Prevalence of persistent symptoms after having COVID-19 in a cohort in Suriname.

Objectives: To determine the prevalence of persistent symptoms after having coronavirus disease 2019 (COVID-19) in a cohort in Suriname, and assess the factors associated with long COVID. Methods: A sample of adults 18 years and older who were registered 3-4 months previously in a national database because of a positive COVID-19 test were selected. They were interviewed about socioeconomic characteristics, pre-COVID-19 health status and lifestyle, and symptoms during and after COVID-19. A subset of participants underwent a physical examination to determine body mass index, waist circumference, cardiovascular parameters, lung function, and functionality. Results: A total of 106 participants (mean age 49 (standard deviation 15) years; 62.3% female) were interviewed, of whom 32 were physically examined. The greatest proportion of participants was of Hindustani descent (22.6%). Overall, 37.7% of participants were physically inactive, 26.4% had hypertension or diabetes mellitus, and 13.2% had been previously diagnosed with heart disease. Most participants (56.6%) had experienced mild COVID-19 and 14.2% had experienced severe COVID-19. A large proportion (39.6%) had experienced at least one persistent symptom after recovery from acute COVID-19 and more women were affected (47.0% of women versus 27.5% of men). Fatigue and alopecia were the most common symptoms, followed by dyspnea and sleep disturbance. Differences were observed between ethnic groups. Based on physical examination, 45.0% of the subset was obese and 67.7% had very high waist-circumference. Conclusions: About 40% of the cohort had at least one persistent symptom 3-4 months after having had COVID-19, with differences observed by sex and ethnic group.

Prevalence of persistent symptoms after having COVID-19 in a cohort in Suriname

[ABSTRACT]. Objectives. To determine the prevalence of persistent symptoms after having coronavirus disease 2019 (COVID-19) in a cohort in Suriname, and assess the factors associated with long COVID. Methods. A sample of adults 18 years and older who were registered 3–4 months previously in a national database because of a positive COVID-19 test were selected. They were interviewed about socioeconomic characteristics, pre-COVID-19 health status and lifestyle, and symptoms during and after COVID-19. A subset of participants underwent a physical examination to determine body mass index, waist circumference, cardiovascular parameters, lung function, and functionality. Results. A total of 106 participants (mean age 49 (standard deviation 15) years; 62.3% female) were inter- viewed, of whom 32 were physically examined. The greatest proportion of participants was of Hindustani descent (22.6%). Overall, 37.7% of participants were physically inactive, 26.4% had hypertension or diabe- tes mellitus, and 13.2% had been previously diagnosed with heart disease. Most participants (56.6%) had experienced mild COVID-19 and 14.2% had experienced severe COVID-19. A large proportion (39.6%) had experienced at least one persistent symptom after recovery from acute COVID-19 and more women were affected (47.0% of women versus 27.5% of men). Fatigue and alopecia were the most common symptoms, followed by dyspnea and sleep disturbance. Differences were observed between ethnic groups. Based on physical examination, 45.0% of the subset was obese and 67.7% had very high waist-circumference. Conclusions. About 40% of the cohort had at least one persistent symptom 3–4 months after having had COVID-19, with differences observed by sex and ethnic group.

[RESUMEN]. Objetivos. Determinar la prevalencia de síntomas persistentes tras la enfermedad por coronavirus 2019 (COVID-19) en una cohorte en Suriname, y evaluar los factores asociados a la COVID-19 de larga duración. Métodos. Se seleccionó una muestra de personas mayores de 18 años que habían sido registradas tres a cuatro meses antes en una base de datos nacional debido a un resultado positivo en una prueba de COVID-19. Se les realizaron preguntas sobre sus características socioeconómicas, estado de salud y modo de vida previos a la COVID-19 y sobre sus síntomas durante y después de esta enfermedad. A un subconjunto de participantes se les realizó un examen físico para determinar su índice de masa corporal, perímetro abdominal, parámetros cardiovasculares, función pulmonar y estado funcional. Resultados. Se entrevistó a 106 participantes (media de edad: 49 años [desviación estándar: 15 años]; 62,3% mujeres); de los cuales a 32 se les realizó una exploración física. La mayor parte de los participantes tenían ascendencia indostana (22,6%). En términos generales, el 37,7% de los participantes eran sedentarios, el 26,4% tenían hipertensión o diabetes mellitus y al 13,2% les habían diagnosticado previamente una cardiopatía. La mayor parte (56,6%) habían presentado síntomas leves de COVID-19 y el 14,2% síntomas graves. Una proporción elevada (39,6%) había manifestado al menos un síntoma persistente tras recuperarse de un cuadro crítico de COVID-19; esto se daba con mayor frecuencia en las mujeres (47,0% de las mujeres frente a 27,5% de los hombres). Los síntomas más frecuentes fueron fatiga y alopecia, seguidos por disnea y alteraciones del sueño. Se observaron diferencias entre los grupos étnicos. De acuerdo con los resultados del examen físico, el 45,0% del subgrupo era obeso y el 67,7% tenía un perímetro abdominal muy elevado. Conclusiones. Aproximadamente el 40% de la cohorte presentaba al menos un síntoma persistente tres o cuatro meses tras haber tenido COVID-19, con diferencias en función del sexo y el grupo étnico.

