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Treatment of Uterine Infections and Associated Endometritis in Mares--A Comparative Study.

Introduction

Uterine infection and associated endometritis is the most common cause of infertility in broodmares, the most important being persistent mating induced endometritis (PMIE) and post-breeding metritis (PMB). PMIE and PBM occur as sequelae to poor uterine defense mechanism in infertile mares (Hughes, 1993) and account for major causes of conception failure in broodmare practice. The recorded incidence of PMIE is about 15% in breeding mares (Traub-Dargatz et al., 1991; Newcombe, 1997; Zent et al.,1998). Uterine infection is inevitable during breeding and foaling in mares and resolves within 72 hours post-breeding and 10-15 days post-foaling in post-partum mares (Ricketts and Mackintosh, 1987; Card, 1997). Young maiden mares are resistant to uterine infections owing to effective cellular and humoral immunological uterine defense mechanisms (Hughes, 1993; Hurtgen, 2006). However, old pleuriparous mares are unable to overcome these uterine infections, due to inadequate uterine defense mechanisms and poor conformation, leading to accumulation of uterine fluids and subsequent development of endometritis associated with oedema and thickness of uterine wall (Hurtgen, 2006; Lu and Morresey, 2006). Mares affected are usually the best performing proven mares and therefore huge effort, manpower and money are required to manage and treat such conditions year after year (Relias, 2001).

Therapeutic management of equine endometritis is of utmost importance and involves adoption of necessary measures to achieve rapid uterine clearance, potentiating uterine cellular and humoral defense mechanisms and effective antibiotic therapy to clear invading uterine pathogens (Causey, 2006). Uterine lavage with isotonic saline removes uterine pathogens, debris and inflammatory exudates, and improve luminal phagocytic activity against pathogens (Asbury, 1984a; Troedsson et al., 1995). Oxytocin (Cadario et al., 1999a, b), Prostaglandin and its analogues (Combs et al., 1996) are of additional advantage to induce evacuation of uterine contents and there by enhance therapeutic effect of antibiotics against uterine pathogens.

Evacuation of uterine inflammatory exudates is primary requirement to obtain success through local and parenteral antibiotic therapy in infertile mares (Causey, 2006). Uterine ecbolics, luteolytic agents, uterine lavage and/or plasma infusion are recommended prior to selection of antibiotic therapy in equine endometritis (Bermudz et al., 1995; Zent et al., 1998; Causey, 2006). The use of antibiotics during treatment should be guided by microbiological investigations and in vitro sensitivity patterns of isolated uterine pathogens from affected mares (Bermudz et al., 1995; Zent et al., 1998). Further, management of perineal disconformation, foaling wounds over perineum and vulvo-vaginal region should be attempted prior to therapeutic antibiotic approach in recurrent and persistent equine endometritis (Hurtgen, 2006; McCue, 2008).

Oxytocin

Therapeutic management of equine endometritis with Oxytocin was initially reported by Allen (1991) and was considered to promote uterine drainage and strengthen uterine defense mechanism (Allen, 1991; Pycock and Newcombe, 1996). Oxytocin induces high amplitude uterine contractions of approximately 30 minutes duration (LeBlanc, 2008). Repeated administration of Oxytocin is required due to its 6.8 minute half-life (Paccamonti et al., 1999; Troedsson et al., 1995). Nie et al. (2002) proposed that Oxytocin should be repeated every 6 hours, while Hurtgen (2006) found that in refractory cases it may be repeated after an interval of 2 hours. Causey (2006) recorded that a single dose of Oxytocin can successfully treat around one third of uterine infections in subfertile mares. Housing of mares susceptible to uterine infection in vicinity of breeding stallions induces endogenous release of Oxytocin and assists in clearance of uterine exudates (Madill et al., 2002).

