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Objetivo Evaluar el impacto del embarazo en mujeres con una alta carga de enfermedad, especialmente con enfermedades crónicas no transmisibles (ECNT) en los costos de una aseguradora de salud. Materiales y Métodos Estudio de costos retrospectivos realizado en Famisanar EPS entre 2016 y 2018. Utilizamos múltiples modelos de regresión lineal para evaluar; los costos generales se calcularon para cada paciente. La perspectiva de la aseguradora fue considerada para el análisis. Resultados El universo de estudio estuvo conformado por 458 249 mujeres en edad fértil afiliadas a Famisanar EPS entre los 15 y 49 años, de las cuales 24 030 (5,2%) mujeres tienen alguna relación con el ECNT. De ellas, 2454 (10,2%) fueron al parto y cesárea. Habíamos determinado los costos del embarazo en mujeres sanas en USD 200,41 y el embarazo en mujeres con ECNT USD 519,95 (97,5%) en términos de los costos de las complicaciones en la atención de gestación. Mediante la regresión multinomial, comparamos los embarazos de ECNT con los otros grupos de mujeres. No observamos diferencias significativas en zona e ingresos, observamos diferencias significativas en la edad. Conclusión El ECNT preexistente en mujeres embarazadas puede conducir al uso de recursos adicionales en el sistema de salud. El ECNT en la sociedad representa una carga severa para un sistema de salud debido a los altos costos, especialmente cuando se habla de mujeres que tienen un ECNT y están embarazadas.

Objetive Evaluate the impact of pregnancy on women with a high disease burden, especially with Chronic Non-Communicable Diseases (CNCD) in the costs of a health insurer. Materials and Methods Retrospective costing study conducted at Famisanar EPS between 2016 and 2018. We used multiple linear regression models to evaluate; the overall costs were calculated for each patient. The insurer's perspective was taken into account for the analysis. Results The study universe was made up of 458 249 women of childbearing age affiliated to Famisanar EPS between 15 and 49 years, of which 24 030 (5.2%) women have some relationship with the CNCD, of these, 2 454 (10.2%) went to childbirth and caesarean section. We had determined the costs of pregnancy healthy's women in USD 200.41 and pregnancy CNCD's women USD 519.95 (97.5%) in terms of the costs for the complication's gestation care. Using multinomial regression, we compared the pregnancy with CNCD with the other groups of women. We did not observe any significant differences in ingress and zone. However, we observe signicant differences in the age. Conclusion Pre-existing CNCD in pregnant women can lead to the use of additional resources in the health system. CNCD in society represent a severe burden for a health system due to high costs and especially when talking about women who have an CNCD and are in pregnant. The study also indicates that female infertility treatments are important for cost containment in health systems.

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Extracellular vesicles (EVs) are lipid bilayer envelopes that encase several types of molecules. Their contents mostly reflect their cell origin and possible targets at other locations in the organism and can be modified in pathological conditions to interfere with intercellular communication, thus promoting disease establishment and development. These characteristics, in addition to their presence in virtually all body fluids, make such vesicles ideal for biomarker discovery in human diseases. Here, we describe the effect of different anticoagulants and the combination of two purification methods for isolation and characterization of circulating EVs from blood of chronic Chagas disease (CCD) patients. We illustrated this procedure by studying a population of patients with Chagas disease at the indeterminate chronic stage, in which the Trypanosoma cruzi is very scarce in circulation. EVs were harvested from blood collected without or with different anticoagulants. Protein and nanoparticle tracking analysis was used to measure EVs size and concentration. The EVs were purified by ultracentrifugation, followed by size-exclusion chromatography and characterized by chemiluminescent enzyme-linked immunosorbent assay and dot blot using antibodies that recognized parasite-derived EVs, such as hyperimmune sera, polyclonal and monoclonal antibodies against trans-sialidase and mucins. In parallel, antibodies against classical human EV markers CD9, CD63, CD81, and CD82, were also analyzed. The results showed that anticoagulants did not interfere with the analyzed parameters and circulating EVs from CCD patients contain T. cruzi antigens and classical human exosomal markers. Overall, our protocol is adequate for the isolation of the total circulating EVs and can serve as an important basis for further studies on biomarker discovery in Chagas' disease.

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BACKGROUND: The presence of Plasmodium vivax malaria parasites in the human bone marrow (BM) is still controversial. However, recent data from a clinical case and experimental infections in splenectomized nonhuman primates unequivocally demonstrated the presence of parasites in this tissue. METHODS: In the current study, we analyzed BM aspirates of 7 patients during the acute attack and 42 days after drug treatment. RNA extracted from CD71+ cell suspensions was used for sequencing and transcriptomic analysis. RESULTS: We demonstrated the presence of parasites in all patients during acute infections. To provide further insights, we purified CD71+ BM cells and demonstrated dyserythropoiesis and inefficient erythropoiesis in all patients. In addition, RNA sequencing from 3 patients showed that genes related to erythroid maturation were down-regulated during acute infections, whereas immune response genes were up-regulated. CONCLUSIONS: This study thus shows that during P. vivax infections, parasites are always present in the BM and that such infections induced dyserythropoiesis and ineffective erythropoiesis. Moreover, infections induce transcriptional changes associated with such altered erythropoietic response, thus highlighting the importance of this hidden niche during natural infections.

