Analyze Diet

Topic:Clinical Findings

Clinical findings in horses encompass a range of observable signs and symptoms identified during veterinary examinations that contribute to diagnosing and managing equine health conditions. These findings can include physical observations, such as changes in behavior, posture, or gait, as well as physiological measurements like heart rate, respiratory rate, and temperature. Diagnostics may also involve laboratory tests, imaging, and other diagnostic procedures to assess organ function and detect abnormalities. Recognizing and interpreting clinical findings are essential components of veterinary practice, aiding in the identification of diseases, monitoring treatment progress, and guiding therapeutic interventions. This page brings together peer-reviewed research studies and scholarly articles that explore the methodologies, interpretations, and implications of clinical findings in the context of equine health care.
Development and Evaluation of a Molecular Diagnostic Method for Rapid Detection of Histoplasma capsulatum var. farciminosum, the Causative Agent of Epizootic Lymphangitis, in Equine Clinical Samples.
Journal of clinical microbiology    October 5, 2016   Volume 54, Issue 12 2990-2999 doi: 10.1128/JCM.00896-16
Scantlebury CE, Pinchbeck GL, Loughnane P, Aklilu N, Ashine T, Stringer AP, Gordon L, Marshall M, Christley RM, McCarthy AJ.Histoplasma capsulatum var. farciminosum, the causative agent of epizootic lymphangitis (EZL), is endemic in parts of Africa. Diagnosis based on clinical signs and microscopy lacks specificity and is a barrier to further understanding this neglected disease. Here, a nested PCR method targeting the internal transcribed spacer (ITS) region of the rRNA operon was validated for application to equine clinical samples. Twenty-nine horses with signs of EZL from different climatic regions of Ethiopia were clinically examined. Blood samples and aspirates of pus from cutaneous nodules were taken, along ...
Four cases of equine motor neuron disease in Japan.
Journal of equine science    September 30, 2016   Volume 27, Issue 3 119-124 doi: 10.1294/jes.27.119
Sasaki N, Imamura Y, Sekiya A, Itoh M, Furuoka H.In this study, fasciculation of the limbs and tongue was observed in four horses kept by a riding club. Neurogenic muscle atrophy was also observed in biopsy of pathological tissues. In addition, in two cases that subjected to autopsy, Bunina-like bodies of inclusion in the cell bodies of neurons in the spinal cord ventral horn were confirmed, leading to a diagnosis of equine motor neuron disease (EMND). Serum vitamin E concentrations varied between 0.3 and 0.4µg/ml, which is significantly lower than the levels in normal horses. Although lack of vitamin E is speculated to be a contributory fa...
Frequency of Undetected Glove Perforation and Associated Risk Factors in Equine Surgery.
Veterinary surgery : VS    September 29, 2016   Volume 45, Issue 8 1066-1070 doi: 10.1111/vsu.12562
Elce YA, Laverty S, Almeida da Silveira E, Piat P, Trencart P, Ruzickova P, Reardon RJ.To estimate the frequency of undetected perforations in surgical gloves during equine surgery and to identify risk factors associated with occurrence. Methods: Observational cohort study. Methods: Surgical gloves-292 pairs. Methods: Water leak tests were performed on gloves after equine surgery to detect perforations. Fifty pairs of unused gloves were also tested. Potential risk factors were recorded. Logistic regression was used to explore associations between putative risk factors and perforation. Results: No perforations were detected in the unused gloves. Of 292 pairs of used gloves tested...
Fatal Oleander Toxicosis in Two Miniature Horses.
Journal of the American Animal Hospital Association    September 29, 2016   Volume 52, Issue 6 398-402 doi: 10.5326/JAAHA-MS-6433
Butler J, Khan S, Scarzella G.Two young American miniature horses from the same farm were evaluated by a veterinarian due to presence of lethargy, anorexia, and cardiac arrhythmias. Both horses were treated aggressively with IV fluids and other supportive measures. The first horse died approximately 72 hr after the start of clinical signs and the second horse was humanely euthanized due to poor response to treatment. Oleander toxicosis was suspected based on the types of clinical signs present and due to several oleander plants and dried leaves present on the property. Oleander toxicosis was confirmed by the presence of ol...
Conservative Management of Unilateral Fractures of the Mandibular Rami in Horses.
