Disease prevention in horses encompasses strategies and practices aimed at minimizing the occurrence and spread of infectious and non-infectious diseases within equine populations. These practices include vaccination programs, biosecurity measures, and regular health monitoring. Vaccination helps to stimulate the horse's immune system to protect against specific pathogens, while biosecurity measures, such as quarantine and sanitation, reduce the risk of disease transmission. Regular health monitoring, including physical examinations and diagnostic testing, aids in early detection and management of potential health issues. This page compiles peer-reviewed research studies and scholarly articles that explore various methods and their effectiveness in preventing diseases in horses, as well as the development and implementation of prevention programs in different equine settings.
Weese JS, Yu AA.Bacterial, dermatophilosis, and superficial ringworm infections are common skin diseases noted in equine dermatology. The ability to recognize and accurately diagnose the skin condition is key to selecting an appropriate and successful treatment regimen. Addressing underlying etiology, environmental management, and infection control play a crucial role in preventing relapse of clinical signs.
Lohmann KL, Lopez AM, Manning ST, Marques FJ, Brownlie R, Allen AL, Sangster AE, Mutwiri G, Gerdts V, Potter A, Townsend HG.We evaluated the immunogenic and protective potential of a recombinant VapA/CpG oligodeoxynucleotide (ODN) 2395 vaccine in neonatal foals undergoing experimental Rhodococcus equi challenge. Foals (n = 8) were vaccinated by intramuscular injection on days 1 and 15 of the study; control foals (n = 7) received a phosphate-buffered saline (PBS) solution. All foals were challenged by intrabronchial administration of 5 × 10⁶ R. equi 103⁺ on day 29. Bronchoalveolar lavages were done on days 15, 29, and 36 and total cell count, differential cell count, rVapA-stimulated cell proliferation and inte...
Upjohn MM, Pfeiffer DU, Verheyen KL.There are an estimated 112 million Equidae (horses, donkeys, mules) in the developing world, providing essential resources for their owners' livelihoods and well-being. The impoverished situation of their owners and the often harsh conditions in which they work mean that the animals' welfare is a cause for concern. A number of equine non-governmental organisations (NGOs) operate within working equid communities providing veterinary care, education and training programmes aimed at improving equine welfare. However, there is little published information available that describes monitoring and ev...
Riet-Correa F, Rivero R, Odriozola E, Adrien Mde L, Medeiros RM, Schild AL.In the current study, mycotoxicoses of ruminants and horses are reviewed, with an emphasis on the occurrence of these diseases in South America. The main mycotoxicoses observed in grazing cattle include intoxications by indole-diterpenoid mycotoxins (Paspalum spp. contaminated by Claviceps paspali, Lolium perenne infected by Neotyphodium lolii, Cynodon dactylon infected by Claviceps cynodontis, and Poa huecu), gangrenous ergotism and dysthermic syndrome (hyperthermia) caused by Festuca arundinacea (syn. Festuca elatior) infected by Neotyphodium coenophialum (syn. Acremonium coenophialum), and ...
De Briyne N, Atkinson J, Pokludová L, Borriello SP, Price S.The Heads of Medicines Agencies and the Federation of Veterinarians of Europe undertook a survey to gain a better insight into the decision-making process of veterinarians in Europe when deciding which antibiotics to prescribe. The survey was completed by 3004 practitioners from 25 European countries. Analysis was to the level of different types of practitioner (food producing (FP) animals, companion animals, equines) and country for Belgium, Czech Republic, France, Germany, Spain, Sweden and the UK. Responses indicate no single information source is universally considered critical, though tra...
Esparza J.Mystery surrounds the extent to which horsepox virus may have contributed to the vaccinia virus used to eradicate smallpox. With few documented cases of horsepox in recent years it may never be solved, says José Esparza, who seeks to raise awareness of the potential historical and scientific importance of identifying new cases.
Blackmore TM, Dugdale A, Argo CM, Curtis G, Pinloche E, Harris PA, Worgan HJ, Girdwood SE, Dougal K, Newbold CJ, McEwan NR.The horse, as a hindgut fermenter, is reliant on its intestinal bacterial population for efficient diet utilisation. However, sudden disturbance of this population can result in severe colic or laminitis, both of which may require euthanasia. This study therefore aimed to determine the temporal stability of the bacterial population of faecal samples from six ponies maintained on a formulated high fibre diet. Bacterial 16S rRNA terminal restriction fragment length polymorphism (TRFLP) analyses of 10 faecal samples collected from 6 ponies at regular intervals over 72 hour trial periods identifie...
