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Topic:Animal Health

Animal Health encompasses a broad range of topics focused on maintaining and improving the well-being of equine species. This field addresses various aspects of horse care, including disease prevention, diagnosis, treatment, and management of health conditions. Key areas of interest include equine nutrition, vaccination protocols, parasite control, dental care, and the management of chronic conditions such as laminitis and colic. Additionally, animal health research in horses investigates the impact of exercise and training on physical health, the role of genetics in disease susceptibility, and the development of new therapeutic approaches. This page compiles peer-reviewed research studies and scholarly articles that explore the latest advancements, challenges, and best practices in preserving and enhancing the health of horses.
Seroprevalence of Leptospira in Lavradeiro horses, a semi-feral ecotype from the Northern Brazilian Amazon.
Veterinary research communications    June 9, 2026   Volume 50, Issue 5 381 doi: 10.1007/s11259-026-11328-8
da Silva Martins A, Silva TA, Heinemann MB, Guedes IB, Soares RR, Dias RA, Passos RF, Braga RM, Santos FCCD, Borsanelli AC.Leptospirosis is a neglected zoonosis with significant impact on public and veterinary health, with equines acting as potential maintenance hosts of infection. This study aimed to investigate the seroprevalence of Leptospira in Lavradeiro horses under semi-feral conditions in Indigenous communities in the state of Roraima, Brazil. A total of 387 serum samples were subjected to the microscopic agglutination test (MAT), using antigens of Leptospira spp. from 18 serogroups. The overall prevalence was 15.8% (95% CI: 12.3-19.8%), with the most frequent serogroups being Australis, Tarassovi, Autumna...
Radiographic identification and description of the equine middle conchal sinus (ethmoidal sinus): Implications for diagnosing middle conchal sinusitis.
Equine veterinary journal    June 8, 2026   doi: 10.1002/evj.70198
Pavard JB, Young A, Robert M, Verwilghen D.The middle conchal sinus (MCS) (ethmoidal sinus) remains one of the least understood equine paranasal compartments. Despite recognition of its involvement in sinonasal disease, disorders of the MCS often remain underdiagnosed in the absence of computed tomographic (CT) imaging due to limited anatomical understanding and challenges with radiographic visualisation. Objective: The objectives of the study were (1) to characterise the radiographic features and anatomical location of the MCS in horses and (2) to illustrate the practical relevance of the anatomical and radiographic findings in two cl...
Imaging of the Equine Abdomen Using Point of Care Ultrasound (POCUS)-A Resource for the Equine Practitioner.
Animals : an open access journal from MDPI    June 8, 2026   Volume 16, Issue 12 1770 doi: 10.3390/ani16121770
Freccero F, Padalino B, Carstens A, Raidal SL.Wireless ultrasound (US) probes for point of care (POC) evaluation of horses presented for veterinary evaluation of colic have become widely available in recent years. The availability and performance of this technology mean POCUS is readily available to the equine practitioner and the technology is well suited to patient evaluation or serial monitoring in first opinion practice. In human health care and veterinary contexts, it has been suggested that there is a need for practitioners to better appreciate the value of POCUS for assessment of gastrointestinal structure and function. This study ...
Novel technique for correcting urovagina via urethral transposition in the horse.
Equine veterinary journal    June 7, 2026   doi: 10.1002/evj.70210
McCarthy R, Kamm JL, Pierce M, Huber M.Vesicovaginal reflux is a common cause of infertility in mares. Surgical correction is commonly recommended and involves caudal relocation of the urethral orifice which forces the urine to be expelled caudally. There have been several previously described techniques. Complications associated with caudal urethral extension occur in 11-33.3% of cases. Objective: To identify a novel technique for performing caudal urethral translocation that effectively corrects vesicovaginal reflux with minimal associated complications. Methods: In vivo experiment and clinical case series. Methods: The experimen...
Prevalence, genomic diversity and emerging antimicrobial resistance of Taylorella asinigenitalis in Grand Noir du Berry breeding donkeys.