Veterinary surgery : VS    September 29, 2016   Volume 45, Issue 8 1063-1065 doi: 10.1111/vsu.12561
Jansson N.To report the outcome of conservative management of unilateral fractures of the mandibular rami in horses. Methods: Retrospective case series. Methods: 24 client-owned horses with unilateral mandibular fractures METHODS: Medical records (January 2000-January 2014) of horses with unilateral mandibular ramus fractures were retrieved. Only conservatively managed horses with follow-up information were included. Follow-up information on clinical outcome was retrieved from the medical records (n=11) or obtained by telephone interviews with the owners or trainers (n=13). Results: Twenty-three horses ...
Efficacy of intravenous administration of hyaluronan, sodium chondroitin sulfate, and N-acetyl-d-glucosamine for prevention or treatment of osteoarthritis in horses.
American journal of veterinary research    September 27, 2016   Volume 77, Issue 10 1064-1070 doi: 10.2460/ajvr.77.10.1064
Frisbie DD, McIlwraith CW, Kawcak CE, Werpy NM.OBJECTIVE To evaluate the efficacy of IV administration of a product containing hyaluronan, sodium chondroitin sulfate, and N-acetyl-d-glucosamine for prevention or treatment of osteoarthritis in horses. ANIMALS 32 healthy 2- to 5-year-old horses. PROCEDURES The study involved 2 portions. To evaluate prophylactic efficacy of the test product, horses received 5 mL of the product (n = 8) or saline (0.9% NaCl) solution (8; placebo) IV every fifth day, starting on day 0 (when osteoarthritis was induced in the middle carpal joint of 1 forelimb) and ending on day 70. To evaluate treatment efficacy, ...
In vitro biomechanical evaluation of four surgical techniques for fusion of equine centrodistal and tarsometatarsal joints.
American journal of veterinary research    September 27, 2016   Volume 77, Issue 10 1071-1081 doi: 10.2460/ajvr.77.10.1071
Biedrzycki AH, Grant BG, Nemke B, Morello SL, Markel MD.OBJECTIVE To evaluate the biomechanical properties of 4 methods for fusion of the centrodistal and tarsometatarsal joints in horses and compare them among each other and with control tarsi. SAMPLE 24 sets of paired tarsi without substantial signs of osteoarthritis harvested from equine cadavers. PROCEDURES Test constructs (n = 6/type) were prepared from 1 tarsus from each pair to represent surgical drilling; 2 medially to laterally placed kerf-cut cylinders (MLKCs); a single large, dorsally applied kerf-cut cylinder (DKC); and a dorsomedially applied locking compression plate (DMLCP). Construc...
Multiple congenital cardiovascular defects including type IV persistent truncus arteriosus in a Shetland pony – Short communication.
Acta veterinaria Hungarica    September 23, 2016   Volume 64, Issue 3 360-364 doi: 10.1556/004.2016.033
Taulescu M, Palmieri C, Leach J, Nagy A, Ober C, Cernea M, Catoi C.This case report describes the pathological findings of multiple congenital cardiac defects in a 2-year-old female Shetland pony with clinical signs of chronic respiratory distress. Persistent truncus arteriosus (PTA) type IV, interventricular septal defect, overriding aorta, pulmonary trunk agenesis, pulmonary arteries arising from the descending aorta, and compensatory right ventricular hypertrophy were observed.
Are horse age and incision length associated with surgical site infection following equine colic surgery?
Veterinary journal (London, England : 1997)    September 22, 2016   Volume 217 3-7 doi: 10.1016/j.tvjl.2016.09.004
Darnaud SJ, Southwood LL, Aceto HW, Stefanovski D, Tomassone L, Zarucco L.It is our clinical impression that age and incision length are more strongly associated with surgical site infection (SSI) following colic surgery than skin closure or wound protection method. Therefore, the objective of this observational clinical cohort study was to identify the risks for SSI in horses undergoing colic surgery. Data collection included pre-, intra-, and postoperative variables. Variables with P < 0.2 following univariable analysis were used in a logistic regression multivariable model. Variables with P <0.05 were included in the final model. Odds ratios (OR; 95% confid...
Equine Pulmonary Cryptococcosis: A Comparative Literature Review and Evaluation of Fluconazole Monotherapy.
