Canine Pyothorax: Comparison of Culture and Susceptibility Results to the BSAVA PROTECT ME Poster and Other Published Recommended Antimicrobial Use Guidelines.

The most common bacterial isolates in dogs with pyothorax include mixed anaerobes, Enterobacteriaceae (especially Escherichia coli), Pasteurella spp., Streptococcus spp., and Staphylococcus spp. A fluoroquinolone with amoxicillin (±clavulanate) or a fluoroquinolone with clindamycin are the most commonly recommended empirical antimicrobials whilst pending bacterial culture of the pleural effusion. The aim of this study is to review and compare the pleural effusion culture and antimicrobial susceptibility results to the PROTECT ME poster and other published antimicrobial use guidelines. The medical records of 53 dogs diagnosed with pyothorax between 2014 and 2020 at two veterinary referral centres were reviewed. Information, including culture and susceptibility results, was assessed. Antimicrobial susceptibility panels varied; susceptibility to a particular antibiotic was calculated as a percentage of isolates tested against the same antibiotic. A total of 30 of 53 dogs (57.7%) had a positive pleural fluid culture. The most common isolates were Pasteurella species (23.3%), Escherichia coli (23.3%), and mixed anaerobes (20%). From the aerobic isolates, 73-83% were susceptible to a fluoroquinolone, 14/19 (74%) to amoxicillin, and 20/22 (91%) to potentiated amoxicillin. Resistance to clindamycin was documented in 9/13 (69%) aerobic isolates, with all Gram-negative bacteria (9/9) being resistant. The combination of potentiated amoxicillin with marbofloxacin would have been appropriate in most of the dogs (75-92.9%). This study shows a high rate of resistance to clindamycin, which is not a suitable option for monotherapy and may be less effective in combination therapy compared to potentiated amoxicillin.

Complications associated with and outcome of surgical intervention for treatment of esophageal foreign bodies in dogs.

OBJECTIVE: To identify complications associated with and short- and long-term outcomes of surgical intervention for treatment of esophageal foreign bodies (EFBs) in dogs. ANIMALS: 63 client-owned dogs. PROCEDURES: Patient records from 9 veterinary hospitals were reviewed to identify dogs that underwent surgery for removal of an EFB or treatment or an associated esophageal perforation between 2007 and 2019. Long-term follow-up data were obtained via a client questionnaire. RESULTS: 54 of the 63 (85.7%) dogs underwent surgery after an unsuccessful minimally invasive procedure or subsequent evidence of esophageal perforation was identified. Esophageal perforation was present at the time of surgery in 42 (66.7%) dogs. Most dogs underwent a left intercostal thoracotomy (37/63 [58.7%]). Intraoperative complications occurred in 18 (28.6%) dogs, and 28 (50%) dogs had a postoperative complication. Postoperative complications were minor in 14 of the 28 (50%) dogs. Dehiscence of the esophagotomy occurred in 3 dogs. Forty-seven (74.6%) dogs survived to discharge. Presence of esophageal perforation preoperatively, undergoing a thoracotomy, and whether a gastrostomy tube was placed were significantly associated with not surviving to discharge. Follow-up information was available for 38 of 47 dogs (80.9%; mean follow-up time, 46.5 months). Infrequent vomiting or regurgitation was reported by 5 of 20 (25%) owners, with 1 dog receiving medication. CLINICAL RELEVANCE: Results suggested that surgical management of EFBs can be associated with a high success rate. Surgery should be considered when an EFB cannot be removed safely with minimally invasive methods or esophageal perforation is present.

Nonsurgical reduction of prolapsed colocolic intussusception in 2 puppies.

