Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges

Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative.

Comparison of nucleic acid amplification, serology, and microbiologic culture for diagnosis of Rhodococcus equi pneumonia in foals

Recently, a technique was described for amplification of Rhodococcus equi-specific chromosomal and vapA DNA from blood and tracheal wash fluids. It was hypothesized that this technique would be more sensitive than standard culture techniques or serology for diagnosis of R. equi pneumonia in foals. Tracheal wash fluid, nasal swabs, whole blood samples, and serum samples from 56 foals with pneumonia were analyzed. Final clinical diagnosis was determined by the attending clinician on the basis of final interpretation of all available information about each foal, including clinical presentation, diagnostic test results, response to therapy, and outcome. Clinical diagnosis was used as a final reference standard for calculation of sensitivity, specificity, and predictive values for PCR, serology using an agar gel immunodiffusion test, and tracheal wash fluid culture. PCR of tracheal wash fluid using primers that recognized the vapA virulence plasmid of R. equi had a diagnostic sensitivity of 100% and specificity of 90.6%. Sensitivity and specificity were 57.1 and 93.8%, respectively, for standard microbiologic culture of tracheal wash fluid and 62.5 and 75.9%, respectively, for serology. PCR of tracheal wash fluid is more sensitive and specific for diagnosis of R. equi pneumonia than are other available diagnostic tests.

Myeloperoxidase activity of the large intestine in an equine model of acute colitis

OBJECTIVE

To determine whether quantification of myeloperoxidase (MPO) activity could be a useful laboratory technique to detect granulocyte infiltration in equine intestinal tissues.

SAMPLE POPULATION

Intestinal tissue (inflamed or healthy) collected from 16 age- and sex-matched Shetland Ponies.

PROCEDURE

Intestinal tissue MPO activity was determined, and histologic assessment of adjacent specimens from healthy and inflamed intestine was done.

RESULTS

Intestinal tissue MPO activity and histopathologic score increased with time after castor oil challenge and peaked at 16 hours in an equine diarrhea model in which individual ponies provided their own control tissues.

CONCLUSIONS

Intestinal tissue inflammation scores correlated positively with tissue MPO activity in adjacent specimens.

CLINICAL RELEVANCE

Tissue MPO assay may be a useful laboratory tool to quantify intestinal mucosal inflammation in ponies.

Brodifacoum toxicosis in two horses

Increased popularity during the past decade of brodifacoum, an anticoagulant rodenticide, has led to an increase in cases of accidental poisoning in nontarget species, including pets and farm animals. Pharmacokinetics of second-generation anticoagulant rodenticides such as brodifacoum are substantially different from those of first-generation anticoagulant rodenticides such as warfarin. This difference dramatically influences management of exposure in terms of duration and cost of treatment and may affect outcome. The National Poison Control Center reports that approximately 50 cases of brodifacoum exposure have occurred in horses between 1993 and 1997. To our knowledge, this report is the first complete clinical description of accidental ingestion of a potentially lethal dose of brodifacoum in horses. Early recognition of exposure to brodifacoum, subsequent treatment with adequate doses of vitamin K1, and sequential monitoring of clotting times and serum brodifacoum concentration permitted poisoning in these horses to be managed successfully.

Penicillin-induced immune-mediated hemolytic anemia in a horse

A 5-year-old female American Quarter Horse was determined to have immune-mediated hemolytic anemia after detection of a positive response to a direct Coombs' test. Penicillin-induced immune-mediated hemolytic anemia was confirmed via a direct antiglobulin test, using penicillin-coated RBC. The horse was clinically improved and the anemia resolved in response to supportive care and discontinuation of penicillin treatment. Penicillin should be considered a possible cause of immune-mediated hemolytic anemia in horses.

The use of ascorbic acid in the treatment of 2 cases of red maple (Acer rubrum)-poisoned horses

Two horses with red maple (Acer rubrum) toxicity responded to treatment with high doses of vitamin C (ascorbic acid), in addition to blood transfusions, and intravenous fluid therapy. The clinical course included Heinz body anemia, marked methemoglobinemia, depression, and evidence of severe tissue anoxia. Clinical recovery was dramatic with stabilization achieved 36 hours following the initiation of ascorbic acid therapy.