Calzolari M, Monaco F, Montarsi F, Bonilauri P, Ravagnan S, Bellini R, Cattoli G, Cordioli P, Cazzin S, Pinoni C, Marini V, Natalini S, Goffredo M....West Nile virus (WNV) is one of the most serious public health threats that Europe and the Mediterranean countries are currently facing. In Italy, WNV emerged in 1998 and has been circulating since 2008. To tackle its continuous incursions, Italian national and regional institutions set up a surveillance program, which includes the serological screening of sentinel horses, sentinel-chickens and backyard poultry flocks and the surveillance on all equine neurological cases, resident captured and wild dead birds, and vectors. This communication aims to assess the importance of the entomological s...
Wylie CE, Collins SN, Verheyen KL, Newton JR.Laminitis is a highly debilitating disease of the foot known to have a complex and multifactorial aetiology of metabolic, inflammatory, traumatic or vascular origin. The disease has major welfare implications due to unrelenting pain associated with degenerative changes, which often necessitate euthanasia on welfare grounds. Despite this, there have been few high-quality studies investigating risk factors for equine laminitis, and only a limited number of risk factors have been previously investigated. The aim of this study was to conduct a case-control study of risk factors for active episodes...
Votion DM, van Galen G, Sweetman L, Boemer F, de Tullio P, Dopagne C, Lefère L, Mouithys-Mickalad A, Patarin F, Rouxhet S, van Loon G, Serteyn D....It is hypothesised that European atypical myopathy (AM) has a similar basis as seasonal pasture myopathy in North America, which is now known to be caused by ingestion of hypoglycin A contained in seeds from the tree Acer negundo. Serum from horses with seasonal pasture myopathy contained the conjugated toxic metabolite of hypoglycin A, methylenecyclopropyl acetic acid (MCPA). Methods: Retrospective study on archived samples. Objective: 1) To determine whether MCPA-carnitine was present in serum of European horses confirmed to have AM; 2) to determine whether Acer negundo or related Acer speci...
Angenvoort J, Brault AC, Bowen RA, Groschup MH.West Nile virus (WNV) is a flavivirus transmitted between certain species of birds and mosquito vectors. Tangential infections of equids and subsequent equine epizootics have occurred historically. Although the attack rate has been estimated to be below 10%, mortality rates can approach 50% in horses that present clinical disease. Symptoms are most commonly presenting in the form of encephalitis with ataxia as well as limb weakness, recumbency and muscle fasciculation. The most effective strategy for prevention of equine disease is proper vaccination with one of the numerous commercially avail...
Kienzle E, Fritz J.Nutrition-induced laminitis is often caused by i) fermentation of large amounts of carbohydrates in the hindgut (usually fructans from grass or starch from cereals), which cause the release and absorption of microbial toxins and ii) insulin resistance induced by being overweight (equine metabolic syndrome). Both causes can act together. Overweight horses with a history of laminitis need to reduce body weight to prevent further incidences of laminitis. Weight reduction occurs normally on a diet of late-cut hay, a hay-straw mixture (maximally one third straw to prevent constipation) or grass see...
Emmerich IU.In 2012, two newly developed active pharmaceutical ingredients for horses and food producing animals were released on the German market for veterinary drug products. Those are the parenterally applicable first generation cephalosporin Cefalonium (Cepravin®) and the nonsteroidal anti-inflammatory drug Suxibuzone (Danilon®). Furthermore, one established veterinary active pharmaceutical ingredient is applicable to additional species: The anticoccidial Amprolium (Eimeryl®) has again been authorized for chicken and turkeys. Additionally, two veterinary drugs with a new formulation as well as thr...
Sevigny LM, Booth BJ, Rowley KJ, Leav BA, Cheslock PS, Garrity KA, Sloan SE, Thomas W, Babcock GJ, Wang Y.Diphtheria antitoxin (DAT) has been the cornerstone of the treatment of Corynebacterium diphtheriae infection for more than 100 years. Although the global incidence of diphtheria has declined steadily over the last quarter of the 20th century, the disease remains endemic in many parts of the world, and significant outbreaks still occur. DAT is an equine polyclonal antibody that is not commercially available in the United States and is in short supply globally. A safer, more readily available alternative to DAT would be desirable. In the current study, we obtained human monoclonal antibodies (h...
