Analyse van de arbeidssituatie en perceptie van de kwaliteit van de opleiding van dierenartsen afgestudeerd aan de Faculteit Diergeneeskunde van de Universiteit Gent

By means of a survey, the authors attempted to determine the work situation of graduated veterinary students and the perception of the quality of education at the Ghent University. Three veterinarian cohorts were contacted who graduated at different time intervals: between 2002 and 2004, 2009 and 2011 and between 2014 and 2016. Out of 488 completed surveys (47% of the contacted respondents), it became apparent that veterinarians in Flanders work on average 47 hours per week and are relatively happy about their day-to-day tasks. Eighty percent (most recently graduated group) and 68% (longest graduated group) of the respondents work as a veterinary practitioner and 81% of these practitioners work in a group practice. Veterinarians with Belgian nationality are mostly self-employed, while most Dutch veterinarians work on the payroll of someone else. The results of the survey show that the respondents are happy with the theoretic part of the veterinary study, but believe that there is not enough focus on the practicing part, which is too limited. According to the respondents, veterinary training should be more focused on first-line veterinary medicine, on the developing of communication skills with clients and colleagues and on business management

A subcutaneous infection mimicking necrotizing fasciitis due to Butyricimonas virosa

Introduction: Butyricimonas virosa is a Gram-negative rod who was first identified in rat faces in 2009. Since then only six human infections have been described in literature of which five bacteremia and one bone abscess. We report a clinical case of a subcutaneous infection mimicking necrotizing fasciitis due to B. virosa. Patient and methods: A 78-year-old man was referred to our hospital because of a wound infection at the surgical site with suspicion of necrotizing fasciitis. Treatment consisted of immediate surgical exploration with obtainment of intra-operative specimens for microbiologic examination, 15 d of negative pressure wound therapy (NPWT) and antibiotic treatment with piperacillin-tazobactam (12 d) plus vancomycin (9 d). Results: Surgical exploration did not show necrotising fasciitis but a subcutaneous infection mimicking necrotising fasciitis. The results of the intra-operative specimens revealed the presence of B.virosa and Finegoldia magna. Cultures taken during the NPWT replacements became negative and the patient was able to leave the hospital after 18 d. Conclusions: Considering there was no necrotizing infection present it may have been possible to safely close the wound sooner. However, it is difficult to differentiate between an actual necrotizing fasciitis and a subcutaneous infection mimicking necrotizing fasciitis. Therefore further studies on effective assessment tools to diagnose necrotizing fasciitis, such as the (modified) laboratory risk indicator for necrotizing fasciitis (LRINEC) score and enhanced computed tomography (CT), could be helpful

Emerging evidence for CHFR as a cancer biomarker : from tumor biology to precision medicine

Novel insights in the biology of cancer have switched the paradigm of a "one-size-fits-all" cancer treatment to an individualized biology-driven treatment approach. In recent years, a diversity of biomarkers and targeted therapies has been discovered. Although these examples accentuate the promise of personalized cancer treatment, for most cancers and cancer subgroups no biomarkers and effective targeted therapy are available. The great majority of patients still receive unselected standard therapies with no use of their individual molecular characteristics. Better knowledge about the underlying tumor biology will lead the way toward personalized cancer treatment. In this review, we summarize the evidence for a promising cancer biomarker: checkpoint with forkhead and ring finger domains (CHFR). CHFR is a mitotic checkpoint and tumor suppressor gene, which is inactivated in a diverse group of solid malignancies, mostly by promoter CpG island methylation. CHFR inactivation has shown to be an indicator of poor prognosis and sensitivity to taxane-based chemotherapy. Here we summarize the current knowledge of altered CHFR expression in cancer, the impact on tumor biology and implications for personalized cancer treatment

Early Initiation of a Standardized Open Abdomen Treatment With Vacuum Assisted Mesh-Mediated Fascial Traction Achieves Best Results

Background: The open abdomen (OA) is an important approach for managing intra-abdominal catastrophes and continues to be the standard of care. Complete fascial closure is an essential treatment objective and can be achieved by the use of different dynamic closure techniques. Both surgical technique and-decision making are essential for optimal patient outcome in terms of fascial closure. The aim of this study was to analyse patients' outcome after the use of mesh-mediated fascial traction (MMFT) associated with negative pressure wound therapy (NPWT) and identify important factors that negatively influenced final fascial closure. Methods: A single center ambispective analysis was performed including all patients treated for an open abdomen in a tertiary referral center from 3/2011 till 2/2020. All patients with a minimum survival >24 h after initiation of treatment were analyzed. The data concerning patient management was collected and entered into the Open Abdomen Route of the European Hernia Society (EHS). Patient basic characteristics considering OA indication, primary fascial closure, as well as important features in surgical technique including time after index procedure to start mesh mediated fascial traction, surgical closure techniques and patients' long-term outcomes were analyzed. Results: Data were obtained from 152 patients who underwent open abdomen therapy (OAT) in a single center study. Indications for OAT as per-protocol analysis were sepsis (33.3%), abdominal compartment syndrome (31.6%), followed by peritonitis (24.2%), abdominal trauma (8.3%) and burst abdomen (2.4%). Overall fascial closure rate was 80% as in the per-protocol analysis. When patients that started OA management with MMFT and NPWT from the initial surgery a significantly better fascial closure rate was achieved compared to patients that started 3 or more days later (p < 0.001). An incisional hernia developed in 35.8% of patients alive with a median follow-up of 49 months (range 6-96 months). Conclusion: Our main findings emphasize the importance of a standardized treatment plan, initiated early on during management of the OA. The use of vacuum assisted closure in combination with MMFT showed high rates of fascial closure. Absence of initial intraperitoneal NPWT as well as delayed start of MMFT were risk factors for non-fascial closure. Initiation of OA with VACM should not be unnecessary delayed

