Barriers to accessing ATLS provider course for junior doctors at a major university hospital in South Africa.

BACKGROUND: Advanced trauma life support (ATLS) is the international standard of care and forms the basis of trauma training in South Africa. Previous local studies demonstrated a low completion rate among junior doctors (JD). This study was designed to determine the reasons and identify possible barriers of JDs to accessing the ATLS course at a major university hospital. METHOD: This was a prospective study utilising a structured survey that included all JDs who were undertaking their internship training. RESULTS: A total of 105 JDs completed the survey. Sixty-two percent were female (65/105) and the mean age was 25 years. Forty-eight percent (50/105) of all JDs were post graduate year 1 (PGY 1) and the remaining 52% were post graduate year 2 (PGY 2) JDs. Sixty-two percent (65/105) of all respondents had completed their mandatory rotation in surgery. The reasons for non-attendance of ATLS were: unable to secure a place on course (52%), unable to afford course fee (18%), permission for attendance not granted (14%), unable to obtain study leave (10%) and lack of interest (5%). Subgroup analysis comparing the reasons for PGY1s vs PGY2s demonstrated that not being able to secure a place on course was more common among PGY2s [19% vs 33%, p < 0.001] while financial reasons were more common among PGY1s [18% vs 0%, p < 0.001]. CONCLUSION: The primary barriers for JDs to attending ATLS training is difficulty in accessing the course due to oversubscription, financial reasons, followed by difficulty in obtaining professional development leave due to staff shortage. There is an urgent need to improve access to the ATLS training course for JDs in our environment.

Quantifying the funding gap for management of traumatic brain injury at a major trauma centre in South Africa.

BACKGROUND: Trauma is an eminently preventable disease. However, prevention programs divert resources away from other priorities. Costing trauma related diseases helps policy makers to make decisions on re-source allocation. We used data from a prospective digital trauma registry to cost Traumatic Brain Injury (TBI) at our institution over a two-year period and to estimate the funding gap that exists in the care of TBI. METHOD: All patients who were admitted to the Pietermaritzburg Metropolitan Trauma Service (PMTS) with TBI were identified from the Hybrid Electronic Medical Registry (HMER). A micro-costing model was utilised to generate costs for TBI. Costs were generated for two scenarios in which all moderate and severe TBI were admitted to ICU. The actual cost was then sub-tracted from the scenario costs to establish the funding gap. RESULTS: During the period January 2012 to December 2014, a total of 3 301 patients were treated for TBI in PMB. The mean age was 30 years (SD 50). There were 2 632 (80%) males and 564 (20%) females. The racial breakdown was overwhelmingly African (96%), followed by Asian (2%), Caucasian (1%) and mixed race (1%). There were 2 540 mild (GCS 13-15), 326 moderate (9-12), and 329 severe (GCS ≤8) TBI admissions during the period under review. A total of 139 patients died (4.2%). A total of 242 (7.3%) patients were admitted to ICU. Of these 137 (57%) had a GCS of 9 or less. A total of 2 383 CT scans were performed. The total cost of TBI over the two-year period was ZAR 62 million. If all 326 patients with moderate TBI had been admitted to ICU there would have been a further 281 ICU admissions. This was labelled Scenario 1. If all patients with severe as well as moderate TBI had been admitted there would have been a further 500 ICU admissions. This was labelled Scenario 2. Based on Scenario 1 and Scenario 2 the total cost would have been ZAR 73 272 250 and ZAR 82 032 250 respectively. The funding gaps for Scenario 1 and Scenario 2 were ZAR 11 240 000 and ZAR 20 000 000 respectively. CONCLUSION: There is a significant burden of TBI managed by the PMTS. The cost of managing TBI each year is in the order of sixty million ZAR. A significant funding gap exists in our environment. This data does not include any data on the broader social costs of TBI. Investing in programs to reduce and prevent TBI is justified by the potential for significant savings.

Surgical resident working hours in South Africa.

BACKGROUND: Surgical training has undergone major changes worldwide, especially with regard to work hour regulations. Very little is known regarding the situation in South Africa, and how it compares with other countries. METHOD: We conducted a retrospective review of the hours worked by surgical residents in a major university hospital in South Africa. RESULTS: The attendance records of 12 surgical residents were reviewed during the three-month study period from January 2013 to March 2013. Ten were males. The mean age of the residents was 33 years. The mean total hours worked by each resident each month was 277 hours in January, 261 hours in February and 268 hours in March. The mean monthly total over the study period was 267 hours. This equates to approximately 70 hours per week. CONCLUSION: The average surgical resident worked 70 hours per week in our unit. This was shorter than that in USA, but higher than that in Europe. There is likely to be a degree of heterogeneity between different training units, which needs to be explored further if a more accurate overall picture is to be provided.

