Euroforgen-NoE collaborative exercise on LRmix to demonstrate standardization of the interpretation of complex DNA profiles.

There has been very little work published on the variation of reporting practices of mixtures between laboratories, but it has been previously demonstrated that there is little consistency. This is because there is no current uniformity of practice, so different laboratories will operate using different rules. The interpretation of mixtures is not solely a matter of using some software to provide 'an answer'. An assessment of a case will usually begin with a consideration of the circumstances of a crime. Assumptions made about the numbers of contributors follow from an examination of the electropherogram(s)--and these may differ between the prosecution and the defence hypotheses. There may be a necessity to evaluate several sets of hypotheses for any given case if the circumstances are uncertain. Once the hypotheses are formulated, the mathematical analysis is complex and can only be accomplished by the use of specialist software. In order to obtain meaningful results, it is essential that scientists are trained, not only in the use of the software, but also in the methodology to understand the likelihood ratio concept that is used. The Euroforgen-NoE initiative has developed a training course that utilizes the LRmix program to carry out the calculations. This software encompasses the recommendations of the ISFG DNA commissions on mixture interpretation and is able to interpret samples that may come from two or more contributors and may also be partial profiles. Recently, eighteen different laboratories were trained in the methodology. Afterwards they were asked to independently analyze two different cases with partial mixture DNA evidence and to write a statement court-report. We show that by introducing a structured training programme, it is possible to demonstrate, for the first time, that a high degree of standardization, leading to uniformity of results can be achieved by participating laboratories.

Tubercoulosis en el área sanitaria de Cádiz: Evolución de la resistencia durante los úlitmos 15 años / Tuberculosis in Area Health of Cádiz, Spain: Evolution of Resistance during the Last 15 Years

Introducción: La tuberculosis sigue siendo frecuente en el mundo y la Resistencia constituye un problema importante. Este trabajo presenta los casos diagnosticados por cultivo con (..) (AU)

Introduction: Tuberculosis remains prevalent worldwide, and drug resistance is an important problem. This report presents the results of the study (..) (AU)

Utilidad de la fibrobroncoscopia en las intubaciones traqueales difíciles / Usefulness of fiberoptic bronchoscopy for difficult tracheal intubations

La fibrobroncoscopia (FB) representa una gran ayuda para la realización de intubaciones difíciles o fallidas por los métodos convencionales. Nuestro objetivo fue conocer el número de intubaciones realizadas mediante FB, así como características de las mismas y analizar los problemas detectados en base a la experiencia acumulada. Metodología: Se recogieron todas las intubaciones realizadas con control de FB, desde enero de 1996 hasta Octubre de 2005.En ésta figuraban el servicio solicitante de la intubación y el de procedencia del paciente, el motivo de la intubación y complicaciones de la técnica. Resultados: Se realizaron un total de 4291 FB delas cuales el 11% fueron intubaciones guiadas con FB. La edad media fue 53,6 años, siendo el 77,2% varones. Casi todas las intubaciones fueron solicitadas por el servicio de anestesia (95,7%).Los servicios de procedencia de los pacientes fueron cirugía general32%, cirugía maxilofacial (MXF) 31,1%, traumatología 14,7%,Otorrinolaringología (ORL) 8,3%, Unidad de Cuidados Intensivos/Unidad de Reanimación Postoperatoria 4,3%, neurocirugía4,1% y otros 5,3%. Las indicaciones fueron intubaciones bronquiales selectivas 23%, tumores MXF 22,6%, rigidez cervical8,5%, limitación en la apertura de la boca 8,3%, obesidad 7%,tumores ORL 4,3%, fracturas MXF, síndrome de apnea del sueño y espondilitis anquilosante el 3,6% respectivamente, patología tiroidea, artritis reumatoide y reintubación el 3,2% y otros en el5,3%. Se produjeron complicaciones (4,2%) todas de escasa importancia. En 5 casos (1%) no se consiguió la intubación con control FB. Conclusiones: la intubación guiada con FB es una técnica segura y con una elevada rentabilidad en los casos de intubaciones difíciles o fallidas con los medios convencionales