Mycopathologia    September 21, 2016   Volume 182, Issue 3-4 413-423 doi: 10.1007/s11046-016-0065-9
Secombe CJ, Lester GD, Krockenberger MB.Cryptococcus is the most common fungal respiratory pathogen in Australian horses, manifesting primarily as pulmonary granulomas. Disease severity at presentation is dependent on the athletic use of the horse. The diagnosis and estimation of disease severity are centred around clinical findings, cytological evaluation of respiratory tract secretions, diagnostic imaging, and antigen titre testing. Both the lateral flow assay and the latex cryptococcal antigen titre are used, and important similarities and differences between species are discussed. Cryptococcus gattii occurs with greater frequenc...
Combined use of platelet rich plasma & micro-fat in sport and race horses with degenerative joint disease: preliminary clinical study in eight horses.
Muscles, ligaments and tendons journal    September 17, 2016   Volume 6, Issue 2 198-204 doi: 10.11138/mltj/2016.6.2.198
Bembo F, Eraud J, Philandrianos C, Bertrand B, Silvestre A, Veran J, Sabatier F, Magalon G, Magalon J.To assess the safety and potential efficacy of a standardized technique consisting of intra-articular injection of 10 cc of a homogeneous mixed product using autologous micro-fat and platelet rich plasma (PRP) (ratio 1:1) in the carpus or the fetlock joint of sport horses presenting degenerative joint disease (DJD). Methods: Eight sport horses with DJD confirmed by radiography and ultrasonography and causing lameness and the impossibility to compete were treated. PRP was prepared after a double centrifugation whereas micro-fat was harvested and purified using a closed system. The two products ...
Laparoscopic Closure of the Nephrosplenic Space in Horses with Nephrosplenic Colonic Entrapment: Factors Associated with Survival and Colic Recurrence.
Veterinary surgery : VS    September 13, 2016   Volume 45, Issue S1 O60-O69 doi: 10.1111/vsu.12549
Nelson BB, Ruple-Czerniak AA, Hendrickson DA, Hackett ES.1) To identify factors associated with short-term survival and time to death after hospital discharge in horses with nephrosplenic entrapment (NSE). 2) To compare the frequency of recurrent colic episodes in horses with and without laparoscopic closure of the nephrosplenic space. Methods: Historical cohort with a nested case control. Methods: Client-owned horses. Methods: Medical records of horses treated for NSE from January 1, 2002 to June 1, 2014 were reviewed. Data collected included signalment, physical examination parameters, laboratory results, diagnostic findings, and treatments. Facto...
Retrospective Evaluation of Hemithyroidectomy in 14 Horses.
Veterinary surgery : VS    September 6, 2016   Volume 45, Issue 7 949-954 doi: 10.1111/vsu.12540
Troillet A, Böttcher D, Brehm W, Scharner D.To describe the presentation, presurgical diagnostic findings, treatment, and outcome of horses with histologically confirmed, unilateral thyroid neoplasia. The complications, particularly laryngeal hemiplegia, were investigated. Retrospective case series. Client-owned horses (n=14). Medical records of horses presenting with a unilateral thyroid mass due to neoplasia from 2003-2015 were reviewed. Horses must have undergone preoperative clinical evaluations that included ultrasound examination of the mass and upper airway endoscopy. Short-term follow-up at 2 weeks after surgery and owner questi...
Comparison of clinical findings and short-term survival between horses with intestinal entrapment in the gastrosplenic ligament and horses with intestinal entrapment in the epiploic foramen.
Journal of the American Veterinary Medical Association    September 2, 2016   Volume 249, Issue 6 660-667 doi: 10.2460/javma.249.6.660
Kilcoyne I, Dechant JE, Nieto JE.OBJECTIVE To compare clinical findings and short-term outcome for horses with intestinal entrapment in the gastrosplenic ligament (GLE) with those of horses with intestinal entrapment in the epiploic foramen (EFE). DESIGN Retrospective case-control study. ANIMALS 43 horses with GLE (cases) and 73 horses with EFE (controls). PROCEDURES Medical records of horses examined because of colic at a veterinary teaching hospital between 1992 and 2012 were reviewed. Signalment was extracted from medical records for all horses with colic (colic population), and additional information regarding colic histo...
Isolation and molecular characterization of Mycobacterium bovis causing pulmonary tuberculosis and epistaxis in a Thoroughbred horse.
