COVID-19 in Africa: the little we know and the lot we ignore.

COVID has stirred up an information deluge that challenges our capacity to absorb and make sense of data. In this unrelenting flow of information, Africa has been largely off the radar, escaping the attention of the scientific literature and the media. International agencies have been the exception: despite the still low numbers of cases and deaths, they have voiced concerns, often in catastrophic terms, on the health, economic and social impacts of COVID in African countries. These concerns contrast sharply with the optimistic view that Africa may be spared the worst consequences of the pandemic.This paper provides a snapshot of a crisis in evolution: its features could change as new data become available and our understanding improves. The paper examines the epidemic trends, the health impact, the containment measures and their possible side effects. Africa has a long experience of responding to epidemics: relevant lessons learned are outlined. The picture of the epidemic and its narrative are heterogenous, given the differing vulnerabilities of African countries and the diverse contexts within their borders. The paper, therefore, singles out selected countries as illustrative of specific situations and advocates for a transnational and subnational approach to future analyses.The virus has shown a strong capacity to adapt; therefore, a response strategy, in order to be effective, needs to be flexible and able to adapt to changes. The paper concludes with the recommendation that affected communities should be engaged in the response, to maintain or build trust. A lesson from the Ebola outbreak of a few years ago was that epidemiologists and community leaders learned, after initial difficulties, how to dialogue and work together.A summary update of the pandemic has been added, in view of its fast evolution.

[Migrants.] / Immigrati.

A summary is presented here of different points of view on the question of migrants' disembarking on the Italian coasts and, more broadly speaking, on the issue of migration towards Europe. These lines of thinking stem from the case of the humanitarian vessel Sea Watch 3, whose commander, the German captain Carola Rackete, after sailing for seventeen days after the rescue, three of which waiting off of the port of Lampedusa, decided to force the blockade in order to disembark the desperate and completely exhausted migrants.

[Somatization]. / Somatizzare.

Functional disorders that we observe neurologically primarily pose terminology problems: some of them such as migraine, narcolepsy, restless legs syndrome have a recognized nosographic status, although without demonstrable lesions; others are interpreted only as somatic manifestations of psychic conflicts. There is also the risk that the "functional" diagnosis masks - as prejudice - lesional pathologies not adequately investigated with the available technology, leading to serious clinical errors. Moreover, even in presence of a probable psychogenic disorder, patients tend to reject the "functional" diagnosis, for cultural reasons linked to the old philosophical separation between diseases of the body and mind (the latter with a "lower" status). The current evolution of neuroscience should lead us to the conclusion that all so-called "functional" disorders are manifestations of cerebral suffering; at the same time an existential approach to the disease must make us wary of reductionist conclusions, because the clinical expression of a lesion is in the great majority of cases modulated by the culture and the history of the patient.

[Stories of foreigners]. / Storie di stranieri.

Immigrant foreigners who attend a public neurology clinic live in our country for a long time and they usually have a fair degree of integration into the cultural fabric. They do not seem to have pathologies or social problems different from those of the Italian users of the same service. However, many of them carry personal and collective stories of deprivation, struggle and suffering that can not be considered common. Some cases are briefly told.

[Successfully aging elderly.] / Vecchiaia di successo.

Only a small proportion of older people (2-5% of 80-90 years old) do not suffers from activity limitation keeping good cognitive and sensorial abilities, living an active, independent life, maintaining social relationships. Interestingly, it is possible sometime to see these "old successful elderly people" in neurology medical facility because of an overzealous practitioner or because their exuberance puts them in danger of falling. Surprisingly, most people consider this uncommon way to grow old as available to anyone, so all those who became pensioners expect to getting old in the same way. In this article the author tells some amazing stories about this "successful old age".

[Neurological contact.] / Contatto neurologico.

To what extent is current clinical practice capable of gathering relevant patient data, observing them and giving them adequate information back? To what extent does the clinical pathway play a role of real care and not simply technology delivery? The neurology clinic is an excellent case study for these questions. Experience shows that the available time is often inadequate to the complexity of the clinical and human cases. In particular, the patterns of clinical history in use ignore the individuality of the patient and his existential dimension. The objective evaluation must be targeted and at the same time must take into account the patient's symbolic expectations. The current practice follows incorrect or inefficient patterns, and is not calibrated for the true recipient, who is the patient. At the current stage of development, it is doubtful that Artificial Intelligence can solve these problems. Rather the opposite.

[Dementia in the real world.] / Demenza: situazioni nel mondo reale.

More than with other diseases, the diagnosis of dementia must be made carefully, as it can have a huge impact on both the patient's social and legal status and the caregiver's own health. Special attention should be put in avoiding diagnostic errors at the time of symptom onset, because a diagnosis made explicitly can affect the patient's self-esteem. If the diagnosis is uncertain, we would recommend not performing unnecessary investigation but rather waiting to get a clearer clinical picture. Dementia, unfortunately, is reversible or partially reversible by drug therapy only in very few cases. We here describe common diagnostic challenges and doubts, and how to manage patients with known dementia in relation to changes in the environment and social interactions. Dementia strongly affects a person's well-being, including maintaining a social life and interpersonal relationships, with either the caregiver and the family.

[Falls in the elderly.] / Cadere da vecchi.

The falls frequently occurring as a result of impaired postural reflexes, due to degenerative changes that accompany the aging process, have a great impact on quality of life in the elderly. Falls and the fear of falling can trigger restraints and limits to freedom, ultimately leading to definitive care from professional or other. In nursing homes, security regulations often predominate over any other consideration and become a source of suffering and oppression. Pharmacological or "medical" management of this condition is effective in only a small proportion of elderly individuals. In the vast majority of cases, preventive measures and daily activity management programs need to be implemented to avoid the partial or complete loss of personal freedom, though these highly depend on the available individual economic resource. Doctors, namely neurologists operating in public services of the territory, have to face difficult medical, human and ethical problems. This article reviews this issue in the light of personal experience and by the analysis of several case reports.

Avaliação do desempenho dos agentes polivalentes elementares (APE´s) - Janeiro / Abril 1994 / Performance evaluation of elemental polyvalent agents (EPA s) January / April 1994

A presente secção assume que há suficiente e consenso acerca da problematica geral dos CSP, na qual o programa dos APE´s dece ser enquadrado, assim como da sua impçementação em Moçambique apoós a independencia nacional. Não será pois descutidas definições, conce+tos e aspectos de politica nacional da saúde que são pratica corrente na Republica de Moçambique. O programa de APE´s tem 16 amos de historia, tendo sido implatado em 1978, ano da conferencia internacional da Alma Ata….