International medical graduates in South Africa and the implications of addressing the current surgical workforce shortage.

BACKGROUND: The surgical workforce in South Africa is currently insufficient in being able to meet the burden of surgical disease in the country. International medical graduates (IMGs) help to alleviate the deficit, yet very little is known about these doctors and their career progression in our healthcare system. METHOD: The demographic profile and career progression of IMGs who worked in our surgical department in a major university hospital in South Africa was reviewed over a four-year period. RESULTS: Twenty-eight IMGs were identified. There were 23 males (92%) and their mean age was 33 years. Seventy-one per cent (20/28) were on a fixed-term service contract, and returned to their respective country of origin. The option of renewing their service contracts was available to the 16 IMGs who left. Three explicitly indicated they would have stayed in South Africa if formal training was possible. Eight of the 28 IMGs (29%) extended their tenure, and remained in the service position as medical officers. All of the eight IMGs stayed with the intention of entering a formal surgical training programme. CONCLUSION: IMGs represented a significant proportion of service provision in our unit. Over one third of IMGs stayed beyond their initial tenure, and of these, all stayed in order to gain entry into the formal surgical training programme. A significant proportion of those who left would have stayed if entry to the programme was feasible.

Endo180 modulation by bisphosphonates and diagnostic accuracy in metastatic breast cancer.

BACKGROUND: Endo180 (CD280; MRC2; uPARAP)-dependent collagen remodelling is dysregulated in primary tumours and bone metastasis. Here, we confirm the release and diagnostic accuracy of soluble Endo180 for diagnosing metastasis in breast cancer (BCa). METHODS: Endo180 was quantified in BCa cell conditioned medium and plasma from BCa patients stratified according to disease status and bisphosphonate treatment (n=88). All P-values are from two-sided tests. RESULTS: Endo180 is released by ectodomain shedding from the surface of MCF-7 and MDA-MB-231 BCa cell lines. Plasma Endo180 was significantly higher in recurrent/metastatic (1.71±0.87; n=59) vs early/localised (0.92±0.37; n=29) BCa (P<0.0001). True/false-positive rates for metastasis classification were: 85%/50% for the reference standard, CA 15-3 antigen (28 U ml(-1)); ≤97%/≥36% for Endo180; and ≤97%/≥32% for CA 15-3 antigen+Endo180. Bisphosphonate treatment was associated with reduced Endo180 levels in BCa patients with bone metastasis (P=0.011; n=42). True/false-positive rates in bisphosphonate-naive patients (n=57) were: 68%/45% for CA 15-3 antigen; ≤95%/≥20% for Endo180; and ≤92%/≥21% for CA 15-3 antigen+Endo180. CONCLUSION: Endo180 is a potential marker modulated by bisphosphonates in metastatic BCa.

History Repeats Itself: The Relevance of Historical Pandemics to the Medical School Curriculum.

Introduction: The dramatic global impact of the coronavirus pandemic has increased consideration on epidemiological progressions of pandemics. Measures implemented to reduce viral transmission have been largely historical, comparable in nature with the 1918 and 2009 influenza pandemics, demonstrating the importance of clinicians' awareness on historical pandemics. Despite this, literature suggests medical students' knowledge on previous pandemics is poor. Objectives: This study aims to gather stakeholder information from UK medical students on the importance of including the history of pandemics in the medical school curriculum. Methods: A cross-sectional cohort study conducted via a mixed question type online survey was distributed to all UK medical schools to explore stakeholder views. Grounded theory emergent coding was used to generate themes to free-text answers and SPSS and Excel were used to analyse quantitative data using pivot tables and Fishers exact tests. Results: Two hundred and forty-one students consented to take part from eight medical schools in the UK with 98% of these students completing the questionnaire. 34% of students reported having teaching on pandemics with 78% of students stating it would be beneficial. Knowledge was poor with 5.7% of students achieving 100% on knowledge-based questions. 72% of students believed that learning about the history of medicine would be beneficial with 87% of these students referring to 'benefiting (the) future' in their answers. Additionally, 79% of students thought it would be beneficial to learn about historical pandemics with reference to the current COVID-19 pandemic. Conclusion: To date, this is the only UK based study assessing stakeholders' views on including the history of pandemics in the medical school curriculum. Our findings demonstrate that medical students wish to have more historical content included in their degree to better prepare tomorrow's doctors for situations that may occur when history repeats itself.

