The paradox of growing technical capacities with low global governance: a review of Voluntary National Reviews' SDG health-related indicators.

BACKGROUND: This study delves into the States' accountability for health-related Sustainable Development Goal (SDG) indicators from 2016 to 2020. An analysis of Voluntary National Reviews (VNR) is employed as an instrument to scrutinize the alignment of States' indicators with the global indicator framework, shedding light on global health governance within the context of the 2030 Agenda and States' strategic prioritization. A curation of 60 health-related indicators from 195 VNRs, produced during the aforementioned period, is organized into thematic groups. RESULTS: Our results highlight a concerning discrepancy in the reporting frequency of various health-related themes. The findings reveal a paradoxical coexistence characterized by the concurrent strengthening and diminution of the global health governance articulated in the Agenda's global health governance. This manifests in the increased utilization and consistency of health-related indicators over the study years, coupled with an emphasis on infectious diseases and child and maternal health indicators. Conversely, a discernible governance decline is evidenced by the inadequate representation of health-related indicators in VNRs, notably within the domains of universal health coverage and health system indicators. Furthermore, High-Income States exhibit diminished accountability. CONCLUSIONS: The VNRs unveil a paradox wherein burgeoning technical capacity coexists with governance deficits, a phenomenon attributable to both statistical capabilities and political preferences. The prevalent use of proxy indicators in VNRs oversimplifies the presentation of official indicators, thereby compromising the aspirational goal of pioneering statistical innovations for measuring intricate issues in the SDGs. In light of our conceptualization of the 2030 Agenda's global health as a regime complex governance, we advocate for comprehensive investigations into each health regime cluster. This approach aims to unravel disputes, discern patterns, and elucidate States' preferences concerning specific thematic areas. Functioning as an accountability mechanism for the Agenda's governance, VNRs underscore States' adaptability and short-term learning capabilities, offering valuable insights for identifying harmful goal prioritization. The discretionary nature of indicator selection by States in the VNRs, enabled by the Agenda's proposition of a contextual adaptation of the SDGs and a blind eye to the guideline's request to review all SDG indicators, highlights a critical flaw in the VNR as an accountability mechanism.

Analysis of glomerular deposition of IgM and C3 in patients with podocytopathies.

Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) are the main causes of nephrotic syndrome in the world. The complement system appears to play an important role in the pathogenesis of these diseases. To evaluate the deposition of immunoglobulins and particles of the complement system in renal biopsies of patients with FSGS and MCD and relate to laboratory data, we selected 59 renal biopsies from patients with podocytopathies, 31 from patients with FSGS and 28 with MCD. Epidemiological, clinical, laboratory information and the prognosis of these patients were evaluated. Analysis of the deposition of IgM, IgG, C3, C1q and C4d in renal biopsies was performed. We related IgM and C3 deposition with laboratory parameters. Statistical analysis was performed using GraphPad Prism version 7.0. Glomerular deposition of IgM was significantly higher in the FSGS group, as was codeposition of IgM and C3. The clinical course of patients and laboratory data were also worse in cases of FSGS, with a higher percentage progressing to chronic kidney disease and death. Patients with C3 deposition had significantly higher mean serum creatinine and significantly lower eGFR, regardless of disease. Patients with FSGS had more IgM and C3 deposition in renal biopsies, worse laboratory data and prognosis than patients with MCD. C3 deposition, both in FSGS and MCD, appears to be related to worsening renal function.

The Colombian Strain of Trypanosoma cruzi Induces a Proinflammatory Profile, Neuronal Death, and Collagen Deposition in the Intestine of C57BL/6 Mice Both during the Acute and Early Chronic Phase.

The objective of this study was to evaluate the histopathological changes caused by infection with the Colombian strain of Trypanosoma cruzi (T. cruzi) in the acute and chronic experimental phases. C57Bl/6 mice were infected with 1000 trypomastigote forms of the Colombian strain of T. cruzi. After 30 days (acute phase) and 90 days (early chronic phase) of infection, the animals were euthanized, and the colon was collected and divided into two parts: proximal and distal. The distal portion was used for histopathological analysis, whereas the proximal portion was used for quantification of pro- and anti-inflammatory cytokines. In addition, the weight of the animals and parasitemia were assessed. The infection induced gradual weight loss in the animals. In addition, the infection induced an increase in interferon gamma (IFNγ) and tumor necrosis factor-alpha (TNF-α) in the intestine in the acute phase, in which this increase continued until the early chronic phase. The same was observed in relation to the presence of intestinal inflammatory infiltrates. In relation to interleukin (IL)-10, there was an increase only in the early chronic phase. The Colombian strain infection was also able to induce neuronal loss in the myenteric plexus and deposition of the collagen fibers during the acute phase. The Colombian strain of T. cruzi is capable of causing histopathological changes in the intestine of infected mice, especially in inducing neuronal destructions. Thus, this strain can also be used to study the intestinal form of Chagas disease in experimental models.

