Highlights of recent clinically relevant papers

In this study, Juliette Preston and co-workers in the UK and Finland aimed to assess the prevalence of blepharospasm, corneal ulceration and uveitis and their impact on outcome in horses diagnosed with immune-mediated keratitis (IMMK). Clinical records of 94 horses with IMMK were evaluated. The UK and Finland populations were comparable; therefore, descriptive statistics were performed on combined data on subtypes of IMMK and clinical features. Odds ratios (OR) and confidence intervals (CI) were calculated for impact of blepharospasm, ulceration or presence of uveitis on the outcome of enucleation and treatment duration. IMMK subtype was classified as 10/94 (10.6%) epithelial, 50/94 (53.2%) anterior stromal, 14/94 (14.9%) mid-stromal, 4/94 (4.25%) endothelial and 16/94 (17.0%) unrecorded. After excluding three horses with incidental corneal ulceration, blepharospasm was documented in 34/91 (37.4%), corneal ulceration in 26/91 (28.6%) and signs of uveitis in 23/91 (25.3%) horses. Increased odds of enucleation were significantly associated with the presence of blepharospasm and signs of uveitis, but not corneal ulceration. The presence of blepharospasm, corneal ulceration or uveitis did not significantly alter the odds of ongoing medication. In this study, Francesca Bindi and co-workers assessed the feasibility and accuracy of a smartphone-based electrocardiograph (ECG) in healthy foals. This study included 22 foals aged <21 days. A reference standard base-apex ECG (rECG) was acquired, and a smartphone ECG (sECG) was recorded immediately after by using a smartphone-based single-lead ECG. All ECG tracings were evaluated by a single board-certified cardiologist, blinded to the ECG device, who judged whether the tracings were acceptable for interpretation and performed ECG measurements and diagnosis. The Spearman correlation coefficient, Cohen's k test and Bland–Altman test were used to assess the agreement between sECG and rECG. All sECG tracings were acceptable for interpretation. All foals showed sinus rhythm on both rRCG and sECG tracings, with perfect agreement in heart rate classification (κ = 0.87). No clinically relevant differences were found in the assessment of waves and intervals duration. The percentage of agreement between rECG and sECG was 78% and 83%, respectively, for P wave and QRS complex polarity. rECG and sECG showed a substantial agreement (κ = 0.624) for ECG tracing quality. The smartphone-based ECG device tested in this study recorded good quality single-lead ECG tracings in foals, reliable for heart rate and ECG measurements, but different polarity of P waves and QRS complexes was found in some foals in comparison to rECG. In this study, Rachel Reed and co-workers in the United States and Australia evaluated the pharmacokinetics and pharmacodynamics of fentanyl administered via transdermal patch in six horses. Treatments in this randomised crossover study included: placebo, two 100 mcg/h patches (LDF), four 100 mcg/h patches (MDF) and six 100 mcg/h patches (HDF). Patches were in place for 72 h. Blood was obtained for fentanyl plasma concentration determination, thermal threshold, mechanical threshold, heart rate, respiratory rate and rectal temperature were obtained prior to patch placement and at multiple time points for the next 96 h. Fentanyl plasma concentration was determined using LC–MS/MS. Data were analysed using a generalised mixed effects model. Mean (range) maximum plasma concentration (Cmax), time to Cmax and area under the curve extrapolated to infinity were 1.39 (0.82–1.82), 2.64 (1.21–4.42) and 4.11 (2.78–7.12) ng/mL; 12.7 (8.0–16.0), 12.7 (8.0–16.0) and 12 (8.0–16.0) h; 42.37 (27.59–55.56), 77.24 (45.62–115.06) and 120.34 (100.66–150.55) h ng/mL for LDF, MDF and HDF, respectively. There was no significant effect of treatment or time on thermal threshold, mechanical threshold, respiratory rate or temperature. There was no significant effect of treatment on heart rate. There was a significant effect of time on heart rate