The endovascular management of penetrating carotid artery injuries: long-term follow-up.

OBJECTIVES: To review a single-centre experience with stent-graft treatment of penetrating carotid artery injuries and long-term follow-up. METHODS: All stable patients with carotid artery injuries presenting between August 1998 and February 2009 were considered for endovascular treatment. Patients were selected based on clinical and radiological criteria and data were prospectively collected. Follow-up was conducted clinically, angiographically and by telephonic contact. Endpoints were stroke, death and any other stent-graft-related complications. RESULTS: A total of 128 patients were treated, of whom only 19 were selected for endovascular management. The recorded technical success rate was 100%, with one early stroke and one non-stent-graft-related procedural death. A further four patients were lost to follow-up. The remaining 14 patients had a mean follow-up of nearly 4 years. No stent-graft-related late deaths, strokes or other complications were reported, although one instance of late stent-graft occlusion was documented. CONCLUSION: Endovascular management of penetrating carotid artery injuries is safe and the long-term outcomes justify a more liberal application of this technique in selected patients.

Effect of cadmium on haemocyte viability of the woodlouse Porcellio laevis (Isopoda, Crustacea).

This study investigated the effects of cadmium on haemocyte viability of the woodlouse Porcellio laevis, using the trypan blue exclusion assay. The ultimate aim is to determine the usefulness of this cellular response as biomarker of cadmium exposure. Results showed that exposure to sublethal concentrations of cadmium, with concomitant cadmium accumulation in the body, significantly lowered the percentages of viable haemocytes in P. laevis. This response was already observed after the first week of exposure and could therefore possibly serve as an early warning of cadmium exposure. A field study is needed to validate these findings.

Civilian cerebral gunshot wounds in rural South African patients are associated with significantly higher mortality rates than in urban patients.

INTRODUCTION: This study focuses on a specific and often dramatic injury, namely gunshot wounds (GSW) of the head in order to determine whether there is a discrepancy in outcome between patients who sustain their injury in a rural setting and those who sustain it in an urban setting. MATERIALS AND METHODS: This study involves a retrospective review of our prospectively maintained regional electronic trauma registry. All patients who sustained a cerebral GSW from January 2010 to December 2014 were reviewed. RESULTS: During the 5-year study period, a total of 102 patients sustained an isolated cerebral GSW. Ninety-two per cent (94/102) were male and the mean age was 29 years. Ninety-four per cent (94/102) of injuries were related to interpersonal violence. Of the 102 patients in the study, 54% (55/102) were urban and were transported directly to our trauma centre. The remaining 46% (47/102) were rural and were transported to a rural district hospital prior to being referred to our trauma centre. The time of injury was available in 60% (61/102) of patients. The mean time from injury to arrival for all patients was 11 h (SD 7). The mean time from injury to arrival was significantly shorter for urban versus rural, 6 h (SD 5) and 15 h (SD 5), respectively (p < 0.001). The median admission GCS score was significantly lower in rural compared to urban patients (p = 0.022). The need for neurosurgery, need for ICU admission or length of hospital stay was not significantly different between rural and urban patients. Rural patients have a fourfold higher mortality compared with urban patients (36 vs 9%, p = 0.001). Amongst survivors, there was no significant difference in median length of hospital stay or mean discharge GCS. CONCLUSIONS: Cerebral GSWs are highly lethal injuries associated with significant mortality. Rural patients have a significantly longer transfer time, lower GCS on arrival and higher mortality than urban patients. Efforts should be directed at improving the pre-hospital EMS system in order to reduce delay to definitive care so that patient outcome can be optimised.

Galvanic corrosion of dental cobalt-chromium alloys and dental amalgam in artificial saliva.

