Extensive, Non-Healing Scalp Ulcer Associated with Trauma-Induced Chronic Osteomyelitis

A 77-year-old woman presented with a trauma to the scalp caused from the blade of a windmill. The condition was persistent from the past 50 years. At the initial examination, a deep, foul-smelling and well-circumscribed ulcer was apparent on the head region, involving the majority of the cranium. Skin biopsy specimens of the lesion were nonspecific. The bone biopsy showed extensive necrotic areas of bone and soft tissues, with lymphocytic exudate foci. A computed tomography scan of the head revealed bone destruction principally involving both the parietal bones, and parts of the frontal and occipital bones. Streptococcus parasanguis was isolated from the skin culture, and Proteus mirabilis and Peptostreptococcus sp. were identified in the cultures from the bone. A long-term treatment with amoxicillin-clavulanic acid (1 g/12 h) and levofloxacin (500 mg/day) was prescribed, but even after 6 months, the lesion remained unchanged. The frequency of occurrence of scalp ulcers in dermatological patients is less, principally because of the rich blood supply to this area. We have not found any similar case report of a scalp ulcer secondary to chronic osteomyelitis discovered more than 50 years after the causal trauma. We want to highlight the importance of complete cutaneous evaluation including skin and bone biopsies, when scalp osteomyelitis is suspected

Proyecto Doctoris

Este proyecto implementa un sistema de gestión de consulta médica multiplataforma, adaptable fácilmente a los Distintos tipos de especialidades médicas y aplicaciones futuras. Se han seguido dos pautas fundamentales en el diseño. La primera diseñar un sistema donde la funcionalidad sea independiente de la interfaz sobre la que se aplica. También conocido como Modelo - Vista - Controlador. Esto permite que la aplicación sea adaptable a cualquier tipo de interfaz de manera sencilla sin suponer grandes cambios en la implementación. Además de la reutilización de código de manera eficiente. En segundo lugar elaborar una implementación distribuida, dividida en distintos componentes para aumentar la flexibilidad en las posibles adaptaciones posteriores. Al dividir la aplicación los cambios que se realicen solo afectan a una parte muy concreta del código. Fácil de localizar y depurar. Y lo nuevo que se añada será siempre independiente a lo ya existente. Para llevar a cabo todo lo arriba mencionado se ha usado la herramienta ICARO-T. ICARO-T es una Infraestructura Ligera de Componentes Software Java basada en Agentes y Recursos y Organizaciones para el desarrollo de aplicaciones distribuidas. Muy útil cuando se trata de construir un sistema distribuido como el que se pretendía en este caso. [ABSTRACT] This project implements a medical clinic management system that can be applied to any kind of interface (computer, mobile, web) and can adapt itself easily to changes. There are two basic guidelines followed in the design of the project. The first one is to design a system where the functionality is independent of the interface to which it is applied. This is generally known as a Model View Controller pattern. This allows the creation of an application which can be adapted to any system in a relatively simple way, without making big changes to the implementation of application. Another advantage is that the code can be reused efficiently. The second guideline followed is to design a distributed implementation, separated in individual components, to make the application more flexible for possible future uses. By doing this division, changes done in one component won’t affect the correct operation of another one. Any change in the code will be done in a localized part of the code which makes it easier to debug. A multiagent system was used in order to accomplish all that was mentioned above. More specifically, a multiagent infrastructure call ICARO-T is the base of the system. ICARO-T is a Light Component Java Software Infrastructure based on Agents, Resources and Organizations for the development of distributed applications. It is a very useful tool when building a distributed system, which is what is pretended in this case

Effectiveness and safety of Methotrexate in psoriasis: an eight-year experience with 218 patients

Background: Methotrexate (MTX), a traditional antipsoriatic drug, is very frequently used either as monotherapy or in combination with other systemic drugs. Objectives: To assess the effectiveness and safety of MTX in psoriasis in usual clinical practice. Methods: We conducted a retrospective study. We performed an electronic and manual chart review of patients treated with MTX in the Psoriasis Unit of our Hospital from January 2007 to December 2014. Demographic and clinical data, PASI/DLQI scores and reasons for suspension of all patients treated with MTX in usual clinical practice were recorded. Results: Two hundred and eighteen patients were included. MTX was administered in 67% of cases as the first systemic treatment. The average treatment duration was 17.2 ± 13.6 months. All patients were subjected to clinical and laboratory monitoring. About 33.5% of them achieved a reduction of 75% or more of the initial PASI at week 12, 34.9% at week16, 44.7% at week 24, and 52.8% at week 48. A 3.3% had to discontinue the therapy due to analytical hepatic (2.8%) or renal (0.5%) abnormalities. Only one patient experienced severe interstitial pneumonitis and none required liver biopsy. Conclusions: MTX is an effective and safe option for the treatment of psoriasis in the real-world clinical practice