Veterinary microbiology    June 6, 2026   Volume 320 111111 doi: 10.1016/j.vetmic.2026.111111
Breuil MF, Duquesne F, Magoga J, Sévin C, Kozak S, Gesbert A, Petit A, Reigner F, Petry S.Taylorella asinigenitalis is a fastidious Gram-negative bacterium of the equine genital tract, found more commonly in donkeys than horses. Although considered non-pathogenic, it is closely related to Taylorella equigenitalis, the agent of contagious equine metritis, and has been linked to experimental and natural cases of endometritis. The SAFRAN project (French acronym for "Sauvegarde de la fertilité de l'âne", meaning "Preservation of donkey fertility"), launched in 2024 by the French National Research Institute for Agriculture, Food and Environment (INRAE) with support from the Centre-Val...
Impact of collagen supplementation on the fecal microbiome of young horses in training.
Journal of equine veterinary science    June 6, 2026   106047 doi: 10.1016/j.jevs.2026.106047
Júnior AMCA, da Silva AH, Buroxid RP, Padovan JR, Nunes AT, Poleti MD, Fukumasu H, Gobesso AAO.Intense training in athletic foals may alter fecal microbiota, highlighting the need for nutritional strategies such as hydrolyzed collagen supplementation. Objective: This study aimed to evaluate the effects of dietary hydrolyzed collagen on the fecal microbiome of weanlings in training. Methods: Twenty Mangalarga Marchador foals (206 ± 18 kg; 7 ± 1 mo age) were assigned to two groups: a supplemented group (50 g/day of hydrolyzed collagen for 180 days) and a control group. A completely randomized design with repeated measures over time was used. Foals were exercised five consecutive days pe...
Estrous cycle-dependent changes in platelet indices in healthy mares.
Veterinary research communications    June 6, 2026   Volume 50, Issue 5 377 doi: 10.1007/s11259-026-11333-x
Satué K, Fazio E, Colomer-Selva R, Gímenez ED, Cravana C, Fauci D.Platelets (PLTs) are key regulators of hemostasis, inflammation, and tissue remodeling, and their phenotype is known to fluctuate with sex steroid concentrations in several species. However, the influence of the estrous cycle on PLT characteristics in mares has not been investigated. We hypothesized that PLT indices vary between reproductive phases in association with changes in estradiol-17β (E2) and progesterone (P4). The aim of this study was to characterize PLT indices in estrus and diestrus and to determine how these hematological parameters relate to circulating E2 and P4 concentrations...
Comparison of Magnetic Resonance Imaging and Computed Tomography for Evaluation of Cervical Vertebral Nerves and Synovial Tissues in Horses with Cervical Spinal Disease.
Animals : an open access journal from MDPI    June 6, 2026   Volume 16, Issue 12 1759 doi: 10.3390/ani16121759
Daniels AM, Morton AJ, Werpy NM, Biedrzycki AH, Tull TM, Denagamage TN, Porter EG, Taintor JS, Bell RJW.Pathology of the cervical spine is an important cause of poor performance in sport horses. Computed tomography (CT) and magnetic resonance imaging (MRI) have improved musculoskeletal diagnostic capabilities. CT is well-suited to assess osseous pathology, although it is limited for assessing soft tissues. MRI, the gold standard for imaging soft tissues, cannot be used for antemortem imaging of the equine cervical spine. The diagnostic potential of CT for evaluating soft tissues of the equine cervical spine compared to MRI is not well-defined and warrants investigation. Postmortem MRI was perfor...
Reduced centrifugation duration improves diagnostic performance of an equine tapeworm egg counting technique.
Parasitology research    June 5, 2026   doi: 10.1007/s00436-026-08706-1
Hughes M, Ripley NE, Smith MA, Carta C, Nielsen MK.Anoplocephala perfoliata, can cause severe health problems in horses. Standard coprological tests have performed poorly for detecting A. perfoliata, and while a centrifugation-enhanced flotation technique is superior to other techniques, it is time consuming due to three 10-minute centrifugation steps. This study aimed to evaluate modifications of this technique that reduce the centrifugation durations to 5 and 1 min, respectively. Fecal samples were collected from ten adult A. perfoliata egg count positive mares and divided into 9 subsamples to allow for three replicate counts for each of th...
Thermal Thresholds and Genetic Sensitivity in Barrel Racing Performance of Quarter Horses Across Temperature-Humidity Indices. Santana ML, Bignardi AB.Heat stress is an increasingly important challenge for the performance and welfare of equine athletes, particularly in competitions conducted across diverse climatic conditions. Understanding the genetic basis of performance responses to increasing thermal load is therefore essential to support robust genetic evaluation and sustainable selection strategies. The objective of this study was to evaluate barrel racing performance of Brazilian Quarter Horses across thermal environments defined by two widely used indicators, the temperature-humidity index (THI) and the wet bulb globe temperature (WB...
