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Topic:Equine Medicine

Equine Medicine encompasses the study and application of medical practices specifically related to the health and well-being of horses. This field involves the diagnosis, treatment, and prevention of diseases and disorders affecting equine species. It covers a wide range of topics, including internal medicine, surgery, reproduction, and pharmacology. Research in equine medicine often focuses on understanding the physiological and pathological processes unique to horses, as well as developing effective therapeutic interventions. This page aggregates peer-reviewed research studies and scholarly articles that explore various aspects of equine medicine, providing insights into the latest advancements and methodologies in the care and management of horse health.
Embodied Communication, Sensed Atmospheres, Joint Situations: Human-Horse Encounters from a Neophenomenological Perspective.
Animals : an open access journal from MDPI    June 7, 2024   Volume 14, Issue 12 1720 doi: 10.3390/ani14121720
Pütz R.This article shows that the German philosopher Hermann Schmitz's new phenomenology can make a valuable contribution to human-animal studies. The three concepts suitable for this purpose are, first, Schmitz's concept of embodied communication, which can be applied to trans-species encounters; second, his understanding of atmospheres, which are always co-communicated in trans-species encounters; and, third, his conception of situation, which can help with analyzing the relationship of society to animals. My contribution applies these three basic elements of new phenomenology-embodied communicati...
Heart rate and heart rate variability in horses undergoing hot and cold shoeing.
PloS one    June 6, 2024   Volume 19, Issue 6 e0305031 doi: 10.1371/journal.pone.0305031
Huangsaksri O, Wonghanchao T, Sanigavatee K, Poochipakorn C, Chanda M.Heart rate variability (HRV) is a frequently used indicator of autonomic responses to various stimuli in horses. This study aimed to investigate HRV variables in horses undergoing cold (n = 25) or hot (n = 26) shoeing. Multiple HRV variables were measured and compared between horses undergoing cold and hot shoeing, including the time domain, frequency domain, and nonlinear variables pre-shoeing, during shoeing, and at 30-minute intervals for 120 minutes post-shoeing. The shoeing method interacted with time to change the HRV variables standard deviation of RR intervals (SDNN), root mean square ...
Monoclonal antibodies for equine CD25 improve detection of regulatory T cells in horses.
Veterinary immunology and immunopathology    June 6, 2024   Volume 274 110790 doi: 10.1016/j.vetimm.2024.110790
Wagner B, Babasyan S, Wilford S, Robbin MG, de Mestre AM.CD25, the interleukin-2 receptor α-chain, is expressed on cell surfaces of different immune cells and is commonly used for phenotyping of regulatory T cells (Tregs). CD25 has essential roles in the maintenance of hemostasis and immune tolerance and Treg cell involvement has been shown in human diseases and murine models for allergy, autoimmunity, cancer, chronic inflammation, and many others. In horses, a cross-reactive anti-human CD25 antibody has previously been used for characterizing Tregs. Here, we developed monoclonal antibodies (mAbs) to equine CD25 and compared their staining pattern ...
Dysbiosis not observed in Canadian horse with free fecal liquid (FFL) using 16S rRNA sequencing.
Scientific reports    June 5, 2024   Volume 14, Issue 1 12903 doi: 10.1038/s41598-024-63868-1
Wester RJ, Baillie LL, McCarthy GC, Keever CC, Jeffery LE, Adams PJ.Free Fecal Liquid (FFL), also termed Fecal Water Syndrome (FWS), is an ailment in horses characterized by variable solid and liquid (water) phases at defecation. The liquid phase can be excreted before, during, or after the solid defecation phase. While the underlying causes of FFL are unknown, hindgut dysbiosis is suggested to be associated with FFL. Three European studies investigated dysbiosis in horses with FFL using 16S rRNA sequencing and reported results that conflicted between each other. In the present study, we also used 16S rRNA sequencing to study the fecal microbial composition in...
The effect of systemic acetazolamide administration on intraocular pressure in healthy horses-A preliminary study.
