Proceedings 3rd ECVSMR congress

peer reviewe

Reversible congenital bilateral laryngeal paralysis (grade IV) in a foal

editorial reviewe

Cas clinique: Fibrome Ovarien chez une jument - Considérations hormonales

peer reviewedThis report shows that, as in humans, AMH as well as steroids productions are low in case of ovarian fibroma, thus preserving normal cyclicity

Metabolic and Endocrine Profiles in Sick Neonatal Foals Are Related to Survival

Background : $b sick neonatal foals suffer from a variety of endocrine and metabolic derangements that may be related to outcome. There are several hepatic and lipid metabolism blood markers that have never been assessed in neonatal foals. Objectives: Assess panel of endocrine and metabolic variables in group of sick and healthy neonatal foals in order to describe their relationship with diagnosis and survival. Animals: All neonatal foals referred to Unitat Equina-Fundacio Hospital Clınic Veterinari during 3 consecutive foaling seasons and a group of healthy foals. Methods: Observational prospective study. Blood samples were obtained on admission and, when possible, after 24-48 h of hospitalization and immediately before discharge or death. Measured variables were triglycerides, nonsterified fatty acids, glucose, creatinine, urea, c-glutamyltransferase, glutamate dehydrogenase (GLDH), insulin, cortisol, bile acids, and adrenocorticotropic hormone (ACTH). ACTH/cortisol and glucose/insulin ratios were calculated. Results: Urea, creatinine, and cortisol had median concentrations in septic and nonseptic foals 2- to 8-fold higher than in the control group (P < .001). Median ACTH concentration in the septic group was approximately 4 times higher than in nonseptic and control foals (P < .001). ACTH/cortisol ratio was significantly lower in sick foals compared to control foals (P < .001). A score was designed including creatinine, GLDH, and cortisol. When 2 of these variables were altered (P < .001), the foal had 32 times more risk of dying (OR, 31.7; 95% CI, 7.7-130.3). Conclusions and Clinical Importance: Plasma creatinine, GLDH, and cortisol should be determined in sick newborn foals on admission because of their association with survival

Association of admission plasma D-Dimer concentration with diagnosis and outcome in horses with colic

Background: Coagulopathies detected in horses with gastrointestinal problems seem to be associated with poor outcome. Plasma D-Dimer concentration is a sensitive test for assessing coagulopathies. Hypothesis: Plasma D-Dimer concentration tested on admission is related to diagnosis and outcome in horses with colic. Animals: Four hundred and ninety three horses referred for evaluation of abdominal pain. Methods: Prospective observational clinical study. Horses were grouped according to diagnosis (medical and surgical intestinal obstructions, ischemic disorders with and without intestinal resection, enteritis, peritonitis), outcome (survivors, nonsurvivors), and number of coagulopathies (normal profile, 1 or 2 coagulopathies, subclinical disseminated intravascular coagulation [DIC]). Blood samples were collected on admission and plasma D-Dimer concentration, clotting times (PT and aPTT), and antithrombin activity were determined. Positive likelihood ratios (LR1) were calculated for evaluation of D-Dimer cut-off values, which were later tested in a logistic regression model. Results: Horses with enteritis or peritonitis had significantly (P o .001) higher plasma D-Dimer concentrations and more severe coagulopathies on admission than horses with other diagnoses. Nonsurvivors also had significantly (P o .001) higher plasma D-Dimer concentrations at presentation than did survivors, and those horses with subclinical DIC on presentation had an odds ratio (OR) 8.6 (95% confidence interval [CI], 3.3-22.5, P o .001) for nonsurvival. Finally, D-Dimer concentrations 44,000 ng/mL had a LR1 of 5.9 and an OR 8.8 (95% CI, 4.5-17.1, Po .001) for nonsurvival. Conclusion and Clinical Importance: Plasma D-Dimer concentration measured on admission can be used to facilitate diagnosis and outcome prediction in horses with colic. A potential cut-off value for nonsurvival was found at approximately 4,000 ng/m