When two or more metals or alloys are placed in contact with one another inside the oral cavity, galvanic coupling may occur which may lead to galvanic corrosion. Galvanic corrosion may release elements from the alloy into the oral cavity with possible harm to the patient. This in vitro study was conducted to determine the extent of galvanic corrosion where different dental amalgams and Co-Cr alloy combinations were placed in contact with artificial saliva as an electrolyte. The tests were conducted with potential measurements as well as potentiodynamic and potentio-static polarisation techniques. Results showed that the galvanic corrosion current density is much lower than the corrosion current density, indicating that galvanic coupling of the samples does not have a substantial effect on the overall corrosion of the samples. The corrosion potential differences between three of the four couples were above the minimum 50 mV potential difference, which is considered a potential harmful level, with only the Wironium Plus and Dispersalloy combination being under 50 mV potential difference. It is concluded that: Galvanic corrosion does not pose a greater threat to the alloys than ordinary corrosion. A Wironium Plus and Dispersalloy combination may be the safest where a Co-Cr and amalgam combination is required in the mouth of a patient.

Developing a simplified clinical prediction score for mortality in patients with cerebral gunshot wounds: The Maritzburg Score.

Introduction Cerebral gunshot wounds are highly lethal and literature on the clinical scores for mortality prediction is limited. Materials and methods A retrospective study was undertaken over a 5-year period at the Pietermaritzburg Metropolitan Trauma Service in South Africa. A simplified clinical prediction score was developed based on clinical and/or physiological variables readily available in the resuscitation room. Results A total of 102 patients were included; 92% (94/102) were male and the mean age was 29 years; 22% (22/102) died during the admission. The presence of visible brain matter (odds ratio 12.4, P = 0.003) and motor score less than 5 (odds ratio 89.6, P  < 0.001) allows the prediction success of 92% (sensitivity 73% and specificity 98%). The area under the receiver operating characteristic curve was 94% (95% confidence interval 88-100%, P  < 0.001). Conclusions The presence of visible brain matter, together with a motor score of less than 5, allows accurate identification of non-survivors of cerebral gunshot wounds. Further study is required to validate this score.

The correlation between ATLS and junior doctors' anatomical knowledge of central venous catheter insertion at a major trauma centre in South Africa.

OBJECTIVE: To review the ability of junior doctors (JDs) in identifying the correct anatomical site for central venous catheterization (CVC) and whether prior Advanced Trauma Life Support (ATLS) training influences this. DESIGN: We performed a prospective, observational study using a structured survey and asked a group of JDs (postgraduate year 1 [PGY1] or year 2 [PGY2]) to indicate on a photograph the exact site for CVC insertion via the internal jugular (IJV) and the subclavian (SCV) approach. This study was conducted in a large metropolitan university hospital in South Africa. RESULTS: A total of 139 JDs were included. Forty-four per cent (61/139) were males and the mean age was 25 years. There were 90 PGY1s (65%) and 49 PGY2s (35%). Overall, 32% (45/139) were able to identify the correct insertion site for the IJV approach and 60% (84/139) for the SCV approach. Of the 90 PGY1s, 34% (31/90) correctly identified the insertion site for the IJV approach and 59% (53/90) for the SCV approach. Of the 49 PGY2s, 29% (14/49) correctly identified the insertion site for the IJV approach and 63% (31/49) for the SCV approach. No significant difference between PGY1 and 2 were identified. Those with ATLS provider training were significantly more likely to identify the correct site for the IJV approaches [OR=4.3, p=0.001]. This was marginally statistically significant (i.e. p>0.05 but <0.1) for the SCV approach. CONCLUSIONS: The majority of JDs do not have sufficient anatomical knowledge to identify the correct insertion site CVCs. Those who had undergone ATLS training were more likely to be able to identify the correct insertion site.

The impact of mechanism on the management and outcome of penetrating colonic trauma.

