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Topic:Risk Factors

Risk factors in horses refer to variables or conditions that increase the likelihood of disease, injury, or other adverse health outcomes in equine populations. These factors can be intrinsic, such as age, breed, and genetic predisposition, or extrinsic, including environmental conditions, management practices, and exposure to infectious agents. Understanding risk factors is important for developing preventive strategies and improving health management in horses. This page aggregates peer-reviewed research studies and scholarly articles that explore the identification, assessment, and mitigation of risk factors in equine health, with the aim of enhancing disease prevention and promoting overall well-being in horses.
Recent advances in the treatment and prevention of equine peripheral caries.
Journal of the American Veterinary Medical Association    June 19, 2023   1-8 doi: 10.2460/javma.23.01.0036
Jackson K, Kelty E.Equine peripheral caries is a common condition characterized by demineralization and degradation of the clinical crown of equine cheek teeth. The condition can cause significant pain and morbidity, particularly in severe cases. Recent studies indicate that the condition is driven by environmental conditions within the mouth, as only the clinical crown of the tooth is affected (the reserve crown below the gingival margin remains unaffected). It is hypothesized that peripheral caries is driven by changes in oral pH, with risk factors for the condition including the intake of high-sugar feeds (oa...
Equine Herpesvirus-1 Outbreak During a Show-Jumping Competition: A Clinical and Epidemiological Study.
Journal of equine veterinary science    June 18, 2023   Volume 128 104869 doi: 10.1016/j.jevs.2023.104869
Couroucé A, Normand C, Tessier C, Pomares R, Thévenot J, Marcillaud-Pitel C, Legrand L, Pitel PH, Pronost S, Lupo C.A total of 752 horses were involved in the CES Valencia Spring Tour 2021. Due to an equine herpesvirus-1 (EHV-1) outbreak, the competition was cancelled and the site was locked down. The objective of this study was to describe epidemiological, clinical, diagnostic, and outcome data of the 160 horses remaining in Valencia. Clinical and quantitative polymerase chain reaction (qPCR) data were analysed for 60 horses in a retrospective case-control observational study. The risk of developing clinical manifestations was explored using a logistic regression approach. EHV-1 was detected by qPCR, genot...
Prevalence and risk factors for laminitis within the Norwegian pony breed Nordlandshest/Lyngshest.
Acta veterinaria Scandinavica    June 16, 2023   Volume 65, Issue 1 22 doi: 10.1186/s13028-023-00687-w
Lykkjen S, Stenbakk LK, Holmøy IH.Laminitis is a systemic condition resulting in debilitating pain and structural changes within the feet, and hence has major welfare implications. Causes include endocrine and systemic inflammatory conditions. Ponies are frequently affected, and observations in the field suggest that occurrence of laminitis is also common in Norwegian breeds. The aim of this study was to estimate the prevalence and risk factors for laminitis within the Norwegian pony breed Nordlandshest/Lyngshest. Results: The study was a cross-sectional study based on questionnaires sent to members of the Norwegian Nordlands...
Audit of animal-related injuries at UK veterinary schools between 2009 and 2018.
The Veterinary record    June 13, 2023   Volume 193, Issue 7 e3171 doi: 10.1002/vetr.3171
Tulloch JSP, Fleming KM, Pinchbeck G, Forster J, Lowe W, Westgarth C.Animal-related injuries pose a significant risk to the veterinary profession. This study aimed to describe the incidence, demographics, context and consequences of animal-related injuries at UK veterinary schools. A multicentre audit of accident records (2009-2018) across five UK veterinary schools was performed. Injury rates were stratified by school, demographics and species. The context and cause of the injury were described. Multivariable logistic models explored factors associated with medical treatment, hospital visits and time off work. An annual rate of 2.60 (95% confidence interval 2....
Occurrence of equine metabolic syndrome, clinical manifestations, and associated risk factors in Nigeria.
Journal of equine science    June 12, 2023   Volume 34, Issue 2 29-35 doi: 10.1294/jes.34.29
Akinniyi OO, Sackey AKB, Ochube GE, Mshelia PW, Musa FA, Elijah MO, Jolayemi KO.Insulin dysregulation (ID) is central to the pathophysiology of equine metabolic syndrome (EMS), putting the horse at risk of laminitis. There is a paucity of information on the status of EMS in Nigeria. This study aimed to determine the occurrence of EMS, clinical manifestations, and associated risk factors in Nigeria. A cross-sectional study was carried out. Selected horses underwent an insulin 2-step response test to ascertain insulin dysregulation; a physical examination was carried out to diagnose laminitis and obesity. Risk factors were assessed using a questionnaire. The overall prevale...