Prostaglandin and its Analogues

PG[F.sub.2[alpha]] causes weaker uterine contractions than Oxytocin and is less effective in evacuating uterine exudates; though myometrial contractions may last longer than Oxytocin for about 5 hours (Cadario et al.,1995; LeBlanc, 1997). PG[F.sub.2[alpha]] enhances uterine immune defense mechanism and induces uterine lymphocytic proliferation in infertile mares (Lewis, 2004) as well as neutrophil chemotaxis and phagocytosis (Kelly et al., 2001; Seals et al., 2003). Cloprostenol is particularly useful in cases with excessive uterine oedema post-ovulation which does not resolve with Oxytocin or other prostaglandin analogues. This is due to sustained uterine contractions caused by action of Cloprostenol (Combs et al., 2006). Cloprostenol is frequently administrated in therapeutic doses of 250 [micro]g IM at interval of 24 hours, but higher and more frequent doses should be avoided (Brendemuehl, 2000; Nie et al., 2002). Fenprostalene, another Prostaglandin analogue was used by Combs et al. (1996) to study its effect on clearance of radiocolloid from uterus of mare and was found inferior to both PG[F.sub.2[alpha]] and Cloprostenol.

Uterine Lavage

Uterine lavage with sterile, isotonic saline promotes evacuation of uterine exudates consisting of cellular debris, phagocyozed bacteria and phagocytes and enhances uterine phagocytosis and circulation (Asbury 1984a; Troedsson et al., 1995). Early drainage of uterine debris and inflammatory exudates by uterine lavage often helps uterine inflammation to subside early (Knutti et al., 2000). Troedsson et al. (1995) observed that saline uterine lavage was as effective as penicillin in reducing Streptococcus population from uterine lumen. Administration of uterine lavage increased conception rates in infertile mares when used in combination plasma infusion and Oxytocin therapy (Asbury, 1984 b; Knutti et al., 2000).

Intrauterine Antibiotics

Intrauterine antibiotics along with parenterel antibiotic therapy are often advocated in equine persistent endometritis. Further, pre-treatment with uterine ecbolics increases therapeutic efficacy of antibiotic treatment in endometritis mares (Pycock and Newcombe, 1996). Persistent uterine infection with highly pathogenic organisms such as Klebsiella, Pseudomonas and Taylorella warrants preference for intrauterine antibiotics over parenteral antibiotic therapy (Watson, 1997; Hughes et al., 1966). Further, minimum inhibitory concentration (MIC) is more rapidly achieved with intrauterine administration of antibiotics as compared to systemic antibiotic therapy (Bowen et al., 1984; Spensley et al., 1986). Indiscriminate use of antibiotics in post-partum equine endometritis favors establishment of fungal uterine infection along with growth of resistant bacteria populations in uterine lumen (Davis and Abbitt, 1977; Ricketts, 1997) and thus such approach should not be adopted in treating uterine infections. Therapeutic management of equine endometritis should involve consideration of infusion vehicle (saline or buffer), volume of vehicle (at least 50 ml) and adequate therapeutic dose of local and/or parenterel antibiotic therapy (Asbury and Lyle, 1993; Brinsko, 1996; Troedsson, 1996; Causey, 2006).

Post-breeding antibiotic therapy prevents establishment of uterine infection and ensures conception in chronically infected mares.

Different workers have reported different treatment protocols for successful therapeutic management of uterine infections in mares, but the reports continue to be equivocal. Present study was therefore attempted to strengthen the existing body of knowledge on therapeutic aspects of equine endometritis along with evaluation of post-treatment fertility with the objective to evaluate therapeutic efficiency of three different treatment regimens in uterine infection in subfertile mares.

Materials and Methods

Mares stationed at Equine Breeding Stud-EBS (an equine breeding establishment of Remount Veterinary Corps of Indian Army, Hisar) constituted the experimental animals for the present investigation.

The ultrasonographic studies were performed at the EBS by means of a portable ultrasound machine. The samples collected at the breeding stud were processed for uterine cytology in the departmental laboratory and for uterine culture and antibiotic sensitivity in the College Central Laboratory.

