One Medicine, One Love, One Hope

denDr Denica Djodjeva

Blue Cross Veterinary Clinic

Sofia, Bulgaria


I was extremely impressed with my visit to Fitzpatrick Referrals , UK. I initially visited the Soft Tissue Surgery and Oncology Hospital in Guilford. My colleague from Bulgaria, Ivan Kalmukov, who is a graduating resident in surgery and a great guy, had informed everyone about my visit. I am extremely grateful to him, for that, because otherwise without his help my visit would not have taken place.pic 11

On the first day, I was greeted by the surgical specialists, who showed me around the hospital and helped me going deeper in the working environment there. They introduced me to a large part of the team. Since my main professional interests are anesthesiology and critical care, I was also introduced to the head of anaesthesia – Daisy. She is a very nice young lady and immediately engaged me with  blood gas analysis problems to solve. From day one, I was already aboard. Unfortunately, there were not so many procedures and operations, but for me it was perfect, because I had time to orient myself in the environment and get to know the team. In the following days, the things continued in another direction and I was able to feel the workload of the clinic. In between the many duties and busy workload, everyone talks calmly, without unnecessary emotions and fulfills their duties. In general, a pleasant working atmosphere. I was left with the impression of a great team in which everyone helps each other and has each other’s back. Needless to say, the professionalism with which all operations and procedures are performed.pic 12

The attitude they have towards the animals is great and my question “Don’t the dogs bite here?” was completely unnecessary. Collars and other protective devices were only used for very aggressive animals. Each one of them was spoken to calmly and there was always a person next to him to reduce the stress of the unfamiliar environment and people. In the postoperative period, each patient is strictly monitored and waited until is completely recovered from anaesthesia. After that, it is accompanied to thd e waror goes to see the owners, who are already waiting for him in one of the consult rooms.pic 13

In my last days, I was able to visit and the other referral centre, for Orthopedics and Neurosurgery in Godalming. I participated in every procedure closely related to my interests in anesthesia and there was always someone to explain everything about it to me. Unfortinately I was not allowed to practice, because I am not a licensed veterinarian in the UK.  In my last days, I attended many operations during which I saw some innovative practices, one of which was on a cat with fractured vertebrae. My colleague Ivan was one of the surgeons. The next day, the animal was already walking.pic 14

Although there were inexperienced colleagues, they always found support in dealing with daily tasks and everyone celebrated their small victories.

During this one week, I learned a lot, I saw the high level of medicine that is being worked on, and I hope I will be able to apply this to my work in Bulgaria or at least some part of it. I am extremely happy for this opportunity and am very grateful to Ivan for helping to make this happen. My experience at both hospitals was a once in a lifetime. I hope I am wrong and have the opportunity to visit them again.pic 15

If you are ucranian vet you can be supported by vets from whole Europe!

Please check here:

First list:

Here we are with the opportunities for Ukrainian vets
1. Hemodiavet and Dr Vitalaru Bogdan Alexandru-6 persons, Bucharest, Romania
2. Alessia Matia-2 persons,Milan, Italy
3. Linda Werme-1 person, Sweden,
4. Larisa Fedotova- 2 persons ,Darlington,UK
5. Natalie Franiek-Krijt-1-2 persons, Austria ,
6. Federica Fogli -1 person, UK ,
7. Aleksandra Pikarevska- 2 persons, Brighton,UK,
8. Calorina Delabre- vet family and work for them, North France
9. Elisabeth Buchinger -2-6 persons, Lower Austria
10. Karena Bonte- a family, Belgium 003292537063
11. Julieta Pedernera-1 person, Frankfurt,Germany
12. Lisa Beffort -live in Germany next to Limburg 65558. We can help organizing train tickets.Phone 0049 176 96 15 46 24
13. Diana Lehner-2 persons, South Germany, about an hour south of Stuttgart
WhatsApp is the best way +436509800071
14. Nadia Kostadinova- a family and job for them in the clinic. Plovdiv,Bulgaria, +359887775165
15. Elisabeth Muller-4 persons , +491714265645 for contact
16. Cristian Cristea-4-6 persons, Bucharest, Romania +40723683806 whatsapp or sms and will call you back.
17. Bojana Mircheva- a family, Gorna Oryahovitsa, Bulgaria, also a job for them , +359885468665
Boryana Vankova- a family and work for veterinarian. Troyan, Bulgaria,email
Phone +359888578783
18. Mila Bobadova- a family, and work for vets,Sofia, Bulgaria , +359888359102
19. Karen Welkenhuyesen- 1 person with kids, Belgium (Diepenbeek)
20. Dr. Michael Greshake-3 persons, Grevener Damm 184, 48282 Emsdetten,
21. Dany Holmes- help in Ireland , holmes
22. Ann Criel –help in Belgium
23. Veerle Guffens- 3 persons, Hoogstaten,Belgium –
24. Sofia Matias 2 persons , Walton,Uk,
25. Kristein Henckaerts-1 person, Hasselt,Belgium,
Second list:
1. Charlotte McGivney
We have a single bedroom available near Newcastle in the UK.
2. Regina Sassenrath
We are a small animal practice in Ober Olm 12km from Mainz, close to Frankfurt. We can offer a job as vetetinarian and help with accommodation. Please contact us. or use messenger.
3.Petra Geisser
Hello from Bavaria,
We could accommodate 1-2 persons. Children and pets are also welcome. Please contact me by Messenger or Mail
4. Ana Cardoso
Hello from Portugal, I can acomodate how much will be needed in one room, and arrange a way for pets if needed, and can help with a job. Please send email for
5. Laura Thirtle Mills
Family home in Cornwall, UK, two spare bedrooms available for small family. Please message if we can help.
6. Emma Morris
copthorne vets in the uk, shrewsbury can host a vet and their family and employ one vet do get in touch
7. Annie Koldeweij
Annie et Ben Koldeweij, center of France 58, can host a family of four, lend a vehicle and eventually employ one vet . for more details
8. Naas Anastasia
We are small animal practice Dyreklinikk Mo AS in Nittedal 25km from Oslo, Norway. We can hire 1 Ukrainian small/equine veterinarian as veterinary assistant and help with local accommodation in our beautiful area:) help with every tasks to introduce our new colleague to Norwegian life and regulation system. . We will assist with language course as well. Please, contact us
9. Maria Ledunger Thulin
Hello from Stockholm Sweden
We can offer a position at our clinics Sollentuna Djurklinik and Vallentuna Djurklinik. For 2-3 ukrainian vets and nurses. Housing can also be solved for up to three adults with 1-2 children, also pets.
10. Bambi Be
Hy I am from Vienna, we can host one person with a child, pm me for details please!
11. Patrick Govart
I can offer accomodaton for up to 2 persons(couple) with young kids and pet in a studio. We are in paris suburb. Contact us via messenger.
12. Riëtte Kok
Assen, the Netherlands, AniCura Dierenkliniek Assen, can host 1 family. We are a small animal practise (mostly cats and dogs).
13. Emily Thomas
Hello from Cambridgeshire in the UK. I am so very sorry that our government is being unhelpful with visas. Please know that many people here are lobbying them to change this. But if you can get to the UK, I can host 1-2 people +/- a child.
14. Nathalie Axelsson
Hi, from Sweden (southern part, close to malmö)
We can host 1-2 (+/- a Child) people and pets are welcome.
15. Holger Volk
If you are small animal vet or a scientist, we at the vet school in Hannover want to help. Need a place to work in a small animal clinic and potentially live close by, please write an email to On a personal note, we can host at our own home one Ukrainian vet +/- partner +/- kid +/- dog.
16. Zsolt Szeghő
We are a small equine clinic at northeast Hungary, about 200 km from the ukrainian border. We can offer accomodation and hosting for a vet or a vet student evacuated from Ukraine. We can speak hungarian, english, slovak and romanian language.
Contact email:
17. Susanna Käppeli
Hello from Interlaken, Switzerland! we can host 1 person (vet or vet student) in a shared Apartement and help in our small animal clinic. please contact me per messenger or +41 33 822 21 41. we help if possible with the travel.
18. Amélie Desvars
Hi from Austria, we have a room for 1 person with 1 kid. Cats welcome.
19. Flamme Martine
Hi, in Belgium (Chimay), we have a place for 2 adults and a young kid, and of course animals.
20. Caro Stolpe
C.Stolpe, Hessen, Germany.
4-6 people, dogs and cats welcome
Contact by FB-Messenger
21. Christiana Ober
We would be happy to have a family (and pets) or anyone in need. Wiltshire, UK Please feel free to get in touch
22. Svein Henriksen
Hello from south west Sweden., We can host one family and pets in apartment on our small farm. We also need help in our small animal clinic. Please contact me
23. Berit Blomstrand
Hi, I can house 1-2 families in need, animals welcome (Mid-Norway)., +4797535891
24. Veterinary practice Kay offers accommodation and a job for Ukrainian veterinarians. We are a family business and treat small animals and horses. The practice is located between Stuttgart and Munich. Gladly WhatsApp +49 151 22672554
25.Eleonora Piseddu
Hi, I am italian vet located in Bergamo. I got two rooms (one double and one single) available for Ukraine colleagues and their animals. My email is Best regards, Eleonora
26.Stephanie Sanderson
We would be happy to host a 3 people ( 1-2 adults +1-2 kids) in north west UK (near liverpool).
27.Ledewij Wiersma
Hi there, Great initiative to host Ukranian vets! My husband and I, our 3 year old, our soon to be born second son and our 6 animals have an independent house that can host up to 4 people comfortably, more if needed. We live in the countryside north of Rome. Children and animals welcome. No veterinary jobs but always enough to do around the property (compensated). I prefer not to share
my phone number and email address directly on the facebook site but for your records: 00393899481311
languages: english, french, italian, spanish, dutch and a little german
28. It is an independent studio, for a couple with a young child, and dogs or cats.
You can reach Martine Flamme with the e-mail in copy of this email:
Hope this will help.
We stand with you.
Martine Martin