Low-molecular-weight heparin dosage in newborn foals

Background: Heparin is used in humans as prophylaxis of hypercoagulable states and disseminated intravascular coagulation (DIC). However, babies need a higher heparin dose than do adults. Septic neonate foals are at high risk of hypercoagulable state and DIC, and there is limited objective information about heparin dose for equine neonates. Objective: To assess whether neonate foals require higher dosages of low-molecular-weight heparin (LMWH) than adults. Animals: Eighteen healthy and 11 septic neonate foals. Methods: Experimental and clinical studies. Firstly, healthy foals were randomly distributed in 2 groups, 1 receiving 50 IU/ kg SC of dalteparin and the 2nd group receiving 100 IU/kg SC of dalteparin, once daily for 3 days. Blood samples were collected before and 3, 6, 27, and 51 hours after the 1st LMWH administration. Plasma antifactor-Xa activity was measured, together with hemostatic and hematologic parameters used to assess the risk of bleeding. Subsequently, septic foals were treated blindly either with placebo (saline) or 100 IU/kg of dalteparin for 3 days. Plasma antifactor-Xa activity and other hemostatic parameters were determined before and after treatment. Results: Plasma antifactor-Xa activity in healthy foals was below prophylactic activity when using the adult dosage (50 IU/ kg), whereas prophylactic activities were achieved when using the double dosage (100 IU/kg). No hemorrhagic events and erythrocyte-related complications were observed with either dosage. In the clinical study, only 4/6 septic foals had plasma antifactor-Xa activity adequate for prophylaxis. Conclusions and Clinical Importance: Equine neonates require higher dosages of LMWH compared with adults to reach prophylactic heparinemia

Diagnosis and prognosis of coagulopathies in horses with colic

La coagulació intravascular disseminada (CID) és una complicació freqüent en cavalls amb problemes gastrointestinals (GI) greus que ha estat associada amb un mal pronòstic. La CID té com a conseqüència el dipòsit microvascular de fibrina que pot acabar causant disfunció multiorgànica . Estudis experimentals recents han demostrat que la detecció i tractament precoç de les coagulopaties subclíniques permet reduir la morbiditat i mortalitat associades amb la CID. La concentració plasmàtica de dímer-D es considera la prova més sensible per diagnosticar pacients amb malaltia tromboembòlica i CID en medicina humana, i també ha demostrat ser un bon predictor de mortalitat. En medicina equina, elevacions plasmàtiques de dímer-D s'han associat amb hipercoagulabilitat en cavalls amb còlic i septicèmia en poltres, i alguns estudis defensen la seva utilitat per ajudar a formular un pronòstic en cavalls amb problemes gastrointestinals aguts. Els objectius d'aquesta tesi doctoral han estat aprofundir en l'estudi de les coagulopaties en cavalls amb còlic per millorar la detecció precoç i el tractament de la coagulació intravascular disseminada, així com avaluar les possibles aplicacions clíniques de mesurar la concentració plasmàtica de dímer-D en cavalls amb còlic . Per això es van dur a terme tres estudis en una població hospitalària de cavalls amb diferents diagnòstics de malaltia gastrointestinal, en què es va avaluar el perfil hemostàtic (incloent dímer-D, temps de protrombina, temps de tromboplastina parcial activada i antitrombina III) i la presència de CID laboratorial en tres moments diferents de la malaltia: l’ ingrés, durant l'hospitalització i abans de morir. A més, en el tercer estudi, aquestes dades clínico-patològiques van ser comparades amb dades histopatològiques dels mateixos cavalls que avaluaven la presència i quantitat de dipòsits microvasculars de fibrina per tal de detectar qualsevol correlació . Els resultats del primer estudi suggereixen que la determinació de la concentració plasmàtica de dímer-D en el moment de l'admissió pot contribuir al diagnòstic i a l'emissió d'un pronòstic en cavalls amb còlic. A més a més, aquest estudi aporta informació nova i d'utilitat clínica , proposant diversos punts de tall amb utilitat pronòstica i diagnòstica. Durant l'hospitalització (segon estudi), l'avaluació de la concentració plasmàtica de dímer-D ha demostrat ser una eina útil per monitoritzar estats d'hipercoagulació en cavalls amb còlic. Així mateix, i confirmant resultats d'estudis previs, es van observar importants elevacions plasmàtiques de dímer-D en la fase postoperatòria. Finalment, el tercer estudi va concloure que la concentració plasmàtica de dímer-D prèvia a la mort no és més útil que la resta de paràmetres hemostàtics avaluats per predir quins pacients presenten microtrombes de fibrina compatibles amb CID a la necròpsia . En conjunt, els tres estudis d’aquesta tesi contribueixen a un millor coneixement de les coagulopaties en cavalls amb problemes gastrointestinals i han proporcionat nova informació sobre les possibles aplicacions de la determinació plasmàtica de dímer-D en diferents etapes del còlic equí.Disseminated intravascular coagulation (DIC) is a frequent complication in horses with severe gastrointestinal (GI) disorders that has been associated with poor outcome. It results in microvascular fibrin deposition and eventually organ dysfunction. Recent experimental studies have shown that rapid detection and treatment of subclinical coagulopathies reduce morbidity and mortality associated with DIC. Plasma D-dimer concentration is considered the most sensitive test to diagnose thromboembolic disease and DIC in human medicine, and it has been shown to be a good predictor of mortality as well. In horses, D-dimers have been found to be useful to detect hypercoagulation in horses with colic and septic foals and some studies advocate its use as prognostic aid in horses with acute GI problems. The objectives of this PhD thesis were to go further into the study of coagulopathies in horses with colic to improve early detection and management of DIC as well as to evaluate the potential clinical applications of the measurement of plasma D-dimer concentration in horses with colic. With that purpose, three studies were conducted in a hospital population of horses with different diagnoses of gastrointestinal disease, evaluating hemostatic profiles (including D-dimer, prothrombin time, activated partial thromboplastin time and antithrombin III) and the presence of laboratorial DIC at three different stages of the disease: on admission, during hospitalization and before dead. Furthermore, in the third study, this clinicopathological data was compared to histopathological data from the same horses evaluating microvascular fibrin deposition to detect any correlation. Results of the first study suggest that measurement of plasma D-dimer concentration at the time of admission can be used to facilitate diagnosis and outcome prediction in horses with colic. Furthermore, this study brings new clinically useful information, proposing several cut-offs with prognostic and diagnostic utility. During hospitalization (second study), evaluation of plasma D-dimer concentration has shown to be a useful tool to monitor hypercoagulative states in equine colic cases. Important increases in D-dimer concentration were observed postoperatively as well, as mentioned in previous reports. Finally, the third study concluded that antemortem D-dimer concentration was not more useful than the rest of measured hemostatic parameters to predict which patients presented fibrin microthrombi consistent with DIC at necropsy. Overall, the three studies within this thesis have contributed to a better knowledge of coagulopathies in horses with gastrointestinal disorders and have provided new information about applications of D-dimer determination at different stages of the colic disease

