Corticotropin-releasing hormone test predicts the outcome of unilateral adrenalectomy in primary bilateral macronodular adrenal hyperplasia

Purpose: Primary bilateral adrenal hyperplasia (PBMAH) is associated with hypercortisolism and a heterogeneous clinical expression in terms of cortisol secretion and related comorbidities. Historically, treatment of choice was bilateral adrenalectomy (B-Adx); however, recent data suggest that unilateral adrenalectomy (U-Adx) may be an effective alternative. For the latter, factors predicting the postsurgical outcome (e.g., biochemical control) have not been identified yet. Methods: PBMAH patients undergoing U-Adx for overt Cushing's syndrome (CS) in two tertiary care centers were retrospectively analysed. Remission was defined as a normalization of urinary free cortisol (UFC) without the need for medical treatment. The potential of hCRH test as a predictor of U-Adx outcome was evaluated in a subgroup. Results: 23 patients were evaluated (69% females, mean age 55 years). Remission rate after U-Adx was 74% at last follow up (median 115 months from UAdx). Before U-Adx, a positive ACTH response to hCRH (Δ¬TH increase > 50% from baseline) was associated with higher remission rates. Conclusions: Three of four patients with PBMAH are surgically cured with U-Adx. Pre-operative hCRH testing can be useful to predict long-term remission rates

Early warning and response to fires in Kalimantan, Indonesia

Scientists at the International Research Institute for Climate and Society (IRI) collaborated with Bogor Agriculture University Indonesia to investigate links between climate anomalies and fire hotspots in Kalimantan, Indonesia. During their investigation, a close relationship between satellite rainfall data and fire hotspot activity was found. Rainfall anomalies during the dry season from June-October were particularly critical in determining fire activity. Vegetation greenness and moisture indices derived from MODIS images, however, did not appear to demonstrate a relationship. These findings were used to develop a prototype online tool that enables stakeholders to view satellite rainfall anomalies and forecast fire activity in Kalimantan. Potential fire activity can be inferred from these data and steps can be taken early on to prevent or minimize the effects of regional fire occurrences

Clinical presentation and management of acromegaly in elderly patients

Background and aim: Acromegaly is a rare disease with a peak of incidence in early adulthood. However, enhanced awareness of this disease, combined with wide availability of magnetic resonance imaging (MRI), has increased the diagnosis of forms with mild presentation, especially in elderly patients. Moreover, due to increased life expectancy and proactive individualized treatment, patients with early-onset acromegaly are today aging. The aim of our study was to describe our cohort of elderly patients with acromegaly. Materials and methods: This is a cross-sectional retrospective study of 96 outpatients. Clinical, endocrine, treatment, and follow-up data were collected using the electronic database of the University Hospital of Padova, Italy. Results: We diagnosed acromegaly in 13 patients, aged 6565\ua0years, presenting with relatively small adenomas and low IGF-1 secretion. Among them, 11 patients were initially treated with medical therapy and half normalized hormonal levels after 6\ua0months without undergoing neurosurgery (TNS). Remission was achieved after TNS in three out of four patients (primary TNS in two); ten patients presented controlled acromegaly at the last visit. Acromegaly-related comorbidities (colon polyps, thyroid cancer, adrenal incidentaloma, hypertension, and bone disease) were more prevalent in patients who had an early diagnosis (31 patients, characterized by a longer follow-up of 24\ua0years) than in those diagnosed aged 6565\ua0years (5\ua0years of follow-up). Conclusions: Elderly acromegalic patients are not uncommon. Primary medical therapy is a reasonable option and is effectively used, while the rate of surgical success is not reduced. A careful cost-benefit balance is suggested. Disease-specific comorbidities are more prevalent in acromegalic patients with a longer follow-up rather than in those diagnosed aged 6565\ua0years

Tele-medicine versus face-to-face consultation in Endocrine Outpatients Clinic during COVID-19 outbreak: a single-center experience during the lockdown period

The COVID-19 outbreak in Italy is the major concern of Public Health in 2020: measures of containment were progressively expanded, limiting Outpatients' visit

Individual Differences, Economic Stability, and Fear of Contagion as Risk Factors for PTSD Symptoms in the COVID-19 Emergency