Veterinary ophthalmology    June 5, 2024   Volume 28, Issue 1 66-72 doi: 10.1111/vop.13240
Shnaiderman-Torban A, Pe'er O, Gustafsson K, Tatz A, Brizi M, Soback S, Abu Ahmad W, Magen R, Ofri R, Kelmer G.In equine glaucoma, topical treatment with carbonic anhydrase inhibitors (CAIs) is recommended. Oral acetazolamide, a systemic CAI, is used in horses with hyperkalemic periodic paralysis. Information regarding its effect on equine intraocular pressure (IOP) is scarce. The aim of the study was to determine the effect of oral acetazolamide treatment on IOP in horses, in a case-control study. Methods: Ten healthy horses. Methods: Horses were treated with oral acetazolamide (4.4 mg/kg) BID for 1 week. Serum acetazolamide concentrations were determined by liquid chromatography/tandem mass spect...
Enhancing prosthesis stability at the cricoid cartilage in equine laryngoplasty using 3-D-printed laryngeal clamps: An ex vivo model study.
Veterinary surgery : VS    June 5, 2024   doi: 10.1111/vsu.14115
Grzeskowiak R, Schumacher J, Omidi O, Bowers K, Cassone LMC, Abedi R, Hespel AM, Mulon PY, Anderson DE.To assess a three-dimensional (3-D)-printed laryngeal clamp (LC) designed to enhance the anchoring of laryngeal prostheses at the cricoid cartilage. Methods: Ex vivo biomechanical study. Methods: A total of 22 equine larynges. Methods: Two experimental groups included larynges with standard prosthetic laryngoplasty (PL; n = 10) and larynges with prosthetic laryngoplasty modified with laryngeal clamps (PLLC; n = 10). All constructs underwent 3000 cycles of tension loading and a single tension to failure. Recorded biomechanical parameters included maximum load, actuator displacement, a...
Hematological and Biochemical Effects Associated with Prolonged Administration of the NSAID Firocoxib in Adult Healthy Horses.
Veterinary sciences    June 5, 2024   Volume 11, Issue 6 doi: 10.3390/vetsci11060256
Ignácio FS, Garcia LV, de Souza GG, Amatti LZ, de Barros LD, Bergfelt DR, Camargo GS, de Meira C, de Almeida BFM.Non-steroidal anti-inflammatory drugs (NSAIDs) represent one of the most commonly used classes of drugs in both human and veterinary medicine. However, many clinical side effects have been observed, especially when treatment has been prolonged. While the anti-inflammatory efficacy and safety of repeated administration of firocoxib (Previcox®), which is a selective NSAID COX-2 inhibitor, has been evaluated for short-term use (one to fourteen days), its clinical relevance for longer-term use is not known. As a preliminary study, healthy, adult male and female horses (n = 7) were treated with fi...
Flow-controlled expiration ventilation using a piston ventilator: effects of expiration time and speed on respiratory and pulmonary mechanics with focus on hysteresis and compliance in healthy horses.
American journal of veterinary research    June 5, 2024   Volume 85, Issue 8 ajvr.24.02.0036 doi: 10.2460/ajvr.24.02.0036
Douglas HF, Brandly J, Hopster K.To investigate the effects of FLow-controlled EXpiration (FLEX) ventilation expiration time and speed on respiratory and pulmonary mechanics in anesthetized horses in dorsal recumbency. Methods: 6 healthy adult research horses. Methods: In this randomized crossover experimental study, horses were anesthetized 3 times and were ventilated each time for 60 minutes using conventional volume-controlled ventilation (VCV), linear emptying of the lung over 50% of the expiratory time (FLEX50), or linear emptying of the lung over 100% of the expiratory time (FLEX100) in a randomized order. The primary o...
Mechanical Properties and Failure Mode of Proximal Screw Fixation Technique Using Locking Compression Plate for Proximal Interphalangeal Arthrodesis in Horses: An Ex Vivo Study.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    June 4, 2024   doi: 10.1055/s-0044-1787680
de Souza AF, Pereira CAM, Costa C, Fürst A, Kümmerle JM, De Zoppa ALV. The aim of this study was to measure the mechanical properties and failure mode of an model of proximal interphalangeal arthrodesis in horses with different methods of proximal screw fixation using a locking compression plate. Methods:  Pastern joint arthrodesis with a 3-hole 4.5-mm narrow locking compression plate was performed on 20 forelimbs of equine cadavers, randomized into four groups based on the fixation method and type of proximal screw used: unicortical cortex, bicortical cortex, unicortical locking, bicortical locking. Single-cycle axial compression testing was conducted unti...
