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Traditional lectures, where students listen passively, often do not reflect the complexity of real-life decision-making situations. Furthermore, modern students are using online devices for daily activities, and this has a challenging side effect for educators, as many people these days can only maintain their focus if topics are discussed in concise and engaging ways. For these reasons, there is growing interest in the use of games for educational purposes. The aim of this study was to introduce a board game based on the Clue game for final-year veterinary students during their practical activity in large animal medicine. This type of learning process was compared with a classical case-based discussion and evaluated via a survey delivered to the students to both test their acquired knowledge and obtain their evaluation of the activity. A total of 49 students were enrolled in this study. While the board game was evaluated significatively better than the traditional class, no statistically significant differences were observed for the answers given to questions assessing their veterinary skills. The proposed game requires few resources other than a case-based visual materials and analyses from clinical patients, a board, two dice, and some imagination to create cases at the appropriate level for students’ knowledge. We conclude that this board game–based activity represents innovative techniques to teach clinical approaches in an interactive way with the same utility as a traditional class but is more enjoyable for the students.

Horse owners' motivators and barriers for consent to exploratory laparotomy are poorly understood.To (1) determine the proportion of Australian and New Zealand horse owners who would consent to exploratory laparotomy and (2) identify motivators and barriers for consent.Cross-sectional survey.A questionnaire was developed and distributed online. Descriptive statistics were calculated by tabulating respondents by their answers to whether they would consent to exploratory laparotomy. Univariate and multivariate analyses were used to identify variables associated with consenting to exploratory laparotomy.Two thousand two hundred horse owners participated with a 68.3% survey completion rate. Most were female (95.6%), and 18.7% stated they would consent to exploratory laparotomy, 55.2% would consider exploratory laparotomy and 26.1% would not consent to exploratory laparotomy being performed on their horse. Geographical location, intended use of the horse and perceptions regarding the cost and prognosis of exploratory laparotomy, as well as the previous experience of respondents significantly impacted the decision. Self-reported level of financial comfort, gender of respondents, number of horses owned and pre-existing relationship with nearest equine referral clinic did not impact the decision. Top motivators for exploratory laparotomy were high probability of survival, trust in hospital, emotional value of horse and the alternative being euthanasia. Top barriers for exploratory laparotomy were financial cost, uncertain outcome, welfare concern and age of the horse.Self-selection bias and acquiescence in responses.Most respondents indicated that they would consider or consent to exploratory laparotomy. Several factors for owners to decide for exploratory laparotomy could be identified. Improved owner education regarding the positively reported survival rates for exploratory laparotomy would be beneficial.Les motivateurs et les obstacles derrières la décision des propriétaires d'autoriser ou pas une laparotomie exploratrice (LE) sur leurs chevaux demeurent mal compris.(1) Déterminer la proportion des propriétaires de chevaux en Australie et Nouvelle-Zélande qui consentiraient à une LE et (2) identifier les motivateurs et obstacles contribuant à leur consentement. TYPE D'ÉTUDE: Étude transversale. MÉTHODES: Un questionnaire a été développé et distribué en ligne. Des statistiques descriptives ont été calculées en classifiant les répondants selon s'ils consentiraient ou non à une LE. Des analyses uni et multivariées ont été utilisées pour identifier les variables associées au consentement à la LE. RÉSULTATS: Deux milles deux cents propriétaires de chevaux ont participé et le taux de remplissage du sondage était de 68.3%. La majorité étaient des femmes (95.6%) et 18.7% donneraient leur consentement pour une LE, 55.2% considéraient une LE et 26.1% ne consentiraient pas à une LE pour leur cheval. La localisation géographique, la discipline du cheval et les perceptions relativement aux coûts et au pronostic pour une LE, de même que leurs expériences précédentes influenceraient la décision des participants de façon significative. La situation monétaire des participants (rapportés de leur plein gré), leur genre, le nombre de chevaux dont ils sont propriétaires et une relation pré-existante avec une clinique de référence à proximité n'influenceraient pas leur décision. Les motivateurs les plus importants pour le consentement à la LE étaient une chance de survie élevée, leur confiance envers le centre de référence, la valeur émotionnelle du cheval et les alternatives possibles à l'euthanasie. Les obstacles les plus flagrants étaient les coûts, une chance de survie incertaine, des préoccupations par rapport au bien-être du cheval et son âge.Biais de sélection et degré d'accord des réponses.La plupart des répondants consentiraient ou au moins considéraient une LE. Plusieurs facteurs influençant la décision des propriétaires ont pu être identifiés. Il est impératif pour les vétérinariares traitants d'éduquer les clients en ce qui concerne les taux de survie plus positifs suivant les laparotomies exploratrices.

