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Topic:Diagnosis

Diagnosis in horses involves the systematic identification of diseases and conditions affecting equine health. This process relies on a combination of clinical evaluations, laboratory tests, imaging techniques, and other diagnostic tools to assess the health status of horses. Veterinarians utilize these methods to identify symptoms, determine the underlying causes of health issues, and formulate appropriate treatment plans. Diagnostic procedures in equine medicine can include blood tests, ultrasound, radiography, endoscopy, and more specialized tests such as genetic screening or advanced imaging modalities like MRI and CT scans. This page aggregates peer-reviewed research studies and scholarly articles that explore various diagnostic techniques, their applications, and advancements in the field of equine veterinary medicine.
New Parvoviruses and Picornavirus in Tissues and Feces of Foals with Interstitial Pneumonia.
Viruses    August 14, 2021   Volume 13, Issue 8 1612 doi: 10.3390/v13081612
Altan E, Hui A, Li Y, Pesavento P, Asín J, Crossley B, Deng X, Uzal FA, Delwart E.Six foals with interstitial pneumonia of undetermined etiology from Southern California were analyzed by viral metagenomics. Spleen, lung, and colon content samples obtained during necropsy from each animal were pooled, and nucleic acids from virus-like particles enriched for deep sequencing. The recently described equine copiparvovirus named eqcopivirus, as well as three previously uncharacterized viruses, were identified. The complete ORFs genomes of two closely related protoparvoviruses, and of a bocaparvovirus, plus the partial genome of a picornavirus were assembled. The parvoviruses were...
Molecular detection and phylogenetic characterization of Theileria equi in horses (Equus caballus) from a peri-urban area of Argentina.
Ticks and tick-borne diseases    August 13, 2021   Volume 12, Issue 6 101810 doi: 10.1016/j.ttbdis.2021.101810
Sebastian PS, Benitez-Ibalo AP, Flores FS, Debárbora VN, Martinez EI, Thompson CS, Mangold AJ.To investigate the presence of Theileria equi in an endemic area of equine piroplasmosis 42 horses (Equus caballus) from Corrientes City, Argentina were sampled. Eighty-one percent (34 blood samples) of the analyzed horses were tested positive to the presence of piroplasmid 18S rDNA. All these samples could be identified as T. equi by amplifying the specific EMA-1 (merozoite antigen 1) gene of this species. Phylogenetic analysis of an obtained 18S rDNA complete sequence from one strain resulted in the identification of this sample as T. equi sensu stricto (genotype A). This study presents the ...
Split Cord Malformation in a Thoroughbred Horse.
Journal of comparative pathology    August 12, 2021   Volume 187 68-74 doi: 10.1016/j.jcpa.2021.07.003
De Jonge B, Dufourni A, Oosterlinck M, Chiers K.We report a 9-year-old Thoroughbred gelding that had sudden onset lameness of the right forelimb with episodes of lateral decubitus and generalized pain after completion of a normal training session. The clinical signs subsequently became less pronounced with only mild right forelimb lameness. However, after further orthopaedic examination, it developed severe, acute ataxia and paraplegia, the Schiff-Sherrington phenomenon and risus sardonicus. At necropsy, a partial duplication of the cervical spinal cord was identified, consistent with split spinal cord malformation type II or diplomyelia. H...
Detection of pathogens in blood or feces of adult horses with enteric disease and association with outcome of colitis.
Journal of veterinary internal medicine    August 12, 2021   Volume 35, Issue 5 2465-2472 doi: 10.1111/jvim.16238
Kopper JJ, Willette JA, Kogan CJ, Seguin A, Bolin SR, Schott HC.Rates of detecting ≥1 potential enteric pathogens (PEP) or toxins (PEP-T) in feces, blood, or both of horses ≥6 months of age with enteric disease and impact of multiple detections on outcome of horses with colitis has not been reported. Objective: To determine detection rates of PEP/PEP-T in feces, blood, or both of horses with enteric disease and effect of detecting multiple agents on outcome of horses with colitis. Methods: Thirty-seven hundred fifty-three fecal samples submitted to IDEXX Laboratories and 239 fecal and blood samples submitted to Michigan State University's Veterinary D...
Equine Parvovirus-Hepatitis Screening in Horses and Donkeys with Histopathologic Liver Abnormalities.