Tropical grass digestibility assessed by the mobile bag and in vitro methods in horses.
Journal of equine veterinary science    June 4, 2024   105112 doi: 10.1016/j.jevs.2024.105112
Silva AH, Lucena JEC, Taran FMP, Cunha DS, Almeida JAT, Lima RS, Dias WS, Santiago JM.This study aimed to compare the digestibility of tropical grasses by horses by the in vivo method using mobile nylon bags with the in vitro digestibility method using horse feces as a source of inoculum. Five horses were used in a 2 × 5 factorial design with randomized blocks featuring two methods (in vivo and in vitro) and five grasses: Tifton 85 hay (Cynodon spp.), sixweeks threeawn grass (Aristida adsencionis, Linn), Alexandergrass (Brachiaria plantaginea (Link) Hitchc.), capim-de-raiz (Chloris orthonoton, Doell), and Sabi grass (Urochloa mosambicensis). No difference (P>0.05) was foun...
Primary phenotypic features associated with caudal neck pathology in warmblood horses.
Journal of veterinary internal medicine    June 3, 2024   doi: 10.1111/jvim.17125
Dyson S, Zheng S, Aleman M.Detailed descriptions of clinical signs associated with radiological findings of the caudal cervical vertebral column are not available. Objective: Describe the clinical features associated with neck pain or stiffness, neck-related thoracic limb lameness, proprioceptive ataxia consistent with a cervicothoracic spinal cord or nerve lesion, and their frequency of occurrence compared with control horses. Methods: A total of 223 Warmblood horses. Methods: Case-control study. Controls and cases were recruited prospectively. All horses underwent predetermined lameness and neurologic examinations. Th...
Changes of faecal bacterial communities and microbial fibrolytic activity in horses aged from 6 to 30 years old.
PloS one    June 3, 2024   Volume 19, Issue 6 e0303029 doi: 10.1371/journal.pone.0303029
Baraille M, Buttet M, Grimm P, Milojevic V, Julliand S, Julliand V.Horse owners and veterinarians report that from the age of 15, their horses can lose body condition and be more susceptible to diseases. Large intestinal microbiome changes may be involved. Indeed, microbiota is crucial for maintaining the condition and health of herbivores by converting fibres into nutrients. This study aimed to compare the faecal microbiome in horses aged from 6 to 30 years old (yo), living in the same environment and consuming the same diet, in order to assess whether the parameters changed linearly with age and whether there was a pivotal age category. Fifty horses were se...
Use of recombinant tissue plasminogen activator (rTPA) for treatment of fibrin in the anterior chamber of the horse.
Veterinary medicine and science    May 31, 2024   Volume 10, Issue 4 e1448 doi: 10.1002/vms3.1448
Pereira R, Bowen M, Rapezzano G, Redpath A, Pratt S, Hallowell G.Recombinant intracameral tissue plasminogen activator (rTPA) administration can aid clearance of fibrin from the anterior chamber. In this retrospective multicentre case series, the effect of intracameral rTPA administration to treat fibrin in the anterior chamber resulting from trauma or inflammatory ocular disease was evaluated. Clinical data from 30 treatments in 29 horses were obtained from medical records from 2003 to 2022. Association between time from onset of clinical signs and time for rTPA treatment to effect was studied with regression analysis. Twenty-seven horses (93.1%) had no pr...
Predicted efficacy and tolerance of different dosage regimens of benzylpenicillin in horses based on a pharmacokinetic study with three IM formulations and one IV formulation.
Frontiers in veterinary science    May 31, 2024   Volume 11 1409266 doi: 10.3389/fvets.2024.1409266
Ferran AA, Roques BB, Chapuis L, Kuroda T, Lacroix MZ, Toutain PL, Bousquet-Melou A, Lallemand EA.Benzylpenicillin (BP) is a first-line antibiotic in horses but there are discrepancies between manufacturers and literature recommendations regarding dosing regimen. Objectives of this study were to evaluate pharmacokinetics and local tolerance of four different formulations of BP in adult horses, and to suggest optimized dosing regimen according to the formulation. Unassigned: A cross-over design was used in 3 phases for the intramuscular injection of three different products: procaine BP alone, procaine BP/ benzathine BP combination or penethamate hydriodide were administered IM in the glute...
Changes in plasma metabolite concentrations and enzyme activities in aging riding horses.