Hind limb preservation surgery in a cat using customised 3D printed expandable arthrodesis plate – case report

IMG_4840Svetoslav Hristov


United Veterinary Clinic, 34 Tzarevetz street, Varna, Bulgaria








The aim of this case report is to describe the technique and clinical outcome of limb salvage procedure in a cat with а distal segmental femoral bone deficit due to bone nonunion using customised expandable stifle arthrodesis plate.




3.5 years old female cat was presented to us after unsuccessful repair of multiple fractures of the right femur. The current condition of the cat was as follow: Gustilo-Anderson type 3b open intercondylar and distal diaphyseal femoral fracture, fracture of the femoral head, fracture of the greater trochanter, patella ligament rupture and extensive skin and soft tissue loss in the right stifle region (1). The aim of the treatment was anatomical reconstruction of the femoral fractures, temporary transarticular fixation and soft tissue reconstruction using ipsilateral mammary chain (caudal superficial epigastric  axial pattern flap) with a future plan of performing stifle arthrodesis due to a non repairable patella tendon rupture (2). Surgical goal was achieved, but sequestration of the whole distal femoral segment was confirmed radiographically  two and a half months after the revision surgery. As the owner declined amputation and insisted for limb salvage procedure, personalised 3D expandable arthrodesis plate was designed, fabricated and used for achieving stifle arthrodesis.



Picture 1-Gustilo-Anderson Grade 3b open distal femur fracture


Picture 2-Shirley, soon after the first surgery when reconstruction of the femur and closure of the soft tissues were performed using caudal superficial epigastric axial pattern flap















Two radiographic examinations immediately postoperatively and five months after surgery were performed. Four months follow up x-rays showed no signs of periprosthetic bone resorption which seems to be in the main concern in this clinical case and whether the porous spacer will be integrated to both the femur and the tibia.





Clinical significance


Designing and fabrication of the customised implant is a complex, time consuming and cost depending process, but 3D printed expandable stifle arthrodesis plate could be a realistic option for hind limb preservation in cats. Further cases and long term follow up are required to determine the success and complication risk of the procedure.




The femur is the most commonly fractured bone in cats, accounting for more than 30% of feline fractures (3). Those involving the shaft and the distal femur are most commonly seen. Inadequate fracture fixation leads to poor mechanical stability and further compromise of the biological environment, especially if there are migrating implants. The basic tenets for treatment of joint fractures are reestablishment of articular congruity, joint stability, axial alignment and preservation of joint mobility (4).  Patella tendon rupture is unusual condition and it is most commonly due to a sharp trauma (5). In our case, an iatrogenic rupture of the patella tendon was suspected due to migrating implants following surgical stabilisation of the distal femur fracture.  Arthrodesis of the stifle joint is a salvage treatment option if joint function cannot be preserved with another methods. Arthrodesis will leave the cat with significant gait alterations, and careful consideration should be made before electing for this option. The angle of fusion is estimated from the standing angle of the contralateral limb, and is around 110°. Strict attention should be paid to surgical technique to avoid complications. These tend to occur because of the long lever arm created, which can result in fracture of the femur or tibia at the implant–bone junction. Implants should end in metaphyseal areas and not over the narrowest part of the diaphysis to avoid this complication (6).


Case Report


3.5 years spayed female cat was presented to us after unsuccessful repair of multiple fractures of the right femur. After removal of the existing implants, reconstruction of the articular fracture was performed using 2.4mm lag screw and antirotational K-wire. 2.0 mm SOP plate was applied as medial transarticular stabilising implant and for fixation of the supracondylar fracture of the femur. Two K-wires and tension band wire were used for fixation of the greater trochanter. The femoral head seemed already stable and no attempt for surgical stabilisation was performed.


Bacterial culture was done during the first surgery and the results came back as Methicillin-resistant staphylococcus. Based on antibiotic susceptibility testing, Amikacin was used as an appropriate antibiotic for seven days. Unfortunately no signs of fracture healing were noticed in the next 8 weeks and small fistulous tract appeared at the lateral aspect of the stifle joint.



Picture 3-Femur fracture configuration with loosed implants before, and the Picture 3-femur anatomically reconstructed after the revision surgery. At the most right radiograph – signs of osteomyelitis and sequestration of the whole femoral condylar segmen



In a subsequent surgery all implants were removed together with the distal femoral fragment, a transarticular external skeletal fixator was applied and CT was performed immediately after that. Bacterial culture has been obtained and came back again positive for Methicillin-resistant staphilococcus. Chloramphenicol was initiated for 7 days p.o. based on bacterial sensitivity testing.

A further attempt was initiated for designing and producing of expandable stifle arthrodesis plate. The aim of the proposed implant was to provide stifle arthrodesis but at the same time to replace the distal femoral segment for overall limb length preservation.  The implant was designed by CABIOMEDE Vet, Poland and consisted of two solid portions with locking screw holes and central porous portion for promoting bone ingrowth. The length of the porous part of the plate was 28mm and was intended to replace the missing distal femoral segment.