OBJECTIVE To compare the extent of inflammation and catabolic collagen response in the middle carpal joints (MCJs) of healthy horses following intra-articular injection of 2% lidocaine, 2% mepivacaine, lactated Ringer solution (LRS), or 0.1% methyl parahydroxybenzoate. ANIMALS 17 adult horses. PROCEDURES In the first of 2 experiments, the left middle carpal joint (MCJ) of each of 12 horses was injected with 10 mL of 2% lidocaine (n = 3), 2% mepivacaine (3), or LRS (control; 6). After a 4-week washout period, the right MCJ of the horses that received lidocaine or mepivacaine was injected with 10 mL of LRS, and the right MCJ of horses that received LRS was injected with 10 mL of 2% lidocaine (n = 3) or 2% mepivacaine (3). In experiment 2, the left MCJ of each of 5 horses was injected with 10 mL of 0.1% methyl parahydroxybenzoate. After a 48-hour washout period, the right MCJ of each horse was injected with 10 mL of LRS. Synovial fluid (SF) samples were aseptically collected before and at predetermined times after each injection. Synovial fluid WBC count, neutrophil percentage, and total protein, neutrophil myeloperoxidase, neutrophil elastase, and Coll2-1 concentrations were compared among treatments. RESULTS Both lidocaine and mepivacaine induced SF changes indicative of inflammation and a catabolic collagen response, but the magnitude of those changes was more pronounced for lidocaine. Methyl parahydroxybenzoate did not cause any SF changes indicative of inflammation. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that mepivacaine was safer than lidocaine for intra-articular injection in horses.

Summary Background In the current era, the importance of proper hand hygiene to reduce the transmission of infectious diseases has become difficult to debate. Yet, compliance rates remain low and are affected by many factors, amongst which is user acceptability of hand hygiene products. Aim The present study aimed at investigating drivers of preference towards different hand hygiene formulations. Methods Three different formulations (liquid, foam and gel) of the same brand were randomly and blindly evaluated by 54 participants based on the WHO Protocol for Evaluation of Tolerability and Acceptability of Alcohol-based Handrubs. Results The majority (76%) of respondents indicated that the product formulation impacted their level of compliance with hand hygiene protocols. The preferred formulation was liquid, with 50% of participants ranking it as first choice. General product satisfaction, the product texture, the drying speed and the ease of application, were the statistically significant drivers for participants to rank a formulation as their first choice vs not ranking it as their first choice. Conclusions When designing alcohol formulations and implementing hand hygiene protocols, understanding drivers of preference for formulations may enhance product user acceptability and therefore compliance with hand hygiene.

A novel total temporomandibular joint replacement (TMJR) was developed with CADskills BV (Ghent, Belgium), aiming to achieve reinsertion of the (LPM) onto a scaffold in the implant. In order to investigate the possibility of reinsertion of the LPM, an animal experiment was conducted. An in vivo sheep experiment was conducted, which involved implanting sheep with a TMJR. Clinical parameters were recorded regularly and computed tomography (CT) scan images of two randomly selected sheep per scan were made at 1, 3, and 6 months. After 9.5 months, the sheep were euthanized, and CT scans of all animals were performed in order to evaluate the LPM's enthesis. A total of 13 sheep were implanted with a TMJR. One sheep was used as a sham. Radiographs revealed four outcome types of enthesis reconstruction. In four sheep, there was no reconstruction between the implant and the LPM. In three sheep, there was a purely soft tissue connection of 0.5–0.9 mm (average 0.7 mm) between the ostectomized bony LPM insertion and the implant's lattice structure. A combination of partial bony and partial soft tissue enthesis attachment (0.3–0.5 mm, average 0.4 mm) was found in three sheep. A bony ingrowth of the enthesis into the scaffold occurred in two sheep. A secondary bony connection between the mandible and the insertion of the LPM was found in 10 of 13 sheep. Four fossa components were found to be displaced, yet TMJ function remained in these ewes. The heterotopic ossification that was seen may be a confounding factor in these results. This in vivo experiment showed promising results for improving the current approach to TMJR with the possibility of restoring the laterotrusive function. The fossa displacement was considered to be due to insufficient fixation and predominant laterotrusive force not allowing for proper osseointegration. Further optimization of the reattachment technique, scaffold position and surface area should be done, as well as trials in humans to evaluate the effect of proper revalidation.

Serum neutrophil gelatinase-associated lipocalin (sNGAL) is a marker of renal injury, and its concentrations are affected by inflammation. Therefore, it could serve as a useful biomarker of disease or fitness in high-level competition. However, it has not yet been determined if sNGAL concentrations are affected by exercise. The aim of this study was to determine whether concentrations of equine sNGAL were affected by 1000 m galloping as the form of exercise used in the study. Pre- and post-gallop sNGAL, serum amyloid A, and creatinine concentrations were evaluated in 14 healthy Thoroughbred racehorses. The results showed that short, high-intensity exercise did not significantly affect sNGAL concentrations in healthy horses (P = .42), and no significant difference was found in either creatinine or serum amyloid A before and after galloping (P > .05). Therefore, it was determined that sNGAL was not influenced by the type of exercise used in the study and could have the potential to be used as a routine laboratory screening tool in horses even after strenuous exercise. Future research should clarify its use in a larger population and a broader range of equine sport disciplines, including endurance-related exercise.