Baxter C.This is a clinician's view of the current state of veterinary dentistry at the level of the general practitioner across the different species. An indication of the work done and the hazards commonly encountered are covered. Conclusions: To increase awareness within the dental profession of the current state of veterinary dentistry.
Tobin T, Dirikolu L, Brewer K, Hughes CG.Equine forensic science can now detect concentrations down to 25 femtograms/mL (parts per quadrillion, ppq) or less in blood and urine. As such, horsemen are increasingly at risk of inadvertent 'positives' due to therapeutic medication 'overages' or trace identifications of dietary or environmental substances. Reviewed here are the factors which determine detection times and 'withdrawal times' for substances administered to horses. Withdrawal times are affected by many factors, including dose, formulation, route and frequency of administration, bioavailability, plasma half-life, sensitivity of...
Daly JM, Newton JR, Wood JL, Park AW.Mathematical modelling of infectious disease is increasingly regarded as an important tool in the development of disease prevention and control measures. This article brings together key findings from various modelling studies conducted over the past 10 years that are of relevance to those on the front line of the battle against equine influenza.
Mendez D, Judd J, Speare R.To identify the perceived barriers to Hendra virus (HeV) management by private equine veterinarians in Queensland. Methods: An exploratory qualitative study of private equine veterinarians registered and working in coastal Queensland. Methods: A questionnaire that included eight open-ended questions about the management of HeV was used in face-to-face in-depth interviews with 21 veterinary personnel working in equine or mixed private practice between Far North and South-East Queensland in 2009-10. The qualitative data was entered and analysed thematically using QSR's International's Nvivo 9 qu...
Schemann K, Firestone SM, Taylor MR, Toribio JA, Ward MP, Dhand NK.A growing body of work shows the benefits of applying social cognitive behavioural theory to investigate infection control and biosecurity practices. Protection motivation theory has been used to predict protective health behaviours. The theory outlines that a perception of a lack of vulnerability to a disease contributes to a reduced threat appraisal, which results in poorer motivation, and is linked to poorer compliance with advised health protective behaviours. This study, conducted following the first-ever outbreak of equine influenza in Australia in 2007, identified factors associated wit...
Mendez D, Büttner P, Speare R.A cross-sectional study of private veterinarians providing equine services in Queensland. Results: The study revealed that a majority of veterinarians would support the introduction of a Hendra virus (HeV) vaccine. Moreover, almost half of the respondents intended to make vaccination a prerequisite to horse patient presentation. However, participants also responded that a vaccine would not reduce the risk sufficiently to cease or downgrade their HeV management plan and infection control measures. Conclusions: When devising promoting and marketing campaigns, government agencies and manufacturer...
Muniz E, Lobo Ladd AA, Lobo Ladd FV, da Silva AA, Kmit FV, Borges AS, Teixeira R, da Mota LS, Belli CB, de Zoppa AL, da Silva LC, de Melo MP, Coppi AA.Ileocolonic aganglionosis (ICA) is the congenital and hereditary absence of neurons that constitute the enteric nervous system and has been described in various species including humans - Hirschsprung's disease - and horses - overo lethal white syndrome (OLWS). Hirschsprung's disease affects circa 1 in 5,000 live births. At best, this disease means an inability to absorb nutrients from food (humans). At worse, in horses, it always means death. Despite our general understanding of the functional mechanisms underlying ICA, there is a paucity of reliable quantitative information about the structu...
Nolen-Walston R, Paxson J, Ramey DW.The use of an evidence-based approach allows veterinary clinicians to assess questions that are clinically relevant to the diagnosis and treatment of equine gastrointestinal tract disease. This approach involves formulating a clinical question, searching the literature, and answering the question with the best available evidence, with the results summarized as a clinical "bottom line." This article is organized to reinforce the principle that the cornerstone of evidence-based medicine is the clinical question. Specific questions are further categorized as to topic, with epidemiologic risk fact...
