(1) Background: Ultrasonography of major vessels helps evaluate fluid status and responsiveness in critical human and canine patients. Aims: transrectal and inguinal ultrasonography of caudal vena cava (CVC), aorta (Ao), and femoral artery (FA) and vein (FV) in horses; calculate CVC collapsibility index (CI CVC) and vein-to-artery ratios; compare B- and M-mode; and evaluate repeatability and reproducibility. (2) Methods: B-mode and M-mode video loops were recorded twice by transrectal (Ao, CVC) and inguinal ultrasonography (FV, FA) by two operators on 17 healthy, sedated adult horses. Diameters and areas were measured. CI CVC, CVC-to-Ao ratio (CVC/Ao), FV-to-FA ratio (FV/FA), reproducibility, and repeatability were calculated. (3) Results: Vessels were successfully visualized (mean time: rectal 4 min, inguinal 3 min). CVC displayed respiratory-related dimension changes. Ratios included CI CVC (mean diameter B-mode 30 ± 13%, M-mode 33 ± 12%; area 36 ± 15%), CVC/Ao (mean diameter B-mode 0.43 ± 0.15, M-mode 0.43 ± 0.11; median area 0.56, IQR 0.53–0.64), and FV/FA (mean diameter 3.80 ± 1.02; median area 26.74, IQR 25.23–32.40). M-mode was inadequate for inguinal analysis. B-mode and M-mode measurements did not differ significantly. Repeatability and reproducibility were excellent (transrectal ratios 93.9% and 94.4%, respectively); FV/FA 96.9%. (4) Conclusions: Assessment of CI CVC, CVC/Ao, and FV/FA is feasible, highly repeatable, and reproducible.

Objective:To establish specific veterinary surgical site infection (SSI) terminology to support the creation of consistent, comparable, and repeatable clinical and research datasets. Methods:Establishment of SSI definitions by iterative Delphi questionnaires leading to a convergence of consensus opinion by a multidisciplinary panel of 32 specialists in large- and small-animal surgery (European College of Veterinary Surgeons, American College of Veterinary Surgeons), veterinary internal medicine (American College of Veterinary Internal Medicine, European College of Veterinary Internal Medicine, European College of Equine Internal Medicine), anesthesia (European College of Veterinary Anesthesia and Analgesia), critical care (American College of Veterinary Emergency and Critical Care, European College of Veterinary Emergency and Critical Care), dentistry (European Veterinary Dental College), microbiology, preventive medicine (American College of Veterinary Preventive Medicine), animal welfare (European College of Animal Welfare and Behavioural Medicine), and human infection control. Consensus was defined as agreement by a minimum of 75% of panel members. Results:The panel defined 18 terms for veterinary use, including those for superficial, deep, and organ/space infections; surgical procedure; pyrexia; wound classification and closure; and agreements on SSI monitoring timeframes. Conclusions:A common clinical and research language appropriate to the veterinary field useable in future SSI surveillance practice has been established through expert consensus. Clinical Relevance:The use of a standard SSI language in veterinary practice is central to the future reliability of studies, their comparison, and the understanding of clinical risk factors in the development and prevention of SSI.

Teaching medical sciences is a continuously evolving process that requires an ongoing update for both students and teachers. Several methods are used to measure learning styles, among which the Visual, Auditory, Read/Write, Kinesthetic (VARK) framework focuses on how learners prefer to obtain information. With this study, we aimed to assess the VARK learning style on a large sample of veterinary students and educators in an aged-variety, multi-lingual, and multi-institutional setting. We obtained a total of 873 replies to our survey: 78.7% students, 6.6% veterinarians, 5.9% people with another occupation inherent to veterinary medicine, 5.7% European or American board-certified specialists, 1.1% veterinary nurses, 0.9% veterinary interns, and 0.9% veterinary residents of different specialties. The replies were obtained from French (56%), English (31.7%), Italian (11.5%), and Spanish (0.8%) versions of the survey. Most respondents (52.6%) were unimodal learners, while 47.4% exhibited two or more learning styles. Baby Boomers and Millennials were significantly less likely to use the visual and the aural style, respectively, compared with Generation Z. Moreover, Baby Boomers were approximately 54.2% less likely to be multimodal learners than Generation Z (χ2 = 4.291, p = .038). According to our results, the current veterinary student population is comprised of multimodal learners highly adapted to learn visually and by listening, although there are some differences between countries. An initial assessment with the VARK survey at the beginning of the course may help teachers to study their specific population. Finally, here we collect some specific recommendations to follow based on the country where students are enrolled.