Picture 4-Shirley with an applied transarticular ESF, waiting for a stifle arthrodesis surgery


Picture 5


Picture 6





















Two DCP holes were designed at both sides of the solid part of the plate in order to provide compression on the osteotomised bone segments against the porous part of the plate. The rest of the plate holes were locking ones and were arranged in such a way so they can engage each bones in a different angle providing some sort of orthogonal fixation and at the same time avoiding the holes form the existing ESF pins. The plate was designed to span almost the entire length of both the femur and the tibia, avoiding possible periprosthetic fracture. Limited contact under-plate surface was designed, reducing the implant footprint on the bone because of the concern of too much implant wrapping  and possible implant-associated infection. The customised implant and dedicated cutting guides were printed from Polygon Medical Engineering, Russia.



Picture7-Renderings of the femur, tibia and lower extremity showing the position of the custom plate. The arrows are indicating the position of the two non-locking screws which are going to provide compression of the bone segments against the porous part of the plate.


Picture 8-A cutting guides designed for precise osteotomies of the bone ends and proper fit of the customised plate


Picture 9-The stifle arthrodesis expandable plate is printed from titanium alloy (Ti6Al4V ELI) which is the gold standard for orthopedic implants when osteointegration is required. Figure 9




























During the surgery, the patient was positioned in a lateral recumbency with the affected limb upermost and cranial skin incision was performed starting from the most proximal aspect of the femur to the the most distal aspect of the tibia. A standard lateral approach to the femur was made which continued over the cranial aspect of the stifle area and on the craniomedial aspect of the tibia. The cutting guides were secured and the bone ends were osteotomised. The plate was then attached to the cranial aspect of the tibia and the femur using temporary K-wires through dedicated holes.  The most distal tibial plate hole and the most proximal femoral one were designed for 2.0mm non locking cortical screw to be inserted in a neutral position and two gliding holes at both sides of the porous part of the plate for 2.4mm cortical screws in a compression mode.  Autogenous cancellous bone graft was obtained from the proximal aspect of the contralateral humerus and applied at both sides of the porous part of the plate. All needed 2.4mm locking screws  were predetermined and their length marked on the plate for faster and precise application.



Picture 10-Tibial cutting guide on place and secured with K-wires (on the left). The 3D printed arthrodesis plate fixed to its final position (on the right)


Picture 11-Medio-lateral radiographs immediately after removal of the transarticular ESF and the application of the printed arthrodesis plate


Picture12-Shirley a few days after performing the limb salvage surgery


















This case report describes fracture complications in a feline femur multiple fracture and application of customised 3D printed expandable plate for stifle arthrodesis as a limb salvage procedure. The customised plate made of Titanium alloy has the features of the replacement of missing bone, providing initial fixation using screws (both non-locking and locking ones) and long-term bone fixation (bone ingrowth) (7). Our main concern was mainly the long-term bone ingrowth and the bending and shear strength of the plate at the porous/solid part of the implant.  Five months after the surgery (at the time of this article has been published) there are positive radiographic signs for osteointegration (no signs of peri-implant bone osteolysis, lack of osteolysis around the screws and progressive bone bridging over the porous part of the plate). In a recent paper (8), porous implants without hydroxyapatite coating showed a consistent bone ingrowth in a canine transcortical model.  Despite the concern of poor functional limb after limb sparing/fuse of the stifle joint (4) , our cat was performing extremely well and almost fully weight-bearing on the operated leg about ten days after surgery. Till today she improved her gait a lot and the limb use while she is running and playing with toys.


“Shirley is doing great. She really behaves as a kitten which never had an issue with that leg” – Shirley’s owner, 25.09.2020



Picture 13-Five months follow up radiograph. Close up views to the bone-implant interface


Picture 14-Abnormal sitting “on a side”. Shirley, about five months after stifle arthrodesis













2 weeks after the surgery:









  1. Kim P.H, Leopold S.S. Gustilo-Anderson classification. Clinical Orthopaedics and Related Research 2012, 470:3270-3274
  2. Moors, A. Axial pattern flaps. In: BSAVA Manual of Canine and Feline Wound Management and Reconstruction. BSAVA: 2009; 100 – 111
  3. Hill, F.W.G. A survey of bone fractures in the cat. J.Small Animal Practice 1977, 18, 457-463
  4. DeCamp C.E, Johnston A.Spencer et al. Principles of joint surgery. In: Handbook of small animal orthopedics and fracture repair. Elsevier, Inc. 2016; 211-229
  5. Das S., Langley-Hobbs S., et al. Patellar ligament rupture in the cat: repair methods and patient outcomes in seven cases. Journal of Feline Medicine and Surgery 2015, Vol. 17(4) 348-352
  6. Voss K, Langley-Hobbs S.J, Montavon P.M. Stifle joint. In: Feline Orthopaedic Surgery and Musculoskeletal Disease. Philadelphia, PA: Saunders Limited: 2009: 475-4907.
  7. Harrysson Ola L.A., Marcellin-Little D. et al. Applications of metal additive manufacturing in veterinary orthopaedic surgery. JOM, Vol 67, No3, 2015
  8. Tanzer M, Chuang P.J., et al. Characterization of bone ingrowth and interface mechanics of a new porous 3D printed biomaterial. Bone & Joint Journal 2019;101-B, 62-67



Friends of Vets on The Balkans- Dr Liliya Mihaylova


Dr Liliya Mihaylova

Today we will present to you another friend of Vets on The Balkans, Dr Liliya Mihailova.


She is veterinary surgeon at the biggest veterinary clinic in Varna, Bulgaria. One of the most famous cardiologist in Bulgaria, teacher and friend of many many vets in Bulgaria and not only.

Let her friends and colleagues discribe her:




78508821_961764280857493_2739612204776030208_nLUIGI VENCO, DVM , SCPA, Dipl EVPC, Pavia, Italy


“When I first met Liliya Mihaylova, I immediately thought she was shy. Then working with her I realized that she is not shy at all. She is an incredibly sweet and respectful person. And the same sweetness and respect she puts into her profession and into relationships with the people around her. We had the opportunity to work together for months, we met each other at courses and conferences in every part of the world and she is always smiling. I was able to appreciate how brilliant she is as a veterinarian but if ask me if I prefer her human or professional aspect I can tell you that I prefer both and that if they are in the same person and if you’re lucky enough to be her friend , you’re very lucky, as I am”

61339937_10219962671486451_5841102552728338432_oDr Gergana Vitanova, veterinarian in veterinary clinic Albaitar, Ruse, Bulgaria

“Life meets you with different people. Some of them manage to provoke you to do your best with their example. Dr. Mihailova is exactly that. There is no way that you will not be infected by this difficult combination – uncompromising professionalism and the rarely found kindness.”





25442892_719068364966330_5338298658327192274_nFlorin Delureanu,DVM, MRCVS, veterinarian from Romania

“I met Liliya in the summer of 2017 through a veterinary medical event in Bucharest. During the lunch break she sat next to me and asked me where and for how long i work as a veterinarian and if the clinic where i work is a big one. Even though the discussion from that day was short, she left me a good impression. About 5 months later, in the winter of the same year, I decided to contact her with the intention of spending my winter holidays in the clinic where she works (United Veterinary Clinic-Varna) to develop even more my knoledge. I was pleasantly surprised by the speed and promptness with which she answered me, the answer being a positive one. After arriving in Varna, Liliya was very polite and intended to give me a lift from the bus station to the clinic. When i arrived at the clinic, i was very excited and wanted to help because there were so many patients waiting and Liliya was very open minded from day one and offered me the opportunity to participate with her in a few surgeries. She also had a pleasant attitude both at work and outside of work, was very friendly and gave me many tips. She has contributed a bit to my present by encouraging me and supporting me to move to another country (England) to develop myself. Because she is in a continuous development especially in the field of cardiology and endoscopy, i can say that she has given me many details, tips and tricks regarding this field! I have a lot of respect for Liliya, and i am grateful for the nice experience she offered me i am honored to know her!”