Quantifying convergence on health-related indicators of the 2030 agenda for sustainable development.

The extended scope and complexity of the United Nations 2030 agenda entail important challenges for the operationalization of the health-related sustainable development goal (SDG) indicators. Divergences in concepts, agendas and implementation strategies among institutions have fostered the parallel development of alternative and concurrent indicators. We aim to determine the convergences and divergences between five key institutions: the Global Burden of Disease Study (GBD), the Pan American Health Organization, the Sustainable Development Solutions Network, the World Bank and the World Health Organization (WHO). Of the 104 health-related indicators listed by these five institutions, 60 are consistent with official Inter-agency and Expert Group SDG indicators. Our analysis considers the indicators included, and the themes these indicators cover, in each institution list and each institution online platform. We quantified convergence in indicators between the institutions themselves, but also between the institutions and the official Inter-agency and Expert Group. Our results indicate important divergences; only 22 of the 60 indicators are included in the lists of all five institutions. The level of adoption of the official metrics varies from 40.5% (15/(47-10)) for the GBD to 86.2% (25/(29-0)) for the World Bank. WHO, the official curator of the Inter-agency and Expert Group SDG indicators, is only convergent with the official metrics by 72.1% (31/(45-2)). Our analysis, and the resulting awareness of the differences, potentialities and limitations of indicators and platforms, provides important contributions to enable the achievement of the health-related SDGs and deliver the promise of the 2030 agenda.

La complexité et l'envergure de l'Agenda 2030 des Nations Unies représentent d'importants défis pour la concrétisation des indicateurs régissant l'objectif de développement durable (ODD) visant à assurer la santé et le bien-être de tous. Les divergences de concepts, de programmes et de stratégies de mise en œuvre au sein des institutions ont engendré l'apparition simultanée d'indicateurs alternatifs et concurrents. Nous cherchons à identifier les convergences et divergences entre cinq institutions clés: l'étude sur la charge mondiale de morbidité (GBD), l'Organisation panaméricaine de la Santé, le Réseau des solutions pour le développement durable, la Banque mondiale et l'Organisation mondiale de la Santé (OMS). Sur les 104 indicateurs de santé repris par ces cinq institutions, 60 sont compatibles avec ceux du Groupe d'experts interinstitutionnel sur les indicateurs des ODD. Notre analyse tient compte des indicateurs inclus, ainsi que des domaines dont ils traitent, dans chaque liste institutionnelle et sur chaque plateforme institutionnelle en ligne. Nous avons quantifié la convergence d'indicateurs entre les institutions elles-mêmes, mais aussi entre ces institutions et le Groupe d'experts interinstitutionnel officiel. Nos résultats révèlent d'importantes divergences; seulement 22 des 60 indicateurs figurent dans les listes des cinq institutions. Le niveau d'adoption des paramètres officiels varie de 40,5% (15/(47­10)) pour le GBD à 86,2% (25/(29­0)) pour la Banque mondiale. L'OMS, administratrice officielle du Groupe d'experts interinstitutionnel sur les indicateurs des ODD, ne s'aligne sur les paramètres officiels qu'à 72,1% (31/(45­2)). Notre analyse et sa mise en évidence des différences, des possibilités et des limites des indicateurs et plateformes, contribue grandement à progresser vers la réalisation des ODD en matière de santé, et vers la concrétisation des promesses de l'Agenda 2030.

El amplio alcance y la complejidad del programa de las Naciones Unidas para 2030 implica importantes desafíos para la puesta en práctica de los indicadores del objetivo de desarrollo sostenible (ODS) relacionado con la salud. Las divergencias en los conceptos, los programas y las estrategias de aplicación entre las instituciones han fomentado la elaboración paralela de indicadores alternativos y simultáneos. Nos proponemos determinar las convergencias y divergencias entre cinco instituciones clave: el Estudio sobre la Carga Mundial de la Enfermedad (GBD, por sus siglas en inglés), la Organización Panamericana de la Salud, la Red de Soluciones para el Desarrollo Sostenible, el Banco Mundial y la Organización Mundial de la Salud (OMS). De los 104 indicadores relacionados con la salud enumerados por estas cinco instituciones, 60 son coherentes con los indicadores oficiales del ODS del Grupo Interinstitucional y de Expertos. Nuestro análisis tiene en cuenta los indicadores incluidos, y los temas que cubren estos indicadores, en cada lista de instituciones y en la plataforma en línea de cada institución. Cuantificamos la convergencia en los indicadores entre las propias instituciones, pero también entre las instituciones y el Grupo Interinstitucional y de Expertos oficial. Nuestros resultados indican importantes divergencias; solo 22 de los 60 indicadores están incluidos en las listas de las cinco instituciones. En cuanto al nivel de adopción de los indicadores oficiales varía entre el 40,5% (15/(47-10)) en el caso del GBD y el 86,2% (25/(29-0)) en el caso del Banco Mundial. La OMS, la comisaria oficial de los indicadores del ODS del Grupo Interinstitucional de Expertos, solo converge con los parámetros oficiales en un 72,1% (31/(45-2)). Nuestro análisis, y la consiguiente conciencia de las diferencias, potencialidades y limitaciones de los indicadores y plataformas, aporta importantes contribuciones para permitir el logro de los ODS relacionados con la salud y cumplir con el compromiso del programa de 2030.