This case report describes a Thoroughbred broodmare referred for colic and pyrexia. The mare had a history of repeated urinary tract infections, placentitis, abortion and endotoxaemia. A diagnosis of bilateral subcapsular renal haematoma was made by ultrasonography and standing laparoscopy and confirmed on post-mortem. Neoplasia and an active clotting disorder were ruled out as a cause of the bleeding. However, histopathology revealed severe, diffuse, acute fibrinosuppurative tubulointerstitial nephritis with degeneration of vascular walls, suggesting that this has caused renal bleeding and development of subcapsular haematomas.

BACKGROUND:Horses and other equids are reliant on the gut microbiome for health, and studies have reported associations between certain clinical conditions and features of the fecal microbiome. However, research to date on the equine fecal microbiome has often relied on small sample sizes collected from single and relatively localized geographic regions. Previous work also largely employs single timepoint analyses, or horses selected based on limited health criteria. RESULTS:To address these limitations and expand our understanding of the core microbiome in health, and the changes associated with adverse outcomes, the Equine Gut Group (EGG) has collected and performed 16S rRNA sequencing on 2,362 fecal samples from 1,190 healthy and affected horses. This resource of 16S rRNA sequencing data with accompanying demographic and clinical metadata represent a diverse equine population in health and disease. We identified features making up the core microbiome of healthy equids and metadata factors influencing the relative abundance of those features. We then identified microbial markers of acute gastrointestinal disease at the community and taxonomic levels. CONCLUSIONS:Here we present the EGG database and demonstrate its utility in characterizing the equine microbiome in health and acute gastrointestinal disease. The EGG 16S rRNA database is a valuable resource to study the equine microbiome and its role in equine health.

In human medicine, neurological diseases have been associated with transient cardiac abnormalities. In horses, myocardial disease is rarely diagnosed and has been associated with a wide variety of causes. The aim of this article is to describe three horses with no previous cardiac disease, which all developed severe cardiomyopathy following neurological disease. A 5-year-old Shetland pony stallion was diagnosed with cardiomyopathy with arrhythmias following an episode of seizures caused by an accidental intra-arterial xylazine injection. A 20-year-old crossbred mare was hospitalised for an open fracture of the left maxillary bone with copious epistaxis from both nostrils and developed acute cardiomyopathy with arrhythmias following a venous air embolism. Both had elevated troponin concentrations. Multifocal areas of haemorrhages and coagulative necrosis within the myocardium were found at the post-mortem examination of a 4-year-old thoroughbred gelding who died shortly after suffering acute brain injury following a backward fall. Based on this report, we suggest that myocardial injury can also occur in horses following neurological disease. Equine patients with acute neurological disease may benefit from cardiac monitoring; otherwise, patients with unspecific or mild symptoms of cardiomyopathy are likely to remain unidentified. The prognosis associated with this type of cardiac disease remains to be defined.

Trimethoprim-sulfonamide (TMPS) combinations are widely used to treat a range of infectious diseases in horses, but some equine practitioners are reluctant to use them for treatment of both neonatal and older foals. Considering the emergence of increased antimicrobial resistance, the use of protected antimicrobials commonly prescribed to foals should be avoided and alternative first-line therapy considered, where appropriate. This review examines the characteristics and pharmacokinetics of TMPS and its suitability for treatment of foals. Data regarding dosage and route of administration are reported on the basis of recent publications in foals. The review intends to share significant information about the common infections that are most likely responsive to TMPS treatment in foals and, as such, where TMPS might be considered a suitable first-line therapeutic option.