78608501_2993069480722815_5314071698566283264_oDr Spas Spasov, veterinarian at veterinary clinic Dr Antonov, Varna, Bularia

“What can I say about Lily.

We’ve known each other for almost 7 years.

She is one of the sweetest people I know, dedicated to her work and friends.

You can always count on her, both for work and if you just want to talk to her about things other than work.

Lily is a person who motivates us to be better professionals and people.

Her desire for continuous development is inspiring.

What else can I tell you about her … she’s always late, hahaha , she’s often quite distracted because she thinks about 100 things hahaha.

Big animal lovers: she has a dog, a cat, two parrots and a fish.

Quite often, she takes care of a wounded wild boar, for example, an owl, a gull, a sparrow, a pigeon, etc. .

When you go to visit her, you actually go to a small home full of friendly animals.


Of course, these things are not enough to describe the Lily as a person and a friend.

In conclusion, Lilia is a wonderful doctor and friend, and I am more than happy to have   her in my life”


THANK YOU Liliya for being such a good friend of Vets on The Blakans!59910676_10219811414505121_5136066701674151936_o


Wound management part 2: The approach of traumatic wounds



51559132_952390804967417_8511078558653743104_nFlorin Delureanu


March 2017



From a general point of wiev, a traumatic injury is defined as a physical damage caused by an external factor. Even if we talk about a road traffic accident, a burn or projectile injuries, all of them represents a trauma for the body. Because the first part of this series described the physiologic process of healing and how can wounds be recognized according to the phase in which they are, the second part will highlight how wounds can be addressed.

Initial assessment of the patient

Due to various types of trauma, the patient should be treated according to the requirements. The patient can be unstable after a road traffic accident, after a fighting with another dog or can be bright, alert if superficial lesions are present (patients that develop wounds due to scratching). If the patient is not stable the plan must be focused first on stabilization by checking the major function (A- airway, B- breathing, C-cardiovascular, etc) followed by a good pain control and assess the life-threatening injuries. In an emergency situations is recommended to cover the wounds with sterile gauze or another type of sterile material to provide haemostasis and to protect against another contaminants that are considered already present in the wound.

Evaluation of the wound

When the patient became comfortable, a wound evaluation must be performed. There are some factors that can help the surgeon to take a decision regarding the local management. Therefore, the following should be considered:

  • the degree of contamination;
  • when the injury took place;
  • the degree of tissue ischaemia;
  • the amount of tissue loss;
  • type of wound (burn, snake bite, etc).

About the length of time between the production of the trauma and the presentation of the patient to the clinic and the degree of contamination, wounds are classified as clean, clean-contaminated, contaminated and infected (see details in part1).               Because every injury has as a result blood loss, the tissue exposed may have different aspect and can help with the prognosis. The first aspect of the wound may be misinterpreted due to colour and integrity of the surrounding tissues. Many times the skin is crushed due to a powerfull trauma and just small superficial wounds may be present. If at first presentation the skin looks normal and the small wounds have a clean aspect and the trauma happend in less than 4-6 hours not every time will be a good ideea to do a primary closure. Some wounds may have good viability but because the tissues are crushed can develop necrosis and some wounds may have an ischaemic aspect but if the surrounding tissues are not traumatised the evolution can be favorable. As a conclusion, not every time a primary closure will be a wright decision, sometimes wounds need 2-4 days to “settle” depending of the type of trauma.                The amount of tissue loss will guide the surgeon to use specific dressings according to depth and length if second intention healing will be elected.               Regarding wound type, some specific considerations must be taken. For example, bite wounds should be explored whereas for an early frostbite wound the patient must be rewarmed first.


Fig1. Basic wound management in six simple steps (Atlas of Small Animal Wound Management and Reconstructive Surgery, 4th Edition Michael M. Pavletic, April 2018

As an approach, wounds can be managed by closure (primary closure, delay primary closure, secondary closure already described in part 1) or can be left for second intention healing.

Second intention healing occurs when a wound is left to heal by contraction and epithelialization. All wounds can be left to heal by second intention but this process may fail at a point or may end without providing a functional outcome. There are some reasons why not every time a complete healing by second intention (especially large wounds and in high motion area-joints, axillary, inguinal) is not recommended: the granulation tissue is very fragile and easly abraded; wound contraction, sometimes excessive, may impede normal function.

Some wounds may fail to completely reepithelialize. Open wound management is indicated in dirty, traumatized, contaminated wounds in which cleansing and debridement is necessary.

Wound preparation – cleansing

To prevent further contamination of the wound in the time of cleaning, all equipement must be sterile. Prior to application of topical treatments, the wound bed must be properly prepared. Initially the wound must be protected with a sterile lubricant (eg. K-Y sterile gel) or sterile gauze soaked in warm saline. After protection, the hair that surrounds the wound must be clipped. The hair represent one of the main foreign body that can imped wound healing in a clean wound. Next, lavage the wound with a proper solution under 7-8 psi to remove the surface contaminants and in the end dry the skin surrounding the wound. This may facilitate the adhesion of the dressing and also will prevent maceration of the skin if the wound is highly exudative.

  • Wound lavage: many lavage solutions are availabile. Most popular are
fig 2

Fig.2 Basic kit for wound lavage composed by seringe, 3 way-stop cock, 18G needle, intravenous tube and 500ml bag of sterile saline.

clorhexidine, betadine, Ringer’s and sterile saline. A study from human medicine compared tap water with sterile saline for wound irrigation and showed no difference in occurance of infection. Clorhexidine is availabile in many concentrations (4%, 2%, 0,5%) but for open wounds 0,05%  solution should be used. To obtain this concentration, 25ml of clorhexidine 2% must be mixed with 1liter bag of solution. Betadine may be a good option to use in wounds located on the face, particulary near eyes because clorhexidine have very toxic effect if will get in contact with the eyes. Betadine also must be diluted to a proper concentration (0,1%-1% solution). To obtain this solution, 1-10ml of 10% betadine must be mixed with 1 liter bag of solution. As a comparation, clorhexidine is not activated by anorganic matter while as betadine is inactivated by anorganic matter such as blood or exudate. Also a 0,01% clorhexidine gluconate with tris-EDTA solution was described for wound lavage. This combination help lyse Pseudomonas aeruginosa, Escherichia coli, and Proteus vulgaris. Recently polyhexanide/betaine (Prontosan), a solution or gel containing 0.1% of the antimicrobial agent polyhexanide and 0.1% of the surfactant betaine was described as a lavage solution in wounds with good results.


One of the key of this procedure is not necessarily the type of solution used, but the amount used. A copious lavage of 500-1000ml is recommended. The ideal pressure of 7-8 psi can be provided by different systems. The most cheapest way is to use an 18G needle, a 3 way stop cock, saline bag, 35-60ml seringe and an intravenous tube. Pressure cuff also can be attached to the solution bag and 300mm Hg pressure can be maintained to provide 7-8 psi in the time of lavage. If the pressure is too high, the healthy tissue can break; if the pressure is under 7-8 psi the surface contaminants may not be removed completely.

After cleansing, if the wound is not considered contaminated, primary closure is indicated. Most of traumatic wounds need also debridement.


Fig. 3 Wet to dry bandage applied on a wound located on the ventral aspect of the metatarsal area in a cat as a nonselective form of debridement

Debridement: can be selective or nonselective. Usually chronic wounds needs debridement but also fresh wounds which present devitalized tissue. Surgical and mechanical debridement are considered nonselective forms. For surgical debridement different surgical instruments can be used (scalpel, scissors, etc.) and adherent bandages (wet-to-dry / dry-to-dry) are used for mechanical debridement.