Experimental Design

The animals were screened on 1st day by per-rectal examination and uterine ultrasonography and uterine flush samples were collected. The flush samples were processed for uterine cytology, uterine culture and ABST (Nafis et al., 2015). Mares declared as having uterine infections by any two of the diagnostic techniques were considered positive for uterine infections and associated endometritis. The results of diagnostic tools used were read independent of mares` history. As such twenty one (21) mares with uterine infections and associated endometritis were identified. These endometritis mares were categorized into three treatments (Group I, II and III) of seven mares each. Group I mares were treated with saline uterine lavage (500 ml) + PG[F.sub.2[alpha]] (10 mg, IM) + intrauterine antibiotic infusion (based on in-vitro ABST). Uterine lavage and PG[F.sub.2[alpha]] was given on day 0 of treatment and intrauterine antibiotics were infused on 3rd day and continued for 3-5 consecutive days or till complete clearance of uterine infection. Few mares evidenced severe sweating following PG[F.sub.2[alpha]] administration. They were given Pheniramine maleate (10 ml, IM). Group II mares were treated with saline uterine lavage (500 ml) + Cloprostenol (250 [micro]g, IM) + intrauterine antibiotic infusion (based on in vitro ABST). Uterine lavage and Cloprostenol was given on day 0 of treatment and intrauterine antibiotics were infused on 3rd day and continued for 3-5 consecutive days or till complete clearance of uterine infection. The mares of group III were treated with saline uterine lavage (500 ml) + Oxytocin (60 IU, IM) + intrauterine antibiotic infusion (based on in vitro ABST). Uterine lavage and Oxytocin was given on day 0 of the treatment. Three doses of Oxytocin (20 IU each) were given to mares after 2 hour intervals. Intrauterine antibiotics were administered from 3rd day of treatment and continued for 3-5 consecutive days or till complete clearance of uterine infection. Besides the twenty one endometritis mares, 6 normal mares were also identified on the basis of history and the aforesaid diagnostic techniques and were assigned to Group IV. These mares were treated with uterine lavage (500 ml) + a single dose of intrauterine penicillin (5 x 106 IU). The intrauterine penicillin was administered in order to negate any chances of seeding infections during lavage procedure in this group. Group IV served as a control group against which the results of groups I, II and III were compared besides being compared amongst themselves.

Therapeutic efficacy of three different treatment regimens was evaluated and compared on the basis of resumption of utero-ovarian function and post-treatment fertility. The utero-ovarian function was evaluated in terms of post-treatment correction of uterine exudates/uterine infection, uterine luminal and wall morphology (edema and thickness) as evidenced by ultrasonographic examination conducted between 7-10th days after completion of treatment protocol. Absence of uterine fluid and wall thickness was interpreted as resolution of infection and treatment was deemed as effective. In case of persistence of uterine fluid after treatment as found by ultrasonography, the treatment was recorded as ineffective. The post-treatment fertility was evaluated by onset of estrus, resumption of normal estrous cycle duration and conception status after first three AIs. All mares were teased daily in the morning with vasectomised stallion for estrus detection, which was later confirmed by recto-vaginal examination and ultrasound for evidence of graffian follicle (>30 mm diameter) and cervical relaxation. Mares in true estrus were subjected to AI and conception was recorded between 20-30th days post-insemination by ultrasonography upto three consecutive estrus cycles.

