A Flexible Membership/Subscription Handling System in an e-commerce Environment

This paper addresses the authorization nature of a membership handling system over the Internet and an abstract architecture is presented, overcoming the drawbacks of mechanisms and techniques proposed and used so far. The system is based on Public Key Infrastructure utilizing attribute certificates

Heart disease in patients with haemoglobinopathies

Hereditary hemoglobin disorders, also termed haemoglobinopathies, include mainly beta -thalasszemia and sickle cell disease and represent the most common monogenic disorders in human. Cardiac complications are still a leading cause of mortality and morbidity in patients with haemoglobinopathy, although heart disease due to either severe anaemia or iron overload have dramatically reduced in patient populations receiving modern regular therapy and follow-up. The spectrum of cardiovascular manifestations in haemoglobinopathies is wide and includes ventricular dysfunction, pulmonary hypertension, pericarditis-myocarditis, arrhythmias stroke and thromboembolic events..

PFO size estimation using TCD: Are the measurements gender related?

There is an ongoing interest in using the findings of Transcranial Doppler (TCD) as a diagnostic technique for patent foramen ovale (PFO) determination. The aim of this study was to investigate the sensitivity of TCD for detection of PFO presence and the correlation of PFO size with the detected microbubble signals. The study group comprised of 103 individuals, healthy volunteers and patients with ischemic stroke or other cerebrovascular diseases. TCD was performed on all subjects, while the presence and size of PFO was estimated with Transesophageal Echocardiography (TEE). PFO diagnosis with TCD had a 92.68% sensibility, 89.47% specificity, 86.65% positive predictive value and 94.44% negative predictive value. PFO size was moderately correlated with the number of microembolic signals detected (rs = 0.404, p = 0.026). Further analysis for gender shown a strong correlation for men (rs = 0.781, p = 0.003), but no correlation for women (p = 0.92). Our results show that TCD is a good predictor of PFO in terms of sensibility and specificity. The correlation between the size of PFO on TEE and the number of microembolic signals detected on TCD is gender biased. Further anatomic and physiological studies are required to identify the reasons for this phenomenon

2021 Thalassaemia International Federation Guidelines for the Management of Transfusion-dependent Thalassemia

Beta-thalassemia and particularly its transfusion-dependent form (TDT) is a demanding clinical condition, requiring life-long care and follow-up, ideally in specialized centers and by multidisciplinary teams of experts. Despite the significant progress in TDT diagnosis and treatment over the past decades that has dramatically improved patients' prognosis, its management remains challenging. On one hand, diagnostic and therapeutic advances are not equally applied to all patients across the world, particularly in several high-prevalence eastern regions. On the other, healthcare systems in low-prevalence western countries that have recently received large numbers of migrant thalassemia patients, were not ready to address patients' special needs. Thalassaemia International Federation (TIF), a global patient-driven umbrella federation with 232 member-associations in 62 countries, strives for equal access to quality care for all patients suffering from thalassemia or other hemoglobinopathies in every part of the world by promoting education, research, awareness, and advocacy. One of TIF's main actions is the development and dissemination of clinical practice guidelines for the management of these patients. In 2021, the fourth edition of TIF's guidelines for the management of TDT was published. The full text provides detailed information on the management of TDT patients and the clinical presentation, pathophysiology, diagnostic approach, and treatment of disease complications or other clinical entities that may occur in these patients, while also covering relevant psychosocial and organizational issues. The present document is a summary of the 2021 TIF guidelines for TDT that focuses mainly on clinical practice issues and recommendations

Epididymal Adenomatoid Tumor: A Very Rare Paratesticular Tumor of Childhood

Adenomatoid tumor is an uncommon benign mesothelial neoplasm, usually localized in the epididymis. It is the most common paratesticular tumor of middle-aged patients (average age of clinical presentation: 36 years). However, these tumors in pediatric and pubertal patients are extremely rare. Due to their rarity, we present a case of adenomatoid tumor of the tail of the epididymis in a 16-year-old patient. After systematic research of the current literature, we did not find another case report of epididymal adenomatoid tumor in a male patient aged 16 years old or less. This notice and our concern, as well, about the patient’s surveillance protocol during the postoperative period were the motive for this case study

Levosimendan in Europe and China: An Appraisal of Evidence and Context

The calcium sensitiser levosimendan (SIMDAX; Orion Pharma) has been in clinical use for the management of acute heart failure and a range of related syndromes in many countries around the world for two decades. More recently, levosimendan has become available in China. The authors have examined the profile of levosimendan in clinical trials conducted inside and outside China and grouped the findings under six headings: effects on haemodynamics, effects on natriuretic peptides, effect on symptoms of heart failure, renal effects, effect on survival, and safety profile. Their conclusions are that under each of these headings there are reasonable grounds to expect that the effects and clinical benefits established in trials and with wider clinical use in Europe and elsewhere will accrue also to Chinese patients. Therefore, the authors are confident that global experience with levosimendan provides a reliable guide to its optimal use and likely therapeutic effects in patients in China

Contemporary role of cardiac magnetic resonance in the management of patients with suspected or known coronary artery disease

Cardiac magnetic resonance imaging (CMR) is a useful non-invasive radiation-free imaging modality for the management of patients with coronary artery disease (CAD). CMR cine imaging provides the “gold standard” assessment of ventricular function, late gadolinium enhancement (LGE) provides useful data for the diagnosis and extent of myocardial scar and viability, while stress imaging is an established technique for the detection of myocardial perfusion defects indicating ischemia. Beyond its role in the diagnosis of CAD, CMR allows accurate risk stratification of patients with established CAD. This review aims to summarize the data regarding the role of CMR in the contemporary management of patients with suspected or known coronary artery disease

Case Report Multiple Gastric Erosion Early after a 3 V Lithium Battery (CR2025) Ingestion in an 18-Month-Old Male Patient: Consideration about the Proper Time of Intervention

Introduction. Button battery ingestion is considered an emergency situation in pediatric patients that needs to be managed promptly; otherwise, it may lead to serious and potentially lethal complications, especially when it is impacted in the esophagus. Less attention has been given in cases where the battery passes into the stomach, with guidelines for emergency intervention being based on the presence of symptoms. Case Report. We present a case of an 18-month-old male patient who presented to our emergency department after button battery ingestion. He did not have any symptoms and no pathological findings were encountered during clinical examination. X-ray investigation revealed the presence of the battery in the stomach. The patient was admitted for observation and two hours later he had two episodes of vomiting. He underwent urgent endoscopic removal of the battery where multiple acute gastric mucosal erosion in place of direct contact of the battery's negative pole with the mucosa of the gastric antrum was found. Conclusion. In specific cases the urgent endoscopic intervention for removal of an ingested button battery that is located in the stomach even in asymptomatic patients should be suggested