OBJECTIVE: To describe the nonsurgical management of prolapsed colocolic intussusception in 2 puppies. CASE SUMMARY: Two 3-month-old male intact puppies (Pug and Labrador Retriever) developed intussusceptions that had prolapsed from the anus after they had suffered from tenesmus with soft feces or diarrhea. Reduction of the prolapsed tissue was performed and colocolic intussusception was diagnosed ultrasonographically in 1 dog. Rectal manipulation and saline enema were performed in both dogs, and reduction of the intussusception was confirmed endoscopically or ultrasonographically. Bupivacaine and prednisolone foam enemas were administered to reduce tenesmus. Abdominal ultrasonography the following day in 1 dog confirmed a normal appearing colon. No further tenesmus was noted in 1 dog; the other had a brief rectal prolapse after an episode of tenesmus that was manually reduced. Intussusception had not recurred 4 months and 1 year following manual reduction procedures. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report of successful nonsurgical management of colocolic intussusception in a companion animal. Nonsurgical management is a first-line treatment of intussusception in children and could be considered in dogs with colocolic intussusception. Further investigation is required to define specific aspects, including rectal manipulation, saline enema, or anesthesia, that aid in resolution of this type of intussusception.

Pubic fractures secondary to extended transpelvic urethrostomy in a cat.

OBJECTIVE: To report the occurrence and describe the management of pubic fractures after the use of an extended transpelvic urethrostomy (TPU) to treat postprostatic intrapelvic urethral obstruction and laceration in a cat. ANIMAL: One 6-year-old domestic short-haired cat. STUDY DESIGN: Case report. METHODS: A cat was presented with urethral obstruction and laceration confirmed by positive contrast retrograde urethrography. Temporary urinary diversion was performed. An attempt was made to perform perineal urethrostomy, but the cranial location of the laceration precluded this technique. An extended TPU was performed, which required removal of 30% to 60% greater length of pelvic bone than has been previously described. RESULTS: Bilateral pubic ramus fractures occurred 1 week after surgery, from which the cat clinically improved with cage rest, and exhibited evidence of healing according to computed tomography after 8 weeks. CONCLUSION: Extended TPU used to treat postprostatic intrapelvic urethral laceration may lead to pubic fractures postoperatively. CLINICAL SIGNIFICANCE: It may be prudent to rest any cat that has had a TPU or extended TPU to reduce fracture risk.

Education, employment and practice: Midwifery graduates in Papua New Guinea.

BACKGROUND: Papua New Guinea has a very high maternal mortality rate (773/100,000), low rates of supervised births and a critical shortage of skilled midwives. A midwifery education initiative commenced in 2012, funded by the Australian Government and led by the National Department of Health. One specific objective of the initiative was to improve the standard of clinical teaching and practice in four schools of midwifery. There were 394 midwives educated over the 4 year period (2012-2015) representing half of all midwives in Papua New Guinea. A study was undertaken to describe the educational programme, employment, practices and experiences of graduates who studied midwifery in 2012 and 2013 as part of the initiative. OBJECTIVE: the aim of this paper is to explore the education, employment and practice of newly graduated midwives in Papua New Guinea. DESIGN: a mixed methods descriptive study design was used. Surveys and focus groups were used to gather data. Ethical approval was granted by the relevant Human Research Ethics Committees. SETTING AND PARTICIPANTS: all midwifery graduates in 2012 and 2013 from the four midwifery schools in Papua New Guinea were included in the study and almost 80% were contacted. FINDINGS: nearly 90% of graduates were working as midwives, with an additional 3% working as midwifery or nursing educators. This study discovered that graduates exhibited increased skills acquisition and confidence, leadership in maternal and newborn care services and a marked improvement in the provision of respectful care to women. The graduates faced challenges to implement evidence based care with barriers including the lack of appropriate resources and differences of opinion with senior staff. CONCLUSIONS: factors affecting the quality of midwifery education will need to be addressed if Papua New Guinea is to continue to improve the status of maternal and newborn health. Specifically, the length of the midwifery education, the quality of clinical practice and the exposure to rural and remote area practice need addressing in many contexts like Papua New Guinea.

Maternal mortality in Australia: learning from maternal cardiac arrest.