Collection of Samples

Uterine flush samples were collected for three procedures viz uterine cytology, uterine culture and ABST. Uterine flushings from experimental mares (Group I, II, III and IV) were collected by low volume flush technique (LeBlanc, 2008; Card et al., 2004; Ball et al., 1988a) using two way Foley`s catheter (Bard Urological Georgia, USA; no. 24) and sterilized phosphate buffer saline-PBS (pH, 7.2). A disposable Foley`s catheter with a sterile metal stillete and covered in sanitary sheath was introduced per vaginum with lubricated hand covered with sterilized glove. Cervix was opened with digital pressure to introduce the catheter beyond the cervix into uterus. Mares with tightly closed cervix that could not yield to digital pressure were administered a single dose of PG[F.sub.2[alpha]] (5-10 mg IM) and were sampled after 36 hours of PG[F.sub.2[alpha]] administration. Uterine flushings were collected just after initial clinical examination. Sterile PBS (100 ml) was infused into the uterus through Foley's catheter using sterile disposable intravenous set. The uterus was manipulated per rectum to distribute the PBS into both uterine horns and then the PBS (60-80 ml) was recovered in sterile glass test tube by gravitational flow assisted by per rectal manipulation of uterine horns. The tubes were immediately capped to prevent contamination.

The uterine sample that was recovered after low volume uterine flush was divided into two parts (20 ml each) inside a safety cabinet (laminar flow) so as to prevent contamination by ambient factors. The two samples were then separately processed, one for uterine cytology and other for uterine microbiology (culture and sensitivity). The portion of flush sample that was selected for microbiological examination was necessarily dispensed into sterile disposable centrifuge tube (conical bottom, centrifuge tube). The test tubes containing the uterine sample were placed inside a thermos flask containing mixture of ice and common salt and taken to laboratory for immediate processing for cytological and microbiological examinations. If processing was delayed due to some reason, samples were necessarily stored in refrigeration.

In Vitro Antibiotic Sensitivity Test

The in vitro antibiotic sensitivity test (ABST) was performed in order to determine the specific antibacterial and antifungal agents that would be specifically active against particular isolates of bacterial of fungal pathogens obtained from infected mares. The sensitivity or otherwise of a total 12 antibacterial and 6 antifungal antibiotics was evaluated. Antibiotics selected for this purpose were all reportedly used by different equine practitioners via intrauterine route for treatment of uterine infections. The pattern of sensitivity of various bacterial isolates to different antibiotics was studied by single disc diffusion method (Ellner, 1978) using commercially available discs (Hi Media laboratories Pvt. Ltd. Mumbai). Antibiotic discs of different concentrations were used (Penicillin-G: 100 units; Streptomycin: 10[micro]g; Tetracycline: 30[micro]g; Ampicillin: 10[micro]g; Gentamicin: 10[micro]g; Ciprofloxacin: 5[micro]g; Ceftriaxone: 30[micro]g; Cephalexin: 30[micro]g; Chloramphenicol: 30[micro]g; Cefuroxime: 30[micro]g; Norfloxacin: 10[micro]g; Co-trimoxazole 25[micro]g).

In vitro sensitivity of fungal isolates to different antibiotics was carried out by disc diffusion method according to recommendations described in M44-A guidelines (NCCLS, 2004). Sensitivity was evaluated against following antibiotic discs. Ketoconazole: 10ug; Itraconazole: 10ug; Clotrimazole: 10[micro]g; Fluconazole: 10[micro]g; Amphotericin: 100 units and Nystatin 100 units. Sabouraud`s dextrose agar (SDA) medium was used for the test. The plates were then incubated at 30 [+ or -] 20C for 24-120 hours. The isolates were classified as resistant or sensitive to a particular antibiotic based on diameter of zone of inhibition (Pfaller et al., 2004).

Procedure of Uterine Lavage

Mares were restrained in trevis and vulva and perineum cleaned with 2% solution of Savlon (a) and disinfected by 5% solution of Povidone-Iodine and rectified spirit. 500 ml of sterile NSS was infused into the uterus using two way Foley`s catheter connected to a disposable intravenous set and uterine contents were then flushed out after thorough rectal massage of uterine horns and uterine body to ensure complete recovery of infused saline. The lavage was recovered under gravitational flow assisted by per-rectal manipulation of uterine horns to collect maximum volume of infused saline.