Study on prevalence and associated risk factors of epizootic lymphangitis in equine in Nagele Arsi town, southeastern Ethiopia.
Research in veterinary science    June 10, 2023   Volume 161 80-85 doi: 10.1016/j.rvsc.2023.06.008
Mathewos M, Bukero R, Endale H, Mekbib B, Giday W, Mekore D.Epizootic lymphangitis is a contagious, chronic and overwhelming disease of equids, characterized by chronic discharging skin nodules. This study was aimed to investigate the prevalence and associated risk factors of epizootic lymphangitis in equines at Nagele Arsi town, southeastern Ethiopia. A cross-sectional study using a random sampling technique was employed from December 2021 to June 2022 via clinical and microscopic examinations of the lesions. The overall prevalence of epizootic lymphangitis was 4.37% with a prevalence of 6.69%, 0.72%, and 0% in horses, donkeys, and mules, respectively...
Relationship between quantitative real-time PCR cycle threshold and culture for detection of Streptococcus equi subspecies equi.
The Canadian veterinary journal = La revue veterinaire canadienne    June 2, 2023   Volume 64, Issue 6 549-552 
Weese JS, Saab M, Moore A, Cai H, McClure JT.To compare PCR and culture results for the detection of subspecies . Respiratory tract samples (N = 158) from horses being tested for Bacterial culture was carried out on samples from which was detected by quantitative real-time PCR. was isolated from 12 (7.6%) samples: 4/9 (44%) samples when the PCR cycle threshold (C) was ≤ 30, 7/30 (23%) when the C was 30.1 to 35, and 1/119 (0.8%) when the C was 35.1 to 40. The highest C sample from a sample that yielded a positive culture was 36.9. The optimal Youden's J value was at a C of 34.2, the same value as determined by number needed to misdi...
Epidemiology of Colic: Current Knowledge and Future Directions.
The Veterinary clinics of North America. Equine practice    May 31, 2023   Volume 39, Issue 2 157-174 doi: 10.1016/j.cveq.2023.03.005
Gillen A, Catherine Archer D.Epidemiologic studies are essential for the generation of evidence-based, preventive health care strategies. This includes ways to minimize colic risk and assist informed decision making concerning diagnosis, treatment, and likely outcomes. It is important to consider that colic is not a simple "disease" but is a syndrome of abdominal pain that encompasses multiple different disease processes, and which is multifactorial in nature. This review focuses on prevention and diagnosis of colic, including specific forms of colic, communications with owners/carers concerning colic risk and management,...
West Nile virus: The current situation in Egypt.
Veterinary world    May 30, 2023   Volume 16, Issue 5 1154-1160 doi: 10.14202/vetworld.2023.1154-1160
Hassanien RT, Hussein HA, Abdelmegeed HK, Abdelwahed DA, Khattab OM, Ali MH, Habashi AR, Ibraheem EM, Shahein MA, Abohatab EM.Due to climatic changes, arthropod-borne viruses have become a global health concern. In Egypt, West Nile virus (WNV) was initially detected in humans in 1950 and then in 1951, 1954, 1968, and 1989. Although WNV infection has been recorded in numerous Middle Eastern countries, its prevalence among the equine population in Egypt is unknown. This study aimed to investigate the current situation of vector-borne WNV in Egypt, estimate its seroprevalence, and assess the associated risk factors. Unassigned: We screened 1100 sera samples and nasal swabs from the same equids, 156 mosquito pools, and 3...
Premature depolarisations in horses competing in United States Eventing Association and Fédération Equestre Internationale-sanctioned 3-day events.
Equine veterinary journal    May 30, 2023   doi: 10.1111/evj.13948
Durando MM, Slack J, Birks E, Belcher C, Kohn C.Injuries and sudden death during the cross-country (XC) phase of eventing have raised interest in the frequency and types of cardiac arrhythmias occurring in these equine athletes. Objective: To characterise the frequency and types of rhythm disturbances and examine possible risk factors for premature depolarisations (PDs) occurring during the XC phase of United States Eventing Association (USEA) and Fédération Equestre Internationale (FEI)-sanctioned events. Methods: Prospective, cross-sectional study. Methods: Continuous electrocardiographic (ECG) recordings were obtained from horses prior...