Surgical debridement must be performed in layers, step by step until the necrotic/ devitalized tissue has been removed and blood can be visible from the wound edges or from the bed. An en block surgical debridement can be performed but this can be limited due to location and size. The wound margins should be closed with suture material or towel clamps can be applied for a temporary closure and after the entire wound is excised, including a margin of healthy tissue. Wound irrigation is also considered a nonselective debridement.There is no strong evidence that cleansing wounds increases healing or reduces infection, but it is almost universally recommended.

Three forms of selective debridement are described: enzymatic, autolytic, biosurgical/ biotherapeutic.



  • Enzymatic debridement – includes proteolytic enzymes that break down the necrotic

Fig.4 An example of ointment with papain and urea used for enzymatic debridement

tissue. Papain, trypsin, chymotripsin, fibrinolysine, collagenase, urea are the most common enzymes used for enzymatic debridement. Castor oil, balsam of Peru, desoxyribonuclease are also described.


As an advantage, they will not damage healthy tissue. This type of debridement is used less and less nowadays in wound management because is less effective and needs a long period of time to have the proper effect. Surgical debridement may facilitate enzymatic debridement.

  • Autolytic debridement – is the most preferate selective debridement. Is less painfull in

compare with the other types. This method involves maintaining a moist environement on the wound so that natural enzymatic “phenomens” can take place. Hydrogels, hydrocolloids and foams are very common used to support autolytic debridement and will be described later as moisture retentive dressings. Due to their high osmolarity, honey and sugar can also be used also for autolytic debridement. They attract the fluid and will keep a moist environement.


  • Biosurgical debridement – refers to usage of maggots (Lucilia Sericata, Phaenicia

Sericata) and have and FDA approval since 2004. The maggots produce enzymes that dissolve the necrotic tissue and don’t interact with healthy tissue, that’s why the debridement is selective. They are applied in the wound as larva stage (4-7 days of life) and can be left in place 3-4 days. At the moment of application the larvae have 2-3 mm and in 4 days grow until 10-15mm. The optimal activity of the maggots depends on the wound pH. They don’t survive in an acidic environment. An 8.5 pH in the wound is preffered. Each maggot may consume up to 75mg of necrotic tissue every day. They cannot penetrate dry necrotic tissue or eschar therefore are not indicated for this situation.



Moisture retentive Dressings (MDR’s)

Transepidermal water loss represents the the amount of fluid lost by the normal skin. In humans with intact skin the transepidermal water loss is 4–9 g/m2/h. In partial and full-thickness wounds the water loss increase up to 90 g/m2/h. Dressings that have a low moisture vapor transmission value, less than 35 g/m2/h, are considered moisture retentive. In humans was found that the dressing with a water vapor transmission rate of 2028.3 ± 237.8 g/m2/24h was able to maintain an optimal moisture content for the proliferation and regular function of epidermal cells and fibroblasts in a three-dimensional culture model.                The process of wound healing can be accelerated by a moist environment. MDR’s retain water and hydrate the tissue and facilitate natural autolytic debridement. All wounds need to be covered with a specific dressing to maintain a proper moisture until full epithelialization otherwise the granulation tissue will get dry and eschar will occur. MDR’s are availabile on the market in various sizes, shapes, thicknesses, with or without adherent margins. They must be applied on top of the wound as a first layer and after can be covered with the second (absorbent layer) and third layer (protective layer).


Fig.5 Lateral view of a polyurethanic foam. Noticed the convex shape that the foam acquired after beign moistened. Due to this particularity this dressing have a good contact with the wound bed.

Polyurethane foams: is a porous nonadherent dressing that can be used in moderate to high exudative wounds. It absorb several times it’s weight. Is recommended to be used in sterile wounds and regularly must be changed every 3-5 days. With time, the period in which the dressing must be kept in place will change according to the amount of exudate. Some articles described that can be used also over infected wound bed but must be changed every 24 hours.


Can or cannot have adhesive borders and does not transform in gel. It is contraindicated in wounds with low exudate and not recommended in areas with bony proeminence because is very soft and cannot protect the damaged area. In compare with hydrocolloids and alginates, foams are less effective for autolytic debridement.

Alginates (calcium alginate): have high absorbtive properties. It absorbs 20-30 times its weight in fluid. In contact with the exudate, alginates transforms in gel. Is derived from brown seaweed and is recommended in high exudative wounds. It promotes haemostasis and Ca2+ stimulates macrophages and fibroblast activity. Is not recommended to be used in low exudative wounds.


Fig.6 Calcium alginate appearance. Left picture represents calcium alginate sheet applied on dorsal and ventral aspect of metatarsal area in a cat with a degloving injury after surgical debridement; Right picture represents the aspect of calcium alginate 24 hours later in the same patient; Note the transformation from dry fibers in gel and the proximal area in which the dressing was absorbed (yellow arrow).















As a presentation form, alginates are used in flat sheets and can be applied even in narrow cavities. On the market alginates can be found in combination with silver, zinc or honey.

Hydrogels: are indicated in low exudative wounds. They donate fluid to wound but can also absorbe it. Can be found in two presentation forms-sheet and gel. Contains 60-95% water and the cooling effect may decrease pain. Is not indicated in high exudative wounds because maceration can occur. Overgranulation has been reported after usage of hydrogels in excess. In cavitary wounds the gel form is inficated due to better contact. Hydrogels can also be used to soak the dry necrotic tissue.


Fig.7 Left picture describes hydrogel sheet used on the lateral aspect of digit IV in a dog with and abrasion wound. The wound had partial epithelialization and a small area with granulation tissue and the level of exudate was low. In the right picture gel shaped hydrogel is placed on Primapore.


Various forms of hydrogels combinations are availabile: with hyaluronic acid, alginate, collagen, etc. Can be left in place 3-4 days in non-infected wounds. They are permeable to gas and water and have proven to be a less effective bacterial barrier than occlusive dressings.






Hydrocolloids: have in composition may constituents like sodium arboxymethylcellulose,

gelatin, pectin, and polyisobutylene. Gelatin, pectin, elastomers, alginates, silver, and other materials can be added to these substrates. In contact with exudate it transform in gel and maintain a moist environment. Hydrocolloids are indicated in wounds with low to moderate exudate.

Sheets, powder and paste are the form of presentation. In compare with alginates, foams and hydrogels, the contact face of hydrocolloids is adherent but just on the skin, not on the granulation bed. Regarding permeability, hydrocolloids are semi-permeable to water vapour and oxygen but not permeable to bacteria and other contaminants. Is not recommended in infected wounds. May cause overgranulation.

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Fig. 8 Different aspects of hydrocolloid dressing. (a) Fresh hydrocolloid applied on a mild exudative wound in a dog; the dressing have is brown and opaque. (b) View of the dressing 5 days after application on the dorsal metacarpal area in cat. Note the brown dark colour that hydrocolloid achieved. (c) Dressing removal in the same patient in the same day. Note the yellow, gelly and bright aspect due to granulation bed contact.



Miscellaneous dressings

Honey – called also natural dressing, they are composed by glucose, fructose, sucrose, maltose, amino acids, vitamins, minerals and enzimes. Honey is the most popular product used as a topical treatment for wounds; have an antimicrobial effect due to low pH (3-4.5 ), release of small amounts of hydrogen peroxide or the presence of methyglyoxal. Honey promotes autolytic debridement and reduce oedema due to high osmolarity. It was demonstrated that honey have effect against a multitude of bacteria including Pseudomonas spp., MRSA and E. coli. Composition of honey does vary according to the geographical source. Many types of honey are availabile, from raw honey to medical grade. Manuka honey (Leptospermum scoparium) that originates from New Zealand is the most common used in humans and animals for wound care. Medical grade Manuka honey is recommended despite raw honey because raw honey may contain bacteria and fungal contaminants including anaerobic spore‐forming organisms. Recently was developed a new type of honey was developed which is not manuka honey. SurgihoneyRO is an antimicrobial wound gel utilising bioengineered honey to deliver Reactive Oxigen and is superior to Manuka honey. It cames in a variety of form such as gels, sheets, in combination with alginates or simple gauze. Honey is recommended in wounds that needs debridement and is not recommended to be applied over the granulation tissue. Despite the multitude of benefits, the quality of the evidence is variable.

