Academic Hospital Paramaribo

Coronary artery aneurysm (CAA) and coronary artery fistula (CAF) are rare cardiovascular anomalies, and their simultaneous occurrence is exceedingly uncommon. This case highlights the diagnostic, therapeutic, and logistical challenges of managing such anomalies in a low-resource setting. We present a 56-year-old woman with diabetes, hypertension, and hypothyroidism who developed a non-ST-elevation myocardial infarction (NSTEMI) in May 2023, nearly two years after being diagnosed with a proximal left anterior descending (LAD) artery saccular aneurysm (15.5 × 19.2 mm) with two fistulous connections (31.9 mm and 20 mm). Initial conservative management was chosen due to patient stability and operating room limitations during the COVID-19 pandemic. Despite optimal medical therapy, aspirin 80 mg/day, clopidogrel 75 mg/day, simvastatin 40 mg/day, and bisoprolol 5 mg/day, worsening symptoms prompted urgent surgical repair. The aneurysm and fistulas were ligated, and a left internal mammary artery (LIMA) to LAD bypass was performed. Postoperative complications included pulmonary congestion and pneumonia, both of which were successfully treated. The patient remains asymptomatic at two-year follow-up. In anatomically complex coronary artery anomalies, surgical intervention may offer a definitive treatment option. Our case emphasizes the importance of adaptable, case-specific strategies for cardiovascular care in resource-limited environments.

To describe the aetiological risk factors, clinical characteristics, access to rehabilitation, and educational status of children with cerebral palsy (CP) in Suriname. Hospital-based surveillance of children with CP aged younger than 18 years was conducted at the Academic Hospital Paramaribo, Suriname (known as the Suriname CP Register [SUR-CPR]). Data were collected on sociodemographic characteristics, aetiological risk factors, clinical characteristics, rehabilitation, and educational status. Registry data on aetiological risk factors were compared with available national prevalence rates in Suriname. Descriptive statistics were reported. Between August 2018 and March 2020, 82 children with CP (mean [SD] age 5 years 10 months [3 years 10 months]) attending the Academic Hospital Paramaribo were registered in the SUR-CPR. The mean (SD) age at diagnosis was 5 years 5 months (4 years 1 month). Spastic CP was predominant in 90.8% of children and 58.8% were classified in Gross Motor Function Classification System levels III to V. Overall, 43.9% had preterm birth compared with 13.9% reported nationally (p < 0.001) and 61.6% had birth-related complications compared with 15% reported nationally (p < 0.001). Additionally, 39.1% had birth asphyxia and 23.2% had early feeding difficulties. Sixty-two percent were admitted to the neonatal intensive care unit, 54.0% of whom required ventilation. Most children (82.5%) had CP acquired pre- or perinatally and 17.5% had CP acquired postneonatally. Seventeen percent had never received any rehabilitation services, and 31.9% of the school-aged children were not enrolled in any education system. The high burden of known aetiological risk factors, delayed diagnosis, and severe functional impairment among children with CP registered at the Academic Hospital Paramaribo is concerning. Public health interventions targeting early diagnosis and early intervention could improve the functional outcome of children with CP in Suriname. Almost half of the children with cerebral palsy (CP) had preterm birth, low birthweight, and signs of birth asphyxia. Most of the children were diagnosed after 5 years of age. Overall, 52.5% of children had severe forms of CP of whom only 36.6% received any assistive devices.