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Plasmodium malariae has a wide geographic distribution, but mainly at very low parasitemias and in co-infections, leading to an underestimated prevalence of this species. Studies for the detection of antibodies against Plasmodium recombinant proteins are increasingly used to map geographical distributions, seroprevalence and transmission intensities of malaria infection. However, no seroepidemiological survey using recombinant P. malariae proteins has been conducted in Brazil. This work evaluated the antibody response in serum samples of individuals from endemic regions of Brazil (the Amazon region and Atlantic Forest) against five recombinant proteins of P. malariae merozoite surface protein 1 (MSP1), and the MSP1 C-terminal portions of P. vivax and P. falciparum, in a multiplex assay. The positivity was 69.5% of samples recognizing at least one MSP1 recombinant protein. The mean of the Reactivity Index for the C-terminal portion of the P. falciparum was significantly higher compared to the other recombinant proteins, followed by the C-terminal of P. vivax and the N-terminal of P. malariae. Among the recombinant P. malariae proteins, the N-terminal of P. malariae showed the highest Reactivity Index alone. This study validates the use of the multiplex assay to measure naturally acquired IgG antibodies against Plasmodium MSP1 proteins and demonstrate that these proteins are important tools for seroepidemiological surveys and could be used in malaria surveillance.

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Cryptic Plasmodium niches outside the liver possibly represent a major source of hypnozoite-unrelated recrudescences in malaria. Maurizio Ascoli, an Italian physician and scientist, suggested that infection was maintained as a result of the persistence of endoerythrocytic parasites in the circulatory bed of some internal organs, mainly the spleen. This would explain a proportion of the recurrences in patients, regardless of the Plasmodium species. Ascoli proposed a method that included the co-administration of adrenaline, in order to induce splenic contraction, and quinine to clear expelled forms in major vessels. Driven by controversy regarding safety and effectiveness, along with the introduction of new drugs, the Ascoli method was abandoned and mostly forgotten by the malaria research community. To date, however, the existence of cryptic parasites outside the liver is gaining supportive data. This work is a historical retrospective of cryptic malaria infections and the Ascoli method, highlighting key knowledge gaps regarding these possible parasite reservoirs.

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RESUMEN Objetivo Determinar la importancia de la transversalidad desde la prespectiva del sexo-género y edad para reconocer las diferencias y su desigualdad en la actual situación de COVID-19. Materiales y Métodos Enfoque cuantitativo, exploratorio, no experimemental, de corte transversal. Se determinaron regresiones polinomiales que explican mejor las tendencias actuales para sexo-género y edad y se calculó el correspondiente R2. Resultados Las tendencias de casos de contagios confirmados son muy similares entre hombres y mujeres. En fallecimientos, existe una mayor relación entre hombres que en mujeres. En cuanto a la edad, existen diferencias en los casos confirmados concentrados entre 21 y 60 años y en los fallecidos en mayores de 50 años. Conclusiones La pandemia de COVID-19 afecta a ambos sexos. Sin embargo, es más alto el número de hombres fallecidos que de mujeres. En cuanto a la edad, se concentra el contagio entre los 21 y 60 años y la mortalidad en mayores de 50 años. La información suministrada por el Instituto Nacional de Salud de Colombia es limitada, pero cuenta con buenas características en grupos de edad pese a que se pueden realizar mejoras en función del sexo-género en cuanto a raza, el personal de salud, las fuerzas militares y la policía nacional infectados de COVID-19.

ABSTRACT Objective To determine the importance of mainstreaming from the perspective of sex-gender and age to recognize the differences and their inequality in the current situation of COVID-19. Materials and Methods Quantitative, exploratory, non-experimental, cross-sectional approach. Polynomial regressions were determined that better explain the current trends for sex-gender and age, the corresponding R2 was calculated. Results The trends of confirmed contagion cases are very similar between men and women. In deaths there is a greater relationship between men than women. Regarding age, there are differences in confirmed cases concentrated between 21 and 60 years and in those who died in those over 50 years of age. Conclusions The COVID-19 pandemic affects both sexes. However, the number of death men is higher than that of women. Regarding age, contagion is concentrated between 21 and 60 years, mortality in over 50 years. The information provided by the National Institute of Health of Colombia is limited, but it has good characteristics in age groups, although improvements can be made based on sex-gender in terms of race, health personnel, the military, and the policemen infected by COVID-19.

