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Summary: Development of a subunit vaccine (Strangvac) from fusion of recombinant Streptococcus equi proteins offers a new tool in the management of infection with Streptococcus equi subspecies equi. Experience to date indicates that the vaccine is effective in limiting disease spread, and through inclusion of only the desired proteins needed for induction of an effective immune response, the safety profile appears far better than with previous vaccines. Published reports of the use of the vaccine are limited, and to date, vets have had limited information upon which to make informed decisions on the potential benefits of this novel vaccine. This article was developed to share the collective experience of the authors in using Strangvac and to highlight potential benefits of integrating vaccination alongside biosecurity measures in controlling 'strangles'. This article reviews the use of vaccination prior to movement, in the face of outbreaks and also discusses use in mares and foals. Safety and the benefits of differentiating vaccinated from infected animals are also discussed. The reader should consider the level of evidence upon which the recommendations are based as it is frequently weak and limited to anecdotal reports or interpretation of unpublished data. The recommendations made are certain to be revised or replaced as new evidence comes forward but provide a basis for practitioners to implement vaccination strategies based on what is known currently. At times, the authors' recommendations deviate from those that were initially put down in the summary of product characteristics. This comes as a result of clinical experience that has been gained since the initial experimental studies were performed prior to registration. Veterinary surgeons using the vaccine outside of the regimen set down in the summary of product characteristics should be cognisant of their local legal framework and should ensure that they have informed consent to do so. [ABSTRACT FROM AUTHOR]

Summary Recent studies report the use of a range of treatments for equine glandular gastric disease, but with all treatments, refractory disease is common. The evidence for some widely used treatments is very poor. Treatments may aim to suppress acid production (e.g. omeprazole), promote mucosal barrier function (e.g. misoprostol/sucralfate), or both. It is imperative that all treatments are combined with management to minimise known risk factors, primarily physiological and psychological stressors. [ABSTRACT FROM AUTHOR]

The article focuses on the use of ertugliflozin as a treatment for hyperinsulinemia-associated laminitis in horses, particularly in cases where dietary and management strategies have failed. It explores the pharmacological effects of ertugliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i), which has shown promise in reducing insulin concentrations and alleviating the symptoms of laminitis in horses with equine metabolic syndrome (EMS).

Copyright of Equine Veterinary Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Background: Preliminary evidence indicates that ertugliflozin benefits horses and ponies (hereafter collectively referred to as horses) with hyperinsulinaemia and hyperinsulinaemia‐associated laminitis. The effects of ertugliflozin on the results of the oral sugar test used widely in the assessment of insulin dysregulation (ID), have not been reported. Objectives: To report the effects of ertugliflozin on responses to the oral sugar test (OST) in horses with ID. Study design: Retrospective case series. Methods: Clinical records were reviewed to identify horses with ID that had an OST (0.45 mL/kg Karo‐Light PO) performed before and after 4 days of treatment with 0.05 mg/kg ertugliflozin PO s.i.d. Pre‐ and post‐treatment insulin concentrations were compared using Wilcoxon sign‐ranked tests. Results: Ten horses with ID met the inclusion criteria. Significant reductions in plasma insulin concentration were identified at all time points after 4 days of treatment with ertugliflozin relative to pre‐treatment values. At T0 (prior to oral sugar), median insulin concentration reduced from 22.4 μu/mL (IQR: 6.5, 39) pre‐treatment to 4.8 μu/mL (IQR: 3.7, 9.2) at day 4 (p = 0.004). At T60 (60 min after oral sugar), median insulin concentration was 165 μu/mL (IQR: 61.2, 222) pre‐treatment and 78.1 μu/mL (IQR: 30.5, 137) at day 4 (p = 0.004). At T90 (90 min after oral sugar), median insulin concentration was 170 μu/mL (IQR: 88.6, 269) pre‐treatment and 84.7 μu/mL (IQR: 28.7, 122) at day 4 (p = 0.002). Serum triglyceride concentration increased from a median of 0.4 mmol/L (IQR: 0.2, 0.8) pre‐treatment to 0.9 mmol/L (IQR: 0.6, 2) at day 4 of ertugliflozin treatment (p = 0.006). Main limitations: A small heterogenous group of horses and ponies, some with PPID, were used in the absence of a control group. Conclusions: Four daily doses of ertugliflozin at 0.05 mg/kg was associated with lowering of insulin concentrations at baseline and in response to an OST in horses with ID; however, insulin levels did not return to normal in all horses. Increases in triglyceride concentrations were also observed. [ABSTRACT FROM AUTHOR]

