Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review.

Leprosy is an infectious chronic disease with a wide range of clinical and serological manifestations. We report a case of a woman presenting with a malar rash, painless oral ulcers, photosensitivity, arthritis, positive antinuclear antibodies test and leuko-lymphopenia. Our case illustrates an unusual presentation of leprosy initially diagnosed as systemic lupus erythematosus (SLE). After the confirmation of multibacillary leprosy and multidrug therapy recommended by the World Health Organization, a good clinical response was observed. Recognition of rheumatic manifestations in leprosy is important as they may be confused with SLE. A literature review is presented to encourage clinicians to consider leprosy as a differential diagnosis. Specifically in patients with unusual rheumatic manifestations and persistent skin lesions, and when neurological symptoms are present. Leprosy has not been eradicated, so misdiagnosis can be frequent. It is necessary to increase medical practitioner awareness in order start proper treatment.

Vasculitis in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a complex heterogeneous autoimmune disease with a wide variety of clinical and serological manifestations that may affect any organ. Vasculitis prevalence in SLE is reported to be between 11% and 36%. A diverse clinical spectrum, due to inflammatory involvement of vessels of all sizes, is present. Even though cutaneous lesions, representing small vessel involvement, are the most frequent, medium and large vessel vasculitis may present with visceral affection, with life-threatening manifestations such as mesenteric vasculitis, pulmonary hemorrhage, or mononeuritis multiplex, with detrimental consequences. Early recognition and an appropriate treatment are crucial. Recent studies have shown that vasculitis in patients with SLE may present different clinical forms based on the organ involved and the size of the affected vessel. It is noteworthy that the episodes of vasculitis are not always accompanied by high disease activity. Recent articles on this topic have focused on new treatments for the control of vascular disease, such as biological therapies such as Rituximab and Belimumab, among others.

Seguridad farmacológica y ambiental: disrupción endocrina / Drug and environmental safety: hyroid endocrine disruption

La exposición humana a compuestos químicos que interfieren con la homeostasis hormonal es bien conocida, a pesar de que la evidencia sea muy desigual para los distintos sistemas hormonales. Mientras que la disrupción endocrina de los esteroides (estrógenos y andrógenos) ha merecido gran atención, la de la homeostasis de las hormonas tiroideas está mal entendida, si se exceptúa lo que se refiere a la captación de yodo. La lista de disruptores endocrinos que interfieren con la síntesis, la circulación, la unión a receptores específicos, el metabolismo y la degradación de las hormonas tiroideas crece día a día. A los bifenilospoliclorados (PCB), las dioxinas y los furanos, se unen ahora los compuestos bromados retardadores de la llama, los bisfenoles y losftalatos. Cambios sutiles en las concentraciones de las hormonas tiroideas pueden ocasionar efectos adversos en períodos esenciales del desarrollo, de tal manera que se empieza a ver los efectos de tal exposición ahora, una vez que los mecanismos que ligan hormonastiroideas y neurodesarrollo son cada vez más evidentes ( AU)

Human exposure to environmental chemicals that disrupt endocrine homeostasis has been related to several hormone systems. Sex hormones (estrogen sand androgens) have received special attention, but thyroid hormone disruption is not so well known except in the special case of iodine intake deficiency. The list of chemicals that alter synthesis, circulation, binding to specific receptors, metabolism and degradation of thyroid hormones increases daily. Brominated flameretardants, bisphenols and phthalates are now included alongside polychlorinated biphenyls (PCBs), dioxins and furans. Subtle changes in circulating thyroid hormones may have undesirable effects during development. As our understanding of the role of thyroid hormones in neurodevelopment improves, exposure to environmental thyroid disruptors becomes a matter of increasing concern (AU)

Integration of telemedicine into emergency medical services.

