Medial compartment disease in a young Large Munsterlander

Medial compartment disease (MCD) is a recently recognized elbow disorder in dogs and refers to extensive cartilage erosions of the medial compartment of the elbow joint. This report describes a case of MCD in a 10-month-old Large Munsterlander that was presented with right frontleg lameness. Based on signalement, history and radiographic examination, there was a strong suspicion of a fragmented coronoid process (FCP) of the right elbow. However, arthroscopic examination revealed extensive cartilage erosions of the medial part of the humeral condyle and the medial coronoid process in addition to a small coronoid fragment (FCP) and a small OCD-like lesion. After the arthroscopic treatment, the dog did not improve. Neither did additional treatment with autologous conditioned plasma (Arthrex ACP (R)) lead to a substantial improvement. Finally, the dog was euthanized because of persistent lameness

Spectrum of arthroscopic findings in 84 canine elbow joints diagnosed with medial compartment erosion

Elbow dysplasia is an important cause of forelimb lameness in large breed dogs. The aim of this study was to report on the arthroscopic findings associated with medial compartment erosion (MCE) of the canine elbow joint. Retrospectively, records of 84 elbow joints from 66 dogs diagnosed arthroscopically with MCE were retrieved from a medical records database (2008 - 2012). The radiographic degree of osteoarthritis was determined. Arthroscopic images and videos were evaluated in detail. In nine joints (10.7%), MCE was the only pathological finding (= group 1). Group 2 (n = 50, 59.5%) consisted of elbows with MCE concomitant with medial coronoid process (MCP) pathology. In group 3 (n = 25 joints, 29.8%), MCE was diagnosed during a second-look arthroscopy in dogs presented with lameness after arthroscopic treatment for medial coronoid disease. There was a significant age difference (p < 0.001) between the groups, with dogs in group 1 being the oldest. Complete erosion of the medial compartment was most commonly found in group 1, whereas focal cartilage erosion was mostly identified in group 2. Overall, additional cartilage pathology of the lateral part of the humeral condyle and/or the radial head was recognized in 58.3% of the joints (49/84)

Meniscusletsels bij de hond

Meniscal injuries in the dog are nearly always seen in combination with a cranial cruciate ligament rupture. The medial meniscus is, by far, most commonly affected. Clinical signs indicative for a meniscal tear are severe lameness or a sudden increase of lameness in dogs with a cranial cruciate rupture. Persistent or recurrent lameness after cranial cruciate surgery can equally be caused by a meniscal teat Different imaging techniques can demonstrate a meniscal lesion, or also arthroscopic or direct inspection via arthrotomy may show the lesion. There are several surgical treatment options

Développement d’un cours francophone en ligne sur les politiques publiques en santé : une collaboration internationale