Bacterial Periodontitis in Horses: An Epidemiological Study in Southern Italy.
Animals : an open access journal from MDPI    May 30, 2023   Volume 13, Issue 11 1814 doi: 10.3390/ani13111814
Occhiogrosso L, Capozza P, Buonavoglia A, Decaro N, Trotta A, Marin C, Corrente M.Equine periodontal disease (EPD) is a painful oral inflammatory syndrome characterized by multifactorial pathogenesis. Although it is well known that bacterial proliferation and consequent gingivitis are caused by the decomposition process of food residues, in hypsodont species, the pathogenetic role and the different bacterial species involved in the progression of EPD must be fully clarified. This study aimed to investigate the association of bacteria, including the complex red bacteria (RCB), with EPD, and to evaluate possible EPD risk factors. Bacterial species, including , , (belonging t...
Recumbency decreases mare and foal survival following in-hospital dystocia management.
Equine veterinary journal    May 25, 2023   doi: 10.1111/evj.13956
Roe H, Macpherson M, Denagamage T, Hopper S, Woodie B, Embertson R.Mare and foal survival are increased with prompt dystocia management. Data regarding mortality outcomes in mares and foals, when mares are recumbent at admission for dystocia resolution, are scarce. Objective: To evaluate recumbency at hospital admission as a risk factor for survival of mares and foals following dystocia management. Subsequent mare fertility was also evaluated. Methods: Retrospective cohort. Methods: Data were obtained from medical records at Rood and Riddle Equine Hospital of mares with dystocia between 1995 and 2018. Mare signalment, ambulation status, survival data and foal...
Pre-Ride Biomarkers and Endurance Horse Welfare: Analyzing the Impact of the Elimination of Superoxide Dismutase, δ-Aminolevulinic-Dehydratase, Thiobarbituric Acid Reactive Substances, Iron, and Serum Amyloid A Levels in Elite 160 km Endurance Rides.
Animals : an open access journal from MDPI    May 17, 2023   Volume 13, Issue 10 1670 doi: 10.3390/ani13101670
Bollinger L, Bartel A, Weber C, Gehlen H.High elimination rates and concerns for horse welfare are important issues in endurance riding. Improved understanding of the causes of elimination could increase completion rates in this sport. We have identified pre-ride laboratory risk factors that enable an assessment of potential elimination before the ride. A longitudinal cohort study was performed among 49 healthy horses competing in the 160 km endurance ride at the 2016 World Championship of Endurance Riding in Samorin/Slovakia. Blood samples were taken before the event. For statistical evaluation, horses were categorized into three gr...
Occurrence and risk factors associated with gastrointestinal parasitism in horses reared in different systems.
Veterinary parasitology, regional studies and reports    May 11, 2023   Volume 42 100890 doi: 10.1016/j.vprsr.2023.100890
Carminatti A, Chitolina MB, Ribeiro AB, Forest M, Collet SG, Prestes AM, Camillo G.To facilitate exploration of the immense range of gastrointestinal parasites in horses and the impact of parasitism on equine health, the present study aimed to evaluate the occurrence and risk factors associated with these infections in horses reared in different management systems in the state of Santa Catarina, Brazil. Samples were collected from 208 horses: 91 from extensive, 64 from semi-extensive, and 53 from intensive rearing systems. The identified helminths included those of the Strongylida order (80.29%), Parascaris equorum (3.36%), Oxyuris equi (4.33%), and Anoplocephala spp. (1.92%...
Characterization of Raid Hipico Uruguayo Competencies by Ride Type: Causes of Death and Risk Factors.
Animals : an open access journal from MDPI    May 10, 2023   Volume 13, Issue 10 1602 doi: 10.3390/ani13101602
Brito G, Damián JP, Suárez G, Ruprechter G, Trigo P.RHU is the oldest endurance sport in Uruguay. However, despite 80 years of racing, there are no studies to characterize this type of competition, explore rates and causes of death, and identify the associated risk factors. The aim was to characterize the Raid Hipico Uruguayo (RHU) competencies according to the distance (short (SR, 60 km) vs. long (LR, 80-115 km)), the causes of deaths, and the associated risk factors. The study population comprised horses ( = 16,856) that participated in RHU rides from 2007 to 2018. LR were more frequent than SR ( < 0.001). The average speed of winners was ...