Renal expression of cytokines and chemokines in diabetic nephropathy.

BACKGROUND: Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Inflammatory mediators have been implicated in the pathogenesis of DN, thus considered an inflammatory disease. However, further studies are required to assess the renal damage caused by the action of these molecules. Therefore, the objective of this study was to analyze the expression of cytokines and chemokines in renal biopsies from patients with DN and to correlate it with interstitial inflammation and decreased renal function. METHODS: Forty-four native renal biopsies from patients with DN and 23 control cases were selected. In situ expression of eotaxin, MIP-1α (macrophage inflammatory protein-1α), IL-8 (interleukin-8), IL-4, IL-10, TNF-α (tumor necrosis factor-α), TNFR1 (tumor necrosis factor receptor-1), IL-1ß, and IL-6 were evaluated by immunohistochemistry. RESULTS: The DN group showed a significant increase in IL-6 (p < 0.0001), IL-1ß (p < 0.0001), IL-4 (p < 0.0001) and eotaxin (p = 0.0012) expression, and a decrease in TNFR1 (p = 0.0107) and IL-8 (p = 0.0262) expression compared to the control group. However, there were no significant differences in IL-10 (p = 0.4951), TNF-α (p = 0.7534), and MIP-1α (p = 0.3816) expression among groups. Regarding interstitial inflammation, there was a significant increase in IL-6 in scores 0 and 1 compared to score 2 (p = 0.0035), in IL-10 in score 2 compared to score 0 (p = 0.0479), and in eotaxin in score 2 compared to scores 0 and 1 (p < 0.0001), whereas IL-8 (p = 0.0513) and MIP-1α (p = 0.1801) showed no significant differences. There was a tendency for negative correlation between eotaxin and estimated glomerular filtration rate (eGFR) (p = 0.0566). CONCLUSIONS: Our results indicated an increased in situ production of cytokines and chemokines in DN, including IL-6, IL-1ß, IL-4, and eotaxin. It was observed that, possibly, eotaxin may have an important role in the progression of interstitial inflammation in DN and in eGFR decrease of these patients.

Littoral cell angioma of the spleen: case report and literature review.

Littoral cell angioma is an extremely rare splenic vascular tumor originating from the cells lining the splenic red pulp sinuses. Approximately 150 cases of littoral cell angioma have been reported since 1991. Its clinical manifestation is usually asymptomatic and is mostly diagnosed as an incidental finding through abdominal imaging. Herein, we present a case of littoral cell angioma in a 41-year-old woman with no previous comorbidities, which initially presented as a nonspecific splenic lesion diagnosed on imaging in the emergency room. The patient was treated through laparoscopic intervention.

Access to health and social protection policies by homeless people during the COVID-19 pandemic: a mixed-methods case study on tailored inter-sector care during a health emergency.

Introduction: The article analyzed homeless people's (HP) access to health and social protection policies and tailored inter-sector care, including emergency measures, during the COVID-19 pandemic in Belo Horizonte (BH), capital of Minas Gerais state, Brazil. It intended to provide data on HP and evaluate existing public policies focused on vulnerable populations during this health emergency. Methods: The study adopted a mixed-methods design with triangulation of quantitative and qualitative data. Results: Social cartography showed that in the early months of the pandemic, the health administration had difficulty reordering the health system, which experienced constant updates in the protocols but was nevertheless consolidated over the months. The evidence collected in the study showed that important emergency interventions in the municipality of BH involved activities that facilitated access by HP to the supply of services. Discussion: The existence of national guidelines for inter-sector care for HP cannot be ruled out as a positive influence, although the municipalities are responsible for their implementation. Significantly, a health emergency was necessary to intensify the relationship between health and social protection services. Roving services were among those with the greatest positive evidence, with the least need for infrastructure to be replicated at the local level. In addition, the temporary supply of various inter-sector services, simultaneously with the provision of day shelters by organized civil society, was considered a key factor for expanding and intensifying networks of care for HP during the emergency phase. A plan exists to continue and expand this model in the future. The study concluded that understanding the inter-sector variables that impact HP contributes to better targeting of investments in interventions that work at the root causes of these issues or that increase the effectiveness of health and social protection systems.

[The interface between public policies for the unhoused population: an integrative review]. / A interface entre as políticas públicas para a população em situação de rua: revisão integrativa.

