Veterinary care in horses encompasses the medical and preventive measures taken to maintain and improve the health and well-being of equine patients. It includes a wide range of practices such as routine health examinations, vaccinations, dental care, parasite control, and management of injuries and diseases. Veterinary care also involves diagnostic procedures, surgical interventions, and therapeutic treatments tailored to the specific needs of horses. This page gathers peer-reviewed research studies and scholarly articles that explore various aspects of equine veterinary care, including advancements in diagnostic techniques, treatment protocols, and health management strategies to support the well-being and performance of horses.
Anaya G, Fernández ME, Valera M, Molina A, Azcona F, Azor P, Solé M, Moreno-Millán M, Demyda-Peyrás S.Twin foaling is associated with chimaerism in several domestic species and is recognised in horses. In this study, 21,097 purebred Spanish (Pura Raza Español) horse births from the 2015 to 2016 breeding season were investigated for chimaerism. Twin foaled and chimaeric individuals were assessed on the basis of foaling records, short-tandem repeat (STR) parentage test results and a sex-linked STR-based technique. Fourteen twin pregnancies with 23 twin foals born alive were identified (0.066% twin foaling prevalence), including five blood chimaeric cases (21.7%; overall prevalence 0.011%), sugg...
McGreevy P, Berger J, de Brauwere N, Doherty O, Harrison A, Fiedler J, Jones C, McDonnell S, McLean A, Nakonechny L, Nicol C, Preshaw L, Thomson P....The aim of this study was to conduct a series of paper-based exercises in order to assess the negative (adverse) welfare impacts, if any, of common interventions on domestic horses across a broad range of different contexts of equine care and training. An international panel (with professional expertise in psychology, equitation science, veterinary science, education, welfare, equestrian coaching, advocacy, and community engagement; = 16) met over a four-day period to define and assess these interventions, using an adaptation of the domain-based assessment model. The interventions were consid...
Cain JL, Jarisch K, Macaluso KR, Luedtke BE.Approximately 700 feral horses, dubbed "trespass horses" by the United States Army, occupy Fort Polk, Louisiana and the surrounding Kisatchie National Forest. These horses are considered a nuisance and hazard, and the military is seeking to remove the horses via adoption. The aim of this research was to evaluate the fecal egg count (FEC), body condition score (BCS), and the presence of Strongylus vulgaris within this previously unstudied horse population prior to removal. The feral horse data was compared to domestic horses living on a single farm in the same area. A modified McMaster FEC, Hen...
Camacho-Luna P, Buchanan B, Andrews FM.Equine gastric ulcer syndrome (EGUS) primarily describes ulceration in the terminal esophagus, nonglandular squamous mucosa, glandular mucosa of the stomach, and proximal duodenum. EGUS is common in all breeds and ages of horses and foals. This article focuses on the current terminology for EGUS, etiologies and pathogenesis for lesions in the nonglandular and glandular stomach, diagnosis, and a comprehensive approach to the treatment and prevention of EGUS in adult horses and foals.
Fielding CL.With advances in technology and owner education, field management in equine veterinary medicine continues to evolve. Equine gastrointestinal disease is one of the most common types of emergencies evaluated by equine practitioners, and many of these patients can be effectively managed in the field. Although the equine veterinarian must make numerous decisions, fluid therapy, pain management, and antimicrobial use are 3 of the major choices that must be addressed when initiating field treatment of equine gastrointestinal disease. This article addresses the practical use of these 3 treatment cate...
Rosenstein PG, Tennent-Brown BS, Hughes D.To review the current literature pertaining to the use of lactate as a prognostic indicator and therapeutic guide, the utility of measuring lactate concentrations in body fluids other than blood or plasma, and the clinical management of hyperlactatemia in dogs, cats, and horses. Methods: Articles were retrieved without date restrictions primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. Unassigned: Increased plasma lactate concentrations are associated with increased morbidity and mortality. In populations with high mortality, hyperlactatemia is moderately predicti...
Tamura N, Kodaira K, Yoshihara E, Mae N, Yamazaki Y, Mita H, Kuroda T, Fukuda K, Tomita A, Kasashima Y.A retrospective cohort study was conducted to investigate risk factors for the failure of Thoroughbred racehorses to return to racing after an injury of the superficial digital flexor tendon (SDFT). Successful return was defined as the completion of five or more races after SDFT injury. The official Japan Racing Association (JRA) medical records of racehorses with a core-type SDFT injury were reviewed for clinical variables related to the characteristics of the horse and the severity of SDFT injuries at the time of diagnosis. Data on racing outcomes were obtained from the official JRA racing d...
