Management of incidental adrenal tumours.

An incidental adrenal tumour, described in this article as an “adrenal incidentaloma,” is an adrenal mass discovered during imaging that was not performed for suspected adrenal disease. These are being detected more frequently in an ageing population through the increased use of computed tomography (eg, computed tomography urogram, or colonoscopy) and magnetic resonance imaging (MRI) scans with enhanced resolution. This article highlights the management of adrenal incidentalomas, collating recommendations from international guidelines, and is aimed at non-specialists

Coordinated optimization of visual cortical maps (I) Symmetry-based analysis

In the primary visual cortex of primates and carnivores, functional architecture can be characterized by maps of various stimulus features such as orientation preference (OP), ocular dominance (OD), and spatial frequency. It is a long-standing question in theoretical neuroscience whether the observed maps should be interpreted as optima of a specific energy functional that summarizes the design principles of cortical functional architecture. A rigorous evaluation of this optimization hypothesis is particularly demanded by recent evidence that the functional architecture of OP columns precisely follows species invariant quantitative laws. Because it would be desirable to infer the form of such an optimization principle from the biological data, the optimization approach to explain cortical functional architecture raises the following questions: i) What are the genuine ground states of candidate energy functionals and how can they be calculated with precision and rigor? ii) How do differences in candidate optimization principles impact on the predicted map structure and conversely what can be learned about an hypothetical underlying optimization principle from observations on map structure? iii) Is there a way to analyze the coordinated organization of cortical maps predicted by optimization principles in general? To answer these questions we developed a general dynamical systems approach to the combined optimization of visual cortical maps of OP and another scalar feature such as OD or spatial frequency preference.Comment: 90 pages, 16 figure

Cosmic rays and molecular clouds

This paper deals with the cosmic-ray penetration into molecular clouds and with the related gamma--ray emission. High energy cosmic rays interact with the dense gas and produce neutral pions which in turn decay into two gamma rays. This makes molecular clouds potential sources of gamma rays, especially if they are located in the vicinity of a powerful accelerator that injects cosmic rays in the interstellar medium. The amplitude and duration in time of the cosmic--ray overdensity around a given source depend on how quickly cosmic rays diffuse in the turbulent galactic magnetic field. For these reasons, gamma-ray observations of molecular clouds can be used both to locate the sources of cosmic rays and to constrain the properties of cosmic-ray diffusion in the Galaxy.Comment: To appear in the proceedings of the San Cugat Forum on Astrophysics 2012, 27 pages, 10 figure

Analysis of some selected toxic metals in registered herbal products manufactured in Nigeria

The use of herbal medicine has been on the increase in many developing and industrialized countries and Nigerians in particular has been using herbal medicine for many centuries. The approval of these herbal remedies by regulatory bodies has further encouraged the use of herbal remedies. The safety of these herbal remedies is however poorly understood. This study investigated the concentration of arsenic, cadmium, lead and mercury in twenty registered ready to use herbal products. Twenty brands of herbal remedies were purchased randomly from the Pharmacy shops in Lagos, digested with aquaregia (3:1 HCl: HNO3) and were analysed using atomic absorption spectroscopy (Buck 205 Atomic Absorption Spectrophotometer). There was no detectable lead in any of the 20 herbal samples; however, all the samples contained a detectable amount of one or more of the other metals of interest. The Oral Component Limit (OCL) for arsenic, cadmium and mercury as stated by USP are 1.5, 0.5 and 1.5 μg/g, respectively. All the samples contained arsenic and mercury below the USP OCL, while sixtyfive percent contained cadmium out of which fifty-five percent were above USP OCL. The results obtained from this study suggest a significant risk to consumers’ health considering the toxicity of these heavy metals.Key words: Herbal remedies, toxic heavy metals, atomic absorption spectrophotometry

