Retrospective analysis of factors associated with umbilical diseases in foals.

In neonatal foals, umbilical remnants can be affected by infectious and non-infectious diseases. This study aimed to retrospectively evaluate historical, management and clinical factors that may be related to the occurrence of umbilical remnant diseases. Clinical reports of foals born or hospitalized within 24 h of life during the 2017-2021 foaling seasons were reviewed. Forty/183 foals (21.9 %) developed umbilical remnant diseases (URD group), while 143/183 foals (78.1 %) had normal umbilical remnants (NUR group). In the URD group, 24/40 (60 %) had a patent urachus, 16/40 (40 %) omphalo-arteritis, 4/40 (10 %) omphalo-phlebitis, 10/40 (25 %) urachitis, 9/40 (22.5 %) abscess, 3/40 (7.5 %) periumbilical hematoma and 12/40 (30 %) more than one condition. URD frequency was higher in foals hospitalized after birth than in those born at the hospital (17/46 vs 23/137; P = 0.0068), lower in those that had access to the paddock before three days of life (p = 0.0426) and higher in recumbent foals (P = 0.0001). URD occurred more frequently after dystocia (P = 0.0068), prolonged stage II parturition (19±20.51 min vs 13±6.41 in NUR group; P = 0.0279), traction at parturition (P = 0.0005), and in foals with lower APGAR scores (8±1.72 vs 9±0.86 in NUR; P = 0.0063). Sepsis (P = 0.0245), neonatal encephalopathy (P = 0.0014), meconium retention (P = 0.0241) and congenital flexural limb deformities (P = 0.0049) were the most common associated diseases. Umbilical cord (UC) coiling, abnormal UC rupture, umbilical hemorrhage and increased umbilical stump volume occurred more frequently in URD than in NUR group (P = 0.0329, P = 0.0191, P = 0.0007 and P < 0.00001, respectively). Recognition of the identified predisposing historical, management and clinical factors should prompt careful umbilical remnant monitoring in neonatal foals.

Early colonisation and temporal dynamics of the gut microbial ecosystem in Standardbred foals.

BACKGROUND: Even if horses strictly depend on the gut microbiota for energy homeostasis, only a few molecular studies have focused on its characterisation and none on the perinatal gut microbial colonisation process. OBJECTIVES: To explore the perinatal colonisation process of the foal gut microbial ecosystem and the temporal dynamics of the ecosystem assembly during the first days of life. STUDY DESIGN: Longitudinal study. METHODS: Thirteen Standardbred mare-foal pairs were included in the study. For each pair, at delivery we collected the mare amniotic fluid, faeces and colostrum, and the foal meconium. Milk samples and faeces of both mare and foal were also taken longitudinally, until day 10 post-partum. Samples were analysed by means of next-generation sequencing of the 16S rRNA gene on Illumina MiSeq. RESULTS: Our findings suggest that microbial components derived from the mare symbiont communities establishes in the foal gut since fetal life. After birth, an external transmission route of mare microorganisms takes place. This involves a rapid and dynamic process of assembling the mature foal gut microbiome, in which the founder microbial species are derived from both the milk and the gut microbial ecosystems of the mare. MAIN LIMITATIONS: The inability to discriminate between live and dead cells, the possible presence of contaminating bacteria in low biomass samples (e.g. meconium and amniotic fluid), the limits of the phylogenetic assignment down to species level, and the presence of unassigned operational taxonomic units. CONCLUSIONS: Our data highlight the importance of mare microbiomes as a key factor for the establishment of the gut microbial ecosystem of the foal.

Time-dependent changes and prognostic value of lactatemia during the first 24 h of life in brachycephalic newborn dogs.