The fiber optic bronchoscopy (FB) represents a great help for difficult or failed intubations by conventional methods. The objective was to know the number of intubations performed by FB, as well as the characteristics of these intubations and, in our experience, to analyze the problems detected during these intubations. Methodology: we analyzed in a data base all the intubations performed by FB guidance, from January 1996 to October 2005. In this database we recorded the services that had asked for the intubation, the admission service of the patient, the reason for the intubation and complications. Results: From a total of 4.291 FB performed,11% were FB to guide intubations. Almost all the intubations were asked for by the an a esthesiology service (95.7%).The admission services of the patients were General Surgery 32%,Maxillofacial (MF) Surgery 31.1%, Traumatology 14.7%, Otorhinolaryngology(ORL) 8.3%, Intensive Care Unit/Postoperative Reanimation Unit 4.3%, Neurosurgery 4.1%, and other services5.3%. The most frequent reasons for the intubations were selective bronchial intubations 23%, MF tumors 22.6%, cervical rigidity8.5%, limitations in the opening of the mouth 8.3%, obesity 7%,ORL tumors 4.3%, MF fractures, sleep apnea syndrome and ankylosing spondylitis 3.6% respectively, thyroid diseases, rheumatoid arthritis and reintubation 3.2% and other 5.3%. We recorded a4.2% rate of mild complications, all of little importance. In 5 cases(1%) the intubation guided by FB was impossible. Conclusions: The intubation guided by FB is a safe technique and with a high yield in the cases of difficult or failed intubations by conventional methods

Staff training influence on non-invasive ventilation outcome for acute hypercapnic respiratory failure.

BACKGROUND: Although non-invasive ventilation (NIV) efficacy in the treatment of acute hypercapnic respiratory failure (AHRF) have been previously demonstrated, not all the studies reveal this fact in the same degree, with some variability in the results. This study aimed to analyse variables related to NIV outcome for AHRF. METHODS: A group of consecutive patients requiring NIV due to AHRF were included in a prospective observational cohort study performed in conventional wards. Variables considered included those reported in the literature, as well as staff problems during the management of the ventilators. The study aimed to include all patients during one year, but after the initial results, it had to be suspended. RESULTS: Fifteen patients were included in the study: 10 males, mean age 68+/-12. APACHE-II score was 17.6+/-6.5. pH and pCO2 before NIV were 7.22+/-0.11 and 110+/-72 mmHg respectively. pH, corticosteroids use, APACHE score, and EPAP were found to influence outcome. Besides, an inadequate use of NIV due to lack of personnel training was detected in all patients with NIV failure (RR 3.5; 95% CI: 1.08-11.2; p = 0.007). In the light of these results, the study had to be suspended and patients were transferred to the respiratory ward. CONCLUSIONS: NIV is a life-saving respiratory treatment influenced by several factors, of which staff training is a key one. Centres attending acute respiratory patients should have an area in which this requirement is fulfilled.

Tuberculosis multirresistente en la Bahía de Cádiz / Multidrug-resistant tuberculosis in the Bay of Cadiz, Spain

Estudiamos 182 pacientes diagnosticados de tuberculosis con el fin de conocer la incidencia de multirresistencia en la Bahía de Cádiz. Las cepas responsables, 173 Mycobacterium tuberculosis y 9 M. hovis, se identificaron mediante hibridación con sondas y técnicas moleculares de RFLP (restriction fragment length Poli morphism) y spoligotyping (spacer oligonucle olido typing). Se detectó algún tipo de resistencia en 51 pacientes (28,0 por ciento), primaria en el 20,9 por ciento y secundaria en el 7, I por ciento. Encontramos cepas multirresistentes en un 12,6 por ciento de pacientes (23,1 por ciento VIII positivos v 8,5 por ciento VIH negativos). La tasa de multirresistencia en Cádiz es superior a las detectadas en otras zonas de España y se asocia preferentemente con infección por el virus de la inmunodeficiencia humana (AU)

[Bronchial atresia and bronchogenic cyst in an adult]. / Atresia bronquial y quiste broncogénico en un adulto.

We present the case of an asymptomatic patient, with a right paracardiac mass discovered in a preoperative radiologic study. The bronchoscopy showed the intermedius bronchus atresia, finished in bottom of sack, with absence of middle and lower right lobes. With the chest computed tomographic scan, two lobulated contour mediastinal masses were seen. The patient was submitted to surgery, being the pathological findings consistent with bronchogenic cysts with atresia of the intermediarius bronchus. The patient evolved favourably after surgery.