On January 30th 2020, the World Health Organization (WHO) declared the COVID-19 pandemic a Public Health Emergency of International Concern (PHEIC). Italy has been one of the most affected countries in the world. To contain further spread of the virus, the Italian government has imposed an unprecedented long-period lockdown for the entire country. This dramatic scenario may have caused a strong psychological distress, with potential negative long-term mental health consequences. The aim of the present study is to report the prevalence of high psychological distress due to the COVID-19 pandemic on the general population, especially considering that this aspect is consistently associated with PTSD symptoms. Furthermore, the present study aims to identify the risk factors for high PTSD symptoms, including individual differences and subjective perception of both economic and psychological aspects. We administered an online survey to 1253 participants during the peak period of the contagion in Italy. A logistic regression on the Impact of Event Scale – Revised (IES-R) scores was used to test the risk factors that predict the possibility to develop PTSD symptoms due to the COVID-19 pandemic. Gender (female), lower perceived economic stability, higher neuroticism, and fear and consequences of contagion were predictors of high PTSD symptomatology. The results, highlighted in the present study, extend our understanding of the COVID-19 pandemic’s impact on the population’s mental health, by identifying individuals at high-risk of developing PTSD. This may help with the implementation of specific protocols to prevent the possibility of developing symptoms of PTSD in target populations

Understanding the behaviour of hackers while performing attack tasks in a professional setting and in a public challenge

When critical assets or functionalities are included in a piece of software accessible to the end users, code protections are used to hinder or delay the extraction or manipulation of such critical assets. The process and strategy followed by hackers to understand and tamper with protected software might differ from program understanding for benign purposes. Knowledge of the actual hacker behaviours while performing real attack tasks can inform better ways to protect the software and can provide more realistic assumptions to the developers, evaluators, and users of software protections. Within Aspire, a software protection research project funded by the EU under framework programme FP7, we have conducted three industrial case studies with the involvement of professional penetration testers and a public challenge consisting of eight attack tasks with open participation. We have applied a systematic qualitative analysis methodology to the hackers’ reports relative to the industrial case studies and the public challenge. The qualitative analysis resulted in 459 and 265 annotations added respectively to the industrial and to the public challenge reports. Based on these annotations we built a taxonomy consisting of 169 concepts. They address the hacker activities related to (i) understanding code; (ii) defining the attack strategy; (iii) selecting and customizing the tools; and (iv) defeating the protections. While there are many commonalities between professional hackers and practitioners, we could spot many fundamental differences. For instance, while industrial professional hackers aim at elaborating automated and reproducible deterministic attacks, practitioners prefer to minimize the effort and try many different manual tasks. This analysis allowed us to distill a number of new research directions and potential improvements for protection techniques. In particular, considering the critical role of analysis tools, protection techniques should explicitly attack them, by exploiting analysis problems and complexity aspects that available automated techniques are bad at addressing

High heterogeneity in Plasmodium falciparum risk illustrates the need for detailed mapping to guide resource allocation: a new malaria risk map of the Lao People's Democratic Republic

<p>Abstract</p> <p>Background</p> <p>Accurate information on the geographical distribution of malaria is important for efficient resource allocation. The Lao People's Democratic Republic has experienced a major decline in malaria morbidity and mortality in the past decade. However, efforts to respond effectively to these changes have been impeded by lack of detailed data on malaria distribution. In 2008, a countrywide survey on <it>Plasmodium falciparum </it>diagnosed in health centres and villages was initiated to develop a detailed <it>P. falciparum </it>risk map with the aim to identify priority areas for malaria control, estimate population at risk, and guide resource allocation in the Lao People's Democratic Republic.</p> <p>Methods</p> <p><it>P. falciparum </it>incidence data were collected from point-referenced villages and health centres for the period 2006-2008 during a country-wide survey between December 2008 and January 2009. Using the highest recorded annual rate, continuous surfaces of <it>P. falciparum </it>incidence were produced by the inverse distance weighted interpolation technique.</p> <p>Results</p> <p>Incidence rates were obtained from 3,876 villages and 685 health centres. The risk map shows that <it>P. falciparum </it>is highly heterogeneous in the northern and central regions of the country with large areas of no transmission. In the southern part, transmission is pervasive and the risk of <it>P. falciparum </it>is high. It was estimated that 3.4 million people (60% of the population) live at risk of malaria.</p> <p>Conclusions</p> <p>This paper presents the first comprehensive malaria risk map of the Lao People's Democratic Republic based entirely on empirical data. The estimated population at risk is substantially lower than previous estimates, reflecting the presence of vast areas with focal or no malaria transmission as identified in this study. These findings provide important guidance for malaria control interventions in the Lao People's Democratic Republic, and underline the need for detailed data on malaria to accurately predict risk in countries with heterogeneous transmission.</p