with overall heart rates being less than baseline at 64 h. Fentanyl administered via transdermal patch is well absorbed and well tolerated but does not result in an antinociceptive effect as measured by thermal and mechanical threshold at the doses studied. In this study, Antoine Symoens and co-workers in Canada compared the efficacy of alfalfa pellets and steamed hay in improving lung function and inflammation of horses with severe equine asthma (SEA). Ten horses with SEA were enrolled and nine completed the study. Horses were housed indoors and fed hay. Once in exacerbation, they were fed pellets and steamed hay for 4 weeks, in a crossover design. Weighted clinical scores and lung function were recorded weekly. Bronchoalveolar lavage fluid (BALF) cytology and mucus scores were recorded before and after each diet. Based on linear mixed model (LMM) analysis, weighted clinical scores significantly improved over time. With pellets, weighted clinical scores decreased from (median (interquartile range)) 13 (5.5) to 2 (1.5), while with steamed hay, they decreased from 10 (9.5) to 6 (8.5). With pellets, lung resistance decreased significantly from a baseline of (mean (SD)) 2.62 (0.77) cmH2O/L/s to 1.17 (0.66), 0.79 (0.54), 0.70 (0.20), 0.62 (0.18) on Weeks 1–4, respectively (LMM with post hoc tests). With steamed hay, the resistance decreased significantly from a baseline of 2.34 (0.93) cmH2O/L/s to 1.38 (0.49) and 1.51 (0.66) on Weeks 1 and 2, respectively. Neutrophils BALF decreased significantly with both diets (pellets: 40.2 (24.4) to 20.1 (11.0)%; steamed hay 30.9 (20.2) to 25.7 (17.6)%). Clinical scores, lung function and BALF inflammation of horses with SEA improved with steamed hay and pellets, but the effect on lung function was more pronounced with pellets. This study by Marco Gandini and co-workers in Italy evaluated the effectiveness of pectin-honey hydrogels (PHHs) in preventing surgical site infection (SSI) in horses subjected to emergency laparotomy. Horses undergoing laparotomy were randomly divided into two groups: Group 1 received PHH application (Manuka honey and pectin) onto the sutured linea alba before skin closure, whereas Group 2 received no treatment. Only 36 of the 44 horses enrolled in the study were ultimately included; exclusions were either due to death before 5 days post-operatively (2 horses) or the administration of post-operative antimicrobials (6 horses). The median length of hospitalisation was 9 days (range 8–14 days). The overall occurrence of SSI was 19.4%. SSI developed in one of 18 horses (5.5%) in Group 1 and 6 of 18 (33.3%) horses in Group 2. Group 2 had an 8.5-fold increased risk of SSI. No macroscopically visible adverse reactions were associated with PHHs. These results indicate that PHH placed at the abdominal incision during surgery was safe and reduced the prevalence of SSI in horses. In this study, Nanna Rasmussen and co-workers in Denmark investigated whether the lung site sampled influenced the horse's bronchoalveolar (BAL) cytology profile, and if a pooled BAL sample would be superior for BAL cytology diagnosis in a cohort of healthy and subclinical asthmatic Warmblood horses. This cross-sectional study (59 horses in 2021 and 70 horses in 2022) with follow-up (53 horses in each year) included BAL cytology samples from individual lungs and from pooled BAL samples. The BAL samples were enumerated, and differential cell counts were applied to categorise the horses as control or with airway inflammation (AI). Bronchoalveolar lavage mast cell count was higher in left lung compared to right lung (2021; median 1.6 [range, 0.6–3.3] vs. 1.2 [0.7–1.5], 2022; median 3.1 [2.1–4.2] vs. 2.4 [1.7–3.4]) and compared to pooled samples (2022; median 2.6 [1.7–3.7]). Between the year 2021 and 2022, 17 of the horses had changes in BAL cytology from control to AI or vice versa. These results showed that the pooled BAL sample was the least reliable for detecting AI and was not representative of the overall lung condition.

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