OBJECTIVE To compare perforation rates between tri-layer nitrile-latex and natural rubber latex surgical gloves after single-layer end-to-end jejunojejunal anastomoses in equine cadavers. STUDY DESIGN Prospective randomized ex-vivo study. SAMPLE POPULATION Pairs of surgical gloves (n = 46) worn during jejunojejunal anastomoses. METHODS Tri-layer nitrile-latex and rubber latex pairs of gloves were equally but randomly allocated to a right-handed surgeon performing 46 single-layer end-to-end jejunojejunal anastomoses on cadaveric material. Number and location of perforations were determined with the water leak test after each procedure. Ten unused pairs of both glove types were tested as controls. RESULTS At least one perforation occurred in 41% (19/46) of the pairs of gloves. Glove perforations were present in 22% (5/23; 95% CI: 9-42) of tri-layer glove pairs and 61% (14/23; 95% CI: 41-78) of the rubber glove pairs. The odds of glove perforation were 5.6 times (p = .009, 95% CI: 1.5-20.5) lower when tri-layer rather than rubber gloves were used. The duration of procedure did not affect the risk of glove perforation (p = .679). No perforations were observed in the unused gloves. CONCLUSION Perforations were less common when the surgeon wore tri-layer nitrile-latex gloves rather than to the natural rubber latex gloves tested in this study. CLINICAL RELEVANCE Tri-layer nitrile-latex gloves were more resistant to perforations in experimental settings; further studies may confirm that they are also superior in a clinical setting.

Purpose Local and systemic toxic reactions to implanted materials can result in morbidities. However, little is reported about cranioplasty implants. Therefore, we performed a systematic review on the toxicity of different materials used for cranioplasty implants. Materials and methods A systematic search was conducted by browsing the Pubmed, Embase, and Cochrane Library databases. All human studies that identified toxic (aseptic) reactions to any types of material used as cranioplasty implants or onplants, published up to January 1, 2019, were included in the review. Results Nineteen studies were identified. Collectively, 36 patients endured some type of toxic reaction to an implanted material. Eleven studies presented several types of toxicity for PMMA cranioplasties in several tissue types. One article highlighted the risk of neurotoxicity for PMMA cranioplasty. Three articles presented toxic reactions to calcium phosphate and titanium implants. Three additional articles presented toxic reactions to PEEK, polypropylene-polyester, and polyethylene. Conclusion All materials currently used for cranioplasty showed occasional toxicity and morbidities. Therefore, none can be considered completely biologically inert. We found that aseptic inflammatory reactions have been underreported in the literature due to a high incidence of infections with questionable evidence.

Objective To identify prognostic variables for adult equids and foals with tetanus. Design Multicenter retrospective study (2000–2014). Setting Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. Animals One hundred fifty-five adult equids and 21 foals with tetanus. Interventions None. Measurements and Main Results Variables from history and clinical examination were statistically compared between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors). Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and 66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and seizures during hospitalization, treatment with glycerol guaiacolate, intravenous fluids, and intravenous glucose solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft food and drinking, older age, and longer hospitalization delay. Outcome was not different between different tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved outcome and shorter hospitalization. Conclusions Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based information related to patient management. Several prognostic indicators relate to the ability to eat or drink, and more severe clinical signs relate to poor outcome. Increasing intravenous dosages of TAT has no significant effect on outcome, but the positive trend identified may support a recommendation for high intravenous TAT dosages. Further evaluation is warranted.

OBJECTIVE: To describe clinical data of hospitalized adult equids and foals with tetanus. DESIGN: Multicenter retrospective study (2000-2014). SETTING: Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. ANIMALS: One hundred fifty-five adult equids (>6 months) and 21 foals (

Non-steroidal anti-inflammatory drugs (NSAIDs) can cause right dorsal colitis, but longitudinal clinical studies are lacking. This study investigates whether NSAID treated horses develop right dorsal colonic pathology in a clinical setting. Non-gastrointestinal hospitalized horses treated with NSAIDs >4 days, and untreated hospital-owned teaching horses and non-gastrointestinal client-owned hospitalized horses were included. All horses were monitored over time with clinical examinations (focusing on presence of colic, depression, reduced appetite, unstructured feces), ultrasonographic intestinal wall measurements, fecal occult blood tests (semi-quantitative results), and blood analysis (total protein and albumin concentrations, white blood cell and neutrophil counts). Outcomes were recorded as “ultrasonographically thickened right dorsal colon (RDC) walls”, “colitis” and “right dorsal colitis”. Findings over time were compared to baseline values and to control horses. Seventeen NSAID treated horses and 5 controls were included. NSAID treated horses developed thickened RDC walls (4/9), and subclinical and mild colitis (9/11) and right dorsal colitis (4/10), whereas all control horses remained healthy. The first changes were identified on treatment day 2. RDC walls of treated horses were significantly thicker compared to their own baseline values and compared to control horses. In conclusion, presumptive colon pathology was identified with a high incidence, starting early in the course of treatment, but with low severity. Appropriate monitoring should be advised throughout NSAID treatment. Additional research for noninvasive diagnostic tests for colon pathology is required.

Objective To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC). Study Design Retrospective case series. Animals Client owned horses and donkeys. Methods Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians. Results Nine horses and 4 donkeys were identified with fractures of the tibial diaphysis (n = 4), ulna (n = 3), distal metatarsus (n = 2), proximal metacarpus (n = 1), radial diaphysis (n = 1), calcaneus (n = 1), and distal femoral physis (n = 1). Follow-up was available for 12 equids, of which 8 (67%) recovered from the fracture and became pasture sound. Six equids developed obvious external deformation of the affected limb. Conclusion Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure.

