There are an estimated 10 million new cases of tuberculosis worldwide annually, with 282,000 new or relapsed cases each year reported from the Americas. With improvements in genome sequencing technology, it is now possible to study the genetic diversity of tuberculosis with much greater resolution. Although tuberculosis bacteria do not engage in horizontal gene transfer, the genome is far more variable than previously thought. The study of genome-wide variation in tuberculosis has improved our understanding of the evolutionary origins of tuberculosis, the arrival of tuberculosis in Latin America, the genetic determinants of drug resistance, and lineage-specific associations with important clinical phenotypes. This article reviews what is known about the arrival of tuberculosis in Latin America, the genetic diversity of tuberculosis in Latin America, and the genotypic determinants of clinical phenotypes.

No abstract

Background Peri- and postnatal events involving newborns occur 24/7 and to improve the quality of care given to this group of babies on NICUs, there has been calls from, Academy of Royal Medical Colleges, RCPCH, BAPM, government (DoH Neonatal Toolkit) to add on or augment the tier 3 level medical staffing out-of-hours leading to a consultant-delivered type of service. This has also become necessary to help plug the shortage in tier 2 medical staffing as a result of the MMC agenda and EWTD. The provision of this level of service, offers a lot of benefits including rapid appropriate diagnosis, intervention, clinical management decision making, more efficient use of resources, improves parent’s experience and arguably outcomes. From the training viewpoint, the contact time of trainees with consultants is also optimised leading to better supervised training. As a progressive specialty, some NICUs over the last few years, have introduced and incorporated Resident Neonatal Consultant (RNC) roles into their rotas. This is the very first national survey looking at the current use of these group of specialist Aims To determine- number of L3 NICUs that employ RNCs total number employed levels of medical staff cover at night (as a proxy of out-of-hours cover) whether this involves RNCs and at what tier Night medical roles of ANNPs Methods Telephone interview survey L3 NICUs in UK Period Oct –Dec 2013 Results All L3 NICUs were surveyed = 63 Employed in 11/63 (17.5%) of Trust = England 5/42 (12%); Scotland 6/9 (67%); Wales 0/6; NI 0/5 (Figure 1) Total Number employed 48.5 = England 27.5; Scotland 21 Number of night they cover = 2–7 nights/week Number who are used on Tier 2 & 3 rota = 7 & 4 (and dual role in 3) Units with 1, 2, 3 and 4 medical staff at night= 3, 38, 17 and 5 respectively Figure 2) Units using ANNPs on night medical rota = 22/63. Abstract G120(P) Figure 1 No Resident Neonatal Consultants employed in Level 3 NICUs. Abstract G120(P) Figure 2 Night staffing on Level 3 NICUS. Conclusions <1/5 of L3 NICUs in UK are using RNC at both Tier 2 and 3 with a dual purpose of covering middle grade rota (tier 2) and to improve services through consultant-delivered care (tier 3) Scottish NICUs lead the way in the used of RNCs Level of medical staff night cover varies ANNPs play a crucial role in the medical staffing of NICUs