Background: Pituitary pars intermedia dysfunction (PPID) is a prevalent, age‐related chronic disorder in equids. Diagnosis of PPID can be challenging because of its broad spectrum of clinical presentations and disparate published diagnostic criteria, and there are limited available treatment options. Objectives: To develop evidence‐based primary care guidelines for the diagnosis and treatment of equine PPID based on the available literature. Study design: Evidence‐based clinical guideline using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Methods: Research questions were proposed by a panel of veterinarians and developed into PICO or another structured format. VetSRev and Veterinary Evidence were searched for evidence summaries, and systematic searches of the NCBI PubMed and CAB Direct databases were conducted using keyword searches in July 2022 and updated in January 2023. The evidence was evaluated using the GRADE framework. Results and recommendations: The research questions were categorised into four areas: (A) Case selection for diagnostic testing, pre‐test probability and diagnostic test accuracy, (B) interpretation of test results, (C) pharmacological treatments and other treatment/management options and (D) monitoring treated cases. Relevant veterinary publications were identified and assessed using the GRADE criteria. The results were developed into recommendations: (A) Case selection for diagnostic testing and diagnostic test accuracy: (i) The prevalence of PPID in equids aged ≥15 years is between 21% and 27%; (ii) hypertrichosis or delayed/incomplete hair coat shedding provides a high index of clinical suspicion for PPID; (iii) the combination of clinical signs and age informs the index of clinical suspicion prior to diagnostic testing; (iv) estimated pre‐test probability of PPID should be considered in interpretation of diagnostic test results; (v) pre‐test probability of PPID is low in equids aged <10 years; (vi) both pre‐test probability of disease and season of testing have strong influence on the ability to diagnose PPID using basal adrenocorticotropic hormone (ACTH) or ACTH after thyrotropin‐releasing hormone (TRH) stimulation. The overall diagnostic accuracy of basal ACTH concentrations for diagnosing PPID ranged between 88% and 92% in the autumn and 70% and 86% in the non‐autumn, depending on the pre‐test probability. Based on a single study, the overall diagnostic accuracy of ACTH concentrations in response to TRH after 30 minutes for diagnosing PPID ranged between 92% and 98% in the autumn and 90% and 94% in the non‐autumn, depending on the pre‐test probability. Thus, it should be remembered that the risk of a false positive result increases in situations where there is a low pre‐test probability, which could mean that treatment is initiated for PPID without checking for a more likely alternative diagnosis. This could compromise horse welfare due to the commencement of lifelong therapy and/or failing to identify and treat an alternative potentially life‐threatening condition. (B) Interpretation of diagnostic tests: (i) There is a significant effect of breed on plasma ACTH concentration, particularly in the autumn with markedly higher ACTH concentrations in some but not all 'thrifty' breeds; (ii) basal and/or post‐TRH ACTH concentrations may also be affected by latitude/location, diet/feeding, coat colour, critical illness and trailer transport; (iii) mild pain is unlikely to have a large effect on basal ACTH, but caution may be required for more severe pain; (iv) determining diagnostic thresholds that allow for all possible contributory factors is not practical; therefore, the use of equivocal ranges is supported; (v) dynamic insulin testing and TRH stimulation testing may be combined, but TRH stimulation testing should not immediately follow an oral sugar test; (vi) equids with PPID and hyperinsulinaemia appear to be at higher risk of laminitis, but ACTH is not an independent predictor of laminitis risk. (C) Pharmacologic treatments and other treatment/management options: (i) Pergolide improves most clinical signs associated with PPID in the majority of affected animals; (ii) Pergolide treatment lowers basal ACTH concentrations and improves the ACTH response to TRH in many animals, but measures of insulin dysregulation (ID) are not altered in most cases; (iii) chasteberry has no effect on ACTH concentrations and there is no benefit to adding chasteberry to pergolide therapy; (iv) combination of cyproheptadine with pergolide is not superior to pergolide alone; (v) there is no evidence that pergolide has adverse cardiac effects in horses; (vi) Pergolide does not affect insulin sensitivity. (D) Monitoring pergolide‐treated cases: (i) Hormone assays provide a crude indication of pituitary control in response to pergolide therapy, however it is unknown whether monitoring of ACTH concentrations and titrating of pergolide doses accordingly is associated with improved endocrinological or clinical outcome; (ii) it is unknown whether monitoring the ACTH response to TRH or clinical signs is associated with an improved outcome; (iii) there is very weak evidence to suggest that increasing pergolide dose in autumn months may be beneficial; (iv) there is little advantage in waiting for more than a month to perform follow‐up endocrine testing following initiation of pergolide therapy; there may be merit in performing repeat tests sooner; (v) timing of sampling in relation to pergolide dosing does not confound measurement of ACTH concentration; (vi) there is no evidence that making changes after interpretation of ACTH concentrations measured at certain times of the year is associated with improved outcomes; (vii) evidence is very limited, however, compliance with PPID treatment appears to be poor and it is unclear whether this influences clinical outcome; (viii) evidence is very limited, but horses with clinical signs of PPID are likely to shed more nematode eggs than horses without clinical signs of PPID; it is unclear whether this results in an increased risk of parasitic disease or whether there is a need for more frequent assessment of faecal worm egg counts. Main limitations: Limited relevant publications in the veterinary scientific literature. Conclusions: These findings should be used to inform decision‐making in equine primary care practice. [ABSTRACT FROM AUTHOR]

