Low TSH is associated with frailty in the older adult. We studied whether low TSH is an independent marker of frailty or is an indicator of subclinical hyperthyroidism, which in turn predicts frailty. Of outpatient veterans seen between January 2005 and December 2016, we identified 100 patients aged ≥60 years with two low TSH (<0.5 µIU/ml) and one fT3 measurement and 50 matched controls (TSH 0.5–5.0 µIU/ml). We used a deficit accumulation approach to create a frailty index (FI). The higher the FI, the more likely (p<0.001) that patients had expired. Patients with low (0.31 ± 0.11 µIU/mL) versus normal (1.84 ± 0.84 µIU/mL) TSH had higher mean FI compared to controls (0.25 ± 0.12 vs. 0.15 ± 0.07, p < .001). Low TSH was significantly associated with frailty ( p < .001), independent of age. However, lower TSH was not associated with higher fT3 or fT4 levels. There was a nonsignificant inverse association of fT3 levels with FI ( p = .13), which disappeared when adjusted for age. Similar to prior studies, low TSH was associated with frailty. However, neither fT3 nor fT4 predicted low TSH or FI, suggesting that the association of low TSH with frailty is not due to subclinical hyperthyroidism, but perhaps to effects of comorbidities on TSH secretion.
Objective: To report a rare case of large adrenocortical oncocytoma in a young patient that was successfully resected by a minimally invasive laparoscopic technique in a community hospital. Methods: Clinical case presentation and review of literature. Results: A 36-year-old male patient was found to have an 8-cm right adrenal mass on magnetic resonance imaging (MRI) of the lumbosacral region that was done to rule out lumbar disc disease. The patient was asymptomatic, but due to concerns of malignancy, further work-up was pursued. Biochemical endocrine studies demonstrated subclinical Cushing syndrome. The patient underwent laparoscopic right adrenalectomy. The final size of the mass was 11 cm, which was larger than the MRI reporting. The final pathology of the mass was consistent with adrenocortical oncocytoma with borderline malignant potential. Conclusion: Functioning adrenocortical oncocytoma with borderline malignant potential is a rare tumor. Only about 25 cases of functional adrenocortical oncocytoma have been reported worldwide. The clinical significance of our case highlights the important differential diagnosis of incidental adrenal masses. In our case, a minimally invasive laparoscopic resection of the tumor was successfully performed despite its relatively large size.
Overweight and obesity is an emerging public health issue in developed world and is also rapidly increasing in developing world. This study was carried out to determine the prevalence and associated risk factors of overweight and obesity among women of child bearing age. A cross sectional study was conducted among 206 women residing in Dharan Sub-Metropolitan city of eastern Nepal. BMI, waist circumference and waist to hip ratio were used as indicators for overweight and obesity based on WHO classification and IDF Classification criteria. Association between socioeconomic factors, dietary factors, physical activity, behavioral factors and health related factors with overweight and obesity among women were assessed by using chi square test. Results showed that 50.48% women were overweight and obese (BMI > 25), while 89% based on WHR and, 75.2% based on waist circumference were abdominally obese. The study also showed that age, marital status, size of family, parity, drinking habit and protein intake were major risk factors for overweight and obesity based on BMI. Abdominal obesity based on waist circumference measurement was associated with age, marital status, parity, TV watching while eating habit, contraceptives use, eating outside and protein intake. The high prevalence of overweight and obesity, and diverse natures of associated risk factors among child bearing age women in Dharan showed that more research in this aspect need to be carried out and concerned agencies should focus on identified risk factors for interventions to reduce existing problems of overweight and obesity among women of reproductive age.
<p> </p> <p>The armed conflict between the Unified Communist Party of Nepal (Maoist) and the Government of Nepal increased the expenditure of the state on security almost doubled from 1.6 percent of the GDP to 3 percent between 2001 and 2004. The defense budget increased from Rs. 4 billion to Rs. 12 billion a year which was largely because the number of Nepalese Army increased from 46,000 to 96,000. There are numerous studies conducted on Nepal’s’ socio- economic and political aspects during the civil conflict. Much research has focused on the impact on trade and commerce, but little attention has been paid to the increasing security expenditure during the conflict. To fully recognize this dimension of expenditure of the state we must therefore understand the increasing security cost during the conflict, not just the impact of conflict on trade and commerce. Examining various data and information on economic analysis of civil conflict, this paper studies the effects of increased expenditure on defense required during the Maoist insurgency in Nepal. What was the opportunity costs of increases in security expenditure by Nepalese government to invest its war against the Maoist rebellion? How sudden increase in security spending by the government reduced development expenditure and investment of Nepal? How conflict has impacted significantly in the development of education, employment opportunities, health services, and public and private investment?</p>
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