Local anaesthetics (LAs) are frequently used for diagnostic procedures in equine veterinary practice. The objective of this study was to investigate the physico-chemical stability and bacterial contamination of bupivacaine, lidocaine and mepivacaine used for lameness examinations in horses. The LAs were stored in 12 different groups at different temperatures (−18 °C to 70 °C), light intensities and in common veterinary field conditions for up to 16 months. The pH, presence of bacterial contamination and concentrations of LAs and methylparaben (a preservative present in lidocaine) were determined serially in both new and repeatedly punctured (RP) vials. Mepivacaine remained chemically stable. A 1.9% increase in bupivacaine concentration was evident in one group, whereas a 1.9–3.7% decrease was noted in six groups. Risk factors associated with a change in concentration were light and RP vials. Lidocaine concentration decreased 6.3% in one group and increased 5.3–7.2% in two groups. Risk factors for degradation were heat and RP vials whereas storage in practice vehicles was a risk factor for increased concentrations. Methylparaben decreased 8.3–75.0% in seven groups, and RP vials, heat and storage in practice vehicles were risk factors for degradation. No contamination was present in any of the LAs and pH remained stable. Commercially available solutions of lidocaine, mepivacaine and bupivacaine stored under common veterinary field conditions are extremely stable and sterile for extended periods. The minor changes in concentration documented in this study are unlikely to affect anaesthetic efficacy during equine lameness examinations. When using products containing methylparaben, degradation of the preservative over time is to be expected.

Summary Even before the discovery of germs, the practice of hand hygiene had revealed itself as a crucial element in the fight against infectious diseases. In fact, supported by the historical discoveries and more recent evidence based data, the World Health Organization considers hand hygiene as the pillar of infection control, particularly when related to nosocomial infections. Therefore, the World Health Organization has a strong focus on “Clean Hands Save Lives” campaigns, a principle that is easily translatable into “Clean Hands Save Horses”. Considering the recognised importance given to skin health and integrity as the first principle of good hand hygiene, using decontamination methods and products that are the least harmful to the skin is mandatory. This is why the currently accepted presurgical hand preparation methods do not involve aggressive brushing and disinfecting soaps anymore. Rather, hands should be washed with a neutral pH friendly soap first before a hydroalcoholic solution is applied. Although the principles and benefits of proper hand hygiene have been recognised in the healthcare world, one of the major drawbacks remains the lack of compliance with established protocols. To increase compliance, equine clinics should work on improving product accessibility, enhancing staff and client education as well as helping each other to remember to actually do it. This article reviews historical and current facts on hand hygiene and relates it to equine practice. Clean equine care is safer equine care: it's all in your hands!

Objectives (1) Evaluate the occurrence and variables associated with incisional morbidities (IMs) after ventral median laparotomy when using interrupted vertical mattress sutures (IVMS) and (2) determine the occurrence of abdominal bandage-associated complications in horses. Methods Occurrence of IM and bandage-associated complications were determined after single laparotomies (SL group; n=546 horses) and repeat laparotomies (RL group: multiple laparotomies within four weeks; n=30 horses) in horses that survived ≥7 days postoperatively. Univariate analysis and multivariate logistic regression were performed to evaluate variables associated with IM. Results The IM rate was 9.52 per cent in the SL group and 33.33 per cent in the RL group. The actual infection rate was 5.31 per cent in the SL group and 26.67 per cent in the RL group. Overall, long-term clinically relevant wound complications was 1.68 per cent. After multivariate analysis, increased anaesthesia duration was associated with IM and performing an enterotomy and postoperative intravenous lidocaine administration were associated with incisional infection in the SL group; no parameter remained significant in the RL group. Bandage-related complications were recorded in 2.95 per cent of the cases. Conclusions These results suggest that the use of IVMS for closure of the linea alba is another viable option for closure and that an abdominal bandage does not appear to cause significant complications.

A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. In this article, current knowledge of SSI risk factors and prevention methods is reviewed. Although new avenues that can be explored in the prevention of SSIs in veterinary medicine are described, the main conclusion drawn is that the best method for prevention of SSI is to adhere to what we already know.

Background Paranasal sinus cysts (PSC) are a common cause of equine secondary sinusitis. The outcome and associated complications have not been frequently reported. Objectives To review the associated clinical signs, associated morbidities and outcomes of horses treated for PSC. Study design Retrospective multicentre case series. Methods Retrospective analysis of case records and telephone follow up survey. Results Subjects were 37 horses 1-24 years old that were presented with nasal discharge (n = 31), facial swelling (n = 25) and epiphora (n = 19). Radiography and computed tomography allowed identification of the cyst-induced changes including concomitant tissue destruction (n = 31), leading among other things to local nerve damage causing headshaking (n = 6) and unilateral blindness (n = 1). Radiographic changes to adjacent dental apices were present in 10 horses. Horses over 10 years old showed more of the named associated problems. Post-operative complications included surgical site infection (SSI) (n = 11), nasofrontal suture periostitis (n = 6) and sequestration (n = 1) following removal of the PSC via osteotomy. The long-term response to treatment was available for 28 cases with 22 horses (78.6%) fully cured, 4 (14.3%) partially cured and 2 (7.1%) not responding to treatment. In 7 horses (18.9%) there was recurrence of the cyst post-operatively. Main limitations Due to the study being a multicentre retrospective case series with collection of data over an extended period, there may be inconsistency in data recording and absence of reporting of some findings. Conclusions Overall, the diagnosis and treatment of sinus cysts is relatively straightforward and carries a good prognosis. In long-standing cases complications secondary to the expansive growth of cysts will dramatically affect the prognosis for full recovery due to pressure-induced changes to facial bones, cheek teeth and nerves. These secondary complications mainly occurring in older horses may be due to a combination of a relatively longer period of affection and the inflexibility of older horses' bones. Cyst recurrence following treatment can occur in up to 19% of cases.