Horses and other equids are reliant on the gut microbiome for health, and studies have reported associations between certain clinical conditions and features of the fecal microbiome. However, research to date on the equine fecal microbiome has often relied on small sample sizes collected from single and relatively localized geographic regions. Previous work largely employs single timepoint analyses, or horses selected based on limited health criteria. To address these issues and expand our understanding of the core microbiome in health, and the changes associated with adverse outcomes, the Equine Gut Group (EGG) has collected and performed 16S rRNA sequencing on 2,362 fecal samples from 1,190 healthy and affected horses. Here we present the EGG database and demonstrate its utility in characterizing the equine microbiome in health and acute gastrointestinal disease. The EGG 16S rRNA database is a valuable resource to study the equine microbiome and its role in equine health. ### Competing Interest Statement The authors have declared no competing interest.

The aim of this consensus statement is to summarize and appraise scientific evidence and combine this with the clinical experience of a panel of experts to optimize recommendations on how to recognize and manage kidney disease in horses.

Neutrophil gelatinase-associated lipocalin (NGAL) has been suggested to be a highly sensitive and specific marker of joint infection in humans. The aim of the study was to investigate NGAL concentrations in synovial fluid (SF) from horses with septic synovitis, horses without septic synovitis, and horses with uncertain status. NGAL was measured in 177 admission samples obtained from 152 horses. From a subset of horses (n = 35), additional samples obtained sequentially over the course of treatment were available. Concentrations of NGAL were significantly higher in septic synovitis (n = 47 samples) than in samples classified as non-septic (n = 103) or samples with uncertain status (n = 27), with median NGAL concentrations in the three groups being 1236, 16.8, and 266.4 µg/L, respectively. NGAL discriminated nearly perfectly between septic and non-septic (area under the receiver operating characteristic curve 0.98, 95% confidence interval 0.95–1.00). The optimal cut-off value for maximal sensitivity (87.2%) and specificity (75.0%) to discriminate septic samples from those with uncertain status was 444.6 µg/L, with an area under the receiver operating characteristic curve of 0.85 (95% confidence interval 0.74–0.93). Concentrations declined over time in horses undergoing treatment. NGAL is a novel biomarker that seems to have great potential for identifying septic synovitis and for monitoring the response to treatment of synovial infection in horses.

Transthoracic echocardiography (TTE) is part of every comprehensive cardiac examination in horses (Schwarzwald, 2019). However, the echocardiographic assessment of cardiac structures, chamber dimensions, and myocardial function is challenging and limited by a variety of technical, anatomic, and physiological factors that need to be considered (Vitale et al., 2021). More recently, transesophageal and threedimensional echocardiography have been described to overcome some of the limitations of the two-dimensional traditional echocardiography, nevertheless they are not widely available in equine hospitals (Schwarzwald, 2018). During the ultrasonographic examination, the valves are inspected for the number and morphology of the leaflets and cusps, the integrity of the support apparatus and motion during the cardiac cycle (Marr, 2019). In the recently published article (Vitale et al., 2021), the authors described a 4-year-old Thoroughbred with mild aortic regurgitation suspected to be due to a quadricuspid aortic valve, a form of aortic valve dysplasia. Valvular dysplasia refers to a valve that is malformed, which may manifest as stenosis, insufficiency, or both (Scansen, 2019). The case presented in the article was referred to the hospital because of the development of paroxysmal atrial fibrillation, and on interrogation with colour flow Doppler, mild aortic and pulmonary regurgitation was identified. These mild regurgitations are unlikely to affect performance or to result in any clinical signs (Reef et al., 2014). Nevertheless, as described in the article, the authors repeatedly obtained images of the aortic valve, which were thought to be abnormal. This clinical commentary arises from the same authors because deeper examination of the recorded images and video loops of that echocardiography, and together with the opinion of a clinician with more experience in cardiology (GvL), indicated that this interpretation was most likely wrong. Indeed, while reviewing the recordings, in diastole, with the valve completely closed, it was possible to obtain static images that are in fact incompatible with a quadricuspid aortic valve (Figure 1). Although at the timeof the article submission and publication, the authors genuinely believed that there was a likelihood of four cusps, with this clinical commentary they provide the readerswith an update. Because static images are difficult to interpret, video loops are included to better evaluate the case presented (Videos S1 and S2). As already mentioned in the original paper (Vitale et al., 2021), when dealingwith concave/convex structures in rapidmovement, such as the

