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Biomedical subjects

N D Cohen

Publications and source records attributed to N D Cohen.

At least 37 records · Page 2Linked to original sources

Association of disease with isolation and virulence of Rhodococcus equi from farm soil and foals with pneumonia.

OBJECTIVE: To determine whether isolation and virulence of Rhodococcus equi from soil and infected foals are associated with clinical disease. DESIGN: Cross-sectional and case-control study. SAMPLE POPULATION: R equi isolates from 50 foals with pneumonia and soil samples from 33 farms with and 33 farms without a history of R equi infection (affected and control, respectively). PROCEDURE: R equi was selectively isolated from soil samples. Soil and clinical isolates were evaluated for virulence-associated protein antigen plasmids (VapA-P) and resistance to the beta-lactam antibiotics penicillin G and cephalothin. Microbiologic cultures and VapA-P assays were performed at 2 independent laboratories. RESULTS: VapA-P was detected in 49 of 50 (98%) clinical isolates; there was complete agreement between laboratories. Rhodococcus equi was isolated from soil on 28 of 33 (84.8%) affected farms and 24 of 33 (72.7%) control farms, but there was poor agreement between laboratories. Virulence-associated protein antigen plasmids were detected on 14 of 66 (21.2%) farms by either laboratory, but results agreed for only 1 of the 14 VapA-P-positive farms. We did not detect significant associations between disease status and isolation of R equi from soil, detection of VapA-P in soil isolates, or resistance of soil isolates to beta-lactam antibiotics. No association between beta-lactam antibiotic resistance and presence of VapA-P was detected. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of soil microbiologic culture and VapA-P assay results, it is not possible to determine whether foals on a given farm are at increased risk of developing disease caused by R equi.

Actinomycetales Infections↗

Risk factors for enterolithiasis among horses in Texas.

OBJECTIVE: To identify risk factors for enterolithiasis in horses. DESIGN: Matched case-control study. ANIMALS: 26 horses with enteroliths, 104 horses with other causes of colic that underwent surgery (52 horses, surgical control group) or were treated medically (52 horses, nonsurgical control group). PROCEDURE: Medical records were reviewed for horses with enteroliths and control horses. Information collected included signalment, anamnesis, and findings on physical examination and clinicopathologic testing at admission. Horses with enteroliths and control horses were compared by means of conditional logistic regression to identify factors associated with enterolithiasis. RESULTS: Horses that were fed alfalfa hay, spent < or = 50% of time outdoors, or were Arabian or miniature breeds had an increased risk of developing enteroliths. Horses with enteroliths were more likely to have been hyperbilirubinemic and to have had clinical signs > 12 hours prior to admission. CONCLUSIONS AND CLINICAL RELEVANCE: Breed and diet appear to influence the risk of enterolithiasis; other management factors also may influence development of enteroliths. Duration of clinical signs may be longer and signs may be less severe among horses with enteroliths, compared with horses with other causes of colic.

Animals↗

Association of high-speed exercise with racing injury in thoroughbreds.

OBJECTIVE: To determine the association between high-speed exercise and risk of injury while racing among Thoroughbreds in Kentucky. DESIGN: Matched case-control study. ANIMALS: 206 Thoroughbreds that sustained a musculoskeletal injury while racing and 412 Thoroughbreds that were not injured during the same races. PROCEDURE: Data regarding official timed workouts and races and the Beyer's numbers for the 3 races before the race during which injury occurred were extracted from past performance charts and compared between injured horses and control horses. RESULTS: For injured horses, cumulative distance of high-speed exercise during the 1- and 2-month periods prior to the race in which injury occurred was significantly less than that of control horses; for either period, a difference of 10 furlongs was associated with approximately 2-fold greater risk of injury. Beyer's numbers were significantly higher for injured horses than for control horses. These effects remained significant after adjusting for age and results of prerace physical inspection. CONCLUSIONS AND CLINICAL RELEVANCE: In Kentucky, injured horses had significantly less cumulative high-speed exercise than did control horses during the 1- and 2-month periods prior to the race in which injury occurred. These results differ from those observed in California. The association of injury with cumulative high-speed exercise appears to vary among regions in the United States.

Age Factors↗

Abomasal displacement and volvulus in beef cattle: 19 cases (1988-1998).

