Índice de recoletas em um laboratório privado de Salvador-BA no ano de 2019

Introdução: O uso dos indicadores da qualidade faz parte do acompanhamento sistemático do desempenho nos processos analíticos laboratoriais, apresentando informações que ajudam a identificar oportunidades de melhoria. Os laboratórios clínicos têm passado por constantes aprimoramentos, especialmente através da evolução tecnológica de instrumentos e equipamentos, bem como atualização e surgimento de novas ferramentas de gestão aplicadas à análise de qualidade, proporcionando mais segurança e confiabilidade em seus processos. Objetivo: Apresentar os índices de recoletas gerados pelo laboratório no período de um ano em um laboratório privado na cidade de Salvador, identificando principais erros na fase pré-analítica. Métodos: Os resultados foram coletados através do sistema de informatização utilizado pelo laboratório para construção da base de dados. Trata-se de um estudo descritivo exploratório no qual foram utilizados dados acerca dos interferentes laboratoriais de um laboratório de análises clínicas privado na cidade de Salvador-Ba, durante o ano de 2019. Resultados: A partir dos parâmetros pré-analíticos avaliados foi possível observar que a falha na coleta é indicador mais frequente, seguido pela presença de coágulo na amostra e falhas na área técnica e/ou no laboratório de apoio, respectivamente. Conclusão: A necessidade de recoleta pode causar desconforto ao paciente, aumentando a repetição inapropriada de exames, tendo impacto direto sobre os custos dos recursos do laboratório clínico. Com a descrição desses elementos será possível construir evidências para avaliação da necessidade da implementação de um sistema de qualidade no laboratório que visem à educação continuada, possibilitando ações corretivas e preventivas para minimizar os problemas.

Introduction: The use of quality indicators is part of the systematic monitoring of performance in laboratory analytical processes, presenting information that helps identify opportunities for improvement. Clinical laboratories have undergone constant improvements, especially through the technological evolution of instruments and equipment, as well as updating and emergence of new management tools applied to quality analysis, providing more safety and reliability in their processes. Objective: To present the recollect rates generated by the laboratory over a period of one year in a private laboratory in the city of Salvador, identifying main errors in the pre-analytical phase. Methods: This is a descriptive exploratory study in which data were used on laboratory interferences from a private clinical analysis laboratory in the city of Salvador-Ba, during 2019. Results: From the pre-analytical parameters evaluated, it was possible to observe that the failure in the collection is the most frequent indicator, followed by the presence of clot in the sample and failures in technical area and/or in the support laboratory, respectively. Conclusion: The need for recollection can cause discomfort to the patient, increasing the inappropriate repetition of tests, having a direct impact on the costs of the resources of the clinical laboratory. With the description of these elements it will be possible to build evidence to avoid the need for the implementation of a quality system in the laboratory aimed at continuing education, enabling corrective and preventive actions to minimize problems.

Line immunoassay for confirmation and discrimination of human t-cell lymphotropic virus infections in inconclusive western blot serum samples from Brazil

Difficulties in confirming and discriminating human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infections by serological Western blot (WB) assays (HTLV Blot 2.4; MP Biomedicals) have been reported in Brazil, mainly in HIV/AIDS patients, with a large number of WB-indeterminate and WB-positive but HTLV-untypeable results. Nonetheless, a line immunoassay (LIA) (INNO-LIA HTLV-I/II; Fujirebio) provided enhanced specificity and sensitivity for confirming HTLV-1/2 infections. To add information concerning the improved ability of the LIA in relation to WB when applied to samples of individuals from different risk groups from Brazil, we performed the present study. Three groups were analyzed group 1 (G1), with 62 samples from HIV/AIDS patients from São Paulo, SP (48 WB indeterminate and 14 HTLV untypeable); group 2 (G2), with 24 samples from patients with hepatitis B or hepatitis C from São Paulo (21 WB indeterminate and 3 HTLV untypeable; 17 HIV seropositive); and group 3 (G3), with 25 samples from an HTLV outpatient clinic in Salvador, Bahia (16 WB indeterminate and 9 HTLV untypeable; all HIV seronegative). Overall, the LIA confirmed HTLV-1/2 infection (HTLV-1, HTLV-2, or HTLV) in 66.1% (G1), 83.3% (G2), and 76.0% (G3) of samples. Interestingly, the majority of WB-indeterminate results were confirmed by the LIA as being HTLV-2 positive in G1 and G2 but not in G3, in which the samples were defined as being HTLV-1 or HTLV positive. These results agree with the virus types that circulate in such patients of different regions in Brazil and emphasize that the LIA is the bes