Evidence of Physiological Comodulation During Human-Animal Interaction: A Systematic Review.
Annals of the New York Academy of Sciences    June 5, 2026   Volume 1560, Issue 1 e70299 doi: 10.1111/nyas.70299
Bargigli G, Frassineti L, Baragli P, Scopa C, Vignoli A, Lanata A.This review examines the evidence in the literature for physiological co-modulation during human-animal interaction, identifying studies that assessed comodulation via simultaneous measurement of physiological signals in both species, performing quantitative comparisons. We searched (last search: August 5, 2025) PubMed, EMBASE, Scopus, Google Scholar, Animal Studies Repository, Cochrane, and the Consensus App academic search engine. Risk of bias was assessed using an adapted version of the ROBINS-I V2 tool. The results, grouped by data analysis method, interaction context, and physiological pa...
Syndrome of High Gamma-Glutamyl Transferase in Racehorses.
The Veterinary clinics of North America. Equine practice    June 5, 2026   S0749-0739(26)00024-6 doi: 10.1016/j.cveq.2026.04.009
Haughan J, Cathcart J, Tomlinson JE.Horses in racing and race training can develop high gamma-glutamyl transferase (GGT) syndrome (HGS), or increased GGT without overt evidence of primary liver disease. Current evidence points toward overtraining and a response to oxidative stress, but the etiology is incompletely understood. Evidence for an association of HGS with poor performance is mixed. Without a clear understanding of the etiology, the only evidence-based treatment option is rest or reduced training intensity. More research is needed to determine whether HGS is a physiologic adaptation, perhaps indicative of overtraining b...
Cervical spinal cord compression may affect anesthetic recovery quality and seizure incidence in horses after myelography.
American journal of veterinary research    June 5, 2026   1-8 doi: 10.2460/ajvr.26.02.0072
Theiss D, Douglas HF, Colmer SF, Owens LA, Stefanoski D, Johnson AL, Hopster K, Midon M.To compare anesthetic recovery quality and seizure incidence after cervical myelography in horses with or without cervical spinal cord compression. Unassigned: Anesthesia and medical records from January 2017 to December 2022 of horses anesthetized for myelography were retrieved. Patients with incomplete records, equine protozoal myeloencephalitis diagnosis, or an anesthetic protocol outside an established standard were excluded. Demographic analysis, ataxia score, and anesthetic management variables were recorded in an observational retrospective fashion. Each variable was compared between gr...
Physiological determinants of plasma biochemical parameters in horses: a structured review.
Journal of equine veterinary science    June 5, 2026   106052 doi: 10.1016/j.jevs.2026.106052
Satué K, La Fauci D, Velasco-Martínez MG, Cravana C, Medica P, Fazio E.The biochemical profile of horses is a cornerstone in equine clinical diagnostics, offering valuable insights into health status, disease progression, and physiological adaptation to internal and external stimuli. However, the interpretation of these biochemical parameters is far from straightforward, as they are subject to significant variation influenced by a range of physiological factors. Age, sex, breed, level of physical activity, nutritional condition, and reproductive status can all modulate baseline biochemical values, potentially leading to diagnostic inaccuracies if not properly con...
Morbidity associated with inhalation anesthesia in horses: the role of opioid use in a university teaching hospital.
Journal of equine veterinary science    June 5, 2026   106055 doi: 10.1016/j.jevs.2026.106055
Cardoso GS, Justo AA, Henriques MAAD, Ferreira MA, Rusch E, Costa FA, Dória RGS, Carregaro AB.Despite concerns among equine practitioners, the effects of opioid administration on intraoperative complications during inhalation anesthesia remain incompletely characterized. This retrospective study evaluated intraoperative complications and perianesthetic mortality in horses undergoing inhalation anesthesia according to opioid use. Medical records from a university veterinary hospital were reviewed (2014-2025) and grouped based on opioid inclusion in anesthetic protocols and surgery type (colic vs. non-colic). Intraoperative hypotension (MAP < 70 mmHg), hypothermia (temperature 65 mmH...
