ABSTRACT Among individuals coinfected with HCV and HIV, studies of mortality from non-hepatic causes have shown inconsistent results. The aim of this study was to investigate the contribution of HCV and HIV co-infection to mortality from hepatic and non-hepatic causes in Brazil. This retrospective cohort study included blood donors from Fundação Pró-Sangue de São Paulo (FPS) who were followed from 1994 to 2016 to compare mortality and its causes between HIV-HCV coinfected individuals versus those seronegative for all tested infections. Records from the FPS database and the Mortality Information System were linked through a probabilistic record Relationship (RL). The Hazard Ratio (HR) was estimated using Cox multiple regression models. HCV-HIV coinfected individuals compared to seronegative individuals had a higher risk of death from all causes (HR = 14.54), non-liver neoplasms (HR = 2.55), infections (HR = 10.37) and liver disease (HR = 7.0). In addition, HCV mono-infected individuals compared to seronegative individuals had a higher risk of death from all causes (HR = 2.23), liver cancer (HR = 32.21), liver disease (HR = 14.92), infection (HR = 3.22), and trauma (HR = 1.68). Individuals coinfected with HCV and HIV have increased overall mortality and death due to infections, liver diseases and non-liver neoplasms as compared to those uninfected with HCV and HIV.

RESUMO. Em julho de 2019, um grupo multidisciplinar de pesquisadores em demência do Brasil e do Reino Unido se reuniu em Belo Horizonte para discutir e propor soluções para os desafios no diagnóstico, percepção pública e tratamento dessa condição. Neste artigo, sintetizamos as conclusões do workshop sobre os desafios no diagnóstico de demência. O Brasil enfrenta um grande problema no subdiagnóstico de demência, principalmente entre a população em condições socioeconômicas adversas. Há pouca disponibilidade de recursos e de especialistas e o conhecimento de médicos generalistas e de outros profissionais de saúde é pouco abrangente. Baixa escolaridade é também um obstáculo no diagnóstico de demência, uma vez que os testes de rastreio mais utilizados na prática clínica não são estruturados para avaliar a população com esse perfil. Os pacientes com demência e suas famílias ainda têm que superar o estigma do diagnóstico, que é ainda muito prevalente no Brasil e colabora para a piora da qualidade de vida. O Reino Unido, por outro lado, dispõe de mais recursos financeiros e de pessoal, possui serviços dedicados à avaliação de problemas de memória e um plano estratégico nacional para demência. Contudo, o National Health Service (NHS) tem verbas limitadas, o que faz com que alguns dos desafios no diagnóstico de demência sejam comuns aos dois países. Os autores sugerem possíveis soluções para enfrentá-los, com o objetivo de melhorar a avaliação e o reconhecimento da demência e reduzir os erros de diagnóstico.

ABSTRACT. In July 2019, a group of multidisciplinary dementia researchers from Brazil and the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil, to discuss and propose solutions to current challenges faced in the diagnosis, public perception and care of dementia. Here we summarize the outcomes from the workshop addressing challenges in diagnosis. Brazil faces a major problem in dementia underdiagnosis, particularly involving the population in an adverse socioeconomic context. There is poor availability of resources and specialists, and the knowledge of general practitioners and other healthcare professionals is far from satisfactory. Low education level is a further obstacle in diagnosing dementia, as the most commonly used screening tests are not designed to evaluate this population. Patients and their families must overcome the stigma of a diagnosis of dementia, which is still prevalent in Brazil and increases the burden of this condition. Whilst the UK has greater resources, dedicated memory services and a National Dementia Strategy plan, the National Health Service (NHS) has limited funding. Therefore, some challenges regarding diagnosis are common across both countries. The authors suggest possible solutions to confront these, with the goal of improving assessment and recognition of dementia and reducing misdiagnosis.