Intrauterine Infusion of Antibiotics

Mares positive for uterine infections were treated with intrauterine administration of antibacterial or antifungal agents in a suitable vehicle, based on in vitro sensitivity of uterine pathogens. Intrauterine antibiotic infusions were performed using sterile plastic intrauterine insemination catheter for mares. Mare was restrained in a stock and vulva and perineum cleaned with with 2% solution of Chlorhexidine (Savlon (a)) and subsequently disinfected by 5% solution of Povidone-Iodine (Cipladine (b)) and rectified spirit to prevent external contamination. The sterile plastic catheter was introduced per vaginum beyond mid cervix with hand covered with sterlized rubber glove. The required antibiotic solution prepared after proper dilution and/or buffering (minimum 100 ml volume) was infused into uterus with the help of disposable plastic syringe (60 ml) and catheter was removed after intrauterine infusion.

Results

Therapeutic Response

The treatment protocol followed and therapeutic response obtained in different treatment groups are shown in tables 1. It can be observed that treatment regimen instituted in Group I mares was successful in clearing the uterine exudates and associated uterine infection in four out of seven mares (57.14%). Treatment protocol applied to group II mares was successful in five out of seven cases (71.4%). In case of group III, five out of six mares (83.33%) could be identified as treated for uterine infections at the time of post-treatment examination. It is thus clear that therapeutic regimen adopted in Group III (saline lavage + Oxytocin + intrauterine antibiotic infusion) was most effective in clearance of uterine luminal exudates and associated uterine infection, followed by protocol instituted in Group II (saline lavage + Cloprostenol + intrauterine antibiotic infusion). The treatment regimen followed for Group I (saline lavage + PG[F.sub.2[alpha]] + intrauterine antibiotic infusion) was found to be least effective in clearance of uterine exudates and uterine infection.

Post-Treatment Fertility

Six out of seven mares treated with assigned therapeutic regimen of Group I resumed estrous cycle (85.71%) and two out of these six mares (28.57%) conceived after AI (one mare at 2nd AI and one mare at 3rd AI). One out of 7 infertile mares failed to resume estrous cycle (14.29%). Of the Group II mares six out of seven resumed estrous cycles (85.71%) and four out of these six mares (57.14%) conceived after AI (two mares at 1st AI and two mares at 2nd AI). One out of 7 infertile mares of this group failed to resume estrous cycle following the treatment (14.29%). Out of the seven mares of treatment group III, one mare died in accident during the treatment period. Four mares out of the remaining 6 infertile mares treated with assigned therapeutic regimen of Group III resumed estrous cycle (66.66%) and two out of these four mares (33.33%) conceived after AI (one mare at 1st AI and one mare at 2nd AI). Two out of these six mares failed to resume estrous cycle following treatment (33.33%). All the 6 mares of Group IV exhibited estrous cycle (100%) and conceived after AI. (two at 1st AI, three at 2nd AI and one mare at 3rd AI). The results of post-treatment fertility for the infertile mares (Group I, II, III) and control mares (Group IV) are represented in Table 2. It is clear from the table that treatment regimen followed for Groups I and II gave the best results for resumption of estrous cycle in treated mares, but higher pregnancy rates (57.14%) were recorded for the treatment protocol followed for Group II. As such the treatment regimen comprised of uterine lavage + Cloprostenol + intrauterine antibiotic infusion was the most effective treatment in the management of uterine infections in endometritis mares.