The heterogeneous and vulnerable nature of the unhoused population reveal the complexity of living on the street and call for the State to play a fundamental role in the provision of health and social care policies. The scope of this study was to evaluate the intersectorality between health policies, social protection and organized civil society actions for the unhoused population in Brazil, based on an integrative literature review. To achieve this, a search was conducted in the SciELO, LILACS and PubMed databases, from which ten articles published between 2004-2021, all of a qualitative nature, were selected. From the analysis of the chosen articles, the evidence of intersectorality between the policies for the unhoused population was observed, mainly described as a point of intersection between the services offered. However, interventions are still poorly explored and systematized. It is recommended that quantitative studies aimed at the evaluation of intersectoral public policies be developed to allow the assessment of the impact of intersectorality between health services, social assistance and organized civil society on the quality of life of the unhoused population.

A heterogeneidade e vulnerabilidade da população em situação de rua revelam a complexidade de viver nessa condição e exige que o Estado tenha papel fundamental na oferta de políticas de saúde e assistência social. O objetivo do estudo, a partir de uma revisão integrativa da literatura, foi avaliar a intersetorialidade entre políticas de saúde, proteção social e ações da sociedade civil organizada para a população em situação de rua no Brasil. Foi realizada uma busca nas bases SciELO, Lilacs e PubMed, sendo selecionados dez artigos, publicados entre 2004-2021, todos de caráter qualitativo. Observou-se indícios da intersetorialidade entre as políticas para a população em situação de rua, descritas principalmente como uma ponte de acesso entre os serviços ofertados. Entretanto, as intervenções ainda são pouco exploradas e sistematizadas. Nesse sentido, recomenda-se que estudos de impacto voltados à avaliação de políticas públicas intersetoriais sejam desenvolvidos para que se permita a avaliação da efetividade da intersetorialidade entre os serviços de saúde, assistência social e sociedade civil organizada na qualidade de vida da população em situação de rua.

In situ assessment of Mindin as a biomarker of podocyte lesions in diabetic nephropathy.

Diabetic nephropathy (DN) is the leading cause of chronic kidney disease and end-stage renal failure worldwide. Several mechanisms are involved in the pathogenesis of this disease, which culminate in morphological changes such as podocyte injury. Despite the complex diagnosis and pathogenesis, limited attempts have been made to establish new biomarkers for DN. The higher concentration of Mindin protein in the urine of patients with type 2 diabetes mellitus suggests that it plays a role in DN. Therefore, this study investigated whether in situ protein expression of Mindin can be considered a potential DN biomarker. Fifty renal biopsies from patients diagnosed with DN, 57 with nondiabetic glomerular diseases, including 17 with focal segmental glomerulosclerosis (FSGS), 14 with minimal lesion disease (MLD) and 27 with immunoglobulin A nephropathy (IgAN), and 23 adult kidney samples from autopsies (control group) were evaluated for Mindin expression by immunohistochemistry. Podocyte density was inferred by Wilms' tumor 1 (WT1) immunostaining, while foot process effacement was assessed by transmission electron microscopy. Receiver operative characteristic (ROC) analysis was performed to determine the biomarker sensitivity/specificity. Low podocyte density and increased Mindin expression were observed in all cases of DN, regardless of their class. In the DN group, Mindin expression was significantly higher than that in the FSGS, MCD, IgAN and control groups. Higher Mindin expression was significantly positively correlated with foot process effacement only in class III DN cases. Furthermore, Mindin protein presented high specificity in the biopsies of patients with DN (p < 0.0001). Our data suggest that Mindin may play a role in DN pathogenesis and is a promising biomarker of podocyte lesions.

Tissue Engineering Applied to Skeletal Muscle: Strategies and Perspectives.

Muscle tissue is formed by elongated and contractile cells with specific morphofunctional characteristics. Thus, it is divided into three basic types: smooth muscle tissue, cardiac striated muscle tissue and skeletal striated muscle tissue. The striated skeletal muscle tissue presents high plasticity, regeneration and growth capacity due to the presence of satellite cells, quiescent myoblasts that are activated in case of injury to the tissue and originate new muscle fibers when they differentiate. In more severe deficiencies or injuries there is a loss of their regenerative capacity, thus compromising the body's functionality at different levels. Tissue engineering studies the development of biomaterials capable of stimulating the recovery of cellular activity in injured body tissues, as well as the activity of cells with muscle differentiation potential in injury repair. However, the need for three-dimensional re-assembly in a complex organization makes it difficult to mimic this tissue and fully regenerate it for the sake of precise and effective movements. Thus, this article aims to provide a narrative review of tissue engineering strategies applied to the regeneration of skeletal muscle, in a critical evaluation of research, whether aimed at injury or atrophies such as spinal muscular atrophy.

Potential and challenges of health monitoring in the 2030 Agenda in Brazil. / Potencialidades e desafios do monitoramento da saúde na Agenda 2030 no Brasil.