Coordinated optimization of visual cortical maps (II) Numerical studies

It is an attractive hypothesis that the spatial structure of visual cortical architecture can be explained by the coordinated optimization of multiple visual cortical maps representing orientation preference (OP), ocular dominance (OD), spatial frequency, or direction preference. In part (I) of this study we defined a class of analytically tractable coordinated optimization models and solved representative examples in which a spatially complex organization of the orientation preference map is induced by inter-map interactions. We found that attractor solutions near symmetry breaking threshold predict a highly ordered map layout and require a substantial OD bias for OP pinwheel stabilization. Here we examine in numerical simulations whether such models exhibit biologically more realistic spatially irregular solutions at a finite distance from threshold and when transients towards attractor states are considered. We also examine whether model behavior qualitatively changes when the spatial periodicities of the two maps are detuned and when considering more than 2 feature dimensions. Our numerical results support the view that neither minimal energy states nor intermediate transient states of our coordinated optimization models successfully explain the spatially irregular architecture of the visual cortex. We discuss several alternative scenarios and additional factors that may improve the agreement between model solutions and biological observations.Comment: 55 pages, 11 figures. arXiv admin note: substantial text overlap with arXiv:1102.335

Corporate reporting and disclosures in the emerging capital market of Kuwait:the perceptions of users and preparers

The objective of this paper is to investigate the perceptions of users and preparers regarding financial disclosure practices in annual reports of Kuwaiti listed firms. To measure participants' views, a questionnaire survey was distributed in Kuwait between October and December 2012, to preparers (financial managers) and users (financial analysts) within Kuwaiti listed companies. The study compares between the perceptions of financial managers and financial analysts regarding disclosing information in corporate annual reports as well as the main obstacles facing the disclosure process and what the problems restricting the use of companies' annual reports. The study also seeks to investigate whether there is a perceived need for improving the usefulness of Kuwaiti companies' annual reports for decision-making. The results, based on 137 responses, indicate that accounting practices in Kuwaiti firms are firmly rooted in a decision-usefulness tradition with management and the board of directors viewed as the key audience for reporting information. Indeed, the annual reports of Kuwaiti listed companies are perceived as the most important sources of information. On the whole both users and preparers shared similar concerns regarding the volume of information contained within annual reports; however, their views differed in terms of identifying potential solutions. The results of the study are likely to have implications for decision makers, the academic community and accounting standard setters. 2018 Macmillan Publishers Ltd., part of Springer Nature

Prévalence de l’hépatite B chez les personnes infectées par le VIH à Parakou au Bénin

Introduction: la co-infection avec l'hépatite B est l'un des défis majeurs de la prise en charge du VIH depuis l'amélioration de l'accès aux  antirétroviraux en Afrique. La présente étude visait à estimer la prévalence de l'hépatite B chez les personnes séropositives au VIH à Parakou et décrire les facteurs associés. Méthodes: il s'agit d'une étude transversale menée de Mai 2011 à Juin 2012 dans le service de Médecine du CHU de Parakou. Ont été inclus tous les adultes séropositifs au VIH vus en  consultation ou hospitalisés. Les données ont été collectées par interviews et dépouillement de dossiers médicaux. L'antigène HBs a été recherché par un test rapide et l'ALAT a été dosé. L'analyse des données a été faite avec le logiciel EpiInfo 3.5.1. Les proportions ont été comparées grâce au test de Chi-deux ou au test de Fisher au seuil de significativité de 5%. Un modèle de régression logistique multivariable a permis d'expliquer la prévalence de l'hépatite B.Résultats: sur les 744 sujets inclus on a dénombré 555 femmes. L'âge moyen était de 35,5 + 10,1 ans. La  prévalence de l'hépatite B a été estimée à 16,9% (IC95 : 14,3%-19,9%). Cette prévalence était plus élevée chez les sujets originaires du  Borgou/Alibori et ceux au stade 4 de l'OMS. Conclusion: la prévalence de la co-infection VIH/VHB au CHU Parakou est élevée. Le dispositif national de prise en charge et de prévention de l'hépatite B chez les personnes  séropositives au VIH doit être renforcé

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events