Earnings management and audit quality:stakeholders’ perceptions

This paper examines the perceptions of Libyan Commercial Banks’ (LCBs) stakeholders regarding the role of the external auditor in relation to earnings management (EM). A total of 28 semi-structured interviews were carried out with a range of LCB stakeholders comprising preparers of financial statements, users, regulators and academics. A questionnaire survey of stakeholders which yielded 102 Responses (response rate 53%) was also carried out. A variety of views were held which varied to some extent according to stakeholder group. A widely held perception amongst interviewees was that the auditor has the ability to detect EM practices but may not be able to prevent it. However questionnaire respondents were, in aggregate, more confident of the auditor’s ability to deter EM due to the influence of the audit report. The paper provides insights into stakeholders’ perceptions of the quality of bank audits. The findings are of particular relevance to regulators, and specifically, the Central Bank of Libya. Perceptions of audit quality raise questions about its guidance and regulations especially in connection with audit firm rotation. Perceptions of audit quality, and therefore, of the credibility of financial statements should be of interest to all stakeholders. The importance of the banking sector for society has been amply demonstrated in recent years. A well-functioning audit function is a key component of its regulation. To the best of our knowledge, this paper is the first to examine issues related to banks’ audit quality and audit firm rotation in Libya

Automated office blood pressure measurements in primary care are misleading in more than one third of treated hypertensives: The VALENTINE-Greece Home Blood Pressure Monitoring study

Abstract Background This study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena. Methods Primary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg. Results A total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p Conclusions In primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH

Phenylalanine plus Ultraviolet Light: Preliminary Report of a Promising Treatment for Childhood Vitiligo

Abstract: l‐Phenylalanine is a promising agent for the treatment of vitiligo when taken orally and followed with ultraviolet light (UVA) irradiation. Of 13 children so treated, 3 experienced repigmentation of all vitiliginous areas, 6 showed 50% to 90% improvement, and 4 falied to respond. None of the children experienced side effects during the treatment. Copyright © 1989, Wiley Blackwell. All rights reserve

Psychological and sympatho-adrenal status in patients with cystic acne

Background Patients with cystic acne (CA) frequently report feeling self conscious, anxiety and social isolation. Methods Mood characteristics as well as self-esteem scores of 38 patients with CA were evaluated before and after 30 days treatment with isotretinoin. A high pressure, liquid chromatography method was used for the evaluation of catecholamines (epinephrine (E) and nor-epinephrine (NE)) in the blood of the patients at the time of the study and in controls (n = 30) after their psychological testing. Moreover, E and NE were measured in the blood of eight healthy volunteers before and after 1 month ‘treatment’ with the drug. Results The CA subjects evidenced anxiety and high catecholamine plasma levels (E = 98.0 +/- 0.8 pg/ml, NE = 250.8 +/- 56.6 pg/ml) before treatment compared to controls (E = 71.8 +/- 23.0 pg/ml, NE = 190.0 +/- 52 pg/ml, P < 0.006), and these levels were lower (E = 75.4 +/- 21.4 pg/ml, NE = 202.0 +/- 49.9 pg/ml, P < 0.001) when their psychological status returned to normal after treatment. No differences were observed in E and NE levels in the eight healthy volunteers who received the same dose of the drug at the same time of study. Conclusions It is suggested that not only the psychological status is influenced in subjects with CA but also their sympathoadrenal system. (C) 1999 Elsevier Science B.V. All rights reserved