Viruses    August 12, 2021   Volume 13, Issue 8 doi: 10.3390/v13081599
Zehetner V, Cavalleri JV, Klang A, Hofer M, Preining I, Steinborn R, Ramsauer AS.There is strong evidence that equine parvovirus-hepatitis (EqPV-H) is associated with the onset of Theiler's disease, an acute hepatic necrosis, in horses. However, the impact of this virus on other hepatopathies remains unknown. The objective of this retrospective study was to evaluate the prevalence and quantify the viral loads of EqPV-H in formalin-fixed, paraffin-embedded equine and donkey livers with various histopathologic abnormalities. The pathologies included cirrhosis, circulatory disorders of the liver, toxic and metabolic hepatic diseases as well as neoplastic and inflammatory dise...
Use of Polyamide (Nylon) Cable Ties for Vascular Ligation of Healthy Equine Jejunal Mesentery.
Frontiers in veterinary science    August 12, 2021   Volume 8 639424 doi: 10.3389/fvets.2021.639424
Hurcombe SD, Roessner HA, Klein CE, Engiles JB, Hopster K.Jejunal vascular ligation is an essential step in performing jejunojejunostomy. Hand sewn ligation is typically used and can increase operative time with long sections of bowel to be removed. Nylon cable ties (NCT) have been used for vascular ligation in horses but are yet to be investigated for application on the mesenteric vasculature of the gastrointestinal tract. Our objective was to evaluate the efficacy and short-term safety of NCT jejunal mesenteric vessel ligation in healthy horses. Eight healthy adult horses underwent midline celiotomy. A segment of jejunal mesentery was identified (â...
Regulation of AI in Health Care: A Cautionary Tale Considering Horses and Zebras.
Journal of law and medicine    August 10, 2021   Volume 28, Issue 3 645-654 
Richards B, Sage Jacobson S, James Aquino YS.The introduction of Artificial Intelligence (AI) into health care has been accompanied by uncertainties and regulatory challenges. The establishment of a regulatory framework around AI in health is in its infancy and the way forward is unclear. There are those who argue that this represents a concerning regulatory gap, while others assert that existing regulatory frameworks, policies and guidelines are sufficient. We argue that perhaps the reality is somewhere in between, but that there is a need for engagement with principles and guidelines to inform future regulation. However, this cannot be...
Comparative studies on faecal egg counting techniques used for the detection of gastrointestinal parasites of equines: A systematic review.
Current research in parasitology & vector-borne diseases    August 9, 2021   Volume 1 100046 doi: 10.1016/j.crpvbd.2021.100046
Ghafar A, Abbas G, King J, Jacobson C, Hughes KJ, El-Hage C, Beasley A, Bauquier J, Wilkes EJA, Hurley J, Cudmore L, Carrigan P, Tennent-Brown B....Faecal egg counting techniques (FECT) form the cornerstone for the detection of gastrointestinal parasites in equines. For this purpose, several flotation, centrifugation, image- and artificial intelligence-based techniques are used, with varying levels of performance. This review aimed to critically appraise the literature on the assessment and comparison of various coprological techniques and/or modifications of these techniques used for equines and to identify the knowledge gaps and future research directions. We searched three databases for published scientific studies on the assessment an...
Equine embryo mobility. A game changer.
Theriogenology    August 8, 2021   Volume 174 131-138 doi: 10.1016/j.theriogenology.2021.08.006
Ginther OJ.The equine embryo or embryonic vesicle on Days 11-15 postovulation travels with profound physiologic purpose throughout the lumen of the two uterine horns and uterine body making 12 to 22 trips between the two uterine horns per day. This phenomenon is termed embryo mobility and is unique in equids among domestic species. Apparently, the embryo first reaches the uterine body on Days 8 or 9. Mobility increases to maximum by Days 11 or 12 and continues until an abrupt cessation of mobility (fixation) on Days 15 (ponies) or 16 (horses and donkeys). The embryo is propelled by uterine contractions i...
Genetic characterization and phylogenetic of Anaplasma capra in Persian onagers (Equus hemionus onager).