Coagulopathies in horses with colic

Disseminated intravascular coagulation (DIC) is a frequent complication in horses with severe gastrointestinal (GI) disorders that has been associated with poor outcome. It results in microvascular fibrin deposition and eventually organ dysfunction.Recent experimental studies have shown that rapid detection and treatment of subclinical coagulopathies reduce morbidity and mortality associated with DIC. Plasma D-dimer concentration is considered the most sensitive test to diagnose thromboembolic disease and DIC in human medicine, and it has been shown to be a good predictor of mortality as well. In horses, D-dimers have been found to be useful to detect hypercoagulation in horses with colic and septic foals and some studies advocate its use as prognostic aid in horses with acute GI problems. The objectives of this PhD thesis were to go further into the study of coagulopathies in horses with colic to improve early detection and management of DIC as well as to evaluate the potential clinical applications of the measurement of plasma D-dimer concentration in horses with colic. With that purpose, three studies were conducted in a hospital population of horses with different diagnoses of gastrointestinal disease, evaluating hemostatic profiles (including D-dimer, prothrombin time, activated partial thromboplastin time and antithrombin III) and the presence of laboratorial DIC at three different stages of the disease: on admission, during hospitalization and before dead. Furthermore, in the third study, this clinicopathological data was compared to histopathological data from the same horses evaluating microvascular fibrin deposition to detect any correlation. Results of the first study suggest that measurement of plasma D-dimer concentration at the time of admission can be used to facilitate diagnosis and outcome prediction in horses with colic. Furthermore, this study brings new clinically useful information, proposing several cut-offs with prognostic and diagnostic utility. During hospitalization (second study), evaluation of plasma D-dimer concentration has shown to be a useful tool to monitor hypercoagulative states in equine colic cases. Important increases in D-dimer concentration were observed postoperatively as well, as mentioned in previous reports. Finally, the third study concluded that antemortem D-dimer concentration was not more useful than the rest of measured hemostatic parameters to predict which patients presented fibrin microthrombi consistent with DIC at necropsy. Overall, the three studies within this thesis have contributed to a better knowledge of coagulopathies in horses with gastrointestinal disorders and have provided new information about applications of D-dimer determination at different stages of the colic disease.Diagnosis and prognosis of coagulopathies in horses with coli