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In 2050 nearly 1.5 billions people aged over 60 will live in less developed countries. According to UN data and WHO facts sheet 2010 Niger will have the fewest people over 60 (5%).

In the picture the dark areas represent regions in 2050 where the percentage of 60+residents rises over 25% of total population.

Longer life fewer babies will push on a demographic shift, by 2050 one in 5 people will be aged 60+ they will outnumber people under 14y

 

Last september the 10th at Stockholmassen took place the EFNS annual meeting. I had the chance to follow this great session chaired by JOHANN SELLNER, MUNICH, GERMANY
ISRAEL STEINER, PETACH-TIKVA, ISRAEL.

Travel related CNS infections
Erich Schmutzhard, INNSBRUCK, AUSTRIA

Diseases such as Malaria and many Parassitosis are getting more and more frequent in western populations. Tailored campaigns may help migrants and travellers to better prevent serious consequences (see post on malaria). Even a a couple of weeks visit to relatives in endemic malaric areas without appropriate prophilaxis may expose a family to infections. Once back in europe in case of troubles doctors should think to uncommon diseases more frequently (? to let them know is our duty).

Neurological complications of vaccination
Israel Steiner, PETACH TIKVA, ISRAEL

Perivaccinic neurological complication in a wide definition may be more frequent then expected even if hard to diagnose. GB syndrome also may be a potential consequence.

Emerging CNS infections of worldwide importance
Johann Sellner, MUNICH, GERMANY

After the large diffusion of transpalnations al over the world in acute post transplantation and later phases minor infectious agent may play a crucial role. (rabia, HSV)


The Lancet, Volume 380, Issue 9842, Page 622, 18 August 2012

as reported by A I Fumagalli

Earlier this year, Mexico reached a truly immense landmark in its pioneering journey of health reform: achieving universal health coverage (UHC) for its 100 million citizens. This remarkable feat has been realised in less than a decade, and is detailed in a Lancet Health Policy paper published online on Aug 16—an update on The Lancet’s 2006 Series on Mexico’s early experiences of health reform.
Central to Mexico’s progress is an ideological shift: health insurance is no longer seen as an employment benefit, but a right of citizenship. The outcome? 52 million previously uninsured Mexicans now have state-protected health cover via the public insurance system and instrument of Mexico’s health reform, Seguro Popular.
It would be naive to assume that achieving UHC is the final destination in Mexico’s journey of health reform. Despite many crucial new changes in the way Mexico organises its health services—such as the investment in disease prevention through public health programmes (the ban on tobacco use in public places being a good example), and encouraging signs of access to the latest drugs in clinical medicine (such as the availability of trastuzumab for breast cancer treatment)—large challenges lie ahead. The threat of a rise in the burden of non-communicable diseases looms large.
There are also important lessons for other low-income and middle-income countries who share Mexico’s quest for UHC, notably the positioning of health reform within a legal framework to secure protection from future political interference. And, crucially, Mexico has showed how UHC, as well as being ethically the right thing to do, is the smart thing to do. Health reform, done properly, boosts economic development.
UHC in other regions will be explored further in a themed issue of The Lancet on Sept 8. And let us not forget Mexico’s northern neighbour, where President Barack Obama is seeking to drive through the most radical reforms in the history of US health care. But for now, let us celebrate success, and hope for a sustained Mexican wave of UHC worldwide.

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.

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