While the administration of convalescent plasma is a promising therapy for coronavirus disease 2019 (COVID-19), upfront costs and technological barriers of conventional plasmapheresis have limited the collection and processing of COVID-19 convalescent plasma (CCP) in Low- and Middle-Income Countries (LMICs). We previously reported that bedside plasma separation using gravity-driven microfiltration has made CCP therapy accessible as a treatment option in Suriname. However, the question remains whether the gravity-driven microfiltration method yields similar amounts of immunoglobulins as compared to conventional plasmapheresis. Here, we compared the gravity-driven microfiltration method with conventional plasma centrifugation for the total and COVID-19-specific immunoglobulin content of the obtained CCP. Blood donations from 10 donors recovered from PCR-confirmed COVID-19 were processed using both methods. Samples were collected pre- and post-processing for analysis to allow direct comparison of both methods. There were no differences in COVID-19-specific IgG levels between convalescent plasma obtained by microfiltration and centrifugation for 4 of the 5 assays used. Anti-RBD-Omicron IgG levels were slightly higher in the plasma obtained after filtration (median 274, range 69 to 1258) than after centrifugation (median 249, range 67 to 1175), Wilcoxon P = 0.0488. No significant differences were detected between the two methods for levels of total albumin, total cholesterol, total IgA, IgM and IgG levels. These results indicate that gravity-driven microfiltration and conventional centrifugation yield CCP with equivalent amounts of total and COVID-19-specific antibodies. This makes the gravity-driven microfiltration method a viable option for the collection and treatment with CCP in the LMICs setting.

To determine if the United States reference values of the Bayley Scales of Infant and Toddler Development, version III motor scale are suitable for Surinamese infants, we assessed 151 healthy infants at 3, 12, 24 and 36 months of age. The mean fine motor, gross motor, and composite scores of the total group did not significantly differ from the US norms, although some significant but not clinically relevant differences were found (lower fine motor scores at 12 months, lower gross motor and total composite scores at 24 months, and higher scores for gross motor and composite scores at 3 months).

Because this conference volume is devoted to the Moravian movement as an impulse for religious and cultural revival in the 18th century, it also looks at its impact and reception into the 19th century.I consider it a challenge to take a long-term view of a period before and after the revolutions of the Napoleonic era, including the religious regime changes that were linked to it.Confessional states that gave one church a dominant position were transformed into national states in which several religious groups could more or less exist in liberty, equality, and fraternity.How could a relatively new movement in Western Christianity exert such a significant influence on this development?This is the broader question that I would like to address specifically for the Netherlands, the small neighbor of the great empire from which the Moravian phenomenon conquered the world. 1 Every historian who works in the field of Dutch Moravian history is indebted to the theologian Wilhelm Lütjeharms.Trained as an aspiring missionary in Herrnhut and Utrecht, he wrote his dissertation in 1935, after ample research in the archives and other primary sources. 2 In this book, he highlighted the Philadelphian ideal of Zinzendorf

About 80% of cardiovascular diseases (including heart failure [HF]) occur in low-income and developing countries. However, most clinical trials are conducted in developed countries. The American Registry of Ambulatory or Acutely Decompensated Heart Failure (AMERICCAASS) aims to describe the sociodemographic characteristics of HF, comorbidities, clinical presentation, and pharmacological management of patients with ambulatory or acutely decompensated HF in America. Descriptive, observational, prospective, and multicenter registry, which includes patients >18 years with HF in an outpatient or hospital setting. Collected information is stored in the REDCap electronic platform. Quantitative variables are defined according to the normality of the variable using the Shapiro-Wilk test. This analysis includes data from the first 1000 patients recruited. 63.5% were men, the median age of 66 years (interquartile range 56.7-75.4), and 77.6% of the patients were older than 55 years old. The percentage of use of the four pharmacological pillars at the time of recruitment was 70.7% for beta-blockers (BB), 77.4% for angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB II)/angiotensin receptor-neprilysin inhibitor (ARNI), 56.8% for mineralocorticoid receptor antagonists (MRA), and 30.7% for sodium-glucose cotransporter type-2 inhibitors (SGLT2i). The main cause of decompensation in hospitalized patients was HF progression (64.4%), and the predominant hemodynamic profile was wet-warm (68.3%). AMERICCAASS is the first continental registry to include hospitalized or outpatient patients with HF. Regarding optimal medical therapy, approximately a quarter of the patients still need to receive BB and ACEI/ARB/ARNI, less than half do not receive MRA, and more than two-thirds do not receive SGLT2i.