Copyright of Equine Veterinary Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on the discussed in papers presented at the NZEVA Annual Conference. These topics include the diagnostic and triage accuracy of the GPT-3 Artificial Intelligence model, a comparison between physician and artificial intelligence chatbot responses to patient questions on a social media forum, and the importation of macrocyclic lactone-resistant cyathostomins on a U.S. Thoroughbred farm.

Summary: Background: Hyperinsulinaemia‐associated laminitis (HAL) is encountered commonly in equine practice. There are currently no registered medications which specifically target hyperinsulinaemia in horses and ponies. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have been demonstrated to limit post‐prandial insulin responses and prevent the development of diet‐induced laminitis. Objectives: The objective of the study was to evaluate the efficacy of an SGLT2i, ertugliflozin, in the management of hyperinsulinaemia and laminitis. Study design: Retrospective case series. Methods: Medical records of 51 horses and ponies that had presented with laminitis and hyperinsulinaemia and had been treated with oral ertugliflozin at 0.05 mg/kg once daily for a minimum of 30 days were reviewed. Results: After 30 days of treatment with ertugliflozin, there was a reduction in insulin concentrations from a median of >300 μu/ml (IQR: 149, >300) to 43 μu/ml (IQR: 20, 66) (p < 0.001). Modified Obel laminitis scores improved, reducing from a median of 10/12 to 1/12 (p < 0.001). Median serum triglyceride concentrations increased from 0.6 (IQR: 0.4, 0.9) before treatment to 1.4 (IQR: 0.8, 3.7) mmol/L after 30 days of treatment (p < 0.001) before declining, however, none of the horses developed any clinical signs of hyperlipaemia. Ten horses (19%) were reported to have polyuria and polydipsia during treatment, otherwise no adverse clinical effects were identified. Main limitations: The study was limited by the absence of a control group, the retrospective data collection and the short period of follow‐up. Conclusions: Ertugliflozin may be effective in reducing insulin concentrations in horses and ponies with equine metabolic syndrome and its use may hasten recovery from laminitis associated with hyperinsulinaemia. [ABSTRACT FROM AUTHOR]

The article discusses hyperinsulinemia-associated laminitis in horses, a condition that poses significant challenges in equine practice. It emphasizes the importance of managing hyperinsulinemia to prevent and treat laminitis in horses with equine metabolic syndrome (EMS). The article highlights the potential use of sodium-glucose cotransporter 2 inhibitors (SGLT2i), such as ertugliflozin, to lower insulin concentrations and improve laminitis outcomes.