SOP III (1/5) Intravascular examination in patients with Very Late Stent Thrombosis Protocol For Prestige Investigators OCT pullback during emergency percutaneous coronary intervention (PCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI) caused by DES LST. Exclusion criteria for OCT pullback: 1. Cardiogenic shock (BP < 80mm Hg
Keswickequineclinic.comMembers of the American
Association of Equine
201 Taylor Avenue, Gordonsvil e, VA 22942 540-832-3030 Greg R. Schmidt, DVM Mark H. Foley, DVM Rebecca W. Kramer, DVM Martha A. Mellish, DVM Variations in each horse’s immune system and management situation should be reflected in its individ- ual de-worming program. Many horses, especially if kept at an appropriate number of horses per acre, with good pasture maintenance, do not require de-worming every 2 months. Studies have shown ZIMECTRIN®, IVER-that in most horse populations, 20% of the horses carry 80% of the parasite burden. These horses with CARE®, ROTECTIN ®1.87%, high worm loads should be treated more frequently than those with a naturally high resistance to worms. To determine whether de-worming is necessary, fecal flotations should be performed 2 to 3 times a year. This test measures the number of parasite eggs being shed in the manure. The appropriate time to take a fecal test is determined by the type of de-wormer last ad- ministered. Parasite eggs, which are being measured in the fecal flotation, are not shed for 4 - 6 weeks after de-worming with fenbendazole (Panacur) and pyrantals (Strongid), 8– 10 weeks after using an ivermectin product and 12 –16 weeks De-wormer used
Weeks post-deworming to
after moxidectin (Quest) administration. Sam- take sample
ples should be taken 1 to 2 weeks after the horses are beginning to shed to determine the By using the results of fecal flotations in the decision to de-worm, anti-parasite drugs can be used more effectively. This wil result in less de-wormers being used, especially for those horses with a naturally high resistance to para- sites. Horses that have a low parasite load should still be de-wormed with an ivermectin product at least twice a year – preferably in the fall (September/October). This de-wormer will be timed to kill strongyles they picked up in spring and to kill any bots they ingested. A second de-worming with ivermectin or moxidectin can be performed, again after a fecal sample is submitted 9-10 weeks after de-worming with ivermectin, in December/ January. Winter is also the best time to de-worm for tapeworms. The combination products of iver-mectin/praziquantel (Equimax or Zimectrin Gold) and moxidectin/praziquantel (Quest Plus) are ideal for the winter de-worming. As the grass begins to grow in the spring, a fecal sample should be taken. Horses appropriately de-wormed with a high resistance to worms may not need to be de-wormed before being turned out on pasture. Horses with a high fecal count should be de-wormed for their own health and to ensure they do not contaminate the pasture. Fecal samples can be collected by us during spring and fall vaccines, or can be submitted to the clinic. Traditional de-worming program. Also used
Modified de-worming program. Used for horses
for horses who shed high numbers of eggs.
with low fecal egg counts.
Moxidectin is a very effective de-wormer. However, due to its potency it is
important to accurately de-worm according to weight. We do not recommend
this medication for foals, horses with an unknown de-worming history, geri-
atric or sick horses.
What to expect.when your mare’s expecting!
Congratulations! You had the good news last summer when your mare was confirmed. You administered pre-foaling vac-
cines and de-wormed with ivermectin 4-6 weeks before the anticipated foaling date. She has been off fescue for 60
days. If she is Cushinoid she has been off Pergolide for 30 days. Now when exactly is she going to foal? The honest an-
swer is whenever she feels like it! We can estimate the foaling date using the normal duration of pregnancy of 335 to
342 days. Other signs of impending foaling include udder enlargement, waxing on teat ends and relaxation around the
tail head, buttocks and lips of the vulva. Udder enlargement normally begins two weeks before foaling with waxing start-
ing 24 to 48 hours prior to foaling.