Veterinary microbiology    August 8, 2021   Volume 261 109199 doi: 10.1016/j.vetmic.2021.109199
Staji H, Yousefi M, Hamedani MA, Tamai IA, Khaligh SG.Anaplasma spp. are among the most recognized arthropod-borne infectious agents. Although the novel A. capra has been isolated from wildlife, livestock, and hard ticks from many parts of the world, there is no report regarding the identification of this pathogen from equines and little is known about the epidemiology of A. capra in Equidae. In this study, A. capra was identified in two out of ten blood specimens of wild onagers (Equus hemionus onager) during a routine health check-up in Semnan, Iran by light microscopy and molecular analyses while other pathogens were not detected. First, inclu...
Clinical insights: Recent advances in donkey medicine and welfare.
Equine veterinary journal    August 7, 2021   Volume 53, Issue 5 859-862 doi: 10.1111/evj.13471
Rickards K, Toribio RE.No abstract available
Clinical performance of a commercially available thymidine kinase 1 assay for diagnosis of lymphoma in 42 hospitalized horses (2017-2020).
Journal of veterinary internal medicine    August 6, 2021   Volume 35, Issue 5 2495-2499 doi: 10.1111/jvim.16239
Moore C, Stefanovski D, Luethy D.Antemortem definitive diagnosis of lymphoma in horses is often difficult. Thymidine kinase 1 (TK1) assay is a potentially useful biomarker for lymphoma in horses. Objective: To report the clinical performance of a commercially available TK1 assay for diagnosis of lymphoma in horses. We hypothesized that there would be no association between serum TK1 activity and a diagnosis of lymphoma in horses. Methods: Forty-two hospitalized horses, 14 with a definitive diagnosis of lymphoma, 4 with other neoplasia, and 24 with inflammatory disease. Methods: Retrospective medical record review, groups were...
Equine pituitary pars intermedia dysfunction: a spontaneous model of synucleinopathy.
Scientific reports    August 6, 2021   Volume 11, Issue 1 16036 doi: 10.1038/s41598-021-95396-7
Fortin JS, Hetak AA, Duggan KE, Burglass CM, Penticoff HB, Schott HC.Equine pituitary pars intermedia dysfunction (PPID) is a common endocrine disease of aged horses that shows a similar pathophysiology as Parkinson's Disease (PD) with increased levels of α-synuclein (α-syn). While α-syn is thought to play a pathogenic role in horses with PPID, it is unclear if α-syn is also misfolded in the pars intermedia and could similarly promote self-aggregation and propagation. Consequently, α-syn was isolated from the pars intermedia from groups of healthy young and aged horses, and aged PPID-afflicted horses. Seeding experiments confirmed the prion-like properties...
Equine grass sickness in italy: a case series study.
BMC veterinary research    August 6, 2021   Volume 17, Issue 1 264 doi: 10.1186/s12917-021-02966-y
Laus F, Corsalini J, Mandara MT, Bazzano M, Bertoletti A, Gialletti R.Equine grass sickness (EGS) has been reported in several European and extra-European countries. Despite this, no scientific paper about clinical cases of EGS in Italy has been published. EGS is a disease affecting almost exclusively horses kept on pasture, characterized by clinical signs related to lesions in autonomic nervous system (ANS), particularly in the enteric nervous system (ENS). According to clinical presentation, acute, subacute and chornic syndromes can be observed, with various sympthoms including dullness, anorexia, dysphagia, drooling of saliva, tachycardia, ptosis, patchy swea...
Intestinal parasites in Przewalski’s horses (Equus ferus przewalskii): a field survey at the Hortobágy National Park, Hungary.
Journal of helminthology    August 6, 2021   Volume 95 e39 doi: 10.1017/S0022149X21000274
Jota Baptista C, Sós E, Szabados T, Kerekes V, Madeira de Carvalho L.The Pentezug Wildhorse Reserve, located in the Hortobágy National Park, Hungary, has one of the biggest ex situ populations of Przewalski's horses and aims to preserve its landscape and to study this subspecies. Between September and November 2018, 79 faecal samples were collected from Przewalski's horses. The McMaster, Willis flotation, natural sedimentation and coproculture methods were applied to all the samples. Results showed an average level of 1287 eggs per gram (EPG), which is a high faecal egg-shedding level. All the samples were positive for strongyle-type eggs (100%). There were no...
Pythiosis in Equidae in Northeastern Brazil: 1985-2020.