Blood lactate concentration is known to be a good prognostic indicator associated with the severity of illness and the patient's outcome both in human and veterinary medicine. It also plays a significant role in the assessment of the newborn, being a good indicator of fetal hypoxia and the ideal predictor of morbidity at term in babies. In veterinary neonatal medicine, hyperlactatemia is considered a valid prognostic marker in critically ill foals; moreover, blood lactate measurement has been proposed for the evaluation of newborn viability and the assessment of fetal distress during delivery in dogs. Unfortunately, only a few studies have been published concerning the canine species. The present work examines 67 brachycephalic newborn dogs and their mothers, with the aim to evaluate the time-dependent changes of blood lactate and glucose concentration during the first 24 h after vaginal or caesarean delivery both in puppies and bitches. To our knowledge, this is the first published study examining the time-dependent changes of these parameters in the bitch after parturition. Within the studied population of puppies, non-surviving was significantly associated with a higher lactatemia and a lower APGAR score. Blood lactate was high at birth then progressively decreased during the first 24 h of life and a lack of normalization of blood lactate levels within this time interval was suggestive for a poor prognosis for the newborn dogs; moreover, the decrease appeared to be slower after vaginal delivery. Lactatemia also showed a positive correlation with glycemia at birth. Concerning the bitches examined, blood lactate was found to be significantly higher after vaginal delivery than after caesarean section; the normalization occurred within 24 h after parturition. Blood glucose level was significantly higher at 2 h from delivery both in the group of bitches submitted to caesarean section and in those undergoing natural whelping but no statistical correlation was found between maternal glycemia and lactatemia. The results of the present study highlighted that the monitoring of lactatemia during the first 24 h of life, in association with the assessment of the APGAR score at birth, can be an useful prognostic tool helping to identify the most severely distressed puppies and to provide them an adequate support.

Cytokine levels in colostrum and in foals' serum pre- and post-suckling.

The purpose of this study is to investigate the presence of IL-4, IL-8, IL-13 and IFN-γ in equine colostrum and in foals' serum. Samples were obtained from 14 mares and their healthy foals. Soon after parturition, 10ml of colostrum was collected, filtered, centrifuged and frozen until assayed. Blood samples were obtained from each foal at birth (TO) and again after 24h (T24), after which they were frozen until assayed. Serum IgG was measured at 24h of age with an immunoturbidimetric quantitative method. Cytokine concentration was determined using commercially available ELISA tests. Statistical analyses revealed a significant difference in serum concentration of IL-4 at T0 and at T24 (p<0.05) and a significant correlation between the serum IL-4 at T24 and colostral IL-4. These results suggest the absorption of IL-4 from colostrum. The presence of IL-8 in the pre-suckle foal's serum may be due to an endogenous production. With the exception of two samples, there was no IL-13 detected in the foals' serum at birth and remained undetectable in 8/14 samples after 24h. This cytokine was also undetectable in four colostrum samples, where its concentration showed a wide range and a high standard deviation. IFN-γ was present in both the colostrum and in the foals serum at birth.

Total plasma magnesium in healthy and critically ill foals.

Abnormalities in total Mg (tMg) concentration in plasma and/or serum are common in critically ill humans, and the association with increased mortality has been documented in several clinical studies in adults and newborns with hypoxic-ischemic encephalopathy. Abnormalities in tMg were studied in hospitalized dogs, cats, and adult horses. Newborn foals were scarcely studied with regard to Mg concentration. The aims of the present study were: (1) to compare two analytical methods for the determination of tMg in plasma: the automated colorimetric method and the atomic absorption spectrometry; (2) to measure plasma tMg in healthy foals during the first 72 hours after birth and in sick foals during the first 72 hours of hospitalization; (3) to compare total plasma Mg concentration among healthy foals, foals affected by perinatal asphyxia syndrome (PAS), prematurity and/or dismaturity, and sepsis; (4) to evaluate tMg plasma concentration in surviving and non-surviving foals. One hundred seventeen foals were included in the study: 20 healthy and 97 sick foals. The automated method used in clinical practice probably overestimates plasma tMg. Due to its higher sensitivity and specificity, the atomic absorption spectrometry should be considered the method of choice from an analytical point of view, but requires an instrumentation not easily available in any laboratory and specific technical skills and competencies. Plasma tMg in healthy foals were included in the range 0.52 to 1.01 mmol/L and did not show any time-dependent change during the first 72 hours of life. In sick foals, tMg evaluated at T0 was statistically higher than tMg measured at subsequent times. Foals affected by PAS had a tMg at T0 significantly higher (P < 0.01) than healthy, septic, and premature and/or dysmature foals. The t test found significantly higher (P < 0.01) plasma tMg measured at T0 in non-surviving than in surviving foals. Plasma tMg could be a useful parameter for the diagnosis of PAS and the formulation of the prognosis in critically ill foals.

Gross placental morphology and foal serum biochemistry as predictors of foal health.