Objectif : Présenter le processus et les défis du développement d’un cours en ligne sur les politiques publiques en santé, conçu en collaboration internationale selon une approche par compétences. Méthodes : Cinq experts de santé publique épaulés d’un expert en technologie éducative onttravaillé à l’élaboration du cours en adoptant une démarche rigoureuse : analyse des besoins, élaboration des cibles et des compétences visées, développement d’un scénario pédagogique comportant pour chaque module la cible visée, les éléments de contenu, la méthode d’enseignement, les activités d’apprentissage, le matériel à identifier ou à développer et les responsabilités et tâches impliquées. Résultats : Le cours d’études supérieures de deux crédits (90 heures de travail) comprend six modules dont un module d’intégration. Les modules débutent pardes étudesde cas variées : loi sur le tabac (paquet neutre), sites d’injection supervisée, logement, réseaux intégrés de services pour personnes âgées en perte d’autonomie, programme de prévention pour les futures mères en milieux défavorisés, port obligatoire du casque de vélo. Les modules 1, 3, 4 et 5 visent l’apprentissage des différentes étapes du développement des politiques publiques : émergence, formulation et adoption, mise en œuvre et évaluation. Le module 2 porte sur l’importance des valeurs et des idéologies dans les politiques publiques. Le module d’intégration permet aux étudiants d’appliquer les connaissances acquises et aborde le rôle des expertsdans lespolitiquespubliques etles considérations éthiques. Conclusion : Le cours est intégré aux programmes d’études supérieures des universités participantes et permet à des étudiants de suivre à distance une formation innovante.Objective: To present the process and challenges of developing an online competency-based course on public health policy using a collaborative international approach. methods: Five public health experts, supported by an expert in educational technology, adopted a rigorous approach to the development of the course: a needs analysis, identification of objectives and competencies, development of a pedagogical scenario for each module and target, choice of teaching methods and learning activities, materialto be identified or developed, and the responsibilities and tasks involved. results: The 2-credit (90-hour) graduate course consists of six modules including an integration module. The modules start with a variety of case studies: tobacco law (neutral packaging), supervised injection sites, housing, integrated servicesfor the frail elderly, a prevention programme for mothersfrom disadvantaged backgrounds, and the obligatory use of bicycle helmets. In modules 1, 3, 4 and 5, students learn about different stages of the public policy development process: emergence, formulation and adoption, implementation and evaluation. Module 2 focuses on the importance of values and ideologies in public policy. The integration module allows the students to apply the knowledge learned and addresses the role of experts in public policy and ethical considerations. Conclusion: The course has been integrated into the graduate programmes of the participating universities and allows students to follow, at a distance, an innovative training programme

Simplified antibiotic regimens for treating neonates and young infants with severe infections in the Democratic Republic of Congo: a comparative efficacy trial

Abstract Background One-quarter of neonatal and infant deaths are due to infection, and the majority of these deaths occur in developing countries. Standard treatment for infection, which includes parenteral treatment only, is often not available in low-resource settings. Infant mortality will not be reduced in developing countries without a reduction in deaths due to infection. We participated in a multi-site trial that demonstrated the effectiveness of three simplified antibiotic regimens compared to standard treatment (The AFRINEST Trial: parent study). For this report, we examined the site-specific data for the Democratic Republic Congo (DRC), the most impoverished of the countries that participated in the study, to determine if outcomes in the DRC were similar to outcomes across all sites. Methods The parent study was an individually randomized, open-label, equivalence trial. Infants with clinical signs of severe infection were randomized to receive one of four regimens: 1) injectable penicillin-gentamicin for 7 days (standard therapy; regimen A), 2) injectable gentamicin and oral amoxicillin for 7 days (regimen B), 3) injectable penicillin-gentamicin for 2 days then oral amoxicillin for 5 days (regimen C), or 4) injectable gentamicin for 2 days and oral amoxicillin for 5 days (regimen D). In the DRC, we enrolled 574 infants, of whom 560 met the per-protocol criteria for analysis of treatment effect. The main outcome was treatment failure within the first week of enrollment. Results Treatment failure occurred in 52 (9.3%) infants: 17 (11.6%) with the referent treatment regimen, 13 (9.6%) with regimen B (risk difference [RD] -2.0%; CI -9.2% to 5.2%), 13 (9.0%) with regimen C (RD -2.6%; CI -9.6% to 4.4%), and 9 (6.7%) with regimen D (RD -5.0%; CI -11.7% to 1.7%). Conclusion As in the parent study, the risk difference between each of the experimental treatments and the reference treatment suggests equivalence. These findings suggest that the conclusion from the parent study, that a simplified antibiotic regimen can be used for the community-based management of possible severe infection in young infants where referral to a hospital for standard care is often not possible, is true in the DRC. We speculate that the widespread use of a simplified, community-based treatment could result in increased coverage with treatment and improved survival in poor areas. Trial registration ACTRN12610000286044 on April 9, 2010

Hip problems in small breed dogs = Heupproblemen bij kleine hondenrassen

Whenever a discussion arises regarding canine hip problems, many veterinarians will automatically conclude that it's hip dysplasia they are dealing with, often followed by the statement that mostly large breed dogs suffer from this condition. In the literature, this statement is largely confirmed; however, canine hip problems include more than the typical dysplastic joint in large to giant breed dogs. In this paper, the other "usual suspects" are discussed, particularly in small breed dogs. The focus lies on the pelvic anatomy, the possible diagnoses and the treatment options, both conservatively and surgically