BMC veterinary research    September 2, 2016   Volume 12, Issue 1 179 doi: 10.1186/s12917-016-0813-6
Hlokwe TM, Sutton D, Page P, Michel AL.Tuberculosis caused by Mycobacterium bovis (M. bovis) is very uncommon in horses worldwide. Methods: In the current study, an eight-year-old male Thoroughbred in good body condition was admitted to the Equine Clinic at the Onderstepoort Veterinary Academic Hospital in 2005 due to bilateral epistaxis accompanied by coughing. Routine examinations were conducted to determine the cause of the condition. Endoscopic examination revealed the major source of the epistaxis as the trachea, whereas thoracic radiography indicated the presence of a primary pulmonary mass. M. bovis was isolated from a bronc...
Dynamic Sonography of the Equine Metacarpo(tarso)phalangeal Digital Flexor Tendon Sheath. DiGiovanni DL, Rademacher N, Riggs LM, Baumruck RA, Gaschen L.Palmar/plantar annular desmitis is a common disease that may be associated with adhesions and structures affecting the flexor tendons, which requires tenoscopy to diagnose. The purpose of this descriptive study was to develop a dynamic sonographic technique for evaluating the motion of normal equine flexor tendons in relation to the palmar/plantar annular ligament and to compare findings with horses previously diagnosed with palmar/plantar annular desmitis. Ten healthy adult horses were examined prospectively and the images of four horses diagnosed with palmar/plantar annular desmitis were ret...
Use of an Absorbable Urethral Stent for the Management of a Urethral Stricture in a Stallion.
Veterinary surgery : VS    August 25, 2016   Volume 45, Issue S1 O41-O48 doi: 10.1111/vsu.12530
Trela JM, Dechant JE, Culp WT, Whitcomb MB, Palm CA, Nieto JE.To describe the successful management of a urethral stricture with an absorbable stent in a stallion. Methods: Clinical report. Methods: Stallion with a urethral stricture. Results: A 12-year-old Thoroughbred breeding stallion was evaluated for acute onset of colic. Uroperitoneum because of presumptive urinary bladder rupture, with urethral obstruction by a urethrolith, was diagnosed. The uroperitoneum was treated conservatively. The urethrolith was removed through a perineal urethrotomy. Approximately 15 weeks after urethrolith removal, the stallion presented with a urethral stricture. The st...
Clinical and Pathologic Features of a Suspected Selenium Deficiency in Captive Plains Zebras.
Biological trace element research    August 23, 2016   Volume 176, Issue 1 114-119 doi: 10.1007/s12011-016-0820-2
Chen F, Gao J, Wu D, Xu L, Han W, Zhang D, Bi X, He M, Pan Y.Previous studies have shown that selenium (Se) deficiency is associated with nutritional myopathy, known as white muscle disease (WMD), in horses. However, correlations between Se deficiency and clinical findings, such as hematologic biochemical values and pathological features, have not been evaluated in captive plains zebras. The purpose of the present study was to investigate the clinical and pathologic features that may be caused by a Se deficiency in the captive plains zebra. Clinical findings, feed analyses, hematologic biochemical analyses, response to treatment, and pathologic examinat...
An epidemiological survey on the prevalence of equine peripheral dental caries in the United Kingdom and possible risk factors for its development.
Equine veterinary journal    August 21, 2016   Volume 49, Issue 4 480-485 doi: 10.1111/evj.12610
Borkent D, Reardon RJM, McLachlan G, Smith S, Dixon PM.Equine peripheral caries (PC) is an increasingly recognised disorder that causes premature wear of teeth and dental fractures and thus has major welfare implications. Little information is available on its prevalence or severity in UK horses and there are no proven associations with any risk factors. Objective: To document the prevalence of PC over a wide area of the UK, assess its intraoral distribution and severity in affected horses and examine for potential risk factors for its development. Methods: Cross sectional study. Methods: Experienced personnel were recruited for a UK wide dental s...
Making the Diagnosis.
Veterinary pathology    August 20, 2016   Volume 54, Issue 1 9-10 doi: 10.1177/0300985816664793
Wobeser BK.No abstract available
[A case of 63,X/64,XX mosaicism in a subfertile pony mare].