[RESUMO]. Objetivos. Determinar a prevalência de sintomas persistentes pós-doença do coronavírus de 2019 (COVID- 19) em uma coorte no Suriname e avaliar os fatores associados à COVID longa. Métodos. Foi selecionada uma amostra de adultos (a partir dos 18 anos) que haviam sido cadastrados 3 a 4 meses antes do estudo em um banco de dados nacional devido a um teste positivo para COVID-19. Os indivíduos selecionados foram entrevistados acerca de seu perfil socioeconômico, estado de saúde, estilo de vida pré-COVID-19 e sintomas durante e após a COVID-19. Um subconjunto de participantes foi submetido a exame físico para determinar índice de massa corporal, circunferência abdominal, parâmetros cardiovasculares, função pulmonar e funcionalidade. Resultados. Foram entrevistados 106 participantes (média de idade, 49 anos; desvio padrão, 15 anos; 62,3% do sexo feminino), dos quais 32 foram submetidos ao exame físico. A maior proporção de participantes era de ascendência hindu (22,6%). No total, 37,7% dos participantes eram fisicamente inativos, 26,4% tinham hiper- tensão ou diabetes e 13,2% tinham diagnóstico prévio de cardiopatia. A maioria dos participantes (56,6%) teve COVID-19 leve, e 14,2%, COVID-19 grave. Uma grande proporção (39,6%) apresentou pelo menos um sintoma persistente após a recuperação da COVID-19 aguda. Mais mulheres foram afetadas (47,0% das mul- heres versus 27,5% dos homens). Fadiga e alopecia foram os sintomas mais comuns, seguidos de dispneia e distúrbios do sono. Foram observadas diferenças entre grupos étnicos. Dos participantes submetidos ao exame físico, 45,0% eram obesos e 67,7% tinham circunferência abdominal muito larga. Conclusões. Cerca de 40% da coorte apresentou pelo menos um sintoma persistente 3 a 4 meses após a COVID-19. Foram observadas diferenças por sexo e grupo étnico.

Prevalence of persistent symptoms after having COVID-19 in a cohort in Suriname / Prevalencia de síntomas persistentes tras la COVID-19 en una cohorte en Suriname / Prevalência de sintomas persistentes após COVID-19 em uma coorte no Suriname

ABSTRACT Objectives. To determine the prevalence of persistent symptoms after having coronavirus disease 2019 (COVID-19) in a cohort in Suriname, and assess the factors associated with long COVID. Methods. A sample of adults 18 years and older who were registered 3-4 months previously in a national database because of a positive COVID-19 test were selected. They were interviewed about socioeconomic characteristics, pre-COVID-19 health status and lifestyle, and symptoms during and after COVID-19. A subset of participants underwent a physical examination to determine body mass index, waist circumference, cardiovascular parameters, lung function, and functionality. Results. A total of 106 participants (mean age 49 (standard deviation 15) years; 62.3% female) were interviewed, of whom 32 were physically examined. The greatest proportion of participants was of Hindustani descent (22.6%). Overall, 37.7% of participants were physically inactive, 26.4% had hypertension or diabetes mellitus, and 13.2% had been previously diagnosed with heart disease. Most participants (56.6%) had experienced mild COVID-19 and 14.2% had experienced severe COVID-19. A large proportion (39.6%) had experienced at least one persistent symptom after recovery from acute COVID-19 and more women were affected (47.0% of women versus 27.5% of men). Fatigue and alopecia were the most common symptoms, followed by dyspnea and sleep disturbance. Differences were observed between ethnic groups. Based on physical examination, 45.0% of the subset was obese and 67.7% had very high waist-circumference. Conclusions. About 40% of the cohort had at least one persistent symptom 3-4 months after having had COVID-19, with differences observed by sex and ethnic group.