Simplified antibiotic regimens for young infants with possible serious bacterial infection when the referral is not feasible in the Democratic Republic of the Congo

Introduction Neonates with serious bacterial infections should be treated with injectable antibiotics after hospitalization, which may not be feasible in many low resource settings. In 2015, the World Health Organization (WHO) launched a guideline for the management of young infants (0–59 days old) with possible serious bacterial infection (PSBI) when referral for hospital treatment is not feasible. We evaluated the feasibility of the WHO guideline implementation in the Democratic Republic of the Congo (DRC) to achieve high coverage of PSBI treatment. Methods From April 2016 to March 2017, in a longitudinal, descriptive, mixed methods implementation research study, we implemented WHO PSBI guideline for sick young infants (0–59 dyas of age) in the public health programme setting in five health areas of North and South Ubangi Provinces with an overall population of about 60,000. We conducted policy dialogue with national and sub-national level government planners, decision-makers, academics and other stakeholders. We established a Technical Support Unit to provide implementation support. We built the capacity of health workers and managers and ensured the availability of necessary medicines and commodities. We followed infants with PSBI signs up to 14 days. The research team systematically collected data on adherence to treatment and outcomes. Results We identified 3050 live births and 285 (9.3%) young infants with signs of PSBI in the study area, of whom 256 were treated. Published data have reported 10% PSBI incidence rate in young infants. Therefore, the estimated coverage of treatment was 83.9% (256/305). Another 426 from outside the study catchment area were also identified with PSBI signs by the nurses of a health centre within the study area. Thus, a total of 711 young infants with PSBI were identified, 285 (40%) 7–59 days old infants had fast breathing (pneumonia), 141 (20%) 0–6 days old had fast breathing (severe pneumonia), 233 (33%) had signs of clinical severe infection (CSI), and 52 (7%) had signs of critical illness. Referral to a hospital was advised to 426 (60%) infants with CSI, critical illness or severe pneumonia. The referral was refused by 282 families who accepted simplified antibiotic treatment on an outpatient basis at the health centres. Treatment failure among those who received outpatient treatment occurred in 10/128 (8%) with severe pneumonia, 25/147 (17%) with CSI, including one death, and 2/7 (29%) young infants with a critical illness. Among 285 infants with pneumonia, 257 (90%) received oral amoxicillin treatment, and 8 (3%) failed treatment. Adherence to outpatient treatment was 98% to 100% for various PSBI sub-categories. Among 144 infants treated in a hospital, 8% (1/13) with severe pneumonia, 23% (20/86) with CSI and 40% (18/45) with critical illness died. Conclusion Implementation of the WHO PSBI guideline when a referral was not possible was feasible in our context with high coverage. Without financial and technical input to strengthen the health system at all levels, including the community and the referral level, it may not be possible to achieve and sustain the same high treatment coverage

Analysis of adequacy levels for human resources improvement within primary health care framework in Africa

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels looking into the following aspects: - adequacy between skills-based profiles for health system professionals, quality of care and service delivery (health care system /medical standards), needs and expectations from the populations, - adequacy between allocation of health system professionals, quality of care and services delivered (health care system /medical standards), needs and expectations from the populations, - adequacy between human resource management within health care system and medical standards, - adequacy between human resource management within education/teaching/training and needs from health care system and education sectors, - adequacy between basic and on-going education and realities of tasks expected and implemented by different categories of professionals within the health care system body, - adequacy between intentions for initial and on-going trainings and teaching programs in health sciences for trainers (teachers/supervisors/health care system professionals/ directors (teaching managers) of schools...). This tool is necessary for decision-makers as well as for health care system professionals who share common objectives for changes at each level of intervention within the health system. Setting this adequacy implies interdisciplinary and participative approaches for concerned actors in order to provide an overall vision of a more broaden system than health district, small island with self-rationality, and in which they operate