The aim of this study was to verify if changes in blood glucose, creatinine, urea, and fibrinogen concentrations evaluated at birth reflect gross placenta abnormalities, and are useful to identify foals that suffered from placental dysfunction. A total of 92 mares were included in the present study: 68 delivered healthy foals and they were included in group 1; 24 delivered sick foals and they were included in group 2. In group 2, foals' clinical diagnoses included perinatal asphyxia syndrome (PAS; n = 20) and prematurity and/or dysmaturity (n = 4). The proportion of sick foals was greater when placental abnormalities were observed (χ(2) [1, n = 89] = 5.00; P = 0.025). Serum creatinine concentration at birth was higher in sick than in healthy foals (P = 0.003), and blood glucose concentrations at birth was smaller in sick than in healthy foals (P = 0.007). No difference was found in blood chemistry results between survivors and nonsurvivors of group 2. Serum creatinine concentration was higher in foals born from grossly abnormal than in foals born from grossly normal placenta (P = 0.029), and it was higher in foals affected by PAS (311.17 µmol/L) than in healthy foals (238.24 µmol/L) (P = 0.004). In a clinical setting, serum creatinine and blood glucose concentrations should be evaluated at birth, particularly in foals born from grossly abnormal placenta. The association of clinical and laboratory data could be particularly important to promptly identify and treat foals with a higher risk to develop PAS.

Amniotic fluid and blood lactate concentrations in mares and foals in the early postpartum period.

Amniotic fluid (AF) lactate concentration and time-dependent changes in blood lactate concentration in mares after parturition have never been evaluated. In this study, the venous blood lactate concentration of mares and foals during the first 72 h of the postpartum period was assessed, and the concentration of lactate in the AF collected during delivery and the utility of its measurement for evaluating the foal's health were investigated. This prospective observational study was carried out on mares attended at delivery. They were divided into mares delivering healthy (Group 1) and sick (Group 2) foals. The following samples were collected: AF and umbilical blood at delivery, mare's and foal's jugular blood every 12 hours from parturition until 72 h postpartum (T0-T72). Sixty-two mares were enrolled in Group 1 and 19 in Group 2. In Group 2, the survival rate was 68.4%. The median blood lactate of the foals at T0 was 3.60 mmol/L in Group 1 and 5.05 mmol/L in Group 2. The monitoring of the blood lactate concentration showed a significant time-dependent decrease from T24 in the foals (P < 0.01) and from T12 in the mares (P < 0.01). Lactate concentration over time was significantly different between healthy and sick foals (P < 0.01) but not between mares with normal and dystocic delivery (P = 0.08). A significant difference (P = 0.04) was detected as regards AF lactate concentration between Group 1 (median 14.99 mmol/L) and Group 2 (median 12.61 mmol/L). For the first time, AF lactate concentration was evaluated during parturition, and significantly higher levels were found in mares delivering healthy foals. This was an unexpected and very interesting result which warrants further investigation involving a larger number of mares. Additional studies are needed before either mare's blood or AF lactate concentration can be used in a clinical setting.

Venous blood lactate evaluation in equine neonatal intensive care.

The use of blood lactate concentration as an indicator of prognosis and disease severity has become a common practice in equine medicine, especially with the validation of handheld analyzers. However, few authors described lactate concentration in critically ill foals, and there are no published studies about the use of handheld analyzers in neonatal foals. In this study, for the first time in the equine neonate, we validated the Lactate Scout analyzer, both in healthy and in critically ill foals. The study also describes the normal range for blood lactate in 26 healthy neonatal foals during the first 72 h of life. Moreover, the utility of venous lactate measurement in 88 critically ill foals was determined, describing lactate values in the most common neonatal pathologies, evaluating serial blood lactate measurements, and investigating its prognostic value. The comparison with the enzymatic-colorimetric reference method showed that the Lactate Scout analyzer is reliable. The mean difference (bias +/-2SD) between the two methods was close to zero for all comparisons, and the SD of difference was +/-0.76 with a 95% confidence interval from -1.58 to 1.40 mmol/L. In healthy foals, blood lactate concentrations at birth and at 12h of life were statistically higher (P<0.01) than lactate concentrations measured at subsequent times. In critically ill foals, the highest lactate concentration at admission was found in hemorrhagic shock, septic shock, and complicated perinatal asphyxia syndrome (PAS). Our results showed that hyperlactatemia, although it does not provide diagnostic information, indicates the severity of illness and the need for an early and aggressive intervention. This could be very useful both during hospitalization and in the field to support veterinarians in making a decision about referral. Furthermore lactatemia proved to be a reliable prognostic parameter: In nonsurviving foals, hyperlactatemia persisted during the entire hospitalization, whereas in survivors there were no significant differences after 24h from admission. Because prognostic parameters have certain limitations, hyperlactatemia should not be used alone to decide whether to discontinue treatments in critically ill foals. A careful and complete clinical examination is always essential.

