Septic Joint Prognosis for Horses

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Septic Joint Prognosis for Horses

Synovial sepsis or contamination in horses is a severe and potentially life-threatening condition, often resulting from traumatic or penetrating injuries in adults and from hematogenous spread in foals. Treatment generally involves aggressive lavage and antimicrobial therapy. Despite appropriate treatment, survival rates vary between 44% and 90%, indicating that the condition can still be fatal even with proper care. Identifying risk factors influencing survival is crucial for improving outcomes. 

This study aimed to assess long-term survival rates and identify risk factors for poor outcomes in adult horses treated for synovial sepsis at multiple referral centers in the UK. The research found that long-term survival was 89.4%, which is comparable to survival rates reported for short-term discharge. Risk factors associated with increased likelihood of death included unknown injury causes, longer surgery durations, heavier weight, injuries to forelimbs, and involvement of bursae and tendon sheaths. 

The study chose to focus on long-term survival rather than survival to discharge to provide a more accurate representation of the overall outcome, considering cases that might be euthanized shortly after discharge. This approach aligned with human follow-up studies, which emphasize long-term survival as a better measure of treatment success. 

Factors like the duration between injury and treatment, and whether surgeries were performed outside working hours, did not significantly affect long-term survival in this study. However, the type of synovial structure affected and the duration of surgery were important. Heavier horses and those with injuries affecting forelimbs or involving bursae and tendon sheaths had a higher risk of death. 

The study also noted that antimicrobial treatment at discharge did not show a clear association with long-term survival, highlighting the need for further research on optimal antimicrobial duration and resistance prevention. Additionally, limitations such as small sample sizes, missing data, and potential biases due to the COVID-19 pandemic were acknowledged. 

Overall, the study provides valuable insights into the factors influencing long-term survival in horses with synovial sepsis, helping to guide clinical decisions and improve the management of affected horses. 

de Souza TC, Burford J, Busschers E, Freeman S, Suthers JM. Multicenter study investigating long-term survival after synovial lavage of contaminated and septic synovial structures in horses presented to 10 UK referral hospitals. Veterinary Surgery. 2024; 53(6): 1083-1092. doi:10.1111/vsu.14107 

Bottom line — 89% had excellent outcomes.

Pancreatic Enzyme Replacement in Dogs

Insufficiency of the exocrine pancreas can arise from various diseases such as pancreatic atrophy, chronic pancreatitis, pancreatic cancer, cystic fibrosis, severe acute pancreatitis, or surgical resections. These conditions lead to a deficiency of pancreatic enzymes, resulting in digestive and absorption disorders. The primary treatment for this enzymatic insufficiency is pancreatic enzyme replacement therapy (PERT), which is a lifelong treatment. PERT typically involves enzymes derived from animal sources, specifically porcine pancreatin. However, there is growing interest in using microbial and plant-derived enzymes as alternatives due to their potential advantages, including easier production and stability. 

Studies have shown that microbial-derived enzymes can be as effective as or even superior to animal-derived enzymes. Despite this, no registered preparations containing a full range of microbial-derived enzymes are currently available. Research is ongoing to explore these enzymes' potential beyond digestion, including their possible hormonal functions, such as the role of amylase in regulating glucose homeostasis and obesity. This suggests a promising future for microbial-derived enzymes in treating not only exocrine pancreatic insufficiency but also other conditions like obesity and diabetes, potentially leading to improved therapeutic options for both humans and animals. 

Szkopek D, Pierzynowski SG, Pierzynowska K, et al. A review: Pancreatic enzymes in the treatment of chronic pancreatic insufficiency in companion animals. J Vet Intern Med. 2024; 38(4): 2026-2033. doi:10.1111/jvim.17096 

Bottom line — Animal-based sources are still required.

Two-Year Health Study in Cats

Despite recommendations, owners are often reluctant to take older cats to the vet compared to younger cats. Educating owners about the benefits of early disease detection could improve their cats' quality of life and longevity. There is a need for data on health findings from both one-time and repeated follow-up examinations in initially healthy older cats. The first aim of a prospective study was to perform extensive health screening in a large group of mature adult and senior cats, seemingly healthy according to their owners, to identify common unnoticed conditions. The second aim was to monitor a subgroup of confirmed healthy cats over two years to determine the incidence and types of diseases they develop. 

Repeated health screenings are beneficial for all cats aged seven years and older. Initial physical examinations often identify conditions requiring intervention or further investigation, and a significant percentage of cats have unnoticed but clinically relevant diseases. Body condition scores at baseline were consistent with previous studies, with a high percentage of overweight or obese cats. Dental disease was common, with most cats having some form of dental calculus or gingivitis. Heart murmurs were found in a notable proportion of cats, and many of these had underlying cardiomyopathy upon further examination. 

The study also found that thyroid gland palpability and systemic hypertension prevalence were comparable to previous reports. Stress hyperglycemia was common, but diabetes mellitus was relatively rare. CKD was more common in older cats, with a higher prevalence in seniors compared to mature adults. Hyperthyroidism prevalence was lower than some previous studies, but a significant number of cases were asymptomatic or unnoticed. The study emphasized the importance of regular T4 testing for early detection of hyperthyroidism. 

The prevalence of FIV antibodies was lower than in previous studies, possibly due to changes in the general cat population. Subclinical bacteriuria was uncommon and did not warrant routine treatment. The study highlighted limitations such as potential selection bias and the difficulty in representing the general cat population accurately. Nonetheless, the study demonstrated the value of repeated health screenings for detecting subclinical or unnoticed diseases, allowing for early therapeutic intervention. Regular health checks are crucial for maintaining the health of older cats, and owners should be informed accordingly. 

Mortier F, Daminet S, Marynissen S, Smets P, Paepe D. Value of repeated health screening in 259 apparently healthy mature adult and senior cats followed for 2 years. J Vet Intern Med. 2024; 38(4): 2089-2098. doi:10.1111/jvim.17138 

Bottom line — Helps tremendously in the early detection and treatment of disease.

Just putting things in perspective …