Ultrasonography is routinely used to achieve the diagnosis of equine suspensory ligament desmopathy. In human medicine, power Doppler ultrasonography has also been found to be useful for the diagnosis of tendon/ligament injuries. The aim of this prospective, pilot study was to assess the presence or absence of power Doppler signal in suspensory ligament branches and compare B-mode findings with power Doppler findings in suspensory ligament branches of lame and non-lame limbs. Thirteen horses were used (eight lame horses, with lameness related to pain in the suspensory ligament branches, and five non-lame horses). Ten lame limbs and 24 sound limbs were assessed by B-mode and power Doppler ultrasonography. The severity of power Doppler signal was scored by two independent readers. The B-mode ultrasonographic examination revealed abnormalities in branches of lame limbs and in branches of sound limbs. Suspensory ligament branches that were considered normal in B-mode showed no power Doppler signal. However, power Doppler signal was detected in suspensory ligament branches that were abnormal in B-mode, both in lame and sound limbs. Power Doppler scores were subjectively higher in suspensory ligament branches of lame limbs and in branches with more severe B-mode changes. Findings supported the use of power Doppler as an adjunctive diagnostic test for lame horses with suspected suspensory desmopathy.

Summary Temporomandibular joint (TMJ) pathology is a rarely reported cause of decreased performance among equine athletes or at least seldom recognised. This case report describes the work-up of a high level dressage horse with decreased performance. Temporomandibular joint pathology was suspected based on computed tomography (CT) and the horse responded very well to joint treatment.

Summary Colic is a major cause of veterinary attendance in general practice and although most colic episodes remain isolated, recurrence may occur and definitive diagnosis can be difficult to obtain. This report describes an unusual presentation of a lipoma in a middle-aged horse presented for recurrent colic. A massive lipoma causing a nonstrangulating space occupying obstruction of the small intestine was found during an exploratory celiotomy and was considered to be the most likely cause of the recurrent episodes of abdominal discomfort.

Summary Reasons for performing the study Few reports are available on the relationship between developmental orthopaedic diseases (DOD) and future performances in Warmblood horses. Objectives To investigate the relationship between performance and the presence of DOD lesions. Methods Records of Warmblood stallions for which radiographic and performance data were available were collected. Showjumping performances were expressed as scores derived from the final ranking of horses in each competition. These scores are available in an established performance database. The relationship between radiographic findings and both performance scores and number of performances was analysed using a linear regression model. Results Two hundred and fifteen horses met the inclusion criteria. There was no difference in either the number of performances or performance score between horses categorised as affected with DOD lesions (independent of joint location) compared with controls. Significantly lower numbers of performances were recorded for horses with osteochondral fragments (OCD) located at the dorsal aspect of the sagittal ridge of the metacarpo/metatarsophalangeal bone. No significant difference was found between horses affected with DOD lesions of the tarsocrural joint and controls. Horses with osteochondrosis of the lateral trochlear ridge of the femur had both significantly lower performance scores and numbers of performances compared with controls. Conclusion This study demonstrated that specific DOD location and site within the joint have an influence on performance. Osteochondral fragments in the femoropatellar and at the dorsal aspect of the sagittal ridge of the metacarpo/metatarsophalangeal joint resulted in lowered performance. Fragmentation in the tarsocrural joint had no influence on performance. Potential relevance The future athletic performance of Warmblood jumping horses may be limited as a result of OCD in the femoropatellar joint and to a certain extent the metacarpo/metatarsophalangeal joint.

Lameness is the most commonly reported health problem in horses, and lameness investigations which include local anaesthetic injections are routinely performed by equine practitioners. Through this process, bacteria can enter the tissues perforated by the needle and may cause local infections at the injection site. The objective of this in vitro study was to investigate if local anaesthetics at concentrations available in commercially available solutions could inhibit growth and/or kill bacteria that could be inoculated into the synovial space or soft tissues during injection. This study evaluated the antimicrobial activity of the local anaesthetics bupivacaine, lidocaine and mepivacaine against 40 equine clinical bacterial isolates of the Actinobacillus, Corynebacterium, Enterobacter, Escherichia, Pseudomonas, Rhodococcus, Staphylococcus and Streptococcus genera. Minimum inhibitory and minimum bactericidal concentrations (MICs and MBCs) were determined by the broth microdilution method. Clinically applied concentrations of bupivacaine, lidocaine, and mepivacaine inhibited visual growth of 93%, 93%, and 80% of isolates tested, respectively. For the majority (80%) of the inhibited isolates, the concentrations were also bactericidal. The tested local anaesthetics possessed antimicrobial activity against equine pathogens at concentrations that are routinely applied in clinical cases. However, this antimicrobial activity should not discourage antiseptic preparation prior to local anaesthetic injections.

