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Clinical symptoms indicative of toxic epidermal necrolysis. The withdrawal of the causative drug improves the vital prognosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Telemedicine allows interaction between patients and doctors living thousands of miles away from each other.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The fact that photographic material complementary to the clinical history can be easily obtained turns specialties such as dermatology or radiology into ideal medical fields for its application in clinical practice, although through the clinical course, being able to comment a case with specialists in different medical or surgical areas becomes tremendously useful in the context of medical cooperation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The benefit affects both the patients treated and the healthcare professional, who are often overwhelmed by the case they are dealing with, very different from the ones that they are used to treat because the local epidemiology is different or because they are required to treat diseases that are not specific to their specialty.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In many countries located in the southern region of the planet (Africa, South America or Southeast Asia), which are characterized by a high multidimensional poverty index (MPI), access to the health system, and particularly medical specialists, is very difficult, almost exceptional outside the big capitals. Cases are treated at the level of basic healthcare clinics or district hospitals, where general practitioners and nurses must treat patients whose illnesses often exceed their area of knowledge.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The <a id="intr0010" class="elsevierStyleInterRef" href="http://www.tropicaltelemedicine.org/">www.tropicaltelemedicine.org</a> project was born 3 years ago.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> It is a web page and an application for Android phones, multilingual, created to make the sending of cases for consultation by any health worker who is working in a southern country accessible, free and simple. It also provides a training platform where the most interesting cases from among those received are discussed and a section where NGOs in need of healthcare volunteers can advertise.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The cases referred are answered by a specialist with experience in tropical medicine in less than 24<span class="elsevierStyleHsp" style=""></span>h. This one will try to make a differential diagnosis among the most feasible possibilities, and, within them, proposes the most plausible option according to the local epidemiology, addressing the problem from a practical point of view and taking into account that the sender does not have too many diagnostic or therapeutic means at his/her disposal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Currently, the cases are mostly sent by Spanish aid workers, who know about the web page through the Internet (social networks, tropical medicine courses, advertising by some institutions, etc.).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Of those received so far, the majority of cases belong to the specialty of dermatology, although radiological diagnosis (X-ray, ultrasound and CT so far), ophthalmology, infectious diseases, mammary disease and paediatrics have also been received.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The Ebola epidemic, the existence of armed conflicts, coup d’états or the threat of radical Islamism may have had an influence on the arrival of volunteers to the field, their profile and the number of cases received so far. Most cases come from Africa, although we have also received cases from Central and South America.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We have observed that when they send us images, their quality is variable and the clinical information that accompanies them tends to be scarce, which makes the diagnosis difficult and slow, since requesting additional information is necessary.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In most cases we do not have <span class="elsevierStyleItalic">feedback</span>, or information about the patient's progress, which can be frustrating.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Knowledge of the area's epidemiology is essential to be able to provide an adequate diagnostic approach (season, climate, altitude, etc. influence the onset of infectious diseases). Tools such as Google Earth have helped us in this aspect when we do not really know the characteristics of a specific region within a country.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The high prevalence of HIV in Africa, the increasingly widespread access to antiretroviral drugs and the existence of certain clinical symptoms that guide the diagnosis of HIV or that correlate with the immune state determine one of the main aspects to be taken into account when suggesting a diagnosis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Performing a HIV test is currently possible in many parts of Africa and the patient's prognosis significantly improves when treatment starts early.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A rapid response is vital in some cases, as in the case of patients with serious drug reactions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) or those with severe infectious conditions, and it is the only way that can be of help to the healthcare professional making the inquiry.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">To conclude, we want to continue receiving cases from different corners of the planet and we hope that with our answers we can facilitate the healthcare process in those areas. We would also like to encourage more doctors to try out the fascinating, rewarding and enriching experience of volunteering.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Barja López JM, Fernández Alonso D, Caballero Fernández P. Tropicaltelemedicine.org: telemedicina en cooperación sanitaria 3 años después. Med Clin (Barc). 2018;150:244–245.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 98538 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rapid onset generalized bullous lesions, evident skin detachment and positive Nikolsky sign. Clinical symptoms indicative of toxic epidermal necrolysis. The withdrawal of the causative drug improves the vital prognosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The African Teledermatology Project: providing access to dermatologic care and education in sub-Saharan Africa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Weinberg" 1 => "S. Kaddu" 2 => "G. Gabler" 3 => "C. Kovarik" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pan Afr Med J" "fecha" => "2009" "volumen" => "3" "paginaInicial" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21532725" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tropicaltelemedicine.org: una nueva herramienta para proyectos de cooperación sanitaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Barja" 1 => "M. Berdeal" 2 => "P. Felpete" 3 => "P. 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Available in: <a id="intr0020" class="elsevierStyleInterRef" href="http://www.who.int/hiv/data/en/">http://www.who.int/hiv/data/en/</a>" ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Ahmed" 1 => "M. Schwarz" 2 => "R.J. Flick" 3 => "C.A. Rees" 4 => "M. Harawa" 5 => "K. Simon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/tmi.12671" "Revista" => array:6 [ "tituloSerie" => "Trop Med Int Health" "fecha" => "2016" "volumen" => "21" "paginaInicial" => "479" "paginaFinal" => "485" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26806378" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack340685" "titulo" => "Acknowledgements" "texto" => "<p id="par0075" class="elsevierStylePara elsevierViewall">We wish to thank all the doctors who participate in the project in an altruistic way and to all the volunteers who have used the platform <span class="elsevierStyleItalic">on-line</span>.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015000000006/v1_201803290432/S2387020618300329/v1_201803290432/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015000000006/v1_201803290432/S2387020618300329/v1_201803290432/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618300329?idApp=UINPBA00004N" ]
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Vol. 150. Issue 6.
Pages 244-245 (March 2018)
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Vol. 150. Issue 6.
Pages 244-245 (March 2018)
Scientific letter
Tropicaltelemedicine.org: Telemedicine in medical cooperation 3 years later
Tropicaltelemedicine.org: telemedicina en cooperación sanitaria 3 años después
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