Silver dressings– should be used when infection is suspected. Has been shown that silver ions have an antibacterial effect in contact with the exudate. Because silver ions are activated by a moist environment, is not indicated to be used in wounds with moderate-to-low exudate. There are some evidence that suggest delay healing if silver dressings are used in acute wounds. Is available as gel, sheets, impregned in alginates, foams and hydrocolloids and can be left in contact with the wound up to 7 days. Silver is a broad-spectrum antimicrobial agent that is effective against bacteria, fungi, viruses, and yeast. It has also been proven to be active against MRSA and vancomycin-resistant enterococci (VRE) when used at an appropriate concentration. Silver destroy bacteria due to multiple mechanisms: disrupts bacterial cell walls, inactivates bacterial enzymes, and interferes with bacterial DNA synthesis. Therefore bacterial resistance has yet to be documented, although reports of isolated Escherichia coli and Pseudomonas aeruginosa have shown resistance to silver in vitro.  Despite the benefits, some articles concluded that is still a lack of evidence about usage of topical silver and silver dressings for treatment of infected or contaminated chronic wounds.

Collagen dressing: are available in different forms such as granules, powders, sheets, pastes, gels. The collagen from these products derived from bovine, porcine, equine, piscean or avian source. Collagen has been widely used in cosmetic surgery, as a healing aid for burn patients for reconstruction of bone. Is the main structural protein in the extracellular space. Is resistant against bacteria and in this way it helps to keep the wound sterile. Platelets interact with the collagen to make a hemostatic plug. Collagen based dressings need a secondary dressing layer to maintain a moist environment. Products that contain collagen promotes angiogenesis and stimulates fibroplasia. Recently, usage of Tilapia skin fish in veterinary medicine and blue shark skin in human medicine for burns were described with promising results.

Silicone dressings– are used mainly in humans to reduce the hypertrophic scar. The mechanism of action of silicone dressings is not fully understood. It is believed that silicone due to occlusive effect, decrease the oxygen of the tissue until anoxia, environment in which fibroblasts cannot have a normal function and undergo apoptosis. In humans has been shown to help reduce trauma and pain. Silicone dressings were tested in rabbits, rats and horses. Silicone dressings are nontraumatic and the contact surface is adherent but just on the skin surrounding, not to the granulation bed. A comparison between silicone dressing and silicone gel in a controlled trial for treatment of keloids and hypertrophic scar. Compared to the untreated controls, all of the measured parameters including scar size and induration were reduced in both silicone and nonsilicone-treated groups. In 2005, silicone dressing was used with good outcomes in horses with exuberant granulation tissue. In 2017, a review of silicone gel sheeting and silicone gel for the prevention of hypertrophic scars and keloids concluded that was statistical significance in the effectiveness of both of them but most of the trials had poor quality with high or uncertain risk of biases.

Borate glass nanofiber – was developed in 2010 by human engineers and is recognized to have regenerative properties on bones and soft tissues due to stimulation of angiogenesis and osteogenesis. Two borate glasse with (1605) or without (13-93B3) CuO and ZnO were studied along with the silicate-based glass, 45S5 for the potential effect on vascular endothelial growth factor. The study demonstrate that silicate glass is inferior to borate glass. Copper and zinc ions together with calcium, phosphorus, magnesium, etc., stimulate the proliferation of human endothelial and osteoblast-like cells, promote angiogenesis, and stimulate vascular endothelial

growth factor secretion. Osteogenesis is encouraged because the fibers convert to hydroxyapatite.


Fig.9 Borate based glass nanofiber. Macroscopic aspect, “cotton-candy” like (left picture) and electron microscopy (right picture).

In 2017, borate glass nanofiber was evaluated for treatment of full thickness wounds in six dogs. The study had many criteria: wound cause and location, type and duration of previous wound management, time to granulation tissue formation, time to complete wound healing, subsequent procedures if applicable, outcome, and complications associated with treatment. With a “cotton candy” aspect and soft texture, the borate glass can be applied to any defect, even in deep wounds can be packed. Is not expensive and did not require hospitalization. A veterinary product was developed and is available (RediHeal) for cats, dogs and horses. Because promotes bone growth, the product can be packed also in the defect which result after dental extraction. After application, the fibers degrades at a controllable rate and release ions.


Wet-to-dry Vs MDR’s


·         Wet to dry bandages: first they overhydrate and after dessicate the wound bed. As

a result, cells involved in the healing process will lose their function. Because is a nonselective debridement form, when wet to dry bandages are removed normal cells (WBCs, macrophages, granulation tissue) are pulled off with the surface contaminants. The environmental bacteria can penetrate the gauze.


Because is adherent, in the time of removal will be not comfortable for the patients due to pain sensation. Small gauze fibers can remain in the wound bed, will act as a foreign body and will extend the inflammatory phase. They are not expensive but if are used as a sole treatment for wounds, the cost may increase semnificatively due to delay healing and daily replacement.


·         Moisture retentive dressings: during the inflammatory phase, support selective


Fig.9 Characteritics of an ideal dressing

autolytic debridement and promote healing because will keep a moist environment. They are nonadherent and nonpermeable for bacteria  so the infection rate is lower in compare with wet to dry bandages. They also require replacement every 3-6 days (depends on the product and the wound appearance) therefore decrease the costs for total wound care. Because MDRs are occlusive or semioclusive in nature, they decrease the pH and oxygen tension in wound and, as a result, WBCs are attracted, angiogenesis and collagen formation are stimulated and inhibit bacteria. MDRs are comfortable  not painfull for the patient when are removed from the wound bed. Also they prevents dessication and necrosis.

There is no dressing that meets all the conditions and cannot be considered that one is better than the other. The aim is to use the correct dressing according to the needs of the wound. Therefore, the physiology of wound healing needs to be understood. As an example, even if gauze (wet-to-dry) have many negative consequences, it can be used for debridement as part of wound management and is very effective but contraindicated in the proliferative phase while calcium alginate (MDRs) is less effective and can dessicate the wound bed when is applied on dry wounds.


Regarding moisture, a simple general rule is considered: exudative wounds need dressing that will absorb the fluid and dry wounds need dressings that will deliver moisture. It is detrimential to assess the volume and the appearance of the exudate each time the bandage is changed. A wound with a favorable evolution will produce less and less exudate with a clear clear aspect.

Alternative therapies


            Wounds have different behavior and the evolution depends on many factors (localization, degree of contamination, size, etc.). In particular situations, wounds may not heal by second intention or they may decrease in size in the time of treatment but in some cases the proliferation may stop. If surgical closure cannot be achieved, alternative therapies may be considered. As an example, vaccum assisted closure (negative pressure therapy), laser therapy or platelet-rich plasma (PRP) should be considered.