Introduction In light of continuing controversy surrounding the management of penetrating colonic injuries, we set out to compare the outcome of penetrating colonic trauma according to whether the mechanism of injury was a stab wound or a gunshot wound. Methods Our trauma registry was interrogated for the 5-year period from January 2012 to December 2016. All patients over the age of 18 years with penetrating trauma (stab or gunshot) and with intraoperatively proven colonic injury were reviewed. Details of the colonic and concurrent abdominal injuries were recorded, together with the operative management strategy. In-hospital morbidities were divided into colon-related and non-colon related morbidities. The length of hospital stay and mortality were recorded. Direct comparison was made between patients with stab wounds and gunshot wounds to the colon. Results During the 5-year study period, 257 patients sustained a colonic injury secondary to penetrating trauma; 95% (244/257) were male and the mean age was 30 years. A total of 113 (44%) sustained a gunshot wound and the remaining 56% (144/257) sustained a stab wound. Some 88% (226/257) of all patients sustained a single colonic injury, while 12% (31/257) sustained more than one colonic injury. A total of 294 colonic injuries were found at laparotomy. Multiple colonic injuries were less commonly encountered in stab wounds (6%, 9/144 vs. 19%, 22/113, P < 0.001). Primary repair was more commonly performed for stab wounds compared with gunshot wounds (118/144 vs. 59/113, P < 0.001). Patients with gunshot wounds were more likely to need admission to intensive care, more likely to experience anastomotic failure, and had higher mortality. Conclusions It would appear that colonic stab wounds and colonic gunshot wounds are different in terms of severity of the injury and in terms of outcome. While primary repair is almost always applicable to the management of colonic stab wounds, the same cannot be said for colonic gunshot wounds. The management of colonic gunshot wounds should be examined separately from that of stab wounds.

The effect of stage of HIV disease as determined by CD4 count on clinical outcomes of surgical sepsis in South Africa.

INTRODUCTION This paper reviews the impact of the stage of human immunodeficiency virus (HIV) disease on the outcome of surgical sepsis. METHODS All adult emergency general surgical patients (aged >15 years) who fulfilled the criteria for sepsis or septic shock, with a documented surgical source of infection, and who were HIV positive were reviewed. RESULTS During the 5-year study period, a total of 675 patients with a documented surgical source of sepsis were managed by our service; 142 (21%) of these were HIV positive. Among the individuals who were HIV positive, the CD4 count was <200 cells/µl in 21 patients and ≥200 cells/µl in 121 patients. There was no difference between these two cohorts in terms of demography or spectrum of surgical conditions. The range of surgical procedures and complications was also similar in both groups. Nevertheless, patients with a CD count of <200 cells/µl had a significantly longer length of hospital stay than those in the cohort with ≥200 cells/µl. For HIV positive patients with a CD4 count of <200 cells/µl, the mortality rate was 66.7% (14/21) while the mortality rate for individuals with HIV and a CD4 count of ≥200 cells/µl was 2.5% (2/121). This difference was statistically significant (p<0.001). CONCLUSIONS The clinical presentation and spectrum of surgical sepsis disease in cases with stage 1 and stage 2 HIV is not markedly different. However, in patients with a CD4 count of <200 cells/µl, the length of hospital stay and mortality is significantly higher. Stage of HIV disease must be considered when stratifying patients' risk for surgery.

Mechanical complications of central venous catheterisation in trauma patients.

INTRODUCTION Central venous catheterisation (CVC) is a commonly performed procedure in a wide variety of hospital settings and is associated with appreciable morbidity. There is a paucity of literature focusing on mechanical complications specifically in the trauma setting. The aim of our study was to determine the spectrum of mechanical complications in a high-volume trauma centre in a developing world setting where ultrasound guidance was not available. METHODS A retrospective study was performed analysing data from a four-year period at the Pietermaritzburg Metropolitan Trauma Service in South Africa. RESULTS A total of 178 mechanical complications (18%) occurred in 1,015 patients undergoing CVC: 117 pneumothoraces, 25 malpositions, 18 catheter dislodgements, 14 arterial cannulations, one air embolism, one chylothorax, one pleural cannulation and one retained guide-wire. The internal jugular vein (IJV) approach was associated with a higher overall complication rate than the subclavian vein (SCV) approach (24% vs. 13%, p<0.001). Pneumothorax (73% vs. 57%, p<0.001) and arterial cannulation (15% vs. 0%, p<0.001) were more common with the IJV. Catheter dislodgement (21% vs. 0%, p<0.001) was more common with the SCV. Junior doctors performed 66% of the CVCs and this was associated with a significantly higher complication rate (20% vs. 12%, p<0.001). CONCLUSIONS CVC carries appreciable morbidity, with pneumothorax being the most frequent mechanical complication. The SCV was the most commonly used approach at our institution. The majority of CVCs were performed by junior doctors and this was associated with a considerable complication rate.

The spectrum and outcome of surgical sepsis in Pietermaritzburg, South Africa.

