Frontier medicine: the future and integrative medicine.

Vigorous and prolonged effort is required to gain true mastery of the healing arts. Conventional and complementary medicine have complementary strengths and weaknesses. Like the yin and yang of traditional Chinese medicine, they naturally flow into one another by a process of induction, creating balance. Integrative medicine is the frontier; it is the future. If we are to progress beyond our current understanding and ability to heal, we must work with theoretic models that allow us and our perception to operate "outside the box." For some, this understanding is intuitive. It is through cooperative and collaborative efforts of intuitively adept and technologically adept minds that we can integrate and advance our understanding; increase our ability to predict, prevent, and diagnose disease; and expand our therapeutic options.     

In vitro investigation of ceruminolytic activity of various otic cleansers for veterinary use

Knowledge of the ceruminolytic activity of commercially available ear cleansing products assists the practitioner to choose the best available product for specific clinical situations. The aim of this study was to quantify and compare the ceruminolytic activity of commercially available canine ear cleansers. For this purpose, the ceruminolytic activity of 13 ear cleansers was evaluated using a standardized synthetic cerumen (SSC) that mimics the composition and texture of canine cerumen. The test products were incubated with mild agitation for 20 min with 500 mg of SSC previously compacted at the bottom of a test tube. Ceruminolytic activity was then assessed by quantifying the SSC removed by decantation. This procedure was repeated five consecutive times on each tube simulating repeated applications in the canine ear canal. Good repeatability among replicates was found in this assay, allowing direct comparisons between products. The final percentage of SSC elimination ranged from none (similar to water), between 8 and 39% for three products and up to 90% for one product (P<0.001). It is concluded that, in the experimental conditions used in this study, only 1/13 products had significant ceruminolytic activity.     

MAGNETIC RESONANCE IMAGING OF PULP IN NORMAL AND DISEASED EQUINE CHEEK TEETH

A retrospective analysis of 619 upper and lower cheek teeth from 62 horses was performed. Based on clinical findings, as well as radiographic and magnetic resonance (MR) imaging findings, the teeth were classified into five groups. There were 20 teeth with abnormal MR imaging signals as well as clinical alterations and 599 healthy teeth. Using MR imaging, the appearance of pulp in diseased and disease‐free teeth was compared, and the appearance of abnormal pulp was studied. Subsequently, the ability of MR imaging to diagnose pulpitis and pulp necrosis in teeth with normal external appearance was investigated. In horses with clinically verified dental disease, abnormal MR imaging findings were confirmed in the pulp of all affected teeth. An enlarged blurred pulp image with a lower signal intensity was observed only in clinically diseased teeth and was a reliable criterion for diagnosing dental disease on MR imaging. On the other hand, partial or complete absence of pulp in all MR imaging sequences was observed in both diseased and nondiseased teeth. These data demonstrate that pulp changes in equine cheek teeth can be evaluated using MR imaging.     

Sialidase activity in Mycoplasma synoviae

Eleven strains of the avian pathogen Mycoplasma synoviae were evaluated for the presence of sialidase activity with the use of the fluorogenic substrate 2'-(4-methylumbelliferyl)-alpha-D-N-acetylneuraminic acid and the sialidase inhibitor 2-deoxy-2,3- didehydro-N-acetylneuraminic acid. The kinetics of in vitro growth in modified Frey medium were also assessed for each strain. Five strains had been isolated from clinically symptomatic chickens, and strains WVU 1853T and K3344 have been demonstrated to be capable of reproducing disease in specific-pathogen-free chickens. All strains exhibited sialidase activity, although the amount varied 65-fold among strains (P < 0.0001) from 1.3 x 10(-7) to 2.0 x 10(-9) activity units per colony-forming unit. Strains originally isolated from clinically symptomatic birds had more (P < 0.05) sialidase activity than strains from asymptomatic birds. Strain WVU1853T exhibited the most sialidase activity (P < 0.0001) and grew to the highest culture density (P < 0.0001) among strains, but across strains, the rank correlation of growth rate with sialidase activity was not significant. Negligible activity was detected in conditioned culture supernatant fluid. This is the first report of sialidase activity in pathogenic strains of M. synoviae, which suggests a potential enzymatic basis for virulence of the organism.     

