ИЗУЧЕНИЕ РАЗНООБРАЗИЯ БАКТЕРИОФАГОВ ЛАКТОКОККОВ, ВЫДЕЛЕННЫХ ИЗ ФЕРМЕНТИРОВАННЫХ МОЛОЧНЫХ ПРОДУКТОВ, С ИСПОЛЬЗОВАНИЕМ МОЛЕКУЛЯРНО-ГЕНЕТИЧЕСКИХ МЕТОДОВ

For production of fermented milk products in the territory of the Republic of Belarus, lactic acid bacteria related to p. Lactococcus are used more often. Continuous phage monitoring makes it possible to limit economic losses due to phagolysis at production of fermented milk products, as well as to reduce the risk of contamination of finished products with pathogenic microbiota. It is necessary to identify and determine the properties of bacteriophages for that circulating at enterprises, considering that at each individual enterprise there are no specific types (kinds) of phages, which is due to the assortment of products, types of ferments used and hygiene conditions. The article dwells on studies on isolation and characterization of lactococci bacteriophages. Of the 51 phagocontaining samples of products selected in the territory of the Republic of Belarus, 68 bacteriophages have been isolated. The spectrum of their lytic activity was determined. Based on the results of PCR with species specific primers, 39 bacteriophages are classified as C2 type. One bacteriophage was identified as P335 according to PCR results. 939 type bacteriophages were not detected among the isolated viruses. Differentiation of C2 type lactococcal phages was carried out. A selection of the restriction enzymes allowing to distinguish phages inside the C2 type is carried out. A scheme of intraspecific differentiation of lactococci bacteriophages was developed using RFLP analysis. RFLP-analysis allowed to divide 39 lactophages of type C2 into six groups. Acknowledgements. The work was carried out within the framework of research under task 9.5.50 “Study of species diversity of lactic acid bacteria obtained from natural sources, variability of lactococci phages obtained at milk processing plants, depending on season and region” of GPNI “Innovative technologies in agro-industrial complex”. В производстве ферментированных молочных продуктов на территории Республики Беларусь чаще других используют молочнокислые бактерии, относящиеся к р. Lactococcus. Непрерывный фаговый мониторинг позволяет ограничить экономические потери от фаголизиса при производстве кисломолочных продуктов, а также снизить риск контаминации готовой продукции патогенной микробиотой. Для этого необходимо выделять, идентифицировать, определять свойства бактериофагов, циркулирующих на предприятиях, принимая во внимание, что на каждом отдельном предприятии присутствуют определенные виды (типы) фагов, что обусловлено ассортиментом выпускаемой продукции, применяемыми видами заквасок и соблюдением санитарно-гигиенических условий. В статье представлены исследования по выделению и характеристике бактериофагов лактококков. Из 51 фагосодержа- щего образца продукции, отобранного на территории Республики Беларусь, выделено 68 бактериофагов. Определен спектр их литической активности. На основании результатов ПЦР с видоспецифичными праймерами 39 бактериофагов отнесены к виду С2. Один бактериофаг по результатам ПЦР идентифицирован как вид Р335. Бактериофагов вида 936 среди выделенных вирусов не выявлено. Проведена дифференциация лактококкофагов вида С2. Проведен подбор рестриктаз, позволяющих различать фаги внутри вида С2. Разработана схема внутривидовой дифференциации бактериофагов лактококков с помощью ПДРФ-анализа. Использование ПДРФ-анализа позволило разделить 39 лактофагов вида С2 на шесть групп. Благодарности. Работа выполнена в рамках исследований по заданию 9.5.50 «Изучение видового разнообразия молочнокислых бактерий, выделенных из природных источников, изменчивости фагов лактококков, выделенных на молокоперерабатывающих предприятиях, в зависимости от сезонности и региональности» ГПНИ «Инновационные технологии в АПК»

Qualitative evaluation of a deferred consent process in paediatric emergency research: a PREDICT study

Background: A challenge of conducting research in critically ill children is that the therapeutic window for the intervention may be too short to seek informed consent prior to enrolment. In specific circumstances, most international ethical guidelines allow for children to be enrolled in research with informed consent obtained later, termed deferred consent (DC) or retrospective consent. There is a paucity of data on the attitudes of parents to this method of enrolment in paediatric emergency research. Objectives: To explore the attitudes of parents to the concept of DC and to expand the knowledge of the limitations to informed consent and DC in these situations.MethodChildren presenting with uncomplicated febrile seizures or bronchiolitis were identified from three separate hospital emergency department databases. Parents were invited to participate in a semistructured telephone interview exploring themes of limitations of prospective informed consent, acceptability of the DC process and the most appropriate time to seek DC. Transcripts underwent inductive thematic analysis with intercoder agreement, using Nvivo 11 software. Results: A total of 39 interviews were conducted. Participants comprehended the limitations of informed consent under emergency circumstances and were generally supportive of DC. However, they frequently confused concepts of clinical care and research, and support for participation was commonly linked to their belief of personal benefit. Conclusion: Participants acknowledged the requirement for alternatives to prospective informed consent in emergency research, and were supportive of the concept of DC. Our results suggest that current research practice seems to align with community expectations.</jats:sec

Treatment patterns and frequency of key outcomes in acute severe asthma in children: A Paediatric Research in Emergency Departments International Collaborative (PREDICT) multicentre cohort study