Bacterial species isolated from cats with lower urinary tract infection and their susceptibilities to cefovecin


Dr Banu Dokuzeylül

Banu Dokuzeylül1, Beren Başaran Kahraman2, Alper Bayrakal1, Belgi Diren Siğirci2, Baran Çelik2, Serkan Ikiz2,
Abdullah Kayar1* and M Erman OR1


Background: The aim of this study was to determine the bacterial species recovered from 61 cats with lower
urinary tract infection (LUTI), and their susceptibility to cefovecin in vitro.
Results: The clinical signs and final clinical diagnosis for cats with confirmed LUTI were also reported. After physical
examination of the cats, urine samples including ≥5-6 leucocytes in microscopic evaluation were cultured using
bacteriological techniques. The isolates were identified by conventional microbiological methods and tested for
in vitro susceptibility using the Kirby-Bauer disc diffusion method recommended by the Clinical Laboratory Standards
Institute. Bacterial growth was observed in 16 of 61 urine samples. Antimicrobial susceptibility tests showed that 13 of
16 (81%) isolates were susceptible to cefovecin. The most frequently isolated bacterium from cats with signs of lower
urinary tract infection, was Escherichia coli.
Conclusion: Cefovecin was found to be effective in cats with LUTI. Because cefovecin is a new antimicrobial agent in
veterinary medicine, there are only few studies about urine culture of cats with LUTI. It is the first study on in vitro
activity of cefovecin against bacterial isolates from cats with lower urinary infections in Istanbul, Turkey.
Keywords: Cat, Urinary tract infection, Urine culture, Antimicrobial susceptibility, Cefovecin


Lower urinary tract infections (LUTI) are rarely seen in cats, dogs and human beings. Various lower urinary tract
disorders can predispose to opportunistic infections as a complication of the underlying disease or its treatment,
while bacteria can be the initial cause [1]. Urine culture is the gold standard used to confirm the diagnosis of urinary tract infection (UTI). The urine sample used for this purpose should be obtained by cystocentesis to avoid bacterial contamination from the lower urogenital tract flora [2]. In urinary tract infections of cats and dogs, the most
commonly isolated bacterial species were reported as Escherichia coli, Proteus spp., Staphylococcus spp. and Streptococcus spp., although the prevalence of the various species varied considerably [3,4]. Cephalosporins belong to the beta-lactam group of antibiotics and they are originally derived by hydrolysis from the natural compound of Cephalosporin C. This class is bactericidal and acts by inhibiting the synthesis of the peptidoglycan
layer of the bacterial cell wall through binding to the penicillin binding protein (PBP) [5]. Cefovecin sodium [Convenia®; Pfizer Animal Health; USA] is a newly developed, semi-synthetic, extended-spectrum injectable third-generation cephalosporin administered at 8 mg/kg subcutaneously (SC) for the treatment of
UTI and skin and soft tissue infections in dogs and cats and it has been approved for subcutaneous (SC)
injections in cats since 2006 in EU and 2008 in USA [4,6-9].Third generation cephalosporins are generally less active
than members of the first or second generation formulations against gram-positive organisms (e.g., Streptococcus
spp. or Staphylococcus spp.) [5]. Stegemann et al. [4]have reported that cefovecin showed good activity
against Gram-negative organisms isolated from dogs and cats, including Escherichia coli, Pasteurella multocida,
Klebsiella spp. (including K. pneumonia), Enterobacter spp. and anaerobic-growing pathogens Fusobacterium spp.,
Bacteriodes spp., Prevotella oralis. However it was not effective against most Pseudomonas aeruginosa isolates.
The aim of this study was to determine the bacterial species recovered from cats with LUTI, and their susceptibility
to cefovecin in vitro. The clinical signs and final clinical diagnosis for cats with confirmed LUTI
were also reported.

In this study, 90 cats with one or more urinary clinical signs such as stranguria, haematuria, pollakiuria, inappropriate urination, excessive licking of the genital area and frequent and/or prolonged attempts to urinate were physically examined at the Department of Internal Medicine,Faculty of Veterinary Medicine, Istanbul University and
their anamnesis was gathered. Complete Blood Count(CBC), blood serum biochemistry (Serum glucose, blood
urea nitrogen (BUN), creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST)) and urine analyseswere performed in all patients. Twenty-nine cats were excluded from the study because antimicrobial treatment had already commenced in private veterinary clinics prior to our physical examination. Sixty-one cats with no antimicrobial treatment and including ≥5-6 leucocytes in urine microscopic examination were included in the study.The examination focussed on the presence of pyuria (≥5 white blood cells/high magnification (40x objective; highpower field, (hpf)) which were indicator of LUTI. The cats in the sample group were from different breeds: mixed (n:38), Persian (n:11), Siamese (n:5), Turkish Van (n:3), Turkish Angora (n:4). Forty-one cats were male, 20 catswere female. Five of the cats were one year old or younger, 38 between 2–7 years old and 18 were 8 years old or older. Samples of 5 ml of urine were collected by ultrasoundguided cystocentesis. Cats were restrained in lateral recumbency, the caudal abdomen area was cleaned with alcohol then the needle was inserted. Urine samples
for culture and antimicrobial susceptibility tests were sent to the laboratory within 1 hour, stored in cooling
boxes.Medical imaging Abdominal radiography and ultrasonography were also performed to diagnose underlying urinary diseases/disorders of the cats. Abdominal ultrasonography was performed using a 3.75-MHz convex transducer (Schimadzu 350-A,Shimadzu Corporation, Kyoto, Japan).

The samples were sent for bacteriological examination to the Laboratory of the Microbiology Department of
Istanbul University, Faculty of Veterinary Medicine. Urine samples were inoculated onto nutrient agar supplemented with 7% sheep blood (blood agar) and MacConkey agar plates. While the MacConkey agar plates were incubated aerobically, the blood agar plates were incubated under aerobic and microaerobic conditions at 37°C for 7 days.The colonies were examined macroscopically and then microscopically using Gram staining. Biochemical identification was performed by conventional methods and all the isolates were confirmed with API systems (BioMérieux, SA, Marcy I’Etolie, France) [10,11]. A bacterial count of more than 103 cfu/ml was considered diagnostic of UTI [9]. Cultures with no growth after 7 days were interpreted as negative.

Antimicrobial susceptibility tests

The antibiotic susceptibility tests were performed according to the Kirby-Bauer method recommended by
the Clinical Laboratory Standards Institute (CLSI) to select the optimal antimicrobial agent for treatment [12].
The zone of inhibition around the disk (30 μg cefovecin) was measured. The inhibition zone of ≥ 23 mm was considered as susceptible, while 20–22 mm as intermediate and ≤ 19 mm as resistant [6,12].banu

Statistical analyses
The results were analysed with the SPSS 13.0 programme. The Chi-squared test was used for the comparisons of
gender groups and age groups with respect to bacterial growth. Differences were considered significant at
p < 0.05.

Clinical signs
The most common presenting clinical signs of bacterial lower urinary tract infection in cats were pollakiuria (n = 41)
followed by stranguria and haematuria, respectively. Clinical disorders associated with lower urinary tract signs
Disorders and the number of cats involved are given in Table 1. Sixteen culture-positive cats were diagnosed
with the following conditions: urethral plaque (n:4), feline idiopathic cystitis (n:1), haemorrhagic cystitis
(n:2), bladder stones (n:1), acute renal failure (n:3), chronic renal failure (n:2), diabetes mellitus (n:1), other diseases
(n:2). The final diagnosis was reached following anamnesis, physical examination, blood and urine analysis, medical
imaging and urine culture.banu1

Complete Blood Count (CBC) and blood serum biochemistry
All the animals in the study were found to be within the normal range of CBC parameters. At the same time,
leucocytosis was not observed in 16 culture-positive cats. Biochemical blood serum values (Serum glucose, blood
urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase) were determined for every patient.
In our study, these parameters were found not to be significant.
Medical imaging
Blood clot formation was seen in the urinary bladder in cats diagnosed with haemorrhagic cystitis. The echogenicity of the clots was variable (hypo- to hyper-) and the bladder wall was thickened. Bladder stones were seen hyperechoic
and distal shadows were detected. The bladder wall was also thickened in cats diagnosed with renal failure and cystitis. No abnormal findings were seen in cats with urethritis.The sonographic appearance of transitional cell carcinoma was irregular, its shape was irregular and the echogenicity seemed non-homogenous. The ultrasonographic findings are compatible with our diagnosis.
Urine analysis microscopic evaluation
Leucocyte numbers detected by urine microscopic evaluation are summarized in Table 2. Bacterial growth was observed in 16 of 61 (26.2%) cats urine samples with a leucocyte count ≥ 5–6 leucocytes
(Figure 1). All the isolates were pure cultures.