Journal of equine veterinary science    August 6, 2021   Volume 105 103726 doi: 10.1016/j.jevs.2021.103726
Souto EPF, Maia LA, Neto EGM, Kommers GD, Junior FG, Riet-Correa F, Galiza GJN, Dantas AFM.The epidemiologic, clinical, pathologic, microbiological and immunohistochemical findings of pythiosis in equidae in northeastern Brazil are described. From January 1985 to December 2020 the Laboratory of Animal Pathology of the Federal University of Campina Grande received 1,331 tissue samples of equidae, 202 (15.17%) of which were diagnosed as pythiosis. Equidae of both sexes with ages varying from 4 months to 25 years were affected. Most animals were mixed breed (79.7%) and reared in an extensive system (73.26%). The disease occurred throughout the year but the highest incidence (70.29%) wa...
Gastric microbiome in horses with and without equine glandular gastric disease.
Journal of veterinary internal medicine    August 5, 2021   Volume 35, Issue 5 2458-2464 doi: 10.1111/jvim.16241
Paul LJ, Ericsson AC, Andrews FM, Keowen ML, Morales Yniguez F, Garza F, Banse HE.The role of the gastric microbiome in development or persistence of equine glandular gastric disease (EGGD) remains to be investigated. Objective: The objective was to characterize the glandular mucosal and gastric fluid microbiomes of horses with and without EGGD. It was hypothesized that differences in the mucosal microbiome are associated with EGGD. Methods: Twenty-four horses were enrolled. Methods: Gastroscopy was performed and EGGD scores recorded (score 0, n = 6; score 1, n = 8; score ≥2, n = 10). Gastric fluid and pinch biopsies of healthy glandular mucosa and EGGD lesions were...
Electrical impedance tomography to measure lung ventilation distribution in healthy horses and horses with left-sided cardiac volume overload.
Journal of veterinary internal medicine    August 4, 2021   Volume 35, Issue 5 2511-2523 doi: 10.1111/jvim.16227
Sacks M, Byrne DP, Herteman N, Secombe C, Adler A, Hosgood G, Raisis AL, Mosing M.Left-sided cardiac volume overload (LCVO) can cause fluid accumulation in lung tissue changing the distribution of ventilation, which can be evaluated by electrical impedance tomography (EIT). Objective: To describe and compare EIT variables in horses with naturally occurring compensated and decompensated LCVO and compare them to a healthy cohort. Methods: Fourteen adult horses, including university teaching horses and clinical cases (healthy: 8; LCVO: 4 compensated, 2 decompensated). Methods: In this prospective cohort study, EIT was used in standing, unsedated horses and analyzed for convent...
Development and Validation of a Test for the Classification of Horses as Broken or Unbroken.
Animals : an open access journal from MDPI    August 4, 2021   Volume 11, Issue 8 2303 doi: 10.3390/ani11082303
Menchetti L, Dalla Costa E, Minero M, Padalino B.Regulation EC 1/2005 has stricter rules for transportation of unbroken (untamed) vs. broken (tamed) horses, but does not provide adequate tools for their identification. This study aimed to develop and validate such a tool. A behavioural test (Broken/Unbroken Test (BUT)) based on approaching, haltering, and leading was applied to 100 horses. Physiological and additional behavioural data were also collected, and the horses' status (broken/unbroken) was assessed by the expert who administered the BUT. Each horse's behaviour during the BUT was scored by four trained observers blinded to the horse...
Fungal osteitis of the axial aspect of the mid body of the medial proximal sesamoid bone in a horse.
The Canadian veterinary journal = La revue veterinaire canadienne    August 4, 2021   Volume 62, Issue 8 867-871 
Merchán A, Voss JK, Dubois MS.The satisfactory outcome of fungal osteitis in an 8-year-old American Quarter Horse is described. The horse was admitted with a grade 4 out of 5 lameness and exhibited metacarpophalangeal synovial effusion, indicative of a mild suppurative inflammation. Results of initial radiographic and ultrasonographic examination were unremarkable. Intra-articular anesthesia of the metacarpophalangeal joint allowed localization of the insult. It was not until day 6 of hospitalization when lytic changes on the axial aspect were observed on radiographic examination. Arthroscopic examination permitted identif...
Medial malleolus fragmentation following talocalcaneal arthrodesis by a dorsomedial approach in a horse.