Purpose of ReviewThe aim of this study was to compile all cases of yellow fever (YF) recorded in the Guiana Shield (GS), a region located on the northeastern shore of South America.Recent FindingsYellow fever causes several deaths in French Guiana during the last years. In this context, we wanted to know if it was due to a lack of vaccination or a reemergence of YF as in Brazil and if it was the same trouble in the neighborhood countries.SummaryPeople living in or returning from the GS with YF-compatible symptoms confirmed by reverse transcriptase polymerase chain reaction between 1990 and 2022 were included. In French Guiana (FG), patients were identified through results from the National Reference Center for Arboviruses at the Pasteur Institute in FG and hospital medical charts. For the other countries, medical literature and the WHO database were reviewed. Public health and infectious diseases specialists were solicited to identify unknown and unpublished cases. Nine patients were identified in the study period: five in FG, two in Venezuela, one in Suriname, one in Brazil, including six autochthonous people, Guiana Shield native, and three tourists. The case fatality rate was 7/9 (78%) within 8 days (range: 7–11 days). The M/F sex ratio was 6/3 (2). They had severe liver involvement progressing to multivisceral failure in 89% of cases. Only the two native Amerindian patients in FG had previously benefited from a YF vaccination in childhood and/or for more than 10 years. In conclusion, the sylvatic cycle of the YF virus is likely to persist in this region. Absence of vaccination or unknown immunization status was documented in most patients (78%). The mortality rate of this case series was high thus highlighting the need to strengthen vaccination coverage for the population and travelers to the GS.

In Suriname, 20% of pregnancies end in adverse birth outcomes. While prenatal exposure to metals may lead to adverse health outcomes, exposure assessments in Suriname are scant. Environmental contamination from mercury (Hg) used in artisanal goldmining in the Amazonian Interior, and the uncontrolled use of pesticides in suburban regions are of particular concern. This study assessed geographic differences in exposures to metals and essential elements in pregnant Surinamese women. This study is a subset (n = 400) of the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort study. Sector-field inductively-coupled plasma mass spectrometry was used to determine concentrations of lead (Pb), Hg, selenium (Se), cadmium (Cd), manganese (Mn) and tin (Sn) in whole blood of the pregnant women. High vs. low exposures to Pb and Hg were determined and were based respectively on CDC (3.5 ug/dL) and USEPA (3.5 ug/L) action levels. Differences in geographic exposures were tested with the Mann-Whitney U-test, and differences between blood elemental concentrations and action levels for Pb and Hg with the Wilcoxon signed rank test. The association between demographics and high exposures of Pb and Hg was examined with multivariate logistic regression models. The median concentrations of Pb, Hg and Se (5.08 μg/dL, 7.87 μg/L, and 228.26 μg/L respectively) in Interior women, were higher than the Urban and Suburban regions (p < 0.001), and higher than internationally accepted action levels (p < 0.001). The median concentrations of Mn and Sn found in Suburban women (17.55 and 0.97 ug/L respectively) were higher than Urban and Interior regions (p < 0.02). Pregnant women living in Suriname's Amazonian Interior are exposed to Hg and Pb at levels of public health concern. Urgently needed is a comprehensive source characterization assessment and the development, implementation and monitoring of environmental health policies, specifically addressing the chemicals of concern. In a subset of participants enrolled in the CCREOH environmental epidemiology cohort study elevated levels of Hg and Pb were identified. This is the first comprehensive exposure assessment in the Surinamese population. Health concerns include adverse birth- and neurodevelopmental outcomes. Geographic differences require a tailored approach to health intervention and comprehensive source characterization. Future research should ascertain the role of Se as a potential protective factor. Environmental policy development, implementation and monitoring is pivotal to mitigate exposures to these neurotoxicants.