A new framework architecture for next generation e-Health services.

The challenge for fast and low-cost deployment of ubiquitous personalized e-Health services has prompted us to propose a new framework architecture for such services. We have studied the operational features and the environment of e-Health services and we led to a framework structure that extends the ETSI/Parlay architecture, which is used for the deployment of standardized services over the next generation IP networks. We expanded the ETSI/Parlay architecture with new service capability features as well as sensor, profiling and security mechanisms. The proposed framework assists the seamless integration, within the e-Health service structure, of diverse facilities provided by both the underlying communication and computing infrastructure as well as the patient's bio and context sensor networks. Finally, we demonstrate the deployment of a tele-monitoring service in smart home environment based on the proposed framework architecture.

A novel mobile telemedicine system for ambulance transport. Design and evaluation.

It is generally accepted that early and specialized pre-hospital patient treatment improves outcome in terms of mortality and morbidity, in emergency cases. The focus of this paper is to present the implementation and the evaluation of an ambulance located telemedicine system for pre-hospital patient treatment The primary emphasis is on the vital sign transmission from the accident site or the moving ambulance to the consultation site, using the GSM mobile telephony network. There, the experts evaluate the patient data, decides about the treatment protocol and provide directions to the ambulance's medical staff concerning on the patient handling until the arrival to the hospital.

Improvement of iodine deficiency after iodine supplementation in schoolchildren of Azerbaijan was accompanied by hypo and hyperthyrotropinemia and increased title of thyroid autoantibodies.

OBJECTIVE: In the mountainous areas of Azerbaijan the schoolchildren suffer from severe Iodine Deficiency (ID) with median Urinary iodine excretion (UIE) 36 mcg/l and prevalence of goiter 99% (estimated by US). In a population of 293,000 schoolchildren aged 8-14 y.o. we administered capsules containing 190 mg of iodized oil (Lipiodol-Guerbet, Cedex, France) twice yearly in 6 months apart (total 380 mg). The aim of the present study was to evaluate the efficacy, the benefits, as well as the possible side-effects in a follow-up period of 6 and 12 months after the initial administration of iodized oil. METHODS: Six and 12 months after the initial administration of iodide, two representative samples of 391 and 326 children respectively were examined. The evaluation included: estimation of goiter by US, determination of UIE and serum measurements of T3, T4, TSH, Tg, autoantibodies against thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg). RESULTS: There was an improvement in median UIE which increased from 36 mcg/l to 68 and 81 mcg/l after 6 and 12 months of treatment respectively. The prevalence of goiter decreased from 99% to 54% and 26% respectively. Tg was decreased at 6 and 12 months from the first administration, whereas TSH remained unchanged at 6 months and decreased at 12 months when compared to the latter value. Hypothyroidism was detected in 7% of children after iodide administration both at 6 and 12 months, but overt hypothyroidism was observed only in 0.5% at 12 months. Subclinical hyperthyroidism was detected in 2% and 6% after iodide administration both at 6 and 12 months. There was a significant increase in the title of thyroid auto antibodies in 6 months which was retained and increased in 12 months. There was no relation between the appearance of thyroid dysfunction and the positive thyroid auto antibodies. CONCLUSION: The dose of 190 mg iodide administered twice yearly, improved iodine deficiency and endemic goiter in schoolchildren. The increase of UIE resulted from iodide administration, was accompanied by an increased title of thyroid auto-antibodies and an increased prevalence of hyper- and hypothyrotropinemia apparently of no autoimmune etiology.

Iodine deficiency in Azerbaijan after the discontinuation of an iodine prophylaxis program: reassessment of iodine intake and goiter prevalence in schoolchildren.