Rationale: Severe acute paediatric asthma may require treatment escalation beyond systemic corticosteroids, inhaled bronchodilators and lowflow oxygen. Current large asthma datasets report parenteral therapy only. Objectives To identify the use and type of escalation of treatment in children presenting to hospital with acute severe asthma. Methods: Retrospective cohort study of children with an emergency department diagnosis of asthma or wheeze at 18 Australian and New Zealand hospitals. The main outcomes were use and type of escalation treatment (defined as any of intensive care unit admission, nebulised magnesium, respiratory support or parenteral bronchodilator treatment) and hospital length of stay (LOS). Measurements and main results: Of 14 029 children (median age 3 (IQR 1–3) years; 62.9% male), 1020 (7.3%, 95% CI 6.9% to 7.7%) had treatment escalation. Children with treatment escalation had a longer LOS (44.2 hours, IQR 27.3–63.2 hours) than children without escalation 6.7 hours, IQR 3.5–16.3 hours; p<0.001). The most common treatment escalations were respiratory support alone (400; 2.9%, 95% CI 2.6% to 3.1%), parenteral bronchodilator treatment alone (380; 2.7%, 95% CI 2.5% to 3.0%) and both respiratory support and parenteral bronchodilator treatment (209; 1.5%, 95% CI 1.3% to 1.7%). Respiratory support was predominantly nasal high-flow therapy (99.0%). The most common intravenous medication regimens were: magnesium alone (50.4%), magnesium and aminophylline (24.6%) and magnesium and salbutamol (10.0%).Simon Craig ... Charmaine Gray ... Amit Kochar ... et. a

A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): The Australasian Paediatric Head Injury Rules Study (APHIRST)

Background: Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting.Methods/design: This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The performance accuracy of each of the rules will be assessed using rule specific outcomes and inclusion and exclusion criteria.Discussion: This study will allow the simultaneous comparative application and validation of three major paediatric head injury clinical decision rules outside their derivation setting.Trial registration: The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR)- ACTRN12614000463673 (registered 2 May 2014). © 2014 Babl et al.; licensee BioMed Central Ltd

First results from the status Epilepticus Australasian registry for children (SEARCh). Multicentre, prospective, observational cohort study of paediatric status epilepticus

Background: Status Epilepticus (SE) is the most frequent neurological emergency in children, with a high morbidity and mortality. There are no prospective national Australian emergency department (ED) data on SE. Objective: To determine clinical characteristics and management of SE in children in Australian EDs. Methods: Prospective, observational cohort study at 4 mixed and tertiary paediatric ED in Australia. Participants were included if presenting with SE (seizure duration >5 min). We present descriptive data on clinical characteristics and management as medians (IQR) using APLS dosing as gold standard. Results: 172 children were enrolled: age 4.0 years (1.8 to 8.5), weight 18.0 kg (12.3 to 26.8) and 50.0% were male. Seizure duration was 15.0 min (7.0 to 40.0). The majority of patients arrived by ambulance (73.8%) and had a history of prior seizures/epilepsy (67.4%). Benzodiazepines were administered by parents/caregivers 45/172 (26.2%), prehospital 58/172 (33.7%) and in ED, 43/172 (25.0%) and were administered after seizure onset at 12.5 min (7–18.1), 13.1 min (9.3–19.3) and 125 min (70–250) respectively. Median doses of benzodiazepines were 0.2 mg (0.1–0.3) and 0.2 (0.1–0.2). Second line drugs (phenytoin or leviteracetam) was administered in ED 21/172 (12.2%) of patients at 125.0 min (70.0–250.0). On discharge, the most common diagnosis was convulsive SE and focal motor SE with prominent motor signs. Disposition included 6.9% ICU and 93.1% ward. Conclusion: Children with SE are generally treated as per APLS guidelines. However, there is a large scope for earlier treatment with both benzodiazepines and second line drugs

Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy randomised controlled trail

Objective: To determine if intravenous paracetamol was superior to oral paracetamol as an adjunct to opioids in the management of moderate to severe pain in the ED setting. Methods: A prospective, randomised, double-blind, double-dummy, controlled trial was conducted at a single academic tertiary care ED. Adult patients with moderate to severe pain were randomly assigned to receive either the intravenous paracetamol or oral paracetamol. The primary outcome was Visual Analogue Scale (VAS) pain reduction at 30 min. A clinically significant change in pain was defined as 13 mm. Results: 87 participants were included in the final analysis, with a median age of 43.5 years and 59.8% were female. Overall mean baseline VAS pain score was 67.9 mm (±16.0). Both formulations achieved a clinically significant mean pain score reduction at 30 min, with no significant difference between the groups with 16.0 mm (SD 19.1 mm) in the intravenous group and 14.6 mm (SD 26.4) in the oral group; difference −1.4 mm (95% CI −11.6 to 8.8, P=0.79). Secondary outcomes, including postintervention intravenous opioid administration, patient satisfaction, side effects and length of stay, did not differ between groups. Conclusions: Overall, there was a small but clinically significant decrease in pain in each group. No superiority was demonstrated in this trial with intravenous paracetamol compared with oral paracetamol in terms of efficacy of analgesia and no difference in length of stay, patient satisfaction, need for rescue analgesia or side effects

Seizure- and syncope-related head injuries in children: A prospective PREDICT cohort study

Abstract not available.Nitaa Eapen, Amit Kochar, Mark D Lyttle, Natalie Phillips, John A Cheek, Jeremy Furyk, Jocelyn Neutze, Silvia Bressan, Amanda Williams, Stephen Hearps, Ed Oakley, Stuart R Dalziel, Meredith L Borlan