OBJECTIVE: To assess signalment, history, results of clinical and laboratory testing, and outcome for beef cattle with a left displaced abomasum (LDA), right displaced abomasum (RDA), or abomasal volvulus (AV). DESIGN: Retrospective study. ANIMALS: 19 beef cattle with an AV, LDA, or RDA. PROCEDURE: Signalment; history; results of physical examination, diagnostic testing, and surgical exploration; and condition of the animal at discharge were obtained from medical records. RESULTS: Fourteen cattle had an AV, 4 had an RDA, and 1 had an LDA. Duration of clinical signs ranged from 1 to 21 days. Eighteen cattle had an AV or RDA; 7 were Brahmans, 12 were males, and median age was 10 months. Abdominal distention was observed in 11 cattle, heart rate of > or = 100 beats/minute was detected in 14, and the abomasum was palpable per rectum in all cattle in which per rectal examination was performed. Leukocytosis, neutrophilia, hyperglycemia, azotemia, hypochloremia, and hypokalemia were common laboratory findings. At surgery, 3 cattle with an AV or RDA had a ruptured abomasum. Of the remaining 15 cattle, 12 survived. CONCLUSIONS: Clinical course in beef cattle with an AV or RDA was more protracted than that typically associated with these conditions in dairy cattle, but survival rate in beef cattle that did not have rupture of the abomasum was similar to that of dairy cattle. CLINICAL RELEVANCE: Abomasal displacement should be considered for beef cattle with abdominal distention. Prognostic indicators recommended for use in dairy cattle may not be useful for beef cattle.

Abomasum↗

Equine lymphocytic-plasmacytic enterocolitis: a retrospective study of 14 cases.

Lymphocytic-plasmacytic enteritis (LPE) is a morphological diagnosis given to a type of infiltrative intestinal disease classified within the complex of idiopathic inflammatory bowel disease (IBD). The purpose of this retrospective study was to describe the details of breed, age and sex, clinical and clinicopathological findings and outcome of horses diagnosed with LPE. Data were reported from 14 horses that had a histopathological diagnosis of LPE; the median age was 12 years, and there was no breed or sex predilection. Common clinical signs were weight loss (100%), diarrhoea (50%) and lethargy (50%). Hypoproteinaemia and hypoalbuminaemia were present in 6/13 (46%) and 9/12 (75%) horses, respectively. Results of the oral glucose tolerance tests or D-xylose absorption tests were abnormal in 9/12 (75%) horses and rectal mucosal biopsies were abnormal in 3/7 (43%) horses. Corticosteroid treatment was used unsuccessfully in 4 horses. All horses were subjected to euthanasia and LPE was diagnosed at necropsy. Diffuse thickening of the small intestine was apparent grossly in 10/13 (77%) horses examined. LPE is an uncommon equine intestinal disease that is difficult to diagnose antemortem and has a poor prognosis.

Adrenal Cortex Hormones↗

Comparison of nuclear scintigraphy and acetaminophen absorption as a means of studying gastric emptying in horses.

OBJECTIVE: To evaluate the correlation between halftime of liquid-phase gastric emptying (T50), determined with nuclear scintigraphy using technetium Tc 99m pentetate, and absorption variables of orally administered acetaminophen. ANIMALS: 6 mature horses. PROCEDURE: Technetium Tc 99m pentetate (10 mCi) and acetaminophen (20 mg/kg of body weight) were administered simultaneously in 200 ml of water. Serial left and right lateral images of the stomach region were obtained with a gamma camera, and T50 determined separately for counts obtained from the left side, the right side and the geometric mean. Power exponential curves were used for estimation of T50 and modified R2 values for estimation of goodness of fit of the data. Serial serum samples were taken, and acetaminophen concentration was determined, using fluorescence polarization immunoassay. Maximum serum concentration (Cmax), time to reach maximum serum concentration (Tmax), area under the curve for 240 minutes and the absorption constant (Ka) were determined, using a parameter estimation program. Correlations were calculated, using the Spearman rank correlation coefficient. RESULTS: Correlations between T50 and Tmax and between T50 and Ka were significant. CONCLUSIONS AND CLINICAL RELEVANCE: Tmax and Ka are valuable variables in the assessment of liquid-phase gastric emptying using acetaminophen absorption. Acetaminophen absorption may be a valuable alternative to nuclear scintigraphy in the determination of gastric emptying rates in equine patients with normally functioning small intestine.