This article has two integrated objectives: (i) to identify the representation of health in the 2030 Agenda from health-related indicators implemented by international and national institutions; and (ii) to compare the potential of platforms for monitoring Brazilian health commitments in the SDGs. It is argued that there are still important controversies brought about by the greater complexity of the 2030 Agenda, particularly in the operationalization of health-related indicators, whose determinants permeate many other objectives and goals. Finally, even though the picture of the country currently available on national and international platforms is already broad, improvements are required for more effective monitoring and evaluation of Brazilian commitments in the SDGs, with greater disaggregation and stratification of indicators in the population.

O presente artigo tem dois objetivos integrados: (i) identificar a representação da saúde na Agenda 2030, a partir dos indicadores relacionados à saúde operacionalizados por instituições internacionais e nacionais; e (ii) comparar as potencialidades das plataformas para o monitoramento dos compromissos de saúde brasileiros nos ODS. Argumenta-se que ainda existem controvérsias importantes trazidas pela maior complexidade da Agenda 2030, em particular na operacionalização dos indicadores relacionados à saúde, cujos determinantes perpassam muitos outros objetivos e metas. O monitoramento e avaliação mais efetivos dos compromissos brasileiros nos ODS requer melhoria, com maior desagregação e estratificação dos indicadores na população, ainda que o retrato do país hoje disponibilizado nas diversas plataformas nacionais e internacionais já seja amplo.

Retrospective study of canine cutaneous tumors submitted to a diagnostic pathology laboratory in Northern Portugal (2014-2020).

BACKGROUND: Cutaneous neoplastic diseases are the most and second-most frequently reported tumors in male and female dogs, respectively. The aims of this study were to report the occurrence of canine cutaneous tumors in a pathology laboratory located in Northern Portugal between 2014 and 2020, and to characterize and categorize the anatomical locations, breed, age, and sex of the animals affected with different types of neoplasms. RESULTS: Throughout the 7-year study, 1,185 cases were diagnosed as cutaneous tumors, with 62.9% being classified as benign, and 37.1% as malignant. Mast cell tumors (22.7%) were the most frequently diagnosed tumor type, followed by benign soft tissue tumors (9.7%), sebaceous gland tumors (8.1%), vascular tumors (7.9%) and soft tissue sarcomas (7.6%). Cutaneous tumors commonly exhibited multicentric occurrence (14.6%) followed by single occurrence in hindlimb (12.1%), forelimb (8.6%), buttock (7.1%), abdominal (6.5%) and costal (5.2%) areas. The odds of developing cutaneous neoplasia were higher with increasing age (p < 0.001). Females had an increased odds of developing skin tumors compared to males (crude OR = 2.99, 95% (2.51, 3.55); adj OR = 2.93, 95% (2.46, 3.49). Purebred dogs, as a group, showed a reduced odds of developing cutaneous tumors when compared to mixed-breed dogs (crude OR = 0.63, 95% (0.53, 0.74); adj OR = 0.75, 95% (0.62, 0.89). CONCLUSIONS: Mast cell tumors, benign soft tissue tumors and sebaceous tumors were the most common histotypes encountered. The epidemiological survey achieved with this study demonstrates the relative frequency of different types of tumors in this particular population. Furthermore, the results herein achieved can act as a basis or a beneficial reference for local veterinarians helping in the establishment of a preliminary and presumptive diagnosis of canine cutaneous tumors histotypes. Skin tumors are the most and second-most frequently reported tumors in male and female dogs, respectively. The aim of this study was to report the occurrence of canine skin tumors in a diagnostic pathology laboratory located in Northern Portugal, between 2014-2020 and to characterize the anatomical distributions, breed, age, and sex of the animals affected by different skin tumors. During this period, 1,185 cases were diagnosed as skin tumors; 62.9% were diagnosed as benign, while 37.1% were malignant. Mast cell tumors (22.7%) were the most frequently diagnosed neoplasia, followed by benign soft tissue tumors (9.7%), sebaceous gland tumors (8.1%), vascular tumors (7.9%) and soft tissue sarcomas (7.6%). Skin tumors commonly developed in more than one location (14.6%) followed by solitary development in hindlimb (12.1%), forelimb (8.6%), buttock (7.1%), abdominal (6.5%) and costal (5.2%) areas. An increased odds of developing skin neoplasms as the patient's age increase was detected. Females showed an increased odds in comparison to male dogs. Purebred dogs presented decreased odds for developing skin tumors in comparison to mixed-breed dogs. The information relevance achieved with this study demonstrates the relative frequency of different types of tumors in this particular population, acting as a basis or a beneficial reference for regional veterinarians when providing an initial diagnosis of canine skin tumors.

Analysis of risk factors for canine mast cell tumors based on the Kiupel and Patnaik grading system among dogs with skin tumors.