BACKGROUND: Sepsis is a leading cause of morbidity and mortality worldwide, and the incidence appears to be increasing. In the resource-limited environment in low- and middle-income countries, the management of surgical sepsis (SS) continues to represent a significant portion of the workload for most general surgeons. OBJECTIVE: To describe the spectrum of SS seen at a busy emergency department, and categorise the outcomes. METHODS: The Pietermaritzburg Metropolitan Trauma Service (PMTS) and Pietermaritzburg Metropolitan Surgical Service (PMSS) in KwaZulu-Natal Province, South Africa (SA), maintain a prospective electronic registry. All patients with features of sepsis among emergency general surgical patients >15 years of age admitted to the PMSS over the period January 2012 - January 2015 were identified. From this cohort, all patients with sepsis that required surgical source control or who had a documented surgical source of sepsis (i.e. had SS) were selected for analysis. RESULTS: Of a total of 6 020 adult surgical patients on the database, a cohort of 1 240 acute surgical patients with features of sepsis were identified, and 675 with SS were then analysed further. Of the 675 patients, 49.2% were male, and the mean age was 46 years (standard deviation (SD) 19); 47.0% presented to the PMSS directly from within the metropolitan area, while the remaining 53.0% were referred from hospitals outside the area. Physiological parameters (mean values) on presentation were as follows: systolic blood pressure 123 mmHg (standard deviation (SD) 23), respiratory rate 22 breaths/min (SD 5.2), heart rate 107 bpm (SD 19), temperature 37°C (SD 2) and white cell count 20 × 109/L (SD 8). Of the patients, 21.6% were known to be HIV-positive, 13.5% (91/675) were negative and 64.9% were of unknown status; 57.6% had intra-abdominal sepsis, 26.1% diabetes-related limb sepsis and the remaining 16.3% soft-tissue infections; 17.5% required intensive care unit admission, with a mean length of stay of 4 days (SD 4), and 30.7% developed complications. In this last group (n=207), a total of 313 morbidities were identified. The overall mortality rate was 12.7% (86/675). The mortality rate for intra-abdominal sepsis was 13.1%, for diabetic foot sepsis 14.2% and for necrotising fasciitis 27.3%. CONCLUSIONS: The spectrum of SS in SA is different to that seen in the developed world. Intra-abdominal sepsis is the most common SS and is overwhelmingly caused by acute appendicitis. Diabetic foot infection is a major cause of SS, reflecting the increasing burden of non-communicable chronic diseases in SA.

Science-based assessment of animal welfare: companion animals.

Human history reveals that the way in which humans treat animals is based on their views of themselves as well as of the living environment around them. These views may vary from an assumption of human superiority to one of equality between humans and animals. Recent trends affecting companion-animal welfare are: modern philosophies on animal issues, the specialised and varied roles that companion animals play in modern societies, new results from animal neuroscience, human-animal interaction studies and the new profession of companion animal ethology. This paper concludes that applied ethology could provide science-based criteria to assess companion-animal welfare. Due to the integral part that companion animals play in human societies, the paper is divided into an animal component that deals with the animal's basic needs and its ability to adapt, and a human component assessing the living environment of animals as provided by humans and responsible companion-animal ownership. The greatest challenge for future research is to find ways to disseminate knowledge of companion animal ethology to companion animal owners.

Animal-assisted therapy - magic or medicine?

A sound theoretical basis supported by scientifically measured physiological parameters is needed to gain medical support for animal-assisted therapy. Six neurochemicals associated with a decrease in blood pressure were measured in humans (n=18) and dogs (n=18) before and after positive interaction. Results (P<.05) indicated that in both species the neurochemicals involved with attention-seeking or attentionis egens behavior have increased. This information can be used as a rationale for animal-assisted therapy.

Neurophysiological correlates of affiliative behaviour between humans and dogs.

Few physiological parameters for positive human-companion animal contact have been identified and those that are established have all been in humans. The implication is that if the physiological reactions are mutual, dogs would experience the same psychological benefits from these neurophysiological changes as humans. Therefore, we have determined the role of certain neurochemicals during affiliation behaviour on an interspecies basis. Our results indicate that concentrations of beta-endorphin, oxytocin, prolactin, beta-phenylethylamine, and dopamine increased in both species after positive interspecies interaction, while that of cortisol decreased in the humans only. Indicators of mutual physiological changes during positive interaction between dog lovers and dogs may contribute to a better understanding of the human-animal bond in veterinary practice.