Bischoff K, Moiseff J.Feed as a cause of poisoning in horses can occur on small or large scales. It is challenging to work up cases of suspected feed contamination, but there are resources available to veterinarians and owners. Feed contamination can be chemical or biological. This article focuses on and provides examples of chemical feed contamination including misformulation, adulteration, and natural contaminants. Additionally, recommendations for feed sampling and diagnostic submission, including legal documentation, are included.
Bosch S, Serra Bragança F, Marin-Perianu M, Marin-Perianu R, van der Zwaag BJ, Voskamp J, Back W, van Weeren R, Havinga P.In this paper, we describe and validate the EquiMoves system, which aims to support equine veterinarians in assessing lameness and gait performance in horses. The system works by capturing horse motion from up to eight synchronized wireless inertial measurement units. It can be used in various equine gait modes, and analyzes both upper-body and limb movements. The validation against an optical motion capture system is based on a Bland-Altman analysis that illustrates the agreement between the two systems. The sagittal kinematic results (protraction, retraction, and sagittal range of motion) sh...
Ida KK, Sauvage A, Gougnard A, Grauwels M, Serteyn D, Sandersen C.Ponies with tracheal collapse may have an increased anesthetic risk due to airway obstruction during induction and recovery. To our knowledge, there are no anesthetic descriptions of these patients, despite a reported 5.6% incidence and 77% mortality rate. Two Shetland ponies with tracheal collapse, a 12-year-old male (pony 1) and a 27-year-old female (pony 2), were referred for right eye enucleation due to a perforating corneal ulcer and severe recurrent uveitis, respectively. Pony 1 was stressed, had lung stridor and hyperthermia, and developed inspiratory dyspnea with handling. Radiography ...
Freeman DE.Colic surgery is one of few treatments in which a veterinarian can use a skill to save an animal's life from a deadly disease within a short timeframe. Unfortunately, such success is not achieved without considerable risk for surgical failure, which is responsible for most complications in the immediate post-operative period. The last 50 years have witnessed considerable improvements in colic surgery, although a ranking of the most important ones might not meet with universal agreement. Teamwork plays a critical role in the final outcome, starting and finishing with the referring veterinarian...
Jacquet-Guibon S, Dupays AG, Coudry V, Crevier-Denoix N, Leroy S, Siñeriz F, Chiappini F, Barritault D, Denoix JM.A randomized controlled trial was performed on racing horses, to evaluate the efficacy of a new class of therapeutic agents in regenerative medicine-ReGeneraTing Agents® (RGTA®), to treat tendinopathies. Preliminary uncontrolled studies on tendon healing in racing horses with RGTA® (OTR4131)-Equitend® showed encouraging results, justifying performing a randomized, controlled, multicenter study with a two-year racing performance follow up. The objective of this study was to evaluate the effect of Equitend® versus placebo on acute superficial digital flexor tendonitis in racing French Stand...
Knickelbein KE, Stock M, Carrasco SE, Reilly CM, Lassaline ME.An 18-year-old American Miniature Horse mare was presented with a complaint of a scleral swelling affecting the right eye and a history of suspected trauma 6 weeks prior to evaluation. Clinical findings included severe blepharospasm, a bulbous swelling of the dorsotemporal bulbar conjunctiva, and phthisis bulbi. Ocular ultrasound was recommended but declined. Enucleation was elected for the blind, painful eye and was performed standing. Gross and histopathologic examinations of the globe were consistent with extrusion of the lens to the episcleral space, which is classified as a traumatic pha...
Borges IA, Reynolds MG, McCollum AM, Figueiredo PO, Ambrosio LLD, Vieira FN, Costa GB, Matos ACD, de Andrade Almeida VM, Ferreira PCP, Lobato ZIP....Since 1999 (VACV) outbreaks involving bovines and humans have been reported in Brazil; this zoonosis is known as Bovine Vaccinia (BV) and is mainly an occupational disease of milkers. It was only in 2008 (and then again in 2011 and 2014) however, that VACV was found causing natural infections in Brazilian equids. These reports involved only equids, no infected humans or bovines were identified, and the sources of infections remain unknown up to date. The peculiarities of Equine Vaccinia outbreaks (e.g., absence of human infection), the frequently shared environments, and fomites by equids and...
