Prevalence and long-term outcomes of non-alcoholic fatty liver disease among elderly individuals from the United States.

BACKGROUND: The prevalence and outcomes of non-alcoholic fatty liver disease (NAFLD) among elderly have not been well described. Our aim was to assess the prevalence, risk factors and mortality of NAFLD in individuals older than 60 years. METHODS: The data from the Third National Health and Nutrition Examination Survey with linked mortality files were utilized. NAFLD was defined by United States Fatty Liver Index in the absence of other causes of liver disease. Cox proportional hazards models were used to assess all-cause and cardiovascular (CV) mortality. All analyses were performed using SAS software. RESULTS: Three thousand two hundred seventy-one NHANES-III participants were included. The prevalence rates from NAFLD were 40.3% (95% CI: 37.2-43.5%) and 39.2% (95% CI: 34.4-44.0%) among 60-74 and > 74 years old. Among aged 60-74, the risks for 5-year and 10-year all-cause mortality were associated with presence of NAFLD [adjusted hazard ratios: 1.60 (95% CI: 1.24-1.96) for 5-year and 1.22 (95%CI: 1.01-1.49) for 10-year]. CV mortality were higher in this group were (aHR: 2.12 (95% CI: 1.20-3.75) for 5-year and 1.06 (95%CI: 0.73-1.52) for 10-year]. In contrast, in individuals > 74 years old, diagnosis of NAFLD was not associated with all-cause or CVD mortality. CONCLUSIONS: NAFLD is common among elderly population. Although NAFLD is associated with increased risk of mortality for 60-74-year-old individuals, this risk was not increased in those older than 74 years.

Compressed sensing MRI: a review.

Compressed sensing (CS) is a mathematical framework that reconstructs data from highly undersampled measurements. To gain acceleration in acquisition time, CS has been applied to MRI and has been demonstrated on diverse MRI methods. This review discusses the important requirements to qualify MRI to become an optimal application of CS, namely, sparsity, pseudo-random undersampling, and nonlinear reconstruction. By utilizing concepts of transform sparsity and compression, CS allows acquisition of only the important coefficients of the signal during the acquisition. A priori knowledge of MR images specifically related to transform sparsity is required for the application of CS. In this paper, Section I introduces the fundamentals of CS and the idea of CS as applied to MRI. The requirements for application of CS to MRI is discussed in Section II, while the various acquisition techniques, reconstruction techniques, the advantages of combining CS and parallel imaging, and sampling mask design problems are discussed in Section III. Numerous applications of CS in MRI due to its ability to improve imaging speed are reviewed in section IV. Clinical evaluations of some of the CS applications recently published are discussed in Section V. Section VI provides information on available open source software that could be used for CS implementations.

Unilateral Thyroid Lobe Involvement of Graves Disease.

A 30-year-old man presented with 3-year history of Graves disease. He was initially diagnosed after he developed unilateral proptosis and was initiated on methimazole 5 mg, on which he was currently euthyroid. Visible right-sided thyromegaly and trouble swallowing developed 2 months after presentation to our practice. Biochemical evaluation revealed suppressed TSH, normal free T4 and total T3, and elevated thyroid stimulating immunoglobulin with normal thyroid receptor antibody. An ultrasound of the thyroid demonstrated left-sided small nodules with right-sided thyromegaly. A nuclear medicine uptake scan revealed significantly greater uptake in the right thyroid lobe, with overall minimal uptake in the left lobe. The need for definitive therapy that would not exacerbate orbitopathy was discussed, and the patient elected for a right-sided hemithyroidectomy. Postoperative biochemical evaluation demonstrated biochemical euthyroidism despite continued elevation in thyroid stimulating immunoglobulin and newly elevated thyroid receptor antibody while remaining off methimazole. Graves disease can rarely involve a single thyroid lobe. Given the rarity, further investigation is needed to determine the natural course of this form of Graves disease.

Localized Rhabdomyolysis Associated With Testosterone Enanthate for Gender-Affirming Hormonal Therapy.

Background/Objective: Rhabdomyolysis is a condition characterized by the destruction of skeletal muscle tissue that leads to systemic complications. We present a case of gender-affirming intramuscular (IM) testosterone therapy precipitating localized deltoid rhabdomyolysis. Case Report: A 34-year-old transgender man presented to the emergency department with dark-colored urine and pain in the left deltoid muscle where he had been injecting IM testosterone. He was found to have significant elevation in the level of creatinine kinase that was consistent with rhabdomyolysis and managed with intravenous fluids. He received trial therapy with IM testosterone again in the contralateral deltoid twice with recurrent rhabdomyolysis. He eventually transitioned to subcutaneous testosterone to achieve his masculinization goals without adverse effects. Discussion: Localized anabolic steroid use has been associated with rhabdomyolysis. However, to the best of our knowledge, this is the first case report of rhabdomyolysis attributed to gender-affirming testosterone therapy. Our patient had been administering testosterone intramuscularly into larger muscles (thigh and gluteus) for many years without any issues, whereas recurrent focal rhabdomyolysis developed only in association with deltoid injections. We theorize that a relative increase in dose and volume of testosterone per gram of muscle after switching to the deltoid site precipitated rhabdomyolysis. Subcutaneous testosterone is an acceptable alternative to IM testosterone for patients desiring an injectable delivery route with minimal adverse effects. Conclusion: This case report highlights the potential risk of rhabdomyolysis associated with IM testosterone administration in the deltoid region for gender-affirming care. Patients on IM testosterone should use the thigh or gluteal muscles rather than the deltoid.