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The association “L’impegno” based in Umbria organized for the months of October and November a medical mission in Burkina Faso.
Planned to go two eye surgeons of the hospital in Gubbio-Gualdo Tadino, a nurse hospital in Città di Castello, two optical technicians from Gubbio.

The project involves the creation in Nanoroo at the hospital, run by fathers Camillians, a center for eye surgery and an optical lab.

For this project, challenging both from the point of view of organization and economy, the association has benefited from the input of specialized companies, private citizens, traders in the industry.

In this way, they succeeded in Burkina to send a large amount of medical supplies for interventions in ophthalmology and for the realization of demonstrations with corrective lenses.
for info see the official site

 

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)

In June, the group of Dr Nzepa gave an interview to the journalists of Rete Sole (central Italy tv/radio broadcasting). In 50minutes was reported the activity undertaken in Djombe Penja together with personnel of Perugia Hospital (doctors and nurses). Dr Vittorio Giuliano during the interview reported the patnership with Developing Medicine to pubblicize the screening activity on the population (600 subjects on hyperetension and diabetes with 1800 measurements). Soon available the mp4 full video.

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.

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.

…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…

A 50-year-old Nigerian man was admitted for generalized non febrile seizures. Two weeks before his GP prescribed antimalaric prophilaxis with clorochine for a planned trip in his home country. He suffered of a minor stroke 2 years before with no residual disability. He had also history of arterial hypertension treated with ace inhibitors and aspirin. At admission he was treated with lorazepam i.v. for a second generalized crisis at admission, and started carbamazepine 1000 per day. No other critical events were found during in hospital staying. A CT scan demonstrated the known subcortical right hemispheric hypodensity with no sulcal effacement or swelling features. Three months later carbamazepine was gradually intterrupted. After few months a new trip to Lagos was planned and chosen an antimalaric prophilaxis with Proguanil/Atovaquone (Malarone). The drug was well tolerated and no side effects were detected.

Take home message:
while choosing antimalaric prophilaxis a medical history of stroke and TIA may encourage the use of non epileptogenic drugs.

A section dedicated to medical updates. Specific geographical areas will be later developed if possible.

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