Ireland JL, McGowan CM.Pituitary pars intermedia dysfunction (PPID) is caused by an age-related degenerative disease of dopaminergic neurones. Despite its importance in equine practice, available information regarding its epidemiology is limited. This systematic review aimed to assess published literature to evaluate available evidence regarding the clinical presentation, prevalence and risk factors for PPID in horses and ponies. Electronic database searches were undertaken using a range of terms, and English language publications published prior to August 2016 were included. Both authors independently reviewed scre...
Limone LE, Baratt RM.This step-by-step article describes radiographic imaging of the horse's teeth and paranasal sinuses with standard radiographic equipment. Obtaining radiographs of the horse's skull that are of diagnostic quality can be challenging. The descriptions offered in this article can help practitioners become more comfortable with obtaining diagnostic images, which will improve recognition of radiographic signs of dental and paradental pathology.
Rabba S, Grulke S, Verwilghen D, Evrard L, Busoni V.Ultrasonography is routinely used to achieve the diagnosis of equine suspensory ligament desmopathy. In human medicine, power Doppler ultrasonography has also been found to be useful for the diagnosis of tendon/ligament injuries. The aim of this prospective, pilot study was to assess the presence or absence of power Doppler signal in suspensory ligament branches and compare B-mode findings with power Doppler findings in suspensory ligament branches of lame and non-lame limbs. Thirteen horses were used (eight lame horses, with lameness related to pain in the suspensory ligament branches, and fi...
Nottrott K, Guio C, Schramme M.We report an unusual case of a young Quarter Horse with a large dental fracture fragment displaced into the maxillary sinus, leaving an oroantral communication that caused food impaction and metaplastic calcification in the sinus and facial deformation with cutaneous fistulation. Oral extraction of a remaining tooth fragment from its alveolus was succeeded by a maxillary sinusotomy for removal of the abnormal sinus contents. Since the oroantral fistula did not heal spontaneously following the placement of a silicone dental prosthesis, minimally invasive transbuccal and transnasal endoscopic ap...
Roels K, Smits K, Ververs C, Govaere J, D'Herde K, Van Soom A.In horse breeding, intracytoplasmic sperm injection (ICSI) has gained interest to obtain offspring from subfertile individuals. This paper presents a case report of a stallion with severe testicular degeneration. Semen analysis showed very low motility and 83.5% of detached heads. Histology of a testicular biopsy showed severely decreased spermatogenesis, while transmission electron microscopy of the sperm cells revealed no significant abnormalities. A total of 39 oocytes were fertilized by ICSI with frozen-thawed spermatozoa of this stallion: 25 oocytes with intact spermatozoa and 24 with det...
Faramarzi B, Nguyen A, Dong F.Appropriate hoof preparation and symmetry are linked to the well-being of the horse. Previous studies have shown the efficacy of pressure plates (PPs) in delivering objective biomechanical analysis. We aimed to assess the effect of hoof trimming on hoof biomechanics using a PP. Nine clinically sound Arabian horses were walked across a PP while foot strike was recorded by a digital camera. Kinetic and kinematic parameters were recorded before and after trimming. Changes were considered significant when ＜ 0.05. Vertical force ( = 0.026) and contact pressure ( = 0.006) increased after trimming...
Jaqueth AL, Iwaniuk ME, Burk AO.It has been estimated in the United States and abroad that 20%-51% of the equine population suffers from over-conditioning or obesity. The objective of this study was to evaluate the prevalence of over-conditioning in the equine population in Maryland, to characterize weight control measures used, and to ascertain how control measures impact the operation. Over-conditioning was defined as a body condition score of 4 or 5 on a 5-point scale. All licensed horse operators in Maryland were invited to participate in an online survey. A total of 93 farm operators completed the survey with 238 ponies...