Dwyer RM.Rotavirus poses a challenge each foaling season to farm managers and veterinarians in intensive horse breeding areas throughout the world. By understanding the epidemiology of the disease as well as characteristics of the virus, veterinarians can make sound recommendations on prevention and control of outbreaks. Even when effective prophylactic products are developed, farm management practices, including quarantine, disinfection, and hygiene, will always need to be in force to prevent any contagious disease outbreak.
Burkom H, Estberg L, Akkina J, Elbert Y, Zepeda C, Baszler T.The Risk Identification Unit (RIU) of the US Dept. of Agriculture's Center for Epidemiology and Animal Health (CEAH) conducts weekly surveillance of national livestock health data and routine coordination with agricultural stakeholders. As part of an initiative to increase the number of species, health issues, and data sources monitored, CEAH epidemiologists are building a surveillance system based on weekly syndromic counts of laboratory test orders in consultation with Colorado State University laboratorians and statistical analysts from the Johns Hopkins University Applied Physics Laborator...
Rampacci E, Mazzola K, Beccati F, Passamonti F.Feeding foals with poor quality colostrum predisposes them to failure of passive transfer (FPT). FPT is a major risk factor for neonatal infections. Objective: To assess the optimal cut-offs for the optical (OR) and digital (DR) refractometer and determine their accuracy for poor quality colostrum diagnosis. Methods: A diagnostic validation study. Methods: Eighty-one colostrum samples and sera were collected from broodmares and their neonatal foals, respectively. Colostral and serum IgG concentrations were measured by radial immunodiffusion (RID), DR and OR. Correlation coefficients were calcu...
Foil L, Foil C.In this discussion of parasitic skin diseases of horses, details on life cycles are given to aid the understanding and development of control strategies.
Brashier MK, Geor RJ, Ames TR, O'Leary TP.To determine whether supplemental i.v. calcium administration would attenuate or prevent gentamicin-induced acute renal failure, defined as an increase in serum creatinine concentration > or = 50% above baseline. Methods: 10 healthy pony mares. Methods: Pony mares were randomly assigned to receive calcium at a dosage of 20 mg/kg of body weight or saline solution i.v., twice daily for 14 days. All pony mares received gentamicin at a dosage of 20 mg/kg i.v. every 8 hours for 14 days. Gentamicin pharmacokinetic, serum biochemical, and urinalysis data were measured every other day for the 14-da...
Equine infectious anaemia (EIA) is a blood borne disease that is listed among the notifiable diseases of the World Organisation for Animal Health (OIE). EIA is also regulated by the OIE for the international trading provisions and is generally subject to control programmes. Since 2011, Italy has been conducting a surveillance plan based on a three-tier diagnostic system, using a serological ELISA as screening test, an agar gel immunodiffusion test (AGIDT) as a confirmatory method, and an immunoblot (IB) as an alternative confirmatory assay for discordant results between the first two tests. As...
Biondi V, Landi A, Pugliese M, Merola G, Passantino A.This study aimed to evaluate possible abnormalities in electrocardiographic findings, and changes in cardiac troponin I (cTnI) and inflammatory biomarkers (serum amyloid A (SAA) and C-reactive protein (CRP)) after inactivated herpesvirus vaccine administration. Eighteen healthy horses were included. All animals were vaccinated with Pneumoequine (Merial, France) according to the protocol provided by the manufacturer. They were evaluated 1 day before the first dose of vaccination (D0), and 7 days (D1) and 14 days (D2) afterwards. At D0, D1, and D2, a blood sample was taken for the evaluation of ...
Pearce DJ, Hitchens PL, Malekipour F, Ayodele B, Lee PVS, Whitton RC.Fatigue-induced subchondral bone (SCB) injury is common in racehorses. Understanding how subchondral microstructure and microdamage influence mechanical properties is important for developing injury prevention strategies. Mechanical properties of the disto-palmar third metacarpal condyle (MCIII) correlate poorly with microstructure, and it is unknown whether the properties of other sites within the metacarpophalangeal (fetlock) joint are similarly complex. We aimed to investigate the mechanical and structural properties of equine SCB from specimens with minimal evidence of macroscopic disease....
Stull CL, Holcomb KE.Every state in the United States has regulations prohibiting acts of neglect and cruelty against animals. Local law enforcement and animal control agencies are responsible in many communities to enforce these statutes. As society's perception of horses has changed from their origin as livestock to companion animals in modern times, owners have transitioned their care and management. The goal of this study was to identify the role and capacities of local animal control services in the United States that investigate equine neglect, cruelty, and abandonment investigations and to identify challeng...
