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Malaria is the most diffused human parasitic disease, with 300-500 million infected in the world and about 2 million deaths per year. This disease is endemic in tropical and subtropical areas of Africa, Asia, and Central and South America. The disease can be seen almost anywhere, however, as a result of international travel. Malaria is transmitted by mosquitos.

Cerebral malaria is a true medical emergency. In critically ill patients, treatment includes chloroquine, usually given by intramuscular injection, and quinine (or quinidine) given intravenously. In less severe cases, chloroquine alone can be used. If infection occurs in an endemic area of chloroquine-resistant falciparum malaria
(now most areas of the world except parts of Central America, Mexico, the Caribbean, and the Middle East), quinine plus pyrimethamine-sulfadoxine (Fansidar), doxycycline, or clindamycin should be used. In Southeast Asia, where multiple drug resistance occurs, various regimens include quinine plus tetracycline, artesunate (or artemether) plus mefloquine, and mefloquine plus doxycycline. Anticonvulsants should be given to control seizures. Transfusions of whole blood or plasma may be required. Other supportive measures include reduction of fever, fluid and glucose replacement, and respiratory support. Sedation may be necessary in excited or delirious patients. The use of dexamethasone is deleterious in the treatment of cerebral malaria. Mannitol should be used for life-threatening cerebral edema. An infrequent possibly corticosteroid-responsive postmalarial encephalopathy has been described.

Brain injury due to malaria+dengue in a 42y old man leading to permanent comatose state.

In 1998 the “first stone” of a new hospital has been laid in the volcanic island of Cape Verde, Fogo. The project was made and sponsored by the AMSES onlus. The building grew slowly up and in 2004 the medical activity began. Up to that time, no surgical assistance had been guaranteed to about 30000 inhabitants in Fogo with
a lot of avoidable sufferings and deaths. At the beginning of 2009, I was thinking about my life, my job, my family, all my good luck. It
was snowing outside and nobody was around. I turned on my computer looking for exotic and hot countries on internet. Casually I found a web page depicting the San Francesco d’Assisi hospital in
Fogo, its activity and the need of voluntary medical doctors.
After reading each word written on the Web, I sent an e-mail to them.
In September I was in Fiumicino airport leaving for Cape Verde with my sweet (pregnant) wife Sara who is a nurse.
The day after we arrived in Fogo; the director Daniela, some doctors from Italy, Cuba and other islands of Cape Verde were waiting for us. We stayed there for about three weeks, working hard
night and day, eating togheter and sleeping in a room leaned on a rocky wall looking forward open Atlantic ocean. Everyday at eight o’clock, patients came to my ambulatory for medical visits and
ultrasound scans. During the night hospital was opened to emergency operations and deliveries. It was not easy because of the language and the absence of everything I considered “routinary”
till that time. With the help of the nurses from Cape Verde who had learnt some Italian words, the courtesy of people, the power of sun and the streaming flavour of exotic fruits, each day became a
wonderful experience. At the end, I felt like I received much more than I had given to those people and that country.

Vittorio Giuliano
Dirigente Medico di Gastroenterologia,
Ospedale Santa Maria della Misericordia, Perugia
e-mail: vittorio.giuliano@unipg.it

Links:
http://www.missionicapoverde.it

An MRI equipment is expensive. 1.5 tesla scanners often cost between US$1 million and US$1.5 million. 3.0 tesla scanners often cost between US$2 million and US$2.3 million. Construction of MRI suites can cost up to US$500,000, or more, depending on project scope. In France, the cost of an MRI exam is approximately 150 Euros. This covers three basic scans including one with an intravenous contrast agent, as well as a consultation with the technician and a written report to the patient’s physician.

MRI provides good imagesbetween the different tissuesof the body, which makes it especially useful in imaging the brain, heart, and tumorscompared with other techniques.

According to the WHO and the Atlas of MS database initiative 6 % of African countries provide MRI machines for their national health care Systems while in eastern Europe the figure is 75% , 95% in western EU, South America 46% and 38% in Central America.

The distribution of MRI machines seems not appropriate with more than 1 MRI per 100,000 inhabitants in US or Italy and less than 0,1 MRI machine per 100, 000 in China or Argentina. LAst update of the database 2009.

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