Patient privacy protection using anonymous access control techniques.

OBJECTIVE: The objective of this study is to develop a solution to preserve security and privacy in a healthcare environment where health-sensitive information will be accessed by many parties and stored in various distributed databases. The solution should maintain anonymous medical records and it should be able to link anonymous medical information in distributed databases into a single patient medical record with the patient identity. METHODS: In this paper we present a protocol that can be used to authenticate and authorize patients to healthcare services without providing the patient identification. Healthcare service can identify the patient using separate temporary identities in each identification session and medical records are linked to these temporary identities. Temporary identities can be used to enable record linkage and reverse track real patient identity in critical medical situations. RESULTS: The proposed protocol provides main security and privacy services such as user anonymity, message privacy, message confidentiality, user authentication, user authorization and message replay attacks. The medical environment validates the patient at the healthcare service as a real and registered patient for the medical services. Using the proposed protocol, the patient anonymous medical records at different healthcare services can be linked into one single report and it is possible to securely reverse track anonymous patient into the real identity. CONCLUSION: The protocol protects the patient privacy with a secure anonymous authentication to healthcare services and medical record registries according to the European and the UK legislations, where the patient real identity is not disclosed with the distributed patient medical records.

CTG repeat polymorphism in DMPK gene in healthy Yugoslav population.

OBJECTIVES: Myotonic dystrophy type 1 (DM1) is caused by large expansions of cytosine-thymine-guanine (CTG)-repeats in myotonic dystrophy protein kinase (DMPK)-gene. This gene is highly polymorphic in healthy individuals. It has been proposed that expanded alleles originated from the group of large sized normal alleles. If this is correct, one should expect a positive correlation between the frequency of large sized normal alleles and a prevalence of this disorder in a population. In this paper we determined the distribution of alleles of DMPK gene in healthy Yugoslav population. MATERIAL AND METHODS: A sample of 235 healthy individuals of Yugoslav origin have been genotyped for the alleles of DMPK locus. RESULTS: We found 22 different alleles, ranging in size from 5 to 29 repeats. Among 470 chromosomes studied, 41 chromosomes had more than 18 repeats (8.72%). CONCLUSIONS: Relatively high frequency of large sized normal alleles found in our population, suggest that prevalence of DM1 in Yugoslavia should not be different from the prevalence in other European populations.

Motor neuron disease and monoclonal gammopathy.

In a study to determine the prevalence of monoclonal gammopathy (MG) among patients with motor neuron disease (MND), 6 out of 56 (10.7%) were found to have a monoclonal paraprotein. Of these 6 patients, 4 had an IgG and 2 had an IgA paraprotein. The clinical syndromes consisted of amyotrophic lateral sclerosis in 2 patients, lower motor neuron syndrome with preserved reflexes in at least one limb in 3 patients, and motor neuropathy with multifocal conduction block in 1 patient. The presence of gammopathy appears to correlate with the absence of marked upper motor neuron involvement and with elevated CSF protein concentration. An underlying malignant disorder was ruled out in all 6 patients, and they were considered to have MG of undetermined significance (MGUS). In a control group of 121 age-matched patients with other neuroimmunological disorders, 5 patients (4.13%) had MG. Four of these had gammopathy associated with malignant myeloma, and 1 had MGUS. These results support previous reports of increased prevalence of MGUS in patients with MND and suggest that an autoimmune mechanism may play a role in the disease.

[The importance of changes in the septal Q wave induced by exercise in the detection of ischemic heart disease]. / Vrednost promene septumskog talasa Q izazvane fizickim opterecenjem u otkrivanju ishemijske bolesti srca.

Among the numerous variables measured by the electrocardiogram during exercise little attention has been paid to the "septal" Q wave. We examined changes of the "septal" Q wave amplitude during exercise in 43 patients with chest pain. Coronary arteriography showed significant changes in 23 patients and normal arteries in 20. The Q wave amplitude was measured in leads V4-V6 immediately before and at the peak of submaximal bicycle exercise. The amplitude of "septal" Q wave increased during exercise in 11 (55%) patients, and decreased or was not changed in 9 (45%) of the normal subjects (p greater than 0.05). However, the Q wave amplitude increased in 6 (26%) patients, and decreased or was not changed in 17 (74%) patients with ischaemic heart disease (p less than 0.05). Thus, the sensitivity of Q wave analysis in the detection of coronary disease was 74% (p less than 0.05), but specificity was only 55% (p greater than 0.05).