Gialletti R, Marchegiani A, Valeriani T, Nannarone S, Beccati F, Fruganti A, Laus F.To describe the association of clinical and ultrasonographic (US) findings in horses affected by visual impairments, to estimate the most frequent ultrasonographic alteration as well importance and limits of US as a part of ophthalmic evaluation in equine patients. Methods: One-hundred-forty-five horses referred to the Veterinary Teaching Hospitals of the University of Perugia and Camerino for ocular problems were submitted to ophthalmic examination and ocular ultrasound. The following group of abnormalities was established: corneal alteration, cataract, synechiae, iris prolapse, anterior cham...
Frisbie DD, McIlwraith CW.The field of equine veterinary practice is in an ever-evolving state, requiring current technologies to be constantly evaluated for new applications. The specific use of gene therapy in the horse is a novel application. The authors want to help familiarize the equine practitioner with the concept of gene therapy, and introduce its use and potential future benefits for the equine industry in the treatment of osteoarthritis.
Bender JB, Tsukayama DT.Infectious agents are insidious, often changing to adapt to host defenses or treatment advances. Because these challenges will continue, the need to apply standard and transmission-based precautions is important not only in the human hospital setting but in the veterinary clinic setting. In addition, to prevent human infection and potential liability, clinics need to establish program algorithms to prevent disease spread for specific agents or planned procedures to respond to potential nosocomial and zoonotic disease events. These need to be done proactively. Furthermore, more money needs to b...
Matthews S, Dart AJ, Reid SW, Dowling BA, Hodgson DR.To determine the predictive values, sensitivity and specificity of abdominal fluid variables associated with the need for surgery in horses with an acute abdominal crisis. Methods: Retrospective study. Methods: Two-hundred and thirty-six horses examined for signs of abdominal pain between January 1993 and June 1999. Methods: Breed, age and gender of the horse and colour, total protein concentration and total nucleated cell count of an abdominal fluid sample were recorded. Colour of the abdominal fluid was classified as normal if it was yellow and transparent. Turbid fluid or fluid that was ser...
Cherdchutham W, Becker CK, Spek ER, Voorhout WF, van Weeren PR.To determine the effects of exercise on collagen fibril diameter distribution in the superficial digital flexor tendon (SDFT) of foals. Methods: 43 Dutch Warmblood foals. Methods: From 1 week until 5 months of age, group-1 foals (n = 14) were housed in stalls and not exercised, group-2 foals (14) were housed in stalls but were exercised, and group-3 foals (15) were maintained at pasture. Biopsy specimens were collected from the SDFT at 2 months, and 8 foals in each group were euthanatized at 5 months. Remaining foals were housed together in a loose stall and paddock until euthanatized at 11 mo...
Gilger BC, Stoppini R, Wilkie DA, Clode AB, Pinto NH, Hempstead J, Gerding J, Salmon JH.To describe the use of episcleral silicone matrix cyclosporine (ESMC) drug delivery devices in horses with immune-mediated keratitis (IMMK) with evaluation of tolerability and efficacy in long-term control of inflammation. Methods: Retrospective study. ESMC implants (1.2 cm length, 30% wt/wt cyclosporine (CsA) in silicone; with approximately 2 μg/day steady-state release for at least 400 days) were used. Results: Nineteen horses (20 eyes) received two or more ESMC implants for superficial stromal (n = 9), midstromal (n = 3), or endothelial (n = 5) IMMK. Three additional horses received two or...
Roser JF, Meyers-Brown G.Advanced reproductive technologies have been developed to enhance fertility in mares and stallions. Some of these technologies in mares include superovulation, embryo transfer (ET), intracytoplasmic sperm injection (ICSI), oocyte transfer (OT), gamete intrafallopian transfer (GIFT), and cloning. Superovulation can provide multiple oocytes for these techniques. This review will focus on how recombinant equine follicle-stimulating hormone (reFSH) and recombinant equine luteinizing hormone (reLH) are important for superovulation and ET and may be useful for ICSI, OT, GIFT, and cloning. Superovula...
Scotty NC, Barrie KB, Brooks DE, Taylor D.A 7-year-old gray Mustang gelding weighing 454 kg was presented for evaluation of a brown mass within the left eye (OS) of 1 year's duration with recent enlargement. Results: A nonpainful, 8 mm diameter, brown, vascularized mass was identified in the anterior chamber of the OS. Ocular B-scan ultrasound confirmed iris involvement and corneal endothelial contact. Histopathology confirmed the presumptive diagnosis of a uveal melanocytic neoplasm, and revealed 1-3 mitotic figures per high power (400x) field. Results: The mass was removed via sector iridectomy without complications, but without com...