To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC).Retrospective case series.Client owned horses and donkeys.Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up6 months after discharge was obtained via telephone consultation with owners or veterinarians.Nine horses and 4 donkeys were identified with fractures of the tibial diaphysis (n = 4), ulna (n = 3), distal metatarsus (n = 2), proximal metacarpus (n = 1), radial diaphysis (n = 1), calcaneus (n = 1), and distal femoral physis (n = 1). Follow-up was available for 12 equids, of which 8 (67%) recovered from the fracture and became pasture sound. Six equids developed obvious external deformation of the affected limb.Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure.

Horse handling and veterinary examination can induce hazardous stress reactions. Such reactions occur especially in young and less-trained horses, particularly stallions, and make their handling a risk for breeders, grooms, and medical staff. Moreover, these stressful situations will affect the animal's health and welfare. Because stress reactivity is thought to be partly determined by genetic factors, scientists, veterinarians, and breeders are likely to be interested in adding temperament assessments to stallion selection schemes, as it is already done in some countries. This study assesses young stallions' temperament and its comparison with their stress reactions during a standardized veterinary examination for studbook admission. The assessment consists of a general examination, a lameness examination including flexion tests, an endoscopy of the upper airway, and a standardized radiological examination. During the years 2008 and 2009, 93 stallions were evaluated. Stallions were observed from the moment they were unloaded from the trailer at the clinic until the end of veterinary examinations. In addition to the behavioral observations made by the experimenter, each staff member in charge of the examination filled in a short questionnaire about the horse's temperament and the "easiness of manipulation" for the performed examinations. Breeders were asked to complete a longer questionnaire about their horse's temperament. The assessments of "aggressiveness," "sociability," and "learning level" temperament traits were the most consistent, as shown by the significant Spearman correlations between judges' assessments. Undesirable behaviors during veterinary examinations leading to handling difficulties were associated with a low "easiness of manipulation" score assessed by the clinical staff. These low "easiness of manipulation" scores were positively correlated to temperament traits such as "anxiousness" and "aggressiveness" and negatively correlated to others such as "sociability" or "learning level." Temperament assessment and behavioral observations can therefore be used to anticipate behaviors that make a horse difficult to handle during veterinary examinations. Thus, it may be important to include temperament assessment as a feature in the selection of breeding stallions—as already practiced for some breeds in some countries. Such evaluations may promote the welfare of horses and ease of handling as well as safety for the handler.

Summary Reasons for performing study: Improved understanding of the epidemiology of atypical myopathy (AM) will help to define the environmental factors that permit or support the causal agent(s) to exert toxicity. Objectives: This European survey of AM aimed to describe spatiotemporal distribution, survival, clinical signs, circumstances in which AM develops and its different expressions between countries and over time. Methods: The spatiotemporal distribution, history and clinical features of AM cases reported to the Atypical Myopathy Alert Group from 2006 to 2009 were described. Comparisons of data from the most severely affected countries and from the large outbreaks were made with Fisher's exact and Welch's tests with Bonferroni correction. Results: Of 600 suspected cases, 354 met the diagnostic criteria for confirmed or highly probable AM. The largest outbreaks occurred during the autumns of 2006 and 2009 in Belgium, France and Germany. For the first time, donkeys, zebras and old horses were affected, and clinical signs such as gastrointestinal impaction, diarrhoea, penile prolapse, buccal ulceration and renal dysfunction were observed. Affected horses spent >6 h/day on pastures that almost always contained or were surrounded by trees. The latency period was estimated at up to 4 days. Overall survival rate was 26%. Although differences between countries in affected breeds, body condition, horse management and pasture characteristics were recognised, the common presenting clinical signs and mortality were similar between countries. Conclusions and potential relevance: This study describes new data on case details, history and clinical course of AM that is of preventive, diagnostic and therapeutic value. However, the true impact of the findings of this study on the development of or severity of AM should be tested with case–control studies.

Reasons for performing study: Appropriate management of atypical myopathy (AM) requires the establishment of an accurate diagnosis and prognosis. Furthermore, preventive measures to avoid AM need to be refined. Objectives: The aims of the study were as follows: 1) to improve the diagnosis of AM; 2) to identify prognostic predictors; and 3) to refine recommended preventive measures based on indicators of risk factors. Methods: An exploratory analysis of cases in Europe between 2006 and 2009 reported to the Atypical Myopathy Alert Group was conducted. Based on clinical data, reported cases were allocated into 2 groups: confirmed or highly probable AM (AM group; further divided into survivors and nonsurvivors); and cases with a low probability of having AM or with another final diagnosis (non-AM group). Using Welch's test and odds ratios corrected for multiple comparisons, the AM vs. non-AM groups were compared to identify indicators for diagnosis and risk factors, and survivors vs. nonsurvivors in the AM group were compared to identify prognostic factors. Sensitivity, specificity and positive and negative predictive values were calculated for specific clinical signs related to final diagnosis and outcome. Results: From 600 reported cases, 354 AM cases (survival rate of 26%) and 69 non-AM cases were identified, while there were insufficient data to categorise the remainder. Variables valuable for diagnosing AM compared with similar diseases were as follows: presence of dead leaves and wood and/or trees on pastures; sloping pastures; full-time pasture access; no food supplementation; normal body condition; pigmenturia; normothermia; and congested mucous membranes. Nonsurvival was associated with recumbency, sweating, anorexia, dyspnoea, tachypnoea and/or tachycardia. Survival was associated with remaining standing most of the time, normothermia, normal mucous membranes, defaecation and vitamin and antioxidant therapy. Conclusions and potential relevance: This study refines the list of risk factors for AM. Clinical signs valuable for diagnosis and prognosis have been identified, enabling clinicians to improve management of AM cases.