Acetaminophen↗

Prokinetic effects of erythromycin on the ileum, cecum, and pelvic flexure of horses during the postoperative period.

OBJECTIVE: To evaluate the effect of erythromycin on motility of the ileum, cecum, and pelvic flexure of horses during the postoperative and post-recovery periods. ANIMALS: 8 healthy adult horses. PROCEDURE: Horses were anesthetized and bipolar electrodes were implanted in smooth muscle of the ileum, cecum, and pelvic flexure. Approximately 4, 16, and 24 hours (postoperative recording sessions) and at least 8 days (post-recovery recording session) after surgery, myoelectric activity was recorded before and after administration of erythromycin (0.5 mg/kg). RESULTS: Following erythromycin administration, myoelectric activity was increased in the ileum during all postoperative recording sessions but not during the post-recovery recording session. Myoelectric activity was increased in the cecum following erythromycin administration only during the post-recovery recording session. Myoelectric activity was increased in the pelvic flexure following erythromycin administration during all recording sessions. During several recording sessions, there were short periods during which myoelectric activity was significantly decreased following erythromycin administration. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that erythromycin has an effect on myoelectric activity of the ileum, cecum, and pelvic flexure in horses; however, prokinetic effects of erythromycin administered during the postoperative period were not always the same as effects obtained when the drug was administered after horses had recovered from the effects of surgical implantation of recording devices. Therefore, caution must be exercised when extrapolating results of prokinetic studies in healthy animals to animals with abnormal gastrointestinal tract motility.

Animals↗

Effects of dietary fructooligosaccharide on selected bacterial populations in feces of dogs.

OBJECTIVE: To evaluate fecal concentrations of selected genera of colonic bacteria in healthy dogs, and to investigate effects of dietary fructooligosaccharides (FOS) on those bacterial populations. ANIMALS: 6 healthy adult Beagles. PROCEDURE: Dogs were randomly assigned to 2 groups of 3 and fed an unsupplemented diet for 370 days. After 88 days, fecal samples were collected. Another fecal sample was collected from each dog 282 days later. Group A then received a diet supplemented with FOS, and group B continued to receive the unsupplemented diet. Twenty-eight to 29 days later, fecal samples were collected. Diets were switched between groups, and fecal samples were collected 31 and 87 days later. Concentrations of Bifidobacterium spp, Lactobacillus spp, Clostridium spp, Bacteroides spp, and Escherichia coli in freshly collected feces were determined. Effects of diet and time on bacterial concentrations were compared between groups. RESULTS: Bifidobacterium spp and Lactobacillus spp were inconsistently isolated from feces of dogs fed either diet. Sequence of diet significantly affected number of Bacteroides spp subsequently isolated from feces, but diet had no effect on numbers of Clostridium spp or E coli. CONCLUSIONS AND CLINICAL RELEVANCE: Some genera of bacteria (eg, Bifidobacterium) believed to be common components of colonic microflora may be only sporadically isolated from feces of healthy dogs. This deviation from expected fecal flora may have implications for the effectiveness of supplementing diets with prebiotics.

Animal Feed↗

Empyema of the guttural pouch (auditory tube diverticulum) in horses: 91 cases (1977-1997).

OBJECTIVE: To identify features of guttural pouch (auditory tube diverticulum) empyema in horses and compare findings of uncomplicated guttural pouch empyema with guttural pouch empyema complicated by chondroids. DESIGN: Retrospective study. ANIMALS: 91 horses with guttural pouch empyema. PROCEDURE: Medical records of horses with guttural pouch empyema were reviewed. RESULTS: The most common owner complaint and abnormal finding was persistent nasal discharge. Chondroids were detected in 21% (19/91) of affected horses. Streptococcus equi was isolated from the guttural pouch in 14 of 44 horses; for Streptococcus spp, in vitro resistance to sulfadimethoxine and trimethoprim-sulfamethoxazole was detected. Retropharyngeal swelling and pharyngeal narrowing were significantly more prevalent in horses with chondroids, compared with horses with uncomplicated empyema. Ninety-three percent of affected horses were discharged from the hospital; at time of discharge, 66% had complete resolution of disease, 19% had improvement without resolution, and 15% did not have improvement. CONCLUSIONS AND CLINICAL RELEVANCE: Horses with persistent nasal discharge should be examined endoscopically for guttural pouch empyema. Treatment with lavage offers a good prognosis for resolution of uncomplicated guttural pouch empyema. Aggressive treatment with lavage and endoscopic snare removal of chondroids offers a good prognosis and may make surgical intervention unnecessary.