The goal of this study was to assess the prevalence of iodine deficiency (ID) in Azerbaijan after the discontinuation of an iodine prophylaxis program by assessing the prevalence of goiter, iodine intake, and thyroid function. The study included 942 schoolchildren (475 boys and 467 girls) ages 8-14 years, from 13 distinct regions. The survey included the following: (1) clinical evaluation; (2) assessment of thyroid volume both by ultrasound and by palpation; (3) determination of iodide in a morning urine specimen using the classic Sandel-Kolthoff reaction in 347 schoolchildren; (4) determinations of thyrotropin (TSH), triiodothyronine (T3), thyroxine (T4), thyroglobulin (Tg), and anti-thyroid peroxidase (TPO) in serum (n = 165) and TSH in whole blood spotted on filter paper (n = 942). The prevalence of goiter for the whole country was determined by ultrasound (US) to be 86% and by palpation 66%, reaching 100% in the mountainous regions of Caucasus. The median urinary iodine excretion (UIE) was 54 microg/L, reaching level of 26 and 39 microg/L in the Caucasus region. In conclusion, according to the World Health Organization (WHO) classification, Azerbaijan now has mild to moderate ID (median UIE, 54 microg/L) and in the mountainous regions with severe ID. The high prevalence of goiter and the low UIE emphasizes the need for urgent medical reintervention. An iodination program is now implemented by our team in the mountainous regions under the auspice of the government of Azerbaijan.

HCV infection in the general population of a Greek island: prevalence and risk factors.

BACKGROUND/AIMS: Although HCV seroprevalence in blood donors in Greece is low (0.2-0.4%) epidemiologic characteristics of HCV infection in the general population have not been studied enough. The objective of this study was to examine the seroprevalence of HCV infection and associated risk factors in the general population of Zakinthos, a Greek island with a well-defined mixed (urban and rural) population. METHODOLOGY: A household health survey was carried out in a randomly selected sample of 718 adults. A questionnaire was completed and a blood sample was obtained from all participants. Serum samples were tested for anti-HCV antibodies by third generation enzyme-linked immunosorbent assay and supplemental test. The influence of sociodemographic characteristics and possible associated risk factors on the HCV seroprevalence was investigated by logistic regression analysis. RESULTS: The overall anti-HCV prevalence was 1.25%. A well-defined rural area with a significant higher prevalence (6.8% vs. 0.62%; P < 0.001) was identified. There was a trend of increasing prevalence with age, with a significant difference (P < 0.027) between the age groups 15-44 (0%) and over 45 (2.15%). The logistic regression analysis confirmed a significant association between anti- HCV positivity and: increasing age (P < 0.001), history of blood transfusion (0.0001), intramuscular injections (P < 0.04). CONCLUSIONS: The results of this field-survey in a well-defined general population, indicates that HCV seroprevalence (1.25%) is much higher than that of blood donors in the same area. The increasing prevalence with age and the association with parenteral exposure indicates that HCV infection can mainly be attributed to parenteral techniques in the past. The identification of a concrete rural area with particularly high seroprevalence needs further study of the whole population of the area.

Intrahepatic bile duct injury and nodular regenerative hyperplasia of the liver in a patient with polyarteritis nodosa.

Although involvement of the hepatic vasculature in patients with polyarteritis nodosa is not unusual, biliary manifestations are very rare. We describe a patient with polyarteritis nodosa presenting with a febrile cholestatic anicteric syndrome. Histological examination of the liver revealed necrotizing arteritis of small hepatic arteries associated with significant lesions of intrahepatic bile ducts of the sclerosing cholangitis type, i.e. fibrous collar around the ducts, periductal inflammation and ductal proliferation. Concomitant nodular regenerative hyperplasia was found, a condition which has rarely been described in association with polyarteritis nodosa. We think that hepatic arteritis compromising arterial blood flow to the liver was responsible for the most likely ischemic nature of the bile duct injury and the nodular regenerative hyperplasia seen in our patient.

Electrocardiographic appearance of a non-Q wave acute myocardial infarction in a patient with thyrotoxicosis. A case history.

A patient with severe thyrotoxicosis developed the typical electrocardiographic (ECG) evolution of a non-q myocardial infarction. This occurred without evidence of myocardial necrosis and in the absence of coronary artery disease. Treatment with beta blockers resolved the ECG changes despite the persistence of the thyrotoxic state.

Stenosis of the colon in pancreatitis.

Persistent or transient stenosis of the colon is a rare complication in the course of acute or chronic pancreatitis. The clinical, laboratory and surgical findings are discussed. Two cases are described here, and 34 cases reported in the literature are reviewed.