Discussion

Four mares out of 7 infected mares (Group I) cleared uterine exudates and associated uterine infection (57.14%) with therapeutic regime involving PG[F.sub.2[alpha]]. PG[F.sub.2[alpha]] induces uterine contractions; however, uterine clearance is considerably slow, with contractions lasting for approximately 5 hours (Combs et al., 1996; Troedsson et al., 1995a). Five mares out of 7 infertile mares (Group II) cleared persistent uterine infection (71.4%) with treatment regimen involving Cloprostenol. This slightly superior therapeutic response with Cloprostenol than PG[F.sub.2[alpha]] can be ascribed to prolonged uterine contractions induced by this synthetic Prostaglandin analogue (Troedsson et al., 1995a; Brendemuehl, 2002). Six out of 7 infertile mares (Group III) responded to therapeutic regimen involving Oxytocin (83.33%) and therapeutic response closely resembles with reported observation of clearance of uterine infection with Oxytocin along with intrauterine antibiotics (72%) than Oxytocin alone (63%) in infertile mares (Pycock and Newcombe, 1996). Further superior response with Oxytocin than PG[F.sub.2[alpha]] and Cloprostenol in clearance of uterine exudates could be attributed to induction of uterine contractions of higher amplitude (for 30 minutes) by Oxytocin (LeBlanc, 2008). Further, PG[F.sub.2[alpha]] is secreted in response to Oxytocin stimulation of the multiparous uterus, owing to neurological sequelae from repeated mechanical stretch (Rigby et al., 2001; DeLille et al., 1998). This may also explain the superior results obtained in group III (Oxytocin treated) compared to groups I and II with respect to proportion of uterine fluid free mares observed on ultrasonography after completion of treatment.

It may be noted that in mares, uterine contractility may be beneficial in reducing fluid volume but not for reducing bacterial quantity (Nikolakopoulos and Watson, 1999). Thus mares declared treated (no intrauterine fluid accumulation) after they were evaluated by post-treatment ultrasonography may necessarily not perform better when evaluated for post-treatment fertility.

Post-Treatment Fertility

Six out of seven infertile mares (Group I) responded to therapeutic regimen involving PG[F.sub.2[alpha]] by exhibiting estrus and cyclic ovarian activity within 7-10 days post-treatment. Further 2 mares out of 6 mares bred by AI conceived. PG[F.sub.2[alpha]] besides being a prompt luteolytic agent, also induces stimulation of uterine cellular immune function, uterine phagocytic activity along with prolonged uterine contractions that aid in clearance of uterine exudates (Lewis, 2004; Hirsbrunner et al., 2003; Nakao et al., 1997; Kelly et al., 2001; Seals et al., 2003). The lower fertility of Group I mares seems to be due to chronic infertility during last two to three breeding seasons and thereby continued hormonal variations along with utero-ovarian dysfunction. The fact that results of clinical trials of PG[F.sub.2[alpha]] for treatment of clinical endometritis in absence of an active corpus luteum are inconsistent (LeBlanc et al., 2002; Steffan et al., 1984; Sheldon and Noakes, 1998) could also explain why animals treated prostaglandins exhibited varied results.

Six out of 7 infertile mares (Group II) responded to therapeutic regimen involving Cloprostenol by exhibiting estrus and cyclic ovarian activity within 7-10 days post-treatment and four out of them conceived. Recorded therapeutic effect of Cloprostenol following uterine lavage in resumption of ovarian cyclic function is consequential to clearance of uterine infection with prolonged stimulation of uterine contractions (Troedsson et al., 1995a; Brendemuehl, 2002) as well as its effective therapeutic response in chronic endometritis with uterine lymphatic stasis (Brendemuehl, 2002). Further, Combs et al. (1996) observed that radiocolloid was not cleared consistently in mares after PG[F.sub.2[alpha]] treatment, while Cloprostenol consistently caused the most rapid clearance of radiocolloid. Administration of Cloprostenol also causes a sustained increase in intrauterine pressure (Goddard and Allen, 1985). The prolonged uterine contractions and possibility that Cloprostenol has a higher binding affinity for prostaglandin receptors in myometrium (Josimovich, 1973) likely contribute to its better performance.

Four out of six infertile mares (Group III) responded to therapeutic regimen involving Oxytocin by exhibiting estrus and cyclic ovarian activity within 7 -10 days post-treatment. Further, two out of these four mares bred by AI conceived. Therapeutic response both in terms of resumption of cyclic ovarian function and occurrence of estrus as well as fertility following three consecutive inseminations were indicative of synergistic effect of uterine lavage and Oxytocin in evacuation of uterine exudate along with associated uterine infection. Oxytocin induces high amplitude uterine contractions, consistent in duration as well as in its ecbolic effect (LeBlanc, 2008).