Effect of different hand-milking techniques on milk production and teat treatment in Zebu dairy cattle

The aim of the study was to test three different hand-milking techniques (“pull down”, “thumb in”, and “full hand grip”) and their effects on milk production and teat treatment. This is important since milk production in many tropical areas still rely on hand-milking. The study was carried out at a peri-urban farm in the Bobo-Dioulasso area in Burkina Faso. Twelve indigenous Zebu cows in early lactation were used in the study. The sequences of the treatments (hand-milking techniques) and the milkers were balanced for carry-over effects between successive periods and days, respectively. The sequences were constructed by using special Latin squares. Yield and composition of saleable milk was not affected by milking technique but there were differences between the milkers in milk yield. There was also a significant interaction for saleable milk yield between milker and milking technique. Hemoglobin in milk was measured as an indicator of teat damage. The hemoglobin content was numerically higher in post-milking strip milk samples than in saleable milk. It was concluded that the amount of milk removed depends mainly on the milker and how well the milking technique works for the individual milker. No effect of milking technique was observed on teat treatment.     

The influence of temperature and age on the T1 relaxation time of the equine distal limb

The extent of fat suppression using short tau inversion recovery (STIR) imaging is variable between horses. Our aim was to determine if patient's age and/or hoof temperature have an influence on the T(1) relaxation time of bone marrow in the equine distal limb, thereby affecting the suppression of fat signal. Magnetic resonance imaging was conducted on standing horses and cadaver samples using a low-field magnet (0.27 T). The hoof temperature was measured at the lateral side of the coronary band. A modified inversion recovery fast spin-echo (IR-FSE) sequence was used to measure the signal intensity for a range of inversion times (TIs) at six different regions of interest (ROI): (1) distal aspect of the proximal phalanx, (2) proximal aspect of the middle phalanx, (3) distal aspect of the middle phalanx, (4) navicular bone, (5) proximal aspect of the distal phalanx, and (6) distal aspect of the distal phalanx. The T(1) of the bone marrow in the equine distal limb was calculated from the results and was found to increase by 3.13 ± 0.08 (SE) ms/°C. There was no significant effect of age (2-16 years) but the T(1) values measured from the limbs of young (< 1 year) animals were considerably longer (32.6 ± 1.7 (SE) ms). Similar effects of temperature and age were found for all measured ROIs but there were significant differences in the mean values of T(1) , ranging from +7.7 (distal aspect of the distal phalanx) to -13.2 ms (distal aspect of the proximal phalanx).     

A review of topical therapy for skin infections with bacteria and yeast

Background – Cutaneous infections with bacteria and yeasts are common in small animal practice. Treatment with systemic antibiotics or antifungal agents may not be ideal, because of the increasing development of multiresistant organisms, the cost and the possible adverse effects. Topical antimicrobials may be used as adjunctive therapy to systemic treatment or as sole therapy instead of systemic treatment. Objective – This literature review evaluated studies on topical antimicrobial treatment of skin infections. Methods – In vitro and in vivo studies evaluating topical antimicrobial agents were identified using a number of electronic and manual searches of textbooks and articles. Studies were evaluated, and the evidence for or against the use of the topical agents was extracted. Results – There is good evidence for the efficacy of chlorhexidine and, to a lesser degree, benzoyl peroxide in canine bacterial skin infections. There is limited evidence for the efficacy of silver sulfadiazine and medical honey against bacterial skin infections in the dog, and for the efficacy of hydrogen peroxide and stannous fluoride in the horse. Good evidence supports the use of a combination of chlorhexidine and miconazole in dogs with cutaneous Malassezia infections. There is insufficient evidence to recommend any other topical therapy for use in cutaneous infections. Conclusions and clinical importance – Although many antimicrobial topicals are marketed in veterinary dermatology, the efficacy has been reported for only a minority of agents. Randomized controlled trials evaluating various topical treatments are therefore urgently needed.