Evaluation of autologous fecal microbiota transplantation for restoring equine gut microbiota after antibiotic-induced dysbiosis.
Journal of equine veterinary science    June 5, 2026   106049 doi: 10.1016/j.jevs.2026.106049
Kinoshita Y, Sato W, Ueno T.Microbial resilience is important to maintain a healthy gut environment in horses, especially after antibiotic administration, but the efficacies of post-antibiotic recovery strategies remain poorly characterized. We used microbial amplicon sequencing to compare spontaneous recovery, autologous fecal microbiota transplantation (FMT), and probiotic administration in 18 horses following antibiotic-induced dysbiosis. Clinically healthy horses received a combination of cephalothin and minocycline for 5 consecutive days before intervention. Fecal microbial recovery was longitudinally evaluated by u...
OPTIMIZING EXTRACTION AND CONCENTRATION METHODS FOR LC-MS/MS ANALYSIS OF VETERINARY PHARMACEUTICALS IN EQUINE-ASSOCIATED ENVIRONMENTAL MATRICES.
Environmental toxicology and pharmacology    June 5, 2026   105069 doi: 10.1016/j.etap.2026.105069
El Abbadi I, Pallier V, Bastos MC, Lissalde S, Feuillade G.This study developed a method for the simultaneous quantification of six potentially environmentally toxic veterinary drugs: benzylpenicillin, acepromazine, flunixin, dexamethasone, ketamine and romifidine, in soils, sediments, equine faeces and natural waters. Three methods were compared for their extraction from solid matrices: Ultrasonic extraction (USE), QuEChERS and Accelerated Solvent Extraction (ASE). ASE method was optimized according to temperature and extraction cycles. Quantification was performed by LC-MS/MS. LC and MS parameters were optimized. The method was validated according t...
Genomic diversity of multidrug-resistant Rhodococcus equi: novel sequence types, pangenome architecture, and phylogenomic evolution.
Applied and environmental microbiology    June 4, 2026   e0248625 doi: 10.1128/aem.02486-25
Lamichhane B, Kabir A, Adams AA, Burns L, Johnson B, Sponseller B, Helmy YA.Rhodococcus equi is a major cause of life-threatening pneumonia in foals under 6 months of age and an opportunistic pathogen in immunocompromised humans. Although common in soil and equine farm environments, its evolutionary dynamics, virulence architecture, and pathways of antimicrobial resistance (AMR) emergence remain poorly understood. This study integrated phenotypic characterization and whole-genome sequencing of 46 R. equi isolates from horses submitted for necropsy (n = 45) and equine fecal samples (n = 1) in Kentucky between January 2022 and December 2023 to define their resistance la...
Psycho-Spiritual Reflections on the Horse/Human Relationship.
Psychoanalytic review    June 4, 2026   Volume 113, Issue 2 175-187 doi: 10.1521/prev.2026.113.2.175
Hamm PJ.This essay offers a psycho-spiritual and psychoanalytic meditation on the horse-human relationship as a nonverbal site of attunement, regulation, and meaning-making. Drawing on autobiographical clinical narrative, it explores how horseback riding became a medium for experiencing and reflecting upon embodied connection, mutual responsiveness, and contemplative presence. Encounters with horses illuminate forms of reciprocity that preceded and exceed speech, while also opening reflection on maternal attachment, separation, loss, and the emergence of selfhood. In dialogue with Freud, Winnicott, Pi...
Plasma and urinary exposure of cannabidiol and cannabidiolic acid in horses following consumption of contaminated feed.
Irish veterinary journal    June 4, 2026   doi: 10.1186/s13620-026-00350-6
Ekstrand C, Michanek P, Hernlund E, Gehring R, Salomonsson M.Cannabidiol (CBD) and cannabidiolic acid (CBDA) are non-psychoactive cannabinoids naturally present in hemp-derived products. While these compounds are prohibited during equine competition, horses may be inadvertently exposed through contaminated feed. Data describing systemic and urinary exposure to CBD and CBDA following such low-dose, involuntary intake are limited. This study aimed to describe plasma and urine concentration-time profiles of CBD and CBDA in horses after consumption of experimentally contaminated feed. Results: Twelve Standardbred horses received feed containing low doses (1...
First molecular detection of Theileria haneyi infection in horses in Southern Spain.