In conclusion, it may be stated that therapeutic regimen involving saline uterine lavage + Cloprostenol + intrauterine antibiotic infusion is recommended as first preference treatment owing to the superior post-treatment fertility achieved with this treatment protocol. However, treatment regimen involving saline uterine lavage + oxytocin + intrauterine antibiotic infusion may be recommended where clearance of uterine exudates is the primary objective. This treatment regimen may also be recommended as a second preference treatment in management of infections in endometritis mares.

Acknowledgements

Sincere thanks to the administration of EBS-Hisar for providing us the mares and assistance in terms of manpower. Special thanks are due to Lt. Col (Dr) A H Haldar and Lt. Col (Dr) J Taneja for their valuable cooperation. Dr Anshu Sharma, Sr. Scientist and Incharge of College Central Laboratory deserves a special mention for all the help and cooperation.

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Nafis Ibni Assad (1), N.S. Bugalia (2) and R.K. Chandolia (2)

Department of Veterinary Gynaecology and Obstetrics

College of Veterinary Science

Lala Lajpat Rai University of Veterinary and Animal Sciences (LUVAS)

Hisar - 125004 (Haryana)

(1.) Resesrch Scholar and Corresponding author.

E-mail: dnnaie2020@gmail.com

(2.) Professor

(a) - Brand of ITC Ltd., Kolkata

(b) - Brand of Cipla Ltd., Mumbai
Table 1: Treatment protocol and its therapeutic response of different
groups

     Treatment regimen besides uterine lavage
     (500 ml NSS)
Sr.  Ecbolic                        Intrauterine     Reference
no   agent                          antibiotic       for antibiotic



     Treatment group I (n=7)
1    PG[F.sub.2[alpha]] (10 mg IM)  Penicillin       Causey
                                    (5-10x106 IU)    (2006)

2    PG[F.sub.2[alpha]] (10 mg IM)  Fluconazole      Dascanio and
                                    (100 mg)         Ley (2000)


3    PG[F.sub.2[alpha]] (10 mg IM)  Chloramphenicol  McKinnon and
                                    (2-3 g)          Voss (1993)
4    PG[F.sub.2[alpha]] (10 mg IM)  Cefalexin        Causey
                                    (4.0 g)          (2006)
5    PG[F.sub.2[alpha]] (10 mg IM)  Penicillin       Causey
                                    (5-10x106 IU)    (2006)

6    PG[F.sub.2[alpha]] (10 mg IM)  Penicillin       Causey
                                    (5-10x106 IU)    (2006)
7    PG[F.sub.2[alpha]] (10 mg IM)  Penicillin       Causey
                                    (5-10x106 IU)    (2006)
     Treatment group II (n=7)
1    Cloprostenol                   Penicillin       Causey
     (250 [micro]g IM)              (5-10x106 IU)    (2006)

2    Cloprostenol                   Cefalexin        Causey
     (250 [micro]g IM)              (4.0 g)          (2006)
3    Cloprostenol                   Cefalexin        Causey
     (250 [micro]g IM)              (4.0 g)          (2006)
4    Cloprostenol                   Penicillin       Causey
     (250 [micro]g IM)              (5-10x106 IU)    (2006)
5    Cloprostenol                   Chloramphenicol  McKinnon and
     (250 [micro]g IM)              (2-3 g)          Voss (1993)

6    Cloprostenol                   Ciprofloxacin    Al-Bagdadi et al.
     (250 [micro]g IM)              (2-3 g)          (2004)
7    Cloprostenol                   Cefalexin        Causey
     (250 [micro]g IM)              (4.0 g)          (2006)
     Treatment group III (n=7)
1    Oxytocin                       Ciprofloxacin    Al-Bagdadi et al.
     (60 IU, IM)                    (2-3 g)          (2004)
2    Oxytocin                       Chloramphenicol  McKinnon and
     (60 IU, IM)                    (2-3 g)          Voss (1993)