Objective: To assess current habits for surgical hand preparation among veterinary surgical specialists and to compare data with current guidelines for hand asepsis techniques. Study design: Survey of veterinary surgical specialists. Sample Population: Diplomates of the American (ACVS) and European Colleges of Veterinary Surgeons (ECVS). Methods: An internet-based survey of hand preparation methods before surgical procedures was conducted of 1300 listed ACVS and ECVS Diplomates. Results: A 42.6% response rate was obtained. Approximately, 80% of respondents use disinfecting soaps as a primary method for hand antisepsis. Of those, 81% use chlorhexidine-based scrubs and 7% use a neutral soap followed by a hydroalcoholic solution. Conclusions: Contrary to current recommendations of the World Health Organization and scientific evidence supporting use of hydro-alcoholic rubs for presurgical hand preparation, veterinary surgical specialists still use surgical scrub solutions containing disinfecting soaps.

The measurement of biomarkers that reflect cartilage breakdown is a powerful tool for investigating joint damage caused by disease or injury. Particularly in cases of osteochondrosis, synovial concentrations of these biomarkers may reveal the presence of osteoarthritic changes. Coll2-1, Coll2-1 NO2 and myeloperoxidase have recently been introduced in equine osteoarticular research but comparison between the concentrations of these markers in OCD affected and healthy joints has not been made. Therefore, this study aimed at reporting the synovial concentrations of these biomarkers in joints affected with osteochondral fragments in the tarsocrural joint compared to unaffected joints. Myeloperoxidase and Coll2-1NO2 revealed to have similar levels between affected joints and controls. However, in contrast to previous studies using C2C the present study demonstrated that synovial levels of Coll2-1 were significantly elevated in tarsocrural joints affected with osteochondrosis. Thus, Coll2-1 may be an earlier marker of cartilage degeneration than other cartilage degradation markers that have been previously used in equine medicine.

Background – Atypical myopathy is an acute, severe rhabdomyolysis occurring in grazing horses. In the beginning of October 2009, a new outbreak occurred in several European countries. Geographic, demographic and clinical data of the reported cases in the month October 2009 are described. Key Findings – The survival rate in this outbreak was 25%. The most frequently observed clinical signs were congested mucous membranes, dyspnea, tachycardia, depression, weakness, stiffness, recumbency, trembling, sweating, and myoglobinuria. Nonsurvivors were significantly more likely to be recumbent than survivors. Prognostic factors, symptomatic treatment, and preventive measures are discussed. Significance – Differences were encountered during the described outbreak of atypical myopathy in October 2009 compared with previous outbreaks reported. Equine practitioners should be aware that previous epidemiological studies have shown that after a high prevalence in the autumn, new cases are likely to occur in the following spring.

A 3-week-old Friesian colt with a history of respiratory distress since birth was presented to our facility. Results after an endoscopy showed obstruction of the right nasal passage to the nasopharynx. Computed tomography was performed to further characterize this unilateral blockage. The images demonstrated a complete membranous obstruction of the ventral meatus, along with deviation of the vomer bone toward the left side of the nasal cavity. The diagnosis of unilateral choanal atresia was confirmed. This report is the first to describe computed tomographic features of choanal atresia in a foal.

Osteochondrosis (OC) is a developmental disease that affects growing horses and that severely affects their ability to perform. The genetic basis of its pathogenesis is poorly understood. The aim of the study was to analyze the transcript profile of leukocytes from horses affected with OC. Two transcriptome libraries were constructed from leukocytes of OC-affected and non-OC-affected horses using digital gene expression analysis (DGE) and real-time PCR. Statistical analysis allowed selection of 1,008 tags upregulated in the non-OC-affected group and 1,545 tags upregulated in the OC-affected group. Among these genes, 16 regulated genes and 5 housekeeping genes were selected. Metabolic pathways analysis showed an obvious dysregulation of several signaling pathways related to cartilage formation or cartilage repair, including Wnt, Indian hedgehog, and TGF-beta signaling. Other genes, including ISG, ApoB, MGAT4, and TBC1D9, showed a significantly different expression between groups. These genes may play a role in high carbohydrate diet, abnormal insulin metabolism, or inflammation, mechanisms suspected to be involved in OC. This DGE analysis of the transcript profile of leukocytes from OC-affected horses demonstrated significant differences in comparison to the control library. These results open new perspectives for the understanding of equine OC.

