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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)

Concentrating on the modern era, ‘War and Medicine’ are considered in the constant evolving relationship between warfare and medicine, beginning with the disasters of the Crimean War and continuing through to today’s conflicts in Afghanistan and Iraq.

This CT scan shows a clear skull fracture due to “arm blanche” beating (see above).

The young (37y old) Bangladesh citizen was working in Tripolis with other houndreds) and attacked during the 2011 summer revolution. Admitted in a local medical centre slowly recovered from a non commotive head trauma. Succeding to cross the Sicily channel on a boat was rescued by Italian Coastal guards. In January while admitted in refugee camp in central Italy suffered of an ischemic stroke (see down).

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.

…Affluent Arabs used to head to hospitals in the US when they needed treatment. But now, post-Iraq, they are increasingly choosing Germany’s private clinics. With the average foreign patient spending an estimated €80,000 a stay, competition to attract the medical tourists is fierce…. by Monocle 2008…

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