Schweizer Archiv fur Tierheilkunde    August 16, 2016   Volume 158, Issue 4 266-268 doi: 10.17236/sat00059
Pieńkowska-Schelling A, Handler J, Neuhauser S, Schelling C.The present case report describes a 6-year old subfertile pony mare, which became pregnant after the eleventh artificial insemination. The examination of the ovaries and the uterus did not reveal any abnormal clinical findings and the mare showed a regular oestrous cycle. Based on cytogenetic and molecular genetic analyses it became possible to elucidate the observed subfertility. The mosaic karyotype of the mare consisted of 63,X (20%) and 64,XX (80%) cells. A PCR analysis failed to amplify sequences from the equine SRY gene. The observed classic 63,X/64,XX mosaicism is a plausible explanatio...
Comparison of treatment outcomes for superficial digital flexor tendonitis in National Hunt racehorses.
Veterinary journal (London, England : 1997)    August 15, 2016   Volume 216 157-163 doi: 10.1016/j.tvjl.2016.08.003
Witte S, Dedman C, Harriss F, Kelly G, Chang YM, Witte TH.Superficial digital flexor (SDF) tendonitis is a common injury in Thoroughbred racehorses. Injuries require prolonged rehabilitation, with unpredictable outcomes and a high incidence of re-injury. This observational case-control study aimed to compare race outcomes after commonly advocated treatments for tendon healing. Clinical and racing records were evaluated for 127 National Hunt racehorses treated between 2007 and 2011 for an SDF tendon injury. Two age- and sex-matched control horses were selected for each case horse to analyse the effect on post-injury racing outcomes of pre-injury data,...
Different horse’s paces during hippotherapy on spatio-temporal parameters of gait in children with bilateral spastic cerebral palsy: A feasibility study.
Research in developmental disabilities    August 9, 2016   Volume 59 65-72 doi: 10.1016/j.ridd.2016.07.015
Antunes FN, Pinho ASD, Kleiner AFR, Salazar AP, Eltz GD, de Oliveira Junior AA, Cechetti F, Galli M, Pagnussat AS.Hippotherapy is often carried out for the rehabilitation of children with Cerebral Palsy (CP), with the horse riding at a walking pace. This study aimed to explore the immediate effects of a hippotherapy protocol using a walk-trot pace on spatio-temporal gait parameters and muscle tone in children with Bilateral Spastic CP (BS-CP). Ten children diagnosed with BS-CP and 10 healthy aged-matched children (reference group) took part in this study. The children with BS-CP underwent two sessions of hippotherapy for one week of washout between them. Two protocols (lasting 30min) were applied on separ...
Effect of auriculopalpebral nerve block on Schirmer tear test I values in normal horses.
Veterinary ophthalmology    August 8, 2016   Volume 20, Issue 6 568-570 doi: 10.1111/vop.12419
Visser HE, Diehl KA, Whitley RD, Myrna KE.To compare Schirmer tear test I (STTI) values collected in normal horses with and without an auriculopalpebral nerve block. Methods: Schirmer tear test I values were measured in 20 clinically normal horses (38 eyes) with a median age of 12 years. The order of eyes tested was randomized. Within 24-48 h, at the same time of day, tear measurements were collected again after administration of an auriculopalpebral nerve block. Each block was performed a minimum of 5 min prior to each STT I. A repeated-measures model was used to analyze differences between STT I values in eyes with and without nerve...
Strangles in Arabian horses in Egypt: Clinical, epidemiological, hematological, and biochemical aspects.
Veterinary world    August 6, 2016   Volume 9, Issue 8 820-826 doi: 10.14202/vetworld.2016.820-826
Neamat-Allah AN, Damaty HM.Respiratory tract infections are considered the major problem of equine worldwide. Strangles is an infectious and highly contagious respiratory bacterial disease of equine caused by Streptococcus equi. This study is aimed to evaluate some clinical and epidemiological investigation associated with strangles and to study the hematological and biochemical changes in 20 Arabian horse naturally infected with S. equi during the disease and after 10 days from treatment by procaine penicillin with benzathine penicillin. Methods: A total of 490 Arabian horses have been examined, 120 (24.5%) have been c...
Pigment retinopathy in warmblood horses with equine degenerative myeloencephalopathy and equine motor neuron disease.