Dogs and their owners have frequent and intensive contact

Contact and interactions between owners and their pets may have beneficial physical and social effects on people, but may also facilitate the transmission of zoonotic agents and resistant bacteria. To estimate the risk of these contacts, more information regarding the frequency and intensity of this physical contact is required. Therefore, an online survey was conducted among pet owners resulting in 701 completed questionnaires. Questions regarding the interactions between dogs and owners were linked with a score from 1 (limited interactions) to 3 (highly intense interactions). After scoring these self-reported interactions, a contact intensity score was calculated for each respondent by summing up the different allocated scores from all questions. This contact intensity score was used to identify predictors of more intense contact based on a multivariable linear regression model. Interactions between dogs and their owners were widespread (e.g., 85.3% of the dogs licked their owner's hand) and intense (e.g., 49.3% of owners reported being licked in the face). The gender, age, and place of residence (city, village, or countryside) of the respondent, together with the size and age of the dog, were significantly associated with the contact intensity score in the multivariable model. On average, female respondents younger than 65 years who lived in the city and had a small young dog had the most intense contact with it. Further research is necessary to evaluate the risk of these interactions in light of zoonotic and antimicrobial resistance transfer

Testiculaire aandoening van seksuele differentiatie (78,XX SRY-negatief) bij een vrouwelijke Franse buldog

A presumably female intact French bulldog of ten months old was presented to the Faculty of Veterinary Medicine of the Ghent University with an enlarged clitoris and purulent vaginal discharge. It was suggested to remove the enlarged clitoris as to avoid further irritation and to perform a gonadectomy at the same time, since the owners were not planning to breed with the dog. An abnormal reproductive tract was observed during surgery. A normal uterus was present, but both gonads resembled testes. Histologic examination of the resected tissues confirmed the presence of bilateral testes in combination with a normal uterus. Karyotyping and molecular analysis of the SRY-gene resulted in a 78,XX SRY-negative karyotype. The French bulldog was diagnosed with a 78,XX SRY-negative testicular disorder of sex development (DSD)

Evaluation of an enhanced recovery program for outcome improvement after pancreaticoduodenectomy : a retrospective cohort study

Background: The introduction of the Enhanced Recovery After Surgery (ERAS) protocol after pancreaticoduodenectomy (PD) has led to a reduction in hospital stay (LOS) without compromising surgical outcome. The primary endpoint of this study is to evaluate the adherence to postoperative targets of the ERAS protocol, and to describe short-term surgical outcomes. The secondary endpoints are 30-day readmission rate, reoperation rate and mortality. Materials and methods: This single centre retrospective analysis reviews all data of patients who underwent a PD in our tertiary referral hospital between August 2016 and December 2019. A total of 170 patients were operated of whom 154 patients were enrolled in the ERAS protocol. As per ERAS protocol, epidural analgesia was stopped on postoperative day (POD) 2, nasogastric tube (NGT) removed on POD3, regular food tolerated by POD5. Drains were removed on POD2 and POD3, the soft drain along the pancreatic anastomosis between POD3-10. Results: Epidural analgesia was removed on POD2 in 26 patients (17.7%), NGT removed on POD3 in 74 patients (49.0%), regular food tolerated by POD5 in 52 patients (34.9%). The lateral drain was removed in 81 patients (52.9%) on POD2, the medial drain in 39 patients (26.2%) on POD3, the soft drain in 95 patients (61.7%) between POD3 and 10. Nine patients (5.8%) had post-pancreatectomy haemorrhage (PPH), 14 (9.1%) postoperative pancreatic fistula grade B or C (POPF), 5 (3.3%) bile leakage, and 44 (28.6%) delayed gastric emptying (DGE). The 30-day readmission rate was 8.4%, reoperation rate 10.4%, and the in-hospital mortality 1.3%. Conclusions: The adherence to targets of the ERAS protocol was found to be rather low. Biliary leakage, POPF, DGE, and PPH all led to an adapted ERAS protocol with prolonged LOS. Most complications were detected along the ERAS pathway, indicating that also patients at high risk for complications can be safely included in the ERAS protocol. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of Surgical Associates Ltd

