勒索病毒

"Give Me All Your Money, or You'll Never See Your Computer System Again"

早上就看到這新聞，
http://news.ltn.com.tw/news/world/breakingnews/2066061
〔即時新聞／綜合報導〕如果在使用Windows XP 、Windows Vista、Windows 7的用戶，請盡快將電腦系統更新。目前名為「WanaCrypt0r 2.0」的勒索病毒席捲全球，包括英國、西班牙、俄羅斯、日本、台灣等99國遭受攻擊，英國的醫療系統在受到攻擊後，電腦停止運作，被迫要將病人轉移醫院。

The hackers holding hospitals to ransom
http://www.bmj.com/content/357/bmj.j2214
Published 10 May 2017

而這BMJ文章提到的一段話讓我感到興趣，「醫院也許是最願意付贖金的」
Hospitals are ideal targets for ransomware companies. They have irreplaceable medicolegal records and data for an increasing number of day to day functions, from patients’ appointments to viewing imaging. Hospitals are probably more willing than other organisations to pay for quick recovery of their data.

醫療體系若是中了電腦病毒，一般是不願意承認的，因為會影響患者對這家醫院的信心。

2015-2016美國付給勒索病毒的錢，根據FBI，可能高達10億美金。

Hollywood Presbyterian was the first hospital to admit paying a ransom, but other US hospitals, in California, Indiana, Kentucky, Maryland, and Texas, were targeted in 2016.6 The number of ransomware attacks rose fourfold from 2015 to 2016, and so did the amount of money paid to hackers, to $1bn, according to the FBI.7 In the UK, a third of NHS trusts have reported a ransomware attack.8

賣病人的個資比賣信用卡個資還有價值10倍。

Hospitals also hold confidential information about their patients, such as birth dates, addresses, insurance or social security details, and personal medical history. These personal data can be sold to other criminals for $10 a patient.10 This is about 10 times what can be earned by selling credit card details. Loss of these data also exposes hospitals to fines and loss of reputation—incentives to keep quiet.

大家要注意資安安全啊

We should be prepared: more hospitals will almost certainly be shut down by ransomware this year.

黃疸和腎衰竭

這一期的Renal Fellow Network提到一位20歲學生，常划獨木舟（喜歡戶外水上活動），有一天發燒、肌肉痛、頭痛，自己服用退燒止痛藥(acetaminophen+ibuprofen)5天後，就產生黃疸和尿量減少了。

Renal Fellow Network: Jaundice and Renal Failure http://renalfellow.blogspot.com/2017/04/jaundice-and-renal-failure.html?spref=tw

在腎臟科基本檢查後只發現conjugated bilirubin 25 mg/dl, creatinine 4.82 mg/dl, potassium 3.4 mmol/L異常，給予36小時的fluid resuscitation後，還是尿量少，因此開始CRRT，接著尿量出來，黃疸也退了。

因為懷疑leptospirosis，醫師開始給予經驗性的ceftriaxone抗生素治療，並抽血送檢leptospirosis serum IgM + urine PCR，6天後證實是陽性。

Renal biopsy can show pigmented bile casts within the tubules and tubular hypertrophy (see image).


要怎麼早點懷疑是leptospirosis呢？
Early clues for leptospirosis in this case include hypokalemia despite being oligoanuric, enlarged kidneys on ultrasound and of course his social history.

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鉤端螺旋體病（Leptospirosis）
主要宿主有老鼠、犬隻、豬、牛、馬、羊等動物。動物感染鉤端螺旋體後，造成腎臟慢性感染，並且由尿液大量排菌，再經由尿液污染水及土壤，進而感染人類。當人們工作（農民、下水道工程、礦工、屠夫）或野外活動時，可經由皮膚、黏膜或傷口接觸到受污染的土壤或水而得病
http://www.cdc.gov.tw/professional/info.aspx?treeid=4c19a0252bbef869&nowtreeid=4dc827595f55c334&tid=47A5BF67EE43BF89