Ellis JA, Steeves E, Wright AK, Bogdan JR, Davis WC, Kanara EW, Haines DM.The objective of this study was to determine whether the administration of modified-live equine herpesvirus (EHV-1) to young horses with residual maternal antibodies stimulated EHV-specific cytolytic responses, and whether these responses were crossreactive between EHV-1 and EHV-4. Eighteen clinically normal Belgian cross-foals were used in the study and were commingled in two adjacent pens. Skin biopsies were harvested from 16 foals within 24 h of birth and fibroblast cultures were established, expanded and cryopreserved. Beginning at approximately 10 weeks of age, 10 randomly chosen foals we...
Van Galen G, Amory H, Busschers E, Cassart D, De Bruijn M, Gerber V, Keen J, Lefere L, Pitel CM, Marr C, Müller JM, Pineau X, Saegerman C....Atypical myopathy is an acute, severe rhabdomyolysis occurring in grazing horses. In the beginning of October 2009, a new outbreak occurred in several European countries. Geographic, demographic and clinical data of the reported cases in the month October 2009 are described. Results: The survival rate in this outbreak was 25%. The most frequently observed clinical signs were congested mucous membranes, dyspnea, tachycardia, depression, weakness, stiffness, recumbency, trembling, sweating, and myoglobinuria. Nonsurvivors were significantly more likely to be recumbent than survivors. Prognostic ...
Hay WP, Mueller PO, Harmon B, Amoroso L.To evaluate the efficacy of 1% sodium carboxymethylcellulose (SCMC) for prevention of experimentally induced abdominal adhesions in horses. Methods: Prospective, controlled, experimental study. Methods: Twelve healthy adult horses. Methods: The effect of 1% SCMC on adhesion formation was evaluated in 12 healthy horses by using an established model of serosal trauma to induce intraabdominal adhesions. After ventral median celiotomy, 2 separate areas of the jejunum were abraded, and three 2-0 chromic gut sutures were placed in each abraded area. Jejunal resection and end-to-end anastomosis was p...
Chowdhary BP, Bailey E.Analysis of the horse genome is proceeding at a rapid pace. Within a short span of 6-7 years, approximately 1,500 markers have been mapped in horse, of which at least half are genes/ESTs. Health, performance and phenotypic characteristic are of major concern/interest to horse breeders and owners. Current efforts to analyze the equine genome are primarily aimed at developing critical resources (including an advanced gene map) that could readily be used in the near future to i) identify genes and mutations responsible for inherited equine diseases/disorders and to formulate approaches for accura...
Pollock S, Hull ML, Stover SM, Galuppo LD.Knowledge of the forces that act upon the equine humerus while the horse is standing and the resulting strains experienced by the bone is useful for the prevention and treatment of fractures and for assessing the proximolateral aspect of the bone as a site for obtaining autogenous bone graft material. The first objective was to develop a mathematical model to predict the loads on the proximal half of the humerus created by the surrounding musculature and ground reaction forces while the horse is standing. The second objective was to calculate surface bone stresses and strains at three cross se...
Vercruysse J, Eysker M, Demeulenaere D, Smets K, Dorny P.A controlled trial was carried out to evaluate the persistence of the effect against small strongyles of a 2 per cent moxidectin gel administered orally to foals at a dose rate of 0.4 mg/kg bodyweight. Five of nine helminth-free foals were treated on day 0, and the remaining four foals were used as controls. On days 0, 7, 14, 21 and 28 all nine foals were infected experimentally with 200,000 small strongyle larvae. Three treated and two control foals were necropsied on day 42 and the rest on day 43. Fourteen species of small or medium sized small strongyles were found in the control foals, 10 ...
Yan W, Shin KS, Wang SJ, Xiang H, Divers T, McDonough S, Bowman J, Rowlands A, Akey B, Mohamed H, Chang YF.Clostridium (C.) difficile is a common cause of nosocomial diarrhea in horses. Vancomycin and metronidazole have been used as standard treatments but are only moderately effective, which highlights the need for a novel alternative therapy. In the current study, we prepared antiserum of equine origin against both C. difficile toxins A and B as well as whole-cell bacteria. The toxin-neutralizing activities of the antibodies were evaluated in vitro and the prophylactic effects of in vivo passive immunotherapy were demonstrated using a conventional mouse model. The data demonstrated that immunized...