Frontiers in veterinary science    June 4, 2026   Volume 13 1841333 doi: 10.3389/fvets.2026.1841333
Mendoza FJ, Pérez-Écija A, Suarez CE, Martínez E, Navarro A, Kappmeyer LS, Bastos RG.Equine piroplasmosis (EP) is a tick-borne disease of equids caused by the hemoparasites , and . , a close relative of that causes mild clinical signs under experimental conditions, has been reported in several countries, adding complexity to EP ecology, diagnosis, and treatment. However, its presence in Spain remains unknown, which is concerning given the country's importance in equine genetics and international trade. Hereby, we investigated the presence of in blood samples from equids in Spain. Unassigned: Blood samples from 222 equids (218 horses, two donkeys, two mules) suspected of EP a...
Assessment of knowledge, attitudes, and preventive practices for equine Endoparasite control among livestock owners in South Gondar Zone, Northwest Ethiopia: A community-based cross-sectional study.
Veterinary parasitology, regional studies and reports    June 3, 2026   Volume 73 101518 doi: 10.1016/j.vprsr.2026.101518
Alemayehu H, Alemneh T, Seyoum Z, Maru M, Ayele A.Endoparasites are a major health concern affecting equine productivity and welfare worldwide. Understanding farmers' knowledge, attitudes, and practices (KAP) toward parasite control is critical for designing effective interventions. This study assessed KAP levels among farmers in South Gondar Zone, Northwest Ethiopia, and identified factors associated with good KAP. A community-based cross-sectional study was conducted among 150 farmers. KAP scores were initially categorized into three levels (low, moderate, and high) and analyzed using chi-square (χ) tests to explore bivariate associations....
Prevalence, risk factors, and antimicrobial resistance of Staphylococcus aureus in equines in Egypt.
Scientific reports    June 3, 2026   Volume 16, Issue 1 17125 doi: 10.1038/s41598-026-55462-4
El-Halim MOA, Shoraba M, Gattan HS, Alruhaili MH, Selim A.Staphylococcus aureus is a common commensal organism in both humans and animals, frequently colonizing the skin and nasal cavities of healthy individuals, although it can also cause a wide range of severe infections. The present study investigated the prevalence and risk factors of S. aureus in equines, along with antimicrobial resistance patterns of methicillin-resistant S. aureus (MRSA) isolates. The results revealed a prevalence of 38.6% in nasal samples collected from equines, highlighting the organism's significant presence and potential to cause infections in these animals. A genotypic p...
Molecular and parasitological evidence of Leishmania (Mundinia) martiniquensis infection in a horse from Brazil.
International journal for parasitology    June 3, 2026   104898 doi: 10.1016/j.ijpara.2026.104898
Franco Leonel JA, Silva MDD, Araujo AC, Vioti G, Borges Martins JP, Strefezzi RF, Galvis-Ovallos F, Bianchi Galati EA, Ferreira de Sousa Oliveira TM.Leishmania (Mundinia) martiniquensis is an emerging human pathogen with increasing reports of infection in domestic animals. This study describes a naturally infected mare from Brazil with no history of international travel, presenting with persistent nodular cutaneous lesions and cervical lymph node enlargement, without evidence of systemic involvement. Considering the endemicity of cutaneous and visceral leishmaniasis in the study area, as well as previous reports of equine leishmaniasis, infection by Leishmania (Leishmania) infantum was initially suspected. Anti-L. (L.) infantum antibodies ...
Viral Hepatitis.
The Veterinary clinics of North America. Equine practice    June 3, 2026   S0749-0739(26)00021-0 doi: 10.1016/j.cveq.2026.04.006
Tomlinson J.Since 2012, 2 viral causes of hepatitis have been identified in horses. Much remains to be discovered about their transmission, risk factors for clinical disease, diagnosis, and treatment approaches. Equine parvovirus-hepatitis has been identified as the cause of acute hepatic necrosis, previously known as Theiler's disease. Equine hepacivirus is recognized as a cause of chronic fibrosing hepatitis. Diagnosis relies on ruling out other causes of hepatitis and documenting infection by serum or liver polymerase chain reaction. There is no direct antiviral for either condition and treatments are ...
Mitigating and addressing complications in equine laparoscopy.
