[Requirements of information security in a telemedicine network: review of IT managers' opinion]

The requirements of information security in a telemedicine network can be categorized in four areas, namely; data storage and data accessibility, data transfer, human resources, and equipment for medical diagnosis. The purpose of this study was to determine the importance of each of the above areas from the perspective of information technology [IT] managers in teaching hospitals affiliated to Tehran and Shahid Beheshti Universities of Medical Sciences, and the experts in the field who worked in the Ministry of Health. This was a survey study conducted in 2013. The participants of the study included 41 information technology [IT] managers in teaching hospitals and seven experts who worked in the Ministry of Health. Data were collected using a five-point Likert scale questionnaire and were analyzed using descriptive statistics. The content and face validity of the questionnaire were confirmed by the experts in the field. The reliability of the questionnaire was calculated using Cronbach's coefficient alpha [alpha= 0/75]. The results of the present study showed that among the requirements of information security in a telemedicine network, human resources were of high importance [mean = 87.50]. The requirements related to the medical diagnostic equipment and those related to data storage and data accessibility were in the second [mean=87.04] and the third place [mean=85.97] of importance respectively. The requirements of information security in the area of data transfer were in the fourth place of importance. Considering the degree of importance that human resources gained compared to the importance of other requirements of information security in a telemedicine network, it seems that employing experts in the field of information security and training health care professionals in the application of telemedicine technology, may facilitate efficient deployment of this technology in the healthcare settings

Study of osteopontin as the "CA125" adjunct for detection of ovarian carcinoma in patients with pelvic mass

Introduction: Ovarian cancer is the most lethal gynecologic cancer, whose high mortality rate is partly due to late diagnosis. Tumor-specific markers that can be detected in early stages of the disease could probably improve treatment results. In this study, we evaluated the diagnostic value of serum levels of osteopontin in patients with epithelial ovarian tumors

Patients and methods: Twenty five patients with ovarian cancer and 25 patients with pelvic masses and 25 healthy women were enrolled in this study. Blood samples were taken from the patients from the first two groups before surgery and the healthy controls donated blood at the same time. Osteopontin serum level was measured by Enzyme-Linked Immunosorbent Assay method using human osteopontin enzyme immunoassay kits. Finally osteopontin levels before surgery were compared between groups

Results: The mean age in patients with ovarian cancer, benign tumor and normal group were 35.1, 32.4 and 31.6 years respectively. The most prevalent clinical symptom in almost half of patients with either benign or malignant pathology was abdominal pain. The average level of CA125 and osteopontin in ovarian cancer patients was 1818.4 and 9.6, respectively. The average level of CA125 and osteopontin in epithelial ovarian tumors was significantly higher than other groups. Significant linear relationship was detected between CA125 and osteopontin

Conclusion: Our study results support the fact that commitment measurement of osteopontin and CA125- due to their significant increase among the ovarian cancer patients- could be helpful in early detection of ovarian cancer

[ survey on barriers to the development and adoption of electronic health records in Iran]

The development and the adoption of electronic health records may face a number of bathers. These barriers can be classified as technical, organizational, individual, financial and ethico-legal. This study aimed at determining the importance of each of the mentioned barriers in the development and adoption of the electronic health records from the perspectives of the experts in the Ministry of Health. This was a descriptive applied research completed in 2011. The study population were constituted the faculty members working in of the departments of health information technology, health information management, and medical informatics, and as well as those who were in charge of the development and adoption of the electronic health records in the Ministry of Health and Medical Education. In this study, no No sampling method was used due to the limited number of the study population. Data were collected using a Likert scale questionnaire and were analysed by means of descriptive statistics. The content and face validity of the questionnaire were established and the reliability was calculated using Cronbach's alpha. In total, 32 participants [51.6%] completed the questionnaire. The participants' perspectives showed that the most important barriers in the development and adoption of electronic health records were the technical barriers [mean=71.00]. The financial barriers and the ethico-legal barriers with the mean values of 70.05 and 68.16 were in the second and third place, respectively. The individual and organisational barriers with the mean values of 64.84 and 62.67 were in the fourth and fifth places. It seems that employing a team of experts in different areas related to the development and adoption of EHR, training users, and addressing technical concerns along with allocating financial resources can help overcome barriers to the adoption of EHR

[ Study of neutrophil hyper segmentation in elderly and its diagnostic value for cobalamin and folic acid deficiency in Mashhad, Iran]