Animals↗

Results of physical inspection before races and race-related characteristics and their association with musculoskeletal injuries in Thoroughbreds during races.

OBJECTIVE: To estimate the relative risk of injury among horses deemed to be at increased risk of injury on the basis of prerace physical inspection findings and to examine the association of injury during races with race-related characteristics. DESIGN: Cohort study. ANIMALS: 2,187 Thoroughbred horses that started 3,227 races in Kentucky. PROCEDURE: All race starts for which a horse was deemed to be at increased risk of injury on the basis of prerace physical inspection findings and a random sample of race starts for which horses were not deemed at increased risk of injury were included in the study. Findings of prerace physical inspection, race-related characteristics, and outcome of the race (race results and whether the horse incurred an injury) were recorded for each race start. Race starts in which a horse incurred an injury during a race were compared with race starts in which injuries were not incurred to identify factors associated with injury during races. RESULTS: Abnormality of the suspensory ligament of the forelimbs detected during prerace physical inspection, racetrack, class of race (claiming race < or = $25,000 vs other classes), and distance of race (< 7 furlongs vs other distances) were significantly associated with increased risk of injury. CONCLUSIONS AND CLINICAL RELEVANCE: Prerace physical inspection findings, particularly abnormalities of the suspensory ligament, may be used to identify horses at increased risk of injury during races. Rate of injury differed among racetracks, and horses in certain types of races (lower-priced claiming races and races of shorter distance) may be at increased risk of injury during races.

Age Factors↗

Frequency of musculoskeletal injuries and risk factors associated with injuries incurred in Quarter Horses during races.

OBJECTIVE: To determine the frequency and anatomic location of musculoskeletal injuries incurred by Quarter Horses during races and to compare data from injured horses and matched control horses. DESIGN: Matched case-control study. ANIMALS: 97 Quarter Horses that sustained a musculoskeletal injury during races and 291 horses from the same races that were not injured. PROCEDURE: Data examined included racing history, race-entrant characteristics, racing events determined by analysis of videotapes of races, and, when performed, results of prerace physical inspections. Data for injured horses were compared with data for control horses, using conditional logistic regression. RESULTS: Incidence of a catastrophic injury among Quarter Horses during races was approximately 0.8/1,000 race starts, whereas incidence of musculoskeletal injury during racing was approximately 2.2/1,000 race starts. Odds of musculoskeletal injury were approximately 8 times greater among horses assessed to be at increased risk of injury on the basis of results of prerace physical inspection than for horses not considered to be at increased risk of injury. Evidence was lacking that 2-year-old horses were at increased risk of injury or that sex influenced the risk of injury among Quarter Horses during races. CONCLUSIONS AND CLINICAL RELEVANCE: Incidence of racing injury among Quarter Horses appears to be lower than that observed among Thoroughbreds. Regulatory veterinarians can identify horses at increased risk of injury on the basis of prerace physical inspection, indicating that these inspections could be used to reduce the risk of injury during races.

Age Factors↗

Dietary and other management factors associated with colic in horses.

OBJECTIVE: To determine whether dietary and other management factors were associated with development of colic in horses. DESIGN: Prospective matched case-control study. POPULATION: 2,060 horses examined by veterinarians in private practice in Texas for colic and noncolic emergencies. PROCEDURE: Each month for 12 months, participating veterinarians were sent forms to collect information on 1 horse with colic and 1 horse that received emergency treatment for a condition other than colic, information collected included signalment, farm management and characteristics, diet, medical and preventive medical factors, transport, and activity or use. Case and control horses were compared by means of conditional logistic regression to identify factors associated with colic. RESULTS: Recent change in diet, recent change in type of hay, history of previous episode of colic, history of abdominal surgery for colic, recent change in weather conditions, recent change in housing, Arabian breed, administration of an anthelmintic during the 7-day period prior to examination, failure to receive regular deworming, age > 10 years, and regular exercise (vs pastured at all times) were associated with increased risk of colic. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that changes in diet (particularly in type of hay fed) contribute to increased risk of colic. A regular program for administration of anthelmintics may reduce the overall frequency at which colic develops, but recent administration of anthelmintics may predispose some horses to colic. Arabian horses may have an increased risk of colic, and horses at pasture may have a decreased risk of colic.

