Oral Paste Research Articles

Prevalence of anthelmintic resistant cyathostomes on horse farms.

To determine prevalence of anthelmintic resistance in cyathostome nematodes of horses in the southern United States. Cross-sectional study. 786 horses on 44 farms and stables in Georgia, South Carolina, Florida, Kentucky, and Louisiana. Fecal egg count (FEC) reduction tests were performed on 44 large farms and stables. Horses on each farm were treated with an oral paste formulation of fenbendazole, oxibendazole, pyrantel pamoate, or ivermectin at recommended label dosages. A mixed linear model was fitted to the percentage reduction in FEC, accounting for differences among farms, states, ages, treatments, and treatment by state interactions. By use of a conservative measure of resistance (< 80% reduction), the percentage of farms with anthelmintic-resistant cyathostomes was 97.7%, 0%, 53.5%, and 40.5% for fenbendazole, ivermectin, oxibendazole, and pyrantel pamoate, respectively. Mean percentage reductions in FEC for all farms were 24.8%, 99.9%, 73.8%, and 78.6% for fenbendazole, ivermectin, oxibendazole, and pyrantel pamoate, respectively. Pairwise contrasts between states for each treatment revealed that in almost all instances, there were no significant differences in results between states. The prevalence of resistance found in this study was higher than that reported previously, suggesting that anthelmintic resistance in equine cyathostomes is becoming a major problem. Furthermore, data from these 5 southern states, which are geographically and physiographically distinct, were remarkably similar. This suggests that drug resistance in cyathostomes is highly prevalent throughout the entire southern United States and probably nationwide.

Helminths in horses : use of selective treatment for the control of strongyles

The current level of anthelmintic resistance in the horse-breeding industry is extremely high and therefore more emphasis is being placed on studies that focus on the judicious use of anthelmintic products. The aims of the study were to: 1) establish if there is variation in the egg excretion pattern of strongyles between the different age classes of Thoroughbred horses in the Western Cape Province (WCP), 2) test if a selective treatment approach successfully reduces the number of anthelmintic treatments and maintains acceptably low helminth burdens in adult Thoroughbred horses, and 3) evaluate the efficacy of subsampling large horse herds for faecal egg counts (FECs) to monitor the strongyle burden. In 2001 the FECs of 4 adult mare, 5 yearling and 3 weanling herds from 8 different farms were compared in the WCP Within the mare herds there were generally fewer egg-excreting individuals with lower mean FECs compared with the younger age classes. Individual faecal samples were collected every 3-4 weeks from 52 adult Thoroughbred mares from 1 farm in the WCP during a 12-month period (2002/2003). Animals with strongyle FECs > or =100 eggs per gram (epg ) were treated with an ivermectin-praziquantel combination drug (Equimax oral paste, Virbac). The mean monthly strongyle FEC for the entire group was <300 epg throughout the study and the number of treatments was reduced by 50 %. Resampling methods showed that an asymptote to mean FEC was reached at 55 animals for each of the pooled weanling, yearling and mare egg counts. Resampling within 4 different mare herds recorded asymptotes of between 24 and 28 animals. Subsampling entire herds for FECs therefore provided an effective approach to treatment management. This study demonstrates that selective treatment is both a practical and an effective approach to the management of anthelmintic resistance.

Outcome of tactile conditioning of neonates, or “imprint training” on selected handling measures in foals