Voorkomen van resistentie tegen de ‘meest kritisch belangrijke antimicrobiële geneesmiddelen’ bij Escherichia coli-isolaten van hond en kat

A descriptive retrospective analysis of 811 antibiograms in dogs and cats was carried out in order to get a better insight into the prevalence of antimicrobial resistance against 'critically important antimicrobials with highest priority for human medicine' in dogs and cats. A veterinary diagnostic laboratory performed antimicrobial susceptibility testing on 811 Escherichia coli isolates obtained from veterinary clinical samples from dogs and cats in Flanders, Belgium. These isolates were mainly from fecal ( 62.5%) or urogenital (30.5%) origin. A disk diffusion method with breakpoints provided by the supplier of the antibiotic disks was used for antimicrobial susceptibility testing. The results indicated that 9.5% of the Escherichia coli isolates were resistant against or intermediate susceptible to marbo-floxacine, 16.7% to enrofloxacine and 15.7% to cefovecin. The unexpected difference in resistance between marbofloxacine and enrofloxacin may be, at least partially, explained by the different clinical breakpoints used to interpret the results of sensitivity tests for dog and cat isolates in both agents. The observed resistance in this study might be related to the regular use of fluoroquinolones and third generation cephalosporins. Therefore, the use of 'critically important antimicrobials with highest priority for human medicine' remains an important issue in small animal veterinary medicine

Emission limit values for building materials. Environmental foundation and consequences for building materials

This report presents alternative emission limit values for inorganic components to be used in the revision of the Building Materials Decree (1999) in the Netherlands. Three key factors determine the emission limit value: (1) the environmental compartment under consideration, with its dimensions and the accounted for, (2) the desired level of environmental protection and (3) the scenario applying to the intended use of the construction material. Emission limit values have been derived here from modelled concentrations in soil, groundwater and surface water. The desired level of protection has been elaborated as a stand-still approach (based on quality target values and a risk-based approach (based on PNECs). Two exposure models were used for taking the effects of a time-dependent exposure of the soil to leached components into account, for vertical transport through the soil profile and for retardation of components in the soil profile. The PEARL model was used for binding described by equilibrium adsorption. The ORCHESTRA model was used for binding that also takes speciation into account. For surface water, a dilution factor was computed assuming a certain mixing zone, dependent on the size of the surface water. The consequences of the proposed alternative emission limit values have been estimated on the basis of information in a database containing results of leaching tests for construction materials. The alternatives proposed form the basis for a political decision-making process, where environmental protection will be balanced with other socio-economic concerns.In dit rapport worden varianten berekend die de huidige normen voor het hergebruik van bouwmaterialen - zoals vastgelegd in het Bouwstoffenbesluit 1999 - kunnen vervangen. De huidige normen vormden een belemmering voor het hergebruik van bouwmaterialen. Omdat er wel behoefte bestond aan hergebruik, zijn de mogelijkheden tot een eventuele verruiming, die wel milieuverantwoord blijft, onderzocht. Het bouwstoffenbesluit bevat normen voor de maximale uitstoot van anorganische stoffen (zoals metalen) in bouwmaterialen. Milieuhygienische belangen worden nu afgewogen tegen de wens tot ruimere mogelijkheden voor hergebruik. Het onderzoek houdt rekening met verschillende elementen bij het hergebruik van bouwmaterialen: het milieucompartiment, het gewenste beschermingsniveau en het toepassingsscenario van de bouwstof. Er zijn twee alternatieve computermodellen gebruikt, die de verschillen in de wijzen waarop vrijgekomen stoffen zich aan de bodem binden, berekenen. Daarnaast is ook de menging van vrijgekomen stoffen voor oppervlaktewater berekend. De berekende waarden zijn afgezet tegen de kwaliteitsgegevens van bouwstoffen die door verschillende bedrijfstakken zijn aangeleverd. De voorgestelde varianten maken onderdeel uit van een beleidsmatig besluitvormingsproces, waarbij ook andere socio-economische aspecten worden afgewogen

The impact of antimicrobial use guidelines on prescription habits in fourteen Flemish small animal practices

A prospective study was performed to explore the prescription habits in fourteen first-line, small animal practices during first consultations of cats and dogs. Consultations one month prior to the implementation of antimicrobial use guidelines and at least 20 days thereafter were examined. Differences in the proportion of consultations during which antimicrobials were prescribed, were assessed. Additionally, changes in the choice of active substance were critically evaluated against the introduced antimicrobial use guidelines. The proportion of consultations where antimicrobials were prescribed decreased in cats and dogs (both -12%) after the introduction of the antimicrobial use guidelines. There was an increase of consultations of cats (+13%) and dogs (+10%) where veterinarians handled according to those guidelines. However, an increase in the prescription of third-choice antimicrobials and highest priority critically important antimicrobials was noticed both in cats (+8% and +12%, respectively) and dogs (both +5%). This unexpected increase invites to create extra awareness amongst prescribers