Cardiac arrest in pregnancy is fortunately a rare event that few midwives will see during their career. The increase in maternal age, the Body Mass Index, cesarean sections, multiple pregnancies, and comorbidities over recent years have increased the probability of cardiac arrest. The early warning signs of impending maternal cardiac arrest are either absent or go unrecognized. Maternal mortality reviews highlight the deficiencies that maternity care providers have in managing cardiac arrest in pregnancy.The aim of this article is to address the knowledge deficiencies of health professionals by reviewing the physiological changes in pregnant women that complicate the management of cardiopulmonary resuscitation, using a case scenario. There are key differences in the management of pregnant women, when compared to standard adult resuscitation.The outcome is dependent on the speed of the response and the consideration of a number of crucial pregnancy-specific interventions. Staff members need to be adequately trained in order to deal with maternal cardiac arrest and have access to training packages and in-service education programs. As cardiac arrest in pregnancy is a rare event, emergency drill simulations are an important component of ongoing education.

In vitro comparison of mechanical and degradation properties of equivalent absorbable suture materials from two different manufacturers.

OBJECTIVE: To compare the mechanical, knotting, and absorption properties of 3 synthetic absorbable suture materials (polyglactin 910, polydioxanone, poliglecaprone 25) from 2 different manufacturers (Huaiyin Medical Instruments Co. Ltd. and Ethicon Inc.). SAMPLE POPULATION: Suture material samples from the same manufacturing lot for each suture type and manufacturer. METHODS: Part 1: 10 samples of each suture were incubated in bovine serum and tested for ultimate load and stiffness at days 0, 1, 7, 14, 21, and 28. Part 2: 10 knotted samples were similarly evaluated, without incubation. RESULTS: Huaiyin polydioxanone had a greater (P<.001) ultimate load on days 0, 1, and 7; and a consistently greater stiffness for the duration of the study, compared with the Ethicon polydioxanone. Ethicon poliglecaprone 25 had a greater ultimate load on days 0, 1, 7 (P<.001); on day 21 Huaiyin had a greater ultimate load. Ethicon poliglecaprone had greater stiffness on days 0, 1, 7 (P<.001). Ethicon polyglactin 910 had a greater (P<.001) ultimate load at all times and a greater stiffness (P<.001) at days 0, 1, 7, and 14 compared with Huaiyin polyglactin 910. Huaiyin polydioxanone and polyglactin 910 had greater knot breaking strengths than Ethicon equivalents (P<.001). CONCLUSION: Differences in mechanical properties exist between nominally identical suture materials from different manufacturers.

Uterine horn torsion in a non-gravid cat.

An 11-year-old female domestic shorthair cat with a previous history of having been spayed, presented with signs of abdominal distension, lethargy and anorexia of 1 week's duration. On the basis of radiological and ultrasonographic findings a tentative diagnosis of pyometra was made. Exploratory coeliotomy revealed a 900 degrees left horn uterine torsion along the longitudinal axis. Ovariohysterectomy was performed without correction of the torsion. To the authors' knowledge this is the first case report of uterine torsion in a non-gravid cat.

Regional load bearing of the canine acetabulum.

OBJECTIVE: To determine the load bearing areas of the canine acetabulum. MATERIALS AND METHODS: A kinematic study of four healthy dogs was used to determine the orientation of the femur to the pelvis at mid-stance. Femora and pelves from 10 canine cadavers were loaded with the physiological canine hip reaction force and angle being replicated. Impression material placed within the acetabulum was extruded from areas of load bearing. Digital images before and after loading were used to assess if six different regions of the acetabulum were fully, partially or non-load bearing. RESULTS: All areas of the acetabulum were partially or fully load bearing. The cranial and caudal thirds of the acetabulum were 7.9 and 13.1 times more likely to be fully load bearing than the central third, respectively. There was a significant difference in load bearing between the axial, middle and abaxial thirds of the acetabulum in all tests, with the middle and abaxial thirds 72.4 and 351 times more likely to be fully load bearing than the axial third, respectively. CONCLUSION: The cranial and caudal thirds and the middle and abaxial thirds of the canine acetabulum are fully load bearing. CLINICAL RELEVANCE: The caudal third of the canine acetabulum is loaded and therefore recommendations that fractures in this area be managed conservatively need to be reconsidered.