Behavioural reactions to selected handling procedures were compared between conditioned, or imprint-trained, and untrained foals raised on the same farm. Nineteen randomly chosen healthy foals were imprint trained at birth and 24 h later (Group A). Twenty-one similar foals that were not imprint-trained served as age-matched controls (Group B). Training began within 10 min of birth and consisted of touch desensitization by gentle rubbing. Each tactile stimulus was repeated 30–50 times over 45–60 min, until the foal no longer resisted the procedure and appeared relaxed. The procedure was then repeated at 24 h of age. At that time a physical examination and blood analysis were performed to assess the foals’ health status. Group B animals were not handled except for a brief physical examination and blood analysis at 24 h of age. Thereafter all foals were kept on pastures with their dams with no further handling until they were three months of age. Any foals handled for other reasons before that time were excluded from the study. At three months, each of the 28 foals that completed the study experienced the following handling procedures: acceptance of restraint, haltering, complete physical examination, acceptance of a plastic rebreathing bag, touching the whole body, intramuscular vaccination in the neck, intranasal vaccination, and deworming with oral paste. Response to each procedure was scored (1=not resistant, 2=low resistance, 3=strong resistance, 4=not possible without major physical restraint). Conditioned foals (Group A) were significantly less resistant to touching the front and hind legs and picking up the hind feet ( P<0.05). The administration of vaccines and paste dewormer and the collection of blood were tolerated by the majority of the foals of both groups with no or low resistance. It appeared that neonatal imprint training resulted in a learned behaviour that resulted in decreased self-defence responses towards handling the limbs at three months of age.

Presence of formaldehyde in topical corticosteroid preparations available on the Swedish market.

The aim of this study was to investigate the formaldehyde content of topical corticosteroid preparations available on the Swedish market. 73 samples were analysed with the chromotropic acid (CA) method for semi-quantitative formaldehyde determination and 30 samples with a high-performance liquid chromatographic method. These included 24 ointments, 28 creams, 1 lotion, 6 liniments, 2 gels, 9 solutions, 2 mousses and 1 oral paste. Formaldehyde was found in 5 creams and 1 ointment. Sources of formaldehyde in these preparations were discussed. Isopropanol was identified as a probable source of yellow discoloration, leading to false-negative results with the CA method.

AMLEXANOX 5% SEBAGAI MODALITAS TERAPI STOMATITIS AFTOSA REKUREN TERKINI

Recurrent Aphthous Stomatitis (RAS) is characterized by painful recurring ulceration of oral mucosa and is the most common oral ulcerative disease. The specific etiology of the disease remains unknown. This situation makes the therapy of RAS difficult and uncertain. This article will discuss the effectiveness and the safety of amlexanox 5% in relieving the symptoms and accelerate heling in RAS lesions. Amlexanox 5% is a new drug used topically in treatment of RAS. The mechanism of action by which alexanox accelerates healing of RAS in unknown. Clnincal study of efficacy amlexanox 5% has been demonstrated significantly accelerate healing and reduce pain of RAS, compared to amlexanox 1% vehicle and no treatment. 5% amlexanox oral paste has an advantageous pharmacological activity to accelerate healing and reduce the pain of RAS, thus it can be used as one of the modality in this therapy.

International Trauma Anesthesia and Critical Care Society (ITACCS).

International Trauma Anesthesia and Critical Care Society (ITACCS).

Pharmacokinetics of ivermectin in llamas (Lama glama)

The pharmacokinetic behaviour of ivermectin was investigated in adult llamas (Lama glama) by using high performance liquid chromatography with a lower limit of quantification of 2 ng/ml to measure its...

Pharmacokinetics of Doramectin and Ivermectin After Oral Administration in Horses*