Bacterial growth and susceptibility testing

Bacterial growth was observed in 5 of 20 (25%) urine samples of female cats and in 11 of 41 (26.8%) samples of male cats (p > 0.05). Three in five cats (60%) with bacterial LUTI were 1 year old or younger, 9/38 (23.6%) 2–7 years old and 4/18 (22.2%) 8 years old or older (p > 0.05). In this study, no significant difference was found between female and male cats with bacterial LUTI (p = 0.879). The differences among age groups were also not significant
(p = 0.200). Antimicrobial susceptibility tests results showed that 13 of 16 (81%) isolates were susceptible to cefovecin. E. avium and S. epidermidis isolates were resistant and Arcanobacterium renale isolate was intermediate.banu2

Discussion and Conclusions

Incorrect therapy of urinary tract disease, overuse and misuse of antimicrobials can have negative effects on patient
health (e.g. failure to resolve infections), the allocation of resources (e.g. need for repeated or prolonged
treatment), and public health (e.g. antimicrobial resistance) and may raise regulatory concerns (e.g. antimicrobial use)[13]. The antimicrobial activity of cefovecin is similar to that of other cephalosporin antibiotics, which share low
toxicity and good activity against many Gram-positive and Gram-negative aerobic bacteria [6]. Bacterial urinary tract infections (UTIs) in cats are relatively rare [14]. Studies of cats with clinical signs of lower urinary tract disease (dysuria, stranguria, pollakiuria) have consistently shown that the overall prevalence of positive bacterial urine cultures is <3% [2,15]. Some studies have reported much higher prevalence rates (15–43%) in cats that have their urinary tract defence mechanisms compromised by the effects of other diseases and/or by the treatment [2]. In this study, bacterial growth was observed in 26.2% of cats’ urine samples with ≥ 5–6 leucocytes. Our findings confirm to a
large extent to the results reported by Weese et al. [15]. Bacteriuria is generally seen in older cats [16]. In our
study, the percentage of young cats (≤1 years old) was highest. Most of the younger cats in our sample group
spent time both indoor and outdoor. They generally hunted and usually drank water from flower bowls and
ponds. These risk factors and their close contact with stray cats, may have contributed to the high prevalence
of urinary problems in this age group compared to indoor and older cats. Urine analyses were shown to be a useful indicator for UTIs. The most commonly isolated bacteria of cats with urinary tract infections were reported to be Escherichia coli, Enterococcus spp., Staphylococcus spp. and Streptococcus spp. [4,6,9]. Our results support these findings.
Proper and timely diagnosis is critical for the treatment of lower urinary tract infections as well as for the
selection of appropriate antimicrobials and drugs. Cefovecin has been specifically developed for the animal
practice as a long-acting third-generation cephalosporin with duration of action of 14 days. Stegemann et al. [4]
reported that cefovecin exhibited a broad activity against a range of Gram-negative pathogens and was not active
in vitro against P. aeruginosa. Wernick and Müntener [5] have reported that cefovecin showed no bactericidal
activity against Enterococcus spp. but it is active against Arcanobacterium renale. Our results (81% of isolates
susceptible to cefovecin) are in agreement with these findings. However, E. avium isolate was found to be resistant,
and Arcanobacterium renale isolate to be of intermediate susceptible to cefovecin. Stegemann et al. [4] reported that cefovecin was not appreciably active against Enterococcus spp., although in this study E. faecalis
isolates were found to be susceptible in vitro. While literature suggests good activity of cefovecin against coagulasenegative staphylococci, in this study S. epidermidis isolate
was resistant to cefovecin [4,8]. It is known that antimicrobials are the cornerstone of LUTI therapy. Despite the high cost of cefovecin in Turkey, its effectiveness and usefulness have been discussed in this study. Cefovecin is one of the antimicrobial agents that can be used in lower urinary tract infections and it is easy to administer a single injection.

Veterinary Faculty in Bucharest ,Romania

History of the Faculty

Most of the professors who have established the faculty,were part of French and German education system.

In 1881 was established the first form of veterinary education and then in 1832  was introduced the first class of veterinary art.

In 1856 Dr Carol Davida established the first medical school in Bucharest,in which had also classes of animal diseases.

In 1861 the veterinary medicine has become independent and the have create veterinary programme.

In 1921 by law,the school of veterinary medicine became Faculty of Veterinary Medicine. In Romanian Veterinary Faculty has been only one in that period on the Balkans. Many students from neighbour countries like Bulgaria, Greece and Yugoslavia graduated there.

Till 1948 was integrated as a part of Bucharest University. And after that it became part of University of Agriculture and Veterinary Medicine in Bucharest.

From 1887 till now the faculty is localizated in the same area.

When I entered the yard I felt the severity of a long history. The noise of many students was like a melody, or I felt this because romanian language sounds nice. I saw a huge building with many people with animals, waiting for examination, it was the clinic of the Faculty.

At the entrance I saw the notice “Bine ai venit la Clinica Facultatii de Medicina Veterinara Bucuresti” or Welcome in Veterinary clinic of Veterinary Faculty in Bucharest. Impressive!

I went in teh building and I was in a big reception room. The clinic has different departments: Obstetrics and Gynecology, Internal disease, Surgery, Ophthalmology center, Imaging sector, Sector for Haemodialysis, huge laboratory department and Pharmacy. Dr Iuliana Ionascu is the responsible person for this clinic. She shared with us all these things and we had a nice chats about the projects of the Faculty.










1.Project HRDSOP 160/2.1/S/139928 “Now a student! Tomorrow a professional! – The improvement of labour market insertion of students enrolled in higher technical/economic/veterinary education”

2. Project HRDSOP 155/1.2/139950  “Imroving quality of national higher education system in accordance with changing knoledge-based society and labor market dynamics”

3.Project HRDSOP 155/1.2/G/136748 “Veterinary emargency medicine-innovation and new skills in higher veterinary education system”

About the last mention project ,the paper present the progress of this project is co-financed by European Social Fund through the Human Resources Development Sectoral Operational Programme 2007-2013, implemented by the Univerity of Agronomical Sciences and Veterinary Medicine Bucharest, University of Agriculture Sciences and Veterinary Medicine Cluj Napoca.

The project aims to improve curriculum in higher veterinary education for a number of 400 students, in accordance with CNCIS, by introducing new disciplines and by developing a Veterinary Sectoral Network in order to achieve a better correlation between labor market and higher education system.

We visited the Ophthalmology center where is possible to diagnose and treat all of eye diseases in dogs and cats, such as Surgical treatment of cataract by the method of phacoemulsification and placement of artificial intraocular lenses, Filtration operations for treatment of glaucoma,vitreoretinal surgery and many others.

We would like to express our gratitude to Dr Iuliana Ionascu for sharing all these things with us .

In this Faculty we can see how the things supposed to be done. We all live on the Balkans and we all know how hard is to involve innovation in our Faculties, but here this is reality. The team of Vets on The Balkans is proud to be part of their work for a few hours.


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