Evaluation of lung maturity by amniotic fluid analysis in equine neonate.

The aim of this study was to gather useful new data for evaluation of lung maturity in the neonatal foal. Because equine neonatal intensive therapy is very expensive, a precocious diagnosis could help to express a prognosis and to offer a respiratory support early after birth, increasing the survival rate and reducing complications. Amniotic fluid was collected at parturition on n=18 mares. Lamellar bodies were isolated in the amniotic fluid and measured with transmission electron microscopy (TEM). Furthermore two tests on amniotic fluid that are commonly used in humane medicine were utilized: lecithin/sphingomyelin ratio (L/S) and lamellar body count (LBC). L/S ratio was determined using thin layer chromatography (TLC) and, for the first time in equine amniotic fluid, with high performance liquid chromatography (HPLC). LBC was performed with an automated blood cell counter. The mean of the L/S ratio obtained in mature foals was 2.5 with TLC and 2.7 with HPLC. The mean LBC in the same group was 48x10(3)/microL. The Spearman's Rank correlation test found a significant correlation between TLC and Apgar score (R=0.66, p<0.01), between TLC and cord pH (R=0.65, p<0.05), between HPLC and Apgar score (R=0.63, p<0.01) and between cord pH and Apgar score (R=0.82, p<0.01). The Student's t-test did not found a significant difference between L/S ratio performed with TLC and with HPLC. These methods may be useful for evaluation of lung maturity in the equine species, but further studies on a large number of mature and premature foals are necessary to establish equine pulmonary maturity standards.

Análisis clínico e histopatológico de la nefropatía a IgA / Clinical and pathological analysis in IgA nephropathy

La nefropatía a IgA (NIgA) es considerada la glomerulopatía primaria más frecuente en el mundo. En el Registro Uruguayo de Glomerulopatías su frecuencia aumentó en los últimos años. Estudiamos 50 pacientes con diagnóstico inmunohistológico de N IgA, 68 hombres con una edad de 28.9+-23,8 años. La presentación clínica más frecuente fue la hematuria macroscópica en 58 por ciento, seguida por las alteraciones del sedimento urinario en un 30 por ciento de los pacientes. El tiempo de seguimiento de los pacientes fue de 65 +- 49 meses. La sobrevida de la función renal fue de 87 por ciento a los 6 años. Ocho pacientes evolucionaron a la insuficiencia renal terminal. Nuestros resultados concuerdan con otras publicaciones, mostrando que una Creatinina más elevada, la presencia de una proteinuria mayor a 2g/litro, la menor edad, y la presencia de factores de riesgo para el desarrollo de insuficiencia renal en esta nefropatía

Tratamiento de las glomerulopatías / Treatment of glomerular diseases

Referimos las medidas terapéuticas para prevenir la progresión de las glomerulopatías a la insuficiencia renal crónica (IRC), poniendose especial atención en el adecuado control de la: presión arterial, en el tratamiento de la dislipemia y adecuación del aporte proteico, todo lo cual tiende a disminuir la hiperfiltración glomerular. Describimos las pautas de tratamiento etiopatogénico de las glomerulopatías (GL) primarias y secundarias, (GL) lúpica (NL) y vasculitis en el adulto. En el sindrome nefrótico (SN) por Lesión Glomerular Mínima o Hialinosis Focal y Segmentaria la primera opción terapéutica son los corticoides (CO), y en aquellos pacientes corticoresistentes o recaedores frecuentes estaría indicada la Ciclofosfamida (CF). La Ciclosporina tiene indicación en este mismo grupo previa valoración del grado de afectación tubulointersticial. La GL Membranosa debe ser tratada con inmunosupresores (Is) en el caso que se presente con SN y factores de riesgo para la progresión a la IRC. En la nefropatía a IgA se propone tratamiento según grado de lesión histológica, con OC e Is y en algunos casos IECA. La Gl Rápidamente Progresiva es una urgencia terapéutica que debe ser tratada en forma precoz con pulsos i/v de Metilprednisolona asociado con CF. Las formas proliferativas de NL, clases III o IV de la OMS, requieren un tratamiento combinado de CO e Is: Azatioprina o CF