A study was undertaken in order to compare plasma disposition kinetic parameters of doramectin (DRM) and ivermectin (IVM) in horses after oral administration. Ten crossbreed adult horses, clinically healthy, weighing 380–470kg body weight (bw) were selected for study. Faecal examinations were performed to determine faecal parasite egg counts. Horses were allocated to two groups of five animals to provide an even distribution considering the variables sex, body weight and faecal egg count. Group I, were treated with an oral paste formulation of IVM at 0.2mg/kg b/w and Group II, were treated with an oral dose of 0.2mg/kg bw of DRM prepared as paste from the injectable formulation for oral administration. Blood samples were collected by jugular puncture between 0h and 75 days post-treatment. Plasma was separated and later solid phase extraction and derivatization samples were analysed by high performance liquid chromatography (HPLC); a computerised kinetic analysis was carried out. Data were compared using the Mann–Whitney U-test.The mean plasma concentrations of DRM and IVM after oral administration in horses were detected until 30 and 20 days, respectively. Both drugs showed similar patterns of absorption and no significant differences were found for peak concentration, the time to peak concentration, or for absorptive half-life. The terminal elimination half-life was significantly (P<0.05) longer in the DRM treated group than for the IVM treated group. The differences observed in the elimination half-life explain the longer mean residence time and high values of area under the concentration time curve for the group treated with DRM, which are 30% higher than those of the IVM group. Considering its pharmacokinetics, tolerance and anthelmintic efficacy, the oral administration of DRM, could be an alternative to IVM for the control of parasitic diseases of horses.

Effect of oral administration of electrolyte pastes on rehydration of horses

To determine whether the composition of electrolyte pastes formulated for oral administration influences voluntary water intake (WI) by horses recovering from furosemide-induced dehydration. 6 horses. Voluntary WI, body weight, and blood and urine constituents were measured before and after induction of dehydration by furosemide administration and overnight withholding of water; these same variables also were measured during a 36-hour rehydration period. Each horse was evaluated 4 times with random application of 4 treatments (electrolyte pastes) that provided 0.5 g of KCl/kg of body weight, 0.5 g of NaCl/kg, 0.25 g of NaCl and 0.25 g of KCl/kg, or no electrolytes (control treatment). Electrolyte pastes were administered 3 times (4, 8, and 12 hours after start of the rehydration period). Administration of all electrolyte pastes resulted in significantly greater voluntarily WI, compared with the control treatment, and was accompanied by significantly greater recovery of body weight when NaCl was a component of the paste. Administration of NaCl and NaCl-KCl pastes tended to produce a state of transient hyperhydration; however, electrolyte administration also resulted in significantly greater urine production and electrolyte excretion during the final 24 hours of the rehydration period. Adverse effects of oral administration of hypertonic electrolyte pastes were not observed. Oral administration of electrolyte pastes to dehydrated horses increases voluntary WI and improves rehydration during the rehydration period. Rehydration is more rapid and complete when NaCl is a component of the electrolyte paste.

Re-evaluation of ivermectin efficacy against equine gastrointestinal parasites

Two trials were conducted to confirm the efficacy of ivermectin paste against endoparasites of horses. In these trials, 20 ponies were treated with ivermectin oral paste at 200 mcg kg body weight once on Day 0, and 20 ponies served as unmedicated controls. The animals carried naturally acquired parasite infections as confirmed by pretrial fecal examination. The animals were necropsied for worm recovery on Days 14, 15 or 16. Parasites recovered were identified to species. Horses treated with ivermectin had significantly ( P<0.05) fewer (>99.0% reduction) adult small strongyles ( Coronocyclus spp including C. coronatus, C. labiatus, C. labratus; Cyathostomum spp including C. catinatum, C. pateratum; Cylicocyclus spp including C. ashworthi, C. elongatus, C. insigne, C. leptostomum, C. nassatus, C. radiatus; Cylicodontophorus bicoronatus; Cylicostephanus spp including C. asymetricus, C. bidentatus, C. calicatus, C. goldi, C. longibursatus, C. minutus; Gyalocephalus capitatus; Parapoteriostomum spp including P. euproctus, P. mettami; Petrovinema poculatum; Poteriostomum spp including P. imparidentatum, P. ratzii) and adult large strongyles ( Strongylus edentatus, S. vulgaris; Triodontophorus spp including T. brevicauda, T. serratus; Craterostomum acuticaudatum) than the controls. Ivermectin was also highly effective (94% to >99%, P<0.05–0.01) against Gasterophilus intestinalis larvae, Habronema spp., Oxyuris equi, Parascaris equorum. The data from these two trials confirm that ivermectin paste administered to horses orally at 200 mcg kg −1 continues to be highly effective for treatment and control of a broad range of small and large strongyle species as well as other species of gastrointestinal parasites.