Animal Husbandry↗

Characteristics and risk factors for failure of horses with acute diarrhea to survive: 122 cases (1990-1996).

OBJECTIVE: To characterize horses with acute diarrhea and determine risk factors for failure to survive. DESIGN: Retrospective study. ANIMALS: 122 adult horses admitted for acute diarrhea at the teaching hospital between Jan 1, 1990 and Dec 31, 1996. PROCEDURE: Medical records of horses with acute diarrhea were reviewed to abstract information regarding signalment, history, physical examination, clinicopathologic testing, treatment, and outcome. RESULTS: 91 of 122 (74.6%) horses lived and were discharged from the hospital. Horses with history of administration of antimicrobials for a problem preceding diarrhea were approximately 4.5 times less likely to survive. The following variables that had been determined at the time of admission were significantly associated with failure to survive: administration of antimicrobial drugs for another illness, serum creatinine concentration > 2.0 mg/dl, PCV > 45%, tachycardia (heart rate > 60 beats/min), and low serum total protein concentration. Prevalence of laminitis was 11.5%. CLINICAL IMPLICATIONS: Diarrheic horses that are azotemic and have clinicopathologic findings consistent with hemoconcentration and hypoproteinemia have a poor prognosis for survival. Antimicrobial administration may induce diarrhea, and antimicrobial-associated diarrhea may have a worse prognosis than other types of acute diarrhea.

Acute Disease↗

Detection of Cryptosporidium parvum in horses: thresholds of acid-fast stain, immunofluorescence assay, and flow cytometry.

Feces collected from three asymptomatic horses and seeded with Cryptosporidium parvum oocysts (10(1) to 10(6)/g of feces) were evaluated by acid-fast staining (AF), an immunofluorescent antibody (IFA) technique, and flow cytometry. The thresholds of detection were 5 x 10(5) oocysts/g of feces for the IFA and AF techniques and 5 x 10(4) oocysts/g for flow cytometry.

Animals↗

Prevalence of and risk factors for fecal shedding of Cryptosporidium parvum oocysts in horses.

OBJECTIVE: To determine prevalence of and risk factors for fecal shedding of Cryptosporidium parvum oocysts among 3 populations of horses. DESIGN: Cross-sectional study. ANIMALS: 152 horses participating in the 1996 Texas State 4-H Horse Show, 144 horses examined by the veterinary teaching hospital, and 70 broodmares and their 10- to 21-day-old foals. PROCEDURE: Information on signalment and potential risk factors for fecal shedding of oocysts was obtained. Fecal samples were evaluated for oocysts by means of acid-fast (AF) staining, immunofluorescence assay (IFA), and, for selected samples, flow cytometry (FC). RESULTS: Results of the 3 diagnostic tests were significantly different. The best agreement was between results of the IFA and FC; AF staining and FC were more sensitive than the IFA, but AF staining was less specific. Fecal samples from 13 horses were classified as positive for oocysts. Risk factors for fecal shedding of oocysts included residence on 2 of 4 breeding farms involved in the study, age < 6 months, and history of diarrhea during the preceding 30 days. A municipal water source was implicated as a risk but could not be verified because of insufficient data. CLINICAL IMPLICATIONS: Mature horses and exposure to cattle did not appear to be important sources of cryptosporidial infection for foals. Overall prevalence of C parvum infection among these horses was low, and C parvum infection appeared to be associated with particular farms, rather than an endemic opportunistic infection in horses.

Animals↗

Pharmacokinetics of a high dose of gentamicin administered intravenously or intramuscularly to horses.