BACKGROUND: Skin tumors are the most frequently diagnosed lesions, of which 7%-21% are mast cell tumors (MCTs). There is a great effort to identify factors that can influence the prospective course of MCTs. Although, the histological grade is considering an important predictor helping to determine the malignancy and metastatic potential of MCTs. AIM: In this study, an epidemiological analysis of risk factors (breed, age, sex, and anatomical site) for dogs having MCTs was evaluated considering the respective MCTs histological grade in comparison to other skin tumors. METHODS: The study included 244 dogs affected by cutaneous MCTs from a universe of 1,185 dogs diagnosed with skin tumors. A univariable analysis with Fisher exact test was performed to determine the odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Boxers had a higher predisposition to Patnaik's grade I (OR = 5.9, 95% CI 2.648-13.152) and to Kiupel's low-grade MCTs (OR = 2.6, 95% CI 1.539-4.447). Labrador retrievers (OR = 2.1, 95% CI 1.423-3.184), and pugs (OR = 12.9, 95% CI 2.336-70.931) had a predisposition for Patnaik's grade II MCTs and Kiupel's low-grade lesions (OR = 2.3, 95% CI 1.478-3.597; OR = 17.1, 95% CI 3.093-94.377, respectively). French bulldogs had a higher risk to grade III MCTs (OR = 7.9, 95% CI 2.381-26.072). Pit bulls had a predisposition to grade III MCTs and Kiupel's high-grade tumors (OR = 4.4, 95% CI 1.221-16.1 and OR = 4.962, 95% CI 1.362-18.077, respectively). Bull terriers (OR = 12.7, 95% CI 2.098-76.818) presented higher risk for having low-grade MCTs. The perigenital area and trunk exhibit a greater risk for high grading lesion (OR = 6.6, 95% CI 2.679-16.334; OR = 1.9, 95% CI 1.028-3.395, respectively) and the limbs had a predisposition to grade II tumor (OR = 1.6, 95% CI 1.134-2.395). A decreased risk of having MCT was seen in older dogs (from 7-10 years to 11-18 years) compared to that in the reference group (4-6 years). CONCLUSION: When comparing to canine skin tumors, this study showed a relationship between MCT histological grading and the risk factors, age, breed, and topography of canine MCTs. The variations noted in the clinical presentation of MCTs amongst predisposed dog breeds reinforces the relevance of the genetic background in MCTs carcinogenesis.

Social isolation relaxation and the effective reproduction number (Rt) of COVID-19 in twelve Brazilian cities.

We analyzed the social isolation relaxation strategies adopted by the twelve biggest Brazilian cities in 2020, in relation to the number of cases, number of deaths and the effective reproduction number (Rt), which are internationally considered the fundamental epidemiological criteria for allowing wider population mobility in public spaces. The Brazilian central government has not set unique guidelines neither for closure nor for opening, and states and cities have taken the lead in strategy definition. Until July 31 2020, in Belém do Pará, Fortaleza, Manaus, Recife and Rio de Janeiro, where the epidemic peak had already been surpassed, and in Salvador and São Paulo, in which the peak seemed to be already reached, the Rt curve followed a decreasing path after the openings. Porto Alegre, a city in which the epidemic curve was flattened, had an increase in Rt after the start of relaxation. In Belo Horizonte, Brasília, Curitiba and Goiânia, where the curve was also flattened, the Rt remained stable after the opening. The decision on how to operationalize the relaxation of social isolation and the speed with which it happened was heterogeneous among the cities studied. Also, broad population testing strategies were not done in any of the cities.

População em situação de rua: comunicação e (des)informação no contexto da pandemia de Covid-19 / The homeless population: communication and (dis)information in the context of the Covid-19 pandemic / Población que vive en la calle: comunicación y (des)información en el contexto de la pandemia de Covid-19

O estudo objetivou identificar os sentidos produzidos pela comunicação dirigida à população em situação de rua (PSR) durante a pandemia de Covid-19 na cidade de Belo Horizonte. Por meio da técnica de análise de conteúdo, analisaram-se 48 entrevistas realizadas com a PSR; gestores e trabalhadores do Sistema Único de Saúde e do Sistema Único de Assistência Social; e representantes da Pastoral do Povo da Rua e da Defensoria Pública. Cinco temáticas identificadas respaldam os resultados e a discussão: pandemia e seu surgimento; fechamento da cidade e consequências para PSR; desinformação e reprodução de estigmas; desinformação e vacinação; e infodemia. Os resultados indicaram que a comunicação relacionada à pandemia foi considerada como fator de menor importância no planejamento público, ocasionando impacto negativo no enfrentamento social da doença. Destaca-se a importância de estratégias de comunicação públicas, inclusivas, dialógicas - com identificação e escuta dos grupos populacionais vulneráveis - e adaptadas às suas necessidades.