Commercial test kits (such as FoalWatch) measure the concentration of calcium in pre-foaling milk. The calcium levels increase as the mare gets closer to foaling. These test are most useful in predicting that a mare is not going to foal in the next 24 hours—hopefully preventing unnecessary monitoring. When your mare does decide to foal, the first stage of labor is often shown by the mare acting restless, some- times looking like a mild colic. This behavior is due to the mare’s uterus beginning to contract and position the foal for delivery. Once the water has broken, labor is an explosive event lasting around 20 minutes. If you are present for labor and your mare is actively straining for longer than 20 minutes, with no progress of delivery, it is time to intervene and call a veterinarian. After the foal is delivered, remember the 1, 2, 3 rule. The foal should be standing by 1 hour, nursing by 2 hours and have passed its meconium by hour 3. A Fleet enema can be administered to encourage the foal to pass the meconium. A normal foal nurses approximately 6 times an hour. The mare should pass the placenta soon after the foal is delivered. A placenta that is retained past 3 hours is a concern. This problem can sometimes be treated with oxytocin injections, however lavage of the uterus may be necessary. Please cal the clinic for advice if your mare does retain her placenta past 3 hours. De-worming the mare with an ivermectin product within 24 hours after foaling is recommended. This decreases the transmission of parasites from mare to foal. The umbilicus should be dipped with a dilute chlorhexidine solution. This can be repeated 3-4 times a day for the first few days of life, or until the umbilicus is dry. A newborn foal does not have any innate protection against the bacteria and viruses present in it’s environment. It receives all of its protection from the anti-bodies in the mare’s colostrum. To ensure the foal has received enough colos-trum, we recommend a blood test approximately 12 to 24 hours after the foal has first nursed, depending on the health of the foal. This test is performed on the farm and measures the levels of anti-bodies present in the foal blood. This trans-mission of immune factors from mare to foal only occurs during the first twelve hours of the foals life. This is when the gut is open and able to absorb the anti-bodies from the colostrum. This is why it is so important the foal starts nursing in a timely manner. The first 24 hours after foaling is an excellent time for us to examine the mare and foal to ensure they are healthy and happy. A placenta exam can also be done at this time—so remember to keep it for us. Please cal the clinic when your mare has foaled to set up an appointment. Highlights from the 2007 Conference of American Association of Equine Practitioners
Researchers from Colorado State University compared the
A study from Texas A & M looked at the effect of feed- response of horses affected with experimentally induced ing alfalfa hay compared to coastal Bermuda hay on carpus (knee) arthritis using a topical anti-inflammatory gastric ulcers. 92% of yearlings fed alfalfa hay did not cream (Surpass®) compared with oral phenylbutazone or develop gastric ulcers or had improvement in gastric ul- no treatment. The best response in lameness scores was ob- cers compared to 25% of those fed coastal Bermuda hay. tained with the Surpass® compared to bute or no treatment. Both groups were fed equivalent amounts of 15% protein The ointment also has the advantage of decreased systemic concentrate feed and exercised 3 times a week on a me- side effects compared to bute. It should be noted that this chanical walker. It was suggested alfalfa hay reduces the study was funded by the makers of Surpass ®. acidity of the equine stomach, decreasing the severity of ulcers. What is a “Fescue Foal”?
you may have heard the term nancy and foaling. Endo- “fescue foal”. This term refers phyte infected fescue is pre- longed pregnancy, thickened ginia— especially with the dier in drougth conditions, but foal. To prevent any prob- Foal vaccine and deworming schedule
Immunity transferred to the foal from colostrum begins waning around 4- 5 months of age. We recommend beginning vacci- nations at this age to ensure the foal is properly protected by the vaccines as the maternal anti-bodies are declining. The schedule outlined below is for foals born from properly vaccinated mares. Foals born from unvaccinated mares can and should be vaccinated earlier—starting as early as 1 month of age. Due to their high susceptibility to parasites, foals should be de-wormed once a month for the first 12 months. As yearlings they can be placed on an adult rotational de-worming program. Eastern and Western Encephalitis Rhinopneumonitis/ Influenza marshy areas, these seed heads rays, using the IDEXX Digital Radi-
ography System. Digital x-rays (or
be reluctant to eat. Avoid hay graphs are displayed on the lap-top CD, allowing you to have a that contains foxtail and keep screen and can be viewed seconds Dr. Martha Mellish is a 2005 graduate of the Atlantic Veterinary College located in her native Prince Edward Is-land, Canada. After moving to Virginia and completing an equine internship at Woodside Equine Clinic, she then prac- ticed in the Shenandoah Val ey. Deciding that Virginia wasn't quite hot enough, she then worked at an equine practice in western Australia for 6 months before joining Keswick Equine Clinic as an associate veterinarian. Dr. Mellish's veteri-nary interests include reproduction and lameness. Dressage is Dr. Mellish's equine sport of choice, having competed up to the Young Rider level. She is currently learning about young horse training on her 5 year old Dutch Warmblood. When not spending time with horses, Dr. Mel- lish enjoys hiking with her boyfriend, who is also a veterinarian. Marci Clowney relocated to Virginia, taking an office staff position at Keswick Equine Clinic in January of 2008 and hasn’t looked back! She was born in Eastern Pennsylvania where she grew up volunteering at the Devon Horse Show and only left home to attend Averett University. A move to South Carolina brought some great experience with two wel known 3 day eventers. From there, Marci went on a world wide adventure when she ran away and joined the circus which eventually led to travelling with Cirque du Soleil on their Asia- Pacific tour. Despite her travels, Marci has always found time for horses, even in the heart of Sydney, Australia. Marci and her son Ayjai, are looking for- ward to exploring all that Virginia has to offer. We’re on the web: www.keswickequineclinic.com 201 Taylor Avenue Gordonsville, VA 22942 Phone: (540)832-3030 Fax: (540)832-2508 E-mail: email@example.com Dr. Rebecca Kramer Dr. Martha Mellish Rachel Harrison Ada S. Patterson Ellen Wrenn Marci Clowney
Veterinary Microbiology 89 (2002) 303–309Distribution and characterization of class 1 integronsin Salmonella enterica serotype GallinarumHyuk Joon KwonTae Eun Kim, Sun Hee ChoJae Goo SeolaInstitute of iNtRON Biotechnology, Seoul, 138-200, South KoreabDepartment of Microbiology, College of Medicine, Cheju National University,cDepartment of Biochemistry, College of Medicine, Cheju Nation