The prevalence of cobalamin and folic acid is high in elderly. Ambiguous clinical findings, various laboratory methods and normal range and cost of laboratory tests have been resulted in complexity and delay of the deficiency diagnosis. The aim of this study is to evaluate the relation between hematologic parameters, especially neutrophil hypersegmentation and cobalamin and folic acid insufficiency as well as increased serum hemocystein. Three hundred subjects more than 65 years age from twelve regions of Mashhad were studied. This population was selected by the Provincial Health Center. 250 subjects were analyzed for serum cobalamin and folate by RIA method. 78 subjects, who had cobalamin 120-450 pg/ml and folate 1.5-17ng/ml without any confounders, were analyzed for homocystein [Hcy] by Elisa method. Hematological parameters were assayed by H1 system and blood smear by microscopic observation. Data were analyzed by SPSS 11.5 software. p<0.05 was considered statistically significant. Among 235 participants, 45.5% and 54.5% were positive and negative for neutrophil hypersegmentation [NH], respectively. Significant correlation was not found between NH and gender. In 216 subjects, 56.7% had red blood cell macrocytosis. There was a significant relation between severity of NH and macrocytosis [p=0.001]. Macrocytosis had significant correlation with folate deficiency [p=0.017]. NH showed a statistically significant relation with folate [p=0.036], however, no correlation with cobalamin<122 pg/ml and increased homocystein. Folate showed significant relation with increased homocystein [p= 0.001]. Specificity and sensitivity of NH for diagnosis of cobalamin and folate deficiency was low. With respect to the high incidence of folate deficiency in elderly, a simple and economic screening test such as NH and macrocytosis could be performed for evaluation of serum folate. Although the specificity and sensitivity of NH for diagnosis of folate deficiency is not high, it may be used as a screening test

[Evaluation of body iron stores in non-over weight women with polycystic ovarian syndrome and its correlation with insulin resistance]

Polycystic ovarian syndrome [PCOS] is the most common cause of anovulation and hyperandrogenism, and obesity and insulin resistance are usually associated with this disease. Body iron stores are positively associated with glucose intolerance, type 2 diabetes mellitus, gestational diabetes and metabolic syndrome. It is reported that serum ferritin levels increase in obese women with PCOS. The aim of this study was to evaluate this relationship in women, neither overweight or obese, but suffering from PCOS. Fifty women with PCOS, without overweight, were selected based on the Rotterdam workshop criteria. After 12 hours fasting, serum ferritin, fasting blood sugar, cholesterol, triglycerides, HDL and insulin were measured and insulin resistance was calculated by HOMA-IR data was compared with that of 38 asymptomatic control subjects, matched for BMI and age. In the patient group, mean age was 27 +/- 5.78 years and mean BMI was 21.11 +/- 3.82 Kg/m2 mean serum ferritin in patients was 60.45 +/- 32.39, being 47.48 +/- 23.65 ng/mL in controls. Insulin resistance in patients was 2.61_0.91 and 1.74 +/- 0.72 in controls. Increases in serum ferritin, insulin and insulin resistance in patients were not statistically significant. There was no correlation between body iron stores and serum insulin level, insulin resistance and serum lipoproteins. Results showed that in non-overweight women with PCOS there is no significant increment of body iron stores

[Comparison of serum ceruloplasmin in preeclampsia and normal pregnancy]

Preeclampsia is a disorder of pregnancy with increased maternal and fetal morbidity and mortality. Endothelial cell dysfunction is important in the pathogenesis of preeclampsia. An imbalance between free radical induced lipid preoxidation and antioxidant system such as ceruloplasmin has been suggested as a possible pathogenic factor in preeclampsia and disturbing endothelial function. The aim of this study is to compare serum ceruloplasmin level in preeclampsia and normal pregnancy. This is a cross-sectional study that was performed on 39 preeclamptic patients [21 mild and 18 severe preeclampsia as case group] and 30 women with normal pregnancy [control group]. Five cc of blood was obtained from each patient and serum ceroloplasmin level was measured with special kit. Data were analyzed by one-way ANOVA Kruskal-wallis tests and ROC curve. P<0.05 was considered statistically significant. Maternal serum ceroloplasmin level was significantly different between the studied groups [P=0.47]. Increased serum ceroloplasmin level can be used as a predictive factor to diagnose severe preeclampsia

use of protein to creatinin ratio in random urine sample for prediction of proteinuria in preeclampsia