Journal of the American Veterinary Medical Association    June 3, 2026   Volume 264, Issue 9 1-9 doi: 10.2460/javma.26.01.0057
Luedke L, Hendrickson DA, Pezzanite LM, Easley JT.The purpose of this article was to report a condensed overview of current strategies for mitigating and managing complications in equine laparoscopic surgery. Minimally invasive surgical techniques have become standard in equine surgery for a variety of diagnostic and therapeutic procedures, with purported advantages including reduced postoperative pain, expedited recovery, fewer incisional complications, and enhanced visual imagery for the surgeon compared to traditional open approaches. Despite these benefits, complications can arise, and the literature demonstrates variability in definition...
Molecular prevalence of equine herpesvirus type 1 and equine herpesvirus type 4 in thoroughbred and Arabian horse facilities in Türkiye.
Acta veterinaria Hungarica    June 2, 2026   004.2026.01202 doi: 10.1556/004.2026.01202
Ekİncİ G, Tİmur MC, Mete A, Altınbay K, Denİz Ö, Derellİ FM, Çeşme GS, Tüfekçİ E, Onmaz AC, Güneş V, Çİtİl M, Keleş İ....Equine herpesvirus-1 and -4 are contagious viruses causing respiratory disease and reproductive losses in horses. This study aimed to determine the prevalence of EHV-1 and EHV-4 in eight Turkish stud farms using RT-PCR analysis of nasal secretions, uterine fluids and aborted foal tissues. Deep nasal swabs were collected from 443 horses showing acute-onset fever and/or clinical signs of respiratory disease. Additionally, uterine swabs and tissue samples (lung, liver, spleen, thymus, kidney, heart) were obtained from 152 abortion cases. Among symptomatic horses, EHV-1 DNA was found in 2 cases (0...
Ovum pick-up in mares: Evidence review and best practice recommendations using a modified GRADE approach.
Theriogenology    June 2, 2026   Volume 264 118021 doi: 10.1016/j.theriogenology.2026.118021
Lewis N, Dini P, Spanner J, Claes A, De Grauw J, Morganti M, Daels P, Cuervo-Arango J.Ovum pick-up (OPU) is a procedure that is now performed in mares worldwide to harvest oocytes for in vitro embryo production. There is a lack of consensus surrounding best practices for various procedural elements of the technique and recently there has been an increasing focus on the welfare aspects of the procedure. Our objective was to summarize current practice and to develop guidelines for OPU in the mare, using a modified GRADE approach to optimize efficiency and mare welfare. Published evidence on various aspects of the procedure was compiled, and to supplement the relative lack of publ...
Case Report: Oral and topical chronic administration of THC-rich and CBD-rich cannabis oil as palliative care in a rescued horse with open wound, sarcoid and chronic pain.
Frontiers in veterinary science    June 2, 2026   Volume 13 1794084 doi: 10.3389/fvets.2026.1794084
Zamith Cunha R, Kuhn EH, Medeiros JLL, Medeiros GC, Amazonas E.Cannabinoid-based therapies have shown analgesic, anti-inflammatory, and wound-healing potential across veterinary species; however, clinical data on long-term use of THC-rich formulations in horses remain scarce. This case report describes the use of combined oral and topical THC-rich and CBD-rich full-spectrum cannabis oils as part of a palliative care strategy in a rescued horse with severe chronic disease. A senior mixed-breed gelding was rescued with a large, chronic ulcerative lesion of the left hind limb, severe malnutrition, non-weight-bearing lameness (AAEP grade 5/5), and refractory ...
Use of computer-assisted tomography for diagnosis and standing surgical reduction of progressive ethmoidal hematoma in a mare.
The Canadian veterinary journal = La revue veterinaire canadienne    June 1, 2026   Volume 67, Issue 6 626-632 
Lee S, Lee EB, Kim T, Jung JY, Kim JH, Seo JP.Progressive ethmoidal hematoma (PEH) is a rare, nonneoplastic mass occurring in the sinonasal passages of horses. An 11-year-old, pregnant Thoroughbred mare was presented with a history of intermittent nasal discharge and stertorous respiration. On examination, radiography revealed increased opacity in the sinus and nasal cavities and endoscopy identified a mass emerging from the left ethmoidal turbinate. Computed tomography (CT) showed the range and origin of the mass, indicative of PEH. A standing frontonasal flap was made under sedation, following temporary tracheostomy to secure the airway...
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