Fleming PR, Crompton JL, Simpson DA.The aim of this study was to highlight the neuro-ophthalmological dangers associated with horse riding, and working around horses, and the importance of wearing adequate headgear to protect the rider from neuro-ophthalmic injuries. It raises the questions of whether the current laws regarding helmet use are satisfactory, and whether helmets currently used are of an adequate standard. Methods: The records over a 20-year period of one neuro-ophthalmologist in Adelaide were reviewed producing 22 patients with neuro-ophthalmological sequelae of head injuries as a result of horse-related accidents....
Dalla Costa E, Dai F, Lecchi C, Ambrogi F, Lebelt D, Stucke D, Ravasio G, Ceciliani F, Minero M.Pain in horses is an emergent welfare concern, and its assessment represents a challenge for equine clinicians. This study aimed at improving pain assessment in horses through a convergent validation of existing tools: we investigated whether an effective analgesic treatment influences the horse grimace scale (HGS) and the concentration of specific circulating microRNAs (miRNAs). Eleven stallions underwent routine surgical castration under general anaesthesia. They were divided into two analgesic treatment groups: castration with the administration of preoperative flunixin and castration with ...
Hébert L, Polledo G, Lecouturier F, Giorgi M, Beck C, Lowenski S, Laroucau K, Büscher P, Hans A, Becù T.Northern Argentina hosts equine populations living under preserved natural areas and extensive breeding conditions, with limited access to veterinary care. Horses can be in contact with i) wildlife considered to be a potential reservoir of horse pathogens (e.g. capybara, coatis and pampas deer) and/or ii) potential disease vectors such as ticks, horse flies, Culicidae and vampire bats. In this context, the aim of this study was to assess the exposure of horses from a herd in northern Argentina to different vector-borne pathogens. Serum samples were collected from 20 horses on a farm in Chaco p...
Gerlach K, Ludewig E, Brehm W, Gerhards H, Delling U.A retrospective analysis of 619 upper and lower cheek teeth from 62 horses was performed. Based on clinical findings, as well as radiographic and magnetic resonance (MR) imaging findings, the teeth were classified into five groups. There were 20 teeth with abnormal MR imaging signals as well as clinical alterations and 599 healthy teeth. Using MR imaging, the appearance of pulp in diseased and disease-free teeth was compared, and the appearance of abnormal pulp was studied. Subsequently, the ability of MR imaging to diagnose pulpitis and pulp necrosis in teeth with normal external appearance w...
Widmer WR, Buckwalter KA, Hill MA, Fessler JF, Ivancevich S.We tested an adaptation of a technique for performing magnetic resonance (MR) imaging of human cadaver limbs in the horse. The forelimbs from a normal horse were collected, frozen, and sealed with a paraffin-polymer combination prior to imaging with either a high- or midfield magnetic resonance scanner. Each forelimb was defrosted, scanned, and refrozen on two separate occasions. A five-point scale was used to evaluate the quality of each set of sagittal and transverse, T1-weighted images of each digit. There was no difference in image quality between first and second scans of either specimen ...
Li C, White SH, Warren LK, Wohlgemuth SE.Aging is associated with decreased mitochondrial content and function in skeletal muscle, possibly due to compromised biogenesis and autophagic removal of dysfunctional mitochondria. The aim of this study was to compare markers of mitochondrial content and biogenesis and of autophagy between skeletal muscle from young and aged American Quarter Horses. Citrate synthase protein and mtDNA copy number were decreased in triceps brachii (TB) muscle (P<0.05) from aged horses, suggesting an age-related decline in mitochondrial content. Concomitantly, mRNA expression of PGC-1α and TFAM, regulators ...
Dukti S, White NA.Prognosticating survival in horses with colic is challenging because of the number of diseases and pathophysiologic processes that can cause the behavior. Although the treatment of horses with colic has improved dramatically over the years, case fatality can still be high because of the delay in recognizing the problem, the time delay inherent in receiving veterinary care, and the lack of effective treatment for the more severe diseases. Intensive case management and surgery for these horses may be expensive and emotionally draining for owners; therefore, providing an accurate prognosis is key...