The Canadian veterinary journal = La revue veterinaire canadienne    August 4, 2021   Volume 62, Issue 8 861-866 
Espinosa-Mur P, Spriet M, Nogues MP, Cullen T, Galuppo LD.A 16-year-old, Quarter Horse mare was presented for a 3/5 right hind lameness associated with osteoarthritis of the talocalcaneal joint (TCLJ). Positron emission tomography (PET) and computed tomography (CT) demonstrated marked increased uptake of 18F-sodium fluoride and bone remodeling at the medial facet of the TCLJ, respectively. Under general anesthesia 2 cortical screws (4.5 and 5.5 mm) were placed in neutral fashion via an arthrotomy from dorsomedial to plantaromedial through the medial facet of the TCLJ followed by copious lavage of the tarsocrural joint. Eight weeks after surgery, obse...
Cryotherapy provides transient analgesia in an induced lameness model in horses.
The Canadian veterinary journal = La revue veterinaire canadienne    August 4, 2021   Volume 62, Issue 8 834-838 
Quam V, Yardley J, Quam M, Paz C, Belknap J.The analgesic effect of cryotherapy in an induced lameness model was evaluated. Lameness was induced with solar pressure from a custom-made shoe in a 10-horse, cross-over study. The degree of lameness was recorded with a commercial non-invasive inertial sensor. The distal limbs were maintained in an ice and water slurry (cryotherapy) or at ambient temperature (control) for 1 hour. Lameness was assessed serially over the following hour. Lameness at each time point was compared to the baseline induced lameness, within and between groups. Lameness had improved significantly in all horses 5 minute...
Some Genetic and Environmental Effects on Equine Asthma in Polish Konik Horses.
Animals : an open access journal from MDPI    August 3, 2021   Volume 11, Issue 8 2285 doi: 10.3390/ani11082285
Borowska A, Wolska D, Niedzwiedz A, Borowicz H, Jaworski Z, Siemieniuch M, Szwaczkowski T.Current knowledge of the genetic and environmental backgrounds of equine asthma seems to be insufficient, especially for primitive horse breeds. The main objectives of this study were to estimate the effects of sex, birth period, stud, parentage line and inbreeding on asthma morbidity in Polish Konik horses. Records of 274 horses (housed in two studs) were analysed. These animals were allocated to maternal and paternal lines. Individual inbreeding coefficients were extracted from the additive relationship matrix. Horses underwent diagnosis based on observation of the basic symptoms (high frequ...
Equine infection with Leishmania spp. in Costa Rica: Study of five cases.
Veterinary medicine and science    August 2, 2021   Volume 7, Issue 6 2234-2239 doi: 10.1002/vms3.587
Ortega-García MV, Salguero FJ, García N, Domínguez M, Moreno I, Berrocal A.Cutaneous forms of leishmaniosis due to Leishmania braziliensis have been reported in horses in the New World. Domestic animals play a role in the transmission of the disease. In Costa Rica, human cases of L. braziliensis, L. panamensis and L. infantum have been reported. The present report describes five cases of equine cutaneous leishmaniosis in Costa Rica. The aetiological diagnosis was based on the presence of the parasite within the lesions. Skin biopsies were used to perform histopathological analyses of the lesions. Immunohistochemistry was used to detect the presence of the Leishmania ...
Simulated validation of intron-less transgene detection using DELLY for gene-doping control in horse sports.
Animal genetics    August 2, 2021   Volume 52, Issue 5 759-761 doi: 10.1111/age.13127
Tozaki T, Ohnuma A, Kikuchi M, Ishige T, Kakoi H, Hirota K, Kusano K, Nagata S.Gene doping is prohibited in horseracing. In a previous study, we developed a method for non-targeted transgene detection using DELLY, which is based on split-read (SR) and paired-end (PE) algorithms to detect structural variants, on WGS data. In this study, we validated the detection sensitivity of DELLY using artificially generated sequence data of 12 target genes. With DELLY, at least one intron was detected as a deletion in eight targeted genes using the 150 bp PE read WGS data, whereas all targeted genes were detected by DELLY using the 100 bp PE read data. The detection sensitivity was h...
Increased α-tocopherol metabolism in horses with equine neuroaxonal dystrophy.