Frontiers in veterinary science    May 31, 2024   Volume 11 1345548 doi: 10.3389/fvets.2024.1345548
Asahi Y, Arai T, Tanaka Y.In older horses, basal metabolic rate decreases, and plasma metabolite and hormone concentrations related to energy metabolism change. The occurrence of age-related diseases, which increases in old animals, may enhance inflammatory reactivity (inflammaging). Finding the appropriate treatment for inflammaging at an early stage may prevent various age-related diseases. Changes in metabolite and hormone concentrations and enzyme activities involved in energy metabolism in the plasma of clinically healthy riding horses of various ages were measured to identify biomarkers of inflammaging (persisten...
A novel approach to ear pain in the horse: A case report.
Open veterinary journal    May 31, 2024   Volume 14, Issue 5 1309-1312 doi: 10.5455/OVJ.2024.v14.i5.26
Lardone E, Landi A, Franci P.During electrochemotherapy (ECT), a chemotherapeutic drug is injected into the tumor and then an electroporation is provided. In horses, ear manipulation may be very painful, and combining a loco-regional technique with sedation might be a good option to avoid anesthesia-related risks. A two-injection-point block of the internal and external pinna and acoustic meatus was described in horse cadavers, and it permitted complete stain of all three branches of the great auricular nerve (GAN), internal auricular nerve branch (IAB), lateral auricular branch (LAB), and caudal auricular nerve (CAN), su...
Effects of astaxanthin on gut microbiota of polo ponies during deconditioning and reconditioning periods.
Physiological reports    May 30, 2024   Volume 12, Issue 11 e16051 doi: 10.14814/phy2.16051
Kawaida MY, Maas KR, Moore TE, Reiter AS, Tillquist NM, Reed SA.To determine the effects of astaxanthin (ASTX) supplementation on the equine gut microbiota during a deconditioning-reconditioning cycle, 12 polo ponies were assigned to a control (CON; n = 6) or supplemented (ASTX; 75 mg ASTX daily orally; n = 6) group. All horses underwent a 16-week deconditioning period, with no forced exercise, followed by a 16-week reconditioning program where physical activity gradually increased. Fecal samples were obtained at the beginning of the study (Baseline), after deconditioning (PostDecon), after reconditioning (PostRecon), and 16 weeks after the ces...
Findings and Prognosis in 149 Horses with Histological Changes Compatible with Inflammatory Bowel Disease.
Animals : an open access journal from MDPI    May 30, 2024   Volume 14, Issue 11 doi: 10.3390/ani14111638
Kranenburg LC, Bouwmeester BF, van den Boom R.Inflammatory bowel disease (IBD) is a chronic disease characterized by different cell infiltrates in the intestine. The aims of this study were to report the clinical and clinicopathological findings in horses with histological changes compatible with IBD in the duodenum. Further, the clinical progression of IBD and survival were investigated. Patient records were reviewed for horses in which histological evidence of IBD was found in duodenal biopsies collected during endoscopy. The histological changes were classified as mild, moderate or severe and the predominant infiltrating cell type was ...
Three-Dimensional Segmentation of Equine Paranasal Sinuses in Multidetector Computed Tomography Datasets: Preliminary Morphometric Assessment Assisted with Clustering Analysis.
Sensors (Basel, Switzerland)    May 30, 2024   Volume 24, Issue 11 3538 doi: 10.3390/s24113538
Borowska M, Lipowicz P, Daunoravičienė K, Turek B, Jasiński T, Pauk J, Domino M.The paranasal sinuses, a bilaterally symmetrical system of eight air-filled cavities, represent one of the most complex parts of the equine body. This study aimed to extract morphometric measures from computed tomography (CT) images of the equine head and to implement a clustering analysis for the computer-aided identification of age-related variations. Heads of 18 cadaver horses, aged 2-25 years, were CT-imaged and segmented to extract their volume, surface area, and relative density from the frontal sinus (FS), dorsal conchal sinus (DCS), ventral conchal sinus (VCS), rostral maxillary sinus ...
La Tène Horse Remains from Alba Iulia CX 143 Complex: A Whole Story to Tell.