Fischer AT.Recent advances in the use of abdominal ultrasound, endoscopy, laparoscopy, radiography, and peritoneal fluid analysis have contributed to the evaluation of horses with colic. Improved diagnostic capabilities allow earlier surgical intervention when necessary, and this should improve survival rates and the economic aspects of case management.
Wylie CE, Collins SN, Verheyen KL, Newton JR.Epidemiological studies into the risk factors for naturally-occurring equine laminitis are limited. There are a small number of such studies, although the results are inconsistent and remain disputed. The reasons for the conflicting results remain unclear. The aim of this review was to critically evaluate previous research in order to identify publications which provide the best evidence of risk factors for naturally-occurring equine laminitis. A systematic review of English language publications was conducted using MEDLINE (1950-2010), CAB Direct (1910-2010) and IVIS (1997-2010). Additional p...
Stromberg B.There appears to be an increasing incidence of osteochondrosis in young fast-growing horses in Europe and the USA. The disease is thought to be congenital in type and affects endochondral ossification in growing bones. It can be localised to one joint or may be a generalised condition. The clinical manifestations of the disease lead to a secondary chronic degenerative joint disease in adult animals. There is a genetic predisposition to the condition which is associated with rapid growth and excessive high energy feeding. The careful genetic selection of bloodstock and restricted intake in earl...
Anaya G, Moreno-Millán M, Bugno-Poniewierska M, Pawlina K, Membrillo A, Molina A, Demyda-Peyrás S.Horses are characterized as having a greater rate of chromosomal abnormalities than other species, which are mainly related to the sex chromosome pair and produce a series of different anomalies known as disorders in sexual development (DSD). In the present study, three Pura Raza Española (PRE) and one Menorquín (MEN) horses were studied and an incompatibility in their genetic and phenotypic sex were detected. Animals were karyotyped by conventional and molecular cytogenetic analyses and characterized using genomic techniques. Although all individuals, were totally unrelated, these animals h...
Medina-Torres CE, Mason SL, Floyd RV, Harris PA, Mobasheri A.The aim of this study was to determine if hypoxia and the hypoxia mimetic cobalt chloride regulate the activity of matrix metalloproteinase (MMP)-2 and -9 in cultures of equine hoof keratinocytes. These effects were assessed in primary cultures of laminar keratinocytes using gelatin zymography. Incubation of keratinocytes with cobalt chloride significantly increased the levels of active MMP-2 compared to untreated controls. Hypoxia significantly increased the expression of active MMP-2 and -9 in keratinocyte cultures. This up-regulation was observed after 6h and peaked at 24h. The study findin...
Begg AP, Reece RL, Hum S, Townsend W, Gordon A, Carrick J.Analysis of pathology results from the 2007 equine influenza (EI) outbreak in Australia indicate that young foals in naïve horse populations are prone to developing broncho-interstitial pneumonia, and that this can be a rare manifestation of EI virus infection in mature horses. All horses may develop secondary bacterial bronchopneumonia, with mature horses more likely to die. EI outbreaks among heavily pregnant mares can result in increased neonatal losses because of premature placental separation and dystocia causing fetal hypoxia.
Ewing PJ, Cowell RL, Tyler RD, MacAllister CG, Meinkoth JH.Pneumocystis carinii pneumonia was diagnosed in 3 foals. In 2 foals (No. 1 and 2), diagnosis was by histologic evaluation of pulmonary tissue. On retrospective evaluation, P carinii cysts were found on sediment smears of bronchoalveolar lavage fluid in 1 foal (No. 1). A different foal (No. 3) was diagnosed as having pneumocytosis by finding P carinii cysts in bronchoalveolar lavage fluid, and was treated successfully. Definitive diagnosis of pneumocytosis in animals is usually made at necropsy. However, careful cytologic evaluation in bronchoalveolar lavage fluid sediment can provide a diagnos...
Sullivan SL, Whittem T, Morley PS, Hinchcliff KW.Furosemide is the most commonly used medication for exercise-induced pulmonary haemorrhage (EIPH); however, critical evaluation of the strength of evidence for efficacy of furosemide is lacking and is warranted so that evidence-based treatment decisions can be made. Objective: To evaluate the efficacy of furosemide to reduce the severity or frequency of detection of EIPH in Thoroughbred and Standardbred racehorses. Methods: Systematic review with meta-analyses. Methods: Primary studies were identified via searches of electronic databases, relevant texts and reference lists of published article...