Mucositis reduction by selective elimination of oral flora in irradiated cancers of the head and neck: a placebo-controlled double-blind randomized study

Purpose: The aim of the study was to test the hypothesis that aerobic Gram-negative bacteria (AGNB) play a crucial role in the pathogenesis of radiation-induced mucositis; consequently, selective elimination of these bacteria from the oral flora should result in a reduction of the mucositis. Methods and Materials: Head-and-neck cancer patients, when scheduled for treatment by external beam radiation therapy (EBRT), were randomized for prophylactic treatment with an oral paste containing either a placebo or a combination of the antibiotics polymyxin E, tobramycin, and amphotericin B (PTA group). Weekly, the objective and subjective mucositis scores and microbiologic counts of the oral flora were noted. The primary study endpoint was the mucositis grade after 3 weeks of EBRT. Results: Seventy-seven patients were evaluable. No statistically significant difference for the objective and subjective mucositis scores was observed between the two study arms ( p = 0.33). The percentage of patients with positive cultures of AGNB was significantly reduced in the PTA group ( p = 0.01). However, complete eradication of AGNB was not achieved. Conclusions: Selective elimination of AGNB of the oral flora did not result in a reduction of radiation-induced mucositis and therefore does not support the hypothesis that these bacteria play a crucial role in the pathogenesis of mucositis.

Faecal Excretion Profile of Moxidectin and Ivermectin after Oral Administration in Horses

A study was undertaken to evaluate and compare faecal excretion of moxidectin and ivermectin in horses after oral administration of commercially available preparations. Ten clinically healthy adult horses, weighing 390–446 kg body weight (b.w.), were allocated to two experimental groups. Group I was treated with an oral gel formulation of moxidectin at the manufacturer’s recommended therapeutic dose of 0.4 mg/kg b.w. Group II was treated with an oral paste formulation of ivermectin at the recommended dose of 0.2 mg/kg b.w. Faecal samples were collected at different times between 1 and 75 days post-treatment. After faecal drug extraction and derivatization, samples were analysed by High Performance Liquid Chromatography using fluorescence detection and computerized kinetic analysis.For both drugs the maximum concentration level was reached at 2.5 days post administration. The ivermectin treatment groups’ faecal concentrations remained above the detectable level for 40 days (0.6 ± 0.3 ng/g), whereas the moxidectin treatment group remained above the detectable level for 75 days (4.3 ± 2.8 ng/g). Ivermectin presented a faster elimination rate than moxidectin, reaching 90% of the total drug excreted in faeces at four days post-treatment, whereas moxidectin reached similar levels at eight days post-treatment. No significant differences were observed for the values of maximum faecal concentration (Cmax) and time of Cmax(Tmax) between both groups of horses, demonstrating similar patterns of drug transference from plasma to the gastrointestinal tract. The values of the area under the faecal concentration time curve were slightly higher in the moxidectin treatment group (7104 ± 2277 ng.day/g) but were not significantly different from those obtained in the ivermectin treatment group (5642 ± 1122 ng.day/g). The results demonstrate that although a 100% higher dose level of moxidectin was used, attaining higher plasma concentration levels and more prolonged excretion and gut secretion than ivermectin, the concentration in faeces only represented 44.3± 18.0% of the total parental drug administered compared to 74.3 ± 20.2% for ivermectin. This suggests a higher level of metabolization for moxidectin in the horse.

Electrolyte and glycerol supplementation improve water intake by horses performing a simulated 60 km endurance ride.