Traditional lectures, where students listen passively, often do not reflect the complexity of real-life decision-making situations. Furthermore, modern students are using online devices for daily activities, and this has a challenging side effect for educators, as many people these days can only maintain their focus if topics are discussed in concise and engaging ways. For these reasons, there is growing interest in the use of games for educational purposes. The aim of this study was to introduce a board game based on the Clue game for final-year veterinary students during their practical activity in large animal medicine. This type of learning process was compared with a classical case-based discussion and evaluated via a survey delivered to the students to both test their acquired knowledge and obtain their evaluation of the activity. A total of 49 students were enrolled in this study. While the board game was evaluated significatively better than the traditional class, no statistically significant differences were observed for the answers given to questions assessing their veterinary skills. The proposed game requires few resources other than a case-based visual materials and analyses from clinical patients, a board, two dice, and some imagination to create cases at the appropriate level for students' knowledge. We conclude that this board game-based activity represents innovative techniques to teach clinical approaches in an interactive way with the same utility as a traditional class but is more enjoyable for the students.

Summary The use of antimicrobials in adult horses with acute colitis is controversial and clear antimicrobial guidelines are lacking. It is generally accepted that antimicrobials should be reserved for patients with specific bacterial enterocolitis such as Neorickettsia risticii or Clostridium difficile ; however, in practice, horses show similar clinical signs independently of the underlying aetiology. The clinician is therefore often confronted with the dilemma of rapid initiation of treatment to avoid mortality vs. delayed and selective targeted antimicrobial treatment based on faecal diagnostic testing. The risk of antibiotic associated diarrhoea and the emergence of antimicrobial resistance are other important considerations.

Abstract Pyelonephritis is a serious condition that is rarely described in horses. In contrast, urinary tract infections are common in humans and small animals, and multi‐drug‐resistant urinary infections are an emerging threat. In this report, we describe a horse with unilateral pyelonephritis caused by extended‐spectrum beta‐lactamase‐producing bacteria belonging to the Enterobacter cloacae complex. [Correction added on 9 August 2023, after first online publication: The preceding sentence was corrected.] An 11‐year‐old Swedish warmblood gelding was diagnosed with a cystolith and a cystotomy through an open left para‐inguinal approach was performed. Seven days after surgery the horse presented with pyrexia, dullness and colic. Diagnostic testing and renal transabdominal ultrasonography confirmed the presence of a right‐sided pyelonephritis. Culture and antimicrobial susceptibility testing revealed a pure growth of extended‐spectrum beta‐lactamases‐producing E. cloacae complex bacteria with resistance against beta‐lactams, aminoglycoside and trimethoprim–sulphonamide classes. Treatment included prolonged oral antimicrobials according to susceptibility testing results (enrofloxacin), judicious use of non‐steroidal anti‐inflammatory drugs, fluid therapy and gastric ulcer prophylaxis. The horse recovered successfully and is currently in good health (follow‐up of 5 years). Once the infection resolved, unilateral renal scarring occurred. Multidrug‐resistant upper‐urinary infections occur in horses and should be considered in a post‐surgical patient that develops fever. Early diagnosis, urine bacterial culturing and antimicrobial susceptibility testing were crucial in this case to successful management.