Robinson C, Heather Z, Slater J, Potts N, Steward KF, Maskell DJ, Fontaine MC, Lee JJ, Smith K, Waller AS.Strangles, caused by Streptococcus equi subspecies equi (S. equi) is one of the most frequently diagnosed infectious diseases of horses and there remains a significant need to develop new preventative vaccines. We generated a live vaccine strain of S. equi containing deletions in six genes: sagA, hasA, aroB, pyrC, seM and recA, which was administered to nine Welsh mountain ponies via the intramuscular route. Four vaccinated ponies developed adverse reactions following the first vaccination from which the live vaccine strain was isolated. Two of these ponies were withdrawn from the study and se...
Acosta H, Rondón-Mercado R, Avilán L, Concepción JL.Trypanosoma evansi is a widely-distributed haemoflagellated parasite of veterinary importance that infects a variety of mammals including horses, mules, camels, buffalos, cattle and deer. It is the causal agent of a trypanosomiasis known as Surra which produces epidemics of great economic importance in Africa, Asia and South America. The main pathology includes an enlarged spleen with hypertrophy of lymphoid follicles, congested lungs, neuronal degeneration and meningoencephalitis, where migration of the parasites from the blood to the tissues is essential. Most cells, including pathogenic cel...
McDowell KJ, Webb BA, Williams NM, Donahue JM, Newman KE, Lindemann MD, Horohov DW.A new abortigenic disease, now known as mare reproductive loss syndrome (MRLS), significantly affected the horse industry in the Ohio River Valley of the United States in late April and early May of 2001 and 2002. In 2001, approximately 25% of all pregnant mares aborted within several weeks (over 3,000 mares lost pregnancies), and abortion rates exceeded 60% on some farms. Mare reproductive loss syndrome struck hard and without warning, it was caused by something in the environment, it was not transmitted between animals, and it was not associated with any known abortigenic agent or disease. T...
Belotta AF, Mayer MN, Waldner CL, Sidhu NP, Robinson KA, Carmalt JL, Freitas FP, Koehncke NK.The objectives of this study were to investigate scattered radiation doses to the hands of equine workers holding the cassette and the x-ray tube by hand, for both limb and vertebral column studies, and to compare the scattered radiation attenuation of lead with radiation protection lead-free gloves. Radiation doses to the hands of the cassette holder in the primary beam were also investigated. Methods: A whole-body horse cadaver. Methods: A portable x-ray unit was used to simulate 6 radiographic study types in the horse cadaver. Doses were measured with no shielding and, for cassette holders,...
Schwartz EJ, Smith RJ.The ability to predict the conditions under which antibodies protect against viral infection would transform our approach to vaccine development. A more complete understanding is needed of antibody protection against lentivirus infection, as well as the role of mutation in resistance to an antibody vaccine. Recently, an example of antibody-mediated vaccine protection has been shown via passive transfer of neutralizing antibodies before equine infectious anemia virus (EIAV) infection of horses with severe combined immunodeficiency (SCID). Viral dynamic modeling of antibody protection from EIAV ...
Biermann NM, McClure JT, Sanchez J, Saab M, Doyle AJ.Currently, the World Health Organization recommends the use of alcohol-based hand rubs (ABR) for surgical hand preparation in human surgery. When disinfecting soaps are used, a rubbing technique causes less skin irritation than brush scrubbing. Based on a recent survey, most equine surgeons still use disinfecting soap. The efficacy of scrubbing vs. rubbing and the use of sole ABR compared with chlorhexidine (CHx)- based products has not been evaluated in the equine surgical setting. Objective: To compare four surgical hand antisepsis techniques in equine surgery for reduction of aerobic bacter...
Wilson DA.The equine practitioner can positively influence wound healing by dispensing appropriate treatment in the first few hours after injury. Positive actions in the early period include hemostasis, meticulous cleansing and debridement of the wound, the use of effective but nonirritating products to disinfect the wound, closure (if indicated)with minimal tension on the suture line, the judicious use of drains,and ensuring adequate tetanus protection. Furthermore, a thorough assessment of the wound and the patient in the initial period after trauma provides pertinent information on prognosis. Finally...