Journal of veterinary internal medicine    July 31, 2021   Volume 35, Issue 5 2473-2485 doi: 10.1111/jvim.16233
Hales EN, Habib H, Favro G, Katzman S, Sakai RR, Marquardt S, Bordbari MH, Ming-Whitfield B, Peterson J, Dahlgren AR, Rivas V, Ramirez CA, Peng S....Equine neuroaxonal dystrophy/equine degenerative myeloencephalopathy (eNAD/EDM) is an inherited neurodegenerative disorder associated with a vitamin E deficiency within the first year of life. Vitamin E consists of 8 isoforms metabolized by the CYP4F2 enzyme. No antemortem diagnostic test currently exists for eNAD/EDM. Objective: Based on the association of α-tocopherol deficiency with the development of eNAD/EDM, we hypothesized that the rate of α-tocopherol, but not γ-tocopherol or tocotrienol metabolism, would be increased in eNAD/EDM-affected horses. Methods: Vitamin E metabolism: Proof...
Distal Gracilis Tear in an Equestrian.
American journal of physical medicine & rehabilitation    July 29, 2021   Volume 101, Issue 1 e8-e10 doi: 10.1097/PHM.0000000000001854
Chen YT, Mills C, von Rickenbach KJ, McInnis KC.A 61-yr-old female equestrian presented after 2 wks of left medial thigh pain, which developed suddenly while exiting a car. She denied any history of recent trauma or falls. On examination, she was found to have tenderness at the left distal medial thigh with a palpable region of decreased tissue volume at the gracilis myotendinous junction. Point-of-care ultrasound and magnetic resonance imaging confirmed a high-grade partial thickness tear of the left distal gracilis at the myotendinous junction, as well as pes anserine bursal distention. She received physical therapy and underwent a 1-time...
Comparative evaluation of clinical findings and prognostic outcome parameters in hospitalized, critically ill neonatal foals and crias.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    July 29, 2021   Volume 31, Issue 5 619-628 doi: 10.1111/vec.13093
Bedenice D, Avila B, Paradis MR.Species-related differences in the prevalence, manifestation, and outcome of neonatal illness may impact management practices of neonatal intensive care. The study aimed to elucidate similarities between disease manifestations and mortality risks of critically ill (CI) neonatal crias and foals admitted to the same referral center. Methods: A comparative, retrospective cohort evaluation of two species (camelid and equine). Methods: The study was conducted in a University hospital. Methods: Two hundred and forty-six CI neonatal crias (January 1999 to May 2016) and 356 neonatal foals (February 20...
Molecular analysis of G3P[6] rotavirus in the Amazon region of Brazil: evidence of reassortment with equine-like strains.
Future microbiology    July 28, 2021   Volume 16 847-862 doi: 10.2217/fmb-2020-0002
Silva Serra AC, Júnior EC, Cruz JF, Lobo PS, Júnior ET, Bandeira RS, Bezerra DA, Mascarenhas JD, Santos Guerra SF, Soares LS. To perform a molecular analysis of rotavirus A (RVA) G3P[6] strains detected in 2012 and 2017 in the Amazon region of Brazil. Eighteen RVA G3P[6] strains were collected from children aged under 10 years hospitalized with acute gastroenteritis, and partial sequencing of each segment genome was performed using Sanger sequencing. Phylogenetic analysis showed that all G3P[6] strains had a DS-1-like genotype constellation. Two strains had the highest nucleotide identities with equine-like G3P[6]/G3P[8] genotypes. Several amino acid alterations in VP4 and VP7 neutralizing epitopes of equine-l...
Gentamicin-induced sensorineural auditory loss in healthy adult horses.
Journal of veterinary internal medicine    July 28, 2021   Volume 35, Issue 5 2486-2494 doi: 10.1111/jvim.16221
Aleman MR, True A, Scalco R, Crowe CM, Costa LRR, Chigerwe M.Irreversible sensorineural auditory loss has been reported in humans treated with aminoglycosides but not in horses. Objective: Investigate if auditory loss occurs in horses treated using the recommended IV daily dosage of gentamicin for 7 consecutive days. Methods: Ten healthy adult horses (7-15 years; females and males, 5 each). Methods: Prospective study. Physical and neurological examinations and renal function tests were performed. Gentamicin sulfate was administered at a dosage of 6.6 mg/kg via the jugular vein on alternating sides for 7 days. Gentamicin peak and trough concentratio...
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