Preeclampsia occurs in approximately 17% of pregnancies, unknown etiology. The gold standard method for assessment of protein excreted in the urine to diagnose preeclampsia is a 24- h urine collection. However, this method is cumbersome and time consuming for the patient and laboratory. The aim of this study is to evaluate the use of protein to creatinin ratio in random urine sample for prediction of proteinuria in preeclampsia. This study is a cross-sectional descriptive study. This study was performed on 150 pregnant women who were hospitalized as preeclampsia in Ghaem Hospital during early 2006. At first, a random urine sample was collected for each patient to determine protein/creatinine ratio. Then, 24-h urine collection was analyzed for the measurement of proteinuria. Statistical analysis was performed with SPSS software and Pearson correlation coefficient for evaluation of the results. A total of 150 patients were entered the study. There was a significant relation between the 24-h urine protein and protein to creatinine ratio [r=0.659, P<0.001]. The use of e protein-to-creatinin ratio in random urine sample is a suitable replacement for the measurement of 24-h urine protein. This method is quick, reliable and cost effectiveness

[Effects of calcitriol [1,25[OH]2D3 treatment on control of glucose intolerance in hemodialysis patients]

Impaired carbohydrate metabolism is a common finding in patients with chronic renal failure. Although intermittent hemodialysis results in a significant improvement of impaired glucose metabolism of uremia, complete normalization did not occur. Vitamin D[3] deficiency, it seems is linked with disturbance of glucose metabolism. A role of vit D in endocrine pancreatic function has been suggested. The aim of this study was to determine the effects of 1,25 [OH]2D3 treatment on glucose tolerance, insulin resistance and beta cell function in hemodialysis patients. Of sixty-five patients with uremia on hemodialysis, twenty -seven who had never been treated with vitamin D or related drugs and without history of diabetes were selected for this study. These patients were randomly divided to two groups, group I were treated with oral calcitriol [0.5 mcg/day] for 8 weeks and group it received placebo for the 8 weeks. In all cases, before and 8 weeks after treatment fasting glucose, insulin, total cholesterol, triglycerides, HDL, LDL, calcium, phosphorous, PTH, HbA1C and blood sugar after 75 gr load of glucose were measured. Insulin resistance [homostatic model assessment-insulin resistance = HOMA-IR] and beta cell function [homostatic model assessment- insulin secretion =HOMA-SECR] were calculated and results of these measurements, before and after 8 weeks, in both groups were compared. In group I, after calcitriol treatment, blood sugar after 75 gr load of glucose [p= 0.045], HOMA -IR [p= 0.035], HbA1C [p=0.00], total cholesterol [p=0.037], and triglycerides [p=0.036] decreased, whereas calcium levels increased, significantly [0.014]; changes in other parameters were not significant. In group II [without treatment] after 8 weeks of observation, fasting blood sugar [p=0.002], HbA1C [p=0.004], HOMA -IR [p=0.036] significantly increased and beta cell function decreased significantly [p= 0.032]; again alterations in other parameters were not significant. These results seem to confirm that the active form of vitamin D influences glucose and lipid metabolism, by the improvement of insulin resistance

Telecytology in the diagnosis of pleural effusion smears

Telecytologic diagnosis of pleural effusion smears is potentially useful because it could allow more efficient use of cytopathologist resources and expertise. The purpose of our investigation was to evaluate how well this type of review correlates with a review which the entire silde is available for examination by the. pathologist. 35 pleural effusion smears with different diagnosis were selected retrospectively. they includ 16 benign, 5 suspiicious for malignancy and 14 malignant which were confirmed with two expert cytopathologists. for each slide number 3 to 11 fields containing abnormal cells were digitaly imaged. Pathologists reviewed all glass slides and digitized images individually. Diagnoses based on selected digitized images were compared with those based on conventional review. The kappa static, a measure of chance-corrected agreement [reroducibility], was calculated in each setting. The interobserver kappa value for the 3 observe for the slides was 76%. The interobserver kappa value for the digital images was 67%. The disagreement between a pathologist's glass slide and digital dignose [mean intraobserver kappa value = 73%] is greate than that or different pathologists reviewing glass slides [mean slide interobserverr kappa value= 76%]. Overall, intraobserver and intreobserrver reproducibility of pleural effusion slides [consists of direct smear after centrifugation and cytospin preparation] diagnoses is good to excellent

Nasal chondromesenchymal hamartoma in an adolescent: a report of case and review of literature