To replace electrolytes lost in sweat during endurance competitions, riders frequently supplement horses with hypertonic oral electrolyte pastes. To determine whether this practice and concurrent administration of the so-called hyperhydrating substance glycerol are of benefit, weight loss, voluntary water intake, plasma osmolality, and plasma protein and electrolyte concentrations were measured in 6 Arabian horses supplemented with a total of 2.4 ml/kg bwt of water (W); 0.2 g/kg bwt KCl and 0.4 g/kg bwt NaCl in 2.4 ml/kg bwt of water (E); or 0.2 g/kg bwt KCl and 0.4 g/kg bwt NaCl in 2.4 ml/kg bwt (3 g/kg bwt) of glycerol (GE) before and during a treadmill exercise test simulating a 60 km endurance ride. Weight loss was greater (P < 0.01) with W (3.2%) than with E and GE (1.0% and 0.9%, respectively) and was associated (r = -0.85, P < 0.0001) with less (P < 0.01) water intake with W (12.2 l) than with E or GE (23.5 l and 25.8 l, respectively). Plasma osmolality increased to a greater extent (P < 0.01) with GE than with E and was unchanged with W. In contrast, plasma protein concentration decreased (P < 0.01) in the later stages of the simulated ride with E and GE, reflecting plasma volume expansion, but remained unchanged with W. Plasma Na+ and Cl- concentrations increased (P < 0.01) with E and GE and were greater (P < 0.01) than values for W during the second half of the 60 km simulated ride. Despite administration are large amounts of potassium with E and GE, plasma K+ concentration was decreased (P < 0.01) at the end of the rest breaks during the simulated ride and after 60 min of recovery with all supplements. Adverse effects of administration of hypertonic oral electrolyte pastes were not observed and decreases in plasma protein concentration within 30 min after drinking with all supplements suggested that intestinal absorption was well maintained during the simulated endurance ride. In conclusion, electrolyte supplementation in the form of hypertonic oral pastes improved water intake during endurance exercise but concurrent glycerol administration provided no additional benefits in comparison to supplementation with electrolytes alone.

Oral nitroglycerin paste did not lower pulmonary capillary pressure during treadmill exercise.

We hypothesised that 22.5 mg of oral nitroglycerin would cause pulmonary vasodilation and therefore decrease pulmonary capillary pressure in horses during strenuous exercise. Six horses were assigned to exercise twice, once with no medication (control) and once with nitroglycerin (22.5 mg orally) in random order. Horses were exercised for 3 min each at 75, 90 and 100% of maximal heart rate (HRmax) with a 2 min period of walking between each period of exertion. Pulmonary artery and oesophageal pressures were recorded continuously. Subsequent analysis was carried out on the pulmonary arterial pressure signal with the oesophageal pressure subtracted, hence pulmonary vascular pressures reported in this paper approximate transmural pressures. Pulmonary arterial pressure, pulmonary arterial wedge pressure, pulmonary capillary pressure, heart rate and arterial blood gas tensions were determined for each level of exercise. Pulmonary arterial wedge and pulmonary capillary pressures were determined from the pulmonary artery waveform after dynamic occlusion of a branch of the pulmonary artery. The resulting decay in pulmonary artery pressure was submitted to an exponential curve fitting and the amplitude at the moment of occlusion on this curve was recorded as pulmonary capillary pressure. The effects of nitroglycerin on the various parameters were evaluated using a 3-way ANOVA blocked on horse treatment, and exercise intensity, followed by Tukey's multiple comparison procedure. Resting pulmonary artery pressure decreased from mean +/- s.e. 34.0 +/- 5.5 mmHg to 24.0 +/- 3.9 mmHg 5 min after administration of nitroglycerin (P < 0.05) but there were no significant effects on pulmonary capillary or wedge pressures. Nitroglycerin at this dose resulted in no significant differences in pulmonary artery, pulmonary capillary, and pulmonary wedge pressure, heart rate, arterial oxygen tension or arterial carbon dioxide tension at 75, 90 and 100% of HRmax. This dose of nitroglycerin does not appear significantly to protect the pulmonary vascular bed from exercise-induced hypertension. These data do not support the use of this dose of oral nitroglycerin in the prevention of EIPH.