Space-time variation of malaria incidence in Yunnan province, China

Abstract Background Understanding spatio-temporal variation in malaria incidence provides a basis for effective disease control planning and monitoring. Methods Monthly surveillance data between 1991 and 2006 for Plasmodium vivax and Plasmodium falciparum malaria across 128 counties were assembled for Yunnan, a province of China with one of the highest burdens of malaria. County-level Bayesian Poisson regression models of incidence were constructed, with effects for rainfall, maximum temperature and temporal trend. The model also allowed for spatial variation in county-level incidence and temporal trend, and dependence between incidence in June–September and the preceding January–February. Results Models revealed strong associations between malaria incidence and both rainfall and maximum temperature. There was a significant association between incidence in June–September and the preceding January–February. Raw standardised morbidity ratios showed a high incidence in some counties bordering Myanmar, Laos and Vietnam, and counties in the Red River valley. Clusters of counties in south-western and northern Yunnan were identified that had high incidence not explained by climate. The overall trend in incidence decreased, but there was significant variation between counties. Conclusion Dependence between incidence in summer and the preceding January–February suggests a role of intrinsic host-pathogen dynamics. Incidence during the summer peak might be predictable based on incidence in January–February, facilitating malaria control planning, scaled months in advance to the magnitude of the summer malaria burden. Heterogeneities in county-level temporal trends suggest that reductions in the burden of malaria have been unevenly distributed throughout the province

Conditions of malaria transmission in Dakar from 2007 to 2010

Background: Previous studies in Dakar have highlighted the spatial and temporal heterogeneity of Anopheles gambiae s.l. biting rates. In order to improve the knowledge of the determinants of malaria transmission in this city, the present study reports the results of an extensive entomological survey that was conducted in 45 areas in Dakar from 2007 to 2010. Methods: Water collections were monitored for the presence of anopheline larvae. Adult mosquitoes were sampled by human landing collection. Plasmodium falciparum circumsporozoite (CSP) protein indexes were measured by ELISA (enzyme-linked immunosorbent assay), and the entomological inoculation rates were calculated. Results: The presence of anopheline larvae were recorded in 1,015 out of 2,683 observations made from 325 water collections. A water pH of equal to or above 8.0, a water temperature that was equal to or above 30 degrees C, the absence of larvivorous fishes, the wet season, the presence of surface vegetation, the persistence of water and location in a slightly urbanised area were significantly associated with the presence of anopheline larvae and/or with a higher density of anopheline larvae. Most of the larval habitats were observed in public areas, i.e., freely accessible. A total of 496,310 adult mosquitoes were caught during 3096 person-nights, and 44967 of these specimens were identified as An. gambiae s.l. The mean An. gambiae s.l. human-biting rate ranged from 0.1 to 248.9 bites per person per night during the rainy season. Anopheles arabiensis (93.14%), Anopheles melas (6.83%) and An. gambiae s.s. M form (0.03%) were the three members of the An. gambiae complex. Fifty-two An. arabiensis and two An. melas specimens were CSP-positive, and the annual CSP index was 0.64% in 2007, 0.09% in 2008-2009 and 0.12% in 2009-2010. In the studied areas, the average EIR ranged from 0 to 17.6 infected bites per person during the entire transmission season. Conclusion: The spatial and temporal heterogeneity of An. gambiae s.l. larval density, adult human-biting rate (HBR) and malaria transmission in Dakar has been confirmed, and the environmental factors associated with this heterogeneity have been identified. These results pave the way for the creation of malaria risk maps and for a focused anti-vectorial control strategy