Animals : an open access journal from MDPI    May 30, 2024   Volume 14, Issue 11 1624 doi: 10.3390/ani14111624
Gudea AI, Bârcă V, Irimie A, Martonos CO, Socaciu A.The present paper deals with the archaeozoological investigation carried out on a horse skeleton discovered in a Late Iron Age La Tène tomb (coded CX 143) in Alba Iulia, Romania. The paper presents all the results of the investigation, with a description of finds, adding a detailed assessment of the dentition with some interesting conclusions on the usage of a horse bit and the possible consequences of this use. The morphological features of the horse indicate a 7-8-year-old male individual, with a recalculated height of 1200-1300 mm. What is also stressed in the investigated sample is the la...
Outcome of tenoscopically guided palmar/plantar annular ligament desmotomy for the treatment of palmar/plantar annular ligament constriction without concurrent intrathecal soft-tissue injury in a UK horse population.
Veterinary surgery : VS    May 29, 2024   doi: 10.1111/vsu.14120
Wood AD, Parker RA, Marcatili M, Anderson J, Robinson N, Stack JD.To determine the outcome of tenoscopically guided palmar/plantar annular ligament (PAL) desmotomy to treat PAL constriction without concurrent intrathecal soft-tissue injury, notably of the digital flexor tendons and manica flexoria. Methods: Retrospective multicenter cohort study. Methods: Sixty-five horses. Methods: Horses from four UK equine hospitals, with digital flexor tendon sheath (DFTS) tenosynovitis, which underwent tenoscopically guided PAL desmotomy for treatment of PAL constriction between 2017 and 2022 were included. All horses had lameness isolated to the DFTS/PAL, and PAL const...
Retrospective evaluation of the effects of a single intraoperative dose of dexamethasone in horses undergoing exploratory laparotomy for small intestinal lesions (2008-2019): 240 cases. Tallon RE, Allen SE, Bladon BM, McGovern KF.To determine the effect of a single intraoperative dose of dexamethasone on the risk of postoperative reflux (POR) in horses undergoing small intestinal surgery and to investigate its association with incisional complications and short-term survival. Methods: Retrospective cohort study over an 11-year period (2008-2019). Methods: UK-based private referral center. Methods: Two hundred and forty client-owned horses >6 months of age undergoing exploratory laparotomy for treatment of a small intestinal lesion. Methods: Ninety-seven horses received a single intraoperative dose of dexamethasone ...
Survey-based investigation of sports and leisure horse owners’ approaches to, and expectations of, equine veterinary care.
The Veterinary record    May 29, 2024   Volume 194, Issue 11 e4197 doi: 10.1002/vetr.4197
Elte Y, Wolframm I, van Grevenhof I, Nielen M, van Weeren R.Client satisfaction depends on the balance between expectations and service experience. Previous research identified seven aspects of equine veterinary professional conduct that are important for client satisfaction: quality of care, quality of service, horsemanship, transfer of knowledge, financial aspects, interpersonal skills and professionalism. Methods: By employing a cross-sectional study design through a survey-based investigation, horse owners' initial contact preferences and their perceptions of the importance of various aspects of veterinary care in different scenarios were explored....
Neck pain but not neurologic disease occurs more frequently in horses with transposition of the ventral lamina from C6 to C7.
Journal of the American Veterinary Medical Association    May 29, 2024   1-7 doi: 10.2460/javma.24.04.0230
Henderson CS, Story MR, Nout-Lomas YS.To determine reasons for horses to have neck radiographs performed, the incidence of transposition of the ventral lamina of C6 onto C7 (TC67), and the final diagnoses for all horses. Our hypotheses were to find a similar incidence of TC67, as has been previously reported, and an increased incidence of neck pain and dysfunction in horses with TC67. Methods: 135 horses. Methods: Retrospective observational study. Medical records of 135 horses with cervical vertebral column radiographs between 2020 and 2022 were assessed. Patient signalment, reasons for radiographs, radiographic findings, and dia...
Comparison of inhaled salbutamol and salmeterol for the treatment of arterial hypoxaemia in anaesthetized horses: a randomized clinical trial.