Effects of electrolyte and glycerol supplementation on recovery from endurance exercise.

Incomplete recovery from endurance exercise after an overnight rest period is reflected by persisting weight loss and an elevated plasma aldosterone concentration, even in successful competitors. To determine whether supplementation with high doses of electrolytes, with or without glycerol, enhances recovery, the following were measured in 6 Arabian horses before and after completion of a 60 km treadmill exercise test simulating an endurance ride and after 12, 24, 48, and 72 h of recovery: bodyweight; plasma osmolality; plasma concentrations of protein, electrolytes, aldosterone and cortisol; and urine and faecal electrolyte concentrations. Before and during the exercise test, horses were supplemented with a total of 2.4 ml/kg bwt of water (W); 0.2 g/kg bwt KCl and 0.4 g/kg bwt NaCl in 2.4 ml/kg bwt of water (E); or 0.2 g/kg bwt KCl and 0.4 g/kg bwt NaCl in 2.4 ml/kg bwt (3 g/kg bwt) of glycerol (GE). Although weight loss after completion of the simulated ride was greater (P < 0.01) for W (3.2%) than for E and GE (1.0 and 0.9%, respectively), horses supplemented with E or GE experienced further weight loss by 24 h after the simulated ride (2.2 and 2.1% for E and GE, respectively) while bodyweight with W remained unchanged (3.0%) from the finish value. After 48 h of recovery, bodyweight was not different from the starting values with E and GE but remained decreased (P < 0.01) with W throughout the recovery period (2.2% persisting weight loss after 72 h of recovery). Plasma osmolality and plasma Na+ and Cl- concentrations increased (P < 0.01) and plasma protein concentration decreased (P < 0.01) after the exercise test with E and GE but were unchanged with W. Plasma osmolality and protein and electrolyte concentrations returned to pre-exercise values within 12 h of recovery with the exception of a persistent increase in plasma Na+ concentration with GE. The greatest plasma aldosterone concentration was measured after 12 h of recovery with W (1357 pmol/l) and was greater (P < 0.02) than that with E and GE (24 and 304 pmol/l, respectively). Urine production during the simulated ride increased (P < 0.01) with GE and resulted in loss of approximately 20% and essentially 100% of supplemented Na+ and K+, respectively. In contrast, electrolyte losses in faeces were unaffected by electrolyte or glycerol supplementation. In conclusion, supplementation with high doses of electrolytes as hypertonic oral pastes attenuated weight loss during a simulated endurance ride (by enhancing voluntary water intake); however, it did not prevent development of significant weight loss during the initial 24 h of recovery. Glycerol administration resulted in no benefits, and actually increased urine electrolyte losses, in comparison to supplementation with electrolytes alone.

Comparison of the pharmacokinetics of moxidectin (Equest) and ivermectin (Eqvalan) in horses.

A study was undertaken in order to evaluate and compare plasma disposition kinetic parameters of moxidectin and ivermectin after oral administration of their commercially available preparations in horses. Ten clinically healthy adult horses, weighing 390-446 kg body weight (b.w.), were allocated to two experimental groups of five horses. Group I was treated with an oral gel formulation of moxidectin (MXD) at the manufacturers recommended therapeutic dose of 0.4 mg/kg bw. Group II was treated with an oral paste formulation of ivermectin (IVM) at the manufacturers recommended dose of 0.2 mg/kg b.w. Blood samples were collected by jugular puncture at different times between 0.5 h and 75 days post-treatment. After plasma extraction and derivatization, samples were analysed by HPLC with fluorescence detection. Computerized kinetic analysis was carried out. The parent molecules were detected in plasma between 30 min and either 30 (IVM) or 75 (MXD) days post-treatment. Both drugs showed similar patterns of absorption and no significant difference was found for the time corresponding to peak plasma concentrations or for absorption half-life. Peak plasma concentrations (Cmax) of 70.3+/-10.7 ng/mL (mean +/- SD) were obtained for MXD and 44.0+/-23.1 ng/mL for IVM. Moreover, the values for area under concentration-time curve (AUC) were 363.6+/-66.0 ng x d/mL for the MXD treated group, and 132.7+/-47.3 ng x d/mL for the IVM treated group. The mean plasma residence times (MRT) were 18.4+/-4.4 and 4.8+/-0.6 days for MXD and IVM treated groups, respectively. The results showed a more prolonged residence of MXD in horses as demonstrated by a four-fold longer MRT than for IVM. The longer residence and the higher concentrations found for MXD in comparison to IVM could possibly explain a more prolonged anthelmintic effect. It is concluded that in horses the commercial preparation of MXD presents a pharmacokinetic profile which differs significantly from that found for a commercial preparation of IVM. To some extent these results likely reflect differences in formulation and doses.