We developed an integrated model of telemedicine services in emergency medical care. The architecture was designed to support pre-hospital management. The experimental work was carried out with the collaboration of the emergency medical services (EMS) in Madrid. Two different study populations were defined: a control population using conventional EMS protocols and a population using the telemedicine system. The telemedicine system was based on a telepresence service; electrocardiograms and images were transmitted from the ambulance to the health emergency coordination centre. The cost of dealing with 100 patients using telemedicine was C6030 less than the cost of conventional care. The response times using telemedicine were significantly lower.

An assistive home care environment for people with special needs.

We have developed a system for supporting people with special needs. It allows remote monitoring of electrocardiographic and other signals together with multimode environmental control. The multimodal approach allows users with disabilities to interact more with the home environment. Telemedicine devices were integrated into the system to provide a link to health services. The system provided support for the independent living of people with special needs. The pilot site was a rehabilitation service attached to the National Paraplegic Hospital of Toledo, Spain. During the six-week trial period, the system did not fail, nor was any unauthorized access reported. Twelve people with special needs and three staff evaluated aspects of the system on a scale from 0 to 9, on which higher scores indicated a positive assessment. The mean score for efficiency was 7.8, for satisfaction 8, for helpfulness 7.4, for controllability 7.2 and for learnability 8.

A telemedicine model for integrating point-of-care testing into a distributed health-care environment.

Centralized testing demands costly laboratories, which are inefficient and may provide poor services. Recent advances make it feasible to move clinical testing nearer to patients and the requesting physicians, thus reducing the time to treatment. Internet technologies can be used to create a virtual laboratory information system in a distributed health-care environment. This allows clinical testing to be transferred to a cooperative scheme of several point-of-care testing (POCT) nodes. Two pilot virtual laboratories were established, one in Italy (AUSL Modena) and one in Greece (Athens Medical Centre). They were constructed on a three-layer model to allow both technical and clinical verification. Different POCT devices were connected. The pilot sites produced good preliminary results in relation to user acceptance, efficiency, convenience and costs. Decentralized laboratories can be expected to become cost-effective.

Transmission trials with a support system for the treatment of cardiac arrest outside hospital.

A mobile electrocardiogram (ECG) transmission system was developed which could transmit single-lead ECG data via GSM mobile telephony. Ambulance transmission trials comprised a total of 72 communications, of which 94% were successful. The system was able to redial up to a predetermined number of times until the GSM call was re-established (during the trials this value was set to five). The average number of GSM call tries was 1.3 per connection. The mean time required to establish a connection was 45 s; the minimum was 34 s, when only one attempt was needed to establish a GSM call. The average duration of ECG transmission between communication breakdowns was 5 min 12 s. When a link breakdown occurred, the user had to wait for an average of only 42 s to continue monitoring the signal.

Mobile technologies in the management of disasters: the results of a telemedicine solution.

Nowadays a great number of applications are used to compile and transmit casualties and disasters information but there are many troubles associated with the technology as can be the communications reliability and the size and weight of the devices medical staff has to carry with. Telecommunication infrastructures support information movement among geographically dispersed locations. Recently a large family of little devices has appeared in the buyer's market. They are called Personal Digital Assistants and because of their physic and technical features, they are very useful in the emergency field. As for the communications reliability, many technologies have been developed in the last years but it is necessary to find a solution that can be used in whatever situation independently of the emergency circumstances. Facing this reality, the Spanish government funded REMAF, an ATYCA (Initiative of Support for the Technology, Security and Quality in the Industry) project. REMAF joined research groups (UPM), phone operators (Fundación Airtel Móvil) and end users (SAMUR) to build a disaster data management system conceived to use modern telemedicine systems to optimize the management in these situations, taking the advantage of the above mentioned mobile communication tools and networks.

Double Descemet's membrane in penetrating keratoplasty.

A rare complication of penetrating keratoplasty is incomplete removal of the host Descemet's membrane, which can progressively become opaque. Utilizing a Nd:YAG laser, we opened the opaque membrane, improving visual acuity from 20/400 to 20/100.