Human Injuries Associated with the Transport of Horses by Road.
Animals : an open access journal from MDPI    May 10, 2023   Volume 13, Issue 10 1594 doi: 10.3390/ani13101594
Riley CB, Padalino B, Rogers CW, Thompson KR.There is an increased understanding of shared human-animal risk in terms of "one welfare", whereby when animals are at risk, so are people, so preventing injury to one species may also prevent injury to the other. Because transport-related injuries to horses are common, the authors considered this paradigm to study road equine transport-related injuries to humans in New Zealand. The aim was to determine their frequency and associated factors by distributing a survey to horse industry participants through industry organisations asking about their horse activities, road transport experiences, an...
Prevalence, Risk Factors and Diagnosis of Helminths in Thoroughbred Horses Kept at Training Centers in Rio de Janeiro, Brazil.
Journal of equine veterinary science    May 1, 2023   Volume 127 104536 doi: 10.1016/j.jevs.2023.104536
Martins AV, Corrêa LL, Ribeiro MS, Lobão LF, Dib LV, Palmer JPS, de Moura LC, Knackfuss FB, Uchôa CMA, Molento MB, Barbosa ADS.The aims of this study were to determine the prevalence of helminths in Thoroughbred horses in Rio de Janeiro; make correlations with risk factors for these infections; and compare the efficiency of three floatation solutions applied in the quantitative Mini-FLOTAC technique. Fecal samples from 520 horses were collected from six training centers between 2019 and 2021. These were subjected to the Mini-FLOTAC technique using three solutions: NaCl (density = 1.200 g/mL), ZnSO4 (1.350 g/mL) and ZnSO4 (1.200 g/mL); and also to qualitative techniques. Information on the horses' sex and age of hors...
Horses as Sentinels for the Circulation of Flaviviruses in Eastern-Central Germany.
Viruses    April 30, 2023   Volume 15, Issue 5 1108 doi: 10.3390/v15051108
Gothe LMR, Ganzenberg S, Ziegler U, Obiegala A, Lohmann KL, Sieg M, Vahlenkamp TW, Groschup MH, Hörügel U, Pfeffer M.Since 2018, autochthonous West Nile virus (WNV) infections have been regularly reported in eastern-central Germany. While clinically apparent infections in humans and horses are not frequent, seroprevalence studies in horses may allow the tracing of WNV and related flaviviruses transmission, such as tick-borne encephalitis virus (TBEV) and Usutu virus (USUV), and consequently help to estimate the risk of human infections. Hence, the aim of our study was to follow the seropositive ratio against these three viruses in horses in Saxony, Saxony Anhalt, and Brandenburg and to describe their geograp...
Anti-Toxoplasma gondii and Anti-Neospora caninum Antibodies in Urban Traction Equids in Northeast Brazil: Seroprevalence and Risk Factors.
Tropical medicine and infectious disease    April 20, 2023   Volume 8, Issue 4 234 doi: 10.3390/tropicalmed8040234
Costa PWL, Oliveira CSM, Bezerra RA, Alvares FBV, Formiga VHAS, Martins MRDD, Feitosa TF, Vilela VLR.The aim of this study was to describe the prevalence of anti- and anti- antibodies in equids that carry out traction work in Northeastern Brazil, and to establish the potential risk factors associated with seropositivity for these agents. Blood samples were collected from 322 traction equids (horses, donkeys and mules) in urban areas of 16 municipalities in the State of Paraíba, Brazil. The samples were sent for serological diagnosis using the Immunofluorescence Antibody Test (IFAT). Epidemiological questionnaires were given to the owners to assess the possible risk factors associated with in...
Concentration of mineral and heavy metals in raw mare (horse) milk consumed in Yazd, Iran: A risk assessment study.