COST-EFFECTIVENESS OF DECONTAMINATION OF THE DIGESTIVE TRACT IN LIVER TRANSPLANTATION

728 Introduction Efficacy and cost-effectiveness of selective decontamination (SD) of the bowel to prevent infections in patients undergoing liver transplantation are still debated. Therefore, a randomised placebo-controlled trial was performed with an integrated economic evaluation. Results of the economic evaluation, which to our knowledge is the first full economic evaluation of SD in liver transplantation, will be presented. Patients and Methods Patients of two university hospitals in the Netherlands were randomised to receive either SD or placebo as soon as they were accepted for elective liver transplantation. Patients on SD had a preoperative regimen consisting of oral norfloxacin 400 mg once daily and lozenges containing 2 mg colistine, 1,8 mg tobramycin and 10 mg amphotericin B, four times daily. Postoperatively, patients received a suspension containing 200 mg colistine, 80 mg tobramycin and 500 mg amphotericin B, four times daily through the nasogastric tube, combined with an oral paste containing a 2% solution of the same drugs. Patients on placebo were on a similar regimen with placebo drugs. An economic evaluation was performed with postoperative infection episodes (till 30 days after transplantation) as effect parameter. As infection episodes did not differ between groups, a cost minimisation analysis was performed, in which incremental costs were assessed. Besides costs related to SD (medication and routine cultures) other direct medical costs (e.g. hospitalisation, outpatient visits, services, other medication) were determined, both pre- and postoperatively (till 30 days after transplantation). True resource costs were assessed against unit prices of 1997. Costs were compared with a Mann-Whitney U test. A p-value of <0.05 was considered significant. All analyses were by per protocol analysis. Results Pre-operative costs were based on 58 patients: 29 in the SD group and 29 in the placebo group. Post-operative costs and infections were based on 55 patients: 26 in the SD group and 29 in the placebo group (3 SD patients died during or immediately after transplantation and were excluded). Costs of SD medication and routine cultures were evidently higher in the SD group; on average $3,300 per patient. The other direct medical costs did not significantly differ between both groups, and became $28,900 and $29,200 in, respectively, the SD and the placebo group. As no differences in other costs existed, incremental costs of SD did not differ from the additional costs of SD medication and routine cultures. There was no significant difference in infection episodes. Conclusions SD leads to additional costs of SD medication and routine cultures, whereas no savings in other costs are realised. Besides that, no improvement in infection episodes is realised by SD. Consequently, SD is a non-efficient approach in liver transplants.