OBJECTIVE: To evaluate pharmacokinetics of a high dose of gentamicin administered i.v. or i.m. to horses. DESIGN: Repeated-measures study. ANIMALS: 6 clinically normal female adult stock-type horses. PROCEDURE: All horses were given gentamicin (6.6 mg/kg [3 mg/lb] of body weight), i.v. and i.m., in a two-way cross-over design. Serum gentamicin concentrations were measured during a 24-hour period. RESULTS: Plasma concentration curves were consistent with a two-compartment model. Maximum plasma gentamicin concentrations were 71.9 +/- 15.7 micrograms/ml (0 hours after injection) and 22.0 +/- 4.9 micrograms/ml (1.31 hours after injection) for the i.v. and i.m. groups, respectively. Area under the curve (AUC) was 116.6 +/- 14.5 and 116.3 +/- 14.6 micrograms.h/ml for the i.v. and i.m. groups, respectively. Elimination half-life for the IV group was 3.0 +/- 2.8 hours. Trough concentrations were < 2 micrograms/ml for > 15 and > 12 hours for the i.v. and i.m. groups, respectively. Significant changes were not detected in clinicopathologic variables before and after administration of gentamicin. CLINICAL IMPLICATIONS: Administration of a high dose of gentamicin i.v. or i.m. resulted in peak plasma concentrations, AUC, and minimum trough plasma concentrations. Results indicate once-daily administration of gentamicin might be as efficacious and safe as multiple-dose daily administration in accordance with traditional low-dose regimens, similar to those used in other species.

Animals↗

Randomized controlled trial of effects of Escherichia coli antiserum on serum immunoglobulin G concentrations and morbidity and mortality rates in foals.

OBJECTIVE: To determine whether administration of commercially available Escherichia coli antiserum to neonatal foals would affect serum IgG concentration or morbidity and mortality rates during the first 60 days of life. DESIGN: Randomized controlled trial. ANIMALS: 271 neonatal foals on 4 well-managed farms. PROCEDURE: Foals were randomly assigned to a treatment or control group. All foals were allowed to suckle colostrum normally. In addition, treatment-group foals were given E coli antiserum (10 micromilligrams) orally between 0 and 8 hours after birth. Serum samples were obtained between 18 and 36 hours after birth, and serum IgG concentration was determined. Foals were monitored for the first 60 days after birth, and causes of disease or death were recorded. RESULTS: Groups did not differ significantly in regard to breed, sex, month of birth, season of birth, age of dams, parity of dams, duration of gestation, or specific gravity of colostrum before suckling. In addition, groups did not differ significantly in regard to mean serum IgG concentration, prevalence of complete or partial failure of passive transfer of immunity, frequency or causes of disease, or frequency of death from infectious causes. CLINICAL IMPLICATIONS: In this group of foals on well-managed farms, administration of E coli antiserum did not alter serum IgG concentrations or morbidity and mortality rates during the first 60 days of life.

Animal Husbandry↗

Alterations in acid-base balance and serum electrolyte concentrations in cattle: 632 cases (1984-1994).

OBJECTIVE: To determine typical alterations in acid-base balance and serum electrolyte concentrations in cattle grouped on the basis of age, breed type, hydration status, clinical signs, and underlying disease. DESIGN: Retrospective study. ANIMALS: 632 cattle. PROCEDURE: Information on blood pH, PVO2, PVCO2, HCO3-concentration, and base excess (BE) as well as serum or plasma sodium, potassium, chloride, and total carbon dioxide concentrations was obtained. Values for calves (ie, cattle < 1 month old) were compared with values for cattle > or = 1 month old. Within each age-group, values were compared for cattle grouped on the basis of breed type, previous treatment, and hydration status. Proportions of cattle with various disorders for which values were within, greater than, or less than reference ranges were determined. RESULTS: BE, pH, and HCO3- concentration were significantly higher and PVCO2 and sodium, potassium, and chloride concentrations were significantly lower among cattle > or = 1 month old than calves. Base excess and HCO3- concentration were significantly lower among dairy than beef calves. Sodium and potassium concentrations were significantly lower among dairy than beef cattle > or = 1 month old. A higher proportion of cattle that did not survive had a high anion gap than cattle that did survive. Sodium, potassium, and chloride concentrations were significantly lower among dehydrated cattle than cattle that were not dehydrated. CLINICAL IMPLICATIONS: Because certain alterations were consistently found in some groups of cattle, it may be possible to make reasonable predictions of alterations in acid-base balance and serum electrolyte concentrations when laboratory evaluations are not available.

Acid-Base Equilibrium↗