Veterinary ophthalmology    August 5, 2016   Volume 20, Issue 4 304-309 doi: 10.1111/vop.12417
Finno CJ, Kaese HJ, Miller AD, Gianino G, Divers T, Valberg SJ.A pigment retinopathy has been reported in adult horses with equine motor neuron disease (EMND) arising from chronic α-tocopherol (α-TP) deficiency. A pigment retinopathy has not been identified in horses with neuroaxonal dystrophy/equine degenerative myeloencephalopathy (NAD/EDM) that affects genetically susceptible young horses with α-TP deficiency. The objective of this report is to describe, for the first time, a pigment retinopathy in a family of α-TP-deficient Warmbloods (WB) with clinically apparent NAD/EDM or EMND. Unassigned: Twenty-five WB horses from one farm underwent complete ...
Using the Horse Grimace Scale (HGS) to Assess Pain Associated with Acute Laminitis in Horses (Equus caballus).
Animals : an open access journal from MDPI    August 3, 2016   Volume 6, Issue 8 47 doi: 10.3390/ani6080047
Dalla Costa E, Stucke D, Dai F, Minero M, Leach MC, Lebelt D.Acute laminitis is a common equine disease characterized by intense foot pain, both acutely and chronically. The Obel grading system is the most widely accepted method for describing the severity of laminitis by equine practitioners, however this method requires movement (walk and trot) of the horse, causing further intense pain. The recently developed Horse Grimace Scale (HGS), a facial-expression-based pain coding system, may offer a more effective means of assessing the pain associated with acute laminitis. The aims of this study were: to investigate whether HGS can be usefully applied to a...
Measurement of distal limb sub-bandage pressure over 96 hours in horses.
Equine veterinary journal    July 28, 2016   Volume 49, Issue 3 329-333 doi: 10.1111/evj.12601
Canada NC, Beard WL, Guyan ME, White BJ.Currently, there is no objective information quantifying pressures exerted by distal limb bandages. Objective: To quantify the pressure exerted by each compression layer, a polo wrap (DLP), a compression bandage (DLC), and to measure the effect of time on sub-bandage pressure. Methods: Longitudinal observational experiment. Methods: A DLC construct included a cotton roll compressed with brown gauze and elastic layers and the DLP construct included a pillow pad compressed by a cloth wrap. Dorsal and lateral sensors were placed on the mid-metacarpus. In healthy horses, sub-bandage pressures were...
A comparison of the effects of a 4% modified fluid gelatin and a 6% hydroxyethyl starch on haemodilution, colloid osmotic pressure, haemostasis and renal parameters in healthy ponies.
Equine veterinary journal    July 28, 2016   Volume 49, Issue 3 363-368 doi: 10.1111/evj.12594
Gratwick Z, Viljoen A, Page PC, Goddard A, Fosgate GT, Lyle CH.Adverse effects on renal health and haemostasis have been documented in human patients administered hydroxyethyl starches (HESs). Gelatins may represent useful substitutes should similar adverse effects be identified in horses. Objective: To compare the effects of a 4% modified fluid gelatin (MFG) with a 6% (130/0.4) HES on haemodilution, colloid osmotic pressure (COP), haemostasis and renal parameters in healthy ponies. Methods: Randomised crossover experiment. Methods: Three treatments (Treatment A: 10 ml/kg bwt HES; Treatment B: 10 ml/kg bwt MFG; Treatment C: 20 ml/kg bwt MFG) were administ...
Response to Intravenous Allogeneic Equine Cord Blood-Derived Mesenchymal Stromal Cells Administered from Chilled or Frozen State in Serum and Protein-Free Media.
Frontiers in veterinary science    July 22, 2016   Volume 3 56 doi: 10.3389/fvets.2016.00056
Williams LB, Co C, Koenig JB, Tse C, Lindsay E, Koch TG.Equine mesenchymal stromal cells (MSC) are commonly transported, chilled or frozen, to veterinary clinics. These MSC must remain viable and minimally affected by culture, transport, or injection processes. The safety of two carrier solutions developed for optimal viability and excipient use were evaluated in ponies, with and without allogeneic cord blood-derived (CB) MSC. We hypothesized that neither the carrier solutions nor CB-MSC would elicit measurable changes in clinical, hematological, or biochemical parameters. In nine ponies (study 1), a bolus of HypoThermosol(®) FRS (HTS-FRS), CryoSt...
1 46 47 48 49 50 246