Nasal chondromesenchymal hamartoma [NCMH] is an extremely uncommon primary benign cartilaginous growth of the nasal and paranasal sinuses. It has been reported almost exclusively in infancy. We report a NCMH in a 23-year-old patient who presented with anosmia, right gaze diplopia and proptosis. CT scan of paranasal sinuses revealed frontal sinus mass extending to the right orbit, ethmoid cells and nose. After an initial inconclusive incisional biopsy, the patient underwent a complete radical resection; and the defect was reconstructed with osteoplastic flap of frontal sinus. Histopathological examination confirmed NCMH, which, we believe, probably had been present and undetected for many years. This report greatly extends the age of NCMH, as part of the differential diagnosis of cartilaginous lesions of the nose and paranasal sinuses

[Diagazostic value of AgNOR staining in neoplastic and non neophstic lesioizs of thyroid]

The aim of this study was to determine the value of the argyrophilic nucleoli organizer region [AgNOR] as a proliferative marker in neoplastic and non-neoplastic lesions of the thyroid i-r Methods: AgNOR count was evaluated in paraffin. Embedded tissue of resection specimens of the thyroid from 100 patients was retrieved from files of the Pathology Department of the Ghaem Hospital Medical Center including: Normal thyroid gland [N = 8] Nodular Goiter [N=19] Follicular Adenoma [N = 34] Follicular carcinoma [N=10] Medullary carcinoma [N = 4] Papillary carcinoma [N = 15] Anaplastic carcinoma [N = 4] Thyroiditis [N = 6] The investigated parameters included the number, size, shape and localization of AgNOR dots in nucleoli of hundred cells and percentage of nucleoli with at least 3 and 5 or more AgNOR dots per cell [distribution score]. The mean AgNOR dots and 3- dot per cell were statistically significantly higher in malignant lesions in comparison to benign lesions. No clear separation statically between groups about parameter 5 or more dots per cells. Total discrimination between follicular adenoma and carcinoma was achieved by quantification of AgNOR dot tumor nucleolus cell [AgNOR distribution score]. The AgNOR and AgNOR distribution score proved to be the most valuable diagnostic criterion for the differentiation between follicular adenoma and carcinoma of the thyroid

[Diagnostic value of AgNOR staining in differentiation between small cell carcinoma and benign lymphocyte in bronchial biopsy]

In some bronchial biopsies, differentiation between small cell carcinoma and severe lymphocytic infiltration of bronchial mucosa may be difficult. The aim of our study was to evaluate usefulness of AgNOR [Argyrophilic Nucleolar Organizer Region] staining method in this differentiation. Formalin fixed paraffin embedded tissues of 30 cases of small cell carcinoma and 30 cases of bronchial mucosa with benign lymphocytic infiltration were selected. Three microscopic slides from each case were prepared and stained for AgNOR, LCA [leukocytic Commn Antigen] and cytokeratin using Immunohistochemical method for the last two. In small cell carcinoma the mean number of AgNOR count was 4.97 per cell, and in lymphocytes it was 1.30[P<0.001]. The percentage of cells which demonstrated at least 3 AgNOR dots were 88.17% and 6.73% in small cell carcinoma and lymphocytes respectively [P<0.001]. The percentage of cells which exhibited at least 5 AgNOR dots were 55.67% and 0.6% respectively. AgNOR technique is a useful procedure for making differentiation between small cell carcinoma and lymphocytic infiltration in bronchial endoscopic biopsyies

[ results of posteromedial release [turco method] for the treatment of congenital clubfoot in children between 6 months to five years old]

In this prospective study, 37 children [65 feet] between 6 months and 5 years old have been chosen. In 75% of cases the disease was bilateral, 23 patients were male and 14 female. There was not family history of congenital clubfoot in any case. The mean age of surgery was 20.3 months 16-56 months]. All patients underwent PMR [Turco method] with two consequent corrective casts under general anesthesia and then clubfoot shoes was ordered Early post-operative complications happened in six cases [blister, edema and infection]. Radiographic evaluations was made before operation, immediately after operation, and as late follow up. Correction achieved in all patients according to immediate post-operative X-rays. After mean follow up of 24.3 months 48 feet [73%] had excellent lo good result, 13 feet [20%], fair and 4 feet [6%] failure [according to turco criteria]. Out of 17 feet with recurrence of deformity the metarsus adducts was most common [13 feet]. All children with recurrence of deformity were over 2 years of age at the time of surgery with upper range of age and 3 cases [6 feet] ignored ordered regular casting and shoe wearing. 11 seems that this method of surgery is effective procedure for correction of deformity for children under 5 years old but best results obtained for children under 2 years old