RESUMEN Objetivos. Determinar la prevalencia de síntomas persistentes tras la enfermedad por coronavirus 2019 (COVID-19) en una cohorte en Suriname, y evaluar los factores asociados a la COVID-19 de larga duración. Métodos. Se seleccionó una muestra de personas mayores de 18 años que habían sido registradas tres a cuatro meses antes en una base de datos nacional debido a un resultado positivo en una prueba de COVID-19. Se les realizaron preguntas sobre sus características socioeconómicas, estado de salud y modo de vida previos a la COVID-19 y sobre sus síntomas durante y después de esta enfermedad. A un subconjunto de participantes se les realizó un examen físico para determinar su índice de masa corporal, perímetro abdominal, parámetros cardiovasculares, función pulmonar y estado funcional. Resultados. Se entrevistó a 106 participantes (media de edad: 49 años [desviación estándar: 15 años]; 62,3% mujeres); de los cuales a 32 se les realizó una exploración física. La mayor parte de los participantes tenían ascendencia indostana (22,6%). En términos generales, el 37,7% de los participantes eran sedentarios, el 26,4% tenían hipertensión o diabetes mellitus y al 13,2% les habían diagnosticado previamente una cardiopatía. La mayor parte (56,6%) habían presentado síntomas leves de COVID-19 y el 14,2% síntomas graves. Una proporción elevada (39,6%) había manifestado al menos un síntoma persistente tras recuperarse de un cuadro crítico de COVID-19; esto se daba con mayor frecuencia en las mujeres (47,0% de las mujeres frente a 27,5% de los hombres). Los síntomas más frecuentes fueron fatiga y alopecia, seguidos por disnea y alteraciones del sueño. Se observaron diferencias entre los grupos étnicos. De acuerdo con los resultados del examen físico, el 45,0% del subgrupo era obeso y el 67,7% tenía un perímetro abdominal muy elevado. Conclusiones. Aproximadamente el 40% de la cohorte presentaba al menos un síntoma persistente tres o cuatro meses tras haber tenido COVID-19, con diferencias en función del sexo y el grupo étnico.

RESUMO Objetivos. Determinar a prevalência de sintomas persistentes pós-doença do coronavírus de 2019 (COVID-19) em uma coorte no Suriname e avaliar os fatores associados à COVID longa. Métodos. Foi selecionada uma amostra de adultos (a partir dos 18 anos) que haviam sido cadastrados 3 a 4 meses antes do estudo em um banco de dados nacional devido a um teste positivo para COVID-19. Os indivíduos selecionados foram entrevistados acerca de seu perfil socioeconômico, estado de saúde, estilo de vida pré-COVID-19 e sintomas durante e após a COVID-19. Um subconjunto de participantes foi submetido a exame físico para determinar índice de massa corporal, circunferência abdominal, parâmetros cardiovasculares, função pulmonar e funcionalidade. Resultados. Foram entrevistados 106 participantes (média de idade, 49 anos; desvio padrão, 15 anos; 62,3% do sexo feminino), dos quais 32 foram submetidos ao exame físico. A maior proporção de participantes era de ascendência hindu (22,6%). No total, 37,7% dos participantes eram fisicamente inativos, 26,4% tinham hipertensão ou diabetes e 13,2% tinham diagnóstico prévio de cardiopatia. A maioria dos participantes (56,6%) teve COVID-19 leve, e 14,2%, COVID-19 grave. Uma grande proporção (39,6%) apresentou pelo menos um sintoma persistente após a recuperação da COVID-19 aguda. Mais mulheres foram afetadas (47,0% das mulheres versus 27,5% dos homens). Fadiga e alopecia foram os sintomas mais comuns, seguidos de dispneia e distúrbios do sono. Foram observadas diferenças entre grupos étnicos. Dos participantes submetidos ao exame físico, 45,0% eram obesos e 67,7% tinham circunferência abdominal muito larga. Conclusões. Cerca de 40% da coorte apresentou pelo menos um sintoma persistente 3 a 4 meses após a COVID-19. Foram observadas diferenças por sexo e grupo étnico.

Sexually transmitted infections on the border between Suriname and French Guiana: A scoping review.