Epidemiology of Anoplocephala perfoliata infection in foals on a stud farm in south-western Sweden

The egg output and humoral antibody response to scolex antigens of the equine tapeworm Anoplocephala perfoliata were monitored in naturally infected foals by an egg flotation/centrifugation method and an indirect enzyme-linked immunosorbent assay (ELISA). The study was performed on a stud farm in south-western Sweden between May 1994 and April 1995. Sequential blood and faecal samples were taken from 21 foals during their first summer on pasture and until tapeworm eggs were detected. Results were expressed separately for 10 and 11 foals born before and after the end of April 1994, respectively. Increased levels of antibodies were noticed from October and onwards in both groups whereas tapeworm eggs were detected in the faeces of all foals about 4 months later. The antibody response was similar in both groups but it was more pronounced in foals born before April 1994. All foals were treated in March 1995 with an oral paste formulation of pyrantel pamoate at a dose rate of 38 mg/kg bodyweight. Most animals responded to the anthelmintic treatment and one month later, tapeworm eggs were only detected in one out of the 18 foals examined one month after treatment. Thus, the treatment reduced the number of A. perfoliata egg positive horses by 94%. A concomitant decline in antibody levels was also observed. Western immunoblot analysis of sequential individual serum samples showed that at least 10 different scolex antigens in the molecular weight range 10–200 kDa were recognised. Banding intensities, especially of the 10 kDa, 35 kDa, 45 kDa and 66 kDa proteins were different in the sequential sera taken during the course of infection.

Composition and Local Planning of Liturgical Chant in the Middle Ages

Striking features of the communion series in the Mass Proper as laid out by James McKinnon indicate a high degree of liturgico-theological planning in the 7th to 8th centuries. As pointed out by McKinnon, however, the overall planning of the series of chants for the church year was never completed.' Within the next century the so-called import of the liturgy into the Carolingian kingdom took place. This process brought with it the final composition of the so-called Gregorian Mass Proper repertory as it has been handed down to us through the written transmission of the following centuries. In spite of different opinions among modern scholars as to the precise nature and process of the rise of such musical notations it seems that the outcome of these musical efforts in the major Carolingian monasteries although certain features of the oral past of the chants were preserved was a high degree of compositional control over the course of the melodies.2 Whereas Richard Crocker has described the Gregorian chant as marked by Roman rigour and severity in the assignment of texts and by the Frank-

Comparative efficacy of moxidectin 2% equine oral gel and ivermectin 2% equine oral paste against Onchocerca cervicalis (Railliet and Henry, 1910) microfilariae in horses with naturally acquired infections in Formosa (Argentina)

On the basis of positive skin snips for Onchocerca cervicalis microfilariae (MF), 45 horses were chosen from 48 in a total of 257 screened on 12 locations in the northeast Province of Formosa (Argentina), and randomly assigned to two treatment groups of 20 horses each, and a nontreated control group of five horses. On Day 14 post-treatment (PT), skin snip samples in the ivermectin-treated (0.2 mg/kg) group were negative for normal viable microfilariae (MF), while horses in the control group maintained their pretreatment level of infection. On the same Day in the moxidectin-treated (0.4 mg/kg) group, 18 horses were negative for MF, but the remaining two had a total of 1 and 2 MF, respectively (equivalent to 10 and 20 MF/g of skin), but all three parasites showed marked cuticular and structural damage. Both horses were negative in a repeat biopsy on Day 21. From Day 3 PT, one ivermectin-treated horse (5%) evidenced an approximate 15 x 2 x 3 cm-sized, apparently nonpainful, oedematous swelling on the ventral midline, 20 cm in front of the navel, which remained unchanged on Day 14 PT. Adverse reactions were not observed in the moxidectin-treated group. Parasitaemia was found in 18.7% of sampled horses (48 of 257), and the number of MF varied between 10–1820/g of skin snip (x172). Similar prevalence and total counts had been described previously in 1985 and 1986 in cattle-farm horses in the same area of Argentina; in surveys in Texas (1974) and Louisiana (1995) in the USA, infection rates were also similar, but total counts much higher. It is concluded that moxidectin 2% equine oral gel and ivermectin 2% equine oral paste, were equally 100% effective in the control of O. cervicalis MF. Contrary to ivermectin, moxidectin did not cause post-treatment dermal reactions.