Veterinary anaesthesia and analgesia    May 29, 2024   S1467-2987(24)00086-2 doi: 10.1016/j.vaa.2024.05.009
Dupont J, Mignini B, Salciccia A, Serteyn D, Sandersen C.To compare the efficacy of inhaled salbutamol with salmeterol for the treatment of arterial hypoxaemia in anaesthetized horses. Methods: Prospective, randomized, clinical study. Methods: A total of 108 client-owned horses (American Society of Anesthesiologists status I-V) anaesthetized for elective and emergency procedures. Methods: Horses were premedicated with acepromazine [intramuscularly 0.1 mg kg or intravenously (IV) 0.05 mg kg] and xylazine (0.6 mg kg IV). Midazolam (0.06 mg kg IV) and ketamine (2.2 mg kg IV) were combined to induce anaesthesia, and isoflurane in oxygen/air mixture (ins...
Opinions regarding equine veterinarian attire and attributes: results of a horse owner survey.
Journal of the American Veterinary Medical Association    May 29, 2024   Volume 262, Issue 8 1081-1089 doi: 10.2460/javma.24.02.0083
O'Neil EK, Fogle CA, Sheats MK, Love K.To investigate potential equine clients' perceptions of equine veterinarians based on attire. Methods: 763 horse owners/lessees. Methods: Participants were invited to complete a survey shared mainly via equestrian social media pages between August and October 2022.1-3 Survey participants were shown pictures of a male veterinarian and a female veterinarian in 7 outfits ranging from casual to business attire and were asked to score the veterinarian on 7 traits: easygoing attitude, friendliness, compassion, trustworthiness, professionalism, competence, and cost of services. The survey asked which...
Vascularity evaluation of the equine tarsocrural and proximal intertarsal joint septum, and comparative analysis of two arthroscopic transection techniques.
Veterinary surgery : VS    May 28, 2024   doi: 10.1111/vsu.14106
Labordère AL, Ruzickova P, Kamus LJ, Beauchamp G, Malo A, Richard H, Laverty S.To evaluate vascularity of the synovial membrane covered septum (SMS) separating the tarsocrural (TC) and proximal intertarsal (PIT) joints (Part 1) and compare two methods of transection, electrosurgical or Ferris Smith rongeur (FS rongeur) (Part 2). Methods: Experimental study. Methods: Part 1, 10 SMS (n = 5 horses). Part 2, six horses (n = 12 tarsi). Methods: In part 1, SMS harvested postmortem were each divided into eight regions of interest (ROIs), processed for histology, and immunostained with anti-α-actin antibody for blood vessel identification. Vascular density was calculate...
Effect of sperm treatment with lysolecithin on in vitro outcomes of equine intracytoplasmic sperm injection.
Journal of equine veterinary science    May 28, 2024   Volume 138 105095 doi: 10.1016/j.jevs.2024.105095
Aguila L, Cabrera P, Arias ME, Silva M, Felmer R.Intracytoplasmic sperm injection (ICSI) in horses is currently employed for clinical and commercial uses, but the protocol could be optimized to improve its efficiency. We have hypothesized that destabilization of plasma and acrosomal membranes prior to injection would positively impact the developmental potential of equine zygotes generated by ICSI. This study evaluated effects of the sperm treatment with lysolecithin on plasma and acrosomal membranes and on oocyte activation ability, initially following heterologous ICSI on bovine oocytes and subsequently employing equine oocytes. The effect...
Using infrared thermography for the evaluation of road transport thermal homeostasis in athletic horse.
Journal of equine veterinary science    May 28, 2024   Volume 138 105102 doi: 10.1016/j.jevs.2024.105102
Aragona F, Arfuso F, Rizzo M, Fazio F, Acri G, Piccione G, Giannetto C.This study aimed to evaluate changes in body temperature in athletic horses during two different road transport distances. Six Italian Saddle horses were subjected to a 100 and 300 km transport during different times of day (am and pm). Rectal and cutaneous temperatures were recorded before (T0), immediately (following 5 min- T1) and 1 hour (T2) after transport by means of a rectal digital thermometer and a thermal infrared camera (FLIR T440) respectively, for the evaluation of left and right side of four body regions: jugular, shoulder, croup and inner thigh. There were no differences between...
ECEIM consensus statement on equine kidney disease.
Journal of veterinary internal medicine    May 27, 2024   doi: 10.1111/jvim.17101
van Galen G, Divers TJ, Savage V, Schott HC, Siwinska N.The aim of this consensus statement is to summarize and appraise scientific evidence and combine this with the clinical experience of a panel of experts to optimize recommendations on how to recognize and manage kidney disease in horses.
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