3    Oxytocin                       Penicillin       Causey
     (60 IU, IM)                    (5-10x106 IU)    (2006)
4    Oxytocin                       Chloramphenicol  McKinnon and
     (60 IU, IM)                    (2-3 g)          Voss (1993)
5    Oxytocin                       Cefalexin        Causey
     (60 IU, IM)                    (4.0 g)          (2006)

6    Oxytocin                       Chloramphenicol  McKinnon and
     (60 IU, IM)                    (2-3 g)          Voss (1993)
7    Oxytocin                       Ciprofloxacin    Al-Bagdadi et al.
     (60 IU, IM)                    (2-3 g)          (2004)


     Post-treatment therapeutic response by
     ultrasonographic examination
Sr.  Ultrasound observation of               Post-
no   uterus                                  treatment
                                             uterine
                                             infection


1    Small amount of echogenic uterine       Positive
     exudates along with non-echogenic
     exudates. Uterine wall compact
2    No echogenic or non-echogenic           Negative
     exudates in uterine lumen.
     Normal uterine wall thickness.
     Uterine cavity hardly appreciable.
3    Some amount of echogenic uterine        Positive
     exudates in left uterine horn.
4    Uterine wall thickening along with      Positive
     some echogenic uterine exudates
5    Small amount of non-echogenic uterine   Negative
     exudates present. Uterine wall
     compact. Probably mare in estrus.
6    No uterine exudates seen, normal        Negative
     uterine wall thickness
7    Compact uterine wall lining without     Negative
     any exudates in uterine lumen.

1    No echogenic or non-echogenic           Negative
     uterine exudates seen. Normal
     uterine wall thickness
2    Uterus contains non-echogenic fluid     Positive
     with spacklings of echogenic material.
3    Small amount of non-echogenic uterine   Negative
     fluids present. Wall lining compact.
4    No uterine wall thickening seen,        Negative
     no uterine exudates appreciated.
5    Echogenic uterine exudates              Positive
     present inside right horn.
     Uterine wall lining little edematous.
6    Normal uterine wall thickness           Negative
     without uterine exudates.
7    Compact uterine wall lining,            Negative
     no uterine exudates seen.

1    Compact uterine wall lining without     Negative
     uterine exudates.
2    No uterine exudates were seen.          Negative
     Normal uterine wall thickness
     recorded.

3    Examination not done.                   Died of
                                             accident
4    No uterine wall thickening seen.        Negative
     No uterine exudates were recorded.
5    Small amount of echogenic exudates      Positive
     along with non-echoic exudates in
     the uterine lumen.
6    No uterine exudates seen, normal        Negative
     uterine wall lining present.
7    No echogenic or non-echogenic           Negative
     uterine exudates were seen.
     Normal uterine wall lining.

Table 2: Post-treatment fertility of infertile and fertile mares (Group
I, II, III and IV)

                                         Pregnant mares (%)
Treatment group  Cycling    Non-cycling
                 mares (%)  mares (%)    1st AI     2nd AI     3rd AI

Group I          6 (85.71)  1 (14.29)    0 (00.00)  1 (14.28)  1 (14.28)
Group II         6 (85.71)  1 (14.29)    2 (28.57)  2 (28.57)  0 (00.00)
Group III        4 (66.66)  2 (33.33)    1 (16.66)  1 (16.66)  0 (00.00)
Group IV         6 (100)    0 (00.00)    2 (33.33)  3 (50.00)  1 (16.66)

                               Non
Treatment group             pregnant
                 Total      mares (%)

Group I          2 (28.57)  4 (57.14)
Group II         4 (57.14)  2 (28.57)
Group III        2 (33.33)  2 (33.33)
Group IV         6 (100)    0 (00.00)
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Title Annotation:Clinical Article
Author:Assad, Nafis Ibni; Bugalia, N.S.; Chandolia, R.K.
Publication:Intas Polivet
Article Type:Report
Date:Jan 1, 2017
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