RESUMO Analisando-se a situação da saúde no Brasil, é perceptível o reforço de uma lógica que torna o direito a ela refém da dinâmica do capitalismo contemporâneo. Nesta perspectiva, destaca-se a renúncia de arrecadação fiscal em saúde no Estado brasileiro, trazendo as renúncias fiscais decorrentes da dedução dos gastos com planos de saúde e símiles no imposto de renda, como também as concessões fiscais às entidades privadas sem fins lucrativos (hospitais filantrópicos) e à indústria químico-farmacêutica. Assim, este artigo realiza uma crítica a estes dispositivos legais, que acentuam a relação de subserviência do Estado à lógica do capital, identificando, socio-historicamente, como tais formas vêm dilapidando, direta e indiretamente, o financiamento do Sistema Único de Saúde.

ABSTRACT When analyzing the health situation in Brazil, one can notice the reinforcement of a logic that turns the right to health assistance into a hostage of the dynamics of contemporary capitalism. From this perspective, the waiver of tax collection in health in the Brazilian State stands out, leading to tax exemptions that result from the deduction of expenses with health insurance and similes from income tax, as well as fiscal grants to private non-profit entities (philanthropic hospitals) and the chemical-pharmaceutical industry. Thus, this article criticizes those legal provisions, which stress the subservience relation of the State to the logic of capital, identifying, socio-historically, how these forms are directly and indirectly dilapidating the financing of the Unified Health System.

RESUMO Analisando-se a situação da saúde no Brasil, é perceptível o reforço de uma lógica que torna o direito a ela refém da dinâmica do capitalismo contemporâneo. Nesta perspectiva, destaca-se a renúncia de arrecadação fiscal em saúde no Estado brasileiro, trazendo as renúncias fiscais decorrentes da dedução dos gastos com planos de saúde e símiles no imposto de renda, como também as concessões fiscais às entidades privadas sem fins lucrativos (hospitais filantrópicos) e à indústria químico-farmacêutica. Assim, este artigo realiza uma crítica a estes dispositivos legais, que acentuam a relação de subserviência do Estado à lógica do capital, identificando, socio-historicamente, como tais formas vêm dilapidando, direta e indiretamente, o financiamento do Sistema Único de Saúde.

ABSTRACT When analyzing the health situation in Brazil, one can notice the reinforcement of a logic that turns the right to health assistance into a hostage of the dynamics of contemporary capitalism. From this perspective, the waiver of tax collection in health in the Brazilian State stands out, leading to tax exemptions that result from the deduction of expenses with health insurance and similes from income tax, as well as fiscal grants to private non-profit entities (philanthropic hospitals) and the chemical-pharmaceutical industry. Thus, this article criticizes those legal provisions, which stress the subservience relation of the State to the logic of capital, identifying, socio-historically, how these forms are directly and indirectly dilapidating the financing of the Unified Health System.

Mast cells and eosinophils actively participate in tissue repair and are prominent components of Schistosoma mansoni granulomas. Since pentoxifillyne (PTX) is an immunomodulatory and antifibrotic substance, we aimed to characterize, by morphological techniques, the effect of this drug on fibrosis developed inside murine hepatic schistosomal granulomatous reaction, beyond the quantification of eosinophil and mast cell populations. The drug (1 mg/100 g animal weight) was administrated from 35 to 90 days post-infection, when the animals were killed. The intragranulomatous interstitial collagen network was analyzed by confocal laser scanning microscopy, the number of eosinophils and mast cells was quantified and the results were validated by t-student test. Treatment did not interfere on the granuloma evolution but caused a significant decrease in the total and involutive number of hepatic granulomas (p = 0.01 and 0.001, respectivelly), and in the intragranulomatous accumulation of eosinophils (p = 0.0001). Otherwise, the number of mast cells was not significantly altered (p = 0.9); however, it was positively correlated with the number of granulomatous structures (r = 0.955). In conclusion, PTX does not affect development and collagen deposition in S. mansoni murine granuloma, but decreases the intragranulomatous eosinophil accumulation possibly due to its immunomodulatory capability, interfering in cellular recruitment and/or differentiation.