This study aimed to identify meanings produced by communication directed at the homeless population during the Covid-19 pandemic in Belo Horizonte. Forty-eight interviews with homeless people, Brazilian National Health System and Brazilian National Social Assistance System managers and workers, and representatives of the Pastoral Ministry for the Homeless and Public Defender's Office were analyzed using content analysis. The results and discussion are structured around five core themes: the pandemic and its onset; closure of the city and the consequences for homeless people; disinformation and reproduction of stigmas; disinformation and vaccination; and the infodemic. The results suggest that communication related to the pandemic was seen as a minor factor in public planning that negatively impacted coping with the disease. The findings highlight the importance of identifying and listening to vulnerable groups and promoting inclusive and dialogical public communication strategies tailored to their specific needs.

El objetivo del estudio fue identificar los sentidos producidos por la comunicación dirigida a la Población que Vive en la Calle (PSR) durante la pandemia de Covid-19 en la ciudad de Belo Horizonte. Por medio de la técnica de análisis de contenido se analizaron 48 entrevistas realizadas con esa población, gestores y trabajadores del Sistema Brasileño de Salud y Sistema Brasileño de Asistencia Social, representantes de la Pastoral de la Población que vive en la Calle y la Defensoría Pública. Cinco temáticas identificadas respaldan los resultados y la discusión: la pandemia y su aparición; cierre de la ciudad y consecuencias para la Población que vive en la Calle; desinformación y reproducción de estigmas; desinformación y vacunación; e infodemia. Los resultados indicaron que la comunicación relacionada con la pandemia se consideró como factor de menor importancia en la planificación pública, ocasionando impacto negativo en el enfrentamiento social de la enfermedad. Se destaca la importancia de estrategias de comunicación públicas, incluyentes y dialógicas, con identificación y escucha de los grupos poblacionales vulnerables y adaptadas a sus necesidades.

Littoral cell angioma of the spleen: case report and literature review

ABSTRACT Littoral cell angioma is an extremely rare splenic vascular tumor originating from the cells lining the splenic red pulp sinuses. Approximately 150 cases of littoral cell angioma have been reported since 1991. Its clinical manifestation is usually asymptomatic and is mostly diagnosed as an incidental finding through abdominal imaging. Herein, we present a case of littoral cell angioma in a 41-year-old woman with no previous comorbidities, which initially presented as a nonspecific splenic lesion diagnosed on imaging in the emergency room. The patient was treated through laparoscopic intervention.

A interface entre as políticas públicas para a população em situação de rua: revisão integrativa / The interface between public policies for the unhoused population: an integrative review

Resumo A heterogeneidade e vulnerabilidade da população em situação de rua revelam a complexidade de viver nessa condição e exige que o Estado tenha papel fundamental na oferta de políticas de saúde e assistência social. O objetivo do estudo, a partir de uma revisão integrativa da literatura, foi avaliar a intersetorialidade entre políticas de saúde, proteção social e ações da sociedade civil organizada para a população em situação de rua no Brasil. Foi realizada uma busca nas bases SciELO, Lilacs e PubMed, sendo selecionados dez artigos, publicados entre 2004-2021, todos de caráter qualitativo. Observou-se indícios da intersetorialidade entre as políticas para a população em situação de rua, descritas principalmente como uma ponte de acesso entre os serviços ofertados. Entretanto, as intervenções ainda são pouco exploradas e sistematizadas. Nesse sentido, recomenda-se que estudos de impacto voltados à avaliação de políticas públicas intersetoriais sejam desenvolvidos para que se permita a avaliação da efetividade da intersetorialidade entre os serviços de saúde, assistência social e sociedade civil organizada na qualidade de vida da população em situação de rua.

Abstract The heterogeneous and vulnerable nature of the unhoused population reveal the complexity of living on the street and call for the State to play a fundamental role in the provision of health and social care policies. The scope of this study was to evaluate the intersectorality between health policies, social protection and organized civil society actions for the unhoused population in Brazil, based on an integrative literature review. To achieve this, a search was conducted in the SciELO, LILACS and PubMed databases, from which ten articles published between 2004-2021, all of a qualitative nature, were selected. From the analysis of the chosen articles, the evidence of intersectorality between the policies for the unhoused population was observed, mainly described as a point of intersection between the services offered. However, interventions are still poorly explored and systematized. It is recommended that quantitative studies aimed at the evaluation of intersectoral public policies be developed to allow the assessment of the impact of intersectorality between health services, social assistance and organized civil society on the quality of life of the unhoused population.

Potencialidades e desafios do monitoramento da saúde na Agenda 2030 no Brasil / Potential and challenges of health monitoring in the 2030 Agenda in Brazil

Resumo O presente artigo tem dois objetivos integrados: (i) identificar a representação da saúde na Agenda 2030, a partir dos indicadores relacionados à saúde operacionalizados por instituições internacionais e nacionais; e (ii) comparar as potencialidades das plataformas para o monitoramento dos compromissos de saúde brasileiros nos ODS. Argumenta-se que ainda existem controvérsias importantes trazidas pela maior complexidade da Agenda 2030, em particular na operacionalização dos indicadores relacionados à saúde, cujos determinantes perpassam muitos outros objetivos e metas. O monitoramento e avaliação mais efetivos dos compromissos brasileiros nos ODS requer melhoria, com maior desagregação e estratificação dos indicadores na população, ainda que o retrato do país hoje disponibilizado nas diversas plataformas nacionais e internacionais já seja amplo.