Veterinary medicine and science    April 17, 2023   Volume 9, Issue 4 1592-1598 doi: 10.1002/vms3.1138
Alipour A, Akrami Mohajeri F, Javdan G, Pourramezani F, Fallahzadeh H, Khalili Sadrabad E.In recent years, the mare's milk has been introduced as a rich source of nutrients with hypoallergic characteristics which is widely used for Iranian infants. The present study aimed to investigate the heavy metal concentration of mare's milk and its consumption risk assessment. About 88 mare's milk was collected from Yazd, the centre of Iran, during the summer of 2020. The raw mare's milk was digested and analysed for mineral and heavy metal content (As, Ca, Cd, Co, Cu, Fe, Mg, Mn, Ni, P, Pb and Zn) by ICP-OES. To estimate the health hazard for consumers the Estimated Daily Intake (EDI), Haza...
Risk Factors for Epistaxis in Thoroughbred Flat Races in Japan (2001-2020).
Animals : an open access journal from MDPI    April 14, 2023   Volume 13, Issue 8 doi: 10.3390/ani13081348
Sugiyama F, Takahashi Y, Nomura M, Ebisuda Y, Mukai K, Yoshida T.We investigated the risk factors for epistaxis in Japanese flat races over a 20-year period. The veterinary records of horses identified as having epistaxis by endoscopy on the race day, and the official racing records of all flat races from April to September between 2001 and 2020, were reviewed. The racecourses (n = 10), surface type, surface condition, race class, race distance, race year, sex, age, two training centers, ambient temperature, and body weight on race days were assessed using multivariable logistic regression (p < 0.05). Of 475,709 race starts, 616 (1.30 cases per 1000 starts;...
A comparative survey of veterinarians, equine owners, and equine keepers regarding the knowledge and implementation of legal requirements in Germany for the use and documentation of veterinary medicines in equines intended for slaughter.
PloS one    April 6, 2023   Volume 18, Issue 4 e0283371 doi: 10.1371/journal.pone.0283371
Schneider ST, Meemken D, Gehlen H, Merle R, Langkabel N.In Europe, equines destined for human consumption (hereafter called slaughter equines) are subject to the same restrictions of usage of veterinary drugs as other food-producing animals, with amendments regulated in the so-called 'positive list', Regulation (EC) No. 1950/2006. Due to the complex legal requirements for drug administration in slaughter equines, it might be that specific knowledge regarding the legislation of slaughter equines may be insufficient among veterinarians, equine owners, and equine keepers. To study this assumption, three target group-specific surveys were conducted in ...
First Detection of Anti-Besnoitia spp. Antibodies in Equids in Israel and the Palestinian Authority.
Microorganisms    April 3, 2023   Volume 11, Issue 4 929 doi: 10.3390/microorganisms11040929
Berman N, Tirosh-Levy S, Steinman A, Minderigiu A, Blinder E, Leszkowicz Mazuz M. is a tissue cyst forming coccidia, which affects multiple host species worldwide. Equine besnoitiosis is characterized mainly by generalized skin lesions and cysts in the scleral conjunctiva. Recent reports revealed exposure to in equines in Europe and the United States. However, the exposure to spp. in the Israeli equine population was never investigated. The aim of this study was to evaluate the seroprevalence and associated risk factors for besnoitiosis in equids in Israel. A cross-sectional serosurvey was performed using serum samples of apparently healthy horses ( = 347), donkeys ( = 9...
Prevalence and Risk Factors Associated With Natural Infection by Trypanosoma evansi in Campeiro Horses.
Journal of equine veterinary science    March 31, 2023   Volume 126 104300 doi: 10.1016/j.jevs.2023.104300
Golombieski L, Bassi das Neves G, Casa MDS, Costa GCS, Miletti LC, Saito ME, Fonteque JH.Campeiro horse is a breed locally adapted to the Santa Catarina plateau region and its main characteristic is the gait, it is known as "Marchador das Araucárias." It is a breed considered in danger of extinction, being fundamental the search for the preservation of this important genetic resource. Surra, caused by the protozoan Trypanosoma evansi, is among the diseases that affect horses. However, there are no data on the prevalence of infection in Campeiro horses. This study aimed to determine the prevalence of T. evansi in Campeiro horses, correlate hematology and serum biochemistry, and id...
Body Condition Score in Danish Horses Related to Type, Use, and Training Level: Patterns, Risk, and Protective Factors.
Animals : an open access journal from MDPI    March 31, 2023   Volume 13, Issue 7 doi: 10.3390/ani13071219
Uldahl M, Dahl J, Clayton HM.Body condition in horses is a growing concern that has different patterns of development in horses that are above and below the ideal range. This study used professional and para-professional evaluators (veterinarians, farriers, trainers, Danish Equestrian Federation (DEF) officials) who were trained and certified in the use of a modified Henneke scoring system to assign a body condition score (BCS) on a scale of 1-9. Scores of 5-6 are regarded as ideal, and 78.6% of the evaluated horses were in these groups. Only 4.8% of horses were below ideal BCS but 16.5% were above ideal BCS, and this was...