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Non-human primates (NHPs) have been shown to be infected by parasites of the genus Plasmodium, the etiological agent of malaria in humans, creating potential risks of zoonotic transmission. Plasmodium brasilianum, a parasite species similar to P. malariae of humans, have been described in NHPs from Central and South America, including Brazil. The merozoite surface protein 1 (MSP1), besides being a malaria vaccine candidate, is highly immunogenic. Due to such properties, we tested this protein for the diagnosis of parasite infection. We used recombinant proteins of P. malariae MSP1, as well as of P. falciparum and P. vivax, for the detection of antibodies anti-MSP1 of these parasite species, in the sera of NHPs collected in different regions of Brazil. About 40% of the NHP sera were confirmed as reactive to the proteins of one or more parasite species. A relatively higher number of reactive sera was found in animals from the Atlantic Forest than those from the Amazon region, possibly reflecting the former more intense parasite circulation among NHPs due to their proximity to humans at a higher populational density. The presence of Plasmodium positive NHPs in the surveyed areas, being therefore potential parasite reservoirs, needs to be considered in any malaria surveillance program.

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OBJECTIVE: To determine the importance of mainstreaming from the perspective of sex-gender and age to recognize the differences and their inequality in the current situation of COVID-19. MATERIALS AND METHODS: Quantitative, exploratory, non-experimental, cross-sectional approach. Polynomial regressions were determined that better explain the current trends for sex-gender and age, the corresponding R2 was calculated. RESULTS: The trends of confirmed contagion cases are very similar between men and women. In deaths there is a greater relationship between men than women. Regarding age, there are differences in confirmed cases concentrated between 21 and 60 years and in those who died in those over 50 years of age. CONCLUSIONS: The COVID-19 pandemic affects both sexes. However, the number of death men is higher than that of women. Regarding age, contagion is concentrated between 21 and 60 years, mortality in over 50 years. The information provided by the National Institute of Health of Colombia is limited, but it has good characteristics in age groups, although improvements can be made based on sex-gender in terms of race, health personnel, the military, and the policemen infected by COVID-19.

OBJETIVO: Determinar la importancia de la transversalidad desde la prespectiva del sexo-género y edad para reconocer las diferencias y su desigualdad en la actual situación de COVID-19. MATERIALES Y MÉTODOS: Enfoque cuantitativo, exploratorio, no experimemental, de corte transversal. Se determinaron regresiones polinomiales que explican mejor las tendencias actuales para sexo-género y edad y se calculó el correspondiente R2. RESULTADOS: Las tendencias de casos de contagios confirmados son muy similares entre hombres y mujeres. En fallecimientos, existe una mayor relación entre hombres que en mujeres. En cuanto a la edad, existen diferencias en los casos confirmados concentrados entre 21 y 60 años y en los fallecidos en mayores de 50 años. CONCLUSIONES: La pandemia de COVID-19 afecta a ambos sexos. Sin embargo, es más alto el número de hombres fallecidos que de mujeres. En cuanto a la edad, se concentra el contagio entre los 21 y 60 años y la mortalidad en mayores de 50 años. La información suministrada por el Instituto Nacional de Salud de Colombia es limitada, pero cuenta con buenas características en grupos de edad pese a que se pueden realizar mejoras en función del sexo-género en cuanto a raza, el personal de salud, las fuerzas militares y la policía nacional infectados de COVID-19.

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BACKGROUND: Splenomegaly is one of the most common features of malaria. However, spontaneous splenic rupture, although unusual, represents a severe complication often leading to death. It is mostly seen in acute infection and primary attack, and it is most commonly associated with Plasmodium vivax. Here, a case of spontaneous splenic rupture diagnosed with a portable ultrasound apparatus shortly after starting treatment and with recurrent parasitaemia after splenectomy, is reported. CASE DESCRIPTION: In November 2015, a 45-year-old Brazilian man presented to the hospital in Manaus with fever, headache and myalgia. He was diagnosed with P. vivax malaria and, after a normal G6PD test, he started treatment with chloroquine and primaquine and was discharged. Two days later, he went back to the hospital with abdominal pain, dyspnea, dry cough, pallor, oliguria and fever. Using a portable ultrasound, he was diagnosed of rupture of the spleen, which was removed by emergency surgery. After this episode, he suffered two more malaria episodes with high parasitaemia at approximately 2-month intervals. DNA from different portions of the spleen was extracted and a qualitative PCR was performed to detect P. vivax. CONCLUSIONS: The splenic rupture suffered by this patient occurred 2 days after starting the treatment. Having a portable ultrasound apparatus may have saved the patient's life, as it revealed a haemorrhage needing an urgent surgery. Parasites were detected by PCR in the extracted spleen. This patient suffered two more vivax malaria diagnosed episodes in spite of receiving and completing treatment with chloroquine and primaquine for each clinical attack. Splenic rupture during acute malaria is uncommon, but it is likely underdiagnosed and underreported, because the lack of means and equipment hinders diagnostic confirmation, especially in endemic areas.

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