EGGD resolved uneventfully in 14/24 horses (58%); 6/11 (55%) horses receiving sole misoprostol and 8/13 (62%) receiving combination therapy. In 10/24 horses (42%) ESGD developed, failed to improve, or increased severity during misoprostol treatment; 5/11 (45%) with sole misoprostol and 5/13 (38%) with combination therapy (Table 1). Median (+ range) ESGD score [2] pre-treatment and post-treatment were 0 (0-1) and 2 (1-3) respectively for sole misoprostol treatment and 0 (0-3) and 2 (2-3) for combination therapy. In this limited subset of horses, ESGD did not resolve, or had the potential to worsen, with misoprostol treatment alone, or in combination therapy. Investigation of inferior acid suppression of misoprostol compared to omeprazole is warranted. The aims of this study were to describe the incidence and postmortem findings in horses that died during or immediately following harness racing in Norway and Sweden during 2014-2019. The study was a retrospective multicenter study using data from the Norwegian and Swedish Trotting Associations respectively. Race-associated sudden death (RASD) were defined as all Standardbred (STB) and Norwegian-Swedish Coldblooded Trotters (NSCT) that died during, or within one hour following racing. Horses that died or were euthanized due to catastrophic orthopedic trauma were excluded from the sudden death (SD) analysis. A total of 48 horses died of which 38 were STB and 10 were NSCT representing an overall RASD incidence rate of 0.059 per 1000 race starts. There was no difference in the overall rate between the two breeds. The overall incidence rate of SD was 0.050 per 1000 race starts and 0.047 and 0.051 for NSCTs and STBs, respectively. Cause of death was stated as acute hemorrhage from major vessel rupture (9/48), cardiac (6/48), pulmonary hemorrhage (3/48) and orthopedic trauma (7/48). The cause of death in the remaining 23 horses was stated as acute circulatory failure of unknown cause. RASD rates were lower than previous reports while the SD rates were similar. This is the first report on incidence rates and causes of RASD in the Norwegian and Swedish harness racing population. A consensus on how to define post-mortem findings and their relevance in explaining the cause of SD is needed. The thermal load was higher for ST when compared to EnduH. However, ST may reach their maximum GT after one-hour post-exercise which should be taken into consideration when organizing posttraining and post-competition transportation.