Towards a safer sport: Risk factors for cross-country horse falls at British Eventing competition.
Equine veterinary journal    March 29, 2023   Volume 56, Issue 1 137-146 doi: 10.1111/evj.13934
Cameron-Whytock HA, Parkin TDH, Hobbs SJ, Brigden CV, Bennet ED.Equestrian eventing is a dangerous Olympic sport, with 16 rider and 69 horse fatalities at competition in the last 10 years. Despite this, there is limited research that aims to improve safety within the sport. Objective: The purpose of this study was to identify risk factors for horse falls, which are the leading cause of rider fatality within the sport. Methods: Retrospective cohort study. Methods: Competition data between January 2005 and December 2015 were analysed. Descriptive statistics followed by univariable logistic regression to identify risk factors for inclusion in a multivariabl...
Horse-riding hazards: an observational cohort study mapping equestrian related injuries at a Scandinavian trauma centre.
BMC sports science, medicine & rehabilitation    March 28, 2023   Volume 15, Issue 1 46 doi: 10.1186/s13102-023-00646-y
Franzén Lindgren E, Hammarqvist F, Ahl Hulme R.Horse-riding is practiced on a regular basis by 500,000 people in Sweden. It is reputed to be one of the most dangerous sports. On average, there were 1756 acute injuries and three fatalities each year between 1997 and 2014 in Sweden related to horses. The primary aim of this study was to outline the injury spectrum related to equestrian activities cared for at a large Swedish trauma centre. The secondary aim was to identify trends in clinical outcomes and to investigate the association between age and such outcomes. Methods: The electronic medical records system at Karolinska University Hosp...
A Horse of a Different Color: A Case Report of Streptococcus Equi Meningitis in a Kidney Transplant Recipient.
Transplantation proceedings    March 26, 2023   Volume 55, Issue 3 664-666 doi: 10.1016/j.transproceed.2023.02.061
Eichenberger EM, Dent A, Hayes T, Woc-Colburn L.Streptococcus equi is an opportunistic pathogen in horses that has rarely been transmitted to humans. Here we present a zoonotic S. equi meningitis case in a kidney transplant recipient with exposure to infected horses. We discuss the patient's risk factors, clinical presentation, and management in the context of the limited literature on S. equi meningitis.
Seroprevalence and Risk Factors for Toxoplasma gondii Infection in Horses.
Veterinary sciences    March 22, 2023   Volume 10, Issue 3 237 doi: 10.3390/vetsci10030237
Marzok M, Al-Jabr OA, Salem M, Alkashif K, Sayed-Ahmed M, Wakid MH, Kandeel M, Selim A. is classified as intracellular protozoa and is one of the major zoonotic parasites. Most warm-blooded intermediate hosts, including humans, are commonly infected by this parasite. The epidemiology of infection in Egyptian horses is currently poorly understood. Methods: 420 blood samples were randomly collected from horses raised in four governorates in Northern Egypt (110 each from Giza and Kafr El Sheikh, and 100 each from Qalyubia and Gharbia) to investigate the existence of antibodies against using a commercial ELISA kit, and to ascertain the risk factors for the infection. Results: the ...
Equine pastern dermatitis: a narrative review on clinical presentation, diagnosis, risk factors, prevention, and therapeutic approaches.
Journal of the American Veterinary Medical Association    March 17, 2023   Volume 261, Issue S1 S58-S65 doi: 10.2460/javma.22.12.0569
Gerber V, Kaiser-Thom S, Oesch S.Equine pastern dermatitis (EPD) is a nonspecific cutaneous reaction pattern on the distal extremities, typically in the palmar/plantar area of the pastern. Although EPD is commonly seen in equine practice and can be a debilitating condition, peer-reviewed original studies on many aspects of this multifactorial syndrome are still scarce. This narrative review aims to give an overview of the clinical presentation (forms of EPD and clinical scores and differential diagnoses), risk factors, and therapeutic approaches. The emphasis is on intrinsic and extrinsic risk factors as most of the original ...
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