L-carnitine supplementation in patients with cystic acne on isotretinoin therapy

Background Patients with cystic acne (CA) on Isotretinoin (Iso) therapy might present muscular symptoms as side effect of the drug. Myalgia, weakness, hypotension are also some of the main characteristics of carnitine (car) deficiency. Methods Two hundred and thirty (N = 230) patients with CA were treated with Isotretinoin (0.5 mg/kg per 24 h). All the patients were requested to visit our out-patient department at the onset of muscular symptoms. Laboratory tests including car (total, free, acylcarnitine) were determined in blood and urine before treatment, at the onset of muscular symptoms and after the end of a 45 day study. Fifty percent of the patients with muscular involvement received L-carnitine (100 mg/kg per 24 h per os) (group C) and 50% placebo (group P). Results Their laboratory tests showed the well known increases of their liver enzymes and lipids, whereas car blood levels were remarkably decreased at the onset of their muscular symptoms and or at the end of the study. Their supplementation with L-car, in patients of group C (N = 20) without Iso discontinuation or reduction, resulted in the disappearance of their muscular symptoms within 5-6 days and normalisation not only of the increased levels of their liver enzymes but also those of car, at the 45 day of their therapy. Additionally, the patients who received placebo (group P, N = 20) continued complaining for mualgias, The rest of the patients (group A, N = 190) did not experience any muscular symptoms, their laboratory tests showed elevation of liver enzymes and lipids and a decrease in car levels in the blood whereas a remarkable increase of car excretion was determined in their urine. Conclusions Iso therapy decreases car blood levels in patients with CA. L-car supplementation might treat liver and muscular side effects of the drug. These hopeful preliminary results need further investigation. (C) 1999 Elsevier Science B.V. All rights reserved

Elevated plasma homocysteine levels in patients on isotretinoin therapy for cystic acne

Background The use of Isotretinoin (Iso) for cystic acne (CA) therapy includes marked side-effects such as dyslipidemia, increased liver enzymes, and reduction of biotinidase activity. Moreover, Homocysteine (Hcy), an amino acid, is metabolized in the liver requiring folate, vitamin B6, vitamin B12, and the activity of enzymes, i.e, cystathionine-beta -synthase. Increased blood levels of Hey are associated with premature occlusive vascular disease. Objective The aim of this study was the evaluation of Hey levels and the responsible vitamins for its metabolism in patients with CA on Iso treatment. Methods and Results Twenty-eight patients with CA were submitted to laboratory examinations before (Value 1) and after (Value 2) 45 days on Iso (0.5 mg/kg/24 h) therapy. Blood levels of Hey and vitamin B6 were evaluated by HPLC methods, and folate and vitamin B12 using a commercial Kit. Hey levels (Value 1 = 7.86 +/- 1.6 mu mol/L; Value 2 = 13.65 +/- 3.3 mu mol/L; P< 0.001) were statistically significantly increased in patients on treatment. Vitamins were unaltered, and lipids and liver enzymes increased. Significant correlation between Hey levels, vitamins, and liver enzymes was found. Methionine loading tests performed in nine patient-volunteers showed an abnormal response post-treatment. Conclusions It is suggested that the elevated Hcy levels in patients after 45 days on Iso therapy could be due either to the ‘inhibition’ of cystathionine-<beta>-synthase by the drug and/or their liver dysfunction. Daily vitamin supplementation along with frequent evaluations of Hey blood levels are recommended for the prevention of a premature occlusive vascular disease

Prevalence of depression and associated factors in patients hospitalized with heart failure

OBJECTIVE To estimate the prevalence of depression and to identify associated factors in patients hospitalized with heart failure (HF) using the Patient Health Questionnaire-9 (PHQ-9). METHOD The study sample consisted of 152 patients with HF who were hospitalized in the Department of Cardiology of a tertiary hospital in Athens, Greece over a period of one year. Data were collected using a questionnaire consisting of three parts; socio-demographic and clinical characteristics, results of laboratory and diagnostic work-up retrieved from the hospital records, and the PHQ-9 scale. RESULTS The prevalence of major depression (PHQ-9 score !10) was 34.2%. Among the factors examined, worse overall perceived health (OPH) (p8 hours being more depressed. After stepwise logistic regression, OPH, NYHA class and age remained statistically significantly associated with major depression. CONCLUSIONS Measures must be taken to identify, evaluate and manage depression in patients hospitalized with HF, the prevalence of which is particularly high in this population. © Athens Medical Society