Abstract This article has two integrated objectives: (i) to identify the representation of health in the 2030 Agenda from health-related indicators implemented by international and national institutions; and (ii) to compare the potential of platforms for monitoring Brazilian health commitments in the SDGs. It is argued that there are still important controversies brought about by the greater complexity of the 2030 Agenda, particularly in the operationalization of health-related indicators, whose determinants permeate many other objectives and goals. Finally, even though the picture of the country currently available on national and international platforms is already broad, improvements are required for more effective monitoring and evaluation of Brazilian commitments in the SDGs, with greater disaggregation and stratification of indicators in the population.

[Incidence of community-acquired infections of lower airways among infants]. / Incidência de infecções comunitárias de vias aéreas inferiores em crianças.

OBJECTIVE: To estimate the incidence of community-acquired infections of the lower respiratory tract and the risk factors associated with its occurrence in infants, in their first year of life. METHODS: A prospective cohort study of infants who were followed up during the first 12 months of life. Interviews were conducted with their mothers, and children were clinically monitored bimonthly to investigate the occurrence of the incidence density of community-acquired infections of the lower respiratory tract. Cox regression analysis was used to estimate the crude and adjusted relative risk of the variables associated with the outcome. RESULTS: The mean age of the mothers was 26 years, 62% of them had more than 11 years of schooling, and 23.5 were at risk of social exclusion regarding economic income. The incidence density of pneumonia and bronchiolitis were, respectively, 0.51 and 3.10 episodes per 100 children-months. Children who had low birth weight (<2500g) were 5.96 (95%CI 1.75-20.40) times more likely to have pneumonia than infants weighing 2500g or over. CONCLUSIONS: The incidence of acute lower respiratory tract infection in children was similar to that found in other studies. Only low birth weight was an independent risk factor for the occurrence of pneumonia.

Social isolation relaxation and the effective reproduction number (Rt) of COVID-19 in twelve Brazilian cities / O relaxamento do isolamento social e o número efetivo de reprodução (Rt) do COVID-19 em doze municípios brasileiros

Abstract We analyzed the social isolation relaxation strategies adopted by the twelve biggest Brazilian cities in 2020, in relation to the number of cases, number of deaths and the effective reproduction number (Rt), which are internationally considered the fundamental epidemiological criteria for allowing wider population mobility in public spaces. The Brazilian central government has not set unique guidelines neither for closure nor for opening, and states and cities have taken the lead in strategy definition. Until July 31 2020, in Belém do Pará, Fortaleza, Manaus, Recife and Rio de Janeiro, where the epidemic peak had already been surpassed, and in Salvador and São Paulo, in which the peak seemed to be already reached, the Rt curve followed a decreasing path after the openings. Porto Alegre, a city in which the epidemic curve was flattened, had an increase in Rt after the start of relaxation. In Belo Horizonte, Brasília, Curitiba and Goiânia, where the curve was also flattened, the Rt remained stable after the opening. The decision on how to operationalize the relaxation of social isolation and the speed with which it happened was heterogeneous among the cities studied. Also, broad population testing strategies were not done in any of the cities.

Resumo Este trabalho analisou as estratégias de relaxamento do isolamento social adotadas pelas doze maiores cidades brasileiras em 2020, em relação ao número de casos, número de óbitos e ao número efetivo de reprodução (Rt), considerados internacionalmente os critérios epidemiológicos fundamentais para permitir uma maior mobilidade da população nos espaços públicos. O governo federal não estabeleceu diretrizes únicas nem para o fechamento nem para a abertura, e os estados e municípios assumiram o protagonismo na definição da estratégia. Até 31 de julho, em Belém do Pará, Fortaleza, Manaus, Recife e Rio de Janeiro, onde o pico epidêmico já havia sido ultrapassado, e em Salvador e São Paulo, em que o pico parecia já ter sido atingido, o Rt seguiu uma curva decrescente após as aberturas. Em Porto Alegre, aonde a curva epidêmica foi achatada, houve aumento do Rt após o início do relaxamento. Em Belo Horizonte, Brasília, Curitiba e Goiânia, nos quais a curva também foi achatada, o Rt manteve-se estável após a abertura. A decisão de como operacionalizar o relaxamento do isolamento social e a velocidade com que isso aconteceu foi heterogênea entre as cidades estudadas. Além disso, amplas estratégias de testagem populacional não foram realizadas em nenhuma das cidades.