Oficinas terapêuticas em Centro de Atenção Psicossocial: para além dos muros da loucura / Therapeutic workshops in Psychosocial Care Center: beyond the walls of madness

Objetivo: refletir sobre oficinas terapêuticas como atividades que possibilitam consolidar o processo de mudança e a inserção social de pessoas com transtornos mentais em Centros de Atenção Psicossocial. Metodologia: trata-se de um estudo de reflexão, com apoio na literatura sobre a temática. O levantamento de dados ocorreu no período de outubro a dezembro de 2017. Resultados: as oficinas terapêuticas são atividades que contribuem para a efetivação da mudança social acerca da loucura e para a inclusão de pessoas com transtornos mentais no cotidiano familiar, na comunidade e do próprio agir do sujeito. Visam à melhoria na qualidade de vida dos usuários do serviço, incentivadas pela abordagem multidisciplinar, tomando como norte a visão de que os profissionais atuem contribuindo para a reabilitação psicossocial dos usuários e para o aprendizado de novos saberes, numa relação dialógica. Considerações finais: é necessário um incessante espírito de reflexão crítica acerca do trabalho em oficinas terapêuticas para se evitar cair nas armadilhas da segregação de cuidado e se avançar na reabilitação.

Objective: to reflect on therapeutic workshops as activities that make it possible to consolidate the process of change and social insertion of people with mental disorders in Psychosocial Care Centers. Methodology: this is a reflection study, supported by the literature on the subject. The data collection took place from October to December 2017. Results: Therapeutic workshops are activities that contribute to the realization of social change about madness and to the inclusion of people with mental disorders in the family's daily life, in the community and in the subject's own actions. They aim to improve the quality of life of service users, encouraged by the multidisciplinary approach, taking as a guideline that professionals act contributing to the psychosocial rehabilitation of users and to the learning of new knowledge, in a dialogical relationship. Final considerations: an incessant spirit of critical reflection on working in therapeutic workshops is necessary to avoid falling in to the pitfalls of segregation of care and advancing rehabilitation.

Performance of commercially available serological screening Tests for human T-Cell lymphotropic virus infection in Brazil

ABSTRACT Serological screening for human T-cell lymphotropic virus type 1 (HTLV-1) is usually performed using enzyme-linked immunosorbent assay (ELISA), particle agglutination, or chemiluminescence assay kits. Due to an antigen matrix improvement entailing the use of new HTLV antigens and changes in the format of HTLV screening tests, as well as newly introduced chemiluminescence assays (CLIAs), a systematic evaluation of the accuracy of currently available commercial tests is warranted. We aimed to assess the performance of commercially available screening tests for HTLV infection diagnosis. A diagnostic accuracy study was conducted on a panel of 397 plasma samples: 200 HTLV-negative plasma samples, 170 HTLV-positive plasma samples, and 27 plasma samples indeterminate by Western blotting (WB). WB-indeterminate samples (i.e., those yielding no specific bands for HTLV-1 and/or HTLV-2) were assessed by PCR, and the results were used to compare agreement among the commercially available ELISA screening tests. For performance analysis, WB-indeterminate samples were excluded, resulting in a final study panel of 370 samples. Three ELISA kits (Murex HTLV-1/2 [Murex], anti-HTLV-1/2 SYM Solution [SYM Solution], and Gold ELISA HTLV-1/2 [Gold ELISA]) and one CLIA kit (Architect rHTLV- 1/2) were evaluated. All screening tests demonstrated 100% sensitivity. Concerning the HTLV-negative samples, the SYM Solution and Gold ELISA kits had specificity values of 99.5%, while the Architect rHTLV-1/2 test presented 98.1% specificity, followed by Murex, which had a specificity of 92.0%. Regarding the 27 samples with WB-indeterminate results, after PCR confirmation, all ELISA kits showed 100% sensitivity but low specificity. Accuracy findings were corroborated by the use of Cohen's kappa value, which evidenced slight and fair agreement between PCR analysis and ELISAs for HTLV infection diagnosis. Based on the data, we believe that all evaluated tests can be safely used for HTLV infection screening.