Search

Background: The Rapid Molecular Test (RMT) Gene Xpert is widely used as a control strategies and surveillance for tuberculosis (TB). In the region of the Americas TB incidence is slowly increasing, owing to an upward trend in Brazil, which is among the high TB burden countries (HBCs) ranking the 19th position. In this context, we aimed to: (i) describe the implementation and history of RMT-TB (Xpert® MTB/RIF and Xpert® MTB/RIF Ultra) in Brazil; (ii) to evaluate the national RMT-laboratory distribution and TB and RIF detection by RMT-TB equipment (by year, by federal units and by region); and (iii) to correlate these data the Brazilian TB incidence. Methods: For this, we collected the quantitative data of Xpert® MTB/RIF and Xpert® MTB/RIF Ultra assays, performed in the pulmonary TB investigation from 2014 to 2020, provided by the Brazilian Ministry of Health. A spatial visualization using ArcGIS software was performed. Results: The Southeast region allocated about double RMT-laboratories from 39.4% - 45.9% of the total value over five which is the number of regions. Regarding the federal units, the São Paulo state allocated alone from 20.2% to 34.1% (5.0 to 8.5 times the value) of RMT-laboratories depending on the year observed. There were significant differences (p < 0.0001) in the frequency of RMT-laboratory in all years of the historical series. There was an unequal distribution of RMT-laboratory between Brazilian regions and federal units. Conclusions: This alerts for the surveillance of rapid molecular detection of TB in different parts of the country, with the possibility of improving the distribution of tests in areas of higher incidence to achieve the disease control recommended by national and worldwide authorities.

The hemotherapy service in health units with high surgical demand has been pointed out as a challenge, especially concerning storage management simultaneously with transfusion demand attendance. The objective of this study is to analyze service efficacy after the implementation of a new strategy to meet storage and transfusion demands. The present study analyzed the records of the hemotherapy service related to blood components management in surgeries where blood reserve was necessary for RhD positive patients at the National Institute of Traumatology and Orthopedics. A shared compatibility test and surgery reserve from the first semester of 2018 was compared to an equivalent period in 2017, prior to its implementation, under an individualized protocol to each patient scheduled on the surgery map. After the implementation of the shared protocol, the transfusion demand was higher, due to an increase in the percentage of surgeries that required transfusion, as well as to the augmented number of blood components used in the surgeries. Even in the presence of a slight decrease in storage, the hemotherapy assistance was considered efficient, since the percentage of surgery suspension reduced from 2 % to 0.2 % after the implementation of the shared protocol. This improvement resulted in an adjustment in the classification of reasons for surgical procedure cancellations, so that the reason "blood shortage" was repositioned from the first to the seventeenth position. This is the first record of a shared compatibility protocol and surgery reserve and we hope to contribute to the development of the hemotherapy service and surgical patient healthcare.