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.

A patient with Graves' disease was admitted with a thyroid storm. She had severe hypercalcaemia caused by thyrotoxicosis. Treatment was complicated by vomiting and diarrhoea. With intravenous ondansetron, hydration and bisphosphonates, GI symptoms improved and oral thyreostatics could be started. This, combined with bisphosphonate administration, resulted in a mild hungry bone syndrome.

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PurposeThe Maroni basin –delineating the border between Suriname and Frnch 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.MethodsWe 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.ResultsFor 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.ConclusionSexually 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.

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.

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. We present two cases of foreign body aspiration. The first case was the aspiration of a broken tracheostomy tube leading to acute respiratory failure and the second case was the aspiration of a medication blister which initially presented as atypical chronic pulmonary symptoms but evolved to a medical emergency of acute respiratory failure. Conclusion: These two cases show the broad range of symptoms and findings associated with FBA. When patients present with nonspecific pulmonary findings, FBA should be included in the differential diagnosis. IJCRI publishes Review

Een neonaat van 48 uur oud werd op de afdeling kindergeneeskunde gezien wegens slecht drinken, spugen en het uitblijven van het eerste meconium. Graviditeit en partus waren probleemloos verlopen. Bij lichamelijk onderzoek werd een matig zieke neonaat gezien met een bolle buik met spaarzame peristaltiek, zonder afwijkingen in het laboratoriumonderzoek. De neonaat werd ter observatie opgenomen. In de loop van enkele uren verslechterde de klinische conditie met toenemend gallig braken, sufheid en dehydratie. Tevens werd de buik toenemend bol met versterkte vaattekening en afnemende peristaltiek. Een buikoverzichtsfoto liet sterk uitgezette darmlissen zien zonder pneumatosis intestinalis of vrij lucht (figuur 1). Differentiaaldiagnostisch werd gedacht aan een darmatresie, meconiumileus, microcolon of de ziekte van Hirschsprung. Na starten van intraveneuze vochtsuppletie, maagzuigdrainage en het plaatsen van een flatuscanule werd het meisje onder verdenking dunnedarmatresie doorverwezen naar een kinderchirurgisch centrum.Omdat patie¨nte geen tekenen van peritoneale prikkeling had, werd in het kinderchirurgisch centrum niet met spoed geopereerd maar eerst aanvullend onderzoek gedaan. Een coloninloopfoto liet een abrupte stop van het contrast ter hoogte van de flexura lienalis zien. De gedilateerde lissen meer proximaal werden niet bereikt. Vervolgens werd een laparotomie verricht waarbij een volledige atresie van het colon ter hoogte van de flexura lienalis werd gezien (figuur 2). De atresie werd verwijderd en er werd een primaire 'end-to-end' anastomose aangelegd met een grote kalibersprong. Het postoperatieve herstel verliep probleemloos. Na twee dagen loosde patie¨nte voor het eerst enige ontlasting. De voeding kon geleidelijk opgehoogd worden naar volledige enterale Mw. L.R.Figuur 1 X-buikoverzicht: neus-maagsonde in situ. Met lucht gevulde maag en fors uitgezette darmlissen. Geen lucht zichtbaar in het rectum.Figuur 2 Peroperatief: uitgezette terminale ileumlissen, appendix en een zeer fors verwijd proximaal colon dat blind eindigt. Bij de middelvinger van de operateur ligt de maag en rechts daarvan het smalle distale colon.