Purpose: The Maroni basin -delineating the border between Suriname and French Guiana- presents sociocultural, geographical and economic circumstances that have been conducive to the circulation of sexually transmitted infections and to delays in diagnosis and care. Given the scarcity of published data, we aimed to describe different sexually transmitted infections along the Maroni and to gain a broader understanding of the epidemiologic situation. Methods: We conducted a scoping review of the efforts to approach the problem of sexually transmitted infections in this complex border area. Temporal trends were plotted and crude numbers were divided by local population numbers. Results: For HIV, despite increasing testing efforts, most patients still present at the advanced HIV stage (median CD4 count at diagnosis is < 20 per mm3), and 25% of patients in Saint Laurent du Maroni were lost to follow-up within 6 years. However, progress on both sides has led to a decline in AIDS cases and mortality. Despite a rapid increase in the 1990's along the Maroni, the current HIV prevalence seemed lower (0.52%) in the rural villages than in coastal urban centers (> 1%). High risk HPV infection prevalence among women reaches 23.3%. The incidence of gonorrhea was 4.2 per 1,000 population aged 15-59. For chlamydiasis it was 3.4 per 1,000 population aged 15-59. For syphilis, the incidence was 2.5 per 1,000 population aged 15-59. Gonorrhea, chlamydiasis, hepatitis B detection increased over time with greater testing efforts and new diagnostic tests. Since the COVID-19 epidemic, congenital syphilis has dramatically increased in Saint Laurent du Maroni reaching 808 per 100,000 live births. Conclusion: Sexually transmitted infections seemed more prevalent in Saint Laurent du Maroni -the sole urban center-than in the remote villages along the Maroni. The syndromic approach and the heterogeneity of diagnostic platforms presumably overlook most infections in the region. Therefore, a concerted approach and a shared diagnostic upgrade with molecular diagnosis and rapid diagnostic tests seem necessary to reduce the burden of sexually transmitted infections on both sides of the Maroni. Congenital syphilis resulting from COVID-19 disruption of health services requires urgent attention.

Acquisition of wild-type HIV-1 infection in a patient on pre-exposure prophylaxis with high intracellular concentrations of tenofovir diphosphate: a case report.

BACKGROUND: Pre-exposure prophylaxis (PrEP) with emtricitabine and tenofovir disoproxil fumarate is highly effective against acquisition of HIV infection, and only two cases of infection with a multidrug-resistant virus have been reported under adequate long-term adherence, as evidenced by tenofovir diphosphate concentrations in dried blood spots. We report a case of wild-type HIV-1 infection despite consistent use of emtricitabine and tenofovir disoproxil fumarate. METHODS: The patient participated in the Amsterdam PrEP project, a demonstration project of daily and event-driven PrEP. We did extensive testing for HIV, including plasma HIV RNA and nested PCR on bulk peripheral blood mononuclear cells (PBMCs) and sigmoid biopsies after seroconversion. FINDINGS: A 50-year-old man who has sex with men and had been on daily emtricitabine and tenofovir disoproxil fumarate for 8 months presented with fever, urinary tract infection caused by Escherichia coli, anal lymphogranuloma venereum infection, and a positive fourth-generation HIV test. We found an atypical seroconversion pattern, with initially only gp160 antibodies detected in the western blot. HIV RNA could not be detected in plasma, and nested PCR for HIV RNA and DNA on bulk PBMCs and sigmoid biopsies were negative. PrEP was discontinued; 3 weeks later HIV RNA was detected in plasma. No drug-resistant mutations were detected. Tenofovir diphosphate concentrations in dried blood spots were stable and high. INTERPRETATION: To our knowledge, this is the first detailed case report suggesting wild-type HIV-1 infection despite good adherence, evidenced by repeatedly high concentrations of tenofovir diphosphate in dried blood spots. PrEP providers need to be aware that infection can occur despite good adherence. Regular HIV testing and awareness of atypical patterns of seroconversion is highly recommended. FUNDING: ZonMw, National Institute for Public Health and the Environment, Internal GGD research funds, Aidsfonds, Stichting AmsterdamDiner Foundation, Gilead Sciences, Janssen Pharmaceutica, M A C AIDS Fund, and ViiV Healthcare.

Guidelines on the management of atrial fibrillation in the emergency department: a critical appraisal.

Several guidelines often exist on the same topic, sometimes offering divergent recommendations. For the clinician, it can be difficult to understand the reasons for this divergence and how to select the right recommendations. The aim of this study is to compare different guidelines on the management of atrial fibrillation (AF), and provide practical and affordable advice on its management in the acute setting. A PubMed search was performed in May 2014 to identify the three most recent and cited published guidelines on AF. During the 1-week school of the European School of Internal Medicine, the attending residents were divided in five working groups. The three selected guidelines were compared with five specific questions. The guidelines identified were: the European Society of Cardiology guidelines on AF, the Canadian guidelines on emergency department management of AF, and the American Heart Association guidelines on AF. Twenty-one relevant sub-questions were identified. For five of these, there was no agreement between guidelines; for three, there was partial agreement; for three data were not available (issue not covered by one of the guidelines), while for ten, there was complete agreement. Evidence on the management of AF in the acute setting is largely based on expert opinion rather than clinical trials. While there is broad agreement on the management of the haemodynamically unstable patient and the use of drugs for rate-control strategy, there is less agreement on drug therapy for rhythm control and no agreement on several other topics.