Abstract Aortic valve malformation is a common congenital abnormality reported in human medicine. The malformation is characterised by an increased or decreased number of cusps. Anatomical variations of the aortic valve that have been documented in humans include unicuspid, bicuspid, quadricuspid and quinticuspid valves. Two reports described a quadricuspid aortic valve in horses associated with either a ventricular septal defect (VSD) or tetralogy of Fallot. In this case report we describe the clinical and echocardiographic findings of a horse with a quadricuspid aortic valve as single congenital abnormality, referred with history of exercise intolerance and an episode of paroxysmal atrial fibrillation. Limitations and risks of misdiagnosis that can be encountered with transthoracic echocardiography are also discussed. The reported case highlights the importance of echocardiographic screening in asymptomatic patients as congenital heart disease can be present without obvious cardiac signs. As advanced imaging on the equine thorax is still far from future possibilities for adult horses, this report may help to reach an accurate diagnosis with similar cases.

Transcutaneous abdominal ultrasonography using alcohol saturation is used in the diagnostic workup of a variety of conditions in horses. The duration of the examination and the amount of alcohol used in each case may vary depending on several factors. The aim of this study is to describe the breath alcohol test results obtained by veterinarians performing abdominal ultrasound on horses. Six volunteers were enrolled, after written consent, and a Standardbred mare was used for the whole study protocol. Each operator performed a total of 6 ultrasounds by pouring the ethanol solution from a jar or by spray application, for a duration of 10, 30, and 60 min. An infrared breath alcohol analyzer was used immediately after completing the ultrasonography and at 5-min intervals until a negative result was obtained. Positive results were obtained for 0–60 min after the procedure. A statistically significant difference was found between the groups that used more than 1000 mL, 300–1000 mL, and less than 300 mL of ethanol. No significant differences were observed between the type of ethanol administration and the time of exposure. Based on this study, equine vets who perform ultrasound on horses can test positive at the breath alcohol test for up to 60 min following ethanol exposure.

BACKGROUND:Equine neonatal sepsis can be challenging to diagnose and prognosticate. Neutrophil gelatinase-associated lipocalin (NGAL), a new marker of renal damage and inflammation, can potentially be helpful.OBJECTIVES:To evaluate NGAL in neonatal foals with sepsis, and assess its relation to outcome.ANIMALS:Foals ≤ 14 days, with admission blood analysis and stored serum.METHODS:NGAL was measured on stored serum from 91 foals. Foals were scored for sepsis and survival and categorized according to sepsis status (septic, sick non-septic, healthy, and uncertain sepsis status) and outcome groups (survivors and non-survivors). The septic foals were further sub-categorized according to severity (normal sepsis, severe sepsis and septic shock). A Kruskal-Wallis test was used to compare serum NGAL concentrations in survivors and non-survivors, in the sepsis status groups, and in the sepsis severity groups. Optimal cut-off values for serum NGAL concentrations to diagnose sepsis and outcome were determined with receiver operating characteristic (ROC) curves. NGAL was compared to creatinine and SAA.RESULTS:Median serum NGAL concentrations were significantly higher in septic than non-septic foals. However, serum NGAL concentrations did not differ between sepsis severity subgroups. Serum NGAL concentrations were significantly lower in survivors than in non-survivors. Optimal cut-off values of serum NGAL concentrations were 455 μg/L (sensitivity 71.4%, specificity 100%) and 1104 μg/L (sensitivity 39.3%, specificity 95.2%) for predicting sepsis and non-survival, respectively. NGAL correlated to SAA, but not to creatinine. NGAL performed similarly to SAA to diagnose sepsis.CONCLUSION:Serum NGAL concentrations may be useful for diagnosing sepsis and predicting outcome.