Establishing the osteoarticular status of the horse is often performed by means of radiological screening of the animals. Widespread blood sampling could reveal to be an interesting alternative to this procedure which is time consuming and sometimes technically difficult. The aim of this study was to investigate the relationship between the radiological status of the horses and the levels of biochemical markers of cartilage degradation and synovial inflammation. A specific radiological scoring and classification system was therefore developed and applied on 63 stallions presented for studbook admission. Additionally, groups of horses were established according to the occurrence of osteochondrosis, degenerative joint disease and distal interphalangeal joint effusion. Insulin growth factor-I, myeloperoxidases, Coll2-1 and Coll2-1NO(2) were used as blood markers. The combination of the blood parameters did not seem to correlate with the used scoring system. Coll2-1NO(2) levels however tended to increase with poorer radiological class and this could therefore potentially be a useful predictor of the osteoarticular status in the horse. Coll2-1 levels were significantly higher in the degenerative joint disease group. A high percentage of horses with distal interphalangeal joint effusion was present in this study and was associated with decreased IGF-I and increased Coll2-1 levels.

Summary This Case Report describes a periarticular abscess and a suppurative arthritis of the atlanto-occipital joint in an adult horse. The horse showed a painful swelling localised on the atlanto-occipital region and ataxia in all 4 limbs. During hospitalisation, the horse developed recumbency, dysphagia, facial paralysis and seizures. Ultrasonography of the atlanto-occipital region enabled a tentative diagnosis to be made, which was later confirmed at autopsy. Culture of the abscess revealed a Staphylococcus aureus. However, the horse had a history of recurrent fever, hypertrophy and abscessation of the submandibular lymph nodes, neck pain and dyspnoea for 2 months, which was suggestive of strangles.

Developmental osteochondral lesions are often encountered in the equine population and are a major cause of lameness. Different growth factors that act systemically as well as locally regulate the growth of cartilage. Among them is Insulin-like Growth Factor I that has been demonstrated to promote chondrocyte growth and differentiation and that has been shown to influence cartilage repair. The aims of this study were to investigate differences in circulating plasma levels of Insulin-like Growth Factor-I in post-pubescent horses affected with developmental osteochondral lesions compared to unaffected ones. Significantly higher values of circulating Insulin-like Growth Factor-I levels were found in the affected group (n = 82) compared to controls (n = 86). This result may still reflect an earlier imbalance in IGF-I levels from horses with developmental osteochondral lesions considering the aetiopathological link which has been made between IGF-I and the occurrence of osteochondrosis. However, other studies have shown increased expression of IGF-I after cartilage damage. The higher levels found in this study could be due to a healing response of the cartilage to the damage caused by the osteochondral lesions.

To describe clinical data of hospitalized adult equids and foals with tetanus.Multicenter retrospective study (2000-2014).Twenty Western, Northern, and Central European university teaching hospitals and private referral centers.One hundred fifty-five adult equids (6 months) and 21 foals (6 months) with tetanus.None.Information on geographic, annual and seasonal data, demographic- and management-related data, clinical history, clinical examination and blood analysis on admission, complications, treatments, and outcomes were described and statistically compared between adults and foals. The described cases were often young horses. In 4 adult horses, tetanus developed despite appropriate vaccination and in 2 foals despite preventive tetanus antitoxin administration at birth. Castration, hoof abscesses, and wounds were the most common entry sites for adults; umbilical cord infections and wounds for foals. Stiffness was the commonest observed initial clinical sign. Blood analyses frequently revealed an inflammatory response, hemoconcentration, muscle damage, azotemia, negative energy balance, liver damage, and electrolyte and acid base disturbances. Common complications or clinical signs developing during hospitalization included dysphagia, dyspnea, recumbency, hyperthermia, seizures, hyperlipemia, gastrointestinal impactions, dysuria, and laryngeal spasms. Cases were supported with wound debridement, antimicrobial treatment, tetanus antitoxin, muscle spasm and seizure control, analgesia, anti-inflammatory drugs, fluid therapy, and nutritional support. Mortality rates were 68.4% in adult horses and 66.7% in foals. Foals differed from adult horses with respect to months of occurrence, signalment, management-related data, potential causative events, clinical signs on admission, blood analysis, complications, and severity grades.This is the first study that rigorously describes a large population of equids affected by tetanus. The information provided is potentially useful to clinicians for early recognition and case management of tetanus in adult horses and foals. Tetanus affects multiple organ systems, requiring broad supportive and intensive care. Neonatal and adult tetanus in the horse should be considered as distinct syndromes, as in human medicine.

To identify prognostic variables for adult equids and foals with tetanus.Multicenter retrospective study (2000-2014).Twenty Western, Northern, and Central European university teaching hospitals and private referral centers.One hundred fifty-five adult equids and 21 foals with tetanus.None.Variables from history and clinical examination were statistically compared between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors). Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and 66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and seizures during hospitalization, treatment with glycerol guaiacolate, intravenous fluids, and intravenous glucose solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft food and drinking, older age, and longer hospitalization delay. Outcome was not different between different tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved outcome and shorter hospitalization.Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based information related to patient management. Several prognostic indicators relate to the ability to eat or drink, and more severe clinical signs relate to poor outcome. Increasing intravenous dosages of TAT has no significant effect on outcome, but the positive trend identified may support a recommendation for high intravenous TAT dosages. Further evaluation is warranted.