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Objective To evaluate bacterial isolates, antimicrobial drug susceptibility, and change in resistance among pre- and post-lavage culture samples in dogs with septic peritonitis. Design Prospective observational study. Setting Private practice referral hospital. Animals Forty client-owned dogs with confirmed septic peritonitis requiring surgical intervention. Interventions All dogs had perioperative abdominal lavage following source control with 200 to 300 mL/kg 0.9% sterile saline. Pre- and post-lavage aerobic and anaerobic culture samples were evaluated. Measurements and main results Thirty-five of 40 dogs (87.5%) survived to hospital discharge. The likelihood of an aerobic organism to have multidrug resistance (resistance to 3 or more antimicrobial classes) post-lavage was a third of that pre-lavage (odds ratio [OR] 0.34, 95% CI [0.17-0.68], P = 0.01). Thirty-nine of 40 dogs (97.5%) received appropriate empiric antimicrobial therapy based on pre- and post-lavage culture results, of which 5 (12.8%) did not survive to discharge. The single dog with inappropriate antimicrobial therapy survived to discharge. The most frequent isolates detected included Escherichia coli, Clostridium perfringens, and Enterococcus faecalis. The same organism based on species was isolated in pre- and post-lavage cultures in 32 dogs, accounting for 59 anaerobic and aerobic isolates. There was a new bacterial isolate detected in 20 dogs, accounting for 46 isolates and an overall total decrease of 14 isolates between pre- and post-lavage culture (P = 0.09). Conclusions This study suggests that there is a significant decrease in the likelihood of isolating a multidrug resistant organism following peritoneal lavage, and aerobic and anaerobic culture results have the potential to change following peritoneal lavage, although this cannot be confirmed without further studies. Overall survival rates were higher than previously reported in the literature for septic peritonitis.

A healthy woman presented with an antepartum haemorrhage at 35/40 during a low-risk pregnancy with normal antenatal bloods and anomaly scan at 20/40 gestation. Following an abnormal ultrasound (USS), the baby was delivered by emergency C-section. A male infant was born in good condition but admitted to the neonatal unit for monitoring. Examination revealed global hypotonia, a weak uncoordinated suck and absent Moro reflex. He had widened sagittal sutures and a large posterior fontanelle. The remainder of the examination was unremarkable. Abnormal bloods are shown in table 1. View this table: Table 1 Initial newborn blood results He was treated for suspected sepsis due to jaundice and temperature instability. Cranial USS was performed immediately (figure 1). Urgent MRI of the brain further characterised these abnormalities (figures 2–3). Figure 1 Coronal section of cranial ultrasound obtained on day 1 of life. Figure 2 Coronal section from MRI …

The University of Wisconsin-Madison Pediatric Pulmonary Center (UW PPC) provides interdisciplinary leadership training for graduate students and postgraduate professionals. The training includes a three-credit on-line course entitled Interdisciplinary Care of Children with Special Health Care Needs. This paper describes the course, the content and organization of which was guided by the life course perspective (LCP). The UW PPC team used the LCP to guide course organization, content development, and evaluation approaches. UW PPC trainees took responsibility for content areas, performed literature reviews and reviews of resources, and suggested student activities. Course content was focused on the child with special health care needs (CSHCN) embedded in contextual environments of family, community, culture, and larger social and public policy arenas. The content included three case-study videos that followed a child with cystic fibrosis from birth to age 18. Key concepts of the LCP were woven in throughout the videos and other course materials. Emphasis was on representing development of the individual during critical/sensitive periods and on social determinants of health. At semester's end, qualitative and quantitative student evaluation results were very positive for all areas of the course. The final course paper, organized similarly to course modules, synthesized all aspects of the course. A successful paper included LCP concepts woven throughout to show integration of course content. The LCP provided a useful framework for course organization and content, and served as a lens through which students came to understand the care needs of CSHCN and their families. A course such as this can serve the important goal of educating future maternal child health professionals in using the LCP to understand how multiple determinants of health interact across the life span to produce health outcomes in this population.

This study evaluated the inclusion of butorphanol to an acepromazine maleate (ACP) premedication in 20 healthy bitches undergoing elective ovariohysterectomy to determine whether this was beneficial in improving the practice's premedication protocol. Ten bitches were administered ACP (0.04 mg/kg) and ten bitches were administered ACP (0.01 mg/kg) and butorphanol (0.01 mg/kg); both groups received carprofen (4 mg/kg). Anaesthesia was induced with propofol (4 mg/kg) to effect and was maintained on isoflurane. The time of extubation, sternal recumbency and standing was recorded, and pain scores were completed at 0, 1, 2, 3 and 24 hours. The volume of propofol required to induce anaesthesia was also recorded. Owners completed a questionnaire regarding the bitch's behaviour post operatively. It was concluded that the addition of butorphanol to an ACP premedication significantly increases the time for the bitch to regain sternal recumbency and to stand (p=0.017); all other differences in effects and observations between the two groups were statistically insignificant.